Tratamiento de mantenimiento: luces y sombras / No disponible

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[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.

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

[Pediatric palliative care: a comprehensive model of care for children with life-threatening conditions and their families]. / Los cuidados paliativos: un modelo de atención integral al niño gravemente enfermo y a su familia.

The present article reviews aspects unique to pediatric palliative care: the attitudes of medical staff toward pediatric death and life-threatening conditions, distinct patterns of pediatric deaths, the causes of suffering in children with life-threatening conditions and their families, and the features that make palliative care a challenge for children, families, medical staff and society. Concepts of pediatric palliative care and various approaches are described. In addition, Universal Principles of Pediatric Palliative Care are presented. Special attention is paid to approaches that start palliative care at diagnosis of a life-threatening conditions, do not require a short-term life prognosis and do not exclude curative or life-prolonging therapies since these approaches can benefit both children who survive life-threatening conditions and those who die, as well as their families. The need for certain changes through education and research is proposed to improve the quality of life of children and families who currently suffer, satisfaction and cohesion among medical staff, and healthcare quality.

Los cuidados paliativos: un modelo de atención integral al niño gravemente enfermo y a su familia / Pediatric palliative care: a comprehensive model of care for children with life-threatening conditions and their families

En este artículo se exponen aspectos como la importancia de las actitudes del personal sanitario ante la muerte y la enfermedad grave del niño, las diferentes trayectorias de la muerte pediátrica, las razones por las que niños con enfermedades que amenazan su vida y sus familias sufren y las características que hacen de los cuidados paliativos un desafío para niños, familias, personal sanitario y la sociedad. Se definen los conceptos de cuidados paliativos pediátricos y se describen diferentes enfoques, además de exponer los principios universales de estos servicios. Se presta especial atención a los modelos que apoyan el inicio de los cuidados paliativos en el diagnóstico de la enfermedad grave, que no requieren un pronóstico de vida a corto plazo, y que no excluyen tratamientos curativos o que prolonguen la vida, ya que estos enfoques pueden beneficiar a los niños que sobreviven condiciones médicas graves, así como a los que fallecen y sus familias. Se propone la necesidad de ciertos cambios mediante educación e investigación para mejorar la calidad de vida de niños y las familias que actualmente sufren, la satisfacción y cohesión del personal sanitario y la calidad de los servicios asistenciales (AU)

Diagnóstico y terapéutica del asma en la infancia. Introducción / No disponible

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Diagnóstico y terapéutica del asma en la infancia. Conclusiones / No disponible

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Análisis de la repercusión de a través del Science Citation Index durante el período 1997-2001 / Analysis of the impact of Anales Españoles de Pediatría through the science citation index from 1997-2000

Objetivos: Describir el factor de impacto de ANALES ESPAÑOLES DE PEDIATRÍA desde el año 1997 hasta el 2001 e identificar los patrones de citación de la revista y las áreas temáticas de mayor repercusión. Métodos: Se recopilaron las citas recibidas en los artículos publicados en ANALES ESPAÑOLES DE PEDIATRÍA entre 1995 y 2000 mediante una búsqueda en SCISEARCH. De cada artículo fuente se recogieron las siguientes variables: año de publicación, autores, revista, país de publicación, idioma, especialidad/es, institución/es, residencia del primer firmante y área temática. El factor de impacto se calculó como el cociente entre las citas recibidas en 1 año por los artículos publicados en ANALES ESPAÑOLES DE PEDIATRÍA los 2 años anteriores entre el total de artículos publicados por ANALES ESPAÑOLES DE PEDIATRÍA en esos 2 años. Resultados: El factor de impacto de ANALES ESPAÑOLES DE PEDIATRÍA fue 0,052 en 1997, 0,080 en 1998, 0,101 en 1999, 0,089 en 2000 y 0,064 en 2001. Se aprecia un patrón de citaciones caracterizado por la dispersión de las revistas fuente, con una mayor proporción de las revistas nacionales de especialidades médicas (35,6%). El 62,8% de las citas recibidas procedían de autores españoles, aunque el índice de autocitación fue moderado (14,3%). Destaca una hegemonía de las áreas temáticas de neurología (16,9% de las citas recibidas), enfermedades infecciosas (16,2%) y neonatología (14,8%). Conclusión: ANALES ESPAÑOLES DE PEDIATRÍA posee un factor de impacto discreto, aunque superior al de otras publicaciones biomédicas incluidas en el Journal Citation Reports (AU)

[Analysis of the impact of Anales Españoles de Pediatría through the Science Citation Index from 1997-2000]. / Análisis de la repercusión de Anales Españoles de Pediatría a través del Science Citation Index durante el período 1997-2001.

OBJECTIVES: To quantify the impact factor of Anales Españoles de Pediatría from 1997 until 2000 and to identify the journal's citation patterns and the topics with the greatest impact. METHODS: SCISEARCH was used to locate citations of articles published in Anales Españoles de Pediatría between 1995 and 1999. The following data were collected for each article: year of publication, authors, journal, country of publication, language, specialty or specialties, institution(s), residence of the first author and topic. The impact factor was calculated as the ratio between citations received over 1 year by articles published in Anales Españoles de Pediatría in the two previous years and the total number of articles published by Anales Españoles de Pediatría over the 2 years under study. RESULTS: The impact factor of Anales Españoles de Pediatría was 0.052 in 1997, 0.080 in 1998, 0.101 in 1999, 0.089 in 2000 and 0.064 in 2001. Citations were found in a wide range of source journals. The greatest proportion (35.6 %) were found in Spanish medical journals. Citations were made mainly by Spanish authors (62.8 %) and self-citation was moderate (14.3 %). Topics related to neurology (16.9 % of the citations received), infectious diseases (16.2 %) and neonatology (14.8 %) had the greatest impact. CONCLUSION: The impact factor of Anales Españoles de Pediatria is modest, although higher than that of some other biomedical publications included in Journal Citation Reports.

[Cut-off point for a positive bronchodilation test]. / Cuándo se considera positivo el test de broncodilatación.

OBJECTIVE: To determine bronchodilation in healthy children aged 7-14 years in order to establish the value defining a positive bronchodilation test. PATIENTS AND METHODS: We performed a cross-sectional study in healthy, nonsmoking schoolchildren aged 7-14 years in the city of Huesca (Spain). The sample (n 145) was representative of the pediatric population aged 7-14 years (N 4,272). Health was determined through a validated questionnaire. Expired carbon monoxide was measured with a Micro III Smokerlyzer EC50(R). Forced basal and post-bronchodilation spirometry (0.2 mg of inhaled salbutamol with a Babyhaler(R) chamber) was performed with a Vitalograph spirometer mod. 2120(R). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, forced expiratory flow at 24-25 % of forced vital capacity (FEF25-75 %) and peak expiratory flow (PEF) were measured. To establish whether increments in the variables followed normal distribution, the Kolmogorov-Smirnov test (Lilliefors modification) and histograms were used. The relationship between increases in FEV1 and the variables in the questionnaire was analyzed using Student's t-test (qualitative variables) and Pearson's correlation (quantitative variables). To evaluate the reliability of the test, Spearman's non-parametric correlation coefficient and dispersion graphs were used. RESULTS: The percentage increase in FEV1 compared with the theoretical value was: mean (SD), 3.97 (2.65); 95 % percentile, 8.87 %; and 97.5 percentile, 10.25 %. The percentage increase in FEV1 compared with the previous value was: mean: 3.99 (2.63), 95-percentile: 8.43 %; and 97.5 percentile: 10.14 %. CONCLUSIONS: In children aged 7-14 years, increases of greater than 9 % above the theoretical or previous FEV1 value define the bronchodilation test as positive.

Cuándo se considera positivo el test de broncodilatación / Cut-off point for a positive bronchodilation test

Objetivo: Determinar la broncodilatación que se produce en la población normal de 7 a 14 años de edad, para establecer el valor que define una prueba de broncodilatación como positiva. Pacientes y métodos. Estudio transversal en niños sanos, no fumadores, realizado en ámbito escolar en la ciudad de Huesca en una muestra representativa (n 145) de la población infantil de 7 a 14 años (N 4.272). Se identificó salud mediante encuesta validada. Se monitorizó el monóxido de carbono (CO) espirado con un Micro III Smokerlyzer EC50. La espirometría forzada basal y posbroncodilatación (salbutamol inhalado, 0,2 mg con cámara Babyhaler) se realizaron con un espirómetro Vitalograph mod. 2120. Se midieron las variables capacidad vital forzada (FVC), volumen espiratorio máximo en el primer segundo (FEV1), FEV1/FVC, flujo espiratorio máximo entre el 25-75% de la FVC (FEF25-75) y pico espiratorio máximo (PEF). Para establecer si los incrementos de los parámetros seguían o no una distribución normal, se utilizó el contraste de Kolmogorov-Smirnov (modificación Lilliefors) y los histogramas. La relación entre el incremento de FEV1 y las variables del cuestionario se establecieron con el test de la t de Student (variables cualitativas) y la prueba de correlación de Pearson (variables cuantitativas). Para evaluar la fiabilidad del test se empleó el coeficiente de correlación no paramétrico de Spearman y los gráficos de dispersión. Resultados: Incremento porcentual de FEV1 respecto al valor teórico: media (desviación estándar [DE]), 3,97 (2,65); percentil (P) P95, 8,87% y P97,5, 10,25%. Incremento porcentual de FEV1 respecto al valor previo: media, 3,99 (2,63): P95, 8,43%, y P97,5, 10,14%. Conclusiones: En niños de 7 a 14 años de edad, los incrementos porcentuales sobre el valor teórico o sobre el previo del FEV1 superiores al 9 por ciento definen la prueba de broncodilatación como positiva (AU)

[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.

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

Antecedentes: La PC wheezing (PCw) o concentración de metacolina que provoca sibilancias auscultables en tráquea parece ser un parámetro válido de la respuesta bronquial mediante el test de metacolina (TMCh). Objetivo: Evaluar la concordancia entre la concentración de metacolina que produce un descenso del 20% del volumen espiratorio máximo al primer segundo (FEV1, PC20) y PCw en el TMCh en niños asmáticos colaboradores. Pacientes y métodos: Se estudian 18 niños asmáticos de edad media 11,5 (límites, 6-16) años, 15/18 en tratamiento con glucocorticoides inhalados. Se realizó el TMCh según las normas de la American Thoracic Society (ATS) (1999) utilizando un nebulizador Hudson calibrado para obtener un débito de 0,14 ml/min. Tras cada nebulización, dos observadores independientes registraron el FEV1 y la auscultación traqueal. El FEV1 se determinó mediante espirometría forzada a los 30 y 90 s posnebulización y la PC20 por interpolación exponencial. Se monitorizaron de forma continua la frecuencia respiratoria y la saturación transcutánea de oxígeno. La tráquea se auscultó los 0, 60 y 120 s posnebulización. La prueba se consideró positiva al auscultar sibilancias sobre la tráquea. Se compararon los valores de PC20 y PCw, así como la concentración de metacolina correspondiente al descenso del FEV1 igual o superior al 20% con la PCw, mediante el test de la t de Student pareada y la prueba de Wilcoxon, y el grado de acuerdo de dichas variables con el test de Bland-Altman. Resultados: El TMCh fue positivo en 17/18 pacientes, sin diferencias entre PC20 y PCw (p 0,15). Ambos parámetros coincidieron en 12/17 casos. Hay una asociación evidente entre ambas medidas (log PCw, log PC20): R, 0,92; p < 0,001. El descenso medio del FEV1 al alcanzar la PCw fue del 24,8% (rango, 10-41). No se objetivaron efectos adversos en ningún caso. Conclusión: La concordancia entre PCw y PC20 en el TMCh en niños asmáticos colaboradores es excelente, y la PCw podría evaluar la hiperreactividad bronquial en el niño no colaborador (AU)

[Acute bronchiolitis: fundamentals of a rational protocol]. / Bronquiolitis aguda: bases para un protocolo racional.

Bronchiolitis is the most frequent respiratory tract disease in the first 2 years of life. It occurs in epidemics in winter and spring. Etiology is viral and the most frequent causative agent is respiratory syncytial virus. In most patients the disease is benign and self-limiting and only occasionally requires hospitalization. In daily clinical practice, one of the problems most frequently faced by the pediatrician is the lack of agreement on the correct pharmacological treatment of bronchiolitis, as well as the absence of simple, or standardized, clinical scores with which to diagnose severity. The present study provides a review of the medical literature on the most commonly used clinical scores and the therapeutic efficacy of the different drugs employed. A protocol for the practical management of bronchiolitis is provided. The use of inhaled adrenaline in the treatment of moderate-to-severe bronchiolitis in hospitalized infants, as well as oxygen and fluid therapy as support measures, are recommended.

[Idiopathic purpura fulminans with transient protein S deficiency]. / Púrpura fulminante idiopática con déficit transitorio de proteína S.

Idiopathic purpura fulminans produces rapidly progressive hemorrhagic necrosis of the skin with disseminated intravascular coagulation in individuals without known abnormalities of the protein C pathway or acute infections. The disease mainly affects children and in 90 % of cases is preceded by a benign infection. Its pathogenesis involves a temporary autoimmune protein S deficiency that provokes a state of hypercoagulability. We present the case of a previously healthy 2-year-old boy with hemorrhagic skin lesions characteristic of purpura fulminans and disseminated intravascular coagulation without sepsis. Severe, temporary protein S deficiency was confirmed. The patient received daily replacement therapy with fresh frozen plasma for 12 days and anticoagulation with heparin for 3 months. Evolution was favorable. Although the other parameters returned to normal, protein S remained low for 50 days despite treatment. The patient has made a complete recovery.