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ABSTRACT Background: Urinary tract infection (UTI) is a common disease in childhood and one of the most common causes of consultation in the pediatric emergency department. Its incidence ranges between 5% and 10% in children under 2 years old. Objective: To generate recommendations on the diagnosis, treatment, and follow-up of UTI in pediatric patients in Colombia. Methods: 15 questions of clinical interest in the diagnosis, treatment, and follow-up of UTI in pediatric patients were formulated. A systematic review of the literature was carried out to identify the clinical practice guidelines (CPG) available in UTI, in order to use this evidence to answer the proposed questions and articulate the recommendations. Local and international tools were used to select and evaluate the CPGs. Information was retrieved from the selected guidelines, preliminary recommendations were compiled, and final recommendations were approved by expert consensus. Finally, the strength and direction of each recommendation was assessed. Results: A total of 4 CPGs were selected: American Academy of Pediatrics, Spanish Ministry of Health, McTaggart, and National Institute for Health and Care Excellence. Final recommendations for the diagnosis, treatment, and follow-up of UTI are presented in this paper. Conclusions: These recommendations will guide the teams to make clinical decisions regarding health care of pediatric patients with UTI in Colombia. This will help to improve health care and to generate policies for timely diagnosis, treatment, and follow-up in these patients.

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BACKGROUND: Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. OBJECTIVE: To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. METHODS: A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. CLINICALTRIALS: gov identifier NCT04331262. DISCUSSION: This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.

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Primitive neuroectodermal tumors (PNETs) belong to the Ewing sarcoma family of tumors. These lesions are highly aggressive and are usually found in paravertebral regions, lower limbs, and thorax. However, abdominal PNETs are extremely rare, and only 3 cases of pediatric PNET of the liver have been previously reported. Most patients exhibit symptoms associated with mass effect, due to rapid tumor growth and dissemination. Therefore, an appropriate differential diagnosis is of pivotal importance in order to initiate the corresponding treatment. Here we report the case of a 4-year-old female patient who was diagnosed with PNET of the liver, and we discuss the analysis of focal liver lesions and differential diagnosis in pediatric patients.

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Among the diverse causes of posterior mediastinal masses, malignant peripheral nerve sheath tumors is a very rare neurogenic tumor. Imaging features tend to be variable. A 20-month-old toddler presented with a 3-month history of persistent diffuse thoracic and abdominal pain. A chest magnetic resonance imaging was taken and shown a posterior mediastinal lesion. Histopathology and immunohistochemical analysis confirmed the diagnosis of a malignant peripheral nerve sheath tumor with myxoid areas. Malignant peripheral nerve sheath tumors are an uncommon entity in the children with a poor prognosis. Magnetic resonance imaging is the preferred technique in children to limit the use of ionizing radiation and because has a higher contrast resolution; however, all suspicious tumors should be biopsied to make an appropriate diagnosis. Treatment is radical surgery with excision of the entire mass; however, there is a high incidence of local recurrence.

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Introducción: El uso de dosis adecuadas de radiación en pacientes pediátricos es un deber de los centros de diagnóstico médico debido a las características y retos que implica esta población. Por lo anterior, se han establecido unos niveles internacionales de referencia de dosis (DRL, del inglés dose reference level) para optimizar y comparar los protocolos de cada institución. En Colombia no se cuenta con estudios al respecto. Objetivo: Mostrar los DRL utilizados en un hospital universitario de alta complejidad en las modalidades de tomografía computarizada (TC), radiografía y fluoroscopia y compararlos con los estándares internacionales. Metodología: Estudio descriptivo retrospectivo realizado entre 2018 y 2019. Se analizaron datos de producto dosis longitud (DLP) para TC de cráneo, tórax, abdomen y TC de tórax de alta resolución (TACAR); y producto dosis área (DAP) para radiografía de tórax, abdomen, huesos y fluoroscopia por grupos etarios. Resultados: Se obtuvieron los datos de 780 pacientes: 360 radiografías, 100 de fluoroscopia y 320 tomografías. Se encontró que los niveles de referencia de dosis de radiación usados en el hospital son bajos, comparados con guías europeas de 2018 de niveles de referencia. Se describen DRL para cada estudio y grupo etario. Conclusión: Se demostró que en el hospital donde hizo el estudio los niveles de referencia de radiación en la población pediátrica son bajos. El presente trabajo puede servir como referente nacional.

Introduction: Due to the characteristics and challenges of the pediatric population regarding radiation, the use of adequate doses of radiation is a duty of medical diagnostic centers. For this reason, the Dose Reference Levels (DRL) have been established in many countries to optimize and monitor the protocols of each institution. In Colombia there are no studies in this subject. Objective: To show the DRLs used in a university hospital of high complexity in the modalities of computed tomography (CT), radiography and fluoroscopy and to compare them with international standards. Methodology: Retrospective descriptive trial between 2018 and 2019. We analyzed dose length product (DLP) data for skull, chest, abdomen, and high-resolution chest CT (HRCT); and dose area product (DAP) for chest, abdomen, bone, and fluoroscopy radiography by age groups. Results: Data were collected for a total of 780 patients. 360 x-rays, 100 fluoroscopy and 320 tomography scans. Reference levels of radiation dose used in the hospital were found to be low compared to European guidelines of 2018 reference levels. DRLs are described for each study and age group. Conclusion: It was demonstrated that at the hospital where the study was conducted, reference levels of radiation in the pediatric population are low. This work can serve as a national reference.

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