Prevalencia y factores de riesgo asociados a infección por virus SARS-CoV-2 en trabajadores del Instituto Nacional de Salud del Niño de Perú, abril 2020 a marzo 2021

Objetivo: Determinar la prevalencia y factores de riesgo asociados a la infección por virus SARS-CoV-2 en trabajadores del Instituto Nacional de Salud del Niño (INSN), en el periodo de abril 2020 a marzo 2021. Materiales y métodos: Estudio no experimental, descriptivo, transversal. La muestra corresponde a 608 trabajadores de salud que resultaron positivos a la prueba serológica rápida. Se revisaron las fichas de investigación clínica epidemiológica COVID-19 elaboradas por el Ministerio de Salud de Perú, que fueron autoadministradas por los trabajadores de salud, y el personal de Epidemiología del INSN verificó el llenado de la ficha. Los datos se introdujeron en una base de datos que sirvió para el análisis estadístico respectivo. El estudio fue aprobado por el Comité Institucional de Ética en Investigación del INSN (código de registro: PI-17/21). Resultados: La prevalencia fue de 7,24 % de COVID-19 en trabajadores del INSN entre abril del 2020 y marzo del 2021. El 71,4 % fueron mujeres, los participantes presentaron una media de edad de 44,71 años, mayoritariamente en el rango de los 30 a 59 años (83,4 %); el 65,6 % fueron asistenciales, de los cuales la mayoría fueron técnicos en enfermería. El 56,9 % de los trabajadores presentaron síntomas, principalmente fiebre/escalofríos (12,2 %), tos (8,9 %), malestar general (7,7 %), dolor de garganta (6,7 %), congestión nasal (2,5 %) y cefalea (1,3 %) . La mayoría de trabajadores residían en los distritos de Lima . Se encontró asociación significativa por sexo y grupos de edad, tipo de trabajador y perfil del trabajador. Conclusiones: La prevalencia de COVID-19 entre los trabajadores del INSN fue del 7,24 %; las características más frecuentes que mostraron diferencias significativas con el resto de los factores fueron el ser mujer, trabajador asistencial y técnica de enfermería. El 56,9 % de los trabajadores presentó síntomas, solo el 20,9 %, signos clínicos y el 10,9 % tuvo comorbilidades.

Objective: To determine the prevalence and risk factors associated with SARS-CoV-2 infection among workers of Instituto Nacional de Salud del Niño (INSN) from April 2020 to March 2021. Materials and methods: A non-experimental, descriptive, cross-sectional study. The sample consisted of 608 workers who tested positive for COVID-19 using a rapid antigen test. The COVID-19 clinical-epidemiological research sheets prepared by the Ministry of Health of Peru and self-administered by the workers were reviewed. The INSN Department of Epidemiology staff verified the completion of the sheets. The data was entered into a database, which was used for the respective statistical analysis. The study was approved by the INSN Institutional Research Ethics Committee (registration code: PI-17/21). Results: COVID-19 prevalence among INSN workers was 7.24 % from April 2020 to March 2021. Out of the workers with COVID-19, 71.4 % were women; 83.4 % were in the 30 to 59 age range with an average age of 44.71 years; 65.6 % were healthcare workers, most of whom were nursing technicians; and 56.9 % experienced symptoms, mainly fever/chills (12.2 %), cough (8.9 %), malaise (7.7 %), sore throat (6.7 %), stuffy nose (2.5 %) and headache (1.3 %). Most workers lived in Lima Centro districts (33.2 %). A significant association between sex, age groups, worker type and worker profile was found. Conclusions: COVID-19 prevalence among INSN workers was 7.24 %; the most frequent characteristics, which showed significant differences with the rest of the factors, were being a woman, healthcare worker and nursing technician. A total of 56.9 % of the workers experienced symptoms, only 20.9 % developed clinical signs and 10.9 % had comorbidities.

Caracterización del dolor abdominal crónico en pacientes del Hospital Pediátrico Provincial Eduardo Agramonte Piña

Introducción: El dolor abdominal recurrente es un síntoma común en los niños y causa gran ansiedad a la familia. Representa hasta el 10 % de las consultas en pediatría, con frecuencia entre escolares y adolescentes, del 85 al 90 % de los casos la causa obedece a un trastorno de tipo funcional. Objetivo: Caracterizar el dolor abdominal recurrente en niños ingresados en el hospital pediátrico Eduardo Agramonte Piña de la provincia Camagüey. Métodos: Se realizó un estudio observacional, descriptivo, transversal, retrospectivo, cuyo universo de trabajo estuvo constituido por 122 pacientes ingresados con diagnóstico de dolor abdominal recurrente, durante el período de estudio. Para la obtención de la información se utilizó el análisis de documentos al revisar las historias clínicas del total de pacientes atendidos y los materiales bibliográficos. Resultados: De 122 pacientes estudiados el grupo más afectado correspondió al de 13-18 años de edad, seguido del grupo escolar de 7-12 años para un total de 73 y 45 casos, respectivamente. Entre los factores que aumentó la frecuencia estuvo la exposición mantenida a situaciones estresantes relacionadas con la disfunción del medio ambiente familiar y social del niño, expresados en los resultados, de 122 pacientes, 91 proceden de medios socio-ambientales disfuncionales, con predominio en las etapas escolares y de la adolescencia. Conclusiones: El número de pacientes con resultados de laboratorio negativos fue mayor que el de los positivos, por lo cual el dolor abdominal de origen funcional superó al de tipo orgánico.

Introduction: Recurrent abdominal pain (RAP) is a common symptom in children and causes great anxiety to the family. It represents up to 10% of pediatric consultations. It occurs frequently among schoolchildren and adolescents and in 85 to 90% of cases the cause is due to a functional disorder. Objective: To characterize the behavior of recurrent abdominal pain in children admitted to the Eduardo Agramonte Piña pediatric hospital in the province of Camagüey. Methods: An observational, descriptive, cross-sectional, retrospective study was carried out, whose universe of work consisted of 122 patients admitted with a diagnosis of recurrent abdominal pain, during the study period. To obtain the information, document analysis was used by reviewing the clinical histories of the total number of patients treated and the bibliographic materials. Results: Of a total of 122 patients studied, the most affected group corresponded to 13 to 18 years of age, followed by the school group of 7 to 12 years for a total of 73 and 45 cases, respectively. Among the factors that increased the frequency was sustained exposure to stressful situations related to the dysfunction of the child's family and social environment, expressed in the results: of 122 patients, 91 come from dysfunctional socio-environmental environments, with predominance in the schoolchildren and adolescents stages. Conclusions: The number of patients with negative laboratory results was greater than that of positive ones, that is why abdominal pain of functional origin exceeded that of organic origin.

Costos de hospitalización de menores de cinco años por gastroenteritis a causa de rotavirus. Hospital Pediátrico de Cienfuegos, 2018

RESUMEN Fundamento El estudio de los costos de la hospitalización por gastroenteritis por rotavirus es un tema estratégico ante la disyuntiva de introducir o no una vacuna contra rotavirus en Cuba. Objetivo estimar el costo institucional de hospitalización de pacientes menores de cinco años de edad por gastroenteritis a causa de rotavirus. Métodos estudio descriptivo, específicamente una evaluación económica parcial del tipo descripción de costos. Se utilizó el costo modelado por protocolo de atención ajustado a la práctica habitual. Fueron revisados los documentos normativos y se aplicó un ejercicio de ajuste a la práctica de rutina mediante consulta a expertos. El costo fue expresado en CUP de 2018. Resultados se estimó el ingreso en sala de Gastroenterología para el 93,1 % de los pacientes, de los cuales el 99,4 % resolvería el problema de salud. El salario resultó la partida de mayor aporte al gasto, aunque en la sala de Gastroenterología lo fueron los exámenes complementarios. El costo de hospitalización promedio modelado para la gastroenteritis por rotavirus fue de 435,13 CUP; este varió según la condición clínica con que arribe el paciente, entre 415,72 CUP y 1057,60 CUP. El costo fue sensible a la variación de la estadía en los servicios. Conclusión La hospitalización de un paciente menor de cinco años por gastroenteritis a causa de rotavirus representa altos gastos para el hospital. El servicio de atención a pacientes críticos y el ingreso previo en una sala clínica distinta a la de gastroenterología incrementan el costo de la atención.

ABSTRACT Background The study of the hospitalization costs for rotavirus gastroenteritis is a strategic issue given the dilemma of introducing or not a rotavirus vaccine in Cuba. Objective to estimate the institutional cost of hospitalization of patients younger than five years of age because of gastroenteritis due to rotavirus. Methods descriptive study, specifically a partial economic evaluation of the costs description type. Modeled cost per care protocol adjusted to standard practice was used. The normative documents were reviewed and an adjustment exercise was applied to routine practice by consulting experts. The cost was expressed in 2018 Cuban pesos. Results admission to the Gastroenterology ward was estimated for 93.1% of the patients, of which 99.4% would solve the health problem. The salary was the item with the highest contribution to spending, although in the Gastroenterology ward it was the complementary examinations. The average cost of hospitalization modeled for rotavirus gastroenteritis was 435.13 Cuban pesos; this varied according to the clinical condition with which the patient arrives, between 415.72 pesos and 1057.60 pesos. The cost was sensitive to the variation of the stay in the services. Conclusion Hospitalization of a patient younger than five years of age for gastroenteritis due to rotavirus represents high costs for the hospital. The attention service to critical patients and the previous admission to a clinical room other than that of Gastroenterology, increase the cost of care.

Dolor abdominal como motivo de consulta pediátrica durante la pandemia del SARSCoV- 2 (COVID-19) en Guayaquil, Ecuador / Abdominal pain as a reason for pediatric visiting during the SARS-CoV-2 (COVID-19) pandemic in Guayaquil, Ecuador

Objetivo: el objetivo de este estudio fue describir los casos de pacientes con dolor abdominal y diagnóstico confirmado de COVID-19. En países de Latinoamérica la pandemia ha tenido un gran impacto por el alto índice de mortalidad. Ecuador es el quinto país más afectado en la región en número de casos confirmados con una tasa de 223 fallecidos por cada millón de habitantes, ubicándose en el primer lugar de letalidad. En la población pediátrica el comportamiento del COVID-19 sigue siendo inespecífico. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el cual se incluyó a todos los pacientes menores de 18 años exceptuando neonatos, que ingresaron por dolor abdominal a un hospital pediátrico de la ciudad de Guayaquil entre los meses de abril y mayo de 2020 y obtuvieron diagnóstico confirmado COVID-19. Resultados: fueron incluidos 30 pacientes con diagnóstico confirmado de COVID-19 y dolor abdominal. La edad promedio fue 8,46 años a predomino del sexo masculino (70%). En la valoración del dolor 19 (63%) tuvieron un EVA moderado-severo y 11 (37%) EVA leve. 7 pacientes (23.33%) requirieron intervención quirúrgica, 21 (70%) necesitaron de unidad de cuidados críticos, y 1 (3.33%) falleció.Conclusiones: el dolor abdominal constituye un desafío diagnóstico en este tiempo de pandemia y debería ser considerado dentro de las posibles manifestaciones clínicas de COVID-19 en la población pediátrica..Au

Objective: the objective of this study was to describe the cases of paediatric patients with abdominal pain and confirmed diagnosis of COVID-19. In Latin American countries the pandemic has had a major impact from the high mortality rate. Ecuador is the fifth most affected country with a rate of 223 deaths per million inhabitants, ranking at the top of the fatality. In the paediatric population, the behavior of COVID-19 remains nonspecific. Materials and methods: an observational, descriptive and retrospective study was conducted, in which patients under the age of 18 were included except for newborns, admitted by abdominal pain and who obtained a confirmed diagnosis COVID-19. Results: 30 patients with confirmed diagnosis of COVID-19 and abdominal pain were included. The average age was 8.46 years at the predomin of the male sex (70%). In the pain assessment 19 (63%) had a moderate-severe EVA and 11 (37%) Mild EVA. 7 (23.33%) required surgery, 21 (70%) needed a critical care unit, and 1 (3.33%) Died. Conclusions: abdominal pain is a diagnostic challenge in this time of pandemic and should be considered within the possible clinical manifestations of COVID-19 in the paediatric population..Au

Congenital thymoma

Thymomas are a heterogeneous group of tumors arising from the epithelium of the thymus. They are categorized by the proportion of neoplastic epithelia to lymphocytes and by the degree of cytologic atypia. Thymomas constitute 0.2-1.5% of all malignancies and nearly all occur in patients over 20 years. We reviewed the available literature and found less than 50 cases of thymoma reported in children (<18 years of age), the youngest being 4 years old, and no cases in newborns. They represent less than 1% of all mediastinal tumors in children. Due to the limited number of cases in the pediatric population, the diagnosis and treatment in this population is extremely challenging. Thymomas in all age groups may be associated with paraneoplastic syndromes, being myasthenia gravis the most common, which is associated with a worse prognosis in the pediatric population. We present the first case of a newborn infant with congenital thymoma. This case demonstrates a rare tumor in an unusual age group and emphasizes the importance of multidisciplinary teamwork in the decision-making and management of this condition.

Manejo de la bronquiolitis aguda en el servicio de neumología pediátrica de Pinar del Río / Management of acute bronchiolitis in the pediatric pulmonology service in Pinar del Río

RESUMEN Introducción: la bronquiolitis aguda es la infección de vías respiratorias inferiores más frecuente en niños menores de un año, y supone el 18 % de todas las hospitalizaciones pediátricas. Objetivo: caracterizar el manejo de la bronquiolitis aguda en los pacientes ingresados en el servicio de neumología del Hospital Pediátrico Provincial Docente "Pepe Portilla" durante el año 2019. Métodos: se realizó un estudio observacional, descriptivo y de corte transversal. El universo estuvo constituido por los 612 pacientes con diagnóstico de bronquiolitis y la muestra fue de 482 pacientes. Resultados: predominaron los pacientes ingresados por cuadros ligeros de bronquiolitis (75,9 %), con estadía hospitalaria promedio menor de cinco días. Se realizaron hemograma, eritrosedimentación y radiografía de tórax en el 100 % de los pacientes, con bajo porcentaje de positividad. La ecografía de precordio se reportó en el 15,6 % por auscultación transitoria de soplos cardíacos. La oxigenoterapia fue prescrita en el 98,9 % de los casos, sin evidencia clínica de hipoxemia. Conclusiones: existió un exceso en la indicación de exámenes complementarios y prescripción de medicamentos. Se encontró prescripción irracional de broncodilatadores inhalados, esteroides sistémicos y antihistamínicos. Existe dependencia de los medios diagnósticos, lo cual refleja la necesidad de un mayor empleo del método clínico.

ABSTRACT Introduction: acute bronchiolitis is the most frequent lower respiratory tract infection in children under one year of old and accounts for 18% of all pediatric hospitalizations. Objective: to characterize the management of acute bronchiolitis in patients admitted to the pulmonology service at Pepe Portilla Pediatric Teaching Hospital during 2019. Methods: an observational, descriptive and cross-sectional study was carried out. The target group comprised 612 patients diagnosed with bronchiolitis and the sample included 482 patients who met the inclusion criteria: moderate, mild cases with risk factors and clinical history with complete data. Descriptive statistical techniques were applied to process the information collected. Results: patients were admitted for mild bronchiolitis (75.9%), with an average stay of less than 5 days. Complete Blood Count (CBC), erythrocyte sedimentation and chest radiography was performed in 100% of patients, with low percentage of positivity. Prechordal ultrasound was reported in 15.6% by transitory auscultation of cardiac murmurs. Oxygen therapy was prescribed in 98.9% of cases, with no clinical evidence of hypoxemia. Conclusions: there was an excess in the indication of complementary examinations and medication prescription. There was found an irrational prescription of inhaled bronchodilators, systemic steroids and antihistamines. There is dependence on diagnostic means, which reflects the need for a better application of the clinical method.

Candidiasis invasiva en pacientes pediátricos ingresados / Invasive candidiasis in hospitalized pediatric patients

RESUMEN Introducción: la candidiasis es una infección fúngica causada principalmente por especies de candida no albicans que aparece generalmente en la piel o las membranas mucosas de los pacientes. Objetivos: caracterizar la incidencia de especies de candida con mayor número de aislamientos en los pacientes pediátricos hospitalizados, en el Hospital Mariana Grajales (Servicio de Neonatología) y Hospital José Luis Miranda, en el período 2013 - 2018, en Villa Clara. Métodos: estudio descriptivo y transversal con 50 aislamientos del género candida en hemocultivos de pacientes hospitalizados Hospital Mariana Grajales (Servicio de Neonatología) y Hospital José Luis Miranda (Servicio de Terapia Intensiva), Villa Clara, de enero 2013 - septiembre 2018. Se utilizó la estadística descriptiva e inferencial, mediante el test de Ji cuadrado de Pearson (x2) o el test exacto de Fisher a las variables: año de estudio, tipo de hospital, tipo de servicio y especie de candida aislada. Resultados: los mayores aislamientos de candidiasis invasiva correspondieron al pediátrico, en el servicio de Terapia Intensiva, 2018 (única con significación estadística).En esta misma unidad, el grupo de candida spp obtuvo el mayor índice, seguido de candida tropicalis, sin significaciones estadísticas. En el servicio de Neonatología el mayor número de aislamientos correspondió a candida spp, seguido de candida guillermondii, ambas sin significación estadística. Conclusiones: el servicio de Terapia Intensiva fue el que mayor número de casos de candidiasis invasiva y el año 2018 fue el más representativo. El grupo de candida spp fueron las especies que más se aislaron en ambos hospitales.

ABSTRACT Introduction: candidiasis is a fungal infection caused mainly by non-albicans Candida species that usually appears on the skin or mucous membranes of patients. Objective: to characterize the incidence of Candida species with the highest number of isolates in hospitalized pediatric patients, at Mariana Grajales Hospital (Neonatology Service) and José Luis Miranda Hospital, in the period 2013 - 2018, in Villa Clara. Methods: descriptive and cross-sectional study with 50 Candida genus isolates in blood cultures of patients hospitalized at Mariana Grajales Hospital (Neonatology Service) and José Luis Miranda Hospital (Intensive Care Service), Villa Clara, from January 2013 to September 2018. Descriptive and inferential statistics using Pearson's chi-squared test (χ2) or Fisher's exact test to the variables: year of study, type of hospital, type of service and isolated Candida species. Results: the largest isolates of invasive candidiasis corresponded to the Intensive Therapy service from the pediatric hospital in 2018 (only with statistical significance). In this same hospital, the Candida spp group obtained the highest index, followed by Candida tropicalis, without statistical significance. The largest number of isolates corresponded to Candida spp in the Neonatology service, followed by Candida guillermondii, both without statistical significance. Conclusions: the Intensive Therapy service was the one with the highest number of cases of invasive candidiasis and the year 2018 was the most representative. The group of Candida spp was the most isolated species in both hospitals.

Effect analysis of diazepam combined with phenobarbital in the treatment of febrile convulsions in children / 中国基层医药

Objective@#To investigate the clinical effect of diazepam combined with phenobarbital in the treatment of febrile convulsions in children.@*Methods@#From January 2015 to July 2017, 100 children with febrile convulsions in the Women's and Children's Hospital of Ningbo were selected and divided into two groups by random number table, with 50 cases in each group.The control group was treated with diazepam, while the observation group was treated with diazepam combined with phenobarbital.The clinical efficacy, anticonvulsive time, myocardial enzyme index, hypersensitive C-reactive protein and incidence of adverse reactions were compared between the two groups.@*Results@#(1)The total clinical effective rate of the observation group(98%) was higher than that of the control group(χ2=4.891, P<0.05), and the time of stopping convulsion[(20.92±4.49)min] was shorter than that of the control group(t=5.443, P<0.05). (2)After treatment, the creatine kinase isoenzymes[(25.93±12.76)U/L], phosphocreatinase[(189.47±7.35)U/L], hydroxybutyrate dehydrogenase[(276.73±12.85)U/L], lactate dehydrogenase[(305.94±13.27)U/L], hypersensitive C-reactive protein[(5.04±1.65)ng/L] in the observation group were lower than those in the control group(t=4.961, 5.333, 5.901, 6.160, 5.354, all P<0.05). (3)During the treatment period, no obvious adverse reactions occurred in both two groups.@*Conclusion@#The combination of diazepam and phenobarbital can effectively arrest febrile convulsions in children, improve the clinical efficacy, protect myocardial cells, it has fewer adverse reactions, it is safe and reliable.

Effect analysis of diazepam combined with phenobarbital in the treatment of febrile convulsions in children / 中国基层医药

To investigate the clinical effect of diazepam combined with phenobarbital in the treatment of febrile convulsions in children.Methods From January 2015 to July 2017,100 children with febrile convulsions in the Women＇s and Children＇s Hospital of Ningbo were selected and divided into two groups by random number table,with 50 cases in each group.The control group was treated with diazepam ,while the observation group was treated with diazepam combined with phenobarbital.The clinical efficacy,anticonvulsive time,myocardial enzyme index,hypersensitive C-reactive protein and incidence of adverse reactions were compared between the two groups . Results (1)The total clinical effective rate of the observation group (98%) was higher than that of the control group (χ2 ＝4.891,P＜0.05),and the time of stopping convulsion [(20.92 ±4.49) min] was shorter than that of the control group(t＝5.443,P＜0.05).(2) After treatment,the creatine kinase isoenzymes [(25.93 ±12.76) U／L], phosphocreatinase [(189.47 ±7.35 ) U／L], hydroxybutyrate dehydrogenase [( 276.73 ±12.85 ) U／L ], lactate dehydrogenase[(305.94 ±13.27)U／L],hypersensitive C-reactive protein[(5.04 ±1.65)ng／L] in the observation group were lower than those in the control group (t＝4.961,5.333,5.901,6.160,5.354,all P＜0.05).(3) During the treatment period, no obvious adverse reactions occurred in both two groups.Conclusion The combination of diazepam and phenobarbital can effectively arrest febrile convulsions in children ,improve the clinical efficacy ,protect myocardial cells,it has fewer adverse reactions ,it is safe and reliable.

Application of the five-level pediatric emergency triage system: a single center study / 中华儿科杂志

Objective@#To assess the effectiveness in optimizing resources and shortening critical children′s waiting time in pediatric emergency department (PED) with five-level pediatric emergency triage system (PETS).@*Methods@#This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied. The data of patients who visited the pediatric emergency department from January 2015 to December 2017 were collected and analyzed, including age, sex, diseases, visiting time, triage rate and destination.@*Results@#A total of 375 985 patients were included, among whom males were 225 308 (59.9%) and females were 150 677 (40.1%), all younger than 14 years of age. The number of critical cases (level Ⅰ, level Ⅱ and level Ⅲ) was increased from 4 719 (3.7%) in 2015, 12 209 (10.2%) in 2016 to 16 188 (12.7%) in 2017. The number of non-critical patients (level Ⅴ) decreased year by year, as from 98 213 (76.8%) in 2015 to 75 210 (62.6%) in 2016 and 78 857 (61.7%) in 2017. The patients who classified as level Ⅰ or levelⅡaccording to the PETS were seen immediately by physician (n=1855, 0.5%). Overall, 119 738 patients (98.3%) who were classified as level Ⅲ or level Ⅳ could be seen by physician in a timely manner according to triage guidelines, while 2 112 patients (1.7%) could not. The mean waiting time was 9.09 min in level Ⅲ, 17.7 min in level Ⅳ, and 55.76 min in level Ⅴ patients, respectively. The critical cases admitted to the intensive care units were 175 (36.2%) in 2015, 350 (62.8%) in 2016 and 374 (66.2%) in 2017. The etiologies were respiratory diseases (73.3%), gastrointestinal diseases (15.8%) and infectious diseases (3.1%).@*Conclusion@#The application of PETS could optimize emergency resources and shorten the waiting time of critically ill children.

Forensic Pathological Examination on 73 Medical Malpractice Cases of Pediatrics / 法医学杂志

Objective To analyse 73 medical malpractice cases of pediatrics for discussing the importance of forensic pathology in solving the issues such as medical malpractice of pediatrics. Methods From January 2002 to August 2016, 73 medical malpractice cases of pediatrics with age of death between 28 days old and 10 years old were collected from Institute of Judical Expertise of Nanjing Medical University. The relationship between causes of death and related medical institutions was retrospectively analysed. Results In 73 cases, the male to female ratio was 1.70:1, and ages of 28 days old to 1 year old were com-mon (26 cases, 35.62％), followed by ages between 1 year old and 3 years old (21 cases, 28.77％). In 71 cases which had been determined the cause of death by postmortem examination, the main cause of death was disease, especially respiratory diseases (33 cases, 46.48％), followed by cardiovascular diseases (12 cases, 16.90％). In 75 medical institutes which involved with these medical malpractices, most were tertiary medical institutes (32, 42.67％), followed by the sub-secondary (excluding the secondary) medi-cal institutions (23, 30.67％). The clinical diagnosis of 38 cases (52.05％) completely or mostly corre-sponded with the pathological findings. There were 35 cases (47.95％) undefined or misdiagnosed cases. Conclusion Autopsy and forensic pathological examination contribute to determine causes of death, which not only provide scientific evidence for medical malpractice of pediatrics, but also enrich and develop clinical medical knowledge, and thus improve diagnosis and treatment level in a certain extent.

Study on the construction of job evaluation index system for clinical nurse specialist in comprehensive children′s hospital / 中国实用护理杂志

Objective To formulate job evaluation index system for clinical nurse specialist in comprehensive children′s hospital. Methods A total of 19 experts were consulted by two-round Delphi method to ensure the item of index system, the order and weight of each index was determined by hierarchy analysis. Results The evaluation index system included 5 level-1 dimensions, 13 level-2 dimensions and 30 level-3 items. The authority of the expert advisory coefficient was 0.84, determine coefficient was 0.91, familiarity cofficient was 0.77. The coordination coefficient of one, two, three indexes were 0.44, 0.52, 0.51, with statistical significance (P < 0. 05). Conclusions The job evaluation index system is reliable and valid, which can provide basis on job management.

Características epidemiológicas y clínicas de niños hospitalizados por enfermedad tuberculosa. centro hospitalario pereira rossell (2010-2013) / Epidemiological characteristics of children hospitalized for tuberculosis. pereira rossell hospital center (2010-2013)

Introducción: la tuberculosis (TBC) continúa siendo un problema de salud pública en el mundo. En Uruguay, en los últimos años se ha notificado un aumento en el número de casos de esta enfermedad en adultos y niños. L os diferentes métodos diagnósticos tienen bajo rendimiento en niños; arribar al diagnóstico especialmente en menores de 5 años constituye un gran desafío. Objetivo: describir las características epidemiológicas y clínicas de niños hospitalizados por enfermedad tuberculosa (ET) en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell ( HP-CHPR). Metodología: se realizó una descripción retrospectiva de los menores de 15 años que egresaron del HP-CHPR entre el 1° de enero de 2010 y el 31 de diciembre de 2013 con diagnóstico de ET. Se describen las características epidemiológicas, la forma de presentación clínica y la evolución. Resultados: en este período egresaron 64 niños con ET, tasa global de 15,4/10.000 egresos. La mayoría eran menores de 5 años, sanos. Se identificó algún contacto en 73,4% de los pacientes. La TBC pleuro-pulmonar fue la principal forma de presentación clínica. Se confirmó el diagnóstico en 17 pacientes (26,5%) en todos los casos de ET diseminada y tres de los cuatro niños con formas extrapulmonares. Las formas diseminada y extrapulmonar se asociaron a hospitalizaciones más prolongadas y mayor mortalidad. Conclusiones: en esta serie la ET afectó a niños pequeños previamente sanos, la mayoría con contacto identificado. La confirmación diagnóstica constituye un problema. La enfermedad extrapulmonar y diseminada presenta elevada morbimortalidad.

Introduction: tuberculosis is still a public health issue around the world. In Uruguay, the number of adults and children with tuberculosis has increased in the last years. The yield of different diagnostic methods is low in children, and thus its diagnosis in children under 5 years old is a great challenge. Objective: to describe the epidemiological and clinical characteristics in children hospitalized due to tuberculosis at the Pereira Rossell Hospital Center. Method: the study consisted of a retrospective description of children under 15 years old who were discharged from the Pereira Rossell Hospital Center from January 1, 2010 through December 31, 2013 with a diagnosis of tuberculosis. The epidemiological characteristics, the forms of clinical presentation and evolution are described in the study. Results: during this period, 64 children were discharged with tuberculosis, a global rate of 15.4/10.000 discharges. Most of them were healthy children under 5 years old. Some kind of contact was identified in 73.4% of patients. Pleuropulmonary tuberculosis was the main form of clinical presentation. Diagnosis was confirmed in 17 patients (26.5%), in all cases of disseminated tuberculosis and in three out of four children with extrapulmonary forms. The disseminated and extrapulmonary forms were associated longer hospitalizations and greater mortality rates. Conclusions: in this series tuberculosis affected small healthy children, most of them with an identified contact. Diagnostic confirmation is a problem. The disseminated and extrapulmonary disease has high morbimortality rates.

Introdução: a tuberculose (TBC) continua sendo um problema de saúde pública no mundo. No Uruguai, um aumento do número de casos em adultos e crianças foi registrado nos últimos anos. Os diferentes métodos diagnósticos disponíveis apresentam baixo rendimento em crianças; diagnosticar , especialmente em menores de 5 anos, é um grande desafio. Objetivo: descrever as características epidemiológicas e clínicas de crianças hospitalizadas por tuberculose (DT) no Hospital Pediátrico do Centro Hospitalario Pereira Rossell (HP-CHPR). Metodologia: uma descrição retrospectiva dos menores de 15 anos que tiveram alta do HP-CHPR no período 1° de janeiro de 2010 - 31 de dezembro de 2013 com diagnóstico de DT foi realizada. As características epidemiológicas, apresentação clínica e evolução foram descritas. Resultados: neste período 64 crianças com DT tiveram alta com uma taxa global de 15,4/10.000 altas. A maioria tinha menos de 5 anos e não apresentava outras patologias. Em 73,4% dos pacientes foi possível identificar pelo menos um contato. A TBC pleuro-pulmonar foi a principal forma de apresentação clínica. Em 17 pacientes (26,5%) o diagnóstico foi confirmado em todos os casos de DT disseminada e três das quatro crianças com formas extrapulmonares. As formas disseminada e extrapulmonar foram associadas a internações mais prolongadas e maior mortalidade. Conclusões: nesta série a DT afetou a crianças pequenas previamente saudáveis, a maioria com contacto identificado. A confirmação diagnóstica é um problema. A doença extrapulmonar e disseminada apresenta morbimortalidade elevada.

Application analysis of antibiotics in the pediatric outpatient and emergency treatment in our hospital / 中国医师进修杂志

Objective To analyze the usage of antibiotics after renovation in the use of this present situation and existing problems of pediatrics.Methods By application of our self-developed analyzing system for the clinical use of antibacterial agents,the prescriptions of pediatric outpatient in 2012 was studied retrospectively and their rationality was evaluated.Results The antibiotic prescription rate was 37.7％ in pediatric outpatient and emergency in our hospital,their were 26 antibacterial agents in clinic use which were involved in 6 pharmacological group.The defined daily dose(DDD) analysis was adopted and the results have shown that macrolides (42.20％),cephalosporins (35.90％) and penicillins (20.90％) were the most prescribed antibiotics and most of them were oral medicines (72.2％) and non restrictive drug (61.0％).The antibacterial agents' s combination therapy rate was 2.4％.Irrational use of drugs mainly include the wrong way of administration (78.0％),application of antibiotics with no indications (21.3％) and irrational combined use of antibiotics (0.5％).Conclusion The application of antibiotics in our hospital pediatric basic structure reasonable,but there are still improper usage and dosage,no indication of medicine,etc.It is necessary to further improve and perfect the use and management of antimicrobial agents.

Enfermedad tipo influenza en el Hospital Pediátrico de Moa. Enero-agosto 2010 / Influenza-like Illness at the Pediatric Hospital of Moa. January to August 2010

Fundamento: La enfermedad respiratoria producida por el virus de influenza A H1N1, constituyó la primera pandemia de influenza del siglo XXI, provocando gran morbilidad y miles de fallecidos, los daños no fueron mayores gracias a que el virus no mutó a formas más letales, no se desarrolló resistencia al Oseltamivir y la vacuna tuvo una buena compatibilidad con los virus circulantes. Objetivo: Caracterizar los pacientes ingresados por enfermedad tipo influenza (ETI) en el Hospital Pediátrico Universitario de Moa. Métodos: Se realizó un estudio de serie de casos, de 50 pacientes con diagnóstico de ETI, en el periodo comprendido entre el primero de enero y el 31 de agosto del año 2010. Las variables analizadas fueron: edad, sexo, tiempo de comienzo de los síntomas, factores de riesgo, síntomas y signos, comorbilidad asociada, signos radiológicos, evolución y confirmación del virus. Resultados: Existió predominio en el sexo masculino y en el grupo de uno a cuatro años; la fiebre se observó en el 100% de los pacientes; el principal factor de riesgo fue la edad menor de dos años en 27 pacientes (54 %); 39 (78 %) presentaron comorbilidad y/o factores de riesgo, con mayor comorbilidad del asma bronquial en 11 pacientes (22 %). Conclusión: La presencia de comorbilidad y/o factores de riesgo, así como el tiempo de comienzo de los síntomas, se relacionan de forma notable con la aparición de complicaciones en los pacientes con ETI.

Background: The respiratory illness due to the influenza A (H1N1) virus was the first influenza pandemic of the XXI century, causing high morbidity and mortality. The damage was not greater since the virus did not mutate into more lethal strains, no oseltamivir resistance was developed and there was a good match between the vaccine and the circulating viruses. Objective: To characterize patients hospitalized for influenza-like illness (ILI) at the University Pediatric Hospital of Moa. Methods: A case series study including 50 patients diagnosed with ILI was conducted from January 1st to August 31, 2010. The variables analyzed were age, sex, time of onset, risk factors, signs and symptoms, associated comorbidity, radiographic signs as well as virus evolution and confirmation. Results: Predominance of the disease was found in males and in the group aged one to four years; fever was observed in 100% of patients; age under two years was the main risk factor in 27 patients (54 %); 39 patients (78 %) had comorbidity and/or risk factors, with greater comorbidity of bronchial asthma in 11 cases (22 %). Conclusion: Presence of comorbidity and/or risk factors as well as time of onset are significantly related to the occurrence of complications in patients with ILI.

Cost-effectiveness of improving pediatric hospital care in Nicaragua / Costo-eficacia de la mejora de la atención hospitalaria pediátrica en Nicaragua

OBJECTIVE: To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. METHODS: Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. RESULTS: Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95 percent credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95 percent CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95 percent CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95 percent CI: -US$ 45- US$ 204). CONCLUSIONS: After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

OBJETIVO: Determinar el costo y la eficacia en función del costo de una intervención para mejorar la calidad de la atención de ni±os con diarrea o neumonía en 14 hospitales de Nicaragua, sobre la base de la información sobre gastos y la medición de las repercusiones. MÉTODOS: Se compilaron datos sobre la duración de la hospitalización y la mortalidad de una muestra aleatoria de 1 294 historias clínicas compiladas en 7 de los 14 hospitales participantes antes de la intervención (2003) y 1 505 historias clínicas compiladas después de dos a±os de ejecución de la intervención ("postintervención", 2006). Los a±os de vida ajustados en función de la discapacidad (AVAD) se obtuvieron de los resultados asistenciales. Se calcularon los costos de hospitalización según los registros de los hospitales y del Ministerio de Salud, y datos del sector privado. Los costos de la intervención se obtuvieron de los registros contables del proyecto. Para calcular la relación costo-eficacia incremental se usó un anßlisis de ßrbol de decisiones. RESULTADOS: La duración promedio de la hospitalización disminuyó de 3,87 y 4,23 días antes de la intervención a 3,55 y 3,94 días después de la intervención para la diarrea (P = 0,078) y la neumonía (P = 0,055), respectivamente. La letalidad disminuyó de 45/10 000 y 34/10 000 antes de la intervención a 30/10 000 y 27/10 000 después de la intervención para la diarrea (P = 0,062) y la neumonía (P = 0,37), respectivamente. Los costos totales promedio de la hospitalización y de los antibióticos para ambos diagnósticos fueron de US$ 451 (intervalo de confianza [IC] de 95 por ciento: US$ 419 a US$ 482) antes de la intervención y US$ 437 (IC 95 por ciento: US$ 402-US$ 464) después. La intervención representó un ahorro de costos en cuanto a los AVAD (IC 95 por ciento: -US$ 522 a US$ 32 por cada AVAD evitado) y costó US$ 21 por cada día de hospitalización evitado (IC 95 por ciento: -US$ 45 a US$2 04). CONCLUSIONES: Después de dos...

A iniciativa hospital amigo da criança sob a ótica dos atores sociais que a vivenciam em Teresina, Piauí / The baby-friendly hospital initiative as perceived by the social actors who experience it in Teresina, Piauí, Brazil

OBJETIVO: Analisar os reflexos da Iniciativa Hospital Amigo da Criança nos atores sociais que a vivenciam. MÉTODOS: Estudo qualitativo. Utilizaram-se entrevistas semiestruturadas, com auxílio de um roteiro temático, junto a vinte mulheres e dez profissionais de saúde em cinco hospitais amigos da criança em Teresina (PI). Para a análise dos dados foi utilizada a técnica de análise de conteúdo do tipo temática. RESULTADOS: A análise das falas levou à construção de dois eixos de discussão: um relacionado à tríade de sustentação da Iniciativa - promoção, proteção e apoio; e o outro a seu próprio modus operandi, os quais permitiram evidenciar dificuldades na implementação das normas e rotinas da Iniciativa Hospital Amigo da Criança desenvolvidas nas instituições. CONCLUSÃO: Os resultados revelaram a necessidade de ajustes para melhorar a resolutividade do programa, com ênfase para: adoção de uma nova matriz ensino-aprendizagem pautada na educação reflexiva e na adoção dos referenciais da pedagogia da problematização; fortalecimento das redes de apoio à mulher; investimentos na melhoria do acolhimento, tornando a relação cliente-profissional mais respeitosa e definição de um processo de monitoramento contínuo que permita a adoção de medidas corretivas sempre que se fizer necessário.

OBJECTIVE: This study analyzed the way the Baby-Friendly Hospital Initiative is perceived by the social actors involved in it. METHODS: This qualitative study administered semi-structured interviews aided by a thematic guide to twenty female patients and ten health professionals from five Baby-Friendly Hospitals in Teresina (PI), in Northeast Brazil. Thematic content analysis was used to analyze the data. RESULTS: Analysis of the testimonials led to two axes of discussion: one related to the foundation triad of the initiative - promotion, protection and support; and the other related to its own modus operandi, highlighting the difficulties for implementing the BFHI norms and practices carried out in these institutions. CONCLUSION: The results showed that adjustments are necessary to improve the effectiveness of the program, with special emphasis to: adoption of a new teaching-learning matrix based on reflexive education; adoption of references from the pedagogy of questioning; strengthening of women's support networks; investments for improving the receptiveness, thus creating a more respectful relationship between customers and professionals; and the establishment of a continuous monitoring system that allows the implementation of corrective measures whenever necessary.

Situación nutricional en pacientes pediátricos internados en un hospital público de la Ciudad de México / Nutritional situation of hospitalized pediatric patients in a public hospital in Mexico City / Estado nutricional de pacientes pediátricos internados em um hospital público da Cidade do México

A desnutrição é comum nos pacientes hospitalizados e tem importância especial nos pacientes pediátricos, já que pode comprometer seu desenvolvimento e crescimento. Por esta razão, é importante incluir a avaliação nutricional como parte da atenção ao paciente; esta prática deve ser realizada por meio de indicadores que reflitam o estado nutricional de maneira prática e simples. O objetivo deste estudo foi determinar a freqüência de desnutrição em pacientes pediátricos hospitalizados por meio de vários indicadores e relacionar ao tempo de internação da criança. A presença de desnutrição crônica, aguda ou crônica-agudizada foi avaliada nos pacientes hospitalizados no Serviço de Pediatria do Hospital Geral do México. Os pacientes foram divididos em grupos, de acordo com seu estado nutricional (desnutrição crônica, agudae crônica-agudizada) ou parâmetros bioquímicos inferiores à normalidade e foi realizada uma análise descritiva, assim como teste t Student para considerar a diferença entre médias em ambos os grupos com relação ao tempo de hospitalização. Foram avaliados 126 pacientes pediátricos. De acordo com os indicadores, foram observados: 21,2% pelo escore Z do peso para a estatura (desnutrição aguda), 32,3% e 37,2% pela estatura para a idade (desnutrição crônica) e peso para a idade, respectivamente; além de 13,8% de desnutrição crônica agudizada. Bioquimicamente, 13,5% das crianças apresentaram valores baixos de hemoglobina,32,2% do hematócrito, 31,9% da albumina e 23,7% das proteínas totais. Não houve diferença significativa entre pacientes desnutridos e com estado nutricional adequado em relação aotempo de hospitalização. A desnutrição é comum em pacientes hospitalizados. Este é um dado de grande importância no paciente do pediátrico, pois a desnutrição pode prejudicar seu crescimento e desenvolvimento ideais...

Malnutrition is a common issue among hospitalized patients. It has particular relevance in the children as it can compromise their optimal growth and development. Thus it is important to include nutritional assessment as part of the services given to the patient; this practice should be performed with practical and simple indicators of nutritional status. The aim of the study was to determine the frequency of malnutrition among hospitalized pediatric patients through various indicators and to relate nutrition status with the child’s length of stay. We evaluated the prevalence of chronic, acute or chronic-acute malnutrition in hospitalized patients at the Pediatrics ward at Hospital General de México. Patients were divided into groups according to their nutritional status (chronic, acute or chronic-acute malnutrition, according to their anthropometrical and biochemical parameters) and data was assessed descriptively and comparatively by Student ttests to determine mean differences between both groups (malnourished vs. well-nourished) inrelation to length of stay. We assessed 126 hospitalized pediatric patients. We found different types of malnutrition according to various indicators: 21.2% according to Z score of weight-for height(acute malnutrition), 32.3% and 37.2% by height-for-age (chronic malnutrition) andweight-for-age, respectively; in addition, we found 13.8% of chronic-acute malnutrition. Biochemical indicators showed that 13.5% of the population studied had abnormally low hemoglobin values, 32.2% low hematocrite values, 31.9% low albumin values and 23.7%total proteins values. We found no significant difference between malnourished and wellnourishedpatients in relation to length of stay. institutional healthsystem in order to assess and provide and adequate nutrition care attention to the patients toimprove their general condition and prognosis...

La desnutrición es común en los pacientes hospitalizados. Tiene especial importancia en los pacientes pediátricos, puesto que puede comprometer su desarrollo y crecimiento. Espor ello importante incluir la evaluación nutricia como parte de la atención al paciente; esta práctica debe llevarse a cabo a través de indicadores que reflejen el estado nutricio de manera práctica y sencilla. Es por ello que el objetivo de este estudio fue determinar la frecuencia de desnutrición en los pacientes pediátricos hospitalizados através de diversos indicadores y relacionarla al periodo de estancia intrahospitalaria del niño. Se evaluó la presencia de desnutrición crónica, aguda o crónica-agudizada en pacientes hospitalizados en el servicio de Pediatría del Hospital General de México. Los pacientes se dividieron engrupos de acuerdo a su estado nutricio (desnutrición crónica, aguda, crónica agudizadao parámetros bioquímicos inferiores a la normalidad) y se llevó a cabo un análisis descriptivo, así como diversas pruebas t para estimar la diferencia entre medias y comparar los dos grupos en relación al tiempo de hospitalización. Se evaluaron 126 pacientes pediátricos. Se observaron diferentes frecuencias de desnutrición de acuerdo a varios indicadores:21.2% de acuerdo al puntaje Z del peso para la talla (desnutrición aguda), 32.3% y37.2% por talla para la edad (desnutrición crónica) y peso para la edad, respectivamente; además se encontró un 13.8% de desnutrición crónico-agudizada...

A survey of transfer forms at the Lady Ridgeway Hospital for Children.

Objective To assess type and adequacy of information provided by transfer forms (TFs) at two units of Lady Ridgeway Hospital for Children (LRHC), Colombo. Design Prospective observational study. Setting Wards 8 and 9 of LRHC. Subjects All children transferred from other medical institutions. Method Study was carried out over 3 months from 15th March, 2002 on all patients transferred to wards 8 and 9 from another hospital. Type of information provided in TFs was assessed and details taken into a pre-tested questionnaire. The information was analysed using Epi Info Version 6.04b. Results A total of 172 TFs, accounting for 3% admissions, were analysed. 74% transfers were under 5 years of age. Full name was not provided in 60%. Race and religion were not given in 35% and 43% respectively. Incomplete addresses were given in 10% and no addresses in 27%. Most transfers were from teaching, provincial and base hospitals. In 54% consultants had not signed TF and in 26% designation of transferring officer was not provided. Results of investigations were provided only in 57%. In 74% there was neither a diagnosis card nor a referral letter. Main complaints and clinical signs were given in 74% but details of patient's condition at time of transfer were given in only 42%. Date of admission to transferring institution was provided in only 18%. Treatment was instituted at transferring station in 74% but only 15% mentioned the date of starting treatment. In 30% duration of treatment was provided and in only 13% was date and time of last dose of drugs documented. Conclusions There were significant inadequacies in information provided in many TFs. A revised format of printed TF should be adopted to minimize these deficiencies.

Comportamiento de indicadores hospitalarios durante el decenio 1990-1999

Se realiza un estudio de tipo serie cronológica, con el objetivo de precisar el comportamiento de indicadores hospitalarios seleccionados, durante el decenio 1990-1999, para lo cual se determinó la tendencia lineal por el método de los semipromedios. Se observó una ligera tendencia al incremento de las consultas realizadas y del promedio de casos vistos por consulta, asimismo la tendencia del número total de casos vistos en consulta mostró un franco incremento, fundamentalmente por el aumento de los casos atendidos en consultas de especialidades quirúrgicas y consultas multidisciplinarias. Se constató una franca tendencia decreciente del número de ingresos en la institución, del índice ocupacional y de la estadía; la tendencia decreciente del número de fallecidos y de la tasa de mortalidad neta fue más discreta. También se evidenció una franca tendencia al incremento del número de operaciones ambulatorias. Como conclusión se verificó un comportamiento favorable durante los últimos 10 años de casi todos los indicadores hospitalarios seleccionados para análisis, posiblemente relacionado con los cambios organizativos efectuados en la institución durante la segunda mitad de la década estudiada.

A chronological study was conducted aimed at knowing the behavior of selected hospital indicators during 1990-1999, for which the lineal trend was determined by the semiaverages method. It was observed a light trend towards the increase of the consultations made and of the average of cases seen at the physician’s office. The trend of the total number of patients that received attention at the physician’s office showed a high increase due mainly to the rise of cases attended by different surgery specialists and multidisciplinary teams. It was observed a decreasing trend of the number of hospital admissions, of the bed occupancy rate and of hospital stay. The trend towards the reduction of deaths and of the net mortality rate was more discrete. A trend towards the increase of the number of ambulatory operations was also observed. A favorable behavior of almost all the hospital indicators selected to be analyzed was confirmed during the last 10 years due possibly to the organizational changes that occurred during the second half of the studied decade.