Lupus nephritis in children. / Nefropatía lúpica en pacientes pediátricos.

INTRODUCTION: Lupus nephritis is an early manifestation in the development of systemic lupus erythematosus that worsens the morbidity and mortality of these patients. OBJECTIVE: To study the form of presentation in patients with lupus nephritis, the clinical and immunological characteristics, and their relationship with renal histology. PATIENTS AND METHOD: Retrospective study in children under 18 years of age, with lupus nephritis, in follow-up in a third level children's hospital in Madrid, between January 2012 and May 2020. We recorded demographic, clinical, and laboratory data (blood count, renal function, liver function, protein, ionogram, blood glucose, uric acid, lactate dehydrogenase, coagulation, and urine analysis), as well as immunological data (immunoglobulins, antinuclear antibodies, comple ment, and lupus anticoagulant), and histological classification data. Descriptive analysis and analysis of associations between variables was performed, with a significant p < 0.05. RESULTS: 16 patients (11 women) were included, the median age at presentation was 10.6 ± 2.3 years (5.7-15.3). The median time between symptoms onset and renal involvement was 6.3 months ± 10.5 (range 0 - 33.6). Renal involvement was the initial manifestation in 37.5% of patients. 50% had arthralgias or arthritis prior to diagnosis, and 25% had fever and constitutional symptoms (asthenia, anorexia, and/or weight loss). The most frequent form of renal involvement was microhematuria associated with proteinuria in non-nephrotic range. In the renal anatomo-pathological study, according to the ISN/RPS 2003 classification, grades III (46.6%) and IV (33.3%) predominated. CONCLUSIONS: Six patients presented renal involvement at baseline with musculoskeletal involvement being more frequent. Most patients (86.6%) presented advanced lupus nephritis in the histological study at diagnosis. Immunologic in volvement was the only marker that correlated with systemic involvement.

Intento autolítico con antidepresivos inhibidores selectivos de la recaptación de serotonina / Suicide attempt with selective serotinin reuptake inhibitor antidepressants

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Subluxación atloaxoidea no traumática: síndrome de Grisel / Nontraumatic atlantoaxial subluxation: Grisel síndrome

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Infección por adenovirus que requiere ingreso hospitalario: epidemiología, datos analíticos y manejo / Adenovirus infections that require hospital admission: epidemiology, laboratory findings and approach

Introducción: las infecciones por adenovirus tienen una presentación clínica variable y son una importante causa de morbilidad en la infancia. Frecuentemente reciben tratamiento antibiótico de forma innecesaria. Este estudio busca analizar las características de los pacientes con infección por adenovirus y ver si difieren de aquellos con infección bacteriana. Pacientes y métodos: se estudiaron 174 pacientes ingresados en un hospital terciario desde enero de 2009 hasta agosto de 2017 a los que se les detectó adenovirus. Se analizaron las variables clínicas y analíticas y se compararon con las de una muestra de pacientes diagnosticados de infección bacteriana confirmada en el mismo centro en 2016. Resultados: la tasa de pacientes con infección por adenovirus fue de 1,58/100 ingresos. El 64% eran varones, siendo la edad media de 17 meses. Los que solo presentaban síntomas gastrointestinales tenían una menor edad y resultados analíticos más favorables que los que solo mostraban síntomas respiratorios. Un 24,5% presentaban coinfección por otro virus, observándose en este grupo una mayor estancia hospitalaria (7,93 frente a 6,17 días, p = 0,006). Los criterios analíticos de infección bacteriana grave no mostraron diferencias significativas al comparar entre los pacientes infectados por adenovirus y los que tenían una infección bacteriana confirmada, excepto una diferencia mínima, aunque estadísticamente significativa, al comparar las cifras de proteína C reactiva. Conclusiones: las variables analíticas y clínicas estudiadas no son suficientes para discriminar entre infección bacteriana y por adenovirus. Sería adecuado descartar infección por adenovirus sistemáticamente antes de instaurar tratamiento antibiótico

Introduction: adenovirus infections have a heterogeneous clinical presentation and are an important cause of childhood morbidity. They are frequently and unnecessarily treated with antibiotics. In this study, we analysed the characteristic of patients with adenovirus infections in order to determine whether they differed from those of patients with bacterial infection. Patients and methods: the study included 174 patients admitted to a tertiary care hospital between January 2009 and August 2017 who tested positive for adenovirus. We analysed the clinical and laboratory findings in these patients and compared them to those of a group of patients that received a diagnosis of confirmed bacterial infection in the same hospital in 2016. Results: the incidence of adenovirus was of 1.58 cases per 100 admissions. Sixty-four percent of the sample was male, and the mean age was 17 months. Patients that presented with gastrointestinal symptoms alone were younger and had more favourable laboratory findings compared to patients with respiratory symptoms alone. Coinfection with another virus was found in 24.5%, and this group had a longer length of stay (7.93 versus 6.17 days, p = 0.006). We found no significant differences in the laboratory criteria indicative of severe bacterial infection between the patients with adenovirus infection and the controls with a confirmed bacterial infection except for a very small, although statistically significant, difference in the levels of C-reactive protein. Conclusions: the clinical and laboratory parameters analysed in our study are not sufficient to discriminate between bacterial infection and adenovirus infection. Thus, it would be appropriate to rule out adenovirus infection before initiating antibiotic treatment