Objectives
The rate of eosinophilic esophagitis (EoE) diagnosis is increasing. This study aims to determine the incidence of EoE in the pediatric population residing in the southwestern Madrid and to ...analyze whether absolute monthly pollen counts, modified or not by the principal atmospheric pollutants, are associated with it.
Methods
A cross‐sectional study on prospectively recruited patients was designed to calculate the incidence of EoE in children aged under 15 years who were diagnosed between September 2014 and August 2016 in twelve hospitals.
We collected demographic and symptoms data, date of onset of symptoms, date of medical consultation, and date of endoscopic diagnosis of each included patient. Relative risk estimation was performed to assess the association between the incidence of diagnosis and monthly pollen counts and levels of atmospheric pollutants. All these models were adjusted for the number of total patients that underwent endoscopy at first time.
Results
One hundred forty‐eight patients were included. The most frequent symptoms were abdominal pain 42.57%, dysphagia 42.57%, and impaction 39%–86%. The median overall monthly incidence was 1.13 interquartile rank: 0.97–1.43 cases/100,000 children, and the annual mean was 15.2. The overall analysis of the relationship between incidence and absolute monthly counts, corrected for the number of first‐time endoscopies performed, revealed no statistically significant association with pollen and air pollutants. There was a higher frequency of diagnosis during the pollination period of Cupressaceae relative risk 1.647; 95% CI (1.192–2.276) p < .002 and during February and November (relative risk 1.67; p < .01).
Conclusions
This study confirms the high incidence of eosinophilic esophagitis and also suggests a period of higher incidence of diagnosis in the months of February and November as well as in the period of high pollination of Cupressaceae.
Abstract
Background
IMPACT-III and IMPACT-III-P are Health-Related Quality of Life (HRQoL) questionnaires for pediatric Inflammatory Bowel Disease (p-IBD) patients and their parents/caregivers. They ...consist of 35 items answered with a 1-5 points Likert scale that evaluate six domains. Higher scores indicate better HRQoL. IMPACT-III has been translated into over 70 languages and validated in several countries. However, the existing IMPACT-III Spanish translation showed room for improvement and none of the tools had been validated in our population. We aimed to perform a transcultural adaptation and validation of the Spanish versions.
Methods
With permission from the questionnaires’ authors, we performed the translation and back-translation by professional translators, followed by evaluation by an expert committee and a small group of p-IBD families (n=12). Members of the SEGHNP (Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition) were invited to recruit p-IBD patients aged 10-18 and their families (February’21-November’22) to complete the questionnaires. Demographical and clinical data of the p-IBD participants were analyzed. Validation was performed with the Cronbach's alpha coefficient (considering 0.8-0.9 a good internal consistency) and a confirmatory factorial analysis with Varimax rotation (desirable values >0.5). The Kaiser Meyer Olkin (KMO) measure (>0.5 good correlation) and the Bartlett’s sphericity test (p<0.05) were calculated to confirm the adequacy of the factor analysis. The utility (method and completion time) was considered. The correlation coefficient between IMPACT-III and IMPACT-III-P was analyzed. Data were collected and analyzed with REDCap and Stata 16.
Results
We included 370 patients and 356 parents/guardians from 37 hospitals. Descriptive statistics of the participants are shown in table 1. The KMO measure (0.8998 and 0.9228, respectively) and the Bartlett's sphericity test (p-value <0.001 for both) confirmed the factor analysis’ adequacy. The factorial model with four factors, complying with Kaiser’s criterion, explained 89.19% and 88.87% of the variance in the model. Cronbach's alpha (0.9123 and 0.9383) indicated excellent internal consistency. The use of a Likert scoring system and the completion median time of 10 minutes for both tools was considered optimal. The correlation coefficient was 0.92, which was considered excellent.
Conclusion
The SEGHNP versions of the IMPACT-III and IMPACT-III-P are valid and reliable to use with Spanish p-IBD families. Our findings suggest a 4-factor scores in both questionnaires, although the optimal factor structure should be further examined. In our sample, parents/caregivers were good proxies for rating their p-IBD children overall HRQoL.
La enfermedad tromboembólica venosa (ETEV) en edad pediátrica es infrecuente y su clínica variable; se relaciona con al menos un factor de riesgo (vía venosa central, trastornos de la coagulación, ...traumatismos, cirugía, enfermedades malignas o tratamiento con anticonceptivos orales). Los objetivos del tratamiento son prevenir la embolización y minimizar las complicaciones. Dada la gravedad de las complicaciones de la ETEV, es preciso tener presente esta posibilidad diagnóstica ante un paciente con factores de riesgo.
El uraco es un remanente embriológico de la alantoides que puede dar lugar a diferentes anomalías, entre las que destaca el quiste de uraco. Se presenta el caso de un varón de cuatro años que ...consulta por dolor abdominal hipogástrico, fiebre y disuria. La tira reactiva de orina es normal; se realiza una ecografía abdominal que identifica en la región umbilical, inmediatamente por debajo de la pared abdominal y en dudosa comunicación con la vejiga, una imagen tubular lobulada que podría tratarse de un quiste de uraco complicado. Ingresa en el hospital para tratamiento antibiótico intravenoso y en un segundo tiempo se realiza la exéresis quirúrgica de la estructura anómala. El uraco es un remanente embriológico de la alantoides que se convierte en un cordón fibromuscular que se extiende desde la cúpula vesical hasta el ombligo. Si no hay una involución completa del uraco al nacer, puede dar lugar a diferentes anomalías, de las que el quiste uracal representa el 30%. Los quistes uracales suelen ser asintomáticos hasta que debutan en forma de complicaciones, siendo la infección la más frecuente. Para el diagnóstico es útil la ecografía. El tratamiento es antibiótico y el drenaje, y en un segundo tiempo la cirugía. Conviene considerar esta patología en el diagnóstico diferencial del niño con dolor abdominal y sintomatología miccional.
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