Tratamiento del paciente pediátrico con COVID-19 / Tratamiento del paciente pediátrico con COVID-19

COVID-19 afecta entre el 1.2 al 5% de niños y adolescentes en diversos países incluyendo Guatemala, la mayoría con manifestaciones clínicas leves a moderadas. La terapéutica farmacológica para enfermedad grave aún no está completamente establecida, por lo que se realizó una revisión de literatura de artículos científicos publicados en revistas indizadas para proporcionar una actualización del tratamiento de COVID-19 en niños y adolescentes, que ayude a orientar las decisiones clínicas. El tratamiento de casos leves consiste en antipiréticos, antibióticos en neumonía leve; en casos moderados, monitoreo de signos vitales, cánula binasal, manejo de líquidos, antipiréticos y analgésicos, toma de hemocultivo, inicio de antibióticos y uso de beta agonistas de acción corta o esteroides inhalados. En enfermedad grave, ventilación mecánica no invasiva o invasiva, ventilación prono temprana, soporte nutricional, hídrico y vasopresor, mantenimiento del equilibrio ácido base y de electrolitos. Se indica el uso de antibióticos y antivirales como remdesivir y el manejo inmunológico con interferón alfa, esteroides y/o inmunoglobulina. Se monitorea función hepática, renal, inmunológica, hematológica y cardíaca. No se ha encontrado evidencia de que la hidroxicloroquina, ivermectina y algunos antivirales disminuyan la mortalidad en pacientes pediátricos. Actualmente no existe ningún medicamento específico, validado científicamente para el tratamiento de COVID-19 en niños. El tratamiento para casos graves se decide a partir de las experiencias del tratamiento en adultos, por lo cual es importante continuar con investigación de fármacos específicos para la población pediátrica.

COVID-19 affects among 1.2 to 5% of children and adolescents in various countries, counting Guatemala, the most with mild to moderate clinical manifestations. Pharmacological therapy for severe disease has not yet been fully established. A literature review of scientific articles from indexed journals was conducted to provide an update on the treatment of COVID-19 in children and adolescents, to help guide clinical decisions. Treatment of mild cases consists of antipyretics and antibiotics for pneumonia. In moderate cases is recommended to monitor vital signs, to obtain blood cultures and to treat with binasal cannula, fluids, antipyretics and analgesics, short-acting beta agonists and/or inhaled steroids and antibiotics when needed. In severe illness, treatment includes non-invasive or invasive mechanical ventilation, early prone ventilation, nutritional, hydration and vasopressor support, maintenance of acid-base, and electrolyte balance. The use of antibiotics and antivirals as remdesivir is recommended, as well as the use of immunomodulators such as interferon alfa, steroids and/or immunoglobulin. To monitor patient´s evolution; liver, kidney, immunological, hematological, and cardiac function must be assessed. No evidence has been found that hydroxychloroquine, ivermectin and other antivirals decrease mortality in pediatric patients. Currently, there is no specific, scientifically validated medication for the treatment of COVID-19 in children. Treatment for severe cases is decided based on management experiences in adults, so it is important to doing research on specific drugs for the pediatric population.

Vulnerabilidad al virus de la hepatitis B y prácticas preventivas en trabajadores de un hospital de Guatemala / Hepatitis B virus vulnerability and preventive practices among workers at a Guatemalan Hospital

La hepatitis B (HB) es un problema de relevancia mundial para la salud pública y ocupacional. Diferentes informes indican una seroprevalencia intermedia del altamente transmisible virus de la hepatitis B (VHB) en Guatemala, que impone un riesgo sobre los trabajadores de salud (TS). Este artículo describe la adherencia a prácticas preventivas, la seroprevalencia de anticuerpos contra el antígeno de superficie (anti-HBs) y el riesgo de accidente ocupacional punzocortante en TS del Hospital Nacional Pedro de Bethancourt de Guatemala. En 121 TS voluntarios, se estimó la prevalencia de exposiciones, prácticas preventivas, concentración de anticuerpos anti-HBs, utilizando Elisa, así como odds ratios (OR) de diferentes factores de riesgo para heridas punzocortantes. Tener contacto con pacientes (69%) y manipular material punzocortante (63%) o biológico (54%) fueron identificados como peligros de exposición al VHB. Los TS entrevistados indicaron respetar las normas de bioseguridad (75%),utilizar guantes (69%) y estar vacunados (48%). La prevalencia de anti-HBs fue del 43%. El riesgo de accidentes punzocortantes fue 9 veces mayor para médicos (OR, 8.9; IC 95% [1.7, 63]; p = .0017) y 3 veces mayor para enfermeros (OR, 3.2; IC 95% [1.15, 9.1]; p = .0121), que para el resto del personal. Las prácticas de bioseguridad e inmunización son deficientes entre los TS del hospital, a pesar de ser una población con riesgo de infección por el VHB. Se recomienda fortalecer las competencias sobre bioseguridad y el cumplimiento de medidas preventivas en el hospital, así como institucionalizar la vacunación contra VHB para todos los TS.

Hepatitis B is a major, global issue for both public and occupational health. Reports indicate an intermediate seroprevalence of the highly transmissible hepatitis B virus (HBV) in Guatemala, imposing a high risk for healthcare workers (HCWs). We describe the adherence to preventive practices, seroprevalence of surface antigen's antibodies (anti-HBs) and the risk of puncture-related occupational accidents with medical sharps among HCWs, at Guatemalan Pedro de Bethancourt National Hospital (PBNH). Prevalence of exposure and prevention practices was estimated in 121 volunteering HCWs, as well as serum concentrations of anti-HBs, using ELISA. Odds ratios (OR) of risk factors for puncture wounds with medical sharps were estimated. Contact with patients (69%), medical sharps (63%) and biological material (54%) were identified as a risk of exposure to HBV. Of all volunteersinterviewed, 75% reported compliance with biosafety standards, 69% use surgical gloves and 48% reported having been vaccinated. Seroprevalence of anti-HBs was 43%. The risk of injuries with medical sharps was 9-fold among physicians and 3-fold among nurses, as compared with the rest of the hospital staff (OR, 8.9, 95% CI [1.7, 63], p = .0017; OR, 3.2, 95% CI) [1.15, 9.1], p = .0121, respectively). Biosecurity and immunization practices are por among hospital HCWs, despite being a population at high risk for HBV infection. We recommend that biosecurity capacity building and compliance with preventive practices be ensured. A sustainable HBV vaccination program for all HCWs should be institutionalized.

The relationship between pay day and violent death in Guatemala: a time series analysis.

OBJECTIVE: To assess if violent deaths were associated with pay days in Guatemala. DESIGN: Interrupted time series analysis. SETTING: Guatemalan national autopsy databases. PARTICIPANTS: Daily violence-related autopsy data for 22 418 decedents from 2009 to 2012. Data were provided by the Guatemalan National Institute of Forensic Sciences. Multiple pay-day lags and other important days such as holidays were tested. OUTCOME MEASURES: Absolute and relative estimates of excess violent deaths on pay days and holidays. RESULTS: The occurrence of violent deaths was not associated with pay days. However, a significant association was observed for national holidays, and this association was more pronounced when national holidays and pay days occurred simultaneously. This effect was observed mainly in males, who constituted the vast majority of violent deaths in Guatemala. An estimated 112 (coefficient=3.12; 95% CI 2.15 to 4.08; p<0.01) more male violent deaths occurred on holidays than were expected. An estimated 121 (coefficient=4.64; 95% CI 3.41 to 5.88; p<0.01) more male violent deaths than expected occurred on holidays that coincided with the first 2 days following a pay day. CONCLUSIONS: Men in Guatemala experience violent deaths at an elevated rate when pay days coincide with national holidays. Efforts to be better prepared for violence during national holidays and to prevent violent deaths by rescheduling pay days when these days co-occur with national holidays should be considered.