Boletín médico del Hospital Infantil de México最新文献

Background: Pediatric circumcision is a common procedure, with reported acute complication rates of 0.5-10%. This study evaluated the safety of diode laser circumcision in pediatric patients treated at a private hospital in Culiacán, Sinaloa, Mexico (2022-2023).

Methods: Retrospective cohort of 51 patients ≤ 17 years who underwent diode laser circumcision diagnosed with phimosis (n = 29), balanitis (n = 13), balanitis xerotica obliterans (n = 5), and paraphimosis (n = 4). General anesthesia was used in patients under 10 years, and local block with sedation in older patients. Acute complications, operative time, and reinterventions were recorded. Operative time was compared by diagnosis using the Kruskal-Wallis test, and age was correlated with procedure duration using Spearman's correlation. Follow-up was performed at postoperative days 7 and 30.

Results: No significant bleeding, wound dehiscence, or reinterventions were observed. Median operative time was 15 minutes across all groups, with similar means among diagnoses. No correlation was found between age and procedure duration (r: -0.08; p = 0.593) and no significant differences were observed among diagnoses (p = 0.183).

Conclusions: Diode laser pediatric circumcision showed a favorable safety profile and homogeneous operative times. The limited sample size restricts generalizability, requiring prospective multicenter studies to confirm these findings.

The present document aims to present a reflection derived from a narrative review on the evolution of complementary feeding (CF) recommendations worldwide and their application in Mexico. Based on the analysis of international guidelines and consensus statements, such as those published by European Society for Pediatric Gastroenterology, Hepatology and Nutrition, Latin American Society of Pediatric Gastroenterology, Hepatology and Nutrition, and the World Health Organization, members of the Mexican Academy of Pediatrics review the main points of convergence and controversy related to the initiation, progression, and characteristics of CF during the first two years of life. The document highlights that this period is critical for growth, neurological development, immune maturation, and the establishment of healthy eating habits in the long term. Likewise, it emphasizes the relevance of the first 1000 days of life and the need to promote breastfeeding, dietary diversity, and the timely introduction of foods rich in essential nutrients. The review also addresses current topics such as the early introduction of allergenic foods, the role of different food textures, the prevention of obesity and allergies, as well as the importance of avoiding sugar-sweetened beverages, ultra-processed foods, and restrictive diets without specialized supervision. From the Mexican perspective, it is recognized that international recommendations must be contextualized according to the epidemiological, cultural, and social realities of the country. Finally, the Academia Mexicana de Pediatría proposes practical recommendations directed at healthcare professionals to promote responsive, safe, and evidence-based CF that contributes to the overall well-being of Mexican infants.

Background: Pityriasis lichenoides chronica (PLC) is a rare dermatosis in children, with limited epidemiological data restricting its clinical and therapeutic characterization.

Methods: A retrospective case series was conducted at two tertiary care hospitals in Mexico City. Electronic records of patients younger than 18 years of both sexes with a diagnosis of PLC confirmed by histopathology were included in the study. The study period was from January 2017 to March 2025.

Results: Thirty-five confirmed cases were analysed (51.4% female and 48.6% male). The mean time to diagnosis was 2.4 years after lesion onset. The median disease duration was 24 months (interquartile ranges 9-49), with recurrence in 67.5% of cases. The most common sites were the trunk and extremities (65.7%), with predominance of erythematous-squamous papules and plaques (48.6%) that, upon resolution, left hypopigmented macules in 80% of patients. Phototherapy was used in 25.7% and oral methotrexate (MTX) in 22.9% of cases. In patients with prolonged disease duration (> 36 months), higher recurrence rates, longer MTX use, and, in some cases, greater use of phototherapy were observed.

Conclusions: Pediatric PLC in a Mexican case series showed a chronic and recurrent course, with a low rate of resolution. The high frequency of recurrences and therapeutic variability, including MTX and phototherapy in prolonged cases, highlights the need for standardized treatment protocols.

Introducción: La coccidioidomicosis es una infección endémica en el norte de México causada por Coccidioides immitis y Coccidioides posadasii. Su principal manifestación es en los pulmones, aunque cerca del 1% puede tener afectación de otros órganos, lo que se conoce como coccidioidomicosis diseminada. De forma infrecuente, estos casos pueden cursar con choque séptico. En pediatría, esta forma de expresión está infraestudiada, pero se ha asociado con elevada mortalidad.

Caso clínico: Se presenta el caso de una paciente de 16 años que acudió por una lesión ulcerativa en región cervical acompañado de fiebre y pérdida de peso de 2 meses de evolución. Durante su estancia desarrolló choque séptico refractario aunado a endocarditis y tuvo fallo multiorgánico con un desenlace fatal.

Conclusiones: Debe considerarse esta micosis como causa de choque séptico en zonas endémicas donde no existe una causa específica.

Background: Coccidioidomycosis is an endemic infection in northern Mexico caused by Coccidioides immitis and Coccidioides posadasii. Its main manifestation is in the lungs, although approximately 1% may affect other organs, which is known as disseminated coccidioidomycosis. Rarely, these cases can present with septic shock. In pediatrics, this form of expression is understudied but has been associated with high mortality.

Clinical case: We describe the case of a 16-year-old female who presented with an ulcerative lesion in the cervical region accompanied by fever and weight loss that had lasted 2 months. During her stay, she developed refractory septic shock combined with endocarditis and suffered multiorgan failure with a fatal outcome.

Conclusions: This mycosis should be considered as a cause of septic shock in endemic areas where there is no specific etiology.

Background: The Autism Behavior Checklist (ABC) evaluates symptoms in individuals with Autism Spectrum Disorders (ASD) within a school setting. The purpose of this study was to evaluate the validity of the ABC Mexican version.

Methods: Participants were children (n = 133, aged 2-17). All parents were interviewed with the autism diagnostic interview-revised (ADI-R) to confirm an ASD diagnosis and then answered the ABC checklist. The sample for the ABC test-retest analysis consisted of 19 parents with unaffected typically developing children between 2 and 17 years old.

Results: Children and adolescents (n = 133) with a mean age of 6.9 years (standard deviation [SD] 3.7), 83.5% were males. The ABC total mean score was 69.3 (SD 25). The Internal consistency through the Cronbach Alfa coefficient was α = 0.83 < p = 0.001 for the 57 ABC items. The 10-day test-retest reliability showed a Pearson correlation coefficient of r = 0.98, p < 0.001. The Spearman correlation coefficients between the ABC subscales and the ADI-R ranged from (rs = 0.494) to (rs = 0.816). Criterion validity with a cutoff of 30 resulted in a sensitivity of 87% and a specificity of 37%. The best Kappa coefficient was 0.285 between the ABC and the ADI-R.

Conclusions: The Mexican ABC has good psychometric properties. Further studies should investigate its value in educational settings.

Background: Langerhans cell histiocytosis (LCH) is a rare, multisystem hematologic disease characterized by the clonal proliferation of mononuclear phagocytes in various tissues and organs. In Mexico, its incidence in children is 4.3 cases per million. The disease presents a clinical variety that can mimic other medical conditions, making diagnosis challenging. Pediatricians play a crucial role in the early identification of adenopathy, which can be indicative of LCH or other pathologies.

Clinical cases: Case 1. A 6-month-old infant with cervical adenopathy, fever, anemia and cutaneous compromise; biopsy with immunohistochemistry confirmed the disease. Case 2. A 2-year-old boy with retroauricular adenopathy, exophthalmos, and pallor. Lytic bone lesions and lymph node biopsy confirmed the disease, classified as group I. Case 3. A 1-year-old boy with generalized dermatosis, progressive adenopathies, and symptoms of diabetes insipidus; studies confirmed LCH and vasopressin deficiency.

Conclusions: LCH is currently classified into groups based on the extent of the disease. The presented cases reflect different clinical forms, underscoring the importance of early detection and accurate diagnosis to improve prognosis. Delayed diagnosis can lead to less effective treatments and additional complications. The clinical variability of LCH poses a diagnostic challenge in pediatrics. This analysis emphasizes the importance of early diagnosis and appropriate treatment to improve prognosis. It is essential for pediatricians to consider other causes of adenopathy before considering an oncological diagnosis and to conduct a thorough evaluation for timely referral to subspecialists.

Background: Generalized pustular psoriasis is a rare and severe systemic inflammatory disease characterized by skin erythema and visible sterile pustules. Associated with hereditary and external factors, it can be life-threatening and requires specialized diagnosis and treatment.

Clinical case: A 6-year-old male with disseminated dermatosis of 7 months evolution, initially appearing in the retroauricular region with erythematous scaly plaques and pustular lesions, spreading to various body segments, accompanied by intense pruritus, fever, and tachycardia. Histopathological examination reported psoriasiform dermatitis with lymphocytes, plasma cell aggregates, and neutrophils forming microabscesses in the stratum corneum, compatible with a diagnosis of pustular psoriasis. Treatment included methotrexate at 12 mg/m²/week, folic acid, 1% methylprednisolone aceponate cream, 0.005% calcipotriol, urea-based emollient at 10%, and antihistamines.

Conclusions: Generalized pustular psoriasis in pediatrics requires comprehensive care, considering not only dermatological aspects but also psychosocial factors. Successful management of pediatric cases, as described, highlights the importance of a personalized approach tailored to each patient's needs to achieve long-term satisfactory outcomes.

Background: In 2020, a multidisciplinary group developed Integrated Asthma Management (MIA), guidelines for asthma in Mexico, based on international asthma guidelines. Since then, several concepts and treatments have been updated.

Objective: To create a current version of MIA, strongly based on evidence, and to add the management of severe asthma exacerbations.

Methodology: MIA 2.0 uses the ADAPTE method. The MIA 2.0 guideline development group consists of a core group (experts in pulmonology-allergology-methodology) and representatives of 16 institutions/societies of specialties that manage asthma. The international reference guidelines (selected with AGREE-II) were: GINA 2024, GEMA 5.4, BTS/SIGN 2024 and Australian Asthma Handbook 2021. MIA 2.0 covers diagnosis, treatment, severe asthma, exacerbations and special groups. Key clinical questions were formulated for I) diagnosis, II) treatment steps 1-4, III) severe asthma and IV) exacerbations.

Results: Based on evidence in reference guidelines, safety, cost and local reality, the core group developed responses to the clinical questions. Through a Delphi process, the MIA 2.0 development group suggested adjustments until consensus was reached.

Conclusion: A document was generated with multiple figures and algorithms, about asthma management including exacerbations treatment, adjusted for Mexico broadly based among different societies that participated in its development.

Background: The foundational elements for optimal well-being and health are established during the early stages of life. When progress does not meet expectations, it is necessary to explore possible disorders, health conditions, or other probable factors affecting it. Health professionals in our country must have access to developmental screening instruments that facilitate early detection of these potential risks and delays, thus enabling timely intervention.

Methods: After a pre-selection of the evidence and adequate training of a multi-sectoral panel, a virtual deliberative dialog was held with key stakeholders and decision-makers to determine the most appropriate development screening instrument for the Peruvian context. The evidence was analyzed and discussed in light of the established criteria. In addition, factors pertaining to implementation on a national level were discussed.

Results: A set of instruments were obtained and prioritized in the following order: Evaluation of Child Development (EDI, Spanish acronym) ranked first, followed by the Abbreviated Developmental Scale Third Edition (EAD-3, Spanish acronym) and the Ages and Stages Questionnaire (ASQ-3, Spanish acronym), based on the established criteria. The primary components implicated in the execution of this evaluation on a national scale were subsequently identified.

Conclusions: This deliberative dialog has enabled a first approach to the selection of a development screening instrument on the national level, providing valuable information to guide the implementation process.