Publications by authors named "Rolando Ulloa-Gutierrez"

Aim: We aimed to develop and test machine learning algorithms for the prediction of severe outcomes associated with MIS-C.

Method: An observational ambispective cohort study was conducted including children aged from 1 month to 18 years old in 84 hospitals from the REKAMLATINA (Red de la Enfermedad de Kawasaki en America Latina) network diagnosed with MIS-C from 1st January 2020 to 31st June 2022. Multiple models were developed to predict four main outcomes: paediatric intensive care unit (PICU) admission, need for inotropes, need for mechanical ventilation, and death.

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Background: Human metapneumovirus (hMPV) is a leading cause of acute respiratory infection in children, particularly early in life. Despite this, there are few prospective hMPV studies in Latin American children and this is the only of that kind in Costa Rica.

Methods: We conducted an observational descriptive prospective study at the only national tertiary referral pediatric hospital of the country.

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The 100-Day Mission, coordinated by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by significant international stakeholders, aims to shorten the timeframe for developing and implementing vaccines to 100 days after the report of a new pathogen. This ambitious goal is outlined as an essential first step in improving pandemic preparedness worldwide. This review highlights the mission's implementation potential and challenges by examining it through the lens of low- and middle-income countries (LMICs), which often face barriers to equitable vaccine access.

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In 2023, the Global Pertussis Initiative met to assess the burden of and vaccination policies against pertussis in 10 Latin American countries. Although pertussis is a notifiable disease in the represented countries, poor disease awareness, underrecognition in older individuals, and limited laboratory capacity and supplies challenge the collection of robust epidemiological data. Infants in all 10 countries receive a 3-dose primary series followed by ≥2 boosters.

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Background: Infants face a high risk of morbidity and mortality from pertussis early in life, leading to the adoption of maternal vaccination. This study aimed to review the characteristics of the maternal pertussis vaccination in Latin American (LATAM) countries and evaluate their impact on pertussis absolute mortality and case fatality rate (CFR) in infants under 1 year old.

Methods: LATAM countries with maternal tetanus, diphtheria and acellular pertussis (Tdap) vaccination in their National Immunization Programs were included.

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Data on the health impact of carbapenem-resistant bloodstream infections (CRE-BSIs) in pediatric populations from Latin America and the Caribbean (LAC) are limited. This systematic review aims to examine the demographic, clinical, and microbiological aspects and resource utilization of this infection in children from this region. This systematic review investigates the impact of CRE-BSIs in pediatric populations across LAC.

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Importance: There is growing understanding that Social Determinants of Health (SDH) impact on the outcomes of different pediatric conditions. We aimed to determine whether SDH affect the severity of MIS-C.

Design: Retrospective cohort study, 2021-2023.

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Background: Multisystem inflammatory syndrome (MIS-C) represents a diagnostic challenge because of its overlap with Kawasaki disease, Kawasaki disease shock syndrome, and toxic shock syndrome. Macrophage activation syndrome (MAS) is a frequently fatal complication of various pediatric inflammatory disorders and has been reported in MIS-C. Early diagnosis and prompt initiation by immune modulating therapies are essential for effectively managing MAS.

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Article Synopsis
  • - The study reviews the incidence and prevalence of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean, highlighting that RSV is a significant cause of lower respiratory tract infections and hospitalizations in the region, especially among young children and high-risk older adults.
  • - A systematic review method was used, analyzing 156 studies conducted from January 2012 to January 2023, primarily from Brazil, Colombia, and Argentina, with most studies being cross-sectional and low-risk for bias.
  • - Findings indicated a high prevalence of RSV in patients under 1 year old (58%), with notable ICU admission rates (42%) and mortality rates varying by age, suggesting a need for better methodological standards in clinical guidelines regarding RSV treatment
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Article Synopsis
  • The study aimed to investigate the epidemiology and outcomes of multisystem inflammatory syndrome in children (MIS-C) across 16 Latin American countries from August 2020 to June 2022.
  • Out of 1239 children with MIS-C, the majority were previously healthy, with common symptoms including abdominal pain and conjunctival injection, and nearly half required intensive care.
  • The overall death rate was 4.88%, notably higher for those not initially diagnosed with MIS-C, emphasizing the need for improved awareness and early detection of the syndrome.
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This Systematic Review assesses the economic impact of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean (LAC) in relation to healthcare resource utilization and associated costs. We searched online databases from January 2012 to November 2022 to identify eligible publications. We identified 12 publications that reported direct costs, indirect costs, and resources associated with RSV and its complications.

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Article Synopsis
  • Multisystem inflammatory syndrome in children (MIS-C) related to COVID-19 shows varied severity, with a lower mortality rate in wealthier countries, highlighting differences in outcomes across regions.
  • In a study of 1,239 children across 16 Latin American countries, the majority were previously healthy, but nearly half required admission to the pediatric intensive care unit (PICU), where they experienced more severe symptoms like myocardial dysfunction.
  • Key risk factors for PICU admission included being over six years old, experiencing shock or seizures, having low platelet counts, elevated inflammatory markers, and abnormalities on chest X-rays, with an overall mortality rate of 4.8%, which is notably higher than in high-income countries.
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Article Synopsis
  • The first 1,000 days of life are vital for child development, but there's a lack of information on influencing factors in the Latin America and the Caribbean (LAC) region.
  • In May 2022, the Latin American Pediatric Infectious Diseases Society (SLIPE) organized a workshop with experts to discuss key issues affecting childhood development and maternal infant health in LAC.
  • The goal was to identify priorities and create actionable recommendations to improve maternal and infant care, focusing on reducing mortality from infections and preventable diseases during this critical developmental period.
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Background: Pertussis remains as one of the oldest leading vaccine-preventable diseases of childhood, despite many decades of primary vaccine doses' and boosters' implementation. Although the epidemiology is well understood in infants and children, premature babies and low-birth weight infants remain a special group where the disease incidence is unknown, severity of the disease is considerable, and specific vaccination recommendations are scarce.

Research Design And Methods: A retrospective review of the available evidence of pertussis vaccination in premature and low birth weight infants was analyzed from January 2000 to December 2022 in six selected countries: Argentina, Mexico, Colombia, Panamá, Costa Rica, and Chile.

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Background: Cytomegalovirus (CMV) is the most common agent of congenital infection in humans. It is a main cause of neurodevelopmental delay and sensorineural hearing loss in infancy. Since the 2000s, a number of studies have used Valganciclovir as a therapy for children with congenital CMV infection.

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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.

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Objectives: To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA).

Study Design: An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected.

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