Characterization and prognostic factors of children with sepsis in a high complexity hospital. / Caracterización y factores pronósticos de niños con sepsis en un hospital de alta complejidad.

OBJECTIVE: To describe the clinical and laboratory characteristics of patients with sepsis admitted to a high-complexity healthcare center in Latin America. PATIENTS AND METHOD: Descriptive observational study. Patients between one month to 17 years of age with sepsis diagnosis were included. Studied variables included demographics, clinical and laboratory characteristics, and treatment administered, determining predictors of mortality. A descriptive analysis was performed using the Chi-square or Fisher test. RESULTS: 186 patients were included and 72% of them had comorbidities. Respiratory disease was the most frequent source of sepsis (29%), followed by gastrointestinal infection (11%) and catheter-related bacteremia (11%). 60% of patients had at least one organ dysfunction, the most frequent being respiratory dysfunction (70%). 60% of the patients presented multiple organ dysfunction syndrome (MODS). Blood cultures showed a positive result in 37% of cases. The two most common first-hour interventions included IV resuscitation fluids (67%) and antibiotics (36%). Vasopressor support and mechanical ventilation were used in 33% and 34% of patients, respectively. Overall mortality was 12% and was higher in patients diagnosed with MODS (59%) or who presented with some organ dysfunction. CONCLUSION: Organ dysfunction was frequent. Patients with some type of organ dysfunction or MODS presented higher mortality. Despite global and institutional guidelines focused on improving diagnosis and treatment, in less than half of the patients sepsis was adequately detected and first-hour IV fluids and antibiotics administration rates were below 70%.

The COVID-19 Pandemic and Dental Professionals' Infection Risk Perception: An International Survey.

A global survey among dentists was used to identify the various impacts of the COVID-19 pandemic on this professional group. Special attention was given to perception and assessment of infection risk. From May to August 2020, the questionnaire was delivered in 36 countries by respective research groups and was completed by 52,491 dental professionals. The survey was designed as a cross-sectional survey based on a previously standardized questionnaire. This study focuses on the part of the questionnaire that deals with the perception of the infection risk of COVID-19 by dentists and their patients. A logistic regression model was used, which consisted of four Likert items as response options and the additional self-reported routine or emergency treatment as the dependent variable. Analysis by continent found that European and Asian dentists were particularly likely to be infected at work (OR = 1.45 95%CI = 1.02/1.84 and OR = 2.68, 95%CI = 1.45/3.22, respectively), while it was likely that Australian dentists did not feel particularly at risk due to low infection rates. Three quarters of Americans treated only emergencies during this survey period, while Europeans (64.71%) and Asians (66.67%) provided mostly routine care. This could affect the Europeans' confidence that they would not be able to protect themselves from infections in the long-term. The COVID-19 pandemic and its impact on dental professionals' infection risk perception is determined by the geographical origin of dentists. This study shows that, especially in high-incidence countries, infection risk perception was higher when dentists tried to provide routine dental procedures to their patients. Dental professionals can offer themselves and their patients good protection by maintaining high standards of hygiene. However, their concerns should be taken seriously and the dental professionals' group that is of great importance for oral health care and prevention, should not be neglected in the future, even in the event of emerging pandemics.

Pediatric Dentists' Service Provisions in South-East Europe during the First Wave of COVID-19 Epidemic: Lessons Learned about Preventive Measures and Personal Protective Equipment Use.

INTRODUCTION: Having in mind the importance of providing continuous pediatric dental services during the COVID-19 pandemic and the fact that children have similar viral loads to adults, the potential to spread the virus to others, and with variable clinical presentation of COVID-19 infection, this study aimed to analyze the impact of COVID-19 outbreak on pediatric dentistry service provision, risks, and preventive measures before and during dental treatment. METHOD: Structured and closed epidemiological cross-sectional survey involved seven Southeastern European countries. The questionnaire was developed using the modified Delphi method, pretested, and tested in North Italy during April 2020. The sample consisted of licensed dental professionals reached via national dental chambers and social media using the best strategies according to the national setting. RESULTS: A total of 3227 dentists participated in the survey, and we included 643 specialists in this study-among them, 164 were pediatric dentists. Most pediatric dentists worked in the public sector (61.0%) and provided emergency (64.6%) and routine dental treatment (18.3%) during the outbreak. One-third of pediatric dentists were COVID-19 tested, statistically significantly more than other specialties, and 3.0% tested COVID-19 positive. In addition, significantly more pediatric dentists (13.4%) reported the presence of at least one symptom related to COVID-19 compared to other specialists (6.1%). None of the pediatric dentists reported PPE shortage. However, 26.2% of all specialists stated that they lacked clear step by step professional guidance in a national language. Similarly, in both groups, around 10% of specialists attended education on coronavirus. CONCLUSIONS: Considering that most pediatric dentists provided dental treatment during lockdown in their countries in public health centers and that they will continue to work during pandemic, our results suggest that pediatric dentists might be at higher risk of COVID-19 infection. Further research should focus on finding better ways to promote and adapt preventive, protective measures and PPE in the pediatric dental setting to be behaviorally acceptable. Moreover, additional efforts should be invested in dental education regarding COVID-19 in the mother tongue.

Study Protocol for an Online Questionnaire Survey on Symptoms/Signs, Protective Measures, Level of Awareness and Perception Regarding COVID-19 Outbreak among Dentists. A Global Survey.

The Centres for Disease Control and Prevention and the World Health Organization have developed preparedness and prevention checklists for healthcare professionals regarding the containment of COVID-19. The aim of the present protocol is to evaluate the impact of the COVID-19 outbreak among dentists in different countries where various prevalence of the epidemic has been reported. Several research groups around the world were contacted by the central management team. The online anonymous survey will be conducted on a convenience sample of dentists working both in national health systems and in private or public clinics. In each country/area, a high (~5-20%) proportion of dentists working there will be invited to participate. The questionnaire, developed and standardized previously in Italy, has four domains: (1) personal data; (2) symptoms/signs relative to COVID-19; (3) working conditions and PPE (personal protective equipment) adopted after the infection's outbreak; (4) knowledge and self-perceived risk of infection. The methodology of this international survey will include translation, pilot testing, and semantic adjustment of the questionnaire. The data will be entered on an Excel spreadsheet and quality checked. Completely anonymous data analyses will be performed by the central management team. This survey will give an insight into the dental profession during COVID-19 pandemic globally.

Varicela visceral en paciente pediátrico, reporte de un caso clínico / Visceral varicella in pediatric patients, clinical case report

Se presenta el caso de un paciente pediátrico de 10 años, inmunosuprimido con corticosteroides y metotrexato por enfermedad reumatológica de base, que presentó varicela visceral con manifestaciones atípicas tales como compromiso pulmonar, hepático y alteraciones hematológicas. Inicialmente, no tuvo manifestaciones cutáneas, las cuales desarrolló a los ocho días de evolución, por lo cual requirió apoyo en la unidad de cuidados intensivos pediátricos y manejo multidisciplinario. La varicela es una enfermedad exantemática frecuente, considerada benigna con presentación leve y de resolución espontánea, en pacientes sin compromiso inmunitario. Por el contrario, la infección por este virus en pacientes inmunosuprimidos es una entidad que amenaza potencialmente la vida, principalmente cuando se presenta con compromiso visceral. Se debe considerar la posibilidad de infección por el virus varicela zóster en pacientes con disfunción hepática inexplicable asociada a dolor abdominal o lumbar, bajo condiciones de inmunosupresión, aun en ausencia de exposición viral o compromiso en piel; tanto la complicación hepática como la de los otros sistemas se han relacionado con alta morbimortalidad. Un alto índice de sospecha de varicela grave en el paciente inmunosuprimido, es importante para el diagnóstico y manejo oportuno.

We report the case of a 10 years old pediatric patient immunosuppressed with steroids and methotrexate for rheumatological disease who presents atypical varicella with visceral involvement such as lung, liver and blood disorders, without skin manifestations initially which development to the 8-day, requiring support in pediatric intensive care unit and multidisciplinary management. Chickenpox is a common rash illness, considered benign with a mild and limited in immunocompetent patients. By contrast, infection with this virus in immunosuppressed patients is an entity that potentially life threatening, especially when presented with visceral involvement. Infection with varicella-zoster virus should be considered in patients with unexplained liver dysfunction associated with abdominal or back pain under conditions of immunosuppression, even in the absence of viral exposure or skin compromise, The hepatic involvement as both of the other systems has been associated with high morbidity and mortality. A high index of suspicion of severe varicella in immunosuppressed patients is important for diagnosis and timely management.

La evolución / Evolution

A manera de introducción citaremos un fragmento del libro del físico químico Peter Atkins de Oxford, con su interesante libro la creación, en el cual dice: Llevaré tu mente a un viaje. Es un viaje de entendimiento, que nos llevará al borde del espacio, el tiempo y la comprensión. Durante el mismo discutiré que no hay nada que no pueda ser comprendido, que no hay nada que no pueda ser explicado y que todas las cosas son extraordinariamente simples... Una gran parte del universo no necesita ninguna explicación. Por ejemplo, los elefantes. Una vez que las moléculas han aprendido a competir y a crear otras moléculas a su propia imagen, los elefantes y las cosas que son como los elefantes se encontrarán, a su debido tiempo, vagando por los campos. En este trabajo trataremos, un tema muy complejo y de por si muy extenso, abarcarlo todo en tan solo unas páginas es más que imposible. La evolución es un tema muy discutido, son muchas las corrientes que surgen a su alrededor alternativas, científicas, e incluso la religión está relacionada con este tema. El hombre siempre ha querido conocer sus orígenes, dando hipótesis, teorías, religiones, dogmas, mitos y leyendas. Pero la discusión está latente y seguirá así por muchos años. Quiénes somos y de dónde venimos? Una incógnita universal que siempre estará en las mentes de los hombres...