Boletín médico del Hospital Infantil de México最新文献

{"title":"Effectiveness and safety of topical sirolimus in children with angiofibromas and tuberous sclerosis complex.","authors":"Andrea Fernández de Lara-Arrieta, Silvestre García-de La Puente, Janett Flores-Pérez, Carmen Flores-Pérez, Rodrigo Lomelí-Valdez, Andrea Venegas-Andrade, Carolina Palacios-López","doi":"10.24875/BMHIM.24000091","DOIUrl":"10.24875/BMHIM.24000091","url":null,"abstract":"<p><strong>Background: </strong>Tuberous sclerosis complex (TSC) is an autosomal dominant disease that can affect any organ with hamartomas. It is characterized by early-onset seizures and is associated with intellectual disability. The main dermatological findings include hypopigmented macules, shagreen patches, and angiofibromas, which appear in 81-96% of patients.</p><p><strong>Method: </strong>We conducted a quasi-experimental, before-and-after, open-label study in 10 patients with TSC and facial angiofibromas, aged 8-17 years, who were treated at the dermatology service of the Instituto Nacional de Pediatría in 2019 and 2020. All patients agreed to participate in the study and signed both consent and assent forms. All patients received treatment with 1% topical sirolimus for 6 months on the right side of the face, followed by 6 months on the left side of the face to assess recurrence. Each patient served as their own control. Measurements of baseline lesions were taken and followed monthly for 6 months. The changes in lesion size, measured in millimeters at each time point, were compared using repeated measures analysis of variance.</p><p><strong>Results: </strong>All children showed a decrease in the size and number of angiofibromas, as well as reduced erythema, from the 3^rd month of treatment. Few recurrences were observed beginning at 4 months after discontinuation of the medication.</p><p><strong>Conclusion: </strong>Topical sirolimus is effective and safe for treating patients with angiofibromas and TSC.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 2","pages":"115-120"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colonic intestinal duplication as a guide point associated with Waugh syndrome in an infant. First national case.","authors":"Jesús R Aguirre-López, Isaías Gómez-Barrera, Othón Romero-Terán, Jorge E Sámano-Pozos, Alberto Delgado-Porras","doi":"10.24875/BMHIM.23000155","DOIUrl":"https://doi.org/10.24875/BMHIM.23000155","url":null,"abstract":"<p><strong>Background: </strong>Waugh syndrome is named to intestinal obstruction caused by intestinal invagination and malrotation, being a pathology rarely reported. The objective is to present the clinical case of a male infant with multiple intestinal obstruction secondary to Waugh Syndrome, having as a guide point a colonic intestinal duplication.</p><p><strong>Case report: </strong>A 4-month-old male patient, with no previous history of importance, previously healthy, with clinical picture of mechanical intestinal obstruction, who underwent emergency exploratory laparotomy, finding colonic-colonic intestinal invagination at the level of the ascending colon, as head of invagination or guide point a cystic intestinal duplication of ascending colon and intestinal malrotation, exvagination by cabs, ileocecocolic resection was performed, which included cystic intestinal duplication, ileotransversoanastomosis and finally Ladd's procedure. His postoperative evolution was satisfactory. Currently with good evolution at 6 months of follow up.</p><p><strong>Conclusions: </strong>Waugh's syndrome is a rare entity; despite having been described more than a century ago, its incidence continues to be rare. Colo-colonic invagination is infrequent, occurring in 2.5% of cases, generally associated with a guide point, as in our case, being extremely rare to cystic duplication of the colon, since there is no case reported in the literature.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 3","pages":"195-198"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facing the COVID-19 pandemic as a resident: a before-and-after study of mental health.","authors":"Gina Chapa-Koloffon, Ma Guadalupe Jean-Tron, Aidee V Ávila-Hernández, Horacio Márquez-González, Ma Anayali Estudillo-Guerra, Ana C Hill-de Titto, Sarbelio Moreno-Espinosa, Juan Garduño-Espinosa","doi":"10.24875/BMHIM.24000120","DOIUrl":"https://doi.org/10.24875/BMHIM.24000120","url":null,"abstract":"<p><strong>Background: </strong>Residents endure psychosocial and work-related situations associated with an increased risk of developing mental health problems. Mental health is often affected during epidemics. Knowledge about the mental health state of residents before and after the onset of the COVID-19 pandemic is scarce.</p><p><strong>Method: </strong>In this cohort study, demographic features, psychosocial characteristics, and mental health disorders were examined before and after one year of training. The second evaluation assessed burnout syndrome (BS) and individual experiences with the pandemic. Non-parametric tests and logistic regression were used to evaluate differences after 1 year and to analyze the relationship between mental health outcomes and the independent variables. Models were adjusted on a priori supposition of confounding variables.</p><p><strong>Results: </strong>A total of 49 pediatric residents were included; none were lost to follow-up. Overall, mental health disorders prevalence increased by 30.6%. The prevalence of depressive episodes and generalized anxiety disorder also increased significantly. The prevalence of BS was 57.1%. The main risk factor for developing a mental health disorder was having a family history of mental health disorders.</p><p><strong>Conclusions: </strong>The increase in the prevalence of mental health disorders after 1 year during the COVID-19 pandemic was more significant than the one observed in pre-pandemic studies. Further research is needed to find strategies to protect mental health among residents, especially during health crises.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 3","pages":"152-159"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnóstico y tratamiento de bronquiectasias en pacientes pediátricos sin fibrosis quística.","authors":"Alejandra Munevar-Velandia, Juan Nofal-Ladino, Sonia Restrepo-Gualteros, Milena Villamil-Osorio, Oscar Ramírez, Juan F López, Natalia Vélez-Tirado, Lina Castaño-Jaramillo","doi":"10.24875/BMHIM.25000036","DOIUrl":"https://doi.org/10.24875/BMHIM.25000036","url":null,"abstract":"<p><p>Bronchiectasis is characterized by the permanent dilation of bronchi, clinically presenting with chronic cough, sputum production, dyspnea, and recurrent exacerbations. Bronchiectasis can occur due to genetic disorders, congenital malformations, endobronchial obstruction of infectious and inflammatory origin, and chronic aspiration, among other causes. Bronchial dilation leads to impaired mucociliary clearance, trapping particles and microorganisms in the airways. Macrophages and epithelial cells release proinflammatory cytokines that promote neutrophil chemotaxis. Neutrophils release enzymes causing epithelial cell damage, reducing ciliary motility, promoting glandular hyperplasia, and increasing mucus secretion. Persistent infection perpetuates local inflammation in bronchiectasis patients. Diagnosis requires high clinical suspicion and early detection improves clinical outcomes. High-resolution computed tomography is the gold standard for confirmation. A comprehensive medical history, initial assessments with complete blood count, total serum immunoglobulins, iontophoresis, and spirometry help assess the underlying etiology and disease severity. The primary goal is preserving lung function and halting disease progression. This involves adopting healthy lifestyles, expanded vaccination schedules, respiratory therapy, and early antibiotic use for exacerbations and colonization by specific microorganisms.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 5","pages":"273-281"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salud mental parental en cardiopatías congénitas: eficacia de un programa psicoeducativo perioperatorio en línea.","authors":"Azalea C Flores-Bobadilla, Bertha Ramos-Del Río, Óscar R Galicia-Castillo, Everardo J F Camacho-Gutiérrez, Ana K Talavera-Peña, Mario H Buenrostro-Jáuregui","doi":"10.24875/BMHIM.24000099","DOIUrl":"https://doi.org/10.24875/BMHIM.24000099","url":null,"abstract":"<p><strong>Background: </strong>Invasive medical procedures in children with congenital heart disease (CHD) increase parental anxiety and stress with a negative impact on the disease and children's coping. Parental psychoeducational programs promote their mental health and positive impact on pediatric health. The objective was to evaluate the efficacy of an online psychoeducational program to promote the mental health of parents of children with CHD who are about to undergo an invasive medical procedure.</p><p><strong>Methods: </strong>Forty-three mothers and fathers of children with CHD about to undergo catheterization or cardiac surgery belonging to the Live Longer Mexico Foundation participated, divided alternately into two groups: 1) online psychoeducational program (n = 22), and 2) control (n = 21). Mental health was evaluated based on three indicators: parental stress, state/trait anxiety and worry before the procedure. The PSI-SF Parental Stress Index, the Parental Worry about Surgery Questionnaire and the Trait-State Anxiety Inventory were used.</p><p><strong>Results: </strong>The group with the psychoeducational program showed a statistically significant decrease in state anxiety and worry about the medical procedure. Additionally, state anxiety and worry about the medical procedure are significantly lower in the group that received the psychoeducational program compared to the control. Parental stress had no significant intra- and inter-group changes.</p><p><strong>Conclusions: </strong>The online psychoeducational program is effective in favoring parental mental health, specifically on state/trait anxiety and worry about surgery in parents of children with CC nearing catheterization or cardiac surgery.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 5","pages":"304-313"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation, validation, and reliability of the child development evaluation test (EDI) in Colombia.","authors":"Luisa M Salamanca-Duque, Ma Mercedes Del C Naranjo-Aristizábal, Luz A Botero-Montoya, Luz Ma Velásquez-Palacio, Sandra Garnica-López, Ma Angélica Enciso-Rodríguez, Yadira Henao-Valencia, Antonio Rizzoli-Córdoba","doi":"10.24875/BMHIM.24000155","DOIUrl":"10.24875/BMHIM.24000155","url":null,"abstract":"<p><strong>Background: </strong>Monitoring child development requires not only the determination of developmental milestones but also surveillance and continuous monitoring, hence the importance of having valid and reliable evaluation instruments. This research aimed to cross-culturally adapt the Child Development Evaluation (CDE) test for Colombia and determine its validity and reliability.</p><p><strong>Methods: </strong>The cross-cultural adaptation process was conducted in four phases: I. Adaptation to Colombian Spanish: adjustments of the test to Colombian Spanish and analysis of equivalences; II. Content and face validity: evaluation by five expert judges who performed quantitative and qualitative assessments of the test; III. Review by the original author; IV. Pilot test. Reliability analyses for internal consistency and intra-rater reliability were performed.</p><p><strong>Results: </strong>For the adaptation to Colombian Spanish, most test items were equivalent to Mexican Spanish, with some requiring minimal conceptual and contextual changes to maintain their meaning; culturally relevant formulations and expressions were adjusted. In the content and face validity assessment, adequate results were found regarding the importance, influence, and observability of the items. Internal consistency reliability was moderate, with Cronbach's α values between 0.41 and 0.57, and intra-rater reliability was very good, with Kappa index values > 0.76.</p><p><strong>Conclusion: </strong>The CDE test demonstrates cross-cultural adaptation, content and face validity, and reliability for its application and use in Colombia.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 Supl 1","pages":"36-44"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of child development evaluation test (CDE test or Prueba EDI) in children under 5 years old in Mexico: a simulation model study.","authors":"José R García-Lira, Rita E Zapata-Vázquez, Alfonso Reyes-López, Antonio Rizzoli-Córdoba","doi":"10.24875/BMHIM.24000171","DOIUrl":"10.24875/BMHIM.24000171","url":null,"abstract":"<p><strong>Background: </strong>The Health Ministry has incorporated the Child Development Evaluation test (CDE test) as the national screening tool for children < 5 years old. The aim of this study is to analyze the cost-effectiveness of the CDE test compared to standard medical consultation in Mexico.</p><p><strong>Methods: </strong>The study was conducted with information available until 2020. A cost-effectiveness analysis was conducted from perspective of the public/social sectors in Mexico with a decision tree model to evaluate the strategies. The time horizon was set at 1 year, no discounting applied. Costs were calculated in Mexican pesos (MXN) at 2019 prices and included both direct/indirect costs. Direct costs encompassed CDE test administration, specialist consultations, and rehabilitation sessions. Indirect costs considered transportation expenses and lost wages related to caregiving. To account for variability and uncertainty, a Monte Carlo simulation with 10,000 iterations was performed. Probabilistic sensitivity analysis was conducted to test robustness of the results.</p><p><strong>Results: </strong>The results confirm that the CDE test consistently outperforms the standard approach, delivering improved outcomes at reduced costs in the majority of scenarios. The incremental net monetary benefit of implementing CDE screening was $44,608 MXN (2019 value), providing additional evidence of its cost-effectiveness.</p><p><strong>Conclusion: </strong>This study suggests that the CDE test is cost-saving from the public and social sector perspective, generating a net increase in both monetary benefits and health outcomes. Furthermore, its implementation is feasible within the Mexican healthcare system, particularly considering its potential to enhance long-term efficiency.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 Supl 1","pages":"59-65"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a national daily monitoring system for demand and capacity of pediatric intensive care units during a respiratory epidemic in Uruguay.","authors":"Mariana Cosio, Nicolás Monteverde-Fernández, Cristóbal Carvajal, Héctor Telechea, Sebastián González-Dambrauskas","doi":"10.24875/BMHIM.24000109","DOIUrl":"10.24875/BMHIM.24000109","url":null,"abstract":"<p><strong>Background: </strong>An online tool for national monitoring of pediatric intensive care unit (PICU) bed occupancy was developed and implemented for 12 weeks in the winter of 2023 in Uruguay.</p><p><strong>Methods: </strong>Using a daily 5-minute survey in each PICU, operational bed capacity, occupancy rates, invasive mechanical ventilation demand, and the number of children admitted for acute lower respiratory infections (ALRI) were collected. The REDCap software platform was used for data capture.</p><p><strong>Results: </strong>Data were collected from 100% (n = 20) of Uruguayan PICUs, 68% located in Montevideo, with 2.72 PICU beds per 10,000 children under 18 years of age, and 32% in the rest of the country, with 0.86 PICU beds per 10,000 children under 18 years of age. The national average bed occupancy rate was 55.5%, with marked variability between centers (32% to 86%). During epidemiological week (SEPI) 28, the system expanded by 36% compared to the initial value of operational beds. The highest percentage of bed occupancy was observed between SEPIs 25 and 28, when the average was above 70%. This peak reached 78% during SEPI 26, coinciding with the epidemiological peak of cumulative incidence of LRTI in children under 15 years of age.</p><p><strong>Conclusions: </strong>In Uruguay, a national ICU bed monitoring tool was implemented, which showed that occupancy rates did not reach critical levels. However, regional and inter-center differences were found that warrant further study to optimize system management.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 4","pages":"228-237"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgments to reviewers 2024.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 1","pages":"1-2"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality.","authors":"Daniel Ibarra-Ríos, José G Mantilla-Uresti, Diana M Barrios-Bautista, Alejandro Peñarrieta-Daher, Cristian R Zalles-Vidal, Deneb A Morales-Barquet, Horacio Márquez-González","doi":"10.24875/BMHIM.24000093","DOIUrl":"10.24875/BMHIM.24000093","url":null,"abstract":"<p><strong>Background: </strong>Congenital diaphragmatic hernia (CDH) is a severe condition associated with high morbidity and mortality. Its severity correlates with the degree of pulmonary hypoplasia. Recent literature has emphasized the importance of identifying distinct hemodynamic phenotypes (HP) to guide physiology-based management.</p><p><strong>Method: </strong>We included all CDH patients evaluated by targeted neonatal echocardiography from January 2017 to April 2022. HPs were classified into three groups: HP1 (mild pulmonary hypertension [PH] without ventricular dysfunction), HP2 (pre-capillary PH), and HP3 (post-capillary PH). We compared differences between survivors and non-survivors using the Mann-Whitney U-test, analyzed baseline and pre/post-surgical echocardiographic parameters using the Wilcoxon test, estimated survival curves using Kaplan-Meier analysis, and compared length of stay using the Kruskal-Wallis test.</p><p><strong>Results: </strong>Among 28 included neonates, 24 survived (86%). HP distribution was: HP1 9 patients (32%), HP2 8 patients (29%), and HP3 11 patients (39%). Four patients died, two post-surgery and two without surgical intervention. Mortality-associated factors included higher pCO₂, lower left ventricular (LV) output, decreased LV compliance, and elevated pulmonary vascular resistance (PVR). Survival analysis revealed a non-significant trend toward higher mortality in HP2 (one death) and HP3 (three deaths). Follow-up demonstrated progressive increases in biventricular output, PVR reduction, and compensatory cerebral vasodilation.</p><p><strong>Conclusion: </strong>HP correlated with patient mortality, particularly in cases with greater pulmonary hypoplasia (higher CO₂) and compromised ventricular performance. Echocardiographic monitoring revealed improvements in biventricular performance, decreased PVR facilitating surgical intervention, and cerebral perfusion adaptation.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 1","pages":"54-62"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}