Pediatric Journal of Panama

Tras las Huellas de Blaschko: Presentación Inusual de Mosaicismo Pigmentario tipo Ito e Hipertricosis en un Paciente Pediátrico

2024-10-07T22:26:07-05:00

Introducción: El mosaicismo pigmentario tipo Ito es una compleja entidad clínica que engloba manifestaciones cutáneas y extracutáneas. Caso Clínico: Presentamos un caso de un niño de 5 años con mosaicismo pigmentario tipo Ito y hipertricosis marcada, un hallazgo poco común. Destacamos su historia clínica y desarrollo, subrayando la necesidad de una evaluación completa. Analizamos las técnicas diagnósticas, incluidos los análisis genéticos y la histopatología. Discutimos los criterios diagnósticos propuestos y la importancia de la educación para pacientes y familias. Este caso resalta la complejidad del mosaicismo pigmentario tipo Ito y su enfoque multidisciplinario en la atención clínica, contribuyendo al entendimiento y manejo de esta entidad única.

Ovarian dermoid cyst with atypical juvenile presentation: case report

2024-09-06T13:25:03-05:00

Germ cell tumors are a diverse group of neoplasms that make up around 20% to 25% of all ovarian tumors. These tumors mainly affect young individuals and make up most of the tumors found in children. The occurrence of mature cystic teratomas is low, ranging from 1.2 to 14.2 cases per 100,000 people per year, and they are typically discovered incidentally.

Clinical case. The case of a 17-year-old female patient, nulliparous, nulliparous, without sexual life, without comorbidities, presented conservative adnexal tumor surgery in 2017 for right ovarian teratoma without complications. A new mass is identified approximately 21x15x10cm left annex. Tumor extraction surgery was performed, histologically resulting in a mature cystic teratoma, a tumor measuring 19 cm in greatest diameter with an intact capsule, and an edematous and congestive salpinx. The incidental findings of the presence of this type of neoplasms are of interest in our patients, given that the incidence of neoplasms at younger ages is a reality. Our patient had a history of a previous contralateral smaller teratoma with benign histology. and presents de novo with an adnexal mass of exaggerated proportions that takes the classic characteristics of the mature dermoid cyst out of context. In this case, since there is no intraoperative study to diagnose benignity or malignancy, conservative surgery of the affected gonad is not performed due to the risk. uncertain whether it is a strain with a high risk of malignant transformation.

Atypical Hemolytic Uremic Syndrome associated with Thrombomodulin genetic variant: a case report

2024-10-12T00:08:04-05:00

Introduction: Atypical Hemolytic Uremic Syndrome (aHUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure, associated with genetic variations in the complement system, such as the THBD gene, responsible for 3-5% of hereditary cases. Case report: A patient with a history of Nephrotic Syndrome developed persistent anemia and thrombocytopenia. Analysis showed ADAMTS 13 activity at 50%. Genetic studies revealed a variant in THBD associated with complement dysfunction. Discussion: The genetic variant in THBD in our patient corresponds to those found in aHUS, which are less common. Complement dysfunction due to the absence of this protein explains the microangiopathy and renal impairment. Eculizumab was initiated early to prevent progression and improve prognosis. Conclusion: aHUS is heterogeneous with multiple genetic causes, including variations in THBD. Identifying these variants is crucial for guiding specific treatments such as Eculizumab, effective in inhibiting the complement pathway. Early genetic diagnosis and individualized management are key in aHUS for better long-term outcomes.

Acute Chest Syndrome in patients with Sickle Cell Anemia: Report of two cases in pediatrics

2024-10-08T15:51:39-05:00

Introduction: Acute Chest Syndrome in sickle cell disease is defined as a process characterized mainly by fever and chest pain, accompanied by new infiltrates in the chest x-ray. Clinical Case: Patients may present with a chest syndrome as described in the second case, or develop it during a hospital stay caused by another process, as described in the first case. It is the second most common complication and can affect any age group, with an incidence peak between 2 and 4 years of age. It is a condition that can be very severe with life-threatening risk, so suspicion, recognition, and evolutionary monitoring determine the prognosis in many of them. Two cases of patients with Chest Syndrome who presented different prodromes are presented, where the multidisciplinary approach played a crucial role in the satisfactory evolution of both.

Diagnostic challenge

2024-10-23T08:18:21-05:00

Male patient, 12 years old, with no relevant personal history, from the Darién area. He presents to the hospital due to periodic unquantified fever, asthenia, anorexia, and weight loss lasting one month. During the last week, he has experienced progressively worsening respiratory difficulty. A chest X-ray shows cardiomegaly (Figure 1), leading to an echocardiogram that reveals severe dilation of the four cardiac chambers. Upon further questioning, the patient's family mentions that they previously lived in the Bocas del Toro area, in a wooden house, where there were bedbugs and scorpions

About other Journals

2024-11-05T00:39:20-05:00

SUMMARY 1

This study assessed the 5-year survival of 116 pediatric cancer patients with febrile neutropenia (FN) using advanced statistical analyses such as Kaplan-Meier and Cox regression models. Significant risk factors identified included solid tumors, sepsis, delays in chemotherapy, and invasive fungal infections. Conversely, post-cancer comorbidities and caregivers' intermediate educational level were associated with better prognosis. The overall 5-year survival rate was 64.7%, emphasizing the importance of these prognostic factors in managing these patients.

SUMMARY 2

This meta-analysis reviewed 23 studies involving 3,335 children to evaluate prophylactic options for recurrent urinary tract infections (RUTIs). Results indicate that nitrofurantoin and cranberry products significantly reduce the incidence of symptomatic urinary tract infections, with nitrofurantoin being the most effective option. However, none of the interventions demonstrated efficacy in preventing renal scarring. The need for future trials investigating non-antibiotic prophylaxis options for children with RUTIs and risk of renal damage is highlighted.

SUMMARY 3

This study evaluated the impact of the 1+1 infant vaccination schedule with PCV13 introduced in the United Kingdom in 2020 compared to the previous 2+1 schedule. Based on 702 episodes of invasive pneumococcal disease (IPD), the results showed that the 1+1 schedule provides similar effective protection as the 2+1 schedule, with no significant differences in overall IPD incidence, serotype distribution, clinical presentation, or fatality rates. Continuous surveillance is emphasized to monitor the long-term effectiveness of the 1+1 schedule.

Care in the pediatric emergency department observation unit for patients with mental health pathology before and during the SARS-CoV-2 pandemic

2024-08-01T23:15:17-05:00

Introduction: Acute psychiatric pathology in children has increased, especially during the SARS-CoV-2 pandemic. This study compared the use of the pediatric emergency observation unit for psychiatric pathology before and during the pandemic, excluding the lockdown period in Spain (March–June 2020). Materials and Methods: A retrospective observational study was conducted with patients aged 5 to 17 years who visited the emergency department (ED) in the 18 months prior to and the 18 months following the lockdown, were attended by psychiatry, and required observation. Demographic, clinical, and hospital data were analyzed, comparing both periods. Results: A total of 1,027 episodes were recorded: 279 before the pandemic and 748 during. The median age was 15.27 years, with 85.98% being female. The frequency of consultations for eating disorders increased from 20% to 31.6% (p < 0.001), and consultations for suicidal ideation increased from 16% to 23.5% (p < 0.001). Suicide attempts per 1,000 visits increased from 0.53 to 1.19 (p < 0.001), and the need for observation in the ED rose from 2.8 to 9.2 per 1,000 visits (p < 0.001). The average observation stay duration increased from 8.8 to 12 hours (p < 0.001), and bed occupancy rose from 1.95% to 7.11% (p < 0.001). Psychiatric admissions increased from 1.66 to 5.20 per 1,000 patients (p < 0.001), and overnight stays in observation increased from 41.2% to 50.2% (p < 0.001). Conclusions: During the pandemic, there was an increase in bed occupancy and observation stay times in the ED for psychiatric pathology, primarily due to eating disorders and self-harming behavior.

Sociocultural factors associated with the intention to vaccinate against COVID -19 in children under 5 years of age in Panama

2024-10-26T23:44:03-05:00

Introduction: In Panama, the percentage of the adult population vaccinated against COVID-19 contrasts with that recorded for children under 5 years of age. By mid-2023, vaccination coverage in this group was 3.1% with the first dose, 0.7% with the second dose, and no data were available for the third dose. Methods: A descriptive, cross-sectional, quantitative study with convenience sampling was conducted at the Dr. José Renán Esquivel Children's Hospital (HDNJRE) in Panama. A simple statistical analysis was performed using frequency distributions. The strength of association between the variables under study and the parents' intention to vaccinate their children under 5 years of age against COVID-19 was determined using the relative inequality test (OR) with a 95% significance level and a 0.05 precision, after verifying statistical significance through the Chi-squared test (X²). Results: Willingness to vaccinate children under 5 years of age against COVID-19 was a limited 34.2%. Monthly household income, information received through social networks, prior vaccine experiences, insufficient awareness campaigns, perceived need for vaccination, distrust in vaccine safety, and fear of adverse effects were barriers to vaccination. Conclusions: The willingness to vaccinate children under 5 years of age against COVID-19 in Panama is largely influenced by perception factors that need to be addressed through health promotion strategies aimed at minimizing the impact of these determinants on vaccination coverage.

Public Health Levels: In Latin America and Panama

2024-11-28T17:24:31-05:00

Public health levels in Latin America vary significantly depending on the policies and healthcare systems implemented. Countries like Costa Rica, Uruguay, Colombia, and Chile stand out for providing accessible and high-quality services, promoting prevention and equity in healthcare. However, Panama faces significant challenges, such as limited investment in infrastructure and technology, and marked inequalities between urban and rural areas.

Despite allocating 5.38% of its GDP to healthcare in 2021, a large portion of the budget is spent on administrative costs, leaving few resources to improve facilities and services. In response, the Ministry of Health and the PAHO/WHO have developed strategies to strengthen the healthcare system, including disease prevention, health promotion, and modernization of infrastructure.

The effective implementation of these measures, along with constant monitoring, will be key to improving the quality and equity of Panama's healthcare system.