Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study.

BACKGROUND: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. METHODS: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women's and children's hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. RESULTS: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. CONCLUSIONS: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

INTRODUCCIÓN: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. MÉTODOS: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. RESULTADOS: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. CONCLUSIONES: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study / Prevalencia del consumo de alcohol, tabaco y drogas ilícitas durante el embarazo en adolescentes: un estudio observacional, prospectivo y transversal

Abstract Background: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. Methods: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women´s and children´s hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. Results: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. Conclusions: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

Resumen Introducción: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. Métodos: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. Resultados: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. Conclusiones: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Pediatric Inflammatory Multisystem Syndrome or Multisystem Inflammatory Syndrome in Children: A New Thread in Pandemic Era.

After the perturbing effects of the COVID-19 Pandemic, we observed intense public health efforts in a global-scale to prevent, control, and treat the SARS-CoV-2. Hundreds of clinical center researched for adequate treatments, other were devoted to the development the COVID-19 vaccines and other studied the nature and the effects of this mutant coronavirus SARS-CoV-2. As time goes by, the pediatric inflammatory multisystem syndrome has been recently defined and associated the COVID-19 past infection and is now considered a shot to middle-term complication of COVID-19. In this paper, we review the actual concepts of PIMS in children, the epidemiology, the clinical presentation, and evolution, the recommended laboratory and other testing. The recommended specialties interconsultation for hospitalized patients and a full discussion on the appropriate treatment of these patients. We include the Latin-American experience with PIMS and a final discussion on the outcome of this disease.

Can sTREM-1 predict septic shock & death in late-onset neonatal sepsis? A pilot study.

BACKGROUND AND OBJECTIVES: The transmembrane glycoprotein TREM-1 triggers an inflammatory response. Its soluble fraction (sTREM-1) has been shown to have diagnostic accuracy for late-onset neonatal sepsis (LONS). Until now, the potential of sTREM-1 to predict septic shock and/or death in septic neonates has not been explored. This study obtained estimates of the incidence and prevalence of septic shock and/or death in septic neonates for future sample size calculations for confirmatory studies and evaluated the feasibility of using sTREM-1 as a predictor of septic shock and/or death in neonates with LONS criteria. STUDY DESIGN: A pilot study with a cross-sectional design was performed from May 1(st) to October 31(st), 2012. The participants were hospitalized neonates who, after three days of life, were diagnosed as having LONS. Plasma sTREM-1 was quantified by ELISA. The main outcome measurement was the development of septic shock and/or death. RESULTS: Of 71 eligible subjects, nine (12.7%) progressed to septic shock and/or death. In the LONS-Non-Shock group, the sTREM-1 median and interquartile range (IQR) plasma value were 10 (10 to 70) pg/mL. In the LONS & Shock/Death group, the values were 567 (260 to 649) pg/mL. These values were significantly different (Mann-Whitney's U test, p=0.001). A ROC curve for a proposed sTREM-1 cut-off value of 300 pg/mL exhibited an area under the curve of 0.884 (95% CI=0.73 to 1.0; p<0.0001), with a sensitivity of 0.78 (95% CI=0.46 to 0.94) and specificity of 0.97 (95% CI=0.92 to 0.99); PPV would be 0.78 (95% CI=0.46 to 0.94) and NPV 0.97 (95% CI=0.92 to 0.99). CONCLUSIONS: In neonates with LONS, sTREM-1 has the potential to provide an excellent predictive value for septic shock/death. Larger sample sizes are needed to identify the optimal cut-off value of plasma sTREM-1 for this diagnosis and to provide diagnostic accuracy measures.

Diagnostic accuracy of buffy coat culture compared to total blood culture in late-onset sepsis of the newborn.

OBJECTIVES: To study the potential of buffy coat culture as a diagnostic tool for neonatal late-onset sepsis. METHODS: This was a study of diagnostic accuracy in newborn infants born at 28-41 weeks of gestation, weighing >800g, with ≥8 points on the NOSEP-1 scale. Paired samples for total blood culture (TBC) and buffy coat culture were drawn. We established the positivity rate, sensitivity, specificity, predictive values, and likelihood ratios, and compared time to positivity and contamination rates. RESULTS: Fifty-two newborns were included in the study. Twenty-one TBC and 22 buffy coat cultures were positive. The positivity rate for TBC was 40.4% and for buffy coat culture was 42.3% (p=not significant). Three TBC were positive with negative buffy coat culture. Four buffy coat cultures were positive with negative TBC; Kappa agreement was 0.723, p <0.001. Buffy coat culture sensitivity was 86% (95% confidence interval (CI) 68.5-95.4%), specificity 87% (75.4-93.7%), positive predictive value 82% (65.4-91.1%), negative predictive value 90% (77.9-96.8%), positive likelihood ratio 6.64 (2.79-15.05), and negative likelihood ratio 0.16 (0.05-0.42). We found no difference in time to positivity in hours; Wilcoxon Z=1224, p=0.22. The contamination rate was 1.9% for both methods. CONCLUSIONS: Buffy coat culture is as good as TBC for the microbiological diagnosis of late-onset sepsis of the newborn. Buffy coat culture allows the use of remaining plasma for further analysis.

[Clinical and laboratory tests characteristics in children with nephrolithiasis: case control study]. / Características clínicas y de laboratorio en niños con nefrolitiasis: una serie de casos y controles.

OBJECTIVES: To evaluate the clinical and laboratory findings in pediatric patients with urolithiasis in a case control study and to obtain variables predicting a low risk of having urolithiasis. METHODS: Retrospective analysis of 24 cases of children with urolithiasis (age range 3 to 17 years old) admitted to the pediatric emergency room or the hospital ward. Clinical and laboratory information was obtained from the clinical charts and compared with a control group of 29 patients with history of abdominal pain admitted to the hospital. Binary logistic regression and recursive partitioning analysis were used to obtain variables predicting a low risk of having urolithiasis. RESULTS: There was no difference in age, gender, dysuria or nausea (p > 0. 2) between groups. A difference regarding the presence of fever (p = 0.007), haematuria (p = 0.001), costovertebral angle tenderness (p = 0.004), family history (p = 0.007) and abdominal pain lasting more than 48 hs (p = 0.04) was detected. After logistic regression and using recursive partitioning, the presence or history of fever, absence of gross haematuria and no family history of urolithiasis showed a 100% negative predictive value and sensitivity (95% CI 84.7 to 100 and 89.2 to 100 respectively). CONCLUSIONS: Children with abdominal pain present a low risk of having urolithiasis if there is a history or presence of fever, absence of gross haematuria and a negative family history of urolithiasis in a first degree relative.

Características clínicas y de laboratorio en niños con nefrolitiasis: una serie de casos y controles / Clinical and laboratory tests characteristics in children with nephrolithiasis: case control study

OBJETIVOS: Evaluar los hallazgos clínicos y de laboratorio en pacientes en edad pediátrica con nefrolitiasis en un estudio de casos y controles, y además obtener aquellas variables clínicas que clasifiquen a un niño con bajo riesgo de presentar esta condición. MÉTODOS: Análisis retrospectivo de 24 casos de niños con urolitiasis (rango de edad de 3 a 17 años) admitidos al hospital o al departamento de emergencias. La información fue obtenida del expediente clínico y se comparó con un grupo control de 29 casos de niños con dolor abdominal admitidos al mismo hospital. Se usó regresión logística binaria y partición recursiva para obtener las variables que definen a un paciente con bajo riesgo para padecer nefrolitiasis. RESULTADOS: No hubo diferencia entre ambos grupos en cuanto a sexo, edad, presencia de náusea o disuria (p>0,2). Se detectó una diferencia en cuanto a la presencia de fiebre (p=0.007), hematuria (p=0.001), dolor a la percusión en ángulo costovertebral (p=0.004), historia familiar de urolitiasis en pariente de primer grado (p=0.007) y dolor abdominal presente por más de 48 horas (p=0.04). Después de la regresión logística y partición recursiva, la presencia de fiebre, ausencia de hematuria macroscópica, y no habiendo antecedentes familiares de nefrolitiasis, en conjunto, mostró un 100% de sensibilidad y valor predictivo negativo (IC 95% de 89.2 a 100 y de 84.7 a 100 respectivamente). CONCLUSIONES: Niños con dolor abdominal presentan un bajo riesgo de presentar como diagnóstico la urolitiasis si (1) presentan fiebre, (2) si no existe historia familiar de primer grado de la misma, y (3) si no presentan hematuria macroscópica

OBJECTIVES: To evaluate the clinical and laboratory findings in pediatric patients with urolithiasis in a case control study and to obtain variables predicting a low risk of having urolithiasis. METHODS: Retrospective analysis of 24 cases of children with urolithiasis (age range 3 to 17 years old) admitted to the pediatric emergency room or the hospital ward. Clinical and laboratory information was obtained from the clinical charts and compared with a control group of 29 patients with history of abdominal pain admitted to the hospital. Binary logistic regression and recursive partitioning analysis were used to obtain variables predicting a low risk of having urolithiasis. RESULTS: There was no difference in age, gender, dysuria or nausea (p>0.2) between groups. A difference regarding the presence of fever (p=0.007), haematuria (p=0.001), costovertebral angle tenderness (p=0.004), family history (p=0.007) and abdominal pain lasting more than 48 hs (p=0.04) was detected. After logistic regression and using recursive partitioning, the presence or history of fever, absence of gross haematuria and no family history of urolithiasis showed a 100% negative predictive value and sensitivity (95% CI 84.7 to 100 and 89.2 to 100 respectively). CONCLUSIONS: Children with abdominal pain present a low risk of having urolithiasis if there is a history or presence of fever, absence of gross haematuria and a negative family history of urolithiasis in a first degree relative