ISPCAN Child Abuse Screening Tool for Children (ICAST-C): Translation and adaptation to Mexican Spanish, and psychometric properties tested in Mexico City adolescents

BACKGROUND

Research using the IPSCAN Child Abuse Screening Tool for Children (ICAST-C), has provided ample evidence of the magnitude of violence against children. Knowledge about its psychometric characteristics and validity is limited. Hence, our objective was to translate and culturally adapt the ICAST-C in adolescents from Mexico City and determine its psychometric properties.

PARTICIPANTS AND SETTING

To determine the psychometric properties of the instrument 723 adolescents between 11 and 18 years of age from 9 public secondary schools in Mexico City participated.

METHODS

The study was carried out in two phases: 1) translation and adaptation of the instrument (in 5 steps) and 2) pilot evaluation of the psychometric properties. Total and factor reliabilities were determined, Pearson correlation was used for temporal stability while construct validity was determined by Confirmatory Factor Analysis (CFA), and final adequacy of the items eliminated by the CFA.

RESULTS

We developed the culturally relevant Mexican Spanish version of the ICAST-C. The CFA confirmed the six-factor structure hypothesis. To improve the original model we eliminated ten items, the final model showed good global fit indices (χ2(1310) = 2207.68, p < .01, χ2/df = 1.68; CFI =0.95; RMSEA = 0.02 [CI95% 0.02-0.03]; SRMR = 0.08). Total and factor reliabilities were adequate (Alpha = 0.79-0.92, r = 0.52-0.75), except for the non-violent discipline factor (Alpha = 0.59, r = 0.38).

CONCLUSIONS

While these data suggest that this version of the ICAST-C is valid and reliable for adolescents in Mexico City public secondary schools, further research should evaluate the psychometric properties in a national sample.

Pediatric Abusive Head Trauma: Multicentric Experience in Mexico

Abusive head trauma (AHT) is one of the most severe forms of child abuse due to its morbidity and mortality. However, AHT is still misdiagnosed in developing countries because of its nonspecific clinical picture and limited knowledge of it on the part of physicians. The aim of this study was to describe some characteristics of children with AHT, their families, and caregivers, as well as the clinical data that could serve as signs for its suspicion and the medical-legal resolution of the cases. Children suspect with AHT in emergency rooms in three Mexican hospitals were included after obtaining informed consent from the parents. All information was obtained from the parents by means of a questionnaire and from different clinical and radiological evaluations of the clinical records of the patients. 15 children, with a median age of 5 months and predominantly males (73.33%), were included in the study. 66% reported a history of irritability periods, and most of the patients (73.33%) had more than one habitual caregiver. The diagnosis of AHT was suspected in only 33.33% on admission in the Emergency Services. Acute symptomatology was present in 53.33%, while less severe symptoms were reported in the rest. Special attention should be paid on babies with history of irritable periods. When a child who is previously healthy and suddenly presents with a seizure or cardiorespiratory dysfunction or brought to the hospital dead, the diagnosis of AHT should be considered as a priority.

Adverse childhood experiences. Knowledge and use by pediatrics residents

INTRODUCTION

Adverse childhood experiences (ACEs) have been associated with the acquisition of risk behaviors and development of chronic and mental diseases since adolescence and in adult life.

OBJECTIVE

To identify the knowledge and the frequency pediatrics residents ask about ACEs with.

METHODS

Through an online survey sent to all resident physicians of the 2017-2018 academic year of a tertiary care children's hospital, demographic variables, knowledge, use, training and barriers to interrogate and search for ACEs were collected.

RESULTS

21% of residents answered the survey; the majority were women (70 %), less than 5 % of participants were familiar with ACEs, 31 % enquired about them in parents and their children, and 71 % considered having some barrier to interrogate about them.

CONCLUSIONS

Participants in this study showed limited knowledge about ACEs, which had an impact on the frequency they enquired about them with in their patients and their parents; at least half had the perception that it is beyond the reach of the pediatrician to identify them.

Maltrato infantil: aspectos jurídicos en México

In Mexico, the complexity of the comprehensive care of a girl, boy or adolescent who is the victim of any form of child abuse requires the necessary legal knowledge for comprehensive management. Physicians probably lack sufficient knowledge of the laws to understand and correctly address the legal aspects immersed in the comprehensive care of this population group. Considering that child abuse has been characterized as a world-wide medical-social-legal problem, it is necessary to know the essential legal mechanisms to protect minors who are victims of it and understand the legal status of their families and of the probable aggressor. The purpose of this article is to present the existing legal framework in Mexico and the actions of world organizations in this area. It is necessary for the Political Constitution of the United Mexican States to be the basis on which legal behaviors related to child abuse, crime investigation and administration of justice are founded, as well as for international agreements on the subject, which have been signed by the government of Mexico, to be adhered to.

[Trauma craneal no accidental en niños: costo económico directo de la atención médica en un hospital de tercer nivel]

Introduction

Abusive head trauma (AHT) is an extreme form of physical abuse that is produced by abruptly shaking an infant or toddler.

Objective

To describe the direct economic cost of care during hospitalization of 14 children with confirmed diagnosis of AHT in a pediatric hospital.

Method

Analysis of the cost of disease in patients with AHT attended to between 2001 and 2010. Partial direct economic cost of medical care (days of hospital stay, laboratory tests and imaging studies, surgical procedures and subspecialist consultations) was calculated adjusting for inflation, with year 2001 taken as base year. Patients were classified in three groups (moderate, severe and fatal AHT). Descriptive and sensitivity analysis was carried out.

Results

Patients with severe AHT generated higher medical care costs ($105,794.88 ± 33,201.91) in comparison with the group of moderate ($37,012.95, ± 7,154.87) and fatal AHT ($18,595.04 ± 6424.47) (p <0.05). Total cost was $665,467.98 Mexican pesos ($71,249.25 international dollars).

Conclusions

Total cost for the 14 patients was an elevated figure, as in other parts of the world. The direct economic cost is closely related to the severity of the clinical presentation.

Maltrato entre pares o acoso escolar (bullying). ¿Debemos enfrentar el problema cuando la tragedia es inevitable?

Como consecuencia del lamentable evento acaecido a mediados del mes de enero de 2017 enla ciudad de Monterrey, Nuevo León, y el cual ha desencadenado una serie de opiniones gubernamentales,en los medios de comunicación electrónica y escrita, así como en algunos grupos de la sociedad civil de México, primordialmente surge la siguiente pregunta: ¿es que ante estos eventos, los mexicanos y, específicamente, los pediatras debemos reaccionar?

[Adolescent pregnancy: its causes and repercussions in the dyad]

Teen pregnancy (TP) is a global public health problem that affects the physical and emotional health, educational and economic status of prospective parents and often also affects the product of gestation. In most cases, the TP is an unplanned event, and often difficult to accept by the couple. But it is more complicated for the future mother who suddenly finds herself without the protection of the couple, her family and her school companions. The risks to which the young mothers are exposed are diverse, but include: submitting to a clandestine abortion, falling into drug addiction, prostitution and crime; Also, it should be noted that with so many adversities, she can develop child maltreatment and frequently, she may be attacked at home, at school or in society giving rise to the twin phenomena of child abuse. To address this problem, it is necessary to develop preventive strategies aimed at risk of early pregnancy or acquiring sexually transmitted diseases by implementing educational programs for personal, family or schools for this age group range. It stresses the need for these programs to be consistent and persistent, as a basic strategy to reduce the consequent risks to unplanned or accepted sex life.

Maltrato infantil: su estudio y manejo en el Instituto Nacional de Pediatría, México

Tema: la violencia contra niñas, niños y adolescentes, y específicamente el maltrato infantil (mi), es una realidad creciente a nivel mundial. Descripción: por las implicaciones en la salud y en la familia de la víctima, así como el manejo jurídico requerido, se propone que el mi sea considerado y entendido como una emergencia médico-social-legal. Enfoque: para el adecuado registro de cada caso de maltrato infantil, se debe emplear la Clasificación Internacional de las Enfermedades (cie-10) al mi con sus cuatro modalidades básicas (abuso físico, abuso sexual, abuso psicológico y negligencia). El diagnóstico de esta patología requiere un manejo interdisciplinario (médicos, trabajadores sociales, profesionales de la salud mental, abogados). Así mismo, para la atención integral de cada caso, es necesaria la intervención interinstitucional (institución hospitalaria, una dependencia jurídica (Agencia del Ministerio Público) o una organización civil (ong principalmente). Conclusiones: todos los profesionales que atienden o interactúan con niñas, niños y adolescentes, y que sospechan la posibilidad de alguna modalidad de mi, o bien han confirmado el diagnóstico, tienen la obligación de hacer una denuncia o notificación médico-legal, directa o anónima, a la autoridad correspondiente para darcumplimiento a la Norma Oficial Mexicana de Violencia Familiar, Sexual y Contra las Mujeres (nom-046-ssa 2-2005). De esta manera, se precisa la condición jurídica de la víctima, del agresor y su familia. Un manejo inadecuado en las acciones de los profesionales involucrados les puede generar un problema legal.

Maltrato infantil: ¿conocer su impacto económico favorece su prevención?

<p>Una patología que ha existido desde tiempo inmemorial en la humanidad es la violencia que sufren las niñas, niños y adolescentes. En 1989, en la Asamblea General de la Organización de las Naciones Unidas, se dio una atención muy especial a este problema y se enfatizó el interés superior por este grupo etario con el objetivo de evitar que se afecten sus integridades física, emocional, educativa y económica, entre otras.</p><p> </p><p> </p>

[Child abuse: its knowledge, attention and diffusion in three pediatric hospitals in Mexico]

Child abuse (CA) was observed in Mexico since the early 60's through isolated publications from clinical cases and where manifestations of physical injury or sexual abuse predominated. Since the 90's, the Clinic for Integral Care of the Abused Child was established at the National Institute of Pediatrics (CAINM-INP, for its Spanish acronym), which actions were addressed to the care, teaching and research on this topic. This approach was replicated in two hospital centers in the country: the Clinic for Integral Care of the Abused Children at Children's Specialty Care Hospital of Chihuahua and the Pediatric Service of the General Hospital of Mexicali. The main objective of this work was to present to the medical community, paramedics, and other professionals who interact with the pediatric population and society, the efforts that have been made in Mexico to address this legal, medical, and social pathology in a logical manner, and always aimed at protecting victims and their families.

Consideración del problema de maltrato infantil en los planes de estudio de medicina y de especialidades médicas en México

<p>Introducción: en México se estima que uno de cada diez niños sufre alguna forma de maltrato, pero solamente uno de cada 100 es detectado y atendido. Una posible razón es que el personal de salud no está adecuadamente entrenado o sensibilizado para detectar y referir estos casos, lo cual produce subregistro.</p><p>Objetivo: conocer si el tópico de maltrato infantil está incluido en los planes de estudio de licenciatura de la carrera de médico cirujano y en los programas de residencias incluidas en el Programa Único de Especialidades Médicas de la Facultad de Medicina de la Universidad Nacional Autónoma de México. </p><p>Materiales y métodos: se buscó información acerca de la inclusión del tópico del maltrato infantil en los programas académicos de los planes de estudio de la carrera de médico cirujano en las escuelas y facultades de medicina certificadas durante 2008, así como de las 78 especialidades médicas incluidas en el Programa Único de Especialidades Médicas avalado por la Facultad de Medicina de la UNAM.</p><p><br />Resultados: A) Licenciatura: de 76 escuelas y facultades de medicina certificadas por la Asociación Mexicana de Facultades y Escuelas de Medicina, A.C., en 2008, se obtuvo la versión completa del plan de estudios de 20 (28.5%). En seis programas se documentaron contenidos sobre maltrato infantil (30.0% con respecto al número de programas recabados). En todos ellos, las asignaturas fueron obligatorias, de tipo presencial y ubicadas en el cuarto (n = 3) y quinto años de la carrera (n = 3). En todos los casos el maltrato infantil se ubicó en el área de pediatría y en un caso se incluyó también en las unidades didácticas de<br />psiquiatría y medicina legal. B) Posgrado: de 78 especialidades del Programa Único de Especialidades Médicas hubo contenidos sobre maltrato infantil en siete (8.97%, cuatro especialidades y tres subespecialidades); en dos de ellas el tópico aparece en el segundo año, en cuatro se ubica en el primero. En un programa no se especificó el nivel en que se debe cursar. El estudio de los contenidos fue obligatorio y presencial dentro del componente denominado “seminario de atención médica”.</p><p><br />Conclusiones: de acuerdo con la información obtenida, el tópico de maltrato infantil parece ser poco considerado en los planes de estudio de medicina. Por la magnitud del fenómeno, y la oportunidad que tiene el médico de atender este tipo de casos, es necesario incluirlo en todos los programas de formación médica. </p>

Síndrome del niño sacudido: cuadro clínico y evolución de 17 casos en el Instituto Nacional de Pediatría

<p>Introducción: el síndrome del niño sacudido es una modalidad grave del maltrato infantil: afecta al cerebro, la retina y a veces algunos huesos. Su frecuencia y características no se han precisado en México.</p><p>Objetivo: describir y determinar los posibles factores desencadenantes, los cuidadores, el cuadro clínico y la evolución de pacientes afectados por el síndrome del niño sacudido.</p><p><br />Materiales y métodos: estudio de serie de casos mediante el análisis de 17 expedientes de pacientes diagnosticados con síndrome del niño sacudido, en el Instituto Nacional de Pediatría, entre 2002 y 2010. </p><p> </p><p>Resultados: doce pacientes (70%) eran del sexo masculino; la edad promedio fue de 5.7 meses (límites de 2 a 14 meses). Los antecedentes en el niño que probablemente pudieron desencadenar el sacudimiento fueron: en 11 casos la irritabilidad (71%), en 8 (47%) el llanto inconsolable y en 6 la presencia de una enfermedad aguda (35%). En los padres se identificó como posible desencadenante impulsividad en cinco casos (29%), estrés en cinco (29%) y enojo en tres (18%). Los cuidadores habituales del menor fueron la madre en 11 casos (65%), los tíos en cinco (29%), ambos padres en cuatro (24%) y los abuelos en tres (18%); el padre presenció el inicio de los síntomas de gravedad en 6 casos (35%), los tíos en cuatro (24%), la madre en tres (18%) y ambos padres en dos (12%). El cuadro clínico se caracterizó por crisis convulsivas en 13 pacientes (76%), irritabilidad en siete (41%), dificultad respiratoria en siete casos (41%), cianosis en seis (35%) y rechazo al alimento en cinco (29%). En el hospital se corroboraron: crisis convulsivas en 14 casos (82%), alteraciones en el estado de conciencia en once (65%), necesidad de apoyo ventilatorio en siete (41%) e irritabilidad en tres (18%). La exploración de fondo de ojo reveló: hemorragia retiniana unio bilateral en 15 pacientes (88%), hemorragia vítrea en nueve (53%) y desprendimiento de retina bilateral en tres (18%). La tomografía axial<br />computada de cráneo mostró edema cerebral en diez casos (59%), hemorragia subaracnoidea en nueve (53%), hematoma subdural en cinco (29%) y fractura de cráneo en cinco (29%), alteraciones con las que se estableció el diagnóstico de síndrome del niño sacudido (71%) y síndrome de niño sacudido y azotado (35%). Fallecieron seis niños (35%). Todos los sobrevivientes (11 pacientes) tuvieron secuelas: daño visual (59%), daño motor (53%), crisis convulsivas (50%), problemas del lenguaje (41%) y problemas en la audición (18%).</p><p>Conclusión: el síndrome del niño sacudido es una forma de abuso físico que debe ser motivo de sospecha en un niño menor de un año que súbitamente presenta crisis convulsivas, dificultad cardiorrespiratoria o llega muerto al hospital.</p><p> </p>

Munchausen syndrome by proxy in Mexican children: medical, social, psychological and legal aspects

INTRODUCTION

The Munchausen Syndrome by Proxy (MSP), is considered as an unusual less frequent variety of child abuse (CA). In this type of abuse the perpetrators purposely provide factitious information, tamper with specimens or actually induce an illness in a child. Nowadays, it is a clinical entity described in pediatrics as more frequently than before. Despite the fact of its presence worldwide, there are still problems in order to get an appropriate diagnostic. It is also difficult to handle both the clinical and legal aspects in various countries.

OBJECTIVE

Make our academic fellows aware of various pediatric, psychological, social and legal aspects of a series of cases attended at the Clínica de Atención Integral al Niño Maltratado from Instituto Nacional de Pediatría (CAINM-INP), Mexico [Integral Clinic of Attention for Abused Children, at National Institute of Pediatrics, Mexico].

MATERIAL AND METHODS

From a series of 25 cases, 18 minors of age were considered with this syndrome since we found that they shared medical, psychological, social and legal characteristics.

RESULTS

18 minors of age belonged to 14 families. 4 of those families had two affected children each one. These affected children were girls 13/18, predominant in children under six years in 10/18. Syndrome expression was distributed as follows: fever from a non determined origin, seizures, chronic diarrhea, hematuria, and probable sexual abuse. 14 children were hospitalized. In all cases, the aggressor was the mother. The psychological evaluation of six perpetrators revealed psychotic, histrionic, and compulsive-obsessive traits. The socio-economic condition was low in 50% of the cases. A legal demand was posed for seven patients in which all the children remained under the custody of the mother.

CONCLUSIONS

In Mexico, reports of CA have increased within the last years according to experience. Some complex forms as MSP require the participation of an interdisciplinary team for both diagnosis and integral attention.

[Nutritional status in children victims of physical and sexual abuse]

OBJECTIVE

To assess and relate the nutritional status by type of abuse in a pediatric population diagnosed with physical abuse (PA) and sexual abuse (SA).

MATERIAL AND METHODS

It's a retrospective, cross-sectional, descriptive study of 178 clinical records of children aged less than 12 years, attended at the Clinic for the Integral Care of the Abused Child of the Instituto Nacional de Pediatría and the Universidad Nacional Autónoma de México (CAINM-INP-UNAM), during the period 1994 to 2005. The relationship of nutritional status with the type of abuse was analyzed in two age ranges (3 months to less than five years, and five to 11 years) and gender with Student t and chi-square tests.

RESULTS

We identified that, in girls PA was associated with stunting (PA: 48% vs. SA: 12%, p < 0.005 and PA: 21% vs. SA: 0%, p < 0.002) and wasting (PA: 21% vs. SA: 0%, p < 0.01 and PA: 21% vs. SA: 0%, p < 0.002). Whereas in girls SA was associated with overweight and obesity in age range five to 11 years (PA: 0% vs. SA: 31%; p < 0.01).

CONCLUSIONS

This study identified acute and chronic under nutrition in girls with PA, and overweight and obesity in girls with SA. These findings enrich the knowledge for the suspicion of maltreatment child syndrome during the search of the aetiology of the clinical expression studied.

[Sleep alterations in childhood victims of sexual and physical abuse]

INTRODUCTION

The abused child syndrome is related to a variety of emotional disorders, among which are the "post-traumatic stress syndrome" and the phenomena "re-experience," which is related to disturbances of the normal sleep-wake cycle.

OBJECTIVE

To determine the polysomnographic characteristics of the abused child syndrome and compare them with paired healthy children.

MATERIAL AND METHODS

After two-night habituation, all-night video-digital polygraphic recordings following recommendations of the International Federation of Clinical Neurophysiology were performed in 15 abused child syndrome and 15 healthy controls.

RESULTS

In the abused child syndrome patients, the main sleep changes were decreased sleep efficiency, decreased sleep onset sleep latency, increased wakefulness, decreased REM sleep and total sleep time.

CONCLUSIONS

The abused child syndrome have abnormal sleep patterns, independent of the type of abuse, age or sex. Sleep alterations are a new characteristic of the abused child syndrome, not previously described.

Anti-cardiolipin, anti-cardiolipin plus bovine, or human beta(2)glycoprotein-I and anti-human beta(2)glycoprotein-I antibodies in a healthy infant population

BACKGROUND

Pathogenic antiphospholipid antibodies studies are usually conducted on populations of adults. Studies involving normal children are scant.

METHODS

Antibody reactivity against CL alone (true aCL), CL-complexed to bovine beta(2)GP-I (aCL-bovine beta(2)GP-I), or human (aCL-human beta(2)GP-I) beta(2)GP-I, or to phospholipid-free human beta(2)GP-I (anti-human beta(2)GP-I) was determined by ELISA in serum samples from 360 Mexican children ranging from 1 month through 8 years of age.

RESULTS

Statistical analysis of variance and rankings of Kruskal-Wallis demonstrated no significant difference in all tested antibody activities between ages and genders of the study population. Values are presented as a percentile distribution included between 5 and 99, corresponding to the percentages of the studied population. Normal arbitrary units (AU) for IgG, IgA, and IgM true aCL that correspond to the 95 and 99 percentiles are as follows: 2.15 and 3.5; 2.35 and 5.0, and 3.15 and 4.5, respectively. IgG, IgA, and IgM aCL-bovine beta(2)GP-I activities are 2.6 and 5.0, 3.0 and 5.0, and 2.7 and 6.0 AU, respectively, while IgG activities of aCL-bovine and human beta(2)GP-I are 1.45 and 1.80, respectively. Normal values for IgG anti-human beta(2)GP-I are 1.85 AU.

CONCLUSIONS

While elevated serum levels of antibodies to CL and/or beta(2)GP-I have been associated with thrombotic and hematologic manifestations, the majority of reports deal with adult populations. We report the cut-off values (in AU, international PL units, and international units for beta(2)GP-I) of the specific serologic response of true aCL, aCL-bovine beta(2)GP-I, aCL-human beta(2)GP-I, and anti-human beta(2)GP-I in healthy Mexican children.

[Abuse of minors. Clinical considerations on physical abuse, sexual aggression and emotional deprivation]

Physicians and other health personnel dealing with the consequences of child abuse ought to have abroad understanding of the magnitude of this serious medical and social phenomenon. The three main patterns of child mistreatment as observed at a pediatric hospital are reviewed, with emphasis on its medical and juridical aspects. Various pathologic entities are to be taken into account for differential diagnoses when child abuse is suspected. Risk factors regarding the victims, the abusers and the psychosocial environment are noted.

Influence of nutritional status on the pharmacokinetics of acetylsalicylic acid and its metabolites in children with autoimmune disease

BACKGROUND

It is unknown whether nutritional status associated with autoimmune disease alters the pharmacokinetics of acetylsalicylic acid (ASA) and its metabolites.

OBJECTIVE

We studied the effects of the nutritional status of children with autoimmune disease on the disposition of ASA and its metabolites.

DESIGN

A prospective, open-label study was performed with 21 children aged 3-15 y who required ASA therapy. Children received 25 mg ASA/kg orally. Blood samples were drawn before and 0.5, 1.0, 2.0, 4.0, 8.0, 12.0, and 24.0 h after ASA administration; urine samples were collected at different intervals. ASA and its metabolites were measured in plasma and urine. Nutritional status was assessed previously.

RESULTS

The ASA maximum plasma concentration, area under the curve, and total clearance were significantly lower in underweight children than in normal-weight children. The elimination rate constants of gentisic acid (GA), salicyluric acid (SUA), and salicylic acid (SA) in plasma were slower for underweight children than for normal-weight children. The distribution volume of SUA increased significantly (r = 0.92) when the deficit percentage in weight-for-height increased. Underweight children excreted less GA and SA, but more SUA, than did normal-weight children.

CONCLUSIONS

These observations suggest a decrease in the hydrolysis and oxidative reactions of the metabolic pathway of ASA and its metabolites in underweight children. The study illustrates the need for pharmacokinetic data to establish the individual doses of drugs, particularly in conditions that alter nutritional status.

[The abused child: some ethical considerations on its care]

An analysis in being made on the prevalent condition of abused children on a world wide level and in Mexico. As far as the importance of the theme is concerned, and the information that has been given to the different professional groups that deal with this social, medical problem, some basic facts of the syndrome are stressed. The participation that medical and paramedical community, government and society have are mentioned in order to achieve an integral solution to each case. Some ethical concepts are put forth and their consequences, whether they are realized or not in the attention given to any kind of battered child cases.

[Antiphospholipid syndrome: a new diagnostic option in rheumatology in children. Analysis of 3 clinical cases]

There are some patients with a clinical picture that suggests to be a rheumatological problem. However, it does not have all the criteria to be accepted such as specific problems like systemic lupus erythematosus, juvenile rheumatoid arthritis, etc. Now we know that a relation between high levels of antiphospholipid antibodies exist in these special patients and the name of the disease is antiphospholipid syndrome. This problem can be primary or secondary. This disease has been studied mainly in adults with SLE an there is not a description of this syndrome in national pediatric literature. For this reason we present three clinical cases that permit us to review both forms of the syndrome. In this way we alert want to the pediatric community about this topic, and if the number of cases increases, it will improve the knowledge and prognosis of the patients at this age.

[Pneumopathy in children with juvenile rheumatoid arthritis]

In the National Institute of Pediatric were studied 35 patients with juvenile rheumatoid arthritis, in a prospective form, in order to asses pulmonary manifestations. Arthritis had between 5 months to five years of clinical evolution. The radiologic patterns of the lung correlated well with respiratory tests, without correlation with pulmonary gammagram which was normal in all the cases. Symptoms were not characteristic of any type of pulmonary lesion.

[Neurologic involvement in juvenile rheumatoid arthritis]

The neurologic complication seen in children with juvenile rheumatoid arthritis (JRA) has hardly been studied for which therefore its prevalence is unknown. Some of the clinical manifestations surrounding this event have been studied and have been divided into the following two groups: cervical articular spinal disease and extra-articular manifestations, more commonly seen in adults, the atlas-axoidal subluxation and the neuropathies. A group of 213 children diagnosed as having JRA according to the criteria setforth by the American Association of Rheumatology and followed by the Department of Internal Medicine of the National Institute of Pediatrics, 10 patients were found to have neurologic symptomatology (4.6%). Their arthritis was studied as well as their association with activity data and seropositivity. We found 6 female and 4 male patients with neurologic manifestations; their ages ranged from 7 to 14 years. Six of them were diagnosed with sero-positive polyarticular JRA and the other four with polyarticular sero-negative. All patients showed some activity and the appearance of the neurologic complications ranged between two months and seven years. No correlation was found between the beginning of the arthritis and the neurologic symptomatology, their sex or the type of arthritis. Seven of the cases showed peripheral neuropathy. Two cases had atlas-atloid subluxation and another child showed having cervical column inflammation with a rheumatoid pannus.(ABSTRACT TRUNCATED AT 250 WORDS)

[Abdominal complications of systemic lupus erythematosus]

An analysis is done on the description of lupus erithematous and its diagnostic criteria, while emphasizing abdominal manifestations, its variations as well as the importance in its early detection for opportune treatment. Three patients with intestinal pneumatosis, pancreatitis and intestinal perforation, are described.

[Munchausen syndrome in children: report of 2 cases]

We report the existence of two cases of an infrequently know form of child abuse, Munchausen syndrome "by proxy" treated in the Department of Internal Medicine of the National Institute of Pediatrics. We have considered it necessary to emphasize the way this clinical entity is presented, pointing out the exact clinical data and how the relatives referred to them when faced with the treating physician, the number of people involved in treating the children as well as the exagerated number of laboratory and X-ray studies performed. The discrepancy in terminology to point to this disease, allows for the use of the term "Munchausen syndrome in children" to differentiate it from that used in psychiatry. The need to alert the medical community who treats these children on this rarely seen disease, will allow for its recognition and early treatment which avoid a reinforcement of the perpetrators attitudes.

[Endrin poisoning]

We present the case of a fifteen months female patient, who accidentally ingested "Endrin Helios" (cyclodiene organochlorinated pesticide) surviving this event. Clinical manifestations were generalized seizures without neither neurologic or hepatic damage. A review is made about the mechanism of intoxication with the toxic and also about the publications dealing with endrin.

[Algorithm of battered children at entrance to a third-level pediatric hospital center]

Many factors intervene in the diagnosis and treatment of the battered child, including all types of maltreatment. This factors are related with the patient and his social familiar background. An algorithm was established at the Department of Internal Medicine of the National Institute of Pediatrics (INP) during 10 months, that indicates the steps to be followed when a patient with suspicion of maltreatment is hospitalized. The patients were compared with others, treated with the same problem, hospitalized in other services. 37 patients were studied from which, 17 were physically assaulted, 3 sexually abused, 5 socially deprived, 9 psychologically deprived and in 3 patients maltreatment was discharged. The final algorithm signals the routes to be followed when this type of patients enter a pediatric hospital. Battered child; algorithm in.

[Endocrine behavior of battered children in the acute stage of the aggression]

To date the cause of growth retardation of children who have suffered physical abuse and emotional deprivation is unknown. Hypophyseal disturbances in these patients have been proposed of the cause but there are still several concerns on the dynamics of growth hormone secretion in these children. In this study, eleven out of sixteen patients had a low height without important diminution of corporal weight. Growth hormone under basal conditions was found to be elevated in battered children compared with a control group (15.2 +/- 4.7 ng/mL vs 9.6 +/- 1.9 ng/mL, p = 0.025). Two weeks after hospitalization a tendency towards normalization was apparent (13.8 +/- 3.0, NS vs controls). Cortisol, thyroid hormones T3 and T4 as well as thyrotrophin did not show significant changes under basal conditions with respect to control patients although there were some isolated cases with abnormal values. While chronic stress could adversely affect hypophyseal trophic hormone secretion, our study did not show either this were effect nor a clear association between growth retardation and a characteristic abnormal endocrine pattern. It seems that the cause growth and developmental retardation in battered children is of a multifactorial.

[Hepatosplenomegaly of unknown etiology: clinical examination in making a diagnosis in 57 cases]

Fifty-seven patients with the diagnosis of hepatosplenomegaly of unknown cause were studied. Most of the patients were infants and preschool age children. They were evenly distributed by sex. The patients were not undernourished nor did they have low height. However if such was the case, they were usually patients with a metabolic or neoplastic problem. Psychomotor retardation, paleness, jaundice and bleeding were the most common signs and symptoms. Hepatic function tests, complete blood count and urinalysis helped to establish the cause of hepatosplenomegaly in 19 of the 57 patients. Other studies only helped to establish the diagnosis of visceromegaly of unknown cause. Liver biopsy, bone marrow biopsy and a metabolic study were useful to establish the diagnosis in 34 cases. Infectious, metabolic and neoplastic problems were the usual cause for visceromegaly.