Archivos argentinos de pediatria最新文献

Objective. Comparing the prevalence and severity of anemia according to the WHO 2011 and WHO 2024 cutoff points. Population and methods. Retrospective cross-sectional study. Hemoglobin data from children aged 6 to 24 months who underwent controls between 2017 and 2024 were analyzed. The prevalence and severity of anemia were established in all children, categorized by age group and sex. Results. A total of 1843 children were included, with 47.7% being girls. The prevalences of anemia were 46.9% (WHO, 2011) and 25.8% (WHO, 2024); they were higher in the 6-12 months group, with no differences according to sex. No child presented with severe anemia. Conclusion. Despite the decrease in the new cutoff point, anemia remains a significant public health issue affecting approximately 1 in 4 children aged 6 to 24 months who have accessed the public health system, in our region. Most of the cases were mild anemias.

Type 1 diabetes mellitus is a chronic disease with a significant impact on the patient's daily life. It is essential to follow appropriate treatment guidelines, which can be particularly challenging during adolescence. This study aimed to review the core areas of psychological intervention in adolescents with type 1 diabetes mellitus (T1DM). A search of the scientific literature was conducted to analyze the central psychological interventions aimed at improving adjustment to T1DM. Thirty-eight articles presenting treatment protocols aimed at adolescents with T1DM were examined. The results show heterogeneity in the intervention methodology and the variables evaluated. Most of the research did not refer to a theoretical model to structure and justify the proposed interventions. This hinders the replicability of these interventions and the generalization of their results, highlighting the need for further research.

Carney complex (CC) is characterized by myxomas, pigmented skin lesions, and endocrine hyperactivity, with a predisposition to tumors. Primary pigmented nodular adrenocortical disease (PPNAD) is notable, manifesting with subclinical, progressive, or cyclical symptoms of Cushing's syndrome (CS) caused by endogenous adrenocorticotropic hormone-independent hypercortisolism, and characterized by a paradoxical increase in urinary free cortisol after a corticosteroid suppression test. PPNAD should be suspected in patients with cyclic CS, and its association with CC should be considered. In cases of strong clinical suspicion, a suppression test should be performed to demonstrate the characteristic paradoxical response and ensure an early diagnosis to avoid the long-term repercussions of hypercortisolism. We describe two patients with clinical and molecular diagnosis of CC who presented with PPNAD with a characteristic biochemical pattern treated with bilateral adrenalectomy in both cases.

Introduction. Spina bifida, particularly its most common form, myelomeningocele (MMC), is a severe congenital malformation associated with high neonatal morbidity and long-term disability. Since 2015, our center has been performing intrauterine repair of MMC using a modified open surgical technique. Objective. To describe the obstetric and perinatal outcomes, the need for treatment of hydrocephalus, and the ability to walk in children who underwent open fetal surgery for repair of spinal dysraphism, and to compare these data with those published in the Management of Myelomeningocele Study (MOMS). Population and methods. Retrospective observational study of 102 consecutive cases operated on between 2015 and 2023. Maternal, neonatal, and neurological variables were analyzed in the mediumterm follow-up. Results. The mean gestational age at the time of surgery was 26.1 weeks. Maternal and neonatal complication rates were similar to or lower than those reported in the MOMS study. The need for ventriculoperitoneal shunting at 12 months was 23.8%. At 30 months, 84.8% of patients were walking with or without orthopedic devices. Conclusion. Open fetal repair of MMC at our center, performed by a multidisciplinary team using a modified surgical technique, presented a favorable maternal-fetal safety profile. The perinatal and neurological outcomes obtained are comparable to those of international reference centers, with a low rate of ventriculoperitoneal shunting and a high percentage of children able to walk at 30 months of age. These findings support the continuation and optimization of this intervention in experienced centers.

We describe a patient with a homozygous loss-of-function mutation in NR1H4, presenting with idiopathic mild elevation of transaminases. His presentation differs from the limited previously reported cases of progressive familial intrahepatic cholestasis type 5 (PFIC5). Case report: A 7-year-old boy was admitted to our outpatient clinic due to persistently elevated transaminases since 12 months of age. While PFIC5 is typically a rapidly progressive disease requiring liver transplantation, this patient's laboratory results showed normal gamma-glutamyl transferase (GGT), international normalized ratio (INR), albumin, and alpha-fetoprotein (AFP) levels. Liver biopsy revealed only mild fibrosis. Over a two-year follow-up, he has remained stable with mild transaminase elevation. Conclusion: Infants with cryptogenic liver disease should be evaluated for NR1H4 mutations-associated PFIC5. This mutation may represent a novel metabolic etiology of idiopathic, mildly elevated transaminases.

Introduction. Dengue fever presents a broad clinical spectrum in pediatrics, and there is limited information on its course in children. During 2023-2024, Argentina experienced its largest dengue epidemic. Objective. To describe the clinical manifestations and hematological and biochemical alterations in pediatric patients with confirmed dengue and compare the results by age subgroup. Population and methods. Retrospective, observational, analytical study in children under 17 years of age with dengue confirmed by RT-PCR or IgM, treated between July 1, 2023, and June 30, 2024, at a privately managed tertiary general hospital. Clinical, biochemical, and hematological variables were analyzed, comparing subgroups by age (<13 vs. ≥13 years). Results. A total of 383 patients were included; 86.4% presented dengue without warning signs and 13.6% with warning signs. The most frequent symptoms were fever, headache, and myalgia. The most common laboratory abnormalities were leukopenia, thrombocytopenia, and elevated transaminases. Patients ≥13 years of age had a higher frequency of warning signs and hematological abnormalities. Most were treated on an outpatient basis; only 1.8% required hospitalization. No patients with severe dengue or deaths were recorded. Conclusions. Early leukopenia and thrombocytopenia were the most frequent findings. The group aged ≥13 years had a higher proportion of dengue with warning signs.

Background. The COVID-19 pandemic is perceived as a major threat to health and the economy worldwide, and its effects have been ongoing for about five years. Studies were generally conducted in the early stages of the pandemic, and usually included adults or adolescents. Studies examining the impact of the pandemic on preschool children (3-6 years old) are quite scarce. This study aimed to evaluate the perceived anxiety levels of children aged 3 to 6 years and their parents, focusing on anxiety-related behavioral patterns in children and the frequency of anxiety-related expressions. The assessment was conducted at four distinct time points over four years following the onset of the COVID-19 pandemic. Method. This descriptive-cross-sectional study was conducted between May 17, 2020 and October 30, 2023. An online questionnaire form was used at four different time points. Results. 3732 parents with children aged 3-6 participated in the study. Children's anxiety-related behaviors and expressions were more frequent during the first and second time points. Anxiety-related behaviors were more common in children during the long-term bans. Conclusion. Perceived anxiety levels of the children aged 3-6 years at different time points during COVID-19 pandemic reflected the epidemic trends of the disease and parental anxiety levels. Understanding how the effects are distributed is important for the future.

The core sets (CS) of the International Classification of Functioning, Disability and Health (ICF) for cerebral palsy (CP) have been applied in different contexts but have not been operationalized in the CP population in Argentina. To select instruments for implementation, a four-stage cross-sectional study was conducted: training in ICF, consensus on instruments, evaluation of intra- and interobserver agreement, and pilot testing. Sixtynine professionals participated in the training, and 13 in the consensus. In the first round, agreement was reached in 15 of 24 categories (92.8%), and new options were proposed for the remaining ones. The second round achieved 95.6% agreement. Intra-observer agreement was 0.84, and inter-observer agreement was 0.86. The pilot test (n = 7) allowed five categories to be adjusted. The first national protocol for assessing ICF CS in children with CP is thus proposed.