ABSTRACT
Resumen Antecedentes: La enfermedad de Kawasaki (EK) representa la principal causa de cardiopatía pediátrica adquirida en muchos países; sin embargo, hay pocos estudios publicados en Latinoamérica. Objetivo: Describir la epidemiología, los aspectos clínicos y el tratamiento de EK en niños en Panamá como parte del estudio de vigilancia de REKAMLATINA-2 en Latinoamérica. Pacientes y Métodos: Estudio retrospectivo, descriptivo, de pacientes internados con diagnóstico de EK, atendidos en tres hospitales pediátricos de Panamá del 1-enero-2009 al 31-diciembre-2013. Resultados: Se analizaron 111 pacientes, 61(54,9%) eran hombres. Todos fueron hospitalizados, siendo la media de hospitalización de 5,8 (4-7) días. La mediana de edad al ingreso fue de 28,9 (12-38) meses. Un 63,9% recibió antimicrobianos recientemente por otros posibles diagnósticos. Recibieron inmunoglobulina intravenosa (IGIV) 105 (94,6%) pacientes; de éstos, 10 (9,5%) fueron resistentes. Un 11,7% tuvo alteraciones cardiovasculares en el ECO inicial, de las cuales las lesiones coronarias se detectaron en 3 (2,9%) pacientes. Conclusiones: Los datos sugieren que EK en Panamá tiene una incidencia cercana a 2,05 x 100,000 bajo 15 años de edad y una frecuencia 2,6 veces mayor bajo 3 años de edad. Se observó un alto porcentaje de uso de antimicrobianos ambulatoriamente antes de la confirmación diagnóstica, lo cual sugiere reconocimiento tardío de EK en Panamá.
Abstract Background: Kawasaki disease (KD) is the leading cause of pediatric acquired heart disease in many countries, however, there are few published studies from Latin America (LA). Aim: To describe the epidemiology, clinical aspects, and treatment of KD in children from Panama as part of the REKAMLATINA-2 in LA. Methods: Retrospective descriptive review of hospitalized patients diagnosed with KD, attended at three main pediatric hospitals of Panama from January-1-2009 to December-31-2013. Results: 111 patients were analyzed, 61(54.9 %) were male. All children were hospitalized, and had a mean length of hospitalization of 5.8 (4-7) days. Median age at admission was 28.9 (12-38) months. Prior to KD final diagnosis, 63.9% patients received antibiotics for other presumed diagnoses. 105 (94.6%) patients received IGIV, 10 (9.5%) were resistant. On initial echocardiogram, 11.7% of cardiovascular complications were reported, of which coronary artery lesions (CALs) were detected in 3 (2.9 %) patients. Conclusion: The data suggest that KD in Panama has an incidence of about 2.05 x 100,000 in children under 15 years of age, and with a frequency 2.6 times higher in children under 3 years. A high rate of antibiotic misuse on outpatient prior to diagnostic confirmation was observed, suggesting KD unawareness and late recognition in Panamá.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Mucocutaneous Lymph Node Syndrome , Panama/epidemiology , Incidence , Retrospective Studies , Hospitalization , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/epidemiologyABSTRACT
BACKGROUND: Kawasaki disease (KD) is the leading cause of pediatric acquired heart disease in many countries, however, there are few published studies from Latin America (LA). AIM: To describe the epidemiology, clinical aspects, and treatment of KD in children from Panama as part of the REKAMLATINA-2 in LA. METHODS: Retrospective descriptive review of hospitalized patients diagnosed with KD, attended at three main pediatric hospitals of Panama from January-1-2009 to December-31-2013. RESULTS: 111 patients were analyzed, 61(54.9 %) were male. All children were hospitalized, and had a mean length of hospitalization of 5.8 (4-7) days. Median age at admission was 28.9 (12-38) months. Prior to KD final diagnosis, 63.9% patients received antibiotics for other presumed diagnoses. 105 (94.6%) patients received IGIV, 10 (9.5%) were resistant. On initial echocardiogram, 11.7% of cardiovascular complications were reported, of which coronary artery lesions (CALs) were detected in 3 (2.9 %) patients. CONCLUSION: The data suggest that KD in Panama has an incidence of about 2.05 x 100,000 in children under 15 years of age, and with a frequency 2.6 times higher in children under 3 years. A high rate of antibiotic misuse on outpatient prior to diagnostic confirmation was observed, suggesting KD unawareness and late recognition in Panamá.
Subject(s)
Mucocutaneous Lymph Node Syndrome , Child , Child, Preschool , Female , Hospitalization , Humans , Incidence , Infant , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/epidemiology , Panama/epidemiology , Retrospective StudiesABSTRACT
La Esclerosis Sistémica Cutánea Difusa (ESCD) es una enfermedad del tejido conectivo multisistémica que afecta la piel y órganos internos. La Enfermedad Pulmonar Intersticial (EIP) se presenta en un 70 a 80% de los casos y aproximadamente un cuarto presentan Fibrosis Pulmonar, lo que es muy raro en la edad pediátrica. La enfermedad pulmonar es una de las principales causas de muerte en los pacientes con Esclerosis Sistémica. Se presenta el caso de una paciente con Esclerosis Sistémica Cutánea Difusa asociada a Fibrosis Pulmonar. El diagnóstico y tratamiento temprano de esta entidad permite prolongar y mejorar la calidad de vida de estos pacientes
Diffuse cutaneous systemic sclerosis is a connective tissue disorder that involve skin and internal organs. Interstitial lung disease is present in 70 80% of all cases and approximately one quarter with lung fibrosis, that is no common in pediatric patients. Lung disease is one of the most important cause of death in patient with systemic sclerosis. A case of diffuse cutaneous systemic sclerosis with lung fibrosis is present.
ABSTRACT
La granulomatosis con poliangitis (GPA), previamente conocida como granulomatosis de Wegener (GW), es una enfermedad autoinmune sistémica. Presentamos el caso de una adolescente de 14 años de edad que acude a consulta con otalgia, otorrea, secreción sanguinolenta bilateral asociada a tinnitus, hipoacusia, cefalea, pérdida de peso de +/- 20 libras, fiebre intermitente no cuantificada , y antecedentes patológicos de sinusitis y asma bronquial. La otoscopía evidenció granulomas a nivel del piso de ambos conductos auditivos externoas y sobre la membrana timpánica. Posteriormente se realiza biopsia que reporta inflamación crónica de aspecto granulomatoso con necrosis, asociado ANCA PR3 positivo. Con los hallazgos anteriores se concluye el diagnóstico de GPA. Ha sido tratado exitosamente con medicamentos citotóxicos e inmunosupresores. El manejo apropiado con estos medicamentos ha mejorado la expectativa de vida de los pacientes con GPA.
Granulomatosis with polyangitis (GPA), previously known as Wegener's granulomatosis (GW), is a systemic autoimmune disease. A male of a 14-years who comes to the hospital with a chief complain of ear pain,otorrhea, bilateral bloody discharge associated with tinnitus, hearing loss, headache, weight loss of +/- 20 pounds and occasional unquantified intermittent, fever that has history of sinusitis and bronchial asthma. Otoscopy revealed granulomas at the floor level of both external auditory passages and the tympanic membrane. Subsequently, a biopsy is performed that reports chronic granulomatous inflammation with necrosis associated with ANCA PR3 positive. With the previously findings we can diagnose GPA. It has been successfully treated with cytotoxic and immunosuppressive drugs for the management and control of this disease. It has dramatically increased life expectancy.