Splenic rupture aSSociated with thrombocytopenic purpura cauSed by infectiouS mononucleoSiS. caSe report palabras clave: Infección; Virus de Epstein-Barr; Púrpura; Rotura de bazo.Keywords: Infection; Epstein-Barr virus; Purpura; Spleen Rupture. Case presentation. Female 12-year-old patient presenting with diffuse abdominal pain, distension, nausea, tegument pallor and unquantified fever for two days. Upon admission to the emergency department, hemodynamic decompensation, purpuric lesions and ecchymosis in the limbs were observed. Laboratory and cabinet studies were carried out to confirm anemia, thrombocytopenia and splenic hematoma. Finally, an exploratory laparotomy was performed considering the possibility of hemoperitoneum.Results. The patient presented with splenomegaly, broken subcapsular hematoma, bleeding of 4000mL and accessory spleen lobe with splenic rupture. Conclusions.Spontaneous splenic rupture is a rare but possible complication of infectious diseases. However, its association with thrombocytopenic purpura is extremely rare. RESUMENIntroducción. La rotura esplénica asociada a la presencia de purpura trombocitopénica causada por mononucleosis infecciosa es extremadamente rara; la evolución de los pacientes con mononucleosis infecciosa asociada al virus de Epstein-Barr es benigna y autolimitada y no requiere intervenciones terapéuticas específicas. El cuadro es bien tolerado y tiene una baja frecuencia de complicaciones.Presentación del caso. Paciente femenino de 12 años de edad con dos días de evolución de dolor abdominal difuso, distensión, náuseas, palidez de tegumentos y fiebre no cuantificada, quien a su ingreso al servicio de urgencias muestra datos de descompensación hemodinámica, lesiones purpúricas y manchas equimoticas en extremidades. Se realizan estudios de laboratorio y gabinete que confirman anemia, trombocitopenia y hematoma esplénico, por lo que se practica laparotomía exploradora ante la posibilidad de hemoperitoneo.Resultados. La paciente presenta esplenomegalia, hematoma subcapsular roto con sangrado de 4000mL y lóbulo accesorio de bazo con rotura esplénica.Conclusiones. La rotura espontánea del bazo es una complicación infrecuente pero posible en enfermedades infecciosas; sin embargo, su asociación a purpura trombocitopenica es extremadamente rara.

Introduction:The psychomotor development evaluation (DSM) is an essential component in health supervision mainly in children under 5 years. The objective of this study is to favor the investigation of retardation in psychomotor development and allow that it is possible to intervene early and in a timely manner. Patients and methods: A descriptive, prospective, cross-sectional, observational study was carried out in the outpatient clinic of the family medicine unit Number 66 of the Mexican Social Security Institute, Xalapa Veracruz. During a year in the right-wing population of children from 1 month to 59 months of age, patients with neurological disease were excluded, a sample of 388 children was obtained and evaluated with the Child Development Assessment (EDI) test in three ABC groups. Results in group A from 1 to 2 months and group B from 2 to 11 months of age, no delay in psychomotor development was found, in group C from 12 to 59 months 4 children had developmental delay being 1.3% of the population studied, presenting alterations in the fine motor area with 0.3%, the language area 1.5% and the social area 1.5% being this group the most representative. Conclusions: the EDI test was shown to be useful for the detection of psychomotor development delay in children under 5 years of age, mainly with a history of prematurity and low birth weight.

Objective: IE is a rare diagnosis in children, although its incidence is increasing, with figures of 0.34 to 0.64 cases per 100,000 inhabitants / year. The NVE has a bimodal distribution with peaks in childhood at 12 to 16 years of age. We present the case of a 14-yearold male with no history of congenital heart disease, respiratory infections, or catheter placement, a course with urinary tract infection treated with cephalosporin, and a month later he developed infectious endocarditis with a double complicated aortic valvular lesion that merited urgent surgical intervention. Conclusion:Infective endocarditis is rare in children. The presence of persistent fever, heart murmur without structural lesion and antecedent infection should be ruled out.

Introduction: Constipation is a common problem and is one of the main causes of consultation in the pediatric age, and the problems are indicated in the diagnosis, in the treatment, or in both. Its estimated prevalence varies between 0.3% and 8% of the child population. There is a case of male 1 month and 18 days of extra uterine life that are caused by the excessive use of laxatives of osmotic type associated with the use of stimulant laxatives in prolonged form and at high doses at a weight level, their clinical evolution and the secondary to this use. Conclusion: The use of laxatives from birth without having an adequate diagnosis of the cause of constipation, means that its use is indiscriminately causing alterations at the gastrointestinal level such as electrolyte imbalance and hypovolemic shock that can evolve to death if not timely manner.