Lesión renal aguda en niños poscirugía cardíaca: factores de riesgo e impacto evolutivo. Estudio de cohorte retrospectiva / Acute kidney injury in children after cardiac surgery: Risk factors and outcomes. A retrospective, cohort study

Introducción. La lesión renal aguda (LRA) ha sido descrita como una complicación frecuente de las cirugías cardíacas en pacientes pediátricos, con impacto documentado en la morbimortalidad. Se estima una incidencia de alrededor del 40 % en este grupo de pacientes. El objetivo del trabajo fue calcular la incidencia de LRA en pacientes que tuvieron cirugía cardiovascular, definir los factores de riesgo asociados y el impacto de la LRA en los parámetros de evolución posquirúrgica.Población y métodos:Se realizó un estudio retrospectivo observacional sobre pacientes pediátricos con cirugías cardiovasculares, operados entre enero de 2015 y diciembre de 2017 en el Hospital Británico de Buenos Aires. Se definió la incidencia de LRA según los criterios de Kidney Disease: Improving Global Outcomes, considerando los valores de creatininemia y ritmo diurético pre- y posquirúrgicos.Resultados.Se incluyeron un total de 125 pacientes. Un 35 % desarrolló LRA. Al analizar los factores de riesgo, se observó una diferencia estadísticamente significativa para administración de vancomicina, diuréticos tiazídicos, requerimiento transfusional de glóbulos rojos, tiempo de bomba de circulación extracorpórea, de clampeo, lactato máximo intraquirúrgico, temperatura mínima y cierre diferido del tórax. Entre los parámetros de evolución posquirúrgica, se observó un incremento en la duración de la internación, requerimiento de inotrópicos, días de asistencia respiratoria mecánica, sangrado y complicaciones neurológicas.Conclusión. La incidencia de LRA en este estudio fue del 35 %. Se pudieron definir factores de riesgo modificables y no modificables asociados, y se detectó una mayor incidencia de complicaciones en aquellos pacientes que desarrollaron LRA

Introduction. Acute kidney injury (AKI) has been described as a common complication of cardiac surgery in pediatric patients, whose impact on morbidity and mortality has been documented. Its incidence has been estimated to be approximately 40 % in this patient group. The objective of this study was to estimate the incidence of AKI in patients who underwent cardiovascular surgery and to define associated risk factors and the impact of AKI on the parameters of the post-operative course.Population and methods. This was a retrospective, observational study of pediatric patients who underwent cardiovascular surgery between January 2015 and December 2017 at Hospital Británico de Buenos Aires. The incidence of AKI was defined as per the Kidney Disease: Improving Global Outcomes criteria, based on pre- and post-operative blood creatinine levels and urine output.Results. A total of 125 patients were included. Of them, 35 % developed AKI. The analysis of risk factors showed a statistically significant difference for the administration of vancomycin and thiazide diuretics, red blood cell transfusion requirement, extracorporeal circulation pump time, clamp time, maximal intraoperative lactate level, minimum temperature, and delayed chest closure. In relation to the parameters of the post-operative course, we observed a longer hospital stay, higher inotropic requirement, more days of mechanical ventilation, bleeding, and neurological complications.Conclusion. In this study, the incidence of AKI was 35 %. Modifiable and non-modifiable associated risk factors were defined and a greater rate of complications was observed in patients who developed AKI.

Epidemiología y clínica de las metástasis cutáneas en un hospital de Lima-Perú: Período 1996-2006 / Epidemiology and clinics of cutaneous metastases in a hospitalfrom LimaûPeru. Period 1996-2006

OBJETIVO: Determinar las características epidemiológicas y clínicas de las metástasis cutáneas en el Hospital Nacional EsSalud Edgardo Rebagliati Martins (HNERM) en el período 1996-2006. MATERIAL Y MÉTODOS: Estudio descriptivo de tipo serie de casos. La población de estudio estuvo constituida por los pacientes con diagnóstico de metástasis cutánea en el HNERM entre los años 1996 y 2006; no se realizó muestreo por ser la población pequeña y accesible. Los pacientes fueron seleccionados de acuerdo a criterios de inclusión y exclusión. Se revisó las historias clínicas de los pacientes obteniéndose las características epidemiológicas, clínicas, histopatológicas y supervivencia. RESULTADOS: Se diagnosticó 51 casos de metástasis cutáneas. La edad promedio fue de 65.0 ±15.4 años, el 58.8% correspondió al sexo femenino y el 41.2% al sexo masculino. El 29.4% se situó entre los 70-79 años, el 31.4% tenía diagnóstico previo de cáncer y el 23.5% tenía antecedentes familiares de cáncer. Se diagnosticó la metástasis cutánea antes que la neoplasia maligna primaria en el 67%. Las metástasis tuvieron origen en neoplasias dermatológicas en el 51.0% y en tumores de órganos sólidos en el 49.0% (cánceres de mama, riñón y vejiga). Los pacientes acudieron a consulta por presentar lesiones de tipo nódulo (31.4%) y tumor (9.8%). Las metástasis se localizaron en los varones predominantemente en el tórax posterior (19.0%) y en las piernas (14.3%); mientras que, en el tórax anterior (46.7%) y cuero cabelludo (23.3%) en las mujeres. La mediana de la supervivencia fue de 5.6 años. CONCLUSIONES: En el HNERM las metástasis cutáneas se presentan a edades avanzadas, predominan las de origen hematológico así como las originarias de mama y con frecuencia constituyen el primer signo para la identificación de una neoplasia oculta. Es relevante el antecedente familiar de neoplasia en los pacientes.

OBJECTIVES: To determine the clinical and epidemiology characteristics of cutaneous metastases at Hospital Nacional EsSalud Edgardo Rebagliati Martins during 1996-2006. MATERIALS AND METHODS: Descriptive study of cases series. The study population was constituted by patients with diagnoses of cutaneous metastases attended in the Hospital Edgardo Rebagliati Martins Essalud between 1996 and 2006; sampling was not performed because of population was small and accessible. Patients were selected in accordance with inclusion and exclusion criteria. Clinical past histories of patients were revised obtaining the next clinical, epidemiology and histopathology characteristics. Data obtained was registered in an instrument of data recollection and became part of a database. RESULTS: A total of 51 cutaneous metastases cases were diagnosed. The mean age of patientswas 65.0 ± 15.4 years, 58.8% corresponded female and the remaining 41.2% were male. The higher frequency was in patients between 70-79 years (29.4%), 31.4 % had previous diagnoses of cancer and 23.5% had family history of cancer (mainly father and brother). Cutaneous metastases were diagnosed before primary malignant neoplasea in 67% of patients. Metastases originated in hematological malignancies in 51.0% of cases and solid organ tumors in the remaining 49.0%. Solid organ tumors that most often gave rise to cutaneous metastases were breast, kidney and bladder. The patients attended mainly consulted for nodule like lesions (31.4%) and tumor (9.8%). Metastases were located predominantly in men in the posterior thorax (19.0%) and legs (14.3%), while in the anterior thorax (46.7%) and scalp (23.3%) in women. CONCLUSIONS: In the Hospital Nacional Edgardo Rebagliati, cutaneous metastases occur in later life, predominantly hematologic origin and those originating in breast and are often the first sign for the identification of occult neoplasy. It is relevant the family history of neoplasia in patients.

Impetigo herpetiforme: reporte de un caso / Impetigo herpetiformis: a case report

El impétigo herpetiforme es una rara dermatosis pustular no infecciosa que se presenta en el embarazo especialmente en el último trimestre. Describimos el caso de una gestante primigesta, de 21 años quien presentó en el último trimestre compromiso cutáneo, que inicia en palma de manos, antebrazo, miembros inferiores y abdomen, tratado con prednisona a 30 mg/dia con buena evolución tanto para la madre y el producto Se presenta el caso por ser inusual y se revisa la literatura.

Impetigo herpetiformis is a rare non-infectious pustular dermatosis that occurs in pregnancy, especially in the last quarter. We describe the case of a pregnant primigravida, aged 21 who presented in the last quarter cutaneou sinvolvement, which began in palm of hands, forearms, lower limbs and abdomen, treated with prednisone at 30 mg / day with a good outcomefor both mother and the product.

Micosis fungoide granulomatosa con linfadenopatías sarcoidales no neoplasicas: reporte de caso y revisiónde literatura / Granulomatous mycosis fungoides associated to sarcoid-like limphadenopathies non neoplasic

Presentamos el caso de una paciente mujer quien desarrolla un episodio de eritrodermia y adenopatías, luego de muchos años, lesiones localizadas en placa compatibles con micosis fungoide granulomatosa presentando una reacción granulomatosa sarcoidal en ganglios durante un periodo de remisión de la enfermedad. La extensión extra cutánea se puede observar en un tercio de los pacientes con micosis fungoide yse asocia a transformación a linfoma anaplásico de células grandes CD30. Otras explicaciones al desarrollo de granulomas sarcoideos son: el desarrollo de sarcoidosis concomitante, asociada o no al linfoma y reacciones sarcoidosis like (en respuesta a antígenos o citoquinas tumorales; en relacióna drogas como la bleomicina, contraste). Algunos autores proponen la existencia de un síndrome linfoma sarcoidosis caracterizado por sarcoidosis activa crónica que inicia el cuadro linfoproliferativo luego de la sarcoidosis. En el caso de nuestra paciente se desarrollan las adenopatías durante un periodo de remisión de la enfermedad en las que no se observa infiltración linfomatoide neoplasica, esto nos orienta a pensar que se trata de una reacción sarcoidosis like ganglionar secundaria a la liberación de citoquinas y antígenos tumorales luego de la radioterapia o que podría tratarse de un caso de sarcoidosisasociada incipiente.

Here we report the case of a female patient who developed an episode of eritrodermia and adenopathies, after many years focus injuries in plate compatible with granulomatous mycosis fungoides presenting a granulomatous sarcoid reaction in ganglia during the sickness remission period. The extra cutaneous extension can be present in one third of the patients with mycosis fungoides and associated with the big cells CD 30+ anaplastic large cell lymphoma. Other explanations to the granulomatous sarcoides development are: the sarcoidosis consistent development, associated or not to the lymphoma and reactions sarcoidosis-like (in response to antigens or tumoral cytokines; related to drugs like bleomicine, contrast). Some authors propose the existence of a syndrome sarcoidosislymphoma characterized by chronic active sarcoidosis that starts the lymphoproliferative scheme after the sarcoidosis. In our case, the patient develops the adenopathies during a sickness remission period which does not show neoplasic lymphomatoid infiltration; that suggest being a sarcoidosis reaction like ganglionar secondary to the cytokines and tumoral antigens liberation after radiotherapy that mey be a incipient case of sarcoidosis associated. Here we report the case of a female patient who developed an episode of eritrodermia and adenopathies, after many years focus injuries in plate compatible with granulomatous mycosis fungoides presenting a granulomatous sarcoid reaction in ganglia during the sickness remission period. The extra cutaneous extension can be present in one third of the patients with mycosis fungoides and associated with the big cells CD 30+ anaplastic large cell lymphoma. Other explanations to the granulomatous sarcoides development are: the sarcoidosis consistent development, associated or not to the lymphoma and reactions sarcoidosis-like (in response to antigens or tumoral cytokines; related to drugs like bleomicine, contrast). Some authors propose the existence of a syndrome sarcoidosis-lymphoma characterized by chronic active sarcoidosis that starts the lymphoproliferative scheme after the sarcoidosis. In our case, the patient develops the adenopathies during a sickness remission period which does not show neoplasic lymphomatoid infiltration; that suggest being a sarcoidosis reaction like ganglionar secondary to the cytokines and tumoral antigens liberation after radiotherapy that mey be a incipient case of sarcoidosis associated.

Calidad de vida en niños mexicanos con fibrosis quística / Quality of life in mexican children with cystic fibrosis

Our interest was to determine the quality of life of mexican children who attended to the National Institute of Pediatrics in Mexico City. A comparative, observational, descriptive and retrospective study was done in children diagnosed with cystic fibrosis with ages between 5 to 18 years. The FQ Mex scale was administered to each child in order to determine their quality of life. A comparison with children without cystic fibrosis was done. Twelve boys and 6 girls with cystic fibrosis were included and 9 healthy children were enrolled as controls. A statistical difference was found between both groups in the FQ Mex scale (p<0.05) for the respiratory area which did not occur with the infectious, gastrointestinal, genitourinary and nutritional aspects. The most probable explanation that it is easier to control these clinical areas with antibiotics and pancreatic enzymes than the respiratory symptoms. The FQ Mex scale is a useful instrument that provides a good idea of the quality of life in children with cystic fibrosis