Short report - Usefulness of point-of-care ultrasound in pediatric SARS-CoV-2 infection.

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.

[Techniques and complementary techniques. Complementary treatments: nitric oxide, prone positioning and surfactant]. / Técnicas y tratamientos complementarios. Tratamientos complementarios: óxido nítrico, posición en prono y surfactante.

The management of hypoxic respiratory failure is based on oxygen delivery and ventilatory support with lung-protective ventilation strategies. Better understanding of acute lung injury have led to new therapeutic approaches that can modify the outcome of these patients. These adjunctive oxygenation strategies include inhaled nitric oxide and surfactant delivery, and the use of prone positioning. Nitric oxide is a selective pulmonary vasodilator that when inhaled, improves oxygenation in clinical situations such as persistent pulmonary hypertension of the newborn, pulmonary hypertension associated with congenital heart disease, and acute respiratory distress syndrome (ARDS). When applied early in ARDS, prone positioning improves distribution of ventilation and reduces the intrapulmonary shunt. The surfactant has dramatically decreased mortality caused by hyaline membrane disease in premature newborns, although the results have been less successful in ARDS. Greater experience is required to determine whether the combination of these treatments will improve the prognosis of these patients.

[Low grade disseminated astrocytoma in childhood]. / Astrocitomas de bajo grado diseminados en la infancia.

INTRODUCTION: Leptomeningeal dissemination is a common event in some kinds of cerebral tumours, but in low-grade astrocytomas who classically have been conferred a benign course. However, multifocal affectation is described each time more frequently in these group of tumours. CLINIC CASES: We present three patients aged respectively 8 and 10 months and 10 years, who were diagnosed of low-grade astrocytoma with multicentric spread. They were treated with systemic chemotherapy and controlled with MRI. At the end of the treatment an important reduction in tumours' size was observed in the three cases. DISCUSSION: Biological behaviour of low-grade astrocytoma as been reviewed in last years. By one side, it has been seen that certain histological characteristics are associated with an aggressive behaviour: on the other hand, long-term evolution of these tumours can be complicated with tumoral recurrence, malignization and leptomeningeal dissemination. This last one is observed each time more frequently since the use of MRI in the diagnose of cerebral tumours has become routine. From the therapeutic point of view, chemotherapy represents an effective choice for these patients' management, when surgery is not possible and radiotherapy not advisable, allowing in many cases to stop tumoral growth and sometimes to reduce it's size strongly.

[Allogenic bone marrow transplantation in Wiskott-Aldrich syndrome]. / Trasplante de medula ósea alogénico en el síndrome de Wiskott-Aldrich.

Two males of 3 and 3 1/2 years of age with the Wiskott-Aldrich syndrome who underwent bone marrow transplantation from an HLA compatible brother following conditioning treatment with busulphan and cyclophosphamide are described. In both patients the taking of the graft was proven by study of blood subgroups and correction of the immunodeficiency, normalization of platelet number and function and disappearance of cutaneous eczema were seen. At 3 and 1 year respectively of the transplantation the patients showed no evidence of graft versus host disease and no severe infections or hemorrhagic episodes have seen.

[Allogeneic bone marrow transplantation in children with acute lymphoblastic leukemia]. / Trasplante de medula ósea alogénico en niños con leucemia linfoblástica aguda.

PURPOSE: Long disease-free survival can be achieved with chemotherapy in over 50% of children with acute lymphoblastic leukaemia (ALL). However, those children suffering relapse or presenting with poor-risk features at diagnosis have scarce possibility of doing well with conventional chemotherapy. Bone marrow transplantation (BMT) is a good choice in such cases. MATERIAL AND METHODS: Between July 1985 and January 1992, twenty-four children with ALL underwent BMT in the Service of Pediatrics of the Hospital Ramón y Cajal. In seven patient with poor-risk criteria at diagnosis BMT was performed in the first complete remission (CR) and in seventeen cases it was performed after the second CR. The conditioning for transplantation consisted of cyclophosphamide plus total body irradiation in 21 patients and cyclophosphamide plus busulphan in 3 others. RESULTS: Fifteen patients persist in CR with post-transplant follow-up of 3 to 73 months (median, 31 months). Five patients died due to complications of the transplantation techniques, and four others died upon leukaemic relapse. The probability of disease-free survival for all cases is 61%, a plateau being reached at 13 months (83% and 52% for BMT in first or second CR, respectively). CONCLUSIONS: These findings confirm the efficacy of BMT in the treatment of children with ALL in second CR, or in first CR when there are very poor risk criteria at diagnosis.

[Bone marrow transplantation in malignant diseases in childhood using reverse isolation technics: evaluation of results]. / Trasplante de médula ósea en enfermedades malignas en la edad pediátrica con aislamiento inverso convencional: valoración de resultados.

Between July 1985 and March 1990, 31 pediatric patients with neoplastic diseases underwent bone marrow transplantation (22 allogenic and 9 autologous). Routine reverse isolation techniques with sterilization of the gastrointestinal tract were used in all cases. Of these patients, 55% had fever and 32% had a documented infection. In allogenic bone marrow transplants, 23% developed graft-versus-host disease, grade I-IV. The incidence of infection and graft-versus-host disease compares favorably with other published reports from centers utilizing laminar air flow rooms during bone marrow transplantation. This suggest that standard reverse isolation techniques may be used without increasing the morbidity and mortality in these patients.