Archivos argentinos de pediatria最新文献

ntroduction. Sepsis is one of the leading causes of pediatric mortality in Argentina. The aim was to describe the epidemiological characteristics of sepsis and septic shock (ESSPED-2 study) in pediatric intensive care units (PICUs) in Argentina and compare them with previous data from the Epidemiological Study of Severe Pediatric Sepsis (ESSPED). Population and methods. An observational, cross-sectional, prospective study in patients with sepsis hospitalized in PICUs in Argentina from September 15, 2021, to December 15, 2021. Results. A total of 3230 patients were admitted to 55 PICUs. We included 428 patients who had 476 events. The median age was 17 months (4.2-74.2). The prevalence was 14.7%, and the 28-day mortality rate was 16.5%; 36.7% of patients did not receive antibiotics within the first hour. Receiving more than 60 mL/kg of fluids in the first 60 minutes showed a negative trend in mortality. Patients with comorbidities, septic shock, acute respiratory distress syndrome (ARDS), dysfunction of 2 or more organs, and phenotype D had higher mortality. The clinical characteristics and prevalence remained unchanged, whereas the administration of fluids and the use of vasoactive drugs changed, and mortality rates decreased significantly. Conclusions. Sepsis is an event of high prevalence and mortality in Argentina. In the multivariate analysis, the variables lose relevance, except for the presence of dysfunction in 2 or more organs, septic shock, a Pediatric Mortality Index (PMI3) value greater than 15, or being an immunocompromised host.

Introduction. Setting the cut-off point in objective structured clinical examinations (OSCEs) is a controversial aspect of assessment. In resource-limited settings, the Hofstee method requires additional tasks from other teachers outside the examination time. In contrast, the borderline group method is applied during the assessment, allowing for a more efficient use of time and resources. Objective. To compare the reliability of the borderline group and Hofstee methods applied in a graduation OSCE at an Argentine public university, providing local evidence to an internationally relevant debate. Population and methods. Cross-sectional study of 56 students in a 12-station OSCE. Two standardsetting methods were applied: borderline group (using observers during the exam) and Hofstee (electronic consultation with expert judges). Cut-off points, failure rates, and reliability (phi coefficient λ) were compared using generalizability theory. Results. The average score was 66.1 (SD 4.7). The cut-off point using the borderline group method was 54 (overall) with a reliability of 0.89 and no failures. The Hofstee method defined cut-off points of 60.7 (overall), with 3 and 1 students failing, respectively, and reliability of 0.68 and 0.82. Conclusions. Both methods show adequate reliability; however, they differ in their practical consequences, as the borderline group method was more lenient, generating a higher number of passing students.

In light of the risk posed by sedentary lifestyles, the importance of school physical education as a health tool and the hierarchy of teachers and graduates who teach this subject is emphasized. The rights of children and adolescents to access health care, medical attention, recreation, and sports must be respected. A health certificate should be required as part of the annual documentation that students must submit, but this should not be a limitation to participate in physical education classes. Only children and adolescents who present a medical certificate indicating otherwise may be excluded from participation in these classes, either temporarily or permanently. Given the low incidence of serious events at these ages during physical exercise, the risk posed by a sedentary lifestyle is much greater.

Introduction. Skeletal dysplasias are rare genetic disorders that affect bone and cartilage development, with a prevalence of 3.2 cases per 10,000 newborns in South America. Neonatal auxologic evaluation enables the early detection of these conditions, serving as a cost-effective and accessible tool for early intervention. This study aims to determine the prevalence of low birth weight, short body length, and body disproportion at birth in patients with a molecular diagnosis of achondroplasia (ACH), hypochondroplasia (HCH), SHOX gene alterations (SHOX), and familial hypophosphatemic rickets (FHR). Population and methods. Retrospective descriptive study based on medical records of patients evaluated between 2002 and 2023 in a high-complexity pediatric hospital. Patients with skeletal dysplasia and complete anthropometric data at birth were included in the study. Weight, body length, and head circumference were analyzed, with the calculation of Z-scores according to the INTERGROWTH-21st standards and the head circumference/body length index using Argentine references. Results. Of the 581 patients, 453 were included (ACH 62%, HCH 12%, SHOX 8%, FHR 18%); 31% of the neonates with ACH and 12% with HCH had body length < ̵2 SD. True macrocephaly (>2 SD) was observed in 47% (ACH) and 32% (HCH), and relative macrocephaly in 57% and 28%, respectively. Conclusion. Low body length at birth was more frequent in achondroplasia and hypochondroplasia. Relative macrocephaly, also prevalent in these groups, highlights the value of the head circumference/body length index as a neonatal screening tool.

Introduction. Congenital syphilis (CS) is a persistent public health problem, and Argentina has been experiencing an increase in its incidence in recent years. Various social factors influence the distribution of CS. The objective of this study is to describe the temporal trends in CS rates and evaluate their association with income inequality in Argentina in the period 2006-2021. Methods. An ecological study was conducted, considering the 24 Argentine jurisdictions (23 provinces plus the Autonomous City of Buenos Aires [CABA, by its Spanish acronym]) as units of analysis. CS rates were estimated by jurisdiction for each year of the study, and their temporal distribution was analyzed for the national total and by region. An exploratory analysis of the distribution of CS rates and the Gini coefficient was performed at the national level and by region. Next, mixed linear models were estimated to assess the association between the Gini coefficient and CS rates. Results. The CS rate showed an oscillating and upward trend at the national level and in most regions, with a sustained increase in the Northwest region (NOA) and recent marked increases in Cuyo. As the Gini coefficient increases, the CS rate in the provinces increases (95% CI: 0.11-0.42). Conclusion. CS rates generally showed an upward trend, with variations across different regions. Income inequality was associated with higher CS rates, highlighting the influence of structural social factors on this disease in Argentina. Income inequality was associated with higher CS rates at the provincial level, demonstrating the impact of structural factors on disparities in this disease in Argentina.

Neurodevelopmental disorder with variable motor and language impairment (NEDMIAL) is a rare condition associated with mutations in the DHX30 gene, which encodes an RNA helicase involved in regulating the translation and stability of messenger RNA. Fewer than 110 cases worldwide have been documented, with no previous reports in Argentina. We present the case of an 11-month-old girl who was admitted to the hospital for acute gastroenteritis in the context of axial hypotonia since the first months of life, significant motor delay, and swallowing difficulties. After three years of multidisciplinary follow-up and after ruling out common causes of infantile hypotonia, a de novo mutation in DHX30 was confirmed, and the diagnosis of NEDMIAL was established. This case underscores the importance of early diagnosis and an interdisciplinary approach in the management of rare neurological diseases.

Feeding difficulty is common in the infant; the causes are varied and often multifactorial, resulting from a confluence of comorbid conditions. Heterotopic brain tissue is an unexpected reason for feeding difficulty, with approximately only 49 cases reported in the pharyngeal region. In this case report, we present a 2-month-old male infant with feeding difficulty, who was finally diagnosed as oropharyngeal heterotopic brain tissue. The patient underwent surgical excision; no functional disturbance of the oropharynx was found postoperatively. This study aims to enhance the comprehension, accurate diagnosis, and appropriate treatment of of feeding difficulty and pharyngeal heterotopic brain tissue by presenting an unusual case.

ntroduction. The recently approved vaccine against respiratory syncytial virus (RSV) is administered to pregnant women and confers immunity to their babies; however, the evaluation of its effectiveness is limited. Objective. To evaluate the effectiveness of the vaccine against hospitalization due to RSV in children under 6 months of age during the vaccination campaign for pregnant women. Population and methods. Case-control study nested in a cohort of newborns whose mothers were indicated for RSV vaccination in Córdoba, Argentina. We included 180 cases with positive laboratory results for RSV and 1,069 asymptomatic controls who attended routine check-ups. Multiple logistic regression models were performed considering the presence of RSV as the primary response variable, adjusted for maternal age, gestational age, birth weight, maternal influenza vaccination, maternal education level, and multiple births. Vaccine effectiveness was calculated using the formula EV = (1 - OR) × 100. Results. The RSV vaccine reduces the likelihood of becoming ill with RSV by 74.0% (OR: 0.26; CI: 0.170.39); the influenza vaccine reduces it by 70% (OR: 0.30; CI: 0.21-0.43). For each completed week of gestational age, protection against the disease increases by 10% (OR: 0.90; CI: 0.81-0.99). Conclusion. The vaccine is effective against hospitalization due to RSV in children under 6 months of age, who are the most vulnerable population, and could be an essential tool for reducing morbidity and mortality due to RSV.

Bartonella henselae is a gram-negative pleomorphic fastidious bacillus that predominantly affects the pediatric population. Its best-known clinical manifestation is cat scratch disease (CSD), which is initiated by inoculation of the bacterium through feline saliva, its main reservoir. The clinical spectrum of Bartonella henselae infections is broad; fever with lymphadenopathy is the most frequent presentation, usually self-limited. Despite the availability of specific serological tests, a delay in diagnosis is common, especially in cases with unusual manifestations. This paper aims to describe an atypical form of systemic bartonellosis with lymph node, pleural and extradural spinal involvement in a pediatric patient.

Mucormycosis is an aggressive fungal infection caused by fungi of the order Mucorales. Diagnosis is based on histopathological identification of microorganisms and culture confirmation. In case of suspicion, early surgical debridement and early antifungal therapy are recommended. The diagnosis and treatment of these infections pose a significant challenge, especially in pediatrics. Initial nonspecific clinical variability leads to late diagnosis. Their suspicion requires urgent intervention due to their rapid progression; late initiation of therapy is associated with higher mortality. We describe the case of a girl with acute lymphoblastic leukemia and steroid-induced diabetes who presented with a Rhizopus spp. infection in the deltoid muscle during the induction phase of oncologic treatment, with bone involvement.