Archivos argentinos de pediatria最新文献

Invasive mechanical ventilation (IMV) is widely used in pediatric intensive care units. Acute lower respiratory infection is its primary indication; it is characterized by increased inspiratory and expiratory resistance, as well as decreased lung compliance. It can progress to acute respiratory distress syndrome, which poses a challenge in optimizing IMV. Although different ventilatory modes are not presumed to generate significant clinical differences, there is a marked preference for the pressure control mode in pediatrics. In predominantly obstructive conditions, volume control mode ensures ventilation regardless of the degree of inspiratory resistance, allowing for extended expiratory time and preventing hyperinflation. In restrictive conditions, pressure control enables ventilation to be adjusted to protective parameters, albeit with the potential risk of inducing damage due to higher flow rates. The physiological basis of the different ventilation modes and their clinical application are reviewed.

Introduction. Although the use of telemedicine appointments has grown exponentially since the COVID-19 pandemic, missed telemedicine appointments remain a relatively understudied topic. We set out to develop and validate a predictive model to identify patients at high risk of missing telemedicine appointments. Methods. Retrospective cohort. We included telemedicine appointments from August 1, 2020, to March 31, 2021. We included as predictors the clinical characteristics of the patients, missed appointment history, appointment characteristics, social determinants of health, and weather conditions. We developed a predictive model using multivariate mixed-effects logistic regression Results. We included 3339 telemedicine appointments, with a missed appointment rate of 11.35% (95%CI 10.3-12.5). Among the risk factors for missing telemedicine appointments, we found that public health coverage (OR 2.2) and having other appointments on the same day (OR 3.2) increased the likelihood of missing telemedicine appointments. On the other hand, having a chronic condition (OR 0.5) and the number of previous appointments requested (OR 0.7) acted as protective factors. The final predictive model included 19 variables and 4 interactions, with an area under the ROC curve of 0.72 (95%CI 0.70.8) and a calibration slope of 0.78 (95%CI 0.6-0.9), indicating slight overfitting. Conclusion. In this study, we developed and validated a predictive model that identifies children at high risk of missing telemedicine appointments. This model helps guide strategies aimed at reducing missed telemedicine appointments.

Acute suppurative thyroiditis (AST) is a rare endocrinological emergency in pediatrics that may require immediate infectious disease and surgical intervention. It is generally associated with bacterial infections and, in some cases, congenital malformations of the branchial arch. We present the case of a 7-year-old girl with recurrent AST, in both episodes with cervical abscess formation, requiring intravenous antibiotics and surgical drainage. From the outset, a piriform sinus fistula was suspected, which was confirmed by direct laryngoscopy in the operating room during the hospitalization for the second episode. Chemical sclerosis of the fistulous tract was performed, with favorable evolution and no recurrence at follow-up. Although rare, this case highlights the importance of considering AST in the differential diagnosis of cervical masses in the pediatric population. It also encourages investigation of underlying causes such as congenital anomalies, which allows for early diagnosis and definitive treatment.

The objective is to describe the presentation, evolution, and treatment of a child who presented with acute lung injury secondary to intralesional sclerotherapy with bleomycin for a venous malformation. The patient was a 4-year-old boy with a venous vascular malformation in his left lower limb, treated with percutaneous sclerosis with bleomycin (0.46 mg/kg). In the immediate postoperative period, he developed acute respiratory failure. During his evolution, pulmonary injury secondary to bleomycin was suspected. He received treatment with intravenous corticosteroids, oral corticosteroids, and supportive measures. At one year of follow-up, he was clinically stable and breathing adequately, although imaging studies showed persistent parenchymal involvement. This case reports a rare but serious complication of percutaneous bleomycin treatment. It highlights the need to maintain a high index of suspicion for acute respiratory symptoms, even at low doses, to enable timely diagnosis and treatment.

Biosimilars are highly similar versions of already authorized biological drugs. A notable benefit of these is their significantly lower price compared to innovator drugs, which frees up healthcare resources and improves affordability. Leading regulatory agencies approve biosimilars after rigorous comparability studies, ensuring that there are no significant differences in quality, safety, and effectiveness. Currently, the structural and functional equivalence of biosimilars to originators may be sufficient evidence, together with post-marketing experience, to support their safe and effective use in pediatrics. Although the extrapolation of indications and interchangeability continues to be debated, research continues to support the use of biosimilars. However, challenges remain, such as regulatory heterogeneity and mistrust due to misinformation. Continuing education and clear public policies are essential to maximize their adoption and access to vulnerable populations such as children.

Introduction: Suicide is a major global public health concern and the fourth leading cause of death among individuals aged 15-29. In Turkey, the crude suicide rate has shown a consistent increase in recent years. This study aimed to evaluate the sociodemographic and clinical characteristics of patients presenting to the pediatric emergency department following non-violent suicide attempts, and to identify associated risk factors. Methods: In this prospective study, patients under 18 years presenting with nonviolent suicide attempts were included. Data collected comprised demographic and clinical features, psychiatric history of children and families, family dynamics, and substance use. Standardized tools used included the Family Assessment Device-Communication subscale, Adolescent Friendship Attachment Scale, Parenting Style Scale, and Beck Scale for Suicide Ideation. Results: Of 101 patients (82.2% female; mean age 15.5 ± 1.3 years), 44.6% used their own medications, most frequently nonsteroidal anti-inflammatory drugs (19.6%). Psychiatric diagnoses were identified in 31.6%, prior suicide attempts in 43.6%, and tobacco/alcohol use in 35.5%. Poor family communication was observed in 73.3% of families, and authoritarian parenting in 35.6%. Substance use was found to predict recurrent suicidal ideation, while previous attempts and poor family communication predicted greater severity of suicidal ideation (OR = 3.093; p = 0.025), (OR = 4.267; p = 0.003), (OR = 3.218; p = 0.011). Conclusion: Adolescents with substance use, prior suicide attempts, and poor family communication are at significantly increased risk for severe or recurrent suicidal ideation.

Introduction. Patient information transfers between professionals on different shifts are a particularly sensitive area for errors and omissions. Our objective was to evaluate the impact of implementing a structured handover (I-PASS) on data omission in patient information transfers between pediatric residents. Population and methods. The study was conducted in a public hospital in the province of Salta, Argentina, from November 14, 2020, to December 14, 2020 (pre-intervention) and from March 15, 2021, to April 15, 2021 (post-intervention). The design was quasi-experimental, before-and-after, uncontrolled. Pre- and post-intervention shift handovers were evaluated. The intervention included training resident physicians in a structured handover using the mnemonic rule I-PASS, teamwork training, and digitized written handover. The quality of the handover was evaluated through direct observation. Results. There were 233 pre-intervention and 245 post-intervention evaluations. The pre- and postintervention comparison showed a significant improvement in most key handover data. Distractions were reduced from 40.8% to 24.1% (p = 0.001); communication of severity increased from 36.8% to 63.2% (p =0.001). Conclusion. The introduction of the I-PASS program reduced the omission of sensitive data and interruptions, without prolonging handover duration.

Introduction. Autism spectrum disorder (ASD) presents challenges in social communication and behavior. It is more common in males (3:1). Girls receive alternative or delayed diagnoses due to better communication skills, atypical but less unusual interests, greater presence of internalizing behaviors, and camouflage strategies. This can lead to underdiagnosis and limit access to adequate support. Objective. To describe the population of girls and female adolescents (GFA) with ASD being monitored at a tertiary hospital, comparing them according to age and clinical characteristics. Population and methods. Descriptive, cross-sectional study with retrospective analysis of medical records of GFAs evaluated between 2002 and 2024. Data on development, physical examination, and sociodemographic variables were collected. The sample was divided into preschoolers and schoolchildren, and by the presence or absence of language at the time of diagnosis. Results. A sample of 415 GFAs was obtained. Sixteen percent (n = 69) received a late diagnosis. In older girls, two profiles were identified: one compatible with the female phenotype of ASD (language present, lower intellectual disability, consultation for social difficulties) and another with characteristics of profound autism (no language, higher intellectual disability, epilepsy, regression, and greater severity). In preschoolers, cognitive impairment or failure to adapt to formal assessments predominated. A family history of ASD or an broader autism phenotype were present in 19.5% (n = 81) of cases. Conclusion. We observed a high clinical variability, which requires greater diagnostic sensitivity and specific tools to facilitate adequate support.