Pediatric gallstone disease-Management difficulties in clinical practice.

BACKGROUND: Gallstone disease (GD) is no longer an exclusive condition of adulthood, and its prevalence is increasing in pediatric age. The management and the extent of the etiological investigation of GD in children and adolescents remains controversial. This study aimed to analyze the difficulties in the work-up and management of pediatric GD patients. METHODS: A retrospective study performed in a single tertiary center enrolled sixty-five patients with GD followed from January 2014 to June 2021. Patients were categorized conveniently according to their age at diagnosis: Group A (<10years, n=35) and Group B (≥10years, n=30). We analyzed demographic, clinical and laboratory data, ultrasonographic findings at presentation, therapeutics and complications. RESULTS: Symptoms were more frequent in patients >10years old (p=0.001). Cholecystectomy was performed in 31 patients (47.7%). A multivariate regression logistic model identified the age >10years (OR=6.440, p=0.005) and underlying entities (OR=6.823, p=0.017) as independent variables to perform surgery. Spontaneous resolution of GD was more common in children <2years old. A multivariate regression logistic model showed a trend for those >10years old to develop more complications. Two out of 18 patients were diagnosed with ABCB4 gene mutations in heterozygosity. CONCLUSIONS: Decision-making on cholecystectomy remains challenging in asymptomatic patients. Identifying predictive factors for the development of complications has proven difficult. However, we found a trend toward the development of complications in individuals older than 10years.

[Detection of microorganisms and resistance genes from positive blood cultures using the FilmArray® BCID2 panel: Experience in a pediatric hospital]. / Detección de microorganismos y genes de resistencia en hemocultivos positivos mediante FilmArray® panel BCID2: experiencia en un hospital pediátrico.

The rapid identification of microorganisms that cause bacteremia and their possible resistance markers are extremely important for the timely initiation of effective antibiotic therapy. The FilmArray® panel BCID2 (an automated rapid multiplex PCR assay) detects microorganisms and resistance genes from positive blood cultures within one hour. The aim of this study was to compare the results obtained from the FilmArray® Panel BCID2 and conventional culture in pediatric patients, as well as the reporting times of both methods. Sixty (60) FilmArray® results were included in the analysis. BCID2 showed high agreement with culture in the identification of microorganisms in monomicrobial bacteremias. However, in polymicrobial blood cultures, BCID2 detected a greater number of microorganisms compared to conventional culture, specifically,1 Staphylococcus aureus, 3 Staphylococcus epidermidis, 1 Enterococcus faecium, 2 Klebsiella oxytoca, 1 Acinetobacter calcoaceticus-baumannii complex, 1 Bacteroides fragilis and 1 Haemophilus influenzae. Furthermore, 88.3% (95%CI: 78.7-94.8) of the FilmArray® results coincided with conventional culture, while in polymicrobial bacteremias, BCID2 detected a greater number of microorganisms with respect to conventional culture [70% (95%CI: 39.3-91.5)]. The agreement of resistance genes was good with a few exceptions (one ESBL was not detected by FilmArray® and one S. aureus strain was characterized as methicillin-resistant by BCID2 and methicillin-sensitive by culture). When comparing the time elapsing since the blood culture was reported as positive up to the results were obtained, BCID2 had a median of 2h 50min (IQR of 1 h 58min to 9h 27min) while the conventional culture had a median of 45h 20min (IQR of 24h 57min to 63h 50min).

[Educational interventions in childhood asthma: A systematic review]. / Intervenciones educativas en asma infantil: Una revisión sistemática.

OBJECTIVE: To analyze educational interventions in pediatric asthmatic patients to achieve an adequate inhalation technique and improve their self-management. DESIGN: Systematic review based on the PRISMA recommendations. DATA SOURCES: Pubmed, Scopus, Cuiden, Web of Science and Google Scholar databases were reviewed. STUDY SELECTION: Sixteen articles published between 2014 and 2021 were included, with access to full text, languages: English, French and Spanish and pediatric population: 0-18 years. DATA EXTRACTION: Two thousand three hundred and thirteen children were participated. The variables analyzed were: level of care, type of intervention, correct performance of the inhalation technique, follow-up of the technique, delivery of written recommendations, professional-educator category, variables related to respiratory pathology, school absenteeism, quality of life and economic costs. RESULTS: The health care level was primary, hospital and community care, where specialist doctors, nurses and pharmacists stood out as educators. The most prevalent educational interventions are on-site demonstration and delivery of recommendations or multimedia interventions. Several articles report that asthma education is not carried out correctly, others state that their technique improves after the intervention, but most of them highlight the importance of periodic review of the technique. CONCLUSIONS: The authors report improvement in the inhalation technique in all of them, as well as greater self-management of the disease and adherence to treatment. It is necessary to intensify the education of patients in the correct handling of the devices, and the follow-up and subsequent review to optimize the control of the disease.

Parental assessment of infantile hemangioma cosmetic clinical outcomes: results of the Spanish Hemangioma Nationwide Prospective Cohort.

BACKGROUND: Functional impairment is the main consideration when it comes to choosing therapy for infantile hemangiomas (IH). However, since most hemangiomas are treated for cosmetic reasons, it is important to know the cosmetic outcome assessed by the parents. OBJECTIVE: To evaluate the aesthetic outcomes of IH, considering the characteristics of the lesions and the treatments used. PATIENTS AND METHODS: The Spanish Infantile Hemangioma Nationwide Prospective Cohort (2016-2022) recruited all consecutive patients diagnosed with IH in 12 Spanish hospitals. The children included had 2 photos of the IH lesion (at both baseline and at the end of the study). A panel of parents blindly assessed all available photos using a scale from 0 (worst cosmetic outcomes) to 10 (best cosmetic outcomes). The different scores -both before and after treatment-as well as the outcomes percent considered excellent (> 9) were described and compared. We analyzed the effect of receiving different therapies and performed causal model analyses estimating the mean treatment effect of parents' assessments. RESULTS: The median follow-up was 3.1 years. A total of 824 photos were evaluated. Baseline aesthetic impact was higher in the propranolol group vs the topical timolol and observation treatment groups (1.85 vs 3.14 vs 3.66 respectively; p < 0.001). After treatment, the aesthetic impact was similar between both treatment groups (7.59 vs 7.93 vs 7.90; p > 0.2). The causal model could only be applied to the comparison between topical timolol and observation, revealing no differences whatsoever. CONCLUSION: This is the first prospective cohort to analyze the aesthetic outcome of IH. The final aesthetic results of the 3 therapies were similar, with nearly 40% of patients achieving excellent aesthetic outcomes.

Biological therapy, surgery, and hospitalization rates for inflammatory bowel disease: An observational Latin American comparative study between adults and pediatric patients.

OBJECTIVE: Compare the proportions of use of biological therapy, surgeries, and hospitalizations between adults and pediatric inflammatory bowel disease (IBD)-Crohn's disease (CD) and ulcerative colitis (UC)-patients. PATIENTS AND METHODS: Observational, retrospective, and multicenter study. Data were collected from all consecutive IBD patients seen as outpatients or admitted to hospital, during 2015-2021, in two IBD tertiary centers in a South Brazilian capital. Patients with unclassified colitis diagnosis were excluded from this study. Patients were classified as having CD or UC and sub-categorized as adult or pediatric according to age. Data were analyzed using frequency, proportion, Fisher's exact test, and Chi-square test. RESULTS: A total of 829 patients were included: 509 with CD (378 adults/131 pediatric) and 320 with UC (225/95). Among patients with CD, no differences were observed for proportions of use of biological therapy (80.2% in pediatric vs. 73.3% in adults; P=0.129), surgery (46.6% vs. 50.8%; P=0.419), or hospitalization (64.9% vs. 56.9%; P=0.122). In UC, significant differences were observed for biological therapy (40.0% vs. 28.0%; P=0.048) and hospitalization (47.4% vs. 24.0%; P<0.001). No significant difference was observed in surgery rates (17.9% vs. 12.4%; P=0.219). CONCLUSIONS: Biological therapy and incidence of hospitalization were greater among pediatric patients with UC, compared with adults; no difference was observed in the need for abdominal surgery. In CD, no significant difference was observed in the three main outcomes between the age groups.

Tofacitinib in the treatment of moderate to severe ulcerative colitis in Colombian pediatric patients: Real world experience. / Tofacitinib en el tratamiento de la colitis ulcerosa moderada a grave en pacientes pediátricos colombianos: experiencia en mundo real.

INTRODUCTION: There are no studies on efficacy of tofacitinib for moderate-severe ulcerative colitis (UC) in pediatric patients in Latin America. The aim of this study was to describe the efficacy and safety, in real world, treated with tofacitinib in our setting. MATERIALS AND METHODS: Case series of pediatric patients with UC who received treatment with tofacitinib in induction phase for 8 weeks and then maintenance therapy between November 2021 and February 2023. RESULTS: Four female patients, median age 14.5 (SD 2.1; RIQ 12.5-16.5) years, all with prior biologic exposure, all 4 with prior use of anti-TNF, and 2/4 with prior use of anti-integrin. Clinical, biochemical and endoscopic remission was obtained in 3/4 at induction. Information was obtained from 3 patients in 6-month maintenance, 2/3 remained in clinical, biochemical and endoscopic remission and 1/3 has not achieved biochemical or endoscopic remission. Information was obtained from 1 patient in 12-month maintenance, achieving clinical and biochemical remission, however, endoscopic remission has not been achieved. One patient was initiated for severe acute UC with risk of colectomy, with significant improvement after 7 days, reaching therapeutic objectives at induction. No serious adverse events were reported in any of the cases. CONCLUSIONS: Efficacy and safety are demonstrated with tofacitinib in pediatric patients. With high percentage of response in induction treatment, sustained over time, and safe. In the context of severe acute hospitalized UC, it has a role as a potential rescue therapy due to its rapid action.

[Primary pneumococcal peritonitis in a pediatric hospital from Argentina]. / Peritonitis primaria por neumococo en un hospital pediátrico de Argentina.

Pneumococcal peritonitis represents a small subset of patients suffering from invasive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

What Proportion of the Spanish Dermatology Caseload Corresponds to Pediatric Dermatoses? Results From the DIADERM National Random Sampling Survey. / ¿Cuánta carga asistencial suponen las dermatosis pediátricas en la actividad ambulatoria en la dermatología española? Resultados del muestreo aleatorio nacional DIADERM.

BACKGROUND: Visits for skin conditions are very common in pediatric primary care, and many of the patients seen in outpatient dermatology clinics are children or adolescents. Little, however, has been published about the true prevalence of these visits or about their characteristics. MATERIAL AND METHODS: Observational cross-sectional study of diagnoses made in outpatient dermatology clinics during 2 data-collection periods in the anonymous DIADERM National Random Survey of dermatologists across Spain. All entries with an International Classification of Diseases, Tenth Revision code related to dermatology in the 2 periods (84 diagnoses) were collected for patients younger than 18 years and classified into 14 categories to facilitate analysis and comparison. RESULTS: In total, the search found 20 097 diagnoses made in patients younger than 18 years (12% of all coded diagnoses in the DIADERM database). Viral infections, acne, and atopic dermatitis were the most common, accounting for 43.9% of all diagnoses. No significant differences were observed in the proportions of diagnoses in the respective caseloads of specialist vs. general dermatology clinics or public vs. private clinics. Seasonal differences in diagnoses (January vs. May) were also nonsignificant. CONCLUSIONS: Pediatric care accounts for a significant proportion of the dermatologist's caseload in Spain. Our findings are useful for identifying opportunities for improving communication and training in pediatric primary care and for designing training focused on the optimal treatment of acne and pigmented lesions (with instruction on basic dermoscopy use) in these settings.

Early relational health: Innovations in child health for promotion, screening, and research.

Relational experiences during infancy and early childhood are key drivers for building health, social emotional development, and learning capacities, each vital for wellbeing. The U.S. child health sectors share a commitment to universal health promotion, prevention and early intervention, and a growing enthusiasm for the research-affirmed primacy of caregiver-child interactions during the critical first 1000 days of life. Given our nation's growing children's mental health crisis, racial justice awakening and the need to reimagine equitable supports for young families post-COVID19, the child health sectors seek new tools and clinical approaches that blend science-to-practice innovations with co-developed activities that are meaningful to families. This special section brings together papers about a journey of co-discovery between researchers, clinicians, and parents during the development and refinement of new video- and interview-based dyadic relational screening and monitoring tools. The collection of papers addresses a range of topics including early relational health (ERH), development and validation of the Early Relational Health Screen, its application within research and clinical settings, and thoughtful discussions from multiple perspectives. Informed by the diversity informed tenets, this journey highlights not only science-informed approaches, but also co-development with families of equitable approaches to understanding and serving children and their caregivers.

Las experiencias en las relaciones durante la infancia y la temprana niñez son conductores claves para fortalecer la salud, el desarrollo socio-emocional y las capacidades de aprendizaje, todas las cuales son vitales para el bienestar. Los sectores de salud infantil en los Estados Unidos comparten un compromiso para promover globalmente la salud, la prevención y la temprana intervención, así como un creciente entusiasmo por la primacía de las interacciones entre quien presta el cuidado y el niño, tal como las reafirma la investigación, durante los críticos primeros mil días de vida. Dada la creciente crisis de salud mental infantil de nuestro país, el despertar de la justicia racial y la necesidad de volver a conceptualizar los apoyos equitativos para familias jóvenes después del Covid-19, los sectores de salud infantil, buscan nuevas herramientas y acercamientos clínicos que mezclan las innovaciones de la ciencia a la práctica con actividades desarrolladas en conjunto que resultan significativas para las familias. Esta sección especial presenta artículos acerca de una trayectoria de descubrimiento en conjunto entre investigadores, profesionales clínicos y padres durante el desarrollo y afinamiento de nuevas herramientas de detección y supervisión de la relación diádica basadas en videos y entrevistas. El grupo de artículos aborda un número de temas que incluyen la temprana saludable relación (ERH), el desarrollo y la validez de la Detección de la Temprana Saludable Relación, su aplicación dentro de los campos de la investigación y clínicos, así como sensatas discusiones a partir de múltiples perspectivas. Respaldada por principios basados en la diversidad, esta trayectoria subraya no sólo los acercamientos cuya información proviene de la ciencia, sino también el desarrollo en conjunto con familias de equitativos acercamientos para comprender y servirles a los niños y a quienes los cuidan.

Les expériences relationnelles le bas âge et la petite enfance sont des facteurs clés pour la construction de la santé, le développement socio-émotionnel et les capacités d'apprentissage, qui sont indispensables au bien-être. Les secteurs de la santé de l'enfant aux Etats-Unis d'Amérique partagent un engagement envers la promotion universelle de la santé, la prévention et l'intervention précoce, et un enthousiasme grandissant pour la primauté des interactions personne prenant soin de l'enfant-enfant, affirmée par les recherches, durant les 100 premiers jours critique de la vie. Au vu de la croissance de la crise de santé mentale des enfants dans notre pays, du réveil de la justice raciale et du besoin de réimaginer les soutiens équitables pour les jeunes familles après le Covid19, les secteurs de la santé mentale de l'enfant cherchent de nouveaux outils et des approches cliniques qui mélange des innovations science-à-pratique avec des activités élaborées conjointement qui sont utiles et ont un sens pour les familles. Cette section spéciale rassemble des articles sur un voyage de codécouverte entre des chercheurs, des cliniciens, et des parents durant le développement et le perfectionnement d'un nouveau dépistage relationnel dyadique à partir d'entretiens et de vidéos, et d'outils de suivi. Cette collection d'articles porte sur un éventail de sujets y compris la Santé Relationnelle Précoce (SRP), le développement et la validation du Dépistage de Santé Relationnelle Précoce, son application dans des contextes de recherche et dans des contextes cliniques, et des discussions attentionnées de perspectives multiples. Informé par des principes fondés sur la diversité, ce voyage met en évidence non seulement des approches scientifiques mais aussi des co-développements avec des familles d'approches équitables à la compréhension et au service des enfants ainsi que des personnes prenant soin d'eux.

[First report of diarrheagenic Escherichia coli in pediatric outpatient population with diarrhea in La Plata, Argentina]. / Primer reporte de Escherichia coli diarreogénica en población pediátrica ambulatoria con diarrea atendida en la ciudad de La Plata, Argentina.

Diarrheagenic Escherichia coli is a heterogeneous group of strains that presents various virulence factors and causes different diarrheal syndromes. The most studied pathotypes are enteropathogenic Escherichia coli (EPEC), enterotoxigenic Escherichia coli (ETEC), enteroaggregative Escherichia coli (EAEC), enteroinvasive Escherichia coli (EIEC) and Shiga toxin-producing Escherichia coli (STEC). The objective was to estimate the frequency of infection of diarrheagenic E. coli pathotypes in children with diarrhea, attended at the Sor María Ludovica Hospital in La Plata, Argentina, during the period May-October 2017. E. coli pathotypes were detected by molecular amplification of eight characteristic virulence genes. The feces of 211 children (76% under 5 years) were studied. Infection with diarrheagenic E. coli was detected in 12.3% of the samples. The pathotypes were EAEC (10.43%), ETEC (1.42%, all of them positive for thermolabile toxin), EPEC (0.95%) and STEC (0.47%, positive for Shiga toxin 2). The EAEC pathotype was prevalent in children of all age groups, while ETEC, EPEC and STEC were only observed in children under 5 years of age. This study constitutes the first report of diarrheagenic Escherichia coli detection in an outpatient pediatric population with diarrhea from La Plata, using molecular amplification techniques. Broader future studies, including the characterization of the isolates with the largest number of genes, asymptomatic controls, different times of the year and population from different geographic areas will be necessary to clarify the relevance of diarrheagenic E. coli infection in children from Argentina.

Individual and Dyadic Coping and Fear of Progression in Mothers and Fathers of Children with Hematologic Cancer.

This study investigated the association of individual and dyadic coping strategies with fear of progression (FoP) in mothers and fathers of children with hematologic cancer. Parental couples (N = 44) whose children had been diagnosed with hematologic cancer were recruited at a university hospital and a rehabilitation clinic in Germany between 03/2017 and 08/2017. Data included parents' self-report on FoP (Fear of Progression Questionnaire-parent version, FoP-Q-SF/PR), individual coping (Coping Health Inventory for Parents, CHIP-D), and dyadic coping (Dyadic Coping Inventory, DCI). Statistical analyses were carried out for mothers and fathers individually as well as for parental couples using dyadic data analyses (e.g., actor-partner interdependence model, APIM). Individual and dyadic coping strategies were significantly correlated with FoP in mothers, but not in fathers. Fathers' evaluation of the couple's dyadic coping significantly predicted mothers' FoP. The more frequent use of familial integration (CHIP-D FAM) and maintaining social support (CHIP-D SUP) as well as a better evaluation of their partners' dyadic coping was significantly associated with lower FoP in mothers. Differences in individual and dyadic coping in parental couples were not associated with FoP. Individual and dyadic coping strategies should be addressed in the psychosocial care of mothers and fathers of children with hematologic cancer. Study results support the benefits of involving fathers in psychosocial interventions, for example, in couple-based interventions that acknowledge interpersonal effects of coping on FoP. Future research should further explore coping strategies applied by fathers of children with hematologic cancer for the regulation of FoP.

Este estudio investigó la asociación de estrategias de afrontamiento individual y diádico con el miedo a la progresión (FoP por sus siglas en inglés) en madres y padres de niños con cáncer hematológico. Se reclutaron parejas de padres (N = 44) cuyos niños recibieron una diagnosis de cáncer hematológico en un hospital universitario y una clínica de rehabilitación en Alemania entre marzo de 2017 y agosto de 2017. Los datos incluyeron autoinformes de los padres sobre FoP (Cuestionario de miedo a la progresión, versión para padres, FoP-Q-SF/PR), afrontamiento individual (Inventario de salud de afrontamiento para padres, CHIP-D) y afrontamiento diádico (Inventario de afrontamiento diádico, DCI). Se realizaron análisis estadísticos para madres y padres de manera individual, así como para parejas de padres usando análisis de datos diádicos, (p.ej., Modelo de interdependencia actor-pareja, APIM). Las estrategias de afrontamiento individual y diádico tuvieron una correlación significativa con el FoP en las madres, pero no en los padres. La evaluación por los padres del afrontamiento diádico de la pareja predijo significativamente el FoP de las madres. El uso más frecuente de integración familiar (CHIP-D FAM) y mantenimiento de apoyo social (CHIP-D SUP), así como una mejor evaluación del afrontamiento diádico de sus parejas se asoció significativamente con un FoP más bajo en las madres. Las diferencias en el afrontamiento individual y diádico en parejas de padres no se asociaron al FoP. Las estrategias de afrontamiento individual y diádico deben ser enfrentadas durante el cuidado psicosocial de madres y padres de niños con cáncer hematológico. Los resultados del estudio respaldan los beneficios de involucrar a los padres en intervenciones psicosociales, es decir, en intervenciones basadas en parejas que reconocen los efectos interpersonales del afrontamiento en FoP. Investigaciones futuras deberán explorar más las estrategias de afrontamiento empleadas por los padres de niños con cáncer hematológico para regular el FoP.

[Epidemiological data description of pediatric patients with diarrhea by Aeromonas spp. and the antibiotic susceptibility of this agent]. / Descripción de datos clínico-epidemiológicos de pacientes pediátricos con diarrea por Aeromonas spp. y estudio de la sensibilidad antibiótica de dicho agente.

The aim of our study was to describe the epidemiological features of pediatric patients with diarrhea caused by Aeromonas spp. and to study the antibiotic susceptibility of this agent during a seven-year period. Aeromonas caviae was identified in 93 stool samples from 52.2% males and 85.6% patients younger than 36 months. The season with the lowest number of isolates was winter (14.4%). Co-infection with other diarrheagenic microorganisms was observed in 31.1% of the cases. The largest number of isolates was obtained from Emergency Department samples (45.6%); 43.3% of the patients presented with fever, 87.8% with diarrhea (43% of these cases were associated with pathological products) and 67.8% with vomiting, while 73.3% of the patients did not require hospital admission. Susceptibility higher than 87% was observed to trimethoprim-sulfamethoxazole, ciprofloxacin, cefotaxime and cefepime. All the patients overcame the infectious process and 63.3% of them did not receive any antibiotic treatment during the process. A. caviae was the isolated species associated with intestinal infection. Antibiotic treatment would be specifically indicated in cases selected for their clinical severity.

[ECoLaE: Validation of a questionnaire on breastfeeding knowledge and skills for Nursing]. / ECoLaE: validación de un cuestionario sobre conocimientos y habilidades en lactancia materna para enfermería.

OBJECTIVE: To validate the "Questionnaire on breastfeeding knowledge and skills" in Nurses (EcoLa). DESIGN: A validation study, with prior linguistic adaptation, according to the skills and training of the nurses. LOCATION: Cantabria. PARTICIPANTS: General nurses, paediatrics specialists, and midwives from the Cantabrian Health Service, with responsibility for mother-child care. MAIN MEASUREMENTS: The psychometric properties of the nursing version of ECoLa were evaluated. Internal consistency was measured using α-Cronbach for multiple choice and overall answer questions, and Kuder-Richardson's formula (KR20) for dichotomous response questions. Inter-observer concordance was measured using the kappa coefficient in items 18 and 21, and the test-retest reliability with 11 subjects using the intraclass correlation coefficient. RESULTS: The mean score in the questionnaire was 21.15±4.67 points. There were no statistically significant differences as regards the gender or number of children. There was an association between the score obtained in the questionnaire and previous experience in lactation, and with the professional profile (midwife 24.23 points, paediatric nurse 21.20 points, and general nurse 20 points; P<.01). The internal consistency showed a KR20 of 0.802, and the α-Cronbach for multiple-choice questions was 0.719, and 0.866 for overall. Interobserver concordance for Item 18 had a kappa=0.6, for item 30 kappa=0.825), and for total score the kappa=0.856). The test-retest reliability overall score (CCI=0.856, 95% CI 0.55-0.96), and for question 30 (CCI=0.93, 95% CI 0.75-0.98). CONCLUSIONS: The questionnaire scale has psychometric properties that make its use valid and reliable in the evaluation of the training of nursing professionals.

El doctor Eduardo Liceaga, pediatra.

Aun cuando se han escrito diversos trabajos acerca de la vida y obra del doctor Eduardo Liceaga, muy poco se menciona acerca de su actividad en el campo de la atención a la salud infantil. Al inicio de su actividad profesional, el doctor Liceaga mostró una inclinación por la atención de los niños enfermos. Preferentemente por los aspectos quirúrgicos, así lo señalan sus primeros trabajos, aunque después también se preocupó por otros temas relacionados con la infancia y, finalmente, por los asuntos sanitarios. El doctor Liceaga fue el médico responsable de la primera sala de niños enfermos que hubo en México en el Hospital de San Andrés, el primer director del Hospital de Infancia, autor de varias publicaciones sobre problemas pediátricos, introductor de la vacuna contra la rabia en México y creador del Hospital General.Although much has been written about Dr. Eduardo Liceaga's life and works, very little is mentioned about his activities in the field of children's healthcare. At the beginning of his professional activities Dr. Liceaga showed an inclination for the care of sick children. His preference for surgical matters is shown by his early works, although later he also took an interest in other childhood-related issues, and ultimately, in healthcare policies. Dr. Liceaga was the physician responsible for the first ward for sick children in Mexico at Hospital de San Andrés, first director of the Hospital de Infancia, and author of several publications on pediatric problems; he introduced the rabies vaccine in Mexico and was the founder of the Hospital General de México.

Association of leptin with cardiometabolic factors in schoolchildren and adolescents with congenital adrenal hyperplasia. / Asociación de leptina con factores cardiometabólicos en escolares y adolescentes con hiperplasia suprarrenal congénita.

Introduction: In congenital adrenal hyperplasia (CAH), obesity, hyperinsulinemia and leptin levels are increased. Objective: To identify the frequency of cardiometabolic risk factors (CRF) in children and adolescents with CAH and to explore the relationship with leptin levels. Method: Cross-sectional study of 40 patients who underwent anthropometric measurements and had fasting glucose, insulin, triglycerides, 17-hidroxyprogesterone, leptin, HDL and LDL-cholesterol assessed. The patients were classified according to the number of CRFs, and leptin levels were analyzed with the Kruskal-Wallis test. Pearson's correlation was applied between leptin, body mass index (BMI) z-score and body fat percentage. Results: Fifty percent of the patients had obesity and overweight, 59% had hypertriglyceridemia, 40%, hypoalphalipoproteinemia, 27.5%, high LDL-cholesterol and 22.5% insulin resistance. There was positive correlation between leptin and body fat percentage (r = 0.64), BMI z-score (r = 0.55) and the number of CRFs (r = 0.65). In the obesity-adjusted multivariate analysis, leptin levels were associated with the number of CRFs. Conclusion: CAH had a high frequency of CRFs and leptin appeared to be associated with a more adverse cardiometabolic profile in subjects with obesity and overweight.

Introducción: En la hiperplasia suprarrenal congénita (HSC), la obesidad, la hiperinsulinemia y los niveles de leptina se encuentran incrementados. Objetivo: Identificar la frecuencia de los factores de riesgo cardiometabólico (FRC) en niños y adolescentes con HSC y explorar la relación con los niveles de leptina. Método: Estudio transversal de 40 pacientes a quienes se realizó somatometría y evaluación de glucosa, insulina, triglicéridos, 17-hidroxiprogesterona, leptina, colesterol HDL y LDL en ayuno. Los pacientes fueron clasificados por el número de FRC y se analizaron los niveles de leptina con Kruskal-Wallis. Se aplicó correlación de Pearson entre la leptina, puntuación Z del índice de masa corporal (zIMC) y porcentaje de grasa corporal. Resultados: 50 % de los pacientes presentó obesidad y sobrepeso, 59 % hipertrigliceridemia, 40 % hipoalfalipoproteinemia, 27.5 % colesterol LDL alto y 22.5 % resistencia a la insulina. Hubo correlación positiva entre leptina y porcentaje de grasa corporal (r = 0.64), el zIMC (r = 0.55) y el número de FRC (r = 0.65). En el análisis multivariado ajustado por obesidad, los niveles de leptina se asociaron con el número de FRC. Conclusión: La HSC tuvo alta frecuencia de FRC y al parecer la leptina se asoció con perfil cardiometabólico más adverso en sujetos con obesidad y sobrepeso.

Effects of a minor surgery on health related quality of life in children from different perspectives / Efectos de una intervención quirúrgica menor sobre la calidad de vida en niños desde diferentes perspectivas.

Objective: To compare the health related quality of life (HRQoL) perceptions in parents and physician regarding the patient undergoing ambulatory surgery, and to analyse the evolution of HRQoL before and after the ambulatory surgery. Method: 36 patients underwent ambulatory surgical interventions taken part in this study. The questionnaires EQ-5D-Y were administered to the patients and questionnaires EQ-5D-Y proxy to parents and physicians. Variable TTO was used. Results: Statistical differences were found at baseline between answers of patients and physicians (p < 0.05). However, after surgery, answers of patients and proxies were similar. Conclusions: Paediatric patients undergone to a minor surgery improve HRQoL after the operation and this improvement goes on a month after the surgery.

Objetivo: Comparar la percepción de la calidad de vida relacionada con la salud (CVRS) de padres y médico con respecto al paciente en población infantil sometida a una intervención quirúrgica menor, y analizar la progresión de la CVRS tras un mes de someterse a la intervención. Método: Participaron 36 pacientes sometidos a intervenciones quirúrgicas menores. Se les administró el cuestionario EQ-5D-Y, y su versión proxy correspondiente a los padres y al médico. Se utilizó la variable TTO. Resultados: Los pacientes refirieron un peor estado de salud, sobre todo en la dimensión de preocupación/tristeza, que los médicos en el preoperatorio (p < 0.05), pero la percepción postoperatoria fue similar en pacientes y adultos, atribuible al efecto techo por buena salud postoperatoria. Conclusiones: Los pacientes pediátricos sometidos a cirugía menor mejoran su CVRS tras la intervención, y esta mejora se mantiene tras un mes de la cirugía.

Assessment of anaerobic blood cultures in pediatric oncology patients.

INTRODUCTION: The routine use of a single aerobic bottle for blood culture in pediatric patients has become commonplace, as anaerobic bacteria are not frequently involved in clinically significant infections. The aim of this study was to assess the usefulness of routinely performing anaerobic blood cultures in pediatric oncology patients. METHODS: Prospective study was conducted on pediatric (<18 years) patients affected with febrile syndrome after receiving chemotherapy for hematological or solid malignancies. Samples were inoculated into pediatric aerobic and standard anaerobic bottles (BacT/Alert automatic system). Strains were considered clinically significant, or deemed as contaminants, depending on isolation circumstances and clinical criteria. RESULTS: A total of 876 blood cultures from 228 patients were processed during the 21-month study period (January 2014 to September 2015). Baseline diagnosis included 143 solid tumors and 67/18 cases of leukemia/lymphoma. Bacterial growth was detected in 90 (10.2%) blood cultures for 95 different isolates, of which 62 (7.1%)/63 isolates were considered clinically significant. Among the latter, 38 (60.3%) microorganisms grew in both aerobic and anaerobic bottles, 18 (28.6%) only in aerobic bottles, and 7 (11.1%) only in anaerobic bottles. Gram-negative bacilli (33; 52.4%), mainly from the Enterobacteriaceae family, were the most frequently isolated microorganisms. Overall, only 3 out of 90 isolates (3.3%) were strict anaerobes (Propionibacterium acnes), and all of them were deemed contaminants. CONCLUSION: Strict anaerobes did not cause significant infections in febrile pediatric oncology patients, and anaerobic blood culture bottles offered no additional advantages over aerobic media. Our results suggest that routine blood cultures should be solely processed in aerobic media in this group of patients.

Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription.

INTRODUCTION: Information about paediatric in-hospital antimicrobial usage and prescribing patterns to guide improvement strategies is scant. We aim to use an evaluation of the prevalence and appropriateness of antimicrobial prescription to identify antimicrobial stewardship priorities in children. METHODS: A cross-sectional point study was performed on hospitalised paediatric patients in a Spanish tertiary hospital, assessing the prevalence of antimicrobial prescription (PAP) and appropriateness of antimicrobial prescription (AAP). AAP was defined as a correct indication plus an appropriate prescribing pattern (dose, spectrum and interval). Evaluation was performed using established antimicrobial guidelines. Other factors that may have a bearing on antimicrobial prescription were also analysed. RESULTS: A total of 171 patients were included. PAP was 49.7% (85/171) and AAP was 60.9% (91/161). The most common indications for antimicrobial use were antimicrobial prophylaxis (28.3%, 32/113) and pneumonia (8.2%, 8/113). Overall, 161 antimicrobials were prescribed (1.9 antimicrobials per patient): 55.3% (89/161) were empiric, 16.1% (26/161) were targeted and 28.6% (46/161) were prophylactic. Amoxicillin/clavulanate (8.2%, 14/171) and sulfamethoxazole/trimethoprim (8.2%, 14/171) were the most prescribed antimicrobials. The prescription of antifungals (11.7%, 20/171) and antivirals (1.8%, 3/171) was analysed. Major causes of inappropriate antibiotic use were prolonged prescriptions (21.7%, 35/161) and use of agents with an excessively broad coverage spectrum (21.1%, 34/161). PAP and AAP varied between wards and antimicrobials. CONCLUSIONS: Measurement of PAP and AAP offers valuable information for detecting priorities in hospital settings and monitoring antimicrobial usage prior to the development of antimicrobial stewardship programmes. In our setting, the main areas for improvement are duration of therapy and proper use of broad-spectrum antimicrobials.

ALL OUR SONS: THE DEVELOPMENTAL NEUROBIOLOGY AND NEUROENDOCRINOLOGY OF BOYS AT RISK.

Why are boys at risk? To address this question, I use the perspective of regulation theory to offer a model of the deeper psychoneurobiological mechanisms that underlie the vulnerability of the developing male. The central thesis of this work dictates that significant gender differences are seen between male and female social and emotional functions in the earliest stages of development, and that these result from not only differences in sex hormones and social experiences but also in rates of male and female brain maturation, specifically in the early developing right brain. I present interdisciplinary research which indicates that the stress-regulating circuits of the male brain mature more slowly than those of the female in the prenatal, perinatal, and postnatal critical periods, and that this differential structural maturation is reflected in normal gender differences in right-brain attachment functions. Due to this maturational delay, developing males also are more vulnerable over a longer period of time to stressors in the social environment (attachment trauma) and toxins in the physical environment (endocrine disruptors) that negatively impact right-brain development. In terms of differences in gender-related psychopathology, I describe the early developmental neuroendocrinological and neurobiological mechanisms that are involved in the increased vulnerability of males to autism, early onset schizophrenia, attention deficit hyperactivity disorder, and conduct disorders as well as the epigenetic mechanisms that can account for the recent widespread increase of these disorders in U.S. culture. I also offer a clinical formulation of early assessments of boys at risk, discuss the impact of early childcare on male psychopathogenesis, and end with a neurobiological model of optimal adult male socioemotional functions.

[Candidemia in Pediatrics: Species distribution and antifungal susceptibility]. / Candidemias en pediatría: distribución de especies y sensibilidad a los antifúngicos.

Serious infections caused by Candida yeasts are frequent in the hospital population. Due to differences in species distribution and antifungal susceptibility testing depending on the geographic area and the type of patient, it is important to study the epidemiology of each institution. For this purpose, we conducted a retrospective, descriptive study on the occurrence of candidemia in the Children's Hospital "Superiora Sor María Ludovica" of the city of La Plata. In a 6-year period (2010-2015), 177 candidemia episodes were recorded. The predominant species were Candida albicans (45%) and Candida parapsilosis (28%). The hospital wards with the highest number of candidemia episodes were the pediatric, neonatal and cardiovascular intensive care units (58%). No resistance to amphotericin B was observed throughout the period whereas resistance to azoles was limited to 4 strains of less frequent species.