Reinfección por SARS-CoV-2 en pacientes con antecedentes de MIS-C. Presentación de dos casos / MIS-C patients who were reinfected with SARS-CoV-2. Report of 2 cases

El síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés) es una enfermedad rara. Se desconoce si los niños que se recuperaron del MIS-C tienen riesgo de recurrencia de MIS-C cuando presentan reinfección por SARS-CoV-2. El objetivo de este estudio es describir los casos de dos niñas que se recuperaron del MIS-C y presentaron reinfección por SARS-CoV-2 sin recurrencia de MIS-C.

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition. It is still unknown if children who have recovered from MIS-C are at a risk of recurrence of MIS-C when they are reinfected with SARS-CoV-2. In this study, we aimed to report 2 children who recovered from MIS-C and reinfected with SARS-CoV-2 without recurrence of MIS-C.

Síndrome inflamatorio multisistémico pos-COVID como abdomen agudo quirúrgico en pediatría / Multisystem inflammatory syndrome post-COVID as acute abdominal pain in pediatrics

RESUMEN Se presenta el caso de un adolescente masculino, de 15 años, que ingresa por Guardia por dolor abdominal y fiebre de una semana de evolución con RT PCR negativa bajo el diagnóstico presuntivo de apendicitis aguda, que se descarta tras estudios complementarios, y se realiza diagnóstico de síndrome inflamatorio multisistémico asociado a infección por COVID-19.

ABSTRACT We report the case of a 15-year-old adolescent male patient who was admitted to the emergency department due to abdominal pain and fever that started one week before, with negative RT-PCR. The suspected diagnosis was acute appendicitis that was ruled out with complementary tests. The final diagnosis was multisystem inflammatory syndrome associated with COVID-19.

Patrón inflamatorio de las vías aéreas en pacientes fumadores con enfermedad pulmonar obstructiva crónica / Inflammatory pattern of the airways in COPD smokers

Introducción: La enfermedad pulmonar obstructiva crónica cursa con un patrón inflamatorio en la vía aérea que incluye neutrófilos, macrófagos, linfocitos, los cuales se pueden obtener mediante un cepillado bronquial citológico. Objetivos: Identificar patrón inflamatorio según células inflamatorias presentes en la vía aérea, mediante el cepillado bronquial citológico e índice tabáquico de paquetes/año en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: Se realizó un estudio descriptivo transversal en pacientes con enfermedad pulmonar obstructiva crónica, que concurrieron al Hospital Neumológico Benéfico-Jurídico, en el período comprendido de junio de 2018 a junio de 2019, con indicación para la realización de fibrobroncoscopía con cepillado bronquial. Resultados: El 53,1 por ciento de los pacientes corresponden al sexo masculino. Un 46,1 por ciento presentó un índice tabáquico de paquetes/año entre 21-40. Predominaron las criptas y estrías como hallazgos broncoscópicos con un 51 por ciento y 40,8 por ciento respectivamente en pacientes con índice paquetes/año mayor que 40. De los pacientes con índice paquetes/año mayor de 40 (13 para un 26,5 por ciento) presentaron hiperplasia de células basales. El 46,9 por ciento de los pacientes presentaron un patrón inflamatorio neutrofílica. Conclusiones: Se identificaron a los pacientes con EPOC que presentaron patrón inflamatorio neutrofílica en la vía aérea y elevado índice tabáquico y desde el punto de vista broncoscópico tienen varios hallazgos que sugieren cronicidad(AU)

Introduction: Chronic obstructive pulmonary disease presents with an inflammatory pattern in the airway that includes neutrophils, macrophages, and lymphocytes, which can be obtained by cytological bronchial brushing. Objectives: To identify inflammatory pattern according to inflammatory cells present in the airway, through cytological bronchial brushing and smoking rate of packs/year in patients with chronic obstructive pulmonary disease. Methods: A cross-sectional descriptive study was carried out in patients with chronic obstructive pulmonary disease, who attended Benefico-Jurídico Pneumological Hospital, from June 2018 to June 2019, with an indication for fiberoptic bronchoscopy with bronchial brushing. Results: 53.1percent of the patients correspond to the male sex. 46.1percent ad a smoking rate of packs/year between 21-40. Crypts and striae predominated as bronchoscopic findings with 51percent and 40.8percent respectively in patients with a pack/year index greater than 40. Patients with a pack/year index greater than 40 (13 for 26.5percent) showed basal cell hyperplasia. 46.9percent of the patients had a neutrophilic inflammatory pattern. Conclusions: Patients with COPD who had a neutrophilic inflammatory pattern in the airway and high smoking index were identified, and from the bronchoscopic point of view they have several findings that suggest chronicity(AU)

Síndrome inflamatorio multisistémico post-COVID en niños: reporte de casos en Montevideo, Uruguay, 2020-2021 / Multsystemic inflammatory syndrome in post-Covid children: clinical case studies in Montevideo, Uruguay, 2020-2021 / Sindrome inflamatório multisistêmico pós-COVID em crianças: relato de casos em Montevdéu, Uruguai, 2020-2021

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.

Rubiadin exerts an acute and chronic anti-inflammatory effect in rodents / A Rubiadina exerce um efeito anti-inflamatório agudo e crônico em roedores

Rubiadin is identified as a bioactive anthraquinone that exists in some quinone rich plants. The current research was carried out to evaluate the potential anti-inflammatory impact of Rubiadin in acute and chronic inflammation test models in rodents. The anti-inflammatory activity of Rubiadin was examined in cotton pellet-induced granuloma and carrageenan-induced edema as chronic and acute inflammation models in rats. TNF-α level and histopathological changes were assessed using sampled foot tissue of rat in the acute model. Also, the IL-1β level was assessed in the chronic model. One-way ANOVA (post hoc Tukey’s) analysis was used for comparing the groups. Rubiadin (0.5 mg/kg, i.p.) induced a significant reduction in TNF α level and the paw edema compared to the control group in carrageenan test. Also, it was observed that the anti-inflammatory activity of Rubiadin (0.5 mg/kg, i.p.) is comparable to mefenamic acid (30 mg/kg, i.p.) as the standard drug. Rubiadin was effective in granuloma induced by cotton pellet concerning the granuloma and transudate formation amount. Rubiadin's anti-inflammatory effects were associated with a significant IL-1β decrease in this model. The results suggest that Rubiadin as a natural compound can possess significant peripheral anti-inflammatory impacts.

A rubiadina é identificada como uma antraquinona bioativa que existe em algumas plantas ricas em quinonas. A presente pesquisa foi realizada para avaliar o potencial impacto anti-inflamatório da rubiadina em modelos de teste de inflamação aguda e crônica em roedores. A atividade anti-inflamatória da rubiadina foi examinada em granuloma induzido por pellet de algodão e edema induzido por carragenina como modelos de inflamação crônica e aguda em ratos. O nível de TNF-α e as alterações histopatológicas foram avaliados usando amostra de tecido do pé de rato no modelo agudo. Além disso, o nível de IL-1β foi avaliado no modelo crônico. A análise ANOVA de uma via (post hoc de Tukey) foi usada para comparar os grupos. A rubiadina (0,5 mg / kg, i.p.) induziu uma redução significativa no nível de TNF α e no edema da pata em comparação com o grupo de controle no teste de carragenina. Além disso, foi observado que a atividade anti-inflamatória da rubiadina (0,5 mg / kg, i.p.) é comparável ao ácido mefenâmico (30 mg/kg, i.p.) como o fármaco padrão. A rubiadina foi eficaz no granuloma induzido por pellet de algodão no que diz respeito à quantidade de granuloma e formação de transudato. Os efeitos anti-inflamatórios da rubiadina foram associados a uma redução significativa de IL-1β nesse modelo. Os resultados sugerem que a rubiadina como um composto natural pode ter impactos anti-inflamatórios periféricos significativos.

Rubiadin exerts an acute and chronic anti-inflammatory effect in rodents

Abstract: Rubiadin is identified as a bioactive anthraquinone that exists in some quinone rich plants. The current research was carried out to evaluate the potential anti-inflammatory impact of Rubiadin in acute and chronic inflammation test models in rodents. The anti-inflammatory activity of Rubiadin was examined in cotton pellet-induced granuloma and carrageenan-induced edema as chronic and acute inflammation models in rats. TNF- level and histopathological changes were assessed using sampled foot tissue of rat in the acute model. Also, the IL-1 level was assessed in the chronic model. One-way ANOVA (post hoc Tukeys) analysis was used for comparing the groups. Rubiadin (0.5 mg/kg, i.p.) induced a significant reduction in TNF level and the paw edema compared to the control group in carrageenan test. Also, it was observed that the anti-inflammatory activity of Rubiadin (0.5 mg/kg, i.p.) is comparable to mefenamic acid (30 mg/kg, i.p.) as the standard drug. Rubiadin was effective in granuloma induced by cotton pellet concerning the granuloma and transudate formation amount. Rubiadins anti-inflammatory effects were associated with a significant IL-1 decrease in this model. The results suggest that Rubiadin as a natural compound can possess significant peripheral anti-inflammatory impacts.

Resumo A rubiadina é identificada como uma antraquinona bioativa que existe em algumas plantas ricas em quinonas. A presente pesquisa foi realizada para avaliar o potencial impacto anti-inflamatório da rubiadina em modelos de teste de inflamação aguda e crônica em roedores. A atividade anti-inflamatória da rubiadina foi examinada em granuloma induzido por pellet de algodão e edema induzido por carragenina como modelos de inflamação crônica e aguda em ratos. O nível de TNF- e as alterações histopatológicas foram avaliados usando amostra de tecido do pé de rato no modelo agudo. Além disso, o nível de IL-1 foi avaliado no modelo crônico. A análise ANOVA de uma via (post hoc de Tukey) foi usada para comparar os grupos. A rubiadina (0,5 mg / kg, i.p.) induziu uma redução significativa no nível de TNF e no edema da pata em comparação com o grupo de controle no teste de carragenina. Além disso, foi observado que a atividade anti-inflamatória da rubiadina (0,5 mg / kg, i.p.) é comparável ao ácido mefenâmico (30 mg/kg, i.p.) como o fármaco padrão. A rubiadina foi eficaz no granuloma induzido por pellet de algodão no que diz respeito à quantidade de granuloma e formação de transudato. Os efeitos anti-inflamatórios da rubiadina foram associados a uma redução significativa de IL-1 nesse modelo. Os resultados sugerem que a rubiadina como um composto natural pode ter impactos anti-inflamatórios periféricos significativos.

Strongyloides stercoralis en la médula ósea de una persona que vive con VIH: reporte de caso

Strongyloides stercoralis es un nemátodo que se caracteriza por causar infección intestinal, usualmente asintomática, en pacientes inmunocompetentes. Sin embargo, en aquellos que viven con VIH, y de acuerdo con su estado inmune, puede generar un síndrome de hiperinfección con complicaciones diversas por diseminación a diferentes órganos. Se presenta el caso de un paciente de 30 años con diagnóstico de novo de infección por el virus de la inmunodeficiencia humana, con documentación de enfermedad linfoproliferativa. En los estudios complementarios se documenta la presencia de Strongyloides stercoralis de manera inusual en la médula ósea. A pesar de contar con un recuento de linfocitos T CD4+ mayor a 400 células/ µL y de haberse iniciado el manejo para esta condición con ivermectina, el paciente fallece por un estado séptico asociado al síndrome de hiperinfección, por lo cual se considera que este es un caso inusitado que obliga al clínico a tener en cuenta la presencia del nemátodo en pacientes que viven con VIH.

Summary Strongyloides stercoralis is a nematode that is characterized by causing a usually asymptomatic intestinal infection in immunocompetent individuals. However, in patients living with HIV and depending on their immune status, it can generate a hyperinfection syndrome with various complications due to dissemination to different organs. We present the case of a 30-year-old patient with a de novo diagnosis of human immunodeficiency virus infection and lymphoproliferative disease. Within the laboratory workup, the presence of Strongyloides stercoralis was documented in the bone marrow. Despite having a CD4+ T lymphocyte count greater than 400 cells/microliter and having started treatment for this condition with ivermectin, the patient died due to a septic state associated with hyperinfection syndrome, which is why this is considered an unusual case that alerts the clinician to take into account the presence of the nematode in patients living with HIV.

Síndrome inflamatorio multisistémico en adultos: revisión sistemática y metaanálisis del espectro reumatológico de las complicaciones postinfecciosas de la COVID-19

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe complication in adults infected with SARS-CoV-2. However, the pathophysiology remains elusive, as the limited number of reports preclude a broader understanding of this syndrome. We conducted this systematic review to explore the clinical spectrum of MIS-A, in particular its rheumato-logical manifestations. Meta-analyses of case-series were also performed. We identified 28 patients from 14 case reports and two case series of MIS-A. This disease occurred equally in both genders, with a mean age of 33 + 10 years old, and predominantly in those of African descent (40%). Rheumatological manifestations consisted of Kawasaki Disease (KD)-like symptoms. Ninety percent of patients had positive COVID-19 serology tests, while 48% of patients were negative for COVID-19 RT-PCR test. Twelve patients were admitted to ICU and unfortunately two died. Although the signs and symptoms of MIS mimicked KD, the gastrointestinal findings were more prominent in the former group. The demographic make-up was also different, with MIS-A occurring mostly in those of African descent. Importantly, unlike their paediatric counterparts, the adult group did not have coronary artery abnormalities. Long-term monitoring is needed as safety data is scarce. Of note, although the prognosis of MIS-A is excellent, the life-threatening nature of this syndrome demands intensive care unit level of care and mechanical support. During the COVID-19 pandemic, a constellation of KD symptoms in an adult patient should alert the clinician to the possibility of MIS-A. © 2021 Asociación Colombiana de Reumatología. Published by Elsevier Espafña, S.L.U. All rights reserved.

El espectro clínico del síndrome inflamatorio multisistémico en adultos (MIS-A) es una complicación rara, pero grave en adultos infectados por el coronavirus del síndrome respiratorio agudo grave de tipo 2. Realizamos una búsqueda bibliográfica en varias bases de datos, y también se hizo en metanálisis. Identificamos 28 pacientes de 14 informes de casos y 2 series de casos de MIS-A. Esta enfermedad se manifestó por igual en ambos sexos, con una edad media de 33 + 10 anos, y se presentó predominantemente en afrodescendientes (40%). Las manifestaciones reumatológicas consistieron en síntomas similares a la enfermedad de Kawasaki (EK). El 90% de los pacientes tuvo pruebas positivas de serología de la enfermedad por el coronavirus de 2019 (COVID-19), mientras que el 48% dio negativo para la prueba de reacción en cadena de la polimerasa con transcriptasa inversa de la COVID-19. Doce pacientes ingresaron en la unidad de cuidados intensivos y, lamentablemente, 2 fallecieron. Encontramos que, si bien los signos y los síntomas de MIS imitaban a EK, los hallazgos gastrointestinales eran más prominentes en el primer grupo. Además, la composición demográfica fue asimismo diferente, con MIS-A que se presentó principalmente en afrodescendientes. Es importante destacar que, a diferencia de sus homólogos pediátricos, el grupo de los adultos no experimentó anomalías en las arterias coronarias. Se necesita un seguimiento a largo plazo, ya que los datos de seguridad son escasos. Es de destacar que, aun cuando el pronóstico de MIS-A es excelente, la naturaleza potencialmente mortal de este síndrome exige el nivel de atención y el soporte mecánico de la unidad de cuidados intensivos. Durante la pandemia por la COVID-19, una constelación de síntomas de EK en un paciente adulto debe alertar al médico sobre la posibilidad de MIS-A.

Kawasaki disease in Colombia: A systematic review and contrast with multisystem inflammatory syndrome in children associated with COVID-19

Introduction: Kawasaki disease (KD) is an acute vasculitis with multisystem involvement. Recently, the increasing incidence of a condition that closely resembles KD in many cases, named multisystem inflammatory syndrome in children (MIS-C), has set off alarms amid the current worldwide coronavirus disease-19 (COVID-19) pandemic. Hence, the aim is to conduct a systematic review of the literature about KD in Colombia and contrast it with COVID-19-related MIS-C. Materials and methods: A search was carried out in both international and Latin American electronic databases for publications concerning patients with KD in the Colombian population. Records were then screened by titles and/or abstracts, assessed for eligibility, and reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. The search included studies reporting MIS-C associated with COVID-19, and compared these patients with our findings of KD in Colombia. Results: Out of 36 publications retrieved, 17 were included, representing 120 individuals. Male to female ratio was 1.6, and most patients (90.4%) were aged 5 years or less. Among the main features of KD, fever was the most frequent (96.2% of the patients), while cervical lymphadenopathy was present in only 40.6%. Intravenous immunoglobulin was administered in 91.4% cases and 6.2% were resistant. Cardiac involvement was found in around 30%, and 20% had coronary artery lesions. Comparison between MIS-C associated with COVID-19 and KD in Colombia indicates that patients affected by MIS-C were older (72.2% of MIS-C patients > 5 years), had higher rates of cardiac involvement, and required critical care more often. Conclusions: Our findings of KD in Colombia are consistent with the available descriptions of KD in the scientific literature. Given the increasing rate of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in Colombia and Latin America, our study raises awareness about MIS-C in pediatric patients with COVID-19 and its relationship with KD.

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis aguda con compromiso multisistémico. Recientemente, la incidencia creciente de una condición que se asemeja en forma considerable a la EK en muchos casos, denominada síndrome inflamatorio multisistémico (SIMS) en niños, ha encendido las alarmas en medio de la actual pandemia mundial de la enfermedad COVID-19. Por consiguiente, nos propusimos realizar una revisión sistemática de la literatura acerca de la EK en Colombia y contrastarla con el SIMS relacionado con COVID-19 en niños. Materiales y métodos: Buscamos publicaciones respecto a pacientes con EK en población colombiana, en bases de datos electrónicas tanto internacionales como latinoamericanas. Los registros hallados fueron tamizados por títulos o resúmenes, evaluados para elegibilidad y revisados. Se siguieron las guías Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Posteriormente, buscamos estudios que reportaran SIMS temporalmente asociado con COVID-19 en niños y comparamos estos pacientes con nuestros hallazgos de EK en Colombia. Resultados: De 36 publicaciones encontradas se incluyeron 17, las cuales representaron 120 individuos. La razón hombre a mujer fue de 1,6 y la mayoría de los pacientes (90,4%) tenía 5 anos o menos. Entre las principales características de EK, la fiebre fue la más frecuente (96,2%), mientras que la linfadenopatía cervical estuvo presente solo en el 40,6%. La inmunoglobulina intravenosa se administró en el 91,4% de los casos y 6,2% presentaron resistencia. Se encontró compromiso cardiaco en alrededor del 30% de los pacientes, en tanto que el 20% tuvo lesiones de arterias coronarias. La comparación entre las características clínicas de la EK y el SIMS asociado a COVID-19 mostró que los individuos afectados por el SIMS eran mayores (72,2% con SIMS tenían más de cinco anos), tuvieron mayores índices de compromiso cardiaco y requirieron cuidado crítico con mayor frecuencia. Conclusiones: Nuestros hallazgos de EK en Colombia son consistentes con las descripciones disponibles de esta enfermedad en la literatura científica. Debido al aumento de infección por SARS-CoV-2 en Colombia y Latinoamérica, nuestro estudio busca crear conciencia sobre el SIMS en pacientes pediátricos con COVID-19 y su relación con la EK.

Pseudotumor inflamatorio hepático, una entidad de difícil diagnóstico / Inflammatory pseudotumor of the liver: a condition hard to diagnose

RESUMEN El pseudotumor inflamatorio hepático es una lesión muy infrecuente, sin una etiología ni patogenia claras. Su diagnóstico preoperatorio no es habitual pero, en caso de realizarse, puede evitar la cirugía. Presentamos el caso de un paciente joven, con antecedente de lupus cutáneo que, tras debutar con una pancreatitis aguda, presenta episodios de colangitis y cuyos hallazgos radiológicos no permiten descartar la presencia de un colangiocarcinoma, por lo que se realiza hepatectomía izquierda, siendo el diagnóstico histológico final de pseudotumor inflamatorio hepático.

ABSTRACT Inflammatory pseudotumors of the liver are rare and lack clear etiology and pathogenesis. The preoperative diagnosis is seldom made but it avoids unnecessary surgery. We report the case of a young male patient with a history of cutaneous lupus and episodes cholangitis after an acute pancreatitis. As the imaging tests could not rule out cholangiocarcinoma, a left liver resection was performed, and the final histologic diagnosis was inflammatory pseudotumor of the liver.

Factores de Riesgo de Hospitalización en Camas Básicas y Críticas asociados a Síndrome Inflamatorio Multisistémico Pediátrico (SIM) relacionado a COVID-19 de Niños, Niñas y Adolescentes: Revisión Sistemática Exploratoria / Risk Factors of Hospitalization in Basic and Critical Cases associated with Pediatric Multisystemic Inflammatory Syndrome (SIM) related to COVID-19 in Boys, Girls and Adolescents: Exploratory Systematic Review

Introducción. Introducción. La pandemia por SARS-CoV-2 en pediatría ha tenido un bajo impacto en niños y niñas adolescentes (NNA) debido a que un gran porcentaje son asintomáticos o desarrollan síntomas leves. No obstante, se han reportado casos de síndrome inflamatorio multisistémico pediátrico (SIM) por este virus, el cual afecta a múltiples órganos y sus manifestaciones se asemejan a la enfermedad de Kawasaki. La mayoría ha requerido hospitalización en unidades críticas (UCI). A pesar de la vigilancia epidemiológica de esta enfermedad, no se han reportado factores de riesgo (FR) para hospitalización. Objetivo. Explorar en la literatura los FR asociados a hospitalización en camas básicas y críticas de NNA con SIM relacionado a COVID-19. Métodos. Revisión sistemática exploratoria de bases de datos Pubmed, Epistemonikos, Lilacs y Scielo desde el año 2020, con un rango etario de 0 a 19 años, con estrategia de búsqueda sensible para FR de hospitalización en camas básicas y críticas por SIM. Resultados. De 84 artículos se seleccionaron 7. Las manifestaciones clínicas incluyeron fiebre persistente, síntomas gastrointestinales y parámetros inflamatorios severos. También se reporta asociación a comorbilidades y estrato socioeconómico bajo. El ingreso mediano a UCI fue de un 60%, y la mortalidad por SIM fue menor a un 2%, pero de mayor magnitud comparado con los ingresos por COVID-19 en este grupo etario. Los FR de ingreso a UCI fueron asociados a dolor abdominal [OR 1,7 (IC95% 1,2; 2,7)] y a mayor edad, con OR ajustado de 1,9 [IC95%1,4; 6] para edad de 6 a 12 años, OR ajustado de 2,6 [IC95% 1,8; 3,8] para edad de 13 a 20 años. La elevación de proteína C reactiva, troponina, ferritina, dímero D, péptido natriurético cerebral (BNP), BNP N-terminal pro tipo B o interleucina-6, y/o recuentos reducidos de plaquetas, linfocitos o albúmina se asociaron a ingreso a UCI. La etnia afroamericana se asoció a mayor ingreso a UCI con OR de 1,6 [IC95% 1,0; 2,4]. Conclusión. Los FR para hospitalización de NNA con SIM, reportados y seleccionados en la literatura, son edad sobre los 6 años, etnia afroamericana, presencia de comorbilidades y nivel socioeconómico bajo. Para el ingreso a UCI, se suma a esto, compromiso clínico respiratorio y/o gastrointestinal, y presencia de parámetros inflamatorios elevados. La mortalidad fue inferior al 2%, pero significativamente mayor que la mortalidad por infección COVID-19 exclusiva.

Background. SARS-CoV-2 pandemic in pediatrics population (children and adolescents) has low impact in due to large percent of asymptomatic or mild symptoms. However, since March 2020, cases of pediatric multisystemic inflammatory syndrome (PMIS) have been reported, which affects multiple organs and its main manifestations resemble Kawasaki disease. This group frequently required hospitalization in critical care units (ICU), and despite epidemiological surveillance of this disease, no risk factors (RF) for hospitalization of these children has been reported. Objetive. To explore RF in literature associated with pediatric hospitalization in basic and critical care beds from children and adolescents with PMIS related to COVID-19. Methodology. exploratory systematic review of Pubmed, Epistemonikos, Lilacs and Scielo databases, with limits: publication date from 2020 until now, and age range from 0 to 19 years. We made a sensitive search strategy for RF of pediatric hospitalization in basic and critical beds by PMIS. Results. clinical manifestations of hospitalized patients included persistent fever (3 to 5 days), gastrointestinal symptoms (vomiting, nausea, diarrhea and abdominal pain), and inflammatory laboratory parameters in highly ranges. It is also reported an association with presence of comorbidities and low socioeconomic status. The median admission to ICU was 60%, and mortality less than 2%, but greater magnitude compared to COVID-19 mortality. RF for ICU admission were associated with older age, with adjusted OR of 1.9 [CI95% 1.4; 6] for age 6 to 12 years, adjusted OR of 2.6 [CI95% 1.8; 3.8] for age 13 to 20 years, and abdominal pain [OR 1.7 (CI95% 1.2; 2.7)]. Among laboratory tests, elevated C-reactive protein, troponin, ferritin, D-dimer, brain natriuretic peptide (BNP), N-terminal pro-B-type BNP or interleukin-6, and/or reduced platelet, lymphocyte or albumin counts were associated with ICU admission. African-American ethnicity was also associated with higher ICU admission with OR of 1.6 [CI95% 1.0; 2.4]. Conclusion. RFs for hospitalization of children with PMIS reported and selected in the literature were: age over 6 years, Afro-American ethnicity, presence of comorbidities and low socioeconomic level. In addition to this, for ICU admission, it is reported respiratory and/or gastrointestinal clinical involvement, and elevated inflammatory parameters presence. Mortality was less than 2%, but significantly higher than mortality due to exclusive COVID-19 infection.

Anti-inflamatórios não esteroides tópicos para o alívio da dor artritica, beneficios para idosos / Non-steroid anti-inflammatory topics for arthritic pain relief, benefits for elderly / Temas antiinflamatorios no esteroides para el alívio del dolor artritico, beneficios para personas mayores

Objetivo: Identificar e analisar os anti-inflamatórios não esteroides tópicos para o alívio da dor artrítica, benefícios para idosos. Métodos: Trata-se de uma revisão integrativa realizada nas bases de dados no mês de maio de 2020, mediante consulta às bases de dados MEDLINE/PubMed, CINAHL, EMBASE, Web of Science, SCOPUS e índice bibliométrico LILACS, acessados por meio do Portal Periódicos da Comissão de Aperfeiçoamento de Pessoal de Ensino Superior, utilizando os descritores: idoso (Aged/elderly), anti-inflamatório não esteroide (Anti-Inflammatory Agents, Non-Steroidal) artrite (Arthritides/Polyarthritis). No qual foram selecionados 13 artigos sem limitador para tempo e idioma. Resultados: Detectou se que as variáveis mais evidenciadas foram: inglês (100%); artigos indexados na MEDLINE/PubMed (69,2%); pais com mais publicações Inglaterra (46%). Destaca-se que 69,3% dos artigos foram ensaios clínicos randomizados controlados; anti-inflamatório tópico mais usado diclofenaco sódico (61,5% seguido do cetoprofeno (38,7%). Conclusão: Concluiu se o diclofenaco e o cetoprofeno apresentam eficácia e segurança no alívio da dor artrítica, e baixa toxicidade cutânea local. (AU)

Objective To identify and analyze topical non-steroidal anti-inflammatory drugs for the relief of arthritic pain, benefits for the elderly. Methods: This is an integrative review carried out on the databases in May 2020, by consulting the MEDLINE / PubMed, CINAHL, EMBASE, Web of Science, SCOPUS and LILACS bibliometric index databases, accessed through the Portal Journals of the Higher Education Personnel Improvement Commission, using the descriptors: elderly (Aged / elderly), non-steroidal anti-inflammatory (Anti-Inflammatory Agents, Non Steroidal) arthritis (Arthritides / Polyarthritis). In which 13 articles were selected without time and language limitations. Results: It was found that the most evident variables were: English (100%); articles indexed in MEDLINE / PubMed (69.2%); parents with the most publications in England (46%). It is noteworthy that 69.3% of the articles were randomized controlled clinical trials; most commonly used topical anti-inflammatory diclofenac sodium (61.5% followed by ketoprofen (38.7%). Conclusion: Diclofenac and ketoprofen were concluded to be effective and safe in relieving arthritic pain and low local skin toxicity. (AU)

Objetivo: Identificar y analizar medicamentos antiinflamatorios no esteroideos tópicos para el alivio del dolor artrítico, beneficios para los ancianos. Métodos: Esta es una revisión integradora realizada en las bases de datos en mayo de 2020, consultando las bases de datos del índice bibliométrico MEDLINE / PubMed, CINAHL, EMBASE, Web of Science, SCOPUS y LILACS, a las que se accede a través del Portal Revistas de la Comisión de Mejoramiento del Personal de Educación Superior, utilizando los descriptores: artritis de edad avanzada (Ancianos / ancianos), antiinflamatorios no esteroideos (agentes antiinflamatorios, no esteroideos) (artritis / poliartritis). En el que se seleccionaron 13 artículos sin limitaciones de tiempo e idioma. Resultados: se encontró que las variables más evidentes fueron: inglés (100%); artículos indexados en MEDLINE / PubMed (69,2%); padres con más publicaciones en Inglaterra (46%). Es de destacar que el 69,3% de los artículos fueron ensayos clínicos controlados aleatorios; diclofenaco sódico antiinflamatorio tópico más utilizado (61.5% seguido de ketoprofeno (38.7%). Conclusión: Se concluyó que el diclofenaco y el ketoprofeno son efectivos y seguros para aliviar el dolor artrítico y la baja toxicidad local de la piel. (AU)

Systemic immune inflammation index in patients with recurrent aphthous stomatitis / Índice de inflamação imune sistêmica em pacientes com estomatite aftosa recorrente

Abstract Objectives: Recurrent Aphthous Stomatitis (RAS) a chronic idiopathic oral mucosal disease. But yet the etiology and pathogenesis of RAS are not exactly known, it is thought that inflammation play an important role in the pathogenesis. The aim of this study is to demonstrate the role of systemic inflammation among the possible etiological factors of RAS and to find the possible diagnostic correlation between Systemic Immune Inflammation Index (SII). Methods: Patients who were consulted the otolaryngology outpatient clinic and diagnosed with RAS between 2019-2021 were retrospectively analyzed. Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and SII values were calculated based on the results of complete blood count. Demographic and hematological parameters between control and RAS groups were compared. The statistical significance level was considered as <0.05. Results: There was no statistically significant difference between the control and RAS groups in terms of sex and age distributions (p = 0.566 and p = 0.173, respectively). SII, NLR and PLR values were significantly higher in the RAS group compared to the controls (p < 0.001, p < 0.001 and p = 0.001, respectively). A very strong correlation between SII and NLR, moderately strong correlation between SII and PLR and moderate correlation between NLR and PLR values were detected (respectively ρ: 0.813, 0.719, 0.532; p-values <0.001). Conclusion: SII, NLR and PLR has significantly higher levels in the RAS group compared to the control group, that it supports the role of systemic inflammation in the etiopathogenesis of RAS. In addition, the results show that SII is a valuable marker for inflammation. Level of evidence: 4. HIGHLIGHTS RAS is a chronic, idiopathic, ulcerative oral mucosal disease. SII is a new and inexpensive biomarker that can easily be calculated using the platelet, neutrophil, and lymphocyte count. SII may be a valuable marker to demonstrate the role of systemic inflammation in RAS etiopathogenesis. Vascular, thrombotic, and inflammatory processes are thought to have a role in RAS activation.

Resumo Objetivo: A estomatite aftosa recorrente (EAR) é uma doença crônica idiopática da mucosa oral. Embora sua etiologia e patogênese não sejam totalmente conhecidas, acredita-se que a inflamação possa desempenhar um papel importante. O objetivo deste estudo é demonstrar o papel da inflamação sistêmica entre os possíveis fatores etiológicos da estomatite aftosa recorrente e encontrar uma possível correlação diagnóstica com o índice de inflamação imunológica sistêmica, SII. Método: Foram analisados retrospectivamente pacientes avaliados no ambulatório de otorrinolaringologia e diagnosticados com estomatite aftosa recorrente entre 2019-2021. A relação neutrófilos/linfócitos, a relação plaquetas/linfócitos e os valores de SII foram calculados com base nos resultados do hemograma completo. Parâmetros demográficos e hematológicos dos grupos controle e de pacientes foram comparados. O nível de significância estatística foi considerado como <0,05. Resultados: Não houve diferença estatisticamente significante entre os grupos controle e com estomatite aftosa recorrente quanto à distribuição por sexo e idade (p = 0,566 e p = 0,173, respectivamente). Os valores de SII, a relação neutrófilos/linfócitos e a relação plaquetas/linfócitos foram significantemente maiores no grupo de pacientes em relação aos controles (p <0,001, p <0,001 e p = 0,001, respectivamente). Foi detectada uma correlação muito forte entre SII e relação neutrófilos/linfócitos, uma correlação moderadamente forte entre SII e relação plaquetas/linfócitos e uma correlação moderada entre valores da relação neutrófilos/linfócitos e relação plaquetas /linfócitos (ρ: 0,813, 0,719, 0,532 respectivamente; p-valores <0,001). Conclusão: SII, relação neutrófilos/linfócitos e relação plaquetas/linfócitos apresentam níveis significantemente maiores no grupo com estomatite aftosa recorrente quando comparados ao grupo controle, o que corrobora o papel da inflamação sistêmica na sua etiopatogênese. Além disso, os resultados mostram que o SII é um marcador inflamatório valioso. Nível de evidência: 4. HIGHLIGHTS A estomatite aftosa recorrente é uma doença ulcerativa crônica idiopática da mucosa oral. O SII (do inglês Systemic Immune Inflammation Index) é um biomarcador novo e de baixo custo que pode ser facilmente calculado que usa a contagem de plaquetas, neutrófilos e linfócitos. O SII pode ser um marcador valioso para demonstrar o papel da inflamação sistêmica na etiopatogênese da estomatite aftosa recorrente. Acredita-se que processos vasculares, trombóticos e inflamatórios tenham um papel na ativação da estomatite aftosa recorrente.

Abdomen agudo quirúrgico relacionado con síndrome inflamatorio multisistémico asociado a covid-19 en pediatría: reporte de caso / Acute surgical abdomen related to multisystem inflamatory syndrome associated with covid-19 in pediatrics

Resumen En el contexto de la enfermedad por el nuevo coronavirus SARS-CoV-2, se ha descrito una afección poco usual denominada síndrome inflamatorio multisistémico en niños, asociada a COVID-19, en la cual los síntomas más frecuentes son los gastrointestinales. El dolor abdominal agudo severo se presenta hasta en un 60 % de los casos, requiriendoprincipalmente un diagnóstico diferencial con la apendicitis aguda. Se reporta el caso clínico de un adolescente quién presentó dolor abdominal, distensión, fiebre y diarrea, con proteína C reactiva muy elevada y hallazgos tomográficos compatibles con apendicitis aguda, por lo que se llevó a cirugía. Fue diagnosticado posteriormente con la enfermedad mencionada, tras reconsultar con fiebre y dolor abdominal. La apendicitis aguda en este síndrome se asocia con isquemia por la vasculitis intestinal y es una complicación inmunológica potencialmente mortal que debe considerarse por riesgo de perforación intestinal.

Abstract In the context of the disease caused by the new coronavirus SARS-CoV-2, an unusual condition called multisystem inflammatory syndrome in children associated with COVID-19 has been described, and its most common symptoms are gastrointestinal. Severe acute abdominal pain occurs in up to 60% of cases, requiring mainly a differential diagnosis with acute appendicitis. It is described the clinical case of an adolescent who presented abdominal pain, bloating, fever and diarrhea, with very high C-reactive protein and tomographic findings compatible with acute appendicitis, for which he underwent surgery. He was later diagnosed with the disease, after consulting again with fever and abdominal pain. Acute appendicitis related to this syndrome is associated with ischemia due to intestinal vasculitis and is a life-threatening immunological complication due to the risk of intestinal perforation.

Características clínicas de pacientes pediátricos con síndrome de dificultad respiratoria aguda asociado con COVID-19 / Clinical characteristics of pediatric patients with acute respiratory distress syndrome due to COVID-19

Resumen Introducción: Existen pocos reportes de síndrome de dificultad respiratoria aguda (SDRA) con COVID-19 en pacientes pediátricos. El objetivo de este estudio fue describir las características de los pacientes pediátricos críticamente enfermos con COVID-19, la frecuencia del SDRA, la mecánica ventilatoria y los resultados de la posición prona. Métodos: Se llevó a cabo un estudio retrospectivo y observacional de los pacientes ingresados del 1 de abril al 30 de septiembre de 2020. Resultados: Ingresaron 34 pacientes a la unidad de terapia intensiva pediátrica (UTIP) con prueba positiva para SARS-CoV-2. De ellos, 13 presentaron SDRA, 11 requirieron ventilación mecánica invasiva y siete fueron pronados como estrategia de oxigenación. Todos los pacientes clasificados como SDRA graves fueron pronados. La obesidad fue la comorbilidad más importante. Las complicaciones asociadas con SDRA fueron el síndrome inflamatorio multisistémico (p < 0.05) y la lesión renal aguda (p < 0.05). La procalcitonina fue mayor en los pacientes con SDRA, al igual que los días de estancia en la UTIP (p < 0.05). El éxito de la maniobra de pronación se alcanzó 8 horas después.Los resultados observados fueron los siguientes relación presión arterial de oxígeno/fracción inspirada de oxígeno 128 vs. 204, índice de oxigenación 8.9 vs. 5.9, distensibilidad pulmonar estática 0.54 vs. 0.70 ml/cmH2O/kg, y presión meseta 24 vs. 19 cmH2O (p < 0.05). El uso de narcóticos fue mayor en el grupo de SDRA más pronación que en los no pronados (124 vs. 27 h; p < 0.01). La mortalidad asociada con SARS-CoV-2 fue del 5.8%. Conclusiones: El SDRA se presentó en el 38.2% de los niños admitidos a UTIP, y con mayor frecuencia en los pacientes con obesidad. La maniobra de pronación aplicada en los casos severos, mejoró la oxigenación de la mécanica pulmonar. Ninguno de los pacientes falleció por SDRA.

Abstract Background: There are only a few reports of acute respiratory distress syndrome (ARDS) in patients with SARS-CoV-2 in pediatrics. This study aimed to describe the characteristics of critically ill pediatric patients with COVID-19, the frequency of ARDS, ventilatory mechanics and results of prone position. Methods: We conducted a retrospective, observational study of patients admitted to the pediatric intensive care unit (PICU) between April 1 to September 30, 2020. Results: Thirty-four patients were admitted to pediatric intensive care unit, 31.7% were SARS-CoV-2 positive. 13 presented ARDS, 11 required invasive mechanical ventilation, and seven were pronated as an oxygenation strategy. All patients classified as severe ARDS were pronated. Obesity was the most important comorbidity. The complications associated with ARDS were multisystemic inflammatory syndrome (8 vs. 4; p < 0.05) and acute kidney injury (8 vs. 3; p < 0.05). Procalcitonin was higher in patients with ARDS, as were the days of stay in PICU (p < 0.05). The success of the pronation maneuver was achieved 8 hours later , with the following results: arterial oxygen partial pressure to fractional inspired oxygen ratio 128 vs. 204, oxygenation index 8.9 vs. 5.9, static lung compliance 0.54 vs. 0.70 ml/cmH2O/kg, plateau pressure 24 vs. 19 cmH2O (p < 0.05). The use of narcotics was higher in the group with ARDS plus pronation 124 vs. 27 hours in the non-pronated (p < 0.01). Mortality associated with SARS-CoV-2 was 5.8%. Conclusions: ARDS was presented in 38.2% of the children admitted to PICU and was more frequent in obese patients. Pronation, performed in severe cases, improved oxygenation and lung mechanics indexes. No patient died of ARDS.

Enfermedad de Kawasaki, enfermedad similar a Kawasaki y MIS-C asociado a COVID-19 en niños: revisión sistemática / Kawasaki disease, Kawasaki-like disease, and MIS-C associated with COVID-19 in children: systematic review

Resumen Objetivo: Sintetizar las características epidemiológicas y clínicas de los niños de COVID-19 con EK, KLD y MIS-C. Métodos: Se realizó una búsqueda en 4 bases de datos y preprints hasta el 31 de Mayo del 2021. Se incluyeron reportes/series de caso que evaluaron las caracte rísticas clínicas del EK, KLD o MIS-C en pacientes pediátricos con COVID-19. Resultados: Se incluyeron 16 estudios (seis informes de casos y diez series de casos, 367 pacientes en total, 58 pacientes con EK, 87 con KLD y 290 pacientes con MIS-C); con edades entre los 6 meses y los 10 años, y el 62% eran mujeres. Se observó COVID-19 positivo en 75,2%. Respecto a EK, KLD y MIS-C, las características clínicas repor tadas fueron compatibles con los cuadros diagnósticos estandarizados en el contexto de COVID-19. La duración de la hospitalización fue de 5 a 14 días para EK y de 4,3 a 13 para MIS-C. Once pacientes con MIS-C (2,8%) necesitaron ECMO. Seis pacientes con MIS-C fueron reportados muertos. Ocho estudios reportaron pacientes en la UCI. Conclusiones: EK o KLD puede asociarse a COVID-19 en niños, y pueden complicarse con MIS-C. El tiempo de hospitalización es prolongado si se presenta EK o KLD asociado a COVID-19 en niños.

Abstract Objective: To synthesize the epidemiological and clinical characteristics of COVID-19 children with MIS-C, KLD and EK. Methods: Databases and preprints were searched until May 31, 2021. Reports/case series that evaluated the clinical features of EK, KLD, or MIS-C in pediatric patients with COVID-19 were included. Results: Sixteen studies were included (six case reports and ten case series, 367 patients total, 58 patients with EK, 87 with KLD, and 290 patients with MIS-C); with ages ranging from 6 months to 10 years, and 62% were female. Positive COVID-19 was observed in 75.2%. Regarding EK, KLD and MIS-C, the reported clinical characteristics were compatible with the standardized diagnostic pictures in the context of COVID-19. The duration of hospitalization was 5 to 14 days for EK and 4.3 to 13 for MIS-C. Eleven patients with MIS-C (2.8%) needed ECMO. Eleven patients with MIS-C (2.8%) needed ECMO. Six patients with MIS-C were reported dead. Eight studies reported patients in the ICU. Conclusions: Children with COVID-19 develop EK or KLD, and can be complicated by MIS-C. Prevention, diagnosis, and treatment measures are needed.

Estudio multicéntrico de casos confirmados de COVID-19: datos preliminares de 2690 pacientes pediátricos en Argentina durante el primer año de la pandemia / A multicenter study of confirmed COVID-19 cases: preliminary data on 2690 pediatric patients in Argentina during the first year of the pandemic

Introducción. La evidencia actual indica que la gravedad de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) es menor en la población pediátrica, los datos locales aún son limitados. Objetivo: caracterizar los aspectos clínicos y epidemiológicos de la infección por COVID-19 en menores de 18 años en Argentina. Población y métodos. Estudio transversal, observacional y analítico de casos confirmados de COVID-19 entre 0 y 18 años asistidos entre marzo de 2020 y marzo de 2021 en 19 centros pediátricos de referencia de Argentina. Se realizó un análisis multivariado para identificar las variables predictoras de cuadros graves. Resultados. Se incluyeron 2690 casos de COVID-19: 77,7 % residentes del área metropolitana de Buenos Aires, 50,1 % de sexo masculino, mediana de edad de 5,6 años. El 90 % ocurrió entre las semanas epidemiológicas 20-47 del 2020; 60,4 % con antecedente de contacto con personas con COVID-19; y 96,6 % en el entorno familiar. El 51,4 % presentó síntomas respiratorios; 61,6 % síntomas generales; 18,8 % síntomas gastrointestinales; 17,1 % síntomas neurológicos; 7,2 % otros y 21,5 % fueron asintomáticos. El 59,4 % fue hospitalizado; 7,4 fueron graves o críticos. Se registraron 57 casos de síndrome inflamatorio multisistémico. El antecedente de asma, displasia broncopulmonar, cardiopatía congénita, desnutrición moderada a grave, obesidad, enfermedad neurológica crónica y/o edad menor de 6 meses resultaron predictores independientes de gravedad. Residir en barrios vulnerables resultó protector. Conclusiones. Más de la mitad de los casos refirieron antecedente de contacto con personas con COVID-19 en el entorno familiar. La hospitalización no respondió a criterios clínicos de gravedad. La gravedad se encuentra asociada a la existencia de ciertas comorbilidades.

Introduction. The current evidence indicates that the severity of the coronavirus disease 2019 (COVID-19) is lower in the pediatric population but local data are still limited. Objective: To characterize the clinical and epidemiological aspects of COVID-19 infection in patients younger than 18 years in Argentina. Population and methods. Cross-sectional, observational, and analytical study of confirmed COVID-19 patients aged 0-18 years seen between March 2020 and March 2021 at 19 referral children's hospitals of Argentina. A multivariate analysis was done to identify predictors of severe cases. Results. A total of 2690 COVID-19 cases were included: 77.7% lived in the Metropolitan Area of Buenos Aires; 50.1% were males; patients' median age was 5.6 years. Of them, 90% were seen during epidemiological weeks 20-47 of 2020; 60.4% had a history of contact with COVID-19 patients; and 96.6% in their family setting. Also, 51.4% had respiratory symptoms; 61.6%, general symptoms; 18.8%, gastrointestinal symptoms; 17.1%, neurological symptoms; 7.2%, other symptoms; and 21.5% were asymptomatic. In addition, 59.4% of patients were hospitalized and 7.4% had a severe or critical course. A total of 57 patients developed multisystem inflammatory syndrome. A history of asthma, bronchopulmonary dysplasia, congenital heart disease, moderate to severe malnutrition, obesity, chronic neurological disease and/or age younger than 6 months were independent predictors of severity.Livinginavulnerableneighborhoodwas a protective factor. Conclusions. More than half of cases referred a history of contact with COVID-19 patients in the family setting. Hospitalization was not based on clinical criteria of severity. Severity was associated with the presence of certain comorbidities

Comportamiento clínico y secuelas de la COVID-19 en niños / Clinical behavior and sequels of COVID-19 in children

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.

Síndrome inflamatorio multisistémico asociado a COVID-19

Introducción: En mayo de 2020 en Reino Unido y EE UU se documentaron casos de una enfermedad que compartía características clínicas y analíticas con la enfermedad de Kawasaki, la cual se asoció a una disregulación inmunitaria secundaria a una infección reciente por SARS-CoV-2. Objetivo: Comunicar las experiencias de la evolución y el tratamiento de una paciente con diagnóstico de esta nueva enfermedad. Presentación del caso: Adolescente de 17 años con antecedentes de haber padecido de COVID-19 seis semanas antes de su presentación en el hospital. Se recibe con lesiones mucocutáneas, polipnea, taquicardia, ictericia y astenia. Dos horas después de llegar a la unidad de cuidados intensivos comenzó con taquicardia ventricular sin pulsos, de la cual hizo dos eventos que requirieron reanimación cardiopulmonar avanzada. Fue necesario apoyo inotrópico por varios días debido a la afectación miocárdica. Después de 72 h con una fracción de eyección del ventrículo izquierdo por debajo de 35 %, comenzó a mejorar hasta la recuperación completa. Recibió tratamiento con metilprednisolona IV y con el péptido inmunoregulador cubano jusvinza. Conclusiones: El síndrome inflamatorio multisistémico asociado a COVID-19, presentado por primera vez en la provincia de Cienfuegos, es una afección nueva, que usualmente es grave y requiere cuidados intensivos debido a que produce disfunción orgánica, pero sobre todo afectación cardíaca. Tiene una presentación clínica similar a enfermedades más comunes, por lo que es fundamental estar alerta para un diagnóstico oportuno que garantice el éxito del tratamiento y evite la muerte.

Introduction: In May 2020, cases of a disease that shared clinical and analytical features with Kawasaki disease were documented in the United Kingdom and the United States, which were associated with immune dysregulation secondary to a recent SARS-CoV-2 infection. Objective: To communicate the experiences of the evolution and treatment of a patient diagnosed with this new disease. Case presentation: A 17-year-old teenager with a history of COVID-19 six weeks ago. He was admitted with mucocutaneous lesions, polypnea, tachycardia, jaundice and asthenia. Two hours after arriving at the intensive care unit, he presented pulseless ventricular tachycardia, of which he did two events that required advanced cardiopulmonary resuscitation. Inotropic support was required for several days due to myocardial involvement. After 72 hours with a left ventricular ejection fraction below 35%, he began to improve until complete recovery. He received treatment with IV methylprednisolone and the Cuban immunoregulatory peptide jusvinza. Conclusions: The multisystem inflammatory syndrome associated with COVID-19, presented for the first time in the province of Cienfuegos, is a new condition, which is usually serious and requires intensive care because it produces organic dysfunction, but above all cardiac involvement. It has a clinical presentation similar to more common diseases, so it is essential to be alert for a timely diagnosis that guarantees the success of treatment and prevents death.

Complejidad del diagnóstico de la enfermedad de Kawasaki en tiempos de COVID-19

Introducción: La enfermedad de Kawasaki es la principal causa de enfermedad cardiaca adquirida en la infancia, sin embargo, su diagnóstico se dificulta después de la aparición del SARS-CoV-2. Objetivo: Examinar un caso con enfermedad de Kawasaki incompleta en el contexto de la pandemia por COVID-19 y el reto diagnóstico que representa. Presentación del caso: Paciente de 5 meses de edad quien es traída por sus padres al servicio de urgencias por síntomas respiratorios superiores y múltiples episodios eméticos. Durante su hospitalización presenta fiebre de difícil control, edema en extremidades, exantema polimorfo y lengua aframbuesada, por lo que, tras descartar el síndrome inflamatorio multisistémico pediátrico temporalmente asociado al COVID 19, se diagnostica la enfermedad de Kawasaki. Se indica tratamiento con inmunoglobulina endovenosa y ácido acetilsalicílico. La paciente evolucionó de forma satisfactoria y egresó al día 10 de hospitalización. Conclusiones: La diferenciación de la enfermedad de Kawasaki con el síndrome inflamatorio multisistémico pediátrico es vital, dado que este último presenta mayor riesgo de morbilidad y mortalidad a corto plazo.

Introduction: Kawasaki disease is the main cause of heart disease acquired in childhood, however, its diagnosis is difficult after the onset of SARS-CoV-2. Objective: To examine a case with incomplete Kawasaki disease in the context of the COVID-19 pandemic and the diagnostic challenge it represents. Case presentation: A 5-month-old female patient brought by her parents to the emergency service due to upper respiratory symptoms and multiple emetic episodes. During her hospitalization, she presented fever that was difficult to control, edema in the extremities, polymorphous exanthema and a strawberry tongue, so after ruling out the pediatric multisystem inflammatory syndrome temporarily associated with COVID 19, Kawasaki disease was diagnosed. Treatment with intravenous immunoglobulin and acetylsalicylic acid is indicated. The patient progressed satisfactorily and was discharged on day 10 of hospitalization. Conclusions: The differentiation of Kawasaki disease with pediatric multisystem inflammatory syndrome is vital, given that the latter presents a higher risk of morbidity and mortality in the short term.