[Costs of serious adverse events in a community teaching hospital, in Mexico]. / Costos de eventos adversos graves en un Hospital Comunitario de Enseñanza en México.

BACKGROUND: Serious adverse events during hospital care are a worldwide reality and threaten the safety of the hospitalised patient. OBJECTIVE: To identify serious adverse events related to healthcare and direct hospital costs in a Teaching Hospital in México. MATERIAL AND METHODS: A study was conducted in a 250-bed Teaching Hospital in San Luis Potosi, Mexico. Data were obtained from the Quality and Patient Safety Department based on 2012 incidents report. Every event was reviewed and analysed by an expert team using the "fish bone" tool. The costs were calculated since the event took place until discharge or death of the patient. RESULTS: A total of 34 serious adverse events were identified. The average cost was $117,440.89 Mexican pesos (approx. €7,000). The great majority (82.35%) were largely preventable and related to the process of care. Undergraduate medical staff were involved in 58.82%, and 14.7% of patients had suffered adverse events in other hospitals. CONCLUSIONS: Serious adverse events in a Teaching Hospital setting need to be analysed to learn and deploy interventions to prevent and improve patient safety. The direct costs of these events are similar to those reported in developed countries.

[Knowledge and attitudes of teachers at a Medical School and the use of clinical practice guidelines]. / Conocimientos y actitudes de los docentes de una Facultad de Medicina y el uso de las guías de práctica clínica (GPC) nacionales.

INTRODUCTION: The National Center for Health Technology Excellence (CENETEC) has published 539 clinical practice guidelines (CPG) whose area of influence is nationwide. OBJECTIVE: To conduct an assessment of the knowledge and attitudes of teachers at a medical school and the use of CPGs. MATERIALS AND METHODS: We performed a cross-sectional study in 2012 among teachers at one medical school in San Luis Potosí, Mexico. RESULTS: Overall, 97.1% of medical school physicians (MDs) reported knowing the existence of CPGs and 94.9% had consulted them. The 87.6% of the MD knew where they could find the guidelines. However, only 15.9% mentioned the CENETEC website as a source, 30.4% The Ministry of Health website, and 7.3% both pages. CONCLUSIONS: It is necessary to develop programs that facilitate the implementation and adoption of clinical practice guidelines by a multidisciplinary team that specifically establishes the importance of their use.

[Prevalence of unsafe conditions associated to non-intentional needlestick injuries among trainee physicians]. / Prevalencia, condiciones y actos inseguros asociados a punciones accidentales de médicos en formación.

INTRODUCTION: Physicians in training face high-risk clinical situations for needlestick injuries during their training. OBJECTIVE: To determine the prevalence and establish behaviors associated with needlestick injuries. MATERIAL AND METHODS: A cross-sectional study was conducted during the 2012-2013 school year among undergraduate and graduate medical students of a Faculty of Medicine in Mexico. RESULTS: There were a total of 441 questionnaires completed, of which 56.7% of students reported having experienced at least one lesion, of which only 44.5% reported it. The conditions and unsafe acts associated were: female students had a greater risk for the first puncture, whereas male students correlated with three or more punctures; third year students, night shift rounds, the feeling of being rushed by someone else, and the presence of fatigue were risk factors for the first puncture (p < 0.05). CONCLUSIONS: The high prevalence and the underreporting of non-intentional punctures places students at a higher risk of transmissible diseases. Strategies focused on prevention, monitoring, and control of accidental punctures should be implemented by hospitals, schools, and medical schools.

[Seroprevalence of syphilis in pregnant women in San Luis Potosí]. / Seroprevalencia de sífilis en mujeres embarazadas en San Luis Potosí.

OBJECTIVE: To determine the seroprevalence of syphilis in pregnant women. METHODS: A seroepidemiologic survey was conducted in 1857 women giving birth at a general hospital in the city of San Luis Potosi, Mexico. RESULTS: Five women (0.27%) were diagnosed with syphilis at the time of delivery. Maternal factors associated with a greater likelihood of syphilis included older age, a higher number of pregnancies and living out of wedlock. CONCLUSIONS: The number of new bhorns exposed to syphilis during pregnancy in San Luis Potosi is underestimated. The results of this study support the need to identify syphilis in infected mothers at the time of delivery.

Seroprevalencia de sífilis en mujeres embarazadas en San Luis Potosí / Seroprevalence of syphilis in pregnant women in San Luis Potosí

OBJETIVO: Determinar la seroprevalencia de sífilis en mujeres embarazadas. MATERIAL Y MÉTODOS: Encuesta seroepidemiológica en 1 857 mujeres que acudieron para la atención del parto a un hospital general de la ciudad de San Luis Potosí. RESULTADOS: Se diagnosticó sífilis en cinco (0.27 por ciento) mujeres al momento del parto. Los factores maternos asociados con una probabilidad superior de presentar sífilis incluyeron mayor edad materna, mayor número de embarazos previos y vivir en unión libre con su pareja. CONCLUSIONES: El número de recién nacidos expuestos a sífilis durante el embarazo, en la ciudad de San Luis Potosí, está subestimado. Los resultados de este estudio sustentan la necesidad de identificar, al momento del parto, a madres infectadas con sífilis.

Tolerance of an enterally administered simulated amniotic fluid-like solution by neonates recovering from surgery for congenital bowel abnormalities.

OBJECTIVE: We report a single-centered, Phase I pilot trial, testing the enteral administration of an experimental amniotic fluid-like solution to 10 neonates who were otherwise "NPO" following surgery for congenital bowel abnormalities. The overall hypothesis was that the trophic effect of the solution on intestinal villi would facilitate advancement to full enteral feedings. The specific hypothesis tested in this pilot trial was that the solution would be tolerated. STUDY DESIGN: Ten neonates who were NPO following surgery for congenital bowel abnormalities, were studied before any "trophic" feedings were begun. Each received an experimental, sterile, isotonic, amniotic fluid-like solution at a dose of 20 ml/kg/day enterally. When milk feedings were begun they were mixed with the experimental solution. Increases in the volume of milk feedings occurred at the discretion of the neonatologist and surgeon, and the experimental solution was discontinued any time the neonatologist or surgeon felt it was not tolerated, or when 100 ml of milk feedings/kg/day was achieved. We quantified the amount and character of emesis, stools, and gastric residuals, measured abdominal girth and blood pressure, looked for skin rashes, and sought any signs of intolerance or adverse events. We recorded the days to achieve milk feedings of 20, 50, 100, and 120 ml/kg/day and length of hospital stay. RESULTS: The experimental solution was begun 4 to 32 days after surgery, invariably prior to the institution of "trophic" milk feedings. All subjects completed the doses with no evidence of intolerance. All achieved 100 ml/kg of milk feedings 14 days, or fewer, following institution of the experimental solution (mean 11.1 days, range, 3 to 14). All lived and were discharged home 20.2 days (range, 8 to 42) after the experimental solution was begun. CONCLUSIONS: In this pilot trial involving 10 neonates who had surgery for congenital bowel abnormalities, the enteral administration of a sterile, isotonic, amniotic fluid-like solution was tolerated.

Tolerance of a sterile isotonic electrolyte solution containing select recombinant growth factors in neonates recovering from necrotizing enterocolitis.

OBJECTIVE: To assess the tolerance of a sterile isotonic electrolyte solution containing select recombinant growth factors enterally administered in neonates who were NPO because of necrotizing enterocolitis (NEC). STUDY DESIGN: A phase I trial was accomplished among 30 neonates. Patients received 5, 10, or 20 mL enterally of the study solution/kg/day divided into every 3-hour dosing, for 3 days prior to when feedings of milk were to resume. The occurrence of emesis, gastric residuals, diarrhea, bloody stools, abdominal distention, skin rashes and death were sought. RESULTS: Gestational ages ranged from 25.2 to 41.1 weeks. A total of 16 neonates had Stage IA NEC, six Stage IB, and eight Stage IIA. The solution was well tolerated in all 30; none developed diarrhea, guaiac positive or bloody stools, or abdominal distention. Administration of the solution was not prematurely discontinued in any infant. Two neonates died secondary to late-onset sepsis remote from the study period. CONCLUSIONS: Enteral administration of a sterile isotonic electrolyte solution containing select recombinant growth factors was well tolerated by neonates with NEC.

Expression of CD64 as a potential marker of neonatal sepsis.

The aim of this study was to identify a novel immunological indicator useful for the early diagnosis (through a rapid and single determination) of neonatal sepsis (NS). Peripheral blood samples were taken from 63 neonates, who were classified into four groups: proven NS (n = 17); clinical NS (n = 14); disease without infection (n = 17); and healthy newborns (n = 15). Neutrophil expression of CD64, CD43, CD44, CD50, CD62L and Mac-1, and plasma levels of interleukin (IL)-1beta, IL-6, tumor necrosis factor-alpha (TNF-alpha) and soluble L-selectin (sCD62L), were determined. Expression of CD64 was significantly enhanced in the group with proven sepsis and clinical NS compared to newborns without infection (p < 0.05). Eight newborns with proven or clinical sepsis, but only one with disease without infection, showed an increased percentage of CD64+ cells (diagnostic specificity = 96.8%). No significant differences were found in the expression of the other leucocyte differentiation antigens studied. As previously described, TNF-alpha and IL-6 levels were significantly elevated in newborns with proven or clinical sepsis compared to neonates without infection (p < 0.05). Our results suggest that, through a single determination, the enhanced expression of CD64 is a highly specific indicator of NS, although its diagnostic sensitivity is low (25.8%). In contrast, we found that plasma levels of IL-1beta and sCD62L, as well as the expression of Mac-1, CD43, CD44, CD50, and CD62L, do not appear to be useful for the diagnosis of NS.

Consideraciones del diagnóstico prenatal del secuestro broncopulmonar a las 26 semanas de gestación: informe de un caso / Prenatal diagnosis of bronchopulmonary sequestration at 26-weeks gestation: a case report

Se presenta el caso de una paciente de 18 años, GI, con 26 semanas de gestación a quien en el ultrasonido se le detectó feto vivo con datos de secuestro broncopulmonar. A las 39 semanas se resolvió el embarazo por vía vaginal. Se obtuvo producto vivo con Apgar 7 y 8 y Silverman 4-4 al minuto y cinco minutos. Al confirmarse el diagnóstico se efectuó resección de la masa a los cinco días y el neonato falleció a los 15 días por sepsis nosocomial. El caso permite enfatizar en la conveniencia de diagnóstico prenatal para valorar las conductas de manejo.

Rabdomioma cardiaco neonatal: Informe de uncaso y consideraciones clínico-epidemiológicas / Neonatal rhabdomyoma of the heart: case report and clinico epidemiological considerations

Los tumores cardiacos primarios son entidades raras en todos los grupos de edad, de ellos el más frecuente en la edad pediátrica es el rabdomioma, el cual se encuentra asociado a esclerosis tuberosa en el 37 a 80 por ciento de los casos, con una frecuencia informada de hasta 1 por cada 40,000 recién nacidos vivos. El presente caso es el de un recién nacido, que desde las primeras horas de vida presentó soplo pansistólico, cardiomegalia grado IV, datos electrocardiográficos de hipertrofia ventricular e insuficiencia cardiaca. El ecocardiograma y la imagen por resonancia magnética mostraron múltiples tumores en la porción muscular del septum y paredes ventriculares. La biopsia confirmó el diagnóstico de rabdomioma. Lo que, aunado a las máculas hipomelanóticas, áreas de hipodensidad del parénquima cerebral y crisis convulsivas, permitió establecer el diagnóstico de esclerosis tuberosa. En nuestro medio existe poca información sobre ambas enfermedades, por lo que se revisa la incidencia, diagnóstico, pronóstico y manejo de casos como el presente

Utilidad de la capnografía en neonatos de pretérmino con síndrome de dificultad respiratoria y asistencia ventilatoria / Capnography utility pre-term infants with respiratory distree syndrome

Objetivo. Evaluar la utilidad de la presión de CO2 al final de la espiración (PETCO2) para predecir la presión arterial de CO2 (PaCO2) en recién nacidos de pretérmino con síndrome de dificultad respiratoria (SDR). Lugar. Hospital Central Dr. Ignacio Morones Prieto, centro de tercer nivel de atención médica. Se estudiaron 18 recién nacidos menores de 24 horas, con peso mayor de 750 g y de 25 a 36 semanas de gestación con SDR grado III-IV, ventilados convencionalmente. Se realizaron mediciones pareadas cada 8 horas de PETCO2 y PaCO2 en sangre capilar por observadores independientes. Análisis estadístico: se evaluó y asociación entre variables por regresión múltiple. Se calculó la sensibilidad, especificidad y razón de probabilidad positiva para el diagnóstico de hipo e hipercarbia. Resultados. Se evaluaron 122 pares de muestras. El análisis mostró que la PETCO2 (ß=0.409) y la PaO2 (ß=-0.36) se asocian con la PaCO2 (P<0.00001, r=0.571), independientemente de la gravedad del SDR, peso, edad gestacional, sexo y hematócritos, sin embargo, para predecir hipercarbia (PaCO2 > 45 mmHg) aún con el mejor punto de corte por PETCO2 la sensibilidad fue de 0.4-0.68, especificidad de 0.50-0.67 y razón de probabilidad de 1.3-1.7. Para la predicción de hiporcarbia (PaCO2<35 mmHg), la sensibilidad fue de 0.67-0.74, especificidad de 0.53-0.60 y razón de probabilidad de 1.67-1.70, según el nivel de oxemia. Conclusiones. La capnografía de flujo principal no es adecuada para la predicción de los niveles de CO2 en sangre en recién nacidos de pretérmino con SDR. La gasometría arterial o arterializada continúa siendo el estándar de oro

Taponamiento cardiaco en neonatos con catéter venoso central y alimentación parenteral / Neonatal cardiac tamponade, central venous catheter and parenteral nutrition

Objetivo: Llamar la atención sobre una entidad poco frecuente o poco informada pero con alta letalidad y que por lo tanto debe considerarse para su detección y tratamiento oportuno en todo neonato críticamente enfermo con alimentación parenteral por catéter venoso central. Reporte de casos: Se trató de dos neonatos, uno de término y otro de pretérmino con catéter venoso central y alimentación parenteral que presentaron deterioro súbito y muerte, secundario a taponamiento cardiaco. Discusión: El taponamiento cardiaco secundario a la instalación de un catéter venoso central es una entidad poco señalada en la literatura nacional e internacional. La incidencia estimada varío de 0.3 por ciento hasta 2 por ciento con letalidad de 74 a 100 por ciento por lo que su sospecha, diagnóstica y manejo temprano son imperativos (si se pretende evitar la muerte) e incrementar la sobrevida de estos neonatos