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      Revisión de las recomendaciones para enfermos reumáticos frente a la COVID-19. Propuesta para los pacientes pediátricos cubanos con enfermedad reumática y sus familiares Translated title: Guidance’s for patients COVID-19 outbreak review. Proposal for Cubans pediatrics patients and families

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          Abstract

          RESUMEN Introducción: La COVID-19 o enfermedad provocada por el nuevo coronavirus SARS-CoV-2 afecta también a la población pediátrica. Ante el actual brote de la pandemia en Cuba, se han generado muchas inquietudes entre los pacientes que padecen alguna enfermedad reumática de la infancia y sus familiares. Estos niños pueden catalogarse como “de riesgo” de manera especial. Objetivos: Reflexionar sobre las recomendaciones dadas a los pacientes con enfermedad reumática ante la pandemia de COVID-19 y brindar nuevas recomendaciones adecuadas a nuestro contexto social a los pacientes pediátricos cubanos con enfermedad reumática. Métodos: Revisión documental. Se emplearon motores de búsqueda (Google académico y SciELO-Scientific Electronic Library Online), y se analizaron evidencias científicas, preprints y revisiones narrativas. Se realizaron recomendaciones basadas en estas. Conclusiones: Las recomendaciones ofrecidas, a partir de la revisión realizada, se han adaptado al contexto social del paciente pediátrico cubano con enfermedad reumática. También se ha hecho referencia a las medidas tomadas por nuestro gobierno y los diferentes ministerios, así como a sitios oficiales de información, y que tienen validez para los ciudadanos cubanos. Se insiste en que cualquier manejo, medida o sugerencia ante la COVID-19 se debe personalizar a cada paciente y grupo de pacientes en cuestión, por región, país y provincia, de acuerdo con el entorno propio y la enfermedad de base.

          Translated abstract

          ABSTRACT Introduction: The COVID-19 or disease caused by the new SARS-CoV-2 coronavirus, in its transmission does not distinguish age, and the pediatric population may also be affected. Given the current outbreak of the pandemic in our country, there have been several concerns that have been generated among patients and their families who suffer from a childhood rheumatic disease and that can be classified as “at risk” in a special way. Objectives: To reflect on the recommendations given to patients with rheumatism due to the SARS-Cov-2 coronavirus pandemic and to offer our own recommendations to Cuban pediatric patients with rheumatic disease already appropriate to our social context. Methods: Documentary review. Search engines (Google academic and SciELO-Scientific Electronic Library Online) were used, and scientific evidence, preprints and narrative reviews were analyzed, recommendations based on them were made. Conclusions: The recommendations given by the authors based on the review carried out have been adapted to the social context of the Cuban pediatric patient with rheumatic disease. Thus, reference has also been made to measures taken by our government and the different ministries, to official information sites, which are understood and have validity for Cuban citizens. Any handling, measure or suggestion before the COVID-19 must be personalized to each patient and group of patients in question, by region, country, province, according to their own environment.

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          Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China

          To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China.
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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.
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              Causes and predictors of mortality in biopsy-proven lupus nephritis: the Sarawak experience

              Abstract Background Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus that can be fatal if left untreated. The causes and prognostic predictors of mortality in LN have been well studied in developed countries but evidence is lacking for developing countries. The objective of this study was to investigate the causes and predictors of mortality in a cohort of Malaysian patients with biopsy-proven LN. Methods We retrospectively studied all patients with biopsy-proven LN treated in Sarawak General Hospital during the period of 2000–15. Demographic data, clinical features and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of mortality. Results There was a total of 250 patients with 259 renal biopsies available for our analysis. Our patients were of multi-ethnic origins with a female predominance (90%). Their mean ± standard deviation age was 37.7 ± 12.8 years. The patients had a mean disease duration of 135.6 ± 81.9 months. Nephrotic syndrome was the most common presentation (29.6%) and acute renal failure was evident at initial presentation in 16% of patients. Class IV LN was the predominant biopsy class within the cohort (66.8%). The majority of patients achieved remission (81.2%) and had normal renal function (83.9%) at the last follow-up. The 5-, 10-, 15- and 20-year survival rates for our cohort were 93%, 88%, 82% and 77%, respectively. There were 37 deaths (14.8%), of which the main causes were: infection and flare (52.7%), infection alone (25.0%) and other causes (22.3%). Independent predictors of mortality in our cohort of LN patients were: the presence of acute kidney injury at presentation [hazard ratio (HR) 3.41; confidence interval (CI) 1.50–7.76], failure to achieve remission at 1-year post-induction therapy (HR 2.99; CI 1.35–6.65) and non-compliance with treatment (HR 1.89; CI 1.22–2.96). Age, ethnicity, class of LN and type of immunosuppressant used were not predictive of mortality. Conclusions Survival and renal outcomes in our LN cohort were comparable to most LN studies reported worldwide. Both flare and infection remained the main causes of death. The presence of acute renal failure at presentation, failure to achieve remission at 1 year post-treatment and non-compliance with treatment were independent prognostic predictors of mortality in LN.
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                Author and article information

                Journal
                rcur
                Revista Cubana de Reumatología
                Rev Cuba Reumatol
                Editorial CIMEQ (La Habana, , Cuba )
                1817-5996
                August 2020
                : 22
                : 2
                : e831
                Affiliations
                [1] La Habana La Habana orgnameUniversidad de Ciencias Médicas de La Habana orgdiv1Servicio de Reumatología Pediátrica orgdiv2Hospital Pediátrico Docente Juan Manuel Márquez Cuba
                Article
                S1817-59962020000200011 S1817-5996(20)02200200011
                94cf1976-16fe-40f5-bbad-6d3d2177551f

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 24 April 2020
                : 12 May 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 0
                Product

                SciELO Cuba

                Categories
                Artículo de opinión

                enfermedad reumática,COVID-19,rheumatic disease,children with rheumatic diseases,rheumatic disease in young people,pediatrics rheumatic diseases,enfermedad reumática de la infancia,pacientes pediátricos

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