Caracterización clínico-epidemiológica de niños convalecientes de COVID-19 / Clinical-Epidemiological Characterization of Children Convalescent of COVID-19

Introducción: Las secuelas de la enfermedad viral COVID-19 resultan múltiples y más frecuentes en la edad adulta, pero también pueden aparecer en niños y adolescentes. Objetivo: Determinar las características clínicas y epidemiológicas de pacientes pediátricos convalecientes de COVID-19. Métodos: Estudio descriptivo, observacional, de corte transversal en pacientes menores de 19 años convalecientes de COVID-19, que asistieron a la consulta poscovid-19 del policlínico docente "Mario Escalona Reguera" del municipio Habana del Este. El período del estudio comprendió desde el 1 de enero hasta el 31 de octubre de 2021. Se estudiaron las variables: edad, sexo, historia epidemiológica, comorbilidades, estado durante su ingreso y secuelas en diferentes sistemas. Resultados: Se caracterizaron 474 niños y adolescentes convalecientes de COVID-19. Los mayores de 10 años constituyeron el grupo de edad más afectado, con discreto predominio del sexo masculino. La fuente de infección quedó definida en la mayoría de los pacientes, por contacto autóctono e intradomiciliario. Las comorbilidades más identificadas resultaron el asma bronquial y las sibilancias recurrentes. Durante su ingreso casi la totalidad de los casos se reportaron de cuidado. La tercera parte de los convalecientes presentaron algún tipo de secuelas. Conclusiones: La mayor incidencia de la COVID-19 durante la etapa de la convalecencia se presentaba en niños de 10 años o más, con predominio ligero del sexo masculino. La tercera parte de los pacientes manifestaba algún tipo de secuelas con predominio de las psicológicas, seguidas de las neurológicas.

Introduction: The sequelae of COVID-19 viral disease are multiple and more frequent in adulthood, but can also appear in children and adolescents. Objective: To determine the clinical and epidemiological characteristics of pediatric patients convalescing from COVID-19. Methods: Descriptive, observational, cross-sectional study in patients under 19 years old convalescing from COVID-19, who attended the post-COVID-19 consultation at "Mario Escalona Reguera" Teaching Polyclinic in Habana del Este municipality. The study period covered from January 1 to October 31, 2021. The following variables were studied: age, sex, epidemiological history, comorbidities, condition during admission and sequelae in different systems. Results: 474 children and adolescents convalescing from COVID-19 were characterized. Children older than 10 years were the most affected age group, with a slight predominance of the male sex. The source of infection was defined in most patients as autochthonous and intra-home contact. The most identified comorbidities were bronchial asthma and recurrent wheezing. During their admission, almost all cases were reported as seriously ill. One third of convalescents presented some type of sequelae. Conclusions: The highest incidence of COVID-19 during the convalescence stage was in children aged 10 years or older, with a slight predominance of the male sex. One third of the patients showed some type of sequelae, with a predominance of psychological sequelae, followed by neurological sequelae.

Caracterización de pacientes pediátricos con infección del tracto urinario / Characterization of pediatric patients with urinary tract infection

Introducción: La infección del tracto urinario se considera, en el mundo desarrollado, la enfermedad bacteriana grave más común durante la lactancia y la niñez temprana. Constituye el motivo de consulta pediátrica más frecuente en relación con el aparato urinario. Objetivo: Caracterizar los aspectos clínicos y microbiológicos de los pacientes con infección del tracto urinario, ingresados en el servicio de Pediatría. Métodos: Estudio descriptivo, transversal de 85 pacientes ingresados, con diagnóstico de infección del tracto urinario, desde septiembre de 2017 a septiembre 2019. Las variables utilizadas fueron: edad, sexo, factores de riesgo, manifestaciones clínicas y germen aislado. Los datos se obtuvieron de las historias clínicas. Se realizaron resúmenes porcentuales para las variables cualitativas y media y desviación estándar para variables cuantitativas. Resultados: La infección urinaria predominó en pacientes menores de un año (58,8 por ciento) del sexo femenino (83,5 por ciento). Los factores de riesgo identificados fueron el uso de culeros desechables (40 por ciento) y la no lactancia materna exclusiva (36,5 por ciento). La fiebre fue el signo que predominó (56,5 por ciento) y la Escherichia coli el germen más aislado en los urocultivos (76,4 por ciento). Conclusiones: La infección del tracto urinario se presenta con mayor frecuencia en los menores de un año, del sexo femenino. Predomina el uso incorrecto de culeros desechables y el destete precoz como factores de riesgo. El germen más frecuente fue Escherichia coli(AU)

Introduction: Urinary tract infection is considered, in the developed world, the most common serious bacterial disease during infancy and early childhood. It is the most frequent reason for pediatric consultation in relation to the urinary system. Objective: To characterize the clinical and microbiological aspects of patients with urinary tract infection admitted to the Pediatric service. Methods: Descriptive, cross-sectional study of 85 admitted patients with a diagnosis of urinary tract infection, from September 2017 to September 2019. The variables used were: age, sex, risk factors, clinical manifestations and isolated germ. Data were obtained from medical records. Percentage summaries were performed for qualitative variables and mean and standard deviation for quantitative variables. Results: Urinary infection predominated in patients under a year (58.8 percent) of the female sex (83.5 percent). The risk factors identified were the use of disposable buttocks (40 percent) and not exclusive breastfeeding (36.5 percent). Fever was the predominant sign (56.5 percent) and Escherichia coli the most isolated germ in urine cultures (76.4 percent). Conclusions: Urinary tract infection occurs more frequently in children under one year of age, female. The incorrect use of disposable calves and early weaning predominate as risk factors. The most frequent germ was Escherichia coli(AU)

Caracterización de la hipertensión inducida por el embarazo en el hospital ginecobstétrico Fe del Valle Ramos / Characterization of pregnancy-induced hypertension in Fe del Valle Ramos gynaecologic-obstetric hospital

Se realizó un estudio descriptivo, longitudinal prospectivo en gestantes que se diagnosticaron con hipertensión inducida en el embarazo en el Hospital Fe del Valle Ramos, municipio Manzanillo en el periodo comprendido desde enero a diciembre del 2014. Para el estudio, se seleccionaron todas las pacientes que presentaron algún tipo de trastorno hipertensivo entre la totalidad de los nacimientos ocurridos en el período de investigación, se hallaron 70 gestantes, las cuales constituyeron el grupo de estudio. Predominaron las gestantes menores de entre 21 y 34 años, las trabajadoras, de los cuales la mayor incidencia fue en las nulíparas, conjuntamente con el de las pacientes con edad gestacional entre 36 a 41.6 semanas donde la enfermedad asociada más relevante fue la hipertensión arterial crónica y en su mayoría demandaron un parto distócico por cesárea. Un gran por ciento de los recién nacidos no presentó alteración alguna al nacer(AU)

A descriptive, prospective longitudinal study was carried out on pregnant women who were diagnosed with induced hypertension in pregnancy at the Hospital Fe del Valle Ramos, municipality of Manzanillo in the period from January to December 2014. For the study, there were selected all the patients who presented some type of hypertensive disorder among all the births occurred in the investigation period, there were found 70 pregnant women, which constituted the study group. Pregnant women between 21 and 34 years of age prevailed, the workers, of whom the highest incidence was in the nulliparous, together with that of the patients with gestational age between 36 to 41.6 weeks where the most relevant associated disease was chronic arterial hypertension, and in the majority they demanded a dystocic delivery by caesarean section. A large percentage of newborns did not present any alteration at birth(EU)

Treatment of acute iliofemoral deep vein thrombosis.

OBJECTIVE: The objective of this systematic review and meta-analysis was to compare the efficacy of three available treatments for acute iliofemoral deep vein thrombosis (DVT): systemic anticoagulation, surgical thrombectomy, and catheter-directed thrombolysis. METHODS: We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus) and sought additional references from experts. Eligible studies enrolled participants with acute iliofemoral DVT and measured the outcomes of interest. Reviewers working independently in duplicate extracted study characteristics, quality, and outcome data (death, pulmonary embolism, local complications, hemorrhagic complications, postthrombotic syndrome, pain, quality of life, and surrogate markers of venous function such as valve competence and patency). We pooled relative risks (RRs) from each study using the random effects model and estimated the 95% confidence intervals (CIs). Bayesian indirect comparison techniques were used to compare thrombectomy to catheter-directed thrombolysis. RESULTS: We found 15 unique studies that fulfilled eligibility criteria. When compared to systemic anticoagulation, thrombectomy was associated with a statistically significant reduction in the risk of developing postthrombotic syndrome (RR, 0.67; 95% CI, 0.52-0.87), venous reflux (RR, 0.68; 95% CI, 0.46-0.99), and a trend for reduction in the risk of venous obstruction (RR, 0.84; 95% CI, 0.60-1.19). When compared to systemic anticoagulation, pharmacologic catheter-directed thrombolysis was associated with statistically significant reduction in the risk of postthrombotic syndrome (RR, 0.19; 95% CI, 0.07-0.48), venous obstruction (RR, 0.38; 95% CI, 0.18-0.37), and a trend for reduction in the risk of venous reflux (RR, 0.39; 95% CI, 0.16-1.00). Overall, the quality of evidence was low; downgraded due to the observational nature of the majority of studies, lack of comparability of study cohorts at baseline, loss to follow-up, imprecision, and indirectness of outcomes (surrogacy). There were insufficient data to compare the outcomes of thrombectomy to catheter-directed thrombolysis. CONCLUSIONS: Low-quality evidence suggests that surgical thrombectomy decreases the incidence of postthrombotic syndrome and venous reflux. Catheter-directed pharmacologic thrombolysis decreases the incidence of postthrombotic syndrome and venous obstruction.

A systematic review and meta-analysis of the treatments of varicose veins.

OBJECTIVES: Several treatment options exist for varicose veins. In this review we summarize the available evidence derived from comparative studies about the relative safety and efficacy of these treatments. METHODS: We searched MEDLINE, Embase, Current Contents, Cochrane Central Register of Controlled Trials (CENTRAL) expert files, and the reference section of included articles. Eligible studies compared two or more of the available treatments (surgery, liquid or foam sclerotherapy, laser, radiofrequency ablations, or conservative therapy with compression stockings). Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. We used random-effects meta-analysis to pool relative risks (RR) and 95% confidence intervals (CI) across studies. RESULTS: We found 39 eligible studies (30 were randomized trials) enrolling 8285 participants. Surgery was associated with a nonsignificant reduction in the risk of varicose vein recurrence compared with liquid sclerotherapy (RR, 0.56; 95% CI, 0.29-1.06) and all endoluminal interventions (RR, 0.63; 95% CI, 0.37-1.07). Studies of laser and radiofrequency ablation and foam sclerotherapy demonstrated short-term effectiveness and safety. The quality of evidence presented in this review was limited by imprecision (small number of events), short-term follow-up, and indirectness (use of surrogate outcomes). CONCLUSION: Low-quality evidence supports long-term safety and efficacy of surgery for the treatment of varicose veins. Short-term studies support the efficacy of less invasive treatments, which are associated with less periprocedural disability and pain.

Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses.

OBJECTIVE: To summarize the available evidence on the cardiovascular effects of cross-sex steroid use in transsexuals. METHODS: We searched relevant electronic databases and sought additional references from experts. Eligible studies reported on cardiovascular events, venous thromboembolism, blood pressure and fasting serum lipids. Data were extracted in duplicate. We used the random-effects model to estimate the pooled weighted mean difference (WMD) and 95% confidence intervals (CIs). RESULTS: We found 16 eligible studies, mostly uncontrolled cohorts of varied follow-up durations (1471 male-to-female (MF) and 651 female-to-male (FM) individuals). In the MF individuals, cross-sex hormone use was associated with a statistically significant increase in fasting serum triglycerides without changes in the other parameters (WMD = 23.39 mg/dl; 95% CI = 4.82-41.95). In the FM individuals, there was a similar increase of triglycerides (WMD = 31.35 mg/dl; 95% CI = 7.53-55.17) and a reduction of high density lipoprotein (HDL)-cholesterol (WMD = -6.09 mg/dl; 95% CI = -11.44 to -0.73). There was a statistically significant but clinically trivial increase in systolic blood pressure (WMD = 1.74 mmHg; 95% CI = 0.21-3.27). Analyses were associated with significant heterogeneity across studies. There were very few reported cardiovascular events (deaths, strokes, myocardial infarctions or venous thromboembolism), more commonly among MF individuals. CONCLUSIONS: Very low quality evidence, downgraded due to methodological limitations of included studies, imprecision and heterogeneity, suggests that cross-sex hormone therapies increase serum triglycerides in MF and FM and have a trivial effect on HDL-cholesterol and systolic blood pressure in FM. Data about patient important outcomes are sparse and inconclusive.

Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes.

OBJECTIVE: To assess the prognosis of individuals with gender identity disorder (GID) receiving hormonal therapy as a part of sex reassignment in terms of quality of life and other self-reported psychosocial outcomes. METHODS: We searched electronic databases, bibliography of included studies and expert files. All study designs were included with no language restrictions. Reviewers working independently and in pairs selected studies using predetermined inclusion and exclusion criteria, extracted outcome and quality data. We used a random-effects meta-analysis to pool proportions and estimate the 95% confidence intervals (CIs). We estimated the proportion of between-study heterogeneity not attributable to chance using the I(2) statistic. RESULTS: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%). CONCLUSIONS: Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.

Factors which influence Latino community members to self-prescribe antibiotics.

BACKGROUND: Although there is consistent evidence of a link between antibiotic use and increasing antimicrobial resistance in the community, inappropriate use of antimicrobials continues to be a global problem. OBJECTIVE: To describe knowledge, attitudes, and practices of Latino community members in upper Manhattan regarding use of antibiotics. METHODS: Written questionnaires and eight focus groups comprised of Hispanic community members (three groups), bodega employees, and healthcare providers (one group) in a Latino neighborhood in New York City. RESULTS: There were major knowledge deficits regarding use of antibiotics. Informants reported taking antibiotics for pain or other conditions as well as for symptoms of infection. Antibiotics were frequently obtained from bodegas without prescription, but generally only for adults, not for children. DISCUSSION: Interventions to improve antibiotic use that are focused on the formal healthcare system (e.g., clinicians, pharmacists, persons with health insurance) are unlikely to be effective with recently immigrated Latino community members. Successful interventions for this population should include targeted messages to bodega employees, community organizations, and children and their parents.

Ingresos en la unidad de terapia intensiva pediátrica de pacientes con diarrea por Shigella en 10 años: (1989-1998) / s. t

En Cuba la diarrea no constituye una causa importante de mortalidad infantil, pero su morbilidad es considerable, demanda una atención esmerada del personal de salud y de un importante gasto de recursos. Se presenta un estudio retrospectivo de la infección por Shigella en pacientes ingresados en la Unidad de Cuidados Intensivos Pediátricos (UCIP) del Instituto Superior de Medicina Militar: Dr. Luis Díaz Soto en 10 años: 1989 a 1998. Se ingresaron 67 pacientes, 12,8 por ciento del total de ingresos por diarreas, el 77,7 por ciento procedían del Servicio de Urgencias. El grupo de edades más afectado fue el comprendido entre 6 meses y un año, 70,1 por ciento. La deshidratación y la acidosis metabólica fueron las complicaciones más frecuentes: 92,5 por ciento y 87 por ciento respectivamente. La shigella flexneri se aisló en un 64.7 por ciento de los casos. La ceftriaxona fue el antibiótico más usado: 53,8 por ciento y el 99,5 por ciento de los pacientes egresaron vivos(AU)

Características clínicas de pacientes ingresados en UCIP con Enfermedad diarreica aguda por Salmonella "no tifoídica" (1990-1999) / s. t

Las enfermedades diarreicas agudas constituyen la primera causa de morbilidad y mortalidad en los primeros 5 años de vida. En los países subdesarrollados más del 50 por ciento de las enfermedades diarreicas agudas (EDA) son de causa bacteriana. Entre el 1 por ciento y el 5 por ciento de las EDA son producidas por las salmonellas "no tifoídicas". Se realizó un estudio retrospectivo de los pacientes ingresados en la Unidad de Cuidados Intensivos Pediátricos (UCIP) del Instituto Superior de Medicina Militar: Dr Luis Díaz Soto (ISMM) afectados de gastroenteritis por salmonella "no tifoídica", en un período 10 de años: 50 pacientes ingresados en la unidad. Los datos analizados se obtuvieron de las historias clínicas y del libro de registro de egresos. Se aplicaron métodos estadísticos de porcentajes y Chi cuadrado con un intervalo de confianza de a = 0,0; el 8,9 por ciento de los pacientes ingresados por EDA, necesitaron atención en Cuidados Intensivos. El 76,2 por ciento de los niños fueron lactantes menores de 6 meses. La salmonella B se aisló en el 51,0 por ciento, la salmonella E en el 27 por ciento y la salmonella C en el: 22 por ciento. El 88,2 por ciento de los casos llegaron a la UCIP con diferentes grados de deshidratación y en el 77,9 por ciento no hubo necesidad del uso de terapéutica antibiótica(AU)

Neumonías graves y estado nutricional en pacientes ingresados en la unidad de cuidados intensivos pediátricos / s. t

Las infecciones respiratorias constituyen el principal motivo de consulta de los servicios de urgencias pediátricos, un número importante de pacientes evolucionan como casos ligeros, característicos de los procesos virales y una pequeña proporción desarrollan cuadros graves, que necesitan tratamiento en las unidades de cuidados intensivos. Se estudiaron variables y incidentes en el estado nutricional de 139 pacientes ingresados por neumonías adquiridas en la comunidad, en la Unidad de Cuidados Intensivos Pediátricos del Instituto Superior de Medicina Militar Dr Luis Díaz Soto durante el período comprendido entre Enero 2002 a Enero de 2004. Todos los datos fueron procesados estadísticamente utilizando medidas de tendencia central y de dispersión. Los grupos de edades más representativos fueron los de 1 a 5 años con un 59.7 por ciento, siendo el sexo masculino el más afectado en todos los grupos de edades con 70.5 por ciento. El antecedente de no lactancia materna exclusiva o destete precoz se mostró en el 71.2 por ciento de los pacientes. El 66.7 por ciento estuvo normopeso y solo el 6.47 por ciento se encontraba desnutrido. Los resultados de la hemoglobina como parámetro indirecto de nutrición arrojaron que 92 pacientes presentaron cifras por debajo de 11 g/dl, predominando en los lactantes menores de 6 meses con un 85.7 por ciento. El mayor número de neumonías graves se presentó en pacientes eutróficos. El destete precoz y la anemia deben ser tenidos en cuenta como factores de riesgo nutricional(AU)

Vasculitis aguda / s. t

La vasculítis es una inflamación de la pared de los vasos, afectándose generalmente el lumen por lo que se asocia con isquemia de tejidos. La inflamación involucra vasos de distintos diámetros y diferentes órganos, todo lo cual explica la variedad de manifestaciones clínicas. Se realiza la presentación de un paciente masculino, blanco de 7 años de edad que ingresa en la Terapia Intensiva Pediátrica del Instituto de Medicina Militar Dr Luis Díaz Soto, con el diagnóstico presuntivo de sepsis severa y vasculítis aguda infecciosa, aplicándosele terapia antimicrobiana de amplio espectro. La persistencia de las manifestaciones clínicas asociado a una gangrena seca del segundo artejo del pie derecho nos hizo pensar en las causas no infecciosas de esta entidad y comenzar con tratamiento inmunosupresor mejorando evolutivamente(AU)