Browsing by Autor "Melisa Naranjo Vanegas"

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Chest X-Ray Interpretation in the EPICO Pediatric COVID-19 Study: Addressing Misconceptions
(2025) Luis Miguel Navarro‐Ramirez; Pablo Vásquez‐Hoyos; María Lucia Mesa-Rubio; Melisa Naranjo Vanegas; Diego Montero; Claudia Burgos; Laura Melissa Mendez; María Rodríguez-Pérez; Arianna Martinez; Paola Andrea Sánchez
Chest X-Ray Interpretation in the EPICO Pediatric COVID-19 Study: Addressing MisconceptionsLuis Miguel Navarro‐Ramirez¹˒² | Pablo Vásquez‐Hoyos³˒⁴ | María Lucía Mesa‐Rubio⁵ | Melisa Naranjo Vanegas¹˒⁶ | Daniela Duarte-Montero¹˒⁷ | Claudia Burgos⁵ | Laura Melissa Mendez⁵ | María Margarita Rodriguez⁵ | Arianna Martinez⁵ | Paola Sanchez⁵ | Carolina Tovar⁵ | Gabriela Friedrich¹ | Gustavo Adolfo Triana‐Rodriguez⁸ | Mónica Royero‐Arias⁹ | Jessica Echeverry¹⁰ | Tamara Gamo¹⁰ | Luz Ángela Moreno⁴˒¹⁰ | Olga Lucía Baquero¹¹ | Luz Marina Mejía¹² | Sonia Restrepo‐Gualteros⁵ | Sergio Moreno‐Lopez¹ | Juan Gabriel Piñeros⁵ | Carlos Álvarez‐Moreno⁴˒¹³ | Alejandro Díaz‐Díaz¹⁴˒¹⁵ | Iván Felipe Gutierrez¹⁶ | Clara Galvis‐Diaz¹⁷ | José Manuel Nieto¹⁸ | Irati Gastesi¹⁹ | Cinta Moraleda¹⁹ | Alfredo Tagarro García¹⁹ | Andrea Ramirez Varela²⁰˒²¹˒²² | EPICO‐Colombia and EPICO‐AEP working groups¹ School of Medicine, Universidad de los Andes, Bogotá D.C., Colombia ² Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA ³ Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay ⁴ School of Medicine, Universidad Nacional de Colombia, Bogotá D.C., Colombia ⁵ Department of Pediatrics, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá D.C., Colombia ⁶ Medical Imaging & AI Group - Bioscience Center, Ayudas Diagnósticas Sura, Medellín, Antioquia, Colombia ⁷ PediAFe Research Group, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá D.C., Colombia ⁸ Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia ⁹ Pediatric Radiology, Servicios de Salud San Vicente Fundación, Medellín, Antioquia, Colombia ¹⁰ HOMI, Fundación Hospital Infantil de la Misericordia, Bogotá D.C., Colombia ¹¹ Clínica Infantil Colsubsidio, Bogotá D.C., Colombia ¹² Instituto de Ortopedia Infantil Roosevelt, Bogotá D.C., Colombia ¹³ Clínica Universitaria Colombia, Clínica Colsanitas, Bogotá D.C., Colombia ¹⁴ Pediatric Infectious Diseases, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia ¹⁵ Pediatric Infectious Diseases, Hospital General de Medellín, Medellín, Antioquia, Colombia ¹⁶ Pediatric Infectious Diseases, Clínica Infantil Santa Maria del Lago, Clínica Colsanitas, Bogotá D.C., Colombia ¹⁷ Hospital Militar Central, Bogotá D.C., Colombia ¹⁸ Hospital Regional de la Orinoquía, Yopal, Casanare, Colombia ¹⁹ Fundación Investigación Biomédica Hospital Universitario 12 de Octubre (FIBH12O), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain ²⁰ Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA ²¹ Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, Texas, USA ²² School of Public Health, Center for Health Equity, University of Texas Health Science Center at Houston, Houston, Texas, USACorresponding author: Luis Miguel Navarro-Ramirez | Lm.navarror@uniandes.edu.coAddress for reprint: Universidad de los Andes, School of Medicine, Carrera 7 # 116-05, Bogotá DC, Colombia.To the editor,We appreciate the opportunity to respond to the commentary by Daungsupawong and Wiwanitkit regarding our manuscript, “What to Look for in Chest X-Rays of Pediatric Patients With COVID-19: Insights From a Colombian Cohort” [1,2]. We thank the authors for their interest in our work and their thoughtful engagement. Several of the concerns raised in the commentary were, in fact, addressed in the original manuscript; nonetheless, we welcome the opportunity to clarify these points and provide additional context where needed.
Impulsando la excelencia investigativa en pediatría a través de la modalidad colaborativa supervisada: un enfoque innovador en la formación en investigación de posgrado.
(CIG Media Group, 2023) Andrea Ramírez Varela; Juan Gabriel Piñeros; Olga Lucía Baquero; Luz Marina Mejía; María Lucia Mesa-Rubio; Sonia Restrepo‐Gualteros; Melisa Naranjo Vanegas; María Adelaida Cordoba; Rafael Martín Acero
Los residentes de los programas médico-quirúrgicos del país se ven confrontados por desafíos notables al emprender sus tesis de grado. Entre estas dificultades destacan la constante presión temporal debido a sus apretadas agendas clínicas, la necesidad de adquirir destrezas de investigación, la complejidad en el acceso a recursos especializados y la carencia de una orientación adecuada. Por ende, es imperativo abordar estas barreras sistémicas y proporcionar un ambiente de apoyo que habilite a los residentes a superar estos desafíos y desarrollar sus competencias en investigación clínica de manera exitosa. Los programas de Posgrado de la Facultad de Medicina de la Universidad de los Andes se destacan por su enfoque en el desarrollo de competencias esenciales para la práctica médica especializada, haciendo hincapié en el aprendizaje basado en la práctica y mejora continua. La investigación se integra en la formación, con la obligación de efectuar investigaciones como parte del trabajo de grado. La investigación colaborativa supervisada es un modelo que involucra a residentes en proyectos compartidos, promoviendo la interacción entre estudiantes, profesores y hospitales asociados con el objeto de generar investigaciones científicas de alto impacto en salud. Este artículo de opinión describe las primeras experiencias de éxito de la modalidad colaborativa supervisada en el Departamento de Pediatría de la Universidad de los Andes. Esta iniciativa busca inspirar y guiar futuras investigaciones y programas educativos en el campo de la salud, ofreciendo un marco valioso para generar conocimiento y abordar los desafíos en la práctica médica, contribuyendo así al avance científico en el ámbito médico.
PHENOTYPIC VARIATION IN DISEASE SEVERITY AMONG HOSPITALIZED PEDIATRIC PATIENTS WITH COVID-19: ASSESSING THE IMPACT OF COVID-19 IN THE EPICO STUDY
(2023) Melisa Naranjo Vanegas; María Camila Sossa; Mónica Paola Gutiérrez; Natalia Becerra; Luz Yessenia Ortegon; María Camila David; Pablo Vásquez‐Hoyos; María Lucia Mesa-Rubio; Sergio Moreno; Olga Lucía Baquero Castañeda
Background: SARS-CoV-2 infection has been extensively documented since the onset of the pandemic, particularly in the adult population. However, there is a lack of evidence describing the phenotypic manifestations of the disease in the pediatric population. We aimed to characterize the clinical phenotypes of SARS-CoV-2 infection in hospitalized children. Methods: The EPICO study is a multicenter cohort conducted between April 2020- November 2021, involving 55 institutions in Spain and 13 institutions in Colombia. Hospitalized children aged 29 days to 17 years with confirmed SARS-CoV-2 infection were included to determine the disease´s evolution, severity factors, and outcomes. Cluster analysis was conducted to characterize clinical phenotypes. Results: A total of 2318 patients from Colombian and Spanish institutions were included. The population was 55% male, with infants being the largest group (36%). Five distinct phenotype clusters emerged, differing significantly in clinical and epidemiological characteristics. Cluster 1 (26.57%) consisted of infants without comorbidities, with low PICU admission and mortality rates. Cluster 2 (18.5%) had respiratory comorbidities, high co-detection, and mortality rates. Cluster 3 (11.51%) showed fever, gastrointestinal symptoms, and high PICU admission. Cluster 4 (32.09%) had mild unspecific symptoms and low mortality. Cluster 5 (11.3%) included adolescents without comorbidities, with low co-detection and hospitalization rates. Comparable findings were observed in both countries. Conclusion: Our study successfully identified distinct patterns of clinical and epidemiological characteristics associated with SARS-CoV-2 infection in hospitalized pediatric patients. These findings may help shape future guidelines and improve risk stratification in children.
Severity and Mortality of Acute Respiratory Failure in Pediatrics: A Prospective Cohort at 2,600 Meters Above Sea Level
(Research Square (United States), 2023) Catalina Vargas‐Acevedo; Mónica Botero Marín; Catalina Jaime Trujillo; Laura Jimena Hernández; Melisa Naranjo Vanegas; Sergio Mauricio Moreno; Paola Rueda‐Guevara; Juan Gabriel Piñeros; Olga Baquero; Carolina Bonilla
Abstract Background: Acute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide, therefore several efforts have been made to better understand its etiology and risk factors for further progression (1–4). The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with acute respiratory failure. Methods: The study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric acute respiratory failure (ARF). For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit length of stay. Setting: Pediatric emergency, in-hospital, and critical care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021. Patients : Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at time of admission. Patients who developed ARF were followed at time of ARF, 48 hours later, at time of admission and at 30 and 60 days after discharge. Measurements and main results : Out of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, ninety patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00–11.5). Incidence of mortality was 6.1% ( n = 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission. Conclusions : ARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.
WHAT TO LOOK FOR IN CHEST X-RAYS OF PEDIATRIC PATIENTS WITH COVID-19: INSIGHTS FROM A COLOMBIAN COHORT.
(2023) Melisa Naranjo Vanegas; Claudia Burgos; Laura Melissa Mendez; María Margarita Rodriguez; Arianna Martinez; Paola Andrea Sánchez; Carolina Tovar; Pablo Vásquez‐Hoyos; María Lucia Mesa-Rubio; Gustavo Triana
Background: Despite advancements in vaccination and the transition from pandemic to endemic, SARS-CoV-2 continues to pose a medical challenge, particularly among children. In this context, imaging diagnostics, such as chest x-rays, are crucial to the initial treatment of patients. This study aims to characterize the radiological findings in pediatric patients with confirmed SARS-CoV-2 infection in Colombia between April 2020 and November 2021, as well as their potential association with intensive care admission. Methods: In Colombia, a multicenter cohort comprised patients aged 29 days to 17 years with confirmed SARS-CoV-2 infection and chest X-ray administered within 72 hours of hospitalization. In two separate groups, four radiologists evaluated the images. A fifth radiologist reviewed all the X-rays; and subsequently, these readings were used to calculate the kappa coefficient and to resolve discrepancies among the other radiologists. The results were compared to admission to intensive care. Results: Analysis was conducted on 392 patients with a mean age of 2 years, the majority of whom (42%) were infants. Sixty-eight percent of the radiographs had normal results. Peribronchial thickening and interstitial opacity were the most common aberrant findings (59%), followed by alveolar opacity (12%). 88 percent of findings were bilateral. The most common association between peribronchial thickening and intensive care admission was ventilatory failure. Interobserver agreement was low for peribronchial thickening (kappa = 0.1), but higher for consolidations and alveolar opacities (kappa = 0.4 and 0.5, respectively). Conclusion: In pediatric patients with SARS-CoV-2, radiological findings are nonspecific and interobserver agreement is minimal. Although consolidation and alveolar opacities demonstrated greater concordance, they were not associated with clinical differences; therefore, chest radiography is not considered useful for determining the severity of COVID-19 in children.