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1.
An. pediatr. (2003. Ed. impr.) ; 92(4): 241.e1-241.e11, abr. 2020. mapas, graf, tab
Artículo en Español | IBECS | ID: ibc-186847

RESUMEN

El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo 7 casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente «nuevo coronavirus», 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declara el brote una Emergencia Internacional. El día 11 de febrero la OMS le asigna el nombre de SARS-CoV2 e infección COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectología Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización


On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them


Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Coronavirus/clasificación , Coronavirus/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Índice de Severidad de la Enfermedad , Sociedades Médicas , España
2.
Texto & contexto enferm ; 29: e20200156, Jan.-Dec. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1117301

RESUMEN

Objetivo: identificar en la literatura la producción científica sobre exámenes y manifestaciones clínicas de COVID-19 en niños y discutir el papel de la enfermería en su atención. Métodos: revisión integradora, cuya búsqueda tuvo lugar entre abril y junio de 2020, en las bases de datos de Web of Science, CINAHL, BDENF, IBECS, LILACS, MEDLINE (a través de PubMed) para responder a la pregunta orientadora: lo que revelan los artículos de investigación sobre COVID -19 en niños? Se incluyeron artículos de investigación originales, publicados de enero a mayo de 2020. Estudios sin metodología de investigación (informes de casos, reflexión, recomendaciones), artículos de revisión, estudios que se centraron en otros temas o se llevaron a cabo exclusivamente con recién nacidos, bebés, población de adolescentes y adultos. Resultados: las búsquedas en las bases de datos buscadas capturaron 314 referencias. Después de las exclusiones, se seleccionaron 59 estudios para ser leídos en su totalidad; de estos, se seleccionaron 14 artículos para componer esta revisión, agrupados empíricamente, de acuerdo con sus similitudes, en dos categorías: Exámenes utilizados en COVID-19 en niños; y Principales hallazgos clínicos en COVID-19 en niños. Conclusión: los estudios enfatizan los exámenes COVID-19 y los hallazgos clínicos en niños; por lo tanto, el papel de la enfermería se destaca al preparar y realizar estos exámenes, ya que son un instrumento para evaluar y monitorear a los niños con COVID-19, así como para promover una atención adecuada y calificada para minimizar los signos y síntomas de esta enfermedad. enfermedad, con miras a la pronta restauración de su salud.(AU)


Objective: to identify in nursing literature scientific production on tests and clinical characteristics of COVID-19 in children and discuss the role of nursing in their care. Methods: an integrative review, which took place between April and June 2020, at Web of Science, CINAHL, BDENF, IBECS, LILACS, MEDLINE (via PubMed) to answer the guiding question: what do research articles on COVID-19 in children reveal? Original research articles published from January to May 2020 were included. Studies without research methodology (case reports, reflection, recommendations), review articles, studies focusing on other themes or conducted exclusively with neonates, infants, adolescents, and adults were excluded. Results: database search found 314 references. After exclusions, 59 studies were selected to be read in full. Of these, 14 articles were selected to compose this review, empirically grouped according to their similarities into two categories: Tests used in COVID-19 in children and Main clinical findings of COVID-19 in children. Conclusion: studies emphasize clinical tests and findings of COVID-19 in children; therefore, the role of nursing at the time of preparation and performance of such tests stands out, since they are an instrument for assessment and follow-up of children with coronavirus as well as in the promotion of adequate and qualified care to minimize the signs and symptoms of this disease, with a view to prompt restoration of their health.(AU)


Objetivo: identificar en la literatura la producción científica sobre exámenes y manifestaciones clínicas de COVID-19 en niños y discutir el papel de la enfermería en su atención. Métodos: revisión integradora, cuya búsqueda tuvo lugar entre abril y junio de 2020, en las bases de datos de Web of Science, CINAHL, BDENF, IBECS, LILACS, MEDLINE (a través de PubMed) para responder a la pregunta orientadora: lo que revelan los artículos de investigación sobre COVID -19 en niños? Se incluyeron artículos de investigación originales, publicados de enero a mayo de 2020. Estudios sin metodología de investigación (informes de casos, reflexión, recomendaciones), artículos de revisión, estudios que se centraron en otros temas o se llevaron a cabo exclusivamente con recién nacidos, bebés, población de adolescentes y adultos. Resultados: las búsquedas en las bases de datos buscadas capturaron 314 referencias. Después de las exclusiones, se seleccionaron 59 estudios para ser leídos en su totalidad; de estos, se seleccionaron 14 artículos para componer esta revisión, agrupados empíricamente, de acuerdo con sus similitudes, en dos categorías: Exámenes utilizados en COVID-19 en niños; y Principales hallazgos clínicos en COVID-19 en niños. Conclusión: los estudios enfatizan los exámenes COVID-19 y los hallazgos clínicos en niños; por lo tanto, el papel de la enfermería se destaca al preparar y realizar estos exámenes, ya que son un instrumento para evaluar y monitorear a los niños con COVID-19, así como para promover una atención adecuada y calificada para minimizar los signos y síntomas de esta enfermedad. enfermedad, con miras a la pronta restauración de su salud.(AU)


Asunto(s)
Humanos , Preescolar , Niño , Enfermería Pediátrica , Diagnóstico de Enfermería , Infecciones por Coronavirus , Salud del Niño , Revisión
3.
Texto & contexto enferm ; 29: e20180348, Jan.-Dec. 2020. tab
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1059138

RESUMEN

ABSTRACT Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.


RESUMEN Objetivo: identificar los factores asociados al deterioro clínico reconocido por una Puntuación Pediátrica de Alerta Temprana. Método: estudio de corte transversal realizado en un hospital público pediátrico terciario con 271 niños de cero a diez años de edad, hospitalizados entre mayo y octubre de 2015. Para identificar a los niños con y sin signos de deterioro clínico, se aplicó la versión traducida, adaptada y validad del Brighton Pediatric Early Warning Score para el contexto brasileño. Se utilizaron el análisis de regresión logística y la relación de prevalencia (RP) para medir la asociación entre las variables estudiadas. Se adoptaron el Intervalo de Confianza (IC) del 95% y el Valor de p como medida de significancia estadística para identificar los potenciales factores asociados. Resultados: los factores asociados al deterioro clínico de los niños estudiados fueron los siguientes: edad ≤ 2 años (p=0,000), internación en la unidad de emergencia (p=0,000), comorbilidad (p=0,020) y diagnóstico clínico de enfermedad respiratoria (p=0,000). Conclusión: los niños con una edad máxima de 2 años, con alguna comorbidad, con diagnóstico de enfermedad respiratoria e internadas en la unidad de emergencia presentaron una mayor probabilidad de deterioro clínico. Identificar factores asociados al deterioro clínico puede servir como alerta y orientar al equipo de salud hacia los niños más susceptibles a este fenómeno.


RESUMO Objetivo: identificar os fatores associados à deterioração clínica reconhecida por um Escore Pediátrico de Alerta Precoce. Método: estudo de corte transversal, realizado num hospital público pediátrico terciário, com 271 crianças de zero a dez anos, hospitalizadas entre maio e outubro de 2015. Para a identificação das crianças com e sem sinais de deterioração clínica, foi aplicada a versão traduzida, adaptada e validada do Brighton Pediatric Early Warning Score para o contexto brasileiro. Foram utilizadas a análise de regressão logística e a razão de prevalência (RP) para medir a associação entre as variáveis estudadas. O Intervalo de Confiança (IC) de 95% e Valor de p foram adotados como medida de significância estatística para a identificação dos potenciais fatores associados. Resultados: os fatores associados à deterioração clínica das crianças estudadas foram idade ≤ 2 anos (p=0,000), internamento na unidade de emergência (p=0,000), comorbidade (p=0,020) e diagnóstico clínico de doença respiratória (p=0,000). Conclusão: crianças ≤ 2 anos, portadoras de comorbidade, com diagnóstico de doença respiratória e internadas na unidade de emergência apresentaram aumento da probabilidade de deterioração clínica. A identificação de fatores associados à deterioração clínica pode alertar e direcionar a equipe de saúde para crianças mais suscetíveis a esse fenômeno.


Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Enfermería Pediátrica , Niño Hospitalizado , Salud , Salud del Niño , Deterioro Clínico , Alertas , Hospitalización
4.
Rev. enferm. UERJ ; 28: e48443, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1116092

RESUMEN

Objetivo: comparar o comportamento de pré-escolares durante o uso de administração por inalação, antes e após sessão de Brinquedo Terapêutico. Método: estudo quase-experimental de abordagem quantitativa, com a técnica de observação antes e após a intervenção, realizado por meio de amostra intencional, recrutadas em uma Unidade de Pronto Atendimento no interior de Minas Gerais. Os dados foram analisados por estatística descritiva e inferencial, coletados entre os meses de novembro de 2017 a abril de 2018. Resultados: foram avaliados 25 comportamentos de 99 pré-escolares durante a administração por inalação. Após a sessão, 73,7% estavam com a postura e expressão facial relaxada, 76,8% estavam à vontade, 19,2% interromperam o procedimento e 38,4 % solicitaram a presença da mãe ou acompanhante. Conclusão: o uso do brinquedo, favoreceu maior aceitação e adaptação de pré-escolares submetidos à administração por inalação, evidenciado a importância em implementar essa estratégia em serviços de pronto atendimento pediátrico.


Objective: to compare the behavior of preschoolers during inhalation therapy, before and after a Therapeutic Play session. Method: quasi-experimental, quantitative study using pre- and post-intervention observation with an intentional sample recruited at an Emergency Care Unit in Minas Gerais. Data were collected from November 2017 to April 2018 and analyzed by descriptive and inferential statistics. Results: twenty-five behaviors of 99 preschoolers were evaluated during inhalation administration. After the session, 73.7% were relaxed in posture and facial expression, 76.8% were comfortable, 19.2% interrupted the procedure, and 38.4% requested the mother or companion to be present. Conclusion: the use of toys favored greater acceptance and adaptation by preschoolers undergoing inhalation therapy, evidencing the importance of implementing this strategy in pediatric emergency services.


Objetivo: comparar el comportamiento de los preescolares durante la terapia de inhalación, antes y después de una sesión de Juego Terapéutico. Método: estudio cuantitativo cuasi-experimental utilizando observación previa y posterior a la intervención con una muestra intencional reclutada en una Unidad de Atención de Emergencia en Minas Gerais. Los datos se recopilaron de noviembre de 2017 a abril de 2018 y se analizaron mediante estadísticas descriptivas e inferenciales. Resultados: se evaluaron veinticinco comportamientos de 99 niños en edad preescolar durante la administración por inhalación. Después de la sesión, el 73.7% se relajó en la postura y la expresión facial, el 76.8% se sintió cómodo, el 19.2% interrumpió el procedimiento y el 38.4% solicitó que la madre o la acompañante estuvieran presentes. Conclusión: el uso de juguetes favoreció una mayor aceptación y adaptación por parte de los preescolares sometidos a terapia de inhalación, lo que evidencia la importancia de implementar esta estrategia en los servicios de emergencia pediátricos.


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Juego e Implementos de Juego/psicología , Administración por Inhalación , Conducta Infantil/psicología , Técnicas de Observación Conductual , Relaciones Enfermero-Paciente , Atención de Enfermería/métodos
6.
Pan Afr Med J ; 36: 257, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33014253

RESUMEN

Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Dolor Abdominal/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Lesiones Encefálicas/complicaciones , Dolor en el Pecho/complicaciones , Niño , Preescolar , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Hallazgos Incidentales , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/etiología , Masculino , Persona de Mediana Edad , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Neumonía Viral/complicaciones , Estudios Prospectivos , Tomografía Computarizada por Rayos X/métodos , Túnez/epidemiología , Adulto Joven
7.
BMC Infect Dis ; 20(1): 720, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004004

RESUMEN

BACKGROUND: Children living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up. METHOD: Children (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6-14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done. RESULTS: At recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73). CONCLUSION: About half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.


Asunto(s)
Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Composición Familiar , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Esputo/microbiología , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Adulto Joven
8.
Aust J Gen Pract ; 49(10): 683-686, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33015684

RESUMEN

BACKGROUND AND OBJECTIVES: SARS-CoV-2 is known to cause milder disease in children when compared with adults, but the extent of this is unclear. The aim of this article is to estimate the case fatality rate (CFR) for SARS-CoV-2 infection and SARS-CoV-2 pneumonia in young children aged <5 years, and compare this with estimated CFRs for respiratory syncytial virus (RSV) and influenza. METHOD: This article reviews published case series of SARS-CoV-2 infection in the paediatric population and epidemiological data on COVID-19 published on official government websites internationally and in Australia. RESULTS: The CFR of SARS-CoV-2 pneumonia in children aged <5 years is estimated to be 0.15-1.35%, which is lower than the estimated CFR of RSV pneumonia of 0.3-2.1%, but higher than the estimated CFR of influenza pneumonia of 0.14-0.45%. DISCUSSION: SARS-CoV-2 infection is likely to be less lethal than RSV in children aged <5 years, but more lethal than influenza.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Gripe Humana/mortalidad , Neumonía Viral/mortalidad , Infecciones por Virus Sincitial Respiratorio/mortalidad , Adolescente , Preescolar , Salud Global/estadística & datos numéricos , Humanos , Recién Nacido , Mortalidad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/etiología
9.
Medwave ; 20(8): e8031, 2020 Sep 25.
Artículo en Español | MEDLINE | ID: mdl-33017383

RESUMEN

Objective: To compare excess mortality by district quintiles according to the Human Development Index (HDI) in Metropolitan Lima, the capital of Peru, and analyze the socioeconomic factors associated with excess mortality within the context of COVID-19. Methods: Retrospective cross-sectional analysis of the mortality records from non-violent causes registered in the National Death Information System in the 50 districts of Metropolitan Lima of the first 24 weeks of the years 2019 and 2020. Descriptive analysis was performed using contingency tables and time series graphs by sex, age group, and quintile of the district of residence according to the HDI. Negative binomial regression analysis was performed to identify possible explanatory factors for excess mortality. Results: An excess of 20 093 non-violent deaths and 2,979 confirmed deaths from COVID-19 were registered in Metropolitan Lima during the study period. The increase was observed primarily in men and adults aged 60 and over. Residents in the districts belonging to the fifth quintile, according to HDI, presented, in most cases, the lowest rates. Multivariate analysis revealed that a higher HDI level (p = 0.009) and a higher proportion of inhabitants living in extreme poverty (p = 0.014) decreased the excess mortality. Conclusion: Excess of non-violent deaths in Metropolitan Lima is higher in the quintiles with the lowest HDI, in men, and the age group from 60 to more years of age. The study of social and economic health determinants in Peru is crucial for the design of measures to be taken by the government against the COVID-19 pandemic.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Mortalidad/tendencias , Neumonía Viral/epidemiología , Adolescente , Adulto , Distribución por Edad , Niño , Preescolar , Infecciones por Coronavirus/mortalidad , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Perú/epidemiología , Neumonía Viral/mortalidad , Pobreza , Estudios Retrospectivos , Distribución por Sexo , Factores Socioeconómicos , Adulto Joven
10.
BMC Surg ; 20(1): 224, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023552

RESUMEN

BACKGROUND: Immunosuppressed patients, including individuals with organ transplantation, have been among susceptible groups with regard to COVID-19, on the other hand pediatric patients more commonly undergo a mild clinical course after acquiring COVID-19. To the best of the authors knowledge, to this date very little data exists on COVID-19 in a pediatric patient with liver transplantation. CASE PRESENTATION: We report a three year-old boy who had liver transplantation at 18 months old. He was admitted due to dyspnea with impression of acute respiratory distress syndrome and was then transferred to the intensive care unit. Chest X-ray at admission showed bilateral infiltration. Vancomycin, meropenem, azithromycin, voriconazole and co-trimoxazole were started from the first day of admission. On day 4 of admission, with suspicion of COVID-19, hydroxychloroquine, lopinavir/ritonavir and oseltamivir were added to the antibiotic regimen. PCR was positive for COVID-19. The patient developed multi-organ failure and died on day 6 of admission. CONCLUSIONS: For pediatric patients with organ transplantations, extreme caution should be taken, to limit and prevent their contact with COVID-19 during the outbreak, as these patients are highly susceptible to severe forms of the disease.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Trasplante de Hígado , Insuficiencia Multiorgánica/etiología , Neumonía Viral/complicaciones , Preescolar , Humanos , Unidades de Cuidados Intensivos , Masculino , Pandemias
11.
Rev Soc Bras Med Trop ; 53: e20200104, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33027414

RESUMEN

INTRODUCTION: Gene-Xpert MTB RIF (Xpert) is based on nucleic acid amplification by real-time polymerase chain reaction, which allows for the identification of Mycobacterium tuberculosis and rifampin resistance. We describe the use of Xpert for extrapulmonary tuberculosis (EPTB) in children and adolescents. METHODS: A case series of two reference centers in Rio de Janeiro from 2014-2019. RESULTS: The final diagnosis of EPTB was established in 11/36 (31%) patients, with five cases detectable by Xpert. For lymph node evaluation (9/11), diagnosis by Xpert occurred in 5/9 patients, all with caseous aspects. CONCLUSIONS: Xpert can facilitate the rapid diagnosis of lymph node tuberculosis.


Asunto(s)
Mycobacterium tuberculosis , Tuberculosis , Adolescente , Niño , Preescolar , Humanos , Lactante , Técnicas de Amplificación de Ácido Nucleico , Rifampin
12.
Rev Assoc Med Bras (1992) ; 66(9): 1270-1276, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33027457

RESUMEN

OBJECTIVES: To evaluate the treatment of wheezing and exacerbation of asthma in a pediatric emergency unit (ED), comparing it to that recommended by the guidelines for this purpose. METHODS: Descriptive cross-sectional study through medical records survey of children and adolescents (0-15 years of age) who received medication for wheezing or asthma exacerbation from January to April 2015 in the ED. The selected treatment was compared to that recommended by the guidelines, being analyzed the variables related to the medication (number and dose of short-acting ß2 agonist, associated or not with anticholinergic, oral or parenteral corticosteroid) and the length of stay in ED (≤1 h, ≥8 h and hospital admission). RESULTS: One-thousand eleven patients were selected with 56.7% between 3 and 15 years and 56% male. Although the selected drugs were in accordance with what was recommended, errors were observed in relation to dose, drug of choice, and method and time of use with the most frequent finding being incorrect dose (short-acting ß2 agonist: 66% and ipratropium bromide: 95.2%). CONCLUSION: The level of use of the measures recommended by the guidelines was low but compatible with other studies, leading to an increased risk of treatment failure and higher costs. Despite wide dissemination, the established concepts have not been sufficiently incorporated into clinical practice, suggesting the need for more effective educational actions for this process to occur.


Asunto(s)
Asma , Ruidos Respiratorios , Adolescente , Niño , Preescolar , Estudios Transversales , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Recién Nacido , Ipratropio , Masculino
13.
BMC Public Health ; 20(1): 1525, 2020 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-33032575

RESUMEN

BACKGROUND: This study was intended to investigate the epidemiological characteristics of COVID-19 clusters and the severity distribution of clinical symptoms of involved cases in Sichuan Province, so as to provide information support for the development and adjustment of strategies for the prevention and control of local clusters. METHODS: The epidemiological characteristics of 67 local clusters of COVID-19 cases in Sichuan Province reported as of March 17, 2020 were described and analyzed. Information about all COVID-19 clusters and involved cases was acquired from the China Information System for Disease Control and Prevention and analyzed with the epidemiological investigation results taken into account. RESULTS: The clusters were temporally and regionally concentrated. Clusters caused by imported cases from other provinces accounted for 73.13%; familial clusters accounted for 68.66%; the average attack rate was 8.54%, and the average secondary attack rate was 6.11%; the median incubation period was 8.5 d; a total of 28 cases met the criteria for incubation period determination, and in the 28 cases, the incubation period was > 14 d in 21.43% (6/28). a total of 226 confirmed cases were reported in the 67 clusters. Ten cases were exposed before the confirmed cases they contacted with developed clinical symptoms, and the possibility of exposure to other infection sources was ruled out; two clusters were caused by asymptomatic carriers; confirmed cases mainly presented with fever, respiratory and systemic symptoms; a gradual decline in the severity of clinical symptoms was noted with the increase of the case generation. CONCLUSIONS: Population movement and gathering restrictions and strict close contact management measures will significantly contribute to the identification and control of cases. Transmission during the incubation period and asymptomatic infections have been noted. Studies on the pathogenicity and transmissibility in these populations and on COVID-19 antibody levels and protective effects in healthy people and cases are required.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China/epidemiología , Análisis por Conglomerados , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pandemias , Adulto Joven
14.
Artículo en Chino | MEDLINE | ID: mdl-33040502

RESUMEN

Objective:To observe the secondary prevention efficacy of subcutaneous immunotherapy in children with allergic rhinitis(AR) and cough variant asthma(CVA) and to analyze its effect on the levels of serum sIgG4, IL-27 and IL-33. Method:The clinical data of 112 children aged 5-12 years with AR and CVA were retrospectively analyzed and divided into control group(52 cases) and SCIT group(60 cases). The patients were followed up for 3 years. The control group was received symptomatic treatment only, and the SCIT group was received SCIT on the basis of the control group. The numbers of cases of the two groups of children who produced new allergens and developed CA were analyze during the 3-year treatment. Changes in serum sIgG4, IL-27, IL-33 levels, TNSS, DCSS, NCSS, TRMS, TCMS, VAS score, and FEV1% before and after treatment were analyzed. Result:During the treatment, 4 patients(6.67%) in the SCIT group produced the new allergen, and 20 patients(38.46%) in the control group(χ²=16.73, P<0.05). There were only 3 cases(5.00%) in the SCIT group, which developed into CA, while 15 cases(28.85%) in the control group. The difference between the groups was statistically significant(χ²=11.74, P<0.05). Compared with baseline, serum levels of sIgG4 and IL-27 in both groups were significantly increased after 3 years of treatment(P<0.05), while serum levels of IL-33 were significantly decreased(P<0.05). After 3 years of treatment, serum levels of sIgG4 and IL-27 in the SCIT group were significantly higher than those in the control group, and serum levels of IL-33 were significantly lower than those in the control group(P<0.05). Compared with baseline, TNSS, DCSS, NCSS, TRMS, TCMS, VAS, and FEV1% in both groups were significantly improved at 1, 2, and 3 years of treatment(P<0.05). There was no significant difference in TNSS, DCSS, NCSS, TRMS, TCMS, VAS and FEV1% between the two groups at baseline(P>0.05), while after 1, 2 and 3 years of treatment the above indicators in the SCIT group were significantly better than those in the control group(P<0.05). Conclusion:SCIT treatment can prevent AR with CVA patients from producing new allergens and developing into CA, and improve serum sIgG4 and IL-27 and IL-33 levels.


Asunto(s)
Asma , Interleucina-27 , Rinitis Alérgica , Asma/terapia , Niño , Preescolar , Tos , Humanos , Inmunoterapia , Inyecciones Subcutáneas , Interleucina-33 , Estudios Retrospectivos , Rinitis Alérgica/terapia , Prevención Secundaria
15.
Ann Acad Med Singap ; 49(7): 449-455, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33000107

RESUMEN

INTRODUCTION: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread on an unprecedented scale from around the world, we described our experience in treating early COVID-19 cases in India. MATERIALS AND METHODS: An observational study of COVID-19 patients admitted to a tertiary care centre in North India between 2 March-4 April 2020 was performed. The clinical, epidemiological, laboratory, treatment and outcome data of patients were evaluated. RESULTS: A total of 75 patients were treated and 56 (74.66%) were men. The clinical spectrum of COVID-19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS). Fever (85.36%) was the most common symptom followed by cough (56.09%) and dyspnoea (19.51%). Findings from hemogram analysis showed that 32%, 21.33% and 18.67% of patients had lymphopaenia, eosinopenia and thrombocytopaenia, respectively. Inflammatory markers such as C-reactive protein, D-dimer, ferritin, fibrin degradation product and interleukin-6 were significantly elevated (P <0.05) in patients who required oxygen therapy than those who did not require it, suggesting the potential role such markers could play in predicting prognosis in patients. Mean hospital stay was 9.2 days and 72 (96%) patients made a complete recovery, but 3 (4%) patients demised after progressing to ARDS. CONCLUSION: The clinical and epidemiological spectrum of COVID-19 has jeopardised the health system in India. Without a proven therapy to combat this pandemic and with no sight of vaccines in the near future, a preventive strategy should be adopted to contain the spread of this infectious disease.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Centros de Atención Terciaria , Adolescente , Adulto , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Femenino , Hospitalización , Humanos , India , Lactante , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Terapia por Inhalación de Oxígeno , Pandemias , Neumonía Viral/epidemiología , Evaluación de Síntomas , Adulto Joven
16.
Lancet Respir Med ; 8(10): 975-986, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33007285

RESUMEN

BACKGROUND: Chronic pulmonary infection with Pseudomonas aeruginosa is one of the most important causes of mortality and morbidity in cystic fibrosis. If antibiotics are commenced promptly, infection can be eradicated. The aim of the trial was to compare the effectiveness and safety of intravenous ceftazidime and tobramycin versus oral ciprofloxacin in the eradication of P aeruginosa. METHODS: We did a multicentre, parallel group, open-label, randomised controlled trial in 72 cystic fibrosis centres (70 in the UK and two in Italy). Eligible participants were older than 28 days with an isolate of P aeruginosa (either the first ever isolate or a new isolate after at least 1 year free of infection). Participants were excluded if the P aeruginosa was resistant to, or they had a contraindication to, one or more of the trial antibiotics; if they were already receiving P aeruginosa suppressive therapy; if they had received any P aeruginosa eradication therapy within the previous 9 months; or if they were pregnant or breastfeeding. We used web-based randomisation to assign patients to 14 days intravenous ceftazidime and tobramycin or 12 weeks oral ciprofloxacin. Both were combined with 12 weeks inhaled colistimethate sodium. Randomisation lists were generated by a statistician, who had no involvement in the trial, using a computer-generated list. Randomisation was stratified by centre and because of the nature of the interventions, blinding was not possible. Our primary outcome was eradication of P aeruginosa at 3 months and remaining free of infection to 15 months. Primary analysis used intention to treat (powered for superiority). Safety analysis included patients who received at least one dose of study drug. TORPEDO-CF was registered on the ISRCTN register, ISRCTN02734162, and EudraCT, 2009-012575-10. FINDINGS: Between Oct 5, 2010, and Jan 27, 2017, 286 patients were randomly assigned to treatment: 137 to intravenous antibiotics and 149 to oral antibiotics. 55 (44%) of 125 participants in the intravenous group and 68 (52%) of 130 participants in the oral group achieved the primary outcome. Participants randomly assigned to the intravenous group were less likely to achieve the primary outcome, although the difference between groups was not statistically significant (relative risk 0·84, 95% CI 0·65-1·09; p=0·18). 11 serious adverse events occurred in ten (8%) of 126 participants in the intravenous antibiotics group and 17 serious adverse events in 12 (8%) of 146 participants in the oral antibiotics group. INTERPRETATION: Compared with oral therapy, intravenous antibiotics did not achieve sustained eradication of P aeruginosa in a greater proportion of patients with cystic fibrosis and was more expensive. Although there were fewer hospitalisations in the intravenous group than the oral group during follow-up, this confers no advantage over oral treatment because intravenous eradication frequently requires hospitalisation. These results do not support the use of intravenous antibiotics to eradicate P aeruginosa in cystic fibrosis. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Asunto(s)
Antibacterianos/administración & dosificación , Ceftazidima/administración & dosificación , Fibrosis Quística/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa , Tobramicina/administración & dosificación , Administración Intravenosa , Administración Oral , Adolescente , Adulto , Niño , Preescolar , Fibrosis Quística/tratamiento farmacológico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/complicaciones , Resultado del Tratamiento , Adulto Joven
18.
Ann Emerg Med ; 76(4): 413-426, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33012377

RESUMEN

STUDY OBJECTIVE: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of coronavirus disease 2019 (COVID-19)-affected populations, especially in low- and middle-income countries with less rapid and reliable vital statistics registration systems. Although official COVID-19 statistics in Mexico report almost exclusively inhospital mortality events, excess out-of-hospital mortality has been identified in other countries, including 1 EMS study in Italy that showed a 58% increase. Additionally, EMS and hospital reports from several countries have suggested that silent hypoxemia-low Spo2 in the absence of dyspnea-is associated with COVID-19. It is unclear, however, how these phenomena can be generalized to low- and middle-income countries. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many low- and middle-income country settings. METHODS: In this observational study, we calculated numbers of weekly out-of-hospital deaths and respiratory cases handled by EMS in Tijuana, and estimated the difference between peak epidemic rates and expected trends based on data from 2014 to 2019. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status, and examined for changing demographic or clinical features, including mean Spo2. RESULTS: An estimated 194.7 excess out-of-hospital deaths (95% confidence interval 135.5 to 253.9 deaths) occurred during the peak window (April 14 to May 11), representing an increase of 145% (95% CI 70% to 338%) compared with expected levels. During the same window, only 5 COVID-19-related out-of-hospital deaths were reported in official statistics. This corresponded with an increase in respiratory cases of 236.5% (95% CI 100.7% to 940.0%) and a decrease in mean Spo2 to 77.7% from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-socioeconomic-status areas, although respiratory cases were more concentrated in high-socioeconomic-status areas. CONCLUSION: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in low- and middle-income countries. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly 3-fold greater than increases reported in EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine whether excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of health care. We also found evidence of worsening rates of hypoxemia among respiratory patients treated by EMS, suggesting a possible increase in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed social disparities in out-of-hospital death that warrant monitoring and amelioration.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Servicios Médicos de Urgencia/estadística & datos numéricos , Hipoxia/virología , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Niño , Preescolar , Registros Electrónicos de Salud , Femenino , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Pandemias , Vigilancia en Salud Pública , Clase Social , Adulto Joven
20.
Rev Saude Publica ; 54: 90, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33027343

RESUMEN

OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.


Asunto(s)
Diarrea/epidemiología , Población Rural/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Colombia/epidemiología , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Lactante , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven
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