Revista de la Sociedad Boliviana de Pediatría

Chikungunya, an emerging disease in Bolivia

Dengue: clinical and laboratory manifestations during the 2011-2012 epidemic in Trinidad - Bolivia

Objetivo: Conocer las manifestaciones clínicas y de laboratorios más frecuentes durante las epidemias 2011-2012 en Trinidad, Departamento del Beni, Bolivia. Métodos: estudio descriptivo, retrospectivo, de corte transversal; en el que recogemos las manifestaciones clínicas más comunes que se presentaron en los pacientes internados en el servicio de Pediatría del Hospital Materno Infantil Boliviano Japonés de la ciudad de Trinidad, durante las epidemias de los años 2011 y 2012. Resultados: las manifestaciones clínicas más frecuentes fueron fiebre, cefalea, artralgias, mialgias y los signos de alarma fueron: vómitos continuos, dolor abdominal, leucopenia y trombocitopenia. Conclusiones: describimos los signos y síntomas más comunes de esta enfermedad endémica en nuestra región para ayudar en el diagnóstico.

Objective: clinical and laboratory manifestations during the 2011-2012 epidemic in Trinidad, Beni, Bolivia. Methods: we present a descriptive, retrospective, cross-sectional study; in which we collect the most common clinical manifestations that occurred in patients admitted to the Pediatric service of the Japanese Mother and Child Hospital Boliviano in Trinidad, during the epidemics of 2011 and 2012. Results: the most frequent clinical manifestations were: fever, headache, arthralgia, myalgia and the warning signs were: continuous vomiting, abdominal pain, leucopenia and thrombocytopenia. Conclusions: We described the most common signs and symptoms of this endemic disease in our region to help in the diagnosis.

Critical aortic coarctation: percutaneous balloon aortoplasty. Case report

La coartación aórtica crítica del recién nacido es una de las cardiopatías congénitas con mayor mortalidad. Se presenta el caso de un paciente diagnosticado de coartación aortica a las dos semanas de vida, operado de coartectomía y anastomosis termino terminal. A los tres meses de edad evoluciona desfavorablemente, con deterioro hemodinámico, confirmándose una recoartación aórtica crítica, por lo que se decide realizar una aortoplastía con balón por vía percutánea, que resulta exitosa y sin complicaciones inmediatas. La aortoplastía con balón constituye una opción terapéutica aceptablemente segura y mínimamente invasiva en pacientes pediátricos con recoartación aórtica.

Aortic coarctation of the newborn is a congenital heart disease with increased mortality. We report the case of an aortic coarctation diagnosed at two weeks old patient, surgery was indicated, the procedure was coarctectomy with end-to-end anastomosis. At three months of age evolves unfavorably, with hemodynamic compromise, confirming critical aortic recoarctation, so it was decided to make a balloon aortoplasty percutaneously, which is successful without immediate complications. The balloon aortoplasty is an acceptably safe and minimally invasive therapeutic option in pediatric patients with aortic coarctation.

Congenital tuberculosis: a case report and review

La tuberculosis congénita es una forma clínica infrecuente de presentación de la enfermedad, de difícil diagnostico por la falta de especificidad de las manifestaciones clínicas. Revisamos las formas de prevención, diagnóstico y tratamiento de la enfermedad.

Congenital tuberculosis is an infrequent form of presentation of the disease, of difficult diagnosis for the lack of specificity of the clinical manifestations. We review the forms of prevention, diagnosis and treatment of the disease.

Diabetic ketoacidosis: evaluation and treatment

Apert syndrome

Can Progression to Severe Dengue in Dengue with Warning Signs Be Predicted in the Emergency Room?

Introducción: El dengue se ha convertido en un serio problema de salud pública en Paraguay. La existencia de factores clínicos o laboratoriales que puedan predecir la evolución de la enfermedad, durante su evaluación en los Servicios de Urgencias, puede favorecer la identificación temprana de individuos con mayor riesgo y así optimizar los recursos en época de epidemias. Objetivos: Determinar los factores de riesgo clínicos y laboratoriales de Dengue Grave (DG) al ingreso, en pacientes hospitalizados por Dengue con Signos de Alarma (DSA). Materiales y Métodos: Estudio de casos y controles, llevado a cabo en el Servicio de Urgencias del Hospital General Pediátrico "Niños de Acosta Ñu" de febrero a junio de 2012. Para identificar los aspectos asociados a la evolución a Dengue Grave se realizó el análisis univariado de las variables clínicas y laboratoriales al ingreso hospitalario. De las variables con significancia estadística se procedió al análisis de regresión logística. Resultados: 217 niños fueron incluidos, 57 casos de DG y 160 controles. La media de edad fue de 11 años (p: 0,719). Los días de enfermedad al ingreso fueron similares 3,4 versus 3,6 (p: 0,643). Presentó asociación con Dengue Grave: la hemoconcentración y descenso de plaquetas (OR: 3,3 IC 95% 2,0-11,3 p: 0,027) y el antecedente de vómitos (OR: 3,2 IC 95% 1,7-7,2 p: 0,007). Para la hemoconcentración y caída de plaquetas la sensibilidad fue del 26% y la especificidad 93%, VPP 57,7% y VPN 78%. La presencia de vómitos, tuvo una sensibilidad del 78,9% y especificidad del 48,8%, con un VPP 35,4% y VPN 86%. La extravasación se produjo entre el 3º y 6° día de enfermedad, media: 5,3 ± 0,9. Conclusiones: La hemoconcentración con descenso de plaquetas aumentó 3,3 veces la posibilidad de tener Dengue Grave cuando está presente, pero su ausencia no implicó que no lo desarrollarían. Ninguna de las variables permitió predecir con suficiente solvencia la evolución a Dengue Grave en el momento del ingreso hospitalario.

Introduction: Dengue has become a serious public health problem in Paraguay. Knowledge of clinical or laboratory test parameters that could predict progression of the disease during assessment in emergency services could improve early identification of individuals at greater risk and optimize use of resources during epidemics. Objectives: We sought to determine the clinical and laboratory test risk factors for severe dengue (SD) on admission in patients hospitalized for dengue with warning signs (DWS). Materials and Methods: We conducted a case-control study in the emergency department of the general pediatric hospital Niños de Acosta Ñu in Paraguay between February and June of 2012. Univariate analysis of clinical and laboratory test values at admission was done to identify characteristics associated with progression to severe dengue. Statistically significant variables were subjected to logistic regression analysis. Results: We included 217 children, 57 with SD and 160 controls with a mean age of 11 years (p= 0.719). Days of illness preceding admission were similar: 3.4 versus 3.6 (p= 0.643). Severe dengue was associated with hemoconcentration and decreased platelet count (OR: 3.3, CI 95% 2.0-11.3, p= 0.027) and a history of vomiting (OR: 3.2, CI 95% 1.7-7.2, p= 0.007). Sensitivity was 26% and sensitivity 93% for hemoconcentration and platelet decrease with a PPV of 57.7% and NPV of 78%. Vomiting showed a sensitivity of 78.9% and specificity of 48.8% with a PPV of 35.4% and NPV of 78%. Extravasation occurred between the third and sixth day of illness, with a mean of 5.3 ± 0.9. Conclusions: Hemoconcentration with decreased platelet count predicted a 3.3 times greater possibility of severe dengue, but its absence did not indicate that it would not occur. None of the associations allowed prediction of severe dengue at time of admission with sufficient certainty.

Neuroblastoma less than 18 months of age. 10 years experience in pediatric hematooncologic of the Pereira Rossell Hospital Center

Introducción: el neuroblastoma es el tumor maligno más frecuente en los lactantes. Su curso clínico es variable, desde la regresión espontánea a la progresión maligna, y los factores pronósticos son múltiples, como edad, estadio, amplificación de N-myc y ploidía tumoral. Se describen las características de todos los pacientes con neuroblastoma menores de 18 meses asistidos en CHOP. Pacientes y métodos: estudio observacional, descriptivo y retrospectivo en el período entre 31 de enero de 2000 y 31 de enero de 2011. El diagnóstico se realizó por histología y aspirado de médula ósea. Los pacientes se estadificaron por INSS; el tratamiento se decidió según estadio y riesgo. Resultados: se incluyeron 22 pacientes menores de 18 meses (52% de todos los neuroblastomas), con una media de edad de 9,6 meses. Once pacientes se encontraban en estadio 4. La localización más frecuente fue suprarrenal; presentaban metástasis 13 pacientes. Quince niños recibieron poliquimioterapia y 20 fueron tratados quirúrgicamente. La amplificación del gen N-myc se demostró en tres pacientes. La sobrevida global fue de 77% y la sobrevida libre de enfermedad fue de 77%. Discusión y conclusiones: la mayor parte de los casos fueron diagnosticados en niños menores de 9 meses. Fueron más frecuentes los estadios 4 y 1. No se pudo demostrar asociación entre N-myc y estadio de enfermedad. La sobrevida fue excelente.

Introduction: neuroblastoma is the most common malignant tumor in infants. Its clinical behavior is variable, from spontaneous regression to malignant progression; prognostic factors are multiple, such as age, stage, N-myc amplification and tumor ploidy. We describe the characteristic of all patients with neuroblastoma less than 18 months of age assisted in CHOP. Patients and methods: retrospective, observational and descriptive study in the period between 31/1/00 y 31/01/11. Diagnose was made from histology and bone marrow aspirate. Patients were classified by INSS stage; treatment was decided according to stage and risk. Results: 22 patients were included (52% of all neuroblastomas), with a mean age of 9,6 months. Eleven patients were classified in stage 4. The most frequent localization was adrenal; 14 patients presented methastasis. Fifteen patients received chemotherapy and 20 were surgically intervened. N-myc amplification was detected in 3 patients. Overall survival was 77% and event-free survival was 77%. Discussion and conclusions: the majority of cases were diagnosed in children younger than 9 months. Stages 4 and 1 were the most frequent. No association between N-myc and stage could be determined. Overall and event-free survival were excellent.

Impact of breastfeeding on the intelligence quotient of eight-year-old children

Objetivo: O objetivo deste estudo foi determinar a influencia do aleitamento materno na capacidade intelectual de crianças pertencentes a uma coorte de um país em desenvolvimento, controlando para os principais fatores de confusão. Métodos: Foi realizado um estudo de coorte prospectiva com todos os recém-nascidos nos hospitais de uma cidade de porte médio e acompanhou-se uma amostra aleatória destes aos 30, 90 e 180 dias de vida e aos 8 anos. No acompanhamento foram avaliados diversos aspectos da amamentação e, aos 8 anos, foi realizada avaliação da capacidade intelectual geral aplicando-se o Teste de Raven. As análises estatísticas utilizaram Teste T, ANOVA e regressão linear e logística, considerando como associações estatisticamente significativas aquelas cujo valor de p foi inferior a 0,05. Resultados: Aos 8 anos 560 crianças participaram da avaliação com o Teste de Raven. A média da pontuação das crianças no teste foi de 22,56 pontos com desvio padrão de 5,93. A diferença de médias entre os grupos em aleitamento materno ou não, aos seis meses, foi de 1,33 (p = 0,008). Permaneceram associadas ao desfecho, após regressão linear e logística, a cor materna e da criança, classe socioeconômica, escolaridade e tabagismo maternos e o aleitamento materno aos 6 meses de idade (p = 0,007). Conclusões: As crianças que mamaram por seis meses ou mais tiveram melhor desempenho na avaliação intelectual geral, mesmo após ajuste para os principais fatores de confundimento.

Objective: This study aimed to determine the influence of breastfeeding on the intellectual capacity of children from a cohort in a developing country, with a control for the main confounding factors. Methods: A prospective cohort study was performed including all infants born in the hospitals of a medium-size city, and a random sample of these newborns was monito-red at 30, 90, and 180 days of life, and at age 8 years. Several aspects of breastfeeding were assessed inthe follow-up and, at 8 years, general intellectual capacity was assessed through the Raven's Colored Progressive Matrices test. The statistical analyses used Student's t-test, ANOVA, and linear regression and logistics, considering p-values less than 0.05 as statistically significant associations. Results: At age 8 years, 560 children were assessed with Raven's Colored Progressive Matrices test. The average score was 22.56 points, with a standard deviation of 5.93. The difference inthe averages foundbetweenthe breastfed and non-breastfed groups at six months of age was 1.33 (p = 0.008). Mother's and child's skin color, social and economic class, maternal education and smoking, and breastfeeding at six months of age (p = 0.007) were still associated with the outcome. Conclusions: Children that were breastfed for six months or more had better performance in the general intellectual assessment, even after adjusting for the main confounding factors.

Basic principles of dentistry to the pediatrician. 1^st part

CUESTIONARIO NÚMERO 53-PREGUNTAS CORRESPONDIENTES AL TEMA: PRINCIPIOS BÁSICOS DE ODONTOLOGÍA PARA EL PEDIATRA. 1^o PARTE

Homenaje póstumo al Ac. Dr. Eduardo Aranda Torrelio