Telemedicina en pediatría para el manejo de enfermedades crónicas y de grupos vulnerables / Telemedicine in Pediatrics for Managing Chronic Diseases and Vulnerable Groups

Introducción: La telemedicina es una herramienta para los servicios de atención en pediatría, ya que permite el seguimiento de los pacientes pediátricos en el manejo de enfermedades crónicas y de grupos vulnerables; disminuye los costos y mejora el acceso a los servicios de salud. Objetivo: Explorar, por medio de una revisión sistemática de la literatura, la efectividad de la teleconsulta en el manejo de enfermedades crónicas y grupos vulnerables en la población pediátrica. Métodos: Se realizó una revisión sistemática de la literatura, utilizando los términos MESH pediatrics AND telehealth AND primary care AND control care en las bases Medline PubMed, EMBASE, Scopus, Web of Science, Cochrane, Science Direct. Se incluyeron metaanálisis, revisiones sistemáticas, experimentos clínicos controlados, estudios de cohortes, casos y controles, realizados desde 1998 hasta julio de 2021. Se obtuvieron 54 estudios para la revisión final. Resultados: Los principales resultados de la búsqueda arrojaron beneficios a nivel del control de enfermedades crónicas, control posterior al egreso de la unidad de cuidado intensivo, poscirugía pediátrica, cuidado paliativo, enfermedades mentales, acceso a los servicios de salud de población proveniente de regiones apartadas. Se encontró un beneficio para prevenir las visitas al servicio de urgencias. Conclusiones: La telemedicina tiene una diversidad de utilidades e intervenciones como herramienta de la salud. Se ha encontrado evidencia científica robusta para la atención de enfermedades crónicas y/o seguimiento en pediatría. Asimismo, la prestación de servicios en la modalidad de telemedicina en pediatría debe incluirse en los procesos de atención y guías de práctica clínica de la especialidad(AU)

Introduction: Telemedicine is a tool for pediatric care services, since it allows monitoring of pediatric patients in the management of chronic diseases and vulnerable groups; lowers costs and improves access to health services. Objective: To explore, through a systematic review of the literature, the effectiveness of teleconsultation in the management of chronic diseases and vulnerable groups in the pediatric population. Methods: A systematic review of the literature was carried out, using the MESH terms pediatrics AND telehealth AND primary care AND control care in Medline PubMed, EMBASE, Scopus, Web of Science, Cochrane, Science Direct databases. Meta-analyses, systematic reviews, controlled clinical trials, cohort, case-control studies, conducted from 1998 to July 2021, were included. Fifty-four studies were obtained for the final review. Results: The main results of the search showed benefits at the level of chronic disease control, control after discharge from the intensive care unit, pediatric post-surgery, palliative care, mental illness, access to health services for populations from remote regions. A benefit was found in preventing visits to the Emergency Department. Conclusions: Telemedicine has a diversity of utilities and interventions as a health tool. Robust scientific evidence has been found for the care of chronic diseases and/or follow-up in pediatrics. Likewise, the provision of services in the telemedicine modality in pediatrics should be included in the care processes and clinical practice guidelines of the specialty(AU)

Frecuencia de síndrome hepatopulmonar en pacientes pediátricos trasplantados en un hospital de alta complejidad en Medellín, Colombia / Frequency of hepato-pulmonary syndrome in pediatric transplanted patients in a high complexity hospital in Medellín, Colombia

Introducción. El síndrome hepatopulmonar (SHP) es una complicación grave en los pacientes con enfermedad hepática crónica y/o hipertensión portal. La frecuencia descrita en adultos es entre 4 % y 47 %. En pediatría, los reportes también son muy variables y van desde el 3 % hasta el 40 %, desconociendo la real incidencia de este. El objetivo de esta descripción es conocer la frecuencia del SHP en pacientes pediátricos en un hospital de alta complejidad, por medio de una búsqueda activa del SHP en los estudios pretrasplante hepático hallados en las historias clínicas. Metodolo-gía. Estudio retrospectivo de 5 años, en un hospital de alta complejidad en Colombia, en menores de 15 años con un primer trasplante hepático. Resultados. Se contó con la información de 24 pacientes, se analizaron variables demográficas y se confirmó el SHP en 18 pacientes (75 %), encontrando una gravedad leve o moderada en el 33 % y 44 %, respectivamente, siendo en este grupo la cirrosis con complicaciones por hipertensión portal la indicación más frecuente para el trasplante, y como etiología de base, la atresia de vías biliares en un 61 %. Conclusión. El SHP en nuestra población se encontró con una alta frecuencia de presentación, por encima de lo reportado en la literatura, llevando a recomendar una búsqueda activa, con el objetivo de brindar un manejo integral y oportuno.

Introduction. Hepatopulmonary syndrome (HPS) is a serious complication in patients with chronic liver disease and/or portal hypertension. The frequency described in adults is between 4% and 47%. In pediatrics, reports are also highly variable and range from 3% to 40%, with the real incidence not clear yet. The objective of this study is to know the frequency of HPS in our population through an active search for HPS in pre-liver transplant studies in clinical records. Methodology. This is a 5-year retrospective study, in a reference hospital in Colombia, that included children under 15 years of age with a first liver transplant. Results. In 24 patients, the information was available, demographic variables were analyzed, and HPS was confirmed in 18 patients (75%), finding mild and moderate severity in 33% and 44%, respectively. In this group, cirrhosis with complications due to portal hyper-tension was the most frequent indication for transplantation and biliary atresia was the main etiology in 61%. Conclusion. HPS in our population was found with a high frequency, higher than is described in the literature, leading to the recommendation of an active search, with the aim of providing com-prehensive and timely management.

Placenta previa: risk factors and impact on maternal and neonatal morbidity and mortality in Bogotá, Colombia / Placenta previa: factores de riesgo e impacto en la morbimortalidad materno-perinatal en Bogotá, Colombia

Abstract Introduction: Placenta previa can cause bleeding during the second half of pregnancy and may compromise the health of both the mother and the fetus. Knowing the associated risk factors allows for the early identification of pregnant women at high risk of placenta previa. Objective: To describe the risk factors for placenta previa in a sample of pregnant women treated in Bogotá D.C., Colombia, as well as their maternal and perinatal morbidity and mortality. Materials and methods: Retrospective descriptive study. 17 pregnant women diagnosed with placenta previa and admitted to the High Obstetric Risk Unit of a tertiary care hospital between 2013 and 2017 were included. Medical records were reviewed to collect data on risk factors for placenta previa and clinical and sociodemo-graphic characteristics. In the descriptive analysis, means and standard deviations and absolute and relative frequencies were calculated for quantitative and qualitative variables, respectively. Results: The most frequent risk factors were >4 pregnancies (64.70%), maternal age >35 years (29.41%), and history of miscarriage (29.41%). Maternal morbidity was higher than fetal morbidity: three patients required transfusion of blood products, and another underwent a subtotal hysterectomy, while no perinatal complications were reported, with the exception of one stillbirth. Conclusions: A history of miscarriage, >4 pregnancies, and maternal age >35 years were the most frequent risk factors. Furthermore, the degree of maternal-perinatal complications did not depend on the type of placenta previa. Knowing which pregnant women are at higher risk of placenta previa as a result of the early identification of these risk factors allows for a better clinical approach, reducing morbidity and mortality rates in both the mother and the child.

Resumen Introducción. La placenta previa puede causar hemorragias en la segunda mitad del embarazo que pueden llegar a comprometer la salud materno-perinatal. Conocer los factores de riesgo asociados permite identificar tempranamente gestantes con alto riesgo de placenta previa. Objetivo. Describir los factores de riesgo de placenta previa en una muestra de gestantes atendidas en Bogotá D.C., Colombia, así como su impacto en la morbimortalidad materno -perinatal. Materiales y métodos. Estudio descriptivo retrospectivo. Se incluyeron 17 gestantes diagnosticadas con placenta previa que ingresaron entre 2013 y 2017 a la Unidad de Alto Riesgo Obstétrico de un hospital de tercer nivel. Se revisaron las historias clínicas para recolectar datos sobre factores de riesgo y características clínicas y sociodemográficas. En el análisis descriptivo, para las variables cuantitativas se calcularon medias y desviaciones estándar y para las cualitativas, frecuencias absolutas y relativas. Resultados. Los factores de riesgo más frecuentes fueron haber tenido >4 embarazos (64.70%), edad materna >35 años (29.41%) y aborto previo (29.41%). La morbilidad materna fue mayor que la fetal: 3 pacientes requirieron transfusión de hemoderivados y en otra fue necesario realizar histerectomía subtotal, mientras que no se reportaron complicaciones perinatales, a excepción de un mortinato. Conclusiones. Haber tenido >4 embarazos, tener una edad materna >35 años y el antecedente de aborto fueron los factores de riesgo más frecuentes; además, el grado de las complicaciones materno-perinatales fue independiente del tipo de placenta previa. Saber cuáles son las gestantes con mayor riesgo de presentar esta condición mediante la identificación temprana de estos factores permite brindarles un mejor abordaje clínico, lo que permitirá disminuir la morbimortalidad del binomio madre-hijo.

Length of preoperative hospital stay is the dominating risk factor for surgical site infection in neurosurgery: A cohort data-driven analysis.

Background: The number of days of preoperative hospital stay (PHS) is a modifiable variable that has shown contradictory surgical site infection (SSI) risk factor results in neurosurgery. We sought to pinpoint the day of PHS length related with a marked increase of risk of SSI. Methods: From a tertiary teaching hospital, January 2015-December 2017, prospectively collected nonpercutaneous neurosurgery procedures with standard antibiotic prophylaxis and 1-year follow-up were evaluated. SSI risk factors were assessed through multiple logistic regression models with different thresholds of PHS. Results: A total of 1012 procedures were included in the study. Incidence of SSI was 4.4%. The median PHS was higher in those with SSI than in those without (1 day, interquartile range [IQR]: 7 vs. 0 days, IQR: 1, respectively, P = 0.002). By the amount of six days of PHS, this exposure risk past the threshold of significance for impact on wound infection (OR 2.8; CI 1.23-6.39, P = 0.014). Operative time past 4 h (OR 2.11; CI 1.12-3.98; P = 0.021), and in some models, previous surgery at same admission were also identified by multivariate analysis as increasing postoperative SSI risk. Conclusion: The gradual increase of the SSI OR associated with longer PHS days was the highest risk factor of SSI in our cohort of patients. Studies directed to reduce this complication should consider the PHS.

The impact of outliers on available resources in a teaching hospital in Colombia.

This letter describes the experience of long-stay patients and provides a perspective of the need for more studies on outliers' impact on health care.

Limited Renal Intravascular Lymphoma: A Case Report and Review of the Literature.

Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin lymphoma. It is characterized by the proliferation of cancerous cells into the intraluminal space of the blood vessels. It has a low incidence rate of 0.095 cases per 1,000,000. The clinical presentation is insidious and unspecific, often delaying the diagnosis. IVLBCL can be diagnosed through body images and histopathology analysis. This neoplasm averages a 60% response rate to current chemotherapy treatment, favoring rituximab, and doxorubicin-based regimen if it is diagnosed in time. Here, we present the case of a 56-year-old man admitted to our hospital with a fever who was eventually diagnosed with IVLBCL. He presented to the consultation with anemia, fever, and splenomegaly. An infection panel, a bone marrow biopsy, and a PET-CT scan were performed and ruled out the possibility of infections and neoplasms. The patient later developed edematous syndrome. As a result, a renal biopsy was performed which tested positive for intravascular large B-cell lymphoma. Currently, the patient has been in complete remission for 33 months. Along with presenting this specific case, we also reviewed previously published cases of IVLBCL to illustrate the renal involvement of this pathology.