Acidosis metabólica neonatal por síndrome de enterocolitis inducido por proteína de alimentos: reporte de caso / Neonatal metabolic acidosis caused by food proteininduced enterocolitis syndrome: a case report

El síndrome de enterocolitis inducido por proteínas de los alimentos (FPIES, por su sigla en inglés) es una reacción alérgica no mediada por inmunoglobulina E (IgE) con síntomas gastrointestinales, como vómitos y diarrea. El diagnóstico se basa en criterios clínicos y en una prueba de provocación para confirmarlo. Es una enfermedad desconocida en las unidades neonatales, debido a la inespecificidad de los síntomas en los recién nacidos. La cifra de metahemoglobina elevada es una opción sencilla de aproximación diagnóstica. Se describe el caso clínico de un recién nacido que ingresa al servicio de urgencias por deshidratación, letargia, vómitos, diarrea y acidosis metabólica grave con elevación de metahemoglobina, con mejora clínica y recuperación total tras el inicio del aporte de fórmula elemental. La sospecha diagnóstica se confirmó tras la prueba de provocación positiva.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated allergic reaction with gastrointestinal symptoms, such as vomiting and diarrhea. FPIES diagnosis is based on clinical criteria and on a food challenge test. It is an unknown disease in neonatal units due to its nonspecific symptoms in newborn infants. An elevated methemoglobin level is a simple way to approach diagnosis. Here we describe a clinical case of a newborn admitted to the emergency department because of dehydration, lethargy, vomiting, diarrhea, severe metabolic acidosis, and a high methemoglobin level. Clinical improvement and complete recovery was achieved after initiation of elemental formula. The diagnostic suspicion was confirmed after a positive challenge test.

Analysis of the clinical characteristics and misdiagnosis of area postrema syndrome manifesting as intractable nausea, vomiting, and hiccups in neuromyelitis optica spectrum disorders / 中华内科杂志

Objective: To investigate the misdiagnosis of area postrema syndrome (APS) manifesting as intractable nausea, vomiting and hiccups in neuromyelitis optic spectrum disease (NMOSD) and reduce the risk of misdiagnosis. Methods: We retrospectively analyzed data from NMOSD patients attending the Department of Neurology at the First Medical Center of PLA General Hospital between January 2019 and July 2021. SPSS25.0 was then used to analyze the manifestations, misdiagnosis, and mistreatment of APS. Results: A total of 207 patients with NMOSD were included, including 21 males and 186 females. The mean age of onset was 39±15 years (range: 5-72 years). The proportion of patients who were positive for serum aquaporin 4 antibody was 82.6% (171/207). In total, 35.7% (74/207) of the NMOSD patients experienced APS during the disease course; of these patients, 70.3% (52/74) had APS as the first symptom and 29.7% (22/74) had APS as a secondary symptom. The misdiagnosis rates for these conditions were 90.4% (47/52) and 50.0% (11/22), respectively. As the first symptom, 19.2% (10/52) of patients during APS presented only with intractable nausea, vomiting and hiccups; 80.8% (42/52) of patients experienced other neurological symptoms. The Departments of Gastroenterology and General Medicine were the departments that most frequently made the first diagnosis of APS, accounting for 54.1% and 17.6% of patients, respectively. The most common misdiagnoses related to diseases of the digestive system and the median duration of misdiagnosis was 37 days. Conclusions: APS is a common symptom of NMOSD and is associated with a high rate of misdiagnosis. Other concomitant symptoms often occur with APS. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing physical examinations are essential if we are to reduce and avoid misdiagnosis.

Enterite mesentérica como complicação rara do lúpus eritematoso sistêmico / Mesenteric enteritis as a rare complication of systemic lupus erythematosus

A dor abdominal no paciente com lúpus eritematoso sistêmico tem amplo espectro clínico, variando desde condições inespecí- ficas, como diarreia e vômitos, até eventos de importante morbi- mortalidade, como o abdome agudo inflamatório e/ou perfura- tivo. A seguir, descreve-se um caso de paciente do sexo feminino, de 23 anos, internada por dor abdominal associada a vômitos e à diarreia crônica e progressiva. Foi diagnosticada com lúpus eritematoso sistêmico há 2 anos. Durante a internação, evoluiu com quadro de abdome agudo, e foi realizada tomografia compu- tadorizada de abdome, revelando importante edema de parede intestinal difuso. Isso, somado a alterações clínico-laboratoriais, permitiu o diagnóstico de enterite lúpica. Foi realizado tratamen- to conservador, com corticoterapia e terapia de suporte com correção de distúrbios eletrolíticos severos, sendo iniciado ciclo- fosfamida, com resolução dos sintomas gastrintestinais.

Abdominal pain in patients with systemic lupus erythematosus has a broad clinical spectrum, ranging from nonspecific symp- toms, such as diarrhea and vomiting, to events of significant morbidity and mortality, such as acute inflammatory and/or per- forating abdomen. This article describes a case of a 23-year-old female patient hospitalized for abdominal pain, associated with vomiting and progressive chronic diarrhea. She was diagnosed with systemic lupus erythematosus 2 years ago. During hospita- lization, the patient progressed with acute abdomen, and an ab- dominal computed tomography scan was performed, revealing major diffuse intestinal wall edema. This, added to clinical and laboratories alterations, allowed the diagnosis of lupus enteritis. A conservative treatment with corticotherapy and supportive therapy with correction of severe electrolyte disturbances were initiated, as well as the prescription of cyclophosphamide, with resolution of gastrointestinal symptoms.

Alterações gastrointestinais durante o acompanhamento nutricional de pacientes oncológicos em acompanhamento ambulatorial de quimioterapia / Gastrointestinal changes during nutritional follow-up of cancer patients undergoing outpatient chemotherapy

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.

Cefaleia sentinela: um quadro presente, mas pouco lembrad / Sentinel headache: present, but poorly remembered

Esta revisão narrativa da literatura tratou da cefaleia sentinela. A cefaleia é um acometimento de alta prevalência mundial, sobretudo em mulheres. São várias as condições que podem levar à sua ocorrência, destacando-se, entre elas, a hemorragia subaracnóidea, que é sabidamente a terceira maior causa de acidente vascular encefálico. No âmbito da hemorragia subaracnóidea, existe um sintoma que, por vezes, é ignorado na investigação clÍnica do acidente vascular encefálico: é a cefaleia sentinela. Ela é conceituada como sendo cefaleia súbita, não usual, do tipo explosiva, persistente e de menor intensidade que a dor de cabeça da hemorragia subaracnóidea. Geralmente precede a hemorragia subaracnóidea por dias ou semanas. Este manuscrito traz uma revisão narrativa da literatura sobre cefaleia sentinela, usando as bases de dados PubMed® e Literatura Latino-Americana e do Caribe em Ciências da Saúde. A prevalência dessa condição é de 10% a 43% na hemorragia subaracnóidea, podendo ser fator preditor na identificação precoce do paciente com risco para sangramento aneurismático. Torna-se, então, necessária tanto a educação médica como a atuação precisa acerca do tema, a fim de mudar os desfechos da hemorragia subaracnóidea.

This narrative review of the literature addressed the sentinel headache. headaches are of high prevalence worldwide, especially in women. Several conditions can lead to its occurrence, such as the subarachnoid hemorrhage (known to be the third main cause of stroke). In the context of subarachnoid hemorrhage, there is a symptom that is sometimes overlooked in the clinical investigation of stroke: the sentinel headache. It is conceptualized as sudden, unusual, of explosive nature, persistent and of lesser intensity than the subarachnoid hemorrhage headache. It usually precedes the subarachnoid hemorrhage by days or weeks. This study provides a narrative review of the literature on sentinel headache, using the PubMed® and Latin American and Caribbean Health Sciences Literature databases. The prevalence of this condition in subarachnoid hemorrhage is 10 - 43%, and may be a predictive factor in the early identification of the patient with risk for aneurysmal bleeding. Both medical education and accurate action on this issue are necessary to change the outcomes of subarachnoid hemorrhage.

Vomiting in newborns as a result of a duodenal membrane: two case reports / Episódios de vômitos em recém-nascidos como consequência de membrana duodenal: relatos de dois casos

ABSTRACT Vomiting episodes in newborns are extremely common and often attributed to gastroesophageal reflux. The symptoms of vomiting, however, may be caused by other complications. In this report, we present two cases of a 1-month-old male and a 2-month-old female, both presenting vomiting episodes that led to malnutrition. Some pediatricians often attribute the diagnosis of gastroesophageal reflux to newborns that are vomiting; however, there is a portion of the population that has other causes that lead to similar symptoms. The pediatrician should be alert to the clinical signs of weight loss, dehydration and malnutrition to investigate other causes of vomiting.

RESUMO Episódios de vômito em recém-nascidos são extremamente comuns e frequentemente atribuídos a refluxo gastresofágico. Os sintomas de vômito, no entanto, podem ser causados por outras complicações. Neste relato, apresentamos dois casos: um lactente masculino, com 1 mês de idade, e um feminino, com 2 meses, ambos apresentando episódios de vômitos que levaram à desnutrição. Alguns pediatras costumam atribuir o diagnóstico de refluxo gastresofágico a recém-nascidos que estão vomitando; mas parcela da população tem outras causas que levam a sintomas semelhantes. O pediatra deve estar atento aos sinais clínicos de perda de peso, desidratação e desnutrição, para investigar outras causas de vômitos.

Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.

Ginger-partitioned moxibustion in prevention of vomiting induced by chemotherapy in advanced malignant bone tumors: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of ginger-partitioned moxibustion on digestive tract reaction, quality of life and white blood cell count after chemotherapy in advanced malignant bone tumors patients.@*METHODS@#A total of 64 patients were randomly divided into an observation group and a control group, 32 cases in each group. Both groups were treated with adriamycin combined with cisplatin (AP) chemotherapy. The patients in the control group were treated by tropisetron hydrochloride intravenous on preventing the vomiting 1 h before receiving chemotherapy. On the basis of the control group, the patients in the observation group were treated with ginger-partitioned moxibustion at Neiguan (PC 6), Zusanli (ST 36), Shenque (CV 8), and Zhongwan (CV 12) 2 h after chemotherapy, once a day, 30 min each time. The course of chemotherapy, ginger-partitioned moxibustion and tropisetron hydrochloride intravenous was 5 days. The digestive tract reaction rating, quality of life score and white blood cell count were compared 1 d before chemotherapy, 2 d after chemotherapy and 7 d after chemotherapy between the two groups.@*RESULTS@#The number of 0 grade in digestive tract reaction 2 d and 7 d after chemotherapy in the observation group was significantly higher than that in the control group (@*CONCLUSION@#Ginger-partitioned moxibustion can prevent and treat vomiting after chemotherapy in advanced malignant bone tumors, and improve the quality of life and white blood cell count of patients.

Hypothermia post-cardiopulmonary resuscitation with low inputs: an experience report / Hipotermia post-ressuscitación cardiopulmonar con bajos insumos: relato de experiencia / Hipotermia pós ressuscitação cardiopulmonar com baixos insumos: relato de experiência

ABSTRACT Objective: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. Method: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. Results: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. Conclusion: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.

RESUMEN Objetivo: relatar la experiencia de la conducción de control dirigido de la temperatura de una paciente después de la resucitación cardiopulmonar, con insumos reducidos y básicos disponibles en la institución. Método: el informe de experiencia de control direccionado de la temperatura en paciente (edad 15 años), después de cuatro horas de resucitación cardiopulmonar en una Unidad de Terapia Intensiva de un hospital del interior del estado de São Paulo, en el año 2016, conforme protocolo sugerido por la American Heart Association en 2015. Se utilizaron aplicaciones de compresas embebidas en agua helada, bolsas plásticas con hielo triturado y control de la temperatura rectal. Resultados: en ocho horas, la temperatura alcanzó los 34 ºC. El enfriamiento corporal se mantuvo durante 24 horas, sin embargo, las bolsas con hielo triturado se utilizaron en las primeras 6 horas. Conclusión: la conducta de los enfermeros para obtener el enfriamiento corporal con insumos reducidos y básicos, se mostró efectiva durante la permanencia en la Unidad de Terapia Intensiva.

RESUMO Objetivo: relatar a experiência da condução de controle direcionado da temperatura de uma paciente pós ressuscitação cardiopulmonar, com insumos reduzidos e básicos disponíveis na instituição. Método: relato de experiência de controle direcionado da temperatura em paciente (idade 15 anos) após quatro horas de ressuscitação cardiopulmonar em uma unidade de terapia intensiva de um hospital do interior do Estado de São Paulo, no ano de 2016, conforme protocolo sugerido pela American Heart Association 2015. Utilizou-se aplicações de compressas embebidas em água gelada, sacos plásticos com gelo triturado e controle da temperatura retal. Resultados: em oito horas a temperatura atingiu 34ºC. O resfriamento corporal foi mantido por 24 horas, todavia os sacos com gelo triturado foram utilizados nas primeiras 6 horas. Conclusão: a conduta dos enfermeiros para obter o resfriamento corporal com insumos reduzidos e básicos, mostrou-se efetiva durante a permanência na unidade de terapia intensiva.

Complications After endoscopic balloon dilatation of esophageal strictures in children. Experience from a tertiary center in Shiraz - Iran (Nemazee Teaching Hospital) / Complicaciones posteriores a dilatación endoscópica con balón en niños con estenosis esofágica. Experiencia de un centro de referencia en Shiraz - Iran (Nemazee Teaching Hospital)

Background: Esophageal stricture is one of the most important complication of the caustic ingestion. Objective: The aim of this study was to evaluate complications of balloon dilatation among children with esophageal stenosis. Material and methods: In this retrospective study 82 children were included. Children who underwent balloon dilatation for esophageal stenosis were included in our study. Duration of study was 14 year starting from 2001. Mean age of the cases was 3.95±0.4 year (Min: 15 days, Max: 14 year). Chart review and telephone calling were the methods of data collection. Data was analyzed using SPSS. Results: In this study, 47% of the patients were male and 53% of the cases were female. Caustic ingestion (33.7%) was the most common etiology for the esophageal stricture. Vomiting (87.8%) was the most common presenting symptom. Among our cases, 76.8% had no compliant after esophageal dilatation. Chest pain was the most common compliant after esophageal dilatation. Response rate was similar among boys and girls. Toddler age had the best treatment response after esophageal dilatation. Conclusion: Among our cases, 76.8% had no post procedural compliant after esophageal dilatation. Esophageal perforation was seen in 4.9% of the cases. Chest pain was the most common post dilatation complication.

Antecedentes: La estenosis esofágica es una de las más importantes complicaciones de la ingesta de caústicos. Objetivo: El objetivo del estudio fue evaluar las complicaciones de la dilatación endoscópica con balón en niños con estenosis esofágica. Material y métodos: En este estudio retrospectivo se incluyeron 82 niños. Se incluyeron todos los niños que se sometieron a una dilatación endoscópica con balón por estenosis esofágica. La duración del estudio fue 14 años iniciando en el año 2001. La edad media de los pacientes fue 3,95 +/- 0,4 años (Min. 15 días, Máx. 14 años). La recolección de datos se realizó revisando las historias clínicas y con llamadas telefónicas. Los datos se analizaron con el Sistema SPSS. Resultados: En este estudio, 47% de los casos fueron varones y 53% fueron mujeres. La ingesta de caústicos fue la causa más frecuente de estenosis esofágica (33,7%). El síntoma más común fueron los vómitos (87,8%). Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. El dolor torácico fue la molestia más común luego de la dilatación esofágica. La tasa de respuesta al tratamiento fue similar entre hombres y mujeres. Los niños pequeños tuvieron la mejor respuesta al tratamiento luego de la dilatación esofágica. Conclusiones: Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. La perforación esofágica se presentó en 4,9% de los casos. El dolor torácico fue la complicación más común posterior a la dilatación.

Trombosis de Senos Venosos, experiencia en un hospital pediátrico en Buenos Aires, Argentina / Venous sinus thrombosis: Experience at a pediatric hospital in Buenos Aires, Argentina

Introducción: La trombosis de senos venosos cerebrales (TSVC) es infrecuente en pediatría. Está asociada a condiciones como infecciones, deshidratación, fallo renal, traumatismo de cráneo, neoplasias, trastornos hematológicos, etc. Cefalea, vómitos, alteración del sensorio y hemiparesia son los síntomas más frecuentes. El diagnóstico es confirmado por TC con angio y/o RM con angio. La anticoagulación es el tratamiento de elección. Los pacientes suelen evolucionar favorablemente. Materiales y Métodos: Estudio descriptivo observacional de pacientes con TSVC atendidos en el Hospital Garrahan desde 2010 a 2017. Las variables registradas fueron: edad, sexo; manifestaciones clínicas, factores de riesgo; estudios diagnósticos, tratamiento y evolución. Resultados: Se describen 34 pacientes con TSVC. Los adolescentes fueron el grupo mayor. La cefalea fue el síntoma más frecuente. Angio TC, RM y/o angio RM confirmaron el diagnóstico; los senos transverso, sagital superior y sigmoideo fueron los más comprometidos. 21 pacientes tenían patología oncológica y 14 procesos infecciosos. El tratamiento de elección fue la anticoagulación. Tuvieron buena evolución el 82%. Conclusiones: Debemos sospechar esta entidad en dos grupos: el primero formado por lactantes y pre-escolares con patología infecciosa; y un segundo integrado por escolares y adolescentes con patología oncológica, especialmente aquellos que reciben L-ASA.Es importante resaltar el valor de la TC y angio TC para hacer diagnóstico oportuno, resultando accesible las 24 horas en el hospital

Introduction: Cerebral venous sinus thrombosis (CVST) is uncommon in children. CVST is associated with conditions, such as infections, dehydration, renal failure, head trauma, cancer, and hematological disorders. Headache, vomiting, sensory alterations, and hemiparesis are the most common symptoms. Diagnosis is confirmed by angio CT and/or MRA. Anticoagulation is the treatment of choice. Outcome is generally good. Material and Methods: An observational, descriptive study of patients with CVST seen at Garrahan Hospital between 2010 and 2017. The following variables were recorded: age, sex; clinical manifestations, risk factors; diagnostic studies, treatment, and outcome. Results: 34 patients with CVST were studied. Most patients were adolescents. Headache was the most common symptom. Angio CT, MRI, and/or MRA confirmed the diagnosis; the transverse, superior sagittal, and sigmoid sinuses were most frequently affected. Of the patients, 21 had oncological disease and 14 infections. Anticoagulation was the treatment of choice. Outcome was good in 82%. Conclusions: CVST should be suspected in the following two groups: A first group consisting of infants and preschool children with infections and a second group of school-age children and adolescents with cancer, especially those receiving L-ASA. It is important to highlight the role of CT and angio CT for early diagnosis as the study is available day and night at the hospital.

Reações adversas no dia zero do transplante de células-tronco hematopoéticas: revisão integrativa / Reacciones adversas en el día cero del trasplante de células madre hematopoyéticas: revisión integrativa / Adverse reactions on day zero of hematopoietic stem cell transplantation: integrative review

Resumo OBJETIVO Identificar as reações adversas ligadas à infusão de células-tronco hematopoéticas no dia zero do transplante de células-tronco hematopoéticas. MÉTODO Revisão integrativa da literatura, sem recorte temporal, a partir de fontes de informação: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science e CAPES; a amostra final foi constituída por dezoito artigos científicos, publicados entre 1998 e 2017, com base nos critérios de inclusão e exclusão. RESULTADOS Reações adversas leves e moderadas foram mais frequentes nos estudos que utilizaram a classificação por severidade, sendo náusea e êmese as de maior incidência; os sistemas orgânicos mais afetados foram o cardiovascular, respiratório e gastrointestinal. CONCLUSÕES As principais reações adversas identificadas nos estudos foram náusea e êmese. As classificadas como leves e moderadas foram as mais frequentes nos estudos que utilizaram a classificação por severidade; e os sistemas cardiovascular, respiratório e gastrointestinal foram os mais afetados naqueles que utilizaram a classificação por sistemas orgânicos.

Resumen OBJETIVO Identificar las reacciones adversas ligadas a la infusión de células madre hematopoyéticas en el día cero del trasplante de células madre hematopoyéticas. METODOLOGÍA Revisión integrativa de la literatura, sin recorte temporal, a partir de los siguientes bancos de datos: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science y CAPES; la muestra final fue constituida por 18 artículos científicos, publicados entre 1998 y 2017, sobre la base de los criterios de inclusión y exclusión. RESULTADOS Las reacciones adversas leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad, siendo náuseas y vómito las de mayor incidencia; los sistemas orgánicos más afectados fueron el cardiovascular, respiratorio y gastrointestinal. CONCLUSIÓN Las principales reacciones adversas identificadas en los estudios fueron náuseas y éstas. Las clasificadas como leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad; y los sistemas cardiovascular, respiratorio y gastrointestinal fueron los más afectados en aquellos que utilizaron la clasificación por sistemas orgánicos.

Abstract OBJECTIVE To identify the adverse reactions associated with the infusion of hematopoietic stem cells on day zero of hematopoietic stem cell transplantation. METHODOLOGY Integrative literature review, without temporal cut, with search in the following databases: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science and CAPES; the final sample consisted of 18 scientific articles, published between 1998 and 2017, based on the inclusion and exclusion criteria. RESULTS Mild and moderate adverse reactions were the most frequent in studies that used the classification by severity, and nausea and emesis had the highest incidence; the most affected organ systems were the cardiovascular, respiratory and gastrointestinal. CONCLUSION The main adverse reactions identified in the studies were nausea and emesis. Those classified as mild and moderate were the most frequent in the studies that used the severity classification; and the cardiovascular, respiratory and gastrointestinal systems were the most affected in those that used the classification by organic systems.

Frecuencia y características del cáncer de vesícula biliar en un hospital de referencia al sur del Perú, 2009-2014: estudio descriptivo / Frequency and characteristics of gallbladder cancer at a referral hospital in southern Peru, 2009-2014: a descriptive study

INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

Adecuación de la terapia nutricional enteral y la relación con la evolución en pacientes adultos críticos durante su estancia en el Sanatorio San Sebastián / Adequacy of enteral nutritional therapy and the relationship with the evolution in critical adult patients during their stay at the San Sebastián Sanatorium

Introducción: La Terapia Nutricional Enteral (TNE) en el paciente crítico forma parte del manejo integral y se asociada a una mejor evolución clínica. Objetivo: Determinar el porcentaje de adecuación de la TNE y la relación con la evolución en pacientes adultos críticos durante su estancia en el Sanatorio San Sebastián en el año 2016 al 2017. Materiales y Métodos: Estudio Observacional, descriptivo, prospectivo con componente analítico en pacientes adultos críticos de la Unidad de Cuidados Intensivos (UCI) que cumplieron con los criterios de inclusión. Se evaluaron 54 pacientes críticos sometidos a NE mayores de 18 años de edad de ambos sexos desde el periodo 2016 al 2017. Se consideró un porcentaje de adecuación calórico-proteica como suficiente a partir de ≥ 70%. Resultados: El 85,2% recibió un aporte calórico suficiente y un aporte proteico suficiente, el 59,3%. El promedio de calorías y proteínas administradas fueron de 1303 ±308 kcal y 62,26 ±30,8 gr respectivamente, mientras que la adecuación calórica alcanzada fue 86 ±16% y la proteica 72,8 ±22,9%. La complicación gastrointestinal más frecuente fue la diarrea y Residuo Gástrico aumentado (RG). Conclusión: Aunque no se observaron diferencias significativas entre aporte calórico y proteico con los días de ventilación mecánica, estancia hospitalaria y mortalidad; no se descarta la posibilidad que los mismos resulten significativos con una población más homogénea y numerosa, junto con un aumento de los días de evaluación.

Introduction: Enteral Nutritional Therapy (ENT) is part of an integral management and has been associated to better clinical outcomes in critically ill adult patients. Purpose: To determine the percentage of adequacy to ENT and its relationship with clinical outcomes in critically ill adult patients during their stay at the Sanatorio San Sebastián from 2016 to 2017. Material and methods: Observational, descriptive, cross-sectional study with analytic component in critically ill adult patients admitted to the ICU who met the inclusion criteria. 54 patients of both sexes, over 18 years old with EN were studied during the evaluation period between 2016-2017. It was considered as a goal a percentage of caloric-protein adequacy of ≥ 70%. Results: 85.2% received a sufficient caloric intake and the 59.3% also received sufficient protein intake. The average intake of calories and protein were 1303 ±308 kcal and 62,26 ±30,8 gr respectively, while the adequacy of calories was 86 ±16% and protein 72,8 ±22,9%. The most common gastrointestinal complication was diarrhea and the increase in gastric residue. Conclusions: Although there was no statistical significant difference between the amount of energy and protein intake with days of mechanical ventilation, length of hospital stay and mortality, the possibility that these could be significant with a more homogeneous and numerous population, together with an increase of the evaluation days, is not ruled out

Características clínicas y manejo de lactantes menores de 1 año con sospecha de alergia a proteína de leche de vaca / Clinical characteristics and management of infants less than 1-year-old suspected with allergy to cow's milk protein

Introducción: La alergia a proteína de leche de vaca (APLV) es frecuente en lactantes (2-5% en < 1 año). Tiene múltiples formas de presentación y un amplio diagnóstico diferencial, por lo que es relevante confirmar el diagnóstico. El estándar de oro del diagnóstico es el test de provocación oral (TPO), que en la práctica no siempre se realiza. En Chile hay escasa literatura respecto a esta entidad. Objetivo: Describir características demográficas, clínicas y manejo de lactantes < 1 año con sospecha de APLV. Pacientes y Método: Estudio retrospectivo en menores de 1 año atendidos por sospecha de APLV entre 2009-2011. Se registraron datos demográficos, historia perinatal, antecedentes de atopia, alimentación al momento del diagnóstico, síntomas de sospecha de APLV, estudios realizados para su confirmación, y respuesta a tratamiento. Se consideró como estándar de diagnóstico la respuesta a la dieta y la contraprueba. Se definió como respuesta a la dieta la ausencia de los síntomas atribuidos a la APLV al menos 4 semanas desde el cambio de leche. Se realizó estadística descriptiva mediante programa Epiinfo™. Resultados: Se incluyeron 106 lactantes, 51% varones, 80% recién nacidos de término, 74% con al menos un progenitor atópico, 34% con alguno de los padres o algún hermano con alergia alimentaria. La mediana de edad al inicio fue 1,5 meses (rango: 1,5-2 m). El 15% recibió fórmula desde el período neonatal y el 50% antes del tercer mes. Los síntomas más frecuentes fueron: vómitos (63%), cólicos (50%) y rectorragia (40%); el 61% presentó ≥ 2 síntomas al comienzo. Solo en el 34% se hizo TPO, en el resto se evaluó la respuesta a la dieta de exclusión y se realizaron exámenes. La realización de exámenes no cambió la conducta. Tratamiento: 43% lactancia materna con dieta de exclusión, 24% solo fórmula extensamente hidrolizada, 26% solo fórmula aminoacídica y 7% otros. Conclusión: Las características demográficas y antecedentes de los pacientes concuerdan con lo descrito en la literatura extranjera. El inicio clínico fue precoz, predominando los síntomas digestivos. Se realizaron exámenes en una proporción alta de pacientes, sin contribuir a un cambio de conducta; el TPO fue subutilizado como herramienta diagnóstica.

Introduction: Cow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile. Objective: To describe the demographic and clinical features of infants with suspected CMPA. Patients and Method: A retrospective study of patients < 1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software. Results: The study included 106 infants, of whom, 51% male, 80% term newborns, 74% with ≥ 1 atopic parent, and 34% with ≥ 1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2 m). Almost half (46%) were breast-feeding ≥ 6 m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had ≥ 2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%). Treatment: 43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others. Conclusion: Demographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.

Revisión de estenosis hipertrófica del píloro / Review of hypertrophic pyloro stenosis

La estenosis hipertrófica del píloro (EHP) es una patología quirúrgica común en la edad pediátrica. Apesar de ser una condición frecuente, su etiología aún no está claramente dilucidada. La presentación clínica corresponde a vómitos explosivos lácteos, no biliosos y en algunos casos oliva palpable en el abdomen u ondas peristálticas luego de ser alimentados. Si bien el manejo resolutivo de esta patología requiere la intervención del cirujano infantil, la sospecha inicial incluye al médico general y pediatra. Este artículo presenta una revisión de la literatura disponible sobre el tema.

Hypertrophic pyloric stenosis (EHP) is a common surgical pathology in children. Despite being a common condition, its etiology is not yet clearly known. The clinical presentation corresponds to milky, explosive and nonbilious threw up, and in some cases palpable olive in the abdomen or peristaltic waves after being fed. While surgical management of this condition requires the intervention of child surgeon, the initial suspicion includes the general physician and pediatrician. This article presents a review of the available literature on the subject.

Quistes de colédoco, una causa inusual de ictericia en pediatría: presentación de serie de casos / Bile duct cysts; an unusual cause of jaundice in paediatrics: presentation of a case series

Introducción Los quistes de la vía biliar o quistes de colédoco (QC) son una patología rara en nuestro medio. La etiología es desconocida, siendo la hipótesis más aceptada las anomalías en la unión biliopancreática. Objetivo Analizar los datos clínicos, diagnóstico y tratamiento de una serie de pacientes diagnosticados de QC y realizar una actualización sobre el tema. Metodo Se revisaron retrospectivamente los diagnósticos de QC en 20 años en un hospital terciario. Casos clínicos Se identificaron 4 casos, con predominio del sexo femenino. Rango de edad 16 meses a 4 años. Los signos y síntomas fueron ictericia y coluria (100%), vómitos (75%), dolor abdominal y acolia (50%). Ninguno tuvo masa palpable. La ecografía abdominal orientó el diagnóstico que se confirmó con colangio-resonancia magnética (colangio-RM). Se clasificaron como QC tipo I tres de los casos y uno como tipo IVa. El tratamiento fue quirúrgico, ningún paciente presentó complicaciones hasta la fecha. Conclusiones Los quistes de las vías biliares son de baja prevalencia. El tratamiento de elección es quirúrgico, requiriendo seguimiento estrecho, dado el riesgo de colangiocarcinoma.

Introduction Cysts of the bile duct or choledochal cysts are rare diseases in our area. The aetiology is unknown, with the most accepted hypothesis being a pancreatobiliary maljunction anomaly. Objective To analyse the clinical data, diagnosis and treatment of a number of patients with choledochal cyst, as well as presenting an update on this condition. Method A retrospective descriptive study was performed on paediatric patients diagnosed with choledochal cyst in the last 20 years in a tertiary hospital. Case reports A total of 4 choledochal cyst cases in childhood, predominantly female, are pre- sented. The most frequent reason for consultation was vomiting, and presenting with jaundice and choluria in all cases. Patients with choledochal cyst were classified as type I in 3 cases, and one case of type IVa. In all cases surgical treatment was performed; any patient had complications to date. Conclusions Cysts of the bile ducts have a low prevalence. The treatment of choice is surgical, requiring close monitoring due to the risk of cholangiocarcinoma.

Initial Serum Ammonia as a Predictor of Neurologic Complications in Patients with Acute Glufosinate Poisoning

PURPOSE: Glufosinate poisoning can cause neurologic complications that may be difficult to treat due to delayed manifestation. Studies assessing possible predictors of complications are lacking. Although serum ammonia level is a potential predictor of severe neurotoxicity, it has only been assessed via case reports. Therefore, we investigated factors that predict neurologic complications in acute glufosinate-poisoned patients. MATERIALS AND METHODS: We conducted a retrospective review of 45 consecutive glufosinate-poisoning cases that were diagnosed in the emergency department (ED) of Wonju Severance Christian Hospital between May 2007 and July 2014. Patients with a Glasgow Coma Scale (GCS) score of <8, seizure, and/or amnesia were defined to a neurologic complication group. RESULTS: The neurologic complication group (29 patients, 64.4%) comprised patients with GCS<8 (27 patients, 60.0%), seizure (23 patients, 51.1%), and amnesia (5 patients, 11.1%). Non-neurologic complications included respiratory failure (14 patients, 31.1%), intubation and ventilator care (23 patients, 51.1%), shock (2 patients, 4.4%), pneumonia (16 patients, 35.6%), acute kidney injury (10 patients, 22.2%), and death (4 patients, 8.9%). Complications of GCS<8, seizure, respiratory failure, and intubation and ventilator care appeared during latent periods within 11 hrs, 34 hrs, 14 hrs, and 48 hrs, respectively. Initial serum ammonia was a predictor of neurologic complications [odds ratio 1.039, 95% confidence interval (1.001-1.078), p=0.046 and area under the curve 0.742]. CONCLUSION: Neurologic complications developed in 64.4% of patients with acute glufosinate poisoning. The most common complication was GCS<8. Initial serum ammonia level, which can be readily assessed in the ED, was a predictor of neurologic complications.