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Nielsen KR, Caporal P, Díaz F, González-Dambrauskas S, Vásquez-Hoyos P, Domínguez-Rojas J. Letter: Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Study Protocol. Neurosurgery 2024; 94:e79-e80. [PMID: 38470124 DOI: 10.1227/neu.0000000000002915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Katie R Nielsen
- Pediatric Critical Care Medicine, University of Washington, Seattle , Washington , USA
- Department of Global Health, University of Washington, Seattle , Washington , USA
| | - Paula Caporal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore , Maryland , USA
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo , Uruguay
| | - Franco Díaz
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo , Uruguay
- Facultad de Medicina, Universidad Finis Terrae, Santiago , Chile
| | - Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo , Uruguay
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo , Uruguay
| | - Pablo Vásquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo , Uruguay
- Universidad Nacional de Colombia, Bogotá , Colombia
| | - Jesús Domínguez-Rojas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo , Uruguay
- Instituto Nacional de Salud del Niño, Lima , Perú
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Domínguez-Rojas J, Coronado Munoz Á, Luna-Delgado Y, Alvarado-Gamarra G, Quispe Flores G, Caqui-Vilca P, Atamari-Anahui N, Muñoz Ramírez CM, Tello-Pezo M, Cruces P, Vasquez-Hoyos P, Díaz F. Lung mechanics in pediatric acute respiratory distress syndrome associated to acute COVID-19 and MIS-C: implications for therapies and outcomes. Andes Pediatr 2023; 94:350-360. [PMID: 37909938 DOI: 10.32641/andespediatr.v94i3.4616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To describe lung mechanics in Pediatric Acute Respiratory Distress Syndrome (PARDS) associated with acute COVID-19 and MIS-C with respiratory failure. METHODS A concurrent multicenter observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care units (PICU) in Peru. The subgroup analysis included PARDS associated with multisystem inflammatory syndrome in children (MIS-C), MIS-PARDS, and PARDS with COVID-19 primary respiratory infection, C-PARDS. In addition, receiver operating characteristic (ROC) curve analysis for mortality and lung mechanics was performed. RESULTS 30 patients were included. The age was 7.5 (4-11) years, 60% were male, and mortality was 23%. 47% corresponded to MIS-PARDS and 53% to C-PARDS groups. C-PARDS had positive RT-PCR in 67% and MIS-PARDS none (p < 0.001). C-PARDS group had more profound hypoxemia (P/F ratio < 100, 86% vs. 38%, p < 0.01) and higher driving-pressure [14(10-22) vs 10(10-12) cmH2O], and lower compliance of the respiratory system (CRS) [0.5 (0.3-0.6) vs 0.7(0.6-0.8) ml/ kg/cmH2O] compared with MIS-PARDS (all p < 0.05). The ROC analysis for mortality showed that driving pressure had the best performance [AUC 0.91(95%CI0.81-1.00), with the best cut-off point of 15 cmH2O (100% sensitivity and 87% specificity). Mortality in C-PARDS was 38% and 7% in MIS-PARDS (p = 0.09). MV-free days were 12(0-23) in C-PARDS and 23(21-25) in MIS-PARDS (p = 0.02). CONCLUSION Patients with C-PARDS have lung mechanics characteristics similar to classic moderate to severe PARDS. This was not observed in patients with MIS-C. As seen in other studies, a driving pressure ≥ 15 cmH2O was the best discriminator for mortality. These findings may help guide ventilatory management strategies for these two different presentations.
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Affiliation(s)
- Jesús Domínguez-Rojas
- Departamento de Emergencias y Áreas Críticas, Instituto Nacional de Salud del Niño, Lima, Perú
| | - Álvaro Coronado Munoz
- Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston, Texas, USA
| | | | | | | | - Patrick Caqui-Vilca
- Departamento de Pediatría, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | | | | | - Mariela Tello-Pezo
- Departamento de Pediatría, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | | | | | - Franco Díaz
- Red Colaborativa Pediátrica de Latinoamérica
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Domínguez-Rojas J, Caute-Lara J, Caqui-Vilca P, Cruz-Arpi M, Martel-Ramírez C, Quispe-Chipana M, Sánchez-Rodríguez A, Atamari-Anahui N. Hyperferritinemic sepsis secondary to invasive Toxoplasma gondii in a child with untreated HIV. Bol Med Hosp Infant Mex 2023. [PMID: 36917806 DOI: 10.24875/bmhim.22000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background Untreated human immunodeficiency virus (HIV)-immunosuppressed pediatric patients show high morbidity and mortality from opportunistic infections. Limited cases of hyperferritinemic sepsis have been described in patients with toxoplasmosis. Case report We describe the case of a 13-year-old female patient with a history of untreated HIV who presented with hyperferritinemic sepsis secondary to Toxoplasma gondii infection and Pneumocystis jirovecci pneumonia. She received ventilatory support, inotropic drugs, treatment for opportunistic germs, and high-dose corticosteroids, but with unfavorable evolution. Conclusions The global approach to sepsis with elevated ferritin guides to using of therapies aimed at neutralizing the severe inflammatory response. A timely diagnosis would allow prompt treatment and minimize complications.
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Affiliation(s)
- Jesús Domínguez-Rojas
- Servicio de Pediatría Clínica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Servicio de Unidad de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño-Breña, Lima, Peru.,Servicio de Unidad de Cuidados Intensivos, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Jackeline Caute-Lara
- Servicio de Unidad de Cuidados Intensivos, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Patrick Caqui-Vilca
- Servicio de Unidad de Cuidados Intensivos, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Mario Cruz-Arpi
- Servicio de Unidad de Cuidados Intensivos, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Carlos Martel-Ramírez
- Servicio de Unidad de Cuidados Intensivos, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Miguel Quispe-Chipana
- Servicio de Unidad de Cuidados Intensivos, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Abel Sánchez-Rodríguez
- Servicio de Unidad de Cuidados Intensivos, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Noé Atamari-Anahui
- Servicio de Unidad de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño-Breña, Lima, Peru.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Atamari-Anahui N, Domínguez-Rojas J, Ruiz-Solsol L, López-Turpo M, Castillo-Delgadillo A, Quiñonez Saif D, Campano Cornejo JW. [Budd Chiari syndrome secondary to antiphospholipid syndrome and systemic lupus erythematosus in an adolescent: a case report]. REVISTA DE GASTROENTEROLOGIA DEL PERU : ORGANO OFICIAL DE LA SOCIEDAD DE GASTROENTEROLOGIA DEL PERU 2022; 42:131-135. [PMID: 36513360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Budd-Chiari syndrome is caused by an obstruction of blood flow to the liver. Published cases of the antiphospholipid syndrome associated with BCS are limited in the pediatric population. We report a 15-year-old adolescent who presented with fever, ascites, and hepatosplenomegaly. Hepatic Doppler ultrasound revealed no flow in the right and middle hepatic veins and in the inferior vena cava. Abdominal tomography revealed extensive thrombosis of the inferior vena cava. During hospitalization, she was diagnosed with antiphospholipid syndrome and systemic lupus erythematosus. She was given treatment with unfractionated heparin, low molecular weight heparin, and anticoagulants. Budd-Chiari syndrome secondary to the antiphospholipid syndrome is a life-threatening disease. Timely diagnosis and treatment improve the quality of life of the patient.
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Affiliation(s)
- Noé Atamari-Anahui
- Instituto Nacional de Salud del Niño-Breña. Lima, Perú; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Perú
| | - Jesús Domínguez-Rojas
- Instituto Nacional de Salud del Niño-Breña. Lima, Perú; Universidad Nacional Mayor de San Marcos. Lima, Perú
| | - Luis Ruiz-Solsol
- Hospital Amazónico de Yarinacocha. Ucayali, Perú; Universidad Nacional de Ucayali, Facultad de Medicina Humana. Ucayali, Perú
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Domínguez-Rojas J, Campano W, Tasayco J, Siu-Lam A, Ortega-Ocas C, Atamari-Anahui N. Thrombotic thrombocytopenic purpura associated with COVID-19 in a critically ill child: a Peruvian case report. Bol Med Hosp Infant Mex 2022; 79:123-128. [PMID: 35073626 DOI: 10.24875/bmhim.21000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Acquired thrombotic thrombocytopenic purpura (TTP) is a rare disease. In middle and low-income countries, specific resources are required for its diagnosis due to the lack of diagnostic tests and the variable response to plasma exchange, especially in the context of the new SARS-CoV-2 pandemic. Case report We report the case of a 9-year-old male Hispanic patient with SARS-CoV-2 infection, atypical presentation, and multisystem involvement, thrombotic microangiopathy with dermal manifestations, hematologic, renal, and neurologic involvement. The patient was followed up after SARS-CoV-2 infection, the PLASMIC score was applied, and a genetic study was performed. Ventilation and hemodynamic support, corticotherapy, immunoglobulins, plasma exchange, renal replacement therapy, and monoclonal antibodies were given without favorable response. Conclusions TTP associated with SARS-CoV-2 in the pediatric population is rare. However, resources for the diagnosis, support, and management of patients with TTP are required to avoid fatal outcomes.
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Affiliation(s)
- Jesús Domínguez-Rojas
- Servicio de Unidad de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño-Breña, Lima, Perú.,Servicio de Pediatría Clínica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - William Campano
- Servicio de Hematología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Jaime Tasayco
- Servicio de Unidad de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño-Breña, Lima, Perú
| | - Andrea Siu-Lam
- Servicio de Unidad de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño-Breña, Lima, Perú
| | - Cesia Ortega-Ocas
- Servicio de Unidad de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño-Breña, Lima, Perú
| | - Noé Atamari-Anahui
- Servicio de Unidad de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño-Breña, Lima, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola. Lima, Per
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Domínguez-Rojas J, Atamari-Anahui N, Chonlon-Murillo K, Tello M, Coronado-Muñoz Á. Systemic lupus erythematosus complicated with macrophage activation syndrome mimicking COVID-19 multisystemic inflammatory syndrome in children. Bol Med Hosp Infant Mex 2021; 78:642-646. [PMID: 34934208 DOI: 10.24875/bmhim.21000064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Macrophage activation syndrome (MAS) is characterized by excessive activation of macrophages and lymphocytes, leading to multiorgan dysfunction. As the initial manifestation of systemic lupus erythematosus (SLE), MAS is rare in children. Due to the COVID-19 pandemic, it is vital to identify the MAS as it shares similar characteristics with the multisystem inflammatory syndrome in children (MIS-C). CASE REPORT We report the case of an 11-year-old male adolescent with symptoms of MIS-C. Although with negative results of RT-PCR (reverse transcription-polymerase chain reaction) and serology for SARS-CoV-2, contact with a positive COVID-19 relative was reported. When admitted to a referral hospital center, the patient received standard treatment for MIS-C. Although the same scheme was given on three occasions, the patient showed no response to initial therapy. Thus, the patient was classified as a refractory case. When the study was extended to other differential diagnoses, we found MAS associated with SLE. Therefore, the patient was treated with etoposide, cyclosporine, dexamethasone, and methotrexate and showed a good clinical response. CONCLUSIONS MAS associated with SLE is rare in the pediatric population. MAS shares inflammatory markers with the MIS-C and is often confused with rheumatologic, infectious, and neoplastic entities. Reporting this case is important to identify differential diagnoses in patients presenting as MIS-C and decide on timely treatment, as it could be harmful or even fatal if a definitive diagnosis is not obtained on time.
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Affiliation(s)
- Jesús Domínguez-Rojas
- División de Cuidados Críticos Pediátricos, Departamento de Pediatría, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Noé Atamari-Anahui
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Mariela Tello
- Instituto Nacional de Salud del Niño-San Borja, Lima, Peru
| | - Álvaro Coronado-Muñoz
- Department of Pediatrics, McGovern Medical School, University of Texas, Houston, Texas, United States of America
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Aguila OD, Domínguez-Rojas J, Garcés-Ghilardi R, Estupiñan-Vigil M, Alvarado-Gamarra G. [Pediatric multisystemic inflammatory syndrome associated with COVID-19: preliminary report of a hospital in Peru]. Rev Peru Med Exp Salud Publica 2021; 38:180-182. [PMID: 34190914 DOI: 10.17843/rpmesp.2021.381.6460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/28/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Olguita Del Aguila
- Servicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Jesús Domínguez-Rojas
- Servicio de Pediatría Clínica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
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