SCIWORA. Una rara entidad clínica en la población pediátrica. Estudio ambispectivo / SCIWORA in children. A rare clinical entity: Ambispective study

Introducción: La lesión medular tipo SCIWORA es una entidad clínica con baja incidencia y alta repercusión funcional. El objetivo del estudio es la descripción epidemiológica de esta lesión y su evolución funcional con un seguimiento medio de 10 años. Material y métodos: Estudio analítico, longitudinal, de cohortes ambispectivo. Fueron evaluados 13 pacientes con el diagnóstico de SCIWORA en el periodo de estudio 2001-2022. Variables evaluadas: edad, sexo, días hasta la lesión medular, causa de lesión, imagen medular en la RM postraumatismo, nivel neurológico de lesión, ASIA ingreso/alta/5 años, SCIM III ingreso/alta/3 años, tipo de tratamiento empleado, empleo de terapia NASCIS III ingreso, tiempo de hospitalización, seguimiento medio. En octubre del 2022 fueron nuevamente evaluados en consultas externas mediante: cuestionario de discapacidad cervical (NDI)/Oswestry y cuestionario de calidad de vida validado en castellano para lesionados medulares (SV-QLI/SCI). Resultados: La mediana de edad fue de 4 años, 77% varones. El 54% de las lesiones corresponden a nivel cervical. El ASIA al ingreso fue del 31% A y del 31% C, nivel neurológico: C2 (22%) y T10 (15%), tráfico como causa de lesión (77%), SCIM III ingreso/alta: 28,5/42. La estancia media hospitalaria fue de 115 días. NDI: 11,6 y Oswestry: 15,3. Conclusión: El 77% de los SCIWORA se producen en menores de 8 años. Al año del alta hospitalaria un 31% de los pacientes fueron catalogados como ASIA D y a los 5 años el porcentaje se mantiene constante. No se encontraron diferencias significativas entre la causa de la lesión y tipo de alteración en RM (p = 0,872), ni entre la edad y el tipo de lesión medular objetivada en RM (p = 0,149).(AU)

Introduction: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. Material and methods: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. Results: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. Conclusions: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.(AU)

[Translated article] SCIWORA in children. A rare clinical entity: Ambispective study.

INTRODUCTION: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P=0.872), age and MRI spinal cord findings (P=0.149) were found in SCIWORA patients.

SCIWORA in children. A rare clinical entity: Ambispective study. / SCIWORA. Una rara entidad clínica en la población pediátrica. Estudio ambispectivo.

INTRODUCTION: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.

Parálisis cerebral en la edad pediátrica y atención primaria de salud

A pesar de existir varios mecanismos para la prevención y manejo de la parálisis cerebral, aún persisten dificultades, en especial en la edad pediátrica. Se presenta como objetivo comentar elementos inherentes a la prevención y manejo de la parálisis cerebral para su abordaje, desde el punto de vista del enfoque psicosocial, obtenidos de la revisión documental con la cual se inició un estudio que forma parte del proyecto de investigación Estrategias para el perfeccionamiento de la prevención y manejo de la Parálisis Cerebral en Camagüey que se ejecuta, desde enero de 2020 y hasta diciembre de 2022, bajo la dirección del Centro de Desarrollo de las Ciencias Sociales y Humanísticas en Salud, adscrito a la Universidad de Ciencias Médicas de Camagüey, en colaboración con los policlínicos José Martí Pérez y Rodolfo Ramírez Esquivel de las áreas de salud de la ciudad. Por su carácter la investigación es cuanticualitativa y se sustenta en la conceptualización y los procesos de evaluación de prevención y manejo de los programas de salud, lo que se evidencia en la forma de intercambiar durante la investigación, con los profesionales, así como expertos en ciencias sociales. Fueron consultados materiales y textos pertinentes a la temática desde el punto de médico y desde la visión del enfoque social de la situación de salud.

Although there are several mechanisms for the prevention and management of cerebral palsy, difficulties still persist, especially in the pediatric age. The objective is to comment on elements inherent to the prevention and management of cerebral palsy for its approach, from the point of view of the psychosocial approach, obtained from the documentary review with which a study was initiated that is part of the research project Strategies for the improvement of the prevention and management of Cerebral Palsy in Camagüey that is executed, from January 2020 and until December 2022, under the direction of the Center for the Development of Social and Humanistic Sciences in Health, attached to the University of Medical Sciences of Camagüey, in collaboration with the José Martí Pérez and Rodolfo Ramírez Esquivel polyclinics of the city's health areas. Due to its nature, the research is quantitative and is based on the conceptualization and evaluation processes of prevention and management of health programs, which is evidenced in the way of exchanging during the investigation, with professionals, as well as experts in social science. Materials and texts pertinent to the theme were consulted from the medical point of view and from the vision of the social approach to the health situation.

Características clínicas de pacientes en edad pediátrica con COVID-19 en diferentes momentos epidemiológicos. Cienfuegos (2020-2022) / Clinical Characteristics of Pediatric Patients With COVID-19 at Different Epidemiological Times. Cienfuegos (2020-2022)

Introducción: Las manifestaciones clínicas de la COVID-19 se presentan con particularidades diferentes en cada momento epidemiológico. Objetivo: Examinar las características clínicas de pacientes en edad pediátrica con COVID-19 durante la fase aguda de hospitalización, en diferentes momentos epidemiológicos. Métodos: Estudio descriptivo, transversal realizado en la provincia de Cienfuegos. Se estudiaron 784 pacientes diagnosticados con COVID-19, entre marzo de 2020 y marzo de 2022. Se analizaron las variables: edad, sexo, procedencia, antecedentes patológicos personales, sintomatología inicial, clasificación clínica, complicaciones, estadía, evolución y momento epidemiológico. Resultados: Los niños más hospitalizados fueron los menores de cinco años (57 por ciento) con un discreto predominio del sexo femenino (52 por ciento). El 71 por ciento de la muestra no presentó comorbilidades. La forma sintomática de la enfermedad se manifestó en 57 por ciento de los pacientes, y la asintomática en 42 por ciento. Solo 1 por ciento presentó formas graves de la infección. El mayor porcentaje de casos sintomáticos se produjo en el momento epidemiológico en el cual prevaleció la cepa Ómicron. La fiebre, la tos, y la secreción nasal fueron, por ese orden, las manifestaciones clínicas predominantes. El 4 por ciento presentó neumonías, y hubo un fallecido en la serie. El 67 por ciento egresó después de una estadía entre uno, y seis días. Conclusiones: Se comprobaron diferencias en el comportamiento clínico de la COVID-19, en sus diferentes momentos epidemiológicos en Cienfuegos. La forma de presentarse la infección por SARS-CoV-2 puede ser similar a otras infecciones respiratorias virales. Esto requiere mantener la vigilancia de esta enfermedad en niños(AU)

Introduction: The clinical manifestations of COVID-19 are presented with different particularities at each epidemiological moment. Objective: To examine the clinical characteristics of pediatric patients with COVID-19 during the acute phase of hospitalization, at different epidemiological times. Methods: A descriptive, cross-sectional study was conducted in the province of Cienfuegos. 784 patients diagnosed with COVID-19 between March 2020 and March 2022 were studied. The following variables were analyzed: age, sex, origin, personal pathological history, initial symptomatology, clinical classification, complications, stay, evolution and epidemiological moment. Results: The most hospitalized children were children under five years of age (57 percent) with a slight predominance of females (52 percent). 71 percent of the sample had no comorbidities. The symptomatic form of the disease manifested itself in 57 percent of patients, and the asymptomatic in 42 percent . Only 1 percent had severe forms of the infection. The highest percentage of symptomatic cases occurred at the epidemiological moment in which the Ómicron strain prevailed. Fever, cough, and runny nose were, in that order, the predominant clinical manifestations. 4 percent of the patients had pneumonia, and there was one death in the series. 67 percent discharged after a stay of one to six days. Conclusions: Differences were found in the clinical behavior of COVID-19, in its different epidemiological moments in Cienfuegos. The way SARS-CoV-2 infection occurs may be similar to other viral respiratory infections. This requires maintaining surveillance for this disease in children(AU)

Conocimientos sobre anemia ferropénica en madres de niños menores de un año de edad

Introducción: La carencia de hierro es la deficiencia específica de micronutrientes más frecuente en la población cubana. Objetivo: Determinar el nivel de conocimiento sobre anemia ferropénica en madres de niños menores de 1 año de edad. Métodos: Estudio descriptivo y transversal realizado en el policlínico "Ramón López Peña". La población de estudio estuvo conformada por 352 madres de niños menores de 1 año de edad, que aceptaron participar en la investigación. Para la recolección de datos se aplicó un cuestionario. La variable a evaluar fue nivel de conocimientos. Resultados: El principal grupo de edad de las participantes fue entre 20 y 35 años (60,9 %) y en su mayoría casadas (59,3 %). El 53,1 % de estas cursaron el preuniversitario y 60,9 % cuenta únicamente con un hijo. El nivel de conocimiento sobre prevención de anemia ferropénica según dimensión conocimientos básicos fue alta en 54,7 % de las madres, 53 % presentaron conocimientos bajos en relación con las medidas preventivas, y en el tratamiento predominó el nivel medio en 54,2 % de la casuística. De forma general 38,9 % de las madres presentaron conocimientos medios sobre la prevención de la anemia ferropénica. Conclusiones: Aparte de que las madres presentan un nivel de medio a alto de conocimientos sobre la prevención de la anemia ferropénica, se deben intensificar las acciones de salud, encaminadas a elevar la educación nutricional, como elemento fundamental para su prevención.

Introduction: Iron deficiency is the most frequent specific micronutrient deficiency in the Cuban population. Objective: To determine the level of knowledge about iron deficiency anemia in mothers of children under one year of age. Methods: Descriptive and cross-sectional study conducted at "Ramón López Peña" polyclinic. The study population consisted of 352 mothers of children under one year of age, who agreed to participate in the research. A questionnaire was applied for data collection. The variable to be evaluated was level of knowledge. Results: The main age group of the participants was between 20 and 35 years (60.9%) and mostly married (59.3%). 53.1% of them had pre-university studies and 60.9% have only one child. The level of knowledge about the prevention of iron deficiency anemia according to basic knowledge dimension was high in 54.7% of the mothers, 53% presented low knowledge in relation to preventive measures, and on the treatment, the average level predominated in 54.2% of the casuistry. In general, 38.9% of the mothers presented average knowledge about the prevention of iron deficiency anemia. Conclusions: Apart from the fact that mothers have a medium to high level of knowledge about the prevention of iron deficiency anemia, health actions should be intensified, aimed at raising nutritional education, as a fundamental element for its prevention.

New diagnoses of type 1 diabetes mellitus in children during the COVID-19 pandemic Regional multicenter study in Spain.

INTRODUCTION: The aim of this study is to determine whether during the year 2020, coinciding with the COVID-19 pandemic, there has been an increase in the incidence of diabetes mellitus in children compared to the previous 2 years. It is also to find out if lockdowns and the difficulty providing face-to-face care in the health system have led to children showing more severe symptoms at the time of diagnosis. MATERIAL AND METHODS: Retrospective observational multicenter study of the province of Tarragona where data is collected from new diagnoses of type 1 diabetes mellitus in patients under the age of 15 during the year 2020 and compared with years 2018 and 2019. RESULTS: The number of new diagnoses of type 1 diabetes during 2020 was 37 cases compared to 2019 and 2018 which was 23 and 29 respectively. The median age at onset was 9 years, 54% males. There was an increase in new diagnoses in the range of 10 to14-year-olds, with a decrease in the range of 0-4 year-olds. In 2020, the incidence in the group of patients with families from the Maghreb area rose from 52.2 cases per 100,000 population/year (c/105 p-y) in 2019 to 135.8 in 2020. Compared to the previous year, 2020 showed a significant decrease of ketoacidosis at the onset. None of the patients was diagnosed with COVID-19 during admission. CONCLUSION: During the year 2020 concurring with the COVID-19 pandemic, there was an increase in the number of new diagnoses of type 1 diabetes mellitus in pediatrics. Contrary to expectations, the presentation did not worsen by decreasing the proportions of ketoacidosis at onset. This data would suggest that, although attendance in the different health facilities dropped drastically during the year 2020 at the expense of virtual consultations, health systems and families were able to detect the symptoms of the disease early.

Trastornos vestibulares en pacientes menores de 20 años. Estudio descriptivo / Vestibular disorders in patients under 20 years of age. Descriptive study

Introducción y objetivo: el vértigo es un síntoma frecuente en la población adulta, pero mucho menos habitual en niños y adolescentes. Mientras que la etiología del vértigo se ha establecido con suficiente evidencia científica en adultos, el diagnóstico en la edad pediátrica no se ha descrito con la misma fuerza por una menor casuística. Los objetivos de este artículo son evaluar la prevalencia y características clínicas de los trastornos vestibulares en niños y adolescentes y realizar una revisión bibliográfica de los últimos estudios epidemiológicos al respecto. Método: nuestro estudio es observacional, retrospectivo, no aleatorizado y realizado en el servicio de Otorrinolaringología del Hospital General Universitario de Castellón. Incluimos 20 pacientes con edades comprendidas entre 18 meses y 20 años, que consultaron por alteraciones en el equilibrio a lo largo de 2 años (2017-2018). Resultados: la migraña vestibular (45%) fue el cuadro más frecuente en nuestra serie, seguido del vértigo paroxístico benigno de la infancia (30%). La enfermedad de Ménière, la neuritis vestibular o la paroxismia vestibular, fueron cuadros menos frecuentes. Conclusiones: el vértigo en niños y adolescentes es una queja relativamente común, pese a estar subestimado en la práctica clínica. Se trata de una patología de bastante importancia puesto que supone un problema que puede influir en el aprendizaje, concentración e, incluso, en la capacidad lectora. Aunque las causas más frecuentes de vértigo en la edad pediátrica son la migraña vestibular y el vértigo paroxístico de la infancia, las etiologías son muy numerosas. Por otro lado, la historia clínica y la exploración otoneurológica son esenciales en el diagnóstico de trastornos vestibulares infantiles. Y, por último, las pruebas de imagen son necesarios en aquellos pacientes sugestivos de centralidad al presentar clínica neurológica, cefaleas persistentes, o traumatismo craneoencefálico previo. (AU)

Osteomielitis crónica agudizada del maxilar. Presentación de un caso pediátrico / Acute chronic osteomyelitis of the maxilla. Presentation of pediatric case / Osteomielite crônica aguda da maxila. Apresentação de um caso pediátrico

RESUMEN Se presentó el caso de una paciente femenina de 9 años con historia de traumatismo a nivel de incisivos centrales superiores, por lo cual recibió tratamiento para apicoformación con hidróxido de calcio durante un periodo prolongado, que luego de realizarle la obturación de los conductos radiculares presentó un cuadro de inflamación aguda en labio superior y vestíbulo bucal. El tratamiento incluyó terapia antimicrobiana, desbridamiento quirúrgico amplio bajo anestesia general, apicectomía de ambos incisivos, obturación a visión directa de los conductos y sellado apical de los dientes con gutapercha. El diagnóstico anatomopatológico fue el de osteomielitis crónica agudizada del maxilar. Año y medio después se observó ausencia clínica de signos inflamatorios y adecuada cicatrización del tejido óseo. Se concluyó que, aunque los reportes de osteomielitis crónica del hueso maxilar son escasos, debe estar presente dentro del diagnóstico diferencial cuando se evalúan pacientes en edad pediátrica con historia de traumatismo dentoalveolar y procesos inflamatorios en la región maxilofacial.

ABSTRACT A nine-year old female patient presented with a history of trauma to the upper central incisors. She received treatment for apicoforming with calcium hydroxide for a prolonged period, who after root canal obturation presented acute inflammation of the upper lip and buccal vestibule. Treatment included antimicrobial therapy, extensive surgical debridement under general anesthesia, apicoectomy of both incisors, and direct visual obturation of the canals and apical sealing of the teeth with gutta-percha. The anatomopathologic diagnosis was acute chronic osteomyelitis of the maxilla. One and a half years later, clinical absence of inflammatory signs and adequate healing of the bone tissue were observed. It was concluded that, although reports concerning chronic osteomyelitis of the maxillary bone are rare events, this type of infection should be always present at the time of the differential diagnosis for evaluating pediatric patients with a history of dentoalveolar trauma and inflammatory processes in the maxillofacial region.

RESUMO Apresentamos o caso de uma paciente feminina de 9 anos de idade com histórico de trauma nos incisivos centrais superiores, para a qual ela recebeu tratamento para apicoformação com hidróxido de cálcio por um período prolongado, que após a obturação do canal radicular apresentou inflamação aguda do lábio superior e vestíbulo vestibular. O tratamento incluiu terapia antimicrobiana, desbridamento cirúrgico extensivo sob anestesia geral, apicoectomia de ambos os incisivos, obturação visual direta dos canais e vedação apical dos dentes com guta-percha. O diagnóstico patológico foi uma osteomielite crônica aguda da maxila. Um ano e meio depois, houve uma ausência clínica de sinais inflamatórios e uma cicatrização adequada do tecido ósseo. Concluiu-se que, embora os relatos de osteomielite crônica do osso maxilar sejam escassos, ela deveria estar presente no diagnóstico diferencial ao avaliar pacientes pediátricos com histórico de trauma dentoalveolar e processos inflamatórios na região maxilofacial.

COVID in Pediatric Age: an opinion paper / COVID en la edad pediátrica: un documento de opinión

The incidence of COVID in pediatrics was underestimated during the first months of the pandemic due to the oligosymptomatic nature of the infection in many children and thescarcity of diagnostic tests applied to this population. It is nowaccepted that children are infected and transmit the diseasein the same way as adults. On the contrary, children have lesssevere and less lethal COVID, probably due to a lower maturityof the child’s immune system, a lower number of ACE2 receptors and the lower presence of comorbidities in this populationgroup.The development of a multisystemic inflammatory syndrome after SARS-CoV-2 infection in children, despite its rarity, is a very serious condition that frequently requires intensivecare. Other less severe post-COVID manifestations have beendescribed in children but are not yet well defined.COVID has had and continues to have a significant psychological impact on the children themselves, on their caregiversand on the exacerbation of pre-existing psychiatric conditions.We apply adult therapeutic principles to children but withvery low levels of evidence. Information on the tolerability of the available medications in this population group is stillscarce. The mortality of COVID in children is very low and generally affects children with significant comorbidities.There are, at present, three vaccines licensed for pediatricuse which are compatible with all other vaccines applicable tochildren.In these circumstances, there has been much speculationabout the indication for vaccination in the pediatric age group,but given its good tolerance, there are clinical and ethical reasons that, in our opinion, justify it. (AU)

La incidencia de COVID en pediatría ha estado infraestimada durante los primeros meses de la pandemia por el carácter oligosintomático de la infección en muchos niños y porla escasez de pruebas diagnósticas aplicadas a esta población.Hoy se admite que los niños se infectan y transmiten la enfermedad igual que los adultos. Por el contrario, los niños tienencuadros clínicos menos graves y letales lo cuál parece relacionado con una menor madurez del sistema inmune del niño,una menor cantidad de receptores ACE2 y la menor presenciade comorbilidades en este grupo de población.El desarrollo de un síndrome inflamatorio multisistémicotras la infección por SARS-CoV-2 en niños, pese a su rareza, esun cuadro muy grave que frecuentemente requiere cuidadosintensivos. Se han descrito otros cuadros post-COVID en niños,menos graves, pero todavía no muy bien definidos.La COVID-19 ha tenido y tiene un importante impacto psicológico en los propios niños, en sus cuidadores y en la exacerbación de cuadros psiquiátricos pre-existentes.Aplicamos a los niños los principios terapéuticos de losadultos pero con niveles muy bajos de evidencia y la toleranciade los medicamentos disponibles en este grupo de poblaciónes todavía mal conocida. La mortalidad de la COVID en niñoses muy baja e incide generalmente en niños con importantescomorbilidades.Hay, en el momento presente, tres vacunas autorizadaspara el uso pediátrico y las vacunas frente a SARS-CoV-2 soncompatibles con el resto de las vacunas aplicables a niños.En estas circunstancias se ha especulado mucho sobre laindicación de vacunación en la edad pediátrica pero dada subuena tolerancia, existen, en nuestra opinión, razones clínicasy éticas que la justifican. (AU)

Repercusión del confinamiento por COVID-19 sobre el control glucémico en niños y adolescentes con diabetes mellitus tipo 1 / Impact of COVID-19 lockdown on glucemic control in children and adolescents with type 1 diabetes mellitus

Introducción y objetivos: Con objeto de hacer frente a la rápida propagación de la pandemia por coronavirus SARS-CoV-2, España decretó el confinamiento domiciliario de la población el 15 de marzo de 2020. El objetivo principal de este estudio es evaluar la repercusión de dicha medida sobre el control glucémico en niños y adolescentes con diabetes mellitus tipo 1 (DM1).Pacientes y métodos: Estudio observacional, retrospectivo, en niños y adolescentes con DM1 usuarios de sistemas de monitorización de glucosa intersticial. Se recogió la siguiente información correspondiente a las 2 últimas semanas de cuarentena, previas al inicio del desconfinamiento, para su posterior comparación con los datos de 2 semanas previas al confinamiento: necesidades diarias de insulina, glucosa intersticial media, HbA1c estimada, coeficiente de variación, tiempo en rango (70-180mg/dl), hipoglucemia (<70 y <54mg/dl) e hiperglucemia (>180 y>250mg/dl), uso del sensor y número de glucemias capilares. Mediante encuesta se obtuvo información acerca de rutinas de ingesta, ejercicio físico, necesidad de ajustes en la terapia, complicaciones agudas surgidas y acompañamiento de los pacientes por sus cuidadores durante el confinamiento. (AU)

Background and aims: To face the rapid spread of SARS-CoV-2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D).Patients and methods: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl), and hyperglycemia (>180 and>250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications, and lockdown of caregivers were assessed via a survey. (AU)

Impact of COVID-19 lockdown on glucemic control in children and adolescents with type 1 diabetes mellitus.

BACKGROUND AND AIMS: To face the rapid spread of SARS-CoV2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). PATIENTS AND METHODS: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl) and hyperglycemia (>180 and> 250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications and lockdown of caregivers were assessed via a survey. RESULTS: 80 patients were studied (mean age 12.61±3.32 years, mean time of evolution of the disease 5.85±3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1±10.5 vs 74.8±10.5%; P=0.011) with lower time in hypoglycemia both <70mg/dl (4.6±3.2 vs 3.2±2.7%; P<0.001) and <54mg/dl (1.2±1.6 vs 0.7±1.2%; P<0.001) and hyperglycemia >250mg/dl (4.6±3.9 vs 3.7±3.7%; P=0.038). CV also decreased (35.8±6.3 vs 33.1±6.1%; P<0.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers' confinement did not have a significant impact. CONCLUSIONS: Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control.

Impacto de faster aspart sobre el control glucémico en niños y adolescentes con diabetes tipo 1 en tratamiento con un sistema integrado / The impact of «faster aspart» on blood glucose control in children and adolescents with type 1 diabetes treated using a sensor-augmented insulin pump

Introducción y objetivos: El control glucémico postprandial es fundamental para conseguir los objetivos metabólicos en pacientes con diabetes mellitus tipo 1 (DM1). La nueva insulina faster aspart presenta un perfil farmacológico caracterizado por una absorción e inicio de acción más rápidos, mayor disponibilidad precoz y menor incremento de la glucosa postprandial. El objetivo principal del estudio fue analizar su eficacia en pacientes con DM1 tratados con un sistema integrado.Pacientes y métodos: Estudio analítico, longitudinal, prospectivo y multicéntrico, evaluando el empleo de faster aspart durante tres meses en pacientes en edad pediátrica con DM1 con sistema integrado MiniMed640G® tratados previamente con insulina aspart. Al inicio y final del estudio se analizaron para posterior comparación: glucosa media, porcentajes de tiempo en objetivo, tiempo en hipoglucemia e hiperglucemia, área bajo la curva (AUC) < 70 y > 180 mg/dL, glucosa media pre y postprandial en comidas principales, necesidades diarias de insulina, porcentaje basal/bolo y HbA1c. Se registraron complicaciones agudas y eventos adversos, y se evaluó grado de satisfacción mediante encuesta.Resultados: Se incluyeron 31 pacientes de 13,49 ± 2,42 años de edad con DM1 de 7,0 ± 3,67 años de evolución. Faster aspart se asoció con menor porcentaje de tiempo en hiperglucemia > 180 mg/dL (25,8 ± 11,3 vs. 22,4 ± 9,5; p = 0,011) y > 250 mg/dL (5,2 ± 4,9 vs. 4,0 ± 3,6; p = 0,04) y AUC > 180 mg/dL (10,8 ± 6,5 vs. 9,3 ± 6,1; p = 0,03), incrementándose el tiempo en objetivo (71,4 ± 10,0 vs. 74,3 ± 9,2; p = 0,03) sin aumentar hipoglucemias. Las necesidades de insulina, porcentajes basal/bolo y HbA1c no se modificaron significativamente. Faster aspart fue bien tolerada y valorada por los participantes.Conclusiones: Faster aspart consigue un mejor control glucémico, aumentando el tiempo de glucosa en objetivo en niños y adolescentes con DM1 en tratamiento con un sistema integrado. (AU)

Background and aims: Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new «faster aspart» insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of «faster aspart» vs. «insulin aspart» in children and adolescents with DM1 on sensor-augmented pump treatment.Patients and methods: Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) < 70 and > 180 mg/dL, mean sensor glucose pre and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed.Results: The study included 31 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia > 180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = 0.011) and > 250 mg/dL (5.2 ± 4.9 vs. 4.0 ± 3.6; p = 0.04), lower AUC > 180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = 0.03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = 0.03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers.Conclusions: Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps. (AU)

The impact of "faster aspart" on blood glucose control in children and adolescents with type 1 diabetes treated using a sensor-augmented insulin pump.

BACKGROUND AND AIMS: Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new "faster aspart" insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of "faster aspart" vs. "insulin aspart" in children and adolescents with DM1 on sensor-augmented pump treatment. PATIENTS AND METHODS: Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) <70 and >180 mg/dL, mean sensor glucose pre- and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed. RESULTS: The study included 32 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia >180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = .011) and >250 mg/dL (5.2±4.9 vs. 4.0 ± 3.6; p = .04), lower AUC >180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = .03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = .03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers. CONCLUSIONS: Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps.

Fractura osteocondral traumática de rodilla en edad pediátrica: reporte de un caso / Traumatic osteochondral knee fracture in pediatric age: report of a case / Fratura osteocondral traumática do joelho em idade pediátrica: relato de um caso

Las fracturas osteocondrales (FOC) traumáticas de rodilla en la edad pediátrica, son lesiones que acompañan hasta un 30% de las luxaciones agudas de rótula (LAR). Si no se mantiene una elevada sospecha clínica, es frecuente su retraso diagnóstico, pudiendo generar potenciales complicaciones. A propósito, presentamos el caso de una paciente de 12 años con una FOC post LAR que pasó inadvertida en la primera consulta, requiriendo la fijación del fragmento osteocondral con tornillos HCS a los 5 meses, logrando un excelente resultado funcional a los 54 meses de seguimiento.

Traumatic osteochondral fractures (OCF) of the knee in pediatric age are injuries that accompany up to 30% of acute patellar dislocations (APD). If high clinical suspicion is not maintained, its diagnostic delay is frequent, and may generate potential complications. Incidentally, we present the case of a 12-year-old patient with a post-APD OCF that went unnoticed in the first consultation, requiring fixation of the osteochondral fragment with HCS screws at 5 months. Achieving an excellent functional result at 54 months follow-up.

As fraturas osteocondrais traumáticas (FOC) do joelho em idade pediátrica são lesões que acompanham até 30% das luxações agudas da patela (LAP). Se uma alta suspeita clínica não for mantida, seu atraso no diagnóstico é frequente e pode gerar complicações potenciais. A propósito, apresentamos o caso de um paciente de 12 anos com FOC pós-LAP que passou despercebido na primeira consulta, exigindo fixação do fragmento osteocondral com parafusos HCS em 5 meses. Obtendo um excelente resultado funcional aos 54 de acompanhamento.

[Impact of COVID-19 lockdown on glucemic control in children and adolescents with type 1 diabetes mellitus]. / Repercusión del confinamiento por COVID-19 sobre el control glucémico en niños y adolescentes con diabetes mellitus tipo 1.

BACKGROUND AND AIMS: To face the rapid spread of SARS-CoV-2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). PATIENTS AND METHODS: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl), and hyperglycemia (>180 and>250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications, and lockdown of caregivers were assessed via a survey. RESULTS: 80 patients were studied (mean age 12.61±3.32 years, mean time of evolution of the disease 5.85±3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: GuardianTM 3 (65%), FreeStyle LibreTM (18.8%) and Dexcom G6TM (16.2%). Time in range in the cohort increased significantly during confinement (72.1±10.5 vs. 74.8±10.5%; P=.011) with lower time in hypoglycemia both<70mg/dl (4.6±3.2 vs. 3.2±2.7%; P<.001) and<54mg/dl (1.2±1.6 vs. 0.7±1.2%; p<0.001) and hyperglycemia >250mg/dl (4.6±3.9 vs. 3.7±3.7%; P=.038). CV also decreased (35.8±6.3 vs. 33.1±6.1%; P<.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers' confinement did not have a significant impact. CONCLUSIONS: Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control.

Epidemiologia del dengue en la edad pediátrica en Guantánamo / Epidemiology of pediatric dengue in Guantánamo

RESUMEN Introducción: El dengue en la edad pediátrica continúa siendo una de las causas frecuentes de morbilidad y mortalidad. Objetivo: Caracterizar la epidemia de dengue en la edad pediátrica en Guantánamo. Métodos: Estudio observacional descriptivo retrospectivo de corte transversal en un universo de 150 casos confirmados atendidos en el Policlínico Docente Emilio Daudinot Bueno durante el periodo entre enero de 2018-diciembre de 2019 y se contrastaron los resultados de estos años. Se evaluaron las variables: grupo de edad, sexo, tiempo de ingreso en horas, manifestaciones clínicas, signos y síntomas de alarma y meses del año. Los datos se obtuvieron de las historias clínicas epidemiológicas de cada uno de los casos. Resultados: El año 2019 tuvo el mayor número de casos confirmados (72,6 %), donde el sexo masculino (50,4 %) y el grupo de edad de 15 a 18 años (30,2 %) prevalecieron. En ambos años (2018 y 2019) el mayor porcentaje de los pacientes que ingresaron, lo hicieron durante las primeras 24 horas del inicio de los síntomas (73,1 y 47,7 % respectivamente). El síntoma predominante fue la fiebre (97,5 % y 92,0 %) durante los años señalados. La aparición de signos de alarma en pacientes al momento de su ingreso tuvo mayor frecuencia durante 2019 (81,5 %). Los meses de mayor número de casos confirmados durante el 2018 fueron los de septiembre, julio y octubre, que agrupó 69 %; en 2019 fueron los de diciembre, septiembre y octubre con el 60 %. Conclusiones: Los resultados obtenidos avalan la necesidad de continuar la vigilancia del dengue en la edad pediátrica y aportan conocimientos necesarios para su prevención.

ABSTRACT Introduction: Pediatric dengue continues to be a frequent cause of morbidity and mortality. Objective: Characterize the pediatric dengue epidemic in Guantánamo. Methods: An observational cross-sectional retrospective descriptive study was conducted of a universe of 150 confirmed cases attending Emilio Daudinot Bueno polyclinic from January 2018 to December 2019, contrasting the results obtained for those years. The variables considered were age group, sex, hospital stay in hours, clinical manifestations, warning signs and symptoms, and month of the year. Data were obtained from the epidemiological medical records of all the cases. Results: There was an increase in the number of confirmed cases in 2019 with respect to 2018. The most affected age groups were 5-9 years in 2018 (36.5 %) and 15-18 years in 2019 (30.2 %) in the male sex. Admission within 24 hours prevailed in both periods, with 73.1 % in 2018 and 47.7 % in 2019. Fever was the main clinical manifestation in both years, with 97.5 % and 92.0 %, respectively. The appearance of alarm signs in patients at the time of admission was more frequent during 2019 (81.5 %). The months with the highest number of confirmed cases during 2018 were September, July and October, which accounted for 69 %; in 2019 they were those of December, September and October with 60 %. Conclusions: The results obtained support the need to continue surveillance of dengue in children and provide the necessary knowledge for its prevention.

Cirugía videolaparoscópica pediátrica en la provincia de Matanzas / Pediatric videolaparoscopic surgery in the province of Matanzas

RESUMEN Las indicaciones de la cirugía de mínimo acceso en el niño han aumentado. Lo que ha traído consigo que aumente el espectro de las entidades resueltas por esta novedosa técnica. En marzo de 2017, se comenzaron a aplicar de manera sistemática estos procedimientos en el Hospital Docente Pediátrico "Eliseo Noel Caamaño", de Matanzas. Con este artículo se pretende describir los resultados de la cirugía mínimamente invasiva en Pediatría, durante su primer año en la mencionada provincia. Se realizó un estudio descriptivo prospectivo para presentar los resultados durante el primer año. Se operaron 77 pacientes. Predominó el sexo femenino, y el grupo etario de 15-19 años. Las intervenciones más realizadas fueron la apendicectomía, 50,6 % y la colecistectomía, 28 %. Se registró un 4 % de conversiones y un 4 % de complicaciones (AU).

ABSTRACT The indications of minimal access surgery in children have increased and the spectrum of the entities resolved with this new technique has enhanced. In March 2017, these procedures began to be used systematically at the Teaching Pediatric Hospital "Eliseo Noel Caamaño", of Matanzas. In this article, the authors pretend to describe the results of the minimally invasive surgery in Pediatrics during the first year in the before-mentioned province. A descriptive prospective study was conducted to present the achieved results. 77 patients underwent surgery. Female sex predominated and the age group of 15-19 years. The most common surgeries were appendectomy (50.6 %) and cholecistectomy (28 %). A 4 % of conversions and 4 % complications were recorded (AU).

Evaluación del método clínico en el diagnóstico de la cefalea oftalmológica en niños / Evaluation of the clinical method in the diagnosis of ophthalmic headache in children / Avaliação do método clínico no diagnóstico de cefaléia oftálmica em crianças

RESUMEN Introducción: la cefalea constituye uno de los motivos de consulta más comunes por el cual las personas acuden a los servicios médicos, es una causa importante de discapacidad, que trae consigo consecuencias a nivel personal. Objetivo: evaluar la utilización del método clínico, en el diagnóstico de la cefalea de causa oftalmológica en la edad pediátrica. Método: se realizó un estudio observacional, descriptivo de corte transversal, a 192 pacientes que asistieron a los servicios de Urgencias de Oftalmología, en el Hospital Pediátrico Hermanos Cordové, en el período comprendido entre enero y diciembre del 2019. Se estudiaron las variables: edad y sexo, enseñanza escolar, antecedentes patológicos personales, características de la cefalea y diagnóstico presuntivo. Resultados: predominó los pacientes entre 6 y 7 años de edad del sexo femenino, cursando la enseñanza primaria, sin antecedentes patológicos personales, con una cefalea de inicio subagudo, episódica, que afecta las actividades cotidianas, que aparece en cualquier momento del día, acompañada principalmente de alteraciones visuales y náuseas y vómitos, predominando como diagnóstico presuntivo la cefalea migrañosa. Conclusiones: se demostró que el mayor por ciento de los pacientes que acudieron por cefalea a los servicios de urgencias de oftalmología, esta, no estaba relacionada a trastornos oftalmológicos.

ABSTRACT Introduction: headache is one of the most common reasons for consultation for which people go to medical services, it is an important cause of disability, which brings with it consequences on a personal level. Objective: to evaluate the use of the clinical method in the diagnosis of headache of ophthalmic cause in pediatric age. Method: an observational, descriptive, cross-sectional study was carried out of 192 patients who attended the Ophthalmology Emergency Services at the Hermanos Cordové Pediatric Hospital, in the period between January and December 2019. The variables were studied: age and sex, school education, personal pathological history, headache characteristics and presumptive diagnosis. Results: there was a predominance of female patients between 6 and 7 years of age, attending primary school, without personal pathological history, with a headache of subacute onset, episodic, which affects daily activities, which appears at any time of the day, accompanied mainly of visual disturbances and nausea and vomiting, prevailing as a presumptive diagnosis migraine headache. Conclusions: It was shown that the highest percentage of patients who attended the ophthalmology emergency department for headache, this was not related to ophthalmological disorders.

RESUMO Introdução: a dor de cabeça é um dos motivos mais comuns de consulta para as quais as pessoas vão aos serviços médicos; é uma importante causa de incapacidade, o que traz conseqüências em nível pessoal. Objetivo: avaliar o uso do método clínico no diagnóstico de cefaleia de causa oftalmológica em idade pediátrica. Método: estudo observacional, descritivo, transversal, com 192 pacientes atendidos no Serviço de Emergência em Oftalmologia do Hospital Pediátrico Hermanos Cordové, no período de janeiro a dezembro de 2019. As variáveis ​​estudadas foram: idade e sexo, educação escolar, história patológica pessoal, características da dor de cabeça e diagnóstico presuntivo. Resultados: houve predomínio de pacientes do sexo feminino entre 6 e 7 anos de idade, frequentadoras do ensino fundamental, sem histórico patológico pessoal, com cefaléia de início subagudo, episódica, que afeta as atividades diárias, que aparecem a qualquer hora do dia, acompanhadas principalmente de distúrbios visuais e náuseas e vômitos, prevalecendo como diagnóstico presuntivo de enxaqueca. Conclusões: Foi demonstrado que o maior percentual de pacientes que compareceu ao pronto-socorro oftalmológico por cefaleia não estava relacionado a distúrbios oftalmológicos.