Archivos argentinos de pediatria最新文献

From its origins, the doctor-patient relationship accompanied the social and cultural changes that have been modeling different forms of interhuman relationships. However, paternalism remained almost unchanged. Only in the 1970s, hand in hand with postmodern thought and the centrality of ethical, psychological, social and anthropological disciplines, respect for the autonomy of patients began to develop, which constituted the essence of a radical change. “Four models of doctor-patient relationship” are described depending on the objectives of the interaction between the actors, the doctor’s obligations and the patient’s values. Some particularities are detailed in the decision-making of children and adolescents, the doctrine of themature minor, and progressive autonomy where the need for informed consent that reflects the autonomy of this age group is evident. It is worth highlighting the importance of communication in the development of a relationship in which the different models can collaborate with a genuine practice of autonomy for patients and their families.

Russell's diencephalic syndrome is a set of signs and symptoms characterized by extreme weight loss, with no impairment of height or head circumference, without changes in intake or appetite. It is due to hypothalamic dysfunction associated with space-occupying lesions in this region. It is a rare cause of malnutrition in pediatrics, so its diagnosis is often delayed. Here we describe the case of a 17-month-old male patient with weight loss for 3 months who was admitted to the pediatric inpatient ward due to suspected intestinal malabsorption syndrome. After ruling out the most common causes of malnutrition, the patient was diagnosed with pilomyxoid astrocytoma of the brainstem.

Introduction. Arboviruses, such as dengue and chikungunya, have caused multiple epidemics in the Americas. They are transmitted through mosquito bites; Aedes aegypti is their main vector. As of January 2023, coinciding with the fourth dengue outbreak in Argentina, a new dengue outbreak was observed in the Americas, coincident with the presence of chikungunya. We considered it essential to describe the demographic, epidemiological, clinical, and evolutionary characteristics of dengue/chikungunya patients seen in a tertiary pediatric hospital in the Autonomous City of Buenos Aires in 2023. Population and methods. Descriptive, observational, retrospective cohort study. Includes children of 0 to 16 years with compatible symptomatology and positive PCR or IgM for dengue or chikungunya from February 1, 2023, through May 31, 2023. Results. A total of 168 patients were identified, with a median age of 138 months (IQR: 107-164). The diagnosis of dengue was confirmed in 140 and of chikungunya in 28. Ninety-eight percent were autochthonous cases. In 85% of the cases, PCR was used to make the virological diagnosis of dengue, and in the remaining 15%, IgM was used. PCR diagnosed chikungunya in 61% of cases. Patients with dengue fever had a longer duration of fever, abdominal pain, headache, myalgias, and retroocular pain. Exanthema and arthralgias were associated with chikungunya. Conclusions. The epidemiology of mosquito-borne diseases is dynamic and is related to what happens in the rest of the countries of South America; knowledge of it is essential to predict the etiological risk and prevalence.

Failure to thrive is a general term describing infants who do not reach weight, length, or body mass index expected for their age. It can be related often to malnutrition due to inadequate caloric and protein intake, but also to excessive loss of nutrients, inadequate metabolism, inadequate absorption, or excessive caloric and energy expenditure. It may be either organic or inorganic in origin, and in most cases, does not require investigation through complementary examinations. It is associated with social and health detrimental outcomes. Most cases of failure to thrive are of non-organic etiology, thus clinical history evaluation and physical examination are of utmost importance in the management of these patients. Therapeutics includes behavioral or nutritional interventions, as well as treatment of possible underlying diseases. The treatment approach is more effective in improving clinical outcomes if applied as early as possible.

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease. Cardiovascular involvement is frequent; however, aneurysm and/or aortic dissection are rare entities with fatal evolution. The objective is to describe a rare and fatal complication of SLE in pediatrics and review the literature. We present the case of a 16-year-old girl with SLE with multisystem involvement without cardiovascular disease at diagnosis. She consulted for severe chest pain. Chest X-ray showed a dilated aortic arch with no cardiomegaly. The presence of a dissection was suspected, and an angiotomography was performed. A descending aortic aneurysm without a dissection flap was confirmed. Antihypertensive treatment was started. After a Valsalva maneuver, she presented an aneurysmal rupture. She died 12 hours after admission. Aneurysm and dissection are infrequent complications in pediatric SLE. As they have high mortality, it is essential to consider them in a patient with SLE and chest pain.

Introduction. Argentina implemented the varicella vaccine in 2015. This study aimed to evaluate the impact of vaccine implementation in each province of Argentina. Materials and methods. An observational, ecological analytic study using secondary data sources. We performed a time series description of varicella cases and built generalized additive models using a negative binomial distribution. We modeled the behavior of varicella in the period 2005-2014 and made a forecast of the most likely behavior until 2019. We assessed the impact by comparing expected and observed incidence rates. We studied whether 2015 was a turning point in the incidence trend in each jurisdiction. We used R and Joinpoint software. Results. Between 2005 and 2019, Argentina had an incidence rate of varicella of 5.93 cases/100,000 population. At the national level, the incidence rate significantly decreased after 2015. In Argentina in general and in 6 provinces, 2015 was a breakpoint, whereas in the rest of the provinces, it occurred before (n = 2) or after (n = 1), or there was none in the time series analyzed (n = 15). Conclusions. The work demonstrates the impact of vaccine implementation in each of Argentina's provinces and highlights the importance of evaluating national policies at the provincial level.

Introduction. Health-related quality of life (HRQL) and its social consequences have not been evaluated in adults who started renal replacement therapy (RRT) in childhood/adolescence and are currently on hemodialysis. Population and methods. We compared 26 patients who started their RRT at <18 years with a group that started their RRT at 18 years or more. We studied social variables and HRQL with the KDQOL-36 questionnaire. Scores >50 indicate good HRQL. Results. The study was conducted in 2018. The scores were: physical health: 55 and 58.1; mental health: 61.2 and 66.7; disease burden: 39.2 and 37.3; symptoms and problems: 75.6 and 78.5; effects: 65.9 and 51.6 (p < 0.019) for those who started RRT at pediatric age or adult age respectively. Socioeconomic status and education were similar in both groups. Fifty percent of the patients with RRT from pediatric age and 38.5% of those who started with RRT in adulthood were unemployed. In the group who started RRT at pediatric age, 61.5% lived with their parents vs. 19% of those who started RRT in adulthood; 11.5% of the patients with RRT at pediatric age had a partner vs. 42.3% of those who started RRT as adults. Conclusions. Adults with the onset of RRT in childhood who are currently on hemodialysis have a good perception of HRQL, superior to adults with a recent onset of RRT. They have a good education, but their lack of work, independent living, and having a partner is related to the burden of illness.

Introduction. The standard treatment for the onset of primary nephrotic syndrome (PNS) consists of 8 weeks of prednisone. Alternatively, it was postulated that extending treatment to 12 weeks is associated with fewer relapses. We aimed to evaluate whether relapses' cumulative incidence (CI) at 2 years was lower with extended treatment. Population and methods. This is a retrospective cohort study of patients with PNS who were followed for 2 years and grouped according to the initial treatment received. Results. Thirty-seven patients were included per regimen. The time to first relapse was similar (p = 0.63), and the CI of relapses at 2 years was 75.6% with standard treatment and 72.9% (p = 0.79) with extended treatment; relative risk was 0.96 (95%CI 0.73-1.26). Relapse-free survival in the 2 years of follow-up was also similar (log-rank test = 0.51). Conclusion. Relapse CI at 2 years was similar with both treatment regimens.

Urticaria multiforme is an allergic hypersensitivity reaction. It manifests as a skin reaction with a vascular response pattern in the dermis. Urticaria multiforme is a benign, self-limited condition of unknown etiology, with onset in pediatric age and a more frequent range of presentation in children from 4 months to 4 years old. It is considered a subtype of urticaria in which the skin lesion corresponds to particular annular and polycyclic wheals, with a purple center and evanescent nature, frequently associated with acral edema and fever. The clinical recognition of urticaria multiforme, together with an adequate symptomatology, are sufficient for the diagnosis and provide peace of mind to parents. The most important differential diagnoses include acute urticaria, urticarial vasculitis, and erythema multiforme. The objectives of this article are to train pediatricians in recognizing urticaria multiforme and the differential diagnoses and to highlight the importance of symptomatology in reaching a diagnosis.