Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

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Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients

BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 +/- 12 vs. 54 +/- 16 years, p < 0.001), had been diagnosed younger (31 +/- 12 vs. 36 +/- 15 years, p < 0.001), and had a shorter disease duration (14 +/- 7 vs. 18 +/- 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92-2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0-1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe

Validez de la orina obtenida por micción directa con técnica de estimulación en el diagnóstico de infección urinaria en lactantes menores de 3 meses

Tesis inédita presentada en la Universidad Europea de Madrid. Facultad de Ciencias Biomédicas. Programa de Doctorado en Biomedicina y Ciencias de la SaludLa infección del tracto urinario (ITU) es la infección bacteriana más frecuente en lactantes febriles menores de 3 meses. Su diagnóstico se basa en un urocultivo positivo con garantías de validez. En niños con control de esfínteres la orina recogida por micción espontánea está aceptada como muestra válida. En niños incontinentes este método está poco difundido y validado, por lo que la recogida de orina se realiza por técnicas invasivas (punción suprapúbica o sondaje vesical) con los consiguientes riesgos y complicaciones. El objetivo de esta Tesis Doctoral es diseñar una técnica de estimulación vesical para la obtención de orina por micción directa en lactantes y estudiar la validez de esta muestra en el diagnóstico de ITU frente al patrón de referencia habitual (sondaje vesical). El estudio se plantea en 2 fases: 1) Diseño de una nueva técnica de estimulación vesical para obtención de orina: estudio descriptivo de 80 niños menores de 3 meses ingresados en la unidad neonatal. Se diseñó una técnica estandarizada en tres etapas: Ingesta oral, limpieza genital y maniobras de estimulación vesical. Tras su aplicación se analizó el éxito de la maniobra (obtención de orina en menos de 5 minutos), el tiempo de obtención y las complicaciones. 2) Validación de la orina obtenida por esta técnica en el diagnóstico de ITU: estudio descriptivo transversal de 60 niños menores de 3 meses ingresados por fiebre sin foco. Se obtuvieron muestras de orina pareadas por dos métodos: sondaje vesical (patrón oro) y micción directa con técnica de estimulación. Se valoró el resultado de la tira reactiva de orina y el urocultivo. Se analizaron la sensibilidad, especificidad, cocientes de probabilidad y tasas de contaminación. Resultados: 1) La técnica de estimulación fue exitosa en el 86% de los niños, con una mediana de tiempo de obtención de 45 segundos y no se observaron complicaciones. 2) La sensibilidad del urocultivo obtenido por micción directa fue del 97% (IC 95%: 82% - 100%) y la especificidad del 89% (IC 95%: 65% - 98%). Las tasas de contaminación fueron muy bajas (5%) e inferiores a las obtenidas en muestras de sondaje (8%). 3) La tira reactiva de la orina recogida por micción directa mostró una sensibilidad para la esterasa leucocitaria 86% (IC 95% 70-95) y del 24% (IC 95% 12-42) para los nitritos; y una especificidad del 80% (IC95% 66-93) para la esterasa leucocitaria y del 100% (IC95% 80-100) para los nitritos. Conclusiones: La nueva técnica de estimulación para obtención de orina por micción directa es eficaz, rápida y segura. El urocultivo recogido con esta técnica es válido para el diagnóstico de la infección del tracto urinario en lactantes menores de 3 meses. La tira reactiva realizada en la orina obtenida por este método es válida como cribado de la infección del tracto urinario en lactantes menores de 3 meses. [Resumen Teseo]UE

Using autofluorescence to detect optic nerve head drusen in children

1.142 JCR (2013) Q3, 43/58 Ophthalmology, 77/117 Pediatric

Response to queries on the use of urine dipstick tests for infants with unexplained fever

Sin financiación2.265 JCR (2018) Q2, 43/125 Pediatrics1.031 SJR (2018) Q1, 51/318 Pediatrics, Perinatology and Child Health, 528/2844 Medicine (miscellaneous)No data IDR 2018UE

Performing a urine dipstick test with a clean-catch urine sample is an accurate screening method for urinary tract infections in young infants

AIM: This study evaluated using urine dipstick tests with the clean-catch method to screen for urinary tract infection (UTI) in febrile infants under 90 days of age. METHODS: We carried out a comparative diagnostic accuracy study of infants under 90 days old, who were studied for unexplained fever without any source, in the emergency room of a hospital in Madrid from January 2011 to January 2013. We obtained matched samples of urine using two different methods: a clean-catch, standardised stimulation technique and catheterisation collection. The results of the leucocyte esterase test and nitrite test were compared with their urine cultures. RESULTS: We obtained 60 pairs of matched samples. A combined analysis of leukocyte esterase and, or, nitrites yielded a sensitivity of 86% and a specificity of 80% for the diagnosis of UTIs in clean-catch samples. The sensitivity of leukocyte esterase and, or, nitrites in samples obtained by catheterisation were not statistically different to the clean-catch samples (p = 0.592). CONCLUSION: Performing urine dipstick tests using urine samples obtained by the clean-catch method was an accurate screening test for diagnosing UTIs in febrile infants of less than 90 days old. This provided a good alternative to bladder catheterisation when screening for UTIs.Sin financiación2.265 JCR (2018) Q2, 43/125 Pediatrics1.031 SJR (2018) Q1, 51/318 Pediatrics, Perinatology and Child Health, 528/2844 Medicine (miscellaneous)No data IDR 2018UE

Accuracy of new clean-catch technique for diagnosis of urinary tract infection in infants younger than 90 days of age

The objective of this study is to evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique. Sixty paired urine cultures were obtained. The median age was 44-days-old. Seventeen percent were male infants. Clean-catch technique sensitivity was 97% (95% CI 82% to 100%) and specificity was 89% (95% CI 65% to 98%). The contamination rate of clean-catch samples was lower (5%) than the contamination rate of catheter specimens (8%). The sensitivity and specificity of urine cultures obtained using the clean-catch method through the new technique were accurate and the contamination rate was low. These results suggest that this technique is a valuable, alternative method for urinary tract infection diagnosis.1.509 JCR (2015) Q3, 61/120 PediatricsUE

Urine collection methods for infants under 3 months of age in clinical practice

Background: Methods of urine collection used in precontinent children are a controversial issue. Definitive diagnosis of urinary tract infection (UTI) requires an uncontaminated urine culture. We aimed to describe methods used to collect urine for culture in infants under 3 months of age and compare results and contamination rates. Methods: This retrospective observational cohort study included 721 urine cultures collected from infants <3 months of age at the Hospital Universitario Infanta Sofía, Madrid, between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex, and patient age. Results: Median patient age was 36 days and 54.6% were male. In total, 592 (82.1%) samples were collected using clean-catch urine stimulation technique (CCUST), 77 (10.7%) by urethral catheterization (UC) and 52 (7.2%) by urine bag (UB). Positive cultures were obtained in 11.7% (95% confidence interval [CI] 9.1, 14.3) of CCUST samples and in 28.6% (95% CI 18.5, 38.7) of UC samples (p<0.001). The contamination rate was 13.7% (95% CI 10.9, 16.4] for CCUST, 23.1% (95% CI 11.6, 34.6) for UB and 5.2% (95% CI 0.2, 10.2) for UC, with statistically significant differences (p=0.007) between UB and UC collection. Conclusions: CCUST is the most commonly used method in our hospital for collecting urine in infants younger than 3 months. The contamination rate of UC is lower but not significantly different to that of CCUST. Urine collection by CCUST serves as a non-invasive alternative to UC for diagnosis of UTI in infants under 3 months of age in routine clinical practice. Graphical abstract.Sin financiación3.654 JCR (2021) Q2, 36/130 Pediatrics0.864 SJR (2021) Q1, 54/320 Pediatrics, Perinatology and Child HealthNo data IDR 2020UE