[SEIP-AEPAP-SEPEAP consensus document on the aetiology, diagnosis and treatment of bacterial skin infections in out-patients]. / Documento de consenso SEIP-AEPAP-SEPEAP sobre la etiología, el diagnóstico y el tratamiento de las infecciones cutáneas bacterianas de manejo ambulatorio.

Skin infections are a common cause for dermatological consultations in the paediatric setting. A review is presented of the clinical manifestations, diagnosis and treatment of the main bacterial skin infections, as well as the diagnosis and treatment of super-infected puncture and bite wounds. The most prevalent bacteria in skin infections are Staphylococcus aureus and Streptococcus pyogenes. Treatment is usually empirical, since microbiological studies are only recommended under certain circumstances or lack of improvement with common therapies. Superficial skin infections can be treated with local antiseptics or antibiotics (mupirocin or fusidic acid). Systemic treatment is usually reserved for patients with extensive or severe disease or with other risk factors. Systemic treatment depends on the suspected infecting bacteria, with penicillin, amoxicillin, amoxicillin-clavulanic acid and first or second generation cephalosporin being the most frequently used drugs. Due to the low incidence of community-acquired methicillin-resistant infection by S. aureus in Spain, the use of clindamycin or co-trimoxazole is only recommended after severe disease, relapses or a clear epidemiological background.

[Psychopathology and child and adolescent type 1 diabetes mellitus outcome]. / Psicopatología y evolución de la diabetes mellitus tipo 1 en niños y adolescentes.

OBJECTIVES: To determine relations between psychopathology and metabolic control of type 1 diabetes mellitus in children and adolescents. MATERIAL AND METHODS: We evaluate socio-demographic and clinical variables, as well as psychopathology in 71 children and adolescents with type 1 diabetes mellitus with an illness evolution period longer than 1 year. We try to establish significant relations between such aspects and metabolic control of diabetes measured through glycosylated hemoglobin A. RESULTS: We find statistical significant correlations between a poor metabolic control (high levels of HbA1c) and depressive symptoms, a high level of state-anxiety or a previous psychiatric diagnosis. In a similar way, poor metabolic control is related to higher levels of personal, social, school maladjustment or family environment dissatisfaction. Such correlations remains significant for the metabolic control of diabetes together with the evolution period of the illness and the dietetic treatment adherence. CONCLUSIONS: The existence of psychiatric disorders in children and adolescents with type 1 diabetes mellitus is a major risk factor in order to determine a poor metabolic control of the illness.

[Psychosocial characteristics of children and adolescents with type 1 diabetes mellitus]. / Características psicosociales de los niños y adolescentes con diabetes mellitus tipo 1.

OBJECTIVES: To determine the psychological and social adjustment patterns of children and adolescents with type 1 diabetes compared with those of a control sample through standardized tests. MATERIAL AND METHODS: We compared a sample of 81 children and adolescents, aged 8-18 years, from a pediatric outpatient endocrinology unit with a randomized control group (n 162), paired by sex, age and school year. Information on clinical, social and family variables, self-image and self-esteem, health and expectations of change in health status, as well as screening for eating disorders, was collected. Symptoms of depression and anxiety, behavior, and psychosocial adjustment were also evaluated. RESULTS: Children and adolescents with diabetes showed lower self-esteem and poorer self-image than controls. No statistical differences were found in health status and expectations of change or in anxiety symptoms between cases and controls. Differences in depressive symptoms or in personal, social and scholastic adjustment showed no relationship with diabetic status. No significant behavioral disorders were found among the cases. CONCLUSIONS: Children and adolescents with type 1 diabetes show appropriate psychosocial adjustment and do not present higher levels of anxiety and depression than healthy controls. They do, however, show lower self-esteem.

Características psicosociales de los niños y adolescentes con diabetes mellitus tipo 1 / Psychosocial characteristics of children and adolescents with type 1 diabetes mellitus

Objetivos: Conocer los patrones de ajuste psicosocial de niños y adolescentes con diabetes tipo 1 comparados con niños sanos a través de escalas estandarizadas. Material y métodos: Se compararon 81 niños y adolescentes (8-18 años) procedentes de una consulta externa de endocrinología pediátrica con un grupo control escogido aleatoriamente (n= 162) apareado por sexo, edad y nivel de escolarización. Se obtuvo información acerca de variables clínicas, sociofamiliares, de autoimagen/autoestima, estado y cambio de salud, así como un cribado de trastornos de la conducta alimentaria. Además, se evaluaron los síntomas depresivos, ansiosos, conductuales y de adaptación psicosocial. Resultados: Entre los sujetos con diabetes, existe una peor autoimagen/autoestima, lo que se relaciona con el hecho de sufrir la enfermedad. No existieron diferencias significativas en cuanto a la percepción del estado de salud y de su cambio, así como en la sintomatología ansiosa entre casos y controles. Las diferencias encontradas en el nivel de sintomatología depresiva o en escalas de inadaptación personal, social y escolar no se relacionaban con el hecho de sufrir la enfermedad. No se encontraron alteraciones conductuales significativas en el grupo de casos. Conclusiones: Los niños y adolescentes con diabetes muestran un ajuste psicosocial adecuado y no presentan mayores grados de ansiedad o depresión por sufrir la enfermedad, aunque sí una peor autoestima (AU)