Evolución y características de los ingresos por COVID-19 pediátricos en un hospital terciario

Introducción. La mayoría de infecciones por SARS-CoV2 en población pediátrica cursan asintomáticas o con síntomas leves, con porcentaje mínimo de casos graves descritos como síndrome inflamatorio multisistémico asociado al SARS-CoV2 (SIM-PEDs). El objetivo fue describir las características clínico-epidemiológicas de aquellos pacientes pediátricos ingresados con diagnóstico confirmado de SARS-CoV2, y las posibles diferencias de la enfermedad considerando dos períodos epidemiológicos. Material y métodos. Estudio retrospectivo observacional de pacientes pediátricos ingresados con diagnóstico de COVID-19, de un hospital terciario. Se recogieron de forma consecutiva, entre marzo de 2020 hasta febrero 2022, analizando datos demográficos, clínicos, pruebas complementarias, tratamiento administrado y evolución. Resultados. Se incluyeron 69 pacientes, clasificándose en 6 grupos según diagnóstico. Los pacientes con neumonía asociaban mayor hipoxemia, mayor edad y eran predominantemente varones (p<0.01), con respecto al grupo de infecciones respiratorias sin condensación. SIM-PEDs fueron pacientes más graves, con afectación analítica marcada y mayor ingreso en UCIP. Durante el 2º periodo se observa una tendencia a la disminución de la infección respiratoria (69% al 47%), menor estancia hospitalaria (de 4 a 3 días), y aumento de los ingresos por otra patología (7,7% al 30,6%). Conclusiones. Los cuadros clínicos de COVID-19 más frecuentes en niños son respiratorios leves-moderados con buena evolución. Hay una tendencia a menor duración de estancia hospitalaria y aumento de ingresos por otra patología en pacientes asintomáticos en el segundo periodo. SIM-PEDs es otra forma de expresión de infección por SARS-COV2 de mayor gravedad, pero habitualmente con buen pronóstico tras diagnóstico precoz y requiriendo frecuentemente ingreso en UCIP. (provisto por Infomedic International)

Introduction. Most SARS-CoV2 infections in pediatric population are asymptomatic or have mild symptoms, with a small percentage of severe cases described as SARS-CoV2-associated multisystem inflammatory syndrome (MIS-C). The objective was to describe the clinical-epidemiological characteristics of those pediatric patients admitted with a SARS-CoV2 confirmed diagnosis, and the possible differences in the disease considering two epidemiological periods. Methods. Observational retrospective study of pediatric patients admitted with a diagnosis of COVID-19, from a tertiary hospital. They were collected consecutively, between March 2020 and February 2022, analyzing demographic and clinical data, complementary tests, administered treatment and evolution. Results. 69 patients were included, classified into 6 groups according to diagnosis. Patients with pneumonia associated greater hypoxemia, older age and were predominantly male (p<0.01), with respect to the group of respiratory infections without condensation. MIS-C were more severe patients, with marked analytic involvement and greater admission to the PICU. During the 2nd period, there was a trend towards a decrease in respiratory infection (69% to 47%), a shorter hospital stays (4 to 3 days), and an increase in admissions for another pathology (7.7% to 30,6%). Discussion. The most frequent clinical manifestations of COVID-19 in children are mild-moderate respiratory symptoms with a good prognosis. There is a trend towards a shorter length of hospital stay and an increase in admissions for another pathology in asymptomatic patients in the second period. MIS-C is another form of expression of SARS-COV2 infection of greater severity, but usually with a good prognosis after early diagnosis and frequently requiring PICU admission. (provided by Infomedic International)

Bacillary Layer Detachment in an Atypical Case of Central Serous Chorioretinopathy Associated with High Hyperopia.

A 16-year-old boy with elevated hyperopia presented to the office with a 24-h history of bilateral blurred vision, mainly of the left eye, and bilateral central serous chorioretinopathy. He showed a clinically recognizable bacillary layer detachment in one eye and excellent multimodal diagnostic image correlation, with the best-corrected visual acuity as 20/400. He had bilateral serous retinal detachment, as confirmed by optical coherence tomography. Laser photocoagulation was performed with good results, and reestablishment of the foveal anatomical structure was documented 16 days after treatment.

Características clínicas de los niños hospitalizados por COVID-19 / Clinical characteristics of children hospitalized for COVID-19

Introducción:La mayoría de las infecciones por SARS-CoV-2 en población pediátrica cursan asintomáticas o con síntomas leves, con porcentaje mínimo de casos graves descritos como síndrome inflamatorio multisistémico asociado al SARS-CoV-2 (SIM-PEDs).El objetivo fue describir las características clínico-epidemiológicas de aquellos pacientes pediátricos ingresados, con diagnóstico confirmado de SARS-CoV-2 desde el inicio de la pandemia hasta mayo de 2021.Métodos:Estudio retrospectivo observacional de pacientes pediátricos ingresados con diagnóstico de COVID-19, de un hospital terciario. Se recogieron datos demográficos, clínicos, pruebas complementarias, tratamiento administrado y evolución.Resultados:Se incluyeron 30 pacientes, clasificándose en 3 grupos según diagnóstico: infección respiratoria, SIM-PEDs y síntomas compatibles. Los pacientes con neumonía asociaban mayor edad, comorbilidades y linfopenia. SIM-PEDs fueron pacientes más graves, con afectación analítica marcada y mayor ingreso en UCIP. La mayoría eran casos secundarios de contacto en el entorno familiar.Discusión:Los cuadros clínicos de COVID-19 más frecuentes en niños son respiratorios leves-moderados con buena evolución. SIM-PEDs es otra forma de expresión de infección por SARS-CoV-2 de mayor gravedad, pero habitualmente con buen pronóstico tras diagnóstico precoz y requiriendo frecuentemente ingreso en UCIP. (AU)

Introduction:Most SARS-CoV-2 infections in the pediatric population are asymptomatic or with mild symptoms, with a minimal proportion of severe cases described as SARS-CoV-2-associated multi-system inflammatory syndrome (MIS-C).The objective was to describe the clinical and epidemiological characteristics of pediatric patients admitted with confirmed diagnosis of SARS-CoV-2 infection from the beginning of the pandemic until May 2021.Methods:Retrospective observational study of pediatric patients hospitalized with confirmed COVID-19, in a tertiary hospital. Epidemiological and clinical data, additional tests, treatments administered and evolution were collected.Results:30 patients were included, classified into 3 groups according to diagnosis: respiratory infection, MIS-C and compatible symptoms. The patients with pneumonia were associated with age older, comorbidities and lymphopenia. MIS-C were more serious patients, with marked laboratory involvement and greater admission to PICU. Most of these were secondary cases of contact in the family environment.Discussion:The most frequent clinical manifestations of COVID-19 in children are mild−moderate respiratory with good evolution. MIS-C is another form of expression of SARS-CoV-2 infection of greater severity, but usually with good prognosis after early diagnosis and frequent PICU admission. (AU)

Clinical characteristics of children hospitalized for COVID-19.

Introduction: Most SARS-CoV2 infections in the pediatric population are asymptomatic or with mild symptoms, with a minimal proportion of severe cases described as SARS-CoV2-associated multi-system inflammatory syndrome (MIS-C).The objective was to describe the clinical and epidemiological characteristics of pediatric patients admitted with confirmed diagnosis of SARS-CoV2 infection from the beginning of the pandemic until May 2021. Methods: Retrospective observational study of pediatric patients hospitalized with confirmed COVID-19, in a tertiary hospital. Epidemiological and clinical data, additional tests, treatments administered and evolution were collected. Results: 30 patients were included, classified into 3 groups according to diagnosis: respiratory infection, MIS-C and compatible symptoms. The patients with pneumonia were associated with age older, comorbidities and lymphopenia. MIS-C were more serious patients, with marked laboratory involvement and greater admission to PICU. Most of these were secondary cases of contact in the family environment. Discussion: The most frequent clinical manifestations of COVID-19 in children are mild-moderate respiratory with good evolution. MIS-C is another form of expression of SARS-COV2 infection of greater severity, but usually with good prognosis after early diagnosis and frequent PICU admission.

Introducción: La mayoría de infecciones por SARS-CoV2 en población pediátrica cursan asintomáticas o con síntomas leves, con porcentaje mínimo de casos graves descritos como síndrome inflamatorio multisistémico asociado al SARS-CoV2 (SIM-PEDs).El objetivo fue describir las características clínico epidemiológicas de aquellos pacientes pediátricos ingresados, con diagnóstico confirmado de SARS-CoV2 desde el inicio de la pandemia hasta mayo 2021. Métodos: Estudio retrospectivo observacional de pacientes pediátricos ingresados con diagnóstico de COVID-19, de un hospital terciario. Se recogieron datos demográficos, clínicos, pruebas complementarias, tratamiento administrado y evolución. Resultados: Se incluyeron 30 pacientes, clasificándose en 3 grupos según diagnóstico: Infección respiratoria, SIM-PEDs y síntomas compatibles. Los pacientes con neumonía asociaban mayor edad, comorbilidades y linfopenia. SIM-PEDs fueron pacientes más graves, con afectación analítica marcada y mayor ingreso en UCIP. La mayoría eran casos secundarios de contacto en el entorno familiar. Discusión: Los cuadros clínicos de COVID-19 más frecuentes en niños son respiratorios leves-moderados con buena evolución. SIM-PEDs es otra forma de expresión de infección por SARS-COV2 de mayor gravedad, pero habitualmente con buen pronóstico tras diagnóstico precoz y requiriendo frecuentemente ingreso en UCIP.

Clinical characteristics of children hospitalized for COVID-19. / Características clínicas de los niños hospitalizados por COVID-19.

INTRODUCTION: Most SARS-CoV-2 infections in the pediatric population are asymptomatic or with mild symptoms, with a minimal proportion of severe cases described as SARS-CoV-2-associated multi-system inflammatory syndrome (MIS-C). The objective was to describe the clinical and epidemiological characteristics of pediatric patients admitted with confirmed diagnosis of SARS-CoV-2 infection from the beginning of the pandemic until May 2021. METHODS: Retrospective observational study of pediatric patients hospitalized with confirmed COVID-19, in a tertiary hospital. Epidemiological and clinical data, additional tests, treatments administered and evolution were collected. RESULTS: 30 patients were included, classified into 3 groups according to diagnosis: respiratory infection, MIS-C and compatible symptoms. The patients with pneumonia were associated with age older, comorbidities and lymphopenia. MIS-C were more serious patients, with marked laboratory involvement and greater admission to PICU. Most of these were secondary cases of contact in the family environment. DISCUSSION: The most frequent clinical manifestations of COVID-19 in children are mild-moderate respiratory with good evolution. MIS-C is another form of expression of SARS-CoV-2 infection of greater severity, but usually with good prognosis after early diagnosis and frequent PICU admission.

Bilaminar Graft of the Anterior Capsule and Internal Limiting Membrane: A Novel Surgical Technique for the Treatment of Macular Hole and Focal Macular Detachment Associated with High Myopia and Posterior Staphyloma.

This case report describes a novel surgical technique for the treatment of macular hole and focal macular detachment associated with high myopia and posterior staphyloma. A 65-year-old female presented with a stage 3C myopic traction maculopathy and VA of 20/600. OCT examination confirmed a macular hole of 958 µm diameter, posterior staphyloma, and macular detachment. We performed combined phacoemulsification surgery with 23G pars plana vitrectomy; the anterior capsule was preserved and divided into two equal circular laminar flaps. We proceeded with central and peripheral vitrectomy, brilliant blue staining, and partial ILM peeling; capsular sheets were introduced sequentially in the vitreous chamber, the first one was implanted below the hole and attached to pigment epithelium, the second lamina was inserted into the hole, and the remaining portion of ILM was implanted crosswise below the edges of the hole. Macular-hole closure and progressive reapplication of the macular detachment were obtained, with a final VA of 20/80. Treatment of macular holes and focal macular detachment in high myopic eyes is complex, even for experienced surgeons. We propose a new technique with additional mechanisms based on anterior lens capsule and internal limiting membrane tissue properties that showed functional and anatomical improvement and could be considered an alternative treatment.

α-Terpineol: An Aggregation Pheromone in Optatus palmaris (Coleoptera: Curculionidae) (Pascoe, 1889) Enhanced by Its Host-Plant Volatiles.

The Annonaceae fruits weevil (Optatus palmaris) causes high losses to the soursop production in Mexico. Damage occurs when larvae and adults feed on the fruits; however, there is limited research about control strategies against this pest. However, pheromones provide a high potential management scheme for this curculio. Thus, this research characterized the behavior and volatile production of O. palmaris in response to their feeding habits. Olfactometry assays established preference by weevils to volatiles produced by feeding males and soursop. The behavior observed suggests the presence of an aggregation pheromone and a kairomone. Subsequently, insect volatiles sampled by solid-phase microextraction and dynamic headspace detected a unique compound on feeding males increased especially when feeding. Feeding-starvation experiments showed an averaged fifteen-fold increase in the concentration of a monoterpenoid on males feeding on soursop, and a decrease of the release of this compound males stop feeding. GC-MS analysis of volatiles identified this compound as α-terpineol. Further olfactometry assays using α-terpineol and soursop, demonstrated that this combination is double attractive to Annonaceae weevils than only soursop volatiles. The results showed a complementation effect between α-terpineol and soursop volatiles. Thus, α-terpineol is the aggregation pheromone of O. palmaris, and its concentration is enhanced by host-plant volatiles.

Comparación del confort de dos protectores bucales en jugadores de fútbol americano / Comparing the comfort of two mouth protectors in football players

Los deportes de contacto aumentan el riesgo de traumatismo causando alteraciones funcionales, estéticas y psicológicas. Los protectores bucales son parte del equipo de seguridad que protegen al deportista de estos accidentes, es importante que brinde confort para lograr el mejor rendimiento físico. Objetivo: Comparar el confort de los jugadores de fútbol americano con el uso de protectores prefabricados y protectores personalizados. Metodología: Se realizó un estudio cuasiexperimental, analítico y prospectivo donde se incluyeron 15 jugadores de futbol americano de la Facultad de Estudios Superiores Acatlán, UNAM, que firmaron consentimiento informado. La autora principal de este proyecto fabricó los protectores bucales superiores con hoja de copolímero de etilvinilacetato (EVA) #35. El protector prefabricado fue de silicón. Los jugadores realizaron dos prácticas de entrenamientos donde hicieron 30 minutos de carrera, 15 de estiramiento, 60 de fuerza y destreza en donde requerían de estar en constante comunicación verbal y 30 de cardiovascular en gimnasio (usaron un protector en cada entrenamiento). Se aplicó un cuestionario ­previamente validado por consenso de expertos­ para evaluar el confort en la respiración, lenguaje, náuseas, adaptación, comodidad e hidratación bucal con cada tipo de protector. La información se analizó en el programa SPSS v19.0; se usaron proporciones para las variables cualitativas y medidas de tendencia central y dispersión para las cuantitativas. Para comparar el confort con el uso de ambos protectores se empleó la prueba χ2, con un nivel de significancia p < 0.05. Resultados: La media de edad fue de 20 ± 2 años. Con el protector personalizado 11 jugadores (0.73) refirieron que respiraron y hablaron mejor, sintieron menos náusea 12 (0.80), mejor adaptación 11 (0.73) y mayor comodidad 12 (0.80) que, con el uso de protector bucal prefabricado, encontrando diferencias estadísticamente significativas (p < 0.05) y ocho (0.53) refirió menos hidratación bucal (p > 0.05). Doce (0.80) de los jugadores mencionaron tener mayor confort con el protector personalizado. Conclusiones: Con la metodología empleada y en la muestra estudiada, el uso de un protector bucal personalizado fabricado con hoja de copolímero de etilvinilacetato (EVA) #35 ofrece una mejor adaptación y comodidad, después de dos prácticas de entrenamiento (AU)

The contact sports, increase the risk of trauma causing functional, aesthetic and psychological alterations, mouth guards are part of the safety equipment that protects the athlete from this kind of accidents, it is also important that the mouth guard had to provides comfort, for achieve a best physical performance. Objective: Make the comparison with the comfort of American football players with the use of prefabricated protectors and customized protectors. Method: A quasi-experimental, analytical and prospective study was carried out, including 15 American football players from the Facultad de Estudios Superiores Acatlán, UNAM, who signed an informed consent. The lead author of this project manufactured the upper mouth guards with ethylvinylacetate (EVA) #35 copolymer foil. The prefabricated protector was made of silicone. The players performed two practice sessions where they did 30 minutes of running, 15 of stretching, 60 of strength and skill where they required being in constant verbal communication and 30 of cardiovascular in a gymnasium (they used a protector in each training). A questionnaire ­previously validated by expert consensus­ was applied to evaluate comfort in breathing, language, nausea, adaptation, comfort and oral hydration with each type of protector. The information was analyzed in the program SPSS v19.0; proportions were used for the qualitative variables and measures of central tendency and dispersion for the quantitative ones. To compare the comfort with the use of both protectors the test χ2 was used, with a level of signifi cance p < 0.05. Results: The mean age was 20 ± 2 years. With the personalized protector, 11 players (0.73) reported that they breathed and spoke better, feeling less nausea 12 (0.80), better adaptation 11 (0.73) and greater comfort 12 (0.80) than with the use of prefabricated mouth guards, fi nding statistically signifi cant diff erences (p < 0.05) and 8 (0.53) reported less oral hydration (p > 0.05). 12 (0.80) of players mentioned having more comfort with the custom protector. Conclusions: The use of a personalized mouth guard off ers better fi t and comfort made with sheet copolymer of ethylvinylacetate, after two training practices (AU)

Genital reconstruction with Integra™ artificial dermis after radical resection in a boy with diffuse lymphangiomatosis. / Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa.

OBJECTIVE: Lymphangiomatosis is a rare disease affecting lymphatic vessels that causes a marked increase of them in the affected area. The final objective of treatment of the genital disease is to preserve sexual function and voiding with a satisfactory aesthetic result with the aim to minimize the emotional impact. METHODS: For the first time in children, we report a case of local reconstruction using artificial dermis after the excision of a genital lymphatic malformation in an eight year old patient. RESULTS: We performed surgical excision of the lymphatic malformation genital component and reconstruction of the scrotal and penile area in two steps, using an autologous graft over artificial dermis. No complications were registered. Both aesthetic and functional results were excellent, and spontaneous erections that were not present before, were also evidenced. No local recurrence was seen at two year follow up. CONCLUSION: The use of artificial dermis for genital surface reconstruction enables radical excision of tissues involved by diffuse lymphangiomatosis in this location. Surgical technique is simple, postoperative care is easy, being ambulatory care feasible. Final result is an elastic, fine skin, very satisfactory aesthetically, and functionally normal, which even keeps local sensitivity. In the long term, this will benefit the sexual field, so damaged in this patients.

Reconstrucción genital con dermis artificial Integra(R) tras resección radical en un niño con linfangiomatosis difusa / Genital reconstruction with INTEGRA(TM) artificial dermis after radical resection in a boy with diffuse lymphangiomatosis

Objetivo: La linfangiomatosis es una rara enfermedad que afecta a los vasos linfáticos causando un marcado aumento de los mismos en el área afectada. El objetivo final del tratamiento en la afección genital consiste en preservar la función sexual y la micción con un resultado estético satisfactorio a fin de minimizar el impacto emocional. Método: Presentamos por primera vez en niños un caso de reconstrucción local usando dermis artificial tras exéresis de malformación linfática genital en un paciente de ocho años. Resultado: Realizamos resección quirúrgica del componente genital de la malformación linfática y reconstruimos el área escrotal y peneana en dos tiempos, usando un injerto autólogo sobre dermis artificial. No se registró ninguna complicación postoperatoria. Tanto la apariencia estética como el resultado funcional fueron excelentes, registrándose además la aparición de erecciones espontáneas que no habían estado presentes anteriormente. A los dos años de seguimiento no se ha registrado recidiva local. Conclusión: El uso de dermis artificial para reconstruir la superficie genital permite una extirpación radical de los tejidos afectos en la linfangiomatosis difusa en esta localización. La técnica quirúrgica es sencilla, los cuidados postoperatorios fáciles, siendo posible llevarlos a cabo de manera ambulatoria. El resultado final es una piel elástica y fina, estéticamente muy satisfactoria y funcionalmente normal, que incluso mantiene la sensibilidad local, lo que, a largo plazo, beneficiará la esfera sexual tan dañada en este tipo de pacientes (AU)

Objetive: Lymphangiomatosis is a rare disease affecting lymphatic vessels that causes a marked increase of them in the affected area. The final objective of treatment of the genital disease is to preserve sexual function and voiding with a satisfactory aesthetic result with the aim to minimize the emotional impact. Methods: For the first time in children, we report a case of local reconstruction using artificial dermis after the excision of a genital lymphatic malformation in an eight year old patient. Results: We performed surgical excision of the lymphatic malformation genital component and reconstruction of the scrotal and penile area in two steps, using an autologous graft over artificial dermis. No complications were registered. Both aesthetic and functional results were excellent, and spontaneous erections that were not present before, were also evidenced. No local recurrence was seen at two year follow up. Conclusion The use of artificial dermis for genital surface reconstruction enables radical excision of tissues involved by diffuse lymphangiomatosis in this location. Surgical technique is simple, postoperative care is easy, being ambulatory care feasible. Final result is an elastic, fine skin, very satisfactory aesthetically, and functionally normal, which even keeps local sensitivity. In the long term, this will benefit the sexual field, so damaged in this patients (AU)

Retrograde Endopyelotomy with Cutting Balloon™ for Treatment of Ureteropelvic Junction Obstruction in Infants.

PURPOSE: The aim of this study is to analyze results of retrograde endopyelotomy with cutting balloon for treatment of ureteropelvic junction obstruction (UPJO) in infants. METHODS: We routinely treat patients with UPJO under 18 months of age with retrograde high-pressure balloon dilatation of the pelviureteric junction (PUJ). During the procedure, in these cases where narrowing at the PUJ persists, endopyelotomy with cutting balloon is performed. Endopyelotomy is performed over guidewire with 5-mm Cutting Balloon™ under fluoroscopic control. Double-J stents is left in situ for 4 weeks. We retrospectively analyzed the postoperative, clinical, and radiological outcome infants treated with cutting balloon endopyelotomy between 2007 and 2015. RESULTS: Sixteen patients required cutting balloon endopyelotomy to achieve complete resolution of narrowing of the waist observed during high-pressure balloon dilatation of the PUJ. Mean operative time was 35 ± 21 min (mean ± SD) and hospital stay was <24 h in all patients. Complete resolution of the narrowing at the PUJ under fluoroscopy was achieved in all cases, with no perioperative complications. One patient presented with urinary tract infection, postoperatively (Clavien grade II). Preoperatively, all cases had grade IV SFU hydronephrosis with parenchymal thinning. During follow-up, resolution of the hydronephrosis was observed in 11 patients (grade I SFU). In four infants, there was an improvement of the hydronephrosis (grade II SFU) and the renogram curve. In one case, an open pyeloplasty was required due to persistent hydronephrosis and obstructive curve. CONCLUSION: We believe that endopyelotomy with cutting balloon could be a valid and safe option in minimally invasive management of UPJO in infants.

Management of ureteropelvic junction obstruction with high-pressure balloon dilatation: long-term outcome in 50 children under 18 months of age.

OBJECTIVE: To analyze the usefulness of dilatation in the treatment of ureteropelvic junction obstruction (UPJ) in children <18 months of age, including newborns and infants. METHODS: Patients (n = 50; <18 months of age) were diagnosed using abdominal ultrasound, cystogram, and diuretic renography. Treatment was with endourologic retrograde balloon dilatation under fluoroscopic guidance. The balloons were, in all cases, semicompliant with a profile of 5 mm, 6 mm, or 7 mm. Follow-up was for 42.9 ± 23.2 months (mean ± SD). Double-J stents were inserted postdilatation, the caliber and length depending on the patient's body weight. RESULTS: Intervention duration was 22 ± 19 minutes. Dilatation was not possible in 5 patients, and pyeloplasty was the alternative treatment. Hospital stay was 24 hours in 44 patients. Analgesic needs were met exclusively by nonsteroidal anti-inflammatory drugs. The double-J stent was withdrawn using cystoscopy and the UPJ was calibrated.Residual stenosis was found in 7 patients. A second dilatation was required in 3 patients 6-18 months after surgery because of the lack of improvement of hydronephrosis. During follow-up, resolution of the hydronephrosis was observed in 45 cases (anterior-posterior diameter of the renal pelvis 7 ± 5 mm). The diuretic renography improved in 45 infants; the shape of the curve being normal in 44 cases and semi-obstructive in 1. CONCLUSION: We believe that high-pressure balloon dilatation could be a valid and safe option in the minimally invasive treatment of UPJ obstruction in infants. The outcome is acceptable with a low complication rate.

Percutaneous endopyelotomy with electrocautery: modified techniques in the treatment of ureteropelvic junction obstruction in a child under 2 years.

OBJECTIVE: In recent years new techniques in minimally invasive treatment of congenital stenosis of ureteropelvic junction have been developed. We report the treatment of pyeloureteral stenosis in children by percutaneous endopyelotomy. METHODS: In the work up study of a child (18 months) with abdominal palpable mass, a severe left hydronephrosis with a renal pelvis diameter of 65 mm and severely thinned renal parenchyma was found. The diuretic renogram showed an obstructive pattern with impaired renal function. Initially, a retrograde dilatation balloon was placed in the ureteropelvic junction under cistoscopic control. With the patient in modified Valdivia position, percutaneous access to the renal pelvis was performed. By Seldinger technique and under fluoroscopy guide, a 5 mm laparoscopic trocar was placed in the renal pelvis. We performed a percutaneous electrical endopyelotomy of the pyeloureteral junction over the 6 mm retrograde balloon dilator passed through. We placed an antegrade double J stent that was removed at 4 weeks uneventfully. RESULT: Good results were assessed without perioperative or postoperative complications with great improvement in renal dilatation two years after the intervention. The renogram showed improvement in the pattern of the curve with a slight increase in differential renal function. CONCLUSIONS: Percutaneous endopyelotomy in children has important issues due to the lack of appropriate material. However it is possible to get good results as a minimally invasive technique. In fact, it could be the ideal technique in severe hydronephrosis with large renal pelvis that prevents the surgical or endourological approach.

Endopielotomía percutánea con electrobisturí en un lactante: modificaciones técnicas / Percutaneous endopyelotomy with electrocautery: modified techniques in the treatment of ureteropelvic junction obstruction in a child under 2 years

OBJETIVO: Las técnicas mínimamente invasivas de tratamiento de la estenosis pieloureteral desarrolladas en adultos tienen grandes dificultades para su aplicación en niños por la ausencia de material adecuado. Presentamos mejoras técnicas de la endopielotomía percutánea para su aplicación en un lactante. MÉTODO: Paciente de 18 meses con severa hidronefrosis izquierda que cruza línea media con pelvis renal de 65 mm. Se sitúa retrógradamente un balón de alta presión en unión pieloureteral tras pielografía retrógrada y paso de guía a pelvis renal. Con el paciente en posición de Valdivia modificado, se realiza el acceso percutáneo mediante técnica de Seldinger guiado por radioscopia hasta colocar un trocar de 5 mm en pelvis renal. Se realiza una endopielotomía percutánea con corte eléctrico sobre el balón. Se deja colocado un stent doble J anterógradamente que se retira a las 4 semanas. RESULTADO: Buena evolución postoperatoria sin complicaciones perioperatorias ni postoperatorias. Gran mejoría de la dilatación renal al año y dos años de la intervención. El renograma muestra clara mejoría en el patrón de la curva con leve ascenso de la función renal diferencial. CONCLUSIONES: La endopielotomía percutánea presenta dificultades en niños por la ausencia de material adecuado. Sin embargo es posible su realización con buenos resultados sin contraindicar otras técnicas posteriores. Podría ser la técnica ideal en severas hidronefrosis con grandes pelvis renales que dificultan su abordaje quirúrgico o endourológico(AU)

OBJECTIVE: In recent years new techniques in minimally invasive treatment of congenital stenosis of ureteropelvic junction have been developed. We report the treatment of pyeloureteral stenosis in children by percutaneous endopyelotomy. METHODS: In the work up study of a child (18 months) with abdominal palpable mass, a severe left hydronephrosis with a renal pelvis diameter of 65 mm and severely thinned renal parenchyma was found. The diuretic renogram showed an obstructive pattern with impaired renal function. Initially, a retrograde dilatation balloon was placed in the ureteropelvic junction under cistoscopic control. With the patient in modified Valdivia position, percutaneous access to the renal pelvis was performed. By Seldinger technique and under fluoroscopy guide, a 5 mm laparoscopic trocar was placed in the renal pelvis. We performed a percutaneous electrical endopyelotomy of the pyeloureteral junction over the 6 mm retrograde balloon dilator passed through. We placed an antegrade double J stent that was removed at 4 weeks uneventfully. RESULT: Good results were assessed without perioperative or postoperative complications with great improvement in renal dilatation two years after the intervention. The renogram showed improvement in the pattern of the curve with a slight increase in differential renal function. CONCLUSIONS: Percutaneous endopyelotomy in children has important issues due to the lack of appropriate material. However it is possible to get good results as a minimally invasive technique. In fact, it could be the ideal technique in severe hydronephrosis with large renal pelvis that prevents the surgical or endourological approach(AU)

Fístula rectouretral tras tratamiento prenatal de paciente Con valvas de uretra posterior / Rectourethral fistula after prenatal treatment of posterior urethra valves

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Effect of oxcarbazepine pretreatment on convulsive activity and brain damage induced by kainic acid administration in rats.

Temporal lobe epilepsy is one of the most common types of epilepsy. Progress in the understanding and treatment of this type of epilepsy would be greatly facilitated by the availability of an animal model, which reproduced the behavioral and electrographic features of this condition. In this context, kainic acid (KA, 2-carboxy-3-carboxymethyl-4-isopropenylpyrrolidine) administration causes a syndrome characterized by an acute status epilepticus and subsequent brain damage similar to that in temporal lobe epilepsy of humans. The aim of the present study was to investigate whether oxcarbazepine (10,11-dihydro-10-oxo-5 H -dibenz(b,f)azepine-5-carboxamide), an antiepileptic drug, protects against both epileptic activity and brain damage induced by KA administration. Chronically implanted adult male Wistar rats were polygraphically recorded during 10 continuous hours under 4 different conditions: a) control, b) after KA administration alone, c) after KA administration in oxcarbazepine pretreated animals and d) after the administration of oxcarbazepine alone. Animals treated with KA alone presented behavioral and electrophysiological convulsive activity as well as brain damage. Latency of seizure installation was lengthened significantly and convulsive activity was slightly reduced, however, brain damage was still present in oxcarbazepine pretreated animals. Administration of oxcarbazepine alone induced a hypnotic behavior and brain damage was also present.

La resonancia magnética como método diagnóstico en los síndromes coronarios agudos e intervenciones de enfermería / Nursery participation in magnetic resonance applied to diagnosis of coronary syndromes

The cardiovascular magnetic resonance is a method diagnose noninvasive that does not use radiation obtaining itself a space resolution and temporary that allows to analyze the anatomy and cardiovascular function. The material of used paramagnetic resistance is the gadolinium which causes increase of signal in vascularized weaves and better characterization of the visualized weave, acute east allows to the analysis of the perfusion of the myocardium Subsequent to the coronary syndrome study allows to determine with exactitude the extension of the zone of necrosis, to stratify the risk and of identifying the viable weave as well as of determining the affected territory. This revision must like intention describe the provided interventions of infirmary to the patient with acute coronary syndrome that is put under this type of study since without a doubt our recent incorporation to the Department of Magnetic Resonance has been translated in an integral attention.

Motivación laboral en un grupo de odontólogos / Work motivation in a group of dentists

El objetivo fue describir las necesidades dominantes de motivación en un grupo de odontólogos de la ciudad de México. La población seleccionada estuvo constituida por odontólogos de nueve Jurisdicciones Sanitarias de los Servicios de Salud Pública del Gobierno de la Ciudad de México, se les hizo saber los objetivos de la investigación, solicitándoles su consentimiento en forma escrita para participar en el estudio, con el llenado de: El inventario de motivación personal. Se procedió a realizar selección aleatoria del número de jurisdicciones necesarias para completar 148 odontólogos. En el 65 por ciento de la muestra de estudio se detectó la necesidad de logro, indispensable para el trabajo productivo y que se distinguen por personas que quieren hacer las cosas mejor

[Nursing participation in magnetic resonance applied to diagnosis of coronary syndromes]. / La resonancia magnética como método diagnóstico en los síndromes coronarios agudos e intervenciones de enfermería.

The cardiovascular magnetic resonance is a method diagnose noninvasive that does not use radiation obtaining itself a space resolution and temporary that allows to analyze the anatomy and cardiovascular function. The material of used paramagnetic resistance is the gadolinium which causes increase of signal in vascularized weaves and better characterization of the visualized weave, acute east allows to the analysis of the perfusion of the myocardium Subsequent to the coronary syndrome study allows to determine with exactitude the extension of the zone of necrosis, to stratify the risk and of identifying the viable weave as well as of determining the affected territory. This revision must like intention describe the provided interventions of infirmary to the patient with acute coronary syndrome that is put under this type of study since without a doubt our recent incorporation to the Department of Magnetic Resonance has been translated in an integral attention.