Aspectos éticos de la Medicina Defensiva / Ethical aspects of Defensive Medicine

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[Transnational adoptions. Medical and ethical issues]. / Adopciones transnacionales. Cuestiones médicas y éticas.

OBJECTIVE: To report our experience in the problems of international adoptions and their characteristics and management. MATERIALS AND METHODS: Review of patients treated in our pediatrics department and review of the literature. COMMENT: The adoption of children from other countries is increasing in Spain. The problems presented by these children include infectious diseases, and nutritional and psycho-emotional disorders. Furthermore, pediatricians should take ethical issues into account and discuss them with the adoptive parents.

[Death caused by designer drugs]. / Muerte por drogas de diseño.

OBJECTIVE: To draw pediatrician's attention to the risks of the use of designer drugs among adolescents and to review the problem. MATERIAL AND METHODS: We report the case of a 15-year-old girl admitted for seizures, who rapidly developed acute liver failure and died. Clinical and pathological details are reviewed. COMMENT: The use of designer drugs has increased considerably amongst Spanish adolescents and has been related to deaths in young adults with a variety of symptoms. Differential diagnosis should be made with the adverse effects of recreational drugs when clinical symptoms are confusing and in any unexplained deaths. Information on the effects of designer drugs should be disseminated among the population.

Adopciones transnacionales. Cuestiones médicas y éticas / International adoptions. Medical and ethical issues

OBJETIVO: Aportar la experiencia en los problemas que generan las adopciones transnacionales de niños, los planteamientos y su manejo. MATERIAL Y MÉTODOS: Revisión de casos asistidos en el servicio de pediatría y revisión de la bibliografía. CONCLUSIÓN: La adopción de niños procedentes de otros países está aumentando en el nuestro. Los problemas que plantean los niños adoptados incluyen enfermedades infecciosas, nutricionales y psicoemocionales. Además, deben tenerse en cuenta condicionantes de índole ética que el pediatra debe conocer y comentar con los padres adoptantes (AU)

Muerte por drogas de diseño / Death due to designer drugs

Llamar la atención de los pediatras sobre los riesgos del consumo de drogas de diseño entre los adolescentes y revisar el problema. Se presenta el caso clínico de una adolescente de 15 años que ingresa con un cuadro convulsivo y desarrolla una insuficiencia hepática aguda con evolución fatal. Se revisan los detalles clínicos y anatomopatológicos. El consumo de drogas de diseño se ha extendido considerablemente entre la población joven en nuestro país. El consumo de drogas de diseño se ha relacionado con casos de muerte entre jóvenes adultos con manifestaciones diversas. Se debe establecer el diagnóstico diferencial con los efectos secundarios de las drogas recreativas en las situaciones en que la clínica no sea clara y ante cualquier muerte inexplicada. Se debe extender la información sobre las drogas de diseño y sus efectos (AU)

[Pediatric care in rural hospitals. Two years' experience (author's transl)]. / La asistencia pediátrica en el hospital comarcal. Experiencia de dos años.

Rural hospitals have an increasing importance in pediatric hospital care as the organization of Public Health is becoming more rational in our country. There is little information about the possibilities for adequate care in rural hospitals. Statistics for admissions, occupancy, morbidity, etc. of two years experience are reported as a base line for guidance in the planning of this type of centers. From data reported, evidence is that neonatal pathology contributes with about one half of hospital admissions. On the other hand infectious diseases represent the largest single cause group of hospital admissions for infants and older children. Mortality is mainly due to that of premature infants with weights under 1.500 grams and low gestational age.

Hepatic toxicity of antituberculous drugs in children.

Three cases of children who developed hepatic toxicity of different degree while on antituberculous treatment with isoniazid and rifampicin are reported. The clinical picture is presented and the pathogenesis of the hepatic damage is discussed. The pathological findings in the liver are those of a drug induced hepatitis. The combined treatment of tuberculosis in children with isoniazid and rifampicin is potentially dangerous and should be reserved for cases in which resistance to other drugs has been demonstrated.

[Etiology of acute respiratory infection in hospitalized children (author's transl)]. / Etiología de infecciones respiratorias agudas en iniños hospitalizados

Incidence of respiratory tract infection represents 23% of the total number of admissions between 1-24 months of age, during a period of 18 months. The diagnosis were: bronchiolities, 143 cases; bronchopneumonia, 134 cases; tracheobronchitis, 50 cases; laryngitis, four cases, and bacterial pneumonia, 61 cases. Monthly incidence was maximal in December of each year. From the total group, 144 cases were included in the present study to determine etiology of the infection. In 19% of the cases a serological diagnosis was posible. The adenovirus group was the most frequently found, followed by mycoplasma pneumoniae, parainfluenza 2, RS virus and M. parotiditis. RS virus was associated with a clinical picture of bronchopneumonia, mycoplasma pneumoniae with one of bronchiolitis and adenovirus was indistinctly associated with features either bronchopneumonia or bronchiolitis. In two cases it was detected a mixed infection by two virus: influenza 2 and mycoplasma pneumoniae. In four cases a bacterial surinfection was demonstrated: in two cases with coagulase-positive staphilococus and other two with klebsiella pneumoniae.