Incidence and Severity of Community- and Hospital-Acquired Hyponatremia in Pediatrics.

Hyponatremia is the most common electrolyte disturbance in hospitalized children, with a reported incidence of 15-30%, but its overall incidence and severity are not well known. The objective of our study was to determine the incidence, severity, and associated risk factors of community- and hospital-acquired hyponatremia on a general pediatric ward. Data of 5550 children admitted from June 2012 to December 2019 on plasma sodium and discharge diagnosis were analyzed by logistic regression model. Clinically relevant diagnostic groups were created. Hyponatremia was classified as mild, moderate, and severe. The incidence of community- and hospital-acquired hyponatremia was 15.8% and 1.4%, respectively. Most of the cases were mild (90.8%) to moderate (8.6%), with only two cases of severe community-acquired hyponatremia. There were no clinical complications in any of the hyponatremic children. Age and diagnosis at discharge were principal factors significantly correlated with hyponatremia. Community-acquired hyponatremia is more common than hospital-acquired hyponatremia in clinical practice. Severe cases of both types are rare. Children from 2 to 11 years of age presenting with infections, cardiovascular disorders, and gastrointestinal disorders are at risk of developing hyponatremia.

Mortality predictors in patients with COVID-19 pneumonia: a machine learning approach using eXtreme Gradient Boosting model.

Recently, global health has seen an increase in demand for assistance as a result of the COVID-19 pandemic. This has prompted many researchers to conduct different studies looking for variables that are associated with increased clinical risk, and find effective and safe treatments. Many of these studies have been limited by presenting small samples and a large data set. Using machine learning (ML) techniques we can detect parameters that help us to improve clinical diagnosis, since they are a system for the detection, prediction and treatment of complex data. ML techniques can be valuable for the study of COVID-19, especially because they can uncover complex patterns in large data sets. This retrospective study of 150 hospitalized adult COVID-19 patients, of which we established two groups, those who died were called Case group (n = 53) while the survivors were Control group (n = 98). For analysis, a supervised learning algorithm eXtreme Gradient Boosting (XGBoost) has been used due to its good response compared to other methods because it is highly efficient, flexible and portable. In this study, the response to different treatments has been evaluated and has made it possible to accurately predict which patients have higher mortality using artificial intelligence, obtaining better results compared to other ML methods.

A comparison of two clinical scores for bronchiolitis. A multicentre and prospective study conducted in hospitalised infants.

BACKGROUND: There are a number of clinical scores for bronchiolitis but none of them are firmly recommended in the guidelines. METHOD: We designed a study to compare two scales of bronchiolitis (ESBA and Wood Downes Ferres) and determine which of them better predicts the severity. A multicentre prospective study with patients <12 months with acute bronchiolitis was conducted. Each patient was assessed with the two scales when admission was decided. We created a new variable "severe condition" to determine whether one scale afforded better discrimination of severity. A diagnostic test analysis of sensitivity and specificity was made, with a comparison of the AUC. Based on the optimum cut-off points of the ROC curves for classifying bronchiolitis as severe we calculated new Se, Sp, LR+ and LR- for each scale in our sample. RESULTS: 201 patients were included, 66.7% males and median age 2.3 months (IQR=1.3-4.4). Thirteen patients suffered bronchiolitis considered to be severe, according to the variable severe condition. ESBA showed a Se=3.6%, Sp=98.1%, and WDF showed Se=46.2% and Sp=91.5%. The difference between the two AUC for each scale was 0.02 (95%CI: 0.01-0.15), p=0.72. With new cut-off points we could increase Se and Sp for ESBA: Se=84.6%, Sp=78.7%, and WDF showed Se=92.3% and Sp=54.8%; with higher LR. CONCLUSIONS: None of the scales studied was considered optimum for assessing our patients. With new cut-off points, the scales increased the ability to classify severe infants. New validation studies are needed to prove these new cut-off points.

Herpes zóster en pediatría. Revisión de la bibliografía a propósito de un caso / Herpes zoster in pediatrics. Case report and review of the literature

El herpes zóster está producido por la reactivación del virus de la varicela zóster tras una primoinfección varicelosa. Es infrecuente en pediatría. En la mayoría de las ocasiones que aparece en niños, tiene unas manifestaciones benignas en comparación con los adultos. El diagnóstico es clínico y los estudios de laboratorio no suelen ser necesarios. El tratamiento debería ser sintomático en la mayoría de los pacientes, reservándose el aciclovir oral o intravenoso para situaciones de riesgo. Respecto a otros antivirales empleados en adultos, debido a la falta de estudios al respecto, no existe consenso sobre su uso en niños. Aprovechamos la comunicación de un caso clínico para hacer una revisión y actualización del tema, incidiendo sobre todo en los aspectos diagnósticos y terapéuticos (AU)

Herpes zoster or shingles is caused by reactivation of varicella-zoster virus long time after the primary infection, varicella. It is unusual in pediatrics. Contrary to the way it can affect adults zoster manifestation is mild if it appears in children. Diagnosis is based on distinctive clinical appearance and laboratory tests are not usually required. Symptomatic treatment of skin lesions should be the best choice to take while systemic oral or intravenous acyclovir should be restricted only to special cases. Regarding other antiviral drugs of proved efficacy in adults, no evidence is gathered for their use in children. To sum up, our main aim is to review and update this subject stressing diagnosis and treatment (AU)

Fibroma desmoplásico de la mandíbula: un tumor de presentación muy infrecuente / Desmoplastic fibroma of the jaw: a rare kind of tumour

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Patología infecciosa periamigdalina en pediatría: actualización del tema / Peritonsillar infectious disease in pediatrics: review

El flemón y el absceso periamigdalinos son pocofrecuentes en la edad pediátrica, conociéndose biensu etiología y manifestaciones clínicas. Su manejoinicial es llevado a cabo en los servicios de urgenciapor parte de pediatras y otorrinolaringólogos paracon posterioridad y ya con el paciente ingresado instaurarun tratamiento definitivo. Ciertos aspectos referentesa su diagnóstico y tratamiento no gozan deunanimidad de criterios. En este trabajo hemos pretendidoactualizar los avances desarrollados en estapatología y sobre todo tratar de unificar criterios respectoa su manejo diagnóstico y terapéutico

Peritonsillar cellulitis and peritonsillar abscess areuncommon in paediatric population. Aetiology andclinical manifestations are well known. Its first assintanceis done by paediatricians and otorhinolaryngologistsin emergency departments and a definitivetreatment is started after the patient is admitted. Someaspects around diagnosis and treatment remainunclear and no consensus exist. In this report afteran exhaustive review of the literature we pretend toupdate the knowlegement and getting an standardway of managing on this illness

Bursitis: análisis clínico de 52 casos / Bursitis: clinical analysis of 52 patients

Estudio retrospectivo longitudinal que evalúa las características clínicas de los pacientes diagnosticados de bursitis durante un año en una sección de reumatología de un hospital terciario, comparándolos con resultados previos de la bibliografía. Se incluyó a 52 pacientes, diagnosticados todos de bursitis según criterios clínicos y ecográficos. De ellos, 19 pacientes (36,5 por ciento) presentaban bursitis superficial, y 33 (63,5 por ciento) bursitis profunda. La mayoría de las bursitis superficiales ocurrieron en varones (84,2 por ciento), con una media de 49,2 años de edad. En cambio, las bursitis profundas se dieron predominantemente en mujeres (78,8 por ciento) con una edad media de 53,8 años. Entre los factores predisponentes para las bursitis superficiales encontramos diferentes profesiones (albañil, fontanero, carpintero y ama de casa), frente a las profundas, en que los pacientes eran predominantemente sedentarios (el 100 por ciento de las bursitis glúteas). Las radiografías simples fueron normales, excepto en un 18,8 por ciento de las bursitis superficiales, en las que se observó un aumento de partes blandas. El diagnóstico clínico fue confirmado ecográficamente en todos los casos. Se obtuvo líquido de las bursas en 17 de las bursitis superficiales (89,4 por ciento), y en todos ellos se practicó examen en fresco y cultivo. En ningún caso se observaron cristales. El cultivo fue positivo en 8 pacientes (47 por ciento), y Staphylococcus aureus fue el germen aislado con más frecuencia (75 por ciento). Otros microorganismos aislados fueron: Streptoccus piogenes y Staphylococcus epidermidis. Sólo en cinco (15,1 por ciento) de las bursitis profundas se obtuvo líquido bursal: el cultivo fue negativo en todos los casos, detectándose la presencia de cristales de hidroxiapatita en un caso. El tratamiento más empleado en las bursitis superficiales consistió en la administración de antibióticos (89,5 por ciento); en cambio, en las bursitis profundas, predominó el uso de la infiltración local de esteroides (57,5 por ciento).Conclusiones: Las diferencias etiológicas encontradas entre las bursitis superficiales y las profundas pueden ser de utilidad a la hora de escoger el tratamiento correcto desde el inicio (AU)