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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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Resumen Introducción: La endocarditis infecciosa del lado derecho representa el 5 al 10% de los casos de endocarditis infecciosa en adultos, menos frecuente en niños. Serie de casos: Caso 1: Niña de 12 años de edad con fiebre y antecedentes de trauma en cadera izquierda por caída. Desarrolló dificultad respiratoria, choque, neumonía bilateral y celulitis en cadera izquierda. Los hemocultivos fueron positivos para Staphylococcus aureus resistente a meticilina (SARM), en tanto que el ecocardiograma mostró vegetación en la válvula tricúspide. Por bicitopenia continua se le realizó aspiración de médula ósea diagnosticándose leucemia linfocítica aguda. Recibió vancomicina durante seis semanas y posteriormente inició quimioterapia. Caso 2: Niña de 5 años de edad, con fiebre, dificultad respiratoria, reacción leucemoide y bicitopenia, desarrolló choque con neumonía bilateral y hepatoesplenomegalia, hemocultivos positivos para SARM. El ecocardiograma mostró vegetación en válvula tricúspide y se realizó aspiración de médula ósea diagnosticándose leucemia linfocítica aguda; falleció. Conclusión: Se reporta la concomitancia de endocarditis infecciosa derecha por SARM en pacientes con leucemia linfocítica aguda, patología con baja incidencia descrita.
Abstract Introduction: Right-sided infective endocarditis, represents from 5% to 10% of infective endocarditis in adults, which is less frequent in children. Case Series: Case 1: A 12 year-old girl with fever and a history a left hip injury due to a fall. She developed breathing difficulties, shock, bilateral pneumonia, and cellulitis in the left hip. The blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA), as such that the echocardiogram showed growth in the tricuspid valve. Due to persistent bicytopenia, a bone marrow aspirate was performed, with acute lymphocytic leukaemia being diagnosed. She received vancomycin for six weeks and chemotherapy was subsequently started. Case 2: A 5 year-old girl, with fever, breathing difficulties, a leukemoid reaction, and bicytopenia, developed shock with bilateral pneumonia, and hepato-splenomegaly, as well as positive blood cultures for MRSA. The echocardiogram showed growth in the tricuspid valve, and the bone marrow aspirate performed helped diagnose an acute lymphocytic leukaemia. The patient died. Conclusion: Right-sided infective endocarditis, concomitant with MRSA, is reported in patients with acute lymphocytic leukaemia, a disease with a low reported incidence.