Background:Polyarteritis nodosa (PAN) is the third most frequent vasculitis in pediatrics, Cutaneous PAN (CPAN) being more common that Systemic PAN (SPAN). CPAN is frequently described as a benign disease. In children, PAN onset is frequent between 9 and 11 years of age, with no sex differences, and its clinical features may be nonspecific.Objectives:To characterize pediatric patients who were diagnosed with CPAN and SPAN and to compare their clinical features, treatments, and outcome.Methods:A descriptive study was conducted in two centers from Medellin- Colombia, using retrospective data from January 2010 to December 2019. Patients under 18 years of age classified as PAN according to EULAR/PRINTO/PRES(1) criteria were included. CPAN patients were defined according to EULAR/PRES definition (2). Data from medical records were registered, and were expressed in median and ranges and mean and standard deviation (SD) according to their distribution. A univariate analysis was carried out by comparing signs, symptoms, and treatment between CPAN and SPAN, and ap-value < 0,05was considered as significant.Results:Twenty patients were included. The median age at diagnosis was ten years. 60% were boys. The median follow-up period was 27 months. CPAN was diagnosed in 11 (55%) and SPAN in 9 patients (45%). The most frequent symptoms were cutaneous manifestations (95%), fever (60%) and Calf Pain (55%). Mucosal ulcers were described in four patients; 3 of them were defined as CPAN. Lingual necrosis was present in two CPAN, and peripheral nervous system involvement was found in one SPAN and two CPAN patients in skin affected with lesions; even though, no significant statistical differences between CPAN and SPAN were found in constitutional, cutaneous, muscle-skeletal symptoms, and acute phase reactants. Arteriographic anomalies as hepatic and renal microaneurysms, carotidal aneurysms without aortic involvement, and renal infarction were found in one patient each. Skin Biopsy was performed in 18 patients, being compatible with PAN in 16. All PAN patients (CPAN and SPAN) required treatment with glucocorticoids. None of the patients died during the follow-up period.Conclusion:In this Colombian pediatric cohort of PAN patients, the disease was more common in boys than girls, and CPAN was more frequent than SPAN, as already been described. As is evident in this cohort, although CPAN has been considered a benign disease, these patients may be severely ill, requiring glucocorticoid treatment. Pediatric CPAN patients should be strictly followed with particular attention to identify systemic involvement, considering that constitutional, cutaneous, and muscle-skeletal features may be very similar between CPAN and SPAN.References:[1]Ozen S, Pistorio A, Iusan S, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010 May;69(5):798–806.[2]Ozen S, Ruperto N, Dillon M, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006;65(7):936–41.Disclosure of Interests:None declared

Objetivo: describir las características del proceso de inducción del trabajo de parto relacionadas con el exceso de cesáreas en las mujeres a quienes se les realiza este procedimiento. Materiales y Métodos: cohorte histórica descriptiva en la que se incluyeron las gestantes sin antecedente de cesárea, con embarazo único, a término y presentación cefálica, sometidas a inducción del trabajo de parto en un hospital de tercer nivel de complejidad, en Medellín, Colombia, en el periodo de mayo de 2015 a octubre de 2016. Se excluyeron mujeres con feto muerto antes de la inducción. Muestreo consecutivo. Se midieron: edad materna, paridad, edad gestacional, indicación de la inducción del trabajo de parto, favorabilidad del cérvix, tiempo de la inducción, calidad de la actividad uterina lograda, tipo de parto, momento de la inducción en que se decide la cesárea. Para definir el cumplimiento de las recomendaciones de inducción se tuvieron como referencia las guías de práctica clínica de organizaciones internacionales de la especialidad y las nuevas directrices generadas en la propuesta de reducción de la primera cesárea del año 2012. Se utilizó estadística descriptiva. Resultados: de 2402 nacimientos se seleccionaron 289 que cumplieron con los criterios de inclusión. Se realizó cesárea al 48 % de las gestantes, a 60,8 % de las nulíparas y a 32,1 % de las multíparas someti- das a inducción. El 72,2 % de las que tenían cérvix desfavorable recibieron oxitocina como método de maduración cervical. A 108 (37%) de las mujeres llevadas a inducción de parto se les realizó cesárea por diagnóstico de inducción fallida que se conside- ró inadecuado en todas ellas, ya que el diagnóstico se realizó antes de alcanzar 6 cm de dilatación en 88 (81,5 %), con membranas íntegras en 67 (62 %), sin actividad uterina en 42 (38,9 %), con actividad uterina de mala calidad en 23 (21,3 %) y 55 (61 %), no tuvieron al menos 24 horas de fase latente antes de realizar la cesárea. Conclusión: se encontró falta de cumplimiento de las recomendaciones para una adecuada inducción que lleva a un diagnóstico errado de inducción fallida.

Introducción: La relación causa efecto entre la hipertensión arterial sistémica y un mayor riesgo para desarrollar síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es aún incierta. El desconocimiento de la influencia del SAHOS sobre lahipertensión arterial ha llevado al excesivo diagnóstico de hipertensión arterial idiopática, desmotivando la búsqueda de la real causa subyacente, que en la mayoría de los casos puede deberse a trastornos del sueño. Materiales y métodos: En el presente estudio se incluyen pacientes hipertensos quienesconsultaron en el centro médico ONIRIS, especializado en sueño, y se evaluó en ellos variables como índice de masa corporal, índice cintura cadera, circunferencia del cuello, tabaquismo y alcohol, para determinar cuáles de ellos desarrollaron SAHOS.Resultados: De 309 pacientes estudiados, el 67,4%, fue positivo para SAHOS, confirmando algún grado de asociación entre ésta y la hipertensión arterial. Además, variables incluidas como factores de riesgo arrojaron resultados muy similares a losobtenidos en otros estudios que han demostrado dicha asociación. Conclusiones: Tiene predominio por el sexo masculino, se presenta generalmente en mayores de 50 años y obesos; dichos factores ponen en un riesgo elevado al pacientede desarrollar eventos vasculares que disminuyen la calidad de vida e incluso  llevarlo a la muerte.

The objective is to know if breast cancer (BC) prognostic factors influence ovarian function and response to controlled ovarian stimulation (COS) in patients seeking fertility preservation (FP)? DESIGN: A total of 151 BC patients undergoing COS for FP were prospectively included between November 2013 and December 2016. COS was initiated regardless of the phase of the cycle, with or without letrozole supplementation. Matured oocytes and/or embryos obtained were vitrified. COS characteristics and outcomes were analyzed in all women MATERIALS AND METHODS: BC prognostic factors considered in the present study were Scarff-Bloom-Richardson (SBR) SBRIII grade, Ki 67> 20%, HER2 overexpression and "triple negative'' tumor. Univariate and multivariate analysis were performed to determine their impact on ovarian reserve markers (serum Anti-M€ ullerian Hormone (AMH) and antral follicle count (AFC)) as well as on ovarian response to exogenous FSH. Less than 8 mature oocytes vitrified, maturation rate under 70% or Follicle Output RaTe (FORT) under 35% were considered as poor COS outcomes RESULTS: A total of 154 COS cycles were performed and analyzed in BC patients 33.4AE4.1 years of age were analyzed. Mean AMH and AFC were 3.2AE4.5 ng/mL and 20.2AE14.3 follicles, respectively. HER2 overexpression was observed in 18.9% and 34.7% of tumors expressed estrogen or progesterone receptors. Triple negative status characterized 25% of tumors. BRCA1/2 mutation was found in 22.4% of patients. A mean of 9.2 AE 7.4 mature oocytes were cryopreserved per cycle. After multivariate analysis, only serum AMH levels, AFC and smoking status were significantly associated with the number of mature oocytes obtained following COS. BC prognostic factors did not appear to have a significant influence on ovarian reserve markers, number of retrieved oocytes, maturity rate or on ovarian response to exogenous FSH assessed by FORT index, defined as the ratio of the number of pre-ovulatory follicle (16-22 mm) count on the triggering day X100 to the antral follicle (3-8 mm) count at baseline CONCLUSIONS: BC prognostic factors probably have no or low impact on ovarian function in terms of ovarian reserve and response to COS. Further analysis, in particular after oocyte thawing will be needed to clarify a possible impact egg quality.

A clinical case of a Kasabach-Merritt syndrome secondary to a kaposiform hemangioendothelioma in a 2-month-old child is presented, which was confirmed clinically, laboratory tests and magnetic resonance imaging. The expression of the disease was characterized by a rapidly growing vascular tumor on the left thigh that progressed to disseminated intravascular coagulation that was difficult to control, requiring multiple transfusions and pharmacological support to compensate for its life-threatening condition.