Impacto de la COVID-19 en la forma de presentación y evolución de la apendicitis aguda en pediatría

IntroductionAcute appendicitis (AA) is the most frequent urgent surgical pathology in pediatrics. The COVID-19 pandemic has led to a decrease in emergency department (ED) visits, which can lead to a delay in health care and an increase in the severity of the pathologies. The objective is to analyze the rate of complicated AA during the pandemic, compared to the same period of the previous year.Materials and methodsRetrospective unicenter observational cohort study that included patients under 14 years of age seen in the ED with a diagnosis of AA during the months of March to May 2019 (non-pandemic) and 2020 (pandemic).Results90 patients were included (41 in non-pandemic and 49 in pandemic). No difference was found between the two periods in the time from the clinic onset until the visit to the ED (37 h vs 38 h, p = 0.881), but there was a difference in the time from arrival at the ED until the surgery (7:00 h vs 10:30 h, p = 0.004). The difference was accentuated when comparing the month of March with April-May 2020 (6 h vs 12 h; p = 0.001). No significant differences were observed in the rate of complicated AA in intraoperative diagnosis (35% vs 33%; p = 0.870) or anatomopathology (35% vs 48%; p = 0.222), nor in the number of postoperative complications, length of hospitalization and readmissions. An increase in the anatomopathological diagnosis of AA with periapendicitis was observed (47% vs 81%; p = 0.001)ConclusionDuring the pandemic, a delay from arrival at the ED until the surgery was observed in children diagnosed with AA. This delay resulted in an increase in the diagnosis of histologically evolved AA, but without an increase in the clinical complications of the disease.     

Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal

ObjectivesThe aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns.Materials and methodsHemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded.ResultsThe study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001].ConclusionsUltrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation.     

Giardiosis en población pediátrica de la provincia de Castellón: clínica e impacto

IntroductionGiardiasis is a gastrointestinal parasitosis that has a great public health impact.Patients and methodsObservational case study - in children under 15 years old in the Health Department 3 of the Province of Castellon (Spain), during the period 2012-2019.ResultsA total of 190 cases of giardiasis were recorded in children under 15 years old. The number of cases varied significantly according to age group and month of the year. There were 115 males. The most frequent symptoms were diarrhea and abdominal pain. The most commonly used treatment was standard metronidazole (80% of patients). Co-infection occurred in 13% of cases, and comorbidities in 36%, especially atopic dermatitis and lactose/fructose intolerance. Relapses and/or re-infections were recorded in 8%. All cases were diagnosed by conventional parasitological stool tests and complementary immunochromatography (63 cases). Thirty-five samples were positive for Giardia duodenalis by qPCR. The direct health cost per patient was 117€. A disease notification bias was detected between 2012-2016 at a national scale.ConclusionsGiardiasis is a current disease in Castellon, and should be considered as a probable diagnosis of gastrointestinal disease in a child under 4 years-old with diarrhea and abdominal pain. Its correct clinical and therapeutic management could reduce the possibility of worsening of the patient's condition and, additionally, would reduce the economic impact of the disease in terms of direct health costs.     

Valoración de la sedación en el niño crítico con ventilación mecánica durante la aspiración endotraqueal

ObjectivesTo compare the changes in clinical sedation scales, bispectral index (BIS) and physiological variables occurring during tracheal suction in critically ill children.DesignProspective, observational study in critically ill children on mechanical ventilation. BIS value, heart rate (HR), systolic blood pressure (SPB), diastolic blood pressure (DBP), modified Ramsay sedation scale score and the dose of sedative drugs were recorded before and 3 minutes after every tracheal suction.ResultsA total of 83 tracheal suctions were analyzed from 46 children, 1 month to 15 years of age. Most of the children (92%) were receiving continuous infusions of fentanyl and midazolam, and 45.7% of them were receiving vecuronium. The increase in BIS, SPB and DBP values were small but statistically significant (BIS, from 51.8 to 57.3; SBP, from 92.9 to 103.1 mmHg; DBP, from 51.8 to 58.9 mmHg). There was poor correlation between the BIS, HR, SBP and DBP values before and after suction. A total of 87% of patients maintained the same Ramsay score values.ConclusionsTracheal suction produces a slight increase in the BIS and the BP in critically ill children who are receiving sedation by continuous infusion. Most children with adequate sedation do not need any other drugs before the tracheal suction. Physiological variables have no correlation with sedation scales or BIS values during the tracheal suction.     

Promoción de la lectura en etapas precoces desde atención primaria en una zona de exclusión social

IntroductionReading is a tool that stimulates brain activity, increasing its cognitive reserve and providing innumerable benefits such as the stimulation of empathy, concentration or language development. Promoting reading at a very early age helps develop reading skills correctly. However, social inequalities can result in this practice being carried out less in groups of low socioeconomic, social or cultural levels. The purpose of this study was to assess the outcomes of a promoting reading habits intervention in a primary health care center located in a social transformation district by talking to the parents, providing books to families and encouraging books to become a part of children's play preferences.Materials and methodsA non-random intervention study in which children born in 2015 and registered in a particular health center took part. A reading promotion intervention was carried out at the ages of 4, 6, 12 and 18 months and at 24 months their preference for reading activities was assessed in relation to other leisure activities.ResultsThree hundred forty-two subjects were included, 154 allocated in the intervention group and 188 in the control group. The children in the intervention group exhibited a greater preference for reading as a leisure activity as compared to those in the control group (reading ranked in last position of favourite activities in 18.8 vs. 33.9%; p=0.003). The variables found on multivariate analysis to have a greater influence on reading position in the ranking of favorite activities were not having participated in the intervention OR: 2.06 (1.19-3.58) and gipsy ethnicity, OR: 2.37 (1.38-4.09).ConclusionsResults reveal a slight improvement in the preference for reading as an activity in the children that took part in the literacy program.     

Influencia étnica en la prevalencia de síndrome metabólico en población pediátrica obesa

IntroductionObesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population.ObjectiveTo analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population.Patients and methodsA retrospective study of 616 obese children and adolescents (BMI ≥ 2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity + 2 or more of the following components: HDL-cholesterol < 40 mg/dl, triglycerides > 110 mg/dl, systolic and/or diastolic blood pressure > p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed.ResultsAlmost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR = 2.4 [CI 95%: 1.5-3.8]), P<.005] and OR = 2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment.ConclusionThere is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood     

Evolución clínica de la forma hiperaguda de la encefalomielitis aguda desmielinizante

IntroductionAcute disseminated encephalomyelitis (ADEM) is an inflammatory disease that damages the white matter of the central nervous system. Its clinical course is monophasic and multifocal. The outcome is usually favourable. We report our experience in the management of the hyperacute form of ADEM.Patients and methodsA retrospective chart review was performed on five patients admitted in coma with a diagnosis of ADEM in the Paediatric Intensive Care Unit (PICU). We describe their epidemiological, clinical, microbiological, magnetic resonance imaging features and their treatment and outcomes.ResultsThe mean age was 5.2 years and all were male. None of them fulfilled radiologic criteria for acute haemorrhagic leukoencephalitis. At admission all patients were in a coma, and all were on controlled mechanical ventilation support. Before their admission all patients had fever. In all cases the time between the first neurological symptom and coma was ≤ 24 hours. The cerebrospinal fluid examination was abnormal in three patients, and in one case, oligoclonal bands were detected. The first brain magnetic resonance imaging (MRI) showed white matter and basal ganglia lesions in all patients, and in three cases the spinal medulla was affected by demyelination. All patients were treated with a course of high-dose methylprednisolone. Four patients were also treated with high-dose immunoglobulins, and one of them received plasmapheresis. Two patients died, and one patient had severe sequelae at discharge from the PICU. At discharge the lesions in the white matter were still present in the MRI. After nine months the three survivors had a Glasgow Outcome Scale score of five and no one relapsed.ConclusionsThere is a hyperacute clinical form of ADEM which has a high mortality rate. In the short term, the clinical improvement of hyperacute ADEM is not accompanied by a decrease of severity of the brain MRI.