Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting

Background Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive. Methods Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach. Results Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice. Conclusion The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.

Prediction of confirmed and death cases of Covid-19 in Chile through time series techniques: A comparative study

Abstract(1)BackgroundChile has become one of the countries most affected by Covid-19, a pandemic that has generated a large number of cases worldwide, which if not detected and treated in time can cause multi-organic failure and even death. The social determinants of health such as education, work, social security, housing, environment, support networks and social cohesion are important aspects to consider for the control and intervention of this pathology. Therefore, it is essential to have information about the progress of the infections at the national level and thus apply effective public health interventions. In this paper, we compare different time series methodologies to predict the number of confirmed cases and deaths from Covid-19 in Chile and thus support the decisions of health agencies;(2)MethodsWe modeled the confirmed cases and deaths from Covid-19 in Chile by using ARIMA models, exponential smoothing techniques, Poisson models for time-dependent counting data. In addition, we evaluated the accuracy of the predictions by using a training set and test set;(3)ResultsThe database used in this paper allows us to say that for the confirmed Covid-19 cases the best model corresponds to a well-known Autoregressive Integrated Moving Average (ARIMA) time-series model, whereas for deaths from Covid-19 in Chile the best model resulted in damped trend method;(4)ConclusionARIMA models are an alternative to model the behavior of the spread of Covid19, however, and depending on the characteristics of the data set, other methodologies can better capture the behavior of these records, for example, Holt-winter’s method and time-dependent counting models.

CYTOKINE REGULATION OF THE IMMUNE RESPONSE IN PATIENTS WITH ACUTE NECROTIC PANCREATITIS COMPLICATED BY MULTI-ORGANIC FAILURE

Aim: To study the cytokine regulation of the immune response in patients with acute necrotic pancreatitis (ANP) complicated by multiple organ failure (MON). Material and methods: A prospective cohort study of 22 patients with ANP complicated by MON who were treated in the clinic during 2014-2020 has been performed. We studied changes in blood cells expressing clusters CDIIa +, CD162 +, CD95 +, CD16 +, HLA-DR + molecules, levels of interleukins IL-2, IL-4, IL-6. The efficacy of treatment was determined by the duration of the organ failure, the level of postoperative complications and mortality. Results: Low expression of CD11a + and CD162 + on immunocompetent cells together with two time reduction of the content of CD95 + cells was observed in patients with ANP complicated by MON, which caused a decrease in the concentration of IL-6 at the same time with a slight increase in IL-4. A permanent reduction of the content of CD11a+-, CD162+- and CD95+-leukocytes simultaneously with a drop of the concentration of IL-4 and an excessive increase in the levels of IL-2 and IL-6 was associated with a negative course of the disease. Conclusions: The imbalance of cytokine regulation of the immune response develops in patients with ANP, complicated by MON. Progressive and excessive increase of plasma concentrations of IL-2 and IL-6 occurs as well as complete absence of IL-4 occurs in patients with an adverse course of the disease.

Mucormycosis in a liver allograft after liver transplantation for secondary biliary cirrhosis due to bile duct injury

Introduction: Mucormycosis refers to a group of opportunistic mycoses that occur generally in immunocompromised patients and are caused by Mucorales, ubiquitous filamentous fungi with broad, thin-walled, sparsely septate, ribbon-like hyphae. Case report: A 57-year-old man with a history of secondary biliary cirrhosis due to inadvertent bile duct injury during cholecystectomy. He was referred to our center and underwent LT on June 2018. Due to severe coagulopathy he underwent exploratory laparotomy and abdominal packing for 48 hours. He recovered with good liver function and LFT´s with a tendency towards normalization. On post op day 8 the patient presented an episode of fever and a CT scan was performed showing a large zone of hypoperfusion with bubbles of gas in the liver dome. A percutaneous biopsy was taken for cultures. Preliminary results reported a filamentous fungus and liposomal amphotericin b was initiated with the suspicion of mucormycosis. The patient remained afebrile and asymptomatic. After 5 days of treatment a new image was performed, and progression of the lesion was noticed, due to these findings the patient was taken to the OR for surgical debridement. Involvement of the liver dome and diaphragm was noticed and a non-anatomic hepatectomy was performed. After surgery the patient required increasing amounts of vasopressors. Despite all the support he progressed to multiple organic failure and finally expired. The product of hepatectomy confirmed the diagnosis of mucormycosis (Rhizopus sp). Discussion: Despite all the efforts the patients’ clinical condition deteriorated after surgery showing the high mortality rate in liver transplant recipients that has been reported of 50 to 100%.

Maternal and paternal psychopathological risk in children with non-organic failure to thrive

Investigaciones en el campo de la psicopatología del desarrollo han subrayado que la psicopatología materna es un factor de riesgo crucial para el desarrollo y mantenimiento de los trastornos alimentarios en los niños. Sin embargo, la literatura científica que ha estudiado los resultados de las dificultades emocionales maternas (por ejemplo, los trastornos alimentarios maternos) sobre el funcionamiento psicológico del niño no ha tenido en cuenta adecuadamente el papel del padre como riesgo potencial o factor de protección. El presente estudio longitudinal tuvo como objetivo elaborar sobre el impacto del funcionamiento psicológico materno en la adaptación del niño entre la primera y la segunda infancia. La muestra está compuesta por N = 60 padres con hijos que han seguido un protocolo de investigación longitudinal y han sido reclutados a través de guarderías, escuelas primarias y clínicas de atención ambulatoria. En tres momentos de evaluación (T1, T2, T3), tanto el Grupo clínico (CG) como el Grupo no clínico (NCG) han sido evaluados a través de: SCID-I (diagnóstico psiquiátrico parental); SCL-90-R (riesgo psicopatológico de los padres); EAT-40 (alimentación desordenada de los padres); CBCL (funcionamiento emocional-conductual de los niños). Nuestra investigación ha confirmado que los niños con dificultades severas en el área de alimentación tienden a tener madres que muestran problemas en el mismo campo. De hecho, el diagnóstico de trastorno alimentario en las madres parece predecir el fracaso para prosperar en los niños solo en el Tiempo 1, mientras que se asocia con un funcionamiento psicológico emocional desadaptativo tanto en la primera como en la segunda infancia. Los niños con trastornos alimentarios también parecen tener más probabilidades de tener padres con perfiles psicológicos problemáticamente estables.

Exploring the Correlation Between Perceived Attachment Security and Levels of GH Hormone in a Sample of Children with Non-organic Failure to Thrive: Preliminary Findings

IntroductionShort stature caused by growth hormone (GH) deficiency is one of the causes of the “Failure to Thrive” (FTT) condition. In absence of clear organic causes, several different psychosocial conditions may play a role in explaining the FTT phenotype. Advances in developmental psychology have highlighted the role of emotions and caregiving behaviors in the organization of child's personality and psychobiology, with the mother–son attachment bond being considered a fundamental developmental experience. The objective of the present preliminary study was to assess whether there are significant correlations between attachment styles and GH levels in a sample of subjects with non-organic FTT.MethodsWe enrolled 27 children (mean age: 9.49 ± 2.63) with non-organic FTT. Perceived attachment security was assessed through the Security Scale (SS) and its subscales focused on maternal and paternal security. Pearson partial correlation was used to test associations between GH levels and SS measures adjusting for confounding factors (i.e. age, gender and BMI).ResultsAcross all subjects, GH was significantly positively correlated with general security (r = 0.425; P = 0.038) and maternal security (SSM) (r = –0.451; P = 0.027) and not significantly correlated with paternal security (SSP) (r = 0.237; P = 0.264).DiscussionThese findings preliminarily suggest that perceived attachment security may play a role in the etiopathogenesis of non-organic GH deficiencies and add to the accumulating evidence that attachment styles are associated with specific psychoendocrine underpinnings.Disclosure of interestThe authors have not supplied their declaration of competing interest.