Children with ASD frequently present with multiple co-occurring conditions affecting clinical management and quality of life. Systematic data on the burden of co-occurring conditions and perinatal risk factors remain scarce in Latin America. This study aimed to characterize the co-occurring condition profile, burden, and perinatal predictors in a large ASD cohort from Northwestern Mexico, examining their relationships with ASD severity and intellectual functioning. This retrospective, cross-sectional study reviewed 1015 children with ASD (January 2022–January 2024) at the Sinaloa Autism Center, Culiacán, Mexico. ASD was diagnosed per DSM-5 by a board-certified pediatric neurologist. Severity was assessed using the CARS-2; intellectual functioning was assessed using the WISC-IV in 508 patients (≥ 6 years). Co-occurring condition burden was scored across seven domains. Three binary logistic regression models were constructed for epilepsy, ADHD, and sleep disorders. Of 1,015 children, 83.3
IntroductionHigh-dose methotrexate (HD-MTX) is a cornerstone of pediatric acute lymphoblastic leukemia (ALL) therapy. It's safe administration requires timely pharmacokinetic monitoring and comprehensive supportive care, which are frequently limited in low- and middle-income countries (LMICs). In Mexico, variability in HD-MTX practices may compromise treatment safety and efficacy. This study aimed to characterize national practice patterns and identify context-specific adaptations in the delivery of HD-MTX in resource constrained settings.MethodsA nationwide, cross-sectional electronic survey was conducted between May and November 2023 among pediatric hematologists and oncologists treating patients younger than 18 years with ALL. The questionnaire assessed institutional guidelines, availability of pharmacokinetic monitoring, and supportive care practices, including hydration, urinary alkalinization, and folinic acid rescue. Data were analyzed descriptively.ResultsA total of 111 specialists from 27 Mexican states participated. Only 56% reported having institutional HD-MTX guidelines. While 97% administered HD-MTX to high-risk ALL patients, only 61% used full protocol-recommended doses, and nearly one-third reported dose reductions. Methotrexate plasma level monitoring was only available in 56% of centers. Most centers (86%) administered HD-MTX exclusively in the inpatient setting. Supportive care practices varied substantially across institutions and risk groups. Reported barriers included limited laboratory capacity (61%), lack of standardized protocols (44%), and delays related to bed availability (39%).ConclusionsOptimizing HD-MTX delivery in Mexico requires integrating standardized clinical practices with targeted system-level interventions to ensure timely access to pharmacokinetic monitoring. The development and implementation of context-adapted national guidelines may improve safety, reduce variability in care, and mitigate outcome disparities in children with ALL.
BACKGROUND Aplasia cutis congenita (ACC) is a rare congenital disorder characterized by localized absence of skin at birth, with an incidence of approximately 1 in 10 000 live births. Type V ACC, according to Frieden's classification, is associated with fetus papyraceus or placental infarction and typically presents with symmetrical lesions on the trunk and extremities. Cases associated solely with a single umbilical artery are exceptionally rare. CASE REPORT We present a singleton male infant born at 39 weeks' gestation via cesarean section due to fetal distress and oligohydramnios. Physical examination revealed extensive bilateral, symmetrical skin defects on the trunk and lower extremities, with absent epidermis and skin appendages. Histopathology confirmed ACC. Umbilical cord examination demonstrated a single umbilical artery, and echocardiography revealed an atrial septal defect (ASD). Genetic testing ruled out chromosomal abnormalities. Treatment consisted of surgical debridement, prophylactic antibiotics, and application of human epidermal allografts with hydrocolloid dressings. Complete re-epithelialization was achieved within 50 days without complications. CONCLUSIONS This case underscores the importance of investigating placental and umbilical cord anomalies in newborns with symmetrical truncal ACC, and adds support to the vascular hypoperfusion etiology of Type V ACC. The association with single umbilical artery and ASD suggests a broader sequence of embryonic vascular disruption. Echocardiography should be considered in all cases of Type V ACC, given the potential association with cardiac anomalies.
BackgroundPediatric Early Warning Systems (PEWS) are evidence-based interventions that monitor hospitalized pediatric patients to improve outcomes and prevent complications, particularly in children with cancer. However, there is limited data on how clinicians perceive the impact of PEWS on patient care across healthcare centers in resource-variable settings. Understanding clinicians’ perceptions of PEWS is crucial, as their recognition of its benefits can enhance adoption and sustainability across various healthcare settings.ObjectiveTo assess clinician perceptions of impacts following PEWS implementation across pediatric oncology centers in Latin America and Spain.MethodsWe conducted a secondary analysis of a study assessing capacity for PEWS sustainability and adaptations at resource-variable hospitals participating in a collaborative to implement PEWS. Anonymous surveys in Spanish and Portuguese were distributed to nurses, physicians, ward, and ICU clinicians using PEWS at 58 hospitals across 19 countries. The survey included one free-text question about adaptations made to PEWS. A qualitative analysis of these responses was conducted using codes developed during a previous study to describe clinician perceptions on PEWS impact. Content analysis focused on clinician perspectives on the multilevel impact of PEWS.ResultsOf 1,909 free-text responses, PEWS impact was mentioned in 48% (n=913) by clinicians at 58 participating hospitals. Participants described impacts at the level of the patient, clinician, team, and institution, and emphasized the positive impact of PEWS at their centers. PEWS was perceived as vital in facilitating timely patient care interventions, mitigating progression of critical illness, and reducing mortality for pediatric oncology patients. Clinicians also reported that PEWS made patient care easier and empowered them in their roles. Finally, PEWS was perceived to improve communication and team dynamics among multidisciplinary clinicians.ConclusionThis study adds to existing literature by describing clinician perceptions of the multilevel impacts of PEWS on hospital care for children with cancer across hospitals of diverse resource-levels, providing further evidence of how this intervention might benefit patients, clinicians, and clinical teams. These findings emphasize that understanding perspectives of clinicians who use evidence-based interventions, like PEWS is crucial to promote adoption and guide sustainability strategies to improve outcomes for children with cancer globally.
Background: they are benign mesodermal tumours, rarely found in babies and children. The etiology is still unknown. These lesions are often seen in the renal pelvis and distal ureter. In addition to hematuria. They are often congenital in children, while in adults they are caused by inflammation, chronic irritation and infection. They manifest in children with an average age of 9 years and have a strong male predominance. Clinical case: a 11-year-old female patient comes to the clinic due to dysuria, urinary urgency and hematuria, for 3 weeks, with pain in the pelvic region, she denies other associated symptoms. A renal bladder ultrasound reported an exophytic lesion, pathological general urine test, simple and contrast-enhanced tomography with excretory phase with a tumor measuring 3.2 x 2.8 x 2.8 cm, transurethral resection of bladder tumour without complications. Clinical implications: histopathological result is reported which describes without evidence of malignancy, a multifragmentation fibroepithelial polyp, a benign condition with a favorable evolution. Conclusions: hematuria is the most common symptom. The differential diagnosis between bladder carcinoma and polyps is difficult. Pathology is the means to differentiate between these two conditions. For treatment, transurethral resection is the most effective operation.
