Hospital Infantil De Research Articles

Molecular analysis and distribution of multidrug-resistant Enterococcus faeciumisolates belonging to clonal complex 17 in a tertiary care center in Mexico City

BackgroundEnterococcus faecium has recently emerged as a multidrug-resistant nosocomial pathogen involved in outbreaks worldwide. A high rate of resistance to different antibiotics has been associated with virulent clonal complex 17 isolates carrying the esp and hyl genes and the purK1 allele.ResultsTwelve clinical vancomycin-resistant Enterococcus faecium (VREF) isolates were obtained from pediatric patients at the Hospital Infantil de México Federico Gómez (HIMFG). Among these VREF isolates, 58.3% (7/12) were recovered from urine, while 41.7% (5/12) were recovered from the bloodstream. The VREF isolates showed a 100% rate of resistance to ampicillin, amoxicillin-clavulanate, ciprofloxacin, clindamycin, chloramphenicol, streptomycin, gentamicin, rifampicin, erythromycin and teicoplanin. In addition, 16.7% (2/12) of the isolates were resistant to linezolid, and 66.7% (8/12) were resistant to tetracycline and doxycycline. PCR analysis revealed the presence of the vanA gene in all 12 VREF isolates, esp in 83.3% (10/12) of the isolates and hyl in 50% (6/12) of the isolates. Phylogenetic analysis via molecular typing was performed using pulsed-field gel electrophoresis (PFGE) and demonstrated 44% similarity among the VREF isolates. MLST analysis identified four different sequence types (ST412, ST757, ST203 and ST612).ConclusionThis study provides the first report of multidrug-resistant VREF isolates belonging to clonal complex 17 from a tertiary care center in Mexico City. Multidrug resistance and genetic determinants of virulence confer advantages among VREF in the colonization of their host. Therefore, the prevention and control of the spread of nosocomial infections caused by VREF is crucial for identifying new emergent subclones that could be challenging to treat in subsequent years.

Genetic modifications present in choroid plexus neoplasias and associated disturbances of psychoneural development

Choroid plexus papillomas or carcinomas are rare forms of brain neoplasias. Some years ago, Steichen-Gersdorf et al. found a choroid plexus papilloma associated to a case of hypomelanosis of Ito and a 17p:Xq translocation in this female patient (Hum Genet 1993; 90:611–613). Recently, a 10-month-old girl with a Brachmann–/INS;Cornelia de Lange syndrome (BCLS) and a choroid plexus papilloma of the third ventricle of the brain was operated upon and studied at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City.

Severe Glotto‐Subglottic Stenosis in Children: Surgical Treatment with Extended Cricotracheal Reconstruction Technique

Objectives: Evaluate the efficacy of an extended variant to the CTR technique in patients diagnosed with severe glottic-subglottic stenosis (GGS), which consists of expanding the glottis stenosis by placing a costal graft over the posterior cricoid plate and then performing a tyrotracheal anastomosis. Methods: Between 2004 to 2011 at the Hospital Infantil de Mexico “Federico Gomez,” patients with severe GSS based on laryngeal endoscopic evaluation, underwent an extended double-stage CTR. They had a silastic stent for 3-4 weeks and a temporal tracheotomy, which was removed when an appropriate size of the glottis and subglottis was confirmed. Results were analyzed, basing the success of the treatment on the patient’s decannulation. Results: A total of 19 patients were identified, 8 male and 11 female, within an age range from 1 year 7 months to 13 years old, with a mean age of 6.2 years. All patients depended on tracheotomy and were sent to surgery. Fourteen had a favorable outcome and were decannulated (74%); the remaining 5 patients presented restenosis. From these 5, 1 patient has improved and is now waiting for decannulation. Only 1 patient presented anastomosis dehiscence and was successfully reoperated upon. There were no fatalities, and the 14 patients have good respiratory function. Conclusions: The combination of an extended technique to amplify the posterior glottis, where the scar is located, and the tirotracheal anastomosis, which eliminates the subglottic damage, is the only effective procedure to solve a severe glottis subglottic stenosis, as shown in our series.

Treatment results of children with neuroblastoma in Hospital Infantil de Mexico Federico Gomez.

10059 Background: Neuroblastoma (NB) is the main extracraneal cancer in children. Progress in survival has not been the same as in other neoplasms despite molecular markers research and new drugs. Our aim was to describe low and high risk patients at Hospital Infantil de México Federico Gómez (HIMFG) and their results. Methods: We included children from 0 to 18 years con NB diagnosed at HIMFG between january, 2002 and december 2011. We perform a retrospective, retrolective and descriptive study analyzing demographic variables and survival with Kaplan Meier. Results: 64 consecutive patients were included. 73.4% had metastasis at diagnosis (bone marrow 23.4%, liver 18.8%, bone 17.2%, 4.7% central nervous system, 9.4% other). 87.5% of patients received neoadyuvant chemotherapy. Patients were treated with POG 8104 y 8441. Global survival of patients with E4 stage was 50% at 120 months, with E3 of 76.5% at 110 months; stage 1, 2 patient´s survival was 4S 100% at120 months. Conclusions: At HIMFG, in Mexico City, 75% of patients with NB arrive with metastatic disease. Clinical prognosis factors are still current in development countries. Our results are similar as in developed countries suggesting that with low resources, we can obtain satisfactory results only with clinical evaluation.

Cuando el intento de suicidio es cosa de niños

IntroductionAttempted suicide in children and adolescents is a disturbing and painful issue for patients, their families and physicians. Current medical literature provides little information about minors who attempt suicide, possibly because there is under-reporting of this condition as a diagnosis, or maybe because it is sometimes considered as a way for the child to draw attention. ObjectiveTo present the experience of the Department of Psychiatry (Universidad Nacional de Colombia) at the Hospital Infantil de La Misericordia, from 2003 to 2013. MethodsAn observational retrospective study was conducted by reviewing 213 cases of children and adolescents treated for attempted suicide at the Hospital Infantil de La Misericordia from January 1, 2003 to October 31, 2013, and who received hospital or outpatient care in Child Psychiatry. ResultsA review was performed of the diagnosis, the number of suicide attempts, the peak months of consultation for this reason, and the methods selected, as well as a detailed description of the group of patients under 12 years old, and those managed with outpatient follow-up. ConclusionThe average patient is a female teenager who becomes intoxicated with drugs. Most often, patients do not return to outpatient follow-up. Those with follow-up have multiple psychopathologies and a high level of suffering. The most common methods, other than poisoning by drugs, are hanging and jumping from heights. Patients under 12 years old generally have their first attempt by drug poisoning. There is a predominance of anxiety disorder and depression, with a strong association with cognitive dysfunction, as a vulnerability factor.

The development of pediatric neurosurgery in Mexico

The Hospital Infantil de Mexico (Children’s Hospital of Mexico) was inaugurated by the President Manual Avila Camacho on April 30, 1943. Dr. Clemente Robles was appointed as neurosurgeon, but as no special ward for neurological surgery existed, he acted only as a consultant. Typical of that elsewhere in the world at that time, Professor Robles, a gifted surgeon who trained in Europe, operated on the abdomen, within the chest (performing open heart surgery), and he also performed neurosurgery. Professor Robles was succeeded by Dr. Miguel RamosMurguia in 1952. Trained at the Neurological Institute of New York, Dr. Ramos-Murguia founded in 1954 the neurosurgical service at the Children’s Hospital of Mexico, the first pediatric neurosurgical unit in the country and in Latin America. Dr. Ramos-Murguia retired in 1985 and Dr. F. Rueda was trained by him from 1963 to 1969. At the present time, Dr. Fernando Chico-Ponce de Leon is the Chief Service. Residents in General Neurosurgery from the General Hospital do their rotation in pediatrics at this hospital (Figs. 1 and 2). The next Pediatric Neurosurgery service was started in 1963 by Dr. Daniel Gonzalez, at the Children’s Hospital of the National Medical Center of the Social Security. Dr. Gonzalez trained at Montreal Neurological Institute. He retired in 1992. Dr. Guillermo QuintanaRoldan was appointed; Dr. Jaime Diegoperez is now in charge. The residents in neurosurgery of the medical center made the rotation in pediatrics at this service (Figs. 3 and 4). The third service dedicated to Pediatric Neurosurgery opened in 1970 at a new Children’s Hospital in the southern part of Mexico City, belonging to the Institucion Mexicana de Asistencia a la Ninez (Mexican Institution for the Care of the Children). I was appointed as Chief Service; in this post, I remained until 1995 when I was named head of the Department of Surgery; in 2001, I received the charge of Medical Director. Since 2006, I am the Coordinator of Neurosciences. In 1983, we became the National Institute of Pediatrics. Nowadays, Dr. Alfonso Marhx-Bracho is the Chief Service. The residents of the National Institute of Neurology and Neurosurgery have their training in Pediatric Neurosurgery in our service since 1977, when the institute closed its pediatric ward (Figs. 5 and 6). The fourth service was created in 1975 at the “La Raza” Medical Center of the Social Security, also in Mexico City, by Dr. Jose Maria Sanchez Cabrera. He retired in 1995. He was succeeded by Dr. Jose Manuel Munoz-Tagle and later on by Jose Reyes de la Cruz (Fig. 7).

Minimal residual disease by flow cytometry at the end of chemotherapy for remission induction in pediatric patients with acute lymphoblastic leukemia: Experience from a center in a low-income country.

9554 Background: The presence of minimal residual disease (MDR) following therapy for acute lymphoblastic leukemia (ALL) has been shown to be an important prognostic marker in many studies. MRD is typically detected either by polymerase chain reaction amplification or by flow cytometry. Flow-based MRD assessment has the potential for rapidly identifying patients at increased risk of relapsed, allowing for prompt changes in therapy, including earlier intensification. There are not many information about the response by MRD in countries with limited resources. Methods: The patients included were 90 ALL patients treated at the Hospital Infantil de Morelia from June 1, 2009 to January 5, 2012. MRD positivity (+) was defined as >0.01% of the gated population. Results: MRD was obtained in 90 patients, 38 males and 36 females. The median age was 7 years (10 months to 15 years). The levels of MRD were: <0.01, 74 (82.2%), 0.01-1%, 9 (10%), ≥1%, 7 (7.7%). There was not a statistically significant association between the most important ALL prognostic factors (Gender, Age at diagnosis, White blood cell count at diagnosis, Central Nervous System disease, Prednisone response, DNA Index, Immunophenotype). Conclusions: The good response found is similar to that reported by international groups, a situation which suggests that the response to chemotherapy is appropriate. However, cure rates are still not equal making it necessary to review institutional treatment protocols and social characteristics of the population to achieve cure rates reported by international groups.

Trabectedin in pretreated pediatric patients with relapsed or progressive advanced sarcomas: Toxicity and efficacy.

e20005 Background: Patients with advanced or metastatic soft tissue and bone sarcomas whose disease progresses after standard chemotherapy (CT) have few options and limited life expectancy. Trabectedin, an alkaloid derived from the sea squirt Ecteinascidia turbinate, has proven activity against some soft tissue (STS) and bone sarcomas. In pediatric patients there is limited information about its efficacy and toxicity profile. Purpose: To describe the toxicity and efficacy of trabectedin in a group of relapsed/refractory pediatric sarcomas. Methods: From January 2009 to December 2011, four relapsed/refractory pediatric sarcoma patients were treated with trabectedin in the Hospital Infantil de Mexico Federico Gomez. Trabectedin was administered as a 24-hour IV infusion every 21 days. Dose levels were 1.3-1.5 mg/m2. All received dexamethasone premedication. Grade 3-4 toxicity was evaluated according to the NCI criteria. Results: Diagnoses included a metastatic Ewing sarcoma, a triton tumor (TT), a metastatic alveolar soft tissue sarcoma and a phylodes sarcoma. All had previously failed to 2 or 3 CT regimens. In 3 patients radiotherapy had also been used and multiple surgical procedures were performed to treat recurrences, before trabectedin. A total of 13 courses of trabectedin were administered. Nausea/vomiting and fatigue were seen in 61.5% of the courses. Laboratory abnormalities included anemia (30.6%), neutropenia (15.3%), ALT (15.3%), AST (15.3%) and GGT (7.7%) elevations and lipasemia/amilasemia (7.7%). One patient presented significant transaminasemia, pancreatitis (probably steroid-related) and died after the first course due to IDC. The TT case, who had a massive unresectable lesion, exhibited a significant response, although her tumor progressed after 4 cycles and eventually died; none of the other patients responded to trabectedin. Conclusions: Trabectedin was generally well tolerated; however we faced a fatal event that might be not trabectedin related. The response observed in the TT case is an interesting finding considering the poor CT response of this aggressive tumor.

447 Asthma Knowledge among Parents and/or Caregivers of Asthmatic Children Attending a Practical Allergy Course

BackgroundAsthma is one of the most frequent chronic diseases, with worldwide prevalence of 1 to 18%. Patient and the patient's family education is considered by all International Guides fundamental to achieve this disease control. The aim of this study is to asses the asthma knowledge among parents and/or caregivers of pediatric asthmatic patients before and after attending to a Practical Allergy Course given at Hospital Infantil de Mexico Federico Gomez by the Pediatric Allergy Department.MethodsTransversal Study that included 115 persons attending to a Practical Allergy Course that answered the previously validated instrument to asses the asthma knowledge among parents or caregivers NAKQ (Newcastle Asthma Knowledge Questionnaire); its Spanish version consisting in 31 questions; before and after the practical course. A descriptive annalysis was made; usefullness of the course was determinated by x2. Stadistical packagge used was SPSS 17.ResultsA total of 115 questionnaires were applied, only 99 were properly answered and were included in the analysis; from these 35 were male and 64 female; 80% with high-school and middle school schooling; 92% were small families with 1 to 3 children; 90% of the families had only one child with asthma; 63% was receiving the practical course for the first time. Before attending the practical course the mean answered questions was 30 and after attending the mean answered questions was 31 (LR = 57.465; P < 0.000); for the first evaluation the mean correct answers was 19 and the latter 22 correct answers, finding statistical significant differences (LR = 30.253; P < 0.000).ConclusionsWe found improved asthma knowledge among parents and caregivers of asthmatic children after attending to a Practical Allergy Course.

Pentalogy of Cantrell

Pentalogy of Cantrell is a rare disease. Approximately 185 cases have been reported around the world. The authors performed a retrospective study that reviewed the clinical files and pathological samples of 22 cases of pentalogy of Cantrell treated at the Hospital Infantil de México Federico Gómez. Thirteen patients had ectopia cordis associated with pentalogy of Cantrell (group I), and there were 9 cases without ectopia cordis (group II). In group I, the following types of congenital heart disease were found: single ventricle (4), double-outlet right ventricle (4), ventricular septal defect (3), aortic coarctation (1), and atrial septal defect (1). In group II, the following types of congenital heart disease were found: double-outlet right ventricle (3), double-inlet left ventricle (2), ventricular septal defect (2), tetralogy of Fallot (1), and hypoplastic right ventricle syndrome (1). Nine cases had a ventricular diverticulum (40%). Ten patients (45%) had some other congenital anomaly associated with pentalogy of Cantrell. Thirteen patients underwent surgery (59%), which included cardiac surgery in 10 cases (45%). Sixteen patients died (73%): 11 from group I and 5 from group II (P < .05). Little more than 50 years since it was first described, pentalogy of Cantrell remains a disease with high mortality, especially in patients with associated ectopia cordis.

Validation of PRISM and PIM2 scores of mortality in a pediatric intensive care unit in Cordoba

Pediatric Index of Mortality 2 (PIM2) and Pediatric Risk of Mortality (PRISM) are scoring systems to predict mortality likehood; thus, it is necessary to validate such predictors in Pediatric Intensive Care Units' population. To assess the validity of PRISM and PIM2 models of Mortality in Pediatrics Intensive Care Units at Hospital Infantil de Córdoba (PICUHI). 435 critically ill admitted patients were retrospectively analized in PICUHI from January 1st 2008 to January 31st 2008; 416 were included in the study, ruling out elective admitted patients with less than 12 hour at PICU length stay. There were no deaths in this Group. Original equations for each models, were used. Calibration was performed (p> 0.05) using Hosmer- Lemeshow (HL) goodness-of-fit tests. Scores were assessed through Standardized Mortality Ratio (SMR) and discrimination between patients alived and dead, was estimated calculating the area under ROC curve. 416 admitted patients were included, (55.04%) were male 55.04%, median age was 3 years (1 month-17 years), with a median of 2 (1-76) admitted days in PICU. Mortality was 6.66%. PIM2 had an area under ROC curve of 0.88 (CI 95% 0.82-0.95) and PRIMS: 0.85 (CI 95% 0.78-0.92), with p 0.3570 value. HL calibration for PRISM was: x2 5.93 (p 0.54), and PIM2 was: x2 14.19 (p 0.07). PRISM, Standardized Mortality Ratio (SMR) was: 1.00 (CI 95% 0.50-1.50) and PIM2 was 1.00 (CI 95% 0.55-1.55). Both scores discriminated and calibrated well as the p-value of the HL test, althougt the analysis of the HL table appears inadequate to PIM2 calibration, in terms of severity-adjusted mortality.

SU-GG-I-55: Dosimetric Quantities for Computed Tomography Examinations of Paediatric Patients on the Thoracic and Abdominal Regions

Purpose: To determine the value of the dosimetric quantities for the Computed Tomography(CT) paediatric examinations of the thoracic and abdominal regions. The protocols studied were those of chest, abdomen, abdomen/pelvis, chest/abdomen/pelvis, pulmonary and mediastine/abdomen, which are the more common examinations performed at the “Hospital Infantil de Mexico Federico Gomez” in these regions. Method and Materials: The measurements were performed on a Siemens SOMATOM Sensation 16 CT Scanner and the equipment used were a CT pencil ionization chamber connected to an electrometer, both calibrated for CT beam qualities and a PMMA phantom with diameter of 16 cm and length of 15 cm. Results: The dosimetric quantities measured were the weighted air kerma index (Cw), the volumetric kerma index (Cvol) and the CT air kerma—length product. It was found that the pulmonary examination presented the highest values for the dosimetric quantities; 31.1 mGy for Cw and 11.1 mGy for Cvol. The examination with the lowest values was the chest/abdomen protocol with 10.47 mGy for Cw and 5.5 mGy for Cvol. Conclusion: There are few publications about the dosimetric quantities for CT on pediatric patients and the reported does not consider the different kinds of examinations of the chest, pelvis and abdomen. This work shows that there is a strong dependence between the protocol used and the imparted dose due to the different values of current and slice thickness. Then, it is important to have a carefully selection of the protocol for the examinations. The values obtained on this work may also serve as diagnostic reference levels for further studies.

In 169, A New Class 1 Integron that Encoded blaIMP-18 in a Multidrug-Resistant Pseudomonas aeruginosa Isolate from Mexico

Carbapenem resistance in Pseudomonas aeruginosa may be due to the presence of metallo-beta-lactamases (MbetaL). The genes that encode these enzymes can be located in association with aminoglycoside-modifying enzymes on class 1 integrons. This study describes the bla(IMP-18) class 1 integron array (In169) from a carbapenem-resistant P. aeruginosa clinical isolate obtained at the Centro Medico Nacional La Raza (CMNR) in Mexico City and compares it to other bla(IMP)-type producers. Twenty six multiresistant P. aeruginosa clinical isolates were recovered between June and December 2004 and tested by MicroScan and CLSI agar dilution methods. The MbetaL production was screened by a disk approximation test and MbetaL Etest strips, whereas MbetaL genes and integrons were detected using PCR primers. DNA sequence analysis was carried out by BLAST, and epidemiological typing was performed by pulsed-field gel electrophoresis (PFGE). A Southern hybridization analysis was performed with a bla(IMP) specific DNA probe. Nine of 26 P. aeruginosa isolates were imipenem-resistant with unique PFGE patterns (no clonal relation), and only one strain (5106) was positive for MbetaL production, corresponding to the IMP-type. The class 1 integron encoding the MbetaL was characterized: it contained the IMP-18, two copies of aadA2 and OXA-2 genes, corresponding to a new class 1 integron array, denoted In169. P. aeruginosa isolate 5106 is genetically related to bla(IMP-18) positive P. aeruginosa isolate from a distant hospital (Hospital Infantil de Morelia). This report is the first to describe the bla(IMP-18) in two genetically related isolates from two different institutions.

Pediatric hematology oncology in Brazil

Pediatric hematology oncology in Brazil

Glioblastoma multiforme in children: experience at Hospital Infantil de Mexico Federico Gomez

To evaluate clinical evolution of pediatric patients diagnosed with glioblastoma multiforme (GBM) at Hospital Infantil de México Federico Gómez. Cases of patients treated from January to May, 2007, were included in this study. Variables analyzed were: age, diagnosis, size of tumor, histopathological description, degree of resection, time of stay in hospital, complications and outcome using Pearson's chi-squared test and logistic regression. Sixteen patients were identified. Mean age of presentation was 8.8. An increased frequency of complications was observed in younger patients and longer survival rates in patients with greater resections; main mode of presentation was directly related to intracranial hypertension; size of tumor was not related to evolution or outcome. Modern histological classifications especially designed for children are deemed necessary to accurately diagnose GBM.

Clinical characteristics of children with scleroderma in a referral hospital

IntroductionScleroderma is an autoimmune disease that involves the connective tissue characterized by skin fibrosis, classified as localized and systemic (participation of one or more internal organs). The primary objective of this study is to describe and analyze the clinical and laboratory findings in a group of children diagnosed with scleroderma at a referral hospital. Material and methodsExtraction of data from clinical charts of children with scleroderma in the rheumatology department at the Hospital Infantil de México Federico Gómez, between January 2000 and December 2007. ResultsSixty-two patients were included in the group. All of them completed the classification criteria for juvenile sclerodema, both systemic and localized. The mean age at diagnosis was 7.8 (1–14) years. The mean time from disease onset to diagnosis, based on clinical manifestations, was 23 months. The lesions found were: linear scleroderma (42%), mixed morphea (22%), circumscribed morphea (19%), generalized morphea (13%), and panclerotic morphea (4%). Involvement associated with systemic scleroderma was gastrointestinal 100% (18 patients), pulmonary 100% (18/18), Raynaud's phenomenon 89% (16/18), proximal sclerosis 89% (16/18), sclerodactilia 67% (12/18), joint pain 28% (5/18), calcinosis 56% (10/18). Positive antinuclear antibodies (ANA) were present in 14/62 (23%) patients (10 with systemic range and 4 localized), antiSCL 70 in 2/62 (4%) cases. The most common drug used was methotrexate. ConclusionThe most common skin lesions found were linear morphea, followed by the mixed and circumscribed types. In systemic scleroderma the most involved systems are the gastrointestinal, respiratory, and vascular (associated with Raynaud's phenomenon). There is a special need for knowledge of this disease in first contact physicians for a faster and better diagnosis and treatment, in order to avoid complications. It is also necessary to improve resources in developing countries for complimentary studies, classification, treatment, and follow-up.

Nueva técnica anestésica en el tratamiento con láser diodo de la retinopatía del prematuro

Anaesthesia in premature infants can have many complications. Although the application of diode laser is less painful than cryotherapy, there has to be adequate immobilization of the patient to provide a correct focus of the spot. At Hospital Infantil de Zaragoza, the same standard anaesthetic technique has been applied since 1999, obtaining sedation with inhaled anaesthetic agents combined with topical anaesthesia. We analyse the results obtained on the application of this technique. The study included 72 consecutive premature infants treated with diode laser for retinopathy of prematurity (ROP), using an anaesthetic technique combining inhalatory sedation and topical anaesthesia. The personal data of each patient was collected (gestational age, birth weight, postconceptional age at the time of initial treatment, associated systemic disorders) together with information related to the surgical intervention (duration, intraoperative and postoperative complications). Intraoperative complications occurred in 12 cases (16.66%). These were self-limited in 9 cases and only 3 cases required orotracheal intubation (4.16%). Postoperative complications occurred in 4 cases (5.55%) during the 48 h following treatment. No statistically significant relationship was found between the presence of intraoperative complications and the mean gestational age and birth weight, and the presence of apnoea, intraventricular haemorrhage or a permeable ductus. A statistically significant relationship was found between the presence of postoperative complications and significant intraventricular haemorrhage. This anaesthetic technique combining inhalatory gases and topical anaesthesia is safe, with few complications and comfortable for the surgeon.

Bronchodilator Reversibility Test and Air Pollution Exposure in Children Residing in Mexico City

ISEE-842 Objective: To examine the relationship between the percent of changes in the bronchoconstriction reversibility test and air pollution level in 91 asthmatic and 34 healthy children aged 6 to 13 years residing in the southwestern part of Mexico City affected by air pollution. Materials and Methods: The children were followed up for 14 weeks and the spirometric tests were measured at the Hospital Infantil de Mexico, once the subject was given 1 inhalation of 200 μg of salbutamol and FEV1 was measured after 15 minutes. For classification, a positive test (BHR) was taken as an increase in FEV1 of more than 12% from baseline FEV1 and an absolute increase of more than 200 mL. Exposure was defined as air pollutant (NO2, O3, and PM2.5) levels measured at the monitoring site of Mexico monitoring network closest to each child's house (within 5 km). Data were analyzed using linear regression models controlling for important variables with log transformation of dependent variable. Results: PM2.5 ranged from 7.3 to 60 μg/m3, mean daily 21.1 (SD = 11.8), O3 ranged from 9 to 63 ppb, mean daily 26 (SD = 10.9), and the mean of NO2 was 30.9 (SD = 8.1) with minimum and maximum values between 17.6 and 56.6 ppb. We found a significant effect of pollutants with the reversibility test in asthmatic children. We observed that by each 10 ppb of increase in NO2 (average 24 hour) the percent of change in the reversibility decrease 1.34% (P < 0.05) and by each 10 ppb of O3 to 5 days lags we observed a decrease of 1.20% in the reversibility test. The effect was higher when we analyzed the accumulative exposure. We found significant effect to PM2.5 to leave from fifth day of accumulate exposure. Conclusions: Our data suggest an impact of air pollution over the bronchodilator effect, because it leads to decrease in the percent of reversibility test supplying the airway obstruction. The chronic exposure could be related with less recovery pulmonary function in long time.

Validez en el registro del pico espiratorio máximo de niños asmáticos de la Ciudad de México

To determine the concordance between maximum peak expiratory flow records (PEFr) reported by the parents of asthmatic children and the electronic values stored by the AirWatch device (PEFe). Records of PEF measurements between October 1998 and 1999 were obtained from 42 asthmatic children 5 to 15 years of age recruited at the Hospital Infantil de Mexico Federico Gomez, in Mexico City. Parents recorded the maximum value in the health diary. Spearman correlation was calculated between PEFe and PEFr and a mixed-effects logistic model was used. The correlation between PEFe and PEFr was r=0.96 (p<0.05) among children with a diagnosis of moderate or severe asthma and r=0.40 (p<0.05) among children diagnosed with mild asthma. Follow-up time, asthma severity, gender and age of the child and their interactions were predictors of the differences between PEFe and PEFr. Parents of children with moderate or severe asthma from 6 to 8 years of age report PEF values with greater accuracy during follow-up than others.

Uso de inmunoglobulina intravenosa en el tratamiento de necrólisis epidérmica tóxica y síndrome de Stevens-Johnson

Toxic epidermal necrolysis and Stevens-Johnson syndrome are described as variants of the same disease with distinct severity and constitute the most frequent cutaneous reactions in children, causing considerable morbidity. Several reports support the use of intravenous immunoglobulin therapy in these entities. We report the cases of two patients, one with toxic epidermal necrolysis and the other with Stevens-Johnson syndrome, in whom immunoglobulin treatment was successfully used. We also reviewed the outcomes of 13 patients with toxic epidermal necrolysis and Stevens-Johnson syndrome in the previous 10 years in the Hospital Infantil de Mexico, in whom conventional treatment was used.