Usefulness of thoracic CT to diagnose tuberculosis disease in patients younger than 4 years of age.

BACKGROUND: There is controversy over the need of using thoracic CT (TCT) systematically for differentiating disease from tuberculosis infection in young children. This distinction is important when making a diagnosis of TB as the treatment changes from a single drug to a multidurug regimen with reported side-effects. AIM: To determine the usefulness of using TCT to diagnose pulmonary tuberculosis (PTB) in patients younger than 4 years of age who have TB infection (IBI). MATERIALS AND METHODS: After the simultaneous detection of four cases of PTB in children who attended the same class, a study on the contact among workers and children was carried out. One hundred sixteen children younger than 4 years and 20 adults were included. The tuberculin skin test (TST) was performed on all of them. CHEST XR (CXR) and TCT were performed on children with positive TST and three samples of gastric acid were taken. CXR and sputum testing were performed on adults with positive TST. RESULTS: TST was positive in 28 children (24.1%). In 92.8% of children with positive TST and normal CXR, TCT showed features compatible with PTB. Out of the 28 children with positive TST, 27 (96.4%) were diagnosed with PTB and only one with latent TBI (4%). CONCLUSIONS: In children younger than 4-year old with positive TST and normal CXR, it would be advisable to perform a TCT since the findings could change the diagnosis from TBI to TB disease.

Prevalence and factors linked to atopic eczema in 10- and 11-year-old schoolchildren. Isaac 2 in Almeria, Spain

Background: Atopic eczema affects 5-10% of the Spanish paediatric population, and has increased in frequency over the last few decades, probably due to changes in the environment and lifestyle. Phase II of the ISAAC (International Study of Asthma and Allergies in Childhood) uses a standardised methodology to establish the prevalence of allergic disorders and factors linked to them in each centre. Objectives: To assess the prevalence and severity of atopic eczema, and to establish factors linked to atopic eczema in 10–11 year-old school children in the city of Almeria (South-East coast of Spain). Material and methods: An ecological study was carried out as part of ISAAC II, using homologated questionnaires and allergic tests in 1143 schoolchildren. Statistic association was assessed by means of ÷2 test, and then logistic regression analysis was performed with the most significant variables from the univariant analysis. Results: The prevalence of atopic eczema was 11.4%. The risk factors found in the multiple logistic regression analysis were: personal antecedents of severe asthma (OR 19 CI 95% 1.35–266) and severe rhinitis (OR 7.7 CI 95% 1.79–33), fungi in bedroom during the first year of life (OR 4.2 CI 95% 1.17–15.1) and atopic eczema in one parent (OR 5.2 CI 95% 2.69–10.1). Conclusions: The prevalence of atopic eczema is similar to that found in other studies within ISAAC Phase I. The most important risk factors for atopic eczema are family and personal history of other atopic diseases and the presence of fungi in the home

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Prevalence and factors linked to allergic rhinitis in 10 and 11-year-old children in Almería. Isaac Phase II, Spain

Background: Allergic rhinitis affects 10-30% of children in developed countries and has increased in frequency over the last few decades, probably due to changes in the environment and life style. Aim: To assess the prevalence, severity, and factors linked to rhinitis in 10 and 11-year-old children from Almeria (Spain). Methods: As part of ISAAC II, a cross-sectional survey was conducted among a representative sample of 1143 schoolchildren in spring and autumn of 2001, using homologated questionnaires and skin-prick testing. Results: The overall prevalence of rhinitis and rhinoconjunctivitis were 38.9% and 24.8%, respectively, 17.9% had medically diagnosed rhinitis. During the previous year symptoms disturbed daily activities and school attendance in some measure in 40% and 26% of children with rhinitis, respectively. Results: The risk factors found in the multiple logistic regression analysis were atopy (OR 2.57; 95% CI 1.92–3.42); cat contact at home during first year of life (OR 2.4 95% CI 1.13–5.12); prior medical diagnosis of asthma (OR 2.2; 95% CI 1.22–4.02); nocturnal cough in absence of colds (OR 1.9; 95% CI 1.25–2.97); diagnosis of rhinitis in one of the parents (OR 1.8; 95% CI 1.31–2.59); wheezing at any time (OR 1.6; 95% CI 1.18–2.28); and nursery school attendance (OR 1.5; 95% CI 1.21–2.5). Conclusions: The prevalence of rhinitis found is superior to that of other centres participating in the ISAAC Phases I and II, and coexists with asthma and eczema in many children. The independent risk factors associated to rhinitis are in accordance with previous reports

Prevalence and factors linked to allergic rhinitis in 10 and 11-year-old children in Almería. Isaac Phase II, Spain.

BACKGROUND: Allergic rhinitis affects 10-30% of children in developed countries and has increased in frequency over the last few decades, probably due to changes in the environment and life style. AIM: To assess the prevalence, severity, and factors linked to rhinitis in 10 and 11-year-old children from Almeria (Spain). METHODS: As part of ISAAC II, a cross-sectional survey was conducted among a representative sample of 1143 schoolchildren in spring and autumn of 2001, using homologated questionnaires and skin-prick testing. RESULTS: The overall prevalence of rhinitis and rhinoconjunctivitis were 38.9% and 24.8%, respectively, 17.9% had medically diagnosed rhinitis. During the previous year symptoms disturbed daily activities and school attendance in some measure in 40% and 26% of children with rhinitis, respectively. The risk factors found in the multiple logistic regression analysis were atopy (OR 2.57; 95% CI 1.92-3.42); cat contact at home during first year of life (OR 2.4 95% CI 1.13-5.12); prior medical diagnosis of asthma (OR 2.2; 95% CI 1.22-4.02); nocturnal cough in absence of colds (OR 1.9; 95% CI 1.25-2.97); diagnosis of rhinitis in one of the parents (OR 1.8; 95% CI 1.31-2.59); wheezing at any time (OR 1.6; 95% CI 1.18-2.28); and nursery school attendance (OR 1.5; 95% CI 1.21-2.5). CONCLUSIONS: The prevalence of rhinitis found is superior to that of other centres participating in the ISAAC Phases I and II, and coexists with asthma and eczema in many children. The independent risk factors associated to rhinitis are in accordance with previous reports.

Prevalence and factors linked to atopic eczema in 10- and 11-year-old schoolchildren. Isaac 2 in Almeria, Spain.

BACKGROUND: Atopic eczema affects 5-10% of the Spanish paediatric population, and has increased in frequency over the last few decades, probably due to changes in the environment and lifestyle. Phase II of the ISAAC (International Study of Asthma and Allergies in Childhood) uses a standardised methodology to establish the prevalence of allergic disorders and factors linked to them in each centre. OBJECTIVES: To assess the prevalence and severity of atopic eczema, and to establish factors linked to atopic eczema in 10-11 year-old school children in the city of Almeria (South-East coast of Spain). MATERIAL AND METHODS: An ecological study was carried out as part of ISAAC II, using homologated questionnaires and allergic tests in 1143 schoolchildren. Statistic association was assessed by means of chi(2) test, and then logistic regression analysis was performed with the most significant variables from the univariant analysis. RESULTS: The prevalence of atopic eczema was 11.4%. The risk factors found in the multiple logistic regression analysis were: personal antecedents of severe asthma (OR 19 CI 95% 1.35-266) and severe rhinitis (OR 7.7 CI 95% 1.79-33), fungi in bedroom during the first year of life (OR 4.2 CI 95% 1.17-15.1) and atopic eczema in one parent (OR 5.2 CI 95% 2.69-10.1). CONCLUSIONS: The prevalence of atopic eczema is similar to that found in other studies within ISAAC Phase I. The most important risk factors for atopic eczema are family and personal history of other atopic diseases and the presence of fungi in the home.

Prevalence and factors linked to atopy in 10-and 11-year-old children in Almería, Spain

Background During the last decades there has been an increase in both allergic diseases and allergic sensitisation, probably due to changes in the environment and living habits. ISAAC Phase II was designed to establish the prevalence and associated factors to asthma and allergic disorders in childhood. Aim To assess the prevalence and factors linked to atopy in 10–11 year-old children from Almería (Spain). Methods As a part of ISAAC II, a survey was conducted among a sample of 1143 schoolchildren using standardised questionnaires and skin-prick testing. Results The overall prevalence of atopy was 42.5%. Most common sensitisations were to Dermatophagoides pteronyssinus (36.2%), D. farinae (32.3%), cat (10.8%), Alternaria (7%), grass (6%), and tree pollen (1.7%). 34.9% of these sensitisations could be regarded as subclinical sensitisations. The fractions of asthma, rhinitis and eczema attributable to atopy were 49.2%, 40.4% y 18.6%, respectively. After multivariate analysis, the risk of atopy was significantly lower among females (OR 0.62, CI 95% 0.45-0.86); children with older siblings (OR 0.67; CI 95% 0.49-0.92); intestinal parasites (OR 0.68; CI 95% 0.48-0.97); contact with farm animals in the past (OR 0.48 CI 95% 0.23-0.99); or other animals at present (OR 0.53 CI 95% 0.30-0.95). To have an allergic father (OR 2.96 CI 95% 1.77-4.94) was the only significant risk factor. Conclusions We found several independent factors which significantly protect against atopic sensitisation. These protective factors were not the same for asthma, rhinitis or eczema, suggesting that other factors could interact to influence atopy and act against such protective factors

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Prevalence and factors linked to atopy in 10-and 11-year-old children in Almería, Spain.

BACKGROUND: During the last decades there has been an increase in both allergic diseases and allergic sensitisation, probably due to changes in the environment and living habits. ISAAC Phase II was designed to establish the prevalence and associated factors to asthma and allergic disorders in childhood. AIM: To assess the prevalence and factors linked to atopy in 10-11 year-old children from Almería (Spain). METHODS: As a part of ISAAC II, a survey was conducted among a sample of 1143 schoolchildren using standardised questionnaires and skin-prick testing. RESULTS: The overall prevalence of atopy was 42.5%. Most common sensitisations were to Dermatophagoides pteronyssinus (36.2%), D. farinae (32.3%), cat (10.8%), Alternaria (7%), grass (6%), and tree pollen (1.7%). 34.9% of these sensitisations could be regarded as subclinical sensitisations. The fractions of asthma, rhinitis and eczema attributable to atopy were 49.2%, 40.4% y 18.6%, respectively. After multivariate analysis, the risk of atopy was significantly lower among females (OR 0.62, CI 95% 0.45-0.86); children with older siblings (OR 0.67; CI 95% 0.49-0.92); intestinal parasites (OR 0.68; CI 95% 0.48-0.97); contact with farm animals in the past (OR 0.48 CI 95% 0.23-0.99); or other animals at present (OR 0.53 CI 95% 0.30-0.95). To have an allergic father (OR 2.96 CI 95% 1.77-4.94) was the only significant risk factor. CONCLUSIONS: We found several independent factors which significantly protect against atopic sensitisation. These protective factors were not the same for asthma, rhinitis or eczema, suggesting that other factors could interact to influence atopy and act against such protective factors.

Tromboembolismo pulmonar / Pulmonary thromboembolism in children

Artículo de revisión del tromboembolismo pulmonar (TEP) en niños. Se describen los factores de riesgo de TEP en niños, manifestaciones clínicas, pruebas diagnósticas (utilidad de la tomografía computarizada helicoidal y de la resonancia magnética), quimioprofilaxis de la enfermedad tromboembólica y tratamiento de la enfermedad. Se propone algoritmo de actuación en niños con TEP en relación a la gravedad del paciente y a la disponibilidad de pruebas diagnósticas (AU)

In this article we have reviewed pulmonary thromboembolism in children (PTE); we describe risk factors, clinical signs and symtoms, diagnostics trials (like helicoidal CT and MR), thromboembolic disease quimioprophylaxis and management of the illness. We propose a management algorithm in children with PTE related to the severity and diagnostics trails availability (AU)