Situación epidemiológica de VIH a nivel global y nacional: Puesta al día / Epidemiological situation of HIV at global and national level: update

INTRODUCCIÓN: En las cuatro décadas de la epidemia por VIH, se han observado avances notables que han contribuido a una disminución progresiva en la incidencia de nuevas infecciones y en la mortalidad a nivel mundial. Sin embargo, no ha ocurrido lo mismo en Latinoamérica y en Chile. OBJETIVO: Esta revisión tiene como objetivo conocer la epidemiología actual a nivel global, latinoamericano y chileno. METODOLOGÍA: Se analizaron los informes epidemiológicos oficiales de infección por VIH emitidos por organismos nacionales e internacionales, más los estudios epidemiológicos nacionales. RESULTADOS: Se estima que 39 millones de personas viven con VIH en el mundo; no obstante, la mortalidad y la incidencia de nuevos casos han disminuido de forma notoria durante las últimas dos décadas, asociado a una expansión en al acceso a terapia antirretroviral en forma global. A diferencia del resto del mundo, América Latina presenta una tendencia de alza en las nuevas infecciones y Chile registra un aumento de 35% en nuevos casos durante los últimos 10 años, coincidiendo con un aumento en los flujos de migrantes que ha afectado a la región. Algunas estrategias preventivas como la profilaxis pre exposición se han implementa-do a un ritmo lento, tanto a nivel mundial, como latinoamericano. CONCLUSIONES: La epidemiología del VIH presenta características propias regionales y nacionales. En particular en Chile, diversos factores incluyendo déficit en políticas públicas de prevención y los recientes flujos migratorios han modelado nuestra actual epidemia. El desafío presente debe contemplar los esfuerzos multisectoriales para lograr los objetivos de ONUSIDA en esta década.

BACKGROUND: Over the course of the last four decades of global HIV epidemic, significant improvements have contributed to gradually reduce the frequency of new infections and global mortality rates. However, in Latin America particularly in Chile, new infections continue increasing. AIM: This review aims to comprehend the_epidemiology today on a worldwide, Latin American, and Chilean scale. METHODS: National epidemiology studies and official HIV reports from international and national organizations were reviewed. RESULTS: It is estimated that 39 million people live with HIV worldwide; however, mortality and the incidence of new cases have decreased markedly over the last two decades, associated with an expansion in access to antiretroviral therapy globally. In contrast to the rest of the world, Latin America shows an upward trend in new infections, with Chile registering a 35% increase in new cases over the last 10 years, coinciding with an increase in migratory flows that has occurred throughout the region. Some preventive strategies, such as pre-exposure prophylaxis, have been implemented at a slow pace, both globally and in Latin America. CONCLUSIONS: The epidemiology of HIV has regional and national characteristics. Specifically in Chile, several factors, including deficits in public prevention policies and recent migratory flows, have shaped our current epidemic. The present challenge must contemplate multisectoral efforts to achieve the UNAIDS objectives during this decade.

Síndrome nefrótico secundario a sífilis

El síndrome nefrótico se caracteriza por proteinuria importante, hipoalbuminemia, edema generalizado e hiperlipidemia. Según su etiología se clasifica en primario y secundario, siendo este último raramente encontrado en pediatría, cuyas causas pueden ser múltiples como enfermedades sistémicas, fármacos, neoplasias o enfermedades infecciosas. Se presenta el caso clínico de una adolescente femenina con síndrome nefrótico secundario a sífilis, quien recibió manejo antibiótico apropiado con resolución del cuadro clínico. (provisto por Infomedic International)

Nephrotic syndrome is characterized by significant proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia. According to its etiology, it is classified as primary and secondary, the latter being rarely found in pediatrics, whose causes can be multiple such as systemic diseases, drugs, neoplasms, or infectious diseases. A clinical case is presented of a female adolescent with nephrotic syndrome secondary to syphilis, who received appropriate antibiotic management with resolution of the clinical condition. (provided by Infomedic International)

El tratamiento del dolor agudo pediátrico en España EN 2021: resultado de una encuesta nacional entre anestesiólogos pediátricos / The management of paediatric acute pain in Spain IN 2021: Results of a national survey among paediatric anaesthesiologists

Objetivo: Mejorar el conocimiento acerca de la práctica clínica habitual en el tratamiento del dolor agudo pediátrico en España.MétodosSe llevó a cabo una encuesta telemática a través de Internet en una muestra representativa de profesionales sanitarios involucrados en el tratamiento del dolor agudo pediátrico (concretamente anestesiólogos) en España. La encuesta incluyó 28 cuestiones acerca de su práctica clínica habitual en la valoración y el tratamiento del dolor agudo, así como aspectos formativos y organizativos en el dolor agudo pediátrico.ResultadosLa encuesta fue completada durante el mes de marzo de 2021 por 150 especialistas en anestesiología. Los encuestados presentaron una amplia experiencia en el tratamiento del dolor agudo pediátrico (media de años de experiencia: 14,3; DE: 7,8) y básicamente en dolor agudo postoperatorio (97% casos). Aunque el 80% de los mismos utilizaba de modo habitual escalas validadas de valoración de dolor agudo pediátrico, solo el 2,6% utilizaba las específicas adaptadas para pacientes con discapacidad cognitiva. La mayoría de los encuestados empleaba habitualmente fármacos analgésicos como el paracetamol (99%) o el metamizol (92%), pero solo el 84% los complementaba con alguna técnica de bloqueo loco-regional u otra medicación tipo antiinflamatorio no esteroideo (62%). Además, únicamente un 62,7% reconocía haber recibido formación específica en dolor agudo pediátrico, solo un 45% seguía protocolos institucionales hospitalarios y un escaso 28% lo hacía a través de unidades de dolor infantil.ConclusionesLa encuesta identificó importantes puntos de mejora en la formación y organización del tratamiento del dolor agudo de los pacientes españoles en edad pediátrica. (AU)

Objective: To improve knowledge about routine clinical practice in the management of paediatric acute pain in Spain.MethodsA telematic survey was conducted via the Internet on a representative sample of healthcare professionals involved in the management of paediatric acute pain (specifically anaesthesiologists) in Spain. The survey included 28 questions about their usual clinical practice in the assessment and treatment of acute pain, and also training and organisational aspects in paediatric acute pain.ResultsThe survey was completed during March 2021 by 150 specialists in anaesthesiology. The respondents widely experienced in the management of acute paediatric pain (mean years of experience: 14.3: SD: 7.8), essentially in acute postoperative pain (97% of cases). Although 80% routinely used validated paediatric acute pain assessment scales, only 2.6% used specific scales adapted for patients with cognitive impairment. Most of the respondents routinely used analgesic drugs such as paracetamol (99%) or metamizole (92%), but only 84% complemented these drugs with a loco-regional blocking technique or other non-steroidal anti-inflammatory drugs (62%). Furthermore, only 62.7% acknowledged having received specific training in paediatric acute pain, only 45% followed hospital institutional protocols, and a scant 28% did so through paediatric pain units.ConclusionsThe survey identified important points for improvement in the training and organisation of acute pain management in Spanish paediatric patients. (AU)

Review of electrical impedance tomography in the pediatric patient.

Electrical impedance tomography (EIT) is a new method of monitoring non-invasive mechanical ventilation, at the bedside and useful in critically ill patients. It allows lung monitoring of ventilation and perfusion, obtaining images that provide information on lung function. It is based on the physical principle of impedanciometry or the body's ability to conduct an electrical current. Various studies have shown its usefulness both in adults and in pediatrics in respiratory distress syndrome, pneumonia and atelectasis in addition to pulmonary thromboembolism and pulmonary hypertension by also providing information on pulmonary perfusion, and may be very useful in perioperative medicine; especially in pediatrics avoiding repetitive imaging tests with ionizing radiation.

Metahemoglobinemia congénita. Reporte de caso / Congenital Methemoglobinemia. A Case Report

Resumen La metahemoglobinemia ocasionalmente causa cianosis, particularmente cuando es congénita. Debido a sus vías enzimáticas deficientes y a la disminución de la capacidad de transporte de oxígeno, para los pacientes con metahemoglobinemia congénita es importante evitar la exposición a agentes oxidantes. A continuación, presentamos un paciente pediátrico con metahemoglobinemia congénita no diagnosticada preoperatoriamente que fue sometido a cateterismo con diagnóstico probable de hipertensión pulmonar bajo anestesia general. El paciente pediátrico era un niño de 10 años que presentaba una lectura de oximetría de pulso (SpO2) 92% antes de la inducción de la anestesia. La metahemoglobinemia se sospechó intraoperatoriamente por primera vez debido a un desajuste de la SpO2 de la oximetría de pulso digital y la SaO2 (saturación arterial de oxígeno), y luego se confirmó mediante múltiples longitudes de onda con la CO-oximetría. Se discuten la fisiopatología, etiología, manifestaciones clínicas, consideraciones anestésicas y opciones de tratamiento de la metahemoglobinemia.

Abstract Methemoglobinemia occasionally causes cyanosis particularly in congenital methemoglobinemia. Avoidance of exposure to oxidizing agents is important for patients with congenital methemoglobinemia because of their deficient enzymatic pathways and decreased oxygen-carrying capacity. Here, we present a pediatric patient with preoperatively undiagnosed congenital methemoglobinemia who underwent catheterization with probably diagnosis of pulmonar hypertension under general anesthesia. The pediatric patient was a 10-year-old who displayed a low pulse oximetry reading of 92% prior to induction of anesthesia. Methemoglobinemia was first suspected intraoperatively because of a mismatch of SpO2 of finger pulse oximetry and SaO2 of arterial blood, and was later confirmed by multiplewavelength CO-oximetry. The pathophysiology, etiology, clinical manifestations, anesthetic considerations, and treatment options of methemoglobinemia are discussed.

Pediatric atlas anatomy and its implications for fracture treatment: an anatomical and radiological study.

INTRODUCTION AND OBJECTIVES: The objective of the study was: (1) to describe changes in the shape of the atlas during growth, including gender and side differences; (2) to assess the dimension essential for identification of the optimal entry point; (3) to determine the age limit for a safe insertion of 3.5-mm screws into the lateral masses according to our own limiting parameters. MATERIALS AND METHODS: Dimensions of the atlas were measured on 200 CT scans of the craniocervical junction in individuals aged 0-18 years and on 34 anatomical specimens of the first cervical vertebra (aged 2.5-18 years). Both series were divided according to the gender and age. The values measured on CT scans were used for statistical comparison of data in boys and girls and comparison of the right and left sides. RESULTS: The atlas reaches its maximum growth rate between 0 and 2 years of age, then the growth decelerates and continues until the age of 18 years. The proportion of dimensions of C1 vertebral foramens changes with age. The youngest children show a relatively greater distance from the left to the right medial pedicle; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater. The transverse foramen has a slightly oval shape throughout the period of growth. Statistically significant differences between boys and girls were observed primarily between 12 and 18 years of age. CONCLUSION: The study has proved adequate size of lateral masses for insertion of 3.5-mm screws in all patients from the age of 5 years. In younger children, the patient´s anatomy should be respected and the surgical technique tailored accordingly.

The management of paediatric acute pain in Spain in 2021: Results of a national survey among paediatric anaesthesiologists.

OBJECTIVE: To improve knowledge about routine clinical practice in the management of paediatric acute pain in Spain. METHODS: A telematic survey was conducted via the Internet on a representative sample of healthcare professionals involved in the management of paediatric acute pain (specifically anaesthesiologists) in Spain. The survey included 28 questions about their usual clinical practice in the assessment and treatment of acute pain, and also training and organisational aspects in paediatric acute pain. RESULTS: The survey was completed during March 2021 by 150 specialists in anaesthesiology. The respondents widely experienced in the management of acute paediatric pain (mean years of experience: 14.3: SD: 7.8), essentially in acute postoperative pain (97% of cases). Although 80% routinely used validated paediatric acute pain assessment scales, only 2.6% used specific scales adapted for patients with cognitive impairment. Most of the respondents routinely used analgesic drugs such as paracetamol (99%) or metamizole (92%), but only 84% complemented these drugs with a loco-regional blocking technique or other non-steroidal anti-inflammatory drugs (62%). Furthermore, only 62.7% acknowledged having received specific training in paediatric acute pain, only 45% followed hospital institutional protocols, and a scant 28% did so through paediatric pain units. CONCLUSIONS: The survey identified important points for improvement in the training and organisation of acute pain management in Spanish paediatric patients.

Vertical dorsal rhinotomy in pediatric nasal dermoid surgery.

INTRODUCTION AND OBJECTIVES: Nasal dermoids are uncommon midline congenital lesions in the nose, usually diagnosed in the first years of life. Imaging is mandatory to evaluate local and intracranial extension and treatment consists in surgical excision. This study aims to review the experience of the department in managing pediatric nasal dermoids using a dorsal rhinotomy surgical approach. MATERIAL AND METHODS: Retrospective case series of pediatric nasal dermoids treated at a tertiary university teaching hospital over a period of seven years. RESULTS: Nine children were treated during this period. Clinical presentation was a dermoid sinus-cyst in seven cases and a cystic lesion in two. Pre-operative imaging revealed extension of the lesion to the foramen cecum in three cases. Surgery was performed via vertical dorsal rhinotomy in all patients, and associated endoscopic surgery was used in three patients. Reconstruction with autologous material was performed in three cases. No complications or recurrences were registered during the follow-up. CONCLUSIONS: In the presented series, a vertical dorsal rhinotomy incision has provided good functional and aesthetic results. The possibility of nasal dermoid intracranial extension should be accessed with imaging but remains uncommon. In its absence, this approach may be useful and can be paired with other techniques, such as nasal endoscopy, to achieve the best outcomes.

Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study.

Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery.Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.

The emergency department provides an opportunity for early trauma-informed care for acutely injured children and their families.Addressing psychological distress in emergency care for acutely injured children and their families should adopt a universal trauma-informed approach.The development of a paediatric trauma-informed intervention should consider barriers which can impact implementation into emergency care. Particular barriers highlighted by clinicians include staff shortages, time constraints, and high caseloads.

Factores asociados a ventilación mecánica prolongada en niños con fallo respiratorio de causa pulmonar: Estudio de cohortes del registro de LARed Network / Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry

Objetivos Identificar los factores asociados con la ventilación mecánica prolongada (pVMI) en pacientes pediátricos en la unidad de cuidados intensivos pediátricos (UCIP). Diseño Análisis secundario de una cohorte prospectiva. Ámbito UCIP en los centros que integran LARed Network entre abril del 2017 y enero del 2022. Participantes Pacientes pediátricos en ventilación mecánica (VMI) debido a causas respiratorias. Definimos pVMI como eventos con tiempo VMI mayor al percentil 75 global. Intervenciones Ninguna.Variables de interés principales Datos demográficos, diagnósticos, puntajes de gravedad, terapias, complicaciones, estancias y morbimortalidad. Resultados Se incluyó a 1.698 niños con VMI de 8 ± 7 días y se definió pVMI en 9 días. Los factores relacionados al ingreso fueron la edad menor de 6 meses (OR 1,61, IC del 95%, 1,17-2,22), la displasia broncopulmonar (OR 3,71, IC del 95%, 1,87-7,36) y las infecciones fúngicas (OR 6,66, IC del 95%, 1,87-23,74), mientras que los pacientes con asma tuvieron menor riesgo de pVMI (OR 0,30, IC del 95%, 0,12-0,78). En cuanto a la evolución y la estancia en UCIP, se relacionó a neumonía asociada a la ventilación mecánica (OR 4,27, IC del 95%, 1,79-10,20), necesidad de traqueostomía (OR 2,91, IC del 95%, 1,89-4,48), transfusiones (OR 2,94, IC del 95%, 2,18-3,96), bloqueo neuromuscular (OR 2,08, IC del 95%, 1,48-2,93) y ventilación de alta frecuencia (OR 2,91, IC del 95%, 1,89-4,48) y una mayor estadía en UCIP (OR 1,13, IC del 95%, 1,10-1,16). Además, la presión media aérea mayor a 13cmH2O se asoció a pVMI (OR 1,57, IC del 95%, 1,12-2,21). Conclusiones Se identificaron factores relacionados con VMI de duración mayor a 9 días en pacientes pediátricos en UCIP en cuanto a ingreso, evolución y estancia. (AU)

Objectives To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). Design Secondary analysis of a prospective cohort.SettingPICUs in centers that are part of the LARed Network between April 2017 and January 2022. Participants Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. Interventions None.Main variables of interestDemographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. Results One thousand 6hundred and ninety 8children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17–2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87–7.36), and fungal infections (OR 6.66, 95% CI 1.87–23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12–0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79–10.20), need for tracheostomy (OR 2.91, 95% CI 1.89–4.48), transfusions (OR 2.94, 95% CI 2.18–3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48–2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89–4.48), and longer PICU stay (OR 1.13, 95% CI 1.10–1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12–2.21). Conclusions Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay. (AU)

Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry.

OBJECTIVES: To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). DESIGN: Secondary analysis of a prospective cohort. SETTING: PICUs in centers that are part of the LARed Network between April 2017 and January 2022. PARTICIPANTS: Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. RESULTS: 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). CONCLUSIONS: Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.

A Fase Terminal do Filho com Câncer: Percepções dos Profissionais Hospitalares / The Terminal Phase of Children with Cancer: Perceptions of Hospital Professionals / La Fase Terminal del Hijo con Cáncer: Percepciones de los Profesionales del Hospital

Resumo: O confronto com o câncer de um filho e a percepção da sua morte como inevitável dão lugar a experiências parentais relevantes para a pesquisa científica. Este estudo teve como objetivo investigar, por meio da percepção dos profissionais hospitalares, o modo como os pais experienciam a fase terminal e fim de vida do filho com câncer para melhor compreender os processos psicoemocionais experienciados por esses pais diante da cronicidade da doença e da morte do filho. No sentido de alcançar esse objetivo, realizou-se um estudo qualitativo de tipo fenomenológico envolvendo 17 profissionais de dois hospitais portugueses de referência em oncologia pediátrica. Os dados foram recolhidos com recurso a um guia de entrevista semiestruturada. Na percepção dos profissionais hospitalares, os resultados evidenciam que esses pais experienciam múltiplas dificuldades e preocupações na fase terminal da doença do filho e no pós-morte, bem como um sofrimento extremo e desestruturação biopsicossocial e espiritual na família. O conhecimento aprofundado da fenomenologia desses processos é essencial para o desenho e a implementação de intervenções emocionais, cognitivas, comportamentais e sociais mais ajustadas às dificuldades e preocupações parentais vividas no fim de vida e pós-morte.

Abstract: Coping with children's cancer and the perception of their inevitable death give rise to parental experiences that are important to study. This study aimed to investigate, based on hospital professionals' perspectives, how parents experience the terminal phase and end of life of their children suffering from cancer to better understand the psycho-emotional processes these parents experienced in face of the chronicity of the disease and their children's death. To achieve this objective, a qualitative phenomenological study was carried out involving 17 professionals of two Portuguese hospitals that are reference in pediatric oncology. Data were collected using a semi-structured interview guide. From the perspective of hospital professionals, results show that these parents experience multiple difficulties and concerns in the terminal phase of their children's disease and postmortem, as well as the extreme suffering and biopsychosocial and spiritual disruption of the family. A deeper understanding of the phenomenology of these processes is essential to design and implement better adjusted emotional, cognitive, behavioral, and social interventions aimed at the parental difficulties and concerns experienced at the end of life and after death.

Resumen: El enfrentamiento del cáncer de un hijo y la percepción de su muerte como inevitable dan lugar a experiencias parentales importantes que deben ser estudiadas. Este estudio pretende identificar desde la percepción de los profesionales del hospital cómo los padres viven la fase terminal y el final de la vida de su hijo con cáncer con el fin de comprender mejor los procesos psicoemocionales que viven estos padres ante la cronicidad de la enfermedad y la muerte de su hijo. Para ello, se realizó un estudio cualitativo, con enfoque fenomenológico, en el que participaron 17 profesionales de dos hospitales portugueses de referencia en oncología pediátrica. Para recoger los datos se aplicó un guion de entrevista semiestructurada. En cuanto a la percepción de los profesionales del hospital, estos padres experimentaron múltiples dificultades y preocupaciones en la fase terminal de la enfermedad de su hijo y postmuerte, así como un sufrimiento extremo y una desestructuración biopsicosocial y espiritual en la familia. El conocimiento en profundidad de la fenomenología de estos procesos es esencial para elaborar e implementar intervenciones emocionales, cognitivas, conductuales y sociales más acordes a las dificultades y preocupaciones parentales que se experimentan al final de la vida y la postmuerte.

Angústia moral entre médicos em terapia intensiva pediátrica / Moral distress among physicians working in pediatric intensive care / Angustia moral entre los médicos en cuidados intensivos pediátricos

Resumo Este estudo tem como objetivo entender e interpretar a ocorrência de angústia moral entre médicos intensivistas pediátricos que atuam em uma Unidade de Terapia Intensiva Pediátrica. Trata-se de uma pesquisa exploratória e descritiva, de abordagem quantitativa e recorte transversal, com foco na aplicação de um instrumento de pesquisa baseado na Moral Distress Scale Revised para levantamento da presença de angústia moral em 43 médicos de determinada unidade de terapia. A maioria das respostas do instrumento de pesquisa quanto à presença de angústia moral esteve relacionada a questões de fim de vida, situações de prolongamento penoso da vida, comunicação deficiente entre a equipe, problemas de saúde do profissional, desconforto com prognósticos incertos, necessidade de visitas multiprofissionais e sofrimento do paciente. O intuito foi buscar evidências na pesquisa sobre determinadas situações que podem ser desencadeadoras de angústia moral com intensidades e frequências distintas entre os profissionais, de acordo com algumas variáveis.

Abstract This study investigates and interprets the occurrence of moral distress among pediatric physicians working in a Pediatric Intensive Care Unit. A cross-sectional, exploratory, descriptive research was conducted to survey the presence of moral distress among 43 physicians from a specific therapy unit assessed by the Moral Distress Scale Revised. Most responses regarding the presence of moral distress revolved around end-of-life issues, painful life-prolonging situations, poor team communication, professional health problems, discomfort with uncertain prognoses, need for multidisciplinary visits and patient suffering. We sought evidence in research on certain situations that can trigger moral distress at different intensities and frequencies among professionals, according to some variables.

Resumen Este estudio tiene como objetivo comprender e interpretar la angustia moral entre los médicos en cuidados intensivos pediátricos que trabajan en una Unidad de Cuidados Intensivos Pediátricos. Se trata de una investigación exploratoria, descriptiva, de enfoque cuantitativo y transversal, centrada en la aplicación de una herramienta basada en la Moral Distress Scale Revised para identificar la presencia de angustia moral en 43 médicos(as) de una unidad específica. La mayoría de las respuestas a la herramienta de evaluación sobre la presencia de sufrimiento moral giraron en torno a cuestiones del final de la vida, situaciones dolorosas que prolongan la vida, mala comunicación entre el equipo, problemas de salud profesional, malestar ante pronósticos inciertos, necesidad de visitas multidisciplinarias y sufrimiento del paciente. El objetivo fue buscar evidencias sobre determinadas situaciones que pueden desencadenar angustia moral con diferentes intensidades y frecuencias entre los profesionales según algunas variables.

Dual x-ray absorptiometry monitoring in pediatric short bowel syndrome: an integrative review / Monitorização por absortometria com duplo raio X na síndrome do intestino curto pediátrica: uma revisão integrativa

ABSTRACT Objective: To analyze the bone health of pediatric patients with short bowel syndrome intestinal failure (SBS-IF). Data source: An integrative literature review was performed using the data published in the MEDLINE-PubMed and Scientific Electronic Library Online (SciELO) databases between January 2010 and April 2021, and through a manual search of the reference lists of relevant studies. Studies were included if they assessed bone mineral density by the Dual X-Ray Absorptiometry (DXA) technique, incorporated pediatric patients (up to 20 years of age) with SBS under parenteral nutrition (PN) and were written in English. Eleven primary sources met the inclusion criteria for this study. Data synthesis: Pediatric patients with SBS-IF under long-term parenteral nutrition experienced frequent changes in bone metabolism, leading to osteoporotic fractures and growth failure. These patients have deficiencies in multiple nutrients, such as calcium, magnesium, phosphorus, and vitamin D. Consequently, there are variations in the secretion and regulation of the parathyroid hormone. In addition, the pharmacotechnical limitations related to calcium and phosphorus in the PN solution, use of glucocorticoids, and difficulty performing physical activity are risk factors for the development of metabolic bone disease in pediatric patients with SBS-IF. Conclusions: Low bone mineral density was associated with a high risk of developing osteoporosis, fractures, and growth deficiency in pediatric patients with SBS-IF on PN therapy in the long term.

Objetivo: Analisar a saúde óssea de pacientes pediátricos com síndrome do intestino curto — falência intestinal (SIC-FI). Fontes de dados: Revisão integrativa da literatura usando os dados publicados nas bases de dados Medical Literature Analysis and Retrieval System Online/ United States National Library of Medicine (MEDLINE/PubMed) e Scientific Electronic Library Online (SciELO) entre janeiro de 2010 e abril de 2021 e por meio de busca manual nas listas de referências de estudos relevantes. Foram incluídos estudos em inglês que avaliaram a densidade mineral óssea pela técnica de absorciometria de raio X duplo (DXA), incluíram pacientes pediátricos (até 20 anos de idade) com SIC sob terpia nutricional parenteral. Onze fontes primárias preencheram os critérios de inclusão para este estudo. Síntese dos dados: A pesquisa revelou que pacientes pediátricos com SIC-FI sob nutrição parenteral (NP) de longo prazo tiveram alterações frequentes no metabolismo ósseo, levando a fraturas osteoporóticas e falha de crescimento. Esses pacientes apresentam deficiências de múltiplos nutrientes, como cálcio, magnésio, fósforo e vitamina D. Consequentemente, houve variações na secreção e regulação do hormônio da paratireoide. Além disso, as limitações farmacotécnicas relacionadas ao cálcio e fósforo na solução de NP, o uso de glicocorticoides e dificuldade para realizar atividade física são fatores de risco para o desenvolvimento de doença óssea metabólica em pacientes pediátricos com SIC-FI. Conclusões: A baixa densidade mineral óssea foi associada a um alto risco de desenvolver osteoporose, fraturas e deficiência de crescimento em pacientes pediátricos com SIC-FI sob terapia nutricional parenteral em longo prazo.

Estudo multicêntrico das neoplasias malignas de boca em pacientes pediátricos e adolescentes / Multicentric study of head and neck neoplasms in pediatric and adolescent patients

O objetivo deste estudo foi descrever as características clínicas, demográficas e histopatológicas e de distribuição das neoplasias malignas de boca em pacientes pediátricos e adolescentes de diversos centros de diagnóstico. Foi realizado um levantamento de dados em prontuários clínicos de pacientes com idade menor ou igual a 19 anos portadores de neoplasias malignas de boca diagnosticados no ICT/SJC, Departamento de Patologia Bucal (UFPb), Fundação Centro de Controle de Oncologia do Estado do Amazonas (FCecon-Am) e Departamento de Patologia e Diagnóstico Oral (UFRJ). Esta coleta de dados foi realizada por meio de uma análise retrospectiva dos prontuários médicos dos pacientes atendidos em um período de 30 anos (1986-2016). No período de 30 anos, 37 neoplasias malignas em boca foram diagnosticadas em 4 diferentes centros no Brasil. A média de idade dos pacientes no momento do diagnóstico foi de 12,2 anos, sendo o sexo feminino e a raça branca os mais acometidos. No geral, os sarcomas foram os mais frequentes (37,9%), seguido dos linfomas (27%). A mandíbula foi a região mais acometida (37,8%), seguido da maxila (32,4%), totalizando mais de 70% dos casos (AU)

The objective of this study was to describe the clinical, demographic and histopathological characteristics and distribution of oral malignant neoplasms in pediatric and adolescent patients from different diagnostic centers. A data collection was carried out in clinical records of patients aged less than or equal to 19 years with malignant neoplasms of the mouth diagnosed at the ICT/SJC, Department of Oral Pathology (UFPb), Fundação Centro de Controle de Oncologia do Estado do Amazonas (FCecon-Am) and Department of Oral Pathology and Diagnosis (UFRJ). This data collection was carried out through a retrospective analysis of the medical records of patients treated over a period of 30 years (1986-2016). Over a 30-year period, 37 malignant neoplasms in the mouth were diagnosed in 4 different centers in Brazil. The average age of patients at the time of diagnosis was 12.2 years, with females and white people being the most affected. Overall, sarcomas were the most common (37.9%), followed by lymphomas (27%). The mandible was the most affected region (37.8%), followed by the maxilla (32.4%), totaling more than 70% of cases (AU)

Reinfección por SARS-CoV-2 en pacientes con antecedentes de MIS-C. Presentación de dos casos / MIS-C patients who were reinfected with SARS-CoV-2. Report of 2 cases

El síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés) es una enfermedad rara. Se desconoce si los niños que se recuperaron del MIS-C tienen riesgo de recurrencia de MIS-C cuando presentan reinfección por SARS-CoV-2. El objetivo de este estudio es describir los casos de dos niñas que se recuperaron del MIS-C y presentaron reinfección por SARS-CoV-2 sin recurrencia de MIS-C.

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition. It is still unknown if children who have recovered from MIS-C are at a risk of recurrence of MIS-C when they are reinfected with SARS-CoV-2. In this study, we aimed to report 2 children who recovered from MIS-C and reinfected with SARS-CoV-2 without recurrence of MIS-C.

Mixoma cardiaco como causa de isquemia en niños. Reporte de casos

El mixoma cardiaco constituye uno de los tumores benignos más frecuentes entre los tumores cardiacos. El mismo se caracteriza por la obstrucción del flujo sanguíneo por trombosis o émbolo, resultando en causa de insuficiencia cardiaca con disfunción ventricular, síncope ortostático, isquemia de diferentes órganos de acuerdo a la arteria afectada, e incluso muerte súbita. Presentamos 2 casos en pacientes pediátricos: el primer caso, una adolescente con ACV isquémico y el segundo caso se trata de un adolescente con isquemia a nivel de miembros inferiores por una tromboembolia en la Aorta distal. En ambos casos se realizó la exéresis del tumor, con éxito.

Cardiac myxoma is one of the most frequent benign tumors among cardiac tumors. It is characterized by the obstruction of blood flow due to thrombosis or embolus, resulting in heart failure with ventricular dysfunction, orthostatic syncope, ischemia of different organs depending on the affected artery, and even sudden death. We present 2 cases in pediatric patients: the first case, an adolescent with ischemic stroke and the second case is an adolescent with ischemia in the lower limbs due to a thromboembolism in the distal aorta. In both cases, the exeresis of the tumor was performed successfully.

Índice de discapacidad vocal en niños: autoevaluación. Traducción, transculturalización y validación al español de Latinoamérica

Objetivo: Los trastornos de la voz son muy frecuentes en la población pediátrica, entre el 6% y el 23% de todos los niños presentan alguna forma de disfonía. La evaluación de la voz abarca los aspectos perceptuales, análisis acústico, métodos de diagnóstico visual, y cuestionarios que orientan al impacto sobre la calidad de vida. El objetivo de nuestro estudio es realizar la traducción, transculturalización y validación del cuestionario Children Voice Handicap Index (CVHI) a hispanohablantes latinoamericanos. Material y Método: El estudio se realizó en el Hospital Italiano de Buenos Aires, Argentina y en el Hospital de Niños Dr. Luis Calvo Mackenna de Santiago de Chile. Se incluyeron pacientes entre 8 y 15 años de edad. Se tradujo, transculturalizó y validó el CVHI para dicha población. Se realizó el cuestionario en dos grupos de pacientes: un grupo de niños con antecedentes de disfonías, n = 48 y el otro grupo pacientes de control, sin patología de la voz, n = 86. El cuestionario se aplicó a los niños, en presencia de sus cuidadores o padres, con la correspondiente conformidad. Resultados: Se encontró una diferencia significativa entre ambos grupos (p < 0,05) con una confianza interna óptima de 0,98 obtenida mediante alfa de Cronbach y una alta fiabilidad test-retest (correlación de Pearson = 0,96). Conclusión: La validación y transculturalización del CVHI para la población hispanohablante de latinoamérica presentó una adecuada validez y fiabilidad. Complementar la evaluación de la patología vocal con un sencillo cuestionario de auto-rrealización en población pediátrica, constituye una valiosa herramienta que completa el diagnóstico del impacto de la alteración de la voz en la calidad de vida.

Aim: Voice disorders are very common in the pediatric population, since between 6% and 23% of all children present some type of dysphonia. Voice evaluation includes perceptual aspects, acoustic analysis, visual diagnostic methods, and questionnaires that guide the impact on quality of life. The objective of this study is to carry out the translation, transculturalization and validation of the Children Voice Handicap Index (CVHI) questionnaire for Latin American Spanish speakers. Material and Method: The study was conducted at the Italian Hospital in Buenos Aires, Argentina and at the Dr. Luis Calvo Mackenna Children's Hospital in Santiago de Chile, Chile. Patients between 8 and 15 years of age were included. The CVHI was translated, transculturalized, and validated for said population. The questionnaire was carried out in two groups of patients: a group of children with a history of dysphonia, n = 48, and the other group, control patients, without voice pathology, n = 86. The questionnaire was applied to the children, in the presence of their caregivers or parents, with the corresponding consent. Results: A significant difference was found between both groups (p < 0.05) with an optimal internal confidence of 0.98 obtained using Cronbach's alpha and high test-retest reliability (Pearson's correlation = 0.96). Conclusion: The validation and transculturalization of the CVHI for the Spanish-speaking population of Latin America presented adequate validity and reliability. Complementing the evaluation of vocal pathology with a simple self-administration questionnaire in the pediatric population constitutes a valuable tool that completes the diagnosis of the impact of voice alteration on quality of life.

Miedo a la muerte y a su proceso en personal de Pediatría durante la pandemia por COVID-19

Introducción: La evidencia obtenida en estudios previos señala que existe mayor ansiedad por el proceso de morir que, por la muerte misma, aunque falta mayor investigación. Objetivo: Analizar el miedo a la muerte y al proceso de morir propio y de otros en el servicio de Pediatría del Hospital Pablo Tobón Uribe. Metodología: Se realizó un estudio analítico transversal con la Escala de Miedo a la Muerte de Collett-Lester en 143 personas: 25,2 % pediatras generales y subespecialistas, 70,6 % profesionales de Enfermería y auxiliares, y 4,2 % terapeutas respiratorios. El análisis incluyó estadística descriptiva, pruebas de Chi2, U de Mann-Whitney, Fisher, T de Student, ANOVA y el Alfa de Cronbach. Resultados: los hallazgos del estudio sugieren que es menor el miedo a la propia muerte que el miedo a la muerte de otros, y no hay diferencia entre el miedo al proceso de morir propio y de otros. Es mayor el miedo a la muerte en enfermeras profesionales y menor en pediatras subespecialistas. Existe mayor miedo a la muerte en el servicio de UCI-UCE (media: 3,53 DS: 0,88) comparado con Urgencias (media: 2,66 DS: 0,59). Hay asociación entre el miedo a la muerte con: el sexo femenino (p = 0,000), tener una creencia religiosa (p = 0,048), y el cargo (p = 0,007). La escala tuvo muy alta fiabilidad (Alfa de Cronbach: 0,95). Discusión: es de aclarar que este estudio fue realizado durante el segundo año de la pandemia del COVID-19, cuando había menor temor, mayor conocimiento y vacunas, cuyos resultados se corresponden con otros estudios. Conclusión: en el presente estudio el mayor miedo a la muerte se asoció con ser mujer, tener creencia religiosa y laborar en UCI-UCE comparado con Urgencias.

Introduction: The evidence obtained from previous research suggests that there is more anxiety related to dying compared with death. Nevertheless, more research is needed. Objective: To analyze the fear of death and dying, oneself and others, in the pediatric service personnel at Pablo Tobón Uribe Hospital in Medellín. Methodology: This was a transversal analytic study to apply the Collett-Lester Fear of Death Scale on 143 people: 25,2 % were general pediatricians and subspecialists, 70,6 % were professional nurses and medical assistants, and 4,2 % were respiratory therapists. The analysis included descriptive statistics, Chi2 test, Mann-Whitney U test, Fisher, StudentsT, ANOVA and Cronbach's Alpha. Results: Here we report the mean of one's fear of death is lower than the fear of others' death. There is no difference when comparing the fear of one's process of dying mean, rather than when it's others. Fear of death is higher in professional nurses and lower in pediatric subspecialists. The study shows higher fear of death in the ICU-IMC services (mean: 3,53 SD: 0,88) compared with the emergency room (mean:2,66 SD: 0,59). There is a statistical association between fear of death and being a woman (p=0,000), having a religious belief (p=0,048) and job position (p=0,007). The scale has a high internal consistency (Cronbach's Alpha: 0,95). Discussion: It is important to mention that this research was conducted during the second year of the COVID-19 pandemic, when the fear had decreased, and with more knowledge and the vaccines were ready, the results are coherent with other papers. Conclusion: In this study the higher fear of death was associated with being a woman, having a religious belief and working in ICU-IMC compared to the emergency room.