Hospital Pedro de Elizalde

Introducción: Las tecnologías de la información y la comunicación (TIC) han transformado la formación en enfermería, ofreciendo simulación virtual, realidad inmersiva, aplicaciones móviles y recursos multimodales que potencian la adquisición de competencias clínicas procedimentales, cognitivas y comunicativas. Objetivos: Evaluar el impacto del uso de las TIC en el desarrollo de competencias clínicas en estudiantes de enfermería. Materiales y métodos: Revisión sistemática PRISMA en PubMed, MDPI, SciELO y ScienceDirect (2015-2025). Se incluyeron estudios empíricos con evaluación de resultados en estudiantes de pregrado; se excluyeron revisiones y estudios teóricos. Tras cribado y aplicación de criterios, 27 estudios fueron analizados cualitativa y temáticamente. Resultados: Las intervenciones fueron heterogéneas: realidad virtual (RV/RA) inmersiva y no inmersiva, simulación en pantalla, apps móviles, serious games y plataformas e-learning. Se observaron mejoras consistentes en habilidades procedimentales (RCP, acceso vascular, transfusión, inyecciones) especialmente en diseños híbridos que combinan práctica virtual, retroalimentación inmediata y práctica háptica. También hubo aumentos en conocimiento, autoconfianza, motivación y satisfacción; los efectos sobre razonamiento clínico fueron variables y dependientes del debriefing y el andamiaje pedagógico. Conclusiones: Las TIC son herramientas efectivas para fortalecer competencias clínicas procedimentales en enfermería si se integran en secuencias híbridas, con evaluación estandarizada y debriefing guiado; se requieren ensayos multicéntricos, estudios longitudinales y análisis de costo-efectividad para consolidar evidencia.

Scurvy is a rare disease caused by exogenous ascorbic acid deficiency. It should be considered in atrisk groups, such as patients with neurodevelopmental disorders who present restrictive diets due to food selectivity. Although pulmonary hypertension associated with vitamin C deficiency is extremely rare, its occurrence is possible. Signs and symptoms such as edema, tachycardia, palpitations, and dyspnea should raise suspicion about the diagnosis. In most cases, this condition is transient and can be reversed with early diagnosis and adequate supplementation with ascorbic acid. We present a case of a patient with autism spectrum disorder and vitamin C deficiency who developed pulmonary hypertension.

This study explores the utility of fractal dimension (FD) analysis in assessing structural alterations in coronary arterioles following 5/6 nephrectomy in rats, a widely used model for chronic kidney disease (CKD). CKD is associated with a heightened risk of cardiovascular morbidity, partly due to microvascular damage. Structural changes in coronary arterioles-typically 10-150 µm in diameter-such as medial thickening, increased collagen deposition, and lumen narrowing, can impair myocardial perfusion and contribute to adverse cardiovascular outcomes. To quantitatively characterize these microvascular changes, we employed FD analysis, a mathematical approach capable of evaluating tissue complexity and self-similarity. This methodology enables objective quantification of remodeling in coronary resistance vessels under pathological conditions. Our findings suggest that FD analysis serves as a reliable marker for the evaluation of microvascular integrity in CKD and provides insights into the mitigating effects of pharmacological interventions targeting the renin-angiotensin system.

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Human renal tubular epithelial cell (HRTEC) primary cultures are isolated from kidneys removed from pediatric patients undergoing nephrectomies indicated by the Pediatric Nephrology Unit of the Hospital General de Pediatría Pedro de Elizalde, Buenos Aires, Argentina. Macroscopically, the normal kidney cortex is dissected from the renal medulla and cut into fragments. Cortical fragments are then digested in Hank's solution supplemented with 0.1% collagenase type 1 and filtered through a 70 µm pore size mesh to separate the renal tubules from glomeruli. Renal tubules undergo a second digestion with collagenase to isolate epithelial cells. Finally, the enzyme digestion is stopped, and the epithelial cells are grown in flasks containing RPMI 1640 with supplements under 5% CO2at 37 °C until confluence. HRTEC cells can be grown as monolayers on 96-well plates, glass coverslips into 24-well plates, or cell-culture holders coated with collagen. Also, three-dimensional human renal tubular epithelial cell (3D-HRTEC) cultures are obtained from HRTEC cells seeded on a basement membrane (BM) matrix. Cell aggregation and formation of tubular shape structures are monitored. We have used HRTEC primary cultures for many years to study the cytotoxic action caused by Shiga toxin in the pediatric kidney, which leads to pathophysiological alterations resulting in hemolytic uremic syndrome (HUS). Both HRTEC and 3D-HRTEC cultures can be used to evaluate the effects of different toxins, synthetic drugs, biological factors, hormones, etc, specifically on the human renal proximal tubule epithelium.

Introduction: Meningitis is an infection of the central nervous system, which, in 80% of the cases, occurs in childhood. Due to its association with high morbimortality, it is considered an infectological emergency. The main etiologies are viral and bacterial. The chemical and cytological analysis of cerebrospinal fluid is key to orient the etiological diagnosis and provide proper treatment. There is evidence that serum C-reactive protein could contribute. Objective: To analyze the utility of cerebrospinal fluid parameters and C-reactive protein in the discrimination of viral and bacterial meningitis in pediatric patients. Materials and methods: The study was observational, analytical, cross-sectional and retrospective. Clinical records of children with diagnosis of meningitis with confirmed etiological agent assessed from January 2016 to December 2019 in the General de Niños Pedro de Elizalde Hospital (Buenos Aires, Argentina) were revised. Results: A total of 101 records were included. Total proteins, cell counts and C-reactive protein were significantly higher in patients with bacterial meningitis, whereas glucose was lower. No difference was found in lactate level. In establishing bacterial etiology, serum C-reactive protein level above 34.77 mg/L showed a sensitivity of 100%, a specificity of 92% and a negative predictive value of 100%; for total proteins, a cut-off point of 0.52 g/L showed the best sensitivity, while for glucose a cut-off point of 55 mg/ dL had the highest specificity. Conclusion: Cerebrospinal fluid protein and glucose levels were the best parameters to discriminate between these etiologies. Serum C-reactive protein showed very good performance, although further studies in pediatric patients are needed to establish its utility.

Most children in Argentina received only the initial COVID-19 vaccine series, with presumed hybrid immunity after multiple Omicron waves. However, the durability of immune memory, particularly in immunocompromised (IC) children, remains poorly studied. A cohort of IC (n=45) and healthy children (HC, n=79) was assessed between 13 to 17 months after receiving two or three doses of BBIBP-CorV and/or BNT162b2. Plasma anti-spike IgG, neutralizing activity and antigen-specific CD4+ and CD8+ T cells against Wuhan and Omicron BA.5 variants were assessed. Most children remained seropositive after two vaccine doses, but compared with HC, IC exhibited lower neutralizing titers against both Wuhan and Omicron BA.5, particularly those vaccinated with BBIBP-CorV. Even after three vaccine doses, IC showed weaker neutralizing antibody response, CD8+ T cell responses and lower IFN-γ production compared with HC. Integrated analysis of neutralizing antibodies, memory CD4+, and CD8+ T cells revealed a weak immune memory among IC with an important compromise in memory CD8+ T cell responses. Immunity can last up to 17 months, but reduced effectiveness against new variants highlights the need for updated COVID-19 vaccines, especially for IC children. Additional efforts are essential to enhance vaccination coverage and protect this vulnerable population.

El Síndrome de Bean, o Blue Rubber Bleb Nevus Syndrome (BRBNS), es una enfermedad genética rara caracterizada por la presencia de múltiples lesiones cutáneas y gastrointestinales. Clínicamente, se manifiesta con la aparición de lesiones azuladas o violáceas, denominadas "blebs", que son hemangiomas venosos. Estas lesiones suelen encontrarse en la piel, pero también pueden aparecer en órganos internos, particularmente en el tracto gastrointestinal. El BRBNS se debe a mutaciones en el gen TEK, que codifica el receptor de tirosina quinasa endotelial (Tie2). La disfunción en este gen afecta la regulación del crecimiento y la formación de vasos sanguíneos, lo que conduce a la formación de las características lesiones vasculares. Los pacientes pueden presentar síntomas como dolor abdominal, sangrado gastrointestinal y anemia crónica debido a la pérdida de sangre. El diagnóstico se basa en la evaluación clínica de las lesiones cutáneas, junto con estudios de imagen y endoscopias para identificar lesiones internas. El manejo del BRBNS implica un enfoque multidisciplinario que incluye la intervención dermatológica para las lesiones cutáneas y el tratamiento de las complicaciones gastrointestinales. En casos severos, puede ser necesario realizar cirugía para tratar o prevenir complicaciones relacionadas con las lesiones vasculares internas. Se presenta el caso de un adolescente de 14 años diagnosticado de Síndrome de Bean para poder entender mejor los mecanismos moleculares del síndrome y en desarrollar tratamientos más específicos para mejorar la calidad de vida de los pacientes afectados. El asesoramiento genético es esencial para la gestión de la enfermedad y la orientación a las familias.