[Consensus document on the clinical use of melatonin in children and adolescents with sleep-onset insomnia]. / Consenso sobre el uso de melatonina en niños y adolescentes con dificultades para iniciar el sueño.

Sleep problems are highly prevalent among our children and adolescents. Its treatment is mainly based on cognitive behavioural therapies and habit modification procedures. However, the use of sleep promoting drugs and substances is widespread without being supported by clinical guidelines. Exogenous melatonin is a neurohormone marketed as a nutritional supplement that is being increasingly used in the management of sleep problems, and with no control over its use. The consensus document is presented on the use of melatonin in sleep-onset insomnia prepared by representatives of the Spanish Paediatric Association, the Spanish Society of Sleep, the Spanish Society of Paediatric Outpatients and Primary Care, the Spanish Society for Adolescent Medicine, the Spanish Society of Child Psychiatry, and the Spanish Society of Paediatric Neurology.

[Psychopathology associated with idiopathic nephrotic syndrome in the pediatric age group]. / Psicopatología del síndrome nefrótico idiopático en la edad pediátrica.

AIM: To analyze the influence of several variables in the genesis of psychological morbidity in children with idiopathic nephrotic syndrome (INS) as compared with healthy controls. METHODS: The Strengths and Difficulties Questionnaire (SDQ) was administered to children with INS (n = 23) and a control group of healthy children (n = 38). The SDQ is a well-known screening instrument for psychological/psychiatric morbidity in childhood. The questionnaire consists of five scales that evaluate emotional symptoms, behavioral problems, hyperactivity, peer problems and prosocial behavior. The total score is calculated by adding all the subscales except the prosocial behavior scale. In children with INS, type of treatment, sex, steroid dose, disease stage, disease duration, and prognosis (number of relapses/disease stage) were also noted. RESULTS: Statistically significant differences were found in two of the scales (emotional symptoms and peer problems), as well as in the total score in children with INS as compared with the control group (p < 0.05). A positive correlation was found between disease duration and total score in the INS group. CONCLUSIONS: Emotional and behavioral problems were more frequent in children with INS. The only variable related to the severity of the symptoms studied in these children was disease duration.

Psicopatología del síndrome nefrótico idiopático en la edad pediátrica / Psychopathology associated with idiopathic nephrotic syndrome in the pediatric age group

Introducción Se analiza la influencia de diferentes parámetros en la sintomatología psicológica de los niños afectados de síndrome nefrótico idiopático (SNI) y se compara dicha sintomatología con los síntomas mentales presentes en un grupo de niños sanos (grupo control). Material y métodos Se ha administrado el Cuestionario de Cualidades y Dificultades (SDQ) a una muestra de niños afectados de SNI (n 23) y a un grupo control (n 38). El SDQ se utiliza como instrumento de detección de alteraciones psicológicas infantiles. Comprende 5 escalas que evalúan síntomas emocionales, problemas de conducta, hiperactividad, problemas con compañeros y conducta prosocial. Así mismo, se calcula una escala total de dificultades que se obtiene de la suma de todas las escalas excepto la conducta prosocial. En el grupo de niños con SNI se ha tenido en cuenta el tipo de tratamiento, el sexo, la evolución de la enfermedad, la dosis de esteroides, el tiempo de evolución de la enfermedad y la gravedad del cuadro. Resultados Existen diferencias estadísticas en la comparación entre ambos grupos en las escalas de síntomas emocionales, problemas con compañeros y en la escala total de dificultades (más sintomatología en el grupo de SNI) (p < 0,05). En los niños con SNI se observa correlación positiva entre la escala total y el tiempo de evolución de la enfermedad. Conclusiones Existe un incremento de la sintomatología emocional y del comportamiento en el grupo experimental en comparación con el grupo control. El tiempo de evolución de la enfermedad es la única variable relacionada con la intensidad de los síntomas estudiados en los niños con SNI

Aim To analyze the influence of several variables in the genesis of psychological morbidity in children with idiopathic nephrotic syndrome (INS) as compared with healthy controls. Methods The Strengths and Difficulties Questionnaire (SDQ) was administered to children with INS (n 23) and a control group of healthy children (n 38). The SDQ is a wellknown screening instrument for psychological/psychiatric morbidity in childhood. The questionnaire consists of five scales that evaluate emotional symptoms, behavioral problems, hyperactivity, peer problems and prosocial behavior. The total score is calculated by adding all the subscales except the prosocial behavior scale. In children with INS, type of treatment, sex, steroid dose, disease stage, disease duration, and prognosis (number of relapses/ disease stage) were also noted. Results Statistically significant differences were found in two of the scales (emotional symptoms and peer problems), as well as in the total score in children with INS as compared with the control group (p < 0.05). A positive correlation was found between disease duration and total score in the INS group. Conclusions Emotional and behavioral problems were more frequent in children with INS. The only variable related to the severity of the symptoms studied in these children was disease duration

[Inhaled corticosteroid therapy and bone metabolism in asthmatic children]. / Glucocorticoides inhalados y metabolismo óseo en niños asmáticos.

OBJECTIVE: To explore the association between inhaled corticosteroids (ICS) therapy and bone metabolism. PATIENTS AND METHODS: The sample was composed of 151 children, aged between 1 and 17 years. There were 71 asthmatics treated with ICS for at least 6 months (group 1), 44 asthmatics treated occasionally with ICS during exacerbations (group 2), and 36 healthy children (group 3). Bone mineral density (BMD) and markers of bone formation and resorption were measured. These measures, as well as other related factors, were compared among groups. Regression models for osteopenia and BMD were used with the group as the independent variable adjusted by factors with differences between groups. A two-tailed level of p < 0.05 was used in all tests. RESULTS: No differences in BMD were found between groups 1 and 2 but significant differences were found between groups 1 and 3 (p = 0.003). No differences were found in markers of bone formation and resorption among the groups. No association was found between BMD and the type, daily dose or accumulated dose of ICS. Group 1 showed an osteopenia odds ratio relative to group 3 of 2.94 (95 % CI: 1.49-5.78) and an average reduction of BMD of 0.50 (95 % CI: 0.32-0.68) was found from group 3 to 2 and from group 2 to 1. In group 1, markers of bone resorption significantly increased in asthmatics with osteopenia compared with those without osteopenia. CONCLUSIONS: ICS treatment in asthmatic children seems to affect BMD. Markers of bone formation and resorption are unaffected. Osteopenia in these children could also be related to other factors that increase bone resorption.

Glucocorticoides inhalados y metabolismo óseo en niños asmáticos / Inhaled corticosteroid therapy and bone metabolism in asthmatic children

Objetivo: Explorar la asociación entre tratamiento con glucocorticoides inhalados (GCI) y metabolismo óseo. Pacientes y métodos: La muestra está compuesta por 151 niños entre 1 y 17 años, 71 asmáticos en tratamiento con GCI al menos durante 6 meses (grupo 1), 44 asmáticos que recibieron GCI ocasionalmente durante las crisis (grupo 2) y 36 sanos (grupo 3). Se determinó la densidad mineral ósea (DMO) y marcadores de formación y de resorción ósea. Se compararon estos valores, y factores asociados a ellos, entre los grupos. Se emplearon modelos de regresión para osteopenia y DMO con el grupo como variable independiente ajustados por factores con diferencia entre grupos. Las pruebas emplean un nivel bilateral p < 0,05. Resultados: No se encontraron diferencias de DMO entre grupos 1 y 2, pero sí entre grupos 1 y 3 (p = 0,003). No se hallaron diferencias en los marcadores de formación, ni de resorción ósea entre grupos. La DMO no se asoció con el tipo, dosis diaria, ni acumulada de GCI. El grupo 1 presentó una odds ratio (OR) respecto al 3 a osteopenia de 2,94 (intervalo de confianza del 95 % [IC 95 %]: 1,49-5,78) y se obtuvo una reducción media de la z-DMO de 0,50 (IC 95 %: 0,32-0,68) en el paso del grupo 3 al 2 y del 2 al 1. En el grupo 1 los pacientes con osteopenia presentaron un aumento significativo de marcadores de resorción ósea respecto a los pacientes sin osteopenia. Conclusiones: El tratamiento con GCI en niños asmáticos parece afectar la DMO. Los marcadores de formación y resorción ósea no se ven afectados. La osteopenia en estos niños además podría estar relacionada con algún factor que incremente la resorción ósea

Objective: To explore the association between inhaled corticosteroids (ICS) therapy and bone metabolism. Patients and methods: The sample was composed of 151 children, aged between 1 and 17 years. There were 71 asthmatics treated with ICS for at least 6 months (group 1), 44 asthmatics treated occasionally with ICS during exacerbations (group 2), and 36 healthy children (group 3). Bone mineral density (BMD) and markers of bone formation and resorption were measured. These measures, as well as other related factors, were compared among groups. Regression models for osteopenia and BMD were used with the group as the independent variable adjusted by factors with differences between groups. A two-tailed level of p < 0.05 was used in all tests. Results: No differences in BMD were found between groups 1 and 2 but significant differences were found between groups 1 and 3 (p = 0.003). No differences were found in markers of bone formation and resorption among the groups. No association was found between BMD and the type, daily dose or accumulated dose of ICS. Group 1 showed an osteopenia odds ratio relative to group 3 of 2.94 (95 % CI: 1.49-5.78) and an average reduction of BMD of 0.50 (95 % CI: 0.32-0.68) was found from group 3 to 2 and from group 2 to 1. In group 1, markers of bone resorption significantly increased in asthmatics with osteopenia compared with those without osteopenia. Conclusions: ICS treatment in asthmatic children seems to affect BMD. Markers of bone formation and resorption are unaffected. Osteopenia in these children could also be related to other factors that increase bone resorption

Hipoparatiroidismo primario de presentación en la edad escolar. Descripción de un caso / Primary hypoparathyroidism presenting in school-aged children: report of a case

El hipoparatiroidismo primario es una entidad poco frecuente en la infancia. Puede cursar de forma asintomática o con una amplia variedad de síntomas neuropsiquiátricos principalmente debido a la hipocalcemia derivada de la disminución de la paratormona sérica y del depósito de calcio en los núcleos de la base. Presentamos el caso de un niño de 12 años afectado de movimientos distónicos, de aparición súbita, como única expresión clínica inicial del hipoparatiroidismo primario. Las exploraciones complementarias mostraron como datos destacables la disminución de la paratormona y el calcio sérico, el aumento del fósforo sérico y la presencia de calcificaciones en núcleos de la base y región subcortical tras la práctica de una TC craneal. El tratamiento con calcio elemento y calcitriol oral estabilizó las cifras de calcio y fósforo sérico. La evolución posterior fue satisfactoria (AU)

Traqueobronquitis necrotizante: descripción de dos casos / Necrotizing tracheobronchitis: a report of two cases

Se presentan dos niños diagnosticados de traqueobronquitis necrotizante. En ambos casos la enfermedad constituye una complicación grave de la ventilación mecánica y la presentación clínica se caracteriza por hipercapnia, pérdida de movimientos torácicos y episodios de obstrucción grave de la vía aérea que producen la muerte. La valoración histológica post mortem manifiesta una necrosis característica de la mucosa traqueal, compatible con el diagnóstico de traqueobronquitis necrotizante. Es necesario el reconocimiento de esta complicación yatrogénica en un niño ventilado cuando las condiciones respiratorias empeoran de forma drástica (AU)