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BACKGROUND: Retinopathy of prematurity (ROP) is a leading cause of avoidable blindness in children, particularly in Latin America, where hyperoxia is a significant risk factor. This study evaluated resource availability and use for administering and monitoring supplemental oxygen in Mexico. METHODS: In 2011, an observational study in which 32 government neonatal intensive care units (NICUs) across Mexico were visited. Data collected included occupancy, staffing levels, and equipment to deliver and monitor supplemental oxygen. Preterm infants receiving oxygen were observed. In 2023, 13 NICUs were revisited, and similar data collected. Staffing levels were benchmarked against Argentinian and US recommendations. RESULTS: In 2011, only 38% of NICUs had adequate medical and staffing levels to meet recommended cot-to-staff ratios for all shifts. Staffing ratios were worse during weekends and at night than during weekdays. Only 25.5% of cots had blenders, and 80.1% had saturation monitors. 153 infants were observed 87% of whom were being monitored. Upper and lower oxygen saturations were ≥ 96% in 53%, and ≤ 89% in 8%, respectively. Alarm settings were inadequate, as 38% and 32% of upper and lower alarms were switched off and 16% and 53% were incorrectly set, respectively. In the 13 NICUs with data from 2011  and 2023, cot-to-staff ratios deteriorated over time, and in 2023 no unit had recommended ratios for all shifts. Equipment provision did not change, with similar proportions of babies in oxygen being monitored (79% 2011; 75% 2023). Rates of hyperoxia decreased slightly from 54% in 2011 to 49% in 2023. More upper alarms were set (46% 2011; 75% 2023), but a higher proportion were incorrectly set (52% 2011; 68% 2023). CONCLUSIONS: Between 2011 and 2023, cot-to-staff ratios worsened, and equipment for safe oxygen delivery and monitoring remained insufficient. Despite available monitoring equipment, oxygen saturations often exceeded recommended levels, and alarms were frequently not set or incorrectly configured. Urgent improvements are needed in healthcare workforce numbers and practices, along with ensuring adequate equipment for safe oxygen delivery.

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BACKGROUND: Living donor kidney transplantation is the best type of renal replacement therapy for patients with end-stage renal disease. Living kidney donors (LKDs) undergo an extensive evaluation before donating, and many potential LKDs are declined. This study aimed to define the reasons for the decline in LKD candidates referred to our center. METHODS: We retrospectively analyzed clinical data of all potential LKDs evaluated between January 2001 and December 2021 at our institution,Western National Medical Center, Pediatric Hospital. Data were obtained by review of an electronic database. RESULTS: A total of 1332 potential LKDs were evaluated, 796 (59.7%) successfully donated; 20 (1.5%) had a complete evaluation, were accepted for donation, and were on the waiting list for intervention; 56 (4.2%) continued in the evaluation process; 200 (15%) were discharged from the program due to administrative aspects, death (donor or receptor), or cadaveric renal transplantation in order of frequency; 56 (4.2%) withdraw by personal choice; and 204 (15.3%) were rejected for donation. Donor-related reasons included medical contraindications (n = 134, 65.7%), anatomic contraindications (n = 38, 18.6%), immunologic barriers (n = 18, 8.8%), and psychological reasons (n = 11, 5.4%). CONCLUSIONS: Despite the large number of potential LKDs, a significant proportion did not proceed for donation for different reasons; in our description, it represents 40.3%. The largest proportion is because of donor-related causes, and most of the reasons result from the candidate's unnoticed chronic diseases.

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Obtaining blood which is safe for transfusions is one of the principal challenges in the health systems of developing countries. Supply of contaminated blood increases morbidity, mortality, and the costs of patient care. In Mexico, serological screening is mandatory, but only a few of the main blood banks routinely perform a nucleic acid test (NAT). Data from 80,391 blood donations processed between August 2018 and December 2019 at the Central Blood Bank of the Western National Medical Center of the Mexican Social Security Institute (IMSS) were analyzed. All donors were screened for serological markers and NAT was performed. Reactive donors were followed-up to confirm their results. The number of reactive donors and seroprevalence rates for HIV, HCV, and HBV were 152 (18.91/10,000), 385 (47.89/10,000), and 181 (22.51/10,000), respectively; however, these rates decreased when NAT-confirmed reactive results were considered. Male donors were found to have a higher seroprevalence than females, and younger donors higher than older donors. The present study shows that HIV, HCV, and HBV seroprevalence in blood donors in Western Mexico is low. We propose that Mexico should establish future strategies, including pathogen reduction technologies (PRTs), in order to improve blood safety and reduce transfusion-transmissible infections (TTIs).

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Obesity can lead children and adolescents to an increased cardiovascular disease (CVD) risk. A diet supplemented with Plantago psyllium has been shown to be effective in reducing LDL-C and IL-6 in adolescents. However, there are no studies that have explored small-dense LDL (sdLDL) or HDL subclasses. The aim of this study was to evaluate the impact of a fiber dietary intervention on LDL and HDL subclasses in adolescents with obesity. In this parallel, double blind, randomized clinical trial, the participants were assigned to Plantago psyllium or placebo (10g/day for 7 weeks). We randomized 113 participants, and evaluated and analyzed 100 adolescents (50 in each group), 15 to 19 years with a body mass index of 29-34. We measured biochemical markers LDL and HDL subclasses using the Lipoprint system (Quantimetrix) and IL-6 by ELISA. Post-treatment there was a decrease in sdLDL between the groups 2.0 (0-5.0) vs 1 (0-3.0) mg/dl (p = 0.004), IL-6 median 3.32 (1.24-5.96) vs 1.76 (0.54-3.28) pg/ml, p <0.0001. There were no differences in HDL subclasses and no adverse effects were reported in either group.Conclusions: Small dense LDL and IL-6 reduced in adolescents with obesity when consuming Plantago psyllium. This may be an early good strategy for the reduction of cardiovascular disease risk in this vulnerable population.Trial registration: ISRCTN # 14180431. Date assigned 24/08/2020 What is Known: • Supplementing the diet with Plantago psyllium lowers LDL-C levels. What is New: • First evidence that soluble fiber supplementation like Plantago psyllium decreases small dense LDL particles in association with lowered IL-6, reducing the risk of cardiovascular disease in obese adolescents.

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This paper reports a case of furuncular myiasis caused by Dermatobia hominis in a domestic dog from Colombia. A male domestic dog, German shepherd breed, of approximately 2 years old was brought for medical consultation. The reason was the presence of one furuncular lesion and discomfort in the patient. Clinical examination revealed a wound over the sacral area similar to an inflammatory papule, with a central punctum exuding a serosanguinous discharge. In the medical examination was applied pressure around the wound, that allowed evidencing a larva inside the tissue. The applied treatment was surgical removal of the larva in the dog. Treatment was complemented with Cephalexin (20 mg / kg, twice a day orally for 7 days), Meloxicam (0.2 mg / kg, once a day orally for 3 days) and cleaning with chlorhexidine, three times a day until removal of points 7 days later. The larva was sent to Parasitology laboratory of the UDES for morphology identification. The larva was identified as Dermatobia hominis.

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This paper reports for the first time in Colombia, two myasis cases caused by Cochliomyia hominivorax in stray dogs. Clinical examination of both patients revealed fever and a large wound at the palpebral level on the right side, and multiple perforating wounds in the right posterior limb where larvae were found. The treatment applied was the manual removal of larvae in the dogs, and subsequent eye enucleation in one dog due to the total loss of the upper right eyelid and the severe mechanical damage that the cornea received. Treatment was reinforced with repellents applied around the wounds and antibiotics. This finding of Cochliomyia hominivorax in stray dogs in Colombia raises concerns about the potential of dogs serving as a reservoir for human infection in the region.

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AIM: The research was conducted to determine the seroprevalence and risk factor associated with respiratory viral pathogens in dual-purpose cattle of Aguachica, Rio de Oro and La Gloria municipalities in Cesar department, Colombia. MATERIALS AND METHODS: The seroprevalence study was done from the random sampling (n=1000) of blood collected from 29 dual-purpose herds, located in three municipalities (Aguachica, Rio de Oro, and La Gloria) of Cesar department. The presence of antibodies against bovine herpesvirus type 1 (BHV-1), bovine respiratory syncytial virus (BRSV), bovine viral diarrhea virus (BVDV), and bovine parainfluenza-3 virus (BPI-3V) in the samples was detected by indirect enzyme-linked immunosorbent assay. Epidemiological data were obtained using a questionnaire administered to the owner or manager of each herd. RESULTS: The overall highest seroprevalence was observed for BHV-1 (94.7%), followed by BRSV (98.6%), BVDV (35.2%), and BPI-3V (47.1%). Regarding the seroprevalence by municipalities, there was a statistical association (p<0.05) for BVDV; however, for BRSV, BHV-1, and BPI-3V, no statistical association was found (p>0.05) between seropositive values and the municipalities, indicating that animal was seropositive in similar proportions in the three municipalities. Female sex and older animals (>24 months) were a significant risk factor for BHV-1 and BPI-3V infection. Regarding the clinical signs, there was a statistical association (p<0.05) between the seropositive values of BVDV and most of clinical signs observed, except for abortion. CONCLUSION: This research confirms the high seroprevalence of the respiratory viral pathogens in nonvaccinated cattle within the study areas. Therefore, appropriate sanitary management practices and routine vaccination programs should be adopted to reduce the seroprevalence of these infectious agents.

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AIM: The study was conducted to determine the prevalence of gastrointestinal (GI) parasites in cattle and sheep from three municipalities in the Colombian Northeastern Mountain. MATERIALS AND METHODS: Overall, 200 fecal samples were collected directly from the rectum in cattle and sheep. The presence of helminths eggs and coccidial oocysts in fecal samples was detected using McMaster and Dennis techniques. Identification of eggs or oocysts was done on the basis of morphology and size of the eggs or oocysts. RESULTS: The global prevalence of GI parasites was 56.3%. Regarding the prevalence by municipalities, there was no statistical association (p>0.05), indicating that the prevalence was similar in the three municipalities. The prevalence of parasitic infection was higher in sheep (63%) as compared to that of cattle (50.5%), but the difference was nonsignificant (p>0.05). The most prevalent parasites were Eimeria spp., Fasciola hepatica, and Strongylida order. Regarding the results for Eimeria spp., different degrees of positivity were observed, but there was no statistical association (p>0.05) with respect to the age group. Likewise, there was no statistical association (p>0.05) between the prevalence for Strongylida order and F. hepatica with respect to the age group. CONCLUSION: Cattle and sheep in Colombian Northeastern Mountain were infected with helminths and coccidia. The prevalence values of GI parasites were moderate in both species warranting treatment. The presence of F. hepatica represents a risk factor to health public. Future studies are required to evaluate the parasitic dynamics throughout the year and the impact on animal production.

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Resumen: El advenimiento de nuevos fármacos para el tratamiento de los distintos componentes del síndrome metabólico, que por su farmacocinética y farmacodinamia tengan un efecto pleiotrópico, ha tomado auge. Hace poco los inhibidores del cotransportador sodio glucosa tipo 2 (SGLT2) prescritos para el tratamiento de la diabetes mellitus 2 han demostrado tener un efecto protector cardiorrenal. Éstos actúan en el segmento S1 del túbulo proximal disminuyendo la filtración de glucosa e incrementando su excreción urinaria; con efecto glucosúrico y natriurético. Este último es el principal mecanismo de protección cardiovascular. Modelos experimentales y estudios, entre los que destacan el estudio EMPAREG y el programa CANVAS, han demostrado que los inhibidores de SGLT2 permiten disminuir la progresión de la miocardiopatía hipertrófica, fibrosis, remodelamiento, disfunción sistólica e insuficiencia cardiaca, por su efecto en la precarga y poscarga. Los resultados de estos estudios reconocen a este grupo de fármacos (específicamente a la empagliflozina y canagliflozina) como tratamiento de protección cardiovascular en pacientes con diabetes mellitus 2, recomendados actualmente por la FDA, ACC/AHA, la Sociedad Europea de Cardiología y recientemente por la Asociación Americana de Diabetes (ADA) en su reciente publicación de 2018.

Abstract: There is an increase in the use of new drugs for the treatment of the different elements that integrate the metabolic syndrome; that, by their pharmacokinetics and pharmacodynamics have a pleiotropic effect. Recently, the inhibitors of sodium glucose cotransporter type 2 (SGLT2) used for the treatment of diabetes mellitus type 2 have demonstrated a cardio-renal protector effect. They function at the S1 segment of the proximal tube, lowering the filtration of glucose and enhancing its excretion; resulting in a glycosuric and natriuretic effect. This is the main mechanism of cardiovascular protection. Experimental essays and different studies, such as the EMAREG study and the CANVAS program, have established that the inhibitors of SGLT2 reduce the progression of hypertrophic cardiomyopathy, fibrosis, cardiac remodeling, systolic dysfunction and heart failure. The results of these studies recognize this group of drugs (empaglifozine and canaglifozine) as a valid treatment for cardiovascular protection in patients with diabetes mellitus type 2, and which is recommended by the FDA, the ACC/AHA, the European Society of Cardiology and the American Diabetes Association (ADA) in its last publication in 2018.

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Objective: Identify percutaneous catheter-related complications in preterm and term newborns. Methods: Comparative cross-section. Were included newborns whit percutaneous catheter insertion, blood culture results and distal catheter segment. Were formed two groups: Preterm and term. Results: Were analyzed the data of preterm (n = 50) and term (n = 50) newborn, the gestational age was 30 ± 3 and 40 ± 2 (p = 0.01). The frecuency in preterm and term newborn was respectively, sepsis catheter 36 and 18% (p = 0.02; OR: 2.56; 95% CI: 1.02-7.17), infected catheter 50 and 22% (p = 0.01; OR: 5.92; 95% CI: 1.66-23.12), colonized catheter of 24 and 14% (p = 0.01; OR: 3.58; 95% CI: 1.32-9.90), local infection 14 and 8% (p = 0.03; OR: 1.87; 95% CI: 1.45-8.29), infiltration 18 and 4% (p = 0.02; OR: 5.27; 95% CI: 1.17-59), accidental removal 6 and 22% (p = 0.02; OR: 0.23; 95% CI: 0.05-0.87) and catheter rupture 10 and 28% (p = 0.02; OR: 0.29; 95% CI: 0.08-0.98). Conclusions: We found a higher association of infections and infiltrations by percutaneous catheter in preterm and term prevailed in accidental removal and catheter rupture.

Objetivo: Identificar las complicaciones asociadas al catéter percutáneo en recién nacidos pretérmino y a término. Método: Estudio transversal comparativo. Se incluyeron recién nacidos que tenían insertado un catéter percutáneo, con resultados de cultivo de sangre y segmento distal del catéter. Se formaron dos grupos: pretérmino y a término. Se calcularon la razón de momios (RM) y el intervalo de confianza del 95% (IC 95%). Resultados: Se analizaron datos de 50 recién nacidos por grupo. En los pretérmino y a término se encontró un valor de la media de edad gestacional de 30 ± 3 y 40 ± 2, respectivamente (p = 0.01), y unos porcentajes de sepsis por catéter del 36 y el 18% (p = 0.02; RM: 2.56; IC 95%: 1.02-7.17), de catéter infectado del 50 y el 22% (p = 0.01; RM: 5.92; IC 95%: 1.66-23.12), de catéter colonizado del 24 y el 14% (p = 0.01; RM: 3.58; IC 95%: 1.32-9.90), de infección local del 14 y el 8% (p = 0.03; RM: 1.87; IC 95%: 1.45-8.29), de infiltración del 18 y el 4% (p = 0.02; RM: 5.27; IC 95%: 1.17-59), de retiro accidental del 6 y el 22% (p = 0.02; RM: 0.23; IC 95%: 0.05-0.87) y de rotura del catéter del 10 y el 28% (p = 0.02; RM: 0.29; IC 95%: 0.08-0.98). Conclusiones: Se encontró mayor asociación de infecciones e infiltraciones por catéter percutáneo en los pretérmino, y de retiro accidental y rotura del catéter en los nacidos a término.

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OBJECTIVE: To determine the risk factors associated with the development of early neurological complications in purulent meningitis in a pediatric population. METHODS: This was a case-control study including 78 children aged one month to 16 years with purulent meningitis divided into two groups: cases, with early neurological complications (defined as those presenting < 72 hours from initiation of clinical manifestation), and controls, without early neurological complications. Clinical, serum laboratory, and cerebrospinal fluid (CSF). RESULTS: Seventy-eight patients were included: cases, n = 33, and controls, n = 45. Masculine gender, 19 (57%) vs. feminine gender, 28 (62%) (p = 0.679). Median age in months, 36 months (range, 1-180) vs. 12 months (range, 1-168) (p = 0.377). Factors associated with neurological complications: convulsive crises on admission, p = 0.038, OR, 2.65 (range, 1.04-6.74); meningeal signs, p = 0.032, OR, 2.73 (range, 1.07-6.96); alteration of the alert state, p = 0.003, OR, 13.0 (range, 1.64-105.3); orotracheal intubation, p = 0.000, OR, 14.47 (range, 4.76-44.01); neurological deterioration, p = 0.000, OR, 9.60 (range, 3.02-30.46); turbid CSF, p = 0.003, OR, 4.20 (range, 1.57-11.20); hypoglycorrhachia, < 30 mg/dl, p = 0.001, OR, 9.2 (range, 3.24-26.06); and positive CSF culture, p = 0.001, OR, 16.5 (range, 1.97-138.1). CONCLUSIONS: The factors associated with early neurological complications included convulsive crises on admission, meningeal signs, alteration of the alert state, need for orotracheal intubation, turbid CSF, hypoglycorrhachia, and positive CSF culture.

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BACKGROUND: The importance of hyponatremia is underestimated despite it is a frequent alteration in a hospital environment. Usually no cause is investigated and it is treated as an isolated data. The aim was to determine the prevalence and etiology of hyponatremia in pediatric patients. METHODS: Cross-sectional study of 72 patients from 1-month to 15-years of age admitted to the emergency room, from May to September, 2015, with lower serum determination of Na < 135 mEq/L at admission. For statistical analysis, frequencies and percentages, as well as medians and ranges were used. RESULTS: 72 patients (3%) out of 2400 admissions to the emergency room were detected. 42 were male (58%), 28 infant (30.5%), and 46 eutrophic (68.5%). The diagnosis at admission was sepsis in 13 (18%), mild hyponatremia in 41 (56.9%), real hyponatremia in 71 (98.6%) and dilutional in 1 (1.4%). The median serum sodium was 130 mEq/L (range 112-134), and the median serum osmolality 266 mOsm/L (range 236-288). The most usual management was the increase of sodium in solutions in 21 cases (29%), and the use of diuretics (n = 21, 29%). The median of sodium input per m2 (BSA) per day was 45 mEq (range 0-158). CONCLUSIONS: Mild and real hyponatremia were the most frequent diagnoses. The infection at admission was the more common etiology. The increase in sodium input in solution was the most common management. The use of intravenous solutions 2:1 (isotonic) did not produce hypernatremia and avoided administration of hypotonic solutions.

Introducción: la importancia de la hiponatremia es subestimada a pesar de ser una alteración frecuente en el medio hospitalario. Habitualmente no se investiga su causa y se trata como dato aislado. Se buscó determinar la prevalencia de hiponatremia y su etiología en pacientes en urgencias pediátricas. Métodos: estudio transversal en 72 pacientes de un mes a 15 años ingresados de mayo a septiembre de 2015 en urgencias con determinación sérica de Na < 135 mEq/L a su ingreso. Para la estadística se emplearon frecuencias y porcentajes, medianas y rangos. Resultados: se detectaron 72 pacientes de 2400 ingresos a urgencias (3%). Fueron varones 42 (58%), 28 lactantes (30.5%) y 46 eutróficos (68.5%). El diagnóstico de ingreso fue de sepsis en 13 (18%), hiponatremia leve en 41 (56.9%), real (hipoosomolar) en 71 (98.6%) y dilucional en 1 (1.4%). La mediana del sodio sérico fue de 130 mEq/L (rango 112-134) y la de la osmolaridad sérica de 266 mOsm/L (rango 236-288). El manejo más frecuente fue el incremento del aporte de sodio en soluciones en 21 casos (29.1%) y el uso de diuréticos en 21 (29%). La mediana del aporte de sodio por m2 SCT al día fue de 45 mEq (rango 0-158). Conclusiones: la hiponatremia leve y la hipoosomolar fueron las más frecuentes. El diagnóstico de origen infeccioso fue la causa más común. El incremento en el aporte de sodio en soluciones fue el manejo más habitual. El uso de soluciones intravenosas 2:1 (isotónicas) no produjo hipernatremia y evitó la administración de soluciones hipotónicas.

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BACKGROUND: Ventilator-associated pneumonia (VAP) represents the second cause of nosocomial infections and it is associated with greater morbility, duration of mechanical ventilation (MV), and hospital stay. The objective was to determine factors related with VAP in neonates. METHODS: Analytical transversal study including newborns admitted already intubated with at least 48 hours of MV or who were intubated in Neonatal Therapy. VAP was defined according to the criteria of the Centers for Disease Control and Prevention: "those patients submitted to MV during at least 48 hours". We used inferential statistics for statistical analysis (chi squared, Mann-Whitney U test, and Kaplan-Meier estimator). RESULTS: 82 neonates were studied, out of which 27 developed VAP (33%). The median time to develop pneumonia was 6 days (range 5-11). The most commonly isolated germ was Escherichia coli (27%). Statistically significant variables were gestational age (p = 0.05), and the use of antacids at admission (p = 0.007). Patients with pneumonia had longer hospital stay (p = 0.001) and time with MV (p = 0.002). Of all the patients, 22 neonates died (27%), of which nine patients had VAP. CONCLUSION: Risk factors for VAP in neonates include lower gestational age, the use of antacids, and prolonged MV.

Introducción: la neumonía asociada a ventilación mecánica (NAVM) representa la segunda causa de infección nosocomial y se asocia con una mayor morbilidad, duración de ventilación mecánica (VM) y estancia hospitalaria. El objetivo fue determinar los factores asociados a NAVM en neonatos. Métodos: estudio transversal analítico en el que se incluyeron recién nacidos que ingresaron intubados con menos de 48 horas de VM o que se intubaron en terapia neonatal. Se definió la NAVM, según los criterios de los Centros para el Control y la Prevencion de Enfermedades (CDC), como "aquella infección nosocomial diagnosticada en pacientes sometidos a VM durante al menos 48 horas". Se empleó estadística inferencial para el análisis estadístico. Resultados: se estudiaron 82 neonatos, desarrollaron NAVM 27 (33%). La mediana del desarrollo de neumonía fue de seis días (rango 5-11). El germen aislado más común fue la Escherichia coli (27%). Las variables estadísticamente significativas fueron la edad gestacional (p = 0.05) y el uso de antiácidos al ingreso (p = 0.007). Los pacientes con neumonía tuvieron mayor tiempo de estancia hospitalaria (0.001) y tiempo con VM (p = 0.002). Murieron 22 neonatos en población general (27%), de los cuales nueve eran pacientes con NAVM. Conclusión: los factores de riesgo para NAVM incluyen menor edad gestacional, antiácidos y ventilación mecánica prolongada.

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BACKGROUND: Retinopathy of prematurity (ROP) is a potentially blinding, retinal neovascular disease. Systemic prolactin accesses the retina to regulate blood vessels. Prolactin is proangiogenic and can be cleaved to antiangiogenic vasoinhibins. We investigated whether circulating prolactin and vasoinhibins associate with incidence and progression of ROP. METHODS: A prospective, longitudinal, case-control study covering postnatal weeks 1 to 9 measured serum prolactin, vasoinhibins, and vascular endothelial growth factor (VEGF) weekly in 90 premature infants diagnosed as ROP or control. RESULTS: Prolactin levels were higher in ROP than in control patients before (106.2 ± 11.3 (SEM) vs. 64.7 ± 4.9 ng/ml, postnatal week 1) and during (120.6 ± 10 vs. 84.7 ± 7.5ng/ml, postnatal week 5) ROP diagnosis. Prolactin, but not gestational age, birth weight, Apgar score, sepsis, or ventilation time, correlated with ROP. The relative risk (RR) of developing ROP increased if Prolactin (PRL) levels were higher than thresholds of 80 ng/ml (RR = 1.55, 95% CI: 1.06-2.28), 100 ng/ml (RR = 1.63, 95% CI: 1.14-2.34), or 120 ng/ml (RR = 1.95, 95% CI: 1.41-2.68). Vasoinhibin levels were 39.7% higher (95% CI: 4.5-77.5) in the circulation of ROP than in control patients at postnatal week 1 and similar thereafter, whereas VEGF serum levels were always similar. CONCLUSION: High serum prolactin and vasoinhibin levels predict and may impact ROP progression.

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BACKGROUND: Estimation of the neurological prognosis of infants suffering from perinatal asphyxia and signs of hypoxic-ischemic encephalopathy is of great clinical importance; however, it remains difficult to satisfactorily assess these signs with current standard medical practices. Prognoses are typically based on data obtained from clinical examinations and neurological tests, such as electroencephalography (EEG) and neuroimaging, but their sensitivities and specificities are far from optimal, and they do not always reliably predict future neurological sequelae. In an attempt to improve prognostic estimates, neurological research envisaged various biochemical markers detectable in the umbilical cord blood of newborns (NB). Few studies examining these biochemical factors in the whole blood of newborns exist. Thus, the aim of this study was to determine the expression and concentrations of proinflammatory cytokines (TNF-α, IL-1ß and IL-6) and specific CNS enzymes (S-100 and enolase) in infants with perinatal asphyxia. These data were compared between the affected infants and controls and were related to the degree of HIE to determine their utilities as biochemical markers for early diagnosis and prognosis. METHODS: The levels of the proinflammatory cytokines and enzymes were measured by enzyme-linked immunosorbent assay (ELISA) and Reverse Transcription polymerase chain reaction (RT-PCR). RESULTS: The expression and serum levels of the proinflammatory cytokines, enolase and S-100 were significantly increased in the children with asphyxia compared with the controls. CONCLUSION: The role of cytokines after hypoxic-ischemic insult has been determined in studies of transgenic mice that support the use of these molecules as candidate biomarkers. Similarly, S-100 and enolase are considered promising candidates because these markers have been correlated with tissue damage in different experimental models.

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OBJECTIVE: To identify the prevalence of depression in Mexican pediatric patients with systemic lupus erythematosus. MATERIALS AND METHODS: Analytical transversal study including patients aged 7-16 years with a diagnosis of systemic lupus erythematosus seen at the Pediatric Rheumatology Consultation Service. The disease was classified by means of the MEX-SLEDAI questionnaire. Descriptive statistics with central tendency and dispersion and comparative measurements with chi-squared and Mann-Whitney U tests. Logistic regression and association with odds ratios. SPSS v.21.0 statistical software package. RESULTS: We evaluated 45 patients who presented depression, n=9 (20%), including eight females (89%) and one male (11%), median age 13 years (range, 7-16) in children with depression vs. 13 years (range, 9-14) p=0.941, depression more frequent in schoolchildren. Habitual residence, disease evolution time, and duration of the immunosuppressor did not show a significant difference between both groups. Divorced parents p=0.037. Neuropsychiatric manifestations of lupus presented in 2.2% of all patients and in 100% of patients with depression. Disease activity index (MEX-SLEDAI) did not demonstrate a relationship with the presence of depression. CONCLUSION: Prevalences in pediatric populations are less that that reported in adults, association with disease activity, evolution time, and immunosuppressor use and duration not found.

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BACKGROUND: Augmentation cystoplasty is a successful surgical procedure for the management of neurogenic bladder in children in order to improve urodynamic parameters. The aim of this article is to describe urodynamic changes after augmentation cystoplasty in children with myelomeningocele. MATERIALS AND METHODS: A descriptive cross-sectional study including children aged 8-16 years with a myelomeningocele operated on for augmentation cystoplasty surgery with sigmoid colon segments due to a neurogenic bladder from the years 2003-2013. A urodynamic study was conducted before and after the surgical procedure. Non-probabilistic sample of consecutive cases. Descriptive statistics with frequencies and percentages, medians, and ranges. Inferential intra-group comparison with the Wilcoxon test and inter-group with Mann-Whitney U. SPSS 20.0 statistical package. RESULTS: The study included 50 patients, of whom 25 were male and 25 were female, with a median age of 12 years (range, 6-15 years). Bladder capacity improved from 52.8% to 95.9% (p<0.001), uninhibited contractions 1.4-1.8, contraction intensity 47-8.5 (p<0.001), mean pre-surgical and post-surgical filling pressure 40.8cm H2O and 11.0cm H2O, respectively (p<0.001), mean emptying pressure 48.5 vs. 3.6cm H2O (p<0.001), and bladder accommodation 4.6 vs. 41.3cm H2O (p<0.001). CONCLUSIONS: Augmentation cystoplasty with sigmoid colon significantly improved urodynamic parameters, such as bladder accommodation and filling pressure in children with myelomeningocele-associated neurogenic bladder.

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OBJECTIVE: To assess the level of knowledge of and capability for application of isolation precautions. MATERIALS AND METHODS: A cross-sectional study was conducted at a tertiary-level pediatric hospital, and a questionnaire including structured questions and clinical scenarios was applied to healthcare personnel. Descriptive and inferential statistics were performed with the chi-squared test and odds ratios were obtained. RESULTS: A total of 131 healthcare workers participated in the study, including 34 (26%) attending physicians, 47 (36%) medical residents, 48 (37%) nurses, and 2 (1%) physicians who were heads of the department. According to our definition, 99 (75%) had poor, 22 (17%) had fair, and 10 (8%), good knowledge. With regard to the capability for application of isolation precautions, 66 (51%), 33 (25%), and 32 (24%) possessed poor, fair, and good levels, respectively. Association with poor knowledge was exhibited as follows: physicians, OR: 0.17 (0.005-0.54), p = 0.001; undergraduate degree in medicine, OR: 0.37 (0.16-0.83), p = 0.01; seniority < 5 years, OR: 0.35 (0.14-0.86), p = 0.019, and training during previous year, OR: 0.09 (0.03-0.24), p = 0.005, while association with poor capability was the following; physician, OR: 0.25 (0.12-0.55), p = 0.005; undergraduate degree in medicine, OR: 0.38 (0.18-0.80), p = 0.009; seniority < 5 years, OR: 0.90 (0.45-1.81), p = 0.78, and training during previous year, OR: 0.23 (0.10-0.51), p = 0.005. CONCLUSIONS: Being a physician, having an undergraduate degree in medicine, < 5 years working at the hospital, and having received training in the previous year were positively associated with knowledge and application of isolation precautions.

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OBJECTIVE: To determine risk factors associated with bacterial growth in systems derived from cerebrospinal fluid in pediatric patients. METHODS: Case and controls study from January to December 2012, in patients aged <16 years who were carriers of hydrocephalus and who required placement or replacement of derivative system. Cases were considered as children with cultures with bacterial growth and controls with negative bacterial growth. Inferential statistics with Chi-squared and Mann-Whitney U tests. Association of risk with odds ratio. RESULTS: We reviewed 746 registries, cases n=99 (13%) and controls n=647 (87%). Masculine gender 58 (57%) vs. feminine gender 297 (46%) (p=0.530). Age of cases: median, five months and controls, one year (p=0.02). Median weight, 7 vs. 10 kg (p=0.634). Surgical interventions: median n=2 (range, 1-8) vs. n=1 (range, 1-7). Infection rate, 13.2%. Main etiology ductal stenosis, n=29 (29%) vs. n=50 (23%) (p=0.530). Non-communicating, n=50 (51%) vs. 396 (61%) (p=0.456). Predominant microorganisms: enterobacteria, pseudomonas, and enterococcus. Non-use of iodized dressing OR=2.6 (range, 1.8-4.3), use of connector OR=6.8 (range, 1.9-24.0), System replacement OR=2.0 (range, 1.3-3.1), assistant without surgical facemask OR=9.7 (range, 2.3-42.0). CONCLUSIONS: Being a breastfeeding infant, of low weight, non-application of iodized dressing, use of connector, previous derivation, and lack of adherence to aseptic technique were all factors associated with ependymitis.

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OBJECTIVE: To describe the results of percutaneous closure by means of the Amplatzer Septal Occluder (ASO) device in pediatric patients with intra-auricular communication (IAC). MATERIALS AND METHODS: Descriptive transversal study in patients submitted to percutaneous closure of IAC from March 2005 to March 2013. Patients aged <16 years, weight>6 kg, IAC type ostium segundum, and patent foramen ovale, with border separations borders>5 mm, and absence of coexisting pathology were included in the study. We excluded from the study children with severe pulmonary blood pressure/arterial hypertension. Descriptive statistics with the SPSS v. 20.0 statistical software package. RESULTS: We included in the study 28 patients, feminine gender (n=19, 68%), median age=8 years (range, 4-14), weight 30.7 kg (range, 15-69). New York Heart Association (NYHA) functional class I (n=21, 75%), II (n=7, 25%). Median IAC size, 15.50 mm (range, 5-25), and a median ASO size of 17.54 mm (range, 8-28). After ASO placement, 100% presented NYHA I at one month, cardiac murmur (n=2, 7.1%), cessation of cardiac murmur at month 6 (n=28, 100%), without evidence of arrhythmias at one month 100%, residual short circuit at 24 hours (n=4, 14%), complete occlusion at month 6 (n=28, 100%), normalization size of VD, and cessation of tricuspid insufficiency 100% at one year. Complications included minimal bleeding during the procedure (n=2, 7%), transitory cephalea (n=5, 18%), and dysautonomia (n=1, 4%). CONCLUSION: Percutaneous closure of IAC of children fitted with the ASO device is safe and exhibits good results.

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