ABSTRACT
Objetivo. La pandemia COVID-19 ha causado una variación en la circulación de otros patógenos respiratorios. Nuestro objetivo fue analizar la epidemiología de las infecciones respiratorias agudas graves (IRAG) en niños durante 3 años de pandemia COVID-19, en comparación con un período previo de la misma dimensión temporal. Pacientes y métodos. Estudio observacional, realizado en un hospital terciario de España, que analizó la frecuencia y características de pacientes ingresados por IRAG en la Unidad de Cuidados Intensivos Pediátricos (UCIP) durante la pandemia COVID-19 (1 marzo-2020 a 28 de febrero-2023), en relación a un período pre-pandemia (1 marzo-2017 a 29 febrero-2020). Resultados. Se incluyeron 268 pacientes (59,6% varones). La mediana de edad fue 9,6 meses (RIQ 1,7 37). En el período pre-pandemia hubo 126 ingresos con una media de 42 admisiones/año. Durante la pandemia se produjeron 142 ingresos, observándose una reducción significativa de admisiones en el primer año (12 ingresos/año), en contraste con 82 ingresos durante el tercer año, que representó un incremento del 95% respecto a la media de admisiones/año en pre-pandemia. Además, en el último año se evidenció un incremento de coinfecciones virales en relación al período prepandemia (54,9% vs 39,7%; p=0,032). No hubo diferencias en días de hospitalización, ni estancia en UCIP. Conclusiones. Durante el último año, coincidiendo con bajas tasas de hospitalización por COVID en España, observamos un notable incremento de ingresos en la UCIP por IRAG por otras causas. Probablemente, el período prolongado de baja exposición a patógenos por las medidas adoptadas durante la pandemia, ha provocado una disminución de la inmunidad poblacional con un repunte de infecciones respiratorias. (AU)
Objective. The COVID-19 pandemic has caused a variation in the circulation of respiratory pathogens. Our aim was to analyze the epidemiology of severe acute respiratory infections (SARI) in children during 3 years of the COVID-19 pandemic, in comparison with a previous period. Patients and Methods. An observational study was conducted in a tertiary hospital in Spain, which analyzed the frequency and characteristics of patients admitted for SARI in the Pediatric Intensive Care Unit (PICU) during the COVID-19 pandemic (1 March 2020 to 28 February 2023), compared to pre-pandemic period (1 March 2017 to 29 February 2020). Results. A total of 268 patients were included (59.6% males). The median age was 9.6 months (IQR 1.7 37). In the pre-pandemic period, there were 126 admissions with an average of 42 admissions/year. During the pandemic, there were 142 admissions, observing a significant reduction in admissions in the first year (12 admissions/year), in contrast to 82 admissions during the third year, which represented an increase of 95% compared to the average of admissions/year in pre-pandemic. In addition, in the last year there was evidence of an increase in viral coinfections in relation to pre-pandemic period (54.9% vs 39.7%; p=0.032). There were no differences in length of hospital stay or PICU stay. Conclusions. During the last year, coinciding with low rates of hospitalization for COVID in Spain, we observed a notable increase in admissions to the PICU for SARI. Probably, the prolonged period of low exposure to pathogens due to the measures adopted during the pandemic might have caused a decrease in population immunity with a rise in severe respiratory infections. (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Respiratory Tract Infections/epidemiology , /complications , Pandemics , Spain/epidemiologyABSTRACT
Objetivos: Describir nuestra experiencia acerca del uso del dímero D (DD) en urgencias pediátricas. Método: Se realiza un estudio descriptivo, retrospectivo. Revisamos todas las historias clínicas de urgencias de nuestro centro en las que se realizó determinación analítica de lDD durante los años 2005 y 2006. Describimos los datos obtenidos y analizamos estadísticamente la asociación del DD con un parámetro de respuesta inflamatoria (la proteína C reactiva) mediante un estudio de correlación no paramétrico. Resultados: Los principales motivos de consulta, en las 137 historias revisadas, fueron exantema y fiebre. El DD resultó positivo en el 34,3% de los casos. No se halló correlación estadísticamente significativa entre el DD y la proteína C reactiva. El DD fue positivo en el 71% de los casos de sepsis. Conclusiones: El DD se eleva en algunos procesos inflamatorios, de manera inespecífica. Su interpretación es difícil y puede llevar a confusión. Es necesario analizarlo en su contexto clínico (AU)
Objectives: To describe our experience using D-dimer levels in attending pediatric emergencies. Methods: For this retrospective descriptive study we reviewed all emergency patient records in which D-dimer levels were measured in 2005 and 2006. We compiled descriptive statistics and analyzed the association between levels of Ddimer and C-reactive protein (as a marker of inflammatory response) using a nonparametric correlation test. Results: Rash and fever were the main reasons for attending the emergency room. The D-dimer level was elevated in34.3% of the cases. D-dimer and C-reactive protein levels were not correlated. The D-dimer level was elevated in 71% of the patients with sepsis. Conclusions: D-dimer elevation is a nonspecific marker in certain inflammatory processes. It is difficult to interpret, may lead to confusion, and should be read in a manner that is consistent with the clinical context. Prospective studies are needed to provide evidence of its utility as a marker in acute conditions in children (AU)
Subject(s)
Humans , Child , Ambulatory Care , Fibrin Fibrinogen Degradation Products/analysis , C-Reactive Protein/analysis , Sepsis/diagnosis , Acute-Phase Reaction/diagnosis , Acute-Phase Reaction/etiology , Biomarkers/blood , Sensitivity and Specificity , Retrospective StudiesABSTRACT
Diffuse mesangial sclerosis (DMS) is a renal disease that usually presents as a nephrotic syndrome. It is characterized by early onset and rapid progression to end-stage renal disease, and can occur as an isolated finding or as part of the Denys-Drash syndrome. The aim of this study was to characterize clinical features and outcomes of DMS in a cohort of children. We retrospectively analyzed all cases of DMS diagnosed in our hospital between 1973 and 2008 and evaluated the progression of the disease in relation to different variables. We studied 14 patients, four with incomplete Denys-Drash syndrome and one with Frasier syndrome. All patients developed renal failure. Eight patients received a renal transplant with no relapse of the disease. Bilateral nephrectomy was performed in nine patients with end-stage renal disease. Seven patients died, with sepsis being the main cause of death. Diffuse mesangial sclerosis must be suspected in a child that presents with early onset proteinuria and/or rapidly progressive renal failure. Karyotype and WT1 gene analysis should be performed because of the predisposition of patients to develop different types of tumors. This nephropathy has a poor prognosis, but the survival rate has improved in the last decade.
