Introduction The COVID-19 pandemic has a great impact on children's health. This study describes the clinical, epidemiological and treatment characteristics of children presenting COVID-19 at the Instituto Nacional de Salud del Niño San Borja (INSN-SB) Methods This was a retrospective study of patients with a confirmed diagnosis of COVID-19 from March to July 2020. Demographic, clinical, laboratory, radiological, and treatment information were collected. Data analysis included descriptive statistics and bivariate analysis to determine differences between patients in general wards and the intensive care unit (ICU). Results We included 91 patients, 33 being females (36.3%). The most affected age group was children > 2 years of age (63 cases) with a median age of 6 years (IQR 3-10), and 61.5% were from Lima. The previous contact was determined in 30.8% of cases. A positive SARS CoV-2 PCR result was obtained in 50.6%. The presence of comorbidity was 53.8%. The most frequent symptoms were: fever (39.6%), general malaise (23.1%), cough (19.8%), and respiratory distress (14.3%). The presence of multisystem inflammatory syndrome in children (MIS-C) was confirmed in 6 patients. Antibiotics were administered in 76.9%. The most frequent radiological pattern was bilateral interstitial infiltrates (57.7%). Mortality was higher in patients in the ICU than in the hospitalization ward (27.3% vs. 4.3%, respectively; p = 0.02) Conclusions COVID-19 in children presents mild and moderate clinical manifestations. The presence of comorbidity is an important factor for hospitalization, and mortality is high upon admission to critical care units.
La equinococosis quística (EQ) en niños es un problema de salud pública. Para describir las características clínicas y epidemiológicas de la EQ se revisaron los registros de 55 niños con diagnóstico confirmado de EQ admitidos entre 2017 y 2019 en un centro quirúrgico referencial del Perú. Se analizaron los datos demográficos, las manifestaciones clínicas y el tratamiento. El 61,8% (34/55) de los niños fue de sexo masculino. La edad promedio fue de 9,25 años (DE: 2,79); un 16,4% tuvo diagnóstico previo de EQ, y un 50,9% tuvo contacto con perros. La mediana de tiempo de enfermedad fue de dos meses. El 65,5% tuvo afectación hepática, el 56,4% pulmonar y el 21,8% hepática y pulmonar. Los síntomas más frecuentes fueron dolor abdominal (80,6%) y tos (80,6%). El tratamiento quirúrgico se realizó en el 87,5% de los casos con EQ hepática y en el 100% de los casos con EQ pulmonar y EQ hepática y pulmonar. Se prescribió albendazol en el 100% de casos hepáticos, en el 73,7% de casos pulmonares y en el 75% de ambas afectaciones. No se reporta mortalidad.
Background Vancomycin serum trough concentrations are monitored to reduce nephrotoxicity and optimize therapeutic efficacy. Vancomycin pharmacokinetics and trough levels used in pediatric patients are extrapolated from the adult population. The pediatric dosing strategies are empirical and there is limited evidence to suggest that these doses result in the recommended steady-state trough concentrations. The objective of the study was to determine the association between vancomycin dosing regimens and trough concentrations levels of 10 to 20 μg/mL in pediatric patients with complicated infections. Methods Retrospective cohort, 505 trough vancomycin serum concentrations of patients of 1 month to 18 years from hospital wards and the Intensive Care Unit of the Instituto Nacional de Salud del Niño San Borja during December 2015 to April 2019. It included only the first vancomycin trough level measured 30 minutes before the fourth doses and serum trough concentrations of 10 to 20 μg/mL were considered as therapeutic levels. A multinomial logistic regression model to estimate the relative risk ratio (RRR) with a 95% confidence interval was used, the comparator group was therapeutic vancomycin levels and it was adjusted by glomerular filtration rate, age group, hospital room, dose interval, and weight. Results Five hundred and five vancomycin dosages were analyzed. Infants and children were 43.12% and 39.22%, respectively, 45.17% were women. 56.77% had a high glomerular filtration rate and only 28.02% of the patients obtained therapeutic trough levels of vancomycin. The RRR of having sub-therapeutic levels in patients with low glomerular filtration rates compared with normal filtration rates was 0.31 (P = 0.049) and the RRR of having sub-therapeutic levels in patients from 2 to 12 years compared with patients under 2 years old was 2.38 (P = 0.007). There was no difference in having therapeutic levels using doses equal or greater than 60 mg/kg/day vs. less than 40 mg/kg/day comparing sub-therapeutic levels (P = 0.655) and supratherapeutic levels (P = 0.264). Conclusions The empirical vancomycin regimens used in pediatric patients did not reach the recommended therapeutic trough levels of 10 to 20 μg/mL. Patients of 2 to 12 years and low glomerular filtration rates were associated to have sub-therapeutic trough levels.
Introducción: El monitoreo terapéutico de vancomicina es una herramienta para guiar el tratamiento en pacientes pediátricos. El objetivo del estudio es correlacionar el nivel sérico de vancomicina con un modelo farmacocinético de cálculo de la área bajo la curva (AUC). Métodos: Estudio retrospectivo del nivel sérico valle de vancomicina en pacientes entre 1 mes a 18 años atendidos en el INSNS-SB durante el periodo de diciembre de 2015 a Julio de 2017. Se analizó la correlación entre el nivel sérico y una estimación de AUC/MIC de un estudio previamente publicado. Se incluyeron a todos los pacientes con al menos 48h de tratamiento con vancomicina, y se excluyeron a neonatos. Resultados: Se incluyeron 74 muestras de 69 pacientes, siendo 34 de sexo femenino (45.9%). La mediana de edad fue 4 años (RIC 1-7). La mediana de peso fue 11.1 kg (RIC 5.8-25) y de talla fue 85 cm (RIC 64-115). La mediana de creatinina sérica fue 0.29 mg/dL (RIC 0.20-0.46), la depuración de creatinina fue 154.6 ml/min (RIC 102.8-240), la dosis mediana de vancomicina fue 600 mg/d (RIC 320-1140) y la concentración sérica valle fue 10.3 ug/mL (RIC 6.3-18.2). Se alcanzó niveles terapéuticos en 16 pacientes (21.6%). La mediana de AUC/MIC calculado fue 390.4 (RIC 322.3-494.6), mientras que la correlación entre el AUC/MIC calculado y el nivel sérico valle de vancomicina no fue significativa (p=0.13)
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