BackgroundAcute 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.ObjectiveTo 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.MethodsA 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.Results685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-day 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.ConclusionsThis 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.
BackgroundHypercalcemia 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 presentationWe 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.ConclusionHypercalcemia 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.
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.
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