Jhon Camacho-Cruz

Introduction: Complicated pediatric appendicitis carries substantial morbidity, including intra-abdominal abscess formation, surgical reintervention, and prolonged hospitalization. Empirical antibiotic therapy is a core component of management, yet when compared with disease severity its relative contribution to outcomes is poorly characterized in institutional practice settings. Methods: This retrospective before-after observational study was conducted at a tertiary hospital in Bogotá, Colombia. Pediatric patients with complicated appendicitis were compared across two sequential first-line empirical antibiotic protocol periods: amikacin plus metronidazole (period 1) changed to ampicillin-sulbactam (period 2). A multivariable logistic regression model was used to identify factors associated with intra-abdominal abscess formation. Results: A total of 220 patients were included (period 1, n =117; period 2, n =103). Despite differences in disease severity between periods, management during period 2 was not associated with intra-abdominal abscess formation (OR=0.72; 95% CI 0.34 to 1.51; p =0.384) or with individual secondary outcomes. Generalized peritonitis was the dominant predictor of abscess formation (OR=3.13; 95% CI 1.48 to 6.62; p =0.003). Conclusions: No differences in postoperative outcomes were observed between institutional antibiotic protocol periods. Disease severity, particularly generalized peritonitis, was the main factor associated with intra-abdominal abscess formation. These findings support prioritizing early severity assessment and source control over modifications in empirical antibiotic selection.

Background: Knowledge regarding the actual frequency of potential drug-drug interactions (DDIs) in pediatric settings remains limited. The aim of this study was to characterize the prevalence and profile of potential DDIs in pediatric patients at two high-complexity hospitals. Methods: A descriptive cross-sectional study was conducted among 470 pediatric patients hospitalized between July and December 2022. Data were extracted from prescription databases, and the theoretical severity of interactions was assessed using Drugs.com® and DrugBank®. Results: The study revealed an overall prevalence of potential DDIs of 57.4% (95% CI, 52.9–61.8%). Regarding clinical relevance, 2.7% were classified as major, 27.6% as moderate, and 42.5% as minor. The therapeutic classes most frequently involved in interactions were analgesics, systemic corticosteroids, and antimicrobials. Conclusions: A high prevalence of potential DDIs was identified, primarily associated with the simultaneous use of multiple medications. These findings underscore the critical need to strengthen systematic treatment reviews and implement clinical decision-support tools for prescribing in hospital practice.

Background: Eosinophilic esophagitis (EoE) is an immune-mediated disease characterised by oesophageal eosinophilic infiltration, leading to chronic inflammation and tissue remodelling. Objectives: To describe the clinical, epidemiological and endoscopic characteristics of children with EoE in Colombia, and explore associations between symptoms, allergen sensitisation and endoscopic findings. Methods: Observational, multicentre retrospective study with an analytical component, conducted on paediatric patients diagnosed with EoE across 10 tertiary referral centres in Colombia between 2015 and 2023. All cases had histological confirmation with ≥15 eosinophils per high-power field. Data were extracted from standardised medical records by trained investigators. Results: A total of 143 cases were included, with a male predominance (66.4%) and median age at diagnosis of 92 months (IQR 56–144). Relevant early exposures included prematurity (11.2%), low birth weight (10.5%), caesarean delivery (50.3%), infant formula use (62.2%) and antibiotics in infancy (27.9%). Family history of atopy was present in 54.6%, and EoE in 4.9%. Food specific IgE was present, particularly to cow’s milk (56.6%) and egg (38.1%). Most frequent symptoms included abdominal pain (67.1%), nausea (60.1%) and vomiting (46.2%). Endoscopic findings included longitudinal furrows (70.9%) and white exudates (67.4%). Statistically significant associations were found between dysphagia and oesophageal rings (p=0.003), vomiting and white exudates (p=0.018), abdominal pain and longitudinal furrows (p=0.025) and regurgitation and oedema (p=0.031). Conclusions: Paediatric EoE in Colombia shows symptom and endoscopic heterogeneity. Identifying potential allergen triggers may contribute to understanding symptoms and endoscopic patterns in EoE.

BACKGROUND Pulmonary abscess is an uncommon complication of pneumonia in pediatric patients. Diagnosis is challenging because early manifestations frequently overlap with those of community-acquired pneumonia. Despite advances in imaging modalities and antimicrobial therapy, pediatric pulmonary abscess remains clinically relevant due to its variable presentation and the difficulty of early identification. This report of pediatric pulmonary abscess highlights clinical features and diagnostic tools that may inform clinical management. CASE REPORT We describe 2 pediatric patients with pulmonary abscess complicating pneumonia. The first was a 4-year-old girl with community-acquired pneumonia who developed a cavitary lesion in the left lower lobe accompanied by empyema, persistent fever, and progressive respiratory compromise despite initial therapy. The second was a 17-month-old boy with right multilobar pneumonia that was complicated by a large right upper lobe abscess and pleural effusion after prolonged febrile illness and multiple evaluations at other hospitals before referral to our institution. In both patients, limited conventional microbiological testing failed to identify a bacterial pathogen, underscoring the diagnostic challenges. Both patients were exclusively treated with intravenous antibiotics followed by oral therapy; surgical and interventional drainage were omitted. Outpatient follow-up at 2 to 6 months confirmed complete clinical recovery and full radiological resolution. CONCLUSIONS These cases emphasize the importance of considering pulmonary abscess as a complication of persistent or worsening pneumonia in children. Early recognition, appropriate imaging, and timely antimicrobial therapy adjustment are essential to prevent complications and support recovery. Individualized follow-up incorporating clinical and radiological assessment ensures complete resolution and appropriate therapeutic response monitoring.

Technological devices with screens-such as computers, smartphones, tablets, video game consoles, and televisions-have become essential in daily life, especially among the pediatric population. This widespread use has significant effects on their physical and mental health, prompting the development of guidelines for appropriate screen use based on age group. In this context, we conducted a narrative review to assess the impact of screen devices on this population, exploring how specific genes and their polymorphisms may act as risk factors for these effects. A systematic literature search was performed to evaluate the clinical and genetic impact of screen exposure, focusing on outcomes such as obesity and overweight, sedentary behavior, depression and anxiety, myopia, behavioral disorders, and sleep and memory disturbances. The findings indicate that screen exposure exceeding 2 hours per day is associated with these outcomes, with the strongest evidence supporting links to obesity and sedentary behavior. Additionally, polymorphisms in genes such as FTO, CACNA1D, and DRD2 were found to influence these outcomes. Overall, the evidence suggests that excessive screen use during childhood is associated with numerous adverse physical and mental health conditions. There is a significant relationship between screen time and increased risk of overweight and obesity, as well as sleep disturbances due to reduced resting hours. Strategies are urgently needed to mitigate these impacts in the pediatric population.

Introducción: La hiperbilirrubinemia neonatal es un problema de salud importante, una causa común de morbilidad. Mundialmente, afecta hasta el 60% de recién nacidos. Su diagnóstico es clínico y se confirma por medio de la toma de bilirrubinas séricas, que se asocia con ciertas desventajas, especialmente molestias relacionadas con la demora en los resultados. Objetivo: Evaluar la relación entre la satisfacción de los cuidadores y los tiempos asociados al ciclo de atención para el diagnóstico de ictericia neonatal. Materiales y métodos: Estudio observacional transversal, se incluyeron neonatos con evidencia clínica de ictericia. Se recolectaron datos demográficos, se aplicó una encuesta de satisfacción para evaluar el nivel de satisfacción de cuidadores, se registraron los tiempos asociados al ciclo de atención desde el momento de ingreso hasta la toma de la conducta médica. Resultados: Se realizó un análisis del flujo de pacientes y se encontró que el tiempo de espera es significativo, especialmente en la obtención de resultados de laboratorio. La satisfacción de los cuidadores con respecto a los tiempos de espera influye en su percepción general de la calidad del servicio. Conclusión: La implementación potencial de nuevos instrumentos diagnósticos podría generar un valor agregado al servicio, acelerando la toma de decisiones médicas.

Introducción: Staphylococcus aureus es un agente causal común de infecciones de piel y tejidos blandos en la población pediátrica. Sin embargo, puede provocar enfermedades invasivas como infecciones osteoarticulares, neumonía y bacteriemia. Este caso clínico describe la progresión de una infección cutánea superficial en un adolescente que evolucionó a una afección invasiva grave. Presentación del caso: paciente de 16 años, previamente sano, quien presentó una lesión cutánea en la región cervical. En cuestión de días, la infección progresó rápidamente, provocando fiebre, malestar general y síntomas sistémicos. Los hemocultivos confirmaron la presencia de S. aureus resistente a la meticilina, y los estudios de imagen revelaron émbolos pulmonares. Se inició tratamiento con antibióticos de amplio espectro, ajustados según las pruebas de sensibilidad. Se observó mejoría clínica y el paciente fue dado de alta sin complicaciones. Conclusión: este caso destaca la posibilidad de que en pacientes pediátricos con infección cutánea por S. aureus progresen a una enfermedad invasiva potencialmente mortal. Por lo que es importante su reconocimiento y el tratamiento apropiados para prevenir complicaciones graves.