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El desarrollo de enterocolitis necrosante, con la consecuente perforacion intestinal, es frecuente en los recien nacidos pretermino. El tratamiento estandar de la perforacion intestinal es quirurgico. Sin embargo, se sugiere que la insercion de un drenaje en el abdomen puede ser efectivo para tratar esta afeccion. Se resumen los resultados de una revision sistematica Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomia en neonatos con enterocolitis necrosante perforada. Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.

Severe coronavirus disease 2019 (COVID-19) is infrequent in children and shows a mortality rate of around 0.08%. This study aims to explore international differences in the pediatric mortality rate.We analyzed several countries with populations over 5 million that report disaggregated data of COVID-19 deaths by quinquennial or decennial age groups. Data were extracted from COVID-19 cases and deaths by age database, National Ministeries of Health, and the World Health Organization.We included 23 countries in the analysis. Pediatric mortality varied from 0 to 12.1 deaths per million children of the corresponding age group, with the highest rate in Peru. In most countries, deaths were more frequent in the 0-4-year-old age group, except for Brazil. The pediatric/general COVID-19 mortality showed a great variation and ranged from 0% (Republic of Korea) to 10.4% (India). Pediatric and pediatric/general COVID mortality correlates strongly with 2018 neonatal mortality (r = 0.77, p0.001; and r = 0.88, p0.001, respectively), while shows a moderate or no correlation (r = 0.47, p = 0.02; and r = 0.19, p = 0.38, respectively) with COVID-19 mortality in the general population.International heterogeneity in pediatric COVID-19 mortality importantly parallels historical neonatal mortality. Neonatal mortality is a well-known index of the quality of a country's health system, which points to the importance of social determinants of health in pediatric COVID-19 mortality disparities. This issue should be further explored.La COVID-19 grave es poco frecuente en la infancia. El objetivo de este estudio fue explorar las diferencias en la tasa de mortalidad internacional por COVID-19 en la población pediátrica.Se analizaron países con poblaciones superiores a 5 millones de habitantes que reporten muertes por COVID-19 con datos desglosados por grupos de edad quinquenales o decenales. Los datos se extrajeron de la base de datos COVerAge-DBs, de los ministerios nacionales de salud y de la Organización Mundial de la Salud.Se incluyeron 23 países. La mortalidad pediátrica varió de 0 a 12.1 muertes por millón de personas del grupo de edad correspondiente, con la tasa más alta en Perú. En la mayoría de los países, las muertes fueron más frecuentes en el grupo de 0 a 4 años, excepto en Brasil. La mortalidad pediátrica/general por COVID-19 mostró una gran variación entre países y osciló entre el 0% (República de Corea) y el 10.4% (India). La mortalidad pediátrica y pediátrica/general por COVID-19 se correlaciona fuertemente con la mortalidad neonatal de 2018, mientras que tiene una moderada o nula correlación con la mortalidad por COVID-19 en la población general.Existe una importante heterogeneidad internacional en la mortalidad pediátrica por COVID-19, que es paralela a la mortalidad neonatal histórica, la cual es un indicador de la calidad de los sistemas de salud y señala la importancia de los determinantes sociales de la salud en las disparidades de mortalidad pediátrica por COVID-19. Este tema debe explorarse a fondo.

BACKGROUND: The new evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by its high capacity to transmit. Health-care personnel is highly susceptible to becoming infected. This study aimed to determine the characteristics and known risk factors for contagion and severe outcomes of SARS-CoV-2 disease in health-care personnel of a pediatric coronavirus disease (COVID) center in Mexico City. METHODS: In the last week of March 2020 (at the beginning of phase 2 of the Ministry of Health's national campaign in Mexico), a study was conducted on healthcare workers of a pediatric COVID hospital in Mexico City. Using a virtual interview, we evaluated comorbidities, mobility, areas and functions where they carry out the activities, protection measures, contact history, and vaccination. According to their activities, healthcare workers were classified into the following areas: medical, nursing, other health-care personnel (researchers, nutritionists, rehabilitation, imaging, and laboratory), administrative, and other services. We compared the variables between the groups of healthcare workers with the X2 test. RESULTS: We included 812 participants. The mean age was 41 ± 11 years, and 33% were overweight or obese, 18% were over 60 years old, and 19% had high blood pressure. Medical and nursing personnel presented a higher proportion in the use of standard protection measures. CONCLUSIONS: Among healthcare workers, there are risk conditions for the development of complications in case of SARS-CoV-2 infection. Most medical and nursing personnel use standard protective measures.

espanolIntroduccion: La obesidad es una pandemia mundial; 3 de cada 10 adolescentes en Mexico la padecen. En la obesidad morbida, el manejo conservador es un fracaso y la cirugia bariatrica es el unico tratamiento util. No hay experiencia en Me- xico y los reportes internacionales son aislados. Metodo: Analisis de las repercusiones metabolicas, efecto sobre la comor- bilidad y complicaciones, en adolescentes con obesidad morbida operados con manga gastrica de 2011 a 2015. Resultados: De 54 pacientes con obesidad morbida, 10 cumplieron criterios; 5 varones; edad de 14.3 ± 1.4 anos; peso de 117.3 ± 15.2 kg; indice de masa corporal basal de 43.71 ± 4.1; cintura de 130.3 ± 6.8 cm; 8 con dislipidemia; 6 con sindrome metabolico; 5 con esteatosis hepatica; 4 con hipertension; 3 con diabetes tipo 2. Complicaciones: 2 atelectasias, 1 fistula, 1 neumonia, 1 colelitiasis; ninguno con carencia nutricional. Disminucion del peso al ano del 33% y a los 2 anos del 23%. Disminucion de la grasa del 22.4%. Aumento de agua corporal del 36.1%. Perdida del exceso de peso significativa p = 0.001. A los 2 anos, remision de esteatosis grave y de diabetes, el perfil lipidico mejoro, la hipertension arterial persistio solo en uno. Discusion: Lo mas destacado es la mejoria o curacion de la comorbilidad, con curacion de la diabetes, la hipertension y la dislipidemia, que dara mejor pronostico a estos ninos. Conclusiones: La manga gastrica es util en adolescentes con obesidad morbida, con mejoria de la comorbilidad grave. Se requiere un mayor seguimiento. EnglishIntroduction: Obesity is a world pandemic; in Mexico 3 out of 10 adolescents suffer from it. Conservative management of morbid obesity is not effective and bariatric surgery is the only useful therapy. International pediatric bariatric surgery series are scarce and in Mexico there is limited experience. Method: We analyze the metabolic repercussions, comorbidities and complications in our series of Mexican adolescents with morbid obesity who underwent a gastric sleeve between 2011 and 2015. Results: 54 morbid obese adolescents were included, 10 fulfilled criteria for surgery. 5 were male, mean age 14.3 ± 1.4 years, weight 117.3 ± 15.2 kg, initial body mass index 43.71 ± 4.1, waist 130.3 ± 6.8 cm, 8 dyslipidemia, 6 metabolic syndrome, 5 liver steatosis, 4 hypertension, 3 type-2 diabetes. Complications: 2 atelectasis, 1 fistula, 1 pneumonia, 1 cholelithiasis; no patient developed nutritional deficits. Weight loss of 33% one-year after surgery and 23% at 2 years. Body fat de- creased 22.4% and water content increased 36.1%. Excess weight loss was significant p = 0.001. Two-years after surgery severe steatosis and diabetes had subsided, lipid profile improved and only one patient remained hypertensive. Discussion: Our results demonstrate that all serious comorbidities associated to morbid obesity were improved (diabetes, dyslipidemia and hypertension) and will confer a better prognosis for these children. Conclusions: Gastric sleeve is useful in morbid obese adolescents. Longer follow-up is needed.