Mayor riesgo de infecciones asociadas a atención en salud en niños con necesidades especiales hospitalizados / Higher risk for health care associated infections in hospitalized children with special health needs

Background: Nosocomial infections (NIs) represent an important public health issue, being associated with high morbidity, mortality and costs. Objectives: To identify risk factors of NIs in a cohort of hospitalized pediatric patients, with emphasis in children with special health care needs (CSHCN). Patients and Methods: We studied patients hospitalized in Sótero del Río Pediatric Hospital at Santiago-Chile, between September and December, 2009. Relative Risk (RR) was calculated between CSHCN-3 (children attended by three or more health care professionals) versus non CSHCN-3, and between children with medical complexity (CMC) versus non CMC, using log-binomial models. Results: 920 patients were included. Prevalence of NIs was 12.7%. The most frequent diagnoses were gastrointestinal and respiratory viral infections. Both crude and adjusted by confounders (age and sex), CSHCN-3 and CMC presented significantly higher risk of NIs compared to patients without these conditions (RR 2.91 and RR 2.16, respectively). Conclusion: CSHCN-3 and CMC represent independent conditions associated to a 2-3 fold risk of NIs.

Introducción: Las infecciones asociadas a atención en salud (IAAS) representan un problema frecuente, el cual se asocia a una mayor morbimortalidad y costos. Objetivos: Evaluar factores de riesgo de IAAS en una cohorte de niños hospitalizados, con énfasis en el grupo de niños y adolescentes con necesidades especiales de atención en salud (NANEAS). Materiales y Métodos: Estudio realizado en el Hospital Sótero del Río, Santiago-Chile, entre septiembre y diciembre de 2009. Se calculó riesgo relativo (RR) de IAAS entre pacientes NANEAS-3 (niños controlados por tres o más profesionales de la salud) versus no NANEAS-3, y entre niños con complejidad médica (NCM) versus no NCM, a través de modelos log-binomial. Resultados: Se obtuvo información de 920 pacientes. Un 12,7% presentó IAAS; las más frecuentes fueron infecciones virales gastrointestinales y respiratorias. Tanto en forma cruda como ajustada por variables confundentes (edad y sexo), los pacientes NANEAS-3 y NCM presentaron significativamente mayor riesgo de IAAS versus aquellos que no cumplían estas definiciones (RR 2,91 y RR 2,16, respectivamente). Conclusiones: Los pacientes NANEAS-3 y NCM representan condiciones independientes asociadas a un riesgo dos a tres veces mayor de IAAS.

Enfermedad renal crónica: Clasificación, identificación, manejo y complicaciones / Clinical guidelines on identitication, management and complications of chronic kidney disease

The key messages of these guidel ines on chronic kidney disease are: • Chronic kidney disease (CKD) is a public health problem due to its wide distribution, high rate of complications and cost. • CKD is a common condition, its prevalence being about 10 percent, and is treatable if it is detected on time. • A patient with CKD has a higher risk of cardiovascular mortality than of progression of its underlying renal disease. • A new definition of CKD, based on estimated Glomerular Filtration Rate (eGFR) and kidney damage, facilitates its detection and management. • CKD is detected with three simple tests: 1) Blood pressure measurement, 2) Detection of proteinuria or albuminuria in an isolated urine sample, and 3) Estimation of renal function (eGFR), based on serum creatinine, age, gender and race. • The CKD risk groups are individuáis with diabetes, hypertension and a family history of renal disease. • The most cost-effective measures are to detect and treat diabetic and hypertensive patients in the community. • Therapy must emphasize the maximal reduction of cardiovascular risk. • The complications of CKD such as anemia and renal osteodystrophy can be identified and treated on time. • Most patients with chronic kidney disease are detected in the community, therefore their initial care must be organized at the level of primary care, along with programs for hypertension and diabetes.

Tumores de párpados: diagnóstico macroscópico / Tumors of the eyelids: macroscopic diagnosis

Los tumores de los párpados son frecuentes. La mayoría de ellos son benignos; sin embargo pueden ser malignos, con gran capacidad de diseminación local y a distancia. La única vía para determinar con seguridad las características de un tumor es tomar una muestra de éste para su estudio histopatológico. El objetivo de esta revisión es estudiar los tumores palpebrales, sus diagnósticos diferenciales y plantear, en caso de que sea necesario, su oportuna derivación a Oftalmología, de acuerdo a las características macroscópicas tumorales.