Pediatric chest x-ray in covid-19 infection.

BACKGROUND: The outbreak of COVID-19 has become pandemic. Pediatric population has been less studied than adult population and prompt diagnosis is challenging due to asymptomatic or mild episodes. Radiology is an important complement to clinical and epidemiological features. OBJECTIVE: To establish the most common CXR patterns in children with COVID-19, evaluate interobserver correlation and to discuss the role of imaging techniques in the management of children. MATERIALS AND METHODS: Forty-four patients between 0 and 16 years of age with confirmed SARS-Cov-2 infection and CXR were selected. Two paediatric radiologists independently evaluated the images and assessed the type of abnormality, distribution and evolution when available. RESULTS: Median age was 79.8 months (ranging from 2 weeks to 16 years of age). Fever was the most common symptom (43.5 %). 90 % of CXR showed abnormalities. Peribronchial cuffing was the most common finding (86.3 %) followed by GGOs (50 %). In both cases central distribution was more common than peripheral. Consolidations accounted for 18.1 %. Normal CXR, pleural effusion, and altered cardiomediastinal contour were the least common. CONCLUSION: The vast majority of CXR showed abnormalities in children with COVID-19. However, findings are nonspecific. Interobserver correlation was good in describing consolidations, normal x-rays and GGOs. Imaging techniques have a role in the management of children with known or suspected COVID-19, especially in those with moderate or severe symptoms or with underlying risk factors.

Reacción adversa cutánea asociada al empleo de ketamina intravenosa en urgencias pediátricas / Cutaneous adverse reaction associated with intravenous ketamine in pediatric emergency department

El empleo de sedoanalgesia no invasiva se ha convertido en una herramienta de uso habitual en el manejo del dolor y la ansiedad asociados a la realización de una gran variedad de procedimientos dolorosos en el contexto de urgencias pediátricas. Sin embargo, ciertos procedimientos particularmente dolorosos, como la cura de quemados o la reducción cerrada de fracturas desplazadas, si-guen precisando un grado de sedación más profundo y el empleo de sedoanalgesia invasiva. La ketamina ha demostrado su seguridad y utilidad en el manejo del dolor asociado a procedimientos especialmente agresivos. Presentamos 2 casos de reacción cutánea transitoria secundaria al uso intravenoso de ketamina para el manejo del dolor durante la reducción de fracturas

The employment of noinvasive analgesia has become a common tool in the management of pain and anxiety associated with painful procedures in pediatric emergency department. However some particularly painful procedures such as cure of burned or closed reduction of displaced fractures still required deeper degree of sedation and the use of invasive sedoanalgesia. Ketamine has proved its safety and usefulness in management of pain caused by aggressive procedures. We present two cases of transient skin reactions associated with intravenous use of ketamine in the management of pain associated with the reduction of fractures

Enfermedades metabólicas congénitas en un servicio de urgencias pediátricas / Inherited metabolic disorders in pediatric emergency services

Introducción: Los avances en el diagnóstico precoz y tratamiento han propiciado una mayor supervivencia, y en mejores condiciones, de los pacientes con enfermedades metabólicas congénitas (EMC). Estos pueden acudir a los Servicios de Urgencias Pediátricas (SUP) por motivos relacionados o no con su enfermedad. El propósito de este trabajo fue revisar las características de las visitas al SUP de estos pacientes, en un hospital de tercer nivel. Material y métodos: Se desarrolló un estudio observacional retrospectivo en el que se analizaron todas las visitas al SUP del Hospital Infantil La Paz durante los años 2011 y 2012 de pacientes con EMC. Se registraron el tipo de EMC, el motivo de consulta, el tiempo de evolución de los síntomas, la necesidad de ingreso hospitalario y la presencia de descompensación metabólica. Resultados: En total, fueron analizadas 107 visitas, siendo el motivo de consulta más frecuente los procesos respiratorios (30,8%). Cuando la consulta fue por vómitos, los pacientes con trastornos relacionados con las proteínas fueron los que menos tardaron en acudir al SUP. Un tercio de las visitas se siguió de ingreso, siendo la mitad de ellas por descompensación metabólica de la patología de base. Conclusiones: Los pacientes con EMC acudieron al SUP por motivos muy diversos, que en algunos casos fueron causa o consecuencia de una descompensación metabólica aguda que motivó el ingreso hospitalario. Al tratarse de enfermedades con baja prevalencia individual, resulta de interés contar con protocolos diagnóstico-terapéuticos que faciliten una atención óptima (AU)

Introduction: Advances in the early diagnosis and treatment have led to improved survival, and a better quality of life for patients with inherited metabolic disorders (IMD). They can go to the Pediatric Emergency Services (PES) for reasons unrelated to their disease. The purpose of this study was to review the characteristics of visitors to the PES of these patients in a tertiary hospital. Material and methods: A retrospective observational study was conducted on all visits from patients with IMD to the PES of Hospital Infantil La Paz over the years 2011 and 2012. IMD type, complaint, duration of symptoms, need for hospitalization, and presence of metabolic decompensation was recorded. Results: A total of 107 visits were analyzed, with the most frequent reason being for consultation of respiratory processes (30.8%). When the consultation was for vomiting, patients with protein-related disorders were those who delayed less in going to PES. One third of visitors were admitted, half of them due to metabolic decompensation of the underlying pathology. Conclusions: Patients with IMD came to PES for many different reasons, which in some cases were the cause or consequence of an acute metabolic decompensation that led to hospitalization. Being diseases with low prevalence, it would be useful to have diagnostic and therapeutic protocols in order to provide optimal care (AU)

[Inherited metabolic disorders in pediatric emergency services]. / Enfermedades metabólicas congénitas en un servicio de urgencias pediátricas.

INTRODUCTION: Advances in the early diagnosis and treatment have led to improved survival, and a better quality of life for patients with inherited metabolic disorders (IMD). They can go to the Pediatric Emergency Services (PES) for reasons unrelated to their disease. The purpose of this study was to review the characteristics of visitors to the PES of these patients in a tertiary hospital. MATERIAL AND METHODS: A retrospective observational study was conducted on all visits from patients with IMD to the PES of Hospital Infantil La Paz over the years 2011 and 2012. IMD type, complaint, duration of symptoms, need for hospitalization, and presence of metabolic decompensation was recorded. RESULTS: A total of 107 visits were analyzed, with the most frequent reason being for consultation of respiratory processes (30.8%). When the consultation was for vomiting, patients with protein-related disorders were those who delayed less in going to PES. One third of visitors were admitted, half of them due to metabolic decompensation of the underlying pathology. CONCLUSIONS: Patients with IMD came to PES for many different reasons, which in some cases were the cause or consequence of an acute metabolic decompensation that led to hospitalization. Being diseases with low prevalence, it would be useful to have diagnostic and therapeutic protocols in order to provide optimal care.

Intoxicación por Spartium junceum (Spanish broom) / Spartium junceum (Spanish broom) poisoning

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Osteomielitis aguda: epidemiología, manifestaciones clínicas, diagnóstico y tratamiento / Acute osteomyelitis: epidemiology, clinical manifestations, diagnosis and treatment

Introducción: El presente estudio revisa la epidemiología, las manifestaciones clínicas y el manejo de los casos de osteomielitis aguda (OA) ingresados en un hospital pediátrico de tercer nivel. Metodología: Estudio descriptivo de los pacientes menores de 15 años ingresados con el diagnóstico de OA entre 2000 y 2011, retrospectivo hasta 2006, y posteriormente prospectivo. Resultados: Se identificaron 50 pacientes (52% varones) con una mediana de edad de 2 años. La sintomatología preponderante al ingreso fue dolor (94%), impotencia funcional (90%) y fiebre (72%). Las localizaciones más frecuentes fueron el fémur (32%), la tibia (28%) y el calcáneo (22%). Se encontró leucocitosis >12.000/μl en el 56%, VSG elevada >20mm/h en un 26 y un 64% con PCR superior a 20mg/l. El 20% de los hemocultivos resultó positivo, siendo Streptococcus del grupo A el germen más frecuente (11%).La gammagrafía ósea con 99Tc permitió el diagnóstico de confirmación en todos los casos. El tratamiento antibiótico fue intravenoso (i.v.) durante una media de 10 días ±3 DE, continuándose por vía oral (v.o.) una media de 18 días ±6 DE. Tres pacientes requirieron drenaje quirúrgico. La evolución en todos los pacientes fue excelente, salvo 3 excepciones, que se resolvieron con el tiempo. Conclusiones: La actual pauta corta de tratamiento i.v. disminuyó la estancia hospitalaria. Tras su instauración no se encontraron diferencias estadísticamente significativas en la duración de la clínica, ni en la PCR en el momento del alta en comparación con las pautas prolongadas previas a 2006 (AU)

Background and aims: The present study focuses on the epidemiology, clinical and laboratory data, and management of osteomyelitis in a pediatric third level hospital. Methodology: All cases of children under 15 years-old admitted with osteomyelitis between 2000 and 2011 were retrospectively reviewed until July 2006, then prospectively from then until 2011.Results: A total of 50 patients were identified (52% males) with median age at diagnosis of 2 years. Principal onset manifestations were pain (94%), functional impairment (90%) and fever (72%). The femur (32%), fibula (28%) and calcaneus (22%) were most affected bones. Leucocytosis > 12.000/micre l was found in 56%, elevated ESR > 20 mm/h in 26%, and elevated CRP > 20 mg/L in 64%. Blood culture was positive in 20%, with group A streptococcus being the most frequently isolated bacteria (11%).All diagnoses were confirmed by a 99Tc scintigraphy bone scan. Antibiotic therapy was initially intravenously (mean time of administration: 10 days ± 3SD), followed by oral medication (mean time of administration: 18 days±6 SD). Surgery was necessary in 3 patients. Evolution of all cases was excellent, despite 3 exceptions that resolved over time. Conclusions: The current short-term intravenous therapy led to shorter hospitalizations. There were no statistically significant differences between time from clinical onset or in CRP levels at discharge compared to long-term therapies prior to 2006 (AU)

[Acute osteomyelitis: epidemiology, clinical manifestations, diagnosis and treatment]. / Osteomielitis aguda: epidemiología, manifestaciones clínicas, diagnóstico y tratamiento.

BACKGROUND AND AIMS: The present study focuses on the epidemiology, clinical and laboratory data, and management of osteomyelitis in a pediatric third level hospital. METHODOLOGY: All cases of children under 15 years-old admitted with osteomyelitis between 2000 and 2011 were retrospectively reviewed until July 2006, then prospectively from then until 2011. RESULTS: A total of 50 patients were identified (52% males) with median age at diagnosis of 2 years. Principal onset manifestations were pain (94%), functional impairment (90%) and fever (72%). The femur (32%), fibula (28%) and calcaneus (22%) were most affected bones. Leucocytosis > 12.000/µl was found in 56%, elevated ESR > 20 mm/h in 26%, and elevated CRP > 20 mg/L in 64%. Blood culture was positive in 20%, with group A streptococcus being the most frequently isolated bacteria (11%). All diagnoses were confirmed by a (99)Tc scintigraphy bone scan. Antibiotic therapy was initially intravenously (mean time of administration: 10 days ± 3 SD), followed by oral medication (mean time of administration: 18 days ± 6 SD). Surgery was necessary in 3 patients. Evolution of all cases was excellent, despite 3 exceptions that resolved over time. CONCLUSIONS: The current short-term intravenous therapy led to shorter hospitalizations. There were no statistically significant differences between time from clinical onset or in CRP levels at discharge compared to long-term therapies prior to 2006.

Recién nacido con dificultad respiratoria y desplazamiento del latido cardíaco a la derecha / Neonate with respiratory distress and rightward displacement of the cardiac impulse

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Diversidad de sintomatología y abordaje en un Síndrome de Patau / Patau Syndrome: clincial diversity and approach

El Síndrome de Patau, también conocido comotrisomía D o trisomía 13, está causado por una mutacióndel cromosoma 13 con alteración de la divisióncelular, constituyendo la tercera cromosomopatíaen frecuencia. A continuación se describe el casode un recién nacido mujer con múltiples anomalíascongénitas al nacimiento compatible con síndromede Patau, que carece de diagnóstico antenatal, confirmándoseposteriormente mediante estudio genético(cariotipo). Diferentes guías diagnósticas, quedescriben patrones de reconocimiento, son útilespara identificar síndromes con sintomatología diversa.Debido a los cambios poblacionales en los últimosaños, se ha incrementado el número de embarazosno controlados, lo que supone el aumento desíndromes dismórficos diagnosticados al nacimiento.Es de gran importancia definir el manejo de estosniños en consenso con sus progenitores por su evolucióntórpida y fatal desenlace en la mayoría de loscasos

Patau syndrome, known as D trisomy or trisomy13, is caused by a mutation in chromosome 13 withaltered cellular division. It is the third most frequentchromosomopathy. We report a female newborn withoutantenatal diagnosis presented at birth with multiplecongenital anomalies compatible with Patausyndrome, which is confirmed later by cytogeneticstudies (cariotype). Different diagnostic guidelinesthat describe recognition patterns are useful to identifysyndromes with diverse symptomatology. Due topopulation changes in last years, there is an increasednumber of no controlled pregnancies resulting inmore diagnosis of dysmorphic syndromes presentedat birth. Is essential to define the management ofthese children in consensus with parents because of their omminous evolution and fatal outcome in mostcases (AU)