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      COVID-19 y enfermedad pulmonar pediátrica: Experiencia en un centro de atención terciaria en Sudáfrica


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          La pandemia de COVID-19 resultó en una rápida diseminación global, con profundos impactos en los sistemas de salud. Aunque los datos pediátricos muestran de manera consistente un cuadro clínico más leve, se ha identificado que la enfermedad pulmonar crónica es un factor de riesgo para la hospitalización y para desarrollar una enfermedad grave. En África, continente formado predominantemente por países con ingresos bajos o medios (LMIC), la elevada prevalencia de VIH, tuberculosis, desnutrición y hacinamiento aumenta aún más los riesgos a la salud. En este trabajo se revisa la literatura sobre COVID-19 y enfermedad pulmonar crónica en niños, y relata nuestra experiencia en un centro de atención pulmonar pediátrico en Ciudad del Cabo, Sudáfrica. Los datos epidemiológicos en Sudáfrica confirman una baja prevalencia de la enfermedad grave, donde los pacientes < 18 años comprenden 8% de todos los casos diagnosticados de COVID-19 y 3% de todas las admisiones por esa causa. Se encontró una reducción en la admisión hospitalaria por otras infecciones del tracto respiratorio inferior. Aunque el servicio de pulmonología atiende niños con una amplia variedad de condiciones respiratorias crónicas, incluyendo bronquiectasias, fibrosis quística, asma, enfermedad pulmonar intersticial y pacientes con traqueostomías, no se observó un incremento significativo en las admisiones por COVID-19, y en quienes desarrollaron COVID-19, el curso de la enfermedad no fue grave. La evidencia actual sugiere que la preexistencia de una enfermedad respiratoria en niños no parece ser un factor de riesgo significativo para el COVID-19 grave. Aún se requieren datos longitudinales para evaluar el riesgo en niños con inmunosupresión y enfermedades pulmonares intersticiales. Los impactos indirectos de la respuesta a la pandemia en la salud respiratoria de los niños son notables, y es muy probable que aún deban comprenderse y cuantificarse. Garantizar el acceso de los niños a servicios preventivos y de cuidado completos durante este tiempo es prioritario.

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          OpenSAFELY: factors associated with COVID-19 death in 17 million patients

          COVID-19 has rapidly impacted on mortality worldwide. 1 There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19 related deaths. COVID-19 related death was associated with: being male (hazard ratio 1.59, 95%CI 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared to people with white ethnicity, black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.29-1.69 and 1.45, 1.32-1.58 respectively). We have quantified a range of clinical risk factors for COVID-19 related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly.
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            Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study

            Summary Background A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were successively reported in Wuhan, China. We aimed to describe the CT findings across different timepoints throughout the disease course. Methods Patients with COVID-19 pneumonia (confirmed by next-generation sequencing or RT-PCR) who were admitted to one of two hospitals in Wuhan and who underwent serial chest CT scans were retrospectively enrolled. Patients were grouped on the basis of the interval between symptom onset and the first CT scan: group 1 (subclinical patients; scans done before symptom onset), group 2 (scans done ≤1 week after symptom onset), group 3 (>1 week to 2 weeks), and group 4 (>2 weeks to 3 weeks). Imaging features and their distribution were analysed and compared across the four groups. Findings 81 patients admitted to hospital between Dec 20, 2019, and Jan 23, 2020, were retrospectively enrolled. The cohort included 42 (52%) men and 39 (48%) women, and the mean age was 49·5 years (SD 11·0). The mean number of involved lung segments was 10·5 (SD 6·4) overall, 2·8 (3·3) in group 1, 11·1 (5·4) in group 2, 13·0 (5·7) in group 3, and 12·1 (5·9) in group 4. The predominant pattern of abnormality observed was bilateral (64 [79%] patients), peripheral (44 [54%]), ill-defined (66 [81%]), and ground-glass opacification (53 [65%]), mainly involving the right lower lobes (225 [27%] of 849 affected segments). In group 1 (n=15), the predominant pattern was unilateral (nine [60%]) and multifocal (eight [53%]) ground-glass opacities (14 [93%]). Lesions quickly evolved to bilateral (19 [90%]), diffuse (11 [52%]) ground-glass opacity predominance (17 [81%]) in group 2 (n=21). Thereafter, the prevalence of ground-glass opacities continued to decrease (17 [57%] of 30 patients in group 3, and five [33%] of 15 in group 4), and consolidation and mixed patterns became more frequent (12 [40%] in group 3, eight [53%] in group 4). Interpretation COVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1–3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia. Funding None.
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              SARS-CoV-2 Infection in Children

              To the Editor: As of March 10, 2020, the 2019 novel coronavirus (SARS-CoV-2) has been responsible for more than 110,000 infections and 4000 deaths worldwide, but data regarding the epidemiologic characteristics and clinical features of infected children are limited. 1-3 A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age. 2 In order to determine the spectrum of disease in children, we evaluated children infected with SARS-CoV-2 and treated at the Wuhan Children’s Hospital, the only center assigned by the central government for treating infected children under 16 years of age in Wuhan. Both symptomatic and asymptomatic children with known contact with persons having confirmed or suspected SARS-CoV-2 infection were evaluated. Nasopharyngeal or throat swabs were obtained for detection of SARS-CoV-2 RNA by established methods. 4 The clinical outcomes were monitored up to March 8, 2020. Of the 1391 children assessed and tested from January 28 through February 26, 2020, a total of 171 (12.3%) were confirmed to have SARS-CoV-2 infection. Demographic data and clinical features are summarized in Table 1. (Details of the laboratory and radiologic findings are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.) The median age of the infected children was 6.7 years. Fever was present in 41.5% of the children at any time during the illness. Other common signs and symptoms included cough and pharyngeal erythema. A total of 27 patients (15.8%) did not have any symptoms of infection or radiologic features of pneumonia. A total of 12 patients had radiologic features of pneumonia but did not have any symptoms of infection. During the course of hospitalization, 3 patients required intensive care support and invasive mechanical ventilation; all had coexisting conditions (hydronephrosis, leukemia [for which the patient was receiving maintenance chemotherapy], and intussusception). Lymphopenia (lymphocyte count, <1.2×109 per liter) was present in 6 patients (3.5%). The most common radiologic finding was bilateral ground-glass opacity (32.7%). As of March 8, 2020, there was one death. A 10-month-old child with intussusception had multiorgan failure and died 4 weeks after admission. A total of 21 patients were in stable condition in the general wards, and 149 have been discharged from the hospital. This report describes a spectrum of illness from SARS-CoV-2 infection in children. In contrast with infected adults, most infected children appear to have a milder clinical course. Asymptomatic infections were not uncommon. 2 Determination of the transmission potential of these asymptomatic patients is important for guiding the development of measures to control the ongoing pandemic.

                Author and article information

                Kompass Neumología
                S. Karger GmbH (Wilhelmstrasse 20A, P.O. Box · Postfach · Case postale, D–79095, Freiburg, Germany · Deutschland · Allemagne, Phone: +49 761 45 20 70, Fax: +49 761 4 52 07 14, information@karger.de )
                9 March 2021
                : 1-7
                [1 ] aDepartamento de Pediatría y Salud Infantil, Universidad de Ciudad del Cabo, Ciudad del Cabo, Sudáfrica
                [2 ] bConsejo de Investigación Médica (MRC), Unidad de Salud Infantil y Adolescente, Universidad de Ciudad del Cabo, Ciudad del Cabo, Sudáfrica
                [3 ] cEscuela de Salud Pública y Medicina Familiar, Universidad de Ciudad del Cabo, Ciudad del Cabo, Sudáfrica
                Author notes
                *Diane M. Gray, Departamento de Pediatría y Salud Infantil, Universidad de Ciudad del Cabo, Ciudad del Cabo, Sudáfrica, diane.gray@ 123456uct.ac.za
                Copyright © 2021 by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 1, References: 65, Pages: 7
                Articulo De Revisión

                covid-19,sars-cov-2,pediatría,enfermedad pulmonar,enfermedad pulmonar crónica en la infancia,países con ingresos bajos o medios,tuberculosis pediátrica


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