ABSTRACT
The acute chest syndrome is a complication of the sickle cell anemia that was define as the onset of chest pain, fever, cough, tachypnea, leukocytosis, and a new infiltrate on chest radiograph. It requires handling with intense hydration, transfusions of packed red blood cells or exchange transfusion, close monitoring, oxygen and ventilatory support either noninvasive or through conventional endotracheal tube. Noninvasive ventilation is a proven treatment option for the management of acute and chronic conditions in children, with fewer side effects than conventional ventilation. Four cases of acute chest syndrome patients who were manage with noninvasive ventilation by facemask on CPAP with pressure support were present. Noninvasive ventilation is an effective ventilation option therapy for the management of acute chest syndrome in children.
ABSTRACT
La criptococosis es una enfermedad oportunista definitoria de sida con bajo incidencia en población pediátrica y de elevada mórbida-mortalidad. Presentamos el caso de un adolescente con diagnóstico reciente de sida con criptococosis diseminada como parte de un síndrome de reconstitución a la séptima semana de inicio de terapia antirretroviral, quien recibió manejo de forma exitosa con anfotericina B en monoterapia y sin complicaciones a un año de seguimiento.
Cryptococcosis is an AIDS-defining opportunistic disease with low incidence in the pediatric population associated with high morbidity and mortality. We report the case of a teenager newly diagnosed with AIDS with disseminated cryptococcosis as part of an immune reconstitution syndrome in the seventh week of initiation of antiretroviral therapy, who received mono therapy with amphotericin B without complications to a year follow up
ABSTRACT
Objetivo: Determinar los factores de riesgo asociados a la apendicitis aguda perforada en el Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" (HEPOTH) Materiales y métodos: Estudio de casos (apendicitis perforada) y controles (apendicitis flegmonosas) pareados 1:2 de febrero 2003 a enero 2009 en el HEPOTH. Se analizaron 7 variables con la t de Student y 4 cualitativas con el x2 corregido de McNemar. Resultados: Se obtuvieron 107 casos y 178 controles. El sexo, la edad promedio de intervención y el peso promedio no fueron significativamente distintos. La mayoría de los sujetos procedía de la provincia de Panamá. El tiempo de intervención fue la variable con mayor fuerza de asociación ( 66.5 vs 34.2 horas ; p<.001; IC 95% 21.0-46.0) aunque también resultaron estadisticamente significativos el percentil del peso para la edad ( p=.048), los leucocitos preoperatorios (p=.027), los neutrófilos preoperatorios (p=.010), la historia de vómitos (p<.0001), de diarrea (p<.0001) para a perforación apendicular. La temperatura preparatoria promedio fue significativamente distinta en ambos grupos (p<.001) pero clínicamente no relevante (37.8 vs 37.2ºC). El uso de antibióticos preoperatorios resultó ser un factor protector (p<0.0001); OR 0.31; IC 95% 0.20-0.47). Conclusiones: El tiempo de intervención desde el primer síntoma es el principal factor de riesgo para la perforación apendicular. Algunos otros criterios clínicos y paraclínicos también deben tomarse en consideración para el diagnóstico y el tratamiento oportuno. El uso preoperatorio de antimicrobianos profilácticos y analgésicos puede mejorar los resultados y la condición del paciente pediátrico con apendicitis aguda.
Aim: To determine the risk factors associated with perforated acute appendicitis at the Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" (HEPOTH) Materials and methods: Matched 1:2 cases control study ( perforated vs flegmonous) from February 2003 to January 2009 at the HEPOTH. Seven quantitative variables were analyzed with Student t and 4 qualitatives variables were analyzed McNemar ´s corrected x2. Results: One hundred and seven cases and 178 controls were obtained.Gender, mean intervention age, and mean weight were not significantly different . Most of the subjects came from the province of Panama. Time until intervention was the variable with the most association strength ( 66.5 vs 34.2 hours ; p<.001; IC 95% 21.0-46.0) even though weight for age percentile ( p=.048), preoperatory leucocytes (p=.027), preoperatory neutrophils (p=.010), and the history of vomits (p<.0001), and diarrhea(p<.0001) also resulted statistically significant for appendices perforation. Mean preparatory temperature was significantly different (p<.001) but not clinically relevant (37.8 vs 37.2ºC) between both groups. The use of preparatory antibiotics turned out to be a protection factor (p<0.0001); OR 0.31; IC 95% 0.20-0.47). Conclusions: Time until intervention since the first symptoms is the main risk factor for appendiceal perforation. Some other clinical and paraclinical criteria must also be taken into account for a timely diagnosis and treatment. Preoperatory use of prophylactic antimicrobial and analgesics can improve the results and the condition of the pediatric patient with acute appendicitis.