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The aims of this study were to introduce a paediatric early warning score (PEWS) into our daily clinical practice, as well as to evaluate its ability to detect clinical deterioration in children admitted, and to train nursing staff to communicate the information and response effectively.An analysis was performed on the implementation of PEWS in the electronic health records of children (0-15 years) in our paediatric ward from February 2014 to September 2014. The maximum score was 6. Nursing staff reviewed scores2, and if3 medical and nursing staff reviewed it. Monitoring indicators: % of admissions with scoring; % of complete data capture; % of scores3; % of scores3 reviewed by medical staff, % of changes in treatment due to the warning system, and number of patients who needed Paediatric Intensive Care Unit (PICU) admission, or died without an increased warning score.The data were collected from all patients (931) admitted. The scale was measured 7,917 times, with 78.8% of them with complete data capture. Very few (1.9%) showed scores3, and 14% of them with changes in clinical management (intensifying treatment or new diagnostic tests). One patient (scored 2) required PICU admission. There were no deaths. Parents or nursing staff concern was registered in 80% of cases.PEWS are useful to provide a standardised assessment of clinical status in the inpatient setting, using a unique scale and implementing data capture. Because of the lack of severe complications requiring PICU admission and deaths, we will have to use other data to evaluate these scales.

The objective of this study was to evaluate the effect of herbage allowance on pasture DM consumption by growing European wild boar. An additional objective was to evaluate the influence of pasture consumption on supplemental diet intake and BW gain. A previously sown grass-clover pasture was managed by cutting to obtain an herbage mass equivalent to 1,500 kg/ha DM. Areas of pasture were limited by fencing to obtain 3 different herbage allowances whereas the pasture was removed in other areas. Forty-eight purebred European wild boars (initial age of 120 d and initial BW of 14.4 kg) were grouped in pairs and each pair was randomly allotted to 1 of 4 treatments (6 pairs per treatment): no pasture (4 m(2); pasture removed), low (5.33 m(2); 400 g/d pasture DM available/wild boar), medium (8 m(2); 600 g/d pasture DM available/wild boar), and high (16 m(2); 1,200 g/d pasture DM available/wild boar). The treatment areas were moved daily with a 7-d rotation. For a 28-d period, wild boars entered their treatment areas from 0830 to 1630 h, after which they had free access to a supplemental diet for 1 h. Pasture consumption was estimated daily by cutting pasture samples pre- and postgrazing. Supplemental diet consumption was determined daily (feed offered minus remaining feed). Animals were weighed weekly. Pasture consumption differed (P0.001) among wild boars receiving different treatments, with cumulative consumptions of 3.0 and 3.9 kg DM/wild boar over 28 d for low and medium herbage allowances, respectively (P0.09), and 6.4 kg DM/wild boar over 28 d for high herbage allowance, with the latter consumption being greater (P0.001) than the consumption recorded with the decreased herbage allowance treatments. The supplemental diet consumption tended (P = 0.16) to be less in wild boars with greater herbage allowance. European wild boars with access to pasture had greater (8.48 vs. 6.27 kg; P = 0.002) BW gain than those without access to pasture. In conclusion, pasture consumption by European wild boars can be enhanced by increasing herbage allowance and greater BW gains can be achieved in wild boars with access to pasture compared with those with no pasture access.

Epidemiological studies have shown a high prevalence of silent celiac disease (CD) among unselected pediatric populations and a low ratio of diagnosed to undiagnosed CD.To quantify the prevalence of silent CD, to assess the clinical features of subclinical CD and to determine the total prevalence of CD (silent plus symptomatic cases).We determined total serum IgA, IgA antiendomysial antibodies (EMA) and IgG antigliadin antibodies (IgG AGA), if IgA deficiency was found, in schoolchildren aged 10-12 years from health district IX in Madrid.A total of 3,378 schoolchildren (47.8 % of the eligible population) were studied. Fifteen were EMA-positive and one child with IgA deficiency was IgG AGA-positive. CD was confirmed by intestinal biopsy in 12 children, representing a prevalence of undiagnosed CD of 1/281. Of these 12 children, 7 showed clinical features of CD. The most frequent symptom was iron-deficiency, followed by recurrent aphthous stomatitis and mild malnutrition. Before the start of this study, CD had been diagnosed in seven children from the same population, which would increase the total prevalence of the disease to 1/220 with an estimated ratio of diagnosed to undiagnosed CD of 1 to 3.5.We confirm the high prevalence of silent celiac disease among the school-aged population. This ratio is one of the highest published and could be due to a high diagnostic suspicion for CD among pediatricians in our health district. Greater awareness of the minor symptoms of CD would reduce the number of patients with undiagnosed CD.

Caroli's disease is a rare entity that is included in the fibropolycystic abnormalities of the bile ducts. Ultrasonographic patterns consist of evident dilatation of the bile ducts. Although it is thought to be a congenital disease, it usually presents in young adults and few cases have been reported in children. We present the case of a 10-year-old boy with Caroli's syndrome (Caroli's disease, congenital hepatic fibrosis and polycystic renal disease). Evolution was favorable.