Aparición temprana de varicela modificada en niños vacunados con una dosis / Early presentation of breakthrough varicella in vaccinated children

Introducción: El uso sistemático de la vacuna de la varicela en niños ha conseguido una reducción significativa de la morbimortalidad. Sin embargo, persiste la incidencia de varicela en sujetos vacunados, varicela modificada (VM), lo que ha motivado la incorporación de una segunda dosis a los calendarios vacunales, a una edad que podría ser demasiado tardía. Se pretende medir el tiempo trascurrido desde la vacunación hasta la aparición de la VM. Pacientes y métodos: Se presentan 23 casos de niños diagnosticados de VM (media de edad al diagnóstico: 4,85 años), vacunados con una dosis (media de edad de vacunación: 2,37 años). Resultados: El tiempo medio transcurrido desde la vacunación hasta la VM fue de 2,48 años y la mediana 2,0 años. El 13% de los niños diagnosticados de VM habían sido vacunados el año previo y el 52%, en los 2 previos, tiempo inferior al recomendado para recibir la segunda dosis de vacuna según los calendarios vigentes. Conclusiones: Para disminuir los fallos vacunales, podría considerarse la aproximación de las dosis de vacuna e incluso la administración consecutiva (AU)

Introduction: The introduction of a routine varicella vaccination program for children has achieved a significant reduction in morbidity and mortality due to varicella. However, there is still an incidence of chickenpox in those vaccinated, called “varicella breakthrough” (VB). This has led to the inclusion of a 2nd dose vaccination schedule, at an age which could be too late. Patients and methods: This study presents 23 cases of children diagnosed with VB (mean age at diagnosis 4.85 years) who had been vaccinated with one dose of varicella vaccine (mean age of vaccination 2.37 years). Results: The mean time between the vaccine and the disease was 2.48 years, with a median of 2.0 years. VB was diagnosed in 13% of children who had been vaccinated the previous year, and 52% diagnosed in the previous two. Therefore many of these patients had suffered the disease before the recommended time of administration of the second dose of vaccine according to the current vaccine schedules. Conclusions: To avoid these vaccine failures, it would be appropriate to bring the two doses of varicella vaccine closer, or even assess the pattern of two consecutive doses (AU)

[Early presentation of breakthrough varicella in vaccinated children]. / Aparición temprana de varicela modificada en niños vacunados con una dosis.

INTRODUCTION: The introduction of a routine varicella vaccination program for children has achieved a significant reduction in morbidity and mortality due to varicella. However, there is still an incidence of chickenpox in those vaccinated, called "varicella breakthrough" (VB). This has led to the inclusion of a 2nd dose vaccination schedule, at an age which could be too late. PATIENTS AND METHODS: This study presents 23 cases of children diagnosed with VB (mean age at diagnosis 4.85 years) who had been vaccinated with one dose of varicella vaccine (mean age of vaccination 2.37 years). RESULTS: The mean time between the vaccine and the disease was 2.48 years, with a median of 2.0 years. VB was diagnosed in 13% of children who had been vaccinated the previous year, and 52% diagnosed in the previous two. Therefore many of these patients had suffered the disease before the recommended time of administration of the second dose of vaccine according to the current vaccine schedules. CONCLUSIONS: To avoid these vaccine failures, it would be appropriate to bring the two doses of varicella vaccine closer, or even assess the pattern of two consecutive doses.

Brote de onicomadesis posvírica en Valladolid / Post viral onychomadesis outbreak in Valladolid

Introducción: En verano del 2008 se notificó un brote epidémico de onicomadesis en Valencia que afectó a más de 200 niños, y se relacionó con una virasis similar a la enfermedad boca-mano-pie (EBMP). Aunque ya se había descrito esta asociación en unos pocos casos, constituía la primera epidemia de este tipo en el mundo. Se comunica la observación de 16 casos de onicomadesis posvírica en Valladolid. Material y métodos: Se recogieron parámetros clinicoepidemiológicos de 15 niños y la madre de uno de ellos que se habían diagnosticado de onicomadesis a través de las consultas de Pediatría de 6 centros de salud, entre noviembre del 2008 y febrero del 2009.ResultadosEn un mes se diagnosticaron 11 casos de onicomadesis en alumnos de 2 guarderías de diferente barrio de Valladolid, y el resto en otros 4 centros escolares de la ciudad y de 2 poblaciones cercanas. Las edades oscilaron entre 18 meses y 3 años. Nueve de los 15 niños (60%) se habían diagnosticado de EBMP entre 3 y 12 semanas antes (media: 6 semanas), y al menos 6 presentaron fiebre. Los pacientes recuperaron ad integrum las uñas entre un mes y 4 meses. Conclusiones: Parece tratarse de otro brote epidémico de onicomadesis posvírica, según la similitud de las características clinicoepidemiológicas con el ocurrido en Valencia: edad, efecto clúster en guarderías, enfermedad vírica previa, a menudo con exantema acral, y recuperación de las uñas. El desconocimiento de esta nueva entidad clínica y el intervalo de tiempo que transcurre entre el proceso agudo vírico y la afectación ungueal probablemente estén originando un infradiagnóstico (AU)

Introduction: An onychomadesis outbreak associated with hand-foot-mouth disease (HFMD) was notified in winter 2008 in Valencia, Spain, with more than 200 people affected, the majority children. Even though this association has already described, this was the first outbreak known in the world. Sixteen cases of post-viral onychomadesis post viral in Valladolid are presented. Material and methods: Between November 2008 and February 2009, 15 children aged between 18 months and 3 years, and one mother, presented with onychomadesis in Primary Care Centres in Valladolid. Results: HFMD was diagnosed in a single month in 11 patients who attended two nurseries. The others attended others nurseries of Valladolid area. Nine children (60%) had the clinical diagnosis of HFMD 3 to 12 weeks before (mean: 6 weeks), six with fever. The nail changes were usually temporary with spontaneous normal re-growth in 1 to 4 months. Conclusions: The clinical and epidemiological characteristics of this report were similar to the Valencia outbreak: age, geographic clustering, acral eruption prior, etc. Perhaps the diagnosis is underestimated due to ignorance of the disease and the long interval between the acute viral process and nail shedding (AU)

[Post viral onychomadesis outbreak in Valladolid]. / Brote de onicomadesis posvírica en Valladolid.

INTRODUCTION: An onychomadesis outbreak associated with hand-foot-mouth disease (HFMD) was notified in winter 2008 in Valencia, Spain, with more than 200 people affected, the majority children. Even though this association has already described, this was the first outbreak known in the world. Sixteen cases of post-viral onychomadesis post viral in Valladolid are presented MATERIAL AND METHODS: Between November 2008 and February 2009, 15 children aged between 18 months and 3 years, and one mother, presented with onychomadesis in Primary Care Centres in Valladolid. RESULTS: HFMD was diagnosed in a single month in 11 patients who attended two nurseries. The others attended others nurseries of Valladolid area. Nine children (60%) had the clinical diagnosis of HFMD 3 to 12 weeks before (mean: 6 weeks), six with fever. The nail changes were usually temporary with spontaneous normal re-growth in 1 to 4 months. CONCLUSIONS: The clinical and epidemiological characteristics of this report were similar to the Valencia outbreak: age, geographic clustering, acral eruption prior, etc. Perhaps the diagnosis is underestimated due to ignorance of the disease and the long interval between the acute viral process and nail shedding.

Acrodermatitis papulosa sin infección / Papular acrodermatitis without infection

No disponible

Errores frecuentes en la comparación de resultados de estudios sobre burn-out o desgaste profesional / Frequent errors in the comparison of results of studies on burn-out

No disponible

Violencia en la pareja: papel del médico de familia / Violence within couples: role of the family doctor

No disponible

Un caso de síndrome de varicela modificada / A case of modified varicella-like syndrome

Se presenta un caso del llamado síndrome de varicela modificada o atenuada -SVM-(del inglés modified varicella-like syndrome) en un niño de 6 años, vacunado de varicela un año antes y contagiado en una epidemia escolar. Se describen las características clínicas del caso, síntomas más leves y de menor duración, que pueden dificultar su diagnóstico, fundamentalmente en nuestro medio, donde la vacuna de la varicela no está incluida de forma sistemática en el calendario vacunal. (AU)

[Screening for adolescent idiopathic scoliosis: is current knowledge sufficient to support its use?]. / Despistaje de escoliosis en el adolescente: está justificado con los conocimientos actuales?

OBJECTIVE: The aim of this study was to re-examine the basis of screening for adolescent idiopathic scoliosis. PATIENTS AND METHODS: Retrospective analysis of scoliosis screening of patients with a positive test was performed. The screening was performed in children between 10 and 15 years by visual inspection of the back and the Adams forward-bending test. RESULTS: In 31.6% of the children, the screening test detected the presence of abnormal findings on initial physical examination. 19% of the total population was sent to a traumatology service. In 11% the diagnosis was confirmed (16 scoliosis, 12 of them idiopathic and 4 due to other conditions), PPV: 58%. In 8% of the adolescents exercise was recommended. In 1.2% braces were recommended. There were no differences in prevalence between sex, but the height of the children with scoliosis was greater (p < 0.001). CONCLUSIONS: Because of the potential severe adverse effects and because the studies of the efficacy of the screening are not reliable, the U.S. Preventive Services Task Force, Canadian Task Force and the Program de Actividades Preventivas y Promoción de la Salud have excluded the routine screening of the asymptomatic adolescent for idiopathic scoliosis.

[Blood lead in a population of children with iron deficiency]. / Estudio de la plumbemia en la población infantil con ferropenia.

BACKGROUND: Analysis of blood lead levels in relation to the state of iron metabolism was carried out in children. METHODS: A transversal study of blood lead levels was designed in 89 iron deficient children (serum ferritin < 15 micrograms/l) (group F). Fifty seven of the children did not have anemia (sub-group FS) and 32 had anemia (sub-group AF) with ages ranging between 6 months and 14 years, and 41 children of the same age with normal iron metabolism (group C). A longitudinal study was also carried out by the determination of blood lead levels prior and after iron therapy in 18 of the iron deficient children. RESULTS: A significant difference was seen between the mean of blood lead levels in iron deficient children (group F), 9.41 micrograms/dl and normal children (group C), 6.88 micrograms/dl (p < 0.01). The mean of blood lead levels of the sub-group FS was 7.79 micrograms/dl and the sub-group AF, 12.30 micrograms/dl (p < 0.01). The prevalence of lead poisoning (blood lead levels > 20 micrograms/dl) was 8% in group F (2% in sub-group FS, 19% in sub-group AF) and 0 in group C (p < 0.01). A significant decrease was found in the longitudinal study in the mean of blood lead levels following iron therapy from 14.12 micrograms/dl to 7.51 micrograms/dl (p < 0.05). CONCLUSIONS: The iron deficient state may constitute a predisposing factor of lead poisoning in childhood.

[Diagnostic evaluation of cervical adenopathies in childhood]. / Evaluación diagnóstica de las adenopatías cervicales en pediatría.

Between 1985 and 1990, 45 children were studied in an inpatient basis hospital because of cervical lymphadenopathy. This was the most important clinical sign in these patients. Forty-three had true adenitis. In the others, one was submaxillitis and one a sarcoma. The age range was from 2.1 to 13.3 years. Seven children (16%) had neoplastic adenitis (2 papillary carcinoma of the thyroid, 4 Hodgkin's lymphoma and one non-Hodgkin's lymphoma). Thirty-six patients had benign disorders (18 mononucleosis infections, 7 nonspecific adenitis, 5 infections of mycobacteria, 2 of toxoplasma and 2 of rickettsia, one cervical Whipple and one desmopathic adenitis). We did no find any differences related to age or morphological characteristics of the lymph nodes. The evolution time in patients with malignant tumors was 16.4 weeks and 9.6 weeks in the benign group. All of the cases with supraclavicular location had a lymphoma. The mean LDH in patients with malignant tumors was 214 U/L and 614 U/L in those with non-malignant tumors (p < 0.01).