UNLABELLED: The aim of this multicentre, double-blind, randomized study was to assess the paediatric antipyretic efficacy of a new ibuprofen formulation containing L-arginine for gastric protection, compared with the efficacy of paracetamol. For this purpose 100 patients were given ibuprofen-arginine (1 drop/kg: 6.67 mg/kg) and 99 paracetamol (4 drops/kg: 10.65 mg/kg). The main efficacy endpoint was the mean change in tympanic temperature 4 h after drug intake. Twelve patients were excluded because of early vomiting or spitting out the medication. The resulting efficacy analysis population included a total of 88 patients treated with ibuprofen-arginine and 87 with paracetamol. Mean change in tympanic temperature (degrees C) showed no difference between groups (p = 0.527) but more patients in the ibuprofen-arginine group attained a temperature reduction greater than 2 degrees C (p = 0.043). A total of 107 patients required antipyretic rescue medication, with a smaller proportion in the ibuprofen-arginine group. Although this was not statistically significant, a trend towards improved activity was observed (p = 0.100). Overall efficacy was judged from the recovery or improvement in 68.8% of patients in the ibuprofen-arginine group compared with 65.5% in the paracetamol group. Nineteen patients reported adverse events, with vomiting being the most common complaint, but no differences were detected between treatments. CONCLUSION: Based on the present results, ibuprofen-arginine oral drops have shown to be a safe, well-tolerated and potent paediatric antipyretic agent. Hence, ibuprofen-arginine should be considered as an adequate choice for the control of paediatric fever of likely infectious aetiology.

Acetaminophen↗

PubMed2002

[Emergency pediatrics: A new specialty].

Explore the source record for details and available documents.

Child↗

PubMed2002

[Dextromethorphan poisoning].

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Antitussive Agents↗

PubMed2001

[Triage criteria in a emergency department].

OBJECTIVE: Accurate patient triage for the early identification of potentially seriously ill or high-risk children is needed due to the increasing demands made on paediatric emergency departments. MATERIAL AND METHODS: A set of triage criteria for patient selection was established. Between October 1998 and April 1999 we selected 20 days with maximum patient flow in our emergency department (average 225 children/day). Patients who satisfied the triage criteria were selected. The following variables were studied: age, sex, triage criteria, waiting time, visit time and final diagnosis. RESULTS: Five hundred and thirteen patients satisfied our triage criteria (11% of patients admitted to the emergency department). Median age was 3.4 years. The most frequent complaints (criteria) were dyspnea (36.4%), referral to the emergency department by another physician (29%), fever and rash (11.7%) and age under 1 month (5.8%). The most common causes of patient referral to hospital were acute abdominal pain and fever (31% each). Waiting and visit times were 29 and 55 minutes, respectively. CONCLUSION: Definition of selection criteria seems effective and equivalent to other triage systems and allows optimization of human resources.

Adolescent↗

PubMed2001

[Causes of adolescent visits to the emergency department].

OBJECTIVE: To determine the complaints leading adolescents to a third level emergency department, as well as the distinguishing features between the different groups of complaints. MATERIAL AND METHODS: Retrospective study of the emergency department reports of 170 adolescents selected from the 1,172 adolescents who visited the Hospital Sant Joan de Déu pediatric emergency department in May 1997. We excluded 517 patients with trauma. Statistical analysis was carried out with the chi-square test for qualitative variables and analysis of variance for quantitative variables; differences were accepted as significant at p,0.05. RESULTS: Eighty-nine patients were female and 81 were male. Median age was 13.8 years. The most frequent discharge diagnoses were abdomen pain in 26 patients, viral illness in 15 and depression-anxiety in 14. Complementary investigations were carried out in 60 patients. One hundred forty-one patients were discharged. Of the 26 patients with psychiatric disorders, 18 were girls and 8 were boys. The proportion of girls was also higher among patients with abdominal and neurological symptoms, although not among patients with organic disorders (p50.03). Most of the patients with psychiatric antecedents were diagnosed with a psychiatric disorder. Ten (11.8%) of the 85 patients with organic complaints were admitted to hospital compared with 13(50%) of the 26 patients with psychiatric disorders (p,0.001). CONCLUSIONS: Adolescents visit emergency departments for a variety of complains. The proportion of psychiatric disorders and non-specific symptoms is high.

Adolescent↗

PubMed2001

[Sexual abuse. Experience in a child sexual abuse unit].

OBJECTIVE: To describe the clinical findings in children treated in a child sexual abuse unit. PATIENTS AND METHODS: We carried out a retrospective study of the clinical histories of children under suspicion of sexual abuse who visited the hospital from January 1992 to April 2000. Data on age, sex, need of urgent medical care, means of arrival, mechanism of discovery of abuse, parental separation, anamnesis, physical findings and complementary investigations were collected. The patients were then classified in four groups: normal, compatible, highly probable or certain sexual contact. In cases with a high probability of abuse, data of the aggressor's identity, place, duration and type of abuse were also collected. RESULTS: We studied 704 patients. Seventy-five percent were girls. The child's account of events was the most frequent means of discovering abuse (51%). Anamnesis was positive in 45% of the patients, genital examination was normal in 74% and anal examination was normal in 79%. According to our classification, 40% of the patients were normal, 11% were compatible, 41% were highly probable and 4% were of certain sexual contact. Ninety-two percent of aggressors were male. Molestation was the most frequent form of abuse and in 25% of cases abuse took place for more than 1 year. CONCLUSION: Diagnosis of sexual abuse is difficult and is almost always based on the child's account of events. The diagnostic yield of physical examination and complementary investigations is very low. We propose a diagnostic classification of four levels: normal, compatible, highly probable abuse and certain sexual contact.

Child↗

PubMed2001

[Procalcitonin in the early diagnosis of invasive bacterial infection in febrile infants].

BACKGROUND: Procalcitonin (PCT) it is a new marker of bacterial infection. Because of its shorter half-life and earlier ascent it offers advantages over C-reactive protein (CRP). OBJECTIVE: To compare the diagnostic performance of PCT in the early detection of invasive bacterial infection in infants with that of CPR. MATERIAL AND METHODS: Between January of 1998 and February of 2000 we performed a prospective observational study in the emergency department of infants aged between 1 and 36 months who had been treated for fever and for whom PCT and CRP plasmatic values had been obtained. Plasmatic PCT and PCR values were evaluated and correlated with the final diagnosis. ROC curves for both markers were calculated. RESULTS: One hundred infants with a mean age of 8.8 months (SD 7.59) were included in four groups of 25 patients each (viral infection, localized bacterial infection, invasive bacterial infection and control group). The mean PCT and CRP values in invasive bacterial infections [PCT: 14.45 ng/mL (SD 27.95) and CRP: 95.10 mg/L (SD 7 2.77)] were significantly higher than in non-invasive infections [PCT: 0.27 ng/mL (SD 0.19) and CRP: 25.67 mg/L (SD 33.04)] but the diagnostic performance of PCT was better. The area under the curve for PCT was 0.95 (SD 0.03), which was significantly higher (p < 0.001) than that obtained for CRP [0.81 (SD 0.05)]. The optimal cut-off for PCT was > 0.4 ng/mL (sensitivity: 95.5 %; specificity: 86.4 %) and that for CRP was > 42.9 mg/L (sensitivity: 75 %; specificity: 81.8 %). In infants who had fever for less than 12 hours (n 30) the area under the curve for PCT was 0.90 (SD 0.06), which was higher (p < 0.001) than that for PCR [0.64 (SD 0.11)]. The optimal cut-off for PCT in this group was > 0.4 ng/mL (sensitivity: 90 %; specificity: 94 %) and that for CRP was > 26.6 mg/L (sensitivity: 60 %; specificity: 77.8 %). CONCLUSIONS: The diagnostic performance of PCT was higher than that of CRP in the early detection of invasive infection in febrile infants, even when evolution was less than 12 hours.

Bacterial Infections↗

PubMed2000

[Voluntary poisoning as a form of attempted suicide].

BACKGROUND: Voluntary intoxication as form of attempted suicide is currently a significant problem among the teenage population. Suicide attempt is the most frequent psychiatric emergency in adolescents. We present our 2-year experience of voluntary intoxication in a pediatric population. MATERIALS AND METHODS: Retrospective and descriptive study of patients admitted because of voluntary intoxication in our center from January 1996 to December 1997. We analyzed age, sex, approximate time of intoxication, toxic habit antecedents, psychiatric evaluations or previous intoxications, type of toxic substance and method of obtaining it, symptomatology on arrival at the emergency department, therapeutic attitude and most common complementary examinations, and days of hospital stay. RESULTS: Forty-six patients with voluntary intoxication were admitted during the study period. The mean age was 15.6 years; 40 patients (87%) were female. Twenty-eight patients (60.9%) had previously been evaluated in a psychiatric department. The toxic substance used was of pharmacological origin, and in 38 patients (82.6%) it was obtained from the home first-aid kit. In 22 patients (47.8%) intoxication was due to multiple drugs. Six patients (13%) required admission to the pediatric intensive care unit. Mean duration of admission was 3 days. COMMENTS: Voluntary intoxication as a form of attempted suicide is a significant problem among the teenage population, especially among teenage girls. The best preventive measure would be identification of the at-risk population, which consists mainly of teenage girls with depression, eating disorders, or previous suicide attempts.

Adolescent↗

PubMed1998

[Complications of cerebrospinal fluid shunt].

OBJECTIVE: The objective of this study was to know the incidence, mode of presentation, clinical and microbiological aspects, as well as the management of ventriculo-peritoneal shunt malfunction. PATIENTS AND METHODS: A retrospective study was carried out where thirty-seven children with malfunctioning shunts were studied. The mechanical causes of shunt malfunction included disconnection, fracture and obstruction, while infection was considered as either a clinical or analytical change (blood and/or CSF). RESULTS: The mean age of the patients was 5.5 years. The most common indication for the insertion of the ventriculoperitoneal shunt was congenital hydrocephalus. The average stay in the ICU was 8.2 days. Mechanical dysfunction was detected in 25 patients (68%) and infectious etiology in 12. The most common clinical manifestations were vomiting, fever and headache. CSF biochemical alteration was found in 8 of the infected group. Staphylococcus was isolated in six of the 8 cases. The ventriculoperitoneal shunt was changed during the first 24 hours in 17 of 25 patients (68%) with mechanical malfunction, while 11 cases with an infective cause (92%) were managed with an external shunt. The interval between the insertion of the ventriculoperitoneal shunt and the malfunction was over 6 months in 20 cases (54%). CONCLUSIONS: Ventriculoperitoneal shunts are the main method for treating hydrocephaly, although they are not without complications which may require surgical procedures. Appropriate surgical technique, asepsis, as well as prophylactic antibiotics are essential to decrease the incidence of complications.

Cerebrospinal Fluid Shunts↗

PubMed1997

[Medical-legal consensus for pediatric emergency units].

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Emergency Medical Services↗

PubMed1996

[Sexual child abuse. Our one-year experience].

OBJECTIVE: We have analyzed our population in regards to child sexual abuse during 1994 and propose a diagnostic classification of our findings. PATIENTS AND METHODS: We reviewed retrospectively 18 cases of abuse, collection in each case the following data: age, sex, reason for the consultation, family situation, perpetrator, positive clinical history or not, physical findings, psychological disorders and complementary examinations. We established 4 classification levels: normal, compatible with abuse, suspicious and sexual contact or certain penetration. RESULTS: The number of children attended was 18. Thirteen (72%) were female. The youngest was 1 month old and the oldest 14.5 years. The clinical history was positive in 6 cases. The physical findings allowed a certain diagnostic in 3 cases. Presence of semen was demonstrated in 1 case and 1 positive culture for gonococci was obtained. The final diagnosis was normal in 6 cases, compatible with abuse in 4, suspicious in 3 and certain sexual contact or penetration in 5. CONCLUSIONS: The diagnosis of sexual abuse is very difficult. The clinical history is still necessary due to the fact that physical findings and complementary tests tend to not be conclusive. We propose that once the information has been evaluated the conclusion be classified into 4 groups: normal, compatible with abuse, suspicious and certain sexual contact or penetration.

Adolescent↗

PubMed1992

[Serology in infectious mononucleosis in children].

28 pediatric patients with signs and symptoms of infections mononucleosis (MI) are presented. We did a serologic study in all of them from two or three serum specimen collected in 2-3 week intervals. We detected IgG VCA but no antibodies against T. gondii or CMV in all of them. The level of the titers of these antibodies didn't help in the establishment of the phase of the illness. IgM VCA was present in the serum of 22 patients, with or without heterophil antibodies (AH), Meanwhile the remaining 6 patients had no antibodies to IgM VCA or AH. In all serum samples we evaluated the ratio of IgM/IgG EBNA. In patients with primary infection of MI, this value was greater than 1 or equal to 1, meanwhile it was less than 1 in recent or past infections.

Adolescent↗

PubMed1992

[Infectious mononucleosis in childhood].

We present 42 cases of infectious mononucleosis caused by the Epstein-Barr virus in children. Patients were divided into two groups: those less than 4 years old and those 4 to 16 years of age. Splenomegaly was more frequent in young patients. Treatment with amoxicillin was associated with cutaneous rash. Heterophil antibodies were more frequent in patients older than four years of age. In 93% of the cases anticapside antibodies of IgM class were present. Complications were rarely encountered. Pneumonia and haemolytic anemia were present. We believe that anticapside antibodies of the IgM class should always be determined in patient younger than four years of age. If heterophil antibodies (Paul-Bunnell) and IgM are negative, we recommend that other specific serology related to the Epstein-Barr virus be determined in any age group.

Adolescent↗

PubMed1989

[The value of granulocyte elastase in the early diagnosis of infantile meningitis].

Elastase-alpha 1-proteinase inhibitor complex (E-alpha 1-PI) was evaluated in blood and cerebrospinal fluid in 176 patients between 1 month and 15 years old. They were divided in three groups: group 1 (n = 61) children without meningitis, group 2 (n = 69) non bacterial meningitis and group 3 (n = 46) bacterial meningitis. The CSF values of E-a 1-PI complex (P50: P2.5; P97.5) (micrograms/L) were (2.85: 0.1; 19.1) in group 1 (31.5: 0.88; 735) in group 2 and (247: 2.6; 10370) in group 3. Significant differences were found in it (p less than 0.001). We didn't find any differences between non bacterial meningitis group and bacterial meningitis group when the granulocytes count were below 100 X mm3. The blood values of E-a 1-PI complex (P50: P2.5; P97.5) (micrograms/L) were (1122: 337; 5005) in group 3, significantly greater (p less than 0.001) than in group 2 (346: 136; 1612). In CSF E-alpha 1-PI complex showed us a sensitivity of 89% and a specificity of 27.7% in the diagnosis of bacterial meningitis, while in blood stream, it was 85.3% and 85.4 respectively.

Adolescent↗