The role of veterinarians in zoonosis prevention: Advising families of immunocompromised children with pets.

Background: Pet ownership is widespread, offering numerous benefits to individuals and families. However, the risk of zoonotic diseases must be carefully considered, especially for immunosuppressed patients. Knowledge gaps in preventive measures for zoonoses have been identified, underscoring the vital role of veterinarians in addressing this issue. Objectives: This study aimed to assess the knowledge and recommendations of veterinarians regarding pet ownership by immunocompromised individuals. Additionally, we compared these insights with responses from European healthcare professionals specializing in pediatric transplant recipients. Methods: We conducted an observational, cross-sectional study involving small animal veterinarians in Spain. An online survey was administered to gather information on veterinarians' knowledge of zoonoses and their recommendations for immunocompromised pet owners. Results: A survey of 514 individuals was collected from experienced veterinarians mainly working in primary care clinics. Surprisingly, 63% of respondents did not routinely inquire about the presence of immunocompromised individuals among pet owners, although 54% offered specific recommendations for this group. Most respondents adhered to deworming guidelines for pets owned by immunocompromised individuals and demonstrated sound practices in Leishmania and Leptospira prevention, as well as the avoidance of raw food. However, gaps were noted concerning Bordetella bronchiseptica vaccination. Notably, veterinarians outperformed medical professionals in their knowledge of zoonotic cases and identification of zoonotic microorganisms. The presence of specific recommendations in veterinary clinics was viewed positively by nearly all respondents. Conclusions: Our findings indicate that veterinarians possess a superior understanding of zoonotic pathogens and exhibit greater proficiency in diagnosing zoonoses compared with physicians. They stay well-informed about recommendations outlined in established guidelines and are more likely to provide written recommendations in their clinics than physicians. Nevertheless, knowledge gaps among veterinarians emphasize the need for enhanced communication between medical and veterinary professionals. Reinforcing the "One Health" concept is imperative, with veterinarians playing a pivotal role in this collaborative effort.

Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence.

INTRODUCTION: Group A Streptococcus (GAS) causes mild diseases, and unfrequently invasive infections (iGAS). Following the December 2022 alert from the United Kingdom regarding the unusual increase in GAS and iGAS infections, we analyzed the incidence of GAS infections in 2018-2022 in our hospital. METHODS: We conducted a retrospective study of patients seen in a pediatric emergency department (ED) diagnosed with streptococcal pharyngitis and scarlet fever and patients admitted for iGAS during last 5 years. RESULTS: The incidence of GAS infections was 6.43 and 12.38/1000 ED visits in 2018 and 2019, respectively. During the COVID-19 pandemic the figures were 5.33 and 2.14/1000 ED visits in 2020 and 2021, respectively, and increased to 10.2/1000 ED visits in 2022. The differences observed were not statistically significant (p=0.352). CONCLUSIONS: In our series, as in other countries, GAS infections decreased during the COVID-19 pandemic, and mild and severe cases increased considerably in 2022, but did not reach similar levels to those detected in other countries.

Hyponatremia and other potential markers of ultrasound abnormalities after a first febrile urinary tract infection in children.

Urinary tract infections are the initial manifestation in 30% of urinary tract malformations. Identifying these patients, who could benefit from a specific treatment, is still challenging. Hyponatremia during urinary tract infection has been proposed as a urinary tract malformation marker. We evaluate the prevalence of hyponatremia during febrile urinary tract infections and its association with subjacent urinary tract malformations. We performed a retrospective study of healthy patients under 16 years, diagnosed with a first episode of febrile urinary tract infection, who had undergone blood testing in the acute episode and at least one renal ultrasound during follow-up (January 2014-November 2020). Hyponatremia was defined as (serum sodium ≤ 130 mEq/L). According to imaging findings, we classified patients into three groups: normal kidney ultrasound, mild pelviectasis, and significant urinary tract malformation. We performed logistic regression models to identify independent risk factors for urinary tract malformation and mild pelviectasis. We included 492 patients and 2.8% presented hyponatremia. We identified normal ultrasound in 77%, mild pelviectasis in 10.8%, and urinary tract malformation in 12% of patients. We found an association between mild pelviectasis and hyponatremia [OR 6.6 (CI95% 1.6-26.6)]. However, we found no association between hyponatremia and urinary tract malformation. The parameters that were associated with malformations were presenting a non-E. coli infection, C-reactive-protein levels over 80 mg/L, and bacteremia. CONCLUSION: Hyponatremia during the first episode of febrile urinary tract infection is present in 2.8% of patients and is associated with mild pelviectasis in imaging. However, hyponatremia does not indicate a greater need for complementary tests to screen for urinary tract malformations. WHAT IS KNOWN: • Urinary tract infection is the first manifestation in 30% of children with urinary tract malformation. • Hyponatremia could be a marker to identify these children and guide the imaging approach. WHAT IS NEW: • Around 12% of children with a first episode of febrile urinary tract infection have a urinary tract malformation. • Non-E. coli infection, C-reactive protein levels over 80 mg/L, and bacteremia are markers for malformations to guide diagnostic imaging tests, but hyponatremia (Na ≤ 130 mEq/l) is not a reliable marker.

An Adolescent Female With Acute Abdominal Pain: A Rare Case in Pediatrics.

We present the case of a 13-year-old female with a 48-hour history of diffuse abdominal pain, fever, nausea, and vomiting, with worsening in the last few hours. On examination, she had signs of acute abdomen, and laboratory tests showed elevated acute phase reactants (APR). Abdominal ultrasound excluded acute appendicitis. A history of risky sexual behavior was reported, so pelvic inflammatory disease (PID) was considered. Although appendicitis is the most common cause of acute abdomen in adolescents, PID should be suspected in adolescents with risk factors. Prompt treatment is necessary to avoid possible complications and sequelae.

Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence / Infecciones por Streptococcus pyogenesen en niños españoles antes y después de la pandemia de COVID. Volviendo a la incidencia previa

Introduction: Group A Streptococcus (GAS) causes mild diseases, and unfrequently invasive infections (iGAS). Following the December 2022 alert from the United Kingdom regarding the unusual increase in GAS and iGAS infections, we analyzed the incidence of GAS infections in 2018–2022 in our hospital. Methods: We conducted a retrospective study of patients seen in a pediatric emergency department (ED) diagnosed with streptococcal pharyngitis and scarlet fever and patients admitted for iGAS during last 5 years. Results: The incidence of GAS infections was 6.43 and 12.38/1000 ED visits in 2018 and 2019, respectively. During the COVID-19 pandemic the figures were 5.33 and 2.14/1000 ED visits in 2020 and 2021, respectively, and increased to 10.2/1000 ED visits in 2022. The differences observed were not statistically significant (p=0.352). Conclusions: In our series, as in other countries, GAS infections decreased during the COVID-19 pandemic, and mild and severe cases increased considerably in 2022, but did not reach similar levels to those detected in other countries.(AU)

Introducción: Streptococcus del grupo A (GAS) causa infecciones leves y ocasionalmente invasivas (iGAS). Tras la alerta publicada en diciembre de 2022 en el Reino Unido respecto al aumento de infecciones por GAS leves e iGAS, analizamos la incidencia de estas infecciones en 2018-2022 en nuestro hospital. Métodos: Realizamos un estudio retrospectivo de los niños atendidos en urgencias pediátricas (UP) diagnosticados de faringitis estreptocócica y escarlatina y los ingresados por iGAS durante 5 años. Resultados: La incidencia de infecciones por GAS fue de 6,43 y de 12,38/1.000 visitas a UP en 2018 y 2019, respectivamente. Durante la pandemia fue de 5,33 y de 2,14/1.000 visitas en 2020 y 2021, respectivamente, y aumentó a 10,2/1.000 visitas en 2022. Estas diferencias no fueron estadísticamente significativas (p=0,352). Discusión: En nuestra serie, al igual que en otros países, las infecciones por GAS disminuyeron durante la pandemia de COVID-19, pero en 2022 aumentaron considerablemente los casos leves y graves, sin alcanzar cifras similares a las detectadas en otros países.(AU)

Balancing the Risks and Benefits of Pet Ownership in Pediatric Transplant Recipients.

In recent decades, the number of pediatric transplantations and their survival rates have increased. Psychological problems and poorer quality of life are notable among children undergoing transplantation and can have long-lasting consequences and affect immunosuppressive therapy adherence. Pet ownership and animal contact have been associated with physical, mental, and social health benefits. Despite these potential benefits, however, companion animals are known to be a source of infection, which is one of the main concerns for clinicians. Because of immunosuppression, these children are particularly vulnerable to infections. Zoonoses comprise a long list of infectious diseases and represent a major public health problem. Nevertheless, many families and most healthcare providers are unaware of these potential risks, and there is a worrisome lack of recommendations to manage the risk-benefit balance, which could pose a risk for acquiring a zoonosis. Furthermore, no data are available on the number of transplanted patients with pets, and this risk-benefit balance is difficult to adequately evaluate. In this document, we review the currently available evidence regarding the epidemiology of zoonotic infections in patients undergoing transplantation, focusing on pediatric patients from a risk-benefit perspective, to help inform decision-making for clinicians. Families and healthcare professionals should be aware of the risks, and clinicians should actively screen for pets and offer comprehensive information as part of routine clinical practice. A multidisciplinary approach will ensure proper care of patients and pets and will establish preventive measures to ensure patients are safe living with their pets.

Amoxicillin overdose in the pediatric emergency department: A descriptive study.

OBJECTIVE: To describe the characteristics of pediatric patients treated in the  emergency department due to amoxicillin overdosing. METHOD: A retrospective single-center observational study was conducted on  patients aged 0 to 16 years treated in a pediatric emergency department due  to amoxicillin overdosing between 2011 and 2021. Epidemiological and  anthropometric data was collected as well as information on the circumstances  of overdosing, clinical manifestations, emergency department management,  and discharge destination. RESULTS: The study comprised 15 patients, 66.6% of them male, with a median age of 3.8 years (interquartile range: 1.9). The most frequent cause  of overdosing was accidental ingestion (8/15; 53.3%). Amoxicillin was mainly ingested in liquid form, except for one case with autolytic attempt,  where it was ingested in the form of tablets. Eighty percent of subjects (12/15) received a single dose of the drug. The median time to presentation to  emergency department was 2.1 hours from ingestion (interquartile range: 2.7) and the median dose of amoxicillin was 219 mg/kg/dose (interquartile range:  148). All patients were asymptomatic, with a normal physical examination.  Blood tests were performed in 7 patients (46.6%) and urinary sediment  analysis in 2 (13.3%), all of them without alterations. Activated charcoal was  administered to 5 (33.3%), patients with a median time to administration of  one hour (interquartile range: 1.2). All patients were discharged to their  homes. Eleven cases (73.3%) required withdrawal of amoxicillin. CONCLUSIONS: Amoxicillin overdosing in this study did not appear to result in  adverse effects, despite the fact that the recommended doses were  significantly exceeded.

OBJETIVO: Describir las características de los pacientes pediátricos atendidos en urgencias por sobreingesta de amoxicilina.Método: Estudio unicéntrico observacional, retrospectivo, en pacientes de 0- 16 años atendidos en urgencias pediátricas por sobreingesta de amoxicilina  entre 2011 y 2021. Se analizaron datos epidemiológicos, antropométricos,  circunstancias de la sobreingesta, síntomas, manejo y destino. RESULTADOS: Se incluyeron 15 pacientes, 66,6% varones, mediana de edad de  3,8 años (rango intercuartílico 1,9). La causa más frecuente de sobreingesta  fue la ingesta accidental por el paciente (8/15; 53,3%). Fue administrada en  forma de suspensión en todos los casos, excepto en un paciente con intención  autolítica (comprimidos). El 80% (12/15) recibieron una única dosis. La  mediana de tiempo de llegada a urgencias desde la sobreingesta fue de 2,1  horas (rango intercuartílico 2,7) y la mediana de dosis de 219 mg/kg/dosis  (rango intercuartílico 148). Todos estaban asintomáticos con exploración  normal. Se realizó analítica sanguínea en 7 (46,6%) y sedimento urinario en 2 (13,3%), sin alteraciones. Cinco (33,3%) recibieron carbón activado, con una mediana de tiempo hasta la administración de 1 hora (rango intercuartílico  1,2). Todos fueron dados de alta, suspendiendo el tratamiento 11 (73,3%). CONCLUSIONES: En este estudio, la sobredosificación de amoxicilina no se  relacionó con efectos adversos, a pesar de exceder las dosis recomendadas.

Sobredosificación por amoxicilina en urgencias pediátricas: Estudio descriptivo / Amoxicillin overdose in the pediatric emergency department: A descriptive study

Objetivo: Describir las características de los pacientes pediátricos atendidos en urgencias por sobreingesta de amoxicilina.Método: Estudio unicéntrico observacional, retrospectivo, en pacientesde 0-16 años atendidos en urgencias pediátricas por sobreingesta deamoxicilina entre 2011 y 2021. Se analizaron datos epidemiológicos,antropométricos, circunstancias de la sobreingesta, síntomas, manejo ydestino.Resultados: Se incluyeron 15 pacientes, 66,6% varones, medianade edad de 3,8 años (rango intercuartílico 1,9). La causa más frecuente de sobreingesta fue la ingesta accidental por el paciente (8/15;53,3%). Fue administrada en forma de suspensión en todos los casos,excepto en un paciente con intención autolítica (comprimidos). El 80%(12/15) recibieron una única dosis. La mediana de tiempo de llegadaa urgencias desde la sobreingesta fue de 2,1 horas (rango intercuartílico 2,7) y la mediana de dosis de 219 mg/kg/dosis (rango intercuartílico 148). Todos estaban asintomáticos con exploración normal. Serealizó analítica sanguínea en 7 (46,6%) y sedimento urinario en 2(13,3%), sin alteraciones. Cinco (33,3%) recibieron carbón activado,con una mediana de tiempo hasta la administración de 1 hora (rangointercuartílico 1,2). Todos fueron dados de alta, suspendiendo el tratamiento 11 (73,3%). (AU)

Objective: To describe the characteristics of pediatric patients treated inthe emergency department due to amoxicillin overdosing.Method: A retrospective single-center observational study was conducted on patients aged 0 to 16 years treated in a pediatric emergencydepartment due to amoxicillin overdosing between 2011 and 2021. Epidemiological and anthropometric data was collected as well as information on the circumstances of overdosing, clinical manifestations, emergency department management, and discharge destination.Results: The study comprised 15 patients, 66.6% of them male, with amedian age of 3.8 years (interquartile range: 1.9). The most frequent cause ofoverdosing was accidental ingestion (8/15; 53.3%). Amoxicillin was mainlyingested in liquid form, except for one case with autolytic attempt, where itwas ingested in the form of tablets. Eighty percent of subjects (12/15) received a single dose of the drug. The median time to presentation to emergencydepartment was 2.1 hours from ingestion (interquartile range: 2.7) and themedian dose of amoxicillin was 219 mg/kg/dose (interquartile range: 148).All patients were asymptomatic, with a normal physical examination. Bloodtests were performed in 7 patients (46.6%) and urinary sediment analysis in2 (13.3%), all of them without alterations. Activated charcoal was administered to 5 (33.3%), patients with a median time to administration of one hour(interquartile range: 1.2). All patients were discharged to their homes. Elevencases (73.3%) required withdrawal of amoxicillin. (AU)

Pets for pediatric transplant recipients: To have or not to have.

Pets have many health, emotional and social benefits for children, but the risk of zoonotic infections cannot be underestimated, especially for immunosuppressed patients. We report the recommendations given by health professionals working with pediatric transplant recipients to their families regarding pet ownership. An online survey addressing zoonosis knowledge and recommendations provided by health care practitioners regarding pets was distributed to clinicians treating pediatric transplant recipients. The European Society of Pediatric Infectious Disease (ESPID) and the European Reference Network ERN-TransplantChild, which works to improve the quality of life of transplanted children, allowed the online distribution of the survey. A total of 151 practitioners from 28 countries participated in the survey. Up to 29% of the respondents had treated at least one case of zoonosis. Overall, 58% of the respondents considered that the current available evidence regarding zoonotic risk for transplanted children of having a pet is too scarce. In addition, up to 23% of the surveyed professionals recognized to be unaware or outdated. Still, 27% of the respondents would advise against buying a pet. Practitioners already owning a pet less frequently advised patients against pet ownership, whereas non-pet-owners were more keen to advise against pet ownership (p = 0.058). 61% of the participants stated that there were no institutional recommendations regarding pets in their centers/units. However, 43% of them reported therapeutic initiatives that involved animals in their centers. Infectious disease specialists were more likely to identify zoonotic agents among a list of pathogens compared to other specialists (p < 0.05). We have observed a huge heterogeneity among the recommendations that health care providers offer to families in terms of risk related to pet ownership for transplant recipients. The lack of evidence regarding these recommendations results in practitioners' recommendations based on personal experience.

Miositis aguda infantil en urgencias pediátricas / Acute myositis in the paediatric emergency department

Introducción: la miositis aguda benigna de la infancia (MAB) es una enfermedad benigna y autolimitada, considerada en la actualidad como una secuela de enfermedades víricas. Su manifestación clínica típica son las mialgias en las extremidades inferiores acompañadas de rechazo a caminar. Pacientes y métodos: realizamos una revisión retrospectiva de los casos de MAB atendidos en nuestro servicio de urgencias pediátricas durante un periodo de 25 años. Obtuvimos datos demográficos, clínicos y de laboratorio a través de la revisión sistemática de historias clínicas. Se elaboraron estadísticas descriptivas y se efectuaron comparaciones entre grupos a través del test U de Mann-Whitney. Las correlaciones entre variables cuantitativas se realizaron mediante el análisis de rangos de Spearman. Resultados: se identificaron 139 casos de MAB (74,8% varones). La mayor incidencia se produjo en los meses de invierno y en niños de 4-8 años. Las mialgias bilaterales en miembros inferiores fueron el principal motivo de consulta. El 86,3% referían fiebre acompañada de síntomas respiratorios (88,5%), confirmándose en urgencias la infección por virus influenza en 37 casos (75,6% del serotipo B). En el momento del diagnóstico, la mediana de creatincinasa (CK) fue 1794 U/l, no existiendo diferencias significativas en función del sexo (p = 0,687). La función renal fue normal en todos los pacientes, ninguno necesitó hospitalización. Conclusiones: la MAB es una entidad fácilmente reconocible teniendo en cuenta sus manifestaciones clínicas y analíticas. A pesar de las masivas elevaciones de CK, sus complicaciones son excepcionales y la mayoría de los pacientes pueden ser dados de alta con tratamiento conservador (AU)

Introduction: benign acute childhood myositis (BACM) is a benign, self-limiting disease currently believed to be a sequela of viral infections. The typical clinical presentation is myalgia in the lower extremities accompanied by refusal to walk.Patients and methods: we did a retrospective review of all the cases of BACM managed in our paediatric emergency department over a 25-year period. We collected data on demographic, clinical and laboratory variables through the systematic review of health records. We performed a descriptive statistical analysis, followed by comparison of groups with the Mann-Whitney U test. The correlation between quantitative variables was assessed by means of the Spearman rank coefficient.Results: we identified 139 cases of BACM (74.8% in male patients). The highest incidence corresponded to children aged 4 to 8 years and the winter months. Bilateral lower limb myalgia was the most frequent presenting complaint. Fever was reported in 86.3% of cases, accompanied by respiratory symptoms (88.5%); influenza virus infection was confirmed in 37 cases (75.6% serotype B). At diagnosis, the median creatine kinase (CK) level was 1794 U/l, with no significant differences between the sexes (p=0.687). All patients had normal renal function, and none required hospitalization.Conclusions: based on its clinical and analytical manifestations, BACM is easy to recognise. Although massive elevation of CK is common, complications are rare, and most patients can be discharged with conservative treatment. (AU)

Gemelos con convulsiones febriles: coincidencia en tiempo y etiología / Febrile seizures in siblings: coincidence in timing and aetiology

Las convulsiones febriles tienen alta prevalencia en la infancia y son un motivo de consulta frecuente en Urgencias, generando gran ansiedad en los cuidadores. La etiología es multifactorial y se ha descrito una agregación familiar (hasta el 25-40% de los niños con crisis febriles presentan antecedentes familiares de estas). Sin embargo, esta es la primera vez que se describen convulsiones febriles en hermanos al mismo tiempo y con el mismo hallazgo microbiológico. Presentamos dos parejas de hermanos gemelos de 23 y 33 meses, valorados en Urgencias por crisis febriles al mismo tiempo que su respectivo gemelo. La exploración física y el examen neurológico fueron normales en todos ellos. La PCR para enterovirus recogida en faringe y/o recto fue positiva. En todos los casos la recuperación fue completa, permitiendo el alta sin requerir otros estudios. En los últimos años, las infecciones por enterovirus están adquiriendo importancia creciente en el papel de las convulsiones. Ante casos de hermanos con crisis febriles al mismo tiempo debería tenerse en cuenta la posible infección por este agente. Establecer una etiología podría ser tranquilizador para los padres (AU)

The prevalence of febrile seizures is high in the paediatric population, and seizures are a frequent reason for emergency department (ED) visits, and a significant source of anxiety in caregivers. Their aetiology is multifactorial, and family aggregation has been described (as many as 25-40% of children with febrile seizures have a positive family history). However, this is the first time that febrile seizures have been described as occurring in siblings at the same time with identification of the same etiological agent.We present the cases of 2 pairs of twins, aged 23 months and 33 months, respectively, who presented at the ED with simple febrile seizures in both twins at the same time. The physical and neurological examination were normal in all of them. Polymerase chain reaction tests for enterovirus in pharyngeal and/or rectal swabs were positive. All of the patients recovered fully and were discharged home without requiring further diagnostic tests.In recent years, there has been a growing awareness of the important role of enterovirus infection in seizures. Therefore, enterovirus infection should be considered in the case of siblings presenting with febrile seizures at the same time. Establishing the aetiology of seizures may be reassuring to parents. (AU)

Vólvulo intestinal en niños de edad escolar: reto diagnóstico en urgencias / Intestinal volvulus in school-age children: an emergency care challenge

El dolor abdominal supone uno de los motivos de consulta más frecuentes en los Servicios de Urgencias Pediátricas. El vólvulo intestinal es una entidad infrecuente pero que sin un diagnóstico y tratamiento quirúrgico precoces tiene consecuencias devastadoras, siendo una de las urgencias que todos los pediatras deben conocer. Los vólvulos suponen hasta el 14% de las causas de síndrome de intestino corto que pueden llegar a precisar trasplante intestinal. Requiere un alto índice de sospecha, ya que las pruebas complementarias pueden ser inespecíficas y su normalidad no descarta esta patología. Únicamente la intervención quirúrgica confirma el diagnóstico de vólvulo intestinal. Presentamos los casos de cuatro pacientes que acudieron al Servicio de Urgencias y fueron diagnosticados de vólvulo intestinal. (AU)

Abdominal pain is one of the most frequent reasons for visiting paediatric emergency departments. Intestinal volvulus is an infrequent condition, but without early diagnosis and surgical treatment it has devastating consequences, and it is one of the emergencies that paediatricians must be aware of. Intestinal volvulus accounts for up to 14% short bowel syndrome cases that may require bowel transplantation. A high level of suspicion must be maintained, as the results of diagnostic tests may be nonspecific and normal results do not rule it out. Surgical intervention is the only way to confirm the diagnosis of intestinal volvulus. We present the cases of 4 patients who attended the emergency department and received a diagnosis of volvulus. (AU)

Oral saliva swab reverse transcription PCR for Covid-19 in the paediatric population.

OBJECTIVES: To evaluate the performance of oral saliva swab (OSS) reverse transcription PCR (RT-PCR) compared with RT-PCR and antigen rapid diagnostic test (Ag-RDT) on nasopharyngeal swabs (NPS) for SARS-CoV-2 in children. DESIGN: Cross-sectional multicentre diagnostic study. SETTING: Study nested in a prospective, observational cohort (EPICO-AEP) performed between February and March 2021 including 10 hospitals in Spain. PATIENTS: Children from 0 to 18 years with symptoms compatible with Covid-19 of ≤5 days of duration were included. Two NPS samples (Ag-RDT and RT-PCR) and one OSS sample for RT-PCR were collected. MAIN OUTCOME: Performance of Ag-RDT and RT-PCR on NPS and RT-PCR on OSS sample for SARS-CoV-2. RESULTS: 1174 children were included, aged 3.8 years (IQR 1.7-9.0); 73/1174 (6.2%) patients tested positive by at least one of the techniques. Sensitivity and specificity of OSS RT-PCR were 72.1% (95% CI 59.7 to 81.9) and 99.6% (95% CI 99 to 99.9), respectively, versus 61.8% (95% CI 49.1 to 73) and 99.9% (95% CI 99.4 to 100) for the Ag-RDT. Kappa index was 0.79 (95% CI 0.72 to 0.88) for OSS RT-PCR and 0.74 (95% CI 0.65 to 0.84) for Ag-RDT versus NPS RT-PCR. CONCLUSIONS: RT-PCR on the OSS sample is an accurate option for SARS-CoV-2 testing in children. A less intrusive technique for younger patients, who usually are tested frequently, might increase the number of patients tested.

Asociación de crisis febriles e infección por enterovirus y parechovirus humano en urgencias pediátricas: estudio piloto / Association between febrile seizures and enterovirus and parechovirus infection in the emergency room: A pilot study

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A Cyanotic Infant: Infrequent Presentation of Cow's Milk Protein Allergy.

We report the case of a three-month-old boy who presented with poor weight gain, loose stools, and poor oral intake for three weeks. Physical examination revealed a pale infant with abdominal distension and cyanosis. Oxygen saturation was normal, but the laboratory showed important methemoglobinemia. The diagnosis of FPIES (food protein-induced enterocolitis syndrome) in the context of cow's milk protein allergy (CMPA) was suspected. Although CMPA is a common condition encountered in small children, chronic forms of FPIES can be difficult to diagnose. Maintaining clinical suspicion about the potential association between methemoglobinemia and gastrointestinal symptoms can lead to prompt recognition and intervention.

Pediatric Emergency Department Management of C1 Inhibitor Deficiency.

INTRODUCTION: C1 inhibitor deficiency is a rare, potentially life-threatening syndrome. Acute attacks of angioedema may occur at any time, so the emergency department (ED) constitutes an indispensable component of its care. AIM: To describe the reasons for consultation by children with C1 inhibitor deficiency at the ED, as well as its management and complications. PATIENTS AND METHODS: This is a longitudinal retrospective study conducted in a pediatric ED of a tertiary care hospital in Madrid. The study includes children with C1 inhibitor deficiency, aged 0 to 16 years, who had consulted the ED for whatever reason, over a span of 9 years (2011-2020). Analyzed data include the following: age, sex, type of disease, reason for query, complementary examinations, established diagnosis, treatment, number of visits to the ED, length of ED stay, and admissions. RESULTS: Sixteen patients, amounting a total of 83 ED visits, were analyzed. Fifty-six percent were boys, and the median age was 6.9 years (5 months to 15.9 years). The median and mean of number of visits to the ED per patient was 2 (1-22) and 5.2 ± 6.11, respectively. There were 85.5% of the ED visits initially attributed to acute angioedema attacks. Additional tests were conducted in 30.1%, and 31.3% required C1 inhibitor concentrate. Three episodes required hospital admission (3.6%), and there were no complications. The stay in the ED was longer for patients who needed specific intravenous treatment. CONCLUSIONS: C1 inhibitor deficiency is a rare disease that may require ED care. The main reasons for ED visits were respiratory problems, and the main location of the acute attacks of angioedema were abdominal and cutaneous. Almost one third of the ED visits needed specific treatment, resulting in longer stays. A proper management in the ED and the specific treatment with C1 inhibitor concentrate were effective in 96.2% of the acute attacks of angioedema. Knowledge of this disease in the ED is key to prevent complications.