Cristóbal Coronel-Rodríguez

Background: Health care digitalization and pediatric information and communication technology have facilitated the use of telemedicine and digital communication tools in pediatric practice, improving accessibility and efficiency. Meanwhile, artificial intelligence (AI) is emerging as a promising tool in medicine. However, the rapid adoption of these technologies has raised concerns regarding reliability and ethics. Objective: This study examines the level of digitalization in pediatric consultations and explores the perspectives of health care professionals (HCPs) on digital technologies in patient care, analyzing differences by age group, health care management, and institution type. Methods: An observational, cross-sectional survey was conducted among Spanish HCPs dedicated to pediatric care. Participants completed an 18-question web-based questionnaire evaluating their use of digital communication tools, perceptions of online health information, and opinions on AI in clinical practice. Statistical analyses compared responses across age groups, health care management type, and institution type. Results: A total of 495 pediatric specialists participated (female: 273/495, 58.2%; aged >45 y: 324/495, 69.8%). Most participants worked in urban settings (409/469, 87.2%), in primary care (243/313, 77.6%), and in the public sector (253/464, 54.5%). The telephone remained the most used communication channel (462/481, 96.1%), followed by email (290/481, 60.3%) and WhatsApp (139/481, 28.9%). Private-sector HCPs used digital platforms more frequently than public-sector HCPs, including email (136/206, 66% vs 135/247, 54.7%; P=.02), Instagram (23/206, 11.2% vs 5/247, 2%; P<.001), WhatsApp (105/206, 51% vs 26/247, 10.5%; P<.001), and Facebook (18/206, 8.7% vs 3/247, 1.2%; P<.001). Nearly all respondents (417/437, 95.4%) believed that parents were increasingly seeking health information online, yet a considerable proportion (158/458, 34.5%) reported that parents rarely consulted them about reliable sources. Overall, 85.4% (410/480) agreed that the internet and social media raise many questions among parents, while only 7.5% (35/465) believed that the information found is generally reliable. Nearly half of the participants (232/443, 48.5%) proactively suggested trustworthy digital resources, while 44.1% (211/443) did so only when asked. Younger respondents (P=.002), public-sector HCPs (P=.005), and primary care specialists (P=.004) were significantly more likely to offer this guidance, with scientific society resources being the most frequently recommended (402/430, 93.5%). We found that 78.6% (369/470) of participants were familiar with AI, with private-sector HCPs demonstrating greater knowledge than public-sector HCPs (P=.003). Overall, 59.6% (279/468) agreed that AI could significantly improve medicine, a view more commonly held by private-sector HCPs (P=.005). However, 94.8% (306/323) expressed ethical concerns, and 89.8% (422/470) wished to receive AI-related training. Conclusions: The survey highlights the increasing use of digital communication tools in pediatric practice, with private-sector HCPs leading adoption. While AI is viewed as promising, ethical dilemmas remain, underscoring the need for training. Limited confidence in online health information highlights the importance of strengthening digital literacy among both HCPs and parents to optimize patient care.

Celiac disease (CD) is a chronic immune-mediated enteropathy that requires strict adherence to a gluten-free diet (GFD) to prevent intestinal damage. Traditional methods for monitoring GFD adherence, such as serology and dietary assessments, often poorly correlate with histological findings and typically involve a waiting period before results are available, limiting their usefulness for immediate clinical decision-making. This cross-sectional case study reports on a 45-year-old mother and her 11-year-old twin daughters, all diagnosed with CD and following a GFD for over two years. Despite being asymptomatic and showing negative anti-tTG serology, the mother continued to present Marsh 1 histological lesions, suggesting ongoing subclinical inflammation. Point-of-care testing (POCT) for gluten immunogenic peptides (GIP) in urine revealed positive results for all three individuals, indicating recent gluten exposure despite reported dietary adherence. A follow-up GIP test after dietary review and reinforcement yielded negative results, confirming improved adherence. Additionally, a psychological assessment using the Hospital Anxiety and Depression Scale (HADS) revealed anxiety symptoms in the mother and one of the daughters, which may have influenced adherence to the GFD. These findings underscore the clinical value of urinary GIP POCT as a rapid, non-invasive tool for detecting hidden gluten exposure, even when traditional monitoring appears normal. Integrating GIP testing and psychological screening into routine clinical practice may enhance management and support timely, personalized interventions in patients with CD.

BACKGROUND Health care digitalization and pediatric information and communication technology have facilitated the use of telemedicine and digital communication tools in pediatric practice, improving accessibility and efficiency. Meanwhile, artificial intelligence (AI) is emerging as a promising tool in medicine. However, the rapid adoption of these technologies has raised concerns regarding reliability and ethics. OBJECTIVE This study examines the level of digitalization in pediatric consultations and explores the perspectives of health care professionals (HCPs) on digital technologies in patient care, analyzing differences by age group, health care management, and institution type. METHODS An observational, cross-sectional survey was conducted among Spanish HCPs dedicated to pediatric care. Participants completed an 18-question web-based questionnaire evaluating their use of digital communication tools, perceptions of online health information, and opinions on AI in clinical practice. Statistical analyses compared responses across age groups, health care management type, and institution type. RESULTS A total of 495 pediatric specialists participated (female: 273/495, 58.2%; aged >45 y: 324/495, 69.8%). Most participants worked in urban settings (409/469, 87.2%), in primary care (243/313, 77.6%), and in the public sector (253/464, 54.5%). The telephone remained the most used communication channel (462/481, 96.1%), followed by email (290/481, 60.3%) and WhatsApp (139/481, 28.9%). Private-sector HCPs used digital platforms more frequently than public-sector HCPs, including email (136/206, 66% vs 135/247, 54.7%; P=.02), Instagram (23/206, 11.2% vs 5/247, 2%; P<.001), WhatsApp (105/206, 51% vs 26/247, 10.5%; P<.001), and Facebook (18/206, 8.7% vs 3/247, 1.2%; P<.001). Nearly all respondents (417/437, 95.4%) believed that parents were increasingly seeking health information online, yet a considerable proportion (158/458, 34.5%) reported that parents rarely consulted them about reliable sources. Overall, 85.4% (410/480) agreed that the internet and social media raise many questions among parents, while only 7.5% (35/465) believed that the information found is generally reliable. Nearly half of the participants (232/443, 48.5%) proactively suggested trustworthy digital resources, while 44.1% (211/443) did so only when asked. Younger respondents (P=.002), public-sector HCPs (P=.005), and primary care specialists (P=.004) were significantly more likely to offer this guidance, with scientific society resources being the most frequently recommended (402/430, 93.5%). We found that 78.6% (369/470) of participants were familiar with AI, with private-sector HCPs demonstrating greater knowledge than public-sector HCPs (P=.003). Overall, 59.6% (279/468) agreed that AI could significantly improve medicine, a view more commonly held by private-sector HCPs (P=.005). However, 94.8% (306/323) expressed ethical concerns, and 89.8% (422/470) wished to receive AI-related training. CONCLUSIONS The survey highlights the increasing use of digital communication tools in pediatric practice, with private-sector HCPs leading adoption. While AI is viewed as promising, ethical dilemmas remain, underscoring the need for training. Limited confidence in online health information highlights the importance of strengthening digital literacy among both HCPs and parents to optimize patient care. CLINICALTRIAL

Faecal calprotectin is used to assess intestinal inflammation, but its role in monitoring mucosal healing in coeliac disease is unclear. This study followed 48 adults with coeliac disease on a gluten‐free diet over 12 months, evaluating faecal calprotectin levels in correlation with anti‐transglutaminase antibodies, gluten‐free diet adherence by dietary questionnaires and histology. Although significant histological lesions (Marsh II–III) decreased from 24% to 10%, faecal calprotectin levels fluctuated without correlation to anti‐transglutaminase, adherence or histological remission, and did not differentiate between lesion grades. Our findings underscore faecal calprotectin's unreliability in monitoring mucosal healing in adults with coeliac disease, highlighting the urgent need for alternative biomarkers.

Background: Exposure to antigens is crucial for child immune system development, aiding disease prevention and promoting infant health. Some common food antigen proteins are found in human breast milk. However, it is unclear whether gluten antigens linked to celiac disease (CD) are transmitted through breast milk, potentially impacting the development of the infant’s immune system. Objective: This study aimed to analyze the passage of gluten immunogenic peptides (GIP) into human breast milk. We evaluated the dynamics of GIP secretion after lactating mothers adopted a controlled gluten-rich diet. Methods: We prospectively enrolled 96 non-CD and 23 CD lactating mothers, assessing total proteins and casein in breast milk, and GIP levels in breast milk and urine. Subsequently, a longitudinal study was conducted in a subgroup of 12 non-CD lactating mothers who adopted a controlled gluten-rich diet. GIP levels in breast milk and urine samples were assayed by multiple sample collections over 96 hours. Results: Analysis of a single sample revealed that 24% of non-CD lactating mothers on a regular unrestricted diet tested positive for GIP in breast milk, and 90% tested positive in urine, with significantly lower concentrations in breast milk. Nevertheless, on a controlled gluten-rich diet and the collection of multiple samples, GIP were detected in 75% and 100% of non-CD participants in breast milk and urine, respectively. The transfer dynamics in breast milk samples were long-enduring and GIP secretion persisted from 0 to 72 h. In contrast, GIP secretion in urine samples was limited to the first 24 h, with inter-individual variations. In the cohort of CD mothers, 82.6% and 87% tested negative for GIP in breast milk and urine, respectively. Conclusions: This study definitively established the presence of GIP in breast milk, with substantial inter-individual variations in secretion dynamics. Our findings provide insights into distinct GIP kinetics observed in sequentially collected breast milk and urine samples, suggesting differential gluten metabolism patterns depending on the organ or system involved. Future research is essential to understand whether GIP functions as sensitizing or tolerogenic agents in the immune system of breastfed infants.

Exclusive breastfeeding is recommended for the first six months of life to promote adequate infant growth and development, and to reduce infant morbidity and mortality. However, whenever some mothers are not able to breastfeed their infants, infant formulas mimicking human milk are needed, and the safety and efficacy of each formula should be tested. Here, we report the results of a multicenter, randomized, blinded, controlled clinical trial that aimed to evaluate a novel starting formula on weight gain and body composition of infants up to 6 and 12 months, as well as safety and tolerability. For the intervention period, infants were divided into three groups: group 1 received formula 1 (Nutribén^® Innova 1 (Alter Farmacia S.A., Madrid, Spain) or INN (n = 70)), with a lower amount of protein, a lower casein to whey protein ratio by increasing the content of α-lactalbumin, and a double amount of docosahexaenoic acid/arachidonic acid than the standard formula; it also contained a thermally inactivated postbiotic (Bifidobacterium animalis subsp. lactis, BPL1^TM HT). Group 2 received the standard formula or formula 2 (Nutriben^® Natal (Alter Farmacia S.A., Madrid, Spain) or STD (n = 70)) and the third group was exclusively breastfed for exploratory analysis and used as a reference (BFD group (n = 70)). During the study, visits were made at 21 days and 2, 4, 6, and 12 months of age. Weight gain was higher in both formula groups than in the BFD group at 6 and 12 months, whereas no differences were found between STD and INN groups either at 6 or at 12 months. Likewise, body mass index was higher in infants fed the two formulas compared with the BFD group. Regarding body composition, length, head circumference and tricipital/subscapular skinfolds were alike between groups. The INN formula was considered safe as weight gain and body composition were within the normal limits, according to WHO standards. The BFD group exhibited more liquid consistency in the stools compared to both formula groups. All groups showed similar digestive tolerance and infant behavior. However, a higher frequency of gastrointestinal symptoms was reported by the STD formula group (n = 291), followed by the INN formula (n = 282), and the BFD groups (n = 227). There were fewer respiratory, thoracic, and mediastinal disorders among BFD children. Additionally, infants receiving the INN formula experienced significantly fewer general disorders and disturbances than those receiving the STD formula. Indeed, atopic dermatitis, bronchitis, and bronchiolitis were significantly more prevalent among infants who were fed the STD formula compared to those fed the INN formula or breastfed. To evaluate whether there were significant differences between formula treatments, beyond growth parameters, it would seem necessary to examine more precise health biomarkers and to carry out long-term longitudinal studies.

This paper presents the case of a child diagnosed with both celiac disease and Asperger’s syndrome. The literature does not report this association to date, and the authors believe it to be a coincidence rather than a casualty.

Gluten-related disorders (GRDs) represent a spectrum of diverse clinical manifestations triggered by the ingestion of gluten in genetically susceptible individuals. The most common and widely recognized diseases within this spectrum are celiac disease and non-celiac gluten sensitivity. The clinical manifestations are intestinal, but extraintestinal manifestations may also appear, such as neurological or psychiatric. This work will specifically review the neurological or psychiatric manifestations that are more frequently associated with GRD in children. Gluten ataxia, celiac disease, neuropathy, and celiac disease-epilepsy-brain calcifications syndrome are key entities that appear silently or oligosymptomatically on many occasions. However, they are more typical disorders in adult patients. The treatment with a gluten-free diet can usually alleviate the symptoms and, in some cases, even the neurological condition is cured. Other conditions, such as headache, behavioral disorders, or generalized developmental disorders, are more typical in children. The pathophysiological basis of these conditions is not completely well-defined, although it is probably triggered by autoimmune mechanisms. The effective treatment approach is a gluten-free diet, although drugs such as antiepileptics, anti-migraine, immunomodulators, analgesics, or psychotropic drugs can control the clinical symptoms. The diagnosis of GRD should be made in the presence of neurological and psychiatric signs and symptoms, especially if they are of an unclear etiology. Also, the diagnosis should be made early, since their early correction can substantially improve the prognosis in some of these disorders.