58 results on '"Ruth García Romero"'
Search Results
2. Evaluation of liver function tests in the paediatric patient
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Víctor Fernández Ventureira, Ignacio Ros Arnal, Gerardo Rodríguez Martínez, Beatriz García Rodríguez, Ruth García Romero, and Eduardo Ubalde Sainz
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Hígado ,Función hepática ,Hipertransaminasemia asintomática ,Enzima alanino aminotransferasa ,Pediatrics ,RJ1-570 - Abstract
Introduction: Although changes in liver function tests can be non-specific in numerous clinical conditions, they can be the first sign of a potentially serious disease in an asymptomatic patient. Material and methods: Retrospective cohort study, performed by reviewing the records of children of a reference hospital central laboratory with alanine aminotransferase enzyme (ALT) elevation during a 6-month aleatory period. Results: 572 blood tests with serum ALT elevation corresponding to 403 patients have been assessed during the period studied. 98 patients were excluded for presenting abnormal liver test before the study period of comorbidity that could produce ALT elevation. The remaining 305 patients, 22.6% were diagnosed with a medical condition during the first blood test that explained the ALT elevation, although only 33.3% of them were followed up until verifying their normalisation. Final study sample consists of 236 patients with abnormal liver test without apparent liver disease. Adequate follow-up was found only in 29% of them. From this group, 9 patients (13%) were diagnosed with liver disease. The rest of the samples were not properly monitored. In patients with higher serum ALT levels, follow-up was early and more appropriate. Conclusions: In our area, most children without apparent liver disease are no properly monitored. Therefore, an opportunity to diagnosis and treat a potential liver disease was lost in a great number of children. All children with unexplained hypertransaminasaemia must be studied. Resumen: Introducción: Las alteraciones del perfil hepático constituyen un hecho inespecífico propio de numerosas condiciones clínicas. Sin embargo, puede implicar la primera manifestación de una patología potencialmente grave en un paciente asintomático. Material y métodos: Estudio observacional retrospectivo que incluye todas las analíticas sanguíneas con elevación de alanino aminotransferasa (ALT) en pacientes pediátricos solicitadas en un sector sanitario en un período de 6 meses. Resultados: Se registraron 572 analíticas correspondientes a 403 pacientes. Se excluyeron 98 pacientes con hipertransaminasemia ya conocida o comorbilidad. De los 305 restantes, el 22,6% se diagnosticaron de patología asociada a hipertransaminasemia, y de estos, se comprobó normalización en el 33,3%. De los 236 pacientes con hipertransaminasemia sin justificar se realizó un seguimiento en el 29%, encontrando patología hepática en 9 pacientes (13% del grupo). En el resto de la muestra no se comprobó analíticamente la evolución de las transaminasas ni la presencia de posible patología hepática. Los pacientes con cifras más elevadas se controlan mejor y antes que los que presentan cifras más bajas. Conclusiones: En nuestra área, la mayoría de los niños sin enfermedad hepática aparente con hallazgo de ALT elevada no son adecuadamente controlados. Esto hace que se pierda una oportunidad única de diagnosticar y tratar precozmente una enfermedad hepática potencial en un gran número de niños. Todo niño con hipertransaminasemia inexplicada debe ser estudiado.
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- 2021
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3. Carga del cuidador del paciente con parálisis cerebral moderada-grave: ¿influye el estado nutricional?
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José Miguel Martínez de Zabarte Fernández, Ignacio Ros Arnal, José Luis Peña Segura, Ruth García Romero, and Gerardo Rodríguez Martínez
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Cerebral palsy ,Caregivers ,Nutrition ,Dependency burden ,Pediatrics ,RJ1-570 - Abstract
Resumen: Introducción: Los pacientes con parálisis cerebral moderada-grave precisan de sus cuidadores para realizar las actividades básicas de la vida diaria (ABVD). Objetivos: Describir la presencia de comorbilidades, la percepción de dificultad de los cuidadores para las ABVD y analizar la influencia del grado de afectación motora, el estado nutricional y otras alteraciones neurológicas. Métodos: Estudio transversal y observacional. Se estudió a pacientes con parálisis cerebral grados III-IV-V según el Sistema de Clasificación de la Función Motora Gruesa (GMFCS). Se registraron las comorbilidades y se estudió la composición corporal mediante antropometría y bioimpedanciometría. Además, se hizo una encuesta de carga del cuidador sobre ABVD (10 ítems que exploran las diferentes actuaciones: higiene, vestido, transferencias, sueño y alimentación). Se estudió qué variables influyen más en la percepción de dificultad para las ABVD. Resultados: Muestra de 69 pacientes (50,7% mujeres, edad media de 10,46 ± 0,4 años), con los siguientes grados de GMFCS: grado III 36,2% (N = 25), grado IV 29,0% (N = 20) y grado V 34,8% (N = 24). Se halló relación entre la puntuación de carga del cuidador y el grado GMFCS (p = 0,003) y la discapacidad intelectual (p
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- 2021
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4. Caregiver burden in patients with moderate-severe cerebral palsy. The influence of nutritional status
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José Miguel Martínez de Zabarte Fernández, Ignacio Ros Arnal, José Luis Peña Segura, Ruth García Romero, and Gerardo Rodríguez Martínez
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Parálisis cerebral ,Cuidadores ,Nutrición ,Carga del cuidador ,Pediatrics ,RJ1-570 - Abstract
Introduction: Patients with moderate-severe cerebral palsy (CP) require the support of their caregivers to carry out the Activities of Daily Living (ADLs). Objectives: to describe the comorbidities, need for care in children with CP and to analyse the influence of the degree of motor involvement, nutritional status and other neurological disorders. Methods: Cross-sectional and observational study. Patients with CP degrees III–IV–V according to the Gross Motor Function Classification System (GMFCS) have been studied. A record of comorbidities has been made and body composition has been studied using anthropometry and bioimpedance. In addition, a caregiver burden survey on ADLs has been carried out (10 items on the different actions: hygiene, clothing, transfers, sleeping and feeding). Which variables have the greatest influence on the perception of difficulty in performing ADLs have been studied. Results: 69 patients (50.7% women, mean age 10.46 ± 0.4 years) were analysed, with GMFCS grades: grade III 36.2% (N = 25), grade IV 29.0% (N = 20), grade V 34.8% (N = 24). A relationship was found between the caregiver burden score and GMFCS grade (p = 0.003) and intellectual disability (DI) (p
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- 2021
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5. Situación nutricional en una población con parálisis cerebral moderada-grave: más allá del peso
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José Miguel Martínez de Zabarte Fernández, Ignacio Ros Arnal, José Luis Peña Segura, Ruth García Romero, and Gerardo Rodríguez Martínez
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Cerebral palsy ,Nutrition ,Bioimpedance ,Anthropometry ,Overweight ,Obesity ,Pediatrics ,RJ1-570 - Abstract
Resumen: Introducción: La parálisis cerebral (PC) es la causa más frecuente de discapacidad motora en la edad pediátrica. El objetivo es estudiar la situación nutricional de los pacientes con PC controlados en una unidad de referencia, así como la relación entre la afectación neurológica y la nutricional. Material y métodos: Estudio transversal, observacional, descriptivo y analítico en el que se han incluido pacientes con PC con grados III-IV-V (GMFCS) procedentes del área de influencia de un hospital pediátrico de referencia, con edades de 4-15 años. Se ha realizado: encuesta (con recogida de datos generales, medicaciones y hábitos nutricionales), estudio antropométrico y bioimpedanciometría (BIA). Resultados: El estudio incluyó 69 pacientes (reclutamiento 84,15%). Edad media 10,46 ± 0,43 años, el 50,7% mujeres. Distribución según GMFCS: grado III (36,2%), grado IV (29%), grado V (34,8%). Según el peso para la talla: desnutrición moderada el 21,8% (grado V: 33,3%), desnutrición grave el 5,8% (grado V: 12,6%), sobrepeso/obesidad el 23,2% (grado III: 24%; grado IV: 35%). Nivel adecuado de masa magra para su talla: grado III (36%), grado IV (55%), grado V (16,7%). Exceso de grasa: grado III (36%), grado IV (40%), grado V (29,2%). Comparación de masa grasa: BIA 6,89 ± 0,64 kg versus antropometría 5,56 ± 4,43 kg. Conclusiones: En PC grado GMFCS V es frecuente el déficit de peso asociado a disminución de masa magra para su talla. Los pacientes con PC grados GMFCS III-IV presentan una prevalencia llamativa de sobrepeso/obesidad. La antropometría es una herramienta útil para la valoración nutricional en niños con PC, aunque los niveles de grasa tienden a infravalorarse. Abstract: Introduction: Cerebral palsy (CP) is the most frequent cause of motor disability in the paediatric age. The aim of this article is the study of the nutritional status of patients with CP followed-up in a reference hospital, as well as the relationship between neurological and nutritional state. Material and methods: A cross-sectional, observational, descriptive and analytical study was conducted on a sample consisting of 4-15 years old patients with CP with Gross Motor Function Classification System (GMFCS) grades III-IV-V, from a specialised paediatric hospital reference area. An interview (collection of general data, medications and nutritional habits), anthropometric study and bioimpedance (BIA) measurements were carried out. Results: The study included 69 patients (recruitment 84.15%), with a mean age of 10.46 ± 0.43 years, and 50.7% females. The distribution according to GMFCS scale was: grade III (36.2%), grade IV (29%), and grade V (34.8%). According to weight for height: moderate malnutrition 21.8% (grade V: 33.3%), severe malnutrition 5.8% (grade V: 12.6%), overweight/obesity 23.2% (grade III: 24%, grade IV: 35%). Adequate level of lean mass for height: grade III (36%), grade IV (55%), and grade V (16.7%). Fat excess: grade III (36%), grade IV (40%), and grade V (29.2%). Fat mass comparison: BIA 6.89 ± 0.64 kg versus anthropometry 5.56 ± 4.43 kg. Conclusions: In CP grade GMFCS V, the weight deficit associated with a decrease in lean body mass is common. Patients with CP grades GMFCS III-IV have a significant prevalence of overweight/obesity. Anthropometry is a useful tool for nutritional assessment in children with CP, although fat levels could be underestimated.
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- 2020
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6. Nutritional status of a population with moderate-severe cerebral palsy: Beyond the weight
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José Miguel Martínez de Zabarte Fernández, Ignacio Ros Arnal, José Luis Peña Segura, Ruth García Romero, and Gerardo Rodríguez Martínez
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Parálisis cerebral ,Nutrición ,Bioimpedanciometría ,Antropometría ,Sobrepeso ,Obesidad ,Pediatrics ,RJ1-570 - Abstract
Introduction: Cerebral palsy (CP) is the most frequent cause of motor disability in the paediatric age. The aim of this article is the study of the nutritional status of patients with CP followed-up in a reference hospital, as well as the relationship between neurological and nutritional state. Material and methods: A cross-sectional, observational, descriptive and analytical study was conducted on a sample consisting of 4–15 year old patients with CP with Gross Motor Function Classification System (GMFCS) grades III–IV–V, from a specialised paediatric hospital reference area. An interview (collection of general data, medications and nutritional habits), anthropometric study and bioimpedance (BIA) measurements were carried out. Results: The study included 69 patients (recruitment 84.15%), with a mean age of 10.46 ± 0.43 years, and 50.7% females. The distribution according to GMFCS scale was: grade III (36.2%), grade IV (29%), and grade V (34.8%). According to weight for height: moderate malnutrition 21.8% (grade V: 33.3%), severe malnutrition 5.8% (grade V: 12.6%), overweight/obesity 23.2% (grade III: 24%, grade IV: 35%). Adequate level of lean mass for height: grade III (36%), grade IV (55%), and grade V (16.7%). Fat excess: grade III (36%), grade IV (40%), and grade V (29.2%). Fat mass comparison: BIA 6.89 ± 0.64 kg versus anthropometry 5.56 ± 4.43 kg. Conclusions: In CP grade GMFCS V, the weight deficit associated with a decrease in lean body mass is common. Patients with CP grades GMFCS III–IV have a significant prevalence of overweight/obesity. Anthropometry is a useful tool for nutritional assessment in children with CP, although fat levels could be underestimated. Resumen: Introducción: La parálisis cerebral (PC) es la causa más frecuente de discapacidad motora en edad pediátrica. El objetivo es estudiar la situación nutricional de los pacientes con PC controlados en una unidad de referencia, así como la relación entre la afectación neurológica y nutricional. Material y métodos: Estudio transversal, observacional, descriptivo y analítico en el que se han incluido pacientes con PC con grados III–IV–V (GMFCS) procedentes del área de influencia de un hospital pediátrico de referencia, con edades de 4–15 años. Se ha realizado: encuesta (con recogida de datos generales, medicaciones y hábitos nutricionales), estudio antropométrico y bioimpedanciometría (BIA). Resultados: N = 69 pacientes (reclutamiento 84,15%). Edad media 10,46 ± 0.43 años, el 50,7% mujeres. Distribución según GMFCS: grado III (36,2%), grado IV (29%), grado V (34,8%). Según el peso para la talla: desnutrición moderada el 21,8% (grado V: 33,3%), desnutrición grave el 5,8% (grado V: 12.6%), sobrepeso/obesidad el 23,2% (grado III: 24%; grado IV: 35%). Nivel adecuado de masa magra para su talla: grado III (36%), grado IV (55%), grado V (16,7%). Exceso de grasa: grado III (36%), grado IV (40%), grado V (29,2%). Comparación de masa grasa: BIA 6,89 ± 0,64 kg Vs antropometría 5,56 ± 4,43 kg. Conclusiones: En PC grado GMFCS V es frecuente el déficit de peso asociado a disminución de masa magra para su talla. Los pacientes con PC grados GMFCS III-IV presentan una prevalencia llamativa de sobrepeso/obesidad. La antropometría es una herramienta útil para la valoración nutricional en niños con PC, aunque los niveles de grasa tienden a infravalorarse.
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- 2020
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7. Implantación de la dieta baja en FODMAP para el dolor abdominal funcional
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María Luisa Baranguán Castro, Ignacio Ros Arnal, Ruth García Romero, Gerardo Rodríguez Martínez, and Eduardo Ubalde Sainz
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FODMAP ,Functional abdominal pain ,Diet ,Pediatrics ,RJ1-570 - Abstract
Resumen: Introducción: La dieta baja en FODMAP (acrónimo en inglés de polioles, monosacáridos, disacáridos y oligosacáridos fermentables) ha demostrado eficacia como tratamiento del síndrome de intestino irritable en adultos, siendo escasos los estudios en niños. Nuestro objetivo es analizar la implantación de esta dieta como tratamiento del dolor abdominal crónico funcional en población pediátrica de un área mediterránea, y su respuesta a esta. Material y métodos: Se elaboró una tabla clasificando los alimentos según su contenido en FODMAP, y se diseñó un «Diario de síntomas y deposiciones» para recoger los datos. Posteriormente se realizó un estudio prospectivo con niños con dolor abdominal crónico funcional de nuestra Unidad de Gastroenterología Pediátrica. Resultados: Se reclutaron 22 pacientes, 20 de los cuales completaron el estudio. Se recogieron durante 3 días datos sobre el dolor abdominal; posteriormente recibieron dieta baja en FODMAP 2 semanas, y al finalizarla recogieron de nuevo dichos datos. Tras la dieta se objetivó disminución en frecuencia diaria de episodios de dolor abdominal (1,16 [RIQ: 0,41-3,33] frente a 2 [RIQ: 1,33-6,33] inicialmente, p = 0,024), menor intensidad del dolor (1,41 cm [RIQ: 0,32-5,23] frente a 4,63 cm [RIQ: 2,51-6,39] inicial, p = 0,035, medido mediante Escala Visual Analógica de 10 cm), menor interferencia con la actividad diaria y menos síntomas acompañantes. Solo un 15% de los pacientes consideraron la dieta difícil. Conclusiones: La implantación de una dieta baja en FODMAP durante 2 semanas en una población pediátrica mediterránea con dolor abdominal crónico funcional es posible utilizando dietas adaptadas, es bien valorada por los pacientes, y su evaluación mediante herramientas objetivas muestra mejoría en los síntomas de dolor abdominal. Abstract: Introduction: The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. Material and methods: A table was designed in which foods were classified according to their FODMAP content, as well as a ‘Symptoms and Stools Diary’. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. Results: A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P = .024), less pain severity compared to baseline (1.41 cm [IQR: 0.32-5.23] versus 4.63 cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P = .035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. Conclusions: The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods.
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- 2019
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8. Implementation of a low FODMAP diet for functional abdominal pain
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María Luisa Baranguán Castro, Ignacio Ros Arnal, Ruth García Romero, Gerardo Rodríguez Martínez, and Eduardo Ubalde Sainz
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FODMAP ,Dolor abdominal funcional ,Dieta ,Pediatrics ,RJ1-570 - Abstract
Introduction: The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. Material and methods: A table was designed in which foods were classified according to their FODMAP content, as well as a ‘Symptoms and Stools Diary’. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. Results: A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41–3.33] versus 2 [IQR: 1.33–6.33] daily episodes, P = .024), less pain severity compared to baseline (1.41 cm [IQR: 0.32–5.23] versus 4.63 cm [IQR: 2.51–6.39] measured by 10-cm Visual Analogue Scale, P = .035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. Conclusions: The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods. Resumen: Introducción: La dieta baja en FODMAP (acrónimo en inglés de polioles, monosacáridos, disacáridos y oligosacáridos fermentables) ha demostrado eficacia como tratamiento del síndrome de intestino irritable en adultos, siendo escasos los estudios en niños. Nuestro objetivo es analizar la implantación de esta dieta como tratamiento del dolor abdominal crónico funcional en población pediátrica de un área mediterránea, y su respuesta a esta. Material y métodos: Se elaboró una tabla clasificando los alimentos según su contenido en FODMAP, y se diseñó un «Diario de síntomas y deposiciones» para recoger los datos. Posteriormente se realizó un estudio prospectivo con niños con dolor abdominal crónico funcional de nuestra Unidad de Gastroenterología Pediátrica. Resultados: Se reclutaron 22 pacientes, 20 de los cuales completaron el estudio. Se recogieron durante 3 días datos sobre el dolor abdominal; posteriormente recibieron dieta baja en FODMAP 2 semanas, y al finalizarla recogieron de nuevo dichos datos. Tras la dieta se objetivó disminución en frecuencia diaria de episodios de dolor abdominal (1,16 [RIQ: 0,41-3,33] frente a 2 [RIQ: 1,33-6,33] inicialmente, p = 0,024), menor intensidad del dolor (1,41 cm [RIQ: 0,32-5,23] frente a 4,63 cm [RIQ: 2,51-6,39] inicial, p = 0,035, medido mediante Escala Visual Analógica de 10 cm), menor interferencia con la actividad diaria y menos síntomas acompañantes. Solo un 15% de los pacientes consideraron la dieta difícil. Conclusiones: La implantación de una dieta baja en FODMAP durante 2 semanas en una población pediátrica mediterránea con dolor abdominal crónico funcional es posible utilizando dietas adaptadas, es bien valorada por los pacientes, y su evaluación mediante herramientas objetivas muestra mejoría en los síntomas de dolor abdominal.
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- 2019
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9. Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica
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Santiago Jiménez Treviño, Gemma Pujol Muncunill, Rafael Martín-Masot, Alejandro Rodríguez Martínez, Oscar Segarra Cantón, Luis Peña Quintana, Honorio Armas Ramos, Francisco Javier Eizaguirre Arocena, Josefa Barrio Torres, José Ignacio García Burriel, Luis Ortigosa Castillo, Ester Donat Aliaga, Vanesa Crujeiras Martínez, Patricia Barros García, Gonzalo Botija Arcos, Juan Manuel Bartolomé Porro, Mercedes Juste Ruiz, Carlos Ochoa Sangrador, Zuriñe García Casales, Gonzalo Galicia Poblet, Pablo Oliver Goicolea, Helena Lorenzo Garrido, Ruth García Romero, Enrique La Orden Izquierdo, David Pérez Solis, Víctor Manuel Navas-López, Juan José Díaz Martin, and Javier Martín de Carpi
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inflammatory bowel disease ,Crohn's disease ,ulcerative colitis ,diagnostic delay ,time to diagnosis ,children ,Pediatrics ,RJ1-570 - Abstract
Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain.Methods: We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified.Results: Overall TD was 4.4 months (interquartile range [IQR] 2.6–10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3–12.3] vs. 3 [IQR 1.6–5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03–7.17] in CD vs. 0.83 months [IQR 0.30–2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2–7) vs. 2 MODs ([IQR 1–5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1–8.9], p = 0.025).Conclusions: TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.
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- 2020
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10. Recomendaciones para el diagnóstico y manejo práctico de la esofagitis eosinofílica pediátrica
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Carolina Gutiérrez Junquera, Sonia Fernández Fernández, Gloria Domínguez-Ortega, Víctor Vila Miravet, Roger García Puig, Ruth García Romero, Ana Fernández de Valderrama, Rebeca Andradas Rivas, Carmen Alonso Vicente, Marina Álvarez Beltrán, Josefa Barrio Torres, Patricia Barros García, Gemma Colomé Rivero, Francisco Javier Eizaguirre Arocena, Beatriz Fernández Caamaño, Enrique la Orden Izquierdo, Rosaura Leis Trabazo, Helena Lorenzo Garrido, Enrique Medina Benítez, Montserrat Montraveta Querol, and Raquel Vecino López
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Eosinophilic oesophagitis ,Recommendations ,Diagnosis ,Proton pump inhibitors ,Diet ,Corticosteroids ,Pediatrics ,RJ1-570 - Abstract
Resumen: La esofagitis eosinofílica es una enfermedad emergente, crónica, mediada por el sistema inmune y caracterizada por síntomas de disfunción esofágica e inflamación con infiltración eosinofílica aislada en el esófago. Es más frecuente en varones y en sujetos atópicos y los síntomas varían con la edad: en niños pequeños se manifiesta con vómitos, dolor abdominal y problemas con la alimentación y en niños mayores y adolescentes con disfagia e impactación alimentaria. El diagnóstico se basa en la presencia de síntomas e inflamación esofágica con ≥ 15 eosinófilos/campo de gran aumento, tras descartar otras causas de eosinofilia esofágica. Sin tratamiento, la enfermedad suele persistir y puede evolucionar a formas fibroestenóticas más frecuentes en el adulto. Las opciones terapéuticas incluyen inhibidores de la bomba de protones, dieta de eliminación empírica y corticoides deglutidos. Tras el tratamiento de inducción es aconsejable la terapia de mantenimiento. La dieta es el único tratamiento que se dirige a la causa de la enfermedad, al identificar los alimentos desencadenantes. La respuesta a los tratamientos requiere la evaluación histológica, por la escasa concordancia entre los síntomas y la inflamación esofágica.El manejo práctico de la esofagitis eosinofílica presenta desafíos debido, entre otras causas, a la falta de disponibilidad actual de fármacos específicos y a su abordaje con tratamientos dietéticos, en ocasiones, complejos. El presente documento, elaborado por el Grupo de Trabajo de Trastornos Gastrointestinales Eosinofílicos de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátricas, tiene como objetivo facilitar el abordaje diagnóstico y terapéutico de la esofagitis eosinofílica pediátrica, con base en las recientes guías de consenso basadas en la evidencia. Abstract: Eosinophilic oesophagitis is an emerging and chronic disorder mediated by the immune system, and is characterised by symptoms of oesophageal dysfunction and inflammation with isolated eosinophil infiltration in the oesophagus. It is more common in males and in atopic subjects, and the symptoms vary with age. In younger children, there is vomiting, abdominal pain and dietary problems, with dysphagia and food impaction in older children and adolescents. The diagnosis is based on the presence of symptoms and oesophageal inflammation with ≥ 15 eosinophils / high power field, and after ruling out other causes of oesophageal eosinophilia. Without treatment, the disease usually persists and can progress to fibrostenotic forms more common in adults. The treatment options included proton pump inhibitors, empirical elimination diets, and swallowed topical corticosteroids. Maintenance therapy is advisable after the induction treatment. Diet is the only treatment that is directed at the cause of the disease, on identifying the triggering food or foods. The response to the treatments requires a histological assessment due to the poor agreement between the symptoms and the oesophageal inflammation.The practical management of Eosinophilic oesophagitis presents with challenges, due to, among other causes, the current lack of availability of specific drugs, and to its approach with, occasionally complex, diet treatments. The present document, prepared by the Working Group on Eosinophilic Gastrointestinal Disorders of the Spanish Society of Paediatric Gastroenterology, Hepatology and Nutrition, has as its objective to help in the diagnostic and therapeutic approach to paediatric eosinophilic oesophagitis, based on the recent evidence-based consensus guidelines.
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- 2020
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11. Recommendations for the diagnosis and practical management of paediatric eosinophilic oesophagitis
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Carolina Gutiérrez Junquera, Sonia Fernández Fernández, Gloria Domínguez-Ortega, Víctor Vila Miravet, Roger García Puig, Ruth García Romero, Ana Fernández de Valderrama, Rebeca Andradas Rivas, Carmen Alonso Vicente, Marina Álvarez Beltrán, Josefa Barrio Torres, Patricia Barros García, Gemma Colomé Rivero, Francisco Javier Eizaguirre Arocena, Beatriz Fernández Caamaño, Enrique la Orden Izquierdo, Rosaura Leis Trabazo, Helena Lorenzo Garrido, Enrique Medina Benítez, Montserrat Montraveta Querol, and Raquel Vecino López
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Esofagitis eosinofílica ,Recomendaciones ,Diagnóstico ,Inhibidores de la bomba de protones ,Dieta ,Corticoides ,Pediatrics ,RJ1-570 - Abstract
Eosinophilic oesophagitis is an emerging and chronic disorder mediated by the immune system, and is characterised by symptoms of oesophageal dysfunction and inflammation with isolated eosinophil infiltration in the oesophagus. It is more common in males and in atopic subjects, and the symptoms vary with age. In younger children, there is vomiting, abdominal pain and dietary problems, with dysphagia and food impaction in older children and adolescents. The diagnosis is based on the presence of symptoms and oesophageal inflammation with ≥15 eosinophils/high power field, and after ruling out other causes of oesophageal eosinophilia. Without treatment, the disease usually persists and can progress to fibrostenotic forms more common in adults. The treatment options included proton pump inhibitors, empirical elimination diets, and swallowed topical corticosteroids. Maintenance therapy is advisable after the induction treatment. Diet is the only treatment that is directed at the cause of the disease, on identifying the triggering food or foods. The response to the treatments requires a histological assessment due to the poor agreement between the symptoms and the oesophageal inflammation.The practical management of Eosinophilic oesophagitis presents with challenges, due to, among other causes, the current lack of availability of specific drugs, and its approach with, occasionally complex, diet treatments. The present document, prepared by the Working Group on Eosinophilic Gastrointestinal Disorders of the Spanish Society of Paediatric Gastroenterology, Hepatology and Nutrition, has as its objective to help in the diagnostic and therapeutic approach to paediatric eosinophilic oesophagitis, based on the recent evidence-based consensus guidelines. Resumen: La esofagitis eosinofílica es una enfermedad emergente, crónica, mediada por el sistema inmune y caracterizada por síntomas de disfunción esofágica e inflamación con infiltración eosinofílica aislada en el esófago. Es más frecuente en varones y en sujetos atópicos y los síntomas varían con la edad: en niños pequeños se manifiesta con vómitos, dolor abdominal y problemas con la alimentación y en niños mayores y adolescentes con disfagia e impactación alimentaria. El diagnóstico se basa en la presencia de síntomas e inflamación esofágica con ≥ 15 eosinófilos/campo de gran aumento, tras descartar otras causas de eosinofilia esofágica. Sin tratamiento, la enfermedad suele persistir y puede evolucionar a formas fibroestenóticas más frecuentes en el adulto. Las opciones terapéuticas incluyen inhibidores de la bomba de protones, dieta de eliminación empírica y corticoides deglutidos. Tras el tratamiento de inducción es aconsejable la terapia de mantenimiento. La dieta es el único tratamiento que se dirige a la causa de la enfermedad, al identificar los alimentos desencadenantes. La respuesta a los tratamientos requiere la evaluación histológica, por la escasa concordancia entre los síntomas y la inflamación esofágica.El manejo práctico de la esofagitis eosinofílica presenta desafíos debido, entre otras causas, a la falta de disponibilidad actual de fármacos específicos y a su abordaje con tratamientos dietéticos, en ocasiones, complejos. El presente documento, elaborado por el Grupo de Trabajo de Trastornos Gastrointestinales Eosinofílicos de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátricas, tiene como objetivo facilitar el abordaje diagnóstico y terapéutico de la esofagitis eosinofílica pediátrica, con base en las recientes guías de consenso basadas en la evidencia.
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- 2020
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12. Evaluación de la disfagia. Resultados tras un año de la incorporación de la videofluoroscopia en nuestro centro
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Ruth García Romero, Ignacio Ros Arnal, María José Romea Montañés, José Antonio López Calahorra, Cristina Gutiérrez Alonso, Beatriz Izquierdo Hernández, and Carlos Martín de Vicente
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Dysphagia ,Video fluoroscopy ,Swallowing ,Aspiration ,Cerebral palsy ,Pediatrics ,RJ1-570 - Abstract
Resumen: Introducción: La disfagia es muy frecuente en niños con discapacidad neurológica. Estos pacientes suelen presentar problemas respiratorios y nutricionales. El estudio de la deglución por videofluoroscopia (VFC) suele ser el más recomendado, ya que revela la situación real durante la deglución. Objetivos: Estudiar los resultados obtenidos en la evaluación diagnóstica tras un año desde la implantación de la VFC en nuestro centro, y analizar la mejoría clínica tras la confirmación por VFC y la prescripción de un tratamiento individualizado en los niños con disfagia orofaríngea. Material y métodos: Se recogen las VFC realizadas en el último año. Se analizan las siguientes variables: edad, enfermedad, grado de afectación neurológica, tipo de disfagia (oral, faríngea y/o esofágica), gravedad, aspiraciones y/o penetraciones, tratamiento prescrito y mejora nutricional y/o respiratoria tras el diagnóstico. Se realiza análisis estadístico mediante SPSS v21. Resultados: Se realizaron 61 VFC. Se detectó disfagia en más del 70%, siendo moderadas-graves en el 58%. Se visualizaron aspiraciones y/o penetraciones en el 59%, siendo silentes el 50%. Se prescribió dieta adaptada al 56% y gastrostomía en 13 pacientes (21%). Se encontró asociación estadística entre enfermedad neurológica y la gravedad de la disfagia, existiendo relación según el grado de afectación motora y la presencia de aspiraciones. Tras la evaluación por VFC y la adecuación del tratamiento se encontró una mejoría nutricional en Z-score de peso (+ 0,3 DE) e IMC (+ 0,4 DE) y una mejoría respiratoria en un 71% de los pacientes disfágicos controlados en Neumología. Conclusiones: Tras la implantación de la VFC se ha diagnosticado a un alto porcentaje de pacientes, que se han beneficiado de un diagnóstico y un tratamiento correctos. La VFC es una prueba diagnóstica fundamental que debería ser incluida en los centros pediátricos, como método diagnóstico de los niños con sospecha disfagia. Abstract: Introduction: Dysphagia is very common in children with neurological disabilities. These patients usually suffer from respiratory and nutritional problems. The videofluoroscopic swallowing study (VFSS) is the most recommended test to evaluate dysphagia, as it shows the real situation during swallowing. Objectives: To analyse the results obtained in our centre after one year of the implementation of VFSS, the clinical improvement after confirmation, and the prescription of an individualised treatment for the patients affected. Material and methods: VFSS performed in the previous were collected. The following variables were analysed: age, pathology, degree of neurological damage, oral and pharyngeal and/or oesophageal dysphagia and its severity, aspirations, prescribed treatment, and nutritional and respiratory improvement after diagnosis. A statistical analysis was performed using SPSS v21. Results: A total of 61 VFSS were performed. Dysphagia was detected in more than 70%, being moderate-severe in 58%. Aspirations and/or penetrations were recorded in 59%, of which 50% were silent. Adapted diet was prescribed to 56%, and gastrostomy was performed on 13 (21%) patients. A statistical association was found between neurological disease and severity of dysphagia. The degree of motor impairment is related to the presence of aspirations. After VFSS evaluation and treatment adjustment, nutritional improvement was found in Z-score of weight (+ 0.3 SD) and BMI (+ 0.4 SD). There was respiratory improvement in 71% of patients with dysphagia being controlled in the Chest Diseases Department. Conclusions: After implementation of VFSS, a high percentage of patients were diagnosed and benefited from a correct diagnosis and treatment. VFSS is a fundamental diagnostic test that should be included in paediatric centres as a diagnostic method for children with suspected dysphagia.
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- 2018
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13. Evaluation of dysphagia. Results after one year of incorporating videofluoroscopy into its study
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Ruth García Romero, Ignacio Ros Arnal, María José Romea Montañés, José Antonio López Calahorra, Cristina Gutiérrez Alonso, Beatriz Izquierdo Hernández, and Carlos Martín de Vicente
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Disfagia ,Videofluoroscopia ,Deglución ,Aspiración ,Páralisis cerebral ,Pediatrics ,RJ1-570 - Abstract
Introduction: Dysphagia is very common in children with neurological disabilities. These patients usually suffer from respiratory and nutritional problems. The videofluoroscopic swallowing study (VFSS) is the most recommended test to evaluate dysphagia, as it shows the real situation during swallowing. Objectives: To analyse the results obtained in our centre after one year of the implementation of VFSS, the clinical improvement after confirmation, and the prescription of an individualised treatment for the patients affected. Material and methods: VFSS performed in the previous were collected. The following variables were analysed: age, pathology, degree of neurological damage, oral and pharyngeal and/or oesophageal dysphagia and its severity, aspirations, prescribed treatment, and nutritional and respiratory improvement after diagnosis. A statistical analysis was performed using SPSS v21. Results: A total of 61 VFSS were performed. Dysphagia was detected in more than 70%, being moderate-severe in 58%. Aspirations and/or penetrations were recorded in 59%, of which 50% were silent. Adapted diet was prescribed to 56%, and gastrostomy was performed on 13 (21%) patients. A statistical association was found between neurological disease and severity of dysphagia. The degree of motor impairment is related to the presence of aspirations. After VFSS evaluation and treatment adjustment, nutritional improvement was found in Z-score of weight (+0.3SD) and BMI (+0.4SD). There was respiratory improvement in 71% of patients with dysphagia being controlled in the Chest Diseases Department. Conclusions: After implementation of VFSS, a high percentage of patients were diagnosed and benefited from a correct diagnosis and treatment. VFSS is a fundamental diagnostic test that should be included in paediatric centres as a diagnostic method for children with suspected dysphagia. Resumen: Introducción: La disfagia es muy frecuente en niños con discapacidad neurológica. Estos pacientes suelen presentar problemas respiratorios y nutricionales. El estudio de la deglución por videofluoroscopia (VFC) suele ser el más recomendado, ya que revela la situación real durante la deglución. Objetivos: Estudiar los resultados obtenidos en la evaluación diagnóstica tras un año desde la implantación de la VFC en nuestro centro, y analizar la mejoría clínica tras la confirmación por VFC y la prescripción de un tratamiento individualizado en los niños con disfagia orofaríngea. Material y métodos: Se recogen las VFC realizadas en el último año. Se analizan las siguientes variables: edad, enfermedad, grado de afectación neurológica, tipo de disfagia (oral, faríngea y/o esofágica), gravedad, aspiraciones y/o penetraciones, tratamiento prescrito y mejora nutricional y/o respiratoria tras el diagnóstico. Se realiza análisis estadístico mediante SPSS v21. Resultados: Se realizaron 61 VFC. Se detectó disfagia en más del 70%, siendo moderadas-graves en el 58%. Se visualizaron aspiraciones y/o penetraciones en el 59%, siendo silentes el 50%. Se prescribió dieta adaptada al 56% y gastrostomía en 13 pacientes (21%). Se encontró asociación estadística entre enfermedad neurológica y la gravedad de la disfagia, existiendo relación según el grado de afectación motora y la presencia de aspiraciones. Tras la evaluación por VFC y la adecuación del tratamiento se encontró una mejoría nutricional en Z-score de peso (+0,3 DE) e IMC (+0,4 DE) y una mejoría respiratoria en un 71% de los pacientes disfágicos controlados en Neumología. Conclusiones: Tras la implantación de la VFC se ha diagnosticado a un alto porcentaje de pacientes, que se han beneficiado de un diagnóstico y un tratamiento correctos. La VFC es una prueba diagnóstica fundamental que debería ser incluida en los centros pediátricos, como método diagnóstico de los niños con sospecha disfagia.
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- 2018
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14. Seronegative autoimmune hepatitis: Description of two paediatric cases
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Lorena Lahílla Cuello, Ignacio Ros Arnal, Ruth García Romero, and Carlos Hörndler Argarate
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Pediatrics ,RJ1-570 - Published
- 2018
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15. Hepatitis autoinmune seronegativa, descripción de 2 casos en edad pediátrica
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Lorena Lahílla Cuello, Ignacio Ros Arnal, Ruth García Romero, and Carlos Hörndler Argarate
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Pediatrics ,RJ1-570 - Published
- 2018
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16. Vitamin D Status in Pediatric and Young Adult Cystic Fibrosis Patients. Are the New Recommendations Effective?
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Carmen Mangas-Sánchez, María Garriga-García, María Juliana Serrano-Nieto, Ruth García-Romero, Marina Álvarez-Beltrán, Elena Crehuá-Gaudiza, Rosana Muñoz-Codoceo, Lucrecia Suárez-Cortina, Saioa Vicente-Santamaría, Cecilia Martínez-Costa, Juan José Díaz-Martin, Carlos Bousoño-García, and David González-Jiménez
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vitamin D ,cystic fibrosis ,multicenter study ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Introduction: In recent years, guidelines for vitamin D supplementation have been updated and prophylactic recommended doses have been increased in patients with cystic fibrosis (CF). Objective: To evaluate safety and efficacy of these new recommendations. Results: Two cohorts of pancreatic insufficient CF patients were compared before (cohort 1: 179 patients) and after (cohort 2: 71 patients) American CF Foundation and European CF Society recommendations were published. Cohort 2 patients received higher Vitamin D doses: 1509 (1306–1711 95% CI) vs 1084 (983–1184 95% CI) IU/Day (p < 0.001), had higher 25 OH vitamin D levels: 30.6 (27.9–33.26 95% CI) vs. 27.4 (25.9–28.8 95% CI) ng/mL (p = 0.028), and had a lower prevalence of insufficient vitamin D levels (p = 0.011). Adjusted by confounding factors, patients in cohort 1 had a higher risk of vitamin D insufficiency: OR 2.23 (1.09–4.57 95% CI) (p = 0.028). Conclusion: After the implementation of new guidelines, CF patients received higher doses of vitamin D and a risk of vitamin D insufficiency decreased. Despite this, almost a third of CF patients still do not reach sufficient serum calcidiol levels.
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- 2021
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17. Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP
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Melinda Moriczi, Gemma Pujol-Muncunill, Rafael Martín-Masot, Santiago Jiménez Treviño, Oscar Segarra Cantón, Carlos Ochoa Sangrador, Luis Peña Quintana, Daniel González Santana, Alejandro Rodríguez Martínez, Antonio Rosell Camps, Honorio Armas, Josefa Barrio, Rafael González de Caldas, Mónica Rodríguez Salas, Elena Balmaseda Serrano, Ester Donat Aliaga, Andrés Bodas Pinedo, Esther Vaquero Sosa, Raquel Vecino López, Alfonso Solar Boga, Ana Moreno Álvarez, César Sánchez Sánchez, Mar Tolín Hernani, Carolina Gutiérrez Junquera, Nazareth Martinón Torres, María Rosaura Leis Trabazo, Francisco Javier Eizaguirre, Mónica García Peris, Enrique Medina Benítez, Beatriz Fernández Caamaño, Ana María Vegas Álvarez, Laura Crespo Valderrábano, Carmen Alonso Vicente, Javier Rubio Santiago, Rafael Galera-Martínez, Ruth García-Romero, Ignacio Ros Arnal, Santiago Fernández Cebrián, Helena Lorenzo Garrido, Javier Francisco Viada Bris, Marta Velasco Rodríguez-Belvis, Juan Manuel Bartolomé Porro, Miriam Blanco Rodríguez, Patricia Barros García, Gonzalo Botija, Francisco José Chicano Marín, Enrique La Orden Izquierdo, Elena Crehuá-Gaudiza, Víctor Manuel Navas-López, and Javier Martín-de-Carpi
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inflammatory bowel disease ,Crohn’s disease ,exclusive enteral nutrition ,calprotectin ,children ,paediatric ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.
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- 2020
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18. Lead ingestion, medical emergency and action plan
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María Teresa, García Castellanos, Ruth, García Romero, and Paolo, Bragagnini Rodríguez
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Ingestion of lead material represents a therapeutic challenge involving high toxicity, significant clinical impact, and controversy regarding management. We report the case of a 2-year-old girl, who accidentally ingested a fishing sinker. She remained asymptomatic and first level tests were performed (blood lead levels and x-ray to locate object). Because of sinker location in the jejunum, two rectal enemas and polyethylene glycol (PEG) were administered, serial blood lead level measurements were performed. Because of sinker persistence, a colonoscopy was undertaken. She did not require chelation treatment. However, she required follow-up to monitor long-term toxicity and sequels.
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- 2022
19. Correlation of Anti-Tissue Transglutaminase Antibodies With the Mucosal Changes and IgA Status of Children With Celiac Disease
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Ester, Donat, María, Roca, Gemma, Castillejo, Félix, Sánchez-Valverde, Jose Ignacio, García-Burriel, Eva, Martínez-Ojinaga, Francisco Javier, Eizaguirre, Josefa, Barrio, Mª Luz, Cilleruelo, David, Pérez-Solís, Carlos, Ochoa-Sangrador, Raquel, Vecino-López, Mª Del Carmen, Miranda-Cid, Salvador, García-Calatayud, Ricardo, Torres-Peral, Mercedes, Juste, Honorio, Armas, Patricia, Barros-García, Rosaura, Leis, Rosa, Solaguren, José Carlos, Salazar, Ruth, García-Romero, Luis, Ortigosa, Luis, Peña-Quintana, Pedro, Urruzuno, Pilar, Codoñer-Franch, Zuriñe, Garcia-Casales, Maria Llüisa, Masiques, Gonzalo, Galicia-Poblet, Elena, Crehuá-Gaudiza, Elena, Balmaseda, Javier, Rubio-Santiago, Isabel, Polanco-Allué, Enriqueta, Román-Riechmann, and Carmen, Ribes-Koninckx
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Celiac Disease ,Transglutaminases ,Adolescent ,Biopsy ,Immunoglobulin G ,Pediatrics, Perinatology and Child Health ,Gastroenterology ,Humans ,Child ,Autoantibodies ,Immunoglobulin A - Abstract
The objective of this study was to assess the association between serological markers and changes of the intestinal mucosa in children with celiac disease (CD).Clinical data from CD patients under 15 years old were collected from the participating centers in an on-line multicenter nationwide observational Spanish registry called REPAC-2 (2011-2017). Correlation between anti-tissue transglutaminase antibodies (t-TGA) levels and other variables, including mucosal damage and clinical findings (symptoms, age, and gender), was assessed.A total of 2955 of 4838 patients had t-TGA and a small bowel biopsy (SBB) performed for CD diagnosis. A total of 1931 (66.2%) patients with normal IgA values had a Marsh 3b-c lesion and 1892 (64.9%) had t-TGA Immunoglobulin A (IgA) ≥ 10 times upper limit of normal (ULN). There is a statistically significant association between t-TGA IgA levels and the degree of mucosal damage ( P0.001), the higher the t-TGA IgA levels the more severe the mucosal damage. Those patients who reported symptoms had more severe mucosal damage ( P = 0.001). On the contrary, there was a negative association between age and changes of the intestinal mucosa ( P0.001). No association was found with gender. Regarding the IgA-deficient patients, 47.4% (18 cases) had t-TGA Immunoglobulin A (IgA) ≥ 10 times ULN and a Marsh 3b-c lesion was observed in 68.4% (26 patients). No statistical relation was found between t-TGA IgG levels and the changes of the intestinal mucosa, neither a relation with age, gender, or symptoms.There is a positive correlation between t-TGA IgA levels and the severity of changes of the intestinal mucosa. Such correlation was not found in IgA-deficient patients who had positive t-TGA IgG serology. The results in this group of patients support the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition recommendations about the need of performing a SBB in IgA-deficient individuals despite high t-TGA IgG levels.
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- 2022
20. Evaluation of liver function tests in the paediatric patient
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Ruth García Romero, Víctor Fernández Ventureira, Eduardo Ubalde Sainz, Ignacio Ros Arnal, Gerardo Rodríguez Martínez, and Beatriz García Rodríguez
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medicine.medical_specialty ,Función hepática ,Disease ,Enzima alanino aminotransferasa ,Asymptomatic ,Pediatrics ,RJ1-570 ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Liver Function Tests ,030225 pediatrics ,Management of Technology and Innovation ,Internal medicine ,medicine ,Blood test ,Humans ,Child ,Retrospective Studies ,medicine.diagnostic_test ,Hígado ,business.industry ,Liver Diseases ,Retrospective cohort study ,Alanine Transaminase ,medicine.disease ,Comorbidity ,Hipertransaminasemia asintomática ,Liver function ,medicine.symptom ,business ,Liver function tests - Abstract
Introduction: Although changes in liver function tests can be non-specific in numerous clinical conditions, they can be the first sign of a potentially serious disease in an asymptomatic patient. Material and methods: Retrospective cohort study, performed by reviewing the records of children of a reference hospital central laboratory with alanine aminotransferase enzyme (ALT) elevation during a 6-month aleatory period. Results: 572 blood tests with serum ALT elevation corresponding to 403 patients have been assessed during the period studied. 98 patients were excluded for presenting abnormal liver test before the study period of comorbidity that could produce ALT elevation. The remaining 305 patients, 22.6% were diagnosed with a medical condition during the first blood test that explained the ALT elevation, although only 33.3% of them were followed up until verifying their normalisation. Final study sample consists of 236 patients with abnormal liver test without apparent liver disease. Adequate follow-up was found only in 29% of them. From this group, 9 patients (13%) were diagnosed with liver disease. The rest of the samples were not properly monitored. In patients with higher serum ALT levels, follow-up was early and more appropriate. Conclusions: In our area, most children without apparent liver disease are no properly monitored. Therefore, an opportunity to diagnosis and treat a potential liver disease was lost in a great number of children. All children with unexplained hypertransaminasaemia must be studied. Resumen: Introducción: Las alteraciones del perfil hepático constituyen un hecho inespecífico propio de numerosas condiciones clínicas. Sin embargo, puede implicar la primera manifestación de una patología potencialmente grave en un paciente asintomático. Material y métodos: Estudio observacional retrospectivo que incluye todas las analíticas sanguíneas con elevación de alanino aminotransferasa (ALT) en pacientes pediátricos solicitadas en un sector sanitario en un período de 6 meses. Resultados: Se registraron 572 analíticas correspondientes a 403 pacientes. Se excluyeron 98 pacientes con hipertransaminasemia ya conocida o comorbilidad. De los 305 restantes, el 22,6% se diagnosticaron de patología asociada a hipertransaminasemia, y de estos, se comprobó normalización en el 33,3%. De los 236 pacientes con hipertransaminasemia sin justificar se realizó un seguimiento en el 29%, encontrando patología hepática en 9 pacientes (13% del grupo). En el resto de la muestra no se comprobó analíticamente la evolución de las transaminasas ni la presencia de posible patología hepática. Los pacientes con cifras más elevadas se controlan mejor y antes que los que presentan cifras más bajas. Conclusiones: En nuestra área, la mayoría de los niños sin enfermedad hepática aparente con hallazgo de ALT elevada no son adecuadamente controlados. Esto hace que se pierda una oportunidad única de diagnosticar y tratar precozmente una enfermedad hepática potencial en un gran número de niños. Todo niño con hipertransaminasemia inexplicada debe ser estudiado.
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- 2021
21. Nutritional status of a population with moderate-severe cerebral palsy: Beyond the weight
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Ruth García Romero, José Miguel Martínez de Zabarte Fernández, Gerardo Rodríguez Martínez, José L. Segura, and Ignacio Ros Arnal
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Male ,Pediatric Obesity ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Population ,Obesidad ,Nutritional Status ,Overweight ,Severity of Illness Index ,RJ1-570 ,Cerebral palsy ,Bioimpedanciometría ,Thinness ,Risk Factors ,Management of Technology and Innovation ,Prevalence ,medicine ,Humans ,Parálisis cerebral ,Child ,education ,education.field_of_study ,business.industry ,Cerebral Palsy ,Malnutrition ,Gross Motor Function Classification System ,Anthropometry ,medicine.disease ,Obesity ,Cross-Sectional Studies ,Antropometría ,Nutrición ,Sobrepeso ,Child, Preschool ,Lean body mass ,Female ,medicine.symptom ,business - Abstract
Introduction: Cerebral palsy (CP) is the most frequent cause of motor disability in the paediatric age. The aim of this article is the study of the nutritional status of patients with CP followed-up in a reference hospital, as well as the relationship between neurological and nutritional state. Material and methods: A cross-sectional, observational, descriptive and analytical study was conducted on a sample consisting of 4–15 year old patients with CP with Gross Motor Function Classification System (GMFCS) grades III–IV–V, from a specialised paediatric hospital reference area. An interview (collection of general data, medications and nutritional habits), anthropometric study and bioimpedance (BIA) measurements were carried out. Results: The study included 69 patients (recruitment 84.15%), with a mean age of 10.46 ± 0.43 years, and 50.7% females. The distribution according to GMFCS scale was: grade III (36.2%), grade IV (29%), and grade V (34.8%). According to weight for height: moderate malnutrition 21.8% (grade V: 33.3%), severe malnutrition 5.8% (grade V: 12.6%), overweight/obesity 23.2% (grade III: 24%, grade IV: 35%). Adequate level of lean mass for height: grade III (36%), grade IV (55%), and grade V (16.7%). Fat excess: grade III (36%), grade IV (40%), and grade V (29.2%). Fat mass comparison: BIA 6.89 ± 0.64 kg versus anthropometry 5.56 ± 4.43 kg. Conclusions: In CP grade GMFCS V, the weight deficit associated with a decrease in lean body mass is common. Patients with CP grades GMFCS III–IV have a significant prevalence of overweight/obesity. Anthropometry is a useful tool for nutritional assessment in children with CP, although fat levels could be underestimated. Resumen: Introducción: La parálisis cerebral (PC) es la causa más frecuente de discapacidad motora en edad pediátrica. El objetivo es estudiar la situación nutricional de los pacientes con PC controlados en una unidad de referencia, así como la relación entre la afectación neurológica y nutricional. Material y métodos: Estudio transversal, observacional, descriptivo y analítico en el que se han incluido pacientes con PC con grados III–IV–V (GMFCS) procedentes del área de influencia de un hospital pediátrico de referencia, con edades de 4–15 años. Se ha realizado: encuesta (con recogida de datos generales, medicaciones y hábitos nutricionales), estudio antropométrico y bioimpedanciometría (BIA). Resultados: N = 69 pacientes (reclutamiento 84,15%). Edad media 10,46 ± 0.43 años, el 50,7% mujeres. Distribución según GMFCS: grado III (36,2%), grado IV (29%), grado V (34,8%). Según el peso para la talla: desnutrición moderada el 21,8% (grado V: 33,3%), desnutrición grave el 5,8% (grado V: 12.6%), sobrepeso/obesidad el 23,2% (grado III: 24%; grado IV: 35%). Nivel adecuado de masa magra para su talla: grado III (36%), grado IV (55%), grado V (16,7%). Exceso de grasa: grado III (36%), grado IV (40%), grado V (29,2%). Comparación de masa grasa: BIA 6,89 ± 0,64 kg Vs antropometría 5,56 ± 4,43 kg. Conclusiones: En PC grado GMFCS V es frecuente el déficit de peso asociado a disminución de masa magra para su talla. Los pacientes con PC grados GMFCS III-IV presentan una prevalencia llamativa de sobrepeso/obesidad. La antropometría es una herramienta útil para la valoración nutricional en niños con PC, aunque los niveles de grasa tienden a infravalorarse.
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- 2020
22. Biliary and Pancreatic Endoscopic Surgery
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María Teresa García Castellanos, Ruth García Romero, and Paolo Bragagnini Rodríguez
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Gastroenterology ,General Medicine - Published
- 2022
23. Association between HLA DNA Variants and Long-Term Response to Anti-TNF Drugs in a Spanish Pediatric Inflammatory Bowel Disease Cohort
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Sara Salvador-Martín, Paula Zapata-Cobo, Marta Velasco, Laura M. Palomino, Susana Clemente, Oscar Segarra, Cesar Sánchez, Mar Tolín, Ana Moreno-Álvarez, Ana Fernández-Lorenzo, Begoña Pérez-Moneo, Inés Loverdos, Victor Manuel Navas López, Antonio Millán, Lorena Magallares, Ricardo Torres-Peral, Ruth García-Romero, Gemma Pujol-Muncunill, Vicente Merino-Bohorquez, Alejandro Rodríguez, Enrique Salcedo, Beatriz López-Cauce, Ignacio Marín-Jiménez, Luis Menchén, Emilio Laserna-Mendieta, Alfredo J. Lucendo, María Sanjurjo-Sáez, Luis A. López-Fernández, Institut Català de la Salut, [Salvador-Martín S, Zapata-Cobo P] Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain. [Velasco M, Palomino LM] Hospital Universitario Infantil Niño Jesús, Madrid, Spain. [Clemente S, Segarra O] Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Gastroenterología y hepatología ,Genetic Phenomena::Genetic Variation::Polymorphism, Genetic::Polymorphism, Single Nucleotide [PHENOMENA AND PROCESSES] ,Otros calificadores::/uso terapéutico [Otros calificadores] ,Polimorfisme genètic ,Farmacología ,Organic Chemistry ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,General Medicine ,Gastroenteritis en els infants ,Factor de necrosi tumoral - Inhibidors - Ús terapèutic ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Monokines::Tumor Necrosis Factor-alpha [CHEMICALS AND DRUGS] ,pharmacogenetics ,single nucleotide polymorphism ,infliximab ,adalimumab ,Catalysis ,Computer Science Applications ,Intestins - Inflamació - Tractament ,enfermedades del sistema digestivo::enfermedades gastrointestinales::gastroenteritis::enfermedad inflamatoria intestinal [ENFERMEDADES] ,Inorganic Chemistry ,fenómenos genéticos::variación genética::polimorfismo genético::polimorfismo de nucleótido único [FENÓMENOS Y PROCESOS] ,Other subheadings::/therapeutic use [Other subheadings] ,Physical and Theoretical Chemistry ,Digestive System Diseases::Gastrointestinal Diseases::Gastroenteritis::Inflammatory Bowel Diseases [DISEASES] ,Molecular Biology ,Spectroscopy ,aminoácidos, péptidos y proteínas::péptidos::péptidos y proteínas de señalización intercelular::citocinas::monocinas::factor de necrosis tumoral alfa [COMPUESTOS QUÍMICOS Y DROGAS] - Abstract
Adalimumab; Infliximab; Pharmacogenetics Adalimumab; Infliximab; Farmacogenètica Adalimumab; Infliximab; Farmacogenética The genetic polymorphisms rs2395185 and rs2097432 in HLA genes have been associated with the response to anti-TNF treatment in inflammatory bowel disease (IBD). The aim was to analyze the association between these variants and the long-term response to anti-TNF drugs in pediatric IBD. We performed an observational, multicenter, ambispective study in which we selected 340 IBD patients under 18 years of age diagnosed with IBD and treated with anti-TNF drugs from a network of Spanish hospitals. Genotypes and failure of anti-TNF drugs were analyzed using Kaplan-Meier curves and Cox logistic regression. The homozygous G allele of rs2395185 and the C allele of rs2097432 were associated with impaired long-term response to anti-TNF drugs in children with IBD after 3 and 9 years of follow-up. Being a carrier of both polymorphisms increased the risk of anti-TNF failure. The SNP rs2395185 but not rs2097432 was associated with response to infliximab in adults with CD treated with infliximab but not in children after 3 or 9 years of follow-up. Conclusions: SNPs rs2395185 and rs2097432 were associated with a long-term response to anti-TNFs in IBD in Spanish children. Differences between adults and children were observed in patients diagnosed with CD and treated with infliximab. This research was funded by Instituto de Salud Carlos III, grant number PI19/00792 (L.A.L.-F.) and Juan Rodes program JR19/00005 (E.L.-M.), by Instituto de Investigación Sanitaria Gregorio Marañón, grant number 2021-II-postdoc-01 (S.S.-M.), and by Consejería de Educación, Universidades, Ciencia y Portavocía Comunidad de Madrid, grant number PEJ-2021-AI/BMD-21866 (P.Z.-C.). The study was co-funded by the European Union.
- Published
- 2023
24. [Vitamin D insufficiency in a healthy pediatric population. The importance of early prophylaxis]
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Alejandro Sanz París, Diana Martínez-Redondo, Pilar Calmarza, Antonio de Arriba Muñoz, Inés Martínez Redondo, and Ruth García Romero
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Male ,Population ,Medicine (miscellaneous) ,Physiology ,chemistry.chemical_element ,First year of life ,Rickets ,Calcium ,Pediatrics ,vitamin D deficiency ,medicine ,Vitamin D and neurology ,Prevalence ,Humans ,Vitamin D ,education ,Child ,education.field_of_study ,Nutrition and Dietetics ,business.industry ,medicine.disease ,Vitamin D Deficiency ,Cross-Sectional Studies ,chemistry ,Child, Preschool ,Vitamin D supplement ,Female ,Pre-Exposure Prophylaxis ,business ,Pediatric population - Abstract
Introduction: vitamin D maintains the concentration of calcium and phosphorus within the physiological range, allowing normal metabolism and bone mineralization. Recently, vitamin D deficiency has been related not only with rickets but also with an increased risk of other pathologies. The aim of this descriptive, observational, cross-sectional study was to assess vitamin D concentration levels in a healthy pediatric population, as well as the current situation of prophylaxis. Vitamin D determination was measured by serum 25-hydroxyvitamin D (25(OH)D) concentration. Methods: a total of 258 healthy patients between 3 months and 15 years of age were enrolled (6.77 ± 3.95 years; 73.6 % were male). Results: the mean value of 25-hydroxyvitamin D was 26.60 ng/mL ± 8.02 ng/mL, and up to 20.9 % of the population showed insufficient levels. Statistically significant differences in vitamin D levels were observed between ages (p = 0.002), ethnicity groups (p = 0.038), and skin types (p = 0.000). In addition, a higher prevalence of vitamin D insufficiency in children who had never previously received vitamin D supplementation (41.6 %) was observed compared to those that had taken supplementation in the first year of life (16.7 %). Conclusion: our study shows a high prevalence of vitamin D deficiency among healthy children, and the benefit of prophylaxis with vitamin D supplementation.Introducción: la vitamina D mantiene la concentración de calcio y fósforo dentro del rango fisiológico, permitiendo un metabolismo normal y la correcta mineralización de los huesos. Recientemente, la deficiencia de vitamina D se ha relacionado no solo con el raquitismo sino también con el aumento del riesgo de otras patologías. El objetivo de este estudio descriptivo, observacional y transversal fue conocer los niveles de concentración de vitamina D en una población pediátrica sana y la situación actual en cuanto a la profilaxis. La determinación de la vitamina D se midió mediante la concentración sérica de 25-hidroxivitamina D (25(OH)D). Material y métodos: se inscribieron 258 pacientes sanos de entre 3 meses y 15 años (6,77 ± 3,95 años; 73,6 % de hombres). Resultados: el valor medio de 25(OH)D fue de 26,60 ng/ml ± 8,02 ng/ml; el 20,9 % de la población mostró un nivel insuficiente. Se observaron diferencias estadísticamente significativas entre los niveles de vitamina D de las distintas edades (p = 0,002), grupos étnicos (p = 0,038) y fototipos (p = 0,000). Además, se observó una mayor prevalencia de la insuficiencia de vitamina D en los niños que nunca antes habían recibido suplementos de vitamina D (41,6 %) en comparación con los que habían tomado suplementos en el primer año de vida (16,7 %). Conclusiones: el presente estudio muestra una alta prevalencia del déficit de vitamina D en los niños sanos y el beneficio de una correcta profilaxis en edades tempranas con suplementos de vitamina D.
- Published
- 2021
25. Implementation of a low FODMAP diet for functional abdominal pain
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Eduardo Ubalde Sainz, Gerardo Rodríguez Martínez, María Luisa Baranguán Castro, Ignacio Ros Arnal, and Ruth García Romero
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Male ,medicine.medical_specialty ,Abdominal pain ,Activities of daily living ,Visual analogue scale ,Polymers ,Oligosaccharides ,FODMAP ,Disaccharides ,Pediatrics ,RJ1-570 ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Management of Technology and Innovation ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Child ,Irritable bowel syndrome ,Paediatric patients ,Pain Measurement ,chemistry.chemical_classification ,business.industry ,Monosaccharides ,medicine.disease ,Dolor abdominal funcional ,Abdominal Pain ,Treatment Outcome ,chemistry ,Low fodmap diet ,Fermentation ,Female ,Dieta ,medicine.symptom ,business - Abstract
Introduction: The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. Material and methods: A table was designed in which foods were classified according to their FODMAP content, as well as a ‘Symptoms and Stools Diary’. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. Results: A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41–3.33] versus 2 [IQR: 1.33–6.33] daily episodes, P = .024), less pain severity compared to baseline (1.41 cm [IQR: 0.32–5.23] versus 4.63 cm [IQR: 2.51–6.39] measured by 10-cm Visual Analogue Scale, P = .035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. Conclusions: The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods. Resumen: Introducción: La dieta baja en FODMAP (acrónimo en inglés de polioles, monosacáridos, disacáridos y oligosacáridos fermentables) ha demostrado eficacia como tratamiento del síndrome de intestino irritable en adultos, siendo escasos los estudios en niños. Nuestro objetivo es analizar la implantación de esta dieta como tratamiento del dolor abdominal crónico funcional en población pediátrica de un área mediterránea, y su respuesta a esta. Material y métodos: Se elaboró una tabla clasificando los alimentos según su contenido en FODMAP, y se diseñó un «Diario de síntomas y deposiciones» para recoger los datos. Posteriormente se realizó un estudio prospectivo con niños con dolor abdominal crónico funcional de nuestra Unidad de Gastroenterología Pediátrica. Resultados: Se reclutaron 22 pacientes, 20 de los cuales completaron el estudio. Se recogieron durante 3 días datos sobre el dolor abdominal; posteriormente recibieron dieta baja en FODMAP 2 semanas, y al finalizarla recogieron de nuevo dichos datos. Tras la dieta se objetivó disminución en frecuencia diaria de episodios de dolor abdominal (1,16 [RIQ: 0,41-3,33] frente a 2 [RIQ: 1,33-6,33] inicialmente, p = 0,024), menor intensidad del dolor (1,41 cm [RIQ: 0,32-5,23] frente a 4,63 cm [RIQ: 2,51-6,39] inicial, p = 0,035, medido mediante Escala Visual Analógica de 10 cm), menor interferencia con la actividad diaria y menos síntomas acompañantes. Solo un 15% de los pacientes consideraron la dieta difícil. Conclusiones: La implantación de una dieta baja en FODMAP durante 2 semanas en una población pediátrica mediterránea con dolor abdominal crónico funcional es posible utilizando dietas adaptadas, es bien valorada por los pacientes, y su evaluación mediante herramientas objetivas muestra mejoría en los síntomas de dolor abdominal.
- Published
- 2019
26. Implantación de la dieta baja en FODMAP para el dolor abdominal funcional
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Ruth García Romero, María Luisa Baranguán Castro, Eduardo Ubalde Sainz, Gerardo Rodríguez Martínez, and Ignacio Ros Arnal
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03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Functional abdominal pain ,Pediatrics, Perinatology and Child Health ,FODMAP ,Pediatrics ,RJ1-570 ,Diet - Abstract
Resumen: Introducción: La dieta baja en FODMAP (acrónimo en inglés de polioles, monosacáridos, disacáridos y oligosacáridos fermentables) ha demostrado eficacia como tratamiento del síndrome de intestino irritable en adultos, siendo escasos los estudios en niños. Nuestro objetivo es analizar la implantación de esta dieta como tratamiento del dolor abdominal crónico funcional en población pediátrica de un área mediterránea, y su respuesta a esta. Material y métodos: Se elaboró una tabla clasificando los alimentos según su contenido en FODMAP, y se diseñó un «Diario de síntomas y deposiciones» para recoger los datos. Posteriormente se realizó un estudio prospectivo con niños con dolor abdominal crónico funcional de nuestra Unidad de Gastroenterología Pediátrica. Resultados: Se reclutaron 22 pacientes, 20 de los cuales completaron el estudio. Se recogieron durante 3 días datos sobre el dolor abdominal; posteriormente recibieron dieta baja en FODMAP 2 semanas, y al finalizarla recogieron de nuevo dichos datos. Tras la dieta se objetivó disminución en frecuencia diaria de episodios de dolor abdominal (1,16 [RIQ: 0,41-3,33] frente a 2 [RIQ: 1,33-6,33] inicialmente, p = 0,024), menor intensidad del dolor (1,41 cm [RIQ: 0,32-5,23] frente a 4,63 cm [RIQ: 2,51-6,39] inicial, p = 0,035, medido mediante Escala Visual Analógica de 10 cm), menor interferencia con la actividad diaria y menos síntomas acompañantes. Solo un 15% de los pacientes consideraron la dieta difícil. Conclusiones: La implantación de una dieta baja en FODMAP durante 2 semanas en una población pediátrica mediterránea con dolor abdominal crónico funcional es posible utilizando dietas adaptadas, es bien valorada por los pacientes, y su evaluación mediante herramientas objetivas muestra mejoría en los síntomas de dolor abdominal. Abstract: Introduction: The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. Material and methods: A table was designed in which foods were classified according to their FODMAP content, as well as a ‘Symptoms and Stools Diary’. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. Results: A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P = .024), less pain severity compared to baseline (1.41 cm [IQR: 0.32-5.23] versus 4.63 cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P = .035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. Conclusions: The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods.
- Published
- 2019
27. Linfangiectasia intestinal en un paciente afectado de síndrome de Sanfilippo B
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Sara M Barbed Ferrández, Ignacio Ros Arnal, Ruth García Romero, Nerea Torrecilla Idoipe, Inés Romagosa Sánchez-Monge, and Raquel Pérez Delgado
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medicine.medical_specialty ,business.industry ,Lymphangiectasia ,medicine.disease ,Sindrome de ,Gastroenterology ,Pathogenesis ,Diarrhea ,Dietary treatment ,Intestinal lymphangiectasia ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Lysosomal storage disease ,medicine ,Sanfilippo B syndrome ,medicine.symptom ,business - Abstract
Mucopolysaccharidosis type IIIB is a lysosomal storage disease caused by a deficiency of the N-acetyl-alpha-d-glucosaminidase enzyme involved in the catabolism of heparan sulfate, causing its accumulation in various tissues. We present an 8-year-old patient with mucopolysaccharidosis type IIIB, with a history of chronic diarrhea and endoscopic and histological findings compatible with intestinal lymphangiectasia. After a dietary treatment with a low-fat diet supplemented with mediumchain triglyceride, our patient presents clinical improvement until today. The pathogenesis of chronic diarrhea in patients with mucopolysaccharidosis type IIIB is still unknown. The Linfangiectasia intestinal en un paciente afectado de sindrome de Sanfilippo B Intestinal lymphangiectasia in a patient with Sanfilippo B syndrome presence of intestinal lymphangiectasia in these patients should be investigated, and appropriate dietary treatment should be initiated, if confirmed, to improve their quality of life.
- Published
- 2021
28. Evaluación del seguimiento de niños con hallazgo de hipertransaminasemia
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Víctor Fernández Ventureira, Eduardo Ubalde Sainz, Beatriz García Rodríguez, Gerardo Rodríguez Martínez, Ignacio Ros Arnal, and Ruth García Romero
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03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Pediatrics, Perinatology and Child Health - Abstract
Resumen Introduccion Las alteraciones del perfil hepatico constituyen un hecho inespecifico propio de numerosas condiciones clinicas. Sin embargo, puede implicar la primera manifestacion de una patologia potencialmente grave en un paciente asintomatico. Material y metodos Estudio observacional retrospectivo que incluye todas las analiticas sanguineas con elevacion de alanino aminotransferasa (ALT) en pacientes pediatricos solicitadas en un sector sanitario en un periodo de 6 meses. Resultados Se registraron 572 analiticas correspondientes a 403 pacientes. Se excluyeron 98 pacientes con hipertransaminasemia ya conocida o comorbilidad. De los 305 restantes, el 22,6% se diagnosticaron de patologia asociada a hipertransaminasemia, y de estos, se comprobo normalizacion en el 33,3%. De los 236 pacientes con hipertransaminasemia sin justificar se realizo un seguimiento en el 29%, encontrando patologia hepatica en 9 pacientes (13% del grupo). En el resto de la muestra no se comprobo analiticamente la evolucion de las transaminasas ni la presencia de posible patologia hepatica. Los pacientes con cifras mas elevadas se controlan mejor y antes que los que presentan cifras mas bajas. Conclusiones En nuestra area, la mayoria de los ninos sin enfermedad hepatica aparente con hallazgo de ALT elevada no son adecuadamente controlados. Esto hace que se pierda una oportunidad unica de diagnosticar y tratar precozmente una enfermedad hepatica potencial en un gran numero de ninos. Todo nino con hipertransaminasemia inexplicada debe ser estudiado.
- Published
- 2021
29. COVID-19 Gastrointestinal Manifestations Are Independent Predictors of PICU Admission in Hospitalized Pediatric Patients
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Ruth García Romero, Juan José Díaz Martín, Macarena Queralt, Gloria Domínguez Ortega, Elena Crehuá-Gaudiza, Pablo Ferrer Gonzalez, Enrique Medina Benítez, David González Jiménez, Laura María Palomino Pérez, Diana García Tirado, Marta Velasco Rodríguez-Belvís, Oscar Segarra, and Raquel Vecino López
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Male ,Microbiology (medical) ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Gi symptoms ,Coronavirus disease 2019 (COVID-19) ,Gastrointestinal Diseases ,MEDLINE ,Comorbidity ,Intensive Care Units, Pediatric ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,030225 pediatrics ,parasitic diseases ,medicine ,Humans ,030212 general & internal medicine ,Pediatrics, Perinatology, and Child Health ,Child ,Pediatric intensive care unit ,business.industry ,Confounding ,COVID-19 ,Infant ,social sciences ,medicine.disease ,Infectious Diseases ,Multicenter study ,Spain ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Intensive Care, Neonatal ,population characteristics ,Female ,business ,human activities ,geographic locations - Abstract
Multicenter study conducted in 15 hospitals including 101 COVID-19 pediatric inpatients aiming to describe associated gastrointestinal (GI) manifestations. GI symptoms were present in 57% and were the first manifestation in 14%. Adjusted by confounding factors, those with GI symptoms had higher risk of pediatric intensive care unit admission. GI symptoms are predictive of severity in COVID-19 children admitted to hospitals.
- Published
- 2020
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30. [Study of personality and anxiety in children and adolescents with inflammatory bowel disease]
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Marta, Marín Andrés, Ruth, García Romero, Beatriz, Puga González, Ignacio, Ros Arnal, Jesús, González Pérez, and Aida María, Gutiérrez Sánchez
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Male ,Adolescent ,Anxiety ,Inflammatory Bowel Diseases ,Personality Assessment ,Extraversion, Psychological ,Introversion, Psychological ,Crohn Disease ,Socioeconomic Factors ,Spain ,Surveys and Questionnaires ,Humans ,Colitis, Ulcerative ,Female ,Prospective Studies ,Child - Abstract
to analyze the presence of common personality traits and anxiety states in children and adolescents with inflammatory bowel disease (IBD).Longitudinal, prospecti ve, and analytical study by applying the questionnaires Children's Personality Questionnaire, High School Personality Questionnaire, State-Trait Anxiety Inventory for Children, and State-Trait Anxie ty Inventory for patients with IBD aged between 9 and 18 years seen at reference IBD units in Ara gon, Spain. The participants excluded were those with active disease, defined as a score10 on the Pediatric Crohn's Disease Activity Index (PCDAI Score) or10 on the Pediatric Ulcerative Colitis Activity Index (PUCAI Score).Twenty-six patients participated (73% male). 61.5% pre sented Crohn's disease (CD) and 38.5% ulcerative colitis (UC). No patient presented active disease. The personality profile as a group was characterized by being open, emotionally stable, calm, sober, sensible, enterprising, impressionable, dependent, serene, perfectionist, and relaxed. 50% of the CD patients were enterprising versus no UC patients (p0.05). There were no statistically significant di fferences when comparing the remaining personality factors based on IBD type, age, or sex. Patients with CD tended to be calmer (p = 0.0511) and patients with UC more introverted (p = 0.0549). The sample presented a state anxiety level (A/E) -1.1 ± 0.8 SD compared with the population average. The level of anxiety as a feature (A/R) was -0.6 ± 1 SD. Males had significantly lower levels than females in the case of A/E (p0.05).The presence of common personality traits in the pediatric population with IBD stands out but there was no greater anxiety than in the reference population.
- Published
- 2020
31. [Intestinal lymphangiectasia in a patient with Sanfilippo B syndrome]
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Sara M, Barbed Ferrández, Ruth, García Romero, Raquel, Pérez Delgado, Inés, Romagosa Sánchez-Monge, Ignacio, Ros Arnal, and Nerea, Torrecilla Idoipe
- Subjects
Diarrhea ,Mucopolysaccharidosis III ,Acetylglucosaminidase ,Quality of Life ,Humans ,Heparitin Sulfate ,Child - Abstract
Mucopolysaccharidosis type IIIB is a lysosomal storage disease caused by a deficiency of the N-acetyl-alpha-d-glucosaminidase enzyme involved in the catabolism of heparan sulfate, causing its accumulation in various tissues. We present an 8-year-old patient with mucopolysaccharidosis type IIIB, with a history of chronic diarrhea and endoscopic and histological findings compatible with intestinal lymphangiectasia. After a dietary treatment with a low-fat diet supplemented with mediumchain triglyceride, our patient presents clinical improvement until today. The pathogenesis of chronic diarrhea in patients with mucopolysaccharidosis type IIIB is still unknown. The Linfangiectasia intestinal en un paciente afectado de síndrome de Sanfilippo B Intestinal lymphangiectasia in a patient with Sanfilippo B syndrome presence of intestinal lymphangiectasia in these patients should be investigated, and appropriate dietary treatment should be initiated, if confirmed, to improve their quality of life.La mucopolisacaridosis tipo III B es una enfermedad de depósito lisosomal causada por la deficiencia de la enzima N-acetil-alfad- glucosaminidasa, implicada en el catabolismo del heparán sulfato, que produce su acúmulo en diversos tejidos. Se presenta a un paciente de 8 años, afectado de mucopolisacaridosis tipo III B, con historia de diarrea crónica y hallazgos endoscópicos e histológicos compatibles con linfangiectasia intestinal. Tras tratamiento dietético con restricción de ácidos grasos de cadena larga y rica en triglicéridos de cadena media, presentó mejoría clínica, mantenida hasta la actualidad. La patogenia de la diarrea crónica en pacientes con mucopolisacaridosis tipo III B es aún desconocida. Debe investigarse la presencia de linfangiectasia intestinal en estos pacientes e iniciar, en caso de confirmarse, un tratamiento dietético adecuado para mejorar así su calidad de vida.
- Published
- 2020
32. Neonatal cystic fibrosis screening: Analysis and differences in immunoreactive trypsin levels in newborns with a positive screen
- Author
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María José Sánchez-Malo, Carlos Martin-de-Vicente, Pilar Samper-Villagrasa, Ruth García-Romero, and Marta Arrudi-Moreno
- Subjects
Male ,medicine.medical_specialty ,Cystic Fibrosis ,Cystic Fibrosis Transmembrane Conductance Regulator ,behavioral disciplines and activities ,Cystic fibrosis ,Gastroenterology ,Pediatrics ,RJ1-570 ,03 medical and health sciences ,Immunoreactive trypsin ,0302 clinical medicine ,Neonatal Screening ,030225 pediatrics ,Management of Technology and Innovation ,Internal medicine ,medicine ,Humans ,Trypsin ,Neonatal screen ,Sweat test ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Cystic fibrosis screening ,Infant, Newborn ,medicine.disease ,Fibrosis quística ,Hospital admission ,Cystic fibrosis screen ,Tripsina inmunorreactiva ,Cribado neonatal ,Female ,business ,psychological phenomena and processes - Abstract
Introduction: Neonatal cystic fibrosis (CF) screening has enabled the disease to be diagnosed early, and is a determining factor in the increase in survival of these patients. Its main disadvantage is its low specificity and elevated number of false positives. The aim of this study is to analyse the differences in immunoreactive trypsin (IRT) between the different groups of newborns (NB) with a positive neonatal screen depending on whether they were healthy, healthy carriers, affected by CF, or CFSPID (Cystic Fibrosis Screen Positive, Inconclusive Diagnosis). Material: Retrospective analytical study of the concentrations of IRT in NB with a positive neonatal screen for CF born in a tertiary hospital during an 8-year period. Results: A total of 790 NB with a positive neonatal screen for CF were analysed. Of these 86.3% were term, 53% girls, and 11.8% were admitted. The mean IRT value was 79.16 ng/mL (range 60–367). Significantly higher concentrations of IRT were found in those affected by CF compared to the other groups (P
- Published
- 2020
33. Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Espanola de Gastroenterologia, Hepatologia y Nutricion Pediatrica
- Author
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Zuriñe García Casales, Luis Ortigosa del Castillo, Ruth García Romero, Mercedes Juste Ruiz, Gonzalo Botija Arcos, Enrique La Orden Izquierdo, Santiago Jiménez Treviño, Gemma Pujol Muncunill, Ester Donat Aliaga, Honorio Miguel Armas Ramos, Pablo Oliver Goicolea, Rafael Martín-Masot, Vanesa Martinez, Javier Martín de Carpi, José Ignacio García Burriel, Carlos Ochoa Sangrador, Alejandro Rodríguez Martínez, Helena Lorenzo Garrido, Patricia Barros García, Oscar Segarra Cantón, Juan José Díaz Martín, Josefa Barrio Torres, Francisco Javier Eizaguirre Arocena, David Pérez Solis, Víctor Manuel Navas-López, Juan Manuel Bartolomé Porro, Luis Peña Quintana, and Gonzalo Galicia Poblet
- Subjects
medicine.medical_specialty ,Referral ,Pediatrics ,Inflammatory bowel disease ,s disease ,children ,Interquartile range ,inflammatory bowel disease ,Internal medicine ,medicine ,Prospective cohort study ,Original Research ,ulcerative colitis ,Crohn's disease ,business.industry ,lcsh:RJ1-570 ,lcsh:Pediatrics ,Odds ratio ,medicine.disease ,diagnostic delay ,Ulcerative colitis ,Confidence interval ,Crohn&apos ,time to diagnosis ,Pediatrics, Perinatology and Child Health ,business ,Crohn's disease, children, diagnostic delay, inflammatory bowel disease, time to diagnosis, ulcerative colitis - Abstract
Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain. Methods: We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified. Results: Overall TD was 4.4 months (interquartile range [IQR] 2.6-10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3-12.3] vs. 3 [IQR 1.6-5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03-7.17] in CD vs. 0.83 months [IQR 0.30-2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2-7) vs. 2 MODs ([IQR 1-5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1-8.9], p = 0.025). Conclusions: TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.
- Published
- 2020
34. Carga del cuidador del paciente con parálisis cerebral moderada-grave: ¿influye el estado nutricional?
- Author
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Gerardo Rodríguez Martínez, Ruth García Romero, José L. Segura, Ignacio Ros Arnal, and José Miguel Martínez de Zabarte Fernández
- Subjects
03 medical and health sciences ,0302 clinical medicine ,Caregivers ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Cerebral palsy ,Dependency burden ,Pediatrics ,RJ1-570 ,Nutrition - Abstract
Resumen: Introducción: Los pacientes con parálisis cerebral moderada-grave precisan de sus cuidadores para realizar las actividades básicas de la vida diaria (ABVD). Objetivos: Describir la presencia de comorbilidades, la percepción de dificultad de los cuidadores para las ABVD y analizar la influencia del grado de afectación motora, el estado nutricional y otras alteraciones neurológicas. Métodos: Estudio transversal y observacional. Se estudió a pacientes con parálisis cerebral grados III-IV-V según el Sistema de Clasificación de la Función Motora Gruesa (GMFCS). Se registraron las comorbilidades y se estudió la composición corporal mediante antropometría y bioimpedanciometría. Además, se hizo una encuesta de carga del cuidador sobre ABVD (10 ítems que exploran las diferentes actuaciones: higiene, vestido, transferencias, sueño y alimentación). Se estudió qué variables influyen más en la percepción de dificultad para las ABVD. Resultados: Muestra de 69 pacientes (50,7% mujeres, edad media de 10,46 ± 0,4 años), con los siguientes grados de GMFCS: grado III 36,2% (N = 25), grado IV 29,0% (N = 20) y grado V 34,8% (N = 24). Se halló relación entre la puntuación de carga del cuidador y el grado GMFCS (p = 0,003) y la discapacidad intelectual (p
- Published
- 2020
35. Evaluación de la disfagia. Resultados tras un año de la incorporación de la videofluoroscopia en nuestro centro
- Author
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María José Romea Montañés, José Antonio López Calahorra, Cristina Gutierrez Alonso, Beatriz Izquierdo Hernández, Ruth García Romero, Carlos Martín de Vicente, and Ignacio Ros Arnal
- Subjects
03 medical and health sciences ,Aspiration ,0302 clinical medicine ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Cerebral palsy ,Dysphagia ,Video fluoroscopy ,Swallowing ,Pediatrics ,030217 neurology & neurosurgery ,RJ1-570 - Abstract
Introducción: La disfagia es muy frecuente en niños con discapacidad neurológica. Estos pacientes suelen presentar problemas respiratorios y nutricionales. El estudio de la deglución por videofluoroscopia (VFC) suele ser el más recomendado, ya que revela la situación real durante la deglución. Objetivos: Estudiar los resultados obtenidos en la evaluación diagnóstica tras un año desde la implantación de la VFC en nuestro centro, y analizar la mejoría clínica tras la confirmación por VFC y la prescripción de un tratamiento individualizado en los niños con disfagia orofaríngea. Material y métodos: Se recogen las VFC realizadas en el último año. Se analizan las siguientes variables: edad, enfermedad, grado de afectación neurológica, tipo de disfagia (oral, faríngea y/o esofágica), gravedad, aspiraciones y/o penetraciones, tratamiento prescrito y mejora nutricional y/o respiratoria tras el diagnóstico. Se realiza análisis estadístico mediante SPSS v21. Resultados Se realizaron 61 VFC. Se detectó disfagia en más del 70%, siendo moderadas-graves en el 58%. Se visualizaron aspiraciones y/o penetraciones en el 59%, siendo silentes el 50%. Se prescribió dieta adaptada al 56% y gastrostomía en 13 pacientes (21%). Se encontró asociación estadística entre enfermedad neurológica y la gravedad de la disfagia, existiendo relación según el grado de afectación motora y la presencia de aspiraciones. Tras la evaluación por VFC y la adecuación del tratamiento se encontró una mejoría nutricional en Z-score de peso (+ 0, 3 DE) e IMC (+ 0, 4 DE) y una mejoría respiratoria en un 71% de los pacientes disfágicos controlados en Neumología. Conclusiones: Tras la implantación de la VFC se ha diagnosticado a un alto porcentaje de pacientes, que se han beneficiado de un diagnóstico y un tratamiento correctos. La VFC es una prueba diagnóstica fundamental que debería ser incluida en los centros pediátricos, como método diagnóstico de los niños con sospecha disfagia. Introduction: Dysphagia is very common in children with neurological disabilities. These patients usually suffer from respiratory and nutritional problems. The videofluoroscopic swallowing study (VFSS) is the most recommended test to evaluate dysphagia, as it shows the real situation during swallowing. Objectives: To analyse the results obtained in our centre after one year of the implementation of VFSS, the clinical improvement after confirmation, and the prescription of an individualised treatment for the patients affected. Material and methods: VFSS performed in the previous were collected. The following variables were analysed: age, pathology, degree of neurological damage, oral and pharyngeal and/or oesophageal dysphagia and its severity, aspirations, prescribed treatment, and nutritional and respiratory improvement after diagnosis. A statistical analysis was performed using SPSS v21. Results: A total of 61 VFSS were performed. Dysphagia was detected in more than 70%, being moderate-severe in 58%. Aspirations and/or penetrations were recorded in 59%, of which 50% were silent. Adapted diet was prescribed to 56%, and gastrostomy was performed on 13 (21%) patients. A statistical association was found between neurological disease and severity of dysphagia. The degree of motor impairment is related to the presence of aspirations. After VFSS evaluation and treatment adjustment, nutritional improvement was found in Z-score of weight (+ 0.3 SD) and BMI (+ 0.4 SD). There was respiratory improvement in 71% of patients with dysphagia being controlled in the Chest Diseases Department. Conclusions: After implementation of VFSS, a high percentage of patients were diagnosed and benefited from a correct diagnosis and treatment. VFSS is a fundamental diagnostic test that should be included in paediatric centres as a diagnostic method for children with suspected dysphagia.
- Published
- 2018
36. Estudio de personalidad y ansiedad en niños y adolescentes con enfermedad inflamatoria intestinal
- Author
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Jesús González Pérez, Ruth García Romero, Beatriz Puga González, Aida María Gutiérrez Sánchez, Marta Andrés, and Ignacio Ros Arnal
- Subjects
Crohn's disease ,medicine.medical_specialty ,education.field_of_study ,business.industry ,media_common.quotation_subject ,Population ,Disease ,medicine.disease ,Inflammatory bowel disease ,Ulcerative colitis ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Personality ,Anxiety ,Big Five personality traits ,medicine.symptom ,business ,education ,media_common - Abstract
Objetivo: Analizar la presencia de rasgos de personalidad comunes y estado de ansiedad en niños y adolescentes con enfermedad inflamatoria intestinal (EII).Pacientes y Método: Estudio longitudinal, prospectivo y analítico mediante la aplicación de los cuestionarios Children’s Personality Questionnaire, High School Personality Questionnaire, State Trait Anxiety Inventory for Children y State Trait Anxiety Inventory a pacientes con EII con edad comprendida entre 9 y 18 años controlados en unidades de referencia en EII de Aragón, España. Se excluyeron aquellos que presentaban enfermedad activa, definido como una puntación ≥ 10 en el Pediatric Crohn Disease Activity Index (PCDAI Score) o ≥ 10 en el Pediatric Ulcerative Colitis Activity Index (PUCAI Score).Resultados: Participaron 26 pacientes (73% varones). El 61,5% presentaba enfermedad de Crohn (EC) y el 38,5% colitis ulcerosa (CU). Ninguno presentaba enfermedad activa. El perfil de personalidad como grupo se caracterizó por ser abierto, emocionalmente estable, calmoso, sobrio, sensato, emprendedor, impresionable, dependiente, sereno, perfeccionista y relajado. El 50% de los pacientes con EC eran emprendedores frente a ningún paciente con CU (p < 0,05). No hubo diferencias estadísticamente significativas al comparar el resto factores de personalidad en función del tipo de EII, edad ni sexo. Los pacientes con EC tienden a ser más calmados (p = 0,0511) y los pacientes con CU más introvertidos (p = 0,0549). La muestra presentaba un nivel de ansiedad estado (A/E) -1,1 ± 0,8 DS respecto a la media poblacional. El nivel de ansiedad como rasgo (A/R) era -0,6 ± 1 DS. Los varones tenían niveles significativamente menores que las mujeres en el caso de la A/E (p < 0,05).Conclusiones: Destaca la presencia de rasgos de personalidad comunes en la población pediátrica con EII pero no se ha constatado mayor ansiedad que en la población de referencia.
- Published
- 2021
37. Artritis como debut de enfermedad inflamatoria intestinal en pediatría
- Author
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Inés Félez Moliner, Marta Medrano San Ildefonso, Eduardo Ubalde Sainz, Ruth García Romero, Marcos Clavero Adell, and Ignacio Ros Arnal
- Subjects
medicine.medical_specialty ,business.industry ,Diagnosis delay ,Peripheral arthritis ,Enthesitis ,Arthritis ,medicine.disease ,Dermatology ,Inflammatory bowel disease ,Lameness ,Pediatrics, Perinatology and Child Health ,Medicine ,Presentation (obstetrics) ,medicine.symptom ,business - Abstract
Inflammatory bowel disease in children has increased worldwide during the last decades. Clinical presentations are diverse and extraintestinal manifestations are the presenting sign in 6-35 % of patients, the most common of them being peripheral arthritis. An atypical clinical presentation results in diagnosis delay and, added to the greater seriousness of inflammatory bowel disease phenotypes in children, it entails more intestinal complications and sequelae. We describe two cases of inflammatory bowel disease with an initial symptom of lameness due to peripheral arthritis and enthesitis, respectively. © 2019 Sociedad Argentina de Pediatria. All rights reserved. La incidencia de enfermedad in amatoria intestinal en la edad pedia´trica se ha incrementado mundialmente en las u´ltimas de´cadas. La forma de presentacio´n puede ser diversa y, hasta en un 6-35 %, las manifestaciones extraintestinales pueden ser el debut; la artritis perife´rica es la ma´s frecuente de estas. Una presentacio´n ati´pica implica un retraso diagno´stico y, asociado a que el fenotipo de enfermedad in amatoria intestinal es ma´s grave en los nin~os, conlleva un incremento de las complicaciones intestinales y secuelas asociadas. Se presentan dos casos cli´nicos de enfermedad de Crohn cuya cli´nica inicial fue la claudicacio´n de la marcha por una artritis perife´rica y una entesitis, respectivamente.
- Published
- 2019
38. [Arthritis as clinical presentation of inflammatory bowel disease in children]
- Author
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Inés, Félez Moliner, Ruth, García Romero, Ignacio, Ros Arnal, Marcos, Clavero Adell, Eduardo, Ubalde Sainz, and Marta, Medrano San Ildefonso
- Subjects
Male ,Arthritis ,Humans ,Female ,Enthesopathy ,Child ,Inflammatory Bowel Diseases ,Gait - Abstract
Inflammatory bowel disease in children has increased worldwide during the last decades. Clinical presentations are diverse and extraintestinal manifestations are the presenting sign in 6-35 % of patients, the most common of them being peripheral arthritis. An atypical clinical presentation results in diagnosis delay and, added to the greater seriousness of inflammatory bowel disease phenotypes in children, it entails more intestinal complications and sequelae. We describe two cases of inflammatory bowel disease with an initial symptom of lameness due to peripheral arthritis and enthesitis, respectively.La incidencia de enfermedad inflamatoria intestinal en la edad pediátrica se ha incrementado mundialmente en las últimas décadas. La forma de presentación puede ser diversa y, hasta en un 6-35 %, las manifestaciones extraintestinales pueden ser el debut; la artritis periférica es la más frecuente de estas. Una presentación atípica implica un retraso diagnóstico y, asociado a que el fenotipo de enfermedad inflamatoria intestinal es más grave en los niños, conlleva un incremento de las complicaciones intestinales y secuelas asociadas. Se presentan dos casos clínicos de enfermedad de Crohn cuya clínica inicial fue la claudicación de la marcha por una artritis periférica y una entesitis, respectivamente.
- Published
- 2018
39. Deficiencia de vitamina D en niños aragoneses sanos
- Author
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José Ignacio Labarta Aizpún, Gerardo Rodríguez Martínez, Antonio de Arriba Muñoz, Pilar Calmarza, Inés Martínez Redondo, and Ruth García Romero
- Subjects
Nutrition and Dietetics ,Vitamina D ,Pediatría ,Medicine (miscellaneous) ,Hipovitaminosis - Abstract
Introducción: la principal acción de la vitamina D es mantener la concentración de calcio y fósforo dentro del rango fisiológico permitiendo el metabolismo normal y la mineralización ósea. Últimamente, se han descrito receptores de vitamina D en muchos tejidos y se ha relacionado la deficiencia de la vitamina D no solo con raquitismo y osteomalacia, sino también con mayor riesgo de diabetes, obesidad, enfermedades cardiovasculares, oncológicas, infecciosas y autoinmunes. Objetivo: el objetivo del estudio fue conocer la concentración de vitamina D en una población pediátrica sana y comprobar sus factores influyentes, así como analizar la situación actual de profilaxis de vitamina D y valorar la eficacia de las recomendaciones actuales. Métodos: se seleccionaron 107 pacientes sanos, de edades comprendidas entre uno y 15 años, que precisaron una analítica sanguínea como preoperatorio de cirugía menor, cuya patología no influyera en los parámetros del estudio. Resultados: la muestra estaba constituida en un 78, 5% por varones y presentaba una media de edad de 7, 17 ± 3, 79 años. La concentración media de vitamina D fue de 26, 07 ± 7, 11 ng/ml y hasta un 72, 9% presentaba niveles insuficientes. Se dividió la muestra en dos grupos: pacientes con hipovitaminosis D y pacientes con niveles óptimos de vitamina D. Se observó en el grupo con hipovitaminosis un predominio de varones, mayor índice de masa corporal y la presencia de fototipos extremos así como provenientes de padres inmigrantes. También presentaban mayor riesgo de hipovitaminosis los que no habían realizado profilaxis durante el primer año de vida. Conclusiones: se pone de manifiesto el alto porcentaje de población infantil sana con déficit de vitamina D y que las recomendaciones actuales de profilaxis no son llevadas a cabo por la población como recomiendan las guías actuales Background: the main action of vitamin D is to maintain the concentration of calcium and phosphorus within the physiological range, allowing normal metabolism and bone mineralization. Vitamin D receptors have recently been described in many tissues, therefore vitamin D deficiency has been related not only to rickets, but also to increased risk of diabetes, obesity, cardiovascular, oncological, infectious and autoimmune diseases. Objective: the aim of the study was to know the vitamin D concentration in a healthy pediatric population and to verify its influential factors, as well as to analyze the current situation of vitamin D prophylaxis and to evaluate the effectiveness of current recommendations. Methods: one hundred and seven healthy patients aged between one and 15 years were selected, who required a blood test as a preoperative minor surgery and whose pathology did not influence the parameters of the study. Results: the sample analyzed had a total of 78.5% males and a mean age of 7.17 ± 3.79 years. Mean values of vitamin D were 26.07 ± 7.11 ng/ml; up to 72.9% had insufficient levels. The sample was divided into two groups: patients with hypovitaminosis D and patients with optimal vitamin D levels. A predominance of males with a higher body mass index, from immigrant parents, and the presence of extreme phototypes were observed in the hypovitaminosis group. There was also a higher risk of hypovitaminosis in those who had not performed prophylaxis during the first year of life. Conclusions: the high percentage of healthy children with vitamin D deficiency is evident, and current recommendations for prophylaxis are not carried out by the population as recommended by current guidelines.
- Published
- 2018
40. Conjugated hyperbilirubinemia after surgery. A diagnosis of Dubin-Johnson syndrome confirmed by genetic testing
- Author
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María Luisa Baranguán Castro, Ruth García Romero, and María Dolores Miramar Gallart
- Subjects
Adult ,Male ,medicine.medical_specialty ,Conjugated hyperbilirubinemia ,Peritonitis ,03 medical and health sciences ,0302 clinical medicine ,Dubin–Johnson syndrome ,Postoperative Complications ,medicine ,Humans ,Genetic Testing ,lcsh:RC799-869 ,Genetic testing ,Hyperbilirubinemia ,medicine.diagnostic_test ,business.industry ,Jaundice, Chronic Idiopathic ,Gastroenterology ,General Medicine ,Surgical procedures ,Jaundice ,medicine.disease ,Appendicitis ,Multidrug Resistance-Associated Protein 2 ,Surgery ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,lcsh:Diseases of the digestive system. Gastroenterology ,medicine.symptom ,Multidrug Resistance-Associated Proteins ,business - Abstract
Dubin-Johnson syndrome is a rare benign inherited disorder, caused by mutations in ABCC2 gen, and it is characterized by predominantly conjugated hyperbilirubinemia that can be increased by intercurrent infectious illnesses or surgical procedures. We report the case of a 10 year-old patient who showed, after a surgical procedure for peritonitis due to appendicitis, jaundice and predominantly conjugated hyperbilirubinemia, and he was diagnosed with Dubin-Johnson syndrome by genetic testing.
- Published
- 2017
41. [Evaluation of dysphagia. Results after one year of incorporating videofluoroscopy into its study]
- Author
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José Antonio López Calahorra, María José Romea Montañés, Ignacio Ros Arnal, Ruth García Romero, Beatriz Izquierdo Hernández, Cristina Gutierrez Alonso, and Carlos Martín de Vicente
- Subjects
Videofluoroscopia ,030506 rehabilitation ,Pediatrics ,medicine.medical_specialty ,Diagnostic methods ,Time Factors ,Deglución ,medicine.medical_treatment ,Video Recording ,Disfagia ,RJ1-570 ,Cerebral palsy ,03 medical and health sciences ,0302 clinical medicine ,Swallowing ,Management of Technology and Innovation ,Esophageal dysphagia ,otorhinolaryngologic diseases ,medicine ,Humans ,Statistical analysis ,Aspiración ,Medical prescription ,Child ,Páralisis cerebral ,business.industry ,medicine.disease ,Gastrostomy ,Dysphagia ,Cross-Sectional Studies ,Fluoroscopy ,medicine.symptom ,0305 other medical science ,business ,Deglutition Disorders ,030217 neurology & neurosurgery - Abstract
Introduction: Dysphagia is very common in children with neurological disabilities. These patients usually suffer from respiratory and nutritional problems. The videofluoroscopic swallowing study (VFSS) is the most recommended test to evaluate dysphagia, as it shows the real situation during swallowing. Objectives: To analyse the results obtained in our centre after one year of the implementation of VFSS, the clinical improvement after confirmation, and the prescription of an individualised treatment for the patients affected. Material and methods: VFSS performed in the previous were collected. The following variables were analysed: age, pathology, degree of neurological damage, oral and pharyngeal and/or oesophageal dysphagia and its severity, aspirations, prescribed treatment, and nutritional and respiratory improvement after diagnosis. A statistical analysis was performed using SPSS v21. Results: A total of 61 VFSS were performed. Dysphagia was detected in more than 70%, being moderate-severe in 58%. Aspirations and/or penetrations were recorded in 59%, of which 50% were silent. Adapted diet was prescribed to 56%, and gastrostomy was performed on 13 (21%) patients. A statistical association was found between neurological disease and severity of dysphagia. The degree of motor impairment is related to the presence of aspirations. After VFSS evaluation and treatment adjustment, nutritional improvement was found in Z-score of weight (+0.3SD) and BMI (+0.4SD). There was respiratory improvement in 71% of patients with dysphagia being controlled in the Chest Diseases Department. Conclusions: After implementation of VFSS, a high percentage of patients were diagnosed and benefited from a correct diagnosis and treatment. VFSS is a fundamental diagnostic test that should be included in paediatric centres as a diagnostic method for children with suspected dysphagia. Resumen: Introducción: La disfagia es muy frecuente en niños con discapacidad neurológica. Estos pacientes suelen presentar problemas respiratorios y nutricionales. El estudio de la deglución por videofluoroscopia (VFC) suele ser el más recomendado, ya que revela la situación real durante la deglución. Objetivos: Estudiar los resultados obtenidos en la evaluación diagnóstica tras un año desde la implantación de la VFC en nuestro centro, y analizar la mejoría clínica tras la confirmación por VFC y la prescripción de un tratamiento individualizado en los niños con disfagia orofaríngea. Material y métodos: Se recogen las VFC realizadas en el último año. Se analizan las siguientes variables: edad, enfermedad, grado de afectación neurológica, tipo de disfagia (oral, faríngea y/o esofágica), gravedad, aspiraciones y/o penetraciones, tratamiento prescrito y mejora nutricional y/o respiratoria tras el diagnóstico. Se realiza análisis estadístico mediante SPSS v21. Resultados: Se realizaron 61 VFC. Se detectó disfagia en más del 70%, siendo moderadas-graves en el 58%. Se visualizaron aspiraciones y/o penetraciones en el 59%, siendo silentes el 50%. Se prescribió dieta adaptada al 56% y gastrostomía en 13 pacientes (21%). Se encontró asociación estadística entre enfermedad neurológica y la gravedad de la disfagia, existiendo relación según el grado de afectación motora y la presencia de aspiraciones. Tras la evaluación por VFC y la adecuación del tratamiento se encontró una mejoría nutricional en Z-score de peso (+0,3 DE) e IMC (+0,4 DE) y una mejoría respiratoria en un 71% de los pacientes disfágicos controlados en Neumología. Conclusiones: Tras la implantación de la VFC se ha diagnosticado a un alto porcentaje de pacientes, que se han beneficiado de un diagnóstico y un tratamiento correctos. La VFC es una prueba diagnóstica fundamental que debería ser incluida en los centros pediátricos, como método diagnóstico de los niños con sospecha disfagia.
- Published
- 2017
42. Seronegative autoimmune hepatitis: Description of two paediatric cases
- Author
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Carlos Hörndler Argarate, Lorena Lahílla Cuello, Ignacio Ros Arnal, and Ruth García Romero
- Subjects
Text mining ,business.industry ,Management of Technology and Innovation ,Immunology ,medicine ,Autoimmune hepatitis ,business ,medicine.disease ,Pediatrics ,RJ1-570 - Published
- 2018
43. Hepatitis autoinmune seronegativa, descripción de 2 casos en edad pediátrica
- Author
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Carlos Hörndler Argarate, Ignacio Ros Arnal, Lorena Lahílla Cuello, and Ruth García Romero
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Medicine ,030211 gastroenterology & hepatology ,business ,Pediatrics ,RJ1-570 - Published
- 2018
44. [VITAMIN D AND CHRONIC LUNG COLONIZATION IN PEDIATRIC AND YOUNG ADULTS CYSTIC FIBROSIS PATIENTS]
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David, González Jiménez, Rosana, Muñoz Codoceo, María, Garriga García, Manuel, Molina Arias, Marina, Alvarez Beltran, Ruth, García Romero, Cecilia, Martínez Costa, Silvia María, Meavilla Olivas, Luis, Peña Quintana, Silvia, Gallego Gutierrez, Jose Manuel, Marugan de Miguelsanz, Lucrecia, Suarez Cortina, Esperanza Natividad, Castejón Ponce, Rosaura, Leis Trabazo, Fayna, Martín Cruz, Juan Jose, Díaz Martín, and Carlos, Bousoño García
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Male ,Adolescent ,Cystic Fibrosis ,Infant ,Vitamins ,Vitamin D Deficiency ,Young Adult ,Cross-Sectional Studies ,Child, Preschool ,Humans ,Female ,Vitamin D ,Child ,Lung - Abstract
evaluate vitamin D status and its association with chronic lung colonisation in Cystic Fibrosis patients.descriptive cross-sectional multicenter study. From November 2012 to April 2014, at 12 national hospitals, 377 patients with Cystic Fibrosis were included. Vitamin D levels30 ng/ml were classified as insufficient. Chronic colonisation was considered if they had at least two positive cultures in the past year.the median age was 8.9 years (2 months to 20 years). 65% had insufficient levels of vitamin D. There was an inverse correlation between age and vitamin D levels (r = -0.20 p0.001). Those diagnosed by screening, were younger and had higher levels of vitamin D. There was an inverse correlation between the number of colonisations and vitamin D levels (r = -0.16 p = 0.0015). Adjusting for age, pancreatic status and diagnosis by screening, colonization by S. aureus in 6 years, increased the risk of insufficient levels of vitamin D: OR 3.17 (95% CI 1.32 to 7.61) (p = 0.010) and OR 3.77 (95% CI 1.37 to 10 , 37) (p = 0.010), respectively.despite adequate supplementation, more than half of our patients did not achieve optimal levels of vitamin D. Regardless of age, diagnosis by screening or pancreatic status, chronic colonization by Pseudomonas sp. in children and adolescents and S. Aureus in infants and preschoolars increases the risk of developing vitamin D deficiency in these patients.Introducción y objetivos: conocer la situación en la que se encuentran los pacientes con fibrosis quística en relación con sus niveles de vitamina D y su asociación con las colonizaciones pulmonares crónicas. Material y métodos: estudio multicéntrico transversal. Participaron 12 hospitales nacionales. De noviembre a abril del 2012 al 2014 se incluyeron 377 pacientes con fibrosis quística. Se consideraron insuficientes niveles de vitamina D30 ng/ml. Presentar al menos dos cultivos positivos en el último año fue considerado un criterio de colonización crónica. Resultados: los pacientes tenían una mediana de edad de 8,9 años (2 meses—20 años). Un 65% presentaban niveles insuficientes de vitamina D. Se observó una correlación inversa entre edad y niveles de vitamina D (r = -0,20 p0,001). Los diagnosticados por cribado eran más jóvenes y tenían niveles de vitamina D más altos. Los niveles de vitamina D presentaron una correlación inversa con el número de colonizaciones pulmonares (r = -0,16 p = 0,0015). Ajustando por edad, función pancreática y diagnóstico mediante cribado, la colonización por S. Aureus en menores de seis años y por Pseudomonas sp. en los mayores de esa edad, incrementaban el riesgo de presentar niveles insuficientes de vitamina D: OR 3,17 (IC95% 1,32-7,61) (p=0,010) y OR 3,77 (IC95% 1,37- 10,37)(p = 0,010), respectivamente. Conclusiones: a pesar de una suplementación adecuada, más de la mitad de nuestros pacientes no alcanzan niveles óptimos de vitamina D. La colonización crónica por Pseudomonas sp. en escolares y adolescentes y por S. Aureus en lactantes y preescolares se asocia de forma independiente con la deficiencia de vitamina D.
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- 2015
45. Conjugated hyperbilirubinemia after surgery: a diagnosis of Dubin-Johnson syndrome confirmed by genetic testing
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María Luisa Baranguán-Castro, Ruth García-Romero, and María Dolores Miramar-Gallart
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Full Text
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46. Blood gene expression biomarkers of response to anti-TNF drugs in pediatric inflammatory bowel diseases before initiation of treatment
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Sara Salvador-Martín, Gianluca Rubbini, Perceval Vellosillo, Paula Zapata-Cobo, Marta Velasco, Laura M. Palomino, Susana Clemente, Oscar Segarra, Ana Moreno-Álvarez, Ana Fernández-Lorenzo, Begoña Pérez-Moneo, Montserrat Montraveta, Cesar Sánchez, Mar Tolín, Inés Loverdos, María José Fobelo, Victor Manuel Navas-López, Lorena Magallares, Ruth García-Romero, Ricardo Torres-Peral, Alejandro Rodríguez, Ferrán Bossacoma, Vicente Merino-Bohórquez, Enrique Salcedo, Rebeca Álvarez, Ana Dopazo, María Sanjurjo-Sáez, and Luis A. López-Fernández
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RNA-seq ,Pharmacogenomics ,Inflammatory bowel disease ,Anti-TNF drugs ,Pediatrics ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Background/aims: Changes in gene expression profiles among individuals with inflammatory bowel diseases (IBDs) could potentially influence the responsiveness to anti-TNF treatment. The aim of this study was to identify genes that could serve as predictors of early response to anti-TNF therapies in pediatric IBD patients prior to the initiation of treatment. Methods: We conducted a prospective, longitudinal, and multicenter study, enrolling 24 pediatric IBD patients aged less than 18 years who were initiating treatment with either infliximab or adalimumab. RNA-seq from blood samples was analyzed using the DESeq2 library by comparing responders and non-responders to anti-TNF drugs. Results: Bioinformatic analyses unveiled 102 differentially expressed genes, with 99 genes exhibiting higher expression in responders compared to non-responders prior to the initiation of anti-TNF therapy. Functional enrichment analyses highlighted defense response to Gram-negative bacteria (FDR = 2.3 ×10–7) as the most significant biological processes, and hemoglobin binding (FDR = 0.002), as the most significant molecular function. Gene Set Enrichment Analysis (GSEA) revealed notable enrichment in transcriptional misregulation in cancer (FDR = 0.016). Notably, 13 genes (CEACAM8, CEACAM6, CILP2, COL17A1, OLFM4, INHBA, LCN2, LTF, MMP8, DEFA4, PRTN3, AZU1, and ELANE) were selected for validation, and a consistent trend of increased expression in responders prior to drug administration was observed for most of these genes, with findings for 4 of them being statistically significant (CEACAM8, LCN2, LTF2, and PRTN3). Conclusions: We identified 102 differentially expressed genes involved in the response to anti-TNF drugs in children with IBDs and validated CEACAM8, LCN2, LTF2, and PRTN3. Genes participating in defense response to Gram-negative bacterium, serine-type endopeptidase activity, and transcriptional misregulation in cancer are good candidates for anticipating the response to anti-TNF drugs in children with IBDs.
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- 2024
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47. Comments on: Polymorphisms indicating risk of inflammatory bowel disease or antigenicity to anti-TNF drugs as biomarkers of response in children
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Paula Zapata-Cobo, Sara Salvador-Matín, Marta Velasco, Laura M. Palomino, Susana Clemente, Oscar Segarra, Ana Moreno-Álvarez, Ana Fernández-Lorenzo, Begoña Pérez-Moneo, Montse Montraveta, Cesar Sánchez, Mar Tolín, Inés Loverdos, María José Fobelo, Victor Manuel Navas-López, Lorena Magallares, Ruth García-Romero, José Germán Sánchez-Hernández, Alejandro Rodríguez, Ferrán Bossacoma, María Jesús Balboa, Enrique Salcedo, María Sanjurjo-Sáez, and Luis A. López-Fernández
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Inflammatory bowel disease ,Pharmacogenetics ,Infliximab ,Adalimumab ,Polymorphism ,Pediatric ,Therapeutics. Pharmacology ,RM1-950 - Published
- 2023
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48. Polymorphisms indicating risk of inflammatory bowel disease or antigenicity to anti-TNF drugs as biomarkers of response in children
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Paula Zapata-Cobo, Sara Salvador-Martín, Marta Velasco, Laura M. Palomino, Susana Clemente, Oscar Segarra, Ana Moreno-Álvarez, Ana Fernández-Lorenzo, Begoña Pérez-Moneo, Montserrat Montraveta, Cesar Sánchez, Mar Tolín, Inés Loverdos, María Jesús Fobelo, Victor Manuel Navas-López, Lorena Magallares, Ruth García-Romero, José Germán Sánchez-Hernández, Alejandro Rodríguez, Ferrán Bossacoma, María Jesús Balboa, Enrique Salcedo, María Sanjurjo-Sáez, and Luis A. López-Fernández
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Inflammatory bowel disease ,Crohn’s disease ,Ulcerative colitis ,Pharmacogenetics ,Infliximab ,Adalimumab ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Few genetic polymorphisms predict early response to anti-TNF drugs in inflammatory bowel disease (IBD), and even fewer have been identified in the pediatric population. However, it would be of considerable clinical interest to identify and validate genetic biomarkers of long-term response. Therefore, the aim of the study was to analyze the usefulness of biomarkers of response to anti-TNFs in pediatric IBD (pIBD) as long-term biomarkers and to find differences by type of IBD and type of anti-TNF drug. The study population comprised 340 children diagnosed with IBD who were treated with infliximab or adalimumab. Genotyping of 9 selected SNPs for their association with early response and/or immunogenicity to anti-TNFs was performed using real-time PCR. Variants C rs10508884 (CXCL12), A rs2241880 (ATG16L1), and T rs6100556 (PHACTR3) (p value 0.049; p value 0.03; p value 0.031) were associated with worse long-term response to anti-TNFs in pIBD. DNA variants specific to disease type and anti-TNF type were identified in the pediatric population. Genotyping of these genetic variants before initiation of anti-TNFs would enable, if validated in a prospective cohort, the identification of pediatric patients who are long-term responders to this therapy.
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- 2023
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49. Arteritis de Takayasu como hallazgo incidental en un paciente con enfermedad celiaca: la importancia de la tomografía computarizada por emisión de positrones
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Amelia Moreno-Sánchez, David Molina-Herranz, Yurena Aguilar-de-la-Red, Lorenzo Jiménez-Montañés, Marta Medrano-SanIldefonso, and Ruth García-Romero
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Pediatría. PET-TC. Reumatología. Takayasu. Vasculitis. ,Pediatrics ,RJ1-570 ,Public aspects of medicine ,RA1-1270 - Abstract
Introducción: La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Ocurre frecuentemente en mujeres entre los 20-30 años, por lo que es muy infrecuente en la edad pediátrica. Caso clínico: Se presenta el caso de una paciente de 15 años en seguimiento desde los 9 años por enfermedad celiaca. A los 13 años se detectó anemia de trastornos crónicos, elevación de proteína C reactiva y velocidad de sedimentación globular. La paciente permaneció en todo momento asintomática. Tras descartar otros procesos, se solicitó tomografía computarizada por emisión de positrones (PET-TC), donde se detectaron lesiones compatibles con vasculitis de grandes vasos. La valoración por Cardiología evidenció un aneurisma en coronaria derecha. Se realizó angio-TC, que sugirió arteritis de Takayasu tipo III. Conclusiones: Es frecuente un retraso en el diagnóstico de la arteritis de Takayasu en los pacientes pediátricos. En este caso se encontraron lesiones de la fase II sin la presencia de síntomas correspondientes a la fase I. El PET-TC permitió el diagnóstico de vasculitis, clave para el diagnóstico de la paciente.
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- 2023
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50. Cribado neonatal de fibrosis quística: análisis y diferencias de los niveles de tripsina inmunorreactiva en recién nacidos con cribado positivo
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Marta Arrudi-Moreno, Ruth García-Romero, Pilar Samper-Villagrasa, María José Sánchez-Malo, and Carlos Martin-de-Vicente
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Immunoreactive trypsin ,Neonatal screening ,Cystic fibrosis ,Pediatrics ,RJ1-570 - Abstract
Resumen: Introducción: El cribado neonatal de fibrosis quística (FQ) ha permitido el diagnóstico precoz de la enfermedad, siendo determinante en el aumento de supervivencia de estos pacientes. Su principal inconveniente es su baja especificidad y elevado número de falsos positivos. El objetivo fue analizar las diferencias de tripsina inmunorreactiva (TIR) entre los diferentes grupos de recién nacidos (RN) con cribado neonatal positivo según fueran sanos, portadores sanos, afectos de FQ o Cystic Fibrosis Screen Positive, Inconclusive Diagnosis (CFSPID). Material: Estudio retrospectivo analítico de las concentraciones de TIR en RN con cribado neonatal positivo para FQ nacidos en un hospital de tercer nivel durante 8 años. Resultados: Se analizaron 790 RN con cribado neonatal positivo para FQ, 86,3% a término, 53% niñas y 11,8% ingresados. El valor medio de TIR fue 79,16 ng/ml (rango 60-367). Se encontraron concentraciones significativamente más elevadas de TIR en afectos de FQ con respecto a los otros grupos (p
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- 2021
- Full Text
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