Características clínicas y demográficas de los niños hospitalizados con infección por SARS-CoV-2

Introducción: en marzo de 2020 se registraron los primeros casos de infección por SARS-CoV-2 en Uruguay y se decretó la emergencia sanitaria. Objetivo: describir las características clínicas demográficas de los menores de 15 años hospitalizados con infección por SARS-CoV-2 en el período 13 de marzo de 2020 al 30 de septiembre de 2021 en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell, centro de referencia público de Uruguay. Metodología: estudio descriptivo, retrospectivo, en el que se describen edad, manifestaciones clínicas, comorbilidades, severidad, tratamiento y evolución. Resultados: se hospitalizaron 207 niños con una frecuencia de 1,6%. La mediana (rango intercuartil) de edad fue 1,5 años (3 meses - 8 años); <1 año 44%; 54% de sexo masculino. Presentaron comorbilidades, 59 niños. Fueron sintomáticos, 71%. De los sintomáticos, presentaron síntomas leves 48%. Las manifestaciones clínicas fueron respiratorias en 96 (65%) y no respiratorias en 51 (fiebre sin foco 15, digestivas 19, exantema viral 3, SIM-Ped S 10 y atípicas 3). Treinta niños ingresaron a unidad de cuidados intensivos (UCI) y tres requirieron ventilación invasiva. Estos pacientes presentaron comorbilidades, tuvieron más días de fiebre y necesitaron oxigenoterapia que los que no requirieron UCI. Un paciente de 2 años con comorbilidades falleció. Conclusión: la frecuencia de hospitalizaciones fue de 1,6%. La mayoría de los niños sintomáticos presentaron formas leves. En los sintomáticos las manifestaciones fueron respiratorias. Los hallazgos en esta serie aportan al conocimiento del comportamiento de la infección por SARS-CoV-2 en niños.

Introduction: in March 2020, the first cases of SARS CoV-2 infection were registered in Uruguay and a health emergency was decreed. Objective: To describe the clinical and demographic characteristics of children under 15 years of age hospitalized with SARS-CoV-2 infection from March 13, 2020, to September 30, 2021, at Pereira Rossell Pediatric Hospital, a public reference center in Uruguay. Method: descriptive, retrospective study describing age, clinical manifestations, comorbidities, severity and treatment. Results: a total of 207 children were hospitalized, with a frequency of 1.6%. The median (interquartile range) age was 1.5 years (3 months - 8 years); <1 year accounted for 44%, and 54% were male. Comorbidities were present in 59 children. 71% of them were symptomatic, and among the symptomatic cases, 48% presented mild symptoms. Clinical manifestations were respiratory in 96 (65%) cases and non-respiratory in 51 (fever without a focus 15, gastrointestinal 19, viral exanthem 3, pediatric inflammatory multisystem syndrome 10, and atypical 3). Thirty patients were admitted to the Intensive Care Unit (ICU), and 3 required invasive ventilation. These patients had comorbidities, more days of fever, and required oxygen therapy compared to those who did not need ICU. One 2-year-old patient with comorbidities died. Conclusion: the hospitalization frequency was 1.6%. Most symptomatic children had mild forms of the disease. Among the symptomatic cases, respiratory manifestations were predominant. The findings from this series contribute to the understanding of the behavior of SARS-CoV-2 infection in children.

Introdução: Os primeiros casos de infecção por SARS CoV-2 no Uruguai foram registrados em março de 2020 quando foi decretada a emergência sanitária. Objetivo: descrever as características clínicas e demográficas das crianças menores de 15 anos internadas com infecção por SARS CoV-2 no período 13 de março de 2020 - 30 de setembro de 2021 no Hospital Pediátrico do Centro Hospitalar Pereira Rossell, centro público de referência no Uruguai. Metodologia: estudo descritivo, retrospectivo, incluindo idade, manifestações clínicas, comorbidades, gravidade, tratamento e evolução. Resultados: 207 crianças foram internadas com infecção por SARS CoV-2 correspondendo a frequência de 1,6% do total de crianças hospitalizadas no período estudado. A mediana (intervalo interquartil) de idade foi de 1,5 anos (3 meses - 8 anos) dos quais 44% eram <1 ano 44% e 54% do sexo masculino. 59 crianças apresentaram comorbidades. 71% eram sintomáticas sendo que 48% delas apresentaram sintomas leves. As manifestações clínicas foram respiratórias em 96 (65%) e não respiratórias em 51 (febre sem foco 15, digestiva 19, exantema viral 3, SIM-Ped S 10 e atípico 3). 30 crianças foram internadas na Unidade de Terapia Intensiva e 3 precisaram de ventilação invasiva; esses pacientes apresentavam comorbidades, necessitaram de oxigenoterapia e tiveram mais dias de febre do que aqueles que não necessitaram de UTI. Uma paciente de 2 anos com comorbidades faleceu. Conclusão: a frequência de internações foi de 1,6%. A maioria das crianças sintomáticas apresentou formas leves. Nas sintomáticas as manifestações foram respiratórias. Os achados desta série contribuem para o conhecimento do comportamento da infecção por SARS CoV-2 em crianças.

Fundamentals and Applications of Raman-Based Techniques for the Design and Development of Active Biomedical Materials.

Raman spectroscopy is an analytical method based on light-matter interactions that can interrogate the vibrational modes of matter and provide representative molecular fingerprints. Mediated by its label-free, non-invasive nature, and high molecular specificity, Raman-based techniques have become ubiquitous tools for in situ characterization of materials. This review comprehensively describes the theoretical and practical background of Raman spectroscopy and its advanced variants. The numerous facets of material characterization that Raman scattering can reveal, including biomolecular identification, solid-to-solid phase transitions, and spatial mapping of biomolecular species in bioactive materials, are highlighted. The review illustrates the potential of these techniques in the context of active biomedical material design and development by highlighting representative studies from the literature. These studies cover the use of Raman spectroscopy for the characterization of both natural and synthetic biomaterials, including engineered tissue constructs, biopolymer systems, ceramics, and nanoparticle formulations, among others. To increase the accessibility and adoption of these techniques, the present review also provides the reader with practical recommendations on the integration of Raman techniques into the experimental laboratory toolbox. Finally, perspectives on how recent developments in plasmon- and coherently-enhanced Raman spectroscopy can propel Raman from underutilized to critical for biomaterial development are provided.

Effects of cranioplasty in cerebral blood perfusion using quantification with 99m-Tc HMPAO SPECT-CT.

BACKGROUND AND PURPOSE: Syndrome of the trephined or sinking skin flap syndrome is an underdiagnosed condition of craniectomized patients that usually improves after cranioplasty. Among the pathophysiological theories proposed, the changes of cerebral blood perfusion (CBP) caused by cranial defects might have a role in the neurological deficiencies observed. We aim to assess the regional cortex changes in CBP after cranioplasty with Technetium 99m hexamethylpropylene-amine oxime (99mTc-HMPAO) SPECT-CT. METHODS: Twenty-eight craniectomized patients subject to cranioplasty were studied with 99mTc-HMPAO SPECT-CT in three different times, before cranioplasty, a week, and 3 months after. The images were processed with quantification software comparing CBP of 24 cortical areas with a reference area, and with a database of controls. A mixed effects model and T-Student were used. RESULTS: CBP increased significantly in both hemispheres after cranioplasty, either using ratio (ß = .019, p-value = .030 first postsurgical SPECT-CT and ß = .021, p-value = .015 in the second study, vs. presurgical) or Z-score (ß = .220, p-value = .026 and ß = .279, p-value = .005, respectively). Nine areas of the damaged side had a significant lower CBP ratio and Z-score than the undamaged. Posterior cingulate showed an increased CBP ratio (p-value = .034) and Z-score (p-value = .028) in the first postsurgical SPECT-CT. These posterior cingulate changes represent a 4.83% increase in ratio and 91.04% in Z-Score (p-value = .035 and .040, respectively). CONCLUSION: CBP changes significantly in specific cortical areas after cranioplasty. Posterior cingulate changes might explain some improvements in attention impairments. SPECT-CT could be a useful tool to assess CBP changes in these patients and might be helpful in their clinical management.

A simple and fast spectroscopy-based technique for Covid-19 diagnosis.

The coronavirus pandemic, which appeared in Wuhan, China, in December 2019, rapidly spread all over the world in only a few weeks. Faster testing techniques requiring less resources are key in managing the pandemic, either to enable larger scale testing or even just provide developing countries with limited resources, particularly in Africa, means to perform tests to manage the crisis. Here, we report an unprecedented, rapid, reagent-free and easy-to-use screening spectroscopic method for the detection of SARS-CoV-2 on RNA extracts. This method, validated on clinical samples collected from 280 patients with quantitative predictive scores on both positive and negative samples, is based on a multivariate analysis of FTIR spectra of RNA extracts. This technique, in agreement with RT-PCR, achieves 97.8% accuracy, 97% sensitivity and 98.3% specificity while reducing the testing time post RNA extraction from hours to minutes. Furthermore, this technique can be used in several laboratories with limited resources.

Malaria importada en niños: primer caso en Uruguay / Imported malaria in children: first case in Uruguay / Malária importada em crianças, o primeiro caso no Uruguai

Resumen: La malaria es un problema de salud a nivel mundial. Si bien en Uruguay existen ejemplares del género Anopheles, las especies descritas con mayor frecuencia no transmiten la enfermedad. Se comunica el primer caso de una niña con malaria importada, no complicada, por Plasmodium falciparum. El objetivo es sensibilizar al pediatra sobre una enfermedad reemergente y analizar su abordaje diagnóstico y terapéutico. Caso clínico: niña de 8 años, sana, procedente de Bolívar (Venezuela). Vive en Uruguay desde hace 15 días. Comienza cinco días previos al ingreso con fiebre de 41 °C, rinorrea y tos seca, vómitos ocasionales en las últimas 24 horas. Anorexia y marcado decaimiento. No lesiones de piel, cefalea, ni artromialgias. Examen físico: decaída, chucho febril, dolor abdominal difuso y hepatoesplenomegalia. Estudios complementarios: anemia, plaquetopenia, elevación de reactantes de fase aguda y de gamma glutamil transferasa. Ecografía abdominal: hepatoesplenomegalia moderada. Estudio parasitológico de sangre periférica: trofozoitos de Plasmodium falciparum, parasitemia menor a 10%. Se administra artemeter-lumefantrina durante tres días, seguido de primaquina por 14 días, con buena evolución. Conclusiones: la malaria debe ser considerada en un niño que proviene de zonas endémicas y se presenta con una enfermedad febril aguda, acompañada de chuchos, decaimiento y hepatoesplenomegalia. El estudio del frotis sanguíneo y gota gruesa realizado por el parasitólogo permitirá confirmar el diagnóstico y definir el abordaje terapéutico. Para disminuir la mortalidad es importante el diagnóstico oportuno y la identificación precoz de signos de malaria grave. El tratamiento será dirigido según la especie involucrada y riesgo de resistencia a los antimaláricos.

Summary: Malaria is a global health problem. Although there are specimens of the genus Anopheles, in Uruguay, the most frequently described species do not transmit the disease. We hereby report the first case of a girl with imported, uncomplicated Plasmodium falciparum malaria. The objective is to raise pediatricians' awareness regarding a re-emerging disease and analyze its diagnostic and therapeutic approach. Clinical case: 8-year-old, healthy girl from Bolívar (Venezuela) who had lived in Uruguay for 15 days. 5 days prior to admission started having 41°C fever, runny nose and dry cough and occasional vomit in the 24 hours prior to admittance. Anorexia and significant asthenia. No skin lesions, headaches or arthromyalgia. Physical exam: asthenia, feverish shivering, diffuse abdominal pain, and hepatosplenomegaly. Complementary studies: anemia, thrombocytopenia, high acute phase reactants and gamma glutamyl transferase. Abdominal ultrasound: moderate hepatosplenomegaly. Parasitological study of peripheral blood: Plasmodium falciparum trophozoites, parasitemia less than 10%. Artemether-lumefantrine was administered for 3 days, followed by primaquine for 14 days, with positive evolution. Conclusions: Malaria should be considered in cases of children from endemic areas who show acute febrile illness, accompanied by shivering, asthenia and hepatosplenomegaly. The study of the thick and peripheral blood smears carried out by the parasitologist will eventually confirm the diagnosis and define the therapeutic approach. In order to reduce mortality, it is essential to carry out a timely diagnosis and to identify symptoms of severe malaria early on. Treatment will depend on the species involved and risk of resistance to antimalarials.

Resumo: A malária é um problema de saúde global. Embora no Uruguai existam exemplares do gênero Anopheles, as espécies mais frequentemente descritas não transmitem a doença. Relatamos o primeiro caso de uma menina com malária importada não complicada por Plasmodium falciparum. O objetivo é sensibilizar o pediatra sobre uma doença reemergente e analisar sua abordagem diagnóstica e terapêutica. Caso clínico: menina saudável de 8 anos, procedente de Bolívar (Venezuela) que tinha morado no Uruguai por 15 dias. 5 dias antes da internação começa a ter febre de 41°C, rinorreia, tosse seca e vômitos ocasionais nas 24 horas anteriores à internação. Anorexia e astenia acentuada. Sem lesões cutâneas, dores de cabeça ou artromialgia. Exame físico: astenia, tremor febril, dor abdominal difusa e hepatoesplenomegalia. Estudos complementares: anemia, plaquetopenia, elevação dos reagentes de fase aguda e gama glutamil transferase. Ultrassonografia abdominal: hepatoesplenomegalia moderada. Estudo parasitológico do sangue periférico: trofozoítos por Plasmodium falciparum, parasitemia inferior a 10%. Administramos artemeter-lumefantrina por 3 dias, seguida de primaquina por 14 dias, com boa evolução. Conclusões: devemos considerar a malária em crianças procedentes de áreas endêmicas e com quadro febril agudo, acompanhado de tremores, astenia e hepatoesplenomegalia. O exame do esfregaço e de gota espessa quando feito pelo parasitologista vai confirmar o diagnóstico e definir a abordagem terapêutica. É importante realizar diagnóstico precoce e identificar os sinais de malária para diminuir o risco de mortalidade. O tratamento será administrado de acordo com a espécie envolvida e com o risco de resistência aos antimaláricos.

Parotiditis tuberculosa: una presentación poco frecuente de una enfermedad reemergente / Tuberculous parotitis: an uncommon presentation of a reemerging disease / Parotidite tuberculosa: uma apresentação rara de uma doença reemergente

Resumen: Introducción: en Uruguay en los últimos años se ha observado un aumento de la incidencia de la enfermedad en niños. El diagnóstico de TB infantil representa un desafío, la infección suele cursar con manifestaciones clínicas inespecíficas y muchas veces en forma asintomática. Objetivo: describir el caso clínico de un niño con parotiditis tuberculosa. Caso clínico: 5 años, varón, sano, hacinamiento, dos adultos convivientes con TB pulmonar en tratamiento. Vacunas vigentes. Consulta por tumoración de cuello derecha de tres días de evolución, adelgazamiento, subfebril. Diagnóstico al ingreso, adenoflemón de probable etiología bacteriana. Tratamiento con antibióticos, mala evolución, persiste febril y no se modifica tamaño de tumoración. Ecografía de partes blandas: glándula parotídea derecha aumentada de tamaño. Prueba tuberculínica: 14 mm. Velocidad de eritrosedimentación: 75 mm/h. Con planteo de TB parotídea se realiza punción de la glándula, obteniéndose material purulento. Se confirma bacteriológicamente la infección por métodos moleculares y cultivo. Se inicia tratamiento para TB. Recibe nueve meses de tratamiento con resolución completa y sin complicaciones. Conclusiones: las formas de presentación extrapulmonares son más frecuentes en niños que en adultos, su diagnóstico no es sencillo. Es fundamental recordar que el diagnóstico de un caso de TB en un niño representa un evento sanitario centinela de la transmisión reciente a partir de adulto bacilífero que habitualmente convive y debe ser diagnosticado y tratado adecuadamente.

Summary: Introduction: according to the World Health Organization (WHO), Childhood tuberculosis (TB) occurs in children under 15 years of age. An increase in the incidence of this disease was detected in children in recent years. The diagnosis of childhood TB is a challenge because of its non-specific clinical manifestations. Objective: describe a case of a child with tuberculous parotitis. Case report: 5-year-old healthy male living with 2 adults with pulmonary TB under treatment. Vaccination according to his age. Consultation regarding a neck tumor of 3 days of evolution, patient showed weight loss and no history of fever. Diagnosis at admission was cervical adenitis probably with bacterial etiology. Antibiotic treatment, poor evolution, fever persisted and tumor size remained unchanged. Soft tissue ultrasound: enlarged right parotid gland. Tuberculin test: 14mm. Erythrosedimentation rate 75mm / h. With a parotid tuberculosis approach, we performed a gland puncture and obtained purulent material. The infection was bacteriologically confirmed by molecular methods and culture. Treatment for tuberculosis began. Patient received treatment for 9 months and showed complete resolution and no complications. Conclusions: although tuberculosis is a reemerging disease and extra-pulmonary presentation forms are more frequent in children than in adults, diagnosis remains a challenge. It is essential to remember that the TB diagnosis in children usually shows a sentinel health event of recent transmission from a bacilliferous adult who usually lives with the child and must be properly diagnosed and treated.

Resumo: Introdução: segundo a Organização Mundial da Saúde (OMS), a tuberculose infantil (TB) ocorre em crianças menores de 15 anos de idade. Nos últimos anos houve um aumento na incidência desta doença em crianças. O diagnóstico da TB infantil é um desafio devido às suas manifestações clínicas inespecíficas. Objetivo: descrever o caso duma criança com parotidite tuberculosa. Relato de caso: menino de 5 anos, saudável, morava com 2 adultos com TB pulmonar em tratamento. Vacinas de acordo com sua idade. Consulta referente a tumor cervical com 3 dias de evolução, paciente apresentava emagrecimento, sem febre. O diagnóstico na admissão foi adenite cervical de etiologia provavelmente bacteriana. Tratamento antibiótico, má evolução, persistência de febre e tamanho do tumor inalterado. Ultrassom de partes moles: glândula parótida direita aumentada. Teste tuberculínico: 14mm. Taxa de eritrosedimentação 75 mm / h. Com abordagem de tuberculose parotídea, realizou-se punção da glândula e obteve-se material purulento. A infecção foi confirmada bacteriologicamente por métodos moleculares e cultura. Começou-se tratamento para a tuberculose, o paciente recebeu tratamento por 9 meses e apresentou resolução completa e sem complicações. Conclusões: embora a tuberculose seja uma doença reemergente e as formas de apresentação extrapulmonar sejam mais frequentes em crianças do que em adultos, o diagnóstico permanece um desafio. É fundamental lembrar que o diagnóstico de um caso de TB na criança representa um evento sentinela de saúde de transmissão recente de um adulto bacilífero que mora com a criança e que deve ser devidamente diagnosticado e tratado.

Empiema raquídeo en pediatría: dificultades en el diagnóstico y las decisiones terapéuticas / Spinal empyema in children: difficulties in the diagnosis and treatment decisions

El empiema raquídeo es una patología poco frecuente en niños. La sospecha clínica del mismo es fundamental para realizar un diagnóstico temprano e iniciar un tratamiento adecuado y oportuno que cambie el pronóstico vital y funcional del paciente. Sin embargo, el mismo es dificultoso en la mayoría de los pacientes dada la poca expresividad clínica al inicio de la enfermedad. En cuanto al tratamiento, se propone que es médico y quirúrgico, estando en discusión la exclusividad del primero y el momento oportuno para el segundo en algunos casos. Se presenta el caso de un niño de 7 años, que presentó un empiema raquídeo en el contexto de una infección de cuero cabelludo. Su presentación clínica, al igual que lo descripto en la literatura, fue insidiosa. Se inició tratamiento antibiótico, pero el aumento de la colección evidenciada en la resonancia magnética requirió la decomprensión quirúrgica. El paciente evolucionó de manera favorable, sin signos neurológicos deficitarios.

Community strains of methicillin-resistant Staphylococcus aureus as potential cause of healthcare-associated infections, Uruguay, 2002-2004.

Community-associated MRSA (CA-MRSA) strains have emerged in Uruguay. We reviewed Staphylococcus aureus isolates from a large healthcare facility in Montevideo (center A) and obtained information from 3 additional hospitals on patients infected with CA-MRSA. An infection was defined as healthcare-onset if the culture was obtained >48 hours after hospital admission. At center A, the proportion of S. aureus infections caused by CA-MRSA increased from 4% to 23% over 2 years; the proportion caused by healthcare-associated MRSA (HA-MRSA) decreased from 25% to 5%. Of 182 patients infected with CA-MRSA, 38 (21%) had healthcare-onset infections. Pulsed-field gel electrophoresis determined that 22 (92%) of 24 isolates were USA1100, a community strain. CA-MRSA has emerged in Uruguay and appears to have replaced HA-MRSA strains at 1 healthcare facility. In addition, CA-MRSA appears to cause healthcare-onset infections, a finding that emphasizes the need for infection control measures to prevent transmission within healthcare settings.

Infecciones de piel y partes blandas en pacientes ambulatorios / Infections of skin and soft tissue in outpatients

Analizar las características clínicas y la etiología de las infecciones de piel y partes blandas en pacientes ambulatorios. 2) Determinar en estas infecciones la prevalencia de Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-com) y su sensibilidad a los antibióticos.

Aciduria glutárica tipo I: descripción del primer caso clínico nacional / Type I glutaric aciduria: first national case report

Presentamos el primer caso nacional de un niño portador de una aciduria glutárica tipo I. Esta afección es un error congénito del metabolismo de los aminoácidos esenciales lisina y triptofano determinado por la deficiencia de la enzima mitocondrial glutaril-coenzima A deshidrogenasa, y en nuestro paciente se presenta como la forma clásica ded la enfermedad con síntomas neurológicos de instalación aguda que involucran principalmente el sistema extrapiramidal. El diagnóstico se realiza al evidedniar la presencia del ácido 3-hidroxiglutárico, específico de esta afección. El tratamiento está dirigido a evitar el compromiso neurológico en los casos asintomáticos ya que una vez instalado el daño neurológico es irreversible.

[A strategy for the management of hospitalized children with acute lower respiratory infections]. / Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas.

OBJECTIVES: To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan". METHODS: The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections. RESULTS: During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs. CONCLUSIONS: To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.