Tocilizumab demonstrates superiority in decreasing C-reactive protein levels in hospitalized COVID-19 patients, compared to standard care treatment alone.

Severe acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crisis. The virus triggers the activation of inflammatory reactants including interleukin-6 (IL-6), ferritin, and C-reactive protein (CRP), causing multiorgan damage, particularly affecting the lungs. Tocilizumab, an IL-6 receptor blocker, has the potential to diminish the progression of the disease and reduce organ damage and long-term complications. The aim of this observational retrospective cohort study was to evaluate the efficacy of tocilizumab in decreasing CRP levels in hospitalized coronavirus disease 2019 (COVID-19) patients compared to standard care without the drug. The study included 141 patients during their Hospital Stay (HS), with 100 in the Tocilizumab group and 41 in the non-Tocilizumab group. Clinical information was collected from the electronic clinical record, analyzed using statistical software, and homogenized the CRP levels from the severe group to the levels of the less complicated group at 48 h of hospitalization. The results showed a statistically significant greater decrease in CRP levels in the Tocilizumab group at 48 h after the use of the treatment, with no differences in mortality or length of stay between the groups. In conclusion, tocilizumab accelerates the diminishing of CRP levels compared to standard treatment alone, and its use may have potential benefits in the management of severe COVID-19 patients when used alongside with follow-up quantification of CRP levels reduction.IMPORTANCESevere acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crises. International guidelines for managing coronavirus disease 2019 (COVID-19) give recommendations according to the severity of the disease and the level of oxygen therapy needed. Tocilizumab is an option for the therapeutic management of hospitalized patients with any level of oxygen therapy; IL-6 serum level is the parameter for the follow-up on the efficacy, but it is not available at many hospitals. In this study, we demonstrate that C-reactive protein determination can predict the response to tocilizumab in severe COVID-19, the target patients for treatment with this drug. The use of this affordable and extensively available biomarker supports clinical decisions for the early escalation of the therapy and for the rational use of this drug on those prone to improve with the use of it.

Outcome classification model for Covid-19 patients using artificial intelligence.

Not available.

Fractional exhaled nitric oxide has a good correlation with asthma control and lung function in latino children with asthma.

BACKGROUND: Although the measurement of fractional exhaled nitric oxide (FE(NO)) has been recommended for observational studies and clinical trials of asthma, FE(NO) has not been examined in studies of childhood asthma in Latin America, OBJECTIVE: To examine the relationship between FE(NO) and indicators of disease control or severity [asthma control test/childhood asthma control test (ACT/C-ACT), lung function, and exercise challenge test (ECT)] in Mexican children with persistent asthma, METHODS: Children (6-18 years of age) with persistent asthma were consecutively recruited in a tertiary asthma clinic and divided into two groups, e.g. FE(NO) < 20 parts per billion (ppb) and ≥20 ppb.Adequate FE(NO) measurements were obtained in 134 (83.2%) of 161 eligible children, RESULTS: Children with FE(NO)<20 ppb had significantly higher scores on the ACT/C-ACT than those with FE(NO) ≥ 20 ppb (median [interquartile range] :23 [20.8-25] vs. 21 [18-24], p = .002, respectively). Compared to children with FE(NO) ≥20 ppb, those with FE(NO) <20 ppb had a higher baseline predicted forced expiratory volume (FEV(1)) [94% (92.5%-99.4%) vs. 83% (81%-89.9%), p = .001] and a lower probability of having a positive ECT (42.7% vs. 71.2%, p = .001). In addition, FE(NO) was significantly inversely correlated with the participants' ACT/C-ACT score and predicted FEV1, and directly correlated with positive ECT, CONCLUSION: Among Mexican children with persistent asthma, low levels of FE(NO) ( <20 ppb) are associated with better asthma control, and higher lung function.

Estrés postraumático en la población pediátrica atendida en el Hospital Infantil del estado de Chihuahua, México / Posttraumatic stress disorder in a pediatric population treated at the Children's Hospital of the State of Chihuahua, Mexico

Introducción. Ante el incremento de acciones violentas de diversa índole en nuestra comunidad surge la preocupación respecto a las consecuencias psicológicas en los niños que viven algún evento traumático. Por lo anterior, el objetivo del presente estudio fue identificar los factores relacionados con el desarrollo de trastorno de estrés postraumático en la población pediátrica atendida en el área de Psicología Infantil del Hospital Infantil del estado de Chihuahua. Métodos. Se realizó un estudio transversal retrospectivo en el que se analizaron los expedientes de de pacientes atendidos en el área de psicología infantil del Hospital Infantil del estado de Chihuahua durante un periodo de 3 meses. Se realizó el estudio de frecuencias y el análisis bivariado. Resultados. Se analizaron 125 expedientes que representaron 51% del total de la consulta del Departamento de Salud Mental. De estos, 41.6% correspondieron al género masculino y 58.4% al femenino. En 52 pacientes el evento desencadenante fue la violencia, mientras que en 73 pacientes éste se debió a accidentes. La edad de los pacientes se encontró dentro del rango de los 5 y los 15 años y la mayor prevalencia entre los 5 y 7 años y medio. No se encontró asociación estadísticamente significativa entre la escolaridad de los padres, la religión de la familia ni el tipo de familia (integrada o desintegrada) con el desarrollo de trastorno de estrés postraumático. Conclusiones. El trastorno de estrés postraumático en la población pediátrica ha aumentado de forma considerable en los últimos años. La identificación adecuada de los pacientes que presentan datos sugestivos del diagnóstico es de suma importancia para poder imple-mentar terapias que permitan evitar las consecuencias psicológicas.

Background. Due to the increase in various types of violent actions in our community, there is a preoccupation regarding the psychological consequences for children who survive a traumatic event. The aim of this study was to identify factors related to the development of posttraumatic stress disorder (PTSD) in pediatric patients treated in the Department of Child Psychology at Children's Hospital of the State of Chihuahua (HIECH). Methods. We conducted a retrospective cross-sectional study examining the clinical files during a 3-month period of patients treated in the Department of Child Psychology of HIECH. The study was conducted with frequencies and bivariate analysis. Results. We analyzed a total of 125 clinical files of which 41.6% corresponded to males and 58.4% to females. In 52 patients the triggering event was a violent action, whereas in 73 patients the event was due to accidents. The age of the patients was between 5 and 15 years and the highest prevalence was found in patients between 5 and 7 years of age. No statistically significant association was found in regard to parental education, religion, or family type (integrated or disintegrated) with the development of PTSD. Conclusions. Posttraumatic stress disorder in the pediatric population has increased considerably in recent years. Proper identification of patients with data suggestive of the diagnosis is important in order to implement therapies that avoid the psychological consequences.

Diagnóstico tardío de la aspiración de un cuerpo extraño / Delayed diagnosis of foreign body aspiration

Introducción. La aspiración de cuerpos extraños es un problema común en el paciente pediátrico y representa una causa importante de morbilidad y mortalidad. En Estados Unidos se considera la causa de 7% de las muertes accidentales de niños de entre 1 y 3 años de edad. La presentación clínica requiere de un alto grado de sospecha diagnóstica por el médico, sobre todo cuando el antecedente del evento de atragantamiento no es claro en la historia clínica debido a que la exploración física y los hallazgos radiológicos son inespecíficos en la mayoría de las ocasiones. Caso clínico. Se presenta el caso de un adolescente de 14 años que, a pesar de tener el antecedente de la aspiración de un cuerpo extraño, no se le dio importancia y sus síntomas se confundieron con otras entidades. Recibió diversos tratamientos pero sus síntomas se mantuvieron por un año. Fue remitido a la Unidad de Neumología Pediátrica Fernando Katz del Instituto Nacional de Enfermedades Respiratorias donde se realizó el estudio broncoscópico y la extracción del cuerpo extraño del bronquio intermedio. Conclusiones. El diagnóstico tardío ocasiona problemas respiratorios que van desde la obstrucción de las vías aéreas (que pone en riesgo la vida) hasta síntomas respiratorios crónicos como sibilancias e infecciones recurrentes de las vías respiratorias. Es común también que estos síntomas se confundan con otras entidades patológicas como el asma, el reflujo gastroesofágico y la disfunción laríngea.

Background. Aspiration of foreign bodies in the central airway is a common problem in the pediatric population, representing a major cause of morbidity and mortality in our country. In the U.S., foreign body aspiration is the cause for 7% of accidental deaths in children between 1 and 3 years of age. Clinical diagnosis requires a high degree of suspicion in the medical history especially when the choking event is unclear in the clinical history because physical examination and radiological findings have a low sensitivity. Case report. We present the case of a 14-year-old male with a history of foreign body aspiration. The patient's symptoms were given little importance. A 1-year delay in diagnosis occurred due to symptoms mimicking other pathologies. The patient was referred to the Pediatric Pulmonology Unit "Fernando Katz" of the National Institute of Respiratory Diseases where bronchoscopic exploration was performed with removal of foreign body (plastic object) from the intermediary bronchus. Conclusions. Delayed diagnosis causes respiratory problems ranging from life-threatining airway obstruction to chronic respiratory symptoms such as wheezing and recurrent respiratory infections. It has been shown that these symptoms can be confused with other pathologies such as asthma.