Fluids in the treatment of diabetic ketoacidosis in children: A systematic review.

AIM: To determine the comparative effectiveness of fluid schemes for children with diabetic ketoacidosis (DKA). METHODS: We conducted a systematic review with an attempt to conduct network meta-analysis (NMA). We searched MEDLINE, EMBASE, CENTRAL, Epistemonikos, Virtual Health Library, and gray literature from inception to July 31, 2022. We included randomized controlled trials (RCTs) in children with DKA evaluating any intravenous fluid schemes. We planned to conduct NMA to compare all fluid schemes if heterogeneity was deemed acceptable. RESULTS: Twelve RCTs were included. Studies were heterogeneous in the population (patients and DKA episodes), interventions with different fluids (saline, Ringer's lactate (RL), and polyelectrolyte solution-PlasmaLyte®), tonicity, volume, and administration systems. We identified 47 outcomes that measured clinical manifestations and metabolic control, including single and composite outcomes and substantial heterogeneity preventing statistical combination. No evidence was found of differences in neurological deterioration (main outcome), but differences were found among interventions in some comparisons to normalize acid-base status (∼2 h less with low vs. high volume); time to receive subcutaneous insulin (∼1 h less with low vs. high fluid rate); length of stay (∼6 h less with RL vs. saline); and resolution of the DKA (∼3 h less with two-bag vs. one-bag scheme). However, available evidence is scarce and poor. CONCLUSIONS: There is not enough evidence to determine the best fluid therapy in terms of fluid type, tonicity, volume, or administration time for DKA treatment. There is an urgent need for more RCTs, and the development of a core outcome set on DKA in children.

Profiles of suicide attempted in children and adolescents.

OBJECTIVE: Suicide attempt (SA) is the strongest predictive variable for completed suicide. The Department of Cauca in Colombia has an SA rate higher than the national average, but the factors are unknown. The objective was to identify the profiles of SA in children and adolescents of Cauca. METHODS: Cross-sectional study, which included all SA (Event-356) records from the SIVIGILA platform in children under 18 years of age between 2016 and 2019. The authors described the variables and multiple correspondence analysis with the Burt method, according to the completeness of the data to establish the possible SA profiles using STATA 15.1, and R. The Ethics Committee at Universidad del Cauca approved it. RESULTS: The study found 977 SA during this period, 72.4% female, 97.1% adolescent, 74.4% mestizo, 19.3% indigenous, 45.3% resided in municipalities exposed to the armed conflict, 32.3% expressed ideation and previous attempts, and 15.5% prior attempts. The MCA included 810 SA and identified three profiles: "Classic", which had mestizo adolescents with a history of prior SA, mental illness, or psychoactive substance use problems; "Related to the armed conflict", which included female adolescents with a first SA and residents in municipalities exposed to the armed conflict; "Ethnic" represented by male indigenous, with housing in a rural area. CONCLUSION: The SA profiles found in Cauca were "Classic", "Related to the armed conflict", and "Ethnic"; these can be considered to implement prevention strategies from a cross-cultural, mental health, and gender perspective, with the presence of the state in the territories.

Quality and credibility of clinical practice guidelines recommendations for the management of neonatal hypoglycemia. A protocol for a systematic review and recommendations' synthesis.

INTRODUCTION: Hypoglycemia is one of the most frequent metabolic conditions in neonates. Clinical practice guidelines (CPGs) influence clinical practice as high-quality CPGs facilitate the use of evidence in practice. This proposed study aims to systematically identify and appraise CPGs and CPG recommendations (CPGRs) for treating neonatal hypoglycemia (NH). METHODS AND ANALYSIS: We will conduct searches in MEDLINE, EMBASE, CINAHL, Cochrane Library, LILACS (Latin American & Caribbean Health Sciences Literature), and Epistemonikos. Authors will search CPGs-specific databases and grey literature. Two reviewers will independently perform the titles and abstract screening, full-text review, and data extraction. Two appraisers will assess the quality of the CPGs and their recommendations using AGREE II (Appraisal of Guidelines Research and Evaluation) and AGREE-REX (Appraisal of Guidelines Research and Evaluation-Recommendations Excellence) instruments. Scores of ≥ 60% in the rigour of development domain will be considered for defining high-quality with AGREE II tool. CPGRs with scores >60% in the three domains will be used to determine high quality with the AGREE REX tool. We will perform a synthesis of the CPGRs to identify the consistency among the CPGRs and the methodological quality of primary studies that support them. ETHICS AND DISSEMINATION: The results will help us to identify the methodological and quality gaps in the existing CPGs for the treatment of NH. Our findings will be submitted to peer-review journals and presented at academic conferences. Based on the study design, approval from the institutional ethics board is not required for this project. TRIAL REGISTRATIONS: Systematic Review Registration Number (PROSPERO): CRD 42021239921.

Clinical course of neonatal acute kidney injury: multi-center prospective cohort study.

BACKGROUND: Neonatal acute kidney injury (AKI) has been associated with unfavorable outcomes, including increased mortality. We aimed to describe the clinical course and outcomes during the first 7 days after diagnosis in newborns with AKI in three neonatal intensive care units in Popayán-Colombia. METHODS: Multi-center prospective cohort study conducted between June 2019 and December 2020 in three NICUs after ethical approval. We included newborns between 2 and 28 days of life, first diagnosed with AKI using the KDIGO classification modified for newborns which consider increased serum creatinine values over baseline values as well as urine output over time in hours or both. Patients with chromosomal abnormalities, major kidney malformations, and complex congenital heart disease were excluded. Patients were followed for up to 7 days after diagnosis and the maximum KDIGO stage, recovery of kidney function, need for renal replacement therapy and cumulative incidence of death were evaluated. RESULTS: Over the 18 months of the study, 4132 newborns were admitted to the NICUs, and 93 patients (2.25, 95% CI 1.82-2.75%) developed neonatal AKI. 59.1% of the newborns were premature and there were no differences in severity according to gestational age. During follow-up, the maximum KDIGO was 64.5% for AKI-stage 1, 11.8% for AKI-stage 2, and 23.7% for AKI-stage 3. Kidney function recovery was higher in AKI-stage 1 patients vs. AKI-severe (AKI-stage 2 and 3) (95% vs. 48.5%). Five patients (5.4%) received renal replacement therapy and 15 died (16.1%), four in AKI-stage 1 vs. 11 in AKI-severe (6.7% vs 33.3%). CONCLUSIONS: Newborns admitted to the NICUs can develop AKI regardless of gestational age, and it is more frequent between the second and ninth days of life. More patients whit AKI-stage 1 recover and die less than those in a severe stage.

Exposure to armed conflict as a factor associated with very low birth weight: Case-control population study.

OBJECTIVE: To determine the association between armed conflict and very low birth wright (VLBW), which is a multifactorial etiology public health problem that includes aspects of poverty and violence. METHODS: Case-control population study matched by year of delivery conducted in Cauca, Colombia, between 2010 and 2016. Cases of VLBW, with weights between 500 and 1499 g and controls weighing between 2500 and 3999 g. Cases and controls were identified through the vital statistics registry, and exposure was determined using a multidimensional index designed by the Colombian State. Multiple gestations were excluded. Conditional logistic regression for matched data was used, adjusting for confounding variables. RESULTS: Overall, 7068 matched participants (1767 cases and 5301 controls) were included. Cases and controls had similar baseline characteristics. Participants were predominantly women in the second and third decades of life, 3222 (46%) were exposed to armed conflict, and 1902 (27%) were of African-Colombian or indigenous ethnicity. Maternal exposure to armed conflict significantly increased the odds of VLBW among women with rural birth (adjusted odds ratio [aOR] 3.86, 95% confidence interval [CI] 2.74-5.45) and inadequate prenatal care (aOR 10.38, 95% CI 8.20-13.12). CONCLUSION: Exposure to armed conflict increases the odds of VLBW neonates. This factor needs to be considered in prenatal care.

Quality of clinical practice guidelines for gestational and congenital toxoplasmosis: A systematic review of the literature.

OBJECTIVE: To evaluate the methodological quality and transparency of the clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of gestational and congenital toxoplasmosis (CT). METHODS: Systematic review of the literature on gestational and CT CPGs conducted in the MEDLINE, Embase, TripDatabase, Biblioteca Virtual en Salud databases and extensive manual searches in 19 CPG repositories. The characteristics of each of the guidelines were extracted using My AGREE PLUS on-line. Three reviewers assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS: The combined systematic review found 8651 citations. Of them 46 full texts were reviewed, and eight documents were finally included: four toxoplasmosis CPGs, three prenatal care CPGs that included recommendations on toxoplasmosis, and one pregnancy infection guideline that also included recommendations on toxoplasmosis. The AGREE II domains found to have the highest scores were 'clarity of presentation' (85%; [37%-100%]), followed by 'scope and purpose' (73%; [33%-98%]), and 'editorial independence' (51%; [3%-94%]); the domains with the lowest scores were 'rigour of development' (36%; [11%-79%]), 'stakeholder involvement' (34%; [24%-85%]), and 'applicability' (17%; [6%-83%]). The Colombian and Spanish-Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA) CPGs had the highest global AGREE II scores. Absolute interrater agreement was good to excellent. CONCLUSION: Substantial quality variation was found among CPGs, which provided recommendations in accordance with the context of the disease in the corresponding country or region. Only two of the CPGs appraised obtained a good score and are classified as 'recommended'.

Tungiasis in the urban area of Popayán, Colombia: A case report / [Tungiasis en el área urbana de Popayán, Colombia: reporte de caso].

Tungiasis is an endemic ectoparasitosis in Latin America associated with risk factors such as rurality, poverty, and living with animals. In Popayán, a city in southwest Colombia, the disease was highly prevalent in the past, to such degree that its inhabitants were given the nickname of patojo, a word that describes the way of walking of people infested by the flea. However, it was believed eradicated at present. We present the case of a 12-year-old boy living in the urban area of Popayán, who presented with a one-month history of papular lesions with circular edges, blackish center, and hyperkeratotic halo on both feet. Tungiasis was suspected based on the clinical findings and ivermectin was administered. The lesions were surgically removed and sent for parasitological analysis, which confirmed the presence of Tunga penetrans. The patient evolved satisfactorily. The Secretaría de Salud Municipal de Popayán carried out an inspection of the patient's home where migrant dogs from the Colombian Pacific were found in the surroundings, some with suspicious lesions of tungiasis. We document here the resurgence of this pathology in urban areas, probably secondary to the migration of animals from rural areas. It is important to recognize the existence of the flea in rural and urban areas, make a medical diagnosis, and report cases to the surveillance entities to enable appropriate management and sanitary control of this neglected ectoparasitosis in humans and animals.

La tungiasis es una ectoparasitosis endémica en Latinoamérica y está asociada a factores de riesgo como la ruralidad, la pobreza y la convivencia con animales. Popayán, una ciudad al suroccidente de Colombia, fue históricamente afectada por la tungiasis, tanto así que a sus habitantes los apodan "patojos" debido a la forma de caminar de sus habitantes infestados por la pulga. Hoy la enfermedad se creía eliminada. Se presenta el caso de un niño de 12 años procedente del área urbana de Popayán, que consultó por lesiones papulares de bordes circulares, centro negruzco y halo hiperqueratósico en ambos pies, de un mes de evolución. Por los hallazgos clínicos se sospechó tungiasis y se le administró ivermectina. Las lesiones se removieron quirúrgicamente y se enviaron para análisis parasitológico, el cual confirmó la presencia de Tunga penetrans. La evolución del paciente fue satisfactoria. La Secretaría de Salud Municipal de Popayán inspeccionó el domicilio del paciente y encontró perros migrantes del Pacífico colombiano en sus alrededores, algunos con lesiones sospechosas de tungiasis. Se documenta, así, el resurgimiento de esta enfermedad en el área urbana, probablemente debido a la migración de animales desde las zonas rurales. Es importante reconocer la existencia de la pulga en zonas rurales y urbanas, hacer el diagnóstico médico y reportar los casos a los entes de vigilancia. Estas acciones permitirán ofrecer un apropiado manejo y control sanitario de esta ectoparasitosis desatendida en humanos y animales.

Tungiasis en el área urbana de Popayán, Colombia: reporte de caso / Tungiasis in the urban area of Popayán, Colombia: A case report

Resumen | La tungiasis es una ectoparasitosis endémica en Latinoamérica y está asociada a factores de riesgo como la ruralidad, la pobreza y la convivencia con animales. Popayán, una ciudad al suroccidente de Colombia, fue históricamente afectada por la tungiasis, tanto así que a sus habitantes los apodan "patojos" debido a la forma de caminar de sus habitantes infestados por la pulga. Hoy la enfermedad se creía eliminada. Se presenta el caso de un niño de 12 años procedente del área urbana de Popayán, que consultó por lesiones papulares de bordes circulares, centro negruzco y halo hiperqueratósico en ambos pies, de un mes de evolución. Por los hallazgos clínicos se sospechó tungiasis y se le administró ivermectina. Las lesiones se removieron quirúrgicamente y se enviaron para análisis parasitológico, el cual confirmó la presencia de Tunga penetrans. La evolución del paciente fue satisfactoria. La Secretaría de Salud Municipal de Popayán inspeccionó el domicilio del paciente y encontró perros migrantes del Pacífico colombiano en sus alrededores, algunos con lesiones sospechosas de tungiasis. Se documenta, así, el resurgimiento de esta enfermedad en el área urbana, probablemente debido a la migración de animales desde las zonas rurales. Es importante reconocer la existencia de la pulga en zonas rurales y urbanas, hacer el diagnóstico médico y reportar los casos a los entes de vigilancia. Estas acciones permitirán ofrecer un apropiado manejo y control sanitario de esta ectoparasitosis desatendida en humanos y animales.

Abstract | Tungiasis is an endemic ectoparasitosis in Latin America associated with risk factors such as rurality, poverty, and living with animals. In Popayán, a city in southwest Colombia, the disease was highly prevalent in the past, to such degree that its inhabitants were given the nickname of patojo, a word that describes the way of walking of people infested by the flea. However, it was believed eradicated at present. We present the case of a 12-year-old boy living in the urban area of Popayán, who presented with a one-month history of papular lesions with circular edges, blackish center, and hyperkeratotic halo on both feet. Tungiasis was suspected based on the clinical findings and ivermectin was administered. The lesions were surgically removed and sent for parasitological analysis, which confirmed the presence of Tunga penetrans. The patient evolved satisfactorily. The Secretaría de Salud Municipal de Popayán carried out an inspection of the patient's home where migrant dogs from the Colombian Pacific were found in the surroundings, some with suspicious lesions of tungiasis. We document here the resurgence of this pathology in urban areas, probably secondary to the migration of animals from rural areas. It is important to recognize the existence of the flea in rural and urban areas, make a medical diagnosis, and report cases to the surveillance entities to enable appropriate management and sanitary control of this neglected ectoparasitosis in humans and animals.