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INTRODUCTION: Malnutrition on admission is closely related to a longer hospital stay and a higher morbidity. The prevalence of hospital malnutrition has been reported as almost as high as 50%, with 6% being the lowest. DHOSPE study investigates nutrition status in Spanish hospitals and its outcome during the hospital stay. PATIENTS AND METHODS: A longitudinal, multicentre, descriptive, cross-sectional study, with a short follow-up period was conducted in 32 hospitals during 2011. A total of 991 patients were included, with ages from 0 to 17 years. Each patient was measured at admission (weight, length, weight for length -W/L-, length for age -L/A-), and at 7 and 14 days. The STAMP nutritional screening tool was completed on admission. Anthropometric measurements were reported as z-score, and nutrition status classified according to W/L and L/A for acute and chronic malnutrition, respectively. RESULTS: The prevalence of malnutrition was 7.1% for moderate, and 0.7% for severe acute malnutrition. For chronic malnutrition, it was 2.7% moderate, and 1.4% severe. There were significant differences according to the underlying condition but not according to age. Results of STAMP show that around 75% of patients had a moderate to high risk of malnutrition. Nutritional status changed during admission for weight, as well as W/L and L/A. A worst nutritional status at admission and a higher STAMP score were positively correlated with the need for nutrition support. CONCLUSIONS: The prevalence of undernutrition was slightly lower (

Introduction: To compare the effectiveness and safety of polyethylene glycol with and without electrolytes (EL) over a 12 week period in treatment of chronic constipation in paediatrics. Material and methods: This was an observational, prospective, longitudinal, parallel group study, including 62 children with chronic constipation according to ROME III criteria and a history of faecal impaction. The children were divided into groups, one group of 30 received polyethylene glycol without EL (PEG) and 32 PEG with EL (PEG + EL) for at least 12 weeks. The main outcomes were the number of bowel movements at 6 and 12 weeks, and the presence of electrolyte disturbances at 6 weeks. Results: The mean weekly stool frequencies were similar in both groups at 6 and 12 weeks, with 5.4 and 4.6 stools per week in the PEG + EL and PEG groups, respectively at 12 weeks. After 6 weeks of treatment, 83% (25 of 30) of the PEG group had at least one electrolyte disturbance compared with 56% (18 of 32) in the PEG + EL group (P=.02). Hyponatraemia was found in 15% (5 of 32) vs. 36% (11 of 30) of PEG + EL and PEG groups, respectively (P=.05). None of the laboratory abnormalities were clinically relevant. Conclusions: PEG formulations with or without EL have a quite similar effectiveness, safety and acceptability. PEG without EL produced more electrolyte abnormalities, but none of them were symptomatic. (C) 2015 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U. All rights reserved.

BACKGROUND: CDEUSSA is a Specific Support Action project from the Sixth Framework Programme Priority of the European Union (EU). Its aim is to bring together basic and applied research in the area of coeliac disease (CD). This paper reviews the main issues that are a result of the CDEUSSA initiative. AIM: To identify the major issues in need of investigation in the areas of clinical aspects, treatment, prevention and public health. METHODS: Key stakeholders, representing a wide range of knowledge with crucial importance for CD research and practice, have participated in two workshops aimed at identifying and proposing to the EU, as high priority research, topics in the areas of clinical aspects, treatment, prevention and public health. RESULTS: In public health, the overall goal should be to improve quality of life of the European population by implementing primary prevention strategies, early diagnosis and improved treatments for CD. New treatment strategies need to be developed. The option of primary prevention should be fully explored, which requires combined epidemiological, clinical and basic scientific research efforts. Such studies should also consider the importance of gene-environment interactions in the development of CD. Increased knowledge is needed on the natural history of CD. Diagnostic criteria need to be revised. CONCLUSIONS: To achieve these goals, a collaboration of the stakeholders is fundamental, including research and patient organizations, as well as industries within both diagnostics and food production.

In addition to genetic risk, environmental factors might influence coeliac disease (CD) development. We sought to assess the effect of the interaction between milk-feeding practices and the HLA-DQ genotype on peripheral lymphocyte subsets and their activation markers in infants at familial risk for CD.

Interactions between environmental factors and predisposing genes could be involved in the development of coeliac disease (CD). This study has assessed whether milk-feeding type and HLA-genotype influence the intestinal microbiota composition of infants with a family history of CD. The study included 164 healthy newborns, with at least one first-degree relative with CD, classified according to their HLA-DQ genotype by PCR-SSP DQB1 and DQA1 typing. Faecal microbiota was analysed by quantitative PCR at 7 days, and at 1 and 4 months of age. Significant interactions between milk-feeding type and HLA-DQ genotype on bacterial numbers were not detected by applying a linear mixed-model analysis for repeated measures. In the whole population, breast-feeding promoted colonization of C. leptum group, B. longum and B. breve, while formula-feeding promoted that of Bacteroides fragilis group, C. coccoides-E. rectale group, E. coli and B. lactis. Moreover, increased numbers of B. fragilis group and Staphylococcus spp., and reduced numbers of Bifidobacterium spp. and B. longum were detected in infants with increased genetic risk of developing CD. Analyses within subgroups of either breast-fed or formula-fed infants indicated that in both cases increased risk of CD was associated with lower numbers of B. longum and/or Bifidobacterium spp. In addition, in breast-fed infants the increased genetic risk of developing CD was associated with increased C. leptum group numbers, while in formula-fed infants it was associated with increased Staphylococcus and B. fragilis group numbers. Overall, milk-feeding type in conjunction with HLA-DQ genotype play a role in establishing infants' gut microbiota; moreover, breast-feeding reduced the genotype-related differences in microbiota composition, which could partly explain the protective role attributed to breast milk in this disorder.

Objetivos: Los objetivos del presente estudio eran: 1) comparar los niveles de ansiedad, depresión y trastornos de alimentación en jóvenes atendidos en un hospital pediátrico por obesidad; 2) determinar si la ansiedad y la depresión explican los síntomas de trastornos de alimentación, y 3) conocer cuáles de esos síntomas discriminan mejor entre jóvenes con distintos grados de obesidad. Material y métodos: Estudio descriptivo, transversal con una muestra de 281 jóvenes (56% mujeres) de entre 11 y 17 años. Los percentiles de IMC se calcularon utilizando las tablas de crecimiento de la OMS. Se crearon dos grupos de estudio: obesidad severa y sobrepeso-obesidad leve-moderada. Se utilizaron los siguiente cuestionarios: Eating Disorders Inventory-2 (EDI-2), cuestionario de depresión(CDI) y cuestionario de ansiedad estado-rasgo (STAI). Resultados: Los jóvenes con obesidad severa mostraron más problemas psicológicos que los jóvenes con sobrepeso-obesidad leve-moderada, un 12% presentaban ansiedad y un 11% depresión. En ambos grupos, las conductas relacionadas con los trastornos de alimentación eran, en parte, explicadas por la mayor presencia de síntomas de ansiedad y de depresión. La insatisfacción corporal junto con una elevada ansiedad rasgo incrementaban el riesgo de perpetuar la obesidad y eran los dos síntomas que mejor discriminaban a los pacientes con o sin obesidad severa. Conclusión: Los programas de prevención de la obesidad deberían incluir la insatisfacción corporal y la ansiedad rasgo en los protocolos de evaluación y tratamiento, y prevenir que la ansiedad se instaure como rasgo de personalidad. Objectives: the goals of the present study were: 1) to compare the levels of anxiety, depression, and eating disorders in young patients assisted at a children's hospital for obesity; 2) to determine whether anxiety and depression explain the symptoms of the eating disorders; and 3) to know which of these symptoms better discriminate the young people with different degrees of obesity. Materials and method: Descriptive, cross-sectional study with a sample comprised by 281 youngsters (56% girls) aged 11-17 years. The BMI percentiles were calculated by using the WHO growth tables. Two study groups were created: severe obesity and overweight/light-moderate obesity. The following questionnaires were used: Eating Disorders Inventory-2 (EDI-2), depression questionnaire (DQ), and Status-Trait Anxiety Questionnaire (STAI). Results: The youngsters with obesity showed more psychological problems than youngsters with overweight/light-moderate obesity, 12% had anxiety, and 11% depression. In both groups, the behaviours related with eating disorders were partially explained by the presence of symptoms of anxiety and depression. Dissatisfaction with the body and high anxiety trait increased the risk for perpetuating the obesity and were the two symptoms that better discriminated the patients with or without severe obesity. Conclusion: Obesity prevention programmes should include body dissatisfaction and the anxiety trait into the assessment and management protocols, and prevent anxiety getting fixed as a personality trait.

Coeliac disease (CD) development involves genetic (HLA-DQ2/DQ8) and environmental factors. Herein, the influence of the HLA-DQ genotype on the gut colonization process of breast-fed children was determined. A cohort of 20 newborns, with at least one first-degree relative with CD, were classified according to their HLA-DQ genotype into high, intermediate and low genetic risk groups, showing 24-28%, 7-8% and less than 1% probability to develop CD, respectively. Faecal microbiota was analysed at 7 days, 1 and 4 months of children's age by fluorescence in situ hybridization. When considering all data, Gram-negative bacteria and Bacteroides-Prevotella group proportions were higher (P&lt, 0.05) in the high than in the intermediate and low genetic risk groups. E. coli, Streptococcus-Lactococcus, E. rectale-C. coccoides, sulphate-reducing bacteria, C. lituseburense and C. histolyticum group proportions were also significantly higher (P&lt, 0.05) in the high than in the low genetic risk group. Correlations between these bacterial groups and the genetic risk were also detected (P&lt, 0.05). In addition, the number and type of CD relative seemed to influence (P&lt, 0.050) these bacterial proportions in children at CD risk. At 4 months of age, similar relationships were established between the high genetic risk to develop CD and the proportions of Streptococcus-Lactococcus (P&lt, 0.05), E. rectale-C. coccoides (P&lt, 0.05), C. lituseburense (P&lt, 0.05), C. histolyticum (P&lt, 0.05), Bacteroides-Prevotella (P&lt, 0.10) groups and total Gram-negative bacteria (P&lt, 0.05). The results suggest a relationship between HLA-DQ genes and the gut microbial colonization process that could lead to a change in the way this disorder is investigated.

Objetivos: Los objetivos del presente estudio eran: 1) comparar los niveles de ansiedad, depresión y trastornos de alimentación en jóvenes atendidos en un hospital pediátrico por obesidad; 2) determinar si la ansiedad y la depresión explican los síntomas de trastornos de alimentación, y 3) conocer cuáles de esos síntomas discriminan mejor entre jóvenes con distintos grados de obesidad. Material y métodos: Estudio descriptivo, transversal con una muestra de 281 jóvenes (56% mujeres) de entre 11 y 17 años. Los percentiles de IMC se calcularon utilizando las tablas de crecimiento de la OMS. Se crearon dos grupos de estudio: obesidad severa y sobrepeso-obesidad leve-moderada. Se utilizaron los siguiente cuestionarios: Eating Disorders Inventory-2 (EDI-2), cuestionario de depresión(CDI) y cuestionario de ansiedad estado-rasgo (STAI). Resultados: Los jóvenes con obesidad severa mostraron más problemas psicológicos que los jóvenes con sobrepeso-obesidad leve-moderada, un 12% presentaban ansiedad y un 11% depresión. En ambos grupos, las conductas relacionadas con los trastornos de alimentación eran, en parte, explicadas por la mayor presencia de síntomas de ansiedad y de depresión. La insatisfacción corporal junto con una elevada ansiedad rasgo incrementaban el riesgo de perpetuar la obesidad y eran los dos síntomas que mejor discriminaban a los pacientes con o sin obesidad severa. Conclusión: Los programas de prevención de la obesidad deberían incluir la insatisfacción corporal y la ansiedad rasgo en los protocolos de evaluación y tratamiento, y prevenir que la ansiedad se instaure como rasgo de personalidad.

Background: autoimmune hepatitis (AIH) is an inflammatory disease of unknown origin that is responsible for progressive liver necrosis and ultimately cirrhosis. Objective: our aim was to evaluate the characteristics of autoimmune hepatitis presenting in the pediatric age. Material and methods: we conducted a retrospective study of all patients diagnosed with AIH in our hospital department during the last 10 years. Variables analyzed included age, sex, clinical presentation, hepatic function, immunoglobulins, autoimmunity markers, histology, treatment, need for transplant, and clinical evolution. According to the positive level of auto-antibodies, AIH patients were classified as type I AIH (ANA and/or smooth-muscle antibodis) and type II (anti-LKM-1). Results: seven patients were diagnosed in this period -5 girls (71.5%) and 2 boys (28.5%). Five patients presented with type-I serological markers, and two with type-II markers. Age range at diagnosis was from 21 months to 12 years. In the type-I group, 3 patients presented with acute hepatitis while 2 other patients were diagnosed from laboratory findings while asymptomatic. Elevated aminotransferase (10 times the normal level) was observed in 71.5%, and 85% had elevated immunoglobulins. Treatment with azathioprine and prednisone was started after diagnosis with an average time to remission of 14 months. Two patients relapsed following steroid withdrawal. Conclusion: AIH can have different forms of clinical presentation, and is sometimes indistinguishable from viral hepatitis. AIH must be ruled out in patients presenting with concomitant elevation of aminotransferases and immunoglobulins. The commonly accepted treatment is a combination of azathioprine and corticosteroids. A high percentage of patients experience a relapse of disease after steroids are withdrawn. Therefore, some patients will need to stay on combined therapy with minimal doses of steroids.

Presentamos un caso de síndrome postpericardiotomía tras la implantación de un marcapasos endovenoso (SPIV) en una mujer de 78 años y revisamos la experiencia publicada. Desde 1975 se han publicado en la literatura médica diez casos más de SPIV. La escasez de casos publicados y la alta tasa de complicaciones contrastan con la elevada prevalencia (4.6%) y el curso benigno de las pericarditis agudas tras la inserción de marcapasos endovenosos en una serie de 126 pacientes consecutivos. Esta clase de SPIV está probablemente infradiagnosticada y los casos publicados probablemente representan solo las formas clínicas más graves. Un alto índice de sospecha debería mejorar su diagnóstico y tratamiento. We report a postpericardiotomy syndrome (PS) following the implantation of endovenous pacemaker in a 78-year-old woman. Ten more single cases were reported in the medical literature since 1975. The infrequent single reports and the high complication rate are in contrast with the 4,6% occurrence and the benign course of acute pericarditis following the insertion of endovenous pacemakers in 126 consecutive patients. This sort of PS is probably underdiagnosed and the cases reported represent the more severe clinical presentations. A higher suspicion index would improve the diagnosis and management.

The aim of this study is to evaluate a new diagnostic test to detect Helicobacter pylori antigen in stool samples (HpSA), and compare the results with those obtained by standard techniques (rapid urease test,culture, histological examination of gastric biopsy specimens,13C-urea breath test and serology), in a paediatric population with gastrointestinal symptomatology.

The purpose of this study was to evaluate the use of polymerase chain reaction (PCR) applied to the diagnosis Helicobacter pylori infection in the pediatric population, by means of a rapid and simple method of extraction and posterior detection by a colorimetric hybridation of amplified H. pylori DNA.Fifty three gastric biopsies, obtained through upper gastrointestinal endoscopy from 53 patients with gastric pathology (45 recidivant abdominal pain and eight hematemesis), were processed from october 1995 to july 1996. Three non invasive tests were performed: detection of IgG by (Cobas) Core Anti-H. pylori EIA (Roche), breath test with 13C-urea and PCR of dental plaque, as well as four invasive ones: histologic study, culture into selective (Pylori Agar, bioMérieux) and non selective media (Columbia Agar with 5% sheep blood, bioMérieux), test of rapid urease and PCR of gastric biopsies. A 20% solution of Chelex 100 resin (DNA Extraction Reagen, Perkin Elmer) was used for DNA extraction, amplification was performed from gen ureA (Clayton, 1992) and amplified DNA was detected by colorimetric hybridation (PCR ELISA, Boehringer, Mannheim). Duration of the PCR process was: extraction 25 min, amplification two hours and detection three hours.Results of culture and PCR from gastric biopsies agreed in 84.3% of cases (27 positives, 16 negatives and two not determined). Two samples were positive by culture and negative by PCR, and were considered as PCR false negatives due to positivity of three or more other tests. Six samples were negative by culture and positive by PCR, being considered as culture false negatives due to positivity of three or more other tests. Sensitivity of PCR and culture was 94.2 and 82.8%. Specificity was 100% for both tests. None of the dental plaque samples was positive.When invasive techniques are to be done for microbiologic diagnose of H. pylori, PCR increases the confirmation rate of infection; the present procedure enables daily routine work due to its simplicity and its short turnaround time.

The aim of this study was to determine the role of Helicobacter pylori infection in dental plaque from 53 children, between 3 and 17 years of age, with recurrent abdominal pain and/or upper gastrointestinal bleeding.