Revista Chilena de Pediatria-Chile最新文献

Introduction: Epilepsy affects 0.5 to 1% of the population. 25% of pediatric patients have drug-resistant epilepsy (DRE). Ketogenic Diet (KD) emerges as an effective, non-pharmacological treatment in this group.

Objective: To describe the effect of KD on seizure control and nutritional status in children whit DRE.

Patients and method: We reviewed the medical records of patients with DRE treated with KD, between 2008 and 2018, evaluating age, diagnosis, number of seizures, number of antiepileptic drugs used, clinical outcomes, and complications. The KD was initiated in all patients hospitalized for a period no longer than seven days, who were evaluated for their nutritional and anthropometric sta tus, with weight and height measurements according to the clinical condition.

Results: We analyzed 35 KD in 33 cases. The median age of KD initiation was 4.8 years with an interquartile range (IQR) of 2-3 to 6.8 years. Classical KD was used in 49% of patients, Modified Atkins Diet (MAD) in 37%, and Low-Glycemic Index Treatment (LGIT) in 14% of cases. The average duration was 13 months (SD 11 months). After three months of using KD, we observed at least 50% reduction of seizures in 82% (27/33) of the patients, out of these, 22.8% presented 90% or more reduction of seizures, and 20% ended up seizure-free. Adverse events were observed in 21 patients, mainly gastrointestinal (62%) and dyslipidemia (14%), without effect on height. All side effects resolved with medical ma nagement.

Conclusions: KD is a useful treatment in pediatric patients with DRE without nutritional impact. The adverse events were easily controlled if the patients are evaluated by a multidisciplinary team, according to international guidelines.

If one knows the probability of an event occurring in a population, Bayesian statistics allows mo difying its value when there is new individual information available. Although the Bayesian and frequentist (classical) methodologies have identical fields of application, the first one is increasin gly applied in scientific research and big data analysis. In modern pharmacotherapy, clinical phar macokinetics has been used for the expansion of monitoring, facilitated by technical-analytical and mathematical-statistical developments. Population pharmacokinetics has allowed the identification and quantification of pathophysiological and treatment characteristics in a specific patient popu lation, especially in the pediatric and neonatal population and other vulnerable groups, explaining interindividual variability. Likewise, Bayesian estimation is important as a statistical tool applied in pharmacotherapy optimization software when pharmacological monitoring is based on clinical phar macokinetic interpretation. With its advantages and despite its limitations, pharmacotherapeutic op timization based on Bayesian estimation is increasingly used, becoming the reference method today. This characteristic is particularly convenient for routine clinical practice due to the limited number of samples required from the patient and the flexibility it shows regarding blood sampling times for drug quantification. Therefore, the application of Bayesian principles to the practice of clinical phar macokinetics has led to the improvement of pharmacotherapeutic care.

Preventing vertical transmission of HIV is a challenge for all countries worldwide. The permanent construction of global societies with a variable degree of international migrant population has made it more complex. Health policies, programs, and actions for preventing vertical transmission of HIV in pregnant migrants demand an intercultural perspective, where social, cultural, and gender dimen sions associated with the infection are addressed. Understanding the local reality regarding the pre vention of vertical transmission in the international migrant population in Chile is essential to carry out concrete actions that favor the prevention of mother-to-child transmission of HIV. This article presents some essential concepts related to this topic. It also presents international and national in formation on risks of vertical transmission in pregnant migrants, the importance of the national plan for preventing vertical transmission of HIV in our country, and some ongoing efforts to adapt such plan to the reality of social and cultural diversity that pregnant migrants currently present in Chile, as a useful public health instrument with an intercultural perspective.

Introduction: Changing the tracheostomy tube in children is a key procedure, however, some of its aspects re main unclear.

Objective: To characterize the tracheostomy tube change in children from a long-stay health institution.

Patients and method: Retrospective observational analytical study based on the 2-year clinical record of hospitalized children who underwent tracheostomy. The variables evaluated were the reason for tracheostomy tube change, size and brand of the tube, operator and participants (assistants/spectators) of the procedure, complications, and education.

Results: We analyzed 630 tracheostomy tube changes. The most frequent operators were relatives (33.7%). The main reason for the change was routine (83.3%). 10.7% of the changes presented some complications, where the most frequent was peristomal bleeding (47.37%) and the first failed attempt (34.21%). There was no association between the presence of balloon and complications (p = 0.24), nor with the use of Mechanical Ventilation (p = 0.8) or the operator (p = 0.74).

Conclusion: The routine change of the tracheostomy tube in children with prolonged artificial airway use is a safe procedure, which can be performed by both health professionals and properly trained family members.

Objective: Based on a sample of children and adolescents of both genders, our objective is to des cribe height growth, estimate the peak age at growth spurt, growth rate at this point, the final adult height expected, and differential patterns Subjects and Method: A cross-sectional study was conduc ted using demographic, clinical, and anthropometric data collected prospectively from children and adolescents of both sexes between 2015 and 2016. Height percentiles were calculated using the LMS (skewness, median, and coefficient of variation) method and then adjusted using the Preece-Baines model 1.

Results: We evaluated 861 participants (484 girls, 377 boys), aged between 2 and 18 years. The estimated peak age at growth spurt (he) was 13.6 years in boys and 11.0 years in girls, with a peak growth rate (V2) at this point of 6.4 cm/year for both sexes. The mean expected adult height (h1) was 173.7 cm in boys and 160.0 cm in girls.

Conclusions: Preece-Baines model 1 provides satisfactory estimates for the peak age at growth spurt, peak growth rate at this point, and final expected adult height.

Introduction: The most common clinical presentation of neuroblastoma is an abdominal mass, but it can present with uncommon symptoms, such as adrenergic storm due to catecholamine release.

Objective: To describe an unusual presentation of neuroblastoma and the wide differential diagnosis that exists in an infant with adrenergic symptoms.

Clinical case: A 7-week old female infant was evaluated due to a 3-week history of sweating and irritability associated with a 24-hour fever and respiratory distress. At admission, she presented poor general condition, irritability, sweating, facial redness, tachypnea and skin paleness, extreme sinus tachycardia, and high blood pressure (HBP), interpreted as adrenergic symptoms. The study was completed with abdominal ultrasound and magnetic reso nance imaging that showed a large retroperitoneal mass compatible with neuroblastoma. Plasma and urinary catecholamines tests showed high levels of dopamine, adrenaline, and noradrenaline, probably of tumor origin. We started antihypertensive treatment with alpha-blocker drugs, showing a good blood pressure control. The tumor was surgically resected without incidents and adequate subsequent recovery. The patient presented a favorable evolution after three years of follow-up. Con clusions: In an infant with adrenergic symptoms such as irritability, redness, sweating associated with HBP, it should be ruled out pathology heart or metabolic (hypoglycemia) pathology, intoxications, and/or adrenal pathology. Within this last one, neuroblastoma is the first diagnostic possibility, since it is one of the main tumors in childhood and, although this presentation is not usual, it can produce these symptoms.

Eating disorders (ED) are very serious diseases that usually begin in adolescence and have, in general, been increasing in developing countries. In the country, there are currently several fac tors that hinder their prevention, detection, and treatment, where the lack of training of health professionals in this emerging issue appears as an important one. The purpose of this article is to contribute to the knowledge that pediatricians have about ED in adolescence, through an updated review of the literature on the subject. This publication addresses the main internatio nal classification of ED in use in the current scientific literature and the epidemiology, etiology, impact on comprehensive health, clinical presentation, and treatment of the most common ED in adolescence.