[Acute pancreatitis associated with SARS-CoV-2 infection in a pediatric patient]. / Pancreatitis aguda asociada a infección por SARS-CoV-2 en un paciente pediátrico.

INTRODUCTION: The recent discovery of SARS-CoV-2 and the disease COVID-19 which affects different organs and systems, mainly the respiratory one, representing a new challenge for physicians. Pancreatic affection is barely described, with only a few cases reported in the literature. OBJECTIVE: to communicate a case of acute pancreatitis associated with SARS-CoV-2 infection, to contribute to the knowledge of this new virus and its possible forms of presentation. CLINICAL CASE: An eleven-year-old male adolescent, with no history of contact with people confirmed or suspected of COVID-19, was admitted to the hospital with a 3-day history of periumbilical and epigastric abdominal pain, vomiting, and absence of stools, with no other symptoms. The laboratory tests showed increased pancreatic enzymes. Com puted tomography was compatible with acute edematous pancreatitis, without signs of biliary patho logy, diagnosing acute pancreatitis, at the same time that SARS-CoV-2 was isolated in the respiratory tract. Other possible differential diagnoses and history of epidemiological contact were ruled out. The patient was managed in the Critical Patient Unit with support measures. He evolved favorably, without respiratory symptoms. CONCLUSION: SARS-CoV-2 infection can be associated with atypical presentations, including acute pancreatitis. The physiopathological mechanism of pancreatic damage is not yet clear. Physicians should be aware of the COVID-19 involvement of other systems, beyond the respiratory one.

Presentación atípica de púrpura de Schönlein-Henoch, a raíz de un caso / Atypical presentation of Henoch-Schönlein purpura. Regarding a clinical case

El Púrpura de Schonlein Henoch (PSH) corresponde a la vasculitis sistémica más común en la edad pediátrica, presentándose el 90% de los casos antes de los 10 años. Gran parte de los casos son precedidos por una infección respiratoria alta, sugiriendo un potencial gatillante infeccioso, sin embargo la causa subyacente aún se desconoce. El depósito de complejos inmunes IgA en distintas localizaciones lleva a las manifestaciones clínicas órgano especificas: púrpura palpable, artralgias, daño renal, dolor abdominal y otras formas de compromiso gastrointestinal, entre otras. La presencia de lesiones cutáneas constituye uno de los pilares diagnósticos de esta patología y la ausencia de éstas orienta el estudio a otros diagnósticos diferenciales. En cuanto al tratamiento, la mayoría de los casos cursan con buena evolución y resolución espontánea de los síntomas, reservándose el uso de glucocorticoides sistémicos para casos severos, obedeciendo al criterio del médico tratante al no existir guías de manejo específicas. Acontinuación se presentará el caso de una niña de 3 años con diagnóstico de PSH cuya manifestación inicial fue el compromiso gastrointestinal, presentando dolor abdominal y hemorragia digestiva baja previa a la aparición del rash cutáneo.

Henoch Schönlein purpura is a systemic vasculitis most commonly found in children, with 90% of cases detected in the under 10´s. Many cases are preceded by an upper respiratory tract infection which suggests a potential infectious trigger, however the underlying cause is not yet known. Deposition of IgAimmune complexes in different locations gives rise to the organ specific clinical signs: palpable purpura, arthralgias, kidney damage, abdominal pain and other forms of gastrointestinal involvement amongst others. The presence of cutaneous lesions is one of the diagnostic pillars of this pathology and its absence suggests other differential diagnoses. As regards treatment, most cases have a favorable clinical course with spontaneous resolution of symptoms, corticoid use being reserved for severe cases at the physician's discretion as there are no clinical guidelines. We present the case of a 3 year old girl with Henoch Schönlein purpura who originally presented with a gastrointestinal disorder with abdominal pain and lower gastrointestinal bleeding prior to the appearance of the rash.

[Influence of weight gain during the first year after kidney transplantation in the survival of grafts and patients]. / Influencia de la ganancia de peso durante el primer año del trasplante renal en la sobrevida de injertos y pacientes.

BACKGROUND: After receiving a kidney allograft, patients tend to gain weight acquiring the risk associated with overweight and obesity. AIM: To compare the evolution during 10 years after transplantation of patients who gained more than 15% of their initial weight during the first year after receiving the graft with those who did not experience this increase. MATERIAL AND METHODS: Cohort study of 182 patients transplanted in a single hospital between 1981 and 2003. Demographic data, weight gain during the first year, drugs used, complications and evolution of patients and grafts were recorded. RESULTS: Seventy two patients gained more than 15% of their weight during the first year. These were discharged after receiving the graft with a lower serum creatinine than their counterparts (1.46 ± 0.71 and 1.97 ± 1.74 mg/dl respectively, p = 0.02). Ten years mortality with a functioning kidney was higher among weight gainers (25 and 12.7% respectively, p = 0.03). No other differences were observed between groups. CONCLUSIONS: Patients who gained more than 15% of their initial weight during the first year after receiving a kidney graft have a higher 10 years mortality with a functioning kidney.

Influencia de la ganancia de peso durante el primer año del trasplante renal en la sobrevida de injertos y pacientes / Influence of weight gain during the first year after kidney transplantation in the survival of grafts and patients

Background: After receiving a kidney allograft, patients tend to gain weight acquiring the risk associated with overweight and obesity. Aim: To compare the evolution during 10 years after transplantation of patients who gained more than 15% of their initial weight during the first year after receiving the graft with those who did not experience this increase. Material and Methods: Cohort study of 182 patients transplanted in a single hospital between 1981 and 2003. Demographic data, weight gain during the first year, drugs used, complications and evolution of patients and grafts were recorded. Results: Seventy two patients gained more than 15% of their weight during the first year. These were discharged after receiving the graft with a lower serum creatinine than their counterparts (1.46 ± 0.71 and 1.97 ± 1.74 mg/dl respectively, p = 0.02). Ten years mortality with a functioning kidney was higher among weight gainers (25 and 12.7% respectively, p = 0.03). No other differences were observed between groups. Conclusions: Patients who gained more than 15% of their initial weight during the first year after receiving a kidney graft have a higher 10 years mortality with a functioning kidney.