Experiences of parents of children with hypoplastic left heart syndrome during their treatment: a qualitative study.

AIM: To investigate the opinion and personal experience of parents of children born with Hypoplastic Left Heart Syndrome and what advice they would give to other parents who have to decide between treatment options. METHODS: We conducted a qualitative, descriptive and retrospective study by means of a survey directed to parents of children born with Hypoplastic Left Heart Syndrome in a tertiary hospital in Buenos Aires (Argentina). Their answers and data regarding medical procedures were analysed. RESULTS: Parents of thirteen out of sixteen patients with Hypoplastic Left Heart Syndrome were surveyed. Norwood surgery had been performed in all the patients, many had received other procedures, and five had died. In relation to the decision-making process, sixty-one percent of parents would recommend other parents to remain at peace after having done everything possible and 54% would suggest to not feel guilt despite the final result. None of the parents would recommend rejecting surgical treatment and choosing comfort care. CONCLUSION: The majority of parents of children with Hypoplastic Left Heart Syndrome would recommend continuing with the therapeutic effort in order to feel at peace and reduce feelings of guilt.

Tratamiento de reposición enzimática en la insuficiencia pancreática exocrina asociada a la fibrosis quística. Grupo de trabajo de Fibrosis Quística de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (LASPHGAN) / Enzyme replacement treatment in exocrine pancreatic insufficiency associated with cystic fibrosis. Cystic fibrosis Working group of the Latin American Society of Pediatric Gastroenterology, Hepatology and Nutrition (LASPHGAN)

La fibrosis quística (FQ) es un trastorno hereditario, de las glándulas de secreción exocrina, considerada la causa más frecuente de insuficiencia pancreática exocrina (IPE) en la infancia. Esta revisión resume el panorama del tratamiento de reposición enzimática en la IPE asociada a la FQ, las formulaciones disponibles, su dosificación y modo de administración, así como las limitaciones y desafíos actuales y las posibles áreas del desarrollo futuro

Cystic fibrosis (CF) is an inherited disorder of the exocrine secretion glands, considered the most frequent cause of exocrine pancreatic insufficiency (EPI) in childhood. This review summarizes the landscape of enzyme replacement therapy in PEI associated with CF, the available formulations, their dosage and mode of administration, as well as the current limitations and challenges and potential areas for future development.

[Guía latinoamericana para el diagnóstico y tratamiento de alergia a las proteínas de la leche de vaca (GL-APLV)].

Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.

The influenza A(H1N1) epidemic in Mexico. Lessons learned.

Several influenza pandemics have taken place throughout history and it was assumed that the pandemic would emerge from a new human virus resulting from the adaptation of an avian virus strain. Mexico, since 2003 had developed a National Preparedness and Response Plan for an Influenza Pandemic focused in risk communication, health promotion, healthcare, epidemiological surveillance, strategic stockpile, research and development. This plan was challenged on April 2009, when a new influenza A(H1N1) strain of swine origen was detected in Mexico. The situation faced, the decisions and actions taken, allowed to control the first epidemic wave in the country. This document describes the critical moments faced and explicitly point out the lessons learned focused on the decided support by the government, the National Pandemic Influenza Plan, the coordination among all the government levels, the presence and solidarity of international organizations with timely and daily information, diagnosis and the positive effect on the population following the preventive hygienic measures recommended by the health authorities. The international community will be able to use the Mexican experience in the interest of global health.

[Distal tibial reconstruction and ankle arthrodesis in osteosarcoma (salvage technique). A case presentation]. / Reconstrucción de tibia distal y artrodesis de tobillo en osteosarcoma (cirugía de salvamento). Presentación de un caso.

UNLABELLED: Treatment of bone sarcomas is aimed in healing and secondarily rescuing the limb. With the use of chemotherapy, radiation therapy, new prostheses and availability of graft, now most tumors can be resected, reducing functional deficit. OBJECTIVE: To present a surgical option in management of osteosarcoma of distal tibia. CASE REPORT: Fifteen year-old man, starting in April 2003 with a mass in the left ankle area. June 2003 pulsatile progressive pain started, increased with activity, decreased with rest. November 2003 the physical exam: limping by left lower limb, with a tumor in the posteromedial ankle surface (3 x 2 cm), hard, not movable, regular edges, painful on palpation, Radiographic observations (November 2003), showed blastic oval stone image (4 x 3.5 cm) with expanded posterior and medial cortices with periosteal reaction. The initial biopsy report (chondroblastoma) was not consistent with the diagnostical assumption. So resection was performed 10 cm wide, placing a methylmethacrylate spacer. The final histological report was positive to osteogenic sarcoma. The patient received 11 sessions of chemotherapy. The reconstruction of the distal tibia and arthrodesis with autologous graft from the fibula, heterologous graft and stabilization with transcalcaneal nail, was done in March 2005. RESULTS: Successful evolution without tumor activity with graft integration to arthrodesis and plantigrade gait.

[Treatment of tibial non-union with a large bone defect with half-tubular fibular graft, centromedullary nailing and bone graft]. / Tratamiento de la no unión tibial con gran defecto oseo con peroné en media caña, clavo centromedular e injerto oseo.

INTRODUCTION: Non-union is most frequent in the tibia. It may occur with bone loss and is most often seen in the mid-third, mainly as a result of high-energy trauma. Our purpose is to present a treatment alternative. MATERIAL AND METHODS: Prospective, longitudinal, experimental trial conducted between 1999 and 2004. Five patients classified according to Judet and Paley were included. A half-tubular fibular graft plus an autologous and/or heterologous iliac crest graft were used with a UTN nail for stabilization purposes; mean follow-up was 24 months. RESULTS: All patients were male. High energy trauma was the cause in 100%; 5 were Gustilo III fractures; Paley B1 type was present in 60%; the mean bone defect was 7.8 cm. Grade III Montoya bone healing was observed on average at 13.6 months. There were two complications; one infection that required removal of the synthesis without disrupting the healing, and one re-fracture which was managed at a different service. CONCLUSIONS: An autologous half-tubular fibular graft, plus autologous and/or heterologous graft, stabilized with a UTN nail, restores the loss caused by the bone defect and allows achieving an appropriate bone healing.