Fluticasone in mild to moderate atopic dermatitis relapse: a randomized controlled trial

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p = 0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD

No disponible

Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial.

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.

Tablas de crecimiento: impacto sobre la prevalencia de los trastornos nutritivos / Growth charts: Impact on the prevalence of nutritional disorders

INTRODUCCIÓN: Las referencias más empleadas en España para evaluar el crecimiento son las gráficas de la Fundación Orbegozo y las gráficas de la Organización Mundial de la Salud (OMS). El objetivo es analizar las diferencias entre ambas para las magnitudes: peso, talla e índice de masa corporal, y valorar su relevancia para identificar problemas nutricionales o de crecimiento. MATERIAL Y MÉTODOS: Se compara el valor de los percentiles extremos de talla, peso e índice de masa corporal para cada sexo desde los 0-10 años de ambas gráficas. Se calculan diferencias absolutas y de puntuación Z. Para evaluar el impacto sobre la prevalencia de trastornos nutritivos o de crecimiento se examina la ubicación del valor numérico de cada percentil extremo entre ambas tablas. RESULTADOS: Se observan diferencias significativas entre los percentiles 3 de talla y peso, 97 de peso y 85 y 97 de índice de masa corporal. Durante los primeros años, la referencia Orbegozo sobreestima con respecto a la referencia OMS la prevalencia de desnutrición entre un 2 y un 19%. En edades posteriores, la subestima entre un 0,7 y un 2,89%. La referencia Orbegozo subestima con respecto a la referencia OMS la prevalencia de sobrecarga ponderal (entre un 2,5 y un 14,8%). El valor del percentil 97 de índice de masa corporal de la referencia Orbegozo se corresponde en la mayoría de los casos con percentiles de la referencia OMS superiores al 99,99%. CONCLUSIÓN: Los patrones analizados presentan diferencias que pueden ser relevantes desde el punto de vista clínico y de salud pública

INTRODUCTION: The references used to assess child growth in Spain are the graphs of the Orbegozo Foundation and the charts of the World Health Organization (WHO). The objective of this study is to analyze the differences between the two charts for weight, height and body mass index, and assess their relevance to identify growth or nutritional problems. MATERIAL AND METHODS: The values of the extreme percentiles of height, weight and body mass index for each sex from 0 to 10 years in both charts are compared. For each value Absolute differences and Z scores are calculated for each value. To evaluate the impact on the prevalence of the various nutritional or growth disorders the location of the value of the respective percentiles of in each of the charts were assessed. RESULTS: Significant differences were observed between the 3th percentile of height and weight, 97th of weight, and 85th and 97th of body mass index. Marked differences were observed for the extreme values of body mass index. During the first years, the Orbegozo charts overestimate the prevalence of malnutrition (between 2% and 19% depending on age and sex) compared to the WHO charts. In subsequent ages Orbegozo underestimates WHO between 0.7% and 2.89%. Orbegozo underestimates the prevalence of overweight (between 2.5% and 14.8%) compared to the WHO charts. The 97th percentile of Body mass index in the Orbegozo charts corresponds in most cases with WHO percentiles above 99.99%. CONCLUSION: The two charts analyzed have significant differences from a clinical and the public health point of view, in the estimation of overweight/obesity and malnutrition

[Growth charts: Impact on the prevalence of nutritional disorders]. / Tablas de crecimiento: impacto sobre la prevalencia de los trastornos nutritivos.

INTRODUCTION: The references used to assess child growth in Spain are the graphs of the Orbegozo Foundation and the charts of the World Health Organization (WHO). The objective of this study is to analyze the differences between the two charts for weight, height and body mass index, and assess their relevance to identify growth or nutritional problems. MATERIAL AND METHODS: The values of the extreme percentiles of height, weight and body mass index for each sex from 0 to 10 years in both charts are compared. For each value Absolute differences and Z scores are calculated for each value. To evaluate the impact on the prevalence of the various nutritional or growth disorders the location of the value of the respective percentiles of in each of the charts were assessed. RESULTS: Significant differences were observed between the 3th percentile of height and weight, 97th of weight, and 85th and 97th of body mass index. Marked differences were observed for the extreme values of body mass index. During the first years, the Orbegozo charts overestimate the prevalence of malnutrition (between 2% and 19% depending on age and sex) compared to the WHO charts. In subsequent ages Orbegozo underestimates WHO between 0.7% and 2.89%. Orbegozo underestimates the prevalence of overweight (between 2.5% and 14.8%) compared to the WHO charts. The 97th percentile of Body mass index in the Orbegozo charts corresponds in most cases with WHO percentiles above 99.99%. CONCLUSION: The two charts analyzed have significant differences from a clinical and the public health point of view, in the estimation of overweight/obesity and malnutrition.

Revisión sistemática: tratamiento nutricional del cólico del lactante (y II) / Systematic review: dietary treatment of infant colic (and II)

Introducción: El cólico del lactante es un problema prevalente en el que se han ensayado a lo largo de la historia diversos tratamientos, ninguno de ellos definitivo. En los últimos años se han realizado nuevas propuestas terapéuticas, y han aparecido en el mercado las llamadas fórmulas anticólico (FAC), o confort. En el presente trabajo se realiza una revisión estructurada sobre el tratamiento nutricional del cólico del lactante, con el objetivo de integrar la información actual sobre este aspecto y establecer las pruebas existentes sobre la utilidad de distintas modalidades de tratamiento nutricional. Metodología: Se efectuó una revisión sistemática mediante búsqueda bibliográfica electrónica de los ensayos clínicos con diseño aleatorizado y controlado acerca del tratamiento nutricional del cólico del lactante. Se realizó un análisis de las modificaciones en la composición de las FAC en relación con la fórmula adaptada convencional, según los datos proporcionados por los fabricantes del producto. Resultados: Los 23 ensayos clínicos incluidos estudiaron seis modalidades de tratamiento nutricional: disminución de lactosa en la fórmula artificial, dieta hipoalergénica, adición de fibra, administración de soluciones azucaradas, probióticos y preparados fitoterápicos. Una proporción significativa de los trabajos analizados presenta problemas metodológicos, como un escaso número de pacientes, una alta tasa de pérdidas y sesgos de selección, que dificultan la extrapolación de sus resultados a la práctica clínica. De las distintas intervenciones nutricionales, la exclusión de proteínas de leche de vaca en lactantes con fórmula artificial, la administración de preparados fitoterápicos y la dieta hipoalergénica extensa en la madre del lactante han demostrado tener algún grado de eficacia. Se necesitan estudios adicionales para verificar la eficacia de otras modalidades de tratamiento nutricional (AU)

Introduction: Infant colic is a common problem for which there is still no definitive treatment, despite the many approaches that have been tested over the course of time. In recent years, a number of proposals have been made, and so-called anticolic or comfort milk formulas have appeared on the market. The aim of this report is to present a systematic review of the dietary treatment of infant colic in order to update the available information and to establish the utility of different forms of nutritional intervention. Methods: A systematic review of the electronic databases was conducted to search exclusively for studies classified as randomized, controlled clinical trials focusing on the dietary treatment of infant colic. The authors analyzed the modifications in the composition of the anticolic formulas, as compared to standard formula, according to the data provided by the manufacturers of the product. Results: Among the twenty-three clinical trials selected, six modalities of nutritional treatment were studied: reduction of lactose, low-allergen diet, fiber-enriched formula, sweetened solutions, probiotics and phytotherapeutic agents. Methodological problems, such as small sample size, high dropout rate and selection bias, were observed in a considerable number of the analyzed trials, making it difficult to extrapolate the results to clinical practice. Removing cow’s milk from the diet of bottle- fed infants and administration of phytotherapeutic agents and a low-allergen diet to the mothers of breast-fed infants have been found to have a certain degree of efficacy. Additional studies are needed to verify the utility of other modalities of dietary treatment (AU)

Revisión sistemática: tratamiento nutricional del cólico del lactante (I) / Systematic review: dietary treatment of infant colic (I)

Introducción: El cólico del lactante es un problema prevalente en el que se han ensayado a lo largo de la historia diversos tratamientos, ninguno de ellos definitivo. En los últimos años se han realizado nuevas propuestas terapéuticas, y han aparecido en el mercado las llamadas fórmulas anticólico o confort (FAC). En el presente trabajo se realiza una revisión estructurada sobre el tratamiento nutricional del cólico del lactante, con el objetivo de integrar la información actual sobre este aspecto y establecer las pruebas existentes sobre la utilidad de distintas modalidades de tratamiento nutricional. Metodología: Revisión sistemática mediante búsqueda bibliográfica electrónica de los ensayos clínicos con diseño aleatorizado y controlado acerca del tratamiento nutricional del cólico del lactante. Análisis de las modificaciones en la composición de las FAC en relación con la fórmula adaptada convencional según los datos proporcionados por los fabricantes del producto. Resultados: Los 23 ensayos clínicos incluidos estudiaron 6modalidades de tratamiento nutricional: disminución de lactosa en la fórmula artificial, dieta hipoalergénica, adición de fibra, administración de soluciones azucaradas, probióticos y preparados fitoterápicos. Una proporción significativa de los trabajos analizados presenta problemas metodológicos, como escaso número de pacientes, alta tasa de pérdidas y sesgos de selección, que dificultan la extrapolación de sus resultados a la práctica clínica. De las distintas intervenciones nutricionales, la exclusión de proteínas de leche de vaca en lactantes con fórmula artificial, la administración de preparados fitoterápicos y la dieta hipoalergénica extensa en la madre del lactante han demostrado tener algún grado de eficacia. Se necesitan estudios adicionales para verificar la eficacia de otras modalidades de tratamiento nutricional(AU)

Introduction: Infant colic is a common problem. Although several treatments have been tested over the years, none have proved to be definitive. A number of novel therapeutic strategies have been proposed in recent years, and anticolic or comfort formulas have appeared in the market. The present report is a systematic review of the dietary treatment of infant colic to provide an update of the available information and to establish the utility of different forms of dietary treatment. Methods: We conducted a systematic review based on electronic databases that entailed searching exclusively for studies classified as randomized, controlled trials involving dietary treatment of infant colic. We analyzed the modifications in the composition of the anticolic formulas, as compared to a standard formula, according to the data provided by the manufacturers of the product. Results: Of the twenty-three clinical trials selected, six modalities of dietary treatment were studied: reduction of lactose, low-allergen diet, fiber-enriched formula, sweetened solutions, probiotics and phytotherapeutic agents. Methodological problems, such as small sample size, high dropout rate and selection bias, were found in a substantial number of the trials analyzed.The elimination of cow’s milk from the diet of bottle-fed infants, administration of phytotherapeutic agents and a low allergen diet in the mother of the breast-fed infant have been found to demonstrate a certain degree of efficacy. Additional studies are needed to verify the utility of other modalities of dietary treatment(AU)

Dolor lumbar y de miembros inferiores con rechazo de la deambulación como modo de presentación de síndrome de Guillain-Barré / Low back and lower limb pain and refusal to walk as presenting features of Guillain-Barré syndrome

No disponible

[An analysis of the relationship between morbidity and the level of demand for pediatric primary care. A study on 1359 children]. / Análisis de la relación entre morbilidad y nivel de demanda en Atención Primaria pediátrica. Un estudio sobre 1.359 niños.

OBJECTIVE: To analyse the relationship morbidity and utilization in the context of paediatric primary health care. To verify if the morbidity of children who most use primary care qualitatively different from the rest of the population. PATIENTS AND METHODS: Prospective study of the utilization and morbidity over one year in two offices paediatric in a Health Center. Reasons for consulting were grouped into generic types of morbidity, analysing the different types of morbidity of each patient in relation to their level of use. RESULTS: Acute problems were the main reason behind demand. 85% of high users as opposed to 12% of low users showed recurrent morbidity and 23% as opposed to 7% showed chronic medical morbidity. 1.5% of high users as opposed to 47% of low users presented acute morbidity. Recurrent morbidity was associated with greater use due to acute morbidity and non-specific signs or symptoms. The child who only presented with acute type problems in the first half-year was less likely (relative risk: 0.57, IC 95%, 0.43-0.67) to be a high user in the second half. CONCLUSIONS: Children with high level of use group together and chronic medical morbidity whereas those with low level of demand more often present exclusively acute problems. The most part of visitor is caused by acute problems which patients who most consult present to a greater extent than the rest. Recurrent morbidity conditions greater demand due to acute and non-specific problems which are not necessarily associated from the biological point of view with the underlying illness.

[Iga and IgG antireticuline in celiac disease. Their application as diagnostic markers of the disease]. / Estudio de la reactividad IgA e IgG antirreticulina en la enfermedad celíaca. Su aplicación como marcador diagnóstico de la enfermedad.

We report the results of indirect immunofluorescent (IFI) detection of IgA and IgG antireticulin antibodies (IgA-ARA and IgG-ARA, respectively) in 283 serum samples from pediatric patients with coeliac disease (with and without gluten containing diets), patients with non-coeliac gastrointestinal disease, patients without gastrointestinal disease (control group) and patients with an increased risk for coeliac disease (diabetes mellitus, dermatitis herpetiformis or first grade relatives of coeliac patients). Our results indicate that IgA-ARA is a reproducible marker, with high positive (99-100%) and negative (100%) prediction values, when it is applied to children who have been on gluten containing diets for a long time (more than six months). The IgA-ARA measurement is not applicable in cases of selective IgA deficiency. Although IgG-ARA has a high predictive positive value, its low predictive negative value makes it a poor diagnostic tool. In the risk groups, our results suggest that these antibodies are useful in patient selection for intestinal biopsy.

[The role of IgA and IgA antigliadin antibodies in the diagnosis and management of celiac disease]. / Importancia de los anticuerpos antigliadina de tipo IgA e IgG en el diagnóstico y seguimiento de la E. celíaca.

The authors reports the results of ELISA IgG and IgA antigliadin antibodies measurements in a study of 271 serum samples proceeding from celiac patients (with and without gluten containing diet) and control subjects. IgA antigliadin antibody measurement had the most specificity and positive predictive value, IgG antigliadin antibody measurement had the most sensitivity and negative predictive value. Our results point out that antigliadin antibodies are helpful in the diagnosis and management of celiac disease. Un the same manner, antigliadin antibodies are helpful to evaluate the adherence of patients to gluten-free diet.

[Anti-endomysium antibodies: new serological markers for the diagnosis and follow-up of patients with gluten-sensitive enteropathy. Preliminary study]. / Anticuerpos antiendomisio: un nuevo marcador serológico para el diagnóstico y seguimiento de pacientes afectos de enteropatía sensible al gluten. Estudio preliminar.

The authors value the parameters of diagnostic efficacy in a preliminary study of anti-endomysium antibodies (EmA), in the diagnostic and follow-up of patients with gluten sensitive enteropathy. The study was made with 84 subjects distributed into four groups. Group I consisted of 21 patients with gluten sensitive enteropathy (GSE) who were eating gluten at the time of diagnosis. Group II consisted of 20 patients with gluten sensitive enteropathy with different periods of time of gluten free diet. Group III consisted of 16 subjects with non-evolutive neuropathies and without intestinal disease. This group was considered as controls. Group IV consisted of 27 patients with toddler diarrhoea. The sensitivity, specificity, positive predictive value, negative predictive value and efficiency were 100%.

[Primary peptic ulcer in childhood: apropos of 20 cases studied using digestive fiberendoscopy]. / Ulcus péptico primario en la infancia: a propósito de 20 casos estudiados mediante fibroendoscopia digestiva.

We report a review of 20 children (14 males and 6 females) between 3 1/2-13 years of age (mean 9.7/ 12 years) with primary peptic ulcer disease, diagnosed by digestive fiberendoscopy. Endoscopy revealed 18 duodenal and 2 gastric ulcers. Positive family history was found in 45% of the patients. Abdominal pain was the most common presenting symptom and gastrointestinal bleeding was the only complication. The time before diagnosis was lesser than one month in 10%, between one to six months in 30% and more than months in 60% of patients. The follow-up period rate from three to 46 months (mean 14.9/12 months). Radiological study was performed in 18 patients and led 50% of false negative. A satisfactory response to mean treatment was found in all cases. Three patients related No patients required surgical treatment.