Revista de la Sociedad Boliviana de Pediatría

Integración Científica e Integral

Sub-clinical infections by visceral leishmaniasis in Caranavi district: study in 123 individuals

En 1999, en el Hospital del Niño se registró un nuevo caso de Leishmaniasis visceral sobre un niño de dos años proveniente del cantón de Taipiplaya (Provincia Caranavi). Por este motivo se realiza en este cantón una evaluación transversal de la leishmaniasis visceral mediante pruebas serológicas y moleculares involucrando a 122 individuos clínicamente sanos y un individuo con infección positiva a Leishmania cutánea, Se demostró la circulación de Leishmania sp. en 32,3% de sujetos estudiados. El 14.4% de la población examinada presentó anticuerpos anti-rk39, demostrándose la circulación de Leishmania chagasi responsable de la leishmaniasis visceral. No podemos descartar la posibilidad de la existencia de coinfecciones mixtas inter-especie de Leishmania como también de coinfecciones mixtas por Leishmania sp. y Trypanosoma cruzi, responsable de la enfermedad de Chagas.

In 1999, in the "Hospital del Niño". a new case of visceral leishmaniasis was identified in a 2 years old child from Taipiplaya in the Caranavi district. For this reason, a visceral leishmaniasis evaluation using serological and molecular tests was realized on 122 healthy people and also on one leishmania cutanea infected person. Leishmania spp was present in 32,3 % of the studied people and 14,4 % had an anti-rk39 antibody, attesting the existence of Leishmania chagasi responsible for visceral leishmaniasis. The possibility of mixed infections with other Leishmania species as well as mixed infections Leishmania spp and Trypanosama cruzi, responsible for chagas disease should not be discarded.

Skin to skin contact and the new born thermoregulation

El recién nacido experimenta varios cambios adaptativos después de nacer, uno de ellos es la regulación térmica. El objetivo de este estudio fue determinar si el contacto inmediato del recién nacido con la madre tiene influencia en la evolución de la temperatura corporal. Se estudiaron recién nacidos de término, sanos, nacidos por parto vaginal y con peso mayor de 2500 gr. Ingresaron al estudio 66 neonatos los que fueron distribuidos en dos grupos: grupo A, aquellos que tuvieron contacto inmediato con la madre y grupo B los que no tuvieron dicho contacto. Concluyeron el estudio 60: 30 en el grupo A y 30 en el grupo B, a todos ellos de les tomo la temperatura rectal a los 15 minutos, dos y cuatro horas de vida. La moda del grupo A mostró una temperatura ascendente de 36ºC; 36,2ºC y 36,7ºC en las sucesivas determinaciones y en el grupo B una temperatura descendente de 37ºC; 36,2ºC y 36ºC respectivamente. Concluimos que los neonatos con contacto inmediato piel a piel con su madre tienen mejor respuesta de adaptación térmica.

Newborn go through several adaptation changes after birth, one of them being thermal regulation. The object of this study was to determine if the newborns immediate contact with his mother influences, in any way, changes in his bodys temperature. Healthy, vaginal delivered, weighing over 2,500 g, full-term newborns were included in this study. 66 newborns were included, distributed in two groups. Group A: those who had immediate contact with their mother. Group B: those who had none. At the end of the study there where 60 newborns, 30 in each group. All of them had their temperature taken at 15 minutes, 2 and 4 hours after the birth. Group A showed ascending temperature of 36ºC, 36.2ºC and 36.7ºC, each time. Those in group B showed descending temperature of 37ºC; 36,2ºC and 36ºC respectively. We therefore conclude that immediate skin to skin contact of the newborn with his mother improves his thermal adaptation.

Occipital encephalocele

Presentamos un recién nacido con encefalocele occipital gigante, que fue atendido en la unidad de neonatología del Hospital "Jaime Mendoza" de la Caja Nacional de Salud de la ciudad de Sucre. Se presenta este caso clínico por lo inusual de esta patología y se hace una revisión de la literatura al respecto.

We described a newborn baby with gigantic occipital encephalocele, who was attended at the neonatal ward of the Hospital "Jaime Mendoza" in the city of Sucre. This is an unusual case presentation for this pathology and we reviewed the pertinent literature.

Atopic dermatitis

Goldenhar Syndrome

Mycoplasma pneumoniae y Chlamydia pneumoniae como causa de enfermedad del tracto respiratorio inferior en pacientes pediátricos

Tratamiento de la fiebre tifoidea en niños

Miliary and lynphadenitis tuberculosis

Cystic higroma

Se presenta un caso de higroma quístico en un niño de cuatro meses de edad, que ingresó al servicio de pediatría del hospital Daniel Bracamonte de Potosi, por presentar una tumoración cervical derecha y bronconeumonía asociada. Aprovechamos el caso para hacer una descripción de una anomalía congénita del sistema linfático sumamente rara en nuestro medio.

A case of cystic higroma is described in a four month-old patient admitted to the Pediatric Ward of the "Hospital Daniel Bracamonte" of the city of Potosi. We take advantage of the case to make a description of this rare congenital anomaly in our city.

Epidemiology of Accidents in the región of Central Cuyo

Introducción. Los accidentes constituyen la primera causa de muerte en niños mayores de 1 año y representan una importante causa de morbilidad, secuelas y erogación de recursos. Se dispone de cifras de mortalidad por accidentes y de registros de internados, pero los datos de todos los pacientes lesionados son difíciles de registrar. Objetivos. Establecer la prevalencia de accidentes en niños atendidos en servicios de guardia, describir sus características, determinar asociaciones entre las variables estudiadas y la posibilidad de accidentarse. Material y métodos. La población estudiada fueron todos los pacientes de 0 a 14 años atendidos por accidentes durante agosto y diciembre de 1998 en 17 servicios de guardia de las provincias de Córdoba, Mendoza, San Luis, San Juan y La Rioja. La prevalencia se calculó dividiendo el número de pacientes accidentados por el número de pacientes atendidos. Las variables estudiadas fueron: sexo, edad, sitio y tipo de accidente, lugar de las lesiones, gravedad, conducta médica, estacionalidad y tamaño de hospital. Las variables cuantitativas continuas se analizaron con análisis de varianza y prueba t de Student; las discretas, con pruebas no paramétricas. Las variables dicotómicas y categóricas, con chi cuadrado. Resultados. Total de pacientes atendidos: 45.206. Total de accidentados: 3.862 (8,5%); 2.428 varones (62,9%) y 1.434 niñas (37,1%). Edad: 256 menores de 1 año, 1.563 entre 1 y 4, 1.247 entre 5 y 9 y 795 entre 10 y 14. Sitio de ocurrencia: hogar (2.004, 51,9%), calle (1.252, 32,4%) y otros. La mayoría de los accidentes ocurrieron en cabeza (1.785) y miembros (1.566). Hubo 72,4% lesiones leves, 26,6% moderadas y 1% graves, de las cuales el 88,4% requirió atención ambulatoria y el resto, internación. La prevalencia difirió significativamente en agosto y diciembre (OR 2,21) y entre diferentes hospitales (grandes vs.medianos). La mayoría fueron caídas (2.505) en todas las edades; las quemaduras predominaron en menores de 1 año, los envenenamientos en los niños de 1 a 4 años, y los accidentes de tránsito se incrementaron con la edad en forma significativa, con mayor incidencia en hospitales grandes (p< 0,1). Conclusiones. El grupo más afectado fue el de 1 a 4 años, y el lugar más frecuente, el hogar. Se halló variación estacional y diferencias entre los centros participantes. Los accidentes de tránsito aumentaron con la edad.

Introduction. Accidents are the first cause of death in children older than 1 year, and they represent an important cause of morbidity, sequelae and resource expenses. Although there are figures of deaths by accidents and patients hospitalized, it is very difficult to register all injured patients data. Objectives. To find out accident prevalence, to describe their characteristics, to determine if there is an association between these variables and the possibility of having accidents. Material & methods. The population studied were all patients from 0 to 14 years old assisted with accidental injuries in 17 emergency services in the provinces of Córdoba, Mendoza, La Rioja, San Juan and San Luis during August and December 1998 . The analyzed variables were: age, sex, place of occurrence, kind of accident, location, seriousness, medical conduct, type of hospital and season. Prevalence was estimated dividing injured patients by the whole population of assisted children. T-Student and ANOVA tests were performed for continued variables. Non parametric tests, for discrete variables; Chi square test for dichotomic and cathegoric variables. Results. 45,206 patients were assisted. 3,862 injuried. Incidence: 8.5 %. There were 2,428 males (62,9%) and 1,434 females (37.1 %). Mean age was 5,64 years. 256 patients were under 1 year, 1,563 between 1 to 4, 1,247 between 5 to 9 and 795 between 10 to 14 years. Occurrence place: home: 2,004 (51.9 %); street: 1,252 (32.4%). Body: head 1,785, arms and legs 1,566. 72.4 % of injuries were mild, 26.6% moderate, and 1%, severe. 88.4% of these children were managed as outpatients, and the remaing ones required hospitalization. Incidence was statistically different between the two periods (OR 2,21) and also between big and medium hospitals. The most frequent accidents in all ages were fallings (2,505); burns predominated in children under 1 year, poisoning among children aged 1 to 4, and traffic accidents increased with age and were most frequent in big hospitals (p< 0.1). Conclusions. This study was useful to analyze prevalence and to characterize injuries. The 1 to 4 years age group was the most affected. The home was the most frequent occurrence place. There were seasonal variation and differences between the assistance centers. Traffic accidents increased with age.

Underground water and intestinal protozoa

Introducción. El objetivo del presente trabajo fue establecer si había asociación entre el consumo de agua obtenida de fuentes subterráneas, sólo desinfectada con cloro, y la presencia de protozoos intestinales en una población pediátrica. Población. Se estudiaron cuatro grupos de niños, de cuatro meses a doce años de edad, que compartían similares condiciones socio-económicas y sanitarias. Los grupos A (n= 34), B (n= 36) y C (n= 45), consumían agua de red proveniente de fuentes subterráneas, sólo tratada con cloro antes de ser distribuida. El grupo control, D (n= 34), consumía agua de fuente superficial con tratamiento de potabilización convencional completo. Material y métodos. En cada grupo se analizó el agua, desde el punto de vista fisicoquímico, bacteriológico y parasitológico y se realizaron cultivos coproparasitológicos seriados a los niños seleccionados. Se realizó, además, una encuesta a los padres. Resultados. Se comprobó contaminación bacteriológica y parasitológica en algunas de las perforaciones que abastecían a los grupos de población A, B y C. Se detectaron quistes u ooquistes de protozoos en los tanques B y C. Los porcentajes de estudios coproparasitológicos positivos en los niños residentes en cada grupo fueron: A, 47%; B, 41%; C, 67% y D, 12%. Se obtuvieron diferencias significativas entre A-D (p= 0,0039; OR 5,16 [1,43-19,65]), B-D (p= 0,012; OR 4,14 [1,16-15,62]) y C-D (p<10-5; OR 11,60 [3,35-42,88]). Según los resultados de la encuesta, los cuatro grupos compartían condiciones socio-económico-sanitarias similares. Conclusiones. En las muestras estudiadas, las diferencias relativas existentes entre el grupo control y el resto de los grupos estudiados permitirían inferir que existe un alto riesgo de infección con protozoos intestinales cuando se consume agua contaminada de origen subterráneo que sólo fue clorada antes de su distribución.

Objective. To investigate if an association exists among the consumption of water obtained from underground sources, only chlorinated, and the presence of intestinal protozoa in a pediatric population. Population. Four groups of children were studied. They were from four months to twelve years old and shared similar socio-economic and sanitary conditions. Three of the groups A (n= 34), B (n= 36) and C (n= 45), drunk underground water, only chlorinated before its distribution. The fourth group D (n= 34), control group, drunk water from a superficial source with complete potabilization treatment. Material & methods. For each group the drinking water was analyzed, from the physicochemical, bacteriological and parasitological point of view, and microscopic examination of the stools, searching for protozoan cysts, were done on selected children. It was also carried out a survey to the parents. Results. Bacteria and protozoan cysts were found in some of the perforations and tanks that supplied groups A, B and C. The percentages of positive stools from children residing in each group were: A, 47%; B, 41%; C, 67% and D, 12%. Significant differences were obtained between A-D (p= 0.0039; OR 5.16 [1.43-19.65]), B-D (p= 0.012; OR 4.14 [1.16-15.62]), and C-D (p<10-5; OR 11.60 [3.35-42.88]). According to the results of the survey, the four groups shared similar socioeconomic-sanitary conditions. Conclusions. It could be inferred that a high risk of infection with intestinal protozoa exists when people drink contaminated water from underground sources, only chlorinated before its distribution.

Risk factors for suspicion of developmental delays at 12 months of age

Objetivo: Verificar a prevalência de suspeita de atraso no desenvolvimento neuropsicomotor aos 12 meses nas crianças nascidas em Pelotas, RS, em 1993, e seus possíveis determinantes. Métodos: Uma amostra de 20% (1.363 crianças) de uma coorte de crianças nascidas nos hospitais de Pelotas, RS, durante o ano de 1993, foi avaliada aos 12 meses quanto ao desenvolvimento neuropsicomotor, através da aplicação do teste de Denver II. As crianças que tiveram dois ou mais itens de falha no teste foram consideradas suspeitas de apresentarem atraso no desenvolvimento. As variáveis independentes escolhidas pertenciam a diferentes níveis de determinação de atraso, conforme modelo teórico hierarquizado (socioeconômico, reprodutivo e ambiental, condições ao nascer, atenção à criança, nutrição e morbidade). A análise foi realizada utilizando-se o X2 de Mantel-Haenszel e técnica multivariada através de regressão logística, com o objetivo de controlar possíveis fatores de confusão. Resultados: Das 1.363 crianças avaliadas aos 12 meses, 463 (34%) apresentaram teste de Denver II suspeito de atraso no desenvolvimento. Na análise multivariada, após controle de variáveis de confusão, verificou-se que as crianças que tinham maior risco de suspeita de atraso em seu desenvolvimento foram: as mais pobres (OR= 1,5), as que haviam nascido com mais baixo peso (OR= 4,0), as que apresentaram idade gestacional menor do que 37 semanas (OR= 1,6), as que tinham mais de três irmãos (OR= 1,9) e as que haviam recebido leite materno por menos de três meses (OR=1,6) ou não haviam sido amamentadas (OR= 1,9). As crianças que apresentaram um índice peso/idade aos seis meses menor ou igual a -2 desvios-padrão da referência tiveram um risco dez vezes maior de suspeita de atraso no desenvolvimento. Conclusões: Este estudo reforça a característica multifatorial do desenvolvimento e o conceito de efeito cumulativo de risco. Na população estudada, a parcela mais desfavorecida acumula os fato-res (sociais, econômicos e biológicos) que determinam uma maior chance de atraso no desenvolvimento das crianças.

Objective: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. Methodology: A sample of 20% (1,363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, children’s care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. Results: At 12 months of age, 34% (463) of the total of 1,363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR= 1, 5), very low birth weight (OR= 4,0), gestational age less than 37 weeks (OR= 1,6), more than three siblings (OR= 1,9), and duration of breastfeeding less than three months (OR=1,6), or no breastfeeding (OR= 1,9). Children who presented weight/age at six months of age less or equal to -2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. Conclusions: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development.