Adenopatía supraclavicular secundaria a vacuna del papilomavirus / Supraclavicular lymph node secondary to papillomavirus vaccine

Las adenopatías cervicales son hallazgos frecuentes en la clínica pediátrica y se asocian de forma prioritaria a procesos infecciosos benignos y controlables. La presentación supraclavicular, o cervical baja, obliga a establecer un diagnóstico diferencial en el que se incluyen los procesos malignos. La asociación con la vacuna del papiloma es menos conocida, pero debe ser tenida en cuenta. Ante una adenopatía supraclavicular en un preadolescente, se hace necesario conocer el antecedente de vacunación frente al virus del papiloma humano (VPH) en los días previos a su aparición, si bien en el diagnóstico diferencial hay que descartar siempre una causa neoplásica (AU)

Cervical lymphadenopathies are frequent findings in pediatric clinics and are primarily associated with benign and controllable infectious processes. The supraclavicular, or lower cervical, presentation requires establishing a differential diagnosis that includes malignant processes. The association with the papilloma vaccine is less known, but must be taken into account. Before a supraclavicular adenopathy in a preadolescent, it is necessary to know the history of vaccination against human papillomavirus (HPV) in the days prior to its appearance, although in the differential diagnosis a neoplastic cause must always be ruled out (AU)

Deshidratación hipernatrémica asociada a la alimentación con lactancia materna en el periodo neonatal / Hypernatremic dehydration associated with breast-feeding in the neonatal period

Introducción: La deshidratación hipernatrémica en el neonato se asocia de forma característica a la alimentación con lactancia materna exclusiva en madres primigestas por una mala técnica de amamantamiento. Pese a los avances en los cuidados perinatológicos, continúa siendo una patología habitual en nuestros días. Población y métodos: Estudio descriptivo retrospectivo de los neonatos alimentados con lactancia materna exclusiva y natremia ≥150 mmol/L, que precisaron ingreso en el Hospital Universitario Central de Asturias en los últimos 14 años. Resultados: Serie de 26 casos (0,54 por cada 1.000 recién nacidos vivos). La pérdida media de peso hasta el ingreso fue del 17,9%, con una natremia media de 162 mmol/L. Se observó una relación lineal entre el sodio sérico y la pérdida de peso. El 73% de las madres eran primigestas. El 34% de los casos procedían de la maternidad de nuestro hospital, el 34% habían acudido al servicio de urgencias de nuestro centro y el 30,6% acudían remitidos por sus pediatras de referencia. Todos los casos evolucionaron satisfactoriamente. Se constató un aumento de la incidencia en los últimos años. Conclusiones: La deshidratación hipernatrémica asociada a la lactancia materna exclusiva aparece, en la mayoría de los casos, en madres primigestas. La formación del personal sanitario, la intensificación de los cuidados del neonato durante su estancia en la maternidad y el control precoz del mismo tras el alta hospitalaria pueden considerarse medidas útiles para evitar esta patología, cuya existencia pone de manifiesto una carencia en el sistema sanitario (AU)

Introduction: Hypernatremic dehydration in newborns is associated to exclusive breastfeeding in primiparous mothers with wrong breastfeeding technique. Despite advances in perinatological care, hypernatremic dehydration remains common today. Subjects and methods: Retrospective study of exclusive breastfeeding neonates with serum sodium concentrations equal to or greater than 150 mmol/L requiring admission in the Hospital Universitario Central de Asturias in the last 14 years. Results: Twenty-six newborn were included in the study (0.54 per 1,000 live births). At admission, the mean percentage of weight loss was 17.9% and mean serum sodium value 162 mmol/L. A linear relationship between serum sodium and weight loss was observed. 73% of the mothers were primiparous. 34% of the sample were admitted directly from the maternity, 34% came from the emergency department and 30,6% were referred to the hospital by their reference pediatrician. All cases evolved satisfactorily. An increase in incidence in recent years was objectively. Conclusions: Hypernatremic dehydration in exclusively breastfed neonates appears in most cases in primiparous. Breastfeeding training for health professionals, to intensify the care of the newborn during their stay in the maternity and to implement an early visit after postnatal discharge may be considered useful measures to prevent this pathology. Nowadays, this disease reflects a lack of support for breast-feeding mothers in health system (AU)

Cambios en la presentación y evolución de la atresia esofágica en los últimos 20 años / Changes in the presentation and evolution of esophageal atresia in the last 20 years

Objetivo: Conocer los cambios ocurridos en las dos últimas décadas en las formas de presentación clínica, malformaciones asociadas, tratamiento y evolución de la atresia esofágica, comparando una serie actual con otra histórica de nuestro mismo centro. Métodos: Estudio descriptivo retrospectivo. Revisión de las historias clínicas de todos los casos codificados como atresia de esófago al alta desde 1/1/2003 a 31/12/2013. Comparación con la serie histórica de nuestro centro de 1/1/1980 a 31/12/1990 publicada en 1992. Resultados: Al comparar la serie ya publicada con la revisión actual no encontramos diferencias estadísticamente significativas en la incidencia de atresia esofágica (2,29 frente a 2,61 casos por cada 10.000 neonatos vivos), ni en el porcentaje de prematuridad (25,9 frente a 45%), ni en el porcentaje de casos con ecografía intraútero patológica (65 frente a 50%), ni en el porcentaje de casos con otras malformaciones asociadas (59,2 frente a 68,1%). Encontramos diferencias estadísticamente significativas en el porcentaje de cirugía en el primer día de vida (40,7 frente a 9%), en el porcentaje de sepsis nosocomial postquirúrgica (44,4 frente a 86%) y en la mortalidad (40,7 frente a 4,5%). Conclusiones: La atresia de esófago es una patología con una importante morbilidad asociada. En los últimos veinte años no hemos encontrado diferencias en su forma de presentación, pero si en su evolución, con un descenso muy importante en la mortalidad

Objective: To know the changes in the last two decades in clinical presentation, associated malformations, treatment and outcome of esophageal atresia, comparing this current series with another historical of our own hospital. Methods: A retrospective descriptive study. Review of medical records of all cases coded as esophageal atresia at discharge from 1/1/2003 to 12/31/2013. Comparison with our historical series from 1/1/1980 to 12/31/1990, published in 1992. Results: No statistically significant differences in the incidence of esophageal atresia (2.29 versus 2.61 cases per 10,000 live infants), or the percentage of prematurity (25.9 vs. 45%), or the percentage of cases with pathological intrauterine ultrasound (65 vs. 50%), or the percentage of cases with associated malformations (59.2 vs. 68.1%). Found significant differences in percentage of surgery on the first day of life (40.7 vs. 9%), the percentage of nosocomial postsurgical sepsis (44.4 vs. 86%) and mortality (40.7 vs 4.5%). Conclusions: Esophageal atresia is a condition associated with significant morbidity. In the last twenty years we have not found differences in their presentation, but we had found differences in its evolution, with a significant decrease in mortality

There is no such a thing as a free cigarette; lining nests with discarded butts brings short-term benefits, but causes toxic damage.

Adaptation to human-modified environments such as cities is poised to be a major component of natural history in the foreseeable future. Birds have been shown to adapt their vocalizations, use of nesting places and activity rhythms to the urban environments, and we have previously reported that some species, including the house finch (Carpodacus mexicanus), use cellulose from smoked cigarette butts as lining material and thus reduce the number of ectoparasites in their nests, probably because the nicotine repels arthropods. Nicotine is only one of hundreds of potentially harmful substances found in cigarette butts. Here, we investigated whether the presence of such chemicals is harmful for house finches adding cigarette butts to their nests. We found that hatching and fledging success and chick immune response were all positively correlated to the proportion of the nest that was made up of butts. However, the signs of genotoxicity in the blood cells also increased with the proportion of butt cellulose in the nests. Although we have not measured the effect of genotoxicity on post-fledging survival and breeding success, it seems that bringing cigarette butts to the nest has negative consequences that may counterbalance the benefits of using them as ectoparasites repellents.

Acute neonatal appendicitis: a diagnosis to consider in abdominal sepsis.

Appendicitis in the neonatal period is extremely rare. Its low incidence together with non-specific clinical symptoms often mean the diagnosis is delayed, leading to increased rates of peritonitis and mortality. We report the case of a 33-week premature infant, small for gestational age (1180 g at birth), clinically stable and receiving exclusive enteral feeding, who presented clinical manifestations of necrotizing enterocolitis at 14 days of life. Acute phase reactants were elevated and abdominal radiography showed pneumoperitoneum. Laparotomy revealed acute perforated appendicitis without intestinal involvement and purulent fluid in the peritoneum, for which appendectomy was performed. Neonatal acute appendicitis should be considered in the differential diagnosis of abdominal sepsis since early diagnosis and treatment significantly reduce associated morbidity and mortality.

Periviabilidad: el límite de la prematuridad en un hospital regional de referencia durante los últimos 10 años / Peri-viability: limits of prematurity in a regional hospital in the last 10 years

OBJETIVO: Conocer la viabilidad de prematuros de 22-25 semanas gestacionales en nuestro centro durante últimos 10 años. PACIENTES Y MÉTODOS: Estudio retrospectivo descriptivo. Neonatos nacidos en nuestro hospital entre 1-1-2002 y 31-12-2011, de 22 a 25 semanas gestacionales. RESULTADOS: De 121 neonatos, 45 (37%) eran mortinatos y 76 (63%) nacidos vivos (16 fallecieron en partos y 60 ingresaron en cuidados intensivos neonatales). De los 60 ingresados, 34 fallecieron antes del alta y 26 sobrevivieron (21% del total, 34% de nacidos vivos y 43% de ingresados en cuidados intensivos neonatales). Causas de fallecimiento: 16, limitación del esfuerzo terapéutico en partos; 8, limitación del esfuerzo terapéutico en neonatología; 7, sepsis nosocomiales; 7, enterocolitis necrosantes; 4, problemas respiratorios, y 8, causa desconocida. No sobrevivió ningún menor de 24 semanas. De los 26 supervivientes, 4 presentaron alteraciones neurológicas importantes y 11, normalidad neurológica aparente. No encontramos diferencias estadísticamente significativas en cuanto a mortalidad entre los 2 quinquenios analizados. CONCLUSIONES: La periviabilidad presenta importantes problemas clínicos y éticos a los neonatólogos

AIM: To determine the preterm viability between 22 and 25 gestational weeks in our hospital in last 10 years. PATIENTS AND METHODS: A descriptive retrospective study was conducted on preterms between22-25 gestational weeks born between 1-1-2002 and 12-31-2011. RESULTS: There were 121 newborns, 45 (37%) stillbirths and 76 (63%) live births (16 died indelivery room, and 60 admitted to neonatal intensive unit). Among the 60 admitted, 34 died before hospital discharge, and 26 survived (21% of total, 34% of live births and 43% of those admitted to neonatal intensive unit). The causes of death were: 16 therapeutic effort limitation in delivery room, 8 therapeutic effort limitation in neonatal ward, 7 nosocomial sepsis, 7 NEC,4 respiratory problems, and 8 of unknown cause. There were no survivors below 24 gestational weeks. Of the 26 survivors, 4 had major neurological disorders, and 11 with a normal neurological outcome. No significant statistical differences were found in the mortality between the two five-year periods analysed. CONCLUSIONS: The peri-viability has important clinical and ethical problems for neonatologist

[Peri-viability: limits of prematurity in a regional hospital in the last 10 years]. / Periviabilidad: el límite de la prematuridad en un hospital regional de referencia durante los últimos 10 años.

AIM: To determine the preterm viability between 22 and 25 gestational weeks in our hospital in last 10 years. PATIENTS AND METHODS: A descriptive retrospective study was conducted on preterms between 22-25 gestational weeks born between 1-1-2002 and 12-31-2011. RESULTS: There were 121 newborns, 45 (37%) stillbirths and 76 (63%) live births (16 died in delivery room, and 60 admitted to neonatal intensive unit). Among the 60 admitted, 34 died before hospital discharge, and 26 survived (21% of total, 34% of live births and 43% of those admitted to neonatal intensive unit). The causes of death were: 16 therapeutic effort limitation in delivery room, 8 therapeutic effort limitation in neonatal ward, 7 nosocomial sepsis, 7 NEC, 4 respiratory problems, and 8 of unknown cause. There were no survivors below 24 gestational weeks. Of the 26 survivors, 4 had major neurological disorders, and 11 with a normal neurological outcome. No significant statistical differences were found in the mortality between the two five-year periods analysed. CONCLUSIONS: The peri-viability has important clinical and ethical problems for neonatologist.

Miocardiopatía hipertrófica obstructiva precoz tras el tratamiento con dexametasona en un recién nacido pretérmino / Early hypertrophic obstructive cardiomyopathy after dexamethasone treatment in a preterm newborn

El uso de corticoides sistémicos para la prevención y/o el tratamiento de la displasia broncopulmonar en prematuros se ha asociado a la aparición de efectos secundarios a corto y largo plazo, y la afectación neurológica es el efecto que ha limitado su uso. Los efectos a corto plazo incluyen los metabólicos y endocrinológicos (fundamentalmente la hiperglucemia y la supresión del eje hipotálamo hipofisario-adrenal), los cardiovasculares (hipertensión, hipertrofia miocárdica), la mayor susceptibilidad para las infecciones y los efectos digestivos (sangrado), aunque éstos suelen ser transitorios y reversibles. La miocardiopatía hipertrófica en prematuros es un efecto frecuente del uso de corticoides, aunque en general carece de relevancia clínica, ya que requiere habitualmente para su aparición tratamientos de una duración superior a los 7 días. Para paliar este efecto se deben retirar o disminuir los corticoides, y se recomienda el uso de propranolol en los casos con una obstrucción dinámica en la salida del ventrículo izquierdo, o si hubiera datos de isquemia miocárdica. Presentamos el caso de un recién nacido de muy bajo peso al nacimiento que desarrolló precozmente una miocardiopatía hipertrófica obstructiva con repercusión clínica tras 2 días de tratamiento con dexametasona(AU)

The use of corticosteroids for the prevention and/or treatment of bronchopulmonary dysplasia in premature infants have been associated with short and long term side-effects being neurological impairment the most important that limit their use. Short-term sideeffects include metabolic and endocrine (hyperglycemia and suppression of the hypothalamic-pituitary-adrenal axis), cardiovascular (hypertension, myocardial hypertrophy), increased susceptibility to infections and gastrointestinal (bleeding). These are usually transient and reversible. Hypertrophic cardiomyopathy in preterm infants is a common side-effect with the use of corticosteroids but usually has not clinical relevance and it is observed in treatments longer than 7 days. Treatment is the withdrawal or reduction of corticosteroids and the use of propranolol in patients with dynamic obstruction in the left ventricular outflow or whether there are signs of myocardial ischemia. We present the case of a very low birth weight newborn who developed early symtomatic hypertrophic obstructive cardiomyopathy after 2 days of treatment with dexamethasone(AU)

Morphological and reproductive variation among populations of the Pacific molly Poecilia butleri.

In viviparous organisms, pregnant females typically experience an increase in body mass and body volume. In this study, the prediction that variation in reproductive traits among populations of viviparous organisms should be related to variation among populations in body shape was tested in the Pacific molly Poecilia butleri, a viviparous fish that inhabits western Mexico and northern Central America. Variation among 10 populations in four reproductive traits was examined: brood size, individual embryo mass, total reproductive allotment and degree of maternal provisioning of nutrients to developing embryos. Variation among these populations in body shape was also examined. Significant variation among populations was observed in both brood size and reproductive allotment but not in embryo mass or degree of maternal provisioning. Significant variation among populations was also observed in body shape. After correcting for female size, however, reproductive traits and body shape were not associated among populations. This suggests that selective pressures acting on reproduction do not necessarily affect morphology and vice versa. Several factors might contribute to this unexpected lack of association between reproductive traits and morphology.

Quilotórax congénito bilateral: descripción y manejo / Bilateral congenital chylothorax: description and management

El quilotórax constituye la causa más frecuente de derrame pleural en el recién nacido. Generalmente, se trata de un derrame unilateral y secundario a la cirugía torácica; en muy pocos casos es bilateral y de origen congénito. Presentamos el caso clínico de un neonato con diagnóstico ecográfico prenatal de derrame pleural bilateral. En la actualidad, el tratamiento para el manejo del quilotórax congénito no está claramente definido (AU)

Chylothorax is the most common cause of pleural effusion in the newborn infant. Generally it has to do with an unilateral effusion and secondary to thoracic surgery, and only in a few cases it is bilateral and has a congenital origin. We report the case of a newborn with echographic prenatal diagnosis of bilateral pleural effusion. The optimal treatment of congenital chylothorax has not been clearly defined (AU)

Influencia de la hipotiroxinemia materna durante la gestación sobre el desarrollo psicomotor / Influence of maternal hypothyroxinaemia during pregnancy on psychomotor development

Introducción: La función tiroidea materna durante los primeros meses de embarazo desempeña un papel determinante en el desarrollo del cerebro fetal, porque no existe producción de hormona tiroidea fetal hasta la semana 20. Material y métodos: Durante el año 2002 se seleccionó una muestra de 147 mujeres embarazadas en la semana 37 de gestación. Para valorar la función tiroidea de estas gestantes se determinaron las concentraciones séricas de T4 libre y de hormona tiroestimulante (TSH). Posteriormente, se evaluó el desarrollo psicomotor de los hijos de dichas mujeres mediante las escalas McCarthy. Resultados: Se obtuvo una mediana de T4 libre de 9,37 pmol/l, y más de la mitad de las gestantes de la muestra presentaron valores por debajo del umbral de hipotiroxinemia. Los hijos de madres con concentraciones de T4 por debajo del percentil 10 presentaban una puntuación en el índice general cognitivo significativamente más baja que la de los hijos cuyas madres tenían concentraciones séricas de T4 libre normales. Existe una correlación positiva entre el valor de T4 libre materna y el índice general cognitivo (r=0,43; p < 0,01). Conclusiones: Las concentraciones de T4 libre materna no sólo son importantes durante los primeros meses de gestación para asegurar un desarrollo adecuado del cerebro fetal, sino durante todo el embarazo (AU)

Introduction: The maternal thyroid function during early pregnancy plays a fundamental role in foetal brain development as synthesis of thyroid hormone does not begin until the 20th week of gestation. Material and methods: Throughout the year 2002, 147 women in their 37th week of pregnancy were enrolled for the study. To evaluate their thyroid function, the serum concentrations of free T4 and of TSH were determined. After birth, the psychomotor development of their children was evaluated with the Mc-Carthy scales. Results: The median value of free T4 was 9.37 pmol/l, being the data obtained from more than half of the sampled women below the hypothyroxinaemia threshold. Children born from mothers with T4 levels below percentile 10 showed a significantly lower score on the general cognitive index than those whose mothers had normal free T4 serum concentrations. A positive correlation was found between the values of maternal free T4 and the general cognitive index (r=0.43; p < 0.01). Conclusions: The concentrations of maternal free T4 are important, not only during the first months of pregnancy, but all along the process to ensure adequate development of the foetal brain (AU)

[Influence of maternal hypothyroxinaemia during pregnancy on psychomotor development]. / Influencia de la hipotiroxinemia materna durante la gestación sobre el desarrollo psicomotor.

INTRODUCTION: The maternal thyroid function during early pregnancy plays a fundamental role in foetal brain development as synthesis of thyroid hormone does not begin until the 20th week of gestation. MATERIAL AND METHODS: Throughout the year 2002, 147 women in their 37th week of pregnancy were enrolled for the study. To evaluate their thyroid function, the serum concentrations of free T4 and of TSH were determined. After birth, the psychomotor development of their children was evaluated with the Mc-Carthy scales. RESULTS: The median value of free T4 was 9.37 pmol/l, being the data obtained from more than half of the sampled women below the hypothyroxinaemia threshold. Children born from mothers with T4 levels below percentile 10 showed a significantly lower score on the general cognitive index than those whose mothers had normal free T4 serum concentrations. A positive correlation was found between the values of maternal free T4 and the general cognitive index (r=0.43; p<0.01). CONCLUSIONS: The concentrations of maternal free T4 are important, not only during the first months of pregnancy, but all along the process to ensure adequate development of the foetal brain.

Comparación de la utilidad de la fiebre y de algunos parámetros analíticos para el diagnóstico de pielonefritis aguda en niños / Comparison of the utility of fever and some laboratory parameters to diagnose acute pyelonephritis in children

Objetivo. Comparar la utilidad de un parámetro clínico como la fiebre, con parámetros analíticos en el diagnóstico temprano de pielonefritis aguda. Material y Métodos. Se estudiaron un total de 35 niños (10 varones) con el diagnóstico de infección urinaria, hospitalizados en el Servicio de Pediatría del hospital de León y a los que se les practicó una gammagrafía renal con DMSA como prueba de referencia para el diagnóstico de pielonefritis aguda. En el momento del ingreso se midió la temperatura axilar y se realizó extracción sanguínea para determinar velocidad de sedimentación globular, niveles séricos de proteína C-reactiva y de interleuquina-6. Se comparó la utilidad de la fiebre y de los parámetros analíticos para el diagnóstico de pielonefritis aguda calculando para cada uno de ellos sensibilidad, especificidad, valor predictivo positivo y negativo, coeficiente de probabilidad e índice de Youden. Resultados. Se demostró la existencia de pielonefritis aguda en 18 (51,5%) pacientes con edad media de 55,6 + 50,5 meses. El 100% presentaron fiebre al diagnóstico. En 17 (48,5%) pacientes, con edad media de 39,1+55,1 meses, la gammagrafía renal fue normal y 8 (47,06%) presentaban fiebre al diagnóstico. La sensibilidad para detectar la localización de las infecciones urinarias de la temperatura axilar > 38º, velocidad de sedimentación globular > 20, proteína –C-.reactiva > 5 mg/l e interleuquina-6>4 pg/ml fue de uno y la especificada de la proteína –C-reactiva > 70 mg/l y de la interleuquina -6>15 pg/ml fue próxima a uno. Conclusiones. El diagnóstico de pielonefritis aguada puede ser casi totalmente descartado en los niños con infección urinaria que no tienen fiebre. Los parámetros analíticos estudiados no tienen más sensibilidad que la fiebre para diagnosticar pielonefritis aguda y sólo tienen una alta especificidad cuando sus niveles séricos son muy elevados (AU)

Aim: To compare the use of a clinical parameter such as fever with analytical parameters for early diagnosis of acute pyelonephritis. Material and methods. The study was conducted in 35 children (10 male) diagnosed with urinary infection and hospitalized in the Paediatric Department in the Leon Hospital, who underwent DMSA renal scintigraphy to test for acute pyelonephritis. Auxiliary temperature was read on admission and a blood sample take to determine the rate of globular sedimentation, serum levels of C-reactive protein and interleukin-6. The usefulness of fever was compared with analytical parameters in diagnosing acute pyelonephritis and in each case sensitivity, specificity, positive and negative predictive values, probability co-efficient and the Youden index were calculated. Results. There was evidence of acute pyelonephritis in 18 (51,5%) patient, with an average age of 55.6+50.5 months. Of these 100% registered fever at diagnosis. Seventeen 17 (48,5%) patients with an average age of 39.1+55.1 months, the renal gammagraphy was normal, and 8 (47,06%) registered fever at diagnosis. Sensitivity for detecting urinary tract infection localization in auxiliary temperature > 38º globular sedimentation rate > 20, C-reactive protein > 5 mg/l and interleukin-6>4pg/ml was 1 and the specificity in C-reactive protein > 70 mg/l and interleuking-6>15 pg/ml was close to 1. Conclusion. Diagnosis of acute pyelonephritis is extremely unlikely in children with urinary infection who do not register high temperature. The analytic parameters studied do not register more sensitivity than high temperature in diagnosing acute pyelonephritis, and only show high specificity in the case of very high serum levels (AU)

The use of activated recombinant coagulation factor VII during haemarthroses and synovectomy in a patient with congenital severe factor V deficiency.

Factor V deficiency is a rare hereditary bleeding disorder. Currently, FV concentrates are not available, and the treatment of spontaneous bleeding or bleeding associated with invasive procedures is transfusion of fresh frozen plasma (FFP). However, FFP transfusion can lead to the development of inhibitor to FV, and is associated with several potential transfusion reactions including allergic reactions. We report a patient with congenital severe FV deficiency with repeated haemarthroses of a shoulder joint, and progressively severe allergic reactions to FFP transfusions. In addition, the patient also developed acute pulmonary oedema. Activated recombinant coagulation factor VII (rFVIIa) was used as an alternative haemostatic agent to FFP. We describe the use of rFVIIa in this patient during haemarthroses, synovectomy, and physiotherapy.

Niveles normales de interleucinas 6 y 8 en suero y orina de niños sanos asintomáticos / Normal levels of interleukin 6 and 8 in serum and urine in asymptomatic healthy children

Introducción: La infección urinaria es una patología muy frecuente en niños, y su diagnóstico y tratamiento precoces dependen de la sospecha clínica y la aplicación de parámetros analíticos. Algunas citocinas han despertado un gran interés en este terreno. Objetivo: Conocer los niveles de las interleucinas (IL) 6 y 8 en sangre y orina en niños sanos, y establecer el rango de normalidad de nuestro laboratorio. Material y métodos: Estudio observacional transversal, descriptivo y analítico, en niños sanos sin infección urinaria. Se analizan las variables sexo, edad, niño mayor o menor de 1 año, y nivel de IL 6 y 8 en sangre y orina (mediante ELISA). Se calcula la estadística básica de las variables cuantitativas. La comparación entre muestras independientes se llevó a cabo con el test U de Mann-Whitney, y la correlación entre las mismas con el test de Pearson. Se consideró un error alfa del 5% (SPSS 9.0). El límite superior de normalidad de las IL se estableció en la media más 2 desviaciones estándar (95% de la población). Resultados: Estudiamos 52 niños (40 varones, 76,92%) con una edad media de 51,31 + 47,98 meses (1-149 meses), sin diferencias en su distribución por sexo y grupos de edad inferior o superior a un año. Los niveles medios de IL (e intervalo de confianza IC: 95%), y el límite superior de la normalidad, fueron respectivamente, para IL-6 suero: 0,49 (IC: 0-1,05), y 3,95 pg/mL; IL-6 orina: 0,17 (IC: 0-0,51), 1,83 pg/mL; IL-8 suero: 136,66 (IC: 0,74-272,58), 974,58 pg/mL; IL-8 orina: 47,23 (14,71-79,75), 242,39 pg/mL. No hubo diferencias entre ambos sexos ni grupos de edad, salvo niveles medios de IL-8 urinaria más elevados en menores de 1 año, con una correlación negativa entre dicha variable y edad (p<0,05). Asimismo, existe una correlación positiva y muy significativa de IL-6 y 8 en orina (p<0,001) y de IL-8 entre suero y orina (p<0,01). Conclusiones: En niños sanos, no se observaron diferencias según sexos en los niveles de IL-6 y 8, pero la producción de IL-8 en orina es mayor en niños más pequeños. Adiferencia de la IL-6, se detectan niveles significativos de IL-8 en suero y orina de niños sanos, cuestionando su validez en el diagnóstico de infección. Finalmente, existe en condiciones normales una excelente correlación entre IL-6 y 8 en orina

Objective: To determine the interleukins (IL) 6 and 8 levels in serum and urine in the healthy pediatric population, and to establish our laboratory reference values, whit the purpose of subsequently to apply this determination to diagnosis of urinary tract infection. Material and methods: Observational, transversal, descriptive and analytical study, in healthy children without urinary tract infection. We analyse the following variables: sex, age, to be oldest or youngest than 1 year, and IL-6 and IL-8 levels in serum and urine (ELISA). We evaluate the basic statistics for quantitative variables. It compare the independent samples by means of Mann-Whitney U test, and its correlation with the Pearson test. We consider an alpha-error of 5% (SPSS 9.0). The upper limit of normality was established in two standard deviation more than the mean (95% of population). Results:We have studied 52 children (40 males, 76.92%). The mean of age was 51.31 + 47.98 months (1-149 months), and it didn’t have differences according to sex, or to be oldest and youngest than 1 year of age. The mean values of IL (and confidence interval IC: 95%), and the upper limit of normality, respectively were for serum IL-6: 0.49 (IC: 0-1,05), and 3.95 pg/mL; urine IL-6: 0,17 (IC: 0-0,51), 1,83 pg/mL; serum IL-8: 136,66 (IC: 0,74-272,58), 974,58 pg/mL; and urine IL-8: 47,23 (14,71-79,75), 242,39 pg/mL. It didn’t have differences neither between both sex nor age groups, except urine IL-8 mean levels greater in youngest of 1 year of age, with a negative correlation between this variable and age (p<0,05). Moreover, it exist a positive and very significant correlation of urine IL-6 and 8 (p<0,001), and serum and urine IL-8 (p<0,01). Conclusions: In healthy pediatric population, it didn’t observe differences according to sex in IL-6 and IL-8 levels, but the urine IL-8 production is greater in more little children. It observe significant serum and urine IL-8 levels in healthy children, making questionable its validity in urinary tract infection diagnosis. Finally, it exist an excellent correlation between urinary IL-6 and IL-8 in normal conditions

Dyadic interactions between deaf children and their communication partners.

This study assesses the quality of communicative interaction in a group of profoundly deaf children, and the nature and efficiency of different modes of communication. Data were video-recorded. Each recording lasted 10 minutes. The situations were of dyadic interactions using materials and tasks that required cooperation and/or information exchange. The participants in the study were deaf and hearing children, some of whom knew each other and some of whom did not; a deaf adult who was unfamiliar to the children; and a hearing adult who was familiar to the children. Interaction variables (initiation, continuation, ending, and complexity) and communicative modalities (sign, actions, conventional gestures, deictics, verbalizations, vocalizations, physical contact, and objects) were analyzed. The findings relate the different modalities used, their communicative efficiency and their relationship to the types of partners, suggesting greater attention to the informal aspects of communication and emphasizing the importance of linguistic adjustments among speakers.

[The use of oxygen as therapy in a general hospital]. / Utilización del oxígeno como terapéutica en un hospital general.

A prospective study of the therapeutic use of oxygen in a general hospital was carried out. 120 patients who received oxygen during the first 24 hours of their admission were included. Oxygen was prescribed continually for 113 patients (94%). This was administered with a Venturi mask in 116 patients (97%). Medium FiO2 prescribed initially was of 0.29 (SD = 0.04). Basal arterial blood gas measurement was performed on 101 patients (84%). PaO2 was equal to or lower than 60 mmHg in 69 (68%). Arterial blood gas measurement control was carried out in 51 patients (42.5%). Of the patients with basal PaO2 lower or equal to 60 mmHg, 44 (64%) were submitted to posterior control measurement. 32 of the latter group showed PaO2 higher than 60 mmHg. We observed important deficiencies: increased prescription in patients with PaO2 greater than 60 mmHg; the frequent noncontrol of arterial blood gas measurement; the lack of correction of FiO2 when the initial application of O2 did not increase the PaO2 higher than 60 mmHg.