El primer año de la “Unidad de Cuidados Paliativos Pediátricos y Patología Crónica Compleja” en Gran Canaria / The first year of the “Pediatric Palliative Care and Complex Chronic Disease Unit” in Gran Canaria

Introducción: Los avances en la ciencia y tecnología y la mejora de la atención pediátrica han logrado un descenso en la mortalidad y un aumento en la supervivencia infantil. Estos pacientes requieren atención integral y coordinada, desempeñando un papel fundamental los cuidados paliativos pediátricos (CPP). En los últimos años su importancia ha crecido exponencialmente en España, lo que fomentó la creación de unidades de CPP. Se presentan características de los pacientes seguidos por la UCPP-PCC del Complejo Hospitalario Universitario Insular Materno Infantil (CHUIMI) de Las Palmas de Gran Canaria durante su primer año de funcionamiento. Material y métodos: Estudio epidemiológico, observacional, descriptivo y bidireccional de pacientes atendidos en la UCPP-PCC del CHUIMI desde noviembre de 2019 hasta enero de 2021. Resultados: Total 86 pacientes, 73 (84,88 %) paliativos, 13 (15,12 %) no-paliativos, 40 (54,79 %) no oncológicos, 33 (45,21 %) oncológicos. Grupo-1 ACT (46,6 %), por grupo de patología predominaron la neurológica (36 %) y desórdenes genéticos (15,1 %). Problemas principales: dolor (70,9 %), problemas gastrointestinales (65,1 %), neurológicos (64 %). Exitus 21 (24,42 % de la muestra), 90,5 % en el hospital. Mediana de E-PaPas 18 puntos, mediana CV 64,4 puntos oncológicos-39,2 puntos no oncológicos. Mayor frecuencia de dolor y fallecimientos en pacientes con gran necesidad de CPP. A mayor necesidad de CPP y mayor número de problemas gastrointestinales, menor puntuación de calidad de vida. (AU)

Introduction: Advances in science and technology and improved pediatric care have achieved a decrease in mortality and an increase in child survival. These patients require comprehensive and coordinated care, with pediatric palliative care (PPC) playing a fundamental role. In recent years its importance has grown exponentially in Spain, which has encouraged the creation of PPC units. We present the characteristics of the patients followed by the CHUIMI PPC-PPC Unit during its first year of operation. Material and methods: Epidemiological, observational, descriptive and bidirectional study of patients seen in the CHUIMI UCPP-PCC from November 2019 to January 2021. Results: Total of 86 patients, 73 (84.88 %) palliative, 13 (15.12 %) non-palliative, 40 (54.79 %) non-oncological, 33 (45.21 %) oncological. Group-1 ACT (46.6 %), by pathology group predominantly neurological (36 %) and genetic disorders (15.1 %). Main problems: pain (70.9 %), gastrointestinal problems (65.1 %), neurological problems (64 %). Exitus 21 (24.42 %) of the sample, 90.5 % in hospital. Mean E-PaPas 18 pts, mean QL 64.4 pts oncological and 39.2 pts non-oncological. Higher frequency of pain and death in patients with a high need for PPC. The greater the need for PPC and the greater the number of gastrointestinal problems, the lower the QL score. (AU)

Role of the SARS-CoV-2 virus in the appearance of new onset type 1 diabetes mellitus in children in Gran Canaria, Spain.

OBJECTIVES: It has been hypothesized that SARS-CoV-2 may play a role in the development of different forms of diabetes mellitus (DM). The Canary Islands have the highest incidence of type 1 DM (T1DM) reported in Spain (30-35/100,000 children under 14 years/year). In 2020-2021 we observed the highest incidence so far on the island of Gran Canaria, as a result of which we decided to evaluate the possible role of COVID-19 in the increased number of onsets. METHODS: We examined the presence of IgG antibodies against SARS-CoV-2 in children with new onset T1DM between October 2020 and August 2021. We compared recent T1DM incidence with that of the previous 10 years. RESULTS: Forty-two patients were diagnosed with T1DM (48.1/100,000 patients/year), representing a nonsignificant 25.7% increase from the expected incidence. Of the 33 patients who consented to the study, 32 presented negative IgG values, with only one patient reflecting undiagnosed past infection. Forty-four percent of patients presented with ketoacidosis at onset, which was similar to previous years. CONCLUSIONS: We conclude that there is no direct relationship between the increased incidence of T1DM and SARS-CoV-2 in the region. The COVID-19 pandemic did not result in an increased severity of T1DM presentation.

Effects of public health measures during the SARS-CoV-2 pandemic on the winter respiratory syncytial virus epidemic: An interrupted time series analysis.

BACKGROUND: Public health measures (PHM) designed to contain the spread of COVID-19 pandemic have influenced the epidemiological characteristics of other viral infections. Its impact on acute RSV bronchiolitis in infants of ≤24 months old has not been systematically studied in our setting. OBJECTIVES: To describe the monthly pattern of visits to the Paediatric Emergency Department (PED) of patients 0 to 14 years of age, the rate of patients diagnosed with RSV acute bronchiolitis per thousand inhabitants of 0 to 24 months, and the rate of them requiring hospital admission during the winter 2020-2021, in the context of local and national COVID-19 restrictions and compare them to the four previous seasons. METHODS: Interrupted time series analysis of patients assisted in the PED and diagnosed with or admitted for RSV acute bronchiolitis in a tertiary University Hospital from January 2016 to February 2020 (pre-intervention period) and from March 2020 to June 2021 (post-intervention period). INTERVENTION: Preventive PHM implemented by the Spanish government weighted by the Containment and Health Index of the Oxford COVID-19 Government Response Tracker. RESULTS: The intervention was followed by an immediate reduction of the rate of visits to the PED of -19.5 (95% confidence interval [CI] -24.0, -14.9) per thousand, and the rate of diagnoses and admissions for RSV acute bronchiolitis of -44.3 (95% CI -73.8, -14.8) and -1.4 (95% CI -2.7, -0.1) per thousand, respectively, with a delayed rebound. CONCLUSIONS: After the implementation of PHM to prevent the spread of SARS-CoV-2 infection, an immediate and important decline in the visits to the PED was observed, with an upward change thereafter. There was also an initial reduction in the diagnoses of and admissions by RSV acute bronchiolitis. An upward trend was observed six to nine months after the usual time of the winter RSV epidemic, coinciding with the relaxation of the preventive PHM.

Should MASP-2 Deficiency Be Considered a Primary Immunodeficiency? Relevance of the Lectin Pathway.

Mannose-binding lectin (MBL)-associated serine protease-2 (MASP-2) is an indispensable enzyme for the activation of the lectin pathway of complement. Its deficiency is classified as a primary immunodeficiency associated to pyogenic bacterial infections, inflammatory lung disease, and autoimmunity. In Europeans, MASP-2 deficiency, due to homozygosity for c.359A > G (p.D120G), occurs in 7 to 14/10,000 individuals. We analyzed the presence of the p.D120G mutation in adults (increasing the sample size of our previous studies) and children. Different groups of patients (1495 adults hospitalized with community-acquired pneumonia, 186 adults with systemic lupus erythematosus, 103 pediatric patients with invasive pneumococcal disease) and control individuals (1119 healthy adult volunteers, 520 adult patients without history of relevant infectious diseases, and a pediatric control group of 311 individuals) were studied. Besides our previously reported MASP-2-deficient healthy adults, we found a new p.D120G homozygous individual from the pediatric control group. We also reviewed p.D120G homozygous individuals reported so far: a total of eleven patients with a highly heterogeneous range of disorders and nine healthy controls (including our four MASP-2-deficient individuals) have been identified by chance in association studies. Individuals with complete deficiencies of several pattern recognition molecules of the lectin pathway (MBL, collectin-10 and collectin-11, and ficolin-3) as well as of MASP-1 and MASP-3 have also been reviewed. Cumulative evidence suggests that MASP-2, and even other components of the LP, are largely redundant in human defenses and that individuals with MASP-2 deficiency do not seem to be particularly prone to infectious or autoimmune diseases.

Pediatricians' attitudes and costs of bronchiolitis in the emergency department: a prospective multicentre study.

BACKGROUND: How pediatricians manage bronchiolitis and the derived total costs (direct and indirect) in the emergency department (ED) have not been fully characterized. The aim of the present study is to calculate those costs in a European country. METHODS: A prospective and observational study, including 10 EDs of tertiary hospitals throughout Spain and during the bronchiolitis season 2010-2011, was performed. Every ED recruited children on random days of the week (3 days per week; always including one non-working day per every week). Recruitment aimed at a total sample size of 600 children. Direct (diagnostic procedures, time spent in the ED and medication) and indirect costs (work hours lost by parents, babysitting, travels, and meals) were collected. Comparisons between bronchiolitis caused by respiratory syncytial virus (RSV) and non-RSV bronchiolitis, as well as costs across severity categories were performed with the Kruskal-Wallis test. A multiple regression model was built to assess the influence of several of the studied factors on the total costs, including a RSV positive test and episode severity as independent variables; and gender, age, attending nursery school, preterm birth, low birth weight, smoker mother during pregnancy, and current smoker father as covariates. RESULTS: From the 664 recruited children, direct mean costs were €213.2 ± 91.8 and indirect ones were €35.9 ± 55.3; the total costs being €249.2 ± 122.9. Costs were significantly higher in children positive to RSV and rose with increased severity. Those associations were maintained in the multiple regression analysis. CONCLUSIONS: Although relatively low at the individual level (€249.2, mean total cost) the costs for just the ED expenses of bronchiolitis in Spain would add up to about €20 million per year.