Etiology and Risk Factors for Admission to the Pediatric Intensive Care Unit in Children With Encephalitis in a Developing Country.

OBJECTIVE: To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). STUDY DESIGN: Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. RESULTS: Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. CONCLUSIONS: Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.

Association of Cancer Diagnosis and Therapeutic Stage With Mortality in Pediatric Patients With COVID-19, Prospective Multicenter Cohort Study From Latin America.

Background: Children with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population. Methods: This study is a multicenter, prospective cohort study conducted at 12 hospitals from 6 Latin American countries (Argentina, Bolivia, Colombia, Ecuador, Honduras and Peru) from April to November 2021. Patients younger than 14 years of age that had an oncological diagnosis and COVID-19 or multisystemic inflammatory syndrome in children (MIS-C) who were treated in the inpatient setting were included. The primary exposure was the diagnosis and treatment status, and the primary outcome was mortality. We defined "new diagnosis" as patients with no previous diagnosis of cancer, "established diagnosis" as patients with cancer and ongoing treatment and "relapse" as patients with cancer and ongoing treatment that had a prior cancer-free period. A frequentist analysis was performed including a multivariate logistic regression for mortality. Results: Two hundred and ten patients were included in the study; 30 (14%) died during the study period and 67% of patients who died were admitted to critical care. Demographics were similar in survivors and non-survivors. Patients with low weight for age (<-2SD) had higher mortality (28 vs. 3%, p = 0.019). There was statistically significant difference of mortality between patients with new diagnosis (36.7%), established diagnosis (1.4%) and relapse (60%), (p <0.001). Most patients had hematological cancers (69%) and they had higher mortality (18%) compared to solid tumors (6%, p= 0.032). Patients with concomitant bacterial infections had higher mortality (40%, p = 0.001). MIS-C, respiratory distress, cardiovascular symptoms, altered mental status and acute kidney injury on admission were associated with higher mortality. Acidosis, hypoxemia, lymphocytosis, severe neutropenia, anemia and thrombocytopenia on admission were also associated with mortality. A multivariate logistic regression showed risk factors associated with mortality: concomitant bacterial infection OR 3 95%CI (1.1-8.5), respiratory symptoms OR 5.7 95%CI (1.7-19.4), cardiovascular OR 5.2 95%CI (1.2-14.2), new cancer diagnosis OR 12 95%CI (1.3-102) and relapse OR 25 95%CI (2.9-214). Conclusion: Our study shows that pediatric patients with new onset diagnosis of cancer and patients with relapse have higher odds of all-cause mortality in the setting of COVID-19. This information would help develop an early identification of patients with cancer and COVID-19 with higher risk of mortality.

Mal de Pott en un paciente pediátrico / Pott's disease in a pediatric patient

La tuberculosis es una de las enfermedades infecciosas más importantes en el mundo. Las manifestaciones extrapulmonares se presentan en el 10 al 15 % de los pacientes con la enfermedad y el compromiso músculo esquelético en el 1 al 2 %. Hasta la mitad de estos pacientes pueden tener tuberculosis en columna vertebral, también llamada mal de Pott, siendo mas frecuente la afectación de la columna lumbar y los segmentos inferiores de la columna dorsal. Los síntomas más comunes de la enfermedad de Pott son el dolor de espalda progresivo y de larga duración, acompañado de síntomas constitucionales. El tratamiento antituberculoso tetraconjugado ha mostrado unas elevadas tasas de éxito, evitando así la necesidad de cirugía. Se presenta el caso de un paciente pediátrico con enfermedad de Pott, que inició con un cuadro de dolor lumbar crónico, fiebre y síntomas constitucionales; por imágenes diagnósticas se comprobó el compromiso lumbar, fue llevado a cirugía y en la tinción de Zielh Nielsen del líquido obtenido se encontraron bacilos acido alcohol resistentes, además se demostró compromiso pulmonar primario. Debido al subdiagnóstico de tuberculosis en nuestro medio, se realizó este reporte para llamar la atención de la necesidad de una alta sospecha, lograr una detección y tratamiento oportunos, y el consiguiente impacto sobre la morbilidad y complicaciones de esta enfermedad.

Tuberculosis is one of the most important infectious diseases in the world; extrapulmonary manifestations occur in 10 to 15% and skeletal compromise in 1 to 2% of the total cases, up to half of these patients may have tuberculosis of the spine or Pott's disease, being most frequently affecting the lumbar and the lower segments of the spine. The most common symptom is a progressive and long lasting back pain, accompanied by constitutional symptoms. Antituberculous treatment using four drug regimens has shown high rates of success, avoiding the need for surgery. We present the following case of a pediatric patient whit Pott's disease, which began with a chronic lumbar pain, fever and constitutional symptoms, lumbar compromise was confirmed by diagnostic imaging, he was taken to surgery and staining of the fluid was positive for acid fast bacilli, primary pulmonary involvement was also showed. Due to the underestimation of tuberculosis in our country, we present this report to bring our attention to the need of a high index of suspicion in order to have a prompt diagnosis and treatment to avoid long term morbidity of this disease.

Trastornos de la alimentación: Su prevalencia y principales factores de riesgo - estudiantes universitarias de primer y segundo año / Eating disorders: Its prevalence and main risk factors – First and second year university female students

Antecedentes: El 95 por ciento de los trastornos de la alimentación se presenta en mujeres, siendo más frecuente en estudiantes de secundaria y universitarias, Su prevalencia en el mundo es el 0.5 al 1 por cinto para anorexia nerviosa y del 1 al 10 por ciento para bulimia. En Colombia es del 2.3 por ciento y 0.1 por ciento respectivamente, y no se conoce la prevalencia real para el trastorno de alimentación compulsiva. Dentro de la etiología, factores culturales como los medios de comunicación, presión social, estrés académico y otros desordenes mentales como depresión y ansiedad están fuertemente asociados."Objetivo": Calcular la prevalencia de los trastornos de alimentación y estimar su asociación con presión familiar, influencia de los medios de comunicación, estrés académico, depresión y ansiedad. Materiales y métodos: Estudio descriptivo realizado en 196 estudiantes universitarias de primer y segundo año en cuatro programas de pregrado del CES. Se aplicó un cuestionario con preguntas dirigidas a evaluar cada trastorno y factor de riesgo mencionado...