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Purpose of ReviewWe aimed to summarize the most current evidence on the main aspects of the diarrheal diseases in children. The following key elements were addressed: definitions, etiology, pathogenesis, diagnosis, dietary management, pharmacological treatments, and prevention. We covered the following questions: What are the most important clinical and laboratory features of the disease? What are the best approaches for the dietary management? What is the best way to classify the hydration status, and to prevent and treat the dehydration? What are the most effective and safe interventions for reducing the diarrhea and vomiting?Recent FindingsDiarrheal diseases are one of the most common diseases in childhood. The most common cause is rotavirus. A key element in the approach of a child with diarrhea is determining their hydration status, which determines the fluid management. Laboratory tests are nor routinely required, as most of the cases, they do not affect the management and it should be indicated only in selected cases. Several treatments have been studied to reduce the duration of the diarrhea. Only symbiotics and zinc have shown to be effective and safe with high certainty on the evidence. Rest of the interventions although seem to be effective have low to very low quality of the evidence. The only effective and safe antiemetic for controlling vomiting is ondansetron. A list of antimicrobials indications according to the identified microorganisms is provided.SummaryWe summarized the most current evidence on diagnosis, management, and prevention of diarrhea in children. More research is needed in some areas such as dehydration scales, rehydration management, antidiarrheals, and antibiotic treatments.

Background Tuberculosis (TB) remains a major global health challenge, and while TB preventive treatment (TPT) helps control it, in 2023, only ~ 42% of eligible household contacts under age 5 began TPT, with a median completion rate of 87% (IQR 74–95%) across reporting countries globally. This study analysed the effectiveness and factors related to isoniazid-based TPT (considered a public health strategy) in children under 5 years of age exposed to confirmed pulmonary TB cases in Medellín, Bello, and Itagüí, Colombia, “TPT” cohort, that was compared to a historic cohort (“non-TPT”) that did not receive TPT. Methods This cohort study included a qualitative component that explored knowledge about TB and children’s health care process as perceived by parents/caregivers and health care workers using of ethnographic strategies. The effectiveness measure of TPT was the occurrence of active TB. Results In the “TPT” cohort, 329 children met the inclusion criteria. Among these children, 74% were evaluated, 66% began treatment, 45% received TPT for six months, and 23.1% for nine months. Adverse events affected 11.1% of the treated children, mostly mild gastrointestinal symptoms (45.8% of all adverse events). At recruitment, the prevalence of active TB was 3.8% ( n  = 11), with 7 cases among indigenous children. No incident active TB cases were detected during follow-up. The “non-TPT” cohort included 240 children. Over two years, the cumulative incidence of active TB was 3.3%, with symptomatic cases at recruitment being diagnosed during follow-up. The adjusted period prevalence ratio was 0.77 (95% CI 0.2–2.4). The qualitative findings revealed three categories: (1) daily life and social conditions, including forced migration, influence TPT effectiveness; (2) the Colombian health system does not guarantee real access to TB diagnosis and treatment; and (3) stigma and differing perceptions of TB among families affect treatment outcomes. Conclusions Isoniazid TPT effectively prevents TB in children; however, treatment-only strategies fall short of ensuring full coverage for children with TB infection. Determinants, including indigenous ethnicity and migration status, influence TB progression from infection to disease. More comprehensive approaches to TB are essential to address health system and socioeconomic barriers that create inequities in children’s access to care.

What you need to know Post-dural-puncture headache is a common complication after lumbar puncture, affecting up to 35% of patientsThis headache results from sustained leakage of cerebrospinal fluid from a dural tear; it can be debilitating and require return to hospital for narcotics or invasive therapyWe issue a strong recommendation for use of atraumatic needles in all patients (adults and children) undergoing lumbar puncture because they decrease complications and are no less likely to work than conventional needles

Approximately 1.4 million women living with HIV become pregnant every year. Most women use antiretroviral therapy, to reduce the risk of vertical transmission or for personal health reasons. Using the GRADE framework according to the BMJ Rapid Recommendation process, we make recommendations for optimal choice of combination antiretroviral regimen considering patient values and preferences, the balance of desirable and undesirable outcomes, their uncertainty, and practical issues. We suggest a zidovudine and lamivudine-based regimen over one that includes tenofovir or emtricitabine (weak recommendation). We recommend alternatives over the combination of tenofovir, emtricitabine, and lopinavir/ritonavir (strong recommendation).

Abstract Introduction: Bacterial meningitis is a severe infection requiring early empirical therapeutic intervention. In Colombia, there is limited information regarding this disease in the neonatal stage, necessitating up-to-date data to guide timely antibiotic therapy. Objective: To describe the clinical, microbiological, and epidemiological characteristics of neonatal bacterial meningitis in three hospital centers in the city of Medellín during the years 2010 to 2019. Methods: A descriptive study was conducted using electronic medical records of newborns treated in three hospitals in Medellín from 2010 to 2019. Clinical records with a discharge diagnosis of bacterial meningitis and corresponding microbiological isolation were reviewed. Data were extracted from SAP® and Servinte Clinical Suite Enterprise® and recorded in a Google® spreadsheet. Results: A total of 125 records with a diagnosis of neonatal meningitis were reviewed with only 42 cases meeting microbiological isolation criteria. The mean gestational age was 35 weeks, and the most frequently isolated pathogens were Escherichia coli (40.5%) and Streptococcus agalactiae (40.5%). In 71.4% of cases, the meningitis was classified as late-onset according to age. Primary symptoms included irritability (56.1%) and fever (48.8%). Conclusions: The most common causative agents identified in this population were S. agalactiae and E. coli. Principal symptoms were irritability and fever. A significant proportion of neonates did not present suggestive symptoms of central nervous system infection. Additionally, prematurity was predominant in the studied population.

Background Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. Objective To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. Methods A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. ClinicalTrials.gov identifier NCT04331262. Discussion This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. Trial registration ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020. 

Introducción: la meningitis bacteriana es una infección grave que requiere un abordaje terapéutico empírico de inicio temprano. En Colombia existe poca información sobre esta enfermedad en la etapa neonatal y es indispensable contar con datos actualizados que orienten la antibioticoterapia de manera oportuna. Objetivo: describir las características clínicas, microbiológicas y epidemiológicas de la meningitis neonatal bacteriana en tres centros hospitalarios de la ciudad de Medellín durante los años 2010 a 2019. Métodos: se realizó un estudio descriptivo a partir de todos los registros médicos electrónicos de recién nacidos atendidos en tres hospitales de la ciudad de Medellín desde 2010 hasta 2019. Se revisaron las historias clínicas con diagnóstico de egreso de meningitis bacteriana y que contaran con aislamiento microbiológico. Los datos fueron extraídos de SAP® y Servinte Clinical Suite Enterprise® y registrados en una hoja de cálculo de Google®. Resultados: se revisaron 125 historias con diagnóstico de meningitis neonatal. Sólo se incluyeron 42 casos con aislamiento microbiológico. La edad gestacional promedio fue de 35 semanas, y los patógenos aislados con mayor frecuencia fueron Escherichia coli (40,5 %) y Streptococcus agalactiae (40,5 %). En el 71,4 % la infección meníngea fue de clasificación tardía según la edad. Los principales síntomas fueron irritabilidad 56,1 % y fiebre 48,8 %. Conclusiones: los agentes causales más frecuentes encontrados en esta población fueron Streptococcus agalactiae y Escherichia coli. Los síntomas principales fueron irritabilidad y fiebre. En un gran porcentaje de neonatos no se evidenciaron síntomas sugestivos de infección del sistema nervioso central. Por otra parte, la prematuridad fue predominante en la población estudiada. 

Introducción: los pacientes con enfermedad renal son una población de alta complejidad por sus condiciones de multimorbilidad, riesgo cardiovascular y requerimiento de terapias inmunosupresoras. La vacunación es una de las principales estrategias para mitigar el riesgo de infecciones, no obstante, la respuesta a las vacunas se ve afectada por la pérdida de la calidad de la función inmunológica, efecto que es mayor en la medida en que la enfermedad renal progresa o se requiere el uso de medicamentos inmunosupresores. Por ello, las prácticas de inmunización deben ser incentivadas en los pacientes en estadios más precoces de su enfermedad. Desafortunadamente, existe un amplio desconocimiento por parte de los prestadores de atención respecto de las mejores prácticas de inmunización, adicionalmente, en Colombia no existe cobertura de aseguramiento en el plan de beneficios de salud para muchos de los biológicos requeridos. Objetivo: generar recomendaciones informadas en evidencia sobre vacunación en pacientes con enfermedad renal y condiciones especiales relacionadas. Metodología: a partir de una revisión y un análisis crítico de evidencia, el grupo desarrollador formuló recomendaciones sobre indicaciones, contraindicaciones y consideraciones especiales de inmunización en pacientes con enfermedad renal. Se consultó a un colectivo de expertos en infectología y nefrología sobre el acuerdo con las recomendaciones propuestas. Se definió un umbral de acuerdo del 80?%. Resultados: inicialmente se formularon 135 recomendaciones, de las cuales 124 recomendaciones fueron aprobadas en la consulta virtual, aquellas que no superaron el umbral fueron consensuadas en una sesión virtual. Al final del proceso se obtuvieron 142 recomendaciones. Conclusiones: la vacunación es una estrategia de prevención altamente recomendable en pacientes con enfermedad renal, con impactos favorables sobre la carga de enfermedad y la supervivencia. Se espera que las recomendaciones propuestas permitan orientar y estandarizar las prácticas de inmunización en estos pacientes y mejorar los desenlaces en salud para esta población.

Introduction: Bacterial meningitis is a severe infection requiring early empirical therapeutic intervention. In Colombia, there is limited information regarding this disease in the neonatal stage, necessitating up-to-date data to guide timely antibiotic therapy. Objective: To describe the clinical, microbiological, and epidemiological characteristics of neonatal bacterial meningitis in three hospital centers in the city of Medellín during the years 2010 to 2019. Methods: A descriptive study was conducted using electronic medical records of newborns treated in three hospitals in Medellín from 2010 to 2019. Clinical records with a discharge diagnosis of bacterial meningitis and corresponding microbiological isolation were reviewed. Data were extracted from SAP[R] and Servinte Clinical Suite Enterprise[R] and recorded in a Google[R] spreadsheet. Results: A total of 125 records with a diagnosis of neonatal meningitis were reviewed with only 42 cases meeting microbiological isolation criteria. The mean gestational age was 35 weeks, and the most frequently isolated pathogens were Escherichia coli (40.5%) and Streptococcus agalactiae (40.5%). In 71.4% of cases, the meningitis was classified as late-onset according to age. Primary symptoms included irritability (56.1%) and fever (48.8%). Conclusions: The most common causative agents identified in this population were S. agalactiae and E. coli. Principal symptoms were irritability and fever. A significant proportion of neonates did not present suggestive symptoms of central nervous system infection. Additionally, prematurity was predominant in the studied population. Keywords Anti-Infective Agents; Bacterial; Electronic Health Records; Infant, Newborn; Meningitis, Pleocytosis; Sepsis Introducción: la meningitis bacteriana es una infección grave que requiere un abordaje terapéutico empírico temprano. En Colombia existe poca información sobre esta enfermedad en la etapa neonatal y es indispensable contar con datos actualizados que orienten la antibioticoterapia de manera oportuna. Objetivo: describir las características clínicas, microbiológicas y epidemiológicas de la meningitis neonatal bacteriana en tres centros hospitalarios de la ciudad de Medellín durante los años 2010 a 2019. Métodos: se realizó un estudio descriptivo a partir de todos los registros médicos electrónicos de recién nacidos atendidos en tres hospitales de la ciudad de Medellín desde 2010 hasta 2019. Se revisaron las historias clínicas con diagnóstico de egreso de meningitis bacteriana y que contaran con aislamiento microbiológico. Los datos fueron extraídos de SAP[R] y Servinte Clinical Suite Enterprise[R] y registrados en una hoja de cálculo de Google[R]. Resultados: se revisaron 125 historias con diagnóstico de meningitis neonatal. Sólo se incluyeron 42 casos con aislamiento microbiológico. La edad gestacional promedio fue 35 semanas, y los patógenos aislados con mayor frecuencia fueron Escherichia coli (40,5%) y Streptococcus agalactiae (40,5%). En el 71,4% la infección meníngea fue de clasificación tardía según la edad. Los principales síntomas fueron irritabilidad 56,1% y fiebre 48,8%. Conclusiones: los agentes causales más frecuentes encontrados en esta población fueron Streptococcus agalactiae y Escherichia coli. Los síntomas principales fueron irritabilidad y fiebre. En un gran porcentaje de neonatos no se evidenciaron síntomas sugestivos de infección del sistema nervioso central. Por otra parte, la prematuridad fue predominante en la población estudiada. Palabras claves Antiinfecciosos; Meningitis Bacteriana; Pleocitosis; Recién Nacido; Registros Médicos; Sepsis