Arturo Loredo-Abdalá

Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study

OBJECTIVES Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. METHODS This is a cross-sectional descriptive study of infants and children under 5, who suffered head trauma and were admitted to the National Pediatrics Institute in Mexico City, a tertiary care referral center. We reviewed medical records and extracted data on clinical and neurological signs and symptoms, fundus, radiological (long bones, thorax, CAT scan), and laboratory tests. We administered a standardized questionnaire assessing child abuse and neglect to the parents of the children included in the study. RESULTS One hundred and twenty children, under 5 presenting with head trauma, were recruited, 13 (11%) were considered abusive head trauma (AbHT) and 107 (89%) were diagnosed as accidental head injury (AcHI). The AbHT group comprised younger infants (mean age 8 months) and the AcHI group included toddlers about an average of 25 months. To account for this significant age difference, we performed a comparison of age matched cases. The children in the AbHT were more likely to be female, the result of the first unintended pregnancy and the children of younger mothers (17-19). Mothers in this group had attended fewer than 5 prenatal care visits and fathers had a history of alcohol abuse. Five (38%) of the 13 AbHT children did not survive their injuries and overall showed greater neurological and respiratory compromise, increased prothrombin time (PT), and lower hematocrit values. The most common intracranial injuries suffered by children in the AbHT group were subdural/epidural hematoma and parenchymal/subarachnoid hemorrhage. Retinal hemorrhage was the most frequent ocular injury. CONCLUSIONS In a tertiary care childrens hospital, 11% of the children presenting with head trauma, were considered of abusive origin. Unintended pregnancy among teen mothers and substance abuse in the father were associated with abusive head trauma in this descriptive study.

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 en la ciudad de Monterrey, Nuevo Leon, y el cual ha desencadenado una serie de opiniones gubernamentales, en los medios de comunicacion electronica y escrita, asi como en algunos grupos de la sociedad civil de Mexico, primordialmente surge la siguiente pregunta: ?es que ante estos eventos, los mexicanos y, especificamente, los pediatras debemos reaccionar?

Maltrato infantil: su conocimiento, atención y difusión en tres hospitales pediátricos de México

El maltrato infantil (MI) se ha visualizado en Mexico desde la decada de los 60 a traves de publicaciones aisladas de casos clinicos donde predominaban las manifestaciones de dano fisico o abuso sexual. A partir de la decada de los 90, se establecio la Clinica de Atencion Integral al Nino Maltrato en el Instituto Nacional de Pediatria (CAINM-INP), cuyo accionar se oriento a la asistencia, docencia e investigacion del tema. Este enfoque fue imitado en dos centros hospitalarios del pais: en la Clinica para la Atencion Integral del Menor Maltratado del Hospital Infantil de Especialidades de Chihuahua y en el Servicio de Pediatria del Hospital General de Mexicali. El objetivo basico de este trabajo fue presentar a la comunidad medica y paramedica, a otros profesionales que interactuan con la poblacion pediatrica y a la sociedad civil los esfuerzos que se han realizado en Mexico para enfrentar esta situacion medica-social y legal de una manera logica, siempre orientada a proteger a las victimas y a sus familias

Transferencia y transición. De la medicina del adolescente a la medicina del adulto

Epidemiologic transition of the last two decades has shown substantial changes in the features and course of diseases world-wide. Thence the need for pediatricians to delve on the management of diseases and complications formerly occurring only in adults. On the other hand physicians caring for adults are now facing diseases which were formerly fatal at relatively early ages and are currently seen in much older individuals. For this reason it has become mandatory to develop policies to encourage children, adolescents and their family to observe the continuity of their health care based on the knowledge and understanding of their disease and its risk factors. This will enhance confidence and a close relationship between a patient and his(her) physician in order to attain a sound adherence to treatment and to preclude complications thus achieving a favorable prognosis and excellent well-being.