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Introducción: Las mordeduras por araña parda pueden manifestarse desde una simple lesión dérmica en el área de la mordedura, hasta formas graves, con falla orgánica múltiple. Caso Clínico: presentamos el caso de una paciente con mordedura por araña parda, quien presenta inicialmente lesiones dérmicas sin necrosis, evolucionando con áreas de necrosis y el desarrollo de síndrome compartimental de extremidad, sepsis, choque séptico y falla renal. Mejora tras manejo intensivo, anti veneno y colocación de terapia de presión negativa (TPN) en herida, conservando la extremidad afectada integra y recuperando la función renal. Discusion: Este caso en particular presenta los tres tipos de manifestaciones que se generan en el loxoscelismo, las cuales son una forma de presentación poco frecuente. El tratamiento con TPN se ha introducido como una terapia poderosa, no farmacológica para ayudar a acelerar el proceso de cicatrización de heridas y puede ser de utilidad en pacientes con mordedura de araña (loxoscelismo).
Introduction: The brown spider bites have the peculiarity of manifesting from a simple skin lesion in the area of the bite, to severe forms, with multiple organic failure. Clinical Case: We present the case of a patient with a brown spider bite, initially presenting dermal lesions without necrosis, evolving with areas of necrosis and the development of compartment syndrome of extremities, sepsis, septic shock and renal failure. Improvement after intensive management and installation in negative pressure therapy wound (NPT), keeping the affected limb integrated and recovering renal function. Discussion: This case in particular presents the three types of manifestations that are generated in loxoscelism, which are a rare form of presentation. The NPT treatment has been introduced as a powerful, non-pharmacological and physical therapy to help accelerate the wound healing process and may be useful in patients with spider bites.
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La vancomicina es un antibiótico de uso común en pacientes hospitalizados. Se han descrito múltiples efectos adversos relacionados a este fármaco, de los cuales la agranulocitosis es una entidad poco frecuente pero potencial mente grave. Este caso muestra una consecuencia médica secundaria al uso prolongado de este antibiótico, generando una neutropenia profunda posterior a 24 días de tratamiento, presentándose clínicamente con un pico febril aislado. Se asume que esta situación es consecuencia de una respuesta inmunológica inadecuada del huésped, por lo que la suspensión del agente etiológico es la clave del tratamiento. Existen pocos reportes de estos casos en la población pediátrica y debe considerarse un efecto secundario que requiere vigilancia estrecha para evitar repercusiones clínicas.
Vancomycin is a commonly used antibiotic in hospitalized patients. Multiple adverse effects related to this drug have been described, of which agranulocytosis is a rare but potentially serious entity. This case shows a medical consequence secondary to the prolonged use of this antibiotic, generating profound neutropenia after 24 days of treatment, presenting clinically with an isolated feverish peak. It is assumed that this situation is the consequence of an inadequate immunological response of the host, for which reason the suspension of the etiological agent is the key to treatment. There are few reports of these effects in the pediatric population and should be considered a side effect that requires close monitoring to avoid clinical repercussions.
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Masculino , Adolescente , Terapêutica , Efeito ReboteRESUMO
RESUMEN Introducción: Actualmente se ha observado que la hipovitaminosis D y la obesidad pueden influir en el desarrollo de enfermedad cardiovascular en el futuro. Objetivo: Identificar la asociación entre deficiencia de vitamina D y factores de riesgo cardiometabólicos en los pacientes pediátricos del noroeste de México. Materiales y métodos : se incluyeron niños de 6 a 15 años, se les midieron variables somatométricas, niveles séricos de colesterol total, C-HDL, C-LDL, triglicéridos, glucosa, insulina, vitamina D e índice HOMA-IR. Se identificó la asociación de factores de riesgo cardiometabólicos y la deficiencia de vitamina D, mediante la prueba de Chi cuadrado. Resultados: De los 114 pacientes evaluados, se detectó eutrofia en 42.1%, sobrepeso en 12.3%, obesidad en 41.2% y desnutrición en 4.4%. La prevalencia de deficiencia en vitamina D, insuficiencia y suficiencia fueron 18.4%, 27.2% y 54.4% respectivamente. La deficiencia de vitamina D mostró mayor predominio en pacientes con obesidad (27 %). La hipertrigliceridemia se asoció estadísticamente con deficiencia de vitamina D (p 0.041). Se observaron correlaciones inversas entre niveles de vitamina D con HOMA (r=-0.191; p=0.41), score Z IMC (r=-0.210; p=0.025) e insulina (r=-0.227; p=0.015). Conclusiones: La deficiencia de vitamina D se asocia en niños con un IMC elevado y resistencia a la insulina, lo cual puede acelerar el desarrollo de síndrome metabólico, diabetes mellitus tipo 2 y enfermedad cardiovascular.
ABSTRACT Introduction: It has currently been observed that hypovitaminosis D and obesity can influence the future development of cardiovascular disease. Objective: To identify the association between vitamin D deficiency and cardiometabolic risk factors in pediatric patients from northwestern Mexico. Materials and methods: Children aged 6 to 15 years were included, somatometric variables, serum levels of total cholesterol, HDL-C, LDL-C, triglycerides, glucose, insulin, vitamin D and HOMA-IR index were measured. The association of cardiometabolic risk factors and vitamin D deficiency was identified using the Chi square test. Results: Of the 114 patients evaluated, normal body-mass index was detected in 42.1%, 12.3% were overweight, 41.2% were obese and 4.4% were malnourished. The prevalence of vitamin D deficiency, insufficiency and sufficiency were 18.4%, 27.2% and 54.4% respectively. Vitamin D deficiency was more prevalent in obese patients (27%). Hypertriglyceridemia was statistically associated with vitamin D deficiency (p = 0.041). Inverse correlations were observed between vitamin D levels with HOMA (r = -0.191; p = 0.41), BMI Z score (r = -0.210; p = 0.025) and insulin (r = -0.227; p = 0.015). Conclusions: Vitamin D deficiency is associated with a higher BMI and insulin resistance in children, which can accelerate the development of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease.
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RESUMEN Introducción: en los últimos años se ha reportado un incremento en la prevalencia de obesidad infantil, siendo este un factor de riesgo para enfermedades crónico-degenerativas como la Enfermedad Renal Crónica; por ende, se requieren de biomarcadores endógenos para detectar las alteraciones en el filtrado glomerular, siendo la Cistatina C uno de ellos. Objetivo: Identificar la frecuencia de Cistatina C elevada en pacientes con sobrepeso y Obesidad del noroeste de México. Material y Métodos: se estudió un grupo de infantes de 6 a 12 años, a los cuales según antropometría se clasificó en normopeso, sobrepeso u obesidad. Se obtuvo la somatometria y los niveles de Cistatina C de cada uno de ellos para el cálculo del filtrado glomerular y clasificar la función renal y se buscó asociación entre estas dos condiciones mediante prueba de chi cuadrado. Resultados: de un grupo de 80 pacientes el 51.3% presentó sobrepeso/obesidad; de estos en el 46.3% se reportaron niveles altos de Cistatina C, de acuerdo con el rango de referencia propuesto por Filler 2003. La media para Tasa de Filtración Glomerular (TFG) en el grupo con sobrepeso/obesidad fue de 103.1 ml/min/1.73 m2, comparada con el grupo normopeso de 121.2 ml/min/1.73 m2. La frecuencia de niveles altos de Cistatina C en población con sobrepeso/obesidad fue de 62.9% comparado con un 26.6% en normopeso. Conclusiones: Los Niños de 6 a 12 años con exceso de peso presentan mayor frecuencia de nivel elevado de Cistatina C.
ABSTRACT Introduction: in recent years an increase has been reported in the prevalence of childhood obesity, which is a risk factor for chronic degenerative diseases such as Chronic Kidney Disease; therefore, endogenous biomarkers are needed to detect alterations in glomerular filtration, Cystatin C being one of them. Objective: To identify the frequency of elevated Cystatin C in overweight and obese patients in northwestern Mexico. Materials and Methods: a group of infants aged 6 to 12 years was studied, who according to anthropometry were classified as normal weight, overweight or obesity. Somatometry and Cystatin C levels were obtained from each of them to calculate glomerular filtration rate and classify renal function, and an association between these two conditions was sought using the chi-square test. Results: of a group of 80 patients, 51.3% were overweight / obese; Of these, 46.3% had high levels of Cystatin C, according to the reference range proposed by Filler 2003. The mean Glomerular Filtration Rate (GFR) in the overweight / obese group was 103.1 ml / min / 1.73 m2, compared to the normal weight group of 121.2 ml / min / 1.73 m2. The frequency of high levels of Cystatin C in the overweight / obese population was 62.9% compared to 26.6% in normal weight. Conclusions: Children from 6 to 12 years of age with excess weight have a higher frequency of high levels of Cystatin C.
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Resumen OBJETIVO: Determinar el desempeño diagnóstico del modelo FullPIERS como predictor de complicaciones perinatales en pacientes con preeclampsia atendidas en un hospital público del Noroeste de México. MATERIALES Y MÉTODO: Estudio retrospectivo, para evaluación de una prueba diagnóstica, efectuado en pacientes con diagnóstico de preeclampsia atendidas en un hospital público de segundo nivel entre octubre de 2018 y febrero 2019. Criterios de inclusión: expedientes con datos suficientes para introducirlos en la calculadora FullPIERS (saturación de oxígeno, recuento de plaquetas, creatinina, aspartato, transaminasa y existencia o no de disnea). Criterios de exclusión: pacientes con diagnóstico previo de padecimientos hepáticos agudos, pulmonares o renales. Se comparó el porcentaje de riesgo al ingreso de cada paciente versus la cantidad de pacientes con y sin complicaciones. Se calcularon: sensibilidad, especificidad y valores predictivos del modelo. RESULTADOS: Se estudiaron 100 expedientes de pacientes con preeclampsia: 11 con resultados positivos según la calculadora Full PIERS (más de 5% de riesgo), en 7 de 11 fue verdadero positivo. Para el modelo Full PIERS se obtuvieron: sensibilidad de 58.3% y especificidad de 95.5%, valor predictivo positivo de 59%, y valor predictivo negativo de 95% para la predicción de complicaciones de la preeclampsia, con área bajo la curva de 0.799. CONCLUSIÓN: La calculadora FullPIERS es una herramienta útil para predecir complicaciones a corto plazo y poder indicar el tratamiento adecuado a cada paciente.
Abstract OBJECTIVE: To determine the diagnostic performance of the FullPIERS model as a predictor of perinatal complications in patients with preeclampsia from a public hospital in Northwest Mexico. MATERIALS AND METHODS: Retrospective study, for the evaluation of a proper diagnosis, performed in patients with diagnosis of preeclampsia attended at a second-level public hospital between October 2018 and February 2019. Inclusion criteria: sufficient data to introduce them into the FullPIERS calculator (saturation of oxygen, platelet retreat, creatinine, aspartate, transaminases and the existence of dysnea). Exclusion criteria: patients with previous diagnosis of acute, pulmonary or renal liver diseases. It is compared to the percentage of the ingrowth risk of each patient versus the number of patients with complications. Calculated: sensitivity, specificity and predictive values of the model. RESULTS: If 100 patients were studied with preeclampsia: 11 with positive results according to the Full PIERS calculator (over 5% risk), and 7 out of 11 were true. For the Full PIERS model, it was obtained: 58.3% sensitivity and 95.5% specificity, 59% positive predictive value, and 95% negative predictive value for the prediction of complications of preeclampsia, with a curve area of 0.799. CONCLUSION: The FullPIERS calculator is a useful tool for predicting complications to cut and can indicate the appropriate treatment for each patient.
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BACKGROUND: Adherence to treatment is a large obstacle in the management of chronic diseases. AIM: To evaluate therapeutic adherence and its relationship with glycemic control in patients with gestational diabetes using two types of treatment. MATERIAL AND METHODS: The Measurement of Treatment Adherence (MAT) questionnaire was applied to 93 patients with gestational diabetes. Fifty-two used metformin 41 were treated with insulin. Obstetric and socio-demographic data were collected. RESULTS: A higher therapeutic adherence was associated with a better glycemic control. Women with a higher education level had a better adherence to treatment. The adherence and metabolic control were higher in women treated with metformin. CONCLUSIONS: Therapeutic adherence is an important factor for adequate glycemic control.
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Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Adulto , Estudos Transversais , Diabetes Gestacional/prevenção & controle , Escolaridade , Feminino , Idade Gestacional , Humanos , Insulina/uso terapêutico , Metformina/uso terapêutico , Gravidez , Inquéritos e Questionários , Adulto JovemRESUMO
Background: Adherence to treatment is a large obstacle in the management of chronic diseases. Aim: To evaluate therapeutic adherence and its relationship with glycemic control in patients with gestational diabetes using two types of treatment. Material and Methods: The Measurement of Treatment Adherence (MAT) questionnaire was applied to 93 patients with gestational diabetes. Fifty-two used metformin 41 were treated with insulin. Obstetric and socio-demographic data were collected. Results: A higher therapeutic adherence was associated with a better glycemic control. Women with a higher education level had a better adherence to treatment. The adherence and metabolic control were higher in women treated with metformin. Conclusions: Therapeutic adherence is an important factor for adequate glycemic control.
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Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Diabetes Gestacional/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Estudos Transversais , Inquéritos e Questionários , Idade Gestacional , Diabetes Gestacional/prevenção & controle , Escolaridade , Insulina/uso terapêutico , Metformina/uso terapêuticoRESUMO
BACKGROUND: Food allergy is an adverse reaction secondary to a specific immune response after exposure to a food. Knowing the natural course of food allergies is essential for opportune diagnosis and treatment. OBJECTIVE: To know the clinical profile of children diagnosed with food allergy attended to at the pediatric allergology department of a secondary care hospital. METHODS: Cross-sectional study of medical records of children with a confirmed diagnosis of food allergy. The type of food allergy, initial clinical presentation, history of familial atopy, time of breastfeeding, ablactation age and positive food allergens per patient, among others, were assessed. Descriptive analysis was performed and association was searched with the chi-square test. RESULTS: Females were predominant among 95 patients. Milk, soy, wheat and egg were the foods with more allergic responses. Predominant clinical manifestations were gastrointestinal. The time from symptoms' onset to definitive diagnosis was 3.2 years. Food allergy was associated with an ablactation age ≥ 6 months, milk and soy with respiratory and gastrointestinal symptoms, egg with respiratory and dermatological symptoms, and wheat with gastrointestinal symptoms. CONCLUSIONS: Food allergies in our population appeared mainly as gastrointestinal symptoms and there was an association between clinical presentation and allergenic foods.
Antecedentes: La alergia alimentaria es una reacción adversa secundaria a una respuesta inmune específica tras la exposición a un alimento. Conocer el curso natural de las alergias alimentarias es esencial para el diagnóstico y tratamiento oportunos. Objetivo: Conocer el perfil clínico de niños con diagnóstico de alergia alimentaria, atendidos en el servicio de alergología pediátrica de un hospital de segundo nivel. Métodos: Estudio transversal de expedientes de niños con diagnóstico confirmado de alergia alimentaria. Se estudió tipo de alergia alimentaria, cuadro clínico inicial, antecedentes de atopia familiar, tiempo de alimentación al seno materno, edad de ablactación, alimentos alérgenos positivos por paciente, entre otros. Se realizó análisis descriptivo y búsqueda de asociación con chi cuadrada. Resultados: De 95 pacientes estudiados, predominaron las mujeres. Leche, soya, trigo y huevo fueron los alimentos con más respuestas alérgicas. Las manifestaciones clínicas más comunes fueron gastrointestinales. El tiempo de inicio de los síntomas al diagnóstico definitivo fue de 3.2 años. La alergia alimentaria se asoció con edad de ablactación ≥ 6 meses; leche y soya con sintomatología respiratoria y gastrointestinal, huevo con respiratoria y dermatológica y trigo con gastrointestinal. Conclusiones: Las alergias alimentarias se manifestaron principalmente con síntomas gastrointestinales y existió asociación entre cuadro clínico y alimentos alérgenos.
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Hipersensibilidade Alimentar/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , México , Estudos RetrospectivosRESUMO
RESUMEN Introducción: La Diabetes Gestacional (DG) es la intolerancia a carbohidratos que se reconoce por primera vez durante el embarazo. En México la prevalencia es del 8.7-17.7%. Estas pacientes tienen mayor riesgo de complicaciones maternas-fetales en comparación con la población general. Objetivo: Determinar el nivel de conocimiento sobre factores de riesgo y complicaciones materno-fetales de DG. Métodos: Se realizó una encuesta en un hospital público del Noroeste de México con 150 embarazadas, se midió el conocimiento sobre factores de riesgo y complicaciones materno-fetales relacionadas con DG mediante una encuesta elaborada y validada con KR-20 del 0.87 y Pérez-Padilla y Viniegra de 8. Resultados: La edad media de la población fue 27 años, con estrato socioeconómico II de Graffar en 88%, predominando escolaridad preparatoria en 41%, el 81% de ellas cuenta con pareja, 79% residen en área urbana, 57% es trabajadora, 80% sin coomorbilidades, 90% sin antecedente de DG, así como no haber recibido platicas sobre DG en 69%. El nivel de conocimiento encontrado fue: 48% azar, 19% muy bajo, 16% bajo, 11% regular, 2% alto, 4% muy alto. Conclusiones: Existe un bajo nivel de conocimiento de factores de riesgo y complicaciones de la DG entre las embarazadas. Éste nivel aumenta a mayor nivel educativo y económico, al tener antecedente de diabetes gestacional en embarazos previos y de recibir pláticas sobre este tema.
ABSTRACT Introduction: Gestational Diabetes (GD) is the carbohydrate intolerance that is recognized for the first time during pregnancy. In Mexico, the prevalence is 8.7-17.7%. These patients have a higher risk of maternal-fetal complications compared to the general population. Objective: To determine the level of knowledge about risk factors and maternal-fetal complications of GD. Methods: A survey was conducted in a public hospital in Northwest Mexico, with 150 pregnant women, knowledge about risk factors and maternal-fetal complications related to GD was measured through a survey developed and validated with KR-20 of 0.87 and Perez-Padilla and Viniegra of 8. Results: The average age of the population was 27 years, with Graffar socioeconomic level II in 88%, with preparatory schooling prevailing in 41%, 81% of them have a partner, 79% live in an urban area, 57% are working, 80% without coomorbidity, 90% without background of DG, as well as not having received talks on DG in 69%. The level of knowledge found was: 48% chance, 19% very low, 16% low, 11% regular, 2% high, 4% very high. Conclusions: There is a low level of knowledge of risk factors and complications of GD among pregnant women. This level increases to a higher educational and economic level, having a history of gestational diabetes in previous pregnancies and receiving talks on this topic.
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Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Diabetes Gestacional/prevenção & controle , Complicações na Gravidez , Inquéritos e Questionários , Fatores de Risco , Diabetes Gestacional/etiologiaRESUMO
Abstract Introduction: Postoperative delirium is defined as an acute confusional state with altered levels of attention and consciousness. It presents for a short period of time with a transient and fluctuating evolution, with long-term outcomes of cognitive dysfunction. It has been observed mostly in extreme age groups and has been associated with factors that increase the risk of occurrence. Objective: To identify any factors associated with the development of postoperative delirium in the elderly following anesthesia. Materials and methods: An analytical cross-section study was conducted in elderly patients receiving anesthesia at a second-level hospital, from November 2016 to November 2017. The confusion assessment method was used based on 4 items for making the diagnosis of delirium. The data obtained were statistically analyzed with measures of central tendency, and the risk probability was estimated. Results: A total of 100 patients aged between 60 and 93 years old were studied, with postoperative delirium present in 18% of the sample. There was a statistically significant association among patients with severe pain, those with a low level of education, and those who did not have a stable partner. Conclusion: It is important to study the postoperative delirium factors to be able to identify the population at higher risk of experiencing postoperative delirium, with a view to reducing the number of long-term complications.
Resumen Introducción: El delirio en el postoperatorio se define como un estado confusional agudo con alteraciones en la atención y conciencia. Este se presenta en un período corto de tiempo y presenta una evolución transitoria y fluctuante, con un desenlace a largo plazo en disfunción cognitiva. Se ha observado una mayor presentación en los extremos de la vida y su asociación con factores que aumentan el riesgo de presentación. Objetivo: Identificarlos factores asociados a la presentación de delirio postoperatorio del adulto mayor sometido a anestesia. Materiales y Métodos: Se realizó un estudio transversal analítico en pacientes adultos mayores sometidos a anestesia en un hospital de segundo nivel, en el periodo de Noviembre 2016 a Noviembre 2017. Se aplicó el método de evaluación de confusión (Test CAM) consistente en 4 ítems que hacen diagnóstico de delirio. Los datos obtenidos se analizaron estadísticamente con medidas de tendencia central y se calcularon probabilidades de riesgo. Resultados: Se estudiaron 100 pacientes con rango de edades entre los 60 y 93 años, obteniendo delirio postoperatorio en 18% de la muestra. Se encontró una asociación estadísticamente significativa entre los pacientes con dolor severo, aquellos que no contaban con algun grado de escolaridad y los que no contaban con una pareja estable. Conclusiones: Es importante el estudio de factores asociados a delirio postoperatorio que permitan identificar la población en más alto riesgo de desarrollarlo, buscando disminuir complicaciones a largo plazo.
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Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Período Pós-Operatório , Delírio , Anestesia , Estudos Transversais , Probabilidade , Confusão , Consciência , Estado de Consciência , Disfunção CognitivaRESUMO
INTRODUCTION: Tetanus is an acute disease caused by a toxin produced by Clostridium tetanii. The disease can affect people of any age, and the fatality rate is high. Thanks to immunization the number of cases of the disease has decreased, although they are still present in isolation in countries with social and economic backwardness. OBJECTIVE: To describe a case of a pediatric patient with generalized tetanus to reinforce the relevance of prophylaxis and early detection. CASE REPORT: 6 years old female patient, with only one dose of pentavalent vaccine, 10 days after sharps injury by wood chips, starts with fever, muscle pain and generalized contractions, Tetanus was diagnosed by clinical symptoms and history. The management was based on the latest recommendations of the World Health Organization (WHO): Penicillin-Metronidazole antibiotic regimen, tetanus toxoid and tetanus high-dose gammaglobulin. After 2 years of follow-up under physiotherapy support, slight motor sequelae were observed. CONCLUSION: Tetanus is still presented in the pediatric population, associated with lack of vaccination. It is necessary to know the disease to provide proper diagnosis and management according to international lineaments.
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Tétano/diagnóstico , Criança , Diagnóstico Precoce , Feminino , Humanos , Tétano/etiologia , Tétano/terapia , Toxoide TetânicoRESUMO
Resumen: Introducción: El síndrome de Evans se caracteriza por la disminución de, al menos, dos líneas celulares en ausencia de otros diagnósticos. Anteriormente, se definía como el desarrollo simultáneo o secuencial de trombocitopenia inmune primaria y anemia hemolítica autoinmune sin etiología específica. Se ha reportado una incidencia del 37% y una mortalidad del 10% de este síndrome. Casos clínicos: Se presenta la información clínica y la evolución del síndrome de Evans en dos pacientes lactantes que inicialmente fueron diagnosticados con trombocitopenia inmune primaria. El diagnóstico clínico se apoyó con estudios de gabinete, donde se corroboraron las alteraciones hematológicas. El manejo se realizó con esteroides e inmunoglobulina. Conclusiones: En el abordaje del paciente pediátrico con trombocitopenia se deben buscar alteraciones de otra línea celular. En los casos reportados se detectó la presencia de anemia hemolítica y monocitosis, por lo que se deben incluir estudios infecciosos e inmunológicos. El tratamiento de primera línea es con esteroides, y debe considerarse la administración de inmunoglobulina si existe trombocitopenia severa asociada, como se observó en estos casos.
Abstract: Background: Evans syndrome is characterized by the reduction of at least two blood cell lineages in the absence of other diagnoses; it was previously described as the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia with unknown etiology. An incidence of 37% and mortality rate of 10% were reported for Evans syndrome. Clinical cases: We report the clinical presentation and evolution of Evans syndrome in two infants who were initially diagnosed with immune thrombocytopenia. The clinical diagnosis was supported on complementary studies, where hematological disorders were corroborated. Both cases received treatment with steroids and intravenous immunoglobulin. Conclusions: For the management of children with thrombocytopenia, the pediatrician must analyze for other cell lineage disorders. In the cases that we report here, we found the presence of autoimmune hemolytic anemia and monocytosis. Therefore, infectious and immunological studies must be included. The first-line treatment of choice are steroids, and intravenous immunoglobulin can be considered if severe immune thrombocytopenia is associated, as observed in these cases.
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BACKGROUND: Evans syndrome is characterized by the reduction of at least two blood cell lineages in the absence of other diagnoses; it was previously described as the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia with unknown etiology. An incidence of 37% and mortality rate of 10% were reported for Evans syndrome. CLINICAL CASES: We report the clinical presentation and evolution of Evans syndrome in two infants who were initially diagnosed with immune thrombocytopenia. The clinical diagnosis was supported on complementary studies, where hematological disorders were corroborated. Both cases received treatment with steroids and intravenous immunoglobulin. CONCLUSIONS: For the management of children with thrombocytopenia, the pediatrician must analyze for other cell lineage disorders. In the cases that we report here, we found the presence of autoimmune hemolytic anemia and monocytosis. Therefore, infectious and immunological studies must be included. The first-line treatment of choice are steroids, and intravenous immunoglobulin can be considered if severe immune thrombocytopenia is associated, as observed in these cases.
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Anemia Hemolítica Autoimune/diagnóstico , Glucocorticoides/administração & dosagem , Imunoglobulinas Intravenosas/administração & dosagem , Trombocitopenia/diagnóstico , Anemia Hemolítica Autoimune/tratamento farmacológico , Anemia Hemolítica Autoimune/fisiopatologia , Humanos , Lactente , Masculino , Púrpura Trombocitopênica Idiopática/diagnóstico , Trombocitopenia/tratamento farmacológico , Trombocitopenia/fisiopatologiaRESUMO
Introducción: El tétanos es una enfermedad aguda causada por una toxina producida por Clostridium tetanii. La enfermedad puede afectar a personas de cualquier edad, y la tasa de letalidad es alta. Gracias a la inmunización se ha logrado reducir el número de casos de la enfermedad, aunque se siguen presentando casos sobre todo en países con rezago social y económico. Objetivo: Describir caso clínico de un paciente pediátrico con tétanos generalizado, para reforzar la importancia de la profilaxis y diagnóstico precoz. Caso clínico: Escolar femenina de 6 años de edad con antecedente de esquema de inmunizaciones incompleto (una dosis de pentavalente), quien 10 días después de hacerse una herida cortopunzante por astilla de madera en brazo derecho, evolucionó con fiebre, dolor muscular y contracciones generalizadas, diagnosticándose tétanos generalizado en base a los antecedentes y el cuadro clínico. El tratamiento se estableció en base a las últimas recomendaciones de la Organización Mundial de la salud (OMS): esquema antibiótico Penicilina-Metronidazol, toxoide tetánico y gammaglobulina antitetánica a dosis altas. Se da de alta con secuelas motoras leves, las que se remitieron luego de 2 años de seguimiento y terapia de rehabilitación. Conclusión: El tétanos se sigue presentando en la población pediátrica principalmente asociado a falta de vacunación, es necesario conocer la enfermedad para hacer diagnóstico temprano y ofrecer manejo acorde a recomendaciones internacionales.
Introduction: Tetanus is an acute disease caused by a toxin produced by Clostridium tetanii. The disease can affect people of any age, and the fatality rate is high. Thanks to immunization the number of cases of the disease has decreased, although they are still present in isolation in countries with social and economic backwardness. Objective: To describe a case of a pediatric patient with generalized tetanus to reinforce the relevance of prophylaxis and early detection. Case Report: 6 years old female patient, with only one dose of pentavalent vaccine, 10 days after sharps injury by wood chips, starts with fever, muscle pain and generalized contractions, Tetanus was diagnosed by clinical symptoms and history. The management was based on the latest recommendations of the World Health Organization (WHO): Penicillin-Metronidazole antibiotic regimen, tetanus toxoid and tetanus high-dose gammaglobulin. After 2 years of follow-up under physiotherapy support, slight motor sequelae were observed. Conclusion: Tetanus is still presented in the pediatric population, associated with lack of vaccination. It is necessary to know the disease to provide proper diagnosis and management according to international lineaments.