Boletín médico del Hospital Infantil de México最新文献

Background: Langerhans cell histiocytosis (LCH) is a rare, multisystem hematologic disease characterized by the clonal proliferation of mononuclear phagocytes in various tissues and organs. In Mexico, its incidence in children is 4.3 cases per million. The disease presents a clinical variety that can mimic other medical conditions, making diagnosis challenging. Pediatricians play a crucial role in the early identification of adenopathy, which can be indicative of LCH or other pathologies.

Clinical cases: Case 1. A 6-month-old infant with cervical adenopathy, fever, anemia and cutaneous compromise; biopsy with immunohistochemistry confirmed the disease. Case 2. A 2-year-old boy with retroauricular adenopathy, exophthalmos, and pallor. Lytic bone lesions and lymph node biopsy confirmed the disease, classified as group I. Case 3. A 1-year-old boy with generalized dermatosis, progressive adenopathies, and symptoms of diabetes insipidus; studies confirmed LCH and vasopressin deficiency.

Conclusions: LCH is currently classified into groups based on the extent of the disease. The presented cases reflect different clinical forms, underscoring the importance of early detection and accurate diagnosis to improve prognosis. Delayed diagnosis can lead to less effective treatments and additional complications. The clinical variability of LCH poses a diagnostic challenge in pediatrics. This analysis emphasizes the importance of early diagnosis and appropriate treatment to improve prognosis. It is essential for pediatricians to consider other causes of adenopathy before considering an oncological diagnosis and to conduct a thorough evaluation for timely referral to subspecialists.

Background: Generalized pustular psoriasis is a rare and severe systemic inflammatory disease characterized by skin erythema and visible sterile pustules. Associated with hereditary and external factors, it can be life-threatening and requires specialized diagnosis and treatment.

Clinical case: A 6-year-old male with disseminated dermatosis of 7 months evolution, initially appearing in the retroauricular region with erythematous scaly plaques and pustular lesions, spreading to various body segments, accompanied by intense pruritus, fever, and tachycardia. Histopathological examination reported psoriasiform dermatitis with lymphocytes, plasma cell aggregates, and neutrophils forming microabscesses in the stratum corneum, compatible with a diagnosis of pustular psoriasis. Treatment included methotrexate at 12 mg/m²/week, folic acid, 1% methylprednisolone aceponate cream, 0.005% calcipotriol, urea-based emollient at 10%, and antihistamines.

Conclusions: Generalized pustular psoriasis in pediatrics requires comprehensive care, considering not only dermatological aspects but also psychosocial factors. Successful management of pediatric cases, as described, highlights the importance of a personalized approach tailored to each patient's needs to achieve long-term satisfactory outcomes.

Background: In 2020, a multidisciplinary group developed Integrated Asthma Management (MIA), guidelines for asthma in Mexico, based on international asthma guidelines. Since then, several concepts and treatments have been updated.

Objective: To create a current version of MIA, strongly based on evidence, and to add the management of severe asthma exacerbations.

Methodology: MIA 2.0 uses the ADAPTE method. The MIA 2.0 guideline development group consists of a core group (experts in pulmonology-allergology-methodology) and representatives of 16 institutions/societies of specialties that manage asthma. The international reference guidelines (selected with AGREE-II) were: GINA 2024, GEMA 5.4, BTS/SIGN 2024 and Australian Asthma Handbook 2021. MIA 2.0 covers diagnosis, treatment, severe asthma, exacerbations and special groups. Key clinical questions were formulated for I) diagnosis, II) treatment steps 1-4, III) severe asthma and IV) exacerbations.

Results: Based on evidence in reference guidelines, safety, cost and local reality, the core group developed responses to the clinical questions. Through a Delphi process, the MIA 2.0 development group suggested adjustments until consensus was reached.

Conclusion: A document was generated with multiple figures and algorithms, about asthma management including exacerbations treatment, adjusted for Mexico broadly based among different societies that participated in its development.

Background: The foundational elements for optimal well-being and health are established during the early stages of life. When progress does not meet expectations, it is necessary to explore possible disorders, health conditions, or other probable factors affecting it. Health professionals in our country must have access to developmental screening instruments that facilitate early detection of these potential risks and delays, thus enabling timely intervention.

Methods: After a pre-selection of the evidence and adequate training of a multi-sectoral panel, a virtual deliberative dialog was held with key stakeholders and decision-makers to determine the most appropriate development screening instrument for the Peruvian context. The evidence was analyzed and discussed in light of the established criteria. In addition, factors pertaining to implementation on a national level were discussed.

Results: A set of instruments were obtained and prioritized in the following order: Evaluation of Child Development (EDI, Spanish acronym) ranked first, followed by the Abbreviated Developmental Scale Third Edition (EAD-3, Spanish acronym) and the Ages and Stages Questionnaire (ASQ-3, Spanish acronym), based on the established criteria. The primary components implicated in the execution of this evaluation on a national scale were subsequently identified.

Conclusions: This deliberative dialog has enabled a first approach to the selection of a development screening instrument on the national level, providing valuable information to guide the implementation process.

Background: Malnutrition is a risk factor for childhood development disorders. Although undernutrition is recognized as a public health problem, the impact of overweight/obesity on childhood development remains unknown. The objective is to determine the effects of undernutrition, overweight, and obesity on development in children aged between 1 and 59 months in rural/urban areas of Mexico.

Methods: The Childhood Development Evaluation (EDI, for its acronym in Spanish) test was administered to children 1-59 months of age who visited primary care units in Guanajuato State, Mexico, between 2013 and 2015. The World Health Organization classification (weight/height ratio) was used for nutritional status. Logistic regression adjusted by sex, age, rural/urban, and level of marginalization, used to calculate odds ratios (OR) to stablish the association between nutritional status and developmental outcomes.

Results: 34,972 participants were included. 50.3% were male, 39.5% had a very low level of marginalization, 58.6% lived in urban areas, and 55.0% were beneficiaries of a conditional cash transfer program. Age distribution: 31.9% between 1 and 12 months old; 17.5% between 13 and 24 months old; 16.3% between 25 and 36 months old; and 34.3% between 37 and 59 months old. Overall 85.8% of participants had normal nutritional status, whereas 9.1% were identified as malnourished, and 5.0% were classified as overweight or obese. 79.1% had typical development. The OR for atypical development was 1.820 (95% confidence interval [95% CI], 1.671-1.981) for mild undernutrition; 2.796 (95% CI: 2.195-3.562) for moderate undernutrition; 14.903 (95% CI: 8.149-27.257) for severe undernutrition; and 1.160 (95% CI: 1.030-1.307) for overweight/obesity.

Conclusion: Undernutrition and overweight/obesity are factors that increase the risk of developmental problems in children < 5 years of age.

Background: Early childhood development (ECD) is a critical period for achieving milestones in cognitive, motor, and socioemotional development. Parental knowledge of ECD influences the manner in which children are stimulated, as evidenced in previous studies, particularly in developing countries. This study examined parents' understanding of ECD, their stimulation and caregiving practices, and the sources of information that they utilize in the Mexican context.

Methods: A descriptive cross-sectional field study was conducted using a questionnaire validated by a panel of experts and a pilot test. A total of 536 mothers and fathers from socioeconomic levels C-, D+, and D/E residing in three Mexican cities were surveyed using non-probability convenience sampling. The questionnaire inquired about respondents' knowledge, stimulation practices, and sources of information related to ECD.

Results: In all, 60% of the surveyed parents did not consider the first 3 years of life as a relevant learning stage. Although 44.3% of mothers and 37.6% of fathers identified early learning (at 0-3 months), few socioemotional activities were considered relevant. Only 33% were familiar with the term "early stimulation," and television was the most consulted medium (30%).

Conclusions: It is necessary to raise awareness among parents about the importance of play, as well as socioemotional and communicative activities in ECD. The quality of information disseminated through mass media should be improved and public policies to strengthen parental education should be promoted.

Early childhood caries (ECC) is the presence of one or more decayed, missing, or filled teeth in children up to 71 months of age. Among the recommendations proposed by the World Health Organization to counteract this condition is the application of silver diamine fluoride (SDF). The aim of this research was to analyze the available information on the cost-effectiveness of SDF as a public health intervention in the prevention and control of ECC. This scoping review included articles published in English between 2008 and 2023 about the cost-effectiveness of SDF for pre-schoolers. Scientific journal databases (PubMed, Free Medical Journal, Science Direct, Springer Link, and Google Scholar) were searched using the following keywords: ECCs, effectiveness, cost, SDF, economic evaluation, caries, pre-school, infant, and minimal invasive treatment. The information extracted included author, year, objective, population, design, perspective of the analysis, options to be compared, time horizon, discount rate, costs, and effectiveness. We identified a total of 526 articles. Of these, 514 were excluded due to lack of relevance to the study objective, and 5 were duplicates. The final sample comprised 7 articles. The reported costs of SDF treatments from the perspective of healthcare practitioners ranged from $0.7 to $1,456, with an incremental cost-effectiveness ratio ranging from -$7.73 to -$518.50. SDF is a cost-effective treatment for public health interventions to prevent and control ECC in pre-schoolers.

Pediatric arrhythmia encompass a diverse array of conditions, ranging from asymptomatic cases to severe life-threatening episodes. Effective management of these conditions, especially for non-specialist physicians, is crucial to improving patient outcomes and reducing the risk of sudden cardiac death (SCD). This integrative review aims to synthesize the present evidence on the strategies for diagnosing and treating pediatric arrhythmias, providing a practical, symptom-based guide for non-specialist physicians. Following Cooper's methodological framework, we conducted a comprehensive literature search using electronic databases (PubMed/MEDLINE and Cochrane Library) up to August 7, 2024. Inclusion criteria focused on studies published between 2019 and 2024, involving pediatric patients aged 2-18 years with several types of arrhythmias, excluding those with congenital heart disease or other systemic conditions. Quality appraisal was performed using the GRADE and CONSORT methodologies. From 176 initially selected studies, 69 met the inclusion criteria. The evidence was synthesized into a symptom-based conceptual framework, categorizing arrhythmias into asymptomatic, paroxysmal tachycardia, and those associated with low cardiac output or syncope. Common arrhythmias, such as sinus arrhythmia, sinus bradycardia, and wandering atrial pacemaker typically do not require treatment. In contrast, conditions, such as supraventricular tachycardia, ventricular tachycardia, and inherited arrhythmias (e.g., long QT syndrome, Brugada syndrome) necessitate specific diagnostic and therapeutic strategies. This review provides a practical guide for non-specialist physicians to diagnose and manage pediatric arrhythmias, aiming to improve patient outcomes and reduce SCD incidence in children. Future research should focus on pediatric-specific studies and the development of novel therapeutic interventions.

Background: Pulmonary mucoepidermoid carcinoma is a rare neoplasm in children. Nonspecific symptoms such as hemoptysis may delay diagnosis because they are confused with other respiratory diseases.

Clinical case: A 9-year-old male patient presented recurrent episodes of cough and hemoptysis. The patient had two similar episodes associated with wheezing in previous months and was treated as an asthma attack. Radiological studies and bronchoscopy reported a lung mass obstructing the left main bronchus, causing atelectasis and involvement of the left lung. Transthoracic biopsy was positive for a salivary gland tumor. Treatment was surgical (left pneumonectomy). Histopathological and immunohistochemical studies reported low-grade mucoepidermoid carcinoma. He did not receive chemotherapy. After two years of follow-up, the patient was asymptomatic, and we did not see any recurrence.

Conclusions: Pulmonary mucoepidermoid carcinoma is rare in children. Hemoptysis and signs of bronchial obstruction may mimic other respiratory diseases, causing a delay in diagnosis. Treatment is surgical, with a good prognosis during follow-up.