Live varicella vaccine in both immunocompromised and healthy children.

BACKGROUND: There is no information on the use of live varicella vaccine in Mexican children. Our objective was to evaluate antibody response and safety of the live varicella vaccine in both healthy and immunocompromised Mexican children. METHODS: One hundred children with no history of varicella/zoster were vaccinated with a live attenuated varicella vaccine. According to their immune status, patients were divided into either a compromised (leukemia, solid tumors, chronic renal failure, and cirrhosis) or a healthy children group. Serum IgG antibodies against VZV were measured by ELISA at baseline and at 3 and 6 months after vaccination. RESULTS: A positive VZV-ELISA at baseline was detected in 36 of 67 (53.7%) immunocompromised children and in 22 of 33 (66%) healthy children. Among VZV-seronegative children, seroconversion at 6 months post-vaccination was observed in 90.3% of compromised children and in 100% of healthy children. Increases in serum antibody levels at 3 and 6 months post-vaccination was similar in both groups. VZV vaccine-related adverse reactions, mostly mild and local, were detected in 29% of the children. Three compromised children had a mild rash symptomatic of varicella after vaccination. CONCLUSIONS: About 50% of immunosuppressed children (mean age 8.8 +/- 3.6 years) with no varicella history were VZV-seronegative. Almost all of these compromised VZV-seronegative patients seroconverted 6 months after vaccine. In addition, antibody titers were similar in both compromised and healthy children.

[The system of evaluating the specialty of pediatrics in the Instituto Mexicano del Seguro Social]. / El sistema de evaluación de la especialidad de pediatría en el Instituto Mexicano del Seguro Social.

A system of evaluation applied to pediatric residents at the Mexican Institute of Social Security (IMSS) is presented. Historical precedents; deficiencies and modifications of the system are commented. Also institutional system of evaluation is described, with emphasis in education strategies: teaching-attendance-research. Usefulness of knowledge tests, supervision, and assessment of evaluation, are mentioned. Finally extrainstitutional evaluation strategies are considered.

[Liaison psychiatry at a neonatal intensive care unit. Interphase between psychiatry of the infant and neonatology]. / Psiquiatría de enlace en una unidad de cuidados intensivos neonatales. Interfase entre la psiquiatría del lactante y la neonatología.

A description is made of the situation of neonates and their families during hospitalization in the Neonatal Intensive Care Unit (NICU). Emphasis is made on the stressful situations faced by the infants, the families and the caregivers as well as on potential interventions to ameliorate their negative impact and to promote a favorable outcome. With the infants, the situation is one of overwhelming aversive stimulation, noncontingent responses and painful procedures, coupled with deprivation of normative experiences, propiciated by their illness and the structure of the unit. With the families, their feelings of impotence, guilt, and separation from their infant are highlighted, and interventions are described that may help them in this situation of crisis. With the staff the intervention consists on education and sensitization to the infant's needs. The liaison psychiatrist is the infant's voices with the families and the staff. The literature is reviewed in terms of the potential effects of favorable stimulation and of the negative experiences of neonates while at the NICU.

[The Mortality Committee: a hospital need]. / El Comité de Mortalidad: una necesidad hospitalaria.

Mortality Committees are multidisciplinary teams whose function is to analyze preventable causes of death in order to decrease the death rate, to contribute to the education of medical and paramedical staff and also to advise the hospital authorities in medical and administrative decision-making. In this paper we discuss the activities of the Mortality Committee of the Hospital de Pediatria from May 1989 to May 1991. The review comprised 202 death cases occurred during this period, and was carried out by the medical personnel involved in attending those cases while alive. In 42.5% of these cases the review was supplemented by the necropsy results. Patients' personal data, referral source, status on admission, principal disease, direct cause of death, adequacy of laboratory test and other studies, clinical/pathological correlation and suggestions to improve medical care are discussed. We suggest for every hospital the convenience of having this committee in order to improve the quality of medical care.

[The degree of agreement of the clinical and the histopathological diagnoses in a tertiary medical care pediatric hospital]. / Grado de concordancia del diagnóstico clínico con el histopatológico en un hospital pediátrico de tercer nivel de atención médica.

In Pediatric Hospital, from the National Medical Center, of the Mexican Institute of Social Security were analyzed 96 histological pieces: 59 biopsies, 21 surgical material and 16 slides. There were showed the agreement rate between clinical diagnosis and the end histopathological report from the Pathology Department. The higher correlation rate were with biopsies (83%) and surgical material (81%) and the lowest rate were with slides samples (69%). There were not statistical difference in the 3 study groups (P greater than 0.05). The overall concordance with the clinical diagnosis were 82%. The overall concordance with the 3 study groups were 80%. It is concluded what agreement rate was satisfactory in biopsies and surgical material and the agreement rate measure is an actual parameter in evaluation of clinical competence and also in the evaluation of medical care quality.

[The transfusion of blood and its derivatives in the neonate]. / Transfusiones de sangre y sus derivados en el neonato.

Blood and its products are valuable therapeutic resources for the pediatrician who care for newborns with severe illnesses. The use of blood and its products requires for the hospital personnel working at neonatal care units to be precise and up to date on the indications and complications of total blood, the globular package, albumin, plasma, the concentration of granulocytes, platelets and immunoglobulins for intravenous use. This review gathers, on the one hand, accumulated experiences by the members of the Commission of Blood and its Products from the Pediatric Hospital of the National Medical Center and on the other hand, a selection of the more important concepts which have been judged so by the authors and expressed in the current medical literature.

Neumoperitoneo secundario a neumotorax en un recien nacido. / Pneumoperitoneum secondary to pneumothorax in a newborn infant

El objetivo de esta comunicacion es el de discribir un neonato con la asociacion de neumoperitoneo (NP) de origen pulmonar coincidiendo con atresia de duodeno, asi como la revision de la fisiopatogenia los elementos del diagnostico y el tratamiento del mismo. El NP se penso que era secundario a ruptura de viscera hueca debido a que se produjo disminucion radiologica del aire en camara gastrica, asi como por la presencia de la atresia duodenal, que impidio evaluar la ausencia de niveles hidroaereos en intestino y liquido libre en peritoneo, datos que corresponden a perforacion intestinal. El NP fue secundario a neumotorax con probable diseccion del aire por las vainas perivasculares de la aorta o la cava con paso en el hiato difragmatico al peritoneo. Finalmente, se senalan los elementos para el diagnostico preciso, asi como la terapeutica

Independent changes in cerebrospinal fluid and in blood pH and lactate concentrations in children with purulent meningitis.

In order to evaluate the relationship of the hydrogen and lactate concentrations in cerebrospinal fluid (CSF) with those in the blood, three groups of children were studied: Group I, (n=20) with purulent meningitis (PM); Group II, (n=20) with metabolic acidosis and Group III, (n=17) with suspicion of septicemia but no metabolic acidosis. In all infants a CSF sample was obtained for cytochemical analysis, culture as well as pH and lactate determinations; the latter two were also measured in a blood sample obtained simultaneously. In group I, the CSF [H+] and [lactate] were higher than in the blood (p less than 0.001 and less than 0.01 respectively) and no significant correlation was observed between the CSF and blood values. In group II, no such differences existed in [H+] and [lactate] between both compartments and again no correlation was disclosed between CSF and blood values. In group III only the [H+] was higher in CSF than in blood (p less than 0.01) and a significant correlation was observed between both compartments (r = 0.486, p less than 0.05). The existence of differences in group I among the CSF and blood [H+] and [lactate], along with the lack of correlation between CSF and blood [H+] or [lactate], could suggest that such compartmental changes are independent from each other. However, the variations were quite large and thus, the biological significance of this observation could be questioned.