Sección de Endocrinología Pediátrica del Hospital General Universitario Gregorio Marañón. Unidad de seguimiento de endocrinopatías del plan de detección precoz de la Comunidad Autónoma de Madrid (CAM) / Pediatric Endocrinology Section of the Hospital General Universitario Gregorio Marañón. Monitoring unit of endocrine disorders early detection program of the Regional Community of Madrid (RCM)

La Sección de Endocrinología Pediátrica se caracteriza por una Cartera de Servicios completa en esta patología y por ser la única Unidad de Seguimiento de Endocrinopatías del Plan de Detección Precoz de Endocrinopatías de la Comunidad Autónoma de Madrid. Enmarcada en el Servicio de Pediatría, Hospital Materno—Infantil del Hospital General Universitario Gregorio Marañón, dispone de una larga trayectoria con profesionales altamente cualificados y ha sido reconocida como Unidad de referencia y prestigio por los trabajos clínicos, docentes v de investigación desarrollados tanto a nivel nacional como internacional (AU)

The Paediatric Endocrinology Section is characterized by a complete portfolio of the speciality and for being the only Unit of Precocious Diagnosis and Treatment of Endocrinopathies, Screening Plan of Endocrine and Metabolic Disorders of the Autonomous Community of Madrid. Included in the Department of Paediatrics, General University Hospital Gregorio Marañon, it has a long history with highly qualified professionals and has been recognized as reference and prestigious unit for clinical work, educational work and clinical research developed at national and international level (AU)

Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias / Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments

OBJETIVOS: Identificar precozmente y analizar las características de pacientes que precisan ingreso por bronquiolitis moderada o grave que cumplen criterios urinarios de SIADH. PACIENTES Y MÉTODOS: Estudio prospectivo observacional, realizado entre octubre de 2012-marzo de 2013 en urgencias pediátricas. Se incluyen menores de 12 meses con bronquiolitis moderada o grave que requieren ingreso. Se consideran criterios urinarios de SIADH: sodio urinario≥40mmol/l, osmolaridad urinaria>500 mOsm/kg y densidad urinaria>1.020g/l. Se recogen variables epidemiológicas y clínicas y se comparan 2 grupos definidos por cumplir o no criterios urinarios de SIADH. RESULTADOS: Se incluyen 126 pacientes con bronquiolitis moderada, 23 (18,6%) cumplen criterios urinarios de SIADH, ninguno grave ni menor de un mes. Los pacientes con criterios urinarios de SIADH tienen mayor incidencia de neumonía y/o atelectasia en la radiografía de tórax (21,7% vs. 1,9%; p = 0,002), peor respuesta al tratamiento con adrenalina (69,5% vs. 28,1%; p = 0,016), mayor asistencia respiratoria: oxigenoterapia de alto flujo (17,4% vs. 7,7%; p = 0,016) y ventilación mecánica no invasiva (13% vs. 5,8%; p = 0,034). Requieren más días oxigenoterapia (p = 0,02) y tratamiento broncodilatador (p = 0,04) y mayor ingreso en cuidados intensivos pediátricos (26,1% vs. 6,8%; p = 0,007). CONCLUSIONES: Los pacientes mayores de 1 mes con bronquiolitis moderada y con criterios urinarios de SIADH tienen peor evolución respiratoria, mayor necesidad de soporte respiratorio, ingreso en UCIP y más alteraciones radiográficas. Por ello recomendamos realizar determinaciones de orina a estos pacientes para detectar precozmente el desarrollo de SIADH y cuidar el manejo hidroelectrolítico, previniendo el desarrollo de complicaciones potencialmente graves

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities

[Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments]. / Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias.

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities.

Psoriasis inducida por infliximab en una adolescente con colitis ulcerosa / Infliximab-induced psoriasis in an adolescent with ulcerative colitis

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