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PubMed | Hospital Of Sabadell, Hospital Universitario 12 Of Octubre, Hospital Sant Joan Of Deu, Hospital Universitario Donostia and 11 more.
Type: Journal Article | Journal: Anales de pediatria (Barcelona, Spain : 2003) | Year: 2016

Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines.An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results.Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids.This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma.


Jimenez J.L.,Hospital Materno Infantil Gregorio Maranon | Jimenez J.L.,CIBER ISCIII | Pion M.,Hospital General Universitario Gregorio Maranon | Pion M.,CIBER ISCIII | And 8 more authors.
New Journal of Chemistry | Year: 2012

According to estimates from the UNAIDS Global Report 2010 around 33.3 million adults were living with HIV/AIDS at the end of 2009, the majority of them in developing countries. More than 50% adults living with HIV/AIDS are women. In the world, more than 90 percent of all adolescent and adult HIV infections have resulted from heterosexual intercourse (UNAIDS, http://www.unaids.org/data/epi2010/). The options for prevention of HIV-infection are the abstinence or the use of condoms due to the lack of effective vaccine and therapy. Therefore, a good education and a preventive microbicide may represent the most promising strategy. Topical microbicides are products that can be applied to vaginal or rectal mucosa with the objective of attacking cellular or viral targets and to prevent, or at least significantly reduce, HIV transmission and the acquisition of HIV-infection. Microbicides may or may not be contraceptives and may or may not include strategies effective against sexually transmitted infections. At this moment, we have a better understanding of the invasion mechanisms that are used by HIV, the importance of HIV replication in target cells and the various host factors that restrict viral replication. However, an effective microbicide is not yet available; innovative approaches for the design of topical vaginal or rectal microbicides are urgently needed. The potential of the advancing field of dendrimers has been incorporated in the increasing efforts to address the major health problems of the developing world. In this review, advances in the design of innovative microbicides based on the use of dendrimers are presented. © 2012 The Royal Society of Chemistry and the Centre National de la Recherche Scientifique.


PubMed | Hospital Materno Infantil Gregorio Maranon and Hospital Infantil La Paz
Type: | Journal: Neurologia (Barcelona, Spain) | Year: 2016

Ischaemic stroke is rare during childhood. Congenital and acquired heart diseases are one of the most important risk factors for arterial ischaemic stroke (AIS) in children.We conducted a retrospective study of all children with AIS and heart disease diagnosed between 2000 and 2014.We included 74 children with heart disease who were eligible for inclusion. 60% were boys with a mean stroke age of 11 months. 20% of the patients died during the study period. 90% of the patients had a congenital heart disease, while cyanotic heart disease was identified in 60%. Hypoplastic left heart syndrome was the most frequent heart disease. In 70% of patients AIS was directly associated with heart surgery, catheterisation or ventricular assist devices. Most patients with AIS were in the hospital. Seizures and motor deficit were the most frequent symptoms. Most patient diagnoses were confirmed by brain CT. The AIS consisted of multiple infarcts in 33% of the cases, affected both hemispheres in 27%, and involved the anterior and posterior cerebral circulation in 10%.Arterial ischaemic strokes were mainly associated with complex congenital heart diseases, and heart procedures and surgery (catheterisation). AIS presented when patients were in-hospital and most of the patients were diagnosed in the first 24hours.


Giron Moreno R.M.,Hospital Of La Princesa | Salcedo Posadas A.,Hospital Materno Infantil Gregorio Maranon | Mar Gomez-Punter R.,Hospital Of La Princesa
Archivos de Bronconeumologia | Year: 2011

Cystic fibrosis is the most frequent fatal genetically-transmitted disease among Caucasians. Chronic bronchial infection, especially by Pseudomonas aeruginosa, is the main cause of morbidity and mortality in this disease. Aerosolized antibiotic therapy achieves high drug concentrations in the airway with low toxicity, allowing chronic use. Currently, two antibiotics have been approved for inhalation therapy, tobramycin inhalation solution and colistimethate sodium aerosol. There is less evidence from clinical trials for the latter. The main indication for these drugs is chronic bronchial colonization by P. aeruginosa, although there is increasing evidence of the importance of the primary infection by this bacterium, whether treated by oral or intravenous antibiotics or not. More controversial is the use of aerosolized antibiotic therapy in bacterial prophylaxis or respiratory exacerbations. For many years, intravenous formulations of distinct antibiotics for aerosolized use have been employed, which are in distinct phases of research for use in nebulizer therapy. In addition to being used to treat P. aeruginosa infection, aerosolized antibiotics have been used to treat other pathogens such as methicillin-resistant Staphylococus aureus, Mycobacterium abscessus and Aspergillus fumigatus. © 2011 Sociedad Española de Neumología y Cirugía Torácica.


Rodriguez R.,Hospital Materno Infantil Gregorio Maranon | Ramilo O.,Ohio State University
Journal of Infection | Year: 2013

Bronchiolitis is the leading cause of hospitalization of infants and young children worldwide. Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants. Studies conducted using molecular diagnostic assays confirmed that RSV accounts for over 50% of bronchiolitis in young children requiring hospitalization. Those studies demonstrate that it is common to identify RSV in association with a second viral agent but it is yet unclear whether the simultaneous detection of two or even three viruses is associated with increased disease severity. Despite extensive efforts, a vaccine for prevention of RSV infection is not yet available. Palivizumab a humanized monoclonal antibody directed against the F protein of RSV is the only agent licensed to prevent severe RSV disease in high-risk children. Among the new antivirals being developed for treatment of RSV infections, an RNA-interference based agent has demonstrated promising results for treatment of lung transplant recipients with acute RSV infection. © 2013.


Bardon-Cancho E.J.,Hospital General Universitario Gregorio Maranon | Munoz-Jimenez L.,Hospital General Universitario Gregorio Maranon | Vazquez-Lopez M.,Hospital General Universitario Gregorio Maranon | Vazquez-Lopez M.,Hospital Materno Infantil Gregorio Maranon | And 4 more authors.
Pediatric Neurology | Year: 2014

Background Heterotopias are a neuronal migration disorder caused by extrinsic factors or by genetic mutations. When the location is periventricular, the most frequent genetic cause is the mutation in the "filamin A2 gene", which is X-linked. New genes for periventricular nodular heterotopia with an autosomal inheritance pattern have been recently discovered. Patients We describe two siblings. The girl, who was prenatally diagnosed ventriculomegaly, had delayed development. At 6 months, she had no head control and variable muscle tone, alternating low axial tone with jerking movements. She became microcephalic. Magnetic resonance imaging at 12 months of age revealed enlarged lateral ventricles, periventricular nodular heterotopia, thin corpus callosum, a T2-hyperintensity of the putamen and the thalamus, and a loss of volume of lenticular nucleus. At 18 months, she developed sporadic myoclonic seizures that were well controlled with valproic acid. Her younger brother also developed progressive microcephaly and psychomotor delay by 6 months. He exhibited axial hypotonia with a prominent dystonic-athetoid component. Magnetic resonance imaging at 15 months of age revealed asymmetric ventriculomegaly plus diffuse nodules lining the temporal horns, a thin corpus callosum, and hyperintensity signal in putamens. He had no seizures. Results Because of the association of microcephaly, developmental delay with dystonic movements, the imaging results, and the probable autosomal recessive inheritance pattern, genetic analysis was requested. This detected a homozygous nonsense mutation in ARFGEF2 gene, at the DNA level c.388C>T in exon 4. Conclusions The presence of dyskinetic movements in individuals with acquired microcephaly could be a manifestation of periventricular nodular heterotopia due to ARFGEF2 mutation. © 2014 Elsevier Inc. All rights reserved.


Corona C.,Hospital Materno Infantil Gregorio Maranon
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2010

Percutaneus gastrostomy placement is a procedure widely performed in children with failure to thrive or intolerance to oral feeding. At the moment of making the indication, the need of an antir-reflux surgery in the same procedure comes to question. The aim of this study was to analyse which preoperative factors are associated with a higher risk of a posterior fundoplication. We realized a retrospective review of 67 patients divided in 2 groups (cases and controls) in which a percutaneus gastrostomy (PEG) had been made by our service in the period of 1997 to 2008. We compared these two groups: Group A (n=11) - patients with severe gastroesophageal reflux who required a Nissen procedure afterwards; Group B (n=56) - patients who kept without reflux after PEG. We analyzed the different preoperative factors that could have been in association to severe reflux after gastrostomy. Mean age at the moment of undergoing PEG was 15 months. Mean time of follow up was 3,5 years. Only neurological impairment and documented reflux pregastrostomy were associated with the need of an antirreflux surgery after PEG. Neurological impairment and documented pregastrosotmy GER could be an indication of concurrent antirreflux surgery at the time of gastrostomy.


Romero R.M.,Hospital Materno Infantil Gregorio Maranon | Rivas S.,Hospital Materno Infantil Gregorio Maranon | Parente A.,Hospital Materno Infantil Gregorio Maranon | Fanjul M.,Hospital Materno Infantil Gregorio Maranon | Angulo J.M.,Hospital Materno Infantil Gregorio Maranon
Actas Urologicas Espanolas | Year: 2011

Introduction: bladder dysfunction causes urinary incontinence and kidney damage in children. When treatment with anticholinergics and intermittent bladder catheterization fails, the alternative therapy is bladder augmentation. Patients and methods: between 2005 and 2009, a prospective study was carried out with Botox® injected into the detrusor of children suffering from high-pressure bladder despite anticholinergic treatment. We assessed their urodynamic, clinical and radiological evolution prior to and at 4 weeks, 6 months and 1 year after the injection (10 u/kg of weight up to 300 u). Reinjection was indicated in the event of clinical or urodynamic worsening. We employed the Wilcoxom test to statistically analyze the urodynamic parameters. Results: 12 patients were treated, 11 with neurogenic bladder (91.7%) and 1 with posterior urethral valves (8.4%). The mean age was 12.6 (4.3-17.8) years and follow-up took place after 40.8 (16.9-45-7) months. Bladder capacity, detrusor accommodation and pressure improved after 4 weeks in all the patients except in 2 (16.7%). This improvement decreased after 6 months, although successive injections produced similar changes. One patient (8.3%) received 1 dose, six (50%) two doses and five (41.7%) received three. Clinical and urodynamic improvement in 8 patients (66.7%) prevented bladder augmentation. Conclusions: repeated botulinum toxin injection in the detrusor is a therapeutic instrument for high pressure and low accommodation bladders in children. It could replace bladder augmentation in some cases, however further studies with long-term follow-up care are required to appropriately evaluate its safety and effectiveness. © 2010 AEU. Published by Elsevier España, S.L. All rights reserved.


Fuentes-Aparicio V.,Hospital Materno Infantil Gregorio Maranon | Alvarez-Perea A.,Hospital Materno Infantil Gregorio Maranon | Infante S.,Hospital Materno Infantil Gregorio Maranon | Zapatero L.,Hospital Materno Infantil Gregorio Maranon | And 2 more authors.
Allergologia et Immunopathologia | Year: 2013

Introduction: Desensitisation or specific oral tolerance induction (SOTI) to food is a new topical-therapeutic approach of food allergy for those children who have not achieved tolerance spontaneously. The objective of this study is to induce clinical tolerance in children with persistent allergy using an oral desensitisation protocol with powdered pasteurised egg. Methods: Seventy-two patients with egg allergy confirmed by open oral challenge test were randomly assigned to SOTI or elimination diet as a control group. Forty children (5-15 years) underwent a SOTI beginning with 1. mg and increasing the dosage weekly until a dose of 10. g, equivalent to an egg. The control group included 32 patients (4-15 years). Results: The procedure's average duration was 10 weeks (range 4-28 weeks). Three patients were withdrawn from the protocol for persistent gastrointestinal symptoms. During SOTI, 21 children (52.5%) presented symptoms. In eight the symptoms were mild and required no treatment. In the other 13 (61.90%), the reactions were more severe. Seventeen children finished the treatment over a year ago and 20 in the past 6-12 months. Thirty-seven patients (92.5%) in the active group achieved tolerance to egg, versus 21.8% in the control group. We only found statistically significant differences (p<0.05) for skin prick tests with powdered egg at various dilutions and IgG levels with egg white after SOTI. Specific IgE concentration did not change significantly. Conclusions: Our SOTI protocol is a safe, effective treatment for food allergy and of reasonable duration, confirming that tolerance can be induced in children who have not achieved it spontaneously. © 2011 SEICAP.


Tardaguila A.R.,Hospital Materno Infantil Gregorio Maranon
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2013

INTRODUCTION AND OBJETIVES: Minimal invasive surgery trends to get prompt recovery in terms of inmediate deambulation and early discharge from hospital, without increasing patient's discomfort neither postoperative complications. This "fast-track" protocol is being progresively introduced in a crescent number of urological procedures. We are evaluating the viability of applying it in retroperitoneoscopic prone- position nephrectomy. We have performed a retrospective review of the clinical reports of the patients submitted to prone nephrectomy with hospitalization between 2007 and 2011 and we present patients submitted to this procedure in an outpatient basis (less than 8 hours hospital stay) from 2011. We have recorded epidemiological factors, diagnosis, surgical time, first postoperative week analgesic requirements, parents cofort and postoperative complications. All the procedures were performed retroperitoneoscopically in prone position using two trocars. We included 34 nephrectomies with a mean surgical time of 107 minutes. Mean postoperative stay was under 24 hours in 23 patients, two of them were discharged in the first 8 hours after the procedure. Hospital stay over this time was due to concomitant pre-existent pathology in 6 patients and to non urological fever in the remaining 3. Analgesia was excellent in every patient with endovenous non-steroid drugs, registering no pain after administering them orally. There were no complications. We believe that "fast-track" requirements can be applied to prone-retroperitoneoscopic nephrectomy in pediatric population, as long as they have no associated pathology. In our experience this surgical procedure can be included in day-case surgery, increasing patient's confort and with a positive economical impact.

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