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.

Impairments in fine motor skills in children with Acute Lymphoblastic Leukaemia. A cross-sectional study.

AIM: We evaluated fine motor skills; precision, motor integration, manual dexterity, and upper-limb coordination according to sex and risk stratification in children with Acute Lymphoblastic Leukaemia (ALL). METHODS: We evaluated twenty-nine children in the maintenance phase aged 6 to 12 years with the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2), and sex and age-specific norm values of BOT-2 were used to compare our results. RESULTS: We found lower scores on the upper-limb coordination subtest, p = 0.003 and on the manual coordination composite, p = 0.008, than normative values. Most boys performed "average" on both the subtests and the composites, but girls showed lower scores with a mean difference of 7.69 (95%CI; 2.24 to 3.14), p = 0.009. Girls' scale scores on the upper-limb coordination subtest were lower than normative values, with mean difference 5.08 (95%CI; 2.35 to 7.81), p = 0.006. The mean standard score difference in high-risk patients was lower than normative on the manual coordination composite, 8.18 (95%CI; 2.26 to 14.1), p = 0.015. High-risk children also performed below the BOT-2 normative on manual dexterity 2.82 (95%CI; 0.14 to 5.78), p = 0.035 and upper limb coordination subtest 4.10 (95%CI; 1.13 to 7.05), p = 0.028. We found a decrease in fine motor precision in children with a higher BMI, rho= -0.87, p = 0.056 and a negative correlation between older age and lower manual dexterity, r= -0.41 p = 0.026; however, we did not find any correlation with the weeks in the maintenance phase. CONCLUSIONS: Fine motor impairments are common in children with ALL in the maintenance phase; it is important to identify these impairments to early rehabilitation.

Differences in the absolute muscle strength and power of children and adolescents with overweight or obesity: a systematic review.

This study aimed to describe absolute muscle strength and power in children and adolescents with obesity, overweight and normal weight, and the assessment tests and tools used. We retrieved observational studies from MEDLINE (PubMed), TripDataBase, Epistemonikos, EBSCO essentials, NICE, SCOPUS, and LILACs up to February 2023. In addition, we recovered data from studies with at least three comparison groups (obesity, overweight, normal weight) and with a description of the absolute muscle strength and power and the assessment tests and instruments used. The methodologic quality of the studies was assessed with the Joanna Briggs checklist, and the review was carried out using the PRISMA 2020 methodology. Eleven studies with 13,451 participants from 6 to 18 years of age were once included, finding that the absolute muscle strength of their upper extremities was greater when they were overweight or obese; however, in the same groups, absolute muscle strength was lower when they carried their body weight. In addition, lower limb absolute muscle strength was significantly lower in obese participants than in normal weight, regardless of age and gender. The most used tools to measure the absolute muscle strength of the upper limbs were the grip dynamometers and push-up exercises. In contrast, different jump tests were used to measure the power of the lower limbs. There are great differences in muscle strength and power between overweight or obese children and adolescents and those with normal weight. Therefore, it is recommended to use validated tests, preferably that assess strength through the load of the patient's body weight, either of the upper or lower limbs, for greater evaluation objectivity that facilitates the management of these children and adolescents.

Association between physical activity and affects in college students during the COVID-19 pandemic: A cross-sectional study / Asociación entre actividad física y afectos en estudiantes universitarios durante la pandemia de COVID-19: estudio transversal

Abstract Introduction The COVID-19 pandemic has negatively impacted physical and mental health worldwide. It is essential to continue exploring the population's psychological manifestations and the pandemic's impact on lifestyles (physical activity, quality of sleep). Objective This research aimed to describe the relationship between affect (positive and negative) and physical activity (PA) in college students during the COVID-19 pandemic. Method A cross-sectional survey was conducted on health sciences students from three universities in Mexico and Colombia. PA was assessed using the short version of the International Physical Activity Questionnaire (IPAQ-S), and affects were measured using the PANAS index. A logistic regression model was used to assess the association between PA and affect. Results We included 430 participants between 16 and 40 years. We found no differences between the male and female participants regarding age, weight (BMI), PA, or the number of hours of sitting per day. The monthly consumption of alcohol and tobacco was more frequent in males (p < .05), and women expressed having worse sleep quality (p < .05). Adjusting for the number of hours spent sitting per day, gender, BMI, age, sleep quality, smoking and alcohol consumption habits, participants reported having more positive affect when they engaged in greater PA. No association was found between PA and negative affect. Discussion and conclusion Prioritizing mental health and assessments that determine the late impact of the COVID-19 pandemic on psychological well-being is critical. Promoting PA in university communities is considered a priority to positively impact students' mental health and provide tools to facilitate coping.

Resumen Introducción La pandemia de COVID-19 impactó negativamente la salud tanto física como mental a lo largo del mundo. Es importante identificar las manifestaciones psicológicas de la población y el impacto de la pandemia en los estilos de vida (actividad física, calidad del sueño). Objetivo Describir la relación entre el afecto (positivo y negativo) y la actividad física (AF) en estudiantes universitarios durante la pandemia de COVID-19. Método Se realizó una encuesta transversal a estudiantes de ciencias de la salud pertenecientes a tres instituciones de educación superior en México y Colombia. La AF se evaluó mediante la versión corta del Cuestionario Internacional de Actividad Física (IPAQ-S), y los afectos se midieron mediante el Índice PANAS. Se utilizó un modelo de regresión logística para evaluar la asociación entre AF y afectos. Resultados Se incluyeron 430 participantes entre 16 y 40 años. No encontramos diferencias entre hombres y mujeres en cuanto a edad, peso (IMC), nivel de AF ni el número de horas sentados por día, sin embargo, el consumo mensual de alcohol y tabaco fueron más frecuentes en hombres (p < .05) y las mujeres expresaron tener peor calidad de sueño (p < .05). Al ajustar por la cantidad de horas que pasaban sentados por día, el género, IMC, edad, calidad del sueño y los hábitos de consumo de tabaco y alcohol, los participantes expresaron tener más afectos positivos cuando realizaban mayor AF, sin embargo, no encontramos asociación entre AF y los afectos negativos. Discusión y conclusión Es fundamental priorizar la salud mental y las evaluaciones que determinan el impacto tardío de la pandemia de COVID-19 en el bienestar psicológico. Se considera necesario promover la AF en las comunidades universitarias para impactar positivamente en la salud mental de los estudiantes y brindar herramientas que faciliten el afrontamiento.

Gross motor disorders in pediatric patients with acute lymphoblastic leukemia and survivors: A systematic review.

Acute Lymphoblastic Leukemia (ALL) is the most common cancer in children and toxicities related to treatment are common. One of these adverse effects is related to the musculoskeletal system and especially to gross motor skills that allow body movements: walking, running, jumping, and balance. This systematic review aims to describe gross motor impairments in pediatric patients with ALL during and after chemotherapeutic treatment and to identify the most commonly used tools for their assessment. Multiple electronic databases were searched for observational studies describing gross motor skills in children with ALL and the assessment tool used. The STROBE checklist was used to assess the reporting quality of each study. Ten studies were included in this review with assessments of gross motor skills in children with ALL undergoing treatment and survivors. Evidence suggests impairments in the performance of daily life activities during intensification and maintenance and persists up to 5 to 6 years after treatment´s cessation. Balance problems are noted at the start of treatment when the cumulative dose of vincristine is low and, in the survivors, it was the most reported alteration. These skills are essential for an adequate performance of children in daily life activities, recreation and leisure. We emphasize the need to assess gross motor skills and implement interventions that include physiotherapy and occupational rehabilitation in children with ALL.

A look into the challenges and complexities of managing low back pain in Mexico.

Low back pain is a global health problem. In Mexico it is one of the most common musculoskeletal conditions as well as the leading cause of disability. This review provides an overview of the challenges and complexities of managing low back pain in Mexico. It begins with an explanation of the Mexican healthcare system and an overview of the burden of low back pain. Usual care for low back pain in Mexico is then contrasted with recommended best practice care to highlight common evidence-practice gaps and drivers of poor care. Finally, solutions are proposed based on positive experiences from other countries. Delving into the Mexican health framework and the burden of low back pain will provide a better understanding of why it is important to pay attention to this musculoskeletal disorder. Potential steps required to reduce the burden are also outlined to benefit not only the people suffering from low back pain but also the Mexican economy and society.

Association between Sociodemographic Factors and Dietary Patterns in Children Under 24 Months of Age: A Systematic Review.

BACKGROUND: Understanding early-life complementary feeding dietary patterns and their determining factors could lead to better ways of improving nutrition in early childhood. The purpose of this review was to evaluate evidence of the association between sociodemographic factors and dietary patterns (DPs) in children under 24 months. METHODS: Medline (PubMed), Cochrane Central, NICE guidelines, and Trip database were searched for observational studies that evaluated sociodemographic factors and their associations with DP. RESULTS: Seven studies were selected for the present review. High education level among mothers was inversely associated with unhealthy DPs and positively associated with healthy DPs. Higher household income was negatively associated with unhealthy DPs. Four studies showed a positive association between low household income and unhealthy DPs and three studies showed a positive association between higher household income and healthy DPs. Additionally, in younger mothers, body mass index (BMI ≥ 30.0 kg/m2) and number of children were positively associated with unhealthy DPs. CONCLUSIONS: This review provides evidence of a positive association between mothers' higher education level, higher household income, higher maternal age, and healthy dietary patterns as well as a negative association between these factors and unhealthy dietary patterns. Further studies from low- and middle-income countries are needed for comparison with associations showed in this review.

Improvement of life quality measured by Lansky Score after enzymatic replacement therapy in children with Gaucher disease type 1.

BACKGROUND: Gaucher disease type 1 (GD1, OMIM# 230800), is a condition with high impact in patient's quality of life (QoL). We report the improvement in QoL of children with GD1 measured by Lansky play-performance scale (LS) after enzymatic replacement therapy (ERT) and to describe our experience in the treatment of children with GD1. METHODS: Five children with diagnosis of GD1 received imiglucerase 60 mg/kg every two weeks. LS, hepatomegaly, splenomegaly, hemoglobin, platelets, and growth rate were measured every 6 months after beginning ERT for 30 months. RESULTS: After ERT, LS increased significantly from 28 ± 16.48 points before ERT to 70 ± 10 (P = 0.0046) and 95 ± 10 (P = 0.0022) points after 6 and 30 months of ERT, respectively; hemoglobin and platelets changed significantly from 9.28 ± 0.61 to 12.40 ± 0.85 (P = 0.0198) and from 71.50 ± 14.89 to 205.00 ± 65.34 (P = 0.0428) after 30 months of ERT, respectively. All patients demonstrated decreased hepatic and splenic size with mean reductions of 66% and 80% at 30 months of treatment and the USG longitudinal axis was reduced in both liver and spleen after ERT. CONCLUSION: The use of ERT with imiglucerase 60 mg/kg every two weeks has substantial benefits and significantly improves QoL, assessed with Lansky Score, of the five children with GD1 studied.

Velocardiofacial syndrome in Mexican patients: Unusually high prevalence of congenital heart disease.

INTRODUCTION: Velocardiofacial syndrome (VCFS) is the most common microdeletion syndrome with an incidence of 1:4000 live births. Its phenotype is highly variable with facial, velopharyngeal, cardiac, endocrine, immunologic and psychiatric abnormalities. It is caused by a microdeletion in chromosome 22q11.2. OBJECTIVES: We present 7 years of experience evaluating patients with VCFS regarding their main clinical characteristics. MATERIAL AND METHODS: The patients included were multidisciplinary evaluated and had a positive FISH analysis for del22q11.2. RESULTS: A total of 62 patients were assessed, a 34 female/28 male ratio was observed with ages ranging from 9 days to 16 years, all but one patient had typical facial features. A diagnosis of congenital heart disease was established in 97% of the patients; other clinical characteristics were identified with different percentages such as cleft palate, and hypocalcaemia. Three cases had a familial presentation. DISCUSSION: While the clinical findings of this study were in general terms in keeping with the literature, it is interesting the unexpectedly high percentage of congenital heart disease identified in Mexican children with VCFS that also was the main cause for clinical referral.

Evaluación de dos técnicas para el registro de relación céntrica mandibular: arco gótico versus céntrica de poder / Assessment of two techniques for the recording of mandibular central relationship: gothic arch versus power centric relation

La búsqueda de la verdadera posición mandibular con respecto a la cavidad glenoidea y la relación de los otros componentes que constituyen la articulación temporomandibular conocida como relación céntrica (RC) son esenciales para el diagnóstico, tratamiento y estabilidad del mismo. El propósito del estudio fue evaluar dos técnicas para el registro de RC (técnica céntrica de poder y técnica del arco gótico) con objeto de determinar el método más eficaz para brindar mayor veracidad en el registro, dado que, en nuestra institución, se han experimentado algunas inconsistencias durante la obtención de registros en pacientes con malformaciones o discrepancias esqueléticas considerables. Se evaluaron quince pacientes sistémicamente sanos, clase ósea II, de entre 13 y 17 años de edad, ocho del sexo femenino (53.4%) y siete del sexo masculino (46.6%). Se realizaron treinta montajes en un articulador semiajustable utilizando ambas técnicas, se monitorearon los cambios a nivel condilar utilizando el indicador de posición axial condilar (IPAC). Los resultados mostraron que no hubo diferencias significativas; sin embargo, los cambios sagitales, verticales y transversales fueron mayores con la técnica del arco gótico.

The search for the true mandibular position with respect to the glenoid fossa and the relationship of the other components which constitute the temporomandibular joint known as centric relation (CR) are essential factors for its diagnosis, treatment and stability. The aim of the present study was to assess two techniques used for recording CR: power centric technique and gothic arch technique, with the purpose of determining the most effective method to confer greater accuracy to the recording. This was triggered by the fact that in our institution some inconsistencies had been detected when taking records of patients afflicted with considerable skeletal discrepancies or malformations. Fifteen healthy skeletal class II patients were assessed. Patients' ages ranged from 13 to 17 years. Eight patients were female (53.4%) and seven male (46.6%). Using both techniques, thirty mountings were performed in a semi-adjustable articulator, condylar changes were monitored using axial condylar position indicator (API). Results revealed no significant differences, nevertheless, observed transversal, vertical and saggital changes were greater with the gothic arch technique.

[Strengths and weaknesses of home management of diarrhea]. / Manejo de la diarrea en el hogar: errores y aciertos.

OBJECTIVE: The aim of the study was to analyze mothers home practices among children with acute diarrhea. METHODS: A cross sectional study was carried out in a group of 260 mothers of children with diarrhea. Mothers were requested to answer the "verbal biopsy" questionnaire to assess their practices concerning effective diarrhea management at home according to the World Health Organization and corresponding to the Norma Oficial Mexicana recommendations. Descriptive statistics and Chi square for differences were used. RESULTS: Two groups of mothers' were identified: those who had consulted a physician before attending the hospital (n = 191), and those who came to the hospital as their first choice (n = 69). The first group used antibiotics, antiemetics, breast-feeding and Oral Hydration Therapy more frequently than the second group (p < 0.05). CONCLUSIONS: The "verbal biopsy " instrument was useful to assess home management of children with diarrhea. This questionnaire was also useful to detect medical malpractice (unjustified prescription of antibiotics and antiemetics) as well as to identify best practices (continued breast feeding and oral hydration).

Rotavirus diarrhea severity is related to the VP4 type in Mexican children.

This report is of a community-based case control study to assess whether the severity of acute diarrhea by rotavirus (RV) in young children is associated with a particular VP7 (G) or VP4 (P) RV serotype. Five hundred twenty children younger than 2 years of age with diarrhea lasting less than 3 days were age and gender matched with 520 children with no diarrhea. The G and P serotypes were determined with specific monoclonal antibodies, and the VP4 serotype specificity in a subgroup was confirmed by genotyping. Infection with a G3 serotype led to a higher risk of diarrhea than infection with a G1 serotype. Infection with a G3-nontypeable-P serotype was associated with more severe gastroenteritis than infection with a G3 (or G1) P1A[8] serotype. A child with diarrhea-associated dehydration was almost five times more likely to be infected with a G3-nontypeable-P serotype than a child without dehydration (P < 0.001). Moreover, the two predominant monotypes within serotype P1A[8] had significantly different clinical manifestations. In this study, the severity of RV-associated diarrhea was related to different P serotypes rather than to G serotypes. The relationship between serotype and clinical outcomes seems to be complex and to vary among different geographic areas.

[Continuous oral hydration or with fractionated doses in acute diarrhea-induced dehydration in children]. / Hidratación oral continua o a dosis fraccionadas en niños deshidratados por diarrea aguda.

OBJECTIVE: To evaluate the safety and effectiveness of two oral rehydration techniques. MATERIAL AND METHODS: A randomized clinical trial was conducted at the oral rehydration unit of Hospital Infantil de Mexico "Federico Gomez", between September 1998 and June 1999. Forty patients five-year old and younger children, dehydrated due to acute diarrhea, were given oral rehydration solution (ORS) ad libitum (AL group); another forty patients received ORS in fractionated doses (FD group). Clinical characteristics were similar in both groups. Results are presented as means, standard deviations and medians, according the distribution of simple and relative frequencies. RESULTS: The mean stool output in the AL group was 11.0 +/- 7.5 g/kg/h; as compared to 7.1 +/- 7.4 in the FD group (p = 0.03). ORS intake, rehydration time, and mean diuresis values were similar in both groups (p > 0.05). Six patients in the AL group and five in the FD group had high stool output (> 10 g/kg/h), that improved after administration of rice starch solution. One patient in the AL group and two in the FD group had persistent vomiting that improved with gastroclisis. No patient required intravenous rehydration. CONCLUSIONS: These results suggest that ORS administration ad libitum under supervision, is a technique as safe and effective as the fractionated doses technique, for the treatment of dehydrated children due to acute diarrhea.

Hidratación oral continua o a dosis fraccionadas en niños deshidratados por diarrea aguda / Continuous oral hydration or with fractionated doses in acute diarrhea-induced dehydration in children

OBJECTIVE: To evaluate the safety and effectiveness of two oral rehydration techniques. MATERIAL AND METHODS: A randomized clinical trial was conducted at the oral rehydration unit of Hospital Infantil de Mexico "Federico Gomez", between September 1998 and June 1999. Forty patients five-year old and younger children, dehydrated due to acute diarrhea, were given oral rehydration solution (ORS) ad libitum (AL group); another forty patients received ORS in fractionated doses (FD group). Clinical characteristics were similar in both groups. Results are presented as means, standard deviations and medians, according the distribution of simple and relative frequencies. RESULTS: The mean stool output in the AL group was 11.0 +/- 7.5 g/kg/h; as compared to 7.1 +/- 7.4 in the FD group (p = 0.03). ORS intake, rehydration time, and mean diuresis values were similar in both groups (p > 0.05). Six patients in the AL group and five in the FD group had high stool output (> 10 g/kg/h), that improved after administration of rice starch solution. One patient in the AL group and two in the FD group had persistent vomiting that improved with gastroclisis. No patient required intravenous rehydration. CONCLUSIONS: These results suggest that ORS administration ad libitum under supervision, is a technique as safe and effective as the fractionated doses technique, for the treatment of dehydrated children due to acute diarrhea.

Pronóstico de la diarrea por rotavirus / Prognosis of rotavirus diarrhea

Objetivo. Comparar la gravedad de la diarrea por rotavirus (RV) y por no rotavirus. Material y métodos. Estudio transversal en 520 lactantes con diarrea aguda, efectuado entre octubre de 1994 y marzo de 1995 en siete centros del primer nivel de atención en cinco estados de México. El diagnóstico de RV se realizó con ensayo inmunoenzimático o por electroforesis. El análisis se hizo a través de medidas de tendencia central. Los resultados se presentan como promedio y desviación estándar o mediana o variación. Resultados. Se aisló RV en 264 lactantes (50.7 por ciento) con predominio en varones de 6 meses a un año. Las manifestaciones clínicas fueron significativamente diferentes entre el grupo rotavirus positivo y el grupo rotavirus negativo en mediana de evacuaciones por 24 horas, frecuencia de vómitos, temperatura > 38º C, deshidratación y calificación de gravedad, respectivamente. Conclusiones. Estos resultados mostraron peor pronóstico por mayor gravedad de la diarrea por RV en lactantes, con relación a otra etiología. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

Alimentación en diarrea aguda / Nutrition in children with acute diarrhea

Las principales complicaciones de la diarrea son la deshidratación y la desnutrición. La diarrea produce daño nutricional porque se pierden nutrimentos, aumentan sus requerimientos y disminuye el apetito.El mantener la alimentación durante la diarrea mejora su evolución así como la hidratación y la nutrición del paciente al estimular la función de absorción intestinal. Por lo tanto, es recomendable continuar la dieta habitual, incluida la lactancia materna, sin introducir nuevos alimentos, y dar comidas con mayor frecuencia para compensar la anorexia. No existen bases científicas que avalen la dilución rutinaria de la leche de vaca ni el uso de fórmulas libres de lactosa más que en casos raros con manifestaciones clínicas de intolerancia. Siguiendo los lineamientos anteriores, los niños con diarrea aguda tienen evolución favorable, sin efectos nutricionales adversos.

Factores de riesgo asociados a deshidratación por diarrea aguda, después de recibir consulta pediátrica / Risk factors for developmenat of dehydration after medical consultation in children with acute diarrhea

Introducción. Objetivo: identificar factores de riesgo asociados a deshidratación por diarrea aguda después de la consulta médica. Material y métodos. Estudio en 25 niños deshidratados (casos) y en 43 no deshidratados (controles). Se capacitó y evaluó al responsable sobre el manejo de la diarrea en el hogar. Se definieron dos grupos: de la primera consulta (A) y de la consulta de revisión (B); se definió el riesgo de deshidratación (razón de momios (RM)) y los "mejores modelos".Resultados. Los factores de riesgo incluyeron: del grupo A, deshidratación (RM 8.65, IC 2.4-18.2) y edad menor a 12 meses (RM 2.82, IC 1.42-4.76); del grupo B, más de 5 evacuaciones/24 horas (RM 8.42, IC 3.13-24.2), más de 4 vómitos/24 horas (RM 4.51, IC 1.28-1.64), ingesta de suero oral mayor de 100 mL/kg/24 horas (RM 5.02, IC 2.0-9.07) y más de 24 horas entre el egreso y la revisión (RM 4.03, IC 1.01-8.08).Conclusiones. Deben resaltarse signos cuantitativos (> 5 evacuaciones/24 horas y/ó >4 vómitos/24 horas) en la capacitación de las madres, principalmente en las de niños menores de un año o que se presentan deshidratados en la primera consulta.

Ensayo clínico controlado con suero oral con sabor a frutas en niños deshidratados por diarrea aguda / A salty tasting solution vs flavored formula in the treatment of diarrhea-associated dehydratation. A clinical controlled trial

Introducción. El sabor salado del suero oral (SO) puede limitar su uso. Objetivo: conocer la preferencia por varios sabores de frutas del SO: manzana, limón, naranja, piña o lima-limón y evaluar su eficacia para rehidratar niños con diarrea. Material y métodos. Cincuenta madres escogieron libremente el sabor. Posteriormente se distribuyeron al azar en 2 grupos, 230 niños deshidratados por diarrea, rehidratados con SO de sabor salado (SO) o con SO con sabor a diferentes frutas (SOF).Resultados. La preferencia de sabor fue: manzana 68 por ciento, limón 14 por ciento, piña 8 por ciento, naranja 8 por ciento, sin sabor 2 por ciento y lima-limón 0 por ciento. En el grupo SO y SOF fueron semejantes: la edad de los niños (10.5 ñ 8.2 y 11.1 ñ 7.2 meses), el porcentaje de deshidratación (3.9 ñ 2.6 y 4.2 ñ 2.4) y de sexo masculino (62 y 54 por ciento), respectivamente; al igual que la evolución con el tratamiento: ingesta de 21.8 ñ 5.6 y 20.9 ñ 5.1 mL/kg/hora, tiempo de hidratación 5.1 ñ 2.7 y 4.9 ñ 2.3 horas; gasto fecal 10.5 ñ 8.2 y 9.3 ñ 8.2 g/kg/hora, proporción de pacientes con vómitos 28 y 34 por ciento, respectivamente. Con el sabor naranja se observó la mayor proporción de vómitos (53 por ciento). En el grupo SO se observaron 15 fracasos (13 por ciento), 14 por gasto fecal alto y 1 por vómito persistente; en el grupo SOF, hubieron 13 fracasos (11.3 por ciento) 12 por gasto fecal alto y 1 por vómito persistente, aunque finalmente todos se hidrataron mediante el uso de atole de arroz o de gastroclisis. Conclusión. El SOF es igualmente aceptado, efectivo y seguro que el SO, en niños deshidratados por diarrea. El sabor preferido fue el de manzana y el que se asoció con más vómitos, el de naranja.

Ensayo clínico controlado para evaluar eficacia y seguridad de dos soluciones de hidratación oral con composición OMS y diferente pH / Safety and efficacy of a Worls Health Organization-based oral rehydration solution with acid pH. A clinical, comparative controlled trial

Introducción. La Organización Mundial de la Salud (OMS) recomienda una fórmula única con sabor salado y pH alcalino para el tratamiento de la deshidratación por diarrea. Se ha considerado que el cambio de sabor de la solución de rehidratación oral (SRO) podría mejorar la aceptación de los pacientes. Estas fórmulas, con sabor más agradable a expensas de habérseles agregado ácido cítrico, están disponibles en México. Contienen la misma composición recomendada por la OMS pero con pH ácido, lo que podría aumentar el gasto fecal e incrementar los vómitos. El presente trabajo se diseñó con el objetivo de determinar la eficacia y seguridad de la SRO con pH ácido, en niños deshidratados por diarrea aguda. Material y métodos. Se dividieron al azar, en 2 grupos, 70 niños menores de 2 años de edad: el grupo A se trató con SRO-OMS (pH 8 ñ 0.05) y el grupo B con SRO con pH ácido (4.9 ñ 0.1). Resultados. El gasto fecal promedio (A: 10 ñ 7.9; B: 12 ñ 10.8 g/kg/hora) y la frecuencia de vómitos (A: 11; B 10 pacientes) fueron semejantes en ambos grupos. Trece casos fueron considerados fracasos, 10 del grupo A y 3 del B: por vómitos persistentes (4 del grupo A) o por gasto fecal alto (6 del A y 3 del B), sin mejoría de la deshidratación; todos ellos, excepto uno del grupo A, se hidrataron por sonda nosogástrica o después de la administración de atole de arroz, respectivamente. Conclusiones. El pH ácido de la SRO no se relacionó con mayor frecuencia de vómitos ni con aumento del gasto fecal. La menor frecuencia de fracasos sugiere que es igual o más efectiva que la SRO-OMS para el tratamiento de la deshidratación por diarrea

Conocimientos y prácticas del manejo efectivo de casos de diarrea / Knowledge and practices in the successful management of acute diarrhea

Introducción. Con el objetivo de analizar los conocimientos y las prácticas de los médicos residentes sobre el manejo efectivo de casos de diarrea en el Hospital Infantil de México Federico Gómez, se consideró conveniente efectuar un estudio observacional y transversal de la calidad de atención proporcionada. Material y métodos. Se analizaron un total de 24 casos de niños con diarrea atendidos en 3 servicios ambulatorios del hospital, por médicos residentes de pediatría, quienes habían recibido capacitación previa en el Servicio de Hidratación Oral del hospital, excepto 2 que no habían rotado por el mismo. Resultados. De los 6 componentes del manejo efectivo de casos, 4 fueron aplicados correctamente por todos los médicos residentes. La evaluación del estado de hidratación y la selección del tratamiento apropiado no fueron correctos en 2 casos, que correspondieron a los atendidos por médicos que no habían pasado por el servicio de hidratación oral. Conclusión. Los resultados de este estudio sugieren como útil e importante que los médicos residentes de pediatría, durante su formación, roten por un servicio docente-asistencial de terapia de hidratación oral para mejorar la calidad de la atención de los pacientes con enfermedad diarreica