Leishmaniasis visceral: Caso clinico pediatrico / Visceral leishmaniasis: Pediatric case report

La leishmaniasis es una enfermedad causada por parásitos obligados intracelulares pertenecientes al género Leishmania y que reconoce tres formas clínicas principales: cutánea, visceral y mucocutánea. Es una patología del grupo de las "enfermedades desatendidas". Es la única enfermedad tropical transmitida a través de vectores que se ha mantenido endémica por décadas en el sur de Europa. La leishmaniasis visceral representa la forma más grave. Se caracteriza por fiebre, pérdida de peso, anemia y hepatoesplenomegalia. Su período de incubación oscila entre 2 semanas y 18 meses. La leishmaniasis se considera una enfermedad reemergente a nivel mundial. Algunos de los factores que favorecen esta situación son los cambios en las condiciones climáticas, migraciones y urbanizaciones deficitarias en saneamiento ambiental. Se presenta el caso de un niño europeo que estaba vacacionando en Córdoba y fue derivado a nuestro Hospital por fiebre y pancitopenia, lo que generó un abordaje multidisciplinario con resolución clínica favorable.

Leishmaniasis is a disease caused by obligate intracellular parasites of the genus Leishmania. There are three main clinical forms of leishmaniasis: cutaneous, visceral and mucocutaneous. It belongs to the diverse group of the tropical "neglected diseases" and is the only tropical vector-borne disease that has remained endemic to southern Europe for decades. Visceral leishmaniasis represents the most serious clinical syndrome. It is characterized by fever, weight loss, anemia and enlargement of the spleen and liver. Incubation period is usually from 2 weeks to 18 months. Leishmaniasis is considered a worldwide reemerging disease. Some of the factors that favor this situation are the changes in the climatic conditions, migrations and urbanizations deficient in environmental sanitation. We report an interesting case of an European child who was spending holidays in Cordoba and presented to our hospital with fever and pancytopenia, motivating a multidisciplinary approach with favorable clinical outcome.

[Visceral leishmaniasis. Pediatric case report]. / Leishmaniasis visceral. Caso clínico pediátrico.

Leishmaniasis is a disease caused by obligate intracellular parasites of the genus Leishmania. There are three main clinical forms of leishmaniasis: cutaneous, visceral and mucocutaneous. It belongs to the diverse group of the tropical "neglected diseases" and is the only tropical vector-borne disease that has remained endemic to southern Europe for decades. Visceral leishmaniasis represents the most serious clinical syndrome. It is characterized by fever, weight loss, anemia and enlargement of the spleen and liver. Incubation period is usually from 2 weeks to 18 months. Leishmaniasis is considered a worldwide reemerging disease. Some of the factors that favor this situation are the changes in the climatic conditions, migrations and urbanizations deficient in environmental sanitation. We report an interesting case of an European child who was spending holidays in Cordoba and presented to our hospital with fever and pancytopenia, motivating a multidisciplinary approach with favorable clinical outcome.

La leishmaniasis es una enfermedad causada por parásitos obligados intracelulares pertenecientes al género Leishmania y que reconoce tres formas clínicas principales: cutánea, visceral y mucocutánea. Es una patología del grupo de las "enfermedades desatendidas". Es la única enfermedad tropical transmitida a través de vectores que se ha mantenido endémica por décadas en el sur de Europa. La leishmaniasis visceral representa la forma más grave. Se caracteriza por fiebre, pérdida de peso, anemia y hepatoesplenomegalia. Su período de incubación oscila entre 2 semanas y 18 meses. La leishmaniasis se considera una enfermedad reemergente a nivel mundial. Algunos de los factores que favorecen esta situación son los cambios en las condiciones climáticas, migraciones y urbanizaciones deficitarias en saneamiento ambiental. Se presenta el caso de un niño europeo que estaba vacacionando en Córdoba y fue derivado a nuestro Hospital por fiebre y pancitopenia, lo que generó un abordaje multidisciplinario con resolución clínica favorable.

[Nutritional status in children hospitalized in minimum care wards. Hospital de Niños de la Santísima Trinidad. Córdoba]. / Estado nutricional en niños internados en Salas de Cuidados Mínimos. Hospital de Niños de la Santísima Trinidad. Córdoba.

INTRODUCTION: Malnutrition in children hospitalized has been informed in papers from Argentina and others countries. It can affect immunity and increases the rate of mortality when it is severe. The objective of the present study was to describe the nutritional status in children admitted in minimum care wards in a tertiary care children's hospital. POPULATION: Children under 6 years (1-71.6 months) admitted in minimum care wards in Hospital de Niños de la Santísima Trinidad, between 15th October 2003 and 15th January 2004, with acute or potentially reversible and chronic medical or surgical conditions. MATERIAL AND METHODS: Anthropometry compared with growth reference data from Argentina and lab methods were used in order to test the nutritional condition in patients who met the inclusion criteria (n=439) carried out from the moment patients were admitted to the hospital. The prevalence of: a) malnutrition with P/E < P3 and modified Waterlow criteria, b) overweight and obesity by relative weight and c) abnormal biochemical parameters were calculated. RESULTS: The prevalence of malnutrition taking into account P/E values < percentile 3 was 25.1% and modified Waterlow criteria: 50.2%. Among the malnourished children, 49.6% of them had acute evolution and 35.1% chronic evolution; 4.5% presented severe malnutrition (60% had a chronic illness); 29 patients (9.1%) were overweight or obese. The haemoglobin values were low in 47.5% and the albumin level in 3.1% of the patients. CONCLUSIONS: The prevalences of malnutrition and anaemia are high among the children admitted to the hospital; the prevalences of overweight and obesity were low in the patients evaluated. A careful evaluation and nutritional care is required in hospitalized children.

White matter hyperintensities are significantly associated with cortical atrophy in Alzheimer's disease.

BACKGROUND AND OBJECTIVE: Methodological variability in the assessment of white matter hyperintensities (WMH) in dementia may explain inconsistent reports of its prevalence and impact on cognition. We used a method of brain MRI segmentation for quantifying both tissue and WMH volumes in Alzheimer's disease (AD) and examined the association between WMH and structural and cognitive variables. METHODS: A consecutive series of 81 patients meeting NINCDS-ADRDA criteria for probable AD was studied. Nineteen healthy volunteers of comparable age served as the control group. Patients had a complete neurological and neuropsychological evaluation, and a three dimensional MRI was obtained. Images were segmented into grey matter, white matter, and cerebrospinal fluid. WMH were edited on segmented images, and lobar assignments were based on Talairach coordinates. RESULTS: Mild and moderate to severe AD patients had significantly more WMH than controls (p<0.05). WMH preferentially involved the frontal lobes (70%), were inversely correlated with grey matter cortical volume (R(2) = 0.23, p<0.001), and were significantly associated with vascular risk factors and with a worse performance on memory tasks. CONCLUSION: Objective measurements of tissue volumes in AD demonstrated that WMH are significantly related to cortical atrophy and neuropsychological impairment.