Bombas de infusión continua de jeringa en unidades neonatales / Continuous infusion pumps at neonatal intensive care units

Introduction: Continuous Infusion pumps (CIP) are frequently used at neonatal intensive care units (NICUs), to administer medications at flow rates lower than 1 ml/H. Various factors have been shown to alter their performance. No studies have been completed in Chile in this area. Objectives: To describe frequent clinical practices to administer medications through CIP at NICUs in Chile, and suggest recommendations about it. Methods: Four professionals at NICUs in 19 centers were surveyed regarding syringe size, flow rate and precautions. Results: When starting countinuous infusion, 81.9 percent of surveyed professionals use 50 cc syringes, and 66.7 percent of them use flow rates under 1 ml/h. Main precautions include elimination of bubbles in the circuit (51.4 percent), review of conections (38.9 percent) and precise fit between the syringe and the CIP (36.1 percent). Conclusions: In surveyed NICUs, low flow rates and 50cc syringes are frequently used to infuse medications. NICU staff must consider factors that affect the performance of CIP, prefer smaller syringes and flow rate over 1 ml/h for continuous infusion of drugs.

Introducción: En las unidades de cuidado intensivo neonatal (UCIN) se utilizan frecuentemente bombas de infusión continua (BIC) a flujos menores de 1 ml/h para administrar medicamentos. Está demostrado que distintos factores alteran el funcionamiento de las BIC a flujos bajos. En Chile, no existen estudios que describan prácticas relacionadas al uso de BIC. Objetivo: Describir prácticas clínicas frecuentes al administrar medicamentos en BIC en UCIN de Chile y proponer recomendaciones respecto a su uso. Método: Se encuestaron 4 profesionales de UCIN en 19 centros. Los principales aspectos evaluados fueron: tamaño de jeringa usado en las BIC, flujos de infusión continua utilizados y precauciones al instalar una BIC. Resultados: Al instalar una infusión continua, el 81,9 por ciento de los profesionales encuestados usa jeringas de 50 ml y el 66,7 por ciento utiliza flujos menores de 1 ml/h. Las principales precauciones fueron la eliminación de burbujas del circuito (51,4 por ciento), la revisión de las conexiones del sistema (38,9 por ciento) y el ajuste preciso entre jeringa y BIC (36,1 por ciento). Conclusiones: En las UCIN estudiadas se utilizan frecuentemente flujos bajos y jeringas de 50 ml para infundir medicamentos. Las UCIN deben considerar los factores que alteran el funcionamiento de las BIC y preferir el uso de jeringas de menor tamaño y flujos mayores de 1 ml/h para la infusión continua de medicamentos.

Knowledge; Attitudes and Practices of Women Regarding the Prevention of Mother-To-Child Transmission (PMTCT) Programme at the Vanguard Community Health Centre; Western Cape - A Pilot Study

Objective.The aim of the study was to determine the knowledge; attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre (CHC). Method. A descriptive study was conducted using an administered; structured questionnaire.Subjects and setting. Thirty-six educated women aged 18 - 39 years and attending the clinic took part.Participants were from informal settlements and mostly unemployed; receiving government grants.Results. The majority (88.9) scored 80or more with regard to general HIV knowledge. Although the majority (78) were formula feeding; primarily owing to their HIV status and convenience while working; 24would not be able to sustain this feeding method after the initial 6 months' free supply provided by the provincial health services. The majority could not define the terms exclusive breastfeeding (89); mixed feeding (81) or cup feeding (94) correctly. Attitudes were found to be positive with regard to both breastfeeding and formula feeding; but HIV status influenced it significantly ( p 0.1). Conclusion. In conclusion; certain aspects of the PMTCT programme appear to have been effective at the CHC included in this study. The women were knowledgeable about HIV transmission and mother-to-child transmission (MTCT); but they were uninformed about certain essential aspects; i.e. prevention; cure and infant feeding.Attitudes were similar towards breastmilk or formula milk as a feeding choice but were influenced by HIV status. It was indicated that an informed decision-making process was not followed; rather that the women were advised to formula feed. Sustainability of formula feeding after 6 months and training of health workers specifically regarding feeding options need to be addresse

Miastenia gravis en pediatría / Myastenia gravis in paediatrics

La miastenia gravis corresponde a una patología auto inmune que se presenta en todas las edades. Tiene una frecuencia general de 10 a 20 por 100 000 individuos y aproximadamente un 15 por ciento corresponde a niños. Se caracteriza por la presencia de debilidad muscular y fatiga fácil secundaria a una alteración de la transmisión sináptica neuromuscular. Su patogenia se basa en la presencia de anticuerpos antireceptor de acetilcolina que generan el bloqueo y destrucción de los receptores de acetilcolina de la unión neuromuscular. Estos anticuerpos al ser pesquisados en un paciente con clínica sugerente confirman el diagnóstico. A pesar del conocimiento actual de la enfermedad su tratamiento aún es controversial existiendo distintas alternativas. En la última década han existido avances en la descripción de mecanismos fisiopatológicos involucrados en la miastenia gravis y asimismo nuevas opciones terapéuticas. El objetivo de esta revisión fue actualizar el conocimiento de la miastenis gravis en pediatría principalmente en las áreas de diagnóstico y tratamiento. Se realizó una revisión en las bases de datos Cochrane, Medline y Doyma de los últimos 10 años. Los resultados muestran descripciones moleculares de la patología, experiencias de la timectomía como tratamiento en niños e investigaciones en el manejo inmunológico de la enfermedad.

Síndrome de activación macrofagico en pediatría: a propósito de cuatro casos / Activated macrophage syndrome in paediatrics: 4 clinical cases

Introducción: El Síndrome de Activación Macrofágico (SAM) es una entidad poco frecuente en la práctica pediátrica que se caracteriza por una excesiva activación del sistema macrofágico y por una liberación exagerada de citoquinas por parte de los linfocitos T, y que clínicamente se manifiesta como un síndrome semejante a una falla orgánica múltiple. Existe actualmente disparidad en la nomenclatura de este síndrome, y es así como a nivel de la reumatología pediátrica se mantiene el término de SAM, mientras que para los hemato-oncólogos esta enfermedad está incluida dentro de las diferentes variedades de histiocitosis. Objetivo: Actualizar el conocimiento respecto de la etiología, clínica y tratamiento del SAM, enfermedad de baja frecuencia y alta mortalidad, en relación al análisis de 4 casos clínicos. Casos clínicos: 2 pacientes eran portadores de una enfermedad reumatológica, Artritis Idiopática Juvenil, el tercer paciente presentaba elementos de Inmunodeficiencia, y el último niño de linfohistiocitosis familiar congénita. Los factores desencadenantes del SAM fueron fármacos en dos pacientes y una posible causa infecciosa en los dos restantes. Los cuatro pacientes sobrevivieron al proceso inicial después de recibir una terapia agresiva inmunosupresora con esteroides en altas dosis y ciclosporina intravenosa. Conclusión: La importancia de dar a conocer este síndrome, radica en que un diagnóstico precoz y una terapia agresiva, preferentemente con ciclosporina y pulsos de esteroides en altas dosis, puede mejorar significativamente el pronóstico de esta enfermedad.

Centro de atenção multidimensional à família do Centro Universitário Franciscano (CAMAF) / Multidementional attention center to the family of the Franciscan University Center

The purpose of this study was to know the family's world where the child and the adolescent live, interact with the family, intending to fortify is as health unit multi-professional care, to promote opportunities of mutual aid to child, adolescent and their families, possibility to construct the best life quality, by multi-professional attention. The actions are developed by a program that works with simultaneous professionals performing, intent to supply the several needs of each and her or his family. This program resulted in good school performance, none hospitalization and effective families participation...

Paw preference in mice with callosal defects induced by prenatal gamma irradiation

The development of the corpus callosum of male Swiss mice was perturbed by exposure to gamma radiation at embryonic day 16 with total doses of 2 Gy (N = 48) or 3 Gy (N = 26). At adulthood paw preference was studied in these callosal defective animals and in 93 control nonirradiated male Swiss mice. The analysis of directional laterality indicated a populational tendency for right paw use in the 2 Gy group (60 per cent ) that was markedly increased in the 3 Gy group (95 per cent ). In the 3 Gy group, directional laterality was significantly different from chance in contrast to that observed in normal controls (49 per cent ). In the three groups most mice presented a significant individual paw preference. These data are consistent with our hypothesis that the early absence of the corpus callosum disrupts the normal pattern of directional asymmetries

The effects of total and partial callosal agenesis on the rotatory behavior of Balb/cCF mice

We report a study on rotational behavior (free swin test) of 30 adult male mice of an inbred strain in which about 20% of the animals are born with callosal defects (the BALB/cCF strain). The experiment was designied to study the relationship between the development of the corpus callosum and the degree of lateralization in rotatory behavior. Most of the BALB/cCF mice (77%) were lateralized rotators. Although most animals with a normal callosal area presented individual asymetry, there was no signficant tendency for a populational asymetry toward one side in this group. In contrast, 75% of the animals with abnormally callosal areas were left rotators. These animals, therefore, presented not only individual asymetry, but also a tendency for a populational asymetry. It was concluded that disturbances in the development of the corpus callosum are related to the appearence of directional populational asymetry in rotatory behavior

Absence of populational cerebral asymmetries in mice with callosal defects induced by prenatal gamma irradiation

The development of the corpus callosum of 19 male Swiss mice was disturved by exposure to a 60Co gamma source on embryonic day 16 with a total dose of 2 Gy (dose rate of 56 to 59 rads/min). At adulthood the animals were perfused with saline followed by formaldehyde and the cerebral hemispheres were weighed and phtographed in dorsal, lateral and medial views. Brain asymmetries were evaluated by measurements of hemisphere weight, as well as dorsal and lateral areas. From the measurements of the midsagittal callosal areas, performed on the medial views, 2 subgroups could be identified: one with a small callosal remnant (N=9) and another with a non-measurable callosal area (N=10). In spite of a pronounced individual asymmetry, the irradiated mice (N=19) did not show a populational asymmetry toward any side. A slight tendency favoring the left hemisphere was found in the small remmant subgroup. These results are consistent with our previous data for a strain of mice in which some animals present callosal defects. We conclude that the present data support the hypothesis that the corpus callosum may play a role in directing morphological hemispheric asymmetries

Métodos de controle da dor pós-operatória / Methods of control of postoperatory pain

A dor pós-operatória é um problema de considerável magnitude e transcendência. Além do sofrimento, ela está geralmente associada a muitos efeitos adversos. Uma melhor compreensäo dos mecanismos neurais envolvidos no processamento da informaçäo nociceptiva e da farmacocinética e farmacodinâmica das drogas usadas em anestesia e controle da dor nos permitiram usar eficazmente métodos farmacológicos e näo farmacológicos para o seu tratamento no pós-operatório. Opióides por via sistêmica, peridural e intratecal; analgesia com quetamina; analgésicos antiinflamatórios näo esteróides; bloqueios neurais; terapia psicológica; eletro-estimulaçäo transcutânea; crioanalgesia e inalaçäo de analgésicos gasosos e voláteis säo discutidos nesta revisäo