Boletín médico del Hospital Infantil de México最新文献

{"title":"Cough-related spontaneous retropharyngeal emphysema in a pediatric patient with Influenza A infection: a case report.","authors":"Javier Arredondo-Montero","doi":"10.24875/BMHIM.24000108","DOIUrl":"10.24875/BMHIM.24000108","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous retropharyngeal emphysema (SRE) is a scarce condition in the pediatric population.</p><p><strong>Clinical case: </strong>An 11-year-old boy presented with respiratory distress and cervical pain after a severe cough attack. A cervical examination revealed a marked subcutaneous emphysema. A polymerase chain reaction (PCR) for respiratory viruses was positive for influenza A/H3. A blood culture was obtained and was negative. A chest and a cervical X-ray showed pneumomediastinum and SRE. A computed tomography scan showed a pulmonary condensation on the left lower lobe and ectopic air at the level of the cardioesophageal junction. An upper gastrointestinal series demonstrated the absence of contrast leakage. The patient was managed conservatively with good clinical evolution and resolution of symptoms. Two weeks after the episode, a chest and a cervical X-ray showed almost complete resolution of the SRE and the pneumomediastinum.</p><p><strong>Conclusions: </strong>The exceptional presentation of spontaneous pneumomediastinum in a pediatric patient without asthma underscores the importance of considering SRE in the differential diagnosis of cervical and thoracic ectopic air in the pediatric population.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 4","pages":"263-266"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882108","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":"Immunotherapies and their potential to preserve beta cells in type 1 diabetes: a review of current immunotherapy.","authors":"Juan D Bonilla-Bonilla, Luis Chávez-Sánchez, María V Legorreta-Haquet","doi":"10.24875/BMHIM.24000174","DOIUrl":"10.24875/BMHIM.24000174","url":null,"abstract":"<p><p>Type 1 diabetes is a chronic immune-mediated disease that leads to the loss of beta cells in the pancreas, clinically characterized by polydipsia, polyphagia, and weight loss. The disease is most prevalent in the first and second decades of life, with a consistent annual increase. The dependence on insulin therapy indefinitely is well known. Although advances in this area, such as new continuous glucose monitoring devices with continuous subcutaneous insulin infusion, have improved patient quality of life, they do not affect disease pathogenesis and do not consistently reduce long-term complications. In addition to requiring lifestyle sacrifices and, in many cases, failing to meet therapeutic target points, it increases the risk of hypoglycemia, an acute and potentially fatal complication. Following decades of research and advances in therapeutic technologies, approaches have been developed based on diverse mechanisms in the disease's pathogenesis. This review focuses on new immunotherapy approaches for type 1 diabetes, including cell-targeted therapies, cytokines, and cell transplants to preserve beta-cell function.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 4","pages":"203-218"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882113","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":"Microorganisms identified in neonatal sepsis and their antimicrobial resistance in a hospital in Western Mexico.","authors":"Juan C Lona-Reyes, Braulio Guillén-Chávez, Lucia Miramontes-Buiza, Larissa M Gómez-Ruiz, Moisés Quiles-Corona, René O Pérez-Ramírez, Brandon J de la Cruz-Bravo","doi":"10.24875/BMHIM.25000002","DOIUrl":"10.24875/BMHIM.25000002","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis is a serious condition that increases neonatal mortality. The objective of this study was to describe the microorganisms causing neonatal sepsis and their resistance patterns in a neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>A cross-sectional cohort study was conducted. Microorganisms identified in blood or cerebrospinal fluid cultures from newborns (NBs) admitted to the Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca were studied. Microorganism identification and susceptibility testing were performed using VITEK^® 2. The cutoff points for classifying resistance were according to the Clinical and Laboratory Standards Institute. Infections were classified as early-onset sepsis (EOS) or late-onset sepsis (LOS).</p><p><strong>Results: </strong>A total of 73 NBs with EOS and 261 with LOS were identified; the incidence rate of EOS was 7.1 events/1000 live births and of LOS was 25.5 events/1000 live births. In both infections, the risk was significantly higher in premature NBs and/or NBs with birth weight < 2500 g. The predominant etiology in all infections was Enterobacterales (63.3%). In EOS, resistance to first-line antibiotics for Enterobacterales was ampicillin 46.6% (27/58) and gentamicin 24.1% (14/58), while in LOS, it was ampicillin 63.7% (186/292) and gentamicin 28.1% (82/292). The second most frequently identified bacteria were Staphylococcus spp. 13.6% (n = 75) with oxacillin resistance of 78.7% (59/75). No ampicillin-resistant Streptococcus spp. or Enterococcus spp. was identified.</p><p><strong>Conclusions: </strong>The incidence of EOS and LOS in a Mexican NICU was 7.1 and 25.5 events/1000 live births, and the main etiologies were Enterobacterales and Staphylococcus spp.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 4","pages":"219-227"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882114","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":"Persistent facial edema due to spider bite: a case of edematous cutaneous loxoscelism.","authors":"Carla Gonzales-Flores, Natalia I Vigo, Noé Atamari-Anahui, Jorge Cuadros-Castro","doi":"10.24875/BMHIM.24000125","DOIUrl":"10.24875/BMHIM.24000125","url":null,"abstract":"<p><strong>Background: </strong>The bite of spiders of the Loxosceles genus causes loxoscelism. It can occur in cutaneous-necrotic, cutaneous-visceral, or predominantly edematous cutaneous loxoscelism forms. This last form is a rare variant characterized by edema without necrosis with a frequency of 5% of all cases of loxoscelism.</p><p><strong>Clinical case: </strong>A 6-year-old girl presented edema in the eyelid that progressively increased and spread to the entire face. The relative reported that this event occurred after a spider bite. Physical examination revealed a bite-type lesion on the lower left eyelid, generalized edema throughout the face, and dysphonia. The tests showed elevated creatinine and bilirubin; the rest were normal. Initially, she received corticosteroids, antihistamines, and adrenaline. Due to the persistence of edema, we administrated anti-loxosceles serum and continued with corticosteroids and antibiotics. After 48 hours, edema decreased, and on the seventh day, it was almost entirely resolved, so the patient was discharged without complications.</p><p><strong>Conclusions: </strong>Predominantly edematous cutaneous loxoscelism is a rare variant. It can mimic other diseases like cellulitis or anaphylaxis in the emergency room. Supportive treatment is essential to avoid complications in children.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 4","pages":"267-271"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882115","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":"Variant of uncertain significance in the DNAI1 gene in a child with typical primary ciliary dyskinesia phenotype.","authors":"Héctor Nuñez-Paucar, Geovanna Gutiérrez-Iparraguirre, Noé Atamari-Anahui, Nelson Purizaca-Rosillo, Carlos Valera-Moreno, Juan Torres-Salas, Giuliana Medina-Sanabria","doi":"10.24875/BMHIM.24000182","DOIUrl":"https://doi.org/10.24875/BMHIM.24000182","url":null,"abstract":"<p><strong>Introducción: </strong>La discinesia ciliar primaria es un trastorno genético heterogéneo autosómico recesivo caracterizado por disfunción de la motilidad ciliar. Se han reportado variantes de significado incierto en pacientes con fenotipo compatible con discinesia ciliar primaria.</p><p><strong>Caso clínico: </strong>Varón de 15 años con historia de infecciones respiratorias y cuadros obstructivos bronquiales recurrentes desde el periodo neonatal. Los estudios radiológicos mostraron atelectasias, alteración de los senos paranasales y bronquiectasias. La ultraestructura ciliar mostró ausencia del par de microtúbulos centrales, de los brazos externos e internos de dineína, y desorganización microtubular. El panel genético reportó una variante genética de significado incierto en el gen DNAI1 (NM_012144.4): c.1489+5G>A. Fue tratado con antibioticoterapia, nebulizaciones con solución salina hipertónica y fisioterapia respiratoria, con buena evolución en el seguimiento.</p><p><strong>Conclusiones: </strong>Es importante el reporte de una variante de significado incierto en el gen DNAI1 en un paciente con fenotipo clínico y hallazgos de clase 1 en la microscopía electrónica ciliar compatibles con discinesia ciliar primaria, con el fin de aportar a la reclasificación de variantes.</p><p><strong>Background: </strong>Primary ciliary dyskinesia is an autosomal recessive heterogeneous genetic disorder characterized by dysfunction of ciliary motility. Variants of uncertain significance have been reported in patients with a phenotype compatible with primary ciliary dyskinesia.</p><p><strong>Clinical case: </strong>A 15-year-old male adolescent with a history of respiratory infections and recurrent bronchial obstructive symptoms since the neonatal period. Radiological studies showed atelectasis, paranasal sinus alterations, and bronchiectasis. Ciliary ultrastructure showed the absence of the central microtubule pair, the external and internal dynein arms, and microtubular disorganization. The genetic panel reported a genetic variant of uncertain significance in the DNAI1 gene (NM_012144.4): c.1489+5G>A. He was treated with antibiotic therapy, nebulizations with hypertonic saline solution, and respiratory physiotherapy with good evolution during follow-up.</p><p><strong>Conclusions: </strong>It is important to report a variant of uncertain significance in the DNAI1 gene in a patient with a clinical phenotype and class 1 findings in ciliary electron microscopy compatible with primary ciliary dyskinesia, to contribute to the reclassification of variants.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 6","pages":"391-396"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843609","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":"Airway ultrasound in pediatric patients with stridor and extubation failure.","authors":"Omar A Burgos-Flores, Gerardo Félix-Ramos, Isaac A Gómez-Jiménez, Luis R Cadena-Mejía, Imuvira D Cruz-Loustaunau","doi":"10.24875/BMHIM.24000104","DOIUrl":"https://doi.org/10.24875/BMHIM.24000104","url":null,"abstract":"<p><strong>Background: </strong>Orotracheal intubation can cause complications such as stridor and airway obstruction, which favors weaning failure. The objective of this study was to assess the usefulness of airway ultrasound prior to extubation to predict stridor and extubation failure.</p><p><strong>Method: </strong>Cross-sectional descriptive study, from March 2023 to June 2024. A total of 50 patients were studied, admitted to the pediatric emergency service of the Children's Hospital of the State of Sonora, under mechanical ventilation ≥ 24 hours and in whom the first extubation attempt. An ultrasound of the airway was performed, calculating the peritube free space and the width of the air column before extubation, and the total number of patients who presented post-extubation stridor and extubation failure were identified.</p><p><strong>Results: </strong>The mean peritube free space in patients who presented stridor was 3.2 mm (0.3-6.2), with a statistically significant difference (p = 0.012) compared to patients who did not present stridor. The mean width of the air column in patients who presented stridor was 1.21 mm (0.16-4.78 mm), but it did not show a statistically significant difference (p = 0.153) compared to patients who did not present stridor. There were no statistically significant differences in both measurements for the outcome of extubation failure.</p><p><strong>Conclusions: </strong>Airway ultrasound seems to have a good correlation with the risk of post-extubation stridor.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 3","pages":"145-151"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706240","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":"Eating disorders and associated factors in patients with type 1 diabetes.","authors":"Gilberto Meléndez-Flores, Martha A Delgadillo-Ruano, Rosa Ortega-Cortés, Gregorio Peña-Rodríguez","doi":"10.24875/BMHIM.24000076","DOIUrl":"10.24875/BMHIM.24000076","url":null,"abstract":"<p><strong>Background: </strong>Eating disorders are a group of diseases with psychiatric background associated with physical manifestations related to weight and body image. We can classify patients with diabetes, into those who suffer from eating disorders or disordered eating behaviors, both being associated with the typical symptoms of eating behavior disorders. The objective was to analyze the frequency and factors associated with nutrition disorders in adolescents with type 1 diabetes.</p><p><strong>Method: </strong>Observational, cross-sectional, prospective and descriptive study of 100 adolescents with type 1 diabetes to whom the DEPS-R survey was applied to determine the frequency of nutrition disorders.</p><p><strong>Results: </strong>A positive DEPS-R survey score was presented for appearance of eating disorders in patients with type 1 diabetes in 33% of patients cases. There was a positive association using the χ² test between body mass index and a positive screening (p = 0.006) and with uncontrolled glycated hemoglobin (p < 0.05), without being related to the patients sex (p = 0.20).</p><p><strong>Conclusions: </strong>The DEPS-R survey is applicable to the Mexican population to screen for risk of altered eating behaviors at pediatric age. Patients with poor glycemic control, overweight and obesity have higher prevalence of eating disorders.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 3","pages":"139-144"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706242","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":"Pediatric vulvar melanoma. Case report.","authors":"Jennifer A Obregón-García, Ángel C Corzo-Centeno, Carolina E Sánchez-López","doi":"10.24875/BMHIM.23000142","DOIUrl":"https://doi.org/10.24875/BMHIM.23000142","url":null,"abstract":"<p><strong>Background: </strong>Melanomas represent a small percentage of skin malignancies, but they represent the majority of deaths from skin cancer. The etiology of vulvar melanomas may differ from other melanomas, where the most important risk factor is exposure to ultraviolet light. Compared to adults, pediatric melanomas have an atypical clinical presentation, posing as low-suspicion lesions, thus leading to a diagnostic delay and increased mortality in this patient population.</p><p><strong>Clinical case: </strong>A 10-year-old female with a painful hyperpigmented lesion localized in the left vulvar region, with no other associated symptoms. Dermatology assessment described a palpable neoformation of 5 × 6 mm, black color, with irregular borders. Dermoscopy shown asymmetrical pattern, peripheral globules, irregular projections, and blue-white veil. Subsequently, an excisional biopsy of the lesion was performed, with a histopathological report of melanoma HMB45 positive, p-53 positive and focal Ki-67, negative margins. Further studies revealed no evidence of metastatic activity; therefore, it was decided to continue medical surveillance by the pediatric oncology service.</p><p><strong>Conclusions: </strong>Vulvar melanoma is a malignant entity with a low incidence rate. There are no case reports published in Mexico that describe its location in the pediatric population. Given the high mortality, early diagnosis and treatment would improve life expectancy in our patients.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 3","pages":"191-194"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706279","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":"Schizencephaly in neonates and clinical importance. Cases report.","authors":"Jorge L Alvarado-Socarras, Andrés F Jiménez, Óscar Peñuela-Vásquez, Salua T Feris-Teherán","doi":"10.24875/BMHIM.24000064","DOIUrl":"10.24875/BMHIM.24000064","url":null,"abstract":"<p><strong>Background: </strong>Schizencephaly is a congenital alteration of the architecture of the cerebral cortex, and its diagnosis in the neonatal period will be determined by prenatal diagnosis or severity of the cases.</p><p><strong>Clinical cases: </strong>We present three neonatal cases with variable clinical expression and electroencephalographic findings during clinical course. Case 1: term neonate, born by cesarean section due to pre-eclampsia and presenting early respiratory distress. On clinical examination, macrocranial was clear, so a cranial tomography (CT) scan was performed showing bilateral open-lip schizencephaly. He early presented recurrent seizure, associated with hypotonia, and swallowing disorder with little improvement despite interventions, and palliative management was decided. Case 2: 36-week-old neonate with a prenatal diagnosis of schizencephaly and delivery by cesarean section due to altered fetal monitoring. Low birth weight and requiring positive pressure ventilation. On day 2, CT scan confirmed the prenatal diagnosis and the video electroencephalogram was normal. Progression of enteral feeding was achieved, without neurological deterioration, and the patient was discharged with recommendations for follow-up. An outpatient magnetic resonance imaging confirms the diagnosis. Case 3: preterm twin of 34 weeks, with prenatal diagnosis of ventriculomegaly. At birth without achieving early saturation goals and on clinical examination with large macrocrania and CT scan showing an image suggestive of open-lipped schizencephaly, associated with hydrocephalus, dysgenesis/agenesis of the corpus callosum. Seizure of difficult control, and required ventriculoperitoneal shunt.</p><p><strong>Conclusions: </strong>Neonatal clinical course is variable but seizures are relevant. Other assessments may be needed early, including genetic concepts.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 3","pages":"180-190"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706281","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":"Serial bronchoalveolar lavage as barium aspiration treatment. Case report.","authors":"Erik Castillo-de la Peña, Brenda Aguilar-Viveros, Alejandra Silva-Hernández, Cristóbal Puentes-Cruz","doi":"10.24875/BMHIM.23000180","DOIUrl":"https://doi.org/10.24875/BMHIM.23000180","url":null,"abstract":"<p><strong>Background: </strong>We present the case of a newborn with respiratory aspiration of barium and the management of this complication by serial bronchoalveolar lavage through bronchoscopy.</p><p><strong>Clinical case: </strong>Female newborn, who underwent barium esophagogram for suspected esophageal atresia, who presented subsequent torpid evolution and radiological changes with persistent radiopaque image, metal density in the left apical and right basal region. Three bronchoalveolar lavages were performed with a decrease in the radiopacity generated by the contrast medium and clinical improvement.</p><p><strong>Conclusions: </strong>Barium aspiration is a possible complication of digestive tract imaging studies and there is no specific management. In our patient, we found a possible benefit from performing serial bronchoalveolar lavages.</p>","PeriodicalId":9103,"journal":{"name":"Boletín médico del Hospital Infantil de México","volume":"82 3","pages":"199-202"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706282","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}