Carlos Ochoa Sangrador

Universidad de Salamanca · Escuela de Enfermería de Zamora

Objectives and Study: Recently, ESPGHAN published a position paper on follow-up of paediatric celiac disease (CD). The objective of this study was to assess the evolution of symptoms, serology and adherence to a gluten-free diet (GFD) in patients under 15 years of age diagnosed with celiac disease (CD). Methods: REPAC3 is a national multicenter reg...

Objectives The prevalence of feeding disorders (FDs) and picky eating in children is high in our region, based on the parents’ perceptions. Although organic disease or a nutritional impact is rarely observed in these children, the problem frequently has an effect on family dynamics. We aimed to estimate the impact of these disorders on the stress l...

We present a summary of the main modifications to the “COVID-19 in Paediatrics” clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its qua...

Resumen Presentamos el resumen de las principales modificaciones surgidas en la guía de práctica clínica “COVID-19 en Pediatría” entre su versión inicial publicada en el año 2021 y la publicada en el año 2022. El documento se ha elaborado siguiendo los pasos estructurados de la Medicina basada en la evidencia e incorporando el sistema GRADE para re...

Resumen Objetivos La prevalencia de niños con dificultades en la alimentación (NDA) o malos comedores es alta en nuestro medio, si consideramos la opinión de los padres. Aunque en la mayoría no observamos enfermedad orgánica o repercusión nutricional, es frecuente que este problema repercuta en la dinámica familiar. Nos proponemos estimar su impac...

Objectives: Over the last several decades, there has been a tendency towards a predominance of less symptomatic forms of coeliac disease (CD) and an increase in the patient age at diagnosis. This study aimed to assess the clinical presentation and diagnostic process of paediatric CD in Spain. Methods: A nationwide prospective, observational, mul...

We present the summary of a critical appraisal document of the available evidence on COVID-19, developed with a clinical practice guide format following GRADE methodology. The document tries to provide answers to a series of structured clinical questions, with an explicit definition of the population, intervention / exposure, comparison and outcome...

Resumen Presentamos el resumen de un documento de valoración crítica de la evidencia disponible sobre COVID-19, elaborado con formato de guía de práctica clínica siguiendo metodología GRADE. El documento trata de dar respuestas a una serie de preguntas clínicas estructuradas, con definición explícita de la población, intervención/exposición, compar...

A clinical scenario is presented, from which a structured clinical question arises: In asthmatic children or adolescents with exacerbation symptoms, does the use of inhaled corticosteroids (newly instituted or base dose increased) reduce the risk of exacerbations that require systemic steroids and/or hospitalization? To answer it, we carried out a...

Background and Aims: Diagnostic delay is especially relevant in children with Inflammatory Bowel Disease, leading to potential complications. We examined the intervals and factors for Diagnostic Delay (DD) in the Pediatric Population of Spain. Methods: We conducted a multicentric prospective study including 149 Pediatric Inflammatory Bowel Disease...

Resumen Se presenta un escenario clínico del que surge una pregunta clínica estructurada: en niños o adolescentes asmáticos con síntomas de exacerbación, ¿el uso de corticoides inhalados (de nueva instauración o aumento de dosis habitual) reduce el riesgo de exacerbaciones que requieran corticoides sistémicos y/o ingreso? Para contestarla realizamo...

RESUMEN Objetivo: Estimar el aumento de la mortalidad asociado a la pandemia por SARS-CoV-2 en la comunidad autónoma de Castilla y León. Método: Estudio ecológico basado en los datos de población y los fallecimientos correspondientes a los meses de marzo de los años 2016 a 2020 en Castilla y León. Se calcularon las tasas estandarizadas globales y p...

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describ...

Abstract Background. Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without having their side effects. Objectives. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD c...

La Asociación Española de Pediatría (AEP) tiene entre sus objetivos desarrollar actividades encaminadas a la formación de sus socios. Así, en 2013 puso en marcha su proyecto formativo más ambicioso, la plataforma de formación virtual «Continuum». Se presenta ahora una nueva sección dirigida a los médicos internos residentes (MIR) en Pediatría y a s...

The Spanish Association of Paediatric (AEP) has, among its objectives, to develop activities aimed at the training of its members. Thus, in 2013, it began its most ambitious training project, the virtual platform, “Continuum”. Now it presents a new section aimed at Internal Medicine Residents (MIR) in Paediatrics and their tutors: “I Prepare My Rot...

Competency-Based Education is a learning method that has changed the traditional teaching-based focus to a learning-based one. Students are the centre of the process, in which they must learn to learn, solve problems, and adapt to changes in their environment. The goal is to provide learning based on knowledge, skills (know-how), attitude and behav...

Editorial. Abstract not available.

La Formación Basada en Competencias es una modalidad formativa que ha cambiado el enfoque tradicional centrado en la enseñanza por otro basado en el aprendizaje. Los alumnos son el centro del proceso, en el que deben aprender a aprender, a resolver problemas y a adaptarse a los cambios en su entorno. El objetivo es lograr un aprendizaje que integre...

Introduction: The perineal adhesive bag is the most used method in our country for urine culture collection in infants, despite having a high risk of contamination and false-positive results. We aim to quantify both types of risks through a systematic review. Methods: Search updated in May 2014 in PUBMED, SCOPUS (includes EMBASE), IBECS; CINAHL,...

The role of vitamin D in recurrent otitis in childhood is a clear example of the evidence based medicine's function. It is the ability to separate hypothesis from recently demonstrated stuff, already applicable, but with poor evidences, which makes of our profession an art.

The role of vitamin D in recurrent otitis in childhood is a clear example of the evidence based medicine’s function. It is the ability to separate hypothesis from recently demonstrated stuff, already applicable, but with poor evidences, which makes of our profession an art. © 2015 Spanish Association of Primary Care Pediatrics. All rights reserved.

The risk of producing bilateral laryngeal paralysis (BLP) in total thyroidectomy (TT) is low, but it is a concern for the surgeon and a serious safety incident that may compromise the airway, require reintubation or tracheostomy and cause serious sequelae or death. Neuromonitoring (NM), as an early diagnostic tool for the existence of injury to the...

Resumen Introducción La bolsa adhesiva perineal es el método más usado en nuestro medio para la recogida de orina para cultivo en el lactante, a pesar de que presenta un alto riesgo de contaminación y de resultados falsos positivos. Nos proponemos cuantificar ambos riesgos a través de una revisión sistemática. Métodos Búsqueda actualizada a mayo...

Introduction and objectives Bilateral laryngeal paralysis cause serious respiratory complications. In thyroid surgery, neuromonitoring helps in identifying the recurrent laryngeal nerve, reports on its functioning at the end of surgery, supports decision making, and may reduce the risk of bilateral paralysis. Our objective was to estimate the influ...

Bilateral laryngeal paralysis cause serious respiratory complications. In thyroid surgery, neuromonitoring helps in identifying the recurrent laryngeal nerve, reports on its functioning at the end of surgery, supports decision making, and may reduce the risk of bilateral paralysis. Our objective was to estimate the influence of neuromonitoring in o...

Background: In the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings. Methods: Th...

Introduction: The management of acute bronchiolitis (AB) is controversial. The aim of this multicenter nationwide study in Spain is to determine the variability in the management of AB in Primary Care centers. Methods: A cross-sectional observational study (from October 2007 to March 2008) was conducted on all cases of AB (McConnochie criteria)...

Journals are the most widely used way for the exchange and dissemination of scientific information in medicine. Researchers publish in journals to validate, disseminate, evaluate and compare scientific research. It is therefore important to know well the scientific journals and propose strategies for a proper use of them. In this article we enter i...

Introduction: The habits of introducing gluten and the implementation of the ESPGHAN-2008 recommendations are evaluated. Materials and methods: A retrospective cohort study was conducted in 2011 using a questionnaire containing various epidemiological variables and supplementary feeding that was completed by the parents of children between 12-18...

Unlabelled: Most patients with acute bronchiolitis have a mild course and only require outpatient care. However, some of them have to go to emergency departments, because they have respiratory distress or feeding problems. There, they frequently receive diagnostic and therapeutic procedures. We want to know the variability and appropriateness of t...

Objetivo. Estudiar la precisión y concordancia de la medición de presión arterial en pacientes pediátricos con dispositivos aneroides y oscilométricos de uso común. Métodos. Estudio transversal de evaluación de medidas repetidas con distintos dispositivos y diferentes observadores de la presión arterial en una muestra consecutiva de 121 pacientes p...

The methodology (literature review, evidence synthesis, method of consensus and strength of recommendations) and recommendations of the Consensus Conference are presented. The evidence on the frequency of bronchiolitis in the general population and risk groups, risk factors and markers of severe forms, scores of severity and clinical-etiological pr...

The methodology (literature review, evidence synthesis, method of consensus and strength of recommendations) and recommendations of the Consensus Conference are presented. The evidence on the frequency of bronchiolitis in the general population and risk groups, risk factors and markers of severe forms, scores of severity and clinical-etiological pr...

We present a review of the evidence on prognosis of acute bronchiolitis, risk factors for severe forms, symptom or severity scores and risk of post-bronchiolitis asthma. Documented risk factors of long stay or PICU admission in hospitalized patients are: bronchopulmonary dysplasia and/or chronic lung disease, prematurity, congenital heart disease a...

Presentamos una revisión de la evidencia sobre la prevención de la bronquiolitis aguda. La prevención en la bronquiolitis aguda se deriva de tres enfoques básicos: tratamiento preventivo para disminuir las sibilancias recurrentes posteriores a un episodio bronquiolitis aguda, tratamiento preventivo para disminuir la frecuencia y gravedad de la bron...

A review of the evidence on prevention of acute bronchiolitis is presented. Acute bronchiolitis prevention arises from three basic approaches: preventive treatment to reduce recurrent wheezing following an episode of acute bronchiolitis, preventive treatment to reduce the frequency and severity of RSV bronchiolitis in the population at risk (premat...

Presentamos una revisión de la evidencia sobre los procedimientos diagnósticos más empleados en la bronquiolitis aguda (BA). Las pruebas de diagnóstico rápido de infección por virus respiratorio sincitial son aceptablemente válidas, presentando una moderada-alta sensibilidad y una alta especificidad en relación a otras pruebas de referencia. Las pr...

Presentamos una revisión de la evidencia sobre el tratamiento de la bronquiolitis aguda. Hay pruebas suficientes de la falta de eficacia de la mayoría de las intervenciones evaluadas en la bronquiolitis. Aparte de la oxigenoterapia, la fluidoterapia intravenosa, la aspiración de secreciones y la ventilación mecánica, pocas opciones de tratamiento s...

The recommendations of the Consensus Conference “Diagnostic and Therapeutic Management of Acute Bronchiolitis” are presented. Evidence on the frequency of bronchiolitis in the general population and risk groups, risk factors and markers of severe forms, severity scores and the clinical-etiological profile is summarized. The commonly used diagnostic...

A review of the evidence on the most commonly used diagnostic procedures in acute bronchiolitis is presented. Rapid diagnostic tests for respiratory syncytial virus infection are acceptably valid. These tests show a moderate to high sensitivity and a high specificity in relation to other reference tests. The tests most commonly used, due to their l...

A review of the evidence on treatment of acute bronchiolitis is presented. There is sufficient evidence on the lack of effectiveness of most interventions tested in bronchiolitis. Apart from oxygen therapy, fluid therapy, aspiration of secretions and ventilation support, few treatment options will be beneficial. There are doubts about the efficacy...

Presentamos una revisión de la evidencia sobre pronóstico de la bronquiolitis aguda, factores de riesgo de formas graves, escalas de valoración de síntomas o gravedad y riesgo de asma postbronquiolitis. En pacientes ingresados son factores de riesgo documentados de estancias prolongadas o ingreso en UCIP: la displasia broncopulmonar y/o enfermedad...

A review of the evidence on epidemiology, risk factors, etiology and clinical-etiological profile of acute bronchiolitis is presented. The frequency estimates are very heterogeneous; in the population under two years the frequency of admission for bronchiolitis is between 1 and 3.5%, primary care consultations between 4 and 20% and emergency visits...

The recommendations of the Consensus Conference "Diagnostic and Therapeutic Management of Acute Bronchiolitis" are presented. Evidence on the frequency of bronchiolitis in the general population and risk groups, risk factors and markers of severe forms, severity scores and the clinical-etiological profile is summarized. The commonly used diagnostic...

Introducción Se han realizado muchos estudios acerca de las controversias en el manejo de la bronquiolitis aguda (BA). El objetivo de este estudio multicéntrico nacional en España es conocer la variabilidad en el manejo de la BA en los distintos ámbitos de atención clínica (atención primaria, urgencias y hospitalización) y analizar el impacto de la...

Authors� conclusions: Ibuprofen is effective in closing a patent ductus arteriosus. Ibuprofen is as effective as indomethacin in closing a ductus and reduces the risk of necrotizing enterocolitis and transient renal insufficiency. Ibuprofen could be the drug of choice, although studies are needed to evaluate the effect of the Ibuprofen treatment co...

Authors´ conclusions: results suggest that the Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neonatal ICU and that it may reduce nosocomial infection. Reviewers´ commentary: although the utilization of Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neon...

There are many studies on the controversial issues involved in the management of acute bronchiolitis (AB). The aim of this multicenter nationwide study in Spain was to find out the variability in the management of AB in various areas of clinical care (primary care, emergency and hospitalization) and to analyze the impact of patient age on diagnosti...

Benign convulsions with mild gastroenteritis (CwG) are a rare diagnosis in Western countries, and it is characterized by afebrile seizures, almost times more than once, during a gastroenteritis without severe hydroelectrolitic affection. The most frequent implied virus is rotavirus. This is a benign disease, in spite of cluster seizures, and neithe...

The Spanish Pediatric Association has asked the Evidence Based Pediatrics' Work Group the development of a technical report on the pandemic flu in children and adolescents. The objective of the report is to offer to all proffesional staff up to date information on epidemiology, diagnosis, preventive measures and treatment of this condition, as well...

Conclusiones de los autores del estudio: montelukast no mejora los síntomas respiratorios postbronquiolitis en niños. Comentario de los revisores: este ensayo clínico de calidad contradice los resultados de uno anterior, con limitaciones metodológicas. Montelukast no ha demostrado ser eficaz en la prevención de la enfermedad reactiva de las vías aé...

Conclusiones de los autores del estudio: los datos que favorecen la actitud conservadora en el tratamiento de la otitis media aguda deben ser reconsiderados hasta que se realicen estudios de mayor calidad. Comentario de los revisores: las limitaciones y la heterogeneidad de los estudios incluidos en la revisión plantean dudas tanto a favor como en...

Objetivos: evaluar la utilidad de incorporar estrategias de participación de los alumnos a un curso de formación continuada. Métodos: seleccionamos ocho escenarios clínicos pediátricos, que implicaban la toma de decisiones diagnósticas y/o terapéuticas, para las que la evidencia disponible no permitía establecer recomendaciones precisas. Los alumno...

Conclusiones de los autores del estudio: una vacuna neumocócica conjugada 11-valente produce una reducción del 22,9% de las neumonías adquiridas en la comunidad confirmada radiológicamente en niños menores de 2 años; este hecho sugiere que una quinta parte de dichas neumonías son producidas por neumococo. Comentario de los revisores: una vacuna neu...

Authors´ conclusions: neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications and on the current A/H1N1 influenza s...

Conclusiones de los autores del estudio: la profilaxis antibiótica con T-S se asocia a un descenso de la recurrencia en niños con ITU en niños predispuestos. Se recomienda el uso selectivo de profilaxis con T-S en niños con alto riesgo de recurrencia por tener antecedentes de ITU previa grave o factores predisponentes conocidos. Comentario de los r...

En el texto del presente taller se presentan los 10 artículos publicados en el último año que consideramos de más impacto para la práctica clínica en Pediatría, es decir, aquellos con más validez, importancia y aplicabilidad en la práctica clínica. Dicha selección se ha realizado a través de los artículos valorados críticamente (AVC) publicados en...

p> Objetivos: Los pacientes con bronquiolitis tienen un riesgo elevado de desarrollo de asma en la infancia. Nos planteamos comunicar los datos preliminares de un estudio de seguimiento de los lactantes ingresados por un primer episodio de sibilancias. Métodos: Estudio transversal. Lactantes menores de 24 meses con un primer episodio de sibilancias...

Objetivo: conocer la prevalencia de la infección del tracto urinario (ITU) en la infancia y adolescencia según edad, sexo, raza y estado de circuncisión. Fuentes de datos: búsqueda en MEDLINE Y EMBASE entre enero de 1966 y octubre de 2005, con los descriptores: urinary tract infection, cystitis, pyelonephritis, prevalence, incidence. Se realizó una...

The methodology of the Consensus Conference "Diagnostic and Therapeutic Management of Urinary Tract Infection in Childhood" is presented. The methodology consisted of two phases. In the first phase, a series of documents was drafted, which included an in-depth review of the existing evidence on the diagnosis and treatment of urinary tract infection...

A review of the scientific evidence available on the validity of existing sample collection methods for urine culture and analysis in childhood is presented. Few studies evaluating diagnostic tests have analyzed the various available techniques with respect to valid patterns of reference. Except for clean catch midstream urine samples, there are no...

A review of the scientific evidence available on the validity of urinalysis in the diagnosis of urinary tract infection in childhood is presented. Numerous studies evaluating the validity of distinct urinalysis parameters have been published. Although many of these studies have methodological deficiencies, the indicators of validity evaluated in th...

A review on the etiological profile of urinary tract infections in childhood and the sensitivity pattern of urinary pathogens in Spain is presented. Escherichia coli continues to be the main etiological agent of urinary tract infection in childhood. Consequently, its sensitivity pattern will usually determine the choice of empirical therapy. The pr...

A review of the scientific evidence available on the indications for hospitalization in pediatric patients with urinary tract infection is presented. We found no studies that specifically evaluated the utility of hospitalization in children with urinary tract infection. Only indirect data were found on the identification of high risk infections, bu...

A review of the scientific evidence available on antibiotic prophylaxis in urinary tract infections in childhood is presented. The evidence supporting prolonged antibiotic use in the prevention of urinary tract infection and the development of renal scars is scarce and of low quality. Most studies have been performed in children with a normal urina...

The present article reviews the scientific evidence available on antibiotic treatment of urinary tract infection in childhood. The information from clinical trials is of little use in decision making, because many of these studies evaluate antibiotics with a high level of resistance in Spain. Although some studies allow certain antibiotics to be id...

The present article reviews the scientific evidence available on diagnostic imaging tests in urinary tract infections in childhood. There is sufficient information on the technical validity of the various imaging tests. Through calculating probabilities, this information can be used in the process of diagnostic decision making. Nevertheless, the di...

The recommendations of the Consensus Conference "Diagnostic and Therapeutic Management of Urinary Tract Infection in Childhood" are presented. Selection of the most appropriate urine collection technique depends on the child's ability to control urination and the urgency of the diagnosis. Directives for the interpretation of the various parameters...

A review of the scientific evidence available on antibiotic prophylaxis in urinary tract infections in childhood is presented. The evidence supporting prolonged antibiotic use in the prevention of urinary tract infection and the development of renal scars is scarce and of low quality. Most studies have been performed in children with a normal urina...

The present article reviews the scientific evidence available on antibiotic treatment of urinary tract infection in childhood. The information from clinical trials is of little use in decision making, because many of these studies evaluate antibiotics with a high level of resistance in Spain. Although some studies allow certain antibiotics to be id...

A review of the scientific evidence available on the indications for hospitalization in pediatric patients with urinary tract infection is presented. We found no studies that specifically evaluated the utility of hospitalization in children with urinary tract infection. Only indirect data were found on the identification of high risk infections, bu...

A review of the scientific evidence available on the validity of existing sample collection methods for urine culture and analysis in childhood is presented. Few studies evaluating diagnostic tests have analyzed the various available techniques with respect to valid patterns of reference. Except for clean catch midstream urine samples, there are no...

The recommendations of the Consensus Conference “Diagnostic and Therapeutic Management of Urinary Tract Infection in Childhood” are presented. Selection of the most appropriate urine collection technique depends on the child's ability to control urination and the urgency of the diagnosis. Directives for the interpretation of the various parameters...

A review on the etiological profile of urinary tract infections in childhood and the sensitivity pattern of urinary pathogens in Spain is presented. Escherichia coli continues to be the main etiological agent of urinary tract infection in childhood. Consequently, its sensitivity pattern will usually determine the choice of empirical therapy. The pr...

The methodology of the Consensus Conference “Diagnostic and Therapeutic Management of Urinary Tract Infection in Childhood” is presented. The methodology consisted of two phases. In the first phase, a series of documents was drafted, which included an in-depth review of the existing evidence on the diagnosis and treatment of urinary tract infection...

A review of the scientific evidence available on the validity of urinalysis in the diagnosis of urinary tract infection in childhood is presented. Numerous studies evaluating the validity of distinct urinalysis parameters have been published. Although many of these studies have methodological deficiencies, the indicators of validity evaluated in th...

La asistencia al jardín de infancia es considerada un factor de riesgo de enfermedad aguda en la primera infancia, sin embargo los trabajos disponibles no permiten cuantificar de forma integrada dicho riesgo. Realizamos una revisión sistemática de ensayos clínicos y estudios de cohortes en los que se hayan estudiado los efectos de la asistencia de...

Child day-care attendance is considered to be an acute early childhood disease risk factor, the studies available however not affording the possibility of fully quantifying this risk. A systematic review of clinical trials and cohort studies was conducted, in which the effects child day-care attendance had on the health of young children based on t...