Evaluación del rendimiento diagnóstico de los índices plaquetarios en el diagnóstico diferencial entre trombocitopenia por destrucción de plaquetas y trombocitopenia por disminución en su producción en la población pediátrica del hospital de la misericordia entre 2012 y 2013.

INTRODUCCIÓN: Los índices plaquetarios: volumen plaquetario medio (VPM), ancho de distribución plaquetaria (ADP) y porcentaje de plaquetas grandes (%PG) tienen buena correlación con la etiología de la trombocitopenia en estudios realizados en adultos. OBJETIVO: Determinar las características de los índices plaquetarios en población pediátrica con trombocitopenia y su posible correlación etiológica. METODOLOGÍA: Estudio de prueba diagnóstica observacional analítico. Pacientes entre 6 meses y 18 años ingresados en un período de 18 meses con trombocitopenia [Formula]. RESULTADOS: 54 pacientes: 18 (33,3%) con púrpura trombocitopénica inmune (PTI) y 36 (66,7%) con leucemia aguda (LA), edad media para PTI 7,4 años y 6,8 para LA, valores de ADP con media de 15,08 fL en PTI y 10,73 para LA, la media del VPM para PTI 11,7 fL y de 9,8 fL para LA y %PG la media para PTI 38,26 % vs 24,97% para LA; las diferencias de los tres índices para cada una de las enfermedades fueron estadísticamente significativas (p=0,00). Las curvas de Característica Operativa del Receptor (ROC) de los índices plaquetarios fueron parámetros suficientes para distinguir las causas de trombocitopenia: VPM y %PG con un área bajo la curva de 0,89 y 0,88 y ADP 0,903. CONCLUSIONES: los índices fueron útiles para el acercamiento inicial al diagnóstico diferencial de trombocitopenias en niños.Abstract. INTRODUCTION: Platelet-derived indices (Mean Platelet Volume/MPV; Platelet size Deviation Width/PDW; and Platelet Large Cell-Percentage/PLCP) are well established correlates for diagnosis of Thrombocytopenia in adult-based research. OBJECTIVE: To determine the values of platelet-derived indices in a pediatric population with diagnostic of Thrombocytopenia and their etiologic correlation. METHODS: Analytic Observational Diagnostic-Test Study. The population for this analytical study were pediatric patients between 6 months to 18 years-old subjects who had thrombocytopenia [Formula], the study period was over 18 months. RESULTS: For 54 subjects: 18 (33,3%) were diagnosed with Immune Thrombocytopenic Purpure (ITP) and 36 (66,7%) diagnosed with Acute Leukemia (AL); mean age was 7,4 years and 6,8 years for ITP and AL, respectively; mean PDW values were 15,08 fL and 10,73 for ITP and AL, respectively; mean MPV was 11,7 fL and 9,8 fL for ITP and AL, respectively. Mean PLCP was 38,26% and 24,97% for ITP and AL, respectively. Differences of this three distinct platelet indices between ITP an AL were statistically significant (p=0,00). The area under the curve of the Receiver Operating Characteristics (ROC) for platelet-derived indices showed that they were adequate for defining the causes of Thrombocytopenia: MPV and PLCP with an area under the curve (AUC) of 0,89 and 0,88, respectively and PLCP with an AUC of 0,903. CONCLUSIONS: Platelet-derived indices could be useful in the initial approach for differential diagnostic of pediatric patients with thrombocytopenia.Pregrad

Results of the 2006 ACHOP protocol on children with acute lymphoblastic leukemia at the HOMI Hospital of Misericordia Foundation in Bogotá in the period 2007 to 2012

Introduction: Acute leukemia is the most common neoplasm in children, accounting for approximately 25% of all tumors in childhood. In Colombia the cure proportion, around 50%, are lower than reported in developed countries. Objective: The main bjective is to determine the global and event-free survival of children with diagnosis of lymphoblastic leukemia, all treated with the ACHOP Protocol 2006, from 2007 to 2012. The secondary objectives are to describe mortality, abandonment, relapse and major complications related to treatment. Material and methods: A descriptive cohort study of 183 patients under 18 years of age, with a confirmed diagnosis of acute lymphoblastic leukemia, who were treated at the Foundation of the Misericordia (HOMI) from 2007 to 2012, was performed. The survival dates were obtained by analysis with Kaplan-Meier curves. Results: We analyzed overall survival at 2, 3 and 5 years with results of 89%, 87.3% and 74.7 % (95% CI 67 - 80.9) respectively. At 5 years survival for the standard risk group was 78.6 % (95 % CI 68.3-85.1) and 61.9 % (95 % CI 50.7-73) for the high risk group. The event-free survival, considering the abandonment and transfer to another institution as an event, was 56.3 % (95% CI 45.5 - 65.8) at 5 years. Mortality in induction was 3.8 %, mortality related to treatment was 3.4 %, 32 patients (17 %) relapsed, bandonment was 16.4 % and transfers 10.4 %. The main complication of the treatment was infections. Conclusions: Overall survival is acceptable for a country with limited resources, the events of abandonment and transfers are very high. Efforts should be made to reduce these situations that worsen the prognosis of the disease

Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study

Background Risk factors for carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-HSCT have not been thoroughly explored. Methods All children with cancer or post-HSCT who developed Enterobacterales bloodstream infections in two cancer referral centres in major Colombian cities between 2012 and 2021 were retrospectively examined. When the infection episode occurred, carbapenem resistance mechanisms were evaluated according to the available methods. Data were divided in a training set (80%) and a test set (20%). Three internally validated carbapenem-resistant Enterobacterales (CRE) prediction models were created: a multivariate logistic regression model, and two data mining techniques. Model performances were evaluated by calculating the average of the AUC, sensitivity, specificity and predictive values. Results A total of 285 Enterobacterales bloodstream infection episodes (229 carbapenem susceptible and 56 carbapenem resistant) occurred [median (IQR) age, 9 (3.5–14) years; 57% male]. The risk of CRE was 2.1 times higher when the infection was caused by Klebsiella spp. and 5.8 times higher when a carbapenem had been used for ≥3 days in the previous month. A model including these two predictive variables had a discriminatory performance of 77% in predicting carbapenem resistance. The model had a specificity of 97% and a negative predictive value of 81%, with low sensitivity and positive predictive value. Conclusions Even in settings with high CRE prevalence, these two variables can help early identification of patients in whom CRE-active agents are unnecessary and highlight the importance of strengthening antibiotic stewardship strategies directed at preventing carbapenem overuse.Q1Q1Los factores de riesgo de resistencia a los carbapenémicos en las infecciones del torrente sanguíneo por Enterobacterales entre niños con cáncer o después de un TCMH no se han explorado a fondo. Métodos Se examinaron retrospectivamente todos los niños con cáncer o post-TCMH que desarrollaron infecciones del torrente sanguíneo por Enterobacterales en dos centros de referencia de cáncer en las principales ciudades de Colombia entre 2012 y 2021. Cuando ocurrió el episodio de infección, se evaluaron los mecanismos de resistencia a los carbapenémicos según los métodos disponibles. Los datos se dividieron en un conjunto de entrenamiento (80%) y un conjunto de prueba (20%). Se crearon tres modelos de predicción de Enterobacterales resistentes a carbapenémicos (CRE) validados internamente: un modelo de regresión logística multivariante y dos técnicas de minería de datos. El rendimiento del modelo se evaluó calculando el promedio del AUC, la sensibilidad, la especificidad y los valores predictivos. Resultados Se produjeron un total de 285 episodios de infección del torrente sanguíneo por Enterobacterales (229 susceptibles a carbapenémicos y 56 resistentes a carbapenémicos) [mediana de edad (RIQ), 9 (3,5 a 14) años; 57% hombres]. El riesgo de CRE fue 2,1 veces mayor cuando la infección fue causada por Klebsiella spp. y 5,8 veces mayor cuando se había utilizado un carbapenem durante ≥3 días en el mes anterior. Un modelo que incluía estas dos variables predictivas tuvo un rendimiento discriminatorio del 77% en la predicción de la resistencia a los carbapenémicos. El modelo tuvo una especificidad del 97% y un valor predictivo negativo del 81%, con baja sensibilidad y valor predictivo positivo. Conclusiones Incluso en entornos con una alta prevalencia de CRE, estas dos variables pueden ayudar a la identificación temprana de pacientes en quienes los agentes activos de CRE son innecesarios y resaltar la importancia de fortalecer las estrategias de administración de antibióticos dirigidas a prevenir el uso excesivo de carbapenémicos.N/AS

Factores asociados a infección respiratoria severa por virus Sincitial respiratorio, adenovirus o influenza, en menores de 3 años en un hospital pediátrico de Bogotá entre septiembre 2017 y marzo de 2018

Introducción y Objetivos: La Infección Respiratoria Aguda Baja (IRAB) es una de las causas más importantes de morbimortalidad en menores de 3 años en el mundo, siendo los virus sus principales causantes. Son pocos los estudios que evalúan predictores de severidad en niños hospitalizados por Adenovirus, Virus Sincitial Respiratorio (VSR) o influenza en nuestro medio. Nuestro objetivo fue analizar posibles factores asociados a severidad en pacientes que presentan infección por uno o mas de estos tres virus. Métodos y Materiales: Estudio analítico de corte transversal, niños menores a 3 años de edad hospitalizados por IRAB con panel viral positivo para mínimo uno de los virus mencionados, en un período de 7 meses en un Hospital de referencia en un país de bajos y medianos ingresos. Análisis multivariado por regresión logística binaria para severidad medida por ingreso a unidad de riesgo (cuidados intensivos y/o intermedios, necesidad de ventilación mecánica invasiva y necesidad de oxígeno domiciliario. Resultados: Se evaluaron 231 niños, 59% del sexo masculino, mediana 8 meses de edad (Rango intercuartilico: 12 meses), 74.5% (172) tenían infección por VSR, 19.2% (41) adenovirus, 13.5% (14) Influenza A. Predictores independientes de Severidad: para Ingreso a Unidad de riesgo tener al ingreso diagnóstico de neumonía OR: 2,69 (IC95% 1,18 - 6,14 p<0.05) y presentar coinfección OR: 2,28 (IC95%: 1,02 - 5,06 p<0.05). Para Necesidad de ventilación mecánica invasiva ser pretérmino OR: 11.75 (IC95% 2,13-64,7 p: 0.00), presencia de vidrio esmerilado en radiografía de tórax OR: 12,08 (IC95% 1,92 – 73,72 p:0.01) y neumonía OR: 8,91 (IC 1,75 – 45,24 p: 0.0) . Para Necesidad de Oxígeno domiciliario tener VSR con un OR 2.51 (IC95%: 1,24-5,09 p<0.05), Displasia Broncopulmonar OR: 6,57 (IC95%: 1,75-24,6 p<0.05), ser menor a 3 meses de edad OR 4,8 (IC95%: 1,84-12,54 p<0.05), ser menor a 6 meses de edad OR 3,49 (IC95%1,99-6,12) p 0.00. No hubo mortalidad durante la hospitalización en el grupo de niños estudiados. Conclusiones: En nuestro grupo de niños estudiados con IRAB por VSR, adenovirus y/o influenza tener neumonía, coinfección, displasia broncopulmonar, vidrio esmerilado y/o ser menor a 6 meses de edad constituyen predictores independientes para severidad, se debe prestar especial atención a este grupo de pacientes durante su tratamiento y establecer estrategias de prevención con énfasis a esta población.Introduction and objectives: Acute lower respiratory tract infection (aLRTI) is a major cause morbidity and mortality worldwide in childhood under three years, mainly caused by viruses. Only few studies have evaluated predictors of severity in children hospitalized for adenovirus, respiratory syncytial virus (RSV) or influenza viruses in our region. The objective was analyze possible factors associated with severity in patients with infection by adenovirus, respiratory syncytial virus (RSV) or influenza. Methods and Materials: Analytical, cross-sectional study in children under three years admitted by aLRTI in a period of 7 months with a positive viral panel for at least one these viruses: adenovirus, RSV or influenza in a reference Hospital center in a low and middle-income country. Multivariate analysis and binary logistic regression for severity measured by admission to the risk unit (intensive and/or intermediate care unit, required invasive mechanical ventilation and need to ambulatory oxygen). Results: A total 213 patients, mean age 8 months (range interquartile: 12), 59% (137) were men, 74.5% (172) were infected by RSV, 19.2% (41) adenovirus, 13.5% (14) Influenza A. Independent predictors of severity: admission to risk unit: had a pneumonia diagnostic to the admission, OR: 2,69 (95% CI: 1,18-6,14) p<0.05, and coinfection OR: 2,28 (95% CI: 1,02-5,06) p<0.05. Required invasive mechanical ventilation OR: 11.75 (95% CI: 2,13-64,7) p: 0.00, ground-glass pattern in chest x-ray OR: 12,08 (95% CI: 1,92-73,72) p:0.01 and pneumonia OR: 8,91 (CI 1,75–45,24) p: 0.0. Need to ambulatory oxygen by RSV OR 2.51 (95% CI: 1,24-5,09) p<0.05. Bronchopulmonary Dysplasia OR: 6,57 (95% CI: 1,75-24,6) p<0.05. <3 months OR 4,8 (95% CI: 1,84-12,54) p<0.05, <6 months OR 3,49 (95% CI: 1,99-6,12) p 0.00. Conclusions: In our patients evaluated with aLRTI by RSV, adenovirus and/or influenza, additionally having pneumonia, coinfection, bronchopulmonary dysplasia, ground-glass pattern in chest x-ray o had age <6 months are independent predictors of severity, special attention should be paid to this group patients during their treatment and establish prevention strategies with emphasis on this population

Evaluation of the diagnostic performance of platelet-derived indices for the differential diagnosis of thrombocytopenia in pediatrics

Background. Platelet-derived indices have a well-established correlation with the differential diagnosis of thrombocytopenia in adult-based research. These indices include mean platelet volume, platelet distribution width, and platelet-large cell ratio. Objective. To determine the values of platelet-derived indices in a pediatric population with diagnoses of thrombocytopenia and their etiologic correlation. Materials and methods. Analytic observational diagnostictest study. The population for this analytical study was pediatric patients between 6 months and 18 years of age who had thrombocytopenia (<100x109/L). The study period was 18 months long. Results. Of 54 subjects, 18 (33.3%) were diagnosed with idiopathic thrombocytopenic purpura, and 36 (66.7%) were diagnosed with acute leukemia. Mean age was 7.4 years and 6.8 years for immune thrombocytopenic purpura and acute leukemia, respectively. Mean platelet distribution width values for immune thrombocytopenic purpura and acute leukemia were 15.08 fL and 10.73, respectively. Mean MPV for immune thrombocytopenic purpura and acute leukemia was 11.7 fL and 9.8 fL, respectively. Mean platelet-large cell ratio was 38.26% and 24.97% for idiopathic thrombocytopenic purpura and acute leukemia, respectively. Differences in these three distinct platelet indices between idiopathic thrombocytopenic purpura and acute leukemia were statistically significant (p=0.00). The area under the ROC curve for platelet-derived indices showed that they were adequate for defining the causes of thrombocytopenia. MPV and platelet-large cell ratio had an area under the curve of 0.89 and 0.88, respectively, while platelet size deviation width had an area under the curve of 0.903. Conclusions. Platelet-derived indices could be useful in the initial approach for the differential diagnosis of pediatric patients with thrombocytopenia