Nevin Manimala

Andes Pediatr. 2022 Oct;93(5):640-647. doi: 10.32641/andespediatr.v93i5.4060.

ABSTRACT

Advances in medical care have increased the survival of children with complex chronic pathology (CCP).

OBJECTIVE: to analyze the epidemiological and clinical characteristics of a cohort of children with CCP.

PATIENTS AND METHOD: retrospective descriptive study performed in a tertiary hospital bet ween June 2017 and June 2020, which included patients with CCP criteria. Epidemiological, clinical, admissions, and services involved data were collected and analyzed. Statistical analysis was perfor med using SPSS v22.0 software.

RESULTS: 323 patients (mean age 7 years) were included. 93.1% had a multisystem disease, with neurological (87.3%) and gastrointestinal (34.1%) as the most frequent chronic conditions. 39.9% were technology dependent. The main diagnoses were Infantile Cerebral Palsy (23.5%) and Epileptic Encephalopathy (13.9%). Each patient was in follow-up by 5 specialists on average. Of the patients, 85.1% were admitted at some time, with a total of 739 admissions. The mean length of stay was 8.7 days. Technology-dependent patients accounted for 54.7% of hospi talizations. The reasons for admission were acute illness (64.3%), surgery (20.3%), and diagnostic procedure (15%). ICU was required in 23.1%. 62 admissions were partially carried out by the Home Hospitalization Unit.

CONCLUSIONS: Children with CCP require an increased number of admissions and multiple specialists. The implementation of specialized referral units may be useful to improve their care.

PMID:37906884 | DOI:10.32641/andespediatr.v93i5.4060

Andes Pediatr. 2023 Jan;94(1):78-85. doi: 10.32641/andespediatr.v94i1.3989.

ABSTRACT

OBJECTIVE: To determine the prevalence of adolescent idiopathic scoliosis (AIS), progression risk, and quality of life in students aged from 10 to 18 years.

PATIENTS AND METHOD: Cross-sectional descriptive study in students 10 – 18 years old from 5 communes in Santiago, Chile, between 2015-2016. Adam’s Test was performed and the angle trunk rotation (ATR) at the thoracic, thoracolumbar, and lumbar levels were measured with a scoliometer. If ATR was ≥ 6°, anteroposterior and lateral radiological images of the spine were taken, and Cobb angle was measured. Scoliosis was confirmed if the Cobb angle was ≥ 10° plus vertebral rotation. Progression factor was calculated with Lonstein and Carlson formula. Quality of life was assessed through spinal deformities questionnaires and the trunk appearance perception scale.

RESULTS: 1200 students were evaluated, 54.9% were female, and 8.17% had ATR ≥ 6°. We found mild scoliosis in 2.91%, moderate in 0.75% and severe in 0.17%. Total prevalence was 3.83% (CI 95%: 2.74 – 4.92). 82.61% of the cases had a late diagnosis, after their growth spurt. Of the patients with scoliosis, 21.74% had a progression risk ≥ 50%. Quality of life had a positive correlation with scoliosis severity, not statistically significant.

CONCLUSIONS: Prevalence of AIS was 3.83%. Most patients were diagnosed after their growth spurt with high progression risk. Quality of life showed a weak positive correlation with scoliosis severity.

PMID:37906874 | DOI:10.32641/andespediatr.v94i1.3989

Andes Pediatr. 2023 Jan;94(1):54-61. doi: 10.32641/andespediatr.v94i1.4049.

ABSTRACT

Weight measurement is essential in the treatment of pediatric patients in emergencies, however, in cases of patient instability or limited resources, weight estimation becomes a plausible alternative. There are rapid estimation methods, although with performance discrepancies in different populations.

OBJECTIVE: To compare the performance of the “Colombian Pediatric Tape” (CPT) and Broselow Tape (BT) in weight estimation in children.

PATIENTS AND METHOD: Descriptive cross-sectional study and concordance analysis. Sample of 42,232 children from the 2010 National Survey of the Nu tritional Situation of Colombia. For the performance evaluation, the prediction of zones and weight of each tool and their concordance using the Kappa coefficient and the Bland-Altman index were considered.

RESULTS: Cohen’s Kappa index for the BT with respect to the color area agreement was 0.57 and for the CPT it was 0.65. The Bland-Altman index for CPT of the actual weight and the esti mated weight showed a mean difference of 0.005 Kg (CI95; -4.1 to +4.1), and for the BT was 0.13 Kg (CI95; -5.2 to 5.5). The percentage difference analysis of concordance between the two tools showed a statistically significant overall difference in favor of the CPT, 66% Vs 70% (p = 0.00001).

CONCLUSIONS: In Colombian children, the BT overestimates or underestimates the weight by up to 21% with respect to the real value, while CPT can be used with better performance to estimate the weight.

PMID:37906871 | DOI:10.32641/andespediatr.v94i1.4049

Andes Pediatr. 2023 Jan;94(1):37-44. doi: 10.32641/andespediatr.v94i1.4179.

ABSTRACT

OBJECTIVE: To describe the presence of obstructive sleep apnea syndrome (OSAS) in children with craniofacial anomalies (CFA), associate biodemographic characteristics and polygraph variables, and analyze the therapeutic management decided after the sleep study and the evaluation by a multidisciplinary team.

PATIENTS AND METHOD: Retrospective study. Polygraphs were performed on patients aged between 1 month and 19 years with CFA. An initial and projected management was established categorized into ventilatory support, tracheostomy, surgery, dental, and medical treatment. Descrip tive and inferential statistics were performed, evaluating the association between demographic and polygraph variables and therapeutic management.

RESULTS: 34 patients were included with a median age of 4.0 years (IQR 0.9 – 6.5). Diagnosis was 41.2% cleft lip and palate, 35.3% craniosynostosis, and 23.5% micrognathia. Polygraphs were altered in 70.6% of the cases; of these, 26.5% were diagnosed as mild, 5.9% moderate, and 38.2% severe OSAS. There was an association between minimum satu ration and diagnosis of OSAS (p = 0.0036), and in the presence of OSAS with the initial management applied (p=0.0013). There was no significant relationship between the different types of CFA with the initial therapeutic management (p = 0.6565). Initial and projected managements, respectively: Venti latory support (11.8% and 2.9%), tracheostomy (11.8% and 0%), surgery (35.2% and 26.5%), dental (20.6% and 53%), and medical treatment (20.6% and 17.6 %).

CONCLUSIONS: 70% of the patients with CFA presented OSAS. The greatest severity was found in Cleft Lip and Palatine and Craniosynostosis. Therapeutic management was mainly oriented towards initial surgical and planned dental treatments based on the diagnosis of OSAS and not on the type of CFA.

PMID:37906869 | DOI:10.32641/andespediatr.v94i1.4179

Andes Pediatr. 2023 Jan;94(1):23-28. doi: 10.32641/andespediatr.v94i1.3834.

ABSTRACT

Bronchiolitis is the main reason for hospitalization in infancy. Breastfeeding is a protective factor aga inst infections, however, although there is evidence that breastfeeding could prevent hospitalizations due to bronchiolitis, its effect in patients already hospitalized because of this disease is less clear.

OBJECTIVE: To evaluate if there are differences in the evolution of patients hospitalized due to bronchiolitis fed with exclusive breastfeeding (EBF) vs. breast milk substitutes (BMS).

PATIENTS AND METHOD: Prospec tive cohort study. Children hospitalized due to bronchiolitis aged from 1 to 6 months were included. Evolution was compared with respect to days of hospitalization, days of oxygen therapy, requirement of high-flow nasal cannula (HFNC), presence of associated pneumonia, transfer to intensive care, and death.

RESULTS: During the study period, 131 infants hospitalized due to bronchiolitis met the selection criteria, 54 were fed with EBF, 29 with BMS, and 48 received mixed feeding. The EBF group required significantly fewer days of oxygen therapy (5.1 ± 2.4 vs. 6.6 ± 3.5; p < 0.02) and hospitalization (7.0 ± 2.4 vs. 8.4 ± 3.6; p < 0.04) than the BMS group. Although males in the BMS group required on average more days of hospitalization and oxygen therapy, this difference was not statistically significant. No deaths were recorded in the groups studied.

CONCLUSION: Patients fed with EBF required fewer days of oxygen therapy and hospitalization than those who received BMS.

PMID:37906867 | DOI:10.32641/andespediatr.v94i1.3834

Andes Pediatr. 2022 Aug;93(4):511-519. doi: 10.32641/andespediatr.v93i4.4003.

ABSTRACT

Congenital adrenal hyperplasia (CAH) is the most common adrenal disorder in childhood. Objecti ve: To describe the clinical and laboratory characteristics of pediatric patients with CAH and perform an exploratory analysis comparing some clinical and laboratory variables according to the types of CAH.

PATIENTS AND METHOD: Observational descriptive longitudinal study. Medical records from the pediatric endocrinology outpatients from four institutions in Medellín, Colombia were reviewed. Sociodemographic, clinical (type of CAH, salt-wasting crisis, associated endocrinopathies), labora tory (17-hydroxyprogesterone, testosterone, dehydroepiandrosterone sulfate, androstenedione, cor tisol, and adrenocorticotropic hormone) variables were analyzed. A descriptive statistical analysis was carried out.

RESULTS: 132 patients (65% female) were included. The median age at diagnosis was 2 months, 44.7% neonatal diagnosis. Seventy-nine children with classical salt-wasting CAH, 31 with simple virilizing, and 22 with non-classical form were documented. Median 17-OHP at diagnosis was 4820 ng/dl. Sexual differentiation disorder was presented in 47% of patients and 48% presented with adrenal crisis (AC) at diagnosis; the median age of the first AC was 15 days. Ninety-three patients required fludrocortisone and 32 patients presented AC after diagnosis and treatment. Median height/ age (last appointment): -0.49 SD, difference between bone and chronological age: 26 months. More than 60% of patients had elevated androstenedione and/or testosterone at the last appointment.

CONCLUSIONS: Sociodemographic and clinical characteristics are similar to those reported in the literature. In 48% of patients, AC was the initial manifestation, making neonatal screening important, as it would allow an early diagnosis. We found virilization in 71% of women in our study. A CAH should be suspected in a newborn with different genitalia.

PMID:37906849 | DOI:10.32641/andespediatr.v93i4.4003

Andes Pediatr. 2022 Aug;93(4):504-510. doi: 10.32641/andespediatr.v93i4.3963.

ABSTRACT

Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy. The prevalence of SCD can change especially by migrations.

OBJECTIVE: To describe the characteristics of patients with SCD at diagnosis, in a referral hospital over a decade.

PATIENTS AND METHOD: Retrospective study of the cli nical and laboratory characteristics of children under 15 years of age with SCD, diagnosed in the Onco-Hematology Service of the Hospital Dr. Roberto del Rio, Santiago, Chile, between April 2008 and March 2018. Sex, age, nationality, symptoms, blood count characteristics, and hemoglobin elec trophoresis results were evaluated by descriptive statistical analysis.

RESULTS: Sixteen patients were included, 2 were healthy carriers so were excluded from the analysis. Of the 14 analyzed, the diagnosis was made before 2015 in 2 patients. Twelve were male, 9 were Chilean, 13 had foreign parents. Eight were less than 2 years old and 12 were symptomatic. The most frequent symptoms were limb pain and anemia. Median hemoglobin was 8.2 g/dL (6.2-12.3), in 11/14 sickle cells were observed, in 4 by metabisulfite test. In 13/14, hemoglobin electrophoresis was performed, median hemoglobin S 70.2% (28.2-87.1) and hemoglobin F 18.7% (0-32.3). Only one patient had a genetic study. Thirteen patients were still in follow-up, 84.6% of them received folic acid and amoxicillin, 53.8% required transfusions, and 69.2% started hydroxyurea.

CONCLUSION: SCD has increased in Chile; therefore, a high degree of suspicion is required. The diagnosis, treatment, and follow-up of this pathology should be improved at the local level.

PMID:37906848 | DOI:10.32641/andespediatr.v93i4.3963

Rev Med Chil. 2022 Jul;150(7):912-918. doi: 10.4067/s0034-98872022000700912.

ABSTRACT

BACKGROUND: Diabetic foot amputation is a public health challenge due to the increasing prevalence of type 2 diabetes mellitus (T2D). Although there are many health indicators aimed at the management and control of T2D and its complications, amputations persist.

AIM: To evaluate the association between diabetic foot amputation index and indicators of care and management of T2D in primary care centers of the eastern section of Santiago, Chile.

MATERIAL AND METHODS: We conducted a mixed ecological study and included information from the Monthly Statistical report of different public health centers from 2014 to 2018. We also analyzed the hospital discharge records from an individual tertiary public health center. The annual index for diabetic foot amputation per 100,000 diabetic patients was used as a response variable. The diabetic compensation percentage was calculated as the proportion of adults with a glycosylated hemoglobin below 7% or the proportion of older people with a value below 8%. The diabetic decompensation percentage was calculated as the proportion of people with a glycosylated hemoglobin over 9%.

RESULTS: A high variability in demographic and management indicators was observed between communes and centers in the study period. Bivariate analysis showed a significant correlation between the amputation index, decompensation, and insulin use. In a regression analysis, the amputation index was significantly associated with the diabetic compensation percentage (β = -3.5; p < 0.05) and a high decompensation percentage (β = 12.3; p < 0.005).

CONCLUSIONS: The diabetic foot amputation index was associated with diabetic compensation and decompensation indicators.

PMID:37906825 | DOI:10.4067/s0034-98872022000700912

Rev Med Chil. 2022 Jul;150(7):855-860. doi: 10.4067/s0034-98872022000700855.

ABSTRACT

BACKGROUND: The measurement of plasma thyroglobulin (Tg) is widely used in the monitoring of differentiated thyroid cancer (CDT). In recent years, its value as a prognostic marker prior to ablation with radioiodine has increased, demonstrating its high negative predictive value. Recent studies indicate that a wide variety of factors could potentially influence pre-ablative Tg values, including residual tumor burden and stimulation modality.

AIM: To relate the value of pre-ablative Tg with the amount of preoperative disease burden, lymph node metastases, treatment, and presence of residual disease.

MATERIAL AND METHODS: Retrospective observational study of 70 patients with CDT treated between 2012 and 2018. The amount of disease burden was defined as the sum of largest diameter of individual tumors in each patient, and as the individually largest tumor per patient and number of metastatic lymph nodes.

RESULTS: A smaller tumor size and absence of remnant tissue was associated with lower Tg values, although the association was not always significant. Furthermore, no significant difference was found between Tg levels measured within or more than 14 days after the surgical procedure. Thus, an early measurement of pTg after surgery would allow an initial therapeutic decision making.

CONCLUSIONS: A statistical association between pre-ablative Tg levels and the amount of preoperative tumor tissue burden was found in some subgroups of patients.

PMID:37906818 | DOI:10.4067/s0034-98872022000700855

Rev Med Chil. 2022 Jul;150(7):849-854. doi: 10.4067/s0034-98872022000700849.

ABSTRACT

BACKGROUND: Philadelphia negative myeloproliferative neoplasms (Ph-MPN) are clonal disorders whose pathogenesis has been elucidated in recent years, creating diagnostic and prognostic algorithms.

AIM: To study JAK2, CALR y MPL gene mutations in patients with Ph-MPN.

MATERIALS AND METHODS: Descriptive cross-sectional observational study of patients with MPN (2015-2019), reviewing clinical, demographic and laboratory data. JAK2, CALR and MPL gene mutations were analyzed by RT-PCR.

RESULTS: We studied 72 patients. Fifty percent had essential thrombocythemia (ET), 26.4% had polycythemia vera (PV) and 23.6% had primary myelofibrosis (PM). Bone marrow biopsy was available in 76.5%. At diagnosis, the mean age was 65.5 years and 61% were symptomatic. A thrombotic event was the most frequent problem in 20% and 25% had splenomegaly. There were statistically significant differences in hematological parameters between the different MPNs. JAK2 V617F mutation was detected in 61.1%. Only 19 JAK2 V617F negative patients were available for CALR and MPL mutation studies, identifying 10 triple negative cases. Kaplan Meier curves showed a median survival of 88 months, being similar in the three MPNs. Causes of death in 20 patients were thrombotic complications in 30%, disease progression in 25%, infection in 20%, other neoplasms in 15% and other causes in 10%.

CONCLUSIONS: The presentation and frequency of JAK2 V617F, CALR and MPL mutations in our cohort was similar to those reported in other studies for ET and PM. JAK2 V617F mutation was lower for PV. No significant differences between the three MPNs were observed for overall survival. We could not assess the prognostic value of the mutations.

PMID:37906817 | DOI:10.4067/s0034-98872022000700849