Ankle movement alterations during gait in children with acute lymphoblastic leukemia with suspected peripheral mononeuropathy. A cross-sectional study.

BACKGROUND: Peripheral neuropathy due to chemotherapeutic drugs causes alterations in ankle movement during gait. This study aimed to describe the spatiotemporal parameters and ankle kinematics during gait in schoolchildren with acute lymphoblastic leukemia with clinically suspected peripheral neuropathy. METHODS: In children with acute lymphoblastic leukemia in the maintenance phase, we calculated spatiotemporal and kinematic parameters of the ankle during gait using Kinovea® software. Furthermore, we identified alterations in the parameters obtained considering the values of the normality data from a stereophotogrammetry system as the reference values. Finally, we represented the kinematic parameters of the ankles calculated with Kinovea® compared to the normality values of the stereophotogrammetry. FINDINGS: We evaluated 25 schoolchildren; 13 were male (52.0%) with a median age of 88.0months and a median of 60.0 weeks in the maintenance phase, and 54.8% were classified as standard risk. Spatiotemporal parameters: cadence (steps/min), bilateral step length (m), and average gait speed (m/s) in ALL children were significantly lower than reference values (p < 0.001). Except for right mid-stance and bilateral foot strike, initial swing showed that both ankles maintained plantar flexion values during gait, significantly lower in ALL patients (p < 0.05). INTERPRETATION: We identified spatiotemporal and kinematics alterations in schoolchildren with acute lymphoblastic leukemia during all phases of the gait suggestive of alteration in ankle muscles during movement, probably due to peripheral neuropathy; nevertheless, our results should be taken with caution until the accuracy and reliability of Kinovea® software as a diagnostic test compared to the stereophotogrammetric system in children with ALL and healthy peers is proven.

Description of the initial approach to patients with suspected child abuse in the emergency department of a pediatric hospital.

BACKGROUND: Child abuse is one of the leading causes of morbidity and mortality worldwide. This study aimed to identify whether the approach to the diagnosis of child abuse was comprehensive in a tertiary care hospital. METHODS: We conducted a retrospective study of patients with a final diagnosis of child abuse admitted through the emergency department. RESULTS: A total of 73 confirmed cases were analyzed. We observed a predominance of female patients (65.8%). Physical abuse was the most common type of abuse (80.8%). Complete blood count and a nutritional status analysis were recorded in 100% of the patients and coagulation times in 43%; however, no patient had a thorough bone series study. CONCLUSIONS: According to the evidence found in medical records, gaps were detected in the approach to patients with suspected child abuse upon arrival at the emergency department. For this reason, all areas where pediatric medical care is provided should have tools that offer agility and ease of diagnosis.

INTRODUCCIÓN: El maltrato infantil es una de las principales causas de morbilidad y mortalidad en todo el mundo. El objetivo de este estudio fue identificar si el abordaje del diagnóstico de maltrato infantil se realizó de manera completa en un hospital de tercer nivel de atención. MÉTODOS: Se llevó a cabo un estudio retrospectivo de pacientes con el diagnóstico final de maltrato infantil que ingresaron a través del servicio de urgencias. RESULTADOS: Se analizaron 73 expedientes. Se observó un predominio de pacientes del sexo femenino (65.8%). El maltrato físico fue el tipo de maltrato más común (80.8%). Se registraron los datos de hemograma y estado nutricional en el 100% de los pacientes y de tiempos de coagulación en el 43%; sin embargo, no se registró en ningún paciente el dato de una serie ósea completa. CONCLUSIONES: Según las evidencias encontradas en los expedientes clínicos, se detectaron lagunas en el abordaje de los pacientes con sospecha de maltrato infantil a su llegada al servicio de Urgencias. Por este motivo, todas las áreas donde se brinda atención médica pediátrica deberían contar con herramientas que ofrezcan agilidad y facilidad para realizar el diagnóstico.

Trends in Medical Specialization and Employability in Mexico According to Gender.

BACKGROUND: Feminization of medicine is a worldwide phenomenon. Countries must consider feminization of medical specializations in the planning of health public politics. OBJECTIVE: To analyze trends in medical specialization and employability in México according to gender. METHOD: We analyzed the electronic repositories of students and hired physicians at IMSS from 2006-2020. RESULTS: 42,647 specialists graduated in the period. The percentage of women increased 3% in medical specializations and 9% in surgical ones. Women significatively predominate in first entry and controllable lifestyle specialization. The percentage of hired women physicians increased 14 and 17% in leadership positions. CONCLUSIONS: There is a steady increase in feminization of medical specialization. To date, 52% of residents, 48% of hired physicians and 42% of leaders are women.

A Rare Cause of Angina: A Single Coronary Artery in Congenitally Corrected Transposition of the Great Arteries.

We report a man with congenitally corrected transposition of the great arteries and moderate anteroseptal ischemia; and cardiac computed tomography showed a single coronary artery with origin from the right aortic sinus. The perfusion of the morphological right ventricle by a single right coronary artery may be a cause of ischemia. (Level of Difficulty: Beginner.).