Fórmulas especiales / Special formulas

Las fórmulas especiales se utilizan como tratamiento nutricional en situaciones de intolerancia y/o alergia a los componentes de las leches infantiles. Dentro de las fórmulas modificadas en hidratos de carbono, el tipo más frecuentemente utilizado es la leche sin lactosa, sobre todo en casos de intolerancia a esta azúcar secundaria a lesión de la mucosa intestinal. Dado que las fórmulas de soja contienen una proteína no láctea y carecen de lactosa, son las indicadas en la galactosemia. Las fórmulas modificadas en proteínas se utilizan principalmente en cuadros de alergia e intolerancia a proteínas de leche de vaca. Dentro de este grupo están los hidrolizados de alto grado de proteínas de la leche de vaca, las fórmulas elementales y las fórmulas de soja. Estas últimas están indicadas en casos de alergia a las proteínas de la leche de vaca (APLV) de manifestación no digestiva en lactantes mayores de 6 meses de edad. Las fórmulas elementales se utilizan en casos graves de alergia a las PLV que no responden a los hidrolizados de alto grado, frecuentemente en el contexto de múltiples alergias alimentarias, o en casos de daño intestinal grave. Los hidrolizados de proteínas de bajo grado están contraindicados en los cuadros de alergia o intolerancia a las PLV. Las fórmulas antirreflujo deben ser utilizadas sólo en niños seleccionados cuya ganancia ponderal se vea comprometida por las pérdidas de nutrientes asociadas a las regurgitaciones (AU)

Special formulas are used for nutritional treatment in situations of intolerance and/or allergy to components of infant formula. Lactose-free infant formula is mainly used for intolerance to this carbohydrate associated to intestinal mucosa injury. Because soy formulas are lactose-free, they are appropiate for use in infants with galactosemia. Formulas with modified proteins are the most commonly used for infants with cow’s milk allergy or cow’s milk intolerance. The main types of this group are: extensively hydrolyzed formula, soy-based formula and free aminoacid-based formula. Soy formulas are indicated in infants older than 6 month with extra-intestinal symptoms. Free aminoacid-based formula are indicated in more severe cases of milk protein, multiple food allergies resistant to extensively hydrolyzed formula therapy and in cases of severe intestinal damage Partially hydrolyzed formulas are not recommended in infants with cow ́s milk protein allergy. Antiregurgitation formula should be used only in selected infants with failure to thrive caused by excessive nutrient losses associated with regurgitation (AU)

Fístula traqueoesofágica secundaria a cuerpo extraño / Tracheoesophageal fistula secondary to foreing body

Se presenta el caso de un niño de 4 años con una fístula traqueoesofágica adquirida, una entidad rara en la edad pediátrica. Se comenta el tratamiento de dicha entidad y se efectúa una revisión de la bibliografía (AU)

Coma en un lactante por intoxicación con "cannabis" / Coma in an infant due tu "cannabis" poisoning

La intoxicación por cannabis en niños es rara. Presentamos el caso de un lactante de 12 meses de edad que fue llevado al servicio de Urgencias en estado de coma. Finalmente, se demostró que la causa del coma era una intoxicación por cannabis. Se revisan aquí las intoxicaciones comunicadas en la bibliografía médica, así como el manejo de dicha entidad (AU)

Gastroenteritis aguda nosocomial e infección asintomática por rotavirus y astrovirus en niños hospitalizados / Nosocomial gastroenteritis and asymptomatic rotavirus and astrovirus infection in hospitalized children

Antecedentes: La gastroenteritis nosocomial es un problema frecuente en las unidades de hospitalización pediátricas, donde el 20-50 por ciento de los episodios por rotavirus y astrovirus son de origen nosocomial. Objetivo: Describir en nuestro medio la incidencia de gastroenteritis nosocomial por rotavirus y astrovirus y de eliminación fecal asintomática de estos virus e identificar los serotipos G de los rotavirus detectados. Métodos: Estudio prospectivo de los niños ingresados durante un año en la unidad de lactantes con seguimiento de la aparición de síntomas de gastroenteritis y estudio periódico de heces para detección de antígeno de rotavirus y de astrovirus por enzimoinmunoanálisis (EIA). En los pacientes con gastroenteritis se realizó también coprocultivo, estudio de adenovirus por EIA y de calicivirus por reacción en cadena de la polimerasa (PCR) y análisis de los serotipos G de los rotavirus por EIA con anticuerpos monoclonales. Resultados: De los 666 niños ingresados sin diarrea, 60 presentaron gastroenteritis nosocomial (9/100 pacientes ingresados y 1,75 por 100 días de estancia hospitalaria): rotavirus en 34 casos (5/100 pacientes) y astrovirus en 2 (0,3/100 pacientes). En 27 pacientes de los 329 estudiados sin diarrea se detectó eliminación viral: rotavirus en 23 pacientes y astrovirus en cuatro; en 13 (4 por ciento) en el ingreso y en 14 (4,2 por ciento) pasadas 72 h (infección nosocomial asintomática). No hubo diferencia en los serotipos G detectados entre los casos de gastroenteritis nosocomial y los de origen comunitario. Conclusiones: Se confirma la importancia de la etiología viral en la gastroenteritis nosocomial y se valora la eliminación fecal asintomática de rotavirus como uno de los factores de transmisión de esta infección (AU)

[Once-daily gentamicin dosing versus thrice-daily dosing in infants with acute pyelonephritis]. / Gentamicina en dosis única diaria frente a tres dosis diarias en lactantes con pielonefritis aguda.

BACKGROUND: Once-daily dosing (ODD) of gentamicin is advocated as an effective and safe treatment of Gram-negative bacterial infections in adults. There are insufficient data in the literature to justify its use in infants. OBJECTIVES: To compare the efficacy of ODD of gentamicin with that of classical thrice-daily (t.i.d.) administration in infants with acute pyelonephritis. METHODS: We performed a quasi-experimental study comparing 33 infants who received ODD of gentamicin with a historical control group of 25 infants treated with gentamicin t.i.d. Leukocytosis, C-reactive protein, creatinine, gentamicin dose, peak and trough values, time required for disappearance of fever, and outcome were analyzed. RESULTS: The mean doses of gentamicin (mg/kg/day) were higher in the t.i.d. group (6.4 1.14) than in the ODD group (5.06 0.22; p < 0.001). Peak serum gentamicin concentrations (micro g/ml) were significantly higher in the ODD group (9.32 1.4) than in the t.i.d. group (5.09 1.15; p < 0.001). Mean trough gentamicin concentrations (micro g/ml) were lower in the ODD group than in the t.i.d. group (0.23 0.26 vs 0.78 0.45; p 0.001). There were no significant differences in the duration of fever between the groups (30.64 32 hours in the t.i.d. group vs. 28.57 32 hours in the ODD group). Serum creatinine levels were normal during treatment in both groups. In all patients outcome was good and no adverse effects were noted. CONCLUSIONS: Treatment with ODD of gentamicin in our population of infants with acute pyelonephritis was as effective as traditional administration t.i.d. and possibly was equally safe or safer.

Gentamicina en dosis única diaria frente a tres dosis diarias en lactantes con pielonefritis aguda / Once-daily gentamicin dosingversus thrice-daily dosing in infants with acute pyelonephritis

Antecedentes. La gentamicina en dosis única diaria se considera un tratamiento seguro y eficaz en adultos para las infecciones por gérmenes gramnegativos. Existen escasos datos en la literatura que justifiquen su uso en lactantes. Objetivos. Comparar la eficacia del tratamiento de la pielonefritis aguda en lactantes con gentamicina en única dosis diaria (UDD) frente a la pauta clásica de tres dosis diarias (TDD).Métodos. Estudio cuasi experimental en el que se compara el grupo de intervención tratado con gentamicina en UDD frente a una cohorte histórica de niños tratados con TDD. Se analizan leucocitosis, proteína C reactiva (PCR), creatinina, dosis de gentamicina, niveles pico y valle, tiempo necesario para la desaparición de la fiebre y evolución clínica. Resultados. Se estudian 58 lactantes con edades entre 1 y 20 meses. Veinticinco de ellos recibieron gentamicina TDD y 33 gentamicina UDD. La dosis de gentamicina en el grupo TDD fue algo superior que en el tratado con UDD 6,4+/- 1,14 mg/kg/día y 5,06+/-0,22 mg/kg/día, respectivamente; p < 0,001). El nivel pico de gentamicina fue superior en el grupo UDD (9,32+/- 1,4 g/ml) que en el grupo TDD (5,09+/- 1,15 g/ml) con p < 0,0001. Los niveles valle fueron inferiores en el grupo UDD que en TDD (0,23+/- 0,26 g/ml frente a 0,78+/- 0,45 g/ml, respectivamente; p= 0,001). No se encontraron diferencias en el tiempo necesario para la desaparición de la fiebre; 30,64+/- 32 h en el grupo TDD y 28,57+/-32 h en el grupo UDD. Los valores de creatinina durante el tratamiento fueron normales en ambos grupos. La evolución fue buena en todos los pacientes y no se observaron efectos secundarios. Conclusiones. El tratamiento con gentamicina en UDD en nuestra población de lactantes con pielonefritis aguda es tan eficaz como el TDD tradicional y, posiblemente, igual o incluso más seguro (AU)

[Silent celiac disease: exploring the iceberg in the school-aged population]. / Enfermedad celíaca silente: explorando el iceberg en población escolar.

BACKGROUND: Epidemiological studies have shown a high prevalence of silent celiac disease (CD) among unselected pediatric populations and a low ratio of diagnosed to undiagnosed CD. OBJECTIVES: To quantify the prevalence of silent CD, to assess the clinical features of subclinical CD and to determine the total prevalence of CD (silent plus symptomatic cases). METHODS: We determined total serum IgA, IgA antiendomysial antibodies (EMA) and IgG antigliadin antibodies (IgG AGA), if IgA deficiency was found, in schoolchildren aged 10-12 years from health district IX in Madrid. RESULTS: A total of 3,378 schoolchildren (47.8 % of the eligible population) were studied. Fifteen were EMA-positive and one child with IgA deficiency was IgG AGA-positive. CD was confirmed by intestinal biopsy in 12 children, representing a prevalence of undiagnosed CD of 1/281. Of these 12 children, 7 showed clinical features of CD. The most frequent symptom was iron-deficiency, followed by recurrent aphthous stomatitis and mild malnutrition. Before the start of this study, CD had been diagnosed in seven children from the same population, which would increase the total prevalence of the disease to 1/220 with an estimated ratio of diagnosed to undiagnosed CD of 1 to 3.5. CONCLUSIONS: We confirm the high prevalence of silent celiac disease among the school-aged population. This ratio is one of the highest published and could be due to a high diagnostic suspicion for CD among pediatricians in our health district. Greater awareness of the minor symptoms of CD would reduce the number of patients with undiagnosed CD.

Enfermedad celíaca silente: explorando el iceberg en población escolar / Silent cardiac disease: exploring the iceberg in the school-aged population

Fundamento: Los estudios epidemiológicos realizados sobre población infantil no seleccionada han demostrado una elevada prevalencia de enfermedad celíaca silente y una baja relación de enfermedad celíaca conocida frente a no diagnosticada. Objetivos: Realizar un cribado de enfermedad celíaca silente en población escolar, caracterizar clínicamente a estos pacientes y valorar su prevalencia global (casos silentes más sintomáticos). Métodos: Se determinaron anticuerpos antiendomisio (EMA), inmunoglobulina A (IgA) sérica y anticuerpos antigliadina IgG (AGA IgG), si existía déficit de IgA, a los escolares de 10 a 12 años del área IX de Madrid. Resultados Se han estudiado 3.378 niños (47,8% de la muestra). Quince fueron EMA positivos y uno déficit de IgA tuvo AGA IgG positivos. La enfermedad celíaca se confirmó mediante biopsia intestinal en 12 niños, lo que representa una prevalencia de enfermedad celíaca silente de 1/281. Siete de los 12 niños mostraban hallazgos clínicos, entre los que los más frecuentes fueron ferropenia, aftas orales recurrentes y malnutrición leve. Previamente a este estudio de detección habían sido diagnosticados 7 enfermos celíacos en la misma población, con lo que la prevalencia global calculada ascendería a 1/220 y la relación entre enfermedad celíaca conocida y no diagnosticada sería de 1/3,5. Conclusiones: Se confirma una elevada prevalencia de enfermedad celíaca silente en nuestro medio. La relación entre enfermedad celíaca conocida y silente es una de las mayores de la bibliografía y podría relacionarse con un importante nivel de alerta frente a esta enfermedad por parte de los pediatras de nuestra área de salud. Un mejor conocimiento de los síntomas menores de la enfermedad celíaca disminuirá el número de casos de enfermedad celíaca no diagnosticada (AU)

Dolor abdominal / Abdominal pain

No disponible

BCG coverage and the annual risk of tuberculosis infection over a 14-year period in the Philippines assessed from the Nationwide Prevalence Surveys.

SETTING: A prevalence survey of tuberculosis (TB) infection was undertaken in the Philippines, a developing country in the Western Pacific region. OBJECTIVE: To determine the bacille Calmette Guerin (BCG) vaccination rate, the prevalence of TB infection and the annual risk of TB infection (ARTI). METHODS: A nationwide stratified multi-stage cluster survey of 21,960 individuals. BCG scar verification and tuberculin test were performed on those aged > or =2 months. The ARTI was calculated using the prevalence rates of TB infection in children aged 5-9 years. RESULTS: BCG scars were noted in 66% of the study population. The prevalence of TB infection was 63.4% among unvaccinated individuals. The prevalence rate was higher in males in both urban and rural areas. With both sexes combined, urban and rural communities had similar prevalence rates. In children aged 5-9 years, the prevalence rate was 16.1% (males 17.4%, females 14.9%), corresponding to an ARTI of 2.3% (males 2.5%, females 2.1%). CONCLUSION: BCG coverage increased substantially between 1981-1983 and 1997. The ARTI, however, was virtually unchanged, indicating that morbidity due to TB continued to be high.

Tuberculosis in the urban poor settlements in the Philippines.

SETTING: Urban poor settlements in the Philippines. OBJECTIVE: To determine the magnitude of the tuberculosis problem in urban poor settlements in comparison with urban areas studied in the Nationwide Tuberculosis Prevalence Survey. STUDY DESIGN AND METHOD: A multistage cluster survey of BCG scar, tuberculin test, chest radiography and sputum examination for bacillary disease, in urban poor areas. RESULTS: The prevalences of culture-positive and smear-positive tuberculosis were 17.5 +/- 2.3 (95% CI 13.3-22.4) and 7.9 +/- 2.3 per thousand (95% CI 2.611.5), respectively. Extrapolated to the total population, the rates in the urban poor settlements were 12.4 +/- 1.7 (95% CI 9.6-16.2) and 5.6 +/- 1.6 per thousand population (95% CI 1.3-8.3), respectively. The prevalence of active pulmonary tuberculosis in subjects aged 10 years or more was 66 +/- 5.6/1000 (95% CI 55-77). The BCG vaccination rate was 72%. The overall prevalence of tuberculosis infection was 66%, and 39% in those aged 5-9 years, corresponding to an annual risk of infection (ARI) of 6.5%. CONCLUSION: The problem of tuberculosis was substantial in the urban poor settlements, and was appreciably worse than that in the general urban population.

Bacillary disease and health seeking behavior among Filipinos with symptoms of tuberculosis: implications for control.

SETTING: Urban and rural communities and urban poor settlements in the Philippines. OBJECTIVE: To determine bacillary disease and action taking among individuals with symptoms of tuberculosis (TB), and to analyze their implications for TB control. STUDY DESIGN AND METHOD: Subjects aged 20 years and older were interviewed in the 1997 nationwide stratified multi-cluster survey. Sputum acid-fast smears and cultures were done in subjects with abnormal screening chest radiographs. RESULTS: Individuals with TB symptoms comprised 18.1% of the population studied. The prevalence of bacillary disease was 39/1000 in symptomatic subjects compared to 13/1000 in asymptomatic subjects. Symptom screening had a 14.3% positive predictive value and a 91.4% negative predictive value for bacillary disease. Significantly more symptomatic than asymptomatic subjects attended chest radiographic screening during the survey. However, in response to their symptoms, the majority (43.0%) took no action or self medicated (31.6%), while 11.8% consulted a private practitioner, 7.5% a public health center, 4.4% a hospital, and 1.7% a traditional healer. CONCLUSION: Sputum smear examination after symptom screening was acceptable for case finding. The health seeking behavior of subjects with TB symptoms was inappropriate. A health education program and public-private collaboration in directly observed therapy, short course (DOTS) are essential for TB control in the Philippines.

The 1997 Nationwide Tuberculosis Prevalence Survey in the Philippines.

SETTING: The Philippines is a developing country where tuberculosis (TB) remains a significant public health problem. OBJECTIVE: To determine the prevalence of TB as a basis for setting the targets of the National Tuberculosis Control Program. STUDY POPULATION AND METHODS: A multi-stage cluster survey of a random sample of 21960 subjects from 36 clusters nationwide was undertaken from 2 April to 31 July 1997. BCG scar verification and tuberculin testing was performed for subjects aged 2 months and over, and chest radiography screening was done on subjects 10 years and older. Sputum samples were collected from individuals who were initially assessed to have abnormal chest radiographs to determine the prevalence of bacillary tuberculosis. Acid-fast smear by modified Kinyoun's technique and culture on Löwenstein Jensen were done to demonstrate Mycobacterium tuberculosis. RESULTS: The prevalence of active pulmonary TB was 42/1000 population. The prevalence of culture-positive and smear-positive cases was 8.1 and 3.1/1000, respectively. The prevalence was similar in urban and rural areas. CONCLUSION: Morbidity from TB remains high. Allowing for methodological differences from the survey in 1981-1983, the prevalence of active pulmonary TB was unchanged. There was only a minimal decrease, of 37% for smear-positive cases and 25% for culture-positive cases, in the 14-year interval.