Boletín médico del Hospital Infantil de México最新文献

Background: Early childhood development is a complex process that requires reliable tools for the timely detection of alterations that may affect a child's progress. The Child Development Evaluation test (EDI, in its Spanish acronym) is a screening test developed and validated in Mexico to be administered in person by a professional. The objective is to evaluate the validity of administering the EDI test through telemedicine in terms of its diagnostic concordance with the face-to-face modality.

Methods: This analytical, prospective, and cross-sectional study included patients aged 18-72 months and was conducted at a tertiary care hospital in Mexico City. The test was administered through telemedicine and subsequently in person. In addition, sensitivity and specificity data were reported with confidence interval of 95% (95% CI). The face-to-face evaluator was blinded to the telemedicine results.

Results: Fifty children with a median age of 47 months participated in the study. A sensitivity of 100% (95% CI, 91-100) and specificity of 100% (95% CI, 70-100) overall were obtained. Language was the higher area with a sensitivity of 100 (95% CI: 91-100) and specificity of 90 (59-98); the results for the other areas are shown. The lowest sensitivity was neurological examination (67; CI 95%: 30-90) but has the highest specificity (98; CI 95%: 88-99).

Conclusion: The EDI test implemented through telemedicine shows high correlation with the face-to-face modality, maintaining high sensitivity and specificity. These results make it an appropriate method for screening children of this age, although further larger studies are needed to corroborate it.

Background: Tethered cord syndrome (TCS) is the clinical manifestation of abnormal traction of the spinal cord, causing sensory-motor impairment of the lower limbs, scoliosis, low back pain, bladder and intestinal dysfunction; cutaneous abnormalities may be present. The diagnosis is suspected through clinical history and detailed physical examination. It is complemented by ultrasound and lumbosacral magnetic resonance imaging.

Methods: A retrospective study was carried out from April 2019 to October 2024. The inclusion criteria: a) Under 17 years old; b)symptoms and physical examination compatible with TCS; c) imaging diagnosis of TCS, and d) having undergone surgery. The results are reported at 12 months after surgery.

Results: Eighteen patients were evaluated, with an average age of 83.27 months (2-180). The etiology was hypertrophic filum (n = 6), dermal sinus (n = 4), lipomyelomeningocele (n = 4), lipomatosus filum (n = 2), and postoperative myelomeningocele (n = 2). The preoperative symptoms were bladder dysfunction 33.33%, constipation 33.33%, paraplegia 22.22%, paresthesia 22.22%, low back pain 22.22%, claw toes 16.66%, fever 16.66%, cerebrospinal fluid leakage 5.55%, club foot 5.55%, scoliosis 5.55%, and acute abdominal pain 5.55%. There were cutaneous stigmata in 61.11%. Magnetic resonance imaging was used in 17 patients and ultrasound in two. With surgery there was improvement in preoperative symptoms, the Wilcoxon test gave us a p < 0.001.

Conclusions: Surgery helps to reduce symptoms and prevent further neurological damage; in asymptomatic patients it prevents the risk of neurological injury.

Background: Eosinophilic esophagitis (EoE) is an immuno-allergic disease characterized by esophageal dysfunction and eosinophilic infiltration of the esophagus. Its prevalence has increased, making it the leading cause of dysphagia and food impaction in children and adolescents. Understanding the approach taken by pediatric gastroenterologists in different regions is crucial.

Method: Multicenter and cross-sectional observational study, carried out through a virtual questionnaire during 2022, answered voluntarily and anonymously. Percentage descriptive statistics were performed.

Results: 118 responses were obtained. Approximately 3% of physicians diagnose up to two cases of eosinophilic esophagitis per year. About 55.9% performed 3-4 biopsies in the upper and lower thirds of the esophagus for diagnosis. Initial treatments in patients without stenosis: proton pump inhibitors (PPI) 33.9%, triple therapy (TT) (PPI + diet + topical corticosteroids [TCSs]) 26.27%, and combined (diet + PPI) 21%. Patients with stenosis: TT 52.58%, combined (TCSs + PPI) 13.4%. Initial dietary treatment: according to allergy tests 26.2%, empirical exclusion of 6-8 foods 25.4%, and 2-4 foods 23.7%. The first endoscopic control is performed at 8 and 12 weeks in 46.6% and 38%, respectively. 52% referred to an allergist and 47.4% to nutrition. About 48.3% do not monitor basal cortisol in corticosteroid treatment for more than 3 months.

Conclusion: The diagnostic and therapeutic approach in EoE is heterogeneous. Dietary treatment shows the exclusion of a large number of foods and monitoring the prolonged use of corticosteroids is not a common practice.

Background: Respiratory viruses are a frequent cause of infection in neonatology. Point-of-care lung ultrasound (LU) and targeted neonatal echocardiography (TnE) allow pulmonary and hemodynamic assessment at the patient's bedside.

Methods: The aim of this study was to describe the pattern of alterations found by LU and to assess the hemodynamic status in neonates diagnosed with viral infection (reverse transcription polymerase chain reaction) during 2018-2023. LU was performed in 10 regions, and a semi-quantitative scale LU score (LUS) was calculated. TnE was performed if pulmonary hypertension (PH) was sus-pected. The thymus was measured by ultrasound if there was evidence of increased dimensions on chest X-ray or during LU.

Results: Forty-seven patients were studied (35 severe acute respiratory syndrome coronavirus 2, four respiratory syncytial virus, four rhinovirus, three influenza, and one parainfluenza). LU showed an interstitial pattern of B-lines in 94%, pleural line anomalies in 85%, coalescing B-lines in 60%, and consolidations in 51% (71% posteriorly). About 30% had PH. An increased thymus was shown in 23%. LUS showed a significant median difference between ventilatory support and a positive correlation with FiO₂ used. Consolidations and the presence of PH were associated with mortality; an increased thymus was shown protective.

Conclusion: Ultrasound at the patient's bedside allows the classification and detection of the seriously ill patient (presence of consolidations and PH) allowing timely intervention. As a clinical finding, an increased thymus was shown to be a protective factor against mortality and could represent a marker of adequate immune response.

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.

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.