Browsing by Autor "Carolina Bonilla González"

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Pancreatic VIPoma as a Differential Diagnosis in Chronic Pediatric Diarrhea: A Case Report and Review of the Literature
(Elmer Press Inc., 2021) Carolina Bonilla González; Juliana Rusinque; Camila Uribe; Ailim Carias; Maria Luisa Contreras
Chronic diarrhea is a common chief complaint in the pediatric population with a wide range of diagnostic differentials; as such, whilst suspecting common causes, less prevalent conditions tend to be overlooked, such as neuroendocrine tumor pathologies. VIPomas are characterized by hypersecretion of the vasoactive intestinal peptide (VIP), causing watery diarrhea, hypokalemia, and achlorhydria. Nonetheless, its low incidence rate in children makes it an easily unnoticed pathology. Herein, we report a case of a 14-year-old female patient and a review of relevant literature. The patient complained of 7-month history of watery diarrhea, multiple emetic episodes, and relevant past medical history of multiple hospitalizations. Chronic diarrheal disease work-up studies, including a high VIP scintigram, showed a lesion suggestive of a VIPoma-type neuroendocrine pancreatic tumor. A distal pancreatectomy was performed with a complete resolution of the symptoms. When faced with a pediatric patient presenting with chronic secretory diarrhea and whose work-up studies rule out the most common pathologies, the possible presence of a neuroendocrine tumor as VIPoma should be considered.
Usefulness of the Combination of FilmArray and procalcitonin in respiratory infections in the Pediatric Intensive Care Unit
(Research Square (United States), 2022) Carolina Bonilla González; Laura Camargo-Agón; Pedro Barrera; Sebastián Peña; Alejandra Mal Chain; Camila Uribe; Jose Fernando Vera‐Chamorro
Abstract Introduction . Acute respiratory infections represent one of the main causes of preventable infant mortality and morbidity in children, and although a significate proportion of cases are of viral etiology, antibiotic treatment is the overly-excessive norm. Studies suggest that the combined use of serum procalcitonin (PCT) and polymerase chain reaction (PCR) multiplex (FilmArray) may be used to guide antibiotic therapy. Methods . A prospective cohort study was conducted of patients between 1 month and 17 years of age with acute respiratory infection hospitalized in the PICU with a negative viral panel report and both respiratory FilmArray and procalcitonin performed in the first 72 hours of hospitalization. A diagnostic algorithm was then applied to these patients, tailored to the result of both tests. Results . Of the total 326 patients recluted, 110 met the inclusion criteria; 23 patients were excluded for infections other than respiratory origin. Of the 87 remaining patients, all had a respiratory FilmArray performed prior to the PCT sample, demonstrating a diagnostic yield of over 80%. Procalcitonin was requested in slightly more than half of the patients and was positive in a third of these cases. When combined in the diagnostic algorithm, FilmAray and PCT lead to changes in treatment plan in 30% of patients in terms of antibiotic management prescribed on admission, with the most frequent treatment plan change being suspending the antibiotic altogether (from 41.4% to 10.3%, for a total of 89.7% of patients without antibiotic therapy following the algorithm. None of the patients died and only 1/87 patients required re-initiating antibiotics after having suspended treatment. The interaction between the identification of a viral pathogen in the FilmArray and a negative PCT result yielded statistically significant results (p=0.004) and affected the change in treatment management mainly in antibiotic discontinuation. Conclusions . The combined use of FilmArray and serum PCT as tools in the diagnostic algorithm is a safe way to guide tailored antibiotic therapy in pediatric patients with ARI in critical state.