ABSTRACT
INTRODUCTION: It has been suggested that the social isolation due to the coronavirus disease 2019 (COVID-19) may increase the incidence of child and adolescent sexual abuse (CASA). OBJECTIVE: To compare the incidence and characteristics of medical consultations made to the Department of Gynecology due to CASA before and during the COVID-19 pandemic. MATERIAL AND METHODS: Descriptive, observational, and comparative study about suspected CASA events occurred during the COVID-19 pandemic compared to those occurred in the previous year at a tertiary care children's hospital. RESULTS: One hundred and twenty-two medical consultations due to suspected CASA were recorded; 78 before and 44 during the pandemic. In both groups, the most common reason for consultation at the hospital was an account of CASA and, at the Department of Gynecology in particular, the external genitalia examination. Most subjects had a normal physical examination. There was a higher prevalence of STI in the pandemic group. In addition, there were also more hospitalizations and police reports for victims protection in this group. The abuser was known to the victim in almost 90% of cases in both groups. CONCLUSIONS: During the pandemic, the total number of medical consultations to the Department of Gynecology decreased so the percentage of those due to suspected CASA was higher. However, the presence of severe lesions, STIs or pregnancy did not change.
Introducción. Se ha postulado que el aislamiento social debido a la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) aumentaría la incidencia de abuso sexual infantojuvenil (ASIJ). OBJETIVO: Comparar la incidencia y las características de las consultas realizadas en Ginecología en relación con ASIJ antes y durante la pandemia de COVID-19. Materiales y métodos. Se realizó un estudio descriptivo, observacional y comparativo entre las situaciones de sospecha de ASIJ ocurridas durante la pandemia de COVID-19 en relación con las del mismo período del año previo en un hospital pediátrico de alta complejidad. RESULTADOS: Se consignaron 122 consultas por sospecha de ASIJ, 78 en el período previo a la pandemia y 44 en la pandemia. El motivo de consulta al hospital más frecuente, en ambos grupos, fue el relato de ASIJ y, al Servicio de Ginecología en particular, la evaluación de genitales externos. La mayor parte presentó un examen físico normal. Se observó una mayor prevalencia de infecciones de transmisión sexual (ITS) en el grupo de pandemia. Se realizaron más internaciones y denuncias para protección de víctimas en dicho grupo. Se registró que el agresor era conocido de la víctima en casi el 90 % de las víctimas de ambos grupos. CONCLUSIONES: Durante la pandemia se evidenció una disminución en el número total de consultas a Ginecología, de modo que aquellas por sospecha de ASIJ representaron un mayor porcentaje. Sin embargo, las características en relación con la presencia de lesiones graves, infecciones de transmisión sexual o embarazo no se vieron modificadas.
Subject(s)
COVID-19 , Child Abuse, Sexual , Gynecology , Sexually Transmitted Diseases , Adolescent , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child Abuse, Sexual/diagnosis , Female , Hospitals, Pediatric , Humans , Pandemics , Pregnancy , Referral and ConsultationABSTRACT
OBJECTIVE: To evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls. METHODS: Cross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed. RESULTS: Musculoskeletal pain (42% vs. 61%, pâ¯=â¯0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, pâ¯=â¯0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, pâ¯=â¯0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, pâ¯=â¯0.043), and tendinitis (0% vs. 9.2%, pâ¯=â¯0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929-6.316; pâ¯=â¯0.0009) and ACT ≥ 20 (OR, 0.194; 95% CI, 0.039-0.967; pâ¯=â¯0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R2â¯=â¯0.206). CONCLUSIONS: Musculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain.
Subject(s)
Asthma , Musculoskeletal Pain , Rheumatic Diseases , Adolescent , Asthma/complications , Cross-Sectional Studies , Electronics , Female , Humans , Musculoskeletal Pain/epidemiology , Musculoskeletal Pain/etiology , SyndromeABSTRACT
Hirschsprung disease is characterized by the lack of migration of intrinsic parasympathetic ganglia from neural crest and consequently absence of them at varying length of the bowel, resulting in functional obstruction. The incidence is 1 per 5000 births. After surgery, short term and long term comorbidity commonly occurs. The aim of this article is to revise the main causes of ongoing symptoms after surgery in Hirschsprung disease patients and to show a diagnostic and therapeutic algorithm that can be developed in our community.
La enfermedad de Hirschsprung ocurre en 1 de cada 5000 nacimientos. La falla de migración de las células ganglionares desde la cresta neural en dirección cefalocaudal genera su ausencia en parte o todo el colon. Se manifiesta con falta de eliminación de meconio, distensión abdominal y dificultades en la evacuación. Luego del tratamiento quirúrgico, existen complicaciones a corto y largo plazo. El objetivo de esta publicación es describir las principales causas de síntomas persistentes en los pacientes operados por enfermedad de Hirschsprung y presentar un algoritmo diagnóstico-terapéutico factible de ser realizado en nuestro medio.
Subject(s)
Hirschsprung Disease/surgery , Intestinal Obstruction/etiology , Postoperative Complications/diagnosis , Algorithms , Hirschsprung Disease/physiopathology , Humans , Infant, Newborn , Postoperative Complications/therapyABSTRACT
Syphilis shows marked increase in its prevalence in Argentina and the world. The World Health Organization estimates that annually there are 12 million people infected in the world, 270,000 corresponding to newborns with congenital syphilis. We describe an 8-year-old girl who was undergoing mononucleosis due to Epstein-Barr virus and presented syphilis as a diagnostic finding, confirmed by two different positive treponemal tests, assuming a compatible picture of late latent congenital asymptomatic syphilis.
La sífilis presenta un marcado aumento de su prevalencia en Argentina y en el mundo. La Organización Mundial de la Salud estima que, por año, hay 12 millones de personas infectadas mundialmente, y 270 000 corresponden a recién nacidos con sífilis congènita. Se presenta a una niña de 8 años de edad con mononucleosis por virus de Epstein-Barr, que mostró como hallazgo diagnóstico sífilis confirmada por dos pruebas treponémicas positivas; se interpretó el cuadro como compatible con sífilis congènita latente tardía asintomática.
Subject(s)
Syphilis, Latent/congenital , Syphilis, Latent/diagnosis , Child , Female , HumansABSTRACT
Blue Rubber-Bleb Nevus Syndrome (BRBNS, Bean Syndrome) is a rare disorder characterized by the presence of cutaneous and visceral vascular malformations. Although it may affect several organs, the gastrointestinal tract is one of the most frequently involved sites. It can cause gastrointestinal bleeding and chronic anemia. We report an 8-years-old girl who was admitted because of cutaneous malformations and anemia suspected to be caused by gastrointestinal bleeding. Cutaneous lesions were compatible with Blue Rubber-Bleb Nevus Syndrome. Vascular malformations were confirmed by diagnostic gastroduodenoscopy and colonoscopy and further therapeutical intervention was planned. We performed banding of 2 lesions located in the stomach and sclerotherapy of a duodenal lesion. Six colonic lesions were treated with banding and three other polypoid lesions were endoscopically resected A combined laparoscopic and endoscopic approach was performed for evaluation and treatment of small-bowel lesions. Eighteen lesions were found. We endoscopically resected 8 polipoid lesions. Eight other large transmural lesions were removed by wedge resection. Only one lesion required termino-terminal anastomosis. We consider that endoscopic treatment and laparoscopically assisted enteroscopy are safe and effective options in the treatment of gastrointestinal bleeding caused by vascular malformations.
Subject(s)
Abnormalities, Multiple/diagnosis , Gastrointestinal Hemorrhage/etiology , Vascular Malformations/complications , Viscera/abnormalities , Abnormalities, Multiple/surgery , Child , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/surgery , Humans , Syndrome , Treatment Outcome , Vascular Malformations/diagnosis , Vascular Malformations/surgeryABSTRACT
Toxocariasis canis or catis is a zoonotic infection disseminated in humans. Human beings can act as non-natural hosts in which the parasite can survive for long periods of time and they become infected by the ingestion of geohelminth eggs. These can be located on the ground, playgrounds and children's games, and are mostly eliminated by dogs or cats. There are different spectra in the clinical presentation of this infection, which can vary from an asymptomatic host to the production of serious organic lesions; some of them are ocular toxocariasis, visceral larva migrans, covert toxocariasis and neurotoxocariasis. In this case report a patient who presents with a history of respiratory problems, prolonged fever, and hepatomegaly. Laboratory analyses show hypereosinophilia, hypergammaglobulinemia and serodiagnosis is positive for toxocariasis. Preliminary diagnosis: Visceral Larva Migrans Syndrome.
La infección por T oxocara canis o catis es una zoonosis diseminada en el ser humano. La toxocariasis puede coexistir con otras parasitosis endémicas. El hombre actúa como huésped no natural y adquiere la infección a través de la ingesta de huevos del geohelminto. Estos pueden localizarse en la tierra, los patios y los juegos de los niños, y son eliminados, principalmente, por perros o gatos. Existen distintos espectros en la presentación clínica; algunos de ellos son toxocariasis ocular, larva migrans visceral, toxocariasis encubierta y neurotoxocariasis. Se presenta el caso de un paciente de 2 años y 3 meses de edad, con antecedente de síntomas respiratorios, fiebre prolongada y hepatomegalia, con resultados de laboratorio que informa hipereosinofilia, hipergammaglobulinemia y serología positiva para toxocariasis (ensayo por inmunoabsorción ligado a enzimas). Se plantea el diagnóstico de síndrome de larva migrans visceral.
Subject(s)
Larva Migrans, Visceral/diagnosis , Liver Abscess/parasitology , Zoonoses/diagnosis , Animals , Child, Preschool , Hepatomegaly/parasitology , Humans , Larva Migrans, Visceral/parasitology , Male , Zoonoses/parasitologyABSTRACT
Mycoplasma pneumoniae (Mp) is responsible for 30% of the respiratory manifestations of the general population. Pneumonia occupies the first place within this group. Among the extra-respiratory forms (40%), the neurological ones are the most frequent. Meningoencephalitis and aseptic meningitis are the most common. The presentation of more than one clinical variant in the same patient associated with primoinfection by Mp is possible. In relation to the serological diagnosis, controversies in interpretation sometimes occur. This is a 7-year-old girl with conjunctival injection, cervical adenopathy, photophobia with bilateral papilla pseudoedema, and scaly rash that develops peripheral facial paralysis and aseptic meningitis. We will discuss diagnostic controversies.
Mycoplasma pneumoniae (Mp) es el agente causal de un 30% de las manifestaciones respiratorias de la población general. La neumonía ocupa el primer lugar dentro de este grupo. Las manifestaciones neurológicas representan las formas más frecuentes de presentación clínica extrapulmonar (40%). Las encefalitis y meningoencefalitis son las formas más habituales de sintomatología neurológica asociada a infección por Mp. La presentación de más de una variante clínica en un mismo paciente asociada a primoinfección por Mp es posible. El diagnóstico serológico plantea, habitualmente, controversias en su interpretación. A partir del caso de una niña de 7 años con inyección conjuntival, adenopatía cervical, rash descamativo y fotofobia con "pseudoedema de papila bilateral", que desarrolla durante su evolución parálisis facial periférica y meningitis aséptica, se analizarán las controversias que se plantean en relación con la interpretación diagnóstica asociada al compromiso neurológico por Mp.
Subject(s)
Meningitis, Aseptic/diagnosis , Meningoencephalitis/diagnosis , Mycoplasma Infections/diagnosis , Mycoplasma pneumoniae/isolation & purification , Child , Facial Paralysis/diagnosis , Facial Paralysis/microbiology , Female , Humans , Meningitis, Aseptic/microbiology , Meningoencephalitis/microbiology , Mycoplasma Infections/microbiology , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/microbiologyABSTRACT
INTRODUCTION: Immunoglobulin G4-related disease (IgG4-RD) is an condition rarely reported in children. Additionally, IgG4-RD may rarely mimic vasculitis in adults and may infrequently present with uveitis. In our service, 6,198 patients were followed-up and only one (0.0001%) of them had IgG4-RD. To our knowledge, the present IgG4-RD case was the first mimicking childhood polyarteritis nodosa (c-PAN) with recurrent uveitis and kidney tumor. CASE REPORT: We describe herein a 7-year-old boy that presented intermittent fever. He developed arthralgia, weight loss, myalgia, skin lesions and recurrent uveitis. Skin biopsy revealed necrotizing vasculitis in medium/small sized vessels associated with septal panniculitis suggesting cPAN. Prednisone and azathioprine were administered with improvement. At 11 years, he had persistent fever and abdominal angiotomography revealed a large tumor in left kidney and he was then submitted to nephrectomy. The renal histopathology showed lymphoplasmacytic and histiocytic proliferation with extensive areas of fibrosis, and lymphomonocitic phlebitis with presence of IgG4 in 43 plasmocyte cells, suggesting IgG4-RD. DISCUSSION: we present herein a unique case of a male pediatric patient with IgG4-RD with rare ocular, cutaneous and renal manifestations.
Subject(s)
Immunoglobulin G4-Related Disease/complications , Immunoglobulin G4-Related Disease/diagnosis , Kidney Neoplasms/etiology , Polyarteritis Nodosa/diagnosis , Uveitis/etiology , Child , Diagnosis, Differential , Humans , MaleABSTRACT
OBJECTIVE: To evaluate symptomatic polyautoimmunity (PA) at childhood-onset systemic lupus erythematosus(cSLE) diagnosis, and its association with demographic data, disease activity, clinical manifestations and laboratorial abnormalities in a large Brazilian cSLE population. METHODS: A multicenter retrospective study was performed in 1463 cSLE(ACR criteria) patients from 27 Pediatric Rheumatology services. Symptomatic PA was defined according to the presence of more than one concomitant autoimmune disease(AD) and symptomatic multiple autoimmune syndrome(MAS) was defined as three or more AD. An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2K were evaluated. RESULTS: At cSLE diagnosis symptomatic PA was observed in 144/1463(9.8%) and symptomatic MAS occurred in solely 10/1463(0.7%). In the former group the more frequently observed associated AD were Hashimoto thyroiditis nâ¯=â¯42/144(29%), antiphospholipid syndrome nâ¯=â¯42/144(29%), autoimmune hepatitis nâ¯=â¯26/144(18%) and type 1 diabetes mellitus nâ¯=â¯23/144(15.9%). Further comparisons between cSLE patients with and without PA showed a higher median age(pâ¯=â¯0.016) and lower mean SLICC criteria (pâ¯=â¯0.039) in those with PA. Additionally, these cSLE patients had less renal involvement(35% vs. 44%, pâ¯=â¯0.038) and red blood cell cast(6% vs. 12%, pâ¯=â¯0.042) and more antiphospholipid antibodies(29% vs. 15%, pâ¯<â¯0.0001). CONCLUSIONS: Approximately 10% of cSLE had symptomatic PA at diagnosis, particularly endocrine autoimmune disorders and antiphospholipid syndrome. Lupus was characterized by a mild disease onset and MAS was infrequently evidenced. Further studies are necessary to determine if this subgroup of cSLE patients have a distinct genetic background with a less severe disease and a better long-term outcome.
Subject(s)
Autoimmunity/immunology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Severity of Illness Index , Adolescent , Age of Onset , Brazil/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Prevalence , Retrospective StudiesABSTRACT
Introducción. Se ha postulado que el aislamiento social debido a la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) aumentaría la incidencia de abuso sexual infantojuvenil (ASIJ). Objetivo. Comparar la incidencia y las características de las consultas realizadas en Ginecología en relación con ASIJ antes y durante la pandemia de COVID-19. Materiales y métodos. Se realizó un estudio descriptivo, observacional y comparativo entre las situaciones de sospecha de ASIJ ocurridas durante la pandemia de COVID-19 en relación con las del mismo período del año previo en un hospital pediátrico de alta complejidad. Resultados. Se consignaron 122 consultas por sospecha de ASIJ, 78 en el período previo a la pandemia y 44 en la pandemia. El motivo de consulta al hospital más frecuente, en ambos grupos, fue el relato de ASIJ y, al Servicio de Ginecología en particular, la evaluación de genitales externos. La mayor parte presentó un examen físico normal. Se observó una mayor prevalencia de infecciones de transmisión sexual (ITS) en el grupo de pandemia. Se realizaron más internaciones y denuncias para protección de víctimas en dicho grupo. Se registró que el agresor era conocido de la víctima en casi el 90 % de las víctimas de ambos grupos. Conclusiones. Durante la pandemia se evidenció una disminución en el número total de consultas a Ginecología, de modo que aquellas por sospecha de ASIJ representaron un mayor porcentaje. Sin embargo, las características en relación con la presencia de lesiones graves, infecciones de transmisión sexual o embarazo no se vieron modificadas
Introduction. It has been suggested that the social isolation due to the coronavirus disease 2019 (COVID-19) may increase the incidence of child and adolescent sexual abuse (CASA). Objective. To compare the incidence and characteristics of medical consultations made to the Department of Gynecology due to CASA before and during the COVID-19 pandemic. Materials and methods. Descriptive, observational, and comparative study about suspected CASA events occurred during the COVID-19 pandemic compared to those occurred in the previous year at a tertiary care children's hospital. Results. One hundred and twenty-two medical consultations due to suspected CASA were recorded; 78 before and 44 during the pandemic. In both groups, the most common reason for consultation at the hospital was an account of CASA and, at the Department of Gynecology in particular, the external genitalia examination. Most subjects had a normal physical examination. There was a higher prevalence of STI in the pandemic group. In addition, there were also more hospitalizations and police reports for victims protection in this group. The abuser was known to the victim in almost 90% of cases in both groups. Conclusions. During the pandemic, the total number of medical consultations to the Department of Gynecology decreased so the percentage of those due to suspected CASA was higher. However, the presence of severe lesions, STIs or pregnancy did not change
Subject(s)
Humans , Female , Pregnancy , Child , Adolescent , Child Abuse, Sexual/diagnosis , Sexually Transmitted Diseases , COVID-19/epidemiology , Referral and Consultation , Pandemics , Gynecology , Hospitals, PediatricABSTRACT
Abstract Objective: To evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls. Methods: Cross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed. Results: Musculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929-6.316; p = 0.0009) and ACT ≥ 20 (OR, 0.194; 95% CI, 0.039-0.967; p = 0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R2 = 0.206). Conclusion: Musculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain.
ABSTRACT
La enfermedad de Hirschsprung ocurre en 1 de cada 5000 nacimientos. La falla de migración de las células ganglionares desde la cresta neural en dirección cefalocaudal genera su ausencia en parte o todo el colon. Se manifiesta con falta de eliminación de meconio, distensión abdominal y dificultades en la evacuación. Luego del tratamiento quirúrgico, existen complicaciones a corto y largo plazo. El objetivo de esta publicación es describir las principales causas de síntomas persistentes en los pacientes operados por enfermedad de Hirschsprung y presentar un algoritmo diagnóstico-terapéutico factible de ser realizado en nuestro medio
Hirschsprung disease is characterized by the lack of migration of intrinsic parasympathetic ganglia from neural crest and consequently absence of them at varying length of the bowel, resulting in functional obstruction. The incidence is 1 per 5000 births. After surgery, short term and long term comorbidity commonly occurs. The aim of this article is to revise the main causes of ongoing symptoms after surgery in Hirschsprung disease patients and to show a diagnostic and therapeutic algorithm that can be developed in our community
Subject(s)
Humans , Hirschsprung Disease/surgery , Hirschsprung Disease/diagnosis , Hirschsprung Disease/therapy , Pediatrics , Chronic Disease , Constipation/diet therapy , Constipation/etiology , Enterocolitis/diet therapy , Enterocolitis/etiology , Fecal Incontinence/diet therapy , Fecal Incontinence/etiologyABSTRACT
La sífilis presenta un marcado aumento de su prevalencia en Argentina y en el mundo. La Organización Mundial de la Salud estima que, por año, hay 12 millones de personas infectadas mundialmente, y 270 000 corresponden a recién nacidos con sífilis congènita. Se presenta a una niña de 8 años de edad con mononucleosis por virus de Epstein-Barr, que mostró como hallazgo diagnóstico sífilis confirmada por dos pruebas treponémicas positivas; se interpretó el cuadro como compatible con sífilis congènita latente tardía asintomática.
Syphilis shows marked increase in its prevalence in Argentina and the world. The World Health Organization estimates that annually there are 12 million people infected in the world, 270,000 corresponding to newborns with congenital syphilis. We describe an 8-year-old girl who was undergoing mononucleosis due to Epstein-Barr virus and presented syphilis as a diagnostic finding, confirmed by two different positive treponemal tests, assuming a compatible picture of late latent congenital asymptomatic syphilis.
Subject(s)
Humans , Female , Child , Syphilis, Congenital/diagnosis , Treponema pallidum , Syphilis Serodiagnosis , Syphilis, Congenital/drug therapyABSTRACT
Bloody discharge from the nipple (thelorrhagia) is a rare symptom in childhood and is a cause of great concern due to the mistaken association with carcinoma in adults. However, in children thelorrhagia is due to benign mammary duct ectasia in the majority of cases. Up to date, only isolated case reports or case series have been published and, although different theories have been postulated, no definite etiology has been identified. We report two cases with similar clinical features and outcome, in whom bleeding resolved spontaneously 4 and 6 weeks after onset. We present a review of the literature. Based on the benign and self-limiting process and in the absence of other findings on physical examination, we suggest a watch-and-wait approach with minimally invasive studies and reassurance and support for the family as most cases resolve spontaneously.
Subject(s)
Blood , Breast Diseases/complications , Nipples , Dilatation, Pathologic , Humans , Infant , MaleABSTRACT
La infección por T oxocara canis o catis es una zoonosis diseminada en el ser humano. La toxocariasis puede coexistir con otras parasitosis endémicas. El hombre actúa como huésped no natural y adquiere la infección a través de la ingesta de huevos del geohelminto. Estos pueden localizarse en la tierra, los patios y los juegos de los niños, y son eliminados, principalmente, por perros o gatos. Existen distintos espectros en la presentación clínica; algunos de ellos son toxocariasis ocular, larva migrans visceral, toxocariasis encubierta y neurotoxocariasis. Se presenta el caso de un paciente de 2 años y 3 meses de edad, con antecedente de síntomas respiratorios, fiebre prolongada y hepatomegalia, con resultados de laboratorio que informa hipereosinofilia, hipergammaglobulinemia y serología positiva para toxocariasis (ensayo por inmunoabsorción ligado a enzimas). Se plantea el diagnóstico de síndrome de larva migrans visceral.
Toxocariasis canis or catis is a zoonotic infection disseminated in humans. Human beings can act as non-natural hosts in which the parasite can survive for long periods of time and they become infected by the ingestion of geohelminth eggs. These can be located on the ground, playgrounds and children's games, and are mostly eliminated by dogs or cats. There are different spectra in the clinical presentation of this infection, which can vary from an asymptomatic host to the production of serious organic lesions; some of them are ocular toxocariasis, visceral larva migrans, covert toxocariasis and neurotoxocariasis. In this case report a patient who presents with a history of respiratory problems, prolonged fever, and hepatomegaly. Laboratory analyses show hypereosinophilia, hypergammaglobulinemia and serodiagnosis is positive for toxocariasis. Preliminary diagnosis: Visceral Larva Migrans Syndrome.
Subject(s)
Humans , Male , Child, Preschool , Larva Migrans, Visceral/diagnosis , Zoonoses/diagnosis , Liver Abscess/parasitology , Larva Migrans, Visceral/parasitology , Zoonoses/parasitology , Hepatomegaly/parasitologyABSTRACT
Mycoplasma pneumoniae (Mp) es el agente causal de un 30% de las manifestaciones respiratorias de la población general. La neumonía ocupa el primer lugar dentro de este grupo. Las manifestaciones neurológicas representan las formas más frecuentes de presentación clínica extrapulmonar (40%). Las encefalitis y meningoencefalitis son las formas más habituales de sintomatología neurológica asociada a infección por Mp. La presentación de más de una variante clínica en un mismo paciente asociada a primoinfección por Mp es posible. El diagnóstico serológico plantea, habitualmente, controversias en su interpretación. A partir del caso de una niña de 7 años con inyección conjuntival, adenopatía cervical, rash descamativo y fotofobia con "pseudoedema de papila bilateral", que desarrolla durante su evolución parálisis facial periférica y meningitis aséptica, se analizarán las controversias que se plantean en relación con la interpretación diagnóstica asociada al compromiso neurológico por Mp.
Mycoplasma pneumoniae (Mp) is responsible for 30% of the respiratory manifestations of the general population. Pneumonia occupies the first place within this group. Among the extra-respiratory forms (40%), the neurological ones are the most frequent. Meningoencephalitis and aseptic meningitis are the most common. The presentation of more than one clinical variant in the same patient associated with primoinfection by Mp is possible. In relation to the serological diagnosis, controversies in interpretation sometimes occur. This is a 7-year-old girl with conjunctival injection, cervical adenopathy, photophobia with bilateral papilla pseudoedema, and scaly rash that develops peripheral facial paralysis and aseptic meningitis. We will discuss diagnostic controversies.
Subject(s)
Humans , Female , Child , Meningitis, Aseptic/diagnosis , Meningoencephalitis/diagnosis , Mycoplasma Infections/diagnosis , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/microbiology , Facial Paralysis/diagnosis , Facial Paralysis/microbiology , Meningitis, Aseptic/microbiology , Meningoencephalitis/microbiology , Mycoplasma Infections/microbiologyABSTRACT
Adolescents with different types of motor handicapping have desires, needs, and feelings, and have the right to express them in the best possible and acceptable way. Sexual education provided to young people with these handicaps is generally more limited than that offered to their normal peers. These adolescents are inadvertently excluded, and some may find difficult to establish a steady couple relationship. Health-care professionals should bear in mind the needs and worries of their handicapped patients and include the topic of sexuality in their visits from the start insisting on the fact that it is a normal activity in the context of a variety of associated problems.
Subject(s)
Disabled Persons/psychology , Sexuality/physiology , Adolescent , Female , Humans , Male , Sex EducationABSTRACT
Con el objetivo de recibir en el Hospital Garrahan a los pacientes provenientes de los municipios del conurbano bonaerense y atenderlos según la complejidad, se elaboró una estrategia en red respetando las modalidades de cada lugar y priorizando la fidelización a los centros locales.
Subject(s)
Humans , Community Networks , Standard of Care , Health StrategiesABSTRACT
INTRODUCTION: Highly active antiretroviral therapy (HAART) has been administered to children infected with human immunodeficiency virus (HIV) since 1996. This kind of therapy is effective in achieving viral suppression and stopping disease progression but prolonged administration increases the risk of toxic effects, favours the onset of viral resistance and leads to decreased adherence. The aim of the present study was to determine prognostic factors among clinical, immunological and virological parameters at the beginning of HAART. POPULATION AND METHODS: We performed a prospective-retrospective observational analysis of a cohort or 564 HIV+ children assisted in Hospitals of Buenos Aires and Rosario, Argentina, treated with HAART since 1998 (media of treatment: 46.78 months. Range: 2-91 months). Patients were divided in groups according to age (younger or older than one year), and outcome (favourable or unfavourable). Stage, CD4 lymphocytes percentage, CD4 lymphocyte cell count and viral load at the beginning of treatment were analyzed with outcome by means of chi(2) tests, and logistic regression. RESULTS: No differences were observed on the percentage of CD4 T cells and viral load at baseline, between children under one year of age with good (n= 79) or bad outcomes (n= 4). Among older children (450 with good outcome, 31 with unfavourable), the following were identified as predictors of bad outcome: HAART initiation during stage C (p= 0.006), CD4 T-cell percentage below 15 percent (p< 0.001) and CD4 absolute value below 500 cells/mm(3) (p= 0.003). CONCLUSIONS: Children older than one year will have better outcome when HAART is initiated before stage C, with more than 15% CD4 or more than 500 cells/mm(3).
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Seropositivity/drug therapy , Adolescent , Child , Child, Preschool , Disease Progression , Female , HIV Seropositivity/diagnosis , HIV Seropositivity/immunology , HIV Seropositivity/virology , Humans , Infant , Male , Prospective Studies , Retrospective StudiesABSTRACT
La descarga de sangre a través del pezón (telorragia) es un síntoma muy infrecuente en pediatría. Si bien genera gran preocupación y alarma por su equivocada asociación con el carcinoma de pacientes adultos, en los niños se asocia, en la mayoría de los casos, con una ectasia ductal benigna. Hasta el momento, sólo existen informes o series de casos y, aunque se proponen diferentes teorías, la causa no se conoce con exactitud. Se presentan dos casos con características clínicas y evolución muy similar, en los que el sangrado se resolvió en forma espontánea, uno en cuatro y el otro en seis semanas. Se realiza una revisión del tema y, dado que se trata de un proceso benigno y autolimitado, se sugiere, en ausencia de otros hallazgos en el examen físico, realizar estudios mínimamente invasivos, adoptar una conducta expectante y tranquilizar a la familia en la espera de una resolución espontánea.
Bloody discharge from the nipple (thelorrhagia) is a rare symptom in childhood and is a cause of great concern due to the mistaken association with carcinoma in adults. However, in children thelorrhagia is due to benign mammary duct ectasia in the majority of cases. Up to date, only isolated case reports or case series have been published and, although different theories have been postulated, no definite etiology has been identified. We report two cases with similar clinical features and outcome, in whom bleeding resolved spontaneously 4 and 6 weeks after onset. We present a review of the literature. Based on the benign and self-limiting process and in the absence of other findings on physical examination, we suggest a watch-and-wait approach with minimally invasive studies and reassurance and support for the family as most cases resolve spontaneously.