A retrospective review of rattlesnake bites in 100 children.

BACKGROUND: A retrospective review of clinical features and treatment of children hospitalized for rattlesnake bite. METHODS: One hundred clinical records were reviewed. Variables included: age, gender, season of the year, signs, symptoms, poisoning grade, complications, treatment and sequelae. RESULTS: Fifty-nine percent were males and 37% were less than 5 years of age; 87% occurred in rural areas; 63% of the snakebites occurred during the summer, of them, 39% occurred within the perimeter of the domicile and 8% within the home. Sixty-seven percent of children bitten by snakes reached the second degree of envenomation. During the first period (1977-1996), treatment for intoxication included treatment with polyvalent equine anti-snake venom serum. During the second period (1997-2014, a polyvalent polyclonal horse anti-snake venom F(Ab) was used. The second period hospitalization time was reduced to 3.9 days (P<0.0001). Hematological complications dominated during the first period (P=0.093) with wound infections occurring in 26% of the cases, neurological symptoms in 24 %, fasciotomy in 6% and mortality in 1%. The second degree poisoning was more frequent and was more severe in 7% of the patients. It was determined that the best treatment for snakebite was F(Ab') 2 therapy. Mortality occurred in 1% of the cases. CONCLUSIONS: Rattlesnake (Crotalus sp.) bite, in Mexico is less frequent as compared to other crotalidae species. The hematological complications are more frequent. We did not observe any recurrent phenomenons.

[Indicators of obsolescence of the medical literature in a mexican pediatric journal]. / Indicadores de obsolescencia de la literatura médica en una revista pediátrica mexicana.

INTRODUCTION: Obsolescence is the decrease of the validity of the information in time and is known as literature aging. OBJECTIVES: To analyze the obsolescence of the literature of original articles published in 10 years in a Mexican pediatric journal. MATERIAL AND METHODS: Articles published in the Clinical Bulletin of Sonora Children's Hospital (BCHIES) were analyzed. The variables were: year, volume, number, percentage of original articles, reference year, total of references per article, operational and file; articles citations and self-citations, Price Indices, Burton-Kebler and Brookes, half-life, and aging factor. RESULTS: The 87 original articles (37%) contained 1,726 references, and the average was 19.8 per article; operational references were 398 (23%) and the file references, 1,287 (74.5%). There were 30 (34.4%) citations to articles, and self-citations were 19 (21%), half-life, 13.2 years; the aging factor was 0.86, the annual loss of income was 14%. CONCLUSIONS: The percentage of original articles from the BCHIES is close to 40%, likely to improve, and in the literature archive, the aging factor reversed.

Mutations in the gene encoding the lamin B receptor produce an altered nuclear morphology in granulocytes (Pelger-Huët anomaly).

Pelger-Huët anomaly (PHA; OMIM *169400) is an autosomal dominant disorder characterized by abnormal nuclear shape and chromatin organization in blood granulocytes. Affected individuals show hypolobulated neutrophil nuclei with coarse chromatin. Presumed homozygous individuals have ovoid neutrophil nuclei, as well as varying degrees of developmental delay, epilepsy and skeletal abnormalities. Homozygous offspring in an extinct rabbit lineage showed severe chondrodystrophy, developmental anomalies and increased pre- and postnatal mortality. Here we show, by carrying out a genome-wide linkage scan, that PHA is linked to chromosome 1q41-43. We identified four splice-site, two frameshift and two nonsense mutations in LBR, encoding the lamin B receptor. The lamin B receptor (LBR), a member of the sterol reductase family, is evolutionarily conserved and integral to the inner nuclear membrane; it targets heterochromatin and lamins to the nuclear membrane. Lymphoblastoid cells from heterozygous individuals affected with PHA show reduced expression of the lamin B receptor, and cells homozygous with respect to PHA contain only trace amounts of it. We found that expression of the lamin B receptor affects neutrophil nuclear shape and chromatin distribution in a dose-dependent manner. Our findings have implications for understanding nuclear envelope-heterochromatin interactions, the pathogenesis of Pelger-like conditions in leukemia, infection and toxic drug reactions, and the evolution of neutrophil nuclear shape.

[Stevens-Johnson syndrome and toxic epidermal necrolysis in children]. / Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica en los niños.

The Stevens-Johnson syndrome (SJS) and the toxic epidermal necrolysis (TEN) are clinical conditions manifesting as adverse cutaneous reaction to drugs in majority of cases, constituting the same clinical spectrum, differing only in the severity of epidermolysis; both conditions are distinguished by their severity and extensiveness of skin lesions; it can also involve mucous membranes of eyes, respiratory, digestive and urogenital tracts. Two per 1,000,000 are affected annually, among them approximately 20% are children and both of them are considered as potentially fatal medical emergency conditions. Even though the condition was described 89 years ago, until now the exact pathophysiology has not been completely explained. An immune-mediated mechanism has been implicated in its origin, which involves cytotoxic lymphocytes, cytokines, Fas-ligand in keratinocyte apoptosis; genetic makers also has been identified in some racial groups (HLA-B*1520, HLA-B*5801) in relationship with specific susceptibility to certain drugs such as carbamazepine, allopurinol. In children there are no uniform criteria for classification of the skin lesions, neither for the treatment, however recently the authors describe better response of the patients with use intravenous immunoglobulin (IGIV).

Giardia lamblia infection and its implications for vitamin A liver stores in school children.

BACKGROUND: Vitamin A deficiency (VAD) is a nutritional problem affecting the health of people in developing countries because VAD compromises innate and adaptive immunity, increasing a person's predisposition toward infectious diseases. In addition, a high prevalence of infectious diseases continues to be a problem in developing countries, including Giardia lamblia. G. lamblia may be related to VAD because of its ability to change the intestinal architecture, thereby compromising the absorption of vitamin A. The aim of this study was to evaluate the effect of giardiasis on serum retinol levels and vitamin A liver stores in school children. METHODS: Thirty Giardia-infected school children participated in this study. Vitamin A liver stores were evaluated with the modified relative dose response (MRDR) technique, and antiparasitic treatment was administered. In addition, anthropometric and dietary data were collected. RESULTS: According to anthropometric indicators (age-appropriate Z scores for weight, height and body mass index) and daily vitamin A intake, the children had a normal nutritional status. Although the mean serum retinol levels did not change significantly after treatment for Giardia (p > 0.05), the MRDR values showed significant improvement (p < 0.002). CONCLUSION: Giardiasis not only compromises the vitamin A status through intestinal malabsorption, it also causes profound mobilization of liver retinol stores.

Transglutaminase treatment of wheat and maize prolamins of bread increases the serum IgA reactivity of celiac disease patients.

Celiac disease (CD) is mediated by IgA antibodies to wheat gliadins and tissue transglutaminase (tTG). As tTG is homologous to microbial transglutaminase (mTG) used to improve foodstuff quality, it could elicit the immune response of celiac patients. This study evaluated the reactivity of IgA of celiac patients to prolamins of wheat and gluten-free (maize and rice flours) breads mTG-treated or not. Prolamins extracted from wheat and gluten-free breads were analyzed by ELISA and immunodetected on membranes with individual or pooled sera from nine celiac patients recently diagnosed. Sera pool IgA titers were higher against prolamins of mTG-treated wheat or gluten-free breads than against mTG-untreated, mainly due to two individual patients' sera. The electrophoretic pattern of gluten-free bread prolamins was changed by the mTG treatment, and a new 31000 band originated in maize was recognized by three CD patients' IgA.

Assessment of the Sensitizing Potential of Proteins in BALB/c Mice: Comparison of Three Protocols of Intraperitoneal Sensitization.

Most food allergy cases are associated with a limited group of allergens. This could be attributed to an increased ability of some foods to sensitize and trigger allergic reactions. However, there are no validated animal models to evaluate the sensitizing or allergenic potentials of proteins. Our aim was to evaluate three protocols of adjuvant-free intraperitoneal sensitization that differ in the time points for sample collection (days 14, 28 and 35 from beginning of the sensitization) and also in the number of immunizations (2, 5 and 3, respectively). Ovalbumin (OVA; 0.05 mg), cow milk proteins (CMP; 0.025, 0.05 and 0.25 mg), and potato acid phosphatase (PAP; low allergenic protein; 250.0 mg) were administered intraperitoneally (ip) to BALB/c mice (n = 4⁻6) and the protein-specific IgE and IgG antibody responses were evaluated using ELISA. Additional serum protein-specific IgE antibodies evaluations were carried out after IgG depletion. Anti-OVA IgE antibodies were detected in mice from all three protocols. The responses were higher in the group of mice that underwent the 28-day protocol than in those that underwent the 14- or 35-day protocols (p < 0.01 and p < 0.05, respectively). Anti-CMP IgE antibodies were detected in both the 14- and 28-day protocols, but the response was higher in the group that underwent the 28-day protocol (p < 0.001). The anti-CMP IgE antibody response detection was improved after serum IgG depletion (p < 0.001). Anti-PAP IgE antibodies were not detected. Mice with undetectable serum levels of protein-specific IgE triggered anti-OVA, -CMP, and -PAP IgG responses. An adjuvant-free 28-day protocol with five ip immunizations seems appropriate for evaluation of the inherent sensitizing or allergenic capacity of the studied proteins. Reproducible results were obtained utilizing the BALB/c mouse strain. Inter-laboratory studies including a larger number of proteins should be carried out to validate this model.

Food Allergy Prevalence in Salvadoran Schoolchildren Estimated by Parent-Report.

The prevalence of food allergy (FA) has not been estimated at a population level in Central American countries and, consequently, the magnitude and relevance of the problem in the Central American region remains unknown. Thus, our aim was to evaluate the parent-reported prevalence of FA in a population of schoolchildren from the Central American country El Salvador. A Spanish version of a structured questionnaire was utilized. Five hundred and eight (508) parents returned the questionnaire with valid responses (response rate, 32%). The estimated prevalence rates (95% CI) were: adverse food reactions 15.9 (13.0⁻19.3), "perceived FA, ever" 11.6 (9.1⁻14.6), "physician-diagnosed FA, ever" 5.7% (4.0⁻8.0), "immediate-type FA, ever" 8.8% (6.6⁻11.6), "immediate-type FA, current" 5.3% (3.6⁻7.6), and anaphylaxis 2.5% (1.5⁻4.3). The most common food allergens were milk (1.7%), shrimp (1.3), chili (0.7%), chocolate (0.7%), and nuts (0.3%). Most of the "food-dependent anaphylaxis" cases (60.5%) sought medical attention, but only one case reported the prescription of an epinephrine autoinjector. Mild and severe FA cases are not uncommon among Salvadoran schoolchildren and both the prescription of epinephrine autoinjectors by healthcare personnel and the use of the autoinjectors by anaphylactic individuals should be encouraged.

[Detection of Helicobacter pylori in children and adolescents using the monoclonal coproantigen immunoassay and its association with gastrointestinal diseases]. / Detección de Helicobacter pylori en niños y adolescentes mediante coproantígeno monoclonal y su asociación con gastropatías.

BACKGROUND: Infection by Helicobacter pylori (H. pilory) affects 50% of the world population. Simple methods for its detection are now available. OBJECTIVES: To identify H. pylori by using a monoclonal coproantigen technique in paediatric patients, and to determine its association with gastrointestinal diseases. MATERIALS AND METHODS: The study included a total of 110 subjects aged 1 to 18 years. The study variables included: Family history of gastrointestinal disease, age, gender, gastrointestinal symptoms, as well as apparently healthy (asymptomatic) subjects. The monoclonal coproantigen test was performed on stool samples. Two groups, I symptomatic (n=29), and II asymptomatic (n=81) were compared using parametric and non-parametric statistics. RESULTS: Of the 110 patients, 59 (54%) were male. The relationship between a family history of gastritis and a positive for H. pylori, was significant for mothers (p<0.0005), fathers (p<0.0001), and paternal grandfathers (p<0.0001). It was significant for gastric cancer in maternal grandparents (p<0.0178) and paternal grandparents (p<0.0092). The monoclonal coproantigen test was positive in 31 (28.2%) of the subjects. All were positive in group I, and only 2 in group II. A significant positive association was observed between H. pylori and various signs and symptoms, such as epigastric pain (p<0.001), recurrent peri-umbilical pain (p<0.001), bloating (p=0.016), heartburn (p=0.0007), nausea (P=0.0061), diarrhoea (p=0.0389), and constipation (p=0.0019). CONCLUSIONS: H. pylori detection, was positive in 28% of both groups, and showed significant relationships with family gastrointestinal diseases and gastrointestinal symptoms.

Syneresis in Gels of Highly Ferulated Arabinoxylans: Characterization of Covalent Cross-Linking, Rheology, and Microstructure.

Arabinoxylans (AXs) with high ferulic acid (FA) content (7.18 µg/mg AXs) were cross-linked using laccase. Storage (G') modulus of AX solutions at 1% (AX-1) and 2% (AX-2) (w/v) registered maximum values of 409 Pa and 889 Pa at 180 min and 83 min, respectively. Atomic force microscopy revealed the grained and irregular surface of the AX-1 gel and the smoother surface without significant depressions of the AX-2 gel. Cured AX gels exhibited a liquid phase surrounding the samples indicating syneresis. The syneresis ratio percentage (% Rs) of the gels was registered over time reaching stabilization at 20 h. The % Rs was not significantly different between AX-1 (60.0%) and AX-2 (62.8%) gels. After 20 h of syneresis development, the dimers of the FA in the AX-1 and AX-2 gels significantly increased by 9% and 78%, respectively; moreover, the trimers of the FA in the AX-1 and AX-2 gels, by 94% and 300%, respectively. Scanning electron microscopy showed that, after syneresis stabilization, AX gels presented a more compact microstructure. Syneresis development in the gels of highly ferulated AXs could be related to the polymer network contraction due to the additional formation of dimers and trimers of the FA (cross-linking structures), which may act like a "zipping" process, increasing the polymer chains' connectivity.

[Poisoning caused by Latrodectus Mactans (Black Widow) spider bite among children. Clinical features and therapy]. / Envenenamiento en niños por mordedura de la araña "Latrodectus Mactans" (Viuda Negra). Características clínicas y tratamiento.

INTRODUCTION: Poisoning caused by "black widow" spider bite, is not commonly observed during childhood, it is not exempt from complications, and must be treated in time or the patient can die. In Mexico we do not have accurate data on the exact number of accidents due to this condition. OBJECTIVE: Identify the signs and characteristic symptoms of children treated at the Children's Hospital from the state of Sonora with the aim of starting early treatment. MATERIAL AND METHODS: We reviewed 43 clinical records of hospitalized patients admitted for "black widow " spider bite between 1978 - 2004. Demographic variables were: age, gender, place of origin, place where accident took place, treatment given prior to hospital admittance, degree of envenomation measured by signs and symptoms, treatment and clinical evolution. RESULTS: 69.7% of cases were male, we did not find differences in the number of patients between infant, pre-school, elementary school children and teenagers. During summer and afternoon hours we registered 44% and 37% cases respectively; 74% patients were poisoned by the spider at home; the anatomical areas most affected were: arms, hands and thorax. Signs and symptoms in infants were: irritability, constanty cry, sialorrea, agitation erythema on wounded areas and seizures. Among elementary school children and teenagers signs included pain in wounded area, abdominal and thoracic, muscle spasms, fine tremor and residual signs. Patients who received fabotherapic treatment had better evolution and less time of hospitalization. No deaths were reported. CONCLUSIONS: The different signs and symptoms between infants, preschool, elementary school children and teenagers allowed us to clearly identify evenommation and differentiate it form confounding diseases. In our study, specific fabotherapy constituted the best treatment choice.

In vitro degradation of covalently cross-linked arabinoxylan hydrogels by bifidobacteria.

Arabinoxylan gels with different cross-linking densities, swelling ratios, and rheological properties were obtained by increasing the concentration of arabinoxylan from 4 to 6% (w/v) during oxidative gelation by laccase. The degradation of these covalently cross-linked gels by a mixture of two Bifidobacterium strains (Bifidobacterium longum and Bifidobacterium adolescentis) was investigated. The kinetics of the evolution of structural morphology of the arabinoxylan gel, the carbohydrate utilization profiles and the bacterial production of short-acid fatty acid (SCFA) were measured. Scanning electron microscopy analysis of the degraded gels showed multiple cavity structures resulting from the bacterial action. The total SCFA decreased when the degree of cross-linking increased in the gels. A slower fermentation of arabinoxylan chains was obtained for arabinoxylan gels with more dense network structures. These results suggest that the differences in the structural features and properties studied in this work affect the degradation time of the arabinoxylan gels.

[Rattlesnake bite poisoning, health damage and treatment in children]. / Envenenamiento por mordedura de serpiente de cascabel, daños a la salud y su tratamiento en edad pediátrica.

INTRODUCTION: In Mexico, we do not know the exact number of cases and the magnitude of health damage conditioned by poisonous rattlesnake bites, and little relative information exists in pediatric population. OBJECTIVE: To inform on continued follow-up of 55 patients at a children's hospital, and to propose a therapeutic sequence adequate for children. MATERIALS AND METHODS: We reviewed clinical records and variables were origin, age, sex, time of year, previous care measures, time passed, hospital treatment complications and care cost. RESULTS: Rattlesnake bite occurred around the home at times and at times inside the home in rural areas; we did not observe any noticeable difference in gender; snake variety most involved was Crotalus atrox, anatomic site most injured were the lower extremities in 78%. Prior to admission, 50% received insufficient antivenom serum doses; the most frequent complication was hematologic in 69%. One patient died with multiple organ failure and disseminated intravascular coagulation (DIC). The treatment protocol that we have recommended since 1986 at the Hospital Infantil del Estado de Sonora, revised and modified in 1996, reduced hospital stay from 15 to 5 days. CONCLUSION: The protocol used avoided further complications and had a favorable influence on cost reduction.

[Treatment of iron deficiency in preschool children with a weekly dose of ferrous sulfate]. / Tratamiento de la deficiencia de hierro en preescolares con dosis semanal de sulfato ferroso.

INTRODUCTION: Iron deficiency is the most frequent haematological disease during the paediatric age and is a health public problem; the iron deficiency has a special interest during early development of human beings; in recent years the group of research recommend intermittent treatment, with ferrous sulphate every week because is more easily adhesion to treatment. OBJECTIVE: To know iron concentration in plasma after treatment, given oral ferrous sulphate daily and single dose every week. METHODS AND MATERIAL: We established two groups A and B, with ten iron deficiency pre-school children each one. RESULTS: Group A: the children received oral ferrous sulphate twice a day during three months; the doses were 3.5 mg of ferric iron per kilogram of weight in children with ages less of three years old, and 2.5 mg/kg/day in children with three to five years old. After the treatment all the patients improved haemoglobin, ferritin an iron concentrations (p = 0.001). Group B: The patient received the some dose per kilogram of weight like that of group A, in a single dose weekly for three months, there was an improvement in haemoglobin not reaching normal levels, half of the patients improved iron and ferritin observing statistical significance; haemoglobin (p = 0.001) iron (p = 0.062) and ferritin (p = 0.01). CONCLUSION: The administration of ferrous sulphate daily provide an positive balance of iron status for the group A. Group B: that they received iron weekly dose showed changes to positive balance of iron status with a statistical significance, it is probably that the half doses of ferrous sulphate also improve the anaemia by iron deficiency.

[Persistent hyperinsulinemic hypoglycemia. Two case reports]. / Hipoglucemia hiperinsulinémica persistente. Informe de dos casos.

We report two cases of infants who presented seizures and persistent hypoglycemia. In both infants, we established diagnosis of persistent hypoglycemia by hyperinsulinism (PHH); glycemic/insulinic ratio was > 0.3, and we found no pancreatic changes by means of other diagnostic procedures. The medical treatment consisted of hydrocortisone, diazoxide, and octreotide without response. Definitive treatment made was sub-total pancreatectomy; postoperatory evolution was satisfactory, and the histologic report showed changes in Langerhans islet of nesidioblastosis. We conclude that PHH and glucose/insulin ratio > 0.3 indicates that surgical treatment with pancreatectomy should not be delayed.

[A review of Kawasaki disease, a perspective from the articles published in Mexico since January 1977 to May 2012]. / Revisión de la enfermedad de Kawasaki en México, desde la perspectiva de las publicaciones médicas (enero de 1977 a mayo de 2012).

Kawasaki disease was described in 1967 by Tomisu Kawasaki. It affects children aged between one and 5 years, and it evolves with fever and small vessel vasculitis, which leads to cardiovascular complications, including coronary aneurisms, myocarditis, valve injuries, pericardial effusion and myocardial infarction; eventually involving many others organs. The etiology actually is not well known, as the exactly pathogenic mechanisms; however, now there are important advances. If the clinical signs and symptoms are identify early and the children received treatment with aspirin and intravenous immunoglobulin, the patients evolves without sequels. The Kawasaki disease is an infrequent disease in Mexico.

Usefulness of second lymph node biopsy with a prior report of reactive lymphoid hyperplasia in pediatric patients.

BACKGROUND: Physicians in daily practice frequently attend children who present an increase in lymph node size. Care should be taken to determine which children require biopsy. Our objective was to analyze the usefulness of the peripheral lymph node biopsy in pediatric diagnosis. METHODS: We reviewed histological reports of 364 lymph node biopsies. Variables were age, sex, lymphadenopathy evolution time, laboratory and imaging studies, and histopathology diagnoses. Parametric and nonparametric tests were used. RESULTS: There were 211 males (57.9 %) and 153 females (42.0 %), the 1- to 6-year age group included 50.8% of cases. Average disease-evolution time was 5 months, and the predominant anatomic site was the cervical region. Histological report was reactive lymphoid hyperplasia (RLH) in 46.9%, followed by neoplasms in (24%), and granulomas (14.5%). Other diagnoses and normal lymph nodes represented 14.6 %. Of the 95 patients with high-risk lymphadenopathy, 29 cases had oncological diagnoses. Spearman coefficient was R(2) = 0.3485. To obtain a specific diagnosis indicates the probability of disease in lymph nodes of risk areas. However, the majority of the diagnoses were obtained from lymph nodes in different areas (Fisher's test, p <0.001). In 25 children with RLH, the binominal probability of diagnosis in the second biopsy was p = 0.0493. There was a >75% chance for detecting disease. CONCLUSIONS: Peripheral lymph nodes in high-risk regions indicate probability relationship for determining disease. In persistent lymphadenopathy with an initial report of RLH, it is important to consider a second biopsy with high probability for obtaining a specific diagnosis.