Características clínicas y epidemiológicas asociadas con internación en niños con COVID-19 en un hospital pediátrico de alta complejidad: Estudio de cohorte enero-marzo 2022 / Clinical and epidemiologic characteristics associated with hospital admission in children with COVID19 in a tertiary-care pediatric hospital: A January-March 2022 cohort study

Introducción: La proporción de casos reportados de niños y adolescentes con COVID-19 aumenta progresivamente. La hospitalización relacionada con COVID-19 en niños es infrecuente, pero causa morbilidad y sobrecarga al sistema de salud. Objetivos: Describir las características clínicas y evolutivas de los niños con diagnóstico de COVID-19 en un hospital pediátrico de alta complejidad. Comparar los pacientes que requirieron internación y los que no. Material y métodos: Cohorte prospectiva. Se incluyeron todos los pacientes con diagnóstico virológico de COVID-19 desde 1.1.2022 a 1.3.22 en un hospital pediátrico de alta complejidad. Se compararon los antecedentes, características clínicas y evolutivas de los pacientes según requirieran o no internación. Se utilizó STATA 16. Resultados: n: 1764 pacientes, de ellos 958 eran varones (54%). La mediana de edad fue 56 meses (RIC 17-116). Tenían enfermedad de base 789 pacientes (46%). Las más frecuentes fueron: enfermedad oncohematológica 215 (12%), neurológica 103 pacientes (6%) , enfermedad pulmonar crónica 68 (4%), cardiopatías congénitas 65 (4%) y síndrome genético 57 pacientes (3%). Eran inmunosuprimidos: 292 (17%). Presentaron síntomas relacionados con COVID-19 1319 pacientes (79%). Requirieron internación 591 (34%). Tuvieron coinfección con otros virus respiratorios 33 pacientes (2%). Ingresaron a Cuidados intensivos en relación a la COVID-19 22 pacientes (1.3%) y fallecieron en relación con la infección 8 (0.5%). En el análisis univariado, la presencia de comorbilidades, la coinfección viral y la inmunosupresión se asociaron estadísticamente con el requerimiento de internación. El antecedente de 2 o más dosis de vacuna para SARS-CoV-2 fue un factor protector para la internación en los mayores de 3 años. En el modelo multivariado, los pacientes menores de 3 años (OR 6.5, IC95% 1.2-36.8, p 0.03), con comorbilidades (OR 2.04, IC 95% 1.7- 3.3, p 0.00) y los huéspedes inmunocomprometidos (OR 2.89, IC95% 2.1-4.1, p 0.00) tuvieron más riesgo de internación. Ajustado por el resto de las variables, haber recibido dos o más dosis de vacuna fue un factor protector para la internación (OR 0.65, IC 95% 0.49-0.87, p<0.01). Conclusiones: En este estudio de cohorte prospectivo de niños con diagnóstico confirmado de COVID-19 predominó la enfermedad sintomática. Fueron admitidos en relación con el COVID-19, 34% de los pacientes. La vacunación con dos o más dosis fue un factor protector para la internación en el modelo multivariado. Además, se asociaron estadísticamente con la hospitalización, la edad menor de 3 años, las comorbilidades previas y la inmunosupresión (AU)

Introduction: The rate of reported cases of children and adolescents with COVID-19 is progressively increasing. COVID-19-related hospital admission in children is uncommon, but leads to morbidity and places a burden on the healthcare system. Objectives: To describe the clinical characteristics and outcome of children diagnosed with COVID-19 in a pediatric tertiary-care hospital and to compare patients who required hospital admission with those who did not. Material and methods: A prospective cohort study. All patients with a virological diagnosis of COVID-19 seen between 1.1.2022 and 1.3.22 in a tertiary-care pediatric hospital were included. We compared patient history, clinical characteristics, and outcome according to whether or not they required hospital admission. STATA 16 was used. Results: n: 1764 patients, 958 of whom were male (54%). The median age was 56 months (IQR, 17- 116). Overall, 789 patients had an underlying disease (46%), the most frequent of which were hematology-oncology disease in 215 patients (12%), neurological disease in 103 (6%), chronic lung disease in 68 (4%), congenital heart disease in 65 (4%), and a genetic syndrome in 57 (3%); 292 were immunosuppressed (17%). Overall, 1319 patients (79%) had COVID-19-related symptoms and 591 (34%) required hospital admission. A coinfection with other respiratory viruses was observed in 33 patients (2%). Intensive care admission due to COVID-19 was required in 22 patients (1.3%) and 8 (0.5%) died with COVID-19. In univariate analysis, the presence of comorbidities, viral coinfecton, and immunosuppression were statistically significantly associated with the need for hospitalization. A history of two or more doses of the SARSCoV2 vaccine was a protective factor against hospital admission in children older than 3 years. In the multivariate model, patients younger than 3 years (OR 6.5, 95% CI 1.2-36.8, p 0.03), with comorbidities (OR 2.04, 95%CI 1.7-3.3, p 0.00) and immunocompromised hosts (OR 2.89, 95% CI 2.1-4.1, p 0.00) had a higher risk of hospital admission. When adjusting for the remaining variables, having received two or more doses of the vaccine was found to be a protective factor against hospital admission (OR 0.65, 95% CI 0.49-0.87, p<0.01). Conclusions: In this prospective cohort study of children with a confirmed diagnosis of COVID-19, symptomatic disease predominated. Thirty-four percent of the patients were admitted for COVID-19. Vaccination with two or more doses was a protective factor against hospitalization in the multivariate model. In addition, age younger than 3 years, previous comorbidities, and immunosuppression were statistically associated with hospital admission (AU)

Características clínicas y evolutivas de niños con infección por SARS-CoV-2 en un hospital de alta complejidad: estudio de cohorte / Clinical and outcome characteristics of children with SARS CoV-2 infection in a tertiary-care hospital: a cohort study

Introducción: Las infecciones por SARS-CoV-2 representan un problema de salud pública a nivel mundial. En los niños se reporta menor incidencia y cuadros clínicos más leves. Se realizó el presente estudio con el objetivo de describir las características clínicas y evolutivas de los niños con diagnóstico de infección por SARS CoV-2 en el Hospital Juan P. Garrahan. Material y métodos: estudio de cohorte prospectivo. Se incluyeron todos los pacientes con diagnóstico confirmado por PCR de COVID-19 desde 20.4.20 hasta el 3.07.21 y con seguimiento en el hospital de Pediatría Juan P. Garrahan. Resultados: n: 1644. Eran varones 836 (51%). La mediana de edad fue 75 meses (RIC 22- 143). Tenían alguna enfermedad de base previa al diagnóstico de COVID-19: 884 pacientes (53,7%), la más frecuente fue la enfermedad oncohematológica. Estaban asintomáticos 423 pacientes (25,7%). De los pacientes sintomáticos, 1071 (65,1%) presentaron cuadro leve, 5 (0,3%) moderado, 69 (4,2%) grave y 76 (4,6%) crítico. La fiebre fue el hallazgo más frecuente n: 782; (47,5%). Se internaron 900 pacientes (54,7%), 33 en UCI (2%). Fallecieron 7 pacientes (0,4%), todos ellos con comorbilidades graves. Conclusiones: En este estudio de cohorte de niños con infección por SARS-CoV-2 confirmada, predominaron los pacientes con enfermedad de base y las formas leves de COVID-19. El ingreso a UCI fue menor al 2%. Fallecieron 7 pacientes (0.4%) todos ellos con comorbilidades y coinfecciones (AU)

Introduction: SARS-CoV-2 infections represent a worldwide public health problem. A lower incidence and milder clinical pictures are reported in children. The aim of this study was to describe clinical and outcome characteristics of children diagnosed with SARS-CoV-2 infection at Hospital de Pediatría Juan P. Garrahan. Methods: A prospective cohort study was conducted. All patients with a PCR-confirmed diagnosis of COVID-19 seen between 20.4.20 and 3.07.21 and followed-up at Hospital de Pediatría Juan P. Garrahan were included. Results: n: 1644; 836 males (51%) were male. Median age was 75 months (IQR, 22-143). Overall, 884 patients (53.7%) had an underlying disease prior to COVID-19 diagnosis, most frequently hematologic/ oncologic disease. 423 patients (25.7%) were asymptomatic. Of the symptomatic patients, 1071 (65.1%) had mild, 5 (0.3%) moderate, 69 (4.2%) severe, and 76 (4.6%) critical disease. Fever was the most frequent finding (n: 782; 47.5%). A total of 900 patients (54.7%) were admitted, 33 of whom to the ICU (2%). Seven patients (0.4%) died, all with severe comorbidities. Conclusions: In this cohort study of children with confirmed SARSCoV-2 infection, patients with underlying disease and mild forms of COVID-19 predominated. ICU admission occurred in less than 2%. Seven patients (0.4%) died, all of them with comorbidities and coinfections. (AU)

Registry of the Spanish Network for Systemic Sclerosis: Survival, Prognostic Factors, and Causes of Death.

Systemic sclerosis (SSc) is a rare, multisystem disease showing a large individual variability in disease progression and prognosis. In the present study, we assess survival, causes of death, and risk factors of mortality in a large series of Spanish SSc patients. Consecutive SSc patients fulfilling criteria of the classification by LeRoy were recruited in the survey. Kaplan-Meier and Cox proportional-hazards models were used to analyze survival and to identify predictors of mortality. Among 879 consecutive patients, 138 (15.7%) deaths were registered. Seventy-six out of 138 (55%) deceased patients were due to causes attributed to SSc, and pulmonary hypertension (PH) was the leading cause in 23 (16.6%) patients. Survival rates were 96%, 93%, 83%, and 73% at 5, 10, 20, and 30 years after the first symptom, respectively. Survival rates for diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc were 91%, 86%, 64%, and 39%; and 97%, 95%, 85%, and 81% at 5, 10, 20, and 30 years, respectively (log-rank: 67.63, P < 0.0001). The dcSSc subset, male sex, age at disease onset older than 65 years, digital ulcers, interstitial lung disease (ILD), PH, heart involvement, scleroderma renal crisis (SRC), presence of antitopoisomerase I and absence of anticentromere antibodies, and active capillaroscopic pattern showed reduced survival rate. In a multivariate analysis, older age at disease onset, dcSSc, ILD, PH, and SRC were independent risk factors for mortality. In the present study involving a large cohort of SSc patients, a high prevalence of disease-related causes of death was demonstrated. Older age at disease onset, dcSSc, ILD, PH, and SRC were identified as independent prognostic factors.

Agenesia unilateral del nervio coclear / Unilateral cochlear nerve aplasia

La agenesia del nervio coclear es un trastorno embriológico en la formación del oído interno que provoca una sordera neurosensorial. Presentamos el caso de un varón de 2,5 años de edad, que consulta por presentar retraso del lenguaje, hipoacusia del oído derecho y problemas del comportamiento. En la exploración se percibe una conexión adecuada con el medio, con un lenguaje limitado, y no se observa ningún hallazgo patológico en el examen neurológico. Ante la sospecha de trastorno específico del lenguaje se solicitó un electroencefalograma, un estudio genético, una resonancia magnética (RM) y una valoración otorrinolaringológica (ORL) y psicopedagógica. La RM craneal mostró una agenesia del nervio vestibulococlear derecho, y el estudio ORL una hipoacusia neurosensorial derecha. Diagnosticado de una afectación grave del desarrollo del lenguaje receptivo-expresivo, no se ha podido valorar su relación con la pérdida auditiva total. Las técnicas de imagen se han convertido en el método ideal para la detección de hallazgos patológicos en el oído interno, y deben realizarse ante toda pérdida de audición. Además, son útiles para la evaluación de los pacientes candidatos a la colocación de un implante coclear, ya que detectan anormalidades que pueden desaconsejar la intervención. Aunque las anomalías del conducto auditivo interno asociado con una agenesia del nervio coclear son, en principio, una contraindicación quirúrgica de implantación coclear, estos pacientes se podrían beneficiar de la estimulación eléctrica directa del núcleo coclear aplicando implantes en el tronco cerebral. En los niños con hipoacusia no sólo se altera el lenguaje, sino también las áreas emocional, social, cognitiva y motora, por lo que es necesario un tratamiento multidisciplinario

Cochlear nerve aplasia is an embryological defect in the formation of the inner ear that causes a sensorineural hearing loss. We report the case of a 2.5-year-old boy with language delay, right-sided hearing loss and behavioral problems. On examination, an adequate connection with the environment and poor language development were observed, and there were no pathological findings in the neurological assessment. Given the suspicion of a specific language disorder, electroencephalogram, genetic studies, magnetic resonance imaging (MRI), ear, nose and throat (ENT) examination and psychological evaluation were requested. The cranial MRI demonstrated right vestibulocochlear nerve aplasia and the ENT assessment revealed right sensorineural hearing loss. It has not been possible to determine the relationship between the diagnosis of severe receptive-expressive language delay and the total hearing loss. Imaging techniques have become the ideal method for the detection of pathological findings in the inner ear, and should be performed in cases of profound hearing loss. Imaging is also useful in the evaluation of cochlear implantation candidates because it can detect abnormalities that may contraindicate intervention. Although anomalies of the internal auditory canal associated with cochlear nerve agenesia are, in principle, surgical contraindications to cochlear implantation, these patients can benefit from direct electrical stimulation of the cochlear nucleus if the source is implanted into the brain stem. In children with hearing loss, not only is language affected, but the emotional, social, cognitive and motor areas as well. For this reason, multidisciplinary therapy is always required

Enfermedad inflamatoria pélvica grave. Respuesta al ertapenem / Severe pelvic inflammatory disease. Response to ertapenem

La enfermedad inflamatoria pélvica es un importante problema de salud. El retraso en su diagnóstico y tratamiento adecuado contribuye ala aparición de secuelas, con riesgo de problemas de fertilidad, así como dolor pélvico crónico. Los tratamientos antibióticos han de dar coberturaempírica de amplio espectro a los patógenos más habituales, teniendo en cuenta además el riesgo de cada paciente. Exponemos elcaso de una paciente joven con un rara malformación vaginal a quien se creó una neovagina con piel del abdomen. Años más tarde la pacienteconsulta con síntomas de enfermedad inflamatoria pélvica. No hubo respuesta clínica ni analítica al tratamiento antibiótico parenteralhabitual, incluso tras tratamiento quirúrgico por absceso tubárico. Del cultivo de cavidad abdominal se aislaron peptoestreptococos conalta resistencia a la clindamicina, por lo que se instauró monoterapia con ertapenem y se obtuvieron excelentes resultados. En conclusión,se necesitan más ensayos clínicos para conocer los patógenos generalmente relacionados con la enfermedad inflamatoria pélvica en nuestromedio, así como conocer las resistencias a los antibióticos para reevaluar los tratamientos antibióticos habituales con la posibilidad de recomendarnuevos agentes, como el ertapenem

Pelvic inflammatory disease (PID) is an important health problem. Delay in diagnosis and effective treatment contributes to inflammatory sequelaewith risk of future fertility problems and chronic pelvic pain. Treatment regimens must provide empiric, broad-spectrum coverage oflikely pathogens but also take into account patient’s risk profile. In this article we report the case of a young woman affected by a rare genitalmalformation who required the creation of a neovagina made of abdominal skin. Years later, the patient presented with symptoms thatsupport the diagnosis of PID. There was no clinical analytical response to classical parenteral antimicrobial regimen, even after surgical interventionfor tubal abscess. Peptostreptococo isolated in abdominal cavity culture showed an infrequent clindamycin resistance, so we startedmonotherapic treatment with ertapenem, with excellent results. In conclusion, more clinical trials are needed to discover the pathogensusually involved in PID in our setting and their antibiotic resistance to re-evaluate standard antimicrobial regimens and perhaps recommendnew agents, such as ertapenem

[Severe pelvic inflammatory disease. Response to ertapenem]. / Enfermedad inflamatoria pélvica grave. Respuesta al ertapenem.

Pelvic inflammatory disease (PID) is an important health problem. Delay in diagnosis and effective treatment contributes to inflammatory sequelae with risk of future fertility problems and chronic pelvic pain. Treatment regimens must provide empiric, broad-spectrum coverage of likely pathogens but also take into account patient's risk profile. In this article we report the case of a young woman affected by a rare genital malformation who required the creation of a neovagina made of abdominal skin. Years later, the patient presented with symptoms that support the diagnosis of PID. There was no clinical analytical response to classical parenteral antimicrobial regimen, even after surgical intervention for tubal abscess. Peptostreptococci isolated in abdominal cavity culture showed an infrequent clindamycin resistance, so we started monotherapy treatment with ertapenem, with excellent results. In conclusion, more clinical trials are needed to discover the pathogens usually involved in PID in our setting and their antibiotic resistance to re-evaluate standard antimicrobial regimens and perhaps recommend new agents, such as ertapenem.

Combinación de 2 técnicas de transposición ovárica laparoscópica previa al tratamiento radioterápico de neoplasias pélvicas / Combination of 2 techniques of laparoscopic ovarian transposition prior to radiotherapy for pelvic neoplasms

El tratamiento con radioterapia de masas pélvicas en mujeres jóvenes causa una alta incidencia de fallos ováricos precoces. Para evitarlo, existe la opción de transponer los ovarios fuera del campo de radiación. Exponemos el caso de 2 mujeres tratadas de un sarcoma de Ewing y de una recidiva de enfermedad de Hodgkin, respectivamente, que se sometieron a una transposición ovárica laparoscópica bilateral a las correderas cólicas, el ovario izquierdo a un nivel algo inferior para mantenerlo unido a su trompa. Esta técnica permite preservar la función ovárica a la vez que mantiene la posibilidad de futuros embarazos espontáneos (AU)

[Program for the substitution of therapeutic equivalents in the hospital setting]. / Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario.

BACKGROUND: A Program of Therapeutic Equivalents (TEP) is here reported which was elaborated and is currently in force at a third level university teaching hospital. MATERIALS AND METHODS: Therapeutic equivalents were selected within the same pharmacologic group on the basis of approved indications and both efficiency and safety data. RESULTS: TEP considers: a) the substitution of drugs which are considered therapeutic equivalents; b) withdrawal of drugs which have not proved efficiency or are of no interest for inpatients; c) continuation of therapies when changes are not advisable, and d) indistinct use of homologous drugs. From August 1998 up to April 1999, TEP was applied in 505 occasions; it was accepted in 499 (99%) and rejected in 6 (1%). DISCUSSIONS: The substitution of therapeutic equivalents should be viewed in the context of selecting the most appropriate drugs to be used in the hospital setting. TEP should be a consensus document and supervised by the Pharmacy and Therapeutics Commission.

Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario / Programme for the substitution of therapeutic equivalents in the hospital setting

Se presenta un Programa de Equivalentes Terapéuticos (PET) elaborado e implantado en un hospital universitario de tercer nivel. Material y métodos. Los equivalentes terapéuticos se seleccionaron dentro del mismo grupo farmacológico en función de las indicaciones aprobadas y los datos de eficacia y seguridad. Resultados. El PET contempla: a) sustitución de fármacos considerados equivalentes terapéuticos; b) suspensión de fármacos que no han mostrado eficacia o sin interés en pacientes hospitalizados; c) continuación de tratamientos que no es aconsejable modificar, y d) utilización indistinta de fármacos homólogos. Desde agosto de 1998 hasta abril de 1999 se aplicó el PET en 505 ocasiones, fue aceptado en 499 (99 por ciento) y rechazado en 6 (1 por ciento). Discusión. La sustitución de equivalentes terapéuticos debe englobarse en el contexto de la selección de medicamentos más adecuados para su utilización en el medio hospitalario. El PET debe ser un documento consensuado y supervisado por la Comisión de Farmacia y Terapéutica (AU)

[Droxicam-induced toxic hepatitis]. / Hepatitis tóxica por Droxicam.

We present four cases of hepatitis with clinical features indicating a direct link with Droxicam. In all the cases, the presentation was that of acute hepatitis with subsequent resolution, whereas one patient developed autoimmune chronic active hepatitis. A full evaluation including ultrasound, liver biopsy, and serologic markers supported the diagnosis. Due to the fact that the "Dirección General de Farmacia y Productos Sanitarios" has approved the postponement of dispensation of products with Droxicam from February 25, 1995, this drug should not be considered anymore in the future as a potential cause of liver injury (acute or chronic hepatitis).

[Non-specific granulomatous prostatitis. Relationship and differential diagnosis with prostatic cancer]. / Prostatitis granulomatosa inespecifica. Relacion y diagnóstico diferencial con el cáncer de próstata.

The unspecific granulomatous prostatitis (GP) is a rare prostate disease. Its relevance lies on the common confusion with prostate carcinoma. Review of 21 cases of unspecific GP, two of which had previously undergone transurethral resection of the prostate. Forty-eight percent of patients developed urinary tract infection prior to GP diagnosis. In 13 patients (62%), prostate carcinoma was suspected after rectal examination of the prostate and transrectal ultrasound. Diagnosis was achieved by histopathology after prostate biopsy and transurethral resection (100%). Prostate Specific Antigen (PSA) was within the normal ranges in all cases that it was performed (six), with the exception of one patient who developed prostate cancer. During follow-up, four patients developed prostate cancer (19%) with an average presentation time of 5.5 years after GP diagnosis.

[Primary adenocarcinoma of the bladder]. / Adenocarcinoma primario de vejiga.

Primary adenocarcinoma of the bladder is a rare tumor type. Histologically it can be mucinous, signet ring cell or clear cell. When diagnosed, it is in the advanced stages and carries a poor prognosis because of its aggressive nature. We report on 9 cases with primary adenocarcinoma of the bladder (2 signet ring cell and 7 mucinous tumors). Those with the advanced stage had a mean survival of 13 months. Of the remaining 4, one survived up to 6 years. This patient had a medium stage tumor and had undergone radical treatment.

[Idiopathic granulomatous orchitis]. / Orquitis granulomatosa idiopática.

Idiopathic granulomatous orchitis is a rare testicle lesion of unknown etiology. This paper illustrates 10 cases studying their presentation, location, ultrasound and histological diagnosis and therapy. A testicular injury background and self-immune reaction appear as likely causes of this entity. Differential diagnosis with testes malignant tumours can only be reached after orchiectomy and a subsequent histological examination.