RESUMEN
Objective: The objective is to expose the cardiovascular alterations in patients diagnosed with pediatric inflammatory multisystem syndrome (PIMS) associated with COVID-19 during the SARS-CoV-2 pandemic, in order to understand the disease, its evolution, and optimal management upon diagnosis. Method: Retrospective, observational, cross-sectional analytical study of patients diagnosed with PIMS according to the criteria of the World Health Organization at the National Institute of Pediatrics, from March 2020 to December 2021. Results: During the study period, 77 patients with PIMS were diagnosed. The results showed correlation between the shock state and alteration of laboratory markers (platelets 144217.29 ± 139321.6 µL [p < 0.001], procalcitonin 27.37 ± 38.37 ng/ml [p = 0.05] and ferritin 1937.87 ± 2562.63 [p < 0.001]). The ventricular function in patients with shock was significantly lower compared to those without shock (49.6 ± 9.1% vs. 58.1 ± 8.4 %; t-Student p < 0.001), as well as injury to the left coronary artery (p = 0.02). There is a correlation between NT-proBNP and ventricular dysfunction (Kruskal-Wallis p = 0.007). Statistical significance was found in the association between death, elevation of inflammatory markers and ventricular dysfunction (p < 0.001). Conclusions: The cardiovascular alterations observed, in order of frequency, were pericardial effusion (25.7%), myocarditis (15%), mild ventricular dysfunction (13.5%) and small coronary aneurysm with predominance of the left coronary artery and the anterior descending one.
Objetivo: Exponer las alteraciones cardiovasculares en los pacientes diagnosticados con síndrome inflamatorio multisistémico pediátrico (PIMS) asociado a COVID-19 durante la pandemia por SARS-CoV-2 con el fin de comprender la enfermedad, su evolución y el manejo óptimo al diagnóstico. Método: Estudio retrospectivo, observacional, transversal y analítico de pacientes con diagnóstico de PIMS de acuerdo con los criterios de la Organización Mundial de la Salud en el Instituto Nacional de Pediatría, de marzo de 2020 a diciembre de 2021. Resultados: Durante el periodo de estudio se diagnosticaron 77 pacientes con PIMS. Los resultados demostraron una correlación entre el estado de choque y la alteración de los marcadores de laboratorio (plaquetas 144217.29 ± 139321.6 µl [p < 0.001], procalcitonina 27.37 ± 38.37 ng/ml [p = 0.05] y ferritina 1937.87 ± 2562.63 [p < 0.001]). La función ventricular en los pacientes con choque se registró significativamente menor en comparación con aquellos sin choque (49.6 ± 9.1 % vs. 58.1 ± 8.4 %; t de Student p < 0.001), así como lesión en la arteria coronaria izquierda (p = 0.02). Existe una correlación entre el NT-proBNP y la disfunción ventricular (Kruskal-Wallis p = 0.007). Se encontró significancia estadística en la asociación entre fallecimiento, elevación de los marcadores inflamatorios y disfunción ventricular (p < 0.001). Conclusiones: Las alteraciones cardiovasculares observadas fueron, en orden de frecuencia, derrame pericárdico (25.7%), miocarditis (15%), disfunción ventricular leve (13.5%) y aneurisma pequeño coronario con predominio de la arteria coronaria izquierda y la descendente anterior.
Asunto(s)
COVID-19 , Síndrome de Respuesta Inflamatoria Sistémica , Humanos , COVID-19/complicaciones , México/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Estudios Transversales , Masculino , Femenino , Estudios Retrospectivos , Niño , Preescolar , Adolescente , Centros de Atención Terciaria , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/epidemiología , Lactante , Choque/etiologíaRESUMEN
PURPOSE: The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. RESULTS: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). CONCLUSION: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.
Asunto(s)
Profilaxis Antibiótica , Nefrolitotomía Percutánea , Complicaciones Posoperatorias , Sepsis , Síndrome de Respuesta Inflamatoria Sistémica , Humanos , Nefrolitotomía Percutánea/efectos adversos , Nefrolitotomía Percutánea/métodos , Profilaxis Antibiótica/métodos , Complicaciones Posoperatorias/prevención & control , Síndrome de Respuesta Inflamatoria Sistémica/prevención & control , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Sepsis/prevención & control , Sepsis/etiología , Factores de Riesgo , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Fiebre/etiologíaRESUMEN
INTRODUCTION: Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP). OBJECTIVE: The aim of this study was to compare the plasma concentration of EMP between patients undergoing aortic valve replacement with conventional bioprosthesis implantation and Perceval™ S (LivaNova) and to evaluate its impact on the inflammatory response in the short-term follow-up. METHODS: This is a randomized clinical trial with 24 patients submitted to isolated aortic valve replacement divided into two groups: Perceval™ S (Group P) and conventional bioprostheses (Group C). Incidence of severe SIRS (three or more criteria) in the first 48 hours postoperatively, EMP release profile, interleukins (IL) 6 and 8, C-reactive protein, and procalcitonin were analyzed preand postoperatively at 24 hours and three months. RESULTS: There were 24 patients (12 in each group), mean age was 69.92±5.17 years, 83.33% were female, the incidence of severe SIRS was 66.7% and 50% in groups C and P, respectively (P=0.68), and EMP showed a significant increase in the 24-hour postoperative period (P≤0.001) and subsequent decrease in the three-month postoperative period (P≤0.001), returning to baseline levels. For IL-6 and IL-8, there was a greater increase in group C at 24 hours postoperatively (P=.0.02 and P<0.001). CONCLUSION: The incidence of severe SIRS was similar in both groups, with significantly higher levels of IL-6 and IL-8, at the 24-hour postoperative period, in group C, however with higher levels of EMP in group P, and subsequent return to baseline levels at the three-month postoperative period in both groups.
Asunto(s)
Estenosis de la Válvula Aórtica , Bioprótesis , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Humanos , Femenino , Persona de Mediana Edad , Anciano , Masculino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Estenosis de la Válvula Aórtica/cirugía , Interleucina-6 , Interleucina-8 , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Bioprótesis/efectos adversos , Diseño de Prótesis , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
PURPOSE: The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used. POPULATION: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589. RESULTS: Three RCT and two prospective studies (475 patients) were included. SIRS/sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 - 0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 - 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 - 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 - 0.663, p = 0.001) than the control group. CONCLUSION: one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.
Asunto(s)
Cálculos Renales , Nefrolitotomía Percutánea , Nefrostomía Percutánea , Sepsis , Adulto , Humanos , Nefrolitotomía Percutánea/efectos adversos , Antibacterianos/uso terapéutico , Estudios Prospectivos , Nefrostomía Percutánea/efectos adversos , Cálculos Renales/cirugía , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Complicaciones Posoperatorias/etiologíaRESUMEN
El síndrome inflamatorio multisistémico asociado a COVID-19 es una presentación postinfecciosa, que puede ser particularmente grave, pudiendo producir una severa disfunción multiorgánica. Se presenta una serie de 6 casos clínicos, asistidos en Servicio Médico Integral, Montevideo-Uruguay, con el fin de exponer las características clínicas y paraclínicas de este nuevo síndrome, y la evolución clínica de los mismos. Se realiza un estudio observacional descriptivo. La edad media fue de 6 años, con predominio en sexo femenino. Estos pacientes tuvieron una presentación clínica leve a moderada, con buena evolución Las manifestaciones clínicas principales fueron: fiebre, compromiso gastrointestinal, mucocutáneo y afectación ocular; dos de estos pacientes presentaron compromiso cardiovascular. Todos tuvieron alteraciones en la paraclínica, destacándose reactantes de fase aguda elevados. Todos los pacientes recibieron inmunoglobulina intravenosa y corticoides, tres de ellos recibieron heparina de bajo peso molecular por valor de D-dímeros 5 veces por encima del valor de referencia. No descartamos el impacto del diagnóstico y tratamiento precoz en la buena evolución de estos niños.
The Multisystem Inflammatory Syndrome associated with COVID-19 is a postinfectious presentation, which can be particularly serious, and can produce severe multiorgan dysfunction. A report of 6 clinical cases, assisted in the Comprehensive Medical Service, Montevideo-Uruguay, is presented in order to expose the clinical and paraclinical characteristics of this new syndrome, and their clinical evolution. A descriptive observational study was carried out. The mean age was 6 years, with a predominance of females. These patients had a mild to moderate clinical presentation, with good evolution. The main clinical manifestations were: fever, gastrointestinal and mucocutaneous involvement, and ocular involvement; two of these patients had cardiovascular compromise. All had alterations in the paraclinical, standing out elevated acute phase reactants. All patients received intravenous immunoglobulin and corticosteroids, three of them received low molecular weight heparin with a value of D-dimers 5 times higher than the reference value. We do not rule out the impact of early diagnosis and treatment on the positive evolution of these children.
A Síndrome Inflamatória Multissistêmica associada à COVID-19 é uma apresentação pósinfecciosa, que pode ser particularmente grave e produzir disfunção grave de múltiplos órgãos. Apresentamos um relato de 6 casos clínicos, atendidos no Serviço Médico Integral, Montevidéu-Uruguai, com o objetivo de expor as características clínicas e para clínicas desta nova síndrome, e sua evolução clínica. Tratase de um estudo observacional descritivo. A média de idade foi de 6 anos, com predomínio do sexo feminino. Esses pacientes tinham apresentação clínica leve a moderada, com boa evolução. As principais manifestações clínicas foram: febre, envolvimento gastrointestinal, muco cutâneo e ocular; dois desses pacientes apresentaram comprometimento cardiovascular. Todos apresentavam alterações para clínicas, destacandose elevados reagentes na fase aguda. Todos os pacientes receberam imunoglobulina e corticosteroides endovenosos, três deles receberam heparina de baixo peso molecular com valor do dímero D 5 vezes acima do valor de referência. Não descartamos o impacto do diagnóstico e tratamento precoces na evolução positiva dessas crianças.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , COVID-19/complicacionesRESUMEN
Desde abril de 2020, em vários países da Europa, América do Norte e inclusive no Brasil, foram identificados casos de crianças e adolescentes com uma nova apresentação clínica associada à Covid-19 e caracterizada por um quadro inflamatório tardio e exacerbado, denominada em português como Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P). Evidências posteriores mostram que, em casos raros, indivíduos adultos (acima dos 20 anos) também podem desenvolver uma síndrome semelhante, associada à infecção atual ou anterior pelo SARS-CoV-2.1-3. Relatos desses pacientes destacam o reconhecimento de uma síndrome hiperinflamatória multissistêmica em adultos, com heterogeneidade de sinais e sintomas clínicos.4 A maioria dos pacientes apresenta febre e hipotensão e uma pequena parcela pode apresentar sintomas similares à síndrome de Kawasaki, síndrome de ativação macrofágica e síndrome do choque tóxico.5 No Brasil, a síndrome foi nomeada de Síndrome Inflamatória Multissistêmica em Adultos (SIM-A). Alguns casos suspeitos dessa condição já foram identificados no país e notificados voluntariamente pelos profissionais de saúde da assistência.
Asunto(s)
Humanos , Adulto , Síndrome de Respuesta Inflamatoria Sistémica/etiología , COVID-19/complicaciones , Enfermedades Respiratorias , Síndrome , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológicoRESUMEN
La COVID 19 es una enfermedad que, habitualmente, no resulta grave en la edad pediátrica, excepto en niños con comorbilidades significativas subyacentes. Es muy importante reconocer los cuadros post COVID, como el síndrome inflamatorio multisistémico (SIM-C) y la COVID-19 prolongada o long COVID que pueden afectar de manera significativa a la población de niños y adolescentes. La pandemia COVID-19 también ha tenido un fuerte impacto en los aspectos sociales, emocionales y nutricionales. El aislamiento prolongado impactó en los controles de salud de niños y adolescentes con enfermedades crónicas y las coberturas de las vacunas de calendario disminuyeron significativamente. Es claro que la vacunación contra el SARSCov-2 en niños, niñas y adolescentes no sólo busca cuidar de su salud; también busca preservar la vida social y presencialidad escolar, reducir el riesgo de los cuadros post COVID-19 y mejorar la inmunidad de rebaño de la población general.
COVID-19 is a disease that is not usually serious in children, except in children with significant underlying comorbidities. Is very important to recognize post-COVID conditions such as multisystem inflammatory syndrome (SIM-C) and prolonged COVID 19 or long COVID, which can significantly affect the population of children and adolescents. The COVID -19 pandemic has also had a strong impact on social, emotional, and nutritional aspects. Prolonged isolation had an impact on health checkups for children and adolescents with chronic diseases, and coverage of scheduled vaccinations decreased significantly. It is clear that vaccination against SARSCov-2 in children and adolescents not only seeks to take care of their health , it also seeks to preserve social life and school presence, reduce the risk of post-COVID-19 conditions and improve herd immunity in the general population.
Asunto(s)
Humanos , Niño , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/prevención & control , COVID-19/complicaciones , Infección Persistente , Dolor en el Pecho/etiología , Disnea/etiología , Vacunas contra la COVID-19/administración & dosificación , COVID-19/diagnóstico , COVID-19/epidemiologíaRESUMEN
OBJECTIVES: We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. METHODS: A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. RESULTS: A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8-9.0); heart rate 120 bpm, OR 2.9 (1.2-7.4); respiratory rate 22 bpm, OR 4.1 (1.6-10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6-7.6). CONCLUSIONS: The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.
Asunto(s)
Infecciones , Complicaciones del Trabajo de Parto , Infección Puerperal , Ajuste de Riesgo/métodos , Síndrome de Respuesta Inflamatoria Sistémica , Adulto , Estudios de Cohortes , Colombia/epidemiología , Diagnóstico Precoz , Femenino , Humanos , Infecciones/complicaciones , Infecciones/diagnóstico , Infecciones/epidemiología , Infecciones/fisiopatología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Recuento de Leucocitos/métodos , Mortalidad Materna , Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/etiología , Complicaciones del Trabajo de Parto/mortalidad , Embarazo , Resultado del Embarazo/epidemiología , Infección Puerperal/sangre , Infección Puerperal/etiología , Infección Puerperal/mortalidad , Infección Puerperal/terapia , Medición de Riesgo/métodos , Evaluación de Síntomas/métodos , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/terapiaRESUMEN
BACKGROUND: To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS: Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS: One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS: Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.
Asunto(s)
Abdomen Agudo/etiología , Abdomen Agudo/virología , Apendicitis/etiología , Apendicitis/virología , COVID-19/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/virología , Adolescente , COVID-19/etiología , COVID-19/virología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , América Latina , Masculino , SARS-CoV-2/patogenicidadRESUMEN
Despite the worldwide spread of SARS-CoV-2 infection (COVID-19), knowledge of the different clinical presentations, ways of transmission, severity and prognosis in children and adolescents is limited. An increasing number of reports describe some of these characteristics in this age range. A non-systematic review was undertaken using MEDLINE (PubMed), LILACS (VHL), Scopus, Web of Science, Cochrane and CAPES Portal databases from 1 January until 30 September 2020 [103] with the search terms SARS-CoV-2, COVID-19, child, children, youth, adolescent and newborn to identify the more recent clinical aspects of SARS-CoV-2 infection in children. In general, SARS-CoV-2 infection in children tends to be asymptomatic or to have mild or moderate signs, and most young ones are infected by family members. Recent reports offer new insights into the disease. Current evidence on SARS-CoV-2 infection in children and adolescents is presented, especially concerning the clinical presentation, imaging and uncommon severe forms of the disease, particularly the COVID-19-associated multisystem inflammatory syndrome. The impact of COVID-19 infection in the perinatal period is described in detail. Knowledge of the various clinical presentations of SARS-CoV-2 in children and adolescents allows the paediatrician to diagnose earlier, monitor warnings signs, implement treatment and, especially, establish preventive measures.Abbreviations : ACE-2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; ARF, acute rheumatic fever; CAA, coronary artery aneurysms; CK-MB, creatine kinase-MB; COVID-19, coronavirus disease-2019; HLA, specific human leucocyte antigen; IPC, infection prevention and control; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; MIS-C, COVID-19-associated multisystem inflammatory syndrome; RNA, ribonucleic acid; RT-PCR, reserve transcription-polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; TCT, thoracic computed tomography; TSS, toxic shock syndrome; WHO, World Health Organization.
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COVID-19/complicaciones , SARS-CoV-2 , Adolescente , COVID-19/etiología , COVID-19/terapia , COVID-19/transmisión , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Síndrome Mucocutáneo Linfonodular/etiología , Síndrome Mucocutáneo Linfonodular/terapia , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/terapiaRESUMEN
A Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P) é uma nova apresentação clínica em crianças e adolescentes, na faixa etária de zero a 19 anos, temporalmente associada à infecção pelo SAR-CoV-2. O objetivo deste estudo é analisar o perfil epidemiológico dos casos de SIM-P na Bahia. Trata-se de um estudo exploratório descritivo, com revisão de literatura, análise documental e das notificações de SIM-P realizadas no formulário on-line do REDCap, no período de 20 de julho a 4 de dezembro de 2020, considerando a orientação do Ministério da Saúde para a realização de busca ativa de casos desde 26 de fevereiro de 2020, data da confirmação do primeiro caso de Covid-19 no país. Na Bahia, nesse período, foram realizadas 66 notificações, com a confirmação de 42 casos, dos quais três evoluíram para óbito, 38 tiveram alta e um continua internado. As faixas etárias foram agrupadas em intervalos de cinco anos, sendo a faixa de 5 a 9 anos a que concentrou o maior número de casos (N = 20; 47,6%) e a faixa de 15 a 19 anos a que apresentou o menor número (N = 2; 4,8%). A média de idade coincidiu com a mediana, que foi de oito anos. Houve predomínio do sexo masculino, com 25 casos, representando 59,5%. Em relação à análise de ocorrência dos primeiros sintomas, o mês de julho registrou a maior concentração de casos no período estudado (28,6%). As informações obtidas por meio da vigilância da SIM-P são fundamentais para o conhecimento do perfil epidemiológico, podendo contribuir para o melhor manejo clínico dos casos.
Multisystem Inflammatory Syndrome in Children (MIS-C) is a new clinical presentation in children and adolescents aged zero to nineteen, temporarily associated with SARS-CoV-2 infection. This study aims at analyzing the epidemiological profile of MIS-C cases in the state of Bahia. This is an exploratory descriptive study, with a literature review, document analysis and MIS-C notifications made on the REDCap online form, from July 20 to December 4, 2020, considering the guidance of the Ministry of Health to conduct an active search for cases since February 26, 2020, date of confirmation of the first case of Covid-19 in the country. In the state, during this period, 66 notifications were made, with the confirmation of 42 cases, of which three evolved to death, 38 were discharged and one is still hospitalized. The age groups were grouped into five-year intervals, with the range of 5 to 9 years old having the highest number of cases (N = 20; 47.6%) and the range of 15 to 19 years old having the lowest number (N = 2; 4.8%). The mean age coincided with the median, which was 8 years. There was a predominance of boys, with 25 cases, representing 59.5%. Regarding the analysis of the occurrence of the first symptoms, July registered the highest concentration of cases (28.6%). The information obtained by the surveillance of MIS-C is fundamental for the knowledge of the epidemiological profile and may contribute to the better clinical management of cases.
El síndrome inflamatorio multisistémico pediátrico (SIM-P) es una nueva presentación clínica en niños y adolescentes de 0 a 19 años, temporalmente asociada a la infección por SARS-CoV-2. El objetivo de este estudio es analizar el perfil epidemiológico de los casos de SIM-P en Bahía. Este es un estudio exploratorio descriptivo, con revisión de literatura, análisis de documentos y notificaciones SIM-P realizadas en el formulario en línea de REDCap, del 20 de julio al 4 de diciembre de 2020, considerando la orientación del Ministerio de Salud para realizar una búsqueda activa de casos desde el 26 de febrero de 2020, fecha de confirmación del primer caso del covid-19 en el país. En Bahía, durante ese período, se realizaron 66 notificaciones, con la confirmación de 42 casos, de los cuales tres evolucionaron a muerte, 38 fueron dados de alta y uno aún se encuentra hospitalizado. Los grupos de edad se agruparon en intervalos de cinco años, con el rango de 5 a 9 años con el mayor número de casos (N = 20; 47,6%) y el rango de 15 a 19 años con el número más bajo (N = 2; 4,8%). La edad media coincidió con la mediana, que fue de 8 años. Predominó el sexo masculino, con 25 casos, representando el 59,5%. En cuanto al análisis de la ocurrencia de los primeros síntomas, el mes de julio registró la mayor concentración de casos en el período analizado (28,6%). La información obtenida por la vigilancia del SIM-P es fundamental para conocer el perfil epidemiológico, lo que puede contribuir al mejor manejo clínico de los casos.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Perfil de Salud , Características de la Residencia , Distribución por Sexo , Distribución por Edad , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Distribución Temporal , COVID-19/complicacionesRESUMEN
ABSTRACT: Pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS) is infrequent, but children might present as a life-threatening disease. In a systematic quantitative review, we analyzed 11 studies of PIMS-TS, including 468 children reported before July 1, 2020. We found a myriad of clinical features, but we were able to describe common characteristics: previously healthy school-aged children, persistent fever and gastrointestinal symptoms, lymphopenia, and high inflammatory markers. Clinical syndromes such as myocarditis and Kawasaki disease were present in only one third of cases each one. Pediatric intensive care unit admission was frequent, although length of stay was less than 1 week, and mortality was low. Most patients received immunoglobulin or steroids, although the level of evidence for that treatment is low. The PIMS-ST was recently described, and the detailed quantitative pooled data will increase clinicians' awareness, improve diagnosis, and promptly start treatment. This analysis also highlights the necessity of future collaborative studies, given the heterogeneous nature of the PIMS-TS.
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COVID-19/complicaciones , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , COVID-19/epidemiología , COVID-19/etiología , COVID-19/terapia , Niño , Terapia Combinada , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/uso terapéutico , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Síndrome Mucocutáneo Linfonodular/epidemiología , Síndrome Mucocutáneo Linfonodular/etiología , Miocarditis/epidemiología , Miocarditis/etiología , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Tratamiento Farmacológico de COVID-19Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Neumonía Viral/etiología , Algoritmos , Infecciones por Coronavirus/etiología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Medición de Riesgo , Técnicas de Laboratorio Clínico , Diagnóstico Precoz , Toma de Decisiones ClínicasAsunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Neumonía Viral/etiología , Índice de Severidad de la Enfermedad , Factores de Riesgo , Infecciones por Coronavirus/etiología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Técnicas de Laboratorio ClínicoRESUMEN
CONTEXTO CLÍNICO: La enfermedad por el Coronavirus 2019 (COVID-19), por su sigla en inglés Coronavirus Disease 2019) es una enfermedad respiratoria de humanos por un nuevo Coronovirus identificado con la sigla SARS-CoV-2. TECNOLOGÍA: Los glucocorticoides (GCS) son una familia de medicamentos antiinflamatorios e inmunomodulares que se utilizan en el tratamiento de diversas patologías cuyo principal componente etiopatogénico es la inflamación. Dentro de los mecanismos de acción propuestos se encuentran> inhibición de citoquinas inflamatorias (IL-1 y IL-2), inhibición de la migración de lecucocitaria, inhibición de la desgranulación de mastocitos, depleción linfocitaria (principalmentelinfocitos T), incremento de citoquinas anti-inflamatorias (IL-10). Dentro de las alternativas para la administración sistémica se pueden mencionar a la hidrocortisona, dexametasona, betametasona, predinisona, prednisolona, metilprednisolona y deflazacort. Todos ellos difieren principalmente en el grado de actividad mineralocorticorticoide y vida media. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia y seguridad de los tratamientos propuestos del síndrome inflamatorio multisistémico asociado a COVID-19 en pacientes pediátricos. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y recomendaciones de diferentes organizaciones de salud. RESULTADOS: No se encontró evidencia acerca de la efectividad comparativa (ya sea contra medidas de soporte/placebo o entre diversos tratamientos activos entre si) del tratamiento con inmunoglobulinas, corticoides o agentes biológicos inmunomoduladores en pacientes pediátricos con síndrome de inflamación multisistémica asociado a COVID-19. Se incluyeron estudios obervacionales y o recomendaciones, acerca del tratamiento de esta patología en niños, niñas y adolescentes. Solo se encontró un ensayo clínico en curso para evaluar el tratamiento con células del estroma mesenquimal a los que se les administrará corticoides (hidrocortisona) y difenhidramina en esta población. Se describe a continuación información proveniente de cuatro series de casos y se incluyen cinco guías de práctica clínica donde mencionan las alternativas terapéuticas en el tratamiento del SIMP. CONCLUSIONES: Evidencia de muy baja calidad proveniente de series de casos no permite determinar la eficacia ni la seguridad del tratamiento con inmunoglobulinas, corticoides y agentes biológicos inmunomoduladores en pacientes pediátricos con síndrome inflamatorio multisistémico asociado a COVID-19.
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Humanos , Infecciones por Coronavirus/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Betacoronavirus/efectos de los fármacos , Glucocorticoides/uso terapéutico , Evaluación de la Tecnología Biomédica , Evaluación en Salud , Análisis Costo-BeneficioRESUMEN
A 12-year-old boy presented to the emergency department with findings concerning for multisystem inflammatory syndrome in children. After clinical stabilization following treatment with antibiotics, remdesivir, and anakinra, the patient was noted to have episodes of altered mentation. Video electroencephalogram revealed status epilepticus, which was subsequently controlled with antiepileptic medications.
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Estado Epiléptico/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Niño , Humanos , MasculinoRESUMEN
The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.
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Glomerulonefritis Membranosa/complicaciones , Inmunosupresores/efectos adversos , Prednisona/efectos adversos , Strongyloides stercoralis , Estrongiloidiasis/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Animales , Criptococosis/complicaciones , Diagnóstico Tardío , Quimioterapia Combinada , Ecuador/etnología , Enterococcus faecium , Infecciones por Escherichia coli/complicaciones , Resultado Fatal , Glomerulonefritis Membranosa/tratamiento farmacológico , Glomerulonefritis Membranosa/orina , Infecciones por Bacterias Grampositivas/complicaciones , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Enfermedades Pulmonares Fúngicas/complicaciones , Masculino , Meningitis Bacterianas/complicaciones , Persona de Mediana Edad , Neumonía Bacteriana/complicaciones , Prednisona/uso terapéutico , Choque Séptico/etiología , España , Stenotrophomonas maltophilia , Estrongiloidiasis/diagnósticoRESUMEN
INTRODUCTION: The typical factors precipitating diabetic ketoacidosis (DKA) include infections (30%), cessation of antidiabetic medication (20%), and a new diagnosis of diabetes (25%). The etiology remains unknown in 25% of cases. Less frequent causes cited in the literature include severe thyrotoxicosis and, infrequently, pericarditis. Few publications have described the role of human T lymphotropic virus type 1 (HTLV-1) in endocrine and metabolic disorders. Based on a clinical case associated with several endocrine and metabolic disorders, we suggest a potential role for HTLV-1, an endemic virus in the Amazonian area, and review the literature concerning the role of this virus in thyroiditis, pericarditis and diabetes mellitus. CASE REPORT: A fifty-year-old Surinamese woman without any medical history was admitted for diabetic ketoacidosis. No specific anti-pancreatic autoimmunity was observed, and the C-peptide level was low, indicating atypical type-1 diabetes mellitus. DKA was associated with thyrotoxicosis in the context of thyroiditis and complicated by nonbacterial pericarditis and a Staphylococcus aureus subcutaneous abscess. The patient was infected with HTLV-1. CONCLUSION: To our knowledge, this uncommon association is described for the first time. Few studies have analyzed the implications of HTLV-1 infection in thyroiditis and diabetes mellitus. We did not find any reports describing the association of pericarditis with HTLV-1 infection. Additional studies are necessary to understand the role of HTLV-1 in endocrine and cardiac disorders.
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Absceso/etiología , Infecciones por Deltaretrovirus/complicaciones , Diabetes Mellitus Tipo 1/etiología , Cetoacidosis Diabética/etiología , Pericarditis/etiología , Tirotoxicosis/etiología , Absceso/inmunología , Absceso/microbiología , Enfermedad Aguda , Infecciones por Deltaretrovirus/virología , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 1/virología , Cetoacidosis Diabética/inmunología , Cetoacidosis Diabética/terapia , Cetoacidosis Diabética/virología , Femenino , Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , Humanos , Inmunocompetencia , Persona de Mediana Edad , Pericarditis/virología , Infecciones Cutáneas Estafilocócicas/etiología , Infecciones Cutáneas Estafilocócicas/inmunología , Infecciones Cutáneas Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Suriname , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/virología , Tiroiditis/virología , Tirotoxicosis/virologíaRESUMEN
BACKGROUND: Systemic inflammatory response syndrome (SIRS) is a well-recognized phenomenon in adult trauma populations. The "initial hit" of the traumatic event is often coupled with a systemic immune response characterized by changes in vital signs and laboratory indicators. A "second hit" from surgery during this time frame often results in acute lung injury, along with deterioration of the patient's clinical condition. We hypothesized that children and adolescents would experience SIRS physiology, but would not experience adult respiratory distress syndrome (ARDS) or "second hit" related death to the extent seen in the adult populations. METHODS: We queried the trauma database of our level 1 pediatric trauma center from January 2005 to December 2015 for patients with injury severity scores of >16. We used the electronic medical record to track SIRS criteria in patients days 1 to 4 posttrauma. Trends were examined in patients with an orthopaedic injury (OI) and with no orthopaedic injury. Patients were further subcategorized and analyzed by age group based on the convention for definition of pediatric SIRS. Patients in the orthopaedic cohort were further examined for pulmonary complications and death. Logistic regression was used to identify risk factors for SIRS physiology in the first 4 days of hospitalization. RESULTS: 81.4% (OI) and 69.1% no orthopaedic injury reached the threshold for SIRS within their first 4 days of hospitalization. Nine patients died in the hospital. Only 3 OI patients developed the criteria for ARDS, and only 3 patients with orthopaedic injuries died, 2 died within 24 hours of presentation and 1 within 48 hours, all had severe brain trauma. Increasing age groups showed increasing proportion of patients with SIRS. Increasing injury severity score and increasing age were independent predictors of SIRS during days 1 to 4. DISCUSSION: SIRS seems to be as common in children as the reported rates for adults, and the proportion of SIRS in children increases with increasing age and injury severity. The high mortality rate and rate of ARDS observed in adults was not observed in our cohort. The presence or absence of major orthopaedic injuries was not a significant predictor. The SIRS response in polytraumatized children is poorly understood. The clinical phenomenon of acute lung injury/ARDS is observed less often in children, but the exact mechanism by which this occurs is unknown. LEVEL OF EVIDENCE: Level III-case control.