Why Do Not All Living Kidney Donor Candidates Are Accepted for Donation? A Pediatric Center Experience.

BACKGROUND: Living donor kidney transplantation is the best type of renal replacement therapy for patients with end-stage renal disease. Living kidney donors (LKDs) undergo an extensive evaluation before donating, and many potential LKDs are declined. This study aimed to define the reasons for the decline in LKD candidates referred to our center. METHODS: We retrospectively analyzed clinical data of all potential LKDs evaluated between January 2001 and December 2021 at our institution,Western National Medical Center, Pediatric Hospital. Data were obtained by review of an electronic database. RESULTS: A total of 1332 potential LKDs were evaluated, 796 (59.7%) successfully donated; 20 (1.5%) had a complete evaluation, were accepted for donation, and were on the waiting list for intervention; 56 (4.2%) continued in the evaluation process; 200 (15%) were discharged from the program due to administrative aspects, death (donor or receptor), or cadaveric renal transplantation in order of frequency; 56 (4.2%) withdraw by personal choice; and 204 (15.3%) were rejected for donation. Donor-related reasons included medical contraindications (n = 134, 65.7%), anatomic contraindications (n = 38, 18.6%), immunologic barriers (n = 18, 8.8%), and psychological reasons (n = 11, 5.4%). CONCLUSIONS: Despite the large number of potential LKDs, a significant proportion did not proceed for donation for different reasons; in our description, it represents 40.3%. The largest proportion is because of donor-related causes, and most of the reasons result from the candidate's unnoticed chronic diseases.

Retrospective Study of the Seroprevalence of HIV, HCV, and HBV in Blood Donors at a Blood Bank of Western Mexico.

Obtaining blood which is safe for transfusions is one of the principal challenges in the health systems of developing countries. Supply of contaminated blood increases morbidity, mortality, and the costs of patient care. In Mexico, serological screening is mandatory, but only a few of the main blood banks routinely perform a nucleic acid test (NAT). Data from 80,391 blood donations processed between August 2018 and December 2019 at the Central Blood Bank of the Western National Medical Center of the Mexican Social Security Institute (IMSS) were analyzed. All donors were screened for serological markers and NAT was performed. Reactive donors were followed-up to confirm their results. The number of reactive donors and seroprevalence rates for HIV, HCV, and HBV were 152 (18.91/10,000), 385 (47.89/10,000), and 181 (22.51/10,000), respectively; however, these rates decreased when NAT-confirmed reactive results were considered. Male donors were found to have a higher seroprevalence than females, and younger donors higher than older donors. The present study shows that HIV, HCV, and HBV seroprevalence in blood donors in Western Mexico is low. We propose that Mexico should establish future strategies, including pathogen reduction technologies (PRTs), in order to improve blood safety and reduce transfusion-transmissible infections (TTIs).

Reduction of small dense LDL and Il-6 after intervention with Plantago psyllium in adolescents with obesity: a parallel, double blind, randomized clinical trial.

Obesity can lead children and adolescents to an increased cardiovascular disease (CVD) risk. A diet supplemented with Plantago psyllium has been shown to be effective in reducing LDL-C and IL-6 in adolescents. However, there are no studies that have explored small-dense LDL (sdLDL) or HDL subclasses. The aim of this study was to evaluate the impact of a fiber dietary intervention on LDL and HDL subclasses in adolescents with obesity. In this parallel, double blind, randomized clinical trial, the participants were assigned to Plantago psyllium or placebo (10g/day for 7 weeks). We randomized 113 participants, and evaluated and analyzed 100 adolescents (50 in each group), 15 to 19 years with a body mass index of 29-34. We measured biochemical markers LDL and HDL subclasses using the Lipoprint system (Quantimetrix) and IL-6 by ELISA. Post-treatment there was a decrease in sdLDL between the groups 2.0 (0-5.0) vs 1 (0-3.0) mg/dl (p = 0.004), IL-6 median 3.32 (1.24-5.96) vs 1.76 (0.54-3.28) pg/ml, p <0.0001. There were no differences in HDL subclasses and no adverse effects were reported in either group.Conclusions: Small dense LDL and IL-6 reduced in adolescents with obesity when consuming Plantago psyllium. This may be an early good strategy for the reduction of cardiovascular disease risk in this vulnerable population.Trial registration: ISRCTN # 14180431. Date assigned 24/08/2020 What is Known: • Supplementing the diet with Plantago psyllium lowers LDL-C levels. What is New: • First evidence that soluble fiber supplementation like Plantago psyllium decreases small dense LDL particles in association with lowered IL-6, reducing the risk of cardiovascular disease in obese adolescents.

[Impact of pasteurization/freeze-drying on available immunoglobulin content of the mature human milk. Use in human milk banking of hospitals]. / Impacto de la pasteurización/liofilización en el contenido disponible de inmunoglobulinas en leche humana madura. Estudio de aplicación en bancos de leche humana en hospitales.

INTRODUCTION: This study analyzes the effect on the content of immunoglobulins and C3 complement of freeze drying after pasteurization by three different methods in mature human milk (MHM). OBJECTIVE: Freeze drying is proposed as a complementary method for the maintenance of MHM therapeutic properties with greater validity. METHODS: This was a descriptive study in which MHM samples were obtained. Next, aliquots of the samples obtained were pasteurized by three methods: 62.5 centigrades degrees/30 minutes, 72 centigrades degrees/15 minutes, 85 centigrades degrees/5 minutes, followed by a rapid cooling at 5 ºC. Then, 30 ml volumes of pasteurized sample were freeze-dried over a period of 36 hours. Total protein determination was performed by the Lowry method. The concentrations of immunoglobulins A, G and M, and complement C3, were determined by conventional nephelometric technique following the manufacturer's instructions. Statistical significance was defined as p < 0.05. RESULTS: The method of pasteurization of MHM with increased protein and immunoglobulin retention was at 62.5 centigrades degrees, however, pasteurization at 72 centigrades degrees before freeze-drying showed better retention of immunoglobulins. CONCLUSIONS: Our results suggest that the freeze-drying of pasteurized MHM is a suitable method for the conservation in human milk banks. Both the nutritional composition and the extension of its validity and the application of the two processes together provide the advantage of maintaining the therapeutic properties of human milk to improve the health of the newborn in a vulnerable, impaired or immunosuppressed state.

INTRODUCCIÓN: este estudio analiza el efecto sobre el contenido de inmunoglobulinas y complemento C3 de la liofilización posterior a la pasteurización por tres métodos diferentes en leche humana madura (LHM). OBJETIVO: la liofilización es propuesta como método complementario para el mantenimiento de las propiedades terapéuticas de la LHM con mayor vigencia. MÉTODOS: estudio descriptivo en el que se obtuvieron muestras de LHM. Alícuotas de las muestras obtenidas se pasteurizaron por tres métodos: 62,5 grados centígrados/30 minutos, 72 grados centígrados/15 minutos 85 grados centígrados/5 minutos, seguido de un enfriamiento rápido a 5 grados centígrados. Después, volúmenes de 30 ml de muestra pasteurizada fueron liofilizados durante un periodo de 36 horas. La determinación de proteínas totales fue realizada por el método Lowry. Las concentraciones de inmunoglobulinas A, G y M y el complemento C3 fueron determinadas por nefelometría convencional, siguiendo las instrucciones del fabricante. La significancia estadística se definió como p < 0,05. RESULTADOS: el método de pasteurización de LHM con mayor retención de proteína e inmunoglobulinas fue a la temperatura de 62,5 grados centígrados, sin embargo, la pasteurización a 72 grados centígrados antes de la liofilización mostró mayor retención de inmunoglobulinas. CONCLUSIONES: nuestros resultados sugieren que la liofilización de LHM pasteurizada es un método eficiente para la conservación en bancos de leche humana. Tanto la composición nutricional como la extensión de su vida útil y la aplicación de los dos procesos juntos proporcionan la ventaja de mantener las propiedades terapéuticas de la leche humana para mejorar la salud del recién nacido en estado vulnerable, desmedro o inmunosuprimido.

[Risk factors associated with the development of early neurological complications in purulent meningitis in a pediatric population]. / Factores de riesgo asociados al desarrollo de complicaciones neurológicas tempranas en meningitis purulenta.

OBJECTIVE: To determine the risk factors associated with the development of early neurological complications in purulent meningitis in a pediatric population. METHODS: This was a case-control study including 78 children aged one month to 16 years with purulent meningitis divided into two groups: cases, with early neurological complications (defined as those presenting < 72 hours from initiation of clinical manifestation), and controls, without early neurological complications. Clinical, serum laboratory, and cerebrospinal fluid (CSF). RESULTS: Seventy-eight patients were included: cases, n = 33, and controls, n = 45. Masculine gender, 19 (57%) vs. feminine gender, 28 (62%) (p = 0.679). Median age in months, 36 months (range, 1-180) vs. 12 months (range, 1-168) (p = 0.377). Factors associated with neurological complications: convulsive crises on admission, p = 0.038, OR, 2.65 (range, 1.04-6.74); meningeal signs, p = 0.032, OR, 2.73 (range, 1.07-6.96); alteration of the alert state, p = 0.003, OR, 13.0 (range, 1.64-105.3); orotracheal intubation, p = 0.000, OR, 14.47 (range, 4.76-44.01); neurological deterioration, p = 0.000, OR, 9.60 (range, 3.02-30.46); turbid CSF, p = 0.003, OR, 4.20 (range, 1.57-11.20); hypoglycorrhachia, < 30 mg/dl, p = 0.001, OR, 9.2 (range, 3.24-26.06); and positive CSF culture, p = 0.001, OR, 16.5 (range, 1.97-138.1). CONCLUSIONS: The factors associated with early neurological complications included convulsive crises on admission, meningeal signs, alteration of the alert state, need for orotracheal intubation, turbid CSF, hypoglycorrhachia, and positive CSF culture.

[Hyponatremia and its etiology in pediatric patients admitted to the emergency room]. / Hiponatremia y su etiología en pacientes pediátricos ingresados a sala de urgencias.

BACKGROUND: The importance of hyponatremia is underestimated despite it is a frequent alteration in a hospital environment. Usually no cause is investigated and it is treated as an isolated data. The aim was to determine the prevalence and etiology of hyponatremia in pediatric patients. METHODS: Cross-sectional study of 72 patients from 1-month to 15-years of age admitted to the emergency room, from May to September, 2015, with lower serum determination of Na < 135 mEq/L at admission. For statistical analysis, frequencies and percentages, as well as medians and ranges were used. RESULTS: 72 patients (3%) out of 2400 admissions to the emergency room were detected. 42 were male (58%), 28 infant (30.5%), and 46 eutrophic (68.5%). The diagnosis at admission was sepsis in 13 (18%), mild hyponatremia in 41 (56.9%), real hyponatremia in 71 (98.6%) and dilutional in 1 (1.4%). The median serum sodium was 130 mEq/L (range 112-134), and the median serum osmolality 266 mOsm/L (range 236-288). The most usual management was the increase of sodium in solutions in 21 cases (29%), and the use of diuretics (n = 21, 29%). The median of sodium input per m2 (BSA) per day was 45 mEq (range 0-158). CONCLUSIONS: Mild and real hyponatremia were the most frequent diagnoses. The infection at admission was the more common etiology. The increase in sodium input in solution was the most common management. The use of intravenous solutions 2:1 (isotonic) did not produce hypernatremia and avoided administration of hypotonic solutions.

Introducción: la importancia de la hiponatremia es subestimada a pesar de ser una alteración frecuente en el medio hospitalario. Habitualmente no se investiga su causa y se trata como dato aislado. Se buscó determinar la prevalencia de hiponatremia y su etiología en pacientes en urgencias pediátricas. Métodos: estudio transversal en 72 pacientes de un mes a 15 años ingresados de mayo a septiembre de 2015 en urgencias con determinación sérica de Na < 135 mEq/L a su ingreso. Para la estadística se emplearon frecuencias y porcentajes, medianas y rangos. Resultados: se detectaron 72 pacientes de 2400 ingresos a urgencias (3%). Fueron varones 42 (58%), 28 lactantes (30.5%) y 46 eutróficos (68.5%). El diagnóstico de ingreso fue de sepsis en 13 (18%), hiponatremia leve en 41 (56.9%), real (hipoosomolar) en 71 (98.6%) y dilucional en 1 (1.4%). La mediana del sodio sérico fue de 130 mEq/L (rango 112-134) y la de la osmolaridad sérica de 266 mOsm/L (rango 236-288). El manejo más frecuente fue el incremento del aporte de sodio en soluciones en 21 casos (29.1%) y el uso de diuréticos en 21 (29%). La mediana del aporte de sodio por m2 SCT al día fue de 45 mEq (rango 0-158). Conclusiones: la hiponatremia leve y la hipoosomolar fueron las más frecuentes. El diagnóstico de origen infeccioso fue la causa más común. El incremento en el aporte de sodio en soluciones fue el manejo más habitual. El uso de soluciones intravenosas 2:1 (isotónicas) no produjo hipernatremia y evitó la administración de soluciones hipotónicas.

[Risk factors related with ventilator-associated pneumonia in a neonatal intensive care therapy]. / Factores asociados a neumonía secundaria a ventilación mecánica en terapia intensiva neonatal.

BACKGROUND: Ventilator-associated pneumonia (VAP) represents the second cause of nosocomial infections and it is associated with greater morbility, duration of mechanical ventilation (MV), and hospital stay. The objective was to determine factors related with VAP in neonates. METHODS: Analytical transversal study including newborns admitted already intubated with at least 48 hours of MV or who were intubated in Neonatal Therapy. VAP was defined according to the criteria of the Centers for Disease Control and Prevention: "those patients submitted to MV during at least 48 hours". We used inferential statistics for statistical analysis (chi squared, Mann-Whitney U test, and Kaplan-Meier estimator). RESULTS: 82 neonates were studied, out of which 27 developed VAP (33%). The median time to develop pneumonia was 6 days (range 5-11). The most commonly isolated germ was Escherichia coli (27%). Statistically significant variables were gestational age (p = 0.05), and the use of antacids at admission (p = 0.007). Patients with pneumonia had longer hospital stay (p = 0.001) and time with MV (p = 0.002). Of all the patients, 22 neonates died (27%), of which nine patients had VAP. CONCLUSION: Risk factors for VAP in neonates include lower gestational age, the use of antacids, and prolonged MV.

Introducción: la neumonía asociada a ventilación mecánica (NAVM) representa la segunda causa de infección nosocomial y se asocia con una mayor morbilidad, duración de ventilación mecánica (VM) y estancia hospitalaria. El objetivo fue determinar los factores asociados a NAVM en neonatos. Métodos: estudio transversal analítico en el que se incluyeron recién nacidos que ingresaron intubados con menos de 48 horas de VM o que se intubaron en terapia neonatal. Se definió la NAVM, según los criterios de los Centros para el Control y la Prevencion de Enfermedades (CDC), como "aquella infección nosocomial diagnosticada en pacientes sometidos a VM durante al menos 48 horas". Se empleó estadística inferencial para el análisis estadístico. Resultados: se estudiaron 82 neonatos, desarrollaron NAVM 27 (33%). La mediana del desarrollo de neumonía fue de seis días (rango 5-11). El germen aislado más común fue la Escherichia coli (27%). Las variables estadísticamente significativas fueron la edad gestacional (p = 0.05) y el uso de antiácidos al ingreso (p = 0.007). Los pacientes con neumonía tuvieron mayor tiempo de estancia hospitalaria (0.001) y tiempo con VM (p = 0.002). Murieron 22 neonatos en población general (27%), de los cuales nueve eran pacientes con NAVM. Conclusión: los factores de riesgo para NAVM incluyen menor edad gestacional, antiácidos y ventilación mecánica prolongada.

Higher prolactin and vasoinhibin serum levels associated with incidence and progression of retinopathy of prematurity.

BACKGROUND: Retinopathy of prematurity (ROP) is a potentially blinding, retinal neovascular disease. Systemic prolactin accesses the retina to regulate blood vessels. Prolactin is proangiogenic and can be cleaved to antiangiogenic vasoinhibins. We investigated whether circulating prolactin and vasoinhibins associate with incidence and progression of ROP. METHODS: A prospective, longitudinal, case-control study covering postnatal weeks 1 to 9 measured serum prolactin, vasoinhibins, and vascular endothelial growth factor (VEGF) weekly in 90 premature infants diagnosed as ROP or control. RESULTS: Prolactin levels were higher in ROP than in control patients before (106.2 ± 11.3 (SEM) vs. 64.7 ± 4.9 ng/ml, postnatal week 1) and during (120.6 ± 10 vs. 84.7 ± 7.5ng/ml, postnatal week 5) ROP diagnosis. Prolactin, but not gestational age, birth weight, Apgar score, sepsis, or ventilation time, correlated with ROP. The relative risk (RR) of developing ROP increased if Prolactin (PRL) levels were higher than thresholds of 80 ng/ml (RR = 1.55, 95% CI: 1.06-2.28), 100 ng/ml (RR = 1.63, 95% CI: 1.14-2.34), or 120 ng/ml (RR = 1.95, 95% CI: 1.41-2.68). Vasoinhibin levels were 39.7% higher (95% CI: 4.5-77.5) in the circulation of ROP than in control patients at postnatal week 1 and similar thereafter, whereas VEGF serum levels were always similar. CONCLUSION: High serum prolactin and vasoinhibin levels predict and may impact ROP progression.

Proinflammatory Cytokines, Enolase and S-100 as Early Biochemical Indicators of Hypoxic-Ischemic Encephalopathy Following Perinatal Asphyxia in Newborns.

BACKGROUND: Estimation of the neurological prognosis of infants suffering from perinatal asphyxia and signs of hypoxic-ischemic encephalopathy is of great clinical importance; however, it remains difficult to satisfactorily assess these signs with current standard medical practices. Prognoses are typically based on data obtained from clinical examinations and neurological tests, such as electroencephalography (EEG) and neuroimaging, but their sensitivities and specificities are far from optimal, and they do not always reliably predict future neurological sequelae. In an attempt to improve prognostic estimates, neurological research envisaged various biochemical markers detectable in the umbilical cord blood of newborns (NB). Few studies examining these biochemical factors in the whole blood of newborns exist. Thus, the aim of this study was to determine the expression and concentrations of proinflammatory cytokines (TNF-α, IL-1ß and IL-6) and specific CNS enzymes (S-100 and enolase) in infants with perinatal asphyxia. These data were compared between the affected infants and controls and were related to the degree of HIE to determine their utilities as biochemical markers for early diagnosis and prognosis. METHODS: The levels of the proinflammatory cytokines and enzymes were measured by enzyme-linked immunosorbent assay (ELISA) and Reverse Transcription polymerase chain reaction (RT-PCR). RESULTS: The expression and serum levels of the proinflammatory cytokines, enolase and S-100 were significantly increased in the children with asphyxia compared with the controls. CONCLUSION: The role of cytokines after hypoxic-ischemic insult has been determined in studies of transgenic mice that support the use of these molecules as candidate biomarkers. Similarly, S-100 and enolase are considered promising candidates because these markers have been correlated with tissue damage in different experimental models.

[Depressive disorder in Mexican pediatric patients with systemic lupus erythematosus (SLE)]. / Trastorno depresivo en pacientes pediátricos mexicanos con lupus eritematoso sistémico (LES).

OBJECTIVE: To identify the prevalence of depression in Mexican pediatric patients with systemic lupus erythematosus. MATERIALS AND METHODS: Analytical transversal study including patients aged 7-16 years with a diagnosis of systemic lupus erythematosus seen at the Pediatric Rheumatology Consultation Service. The disease was classified by means of the MEX-SLEDAI questionnaire. Descriptive statistics with central tendency and dispersion and comparative measurements with chi-squared and Mann-Whitney U tests. Logistic regression and association with odds ratios. SPSS v.21.0 statistical software package. RESULTS: We evaluated 45 patients who presented depression, n=9 (20%), including eight females (89%) and one male (11%), median age 13 years (range, 7-16) in children with depression vs. 13 years (range, 9-14) p=0.941, depression more frequent in schoolchildren. Habitual residence, disease evolution time, and duration of the immunosuppressor did not show a significant difference between both groups. Divorced parents p=0.037. Neuropsychiatric manifestations of lupus presented in 2.2% of all patients and in 100% of patients with depression. Disease activity index (MEX-SLEDAI) did not demonstrate a relationship with the presence of depression. CONCLUSION: Prevalences in pediatric populations are less that that reported in adults, association with disease activity, evolution time, and immunosuppressor use and duration not found.

Models Predictive of Metabolic Syndrome Components in Obese Pediatric Patients.

BACKGROUND AND AIMS: Components of metabolic syndrome (MetS) are complications caused by abdominal obesity and insulin resistance (IR). Diagnosis of MetS by clinical indicators could help to identify patients at risk of cardiovascular disease and type 2 diabetes. We undertook this study to propose predictive indicators of MetS in obese children and adolescents. METHODS: A cross-sectional study was carried out. After obtaining informed consent and the registration of the study with an institutional research committee, 172 obese patients from an Obesity Clinic, aged 6-15 years, were included. Variables included were waist circumference (WC), glucose, high-density lipoprotein (HDL), triglycerides (TGL), blood pressure, insulin resistance (by homeostatic model assessment HOMA-index), acanthosis nigricans (AN), uric acid, serum glutamic oxaloacetic transaminase (GOT) and alanine transaminase, and hepatic sonogram. International standards for age and sex variables were used. Multivariate analysis was applied. RESULTS: Variables predicted components of MetS in children: HOMA-IR (insulin resistance by HOMA index) was increased by 2.4 in hepatic steatosis, by 0.6 for each unit of SUA (serum uric acid), and by 0.009 for every mg/dL of triglycerides. In adolescents, every cm of waist circumference increased systolic blood pressure by 0.6 mmHg, and each unit of SUA increased it by 2.9 mmHg. CONCLUSIONS: Serum uric acid and waist circumference are useful and accessible variables that can predict an increased risk of cardiovascular disease in obese pediatric patients.

[Urodynamic changes after bladder augmentation surgery in paediatric patients with myelomeningocele due to neurogenic bladder]. / Cambios urodinámicos posteriores a cirugía de ampliación vesical por vejiga neurogénica en pacientes pediátricos con mielomeningocele.

BACKGROUND: Augmentation cystoplasty is a successful surgical procedure for the management of neurogenic bladder in children in order to improve urodynamic parameters. The aim of this article is to describe urodynamic changes after augmentation cystoplasty in children with myelomeningocele. MATERIALS AND METHODS: A descriptive cross-sectional study including children aged 8-16 years with a myelomeningocele operated on for augmentation cystoplasty surgery with sigmoid colon segments due to a neurogenic bladder from the years 2003-2013. A urodynamic study was conducted before and after the surgical procedure. Non-probabilistic sample of consecutive cases. Descriptive statistics with frequencies and percentages, medians, and ranges. Inferential intra-group comparison with the Wilcoxon test and inter-group with Mann-Whitney U. SPSS 20.0 statistical package. RESULTS: The study included 50 patients, of whom 25 were male and 25 were female, with a median age of 12 years (range, 6-15 years). Bladder capacity improved from 52.8% to 95.9% (p<0.001), uninhibited contractions 1.4-1.8, contraction intensity 47-8.5 (p<0.001), mean pre-surgical and post-surgical filling pressure 40.8cm H2O and 11.0cm H2O, respectively (p<0.001), mean emptying pressure 48.5 vs. 3.6cm H2O (p<0.001), and bladder accommodation 4.6 vs. 41.3cm H2O (p<0.001). CONCLUSIONS: Augmentation cystoplasty with sigmoid colon significantly improved urodynamic parameters, such as bladder accommodation and filling pressure in children with myelomeningocele-associated neurogenic bladder.

[Risk factors associated with bacterial growth in derivative systems from cerebrospinal liquid in pediatric patients]. / Factores de riesgo asociados a crecimiento bacteriano en sistemas derivativos de líquido cefalorraquídeo en pacientes pediátricos.

OBJECTIVE: To determine risk factors associated with bacterial growth in systems derived from cerebrospinal fluid in pediatric patients. METHODS: Case and controls study from January to December 2012, in patients aged <16 years who were carriers of hydrocephalus and who required placement or replacement of derivative system. Cases were considered as children with cultures with bacterial growth and controls with negative bacterial growth. Inferential statistics with Chi-squared and Mann-Whitney U tests. Association of risk with odds ratio. RESULTS: We reviewed 746 registries, cases n=99 (13%) and controls n=647 (87%). Masculine gender 58 (57%) vs. feminine gender 297 (46%) (p=0.530). Age of cases: median, five months and controls, one year (p=0.02). Median weight, 7 vs. 10 kg (p=0.634). Surgical interventions: median n=2 (range, 1-8) vs. n=1 (range, 1-7). Infection rate, 13.2%. Main etiology ductal stenosis, n=29 (29%) vs. n=50 (23%) (p=0.530). Non-communicating, n=50 (51%) vs. 396 (61%) (p=0.456). Predominant microorganisms: enterobacteria, pseudomonas, and enterococcus. Non-use of iodized dressing OR=2.6 (range, 1.8-4.3), use of connector OR=6.8 (range, 1.9-24.0), System replacement OR=2.0 (range, 1.3-3.1), assistant without surgical facemask OR=9.7 (range, 2.3-42.0). CONCLUSIONS: Being a breastfeeding infant, of low weight, non-application of iodized dressing, use of connector, previous derivation, and lack of adherence to aseptic technique were all factors associated with ependymitis.

[Level of knowledge of and capability for application of isolation precautions in a tertiary-level pediatric hospital]. / Grado de conocimiento y aptitud para la aplicación de las precauciones de aislamiento en un hospital pediátrico de tercer nivel.

OBJECTIVE: To assess the level of knowledge of and capability for application of isolation precautions. MATERIALS AND METHODS: A cross-sectional study was conducted at a tertiary-level pediatric hospital, and a questionnaire including structured questions and clinical scenarios was applied to healthcare personnel. Descriptive and inferential statistics were performed with the chi-squared test and odds ratios were obtained. RESULTS: A total of 131 healthcare workers participated in the study, including 34 (26%) attending physicians, 47 (36%) medical residents, 48 (37%) nurses, and 2 (1%) physicians who were heads of the department. According to our definition, 99 (75%) had poor, 22 (17%) had fair, and 10 (8%), good knowledge. With regard to the capability for application of isolation precautions, 66 (51%), 33 (25%), and 32 (24%) possessed poor, fair, and good levels, respectively. Association with poor knowledge was exhibited as follows: physicians, OR: 0.17 (0.005-0.54), p = 0.001; undergraduate degree in medicine, OR: 0.37 (0.16-0.83), p = 0.01; seniority < 5 years, OR: 0.35 (0.14-0.86), p = 0.019, and training during previous year, OR: 0.09 (0.03-0.24), p = 0.005, while association with poor capability was the following; physician, OR: 0.25 (0.12-0.55), p = 0.005; undergraduate degree in medicine, OR: 0.38 (0.18-0.80), p = 0.009; seniority < 5 years, OR: 0.90 (0.45-1.81), p = 0.78, and training during previous year, OR: 0.23 (0.10-0.51), p = 0.005. CONCLUSIONS: Being a physician, having an undergraduate degree in medicine, < 5 years working at the hospital, and having received training in the previous year were positively associated with knowledge and application of isolation precautions.

[Evaluation of the results of percutaneous closure by means of the Amplatzer device in pediatric patients with intra-auricular communication (IAC)]. / Evaluación de los resultados del cierre percutáneo mediante el dispositivo Amplatzer en pacientes pediátricos con comunicación interauricular (CIA).

OBJECTIVE: To describe the results of percutaneous closure by means of the Amplatzer Septal Occluder (ASO) device in pediatric patients with intra-auricular communication (IAC). MATERIALS AND METHODS: Descriptive transversal study in patients submitted to percutaneous closure of IAC from March 2005 to March 2013. Patients aged <16 years, weight>6 kg, IAC type ostium segundum, and patent foramen ovale, with border separations borders>5 mm, and absence of coexisting pathology were included in the study. We excluded from the study children with severe pulmonary blood pressure/arterial hypertension. Descriptive statistics with the SPSS v. 20.0 statistical software package. RESULTS: We included in the study 28 patients, feminine gender (n=19, 68%), median age=8 years (range, 4-14), weight 30.7 kg (range, 15-69). New York Heart Association (NYHA) functional class I (n=21, 75%), II (n=7, 25%). Median IAC size, 15.50 mm (range, 5-25), and a median ASO size of 17.54 mm (range, 8-28). After ASO placement, 100% presented NYHA I at one month, cardiac murmur (n=2, 7.1%), cessation of cardiac murmur at month 6 (n=28, 100%), without evidence of arrhythmias at one month 100%, residual short circuit at 24 hours (n=4, 14%), complete occlusion at month 6 (n=28, 100%), normalization size of VD, and cessation of tricuspid insufficiency 100% at one year. Complications included minimal bleeding during the procedure (n=2, 7%), transitory cephalea (n=5, 18%), and dysautonomia (n=1, 4%). CONCLUSION: Percutaneous closure of IAC of children fitted with the ASO device is safe and exhibits good results.

[Early complications with colon esophageal substitution for children via retrosternal]. / Complicaciones tempranas de la sustitución esofágica con colon por vía retroesternal en niños.

OBJECTIVE: To describe the early complications of esophageal replacement with colon in children. METHODS: Descriptive cross-sectional study from 2005 to 2011 in pediatric patients diagnosed with alkali intake, esophageal atresia or esophageal injury traumatic esophageal replacement handled via retrosternal colon. Descriptive statistical analysis using SPSS 20.0. RESULTS: We included 19 esophageal replacements, age seven (4-15), 13 (68%) male and six (31%) female. Initial diagnosis of ingestion of caustic 13 patients (68%) and type III esophageal atresia six cases (32%). Of the six esophageal atresia, four(66%) had dehiscence plasty, one (17%) long-gap atresia and type 1 (17%) esophageal perforation by dilatation. The segment of transverse colon was used in eight (42%), transverse/descending seven (36%), ascending/transverse three (15%), and descending colon one (5%). Early complications were pneumothorax one patient (5%), pneumonia three (15%), sepsis three (15%), intestinal obstruction due to adhesions two (10%), intussusception one (5%), cervical fistula three (15%). One death from sepsis (5%) at four days after surgery. DISCUSSION: Esophageal replacement with colon is a good alternative for esophageal replacement; the most frequent early complications were cervical fistula, pneumonia, and sepsis.

[Comparison of participative educative strategy versus traditional educative strategy in health personnel]. / Comparación de la estrategia educativa participativa con la tradicional en el desarrollo de aptitud clínica en reanimación neonatal en personal de salud.

OBJECTIVE: To compare the clinical aptitude in neonatal resuscitation with participative educative strategy versus traditional educative strategy in health personnel. MATERIAL AND METHODS: Quasi-experimental study design including physicians and nurses distributed in two groups: (i) participative educative strategies n=156, and (ii) traditional n=158, were imparted in 12 sessions. Evaluation of clinical aptitude evaluated with validated questionnaire. Descriptive and interferential statistical inter- and intragroup. RESULTS: Clinical aptitude median score before/after: participative educative strategy 25.0/36.5 (p=0.000) and traditional 24.5/31.0 (p=0.000); differences between intergroup p=0.040. Changes to higher category according to the score before/after in participative 114 (73%) vs. traditional 65 (41%); p=0.010. There were no significant differences in the intergroup results in the category of evaluation of clinical aptitude, but there were differences in the intragroup when we evaluated median before and after with both strategies. CONCLUSIONS: Increase of clinical aptitude in neonatal resuscitation in health personnel,with both educative strategies being higher with participative strategy.

[Depression in school children and adolescents carriers of acute leukemia during the treatment phase]. / Depresión en escolares y adolescentes portadores de leucemia aguda en fase de tratamiento.

UNLABELLED: Objective: To describe depression levels in school aged children and adolescents with acute leukemia during the treatment. MATERIALS AND METHODS: This transversal descriptive study took place during January to September 2012 and included school aged children and adolescents, carriers of acute leukemia, in treatment at a high-ranking specialty hospital. A modified Kovacs questionnaire (C O/) was applied. They were grouped according to presence or absence of depression. Inferential statistics with x2 and Statistical package SPSS 20.0 were used. RESULTS: Forty-six patients were included in the study: with depression n = 43 (94%), without depression n=3 (6%), males n= 32 (70%) and females n=14 (30%), average age 8 years old (7-15). Acute lymphoblast leukemia was the most frequent n=42 patients (91 %). Depression was found in 42 patients (91 "'o), with nine presenting a minor level (21 "'o), 11 a moderate level (26 "/o), and 23 a severe level (53 "/o). Mostly during the consolidation phase, 30 patients (70"/o) patients with no relapses showed a higher incidence of depression, 23 (54 "/o) vs. with relapses 20 (47"/o) (p = 0.870); the majority had no family history of depression 41 (95 "/o) vs. 2 (5"/o) (p = 0.017). CONCLUSIONS: We found a high percentage of severe level depression, which affected mostly male patients, suffering a relapse during the consolidation treatment phase.

Farmacovigilancia en el recién nacido crítico en el estado de Jalisco: Obligación olvidada / Pharmacovigilance in the critical newborn in the state of Jalisco: Forgotten obligation

En los neonatos en estado crítico es necesario establecer un sistema de farmacovigilancia con el cual se les proteja de posibles reacciones adversas a los medicamentos; estas reacciones pueden ser por el efecto farmacológico, la interacción con otros medicamentos, errores de dosificación y la idiosincrasia del paciente, de acuerdo con la Norma Oficial Mexicana 220. Objetivo: Conocer el estado actual de la farmacovigilancia en unidades de cuidado intensivo neonatal del estado de Jalisco. Material y métodos: Mediante un cuestionario estructurado de 12 preguntas, se practicó una encuesta de opinión en referencia a los programas de farmacovigilancia en los recién nacidos en estado crítico en instituciones del área metropolitana de Guadalajara y el interior del estado de Jalisco. Se aplicó en ocho centros hospitalarios que cuentan con terapia intensiva neonatal y en un congreso estatal de pediatría en el año 2011. A todos los participantes se les pidió que de manera voluntaria, llenaran una documento ad hoc; los resultados se procesaron en el programa Epi info 2010. Discusión y conclusiones: Los resultados demuestran que no se está cumpliendo la NOM 220. Existe un gran déficit de unidades con programas implementados de farmacovigilancia y proceso de notificación de reacciones adversas a medicamentos; la cobertura es menor al 50%. Al parecer, el problema es aún mayor en instituciones particulares. Es necesario cumplir con la NOM 220 para asegurar la calidad de atención en los recién nacidos críticos en el estado de Jalisco.

There is a need to establish medication surveillance/monitoring systemsfor newborn patients in critical condition in order to protect these patients from possible adverse reactions to prescribed drugs. In accordance with Mexican official standard NOM 220, these reactions may result from pharmacological effects, interaction with other drugs, dosage errors, and the patient's nature/idiosyncrasy. Objective: Our goal was to gain knowledge on the current situation regarding medication surveillance in neonatal intensive care units within the state of Jalisco. Material and methods: By means of a structured questionnaire involving 12 questions, an opinion poll was carried out with reference to medication surveillance programs for newborn patients in critical condition at institutions within Guadalajara's metropolitan area and the State of Jalisco. The survey was conducted in 8 hospital centers that provide neonatal intensive care and at a state congress on pediatrics that took place in 2011. All of the respondents were asked to voluntarily fill out a questionnaire Ad-hoc, and the results were processed using the Epi Info 2010 program. Discussion and conclusions: The results show that there is widespread noncompliance of NOM 220. There is a considerable deficit with respect to units implementing medication surveillance systems and methods to notify adverse reactions to medication, with implementation rates lower than 50%. It appears that the problem is even greater in private institutions. Compliance with NOM 220 is essential in order to guarantee the quality of the care provided to newborn patients in critical condition within the state of Jalisco.

[Clinical course of children of mothers with addictions into a neonatal intensive care unit in western Mexico]. / Evolución clínica de hijos de madres con adicciones internados en una unidad de terapia intensiva neonatal del Occidente de México.

BACKGROUND: Pregnancy in women addicted represents, in itself, a major risk of destruction of physical and mental health of the unborn child; urgent prevention is the same as essential to providing quality care to the mother and child knowledge. OBJECTIVE: Describe the physical and sociodemographic characteristics of neonates in intensive care units, born of mothers with addictions. MATERIALS AND METHOD: Cross-sectional, descriptive study of neonates with addict mothers, analyzing age, gender, clinical symptoms and complications. Findings for frequency-percentages with regard to qualitative variables, and medians and ranges for quantitative variables. SPSS-20.0-Windows Statistics software package. RESULTS: 618 patients admitted to the NICU, 180(29%) showing withdrawal symptoms; irritability in 117 (63%), intensive crying in 93 (51%), spontaneous Moro reflex 74 (42%), diarrhea 61 (30%), fever 61 (30%). Birth defects 124 (20%), from greater to lesser occurrence: disorders in central nervous system, digestive tract and abdominal wall, extremities, kidneys, and others. 309 (50%) weight lower than 2600g. The most frequent metabolic disorders were hypoglycemia, Metabolic Acidosis and jaundice, among others. CONCLUSIONS: Every day, we see more children born of substance-dependent mothers in the Mexico. Our study reveals high mortality rate and many complications for this group; thus, it becomes necessary to institute preventive measures among Mexican women of childbearing age in order to prevent illegal drug use and to increase treatment among pregnant addicts. Gynecologists, pediatricians and neonatologists must have extensive knowledge regarding the entire clinical-social spectrum of symptoms that may be observed in children of mothers suffering addictions.