A First Estimate of the Prevalence of Developmental Language Disorder in Mexico: A Retrospective Study.

This was a retrospective study that aimed to provide a first estimate of the prevalence of developmental language disorder (DLD) in Mexico, where there is currently a lack of epidemiological data on this disorder. Children aged 4;0 to 6;11 years in the cities of Mexico, Queretaro, and Monterrey were classified into two groups: those with DLD (N = 46) and those with typical language development (N = 497). The diagnosis of DLD was based on standardized norm-referenced assessment and language sample analyses. Children with other disabilities were excluded from the final sample. The final sample consisted of 543 children (55% male; 45% female) aged 4;0 to 6;11 years. The estimated prevalence of DLD was 8.5%. The study has clinical implications given that the prevalence of DLD in Mexico may raise awareness of this long-lasting disorder and may help health and educational authorities establish a system to early identify and diagnose children with DLD.

Chlamydophila pneumoniae-associated community-acquired pneumonia in paediatric patients of a tertiary care hospital in Mexico: molecular diagnostic and clinical insights.

Chlamydophila pneumoniae is a cause of community-acquired pneumonia (CAP) and responsible for 1-2% of cases in paediatric patients. In Mexico, information on this microorganism is limited. The aim of this study was to detect C. pneumoniae using two genomic targets in a real-time PCR and IgM/IgG serology assays in paediatric patients with CAP at a tertiary care hospital in Mexico City and to describe their clinical characteristics, radiological features, and outcomes. A total of 154 hospitalized patients with diagnosis of CAP were included. Detection of C. pneumoniae was performed by real-time PCR of the pst and arg genes. Complete blood cell count, C-reactive protein measurement and IgM and IgG detection were performed. Clinical-epidemiological and radiological data from the patients were collected. C. pneumoniae was detected in 25 patients (16%), of whom 88% had underlying disease (P = 0.014). Forty-eight percent of the cases occurred in spring, 36% in girls, and 40% in children older than 6 years. All patients had cough, and 88% had fever. Interstitial pattern on chest-X-ray was the most frequent (68%), consolidation was observed in 32% (P = 0.002). IgM was positive in 7% and IgG in 28.6%. Thirty-six percent presented complications. Four percent died. A high proportion showed co-infection with Mycoplasma pneumoniae (64%). This is the first clinical report of C. pneumoniae as a cause of CAP in Mexican paediatric patients, using two genomic target strategy and serology. We found a frequency of 16.2% with predominance in children under 6 years of age. In addition; cough and fever were the most common symptoms. Early detection of this pathogen allows timely initiation of specific antimicrobial therapy to reduce development of complications. This study is one of the few to describe the presence of C. pneumoniae in patients with underlying diseases.

Predictive validity of a parental questionnaire for identifying children with developmental language disorders.

Background: The underdiagnosis of developmental language disorder (DLD) in children is a serious problem in developing countries with limited resources. It has long been noted that the concerns parents have about their children's health and development are richly informative, and if this information can be used for diagnosis, it may provide a means to address the problem of underdiagnosis of DLD. This study aimed to quantify the utility of parental linguistic concern questions (PLCQ) on the identification of language disorders in monolingual Spanish-speaking children in Mexico. It also explored whether a combination of biological and environmental conditions questions (BECQ) might improve the performance of a screening test to identify DLD. Methods: A total of 680 monolingual Mexican Spanish-speaking children and their parents from urban areas in Mexico participated in the study. The distribution of responses to questions about DLD concerns was compared between 185 children diagnosed with DLD and 495 control subjects, and multiple logistic regression analysis was performed to select questions with high predictivity, based on the Akaike information criterion. The diagnostic utility of the questions was assessed by receiver operating characteristic (ROC) curves, stratum-specific likelihood ratios (SSLRs), and changes in pretest and post-test probabilities of DLD. A similar procedure was used to explore whether adding BECQ would improve the diagnostic utility of questions about DLD concerns using data of 128 children. Results: Four questions regarding parental linguistic concerns were found to be useful in identifying children with DLD. When all four concerns were present, the SSLR was 8.79, while it was only 0.27 when there were no concerns at all. The estimates of DLD probability increased from 0.12 to 0.55 at pretest and post-test. On the other hand, the BECQ did not perform as well as the PLCQ in identifying DLD, and the improvement in diagnostic performance it provided was limited to one question. Conclusion: The parental questionnaire can be used as a screening tool to help in identifying children with DLD. The data presented in this study underscore the importance of considering linguistic parental concerns as part of the screening process. This is a realistic option to provide a solution to the current problem of underdiagnosis of DLD in Mexico.

"Early detection of Spanish-speaking children with developmental language disorders: Concurrent validity of a short questionnaire and a screening test".

BACKGROUND: . Under-identification of Developmental Language Disorder (DLD) is a significant problem in monolingual Latin American Spanish-speaking children. We evaluated the identification utility of the sequential use of two screening tools, the "Parental Questionnaire (PQ)" and the "Screening for Language Problems (TPL)", to identify children who require confirmatory diagnosis of DLD. METHODS: Parents of children (4 to 6 years) were contacted in schools and public health centers in Mexico. Monolingual Spanish-speaking children with no auditory and cognitive disorders were eligible. The reference diagnosis of DLD was established using BESA (Bilingual English-Spanish Assessment) or SCELF-4 (Spanish Clinical Evaluation of Language Fundamentals), combined with data from the narrative samples that yielded the percentage of ungrammaticality and the clinical judgment of two Speech-Language Pathologists (SLPs). Responses to the PQ were obtained as a parental report, and the TPL was applied by a trained SLPs. RESULTS: . Both PQ and TPL presented a significant difference between the groups of children with DLD and typical language development (TLD). By combining the two instruments, a notable improvement in diagnostic utility was shown. CONCLUSION: . The combination of these two procedures provides an efficient method for screening children having the risk of DLD and contributes to resolving the problem of under-identification.

Efficacy and Safety of Interferon-Gamma in Chronic Granulomatous Disease: a Systematic Review and Meta-analysis.

BACKGROUND: Chronic granulomatous disease (CGD) is a primary immunodeficiency with increased susceptibility to several bacteria, fungi, and mycobacteria, caused by defective or null superoxide production by the NADPH oxidase enzymatic complex. Accepted treatment consists mainly of antimicrobial prophylaxis. The role of human recombinant subcutaneous interferon-gamma (IFNγ) is less clear since the available evidence on its efficacy derives mainly from a single clinical trial that has been challenged. OBJECTIVE: We aimed to assess the efficacy and safety of IFNγ as an added treatment for CGD when compared to antimicrobial prophylaxis alone. METHODS: A literature search was conducted using MeSH terms "Chronic granulomatous disease" AND ("interferon gamma" OR "interferon-gamma"), as well as antibiotics, placebo, no therapy, clinical trial, and trial, on MEDLINE, EMBASE, LILACS, WHOs, CENTRAL, KOREAMED, The Cochrane Library, clinicaltrials.gov, and abstracts from meetings, from 1976 to July 2022. We included clinical trials (CT) and prospective follow-up studies and registered the number of serious infections (requiring hospitalization and IV antibiotics) and deaths, adverse events, and autoimmune complications, in patients treated for CGD with antimicrobial prophylaxis plus IFN-γ, versus antimicrobial prophylaxis alone. We assessed the quality of the studies using risk of bias and STROBE. We performed a meta-analysis by calculating both Peto's odds ratio (OR) and risk reduction (RR) through the Mantel-Haenszel method with a fixed-effect model, using Review Manager 5.4, and we reported the number needed to treat (NNT). RESULTS: We identified 54 matches from databases and 4 from other sources. We excluded 12 duplicates, 7 titles, and 9 abstracts for relevance, after which we had 30 eligible studies. Twenty-four were then excluded after reading the full text. Six papers were included: one randomized CT and 5 follow-up studies. In total, 324 patients with Chronic granulomatous disease were followed for 319 months under treatment with antibiotic prophylaxis plus interferon-gamma or placebo (or antibiotic prophylaxis alone), reported between the years 1991 and 2016. Three of the studies included a control group, allowing for the aggregate analysis of efficacy (prevention of serious infections). The aggregate OR was 0.49, with a 95% confidence interval of 0.19 to 1.23. The risk ratio for serious infection was 0.56 (95%CI 0.35-0.90) under IFN-γ. The meta-analysis thus favors interferon-gamma for a risk reduction of serious infection. DISCUSSION: The results from this meta-analysis support the use of IFN-γ in the treatment of patients with CGD. However, we found insufficient clinical evidence and believe more clinical trials are needed to better assess the efficacy and long-term safety of IFN-γ.

Activating de novo monoallelic variants causing inborn errors of immunity in two unrelated children born of HIV-seroconcordant couples.

INTRODUCTION: Around 20% of all inborn errors of immunity (IEI) are autosomal dominant or monoallelic, either by haploinsufficiency, negative dominance, or gain of function (GOF). GOF phenotypes usually include autoinflammation, autoimmunity, lymphoproliferation, allergies, and some infections. CASE SERIES: We describe the cases of two unrelated patients born of HIV-seroconcordant parents. Both patients are HIV-negative but carry de novo GOF missense variants that resulted in inflammatory lymphoproliferative IEI diseases: signal transducer and activator of transcription 3 (STAT3)-GOF and phosphatidylinositol 3-kinase, catalytic delta (PIK3CD)-GOF. Both variants were found through whole-exome sequencing and confirmed by Sanger.An 11-year-old male with recurrent sinopulmonary infections, dysmorphism, growth delay, bronchiectasis, and mild mental retardation, as well as lymphopenia, thrombocytopenia, and high immunoglobulin M. Both his parents were known to be HIV-positive under anti-retroviral treatment. HIV infection was repeatedly ruled out in the patient, whom through whole-exome sequencing was found to have a heterozygous missense variant in exon 24 of PIK3CD, a hotspot transition, and the most reported variant in PIK3CD-GOF patients.A 6-year-old male with autoimmune hemolytic anemia, lymphoproliferation, short stature, and intractable diarrhea. Both his parents were found to be HIV-positive. HIV was repeatedly ruled out in the patient by ELISA and viral load. He was found to have a heterozygous missense/splice variant in exon 22 of STAT3, a hotspot transition, and the most reported variant in STAT3-GOF patients. DISCUSSION: The AID/APOBEC3 A-H family of proteins are cytidine deaminases that induce G>A hypermutation in both the invading viral DNA and the host genome, which results in stop codons inside the endogenized retroviral sequence. Both variants found in our patients are G to A transitions. Retroviral infection might thus have resulted in host genome instability, and our patients' rare congenital diseases are the unfortunate consequence of somatic hypermutation in one of their parents' gametes.

Association between brain natriuretic peptide and cardiac dysfunction in hypertensive pregnancy disorders.

OBJECTIVE: The aim of this work is to identify the correlation between serum brain natriuretic peptide (BNP) and left ventricle (LV) systolic and diastolic function in hypertensive pregnancy disorders (HPD) through echocardiographic parameters. STUDY DESIGN: Eighty-seven pregnant patients were included, 23 with normotensive pregnancy (NP), 28 with gestational hypertension (GH) and 36 with preeclampsia (PE). Conventional 2D echocardiography was used to evaluate systolic and diastolic function such as E/a, E/e', LV mass index, LV ejection fraction, as well as left atria (LA) diameters, LA indexed volume, LV strain and LA strain (LAS). Brain natriuretic levels (BNP) blood levels were also determined. MAIN OUTCOME MEASURES: The serum levels of BNP were higher in patients with PE [median (interquartile range, IQR)] 189 (142-215) pg/ml and GH 105 (46-162) pg/ml compared to NP 23 (9-33) pg/ml, (p = 0.001). BNP levels had a negative correlation with LAS (Rho = -0.79, p < 0.001). Preeclampsia patients had lower LAS [median (IQR)] 22% (20%-24%) compared to the GH group 23% (20%-24%) and NP 35% (34% -35%), p = 0.001. Classification and Regression Trees multivariate analysis found patterns that define trends to form mutually excluding homogeneous groups such as: a) First parameter that separates 2 groups is septal e > 8.2 or < 8.2b), BNP serum levels above 89 pg/ml, and c) LAS increases the discriminatory performance to detect and define the diastolic dysfunction or not. CONCLUSIONS: At least one third of women with HPD had moderate diastolic dysfunction. The degree of diastolic dysfunction was negatively correlated with serum BNP levels and severity of HPD. LAS increase discriminatory performance to identify diastolic dysfunction in HPD.

Birth order, stimulating environment, and maternal factors in developmental outcomes: A longitudinal Mexican study.

This study longitudinally examined the interplay between birth-order and well-known risk factors in impoverished environments such as inadequate environmental stimulation, low maternal education, and young maternal age in children from birth to 36 months. In the developmental motor domain, the effect of the stimulating environment over time, favored first-borns. In the adaptive domain, maternal education privileged first-born boys. In language development, first-borns reached higher scores over time than laterborn identifying a positive impact of stimulation. In the personal-social domain, firstborns obtained higher averages overall, but stratified models revealed that later-borns reached the first-borns scores as maternal age increased.

Analgesia postoperatoria para craneotomías en pediatría: experiencia en un Hospital de Tercer Nivel / Postoperative analgesia for craniotomies in pediatrics: experience in a Third Level Hospital

Resumen: Introducción: Existe la creencia de que los pacientes no experimentan dolor intenso después de cirugía intracraneal. La estimulación simpática secundaria a dolor puede ocasionar hipertensión intracraneal y sangrado postoperatorio. Es controvertido el uso de opioides para analgesia postcraneotomías por temor a sus efectos colaterales que pueden enmascarar signos de alteración neurológica. En pediatría hay estudios limitados. Objetivo: Describir el nivel de control del dolor postcraneotomías al usar buprenorfina ketorolaco y ondansetrón en pacientes pediátricos. Métodos: Estudio de cohorte descriptivo. Incluimos niños de 0-17 años programados para cirugía intracraneal electiva. Para el control del dolor se administró buprenorfina, ketorolaco y ondansetrón en infusión por 30 horas. Se investigó dolor al iniciar la infusión a las cuatro, ocho, 12, 24 y 30 horas; variables hemodinámicas y grado de sedación. Resultados: 109 pacientes fueron incluidos. Se observó adecuado control del dolor en 71.56%, 28.4% tuvo control insuficiente con una diferencia estadísticamente significativa (p < 0.001). Hubo sedación moderada en 5.6% iniciando la infusión y a las 24 horas (4.5%) sin repercusión hemodinámica. Se detectó náusea en 8.2% y vómito en 6.64%; no se presentó sedación profunda, ni depresión respiratoria. Conclusiones: Estos hallazgos sugieren que es una opción efectiva para tratar el dolor postcraneotomías en pediatría.

Abstract: Introduction: There is still a belief that patients do not experience intense pain after intracranial surgery. Sympathetic stimulation associated with pain can lead to elevated intracranial pressure and postoperative haemorrhage. There is controversy about the use of opioids for postoperative analgesia in craniotomies, owing to fear of its side effects, which can mask signs of neurological alteration. There are limited studies in the pediatric patient for post-craniotomy analgesia. Objective: To describe the postcraneotomies pain control level, using buprenorphine in partnership with ketorolac and ondansetron in pediatric patients. Methods: Descriptive cohort study. For postoperative pain control, patients were given continuous infusion buprenorphine, ketorolac and ondansetron for 30 hours. The main variables to investigate were pain at beginning of infusion, at four, eight, 12, 24 and 30 hours, hemodynamic variables and depth of sedation. Results: 109 patients were included. Adequate control of pain was observed in 71.56% of patients, whereas in 28.4% insufficient control was found, with a statistically significant difference (p < 0.001). There was moderate sedation in 5.6% of the patients at the start of infusion and at 24 hours (4.5%), without significant impact on hemodynamic variables. Nausea was found in 8.2% and vomiting in 6.64%. No deep sedation, or respiratory depression was presented. Conclusions: These findings suggest that is an effective option to treat postcraneotomy pain in pediatric patients.

Kawasaki disease presenting with hoarseness: A multinational study of the REKAMLATINA network.

BACKGROUND: Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki disease (KD). The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS: We used prospective data from the multinational Red de Enfermedad de Kawasaki en America Latina (REKAMLATINA) network. A total of 865 patients from 20 countries were enrolled during the 3 year study period. Data on hoarseness were available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS: Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger than those with KD without hoarseness (median age 18 vs 26 months; P = 0.002) and presented with lower hemoglobin (10.7 g/dL vs 11.3 g/dL; P = 0.040) and hematocrit levels (32% vs 33%, P = 0.048). CONCLUSIONS: Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.

Delivery mode-associated gut microbiota in the first 3 months of life in a country with high obesity rates: A descriptive study.

Delivery methods during childbirth and their related gut microbiota profiles have important impacts on health later in life, they can contribute to the development of diseases such as obesity, whose highest prevalence rate is found among the Mexican child population. Coincidentally, Mexico has one of the highest global average annual rate increase in cesarean births (C-section). Since Mexico leads the world in childhood obesity, studying the relationship between childbirth delivery methods and gut microbiota profiles in this vulnerable population may be used to identify early risk factors for obesity in other developed and developing countries. The objective of this study is to determine the association between child delivery method and gut microbiota profiles in healthy Mexican newborns.Fecal samples of 57 term infants who participated in a randomized clinical trial in 2013 to study the safety of Agave fructans in newborns, were used in this study. DNA samples were extracted and used to characterize the microbiota composition using high-throughput 16S rRNA gene sequencing. The samples were further divided based on childbirth delivery method, as well as early diet. Gut microbiota profiles were determined and analyzed using cluster analysis followed by multiple correspondence analysis.An unusual high abundance of Proteobacteria was found in the gut microbiota of all Mexican infants studied, regardless of delivery method. Feces from infants born by C-section had low levels of Bacteroidetes, high levels of Firmicutes, especially Clostridium and Enterococcus, and a strikingly high ratio of Firmicutes/Bacteroidetes (F:B). Profiles enriched in Bacteroidetes and low F:B ratios, were strongly associated with vaginal delivery.The profile of gut microbiota associated with feces from Mexican infants born by C-section, may be added to the list of boosting factors for the worrying obesity epidemic in Mexico.

Protein-conformational diseases in childhood: Naturally-occurring hIAPP amyloid-oligomers and early ß-cell damage in obesity and diabetes.

BACKGROUND AND AIMS: This is the first time that obesity and diabetes mellitus (DM) as protein conformational diseases (PCD) are reported in children and they are typically diagnosed too late, when ß-cell damage is evident. Here we wanted to investigate the level of naturally-ocurring or real (not synthetic) oligomeric aggregates of the human islet amyloid polypeptide (hIAPP) that we called RIAO in sera of pediatric patients with obesity and diabetes. We aimed to reduce the gap between basic biomedical research, clinical practice-health decision making and to explore whether RIAO work as a potential biomarker of early ß-cell damage. MATERIALS AND METHODS: We performed a multicentric collaborative, cross-sectional, analytical, ambispective and blinded study; the RIAO from pretreated samples (PTS) of sera of 146 pediatric patients with obesity or DM and 16 healthy children, were isolated, measured by sound indirect ELISA with novel anti-hIAPP cytotoxic oligomers polyclonal antibody (MEX1). We carried out morphological and functional studied and cluster-clinical data driven analysis. RESULTS: We demonstrated by western blot, Transmission Electron Microscopy and cell viability experiments that RIAO circulate in the blood and can be measured by ELISA; are elevated in serum of childhood obesity and diabetes; are neurotoxics and works as biomarkers of early ß-cell failure. We explored the range of evidence-based medicine clusters that included the RIAO level, which allowed us to classify and stratify the obesity patients with high cardiometabolic risk. CONCLUSIONS: RIAO level increases as the number of complications rises; RIAOs > 3.35 µg/ml is a predictor of changes in the current indicators of ß-cell damage. We proposed a novel physio-pathological pathway and shows that PCD affect not only elderly patients but also children. Here we reduced the gap between basic biomedical research, clinical practice and health decision making.

The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis.

There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.

Are apoptosis-determining techniques useful to establish an early diagnosis of acute graft-vs-host disease in pediatric patients under treatment with multiple drugs?

BACKGROUND: There are no pathognomonic histopathological features to distinguish acute graft-vs-host disease (aGVHD) from skin drug reactions (SDRs) in pediatric patients with multiple drug regimens that have received blood transfusions and/or transplants. We aimed to determine if the addition of apoptosis markers is helpful to distinguish aGVHD from SDRs in these patients. METHODS: Skin biopsy specimens from patients with a clinical diagnosis of aGVHD or SDRs were evaluated for the presence of apoptotic bodies, satellitosis, interface damage, vasculitis, and inflammatory infiltrate on H&E stain. Information was completed with apoptotic markers (transferase-mediated dUTP nick end-labeling [TUNEL], bcl-2, and caspase-3). RESULTS: The skin biopsy specimens of 32 patients with aGVHD and 11 with SDRs were included for study. Only the number of apoptotic keratinocytes per 10 high-power fields (hpf) showed a significant difference between both groups (P = 0.02); the presence of ≥4 apoptotic keratinocytes per 10 hpf was identified as the optimal cut-off point to discriminate aGVHD from SDRs. No SDRs cases had follicular apoptotic cells. TUNEL, bcl-2, and caspase-3 determination showed no difference between both groups. CONCLUSIONS: The presence of ≥4 apoptotic keratinocytes per 10 hpf (in aGVHD) and the absence of follicular apoptotic cells (in SDRs) might be a useful marker to distinguish between them.

IgA vasculitis (Henoch - Schönlein Purpura) as the first manifestation of juvenile Systemic Lupus Erythematosus: Case-control study and systematic review.

BACKGROUND: We have recognized 15 children with jSLE and the antecedent of IgA vasculitis (HSP). This association is not broadly present in the literature. AIM: To know the age and gender distribution of children with IgA vasculitis (HSP), compare it to our IgA vasculitis (HSP) + jSLE cases, and identify prognostic factors to develop jSLE within our case series, IgA vasculitis (HSP) vs. IgA vasculitis (HSP) + jSLE. METHODS: A systematic review was carried out to know the age and gender distribution of children with IgA vasculitis (HSP). The information obtained plus data from 110 children with IgA vasculitis (HSP) from the Instituto Nacional de Pediatría were used to compare groups and identify prognostic factors. We performed a case-control study in patients < 18 years, consisting of 15 cases retrospectively identified with IgA vasculitis (HSP) + jSLE, and 110 IgA vasculitis (HSP) control subjects. RESULTS: The information of 12,819 IgA vasculitis (HSP) subjects from the systematic review and 110 IgA vasculitis (HSP) controls was obtained and compared to our 15 IgA vasculitis (HSP) + jSLE cases. The mean age of IgA vasculitis (HSP) was 7.1-years vs. 10.4-years of IgA vasculitis (HSP) + jSLE at the HSP diagnosis. Female to male ratio of IgA vasculitis (HSP) was 1:1.33 vs. 1:0.25 of IgA vasculitis (HSP) + jSLE. Patients with IgA vasculitis (HSP) + jSLE had lower levels of Hemoglobin (Hb) compared to patients with IgA vasculitis (HSP) 109 g/L vs. 141 g/L. For the development of jSLE, we found older age and lower levels of Hb as prognostic factors with OR [95% CI]: 1.37 [1.06, 1.89] and 5.39 [2.69, 15.25], respectively. CONCLUSION: IgA vasculitis (HSP) + jSLE patients are older and have lower levels of Hb than patients with IgA vasculitis (HSP). It is necessary to confirm these findings through a prospective study.

Modification of Alvarado score with pain semiology for the diagnosis of acute appendicitis.

BACKGROUND: Acute appendicitis is the most frequent surgical pathology in the emergency services. It affects approximately 9% of the population. Its differential diagnosis is extremely difficult especially in the elderly, children and women of childbearing age. The Alvarado score (AS) is a useful tool for suspected diagnosis of appendicitis. Our experience suggests the possibility of improving the diagnostic performance of this scale by including pain semiology. OBJECTIVE: To compare the diagnostic utility of AS with and without including pain semiology used in the general surgery service of the high specialty naval hospital, as well as to identify fewer useful variables for the diagnosis. METHOD: The files of all the patients operated for the suspicion of acute appendicitis from March 2015 to March of the year 2017 were reviewed. The included patients have complete file and histopathological report. For each patient, diagnosis of appendicitis was established with the application of the AS and another, adding the pain semiology, and the result was contrasted with the histopathological diagnosis. The parameters of diagnostic utility were estimated, based on the cut points determined by the logistic regression model and the ROC curves. RESULTS: AS modified with pain semiology showed greater diagnostic utility than the original scale. Six variables were also identified with a satisfactory performance. CONCLUSION: Pain semiology can improve the diagnostic utility of the current AS.

ANTECEDENTES: La apendicitis aguda es la patología quirúrgica más frecuente en los servicios de urgencias. Afecta ­aproximadamente al 9% de la población. Su diagnóstico diferencial es en extremo difícil, en especial en ancianos, niños y mujeres en edad fértil. La escala de Alvarado (EA) es una herramienta útil para la sospecha diagnóstica de apendicitis. Nuestra experiencia sugiere la posibilidad de mejorar el desempeño diagnóstico de esta escala al incluir la semiología del dolor. OBJETIVO: Comparar la utilidad diagnóstica de la EA con y sin incluir semiología del dolor utilizada en el Servicio de Cirugía General del Hospital General Naval de Alta Especialidad, así como identificar el menor número de variables útiles para el diagnóstico. MÉTODO: Fueron revisados los expedientes de todos los pacientes operados por sospecha de apendicitis aguda de marzo de 2015 a marzo de 2017. Los pacientes incluidos cuentan con expediente completo y reporte histopatológico. Para cada paciente se establecieron el diagnóstico de apendicitis con la aplicación de la EA y agregando la semiología del dolor, y se contrastó el resultado con el diagnóstico histopatológico. Se estimaron los parámetros de utilidad diagnóstica de acuerdo con los puntos de corte determinados por el modelo de regresión logística y las curvas ROC. RESULTADOS: La EA modificada con semiología del dolor mostró una mayor utilidad diagnóstica que la escala original. Se identificaron, además, seis variables con un rendimiento satisfactorio. CONCLUSIÓN: La semiología del dolor puede mejorar la utilidad diagnóstica de la actual EA.

Expression of ZNF695 Transcript Variants in Childhood B-Cell Acute Lymphoblastic Leukemia.

B-cell acute lymphoblastic leukemia is the most commonly diagnosed childhood malignancy worldwide; more than 50% of these cases are diagnosed in Mexico. Although the five-year survival rate is >80%, 30% of patients experience relapse with poor prognosis. Cancer-associated gene expression profiles have been identified in several malignancies, and some transcripts have been used to predict disease prognosis. The human transcriptome is incompletely elucidated; moreover, more than 80% of transcripts can be processed via alternative splicing (AS), which increases transcript and protein diversity. The human transcriptome is divided; coding RNA accounts for 2%, and the remaining 98% is noncoding RNA. Noncoding RNA can undergo AS, promoting the diversity of noncoding transcripts. We designed specific primers to amplify previously reported alternative transcript variants of ZNF695 and showed that six ZNF695 transcript variants are co-expressed in cancer cell lines. The amplicons were sequenced and identified. Additionally, we analyzed the expression of these six transcript variants in bone marrow from B-cell acute lymphoblastic leukemia patients and observed that ZNF695 transcript variants one and three were the predominant variants expressed in leukemia. Moreover, our results showed the co-expression of coding and long noncoding RNA. Finally, we observed that long noncoding RNA ZNF695 expression predicted survival rates.

Detection of Mycoplasma pneumoniae in Mexican children with community-acquired pneumonia: experience in a tertiary care hospital.

Purpose: Mycoplasma pneumoniae is an important cause of community-acquired pneumonia (CAP). Information on the prevalence of M. pneumoniae in pediatric patients with CAP in Mexico is limited. The aim of this study was to detect M. pneumoniae in hospitalized pediatric patients with CAP. Patients and methods: We performed a descriptive study in a tertiary-level pediatric reference center, obtaining 154 respiratory samples from patients under 18 years of age and diagnosed with CAP. M. pneumoniae was detected by real-time polymerase chain reaction (PCR) targeting the p1 and CARDS genes. Complete blood cell count, measurement of C-reactive protein and detection of IgM and IgG anti-P1 were performed. Clinical, epidemiological and radiological data of the patients were analyzed. Results: M. pneumoniae was detected by real-time PCR in 26.6% of the samples. 39% of the cases occurred during the spring season. A total of 83% of the patients with M. pneumoniae had some underlying disease; renal disease, autoimmune disease and primary immunodeficiencies had a significant association with M. pneumoniae CAP. Children under 6 years of age represented 53.7% of the cases. Fever and cough were the most frequent symptoms. IgM and IgG were positive in 1.9% and 14% of the patients, respectively. In the chest X-ray, 17.1% of the patients showed multifocal alveolar infiltrates pattern. The complications in this series were 26.8%. The mortality in this study was 4.9%. Conclusion: This is the first report in Mexico about M. pneumoniae as a causal agent of CAP in a tertiary care pediatric hospital using real-time PCR and serology. M. pneumoniae was responsible for 26.6% of the cases and was frequent in children under 6 years of age. In addition, we described the clinical presentation in patients with underlying diseases.

Impact factor correlations with Scimago Journal Rank, Source Normalized Impact per Paper, Eigenfactor Score, and the CiteScore in Radiology, Nuclear Medicine & Medical Imaging journals.

INTRODUCTION: In the last decade, several journal's editors decided to publish alternative bibliometric indices parallel to the impact factor (IF): Scimago Journal Rank (SJR), Source Normalized Impact per Paper (SNIP), Eigenfactor Score (ES) and CiteScore™ (CiteScore); however, there is scarce information about the correlations among them. In this study, we aimed to evaluate the associations between this bibliometrics in the Radiology, Nuclear Medicine & Medical Imaging category of the Web of Knowledge. We hypothesized the IF did not show the best correlation with other metrics. METHODS: Retrospective study. We used bibliometrics recorded from the 2017 publicly available versions of the Journal Citation Reports (JCR), SJR ( www.scimagojr.com ), SNIP ( www.journalindicators.com ), and CiteScore ( www.scopus.com ); we also included the Total Cites. We measured the correlations using the Spearman correlation coefficients (RS) for all combinations of the bivariate pair, performed pairwise comparisons of the RS values, and calculated the coefficients of determination. We also tested the statistical significance of the difference between r coefficients between groups. All analyses were conducted with the JMP Pro software. RESULTS: The stronger bivariate correlations were represented by the ES↔Total Cites RS = 0.968, p < 0.001, R2 = 0.937; and the CiteScore↔SJR RS = 0.911, p < 0.001, R2 = 0.829. From 105 possible combinations of pairwise comparisons, 38 depicted a p value > 0.050 which would suggest interchangeability among bivariate correlations. CONCLUSIONS: Our findings support our hypothesis that the IF does not show the best correlation between other metrics. Radiologists, interventional radiologist, or nuclear medicine doctors should have a clear understanding of the associations among the journal's bibliometrics for their decision-making during the manuscript submission phase.

IgG levels in Kawasaki disease and its association with clinical outcomes.

Previous studies have suggested an association of IgG levels (before and after IVIG infusion) with clinical outcomes in Kawasaki disease. A retrospective analysis was performed that included 418 patients with KD admitted to Tokyo Women's Medical University Yachiyo Medical Center to evaluate pre- and post-IVIG IgG levels and its relation to outcomes. All patients received an initial IVIG infusion and aspirin; IgG levels were measured in 350 patients before IVIG (pre-IVIG IgG levels) and in 373 patients 48 h after starting IVIG infusion (post-IVIG IgG levels). Media and standard deviation of the pre- and post-IVIG IgG levels were reported and classified according to age. Also, IgG z-scores were calculated according to normal values of IgG by age. The number of cases and corresponding percentage of non-responders were reported by age and total patients. The association of pre-IVIG, post-IVIG IgG levels and post-IVIG IgG level/pre-IVIG IgG level ratio with no-response was evaluated by simple logistic regression model based on the IgG z-score, and regression coefficient, X2 value, p, and R2 of Nagelkerke were reported. Pre-IVIG and post-IVIG IgG levels presented an association with non-responders with statistical significance. This association was more evident between post-IVIG IgG levels and non-responders. Regarding coronary alterations, it was not possible to perform an adequate statistical analysis due the small number of patients. Pre- and post-IVIG infusion IgG levels could be an important biomarker in KD as well as in other inflammatory conditions. Higher IgG levels could be associated with a more effective immunomodulatory action and associated with better clinical outcomes.