Clinical, radiologic, and endoscopic characteristics upon diagnosis of patients with prehepatic portal hypertension at the Instituto Nacional de Pediatría from 2001 to 2011.

BACKGROUND: Prehepatic portal hypertension in children can be asymptomatic for many years. Once diagnosed, the therapeutic measures (pharmacologic, endoscopic, and surgical) are conditioned by the specific characteristics of each patient. In Mexico, there are no recorded data on the incidence of the disease and patient characteristics. AIMS: To determine the main clinical, radiologic, and endoscopic characteristics upon diagnosis of these patients at the Instituto Nacional de Pediatría within the time frame of January 2001 and December 2011. METHODS: A cross-sectional, retrolective, descriptive, and observational study was conducted in which all the medical records of the patients with portal hypertension diagnosis were reviewed. RESULTS: There was a greater prevalence of prehepatic etiology (32/52) (61.5%) in the portal hypertension cases reviewed. Males (62.5%) predominated and 11 of the 32 patients were under 4 years of age. The primary reason for medical consultation was upper digestive tract bleeding with anemia (71.9%) and the main pathology was cavernomatous degeneration of the portal vein (65.6%). Splenoportography was carried out on 17 of the 32 patients. A total of 65.5% of the patients received the combination therapy of propranolol and a proton pump inhibitor. Initial endoscopy revealed esophageal varices in 96.9% of the patients, 12 of whom presented with gastroesophageal varices. Congestive gastropathy was found in 75% of the patients. The varices were ligated in 8 cases, sclerotherapy for esophageal varices was carried out in 5 cases (15.6%), and sclerotherapy for gastric varices was performed in 2 patients. Seventeen patients (53.1%) underwent portosystemic diversion: 10 of the procedures employed a mesocaval shunt and 7 a splenorenal shunt. Nine patients (28.1%) underwent total splenectomy. CONCLUSIONS: The primary cause of the disease was cavernomatous degeneration of the portal vein; it was predominant in males and the first symptom was variceal bleeding.

A new formula proposal for placing pH-impedance catheters in pediatric patients.

INTRODUCTION: Esophageal pH-impedance monitoring is a tool for diagnosing gastroesophageal reflux in children. The position of the pH catheter is essential for a reliable reading and the current formulas for calculating catheter insertion length are not completely accurate. The aim of the present study was to develop a new formula for adequate insertion of the pH catheter. MATERIAL AND METHODS: A cross-sectional study was conducted on children that underwent pH-impedance monitoring and later radiographic control, to calculate the correct catheter insertion length. The documented variables were age, sex, weight, height, naris to tragus distance, tragus to sternal notch distance, sternal notch to xiphoid process distance, and initial insertion length determined by the Strobel and height interval formulas. A multivariate regression analysis was carried out to predict the final insertion length. Regression ANOVA and Pearson's adjusted R-squared tests were performed. RESULTS: Forty-five pH-impedance studies were carried out, 53% of which were in males. The age and weight variables were not normally distributed. In the initial regression model, the variables that did not significantly correlate with the final insertion length were: sex (P 0.124), length determined by the Strobel or height interval formulas (P 0.078), naris to tragus distance (P 0.905), and tragus to sternal notch distance (P 0.404). The final equation: 5.6 + (height in cm * 0.12) + (sternal notch to xiphoid process distance * 0.57) produced an R2 of 0.93 (P 0.000). CONCLUSIONS: This formula can be considered a valid option for placement of the pH-impedance monitoring catheter in pediatrics.

A comparison of endoscopic procedures performed at a tertiary care hospital before and during the SARS-CoV-2 pandemic.

INTRODUCTION AND AIM: SARS-CoV-2 emerged in 2019 and had a huge impact on the world. The area of endoscopy suffered great changes, causing a reduction in the number of procedures and its indications. The aim of our study was to compare the quantity, indication, and type of procedures in 2019 with those in 2020. METHOD: A retrospective, observational, analytic, and cross-sectional study was conducted, obtaining information from the endoscopy registry. The STROBE checklist was employed. STATISTICAL ANALYSIS: The quantitative variables were analyzed with descriptive statistics (measures of central tendency and dispersion) and the categorical variables with frequencies and percentages. The quantitative variables were compared, using the Student's t test/Mann-Whitney U test, and the categorical variables with contingency tables, using the Fisher's exact test. RESULTS: In 2019, a total of 277 procedures were performed, compared with 139 in 2020. Mean patient age was 98.53 months (61.46 SD) in 2019 and 77.02 months (59.81 SD) in 2020; 352 diagnostic procedures and 136 therapeutic procedures were carried out in 2019, compared with 51 diagnostic procedures and 88 therapeutic procedures in 2020. The number of diagnostic and therapeutic procedures were inverted (72.1%-36.7% and 27.9%-63.3%, respectively) (p<0.0001). Esophageal varices, upper gastrointestinal bleeding (UGIB), and foreign body extraction were the indications, in order of predominance in 2019, compared with foreign body extraction (p<0.05), UGIB, and esophageal varices in 2020. There were no differences regarding colonoscopy. CONCLUSION: There was a clear difference in indication and type of procedure, with an increase in foreign body extraction in preschoolers.

The Asociación Mexicana de Gastroenterología consensus on the diagnosis and treatment of acute pancreatitis in children and adolescents.

Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.

[Blue rubber bleb nevus syndrome: A case report]. / Síndrome de nevos azules ahulados: reporte de un caso.

Blue Rubber Bleb Nevus Syndrome (BRBS) is a rare disease, characterized by multiple vascular malformations in the skin and gastrointestinal tract. Other organs can also be affected, presenting different clinical manifestations such as arthralgia, epistaxis, hemoptysis, hematuria, hemothorax, mild thrombocytopenia, consumptive coagulopathy, and bone deformities, among others. We present a case of BRBS in a nine-year-old boy with the characteristic clinical manifestations of punctated purplish-blue skin lesions that vary in size and gastrointestinal vascular malformations with upper digestive tract bleeding.

Barking up the Right Tree: Using Tree Bark to Track Airborne Particles in School Environment and Link Science to Society.

Children's exposure to air pollution affects both their health and learning skills. Fine and ultrafine particulate matter (PM2.5, PM1), notably issued from traffic sources in urban centers, belong to the most potential harmful health hazards. However their monitoring and the society's awareness on their dangers need to be consolidated. In this study, raising teacher and pupil involvement for air quality improvement in their schools environment is reached through developing a passive monitoring technique (bio-sensors made of tree bark). The experiment was implemented in two urban elementary schools situated close to a main traffic road of the city of Toulouse (South of France). Magnetic properties, carbonaceous fraction measurements, and scanning electronic microscopy (SEM-EDX) investigations were realized both on passive bio-sensors and filters issued from active sampling. We find that traffic is the main PM1 source for both outdoors and indoors at schools. Higher levels of outdoor PM in the school's environments compared to urban background are reached especially in the cold period. The schools proximity to a main traffic source and lack of ventilation are the main causes for observed PM1 accumulation in classrooms. The co-working experiment with educational teams and pupils shows that the use of bio-sensors is a driver for children empowerment to air pollution and therefore represents a potential key tool for the teachers though limiting eco-anxiety. As PM accumulation is observed in many scholar environments across Europe, the proposed methodology is a step toward a better assessment of PM impact on pupil's health and learning skills.

Foreign body ingestion and associated factors in pediatric patients at a tertiary care center.

INTRODUCTION AND AIMS: Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS: An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS: Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p<0.05), as well as objects with a diameter larger than 2cm (p<0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS: Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.

Identifying women's preferences for treatment of urinary tract infection: a discrete choice experiment.

OBJECTIVE: To identify the preferences of women regarding management of urinary tract infections (UTIs). DESIGN: A discrete choice experiment of the preferences for certain treatment attributes was conducted by survey. Attributes included treatment duration, time to complaint resolution, complication risk, side effect risk and contribution to antimicrobial resistance. SETTING: General population in the Netherlands, recruited via social media. PARTICIPANTS: Women aged 18 years or older. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the relative importance of the attributes for treatment choice, using a conditional logit model. The secondary outcome was the heterogeneity in these preferences. RESULTS: The discrete choice experiment was completed by 833 women. Most attributes were important to decisions for UTI treatment. Women were willing to accept management with, for example, a higher chance of complications or longer time to resolution, if it could help avoid antimicrobial resistance. However, there was heterogeneity in the preferences. Women who had one previous UTI had a stronger preference for faster symptom resolution compared with those who had no previous UTI. Younger women also preferred faster symptom resolution. Finally, women with a low or middle education level gave less importance to preventing antimicrobial resistance than women with a high education level. CONCLUSIONS: The current study indicated that a considerable part of women valued alternatives to antimicrobial treatment and were prepared to tolerate management that was less optimal in certain respects to avoid antimicrobial treatment.

Esophagogastric junction outflow obstruction in the differential diagnosis of post-fundoplication dysphagia in children.

INTRODUCTION AND AIMS: Post-fundoplication dysphagia is resolved with no therapeutic intervention in the majority of cases but it can persist in 5.3% of children that undergo the procedure. Among the differential diagnoses, esophagogastric junction outflow obstruction (EGJOO) is a disorder that should be suspected if there is a persistence of dysphagia. The aim of our study was to describe the clinical characteristics, treatment, and follow-up in a case series of patients diagnosed with post-fundoplication EGJOO. MATERIALS AND METHODS: The clinical records of patients diagnosed with EGJOO at a tertiary care hospital within the time frame of September 2015 to September 2019 were reviewed, with respect to manometry, etiology, treatment, and clinical course of the disease. RESULTS: Of the 213 high-resolution esophageal manometries performed, 4 patients met the criteria for post-fundoplication EGJOO. The primary symptom was dysphagia, presenting 15 days after the procedure. Esophageal dilations were carried out on all the patients but with no improvement. Symptoms related to the condition resolved spontaneously in three of the four patients. CONCLUSION: The management of children with post-fundoplication EGJOO continues to be a challenge. Even though more than half of the cases resolve with no intervention, optimum management of the motility disorder is still limited, given the scant experience with the condition in the pediatric population.

Foreign body ingestion and associated factors in pediatric patients at a tertiary care center. / Ingesta de cuerpo extraño en pacientes pediátricos en un hospital de tercer nivel y factores asociados.

INTRODUCTION AND AIMS: Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS: An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS: Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p <0.05), as well as objects with a diameter larger than 2cm (p <0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS: Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.

Broad ligament hernia-associated bowel obstruction.

BACKGROUND AND OBJECTIVE: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. METHODS: The patient was admitted to the hospital's emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient's admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient's hospital stay, pain and vomiting increased in intensity and frequency. RESULTS: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach. CONCLUSION: The patient's evolution was excellent.

Incidental cystic schwannoma of the left sphenoid and cavernous sinuses in an asymptomatic woman. / Schwannoma quístico incidental del seno esfenoidal y cavernoso izquierdo en una mujer asintomática.

TITLE: Schwannoma quístico incidental del seno esfenoidal y cavernoso izquierdo en una mujer asintomática.

Anthropometric measurements in both sides of the body in the assessment of nutritional status in prepubertal children.

OBJECTIVE: To analyze the impact of choosing the left or the right side of the body on the anthropometric measurements and derived nutritional indices, in prepubertal children. DESIGN: Cross-sectional pilot nutrition survey. SETTING: General prepubertal school-age population. SUBJECTS: One-hundred and sixty-four children (97 boys and 67 girls) aged 7-9 y. INTERVENTIONS: None. RESULTS: The agreement between anthropometric measurements in both sides of the body showed that in males and in females, suprailiac skinfold thickness and arm circumference were significantly higher in the left than in the right side of the body. The agreement between body composition assessed by anthropometric measurements in both sides of the body showed that only in males was arm muscle area significantly higher in the left than in the right side, and arm fat percentage was higher in the right than in the left side of the body. Total body fat percentage calculated from skinfold thickness did not show statistically significant differences when skinfolds were obtained in the both sides of the body, either in boys and in girls. CONCLUSIONS: Our results show that differences between the sides of the body were lower than the technical error of measurement of the anthropometric measurements obtained and seem not to be biologically significant in this age group. It is necessary to standardize the method of anthropometric assessment of the nutritional status in terms of body side.

[Aortic stenosis and pregnancy: presentation and physiopathology of a case]. / Estenosis aórtica y embarazo: presentación de un caso y revisión fisiopatológica.

This is the case of a female patient, 31 years of age with the diagnosis of aortic stenosis, prolapse of mitral valve, aortic insufficiency, with pregnancy. The literature is reviewed and the management of this type of condition is analyzed.

[Early diagnosis of heterotopic pregnancy with viability of the intrauterine fetus. Report of two cases and review of the literature]. / Diagnóstico temprano de embarazo heterotópico con viabilidad del producto intrauterino. Informe de dos casos y revisión de la literatura.

Heterotopic pregnancy, or coexistence of intrauterine and extrauterine pregnancy, is a rare entity, with a difficult pre-operative diagnosis, and potentially dangerous for the mother and for the intrauterine pregnancy. There are risk factors that are increased by this entity, so it should be taken into consideration if assisted reproduction techniques are used. The use of ultrasonography and laparoscopy is fundamental for detection, in order to implant an opportune treatment. Two cases of heterotopic pregnancy with viability of intrauterine gestation, are presented.

[Analysis of the predictive value of prolactin concentration in the umbilical cord as an evaluation parameter for respiratory insufficiency in the newborn]. / Análisis del valor predictivo de la concentración de prolactina en cordón umbilical como parámetro evaluatorio de la insuficiencia respiratoria del recién nacido.

In fetal pulmonary development several substances and hormones which directly participate, have been involved. One of these is prolactin, which by raising concentrations through a complex mechanism seems to participate in pulmonary maturation. Due to the importance of product's pulmonary maturity producing respiratory failures of the newborn, some progress has been made in opportune diagnosis, and mainly in prophylaxis of this condition. In this study, serum samples were taken from the umbilical chord to know perinatal evolution after analysis of the evolution of each of the 37 cases, the results corresponded to previous results as published in literature for different conditions as toxemia, diabetes mellitus or prematurity, as well as the relationship between hormonal serum concentrations, and gestational age and weight.

[Laparoscopic findings in patients with pelvic pain, dysmenorrhea and sterility]. / Hallazgos laparoscópicos en pacientes con dolor pélvico, dismenorrea y esterilidad.

Endometriosis is a frequent gynecologic disease and is associated with dysmenorrhea, pelvic pain and infertility. We evaluated 71 patients who had any of these entities and were treated with laparoscopic procedures. We found a higher frequency of endometriosis in these groups in comparation with the reports of the literature but, there was no direct relation between the severity of endometriosis and the three groups (Revised Classification of the American Fertility Society). The organic pathology was the principal factor associated with the pelvic pain in most cases. Finally, we established the utility of laparoscopy in the diagnosis stading and treatment of endometriosis.