Retrospective study of acute mastoiditis in children in Spain attended in a Pediatric Emergency department.

OBJECTIVE: To analyze the cases of acute mastoiditis, characteristics, management and complications in children attended in the emergency department. METHODS: Retrospective study of acute mastoiditis in a Spanish tertiary hospital over a 6-year period (2018-2023). RESULTS: One hundred two episodes of acute mastoiditis were analyzed (54% males, median age 1.8 years). Microorganisms were isolated in one third of cases, mainly Streptococcus pyogenes (64% of ear secretion cultures). Complications occurred in 27.5%, primarily subperiosteal abscess. A younger age, absence of vaccination schedule, previous history of otitis, cochlear implant carriers or white blood cell counts and C-reactive protein levels were not associated with complications. Complicated cases had longer hospitalizations. Treatment included antibiotics, corticosteroids, and surgery in 50% of cases. CONCLUSIONS: This study shows an increase of acute mastoiditis during 2023, with a relevant role of S. pyogenes. A younger age, absence of vaccination, personal history of otitis or cochlear implant, blood cell counts and C-reactive protein levels were not associated with complications.

Preparation of a Molecularly Imprinted Polymer on Polyethylene Terephthalate Platform Using Reversible Addition-Fragmentation Chain Transfer Polymerization for Tartrazine Analysis via Smartphone.

This work describes the preparation of a molecularly imprinted polymer (MIP) platform on polyethylene terephthalate (MIP-PET) via RAFT polymerization for analyzing tartrazine using a smartphone. The MIP-PET platform was characterized using Fourier transform infrared (FTIR) techniques, Raman Spectroscopy, X-ray photoelectron spectroscopy (XPS), and confocal microscopy. The optimal pH and adsorption time conditions were determined. The adsorption capacity of the MIP-PET plates with RAFT treatment (0.057 mg cm-2) was higher than that of the untreated plates (0.028 mg cm-2). The kinetic study revealed a pseudo-first-order model with intraparticle diffusion, while the isotherm study indicated a fit for the Freundlich model. Additionally, the MIP-PET demonstrated durability by maintaining its adsorption capacity over five cycles of reuse without significant loss. To quantify tartrazine, images were captured using a smartphone, and the RGB values were obtained using the ImageJ® free program. A partial least squares regression (PLS) was performed, obtaining a linear range of 0 to 7 mg L-1 of tartrazine. The accuracy of the method was 99.4% (4.97 ± 0.74 mg L-1) for 10 samples of 5 mg L-1. The concentration of tartrazine was determined in two local soft drinks (14.1 mg L-1 and 16.5 mg L-1), with results comparable to the UV-visible spectrophotometric method.

Sedoanalgesia With Ketamine in the Emergency Department: Factors Associated With Unsatisfactory Effectiveness.

OBJECTIVE: Ketamine is a safe and widely used sedative and analgesic in children. The purpose of this study is to evaluate the response to sedoanalgesia for painful procedures in the pediatric emergency department. METHODS: A retrospective study was conducted in children younger than 16 years who underwent painful procedures with intravenous/intranasal ketamine between January 2016 and December 2022. We collected demographic variables, effectiveness, route of administration, indication, dose, sedation strategy, duration of procedure, and associated adverse effects. RESULTS: A total of 671 ketamine sedation procedures (411 males/260 females) were included, with a mean age of 7.2 years. Closed reduction was the most common painful procedure (53.8%), followed by burn healing (24.6%). Ketamine was administered intravenously in 93.4% of procedures and intranasally in 6.6%. The result of sedoanalgesia was satisfactory in 84.9% and unsatisfactory in 15.1%. The percentage of cases with unsatisfactory analgesia was higher with intranasal administration (36.4%; P < 0.001). In the intravenous group, the percentage of cases with unsatisfactory effectiveness (28.7%) was higher for patients younger than 2 years of age (P < 0.001). Arthrocentesis procedures were associated with the highest percentage of unsatisfactory sedoanalgesia failures among patients receiving intravenous ketamine (39.3%; P < 0.001). Intranasal ketamine patients who received a dose between 3.6 and 4 mg/kg had a significantly higher percentage of unsatisfactory sedoanalgesia (66.7%; P = 0.048). Patients receiving intravenous ketamine had significantly higher rates of unsatisfactory sedoanalgesia when the initial dose interval was 1.6 to 2 mg/kg (11.8%; P = 0.002) and when the final total dose was also 1.6 to 2 mg/kg (17.6%; P = 0.002). CONCLUSIONS: This study concludes that intravenous/intranasal ketamine can provide safe and successful analgesia in pediatric patients in the ED. At intravenous doses of 1-1.5 mg/kg, good effectiveness was achieved in almost 90% of cases. Arthrocentesis had the highest percentage of unsatisfactory results. Repeat dosing should be considered for procedures longer than 20 minutes.

Cross-Cultural Adaptation and Validation of the Perception of the Doctor-Patient Relationship (PREMEPA) Questionnaire in Chronic Multi-Pathological Patients.

OBJECTIVE: To conduct a cross-cultural adaptation and validation in Primary Care of the PREMEPA doctor-patient relationship perception questionnaire. DESIGN: Descriptive, cross-sectional study, using self-administered questionnaires. Qualitative validation: an adapted version of the original questionnaire, was adapted to our culture. The process consisted of the evaluation, cross-cultural adaptation and consensus of a group of experts. The questionnaire was piloted on a sample of 32 patients diagnosed with at least 2 chronic pathologies. MEASURES: Cognitive piloting, comprehensibility assessment, content validation and internal consistency analysis using Cronbach's alpha coefficient. Quantitative validation: the internal consistency, construct validity and validity of the questionnaire were studied by means of a confirmatory factor analysis developed in a multicenter study, randomly selecting 202 patients with at least 2 chronic pathologies. RESULTS: Content validity of the new Spanish version was confirmed to be adequate. Comprehensibility and internal consistency (Cronbach's α coefficient = 0.78) were adequate. The confirmatory factor analysis showed good dimensionality, factor relationship and internal consistency, as well as acceptable construct validity. The final result was a 13-item questionnaire consisting of 2 dimensions, which explain 58.5% of the variance: participation in decision-making (accounting for 45.2% of the variance) and person-centered communication (encompassing courtesy, empathy, humanity, and trust). CONCLUSIONS: This adapted version of the PREMEPA questionnaire can be considered valid for use in the Spanish population with a history of chronic pathology. This version of PREMEPA provides a new instrument to understand and improve chronic patient care, which can improve the doctor-patient relationship, encouraging adherence to treatment and enhancing health outcomes.

NUM-score: A clinical-analytical model for personalised imaging after urinary tract infections.

AIM: To identify predictive variables and construct a predictive model along with a decision algorithm to identify nephrourological malformations (NUM) in children with febrile urinary tract infections (fUTI), enhancing the efficiency of imaging diagnostics. METHODS: We performed a retrospective study of patients aged <16 years with fUTI at the Emergency Department with subsequent microbiological confirmation between 2014 and 2020. The follow-up period was at least 2 years. Patients were categorised into two groups: 'NUM' with previously known nephrourological anomalies or those diagnosed during the follow-up and 'Non-NUM' group. RESULTS: Out of 836 eligible patients, 26.8% had underlying NUMs. The study identified six key risk factors: recurrent UTIs, non-Escherichia coli infection, moderate acute kidney injury, procalcitonin levels >2 µg/L, age <3 months at the first UTI and fUTIs beyond 24 months. These risk factors were used to develop a predictive model with an 80.7% accuracy rate and elaborate a NUM-score classifying patients into low, moderate and high-risk groups, with a 10%, 35% and 93% prevalence of NUM. We propose an algorithm for approaching imaging tests following a fUTI. CONCLUSION: Our predictive score may help physicians decide about imaging tests. However, prospective validation of the model will be necessary before its application in daily clinical practice.

Electrochemical Analysis of Curcumin in Real Samples Using Intelligent Materials.

Curcumin is a compound of great importance in the food industry due to its biological and pharmacological properties, which include being an antioxidant, anti-inflammatory, antibacterial, antiviral, and anticarcinogenic. This paper proposes the synthesis of an electrochemical sensor based on molecularly imprinted polymers (MIPs) and MWCNT by drop casting deposited on a glassy carbon electrode (GCE) for the selective quantification of curcumin in food samples. The synthesized compounds are characterized by Fourier transform infrared (IR), Brunauer-Emmett-Teller (BET), and electrochemical techniques such as cyclic voltammetry (CV) and differential pulse voltammetry (DPV). The optimal conditions for further experiments were determined by selecting these parameters. We examined three food products, commercial capsules, turmeric rhizomes, and commercial turmeric powder, employing both electrochemical and HPLC methods for the analysis. The electrochemical method revealed a limit of detection (LOD) value of 0.1365 µmol L-1, compared with the HPLC analysis, which gave a value of 3.55 µmol L-1. Furthermore, the MIP material demonstrated superior selectivity for the analyte compared to potential interferents. The recovery percentage, determined using the HPLC method, fell within the range of 87.5% to 102.6.

Ventilatory improvement with mechanical ventilator versus bag in non-traumatic out-of-hospital cardiac arrest: SYMEVECA study, phase 1.

AIM: To analyze differences in ventilatory parameters and outcome with different ventilatory methods during CPR. METHODS: Pragmatic prospective quasi-experimental study in out-of-hospital urban environment. Patients over 18 years of age in non-traumatic cardiac arrest, attended by an emergency medical service between April 2021 and September 2022, were included. Two groups were compared according to the ventilatory method: mechanical ventilator (IPPV, tidal volume 7 ml/kg, frequency 10-12 bpm) or manual resuscitator bag. The main variables of interest are those of gasometry performed 15 minutes after intubation or when spontaneous circulation is recovered and final outcome. Patients were followed up to hospital discharge. RESULTS: Of the 359 patients attended, 150 were included (71 in IPPV and 79 with a bag). In patients with arterial blood gases, pCO2 was 67.8 ± 21.1 in the IPPV group vs 95.9 ± 39.0 mmHg in the bag group (p = 0.006) and pH was 7.00 ± 0.18 vs 6.92 ± 0.18 (p = 0.18). With a venous sample, the pCO2 was 68.1 ± 18.9 vs 89.5 ± 26.5 mmHg (p < 0.001) and the pH was 7.03 ± 0.15 vs 6.94 ± 0.17 (p = 0.005), respectively. Survival with CPC 1-2 to hospital discharge was 15.6% with IPPV and 11.3% with bag (p = 0.44). CONCLUSION: The use of a mechanical ventilator in IPPV was associated with a better ventilatory status during CPR compared to the use of the bag, without conclusive data regarding its clinical repercussion with the sample collected.

Synthesis, Characterization, and Evaluation of a Novel Molecularly Imprinted Polymer (MIP) for Selective Quantification of Curcumin in Real Food Sample by UV-Vis Spectrophotometry.

Curcumin is the main colorant of the curcuma longa plant, a food with many benefits for human health. This work aims to synthesize a novel molecularly imprinted polymer (MIP) for the selective detection of curcumin in real samples obtained from the local market of Peru. MIPs were synthesized via bulk polymerization using curcumin, acrylamide, ethylene glycol dimethacrylate, ABCV, and acetonitrile. FTIR spectra showed equal spectra for MIP and NIP. N2 physisorption analysis presented a higher value BET surface for the MIP (28.5 m2 g-1) compared to the NIP (18.5 m2 g-1). The adsorption capacity of the MIP was evaluated using UV-vis spectrophotometry in the band around 430 nm. The adsorption kinetics found were of pseudo-second-order and a Qe value of 16.2 mg g-1. Furthermore, the adsorption process resembles the Freundlich adsorption model with a heterogeneity factor of less than 1 (0.61) and Kf greater for MIP (1.97). The selectivity test indicated that MIP is more selective for curcumin (Q = 13.20 mg g-1) than against interferents (Q = 2.19 mg g-1). The specific selectivity factor (S) obtained for the interferents was greater than 1 which indicates a good selectivity. Finally, the application of MIP in real samples using UV-vis spectrophotometry yielded a recovery value greater than 70%.

Hyponatremia and other potential markers of ultrasound abnormalities after a first febrile urinary tract infection in children.

Urinary tract infections are the initial manifestation in 30% of urinary tract malformations. Identifying these patients, who could benefit from a specific treatment, is still challenging. Hyponatremia during urinary tract infection has been proposed as a urinary tract malformation marker. We evaluate the prevalence of hyponatremia during febrile urinary tract infections and its association with subjacent urinary tract malformations. We performed a retrospective study of healthy patients under 16 years, diagnosed with a first episode of febrile urinary tract infection, who had undergone blood testing in the acute episode and at least one renal ultrasound during follow-up (January 2014-November 2020). Hyponatremia was defined as (serum sodium ≤ 130 mEq/L). According to imaging findings, we classified patients into three groups: normal kidney ultrasound, mild pelviectasis, and significant urinary tract malformation. We performed logistic regression models to identify independent risk factors for urinary tract malformation and mild pelviectasis. We included 492 patients and 2.8% presented hyponatremia. We identified normal ultrasound in 77%, mild pelviectasis in 10.8%, and urinary tract malformation in 12% of patients. We found an association between mild pelviectasis and hyponatremia [OR 6.6 (CI95% 1.6-26.6)]. However, we found no association between hyponatremia and urinary tract malformation. The parameters that were associated with malformations were presenting a non-E. coli infection, C-reactive-protein levels over 80 mg/L, and bacteremia. CONCLUSION: Hyponatremia during the first episode of febrile urinary tract infection is present in 2.8% of patients and is associated with mild pelviectasis in imaging. However, hyponatremia does not indicate a greater need for complementary tests to screen for urinary tract malformations. WHAT IS KNOWN: • Urinary tract infection is the first manifestation in 30% of children with urinary tract malformation. • Hyponatremia could be a marker to identify these children and guide the imaging approach. WHAT IS NEW: • Around 12% of children with a first episode of febrile urinary tract infection have a urinary tract malformation. • Non-E. coli infection, C-reactive protein levels over 80 mg/L, and bacteremia are markers for malformations to guide diagnostic imaging tests, but hyponatremia (Na ≤ 130 mEq/l) is not a reliable marker.

Blood analysis for screening of electrolyte and kidney function alterations in patients with febrile urinary tract infection.

AIM: To describe the prevalence, severity, risk factors, and clinical relevance of electrolyte disturbances and acute kidney injury (AKI) during febrile urinary tract infection (fUTI). METHODS: Retrospective observational study of well/fair-appearing patients between 2 months and 16 years, with no previous relevant medical history, diagnosed with fUTI in the paediatric emergency department (PED) with subsequent microbiological confirmation. Analytical alteration (AA) data were considered: AKI (creatinine elevation × 1.5 the median for age), plasma sodium alteration (≤130 or ≥150 mEq/L), and potassium alteration (≤3 or ≥6 mEq/L). RESULTS: We included 590 patients, 17.8% presented AA (13 hyponatremia, 7 hyperkalaemia, and 87 AKI). No patient presented severe analytic alterations or a higher frequency of symptoms potentially attributable to these alterations (seizures, irritability, or lethargy). Risk factors associated with these AA were clinical dehydration (OR = 3.5 95% CI: 1.04-11.7; p = 0.044) and presenting a temperature >39°C (OR = 1.9 95% CI: 1.14-3.1; p = 0.013). CONCLUSIONS: Electrolyte and renal function disturbances are infrequent in the previously healthy paediatric population with a fUTI. If present, they are asymptomatic and not severe. Based on our results, performing systematic blood analysis to rule out AA appears no longer justified, especially in the absence of risk factors.

Using a Smartphone-Based Colorimetric Device with Molecularly Imprinted Polymer for the Quantification of Tartrazine in Soda Drinks.

The present study reports the development and application of a rapid, low-cost in-situ method for the quantification of tartrazine in carbonated beverages using a smartphone-based colorimetric device with molecularly imprinted polymer (MIP). The MIP was synthesized using the free radical precipitation method with acrylamide (AC) as the functional monomer, N,N'-methylenebisacrylamide (NMBA) as the cross linker, and potassium persulfate (KPS) as radical initiator. The smartphone (RadesPhone)-operated rapid analysis device proposed in this study has dimensions of 10 × 10 × 15 cm and is illuminated internally by light emitting diode (LED) lights with intensity of 170 lux. The analytical methodology involved the use of a smartphone camera to capture images of MIP at various tartrazine concentrations, and the subsequent application of the Image-J software to calculate the red, green, blue (RGB) color values and hue, saturation, value (HSV) values from these images. A multivariate calibration analysis of tartrazine in the range of 0 to 30 mg/L was performed, and the optimum working range was determined to be 0 to 20 mg/L using five principal components and a limit of detection (LOD) of 1.2 mg/L was obtained. Repeatability analysis of tartrazine solutions with concentrations of 4, 8, and 15 mg/L (n = 10) showed a coefficient of variation (% RSD) of less than 6%. The proposed technique was applied to the analysis of five Peruvian soda drinks and the results were compared with the UHPLC reference method. The proposed technique showed a relative error between 6% and 16% and % RSD lower than 6.3%. The results of this study demonstrate that the smartphone-based device is a suitable analytical tool that offers an on-site, cost-effective, and rapid alternative for the quantification of tartrazine in soda drinks. This color analysis device can be used in other molecularly imprinted polymer systems and offers a wide range of possibilities for the detection and quantification of compounds in various industrial and environmental matrices that generate a color change in the MIP matrix.

Mobile-phone text messaging to promote ideal cardiovascular health in women.

OBJECTIVE: Ideal cardiovascular health (CVH) was developed to promote CVH as a key component of primordial prevention. Mobile short message service (SMS) is useful for improving health behaviours. We aim to test the effectiveness of SMS intervention in women to improve CVH. METHODS: In a single-blinded, randomised, controlled study, 620 women, aged 35-70 years, without cardiovascular disease, were enrolled in SMS intervention versus no SMS. CVH metrics by self-report, and biochemical laboratory, anthropometric and blood pressure measurements were collected during home visits at baseline and 9 months. Women were categorised as having poor (0-2), intermediate (3-4) or ideal (5-7) CVH according to the number of ideal CVH metrics. Participants were randomised 1:1 to SMS intervention versus control. SMS was sent every 5-6 days for 9 months. The primary outcome was the difference in the proportion of women with ideal CVH between SMS and control groups at 9 months. Rates of intermediate CVH, poor CVH and each of the seven ideal CV health metrics at 9 months were key secondary endpoints. RESULTS: At 9 months, there was no significant difference between groups for the primary outcome (16.3% at baseline and 13.3% at 9 months, and 10.1% and 11.1%, in SMS and control groups, respectively, adjusted RR 1.0; 95% CI 0.6 to 1.6). Similarly, there were no significant differences between groups for the key secondary endpoints. SMS had an acceptance rate of 94.9%. CONCLUSIONS: Behavioural SMS intervention did not improve rates of ideal CVH in women, despite being feasible and well received. TRIAL REGISTRATION NUMBER: 6377.

Social anxiety and academic performance during COVID-19 in schoolchildren.

The purpose of the present study was to determine the perception of schoolchildren whether their academic performance improved or worsened during the pandemic, analyzing their social anxiety, gender, use of masks in the classroom, and school year. The total sample was 107 primary school students (25 in the fourth, 40 in the fifth and 42 in the sixth grade), with a mean age of 10.51 years old (SD = 1). The gender were 58 girls and 49 boys, from a school in the province of La Coruña (Spain). The study was based on a quantitative methodology, and the design was cross-sectional, descriptive, observational and correlational. The social anxiety questionnaire (CASO-N24) was used to assess social anxiety, and an ad hoc self-report register was elaborated to evaluate sociodemographic variables. The results indicated that 44.8% of the schoolchildren considered that the pandemic had neither improved nor worsened their academic performance. Although 38.3% considered that high and very high social anxiety increased progressively as the school year progressed, both in boys and girls. Besides, the schoolchildren who presented very low and low social anxiety improved their grades in Physical Education, while those who presented high social anxiety worsened them. In conclusion, having a low social anxiety, lower grades before the pandemic and higher grades after, makes children perceive an improvement in their academic performance during the pandemic.

Vólvulo intestinal en niños de edad escolar: reto diagnóstico en urgencias / Intestinal volvulus in school-age children: an emergency care challenge

El dolor abdominal supone uno de los motivos de consulta más frecuentes en los Servicios de Urgencias Pediátricas. El vólvulo intestinal es una entidad infrecuente pero que sin un diagnóstico y tratamiento quirúrgico precoces tiene consecuencias devastadoras, siendo una de las urgencias que todos los pediatras deben conocer. Los vólvulos suponen hasta el 14% de las causas de síndrome de intestino corto que pueden llegar a precisar trasplante intestinal. Requiere un alto índice de sospecha, ya que las pruebas complementarias pueden ser inespecíficas y su normalidad no descarta esta patología. Únicamente la intervención quirúrgica confirma el diagnóstico de vólvulo intestinal. Presentamos los casos de cuatro pacientes que acudieron al Servicio de Urgencias y fueron diagnosticados de vólvulo intestinal. (AU)

Abdominal pain is one of the most frequent reasons for visiting paediatric emergency departments. Intestinal volvulus is an infrequent condition, but without early diagnosis and surgical treatment it has devastating consequences, and it is one of the emergencies that paediatricians must be aware of. Intestinal volvulus accounts for up to 14% short bowel syndrome cases that may require bowel transplantation. A high level of suspicion must be maintained, as the results of diagnostic tests may be nonspecific and normal results do not rule it out. Surgical intervention is the only way to confirm the diagnosis of intestinal volvulus. We present the cases of 4 patients who attended the emergency department and received a diagnosis of volvulus. (AU)

Influencia de las necesidades psicológicas básicas y estados de ánimo en jugadores de tenis de mesa / Influence of basic psychological needs and mood states in table tennis players

Este estudio pretende conocer la relación entre los estados de ánimo en una prueba con y sin mascarilla; y, por otro lado, comprobar si existe relación entre la frustración de necesidades psicológicas básicas y la realización de un test con y sin mascarilla en jugadores de tenis de mesa. Han participado 5 jugadores veteranos, de entre 12 y 16 años. Se emplearon la Course Navette en dos momentos espaciados en 3 semanas, y los cuestionarios Profile of Mood Status (POMS) y Psychological Need Thwarting Scale (PNTS) justo al terminar la prueba. Al realizar la prueba sin mascarilla, se obtienen mayores puntuaciones del cuestionario POMS en la escala de vigor, obteniendo un mayor estado de ánimo, perfil característico del deportista psicológicamente sano. En cuanto a la frustración de necesidades psicológicas básicas, se observó una media ligeramente elevada, siendo éstas predictoras de la variable confusión del estado de ánimo. (AU)

This study aims, on the one hand, to find out the relationship between moods in a test with and without a mask; and on the other, to check if there is a relationship between the frustration of basic psychological needs and the performance of a test with and without a mask in table tennis players. 5 veteran players have participated, between 12 and 16 years old. The Course Navette was used in two moments, spaced 3 weeks apart, and the Profile of Mood Status (POMS) and Psychological Need Thinking Scale (PNTS) questionnaires just at the end of the test. When performing the test without a mask, higher scores are obtained from the POMS questionnaire on the vigor scale, obtaining a higher state of mind, a characteristic profile of a psychologically healthy athlete. Regarding the basic psychological needs. Regarding the frustration of basic psychological needs, a slightly high mean was observed, these being predictors of the variable mood confusion. KeyWords Mood; frustration; athletes; table tennis; basic psychological needs. (AU)

Documento de recomendaciones sobre la rehidratación intravenosa rápida en gastroenteritis aguda / Recommendation document on rapid intravenous rehydration in acute gastroenteritis

Introducción: Existe consenso en cuanto a la eficacia y seguridad de las pautas de rehidratación intravenosa rápida (RIR) en niños con deshidratación secundaria a gastroenteritis aguda (GEA), pero también una gran variabilidad en su uso en la práctica clínica. Objetivo: Elaborar un documento de recomendaciones sobre la RIR en población pediátrica basadas en la evidencia científica. Metodología: Se diseñó un proyecto basado en metodología GRADE, siguiendo el siguiente esquema de trabajo: formación del grupo de trabajo; formulación de preguntas de investigación y definición de «desenlaces de interés»; puntuación y selección de ítems; revisión bibliográfica; evaluación y síntesis de la evidencia (GRADE); revisión, discusión y formulación de recomendaciones. Se incluyeron 10 preguntas clínicas y 15 desenlaces de interés (siete de eficacia y ocho de seguridad). Resultados: Se establecieron 16 recomendaciones, destacando como principales: 1) la RIR es segura en niños con deshidratación leve-moderada secundaria a GEA, salvo contraindicación expresa o comorbilidad aguda grave (recomendación fuerte, evidencia moderada); 2) se recomienda su uso en este contexto cuando la rehidratación oral haya fracasado o esté contraindicada (fuerte, alta); 3) se recomienda utilizar sueros isotónicos (fuerte, alta), sugiriendo como primera opción el suero fisiológico (débil, baja), añadiendo glucosa (2,5%) en pacientes con glucemia normal y cetosis (fuerte, moderada); 4) se recomienda un ritmo de infusión de 20 mL/kg/hora (fuerte, alta), durante una a cuatro horas (fuerte, moderada). Conclusiones: En este documento se establecen recomendaciones de consenso, basadas en la evidencia científica disponible, que podrían contribuir a homogeneizar el uso de la RIR en nuestro medio. (AU)

Introduction: The efficacy and safety of the rapid intravenous rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. Objective: To prepare a document with evidence-based recommendations about RIR in paediatric population. Methods: The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of «relevant outcomes»; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). Results: Sixteen recommendations were set up, from which we can highlight as the main ones: (1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation and moderate evidence). (2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong and high). (3) Isotonic fluids are recommended (strong and high), suggesting saline fluid as the first option (light and low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong and moderate). (4) A rhythm of 20 cc/kg/h is recommended (strong and high) during 1–4 h (strong and moderate). Conclusions: This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting. (AU)

Recommendation document on rapid intravenous rehydration in acute gastroenteritis.

INTRODUCTION: The efficacy and safety of the Rapid Intravenous Rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. OBJECTIVE: To prepare a document with evidence-based recommendations about RIR in paediatric population. METHODS: The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of "relevant outcomes"; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). RESULTS: 16 recommendations were set up, from which we can highlight as the main ones: 1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation, moderate evidence). 2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong, high). 3) Isotonic fluids are recommended (strong, high), suggesting saline fluid as the first option (light, low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong, moderate). 4) A rhythm of 20cc/kg/h is recommended (strong, high) during 1-4 h (strong, moderate). CONCLUSIONS: This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.

Valor de la ecografía abdominal en la evaluación de la ileítis infecciosa aguda en niños / Value of abdominal ultrasound for evaluation of acute infectious ileitis in children

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