Point-of-care ultrasound by the pediatrician in the diagnosis and follow-up of community-acquired pneumonia

Abstract Objectives: To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines. Source of data: A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected. Synthesis of data: CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance. Conclusions: Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.

Prevalencia y factores asociados a macrosomía en Perú, 2013 / Prevalence and associated factors of macrosomia in Peru, 2013

RESUMEN Objetivos Determinar la prevalencia de macrosomía y factores asociados en Perú, y describir la ocurrencia de complicaciones durante el parto y posparto. Materiales y métodos Los pesos al nacer de los niños menores de cinco años fueron analizados usando datos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2013, llevada a cabo por el Instituto Nacional de Estadística e Informática. Los niños con un peso mayor a 4000 g al nacer fueron considerados como macrosómicos. Se empleó un análisis de regresión logística para establecer la asociación independiente de factores sociodemográficos con la macrosomía. Resultados La muestra estuvo constituida por 6121 niños. La prevalencia de macrosomía fue 5,3% (intervalo de confianza al 95%: 4,8 a 5,9). El sexo masculino, un orden de nacimiento mayor, la obesidad materna y una mayor estatura materna estuvieron independientemente asociados con la macrosomía. Los partos por cesárea fueron más frecuentes en niños macrosómicos (43,9% vs 26,9%). Las complicaciones durante el parto y posparto fueron frecuentes, pero no estadísticamente asociadas con la macrosomía. Conclusiones La prevalencia de macrosomía en Perú es relativamente baja comparada con otros países de ingresos bajos o medios. Los factores asociados con la macrosomía fueron principalmente no modificables, con excepción de la obesidad materna. Los niños macrosómicos nacieron más frecuentemente por cesárea. La reducción del peso y la prevención de la obesidad en mujeres en edad fértil en Perú podrían potencialmente reducir la macrosomía y las tasas de cesáreas.

ABSTRACT Objectives To determine the prevalence of macrosomia and factors associated with it in Peru and to describe the occurrence of complications peri- and postpartum. Materials and Methods Birth weights of children under the age of 5 years were analyzed using data from the 2013 Demographic and Family Health Survey (ENDES) carried out by the Instituto Nacional de Estadística e Informática. Children with a birth weight higher than 4000 g were considered macrosomic. A logistic regression analysis was used to establish the independent association of sociodemographic factors with macrosomia. Results The sample comprised 6121 children. The prevalence of macrosomia was 5.3% (95% interval confidence: 4.8-5.9%). Being male, a higher birth order, maternal obesity, and greater maternal height were independently linked with macrosomia. Caesarean births were more common in macrosomic children than unaffected ones (43.9% vs 26.9%). Complications during birth and postpartum were common but not statistically linked with macrosomia. Conclusions The prevalence of macrosomia in Peru is relatively low compared to other low-to-middle income countries. The factors associated with macrosomia were mainly unmodifiable, with the exception of maternal obesity. Macrosomic children were more frequently born by caesarean. Weight reduction and the prevention of obesity in women of childbearing age in Peru could potentially reduce macrosomia and caesarean rates.

Validación de los métodos de laboratorio / Validation of the laboratory methods

Validar un método es una manera de probar si un procedimiento en particular es adecuado para el propósito requerido. La correcta estandarización de un ensayo analítico, seguida de su validación y la homogeneidad de los reactivos químicos y biológicos a lo largo de los diferentes pasos, son elementos imprescindibles para alcanzar óptimos resultados. Los métodos necesitan ser validados o revalidados antes usarlos rutinariamente, cuando cambian las condiciones en las cuales se han validado y cuando el cambio está fuera del alcance del proceso original. Los analistas se preguntan a menudo si una técnica publicada validada se debe revalidar en su propio laboratorio. Se considera inaceptable que el profesional la utilice sin demostrar dichas propiedades in situ. Esto no significa, sin embargo, que el analista debe repetir completamente el estudio original de normalización. Es por lo tanto importante que esté familiarizado con el proceso de validación del método para seleccionar así los parámetros apropiados para cada caso.

Method validation is a way of testing a particular process to see if it is suitable for its intended purpose. The appropriate standardization of analytical assay, followed by the validation of the method and the homogeneity of the chemical and biological reagents used during the different test are indispensable elements for obtaining optimal results. Method validation is the process to confirm that the analytical procedure employed for a specific test is suitable for its intended use. Methods need to be validated or revalidated before their introduction into routine use, whenever the conditions change for which the method has been validated and the change is outside the original scope of the method. Analyst often wonder if a published validated technique must be revalidated in their own laboratory. It is considered unacceptable for the analyst to use a published validated method without demonstrating their capability "in situ". This does not mean, however, that the analyst must repeat completely the original normalization study. It is therefore important for the analyst to be familiar with the method validation process to enable the selection of the validation approach that's appropriate for the situation.