Calidad de vida en pacientes con esclerosis sistémica en confinamiento por pandemia de COVID-19 en Argentina / Quality of life in patients with systemic sclerosis in confinement due to the COVID-19 pandemic in Argentina

Introducción: los pacientes con enfermedades reumáticas tienen una calidad de vida significativamente deteriorada. La pandemia por COVID-19 tuvo un notable impacto sobre la población y los sistemas de salud de todo el mundo. Objetivos: en este trabajo nos proponemos conocer el impacto de la pandemia en la calidad de vida de los pacientes con esclerosis sistémica (ES) y cómo fue el acceso a la atención médica. Materiales y métodos: mediante encuestas anónimas y digitales a pacientes durante julio y agosto de 2020 se evaluó la calidad de vida utilizando el cuestionario de calidad de vida de la esclerosis sistémica (SScQoL). Además, se realizaron preguntas para evaluar el acceso al sistema de salud durante ese período. Resultados: se encuestaron 300 pacientes con ES. La mediana de afectación de la calidad de vida según el cuestionario utilizado fue de 17 (9,25-22) y el dolor fue el dominio más afectado. El 29,33% no hizo los controles médicos. El 74,33% refirió haber tenido estudios médicos pendientes al inicio de la cuarentena y solo el 25% pudo realizarlos. Conclusiones: los pacientes con ES presentaron compromiso de la calidad de vida durante la pandemia y mostraron dificultades en el acceso al sistema de salud.

Introduction: patients with rheumatic diseases have a significantly impaired quality of life. The COVID-19 pandemic has had a significant impact on the population and health systems around the world. Objectives: to analyze the impact of the pandemic on the quality of life and access to medical care of patients with systemic sclerosis (SS). Materials and methods: through anonymous and digital surveys of patients during July and August 2020, quality of life was assessed using the Systemic Sclerosis Quality of Life Questionnaire (SScQoL). In addition, questions were asked to assess access to the health system during that period. Results: 300 patients with SS were surveyed. The median quality of life affectation according to the questionnaire used was 17 (9.25-22), with pain being the most affected domain. Twenty-nine percent did not attend their medical appointments, 74.33% reported having pending medical studies at the beginning of the quarantine, and only 25% could carry them out. Conclusions: patients with SS presented compromised quality of life during the pandemic and showed difficulties in accessing the health system.

Taller de concordancia en la evaluación de imágenes capilaroscópicas / Reliability of nailfold videocapillaroscopy workshop

Introducción: la capilaroscopia es un método no invasivo que permite observar la microvasculatura en el área periungueal. Los resultados informados pueden ser altamente variables entre distintos observadores. A lo largo del tiempo surgieron métodos cuantitativos y semicuantitativos para mejorar la reproducibilidad. Objetivos: conocer el nivel de acuerdo intra e interobservador al informar los diferentes patrones capilaroscópicos en individuos con diferente nivel de entrenamiento. Materiales y métodos: estudio de corte transversal. Participaron médicos reumatólogos especialistas y en formación que habían realizado previamente un curso virtual de capacitación en capilaroscopia. Recibieron 40 imágenes capilaroscópicas proyectadas en una presentación de PowerPoint y debían responder a través de un cuestionario digital. Se evaluó la concordancia de respuestas intra e interobservador. Resultados: se encontró un alto nivel de concordancia global con un kappa 0,66 IC 95% (0,63-0,70) p<0,0000. También en otros grupos como reumatólogos en formación: kappa 0,65 IC 95% (0,60-0,71) p=0,0000, y médicos reumatólogos: kappa 0,67 IC 95% (0,62-0,72) p=0,0000. Conclusiones: el nivel de concordancia encontrado fue globalmente alto, independientemente del nivel de entrenamiento de los profesionales, y de ser o no reumatólogo. La concordancia fue superior cuando se comparó a quienes tenían más de 4 años de experiencia en la realización de videocapilaroscopia.

Introduction: videoapillaroscopy is a non-invasive method that allows the observation of the microvasculature in the periungual area. Reported results can be highly variable between different observers. Over time, quantitative and semi-quantitative methods emerged to improve reproducibility. Objetives: to know the level of intra and interobserver agreement when reporting the different capillaroscopic patterns in individuals with different levels of training. Materials and methods: cross section study. Specialist rheumatologists and those in training who had previously completed a virtual capillaroscopy training course participated. They received 40 capillaroscopic images projected in a PowerPoint presentation and had to issue their response through a digital questionnaire. Concordance of intra and interobserver responses was evaluated. Results: a high level of global agreement was found with a kappa 0.66 CI 95% (0.63-0.70) p<0.0000, also in other groups such as rheumatologists in training: kappa 0.65 CI 95% (0.60-0.71) p=0.0000, physicians rheumatologists: kappa 0.67 95% CI (0.62-0.72) p=0.0000. Conclusions: the level of agreement found was globally high, regardless of the level of training of the professionals, and whether or not they were a rheumatologist. Concordance was higher when compared to those who had more than 4 years of experience performing videocapillaroscopy.

Características clínicas de los pacientes con parálisis cerebral infantil portadores de gastrostomía atendidos en un instituto especializado de salud de Lima, Perú

Introducción: La parálisis cerebral infantil constituye una condición importante de discapacidad, y el trastorno motor suele acompañarse de otras comorbilidades como los trastornos de deglución. La gastrostomía en pacientes que son incapaces de alimentarse de manera satisfactoria es una intervención importante y cada vez más frecuente. Objetivo: Determinar las características clínicas de los pacientes con parálisis cerebral infantil portadores de gastrostomía atendidos en el Instituto Nacional de Salud del Niño entre 2013 y 2017. Métodos: Estudio tipo serie de casos de pacientes con diagnóstico de PCI portadores de gastrostomía atendidos en el Instituto de Salud del Niño durante 2013 - 2017. Resultados: Se incluyeron 74 pacientes. La edad promedio de colocación de gastrostomía fue a los 5,8 años, la indicación más frecuente fue el trastorno de deglución. El PCI tipo espástico (74,3%) y el nivel funcional IV y V (96%) fueron las principales características clínicas. El sexo masculino (58,1%), el antecedente de parto pretérmino (54%) y la etiología perinatal (45,9%) fueron hallazgos similares a las descritas en la población con PCI. El promedio de atenciones por consulta externa fue 5,8 atenciones/año, por emergencia 1,8 atenciones/año y el de hospitalizaciones 1,3 veces/año. Conclusiones: La gastrostomía se colocó en pacientes con un gran compromiso motor, y alta dependencia para sus actividades. El tipo espástico, y la etiología perinatal, fueron los hallazgos clínicos más frecuentes. Las atenciones anuales por consulta externa fueron en promedio bajas, lo que muestra que falta mucho para implementar un trabajo multidisciplinario en este grupo de pacientes.

Introduction: Cerebral palsy is an important disability condition, and the motor disorder is usually accompanied by other comorbidities such as swallowing disorders. Gastrostomy in patients who are unable to feed satisfactorily is an important and increasingly common intervention. Objective: To determine the clinical characteristics of patients with infantile cerebral palsy with gastrostomy treated at the National Institute of Children's Health between 2013 and 2017. Methods: Case series study of patients diagnosed with PCI with gastrostomy treated at the Children's Health Institute during 2013 2017. Results: 74 patients were included. The average age of gastrostomy placement was 5,8 years, the most frequent indication was swallowing disorder. Spastic type PCI (74,3%) and functional level IV and V (96%) were the main clinical characteristics. Male sex (58,1%), history of preterm delivery (54%) and perinatal etiology (45.9%) were findings like those described in the population with PCI. The average number of outpatient visits was 5,8 times/year, for emergencies 1,8 times/year and for hospitalizations 1,3 times/year. Conclusions: The gastrostomy was placed in patients with a great motor commitment, and high dependency for their activities. The spastic type and perinatal etiology were the most frequent clinical findings. Annual outpatient visits were low on average, which shows that there is still a long way to go to implement multidisciplinary work in this group of patients.

Vacunación contra SARS-CoV-2 en pacientes con esclerosis sistémica en Argentina: preferencias, acceso y adherencia al plan de vacunación / Vaccination against SARS-CoV-2 in patients with systemic sclerosis in Argentina: preferences, access and adherence to the vaccination plan

Introducción: en pacientes con enfermedades reumatológicas autoinmunes se recomienda la aplicación sistemática y secuencial de una serie de vacunas para la prevención de enfermedades transmisibles. El objetivo de este estudio fue estimar la proporción de pacientes con esclerosis sistémica (ES) que recibieron vacunación contra el coronavirus (SARS-CoV-2). Materiales y métodos: se envió una encuesta anónima por correo electrónico o contacto por WhatsApp desde mayo a septiembre de 2021, con preguntas para evaluar la adherencia al esquema de vacunación recomendado en pacientes con enfermedades reumatológicas, así como temores, preferencias y adherencia al esquema de vacunación contra el SARS-CoV-2. Resultados: se incluyeron 295 pacientes con ES. El 68,81% estaba vacunado contra el SARS-CoV-2 con al menos una dosis, de los cuales el 48,7% tenía dos dosis. El 84,75% refirió conversar con su médico sobre su esquema de vacunación general. Solo el 5,4% tenía las cuatro vacunas. El 93,56% manifestó voluntad de vacunarse contra el SARS-CoV-2; el 56,27% prefirió la vacuna Sputnik V. El 7,46% manifestó su voluntad de no vacunarse. Los factores que influyeron en la adherencia a la vacunación, con mayor frecuencia, fueron el miedo a contraer la infección por SARS-CoV-2 (86,1%) y las reacciones adversas (23,05%). Conclusiones: destacamos el hecho de que solo 6 meses después de que se dispusiera la vacunación contra el SARS-CoV-2, la mitad de los pacientes con ES tenía el esquema recomendado completo.

Introduction: in patients with autoimmune rheumatic diseases, the systematic and sequential application of a series of vaccines is recommended for the prevention of communicable diseases. The objective was to estimate the proportion of patients with systemic sclerosis (SSc) who received vaccination against coronavirus (SARS-CoV-2). Materials and methods: since may to september 2021, an anonymous survey was sent by email or messaging app, containing questions to assess adherence to the recommended vaccination schedule in patients with rheumatic diseases, as well as fears, preferences and adherence to vaccination schedule against SARS-CoV-2. Results: 295 patients with SSc were included. 68.81% were vaccinated for SARS-CoV-2 with at least one dose, 48.7% of this group had two doses. 84.75% reported talking to their doctor about their general vaccination schedule. Only 5.4% had all four vaccines. 93.56% expressed willingness to be vaccinated against SARS-CoV-2, 56.27% preferred the Sputnik V vaccine. 7.46% expressed their willingness to not be vaccinated. The factors that most frequently influenced adherence to vaccination were fear of contracting SARS-CoV-2 infection (86.1%) and adverse reactions (23.05%). Conclusions: we highlight the fact that only 6 months after vaccination against SARS-CoV-2 became available, half of the patients with SSc had the full recommended schedule.

Disfunción sexual en mujeres con esclerosis sistémica / Sexual dysfunction in women with systemic sclerosis

Introducción: la disfunción sexual (DS) es común entre las mujeres con enfermedades crónicas, incluyendo esclerosis sistémica (ES). Se ha asociado con características como la duración de la enfermedad, dolor, disminución de la actividad funcional, entre otras. Desde nuestro conocimiento, aún no contamos con datos locales. Objetivos: evaluar la frecuencia de DS en mujeres con ES; describir las características sociodemográficas, clínicas y psicológicas asociadas con la DS en mujeres con ES. Materiales y métodos: estudio observacional, analítico y de corte transversal. Se incluyeron mujeres de entre 20 y 59 años con diagnóstico de ES, según los criterios de clasificación del European League Against Rheumatism/American College of Rheumatology (ACR/EULAR 2013). Se excluyeron pacientes con enfermedades crónicas no controladas, otras patologías reumatológicas autoinmunes, e inactividad sexual o patología genitourinaria no relacionadas a ES en las últimas 4 semanas. La DS se evaluó con la versión en español del cuestionario índice de función sexual femenina (Female sexual function index, FSFI). Resultados: se incluyeron 56 pacientes. El 78,57% presentó DS y 19,64% era sexualmente inactiva debido a la enfermedad. Escala visual análoga (EVA) de fatiga (coeficiente β: -0,08, IC 95%: -0,14 a -0,02; p<0,01), edad (coeficiente β: -0,23, IC 95%: -0,40 a -0,05; p=0,01) y fibromialgia (coeficiente β: -11,90, IC 95%: -17,98 a -5,82; p<0,01) mostraron una asociación significativa e independiente con DS en el análisis multivariado. Conclusiones: la DS es frecuente entre las mujeres con ES, y las pacientes más jóvenes, sin fibromialgia y con menor fatiga presentaron una mejor funcionalidad sexual.

Introduction: sexual impairment (SI) is common among women with chronic diseases, including systemic sclerosis (SSc). It has been associated with characteristics such as the duration of the disease, pain, decreased functional activity, among others. To the best of our knowledge, we still do not have local data. Objectives: to evaluate the frequency of SI in women with SSc. To describe the sociodemographic characteristics, disease itself and psychological items associated with SI in women with SSc. Materials and methods: observational, analytical, cross-sectional study. We included women between 20 and 59 years diagnosed with SSc according to 2013 classification criteria ACR/EULAR. We excluded patients with uncontrolled chronic diseases or other autoimmune rheumatologic diseases and patients who, in the last 4 weeks, had dyspareunia or were sexually inactive due to causes not attributable to their disease. SI was assessed using the Spanish version of female sexual function index questionnaire (FSFI). Results: 56 patients were included. 78.57% presented SI and 19.64% of them were sexually inactive patients due to the disease. Fatigue VAS (β coefficient: -0.08, CI 95%: -0.14 to -0.02; p<0.01), age (β coefficient: -0.23, CI 95%: -0.40 to -0.05; p=0.01) and fibromyalgia (β coefficient: -11.90, CI 95%: -17.98 to -5.82; p<0.01) showed significant and independent association with SI in the multivariate analysis. Conclusions: SI is frequent among women with SSc, and younger patients, without fibromyalgia and with less fatigue have better sexual function.

Disfunción sexual en mujeres con esclerosis sistémica / Sexual dysfunction in women with systemic sclerosis

Introducción: la disfunción sexual (DS) es común entre las mujeres con enfermedades crónicas, incluyendo esclerosis sistémica (ES). Se ha asociado con características como la duración de la enfermedad, dolor, disminución de la actividad funcional, entre otras. Desde nuestro conocimiento, aún no contamos con datos locales. Objetivos: evaluar la frecuencia de DS en mujeres con ES; describir las características sociodemográficas, clínicas y psicológicas asociadas con la DS en mujeres con ES. Materiales y métodos: estudio observacional, analítico y de corte transversal. Se incluyeron mujeres de entre 20 y 59 años con diagnóstico de ES, según los criterios de clasificación del European League Against Rheumatism/American College of Rheumatology (ACR/EULAR 2013). Se excluyeron pacientes con enfermedades crónicas no controladas, otras patologías reumatológicas autoinmunes, e inactividad sexual o patología genitourinaria no relacionadas a ES en las últimas 4 semanas. La DS se evaluó con la versión en español del cuestionario índice de función sexual femenina (Female sexual function index, FSFI). Resultados: se incluyeron 56 pacientes. El 78,57% presentó DS y 19,64% era sexualmente inactiva debido a la enfermedad. Escala visual análoga (EVA) de fatiga (coeficiente ß: -0,08, IC 95%: -0,14 a -0,02; p<0,01), edad (coeficiente ß: -0,23, IC 95%: -0,40 a -0,05; p=0,01) y fibromialgia (coeficiente ß: -11,90, IC 95%: -17,98 a -5,82; p<0,01) mostraron una asociación significativa e independiente con DS en el análisis multivariado. Conclusiones: la DS es frecuente entre las mujeres con ES, y las pacientes más jóvenes, sin fibromialgia y con menor fatiga presentaron una mejor funcionalidad sexual.

Introduction: sexual impairment (SI) is common among women with chronic diseases, including systemic sclerosis (SSc). It has been associated with characteristics such as the duration of the disease, pain, decreased functional activity, among others. To the best of our knowledge, we still do not have local data. Objectives: to evaluate the frequency of SI in women with SSc. To describe the sociodemographic characteristics, disease itself and psychological items associated with SI in women with SSc. Materials and methods: observational, analytical, cross-sectional study. We included women between 20 and 59 years diagnosed with SSc according to 2013 classification criteria ACR/EULAR. We excluded patients with uncontrolled chronic diseases or other autoimmune rheumatologic diseases and patients who, in the last 4 weeks, had dyspareunia or were sexually inactive due to causes not attributable to their disease. SI was assessed using the Spanish version of female sexual function index questionnaire (FSFI). Results: 56 patients were included. 78.57% presented SI and 19.64% of them were sexually inactive patients due to the disease. Fatigue VAS (ß coefficient: -0.08, CI 95%: -0.14 to -0.02; p<0.01), age (ß coefficient: -0.23, CI 95%: -0.40 to -0.05; p=0.01) and fibromyalgia (ß coefficient: -11.90, CI 95%: -17.98 to -5.82; p<0.01) showed significant and independent association with SI in the multivariate analysis. Conclusions: SI is frequent among women with SSc, and younger patients, without fibromyalgia and with less fatigue have better sexual function.

[Neurological manifestations in pediatric patients with COVID-19: case report]. / Manifestaciones neurológicas en pacientes pediátricos con COVID-19: reporte de casos.

The COVID-19 pandemic currently affects millions of people including the pediatric population. The clinical manifestations in children are diverse: respiratory, gastrointestinal, hematological, neurological and systemic. In order to describe the various clinical and neurological manifestations during the evolution of the disease, we documented a series of cases of pediatric patients with COVID-19. Various mechanisms are proposed through which SARS-CoV-2 would cause neurological injury (direct injury, secondary to an immune response, among others) with variable clinical characteristics (seizures, muscle weakness, sensorial disorder). Studies on clinical characteristics and prognostic factors in children and adolescents with SARS-CoV-2 are limited, therefore, this report provides a spectrum of neurological manifestations associated with SARS-CoV-2 in pediatric population.

La pandemia por la COVID-19 afecta actualmente a millones de personas sin exceptuar la población pediátrica. Las manifestaciones clínicas en niños son variables: respiratorias, gastrointestinales, hematológicas, neurológicas y sistémicas. Con el objetivo de describir las diversas presentaciones clínicas y neurológicas durante la evolución de la enfermedad se documentó una serie de casos de pacientes pediátricos con la COVID-19. Se plantean diversos mecanismos a través de los cuales el SARS-CoV-2 causaría daño neurológico (daño directo, secundario a respuesta inmune, entre otras) con características clínicas variables (convulsiones, debilidad muscular, trastorno del sensorio). Los estudios sobre características clínicas y factores pronósticos en niños y adolescentes con SARS-CoV-2 son limitados, por lo cual el presente reporte contribuye con un espectro de manifestaciones neurológicas asociadas al SARS-CoV-2 en población pediátrica.

Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in central american people living with HIV.

OBJECTIVES: Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory assays, based on microscopy and culture, are not optimal for the diagnosis of either disease. However, antigen (Ag) assays are rapid and highly accurate for the diagnosis of these infections. METHODS: Laboratory surveillance of PLHIV was carried out in four hospitals in Panama, Honduras and Nicaragua, between 2015 and 2019. Detection of Histoplasma antigens in urine was performed by enzyme immunoassay (EIA), and Cryptococcus antigen detection in sera and cerebrospinal fluid specimens was performed by lateral flow assay (LFA). RESULTS: A total of 4,453 PLHIV with clinical suspicion of histoplasmosis (n = 1,343) or cryptococcosis (n = 3,110; 2,721 sera and 389 CSF) were tested. Of 1,343 patients suspected of having histoplasmosis, 269 (20%) were Histoplasma Ag positive. Of 3,110 patients tested using the Cryptococcus Ag assay, 329 (11%) were positive. Honduras reported the highest positivity rates (32% for Histoplasma Ag, and 16% for Cryptococcus Ag); Panama reported the largest number of patients testing positive using the Histoplasma Ag assay (n = 201); and Nicaragua reported the largest number of patients testing positive using the Cryptococcus Ag assay (n = 170). CONCLUSION: Here, we show how the implementation of rapid diagnostics assays impacted case detection and was useful for the care of people with advanced HIV. Rapid and accurate diagnosis could reduce mortality associated with histoplasmosis and cryptococcosis in PLHIV.

Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study.

BACKGROUND: Cryptococcal meningitis is a major cause of death among people with human immunodeficiency virus (PWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high-incidence areas. However, limited data exist on CrAg prevalence in Central America. METHODS: We conducted a prospective cohort study at the 2 largest human immunodeficiency virus (HIV) clinics and hospitals in Honduras. Cryptococcal antigen in serum and cerebrospinal fluid was performed in individuals with HIV who had CD4 ≤100 cells/mm3 between 2017 and 2018. After CrAg testing, individuals were observed for 12 months to assess mortality using adjusted Cox proportional hazard models. RESULTS: A total of 220 PWH were tested for CrAg, 12.7% (n = 28) of which tested positive. Cryptococcal antigen prevalence was higher among hospitalized individuals in 40% (n = 10 of 25) of the cases. The proportion (35.8%) of individuals taking antiretroviral therapy was significantly (P < .01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n = 25 of 220) by 12 months. Cryptococcal antigen-positive cases were at a significantly higher risk of death (adjusted hazard ratio, 2.69; 95% confidence interval, 1.07-6.84) compared with CrAg-negative participants. CONCLUSIONS: Cryptococcal antigen prevalence in Honduras was high among PWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PWH with a CD4 ≤100 cells/mm3 should be routinely performed in Central America.

Manifestaciones neurológicas en pacientes pediátricos con COVID-19: reporte de casos / Neurological manifestations in pediatric patients with COVID-19: case report

La pandemia por la COVID-19 afecta actualmente a millones de personas sin exceptuar la población pediátrica. Las manifestaciones clínicas en niños son variables: respiratorias, gastrointestinales, hematológicas, neurológicas y sistémicas. Con el objetivo de describir las diversas presentaciones clínicas y neurológicas durante la evolución de la enfermedad se documentó una serie de casos de pacientes pediátricos con la COVID-19. Se plantean diversos mecanismos a través de los cuales el SARS-CoV-2 causaría daño neurológico (daño directo, secundario a respuesta inmune, entre otras) con características clínicas variables (convulsiones, debilidad muscular, trastorno del sensorio). Los estudios sobre características clínicas y factores pronósticos en niños y adolescentes con SARS-CoV-2 son limitados, por lo cual el presente reporte contribuye con un espectro de manifestaciones neurológicas asociadas al SARS-CoV-2 en población pediátrica.

The COVID-19 pandemic currently affects millions of people including the pediatric population. The clinical manifestations in children are diverse: respiratory, gastrointestinal, hematological, neurological and systemic. In order to describe the various clinical and neurological manifestations during the evolution of the disease, we documented a series of cases of pediatric patients with COVID-19. Various mechanisms are proposed through which SARS-CoV-2 would cause neurological injury (direct injury, secondary to an immune response, among others) with variable clinical characteristics (seizures, muscle weakness, sensorial disorder). Studies on clinical characteristics and prognostic factors in children and adolescents with SARS-CoV-2 are limited, therefore, this report provides a spectrum of neurological manifestations associated with SARS-CoV-2 in pediatric population.

[COVID-19-associated multisystem inflammatory syndrome in children: case series at a pediatric hospital in Peru]. / Síndrome inflamatorio multisistémico asociado a COVID-19 en niños: serie de casos en un hospital pediátrico de Perú.

During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.

Características clínicas, de laboratorio y radiológicas de pacientes pediátricos hospitalizados con COVID-19: serie de casos / Clinical, laboratory and radiological characteristics of pediatric patients hospitalized with COVID-19: case series

RESUMEN De toda la población infectada por el SARS-CoV-2, la población pediátrica representa del 1 al 5%, siendo un reto caracterizarla clínicamente. Presentamos cinco casos de pacientes pediátricos con diagnóstico de COVID-19; el rango de edad fue de 1 a 14 años, tuvieron manifestaciones clínicas variadas, tres de ellos presentaron fiebre, tos y dificultad respiratoria, otro fiebre y dermatosis, y un adolescente con diarrea y vómitos asociado al síndrome de Guillain-Barré. Los exámenes de laboratorio revelaron elevación de lactato deshidrogenasa, dimero-D y ferritina. El patrón radiológico más frecuente fue el engrosamiento peribronquial perihiliar. Todos los casos tuvieron evolución clínica y radiológica favorable. La diversidad en las presentaciones clínicas en niños debe considerarse para un diagnóstico temprano de la enfermedad.

ABSTRACT Children represent 1 to 5% of the entire SARS-CoV-2 infected population, and it is challenging to identify them based on clinical characteristics. We present 5 cases of pediatric patients diagnosed with COVID-19; the age range was from 1 to 14 years. They had different clinical characteristics, three of them presented fever, cough and respiratory distress, another one fever and dermatosis, and the other patient had diarrhea and vomiting associated with Guillain-Barre syndrome. Laboratory tests revealed elevated lactate dehydrogenase, D-dimer, and ferritin. The most frequent radiological pattern was perihilar peribronchial thickening. All cases had favorable clinical and radiological evolution. Diverse clinical characteristics should be considered for early diagnosis of COVID-19 in children.

Síndrome inflamatorio multisistémico asociado a COVID-19 en niños: serie de casos en un hospital pediátrico de Perú / COVID-19-associated multisystem inflammatory syndrome in children: case series at a pediatric hospital in Peru

RESUMEN La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.

ABSTRACT During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

[Clinical, laboratory and radiological characteristics of pediatric patients hospitalized with COVID-19: case series]. / Características clínicas, de laboratorio y radiológicas de pacientes pediátricos hospitalizados con COVID-19: serie de casos.

Children represent 1 to 5% of the entire SARS-CoV-2 infected population, and it is challenging to identify them based on clinical characteristics. We present 5 cases of pediatric patients diagnosed with COVID-19; the age range was from 1 to 14 years. They had different clinical characteristics, three of them presented fever, cough and respiratory distress, another one fever and dermatosis, and the other patient had diarrhea and vomiting associated with Guillain-Barre syndrome. Laboratory tests revealed elevated lactate dehydrogenase, D-dimer, and ferritin. The most frequent radiological pattern was perihilar peribronchial thickening. All cases had favorable clinical and radiological evolution. Diverse clinical characteristics should be considered for early diagnosis of COVID-19 in children.

De toda la población infectada por el SARS-CoV-2, la población pediátrica representa del 1 al 5%, siendo un reto caracterizarla clínicamente. Presentamos cinco casos de pacientes pediátricos con diagnóstico de COVID-19; el rango de edad fue de 1 a 14 años, tuvieron manifestaciones clínicas variadas, tres de ellos presentaron fiebre, tos y dificultad respiratoria, otro fiebre y dermatosis, y un adolescente con diarrea y vómitos asociado al síndrome de Guillain-Barré. Los exámenes de laboratorio revelaron elevación de lactato deshidrogenasa, dimero-D y ferritina. El patrón radiológico más frecuente fue el engrosamiento peribronquial perihiliar. Todos los casos tuvieron evolución clínica y radiológica favorable. La diversidad en las presentaciones clínicas en niños debe considerarse para un diagnóstico temprano de la enfermedad.

Unusual Fluorescence Behavior of Pyrene-Amine Containing Dendrimers.

A new class of pyrene-based dendrimers, characterized by the presence of a 1,4,7,10-Tetraazacyclododecane (cyclen) unit as the core, was studied by SSF (steady-state fluorescence) and SPC (single-photon counting fluorescence). The photophysical behavior of these dendrimers was studied in THF, DMF and DMSO solution. The typical signals for pyrene-labeled molecules were recorded in each solvent, showing the representative fluorescence spectra: the corresponding emissions of monomer and excimer of the pyrene chromophore are observed. Unexpectedly, the typical quenching of tertiary amine on the pyrene emission was not observed in these dendrimers. Quenching studies were performed by adding up to 3 equivalents of trifluoroacetic acid (TFA). To our knowledge, this is the first report of pyrene's unquenching behavior by a tertiary amine.

Synthesis and photophysical properties of novel pyrene-metalloporphyrin dendritic systems.

A novel series of dendronized porphyrins bearing pyrene units in the periphery (Porph-O-Gn) and their metal complexes (M-[Porph-O-Gn]) are reported. The pyrene-containing Frechet-type dendrons up to the first generation were synthesized and further reacted with 5-phenol-10,15,20-triphenylporphyrin via an esterification reaction to afford the desired pyrene-labeled dendronized porphyrins. Later, these compounds were used as ligands to produce the corresponding complexes of Zn2+, Cu2+, Mg2+ and Mn3+. With the compounds in hand, the optical and photophysical properties of the dendritic metalloporphyrins were studied by absorption and fluorescence spectroscopy. The quantum yields, Förster radius and efficiency of energy transfer were determined and discussed as a function of the structure and the donor-acceptor distances, finding an efficient energy transfer from the pyrene moiety to the metallated porphyrin core in each case.

Lung Ultrasound as a Screening Method for Interstitial Lung Disease in Patients With Systemic Sclerosis.

BACKGROUND: Patients with systemic sclerosis (SSc) undergo chest radiographs and high-resolution computed tomography (HRCT) of the thorax both for interstitial lung disease (ILD) detection and for disease progression monitoring. OBJECTIVE: The aim of this study was to assess whether lung ultrasound (LUS) is a useful screening tool for ILD in patients with SSc in comparison with HRCT. METHODS: This was a longitudinal cohort study carried out from December 2015 to April 2016. An LUS was performed to examine B-lines in 67 consecutive patients who met the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for SSc and had a previous HRCT. B-lines were quantified and classified according to the score modified from Picano. Severity and extent of lung involvement on the HRCT were determined by means of the Warrick score. RESULTS: Twenty-nine patients had both abnormal HRCT (Warrick score >7) and abnormal LUS, 2 had a mild score (6-15 B-lines), and 27 had either moderate or severe scores (≥16 B-lines). Of the 38 patients with negative HRCT, 25 presented some degree of lung involvement on the LUS. Thus, LUS has a sensitivity of 100% and a specificity of 34%. Receiver operating characteristic curve analysis showed the analytic relation between the number of B-lines and the presence of ILD on the HRCT (area under the curve, 0.80; 95% confidence interval, 0.69-0.90). CONCLUSIONS: Lung ultrasound may be a method to detect abnormal lung findings in a noninvasive manner in patients with SSc. Because of its high sensitivity, a low score almost rules out the need for an HRCT.

Relación del funcionamiento cognitivocon variables clínicas en pacientes con trastornobipolar tipo I / Relationship Between Cognitive Function and Clinical Features in Patients With Bipolar I Disorder

Introducción: Estudios previos indican que la gravedad de las alteraciones de las funciones cognitivas de los diagnosticados de trastorno bipolar tipo I (TBI) están directamente relacionadas con el deterioro del funcionamiento general y la calidad de vida. Un funcionamiento cognitivo alterado se asocia con peor pronóstico del TBI, pero se conoce poco de la relación entre las funciones cognitivas y las características clínicas del TBI. Objetivo: Establecer posibles asociaciones entre el funcionamiento cognitivo y las características clínicas y sociodemográficas de los pacientes con TBI. Métodos: Se evaluó el funcionamiento cognitivo a través de la aplicación de una batería neuropsicológica a un grupo de pacientes con diagnóstico de TBI que se encontraran en ausencia de episodios afectivos durante al menos 6 meses, atendidos ambulatoriamente en la Clínica San Juan de Dios de Manizales. El análisis estadístico implicó la metodología de clasificación en clusters para dividirlos pacientes con mejor y peor funcionamiento cognitivo, y después se correlacionó con las variables clínicas y sociodemográficas. Resultados: Se encontró asociación estadísticamente significativa entre el número de años de estudio y la edad de inicio del trastorno con alteraciones en el nivel de funcionamiento cognitivo (p = 0,002 y p = 0,017 respectivamente). No se encontraron asociaciones significativas con otras variables. Conclusiones: El inicio temprano de la afección y un menor número de años de estudio serían factores de riesgo asociados con un peor funcionamiento cognitivo de los pacientes con TBI.

Introduction: Previous studies suggest that the severity of alterations in cognitive functions in people with a diagnosis of bipolar I disorder (BP-I) are directly related to the deterioration in overall functioning and life quality. Altered cognitive function is associated with a worse prognosis of BP-I, however little is known about the relationship between cognitive functions and the clinical features of BP-I. Objective: To establish possible associations between cognitive function and the clinical and socio-demographic characteristics of patients with BP-I. Methods: Cognitive function was evaluated by applying a neuropsychological battery to a group of patients with a BP-I diagnosis, who did not have affective episodes for at least 6 months, and who were outpatients treated at the San Juan de Dios Clinic in Manizales. The statistical analysis involved using clustering methodology in order to divide those patients with the best and worst cognitive function and it was later correlated with the clinical and socio-demographic variables. Results: A statistically significant corrrelation was found between the number of years of education and the age the disorder started with alterations in the level of cognitive function (P=.002 and P=.017 respectively). No significant correlations were found with other variables. Conclusions: An early onset of the pathology and fewer years of education seems to be risk factors associated with poorer cognitive function in patients with BP-I.

Relationship Between Cognitive Function and Clinical Features in Patients With Bipolar I Disorder. / Relación del funcionamiento cognitivo con variables clínicas en pacientes con trastorno bipolar tipo I.

INTRODUCTION: Previous studies suggest that the severity of alterations in cognitive functions in people with a diagnosis of bipolar I disorder (BP-I) are directly related to the deterioration in overall functioning and life quality. Altered cognitive function is associated with a worse prognosis of BP-I, however little is known about the relationship between cognitive functions and the clinical features of BP-I. OBJECTIVE: To establish possible associations between cognitive function and the clinical and socio-demographic characteristics of patients with BP-I. METHODS: Cognitive function was evaluated by applying a neuropsychological battery to a group of patients with a BP-I diagnosis, who did not have affective episodes for at least 6 months, and who were outpatients treated at the San Juan de Dios Clinic in Manizales. The statistical analysis involved using clustering methocology in order to divide those patients with the best and worst cognitive function and it was later correlated with the clinical and socio-demographic variables. RESULTS: A statistically significant corrrelation was found between the number of years of education and the age the disorder started with alterations in the level of cognitive function (P=.002 and P=.017 respectively). No significant correlations were found with other variables. CONCLUSIONS: An early onset of the pathology and fewer years of education seems to be risk factors associated with poorer cognitive function in patients with BP-I.