Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient-a diagnostic and therapeutic approach: Case report.

Background: Hypercalcemia is a rare metabolic disorder in the pediatric population, with several differential diagnoses that resemble hematologic malignancies. In cases of severe hypercalcemia, therapeutic strategies other than hyperhydration, such as the use of bisphosphonates, have been described. Case presentation: We present the case of a previously healthy 12-year-old boy who was admitted to the emergency department due to fatigue, hypo-responsiveness, and progressively worsening poor appetite for the previous 19 days. Initial laboratory tests revealed severe hypercalcemia (total calcium: 19 mg/dl), hyperphosphatemia, elevated creatinine, and hyperuricemia. Management with hyperhydration and xanthine oxidase inhibitor (allopurinol) was provided. The patient was transferred to the pediatric intensive care unit where treatment with furosemide, systemic corticosteroid, and zoledronic acid was started. Metabolic, infectious, renal, and endocrinological causes were excluded. Follow-up paraclinical studies showed a progressive hematologic involvement with heterogeneous hypochromic microcytic anemia, thrombocytopenia, and elevated lactic dehydrogenase. Bone marrow aspiration and biopsy were performed, which confirmed the diagnosis of B-precursor acute lymphoblastic leukemia. Hypercalcemia was resolved 72 h after the application of bisphosphonates. Conclusion: Hypercalcemia as an oncological metabolic emergency in the onset of acute lymphoblastic leukemia is uncommon in children. The use of intravenous bisphosphonates is an effective therapy in the early resolution of the condition. We present the case of a 12-year-old patient with malignant hypercalcemia who responded favorably to the use of a single dose of bisphosphonates.

Incidence, etiology, sociodemographic and clinical characterization of acute respiratory failure in pediatric patients at a high-altitude city: A multicenter cohort study.

Background: Acute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce. Objective: To determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic. Methods: A multicenter prospective cohort study called the FARA cohort was developed between April 2020 - December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included. Results: 685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-year CI 95%, (37.3-47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72 h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce. Conclusions: This multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.

Comportamientos y factores de riesgo asociados a la enfermedad cardiovascular desde la infancia / Behaviors and factors of risk associated with the cardiovascular disease from the infancy / Comportamentos e fatores de risco associados à doença cardiovascular da infância

Introducción: las enfermedades no transmisibles (ENT), y, principalmente, la enfermedad cardiovascular (ECV), representan la primera causa de muerte a escala mundial; tienen sus orígenes durante la infancia y la adolescencia y se encuentran relacionadas con comportamientos y estilos de vida no adecuados. Objetivo: la presente revisión de tema ofrece conceptos actualizados sobre los diferentes comportamientos y factores de riesgo presentes desde la infancia y que llevan al desarrollo de la ECV; adicionalmente, presenta elementos de la epidemiología, planes de reducción en ECV, bases fisiológicas y recomendaciones generales para prevenir el desarrollo de ECV. Método: se hizo una revisión de la literatura en bases de datos electrónicas, entre noviembre de 2017 y enero de 2018, PubMed, Scielo, Science Direct y UpToDate. Se utilizaron términos libres de búsqueda y términos MeSH; se dio prioridad de selección a aquellos relacionados con la población infantil. Se incluyeron datos nacionales obtenidos de las páginas del Ministerio de Salud y Protección Social, del Instituto Nacional de Salud (INS), de la Organización Panamericana de la Salud (OPS) y del Banco Iberoamericano de Desarrollo (BID). Discusión: para abordar adecuadamente la ECV y sus factores de riesgo, es necesario reconocer el estado actual y el grado de progreso de un país. El desarrollo de intervenciones adecuadas y costo-efectivas permitirá reducir la carga y el impacto de estas enfermedades en el presente y el futuro. Las intervenciones sociales han demostrado ser el camino hacia la promoción de la salud. Conclusiones: la educación en salud desde la infancia parece ser clave en la reducción de patologías crónicas no transmisibles

Background: Chronic non communicable diseases, mainly Cardiovascular Disease (CVD), represent the first cause of death worldwide; it has its origins during childhood and adolescence, and is related to unsuitable behaviors and lifestyles. Aim: The present topic review offers up-to-date concepts about the different behaviors and risk factors present since childhood that lead to the development of cardiovascular disease, additionally, presents elements of epidemiology, reduction plans in cardiovascular disease, physiological bases and general recommendations for the prevention of the cardiovascular disease. Method: A review of the literature was performed between November to January 2018, in electronic databases as PubMed, Scielo, ScienceDirect and UpToDate. Free search terms and MeSH terms were used, giving priority to those related to children. National information were obtained from the page of the Ministerio Nacional de salud y Protección social, del Instituto Nacional de Salud, Organización Panamericana de la Salud and banco Iberoamericano de desarrollo. Discussion: To adequately address CVD and its risk factors, it is necessary to recognize the current status and progress of a country. The development of appropriate and cost-effective interventions will reduce the burden and impact of these diseases in the present and the future. Social interventions have proven to be the path to health promotion. Conclusions: Health education since childhood seems to be the key to reducing non-communicable chronic pathology

Introdução: As doenças crônicas não transmissíveis, principalmente a Doença Cardiovascular (DCV), representam a primeira causa de morte no mundo, têm suas origens na infância e adolescência e estão relacionadas a comportamentos e estilos de vida inadequados. Objetivo: A presente revisão temática oferece conceitos atualizados sobre os diferentes comportamentos e fatores de risco presentes desde a infância que levam ao desenvolvimento de doenças cardiovasculares, além de apresentar elementos de epidemiologia, planos de redução em doenças cardiovasculares, bases fisiológicas e recomendações gerais para a prevenção da doença cardiovascular. Método: Revisão da literatura realizada entre novembro a janeiro de 2018, em bases de dados eletrônicas como PubMed, Scielo, ScienceDirect e UpToDate. Foram utilizados termos de pesquisa gratuitos e termos MeSH, dando prioridade àqueles relacionados a crianças. Informações nacionais foram obtidas da página do Ministério Nacional de Saúde e Proteção Social, do Instituto Nacional de Saúde, da Organização Pan-Americana da Saúde e do Banco Ibero-americano de Desenvolvimento. Discussão: Para abordar adequadamente as DCV e seus fatores de risco, é necessário reconhecer o status atual e o progresso de um país. O desenvolvimento de intervenções apropriadas e custo-efetivas reduzirá a carga e o impacto dessas doenças no presente e no futuro. Intervenções sociais provaram ser o caminho para a promoção da saúde. Conclusões: A educação em saúde desde a infância parece ser a chave para reduzir a patologia crônica não transmissível