Increment of D-dimer Associated with Immune Thrombotic Thrombocytopenia in ChAdOx1 nCoV-19 Vaccinated Individuals.

AIM OF THE STUDY: Development of thrombocytopenia and thrombosis after administration of the ChAdox1 nCoV-19 (AstraZeneca-Oxford) vaccine has recently been described. This new condition is called vaccine-induced immune thrombotic thrombocytopenia (VITT). Our objective was to summarize case reports on VITT with/without D-dimer increments in AstraZeneca-Oxford vaccinated individuals. DATA SOURCES: MEDLINE, PubMed, and Scopus databases were searched. STUDY SELECTION: Case series, case reports, letters to the editor; and abstracts of AstraZeneca-Oxford vaccinated patients with a clinical profile of thrombocytopenia (platelet count <150X10 3 /dL) and D-dimer determination, with or without thrombosis, and/or bleeding, and/or antibodies against platelet factor 4 (aPF4), were included. DATA EXTRACTION: Baseline risk factors, symptoms, physical signs; laboratory results, imaging findings, treatment; and outcome in patients with VITT reported in case series, were examined. DATA SYNTHESIS: Patients who developed VITT were more likely to be young women (ages 21 to 77) given the AstraZeneca-Oxford vaccine 5-14 days prior to presentation. Patients' signs, symptoms, and imaging findings were consistent with cerebral venous sinus thrombosis, or deep veins, lung, and other sites. Laboratory findings showed thrombocytopenia, low fibrinogen, and elevated D-dimer levels, while aPF4 was positive in most assays performed. Treatment was non-heparin anticoagulants, IV immunoglobulin, and steroids, as recommended by medical guidelines. CONCLUSIONS: Vaccine-induced immune thrombotic thrombocytopenia is a rare complication with high morbidity, related to administration of the AstraZeneca-Oxford vaccine. Clinicians should prepare for early identification of patients with suspicious symptoms, and prompt treatment initiated to avoid catastrophic events. D-dimer determination is useful for surveillance of cases with suspected VITT.

[The cross-sectional area of the median nerve by sonography in the diagnosis of carpal tunnel syndrome]. / Determinación ultrasonográfica del área de corte transversal del nervio mediano en síndrome del túnel carpiano.

OBJECTIVE: To measure the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) level by sonography (S) in a Mexican population. METHODS: A comparative cross-sectional design study with a nonprobabilistic sampling with 50 women and 50 men in good health were submitted for measuring MNCSA at the level of the CT. Other variables like sex; side and degree of daily hand activity were also studied. The analysis was made by descriptive statistics, and Mann-Whitney U or Kruskal-Wallis tests. RESULTS: The mean MNCSA was 0.063 +/- 0.015 cm(2), in women; in men it was 0.072 +/- 0.018 cm(2); the difference was significant (p < 0.004). The median MNCSA among women was 0.062 cm(2) in the right side and 0.060 cm(2) in the left (90th percentile for both hands of 0.084 cm(2)); in men, it was of 0.070 cm(2) in the right hand and of 0.069 cm(2) in the left (90th percentile for both hands of 0.097 cm(2)). The difference between women and men was significant in each side, but not between right and left hands (p = 0.21). There was no correlation between age and MNCSA on either side, or with hand activity. CONCLUSIONS: A MNCSA value of 0.1 cm(2) for men and 0.09 cm(2) for women is proposed as a standard parameter for the Mexican population.

La mortalidad infantil por malformaciones congénitas en México: un problema de oportunidad y acceso al tratamiento / Infant mortality from congenital malformations in Mexico: an issue of opportunity and access to treatment

Objetivos. Caracterizar el comportamiento del Sistema Nacional de Salud (SNS) de México en la tarea de reducir el número de muertes por malformaciones congénitas mediante el análisis de la tendencia de las tasas de mortalidad infantil específicas por esas afecciones. Métodos. Análisis de series de tiempos de las defunciones de niños y niñas menores de 1 año entre 1980 y 2005, según las bases de datos nacionales anuales de mortalidad de la Secretaría de Salud de México. Se calcularon las tasas de mortalidad infantil específicas (TMIe) pormalformaciones congénitas graves más frecuentes en México: defectos del tubo neural, hernia diafragmática congénita, exonfalos (onfalocele y gastrosquisis) y malformaciones cardíacas y del tubo digestivo, agrupadas según el grado de urgencia y de sofisticación tecnológica que demanda su tratamiento y el desenlace más frecuente. Resultados. Entre 1980 y 2005, la tasa de mortalidad infantil en México descendió de 40,7 a 16,9 por 1 000 nacimientos (b = –0,86; P < 0,001); en cambio, la tasa de mortalidad específica por malformaciones congénitas creció de 2,2 a 3,5 por 1 000 nacimientos (b = 0,05; P < 0,001). La hipertrofia pilórica y la atresia anorrectal, malformaciones con buen pronóstico y tratamiento programable en unidades con equipamiento básico, fueron las únicas que mostraron una tendencia descendente en su TMIe (b = –0,01 a –0,09; P < 0,001), mientras que las que requieren tratamiento urgente en unidades especializadas mostraron TMIe crecientes (b = 0,03 a 0,05; P < 0,001).Conclusiones. El desarrollo del SNS de México entre 1980 y 2005 no se ha traducido en una reducción en la mortalidad por malformaciones congénitas; esta ineficacia fue más notoria en las enfermedades cuyo tratamiento es urgente y requiere tecnología sofisticada.

Objectives. To evaluate the role that Mexico’s National Health System (Sistema Nacional de Salud–SNS) has played in the task of reducing the number of deaths due to congenital malformations through a trends analysis of cause-specific infant mortality rates (IMRcs). Methods. Time-series analysis of deaths of boys and girls under 1 year of age from 1980–2005, according to databases of national and annual mortality maintained by the Secretariat of Health of Mexico. Cause-specific mortality rates were calculated for themost frequently occurring, severe, congenital malformations in Mexico: neural tube defects, diaphragmatic hernias, exomphalos (omphalocele and gastroschisis), and heart and digestive tract defects, grouped according to severity, degree of technologicalsophistication required for treatment, and most frequent outcome. Results. From 1980–2005, the infant mortality rate in Mexico decreased from 40.7 to16.9 per 1 000 births (â = –0.86; P < 0.001); however, the mortality rate for congenital malformations rose from 2.2 to 3.5 per 1 000 births (â = 0.05; P < 0.001). Only infantile hypertrophic pyloric stenosis and anorectal atresia, anomalies with good prognoses and treatments available in minimally-equipped facilities, exhibited downward trends in their IMRcs (â = –0.01 to –0.09; P < 0.001); while malformations requiring immediate treatment in specialized facilities showed rising IMRcs (â = 0.03 to 0.05; P < 0.001).Conclusions. The development of Mexico’s SNS from 1980–2005 has not translated into a reduction of mortality from congenital malformations; this deficiency was more pronouncedfor anomalies that require immediate treatment and sophisticated technology.

[Infant mortality from congenital malformations in Mexico: an issue of opportunity and access to treatment]. / La mortalidad infantil por malformaciones congénitas en México: un problema de oportunidad y acceso al tratamiento.

OBJECTIVES: To evaluate the role that Mexico's National Health System (Sistema Nacional de Salud-SNS) has played in the task of reducing the number of deaths due to congenital malformations through a trends analysis of cause-specific infant mortality rates (IMRcs). METHODS: Time-series analysis of deaths of boys and girls under 1 year of age from 1980-2005, according to databases of national and annual mortality maintained by the Secretariat of Health of Mexico. Cause-specific mortality rates were calculated for the most frequently occurring, severe, congenital malformations in Mexico: neural tube defects, diaphragmatic hernias, exomphalos (omphalocele and gastroschisis), and heart and digestive tract defects, grouped according to severity, degree of technological sophistication required for treatment, and most frequent outcome. RESULTS: From 1980-2005, the infant mortality rate in Mexico decreased from 40.7 to 16.9 per 1 000 births (beta = -0.86; P < 0.001); however, the mortality rate for congenital malformations rose from 2.2 to 3.5 per 1 000 births (beta = 0.05; P < 0.001). Only infantile hypertrophic pyloric stenosis and anorectal atresia, anomalies with good prognoses and treatments available in minimally-equipped facilities, exhibited downward trends in their IMRcs (beta = -0.01 to -0.09; P < 0.001); while malformations requiring immediate treatment in specialized facilities showed rising IMRcs (beta = 0.03 to 0.05; P < 0.001). CONCLUSIONS: The development of Mexico's SNS from 1980-2005 has not translated into a reduction of mortality from congenital malformations; this deficiency was more pronounced for anomalies that require immediate treatment and sophisticated technology.

[Asymptomatic bacteriuria among pregnant women. An underestimated threat]. / Bacteriuria asintomática en mujeres embarazadas. Una amenaza subestimada.

BACKGROUND: Urinary tract infection is a common pregnancy complication. Asymptomatic bacteriuria (AB) can trigger the development of serious complications affecting both the mother and the fetus. OBJECTIVE: Determine the frequency of AB among pregnant women attending to antenatal care at the family medicine clinic number 1 of the Instituto Mexicano del Seguro Social, located in Ciudad Obregón, Sonora. METHODOLOGY: A longitudinal study was carried out from September to December 2004. Seventy-two 72 pregnant women with gestational age of 24 weeks or less were followed up during four months. All pregnant women were selected by a non-probabilistic method. Every patient had a monthly urine culture during the follow up period. RESULTS: Among the 72 pregnant women, 16.7% developed symptomatic urinary infections during the follow-up and 25% had at least one positive urine culture without urinary symptoms, being classified as AB, thus receiving treatment. Frequency of positive urine cultures was common at first and fourth months of follow-up. CONCLUSION: Urine culture is an important component of prenatal care, and helps in identifying a significant number of urinary tract infections that would go otherwise undetected.

[Satisfaction of users at a family medicine unit]. / Satisfacción de los usuarios de una unidad de medicina familiar.

OBJECTIVE: To evaluate the satisfaction of the users seen at the external consultation of the Family Medicine Unit 1 of the IMSS, in Ciudad Obregón, Sonora. MATERIAL AND METHODS: A transversal study was performed during a day of January 2004, selecting at random a sample of 380 users taken from the base of 38,000 monthly consultations. Rightful claimants of more than 15 years old who received consultation that day were included, and his/her satisfaction with the reception and the medical attention were evaluated by means of a questionnaire on the opportunity, kindness, attention, results, information, comfort, medical appointment, exploration, relationship doctor-patient, number of medicines, and perception of the general treatment. The analysis of the results was made by means of descriptive statistics. RESULTS: 104 men and 276 women were surveyed. The rating of the reception was excellent according to 85 users (22.1%), average according to 138 (36.3%) and poor according to 142 (37.4%). The rating of the received medical attention was excellent according to 123 users (32.4%) and average according to 157 (41.3%). The perception of the received treatment was good in 232 rightful claimants (61.1%). CONCLUSION: Although the results show that more than a half of the users perceive a good treatment, they are frequently unsatisfied with the medical attention received. It will be necessary to deepen in the factors that influence the unsatisfaction, such as the kind treatment in the reception, greater medicine stock in pharmacy, enough and comfortable seats in waiting rooms, cleaner waiting rooms and doctor's offices, and the possibility of arranging appointments and consultations by telephone.

[Chronic complications of diabetes mellitus. What is the prevalence of diabetes in a family medical unit?]. / Complicaciones crónicas en la diabetes mellitus. Prevalencia en una unidad de medicina familiar.

INTRODUCTION: The role of the family doctor in fundamental in the prevention of diabetic complications, because these complications will be minor if there is good glycemic control during life. OBJECTIVE: Determine the frequency of late complications of diabetes mellitus (DM) among IMSS-insured population in Ciudad Obregón, Sonora, México. MATERIALS AND METHODS: A retrospective analysis included 252 diabetic patients selected by a systematized and stratified randomized sampling including all patient files available in the Family Medicine Unit 1 in Ciudad Obregón, Sonora. The information was taken from the clinical charts got by family physicians and specialists. We used descriptive statistics and correlation of Pearson looking for the association between glicemia's level and enough time to produce complications. RESULTS: Arterial hypertension was found in 168 cases (67%), hypertriglyceridemia in 148 (59.4%), neuropathy in 106 (42.6%), hypercholesterolemia in 89 (35.7%), retinopathy in 69 (27.5%), nephropathy in 51 (20.5%), diabetic foot in 27 (10.8%), ischemic cardiopathy in 25 (10%), cerebral thrombosis in 11 (4.4%). The period between DM diagnosis and the appearance of complications was 3.2 to 13.1 years. The correlations were high and significant in every complication. CONCLUSIONS: The frequency of DM complications in this study was very high, with an increasing tendency of developing complications throughout the time.

[Early breastfeed weaning as a risk factor for acute appendicitis in children]. / El destete precoz como factor de riesgo de apendicitis aguda en niõs.

OBJECTIVE: To determine if short term exclusive (EBF), combined breastfeeding (CBF), or an early start of other kind of food constitute risk factors for appendicitis in children. MATERIALS AND METHODS: By means of a case-control study, the mothers of 200 children up to 16 years with a diagnosis of acute appendicitis and 200 matched controls were interviewed regarding the duration of breastfeeding and the start of other foods. Data were analyzed to calculate chi-square c2; odds ratio (OR) was used to calculate risk factors, confidence intervals (CI 95%) were also determined. RESULTS: There was no EBF in 52 cases (26%), or in 5 controls (2.5%) (p< 0.001). EBF lasted for 2.3 +/- 1.8 months in cases and 3 +/- 1.1 months in controls (p< 0.001). CBF lasted for 8.1 +/- 7.5 months in cases and 8.8 +/- 3.5 in controls (p< 0.001); ablactation was started at 4.4 +/- 1.3 months in cases and at 4.7+/-1.2 in controls (p< 0.05). The OR of developing appendicitis for non- EBF was 10.4 (CI 95% 4 - 26.5), for ablactation before 4 months 1.4, (CI 95% 0.9 - 2) and for CBF for less than 6 months 4.6, (CI 95% 2.3 - 8.3). CONCLUSIONS: The risk of developing appendicitis is higher among children who never received EBF and who were breastfed for less than 6 months.

El destete precoz como factor de riesgo de apendicitis aguda en niños / Early breastfeeding as a risk factor for acute appendicitis in children

Objetivo: Determinar si un régimen de alimentación al seno materno exclusiva (ASME) o combinada (ASMT) de corta duración, o una temprana ablactación constituyen factores de riesgo para desarrollar apendicitis aguda en la niñez. Material y métodos: Mediante un estudio de casos y controles se interrogó a las madres de 200 menores de edad preescolar, escolar y adolescente con diagnóstico de apendicitis aguda y de 200 controles pareados acerca de la duración de la alimentación al seno materno y la edad al inicio de fórmulas o papillas. Los datos fueron analizados mediante la prueba x², razón de momios (RM) e intervalos de confianza (IC 95%). Resultados: En 52 casos (26%), 5 controles no recibieron ASME (2.5%) (p< 0.001). La ASME se prolongó durante 2.3 ± 1.8 meses en los casos y 3 ± 1.1 meses en los controles (p< 0.001), y la ASMT durante 8.1 ± 7.5 meses en los casos y 8.8 ± 3.5 en los controles (p< 0.001); la ablactación ocurrió a los 4.4 ± 1.3 meses en los casos y 4.7 ± 1.2 en los controles (p< 0.05). El riesgo de padecer apendicitis para el que nunca recibió ASME fue de 10.4 (IC 95% 4 -26.5), para la ablactación antes de los 4 meses de 1.4, (IC 95% 0.9 - 2) y para la alimentación al seno materno menor a 6 meses de duración de 4.6, (IC 95% 2.3 8.3). Conclusiones: El riesgo de padecer apendicitis aumenta en los niños que no recibieron ASME y en los que recibieron ASMT por menos de seis meses.

Objective: To determine if short term exclusive (EBF), combined breastfeeding (CBF), or an early start of other kind of food constitute risk factors for appendicitis in children. Materials and methods: By means of a case control study, the mothers of 200 children up to 16 years with a diagnosis of acute appendicitis and 200 matched controls were interviewed regarding the duration of breastfeeding and the start of other foods. Data were analyzed to calculate chi square c²; odds ratio (OR) was used to calculate risk factors, confidence intervals (CI 95%) were also determined. Results: There was no EBF in 52 cases (26%), or in 5 controls (2.5%) (p< 0.001). EBF lasted for 2.3 ± 1.8 months in cases and 3 ± 1.1 months in controls (p< 0.001). CBF lasted for 8.1 ± 7.5 months in cases and 8.8 ± 3.5 in controls (p< 0.001); ablactation was started at 4.4 ± 1.3 months in cases and at 4.7 ± 1.2 in controls (p< 0.05). The OR of developing appendicitis for non- EBF was 10.4 (CI 95% 4 -26.5), for ablactation before 4 months 1.4, (CI 95% 0.9 - 2) and for CBF for less than 6 months 4.6, (CI 95% 2.3 8.3). Conclusions: The risk of developing appendicitis is higher among children who never received EBF and who were breastfed for less than 6 months.

[Factors related to the olive size in patients with hypertrophic pyloric stenosis]. / El tamaño de la oliva y su relación con el cuadro clínico en pacientes con estenosis hipertrófica del píloro.

INTRODUCTION: The pyloric "olive" (PO) is the result of the anomalous growth of the pyloric muscle among patients with pyloric stenosis (PS). It frequently is unexpectedly large, or some other times surprisingly small, and those variations in size have been difficult to explain. MATERIALS AND METHODS: We measured the PO in 145 consecutive patients with PS during the operation, and then we classified them as small if their length was less than 20 mm, medium if 20 to 30 mm, or large if more than 30 mm; several variables were analyzed by mean of the chi square or Spearman rho tests. RESULTS: Six cases were excluded due to an unclear total length record of the PO. The PO size was classified as small in 19 (13.7%), medium in 71 (51%) and large in 49 (35.3%). The PO size did not associate with gender, way of birth, the presence of jaundice, constipation or any specific blood group or Rh factor, and it did not correlate with birth weight or month and gestational order either. Medium and large PO were more frequently palpated than smaller (94-100% vs. 83%, p = 0.009); PO size correlated with the duration of the history of vomiting (CQ 0.267, p = 0.002), child's age (CQ 0.243, p = 0.005) and weight at operation (CQ 0.190, p = 0.048). A daily weight loss surpassing 5 g was more commonly found among small PO (p = 0.038). CONCLUSIONS: In more than a third of the PS patients, PO is unexpectedly large, and in one of every seven it is surprisingly small. The bigger PO size associates with a longer disease, and with older and heavier patients, which probably is explained by a slighter clinical course. A small PO is more difficult to palpate during clinical evaluation.

Successful treatment of Naegleria fowleri meningoencephalitis by using intravenous amphotericin B, fluconazole and rifampicin.

BACKGROUND: Primary amebic meningoencephalitis (PAM) is an emerging disease with a rapidly fatal outcome. Only eight reports of cured cases have appeared in the medical literature to date. METHODS: A 10-year-old boy developed PAM caused by Naegleria fowleri 1 week after swimming in an irrigation canal. He was admitted to our hospital after 9 h of severe headache and vomiting, fever, ataxic gait, mild confusion, and seizures were evident. Trophozoites were identified in the cerebrospinal fluid (CSF). Treatment with intravenous (i.v.) dexamethasone, amphotericin B, fluconaloze, and oral rifampicin was started. After several hours of conflicting clinical signs, recovery began, and on the third day he was conscious again. Hospital discharge occurred on day 23, after a normal brain CT scan. There was no sequel to the disease during the following 12 months. RESULTS: The amebas present in the CSF were identified and confirmed as N. fowleri after observation of wet mounts and of cultures seeded on 1.5% non-nutrient agar plates covered with Escherichia coli, vegetative and cystic forms, enflagellation experiments in distilled water at 98 degrees F, temperature tolerance testing and by indirect immunofluorescence using N. fowleri LEE antibody. The genotype was determined by PCR amplification and sequencing of the internal transcribed spacers (ITS) including the 5.8S rDNA. CONCLUSIONS: Early treatment of PAM by i.v. administration of amphotericin B and fluconazole, and oral administration of rifampicin can offer some hope of cure for this devastating disease.

Cirugía neonatal inmediata: experiencia inicial en el tratamiento de gastrosquisis y onfalocele en el noroeste de México / Immediate neonatal surgery: initial experience in gastroschisis and omphalocele treatment in Northwestern Mexico

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5) and in four cases with use of native tissues only (36.4); nine neonates survived (81.8), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.

[Immediate neonatal surgery: initial experience in gastroschisis and omphalocele treatment in Northwestern Mexico]. / Cirugía neonatal inmediata: experiencia inicial en el tratamiento de gastrosquisis y onfalocele en el noroeste de México.

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5%) and in four cases with use of native tissues only (36.4%); nine neonates survived (81.8%), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.

Recuperación de la motilidad intestinal después de apendicectomía en niños: hidratación oral vs parenteral / Recuperation of intestinal motility after appendectomy in children: oral hydration vs parenteral hydration

El objetivo del estudio fue comparar el efecto que tienen sobre la motilidad intestinal, en niños con diagnóstico de apendicitis no complicada, dos esquemas de hidratación postoperatoria: el convencional, a base de soluciones glucoelectrolíticas parenterales, y el oral, mediante soluciones comerciales saborizadas glucoelectrolíticas.Material y método: se diseñó un estudio prospectivo, longitudinal, comparativo, en el que se incluyeron niños de 5 a 15 años de edad, con diagnóstico de apendicitis aguda en fase edematosa o supurativa. Una vez que se concluyó apendicectomía, los menores recibieron hidratación intravenosa con soluciones glucoelectrolíticas a dosis de 1,500 a 2,000 mL/m2 SC/día (Grupo A), o bien, hidratación oral con solución glucoelectrolítica saborizada comercial administrada a libre demanda (Grupo B). Se evaluó la presencia de vómito, ruidos peristálticos y paso de flatos a las 8, 16 y 24 horas de la apendicectomía, así como las complicaciones infecciosas asociadas en los primeros 10 días.Resultados: se estudiaron 64 pacientes, 41 varones y 23 mujeres, que se dividieron en los dos grupos (n = 32). Se presentó vómito en cuatro pacientes del grupo A (12.5 por ciento) y en tres del grupo B (9.4 por ciento). Los ruidos intestinales fueron auscultables a las ocho horas del procedimiento en 19 pacientes del grupo A (59.4 por ciento) y en 13 del grupo B (40.6 por ciento), pero a las 24 horas se escuchó en la totalidad de los pacientes de cada grupo. El paso de flatos en las primeras ocho horas se presentó en sólo un paciente del grupo A (3.1 por ciento) y en cinco del grupo B (15.6 por ciento). La totalidad de los pacientes del grupo B y 28 del grupo A (87.5 por ciento), había pasado flatos a las 24 horas. La única complicación que se observó fue infección de herida quirúrgica en un paciente del grupo B (3.1 por ciento). Ninguna de las diferencias observadas alcanzó significación estadística (p > 0.05).La recuperación de la motilidad intestinal es rápida en niños operados por apendicitis aguda no complicada, y no se modifica significativamente por utilizar hidratación postoperatoria por vía oral con soluciones glucosalinas comerciales, o por vía parenteral con las soluciones glucosalinas convencionales.Palabras clave: apendicitis, hidratación oral, fisiología intestinal, motilidad intestinal, apendicectomía.

Características del líquido peritoneal en niños con diarrea grave / Characteristics of peritoneal fluid in children with acute diarrhea

Introducción: un número significativo de las enfermedades diarreicas agudas produce lesiones graves en la pared intestinal que pueden ocasionar la muerte al paciente. El estudio del líquido peritoneal (LP) ha sido propuesto como una herramienta útil para establecer su diagnóstico oportuno. Material y método: fueron sometidos a paracentesis 30 pacientes con diagnóstico de diarrea aguda y probable infarto o perforación intestinal. El LP se calificó por su aspecto macroscópico inmediato a su obtención y fue procesado para determinar su contenido de leucocitos, glucosa, proteínas y cloro. El diagnóstico clínico se estableció durante la laparotomía o la necropsia, o por la buena evolución clínica. Los datos fueron analizados mediante la estadística de valoración de pruebas diagnósticas.Resultados: el LP transparente y amarillo fue interpretado como un signo de ausencia de infarto o perforación intestinal, con una sensibilidad (S) de 87 por ciento, una especificidad (E) y valor predictivo positivo (VPP) de 100 por ciento y un valor predictivo negativo (VPN) del 91.6 por ciento, con una precisión de la prueba (PP) de 95 por ciento. Un LP sanguinolento fue un signo de infarto intestinal, con una S de 54 por ciento, E y VPP de 100 por ciento, y VPN de 72 por ciento (PP 80 por ciento). Más de 1000 leucocitos por mm3 de LP fue un signo de la presencia de alguna lesión macroscópica de la pared intestinal, con una S de 68 por ciento, una E de 88 por ciento, un VPP de 91 por ciento y un VPN de 61 por ciento (PP 76 por ciento). Una cifra de glucosa en la ascitis menor de 4O mg/dl fue signo de infarto intestinal con una S de 42 por ciento, una E de 78 por ciento, un VPP de 71 por ciento y un VPN de 50 por ciento (PP 57 por ciento), y uno de viabilidad bacteriana con una S y un VPN de 100 por ciento, una E de 80 por ciento y un VPP de 67 por ciento (PP 86 por ciento). Niveles de cloro ascítico superiores a 90 meq/l fueron característicos de perforación o infarto intestinal con una S y un VPN de 100 por ciento, una E de 60 por ciento, y un VPP de 82 por ciento (PP 86 por ciento). Conclusión: el estudio del LP es de gran utilidad en la evaluación del niño con diarrea grave en quien se sospecha perforación o infarto intestinal. El color amarillo transparente, una cifra de leucocitos menor a 1000 por mm3, una cifra de glucosa superior a 40 mg/dl y una de cloro inferior a 90 meq/lt sugieren que la enteritis no ha causado daños irreversibles en la pared intestinal.

Espectro clínico de la torsión tubo-ovárica en niñas / Clinical spectrum of ovarian torsión in girls

La torsión tubo-ovárica en las niñas, en ausencia de alguna masa ovárica predisponente, es una entidad que ocurre con mayor frecuencia de lo que se cree, y que de no tratarse conduce a la necrosis del órgano afectado.Se presentan tres casos representativos: sólo uno manifestó dolor abdominal bajo agudo e intenso, que orilló a laparotomía con destorsión de la trompa y el ovario afectados. Los otros dos casos manifestaron dolor abdominal intermitente, de corta duración, que fue insuficientemente valorado y su diagnóstico sólo se estableció por la aparición de imágenes de desorganización o calcificación ovárica en estudios radiológicos indicados para la evaluación de síntomas urinarios.Se concluye la importancia de realizar una evaluación precisa de todos los cuadros de dolor abdominal bajo agudo de las niñas, especialmente de las que tienen entre ocho y 13 años de edad y dolor en el lado izquierdo.

Predominio masculino y peso al nacer en estenosis hipertrófica del píloro / Male predominance and birthweight in hypertrophic pyloric stenosis

Introducción: La estenosis hipertrófica del píloro (EHP) es una enfermedad cuya frecuencia es mayor entre los niños varones (M) con antecedentes familiares de la enfermedad y elevado peso natal. El objetivo del estudio fue analizar el patrón del predominio de la EHP en M en relación con el peso al nacer (PN).Métodos: Se revisaron y estratificaron 115 casos consecutivos de EHP por su género y rango de PN (rangos de 500 g). El análisis estadístico se hizo por medio de chi cuadrada y comparación de proporciones.Resultados: El predominio de M no se observó en los pacientes con EHP con PN de 2,500 g o menor(n = 11, 6 M). Las niñas (F) no incrementaron su número de casos a medida que el PN aumentó, pero sí lo hicieron los M, alcanzando un 8.8/1 de razón M/F entre aquellos con PN de 3,500 g o más (p < 0.005). La proporción de M con PN de 3,000 g o más fue significativamente superior que en F (0.826 vs. 0.521, p < 0.005).Conclusión: En EHP, el número excesivo de casos de M, responsable de la disparidad MIF, se concentra en los neonatos con PN superior a los 3,000 g. la entidad no muestra esta relación con el PN en F