RESUMO
Introducción. La pancreatitis aguda es una enfermedad poco frecuente en pediatría, y que no cuenta con un sistema adecuado para predecir gravedad. Objetivo: determinar las variables más frecuentes que se asocian a complicaciones de pancreatitis aguda en niños. Métodos. Se revisaron expedientes de pacientes menores de 17 años que fueron hospitalizados de enero de 2001 a diciembre de 2006 con pancreatitis aguda. Se analizaron sus características demográficas, la presencia o no de complicaciones, estado nutricional y tipos, y duración de intervenciones nutricionales. Resultados. De 181 expedientes revisados, 47 cumplieron con criterios de inclusión; 30% correspondieron al sexo masculino, con una media de edad de 8.7 ± 4 años. El peso para la talla fue de 106 ± 21% y el índice de masa corporal (IMC) de 17 ± 3 kg/ m² (zIMC: 0.031 ± 0.21), 13% de pacientes tuvieron sobrepeso, con un peso para la talla (P/T) mayor a 110%; 38% desarrollaron complicaciones y se registraron 2 muertes. Los pacientes con complicaciones vs los que no las tuvieron, mostraron diferencia en P/T, IMC y zIMC (P <0.01), pero no en otros parámetros medidos. El apoyo nutricio se inició en promedio a los 5.7 días con nutrición parenteral total en 89% de los casos, y la vía enteral a los 13 ± 10 días. Conclusiones. En nuestro estudio, casi la mitad de pacientes con pancreatitis aguda tuvo una enfermedad oncológica de base, y etiología farmacológica en 57% de los casos. De los factorespronósticos analizados, no hubo diferencia estadísticamente significativa en leucocitos séricos y en concentraciones plasmáticas de amilasa y lipasa entre pacientes con y sin complicaciones, y el mayor número de complicaciones de pancreatitis aguda se detectó en los pacientes con mayor P/T e IMC; esta asociación orienta al diseño de escalas pronósticas que incluyan estas variables.
Introduction. Acute pancreatitis is an uncommon disease in childhood that lacks an adequate scale for predicting disease severity. The objective of this study was to determine the main factors that predict severe acute pancreatitis. Methods. A chart review of children under 17 years of age hospitalized with diagnosis of acute pancreatitis from January 2001 to December 2006 was conducted. Demographics, local and systemic complications, nutritional status and nutritional support were analyzed. Results. Forty-seven patients were included with a mean age of 8.7 ± 4 years. Weight for height (W/H) was 106 ± 21% and BMI 17.3 kg/m² (zBMI 0.031 ± 0.21); 13% of patients were overweight, with W/H greater than 110%. Thirty-eight percent of patients developed complications; these patients, compared with patients without complications, showed a difference in W/ H, BMI and zBMI (P <0.01), but not in other parameters. Nutritional support started on average at 5.7 days with parenteral nutrition in 89% of cases, and enteral feeding after 13 ± 10 days of fasting. Conclusion. In our study, more than 50% of patients had oncological diseases, and 57% presented pharmacological etiology. Prognosis factors were analyzed and no statistical differences in serum leucocytes, amylase and lipase were found between patients with or without complications; most complications were found in patients with higher W/H and BMI. This association suggests that future prognosis scales of acute pancreatitis in children should include these variables.
RESUMO
For the first time in Mexico, two cases of acute pulmonary edema of high altitude are reported in a 6 year -old child and in a 16 year- old adolescent; both children lived in the city of Mexico. In identical circumstances, both developed progressive acute respiratory insufficiency on their return to Mexico City after several days at sea level. The final diagnosis was acute pulmonary edema of high altitude. In this paper, the producing mechanisms of this complication are discussed, together with the importance of making it known, in order to put on the lookout the medical personel, who work in the plateau, so that they may be conscious that this disturbance may occur at altitudes like that of Mexico City, (2480 meters above sea level) which is much lower than the altitude considered dangerous. (3000 meters). The most important facts of the clinical picture, together with the treatment recommended are pointed out.
Assuntos
Edema Pulmonar/diagnóstico por imagem , Doença Aguda , Adolescente , Altitude , Criança , Humanos , Masculino , México , Oxigenoterapia , Edema Pulmonar/terapia , RadiografiaRESUMO
Antibodies to influenza A2, influenza B, parainfluenza 2 and 3, adenovirus and respiratory syncytial viruses were determined in thirty nine children with acute laryngotracheobronchitis; nine cases were not included in the analysis because of the presence of anticomplementary sera; 40% of cases were positive, 20% to influenza A2, 10% to influenza B (one case of double infection with influenza B and parainfluenza 2 viruses), 6.7% to respiratory syncytial virus and 3.3% to parainfluenza 2. Results are compared with previous studies done in Mexico.
Assuntos
Anticorpos Antivirais/análise , Infecções Respiratórias/imunologia , Doença Aguda , Bronquite/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Laringite/imunologia , Masculino , Respirovirus/imunologia , Traqueíte/imunologiaRESUMO
The study included 28 infants with infectious gastroenteritis who evolved with disturbances of coagulation and in whom laboratory tests were practiced by micromethods through capillary puncture. The most frequently seen abnormality was a combination of vitamin K dependent factors deficiency with thrombocytopenia. Another observation in our study is that hypofibrinogenemia in infants with infectious gastroenteritis is not always secondary to disseminated intravascular coagulation. A decrease in fibrinogen in these cases is explained by a lack in synthesis of this factor in infants with malnutrition since out of 16 malnourished infants, 75% evolved with hypofibrinogenemia, while eutrophic infants evolved with normal fibrinogen. The disseminated intravascular coagulation syndrome was seen more frequently in patients with infectious gastroenteritis complicated with septicemia and shock, 57% of the patients did not show manifestations of bleeding nor of thrombosis which justifies in these cases a systematic investigation of the coagulation mechanism.