María José Cilleruelo

Pandemic H1N1 influenza-associated hospitalizations in children in Madrid, Spain.

Please cite this paper as: del Rosal et al. (2011) Pandemic H1N1 influenza‐associated hospitalizations in children in Madrid, Spain. Influenza and Other Respiratory Viruses 5(6), e544–e551.

Drug Utilization and Off-label Drug Use in Spanish Pediatric Gastroenterology Outpatients

Background and Objectives: The clinical use of medicines outside the conditions authorized in their Summary of Product Characteristics (SPC) (off-label use) is a common practice in pediatrics. The aim of the present study was to describe and quantify the medicines received by children attended in the pediatric gastroenterology department, their off-label use, and compliance with accepted rules for said use. Methods: A retrospective observational study was performed on all of the patients who had their first consultation in pediatric gastroenterology between January 1 and October 31, 2010. All of the clinical information and medicines prescribed were analyzed. Off-label use was defined as the use of medicines in indications not included in the officially approved SPC or in ages not included or recommended in the SPC as well as the use of doses, intervals, or administration routes different from those considered in the SPC. Results: A total of 695 patients (52.8% male) were included, 48.2% younger than 2 years. Two-hundred seven patients (29.8%) received 331 prescriptions. The most commonly used medicines were anti-H2 and proton pump inhibitors. Of all the prescriptions, 33.2% were considered off-label, and up to 47.3% of the prescribed patients had at least 1 medicine under off-label conditions. The medical records contained no documentation on information given to the parents regarding off-label use. Conclusions: The study found a high percentage of off-label use of medicines in the Pediatric Gastroenterology outpatient setting, especially in children younger than 2 years. Several initiatives were derived from the present study and implemented in our hospital.

Oseltamivir treatment for influenza in hospitalized children without underlying diseases.

Aim: To determine whether the treatment with oseltamivir improves the outcome of children with confirmed influenza infection and no other underlying disease. Methods: Multicentric, retrospective study performed in 10 hospitals of Madrid between September 2010 and June 2012. All children admitted to the hospitals with confirmed influenza infections were eligible. Children with risk factors for serious disease and nosocomial influenza infections were excluded. Asthma was not considered an exclusion factor. The study compared patients treated and untreated with oseltamivir. Fever duration, oxygen support, antibiotics administration, length of hospital stay, intensive care admission and bacterial complications were analyzed. To compare variables, &khgr;2 test, Fisher exact test, ANOVA or Mann-Whitney U test were used. Results: Two hundred eighty-seven children were included and 93 of them were treated with oseltamivir (32%). There were no significant differences between treated and untreated patients in days of fever after admission (1.7 ± 2; 2.1 ± 2.9, P > 0.05), length of stay (5.2 ± 3.6; 5.5 ± 3.4, P > 0.05), days of hypoxia (1.6 ± 2.3; 2.1 ± 2.9, P > 0.05), diagnosis of bacterial pneumonia (10%; 17%, P > 0.05), intensive care admission (6.5%; 1.5%,P > 0.05) or antibiotic prescription (44%; 51%, P > 0.05). There were no differences when the population was stratified by age (below or over 1 year) or by the presence or absence of asthma. Conclusions: There were no proven benefits of treatment with oseltamivir in hospitalized pediatric patients without the underlying diseases or risk factors for developing a serious illness, including those with asthma.

Documento de consenso SEIP-SERPE-SEOP sobre el tratamiento de la osteomielitis aguda y artritis séptica no complicadas

This is a Consensus Document of the Spanish Society of Paediatric Infectious Diseases (Sociedad Española de Infectología Pediatrica), Spanish Society of Paediatric Rheumatology (Sociedad Española de Reumatología Pediátrica) and the Spanish Society of Paediatric Orthopaedics (Sociedad Española de Ortopedia Pediátrica), on the treatment of uncomplicated acute osteomyelitis and septic arthritis. A review is presented on the medical and surgical treatment of acute osteoarticular infection, defined as a process with less than 14 days of symptomatology, uncomplicated and community-acquired. The different possible options are evaluated based on the best available scientific knowledge, and a number of evidence-based recommendations for clinical practice are provided.

Is there interference in the interpretation of the tuberculin skin test in children with intestinal parasitic infestation

Abstract Background: Infestation by intestinal parasites could be a cause of a false-negative tuberculin skin test (TST) result. Objective: To evaluate TST results in a population of immigrants and internationally adopted children and to analyze whether intestinal parasitic infestation may modify or not TST results. Methods: A cross-sectional observational study which includes adopted children or immigrants evaluated in our hospital between January 2003 and December 2008. The TST was considered as the dependent variable and independent variables were gender, age, geographical origin, bacille Calmette–Guérin scar, nutritional status, immune status, and intestinal parasitism. Results: One thousand and seventy-four children were included, of whom 69·6% were female. There was a bacillus Calmette–Guérin scar in 79% of the children and in 20·3% intestinal parasites were found. There were no differences in TST results among infested and non-infested children. Conclusions: Intestinal parasitic infestation did not change TST results in our study and these results coincide with recent articles regarding questionable interference that intestinal parasitic infestations may produce on TST results.

Documento de Consenso SEIP-SERPE-SEOP sobre etiopatogenia y diagnóstico de la osteomielitis aguda y artritis séptica no complicadas

This is a Consensus Document of the Sociedad Española de Infectología Pediátrica, Sociedad Española de Reumatología Pediátrica and Sociedad Española de Ortopedia Pediátrica on the aetiology and diagnosis of uncomplicated acute osteomyelitis and septic arthritis. A review is presented of the aetiopathogenesis and pathophysiology of acute osteoarticular infection defined as a process with less than 14 days of symptomatology, uncomplicated, and community-acquired. The diagnostic approach to these conditions is summarised based on the best available scientific knowledge. Based on this evidence, a number of recommendations for clinical practice are provided.

Viral phenotype, antiretroviral resistance and clinical evolution in human immunodeficiency virus-infected children.

BACKGROUND The syncytium-inducing (SI) viral phenotype and the emergence of viral strains resistant to zidovudine have been described in persons infected with HIV, and in some cases they have been associated with poor prognosis. METHODS HIV isolates obtained from 37 HIV-infected children were analyzed to determine whether the SI viral phenotype and the mutation on the 215 position of the reverse transcriptase (M215) could be used as markers of disease progression. We performed peripheral blood coculture mononuclear cells, and we analyzed the induction of syncytia using the MT-2 cell line. The emergence of mutations on the 215 position was determined by PCR. RESULTS We found a statistically significant association (P < 0.05) between SI viral phenotype and (1) recurrent serious bacterial infections, (2) absolute CD4+ cell counts <2 SD, (3) progression to AIDS and (4) death. Sixty percent of the children treated with zidovudine developed 215 mutant viral strains without statistically significant association with clinical or immunologic findings. The SI viral phenotype was statistically associated with the presence of the 215 mutation (P < 0.05). CONCLUSIONS SI viral phenotype is a marker associated with a poor clinical and immunologic progression of the disease and it may facilitate the emergence of mutant strains in children treated with zidovudine.

Anticuerpos anti-VHB y VHA en niños y adolescentes con VIH

INTRODUCTION Patients coinfected with HIV and hepatitis B virus (HBV) have a higher risk of developing chronic HBV infection and a higher risk of hepatotoxicity. Hepatitis A virus (HAV) in HIV-infected patients may require antiretroviral treatment interruption, producing prolonged viremia. In this study, we assess the prevalence of protective antibodies in these patients. METHODS A cross-sectional study was conducted to determine the prevalence of IgG antibodies against HAV and antibody against HBs (anti-HBs) in a cohort of 121 HIV-infected children and adolescents (1-19 years), followed-up in 4 public hospitals in Madrid (Spain). RESULTS Among the total, 12.4% (95% CI: 7.1-19.6%) of children and adolescents had positive serology for HAV. Children of immigrant origin presented a higher percentage than children born in Spain: 50% vs. 6.2%, respectively (P<0.001). In addition, 16.5% (95% CI: 10.4-24.3) of the study population had protective anti-HBs. A higher percentage of children with anti-HBs antibodies was seen in CDC clinical category A: 20% vs. 16% of those in clinical category B vs. 9.4% of those in clinical category C (P=0.19). The percentage of positive-positive children progressively decreased according to the years elapsed since HBV vaccination. DISCUSSION Most HIV-infected children and adolescents have no protective antibodies against natural infection by HBV and HAV. More studies are needed to define the best vaccination strategy to achieve a higher percentage of patients protected against these infections.

Viral load in relation to clinical outcome in HIV-infected children

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Otras parasitosis importadas

Con la expresion “otras parasitosis importadas” nos referimos a enfermedades parasitarias, distintas de la malaria, que diagnosticamos en ninos inmigrantes o viajeros de areas endemicas para esas enfermedades. En Espana viven unos 300.000 ninos inmigrantes, un grupo creciente de ninos procedentes de adopciones internacionales y una minoria de ninos viajeros de zonas endemicas. La complejidad de estas enfermedades hace necesario conocer la distribucion geografica de los parasitos, un alto indice de sospecha y un laboratorio especializado. El tratamiento implica conocer los farmacos disponibles y los dispensados por “medicamentos extranjeros”, las indicaciones y dosis pediatricas y las pautas alternativas para resistencias.