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Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.
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La medicina como ciencia y arte se complementan en la práctica cotidiana. Cuando se entienda la propiedad plástica de sistemas como el inmunológico, se estará en capacidad de inclinarnos respetuosos y reverentes ante el concepto de la creación...
Medicine as a science and art it complement each other in everyday practice. When we comprehend the attribute of plasticity of the immune system, we will be able to incline with respectful and reverential when we think in the concept of Creation...
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Medicina nas Artes , Medicina/classificação , Sistema ImunitárioRESUMO
Las reacciones de choque e hipersensibilidad a los anestésicos locales y generales y a otros medicamentos utilizados durante los procedimientos quirúrgicos, continúan siendo un reto en la práctica clínica. Las reacciones de hipersensibilidad alérgica pueden variar en su presentación e intensidad, y pueden producir desde síntomas leves en la piel hasta la muerte.
Shock and hypersensitivity reactions to local and general anesthetics and to other drugs used during surgical procedures continue being a challenge in clinical practice. Allergic hypersensitivity can vary in presentation and intensity and might manifest itself from mild cutaneous symptoms to death.
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Anafilaxia , Anestésicos , HipersensibilidadeRESUMO
El asma bronquial se considera una enfermedad de interés en salud pública. Latinoamérica tiene una de las prevalencias mas elevadas del mundo; en Colombia se encontró una prevalencia global de 10,4/100. Por tanto es pertinente revisar su definición, epidemiología, clínica, factores de riesgo, diagnóstico, clasificación y tratamiento para realizar el mejor y más adecuado enfoque y seguimiento de los pacientes que la padecen.
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Asma , Fatores de Risco , ColômbiaRESUMO
La rinitis alérgica es una enfermedad de alta prevalencia. En la población infantil, infortunadamente el diagnóstico se hace en forma tardía, alrededor de los seis años. En el presente artículo se intenta estimular al lector a buscar los signos clínicos más sensibles para su diagnóstico y tratamiento tempranos.