NUM-score: A clinical-analytical model for personalised imaging after urinary tract infections.

AIM: To identify predictive variables and construct a predictive model along with a decision algorithm to identify nephrourological malformations (NUM) in children with febrile urinary tract infections (fUTI), enhancing the efficiency of imaging diagnostics. METHODS: We performed a retrospective study of patients aged <16 years with fUTI at the Emergency Department with subsequent microbiological confirmation between 2014 and 2020. The follow-up period was at least 2 years. Patients were categorised into two groups: 'NUM' with previously known nephrourological anomalies or those diagnosed during the follow-up and 'Non-NUM' group. RESULTS: Out of 836 eligible patients, 26.8% had underlying NUMs. The study identified six key risk factors: recurrent UTIs, non-Escherichia coli infection, moderate acute kidney injury, procalcitonin levels >2 µg/L, age <3 months at the first UTI and fUTIs beyond 24 months. These risk factors were used to develop a predictive model with an 80.7% accuracy rate and elaborate a NUM-score classifying patients into low, moderate and high-risk groups, with a 10%, 35% and 93% prevalence of NUM. We propose an algorithm for approaching imaging tests following a fUTI. CONCLUSION: Our predictive score may help physicians decide about imaging tests. However, prospective validation of the model will be necessary before its application in daily clinical practice.

An Adolescent Female With Acute Abdominal Pain: A Rare Case in Pediatrics.

We present the case of a 13-year-old female with a 48-hour history of diffuse abdominal pain, fever, nausea, and vomiting, with worsening in the last few hours. On examination, she had signs of acute abdomen, and laboratory tests showed elevated acute phase reactants (APR). Abdominal ultrasound excluded acute appendicitis. A history of risky sexual behavior was reported, so pelvic inflammatory disease (PID) was considered. Although appendicitis is the most common cause of acute abdomen in adolescents, PID should be suspected in adolescents with risk factors. Prompt treatment is necessary to avoid possible complications and sequelae.

Amoxicillin overdose in the pediatric emergency department: A descriptive study.

OBJECTIVE: To describe the characteristics of pediatric patients treated in the  emergency department due to amoxicillin overdosing. METHOD: A retrospective single-center observational study was conducted on  patients aged 0 to 16 years treated in a pediatric emergency department due  to amoxicillin overdosing between 2011 and 2021. Epidemiological and  anthropometric data was collected as well as information on the circumstances  of overdosing, clinical manifestations, emergency department management,  and discharge destination. RESULTS: The study comprised 15 patients, 66.6% of them male, with a median age of 3.8 years (interquartile range: 1.9). The most frequent cause  of overdosing was accidental ingestion (8/15; 53.3%). Amoxicillin was mainly ingested in liquid form, except for one case with autolytic attempt,  where it was ingested in the form of tablets. Eighty percent of subjects (12/15) received a single dose of the drug. The median time to presentation to  emergency department was 2.1 hours from ingestion (interquartile range: 2.7) and the median dose of amoxicillin was 219 mg/kg/dose (interquartile range:  148). All patients were asymptomatic, with a normal physical examination.  Blood tests were performed in 7 patients (46.6%) and urinary sediment  analysis in 2 (13.3%), all of them without alterations. Activated charcoal was  administered to 5 (33.3%), patients with a median time to administration of  one hour (interquartile range: 1.2). All patients were discharged to their  homes. Eleven cases (73.3%) required withdrawal of amoxicillin. CONCLUSIONS: Amoxicillin overdosing in this study did not appear to result in  adverse effects, despite the fact that the recommended doses were  significantly exceeded.

OBJETIVO: Describir las características de los pacientes pediátricos atendidos en urgencias por sobreingesta de amoxicilina.Método: Estudio unicéntrico observacional, retrospectivo, en pacientes de 0- 16 años atendidos en urgencias pediátricas por sobreingesta de amoxicilina  entre 2011 y 2021. Se analizaron datos epidemiológicos, antropométricos,  circunstancias de la sobreingesta, síntomas, manejo y destino. RESULTADOS: Se incluyeron 15 pacientes, 66,6% varones, mediana de edad de  3,8 años (rango intercuartílico 1,9). La causa más frecuente de sobreingesta  fue la ingesta accidental por el paciente (8/15; 53,3%). Fue administrada en  forma de suspensión en todos los casos, excepto en un paciente con intención  autolítica (comprimidos). El 80% (12/15) recibieron una única dosis. La  mediana de tiempo de llegada a urgencias desde la sobreingesta fue de 2,1  horas (rango intercuartílico 2,7) y la mediana de dosis de 219 mg/kg/dosis  (rango intercuartílico 148). Todos estaban asintomáticos con exploración  normal. Se realizó analítica sanguínea en 7 (46,6%) y sedimento urinario en 2 (13,3%), sin alteraciones. Cinco (33,3%) recibieron carbón activado, con una mediana de tiempo hasta la administración de 1 hora (rango intercuartílico  1,2). Todos fueron dados de alta, suspendiendo el tratamiento 11 (73,3%). CONCLUSIONES: En este estudio, la sobredosificación de amoxicilina no se  relacionó con efectos adversos, a pesar de exceder las dosis recomendadas.

Sobredosificación por amoxicilina en urgencias pediátricas: Estudio descriptivo / Amoxicillin overdose in the pediatric emergency department: A descriptive study

Objetivo: Describir las características de los pacientes pediátricos atendidos en urgencias por sobreingesta de amoxicilina.Método: Estudio unicéntrico observacional, retrospectivo, en pacientesde 0-16 años atendidos en urgencias pediátricas por sobreingesta deamoxicilina entre 2011 y 2021. Se analizaron datos epidemiológicos,antropométricos, circunstancias de la sobreingesta, síntomas, manejo ydestino.Resultados: Se incluyeron 15 pacientes, 66,6% varones, medianade edad de 3,8 años (rango intercuartílico 1,9). La causa más frecuente de sobreingesta fue la ingesta accidental por el paciente (8/15;53,3%). Fue administrada en forma de suspensión en todos los casos,excepto en un paciente con intención autolítica (comprimidos). El 80%(12/15) recibieron una única dosis. La mediana de tiempo de llegadaa urgencias desde la sobreingesta fue de 2,1 horas (rango intercuartílico 2,7) y la mediana de dosis de 219 mg/kg/dosis (rango intercuartílico 148). Todos estaban asintomáticos con exploración normal. Serealizó analítica sanguínea en 7 (46,6%) y sedimento urinario en 2(13,3%), sin alteraciones. Cinco (33,3%) recibieron carbón activado,con una mediana de tiempo hasta la administración de 1 hora (rangointercuartílico 1,2). Todos fueron dados de alta, suspendiendo el tratamiento 11 (73,3%). (AU)

Objective: To describe the characteristics of pediatric patients treated inthe emergency department due to amoxicillin overdosing.Method: A retrospective single-center observational study was conducted on patients aged 0 to 16 years treated in a pediatric emergencydepartment due to amoxicillin overdosing between 2011 and 2021. Epidemiological and anthropometric data was collected as well as information on the circumstances of overdosing, clinical manifestations, emergency department management, and discharge destination.Results: The study comprised 15 patients, 66.6% of them male, with amedian age of 3.8 years (interquartile range: 1.9). The most frequent cause ofoverdosing was accidental ingestion (8/15; 53.3%). Amoxicillin was mainlyingested in liquid form, except for one case with autolytic attempt, where itwas ingested in the form of tablets. Eighty percent of subjects (12/15) received a single dose of the drug. The median time to presentation to emergencydepartment was 2.1 hours from ingestion (interquartile range: 2.7) and themedian dose of amoxicillin was 219 mg/kg/dose (interquartile range: 148).All patients were asymptomatic, with a normal physical examination. Bloodtests were performed in 7 patients (46.6%) and urinary sediment analysis in2 (13.3%), all of them without alterations. Activated charcoal was administered to 5 (33.3%), patients with a median time to administration of one hour(interquartile range: 1.2). All patients were discharged to their homes. Elevencases (73.3%) required withdrawal of amoxicillin. (AU)

Transient Hyperphosphatasemia Due to Pomegranate Juice.

In most cases, feeding problems in young children are mild and of no consequence. However, it is one of the situations that generate more anxiety in parents and can lead them to incorrect feeding patterns. We present the case of a 20-month-old male child who came to the emergency room with a pathological elevation of alkaline phosphatase secondary to an error in his dietary pattern.