[Correlation between transcutaneous bilirubinometry and serum bilirubin in newborns ≥ 35 weeks]. / Correlación entre bilirrubinometría transcutánea y bilirrubina sérica en recién nacidos ≥ 35 semanas.

Clinical control and monitoring of bilirubin in the neonatal stage are essential to avoid toxicity in the central nervous system. OBJECTIVE: to determine the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) levels in newborns ≥ 35 weeks. PATIENTS AND METHOD: observational, cross-sectional, analytical, retrospective study that included 90 neonates of gestational age ≥ 35 weeks with mucocutaneous jaundice who underwent TcB and TSB measurement simultaneously between June 1, 2022, and January 31, 2023. Both variables were compared, determining their correlation. RESULTS: the validity indicators were analyzed, obtaining 100% sensitivity and negative predictive value. The mean of TcB determinations was 14.84 mg/dl ± 2.27 and that of TSB was 13.1 mg/dl ± 2.39. The correlation obtained indicates that both variables are related, which is a direct correlation and, according to the prediction equation, there is an appropriate correlation between them. It was determined that TcB overestimated TSB in 95.56% of the determinations, and underestimated TSB in the rest (4.44%). Simultaneous measurements of TcB and TSB were different in all determinations with a mean difference of 1.72 ± 1.48. CONCLUSIONS: the non-invasive TcB method can be used as an initial screening tool for the neonatal population ≥ 35 weeks, given its adequate sensitivity and negative predictive value.

Cánula Nasal de Alto Flujo Asimétrica: una Revisión Narrativa / Asymmetrical High Flow Nasal Cannula: a Narrative Review

Los sistemas de Cánula nasal de alto flujo (CNAF) han sido ampliamente utilizados en el campo clínico como soporte no invasivo en el manejo de la falla respiratoria aguda (sobre todo hipoxémica) y cuidados post extubación. Clínica y fisiológicamente, las cánulas nasales de alto flujo son capaces de entregar un flujo de oxigeno alto que, debido a que ese gas se encuentra optimamente humidificado y calefaccionado, permite una mejor tolerancia por parte del paciente al ser comparada con las cánulas de oxigeno tradicionales. Por otra parte, este alto. Flujo es capaz de generar una presión positiva al final de la espiración (CPAP) en la vía área y favorecer tanto en barrido de dióxido de carbono (CO2) desde la vía aérea superior, lo que disminuye el trabajo respiratorio del paciente y mejora su confort.. Sin embargo; aún existe un alto porcentaje de pacientes que fracasan la terapia con CNAF y requiere soportes mas complejos como la ventilación mecánica, ya sea imvasiva o no. Estos resultados con la terapia CNAF pueden ser influidos por aspectos técnicos como, por ejemplo, la turbulencia que pueden generar estos sistemas a nivel de la región nasal. Por esta razón se han desarrollado nuevas tecnologías en el diseño y uso de interfaces para suministrar este alto flujo. Una de estas innovaciones es el uso de cánulas asimétricas, las que potencian los beneficios fisiológicos que entrega una cánula de alto flujo convencional. La presente revisión pretende exponer las principales diferencias que presenta el sistema de alto flujo convencional versus la nueva interface asimétrica.

High-flow nasal cannula (HFNC) systems have been widely used in the clinical field as non-invasive support in the management of acute respiratory failure (especially hypoxemic) and post-extubation care. Clinically and physiologically, high flow nasal cannulas are capable of delivering a high flow of oxygen which, because this gas is optimally humidified and heated, allows better tolerance by the patient when compared to traditional oxygen cannulas. . On the other hand, this high. Flow is capable of generating positive pressure at the end of expiration (CPAP) in the airway and favoring the sweep of carbon dioxide (CO2) from the upper airway, which reduces the patient's respiratory work and improves their comfort. .. However; There is still a high percentage of patients who fail therapy with HFNC and require more complex supports such as mechanical ventilation, whether invasive or not. These results with HFNC therapy can be influenced by technical aspects such as, for example, the turbulence that these systems can generate in the nasal region. For this reason, new technologies have been developed in the design and use of interfaces to provide this high flow. One of these innovations is the use of asymmetric cannulas, which enhance the physiological benefits provided by a conventional high-flow cannula. The present review aims to expose the main differences that the conventional high flow system presents versus the new asymmetric interface.

[Clinical and epidemiological features of SARS-CoV-2 infection in children under 16 years of age]. / Caracterización clínica y epidemiológica de la infección por SARS-CoV-2 en menores de 16 años.

INTRODUCTION: During the SARS-CoV-2 pandemic, efforts have focused on trying to identify the routes of transmis sion of the virus, characterize its symptoms and signs, and investigate the best diagnostic and thera peutic methods. There are fewer published data and series in the pediatric population than in adults. OBJECTIVE: To analyze the clinical and epidemiological characteristics in children under 16 years of age diagnosed with SARS-CoV-2. PATIENTS AND METHOD: Descriptive study carried out on children who underwent SARS-CoV-2 RNA testing due to compatible symptoms, close contact, or requiring hospitalization or surgery, in the Emergency Department of a hospital in Madrid, Spain. 30 variables were collected including epidemiological data, symptoms, and signs of infection. RESULTS: Out of 1378 patients, 12% were positive (165). There was a higher proportion of patients of North African origin in the positive group than in the negative one (p < 0.01). Of all patients, 35.6% reported close contact with a confirmed case, which was more frequent in the positive group. 75.8% of the positive patients had some symptoms, most frequently fever, runny nose, and cough, followed by digesti ve symptoms. There was one case of COVID-19 pneumonia and two patients with MIS-C, one of which had SARS-CoV-2 infection. Eight of the positive patients (4.8%) required hospitalization due to SARS-CoV-2 infection. CONCLUSION: Although SARS-CoV-2 infection is milder in the pediatric population, almost 5% will require hospitalization. No close contact was identified in a high percen tage of patients (61%). Further studies are needed at all levels of care to characterize the infection in children and adolescents.

Impacto de la Pandemia por SARS-CoV-2 en el Perfil de Ingreso y Egreso de una Unidad de Cuidados Intensivos según Escala de Categorización Kinesiológica / Impact of the SARS-CoV-2 Pandemic on the Admission and Discharge Profile of an Intensive Care Unit according to the Kinesiological Categorization Scale

Introducción. La pandemia por coronavirus trajo consigo una modificación y una reestructuración de las unidades de cuidados intensivos(UCI). Además se produjo un cambio en el perfil de pacientes que ingresan y egresan en estas unidades. Objetivo. Valorar el impacto de la presente pandemia en el perfil de ingreso y egreso de pacientes en UCI según escala de categorización kinesiológica de la unidad. Métodos. Estudio observacional descriptivo que incluyó 50 sujetos de UCI que contaran con escala de categorización kinesiológica (ECK) al ingreso y egreso de la unidad. La ECK contemplo 3 item de evaluación: Función ventilatoria, manejod e secreciones, grado de cooperación y nivel de actividad. El registro de la ECK se planteó de manera retrospectiva para los periodos Julio-agosto 2018 (prepandemia) y Julio - Agosto 2020 (pandemia). Se utilizó estadística descriptiva, utilizando porcentaje y/o promedio para cada variable según corresponda. Resultados. Al observar la función ventilatoria, el requerimiento de soporte ventilatorio varió de un 64% a un 16% pre ­ pandemia, y de un 100% a un 88% durante la pandemia. Respecto al manejo de secreciones, se observó que los sujetos con tos efectiva varío desde un 60% a un 22% en el periodo pandemia Por otra parte, los pacientes que requirieron succión traqueal de manera constante en pandemia, se mantuvo. entre un 88% a un 92% durante la estadía en UCI. En relación al grado de cooperación, un 78% de los pacientes con COVID-19 ingresó con una dependencia severa o nula cooperación, y al momento del egreso de UCI un 54% se mantenía en la misma condición. Respecto al nivel de actividad, durante el periodo pandemia, un 100% de los ingresos y un 96% de los egresos presentó dependencia total. Conclusión. La pandemia causada por SARS-CoV-2 ha influido directamente en el perfil de ingreso y egreso de pacientes UCI, lo cual enfrentó al personal de salud a un aumento considerable en la carga de trabajo.

Introduction. The coronavirus led to a modification and a building of new intensive care units (ICU). In addition, there was a change in the profile of patients admitted and discharged from these units. Objetive. Assess the impact of this pandemy on the admission and discharge profile of patients in the ICU according to a kinesiological categorization scale of the unit. Methods. Descriptive observational study that included 50 ICU subjects who had a Kinesiology Categorization Scale (ECK) at admission and discharge from the unit. The ECK contemplates 3 evaluation elements: ventilatory function, management and secretions, degree of cooperation and level of activity. The ECK registry was considered retrospectively for the periods July-August 2018 (pre-pandemy) and July-August 2020 (pandemy). Descriptive statistics was developed, using percentage and/or average for each variable as appropriate. Results: Looking at ventilatory function, the requirement for ventilatory support varied from 64% to 16% pre-pandemic, and from 100% to 88% during the pandemic. Regarding the management of secretions, it was shown that the subjects with effective cough varied from 60% to 22% in the pandemic period. On the other hand, the patients who required tracheal suctioning constantly in the pandemic were maintained. between 88% and 92% during the ICU stay. Regarding the degree of cooperation, 78% of the patients with COVID-19 were admitted with a severe dependency or no cooperation, and at the time of discharge from the ICU, 54% were pressed in the same condition. Regarding the level of activity, during the pandemic period, 100% of income and 96% of expenses presented total dependency. Conclusion. The pandemy caused by SARS-CoV-2 has directly influenced the admission and discharge profile of ICU patients, which confronted health personnel with a considerable increase in workload.

Anaerobio osteomyelitis. A rare condition in children / Osteomielitis por anaerobios. Una entidad poco frecuente en pediatría

ABSTRACT Osteoarticular infections due to anaerobes are very rare in children, with the Fusobacterium genus being the most frequently isolated. The course is usually subacute and, although there are predisposing factors described, most patients do not present with them. Generally, joint fluid cultures are sterile since these microorganisms are very sensitive to contact with oxygen, so they require specific culture media. All of the above causes the diagnosis to be delayed, increasing the risk of long-term sequelae. However, the prognosis improves when treatment is started early. The case is presented of a 10-year-old patient who was admitted for 30 days due septic arthritis of the right hip caused by Fusobacterium nucleatum During the admission, he required three surgical interventions, and completed 6 weeks of effective antibiotic therapy, with a good outcome and remaining asymptomatic at the current time.

RESUMEN Las infecciones osteoarticulares por anaerobios son muy raras en los niños, siendo el género Fusobacterium el que se aisla con más frecuencia. El curso suele ser subagudo y, aunque hay factores predisponentes descritos, la mayoría de los pacientes no los presenta. Generalmente, los cultivos de liquido articular son estériles ya que estos microorganismos son muy sensibles al contacto con el oxigeno, por lo que precisan medios de cultivo específicos. Todo lo anterior hace que el diagnóstico se retrase y que el riesgo de secuelas a largo plazo aumente. Sin embargo, el pronóstico mejora cuando el tratamiento se inicia de modo precoz. Por todo ello, presentamos el caso de un paciente de 10 anos con una artritis séptica de cadera derecha por Fusobacterium nucleatum que permaneció ingresado 30 dias. Durante el ingreso precisó 3 intervenciones quirúrgicas y cumplió 6 semanas de antibioterapia efectiva, con buena evolución; permanece asintomático en el momento actual.

Survival of Critically Ill Oncologic Patients Requiring Invasive Ventilatory Support: A Prospective Comparative Cohort Study With Nononcologic Patients.

PURPOSE: Cancer is in the process of changing to become a chronic disease; therefore, an increasing number of oncologic patients (OPs) are being admitted to intensive care units (ICUs) for supportive care of disease or therapy-related complications. We compare the short- and long-term outcomes of critically ill mechanically ventilated OPs with those of their nononcologic counterparts. PATIENTS AND METHODS: We performed a prospective study of patients admitted to our ICU between October 2017 and February 2019. Demographic, physiologic, laboratory, clinical, and treatment data were obtained. The primary outcome was survival at 28 days and at the end of the follow-up period. Secondary outcomes were survival according to acute severity scoring (Acute Physiology and Chronic Health Evaluation II score), Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson comorbidity index. RESULTS: A total of 1,490 patients were admitted during the study period; 358 patients (24%) were OPs, and 100 of these OPs were supported with mechanical ventilation. Seventy-three percent of OPs had an ECOG performances status of 0 or 1, and 90% had solid tumors. Reason for admission to the ICU was postoperative admission in 44 patients and neutropenic infection in 10 patients. The follow-up period was 148 days (range, 42 to 363 days). Survival at 28 days was similar between OPs and nononcologic patients and associated with the Acute Physiology and Chronic Health Evaluation II score. However, long-term survival was lower in OPs compared with nononcologic patients (52% v 76%, respectively; P < .001) and associated with poor ECOG performance status. CONCLUSION: Short-term survival of critically ill, mechanically ventilated OPs is similar to that of their nononcologic counterparts and is determined by the severity of the critical illness.