Boletín médico del Hospital Infantil de México最新文献

Introduction: Acute lymphoblastic leukemia (ALL) is the most common oncological disease in the pediatric population; however, skin infiltration occurs only in 1-3% of the patients and almost always manifests after the diagnosis is made.

Clinical case: A male teenage patient who presented with facial edema and infiltration, associated with systemic symptoms such as asthenia and adynamia. On physical examination, the patient presented facial edema and indurated plaques, as well as cervical, inguinal, and axillary adenopathy. Complete blood count showed pancytopenia and a chest X-ray revealed a mediastinal mass. Due to a high suspicion of malignancy a bone marrow and skin biopsy was taken, both with pre-B ALL. Chemotherapy was started and the patient is now in maintenance phase.

Conclusions: Leukemia cutis manifestations are heterogenous, from a small papule to a big nodule. It is more common in patients with acute myeloid leukemia and it is rare in patients with pre-B ALL, specially in the pediatric population. The diagnosis should be done with a biopsy and the treatment is with systemic chemotherapy. The diagnosis should always be considered in patients with unexplained edematous or indurated lesions, especially in the context of systemic symptoms.

Background: Intramuscular vascular malformations (IVMs) are rare developmental congenital structural abnormalities. Their clinical diagnosis is difficult, and imaging studies are essential to determine the type and extent of vessels involved. Treatment can be challenging and must be managed by a multidisciplinary team.

Methods: A descriptive, observational, retrospective, longitudinal study of clinical records of patients diagnosed with IVMs who were evaluated at the vascular anomalies clinic from January 2011 to December 2021 was performed. Demographic, clinical, imaging, diagnosis, treatment, and response data were collected.

Results: Seven patients (five females and two males) with a mean age of 13.66 years (standard deviation 5.82 years) were included in the study. In all cases, the clinical diagnosis was venous and lymphatic malformation. The radiological findings were dilated and tortuous vascular structures or multilobulated lesions with septa inside, with or without vascular flow; these findings allowed diagnosis in all cases. Treatment modalities included sclerotherapy in five patients, surgical resection in two, medical treatment with sirolimus in three, and surveillance in one. Subsequent clinical evolution was favorable in all patients, with decreased pain in six (partial in four and total in two) and size reduction in one patient.

Conclusion: IVMs in our pediatric population most frequently affect the lower extremities. The main symptoms and signs were pain on exertion and volume increase. Treatment can be challenging given the extension and depth of the malformations, so a combination of therapeutic modalities may be necessary to obtain the best outcome.

Introduction: Linear IgA bullous dermatosis (LABD) is a rare autoimmune disease. Although dapsone is the initial treatment, other immunomodulators are used in resistant cases or when dapsone is unavailable.

Case report: A 12-year-old Mexican child, with no relevant medical history, developed in May 2023 a disseminated dermatosis affecting all body segments, including mucous membranes, characterized by erythematous patches and plaques evolving into the formation of serous and serosanguinous blisters and vesicles, distributed in a "string of pearls" pattern. LABD was suspected and confirmed by skin biopsy, which showed a subepidermal blister with neutrophilic infiltration and linear Immunoglobulin A deposits at the dermo-epidermal junction by direct immunofluorescence. Treatment with prednisone (2 mg/kg/day) and cyclosporine (5 mg/kg/day) resulted in improvement and lesion remission within 2 weeks. Both drugs needed to be discontinued for 3 months due to intermittent blistering. Cyclosporine was continued as maintenance therapy at a dose of 4 mg/kg/day for 8 months.

Conclusions: The report highlights the use of cyclosporine as an alternative immunomodulator for DAAL, an immunosuppressive agent used in autoimmune disorders. Few cases, including this one, have described complete remission and control of the dermatosis with cyclosporine, accompanied by prednisone at the start of treatment.

Introduction: The increase in the production of substances to enhance the quality of life, the biodiversity of the different ecosystems in Mexico, and the unique characteristics of pediatric patients, contribute to intoxications within this population.

Method: Analytical retrospective study of admissions to pediatric emergency care due to poisoning in < 16-year-old (2016 to 2020). Included variables were age, gender, type of toxic substance, exposure characteristics, and the season of the year. Frequencies, percentages, range, average and standard deviation were obteined. In the bivariate análisis, the Chi square test was used. A p-value < 0.05 was considered statistically significant.

Results: Over 5 years, there were 459 cases, with a prevalence of 3.16%. No gender predominance was observed. The most common was caused by venomous animals (28.5%), followed by medication ingestion (27.6%). Only 5% of cases were suicide attempts, the rest were accidental (95%). Children up to 5 years old were more commonly by medication ingestion, hydrocarbons, or household products (p = 0.03, p = 0.0001), while the causes in older children were contact with venomous animals and ingestion of stimulants drugs (alcohol, amphetamines, cannabis, cocaine) (p = 0.0001, p = 0.006). Intoxication with quaternary ammonium herbicides was lethal in all cases.

Conclusions: Children under the age of 5 are more susceptible to intoxication from common household products. Older kids tend to be more frequently a combination of stimulants drugs.

Background: The cochlear implant (CI) is effective for rehabilitating patients with severe to profound sensorineural hearing loss. However, its placement and use have been associated with various complications, such as those affecting the vestibular system. The objective of this study was to compare vestibular function using the video head impulse test (vHIT) in pediatric patients before and after CI placement.

Methods: A descriptive and retrospective study was conducted. The outcomes of 11 pediatric patients of both sexes with a history of profound hearing loss were evaluated. The results of vestibular-ocular reflex (VOR) gain, saccades, asymmetry, Pérez Rey (PR) index, and VOR/saccade ratio for both ears obtained by the vHIT test before and after CI placement were compared.

Results: Of the 11 patients evaluated, the VOR gain showed that 81.8% had normal function, 18.2% had hypofunction, and no patients had hyperfunction before implantation. No statistically significant differences were found when compared with post-implant off and post-implant on conditions (p > 0.05). The extracted variables, asymmetry, PR index, and the VOR/saccades ratio also showed no statistically significant differences between the pre- and post-implant conditions, whether off or on.

Conclusions: The vestibular function of pediatric patients did not show significant changes before and after CI placement. The vHIT test is a valuable tool for assessing vestibular function and could be considered a criterion for surgical and rehabilitation decisions in patients undergoing CI placement.

Introduction: Septic shock is a potentially life-threatening condition. The aim of this study was to identify clinical and epidemiological factors associated with mortality in pediatric patients admitted to a pediatric intensive care unit (PICU) with septic shock.

Materials and methods: A retrospective comparative case series study was conducted with children aged 1 month to 14 years with septic shock from 2018 to 2020 in a PICU in Lima, Peru. Patients were divided into deceased and survivor groups based on their condition at discharge from the PICU. The influence of each variable on mortality was assessed using a logistic regression model.

Results: A total of 174 patients were included in the study, with 51 (29.3%) fatalities. Deceased patients, compared to survivors, were older, had a higher incidence of oncological disease (31.4% vs. 14.6%; p = 0.011), more frequently presented with hemoglobin ≤ 9 g/dL (44% vs. 28%; p = 0.043), lactate > 2 mmol/L (70% vs. 44%; p = 0.002), platelets ≤ 150 (×10³)/μL (77% vs. 42%; p < 0.001), and pH ≤ 7.1 (31% vs. 6%; p < 0.001). In the logistic regression model, factors related to mortality were having a pH ≤ 7.1 (odds ratio [OR] = 8.95; 95% confidence interval [CI]: 2.52-31.75) and platelets ≤ 150 (×10³)/μL (OR = 3.89; 95% CI: 1.40-10.84).

Conclusions: Factors associated with mortality in pediatric patients with septic shock were a pH ≤ 7.1 and platelets ≤ 150 (×10³)/μL in the assessments conducted upon admission to the PICU.

Background: Pilomatricoma is a common benign adnexal neoplasm in children. There are few epidemiological studies on this subject, with most relying solely on descriptive statistics.

Methods: A cross-sectional study conducted in two tertiary hospitals in Mexico City from January 2017 to December 2023. Clinical and electronic records of patients with histopathological diagnosis of pilomatricoma, both sexes, under 18 years old, with any type of present comorbidity were selected. Records of patients with diagnosis not confirmed by histopathology or incomplete records were not included in the study.

Results: Fifty-two cases with pilomatrixoma were included in the study, showing a total of 74 lesions. About 23.1% of the cases had multiple pilomatrixomas. 40.4% of the cases experienced pain; this symptom was associated with lesions > 15 mm in diameter and with multiple pilomatrixomas. Risk factors for lesions > 15 mm included age under 8 years, positive tent sign, tumor evolution longer than a year, and a non-classical clinical variety. The head and neck were the most commonly affected areas. The left upper extremity presented larger pilomatrixomas (median 18.5 mm) and occurred more frequently in adolescent patients (mean age 12.1 years) compared to other body areas.

Conclusions: Pilomatrixoma in children shows clinical diversity, with specific findings based on size, number, and anatomical location.

Background: Hand hygiene (HH) is an important strategy for preventing health-care-associated infections (HAIs). Few programs focus on HH for family members and primary caregivers but fewer for patients. This study aimed to estimate the frequency with which hospitalized pediatric patients have hand contact with hospital surfaces.

Methods: We conducted a cross-sectional descriptive observational study consisting of three phases: the first was the creation of an observation and data collection tool, the second was the training of the monitors, and the third was the observational study of hand contact and HH opportunities in hospitalized pediatric patients.

Results: Over 3600 minutes of observation, 2032 HH opportunities were detected, averaging 33.8/h (SD 4.7) as determined by hand contact with hospital surfaces of hospitalized pediatric patients. In our study, infants and preschool children had the highest frequency of hand contact.

Conclusion: The high frequency of hand contact of hospital surfaces by children suggests that hourly hand disinfection of patients and caregivers, objects and surfaces around the patients may be prevention measures that could be incorporated to reduce HAIs in pediatric hospitals.