RESUMO
BACKGROUND: Asthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. METHODS: We used data from a prospective cohort of 213 children aged 5-17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). RESULTS: During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72-1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14-0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04-0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90-1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10-1.58, P = 0.003). CONCLUSIONS: In a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.
RESUMO
El shunt porto-sistémico congénito extrahepático, es una patología muy poco frecuente del sistema vascular venoso del abdomen, descrita por John Abernethy en 1793. En esta malformación existe pasaje de sustancias no metabolizadas del hígado a la circulación sistémica y dilatación del lecho capilar pulmonar. Se divide en 2 grupos según la presencia (tipo II) o ausencia total (tipo I) de flujo portal. Se presenta un caso de un niño de 6 años de edad, producto de embarazo gemelar de la primera gesta de madre de 22 años de edad, atendido en el Hospital Vicente Corral Moscoso en la ciudad de Cuenca, con sintomatología respiratoria, sin un diagnóstico inicial definido; encontrándose en un estudio ecográfico abdominal casual, la presencia de una anomalía vascular portal, diagnosticándose de malformación de Abernethy tipo II mediante angiotomografía abdominal y resonancia magnética nuclear.Se realizó una revisión bibliográfica exhaustiva y posterior discusión del caso; encontrando como datos de importancia, la existencia de 80 casos reportados hasta el año 2014 a nivel mundial. En Latinoamérica hay el reporte de un caso en Venezuela en el año 2011 y en Argentina en el año 2016.Concluimos remarcando la importancia de una correcta anamnesis, examen físico y uso de las diferentes técnicas diagnósticas en cuanto a los síntomas respiratorios, debido a que existen patologías poco frecuentes que al ser diagnosticadas de forma temprana pueden ser tratadas con éxito, dando así al paciente una vida normal. El presente caso es el único reportado en Ecuador, con abordaje y tratamiento exitoso.
The extrahepatic congenital porto-systemic derivation is a very rare pathology of the venous vascular system of the abdomen described by John Abernethy in 1793. In this malformation there is a passage of substances not metabolized from the liver to the systemic circulation and dilation of the pulmonary capillary bed. It is divided into 2 groups according to the presence (type II) or total absence (type I) of portal flow.We present a case of a 6-year-old child, the product of twin pregnancy of the first pregnancy of a 22-year-old mother, who was treated at the Vicente Corral Moscoso Hospital in Cuenca, with respiratory symptoms, without an initial efinite diagnosis. The presence of a portal vascular abnormality was found in a casual abdominal ultrasound study, which was diagnosed as Abernethy type II malformation by abdominal angiography and nuclear magnetic resonanceA bibliographical review and subsequent discussion of the case was carried out; finding as important data, the existence of 80 cases reported until 2014 worldwide. In Latin America there is a case report in Venezuela in 2011 and in Argentina in 2016.We conclude by emphasizing the importance of a correct anamnesis, physical examination and use of different diagnostic techniques in terms of respiratory symptoms due to there are rare pathologies that being diagnosed early, can be treated successfully, thus giving the patient a normal life.The present case is the only one reported in Ecuador with a successful approach and treatment.
Assuntos
Humanos , Masculino , Criança , Patologia , Anormalidades Congênitas , Malformações Vasculares , Diagnóstico por Imagem , Ultrassonografia , Lesões do Sistema VascularRESUMO
El Síndrome de Jeune es una distrofia esquelética rara, caracterizada por costillas cortas y alteraciones en extremidades y pelvis. La dificultad respiratoria viene determinada por el grado de estrechez torácica, más tar-díamente pueden aparecer insuficiencia pancreática o renal. Se presenta el caso de un lactante de 7 meses que acudió al Hospital Vicente Corral Moscoso por neumonía sin respuesta al tratamiento en hospital cantonal;a su ingreso presenta insuficiencia respiratoria y llama la atención un tóraxcilíndrico, marcadamente estrecho y alargado además de micromelia y polidactilia. Se administró soporte ventilatorio y antibióticos teniendo una evolución favorable durante hospitalización.
Jeune Syndrome is a rare skeletal dystrophy, characterized by short ribsand alterations in limbs and pelvis. The respiratory distress is determinedby the degree of thoracic stricture, and later, pancreatic or renal insufficiencymay occur. A case of a 7-months-old infant who came to the Vicente Corral Moscoso Hospital for pneumonia without treatment response in the cantonal hospital was presented. When the patient arrives he presentsa respiratory insufficiency and it calls the attention a cylindrical thorax,markedly narrow and elongated in addition of micromelia and polydactyly.A respiratory support and antibiotics were given during hospitalization having a favorable evolution.
