Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study).

BACKGROUND: The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. METHODS: An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. RESULTS: There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). CONCLUSIONS: Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.

Lemierre's Syndrome Caused by Streptococcus anginosus Presenting as Postseptal Cellulitis in a Pediatric Patient.

Lemierre's syndrome is an infrequent disease characterized by septic thrombosis of the internal jugular vein followed by pulmonary embolism generally occurring after upper respiratory and gastrointestinal tract infections. We present the case of a 15-year-old female patient with postseptal cellulitis and cervical abscess who developed pulmonary embolism and pleural effusion secondary to internal jugular vein thrombosis. Cultures were positive for Streptococcus anginosus, antibiotic treatment was established with satisfactory clinical outcome. High clinical suspicion is required for a diagnosis. The mainstay of treatment is a multidisciplinary approach based on two essential pillars: antibiotic therapy and surgical drainage. This is an important case because of the unusual presentation, the isolation of an infrequent pathogen, and the primary infection site (postseptal cellulitis), which are rare characteristics of this condition in the pediatric population.

Bronquiolitis: factores de riesgo en menores de dos años. Hospital de San José de Bogotá DC, Colombia 2013 - 2014 / Bronchiolitis: risk factors in children under two years of age. Hospital de san José de Bogotá DC, Colombia 2013 - 2014

Determinar los factores de riesgo de bronquiolitis en menores de dos años que consultaron al servicio de urgencias del Hospital de San José de Bogotá DC entre 2013 y 2014. Materiales y métodos: estudio de tipo transversal mediante entrevistas a los acompañantes y análisis de las historias clínicas. Se registró la frecuencia de consultas en menores de dos años. Resultados: se reclutaron 127 pacientes con prevalencia de 2.8%. La mediana de edad fue 4 meses (RI 2-8 meses), en su mayoría hombres n: 74 (58.27%), los factores de riesgo fueron bajo peso al nacer n: 26 (20.47%), virus sincicial respiratorio (VSR) positivo n: 24 (18.9%) y prematuridad n: 20 (17.54%). Escolaridad de la madre (secundaria) n: 76 (59.84%), el 73.8% provenían de hogares de estrato bajo (1-2) factor frecuente en nuestra población, hermanos escolarizados n: 82 (64.57%) y exposición a humo de tabaco n: 22 (17.32%). Los meses de mayor consulta fueron marzo n: 34 (26.77%), abril n: 27 (21.26%) y julio n: 27 (21.26%). La mediana de estancia hospitalaria fue cinco días (RI 3 - 7 días). Conclusiones: la etiología más frecuente fue el VSR; el palivizumab se utilizó en 7.09% de los pacientes. La prevención se basará en interrumpir la transmisión con técnicas de lavado y reducción de factores de riesgo ambientales, mientras se logra el desarrollo de la vacuna...

To determine the risk factors associated to bronchiolitis in infants less than two years of age who consulted to the emergency ward at Hospital de San José, Bogotá DC between 2013 and 2014. Materials and Methods: a crosssectional study conducted by interviewing relatives and by clinical record analysis. The frequency of consultation of children less than two years of age was recorded. Results: 127 patients were recruited, prevalence 2.8%. Mean age was 4 months (IR 2 - 8 months), mostly males n: 74 (58.27%), risk factors were, low weight at birth n: 26 (20.47%), taquippositive respiratory syncytial virus (RSV) n: 24 (18.9%) and prematurity n: 20 (17.54%). Mother´s level of education (high school graduates) n: 76 (59.84%), lower socioeconomic class (1 - 2) 73.8%, a common factor in our population, siblings who attend school n: 82 (64.57%) and exposure to tobacco smoke n: 22 (17.32%). The highest frequency of consultation occurred during March n: 34 (26.77%), April n: 27 (21.26%) and July n: 27 (21.26%). The median hospital stay was five days (IR 3 - 7 days). Conclusions: RSV was the primary cause; 7.09% of patients received palivizumab. Prevention will be based on interrupting transmission through cleaning techniques and reducing environmental risk factors while a vaccine is developed...

Enfoque diagnóstico de la hematuria en pediatría / Diagnostic approach to a child with hematuria

La hematuria es un hallazgo clínico observado por el paciente o un familiar cuando es macroscópica o bien incidental en un parcial de orina rutinario. La prevalencia es baja pero el enfoque diagnóstico al cual está enfrentado el clínico es amplio. La hematuria indica enfermedad, lesión o malformación del tracto urinario, por ello el médico general y el pediatra deben estar en capacidad de determinar a tiempo algunas de las causas con pronóstico grave o diagnóstico complejo que requieren la remisión al nefrólogo pediatra. Se hace énfasis en diferenciar si es o no de origen glomerular, adoptando un algoritmo de enfoque diagnóstico que orienta al clínico. Se realizó una búsqueda limitada de 2001-2014 en las principales bases de datos en inglés y español encontrando revisiones de la literatura, consensos de expertos y guías de práctica clínica basadas en la opinión de pediatras, nefrólogos y urólogos pediatras, así como de radiólogos que ofrecen una aproximación real a la imagenología. Está dirigida a personal de la salud, médicos generales y pediatras quienes enfrentan a diario esta condición clínica.

Hematuria is a clinical finding observed by the patient or a relative if it is macroscopic, or is an incidental finding in a routine urinalysis. Prevalence rate is low but the range of differential diagnoses faced by the physician is broad. Hematuria indicates disease, lesion or malformation of the urinary tract, thus the general practitioner and the pediatrician must be capable to determine the etiologies that have a poor prognosis or are difficult to diagnose which require prompt referral to a pediatric nephrologist. We emphasize on the development of a diagnostic algorithm to help the physician distinguish glomerular from non-glomerular hematuria. A limited search from 2001-2014 was conducted in the major data bases in English and Spanish finding literature reviews, expert consensus and clinical practice guidelines based on the opinion of pediatricians, and pediatric nephrologists and urologists, as well as radiologists who offer a real approach to imaging. It is oriented toward health care providers, general practitioners and pediatricians who face this clinical condition in their daily practice...