Implementation of Psychosocial Screening into Diabetes Clinics: Experience from the Type 1 Diabetes Exchange Quality Improvement Network.

PURPOSE OF REVIEW: Although advances in diabetes technology and pharmacology have significantly and positively impacted diabetes management and health outcomes for some, diabetes care remains burdensome and can be challenging to balance with other life priorities. The purpose of this article is to review the rationale for assessment of psychosocial domains in diabetes care settings and strategies for the implementation of psychosocial screening into routine practice. Survey data from the Type 1 Diabetes Exchange Quality Improvement Network is highlighted. RECENT FINDINGS: Implementation of psychosocial screening requires identifying the population; selecting validated tools to assess target domains; determining frequency of screening and mode of survey delivery; and scoring, interpreting, documenting, and facilitating referrals such that these processes are part of clinical workflows. Recognizing the influence of psychosocial factors for people with diabetes (PWD), professional society guidelines for comprehensive diabetes care recommend the integration of psychosocial screening into routine care.

Single-Step Protocol for Isolating the Recombinant Extracellular Domain of the Luteinizing Hormone Receptor from the Ovis aries Testis.

The luteinizing hormone receptor (LHR) is a glycoprotein member of the G protein-coupled receptors superfamily. It participates in corpus luteum formation and ovulation in females and acts in testosterone synthesis and spermatogenesis in males. In this study, we extracted RNA from sheep testicles and synthetized the cDNA to amplify the gene lhr-bed. This gene consists of 762 bp and encodes 273 amino acids of the extracellular domain of LHR. The lhr-bed was cloned into pJET1.2/blunt, then subcloned into pCOLD II, and finally, transformed in E. coli BL21 (DE3) cells. Because the induced rLHR-Bed protein was found in the insoluble fraction, we followed a modified purification protocol involving induction at 25 °C, subjection to denaturing conditions, and on-column refolding to increase solubility. We confirmed rLHR-Bed expression by means of Western blot and mass spectrometry analysis. It is currently known that the structure stem-loop 5'UTR on pCOLD II vector is stable at 15 °C. We predicted and obtained RNAfold stability at 25 °C. We successfully obtained the recombinant LHR extracellular domain, with protein yields of 0.2 mg/L, and purity levels of approximately 90%, by means of a single chromatographic purification step. The method described here may be used to obtain large quantities of rLHR-Bed in the future.

The Changing Face of Pediatric Diabetes: How the Pandemic Brought an Epidemic to Light.

Editor's Note: This article is adapted from a speech Dr. Muñoz delivered in June 2021 as President, Health Care & Education of the American Diabetes Association. She delivered her address at the Association's 81st Scientific Sessions, which was held online as a result of the coronavirus disease 2019 pandemic. A webcast of this speech is available for viewing at https://bit.ly/3rk3Esp.

Internal and Maternal Distribution of Persistent Organic Pollutants in Sea Turtle Tissues: A Meta-Analysis.

We aimed to identify patterns in the internal distribution of persistent organic pollutants (POPs) and assess contributing factors using sea turtles and their offspring as a case study of a long-lived wildlife species. We systematically synthesized 40 years of data and developed a lipid database to test whether lipid-normalized POP concentrations are equal among tissues as expected under steady state for lipophilic compounds. Results supported equal partitioning among tissues with high blood flow or perfusion including the heart, kidney, muscle, and lung. Observed differences in the brain, fat, and blood plasma, however, suggest the physiological influence of the blood-brain barrier, limited perfusion, and protein content, respectively. Polybrominated diphenyl ethers partitioned comparably to legacy POPs. Polycyclic aromatic hydrocarbons, meanwhile, partitioned more into the lung, colon, and muscle compared to the liver under chronic and acute field exposure. Partitioning ratios of individual POPs among tissues were significantly related to the lipophilicity of compounds (as estimated by Kow) in half of the observed cases, and significant differences between juveniles and adults underscore physiological differences across life stages. The comprehensive tissue partitioning patterns presented here provide a quantitative basis to support comparative assessments of POP pollution derived from biomonitoring among multiple tissues.

Misdiagnosis and Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: Patient and Caregiver Perspectives.

IN BRIEF Diabetic ketoacidosis (DKA) is a life-threatening complication that frequently occurs at diagnosis of type 1 diabetes, occurs more commonly when a patient is misdiagnosed, is the leading cause of death in children with type 1 diabetes, and is associated with worse long-term outcomes. Our retrospective online survey found that 25% of all participants were misdiagnosed and that misdiagnosis was associated with an 18% increased risk for DKA compared to those correctly diagnosed. Adult providers should consider type 1 diabetes when diagnosing type 2 diabetes, and pediatric providers should rule out type 1 diabetes when a patient reports nonspecific viral symptoms.

A Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Design of Healthy Eating and Lifestyle after Stroke (HEALS).

BACKGROUND: Stroke survivors have high rates of subsequent cardiovascular and recurrent cerebrovascular events, and mortality. While healthy lifestyle practices - including a diet rich in fruits and vegetables, limited alcohol intake, and regular physical activity - can mitigate these outcomes, few stroke survivors adhere to them. Minorities from socioeconomically disadvantaged communities who obtain care in safety-net health systems experience the most barriers to implementing healthy lifestyle changes after stroke. PURPOSE: To report the design of Healthy Eating and Lifestyle After Stroke (HEALS), a randomized controlled trial (RCT) was designed to test the feasibility of using a manualized, lifestyle management intervention in a safety-net setting to improve lifestyle practices among ethnically diverse individuals with stroke or transient ischemic attack (TIA). METHODS: Design: Pilot RCT. PARTICIPANTS: Inclusion criteria: 1) Adults (≥40 years) with ischemic stroke or TIA (≥ 90 days prior); 2) English- or Spanish-speaking. SETTING: Outpatient clinic, safety-net setting. INTERVENTION: Weekly two-hour small group sessions led by an occupational therapist for six weeks. The sessions focused on implementing nutrition, physical activity, and self-management strategies tailored to each participant's goals. MAIN OUTCOME MEASURES: Body mass index, diet, and physical activity. CONCLUSIONS: Recruitment for this study is complete. If the HEALS intervention study is feasible and effective, it will serve as a platform for a large-scale RCT that will investigate the efficacy and cost-effectiveness of life management interventions for racially and ethnically diverse, low-income individuals with a history of stroke or TIA who seek healthcare in the safety-net system.

Isoindoline Derivatives of α-Amino Acids as Cyclooxygenase 1 and 2 Inhibitors.

IC50 values were obtained for two series of isoindolines derived from α-amino acids over cyclooxygenase 1 and 2 (COX-1 and COX-2). In order to explain the biological activity observed, a structure-activity relationship (SAR) model was achieved for the tested compounds and 19 reference compounds with known selective inhibitory activity, through the correlation of the binding energies calculated from rigid docking of the best conformations into the catalytic sites of COX-1 and COX-2, as well as their molecular descriptors: Log P, molecular weight (MW), volume (V), and solvation energy (Esol) versus their experimental IC50 values by MLR and LS-SVM methods. The model probed whether the COX-1 and COX-2 inhibitory activities of the isoindolines correlate with steric, hydrophobic, and thermodynamic parameters. The correlation values with MLR for COX-1 and COX-2 (r(2) = 0.4193 and r(2) = 0.5929) were optimized with LS-SVM until r(2) = 0.6818 for COX-1 and r(2) = 0.8985 for COX-2, resulting in a good predictive ability for COX-1 and -2 inhibition with this model. In conclusion, the data suggests that the physicochemical descriptors evaluated have an impact on the inhibitory activity and selectivity of isoindolines over COX-1 and COX-2.

Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care.

The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.

Development and psychometric evaluation of child acute stress measures in Spanish and English.

Clinicians and researchers need tools for accurate early assessment of children's acute stress reactions and acute stress disorder (ASD). There is a particular need for independently validated Spanish-language measures. The current study reports on 2 measures of child acute stress (a self-report checklist and a semistructured interview), describing the development of the Spanish version of each measure and psychometric evaluation of both the Spanish and English versions. Children between the ages of 8 to 17 years who had experienced a recent traumatic event completed study measures in Spanish (n = 225) or in English (n = 254). Results provide support for reliability (internal consistency of the measures in both languages ranged from .83 to .89; cross-language reliability of the checklist was .93) and for convergent validity (with later PTSD symptoms, and with concurrent anxiety symptoms). Comparing checklist and interview results revealed a strong association between severity scores within the Spanish and English samples. Differences between the checklist and interview in evaluating the presence of ASD appear to be linked to different content coverage for dissociation symptoms. Future studies should further assess the impact of differing assessment modes, content coverage, and the use of these measures in children with diverse types of acute trauma exposure in English- and Spanish-speaking children.

Sea turtle egg yolk and albumen as biomonitoring matrices for maternal burdens of organic pollutants.

To establish the use of eggs as biomonitoring tools for maternal body burdens, we investigated the mother-to-egg ratio of 56 PCB, 12 OCP and 34 PBDE unique compounds from maternal plasma into replicate egg yolk and albumen samples in the loggerhead turtle (Caretta caretta) as a case study of a threatened migratory marine species. We applied robust Regression on Order Statistics to fully account for the information in both censored and uncensored data. Our results added new insights into the use of yolk as a suitable biomonitoring matrix; the difference between yolk and albumen which were previously analysed as a homogeneous mixture; and the value of accounting for censored data. Overall, compound-specific mother-to-egg ratios need to be considered when translating yolk levels back to maternal pollution burdens, and when assessing the risk to the subsequent generations of turtle embryos.

Microplastic distribution among estuarine sedimentary habitats utilized by intertidal crabs.

The high accumulation potential of estuaries for plastics, particularly microplastics, poses a threat to the high societal value and biodiversity they provide. To support a spatially refined evaluation of the risk that microplastic pollution poses to fauna utilizing estuarine sedimentary habitats, we investigated the distribution of microplastics (lower limit of quantification, LOQ = 62 µm) at the sediment surface of two dominant habitats, and subsequently compared microplastic burdens between two crabs species utilizing these habitats. Microplastics were dominated by low density polyolefins (45-50 %), comparable to the polymer composition of macroplastics. The vast majority (99 %) of microplastics were ≤1 mm, and increased exponentially (with an exponent of 2.7) in abundance at smaller sizes, hinting at three-dimensional fragmentation. Our results suggest that the presence of vegetation needs to be accounted for in risk assessments with small microplastics (≥62 µm and ≤1 mm) on average 2.6 times more prevalent within reed beds compared to mudflats. Additionally, sediment properties also play a role with an exponential decrease in small microplastic abundance at coarser sediments, increased organic matter content, and decreased water content. These results suggest that at specific locations, such as the study area, local sources can provide a substantial contribution to microplastic contamination. To translate these habitat- and site-specific differences into a risk assessment relevant for macroinvertebrates, ecological traits such as differences in feeding modes should be accounted for, as we found substantial differences in both size and abundance of microplastics in gastrointestinal tracts of two crab species, Chiromantes dehaani and Chasmagnathus convexus, with different feeding modes.

The ATTAC guiding principles to openly and collaboratively share wildlife ecotoxicology data.

The inability to quantitatively integrate scattered data regarding potential threats posed by the increasing total amount and diversity of chemical substances in our environment limits our ability to understand whether existing regulations and management actions sufficiently protect wildlife. Systematic literature reviews and meta-analyses are great scientific tools to build upon the current push for accessibility under the Open Science and FAIR movements. Despite the potential of such integrative analyses, the emergence of innovative findings in wildlife ecology and ecotoxicology is still too rare relative to the potential that is hidden within the entirety of the available scattered data. To promote the reuse of wildlife ecotoxicology data, we propose the ATTAC workflow which comprises five key steps (Access, Transparency, Transferability, Add-ons, and Conservation sensitivity) along the chain of collecting, homogenizing, and integrating data for subsequent meta-analyses. The ATTAC workflow brings together guidelines supporting both the data prime movers and re-users. As such, the ATTAC workflow could promote an open and collaborative wildlife ecotoxicology able to reach a major objective in this applied field, namely, providing strong scientific support for regulations and management actions to protect and preserve wildlife species.

Reliability of the NACC Telephone-administered Neuropsychological Battery (T-cog) and Montreal Cognitive Assessment for participants in the USC ADRC.

Introduction: Restrictions during the COVID-19 pandemic necessitated remote administration of neuropsychological testing. We assessed the test-retest reliability for a telephone-administered cognitive battery, recommended for use in the National Institute on Aging Alzheimer's Disease Research Center (ADRC). Methods: 64 participants in the University of Southern California ADRC clinical core underwent repeat telephone evaluation using the T-cog Neuropsychological Battery. Reliability was measured by intraclass correlation coefficient (ICC) for continuous variables and weighted Kappa coefficient for categorical variables. Mean scores for Montreal Cognitive Assessment (MoCA) total and Craft Story 21 Immediate and Delayed Recall were compared using paired t tests. Results: Mean age was 74.8 (8.3 standard deviation); 73.4% were female. ICCs ranged from 0.52 to 0.84, indicating moderate test-retest reliability except for number span backward, which showed poor reliability. Weighted Kappa for MoCA items ranged from -0.016 to 0.734; however, relatively good observed agreement was seen across all items (70.3% to 98.4%). Although MoCA total scores did not significantly change, Craft Story 21 Immediate and Delayed Recall mean scores increased between first and second administrations (P < 0.0001). Discussion: Test-retest reliability for the T-cog Neuropsychological Battery is adequate. The variation seen in testing is similar to results seen from face-to-face testing, with Craft Story 21 recall showing modest and expected practice effects. Highlights: Moderate test-retest reliability is seen in most measures of the National Alzheimer's Coordinating Center Neuropsychological Test Battery and the Montreal Cognitive Assessment (MoCA).Intraclass correlation coefficients ranged from 0.52 to 0.84, except for number Span backward.Weighted Kappa for MoCA items varied, but good observed agreement was seen.MoCA total mean score did not change significantly between administrations.Craft Story 21 Immediate and Delayed Recall means increased on repeat testing (P < 0.0001).

Pulmonary embolism in an adolescent with COVID-19 pneumonia.

BACKGROUND: Pulmonary embolism (PE) is a complication reported in the adult population with coronavirus disease 2019 (COVID-19); however, its documentation in the pediatric population is limiteda. CASE REPORT: We report the case of a 15-year-old male with obesity and Down syndrome who was admitted for severe COVID-19 pneumonia. On day 7 of admission, he presented with chest pain, hemoptysis, respiratory distress, and marked elevation of D-dimer. Pulmonary CT angiography found an extensive thrombus in the right lower lobar artery. He received treatment with enoxaparin and rivaroxaban and had a favorable clinical outcome. In the tomographic control 1 month after treatment, thrombus was not evidenced and was successfully resolved. CONCLUSIONS: There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.

INTRODUCCIÓN: El tromboembolismo pulmonar es una complicación reportada en la población adulta con COVID-19; sin embargo, en la población pediátrica, su descripción es limitada. CASO CLÍNICO: Se reporta el caso de un varón de 15 años con antecedente de obesidad y síndrome de Down que fue hospitalizado por neumonía COVID-19 severa. En el séptimo día de hospitalización presentó dolor torácico, hemoptisis, dificultad respiratoria y elevación del dímero D. En la angiotomografía pulmonar se encontró un extenso trombo en la arteria lobar inferior derecha. Recibió tratamiento con enoxaparina y rivaroxabán evolucionando favorablemente. La resolución al mes de tratamiento fue existosa, ya que el control tomográfico no evidenció más el trombo. CONCLUSIONES: El tromboembolismo pulmonar es una complicación poco reportada en niños con neumonía COVID-19. El diagnóstico oportuno y tratamiento anticoagulante es importante para evitar complicaciones mortales.

Sediment grain size determines microplastic exposure landscapes for sandy beach macroinfauna.

Despite the global occurrence of microplastic contamination on sandy beaches, evidence of microplastic distribution within beaches remains contradictory. When conflicting evidence is used to inform sampling surveys, it increases uncertainty in resulting data. Moreover, it hampers spatially explicit risk characterization of microplastic pollution to intertidal fauna. We aimed to guide sampling designs for microplastic monitoring on beaches, and to quantify macroinfauna exposure to microplastics. Microplastic abundance, quantified between 5 mm-66 µm, lacked a significant zonation across the top sediment layer of sub-terrestrial, upper and lower midlittoral, and swash zones at two sites with varying anthropogenic influence on a microtidal dissipative beach in Uruguay. Microplastic abundance decreased exponentially with increasing grain size, as revealed by Bayesian Poisson regression, although the decrease was less steep compared to prior knowledge regarding sediment - plastic interactions obtained for large (millimeter-sized) industrial pellets. Significant differences in microplastic contamination between the two sites with varying anthropogenic influence likely related to their proximity to a freshwater canal. Corresponding field measurements of body burdens of fibers and irregular particles were significantly lower for the polychaete Euzonus (Thoracophelia) furcifera, despite its preference for finer sediments with higher microplastic loads, compared to the isopods Excirolana braziliensis and Excirolana armata. Results provide critical insights toward representative sampling of microplastics within beach sites. Specifically, we caution against sampling limited to the drift line, and instead recommend: 1) reporting beach morphodynamic characteristics; 2) using clearly defined, ecologically-informed zonation schemes; and 3) accounting for sediment grain size as a covariate to normalize among reported contamination levels. The results contribute valuable baseline data toward realistic exposure landscapes relative to the sediment grain size preferences of macroinfauna, needed to inform laboratory experiments.

Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial.

Importance: Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. Objective: To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). Design, Setting, and Participants: This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. Interventions: Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. Main Outcomes and Measures: The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. Results: Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. Conclusions and Relevance: This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. Trial Registration: ClinicalTrials.gov Identifier: NCT01763203.

Maternal Transfer of Persistent Organic Pollutants to Sea Turtle Eggs: A Meta-Analysis Addressing Knowledge and Data Gaps Toward an Improved Synthesis of Research Outputs.

Maternal transfer of persistent organic pollutants (POPs) confronts developing embryos with a pollution legacy and poses conservation concerns due to its potential impacts unto subsequent generations. We conducted a systematic review focusing on: 1) processes of POP maternal transfer, 2) challenges and opportunities to synthesizing current knowledge on POP concentrations in eggs, and 3) a meta-analysis of patterns in current egg pollution data. Results suggest selective maternal transfer of individual compounds. These relate to biological factors such as the foraging and remigration behavior, and to the selective mobilization of POPs during vitellogenesis, such as increased diffusion limitation for lipophilic POPs and slower release and higher reabsorption of apolar POPs. A key gap relates to knowledge of further selective toxicokinetics during embryonic development, as research to date has mainly focused on initial uptake into eggs. Challenges in the synthesis of current data on egg contamination profiles relate to methodological differences, varying analytical approaches, restricted data access, and reporting transparency among studies. To increase opportunities in the use of current data, we propose best practice guidelines, and synthesize a database on POP concentrations within sea turtle eggs. The meta-analysis revealed a geographical and taxonomic bias on the West Atlantic Ocean, including the Gulf of Mexico and Caribbean Sea, with most studies conducted on green turtles. Concentrations of POPs show temporal patterns related to trends in usage, production, release, and persistence in the environment, often with regional patterns. The trophic level has the potential to influence POP patterns with higher concentrations in loggerheads compared to other species, but this is confounded by temporal and geographic trends. We argue for more mechanistically process-focused and methodologically comparable research. Environ Toxicol Chem 2019;39:9-29. © 2019 SETAC.

[Clinical, laboratory and radiological characteristics of pediatric patients hospitalized with COVID-19: case series]. / Características clínicas, de laboratorio y radiológicas de pacientes pediátricos hospitalizados con COVID-19: serie de casos.

Children represent 1 to 5% of the entire SARS-CoV-2 infected population, and it is challenging to identify them based on clinical characteristics. We present 5 cases of pediatric patients diagnosed with COVID-19; the age range was from 1 to 14 years. They had different clinical characteristics, three of them presented fever, cough and respiratory distress, another one fever and dermatosis, and the other patient had diarrhea and vomiting associated with Guillain-Barre syndrome. Laboratory tests revealed elevated lactate dehydrogenase, D-dimer, and ferritin. The most frequent radiological pattern was perihilar peribronchial thickening. All cases had favorable clinical and radiological evolution. Diverse clinical characteristics should be considered for early diagnosis of COVID-19 in children.

De toda la población infectada por el SARS-CoV-2, la población pediátrica representa del 1 al 5%, siendo un reto caracterizarla clínicamente. Presentamos cinco casos de pacientes pediátricos con diagnóstico de COVID-19; el rango de edad fue de 1 a 14 años, tuvieron manifestaciones clínicas variadas, tres de ellos presentaron fiebre, tos y dificultad respiratoria, otro fiebre y dermatosis, y un adolescente con diarrea y vómitos asociado al síndrome de Guillain-Barré. Los exámenes de laboratorio revelaron elevación de lactato deshidrogenasa, dimero-D y ferritina. El patrón radiológico más frecuente fue el engrosamiento peribronquial perihiliar. Todos los casos tuvieron evolución clínica y radiológica favorable. La diversidad en las presentaciones clínicas en niños debe considerarse para un diagnóstico temprano de la enfermedad.

[COVID-19-associated multisystem inflammatory syndrome in children: case series at a pediatric hospital in Peru]. / Síndrome inflamatorio multisistémico asociado a COVID-19 en niños: serie de casos en un hospital pediátrico de Perú.

During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.