La punción-aspiración es una técnica segura y eficazen el tratamiento del neumotórax espontáneo primario / Needle aspiration is safe and effective for treating primary spontaneous pneumothorax

Objetivo: Demostrar la eficacia y seguridad de la técnica de punción-aspiración (PA) en el tratamiento del neumotórax espontáneo primario (NEP).Método: Estudio retrospectivo basado en una base de datos prospectiva de pacientes con neumotórax espontáneo primario que acudieron al servicio de urgencias (10 años).Se compara a los pacientes en los que se ha realizado la punción-aspiración (PA) frente a los que no. Además, se compara en términos de recidivas, reingresos, necesidad de cirugía o complicaciones, el grupo con un manejo ambulatorio frente al grupo de manejo hospitalario, y se analizan las variables asociadas al éxito de la técnica. Resultados: Se observan características similares en cuanto a las variables descriptivas(sexo, lado del neumotórax, hábito tabáquico, volumen aspirado) entre los dos grupos. La PA parece ser un factor protector en cuanto a la necesidad de ingreso con una OR0,7 (IC95: 0,62-0,78). No se observan diferencias significativas en cuanto a recidivas, reingresos o necesidad de intervención quirúrgica. Ninguna variable descriptiva ha mostrado relación con el éxito o fracaso de la técnica. La incidencia de complicaciones condicha técnica ha sido del 2,4%.Conclusiones: La técnica de PA es segura y eficaz como primer escalón en el tratamiento del NEP y reduce los ingresos hospitalarios sin aumentar el riesgo de reingreso o recidiva (AU)

Objective: Our main aim was to demonstrate the efficacy and safety of needle aspiration for treating primary spontaneous pneumothorax. Methods: Retrospective study of data collected prospectively for patients who came to the emergency department with primary spontaneous pneumothorax over a 10-year period. We compared patients who underwent needle aspiration to those who did not. Patients who were hospitalized were compared to those managed as outpatients in terms of recurrences, readmissions, need for surgery, and complications. Variables that might be related to the success of the procedure were explored. Results: Patients who underwent needle aspiration were similar to those who did not with respect to sex, side affected, and pneumothorax size (volume), and smoking status. Needle aspiration seems to be a protective factor against hospitalization (odds ratio, 0.7; 95% CI, 0.62-0.78). No significant between-group differences were detected with respect to recurrence, readmission, or need for surgery. None of the descriptive variables were related to success or failure of needle aspiration. The incidence of complications of needle aspiration was 2.4%Conclusions: Needle aspiration is a safe, effective first-line treatment for primary spontaneous pneumothorax and does not increase risk for readmission or recurrence (AU)

Estudio de la ingesta de yodo en los niños de 6 meses a 3 años de edad de Guipúzcoa / Study of iodine intake in children from 6 months to three years-old in Guipúzcoa

Objetivo: Evaluar si existe deficiencia de yodo en niños sanos con edades comprendidas entre los 6 meses y los 3 años, mediante cuantificación de yoduria. Diseño: Estudio descriptivo transversal, con muestreo intencional de niños que acuden a sus centros de salud para una revisión de salud rutinaria, en 10 centros de salud de Guipúzcoa. Sujetos: Ciento treinta niños de edades comprendidas entre los 6 y los 36 meses, sanos, 61 (46.9%) eran niñas y 69 (53.7%) niños. Mediciones: Edad en meses, procedencia, sexo, encuesta nutricional (en especial ingesta de sal yodada, pescado de mar y lácteos) y yoduria en micción aislada. Resultados: La mediana de yoduria es de 127μg/l. Aproximadamente, un tercio (36.9%) de los niños presentaban yoduria inferior a 100μg/l. No hemos encontrado asociación entre la yoduria y las variables de la encuesta nutricional. Conclusión: La ingesta de yodo en los niños estudiados es adecuada de acuerdo a las recomendaciones de la Organización Mundial de la Salud(AU)

Objective: To assess whether iodine deficiency exists in healthy children aged 6 months to 3 years by measuring urinary iodine. Design: A descriptive, cross-sectional study using purposeful sampling of children who attended 10 Primary Health Care centres in Guipúzcoa for routine health examinations. Subjects: A total of 130 healthy children aged between 6 and 36 months, of whom 61 (46.9%) were girls and 69 (53.1%) boys. Measurements: Age in months, origin, sex, nutritional survey (particularly intake of iodised salt, sea fish and dairy products) and urinary iodine excretion in a random urine sample. Results: The median urinary iodine was 127μg/L. About one third (36.9%) of children had a urinary iodine below 100μg/L. No relationship was found between urinary iodine and nutritional survey variables. Conclusion: Iodine intake in the children studied is adequate according to WHO recommendations(AU)

Derivaciones directas vs. indirectas a rehabilitación desde atención primaria / Direct vs. indirect referrals to rehabilitation from primary care

Se estudia la derivación a rehabilitación de pacientes afectos de algias y entesopatías directamente desde atención primaria (AP) o a través del servicio de traumatología, con el objetivo de comparar el tiempo de espera tras la derivación directa desde el médico de AP a rehabilitación, con derivación indirecta (DI), esto es, llegar a rehabilitación tras haber pasado por consulta de traumatología y analizar qué aporta la consulta de traumatología, además del aumento en la demora. El objetivo último de este trabajo es comparar la efectividad de las derivaciones. Material y métodos. Se seleccionan 787 pacientes remitidos a rehabilitación entre julio de 2007 y julio de 2008 por patología del aparato locomotor, que se agrupan en dos categorías, 239 corresponden a procesos cuya derivación a través de traumatología es incuestionable y 548 que llamamos «algias y entesopatías». Material y métodos. De esas 548, un 66% proceden de traumatología (DI) y un 34% han sido derivadas directamente desde AP. Material y métodos. Se describen las características de los pacientes y se analiza qué le aporta la consulta de traumatología a los de DI. Resultados y conclusión. La derivación directa desde AP a rehabilitación para algias y entesopatías puede contribuir a evitar demoras innecesarias y consultas duplicadas (AU)

We studied the referral to rehabilitation of patients affected by joint pain and enthesophatiy directly from Primary Care or by an orthopaedist. The aim of the study is to compare waiting times following direct referral from a primary care physician to rehabilitation, with those following indirect referral, that is, arriving at Rehabilitation after orthopaedist consultation. We also studiet the orthopaedist consultation contribution apart from increased delay. The goald of this paper is to seek improved effectiveness of referral. Material and methods. We selected 787 patientes referred to Rehabilitation between July 2007 and July 2008 due to musculoskeletal pathology. These were then grouped into two categories, 239 related to patients whose referral via orthopaedist is irrefutable, and 548 wich we call "Joint and Enthesophaty". Of these 548, 66% came from orthopaedist (Indirec referral) and 34% were referred directly from Primary Care. Material and methods. We described the patients charactheristics and discussed the orthopaedist consultation contribution to those patients who were indirectly referred. Results and conclusion. Direct referral from Primary care to Rehabilitation for Joint Pain and Enthesophaty can help avoid unnecessary delais and duplicateds consultation (AU)

Estudios por imagen en la primera infección urinaria con fiebre del lactante. ¿Es necesaria la cistografía miccional? / Imaging studies in the first urinary infection with fever in infants: is voiding cystourethrography necessary?

Introducción: En el lactante con infección del tracto urinario (ITU), no es necesaria la presencia de reflujo vesicoureteral (RVU) para que se produzca una lesión renal adquirida. Sólo los reflujos graves pueden ser un factor que favorezca su aparición. Objetivos: Valorar si en los lactantes diagnosticados por primera vez de una ITU con fiebre, una gammagrafía renal con ácido dimercaptosuccínico (DMSA) inicial normal puede ser utilizado como método de cribado para detectar los reflujos graves y sustituir a la cistouretrografía miccional seriada(CUMS). Pacientes y métodos: Hemos estudiado retrospectivamente 162 lactantes menores de 2 años controlados en nuestro hospital por haber presentado la primera manifestación de una ITU con fiebre (92 varones y 70 mujeres). En todos los casos se habían practicado, a los pocos días del diagnóstico, una ecografía renal, una DMSA y una CUMS. Resultados: De los 162 pacientes, 62 (38 %) tenían RVU, de los cuales56 (90 %) eran leves y seis (10 %), graves. El DMSA era anormal en 26 de 100 pacientes sin RVU (26 %), en 12 de56 con RVU leve (21 %) y en 6 de 6 casos de los que tenían RVU grave (100 %). La sensibilidad del DMSA para detectarlos reflujos graves era del 100 % y la especificidad del 76%.El valor predictivo positivo y el valor predictivo negativo eran del 14 y el 100 %, respectivamente. El cociente de probabilidad positivo era de 4,17 y el cociente de probabilidad negativo de 0. Conclusiones: En el lactante con una primera manifestación de una ITU, una DMSA inicial negativa hace innecesaria la realización de la CUMS (AU)

Introduction: The presence of vesicoureteral reflux (VUR) in an infant with urinary tract infection (UTI), does not necessarily lead to an acquired renal injury. Only serious reflux can be a factor in fostering its appearance. Objectives: To assess whether in infants diagnosed for the first time with a UTI with a fever, a routine initial DMSA can be used as a screening method for detecting severe reflux and replace voiding cystourethrography (VCUG). Patients and methods: We retrospectively studied 162 infants under 2 years old admitted to our hospital due to having a ITU with fever for the first time (92 males and 70 females). In all cases, arenal ultrasound, DMSA and VCUG had been performed a few days after the diagnosis. Results: Of the 162 patients, 62 (38 %) had VUR, of which 56(90 %) were mild and 6 (10 %) were severe. The DMSA was abnormal in 26/100 patients without VUR (26 %), 12/56 with mild VUR (21 %) and 6/6 of those with severe VUR (100 %). DMSA sensitivity for detecting severe reflux was 100 % and specificity was 76 %. The positive predictive value and negative predictive value was 14 % and 100 % respectively. The positive likelihood ratio was 4.17 and the negative likelihood ratio was 0. Conclusions: It is unnecessary to carry out VCUG in an infant with an initial UTI, and a negative DMSA (AU)

Revisión sistemática sobre la eficacia de racecadotrilo en el tratamiento de la diarrea aguda / Systematic review of the efficacy of racecadotril in the treatment of acute diarrhoea

Objetivo: Obtener un estimador de la eficacia del racecadotrilo en el tratamiento de la diarrea aguda mediante revisión sistemática y metaanálisis. Material y métodos: Se seleccionaron ensayos clínicos de calidad realizados en niños en los que se compara la eficacia del racecadotrilo frente a placebo en cuanto a duración de los síntomas, cantidad de deposiciones y efectos secundarios. La búsqueda se ha realizado en bases electrónicas (Med-line, EMBASE, CENTRAL, CINAHL, mRCT, Pascal), en las referencias de los artículos recuperados y mediante contacto con el fabricante, hasta diciembre de 2007. Dos evaluadores independientes han evaluado la calidad. Resultados: Se seleccionaron dos ensayos de muestra pequeña (135 y 172 niños, todos hospitalizados) y de calidad media. Éstos incluyen a niños de edades comprendidas entre 3 meses y 4 años con diarrea aguda de menos de 5 días de evolución a quienes al tratamiento habitual se añade racecadotrilo o placebo. No existen diferencias en la proporción de niños enfermos al quinto día (riesgo relativo [RR] = 0,73; intervalo de confianza [IC] del 95 %, 0,29-1,81). Se demuestra una eficacia leve en el volumen de las deposiciones en las primeras 48 h (diferencia estandarizada de medias [DEM] = -0,65; IC 95 %, -0,88 a -0,42). No se observan diferencias en los efectos secundarios (vómitos, RR = 1,16; IC 95 %, 0,64-2,12). Conclusión: La proporción de curados al quinto día no mejora añadiendo racecadotrilo al tratamiento habitual, si bien disminuye el volumen de deposiciones en las primeras 48 h. Sería interesante estudiar la eficacia en atención primaria valorando el número y volumen de las deposiciones y la duración y número de ingresos (AU)

Objective: To estimate, through a systematic review of the literature, the efficacy of racecadotril in the treatment of acute diarrhoea. Material and methods: Randomised trials carried out in children comparing racecadotril with placebo in terms of diarrhoea recovery, stools output and adverse effects were selected. Electronic databases (Medline, EMBASE, CENTRAL, CINAHL, mRCT, Pascal) and bibliographies of retrieved articles were searched, and the drug developer was contacted. Two authors independently assessed the quality of the retrieved articles and extracted the data. Results: Two small sample size randomised trials (135 and 172 children) of moderate quality were selected. They included children with less than five days diarrhoea and aged between 3 months and 4 years. There was no difference in the proportion of children who recovered by day 5 (RR = 0.73, CI95 % 0.29 to 1.81), although the stools volume during the first 48 hours was less in the racecadotril group (SMD = -0.65, CI95 % -0.88 to -0.52). There is no difference in the risk of vomiting (RR = 1.16, CI95 % 0.64 to 2.12). Conclusion: The proportion of recoveries by the 5th day is the same, although the stool volumes during the first 48 hours are less in the racecadotril treated children. It would be interesting to study the efficacy in a primary care setting assessing the cure rate, the stool volumes and the admission rate to elucidate if there is room for this drug (AU)

[Fractional exhaled nitric oxide: validation of a 6 second exhalation time with two different analysers]. / Fracción exhalada de óxido nítrico: validación de la medida con tiempo de espiración de 6 s con dos analizadores diferentes.

OBJECTIVE: To validate the measurement of fractional exhaled nitric oxide concentration (FE(NO)) using a 6-sec exhalation time in patients aged between 5 and 17 years with a stationary chemiluminescence analyser (NIOX, Aerocrine) and a portable electrochemical analyser (NIOX-MINO, Aerocrine). MATERIAL AND METHODS: FE(NO) was assessed in 60 patients randomised into two groups. In Group 1 (n = 30, NIOX analyser), three valid FE(NO) measurements were obtained for two exhalation times (10 sec and 6 sec); the mean of the three measurements was recorded. In Group 2 (n = 30, NIOX-MINO), a single valid measurement of FE(NO) was obtained for each exhalation time. We analysed age, gender, weight, height, diagnosis, treatment, FE(NO) and the number of attempts with both exhalation times in each analyser. Agreement between FE(NO) assessed using 10-sec and 6-sec exhalations was assessed by Bland-Altman analysis and Cohen's kappa. RESULTS: The mean (SD) age in Group 1 was 10.1 (3.07) years. The mean age in Group 2 was 10.43 (2.94) years. Bland-Altman analysis demonstrated good agreement between FE(NO) values obtained with both exhalation times and with both devices. Cohen's kappa, also demonstrated good agreement (NIOX, kappa = 1; NIOX-MINO, kappa = 0.93). CONCLUSIONS: A 6-sec exhalation time is valid for measuring FE(NO) with both analysers in children aged over 5 years.

[Diagnosis and quantification of iron overload in the liver using MRI]. / Diagnóstico y cuantificación de la sobrecarga férrica en el hígado mediante resonancia magnética.

Hereditary hemochromatosis is the most common cause of iron overload. The diagnosis of hereditary hemochromatosis has improved since Feder et al. isolated the HFE gene in 1996 and discovered the mutations related with this disease. Nevertheless, in many cases genetic tests for hereditary hemochromatosis are negative. These cases require diagnostic confirmation by quantifying the concentration of iron in the liver (LIC); this has traditionally been accomplished by liver biopsy. Many studies have shown that it is possible to quantify LIC using MRI. However, a consensus has yet to be reached about the most appropriate technique or whether it is possible to reproduce the same methods of calculation on different MRI units. This article reviews the current state of these questions and points to possible lines to standardize this noninvasive method of quantifying LIC in the future.

Diagnóstico y cuantificación de la sobrecarga férrica en el hígado mediante resonancia magnética / Diagnosis and quantification of iron overload in the liver using MRI

La hemocromatosis hereditaria es la modalidad más frecuente de sobrecarga férrica. El diagnóstico de la misma ha mejorado desde que en 1996 Feder et al aislaron el gen HFE descubriendo las mutaciones relacionadas con la enfermedad. Sin embargo, son muchos los pacientes con estudios genéticos negativos, y que por tanto requieren una confirmación diagnóstica mediante la cuantificación de la concentración de hierro en hígado (CHH) que tradicionalmente se ha realizado mediante biopsia hepática. Muchos estudios han demostrado la posibilidad de cuantificar la CHH mediante resonancia magnética. Sin embargo, todavía no existe un consenso en cuanto a la técnica más idónea ni en cuanto a la posibilidad o no de reproducir el mismo método de cálculo en diferentes máquinas. Este artículo revisa la realidad de estas cuestiones y señala posibles líneas de futuro para estandarizar este método no invasivo de cuantificación de la CHH

Hereditary hemochromatosis is the most common cause of iron overload. The diagnosis of hereditary hemochromatosis has improved since Feder et al. isolated the HFE gene in 1996 and discovered the mutations related with this disease. Nevertheless, in many cases genetic tests for hereditary hemochromatosis are negative. These cases require diagnostic confirmation by quantifying the concentration of iron in the liver (LIC); this has traditionally been accomplished by liver biopsy. Many studies have shown that it is possible to quantify LIC using MRI. However, a consensus has yet to be reached about the most appropriate technique or whether it is possible to reproduce the same methods of calculation on different MRI units. This article reviews the current state of these questions and points to possible lines to standardize this noninvasive method of quantifying LIC in the future

[Systematic review of the efficacy of racecadotril in the treatment of acute diarrhoea]. / Revisión sistemática sobre la eficacia de racecadotrilo en el tratamiento de la diarrea aguda.

OBJECTIVE: To estimate, through a systematic review of the literature, the efficacy of racecadotril in the treatment of acute diarrhoea. MATERIAL AND METHODS: Randomised trials carried out in children comparing racecadotril with placebo in terms of diarrhoea recovery, stools output and adverse effects were selected. Electronic databases (Medline, EMBASE, CENTRAL, CINAHL, mRCT, Pascal) and bibliographies of retrieved articles were searched, and the drug developer was contacted. Two authors independently assessed the quality of the retrieved articles and extracted the data. RESULTS: Two small sample size randomised trials (135 and 172 children) of moderate quality were selected. They included children with less than five days diarrhoea and aged between 3 months and 4 years. There was no difference in the proportion of children who recovered by day 5 (RR=0.73, CI 95% 0.29 to 1.81), although the stools volume during the first 48 hours was less in the racecadotril group (SMD=-0.65, CI 95% -0.88 to -0.52). There is no difference in the risk of vomiting (RR=1.16, CI 95% 0.64 to 2.12). CONCLUSION: The proportion of recoveries by the 5th day is the same, although the stool volumes during the first 48 hours are less in the racecadotril treated children. It would be interesting to study the efficacy in a primary care setting assessing the cure rate, the stool volumes and the admission rate to elucidate if there is room for this drug.

[Imaging studies in the first urinary infection with fever in infants: is voiding cystourethrography necessary?]. / Estudios por imagen en la primera infección urinaria con fiebre del lactante. Es necesaria la cistografía miccional?

INTRODUCTION: The presence of vesicoureteral reflux (VUR) in an infant with urinary tract infection (UTI), does not necessarily lead to an acquired renal injury. Only serious reflux can be a factor in fostering its appearance. OBJECTIVES: To assess whether in infants diagnosed for the first time with a UTI with a fever, a routine initial DMSA can be used as a screening method for detecting severe reflux and replace voiding cystourethrography (VCUG). PATIENTS AND METHODS: We retrospectively studied 162 infants under 2 years old admitted to our hospital due to having a ITU with fever for the first time (92 males and 70 females). In all cases, a renal ultrasound, DMSA and VCUG had been performed a few days after the diagnosis. RESULTS: Of the 162 patients, 62 (38 %) had VUR, of which 56 (90 %) were mild and 6 (10 %) were severe. The DMSA was abnormal in 26/100 patients without VUR (26 %), 12/56 with mild VUR (21 %) and 6/6 of those with severe VUR (100 %). DMSA sensitivity for detecting severe reflux was 100 % and specificity was 76 %. The positive predictive value and negative predictive value was 14 % and 100 % respectively. The positive likelihood ratio was 4.17 and the negative likelihood ratio was 0. CONCLUSIONS: It is unnecessary to carry out VCUG in an infant with an initial UTI, and a negative DMSA.

[Agreement between two devices for measuring exhaled nitric oxide]. / Concordancia entre dos dispositivos de medida de óxido nítrico exhalado.

BACKGROUND: Measurement of fractional exhaled nitric oxide (FENO) is a non-invasive marker of eosinophilic airway inflammation that can be useful in asthma diagnosis and control, as well as in treatment monitoring. OBJECTIVE: We studied the correlation between two techniques for measuring FENO: the chemiluminescence-based analyzer (NIOX, Aerocrine, Sweden) and a new portable electrochemical sensor-based analyzer (NIOX-MINO, Aerocrine). MATERIAL AND METHODS: FENO was measured by the single breath on-line method. In all children, three consecutives measurements were obtained with NIOX, with a maximum of six attempts, and the arithmetic mean was calculated. Next, using NIOX-MINO, a single measurement was made successively in each of the children. The variables analyzed were sex, age, height, weight, diagnosis, treatment, NIOX-MINO value, mean of three values obtained with NIOX and the NO elimination rate (nL/min). For the statistical analysis, the Bland-Altman plot was used to compare the means and the differences between measurements of FENO from NIOX and NIOX-MINO. The agreement between the two analyzers was estimated by Cohen's Kappa statistic. RESULTS: Thirty children were included, 14 (46.67%) boys and 16 (53.33%) girls. The mean age was 11.3+/-3.09 years. All of the children successfully performed the measurements with two analyzers. The relationship between the means and the differences in the values obtained with NIOX-MINO and NIOX were statistically significant (p<0.005). In addition, Cohen's Kappa statistic (0.78) suggested a high degree of agreement between the results obtained with the two devices. CONCLUSIONS: The two analyzers, NIOX-MINO and NIOX, were not equivalent. There was good agreement between the FENO values measured with the two devices. Measurement of FENO with the portable electrochemical sensor-based analyzer (NIOX-MINO) is valid and feasible in children older than 5 years.

[Prenatal detection of primary non-refluxing megaureter. Review of our casuistics]. / Megauréter primario no refluyente detectado prenatalmente.

BACKGROUND: Most primary non-refluxing megaureters resolve spontaneously and the indications for surgery are not sufficiently well established. OBJECTIVES: To analyze the clinical features, treatment and outcome of asymptomatic primary non-refluxing megaureter. PATIENTS AND METHODS: We retrospectively studied 58 infants with primary non-refluxing megaureter. The diagnostic methods used were renal ultrasound, renal isotopic renogram, DMSA scan, and evaluation of renal function. RESULTS: The mean age at postnatal diagnosis was 24 days. The mean follow-up was 4 years. Sixty-nine percent of the patients were male. Fifty-seven percent were left megaureters and 22% were bilateral (71 affected renal units). Eleven percent of megaureters were grade I, 48% were grade II, and 41% were grade III. Only nine patients (15%) received surgical treatment. The indications for surgical treatment were severe megaureter (3/9 patients; 33%), prolonged T1/2 (3/9 patients; 33%), reduced function (1/9 patients; 11%), prolonged T1/2 plus reduced function (1/9 patients; 11%) and increased dilation (1/9 patients; 11%). The mean age at surgery was 7 months. Outcomes in the non-surgical group (85% of the patients; 60 renal units) were as follows: 90% of megaureters were corrected or improved on ultrasound scan and 10% showed no change. In the first renogram, function was low in 4/60 kidneys (7%) and T1/2 was prolonged in 3/60 (5%). Finally, all kidneys in the non-surgical group had normal function, except one, which was injured from the beginning. T1/2 was normal in all kidneys. Outcomes in the surgical group (10 megaureters) were as follows: 80% of megaureters were corrected or improved after surgical intervention and 20% showed no change. At diagnosis, 4/10 kidneys (40%) had reduced function. In the post-surgical renogram 2/10 kidneys (20%) continued to show reduced function, 1/10 kidney (10%) showed restored renal function, and 1/10 kidney (10%) was nephrectomized. Initial T1/2 was prolonged in 4/10 patients (40%), and after surgery T1/2 was normal in all patients. The final DMSA scan showed 5/71 kidneys (7%) with irreversible damage (one slightly injured, two moderately injured, and three severely injured). The remaining 66 kidneys were normal. Overall renal function and blood pressure were normal in all patients. CONCLUSIONS: Primary non-refluxing megaureter is usually a functional and benign congenital malformation that resolves during the first months of life. Although the malformation can persist, only a few patients require surgical treatment. Most authors agree that initial treatment should not be surgical and that surgery should be reserved for patients who develop ureteral dilation, a decrease in differential renal function, and/or severe symptoms during follow-up. In a few patients (7% of our series), the renal unit belonging to the megaureter shows irreversible congenital injury. In these patients, surgery is not useful.

[Diagnostic utility of nocturnal in-home respiratory polygraphy]. / Rentabilidad de la poligrafía respiratoria del sueño realizada en el domicilio.

INTRODUCTION: Sleep apnea-hypopnea syndrome (SAHS) is relatively frequent in children. The gold standard for diagnosis is polysomnography. However, because of technical difficulties and the cost of this method, new alternatives have become available, such as respiratory polygraphy (RP) performed at home or in hospital, which have provided satisfactory results in children with clinical suspicion of SAHS. OBJECTIVE: The aim of this study was to analyze the diagnostic utility of in-home RP in the diagnosis of SAHS in a sample of boys and girls referred to the pediatric respiratory care department for suspected sleep apnea, snoring, or both. MATERIAL AND METHODS: In all patients, a history and physical examination were performed; X-ray of the chest and cavum and RP were carried out. The following qualitative variables were analyzed: place where RP was performed, the result, sex, the reason for consulting, place of residence, results of otorhinolaryngological examination, and treatment. The quantitative variables analyzed were age, total number of apneas, total number of hypopneas, apnea index/hour, hypopnea index/hour, mean and minimum SpxO2, number of snores per hour and the snore index/hour. Statistical analysis was performed using Pearson's chi-square test and Student's t-test. RESULTS: A total of 132 patients were studied, 44 (33.3 %) through in-home RP (group 1) and 88 (66.6 %) through in-hospital RP (group 2). In group 1, two recordings (4.5 %) were considered nonvalid. The mean age of the patients was 8.3 years (SD 3.02). The results [means (standard deviation)] of in-home RP were as follows: apnea-hypopnea index (AHI)/h: 3.4 (4.3); mean SpxO2: 97.3 (1.8); minimum SpxO2: 87.7 (10.3). In group 2, four recordings (4.5 %) were nonvalid. The mean age of the patients was 7.4 years (SD 3). The results of in-hospital RP were as follows: AHI/h: 4.45 (5.4); mean SpxO2: 96.8 (1.8); minimum SpxO2: 87 (11). No significant differences were found between the validity of in-home and in-hospital RP. Likewise, no significant differences were found between AHI/h, SpxO2 and in-home and in-hospital RP. CONCLUSION: In conclusion, in our sample, the diagnostic utility of in-home RP was equal to that of in-hospital RP. In-home RP allows the possibility of performing a more physiological sleep study and, by eliminating the cost of hospitalization, is more cost-efficient. Therefore, in-home RP is a valid and reliable technique for the diagnosis of childhood SAHS.

Rentabilidad de la poligrafía respiratoria del sueño realizada en el domicilio / Diagnostic utility of nocturnal in-home respiratory polygraphy

Introducción El síndrome de apneas-hipopneas del sueño (SAHS) es una entidad relativamente frecuente en niños. La polisomnografía es el patrón oro para el diagnóstico; sin embargo, dada la dificultad técnica y económica para realizarla, han surgido nuevas alternativas como la poligrafía respiratoria hospitalaria (PRH) y domiciliaria (PRD), que en niños con sospecha clínica de SAHS están obteniendo resultados satisfactorios. Objetivo El objetivo de nuestro estudio ha sido analizar en una muestra de niños y niñas, remitidos a consultas de Neumología Infantil por sospecha de apneas del sueño, ronquido o ambos, la rentabilidad de la PRD en el diagnóstico de SAHS. Material y métodos Se ha realizado anamnesis, exploración física, radiografía de tórax y cavum y poligrafía respiratoria (PR) del sueño en todos los casos. Se han analizado las variables cualitativas: lugar de realización, resultado, sexo, motivo de consulta, procedencia, consultas externas de otorrinolaringología (ORL) y tratamiento. Las variables cuantitativas han sido la edad, el número total apneas y de hipopneas, el índice de apneas hora, el índice de hipopneas hora, índice de apneas-hipopneas hora, saturación de oxígeno por pulsioximetría (SpxO2) medio y mínimo, número ronquidos e índice ronquidos hora. Se ha realizado análisis estadístico mediante chi cuadrado de Pearson y la t de Student. Se han estudiado 132 pacientes, 44 de ellos (33,3 %) mediante PRD (grupo 1) y 88 (66,6 %) mediante PRH (grupo 2). En el grupo 1, fueron estudios no válidos 2 (4,5 %) y la edad media fue de 8,3 años (desviación estándar [DE] 3,02). Resultados Los resultados de la PRD en medias y DE fueron: índice de apnea-hipopnea (IAH)/h 3,4 (4,3), SpxO2 media 97,3 (1,8) y SpxO2 mínima 87,7 (10,3). En el grupo 2 fueron estudios no válidos 4 (4,5 %) y la edad media fue de 7,4 años (DE 3). Los resultados de la PRH fueron: IAH/h 4,45 (5,4), SpxO2 media 96,8 (1,8) y SpxO2 mínima 87 (11). No se han encontrado diferencias significativas entre validez de la PR y lugar de realización de la prueba. Así mismo, tampoco se han encontrado diferencias entre edad, IAH/h, SpxO2 y lugar de realización de la PR. Conclusión Podemos decir que en nuestra muestra, la rentabilidad diagnóstica de la poligrafía respiratoria domiciliaria ha sido igual que la hospitalaria. Así mismo, ofrece la posibilidad de realizar un estudio más fisiológico del sueño y ofrece además una mayor rentabilidad económica, al eliminar el coste de hospitalización. Se trataría, por tanto, de una técnica diagnóstica válida y fiable para el diagnóstico de SAHS en la infancia

Introduction Sleep apnea-hypopnea syndrome (SAHS) is relatively frequent in children. The gold standard for diagnosis is polysomnography. However, because of technical difficulties and the cost of this method, new alternatives have become available, such as respiratory polygraphy (RP) performed at home or in hospital, which have provided satisfactory results in children with clinical suspicion of SAHS. Objective The aim of this study was to analyze the diagnostic utility of in-home RP in the diagnosis of SAHS in a sample of boys and girls referred to the pediatric respiratory care department for suspected sleep apnea, snoring, or both. Material and methods In all patients, a history and physical examination were performed; X-ray of the chest and cavum and RP were carried out. The following qualitative variables were analyzed: place where RP was performed, the result, sex, the reason for consulting, place of residence, results of otorhinolaryngological examination, and treatment. The quantitative variables analyzed were age, total number of apneas, total number of hypopneas, apnea index/hour, hypopnea index/hour, mean and minimum SpxO2, number of snores per hour and the snore index/hour. Statistical analysis was performed using Pearson's chi-square test and Student's t-test. Results A total of 132 patients were studied, 44 (33.3 %) through in-home RP (group 1) and 88 (66.6 %) through in-hospital RP (group 2). In group 1, two recordings (4.5 %) were considered nonvalid. The mean age of the patients was 8.3 years (SD 3.02). The results [means (standard deviation)] of in-home RP were as follows: apnea-hypopnea index (AHI)/h: 3.4 (4.3); mean SpxO2: 97.3 (1.8); minimum SpxO2: 87.7 (10.3). In group 2, four recordings (4.5 %) were nonvalid. The mean age of the patients was 7.4 years (SD 3). The results of in-hospital RP were as follows: AHI/h: 4.45 (5.4); mean SpxO2: 96.8 (1.8); minimum SpxO2: 87 (11). No significant differences were found between the validity of in-home and in-hospital RP. Likewise, no significant differences were found between AHI/h, SpxO2 and in-home and in-hospital RP. Conclusion In conclusion, in our sample, the diagnostic utility of in-home RP was equal to that of in-hospital RP. In-home RP allows the possibility of performing a more physiological sleep study and, by eliminating the cost of hospitalization, is more cost-efficient. Therefore, in-home RP is a valid and reliable technique for the diagnosis of childhood SAHS

[Obstructive sleep apnea-hypopnea syndrome]. / Síndrome de apneas-hipopneas obstructivas del sueño.

We analyzed a cohort of 400 patients referred from the otorhinolaryngology department (40.05 %), primary care (PC) (36.52 %), and the pediatric pulmonary unit (17.63 %). The children were referred for clinical suspicion of apneas in 191 (47.87 %), snoring and apneas in 101 (25 %), and snoring in 87 (21.80 %). Adenotonsillar hypertrophy was found in 211 patients (52.75 %), tonsillar hypertrophy in 87 (21.75 %), and adenoid hypertrophy in 73 (18.25 %). All patients underwent respiratory polygraphy (RP) during sleep. Obstructive sleep apnea-hypopnea syndrome (OSAHS) was diagnosed in 298 patients (74.5 %). OSAHS was mild in 96 patients (24 %), moderate in 148 (37 %), and severe in 54 (13.5 %). The results of RP expressed in means plus standard deviation were as follows: number of apneas 21.38 (24.47), number of hypopneas 19.81 (20.74), apnea-hypopnea index per hour (AHI/h) 5.29 (7.10), mean oxygen saturation 94.60 (11.80), minimal saturation 83.14 (13.45), number of snores 98.27 (254.55), and snoring index per hour 5.68 (6.5). Significant differences were found between oxygen saturation and AHI/h per hour. No differences were found among age, mean oxygen saturation, area of residence, reason for consulting, and AHI/h. Adenotonsillectomy was performed in 289 patients (72.25 %) of the initial cohort. In conclusion, OSAHS in childhood is frequent. RP during sleep aids diagnosis. The main cause of OSAHS in children is adenotonsillar hypertrophy.

[Current prevalence of asthma in schoolchildren in San Sebastián (Spain)]. / Prevalencia actual de asma en escolares en San Sebastián.

OBJECTIVE: To determine the current prevalence of asthma in children aged 6-12 years old in San Sebastian (Guipuzcoa, Spain). PATIENTS AND METHODS: An observational, cross sectional study was performed in 6-12-year-old children in schools. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was employed. Bronchial hyperresponsiveness was investigated using the free running test, with peak expiratory flow (PEF) measured with a peak flow meter as the main measurement. The ISAAC questionnaire (n = 919) was distributed to 460 boys (50.1%) and 459 girls (49.9%) with a mean age of 8 years (SD 1.87). The response rate to the questionnaire was 93 % (n = 855). Participation in the free running test was 90.8% (n = 835). A total of 89.88% of the children (n = 826) completed both tests. RESULTS: The questionnaire of symptoms and signs compatible with asthma revealed a current prevalence of asthma of 25.56% (n = 216) and a cumulative prevalence of 25.44% (n = 85). Nocturnal asthma was found in 29.37% (n = 47) and severe asthma in 9.27% (n = 14). Bronchial hyperresponsiveness was found in 23% of the participants. An epidemiological diagnosis of asthma (asthma-related symptoms plus bronchial hyperresponsiveness) was made in 6.54%. CONCLUSIONS: The current prevalence of asthma in 6-12-year-old schoolchildren in San Sebastian, determined through symptoms and signs compatible with asthma in the previous year and a positive free running test, is similar to that reported in other national studies.

[Severe primary congenital unilateral hydronephrosis. A review of 98 cases]. / Hidronefrosis congénita primaria unilateral grave en lactantes asintomáticos. Revisión de 98 casos.

INTRODUCTION: Currently, consensus is lacking on the indications for surgery in primary congenital unilateral hydronephrosis. OBJECTIVES: To analyze the clinical characteristics, treatment and outcome of severe asymptomatic primary congenital unilateral hydronephrosis (grades 3 and 4). PATIENTS AND METHODS: We performed a retrospective study of 98 neonates with severe primary congenital unilateral hydronephrosis. Diagnostic techniques consisted of ultrasound, renogram, and DMSA scan. RESULTS: The mean age at diagnosis was 24 days. The mean length of follow-up was 4 years. Forty-eight percent of cases were grade 3 and the remaining cases were grade 4. Fifty-six percent of the patients received conservative treatment. Forty-four percent underwent surgery. Surgical indications consisted of prolonged T1/2, reduced differential renal function and/or very severe hydronephrosis. The mean age at surgery was 5.5 months. In 94 % of the patients who received conservative treatment, hydronephrosis resolved spontaneously. In this group, renal parenchyma and renal function were normal in all patients except two. In 97 % of the patients who received surgical treatment, hydronephrosis was corrected or improved after pyeloplasty. At diagnosis, 19 kidneys had reduced function. In the postsurgical renogram, although T1/2 had markedly improved, 8 kidneys showed reduced function. DMSA performed in 63 patients belonging to both groups, outside the active phase of hydronephrosis, revealed 8 atrophic kidneys, 4 with moderately reduced renal size and function and 4 with scarring and normal renal size and function. During the study period, overall function was maintained in all patients and none developed hypertension. CONCLUSIONS: Severe congenital unilateral hydronephrosis resolves spontaneously in most patients. Consequently, clinicians increasingly adopt a conservative approach. The available diagnostic techniques cannot identify patients who will benefit from pyeloplasty. In general, accepted surgical indications are an increase in hydronephrosis and/or worsening of renal function. In our series, 15 % of the patients with hydronephrosis had an irreversible lesion of variable severity, which in some patients seemed to have developed during embryogenesis. Kidneys at risk of presenting a lesion were those that had grade 4 hydronephrosis.

Síndrome de apneas-hipopneas obstructivas del sueño / Obstructive sleep apnea-hypopnea syndrome

Se ha analizado una cohorte de 400 pacientes remitidos desde consultas de otorrinolaringología (ORL) (40,05 %), de atención primaria (AP) (36,52 %) y de la unidad de neumología infantil (UNI) (17,63 %). El motivo de consulta fue la sospecha clínica de apneas en 191 pacientes (47,87 %), ronquido y apneas en 101 (25 %) y ronquido en 87 (21,80 %). En 211 casos (52,75 %) se constató hipertrofia adenoamigdalar, en 87 (21,75 %) hipertrofia amigdalar y en 73 (18,25 %) hipertrofia adenoidea. En todos los casos se realizó poligrafía respiratoria del sueño (PR) y se diagnosticó síndrome de apneas-hipopneas obstructivas del sueño (SAHOS) en 298 casos (74,5 %), distribuido en leve en 96 casos (24 %), moderado en 148 casos (37 %) y grave en otros 54 casos (13,5 %). Los resultados de la PR del sueño expresados en medias y desviación estándar fueron los siguientes: número de apneas 21,38 (24,47); número de hipopneas 19,81 (20,74); índice de apneas-hipopneas por hora 5,29 (7,10); saturación media de oxígeno 94,60 (11,80); saturación mínima 83,14 (13,45); número de ronquidos 98,27 (254,55) e índice de ronquidos por hora 5,68 (6,5). Se han encontrado diferencias significativas entre saturación de oxígeno y el índice de apneas e hipopneas por hora. No se han encontrado diferencias entre edad, saturación media, procedencia, motivo de consulta e índice de apneas e hipopneas por hora. Se realizó adenoamigdalectomía en 289 casos (72,25 %) de la cohorte inicial. En conclusión, el SAHOS en la infancia es una patología frecuente, el estudio mediante poligrafía respiratoria del sueño facilita el diagnóstico y la hipertrofia adenoamigdalar es la principal causa de SAHOS en niños

We analyzed a cohort of 400 patients referred from the otorhinolaryngology department (40.05 %), primary care (PC) (36.52 %), and the pediatric pulmonary unit (17.63 %). The children were referred for clinical suspicion of apneas in 191 (47.87 %), snoring and apneas in 101 (25 %), and snoring in 87 (21.80 %). Adenotonsillar hypertrophy was found in 211 patients (52.75 %), tonsillar hypertrophy in 87 (21.75 %), and adenoid hypertrophy in 73 (18.25 %). All patients underwent respiratory polygraphy (RP) during sleep. Obstructive sleep apnea-hypopnea syndrome (OSAHS) was diagnosed in 298 patients (74.5 %). OSAHS was mild in 96 patients (24 %), moderate in 148 (37 %), and severe in 54 (13.5 %). The results of RP expressed in means plus standard deviation were as follows: number of apneas 21.38 (24.47), number of hypopneas 19.81 (20.74), apnea-hypopnea index per hour (AHI/h) 5.29 (7.10), mean oxygen saturation 94.60 (11.80), minimal saturation 83.14 (13.45), number of snores 98.27 (254.55), and snoring index per hour 5.68 (6.5). Significant differences were found between oxygen saturation and AHI/h per hour. No differences were found among age, mean oxygen saturation, area of residence, reason for consulting, and AHI/h. Adenotonsillectomy was performed in 289 patients (72.25 %) of the initial cohort. In conclusion, OSAHS in childhood is frequent. RP during sleep aids diagnosis. The main cause of OSAHS in children is adenotonsillar hypertrophy

[Agreement between tracheal auscultation and pulmonary function in methacholine bronchial inhalation challenge in asthmatic children]. / Medida de la respuesta bronquial a la metacolina en niños asmáticos mediante la auscultación traqueal.

BACKGROUND: PC wheezing (PCw) is defined as the concentration of methacholine at which wheeze is detected on auscultation of the trachea. PCw has been suggested as a measure of bronchial hyperresponsiveness in methacholine challenge testing (MCT). OBJECTIVE: The aim of this study was to determine the agreement between the concentration of methacholine that produces a 20 % decrease in forced expiratory volume in 1 second (FEV1) (PC20) and PCw in MCT in asthmatic children. PATIENTS AND METHODS: Eighteen asthmatic children with a mean age of 11.5 years (range: 6-16 years) were studied. Fifteen of the children were under treatment with inhaled glucocorticoids. MCT was performed according to the guidelines of the American Thoracic Society (1999) using a Hudson nebulizer calibrated to obtain a mean output of 0.14 ml/min. After each nebulization, two independent observers registered FEV1 and tracheal auscultation. FEV1 was determined by forced spirometry 30 and 90 seconds after the end of nebulization and PC20 was registered (exponential model). Respiratory rate and transcutaneous oxygen saturation were continuously monitored. Tracheal auscultation was performed at 0, 60 and 120 seconds after the end of nebulization. The end point was defined as the appearance of wheezing over the trachea. The values of PC20 and PCw, as well as the concentration of methacholine corresponding to a decrease in FEV1 equal to or higher than 20 %, were compared using Student's matched pairs-test and Wilcoxon's test. The degree of agreement between variables was compared by using Bland-Altman's test. RESULTS: MCT was positive in 17 of 18 patients. No differences were found between PC20 and PCw (p 0.15). Both variables showed agreement in 12 of 17. A clear association was found between both measures (log PCw, log PC20): R: 0.92; p < 0.001. The mean decrease in FEV1 on reaching PCw was 24.8 % (range: 10-41). No adverse effects were observed. CONCLUSION: The agreement between PC20 and PCw in MCT in asthmatic children is excellent. PCw could be helpful in determining bronchial hyperresponsiveness in young asthmatic children in whom spirometry is not feasible.