Early treatment with N-acetylcysteine in children with acute liver failure secondary to hepatitis A.

INTRODUCTION: Hepatitis A virus can evolve to acute liver failure with a fatal outcome if it is not reversed. OBJECTIVE: We describe the clinical course of 12 children who presented with hepatitis A acute liver failure and received treatment with oral N-acetylcysteine (NAC). MATERIALS AND METHODS: Of the seventy-two patients with viral hepatitis A, 12 patients who had acute hepatic failure were included. The variables evaluated were age, sex, duration of clinical features prior to hospitalization, signs and symptoms, laboratory parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), partial thromboplastin time (PTT), internal normalization ratio and ammonia], treatment (oral NAC 100 mg/kg/day, lactulose, neomycin and general measures) and clinical course during hospitalization. RESULTS: Six males and six females were included. School-aged and adolescent children predominated. All presented with jaundice, nausea, vomiting and hepatomegaly. Two had stage 2 neurological signs as per the West-Haven scale. All had altered laboratory parameters. All received NAC, six patients for a week and the remaining six for 9-36 days. Treatment was not ceased until patients showed clinical and laboratory improvement. All data were analyzed using both student's t test and Wilcoxon signed rank with alpha = 0.05, the ALT with P = 0.0003 and 0.005, AST with P = 0.0001 and 0.0005, PT with P = 0.0237 and 0.0005, PTT with P = 0.0515 and 0.0039, ammonia with P = 0.0197 and 0.0015 and direct bilirubin with P = 0.0190 and 0.068. There was good tolerance to medications and a satisfactory clinical course. DISCUSSION: The use of oral NAC appears to be an effective therapeutic alternative for hepatitis A-induced liver failure if it is offered appropriately. It can modify the clinical course to a favorable one and prevent the fatal outcome of hepatic encephalopathy.

Fanconi-Bickel syndrome--two cases report.

A one year eight month old male child and his nine month old female sibling were presented with Growth retardation, abdominal distension, doll-like faces, hepatomegaly, phosphaturia, proximal renal tubular dysfunction. The elder sibling also presented with glucosuria, hyperglycemia, hypoinsulinemia. The younger one later presented with galactosemia. Biopsy of liver on these two patients revealed the accumulation of glycogen in hepatocytes.

Review of treatment and complications in 79 children with rattlesnake bite.

INTRODUCTION: Envenomation by snakebite is a health problem in Mexico. OBJECTIVE: To review the treatment and complications of rattlesnake bites in 79 children. MATERIALS AND METHODS: The variables studied were age, sex, season, hour, signs, symptoms, and complications during 1977 to 1996 (group I) and 1997 to 2006 (group II). Hospitalization time and antivenom type, including polyvalent equine antiviperin serum and a [F(ab')2] antivenom (fabotherapic), were also studied. Results. Most incidents (35%) occurred within the perimeter of children's homes and 8.8% took place inside homes; 40.5% of the children were females; and most snakebites occurred during the summer (70.8%). Members of groups I and II received polyvalent equine antiviperin serum and fabotherapy, respectively. Hospitalization time was less in group II members (P < .0001). The complications in group I members included hypoprothrombinemia and hypofibrinogenemia (P < .0001). CONCLUSIONS: Hospitalization time, complications, and treatment cost were less in patients undergoing fabotherapy.

Kawasaki disease: a rare pediatric pathology in Mexico: twenty cases report from the Hospital Infantil del Estado de Sonora / Enfermedad de Kawasaki: una patología pediátrica rara en México: reporte de 20 casos del Hospital Infantil del Estado de Sonora

BACKGROUND: Kawasaki disease (KD) is an etiological illness that is relatively unknown and scarcely identified in Mexico; it affects children mainly aged 1-4 years, evolves with fever, vasculitis in diverse organs, and in the heart the disease mainly affects the coronary arteries. OBJECTIVES: Our aim was to inform the clinical findings and evolution of 20 patients diagnosed with KD. MATERIALS AND METHODS: We reviewed the patient clinical files retrospectively and descriptively to obtain information with regard to age, sex, clinical signs, laboratory and consultory results, echocardiography findings, complications, evolution during hospitalization, followup, and out-patient ambulatory consultations. RESULTS: Eighteen patients were male, two were female, six developed coronary damage, two aortic mitral-valve insufficiency, one pericardial shedding, and one, myocarditis. All patients received gamma globulin treatment with aspirin, and 16 were controlled during 6-8 months after the acute medical profile. CONCLUSIONS: The opportune clinical diagnostic it is fundamental to establish an early treatment with gammmaglobuline to avoid injuries in the arterial coronary level. This injury may cause eventualy ischemia or myocardial infarct.

Kawasaki disease: a rare pediatric pathology in Mexico. Twenty cases report from the Hospital Infantil del Estado de Sonora.

BACKGROUND: Kawasaki disease (KD) is an etiological illness that is relatively unknown and scarcely identified in Mexico; it affects children mainly aged 1-4 years, evolves with fever, vasculitis in diverse organs, and in the heart the disease mainly affects the coronary arteries. OBJECTIVES: Our aim was to inform the clinical findings and evolution of 20 patients diagnosed with KD. MATERIALS AND METHODS: We reviewed the patient clinical files retrospectively and descriptively to obtain information with regard to age, sex, clinical signs, laboratory and consultory results, echocardiography findings, complications, evolution during hospitalization, followup, and out-patient ambulatory consultations. RESULTS: Eighteen patients were male, two were female, six developed coronary damage, two aortic mitral-valve insufficiency, one pericardial shedding, and one, myocarditis. All patients received gamma globulin treatment with aspirin, and 16 were controlled during 6-8 months after the acute medical profile. CONCLUSIONS: The opportune clinical diagnostic it is fundamental to establish an early treatment with gammmaglobuline to avoid injuries in the arterial coronary level. This injury may cause eventualy ischemia or myocardial infarct

Autoimmune-type chronic active hepatitis in children. A report of 23 cases at a Hospital in Northwestern Mexico.

INTRODUCTION: Autoimmune type chronic active hepatitis (AI-CAH) is a rare pediatric disorder whose principal characteristics include hepatocellular dysfunction and active tissue damage with evolution to cirrhosis in 25-30% of cases. OBJECTIVE: Our aim was to ascertain the evolution of 23 children with AI-CAH treated between 1978 and 2004 at the Hospital Infantil del Estado de Sonora in the Sonora State capital of Hermosillo in northern Mexico. MATERIALS AND METHODS: We conducted a retrospective review that included the following variables: age; sex; personal antecedents; signs and symptoms; laboratory and medical office studies; histologic tissue pattern obtained by biopsy; treatment; evolution, and mortality. RESULTS: Thirteen males and 10 females participated in the study; predominant signs were hyporexia, fatiguehepatomegalia, and icterus. Ten patients presented moderate anemia and six patients, leukopenia and thrombocytopenia. Eighteen patients presented hypergammaglobulinemia. Twenty three patients had percutaneous (p.c.) liver biopsy, and we observed the following histologic pattern: rupture of the limiting plate; necrotic foci; cholangiolar proliferation, and fibrotic bridges; in addition, four patients demonstrated precirrhotic changes. Twenty one children received prednisone for periods of between 1 and 12 years; in seven cases, children were administered azatioprine. Six children presented histologic, biochemical, and clinical remission, nine experienced biochemical remission but presented inflammatory activity,five abandoned treatment, and three died due to cirrhosis, liver insufficiency, and other complications. DISCUSSION: To date, AI-CAH etiology continues to be unknown, while treatment has not been importantly modified in 50 years and continues to consist of prednisone alone or in association with azathioprine.

Effects of asymptomatic Giardia intestinalis infection on carbohydrate absorption in well-nourished Mexican children.

The aim of this study was to evaluate carbohydrate absorption in well-nourished children with asymptomatic giardiasis. Two groups were selected based on results of stool examination of 211 children attending pre-school centers in Hermosillo, Sonora, Mexico: a control group of six non-infected children, and an infected group of seven children harboring Giardia intestinalis, without gastrointestinal symptoms of disease. Carbohydrate absorption was determined in the control group, before and after drug therapy in the infected group by the hydrogen breath test. Hydrogen production after lactose ingestion was higher in children with giardiasis compared with control group and after anti-parasite treatment; however, hydrogen production was not high enough to classify children as lactose malabsorbers by the cut-off criteria. Similar results were obtained for xylose absorption. None of the children had hydrogen increments high enough to be considered xylose malabsorbers. In conclusion, children asymptomatically infected with G. intestinalis showed significantly higher hydrogen production. However, the biological relevance is questionable since they did not exceed cut-off criteria to classify them as carbohydrate malabsorbers.

Prevalencia de gérmenes causantes de faringoamigdalitis en niños. Sensibilidad y respuesta terapéutica a la ampicilina- / Prevalence of germs causing pharyngotonsillitis in children. Sensiativity and therapeutic response to ampicillin

Este estudio fue realizado para analizar la prevalencia de gérmenes aislados en pacientes pediátricos con faringoamigdalitis bacteriana en la consulta privada a nivel de la comunidad, y al mismo tiempo evaluar la respuesta clínica al tratamiento con ampicilina. Material y métodos. Se incluyó a 516 pacientes de 12 ciudades de México, con diagnóstico de faringoamigdalitis bacteriana. Se practicaron exudados faríngeos antes y después del tratamiento con ampicilina y se probó la susceptibilidad in vitro a varios antibióticos (incluida la ampicilina). Resultados. El patógeno más aislado fue el estreptococo betahemolítico del grupo A de Lancefield (S. pyogenes), con 26.6 por ciento de prevalencia. En dichos cultivos la sensibilidad in vitro a ampicilina fue de 100 por ciento para el estreptococo grupo A betahemolítico. La respuesta global a ampicilina fue satisfactoria en 95 por ciento de los pacientes. Conclusiones. Los resultados de este estudio confirman datos anteriormente reportados en población pediátrica a nivel de la comunidad en México y otros países en vías de desarrollo; contrastan con los obtenidos en países del primer mundo y confirman la utilidad del tratamiento de las faringoamigdalitis bacterianas con ampicilina en países en vías de desarrollo.

Prevalencia de gérmenes causantes de faringoamigdalitis. Sensibilidad y respuesta terapéutica a la ampicilina / Prevalence of microorganism causing pharyngoamigdalitis. Sensitivity and therapeutic response to ampicillin

La flora causante de infecciones de tracto respiratorio superior ha cambiado su espectro de sensibilidad y resistencia los antibióticos tras la generación de cepas productoras de ß-lactamasas. La ampicilina ha sido de utilidad durante más de 30 años; sin embargo, actualmente se reporta cada vez con mayor frecuencia resistencia microbiana, sobre todo en países considerados como desarrollados, tales como Estados Unidos y algunos países europeos. La causa de todo ello parece ser el uso inadecuado de antibióticos en este tipo de enfermedades. El presente estudio analizó la prevalencia de gérmenes causantes de faringoamigdalitis en 591 pacientes mexicanos pediátricos ambulatorios, su sensibilidad a los antimicrobianos y la respuesta al tratamiento con ampicilina en las dosis recomendadas por la OMS. La respuesta se midió en términos clínicos con base en la historia clínica del paciente, sus signos y síntomas en una consulta de primera vez y en otra posterior al tratamiento. De esta manera se analizó la persistencia o desaparición de los mencionados signos y síntomas, así como la respuesta terapéutica se tradujera en curación o no. Se encontró que el 90 por ciento de los pacientes, los signos y síntomas disminuyeron después del tratamiento de ampicilina. El análisis bacteriológico en 1,145 exudados mostró positividad en 637 de ellos. El germen patógenos que se aisló fue Streptococcus pyogenes, todos ellos fueron sensibles a la ampicilina (16.9 por ciento), otros gérmenes aislados fueron Staphylococcus aureus (25.1 por ciento), Haemophilus influenzae (19.4 por ciento, Streptococcus pneumoniae (19.9 por ciento) y Moraxella catarrhalis (17.7 por ciento)