Search

Abstract: A swallowing disorder or dysphagia is defined as a disorder in the sequence of swallow-ing, during the oral or pharyngeal phase, which compromises the safety and/or efficiency of transit of the food bolus to the esophagus. The evaluation of neurodevelopment, nutrition, and preventive medicine actions are as important as the clinical evaluation of dysphagia, so they must be included and systematized in all pediatric evaluations; This evaluation can be divided into different parts: bedside swallowing evaluation, in-strumental swallowing evaluation, and additional studies. The management of swallowing disorders requires a multidisciplinary team approach, depending on the child's age, cognitive and physical abilities, and the specific swallowing and feeding disorder, ensuring adequate and safe nutrition and improving the patient's quality of life.

Guadua angustifolia Kunth cane is a material that has a great potential for industrialization, but it lacks a technical guide for its preservation. The objective of this research was to quantify impregnation levels of the boron salt preservative applied by the immersion method in Guadua angustifolia Kunth cane. Fresh mature cane test tubes were used, which were oven-dried and submerged during different time periods in a solution made of borax and 4% boric acid. For the qualitative analysis, the specimens were cut in half crosswise and the segments were exposed to revealing substances made from Curcuma longa and hydrochloric acid. Additionally, the dimension of the coloration obtained after this chemical reaction was evaluated through quantitative analysis using formulas. The main results showed that, in order to obtain absorption levels higher than 200 kg/m3, it is necessary that the samples have a moisture content of less than 15% prior to preservation. In addition, it was established that an immersion time of at least 72 hours guarantees reaching an effective retention toxic level of 0.40 to 0.50 kg/m3 active product.

La educación en tiempos modernos ha experimentado un gran cambio. El mundo está cada vez más conectado a través de la tecnología y la educación no es la excepción. La tecnología está cambiando los métodos de enseñanza y aprendizaje y esto se refleja en la forma en que se imparte la educación. Los maestros y profesores ahora tienen la oportunidad de utilizar herramientas como el aprendizaje en línea, los simuladores, la realidad virtual y las redes sociales para mejorar el proceso de enseñanza. Estas herramientas ayudan a los estudiantes a estar mejor conectados con el contenido y a tener una mejor comprensión de los temas. Esto también les permite trabajar de manera más eficiente y aprovechar al máximo los recursos disponibles. Los estudiantes también tienen ahora la oportunidad de acceder a una amplia gama de recursos educativos, como libros electrónicos, videos educativos, podcast y otros. Esto les permite tener un mejor acceso a la información y aumentar su conocimiento. Además, la tecnología también ofrece la oportunidad de trabajar en equipo y colaborar con otros estudiantes de todo el mundo. En definitiva, la tecnología ofrece una gran cantidad de oportunidades para mejorar la educación en tiempos modernos. Los docentes deben aprovechar al máximo estas herramientas para ayudar a los estudiantes a mejorar su conocimiento y habilidades. El mundo está cambiando y la educación debe evolucionar junto con él.

Resumen: Introducción y objetivos: La ingestión de cuerpo extraño (CE) es un problema común en niños menores de 5 años, siendo una de las principales indicaciones para realizar endoscopias. El propósito de este estudio es describir las características clínicas, radiográficas y endoscópicas de pacientes con ingesta de CE, así como los factores asociados con la localización anatómica y el tipo de objeto ingerido. Material y métodos: Estudio transversal analítico del total de pacientes con ingesta de CE en el servicio de gastroenterología de enero de 2013 a diciembre de 2018. Los datos se analizaron con el programa SPSS®, y se obtuvieron frecuencias, porcentajes, medianas, rangos intercuartílicos y, además, se buscaron asociaciones mediante Chi-cuadrado. Resultados: Se incluyeron 85 pacientes, 52 varones y 33 mujeres, la mediana de edad fue de 4 años. El síntoma más común fue el vómito (29.4%). En el 72.9% de los casos se realizaron 2 proyecciones radiográficas, siendo el estómago el sitio donde se visualizó con más frecuencia (32.9%). Los objetos más comúnmente ingeridos fueron monedas (36%) con localización principalmente esofágica (p

El presente trabajo aborda una revisión bibliográfica sobre los aspectos más relevantes que han motivado los cambios o transiciones sociales en los últimos tiempos. Se revisan diversos documentos académicos con el fin de conocer si estos cambios sociales han afectado de una u otra forma las metodologías educativas, y más aun la enseñanza online, que ha representado un importante cambio en la época reciente. Y, además, si esta metodología online puede garantizar resultados similares o mejores a la educación presencial. Los resultados muestran que la educación tradicional es la que continúa vigente en los tiempos actuales, y es la que ha estado presente durante años, que la sociedad ha sufrido importantes cambios y evoluciones, pero la educación es en esencia la misma.

The present houses situations that promote the unavoidable change in education, the economy, and society in general. The COVID-19 pandemic has triggered emotional contrasts, including depression, but also hostility. In this work, various academic materials are analyzed, which show the emotional impacts of the pandemic on society, which impact education and require a transformation of methodologies and processes with an ideal vision for new professional challenges.Emotions play a critical role in future job challenges. The results of this work reveal that the pandemic has broadly affected society, affective bonds have become more complex and university activities are the consequence of a set of reasons that motivate it to change form and substance. Keywords: emotional states, educational transformation, university studies. References [1]F. Suárez and L. Rosales, La ingeniería de las emociones humanas, Quito: AutanaBooks, 2021. [2]M. Tamayo, Z. Miraval and P. Mansilla, «Trastornos de las emociones a consecuencia del covid-19 y el confinamiento en universitarios de las diferentes escuelas de la universidad nacional Hermilio Valdizán. perú,» Rev. Comun Salud., vol. 10, nº 2, p. 343–354., 2020. [3]A. Cervio, «EN cuarentena, en casa. Prácticas y emociones durante el aislamiento social, preventivo y obligatorio por COVID-19 en hogares urbanos de Argentina, » CONICET, Buenos Aires-Argentina, 2020. [4]J. Salvador-Moreno, M. Torrens-Pérez, V. Vega-Falcón and D. Noroña-Salcedo, «Diseño y validación de instrumento para la inserción del salario emocional ante la COVID-19,» Revista de Ciencias de la Administración y Economía, vol. 11, nº 21, pp. 1390-8618, 2021. [5]A. M. Fernández, «Antropología de las emociones y teoría de los sentimientos,» Versión, vol. 26, pp. 1-24, 2011. [6]A. Fernández, «2020: Estudiantes, emociones, salud mental y pandemia,» Revista Andina de Educación, vol. 4, nº 1, pp. 23-29, 2021. [7]UNICEF, «El impacto del COVID-19 en la salud mental de adolescentes y jóvenes,» Septiembre 2020. [Online]. Available: https://www.unicef.org/lac/el-impacto-del-covid-19-en-la-salud-mental-de-adolescentes-y-j%C3%B3venes. [Last access: September 15, 2021]. [8]Statista, «Sentimientos de la población durante el aislamiento impuesto por la pandemia del coronavirus (COVID-19) en Perú en marzo de 2020,» 9 septiembre 2020. [Online]. Available: https://es.statista.com/estadisticas/1110475/peru-sentimientos-cuarentena-covid-19/. [Last access: September 15, 2021]. [9]B. Manrique-Losada, M. C. Gómez-Álvarez and L. González-Palacio, «Estrategia de transformación para la formación en informática: hacia el desarrollo de competencias en educación básica y media para la Industria 4.0 en Medellín – Colombia,» RISTI, vol. 39, nº 10, pp. 1-17, 2020. [10]GEINFOR, «¿Qué es la industria 4.0?,» [Online]. Available: https://geinfor.com/blog/industria-40/. [Last access: September 12, 2021] [11]J. Carvajal, «La Cuarta Revolución Industrial o Industria 4.0 y su Impacto en la Educación Superior en Ingeniería en Latinoamérica y el Caribe,» de 15thLACCEI International Multi-Conference for Engineering, Education, and Technology: “Global Partnerships for Development and Engineering Education”,, Bocaratón, Estados Unidos, 2017. [12]C. Jose, B. Rildo, A. Vilca, M. Blanca, G. Monzón and F. Ceballos, «Capítulo 2: Enunciado del problema y marco teórico en la investigación cuantitativa,» de Lainvestigación cuantitativa y algunas aplicaciones, Quito, AutanaBooks, 2020, pp. 88-105. [13]F. Suárez, L. Rosales and Á. Lezama, Computación inteligente y estados emocionales, Quito: AutanaBooks, 2020.

BACKGROUND The baseline impedance (BI) and the mean nocturnal baseline impedance (MNBI) serve as markers of mucosal integrity in patients with pathologic acid exposure time (AET). This work aims to investigate the association between the BI and MNBI with the AET in children. METHODOLOGY A retrospective study was performed in children ≤ 18 years old with suspicion of gastroesophageal reflux disease who underwent both endoscopy and pH-impedance monitoring (pH-MII). Esophagitis was graded according to the Los Angeles classification.The pathological AET was determined depending on the age (≥ 5% in patients >1 year and ≥ 10% in those aged ≤ 1 year). For the BI, 60-s measurements were taken every 4 h, and for the MNBI, three 10-min measurements were taken between 1:00 and 3:00 AM; then, they were averaged. The means of BI and MNBI were compared with each other, with the AET, and other variables. RESULTS Sixty-eight patients were included, 25% of patients presented pathological AET. The mean of the MNBI was higher than BI in channels 6 (2195 Ω vs. 1997 Ω p = 0.011) and 5 (2393 Ω vs. 2228 Ω p = 0.013). BI and MNBI at channel 6 were lower in patients with pathological AET than in those with normal AET (1573 Ω vs. 2138 Ω p = 0.007) and (1592 Ω vs. 2396 Ω p = 0.004), respectively. CONCLUSIONS Children with pathological AET had lower impedance values than those with normal AET. BI and MNBI measurements should be part of the routine MII-pH assessment in children.

Immunological mechanisms of non-IgE-mediated cow's milk protein allergy (CMPA) are not well understood. Such a circumstance requires attention with the aim of discovering new biomarkers that could lead to better diagnostic assays for early treatment. Here, we sought both to investigate the mechanism that underlies non-IgE-mediated CMPA and to identify cow's milk immunoreactive proteins in a Mexican pediatric patient group (n = 34). Hence, we determined the IgE and IgG

Background Acute diarrhea is the second leading cause of preventable mortality and morbidity in children worldwide. This study aimed to identify the main pathogens associated with acute diarrhea and to describe changes in gut microbiota in Mexican children. Methods This single-center observational study included 30 children (6 months to 5 years old) with acute diarrhea who were referred to the Instituto Nacional de Pediatria of Mexico City and 15 healthy volunteers (control group). Stool samples at day 0 (D0) and day 15 (D15) were collected for identification of microorganisms (reverse transcriptase-polymerase chain reaction analyses with xTAG gastrointestinal pathogen panel multiplex assay) and microbiota analysis (16S gene amplification sequencing). Prescription decisions were made by the treating clinician. Results The main pathogens identified were norovirus and Campylobacter jejuni (20% each). The majority of patients (n = 24) were prescribed Saccharomyces boulardii CNCM I-745 for treatment of acute diarrhea. Diarrheic episodes resolved within 1 week of treatment. Compared with D15 and control samples, D0 samples showed significantly lower alpha diversity and a clear shift in overall composition (beta diversity). Alpha diversity was significantly increased in S. boulardii-treated group between D0 and D15 to a level similar to that of control group. Conclusions In these children, acute diarrhea was accompanied by significant alterations in gut microbiota. S. boulardii CNCM I-745 treatment may facilitate gut microbiota restoration in children with acute diarrhea, mostly through improvements in alpha diversity.

Introduction and aims: Post-fundoplication dysphagia is resolved with no therapeutic intervention in the majority of cases but it can persist in 5.3% of children that undergo the procedure. Among the differential diagnoses, esophagogastric junction outflow obstruction (EGJOO) is a disorder that should be suspected if there is a persistence of dysphagia. The aim of our study was to describe the clinical characteristics, treatment, and follow-up in a case series of patients diagnosed with post-fundoplication EGJOO. Materials and methods: The clinical records of patients diagnosed with EGJOO at a tertiary care hospital within the time frame of September 2015 to September 2019 were reviewed, with respect to manometry, etiology, treatment, and clinical course of the disease. Results: Of the 213 high-resolution esophageal manometries performed, 4 patients met the criteria for post-fundoplication EGJOO. The primary symptom was dysphagia, presenting 15 days after the procedure. Esophageal dilations were carried out on all the patients but with no improvement. Symptoms related to the condition resolved spontaneously in three of the four patients. Conclusion: The management of children with post-fundoplication EGJOO continues to be a challenge. Even though more than half of the cases resolve with no intervention, optimum management of the motility disorder is still limited, given the scant experience with the condition in the pediatric population. Resumen: Introducción y Objetivos: La disfagia postfunduplicatura en la mayoría de los casos se resuelve sin intervención terapéutica, sin embargo, en algunas ocasiones esta puede persistir en 5.3% de los niños sometidos a este procedimiento. Dentro de los diagnósticos diferenciales, la obstrucción al tracto de salida de la unión esofagogástrica (OTSUEG) es un trastorno que se debe sospechar ante la persistencia de la disfagia. El objetivo de este estudio es describir las características clínicas, tratamiento y seguimiento de una serie de pacientes con diagnóstico de OTSUEG postfunduplicatura. Material y métodos: Se llevo a cabo la revisión de los expedientes clínicos con diagnóstico de OTSUEG en un hospital de tercer nivel durante el periodo de septiembre 2015 a septiembre 2019. En todos ellos se revisó la manometría, sintomatología, etiología, tratamiento y el curso clínico de la enfermedad. Resultados: Del total de 213 manometrías esofágicas de alta resolución realizadas, 4 pacientes cumplían con los criterios de OTSUEG postfunduplicatura. El síntoma principal fue la disfagia, presentándose 15 días posteriores al procedimiento. En todos los pacientes se realizaron dilataciones esofágicas, con pobre respuesta al tratamiento tras procedimiento. Los síntomas relacionados con la condición se resolvieron en 3/4 de los pacientes de manera espontánea. Conclusión: El manejo de niños con OTSUEG postfunduplicatura continúa siendo un desafío, ya que, si bien mas de la mitad de ellos resuelven sin intervención alguna, aun existen limitaciones para definir un manejo óptimo de este trastorno de la motilidad dada la poca experiencia que existe en la población pediátrica.

Resumen: Introducción y objetivos: La disfagia posfunduplicatura en la mayoría de los casos se resuelve sin intervención terapéutica, sin embargo, en algunas ocasiones esta puede persistir en 5.3% de los niños sometidos a este procedimiento. Dentro de los diagnósticos diferenciales, la obstrucción en el tracto de salida de la unión esofagogástrica (OTSUEG) es un trastorno que se debe sospechar ante la persistencia de la disfagia. El objetivo de este estudio es describir las características clínicas, tratamiento y seguimiento de una serie de pacientes con diagnóstico de OTSUEG posfunduplicatura. Material y métodos: Se llevó a cabo la revisión de los expedientes clínicos con diagnóstico de OTSUEG en un hospital de tercer nivel durante el periodo de septiembre 2015 a septiembre 2019. En todos ellos se revisó la manometría, sintomatología, etiología, tratamiento y el curso clínico de la enfermedad. Resultados: Del total de 213 manometrías esofágicas de alta resolución realizadas, cuatro pacientes cumplían con los criterios de OTSUEG posfunduplicatura. El síntoma principal fue la disfagia, presentándose 15 días posteriores al procedimiento. En todos los pacientes se realizaron dilataciones esofágicas, con pobre respuesta al tratamiento tras procedimiento. Los síntomas relacionados con la condición se resolvieron en el 75% de los pacientes de manera espontánea. Conclusión: El manejo de niños con OTSUEG posfunduplicatura continúa siendo un desafío, ya que, si bien más de la mitad de ellos resuelven sin intervención alguna, aún existen limitaciones para definir un manejo óptimo de este trastorno de la motilidad, dada la poca experiencia que existe en la población pediátrica. Abstract: Introduction and aims: Post-fundoplication dysphagia is resolved with no therapeutic intervention in the majority of cases but it can persist in 5.3% of children that undergo the procedure. Among the differential diagnoses, esophagogastric junction outflow obstruction (EGJOO) is a disorder that should be suspected if there is a persistence of dysphagia. The aim of our study was to describe the clinical characteristics, treatment, and follow-up in a case series of patients diagnosed with post-fundoplication EGJOO. Materials and methods: The clinical records of patients diagnosed with EGJOO at a tertiary care hospital within the time frame of September 2015 to September 2019 were reviewed, with respect to manometry, etiology, treatment, and clinical course of the disease. Results: Of the 213 high-resolution esophageal manometries performed, 4 patients met the criteria for post-fundoplication EGJOO. The primary symptom was dysphagia, presenting 15 days after the procedure. Esophageal dilations were carried out on all the patients but with no improvement. Symptoms related to the condition resolved spontaneously in three of the four patients. Conclusion: The management of children with post-fundoplication EGJOO continues to be a challenge. Even though more than half of the cases resolve with no intervention, optimum management of the motility disorder is still limited, given the scant experience with the condition in the pediatric population.

Background The clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barre Syndrome (GBS) have not been described. Materials and methods A single center, ambispective, cohort study was performed (2015–2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. Results 137 GBS patients (92 males; mean age 46.6 ± 16.6). 132 (96.3%) underwent an electrodiagnostic assessment. 68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%. Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) Conclusions AMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.

Refractory myasthenia gravis (MG) is defined as a failure to respond adequately to conventional therapies, the inability to reduce immunosuppressive therapy without clinical relapse or the need for ongoing rescue therapy, severe adverse effects from immunosuppressive therapy (treatment intolerant) or frequent myasthenic crisis even on therapy. Cyclophosphamide (CYC) is a DNA alkylating agent that causes important interference in transcription processes and DNA replication, it has been used in refractory MG with controversial results. We aim to determine the efficacy of CYC in refractory MG in the Mexican population. In an observational, longitudinal retrospective study, we identified eight refractory MG patients treated with 30–50 mg/kg monthly CYC for at least 6 months. The efficacy was assessed by Osserman scale considering significant improvement a ≥ 1 point reduction and Myasthenia Gravis Composite Scale. The relapse-free and remission-free period were also calculated using the Kaplan–Meier statistic. Clinical improvement was achieved in 75% of the patients. According to the Kaplan–Meier analysis, the median progression-free survival (PFS) was 9 (6.2–11.5) months and the median time to progression (TTP) was 4 (1–8) months. Response was independent of patient's characteristics, except for the MG age of onset (p = 0.0025). CYC was effective in all patients with refractory MG for a mean of 9 months, with worsening thereafter, which could be associated with low cumulative dose. The symptomatic improvement with CYC was noted within the 1st month. We conclude that CYC is effective as an induction to remission therapy, although our data suggest it is not effective as a long-term therapy.

Resumen: Introducción: Los niños con estreñimiento funcional presentan frecuentemente alteraciones de la distensibilidad y sensación defecatoria, que se pueden valorar mediante manometría anorrectal (MAR). En este estudio evaluamos la utilidad de los parámetros que se obtienen en la MAR en niños con incontinencia fecal retentiva (IFR). Material y métodos: Incluimos a niños de 4 a 17 años con estreñimiento funcional a quienes se realizó MAR. Resultados: Un total de 35 niños fueron incluidos: 21 presentaban estreñimiento funcional y 14, estreñimiento con IFR. Los niños con estreñimiento funcional e IFR toleraron mayores volúmenes en la insuflación de aire para desencadenar urgencia defecatoria y dolor a la máxima tolerabilidad, en comparación con quienes no presentan IFR. Identificamos un punto de corte de 135 ml de aire de máxima tolerabilidad para discriminar niños con IFR. Conclusiones: La máxima tolerabilidad fue el parámetro más útil para evaluar IFR en niños con estreñimiento funcional. Abstract: Introduction: Children with functional constipation frequently present with alterations in rectal compliance and the urge-to-defecate sensation that can be evaluated through anorectal manometry (ARM). In the present study, we evaluated the usefulness of the parameters obtained through ARM in children with retentive fecal incontinence (RFI). Materials and methods: Children with functional constipation, aged 4 to 17 years, that underwent ARM were included in the study. Results: Of the 35 children evaluated, 21 presented with functional constipation and 14 had functional constipation and RFI. The children with both constipation and RFI tolerated greater volumes of air insufflation for triggering the urge to defecate and reaching maximum tolerance of pain, compared with the children that did not have RFI. We identified the cutoff point of 135 ml of air as the maximum tolerance sensation for distinguishing children with RFI. Conclusions: Maximum tolerance of pain was the most useful parameter for evaluating RFI in children with functional constipation. Palabras clave: Incontinencia fecal, Estreñimiento funcional, Manometría anorrectal, Keywords: Fecal incontinence, Functional constipation, Anorectal manometry

Introduction: Children with functional constipation frequently present with alterations in rectal compliance and the urge-to-defecate sensation that can be evaluated through anorectal manometry (ARM). In the present study, we evaluated the usefulness of the parameters obtained through ARM in children with retentive fecal incontinence (RFI). Materials and methods: Children with functional constipation, aged 4 to 17 years, that underwent ARM were included in the study. Results: Of the 35 children evaluated, 21 presented with functional constipation and 14 had functional constipation and RFI. The children with both constipation and RFI tolerated greater volumes of air insufflation for triggering the urge to defecate and reaching maximum tolerance of pain, compared with the children that did not have RFI. We identified the cutoff point of 135 ml of air as the maximum tolerance sensation for distinguishing children with RFI. Conclusions: Maximum tolerance of pain was the most useful parameter for evaluating RFI in children with functional constipation. Resumen: Introducción: Los niños con estreñimiento funcional presentan frecuentemente alteraciones de la distensibilidad y sensación defecatoria, que se pueden valorar mediante manometría anorrectal (MAR). En este estudio evaluamos la utilidad de los parámetros que se obtienen en la MAR en niños con incontinencia fecal retentiva (IFR). Material y métodos: Incluimos a niños de 4 a 17 años con estreñimiento funcional a quienes se realizó MAR. Resultados: Un total de 35 niños fueron incluidos: 21 presentaban estreñimiento funcional y 14, estreñimiento con IFR. Los niños con estreñimiento funcional e IFR toleraron mayores volúmenes en la insuflación de aire para desencadenar urgencia defecatoria y dolor a la máxima tolerabilidad, en comparación con quienes no presentan IFR. Identificamos un punto de corte de 135 ml de aire de máxima tolerabilidad para discriminar niños con IFR. Conclusiones: La máxima tolerabilidad fue el parámetro más útil para evaluar IFR en niños con estreñimiento funcional. Keywords: Fecal incontinence, Functional constipation, Anorectal manometry, Palabras clave: Incontinencia fecal, Estreñimiento funcional, Manometría anorrectal

El cultivo del eucalipto es una importante alternativa económica, social y ambiental para el desarrollo sostenible en el mundo. Este cultivo posee una regeneración rápida, pero los costos del raleo son altos, por lo que se requiere un manejo silvícola adecuado de los rebrotes. El objetivo principal de la presente investigación fue evaluar el crecimiento de los rebrotes de eucalipto después de aplicado los tratamientos silvícolas. El raleo influyó positivamente tanto en el crecimiento longitudinal como radial de las plantas de Eucalytus urograndis, el incremento en diámetro y altura proyectados a doce meses de las plantas sometidas a dos intensidades de raleo (70 -80%) en relación al tratamiento control osciló en valores de 0.34 – 0.47 cm y 1.04 – 1.45 m, respectivamente.

La desnutrición se define como aquella condición patológica, inespecífica, sistémica y potencialmente reversible que resulta de la deficiente utilización de los nutrimientos por las células de los organismos.1 De acuerdo con la Sociedad Americana de Nutrición Enteral y Parenteral (ASPEN, por sus siglas en inglés) se precisa como un desequilibrio entre el requerimiento y gasto energético, lo cual resulta en un déficit acumulativo de energía, proteína o micronutrientes que afectan de forma negativa el crecimiento, desarrollo y otros resultados relevantes en la población pediátrica. En cuanto a su severidad, de acuerdo con la Organización Mundial de la Salud (OMS), se clasifica según su puntuación Z en leve, moderada y severa.2

La infección crónica activa por Epstein Barr (CAEBV) es una condición poco común, donde el organismo no es capaz de contrarrestar la replicación del virus de Epstein Barr (EBV), llevando al paciente a un estado crónico con sintomatología variable. Es relevante el reconocimiento temprano de las manifestaciones clínicas poco frecuentes o atípicas, debido a las particularidades de su manejo y pronóstico. Objetivo: describir un caso de CAEBV manifestada con colitis y hepatitis. Caso Clínico: Niña de 6 años, previamente sana, presentó episodio recurrente de ictericia, hepatoesplenomegalia y fiebre, se diagnosticó hepatitis por EBV con una carga viral en sangre de 328,000 copias/mL. Su biopsia hepática reveló ARN codificado por el virus de Epstein Barr (EBER). Evolucionó con diarrea mucosanguinolenta y baja de peso, la colonoscopia mostró pérdida del patrón haustral, múltiples úlceras aftoides cubiertas con fibrina y se encontraron 7 millones de copias de EBV/gramo de tejido en colon. Se identificó la infección del linaje de células T, se inició Rituximab, con disminución de carga viral, resolución completa de diarrea y mejoría en pruebas de función hepática. El tratamiento definitivo realizado fue trasplante de médula ósea. Conclusiones: La CAEBV es un trastorno grave, poco documentado, debe ser considerado ante el curso prolongado o intermitente de una hepatitis, acompañado de manifestaciones generales y gastrointestinales como diarrea crónica, hematoquecia, pérdida de peso, ya que su desenlace sin tratamiento puede ser fatal.

Chronic active Epstein Barr virus infection (CAEBV) is a rare condition, where the body is unable to counteract Epstein Barr viral replication (EBV), leading the patient to a chronic state with variable symptoms. Early recognition of infrequent or atypical clinical manifestations is relevant due to the particularities of their management and prognosis.to describe a case of CAEBV manifes ted with colitis and hepatitis, summarizing the clinical-pathological and endoscopic characteristics and their evolution.A 6-year-old girl, previously healthy, presented recurrent episodes of jaundice, hepatosplenomegaly, and fever. EBV hepatitis was diagnosed with a blood viral load of 328,000 copies / mL. Her liver biopsy revealed Epstein-Barr virus-encoded small RNAs (EBER). She evolved with mucosanguineous diarrhea and weight loss; the colonoscopy showed loss of the haustral pattern, multiple aphthous ulcers covered with fibrin, and 7 million copies of EBV / gram of tissue were found in the colon. T-cell lineage infection was identified, therefore Rituximab was started, with a decrease in viral load, complete resolution of diarrhea, and improvement in liver function tests. The definitive treatment was bone marrow transplantation.CAEBV is a serious disor der, little documented, and should be considered in the face of a prolonged or intermittent course of hepatitis, accompanied by general and gastrointestinal manifestations such as chronic diarrhea, hematochezia, and weight loss, since its outcome without treatment can be fatal.

Cow’s milk protein allergy (CMPA) is the most prevalent food allergy in children, and its pathogenesis remains poorly understood. It has been shown that the combination of genetic predisposition, perinatal factors, and intestinal imbalance of the immune response mediated by cytokines may play an essential role in CMPA pathogenesis. To characterize the gene expression of Th1, Th2, and Th17 cytokines in the duodenum and rectum in patients with CMPA. This is an observational, descriptive, cross-sectional, prospective study. We used specific IgE (ImmunoCAP®) in serum and biopsies from the rectum and duodenum for the detection of cytokine messenger RNA levels by real-time PCR in patients with a positive oral food challenge for CMPA. We analyzed the relative quantification of the gene expression of cytokines by real-time PCR, and we used the housekeeping gene GAPDH for normalization purposes. Thirty children (13 male and 17 female) were evaluated. All patients had an open challenge for CMPA. IgE specific to casein, alfa-lactalbumin, and beta-lactoglobulin was negative in all patients. In terms of cytokine levels, the levels of TNFα, IL-6, IL-12 (Th1), IL-4, IL-10, IL-13 (Th2), and IL-17 were found to be higher in the rectum than in the duodenum (p

Introduction and aims: Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. Materials and methods: An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. Results: Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p

Esophageal achalasia is a primary motor disorder that presents with dysphagia secondary to esophageal body dysfunction and functional obstruction of the lower esophageal sphincter. High-resolution manometry is considered the gold standard for the diagnosis of achalasia and, according to the Chicago classification v3.0; it can be further divided into three different subtypes based on the pressurization patterns. Herein, we present the case series of 6 pediatric patients in whom high-resolution manometry was performed for the diagnosis and classification of esophageal achalasia.

Se presenta el caso de una paciente con tirosinemia hepatorrenal (TYR- 1) que, debido a la interrupción por cuatro semanas de tratamiento con nitisinona, tuvo una grave crisis neurológica de pseudoporfiria caracterizada por vómito, dolor abdominal, irritabilidad e hipertensión arterial, con gran elevación de la succinilacetona y alfafetoproteína. La crisis requirió tratamiento intrahospitalario. Una semana después de reiniciar la administración del fármaco revirtió totalmente. Este caso enfatiza la importancia de mantener el tratamiento ininterrumpido con nitisinona en pacientes con tirosinemia hepatorrenal. También es útil para reconocer el cuadro clínico y la fisiopatología de las crisis neurológicas características de esta enfermedad.

Introduction Ambulatory laparoscopic cholecystectomy (ALC) reduces the use of hospital beds and benefits the patient by returning home sooner. Therefore, it is important to evaluate the degree of patient satisfaction. Materials and methods A controlled clinical trial was designed to assess the efficacy, safety, and satisfaction of ALC, compared to the usual laparoscopic cholecystectomy (ULC). Efficacy and safety were evaluated based on; recovery of the oral route, spontaneous urination, gas channeling, presence of pain, nausea, vomiting, bleeding, pain, penrose expense. Satisfaction was explored through an adaptation of the SATISCORE questionnaire. Results We included 71 patients, 38 from the experimental group (ALC) and 33 from the control group (ULC). There was a higher proportion of women, average age at the fifth decade, and a similar distribution of comorbidities. In safety and efficacy, the results were similar. In the survey, the ALC group showed an 89.5% high degree of satisfaction. Discussion There was a good postoperative recovery in both groups as they reincorporated earlier, identified in a better satisfaction index referred by the patient. Conclusion The ALC is as effective and safe as ULC, so it can be considered as the new "gold standard" for the surgical management of uncomplicated biliary pathology.

Las enfermedades del tubo gastrointestinal forman parte importante de la morbilidad y de la mortalidad mundiales; incluyen desde las enfermedades infecciosas, alérgicas, inflamatorias crónicas (como la enfermedad de Crohn y la colitis ulcerativa) hasta padecimientos considerados como funcionales, como el síndrome de intestino irritable. En algunas de ellas el tratamiento puede ser difícil, ya que en ocasiones pueden existir diferentes teorías en relación a las mismas y en las que se han encontrado múltiples factores tanto psicosociales como genéticos. En los últimos años ha cobrado gran importancia el papel que desempeña la microbiota intestinal en la génesis de algunas de ellas. Desde el siglo XV se describió la presencia de microorganismos en el tubo gastrointestinal, pero fue hasta que se originó la biología molecular cuando se logró un mejor conocimiento de la función y la composición del ecosistema gastrointestinal, el cual contribuye de manera importante para los procesos de digestión y absorción de sustratos de la dieta, así como para las funciones inmunológicas y protectoras de la microbiota gastrointestinal en cada organismo, lo que resulta esencial para comprender su participación en el tratamiento y en la prevención de múltiples enfermedades.

BackgroundEvaluation is a means for significant and rigorous improvement of the educational process. Therefore, competence evaluation should allow assessing the complex activity of medical care, as well as improving the training process. This is the case in the evaluation process of clinical–surgical competences.Materials and methodsA cross-sectional study was designed to measure knowledge about the evaluation of clinical–surgical competences for the General Surgery residency programme at the Faculty of Medicine, Universidad Autónoma de Chihuahua (UACH). A 55-item questionnaire divided into six sections was used (perception, planning, practice, function, instruments and strategies, and overall evaluation), with a six level Likert scale, performing a descriptive, correlation and comparative analysis, with a significance level of 0.001.ResultsIn both groups perception of evaluation was considered as a further qualification. As regards tools, the best known was the written examination. As regards function, evaluation was considered as a further administrative requirement. In the correlation analysis, evaluation was perceived as qualification and was significantly associated with measurement, assessment and accreditation. In the comparative analysis between residents and staff surgeons, a significant difference was found as regards the perception of the evaluation as a measurement of knowledge (Student's t test: p=0.04).ConclusionThe results provide information about the concept we have about the evaluation of clinical–surgical competences, considering it as a measure of learning achievement for a socially required certification. There is confusion as regards the perception of evaluation, its function, goals and scopes as benefit for those evaluated.