ABSTRACT
Introducción: la asistencia de niños con condiciones de salud pasibles de Cuidados Paliativos (CP) en servicios de emergencia pediátrica constituye un desafío para los equipos de salud. Objetivo: describir la prevalencia de consultas, problemas de salud y características de niños pasibles de CP asistidos en el Departamento de Emergencia Pediátrica del Centro Hospitalario Pereira Rossell. Metodología: estudio descriptivo, retrospectivo entre el 20/06/2014 y el 19/06/2015. Variables: edad, condición de salud, requerimiento de prótesis, motivo de consulta, existencia de: consulta previa, pediatra tratante, vinculación con Unidad de Cuidados Paliativos Pediátricos (UCPP), directivas anticipadas y condición al egreso. Resultados: se incluyeron 175 niños pasibles de CP. Éstos significaron 0,7% (340/ 46.706) de las consultas en el período analizado. Mediana de edad: 5,7 años, (1 mes - 16 años). Presentaban afectación neurológica severa 65%; portaban prótesis o dispositivo de tecnología médica 50,3% (11% más de una); consultaron por infecciones 42% (respiratoria 81%), problemas neurológicos 20,3% (convulsiones 87%). Presentaban consulta previa por igual motivo 93%. Refirieron: contar con pediatra tratante 66,3%; estar vinculados con la UCPP 42,3%; contaban con directivas anticipadas 20%. Ingresaron a: cuidados moderados 39%; terapia intensiva 2%. No se registraron fallecimientos. Conclusiones: se constataron diversas situaciones y características de los pacientes incluidos que traducen la complejidad de su condición clínica y eventuales dificultades para el abordaje en el primer nivel de atención o en sus departamentos de procedencia.
Introduction: the assistance of children in need of Palliative Care (CP) in pediatric emergency services is a challenge for health teams. Objective: To describe the prevalence of consultations, health problems and characteristics of children in need of PC assisted in the Pereira Rossell Hospital Center Pediatric Emergency Department. Methodology: descriptive, retrospective study between 20/06/ 2014- 19/06/2015. Variables: age, health condition, prosthesis, previous consultation, attending pediatrician, relation with Pediatric Palliative Care Unit (UCPP), advanced care plan and condition at discharge. Results: 175 children in need of PC were included which represented 0.7% (340 / 46,706) of consultations in the period. Median age: 5.7 years (1 month - 16 years); 65% had severe neurological impairment; 50.3% carried prosthesis or medical technological devices (11% more than one); reason for consultation was: 42% infections, 42% (81% respiratory), 20. 3% neurological problems (87% seizures); 93% presented a previous consultation for the same reason; 66.3% reported having an attending pediatrician; 42.3% were under UCPP assistance; 20% had advanced care plan. At discharge: 39% were admitted in moderate care; 2% in intensive care. No deaths were recorded. Conclusion: the different situations and characteristics of the patients included represent the complexity of their clinical condition and may be related to possible difficulties in addressing their problems at the primary care level or their provinces of origin.
Subject(s)
Humans , Male , Infant , Child, Preschool , Child , Adolescent , Office Visits/statistics & numerical data , Palliative Care/statistics & numerical data , Pediatrics , Emergency Medicine/statistics & numerical data , Therapeutics/statistics & numerical data , Uruguay/epidemiology , Chronic Disease , Epidemiology, Descriptive , Prevalence , Retrospective StudiesABSTRACT
The potential for microbially mediated anaerobic redox cycling of iron (Fe) was examined in a first-generation enrichment culture of freshwater wetland sediment microorganisms. Most probable number enumerations revealed the presence of significant populations of Fe(III)-reducing (approximately 10(8) cells ml(-1)) and Fe(II)-oxidizing, nitrate-reducing organisms (approximately 10(5) cells ml(-1)) in the freshwater sediment used to inoculate the enrichment cultures. Nitrate reduction commenced immediately following inoculation of acetate-containing (approximately 1 mM) medium with a small quantity (1% v/v) of wetland sediment, and resulted in the transient accumulation of NO(2)(-) and production of a mixture of gaseous end-products (N(2)O and N(2)) and NH(4)(+). Fe(III) oxide (high surface area goethite) reduction took place after NO(3)(-) was depleted and continued until all the acetate was utilized. Addition of NO(3)(-) after Fe(III) reduction ceased resulted in the immediate oxidation of Fe(II) coupled to reduction of NO(3)(-) to NH(4)(+). No significant NO(2)(-) accumulation was observed during nitrate-dependent Fe(II) oxidation. No Fe(II) oxidation occurred in pasteurized controls. Microbial community structure in the enrichment was monitored by denaturing gradient gel electrophoresis analysis of polymerase chain reaction-amplified 16S rDNA and reverse transcription polymerase chain reaction-amplified 16S rRNA, as well as by construction of 16S rDNA clone libraries for four different time points during the experiment. Strong similarities in dominant members of the microbial community were observed in the Fe(III) reduction and nitrate-dependent Fe(II) oxidation phases of the experiment, specifically the common presence of organisms closely related (>or= 95% sequence similarity) to the genera Geobacter and Dechloromonas. These results indicate that the wetland sediments contained organisms such as Geobacter sp. which are capable of both dissimilatory Fe(III) reduction and oxidation of Fe(II) with reduction of NO(3)(-) to NH(4)(+). Our findings suggest that microbially catalysed nitrate-dependent Fe(II) oxidation has the potential to contribute to a dynamic anaerobic Fe redox cycle in freshwater sediments.
