Introduction Antibiotic self-medication is a common practice in pediatric caregivers in low-income countries with limited resources and represents a public health problem. Our study sought to ...determine what factors are associated with this practice, including differences in knowledge or attitudes of caregivers who attend a pediatric emergency service. Methods Case-control study based on surveys of caregivers of pediatric patients brought to the emergency room with clinical symptoms suggestive of acute infection. Cases were defined as those caregivers who reported self-medication of antibiotics for the current illness and controls where those who did not report self-medication. Information was collected through a self-administered questionnaire that inquired about demographic and family characteristics, attitudes and knowledge toward self-medication of antibiotics. Data were compared using logistic regression and are presented with odd ratios and confidence intervals. Results A total of 728 caregivers, 182 cases and 546 controls were included. We found that higher parental education, both in mothers (OR 0.56, 95% CI 0.40-0.79) and fathers (OR 0.62, 95% CI 0.43-0.89) was associated with less self-medication. Attitudes such as always requesting antibiotics from their doctors (OR 3.92, 95% CI 1.59-9.66), frequently buying antibiotics without a prescription (OR 23.66, 95% CI 11.76-47.59) and giving advice on antibiotics among family members (OR 2.90, 95% CI 1.75-4.82) resulted in an increased likelihood of self-medication. There was also a higher probability of antibiotic self-medication in older children (OR 1.13, 95% CI 1.09-1.17), those with a greater number of siblings (OR 1.25, 95% CI 1.09-1.43) and in those cases that received antibiotics within the last 3 months (OR 6.27, 95% CI 4.35-9.04). Overall knowledge of risk of antibiotic self-medication was low. Conclusions Some patient and family characteristics such as age, number of siblings, recent antibiotic usage and inappropriate attitudes are strongly related to antibiotic self-medication. These findings will inform future interventions to reduce self-medication in children. Keywords: Anti- bacterial agents, Self-medication, Emergency Medical Services, Caregivers
Deforestation has been at the heart of the transformation of the Amazon. Global concerns over deforestation and its impact on climate change have resulted in the adoption of a number of initiatives ...in the framework of zero deforestation. However, undifferentiated application of the concepts of zero net, gross, and illegal deforestation has revealed a lack of understanding of their scope and of challenges to their implementation. Zero legal and illegal deforestation is, in particular, a controversial subject from the point of view of regulation and sovereignty but an essential aspect from the perspective of public policy design. In Colombia, zero deforestation commitments make no mention of legal deforestation. Papers that analyze deforestation and official data sources fail to incorporate the legal dimension in their analysis. This article addresses this gap by identifying areas where deforestation is legal and where it is illegal in one deforestation hotspot of the Colombian Amazon, the administrative department of Guaviare. Our results show that deforestation has increased since 2013, mainly occurs in illegal zones, and that Guaviare department, 85% of which is covered by forest, has very little legal deforestation potential. Our findings reveal that assessing the legality and illegality of deforestation is more complex than often assumed and must become a priority, especially in forested countries where regulation on forest and land management is shared between different level of governments and institutions.
Objective
To compare the duration (hours until HCO3‐ ≥ 15 mmol/L) of diabetic ketoacidosis (DKA) episodes that are the first manifestation of new type 1 diabetes (NT1D) and those that are a ...complication in patients with previously diagnosed type 1 diabetes (PT1D).
Methods
A multicenter retrospective cohort study was designed. The duration of DKA was measured from the start of the treatment. The primary outcome was the comparison of the time needed in each group to reach HCO3‐ ≥ 15 mmol/L. The secondary outcomes were the comparison of the time to reach pH ≥ 7.3 and length of hospital stay in each group. Data were analyzed with a bivariate analysis of the variables vs primary outcome. Then, a regression model was analyzed.
Results
There were 305 episodes included (NT1D: 115, PT1D: 190). DKA in the NT1D group lasted longer (NT1D 20 (16‐19) vs PT1D 12 (8‐16), hours, P < .01) with a significant difference in each level of DKA severity. This group also took longer to reach pH ≥ 7.3 (NT1D 16 (12‐22) vs PT1D 9 (6‐12), hours, P < .01) and had a longer hospital stay (NT1D 9 (6‐12) vs PT1D 7 (4‐10), hours, P < .01).
Conclusion
The duration of DKA is longer in patients with NT1D regardless of characteristics like DKA severity, duration of symptoms, and type of treatments received.
Introduction:. Patients with Down syndrome (DS) have an increased risk of developing autoimmune diseases. This is a rare case of a pediatric patient with DS with an initial clinical profile of ...diabetic ketoacidosis.Case presentation:. 6-year-old male patient with symptoms suggestive of diabetes mellitus type 1 (DM1) of 15 days of evolution (polyuria, polydipsia, polyphagia and loss of 2 kilos of weight), who was admitted to the emergency department of the Hospital de San José, in Bogotá, Colombia, with uncontrollable vomiting and dehydration. The tests performed confirmed moderate ketoacidosis: glycometry: 592 mg/dL, pH: 7.19, HCO3: 10 mmol/L, PCO2: 45, PO2: 95 and lactic acid: 1.4 mmol/L. Management with isotonic fluids and intravenous insulin therapy was initiated and the patient was transferred to the pediatric intensive care unit, where ketoacidosis was controlled in approximately 10 hours. Subcutaneous insulin schedule was initiated without complications.Discussion:. This case highlights the importance of monitoring possible autoimmune complications in patients with DS, since the risk of developing them is 4.2 times higher than in the general population.Conclusion:. This case calls on to contemplate autoimmune complications in patients with DS during clinical practice. Although they are not part of the most frequent reasons for consultation, they cannot be underestimated and should be suspected and treated in a timely manner.
Introduction: Neuromyelitis optica is an inflammatory disorder of the central nervous system that accounts for 5% of demyelinating diseases in pediatrics. Its clinical presentation is variable and ...associated to the involved area of the central nervous system.Case presentation: This is the case of a 15-year-old patient who consulted several times for nonspecific neurological symptoms. During his last visit to the Clínica Universitaria Colombia in Bogotá, he presented with bilateral optic neuritis, associated with frontal and parietal headache. Immunophenotyping studies were carried out, reporting positive IgG anti-aquaporin 4 antibodies (anti-AQP4 antibody), thus leading to a diagnosis of seropositive neuromyelitis optica spectrum disorder (NMOSD). Management with methylprednisolone pulses was initiated with subsequent outpatient management with rituximab that allowed stabilizing the disease.Discussion: This is an interesting case due to its insidious and uncertain onset in a pediatric patient. It was possible to evaluate clinical and diagnostic differences in relation to its presentation in adults. NMOSD mediated by anti-AQP4 is rare; brain and bone marrow MRI are essential for diagnosis. The treatment of choice for acute conditions consists of high doses of methylprednisolone.Conclusion: This disorder may result in irreversible neurological damage; for this reason, high suspicion is required for early diagnosis and timely treatment.
ObjectiveThis study aims to assess anxiety and suffering symptoms amid the pandemic, determine factors linked to physicians’ anxiety with COVID-19 patients and describe symptom progression in the ...initial year of follow-up.MethodsDescriptive cohort study involving general practitioners, specialists and interns in the city of Bogotá. The Zung Anxiety Scale and the Traumatic Event Scale (TES) were employed and completed four times during the pandemic. A sample of 558 participants was taken. Physicians with prior diagnoses of psychiatric disorders were excluded. Bivariate tests and a logistic regression model were used.ResultsSome 7.3% of respondents had anxiety symptoms during the first survey (29/397 physicians) with a clinically significant impact of the traumatic event on 279 of the 397 (70%). Female gender (p=0.04), comorbidities (p=0.01), use of surgical gown (protective, p=0.01), perception of negative thoughts on the part of society (p=0.05), thoughts of wanting to give up or death (p<0.001) and presenting some clinical level of traumatic event impact (p<0.001) were associated with these anxiety symptoms. The multivariate model associated thoughts of quitting (OR 4.55; 95% CI 1.8 to 11.6) and the clinically significant level of TES (OR 7.8; 95% CI 1.0 to 62.5) with anxiety symptoms and the use of a surgical gown as a personal protection element (OR 0.222; 95% CI 0.12 to 0.73; p=0.009) with the protective factor.ConclusionsThe pandemic significantly impacted Bogota physicians, with around 7.3% of exhibiting anxiety symptoms during the initial assessment. This traumatic experience had a clinically significant effect on 70% of respondents. Over time, anxiety symptoms diminished. Addressing post-traumatic stress phenomena is crucial in similar scenarios to alleviate the impact on healthcare personnel’s anxiety.
Self-limited epilepsy with autonomic seizures, formerly known as benign occipital epilepsy of childhood or Panayiotopoulos syndrome is a focal epilepsy that is part of the epileptic syndromes with ...onset during childhood. The objective of this report is to raise awareness about its importance and describe the clinical manifestations, timely diagnosis, and treatment. A pediatric patient admitted with gastrointestinal manifestations is presented. The autonomic manifestations must be considered as part of the clinical spectrum that includes this disease and the digestive and autonomic manifestations that mask the diagnosis, sometimes even in the absence of motor seizures themselves. Electroencephalographic confirmation was performed, avoiding cataloging it in other differential diagnoses.
IntroductionMost scales for acute respiratory infection (ARI) are limited to healthcare worker (HCW) use for clinical decision-making. The Respiratory Syncytial Virus network (ReSVinet) Scale offers ...a version for parents that could potentially help as an early warning system.ObjectiveTo determine whether or not the ReSVinet Scale for ARI in infants can be reliably used by HCWs and parents in an emergency service.MethodsA prospective study was done of infants with ARI who were admitted to a paediatric emergency room to assess the ReSVinet Scale when used by faculty (paediatric doctor-professors), residents (doctors doing their first specialty in paediatrics) and parents. Spearman’s correlation and a weighted kappa coefficient were used to measure interobserver agreement. Internal consistency was also tested by Cronbach’s alpha test.ResultsOverall, 188 patients, 58% male, were enrolled. A Spearman’s correlation of 0.92 for faculty and resident scoring and 0.64 for faculty or resident and parent scoring was found. The weighted kappa coefficients were 0.78 for faculty versus residents, 0.41 for faculty versus parents, and 0.41 for residents versus parents. Cronbach’s alpha test was 0.67 for faculty, 0.62 for residents and 0.69 for parents.ConclusionThere was good correlation in the ReSVinet scores between health professionals when used in the paediatric emergency area. Agreement between parents and health professionals was found to be more variable. Future studies should focus on finding ways to improve its reliability when used by parents before the scale is used in the emergency room.
Background
Acute appendicitis is an infrequent pathology in children under 4 years of age, and its diagnosis is a clinical challenge that can lead to late detection. The intention of this study is to ...describe the clinical and surgical findings and to explore factors and outcomes associated with appendiceal perforation in patients under 4 years of age with histologically confirmed acute appendicitis. Cross-sectional study of historical data is on patients with a pathologic diagnosis of appendicitis. Clinical, surgical, and pathological variables were described. The relationship between the presence of perforation and associated factors and outcomes was explored using odds ratios (OR) and 95% confidence intervals.
Results
Seventy-five patients were found between 2013 and 2019. Seventy-four cases presented with pain on palpation, 56 (75%) with signs of peritoneal irritation, and 70 (93%) with sepsis on admission to the emergency room. An ultrasound was done on 57 patients (76%), and only 26 (45%) were suggestive of appendicitis. Forty-one (55%) cases were operated on by open surgery and 34 (45%) by laparoscopy. In 61 (81%), they were perforated, and 48 (64%) presented peritonitis. Perforation was associated with increased hospital days (
OR
= 2.54 1.60−4.03), days of antibiotics (
OR
= 4.40 2.09−9.25), and admission to intensive care (
OR
= 9.65 1.18−78.57).
Conclusions
Abdominal pain reported by parents, pain on abdominal palpation, and clinical criteria of sepsis on admission to the emergency room are common features. Acute appendicitis complicated by perforation leads to high morbidity due to longer antibiotic treatment, hospitalization days, admission to PICU, and postoperative ileus.
Abstract
Multiple hereditary exostoses (MHE) is a rare disease with autosomal dominant inheritance, caused by heterozygous germline mutations in the
EXT1
or
EXT2
genes. This disorder is characterized ...by the growth of prominences surrounded by cartilage in the growth plates and the long bones. Here, we report a family affected by MHE. In this family, a pathogenic variant c.544C > T (p. Arg182Ter) was identified in the
EXT2
gene. This variant has been previously described in the literature, and here we are reporting the relationship with clinical findings. MHE is suspected according to the clinical manifestations; molecular research should be performed to establish the most frequent mutations. A support, diagnosis, and follow-up group should be created, and genetic counseling should be available for patients and families.
PDF
