Vulnerability in women primary caregivers of children in palliative care due to intimate partner violence in a pediatric hospital in Mexico.

BACKGROUND: Women are the primary caregivers of children in palliative care. Research has shown that the presence of intimate partner violence at home exacerbates the vulnerability of the caregiver. Current statistics indicate a high prevalence of violence in Mexico present in the intersectionality between intimate partner violence and the role of the primary caregiver. This study aimed to describe the frequency of intimate partner violence among primary palliative caregivers at the Hospital Infantil de México Federico Gómez. METHODS: We conducted a cross-sectional and prospective study with convenience sampling; no sample calculation was performed. All female primary caregivers of children in the palliative care unit were invited to participate. The Scale of Violence and Index of Severity of Violence was used as the measuring instrument. RESULTS: One hundred women participated in the study by submitting their survey in a designated mailbox. No sociodemographic data or patient diagnoses were collected. The frequency of intimate partner violence was 28%, of which 16% were considered severe cases. Women reported psychological violence (36%), sexual violence (23%), and physical violence (22%). CONCLUSIONS: Almost one-third of female primary caregivers of pediatric patients at the Hospital Infantil de México Federico Gómez have been victims of some form of violence by current partners. This study highlights a previously unreported problem and opens the door for studies to correlate intimate partner violence among primary caregivers and the quality of life of children in palliative care.

INTRODUCCIÓN: Las mujeres son las principales cuidadoras de los niños en cuidados paliativos. Las investigaciones han demostrado que la violencia de pareja en el hogar exacerba la vulnerabilidad del cuidador. Las estadísticas actuales sobre violencia en México indican una alta prevalencia presente en la interseccionalidad entre la violencia de pareja y el rol de cuidador principal. El objetivo de este estudio fue describir la frecuencia de violencia de pareja entre los cuidadores primarios del Hospital Infantil de México Federico Gómez (HIMFG). MÉTODOS: Se llevó a cabo un estudio transversal y prospectivo con muestreo por conveniencia; no se realizó ningún cálculo de muestra. Se invitó a participar a todas las mujeres cuidadoras primarias de niños en la Unidad de Cuidados Paliativos. Se utilizó como instrumento la Escala de Violencia e Índice de Severidad de la Violencia. RESULTADOS: Cien mujeres participaron en el estudio; no se recogieron sus datos sociodemográficos ni diagnósticos. La frecuencia de violencia de pareja fue del 28%: 16% se consideraron casos graves. Las mujeres reportaron violencia psicológica (36%), violencia sexual (23%) y violencia física (22%). CONCLUSIONES: Alrededor de la tercera parte de las mujeres cuidadoras principales de pacientes pediátricos del HIMFG han sido víctimas de algún tipo de violencia por parte de sus parejas actuales. Este estudio destaca un problema no informado previamente y abre la puerta a estudios para correlacionar la violencia de pareja íntima entre los cuidadores primarios y la calidad de vida de los niños en cuidados paliativos.

Vulnerability in women primary caregivers of children in palliative care due to intimate partner violence in a pediatric hospital in Mexico / Vulnerabilidad en mujeres cuidadoras primarias de menores en cuidados paliativos debida a violencia de pareja en un hospital de niños en México

Abstract Background: Women are the primary caregivers of children in palliative care. Research has shown that the presence of intimate partner violence at home exacerbates the vulnerability of the caregiver. Current statistics indicate a high prevalence of violence in Mexico present in the intersectionality between intimate partner violence and the role of the primary caregiver. This study aimed to describe the frequency of intimate partner violence among primary palliative caregivers at the Hospital Infantil de México Federico Gómez. Methods: We conducted a cross-sectional and prospective study with convenience sampling; no sample calculation was performed. All female primary caregivers of children in the palliative care unit were invited to participate. The Scale of Violence and Index of Severity of Violence was used as the measuring instrument. Results: One hundred women participated in the study by submitting their survey in a designated mailbox. No sociodemographic data or patient diagnoses were collected. The frequency of intimate partner violence was 28%, of which 16% were considered severe cases. Women reported psychological violence (36%), sexual violence (23%), and physical violence (22%). Conclusions: Almost one-third of female primary caregivers of pediatric patients at the Hospital Infantil de México Federico Gómez have been victims of some form of violence by current partners. This study highlights a previously unreported problem and opens the door for studies to correlate intimate partner violence among primary caregivers and the quality of life of children in palliative care.

Resumen Introducción: Las mujeres son las principales cuidadoras de los niños en cuidados paliativos. Las investigaciones han demostrado que la violencia de pareja en el hogar exacerba la vulnerabilidad del cuidador. Las estadísticas actuales sobre violencia en México indican una alta prevalencia presente en la interseccionalidad entre la violencia de pareja y el rol de cuidador principal. El objetivo de este estudio fue describir la frecuencia de violencia de pareja entre los cuidadores primarios del Hospital Infantil de México Federico Gómez (HIMFG). Métodos: Se llevó a cabo un estudio transversal y prospectivo con muestreo por conveniencia; no se realizó ningún cálculo de muestra. Se invitó a participar a todas las mujeres cuidadoras primarias de niños en la Unidad de Cuidados Paliativos. Se utilizó como instrumento la Escala de Violencia e Índice de Severidad de la Violencia. Resultados: Cien mujeres participaron en el estudio; no se recogieron sus datos sociodemográficos ni diagnósticos. La frecuencia de violencia de pareja fue del 28%: 16% se consideraron casos graves. Las mujeres reportaron violencia psicológica (36%), violencia sexual (23%) y violencia física (22%). Conclusiones: Alrededor de la tercera parte de las mujeres cuidadoras principales de pacientes pediátricos del HIMFG han sido víctimas de algún tipo de violencia por parte de sus parejas actuales. Este estudio destaca un problema no informado previamente y abre la puerta a estudios para correlacionar la violencia de pareja íntima entre los cuidadores primarios y la calidad de vida de los niños en cuidados paliativos.

Múltiples Dientes Supernumerarios en Paciente Pediátrico No Sindrómico. Una Revisión de la Literatura y Presentación de Caso Clínico / Multiple Supernumerary Teeth In A Non-Syndromic Pediatric Patient. A Review Of The Literature and Presentation of a Clinical Case

Aquellos casos en que se excede la fórmula dentaria normal primaria de 20 dientes o definitiva de 32 dientes se conocen como dientes supernumerarios o hiperodoncia. Los supernumerarios se pueden presentar de manera única o múltiple y de forma heteromórfica o eumórfica. El supernumerario más prevalente es el mesiodens, se da más en hombres, en dentición permanente y en el maxilar. Su etiología no está confirmada, pero puede deberse a una hiperactividad de la lámina dental. El tratamiento varía de acuerdo a cada paciente según si está afectando a la dentición normal o no y el desarrollo que tengan las estructuras dentarias. El siguiente reporte de caso habla de un paciente de 6 años, no sindrómico, en donde se presentó con un mesiodens erupcionado y se encontraron más supernumerarios gracias a la radiografía complementaria.

Those cases in which the primary normal dental formula of 20 teeth or the final one of 32 teeth is exceeded are known as supernumerary teeth or hyperdontia. The supernumeraries can be presented in a single or multiple way and in a heteromorphic or eumorphic way. The most prevalent supernumerary is the mesiodens, it occurs more in men, in the permanent dentition and in the maxilla. Its etiology is not confirmed, but it may be due to hyperactivity of the dental lamina. The treatment varies according to each patient depending on whether it is affecting the normal dentition or not and the development of the dental structures. The following case report talks about a 6-year-old, non- syndromic patient, who presented with an erupted mesiodens and more supernumeraries were found thanks to the complementary radiography.

SARS-CoV-2 en pacientes de la Unidad de Cuidados Intensivos Pediátricos. Hospital de Especialidades Portoviejo, Ecuador

Introducción: el manejo del SARS-CoV-2 en pacientes pediátricos por el profesional de enfermería, debe estar regido por las directrices y protocolos que la Organización Mundial de la Salud y el Ministerio de Salud Pública han diseñado para minimizar las complicaciones y el índice de morbimotalidad que el coronavirus puede desencadenar. Objetivo: analizar el manejo del SARS-CoV-2 en pacientes de la Unidad de Cuidados Intensivos Pediátricos del Hospital de Especialidades Portoviejo, en Ecuador. Materiales y métodos: se realizó una investigación transversal, descriptiva y cuantitativa. La población estuvo constituida por 11 profesionales de enfermería y 19 pacientes pediátricos que estuvieron hospitalizados con SARS-CoV-2 y que requirieron soporte ventilatorio. Para la recolección de datos, se realizó una encuesta mediante Google Forms, con el fin de conocer los diferentes procedimientos y revisión de las historias clínicas, así como las complicaciones, tratamiento ventilatorio y egreso. Resultados: el 100 % del personal de enfermería empleó medidas contempladas en los protocolos de bioseguridad. Además de los pacientes que requirieron soporte ventilatorio, el 62,5 % presentó una insuficiencia respiratoria aguda asociada a la COVID-19, frente al 37,5 % que tuvieron una clínica de síndrome inflamatorio multisistémico. Los pediátricos fallecidos padecían de enfermedades congénitas. Conclusiones: la asistencia del personal de enfermería a los pacientes de la Unidad de Cuidados Intensivos Pediátricos, demuestra que los conocimientos adquiridos por dichos profesionales logró el restablecimiento de la salud de los menores ingresados.

Introduction: the management of SARS-CoV-2 in pediatric patients by nursing professionals should be governed by the guidelines and protocols that the World Health Organization and the Ministry of Public Health have designed to minimize the complications and morbimortality rate that coronavirus can trigger. Objective: to analyze the management of SARS-CoV-2 in patients of the Pediatric Intensive Care Unit of Portoviejo Specialties Hospital, in Ecuador. Materials and methods: a cross-sectional, descriptive and quantitative research was carried out. The population consisted of 11 nursing professionals and 19 pediatric patients who were hospitalized with SARS-CoV-2 and who required ventilatory support. For data collection, a survey was carried out using Google Forms, in order to know the different procedures and review of clinical histories, as well as complications, ventilatory treatment and discharge. Results: 100% of the nursing staff used measures covered by the biosecurity protocols. In addition to the patients who required ventilatory support, 62.5% presented acute respiratory failure associated to COVID-19, compared to 37.5% who had symptoms of multisystem inflammatory syndrome. The deceased pediatric patients suffered from congenital diseases. Conclusions: the assistance of the nursing staff to the patients of the Pediatric Intensive Care Unit shows that knowledge acquired by these professionals achieved the restoration of the health of the children admitted there.

El rol del cirujano plástico en las mordeduras por ofidios en niños: presentación de 2 casos / The role of the plastic surgeon in snake bites in children: two cases report

Las mordeduras de ofidios venenosos son lesiones potencialmente letales y continúan siendo un problema de salud en muchos países. Pueden determinar secuelas locorregionales y son más graves en los niños. Si bien existe consenso en cuanto al tratamiento sistémico, los datos acerca del tratamiento local son escasos y controversiales. Con frecuencia se convoca al cirujano plástico pediátrico para participar en el tratamiento de las heridas, el cual difiere del que solemos realizar en lesiones de otra etiología. Presentamos dos casos clínicos en los que obtuvimos excelentes resultados con el tratamiento conservador guiados por las recomendaciones del equipo de Toxicología y realizamos una revisión bibliográfica del tema. (AU)

Snake envenomation are potentially deadly accidents that still represent a public health issue in some countries. They may determine severe locoregional sequalae and are more serious in children. General treatment has been agreed, but there is little information available about adequate local management, where controversy remains. The pediatric plastic surgeon is usually involved in local treatment, which differs from standard measures applied to wound care in other situations. We present two clinical cases which, following the recommendations from toxicologists, received conservative treatment with excellent results, and we conducted a bibliographical review on the subject. (AU)

Tuberculosis screening after detection of a case in a paediatric haemato-oncology unit in a low prevalence country.

BACKGROUND: There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected. METHODS: After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8-12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up. RESULTS: After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients. CONCLUSIONS: The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.

Tuberculosis screening after detection of a case in a paediatric haemato-oncology unit in a low prevalence country / Cribado de tuberculosis tras la detección de un caso en una unidad de hematooncología pediátrica en un país con baja prevalencia

Background: There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected. Methods: After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8–12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up. Results: After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients. Conclusions: The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.(AU)

Antecedentes: No existen pautas para el cribado de niños hematooncológicos cuando se sospecha de un brote de tuberculosis (TB). Métodos: Después de la exposición a un adulto con TB activa, se evaluó a los niños expuestos de una unidad de hematooncología según el estado de inmunosupresión y el tiempo de exposición. Hasta una evaluación después de ocho a12 semanas desde la última exposición, se indicó isoniazida para aquellos con un proceso inicial negativo. Resultados: Tras 210 intervenciones se detectó un caso de tuberculosis pulmonar y otro con infección por TB latente. Los hallazgos pulmonares y el método de tratamiento fueron un desafío en algunos pacientes. Conclusiones: El cribado de TB en niños oncológicos requirió un método multidisciplinario y los médicos manejaron situaciones complejas.(AU)

Descripción del manejo con terapia cetogénica en pacientes pediátricos con epilepsia refractaria tratados en una institución de salud / Description of management with ketogenic therapy in pediatric patients with refractory epilepsy treated in a health care institution

Fundamentos: Los pacientes diagnosticados con epilepsia refractaria (ER) son aquellos que no alcanzan el controlde sus crisis aún tras la aplicación de varios fármacos antiepilépticos (FAEs), por esto se hace necesario laimplementación de un tratamiento coadyuvante, como la dieta cetogénica (DC). El objetivo de la presenteinvestigación es describir el manejo con terapia cetogénica en pacientes pediátricos con epilepsia refractariatratados en el Instituto Roosevelt entre 2019 y 2020. Métodos: Estudio observacional, descriptivo, retrospectivo, incluyó una muestra de 25 pacientes pediátricosdiagnosticados con ER atendidos por el servicio de nutrición en una institución hospitalaria de Colombia, queiniciaron tratamiento con DC. Se identificaron aquellos que cumplían con los criterios de inclusión, se diseñó unformulario en la plataforma REDCap para recolectar los datos, incluyendo características sociodemográficas, datosantropométricos, información del manejo nutricional y datos clínicos relacionados con su enfermedad de base.Posteriormente se realizó un análisis descriptivo. Resultados: El estudio incluyó 9 pacientes, todos en manejo con terapia cetogénica clásica, 8 casos se alimentabanpor vía oral y uno era usuario de gastrostomía. Los principales efectos secundarios asociados fueron, emesis ydiarrea. Se observó reducción parcial de crisis en la mayoría de los pacientes (88,9%) y un caso presentó remisióntotal de crisis (11,1%). Asimismo, durante la terapia 5 pacientes lograron reducir el número de FAEs indicados. Conclusiones: La DC es una alternativa adecuada de tratamiento en pacientes pediátricos con ER, contribuye en ladisminución de crisis epilépticas de los pacientes. (AU)

Background: Patients diagnosed with refractory epilepsy (RE) are those who do not achieve control of their seizureseven after the application of several antiepileptic drugs (AEDs), therefore the implementation of an adjuvanttreatment, such as the ketogenic diet (KD), becomes necessary. The aim of the present investigation is to describethe management with ketogenic therapy in pediatric patients with refractory epilepsy treated at the RooseveltInstitute between 2019 and 2020. Methods: Observational, descriptive, retrospective study, included a sample of 25 pediatric patients diagnosed withRD attended by the nutrition service in a hospital institution in Colombia, who initiated treatment with CD. Thosewho met the inclusion criteria were identified, a form was designed in the Redcap platform to collect data, includingsociodemographic characteristics, anthropometric data, nutritional management information and clinical datarelated to their underlying disease. Subsequently, a descriptive analysis was performed. Results: The study included 9 patients, all under management with classic ketogenic therapy, 8 cases were fedorally, and one was a gastrostomy user. The main associated side effects were emesis and diarrhea. Partialreduction of seizures was observed in most patients (88.9%) and one case presented total remission of seizures(11.1%). Likewise, during therapy, 5 patients were able to reduce the number of indicated AEDs.Conclusions: CD is an adequate treatment alternative in pediatric patients with RD, contributing to the reduction ofepileptic seizures in patients. (AU)

Características epidemiológicas en pacientes pediátricos con COVID-19 durante la primera ola pandémica / Experience in pediatric patients with COVID-19 during the first pandemic wave

Resumen La infección por SARS-CoV-2 se ha extendido en todo el mundo. La mayoría de las publicaciones describen un comportamiento diferente entre población adulta y pediátrica, esta última asociada a menor gravedad y morbimortalidad. El objetivo del trabajo fue analizar el proceso de atención, las característi cas clínicas epidemiológicas, la evolución y la utilización de recursos en pacientes pediátricos asistidos durante la primera ola pandémica a principio del 2020. Se realizó un estudio observacional, retrospectivo, descriptivo y analítico de pacientes pediátricos con infección por SARS-CoV-2, desde el 1 de abril al 31 de agosto del 2020, atendidos en un centro de alta complejidad. Se incluyeron 333 pacientes, 175 (53%) residentes del área Metropolitana de Buenos Aires (AMBA). La mediana de edad fue de 5.5 años (RIC 1.1-10.9) y 177 (53%) eran mujeres. Requirieron internación 209 (63%) y 152 (46%) tenían enfermedad de base. El 89% (n 295) cursó una enfermedad leve/asintomática y el síntoma predominante fue fiebre (n 169, 65%). En el análisis univariado, la enfermedad neurológica (OR 4.5, IC95% 1.9-11, p 0.002), pulmonar crónica (OR 3.9, IC95%1.5-10.3, p 0.002) y genética (OR 11, IC95%3.4-34.4, p< 0.001), así como los síntomas neurológicos (OR 2.8, IC95%1.1-6.6, p 0.035) y respiratorios (OR 20.2, IC95%8.5-48.2, p 0.001) se asociaron a mayor gravedad. Se deberá continuar con la vigilancia activa de aquellos con enfermedad compleja a fin de determinar los efectos de la pandemia en esta población.

Abstract Coronavirus 2 infection has spread rapidly throughout the world. Most of the current publications describe differ ent behavior between an adult and pediatric population, this last one is associated with less clinical severity. The purpose of this study was to analyze the process of care, the epidemiological and clinical features, the evolution and the use of resources in pediatric patients with SARS-Cov-2 infection, treated during the first pandemic wave, at the beginning of 2020. An observational and retrospective study was carried out in the pediatric population with SARS-CoV-2 infection, treated in a highly complex pediatric hospital from April 1 to August 31, 2020. A total of 333 patients were included, 175 (53%) residents of the Metropolitan area of Buenos Aires (AMBA). The median age was 5.47 years (IQR 1.1-10.9) and 177 (53%) were women. A total of 209 (63%) patients required hospi talization and 152 (46%) had an underlying disease. Most of the patients (n 295, 89%) had mild/asymptomatic disease and the main symptom was fever (N169, 65%). In the univariate analysis, neurological disease (OR 4.5, IC95% 1.9-11, p 0.002), chronic respiratory disease (OR 3.9, IC95%1.5-10.3, p 0.002) and genetics (OR 11, IC95%3.4-34.4, p < 0.001), as well as neurological symptoms (OR 2.8, IC95%1.1-6.6, p 0.035) and respiratory (OR 20.2, IC95%8.5-48.2, p 0.001) were associated with more severe disease. Active surveillance of pediatric patients with underlying diseases should continue to define the pandemic's impact on this specific population.

Gammaglobulina subcutánea: Revisión sistemática / Subcutaneous gamma globulin: A systematic review

Las inmunodeficiencias primarias constituyen enfermedades determinadas genéticamente, caracterizadas por la alteración cuantitativa y/o funcional de distintos mecanismos implicados en la respuesta inmunitaria. Algunas de ellas se caracterizan por una alteración en la producción de anticuerpos, por lo que algunos pacientes se benefician con la administración supletoria de gammaglobulina, la cual se administra mayormente por vía endovenosa, siendo la vía subcutánea una alternativa terapéutica. La siguiente revisión sistemática tiene por objetivo determinar si la gammaglobulina subcutánea tiene alguna ventaja frente al clásico uso de gammaglobulina endovenosa, en pacientes pediátricos con inmunodeficiencias primarias, revisando la bibliografía disponible hasta la actualidad (AU)

Primary immunodeficiencies are genetically determined diseases characterized by the quantitative and/or functional alteration of different mechanisms involved in the immune response. Some of these diseases are characterized by an alteration in the antibody production and therefore some patients benefit from the supplementary administration of gamma globulin, which is mostly administered intravenously, with the subcutaneous route being a therapeutic alternative. The following systematic literature review aims to determine whether subcutaneous gamma globulin has any advantage over the classic use of intravenous gamma globulin in pediatric patients with primary immunodeficiencies (AU)

Niveles glutatión reducido y estado redox celular en pacientes pediátricos con inmunodeficiencias / Reduced glutathione levels and cellular redox status in pediatric patients with immunodeficiencies

Introducción: Las alteraciones en el estado redox celular se han descrito como factores causales en diversas enfermedades. La depleción del glutatión reducido se ha asociado fundamentalmente a enfermedades neurodegenerativas, pulmonares, hepáticas, cardiovasculares e inmunológicas. Objetivo: Determinar las concentraciones de glutatión reducido y el estado redox celular en pacientes pediátricos con inmunodeficiencias. Métodos: Se estudiaron 21 pacientes con inmunodeficiencias procedentes de la consulta de Inmunogenética, en edades comprendidas entre 1 y 8 años, de ambos sexos, y 8 niños en el mismo rango de edad de los pacientes, como grupo control, con estudios de inmunidad humoral y celular normales. Los pacientes con diagnóstico de inmunodeficiencia se dividieron para su estudio en 2 grupos según el componente afectado de la respuesta inmune: humoral y celular. Fueron determinadas las concentraciones intraeritrocitarias de glutatión reducido y oxidado, mediante un método de HPLC-UV. Para evaluar el estado redox celular se calculó la relación entre las formas reducidas y oxidadas del glutatión (GSH/GSSG). Resultados: Las concentraciones de glutatión reducido y el estado redox celular se encontraron disminuidos en ambos grupos de pacientes en relación con los niños sin inmunodeficiencia (p=0,031 y p=0,03; respectivamente). El glutatión oxidado no mostró diferencias entre los grupos. Conclusiones: En los pacientes con inmunodeficiencia se evidenció la afectación del estado redox celular como consecuencia de la disminución del glutatión reducido. Este primer acercamiento ofreció las potencialidades del empleo de estos biomarcadores en la evaluación integral de pacientes con inmunodeficiencia(AU)

Introduction: Alterations in the cellular redox state have been described as causal factors in various diseases. Reduced glutathione depletion has been fundamentally associated with neurodegenerative, pulmonary, liver, cardiovascular and immunological diseases. Objective: To determine the concentrations of reduced glutathione and the cellular redox status in pediatric patients with immunodeficiencies. Methods: We studied 21 patients with immunodeficiencies from the immunogenetic service, aged between 1 and 8 years and as a control group, 8 children in the same age range as the patients, with normal humoral and cellular immunity studies. Patients diagnosed with immunodeficiency were divided into two groups according to the affected component of the immune response: humoral and cellular. The intraerythrocyte concentrations of oxidized and reduced glutathione were determined by means of an HPLC-UV method. To evaluate the cellular redox state, the relationship between the reduced and oxidized forms of glutathione (GSH/GSSG) was calculated. Results: Reduced glutathione concentrations and cellular redox status were found to be decreased in both groups of patients in relation to children without immunodeficiency (p=0,031 and p=0,03; respectively). Oxidized glutathione showed no difference between the groups. Conclusions: In patients with immunodeficiency, the cellular redox state is affected as a consequence of the decrease in reduced glutathione. This first approach offers the potential for the use of these biomarkers in the comprehensive evaluation of patients with immunodeficiency(AU)

SARS-CoV-2 vs. COVID-19 de adquisición nosocomial: estudio en un hospital pediátrico de tercer nivel de atención / Acquired nosocomial SARS-CoV-2 vs. COVID-19: Study in a pediatric hospital of tertiary level hospital care

Resumen Introducción: La infección nosocomial por coronavirus, del síndrome respiratorio agudo grave (SARS-CoV-2) se ha reportado sobre todo en unidades de adultos. Objetivo: Dar a conocer un reporte de casos pediátricos con infección nosocomial por SARS-CoV-2. Materiales y métodos: Se analizaron pacientes con infección nosocomial por SARS-Cov-2 vs. COVID-19, confirmados mediante reacción en cadena de la polimerasa transcriptasa inversa (RT-PCR) en tiempo real, ingresados al Hospital Infantil de México. Resultados: De un total de 163 pacientes analizados, solo 9 (5.5%) adquirieron SARS-CoV-2 durante su estancia hospitalaria. Cinco fueron del sexo masculino (55.5%) y 4 (44.4%) femenino, predominando los adolescentes (4 [44.4%]), todos mayores de 17 años. Solo uno desarrolló síndrome inflamatorio multisistémico. Analizamos 18 datos clínicos, de los cuales el síntoma más frecuente fue la fiebre, seguida de hiporexia y dolor abdominal. Discusión: La infección nosocomial por SARS-CoV-2 en pediatría se estará reportando más seguido. Conclusiones: Es necesario tener una definición más homogénea en cuanto a SARS-CoV-2 vs. COVID-19 nosocomial.

Abstract Background: Nosocomial infection by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been reported mainly in adult units. Objective: To present a report of pediatric cases with nosocomial infection by SARS-CoV-2. Materials and methods: Patients with nosocomial infection by SARS-Cov-2 vs. COVID-19, confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR), admitted to the Children´s Hospital of Mexico. Results: Of a total of 163 patients analyzed, only 9 (5.5%) acquired SARS-CoV-2 during their hospital stay. Five were male (55.5%) and 4 (44.4%) females, predominantly adolescents (4 [44.4%]), all older than 17 years. Only one developed multisystem inflammatory syndrome. We analyzed 18 clinical data, of which the most frequent symptom was fever, followed by hyporexia and abdominal pain. Discussion: Nosocomial SARS-CoV-2 infection in pediatrics will be reported more often. Conclusions: It is necessary to have a more homogeneous definition regarding SARS-CoV-2 vs. nosocomial COVID-19.

Ultrasound-guided percutaneous liver biopsy in children. Five-year experience at a tertiary care center.

INTRODUCTION AND AIMS: Percutaneous liver biopsy with histopathologic analysis is a valuable tool for the diagnosis, prognosis, and treatment evaluation of liver diseases. Its ultrasound-guided performance is useful, making the procedure safer and reducing the risk for complications and hospital stay. Our aim was to describe the indications, histopathologic study, and complications associated with the performance of ultrasound-guided percutaneous liver biopsy in pediatric patients. MATERIAL AND METHODS: The study included 102 ultrasound-guided percutaneous liver biopsies performed on patients <16 years of age, within the time frame of January 2014 and December 2019. The information was obtained from electronic files and histopathologic studies and the data were analyzed through descriptive statistics. RESULTS: A total of 102 procedures were carried out on 99 patients. Mean patient age was 72 months and 58.8% of the patients were female. Over 65% of the indications for liver biopsy included autoimmune hepatitis (23.5%), elevated liver enzymes (21.5%), and chronic liver disease (20.5%). Four patients presented with immediate complications (3.9%), three of which were major (2.9%), concurring with that reported in the international literature. CONCLUSIONS: Our study corroborates the importance of ultrasound-guided liver biopsy in the diagnosis and follow-up of pediatric patients. The procedure also had a low complication rate of only 3.9%.

Fratura condilar em paciente pediátrico: um relato de caso condilar / Fracture in pediatric patient: a case report

As fraturas faciais em crianças são raras, já que os ossos faciais pediátricos têm maior elasticidade, menos pneumatização, tecido adiposo circundante mais espesso e mais estabilização da mandíbula e maxila pelos dentes não irrompidos. Em geral, lesões nos tecidos moles são mais comuns em crianças do que fraturas esqueléticas. Entre as fraturas faciais pediátricas, as fraturas da mandíbula são as mais comuns, sendo o côndilo a área mais acometida em pacientes pediátricos. O côndilo é considerado o principal centro de crescimento da mandíbula em crianças, assim é de suma importância a definição do tratamento adequado, pautado em diversos critérios de avaliação, com o intuito de erradicar possíveis complicações advindas da fratura condilar. Assim o objetivo deste estudo é relatar um caso de fratura de côndilo unilateral em uma criança, na qual realizou-se abordagem cirúrgica com fixação interna, afim de elucidar e discutir as possíveis condutas terapêuticas acerca de tratamentos a serem aplicados, visto que esses ainda são bastante controversos na literatura e os resultados das diversas condutas são os mais diversos, apresentando variados aspectos que interferem na evolução dos pacientes(AU)

Facial fractures in children are rare, since pediatric facial bones have greater elasticity, less pneumatization,thicker surrounding adipose tissue and more stabilization of the jaw and jaw by unerupted teeth.In general, soft tissue injuries are more common in children than skeletal fractures.Among pediatric facial fractures, mandible fractures are the most common, with condyl being the most affected area in pediatric patients.The condyl is considered the main center of mandible growth in children, so it is of Paramount importance to define the appropriate treatment, based on several evaluationcriteria, in order to eradicate possible complications resulting from the condilar fracture.Thus, the aim of this study is to report a case of unilateral condyl fracture in a child, in which a surgical approach with internal fixation was performedin order to elucidate and discuss the possible therapeutic approaches about treatments to be applied, since these are still quite controversial in the literature and the results of the various behaviors are the most diverse,presenting several aspects that interfere in the evolution of patients(AU)

Agreement and differences between macular values in children using two types of spectral optical coherence tomography.

OBJECTIVES: To determine the degree of agreement and differences between macular parameters according to sex, age, laterality, ethnicity and type of optical coherence tomography (OCT) in paediatric patients. MATERIALS AND METHODS: Prospective, transversal, and comparative study. OCT Spectralis and OCT Cirrus were used to obtain the macular values of both eyes in 100 patients between 5 and 15 years without ocular pathology. Due to the similarity between the values of both eyes, in the final sample we only considered the right eyes (OD) (n = 100). RESULTS: The average central macular thickness (CMT) was 244.2 µm with Cirrus and 261.7 µm with Spectralis. The degree of agreement for the GMC was moderate (Intraclass Correlation Coefficient: 0.66) and from low to very low in the other quadrants. The GMC values of both systems were significantly higher in men than in women (P < .05). The macular retinal nerve fibre layer (mRNC), ganglion cell layer (GCC), the inner plexiform layer (IPLC), and the inner nuclear layer (INFL) had significantly higher values in men than in women (P < .01). There were no statistically significant differences in the GMC by age and laterality, however it was significantly higher in ethnic European children than in ethnic Latin American children; Cirrus (P = .042) and Spectralis (P = .033). CONCLUSIONS: Macular parameters obtained by OCT Spectralis and OCT Cirrus should not be interchangeable in pediatric patients.

Grado de concordancia y diferencias entre valores maculares en niños mediante dos tipos de tomografía de coherencia óptica espectral / Agreement and differences between macular values in children using two types of spectral optical coherence tomography

Objetivo Determinar el grado de concordancia y las diferencias entre los parámetros maculares en función de sexo, edad, lateralidad, etnia y tipo de tomografía de coherencia óptica (OCT) en pacientes pediátricos. Materiales y métodos Estudio prospectivo, transversal y comparativo. Se hizo uso de la OCT Spectralis y la OCT Cirrus para obtener los valores maculares de ambos ojos en 100 pacientes entre 5 y 15años sin patología ocular. Debido a la semejanza entre los valores de ambos ojos, en la muestra final solo consideramos los ojos derechos (OD) (n=100). Resultados La media del grosor macular central (GMC) fue de 244,2μm con Cirrus y 261,7μm con Spectralis. El grado de concordancia para el GMC fue moderado (coeficiente de correlación intraclase: 0,66) y de bajo a muy bajo en el resto de cuadrantes. Los valores de GMC de ambos sistemas fueron significativamente mayores en varones que en mujeres (p<0,05). La capa de fibras nerviosas de la retina macular (CFNRm), la capa de células ganglionares (CCG), la capa plexiforme interna (CPI) y la capa nuclear interna (CNI) tuvieron valores significativamente mayores en varones que en mujeres (p<0,01). No hubo diferencias estadísticamente significativas en el GMC según edad y lateralidad; sin embargo, fue significativamente mayor en niños de etnia europea que en niños de etnia latinoamericana; Cirrus (p=0,042) y Spectralis (p=0,033). Conclusiones Los parámetros maculares obtenidos mediante OCT Spectralis y OCT Cirrus no deberían ser intercambiables en pacientes pediátricos (AU)

Objective To determine the degree of agreement and differences between macular parameters according to sex, age, laterality, ethnicity and type of optical coherence tomography (OCT) in paediatric patients. Materials and methods Prospective, transversal, and comparative study. OCT Spectralis and OCT Cirrus were used to obtain the macular values of both eyes in 100 patients between 5 and 15years without ocular pathology. Due to the similarity between the values of both eyes, in the final sample we only considered the right eyes (OD) (n=100). Results The average central macular thickness (CMT) was 244.2μm with Cirrus and 261.7μm with Spectralis. The degree of agreement for the GMC was moderate (intraclass correlation coefficient: 0.66) and from low to very low in the other quadrants. The GMC values of both systems were significantly higher in men than in women (P<.05). The macular retinal nerve fibre layer (mRNC), ganglion cell layer (GCC), the inner plexiform layer (IPLC), and the inner nuclear layer (INFL) had significantly higher values in men than in women (P<.01). There were no statistically significant differences in the GMC by age and laterality, however it was significantly higher in ethnic European children than in ethnic Latin American children; Cirrus (P=.042) and Spectralis (P=.033). Conclusions Macular parameters obtained by OCT Spectralis and OCT Cirrus should not be interchangeable in pediatric patients (AU)

Ultrasound-guided percutaneous liver biopsy in children. Five-year experience at a tertiary care center. / Biopsia hepática percutánea guiada por ultrasonido en pediatría. Experiencia de 5 años en un centro de tercer nivel.

INTRODUCTION AND AIMS: Percutaneous liver biopsy with histopathologic analysis is a valuable tool for the diagnosis, prognosis, and treatment evaluation of liver diseases. Its ultrasound-guided performance is useful, making the procedure safer and reducing the risk for complications and hospital stay. Our aim was to describe the indications, histopathologic study, and complications associated with the performance of ultrasound-guided percutaneous liver biopsy in pediatric patients. MATERIAL AND METHODS: The study included 102 ultrasound-guided percutaneous liver biopsies performed on patients <16 years of age, within the time frame of January 2014 and December 2019. The information was obtained from electronic files and histopathologic studies and the data were analyzed through descriptive statistics. RESULTS: A total of 102 procedures were carried out on 99 patients. Mean patient age was 72 months and 58.8% of the patients were female. Over 65% of the indications for liver biopsy included autoimmune hepatitis (23.5%), elevated liver enzymes (21.5%), and chronic liver disease (20.5%). Four patients presented with immediate complications (3.9%), three of which were major (2.9%), concurring with that reported in the international literature. CONCLUSIONS: Our study corroborates the importance of ultrasound-guided liver biopsy in the diagnosis and follow-up of pediatric patients. The procedure also had a low complication rate of only 3.9%.

Atención Farmacéutica Integral a pacientes pediátricos hospitalizados con trastornos siquiátricos / Comprehensive Pharmaceutical Care in pediatric inpatient with psychiatric disorders

Introducción: el incremento de nuevos psicofármacos en la edad pediátrica, requieren la valoración de problemas relacionados con medicamentos, de ahí que resulte necesario el desarrollo de los servicios de Atención Farmacéutica. Objetivo: desarrollar la Atención Farmacéutica Integral para pacientes pediátricos con trastornos psiquiátricos hospitalizados. Métodos: se realizó un estudio prospectivo y de intervención, desde febrero a abril del 2017, en el que participaron pacientes pediátricos con trastornos psiquiátricos. El servicio se desarrolló en tres fases del proceso de cuidado farmacéutico y se empleó un procedimiento normalizado de trabajo. Se determinó el impacto de las intervenciones en la prevención o resolución de los resultados negativos asociados a la medicación, el estado clínico de los pacientes y la satisfacción de los cuidadores. Resultados: predominó el sexo femenino (55%), edades comprendidas entre 15 y 18 años (80%) y nivel de escolaridad medio de los cuidadores (45%). Se identificó falta de adherencia terapéutica antes del ingreso, corroborada con las experiencias subjetivas. Se detectaron 19 resultados negativos asociados a la medicación, predominando los de seguridad (89,4%). Se realizaron 36 intervenciones farmacéuticas, para un 80,5% de aceptación, se previnieron 57,1% y se resolvió el 80 % del total de resultados negativos asociados a la medicación. El 100 % de los pacientes tuvieron una evolución favorable y los cuidadores mostraron satisfacción. Conclusiones: La Atención Farmacéutica Integral permitió identificar factores psicosociales del paciente asociados a la enfermedad y la farmacoterapia y la prevención y resolución de la mayoría de los resultados negativos asociados a la medicación.(AU)

Introduction: the use of new psychoactive drugs and their widespread use in the pediatric age underline the importance of assessing the appearance of drug-related problems, hence the need for the development of Pharmaceutical Care services. Objective:to show the preliminary results of the development of the Comprehensive Pharmaceutical Care service for pediatric inpatients with psychiatric disorders. Methods: in 2020, it was carried out a retrospective study about the preliminary implementation of a service provided to pediatric inpatients with psychiatric disorders, from February 1stto April 28thin 2017. The pharmaceutical care process was developed in three phases, a standard operating procedure and the pharmacotherapeutical profiles of patients were used. The preliminary impact of the interventions on the prevention or resolution of negative results associated with medication, the clinical status of the patients and the satisfaction of the caregivers was determined. Results :twenty patients were included, female sex predominated (55%), ages between 15 and 18 years (80%) and average level of education of caregivers (45%). Lack of therapeutic adherence was identified before admission, corroborated with subjective experiences from patients, 19 negative results associated with medication were detected, predominantly related to safety (89.4%), 36 pharmaceutical interventions were carried out with 80.5% of acceptance, 57.1% were prevented and 80% of the total negative results associated with the medication were resolved. 100% of the patients had a favourable progress and caregivers showed 100 % of satisfaction. Conclusions: the Comprehensive Pharmaceutical Care service allowed to identify psychosocial factors in patients associated to disease and pharmacotherapy and contributed to the...(AU)

Complicaciones postransfusionales en pacientes pediátricos con leucemia / Post-transfusion complications in pediatric patients with leukemia

Introducción: El cáncer pediátrico es un importante problema de salud pública y el más frecuente es la leucemia. En ocasiones, esta enfermedad puede generar depleción de las líneas celulares y es la transfusión de hemocomponentes un importante pilar de su tratamiento. Este procedimiento puede generar reacciones postransfusionales que pueden ser letales. Objetivo: Exponer las diferentes características clínicas y epidemiológicas de las reacciones postransfusionales en población pediátrica con leucemia. Métodos: Se realizó una búsqueda sistemática en las principales bases de datos de literatura médica. Se incluyeron 46 artículos. Resultados: La complicación más frecuente es la reacción febril no hemolítica. También es frecuente la sobrecarga de hierro. El factor de riesgo más importante para presentar esta sobrecarga es el número de transfusiones. Es necesario monitorizar la cantidad de hierro hepático. La reacción pulmonar aguda relacionada con la transfusión es una condición potencialmente mortal. Las infecciones pueden presentarse y pueden ser mortales dada la inmunosupresión de este grupo de pacientes. Otras reacciones inmunológicas pueden ser raras, pero deben ser tenidas en cuenta. Consideraciones finales: Las reacciones postransfusionales pueden ser más graves en los pacientes con leucemia. Se requiere realizar estudios con modelos epidemiológicos adecuados para identificar las reacciones postransfusionales más frecuentes en población pediátrica con esta enfermedad(AU)

Introduction: Pediatric cancer is a major public health problem and leukemia is the most common. Sometimes this disease can lead to depletion of cell lines and the transfusion of blood components is an important pillar of their treatment. This procedure can generate post-transfusion reactions that can be lethal. Objective: Show the different clinical and epidemiological characteristics of post-transfusion reactions in pediatric population with leukemia. Methods: A systematic search was carried out in the main databases of medical literature. 46 items were included. Results: The most common complication is the non-hemolytic febrile reaction. Iron overloading is also common. The most important risk factor for this overload is the number of transfusions. It is necessary to monitor the amount of iron in the liver. Acute transfusion-related pulmonary reaction is a life-threatening condition. Infections can occur and can be fatal given the immunosuppression of this group of patients. Other immune reactions may be rare, but they should be taken into account. Final considerations: Post-transfusion reactions may be more severe in patients with leukemia. Studies with appropriate epidemiological models are required to identify the most common post-transfusion reactions in the pediatric population with this disease(AU)

Tuberculosis screening after detection of a case in a paediatric haemato-oncology unit in a low prevalence country.

BACKGROUND: There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected. METHODS: After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8-12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up. RESULTS: After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients. CONCLUSIONS: The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.