Mexican consensus on cow’s milk protein allergy

Background: The aim of this study is to present the current views of a diverse group of experts on the diagnosis and treatment of Cow’s Milk Protein Allergy (CMPA) in children under 2 years of age in Mexico. Material and methods: The study, led by a scientific committee of five experts in CMPA, was divided into six phases, including a modified Delphi process. A total of 20 panelists, all of whom were pediatric specialists, participated in administering a comprehensive 38-item questionnaire. The questionnaire was divided into two blocks: Diagnosis and Treatment (20 items each). Results: Consensus was reached on all the proposed items, with an agreement rate of over 70% for each of them. As a result, a diagnostic and treatment algorithm was developed that emphasized the reduction of unnecessary diagnostic studies and encouraged breastfeeding whenever possible. In cases where breast milk is not available, appropriate use of hypoallergenic formulas was recommended. In addition, recommendations on treatment duration and gradual reintroduction of cow’s milk protein were provided. Conclusions: The recommendations endorsed by 20 Mexican pediatricians through this study are applicable to everyday clinical practice, thereby enhancing the diagnosis and treatment of children under 2 years of age with CMPA. This, in turn, will foster improved health outcomes and optimize the utilization of healthcare resources (AU)

Nutritional benefits in pediatric patients with percutaneous endoscopic gastrostomy placement.

Gastrostomy is an enteral nutrition option. Indications for its placement are diverse, among them, the alteration in the mechanics of swallowing, frequently present in patients with neurological diseases. Nutritional recovery is the objective in these patients evaluating the nutritional status after the placement of a PEG in the pediatric population. This is a retrospective cohort conducted to evaluate nutritional recovery in pediatric patients with PEG placement. It was performed using anthropometric and biochemical parameters before and after placement. Forty-seven subjects were included, from which weight, height, and upper arm circumference were obtained, to evaluate nutritional recovery using BMI or W/L according to age. Significant nutritional improvement was demonstrated in a population of 39 patients, who had a mean follow-up of 7 months. In our population, PEG is an enteral nutrition strategy that has a significant positive impact on nutritional status in a mean of 7 months after its placement. Therefore, considering the evolution time of these patients will guide the clinician in making decisions regarding surveillance and monitoring parameters of the nutritional status.

Anomalía de Ebstein en un paciente con síndrome de Down. Reporte de un caso / Ebstein's anomaly in a patient with Down syndrome. Case report

Resumen Paciente con síndrome de Down referido a nuestro departamento con cianosis y soplo cardíaco. Un ecocardiograma transtorácico mostró anomalía de Ebstein. Esta asociación es extremadamente rara. Se inició manejo médico ya que la lesión en la válvula tricúspide era leve. De acuerdo con nuestra revisión, se han descrito únicamente 12 casos en literatura médica.

Abstract An infant with Down's syndrome was referred to our department with cyanosis and heart murmur. A transthoracic echocardiogram demonstrated the presence of Ebstein's anomaly. This association is extremely unusual. Medical management was initiated since the tricuspid valve lesion was mild. Only twelve cases, to our knowledge, have been previously reported.

Stress myocardial blood flow correlates with ventricular function and synchrony better than myocardial perfusion reserve: A Nitrogen-13 ammonia PET study.

BACKGROUND: Cardiac PET quantifies stress myocardial blood flow (MBF) and perfusion reserve (MPR), while ECG-gated datasets can measure components of ventricular function simultaneously. Stress MBF seems to outperform MPR in the detection of significant CAD. However, it is uncertain which perfusion measurement is more related to ventricular function. We hypothesized that stress MBF correlates with ventricular function better than MPR in patients studied for suspected myocardial ischemia. METHODS: We studied 248 patients referred to a rest and adenosine-stress Nitrogen-13 ammonia PET. We performed a multivariate analysis using systolic function (left ventricular ejection fraction, LVEF), diastolic function (mean filling rate in diastole, MFR/3), and synchrony (Entropy) as the outcome variables, and stress MBF, MPR, and relevant covariates as the predictors. Secondarily, we repeated the analysis for the subgroup of patients with and without a previous myocardial infarction (MI). RESULTS: 166 male and 82 female patients (mean age 63 ± 11 and 67 ± 11 year, respectively) were included. 60% of the patients presented hypertension, 57% dyslipidemia, 21% type 2 diabetes mellitus, 45% smoking, and 34.7% a previous MI. Mean stress MBF was 1.99 ± 0.75 mL/g/min, MPR = 2.55 ± 0.89, LVEF = 61.6 ± 15%, MFR/3 = 1.12 ± 0.38 EDV/s, and Entropy = 45.6 ± 11.3%. There was a significant correlation between stress MBF (P < .001) and ventricular function. This was stronger than the one for MPR (P = .063). Sex, age, diabetes, and extent of previous MI were also significant predictors. Results were similar for the analyses of the 2 subgroups. CONCLUSION: Stress MBF is better correlated with ventricular function than MPR, as evaluated by Nitrogen-13 ammonia PET, independently from other relevant cardiovascular risk factors and clinical covariates. This relationship between coronary vasodilatory capacity and ventricular function is sustained across groups with and without a previous MI.