Archivos argentinos de pediatria最新文献

Introduction. Acute lower respiratory infections (ALRI) due to respiratory syncytial virus (RSV) are a significant cause of disease. Most of them are treated outpatient without etiological investigation, making it difficult to estimate the disease burden. In 2020, an algorithm was developed to identify consultations for ALRI in electronic health records. We evaluated the algorithm's behavior in patients with RSV ALRI. Methods. The cross-sectional study included children under 5 years of age who consulted for ALRI with viral screening. The algorithm was applied to their health records, calculating diagnostic capacity to identify RSV ALRI. Results. We included 133 patients (age 4.9 ± 4.1 years). RSV was identified in 21.8%. The algorithm identified ALRI in 33.8% (95%CI: 26.3-42.2) and showed a limited ability to identify RSV infection (sensitivity: 55.2%, specificity: 72.1%). Conclusion. An algorithm for identifying ALRI consultations in electronic health records does not adequately distinguish those caused by RSV.

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.

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.

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.

Posterior reversible encephalopathy syndrome (PRES) is a type of leukoencephalopathy that usually presents symptoms such as headache, altered consciousness, seizures, blurred vision, and imaging signs such as subcortical white matter edema, predominantly in the parieto-occipital lobes. Numerous risk factors have been identified, which involve impaired cerebral blood flow autoregulation and vasogenic edema. We present the case of a 14-year-old female patient who, in the context of an induction treatment for Crohn's disease with high-dose corticosteroids, azathioprine, and infliximab, presented with posterior reversible encephalopathy, a rare complication in patients with inflammatory bowel disease.

Langerhans cell histiocytosis (LCH) is a rare disease that predominantly affects children, characterized by the abnormal clonal proliferation of Langerhans cells with a broad clinical spectrum and prognosis. Refractory LCH to standard treatment usually presents multisystem and risk organs involvement, and mainly affects children under 2 years of age. In these cases, more than half present the BRAF-V600E mutation; detection of this mutation is essential for targeted treatment, such as vemurafenib, a BRAF inhibitor. We present the case of a 6-month-old patient diagnosed with multisystemic LCH without involvement of risk organs, who responded poorly to first- and second-line therapy. A molecular biology study was performed, which reported a BRAF-V600E mutation. Treatment with vemurafenib was indicated, and a good clinical response was obtained after 2 weeks.

Introduction. Specialized units for children with medical complexity (CMC) aim to improve the quality of life of these patients. The objective of this study is to analyze the characteristics of patients and families evaluated in a recently created CMC specialized unit, as well as factors related to their quality of life. Population and methods. Analytical cross-sectional study that included CMCs seen in a monographic consultation between 2020 and 2024. Clinical data were collected, and parents completed a questionnaire with questions taken from quality-of-life scales. Results. We included 60 of the 217 children who were seen. The mean age was 7.18 years. 68.3% were male. 41.7% had cerebral palsy; 38.3% were dependent on technical support. About the questions, 11/19 related to parents and 1/12 related to patients showed negative answers. Risk factors were non-Spanish origin, behavioral disorders, and sleep disturbances. Conclusions. Our results showed different perspectives on quality of life between CMCs and their families, identifying origin, behavior, and sleep as risk factors.

Hypovitaminosis D (HD) is a relevant deficit. This vitamin has implications in bone health, as well as immunological and metabolic functions, and in the pathophysiology of cancer. Pediatric oncology patients are at increased risk for this deficiency. A cross-sectional, retrospective study was conducted to determine the prevalence of HD in pediatric oncology patients in a high-complexity hospital between January 2019 and August 2023. Eighty-nine patients were included. The overall median vitamin D levels were 18.3 ng/mL (IQR: 11.1-26.7). The prevalence of HD was 52.8% (95%CI: 41.9-63.5). These results indicate that, in this sample, more than half of pediatric oncology patients present HD. We emphasize the importance of determining the levels of this vitamin at diagnosis and during treatment of the disease in this highly vulnerable group.