Repositorio UFT :: Examinando por Autor "Díaz, Franco"

Examinando por Autor "Díaz, Franco"

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Análisis de la epidemia estacional por virus respiratorios y virus respiratorio sincicial (VRS) del año 2023 comparado con cohorte prepandemia (2015-2019) en Chile
(Sociedad Chilena de Pediatría, 2025) Díaz, Franco; Carvajal, Cristóbal
Durante la pandemia de COVID-19, las infecciones respiratorias pediátricas disminuyeron drásticamente a nivel mundial. Sin embargo, en el otoño-invierno de 2023, estas enfermedades resurgieron de manera inusual, causando estrés en el sistema de salud. Comparando los datos del 2023 con los del quinquenio prepandemia del Departamento de Estadísticas e Información de Salud (DEIS) de Chile, observamos que la magnitud y frecuencia de las enfermedades respiratorias pediátricas fueron similares. No obstante, el estrés en el sistema de salud se debió al inicio temprano de la demanda, la sincronicidad de grupos etarios, la heterogeneidad geográfica y la capacidad de respuesta global y local. En la Región Metropolitana (RM), los casos no aumentaron en número, pero se presentaron 4 semanas antes. En las regiones central, centro-sur y sur, los casos aparecieron más temprano y durante un periodo más corto, resultando en un pico de hasta 4 veces más en hospitalizaciones y consultas de urgencia. La eficacia de las políticas públicas, como los cambios en programas educacionales y la inmunización contra el virus respiratorio sincicial (VRS), requiere un análisis objetivo y multisectorial. Es necesario ajustar las políticas para evitar la sobrerrepresentación de la RM y fomentar la colaboración público-privada para perfeccionar la información de la carga del VRS, y así mejorar los estándares de atención, tratamientos y su disponibilidad a lo largo de Chile.
Aprendizajes sobre la vulneración a la infancia durante la pandemia COVID-19: enfermedad, evidencia y políticas públicas
(Sociedad Chilena de Pediatría, 2024-11-01) Díaz, Franco
La pandemia de COVID-19 ha tenido repercusiones significativas en niños, niñas y adolescentes (NNA), tanto por los efectos directos del virus como por las medidas de salud pública aplicadas. Presentamos un análisis de los aciertos y errores en la respuesta gerontocéntrica a la pandemia, que invisibilizó a los NNA del panorama global, de su salud y ciclo vital. Contraponiéndose con la discreta incidencia de COVID-19 pediátrico, múltiples guías se desarrollaron precipitadamente para terapia, afectando el enfrentamiento de otras enfermedades, por ejemplo, el soporte respiratorio no-invasivo y terapia inhalada. Las medidas de confinamiento y cierre de colegios tuvieron un impacto mínimo en la propagación del virus, desmitificando el rol de supercontagiantes, pero su mantención prolongada se basó en decisiones no respaldadas por evidencia, resultando en una importante pérdida educativa y trastornos psicosociales. La crisis de salud mental en NNA se ha agudizado, con un aumento rápido de depresión y trastornos alimentarios, especialmente en grupos socioeconómicamente vulnerables. Otros ámbitos de salud fueron alterados, como la interrupción de servicios sanitarios preventivos, chequeos rutinarios y vacunaciones, diagnósticos de enfermedades como cáncer y terapias de rehabi-litación. Además, se analiza críticamente la narrativa de los mandatos de uso de mascarillas y vacunas en NNA. En conclusión, reflexionamos sobre los aciertos y errores durante la pandemia en puntos críticos de la salud de NNA, con el fin de aprender y optimizar nuestra respuesta a situaciones futuras. Es imperativo adoptar medidas urgentes para identificar y mejorar en estas áreas, cuyos catastróficos efectos recién comenzamos a entender en NNA, y futuros adultos.
Capnometry after an inspiratory breath hold, PLATCO2, as a surrogate for PaCO2 in mild to moderate Pediatric Acute Respiratory Distress Syndrome: A feasibility study
(Wiley Periodicals, 2023-07-10) Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Améstica, Marjorie; Araneda, Patricio; Ramirez, Yennys; Vásquez-Hoyos, Pablo; Díaz, Franco
Objective: Accurate and reliable noninvasive methods to estimate gas exchange are necessary to guide clinical decisions to avoid frequent blood samples in children with pediatric acute respiratory distress syndrome (PARDS). We aimed to investigate the correlation and agreement between end‐tidal PCO2 measured immediately after a 3‐s inspiratory‐hold (PLATCO2) by capnometry and PaCO2 measured by arterial blood gases (ABG) in PARDS. Measurements and Main Results: All patients were in volume‐controlled ventilation mode. The regular end‐tidal P P CO ETCO ( ) 2 2 (without the inspiratory hold) was registered immediately after the ABG sample. An inspiratory‐hold of 3 s was performed for lung mechanics measurements, recording PETCO2 in the breath following the inspiratory‐hold. (PLATCO2). End‐tidal alveolar dead space fraction (AVDSf) was calculated as [( – )/ PP P aCO ETCO aCO ] 2 2 2 and its surrogate (S)AVDSf as [( CO – )/ CO PLAT 2 ETCO PLAT 2 P ] 2 . Measurements of PaCO2 were considered the gold standard. We performed concordance correlation coefficient (ρc), Spearman's correlation (rho), and Bland–Altmann's analysis (mean difference ± SD [limits of agreement, LoA]). Eleven patients were included, with a median (interquartile range) age of 5 (2–11) months. Tidal volume was 5.8 (5.7–6.3) mL/kg, PEEP 8 (6–8), driving pressure 10 (8–11), and plateau pressure 17 (17–19) cm H2O. Forty‐one paired measurements were analyzed. PaCO2 was higher than PETCO2 (52 mmHg [48–54] vs. 42 mmHg [38–45], p < 0.01), and there were no significant differences with PLATCO2 (50 mmHg [46–55], p > 0.99). The concordance correlation coefficient and Spearman's correlation between PaCO2 and PLATCO2 were robust (ρc = 0.80 [95% confidence interval [CI]: 0.67–0.90]; and rho = 0.80, p < 0.001.), and for PETCO2 were weak and strong (ρc = 0.27 [95% CI: 0.15–0.38]; and rho = 0.63, p < 0.01). The bias between PLATCO2 and PaCO2 was −0.4 ± 3.5 mmHg (LoA −7.2 to 6.4), and between PETCO2 and PaCO2 was −8.5 ± 4.1 mmHg (LoA −16.6 to −0.5). The correlation between AVDSf and (S)AVDSf was moderate (rho = 0.55, p < 0.01), and the mean difference was −0.5 ± 5.6% (LoA −11.5 to 10.5) Conclusion: This pilot study showed the feasibility of measuring end‐tidal CO2 after a 3‐s end‐inspiratory breath hole in pediatric patients undergoing controlled ventilation for ARDS. Encouraging preliminary results warrant further study of this technique.
Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia
(Sociedad Chilena de Pediatria, 2021) Wooldridge, Gavin; O’Brien, Nicole; Muttalib, Fiona; Abbas, Qalab; Adabie Appiah, John; Baker, Tim; Bansal, Arun; Basnet, Sangita; Campos-Miño, Santiago; Carla de Souza, Daniela; Díaz, Franco; Dramowski, Angela; Fernández-Sarmiento, Jaime; Fustiñana, Ana; González, Gustavo; Jabornisky, Roberto; Jaramillo-Bustamante, Juan Camilo; Chor Yek Kee Yek Kee; Lang, Hans-Joerg; Soares Lanziott, Vanessa; Kohn Loncarica, Guillermo; Mohsenibod, Hadi; Ode, Bunmi; Murthy, Srinivas; Amelie von Saint Andre-von Arnim; Hansmann, Andreas; González-Dambrauskas, Sebastián
The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children was released in 2020 and is intended for use in all global settings that care for children with sepsis. However, practitioners managing children with sep- sis in resource-limited settings (RLS) face several challenges and disease patterns not experienced by those in resource-rich settings. Based upon our collective experience from RLS, we aimed to reflect on the difficulties of implementing the international guidelines. We believe there is an urgent need for more evidence from RLS on feasible, efficacious approaches to the management of sepsis and septic shock that could be included in future context-specific guidelines.
Clinical and organizational framework of repurposing pediatric intensive care unit to adult critical care in a resource-limited setting: Lessons from the response of an urban general hospital to the COVID-19 pandemic
(Elsevier, 2022) Díaz, Franco; Kehr, Juan; Cores, Camila; Rubilar, Patricia; Medina, Tania; Vargas, Caroline; Cruces, Pablo
Purpose We aim to describe the action plan and clinical results of a COVID-19 unit for adult patient care in units intended for critically ill children, proposing a clinical/administrative framework. Methods We reviewed the preparedness of the PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds in a six-bed PICU allocated to adult critical care in a government-funded general hospital in Latin America. We analyzed the prospectively collected administrative/clinical data of severe COVID-19 cases admitted to PICU during the peak of the first wave of the pandemic. Results We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy, and general and respiratory equipment. The 6-bed PICU was allocated to adult care for 20 weeks, progressively increasing capacity to a 23-bed dedicated COVID-19 unit managed by the PICU team. A six-block bed organizational units were implemented, and personnel increased from 40 to 125 healthcare workers in 24 h shifts. COVID-19 incidence in personnel was 0.5/1000 workdays. One hundred thirty-six patients were admitted, median age 59 (51,65) years old, 68% were male, and 63% had P/F ≤ 100. In addition, 48% received mechanical ventilation, the median length of stay was 7 (3,17), and in-hospital mortality was 15%. Conclusions We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes. These data are valuable to plan coordinated actions of the healthcare system for future scenarios.
Comparison of Interleukin-6 plasma concentration in multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 and pediatric sepsis
(Frontiers Media S.A., 2021-11-15) Díaz, Franco; Bustos B., Raúl; Yagnam, Felipe; J. Karsies, Todd; Vásquez-Hoyos, Pablo; Jaramillo-Bustamante, Juan-Camilo; Gonzalez-Dambrauskas, Sebastián; Drago, Michelle; Cruces, Pablo
Importance: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection is thought to be driven by a post-viral dysregulated immune response, where interleukin 6 (IL-6) might have a central role. In this setting, IL-6 inhibitors are prescribed as immunomodulation in cases refractory to standard therapy. Objective: To compare plasma IL-6 concentration between critically ill children with MIS-C and sepsis. Design: A retrospective cohort study from previously collected data. Setting: Individual patient data were gathered from three different international datasets. Participants: Critically ill children between 1 month-old and 18 years old, with an IL-6 level measured within 48 h of admission to intensive care. Septic patients were diagnosed according to Surviving Sepsis Campaign definition and MIS-C cases by CDC criteria. We excluded children with immunodeficiency or immunosuppressive therapy. Exposure: None. Main Outcome(s) and Measure(s): The primary outcome was IL-6 plasma concentration in MIS-C and sepsis group at admission to the intensive care unit. We described demographics, inflammatory biomarkers, and clinical outcomes for both groups. A subgroup analysis for shock in each group was done. Results: We analyzed 66 patients with MIS-C and 44 patients with sepsis. MIS-C cases were older [96 (48, 144) vs. 20 (5, 132) months old, p < 0.01], but no differences in sex (41 vs. 43% female, p = 0.8) compared to septic group. Mechanical ventilation use was 48.5 vs. 93% (p < 0.001), vasoactive drug use 79 vs. 66% (p = 0.13), and mortality 4.6 vs. 34.1% (p < 0.01) in MIS-C group compared to sepsis. IL-6 was 156 (36, 579) ng/dl in MIS-C and 1,432 (122, 6,886) ng/dl in sepsis (p < 0.01), while no significant differences were observed in procalcitonin (PCT) and c-reactive protein (CRP). 52/66 (78.8%) patients had shock in MIS-C group, and 29/44 (65.9%) had septic shock in sepsis group. Septic shock had a significantly higher plasma IL-6 concentration than the three other sub-groups. Differences in IL-6, CRP, and PCT were not statistically different between MIS-C with and without shock. Conclusions and Relevance: IL-6 plasma concentration was elevated in critically ill MIS-C patients but at levels much lower than those of sepsis. Furthermore, IL-6 levels don’t discriminate between MIS-C cases with and without shock. These results lead us to question the role of IL-6 in the pathobiology of MIS-C, its diagnosis, clinical outcomes, and, more importantly, the off-label use of IL-6 inhibitors for these cases.
Concurrencia de encefalitis diseminada aguda en lactante con síndrome inflamatorio multisistémico asociado a infección por SARS-CoV-2
(Sociedad Chilena de Pediatría, 2021) Ampuero Acuña, Camila; Díaz, Franco; Donoso Fuentes, Alejandro
La presente comunicación permite destacar que en el curso de MIS-C puede existir una grave complicación como ADEM. Aunque en un inicio el tratamiento inmunomodulador con altas dosis de metilprednisolona y IGIV no varía de forma significativa, es de importancia una precoz intervención pues un tratamiento oportuno tiene resultados clínicos favorables, además de ser relevante el disponer de este antecedente para un adecuado seguimiento. Finalmente, en el niño con MIS-C y encefalopatía con déficit neurológico se debe considerar la eventual existencia de ADEM, entre las posibles complicaciones del sistema nervioso central.
Critical asthma in infancy and toddlers: how can we mechanically discriminate from critical bronchiolitis?
(Wiley, 2024-11-06) Cruces, Pablo; Alcántar, Valentina; Caviedes, Paola; Díaz, Franco
Asthma in infancy and toddlers has been increasingly recognized, referring to recurrent episodes of wheezing, also in mechanically ventilated children [1]. We analyzed the working pressures of the respiratory system under static conditions in a cohort of infants and toddlers with a discharge diagnosis of critical asthma. Also, we compare them with critical bronchiolitis cohort and anesthetized children without respiratory disease (normal physiology). Finally, we aimed to identify consistent thresholds in lung mechanics to discriminate between these conditions.
Diez recomendaciones clave para fortalecer los cuidados intensivos pediátricos: una revisión narrativa desde América Latina
(Sociedad y Fundación Española de Cuidados Intensivos Pediátricos, 2025-10-01) Gómez-Lund, Oscar; Donoso-Fuentes, Alejandro; López-Barón, Eliana; Ruge-Joya, Erika Johana; Díaz, Franco; Alzate-Hernández, Hulizay Paola; Morantes-Flórez, Jennifer Giseth; Jaramillo-Bustamante, Juan Camilo; Higuera-Álvarez, Lorena Alejandra; Sarmiento-Guzmán, María Piedad; Aguilar-Zamora, Nadia Sofía Alejandra; Vásquez-Hoyos, Pablo; Torres-González, Pamela; Zárate-Castañon, Patricia; Jabornisky, Roberto; Roa-Giraldo, Juan David
Esta revisión narrativa presenta diez recomendaciones clave para fortalecer la práctica de las unidades de cuidados intensivos pediátricos (UCIP) en el entorno clínico actual. Estas reflexiones surgieron de la experiencia compartida de intensivistas pediátricos latinoamericanos y se sustentan en la literatura relevante. Abordan desafíos comunes como el reconocimiento y el manejo tempranos del deterioro clínico, el equilibrio entre la reanimación con líquidos y el uso temprano de vasopresores, la detección temprana de la falla de la ventilación no invasiva (VNI) y la promoción de la nutrición enteral. Otros temas incluyen el uso racional de antibióticos, las prácticas éticas de restricción y la integración de las familias como participantes activos en la atención. La revisión también destaca la importancia de tomar decisiones oportunas sobre la extubación, un mejor uso de los recursos y el equilibrio entre el juicio clínico y las herramientas objetivas. Aunque estas recomendaciones surgieron en América Latina, consideramos que son de aplicación universal. This narrative review presents ten key recommendations aimed at strengthening pediatric intensive care unit (PICU) practice in today’s clinical environment. These reflections emerged from the shared experience of Latin American pediatric intensivists and are supported by relevant literature. They address common challenges such as early recognition and management of clinical deterioration, balancing fluid resuscitation with early vasopressor use, early detection of non-invasive ventilation (NIV) failure, and promoting enteral nutrition. Additional topics include rational antibiotic use, ethical restraint practices, and the integration of families as active participants in care. The review also highlights the value of timely extubation decisions, better resource use, and the balancing clinical judgment with objective tools. Although developed from the perspective of Latin American clinicians, we consider these recommendations to have universal applicability.
Enfermedad de Kawasaki y Síndrome Inflamatorio Multisistémico Pediátrico: ¿Cuál es la situación postpandemia?
(Sociedad Chilena de Pediatría, 2025-02-24) Díaz, Franco
Tras los primeros meses de la pandemia de COVID-19, se identificó el Síndrome Inflamatorio Multisistémico Pediátrico (MIS-C) como una entidad asociada a la infección por SARS-CoV-2. Diversos factores, junto con el cambio epidemiológico viral, han contribuido a que el MIS-C sea una condición excepcional en la actualidad. Su similitud con otras enfermedades previamente descritas en la población pediátrica ha dificultado su abordaje clínico en la era postpandemia. No obstante, dada su potencial gravedad, es fundamental incorporar sus distintos fenotipos en la aproximación diagnóstica y terapéutica de patologías y síndromes pediátricos frecuentes, con el fin de minimizar tanto el subdiagnóstico como el sobretratamiento. El fenotipo enfermedad de Kawasaki de MIS-C (f EK/MIS-C) y enfermedad de Kawasaki (EK) requieren una atención especial, dado que comparten múltiples características clínicas. Mientras que la evidencia actual sobre la EK es sólida en términos de tratamiento, gravedad y seguimiento ambulatorio, el abordaje del MIS-C se basa casi exclusivamente en recomendaciones de expertos. Es importante reconocer los elementos claves en común y distintivos de estas dos entidades, para optimizar el diagnóstico, identificar grupos de riesgo e individualizar la terapia en el periodo agudo y también en el periodo ambulatorio. No obstante, las implicancias a largo plazo aún no se han esclarecido completamente en fEK/MIS-C
Factores asociados a ventilación mecánica prolongada en niños con fallo respiratorio de causa pulmonar: estudio de cohortes del registro de LARed Network
(Elsevier, 2023-06-15) Barajas-Romero, Juan Sebastían; Vásquez-Hoyos, Pablo; Pardo, Rosalba; Jaramillo-Bustamante, Juan Camilo; Grigolli, Regina; Monteverde-Fernández, Nicolas; Gonzalez-Dambrauskas, Sebastián; Jabornisky, Roberto; Cruces, Pablo; Wegner, Adriana; Díaz, Franco; Pietroboni, Pietro
Objectives: To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). Design: Secondary analysis of a prospective cohort. Setting: PICUs in centers that are part of the LARed Network between April 2017 and January 2022. Participants: Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. Main variables of interest: Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. Results: 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). Conclusions: Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay
Fisiopatología y clasificación de los estados de choque
(Grupo Distribuna, 2024) Jaramillo-Bustamante, Juan Camilo; Díaz, Franco; Donoso Fuentes, Alejandro
El choque es una condición de la naturaleza aguda, sindrómica y patológica, y es una manifestación común de muchas formas de enfermedades críticas en la población infantil. Si bien la presencia de hipotensión arterial señala un estado de choque, su ausencia no la descarta. La fisiopatología del choque se basa en los conceptos de entrega de oxígeno, en los factores que regulan esta entrega y en los requerimientos tisulares del mismo (consumo de oxígeno).
Functional echocardiography identifies association between early ventricular dysfunction and outcome in pediatric sepsis
(Frontiers Media S.A., 2025-06-01) Reveco, Sonia; Barbagelata, Stella; Cruces, Pablo; Díaz, Franco; Yohanessen, Karla; Larraín, Marcos; Guerra, Mario; Bataszew, Alexander
Objective: This feasibility study aimed to describe the relation between ventricular dysfunction and outcome in pediatric sepsis.Methods: This prospective observational multicenter study was conducted in two Pediatric Intensive Care Units (PICU). We enrolled 51 patients aged younger than 15 year-old diagnosed with sepsis or septic shock. Functional echocardiography was performed by a pediatric intensivist within the first 24 h of admission and blind validated by a pediatric cardiologist. Ventricular dysfunction was defined by the presence of left or right systolic and/or diastolic dysfunction. The absence of these findings was considered normal ventricular function. Outcome was assessed by septic shock diagnosis rate, pediatric adaptation of Sequential Organ Failure Assessment (pSOFA),cardiovascular component of pSOFA, PICU-free and ventilator-free days.Results: 29 patients had sepsis, and 22 had septic shock. The main sites of infection were pulmonary (58.8%) and abdominal (17.6%). One out of four had ventricular dysfunction, and this group presented higher frequency of septicshock (69.2% vs. 34.2%, p = 0.028), higher frequency of total pSOFA ≥3 at 24 h (92% vs. 64%, p = 0.04), cardiovascular component of pSOFA (69.2% vs.31.2%, p = 0.017), and fewer PICU-free days [18 [0–23] vs. 23 [18–25],p = 0.027], compared to normal ventricular function group. Additionally, therewere more abnormal tissue doppler measurements, lower ś wave Z-Score[−0.6 [−1.3;0.4] vs. 0.5 [−0.2;1.1], p = 0.01] and lower é wave Z-Score [1.5[−2;0,1] vs. −0.3 [−2;0.4], p = 0.03] in the ventricular dysfunction group.Conclusion: Ventricular dysfunction was associated with more sepsis severity at 24 hours, fewer PICU—free days. Tissue doppler parameters were related to ventricular dysfunction.
Hipofosfatemia en UCI: No todo es síndrome de realimentación
(Sociedad Chilena de Pediatría, 2025-03) Gómez Lund, Oscar; Reyes, Marco; Díaz, Franco
Hemos leído con sumo interés la investigación publicada por Martínez en Andes pediátrica, en el que reportan la presencia de síndrome de realimentación en 111 de 343 niños ingresados a una unidad de cuidados intensivos (UCIP) de un hospital de referencia, una frecuencia alta en en línea con otras cohortes internacionales. Tal como es comentado por los autores el síndrome de realimentación es una entidad compleja, frecuentemente subvalorada, con consecuencias graves y pobremente estudiada.
Imagen clínica: Triangulo de Filatov
(Sociedad Chilena de Pediatría, 2025-06-25) Carruyo, José Luis; Córdova, Tamara; Díaz, Franco
A pesar de que la caracterización clínica de la escarlatina está ampliamente documentada, y las vías moleculares involucradas han sido estudiadas en profundidad, la causa de la secuencia temporal del exantema y su distribución topográfica, al igual que en otros exantemas infecciosos, aún no se comprende completamente. En el caso del triángulo de Filatov, se postulan distintas características anatómicas y mecanismos fisiopatológicos para explicarlo, entre los cuales destacan las peculiaridades de la irrigación regional y las particularidades histológicas de la piel en dicha zona. Fundamentalmente, representan zonas de circulación terminal, con menor densidad capilar y escaso tejido subcutáneo, conformando un territorio especialmente susceptible a fenómenos de vasoconstricción simpática refleja, originando así al aspecto característico. En conclusión, más de un siglo después de la descripción de este signo por el Dr. Nicolai Filatov, uno de los padres de la pediatría rusa, este permanece vigente. Tiene una gran relevancia para el diagnóstico diferencial con otras enfermedades exantemáticas de la infancia, en especial ante el cambio epidemiológico y reemergencia de S. pyogenes en los últimos años.
Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study
(Elsevier, 2023-02-14) Channon-Wells, Samuel; Vito, Ortensia; McArdle, Andrew J.; Díaz, Franco
Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries.
Infancia y COVID-19: Los efectos indirectos de la pandemia COVID-19 en el bienestar de niños, niñas y adolescentes
(Sociedad Chilena de Pediatría, 2022) Díaz, Franco; Donoso Fuentes, Alejandro
El impacto de la pandemia COVID-19 ha sido invisibilizado en niños, niñas y adolescentes, ya que muchos de los efectos negativos han sido producto de las medidas de contención y mitigación, y sólo serán cuantificables a mediano y largo plazo. Aunque la respuesta mundial ha sido exitosa en disminuir la letalidad de la enfermedad, el efecto nocivo en poblaciones vulnerables, como niños, niñas y adolescentes es de alto impacto, catalogado como catastrófico por organismos internacionales. La pandemia ha afectado profundamente la salud física y mental de este grupo etario, y sus efectos ne gativos silenciosos se extienden a diferentes ámbitos como la escolaridad, economía familiar, trabajo infantil y seguridad alimentaria. El tercer año de la pandemia es una oportunidad para incorporar el bienestar multidimensional de los niños, niñas y adolescentes como piedra angular de la respuesta de la sociedad a una crisis global, sea esta de salud, económica o política.
La extubación durante la noche no se asocia con su fracaso en pacientes pediátricos de Unidad de Cuidados Intensivos: Estudio de cohorte retrospectivo
(Sociedad Chilena de Pediatría, 2023-04-17) Ibarra V., Maybreet; Andrades E., Francisca; Satta S., María; Díaz, Franco; Donoso F., Alejandro
Poco es conocido sobre la hora del día y carácter de éste (hábil/no hábil) en que se efectúa la extubación, y si durante la noche esta es segura. Objetivo: describir la frecuencia de extubación nocturna (EN) y en día no hábil (ENH). Adicionalmente determinar la asociación entre éstas y resultados clínicos. Pacientes y Método: Estudio de cohorte retrospectivo de pacientes menores de 18 años quienes recibieron ventilación mecánica (VM) invasiva y se efectuó un intento extubación en una Unidad de Paciente Crítico Pediátrico (UPCP) médico quirúrgica de alta complejidad entre el 01/01/2018 al 31/12/2021. Exposición primaria: EN, la cual fue definida como la realizada entre 20:01 - 8:00 horas. Se evaluó su asociación con fracaso de extubación (FE), duración de VM invasiva y tiempo de esta- día en la UPCP. Resultados: 146 pacientes fueron incluidos (58,9% hombres, edad 1,14 (0,25 - 5,5) años). En el 17,8% se efectuó EN. La extubación nocturna no se asoció con FE como tampoco el día de extubación. El FE fue 3,8% en EN y 5% en la extubación diurna (ED) (p = 0,80). La duración de la VM invasiva fue menor en EN que ED (48 (24-73,5) vs. 72 (48-96) h, p = 0,02). Conclusiones: La EN no se asoció con FE. Los pacientes con EN tuvieron menor duración de VM invasiva, y ésta última se asoció con FE. La retirada de la VM invasiva debe ser considerada en la primera oportunidad y estar determinada por factores clínicos, más que por la hora del día.
Las fisuras del sistema en la publicación académica en pediatría: una crítica al acceso abierto y sus consecuencias
(Sociedad Chilena de Pediatría, 2025-10-21) Díaz, Franco; Gómez-Lund, Oscar; Riderelli, Jocelyn; Monteverde-Fernández, Nicolás; González-Dambrauskas, Sebastián; Jabornisky, Roberto; Jaramillo-Bustamante, Juan Camilo; Caporal, Paula
En las últimas dos décadas, la publicación académica ha experimentado transformaciones profundas con la digitalización y el acceso a internet. En forma concomitante, el movimiento de Acceso Abierto ha desempeñado un papel fundamental en la mejora de la accesibilidad al conocimiento científico mediante la eliminación de pagos y otras barreras restrictivas. Si bien esta democratización de la información ha generado beneficios sustanciales, también ha introducido desafíos complejos, convirtiendo las publicaciones médicas en una industria lucrativa que pone a prueba los límites éticos de las prácticas comerciales y, en última instancia, la integridad de la investigación. La concentración de poder en unas pocas grandes editoriales dentro de un mercado sesgado e inelástico, la proliferación de editoriales con fines de lucro y la creciente carga financiera, trasladada a los autores, son factores críticos que contribuyen a la crisis actual de la academia. El objetivo de este manuscrito es examinar los principales hitos en la evolución de la publicación académica, analizar su panorama actual y discutir los desafíos fundamentales que enfrenta la industria en la era del Acceso Abierto, particularmente desde la perspectiva de investigadores en pediatría en América Latina. Over the past two decades, academic publishing has undergone substantial transformation, largely driven by digitalization and increased global Internet access. In parallel, the Open Access (OA) movement has played a critical role in advancing equitable access to scientific knowledge by eliminating paywalls and licensing restrictions. While these developments have yielded considerable benefits–particularly in enhancing the dissemination and democratization of research– they have also generated complex ethical and structural challenges. Notably, the consolidation of publishing power among a few major editorial houses, the emergence of profit-driven publication models, and the shifting of publication costs onto authors, have contributed to a growing crisis in academic medicine. These trends have raised concerns regarding transparency, editorial independence, and the overall integrity of the scientific record. This manuscript aims to delineate the historical and structural evolution of academic publishing, assess its current landscape, and critically examine the key challenges facing the field in the context of Open Access. Particular attention is given to the implications for pediatric researchers in Latin America, who are disproportionately affected by these systemic barriers.
Latin American Consensus on the Management of Sepsis in Children: Sociedad Latinoamericana de Cuidados Intensivos Pediátricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive Summary
(SAGE Publications, 2022) Fernández-Sarmiento, Jaime; De Souza, Daniela Carla; Martinez, Anacaona; Nieto, Victor; López-Herce, Jesús; Soares Lanziotti, Vanessa; Arias López, María del Pilar; Brunow De Carvalho, Werther; Oliveira, Claudio F.; Jaramillo-Bustamante, Juan Camilo; Díaz, Franco; Yock-Corrales, Adriana; Ruvinsky, Silvina; Munaico, Manuel; Pavlicich, Viviana; Iramain, Ricardo; Márquez, Marta Patricia; González, Gustavo; Yunge, Mauricio; Tonial, Cristian; Cruces, Pablo; Palacio, Gladys; Grela, Carolina; Slöcker- Barrio, Maria; Campos-Miño, Santiago; González- Dambrauskas, Sebastian; Sánchez-Pinto, Nelson L.; Celiny García, Pedro; Jabornisky, Roberto
Objective: The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.

Examinando por Autor "Díaz, Franco"

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