[Tetany secondary to deficiency rickets]. / Tetania secundaria a raquitismo carencial.

Hypocalcemia is an uncommon illness in children. In developed countries the incidence of rickets has decreased significantly, although last years this pathology is increasing at the expense of immigration. Its etiology is due to different factors such as low sun exposure, inadequate clothing and bad feeding and excessive contributions in phytates, exclusive breastfeeding and genetic factors. We report a case of a teenager 13 year old from Pakistan, who consulted for myoclonus, paresthesias, hand midwife and asymmetry walking. The laboratory emphasizes hypocalcemia deficit of 25 (OH) D and increased parathyroid hormone. Administration of calcium and vitamin D along with changes in his diet normalized clinical and laboratory parameters. Due to increased migration, the lack of sun exposure and inadequate supply this disease which was almost forgotten will appear another time.

[Final size attained in type 1 diabetes children]. / Talla final en diabéticos tipo 1 diagnosticados en la edad pediátrica.

OBJECTIVE: To describe the final height and height-gain in relation to target height, in children with type 1 diabetes mellitus, and analyse their relationship to different variables. PATIENTS AND METHODS: Retrospective analysis of the growth data of 52 children (27 girls) diagnosed with type 1 diabetes mellitus before 14 years old, and followed up until their final height was attained. MAIN VARIABLES: final height, target height, illness duration, glycated haemoglobin (HbA1c), insulin dose, BMI, and other autoimmune diseases. RESULTS: The height SDS (standard deviation scale) at diagnosis was slightly higher (0.734 in boys and 0.563 in girls). During the development of the disease, a growth reduction was seen, which was significantly higher in boys of prepubertal age (p = 0.016). The mean final height attained was 173.14 +/- 5.28 cm in boys and 161.9 +/- 6.97 cm in girls. Height gain was 1.56 +/- 3.66 in boys (SDS = -0.034) and 2.26 +/- 6.13 in girls (SDS = 0.385). The only variable significantly related to height gain was mean glycated-haemoglobin (growth reduction of 2 cm for every increment of 1% in mean glycated-haemoglobin). CONCLUSIONS: At onset, diabetic children were slightly taller than the general population. A growth reduction was shown as the disease developed, significantly higher in boys of prepubertal age. The final height in boys was slightly lower than the mean, but in girls was similar to the general population. Both sexes attained their target height, although the height gain was less in boys. Poorer metabolic control was associated with reduced height gain.

Talla final en diabéticos tipo 1 diagnosticados en la edad pediátrica / Final size attained in type 1 diabetes children

Objetivo: describir la talla final y la ganancia sobre la talla diana, en un grupo de niños diabéticos tipo 1 y analizar su relación con distintas variables. Pacientes y métodos: estudio retrospectivo de 52 pacientes (27 mujeres) diagnosticados de diabetes tipo 1 antes de los 14 años y seguidos hasta la talla final. Variables principales: talla final, talla diana, tiempo de evolución de la diabetes, glucohemoglobina (HbA1c) media, requerimiento insulínico, índice de masa corporal, enfermedades autoinmunes asociadas. Resultados: al inicio de la diabetes la escala de desviación estándar (EDE) de talla se encontraba ligeramente por encima de la media (0,734 en varones y 0,563 en mujeres). A lo largo de la evolución se produce un pérdida de talla generalizada, más acusada en varones en etapa prepuberal (p=0,016). La talla final alcanzada fue 173,14±5,28cm en varones (EDE=−0,034) y 161,9±6,97cm en mujeres (EDE=0,385). La ganancia de talla fue 1,56±3,66cm en varones y 2,26±6,13cm en mujeres. La única variable relevante relacionada significativamente con la ganancia de talla fue la HbA1c media (pérdida de 2cm por cada aumento del 1% de HbA1c media a igualdad del resto de las variables). Conclusiones: nuestros resultados indican que, aunque al inicio de la diabetes los niños tienen una talla algo mayor que la de la población de referencia, se produce una pérdida de talla durante la evolución de la enfermedad, más acusada en varones en periodo prepuberal. Ello produce que la talla final de los varones se encuentre ligeramente por debajo de la media, mientras que las mujeres alcanzan una talla final similar a la de la población de referencia. Ambos sexos alcanzaron su talla diana, pero en varones la ganancia sobre ésta fue escasa. El mal control metabólico se relacionó con la menor ganancia de talla en niños diabéticos (AU)

Objective: To describe the final height and height-gain in relation to target height, in children with type 1 diabetes mellitus, and analyse their relationship to different variables. Patients and methods: Retrospective analysis of the growth data of 52 children (27 girls) diagnosed with type 1 diabetes mellitus before 14 years old, and followed up until their final height was attained. Main variables: final height, target height, illness duration, glycated haemoglobin (HbA1c), insulin dose, BMI, and other autoimmune diseases. Results: The height SDS (standard deviation scale) at diagnosis was slightly higher (0.734 in boys and 0.563 in girls). During the development of the disease, a growth reduction was seen, which was significantly higher in boys of prepubertal age (p=0.016). The mean final height attained was 173.14±5.28cm in boys and 161.9±6.97cm in girls. Height gain was 1.56±3.66 in boys (SDS=−0.034) and 2.26±6.13 in girls (SDS=0.385). The only variable significantly related to height gain was mean glycated-haemoglobin (growth reduction of 2cm for every increment of 1% in mean glycated-haemoglobin). Conclusions: At onset, diabetic children were slightly taller than the general population. A growth reduction was shown as the disease developed, significantly higher in boys of prepubertal age. The final height in boys was slightly lower than the mean, but in girls was similar to the general population. Both sexes attained their target height, although the height gain was less in boys. Poorer metabolic control was associated with reduced height gain (AU)

[Family impact of rotavirus gastroenteritis in children under two years]. / Impacto familiar de la gastroenteritis por rotavirus en menores de dos años.

INTRODUCTION: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. MATERIAL AND METHODS: Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. RESULTS: Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. CONCLUSION: AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.

Utilidad del Pediatric Appropriateness Evaluation Protocol para detectar deficiencias de circuitos asistenciales hospitalarios / Utility of the pediatric appropriateness evaluation protocol (pAEP) to detect deficiencies in the healthcre circuit

Objetivos Cuantificar el porcentaje de ingresos inadecuados según el Pediatric Appropriateness Evaluation Protocol (pAEP), sus causas, la utilidad clínica del pAEP y detectar deficiencias en los circuitos asistenciales en los pacientes pediátricos hospitalizados.Material y métodos Estudio descriptivo, prospectivo de 236 pacientes hospitalizados en el Servicio de Pediatría. Entre las variables analizadas destacan: edad del paciente, protocolo pAEP, causas de ingresos inadecuados, diagnóstico principal y secundario al ingreso del paciente, prueba diagnóstica motivo del ingreso, día de la semana y mes del ingreso.Resultados El 13,6 por ciento (IC 95 por ciento, 9,5-18 por ciento) de las hospitalizaciones pediátricas son inadecuadas según el protocolo pAEP. Las causas de ingresos inadecuados son: pruebas diagnósticas (2,5 por ciento de los ingresos pediátricos) y tratamientos (11 por ciento de los ingresos pediátricos) que podrían haberse realizado como paciente externo. El 90,6 por ciento de los ingresos inadecuados según el pAEP también son considerados inadecuados cuando son evaluados por pediatras expertos.Conclusiones Observamos deficiencias en los circuitos asistenciales cuya mejora podría disminuir el porcentaje de ingresos inadecuados (mayor coordinación atención primaria y hospitalizada y mejor accesibilidad desde urgencias a consultas externas especializadas pediátricas). Para mejorar la calidad en la asistencia pediátrica, el pAEP nos permite identificar ingresos inapropiados y sus causas, así como detectar deficiencias en los circuitos asistenciales (AU)

[Utility of the Pediatric Appropriateness Evaluation Protocol (pAEP) to detect deficiencies in the healthcare circuit]. / Utilidad del Pediatric Appropriateness Evaluation Protocol para detectar deficiencias de circuitos asistenciales hospitalarios.

OBJECTIVES: To quantify the number of inappropriate pediatric hospital admissions using the Pediatric Appropriateness Evaluation Protocol (pAEP), the causes of inappropriate admissions, and the clinical utility of the paep, as well as to detect deficiencies in the healthcare circuit in hospitalized pediatric patients. MATERIAL AND METHODS: A prospective, descriptive study was carried out in a sample of 236 pediatric admissions. We analyzed several items such as age, pAEP, factors associated with inappropriate admission, main and secondary diagnoses, the diagnostic tests motivating admission, and day of the week and month of admission. RESULTS: A total of 13.6 % (CI: 9.5 %-18 %) of pediatric admissions were inappropriate. The most frequent reasons for inappropriate admissions were diagnostic tests (2.5 %) and treatment (11 %) that could have been performed on an outpatient basis. Most (90.6 %) of the admissions deemed inappropriate by the pAEP were also considered inappropriate when evaluated by experienced pediatricians. CONCLUSIONS: Improvement of healthcare circuits could decrease inappropriate admissions (better coordination between primary care and hospitals and improved access from the emergency unit to the specialized pediatric outpatient service). The pAEP allows identification of inappropriate admissions and their causes, as well as detection of deficiencies in the healthcare circuit.