Showing papers in "Revista chilena de pediatría in 2014"
TL;DR: Since the duration of mechanical ventilation is the primary responsible for the absence of mechanical stimulation on the diaphragm, the use of ventilatory strategies for successful early weaning and early use of partial modalities should be the main pillars in the prevention of this condition.
Abstract: The ventilator-induced diaphragmatic dysfunction is a group of disorders caused by the inactivity of the diaphragm muscle during controlled mechanical ventilation. From a structural point of view, the diaphragm subjected to mechanical ventilation undergoes an atrophy process, in which decreased synthesis and increased muscle protein degradation are observed. Recent research has identified different molecular signaling pathways that link both processes in the diaphragm, describing compelling evidence that shows that oxidative stress contributes to this phenomenon. Also, functional changes characterized by a reduction in stress and fatigue resistance, associated with an increase in the maximum shortening velocity are observed. The purpose of the present review is to analyze the impact of mechanical ventilation on the structure and function of the diaphragm muscle. Clinical implications and potential preventive steps are discussed. Since the duration of mechanical ventilation is the primary responsible for the absence of mechanical stimulation on the diaphragm, the use of ventilatory strategies for successful early weaning and early use of partial modalities should be the main pillars in the prevention of this condition.
79 citations
TL;DR: Moneta et al. as mentioned in this paper presented the results of a study conducted at the International Psychoanalytic University (IPU-Berlin), Berlin, Germany, with the aim of identifying the root cause of depression.
Abstract: 1. PHD, Facultad de Medicina, Universidad de Munchen. Profesor Asociado, Facultad de Medicina, Universidad de Chile. Profesor invitado, International Psychoanalytic University (IPU-Berlin), Berlin.Recibido el 26 de febrero de 2014, segunda version 31 de marzo de 2014, aceptado para publicacion el 3 de abril de 2014.Correspondencia a:Maria Eugenia Moneta C.E-mail: mmoneta@med.uchile.clev Chil Pediatr 2014; 85 (3): 265-268
23 citations
TL;DR: In this article, the authors describe the DSM assessment practices used in Chile and back up the use of monitoring systems based on the report of parents/caregivers, which have the advantage of being inexpensive, requiring little application and interpretation time and involve the adults who are responsible for the care and stimulation of the child.
Abstract: The screening and timely intervention of developmental psychomotor delay (DSM) has proven benefits for the child, families and society. In order to improve the efficiency in the identification of these disorders, many scientific groups recommend performing clinical monitoring during health controls and the use of standard evaluations at specific patient age or when delays are suspected. In recent years, screening instruments have been developed based on the report of parents or primary caregivers, which have the advantage of being inexpensive, require little application and interpretation time and involve the adults who are responsible for the care and stimulation of the child. One of these tools is the Ages and Stages Questionnaires (ASQ), which has been widely used in the US and validated by several countries. This study describes the DSM assessment practices used in Chile and backs up the use of monitoring systems based on the report of parents/caregivers. ASQ validation experiences in other countries are discussed along with their psychometric characteristics for the Chilean population and consequent applicability.
21 citations
TL;DR: For instance, this article found that 73.3% of the children assessed had deficits in some area of the language, including narrative skills, while 86.4% showed significant difficulties in narrative skills.
Abstract: Language difficulties in preschool children with a history of extreme prematurity Introduction: Preterm infants are prone to present language development difficulties. There is evidence that verbal deficits are common and adversely affect social interaction as well as school learning. In Chile, these skills are not evaluated by the premature follow-up program; therefore, the extent of this problem is unknown. The objective of this study is to describe the language difficulties of a group of preschoolers with a history of extreme prematurity. Patients and Methods: Thirty children aged 4 and 5 years old, with a history of extreme prematurity, but without severe neurological damage or hearing loss were evaluated through language tests at the Premature Follow-up Polyclinic of the Eastern Cordillera Health Reference Center. Results: 73.3% of the children assessed had deficits in some area of the language. Of these, 77.3% had comprehensive and expressive difficulties. In this group, 86.4% showed significant difficulties in narrative skills. Discussion: a high preterm infant proportion presents language difficulties in preschool, resulting in the need of including specific inter-vention programs that promote better language development for this population.(Key words: Prematurity, language, preschooler, learning).Rev chil pediatr 2014; 85 (3): 319-327ResuMenIntroduccion: Los ninos prematuros son una poblacion vulnerable a presentar dificultades en su desarrollo linguistico posterior. Existe evidencia que los deficits verbales son frecuentes y que repercuten negativamente en la interaccion social y en el aprendizaje escolar. En Chile, estas habilidades no son evaluadas por el progra-ma de seguimiento de prematuros, desconociendose la magnitud de este problema. El objetivo fue describir
15 citations
TL;DR: Las recomendaciones de the Rama de Nutricion de the Sociedad Chilena de Pediatria para el diagnostico, tamizaje y tratamiento de las dislipidemias en the ninez.
Abstract: The prevalence of dyslipidemia has dramatically increased in children and adolescents, and many of these cases are associated with increased obesity. As this condition represents cardiovascular risk in the future, the bases of its treatment should be widely known. In the vast majority of patients, there will be lifestyle changes, specific diet and increased physical activity, usually all of these resulting in a favorable response. Only a minority will require drug treatment, which must be prescribed by a specialist in the context of a comprehensive cardiovascular risk assessment, including the patient and his family. The prevention of cardiovascular risk factors should be performed by all members of the health team. This article presents the recommendations of the Nutrition specialists of the Chilean Society of Pediatrics for screening, diagnosis and treatment of dyslipidemia in childhood.
11 citations
TL;DR: The prevalencia of Pediculus humanus capitis, a ectoparasitosis that ha recibido poca atencion in el norte de Chile, was investigated in this article, a pesar de que pediculosis is recurrente in la población infantil escolar.
Abstract: Introduccion: La Pediculosis es una ectoparasitosis que ha recibido poca atencion en el norte de Chile, a pesar de que es recurrente en la poblacion infantil escolar Nuestro objetivo fue determinar la prevalencia de Pediculus humanus capitis, en la poblacion escolar basica de la Provincia de Arica Pacientes y Metodo: Se estudio un grupo de 665 alumnos de ensenanza basica del sistema municipalizado, de la Provincia de Arica, durante agosto a noviembre de 2010 Se seleccionaron 467 ninos que cumplian con los criterios de inclusion Previo consentimiento informado de los alumnos y apoderados, el diagnostico se llevo a cabo a traves de la revision a ojo descubierto de la cabeza de los escolares participantes, en dependencias de cada establecimiento, registrando la presencia de Pediculus humanus capitis, grado de infestacion y estadio del ectoparasito Resultados: De la poblacion analizada, el 40,3% (188/467) presento Pediculosis, afectando a las seis escuelas estudiadas Las mujeres presentaron Pediculosis en un 55,2% (138/250) y los hombres un 23% (50/217) Conclusion: La poblacion escolar de la Provincia de Arica esta significativamente afectada por Pediculosis y su prevalencia es similar a otras regiones del pais
11 citations
TL;DR: There were more cases of early care behaviors among participating fathers at birth, even belonging to a discouraging socio cultural environment, and there was stability in HR, RR and temperature one hour postpartum.
Abstract: Introduction: Recent initiatives have promoted the participation of fathers in the early care of their children. Objective: To assess the results of a program to encourage parental involvement in childbirth. Parents of healthy term newborns were randomly allocated to participate either in the birth experience or control. Patients and Methods: The protocol included: to dry the skin, umbilical cord cutting off, weight, height, and finally give him/her to the mother for the skin-to-skin contact. Heart rate (HR), respiratory (RR) and temperature were evaluated one hour later. In the first outpatient clinic assessment, mothers completed a questionnaire. 127 fathers participated either in the birth experience or control. Results: 62 followed the protocol and 65 the control. Both newborn groups were comparable. Also were fathers in age, education and rurality; mothers in primiparity. Significant differences: night care (37/62, 10/65 59.6% vs 15.4%, p < 0.01); post prandial assistance (50/62, 14/65 80.6% vs 21.5%, p < 0.01); participation in bathing (38/62, 61.3% vs 15/65, 23.1%, p < 0.01); newborn visit upon arrival at home (46/62, 74.2% vs 22/65, 33.8%, p < 0.01); helping in crying episodes (42/62, 67.7% vs 17/65, 26.1%, p < 0.01). There was stability in HR, RR and temperature one hour postpartum. Only one case of complication among parents (fainting). Conclusions: There were more cases of early care behaviors among participating fathers at birth, even belonging to a discouraging socio cultural environment.
10 citations
TL;DR: In this paper, a questionnaire of 50 questions (20 minutes), created by 6 experts and previously validated, was conducted by 10 interviewers and 3 supervisors, to determine demographic, clinical and health care factors associated to prevalence of burns in children less than 20 years of age in Chile's metropolitan region.
Abstract: Epidemiology of burns in children and adolescents from Chile’s Metropolitan Region Objective: To determine demographic, clinical and health care factors associated to prevalence of burns in children less than 20 years of age in the districts of Cerro Navia, Lo Prado and Pudahuel, and their comparison with incidence in 2011. Patients and Method: Population survey based on probability and two-stage stratified complex sample of households, registering 4,968 households. In 302 of them randomly selected, the mother/ adult present at the time of the injury took a survey. A questionnaire of 50 questions (20 minutes), created by 6 experts and previously validated, was conducted by 10 interviewers and 3 supervisors. People were contacted by telephone before visiting them at their homes. The non-response rate was 6%, after up to 3 home visits. Results: Regarding prevalence, the male-to-female ratio was 1.16:1. Main reasons were hot objects (42.4%) and liquids (41.5%). 84.1% of burns occurred inside the home and in the afternoon (50.7%). 93.3% of the burns took place with an adult present. Hands were the most affected areas (46.7%). 30.2% were left with scars the first time of the accident. 34.4% of the burn victims did not require health care and 8.4% of them required hospitalizations. Over 60% of respondents reported that they poured cold water on the burn as a first step. Conclusion: Relevant information was obtained to be used in burn prevention in children and adolescents. Recall bias is the main limitation of the study. (Key words: Burns, cross-sectional study, incidence, prevalence, demographics). Rev Chil Pediatr 2014; 85 (6): 690-700
9 citations
TL;DR: La deficiencia de G6PD puede ser muy variable en su expresion clinica, por lo cual es necesario tenerla presente dentro del diagnostico diferencial of las anemias hemoliticas a toda edad.
Abstract: Introduction: Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) is the most common red blood cell (RBC) enzyme disorder. The decrease as well as the absence of the enzyme increase RBC vulnerability to oxidative stress caused by exposure to certain medications or intake of fava beans. Among the most common clinical manifestations of this condition, acute hemolysis, chronic hemolysis, neonatal hyperbilirubinemia, and an asymptomatic form are observed. Objective: To analyze the case of a child who presented hemolytic crisis due to favism. Case Report: A 2 year and 7 month old boy with a history of hyperbilirubinemia during the newborn period with no apparent cause, no family history of hemolytic anemia or parental consanguinity. He presented a prolonged neonatal jaundice and severe anemia requiring RBC transfusion. An intake of fava beans 48 h prior to onset of symptoms was reported. G6PD qualitative determination was compatible with this enzyme deficiency. Conclusion: G6PD deficiency can be highly variable in its clinical presentation, so it is necessary to keep it in mind during the diagnosis of hemolytic anemia at any age.
9 citations
TL;DR: Las complicaciones intrahospitalarias that condicionan una estancia prolongada fueron seguridad social in salud, escolaridad materna y control prenatal, y deben ser consideradas en the evaluacion of los indicadores de calidad de atencion hospitalaria.
Abstract: Objective: To evaluate factors present on newborn admission to a neonatal intensive care and associated with a prolonged hospital stay. Patients and Method: Non-matched case-control study, with 555 infants, 111 with more than 7 days of hospital stay and 444 who stayed hospitalized between 1 and 7 days, between 2005 and 2010. Pre hospitalization maternal factors (age, pregnancy, health insurance, education, prenatal care, marital status, history of preeclampsia, prolonged rupture of membranes, chorioamnionitis infection) and neonatal ones (age at admission, gestational age, birth weight, gender, delivery practice, route of admission, Apgar and type of resuscitation) that were associated with prolonged hospital stay were analyzed. Analyses were conducted using STATA 11.0 and logistic regression in the multivariate analysis. Results: Maternal factors such as prenatal care with less than 5 doctor visits (AOR 2.7, 95% CI 1.3-5.5), lack of social health insurance (AOR 1.9, 95% CI 1.4-29), pregnant three or more times (AOR 1.7, 95% CI 1.1-2.7), neonatal birth weight under 2,000 g (AOR 4.2, 95% CI 1.9-9.5), need for cardiopulmonary resuscitation (AOR 4.2, 95% CI 2-9.1), gestational age less than 36 weeks (AOR 3.9, 95% CI 2-7.7) and admission to the neonatal unit through emergency room or referral from another hospital (AOR 2.8, 95% CI 1.7-4.6) were associated with hospital stays longer than 7 days. Conclusions: In-hospital complications that affect a prolonged stay at the health center were social health insurance, maternal education and prenatal care, and these should be considered in the evaluation of the hospital care quality indicators.
9 citations
TL;DR: A nutritional anamnesis performed on the mother to estimate her reserves in the period prior to, during and after delivery can be critical to detect the risk of this vitamin deficiency in young children.
Abstract: Hematological and neurological compromise due to vitamin B12 deficit in infant of a vegetarian mother: case report introduction : Vitamin B12 deficiency is extremely common in strict vegetarians and their variants. Infants of vegetarian mothers have a higher risk of deficiency and are more prone to its effects. Objective: To report a case in order to warn people about the importance of suspected vitamin B12 deficiency in children of vegeta-rian mothers. case report : A 12-month old infant, daughter of a longtime vegetarian woman, who presented neurological and hematological compromise due to vitamin B12 deficiency, is discussed. After a short period of parenteral administration of cyanocobalamin and enteral nutrition, the patient evolved with clinical and laboratory improvement, although she still had residual development delay. conclusions : Vitamin B12 defi-ciency is often not suspected by the pediatrician in healthy infants. Clinical manifestations can be nonspecific, such as apathy, food refusal and progressive impairment of psychomotor development. A nutritional anamnesis performed on the mother (with great emphasis on those strict vegetarians) to estimate her reserves in the period prior to, during and after delivery can be critical to detect the risk of this vitamin deficiency in young children.(Key words: Vitamin B12, vegetarianism, megaloblastic anemia, delayed psychomotor development).Rev Chil Pediatr 2014; 85 (3): 337-343resumenIntroduccion: La deficiencia de vitamina B12 es una de las complicaciones delvegetarianismo y sus varian -tes. Los lactantes de madres vegetarianas tienen mayor riesgo de deficiencia y son mas labiles a sus efectos. Objetivo: Relatar un caso para alertar sobre la importancia de la sospecha de deficiencia de vitamina B12 en hijos de madres con habito vegetariano. Caso clinico: Se presenta una lactante de 12 meses, hija de una mujer
TL;DR: A case of erythema ab igne on the hands of a 8-year-old girl, induced by classic homemade radiator is reported.
Abstract: The cutaneous lesion of erythema ab Igne are characterized by a reticulate erythema, hyperpigmentation, fine scaling, epidermal atrophy and telangiectasias, and reticulated erythema. We report a case of erythema ab igne on the hands of a 8-year-old girl, induced by classic homemade radiator.
TL;DR: El mayor riesgo asociado a CTI en pacientes con malnutricion por exceso invita a generar las instancias de derivacion oportuna desde el profesional que pesquisa a ninos con malnutsricion hacia el odontologo infantil, with the fin of desarrollar intervenciones preventivas para ambas patologias.
Abstract: Objective: To determine whether overweight is a risk factor for the development of early childhood caries (ECC) in preschoolers. Patients and Method: An observational retrospective cohort study was performed in 196 children under 2 years of age at Calbuco Hospital, Los Lagos Region, Chile, who were admitted between 2007 and 2009. Patients were grouped based on their nutritional status at admission in the two following categories: eutrophic and overweighed children as a result of excessive intake. Information regarding caries incidence and nutritional status were annually retrieved from records until the age of 5 years, according to medical and dental records. Results: At the beginning of the study, 33.67% were overweight and 16.33% were obese, reaching 40% overweight and 20.56% obese at four years of age. The incidence of early childhood caries in overweighed children was 57.14% compared to 40.82% in normal weight children (p = 0.022), with 1.4 RR (95% CI, 1044-1.88). Conclusions: The increased risk of early childhood decay in overweighed patients makes necessary to create instances of timely mutual referral between the professional that diagnoses overweighed children and the pediatric dentist in order to develop preventive treatments for both diseases.
TL;DR: El diagnostico temprano del situs inversus totalis es importante, dado que el abordaje quirurgico toracico y abdominal es diferente y determinadas patologias pueden presentarse con clinica inusual.
Abstract: Introduction: Situs inversus totalis is a rare find and only a small percentage are associated with heart disease; its diagnosis is usually made incidentally. Objective: To discuss the diagnostic features of situs inversus totalis and the importance of early diagnosis. C ase Reports: Two pediatric patients aged 9 and 14 years who were incidentally diagnosed are reported. The first case presented chest pain and during cardiac auscultation, increased heart sounds were heard on the right precordium and attenuated on the left. An electrocardiogram (ECG) showed P wave and QRS axis equal to +150°, narrow QRS voltage attenuated in V3-V6 precordial leads, and negative T waves in leads V1-V4 and aVL. Chest radiography confirmed dextrocardia, and gastric bubble was on the right and hepatic shadow on the left. Echocardiography showed classic mirror dextrocardia without associated malformations. In the second case, dextrocardia was found incidentally after radiography was requested for the evaluation of scoliosis. ECG showed QRS of +120°, P wave axis of +150° and narrow QRS voltage axis attenuated on left precordial leads. Doppler echocardiography confirmed dextrocardia without associated anomalies. Abdominal ultrasound found the liver in left upper quadrant and the spleen in right upper quadrant. Conclusions: Early diagnosis of situs inversus totalis is important because the thoracic and abdominal surgical approach is different and certain diseases could be presented with unusual characteristics. Also, after the diagnosis of situs inversus, the presence of associated pathologies such as primary ciliary dyskinesia can be studied (Kartagener syndrome).
TL;DR: Evaluated the use of enemas to speed up meconium evacuation, facilitating feeding tolerance in very low birth weight preterm infants, finding no significant differences in the age to reach full enteral intake or 100 ml/kg/day.
Abstract: Introduction: It has been reported that feeding tolerance in preterm infants is associated with an early passage of meconium Prospective, randomized or historical control studies that stimulate meconium evacuation have reported varied results This study was intented to evaluate the use of enemas to speed up meconium evacuation, facilitating feeding tolerance Patients and Method: A controlled multicenter randomized trial that evaluated the use of physiological saline enemas with glycerol (08 ml glycerol + 3 ml saline or 1 ml glycerol + 5 ml saline depending on babies weighing less or more than 800 g at birth, respectively) versus simulation This procedure was performed in the first 96 hours of life in infants with birth weight between 500 and 1,250 g Maternal (preterm delivery, clinical chorioamnionitis, gestational hypertension, administration of magnesium sulfate and prenatal corticosteroids, fetal Doppler altered, type of delivery, gender, weight and gestational age, assessment of Apgar and need for assisted ventilation and oxygenotherapy) and nutritional history (age when feeding volumes of 100 ml/kg/day and full enteral feeding were reached, age to remove meconium, number of days on parenteral nutrition, weight at 28 days, weekly volumes of breast milk and preterm formula) were described Results: No significant differences were obtained regarding the age to reach full enteral intake or 100 ml/kg/day were found among the 101 patients in the study Also, no differences in the following secondary variables are observed: number of episodes of late sepsis with or without positive blood culture, hyperbilirubine mia, necrotizing enterocolitis and intraventricular hemorrhage Conclusions: The routine use of saline enemas and glycerin in this study does not alter the enteral feeding tolerance in very low birth weight preterm infants
TL;DR: In this paper, analizar descriptivamente los diversos aspectos of madres with history of TCA and implicancias in the nutricion, crecimiento, and desarrollo de sus hijas (os).
Abstract: Antecedentes: Existe concluyente evidencia de la influencia de madres con trastornos de la conducta alimentaria (TCA) en sus hijas (os). Objetivo: Analizar descriptivamente los diversos aspectos de madres con historia de TCA y sus implicancias en la nutricion, crecimiento y desarrollo de sus hijas (os). Metodo: Se efectuo una revision de la literatura disponible en PubMed y textos de consulta especializados. Resultados: Las madres con TCA previo o actual muestran patrones alimentarios restrictivos, un vinculo afectivo deficitario con sus propias madres, exhiben mas comorbilidades psiquiatricas, principalmente depresion y ansiedad; ademas sentimientos de culpa y verguenza, cese precoz de la lactancia, elevado control del consumo de alimentos de sus hijas (os) y/o presion para comer, horarios irregulares de comidas, dieta desequilibrada y monotona, preferencia por la delgadez y actitud critica sobre la silueta corporal de sus hijas (os). La lactancia representa un periodo critico para la irrupcion o recaida de un TCA por la adaptacion que implican los cambios caracteristicos de su figura corporal durante el embarazo. Conclusiones: Existe una particular relacion entre la presencia de un TCA materno y su ocurrencia en hijas (os), considerandose un factor de riesgo para su desarrollo.
TL;DR: The equations to estimate stature from the body segments, tibia length and knee height, are valid and useful to assess the linear growth in children with cerebral palsy in the authors' population.
Abstract: INTRODUCTION The assessment of nutritional status plays a critical role in comprehensive child care, however, in children with cerebral palsy (CP) is difficult to meet some reliable anthropometric measures, particularly height. OBJECTIVE To determine if the equations to estimate stature, developed and validated in CP populations of other countries, apply to our reality. PATIENTS AND METHOD An anthropometric assessment in 60 children with cerebral palsy that included measurement of weight, height and body segments like tibia length (TL) and knee height (KH) was performed. The height was estimated using the above described segments and the Stevenson et al.¹ equations. The correlation and agreement between the measured and the estimated stature were evaluated. RESULTS Height could be reliably measured in 36 individuals and in all cases height was estimated. The correlation between the measured and the estimated lengths for TL and KH was 0.975 and 0.981 respectively (p < 0.001). The analysis of agreement between the estimated and measured lengths showed on average a significant level of agreement, with an error of -2.96 cm for TL and 0.21 cm for KH. CONCLUSIONS The equations to estimate stature from the body segments, tibia length and knee height, are valid and useful to assess the linear growth in children with CP in our population.
TL;DR: In this article, the authors proposed that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed and that it is not acceptable in our setting.
Abstract: The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.
TL;DR: The radiographic assessment of the catheter performed by pediatricians and/or radiologists, who must be able to recognize those poorly positioned as they can cause serious complications, is essential.
Abstract: radiographic assessment of catheters in a neonatal intensive care unit (niCu) Intravascular catheters are widely used in Neonatal Intensive Care Units. The major types of intravascular access in the newborn are peripheral catheters, venous or arterial umbilical catheters, central venous catheters and peripherally-inserted central venous catheters (PICC). Anomalous positioning of catheters, especially umbilical catheters, is quite frequent as their installation is without imaging guidance. The radiographic assessment of the catheter performed by pediatricians and/or radiologists, who must be able to recognize those poorly positioned as they can cause serious complications, is essential. This article contains a sample of correct and misplaced catheter x-ray often used in a NICU. (Key words: Umbilical catheters, central venous catheter, catheter complications). Rev Chil Pediatr 2014; 85 (6): 724-730
TL;DR: El surco perineal es una entidad benigna que debe ser conocida by medicos de atencion ambulatoria debido a the alarma that pueden generar sus diagnosticos diferenciales.
Abstract: Introduction: the perineal groove is a very uncommon anorectal anomaly. It is the result of an unknown embryology anomaly. The perineal groove is a wet sulcus extending from de fourchette to the anus. It is a benign pathology and tends to resolve spontaneously. Objective: We report two cases of girls diagnosed with perineal groove and their follow up. Cases Reports: The first case is an 18 days old baby girl, that during her first clinical examination there was found a painless lineal lesion in the perineum from the fourchette to the anus, which created a big anxiety in her family. She was cared at the Pediatric Gynecology Unit, with local lubrication, doing well with the epithelization of it. The second case is an 8 year-old girl who consulted because, when being a child, she was diagnosed with a perineal lesion, but she didn't receive any special treatment and now she feels some aches in the perineum. Conclusions: The perineal groove is a benign entity pretty unknown by general practitioners or pediatricians. It is important to be up to date with this condition to avoid alarming misinterpretations.
TL;DR: PDI were more frequent in patients associated with major polypharmacy and longer hospital stay, and the therapeutic group most involved was antimicrobials and the most frequently involved individual drugs were chloral hydrate, midazolam and vecuronium.
Abstract: Introduction: The aim of this study is to calculate the theoretical frequency of potential drug interactions (PDI) and their characteristics in the therapeutic plan of hospitalized patients in a Pediatric Intensive Care Unit (PICU) Patients and Methods: An observational study was conducted which analyzed PICU prescriptions between September and November 2011 The inclusion criteria included to be hospitalized in a PICU, requirements of at least 3 drugs, except those topically applied, either gender, no age limit, no hospital stay required The Micromedex ® 20 program was used to detect and classify PDI Results: Of 223 patients, 100 met inclusion criteria, 610 prescriptions were analyzed and 815 drugs were prescribed 1,240 PDI were detected in 44 patients; 12 patients received more than 10 drugs each, presenting 1,162 PDI (937% of total PDI) 8 patients were hospitalized for more than 10 days, presenting 1,035 PDI (835% of total PDI) According to PDI theoretical severity, 375% were high, 517% moderate, 67% low and 41% contraindicated The therapeutic group most involved was antimicrobials (176%) and the most frequently involved individual drugs were chloral hydrate (159%), midazolam (141%) and vecuronium (134%) Conclusion: PDI were more frequent in patients associated with major polypharmacy and longer hospital stay
TL;DR: A consensus paper as discussed by the authors reviewed international and national evidence concerning diagnosis, etiologies, hospitalization criteria and indications for home monitoring for ALTE, which is characterized by some combination of apnea, color or muscle tone change, chocking and has to be followed by cardiorespiratory reanimation.
Abstract: Apparent life threatening events are defined as an acute episode in which the observer fears an infant < 1 year may die. ALTE is characterized by some combination of apnea, color or muscle tone change, chocking and has to be followed by cardiorespiratory reanimation. The present consensus paper reviews international and national evidence concerning diagnosis, etiologies, hospitalization criteria and indications for home monitoring.
TL;DR: Endoscopic removal of gastrointestinal FBs is a safe procedure given the risk of serious injury, especially in foreign bodies in the esophagus, and performing endoscopy within a reasonable time must always be considered.
Abstract: Gastrointestinal foreign body in children Gastrointestinal foreign bodies (FB) are frequent complaints in the emergency departments, with esophageal foreign bodies as the most frequent cases. Symptoms are varied and depend on the location of the FB, with several techniques available for removal. objective: To describe the FB removed by endoscopy in children as well as the consulting population characteristics. patients and method: Patient chart reviews of those who, during the last six years, underwent gastrointestinal endoscopy were performed. Descriptive statistics were used to analyze the data. results: 51 patients, 28 males and 23 females, with average age of four years old, underwent endoscopy due to FB intake. The most common symptoms were drooling (45%) and dysphagia (35%); the FBs were extracted mostly under general anesthesia. Coins were the most common foreign bodies found (57%) and they were mainly located in the esophagus (91%). All bodies were extracted by direct en-doscopy or endoscopically assisted extraction; lesions that corresponded to erosions were found in 19 (37%) patients and ulcers in 4 (8%). There were no complications.
TL;DR: La SC presenta un desafio diagnostico importante dado that no existe un examen that permita su confirmacion precoz, por lo que un alto indice de sospecha puede ser determinante en the oportunidad of tratamiento y consecuente pronostico.
Abstract: Early congenital syphilis. A case report Introduction: Congenital syphilis (CS) is a multisystemic infection of the newborn (NB) which can produce severe symptoms, and in some cases, even be fatal. In recent years, the incidence of syphilis has increased worldwide and similarly, the cases of CS in neonates have increased. Objective: To report two cases of early and severe presentation of CS, focusing on the importance of prevention of vertical transmission and moni-toring of treated mothers. The diagnostic difficulties are discussed. Clinical cases: Two premature newborns that were diagnosed with probable CS present in the newborn period are presented. In the first case, due to a high index of suspicion, but without confirmatory testing, treatment was started with good clinical response. In the second case, CS was confirmed through positive serology and the specific treatment was given. Conclu-sion: CS has significant diagnostic challenges as there is no test for early confirmation, therefore, a high index of suspicion might be key in the treatment and consequent prognosis. Due to the current epidemiology of the condition, it is also important to focus on preventive measures.(Key words: Congenital syphilis, sepsis, newborns).Rev Chil Pediatr 2014; 85 (1): 86-93RESUMENIntroduccion: La sifilis congenita (SC) es una infeccion multisistemica que afecta al recien nacido (RN) y que puede producir manifestaciones clinicas de variada gravedad, e incluso ser fatal. Durante los ultimos anos, la incidencia de la sifilis ha aumentado a nivel mundial y, de igual forma, la SC en neonatos. Objetivo: Reportar 2 casos de presentacion precoz y grave de SC, recalcando la importancia de la prevencion de la trasmision vertical y el seguimiento de las madres tratadas. Se discuten las dificultades diagnosticas. Casos clinicos: Se presentan dos RN prematuros, a quienes se les diagnostico una probable SC durante su periodo neonatal inme-diato. En el primer caso, debido a un alto indice de sospecha, aunque sin examenes confirmatorios, se inicio
TL;DR: Chile ha venido adoptando diversas me-didas para concentrar esfuerzos de inversion social en la infancia, e.g., la promulgación de la ley 20.545 (2011) that extiende el perio-do posnatal a veinticuatro semanas and, the instau-racion de la obligatoriedad del kinder as mentioned in this paper.
Abstract: Chile ha venido adoptando diversas me-didas para concentrar esfuerzos de inversion social en la infancia, las que se han traducido en iniciativas relevantes para el pais y para el resto de las americas, como son: el Sistema de Proteccion integral a la infancia Chile Crece Contigo (en adelante CCC), la promulgacion de la ley 20.545 (2011) que extiende el perio-do posnatal a veinticuatro semanas y, la instau-racion de la obligatoriedad del kinder. En salud infantil, las politicas centradas en la reduccion de la mortalidad infantil la lucha contra las enfermedades infecciosas (en par-ticular inmuno-prevenibles) y la malnutricion por deficit, han colocado a Chile en una posi-cion de ventaja respecto del resto de Sudame-rica. Para 2012, Chile muestra una mortalidad en menores de 5 anos, de 9 por 1.000, ubican-dose en el sexto lugar de menor mortalidad en las americas, y el segundo en Sudamerica (superado por uruguay con una tasa de 7 por 1.000). En el contexto mundial, los paises con menor tasa son luxemburgo e islandia con 2 y los paises escandinavos con 3 por 1.000. des-de 1990 la reduccion en Chile de la mortalidad en menores de 5 anos ha sido sostenida, cayen -do un 52%
TL;DR: The decreased adherence to recommendations for siDs prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.
Abstract: Adherence to recommendations to reduce the risk of Sudden infant Death Syndrome introduction : Recommendations for sudden infant Death syndrome (siDs) are available, although it is un-certain the degree of adherence to these measures. the aim of the study is to assess the adherence to recom-mendations to reduce the risk of siDs, seeking factors associated to the noncompliance with these recom-mendations. Patients and Method : 468 infants were enrolled in two maternity hospitals, one public and one private. postpartum and 4-month assessments were performed. a questionnaire was used adapting a model validated by the international child care practices study. results : adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). conclusions:
TL;DR: The current definition of Celiac disease, clinical presentations, potential patients, how to search for the disease, how the diagnosis is made and characteristics of the treatment and monitoring of celiac patients are reviewed, all based on internationally agreed standards.
Abstract: Catching up on celiac disease Knowledge about celiac disease continues to grow and amaze those who investigate, seek and treat this condition. Gone are the days when it was considered just a rare child’s digestive disease. It is now recognized as a highly prevalent autoimmune condition that affects children and adults with digestive and extra-digestive symptoms of diverse intensity, disorder that may be either mono, oligo or asymptomatic from a digestive point of view. Today, it is an underdiagnosed condition, not actively considered, and often mistakes are made regarding its diagnosis, treatment and gluten-free diet monitoring. This article reviews the current definition of the disease, clinical presentations, potential patients, how to search for the disease, how the diagnosis is made and characteristics of the treatment and monitoring of celiac patients, all based on internationally agreed standards, and emphasizing those aspects that have proven to be useful in other countries regarding the management of the disease. (Key words: Celiac disease, clinical, active search, gluten-free diet). Rev Chil Pediatr 2014; 85 (6): 658-665
TL;DR: El sindrome Hiper IgE-AD es una inmunodeficiencia primaria asociada a alteraciones del tejido conectivo, esqueleticas, cerebrales y vasculares, which difieren en el contexto, respuesta and resolucion frente a las infecciones y the falta oficiales fenotipicas.
Abstract: Introduccion: El sindrome Hiper IgE (SHIGE) autosomico dominante (SHIGE-AD) es una inmunodeficiencia primaria asociada a alteraciones del tejido conectivo, esqueleticas, cerebrales y vasculares. La patogenesis de la inmunodeficiencia reside en una alteracion en la via Th17 lo que explica la susceptibilidad especial de estos pacientes a infecciones por S. aureus y Candida. Objetivo: Describir tres ninos diagnosticados como sindrome Hiper IgE y realizar una revision sobre el tema, con especial foco en la forma dominante de la enfermedad. Casos clinicos: Se presentan 3 ninos con SHIGE (2 varones), con rash eccematoso desde el periodo de recien nacido, infecciones cutaneas, oticas, pulmonares, ganglionares, con niveles de IgE serica sobre 2.000 UI/ml y eosinofilia, tratados con antimicrobianos y topicos, con seguimiento mas de 7 anos. Conclusiones: Es una entidad infrecuente, que requiere alto grado de sospecha y el manejo precoz de las infecciones. Uno de sus principales diagnosticos diferenciales esta dado por el nino atopico con infecciones recurrentes pero difieren en el contexto, respuesta y resolucion frente a las infecciones y la falta de las otras caracteristicas fenotipicas.
TL;DR: The aim of this study is to discuss the most important characteristics of this type of questionnaire such as age range, language of validation, number of questions, administration mode, the evaluated period and fields, and the minimum clinically relevant difference.
Abstract: The assessment of symptoms and quality of life are important aspects in the control of childhood asthma. Questionnaires regarding symptoms control and quality of life give valuable information about the disease from the perspective of the child and his family. The aim of this study is to discuss the most important characteristics of this type of questionnaire such as age range, language of validation, number of questions, administration mode, the evaluated period and fields, and the minimum clinically relevant difference. The ACT questionnaires, for children older than 11 years of age, and CAN questionnaires, for children between 2 and 14 years of age in their Spanish versions, are suitable for measuring asthma control in our country. Regarding quality of life, PAQLQ for children between 7 and 17 years of age and PACQLQ for their care givers are the most popular oversees; Spanish versions have been adapted for Chile.
TL;DR: The quiste del conducto de Skene, a rara anomalia congenita descrita en neonatos de sexo femenino, se puede presentar in el transcurso de la vida as mentioned in this paper.
Abstract: Introduccion: El quiste del conducto de Skene, se describe dentro de los quistes parauretrales, siendo una rara anomalia congenita descrita en neonatos de sexo femenino, que se puede presentar en el transcurso de la vida. La incidencia varia de 1 cada 2.000-3.000 recien nacidos vivos femeninos. Objetivo: Dar a conocer las caracteristicas y formas de presentacion del quiste del conducto de Skene en distintas etapas del desarrollo del nino para su sospecha y diagnostico oportuno. Casos clinicos: Se presenta una recien nacida con una lesion tumoral amarillenta, adyacente al meato uretral, no dolorosa, que drena espontaneamente y un segundo caso de una adolescente que consulto por leucorrea de un ano de evolucion, con una lesion parauretral de tres centimetros de diametro entre labios menores, que requirio tratamiento quirurgico y estudio de la masa parauretral. Conclusiones: Basado en la revision de la literatura, concluimos que la frecuencia de los quistes de conducto de Skene es mas alta que el numero de casos informados. La extirpacion, marsupializacion, la puncion y aspiracion del quiste son todos metodos eficaces de tratamiento. El drenaje espontaneo tambien es una conducta apropiada en ciertos casos. Se sugiere utilizar la tecnica menos agresiva acorde a cada caso.