Acute kidney injury in children after cardiac surgery: Risk factors and outcomes. A retrospective, cohort study. / Lesión renal aguda en niños poscirugía cardíaca: factores de riesgo e impacto evolutivo. Estudio de cohorte retrospectiva.

INTRODUCTION: Acute kidney injury (AKI) has been described as a common complication of cardiac surgery in pediatric patients, whose impact on morbidity and mortality has been documented. Its incidence has been estimated to be approximately 40 % in this patient group. The objective of this study was to estimate the incidence of AKI in patients who underwent cardiovascular surgery and to define associated risk factors and the impact of AKI on the parameters of the postoperative course. POPULATION AND METHODS: This was a retrospective, observational study of pediatric patients who underwent cardiovascular surgery between January 2015 and December 2017 at Hospital Británico de Buenos Aires. The incidence of AKI was defined as per the Kidney Disease: Improving Global Outcomes criteria, based on pre- and post-operative blood creatinine levels and urine output. RESULTS: A total of 125 patients were included. Of them, 35 % developed AKI. The analysis of risk factors showed a statistically significant difference for the administration of vancomycin and thiazide diuretics, red blood cell transfusion requirement, extracorporeal circulation pump time, clamp time, maximal intraoperative lactate level, minimum temperature, and delayed chest closure. In relation to the parameters of the post-operative course, we observed a longer hospital stay, higher inotropic requirement, more days of mechanical ventilation, bleeding, and neurological complications. CONCLUSION: In this study, the incidence of AKI was 35 %. Modifiable and non-modifiable associated risk factors were defined and a greater rate of complications was observed in patients who developed AKI.

Introducción. La lesión renal aguda (LRA) ha sido descrita como una complicación frecuente de las cirugías cardíacas en pacientes pediátricos, con impacto documentado en la morbimortalidad. Se estima una incidencia de alrededor del 40 % en este grupo de pacientes. El objetivo del trabajo fue calcular la incidencia de LRA en pacientes que tuvieron cirugía cardiovascular, definir los factores de riesgo asociados y el impacto de la LRA en los parámetros de evolución posquirúrgica. Población y métodos: Se realizó un estudio retrospectivo observacional sobre pacientes pediátricos con cirugías cardiovasculares, operados entre enero de 2015 y diciembre de 2017 en el Hospital Británico de Buenos Aires. Se definió la incidencia de LRA según los criterios de Kidney Disease: Improving Global Outcomes, considerando los valores de creatininemia y ritmo diurético pre- y posquirúrgicos. Resultados. Se incluyeron un total de 125 pacientes. Un 35 % desarrolló LRA. Al analizar los factores de riesgo, se observó una diferencia estadísticamente significativa para administración de vancomicina, diuréticos tiazídicos, requerimiento transfusional de glóbulos rojos, tiempo de bomba de circulación extracorpórea, de clampeo, lactato máximo intraquirúrgico, temperatura mínima y cierre diferido del tórax. Entre los parámetros de evolución posquirúrgica, se observó un incremento en la duración de la internación, requerimiento de inotrópicos, días de asistencia respiratoria mecánica, sangrado y complicaciones neurológicas. Conclusión. La incidencia de LRA en este estudio fue del 35 %. Se pudieron definir factores de riesgo modificables y no modificables asociados, y se detectó una mayor incidencia de complicaciones en aquellos pacientes que desarrollaron LRA.

Efficient bibliographic searches on allergy using ISI databases.

The aim of this article is to provide an introduction to using databases from the Thomson ISI Web of Knowledge, with special reference to Citation Indexes as an analysis tool for publications, and also to explain the meaning of the well-known Impact Factor. We present the partially modified new Consultation Interface to enhance information search routines of these databases. It introduces distinctive methods in search bibliography, including the correct application of analysis tools, paying particular attention to Journal Citation Reports and Impact Factor. We finish this article with comment on the consequences of using the Impact Factor as a quality indicator for the assessment of journals and publications, and how to ensure measures for indexing in the Thomson ISI Databases.

Buscando la mejor "evidencia" en Alergología / Searching for the best evidence in allergology

La Alergología Clínica y las ciencias médicas generan día a día preguntas a los que las practicamos. Para responder a estas preguntas existen distintos tipos de fuentes; sin embargo, estamos obligados a buscar la mejor información posible para resolverlas. Los tiempos en los que vivimos y desarrollamos la profesión médica exigen información de calidad dado el mar de datos disponibles en las fuentes a nuestra disposición; de entre todas las conocidas, es Internet la que mayor volumen nos ofrece. El adecuado manejo de este recurso nos permitirá acceder a información que debería ser por regla general basada en la evidencia. El objetivo de este artículo es proponer una guía de recursos web de utilidad para la práctica diaria en alergología.(AU)

Clinic Allergology and medical sciences practice are constant generators of questions. To answer these questions there are multiple sources; however, we most search for the best possible information. Times we are living in and practice medical profession require high quality information because of the great sea of data we find in the available sources; from all of these, internet is the one that offers a great volume of information. An appropriate use of this resource will allow us to achieve information that should be always evidence based medicine. The objective of this article is to propose a guide of web resources useful in daily Allergology practice. (AU)

Efficient bibliographic searches on allergology using PubMed.

INTRODUCTION: PubMed is the most important of the non-specialized databases on biomedical literature. International and quickly updated is elaborated by the American Government and contains only information about papers published in scientific journal/s. Although it can be used as an unique Data Base, as a matter of fact is the addition of several subgroups (among them MEDLINE) that can be searched simultaneously. OBJECTIVES: To present the main characteristics of PubMed, as well as the most important procedures of search, for obtaining efficient results in searches on allergology. CHARACTERISTICS AND SEARCH PROCEDURES: PubMed is elaborated by the American Administration, that condition the character of the registered papers, 90 % of them are written in English in American (50 %) or British (20 %) Journals. Because of this, the information for certain specialties or countries must be obtained from other sources. This paper shows how PubMed allows to search in natural language due to the Automatic Term Mapping that links terms from the natural language with the descriptors producing searches with a higher sensitivity although with a low specificity. Nevertheless the MeSH (Medical Subject Headings) thesaurus allows to translate those terms from the natural language to the equivalent descriptor, as well as to make queries in the PubMed's documental language with a high specificity but with lower sensitivity than the natural language. The use of union (OR), intersection (AND) and exclusion (NOT) operators, as well as tags, such as delimiters of the search fields, allows to increase the specificity of the results. Similar results may be obtained with the use of Limits. Searches done using Clinical Queries are very interesting due to their direct clinical application and because allow to find systematic reviews, metaanalysis or clinically oriented papers (treatment, diagnostic, etiology, prognosis or clinical prediction guides) on the area of interest. Other procedures such as the Index, History of searches, and the widening of the selection using Related Articles and the storing of separate results in the Clipboard to be kept by the user, are presented in this paper.

Karyomegalic interstitial nephritis: report of 3 new cases and review of the literature.

Karyomegalic interstitial nephritis is a rare, but perhaps an "underdiagnosed" condition. Peculiar nuclear changes characterize it, involving mainly tubular cells along with glomeruli and blood vessels. Herein, 3 bioptically proven new cases of patients with chronic renal failure are discussed. The first case had a recently diagnosed karyomegalic nephritis which, to date, still does not require dialysis. The other 2 (brother and sister) required dialysis 4 and 1 years after diagnosis. Karyomegalic changes were found not only in the skin and duodenal biopsies of the male, in skin and liver biopsies of the female and in the urine cells of both patients, but also in several organs (brain, thyroid, lung, esophagus, arteries) as shown at the autopsy of the female. There was a fatal outcome for both patients. The data reported in this study emphasize the usefulness of pathologic investigation of both tissue and urine samples in the identification of this disease. Moreover, as karyomegalic interstitial nephritis is strongly suspected to have a genetic background, its identification may well not only be of clinical relevance, due to its ominous outcome, but may also bear eugenetic value.

Large intramyometrial cystic adenomyosis: a hysteroscopic approach with bipolar resectoscope: case report.

A case of an adenomyotic cyst in a 46-year-old woman was examined by means of transvaginal ultrasound, hysteroscopy and microscopy. The transvaginal ultrasound showed an anechoic area. Hysteroscopy revealed a cystic mass of the posterior wall and by means of a bipolar loop resectoscope the mass was removed. Histological examination of the lesion showed typical characteristics of an adenomyotic cyst. These results were consistent with those of previous reports and suggest that transvaginal ultrasound together with hysteroscopy is specific to diagnose and treat this kind of adenomyotic lesion.

[Treatment of Helicobacter pylori in children]. / Il trattamento dell'Helicobacter pylori nell'infanzia.

BACKGROUND: There are very few studies that compare therapeutic protocols against H. pylori infection in children and the few available data derive from studies that usually evaluate the remission of symptoms or the accuracy of diagnostic procedures before and after treatment. Furthermore, no randomised, controlled clinical trials using placebo have been carried out in children. METHODS: We systematically collected data from the pediatric literature on the treatment of H. pylori to assess the efficacy of various treatments. This review included all articles and letters published since 1987 and all abstracts presented at the three main international meetings from 1997 to 1999. The results of studies published in English and French journals were collected and analysed. RESULTS: We only found 30 articles and 17 abstracts containing results on the treatment of H. pylori, carried out respectively in a total of 870 and 1552 children. All the data collected seemed to indicate that single-therapy or dual therapy with an antisecretory drug combined with an antibiotic showed a low level of efficacy. Dual therapy proved effective, in the form of bismuth and one antibiotic (amoxycillin or a nitroimidazole) or two antibiotics when administered for two or more weeks. The same was true of triple therapy based on bismuth or a proton pump inhibitor associated with two antibiotics. Triple therapies were less effective in children than in adults, and although triple therapies based on bismuth were more effective when administered for at least two weeks, the triple therapies based on a proton pump inhibitor showed a comparable level of efficacy irrespective of duration. CONCLUSIONS: Dual therapies in children using two antibiotics appear to have a similar efficacy as triple therapies, and if the latter contain a proton pump inhibitor, they show a similar efficacy irrespective of duration. For this reason, it does not seem necessary to administer them for more than one week.

[Immunological study of acute forms of acne]. / Estudio inmunológico de las formas severas de acné

In severe forms of acne (grade IV) there is probably an inmunological alteration consisting of: 1) Alterations in the IgG. 2) They may be produced in small quantity or destroyed more rapidly. 3) Cellular immunity is normal using PHA and diminished with habitual tests. 4) It is necessary to normalize these globulin levels before or during specific medication, with antibiotics or sulfa drugs. 5) Essential aminoacids should be given so as to raise the inmunoglobulins to normal levels. The administration of commercial inmunoglobulins should be avoided, because, for genetic reason, they could produce autoimmunity or isosensibility and diminished the levels one is trying to raise.