Comparison of Epidemiologic and Clinical COVID-19 Profiles in Children in Argentina, During Circulation of Original and Variant (Alpha, Gamma and Lambda) Strains.

BACKGROUND: Information on the impact of the different variants in children in Latin America is scarce. The objective of this study was to describe epidemiologic and clinical features of COVID-19 infection in children under 18 years of age in Argentina, comparing the periods before and after the circulation of new variants. METHODS: Observational, cross-sectional, multicentric, analytical study. All patients under 18 years of age with confirmed SARS-CoV-2 infection admitted at 22 healthcare centers were included. Two study periods were established: Period 1 (EW10-2020 to EW12-2021) for the Wuhan strain; Period 2 (EW13 to EW35 2021) for Alpha, Gamma, Delta and Lambda variants. FINDINGS: A total of 6330 confirmed cases were included. Period 1: 3575 (56.5%), period 2: 2755 (43.5%). During period 2, a lower number of asymptomatic cases was observed, while general, respiratory and neurologic signs and symptoms increased in all age groups. Oxygen therapy requirement was higher during the first period (36.7% vs 19.1%; P < 0.001). No significant differences were observed in the rates of severe or critical cases (6.3% vs 5,4%; P = 0.102), intensive care admission (2.1% vs 2%; P < 0.656) or case fatality (0.3% vs 0.5 %; P < 0.229). MIS-C cases occurred more frequently during the first period (1.9% vs 1.1%; P = 0.009). INTERPRETATION: The clinical spectrum of COVID-19 in Argentina has evolved. With the emergence of new variants, although the number of asymptomatic cases declined, numbers of severe and critical cases, as well as case fatality rates in children, remained unchanged.

A multicenter study of confirmed COVID-19 cases: preliminary data on 2690 pediatric patients in Argentina during the first year of the pandemic. / Estudio multicéntrico de casos confirmados de COVID-19: datos preliminares de 2690 pacientes pediátricos en Argentina durante el primer año de la pandemia.

INTRODUCTION: The current evidence indicates that the severity of the coronavirus disease 2019 (COVID-19) is lower in the pediatric population but local data are still limited. Objective: To characterize the clinical and epidemiological aspects of COVID-19 infection in patients younger than 18 years in Argentina. POPULATION AND METHODS: Cross-sectional, observational, and analytical study of confirmed COVID-19 patients aged 0-18 years seen between March 2020 and March 2021 at 19 referral children's hospitals of Argentina. A multivariate analysis was done to identify predictors of severe cases. RESULTS: A total of 2690 COVID-19 cases were included: 77.7% lived in the Metropolitan Area of Buenos Aires; 50.1% were males; patients' median age was 5.6 years. Of them, 90% were seen during epidemiological weeks 20-47 of 2020; 60.4% had a history of contact with COVID-19 patients; and 96.6% in their family setting. Also, 51.4% had respiratory symptoms; 61.6%, general symptoms; 18.8%, gastrointestinal symptoms; 17.1%, neurological symptoms; 7.2%, other symptoms; and 21.5% were asymptomatic. In addition, 59.4% of patients were hospitalized and 7.4% had a severe or critical course. A total of 57 patients developed multisystem inflammatory syndrome. A history of asthma, bronchopulmonary dysplasia, congenital heart disease, moderate to severe malnutrition, obesity, chronic neurological disease and/or age younger than 6 months were independent predictors of severity. Living in a vulnerable neighborhood was a protective factor. CONCLUSIONS: More than half of cases referred a history of contact with COVID-19 patients in the family setting. Hospitalization was not based on clinical criteria of severity. Severity was associated with the presence of certain comorbidities.

Introducción. La evidencia actual indica que la gravedad de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) es menor en la población pediátrica, los datos locales aún son limitados. OBJETIVO: caracterizar los aspectos clínicos y epidemiológicos de la infección por COVID-19 en menores de 18 años en Argentina. Población y métodos. Estudio transversal, observacional y analítico de casos confirmados de COVID-19 entre 0 y 18 años asistidos entre marzo de 2020 y marzo de 2021 en 19 centros pediátricos de referencia de Argentina. Se realizó un análisis multivariado para identificar las variables predictoras de cuadros graves. RESULTADOS: Se incluyeron 2690 casos de COVID-19: 77,7 % residentes del área metropolitana de Buenos Aires, 50,1 % de sexo masculino, mediana de edad de 5,6 años. El 90 % ocurrió entre las semanas epidemiológicas 2047 del 2020; 60,4 % con antecedente de contacto con personas con COVID-19; y 96,6 % en el entorno familiar. El 51,4 % presentó síntomas respiratorios; 61,6 % síntomas generales; 18,8 % síntomas gastrointestinales; 17,1 % síntomas neurológicos; 7,2 % otros y 21,5 % fueron asintomáticos. El 59,4 % fue hospitalizado; 7,4 % fueron graves o críticos. Se registraron 57 casos de síndrome inflamatorio multisistémico. El antecedente de asma, displasia broncopulmonar, cardiopatía congénita, desnutrición moderada a grave, obesidad, enfermedad neurológica crónica y/o edad menor de 6 meses resultaron predictores independientes de gravedad. Residir en barrios vulnerables resultó protector. CONCLUSIONES: Más de la mitad de los casos refirieron antecedente de contacto con personas con COVID-19 en el entorno familiar. La hospitalización no respondió a criterios clínicos de gravedad. La gravedad se encuentra asociada a la existencia de ciertas comorbilidades.

Estudio multicéntrico de casos confirmados de COVID-19: datos preliminares de 2690 pacientes pediátricos en Argentina durante el primer año de la pandemia / A multicenter study of confirmed COVID-19 cases: preliminary data on 2690 pediatric patients in Argentina during the first year of the pandemic

Introducción. La evidencia actual indica que la gravedad de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) es menor en la población pediátrica, los datos locales aún son limitados. Objetivo: caracterizar los aspectos clínicos y epidemiológicos de la infección por COVID-19 en menores de 18 años en Argentina. Población y métodos. Estudio transversal, observacional y analítico de casos confirmados de COVID-19 entre 0 y 18 años asistidos entre marzo de 2020 y marzo de 2021 en 19 centros pediátricos de referencia de Argentina. Se realizó un análisis multivariado para identificar las variables predictoras de cuadros graves. Resultados. Se incluyeron 2690 casos de COVID-19: 77,7 % residentes del área metropolitana de Buenos Aires, 50,1 % de sexo masculino, mediana de edad de 5,6 años. El 90 % ocurrió entre las semanas epidemiológicas 20-47 del 2020; 60,4 % con antecedente de contacto con personas con COVID-19; y 96,6 % en el entorno familiar. El 51,4 % presentó síntomas respiratorios; 61,6 % síntomas generales; 18,8 % síntomas gastrointestinales; 17,1 % síntomas neurológicos; 7,2 % otros y 21,5 % fueron asintomáticos. El 59,4 % fue hospitalizado; 7,4 fueron graves o críticos. Se registraron 57 casos de síndrome inflamatorio multisistémico. El antecedente de asma, displasia broncopulmonar, cardiopatía congénita, desnutrición moderada a grave, obesidad, enfermedad neurológica crónica y/o edad menor de 6 meses resultaron predictores independientes de gravedad. Residir en barrios vulnerables resultó protector. Conclusiones. Más de la mitad de los casos refirieron antecedente de contacto con personas con COVID-19 en el entorno familiar. La hospitalización no respondió a criterios clínicos de gravedad. La gravedad se encuentra asociada a la existencia de ciertas comorbilidades.

Introduction. The current evidence indicates that the severity of the coronavirus disease 2019 (COVID-19) is lower in the pediatric population but local data are still limited. Objective: To characterize the clinical and epidemiological aspects of COVID-19 infection in patients younger than 18 years in Argentina. Population and methods. Cross-sectional, observational, and analytical study of confirmed COVID-19 patients aged 0-18 years seen between March 2020 and March 2021 at 19 referral children's hospitals of Argentina. A multivariate analysis was done to identify predictors of severe cases. Results. A total of 2690 COVID-19 cases were included: 77.7% lived in the Metropolitan Area of Buenos Aires; 50.1% were males; patients' median age was 5.6 years. Of them, 90% were seen during epidemiological weeks 20-47 of 2020; 60.4% had a history of contact with COVID-19 patients; and 96.6% in their family setting. Also, 51.4% had respiratory symptoms; 61.6%, general symptoms; 18.8%, gastrointestinal symptoms; 17.1%, neurological symptoms; 7.2%, other symptoms; and 21.5% were asymptomatic. In addition, 59.4% of patients were hospitalized and 7.4% had a severe or critical course. A total of 57 patients developed multisystem inflammatory syndrome. A history of asthma, bronchopulmonary dysplasia, congenital heart disease, moderate to severe malnutrition, obesity, chronic neurological disease and/or age younger than 6 months were independent predictors of severity.Livinginavulnerableneighborhoodwas a protective factor. Conclusions. More than half of cases referred a history of contact with COVID-19 patients in the family setting. Hospitalization was not based on clinical criteria of severity. Severity was associated with the presence of certain comorbidities

Fungemia and interstitial lung compromise caused by Malassezia sympodialis in a pediatric patient.

A case of fungemia with interstitial lung compromise caused by Malassezia sympodialis is reported in an obese pediatric patient on long-term treatment with inhaled corticosteroids for asthma. The patient was hospitalized due to a post-surgical complication of appendicitis. The patient was treated with amphotericin B for 3 weeks, with good clinical evolution and subsequent negative cultures.

Características clínico-epidemiológicas y predictores de complicaciones coronarias en niños de Argentina con enfermedad de Kawasaki / Clinical- epidemiological characteristics and predictors of coronary complications in children of Argentina with Kawasaki disease

Resumen Introducción: La enfermedad de Kawasaki (EK) es una vasculitis sistémica aguda con riesgo de desarrollar aneurismas coronarios. Objetivos: Describir características clínico-epidemiológicas en niños con diagnóstico de EK en Argentina. Analizar factores de riesgo para el desarrollo de complicaciones coronarias (CC). Población y Métodos: Estudio multicéntrico, retrospectivo, transversal, observacional y analítico. Incluyó pacientes bajo 18 años de edad, con diagnóstico de EK en hospitales de Argentina, entre el 1 de enero de 2010 y el 31 de diciembre de 2013. Resultados: N = 193 sujetos. Edad: mediana: 29 meses. Tasa promedio total país 5 casos/10.000 egresos hospitalarios. Presentaron CC 15,5%. Mayor riesgo de CC: Mayor cantidad de días de fiebre al momento de colocación del tratamiento (p = 0,0033); Aumento de: frecuencia cardíaca (p = 0,0021), eritrosedimentación (VSG) (p = 0,005), proteína C reactiva (PCR) (p < 0,0001), leucocitosis (p = 0,0006), neutrofilia (p = 0,0021); Disminución de hematocrito (p = 0,0007) y hemoglobina (p < 0,0001). Asociación con CC: alteraciones cardiológicas no coronarias (ORv10.818); PCR mayor de 68 mg/L (OR = 11.596); leucocitos mayores a 20.000/mm3 (OR= 4.316); y VSG mayor de 64 mm/1° hora (OR = 4.267). Conclusión: La forma de presentación más frecuente fue EK completa, el riesgo de CC fue mayor en varones, menores de 5 años de edad, los factores de riesgo (clínicos y de laboratorio) fueron semejantes a los descritos en la bibliografía.

Background: Kawasaki disease (EK) is an acute systemic vasculitis with a risk of developing coronary aneurysms. Aim: To describe the clinical and epidemiological characteristics of children with EK in Argentina and to analyse the risk factors for the development of coronary's complications (CC). Methods: Multicenter, retrospective, cross-sectional, observational and analytical study. It included patients younger than 18 years of age diagnosed with EK in hospitals in Argentina, between January the 1st, 2010 and December the 31th, 2013. Results: N = 193 subjects. Age: medium: 29 months. Total incidence 5 cases / 10,000 hospital discharges. CC was observed in 15.5% of patients. Increased risk factors for CC: Elevated number of days with fever at the time of treatment placement (p = 0.0033); Increased of: heart frequency (p = 0.0021), erythrosedimentation (ESR) (p = 0.005), C-reactive protein (CRP) (p < 0.0001), leukocytes (p = 0.0006), neutrophils (p = 0.0021); Decreased of hematocrit (p = 0.0007) and hemoglobin (p < 0.0001).Association with CC: non-coronary cardiological alterations (OR = 10,818); PCR greater than 68 mg /L (OR = 11,596); leukocytes greater than 20,000 / mm3 (OR = 4.316); and ESR greater than 64 mm / 1 hour (OR = 4.267). Conclusion: The most frequent form of presentation was complete EK, the risk of CC was higher in males, younger than 5 years old, the risk factors (clinical and laboratory) were similar to those described in the literature.

Aspectos de la atencion medica en los Centros perifericos de la capital de la Provincia del Chaco

Estadisticas de atencion de los Centros de Salud de Resistencia y propuesta de que se adopten decisiones concretas para la APS utilizando los medios disponibles