[Prevalence of hypophosphatemia in children with diabetic ketoacidosis and treatment with subcutaneous regular insulin. Observational study]. / Prevalencia de Hipofosfatemia en niños con cetoacidosis diabética y tratamiento con insulina regular subcutánea. Estudio observacional.

Diabetic ketoacidosis (DKA) is one of the most serious complications of type 1 diabetes mellitus. Its treatment requires fluid and electrolyte replacement and insulin. Hypophosphatemia as a complication of treatment has been scarcely evaluated. OBJECTIVES: To estimate the incidence of hypophosphatemia in children with DKA, treated with subcutaneous regular insulin (IRS), and to explore factors associated with this complication. PATIENTS AND METHOD: Prospective, observational study. Patients diagnosed with DKA hospitalized in the general care ward were included. Data on phosphatemia, glycemia, acid-base status, and IRS amount (U/kg) received were recorded at baseline and after 24 h of treatment. Hypophosphatemia was defined as values below 2.5 mg/dl. The correlation between initial phosphate and at 24 h of treatment was evaluated; the incidence of hypophosphatemia at 24 h was expressed as a percentage of the total number of patients. RESULTS: 30 patients were included, 15 were female, mean age 11.4 ± 3.2 years. At 24 h of treatment with IRS, 36.7% (95%CI 22-55%) presented hypophosphatemia, mean value 1.9 ± 1.5 mg/dl. Initial bicarbonate < 10 mmol/L acted as a predictor of hypophosphatemia (OR 7.5; 95%CI 1.4-39.8%; p = 0.01). No patient required intravenous phosphate correction, and no associated clinical complications were observed. CONCLUSION: In the group studied, the incidence of hypophosphatemia reached 36.7% at 24 hours of treatment. Initial bicarbonate lower than 10 mmol/L was significantly associated with hypophosphatemia. No complications associated with hypophosphatemia were observed.

Membrane potential hyperpolarization: a critical factor in acrosomal exocytosis and fertilization in sperm within the female reproductive tract.

Hyperpolarization of the membrane potential (Em), a phenomenon regulated by SLO3 channels, stands as a central feature in sperm capacitation-a crucial process conferring upon sperm the ability to fertilize the oocyte. In vitro studies demonstrated that Em hyperpolarization plays a pivotal role in facilitating the mechanisms necessary for the development of hyperactivated motility (HA) and acrosomal exocytosis (AE) occurrence. Nevertheless, the physiological significance of sperm Em within the female reproductive tract remains unexplored. As an approach to this question, we studied sperm migration and AE incidence within the oviduct in the absence of Em hyperpolarization using a novel mouse model established by crossbreeding of SLO3 knock-out (KO) mice with EGFP/DsRed2 mice. Sperm from this model displays impaired HA and AE in vitro. Interestingly, examination of the female reproductive tract shows that SLO3 KO sperm can reach the ampulla, mirroring the quantity of sperm observed in wild-type (WT) counterparts, supporting that the HA needed to reach the fertilization site is not affected. However, a noteworthy distinction emerges-unlike WT sperm, the majority of SLO3 KO sperm arrive at the ampulla with their acrosomes still intact. Of the few SLO3 KO sperm that do manage to reach the oocytes within this location, fertilization does not occur, as indicated by the absence of sperm pronuclei in the MII-oocytes recovered post-mating. In vitro, SLO3 KO sperm fail to penetrate the ZP and fuse with the oocytes. Collectively, these results underscore the vital role of Em hyperpolarization in AE and fertilization within their physiological context, while also revealing that Em is not a prerequisite for the development of the HA motility, essential for sperm migration through the female tract to the ampulla.

Ética en investigación: desafíos durante la pandemia / Research ethics: challenges during the pandemic

Durante la pandemia de Covid-19 los hospitales pediatricos se vieron menos afectados, debido a la menor infección en niños, y sus recursos fueron reasignados en distintas tareas.. El Comité de Ética en Investigación del Hospital General de Niños Pedro de Elizalde presenta los distintos procedimientos implementados en esta emergencia, para sostener diferentes investigaciones, y que les permitió una rápida respuesta a esta situación.

Use of a Flexible Catheter for the Administration of Subcutaneous Insulin in Diabetic Ketoacidosis: A Feasibility Controlled Clinical Trial.

BACKGROUND: Although intravenous insulin administration is the standard of care in diabetic ketoacidosis (DKA), subcutaneous insulin administration could be a suitable alternative in resource-limited settings, but pain caused by hourly insulin applications are limiting factors for using it, especially in children. We aimed to assess whether the use of a flexible subcutaneous catheter improves comfort in patients with DKA compared with the usual hourly injections' treatment. We also compared the evolution of metabolic variables in patients with DKA using both insulin administration systems. METHODS: Randomized feasibility controlled open trial, comparing 2 ways (flexible catheter and steel needle) for the initial insulin administration in children with DKA, who were randomly selected to receive subcutaneous insulin by a flexible catheter or using standard needles. The main outcome was pain, assessed hourly and secondary outcome time to achieve ketoacidosis resolution. RESULTS: Twenty subjects were included (10 by group). There were no differences between groups in baseline lab values (glycemia, urea, sodium, bicarbonate and pH). Pain assessment at first insulin administration was significantly lower in the intervention group (4.5 vs 0 points; P = 0.001). Similar differences between both treatment arms were observed in every pain assessment. There were no differences between groups regarding the time elapsed to achieve ketoacidosis resolution. (11.4±4.3 vs 16±8.4; P = 0.12). No adverse events or DKA complications were observed. CONCLUSIONS: The use of a flexible catheter reduced the pain associated with subcutaneous insulin administration in nonsevere DKA. The flexible subcutaneous catheter could be a safe alternative for the treatment of uncomplicated DKA in resource-limited settings.

A chloride channel blocker prevents the suppression by inorganic phosphate of the cytosolic calcium signals that control muscle contraction.

KEY POINTS: Accumulation of inorganic phosphate (Pi ) may contribute to muscle fatigue by precipitating calcium salts inside the sarcoplasmic reticulum (SR). Neither direct demonstration of this process nor definition of the entry pathway of Pi into SR are fully established.  We showed that Pi promoted Ca2+ release at concentrations below 10 mm and decreased it at higher concentrations. This decrease correlated well with that of [Ca2+ ]SR .  Pre-treatment of permeabilized myofibres with 2 mm Cl- channel blocker 9-anthracenecarboxylic acid (9AC) inhibited both effects of Pi .  The biphasic dependence of Ca2+ release on [Pi ] is explained by a direct effect of Pi acting on the SR Ca2+ release channel, combined with the intra-SR precipitation of Ca2+ salts. The effects of 9AC demonstrate that Pi enters the SR via a Cl- pathway of an as-yet-undefined molecular nature. ABSTRACT: Fatiguing exercise causes hydrolysis of phosphocreatine, increasing the intracellular concentration of inorganic phosphate (Pi ). Pi diffuses into the sarcoplasmic reticulum (SR) where it is believed to form insoluble Ca2+ salts, thus contributing to the impairment of Ca2+ release. Information on the Pi entrance pathway is still lacking. In amphibian muscles endowed with isoform 3 of the RyR channel, Ca2+ spark frequency is correlated with the Ca2+ load of the SR and can be used to monitor this variable. We studied the effects of Pi on Ca2+ sparks in permeabilized fibres of the frog. Relative event frequency (f/fref ) rose with increasing [Pi ], reaching 2.54 ± 1.6 at 5 mm, and then decreased monotonically, reaching 0.09 ± 0.03 at [Pi ] = 80 mm. Measurement of [Ca2+ ]SR confirmed a decrease correlated with spark frequency at high [Pi ]. A large [Ca2+ ]SR surge was observed upon Pi removal. Anion channels are a putative path for Pi into the SR. We tested the effect of the chloride channel blocker 9-anthracenecarboxylic acid (9AC) on Pi entrance. 9AC (400 µm) applied to the cytoplasm produced a non-significant increase in spark frequency and reduced the Pi effects on this parameter. Fibre treatment with 2 mm 9AC in the presence of high cytoplasmic Mg2+ suppressed the effects of Pi on [Ca2+ ]SR and spark frequency up to 55 mm [Pi ]. These results suggest that chloride channels (or transporters) provide the main pathway of inorganic phosphate into the SR and confirm that Pi impairs Ca2+ release by accumulating and precipitating with Ca2+ inside the SR, thus contributing to myogenic fatigue.

¿Cuáles determinantes se relacionan con la percepción de inseguridad? Un análisis estadístico y espacial para la ciudad de Bogotá, D. C. / Which are the determinants associated with the insecurity perception? A statistical and spatial analysis for Bogota, D. C. / Quais determinantes se relacionam com a percepção de insegurança? Uma análise estatística e espacial para a cidade de Bogotá, D. C.

Resumen La inseguridad y la percepción de inseguridad son fenómenos diferentes. Si bien podría pensarse que estas deberían ir de la mano, la evidencia ha mostrado que este no siempre es el caso. El objetivo es encontrar cuáles son los determinantes de la percepción de inseguridad en Bogotá. Asimismo, se pretende encontrar si existen efectos heterogéneos por género, ingresos y nivel educativo. De igual manera, se analiza la incidencia que tiene el conocimiento acerca de programas de seguridad ciudadana sobre la percepción de seguridad de la población. Para esto se utilizaron la Encuesta de Convivencia y Seguridad Ciudadana y la Encuesta de Percepción, del DANE y la Cámara de Comercio, respectivamente, para hacer una descripción estadística y espacial de los datos en la ciudad, la localidad y el hogar en Bogotá, mediante el análisis de la relación entre victimización (delitos cometidos a la persona) y la percepción de inseguridad. Además, se realizaron estimaciones probabilísticas que respondieran la pregunta de interés, separando los efectos para grupos poblacionales, con el objetivo de identificar la existencia de resultados heterogéneos. Como principales resultados, se encontró una fuerte relación entre la exposición a delitos, como hurto (a personas y a viviendas), homicidios y riñas, y la percepción de inseguridad en el barrio. Asimismo, las mujeres y la población de bajos recursos tienden a sentirse más inseguras en su lugar de residencia. Finalmente, conocer programas de seguridad ciudadana -como el plan cuadrantes o planes comunitarios- no tiene relación alguna con la sensación de inseguridad en el barrio.

Abstract Insecurity and insecurity perception are different issues. It might be considered that they should go hand in hand. However the evidence has demonstrated that this is not always the case. The objective is to find out the insecurity perception determinants in Bogotá. Likewise, it aims to discover if there are heterogeneous effects by gender, incomes and educational level. Similarly, this study analyses the incidence of knowledge about citizen security programs on populations' security perception. For this, the Coexistence and Citizenship Security Survey and the Perception Survey of the DANE (National Administrative Department of Statistics) and the Chamber of Commerce were used to conduct a statistical and spatial description of the data in the city, locality and home in Bogotá. Thus, it was developed through the analysis of the relationship between victimization (crimes perpetuated to the person) and the insecurity perception. Moreover, probabilistic estimations were done that answered the question of interest, separating the effects for population groups to identifying the existence of heterogeneous results. As main results, a strong relationship was found between exposure to crimes, such as theft (affecting people and houses), homicides and squabbles; and the insecurity perception in the neighborhood. Similarly, women and the low-income population are likely to feel more insecure in their place of residence. Finally, knowing citizen security programs -such as the quadrants or community plans- are not connected to the perception of insecurity in the neighborhood.

Resumo A insegurança e a percepção de insegurança são fenômenos diferentes. Embora poderia se pensar que deveriam ser concomitantes, a evidência tem mostrado que esse não é sempre o caso. O objetivo é encontrar quais são os determinantes da percepção de insegurança em Bogotá. Assim mesmo, retendese encontrar se existem efeitos heterogêneos por género, renda e nível de escolaridade. De igual maneira, analisa-se a incidência que tem o conhecimento acerca de programas de segurança cidadã sobre a percepção de segurança da população. Para isso se utilizaram a Encuesta de Convivencia y Seguridad Ciudadana e a Encuesta de Percepción, pelo DANE e pela Câmara de Comércio, respectivamente, para fazer uma descrição estatística e espacial dos dados na cidade, na localidade e no lar em Bogotá, por meio da análise da relação entre vitimização (delitos cometidos contra a pessoa) e a percepção de insegurança. Além, se realizaram estimativas probabilísticas que respondessem à pergunta de interesse, separando os efeitos para grupos populacionais, com o objetivo de identificar a existência de resultados heterogêneos. Como resultados principais, se encontrou uma forte relação entre a exposição aos delitos, como furto (a pessoas e nas vivendas), homicídios e brigas, e a percepção de insegurança no bairro. Também, as mulheres e a população de baixos recursos tendem a sentir mais insegurança no seu lugar de residência. Finalmente, conhecer programas de segurança cidadã -como o plan cuadrantes ou planos comunitários-, não tem relação nenhuma com a sensação de insegurança no bairro.

Impacto del componente hiperclorémico de la acidosis metabólica en el estado de hidratación y en el tratamiento de la cetoacidosis diabética / Impact of the hyperchloremic component of metabolic acidosis on the patient's hydration status and the treatment of diabetic ketoacidosis

Introducción. La cetoacidosis diabética (CAD) se caracteriza por acidosis metabólica (AM) con anión restante (AR) elevado, aunque, ocasionalmente, puede presentar hipercloremia. Se postuló que la presencia de hipercloremia inicial podría reflejar un mejor estado de hidratación; sin embargo, su prevalencia y su impacto en el tratamiento de la CAD se desconoce. Objetivos. Determinar la prevalencia de AM con componente hiperclorémico previo al inicio del tratamiento y evaluar si su presencia se asocia con mejor estado de hidratación y con menor tiempo de salida de la CAD, en comparación con los pacientes con AR elevado exclusivo. Pacientes y métodos. Se agruparon los pacientes internados con CAD (período entre enero de 2014 y junio de 2016) según presentaran, al ingresar, AM con AR elevado exclusivo o con hipercloremia y se compararon sus variables clínicas, de laboratorio y la respuesta al tratamiento. Resultados. Se incluyeron 40 pacientes -amp;#91;17 varones, mediana de edad: 14,5 años (2,4-18)-amp;#93;, 22 con AM con componente hiperclorémico (prevalencia de 55%) y 18 con AR elevado exclusivo. La presencia de hipercloremia no se asoció con mejor estado de hidratación (porcentaje de déficit de peso en ambos grupos: 4,9%; p= 0,81) ni con una respuesta terapéutica más rápida (con componente hiperclorémico: 9,5 horas; con AR elevado exclusivo: 11 horas; p= 0,64). Conclusiones. En niños con CAD, la prevalencia de AM con componente hiperclorémico fue del 55% y no se asoció con un mejor estado de hidratación ni con una salida más temprana de la descompensación metabólica.

Introduction. Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. Objectives. To determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Patients and Methods. Patients hospitalized with DKA (between January 2014 and June 2016) were grouped according to whether they were admitted with MA with high AG only. or with hyperchloremia, and clinical and laboratory outcome measures and response to treatment were compared. Results. Forty patients (17 males, median age: 14.5 years -amp;#91;2.4-18-amp;#93;) were included; 22 with hyperchloremic metabolic acidosis (prevalence of 55%) and 18 with metabolic acidosis with high AG only. The presence of hyperchloremia was not associated with a better hydration status (weight loss percentage in both groups: 4.9%; p= 0.81) nor with a faster treatment response (MA with a hyperchloremic component: 9.5 hours; MA with high AG only: 11 hours; p= 0.64). Conclusions. The prevalence of MA with a hyperchloremic component among children with DKA was 55% and was not associated with a better hydration status nor with a faster recovery from the metabolic decompensation.

Impact of the hyperchloremic component of metabolic acidosis on the patient's hydration status and the treatment of diabetic ketoacidosis. / Impacto del componente hiperclorémico de la acidosis metabólica en el estado de hidratación y en el tratamiento de la cetoacidosis diabética.

INTRODUCTION: Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Patients and Methods. Patients hospitalized with DKA (between January 2014 and June 2016) were grouped according to whether they were admitted with MA with high AG only. or with hyperchloremia, and clinical and laboratory outcome measures and response to treatment were compared. RESULTS: Forty patients (17 males, median age: 14.5 years [2.4-18]) were included; 22 with hyperchloremic metabolic acidosis (prevalence of 55%) and 18 with metabolic acidosis with high AG only. The presence of hyperchloremia was not associated with a better hydration status (weight loss percentage in both groups: 4.9%; p= 0.81) nor with a faster treatment response (MA with a hyperchloremic component: 9.5 hours; MA with high AG only: 11 hours; p= 0.64). CONCLUSIONS: The prevalence of MA with a hyperchloremic component among children with DKA was 55% and was not associated with a better hydration status nor with a faster recovery from the metabolic decompensation.

Introducción. La cetoacidosis diabética (CAD) se caracteriza por acidosis metabólica (AM) con anión restante (AR) elevado, aunque, ocasionalmente, puede presentar hipercloremia. Se postuló que la presencia de hipercloremia inicial podría reflejar un mejor estado de hidratación; sin embargo, su prevalencia y su impacto en el tratamiento de la CAD se desconoce. Objetivos. Determinar la prevalencia de AM con componente hiperclorémico previo al inicio del tratamiento y evaluar si su presencia se asocia con mejor estado de hidratación y con menor tiempo de salida de la CAD, en comparación con los pacientes con AR elevado exclusivo. Pacientes y métodos. Se agruparon los pacientes internados con CAD (período entre enero de 2014 y junio de 2016) según presentaran, al ingresar, AM con AR elevado exclusivo o con hipercloremia y se compararon sus variables clínicas, de laboratorio y la respuesta al tratamiento. Resultados. Se incluyeron 40 pacientes [17 varones, mediana de edad: 14,5 años (2,4-18)], 22 con AM con componente hiperclorémico (prevalencia de 55%) y 18 con AR elevado exclusivo. La presencia de hipercloremia no se asoció con mejor estado de hidratación (porcentaje de déficit de peso en ambos grupos: 4,9%; p= 0,81) ni con una respuesta terapéutica más rápida (con componente hiperclorémico: 9,5 horas; con AR elevado exclusivo: 11 horas; p= 0,64). Conclusiones. En niños con CAD, la prevalencia de AM con componente hiperclorémico fue del 55% y no se asoció con un mejor estado de hidratación ni con una salida más temprana de la descompensación metabólica.

Prueba de concordancia de script: primera experiencia en pediatría de alcance nacional / Script Concordance Test: first nationwide experience in pediatrics

La prueba de concordancia de script es una herramienta adecuada para evaluar el razonamiento clínico. Se describe la primera experiencia de aplicación de esta prueba a nivel nacional en residentes de Pediatría, utilizando internet, en tiempo real. Participaron 268 residentes de 3.er año correspondientes a 56 sedes. La duración promedio del examen fue 46,1 ± 27,1 minutos, y se obtuvo un puntaje promedio de 65,3 ± 7,47 (sobre 100). Una encuesta posterior mostró una limitada satisfacción de los participantes. Esta experiencia muestra la factibilidad de la propuesta y su aplicabilidad en la formación de posgrado en Pediatría a nivel nacional.

The Script Concordance Test is a suitable test for assessing clinical reasoning in postgraduate medical education. We present the first nationwide, realtime, web-based experience of a Script Concordance Test administered to 3rd year pediatric residents. The test was administered to 268 residents (postgraduate year 3), from 56 different programs, requiring 46.1 ± 27.1 minutes to complete it, and scoring 65.3 ± 7.47 points. A later survey showed limited satisfaction from participants. This experience showed that this kind of test is feasible in this setting.

[Script Concordance Test: first nationwide experience in pediatrics]. / Prueba de concordancia de script: primera experiencia en pediatría de alcance nacional.

The Script Concordance Test is a suitable test for assessing clinical reasoning in postgraduate medical education. We present the first nationwide, realtime, web-based experience of a Script Concordance Test administered to 3rd year pediatric residents. The test was administered to 268 residents (postgraduate year 3), from 56 different programs, requiring 46.1 ± 27.1 minutes to complete it, and scoring 65.3 ± 7.47 points. A later survey showed limited satisfaction from participants. This experience showed that this kind of test is feasible in this setting.

La prueba de concordancia de script es una herramienta adecuada para evaluar el razonamiento clínico. Se describe la primera experiencia de aplicación de esta prueba a nivel nacional en residentes de Pediatría, utilizando internet, en tiempo real. Participaron 268 residentes de 3.er año correspondientes a 56 sedes. La duración promedio del examen fue 46,1 ± 27,1 minutos, y se obtuvo un puntaje promedio de 65,3 ± 7,47 (sobre 100). Una encuesta posterior mostró una limitada satisfacción de los participantes. Esta experiencia muestra la factibilidad de la propuesta y su aplicabilidad en la formación de posgrado en Pediatría a nivel nacional.

Herbage intake of dairy cows in mixed sequential grazing with breeding ewes as followers.

This study aimed to evaluate the hypothesis that mixed sequential grazing of dairy cows and breeding ewes is beneficial. During the seasons of spring-summer 2013 and autumn-winter 2013-2014, 12 (spring-summer) and 16 (autumn-winter) Holstein Friesian cows and 24 gestating (spring-summer) and lactating (autumn-winter) Pelibuey ewes grazed on six (spring-summer) and nine (autumn-winter) paddocks of alfalfa and orchard grass mixed pastures. The treatments "single species cow grazing" (CowG) and "mixed sequential grazing with ewes as followers of cows" (MixG) were evaluated, under a completely randomized design with two replicates per paddock. Herbage mass on offer (HO) and residual herbage mass (RH) were estimated by cutting samples. The estimate of herbage intake (HI) of cows was based on the use of internal and external markers; the apparent HI of ewes was calculated as the difference between HO (RH of cows) and RH. Even though HO was higher in CowG, the HI of cows was higher in MixG during spring-summer and similar in both treatments during autumn-winter, implying that in MixG the effects on the cows HI of higher alfalfa proportion and herbage accumulation rate evolving from lower residual herbage mass in the previous cycle counteracted that of a higher HO in CowG. The HI of ewes was sufficient to enable satisfactory performance as breeding ewes. Thus, the benefits of mixed sequential grazing arose from higher herbage accumulation, positive changes in botanical composition, and the achievement of sheep production without negative effects on the herbage intake of cows.

Medicamentos fuera de prospecto en Pediatría / Off-label drugs in Pediatrics

INTRODUCCIÓN El término "off label" se refiere al uso de un medicamento que no está incluido en el prospecto (MFP), como es el caso de su posología, indicación, dosis, rango de edad y vía de administración. OBJETIVOS Estimar la prevalencia de prescripción de MFP en niños hospitalizados en unidad de cuidados generales y la prevalencia de EAM en este grupo. Evaluar si los pacientes con MFP presentan mayor riesgo de EAM comparado con los autorizados. MATERIALES Estudio transversal. Se incluyo una muestra aleatorizada de historias clínicas de pacientes de 1 mes y 18 años hospitalizados durante el año 2017. Dos especialistas en pediatría evaluaron en forma sistemática y estandarizada todas las historias seleccionadas en busca disparadores asociados a EAM, y de EAM y de prescripción de MFP. EAM, se expresó mediante proporción sobre el número total de prescripciones y sobre el número total de pacientes, para ambos grupos con y sin MFP. La MFP se expresó en proporción sobre el número total de prescripciones y sobre el número total de pacientes. RESULTADOS Se incluyeron 412 historias clínicas, 225 varones (54,9%), el promedio de edad de 2,2 años. Se registraron 1353 prescripciones, de la cuales 286 fueron MFP 21% y la prevalencia de uso de MFP sobre el total de sujetos fue de 56%. Dentro del número total de MFP la causa más frecuente fue la edad 58%, seguido por dosis administrada 35%, por vía de administración 4%, 4 sujetos (2%) recibieron MFP sin indicación médica y finalmente 3 sujetos (1%) por preparados farmaceuticos. Utilizando la herramienta de detección de EAM se detectaron 22 disparadores. De estos solo se observaron 5 efectos adversos. La prevalencia de EAM fue menor al 2%. DISCUSIÓN La prevalencia de uso de MFP sobre el total de sujetos fue de 56%, la prevalencia de EAM fue menor al 2%. Se requieren otros estudios para evaluar si los MFP presenta mayor riesgo de EAM comparado con los autorizados

Detección de eventos adversos en pacientes pediátricos hospitalizados mediante la herramienta de disparadores globales Global Trigger Tool / Measuring adverse events in pediatric inpatients with the Global Trigger Tool

Introducción: La seguridad del paciente hospitalizado es prioritaria para el sistema de salud. La herramienta de disparadores globales parecería ser adecuada para estimar la incidencia de eventos adversos (EA) en niños hospitalizados. Objetivos: Describir la incidencia y la categorización de EA en niños hospitalizados utilizando la herramienta de disparadores globales e identificar los factores de riesgo asociados a su aparición. Población y métodos: Estudio retrospectivo. Se incluyeron 200 historias clínicas de pacientes internados en el Hospital Elizalde en el año 2013. Variables de resultado: número de EA/100 ingresos y distribución del dano. Se utilizó la prueba de chi cuadrado, la prueba de t y la correlación de Pearson. Nivel de significación de p < 0,05. Resultados: Se detectaron 289 disparadores (1,4/paciente); 52 EA (26 EA cada 100 pacientes, IC 95%: 20,4-32,5). Presentaron, al menos, un EA 36 pacientes; 7 pacientes sufrieron más de uno; 45 EA fueron categoría E y F (dano temporario). Los disparadores de cuidados médicos se asociaron con EA (OR 8,1; IC 95%: 3,7-17,3; p < 0,001). Se encontró una correlación positiva entre el número de disparadores y el número de EA por paciente (R= 0,46; p < 0,001). Los pacientes internados en unidad cerrada (OR 2,8; IC 95%: 1,2-6,5; p= 0,03) y el mayor promedio de días de internación se asociaron a EA (p < 0,001). Conclusión: Se identificó una frecuencia de 26% de EA; la mayoría fue dano temporario. La internación en una unidad cerrada, la mayor cantidad de días de internación, el mayor número de disparadores y los disparadores de cuidados generales se asociaron con la presencia de EA.

Introduction: The safety of inpatients is a priority in the health care system. The Global Trigger Tool seems to be suitable to estimate the incidence of adverse events (AE) in pediatric inpatients. Objectives: To describe the incidence and categories of AE in pediatric inpatients using the Global Trigger Tool and to identify risk factors associated to their development. Population and methods: Retrospective study. Medical records of 200 patients hospitalized at Hospital Elizalde during 2013 were included. Outcome measures: number of AE/100 admissions and distribution of harm. A chi² test, Student's t test and Pearson's correlation test were carried out. Significance level = p < 0.05. Results: The study detected 289 triggers (1.4/patient); 52 AEs (26 AEs/100 patients, 95% CI: 20.4-32.5). There was at least one AE every 36 patients; 7 patients had more than one AE; 45 AEs were in the E and F categories (temporary harm). Medical care triggers were associated to AEs (OR 8.1; 95% CI: 3.7-17.3, p < 0.001). A positive correlation was found between the number of triggers and the number of AEs per patient (R= 0.46; p < 0.001). Being hospitalized in a closed unit (OR 2.8; 95% CI: 1.2-6.5; p= 0.03) and a longer hospital stay were associated to AEs (p < 0.001). Conclusion: An AE frequency of 26% was identified, and most AEs resulted in temporary harm. The presence of AEs was associated to hospitalization in a closed unit, longer hospital stay, higher number of triggers and general care triggers.

Measuring adverse events in pediatric inpatients with the Global Trigger Tool. / Detección de eventos adversos en pacientes pediátricos hospitalizados mediante la herramienta de disparadores globales Global Trigger Tool.

INTRODUCTION: The safety of inpatients is a priority in the health care system. The Global Trigger Tool seems to be suitable to estimate the incidence of adverse events (AE) in pediatric inpatients. OBJETIVES: To describe the incidence and categories of AE in pediatric inpatients using the Global Trigger Tool and to identify risk factors associated to their development. POPULATION AND METHODS: Retrospective study. Medical records of 200 patients hospitalized at Hospital Elizalde during 2013 were included. Outcome measures: number of AE/100 admissions and distribution of harm. A chi² test, Student´s t test and Pearson's correlation test were carried out. Significance level = p < 0.05. RESULTS: The study detected 289 triggers (1.4/patient); 52 AEs (26 AEs/100 patients, 95% CI: 20.4-32.5). There was at least one AE every 36 patients; 7 patients had more than one AE; 45 AEs were in the E and F categories (temporary harm). Medical care triggers were associated to AEs (OR 8.1; 95% CI: 3.7-17.3, p < 0.001). A positive correlation was found between the number of triggers and the number of AEs per patient (R= 0.46; p < 0.001). Being hospitalized in a closed unit (OR 2.8; 95% CI: 1.2-6.5; p= 0.03) and a longer hospital stay were associated to AEs (p < 0.001). CONCLUSION: An AE frequency of 26% was identified, and most AEs resulted in temporary harm. The presence of AEs was associated to hospitalization in a closed unit, longer hospital stay, higher number of triggers and general care triggers.

INTRODUCCIÓN: La seguridad del paciente hospitalizado es prioritaria para el sistema de salud. La herramienta de disparadores globales parecería ser adecuada para estimar la incidencia de eventos adversos (EA) en niños hospitalizados. OBJETIVOS: Describir la incidencia y la categorización de EA en niños hospitalizados utilizando la herramienta de disparadores globales e identificar los factores de riesgo asociados a su aparición. POBLACIÓN Y MÉTODOS: Estudio retrospectivo. Se incluyeron 200 historias clínicas de pacientes internados en el Hospital Elizalde en el año 2013. Variables de resultado: número de EA/100 ingresos y distribución del daño. Se utilizó la prueba de chi cuadrado, la prueba de t y la correlación de Pearson. Nivel de significación de p < 0,05. RESULTADOS: Se detectaron 289 disparadores (1,4/paciente); 52 EA (26 EA cada 100 pacientes, IC 95%: 20,4-32,5). Presentaron, al menos, un EA 36 pacientes; 7 pacientes sufrieron más de uno; 45 EA fueron categoría E y F (daño temporario). Los disparadores de cuidados médicos se asociaron con EA (OR 8,1; IC 95%: 3,7-17,3; p < 0,001). Se encontró una correlación positiva entre el número de disparadores y el número de EA por paciente (R= 0,46; p < 0,001). Los pacientes internados en unidad cerrada (OR 2,8; IC 95%: 1,2-6,5; p= 0,03) y el mayor promedio de días de internación se asociaron a EA (p < 0,001). CONCLUSIÓN: Se identificó una frecuencia de 26% de EA; la mayoría fue daño temporario. La internación en una unidad cerrada, la mayor cantidad de días de internación, el mayor número de disparadores y los disparadores de cuidados generales se asociaron con la presencia de EA.

Meta-QTL for resistance to white mold in common bean.

White mold, caused by the fungus Sclerotinia sclerotiorum (Lib.) de Bary, is a major disease that limits common bean production and quality worldwide. The host-pathogen interaction is complex, with partial resistance in the host inherited as a quantitative trait with low to moderate heritability. Our objective was to identify meta-QTL conditioning partial resistance to white mold from individual QTL identified across multiple populations and environments. The physical positions for 37 individual QTL were identified across 14 recombinant inbred bi-parental populations (six new, three re-genotyped, and five from the literature). A meta-QTL analysis of the 37 QTL was conducted using the genetic linkage map of Stampede x Red Hawk population as the reference. The 37 QTL condensed into 17 named loci (12 previously named and five new) of which nine were defined as meta-QTL WM1.1, WM2.2, WM3.1, WM5.4, WM6.2, WM7.1, WM7.4, WM7.5, and WM8.3. The nine meta-QTL had confidence intervals ranging from 0.65 to 9.41 Mb. Candidate genes shown to express under S. sclerotiorum infection in other studies, including cell wall receptor kinase, COI1, ethylene responsive transcription factor, peroxidase, and MYB transcription factor, were found within the confidence interval for five of the meta-QTL. The nine meta-QTL are recommended as potential targets for MAS for partial resistance to white mold in common bean.

Aplicación del Examen Clínico Objetivo Estructurado en la residencia de Pediatría de la Ciudad de Buenos Aires / The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires

Introducción: A pesar de considerarse el estándar de oro para la evaluación de competencias en posgrado, el Examen Clínico Objetivo Estructurado (ECOE) es escasamente aplicado en América Latina. El Gobierno de la Ciudad de Buenos Aires (GCBA) posee un sistema de residencia de Pediatría con cerca de 400 residentes, distribuidos en 13 hospitales, que comparten examen de ingreso y programa de formación. Nuestro objetivo es describir la experiencia de aplicación del ECOE a todos los residentes de Pediatría del GCBA, y comparar el desempeño según el tipo de hospital. Sujetos y método: Estudio descriptivo, incluyendo a todos los residentes de Pediatría del GCBA que finalizaban primer año, pertenecientes a 13 hospitales (2 pediátricos y 11 generales). El ECOE incluyó 10 estaciones. Resultados: Participaron 85 residentes; el 88,2% (IC 95% 79,7-93,5) aprobó la evaluación. No se encontraron diferencias significativas en la proporción de residentes que aprobó la evaluación entre los que provenían de hospitales pediátricos y los de hospitales generales (89,5 vs. 85,7%; OR = 1,4; IC 95% 0,4-5,5; p = 0,8). Conclusiones: En 2015 por primera vez se desarrolló un ECOE como evaluación unificada para todos los residentes de Pediatría del GCBA. La experiencia permitió identificar debilidades de cada evaluado y del sistema, estableciendo estrategias para superarlas.

Introduction: The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. Subjects and method: Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. Results: Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR = 1.4; 95% CI 0.4-5.5; P = .8). Conclusions: In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them.

[Correlation between results of the residency admission test and of pediatric certification test in Buenos Aires, Argentina]. / Relación entre el desempeño en el examen de ingreso a la residencia y en el de especialización en pediatría en la Ciudad de Buenos Aires.

In the city of Buenos Aires (CABA), pediatric residents enter the residency program after taking a unified admission test. After completion of the program and passing a final test, the Universidad de Buenos Aires (UBA) provides a professional certification. The objective of this study is to determine if the results obtained in the residency admission test (RAT) and those of the professional certification test (PCT) correlated. This is a cross-sectional study, that included all subjects who passed the pediatrics RAT in CABA in 2004-2009, and that attended the pediatric PCT of the UBA. The score for each subject in both tests was obtained and the corresponding correlation was calculated. Results were divided in quintiles, and the proportion of subjects who improved their position in the PCT with respect to the RAT was calculated. Data from 303 subjects was obtained. The RAT showed a median of 45.0 (over 60 maximum) (IC-range: 43.0-48.7), and the PCT showed a median of 6 points (over 10 max.)(IC-range: 6-8). A significative correlation between results in RAT and PCT was observed (r = 0.37, p < 0.001). Based on their position in the RAT, 43.8% of subjects improved their position in the PCT, without differences between residents attending pediatric and general hospitals (45.6 vs. 31.5%; p = 0.1). In the case of pediatric residents, results of the residency admission test correlate with those obtained in the professional certification test.

Relación entre el desempeño en el examen de ingreso a la residencia y en el de especialización en pediatría en la ciudad de Buenos Aires / Correlation between results of the residency admission test and of pediatric certification test in Buenos Aires, Argentina

En la Ciudad de Buenos Aires (CABA) los ingresantes al sistema de residencia en pediatría lo hacen mediante un examen unificado y, al finalizar, rinden su examen de especialización en la Universidad de Buenos Aires (UBA). Existe evidencia de que el desempeño en determinadas evaluaciones podría predecir el rendimiento posterior. El objetivo de este estudio es evaluar si existe relación entre el examen de ingreso a la residencia (EIR) y el de especialización (EE) en pediatría. Se trata de una investigación transversal que incluye todos los sujetos que aprobaron el EIR de pediatría en CABA en 2004-2009 y que rindieron EE de pediatría en la UBA. Se obtuvo el puntaje de cada sujeto en ambos exámenes y se calculó la correlación correspondiente. Las notas fueron divididas en quintiles, calculando la proporción de alumnos que mejoró su ubicación en el segundo examen con respecto al primero. Se obtuvieron datos de 303 participantes. El examen de ingreso (calificación máxima de 60 puntos) mostró una mediana de 45.0 puntos (IIC: 43.0-48.7) y el examen de especialización (calificación máxima de 10 puntos) mostró una mediana de 6 puntos (IIC: 6-8), verificándose una correlación significativa entre la calificación del EIR y la del EE (r = 0.37, p < 0.001). En relación al quintil de referencia, 43.8% de los alumnos mejoró su ubicación en el EE respecto de la obtenida en el EIR, sin que se registraran diferencias entre residentes de hospitales pediátricos y de hospitales generales (45.6 vs. 31.5%; p = 0.1).

In the city of Buenos Aires (CABA), pediatric residents enter the residency program after taking a unified admission test. After completion of the program and passing a final test, the Universidad de Buenos Aires (UBA) provides a professional certification. The objective of this study is to determine if the results obtained in the residency admission test (RAT) and those of the professional certification test (PCT) correlated. This is a cross-sectional study, that included all subjects who passed the pediatrics RAT in CABA in 2004-2009, and that attended the pediatric PCT of the UBA. The score for each subject in both tests was obtained and the corresponding correlation was calculated. Results were divided in quintiles, and the proportion of subjects who improved their position in the PCT with respect to the RAT was calculated. Data from 303 subjects was obtained. The RAT showed a median of 45.0 (over 60 maximum) (IC-range: 43.0-48.7), and the PCT showed a median of 6 points (over 10 max.)(IC-range: 6-8). A significative correlation between results in RAT and PCT was observed (r = 0.37, p < 0.001). Based on their position in the RAT, 43.8% of subjects improved their position in the PCT, without differences between residents attending pediatric and general hospitals (45.6 vs. 31.5%; p = 0.1). In the case of pediatric residents, results of the residency admission test correlate with those obtained in the professional certification test.

Unlocking the genetic diversity of Creole wheats.

Climate change and slow yield gains pose a major threat to global wheat production. Underutilized genetic resources including landraces and wild relatives are key elements for developing high-yielding and climate-resilient wheat varieties. Landraces introduced into Mexico from Europe, also known as Creole wheats, are adapted to a wide range of climatic regimes and represent a unique genetic resource. Eight thousand four hundred and sixteen wheat landraces representing all dimensions of Mexico were characterized through genotyping-by-sequencing technology. Results revealed sub-groups adapted to specific environments of Mexico. Broadly, accessions from north and south of Mexico showed considerable genetic differentiation. However, a large percentage of landrace accessions were genetically very close, although belonged to different regions most likely due to the recent (nearly five centuries before) introduction of wheat in Mexico. Some of the groups adapted to extreme environments and accumulated high number of rare alleles. Core reference sets were assembled simultaneously using multiple variables, capturing 89% of the rare alleles present in the complete set. Genetic information about Mexican wheat landraces and core reference set can be effectively utilized in next generation wheat varietal improvement.

[The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires]. / Aplicación del Examen Clínico Objetivo Estructurado en la residencia de Pediatría de la Ciudad de Buenos Aires.

INTRODUCTION: The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. SUBJECTS AND METHOD: Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. RESULTS: Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR=1.4; 95% CI 0.4-5.5; P=.8). CONCLUSIONS: In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them.