[Evaluation of healthcare for patients with diabetes in primary care: A systematic review]. / Evaluación de la asistencia sanitaria del paciente con diabetes en atención primaria: una revisión sistemática.

OBJECTIVE: Have the most current evidence in relation to the evaluation of medical healthcare for patients with diabetes in primary care. METHOD: During the review process, we followed the recommendations to improve the publication of systematic reviews and meta-analyses and the preferred reporting points for PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/ PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: «Physicians, Primary Care¼, «Diabetes Mellitus, Type2¼. Eight selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2019 and 2023. RESULTS: The main study tool represents interventions in knowledge and practice about the care of patients with diabetes among primary care physicians. The most important discussion topics extracted in the analyzed articles refer to knowledge, clinical inertia, patients' housing challenges, adherence intervention programs, and a self-care application for patients with diabetes. CONCLUSIONS: The findings of this study indicate the need to improve medical health care through knowledge, attitudes and practices in primary care regarding patients with diabetes. In this way, it could be considered a useful tool to promote medical healthcare in primary care.

[Efficacy and safety of pediatric flu vaccination: a systematic review]. / Eficacia y seguridad de la vacunación antigripal pediátrica: una revisión sistemática.

OBJECTIVE: Children are at a higher risk of influenza infection compared to the general population. The World Organization Health and recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics contemplate annual vaccination as the most effective way to prevent the disease. Therefore, the purpose of this review was to update information on efficacy and safety in the anti -shed vaccine in children and adolescents. METHODS: A search in four electronic databases (Scopus, Cumulative Index to Nursing and Allied Health Literature, Medline / Pubmed, Google Scholar and Cochrane), as well as a manual search to identify original research published between 2012 and 2022. The guidelines of ANALYSIS (PRISMACR) as a preferred report element for systematic reviews. RESULTS: Seven original research articles were included where two issues of antigripal vaccination were identified in healthy children/adolescents and with pathologies. The efficacy (between approximately 30% and 80%) varied depending on the vaccine used and circulating subtypes. Most adverse reactions were mild intensity, and the most common local adverse event was pain in the injection site. CONCLUSIONS: We positively highlight the safety of pediatric flu vaccination in analyzed studies, on the contrary, with respect to the efficacy of flu vaccination, we observe a wide variability of results. There is a clear need to continue conducting efficacy and safety studies in the child.

[Effectiveness of influenza vaccine in preventing severe influenza]. / Efectividad de la vacuna antigripal en la prevención de la gripe grave.

INTRODUCTION: Influenza is one of the diseases with the greatest epidemiological impact and the greatest relevance in the management of health services. The flu vaccine can have great variability each season, so our objective was to know the effectiveness of the flu vaccine for the 2017/2018 season for the prevention of severe cases of flu in a general acute hospital in 385 beds. MATERIAL AND METHOD: Case control study. All hospitalized patients with laboratory confirmed influenza during the 2017/2018 season were included. Those who met the criteria for a severe case of influenza were considered cases. Those that did not meet the severity criteria were considered controls. The factors associated with the development of severe influenza were calculated. RESULTS: The effectiveness adjusted by age group and comorbidity was 60.7% (20.5-80.5). The vaccinated and unvaccinated groups were different in terms of age (P<.0381). The highest proportion of cases were concentrated in those over 65 years of age (45.5%). Vaccination status against severe influenza was found to be an independent protective factor (OR=.746; .694-.831). CONCLUSIONS: The effectiveness of influenza vaccination provided greater protection against infection and reduced the severity of influenza in hospitalized patients. These findings should be considered to improve vaccination strategies and achieve better vaccination coverage in the population at risk.

[Pediatric bipolar disorder: on one case]. / Trastorno bipolar infantil: a propósito de un caso.

We present the case of a 14 year old male without antecendents of psychiatric treatment, although one year ago, following a surgical intervention on his knee, he presented a period of greater despondency and social withdrawal. Since three months ago he has been more euphoric and hyperactive, with conflicts with his family and friends. He came to the Accidents and Emergencies Service of this hospital accompanied by his father. Evaluation by the Psychiatry Service was requested facing the presence of maniac symptoms (psychomotor anxiety, verbal incontinence, dysphoria and delusions of grandeur). Following evaluation it was decided to send him to the Psychiatric Hospitalization Unit for diagnostic evaluation and treatment. During his hospital stay the patient was diagnosed as having bipolar disorder (in its maniac phase) and a long term treatment was initiated with a mind stabilizer (Valproic acid) and antipsychotic (Risperidone). Following the stay he was sent to the Mental Health Centre for follow up and evaluation of the disease.

Role of the chemokines RANTES, monocyte chemotactic proteins-3 and -4, and eotaxins-1 and -2 in childhood asthma.

Eosinophil recruitment into the airways is a feature of asthma in children. However, the mechanisms by which these cells migrate into the airways are not fully understood. The present study investigated the presence of the eosinophil-activating chemokines regulated on activation, normal T-cell expressed and secreted (RANTES), monocyte chemotactic proteins (MCP)-3 and -4, and eotaxins-1 and -2 in the bronchoalveolar lavage (BAL) fluid obtained from both asthmatic (n=10, age 6-10 yrs) and normal children (n=10, age 5-10 yrs). Measurements of chemokines in BAL fluid showed that levels of RANTES, MCPs-3 and -4, and eotaxins-1 and -2 were significantly increased in fluid obtained from asthmatic children when compared with normal children. Among the different chemokines, RANTES was the cytokine released in greatest quantities in BAL fluid from asthmatic children. There was a significant correlation between the concentrations of MCP-4 and eosinophil numbers in BAL fluid and a trend between both chemokines MCP-3 and eotaxin-2 and eosinophils. Interestingly, the levels of most chemokines correlated with one another. These findings suggest that RANTES monocyte chemotactic proteins-3 and -4, and eotaxins-1 and -2 may regulate eosinophil trafficking into the airways of asthmatic children in a coordinated manner.

[Observer variability in the radiologic interpretation of interstitial lung disease]. / Variabilidad de observadores en la interpretación radiológica de la afección pulmonar intersticial.

OBJECTIVES: To study intra and interobserver variability of two pediatric neumologists in X-ray readings of interstitial lung disease (ILD), to determine the effect of clinical data on the readings, and to evaluate their interpretation in terms of the histopathology diagnosis. DESIGN: Prospective, cross sectional, comparative, blinded. SETTING: The Instituto Nacional de Pediatria of Mexico City. MATERIAL AND METHODS: Chest X-rays of 45 ILD pediatric patients with diagnosis confirmed by open lung biopsy were read by the two observers three times at two weeks intervals and in a randomized fashion. The observers were blinded to previous readings of both observers as well as to the diagnosis. The first two readings were done with no clinical information given to the observers, but some was given for the third reading (age of inception, length of evolution, and main symptoms at time of the X-rays). A classification in one of 5 patterns (lineal, reticular, reticulonodular, grounded glass, honeycomb) was established by the observers. Associations of patterns with anatomopathological diagnosis was explored. Weighted kappa was used in the statistical analysis. RESULTS: With one exception, good agreement (Kw 0.57-0.88) was found intra and interobservers. CONCLUSION: We believe the low variability is the result of the 15 years of shared experience of the two observers participating in this study.

[Asymptomatic bacteriuria or "detected" bacteriuria in the female. Incidence in our health area]. / Bacteriuria asintomática o bacteriuria "detectada" en la mujer. Incidencia en nuestra área de salud.

OBJECTIVES: To determine the incidence of asymptomatic bacteriuria in women consulting at our hospital and its relationship with other chronic diseases. METHODS: A cross-sectional study was conducted on 735 women who had consulted at our hospital from February to September, 1996. Urinary sediment, serial urine culture, serum urea and creatinine values were analyzed. Patient records were reviewed to obtain pertinent data for the study. RESULTS: The incidence of asymptomatic bacteriuria was 8%; 47.4% of the cases were women over 60 years of age. E. coli was identified as the causative organism in 77.9% of the urine cultures. Diabetes mellitus was the most frequent associated chronic disease (27.1%). The incidence of renal damage was not statistically significant and was not directly related with bacteriuria. CONCLUSIONS: We emphasize the importance of performing a urine culture when leukocyturia is detected. The incidence of asymptomatic bacteriuria increases with age. E. coli was the most frequent causative organism. Diabetes mellitus was the most frequent associated chronic disease. The incidence of renal damage was not statistically significant.

Antibody response to Mycobacterium tuberculosis antigens in children with pulmonary tuberculosis and in BCG vaccinated non tuberculous pediatric patients.

In this work we look for the antibody response to M. tuberculosis antigens in 38 children with pulmonary tuberculosis: 18 bacteriologically and 20 clinically diagnosed as compared to the response of 52 children with other respiratory illnesses in which tuberculosis was definitively ruled out. In this control group 24 had been BCG vaccinated and 28 had not. Antibodies were detected by ELISA and immunoblot using a crude extract of M. tuberculosis as antigen. All 38 tuberculous diagnosed children tested positive, by ELISA, to the bacterial extract as did previously vaccinated controls (18/24), while all 28 non vaccinated controls gave negative results (sensitivity = 1.0, specificity = 0.68). By Western blot, tuberculous patients recognized a 12 kDa protein that was not recognized by the control vaccinated group. This partially purified protein which was used in an ELISA resulted positive in all 18 bacteriologically, in 17/20 clinically diagnosed patients, and in only 6/24 vaccinated controls. Specificity increased to 0.86, with a sensitivity of 0.93.

Efecto de la inmunosupresión con azatioprina-prednisona sobre la anastomosis bronquial telescopiada en el trasplante pulmonar unilateral experimental / Effect of immunosuppresion with azatioprine-prednisone on bronchial anastomosis in experimental unilateal pulmonary transplant

El efecto de altas dosis de azatioprina - prednisona sobre la anastomosis bronquial en el transplante pulmonar fue investigada en el presente trabajo en diez perros. Se realizó un trasplante pulmonar unilateral con anastomosis realizada en forma telescopiada en todos los casos. No observamos complicaciones en el seguimiento de los animales hasta los 18 meses, a pesar de las altas dosis de inmunosupresión

[Prune belly syndrome associated with cystic adenomatoid malformation of the lung and pulmonary sequestration]. / Síndrome de "prune belly" asociado a malformación adenomatoide quística pulmonar y secuestro pulmonar.

The "prune belly" syndrome classically described in males, has also been described in female patients with a variable incidence. Associations with multiple respiratory tract malformations have been reported which together with urinary tract anomalies and renal failure are often the cause of early mortality. We report the case of a female patient with prune belly in association with cystic adenomatoid malformation of the lung and pulmonary sequestration with a favorable clinical evolution following medical and surgical treatment.

[Foreign bodies in digestive tract of pediatric patients]. / Cuerpos extraños en vías digestivas en el paciente pediátrico.

We present our experience in the endoscopic management of 421 children with upper gastrointestinal foreign bodies. Only in the 1% of the cases (5 patients) we had complications who needs surgical intervention. We found a 1.5:1 ratio in male/female and the highest prevalence in the 2 to 5 years group. Most common foreign bodies were coins and small metallic objects (59%) followed by small plastic by objects (35%) and seeds, fish bones and meat in 6%, meat in 6%.

Osler-Weber-Rendu disease in an infant.

A 23-month-old girl with Osler-Weber-Rendu (OWR) disease manifested by hemoptysis died of massive pulmonary hemorrhage. Autopsy showed predominant respiratory tract involvement, but telangiectatic vessels were also present in other sites. Skin lesions were absent. A grandfather had died after bleeding by mouth following physical exertion. This disease seldom appears in children and hemorrhage usually manifests after 30 years of age.