Análisis de los pacientes que reconsultaron a un servicio de emergencias pediátricas de un hospital materno infantil como indicador de calidad asistencial / Analysis of patients who consulted for a second time at a pediatric emergency department at a mother-and-child hospital as a marker of quality of care

Objetivos: 1) Analizar las reconsultas (RC) de pacientes a las 72 horas de su primera consulta en el Servicio de Emergencias Pediatría (SEP) de un hospital materno infantil del conurbano bonaerense. 2) Comparar las reconsultas entre dos periodos, luego de implementar mejoras en los procesos asistenciales y de contrarreferencia. Materiales y Metodos: Diseño: retrospectivo, observacional y transversal. Criterios de inclusión: pacientes de 30 días a 15 años de edad, que reconsultaron en el SEP del 01/01 al 31/03 de los años 2010 y 2014. Resultados: Las consultas que se atendieron en el periodo de estudio fueron: 14.003 en 2010 y 13.011 en 2014. Los diagnósticos más frecuentes fueron: infección respiratoria aguda alta (19.2%), fiebre (13%) y diarrea/ gastroenteritis (13.3%). Hubo 7.11% (n=966) de RC en el 2010 y 12.21% (n=1589) en el 2014. La mediana de edad de los pacientes con RC fue 24 meses en ambos años. Los motivos de RC más frecuentes fueron: persistencia de los síntomas (41% y 53.67%); progresión de la enfermedad (25% y 11.43%); otros diagnósticos nuevos (14.07% y 19.5%) y control (14% y 8.3%). Las RC de los domiciliados en San Isidro fueron 72.97% (n=694) en el 2010 y 69.32% (n=1071) en el 2014 del total de RC. La disminución de las RC observada al comparar ambos períodos es estadísticamente no significativa. (Pearson chi2 2.4506, p = 0.117). Conclusiones: 1) Los principales motivos de consulta fueron fiebre, diarrea y patología de la vía aérea superior. 2) Las RC dentro de las primeras 72 horas fueron 7% en 2010 y 12.9% en 2014. 3) La mayoría de los niños que concurren por RC lo hacen por la persistencia de síntomas de procesos que revisten poca gravedad. 4) Hubo una leve disminución, estadísticamente no significativa, de la RC de los pacientes domiciliados en San Isidro (AU)

Aims: 1) To analyze second consultations (SC) in patients within 72 hours of the first consultation at the Pediatric Emergency Department (PED) of a mother-and-child hospital in Greater Buenos Aires. 2) To compare SC between two time periods, after implementing a program of care and counter-referral. Material and Methods: Study design: a retrospective, observational, and cross-sectional study was conducted. Inclusion criteria: patients between 30 days of life and 15 years of age, who consulted at the PED between 01/01 and 31/03 from 2010 to 2014. Results: Patients seen during the study period were: 14,003 in 2010 and 13,011 in 2014. The most common diagnoses were: Acute upper respiratory infection (19.2%), fever (13%) and diarrhea/gastroenteritis (13.3%). SC were 7.11% (n=966) in 2010 and 12.21% (n=1589) in 2014. Median age of patients with a SC was 24 months in both years. Most common reasons for SC were persistent symptoms (41% and 53.67%); disease progression (25% and 11.43%); new diagnosis (14.07% and 19.5%) and control (14% and 8.3%). Home visits for SC in San Isidro were 72.97% (n=694) in 2010 and 69.32% (n=1071) in 2014 of all SC. The decrease in SC when comparing both periods was not statistically significant (Pearson chi2 2.4506, p = 0.117). Conclusions: 1) The main reasons for consult were fever, diarrhea, and upper airway infections. 2) SC within 72 hours were 7% in 2010 and 12.9% in 2014. 3) The majority of childrenwho were seen in a SC had persistent symptoms that were not severe. 4) A slight decrease, that was not statistically significant, was observed in SC of patients seen in the area of San Isidro (AU)

Identification of a novel mutation in the ryanodine receptor gene (RYR1) in a malignant hyperthermia Italian family.

Malignant hyperthermia (MH) is an inherited autosomal dominant pharmacogenetic disorder and is one of the main causes of death subsequent to anaesthesia. Around 50% of affected families are linked to the ryanodine receptor (RYR1) gene. To date, 19 mutations have been identified in the coding region of this gene and appear to be associated with the MH-susceptible phenotype. Here we report the identification by two independent methods of a novel mutation associated with the MH-susceptible phenotype in the RYR1 gene: the 6488G-->C transversion, resulting in the replacement of the Arg2163 with a proline residue.

Significantly improved survival time in pigs with complete liver ischemia treated with a novel bioartificial liver.

Aim of the study was to evaluate treatment efficacy and safety of a scaled-up version of our porcine hepatocytes based BAL system in pigs with complete liver ischemia (LIS). Thirty-one pigs underwent total devascularization of the liver (LIS) by termino-lateral porta-caval shunts and sutures around the bile duct, the common hepatic and gastroduodenal arteries and their accessory branches. The hepato-duodenal ligament was completely transected. Four experimental groups were studied: the first control group (LIS Control, n = 10) received glucose infusion only, the second control group (LIS Plasmapheresis, n = 8) was connected to a centrifugal plasma-separator with a bottle representing the bioreactor volume, the third control group (LIS Empty-BAL, n = 5) received BAL treatment without cells, and the treated group (LIS Cell-BAL, n = 8) was connected for a maximum period of 24 hours to our scaled-up BAL seeded with around 14 billion viable primary porcine hepatocytes. BAL treatment significantly prolonged life in large animals (approximately 35 kg) with complete LIS (Controls, mean +/- SEM: 33.1 +/- 3 h, Cell-BAL: 51.1 +/- 3.4 h; p = 0.001; longest survivor 63 h). In addition, blood ammonia and total bilirubin levels decreased significantly, indicating metabolic activity of porcine hepatocytes in the bioreactor. No significant differences were noticed among the three control groups, indicating that there was no device effect and that the plasmapheresis procedure was well tolerated. No important adverse effects were observed.

Minimal flow and half-closed system ventilation in lung surgery.

BACKGROUND: This study aimed at determining the applicability of minimal flow anaesthesia in lung surgery. METHODS: The standards anaesthesiological technique was modified to perform minimal flow half-closed system ventilation. For procedures on left lung orobronchial intubation was performed by a White no. 41 and no. 39 orotracheal tube, respectively in male and in female patients, in order to achieve a perfect tight of bronchial cuff and prevent gas loss from the circuit, because of the greater calibre of the right stem bronchus. The metal double lumen connector was replaced by a plastic tube that is clamped to exclude the lung from ventilation, whenever necessary. Fibrin glue was systematically applied on the bronchial stump or resected lung tissue before restoring ventilation. RESULTS: No significant changes were recorded in heart rate, arterial systolic and diastolic pressure, end-expiratoy CO2 concentration, oxygen saturation, airways maximum and minimum pressure. CONCLUSIONS: Minimal flow half-closed system ventilation can be easily performed also in pulmonary surgery provided that gas loss from the circuit is 50 ml/min by means of specific technical adjustments.

beta 25-35 alters calcium homeostasis and induces neurotoxicity in cerebellar granule cells.

We studied the neurotoxic effects of beta 25-35 amyloid fragment (beta 25-35) on cerebellar granule cells and the intracellular mechanisms involved. Treatment for 3 days with peptide greatly reduced the survival of 1 day in vitro (DIV) cultures kept in 5 mM KCI but slightly modified the survival of 25 mM KCI-cultured cerebellar granule cells. We also studied the effect of glutamate on survival of undifferentiated cerebellar granules. We report no neurotoxic effect of glutamate on 3-DIV-treated cultures; whereas in beta 25-35-pretreated cells, a significant glutamate toxicity was observed. Treatment of 6-DIV cells with beta 25-35, performed with 25 mM KCI, induced a late but significant neurotoxic effect after 5 days of exposure, and death occurred within 8 days. Differentiated cerebellar granule cells were also sensitive to glutamate-related neurotoxicity, and this effect was enhanced by beta 25-35 pretreatment. To study the molecular mechanisms underlying the neurotoxic effects of beta 25-35, changes in calcium homeostasis after glutamate stimulation were evaluated in control and beta 25-35-treated cells. beta 25-35 did not affect basal [Ca2+]i but modified glutamate-induced [Ca2+]i increase, causing a sustained plateau phase that persisted even after the removal of the agonist. These results show that beta 25-35 induces neurotoxicity in cerebellar granule cells and that this effect is related to modifications in the control of calcium homeostasis.

Somatostatin inhibits PC Cl3 thyroid cell proliferation through the modulation of phosphotyrosine activity. Impairment of the somatostatinergic effects by stable expression of E1A viral oncogene.

In this study, we report the effects of somatostatin on the proliferation of PC C13 thyroid cell line and the intracellular mechanisms involved. We also evaluated the possible alterations, induced by E1A oncogene transformation on the intracellular pathways mediating somatostatin inhibition of cell proliferation. We showed that somatostatin was able to powerfully inhibit insulin- and insulin + TSH-dependent cell proliferation by inducing a block in the G1/S progression in the cell cycle. These cytostatic effects were completely reverted by vanadate, suggesting that somatostatin may induce antiproliferative effects through the modulation of phosphotyrosine phosphatases. In the E1A-transformed cell line, somatostatin was completely ineffective. The lack of somatostatin inhibitory effects on cell proliferation were not due to alterations in the expression of somatostatin receptors, which were regularly expressed and coupled to adenylyl cyclase activity, but were dependent on an alteration in their coupling with the phosphotyrosine phosphatase. In fact, although in PC C13 cells somatostatin increased by 100% phosphotyrosine phosphatase activity, it was completely ineffective in E1A-expressing cells. In conclusion we demonstrated that somatostatin activates phosphotyrosine phosphatases in PC C13 thyroid cells to inhibit cell proliferation and that the stable expression of E1A oncogene in these cells completely abolishes this antiproliferative effect.

Alpha 1 B, but not alpha 1A, adrenoreceptor activates calcium influx through the stimulation of a tyrosine kinase/phosphotyrosine phosphatase pathway, following noradrenaline-induced emptying of IP3 sensitive calcium stores, in PC Cl3 rat thyroid cell line.

In PC Cl3 rat thyroid cell line noradrenaline-induced Ca2+ response, mainly due to the activation of alpha 1B receptors, is characterized by a rapid peak phase, due to the Ca2+ mobilization from inositol trisphosphate-sensitive internal stores, followed by a sustained plateau, representing the capacitative calcium entry. The plateau phase elicited by noradrenaline returns to the basal value within 100 sec from the removal of agonist. The tyrosine kinases inhibitor genistein completely abolishes the plateau upon noradrenaline withdrawal. On the contrary, the tyrosine phosphatases blocker, vanadate, potentiates the plateau phase of calcium response to noradrenaline and prevents the gradual decrease of [Ca2+]i after removal of noradrenaline. The noradrenaline-induced Ca2+ influx, due to the activation of alpha 1A receptor-operated Ca2+ entry is not affected by vanadate. The treatment with noradrenaline induced the tyrosine phosphorylation of specific substrates in lysates derived from PC Cl3 cells, an effect inhibited by genistein pretreatment. These results show that a balance between tyrosine phosphorylation and dephosphorylation is required for the regulation of capacitative calcium entry following noradrenaline stimulation of alpha 1B receptor, whilst the influx of Ca2+ directly operated by alpha 1A receptor activation seems to be independent of the tyrosine phosphorylating pathway.