ABSTRACT
BACKGROUND: The impact of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in low- and middle-income countries remains poorly understood. Our aim was to understand the characteristics and outcomes of PIMS-TS in Argentina. METHODS: This observational, prospective, and retrospective multicenter study enrolled patients younger than 18 years-old manifesting PIMS-TS, Kawasaki disease (KD) or Kawasaki shock syndrome (KSS) between March 2020 and May 2021. Patients were followed-up until hospital discharge or death (one case). The primary outcome was pediatric intensive care unit (PICU) admission. Multiple logistic regression was used to identify variables predicting PICU admission. RESULTS: Eighty-one percent, 82%, and 14% of the 176 enrolled patients fulfilled the suspect case criteria for PIMS-TS, KD, and KSS, respectively. Temporal association with SARS-CoV-2 was confirmed in 85% of the patients and 38% were admitted to the PICU. The more common clinical manifestations were fever, abdominal pain, rash, and conjunctival injection. Lymphopenia was more common among PICU-admitted patients (87% vs. 51%, p < 0.0001), who also showed a lower platelet count and higher plasmatic levels of inflammatory and cardiac markers. Mitral valve insufficiency, left ventricular wall motion alterations, pericardial effusion, and coronary artery alterations were observed in 30%, 30%, 19.8%, and 18.6% of the patients, respectively. Days to initiation of treatment, rash, lymphopenia, and low platelet count were significant independent contributions to PICU admission. CONCLUSION: Rates of severe outcomes of PIMS-TS in the present study agreed with those observed in high-income countries. Together with other published studies, this work helps clinicians to better understand this novel clinical entity.
Subject(s)
COVID-19 , Lymphopenia , Mucocutaneous Lymph Node Syndrome , Thrombocytopenia , Child , Humans , Adolescent , COVID-19/complications , SARS-CoV-2 , Argentina , Prospective Studies , Systemic Inflammatory Response Syndrome/complications , Mucocutaneous Lymph Node Syndrome/complications , Thrombocytopenia/complications , Lymphopenia/complicationsABSTRACT
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Argentinian Spanish language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 373 JIA patients (23.1% systemic, 30.8% oligoarticular, 28.1% RF negative polyarthritis, 18% other categories) and 100 healthy children were enrolled in five centres. The JAMAR components discriminated well healthy subjects from JIA patients. Notably, there was no significant difference between healthy subjects and their affected peers in the school-related item. All JAMAR components revealed good psychometric performances. In conclusion, the Argentinian Spanish version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
Subject(s)
Arthritis, Juvenile/diagnosis , Disability Evaluation , Patient Reported Outcome Measures , Rheumatology/methods , Adolescent , Age of Onset , Argentina , Arthritis, Juvenile/physiopathology , Arthritis, Juvenile/psychology , Arthritis, Juvenile/therapy , Case-Control Studies , Child , Child, Preschool , Cultural Characteristics , Female , Health Status , Humans , Male , Parents/psychology , Patients/psychology , Predictive Value of Tests , Prognosis , Psychometrics , Quality of Life , Reproducibility of Results , TranslatingABSTRACT
Se analizaron 215 niños alimentados en forma exclusiva y desde el nacimiento con un solo tipo de leche. El Grupo I (GI) correspondió a 124 niños alimentados con leche materna y el Grupo II (GII) a 91 niños que recibieron formulas de leche de vaca. Se observo que el GI presento menor cantidad de episodios de infecciones gastrointestinales agudas (P:0,02)No se hallaron diferencias significativas (P:0,12) en relación a los procesos infecciosos agudos de las vías respiratorias. En el análisis de peso y talla a los 6 meses de vida se encontró una diferencia significativa con respecto al peso en el GII (P:0,041), pero no en relación a talla (P:0,25)A los 12 meses de vida la diferencia de peso (P:0,003) y talla (P:0,004) fueron altamente significativas, siendo mayores en los niños de GII.Los resultados indican que los niños del GI presentaron menor número de infecciones del tracto digestivo que los del GII, pero estos últimos ganaron mayor peso y talla. Estos datos parecen indicar que una ganancia de peso y talla mayor no siempre se acompaña de menor número de episodios infecciosos.
Subject(s)
Child , Breast-Milk Substitutes , Milk, Human , Gastrointestinal DiseasesABSTRACT
Se analizaron 215 niños alimentados en forma exclusiva y desde el nacimiento con un solo tipo de leche. El Grupo I (GI) correspondió a 124 niños alimentados con leche materna y el Grupo II (GII) a 91 niños que recibieron formulas de leche de vaca. Se observo que el GI presento menor cantidad de episodios de infecciones gastrointestinales agudas (P:0,02)No se hallaron diferencias significativas (P:0,12) en relación a los procesos infecciosos agudos de las vías respiratorias. En el análisis de peso y talla a los 6 meses de vida se encontró una diferencia significativa con respecto al peso en el GII (P:0,041), pero no en relación a talla (P:0,25)A los 12 meses de vida la diferencia de peso (P:0,003) y talla (P:0,004) fueron altamente significativas, siendo mayores en los niños de GII.Los resultados indican que los niños del GI presentaron menor número de infecciones del tracto digestivo que los del GII, pero estos últimos ganaron mayor peso y talla. Estos datos parecen indicar que una ganancia de peso y talla mayor no siempre se acompaña de menor número de episodios infecciosos.
Subject(s)
Child , Breast-Milk Substitutes , Milk, Human , Gastrointestinal DiseasesABSTRACT
Lactante masculino de 9 meses que llegó a la consulta por presentar fiebre, vómitos y diarrea de 3 días de evolución. En el camino hacia el hospital presentó un episodio de convulsión tónica. En la Sala de Emergencia se decidió su internación para estudio y tratamiento.
Subject(s)
Infant , Infant , Seizures , Diarrhea, Infantile , VomitingABSTRACT
Lactante masculino de 9 meses que llegó a la consulta por presentar fiebre, vómitos y diarrea de 3 días de evolución. En el camino hacia el hospital presentó un episodio de convulsión tónica. En la Sala de Emergencia se decidió su internación para estudio y tratamiento
