Experiencia en el manejo de anafilaxia en un Departamento de Emergencias Pediátricas

Introducción: La anafilaxia es una reacción multisistémica potencialmente mortal; su reconocimiento temprano y abordaje oportuno son fundamentales. La variabilidad de presentación y gravedad requieren la utilización de criterios diagnósticos para la mejora de la atención en urgencias. Objetivo: Describir las características clínicas, criterios de diagnóstico y tratamiento de los pacientes con anafilaxia atendidos en un Departamento de Emergencias Pediátricas (DEP). Materiales y métodos: Revisión retrospectiva, descriptiva, de casos ingresados en el DEP de enero 2015 a diciembre 2020. Los criterios diagnósticos fueron aplicados por dos observadores emergentólogos evaluando la concordancia con el índice к de Cohen. Se utilizó estadística descriptiva: proporciones, medianas y rango intercuartílico. Resultados: Se aplicaron los criterios NIAID/FAAN a 65 historias clínicas con diagnóstico de egreso de anafilaxia encontrándose una concordancia de 0,64 (IC 95%: 0,41-0,88). De ellos, 35 (54%) cumplieron los criterios diagnósticos. El 66% (23/35) recibió adrenalina. La mediana de edad fue de 7 años (RIC: 3-11,5). Antecedente de asma en 9/35, atopia en 7/35 y anafilaxia previa en 7/35. Como factor desencadenante se constató consumo de medicamentos en 16/35, alimentos en 8/35. La estadía hospitalaria tuvo una mediana de 18 horas (RIC: 12-24). Conclusiones: Los resultados sugieren una brecha entre identificación precisa de los casos de anafilaxia y el tratamiento oportuno con adrenalina cuando se utilizan criterios estandarizados.

Introduction: Anaphylaxis is a potentially fatal multisystem reaction; early recognition and timely approach are essential. The variability in its presentation and severity requires the use of diagnostic criteria to improve emergency care. Objective: To describe the clinical characteristics, diagnostic criteria and treatment of patients with anaphylaxis treated in a Pediatric Emergency Department (PED). Materials and methods: This was a retrospective and descriptive review of cases admitted to the PED from January 2015 to December 2020. The diagnostic criteria were applied by two emergentologist observers; Cohen's к index was used to evaluate their agreement. Descriptive statistics were used: proportions, medians and interquartile range. Results: The NIAID/FAAN criteria were applied to 65 medical records with a discharge diagnosis of anaphylaxis, finding an agreement of 0.64 (95% CI: 0.41-0.88). Of these, 35 (54%) met the diagnostic criteria. 66% (23/35) received adrenaline. The median age was 7 years (IQR: 3-11.5). 9/35 had a history of asthma, 7/35 had atopy and previous anaphylaxis was noted in 7/35. As a triggering factor, medication consumption was found in 16/35, and food in 8/35. The hospital stay had a median of 18 hours (IQR: 12-24). Conclusions: The results suggest a gap between accurate recognition of anaphylaxis cases and timely treatment with adrenaline when standardized criteria are used.

Tratamiento de las cefaleas en sala de emergencia pediatrica / Headache treatment in the pediatric emergency depart ment

Resumen Introducción : Las cefaleas son la segunda causa de consultas neurológicas en la sala de emergencia pediá trica. Muchos pacientes realizan varias visitas al año por este mismo problema, debemos conocer el tratamiento basado en evidencia. Métodos : Se realizó una búsqueda de publicaciones realizadas en los últimos 5 años en diferentes bases de datos. Discusión : Se presentan recursos para investigar sistemáticamente signos de alarma, recomendaciones para el uso racional de estudio de imágenes. Las cefaleas primarias son causa frecuente de consulta en la sala de emergencia. Se presenta tratamiento que cumple el res paldo científico para su utilización en pacientes con ce faleas primarias de tipo migraña en sala de emergencia.

Abstract Introduction : Headache is the second most frequent cause of neurological consultations in the pediatric emergency department. Patients become frequent visi tors per year due to headaches, evidence-based treat ment should be used. Methods : A search of publications within the last 5 years was conducted in different databases. Discussion : Strategies for a systematic approach in the evaluation of red flags, and recommendations for a rational use in neuroimaging studies are presented. Primary headaches are frequently seen in the emergency department. Migraine evidence-based treatment in the emergency department is reviewed.

Low-cost versus high-fidelity pediatric simulators for difficult airway management training: a randomized study in continuing medical education

Abstract Background: High-fidelity (HF) pediatric patient simulators are expensive. This randomized study aimed to compare the quality and educational impact of a full-scale simulation workshop with an HF infant simulator (SimBaby™, Laerdal) or with a low-cost (LC) simulator composed of an inert infant manikin with SimBaby™ software that displays respiratory/hemodynamic parameters on a monitor for medical education in pediatric difficult airway management. Methods: After written informed consent, anesthetists and emergency or ICU physicians participated in teams (4 to 6 participants) in a training session that included direct participation and observation of two difficult intubation scenarios. They were randomized into two groups (HF group, n = 65 and LC group, n = 63). They filled out a simulation quality score (SQS, 0 to 50), self-evaluated their anesthetists' non-technical skills (ANTS) score (15 to 60), and an educational quality score (EQS, 0 to 60) immediately (T0, main criteria), as well as 3 (T3) and 6 (T6) months after the training session. Results: We enrolled 128 physicians. Direct participation SQS (39 ± 5 HF group versus 38 ± 5 LC group), observation SQS (41 ± 4 H F group versus 39 ± 5 LC group), ANTS scores (38 ± 4 HF group versus 39 ± 6 LC group), T0 SQS (44 ± 5 HF group versus 43 ± 6 LC group), T3 and T6 SQS were not different between groups. Conclusion: Our low-cost simulator should be suggested as a less expensive alternative to an HF simulator for continuing medical education in pediatric difficult airway management.

Estudio transversal en profesionales de la salud sobre aplicación y percepción de conocimientos bioéticos adquiridos en urgencias pediátricas / Estudio transversal en profesionales de la salud sobre aplicación y percepción de conocimientos bioéticos adquiridos en urgencias pediátricas

Introducción En comparación con ciencias clínicas básicas o aplicadas, la bioética es considerada una disciplina secundaria y subutilizada en la práctica diaria. Sin embargo, el razonamiento ético es indispensable para la calidad del cuidado. Existen pocos estudios sobre bioética en unidades de emergencia pediátrica. Nuestro objetivo fue evaluar la percepción sobre la importancia y la suficiencia del conocimiento teórico adquirido y la aplicación de los principios bioéticos en casos estandarizados. Métodos Realizamos un estudio descriptivo transversal en profesionales médicos y de enfermería que se desempeñan en unidades de emergencia pediátrica de Puerto Montt. Mediante una encuesta, evaluamos la percepción de la importancia y suficiencia del conocimiento bioético obtenido y la aplicación de los principios bioéticos en casos hipotéticos, pero probables, en la atención de urgencias pediátricas. Resultados De una población total de 50 médicos y 53 enfermeras, participaron en nuestro estudio 30 médicos (60%) y 20 enfermeras (37,7%). La mayoría reportó formación ética en pregrado (84%). Una minoría reportó formación durante la práctica (20%). Sin embargo, sólo 60% percibía tener conocimientos suficientes de bioética y 72% la consideraba importante para la práctica diaria. Además, al aplicar los principios de Beauchamp y Childress a casos clínicos estandarizados, el 82,7% no reconoció el principio de justicia y solo 50% reconoció los principios de autonomía y no maleficencia. Conclusión Aunque la mayoría de los profesionales de la salud tienen formación en bioética, el aprendizaje muchas veces se considera insuficiente y no se incorpora a la práctica diaria en las unidades de emergencia pediátrica.

Background Compared to basic or applied clinical sciences, bioethics is frequently considered as a secondary discipline and underutilized in daily practice. However, ethical reasoning is indispensable for the quality of care. There are few studies on bioethics in pediatric emergency units. Our objective was to evaluate the perception of the acquired bioethical knowledge and the application of bioethical principles in standardized cases. Methods We conducted a cross-sectional descriptive study in medical and nursing professionals working at pediatric emergency units in Puerto Montt. Through a survey, we assessed the perception of the sufficiency of the acquired bioethics knowledge and the application of bioethical principles on hypothetical, but probable cases in emergency pediatric care. Results Of a total population of 50 physicians and 53 nurses, 30 physicians (60.0%) and 20 nurses (38.7%) participated in our study. The majority reported ethics training in undergraduate education: 84%. A minority reported training during practice: 20%. However, only 60.0% perceived having sufficient knowledge of bioethics and 72.0% considered it important for daily practice. Further, when applying the principles of Beauchamp and Childress to standardized clinical cases, 82.7% did not recognize the justice principle and only 50.00% the principles of autonomy and nonmaleficence. Conclusion Although most health professionals undergo bioethics training, learning is often considered insufficient and not incorporated into daily practice at pediatric emergency units.

Application of outcome-based education combined with team-based learning in practice teaching of pediatric emergency and critical care nursing / 中华医学教育探索杂志

Objective:To investigate the application value of outcome-based education (OBE) combined with team-based learning (TBL) in the practice teaching of pediatric emergency and critical care nursing.Methods:A total of 84 nursing students who studied in the pediatric intensive care unit (PICU) of The First Affiliated Hospital of Air Force Medical University were selected and divided into control group and observation group. The 41 nursing students in the control group received traditional teaching, and the 43 nursing students in the observation group received OBE+TBL teaching. The two groups were assessed in terms of theoretical knowledge, practical operation ability, clinical thinking ability, and self-learning ability after teaching, and the degrees of satisfaction with teaching and participation in teaching were compared between the two groups. SPSS 22.0 was used for the t-test and the chi-square test. Results:After teaching, the observation group had significantly better theoretical knowledge, practical operation ability, and self-learning ability than the control group ( P<0.05). Compared with the control group, the observation group had significantly higher scores of learning engagement (recognition, behavior, emotion) ( P<0.05) and satisfaction with classroom effect, knowledge mastery, and learning interest ( P<0.05). Conclusion:The application of OBE+TBL teaching in PICU nursing students can effectively improve their self-learning ability and participation and help them to understand PICU nursing priorities and improve their practical operation ability.

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children / Análise de eficácia e segurança do tratamento conservador do trauma abdominal contuso em crianças: estudo retrospectivo. Tratamento conservador de trauma abdominal contuso em crianças

ABSTRACT Introduction: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. Methods: retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. Results: only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. Conclusion: the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.

RESUMO Introdução: no Brasil, o trauma é responsável por 40% dos óbitos na faixa etária entre 5 e 9 anos, e 18% entre 1 e 4 anos, e o sangramento é a principal causa de prevenção morte na criança traumatizada. O manejo conservador de trauma abdominal contuso com lesão de órgãos sólidos - iniciado na década de 60 - é a tendência mundial atual, com estudos mostrando taxas de sobrevivência acima de 90%. O objetivo do presente trabalho foi avaliar a eficácia e segurança do tratamento conservador em crianças com trauma abdominal contuso tratado no Hospital das Clínicas da Universidade de Campinas, nos últimos cinco anos. Métodos: análise retrospectiva de prontuários de pacientes classificados por níveis de gravidade da lesão, em 27 crianças. Resultados: apenas uma criança foi submetida a cirurgia por falha inicial do tratamento conservador (instabilidade hemodinâmica persistente), resultando em uma taxa de sucesso global de 96% do tratamento conservador inicial. Outras cinco crianças (22%) desenvolveram complicações tardias que exigiram cirurgias eletivas: lesão na bexiga, dois casos de coleção perirenal infectada (secundária à lesão de sistema de coleta renal), um pseudocisto pancreático e um cisto esplênico. Resolução da complicação foi atingida em todas as crianças, com preservação anatômica e funcional do órgão afetado. Não houve mortes nesta série. Conclusão: a abordagem inicial conservadora no tratamento de trauma abdominal contundente foi eficaz e segura com alta resolução e baixa taxa de complicações levando a uma alta taxa de preservação dos órgãos afetados. Nível de evidência III - estudo prognóstico e terapêutico.

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency

ABSTRACT Introduction: The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program. Objective: To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results. Methods: Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training. Results: There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject. Conclusion: This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.

Guía de valoración pediátrica de urgencias en Cuba / Guide of pediatric emergency assessment in Cuba

La valoración pediátrica de urgencias tiene características especiales respecto al resto de la atención pediátrica. El diagnóstico final será una prioridad secundaria. Es una evaluación clínica, cuyo intento principal es la identificación de aspectos anatómicos y fisiológicos anormales, la estimación de la gravedad de la enfermedad o lesión y la determinación de la necesidad de tratamiento urgente. El objetivo de esta colaboración es brindar una sistemática clara, con una secuencia de valoraciones y acciones que sirvan de base para la toma de decisiones clínicas orientadas a la estabilización del paciente y a evitar situaciones que pueden amenazar la vida en poco tiempo. El triángulo de evaluación pediátrica, la secuencia ABCDE, una breve anamnesis y examen enfocado que identifique el motivo de consulta de mayor prioridad, signos de alarma que pueden cambiar la prioridad y las reevaluaciones frecuentes serán los pilares de la actuación médica. Con el propósito de respetar el derecho del niño al disfrute del más alto nivel posible de salud, de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos con entidades agudas o traumatismos, el grupo nacional de pediatría desarrolló y aprobó la guía de valoración pediátrica de urgencias en Cuba. Mediante la aplicación de esta guía se puede optimizar el proceso de valoración pediátrica de urgencias de forma que los pacientes de este segmento de edad reciban el nivel de cuidados médicos más apropiado para su situación clínica(AU)

The pediatric emergency assessment has special characteristics with respect to the rest of pediatric care. The final diagnosis will be a secondary priority. It is a clinical evaluation, and the main purpose of it is the identification of abnormal anatomical and physiological aspects, the estimation of the severity of the disease or injury and the determination of the need for urgent treatment. The objective of this collaboration is to provide a clear system, with a sequence of assessments and actions that serve as a basis for clinical decision-making aimed at stabilizing the patient and avoiding life-threatening situations in a short time. The pediatric assessment triangle, the ABCDE sequence, a brief history and focused examination that identifies the highest priority reason for consultation, warning signs that may change priority and frequent re-evaluations will be the pillars of medical action. To respect the right of the child to have access to the highest possible level of health, to guarantee the quality of care and its safety in the face of acute conditions or trauma, the National Group of Pediatrics developed and approved the guide for pediatric emergency assessment in Cuba. Through its application, the pediatric emergency evaluation process can be optimized so that patients of this age segment receive the most appropriate level of medical care for their clinical situation(AU)

Fast, cheap and feasible: Implementation of pediatric telemedicine in a public hospital during the Covid-19 pandemic

Abstract Objective: In Brazil, telemedicine was allowed as an exception during the coronavirus disease (COVID-19) pandemic. Despite its recognized value and availability, telemedicine is not universally used, suggesting that some barriers prevent its adoption and acceptance within the community. This study aims to describe the implementation of a low-cost telemedicine service in a pediatric hospital in Brazil. Method: Retrospective descriptive study reporting the first three months (April to June 2020) of the experience of implementing a low-cost telemedicine emergency care program in a public tertiary hospital. The service was available to patients up to 18 years of age enrolled in this hospital. A tool for assessing the severity of the patient was developed, the aim of standardizing the procedure, while maintaining quality and safety. Guardian's satisfaction was assessed with a questionnaire sent after teleconsultations. Results: 255 teleconsultations were carried out with 140 different patients. Of the total consultations, 182 were from 99 patients that had performed the Real-Time Polymerase Chain Reaction (RT-PCR) test for the new coronavirus (SARS-Cov-2) or had direct contact with a person known to be positive for COVID-19. Only 26 (14%) were referred to an in-person consultation. No deaths, adverse events or delayed diagnosis were recorded. 86% of the patients who answered the satisfaction questionnaire were satisfied and 92% would use telemedicine again. Conclusion: This study presents an innovative implementation of a telemedicine program in a public and exclusively pediatric tertiary service, serving as a reference for future implementation in other public services in Brazil and developing countries.

Risk classification in a pediatric service: evaluation of the structure, process, and outcome / Clasificación de riesgo en un servicio pediátrico: evaluación de la estructura, proceso y resultado / Classificação de risco em um serviço pediátrico: avaliação da estrutura, processo e resultado

ABSTRACT Objectives: to evaluate a pediatric risk evaluation and classification service in the aspects of structure, process, and outcome. Methods: a cross-sectional, descriptive, and exploratory study in which qualitative data complement the results. Data collection by non-participant observation, interview, and consultation of medical records. Results: we observed two hundred and four visits. The service works in a makeshift room and without privacy. The nurses did not use various materials/equipment available for evaluation, rarely performed a physical examination, used the interview most of the time, and did not consult the protocol. Parents/companions received no information, and medical records showed incomplete records. Nurses classified 69.1% of the children as non-emergency. The most frequent outcome of the visits was discharge. Conclusions: the service showed weaknesses in the physical structure, in the risk classification process, and the outcomes, but it presents a good resolution in the assistance. We recommend a revision in the protocol used and sensitize nurses about the work process and communication with parents/companions.

RESUMEN Objetivos: evaluar un servicio de evaluación y clasificación de riesgo pediátrico en los aspectos de estructura, proceso y resultado. Métodos: estudio transversal, descriptivo y exploratorio, en que datos cualitativos complementan los resultados. Datos recogidos por observación no participante, entrevista y consulta a prontuarios. Resultados: observados 204 atenciones. Servicio funciona en sala improvisada y sin privacidad. Enfermeros no usaron varios materiales/equipos disponibles a la evaluación, raramente realizaron examen físico, usaron la entrevista casi siempre y no consultaron el protocolo. Padres/acompañantes no recibieron información, y los prontuarios mostraron registros incompletos. Enfermeros clasificaron 69,1% de los niños como no urgencia. Desfecho de las atenciones más frecuente fue la alta. Conclusiones: servicio mostró fragilidades en la estructura física, en el proceso de clasificación de riesgo y resultados, pero presenta buena resolutiva en las atenciones. Recomienda la revisión del protocolo usado y sensibilización de los enfermeros cuanto al proceso de trabajo y comunicación con padres/acompañantes.

RESUMO Objetivos: avaliar um serviço de avaliação e classificação de risco pediátrico nos aspectos de estrutura, processo e resultado. Métodos: estudo transversal, descritivo e exploratório, em que dados qualitativos complementam os resultados. Dados coletados por observação não participante, entrevista e consulta a prontuários. Resultados: foram observados 204 atendimentos. O serviço funciona em sala improvisada e sem privacidade. Os enfermeiros não usaram vários materiais/equipamentos disponíveis para a avaliação, raramente realizaram exame físico, usaram a entrevista quase sempre e não consultaram o protocolo. Pais/acompanhantes não receberam informação, e os prontuários mostraram registros incompletos. Os enfermeiros classificaram 69,1% das crianças como não urgência. O desfecho dos atendimentos mais frequente foi a alta. Conclusões: o serviço mostrou fragilidades na estrutura física, no processo de classificação de risco e nos resultados, mas apresenta boa resolutividade nos atendimentos. Recomenda-se a revisão do protocolo usado e sensibilização dos enfermeiros quanto ao processo de trabalho e comunicação com pais/acompanhantes.

The characterization of a hospitalized population at the pediatric emergency service of mother and child hospital, Marrakech, Morocco

Introduction: the pediatric emergency department is the first contact between the population and the hospital. Consequently, its dysfunction influences the quality of general health care. However, any successful policy must first be based on convincing results hence the need to better explore this service, diagnose the various dysfunctions, and survey disease trends to identify the needs of the local population. In this perspective, we propose to describe the epidemiological profile of children hospitalized at the emergency service of the Mother-Child hospital, University Hospital Centre Marrakech, and establish the prevalence table for childhood pathologies. Methods: a retrospective study was carried out in pediatric emergency services for 1658 hospitalized patients between March 2015 and December 2018. The collected data concerns mainly the socio-demographic, clinical profile, evolution status, mode of admission, and medical history. Results: the characterization of the studied population by sex and age showed a predominance of Male with a sex ratio of 1.36, infants with 625 patients. Concerning the final diagnosis, the most frequent pathologies affected the respiratory system in 28% of cases, then the digestive system (11.3%), while infectious pathologies represented 10.7% of admissions. The death rate in the emergency department was 7.4%. Multivariate analysis of the data showed a statistically significant relationship between the final diagnosis (16 diseases by a system according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and age, season, and weight. Thus, for the association between Diseases of the digestive system and weight (aOR=1.052, 95% CI= 1.019-1.086, p=0.02). While for Diseases of the skin and subcutaneous tissue and the autumn season (aOR=11.37, 95% CI= 1.272-<101.777, p=0.03) and age has a negative significance for most diseases. Conclusion: the epidemiological profile study will allow knowledge of patient´s pathologies typology for a well-supported and better definition of needs.

Cambios en las consultas traumatológicas de urgencias pediátricas durante la pandemia SARS-CoV-2 / Changes in pediatric emergency trauma consultations during the SARS-CoV-2 pandemic

In pediatrics urgency room, one of the main causes of consultation are traumatological problems, including those caused by school accidents and car accidents. We analyzed the change in these causes during SARS-CoV-2 pandemics at a regional hospital in Talca, Chile . We saw a clear droop in traumatological consultations due to sanitary restrictions. This clearly shows the impact that sanitary restrictions had on population behavior

Cambios epidemiológicos en urgencia infantil durante la pandemia por SARS-CoV-2 en Hospital Regional de Talca / Epidemiolocal changes in childrens emergency consultations during SARS-CoV-2 pandemic at Hospital Regional de Talca

Infection by SARS-COV-2, was first described in November 2019 in Wuhan, China. First chilean cases where reported in March 2020.Our objective was to identify epidemiological changes in the pediatric population in the emergency service of the Hospital Regional de Talca (HRT). We carried out an observational and retrospective study. The reason and number of consultations in pediatric patients in the emergency room was analyzed during the periods defined as "Pre-pandemic" and "Pandemic". The target population was all consulting patients between 0-15 years of age. We separated the cases according to the reason of consultation. We obtained the data from the HRT statistics department. The number of consultations decreased by 67.6% per month, while the number of patients who consulted in pediatric emergencies for respiratory symptoms decreased by 75.4% per month. Within the pandemic period, 15,101 COVID PCR samples were performed in pediatric patients, with 13.7% positivity. This allows us to see the epidemiological impact that this new disease has had on pediatric patients in the Maule región

Tratamiento conservador del quilotórax posquirúrgico en paciente pediátrico / Conservative treatment of post-surgical chylothorax in pediatric patient

INTRODUCCIÓN. El quilotórax resulta de un daño al conducto torácico por ruptura, laceración, desgarro o compresión. Es una patología rara de derrame pleural en la edad pediátrica, pero frecuente como complicación posterior a cirugía cardiotorácica. La base del tratamiento conservador se ha fundamentado en: drenaje inicial, modificación de la dieta, uso de somatostatina o análogos sintéticos como octreotide, cirugía, prevención y manejo de complicaciones. Fue preciso describir la experiencia institucional clínica así como su abordaje. CASO CLÍNICO. Paciente masculino de 4 meses de edad, que ingresó a la Unidad Pediátrica Área de Emergencias del Hospital de Especialidades Carlos Andrade Marín, el 13 de septiembre de 2019 con antece-dente quirúrgico de atresia de esófago corregida en etapa neonatal. Acudió con dificultad respiratoria, radiografía de tórax que evidenció derrame pleural derecho, toracentesis diagnóstica con salida de líquido de aspecto turbio y lechoso; se colocó tubo de tórax derecho. Se prescribió ayuno inicial, nutrición parenteral durante 4 semanas hasta comprobar resolución del quilotórax. Fue dado de alta en condición estable tras 43 días de hospitalización. DISCUSIÓN. La evidencia científica registró que el tratamiento conservador del quilotórax se basó en: drenaje, reposo digestivo inicial, nutrición parenteral, modificación cualitativa de la dieta enteral y uso de octreotide; el mismo que fue aplicado al paciente de este caso clínico con evolución favorable. CONCLUSIÓN. El tratamiento conservador y multidisciplinario en el abordaje del qui-lotórax fue exitoso y no necesitó manejo quirúrgico.

INTRODUCTION. Chylothorax results from damage to the thoracic duct by rupture, la-ceration, tear or compression. It is a rare pathology of pleural effusion in pediatric age, but frequent as a complication after cardiothoracic surgery. The basis of conservative treatment has been based on: initial drainage, diet modification, use of somatostatin or synthetic analogues such as octreotide, surgery, prevention and management of complications. It was necessary to describe the clinical institutional experience as well as its approach. CLINICAL CASE. A 4-month-old male patient was admitted to the Emergency Area Pediatric Unit of the Carlos Andrade Marín Specialties Hospital on september 13, 2019 with a surgical history of esophageal atresia corrected in the neonatal stage. He went with respiratory distress, chest X-ray that showed right pleural effusion, diagnostic thoracentesis with outflow of cloudy and milky fluid; a right chest tube was placed. Initial fasting was prescribed, parenteral nutrition for 4 weeks until resolution of the chylothorax was verified. He was discharged in stable condition after 43 days of hospitalization. DISCUSSION. The scientific evidence recorded that the conservative treatment of chylothorax was based on: drainage, initial digestive rest, parenteral nutrition, qualitative modification of enteral diet and use of octreotide; the same that was applied to the patient of this clinical case with favorable evolu-tion. CONCLUSION. Conservative and multidisciplinary treatment in the approach to chylothorax was successful.

Arteriopathy in pediatric stroke: an underestimated clinical entity / Arteriopatia em crianças com acidente vascular cerebral: uma entidade clínica subestimada

ABSTRACT Background: Pediatric arterial ischemic stroke (AIS), which was thought to be a rare disorder, is being increasingly recognized as an important cause of neurological morbidity, thanks to new advances in neuroimaging. Objective: The aim of this study was to review the main etiologies of stroke due to arteriopathy in children. Methods: Using a series of cases from our institution, we addressed its epidemiological aspects, physiopathology, imaging findings from CT, MR angiography, MR conventional sequences and MR DWI, and nuclear medicine findings. Results: Through discussion of the most recent classification for childhood AIS (Childhood AIS Standardized Classification and Diagnostic Evaluation, CASCADE), we propose a modified classification based on the anatomical site of disease, which includes vasculitis, varicella, arterial dissection, moyamoya, fibromuscular dysplasia, Takayasu's arteritis and genetic causes (such as ACTA-2 mutation, PHACE syndrome and ADA-2 deficiency). We have detailed each of these separately. Conclusions: Prompt recognition of AIS and thorough investigation for potential risk factors are crucial for a better outcome. In this scenario, neurovascular imaging plays an important role in diagnosing AIS and identifying children at high risk of recurrent stroke.

RESUMO Introdução: O acidente vascular cerebral (AVC) pediátrico, considerado um distúrbio raro, está sendo cada vez mais reconhecido como importante causa de morbidade neurológica, graças aos novos avanços na neuroimagem. Objetivo: Revisar as principais etiologias do AVC por arteriopatia em crianças. Métodos: Utilizando-se de uma série de casos de nossa instituição, abordamos seus aspectos epidemiológicos, fisiopatológicos e de imagem na angiotomografia computadorizada e angiorressonância magnética, sequências convencionais e avançadas de ressonância magnética e medicina nuclear. Resultados: Com base na classificação mais recente de AVC na infância (Classificação Padronizada e Avaliação Diagnóstica do AVC na Infância - CASCADE) propusemos uma classificação modificada com base no local anatômico da doença, que inclui vasculite, varicela, dissecção arterial, Moyamoya, displasia fibromuscular, arterite de Takayasu e causas genéticas (como mutação ACTA-2, síndrome PHACE e deficiência de ADA-2), detalhando cada uma separadamente. Conclusões: O reconhecimento imediato do AVC na infância e a investigação minuciosa de possíveis fatores de risco são cruciais para um melhor resultado. Nesse cenário, a imagem neurovascular desempenha papel importante no diagnóstico de AVC e na identificação de crianças com alto risco de recorrência.

Factors Predicting Heart Failure in Children Admitted to a Pediatric Emergency Ward in a Developing Country

Abstract Background Heart failure is an important cause of morbidity and mortality in children. Objective To determine the clinical characteristics of children with acute heart failure syndrome in the emergency ward of River state university teaching hospital, Nigeria and identify factors associated with poor outcomes. Methods This was an 18month retrospective review of the acute heart failure register. Poor outcome measures were defined as the persistence of heart failure after 4 days on admission or death. Results Ninety-two (4.1%) of 2,244 children admitted were in heart failure, Non-cardiac disorders [bronchopneumonia 32(36%), sepsis 21(24%), severe malaria 10(11%), sickle cell anaemia 8(9%) and tuberculosis 3(3%)] contributed to 74(83%) while congenital heart disease(CHD) was 15(17%). Seventy-four (83%) were discharged, 10(11%) died and 4(5%) left against medical advice. The median time to resolution of heart failure was significantly 24 hours longer for malnourished children than those with normal-nutritional status, 72Vs48hrs, log rank:0.001. Those with modified Ross score of >7 and sepsis were more likely to die, OR,8.8(95% CI,1.2 to 72.5,p = 0.02) and 3.9(95% CI,1.01 to 15.2;p =0.04). Age <2yrs(OR,3.1,CI,1.2 to 8.5,p = 0.02), and CHD (OR 3.6,95% CI,1.1 to 12,P=0.02) were associated with a higher likelihood of having a poor outcome. Each unit increase in weight for age Z score of 1, decreased the odds of having a poor outcome, OR,0.77 (95% CI,0.63 to 0.95)p=0.016. Conclusion Heart failure in our setting is predominantly caused by non-cardiac disorders. Modified Ross score of >7 and sepsis are risk factors for mortality in children with heart failure. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Diagnóstico y tratamiento de pacientes COVID-19 en Urgencia Pediátrica. Guía para esta pandemia / Diagnosis and treatment of pediatric patients with COVID-19 infectious disease at the emergency room. A guideline for this pandemia

Resumen: La emergencia del virus SARS-CoV-2 (CoV-2), ha producido nuevos y grandes desafíos para la salud pública y la atención de urgencia desde su aparición en Wuhan, China(1). Los desafíos en urgencia, van desde cambios en los flujos de pacientes, áreas de atención, sistemas de trabajo, equipo de protección personal (EPP) necesarios y una gran capacitación para lograr atender adecuadamente a adultos y niños con la enfermedad producida por este virus (COVID-19)(2-4). En esta publicación, se propone una guía de cómo organizar un servicio de urgencias en tiempos de pandemia y cómo atender al niño sospechoso o con COVID-19 que consulta en urgencias. La información necesaria se obtuvo a través de guías nacionales e internacionales y la literatura científica obtenida a través de PubMed, CDC y NIH y de la autoridad sanitaria nacional.

Abstract: The SARS-CoV-2 emergency has caused major new challenges for both public health and medical clinical practice since the first cases reported in Wuhan, China. The challenges in emergency care ran ge from changes in the flow of patients, care areas, ways of working, personal protective equipment, and intensive training in order to properly care for adults and children with coronavirus disease (COVID-19). In this publication, we propose guidelines on organizing the emergency department in the face of this pandemic, and how to provide medical care for the pediatric patient with either suspected or confirmed COVID-19 who seek care in the emergency room. We obtained the necessary data from national and international guidelines and the scientific literature available from PubMed, CDC, NIH, and the Chilean national health authorities.

Urgencia pediátrica: la primera línea de atención hospitalaria del paciente pediátrico con virus SARS-COV-2: el desafío que tenemos / Emergency room: the first line in the hospital medical attention of the pediatric patient with SARS-COV-2 virus: the challenge we have

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed great challenges for both public health and medical clinical practice since the first cases reported in Wuhan, China. Coronavirus disease (CoVID-19) is a zoonotic disease caused by an RNA virus. SARS-CoV-2 is transmitted through respiratory droplets and fomites, and it has a lethality estimated at 4%. In the pediatric population it mainly produces mild cases, but it also can cause severe cases with hypoxemia, respiratory distress, and multiple organ failure. Children have been recognized as an important disease vector than can spread disease to higher risk groups. It is fundamental to rearrange emergency department functioning, in order to achieve an adequate patient flow that reduces the risk of disease transmission. In the following, we lay out the recommendations for patient care in the emergency room.

La emergencia mundial del virus SARS-CoV-2 (CoV2) ha producido grandes desafíos para la salud pública y para la atención clínica, desde la aparición de los primeros casos en Wuhan, China. La enfermedad, CoVID-19, es una infección zoonótica producida por un virus RNA (1). Se transmite a través de gotitas y fómites con una letalidad estimada en 4%. En pediatría, provoca cuadros respiratorios en su mayoría leves, pero también cuadros severos con hipoxemia y distrés respiratorio (2). Se ha reconocido al niño como un vector importante que aumenta los contagios en personas que tendrán probablemente cuadros de gravedad. La organización adecuada de los servicios de urgencias es fundamental para lograr un flujo y áreas especiales para los pacientes sospechosos de CoVID-19 y así evitar nuevos contagios. A continuación, se detallan las principales recomendaciones para la atención de estos pacientes en un servicio de urgencias.

Clinical study to assess the risk factors for recurrence of febrile seizures in tertiary hospital at Cuddalore district

Background: Febrile seizures are the most common and benign convulsive disorder in childhood and a frequent cause of emergency hospital admission' Febrile Seizures (FS) are age-dependent and are rare before the age of 9 months and after 5 years of age, the peak age of onset is 14-18months. To assess the clinical profile in children with febrile seizures and compare these values with febrile children without seizures.Methods: The study included children admitted with bronchiolitis in between during the period of August 2018 to March 2019 at Department of Pediatrics, Raja Muthiah Medical College and Hospital. It is a case-control study. The study group includes 50 cases (febrile seizures) and 50 controls (fever without seizures) aged 6months to 5 years (6-60 months) attending the pediatric out-patient department.Results: 54% of the cases were male (27) and 46% of the cases were female (23). Male: female ratio was 1.17:1. Mean temperature in cases and controls were 101.61'1.31 'F and 101.17'0.86 'F respectively. The difference between the two groups was not statistically significant (p-value >0.05). duration of seizure was <5 minutes in 80% of cases (40/50) and >5mins in 20% of the cases (10/50).Conclusions: Simple febrile seizures may slightly increase the risk of developing epilepsy, but have no adverse effects on behaviour, scholastic performance, or neurocognition. The risk of developing epilepsy is increased further in children with a history of complex febrile seizures. A strong association exists between febrile status epilepticus or febrile seizures characterized by focal symptoms and later development of temporal lobe epilepsy.

Pediatric scorpionism in northern Amazonia: a 16-year study on epidemiological, environmental and clinical aspects

The Amazon basin is one of the seven major geographical areas where scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants are registered per year. As the severity of cases is higher in children, descriptive studies are needed to have a better understanding of this pathology. The aim of the present study is to describe pediatric scorpionism in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion stings in all pediatric patients admitted to Cayenne General Hospital from January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients with general signs of envenomation were younger and lighter (p = 0.04). The picture was "one sting" (95.3%) by a "big" (47.6%), "black" (60%) and "small pincer" (58%) scorpion on the extremity of the body (84%). Stings occurred mainly during the day, while patients changed clothes. There was no envenomation during night. The monthly evaluation highlights that the number of stings and percentage of general signs of envenomation were closely connected to a composite variable including the variation of the level of rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with general signs of envenomation. The presence of pulmonary; ear, nose, and throat (ENT); or gastrointestinal symptoms are related to major envenomation (p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia increased according to the envenomation grade whereas serum potassium and alkaline reserve decreased. Forty-six patients needed hospitalization and seven of them required intensive care. No patient died nor presented sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child activities and climatic conditions. Severe envenomation presented most of the time with cardiac, pulmonary, and gastrointestinal symptoms.(AU)