Feasibility of an observational procedure to enhance early identification of autism spectrum disorder in paediatric settings: A mixed-methods study on an Ecuadorian sample.

LAY ABSTRACT: In Ecuador, the low official estimate of the number of persons with autism spectrum disorder suggest that many children are not identified and are not receiving support. Screening tools are short parent-addressed questionnaires used to identify children that may be developing with autism. Their use is recommended, but their application can be perceived as challenging in paediatric routines. Some professionals prefer looking for autism-related behaviours in a child rather than using screening questionnaires. Although a short observation does not replace the use of validated screening questionnaires, tasks to guide the observation of autistic early signs can help professionals decide to screen or refer the family for assessment and early intervention. In this study, we tested observational tasks that could be adapted to the Ecuadorian paediatric contexts.

¿Día o noche? El momento ideal para realizar la colecistectomía / Day or night? The right time to perform cholecystectomy

Introducción. La frecuencia de complicaciones postquirúrgicas de la colecistectomía realizada en la noche es un tema de controversia, siendo que se ha reportado una frecuencia mayor durante el horario nocturno. El objetivo de este estudio fue analizar la presentación de colecistectomía difícil dependiendo de la hora en que se realizó la cirugía, además de otras complicaciones, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Métodos. Se realizó un estudio retrospectivo, observacional, analítico y transversal, comparando la presentación de colecistectomía difícil y su frecuencia en horario diurno (8:00 am a 7:59 pm) y nocturno (8:00 pm a 7:59 am), además de seroma, absceso, hematoma, fuga biliar, biloma, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Resultados. Se incluyeron en el estudio 228 pacientes, 117 operados durante el día (52 %) y 111 durante la noche (48 %). La colecistectomía difícil se presentó 26 % vs 34 % de los casos intervenidos en el día y la noche, respectivamente. La complicación más frecuente fue seroma (14 %). La estancia hospitalaria media fue de 2,7 días en cirugías diurnas y de 2,5 en cirugías nocturnas; hubo 3 % de reintervenciones y 6 %, respectivamente. También hubo 2 % de reingresos a los 30 días entre los pacientes operados en el día y 3 % entre los operados en la noche. Conclusiones. La frecuencia de colecistectomía difícil y las complicaciones, la estancia intrahospitalaria postquirúrgica, el reingreso a 30 días y la necesidad de reintervención, no tuvieron diferencias significativas respecto al horario de la cirugía.

Introduction. The frequency of post-surgical complications of cholecystectomy performed overnight is a matter of controversy, and a higher rate has been reported during the night shift. The objective of this study was to analyze the presentation of difficult cholecystectomy depending on the time the surgery was performed, in addition to other complications, postoperative hospital stay, 30-day readmission, and reintervention. Methods. A retrospective, observational, analytical and cross-sectional study was carried out, comparing the presentation of difficult cholecystectomy and its frequency during daytime (8:00 am to 7:59 pm) and at night (8:00 pm to 7:59 am), in addition of seroma, abscess, bile leak, biloma, hematoma, post-surgical hospital stay, 30-day readmission, and reintervention.Results. A total of 228 patients were included in the study, 117 patients operated during the day (52%), and 111 at night (48%). Difficult cholecystectomy occurred in 26% vs. 34% of the cases operated on during the day and at night, respectively. The most frequent complication was seroma (14%). The mean hospital stay was 2.7 days in day surgeries and 2.5 in night surgeries; there were also 2% readmission at 30 days among patients operated during the day and 3% among those operated on at night. Conclusions. The frequency of difficult cholecystectomy and complications, postoperative hospital stay, 30-day readmission, and the need of reintervention, did not have significant differences with respect to the time of surgery.

Experiences and Attitudes on Early Identification Practices of Autism: A Preliminary Survey of Pediatric Professionals in Ecuador.

Early identification of children with autism is necessary to support their social and communicative skills and cognitive, verbal, and adaptive development. Researchers have identified several barriers to early diagnosis. Data collected in low- and middle-income contexts-where the vast majority of children in the world live-is scarce. In Ecuador, as in many other countries, estimates are lower compared to the global prevalence. Health authorities estimate a prevalence of 0.28% (0.18%-0.41%) in children aged five years old or less. Based on the hypothesis that, as in many parts of the world, children in Ecuador are not routinely screened and that this situation may result from poor recognition of this condition, our objective was to identify potential obstacles to case identification in pediatric settings. Several barriers, consistent with those identified in other countries, were reported by 153 participants on a survey, including lack of time, lack of resources to refer, fear of unnecessarily alarming families, and lack of information to guide families with concerns. The vast majority of participants are aware of the need for a screening tool for autism detection but report a lack of knowledge of its formal application. Most of the barriers reported in this study could be overcome by educational programs tailored to professional needs in order to support the well-being of children with autism and their families.

Colecistectomía segura: ¿Qué es y cómo hacerla? ¿Cómo lo hacemos nosotros? / Safe cholecystectomy: What is it and how to do it? How do we do it?

La colecistectomía laparoscópica es uno de los procedimientos más realizados a nivel mundial. La técnica laparoscópica se considera el estándar de oro para la resolución de la patología de la vesícula biliar secundaria a litiasis, y aunque es un procedimiento seguro, no se encuentra exenta de complicaciones. La complicación más grave es la lesión de la vía biliar, que, aunque es poco frecuente, con una incidencia de 0,2 a 0,4%, conduce a una disminución en la calidad de vida y contribuye a un aumento en la morbi-mortalidad. El objetivo de este artículo es reportar nuestra técnica quirúrgica, enfatizando los principios del programa de cultura para una colecistectomía segura, propuesta y descrita por the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), para minimizar los riesgos y obtener un resultado quirúrgico satisfactorio

Laparoscopic cholecystectomy is one of the most performed procedures worldwide. The laparoscopic technique is considered the gold standard for the resolution of gallbladder pathology secondary to lithiasis, and although it is a safe procedure, it is not without complications. The most serious complication is the injury to the bile duct, which, although rare, with an incidence of 0.2% to 0.4%, leads to a decrease in quality of life and contributes to an increase in morbidity and mortality. The objective of this article is to report our surgical technique, emphaszing the principles of the program for a safe cholecystectomy, proposed and described by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), to minimize the risks and obtain a satisfactory surgical result

Cystic neoplasm of the appendix. Report of an unusual clinical case at the South Central High Specialty Hospital PEMEX.

Las neoplasias del apéndice son un grupo heterogéneo de tumores con una incidencia baja, la presentación clínica es inespecífica, cursando generalmente de forma asintomática, y la tomografía es el estudio de elección para el diagnóstico. El tratamiento dependerá del tipo histológico del tumor.The appendix neoplasms are a heterogeneous group of tumors with a low incidence, the clinical presentation is nonspecific, usually being asymptomatic, tomography is the study of choice for the diagnosis. Treatment will depend on the histological type of the tumor.

Incidencia de ectasia pielocalicial neonatal en el Hospital Metropolitano de Quito, 2014 a 2018: continuación de un estudio / Pyelocalyceal incidence of neonatal ectasia in Hospital Metropolitano of Quito, from 2014 to 2018: the next part of the study

Objetivo: determinar la incidencia de ectasia pielocalicial e hidronefrosis en el Hospital Metropolitano de Quito durante el período 2014-2018. Métodos: se realizó un estudio analítico retrospectivo de incidencia de ectasia pielocalicial en el Hospital Metropolitano de Quito. Se presentaron 7 casos de neonatos diagnosticados de esta entidad durante un período de 4 años 5 meses, desde 2014 a 2018 (incidencia: 0,18%) en el Hospital. Edad: 25 meses promedio; 5 de sexo masculino y 2 de sexo femenino; 57% diagnosticados durante el período prenatal y 43% en el periodo neonatal. Resultados: de los neonatos diagnosticados por ecografía prenatal, en 100% se ratificó el diagnóstico ecográfico posterior al nacimiento. En este estudio se encontró que 85,7% padecía ectasia I-II, 0% ectasia III-IV y en 14,28% no se pudo identificar el tamaño de la dilatación. El 71,42% presentó asociación con hidronefrosis, 14,28% con doble sistema pielocalicial, 42,85% megauréter, 14,28% agenesia renal. Localización: 57,14% izquierdo, 28,57% derecho y 14,28% bilateral. De los 7 pacientes, 14% acudió al Hospital por fiebre, 57% para control diagnóstico prenatal, 14% por control posnatal y 14% por hematuria. Conclusiones: la ectasia pielocalicial es una entidad de importancia que debe ser diagnosticada durante la etapa prenatal y confirmada en la etapa neonatal para lograr su correcto y oportuno manejo.

Objective: Determine the incidence of pyelocalyceal ectasia at Hospital Metropolitano of Quito from 2014 to 2018. Methods: A retrospective analytical study of pyelocalyceal ectasia incidence was performed at the Metropolitan Hospital of Quito. There were 7 patients with this disease from 2014 to 2018 (incidence of 0,18%) at the Hospital. The average age was 25 months. Of this, 5 were male and 2 female, 57% were diagnosed during prenatally and 43% of neonatal form. Results: From the group of patients that were diagnosed by prenatal ultrasound, 100% the diagnosis was confirmed by ultrasound performed within a few days of birth. In this study it was found that 85,7% had I-II ectasia grade, 0% ectasia III-IV, and 14,28% could not be identified due to lack of information about the size of expansion. Of the cases, 71,42% was associated with hydronephrosis, 14,28% with double pyelocalicial system, 42,85% megaureter, 14,28% renal agenesis. 57% affected the left side, 28% the right side and 14% afected bilaterally. From the 7 patients, 14% went to hospital due to fever, 57% for prenatal diagnosis, 14% for postnatal control, and 14% for hematuria. Conclusions: The pyelocalyceal ectasia is an important entity that must be diagnosed during the prenatal stage and confirmed in newborns for its correct management.

Pleuropulmonary blastoma type III extended into the left atrium in a 16-month old boy.

Pleuropulmonary blastoma is an uncommon paediatric neoplasm. Approximately 300 cases have been reported. In seven tumours, extension involved the left heart. Type III occurs typically at ages 3 or 4 years. We report this very unusual case of extensive disease in a 16-month old male patient. Chest computerized tomography revealed a mass extending into the right hemithorax from the posterior mediastinum and propagating inside the left atrium through the right pulmonary veins. Echocardiography showed a huge flexible mass occupying almost all of the left atrium cavity and intermittently prolapsing through the mitral valve. Two preoperative chemotherapy courses of ifosfamide, vincristine, actinomycin D and doxorubicin were administered at 3-week intervals. The patient was placed on cardiopulmonary bypass, cardiac arrest and the left atrium was opened. The tumour and orifice of the inferior right pulmonary vein were resected and the normal free borders reconstructed. A large mass occupying the right pleural space was removed. Seven additional courses of chemotherapy were given. In a 'second-look' surgery 6 months later, through a right thoracotomy, the residual mass at the posterior mediastinum was resected. The child received four additional courses of chemotherapy. After 12 months of the initial resection, there is no evidence of recurrence.

Interrupted left aortic arch and isolated right subclavian artery from the right pulmonary artery.

We report a 10-day-old newborn, weighing 2.9 kg with an interrupted left aortic arch type B, a large subarterial ventricular septal defect and a right ductus connecting the right pulmonary artery to an isolated right subclavian artery. The patient underwent successful total surgical repair and the isolated right subclavian artery was ligated. He was discharged from hospital without complication and maintains excellent perfusion to the right arm via collaterals.

Malformación quística adenomatoide pulmonar congénita tipo 4 / Pulmonary congenital cystic adenomatoid malformation type 4

La malfonnación quística adenomatoide pulmonar congénita (MAQC) es una lesión poco frecuente; su etiología y patogenia son desconocidas. Se trata de una anomalía de la diferenciación embrionaria pulmonar que da como resultado la formación de estructuras quísticas; puede ser diagnosticado, durante el período prenatal, mediante ecografia. Su expresión clínica es variable y una vez diagnosticado, su tratamiento es quirúrgico

Prevalence of VP4 and VP7 genotypes of human rotavirus in Ecuadorian children with acute diarrhea.

The objective of the present study was to determine rotavirus etiology and prevalence of the different rotavirus serotypes in Ecuadorian children younger than 5 years of age with gastroenteritis. Children (729) less than 5 years of age with acute diarrhea from either public or private primary health care centers in 10 different provinces of Ecuador, between March 2006 and August 2006 were included in the study. Rotavirus infection was diagnosed using a commercial immunoenzymatic test. Rotavirus isolated from stool samples was genotyped. Rotavirus was detected in the feces of 269 of the 729 children (37%) with diarrhea. The most prevalent G genotypes were G9 (46.1%) and G2 (27.2%), while the predominant P genotypes were P[8] (57%) and P[4] (29.5%). Among the single infections, the predominant P/G combinations were: P[8]G9 (56.9%) and P[4]G2 (32.6%). The present countrywide survey is one of the major studies for one single season in Latin America and the first in its class in Ecuador. The value of expanding laboratory capability throughout Latin America in order to monitor rotavirus strains over time, with special attention directed at those strains obtained from children who experience vaccine failure, is critical. Only continuous monitoring of rotavirus disease burden and genotype surveillance will provide this information.

Meninguitis Bacteriana en la infancia

Se realizo un estudio retrospectivo de 377 pacientes pediatricos