Apnea or cyanosis as COVID-19 initial presentation in newborns.

INTRODUCTION: The clinical manifestation of coronavirus disease 2019 (COVID-19) infection in newborns varies from asymptomatic infection to severe illness. Apnea or cyanosis as the earliest symptoms is rarely mentioned. The aim of this study is to describe the characteristics of newborns with COVID-19 infection admitted to the neonatal intensive care unit considering cyanosis or apnea as a form of presentation. METHODOLOGY: This is a descriptive observational study with retrospectively collected data. All neonates under 30 days old and preterm infants with corrected gestational age of 44 weeks who had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with a positive antigen or reverse transcriptase polymerase chain reaction (RT-PCR) test and who were attended to between March 2020 and March 2022 were included. RESULTS: During the two years of the study, 410 patients were admitted to the neonatal unit. Twenty-six patients (6.3%) presented with confirmed SARS-CoV-2 infection. The main clinical characteristic at admission was apnea in 55% and cyanosis in 45%. Of the 11 patients admitted with this presentation, eight were diagnosed with COVID-19 acute upper respiratory disease, and three met the definition of COVID-19 bronchiolitis. A large proportion of the patients had a mild infection (65%, n = 17), 31% (n = 8) had a severe infection and only one patient had a critical infection, accounting for 4%. CONCLUSIONS: Apnea and cyanosis can be a manifestation of SARS-CoV-2 infection in newborns, which suggests the need to include it in the diagnostic workup as other viral respiratory infections.

Clinical Characteristics of Children With SARS-CoV-2 Infection in a Hospital in Latin America.

Objective: COVID-19 infections have shown a different behavior in children than in adults. The objective of this study was to describe the clinical characteristics and severity of SARS-CoV-2 infection in pediatric patients seen at a reference hospital in Colombia. Method: A descriptive, observational study in patients under the age of 18 years with a positive test for SARS-CoV-2 infection (RT-PCR or antigen) between April 2020 and March 2021. Multiple variables were studied, including demographic data, clinical characteristics, lab measurements, treatments administered, intensive care unit admission, and mortality. Results: A total of 361 patients were included of whom 196 (54%) were males. The median age was 3 years. Of all the patients, 65 (18%) were asymptomatic. The majority of patients had no comorbidities (n = 225, 76%). In those who were symptomatic (n = 296, 82%), the most frequent complaints were fever (n = 178, 60%), nasal congestion (n = 164, 55%) and cough (n = 149, 50%). Chest x-rays were normal in 73 patients (50%). When abnormalities were found, interstitial (29%) and alveolar (12%) patterns were the most prevalent. One hundred and fifty-seven children (53%) required general ward hospitalization, and 24 patients (8%) required pediatric intensive care admission. The global mortality was 0.8% (3 patients). Conclusions: The majority of cases were asymptomatic or mild. However, a significant percentage of patients required general ward admission, and some even required intensive care. The main symptom of COVID-19 infections in newborns was apnea. A second COVID-19 RT-PCR may be necessary to detect infections in critically ill patients with a high clinical suspicion of the disease if an initial test was negative.

Global PARITY: Study Design for a Multi-Centered, International Point Prevalence Study to Estimate the Burden of Pediatric Acute Critical Illness in Resource-Limited Settings.

BACKGROUND: The burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally. METHODS: We will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites. DISCUSSION: This study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes.

Análisis de costo - oportunidad del uso de coproscópico en diarrea aguda en menores de 5 años / Cost-opportunity analysis of the use of fecal screening test in acute diarrhea in children under 5 years old / Análise custo-oportunidade do uso do teste de verificação fecal na diarreia aguda em crianças menores de 5 anos

Objetivo: Analizar el uso de coproscópico de rutina, en menores de 5 años con diarrea aguda, en un Hospital de primer nivel de Bogotá y evaluar la mejor forma de asignar los recursos usados en esta intervención a una alternativa que produzca mayor beneficio. Métodos: Revisión de la literatura en diarrea aguda y utilidad del coproscópico. Recopilación de datos de consultas por diarrea en niños de 0-5 años y coproscópicos realizados entre octubre de 2011 y febrero de 2012 en Hospital de Bogotá, con selección de aquellos sugestivos de enfermedad enteroinvasiva, cálculo del costo de su uso y estimación del costo-oportunidad en realización de programas que reduzcan la morbimortalidad en menores de 5 años. Resultados: La principal etiología de la enfermedad diarreica es viral. Más de 5 leucos/campo tiene una sensibilidad y especificidad adecuada que no supera la valoración clínica. Se solicitó coproscópico en 44.8%; el 14.6% sugerían enfermedad enteroinvasiva. El 30.2% de los pacientes no requerían coproscópico y su costo corresponde a $5.266.400. Conclusiones: La utilidad del coproscópico es baja y no mejora la probabilidad pretest de diarrea enteroinvasiva, es necesario abordar la el análisis de costo-oportunidad para la distribución correcta de los recursos en intervenciones que reduzcan la morbimortalidad.

Objective: To analyze the use of routine fecal screening test in children under 5 years old, with acute diarrheal disease in a primary care level hospital in Bogotá and evaluate how best the resources used in this intervention can be allocated to an alternative one, that produces greater benefit . Methods: Review of the literature on acute diarrhea and utility of fecal screening test. Data collection of diarrhea consultations in children under 5 years old and fecal screening test done between October 2011 and February 2012 in a Bogota´s Hospital. Selecting those one, which diagnoses enteroinvasive diarrhea and costing of routine use, and estimated opportunity-cost in programs to reduce morbi-mortality in children under 5 years old. Results: The main etiology of diarrhea is viral. More than 5 WBCs / field has adequate sensitivity and specificity, but the clinical assessment is better on detection of enteroinvasive disease. Fecal screening test was requested in 44.8 %; 14.6 % was suggested enteroinvasive disease. The resources used in 30.2 % of patients did not require the test match to US$2.633. Conclusions: The utility of Fecal screening test is low and does not imprve the pretest probability of enteroinvasive diarrhea. Is necessary to address the cost-opportunity analysis for the proper distribution of resources in intervetions that reduce the morbi-mortality.

Objetivo: Analisar o uso do teste rotineiro de triagem fecal em crianças menores de 5 anos com doença diarréica aguda em um hospital de atenção primária em Bogotá e avaliar a melhor forma de alocação dos recursos utilizados nessa intervenção para uma alternativa que produza maior benefício. Métodos: Revisão da literatura sobre diarréia aguda e utilidade do teste de triagem fecal. Coleta de dados de consultas de diarréia em crianças menores de 5 anos e teste de triagem fecal realizado entre outubro de 2011 e fevereiro de 2012 em um hospital de Bogotá. Selecionar aquelas que diagnosticam diarréia entero-invasiva e custo de uso rotineiro e custo de oportunidade estimado em programas para reduzir a morbi-mortalidade em crianças menores de 5 anos. Resultados: A principal etiologia da diarréia é viral. Mais de 5 WBCs / campo tem sensibilidade e especificidade adequadas, mas a avaliação clínica é melhor na detecção de doença enteroinvasiva. O teste de triagem fecal foi solicitado em 44,8%; 14,6% foi sugerida doença enteroinvasiva. Os recursos utilizados em 30,2% dos pacientes não necessitaram do teste correspondente a US $ 2,633. Conclusões: A utilidade do teste de triagem Fecal é baixa e não melhora a probabilidade pré-teste de diarréia enteroinvasiva. É necessário abordar a análise custo-oportunidade para a distribuição adequada de recursos em intervenções que reduzam a morbi-mortalidade.

[Primary prostatic tuberculosis. Case report and bibliographic review]. / Tuberculosis prostática primaria. Presentación de un caso y revisión de la literatura.

OBJECTIVE: Primary prostatic tuberculosis is a very rare form of presentation of the tuberculous infection, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency (AIDS).We describe a case of primary prostatic tuberculosis attended at the Hospital Universitario de Santander, Colombia, and to perform a discussion about this topic. METHODS/RESULTS: 65 year old man who consulted with symptoms of frequency, dysuria and hesitancy, and 10 Kg weight loss in the last 6 months, without pulmonary symptoms and negative ELISA test for HIV. On physical examination there was evidenceof the presence of a high volume, irregular and hard prostatic gland. That is why a prostatic Doppler ecography was performed showing a prostatic volume of 39 cm3, without sign of malignity. Biopsy of the prostatic gland showed multiple granulomas and the ZN staining was positive for mycobacteria. With these findings the diagnosis of primary prostatic tuberculosis was established, and treatment was carried out and now the patient is asymptomatic with no evidence of active tuberculosis. CONCLUSIONS: Primary prostatic tuberculosis without history or evidence of commitment of the immune system is a very rare condition, nevertheless, it is particularly important to know it due to the progressive increase of its presentation and the possibility of a curative treatment to affected patients.

Tuberculosis prostática primaria. Presentación de un caso y revisión de la literatura / Primary prostatic tuberculosis. Case report and bibliographic review

OBJETIVO: La tuberculosis prostática primaria es una forma de presentación de la infección tuberculosa muy poco frecuente, es ocasionada generalmente por el M. Tuberculosis, la cual ha mostrado un aumento en su incidencia y prevalencia, debido al aumento de pacientes inmunodeficientes y la pandemia del Síndrome de Inmuno-Deficiencia Adquirida (SIDA).Describir un caso de tuberculosis prostática primaria atendido en el Hospital Universitario de Santander, Colombia, y realizar una discusión de este tema.MÉTODO/RESULTADO: Hombre de 65 años de edad quien consultó por polaquiuria, disuria y hesitancia. Con pérdida de 10 Kg. de peso en los últimos 6 meses, sin sintomatología pulmonar y prueba de ELISA negativa para VIH. En el examen físico se documentó la presencia de una próstata aumentada de volumen, irregular y dura. Por lo cual se realizo ecografía Doppler prostática que mostró un volumen prostático de 39 cm3, sin características indicadoras de malignidad. La biopsia por punción de la glándula mostró múltiples granulomas y la tinción de Ziel-Nielsen fue positiva para micobacterias. Con los anteriores hallazgos se realizó el diagnostico de tuberculosis prostática primaria, la cual fue tratada y actualmente el paciente se encuentra asintomático sin evidencia de enfermedad tuberculosa activa.CONCLUSIONES: La tuberculosis prostática primaria sin historia o evidencias de compromiso del sistema inmune, es una enfermedad muy poco frecuente, a pesar de lo anterior su conocimiento es de particular importancia debido al aumento progresivo de su presentación y a la posibilidad de realizar un tratamiento curativo a los pacientes afectados(AU)

OBJECTIVE: Primary prostatic tuberculosis is a very rare form of presentation of the tuberculous infec-tion, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency (AIDS).We describe a case of primary prostatic tuberculosis attended at the Hospital Universitario de Santander, Colombia, and to perform a discussion about this topic.METHODS/RESULTS: 65 year old man who consulted with symptoms of frequency, dysuria and hesitancy, and 10 Kg weight loss in the last 6 months, without pulmonary symptoms and negative ELISA test for HIV. On physical examination there was evidenceof the presence of a high volume, irregular and hard prostatic gland. That is why a prostatic Doppler ecography was performed showing a prostatic volume of 39 cm3, without sign of malignity. Biopsy of the prostatic gland showed multiple granulomas and the ZN staining was positive for mycobacteria. With these findings the diagnosis of primary prostatic tuberculosis was established, and treatment was carried out and now the patient is asymptomatic with no evidence of active tuberculosis.CONCLUSIONS: Primary prostatic tuberculosis without his-tory or evidence of commitment of the immune system is a very rare condition, nevertheless, it is particularly important to know it due to the progressive increase of its presentation and the possibility of a curative treatment to affected patients(AU)