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BACKGROUND AND OBJECTIVE: Acquired methemoglobinemia (MHb) induced in infants by intake of vegetables is a condition uncommonly reported in the literature. The purpose of the present study was to study new vegetables involved and other epidemiological risk factors. METHODS: Seventy-eight cases of diet-induced MHb seen in Pamplona from 1987 to 2010 are reported. Infant characteristics were collected, and a case-control study was conducted using as controls 78 age- and sex-matched infants selected at the same geographic area. Bivariate logistic regression analyses were performed to detect factors involved in MHb occurrence. Nitrate levels were tested in natural vegetables used to prepare purées. RESULTS: A clear relation was found between MHb and use of borage (Borago officinalis) (OR 5.2; 95% CI 1.1-24.6) and maybe chard (Beta vulgaris var cicla) (OR 2.0; 95% CI 0.4-8.7), time from preparation to use (OR 17.4, 95% CI 3.5-86.3 if the purée had been prepared 24-48 hours before and OR 24.9, 95% CI 3.3-187.6 if prepared >48 hours before), and breast-feeding (OR 10.4; 95% CI 1.9-57.2). Tests confirmed that vegetables with the highest nitrate levels were borage (n = 15), with mean nitrate levels of 3968 mg/kg, and chard (n = 17), with mean levels of 2811 mg/kg. CONCLUSIONS: The main associated factors were shown to be time from purée preparation to use (>24 hours), use of certain vegetables (borage and chard), and breast-feeding. Nitrate levels in both vegetables implicated as etiological factors in acquired MHb are high.

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Poisonings during childhood account for 0.3-0.4% of consultations in the emergency pediatric services and constitute a pathology that must be born in mind, because of its frequency, its consumption of resources, its repercussion on the surrounding milieu and the possibility of its prevention. With respect to its epidemiology, the first cause of pediatric poisoning are medicines, with paracetamol outstanding as the most frequent cause of poisoning. In the second place in order of frequency we find products of household use, although their importance in pediatric toxicology rests basically on the fact that some of these products, such as cosmetics, can result in accidental ingestion, almost exclusively involving children. Hospital procedure concerning the poisoned child involves a first phase of life support and stabilization measures, followed by identification of the toxin and measures of detoxification where necessary. Given the broad scope of the issue and the impossibility of covering all of pediatric toxicology, this article describes its epidemiology in our milieu and some considerations are made with respect to dealing with the most frequent or characteristic poisonings involving children. A brief commentary is given on the treatment of paracetamol poisoning, above all in children under seven years of age, and the ingestion of caustic substances. Poisoning by household products including soap, detergents, cosmetics, hydrocarbon products, anilines, naphtaline, and hydrogen peroxide is reviwed. Finally, methaemoglobinaemia's physiopathology, aetiology, clinical picture, diagnosis and treatment is reviewed.

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Las intoxicaciones en la infancia constituyen el 0,30,4 por ciento de las consultas en los servicios de urgencias pediátricas y son una patología a tener en cuenta por su frecuencia, consumo de recursos sanitarios, repercusión en el entorno y posibilidad de ser evitadas. En lo que respecta a su epidemiología, la primera causa de intoxicación pediátrica son los fármacos, destacando el paracetamol como intoxicación más frecuente. En segundo lugar por orden de frecuencia se encuentran los productos de uso doméstico, aunque su importancia en toxicología pediátrica radica fundamentalmente en que algunos de estos productos, como el caso de los cosméticos producen ingestas accidentales casi exclusivamente en niños. La actuación hospitalaria del niño intoxicado consta de una primera fase de medidas de soporte vital y estabilización, seguida de identificación del tóxico y medidas de descontaminación en caso de ser necesario. Dada la gran amplitud del tema y la imposibilidad de desarrollar toda la toxicología pediátrica, en este artículo se describe su epidemiología en nuestro medio y se hacen algunas consideraciones sobre el abordaje de las intoxicaciones infantiles más frecuentes o más características. Se comenta brevemente el tratamiento de la intoxicación por paracetamol sobre todo en niños menores de 7 años y la ingesta de cáusticos. Se revisan las intoxicaciones por productos del hogar incluyendo jabones, detergentes, cosméticos, hidrocarburos, anilinas, naftalina y peróxido de hidrógeno. Un apartado que se aborda con especial detenimiento es la metahemoglobinemia, revisando su fisiopatología, etiología, clínica, diagnóstico y tratamiento (AU)

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Between January 1973 and September 1989, 51 patients younger than 3 months with coarctation of the aorta underwent surgery. All of them had atrio-ventricular and ventriculo-arterial concordance with well developed ventricular cavities. Thirty-four were male and 17 female. Thirty five had associated anomalies and catheterism was done in 36 before surgical correction. The surgical procedures we used were 19 subclavian plasty (Waldhausen), 13 end-to-end anastomosis, 13 Alvarez technique and three goterex parch. Twelve died (23.5%), three during surgery and the others in a period of 3 to 20 days after surgery. Eight were younger than 17 days, seven had aortic arch hypoplasia associated and six had ventricular septal defect (five with pulmonary hypertension). Other ten developed recoarctation (gradient greater than 20 mmHg) between 10 days and 8 months after first intervention (media = 3 months). Five had previously end-to-end correction (41.6%), two angioplasty with parch (66%), two Alvarez (20%) and one Waldhausen (7%). The correction of the recoarctation required surgery in 4 patients (three with angioplasty with parch and one with end to end correction), and the other six underwent angioplasty with catheter-balloon. None of the 15 patients without previous catheterism died, and neither did those who underwent surgery during the last 4 years. The associated anomalies required a second time surgery. We conclude that morbimortality is related to the aortic arch hypoplasia, pulmonary hypertension and surgery during the first 2 weeks. We recommend surgery without previous catheterism. The recoarctation is more frequent in patients with end to end correction, without an increase of the mortality.

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Between 1971-1988 we have studied 46 children with dilated cardiomyopathy. Twenty were males and 18 females, with a median age of 17 months (range from 1 day to 11 years). The incidence of 3.4 cases a year during the first nine years dropped to 1.3 cases a year in the following years. Two patients were siblings. Seventeen patients were studied with Eco-Doppler, cardiac catheterization and angiocardiography. The most frequent presentation was heart failure, present in 45 cases (98%). By bidimensional echocardiography it was observed that all patients had a dilated left ventricle, with a left atrial/aorta ratio of 1.5 +/- 0.3; the ejection fraction was diminished in 12 patients (11-36%) and the length of the left ventricle in the long parasternal axis view 4.2 +/- 0.7. All the patients studied had an elevated telediastolic pressure in the left ventricle, four with pulmonary artery pressure of 96 +/- 11 and seven with right atrial pressure of 24 +/- 5. There was mitral insufficiency in 4 patients and tricuspid insufficiency in three. Clinical course was favorable in 18 patients with median age at present of 112 months (range: 11 months to 15 years). The last 6 patients, treated with vasodilators, are living. In conclusion, dilated cardiomyopathy is a moderately frequent disease, with trend to diminish in incidence prognosis improved after treatment with vasodilator was introduced, and easily assessed with non-invasive methods.

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