Endoscopic retrograde cholangiopancreatography and carbohydrate antigen 19-9 in the differential diagnosis of biliary strictures.

INTRODUCTION: bile-duct strictures include a wide spectrum of benign and malignant diseases. OBJECTIVE: to determine the usefulness of endoscopic retrograde cholangio-pancreatography (ERCP) and circulating carbohydrate antigen 19-9 (CA 19-9) for the differential diagnosis of biliary strictures. METHOD: an observational, prospective, cross-sectional study was performed in 75 patients with biliary stricture diagnosed by ERCP between October 2018 and January 2020. The variables included type of biliary stricture as diagnosed by ERCP, biliary cytology, and CA 19-9 levels. For the statistical analysis, descriptive statistics were used according to type of variable. The relationships between them was analyzed using Pearson's chi-square and Fisher's exact probability tests, assuming differences were significant when p < 0.05. The cut-off point for CA 19-9 was calculated using the ROC curve, and Cohen's kappa index was used to measure concordance between diagnostic methods. RESULTS: cytology was positive in 51 (68 %) patients with biliary stenosis. Mean age was 63 years. Acute cholangitis predominated in malignant strictures (93.7 %). There was agreement between cytology and the cut-off value calculated for CA 19-9 of 85.4 U/mL, with a kappa agreement index of 0.332 (p = 0.004), and between ERCP and cytology, with a kappa concordance index of 0.701 (p < 0.001). CONCLUSIONS: a serum CA 19-9 value higher than 85.4 U/mL is highly related to neoplastic biliary stenosis.

Effect of symbiotic fermented milk together with conventional therapy in the eradication treatment of Helicobacter pylori.

Helicobacter pylori (H. pylori) infection is associated with various gastrointestinal diseases and is the dominant microorganism in gastric microbiota. There are multiple therapeutic combinations used with uneven results for eradication. Studies have been carried out with some strains of Lactobacillus (L) that support its preponderant role in the treatment of infection and reduction of inflammation.

Real-world effectiveness of the heterologous SOBERANA-02 and SOBERANA-Plus vaccine scheme in 2-11 years-old children during the SARS-CoV-2 Omicron wave in Cuba: a longitudinal case-population study.

Background: Increased pediatric COVID-19 occurrence due to the SARS-CoV-2 Omicron variant has raised concerns about the effectiveness of existing vaccines. The protection provided by the SOBERANA-02-Plus vaccination scheme against this variant has not yet been studied. We aimed to evaluate the scheme's effectiveness against symptomatic Omicron infection and severe disease in children. Methods: In September 2021, Cuba implemented a mass pediatric immunization with the heterologous SOBERANA-02-Plus scheme: 2 doses of conjugated SOBERANA-02 followed by a heterologous SOBERANA-Plus dose. By December, before the Omicron outbreak, 95.4% of 2-18 years-old had been fully immunized. During the entire Omicron wave, we conducted a nationwide longitudinal post-vaccination case-population study to evaluate the real-world effectiveness of the SOBERANA-02-Plus scheme against symptomatic infection and severe disease in children without previous SARS-CoV-2 infection. The identification of COVID-19 cases relied on surveillance through first line services, which refer clinical suspects to pediatric hospitals where they are diagnosed based on a positive RT-PCR test. We defined the Incidence Rate ratio (IRR) as IRvaccinated age group/IRunvaccinated 1-year-old and calculated vaccine effectiveness as VE = (1-IRR)∗100%. 24 months of age being the 'eligible for vaccination' cut-off, we used a regression discontinuity approach to estimate effectiveness by contrasting incidence in all unvaccinated 1-year-old versus vaccinated 2-years-old. Estimates in the vaccinated 3-11 years-old are reported from a descriptive perspective. Findings: We included 1,098,817 fully vaccinated 2-11 years-old and 98,342 not vaccinated 1-year-old children. During the 24-week Omicron wave, there were 7003/26,241,176 person-weeks symptomatic COVID-19 infections in the vaccinated group (38.2 per 105 person-weeks in 2-years-old and 25.5 per 105 person-weeks in 3-11 years-old) against 3577/2,312,273 (154.7 per 105 person-weeks) in the unvaccinated group. The observed overall vaccine effectiveness against symptomatic infection was 75.3% (95% CI, 73.5-77.0%) in 2-years-old children, and 83.5% (95% CI, 82.8-84.2%) in 3-11 years-old. It was somewhat lower during Omicron BA.1 then during Omicron BA.2 variant circulation, which took place 1-3 and 4-6 months after the end of the vaccination campaign. The effectiveness against severe symptomatic disease was 100.0% (95% CI not estimated) and 94.6% (95% CI, 82.0-98.6%) in the respective age groups. No child death from COVID-19 was observed. Interpretation: Immunization of 2-11 years-old with the SOBERANA-02-Plus scheme provided strong protection against symptomatic and severe disease caused by the Omicron variant, which was sustained during the six months post-vaccination follow-up. Our results contrast with the observations in previous real-world vaccine effectiveness studies in children, which might be explained by the type of immunity a conjugated protein-based vaccine induces and the vaccination strategy used. Funding: National Fund for Science and Technology (FONCI-CITMA-Cuba).

Intranasal administration of proteoliposome-derived cochleates from Vibrio cholerae O1 induce mucosal and systemic immune responses in mice.

Conservative estimates place the death toll from cholera at more than 100,000 persons each year. A particulate mucosal vaccine strategy combining antigens and immune stimulator molecules from Vibrio cholerae to overcome this problem is described. Proteoliposomes extracted from V. cholerae O1 were transformed into cochleates (AFCo2, Adjuvant Finlay cochleate 2) through a calcium inducible rotary dialysis method. Light microscopy was carried out and tubules of 16.25+/-4.57 microm in length were observed. Western blots were performed to verify the immunochemical properties of the main AFCo2 incorporated antigens, revealing full recognition of the outer membrane protein U (OmpU), lipopolysaccharide (LPS), and mannose-sensitive hemagglutinin (MSHA) antigens. AFCo2 were administered by the intranasal route using a two or three dose schedule and the immune response against V. cholerae antigens was assessed. Three AFCo2 doses were required to induce significant (p<0.05), antigen specific IgA in saliva (1.34+/-0.135) and feces (0.60+/-0.089). While, two or three doses of AFCo2 or proteoliposomes induce similar specific IgG and vibriocidal activity responses in sera. These results show for the first time that AFCo2 can be obtained from V. cholerae O1 proteoliposomes and have the potential to protect against the pathogen when administered intranasally.

Two polymeric structures with a benzene-1,2,4,5-tetracarboxylate ligand acting in mu2- and mu4-bridging modes.

catena-Poly[[tetraaquabis(1H-pyrazole-kappaN(2))nickel(II)] [[diaquabis(1H-pyrazole-kappaN(2))nickel(II)]-mu-benzene-1,2,4,5-tetracarboxylato-kappa(2)O(1):O(4)] tetrahydrate], {[Ni(C(3)H(4)N(2))(2)(H(2)O)(4)][Ni(C(10)H(2)O(8))(C(3)H(4)N(2))(2)(H(2)O)(2)].4H(2)O}(n), (I), and poly[[(mu(4)-benzene-1,2,4,5-tetracarboxylato-kappa(4)O(1):O(2):O(4):O(5))octakis(1H-pyrazole-kappaN(2))dicobalt(II)] tetrahydrate], {[Co(2)(C(10)H(2)O(8))(C(3)H(4)N(2))(8)].4H(2)O}(n), (II), are polymeric compounds crystallizing in the space group P1, with two independent metallic cations and one benzene-1,2,4,5-tetracarboxylate (btc) anion, each lying on symmetry centres. Individual coordination polyhedra are regular and the main differences are in the way the btc anion binds [mu(2) in (I) and mu(4) in (II)], promoting a 'chain-like' one-dimensional structure in (I) and a 'sieve-like' two-dimensional motif in (II).

Two polymeric nickel(II) complexes with aromatic benzene-1,2,4,5-tetracarboxylate and pyridine-2,5-dicarboxylate linkers.

(Mu-benzene-1,2,4,5-tetracarboxylato-kappa(2)O(1):O(4))bis[aquabis(2,2-methylpropane-1,3-diamine-kappa(2)N,N')nickel(II)] methanol disolvate tetrahydrate, [Ni(2)(C(10)H(2)O(8))(C(5)H(14)N(2))(4)(H(2)O)(2)].2CH(4)O.4H(2)O, (I), is dinuclear, with elemental units built up around an inversion centre halving the benzene-1,2,4,5-tetracarboxylate (btc) anion, which bridges two symmetry-related Ni(II) cations. The octahedral Ni polyhedron is completed by two chelating 2,2-methylpropane-1,3-diamine (dmpda) groups and a terminal aqua ligand. Two methanol and four water solvent molecules are involved in a number of N-H...O and O-H...O hydrogen bonds which define a strongly bound two-dimensional supramolecular structure. The structure of catena-poly[[[bis(2,2-methylpropane-1,3-diamine-kappa(2)N,N')nickel(II)]-mu-pyridine-2,5-dicarboxylato-kappa(3)O(5):N,O(2)-[(2,2-methylpropane-1,3-diamine-kappa(2)N,N')nickel(II)]-mu-pyridine-2,5-dicarboxylato-kappa(3)N,O(2):O(5)] octahydrate], {[Ni(2)(C(7)H(3)NO(4))(2)(C(5)H(14)N(2))(3)].8H(2)O}(n), (II), is polymeric, forming twisted chains around three independent Ni centres, two of which lie on inversion centres and the third in a general position. There are three chelating dmpda ligands (one disordered over two equally populated positions), which are each attached to a different cation, and two pyridine-2,5-dicarboxylate (pdc) anions, both chelating the Ni centre in general positions through an -O-C-C-N- loop, while acting as bridges to the remaining two centrosymmetric Ni atoms. There are, in addition, eight noncoordinated water molecules in the structure, some of which are disordered.

Stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer: toxicity profile and early oncologic outcomes.

BACKGROUND: Multiple phase I-II clinical trials have reported on the efficacy and safety of prostate stereotactic body radiotherapy (SBRT) for the treatment of prostate cancer. However, few have reported outcomes for prostate SBRT using periprostatic hydrogel spacer (SpaceOAR; Augmenix). Herein, we report safety and efficacy outcomes from our institutional prostate SBRT experience with SpaceOAR placement. METHODS: Fifty men with low- or intermediate-risk prostate cancer treated at a single institution with linear accelerator-based SBRT to 3625 cGy in 5 fractions, with or without androgen deprivation therapy (ADT) were included. All patients underwent SpaceOAR and fiducial marker placement followed by pre-treatment MRI. Toxicity assessments were conducted at least weekly while on treatment, 1 month after treatment, and every follow-up visit thereafter. Post-treatment PSA measurements were obtained 4 months after SBRT, followed by every 3-6 months thereafter. Acute toxicity was documented per RTOG criteria. RESULTS: Median follow up time was 20 (range 4-44) months. Median PSA at time of diagnosis was 7.4 (2.7-19.5) ng/ml. Eighteen men received 6 months of ADT for unfavorable intermediate risk disease. No PSA failures were recorded. Median PSA was 0.9 ng/mL at 20 months; 0.08 and 1.32 ng/mL in men who did and did not receive ADT, respectively. Mean prostate-rectum separation achieved with SpaceOAR was 9.6 ± 4 mm at the prostate midgland. No grade ≥ 3 GU or GI toxicity was recorded. During treatment, 30% of men developed new grade 2 GU toxicity (urgency or dysuria). These symptoms were present in 30% of men at 1 month and in 12% of men at 1 year post-treatment. During treatment, GI toxicity was limited to grade 1 symptoms (16%), although 4% of men developed grade 2 symptoms during the first 4 weeks after SBRT. All GI symptoms were resolving by the 1 month post-treatment assessment and no acute or late rectal toxicity was reported > 1 month after treatment. CONCLUSIONS: Periprostatic hydrogel placement followed by prostate SBRT resulted in minimal GI toxicity, and favorable early oncologic outcomes. These results indicate that SBRT with periprostatic spacer is a well-tolerated, safe, and convenient treatment option for localized prostate cancer.

Guía de valoración pediátrica de urgencias en Cuba / Guide of pediatric emergency assessment in Cuba

La valoración pediátrica de urgencias tiene características especiales respecto al resto de la atención pediátrica. El diagnóstico final será una prioridad secundaria. Es una evaluación clínica, cuyo intento principal es la identificación de aspectos anatómicos y fisiológicos anormales, la estimación de la gravedad de la enfermedad o lesión y la determinación de la necesidad de tratamiento urgente. El objetivo de esta colaboración es brindar una sistemática clara, con una secuencia de valoraciones y acciones que sirvan de base para la toma de decisiones clínicas orientadas a la estabilización del paciente y a evitar situaciones que pueden amenazar la vida en poco tiempo. El triángulo de evaluación pediátrica, la secuencia ABCDE, una breve anamnesis y examen enfocado que identifique el motivo de consulta de mayor prioridad, signos de alarma que pueden cambiar la prioridad y las reevaluaciones frecuentes serán los pilares de la actuación médica. Con el propósito de respetar el derecho del niño al disfrute del más alto nivel posible de salud, de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos con entidades agudas o traumatismos, el grupo nacional de pediatría desarrolló y aprobó la guía de valoración pediátrica de urgencias en Cuba. Mediante la aplicación de esta guía se puede optimizar el proceso de valoración pediátrica de urgencias de forma que los pacientes de este segmento de edad reciban el nivel de cuidados médicos más apropiado para su situación clínica(AU)

The pediatric emergency assessment has special characteristics with respect to the rest of pediatric care. The final diagnosis will be a secondary priority. It is a clinical evaluation, and the main purpose of it is the identification of abnormal anatomical and physiological aspects, the estimation of the severity of the disease or injury and the determination of the need for urgent treatment. The objective of this collaboration is to provide a clear system, with a sequence of assessments and actions that serve as a basis for clinical decision-making aimed at stabilizing the patient and avoiding life-threatening situations in a short time. The pediatric assessment triangle, the ABCDE sequence, a brief history and focused examination that identifies the highest priority reason for consultation, warning signs that may change priority and frequent re-evaluations will be the pillars of medical action. To respect the right of the child to have access to the highest possible level of health, to guarantee the quality of care and its safety in the face of acute conditions or trauma, the National Group of Pediatrics developed and approved the guide for pediatric emergency assessment in Cuba. Through its application, the pediatric emergency evaluation process can be optimized so that patients of this age segment receive the most appropriate level of medical care for their clinical situation(AU)

Colangiopancreatografía retrógrada endoscópica y antígeno carbohidrato 19-9 en el diagnóstico diferencial de las estenosis biliares / Endoscopic retrograde cholangiopancreatography and carbohydrate antigen 19-9 in the differential diagnosis of biliary strictures

Introducción: las estenosis de vías biliares incluyen un amplio espectro de enfermedades benignas y malignas.Objetivo: determinar la utilidad de la colangiopancreatografía retrógrada endoscópica (CPRE) y del antígeno carbohidrato 19-9 (CA 19-9) en el diagnóstico diferencial de las estenosis biliares.Método: estudio observacional, prospectivo y transversal de 75 pacientes con estenosis biliar diagnosticada por CPRE entre octubre de 2018 y enero de 2020; las variables fueron: tipo de estenosis biliar por CPRE, citología biliar y CA 19-9. Para el análisis estadístico se utilizaron medidas descriptivas de resumen de acuerdo con el tipo de variable. La relación entre ellas se realizó mediante los test estadísticos del chi cuadrado de Pearson y la probabilidad exacta de Fisher, denotando las diferencias como significativas cuando p < 0,05. Se calculó el punto de corte del CA 19-9 mediante la curva ROC yel índice kappa de Cohen para medir la concordancia entre los métodos diagnósticos.Resultados: la citología fue positiva en 51 (68 %) pacientes con estenosis biliar. La edad media fue de 63 años. La colangitis aguda predominó en las estenosis malignas (93,7 %). Existió concordancia entre la citología y el valor de corte calculado para el CA 19-9 de 85,4 U/ml, con índice de concordancia kappa = 0,332 (p = 0,004), así como entre la CPRE y la citología, con índice de concordancia kappa = 0,701 (p < 0,001).Conclusiones: un valor sérico de CA 19-9 superior a 85,4 U/ml está altamente relacionado con la estenosis biliar neoplásica. (AU)

Leche fermentada simbiótica y triple terapia en el tratamiento de Helicobacter pylori

RESUMEN Introducción: Helicobacter pylori se relaciona con enfermedades benignas y malignas gastrointestinales. No se dispone de un esquema ideal para su erradicación, pero el uso de probióticos y prebióticos puede servir como terapia adyuvante. Objetivo: Describir las manifestaciones clínicas, endoscópicas, histopatológicas y la erradicación de la infección por Helicobacter pylori en los pacientes tratados con triple terapia y leche fermentada simbiótica. Métodos: Se realizó un estudio descriptivo, entre enero de 2017 y mayo de 2019, en 30 pacientes con Helicobacter pylori (diagnosticado mediante estudio histopatológico y prueba de ureasa). Las variables incluidas fueron: edad, sexo, manifestaciones clínicas, diagnóstico endoscópico e histopatológico y erradicación de la bacteria. Para el análisis de los resultados se emplearon estadísticas descriptivas (porcentaje y medidas de tendencia central). Resultados: Hubo 71 % de pacientes femeninos. La edad media fue de 48,6 ± 16,3 años (mínima 18 y máxima de 74 años). La dispepsia estuvo presente en 46,6 % pacientes. La gastritis eritematosa antral, antral eritematoerosiva y eritemato nodular se presentaron en 23,3 % cada una. La gastritis crónica atrófica moderada estuvo presente en el 40 % de los individuos. En 96,7 % enfermos se erradicó la bacteria. Conclusiones: La dispepsia y la gastritis crónica atrófica moderada representan el síntoma y el diagnóstico histopatológico más frecuente, respectivamente. La gastritis eritematosa antral, antral eritematoerosiva y eritematonodular constituyen los diagnósticos endoscópicos más comunes. La tasa de erradicación de H. pylori es elevada.

ABSTRACT Introduction: Helicobacter pylori infection has a wide worldwide distribution and is related to benign and malignant gastrointestinal diseases. Although there is no ideal scheme to eradicate the bacteria, the use of probiotics and prebiotics can serve as adjunctive therapy. Objective: To describe the clinical, endoscopic, histopathological manifestations and the eradication of Helicobacter pylori infection in patients treated with triple therapy and symbiotic fermented milk. Method: A descriptive, cross-sectional study was carried out from January 2017 to May 2019. 30 patients with Helicobacter pylori infection (diagnosed by histopathological study and urease test) were included. The variables included were: age, sex, clinical manifestations, endoscopic and histopathological diagnosis, and eradication of the bacteria. Descriptive statistics (percentage and measures of central tendency) were used to analyze the results. Results: There were 71 % female patients. The mean age was 48,6 ± 16,3 years; minimum age of 18 and maximum of 74 years. Dyspepsia was present in 46,6 % of patients and epigastric pain in 33,3 %. Erythematous antral, antral erythematous erythematonodular and erythematonodular gastritis occurred in 23,3% each. Moderate atrophic chronic gastritis was found in 40 % of individuals. Helicobacter pylori was eradicated in 96,7 % of patients. Conclusions: Female sex and the fourth decade of life predominated. Dyspepsia and moderate atrophic chronic gastritis are the most frequent symptom and histopathological diagnosis, respectively. Erythematous antral, antral erythematous, and erythematonodular gastritis represent the most common endoscopic diagnoses. The eradication rate of Helicobacter pylori was high.

Supervivencia postrasplante hepático en receptores con complicaciones biliares / Survival after liver transplantation in recipients with biliary complications

RESUMEN Introducción: Las complicaciones relacionadas con la anastomosis biliar son reconocidas como la primera causa de morbilidad postrasplante hepático y pueden repercutir de manera negativa en la supervivencia de los pacientes. Objetivo: Evaluar el comportamiento de la supervivencia a largo plazo en los pacientes con complicaciones biliares postrasplante. Métodos: Se realizó un estudio observacional, longitudinal y retrospectivo en 152 pacientes con trasplante hepático entre 1999 y 2019. Se excluyeron: pacientes con supervivencia menor de 72 horas, retrasplantes y pacientes con trombosis de la arteria hepática. Las variables estudiadas fueron edad y sexo de los receptores, causa pretrasplante, escala Model for End Stage Liver Desease, usada a nivel mundial para determinar el estado de la enfermedad hepática y asignar órganos a los candidatos a trasplante, técnica de anastomosis biliar, tipo de complicación biliar, tiempo de aparición y terapéutica empleada. Las variables categóricas se relacionaron mediante la prueba estadística chi cuadrado y prueba exacta de Fisher, con diferencias significativas cuando p< 0,05; en el estudio de las variables cuantitativas se aplicó la prueba t - Student y para el análisis de la supervivencia se utilizaron curvas de Kaplan-Meier. Resultados: Se relacionaron de forma significativa con la presencia de complicación biliar, una puntuación mayor de la escala de valores de Model for End Stage Liver Desease (p=0,008) y la técnica de anastomosis término-terminal (p=0,039). Predominaron las complicaciones biliares precoces y la estenosis anastomótica. El tratamiento por colangiopancreatografía retrógrada endoscópica fue el más empleado. Los pacientes con complicación biliar tuvieron una media de supervivencia de 10,9 años (IC del 95 % 8,75-13,19), mientras que los pacientes sin ésta, tuvieron una media de nueve años (IC del 95 % 7,03-10,98); no existió diferencia significativa (p=0,24). Conclusiones: Las complicaciones biliares constituyeron una causa importante de morbilidad postrasplante, pero sin afectar la supervivencia de los pacientes.

ABSTRACT Introduction: Complications related to biliary anastomosis are recognized as the first cause of post-liver transplantation morbidity and can negatively affect patient survival. Objective: To evaluate the behavior of long-term survival in patients with post-transplant biliary complications. Methods: An observational, longitudinal, and retrospective study was carried out in 152 patients with liver transplantation between 1999-2019, the following were excluded: patients with survival less than 72 hours, retransplants and patients with hepatic artery thrombosis. The variables studied were age and sex of the recipients, pre-transplant etiology, MELD index (Model for End Stage Liver Desease), biliary anastomosis technique, type of biliary complication, time of onset and treatment used. The categorical variables were related using the Chi square statistical test and Fisher's exact test, with significant differences when p <0.05; In the study of quantitative variables, the T-Student test was applied and Kaplan - Meier curves were used for survival analysis. Results: They were significantly related to the presence of biliary complication, a higher MELD index score (p = 0.008) and the end-to-end anastomosis technique (p = 0.039). Early biliary complications (66.7%) and anastomotic stenosis (58.7%) predominated. Treatment by endoscopic retrograde cholangiopancreatography (ERCP) was the most used (68.2%). Patients with biliary complications had a mean survival of 10.9 years (95% CI 8.75-13.19), while patients without it had a mean of 9 years (95% CI 7.03 -10.98); there was no significant difference (p = 0.24). Conclusions: Biliary complications were an important cause of post-transplant morbidity, but without affecting patient survival.

Hematoma de Morel-Lavallée en la rodilla. Reporte de un caso / Morel-Lavallée lesion of the knee. Case report

Una contusión tangencial sobre determinadas regiones del cuerpo puede provocar una colección subcutánea serosa límpida o translúcida que aparece súbita o lentamente, conocida como hematoma disecante de Morel-Lavallée. La localización en la cadera es muy frecuente, pero es infrecuente en la rodilla. A la lesión de Morel-Lavallée también se la llama seudoquiste, quiste postraumático de tejidos blandos o extravasación de Morel-Lavallée. Presentamos a un paciente de 49 años, con una lesión traumática y un hematoma seroso de Morel-Lavallée que se produce por la fricción entre el tejido celular subcutáneo y la fascia durante la lesión traumática. Dada su localización infrecuente, se decidió comunicar este caso, ya que se han publicado solo un par de pacientes con este cuadro. Nivel de Evidencia: IV

A tangential contusion on certain regions of the body can lead to a clear or translucent serous subcutaneous collection that appears suddenly or slowly, known as Morel-Lavallée dissecting hematoma. It is frequently located in the hip and infrequently in the knee. The Morel-Lavallée lesion can be called pseudocyst, soft tissue posttraumatic cyst, or Morel-Lavallée extravasation. We present the case of a 49-year-old patient with a serous Morel-Lavallée lesion, caused by friction between the subcutaneous cellular tissue and the fascia during a traumatic injury. Given its infrequent location, it was decided to report this case, since few cases of patients with this condition have been published in the literature. Level of Evidence: IV

Aspectos clínicos, epidemiológicos y cardiovasculares en niños convalecientes por COVID 19 en Villa Clara, Cuba / Clinical, epidemiological and cardiovascular aspects in children convalescents of COVID-19 in in Villa Clara province, Cuba

Introducción: La COVID-19, enfermedad causada por Coronavirus SARS-CoV 2, ha devenido en pandemia en 185 países. Cuba la ha enfrentado sin informar fallecidos en edad pediátrica Objetivo: Examinar aspectos clínicos, epidemiológicos y cardiovasculares en menores de 18 años en período de convalecencia por COVID 19. Métodos: estudio descriptivo transversal en 36 pacientes diagnosticados de marzo a mayo de 2020 en Villa Clara, Cuba y evaluados posterior al alta clínica y epidemiológica en consulta de cardiología del Hospital Universitario "José Luis Miranda". La muestra no probabilística, se conformó por los que asistieron a consulta. Se estudiaron variables: edad, sexo, peso, talla, antecedentes patológicos y epidemiológicos, período de hospitalización, examen físico, exámenes complementarios iniciales y en la convalecencia. Se utilizaron técnicas de estadística descriptiva. Resultados: Predominaron edades mayores de 10 años (60,0 por ciento), sexo femenino (55,5 por ciento), estado nutricional óptimo sin enfermedad crónica previa. En Santa Clara y Camajuaní se presentaron eventos de transmisión local con mayores tasas de incidencia. La mayoría de los niños se encontraban asintomáticos, detectados por historia epidemiológica de contactos, de confirmados y sospechosos (89,0 por ciento). Las alteraciones en fases iniciales de convalecencia fueron miocarditis y pericarditis (13,8 por ciento). Conclusiones: En este estudio se detectaron complicaciones cardiovasculares secundarias a infección viral por coronavirus SARS COV 2, con criterios epidemiológicos, clínicos, electrocardiográficos, radiológicos de tórax y ecocardiográficos(AU)

Introduction: COVID-19 is caused by SARS-CoV-2 coronavirus and it has become a pandemic in 185 countries. Cuba has faced this pandemic without having any deaths in the pediatric ages. Objective: Examine clinical, epidemiological and cardiovascular aspects in patients under 18 years' old who are convalescents of COVID-19. Methods: Descriptive cross-sectional study in 36 patients diagnosed with COVID-19 from March to May, 2020 in Villa Clara province, Cuba; whom were attended after the clinical and epidemiological discharge in the Cardiology consultation of "José Luis Miranda" University Hospital in July, 2020.The non-probabilistic sample was formed with the patients that went to the consultation. The variables studied were: age, sex, weight, size, personal and epidemiological pathologic background, period of hospitalization, physical exam, initial and during recovery's complementary tests. The results were expressed in absolute and relative values. Results: There was a predominance of patients older than 10 years (60.0 percent), female sex (55.5 percent), optimal nutritional state and no chronic diseases. Santa Clara and Camajuaní presented events of local transmission and showed higher incidence rates. Most of the patients there were asymptomatic, and were detected mainly due to the epidemiological record of confirmed and suspicious cases (89.0 percent). Complications in the initial phases of convalescents were myocarditis and pericarditis (13.8 percent). Conclusions: There were detected cardiovascular complications as a consequence of the viral infection by SARS-CoV-2 coronavirus, with epidemiological, clinical, electrocardiographic, thorax radiology and echocardiographic criteria(AU)

Síndrome inflamatorio multisistémico en niños asociado a COVID-19 / Multisystem inflammatory syndrome related to COVID-19 in children

Las manifestaciones clínicas de la infección por SARS-CoV-2 son menos frecuentes y graves en niños que en adultos; sin embargo, recientes publicaciones sugieren la posibilidad de un cuadro clínico severo secundario a la infección por este coronavirus en pacientes pediátricos, denominado síndrome inflamatorio multisistémico. El objetivo de este trabajo es examinar los aspectos relacionados con la epidemiologia, patogenia, presentación clínica, diagnóstico y tratamiento del síndrome inflamatorio multisistémico en niños. Este síndrome tiene un carácter posinfeccioso y su fisiopatología probablemente resulte de una activación anormalmente organizada del sistema inmune, en un contexto genético de predisposición y activada por la peculiar biología del SARS-CoV-2. Las características clínicas de los pacientes afectados incluyen fiebre mantenida, con afectación de múltiples órganos y sistemas y resultados positivos de marcadores inflamatorios, además de cumplir con los criterios de infección reciente o concurrente por SARS-CoV-2. Para el tratamiento, además de las medidas de apoyo vital y el uso de antibióticos en la etapa inicial, se recomienda el empleo de terapias específicas inmunomoduladoras, como la inmunoglobulina intravenosa y los esteroides, así como el ácido acetilsalicílico. El correcto abordaje de esta entidad requiere mantener un alto nivel de alerta, con una definición clara de los casos sospechosos, la participación multidisciplinaria y la implementación de una estrategia terapéutica inmediata(AU)

The clinical manifestations of the infection by SARS-CoV-2 are less frequent and severe in children than in adults; however, recent publications suggest the possibility of a severe clinical picture called multisystem inflammatory syndrome which is caused by the infection with coronavirus in pediatric patients. The objective of this work is to examine the aspects related to the epidemiology, pathogenesis, clinical presentation, diagnosis and treatment of the multisystem inflammatory syndrome in children. This syndrome has a post-infection nature and its physiopathology is probably the result of an abnormally organized activation of the immune system, in a genetic context of predisposition and activated by the peculiar biology of the SARs-CoV-2.The clinical characteristic of the affected patients include constant fever, affectation of multiple organs and systems, and positive results of inflammatory markers, and in addition meeting the criteria of recent or concurrent infection by SARS-CoV-2. For the treatment, apart from the measures of vital support and the use of antibiotics in the initial stage, it is recommended the use of specific immunomudolatory therapies, as intravenous immunoglobulin and steroids; as well as acetylsalicylic acid. The right approach to this entity requires maintaining a high level of alerts, with a clear definition of the suspected cases, the multidisciplinary participation and the implementation of an immediate therapeutic strategy(AU)

Anemia microangiopática y síndrome inflamatorio multisistémico asociado con COVID-19 en paciente pediátrico cubano / Microangiopathic anemia and multisystem inflammatory syndrome associated to COVID-19 in a Cuban pediatric patient

Introducción: Las manifestaciones clínicas de la infección por SARS-CoV-2 son menos frecuentes y graves en el niño que en el adulto, sin embargo, recientes publicaciones sugieren la posibilidad de un cuadro clínico severo secundario a la infección por este coronavirus, denominado síndrome inflamatorio multisistémico en el niño. Este síndrome tiene un carácter posinfeccioso y su fisiopatología probablemente resulte de una activación anormalmente organizada del sistema inmune, en un contexto genético de predisposición y activada por la peculiar biología del SARS-CoV-2. Objetivo: Describir el primer caso cubano con criterios de síndrome multisistémico asociado a COVID 19. Presentación del caso: Paciente masculino de 2 años de edad, previamente sano, con evidencias clínicas y de laboratorio de anemia microangiopática, hiperinflamación sistémica y disfunción múltiple de órganos y sistemas, asociado con evidencias serológicas de infección previa por SARS-CoV-2. Conclusiones: El correcto abordaje de casos como el notificado en este trabajo, requiere mantener un alto nivel de alerta clínica, con una definición clara de los casos sospechosos, la participación multidisciplinaria y la instauración temprana de una estrategia terapéutica adecuada que resultaría trascendental en la reducción de la extensión del daño de órganos y sistemas, así como incrementar la posibilidad de revertir la disfunción establecida(AU)

Introduction: Clinical manifestations of the infection by SARS-CoV-2 are less frequent and severe in children than in adults; however, recent publications suggest the possibility of a severe clinical scenario secondary to the infection by this coronavirus called multisystem inflammatory syndrome in children (MIS-C). This syndrome has a post-infection nature and its physiopathology is probably the result of an abnormally organized activation of the immune system in a genetic context of predispostion, and actived by the particular biology of SARS-CoV-2. Objective: To describe the first Cuban case with criterion of multisystemic syndrome associated to COVID-19. Case presentation: 2 years old male patient, previously healthy, with clinical and laboratory evidences of microangiopathic anemia, systemic hyperinflammation and organs and systems´ multiple dysfunction, associated with serologic evidences of previous infection by SARS-CoV-2. Conclusions: The proper approach to cases as the above mentioned in this work requires to keep a high level of clinical alert, with a clear definition of suspicious cases, multidisciplinary participation and the early establishment of and adequate therapeutic strategy that will be significant in the reduction of systems and organs damage´s extension; as well as increasing the chance to improve the dysfunction(AU)

Caracterización clínico epidemiológica de 183 niños cubanos con infección por SARS-CoV-2 / Clinical-epidemiologic characterization of 183 Cuban children with infection by SARS-CoV-2

Introducción: La epidemiologia y los patrones clínicos de la COVID-19 aún no están bien esclarecidos, particularmente en la edad pediátrica. Objetivo: Caracterizar clínica y epidemiológicamente 183 casos pediátricos infectados por SARS-CoV-2 en Cuba. Métodos: Estudio descriptivo, trasversal realizado en el periodo comprendido entre 11 de marzo y 29 de abril del 2020 en Cuba. Resultados: Se diagnosticaron 1619 pacientes, 183 casos (11,30 por ciento) fueron niños, porcentaje mayor de pacientes pediátricos infectados por SARS-CoV-2 en Cuba que en la mayoría de las informaciones internacionales. Los mayores de 5 años constituyeron el grupo de edad más afectado, el promedio de edad fue de 10,36 años, 54 por ciento del sexo masculino, 46 por ciento del femenino; 59 por ciento asintomáticos. La fuente de infección quedó definida en 98,36 por ciento de los casos. Los síntomas clínicos predominantes fueron la fiebre y la tos, 24,59 y 17,49 por ciento, respectivamente. Presentaron alteraciones radiológicas 8,7 por ciento de los casos y se registraron complicaciones en 0,5 por ciento. No hubo fallecido. La excreción viral no se detectó en 96,18 por ciento de los casos a los 14 días del diagnóstico. Conclusiones: La sintomatología clínica de los pacientes infectados por SARS-CoV-2 no difiere de las infecciones respiratorias virales comunes, con predominio de fiebre y tos; la excreción viral en las secreciones respiratorias se aclaró en menos de 14 días en más de 90 por ciento de los pacientes. La posibilidad de manifestaciones neurológicas, aunque infrecuente, constituye una complicación de elevada severidad en el curso de la COVID-19. No se registran fallecidos(AU)

Introduction: Epidemiology and clinical patterns of COVID-19 are not yet distinguished, particularly in pediatric ages. Objective: To characterize 183 pediatric cases infected by SARS-CoV-2 in Cuba clinically and epidemiologically. Methods: Descriptive, cross-sectional study carried out in the period from 11 March to 29 April, 2020 in Cuba. Results: 1619 patients were diagnosed, 183 cases (11.30 percent) were children, a higher percentage of pediatric patients infected by SAR-CoV-2 in Cuba that in most of the international reports. Children over 5 years were the most affected age group, the average age was 10.36 years, 54 percent were males, 46 percent were females, and 59 percent were asymptomatic. The source of infection was determined in 98.36 percent of the cases. Predominant clinical symptoms were fever (24.59 percent) and cough (17.49 percent). 8.7 percent of the cases presented radiologic changes, and complications were recorded in 0.5 percent. There were no deceased patients. Viral excretion was not detected in 96.18 percent of the cases after 14 days of being diagnosed. Conclusions: Clinical symptomatology of the patients infected is not different from the common viral respiratory infections, prevailing fever and cough; viral excretion in respiratory secretions was cleared in less than 14 days in more than 90 percent of the patients. The possibility of presenting neurologic manifestations, although infrequent, is a complication of high seriousness in the evolution of COVID-19. There are no records of deceased patients(AU)

Síndrome de dificultad respiratoria aguda en niños: duración de la ventilación y supervivencia / Acute respiratory distress syndrome in children: duration of ventilation and survival

Introducción: El síndrome de dificultad respiratoria aguda es una enfermedad que cursa con hipoxemia severa, poco frecuente en las unidades de cuidados intensivos pediátricos, pero con elevada mortalidad. Objetivo: Determinar la relación entre variables demográficas y clínicas con la duración de la ventilación mecánica y la supervivencia en niños con síndrome de dificultad respiratoria aguda. Métodos: Estudio retrospectivo de los pacientes ingresados en 15 unidades de cuidados intensivos pediátricos, con diagnóstico de síndrome de dificultad respiratoria aguda. Se evaluaron variables demográficas, las formas clínicas del síndrome de dificultad respiratoria aguda, duración de la ventilación mecánica y la supervivencia. Las variables cualitativas se expresaron en valores absolutos y porcentajes, las variables cuantitativas se analizaron con la prueba ji-cuadrada de Pearson y comparación de medias. Resultados: Se registraron 282 pacientes, de ellos 63,7 por ciento menores de seis años, el 54,4 por ciento del sexo masculino y el 51,1 por ciento de piel blanca. Las formas clínicas pulmonares prevalecieron (58,1 por ciento) y se correlacionaron (p= 0,022) con la supervivencia, la mediana de la duración de la ventilación mecánica fue de 10 días. Existió relación (p= 0,000) entre la duración de la ventilación y la mortalidad. Se registró una mortalidad global de 40,78 por ciento, (n= 115). Conclusiones: El síndrome de dificultad respiratoria aguda tiene mayor incidencia en los menores de seis años y en las formas clínicas pulmonares que se relacionan con una mayor supervivencia, la cual se eleva en la medida que aumentan los días de ventilación mecánica(AU)

ABSTRACT Introduction: The acute respiratory distress syndrome is a disease that evolves with severe hypoxemia, and it is not frequent in pediatric intensive care units, but it has high mortality rates. Objective: To determine the relation between demographic and clinical variables with the mechanical ventilation and survival in children with acute respiratory distress syndrome. Methods: Retrospective study in patients admitted in 15 pediatric intensive care units with diagnosis of acute respiratory distress syndrome. There was an assessment of the demographic variables, the clinical forms of this syndrome, the duration of mechanical ventilation and the survival rates. Qualitative variables were presented in absolute values and percentages, and were analyzed with the Pearson´s ji-square test and means comparison. Results: 282 patients were recorded, 63.7 percent of them were under 6 years old, 54.4 percent were males and 51.1 percent were white. Pulmonary clinical forms prevailed (58,1 percent) and were correlated (p= 0,022) with the survival rates, and the mean of mechanical ventilation´s duration was of 10 days. There was relation (p= 0,000) between the duration of ventilation and mortality. It was recorded a total mortality of 40.78 percent (n= 115). Conclusions: Acute respiratory distress syndrome has higher incidence in children under 6 years and in the pulmonary clinical forms that are related with a higher survival, which increases in the same way that mechanical ventilation´s amount of days do(AU)

Valor del ultrasonido endoscópico en el diagnóstico de las lesiones subepiteliales del tracto gastrointestinal / Value of endoscopic ultrasound in diagnosis of subepithelial lesions of the gastrointestinal tract

Introducción: El ultrasonido endoscópico (USE) es el método de mayor valor y el que con más frecuencia se emplea en la evaluación de las lesiones subepiteliales del tracto digestivo, como lo han demostrado grandes estudios multicéntricos. Objetivo: Describir la experiencia con el uso del ultrasonido endoscópico en el diagnóstico de las lesiones subepiteliales del tracto gastrointestinal. Método: Se realizó un estudio descriptivo longitudinal prospectivo desde mayo 2016 hasta enero 2018 en el Centro de Investigaciones Médico Quirúrgicas (CIMEQ) de La Habana, Cuba. La muestra quedó conformada por un total de 26 pacientes en los que predominó el sexo femenino con edades comprendidas entre 43 y 80 años. Resultados: La dispepsia fue el síntoma más reportado, así como los tumores del estroma gastrointestinal, seguido de los lipomas el diagnóstico más frecuente. En la mayoría de los pacientes se decidió una conducta quirúrgica. Conclusiones: El ultrasonido endoscópico es un método seguro, de mínima invasión y nos permite decidir la conducta a seguir en la mayoría de los pacientes con lesiones subepiteliales(AU)

Introduction: Endoscopic ultrasonography is the method of highest value and the most frequently used in the evaluation of subepithelial lesions of the digestive tract, as it has been shown in large multicenter studies. Objective: To describe the experience gained in the use of endoscopic ultrasonography for the diagnosis of subepithelial lesions of the gastrointestinal tract. Method: A prospective, longitudinal and descriptive study was conducted in the Center of Medical and Surgical Research of Havana from May 2016 to January 2018. The final sample was made up of 26 patients, mainly women, aged 43 to 80 years. Results: Dyspepsia was the most reported symptom as well as the most frequent diagnosis was gastrointestinal stroma tumors followed by lipomas. Surgical treatment was decided to be applied in most of these patients. Conclusions: The endoscopic ultrasonography is a safe, minimally invasive method that allows making decisions on the behavior to be followed in the treatment of most of the patients with subepithelial lesions(AU)

Valor del ultrasonido endoscópico en el diagnóstico de las lesiones subepiteliales del tracto gastrointestinal / Value of endoscopic ultrasound in diagnosis of subepithelial lesions of the gastrointestinal tract

Introducción: El ultrasonido endoscópico (USE) es el método de mayor valor y el que con más frecuencia se emplea en la evaluación de las lesiones subepiteliales del tracto digestivo, como lo han demostrado grandes estudios multicéntricos. Objetivo: Describir la experiencia con el uso del ultrasonido endoscópico en el diagnóstico de las lesiones subepiteliales del tracto gastrointestinal. Método: Se realizó un estudio descriptivo longitudinal prospectivo desde mayo 2016 hasta enero 2018 en el Centro de Investigaciones Médico Quirúrgicas (CIMEQ) de La Habana, Cuba. La muestra quedó conformada por un total de 26 pacientes en los que predominó el sexo femenino con edades comprendidas entre 43 y 80 años. Resultados: La dispepsia fue el síntoma más reportado, así como los tumores del estroma gastrointestinal, seguido de los lipomas el diagnóstico más frecuente. En la mayoría de los pacientes se decidió una conducta quirúrgica. Conclusiones: El ultrasonido endoscópico es un método seguro, de mínima invasión y nos permite decidir la conducta a seguir en la mayoría de los pacientes con lesiones subepiteliales(AU)

Introduction: Endoscopic ultrasonography is the method of highest value and the most frequently used in the evaluation of subepithelial lesions of the digestive tract, as it has been shown in large multicenter studies. Objective: To describe the experience gained in the use of endoscopic ultrasonography for the diagnosis of subepithelial lesions of the gastrointestinal tract. Method: A prospective, longitudinal and descriptive study was conducted in the Center of Medical and Surgical Research of Havana from May 2016 to January 2018. The final sample was made up of 26 patients, mainly women, aged 43 to 80 years. Results: Dyspepsia was the most reported symptom as well as the most frequent diagnosis was gastrointestinal stroma tumors followed by lipomas. Surgical treatment was decided to be applied in most of these patients. Conclusions: The endoscopic ultrasonography is a safe, minimally invasive method that allows making decisions on the behavior to be followed in the treatment of most of the patients with subepithelial lesions(AU)

Guía para la enseñanza del apoyo vital pediátrico y neonatal. Consenso para el proyecto de formación e investigación en apoyo vital. Cienfuegos, 2018 / Guideline for pediatric and neonatal life support. Consensus for the project of training and research in life support. Cienfuegos, 2018

Fundamento: La parada cardiorespiratoria en el niño es considerada un problema de salud. El determinante más importante para la supervivencia es la presencia del individuo entrenado para efectuar las maniobras de reanimación cardiopulmocerebral. En el marco del proyecto Formación e investigación en apoyo vital en emergencias y desastres, la actualización de las guías para la enseñanza del apoyo vital pediátrico y neonatal puede contribuir al éxito de la resucitación y sobrevida con calidad.Objetivo: actualizar las guías y estrategia docente para la enseñanza del apoyo vital pediátrico y neonatal.Métodos: se realizó un taller nacional con diez expertos y tres informantes clave, los días 10 y 11 de julio del 2018 en Cienfuegos. Se utilizaron las técnicas de tormenta de ideas y grupo nominal, y se aplicó un cuestionario semiestructurado con revisión documental previa.Desarrollo: se conciliaron los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance y habilidades a desarrollar para la enseñanza del apoyo vital pediátrico y neonatal. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución.Conclusión: las propuestas académicas para el curso Apoyo vital avanzado pediátrico y neonatal permiten el abordaje de la enseñanza en la atención del paciente pediátrico en situaciones de emergencia por el personal médico de asistencia.

Foundation: cardio-respiratory failure in the child is considered a Health problem. The most important determinant for survival is the presence of a trained individual to performer cardio-pulmonary-cerebral resuscitation. In the framework of the project Training and research for life support in Emergencies and disasters, updating guidelines for teaching pediatric and neonatal life support may contribute to resuscitation success and quality survival.Objective: to update the guidelines and strategies for teaching pediatric and neonatal life support.Method: a National Workshop with ten experts and three key informers, during the 10th and 11th of July 2018 in Cienfuegos. Brain storming and nominal group were used as techniques and it was applied a semi-structured questionnaire with previous documentary review.Development: objectives, didactic aspects, teaching strategy, contents, scope, and skills to develop for teaching pediatric and neonatal life support. It was defined the structure a model course for teaching the topic and the main considerations for its execution.Conclusion: academic proposals for the course Advanced pediatric and neonatal life support allow approaching the pediatric patient in emergency situations by the assisting medical personnel.