Short-term complications and post-acute sequelae in hospitalized paediatric patients with COVID-19 and obesity: A multicenter cohort study.

BACKGROUND: Obesity increases the severity of coronavirus disease 2019 illness in adults. The role of obesity in short-term complications and post-acute sequelae in children is not well defined. OBJECTIVE: To evaluate the relationship between obesity and short-term complications and post-acute sequelae of SARS-CoV-2 infection in hospitalized paediatric patients. METHODS: An observational study was conducted in three tertiary hospitals, including paediatric hospitalized patients with a confirmatory SARS-CoV-2 RT-PCR from March 2020 to December 2021. Obesity was defined according to WHO 2006 (0-2 years) and CDC 2000 (2-20 years) growth references. Short-term outcomes were intensive care unit admission, ventilatory support, superinfections, acute kidney injury, and mortality. Neurological, respiratory, and cardiological symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms were considered as post-acute sequalae. Adjusted linear, logistic regression and generalized estimating equations models were performed. RESULTS: A total of 216 individuals were included, and 67 (31.02%) of them had obesity. Obesity was associated with intensive care unit admission (aOR = 5.63, CI95% 2.90-10.94), oxygen requirement (aOR = 2.77, CI95% 1.36-5.63), non-invasive ventilatory support (aOR = 6.81, CI95% 2.11-22.04), overall superinfections (aOR = 3.02 CI95% 1.45-6.31), and suspected bacterial pneumonia (aOR = 3.00 CI95% 1.44-6.23). For post-acute sequalae, obesity was associated with dyspnea (aOR = 9.91 CI95% 1.92-51.10) and muscle weakness (aOR = 20.04 CI95% 2.50-160.65). CONCLUSIONS: In paediatric hospitalized patients with COVID-19, severe short-term outcomes and post-acute sequelae are associated with obesity. Recognizing obesity as a key comorbidity is essential to develop targeted strategies for prevention of COVID-19 complications in children.

[Nosocomial infections after cardiac surgery in infants and children with congenital heart disease]. / Infecciones asociadas a la atención en salud (IAAS) en pacientes pediátricos post-operados de cardiopatías congénitas.

INTRODUCTION: Nosocomial infections generate high morbidity and mortality in children undergoing cardiac surgery. OBJECTIVE: To determine risk factors for nosocomial infections in children after congenital heart surgery. METHODS: A retrospective case-control study, in patients younger than 15 years undergoing surgery for congenital heart disease from January 2007 to December 2011 admitted to the Pediatric Critical Patient Unit (UPC-P) in a university hospital. For cases, the information was analyzed from the first episode of infection. RESULTS: 39 patients who develop infections and 39 controls who did not develop infection were enrolled. The median age of cases was 2 months. We identified a number of factors associated with the occurrence of infections, highlighting in univariate analysis: age, weight, univentricular heart physiology, complexity of the surgical procedure according to RACHS-1 and cardiopulmonary bypass (CPB) time ≥ 200 minutes. Multivariate analysis identified CPB time ≥ 200 minutes as the major risk factor, with an OR of 11.57 (CI: 1.04 to 128.5). CONCLUSION: CPB time ≥ 200 minutes was the mayor risk factor associated with the development of nosocomial infections.

Infecciones asociadas a la atención en salud (IAAS) en pacientes pediátricos post-operados de cardiopatías congénitas / Nosocomial infections after cardiac surgery in infants and children with congenital heart disease

Introduction: Nosocomial infections generate high morbidity and mortality in children undergoing cardiac surgery. Objective: To determine risk factors for nosocomial infections in children after congenital heart surgery. Methods: A retrospective case-control study, in patients younger than 15 years undergoing surgery for congenital heart disease from January 2007 to December 2011 admitted to the Pediatric Critical Patient Unit (UPC-P) in a university hospital. For cases, the information was analyzed from the first episode of infection. Results: 39 patients who develop infections and 39 controls who did not develop infection were enrolled. The median age of cases was 2 months. We identified a number of factors associated with the occurrence of infections, highlighting in univariate analysis: age, weight, univentricular heart physiology, complexity of the surgical procedure according to RACHS-1 and cardiopulmonary bypass (CPB) time ≥ 200 minutes. Multivariate analysis identified CPB time ≥ 200 minutes as the major risk factor, with an OR of 11.57 (CI: 1.04 to 128.5). Conclusion: CPB time ≥ 200 minutes was the mayor risk factor associated with the development of nosocomial infections.

Introducción: Las infecciones asociadas a la atención en salud (IAAS) generan elevada morbilidad y mortalidad en niños sometidos a cirugía cardíaca. Objetivo: Determinar factores de riesgo que inciden en la ocurrencia de IAAS en niños operados de cardiopatías congénitas. Métodos: Estudio retrospectivo de casos y controles, en pacientes menores de 15 años sometidos a cirugía por cardiopatías congénitas desde enero 2007 a diciembre 2011 admitidos en la Unidad de Paciente Crítico Pediátrico (UPC-P) de un hospital universitario. Para los casos, se analizó la información del primer episodio de infección. Resultados: Se enrolaron 39 pacientes con IAAS y 39 controles operados que no desarrollaron infección. La mediana de edad de los casos fue 2 meses. Se identificó una serie de factores asociados a la ocurrencia de IAAS, destacando en el análisis univariado: edad, peso, fisiología cardíaca tipo univentricular, complejidad del procedimiento quirúrgico según RACHS-1 y tiempo de circulación extracorpórea (CEC) ≥ 200 min. El análisis multivariado identificó al tiempo de CEC ≥ 200 min como el principal factor de riesgo, con un OR de 11,57 (IC: 1,04-128,5). Conclusión: El tiempo de CEC ≥ 200 min fue el factor de riesgo más asociado al desarrollo de IAAS en niños operados de cardiopatías congénitas.

[Clinical and endoscopic features of a selected population with serrated colorectal adenomas in a private clinic in Lima - Peru]. / Características clínicas y endoscópicas de una población seleccionada con adenomas aserrados de colon en una clínica privada de Lima - Perú

OBJECTIVE: To describe the clinical and endoscopic caracteristics of a population that has only serrated polyps of colon (mainly sessile serrated adenomas) in a private clinic in Lima, Perú, from 2009-2011. MATERIALS AND METHODS: Retrospective study conducted at the endoscopy center of Clinic Ricardo Palma, Lima, Peru. Olympus colonoscope was used with high definition, including NBI (narrow band imaging) and electronic magnification. Patients had pathologic diagnosis of â€Å“polyps and / or colorectal serrated adenomas” and excluded those with synchronous tubular or villous adenomas. Images were evaluated by two endoscopists and then by a third gastroenterologist. RESULTS: We found 201 serrated polyps in 108 patients. Women were 60.2% and overweight predominated. Eighty (74.1%) had only one serrated adenoma and 23 (21.3%) with at least one synchronous hyperplastic polyp. The average size of sessile serrated adenomas was 5.12 mm (± 3.87 DS) and the flat type was 91 (58.7%). There were significant differences in the diameter of sessile serrated adenomas between the distal and proximal colon (4.47 mm ± 2.23 vs. 6.90 mm ± 6.25; p<0.000). The common features of sessile serrated adenomas were: White (31/36, 86.1%), smooth (28/36, 77.8%) and regular margins (26/36, 72.2%). There was a relationship between vascular pattern according NBI and serrated polyp histology (p=0.024). CONCLUSION: The endoscopic features of sessile serrated adenomas can evade detection to white light. NBI is a useful tool to define some features of these lesions.

Características clínicas y endoscópicas de una población seleccionada con adenomas aserrados de colon en una clínica privada de Lima - Perú / Clinical and endoscopic features of a selected population with serrated colorectal adenomas in a private clinic in Lima - Perú

Objetivo: Describir las características clínicas y endoscópicas de una población que sólo presenta pólipos aserrados de colon (principalmente adenomas aserrados sésiles) en una clínica privada de Lima del 2009 al 2011. Materiales y métodos: Estudio retrospectivo realizado en el centro endoscópico de la Clínica Ricardo Palma, Lima, Perú. Se usó colonoscopios Olympus con alta definición, incluyendo NBI (narrow band imaging) y magnificación electrónica. Los pacientes tuvieron diagnóstico patológico de “pólipos y/o adenomas aserrados de colon”, excluyéndose aquéllos con adenomas tubulares o vellosos sincrónicos. Las imágenes fueron evaluadas por dos endoscopistas y luego por un tercer gastroenterólogo. Resultados: Se encontraron 201 pólipos aserrados en 108 pacientes. El 60,2% fueron mujeres y predominó el sobrepeso. Ochenta (74,1%) tuvieron sólo un adenoma aserrado y 23 (21,3%) con al menos un pólipo hiperplásico sincrónico. El tamaño promedio de los adenomas aserrados sésiles fue 5,12 mm (± 3,87 DS) y 91 (58,7%) fueron planos. Hubo diferencias significativas en el diámetro de adenomas aserrados sésiles entre el colon distal y proximal (4,47 mm ± 2,23 vs. 6,90 mm ± 6,25; p<0,000). El color blanco (31/36, 86,1%), superficie lisa (28/36, 77,8%) y márgenes regulares (26/36, 72,2%) fueron las características más frecuentes de adenomas aserrados sésiles. Hubo relación entre el patrón capilar según NBI y el tipo histológico del pólipo aserrado (p=0,024). Conclusión: Las características endoscópicas de los adenomas aserrados sésiles pueden dificultar su detección a la luz blanca. El NBI es una herramienta útil para definir algunas características de estas lesiones.

Objective: To describe the clinical and endoscopic caracteristics of a population that has only serrated polyps of colon (mainly sessile serrated adenomas) in a private clinic in Lima, Perú, from 2009-2011. Materials and methods: Retrospective study conducted at the endoscopy center of Clinic Ricardo Palma, Lima, Peru. Olympus colonoscope was used with high definition, including NBI (narrow band imaging) and electronic magnification. Patients had pathologic diagnosis of “polyps and / or colorectal serrated adenomas” and excluded those with synchronous tubular or villous adenomas. Images were evaluated by two endoscopists and then by a third gastroenterologist. Results: We found 201 serrated polyps in 108 patients. Women were 60.2% and overweight predominated. Eighty (74.1%) had only one serrated adenoma and 23 (21.3%) with at least one synchronous hyperplastic polyp. The average size of sessile serrated adenomas was 5.12 mm (± 3.87 DS) and the flat type was 91 (58.7%). There were significant differences in the diameter of sessile serrated adenomas between the distal and proximal colon (4.47 mm ± 2.23 vs. 6.90 mm ​​± 6.25; p<0.000). The common features of sessile serrated adenomas were: White (31/36, 86.1%), smooth (28/36, 77.8%) and regular margins (26/36, 72.2%). There was a relationship between vascular pattern according NBI and serrated polyp histology (p=0.024). Conclusion: The endoscopic features of sessile serrated adenomas can evade detection to white light. NBI is a useful tool to define some features of these lesions.

Hyperglycemia in postmenopausal women screened for the metabolic syndrome is associated to increased sexual complaints.

BACKGROUND: Postmenopausal metabolic changes increase cardiovascular risk and impair quality of life (QoL). Despite this, few reports have addressed the association of these changes with female sexuality. OBJECTIVE: To determine the association between the metabolic syndrome (METS), and its components, and female sexuality. METHODS: Data of sexually active postmenopausal women who participated in a METS screening program who filled out the menopause-specific quality of life questionnaire (MENQOL) were assessed. Specifically the sexual domain of the MENQOL was analyzed in regard to mean total and item scores (decreased libido, vaginal dryness, and sexual avoidance). Criteria of the Third Adult Treatment Panel (ATP III) were used to identify women with the METS. RESULTS: Two hundred six women fulfilled inclusion criteria. Mean age of participants was 54 ± 6.9 years (median: 54 years). Prevalence of the METS in this sexually active postmenopausal series was 39.8%. About 52.9% of them presented abdominal obesity, 35.4% hypertension, 55.8% high triglycerides, 17.5% hyperglycemia, and 59.7% decreased high density lipoprotein cholesterol (HDL-C). Women with the METS as compared with those without the syndrome displayed no significant differences in MENQOL sexual scorings (total or of its composing items). Equally there were also no score differences among those presenting any of the five components of the METS, except women with hyperglycemia who significantly displayed a higher total sexual domain score (5.6 ± 2.1 vs. 4.8 ± 2.3, p < 0.05) in association to a higher mean score in the decreased libido item (6.0 ± 2.3 vs. 4.8 ± 2.6, p < 0.01). After controlling for several confounding factors, logistic regression confirmed that women with hyperglycemia were significantly at higher risk for presenting decreased libido (higher item score, OR 2.4, CI 95%: 1.0-5.7, p < 0.05) and more impaired sexuality (higher total MENQOL sexual domain score: OR, 2.5, CI 95%: 1.1-5.4, p < 0.05). CONCLUSION: Despite the limitations of this study, as assessed with the MENQOL, hyperglycemia in postmenopausal women screened for the METS was associated to a negative impact in sexuality. More research is warranted in this regard.

Biliary strictures after liver transplantation. Predictive factors for response to endoscopic management and long-term outcome.

BACKGROUND: Biliary strictures after liver transplantation are frequent. The long-term prognosis and predictive factors of response to endoscopic treatment are not well known. METHODS: The aim of this study was to demonstrate the role of endoscopic treatment, predictive factors of response, and outcome in patients with biliary stricture after liver transplantation. We performed a retrospective review of medical records of all consecutive post-liver transplantation patients who underwent endoscopic retrograde cholangiography in our center during the period from October 2001 to October 2006. RESULTS: Twenty-five of 43 patients referred for endoscopic retrograde cholangiography had biliary stricture. Eighteen had stricture at the area of the anastomosis alone, 2 patients had a stricture at the area of the anastomosis and also another area, and 5 had nonanastomotic biliary strictures. Twenty-one patients had a single stricture and 4 had more than 1 stricture. Initially 19 of 24 patients (79%) responded to endoscopic management with normalization of liver enzymes. Four patients (16%) did not respond clinically despite a successful endoscopic approach. All patients who did not respond to endoscopic dilation had more than 1 area of stricture. There was a significantly better response to endoscopic treatment in patients with an anastomotic stricture versus patients with nonanastomotic strictures 17/19 versus 2/5 (P = 0.042). CONCLUSIONS: In our experience, endoscopic treatment of anastomotic biliary strictures is highly effective with a good long-term outcome. The presence of nonanastomotic and multiple strictures should be considered a factor associated with poor response to endoscopic management.

Sedation for upper endoscopy: comparison of midazolam versus fentanyl plus midazolam.

BACKGROUND: The benefit of using one or two drugs for conscious sedation in upper endoscopy remains unproven. This study evaluates the adequacy of conscious sedation during upper endoscopy using midazolam alone compared with midazolam plus fentanyl. METHODS: Patients older than 18 years of age who underwent elective, outpatient upper endoscopy were included. They were randomized to receive either a combination of midazolam/fentanyl or midazolam alone. The adequacy of sedation obtained was assessed using a questionnaire answered by the physician at the end of the procedure, and by the patient 24 to 72 hours after endoscopy. RESULTS: From the endoscopist's perspective, following an intention-to-treat analysis, patients had better tolerance in the combination group (78.3% excellent/good tolerance M/F group versus 55.8% M group) (P = 0.043) (Table 2). Per patient's assessment excellent/good tolerance was found in 93% of M group and 94% in F/M group (P = 1.0). No difference in duration of the procedure was found between the two groups. No complications during endoscopies were reported. CONCLUSIONS: In diagnostic upper endoscopy, an adequate level of sedation can be obtained safely either by midazolam or midazolam plus fentanyl. From an endoscopist's perspective, the combination is significantly better.

Educational and organizational interventions used to improve the knowledge of metabolic syndrome among postmenopausal women.

A total of 105 postmenopausal women previously diagnosed with metabolic syndrome consented to take part in this educational program. After receiving the training, women significantly improved their knowledge regarding menopause and related issues, and, since the program increased their awareness of menopause and related risks, we propose that these cost-effective measures could eventually reduce cardiovascular morbidity and mortality among high-risk populations.

Emphysematous gastritis.

Emphysematous gastritis is a rare condition in which gas collects within the stomach wall secondary to infection by gas-producing organisms. The authors report a case of an 82-year-old diabetic man admitted for altered mental status, fever, and leukocytosis. Intramural air within the gastric wall was incidentally found by computed tomography. The case is discussed and differential diagnosis, early diagnosis, and outcome are reviewed.

[Relapsing viral hepatitis type A complicated with renal failure]. / Hepatitis viral tipo A recurrente complicada con insuficiencia renal.

We report the case of a 42-year old male with an episode of relapsing hepatitis A of cholestatic pattern, which clinic course was complicated by fever, anemia and renal failure, requiring hemodialysis. The occurrence of cryglobulins and diminished complement levels was detected. A kidney biopsy was performed showing evidence of thrombotic microangiopathy. The patient had a good therapeutic response to corticosteroids, although he developed recurrence of fever and a palpable purpuric rush over his lower extremities when dose was reduced. A skin biopsy found leukocytoclastic vasculitis. Symptoms and physical findings improved when therapy with cycloposphamide was started and the dose of corticosteroids was increased. Hepatitis A virus infection usually has a benign course, although complications may occasionally develop. The relapsing form can be seen in 3-20% of the case; it can appear with a cholestatic pattern and most of the time it has a mild clinic development. Unlike hepatitis B, extra-hepatic manifestations are unusual in hepatitis A, and renal manifestations are even more infrequent. Acute renal failure (ARF) in non-fulminating hepatitis A has been reported only occasionally and its etiology remains unclear. Several hypotheses have been proposed, including renal toxicity due to hyperuricemia or increased bilirrubin, cryoglobulinemia, alterations in the renal blood flow due to endotoxemia or peripheral immune complex-mediated damage when hypocomplementemia is found. Kidney biopsy showed evidence of thrombotic microangiopathy, which raised the hypothesis of a Hemolytic Uremic Syndrome (HUS). An association with HUS has been described in a patient with surface antigen for hepatitis B (HBsAg) and anomalies in the hepatic biochemical tests, but as far as we know this is the first case of relapsing hepatitis A associated with a confirmed microangiopathic renal involvement.

[Crohn's disease associated with focal pulmonare lesion]. / Enfermedad de Crohn asociada a la lesion pulmonar focal.

40 year-old male recently diagnosed with Crohn's disease. A routine chest X ray showed a round, well defined opacity in right lung field. A chest CT scan confirmed the finding and also described bronchiectasis. Patient had no respiratory symptoms. He was prescribed with oral sulfasalazine and corticosteroids with rapid improvement of intestinal symptoms as well as resolution of the pulmonary opacity. We describe the clinical presentation of a male newly diagnosed with Crohn's disease who was found to have an asymptomatic pulmonary lesion on imaging studies. Pulmonary complications have been previously described in inflamatory bowel disease being more common in ulcerative colitis than in Crohn's disease; these can involve the lung parenchyma, the tracheobronchial tree, and the pleura. The true prevalence and etiology of these lesions is currently unknown and are not necessarily associated with bowel disease activity. Abnormal pulmonary functions test have been reported during inflammatory bowel disease exacerbations, and although pulmonary findings can present with a variety of symptoms, subclinical presentations have also been described. Pulmonary manifestations are usually steoid-responsive, as was the case in our patients.

[ANISAKIASIS. REPORT OF A CASE AND REVIEW OF THE LITERATURE] / Anisakiasis: Presentación de un caso y revisión de la literatura.

We present the case of a 38 year-old woman, who attended the Gastroenterology Service of a private hospital in Lima, complaining of a one week history of retroesternal "burning" sensation and mild, sporadic right lower quadrant abdominal pain. Laboratory test within normal limits were obtained and an upper endoscopic study was done. A white, mobile, 30 mm length parasite found attached to the gastric mucosa. Which was removed and identified as Anisakis spp. Taking into account how unusual is the report of this type of findings, the authors decided to review the literature and present it to the medical community. We suspect this parasitosis is subregistered in our country.