Endocrine Sequelae in 157 Pediatric Survivors of Hematopoietic Stem Cell Transplantation (HSCT).

Context: Successful rates of hematopoietic stem cell transplantation (HSCT) face paralleled escalation of late endocrine and metabolic effects. Objective: This work aimed to characterize these sequelae distinguishing between the underlying pathologies and treatments received. Methods: A retrospective descriptive study was conducted in 157 children post-HSCT (hematopoietic pathology [N = 106], solid tumors [N = 40], and rare entities [N = 11]) followed at a single endocrine department between 2009 and 2019. Regression analysis was used to ascertain association. Results: Of all patients, 58.7% presented with at least one endocrine abnormality. Endocrinopathies post HSCT were most frequently developed in lymphoblastic leukemia (60.5% of them), whereas myeloid leukemias had the fewest. A total of 64% of patients presented with primary hypogonadism, 52% short stature, and 20% obesity. Endocrinopathy was associated with older age at HSCT (9.78 years [6.25-12.25] vs 6.78 years [4.06-9.75]) (P < .005), pubertal Tanner stage V (P < .001), chronic graft-vs-host disease (GVHD) (P = .022), and direct gonadal therapy (P = .026). The incidence of endocrinopathies was higher in girls (15% more common; P < .02) and in patients who received radiotherapy (18% higher), steroids (17.4% increase), allogenic HSCT (7% higher), thymoglobulin, or cyclophosphamide. Those on busulfan presented with a 27.5% higher rate of primary hypogonadism (P = .003). Conclusion: More than half of children surviving HSCT will develop endocrinopathies. Strikingly, obesity has risen to the third most frequent endocrine disruption, mainly due to steroids, and partly adhering to the general population tendency. Lymphoblastic leukemia was the condition with a higher rate of endocrine abnormalities. Female sex, older age at HSCT, pubertal stage, allogenic transplant, radiotherapy, alkylating drugs, and GVHD pose risk factors for endocrine disturbances.

¿Neumonía redonda o hallazgo casual? / Round pneumonia or incidental finding?

El diagnóstico diferencial de las neumonías redondas es amplio y engloba enfermedades infecciosas, neoplásicas y congénitas. La paciente que se presenta a continuación fue diagnosticada de una neumonía redonda con una clínica e imagen radiológica compatible. Sin embargo, el diagnóstico definitivo fue una malformación vascular. Este caso permite reflexionar sobre la importancia de valorar distintitos diagnósticos ante una condensación redondeada y sobre la necesidad o no de realizar una radiografía de control en estos casos. Además, lo más original del caso radica en el tratamiento que recibió para la malformación vascular, que no estaba descrito previamente: el propranolol (AU)

The differential diagnosis of round pneumonia is broad and includes infectious, malignant, and congenital diseases. The patient presented below received a diagnosis of round pneumonia based on compatible clinical and radiological findings; however, the definitive diagnosis was a vascular malformation. This case allows us to reflect on the importance of considering alternative diagnoses in the presence of round opacities in the lung and when performance of a follow-up X-ray is or not required in such cases. In addition, the most original aspect of this case lies in the treatment provided for the vascular malformation, which has not been previously described: propranolol. (AU)

Evolution of incidence of chilblain-like lesions in children during the first year of COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has brought innumerable reports of chilblains. The relation between pernio-like acral eruptions and COVID-19 has not been fully elucidated because most reported cases have occurred in patients with negative microbiological tests for SARS-CoV-2. METHODS: A retrospective study of 49 cases of chilblains seen during the first year of the pandemic in a children's hospital in Madrid, Spain. The incidence of these skin lesions was correlated with the number of COVID-19 admissions and environmental temperatures. Patients were separated into two groups depending on the day of onset (strict lockdown period vs. outside the lockdown period). RESULTS: Most chilblains cases presented during the first and third waves of the pandemic, paralleling the number of COVID-19 admissions. The first wave coincided with a strict lockdown, and the third wave coincided with the lowest ambient seasonal temperatures of the year. Systemic symptoms preceding chilblains were more frequent in the first wave (45.8% vs. 8.0%, p = .002), as was the co-occurrence with erythema multiforme-like lesions (16.7% vs. 0%, p = .033). Laboratory test and skin biopsies were performed more frequently in the first wave (75.0% vs. 12.0%, p < .001; and 25.0% vs. 0%, p = .007; respectively). Five patients developed recurrent cutaneous symptoms. CONCLUSIONS: An increased incidence of chilblains coincided not only with the two major waves of the pandemic, but also with the strict lockdown period in the first wave and low seasonal temperatures during the third wave. Both increased sedentary behaviors and cold environmental temperatures may have played an additive role in the development of COVID-19-related chilblains.

Organización y valoración de la atención telefónica urgente hospitalaria pediátrica ante la pandemia COVID-19 / Organisation and assessment of urgent paediatric telephonic hospital care during the COVID-19 pandemic

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Taquicardia como factor pronóstico de morbimortalidad en pacientes sin enfermedad previa con fiebre en urgencias pediátricas / Tachycardia as a prognostic factor for morbidity and mortality in patients without previous pathology with fever in pediatric emergencies

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Síndrome del abdomen en ciruela pasa / Prune belly syndrome

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Chilblains in children in the setting of COVID-19 pandemic.

BACKGROUND: Different skin manifestations of COVID-19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the COVID-19 pandemic. MATERIAL AND METHODS: A retrospective review of 22 children and adolescents with chilblain-like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID-19 in Madrid, Spain. RESULTS: All patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D-dimer results, but without systemic symptoms or other laboratory anomalies. SARS-CoV-2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow-up, all cases showed spontaneous marked improvement or complete healing. CONCLUSION: Acute chilblains were observed during COVID-19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.

Erythema multiforme-like lesions in children and COVID-19.

During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS-CoV-2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS-CoV/SARS-CoV-2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID-19, and the positivity for SARS-CoV/SARS-CoV-2 spike protein by immunohistochemistry strongly suggest a link between EM-like lesions and SARS-CoV-2.

Infección por adenovirus que requiere ingreso hospitalario: epidemiología, datos analíticos y manejo / Adenovirus infections that require hospital admission: epidemiology, laboratory findings and approach

Introducción: las infecciones por adenovirus tienen una presentación clínica variable y son una importante causa de morbilidad en la infancia. Frecuentemente reciben tratamiento antibiótico de forma innecesaria. Este estudio busca analizar las características de los pacientes con infección por adenovirus y ver si difieren de aquellos con infección bacteriana. Pacientes y métodos: se estudiaron 174 pacientes ingresados en un hospital terciario desde enero de 2009 hasta agosto de 2017 a los que se les detectó adenovirus. Se analizaron las variables clínicas y analíticas y se compararon con las de una muestra de pacientes diagnosticados de infección bacteriana confirmada en el mismo centro en 2016. Resultados: la tasa de pacientes con infección por adenovirus fue de 1,58/100 ingresos. El 64% eran varones, siendo la edad media de 17 meses. Los que solo presentaban síntomas gastrointestinales tenían una menor edad y resultados analíticos más favorables que los que solo mostraban síntomas respiratorios. Un 24,5% presentaban coinfección por otro virus, observándose en este grupo una mayor estancia hospitalaria (7,93 frente a 6,17 días, p = 0,006). Los criterios analíticos de infección bacteriana grave no mostraron diferencias significativas al comparar entre los pacientes infectados por adenovirus y los que tenían una infección bacteriana confirmada, excepto una diferencia mínima, aunque estadísticamente significativa, al comparar las cifras de proteína C reactiva. Conclusiones: las variables analíticas y clínicas estudiadas no son suficientes para discriminar entre infección bacteriana y por adenovirus. Sería adecuado descartar infección por adenovirus sistemáticamente antes de instaurar tratamiento antibiótico

Introduction: adenovirus infections have a heterogeneous clinical presentation and are an important cause of childhood morbidity. They are frequently and unnecessarily treated with antibiotics. In this study, we analysed the characteristic of patients with adenovirus infections in order to determine whether they differed from those of patients with bacterial infection. Patients and methods: the study included 174 patients admitted to a tertiary care hospital between January 2009 and August 2017 who tested positive for adenovirus. We analysed the clinical and laboratory findings in these patients and compared them to those of a group of patients that received a diagnosis of confirmed bacterial infection in the same hospital in 2016. Results: the incidence of adenovirus was of 1.58 cases per 100 admissions. Sixty-four percent of the sample was male, and the mean age was 17 months. Patients that presented with gastrointestinal symptoms alone were younger and had more favourable laboratory findings compared to patients with respiratory symptoms alone. Coinfection with another virus was found in 24.5%, and this group had a longer length of stay (7.93 versus 6.17 days, p = 0.006). We found no significant differences in the laboratory criteria indicative of severe bacterial infection between the patients with adenovirus infection and the controls with a confirmed bacterial infection except for a very small, although statistically significant, difference in the levels of C-reactive protein. Conclusions: the clinical and laboratory parameters analysed in our study are not sufficient to discriminate between bacterial infection and adenovirus infection. Thus, it would be appropriate to rule out adenovirus infection before initiating antibiotic treatment