Revista Ecuatoriana de Pediatría

Brain abscess as an otorhinolaryngological complication

Miguel Hernández, Mildred P. Zambrano Leal — Thu, 28 Dec 2023 00:00:00 +0000

Introduction: A brain abscess can be fatal if not diagnosed or treated promptly. It is more common in children than in adults and has a high mortality rate. Respiratory infections, such as otitis and sinusitis, usually precede brain abscesses. In most cases, double treatment, antibiotics, and surgery are necessary. Complications can be fatal even with proper treatment.

Clinical case: This was a 3-year-old girl with a history of respiratory infection. His parents took her to the emergency room due to a severe headache and a seizure episode. Clinical examination revealed left ear otalgia associated with pain and sensitivity to palpation of the mastoid region. Laboratory tests revealed leukocytosis of 18,770/MMC with neutrophilia, thrombocytosis of 628,000/MMC, elevated C-reactive protein of 8.35 mg/dl (average value 0.10-0.30 mg/dl) and elevated ferritin of 250.20 ng/dl (standard value 7-140 ng/dl). Due to the patient’s history and clinical findings, the skull's computed tomography (CT) was performed, revealing an image of evident hypodensity in the left hemisphere. MRI was also performed and revealed that the lesion was previously associated with left breast thrombosis. She received antibiotics and low-molecular-weight heparin with neurosurgical therapy, which produced good results.

Evolution: Despite the extent of the injury, he had two episodes of seizures. He promptly received appropriate antibiotic therapy and surgical treatment, which produced good results. Three months later, during the follow-up, he looked normal and had no long-term complications.

Conclusions: Complications of brain abscess, even with adequate treatment, can be severe and include epilepsy or death. Early treatment minimizes lethal risks.

Chronic myeloid leukemia in a pediatric patient

Thu, 28 Dec 2023 00:00:00 +0000

Introduction: Chronic myeloid leukemia (CML) is a rare pathology that occurs in childhood and represents 2-3% of leukemias diagnosed in children and adolescents; the incidence of CML ranges from 0.6 to 1.2/million children/year, and the incidence of CML increases with age.

Clinical case: The case of an 11-year-old boy who presented with abdominal pain secondary to acute appendicitis with persistent leukocytosis during his hospitalization is reported.

Evolution: He was evaluated by hematology. He was diagnosed with this disease and referred to a specialized entity. An RT‒PCR was performed for BCR-ABL1, and the results were positive, confirming the findings of this study.

Conclusions: Chronic myeloid leukemia should be suspected in pediatric patients who present with hyperleukocytosis accompanied by thrombocytosis and splenomegaly without any cause, especially during adolescence, which is the most common age at which this pathology appears.

Pediatric multisystem inflammatory syndrome associated with COVID-19

Isabel Carrasco, Greta Munoz, Gabriela Carrasco — Thu, 28 Dec 2023 00:00:00 +0000

Introduction: Multisystem inflammatory syndrome (MIS) is a hyperinflammatory disorder that has emerged as a significant concern during the COVID-19 pandemic. This syndrome also affects the pediatric population, and notifications of cases of multisystem inflammatory syndrome in children (MIS-C) have increased worldwide. An exceptionally high incidence of Hispanic and Afro-descendant patients is observed, reaching 23% in Latin America. Although a direct link between MIS-C and the SARS-CoV-2 has not been established, research suggests a late immunological connection mediated by an imbalance in the expression of Th17 cells/Thregs, autoantibodies, and immune complexes, especially in genetically susceptible individuals and those with an altered endogenous environment.

Methods: In this theoretical review, an exhaustive bibliographic search was conducted in the MEDLINE, LILACS, and Google Scholar databases. Relevant data were collected on the pathogenic and immunological mechanisms that contribute to the development of MIS-C, as well as information on its clinical presentation and relationship with other childhood inflammatory syndromes.

Results: MIS-C predominantly affects the digestive, cardiovascular, and neurological systems and is associated with fever, significantly elevated inflammatory marker levels, and symptoms of organ dysfunction. This syndrome shares similarities with Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. Research has confirmed that MIS-C patients present unique immune and laboratory profiles, establishing it as a distinct clinical entity.

Conclusions: This review highlights the importance of recognizing multisystem inflammatory syndrome in children infected with SARS-CoV-2. The causal connection has yet to be fully established, but initial data support the existence of MIS-C as a unique clinical entity. Understanding the immunological mechanisms and distinctive clinical characteristics of this disease is essential for its early identification and appropriate management in the pediatric population.

Comorbid neurodevelopmental disorders in children with epilepsy

Oscar Meza — Tue, 26 Dec 2023 00:00:00 +0000

Introduction: Neurodevelopmental disorders are a group of conditions that occur before school age and affect development. They can cause learning, communication, social interaction, or behavior difficulties. The objective of the present study was to identify the neurodevelopmental disorders present in children with a diagnosis of epilepsy who attended a public reference hospital in Venezuela.

Methods: The present cross-sectional observational study included children diagnosed with epilepsy who attended a neuropediatric consultation at the University Hospital of Maracaibo in Venezuela between March 2022 and March 2023. The presence of neurodevelopmental disorders was established according to the doctor's criteria, who evaluated each patient in the controlled trials. The chi-square test was used to analyze the categorical variables.

Results: A total of 110 patients were analyzed; 66 men (60.0%) were aged 7.3 ± 6.2 years, and generalized epilepsy predominated (76.4%). A total of 56 patients presented with neurodevelopmental disorders: 19 with intellectual development disorders (33.9%), 9 with attention deficit hyperactivity disorder (16.0%), 14.2%, 7 with autism spectrum disorders (12.5%), 7 with language disorders (12.5%), and 6 with motor disorders (10.9%).

Conclusions: In the present investigation, it was observed that patients diagnosed with epilepsy had a high incidence of comorbid neurodevelopmental disorders, which included cognitive and behavioral alterations. Therefore, every professional needs to recognize the clinical signs of these disorders to provide timely multidisciplinary care that improves the quality of life of these patients and their families.

Prevalence of bronchial asthma in patients infected with respiratory syncytial virus

Kristell Franco, Eugenia Cevallos Velásquez , Vanessa Salazar, Luis Arroba — Tue, 26 Dec 2023 00:00:00 +0000

Introduction: Asthma is the most common noncommunicable disease in children. Respiratory syncytial virus (RSV) affects primarily children two years of age and is the leading cause of bronchiolitis in children worldwide. The objective of the present study was to establish the prevalence and relationship between bronchial asthma and RSV in preschool patients.

Methods: A descriptive, analytical, observational, cross-sectional, nonexperimental study was conducted at Dr. Francisco de Icaza Bustamante Hospital in Guayaquil from January 2017 to April 2019. The statistical analysis used the Chi-square test, for which the statistical significance value was <0.005, and InfoStat statistical software.

Results: There were 64 patients. The prevalence was 83% in patients diagnosed with RSV who subsequently developed asthma before six years of age. The comorbidity with the most significant presence in the population was prematurity (20%). There was a predominance of males (63%), as did the 3-year-old group (38%). Family history of asthma (21.88%). Patients were admitted with a classification of triage 2 (20.31%) or triage 1 (6.25%). Maternal age was <18 years (17.1%). The most frequent respiratory complication was unspecified acute bronchiolitis (71.8%), followed by unspecified pneumonia (65.6%). The patients were admitted to the intensive care unit (12.5%) and were hospitalized (7.8%).

Conclusions: There was a relationship between a history of respiratory syncytial virus infection and bronchial asthma. The prevalence of bronchial asthma in RSV-infected patients was high, with a predominance of 3-year-old preschoolers, males, and premature infants. The most common respiratory complication was unspecified acute bronchiolitis.

Comparison of the evolution of patients with gastroschisis treated with the Simil exit technique vs. primary closure

Wed, 27 Dec 2023 00:00:00 +0000

Introduction: The surgical treatment of gastroschisis involves closing the abdominal wall after the intra-abdominal organs are reduced. The Simil-exit (SE) method is used to reduce morbidity and mortality. The objective of the present study was to compare the outcomes of patients with gastroschisis who underwent surgery via the SE technique versus those treated with primary closure (PC).

Methods: The present observational study analyzed the records of patients with gastroschisis at the "Dr. Roberto Gilbert Elizalde" Hospital from 2019 to 2022. The SE and CP techniques are compared. The variables included closure success, the start of enteral feeding, the length of hospital stay, and mortality.

Results: A total of 9 patients with ES and 26 patients with PC were included. There were no differences between the start time of enteral feeding (P = 0.13) and the hospitalization time (P = 0.43). Four patients died in the CP technique group (15.4%; P = 0.5), which was significantly related to reoperation (P = 0.002) and complex gastroschisis (P <0.001).

Conclusions: Closure via the SE technique has noninferiority equivalence concerning that via the CP technique.

Electroencephalographic alterations in children with attention deficit hyperactivity disorder

Nicolay Astudillo Mariño, Domenica Santamaria — Wed, 27 Dec 2023 00:00:00 +0000

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects daily functioning. The potential of video electroencephalogram (V-EEG) and rhythm map analysis for the early diagnosis of ADHD, particularly in at-risk children, has been investigated. The objective of the present study was to evaluate electroencephalographic alterations in children with ADHD.

Methods: A retrospective analysis was performed at the Center for Neuropsychological Evaluation and Advanced Neurotherapy (CENNA) in Quito-Ecuador from January to March 2022; the demographic characteristics, V-EEG use, and rhythm map findings were documented.

Results: The sample included 73 patients aged 3 to 16 years, 21.92% of whom were women and 78.08% of whom were men. The average age was nine years. All patients underwent V-EEG as part of their evaluation, revealing slow waves (delta range) in 30% (n=22) of patients. The bilateral temporal region was the most affected in 63.64% (n=14) of the patients with slow waves, followed by the frontal areas in 18.18% (n=4), occipital regions in 9.09% (n=2), frontotemporal regions in 4 55% (n=1) and parietal regions in 4.55% (n=1).

Conclusions: V-EEG, which reveals slow waves in bilateral temporal regions, may be a valuable tool for diagnosing ADHD. These results indicate the need for further research to confirm these findings and establish the validity and clinical utility of V-EEG in ADHD patients.

Evaluation in pediatric patients of colostomy closure with manual suture versus mechanical suture

Thu, 28 Dec 2023 00:00:00 +0000

Introduction: Colostomy is a rescue alternative for preventing normal movement of the fecal bolus through the rectum and anus. The objective of the present study was to evaluate colostomy closure with manual sutures vs. mechanical sutures in pediatric patients.

Methods: This observational study was conducted at the Dr. Roberto Gilbert Elizalde Children's Hospital in Guayaquil, Ecuador. Cases of colostomy closure via manual suturing versus mechanical suturing were analyzed from 2018 to 2023. Hospitalization time, complications, and need for reintervention were compared. Percentages were compared with chi-square tests, and data were compared with Cox regression.

Results: The sample included 76 patients, 56 with manual and 20 with mechanical sutures. The need for reintervention with both techniques was 5%, which was similar. There were also no differences in the length of hospital stay. There were no significant differences in the number of complications between the study groups (12% in the manual suture group and 25% in the mechanical suture group). Cox regression is beneficial for determining the appropriate mechanical technique.

Conclusions: The findings suggest that both techniques yield similar postoperative results for both hospitalization and complications, with less reintervention via the mechanical method.

Cardiac manifestations and echocardiographic findings associated with multisystem inflammatory syndrome due to COVID-19 in children

Thu, 28 Dec 2023 00:00:00 +0000

Introduction: In children hospitalized for multisystem inflammatory syndrome (MIS) due to COVID-19, cardiac manifestations may occur, the outcome of which may be fatal. This study analyzed the cardiac manifestations and echocardiographic findings associated with SIM in children with COVID-19.

Methods: The present observational study was conducted at the “Vicente Corral Moscoso” Hospital in Cuenca, Ecuador. The study period was from April 2020 to March 2022. Children with SIM and COVID-19 were included, and medical records and echocardiograms were examined.

Results: There were 19 patients; 31.6% of the affected children were between 1 and 4 years old, and 52.6% were girls. Notably, 63.2% were overweight. Obesity was the most common comorbidity, affecting 84.2% of the patients. The predominant symptoms were fever (68.4%), vomiting (47.4%), and abdominal pain (42.1%). The echocardiographic findings were pericardial effusion in 15.8% and right ventricular dysfunction in 5.3%. The most common cardiac complications were pericardial and valvular dysfunction, arrhythmias, and pericardial effusion, each occurring in 10.5% of patients. In addition, 26.3% mortality was recorded in the sample studied.

Conclusions: A clear relationship between inflammatory symptoms and cardiac complications after contracting COVID-19 infection was observed.

Transfusion characteristics and hemovigilance of pediatric cancer patients

Adriana Urdiales, Enmanuel Guerrero — Thu, 28 Dec 2023 00:00:00 +0000

Introduction: Transfusion therapy is not risk-free, and hemato-oncological patients are the most commonly transfused patients; hence, hemovigilance is needed. The objective of the present study was to identify the transfusion characteristics and hemovigilance of pediatric patients with cancer at the SOLCA Institute-Cuenca from January to December 2021.

Method: A descriptive study was carried out with all patients under 18 years of age who required transfusions, and all blood transfusions were performed at SOLCA-Cuenca 2021. The data were collected in a previously validated form and analyzed with the SPSS v25.0 program; the results are presented as the frequency, percentage, mean, and standard deviation.

Results: A total of 73 patients and 620 transfusions were studied; 45.2% were adolescents, 63% were male, 98.6% were mixed race, 76.7% were urban, and 83.5% were ORH+ patients. B-cell acute lymphoblastic leukemia (49.3%) and induction chemotherapy (41.1%) were used. A total of 58.9% had a transfusion history, and 4.1% had a previous reaction (urticaria). The average number of transfusions per patient was 8.49, and 7.1% of the patients were premedicated with steroids. Concentrated erythrocytes were mainly transfused (49%) for anemia (95.4%) at 9.32 ml/kg (mean) in 121 to 180 minutes (56.9%). Of the 3.1% of reactions detected, 100% were immediate, 84.2% were noninfectious (urticaria), definitive, and were treated with medications (84.2% steroid); 79% of the reactions were mild; they were secondary to erythrocyte concentrates (47.4%), apheresis (47.4%) and B-cell acute lymphoblastic leukemia (31.5%).

Conclusions: Patients with B-cell acute lymphoblastic leukemia required additional blood transfusions, mainly erythrocyte concentrates, while transfusion reactions were frequently associated with erythrocyte concentrates and apheresis.