RESUMO
OBJECTIVE: Pediatric cardiac tumors are rare and, among them, 90% are benign. Cardiac fibroma is the second most frequent tumor, after rhabdomyoma. The objective of this study is to report a case of cardiac fibroma diagnosed incidentally in a patient admitted with acute viral bronchiolitis. CASE DESCRIPTION: A 5-month-old male infant was admitted to the pediatric emergency department with acute viral bronchiolitis requiring hospitalization. He presented a detectable respiratory syncytial virus in oropharyngeal swab, blood test with lymphocytosis and a chest radiography revealed cardiomegaly. Further cardiologic testing was performed detecting elevation of cardiac biomarkers, an electrocardiogram with alteration of left ventricular repolarization and echocardiogram with a heterogeneous mass in the left ventricular, with areas of calcification. A chest angiotomography suggested rhabdomyosarcoma or cardiac fibroma and a magnetic resonance showed a mass, with characteristics suggesting fibroma. The final diagnosis was made after two cardiac catheterizations for biopsy of the lesion, confirming cardiac fibroma by anatomopathological examination. Because the patient had moderate to severe systolic dysfunction, he was submitted to heart transplant. COMMENTS: One third of cardiac fibromas are asymptomatic, generally diagnosed late through tests ordered for other reasons. The gold-standard test for definitive diagnosis is biopsy. Cardiac fibroma usually does not present spontaneous regression and, in most cases, partial or total surgical resection is necessary. When tumors are unresectable, heart transplantation should be indicated. It is essential to have detailed characterization of the cardiac mass to establish the most appropriate therapeutic approach for each patient.
Assuntos
Bronquiolite Viral , Fibroma , Neoplasias Cardíacas , Achados Incidentais , Humanos , Masculino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/complicações , Fibroma/diagnóstico , Fibroma/complicações , Lactente , Bronquiolite Viral/diagnóstico , Doença AgudaRESUMO
OBJECTIVES: To identify factors independently associated with respiratory syncytial virus (RSV) detection in infants admitted for viral bronchiolitis during 3 consecutive years, before and during the COVID-19 pandemic, in Bogota, Colombia, a middle-income country with a subtropical highland climate. METHODS: An analytical cross-sectional study was conducted before and during the COVID-19 pandemic, including patients with a diagnosis of viral bronchiolitis admitted to all the hospitals of the city between January 2019 and November 2021. We evaluated a set of a priori-selected predictor variables that included individual, healthcare system, meteorological, air pollutant, and COVID-19 variables. Since the variables analyzed are hierarchical in nature, multilevel modeling was used to identify factors independently associated with detection of RSV as the causative agent of viral bronchiolitis. RESULTS: A total of 13,177 patients were included in the study. After controlling for potential confounders, it was found that age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.76-0.97), a third level of medical care institution (OR 3.05; 95% CI 1.61-5.76), temperature (OR 1.60; 95% CI 1.24-2.07), rainfall (OR 1.003, 95% CI 1.001, 1.005), NO2 (OR 0.97; 95% CI 0.95-0.99), CO (OR 0.99; 95% CI 0.99-0.99), and COVID-19 pandemic period (OR 0.84, 95% CI 0.71-0.99) were independently associated with RSV detection in our sample of patients. CONCLUSIONS: The identified factors associated with RSV detection provide additional scientific evidence that may be useful in the development of specific interventions aimed at ameliorating or preventing the impact of RSV in Bogota and probably other similar low- to middle-income countries in high-risk infants.
Assuntos
Bronquiolite Viral , Bronquiolite , COVID-19 , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Lactente , Humanos , Bronquiolite Viral/diagnóstico , Bronquiolite Viral/epidemiologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/epidemiologia , Análise Multinível , Estudos Transversais , Pandemias , COVID-19/epidemiologia , Bronquiolite/epidemiologiaAssuntos
Bronquiolite Viral , Bronquiolite , Bronquiolite/diagnóstico , Bronquiolite Viral/diagnóstico , Criança , Pré-Escolar , Humanos , LactenteRESUMO
Although there is increasing evidence showing that infants with viral bronchiolitis exhibit a high degree of heterogeneity, a core uncertainty shared by many clinicians is with regard to understanding which patients are most likely to benefit from bronchodilators such as albuterol. Based on our review, we concluded that older infants with rhinovirus (RV) bronchiolitis, especially those with a nasopharyngeal microbiome dominated by Haemophilus influenzae; those affected during nonpeak months or during non-respiratory syncytial virus (RSV) predominant months; those with wheezing at presentation; those with clinical characteristics such as atopic dermatitis or a family history of asthma in a first-degree relative; and those infants infected with RSV genotypes ON1 and BA, have the greatest likelihood of benefiting from albuterol. Presently, this patient profile could serve as the basis for rational albuterol administration in patients with viral bronchiolitis, at least on a therapeutic trial basis, and it could also be the starting point for future targeted randomized clinical trials (RCTs) on the use of albuterol among a subset of infants with bronchiolitis.
Assuntos
Albuterol/uso terapêutico , Bronquiolite Viral/tratamento farmacológico , Broncodilatadores/uso terapêutico , Bronquiolite Viral/diagnóstico , Bronquiolite Viral/virologia , Humanos , Lactente , Nasofaringe/microbiologia , Fenótipo , Vírus Sincicial Respiratório Humano/genética , Vírus Sincicial Respiratório Humano/patogenicidade , Rhinovirus/patogenicidade , Estações do AnoRESUMO
INTRODUCTION AND OBJECTIVES: Despite the recommendation against routine use of inhaled bronchodilators in infants with viral bronchiolitis given in the main clinical practice guidelines (CPGs) on viral bronchiolitis, albuterol is widely prescribed to patients with this disease. The aim of this study was to identify predictors of prescription of albuterol in a population of infants hospitalized for viral bronchiolitis. MATERIAL AND METHODS: An analytical cross-sectional study performed during the period from March 2014 to August 2015, in a random sample of patients <2 years old hospitalized in the Fundacion Hospital La Misericordia, a hospital located in Bogota, Colombia. After reviewing the electronic medical records, we collected demographic, clinical, and disease-related information, including prescription of albuterol at any time during the course of hospitalization as the outcome variable. RESULTS: For a total of 1365 study participants, 1042 (76.3%) were prescribed with albuterol therapy. After controlling for potential confounders, it was found that age (OR 1.11; CI 95% 1.08-1.15; p<0.001), and a prolonged length of stay (LOS) (OR 1.93; CI 95% 1.44-2.60; p<0.001) were independent predictors of prescription of albuterol in our sample of patients. By contrast, albuterol prescription was less likely in the post-guideline assessment period (OR 0.41; CI 95% 0.31-0.54; p<0.001), and in infants with RSV isolation (OR 0.71; CI 95% 0.52-0.97; p=0.035). CONCLUSIONS: Albuterol was highly prescribed in our population of inpatients with the disease. The independent predictors of prescription of albuterol in our sample of patients were age, implementation of a CPG on viral bronchiolitis, RSV isolation, and LOS.
Assuntos
Albuterol/administração & dosagem , Bronquiolite Viral/tratamento farmacológico , Broncodilatadores/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Administração por Inalação , Fatores Etários , Albuterol/normas , Bronquiolite Viral/diagnóstico , Bronquiolite Viral/imunologia , Bronquiolite Viral/virologia , Broncodilatadores/normas , Colômbia , Estudos Transversais , Prescrições de Medicamentos/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Vírus Sinciciais Respiratórios/isolamento & purificação , Medição de Risco/estatística & dados numéricos , Fatores de RiscoRESUMO
RATIONALE, AIMS AND OBJECTIVES: Recently, in an attempt to reduce variability in clinical practice and produce better results for patients, several clinical practice guidelines (CPGs) for the appropriate diagnosis and management of bronchiolitis in infants have been developed. However, the quality of available CPGs for bronchiolitis management has not yet been systematically evaluated. The aim of this study was to assess the quality of acute viral bronchiolitis CPGs. METHOD: We performed a systematic and exhaustive search of CPGs on bronchiolitis published from 2000 to 2014. Three independent appraisers assessed the quality of the CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. A standardized score was calculated for each of the six domains, and the CPGS were rated as recommended, recommended with modifications, or not recommended. RESULTS: Six CPGs published between the years 2000 and 2014 were selected from a total of 111 citations. There was substantial agreement among reviewers (ICC: 0.75; 95% CI, 0.61-0.89). The domains that scored the highest were 'scope and purpose', with a mean value of 92.1% (range: 77.8-100%), and 'clarity of presentation' [83.3% (69.4-91.7%)]. Those that scored the lowest were 'applicability' [44.3% (8.3-77.1%)], and 'stakeholder involvement' [66.7% (47.2-94.4%)]. Three CPGS were evaluated as being recommended with modifications, and only two were recommended for use in clinical practice. CONCLUSIONS: Available bronchiolitis CPGs vary in quality, and the findings of the present study are useful for identifying aspects or domains where there is room for improvement in future CPGs.
Assuntos
Bronquiolite Viral/diagnóstico , Bronquiolite Viral/terapia , Guias de Prática Clínica como Assunto/normas , Doença Aguda , Humanos , Qualidade da Assistência à Saúde/normasRESUMO
Viral bronchiolitis is a major worldwide cause of morbidity and mortality in children under two years old. Evidence-based management guidelines suggest that there is no effective treatment for bronchiolitis and that supportive care - hydration and oxygenation - remains the cornerstone of clinical management. In this review we describe the current guidelines of treatment with emphasis in the limitation of unnecessary testing and intervention. Also, we discuss the future directions in the research of new therapies for bronchiolitis.
La bronquiolitis viral es una causa importante de morbilidad y mortalidad en niños de menos de dos años de edad en todo el mundo. Las guías clínicas basadas en la evidencia sugieren que no existe un tratamiento efectivo para la bronquiolitis y que la hidratación y una adecuada oxigenación, siguen siendo la base del manejo clínico. En esta revisión, se describen las actuales guías de tratamiento haciendo énfasis en limitar los exámenes e intervenciones innecesarias. También discutimos la investigación en nuevas terapias para la bronquiolitis.
Assuntos
Humanos , Criança , Bronquiolite Viral/terapia , Doença Aguda , Broncodilatadores/uso terapêutico , Bronquiolite Viral/diagnóstico , Bronquiolite Viral/etiologia , Bronquiolite Viral/fisiopatologia , Epinefrina/uso terapêutico , Guias como Assunto , Oxigenoterapia , Guias de Prática Clínica como Assunto , Vírus Sinciciais RespiratóriosRESUMO
Children with bronchiolitis often are considered a homogeneous group. However, in a multicenter, prospective study of 2207 young children hospitalized for bronchiolitis, we found that children with respiratory syncytial virus detected differ from those with rhinovirus detected; the latter patients resemble older children with asthma, including more frequent treatment with corticosteroids.
Assuntos
Asma/diagnóstico , Bronquiolite Viral/diagnóstico , Infecções por Picornaviridae/diagnóstico , Infecções por Vírus Respiratório Sincicial/diagnóstico , Diagnóstico Diferencial , Feminino , Hospitalização , Humanos , Lactente , Masculino , Estudos Prospectivos , Vírus Sinciciais Respiratórios , RhinovirusRESUMO
OBJECTIVES: To evaluate surfactant content and function through the lamellar body count (LBC) and stable microbubble test (SMT) in mechanically ventilated infants with severe acute viral bronchiolitis. STUDY DESIGN: Controlled cross-sectional study of 32 infants receiving mechanical ventilation: 16 with a diagnosis of acute viral bronchiolitis and 16 with normal lungs. Tracheal fluid was collected and LBC was performed in an automated cell counter. Samples were kept frozen and thawed for testing. At the time of analysis, samples were diluted in a dithiothreitol solution, vortexed for 10 seconds, and aspirated by the cell counter. SMT was performed using the Pattle technique. RESULTS: In the bronchiolitis group, the median (IQR) LBC was significantly lower than in the control group: 130,000 (61,250-362,250) vs. 518,000 (180,250-896,000) lamellar bodies/µL; P = .003. Median (IQR) SMT values were also significantly lower in the bronchiolitis group: 10 (2-13) vs. 400 (261-615) microbubbles/mm2; P < .001. CONCLUSIONS: Infants with acute viral bronchiolitis have reduced surfactant content and function. We speculate that these simple tests may be useful to identify infants with bronchiolitis who would benefit from surfactant replacement therapy.
Assuntos
Bronquiolite Viral/diagnóstico , Bronquiolite Viral/terapia , Deficiências Nutricionais/diagnóstico , Surfactantes Pulmonares/análise , Tensoativos/uso terapêutico , Doença Aguda , Líquido da Lavagem Broncoalveolar/química , Estudos de Casos e Controles , Terapia Combinada , Cuidados Críticos/métodos , Estudos Transversais , Deficiências Nutricionais/terapia , Feminino , Seguimentos , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Microbolhas , Valores de Referência , Respiração Artificial/métodos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Bronchiolitis is a common childhood disease and is the leading cause of hospitalization in children under 2 years, lower respiratory tract infection. It is characterized by upper respiratory symptoms which lead to lower respiratory symptoms for primary infection or reinfection with a viral pathogen, more identified is the respiratory syncytial virus. Despite the frequency and importance of this disease, there is still much controversy regarding the most appropriate treatment protocol. Its definition and treatment remain the subject of ongoing debate and the subject of study, seeking to reach a global consensus on the appropriate approach to this entity, so this article is a practical approach to bronchiolitis, based on the available scientific evidence to epidemiology, clinical manifestations, diagnosis, treatment and prevention of bronchiolitis. The implementation of a treatment algorithm is feasible and can help reduce operating errors and the rate of inadequate prescription of steroids and antibiotics in children with bronchiolitis.
La bronquiolitis, es una enfermedad frecuente en la infancia y constituye la principal causa de ingreso hospitalario en los menores de 2 años, por infección del tracto respiratorio inferior (ITRI). Se caracteriza por síntomas respiratorios superiores que conducen a síntomas respiratorios inferiores por la infección primaria o la reinfección con un patógeno viral, el más identificado es el virus respiratorio sincicial (VRS). A pesar de la frecuencia e importancia de esta enfermedad, aún existen grandes controversias en cuanto al protocolo terapéutico más adecuado. Su definición y tratamiento siguen siendo tema de constantes debates y motivo de estudio, buscando llegar a un consenso mundial sobre el adecuado abordaje de esta entidad, por lo que este artículo es un enfoque práctico de la bronquiolitis, basado en la evidencia científica disponible en cuanto a la epidemiología, manifestaciones clínicas, diagnóstico, tratamiento y prevención de la bronquiolitis. La implementación de un algoritmo terapéutico es factible y puede ayudar a reducir los errores de manejo y la tasa de prescripción de esteroides y antibióticos, inadecuados en niños con bronquiolitis.