Publications by authors named "Martha Aviles-Robles"

Chikungunya virus (CHIKV), a mosquito-borne alphavirus, has emerged as a significant global health concern, particularly due to its neurological complications in pediatric populations. This scope review summarizes current understanding of CHIKV virology, epidemiology, transmission dynamics, and clinical manifestations, with an emphasis on neurologic sequelae in neonates and children. We explore the mechanisms of neuroinvasion, describe central and peripheral nervous system involvement, and outline diagnostic strategies and therapeutic approaches.

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Background: The introduction of pneumococcal conjugate vaccines (PCVs) since 2000 has altered the epidemiology of invasive (IPD) and non-invasive pneumococcal diseases (NIPD). This study aims to analyze trends in pneumococcal serotype distribution among children in Mexico, focusing on the period following the introduction of PCV13, and assess the potential impact of future vaccines.

Material And Methods: Pneumococcal isolates were collected from hospitalized children in participating hospitals from January 2012 to December 2023.

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Background: Respiratory syncytial virus (RSV) is a common cause of respiratory illness in children and adults in Latin America and Mexico. RSV circulates with seasonal peaks in fall and winter. Individuals at highest risk for severe infection are premature infants and those with comorbidities, as well as older adults with cardiopulmonary pathologies and/or varying degrees of immunocompromise.

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Of 319 children with invasive candidiasis, 67 (21%) transitioned from intravenous to enteral antifungal therapy. Eight (12%) transitioned back to intravenous antifungal therapy, one due to perceived treatment failure defined by clinical progression or worsening. Global treatment response at study completion was successful in 66 participants who transitioned to enteral therapy.

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  • Outpatient management of febrile neutropenia (FN) in pediatric cancer patients has shown to be as safe and effective as inpatient care, prompting this cost-minimization analysis (CMA) in Mexico.
  • The study analyzed data from 117 FN episodes, finding that outpatient management resulted in an average savings of $1,087 per episode, equating to a 92% reduction in total costs compared to inpatient treatment.
  • The findings suggest that outpatient care is more cost-effective, supporting its implementation in the Mexican public health care system for managing FN in children with cancer.
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  • Central line-associated bloodstream infections (CLABSIs) are significant healthcare-related infections, and the aseptic non-touch technique (ANTT) is used to prevent them.
  • After training nurses in ANTT and completing 6 PDSA cycles, adherence to the technique reached 95%, while hand hygiene and cleaning standards were perfect, although port disinfection and material collection had lower adherence rates.
  • The CLABSI rate significantly decreased from 5.7 to 1.26 per 1000 catheter days, highlighting that proper training and ongoing monitoring are essential for sustaining ANTT adherence.
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Introduction: Despite the end of the COVID-19 pandemic being declared by the WHO, the economic consequences are far from over. One of these implications was the cost of inpatient care for health institutions. To date, some studies have examined the economic burden of COVID-19 in the adult population but only a few have focused on child populations.

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Background: Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown.

Methods: Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017.

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Introduction: Acute leukemia accounts for more than 30% of all pediatric cancer cases, and of these, 15-20% are acute myeloid leukemia (AML). Children who super from AML are more likely to develop infections due to the humoral and cellular immune deficits generated by the disease and its treatment. The incidence of fungal infections is underestimated; reports show that up to 75% of fungal infections go undiagnosed until autopsy.

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Background: Febrile neutropenia (FN) is an early indicator of infection in oncology patients post-chemotherapy. We aimed to determine clinical predictors of septic shock and/or bacteremia in pediatric cancer patients experiencing FN and to create a model that classifies patients as low-risk for these outcomes.

Methods: This is a retrospective analysis with clinical data of a cohort of pediatric oncology patients admitted during July 2015 to September 2017 with FN.

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Background: Invasive candidiasis is the most common invasive fungal disease in children and adolescents, but there are limited pediatric-specific antifungal effectiveness data. We compared the effectiveness of echinocandins to triazoles or amphotericin B formulations (triazole/amphotericin B) as initial directed therapy for invasive candidiasis.

Methods: This multinational observational cohort study enrolled patients aged >120 days and <18 years with proven invasive candidiasis from January 1, 2014, to November 28, 2017, at 43 International Pediatric Fungal Network sites.

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Respiratory viruses are among the leading causes of disease and death among children. Co-circulation of influenza and SARS-CoV2 can lead to diagnostic and management difficulties given the similarities in the clinical picture. This is a cohort of all children hospitalized with SARS-CoV2 infection from March to September 3rd 2020, and all children admitted with influenza throughout five flu-seasons (2013-2018) at a pediatric referral hospital.

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Article Synopsis
  • Viral respiratory infections significantly affect pediatric patients who have undergone hematopoietic stem cell transplantation (HSCT), leading to increased morbidity and mortality rates.
  • A study conducted from 2017 to 2019 found that over half of 54 HSCT patients had viral airway infections, with the most common viruses being influenza, human rhinovirus, and respiratory syncytial virus.
  • The findings highlight the need for preventive strategies and timely treatment to manage these infections, which resulted in complications like supplemental oxygen use, mechanical ventilation, ICU admissions, and mortality in some cases.*
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Background: It has been suggested that low-risk febrile neutropenia (FN) episodes can be treated in a step-down manner in the outpatient setting. This recommendation has been limited to implementation in middle-income countries due to concerns about infrastructure and lack of trained personnel. We aimed to determine whether early step-down to oral antimicrobial outpatient treatment is not inferior in safety and efficacy to inpatient intravenous treatment in children with low-risk FN.

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A case of disseminated infection caused by Penicillium chrysogenum in a 10-year-old boy with a history of Henoch-Schönlein purpura and proliferative glomerulonephritis, treated with immunosuppressors, is reported herein. The patient had a clinical picture of 2 weeks of fever that did not respond to treatment with broad-spectrum antibiotics and amphotericin B. Computed tomography imaging showed diffuse cotton-like infiltrates in the lungs, hepatomegaly, mesenteric lymphadenopathy, and multiple well-defined round hypodense lesions in the spleen.

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Article Synopsis
  • The study aimed to estimate the prevalence of malnourishment among pediatric cancer patients undergoing chemotherapy in Mexico City and its impact on hospital stay duration.
  • The research found that 14% of the patients were malnourished, which is significantly higher than the global average, and that malnourished patients had a median hospital stay of 15 days, 50% longer than those who were not malnourished.
  • The authors suggest that future research should focus on interventions to address malnourishment in this population, with the goal of reducing hospital stays and related complications.
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Unlabelled: Limited evidence is available about varicella-zoster virus (VZV) infection among pediatric cancer patients in developing countries, which raises questions about the generalizability of VZV vaccine recommendations for pediatric cancer patients (derived from developed countries) to these settings. We assessed the incidence and case-fatality of VZV infection at three institutions in developing countries (Argentina, Mexico, and Nicaragua). Individuals eligible for our study were aged <20 years and actively receiving cancer-directed therapy.

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We assessed the association between bloodstream infections (BSIs) and inpatient length of stay among pediatric cancer patients with febrile neutropenia in Mexico City. The estimated length of stay for BSIs was 19 days, which corresponded with a 100% (95% confidence limits, 60%-160%) relative increase in the length of stay compared with patients for whom no pathogen was identified. Feasible options for reducing the length of stay should be considered to alleviate patient and resource burden.

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