Mr. Editor. In several countries, newborns are screened for tyrosinemia type 1 using tyrosine as a primary marker. In some situations, elevated blood tyrosine levels are discovered due to elevated tyrosine on a urine metabolic screen. In Peru, some pediatric patients suspected of having a genetic condition (inborn error of metabolism) undergo a metabolic screening in urine that includes - among other things - the qualitative detection of tyrosine. However, when there are high levels of tyrosine in the urine this does not always mean that the patient has a genetic condition. Hypertyrosinemia is most often non-genetic in origin. Therefore, it is important to review the non-genetic causes of hypertyrosinemia and thus avoid potential misinterpretations of this finding.

Efficiency evaluation is a useful tool for making right decisions at health care institutions. This includes knowing the variability and reliability of registered medical and surgical procedures times. Objectives: To determine variability and confidence of registered cesarean deliveries surgical processes times. Design: Cross-sectional study. Institution: Clinica Centenario Peruano Japonesa. Participants: Patients’ cesarean deliveries registries. Interventions: Medical and surgical times data were obtained from the surgical registry and clinical records' registry, 2011. Main outcome measures: Dispersion measures of all indicators and intraclass correlation coefficients (ICCs) from the studied registries. Results: Operating room patient transfer time showed the greatest variability and the ICCs between studied registries for starting and ending time of cesarean delivery were 0.902 and 0...

Introduction: Suicidal planning is a previous step to suicide. High rates of suicidal planning among university students have been found in different populations, even higher than in the population students come from. Objectives: To determine which factors are associated with suicidal planning in students from a School of Nutrition. Design: Cross-sectional study. Institution: School of Nutrition, San Fernando Faculty of Medicine, Universidad Nacional Mayor de San Marcos. Participants: First to fourth academic year students of Nutrition. Interventions: A survey was carried out. Main outcome measures: Statistical significance in logistic regression tests. Results: In bivariate analysis none of the studied variables was associated with suicidal planning. In analysis adjusted to socioeconomic variables difficulty to fall asleep at night showed association (p=0.044). Difficulty to fall asleep...

Millions of cases of cholinesterase inhibitors poisonings occur in the world and thousands of deaths by these substances are reported. Our country is not different scenario. The most useful treatment regimen is currently under research and some extensively used measures are on debate. The current trend is aggressive treatment as severe life-threatening adverse effects by drugs like atropine are very rare. In Peru there is no active research on this issue and only an organophosphate and carbamate poisoning in children treatment guide by the Ministry of Health in 2005 is available. It is urgent to update these guidelines, since they contain concepts that in some cases have radically changed due to current knowledge. The aim of this review is to briefly expose the most relevant updated information on treatment of these poisonings, to suggest evaluation of the mentioned guidelines, and to ca...

Introduction: In Peru there is a lack of published studies about self-medication that had been performed nationwide. Most of the information available is descriptive and from small sectors of the population. Objectives: The aim of this study was to analyze if factors related with health services accessibility, perception about disease, doctors and traditional medicine, as well as socioeconomic factors, are associated with selfmedication among people with a recent illness who did not seek for attention at a healthcare facility. Design: Transversal analysis from the National Household Survey (ENAHO) of year 2015. Setting: Nationwide study. Study subjects: Those who had an illness in the last 4 weeks and did not look for attention in a healthcare facility. Interventions: Summary measures were calculated. Bivariate and multivariate logistic regression were used. Results: All variables of int...

As a result of acute pancreatitis (AP), there may be subsequent diabetes or transient hyperglycemia during the episode of AP. The incidence of AP in pediatric age is up to 12.2 cases per 100,000 children per year and only 4 to 5% later develop diabetes. Regarding transient hyperglycemia in children, information is scarce, and no publications have been made about it in our country. The case of a girl with transient hyperglycemia secondary to severe necrotizing AP is reported. It is important to constantly monitor glucose levels and timely manage hyperglycemia in children with AP since, at least in adults, it is associated with severe AP and higher mortality.

Durante el ayuno, la oxidación de ácidos grasos y la formación de cuerpos cetónicos son necesarios para la producción de energía. La carnitina es esencial para que los ácidos grasos de cadena larga se transfieran a la mitocondria para la oxidación de ácidos grasos. La deficiencia primaria de carnitina es un defecto recesivo que se expresa con un espectro clínico amplio que incluye descompensación metabólica, hipoglicemia hipocetósica o cardiomiopatía en la niñez, fatigabilidad en la adultez o ausencia de síntomas. En nuestro país no hay publicaciones sobre el tema, por lo que en el presente artículo se reporta el caso de un niño que presentó una deficiencia de carnitina expresada como hipoglicemia hipocetósica y se analiza sus hallazgos clínicos, bioquímicos e histopatológicos.

Introducción: La hiperbilirrubinemia significativa (HS) es una causa importante de hospitalización en la primera semana de vida. Se desconoce si la variación de peso en diferentes momentos después del nacimiento predice HS. El objetivo principal fue evaluar si la variación de peso en diferentes momentos después del nacimiento es un buen predictor de HS. Metodología: Este fue un estudio de cohorte retrospectiva desarrollado en un hospital. Se incluyó a 342 recién nacidos ictéricos nacidos en el Hospital Nacional Daniel Alcides Carrión de Lima entre 2016 y 2017. HS se definió como una bilirrubina sérica total superior al percentil 95 en un nomograma de bilirrubina sérica total. El peso después del nacimiento se evaluó todas las mañanas (es decir, se evaluó en diferentes momentos después del nacimiento). Se exploraron tres variables como predictores principales de HS: var...

Concluye que los niños con CAD que han iniciado insulinoterapia y presentan mejoría clínica, sin trastorno del sensorio ni síntomas gastrointestinales, es probable que la alimentación oral tenga un escaso riesgo. Es necesario realizar más investigaciones sobre el inicio de la alimentación oral previo a la resolución de la CAD en niños.

Es posible que hoy en día, en nuestro país, el uso de la reacción inflamatoria en heces esté contribuyendo de forma importante al fenómeno de resistencia antibiótica desde edades tempranas. Por tanto es necesario estudiar cuán extendido está el uso de esta prueba y la forma en que se está interpretando los resultados de la misma. Finalmente se insta a evitar el uso de la reacción inflamatoria en heces en la toma de decisiones con respecto al manejo de pacientes con enfermedad diarreica aguda.

Los craneofaringiomas son tumores benignos, de los cuales hasta el 50% ocurren en niños. Sin embargo, no hay estudios en niños peruanos. Objetivo: describir las características clínicas e histopatológicas de niños con craneofaringioma hospitalizados en el Hospital Nacional Edgardo Rebagliati Martins entre agosto de 2019 y mayo de 2021. El estudio: El diseño es transversal y la fuente de los datos fueron las historias clínicas. Se recolectó información sobre el sexo, edad, cirugías y características relacionadas a la primera cirugía de resección tumoral. Hallazgos: Incluimos 12 pacientes. El 83.3% fueron varones, al momento del diagnóstico la mediana de edad fue de 6 años y predominaron los síntomas visuales, todos tuvieron deficiencias hormonales luego de la primera cirugía de resección. Conclusión: tres recibieron radioterapia, uno desarrolló transformación maligna...

Los niños con deficiencia de vitamina D pueden tener fósforo normal o alto a pesar de tener una prueba de hormona paratiroidea (PTH) elevada. El pseudohipoparatiroidismo (PHP) se caracteriza por cursar con hiperfosfatemia. La similitud que puede ocurrir entre la deficiencia de vitamina D asociada a hiperfosfatemia y el PHP hace importante revisar reportes de casos de deficiencia de vitamina D asociada a hiperfosfatemia para entender por qué puede ocurrir esta asociación y cuál es la relevancia de estudiar el nivel de vitamina D en niños con sospecha de PHP. El objetivo de esta revisión fue identificar reportes de niños con deficiencia de vitamina D asociada a hiperfosfatemia y discutir los mecanismos de esta asociación. Se identificaron reportes de 7 casos en niños. La deficiencia de vitamina D reduciría la respuesta fosfatúrica ante una PTH elevada. Se concluye que es import...

Conclusiones del estudio: El análisis general no indica beneficio de la terapia combinada (análogo de hormona liberadora de gonadotropina [GnRHa] + hormona de crecimiento humana recombinante [rhGH]) versus solo GnRHa, solo rhGH o ausencia de tratamiento. Sin embargo, hay beneficios en mayor o menor medida en ciertas subpoblaciones. Comentario crítico: El artículo es relevante al no haber previamente un meta-análisis sobre la terapia combinada. Por otro lado, es importante ya que la terapia combinada implica el uso de rhGH, el cual puede ser costoso, de difícil adherencia y conllevar a efectos adversos. Además, la conclusión general del artículo – no usar terapia combinada – es aplicable. Sin embargo, falta la evaluación de sesgo de publicación y de reporte selectivo, y hay conclusiones secundarias que requieren una mejor explicación. La presente revisión crítica no encu...

Children with vitamin D deficiency can have normal or high phosphorus despite having a high parathyroid hormone test (PTH). Pseudohypoparathyroidism (PHP) is characterized by hyperphosphatemia. The similarity that can occur between vitamin D deficiency associated with hyperphosphatemia and PHP makes it important to review case reports of vitamin D deficiency associated with hyperphosphatemia to understand why this association may occur and what is the relevance of studying the vitamin D level in children with suspected PHP. The aim of this review was to identify reports of children with vitamin D deficiency associated with hyperphosphatemia and to discuss the mechanisms of this association. Reports of 7 children cases were identified. Vitamin D deficiency could reduce the phosphaturic response to elevated PTH. It is concluded that it is important to rule out vitamin D deficiency in all c...

Children with vitamin D deficiency can have normal or high phosphorus despite having a high parathyroid hormone test (PTH). Pseudohypoparathyroidism (PHP) is characterized by hyperphosphatemia. The similarity that can occur between vitamin D deficiency associated with hyperphosphatemia and PHP makes it important to review case reports of vitamin D deficiency associated with hyperphosphatemia to understand why this association may occur and what is the relevance of studying the vitamin D level in children with suspected PHP. The aim of this review was to identify reports of children with vitamin D deficiency associated with hyperphosphatemia and to discuss the mechanisms of this association. Reports of 7 children cases were identified. Vitamin D deficiency could reduce the phosphaturic response to elevated PTH. It is concluded that it is important to rule out vitamin D deficiency in all c...

Carta al editor (sin resumen)

Study conclusions: The overall analysis does not indicate benefit of combination therapy (gonadotropin-releasing hormone analog [GnRHa] + recombinant human growth hormone [rhGH]) versus GnRHa alone, rhGH alone, or no treatment. However, there are benefits to a greater or lesser extent in certain subpopulations. Critical comment: The article is relevant as there was no previous meta-analysis on combination therapy. On the other hand, it is important since combination therapy involves the use of rhGH, which can be expensive, difficult to adhere to, and lead to adverse effects. Furthermore, the general conclusion of the article - do not use combination therapy - is applicable. However, the assessment of publication bias and selective reporting is lacking, and there are secondary conclusions that require better explanation. The present critical review does not find sufficient evidence to sug...

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Introduction: Craniopharyngiomas are benign tumors, of which up to 50% occur in children. However, there are no studies in Peruvian children. Objective: to describe the clinical and histopathological characteristics of children with craniopharyngioma hospitalized at the Edgardo Rebagliati Martins National Hospital between August 2019 and May 2021. The study: The design is cross-sectional and the data source were medical records. Information on sex, age, surgeries and characteristics related to the first tumor resection surgery were collected. Findings: We included 12 patients. 83.3% were male, at the time of diagnosis the median age was 6 years and visual symptoms predominated, all had hormonal deficiencies after the first resection surgery. Conclusions: three received radiotherapy, one developed malignant transformation and one died. Future prospective studies are necessary.

El objetivo del presente reporte es identificar los factores –relativos a los usuarios y a la oferta de servicios– que están asociados a la calidad percibida de atención en consulta externa, hospitalización y emergencias en la población adulta y urbana de afiliados a EsSalud que necesitó atención médica los últimos 6 meses.