Neumonía complicada adquirida en la comunidad: Resolución de los hallazgos clínicos y radiológicos en niños

Introducción: las infecciones respiratorias agudas, sobre todo la neumonía, constituyen un grave problema de salud al ser causa frecuente de morbilidad y mortalidad infantil en el mundo. Objetivo: determinar la evolución de los hallazgos clínicos y radiológicos. Material y métodos: se realizó un estudio descriptivo longitudinal;  207 pacientes ingresaron en el Servicio de Neumología del Pediátrico "Juan Manuel Márquez", con diagnóstico de Neumonía Complicada adquirida en la comunidad  del 2008 al 2012. Se estudiaron la edad, el sexo, las características clínicas y radiológicas. Todos los pacientes fueron seguidos a su egreso en una consulta especializada, hasta la desaparición de las lesiones pulmonares. Se utilizó el test Chi cuadrado para conocer la posible homogeneidad de grupo. Resultados: hubo un predominio de pacientes en el grupo de edades de 1-4 años (126 para un 61%). Fueron afectados por igual los varones y las hembras. Los hallazgos clínicos más frecuentes fueron la fiebre, en 207 (100%), el murmullo vesicular disminuido, en 197 (95%) y la polipnea, en 148(71%). Las complicaciones más frecuentes fueron: el derrame pleural y el absceso pulmonar, en 176 pacientes (85%) y 35(16.9%), respectivamente. La resolución de los hallazgos clínicos y radiológicos se produjo en más de la mitad de los pacientes en menos de 2 semanas, seguido de 2-4 semanas, excepto en los pacientes con absceso pulmonar y neumatocele. Conclusiones: la duración de los hallazgos radiológicos fue más prolongada que los clínicos y de estos los que más se prolongaron fueron el murmullo vesicular disminuido, la submatidez y los estertores.Palabras clave: neumonía complicada, neumonía comunitaria, derrame pleural, absceso pulmonar, resolución lenta, características imaginológicas.ABSTRACTIntroduction: acute respiratory diseases overall pneumonia are a critical health problem because are frequent causes of infant morbidities and mortalities around the world. Objective: to determine the evolution of clinical and radiological finding. Material and Methods: a descriptive and longitudinal study was performed it  included 207 patients admitted at the Respiratory Service of the Pediatric University Hospital "Juan Manuel Márquez" with diagnose of Complicated community acquired pneumonia from 2008 up to 2012. The age, sex clinical and radiological characteristics were studied. The entire patient enrolled was following up from the hospital discharged up to lung lesions disappear in the respiratory outpatient consult. Chi-square test was used to know the possible homogeneity’s group. Results: there was a preponderance of patient aged from 1 to 4 years old and were affected male and female equally. The clinical findings most frequent were fiber in 207(100%) vesicular breath sound diminished in 197(95%) and polypnea in 148(71%). The most frequent complications were pleura effusion and lung abscess in 176 (85%) patients and 35(16.9%) respectively. The solution of clinical and radiological findings appeared in the half of patients in less than 2 weeks, followed of 2-4 weeks excepting in patients with lung abscess and pneumatocele. Conclusions:  length of radiological findings was more extended than clinical and from these the most extended were vesicular breath sound diminished, sub dullness and the rattles.Key words: complicated pneumonia, community pneumonia, pleura effusion, slow solution, images characteristics. </p

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Síndrome coqueluchoide y tos ferina Pertussis-like syndrome and whooping cough

El síndrome coqueluchoide, cuadro parecido a la tos ferina, es uno de los síndromes respiratorios bajos más comunes en la práctica pediátrica sobre todo en los últimos años. La tos ferina sigue siendo la enfermedad inmunoprevenible más antigua de la infancia que aún causa brotes importantes, principalmente en niños, pero también en adolescentes y adultos. El objetivo de esta revisión es proporcionar información a todos los médicos generales y pediatras de atención primaria y secundaria de salud sobre este problema epidemiológico y de su actual reemergencia. El control de esta enfermedad es un problema de salud tanto en países desarrollados como en vías de desarrollo. Uno de los mayores obstáculos que ha contribuido a una tardía intervención epidemiológica y tratamiento de la tos ferina en varios países del mundo, ha sido la baja sospecha clínica de esta enfermedad en los médicos y trabajadores de la salud, y el desconocimiento de la familia, en la mayoría de las veces. En el momento actual existe una reemergencia mundial de la tos ferina, situación que es necesario conocer y aceptar para un oportuno diagnóstico y tratamiento.<br>Pertussis-like syndrome, a clinical picture similar to whooping cough, is one of the most common lower respiratory syndromes in the pediatric practice in recent years. Whooping cough continues to be one of the oldest preventable diseases in infants, which still causes significant outbreaks mainly in children, but also in adolescents and adults. The objective of this review was to provide general physicians and pediatricians at the primary and the secondary health care levels with information about this present re-emerging epidemiological problem. The management of this disease is difficult for both the developed and the developing countries. One of the major obstacles that lead to delayed epidemiological intervention and treatment of whooping cough in several countries has been the poor clinical suspicion of the presence of the disease on the part of health workers and physicians, and the lack of knowledge within the family setting. It is required to know and to accept the re-emergence of whooping cough at present, in order to make a timely diagnosis and to apply a line of treatment

Broncoaspiración de cuerpo extraño

Se presenta el caso de un paciente masculino de un año de edad, con antecedentes previos de asma bronquial. Refiere la mamá que hacía 11 días el paciente había sufrido una caída, en ese momento se encontraba ingiriendo maní, pasadas unas horas aparece tos seca, la madre consultó al policlínico de su área donde le pusieron tratamiento con prednisona oral por 3 días, con lo cual nota discreta mejoría, sin desaparecer del todo la tos. Al sexto día del evento comenzó a presentar fiebre de 38°C haciendo dos picos al día, los cuales cedían con la administración de Dipirona en tableta. Debido a que los síntomas persistían (tos y fiebre) la madre lleva nuevamente al niño al facultativo, donde le realizaron radiografía de tórax, observando una imagen atelectásica a nivel del pulmón derecho, por lo que deciden remitir al Hospital "Juan Manuel Márquez"

Open-label phase I/II clinical trial of SARS-CoV-2 receptor binding domain-tetanus toxoid conjugate vaccine (FINLAY-FR-2) in combination with receptor binding domain-protein vaccine (FINLAY-FR-1A) in children

Objectives: To evaluate a heterologous vaccination scheme in children 3-18 years old (y/o) combining two SARS-CoV-2r- receptor binding domain (RBD)protein vaccines. Methods: A phase I/II open-label, adaptive, and multicenter trial evaluated the safety and immunogenicity of two doses of FINLAY-FR-2 (subsequently called SOBERANA 02) and the third heterologous dose of FINLAY-FR-1A (subsequently called SOBERANA Plus) in 350 children 3-18 y/o in Havana Cuba. Primary outcomes were safety (phase I) and safety/immunogenicity (phase II) measured by anti-RBD immunoglobulin (Ig)G enzyme-linked immunoassay (ELISA), molecular and live-virus neutralization titers, and specific T-cells response. A comparison with adult immunogenicity and predictions of efficacy were made based on immunological results. Results: Local pain was the unique adverse event with frequency >10%, and none was serious neither severe. Two doses of FINLAY-FR-2 elicited a humoral immune response similar to natural infection; the third dose with FINLAY-FR-1A increased the response in all children, similar to that achieved in vaccinated young adults. The geometric mean (GMT) neutralizing titer was 173.8 (95% confidence interval [CI] 131.7; 229.5) vs Alpha, 142 (95% CI 101.3; 198.9) vs Delta, 24.8 (95% CI 16.8; 36.6) vs Beta and 99.2 (95% CI 67.8; 145.4) vs Omicron. Conclusion: The heterologous scheme was safe and immunogenic in children 3-18 y/o. Trial registry: https://rpcec.sld.cu/trials/RPCEC0000037