Nutrición materno infantil en los primeros 1000 días de vida: Manual de Bolsillo / Maternal and child Nutrition in the first 1000 days of life: Pocket Manual

USAID, conjuntamente con el INCAP impulsan un proceso de capacitación para 300 auxiliares de enfermería situados en el primer nivel de atención en salud, en el ámbito geográfico de cinco departamentos del occidente de Guatemala (Quetzaltenango, Totonicapán, San Marcos, Quiché y Huehuetenango), dirigido a fortalecer las competencias para mejorar la atención en salud y nutrición materno infantil, en el marco de la Ventana de Oportunidad de los 1,000 días de vida y se ha considerado necesario dotar de una herramienta de consulta rápida con información priorizada y condensada que faciliten las acciones de evaluación del estado nutricional y consejería efectiva para el grupo materno infantil.

Balloon valvuloplasty in dysplastic pulmonary valve stenosis: immediate and intermediate outcomes

To determine the immediate and intermediate outcome in dysplastic and doming pulmonary valve stenosis in children and to determine various factors associated with unsuccessful outcome. An interventional study. The Children's Hospital, Lahore, Pakistan, from June 2006 to December 2012. All patients presenting with severe pulmonary valve stenosis were enrolled in the study. Balloon valvuloplasty was performed on all patients. Successful outcome [residual gradient < 36 mmHg] was compared with matched doming pulmonary valve stenosis control group valvuloplasty. Difference in various quantitative variables was calculated using independent t-test and Mann Whitney U test. Categorical variables were compared using Chi square and Kruskal-Wallis test. Multivariate analysis was performed to determine various factors associated with outcome. Kaplan- Meier survival table was used to determine freedom from re-intervention proportions. One hundred and fifty two patients [Dysplastic group A, n=73; Doming group B, n=79] with median age of 24 months [range 3 - 192 months] and M:F; 2:1 were included in the study. Mean gradient decreased from 96 +/- 33 mmHg to 29 +/- 20 mmHg. Group A had significantly higher number of patients with unsuccessful outcome [9.6%, p=0.02]. Preprocedure gradient > 75 mmHg was the most significant factor associated with unsuccessful outcome [p < 0.001]. Median follow-up duration was 3 years [range 1 - 6 years]. Freedom from re-intervention proportion at 1, 3 and 6 years was 91.3%, 86.7% and 78.9% respectively in group A compared to 100%, 96.5% and 96.5% respectively in group B. Immediate postprocedure gradient > 60 mmHg was the only significant factor associated with re-intervention in group A [p=0.001]. The results from balloon valvuloplasty in dysplastic pulmonary valve were suboptimal when compared to doming valves. However, it provides a high freedom from re-intervention rate in intermediate follow-up. Intervention at moderate severity can result in better outcome

Pertinencia entre el perfil de los egresados(as) de Medicina y Enfermería con el Sistema Nacional Integrado de Salud en el primer nivel de atención, 2010-2011 / Relevance between the profile of graduates of Medicine and Nursing with the National Integrated Health System in the first level of care, 2010-2011

La presente investigación tuvo como propósito realizar un análisis de pertinencia entre las competencias genéricas y específicas de los egresados y las egresadas de las carreras de medicina y enfermería, y las necesidades del actual Sistema Integrado e Integral de Salud en el primer nivel de atención. Los objetivos fueron identificar el nivel al cual dichas competencias habían sido desarrolladas en los Egresados(as) durante su formación académica; identificar las capacidades de los profesionales médicos y de enfermería que se demandan y ejercen en los servicios de APSI durante su servicio social; identificar la existencia de posibles brechas entre las competencias requeridas por el Sistema Integrado de Salud en el primer nivel de atención y las que fueron desarrolladas a través de los planes de estudio a los Egresados(as) de las carreras anteriormente mencionadas con el fin de proponer alternativas de solución para la disminución de las brechas identificadas. El estudio fue de carácter descriptivo y transversal, realizando análisis de la percepción de los Egresados(as) de Medicina y Enfermería que se encontraban realizando su Servicio Social durante el 2010 y que estaban asignados en las Unidades de Salud de las cinco Regiones de Salud, teniendo además como fuentes de información a los responsables de los servicios durante su servicio social y a sus profesores/as. El Universo de estudio estuvo conformado por 589 estudiantes egresados(as), 410 médicos y 179 enfermeras. La muestra 345 estudiantes, de los cuales 199 eran médicos, 77 licenciadas en enfermería y 69 tecnólogas en enfermería; el muestreo utilizado fue probabilístico estratificado por instituciones formadoras; además como fuente de información participaron 195 docentes y/o administradores de carrera provenientes de las instituciones educativas, así como 167 Directores de Unidades de Salud y 89 Supervisoras locales de enfermería, procedentes de las 5 Regiones de Salud del país. Para la obtención de los datos cuantitativos se utilizaron seis instrumentos, tipo encuestas, una para cada una de las poblaciones participantes y ( los/as Egresados(as), Formadores(as) y Jefaturas médicas y de enfermería de las Unidades de Salud) en quienes se estudiaron las siguientes variables: nivel de importancia, nivel de desarrollo y nivel de aplicación otorgada a la competencia., para verificar su percepción sobre las competencias genéricas (CG), y las competencias específicas (CE), evaluadas en este estudio; para la obtención de los datos cualitativos se realizaron 16 grupos focales, con un total de 137 participantes y entrevistas individuales explorando los cuatro temas más recurrentes: (1) al (4). Según resultados, la percepción de egresados(as), formadores(as) y Jefes(as), tanto de medicina como de enfermería, todas las CG y todas las CE, evaluadas en este estudio, son consideradas como importantes y además se aplican en el Primer Nivel de Atención (PNA). Asimismo, todas estas competencias, según los formadores son parte del currículo de las Universidades e Institutos; sin embargo no todas reciben el mismo énfasis, ni se logran desarrollar equitativamente entre lo(as) estudiantes. Las CG consideradas como las más altamente desarrolladas o adquiridas, para ambos grupos y según la percepción de las tres fuentes de información, se encontraron aquellas que tradicionalmente han recibido más énfasis en la formación, tales como: el desarrollar compromiso por la ética profesional; brindar atención de salud con calidad, valorar a la familia como base de la sociedad, defender la dignidad de las personas utilizando el enfoque de derecho a la vida y a la salud; el desarrollar los conocimientos básicos de la profesión (aplicando la teoría y los principios de la profesión a las prácticas, sabiendo utilizar el equipo e instrumentación requerido para el cuidado de la salud); y el desarrollo del sentido de pertenencia y orgullo a la profesión, trabajando con responsabilidad y profesionalismo. Las CE que se perciben como más desarrolladas en la carrera de Enfermería se encuentran las relacionadas a la provisión de los Servicios de Salud y aquellas necesarias para la provisión adecuada de la atención materna e infantil. Las CE percibidas con más alto nivel de desarrollo en medicina se señalaron las relacionadas con llevar a cabo una buena práctica clínica, proveer atención de emergencias y saber prescribir medicamentos; Sin embargo, en la percepción de los Formadores(as) y Jefes(as) de estos, ninguna de las CE ha sido altamente desarrollada por la carrera. Para ambas carreras, puede afirmarse que existen competencias que se han relegado a un segundo plano y constituyen una brecha significativa, entre las se mencionan: Las relacionadas a lograr habilidad para trabajar en equipos interdisciplinarios; capacidad para realizar investigaciones, interpretar los datos y tomar decisiones a partir de los hallazgos; habilidad para la formulación, ejecución, administración y evaluación de proyectos encaminados a mejorar la salud de familias y comunidades; habilidad para educar y comunicarse efectivamente con otros; habilidad para involucrar a los individuos, familia y sociedad en los procesos para el mejoramiento y mantenimiento de su propia salud; capacidad para negociar y gestionar recursos a nivel local; habilidad para contribuir al establecimiento de un sistema de referencia y retorno en la RIISS; la competencia para utilizar la tecnología informática para su propio desarrollo profesional, para realizar investigaciones y para mantener una adecuado sistema de Vigilancia Epidemiológica; y la habilidad para preservar y cuidar el medio ambiente; todas estas importantes para el desarrollo adecuada de la atención integral de individuos, familias y comunidades en el PNA. (AU)

Congenital heart defects associated with atrial heterotaxy

To determine the frequency of various congenital cardiac defects associated with atrial heterotaxy and the difference between spectrum of cardiac defects in right atrial isomerism [RAI] and left atrial isomerism [LAI] in these patients. Cross-sectional observational study. Department of Cardiology, The Children's Hospital and Institute of Child Health, Lahore, from July 2006 to June 2011. All children presenting to the hospital with suspected congenital heart defect were included in the study. Echocardiography based sequential segmental analysis was used, taking atrial symmetry, interrupted inferior vena cava [IVC] and juxtaposed aorta to IVC relation into account for identifying atrial heterotaxy. Various segmental defects were noted for RAI and LAI. Children had atrial heterotaxy [M:F; 1.7:1] with 61.6% [n=82] having LAI. Most common lesions associated with RAI included complete atrioventricular [AV] septal defect [n=48, 94.1%], single AV valve [n=45, 88.2%] and pulmonary outflow tract obstruction [n=41, 80.4%]. LAI was associated with ventricular septal defect [n=68, 82.9%], atrial septal defect [n=63, 76.8%, mostly secundum variety], and miscellaneous left sided obstructive lesions. Atrial heterotaxy encompasses a wide spectrum of congenital cardiac defects. The frequency of various defects associated with RAI or LAI in local South Asian population of Lahore, Pakistan is similar to those as reported in the Western literature

Optimal dose of adenosine effective for supraventricular tachycardia in children

To determine the optimal adenosine dose effective in supraventricular tachycardia [SVT] and underlying conditions affecting the effective dose in children. Experimental study. Department of Cardiology, The Children's Hospital and Institute of Child Health, Lahore, from July 2008 to June 2011. All children presenting with SVT were administered adenosine in rapid boluses according to PALS guidelines using incremental doses of 100, 200 and 300 micro g/kg. The response was recorded on 12 lead ECG. Preexcitation was documented and echocardiography performed on all children after attaining sinus rhythm. Mann Whitney test and Kruskal-Wallis test were used as a test of significance to determine any difference in effective adenosine dose between normal heart and various underlying conditions, taking p < 0.05 as significant. Eighty five patients were treated for 110 episodes of SVT with adenosine. M:F ratio was 2.2:1. Their age ranged from 6 days to 14 years with mean age of 27.9 months. Adenosine was effective in reverting 97 episodes of SVT to sinus rhythm [88.2%]. A dose of upto 100 micro g/kg was only effective in 36.4% episodes of SVT. Two hundred micro g/kg was effective in 44.3% of those not responding to 100 micro g/kg dose [n = 31/70, cumulative 64.5%]. A dose of 300 micro g/kg was effective in further 25 patients not responding to lower doses [n = 25/38, 65.8%; cumulative 88.2%]. Mean effective dose of adenosine was 185.3 +/- 81.0 micro g/kg with median effective dose of 200 micro g/kg. Significantly higher dose of adenosine was required in children with underlying pre-excitation, n = 18/97 [220.8 +/- 67.6 micro g/kg vs. 177.2 +/- 81.9 micro g/kg, p = 0.039]. Adenosine is an effective medicine in treating SVT in children. A higher dose of 200 micro g/kg may be used as first bolus particularly in children with pre-excitation

Frequency of diseases among flood affected individuals at relief camps of Karachi Pakistan

To determine the frequency of diseases among flood affected individuals and facilities available at relief camps of Karachi Pakistan. A cross sectional study. This study was conducted at the Department of Community Medicine, Sindh Medical College, DUHS, Karachi from July 2010 to Nov. 2010. A cross sectional study was conducted and data was collected by using a structured questionnaire. A sample size of 300 flood affected individuals were drawn by using convenient sampling methods from four different flood camps located in Karachi. Out of the 300 case studied cases studied 46.0% had malaria, 90.5% of malarial patients admitted that they did not use mosquito repellents or nettings to protect themselves. About 27.3% suffered from diarrhea and 26.7% had skin infections. Adequate water supply was supplied to 66.7% of the patients. This study concluded that malaria had higher frequency at relief camps of Karachi followed by diarrhea and skin infections

Socioeconomic status and impact of treatment on families of children with congenital heart disease

To assess the socioeconomic status, treatment being offered and the impact of congenital heart disease treatment on families. Observational study. The Children's Hospital / Institute of Child Health, Lahore, from 1st March to 31[st] August 2010. All patients undergoing a cardiac surgical or angiographic intervention were enrolled. Socioeconomic status was assessed by Kuppuswamy socioeconomic status scale with income group modification. The impact was measured by the source of financing, effect on family financing source and schooling and health of siblings. Of 211 patients undergoing treatment in the study period, surgery was the definitive treatment in 164 [77.7%] and angiographic intervention in 47 [22.3%] patients. Male to female ratio was 1.5:1. The mean age of the patient was 39.1 +/- 3.2 months [range 01 day to 15 years]. Majority of families belonged to middle [66.4%, n=140] and lower [27%, n=57] socioeconomic class. The mean cost of medicines and disposables was PKR 78378.2 +/- 8845.9 [US$ 933.1 +/- 105.3] in open heart surgery, PKR 12581 +/- 7010.8 [US$ 149.8 +/- 83.5] in closed heart surgery and PKR 69091 +/- 60906 in angiographic interventions. In 63.1% patients, families contributed towards these costs either completely [12.3%] or partly [50.8%] with significant contribution from the hospital. Adverse effect on families ranged from leave without pay to losing jobs or business [46%], and selling their assets [11.3%]. It also affected schooling and health of siblings [22.7% and 26.1% respectively]. Majority of children with congenital heart disease belonged to middle and lower socioeconomic status in this study. Main definitive treatment was surgery. The cost of health care facilities posed a marked socioeconomic burden on those families

child with roberts syndrome

Roberts syndrome Is a genetically determined rare birth defect causing, skeletal deformities, particularly symmetrical limb reduction and craniofacial anomalies. For any child with limb and craniofacial bony malformations, this syndrome should be considered in the differentials. Although this syndrome represents only a small proportion of the total number of individuals with limb deficiency, it is important to be identified in order to give accurate genetic counselling including recurrence risk in siblings and possible prenatal diagnosis. This is the case report of a 22 days old male infant who presented with defective development of all four extremities and craniofacial abnormalities. The overall clinical and radiological features were suggestive of Roberts syndrome

neonate with Poland-Mobius syndrome

Poland-Mobius syndrome is a combination of two rare congenital syndromes characterized by congenital facial weakness, loss of abduction of eyes, limb defects, and absence or hypoplasia of the pectoral muscles. A patient with features of both the Mobius syndrome and the Poland syndrome is presented in this case report

case of polyglandular autoimmune syndrome type I with unusual presentation

Eight years old girl presented with mucocutaneous candidiasis, nail dystrophy, twitching left half of face, progressively increasing generalized skin hyperpigmentation and hypopigmented patches over both shins. Her investigations revealed low intact PTH level, low serum cortisol, high ACTH, impaired glucose tolerance test and candidal onycomycosis. She was diagnosed as Polyglandular Autoimmune Syndrome [PGA] type I. She also developed idiopathic generalized epileptiform seizures and Alcaligenes faecalis septicemia not previously reported with PGA type I. The patient responded well to alphacalcidol, hydrocortisone, valproate sodium, topical antifungal and systemic antibiotic

Relationship of joint hypermobility and musculoskeletal problems and frequency of benign joint hypermobility syndrome in children

The majority of individuals with joint hypermobility remain asymptomatic. However, those associated with Benign Joint Hypermobility Syndrome [BJHS], develop a number of systemic manifestations. Our objective was to determine the relationship between joint hypermobility and musculoskeletal problems, and frequency of BJHS in children and adolescents. This crosssectional observational descriptive study was conducted at Outpatient Department, The Children's Hospital, Lahore, Pakistan. A total of 872 individuals [4-18 year] were examined for hypermobile joints using Beighton score >/= 4. A questionnaire was implied to get data regarding demographic profile, musculoskeletal and extra-articular complaints, family history of joint problems and daily activity. Brighton's criteria were implied for diagnosis of BJHS. The frequency of joint hypermobility was 37.0%; male 39.5%, and female 34.2% [p=0.1]. There was a gradual decline in mean Beighton score with age. The female population showed increase in mean Beighton score around 16-17 year age. Arthralgias and back pains 7.7% vs. 1.6%, [p<0.001], and hernias 2.5% [p=0.03] were significantly higher in individuals with joint hypermobility. History of joint problems in the family was also significantly higher in children with joint hypermobility [p=0.01]. BJHS was detected in 4.8% children [male 3.6% and female 6.3%, p=0.06]. Arthralgias [51.0%], hernias [16.3%], joint dislocations [8.2%] and varicose veins [8.2%] were the most common presentations. BJHS is common among children. Arthralgias, back pains and hernias are significantly higher in these individuals

Predictors of clinical course of subacute sclerosing panencephalitis: experience at the children's hospital, Lahore

To determine the clinical course of Subacute Sclerosing Panencephalitis [SSPE] and different factors affecting the clinical course. Descriptive study. The Children's Hospital, Lahore, from October 2005 to May 2008. All serologically confirmed patients of SSPE were registered and clinical staging of these patients were done from stage-I to stage-IV. Clinical course of these patients was classified by using neurological disability index as fulminant, acute, subacute, and chronic course. Clinical course was analyzed for any difference with age, gender, immunization for measles, measles infection, nutritional status and correlation with age of onset of SSPE, [Spearman's correlation], using statistic package for social science [SPSS] V. 14. A total of 57 cases [41 males, 16 females] with mean age of 7.45 years were studied. Forty [71.4%] of them were vaccinated with single dose at about 9 months of age, 41% [23/57] had measles infections 2 years of age. Using the Neurology Disability Index for these patients 10.5% had fulminant, 17.5% had acute, 49.2% subacute and 22.8% had chronic course. Age, gender, age at measles infection, SSPE onset age and nutritional status were poor predictors of clinical course of SSPE. Unvaccinated patients showed significantly more rapid course of disease [p = 0.04]. Clinical course of SSPE cannot be predicted at the onset of this catastrophic disorder. Children not immunized against measles had a significant rapid course of disease

Disproportionate short stature with multisystem involvement - Ellis-van Creveld syndrome

Ellis-van Creveld syndrome is a rare form of mesenchymal - ectodermal dysplasia. It is an autosomal recessive disorder characterized by disproportionate short stature, postaxial polydactyly, ectodermal dysplasia and congenital heart defect. This case report presents two cases with classical clinical findings along with some unusual features including rhizomelic limb shortening, global developmental delay and bilateral lens subluxation not reported previously

Comparison of three prognostic scores [PRISM, PELOD and PIM 2] at pediatric intensive care unit under Pakistani circumstances

To compare the performance of the Pediatric Risk of Mortality [PRISM], the Pediatric Index of Mortality 2 [PIM 2] and Pediatric Logistic Organ Dysfunction [PELOD] scores at general pediatric intensive care unit in a developing country setting, investigating the relation between observed and predicted mortality. A contemporary cohort study was undertaken at Pediatric Intensive Care Unit [PICU], Children's Hospital, Institute of Child Health, Lahore, Pakistan. 131 consecutive admissions fulfilling the inclusion criteria were enrolled in the study. PRISM, PIM 2 and PELOD calculations were performed as set out by original articles, using the published formulae. Statistical analysis included Standardized Mortality Rate [SMR], Hosmer Lemeshow goodness of fit test, receiver operating curve [ROC] characteristics and Spearman's correlation test. 139 patients were admitted to PICU. 38 presented exclusion criteria. 29 [28.7%] patients died. Estimated mortality was; PRISM: 19.7[19.5%], PIM: 21.01[20.5%] and PELOD: 18.4[18.3%]. SMR was 1.47 [SD +/- 0.19], 1.4 [SD +/- 0.19] and 1.57 [SD +/- 0.19], respectively. PRISM had better calibration [x[2] = 7.49, p = 0.49] followed by PIM 2 [x[2] = 9.65, p = 0.29]. PIM 2 showed best discrimination with area under ROC = 0.88 [0.81-0.94] followed by PRISM 0.78 [0.67-0.89] and PELOD 0.77 [0.68-0.87]. Spearman's correlation r between PRISM and PIM 2 returned 0.74 [p < 0.001]. PRISM as well as PIM 2 is validated for PICU setting in Pakistani circumstances. PELOD performed poorly. PIM 2 has advantages over PRISM for stratification of patients in clinical trials