Archivos argentinos de pediatria最新文献

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.

Introduction. Central nervous system tuberculosis (CNS TB) represents a severe form of Mycobacterium tuberculosis (Mtb) infection. Late diagnosis is associated with increased mortality and neurological sequelae. Objective. To characterize CNS TB diagnosed in a pediatric hospital and describe the diagnostic elements, estimating their sensitivity. Materials and methods. An observational, retrospective study included CNS TB cases diagnosed between January 2013 and February 2022. Medical and laboratory records were reviewed, and epidemiological, clinical, imaging, cerebrospinal fluid cytochemical, and bacteriological data for mycobacteria were recorded. Results. Twenty-six cases of CNS TB were diagnosed, and 22 had pulmonary involvement. Ninety-six percent had neurological symptoms, with sensitivities of 46% for focal symptoms, 92% for meningeal symptoms, and 73% for the presence of fever. Hydrocephalus was more frequently observed in children under 5 years of age. In the study of cerebrospinal fluid, the clear aspect (92%) and proteins upon 1 g/L (50%) showed higher sensitivity, with higher levels in children under 5 years of age. As for microbiological results, smear microscopy was negative in all cases, while molecular biology and culture showed 61% and 75% sensitivity, respectively. The detection time was significantly shorter for molecular biology than for culture (p < 0.01). Conclusions. The presence of neurological symptoms, compatible cerebrospinal fluid, epidemiological link, and pulmonary involvement showed high sensitivity. Molecular biology allowed for earlier microbiological confirmation.

Introduction. The number of vacancies for medical residencies in Argentina, especially in pediatrics, has increased. Knowing some aspects of medical students (MS) and postgraduate students (PS) in pediatrics could explain this phenomenon. Objectives. Describe the motivational profile, the intention to migrate, and the perception of primary care in MS and PS in pediatrics. Population and methods. A cross-sectional study was conducted in a pediatric hospital in the City of Buenos Aires, on a self-administered survey between October 2023 and September 2024. Results. Eighty-two MSs and 48 PSs participated; 96.9% presented high intrinsic motivation, 29.2% had high extrinsic motivation, 17% intended to migrate, and 60.8% had a positive perception of primary health care. Conclusions. The majority showed high intrinsic motivation. The intention to migrate was low. More than half perceived primary health care positively.

Recurrent acute pancreatitis (RAP) affects 15-36% of children with acute pancreatitis (AP) and may progress to chronicity. To determine the etiology and evolution of RAP, a descriptive retrospective cohort study was conducted in patients aged 1-18 years. Twelve patients with RAP were included out of 79 with AP, and demographic, etiological, clinical, analytical, and imaging data were collected. The results showed that the median age was 11 years for RAP and 13 years for AP. There were no significant differences between sexes or initial severity. Significant associations were found in the weight percentile, ultrasound findings, and genetic studies. These factors may influence the progression of RAP. Biliary lithiasis was the most common etiology in both groups. The multidisciplinary approach allows for avoiding its progression to chronicity.

Introduction. Idiopathic premature thelarche (IPT) is defined as breast growth in girls before age 8 without activation of the gonadotrophic axis. Among the probable etiologies, endocrine disruptors (ED) with estrogenic action have been suggested. Objective. To evaluate whether there is an association between exposure and degree of exposure to the main EDs with estrogenic action in our environment and the development of IPT. Population and methods. Structured survey of caregivers of girls aged 3 to 8 years diagnosed with IPT and controls. The exposure evaluated included different EDs: bisphenol A (BPA), phytoestrogens, phthalates, and parabens, considering the degree of exposure according to weekly frequency. Results. Caregivers of 50 cases (7.2±1.3 years) and 48 controls (6.7±1.5 years) were interviewed. An association was found between IPT and exposure to phytoestrogens in food (OR: 14.6; 95%CI 1.8-118; p<0.01), the use of BPA containers exposed to temperature changes (OR 2.6; 95%CI 1.1-6.5; p<0.05), contact with phthalates (OR 2.9; 95%CI 1.2-7.5; p<0.05) and parabens (OR 2.7; 95%CI 1.2-6,1; p<0.05). In all the detailed EDs, we also found an association of IPT according to their degree of exposure. Conclusions. Exposure and degree of exposure to different sources of phytoestrogens, BPA, parabens, and phthalates were associated with the development of IPT.