Neuritis óptica postencefalitis por virus de Epstein-Barr en niños inmunocompetentes. Caso clínico / Optic neuritis following Epstein-Barr virus encephalitis in immunocompetent children: a case report

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Relationship between aggressive behavior, depressed mood, and other disruptive behavior in Puerto Rican children diagnosed with attention deficit and disruptive behaviors disorders

OBJECTIVE: The present study was directed at examining the relationship between aggressive behavior, depressed mood, other disruptive behaviors in children diagnosed with ADHD or ODD disorders in Puerto Rico. METHODS: One hundred seventy six (176) students (127 males and 49 females) from 12 public elementary schools in the San Juan Area of Puerto Rico participated in the study. The participants were divided into a group of ADHD children who exhibited aggressive behavior, a group of ADHD children that did not show aggressive behavior, and a normal group. Several self-report measures were administered to the children and teachers. RESULTS: Our results indicate that the best predictor of aggressive behavior was the hyperactivity and impulsiveness for both ADHD males and females. In addition, depressed mood in both males and females was also a significant predictor of aggressive behavior in Puerto Rican ADHD children. However, in females the social problems variable was also found to be a significant grouping variable. CONCLUSION: The first conclusion of these results is that inattentiveness does not appear to be a relevant factor in ADHD Puerto Rican children who exhibit aggressive behavior. Second, we need to be cognizant to the fact that Puerto Rican ADHD children do exhibit high co-morbidity for aggressive behavior, depressed mood, and social problems. Thus, our diagnostic and treatment approaches with ADHD Puerto Rican children need to include an assessment of the social environment of the child and its effect on his emotional state, in particular his or her mood.

[Management of isolated minor head trauma. A multicenter study]. / Tratamiento del traumatismo craneoencefálico aislado leve. Estudio multicéntrico.

OBJECTIVE: To detect intracranial injuries (ICI) earlier in children with minor head trauma through the use of a previously established decision tree. METHOD: We performed a prospective multicenter study from September 2003 to January 2005. All patients aged between 3 months and 14 years old who visited the emergency department with minor head trauma (Glasgow Coma Scale score 13-15) were included. Six situations were established according to age (older or younger than 2 years) and low, intermediate or high risk for ICI. The management of each situation was suggested: observation at home, hospital observation or computed tomography (CT). The records of all patients were audited and categorized into: "properly classified, correct management", "properly classified but incorrect management", and "wrongly classified". All the patients were followed-up after discharge. RESULTS: A total of 2148 patients were included. Low risk was assigned to 54.8 %, intermediate risk to 32.4 %, and high risk to 12.8 %. Observation at home or in hospital was assigned to 53.4 % and 24 % respectively. CT was performed in 22.6 %. ICI was detected in 1.6 % and 0.32 % required neurosurgery. There were 25 ICI in the high risk group, seven in the intermediate risk group, and none in the low risk group. No ICI were detected during follow-up. Most patients (90.1 %) were properly classified and the proposed management was carried out in 87.4 %. CONCLUSIONS: When the recommendations of the management protocol were applied, early detection of ICI was achieved in all the situations in which these lesions occurred.

Tratamiento del traumatismo craneoencefálico aislado leve. Estudio multicéntrico / Management of isolated minor head trauma. A multicenter study

Objetivo Detectar precozmente la lesión intracraneana (LIC) en niños con traumatismo craneoencefálico (TCE) leve, mediante un diagrama de decisiones previamente establecido. Método Estudio prospectivo, multicéntrico, entre septiembre de 2003 y enero de 2005. Se incluyeron niños entre 3 meses y 14 años, que consultaron en urgencias por TCE leve (Glasgow 13-15). Se asignaron seis situaciones diferentes de acuerdo con la edad (mayor o menor de 2 años) y riesgo de LIC (bajo, intermedio o alto). Cada situación contenía la conducta recomendada: observación domiciliaria, hospitalaria o tomografía de cráneo. Se auditaron todas las fichas y se categorizaron en: 'bien clasificados, cumplimiento de la conducta'; 'bien clasificados, no cumplimiento de la conducta' y 'mal clasificados'. Se realizó seguimiento a todos lo pacientes tras el alta. Resultados Se incluyeron 2.148 pacientes. Al 54,8 % se asignó riesgo bajo, al 32,4 % riesgo intermedio y al 12,8 % riesgo alto. El 53,4 % se manejó con observación domiciliaria, el 24,0 % con observación hospitalaria y al 22,6 % se efectuó tomografía computarizada de cráneo. Se detectó el 1,6 % de LIC y el 0,32 % requirió neurocirugía. Se detectaron 25 LIC en el grupo de riesgo alto, siete en el grupo de riesgo intermedio y ninguna en el grupo de riesgo bajo. En el seguimiento no se detectó ninguna LIC. El 90,1 % estuvo correctamente clasificado y se cumplió con la conducta propuesta en el 87,4 % de los pacientes. Conclusiones Aplicando las recomendaciones del protocolo de tratamiento, fue posible detectar precozmente LIC en todas las situaciones en que ocurrió

Objective To detect intracranial injuries (ICI) earlier in children with minor head trauma through the use of a previously established decision tree. Method We performed a prospective multicenter study from September 2003 to January 2005. All patients aged between 3 months and 14 years old who visited the emergency department with minor head trauma (Glasgow Coma Scale score 13-15) were included. Six situations were established according to age (older or younger than 2 years) and low, intermediate or high risk for ICI. The management of each situation was suggested: observation at home, hospital observation or computed tomography (CT). The records of all patients were audited and categorized into: 'properly classified, correct management', 'properly classified but incorrect management', and 'wrongly classified'. All the patients were followed-up after discharge. Results A total of 2148 patients were included. Low risk was assigned to 54.8 %, intermediate risk to 32.4 %, and high risk to 12.8 %. Observation at home or in hospital was assigned to 53.4 % and 24 % respectively. CT was performed in 22.6 %. ICI was detected in 1.6 % and 0.32 % required neurosurgery. There were 25 ICI in the high risk group, seven in the intermediate risk group, and none in the low risk group. No ICI were detected during follow-up. Most patients (90.1 %) were properly classified and the proposed management was carried out in 87.4 %. Conclusions When the recommendations of the management protocol were applied, early detection of ICI was achieved in all the situations in which these lesions occurred

[Neonatal hospitalization through a hospital emergency service in Uruguay]. / Hospitalización neonatal desde el servicio de urgencias en un centro hospitalario de Uruguay.

OBJECTIVE: To determine the prevalence of neonatal admissions through a pediatric emergency department (PED), and to evaluate the characteristics of patients who present vital risk on arrival. METHODS: We performed a descriptive, retrospective review of neonates aged 2-28 days arriving from home who presented to the pediatric emergency department between 01/01/03 and 31/12/03. RESULTS: Of a total of 943 neonatal consultations, 277 (29.3 %) required admission. The most common diseases were respiratory (42.6 %) and fever without source (17 %). Among the 943 patients attended, 42 (4,5 %) showed vital risk, and in this group, 81 % were full term neonates, with a P50 of age of 19 days, and a P50 of weight of 3200 g. Among these, there was a predominance of infectious diseases (74 %), especially respiratory tract infections (50 %). Respiratory syncytial virus (RSV) was identified in 14 of the 42 patients. Thirty-six percent required mechanical ventilation and 71.5 % were transferred to the pediatric intensive care unit. Sixty percent of the critically-ill neonates were admitted in the 3 winter months (p < 0.001). CONCLUSIONS: A high percentage of the neonates arriving from home required admission, and vital risk was more frequent in this age group than in other ages (p < 0.001). This does not correspond to risk related to perinatal pathology, or to nutritional reasons, but to community-acquired infections, particularly those of the respiratory tract, the most frequent cause of which is RSV.

Hospitalización neonatal desde el servicio de urgencias en un momento hospitalario de Uruguay / Neonatal hospitalization through a hospital emergency in Uruguay

Objetivo: Determinar la prevalencia de admisiones de recién nacidos a través de un servicio de urgencias pediátricas y evaluar las características de aquellos que a su llegada presentan riesgo vital. Métodos: Estudio descriptivo, retrospectivo, de niños entre 2 y 28 días procedentes del domicilio que consultaron en urgencias pediátricas entre el 1 de enero de 2003 y el 31 de diciembre de 2003. Resultados: Sobre un total de 943 consultas, requirieron admisión 277 (29,3 %). Las enfermedades más frecuentes fueron la respiratoria (42,6 %) y la fiebre sin foco (17 %). Entre los 943 pacientes que consultaron, 42 (4,5 %) presentaban riesgo vital y en este grupo el 81 % eran recién nacidos a término, con un P50 de edad en 19 días y un P50 de peso en 3.200 g. Entre ellos predominaron las enfermedades infecciosas (74 %), en particular las respiratorias (50 %). Se detectó virus respiratorio sincitial (VRS) en 14 de los 42 pacientes. El 36 % requirió asistencia ventilatoria mecánica y el 71,5 % fue derivado a cuidados intensivos o intermedios. El 60 % de los recién nacidos graves consultó en los 3 meses de invierno (p < 0,001). Conclusiones: Los recién nacidos procedentes del domicilio tienen una tasa de ingresos muy alta y presentan riesgo vital con más frecuencia que en otras edades (p < 0,001). Esto no parece responder a riesgos vinculados a patología perinatal o a razones nutricionales, sino a infecciones adquiridas fuera del hospital, en particular de tipo respiratorio, en las que el agente más frecuente es el VRS

Objective: To determine the prevalence of neonatal admissions through a pediatric emergency department (PED), and to evaluate the characteristics of patients who present vital risk on arrival. Methods: We performed a descriptive, retrospective review of neonates aged 2-28 days arriving from home who presented to the pediatric emergency department between 01/01/03 and 31/12/03. Results: Of a total of 943 neonatal consultations, 277 (29.3 %) required admission. The most common diseases were respiratory (42.6 %) and fever without source (17 %). Among the 943 patients attended, 42 (4,5 %) showed vital risk, and in this group, 81 % were full term neonates, with a P50 of age of 19 days, and a P50 of weight of 3200 g. Among these, there was a predominance of infectious diseases (74 %), especially respiratory tract infections (50 %). Respiratory syncytial virus (RSV) was identified in 14 of the 42 patients. Thirty-six percent required mechanical ventilation and 71.5 % were transferred to the pediatric intensive care unit. Sixty percent of the critically-ill neonates were admitted in the 3 winter months (p < 0.001). Conclusions: A high percentage of the neonates arriving from home required admission, and vital risk was more frequent in this age group than in other ages (p < 0.001). This does not correspond to risk related to perinatal pathology, or to nutritional reasons, but to community-acquired infections, particularly those of the respiratory tract, the most frequent cause of which is RSV