Pregnancy Outcomes Among Perinatally HIV-Infected Women in Spain.

BACKGROUND: An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this population frequently exposed to numerous antiretroviral regimens. This study describes the long-term outcomes of pregnant women living with perinatally acquired HIV in Spain. METHODS: Descriptive, retrospective, multicenter study of the women living with perinatally acquired HIV who gave birth between January 2000 and December 2019 in Madrid. Epidemiological, clinical, and HIV-related data were collected from the first delivery to the end of the study period, including antiretroviral therapy, prevention strategies, and outcomes. RESULTS: Sixty-three live births in 33 women were included. The mean number of pregnancies per women was 1.9 (range: 1-6). At first delivery, women's median age was 20 years (interquartile range: 18-23), 11 (33.3%) had been previously diagnosed with AIDS and 6 (18%) with mental health disorders. Forty percent became pregnant unsuppressed, whereas 81% achieved viral suppression at delivery. Treatment interruptions were common after delivery, as were losses to follow-up, with no positive effect of pregnancy on retention to care or the immune virological situation. Five women (15%) experienced a new AIDS event, and there were 2 deaths (6%) during follow-up. There was 1 case of mother-to-child transmission in a nonadherent woman in whom preventive measures could not be implemented. CONCLUSIONS: Pregnancy in this unique population of women living with perinatally acquired HIV poses particular challenges. Specific strategies, including a multidisciplinary approach, are needed to minimize perinatal transmission risks and improve outcomes during the postpartum period.

Impact of Coronavirus Pandemic on Tuberculosis and Other Imported Diseases Screening among Migrant Minors in Spain.

BACKGROUND: In recent decades, the increase in population movements has turned the focus to imported diseases. The COVID-19 pandemic has negatively impacted the access to health care systems, especially in highly vulnerable populations. We address the effects of the pandemic on the health screening of migrant unaccompanied minors (UM) in Spain. METHOD: Retrospective cross-sectional study including UM screened for imported diseases with a unified protocol at a pediatric reference unit for tropical and infectious diseases in Madrid, Spain. We compared the pre-pandemic (2018-2019) and post-pandemic periods (2020-2021). RESULTS: A total of 192 minors were screened during the study period, with a drop in UM's referral to our center in the post-pandemic years (140 in 2018-2019 vs. 52 in 2020-2021). Out of 192, 161 (83.9%) were diagnosed with at least one medical condition. The mean age was 16.8 years (SD 0.8) and 96.9% were males. Most cases were referred for a health exam; only 38% of children were symptomatic. Eosinophilia was present in 20.8%. The most common diagnosis were latent tuberculosis infection (LTBI) (72.9%), schistosomiasis (15.1%), toxocariasis (4.9%) and strongyloidiasis (4.9%). The prevalence of LTBI did not vary significantly (69.3% vs. 82.7%, p = 0.087). A total of 38% of the patients diagnosed with LTBI never started treatment or were lost to follow-up, as were two out of three patients with active pulmonary tuberculosis. CONCLUSIONS: In this series, the number of UM referred for health screening has dropped dramatically after the COVID pandemic, and two years after the beginning of the pandemic, access to care is still limited. Lost to follow-up rates are extremely high despite institutionalization. Specific resources, including multidisciplinary teams and accessible units are needed to improve diagnoses and linkage to care in this vulnerable population.

Seguimiento telemático de COVID-19: experiencia de un hospital terciario / Telemedicine follow-ups for COVID-19: Experience in a tertiary hospital

Introducción: El seguimiento telefónico es una posible alternativa para la atención médica de niños con COVID-19. Nuestro objetivo es describir la experiencia del seguimiento telemático realizado en un hospital terciario.Pacientes y métodos: Estudio descriptivo retrospectivo de los niños con diagnóstico confirmado o probable de COVID-19 atendidos en la consulta de seguimiento del Hospital La Paz entre marzo y junio del 2020. Se realizaron llamadas cada 48 h hasta desaparecer los síntomas y posteriormente semanales hasta estar 14 días asintomáticos.Resultados: Se incluyó a 72 niños con una mediana de edad de 83,5 meses (RIC=16,3-157,5); 46 eran varones (63,9%) y 14 tenían comorbilidades (19,4%); 32 pacientes (44,4%) habían requerido ingreso hospitalario. Se confirmó diagnóstico de COVID-19 en 33 niños por PCR y en 7 por serología. De los confirmados por PCR, seroconvirtió el 67,7%. Se demostraron otras etiologías en 7 pacientes (5 Mycoplasma pneumoniae, uno parvovirus y uno citomegalovirus).La mediana de duración de síntomas fue 25,5 días (RIC=13,8-37), con mediana de tiempo de seguimiento de 28 días (RIC=21-39). Se realizó una mediana de 6 llamadas (RIC=4-8) por niño; 19 pacientes (26,4%) refirieron empeoramiento en el seguimiento, precisando 14 (19,4%) ser revaluados en Urgencias. Un niño necesitó reingresar, siendo la evolución favorable.Conclusiones: Ante sospecha de COVID-19, es recomendable el seguimiento médico por la prolongada duración de síntomas y el riesgo de empeoramiento. Las consultas telefónicas son útiles y seguras para el seguimiento de casos leves y pacientes hospitalizados tras el alta, permitiendo reducir controles presenciales y el consumo de otros recursos. (AU)

Introduction: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital.Patients and methods: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48hours until symptoms resolved, then weekly until completing 14 days without symptoms.Results: A total of 72 children were included, with median age of 83.5 months (IQR=16.3-157.5). Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 cytomegalovirus).Median symptom duration was 25.5 days (IQR=13.8-37), while median follow-up duration was 28 days (IQR=21-39). The median number of telephone consultations per patient was 6 (IQR=4-8). Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome.Conclusions: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital. (AU)

Telemedicine follow-ups for COVID-19: Experience in a tertiary hospital.

INTRODUCTION: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital. PATIENTS AND METHODS: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48 h until symptoms resolved, then weekly until completing 14 days without symptoms. RESULTS: A total of 72 children were included, with median age of 83.5 months [IQR = 16.3-157.5]. Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 CMV). Median symptom duration was 25.5 days [IQR = 13.8-37], while median follow-up duration was 28 days [IQR = 21-39]. The median number of telephone consultations per patient was 6 [IQR = 4-8]. Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome. CONCLUSIONS: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital.

[Telemedicine follow-ups for COVID-19: Experience in a tertiary hospital]. / Seguimiento telemático de COVID-19: experiencia de un hospital terciario.

INTRODUCTION: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital. PATIENTS AND METHODS: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48hours until symptoms resolved, then weekly until completing 14 days without symptoms. RESULTS: A total of 72 children were included, with median age of 83.5 months (IQR=16.3-157.5). Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 cytomegalovirus). Median symptom duration was 25.5 days (IQR=13.8-37), while median follow-up duration was 28 days (IQR=21-39). The median number of telephone consultations per patient was 6 (IQR=4-8). Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome. CONCLUSIONS: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital.

Seguimiento telemático de COVID-19: experiencia de un hospital terciario / Telemedicine follow-ups for COVID-19: Experience in a tertiary hospital

INTRODUCCIÓN: El seguimiento telefónico es una posible alternativa para la atención médica de niños con COVID-19. Nuestro objetivo es describir la experiencia del seguimiento telemático realizado en un hospital terciario. PACIENTES Y MÉTODOS: Estudio descriptivo retrospectivo de los niños con diagnóstico confirmado o probable de COVID-19 atendidos en la consulta de seguimiento del Hospital La Paz entre marzo y junio del 2020. Se realizaron llamadas cada 48 h hasta desaparecer los síntomas y posteriormente semanales hasta estar 14 días asintomáticos. RESULTADOS: Se incluyó a 72 niños con una mediana de edad de 83,5 meses (RIC = 16,3-157,5); 46 eran varones (63,9%) y 14 tenían comorbilidades (19,4%); 32 pacientes (44,4%) habían requerido ingreso hospitalario. Se confirmó diagnóstico de COVID-19 en 33 niños por PCR y en 7 por serología. De los confirmados por PCR, seroconvirtió el 67,7%. Se demostraron otras etiologías en 7 pacientes (5 Mycoplasma pneumoniae, uno parvovirus y uno citomegalovirus). La mediana de duración de síntomas fue 25,5 días (RIC = 13,8-37), con mediana de tiempo de seguimiento de 28 días (RIC = 21-39). Se realizó una mediana de 6 llamadas (RIC = 4-8) por niño; 19 pacientes (26,4%) refirieron empeoramiento en el seguimiento, precisando 14 (19,4%) ser revaluados en Urgencias. Un niño necesitó reingresar, siendo la evolución favorable. CONCLUSIONES: Ante sospecha de COVID-19, es recomendable el seguimiento médico por la prolongada duración de síntomas y el riesgo de empeoramiento. Las consultas telefónicas son útiles y seguras para el seguimiento de casos leves y pacientes hospitalizados tras el alta, permitiendo reducir controles presenciales y el consumo de otros recursos

INTRODUCTION: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital. PATIENTS AND METHODS: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48 hours until symptoms resolved, then weekly until completing 14 days without symptoms. RESULTS: A total of 72 children were included, with median age of 83.5 months (IQR = 16.3-157.5). Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 cytomegalovirus). Median symptom duration was 25.5 days (IQR=13.8-37), while median follow-up duration was 28 days (IQR = 21-39). The median number of telephone consultations per patient was 6 (IQR = 4-8). Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome. CONCLUSIONS: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital

Lesión pulmonar: ¿causa o consecuencia de infección respiratoria? / Pulmonary Lesions: Cause Or Consequence Of Respiratory Infection?

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