J.P. López Siguero

Treatment with Growth Hormone

Treatment with growth hormone in children is a very effective promotor of growth. The psychosocial environment of children may influence the results of this treatment. It has been shown that there is a clear relationship between the knowledge and understanding a child has of the treatment and the degree of compliance and acceptance. We have studied 90 children treated with growth hormone who filled in a questionnaire in order to know the knowledge and acceptance of their treatment. The scores for acceptance were significantly higher than for knowledge (p < 0.00001), without correlations between the two variables. The higher marks were achieved by children who had attended an educational camp. A serious lack of knowledge about the aspects directly related with the injection system was noted. We advise to design a suitable educational program for these patients.

Epidemiología de la diabetes mellitus tipo 1 en menores de 15 años en España

INTRODUCTION Epidemiological studies in many regions and countries have contributed to determining the epidemiology of type 1 diabetes (T1DM) in children less than 15 years old. Studies in many regions of Spain have been published, but the national incidence is not really known. MATERIAL AND METHODS A review was made of the publications on the epidemiology of T1DM in Spain, selecting the references on patients less than 15 years old. RESULTS Many epidemiological studies on T1DM in almost all regions in Spain have been published. The methodology of these studies is heterogeneous, with variations in geographical definition, duration, period of study, limit of age, and data collection. The incidence rates are variable, from 11.5 cases per 100,000/year in Asturias to 27.6 in Castilla-La Mancha. Some studies report the percentage of diabetic ketoacidosis at the time of diagnosis, which is usually in the range of 25-40%. CONCLUSIONS Although there have been various epidemiological studies on T1DM in almost all regions in Spain, the methodology is heterogeneous. The mean incidence of T1DM in children less than 15 years old in Spain, stimated from the selected studies is 17,69 cases per 100,000/year. T1DM registers need to be created and updated, using standardized methodology, to get more reliable data of the epidemiology of T1DM in Spain in the near future.Introduction Epidemiological studies in many regions and countries have contributed to determining the epidemiology of type 1 diabetes (T1DM) in children less than 15 years old. Studies in many regions of Spain have been published, but the national incidence is not really known.

Valores normales de TSH en el cribado neonatal del hipotiroidismo congénito en nacimientos gemelares

Introduccion A pesar del gran numero de trabajos publicados desde que, en la decada de 1970, se implantaron los programas de cribado neonatal para el diagnostico del hipotiroidismo congenito, no hay demasiados datos sobre resultados paradojicos o casos que pudieran escapar del cribado. Pacientes y metodos Hasta marzo de 2005, en Malaga se ha estudiado la hormona tiroestimulante (TSH) en 360.651 recien nacidos detectandose 156 hipotiroidismos congenitos, de los que 86 % fueron permanentes y 14 % transitorios. En este trabajo se analiza, retrospectivamente, un grupo de 13 hipotiroidismos congenitos nacidos de parto gemelar, en los que solamente uno de los hermanos ha tenido la enfermedad. Resultados Los dos primeros fueron diagnosticados tarde y se desconoce si se estudiaron en el cribado. En 7 casos la TSH dio un valor normal: cinco, diagnosticados mediante una segunda muestra realizada a los 14 dias, se trataron antes de un mes de vida; a dos no se repitio la prueba, iniciando tarde el tratamiento. Los cuatro restantes tuvieron desde la primera prueba un valor elevado de TSH, siendo significativamente inferior al obtenido para su confirmacion. Conclusiones En la actualidad se acepta que la funcion tiroidea pueda estar compensada entre los dos gemelos, resultando un falso negativo en el caso de ser uno de ellos hipotiroideo congenito. De los datos que se presentan se deduce la necesidad de repetir la prueba a los 14 dias en todos los nacimientos gemelares.

Función suprarrenal en niños con sepsis y shock séptico

Objetivos Estudiar la funcion suprarrenal en ninos con sepsis y shock septico asociados a petequias. Establecer la relacion entre insuficiencia suprarrenal e imagen ecografica de hemorragia suprarrenal bilateral masiva y otras variables disponibles precozmente. Pacientes y metodos Estudio prospectivo observacional de 24 pacientes (14 varones) de 2,9 ± 2,4 anos ingresados en una unidad de cuidados intensivos pediatricos con sepsis y shock septico asociados a petequias en un periodo de 1,5 anos. El grupo control incluyo 26 ninos sanos (13 varones) de 8,8 ± 4,2 anos. Se determinaron el cortisol y la hormona corticotropa (ACTH) mediante radioinmunoanalisis (RIA) en plasma y se realizo ecografia de suprarrenales. Resultados Los valores de cortisol y ACTH fueron 243,7 ng/ml y 135,0 pg/ml en el grupo estudiado y 145,4 ng/ml y 21,1 pg/ml en el control (p Conclusiones Los ninos con sepsis y shock septico presentan concentraciones plasmaticas de cortisol y ACTH elevadas. Una escasa proporcion presenta insuficiencia suprarrenal. La aparicion de insuficiencia suprarrenal se relaciona con presencia de grave afectacion hemodinamica, purpura necrotica, coagulacion intravascular diseminada (CID), hemorragia suprarrenal bilateral masiva y alta mortalidad.

Talla baja idiopática. Revisión y puesta al día

Idiopathic short stature (ISS) refers to all clinical conditions involving an alteration of growth (height<-2 SD) of unknown cause, with preservation of proportionality among body segments, with the expectation of adult height < -2 SDS, and in which a diagnosis of constitutional delay of growth and development has been previously ruled out. ISS is an exclusion diagnostic which requires clinical, biochemical, hormonal and molecular studies in order to rule out all known causes of growth retardation and short stature. ISS is a frequent diagnosis among children with short stature. Despite its frequency, there is still controversy on the best diagnostic and therapeutic approach when treating patients with ISS. This consensus document contains updated information on the definition, diagnosis and treatment of ISS, and provides new data and recommendations that have not been addressed in previous documents.

Insuficiencia suprarrenal secundaria a dosis altas de fluticasona inhalada

Recibido en septiembre de 1999. Aceptado para su publicación en febrero de 2000. INTRODUCCIÓN Los corticoides inhalados tienen una indicación bien establecida en la prevención y el tratamiento de la hiperreactividad bronquial, pero los estudios sobre sus efectos en niños, sobre todo menores de 6 años, son escasos. El gran aumento del uso prolongado de estos medicamentos conlleva la posibilidad de efectos sistémicos, de los cuales la supresión del eje suprarrenal es uno de los más importantes.

PO-0062 Technological Tools To Optimise Metabolic Control In Adolescents With Type 1 Diabetes

Introduction Flexible intensive therapy (FIT) emphasises in insulin administered before meals, adjusting the number of portions of carbohydrates and preprandialglycemic control. Accu - check expert (ACE) glucometer is a calculator with integrated data. It is necessary to introduce bolus insulin/carbohydrate ratio, factor sensitivity to insulin (FSI), ideal blood sugar and insulin duration adjusted by different time zones. It makes the calculation of insulin, managing in real-time the number of portions of carbohydrates and the glycemic control obtained. The patient must be trained how to change these parameters if it is required. Aims and methods Prospective randomised intervention to determine the effectiveness of bolus calculator ACE in type 1 diabetic (D1) adolescents with FIT and values of HbA1c higher than 7%. We measure glycosylated haemoglobin at 0, 3 and 6 months. Control group: 12 patients with D1 whose educational support involves counting portions and calculation of ratio and FSI before this intervention and at 3 months. Case group: 12 patients with D1 who have received equal educational support as control group and specific training on bolus calculator, before baseline and at 3 months. Results The groups are homogeneous in age, duration of diabetes and HbA1c before starting study. In both groups decreased HbA1c. There is a higher decrease in intervention group. The difference of HbA1c is significative statistically in case group at 6 months. Conclusions After the intervention both groups showed a decrease in HbA1c at 3 and 6 months, with higher difference in case group. This difference is clinically relevant and statistically significant in the case group when it is compared from baseline to 6 months. Abstract PO-0062 Table 1Introduction Flexible intensive therapy (FIT) emphasises in insulin administered before meals, adjusting the number of portions of carbohydrates and preprandialglycemic control. Accu - check expert (ACE) glucometer is a calculator with integrated data. It is necessary to introduce bolus insulin/carbohydrate ratio, factor sensitivity to insulin (FSI), ideal blood sugar and insulin duration adjusted by different time zones. It makes the calculation of insulin, managing in real-time the number of portions of carbohydrates and the glycemic control obtained. The patient must be trained how to change these parameters if it is required. Aims and methods Prospective randomised intervention to determine the effectiveness of bolus calculator ACE in type 1 diabetic (D1) adolescents with FIT and values of HbA1c higher than 7%. We measure glycosylated haemoglobin at 0, 3 and 6 months. Control group: 12 patients with D1 whose educational support involves counting portions and calculation of ratio and FSI before this intervention and at 3 months. Case group: 12 patients with D1 who have received equal educational support as control group and specific training on bolus calculator, before baseline and at 3 months. Results The groups are homogeneous in age, duration of diabetes and HbA1c before starting study. In both groups decreased HbA1c. There is a higher decrease in intervention group. The difference of HbA1c is significative statistically in case group at 6 months. Conclusions After the intervention both groups showed a decrease in HbA1c at 3 and 6 months, with higher difference in case group. This difference is clinically relevant and statistically significant in the case group when it is compared from baseline to 6 months.

Artículo especialEpidemiología de la diabetes mellitus tipo 1 en menores de 15 años en EspañaEpidemiology of type 1 diabetes mellitus in children in Spain

INTRODUCTION Epidemiological studies in many regions and countries have contributed to determining the epidemiology of type 1 diabetes (T1DM) in children less than 15 years old. Studies in many regions of Spain have been published, but the national incidence is not really known. MATERIAL AND METHODS A review was made of the publications on the epidemiology of T1DM in Spain, selecting the references on patients less than 15 years old. RESULTS Many epidemiological studies on T1DM in almost all regions in Spain have been published. The methodology of these studies is heterogeneous, with variations in geographical definition, duration, period of study, limit of age, and data collection. The incidence rates are variable, from 11.5 cases per 100,000/year in Asturias to 27.6 in Castilla-La Mancha. Some studies report the percentage of diabetic ketoacidosis at the time of diagnosis, which is usually in the range of 25-40%. CONCLUSIONS Although there have been various epidemiological studies on T1DM in almost all regions in Spain, the methodology is heterogeneous. The mean incidence of T1DM in children less than 15 years old in Spain, stimated from the selected studies is 17,69 cases per 100,000/year. T1DM registers need to be created and updated, using standardized methodology, to get more reliable data of the epidemiology of T1DM in Spain in the near future.Introduction Epidemiological studies in many regions and countries have contributed to determining the epidemiology of type 1 diabetes (T1DM) in children less than 15 years old. Studies in many regions of Spain have been published, but the national incidence is not really known.

Glucemia y cetonemia en diabéticos tipo 1 en el ambiente controlado de una colonia de verano

INTRODUCTION: Control of blood ketone levels and glycemia is advisable in certain situations in type 1 diabetic children and adolescents. The aims of this study were to assess the relationship between glycemia, ketonemia and ketonuria in children and adolescents in a summer camp under different conditions (fasting, casual hyperglycemia, moderate physical exercise) and to assess the utility of ketonemia determinations in diabetes control during this time. PATIENTS AND METHODS: There were 47 participants (25 boys and 22 girls), with a mean HbA1c determination prior to enrollment of 7.7 +/- 1.5 %. The mean age was 11.7 +/- 1.8 years and the mean time from onset of diabetes was 3.0 +/- 2.7 years. The mean body mass index was 18.3 +/- 3.9 kg/m2 (SDS -0.16 +/- 0.44), the mean insulin dose was 0.8 +/- 0.4 U/kg/ day, and the number of doses per day was between 2 and 4 (median = 3). Blood glucose and ketones (both measured with the Optium system, Abbott Diabetes Care) and urine ketones (Ketodiastix, Bayer) were determined in different situations. Statistical analysis was performed with the SPSS 11.5 program. RESULTS: Ketonemia results 45 minutes before and after moderate physical activity showed no significant increase in ketones (0.1 +/- 0.03 vs 0.23 +/- 0.07 mmol/l, ns). Preprandial blood ketone levels of > or = 0.5 mmol/l were found in 17.02 % of participants. Ketonemia was resolved during the first hour in all participants except one, in whom ketonemia resolved in 3 hours. Blood ketones were higher before breakfast than during the rest of the day (0.12 +/- 0.17 vs 0.02 +/- 0.05, p or = 0.5 mmol/l) was 174.5 +/- 64.7 mg/dl, a value slightly higher than the overall mean glycemia value (156.87 +/- 87.8 mg/dl). Ketonuria could not be measured in a high percentage of participants due to the difficulty of obtaining samples (between 24.5 % and 58.6 % in the different study groups). CONCLUSIONS: Measurement of glycemia together with ketonemia in a summer camp allows reliable follow-up of glycemic control to be performed. Ketonemia usually occurred before breakfast in parallel with slightly elevated glycemia, but resolved quickly. Moderate physical activity for 45 minutes does not seem to significantly increase blood ketones if metabolic control is normal. beta -HB is a useful parameter to determine whether moderate physical exercise is advisable or not. The lack of urinary ketone tests due to the difficulties of obtaining a sample can currently be solved by blood ketone measurement.

Adenoma de paratiroides en la edad preescolar

El hiperparatiroidismo primario es una entidad rara en la infancia. La forma neonatal se produce por hiperplasia de las glandulas paratiroides. En el resto de edades pediatricas las formas esporadicas se deben principalmente a adenomas y las familiares a hiperplasia. Los adenomas se presentan generalmente en adolescentes. En el caso que se describe, un adenoma de paratiroides fue extirpado en una nina de 11 anos con antecedente de hipercalcemia esporadica desde los 5,5 anos de edad, descubierta en una analitica y sin presentar sintomas ni complicaciones debidas a ella. Los estudios de imagen preoperatorios, entre ellos la gammagrafia con 99mTc-sestabimi, localizaron la lesion y la intervencion normalizo la calcemia. El adenoma de paratiroides se presenta tambien en la edad preescolar y su diagostico puede demorarse por la ausencia de sintomas.