Bowman Layer Transplantation With Stromal Inclusion Using Femtosecond Laser: 3-year Results.

PURPOSE: The aim of this study was to evaluate the 3-year clinical results of Bowman layer with stromal inclusion (Bowman layer) transplantation using femtosecond laser for patients with advanced keratoconus. METHODS: This single-center retrospective study included 7 eyes of 7 patients diagnosed with progressive keratoconus who underwent Bowman layer transplantation with stromal inclusion between 2018 and 2020. Follow-up was carried out from the date of surgery until 36 months later. Bowman layer grafts were positioned into a mid-stromal pocket performed by a femtosecond laser and patients were evaluated up to 3 years after surgery. RESULTS: Corneal flattening of 5.49 D (P = 0.0020) in Kmax was observed, increased in corneal pachymetry, and an improvement best-corrected visual acuity measured in logarithm of minimum angle of resolution (LogMAR) from 0.89 to 0.60 and tolerance to contact lens from 42% of the patients to 100% of them. Stabilization of the cornea was achieved in 100% with no further progression of the keratoconus; all surgical procedures were uneventful, and no complications were observed during the 3 years of follow-up. CONCLUSIONS: Bowman layer transplantation with stromal inclusion flattened the cornea improving best-corrected visual acuity and contact lens tolerance and stabilized keratoconus in 100% of the patients during 3 years of follow-up and may be a feasible option in patients with advanced and progressive KC to delay or avoid the need for PK or DALK.

Factors associated with all-cause mortality in pediatric invasive fungal rhinosinusitis.

INTRODUCTION: Pediatric invasive fungal rhinosinusitis (PIFR) is a potentially lethal infection seen in immunocompromised pediatric patients. Even with timely treatments, mortality ranges between 18 and 80% of the cases. OBJECTIVE: To analyze the factors associated with all-cause mortality in pediatric patients with acute invasive fungal rhinosinusitis. SETTING: Tertiary pediatric referral center. RESULTS: A total of 18 patients were included, 12 male and 6 female. The average age at diagnosis was 8.7 years (range 4 months-17 years), with 56% overall mortality and 44% survival after 60 months. The most common cause of immunosuppression was acute lymphoblastic leukemia. The only factor found affecting mortality was a time between diagnosis and surgery greater than 7 days. CONCLUSION: PIFR is an aggressive entity with high mortality. An appropriate diagnosis with an opportune surgical debridement followed by systemic antifungal therapy is essential to improve survival. Delay in surgical treatment is associated with higher mortality.

Complete polysomnographic parameters in infants with severe laryngomalacia prior to and after supraglottoplasty.

INTRODUCTION: Laryngomalacia is the most common congenital laryngeal anomaly. Because of supraglottic prolapse, laryngomalacia may be associated with obstructive sleep apnea (OSA) and sleep disturbances. The effects of OSA and sleep disorders in children include failure to thrive, cognitive and behavioral disturbances, cardiovascular compromise, and an association with sudden infant death syndrome. OBJECTIVE: To evaluate the presence of OSA and sleep disturbances in children with severe laryngomalacia through complete nocturnal polysomnography, as well as to establish the effects of supraglottoplasty in each of the polysomnographic parameters. RESULTS: Nine infants with severe laryngomalacia were included, all with a complete polysomnographic study prior to and after supraglottoplasty. The average age was 5.5 months. All patients presented an Apnea-Hypopnea Index (AHI) within the range of severe OSA. After supraglottoplasty, a significant reduction in AHI was found, from 34.87 ±â€¯20.34 to 9.44 ±â€¯5.28 after surgery (p: 0.022). Additionally, sleep efficiency had a significant increase, from 21.4% to 56.29% of total sleep time (p: 0.0013). All patients presented a significant decrease in obstructive apnea episodes (p < 0.0001), as well as in hypopnea episodes (p: 0.0154). The mean and minimum peripheral oxygen saturation (SpO2) had a significant increase after supraglottoplasty from 88.2% to 94.09% (p: 0.0002), and from 81.01% to 89.33% (p < 0.0001), respectively. CONCLUSION: Polysomnography (PSG) may provide better surgical sustenance in infants with severe laryngomalacia and OSA, as well as, serving as a monitoring tool of success. However, the surgical decision should not be reduced to polysomnographic results, and a good history and examination remain as the fundamental criteria.

Changes in biofilm in chronic cholesteatomatous otitis media in children following the application of sodium 2-mercaptoethanesulfonate (MESNA).

BACKGROUND: Pediatric cholesteatoma is a clinically challenging disease entity. Its biological behavior in the pediatric population differs from its behavior in adult population in terms of aggressiveness and recurrence. Several studies have shown the presence of biofilms associated with cholesteatoma that hinder the management and eradication of the infection. This led is to study the use of non-antimicrobial treatments impacting on the structure or composition of biofilms. OBJECTIVE: To evaluate the changes that occur in the biofilm of cholesteatoma in pediatric patients after the application of sodium 2-mercaptoethanesulfonate (MESNA). METHODS: A pilot study of 10 pediatric patients, with a median age of 10 years and a diagnosis of cholesteatomatous chronic otitis media, who underwent surgery for primary or revision mastoidectomy in the Otorhinolaryngology Service of the Hospital Infantil de México Federico Gómez between January 2016 and May 2017. During the surgery, basal samples of cholesteatoma and tissue were taken after topical application of 4% MESNA for 10 min. The samples were then processed for confocal laser microscopy. RESULTS: In all samples structures compatible with bacterial biofilms were identified. The most relevant finding was the changes in the structure of the biofilm after the application of MESNA, such as disintegration and separation of the underlying tissue. CONCLUSIONS: This is the first study that showing changes associated with cholesteatoma in the structure of the bacterial biofilm after the application of MESNA. The observed disintegration of cholesteatoma biofilm ultrastructure could aid in the management of the chronic infection associated with cholesteatoma.

Lesiones de la línea media nasofrontal en niños / Naso frontal lesions in the midline of children

Las lesiones congénitas de la línea media nasofrontal son anormalidades congénitas raras como quistes dermoides, gliomas nasales y encefaloceles, cuya ocurrencia es de 1:20,000 a 40,000 nacimientos. Su importancia radica en la conexión con el sistema nervioso central. La biopsia de las lesiones con comunicación intracraneal, producen fístulas de líquido cefalorraquídeo o meningitis. Objetivo: Determinar la prevalencia de lesiones de la línea media nasofrontal en un hospital de tercer nivel de referencia regional y su relación con otro tipo de malformaciones. Material y Métodos: Diseño del estudio: Transversal retrospectivo. Pacientes masculinos y femeninos de 1 mes a 13 años de edad con lesiones congénitas de la línea media nasofrontal, atendidos en el hospital infantil entre 1990 a 2005. Se obtuvo mediante un muestreo no probabilística de casos consecutivos. Análisis estadísticos: Por medio del paquete estadístico para las ciencias sociales (SPSS) versión 13.0 se realizó una estadística descriptiva que incluyo a la mediana como medida de tendencia central y la distribución de frecuencia y proporción como medida de dispersión. Resultados: Se realizó una revisión de expedientes clínicos desde 1990 al 2005, encontrando 38 expedientes de 67 revisados, se excluyeron 29 expedientes por corresponder al diagnóstico de encefaloceles occipitales. La prevalencia fue 38 casos en 15 años. La distribución por sexo de las lesiones de la línea medio nasofrontal en general fue ligeramente mayor en el sexo femenino con 22 casos y masculino 16 casos. Las lesiones de la línea media nasofrontal encontradas fueron encefaloceles, gliomas y quistes dermoides, en nuestra revisión predominó los encefaloceles que no presentaron alteración asociada a nivel del sistema nervioso central y 11 casos si presentaron alguna alteración asociada; encontrando 5 casos conhidrocefalia y/o quistes temporales u occipitales y 6 casos con agenecia del cuerpo calloso más hidrocefalia...

Congenital nasofrontal lesions of the midline are rare congenital abnormalities such as dermoid cysts, nasal gliomas and encephaloceles, with an occurrence of 1: 20,000 to 40,000 births. Its importance lies in the connection to the central nervous system. The biopsy of the lesions with intracranial communication, produce cerebrospinal fluid leaks or meningitis. Objective: To determine the prevalence of midline nasofrontal lesions in a tertiary hospital of regional referral and it's relationship with other malformations. Material and Methods: Study Design: Transversal retrospective. Male and female patients aged 1 month to 13 years of age with congenital lesions of the nasofrontal midline, treated at Children'spspital from 1990 to 2005. Sample: was obtained by a non-probabilistic sample of consecutive cases. Through the Statistical Package for the Social Sciences (SPSS) version 13.0 which included descriptive statistics: median as a measure of central tendency and frequency distribution and proportion as a measure of dispersion. Results: a review of clinical records was conducted from 1990 to 2005, finding 38 of 67 records reviewed, 29 files were excluded because they correspond to the diagnosis of occipital encephalocele. Prevalence was 38 cases in 15 years. The gender distribution of nasofrontal midline lesions was slightly higher in females with 22 cases and 16 cases in males. The midline nasofrontal lesions found were midline encephalocele, gliomas and dermoid cysts. In our review most encephaloceles were not associated with the central nervous system and 11 cases did have an associated disorder; 5 cases with hydrocephalus and / or temporal or occipital cysts and 6 cases with nondevelopment of the corpus callosum plus hydrocephalus...

[Intrasal corticosteriods prescription to allergic rhinoconjunctivitis and rhinosinusitis during pediatric ages]. / Prescripción de corticosteroides intranasales para la rinoconjuntivitis alérgica y rinosinusitis en la edad pediátrica.

The different diseases that affect the upper respiratory tract, like allergic rhinitis, rhinoconjunctivitis, and rhinosinusitis have inflammation as their main pathophysiological component. Affects approximately 25% of the adults and 40% of the children. Intranasal corticosteroids (INSs) are considered the most effective treatment for the management of allergic rhinoconjunctivitis. Unlike antihistamines or antileukotrienes, INSs have a more profound effect on nasal congestion and the related sleep disturbance and daytime somnolence resulting from nasal congestion that affect their everyday quality of life. We review INSs mechanism of action, pharmacological properties of the different INSs, their therapeutic use and give our suggestions for their proper use.

[Comparative meta-analysis of immunoestimulant agents used in pediatric patients in Mexico]. / Metaanálisis comparativo de los inmunoestimulantes utilizados en pediatría en México.

OBJECTIVES: To gather basic information of the double-blinded, placebo controlled studies about the use of immunostimulant agents to prevent acute respiratory infections in children and to make a meta-analysis of each one of them after six months of treatment. MATERIAL AND METHODS: Articles related to immunostimulant agents were looked up in Medline and EMBASE, and the ones referring to controlled studies were selected. Average data and the dispersion of the number of acute respiratory infections were extracted and combined as average differences considering the random-effect model for each one of the immunostimulant agents. RESULTS: Only D53, LW50020, OM-85, pidotimod, and RU41740 had controlled studies. It was only possible to calculate the combined effects of D53, OM-85, pidotimod, and RU41740. The effects in the reduction of the number of acute respiratory infections were: global D53 -0.92 (-1.46, -0.39), average difference (confidence interval 95%) (p < 0.05); global OM-85 -1.20 (-1.70, -0.69) (p < 0.05), OM-85 in Mexico City -1.55 (-2.00, -1.10) (p < 0.05); global pidotimod -0.82 (-1.84, +0.21) (p > 0.05); global RU41740 -0.81 (-2.24, +0.62) (p > 0.05), RU41740 in Mexico City -1.20 (-4.33, +1.94) (p > 0.05). Effects in the reduction of acute respiratory infections as percentages were: global D53 31.86% (-34.32, -29.40) (p < 0.05); global OM-85 -39.28% (-52.58, -25.98) (p < 0.05), OM-85 in Mexico City -46.85% (-54.98, -38.72) (p < 0.05); global pidotimod -31.26% (-42.51, -20.01) (p < 0.05); global RU41740 -27.60 (-73.88, +18.69) (p > 0.05), RU41740 in Mexico City -27.89 (-104.11, +48.33) (p > 0.05). DISCUSSION: Only D53 and OM-85 proved to have significant effect in the prevention of acute respiratory infections in children. Only OM-85 showed significant efficacy in Mexico City. LW50020, pidotimod, and RU41740 have some evidence of their efficacy, contrary to other immunostimulant agents that do not have it.

Mucormicosis rinoorbitaria nosocomial causada por Rhizopus oryzae en un lactante desnutrido / Rhyno-orbitary mucomycosis due to Rhyzopus oryzae in a melnourished infant

Introducción. La mucormicosis es una infección causada por zigomicetos del orden de los mucorales, la cual ha ido en aumento en relación con alguna forma de inmunocompromiso. La forma rinoorbitaria es considerada un estadio temprano de la presentación rinocerebral, que al ser sometida a un tratamiento médico y quirúrgico oportuno e individualizado presenta un mejor pronóstico.Caso clínico. Lactante masculino de 6 meses que presentaba a su inicio gastroenteritis infecciosa con deshidratación grave aunado a desnutrición calórico-proteica. A la semana de recibir doble esquema antibiótico se complicó con enfermedad isquémica intestinal; a los 11 días de estancia hospitalaria presentó lesión puntiforme violácea en región malar derecha la cual progresó hacia la necrosis, iniciándose ceftazidima además de realizarse desbridación quirúrgica. A su ingreso al Hospital Infantil de México Federico Gómez presentaba pérdida completa de tejidos blandos en región malar derecha de 6 x 4 cm, destrucción de alerón y dorso de nariz y párpado inferior derecho, exotropia, secreción ocular y una placa blanquecina en paladar duro y en dorso de lengua. Se descartó compromiso del sistema nervioso central, realizándose desbridación extensa. El reporte histopatológico refirió formas micóticas, iniciando manejo con anfotericina B a 1 mg/kg/día, después de varias desbridaciones y una dosis acumulada de anfotericina se detectó nuevamente zona de inflamación que por biopsia y cultivo se identificó como Rhizopus oryzae.Conclusión. Son de interés la forma de adquisición nosocomial y la entidad subyacente ya que se consideran asociaciones inusuales; además, es un ejemplo claro de cómo a pesar del tratamiento adecuado éste debe ser agresivo, multidisciplinario y siempre individualizado eliminando o controlando lo antes posible la entidad subyacente y asegurando un seguimiento prolongado.

Complicaciones en el manejo de cuerpos extraños de oído en pacientes pediátricos / Handling complications of foreing bodies located in the ear of pediatric patients

Introducción. La presencia de un cuerpo extraño en el oído es un problema común en la consulta pediátrica; sin embargo, existe escasa información publicada al respecto. Material y métodos. El promedio de edad fue de 6 años. El oído más afectado fue el derecho. Los cuerpos extraños más frecuentes fueron semillas (31 por ciento). En el 49 por ciento de los pacientes existía antecedente de intento de extracción y en el 36 por ciento se ignoraba el tiempo de evolución. Se logró la extracción en el 100 por ciento de los casos, utilizándose la visión microscópica en 97 por ciento de los mismos. Fue necesaria la extracción en quirófano en el 18 por ciento, de los cuales 83 por ciento tenía el antecedente de manipulaciones previas. La complicación más frecuente fue laceración del conducto auditivo externo. Cinco pacientes presentaron complicaciones permanentes. Conclusión. La extracción de un cuerpo extraño debe ser realizada por el especialista, ya que no constituye una urgencia absoluta. La manipulación inadecuada puede originar complicaciones permanentes

Otitis media aguda. Tratamiento médico / Mecial treatment of acute otitis media

La otitis media aguda es una entidad con una gran importancia epidemiológica en pediatría, pues se ha comprobado que la mayoría de los niños han padecido al menos un cuadro de otitis al cumplir un año de vida y que casi la mitad de los niños a los 3 años de edad tienen antecedente de 3 o más episodios de esta infección. La causa de este problema es multifactorial y las bacterias están implicadas en la mayoría de los casos. El médico de primer contacto y el pediatra general, son los encargados de hacer el diagnóstico y realizar el tratamiento adecuado. En este artículo se revisan aspectos importantes sobre el tratamiento de la otitis media aguda, haciendo énfasis en la necesidad del uso de antibióticos, con el fin de aliviar más rápido la sintomatología, erradicar oportunamente el agente causal y disminuir la incidencia de complicaciones supurativas. Se hace una revisión de la literatura sobre cuáles con los antibioticos, con el fin de aliviar más rápido la sintomatología, erradicar oportunamente el agente causal y disminuir la incidencia de complicaciones supurativas. Se hace una revisión de la literatura sobre cuáles son los antibióticos de primera elección y cuáles con las alternativas terapéuticas incluyendo a aquellos pacientes calificados como de alto riesgo. También se hace hincapié en la importancia de Streptococcus pneumoniae resistente a la penicilina como agente causal de la otitis media aguda. Finalmente se recomiendan las medidas preventivas de ésta