Caracterización clínico-epidemiológica del virus chikungunya en pacientes pediátricos de un Hospital Regional de Paraguay, 2023 / Clinical-epidemiological characterization of Chikungunya fever in pediatric patients of a Regional Hospital of Paraguay, 2023

Introducción: El virus chikungunya (CHIKV), es un alfavirus con genoma de ARN monocatenario, perteneciente a la familia Togaviridae, transmitido a través de la picadura de mosquitos del género Aedes sp., caracterizada por fiebre y dolores articulares incapacitantes. Objetivo: Determinar las características clínicas y epidemiológicas del virus chikungunya en pacientes pediátricos que acudieron a un Hospital Regional de Paraguay entre enero y junio del 2023. Material y Métodos: Estudio cuantitativo, observacional, descriptivo de corte transversal. Se incluyeron en el estudio todos los pacientes que presenten variables de interés; sexo, edad, procedencia, hallazgos clínicos y síntomas atípicos. Resultados: Se ha realizado la revisión de 465 fichas clínicas de pacientes con cuadro confirmado de chikungunya. La edad mínima de los pacientes fue de 4 días y la máxima de 17 años, la mitad de los pacientes estuvieron ubicados entre 1 y 10 años de edad. El 62,6% tuvo una presentación típica del cuadro de infección por chikungunya, el 37,4% tuvo una forma de presentación atípica. El 4,3% presentó complicaciones entre las que se citan encefalitis-meningoencefalitis y miocarditis. El 10,8% tuvo desenlace fatal, obitó. Conclusión: En cuanto a los datos demográficos, hubo predominio del sexo masculino y procedencia urbana. En cuanto a la presentación clínica, se reportaron formas típicas con fiebre, polialtralgias y mialgias. Las formas atípicas se presentaron con alteración del sistema cardiovascular, discrasia sanguínea y neumonías asociadas. Los casos que se consideraron complicados representan el 4,3% de la muestra y fue del 10,8% la mortalidad.

Introduction: Chikungunya virus (CHIKV) is an alphavirus with a single-stranded RNA genome belonging to the Togaviridae family. It is transmitted through the bite of mosquitoes of the Aedes sp. genus and is characterized by fever and disabling joint pain. Objetive: Determine the clinical and epidemiological characteristics of the chikungunya virus in pediatric patients who attended a Regional Hospital in Paraguay between January and June 2023. Materials and method: Quantitative, observational, descriptive cross-sectional study. All patients with variables of interest were included in the study; sex, age, origin, clinical findings and atypical symptoms. Results: A total of 465 clinical records of patients with confirmed chikungunya were reviewed. The minimum age of the patients was four days, and the maximum was 17 years; half of the patients were between 1 and 10 years of age. Male predominance in 52.7%, patients from urban areas in 72.5%. 62.6% had a typical presentation of chikungunya infection, and 37.4% had an atypical presentation. Fever, polyarthralgia, myalgia, headache, vomiting, and nausea predominated in the usual manner. In the atypical form, alterations of the cardiovascular system, bleeding dyscrasias, and pneumonia, among others, predominate. 4.3% presented complications, including encephalitis-meningoencephalitis and myocarditis. There was a death rate of 10.8%. Conclusion: Male sex predominated, coming from urban areas with typical presentation of chikungunya, with predominant symptoms of fever, polyarthralgia, and myalgia. Atypical form alteration of the cardiovascular system, bleeding dyscrasias, pneumonia. 4.3% presented complications, 10.8% died.

Estudio epidemiológico de rinitis alérgica en una población de niños atendidos en el servicio de pediatría de un hospital general. Corte transversal / Epidemiological study of allergic rhinitis in a population of children seen at the Department of Pediatrics of a general hospital. Cross-sectional study

Introducción. La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes en la población pediátrica, afecta la calidad de vida del niño y la familia, tiene impacto económico y es frecuentemente subdiagnosticada y subtratada. Dada la escasez de datos locales, se describe su prevalencia y las características clínicas de la población en estudio. Población y métodos. Estudio observacional de corte transversal de pacientes menores de 19 años. Resultados. Se incluyeron 250 pacientes al azar, con una media de edad de 9 años (DE 5) Presentaron diagnóstico de RA 14 de ellos; se observó una prevalencia de RA del 6 %. Conclusiones. La prevalencia de RA en nuestro medio es del 6 %. Debemos darle la relevancia que amerita para brindar un diagnóstico y tratamiento adecuado.

Introduction. Allergic rhinitis (AR) is one of the most frequent chronic diseases in the pediatric population; it affects the quality of life of children and their families, has economic impact, and is frequently underdiagnosed and undertreated. Given the scarcity of local data, here we describe the prevalence of AR and the clinical characteristics of the study population. Population and methods. Observational, cross-sectional study in patients younger than 19 years. Results. A total of 250 patients were randomly included; their mean age was 9 years (SD: 5). AR was diagnosed in 14 of them. The prevalence of AR was 6%. Conclusions. The prevalence of AR in our setting was 6%. AR should be given the relevance it deserves so as to provide an adequate diagnosis and treatment.

Tumores en ovario en pediatría / Ovarian tumors in pediatrics

Los tumores de ovario en la edad pediátrica son raros, representan 1-5 % de los tumores infantiles, con una incidencia anual de 2,6 casos por cada 100.000 pacientes. La mayoría son benignos y se tratan de quistes funcionales, sin embargo, entre 10-20 % son malignos y generalmente se presentan en adolescentes; estos últimos, se dividen en 3 grupos: tumores epiteliales, germinales, y estromales o de células sexuales. Método: Estudio retrospectivo de tipo transversal, observacional, no experimental. Se analizaron los pacientes con diagnóstico de tumor de ovario, ingresados en el Servicio de Cirugía Pediátrica del Hospital de Niños "Dr. José Manuel de los Ríos", entre el 1 de enero de 2017 y 01 de julio de 2022. Resultados: 18 pacientes incluidos en el estudio, con edad media de 8,23 años (DE 4,77); los síntomas más frecuentes presentados al momento del ingreso fueron: aumento de volumen abdominal (52,94 %, 9 pacientes), y dolor abdominal (35,29 %, 6 pacientes), entre otros. Reporte patológico: 2 pacientes con quistes de ovario funcional (11,76 %) y 16 pacientes con tumor neoplásico (88,23 %), de los cuales 8 fueron germinales (53,33 %), 5 tumores epiteliales (33,33 %) y 2 pacientes con linfoma (13,33 %). Conclusión: Los tumores de ovario en general tienen una edad promedio de presentación de 8 años y los tumores neoplásicos se presentaron principalmente en adolescentes, siendo el tipo histológico más frecuente el tumor germinal y dentro de este grupo el teratoma quístico maduro. (AU)

Ovarian tumors in pediatric age are rare, representing 1-5 % of childhood tumors, with an annual incidence of 2.6 cases per 100,000 patients. Most of them are benign and functional cysts; however, between 10-20 % are malignant and generally occur in teenagers; the latter are divided into 3 groups: epithelial, germinal, and stromal or sex cell tumors. Methods: Retrospective, cross-sectional, observational, non-experimental study. Patients with a diagnosis of ovarian tumor, admitted to the Pediatric Surgery Service of the Children's Hospital "Dr. José Manuel de los Ríos", between January 01, 2017 and July 01, 2022, were analyzed. Results: 18 patients included in the study, with mean age 8.23 years (SD 4.77); the most frequent symptoms presented at admission were: increased abdominal volume (52.94 %, 9 patients), and abdominal pain (35.29 %, 6 patients), among others. Pathological report: 2 patients with functional ovarian cysts (11.76 %) and 16 patients with neoplastic tumor (88.23 %), of which 8 were germinal (53.33 %), 5 epithelial tumors (33.33 %) and 2 patients with lymphoma (13.33 %). Conclusion: Ovarian tumors in general have an average age of presentation of 8 years and neoplastic tumors occurred mainly in teenagers, the most common histological type being the germ cell tumor and within this group the mature cystic teratoma. (AU)

Pericardiectomía parcial y drenaje pericárdico mínimamente invasivo en cirugía infantil / Partial pericardiectomy and minimally invasive pericardial drainage in pediatric surgery

Introducción. Una de las patologías más frecuentes del pericardio es la pericarditis, que puede presentarse como pericarditis aguda, subaguda o crónica, derrame pericárdico, taponamiento cardíaco o pericarditis constrictiva. Sin embargo, es una condición infrecuente en la población pediátrica. Métodos. Presentamos una serie de casos de pacientes con pericarditis que fueron llevados a pericardiotomía, drenaje pericárdico y pericardiectomía parcial anterior, entre julio de 2014 y junio de 2023. Se recolectaron las variables demográficas y clínicas, se evaluaron los aislamientos microbiológicos y el manejo recibido. Resultados. Un total de 12 pacientes fueron llevados a manejo quirúrgico mínimamente invasivo; de estos, 58 % pertenecían a comunidades indígenas y residían en zonas rurales. La mitad tenían neumonía asociada. En la mayoría de los casos no se obtuvo aislamiento microbiológico. Conclusión. La necesidad de manejo quirúrgico está determinada por la repercusión en las variables hemodinámicas relacionadas con el derrame y el compromiso pericárdico. La pericardiectomía parcial por toracoscopia es una alternativa en estos casos.

Introduction. One of the most common pathologies of the pericardium is pericarditis, which can present as acute, subacute or chronic pericarditis, pericardial effusion, cardiac tamponade or constrictive pericarditis. However, it is a rare condition in the pediatric population. Methods. A series of cases of patients with pericarditis who were taken to pericardiotomy, pericardial drainage and anterior partial pericardiectomy, between July 2014 and June 2023 is presented. Demographic and clinical variables were collected, microbiological isolates and the management received were evaluated. Results. A total of 12 patients underwent minimally invasive surgical management; of these, 58% belonged to indigenous communities and lived in rural areas. Half had associated pneumonia. In most cases, no microbiological isolation was obtained. Conclusion. The need for surgical management is determined by the impact on the hemodynamic variables related to the effusion and pericardial compromise. Partial pericardiectomy by thoracoscopy is an alternative in these cases.

Un caso de Chagas agudo en edad pediátrica / Acute Vector-transmitted Chagas in Pediatric Age. A Case Reportt

Presentación del caso. Se trata una niña de siete años de edad, originaria de una zona rural del departamento de San Miguel, quién consultó por presentar fiebre y edema bipalpebral derecho indoloro, de seis semanas de evolución, sin otros síntomas acompañantes. El estudio para el diagnóstico de enfermedad de Chagas fue realizado en una clínica privada; la Inmunoglobulina M para Chagas tuvo un resultado positivo, luego, se realizó la microscopía directa mediante gota al fresco y técnica de Strout con resultado negativo. En las intervenciones comunitarias se identificó la presencia del vector y la positividad del mismo, así como el diagnóstico de un caso crónico en otro miembro de la familia. Intervención terapéutica. Se indicó tratamiento con nifurtimox 150 mg cada ocho horas por 60 días y se realizó el seguimiento clínico de la evolución y control de efectos secundarios del tratamiento y exámenes de laboratorio. Evolución clínica. Evolucionó con leve disminución del apetito, se manejó con protectores gástricos. El concentrado de Strout y la gota al fresco resultaron negativos y los demás exámenes de laboratorio se mantenían en los rangos normales.

Case presentation. A seven-year-old female patient, with no previous medical history, originally from a rural area of the department of San Miguel, who presented febrile process plus long-term right bipalpebral edema of six weeks of evolution, without accompanying symptoms. Immunoglobulin M for Chagas was positive, direct microscopy by fresh drop and Strout technique was performed with negative results. In community interventions, the presence of the vector and its positivity were identified, as well as the diagnosis of a chronic case in another family member. Treatment. The patient was treated with nifurtimox 150 mg every eight hours for 60 days, subsequent controls were performed to investigate side effects of the treatment, and control tests. Outcome. With the treatment, the patient evolved with a slight decrease in appetite, and was managed with gastric protectors. Strout's concentrate and fresh gout were negative and the other laboratory tests were within normal ranges.

Ángulo de fase en pacientes diabéticos mellitus tipo 1 y pacientes sin diabetes mellitus tipo 1: estudio transversal / Phase angle in patients with type 1 diabetes mellitus and patients without type 1 diabetes mellitus: cross-sectional study

INTRODUCCIÓN: La bioimpedancia eléctrica, fundamentada en la resistencia de los tejidos biológicos a las corrientes eléctricas, ha emergido como una herramienta clave en la evaluación de la salud metabólica y nutricional en niños y adolescentes. En este contexto, el ángulo de fase, derivado de la bioimpedancia, se destaca como un indicador que proporciona información detallada sobre la integridad celular y la distribución del agua. OBJETIVO: Investigar la asociación del ángulo de fase con la salud celular en niños y adolescentes con Diabetes Mellitus Tipo 1 (DM1). MATERIALES Y MÉTODOS: Estudio transversal que incluyó treinta niños y adolescentes con DM1 obesos DM1 y eutrófico. RESULTADOS: Los hallazgos revelaron asociaciones no significativas entre el ángulo de fase y cambios en la salud celular y la distribución del agua en pacientes con DM1. DISCUSIÓN: A pesar de la falta de asociaciones significativas, la identificación de diferencias en la composición corporal sugiere que la bioimpedancia eléctrica y el ángulo de fase podrían ser útiles para evaluar la DM1 en niños y adolescentes CONCLUSIÓN: A pesar de no encontrarse asociaciones significativas entre el ángulo de fase y cambios en la salud celular y la distribución del agua en niños y adolescentes con DM1 en este estudio, se observaron diferencias significativas en la masa magra y el porcentaje de grasa corporal entre los grupos de pacientes. Estos hallazgos sugieren que la bioimpedancia eléctrica y el ángulo de fase podrían ser herramientas útiles para evaluar la composición corporal en esta población. Se requieren investigaciones adicionales para confirmar estos resultados y explorar más a fondo el papel del ángulo de fase en la evaluación de la DM1 en niños y adolescentes.

ABSTRACT: INTRODUCTION: Bioelectrical impedance, based on the resistance of biological tissues to electrical currents, has emerged as a key tool in assessing metabolic and nutritional health in children and adolescents. In this context, phase angle, derived from bioimpedance, stands out as an indicator that provides detailed information on cellular integrity and water distribution. OBJECTIVE: To investigate the association of phase angle with cellular health in children and adolescents with Type 1 Diabetes Mellitus (T1DM), MATERIALS AND METHODS: A cross-sectional study that included thirty children and adolescents with obese and eutrophic T1DM. RESULTS: The findings revealed non-significant associations between phase angle and changes in cellular health and water distribution in T1DM patients. DISCUSSION: Despite the lack of significant associations, the identification of differences in body composition suggests that bioelectrical impedance and phase angle could be useful for evaluating T1DM in children and adolescents. CONCLUSION: Despite not finding significant associations between phase angle and changes in cellular health and water distribution in children and adolescents with Type 1 Diabetes Mellitus (T1DM) in this study, significant differences were observed in lean mass and body fat percentage between patient groups. These findings suggest that bioelectrical impedance and phase angle could be useful tools for evaluating body composition in this population. Further research is needed to confirm these results and explore more deeply the role of phase angle in the evaluation of T1DM in children and adolescents.

Osteocondroma en una localización atípica. Reporte de Caso / Osteochondroma in an atypical location. Case report

INTRODUCCIÓN. Los osteocondromas son considerados como el tumor benigno más común entre los de origen óseo, se denomina también exostosis, y se lo define por la Organización Mundial de la Salud como una proyección ósea cubierta de una capa cartilaginosa en la superficie externa. Representa el 20-50% de todos los tumores benignos óseos. Se diagnostica en su mayoría en pacientes pediátricos. RESULTADOS. Presentamos el caso de una paciente de 8 años con osteocondroma único en escápula de aparición espontánea, sin otras lesiones en el cuerpo. DISCUSIÓN. Los lugares comunes de aparición de osteocondromas son los huesos largos con placa de crecimiento o metáfisis, localizaciones raras como la escapula comprenden menos del 1%. El tratamiento es expectante y al momento de producirse síntomas, está indicado la excision quirúrgica. CONCLUSIÓN. La enfermedad tiene un curso benigno sin complicaciones cuando se trata de un tumor esporádico, en los síndormes de exostosis, las recurrencias y riesgo de malignidad hacen necesario un seguimiento más cercano.

INTRODUCTION. Osteochondromas are considered the most common benign tumor among those of bone origin, it is also called exostosis, and is considered by the World Health Organization as a bone projection covered with a cartilaginous layer on the external surface), it represents 20­50% of all benign tumors and is mostly diagnosed in pediatric patients. RESULTS. We present the case of an 8-year-old female with a single osteochondroma in the scapula of spontaneous appearance, without other lesions in the body. DISCUSSION: The common places of appearance are long bones with a growth plate or metaphysis, rare locations such as the scapula comprise less than 1%. The treatment is expectant, and when symptoms occur, surgical excision is indicated. CONCLUSION: The disease has a benign course without complications when it is a sporadic tumor, in exostosis syndromes the recurrences and risk of malignancy make closer follow-up necessary.

Aspectos genéticos e imagenológicos de la enfermedad quística renal en pediatría: serie de casos / Genetic and radiological aspects of pediatric renal cystic disease: A case series

Las enfermedades quísticas renales son condiciones frecuentes cuya etiología puede ser muy heterogénea, por lo que se requiere un adecuado abordaje para su diagnóstico y manejo. El objetivo de este trabajo fue ilustrar parte del espectro de la enfermedad renal quística por medio de casos clínicos manejados en la Fundación Valle del Lili. Se describen 11 casos clínicos que incluyen enfermedades como displasia multiquística renal, enfermedad poliquística renal autosómica dominante y autosómica recesiva, entre otras. Las enfermedades quísticas renales varían en su presentación clínica, historia natural, hallazgos imagenológicos, bases genéticas y fisiopatológicas, por consiguiente, el enfoque diagnóstico y el manejo integral se debe realizar de forma individualizada y con un abordaje multidisciplinario.

Renal cystic diseases are common conditions whose etiology can be highly heterogeneous. They require a correct approach for adequate diagnosis and management. We aimed to illustrate part of the spectrum of renal cystic diseases through some clinical cases managed in our service. We describe 11 clinical cases including clinical entities such as renal multicystic dysplasia, and autosomal dominant and autosomal recessive polycystic renal disease, among other pathologies. Renal cystic diseases are heterogeneous in their clinical presentation, natural history, radiological findings, and genetic and pathophysiological basis. An integral clinical approach is needed to get a clear etiological diagnosis and offer adequate individualized care and follow-up for patients.

Repercussões da covid-19 nos serviços de hospitalização pediátrica / Repercussions of covid-19 on pediatric hospitalization services / Repercusiones del covid-19 en los servicios de hospitalización pediátrica

Objetivo: Identificar, nas produções científicas, as repercussões ocorridas nos serviços de hospitalização pediátrica decorrentes da pandemia da Coronavirus Disease 2019 (covid-19). Métodos: Revisão Integrativa da Literatura, realizada entre os anos de 2019 e 2021 nas seguintes bases de dados SCIELO, LILACS, SCOPUS, CINAHL, MEDLINE e COCHRANE. Resultados: Dos 1.424 estudos encontrados, 25 foram selecionados para leitura na íntegra, resultando em uma amostra final de 14 estudos incluídos na revisão. Foram constituídas categorias para representar os temas recorrentes: declínio de atendimentos nos serviços de emergência pediátrica; adaptações dos serviços pediátricos no controle e prevenção da covid-19; e hospitalização pediátrica e necessidades em saúde das crianças. Conclusão: Os achados intensificaram necessidade de reavaliação sobre o cuidado prestado no período de hospitalização pediátrica pelos gestores em saúde, além da assistência prestada as crianças durante este período, principalmente no que tange ao cuidado integral a essa clientela. (AU)

Objective: To identify, in scientific production, the repercussions that occurred in pediatric hospitalization services resulting from the Coronavirus Disease 2019 pandemic (covid-19). Methods: Integrative Literature Review, carried out between april and june 2021 in the following databases SCIELO, LILACS, SCOPUS, CINAHL, MEDLINE and COCHRANE. Results: Of the 1,424 studies found, 25 were selected for full reading, resulting in a final sample of 14 studies included in the review. Categories were created to represent the recurrent themes: decline in pediatric emergency services; adaptations of pediatric services in the control and prevention of covid-19; and pediatric hospitalization and children's health needs. Conclusion: The findings intensified the need for reassessment of the care provided during the period of pediatric hospitalization by health managers, in addition to the care provided to children during this period, especially with regard to comprehensive care for this clientele. (AU)

Objetivo: Identificar, en la producción científica, las repercusiones ocurridas en los servicios de hospitalización pediátrica producto de la pandemia de Enfermedad por Coronavirus 2019 (covid-19). Métodos: Revisión Integrativa de Literatura, realizada entre abril y junio de 2021 en las siguientes bases de datos SCIELO, LILACS, SCOPUS, CINAHL, MEDLINE y COCHRANE. Resultados: De los 1,424 estudios encontrados, 25 fueron seleccionados para lectura completa, lo que resultó en una muestra final de 14 estudios incluidos en la revisión. Se crearon categorías para representar los temas recurrentes: disminución de los servicios de emergencia pediátrica; adaptaciones de los servicios pediátricos en el control y prevención de covid-19; y hospitalización pediátrica y necesidades de salud infantil. Conclusión: Los hallazgos intensificaron la necesidad de reevaluar la atención brindada durante el período de hospitalización pediátrica por parte de los administradores de salud, además de la atención brindada a los niños durante este período, especialmente en lo que respecta a la atención integral a esta clientela. (AU)

Descentralización en la formación de especialistas en Pediatría en la Facultad de Medicina, Universidad de la República. Uruguay / Decentralization in the training of pediatricians at the School of Medicine, University of the Republic, Uruguay Uruguay / Descentralização na formação de especialistas em Pediatria na Faculdade de Medicina da Universidade de la República. Uruguai

Introducción: centralizar estudios superiores en Montevideo implica para las familias del interior del país gastos económicos, desarraigo familiar y pérdida de recursos humanos. La formación de especialistas en Pediatría en el interior comenzó en la década de 1980. En los últimos años se ha fortalecido, agregando escenarios de aprendizaje, docentes, recursos didácticos y evaluaciones. Objetivo: describir la experiencia en la descentralización de la docencia de especialistas en Pediatría entre 2007 y 2021 en los departamentos de Maldonado, Paysandú, Rivera y Salto. Metodología: estudio descriptivo, incluyendo estudiantes del posgrado de especialistas en Pediatría que realizaron su formación en Maldonado, Paysandú, Rivera y Salto, entre 2007 y 2021. Se describe el número de especialistas formados, las características personales o familiares que incidieron en la decisión de realizar el curso en el interior, desempeño curricular, lugar de ejercicio profesional, recursos humanos docentes disponibles. Resultados: en el período analizado 88 estudiantes cursaron el posgrado en las ciudades evaluadas, 33 en régimen de residencia. Eran oriundos/residentes del lugar, 78. Egresaron 57; 19 se encontraban cursando, 4 abandonaron. Un porcentaje variable de las instancias obligatorias del curso se realizaron en el interior. El tiempo promedio para realizar todas las actividades obligatorias fue de 3,3 años. Ejercen en el lugar de formación o en ciudades cercanas, 60. Paysandú y Salto cuentan con 34 horas docentes/semana. Maldonado con 6 horas docentes/semana y docentes honorarios. Rivera cuenta con docentes/tutores honorarios. Conclusiones: la descentralización de la docencia de Pediatría es un gran logro para las ciudades del interior, que forman sus propios recursos humanos, permitiendo que se radiquen en estas ciudades. Es necesario mejorar la oferta de actividades curriculares y horas docentes.

Introduction: Centralizing higher education studies in Montevideo entails economic expenses, family uprooting, and loss of human resources for families living in the interior of Uruguay. The training of pediatric specialists outside the capital city began in the 1980s. In recent years, this innovations has been reinforced by adding learning scenarios, teachers, didactic resources, and evaluations. Objective: to describe the experience of decentralizing the teaching of pediatric specialists between 2007 and 2021 in Maldonado, Paysandú, Rivera, and Salto. Method: Descriptive study, including postgraduate students of pediatris who completed their training in Maldonado, Paysandú, Rivera, and Salto between 2007 and 2021. The study describes the number of specialists trained, personal or family characteristics that influenced the decision to take the course in the interior, academic performance, place of professional practice, and available teaching staff. Results: during the study period, 88 students undertook postgraduate studies in the evaluated cities, 33 of which studied in a residency program. Of these, 78 were native to or residents of the area. Fifty six pediatricians graduated, 18 were still enrolled, and 4 dropped out. A variable percentage of the course's mandatory components were conducted in the interior. Average time to complete all mandatory activities was 3.3 years. Sixty graduates practice in the place of training or in nearby cities. Paysandú and Salto have 34 hours of teaching per week; Maldonado has 6 hours per week and honorary teachers. Rivera has honorary teachers/tutors. Conclusions: the decentralization of pediatric teaching is a significant achievement for inland cities in the interior of the country, as it allows them to train their own human resources, enabling them to settle in these cities. There is a need to improve the offer of curricular activities and teaching hours.

Introdução: a centralização do ensino superior em Montevidéu implica custos econômicos para as famílias do interior do país, o desenraizamento familiar e a perda de recursos humanos. A formação de especialistas em Pediatria no interior do país começou na década de 1980. Nos últimos anos foi fortalecida acrescentando cenários de aprendizagem, professores, recursos didáticos e avaliações. Objetivo: descrever a experiência de descentralização do ensino de especialistas em Pediatria entre 2007 e 2021 nos departamentos de Maldonado, Paysandú, Rivera e Salto. Metodologia: estudo descritivo, incluindo estudantes de pós-graduação em Pediatria que se formaram em Maldonado, Paysandú, Rivera e Salto, no período 2007-2021. Descrevemos o número de especialistas formados, as características pessoais ou familiares que influenciaram a decisão de fazer o curso no interior do país, o desempenho curricular, o local de prática profissional e recursos humanos docentes disponíveis. Resultados: no período analisado, 88 alunos fizeram a pós-graduação nas cidades avaliadas, 33 deles em regime de residência. Eram nativos/residentes no local, 78. 57 terminaram a pós-graduação, 19 ainda estavam em formação e 4 desistiram. Uma porcentagem variável das disciplinas obrigatórias do curso foi cursada no interior do país. O tempo médio para a realização das atividades obrigatórias foi de 3,3 anos. Sessenta trabalham no lugar de pós-graduação ou en cidades próximas. Paysandú y Salto tem 34 horas docentes/semana, Maldonado 6 horas docentes/semana e docentes honorários. Rivera tem docentes/tutores honorários. Conclusões: a descentralização do ensino de Pediatria é uma grande conquista para as cidades do interior, que formam seus próprios recursos humanos, permitindo que se estabeleçam nessas cidades. É necessário melhorar a oferta de atividades curriculares e a carga horária de ensino.

Clinical aspects of co-infection by HIV and syphilis in pregnancy and exposure in newborn intended at Pediatric Hospital of Santa Catarina / Aspectos clínicos da coinfecção por HIV e sífilis na gestação e da exposição de recém-nascidos atendidos em Hospital Pediátrico de Santa Catarina

Introduction: Sexually transmitted infections frequently affect pregnant women and, consequently, newborns. HIV and syphilis are vertically transmitted to children and co-infection requires special attention due to its clinical implications. Objective: To describe clinical aspects of HIV/syphilis coinfection during pregnancy and the exposure of newborns to infections treated at a pediatric reference hospital in Santa Catarina between 2015 and 2020. Methods: Observational, descriptive study, secondary to a line of research "Epidemiological description of children exposed to HIV" from January 2015 to December 2020 in a tertiary pediatric hospital in Santa Catarina. Results: 678 medical records were analyzed with ICD Z.206 (contact with and exposure to HIV), in which 71 (10.5%) newborns were exposed to HIV and Syphilis co-infection. Of these, 37 (52.1%) were male, 14 (19.7%) confirmed a diagnosis of HIV and 30 (42.2%) of congenital syphilis. Of the co-infected pregnant women, 38 (53.5%) were diagnosed with HIV prior to pregnancy, 53 (74.6%) used ART and 40 (52.1%) used harmful substances. Furthermore, 34 (46.4%) pregnant women had a minimum number of 6 prenatal consultations, 35 (49.3%) had vaginal births and 29 (40.8%) had undetectable HIV RNA quantification at the time of delivery. HIV prophylaxis for newborns occurred in 66 (92.9%) of cases. Conclusion: It is concluded that the studied population was mostly made up of pregnant women who were diagnosed with HIV infection prior to pregnancy. Of these, the majority were using ART, but the minority carried out the minimum number of consultations recommended by the Ministry of Health. Regarding newborns, the majority received HIV prophylaxis. (AU)

Introdução: As infecções sexualmente transmissíveis afetam frequentemente gestantes e, consequentemente, os recém-nascidos (RN). O vírus da imunodeficiência humana (HIV) e a sífilis são transmitidos verticalmente para as crianças e a coinfecção requer atenção especial por suas implicações clínicas. Objetivo: Descrever aspectos clínicos da coinfecção HIV/sífilis na gestação e da exposição de RN às infecções atendidos em um hospital de referência pediátrica em Santa Catarina entre 2015 e 2020. Métodos: Estudo observacional, descritivo, secundário à linha de pesquisa "Descrição epidemiológica de crianças expostas ao HIV" no período de janeiro de 2015 a dezembro de 2020, em um hospital pediátrico terciário de Santa Catarina. Resultados: Foram analisados 678 prontuários com Classificação Internacional de Doenças ­ CID Z.206 (contato com e exposição ao HIV), nos quais 71 (10,5%) RN foram expostos à coinfecção HIV e sífilis. Destes, 37 (52,1%) eram do sexo masculino, 14 (19,7%) confirmaram diagnóstico de HIV e 30 (42,2%) de sífilis congênita. Das gestantes coinfectadas, 38 (53,5%) possuíam diagnóstico do HIV prévio à gestação, 53 (74,6%) usaram terapia antirretroviral (TARV) e 40 (52,1%) utilizaram substâncias nocivas. Ainda, 34 (46,4%) gestantes obtiveram o número mínimo de seis consultas pré-natais, 35 (49,3%) realizaram partos vaginais e 29 (40,8%) possuíam quantificação RNA-HIV não detectável no momento do parto. A profilaxia para o HIV do RN ocorreu em 66 (92,9%) dos casos. Conclusão: Conclui-se que a população estudada foi formada, na sua maioria, por gestantes que receberam o diagnóstico de infecção pelo vírus do HIV prévio à gestação. Destas, a maioria estava em uso de TARV, porém a minoria realizou o número mínimo de consultas preconizadas pelo Ministério da Saúde. Com relação aos RN, a maioria recebeu profilaxia ao HIV. (AU)

Características de crianças e adolescentes com disforia de gênero quanto ao cuidado à saúde: revisão de escopo / Characteristics of children and adolescents with gender dysphoria for their health care: scoping review

Objetivo: Identificar as características demográficas e psicossociais de crianças e adolescentes com disforia de gênero e dos profissionais de saúde envolvidos no seu cuidado.Métodos: Revisão de escopo segundo o PRISMA-ScR com as bases de dados Web of Science, Science Direct, Scopus, Biblioteca Virtual em Saúde e Pubmed, usando os descritores: crianças, adolescentes, disforia de gênero, pediatria e profissionais de saúde. Critérios de inclusão: pesquisas primárias e secundárias sobre disforia de gênero e diversidade sexual na assistência à saúde, com estudantes ou profissionais de saúde. Critérios de exclusão: população adulta, outro contexto de assistência à saúde, tratamentos, comorbidades e publicação cinza. Quinze artigos foram incluídos.Resultados: As crianças apresentam disforia por volta dos 6 anos de idade, com diagnóstico e tratamento tardios. Têm maior tendência a problemas de saúde mental como ansiedade, depressão e distúrbios alimentares, sendo fundamental o apoio familiar. Os profissionais desaúde possuem baixa formação de graduação, escassa formação permanente e atuação multidisciplinar.Conclusão: É necessário incorporar na formação dos profissionais de saúde temas sobre diversidade, identidade de gênero e disforia, bem como formação contínua com ferramentas que permitam uma abordagem abrangente, aumentem a confiança e a segurança na relação prestador-paciente, de forma a melhorar o bem-estar das crianças.

Objective: To identify the demographic and psychosocial characteristics of children and adolescents with gender dysphoria and of the health professionals involved in their care.Methods: Scoping review according to PRISMA-ScR with the databases Web of Science, Science Direct, Scopus, Virtual Health Library and Pubmed, using the descriptors: children, adolescents, gender dysphoria, pediatrics and health professionals. Inclusion criteria: primary and secondary research on gender dysphoria and sexual diversity in health care, with students or health professionals. Exclusion criteria: adult population, other context of health care, treatments, comorbidities and gray publication. Fifteen articles were included.Results: Children present with dysphoria around 6 years of age, with late diagnosis and treatment. They have a greater tendency toward mental health problems such as anxiety, depression and eating disorders, and family support is crucial. Health professionals have low undergraduate training, scarce continuous training and multidisciplinary work.Conclusion: It is necessary to incorporate subjects on diversity, gender identity and dysphoria into the training of health professionals, as well as continuous training with tools that allow a comprehensive approach, increasing confidence and security in the provider-patient relationship, in order to improve the well-being of children.

Factors associated with adverse outcomes among SARS-CoV-2 positive children in a Tertiary Government COVID-19 Referral Hospital in the Philippines

Background and Objective@#Pediatric COVID-19 epidemiology and factors associated with adverse outcomes-mortality, need for invasive mechanical ventilation, and ICU admission, are largely unstudied. We described the clinicodemographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes.@*Methods@#This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases 0-18 years old from April 2020 to August 2021 in a tertiary COVID-19 referral hospital in Manila, National Capital Region. Crude associations were determined using chi-squared or Fisher’s exact tests; and medians were compared using the Mann-Whitney test. Factors predictive of mortality were determined using Cox proportional hazards regression analysis. The survivor functions were depicted in graphs.@*Results@#About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% had at least one comorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, 95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, 28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, 1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc 4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, 363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, 60.38) were significantly associated with mortality while alar flaring appeared to be protective (HRa 0.10, 95% CI 0.01, 0.95). Several clinical characteristics were consistently associated with adverse outcomes.@*Conclusions@#Majority of hospitalized pediatric COVID-19 patients were very young, males, had mild disease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, and ICU admission were relatively low. Except for alar flaring which appeared to be protective, retractions, seizure, and use of corticosteroids were associated with adverse outcomes.

Sleep disturbances among 4- to 12-year-old Filipino children with drug resistant epilepsy in a pediatric tertiary hospital

Objectives@#To perform a pilot study on the frequency of sleep-disturbance (Total sleep Disturbance Score (TSD) of > 41) in children diagnosed with Drug Resistant Epilepsy aged 4 to 12 years, using the Children’s Sleep Habits Questionnaire (CSHQ).@*Methodology@#The Children’s Sleep Habits Questionnaire (CSHQ) was used to screen for sleep disturbances among 73 patients aged 4 to 12 years old with drug-resistant epilepsy seen at the Seizure Clinic of Philippine Children’s Medical Center. Descriptive statistics were used to characterize sociodemographic variables, and sleep and epilepsy-related variables. Continuous data were presented as mean ± standard deviation (SD), and categorical data as frequencies (percentages).@*Results@#Sleep disturbances were common and severe in children with drug-resistant epilepsy. Out of the seventy-three participants, 61 patients had a TSD score of greater than 41 (84%) and 12 (16%) had TSD scores below 41 with a mean CSHQ score of 58. The most frequently occurring sleep disturbances involve the domains of bedtime resistance (29%), night wakings (28%), and daytime sleepiness (23%). Meanwhile, the least frequently occurring sleep disturbances involve the domains of sleep disordered breathing (76%), parasomnias (65%), and sleep anxiety (56%).@*Conclusion@#Majority of the children with drug-resistant epilepsy are sleep disturbed exhibiting high TSD scores (>41) using the Children’s Sleep Habits Questionnaire. We recommend to actively evaluate and screen for sleep and behavioral problems concurrently in children with epilepsy.

Antibiotic prescription patterns among pediatric patients with pneumonia in primary care – A retrospective cohort study

Background and Objectives@#The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics. @*Methods@#A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG). @*Results@#There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213). @*Conclusion@#Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

Perfil clínica y electromiográfico de las distrofias musculares en República Dominicana / Clinical and electromyographic profile of muscular dystrophies in the Dominican Republic

Introducción: Las distrofias musculares son trastornos miogénicos hereditarios caracterizados por una atrofia muscular progresiva y una debilidad de distribución y gravedad variable. La población de Republica Dominicana es fruto de una mezcla de etnias, haciéndola portadora de una herencia cromosómica y ADN diverso, siendo susceptibles a poder presentar cualquier desorden de carácter hereditario. Material y métodos: Con una muestra de 17 pacientes obtenidos entre septiembre 2019- marzo 2020, se realizó un estudio retrospectivo, descriptivo y transversal, en el cual se hizo una revisión de los expedientes de la clínica de miopatías en la consulta de neurología pediátrica del Hospital Infantil Doctor Robert Reid Cabral, para describir el perfil clínico de los pacientes con distrofia muscular y los hallazgos de electromiografía en los casos que la misma. Resultados: se encontró que la distribución de la edad correspondió a 5-9 años en un 53%, siendo el sexo masculino, el más frecuente. En el 70.59% presentaron antecedentes familiares de distrofia muscular. Los principales motivos de consulta fueron cansancio y caídas frecuentes. Conclusión: En los hallazgos de electromiografía, el porcentaje de pacientes que presentó esta prueba con alteraciones fue de 88.24% y sin alteraciones el 11.76%. Esto nos demuestra, la gran utilidad de dicho estudio en el diagnóstico de las distrofias musculares en países donde no se cuenta con estudio molecular, siendo una de las pruebas esenciales en el abordaje diagnóstico de los pacientes con sospecha clínica de dichas patologías.

Introduction: Muscular dystrophies are hereditary myogenic disorders characterized by progressive muscular atrophy and weakness of variable distribution and severity. The population of the Dominican Republic is the result of a mixture of ethnic groups, making it the bearer of a diverse chromosomal inheritance and DNA, being susceptible to presenting any hereditary disorder. Methods: With a sample of 17 patients obtained between September 2019-March 2020, a retrospective, descriptive and cross-sectional study, in which a review of the files of the myopathies clinic was made in the pediatric neurology consultation of the Children's Hospital Doctor Robert Reid Cabral, to describe the clinical profile of patients with muscular dystrophy and the electromyography findings in the cases with the same. Results: The age distribution corresponded to 5-9 years; 53%, being the masculines, the most frequent sex. In 70.59%, there was a family history of muscular dystrophy. The main reasons for consultation were fatigue and frequent falls. Conclusion: In the electromyography findings, the percentage of patients who presented this test with alterations was 88.24% and 11.76% without alterations. This result shows us the great utility of said study in the workup of muscular dystrophies in countries with no availabilities for molecular studies, being one of the essential tests in the diagnostic approach of patients with clinical suspicion of said pathologies.

Cuidados de enfermagem para paciente pediátrico com dermatite atópica e epidermólise bolhosa: revisão integrativa / Nursing care for pediatric patients with atopic dermatitis and epidermolysis bullosa: integrative review / Atención de enfermería a pacientes pediátricos con dermatitis atópica y epidermólisis ampollosa: revisión integrativa

A Dermatite Atópica e a Epidermólise Bolhosa são doenças crônicas que afetam a estrutura morfológica e bioquímica da pele, provocando lesões e alterações sistêmicas nos indivíduos afetados, podendo ocasionar infecções generalizadas. Este estudo teve como objetivo avaliar e sintetizar as contribuições das pesquisas produzidas sobre os cuidados de enfermagem para crianças com dermatite atópica ou epidermólise bolhosa. Trata-se de uma revisão integrativa, cuja pergunta norteadora foi: "Quais são os cuidados de enfermagem para o paciente pediátrico com dermatite atópica ou epidermólise bolhosa?". Sua busca aconteceu nas bases de dados: Medline; CINAHL; LILACS e CUIDEN. Não houve restrição quanto ao ano de publicação e foram analisados estudos publicados nos idiomas inglês, português e espanhol. Como resultados foram incluídos 23 estudos, dois quais duas categorias foram elencadas: Assistência de Enfermagem às Crianças Portadoras de Dermatite Atópica e a Epidermólise Bolhosa e, Educação em Saúde. Evidenciou-se a necessidade de investimento em pesquisas bem delineadas sobre o tema, pois a raridade da condição, a escassez de referencial e a dificuldade em encontrar pacientes aptos para intervenções são fatores que contribuem neste cenário científico.

The Atopic Dermatitis and Epidermolysis Bullosa are chronic diseases that affect the morphological and biochemical structure of the skin, causing lesions and systemic changes in affected individuals, which can lead to generalized infections. This study aimed to evaluate and synthesize the contributions of research produced on nursing care for children with atopic dermatitis or epidermolysis bullosa. This is an integrative review, whose guiding question was: "What is the nursing care for pediatric patients with atopic dermatitis or epidermolysis bullosa?". Your search took place in the following databases: Medline; CINAHL; LILACS and CUIDEN. There was no restriction on the year of publication and studies published in English, Portuguese and Spanish were analyzed. As results, 23 studies were included, two of which two categories were listed: Nursing Care for Children with Atopic Dermatitis and Epidermolysis Bullosa and Health Education. The need for investment in well-designed research on the topic was highlighted, as the The rarity of the condition, the scarcity of references and the difficulty in finding patients suitable for interventions are factors that contribute to this scientific scenario.

La Dermatitis Atópica y la Epidermólisis Bullosa son enfermedades crónicas que afectan la estructura morfológica y bioquímica de la piel, provocando lesiones y cambios sistémicos en los individuos afectados, que pueden derivar en infecciones generalizadas. Este estudio tuvo como objetivo evaluar y sintetizar las contribuciones de las investigaciones producidas sobre los cuidados de enfermería al niño con dermatitis atópica o epidermólisis ampollosa. Se trata de una revisión integradora, cuya pregunta orientadora fue: "¿Cuál es el cuidado de enfermería al paciente pediátrico con dermatitis atópica o epidermólisis ampollosa?". Su búsqueda se realizó en las siguientes bases de datos: Medline; CINAHL; LILAS y CUIDEN. No hubo restricción en el año de publicación y se analizaron los estudios publicados en inglés, portugués y español. Como resultados se incluyeron 23 estudios, dos de los cuales se enumeraron dos categorías: Atención de Enfermería al Niño con Dermatitis Atópica y Epidermólisis Bullosa y Educación para la Salud.Se destacó la necesidad de invertir en investigaciones bien diseñadas sobre el tema, ya que la rareza de la condición, la escasez de referencias y la dificultad para encontrar pacientes aptos para las intervenciones son factores que contribuyen a este escenario científico.