Andes pediatrica : revista Chilena de pediatria最新文献

Anemia (An) is a public health problem in South America, with iron deficiency (ID) as the main cause. In high-altitude cities, hypobaric hypoxia causes an increase in hemoglobin (Hb) levels in residents. For the diagnosis of An, Hb is measured, which is modified after erythrocyte indices (EI) measurements. There is evidence that there is an overestimation of the prevalence of An at high altitudes.

Objective: To correlate serum ferritin (SF) with Hb and EI, and to determine the Hb cut-off point for predicting ID in 6-month-old infants at 3400 m of altitude.

Subjects and method: 128 infants aged 6 months at 3400 m altitude were evaluated. The SF was considered an independent variable. IE and Hb were the dependent variables. The An in the infant was defined with an Hb < 13.4 g/dl. The DH was defined by FS <12 ug/dL. Data were processed in SPSS® version 25. Spearman correlation was used for bivariate analysis. The ROC curve was constructed to determine the Hb cut-off point for ID.

Results: The highest correlation of SF was observed with mean corpuscular hemoglobin (MCH), rho = 0.449 (p < 0.001), and mean corpuscular volume (MCV) rho= 0.423 (p < 0.001). The Hb cut-off point according to SF, defining ID was 12.15 g/dL (ROC curve: 0.704; 95% CI: 0.597-0.811; p < 0.001).

Conclusion: MCV and MCH showed a better correlation with SF. The cubic and logarithmic models were the ones that best represented these relationships, respectively. Hb < 12.15 g/dL allows diagnosing ID in 6-month-old infants at 3400 m altitude.

Objective: To examine disparities in the use of mental health services (MHS) in adolescents according to sociodemographic factors.

Subjects and method: 2,022 adolescents aged 13-19 years in Santiago, Chile, participated in the study. Between April and May 2008, they answered a self-report survey that assessed lifetime (history of treatment for depression) and current (psychological or pharmacological treatment) use of MHS, sociodemographic variables, and psychopathology as symptoms of depression, symptoms of generalized anxiety disorder, and risk of problematic substance use. Data were analyzed using logistic regression.

Results: 16.5% of participants reported lifetime use of MHS due to depression, 9.7% were on current psychological treatment, and 2.7% were on current pharmacological treatment. Among those meeting criteria for a mental health problem, only 14.9% to 18.9% were currently on treatment. Males, younger participants, and those who had immigrants' parents reported lower lifetime use of MHS due to depression. Those with parents with 9 to 12 years of education and who had immigrants' parents reported lower current MHS use. Youth not living with both parents reported higher lifetime and current MHS use.

Conclusions: We observe a high treatment gap in those with mental health needs as well as differences in MHS use based on socio-demographic variables. These results may be useful for planning interventions that favor access to and use of MHS, especially in the most disadvantaged groups of adolescents.

Childhood tuberculosis (c-TB) continues to be one of the causes of morbidity and mortality in children, but there is still little information on the delay in the initiation of specific treatment.

Objective: To determine the risk factors associated with delayed initiation of tuberculosis (TB) treatment in children under 15 years of age.

Patients and method: Case-control study. Patients <15 years of age with a diagnosis of childhood pulmonary tuberculosis (c-PTB) with delayed treatment initiation >24 hours were included. Clinical and epidemiological variables were evaluated: age, gender, guardian's education, poverty level, origin, family history of TB, altered imaging findings, symptomatic, PPD >10mm, histology, bacteriology, resistance to treatment, and healthcare network. Bi and multivariate logistic regression analysis was performed, through which odds ratios were calculated.

Results: We evaluated 116 patients with c-PTB with a delayed initiation of specific treatment of more than 24 hours, and 264 with start of treatment in the first 24 hours. The delay in anti-tuberculosis treatment had a median of 3 days with an interquartile range of 2 to 7 days. The patient with the least educated guardian had a delay in treatment initiation with an odds ratio of 7.47 (95%CI: 4.13 - 13.52). Belonging to the healthcare network A of Callao decreased the probability of having tuberculosis by 0.224 times (95%CI:0.11 - 0.46).

Conclusion: Incomplete education level of the guardian is a risk factor associated with delayed initiation of c-PTB treatment in children under 15 years of age while belonging to the Callao healthcare network A is a factor that decreases the risk in the group under study.

The deficiency of two or more pituitary hormones is called multiple pituitary hormone deficiencies (MPHD). Its prevalence is estimated to be about 1/8,000 worldwide.

Objective: To present the diagnosis processes, clinical findings, and long-term follow-up of patients with MPHD.

Patients and method: Between 1999 and 2015, patients diagnosed with MPHD were evaluated. Clinical presentation, anthropometry, imaging studies, and clinical evolution were analyzed. Hormone status was evaluated, including growth hormone (GH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle-stimulating hormone/luteinizing hormone (FSH/LH), and prolactin (PRL). Data were assessed using the student's t-test and the Mann-Whitney U test. Spearman's correlation was used for correlations. A p-value < 0.05 was considered statistically significant.

Results: Forty-five patients were included; 55.6% were male, the mean age at presentation was 5.6 ± 3.9 (0-14.4) years, and the median bone age was 3.5 ± 2.3 (0.5-11) years. At admission, GH deficiency was found in 88.9% of the cases, TSH deficiency in 77.8%, ACTH deficiency in 33.3%, FSH/LH deficiency in 22.2%, and PRL deficiency in 17.8%. During the follow-up, 62% of the cases added other hormone deficiencies. The mean follow-up period was 9.18 ± 3.6 (3.02-17.2) years.

Conclusion: Patients with MPHD have very different clinical presentations, with GH and TSH deficiency being the most common in this study. Additional hormonal deficiencies can occur even years after the initial diagnosis and our results demonstrate that genetic height potential is achieved with GH treatment.

Pleuropulmonary blastoma (PPB) is the most common pediatric malignant primary lung tumor. It's associated with the DICER1 gene pathogenic germline variants. Antenatal presentation is infrequent and poses a challenge in the differential diagnosis of congenital pulmonary airway malformation (CPAM).

Objective: to report a case of unusual presentation of PPB associated with DICER1 syndrome and to describe the difficulty in differentiating it from CPAM.

Clinical case: Male patient with prenatal diagnosis of hypervascular left lung lesion, with mediastinal shift and progressive growth, initially interpreted as CPAM. He was born at 38 weeks, requiring transitory treatment with positive pressure due to ventilatory impairment. A CT scan with contrast showed a large multilocular cystic mass containing air causing mass effect, requiring open left upper lobectomy. Histology results were compatible with type I PPB, with negative margins, and positive genetic study for DICER1 syndrome. Seven weeks post-resection, an aerial image was detected in the upper left side of the chest, with progressive growth, requiring a new tumor resection and upper segmentectomy, with biopsy corresponding to recurrence of type I PPB with negative margins. He received adjuvant treatment with chemotherapy, with follow-up for 2 years, remaining asymptomatic, without recurrence, and with negative screening for other neoplasms associated with DICER1 syndrome. Among the family history, the mother had papillary thyroid cancer and tested positive for the mutation.

Conclusion: PPB is a rare cancer, difficult to distinguish from CPAM, especially in its antenatal presentation. Nowing its association with DICER1 syndrome and performing a genetic study are key to the early detection of BPP and the search for other tumors associated with the syndrome.