[Evolution of the perception of the safety culture of healthcare professionals in a pediatric emergency department]. / Evolución de la percepción de la cultura de seguridad de los profesionales sanitarios en una urgencia pediátrica.

BACKGROUND AND AIM: Safety culture (SC) is a fundamental tool for minimizing adverse events and improving safety and quality of care. Our objective, therefore was to analyze the evolution of the SC of healthcare professionals in a pediatric emergency department (PED) after the implementation of a risk management system for patient safety based on the UNE:EN:ISO 179003 Standard and the execution of new safe practices for Joint Commission International accreditation. At the same time describe the current strengths and weaknesses. METHODS: Quasi-experimental, single-center study. All PED professionals participated in the study. An initial measurement of SC was performed through the Hospital Survey on Patient Safety Culture (HSOPS) questionnaire of the Agency for Healthcare Research and Quality adapted to Spanish in 2014. Pro-patient safety strategies were implemented between 2015 and 2022. A subsequent measurement was performed in 2022. RESULTS: The response rate in 2014 was 55% and 78% in 2022. On both occasions the group with the highest participation was nurses with 35.1% and 34.8%, respectively. Five dimensions improved after the interventions: frequency of adverse events (25.2%, p<0.001), organizational learning (25%, p<0.001), feedback and communication about errors (22.3%, p<0.001), non-punitive response to errors (6.5%, p = 0.176), and management support (4%, p = 0.333). CONCLUSIONS: The actions carried out had a positive influence on organizational learning and the frequency of adverse events reported and communication within the team. In contrast, the perception of SC did not increase.

[Evaluation of the effectiveness of a procedure for identifying patients with allergy in paediatric emergency rooms]. / Evaluación de la efectividad de un procedimiento de identificación de pacientes con alergia en urgencias pediátricas.

INTRODUCTION: Correct identification of the patient with an allergy is critical for patient safety, since it involves a potential risk of a serious adverse event (AE). Our Emergency Pediatric department has an integrated quality management and risk management system focused on the continuous improvement of patient care quality and safety, which incident reporting system could identified a potential risk arising from the registration of allergies in new computer softwares. As a safety barrier, an allergy identification procedure was implemented, using a sticker placed on the identification bracelet (RED: allergy; WHITE: non-allergies). MATERIALS AND METHODS: A descriptive study was conducted to evaluate, by direct observation, the correct identification of patients with allergy using this new protocol. The reports of incidents related to this procedure were analyzed. RESULTS: Of the 342 patients included, 327 (95.6% (95%:93.4-97.8%)) were correctly identified. Identification errors were most common in the group of patients with allergies [10 of 45; 22.2% (95%:10.1-34.4%) than in the non-allergic group: 5 of 297; 1.7% (95%:0.2-3.2); p<0.001)]. No AEs were reported. 2 quasi-incidents detected before reaching the patient were reported thanks of the protocol application. CONCLUSIONS: This procedure is a useful safety barrier and can be easily exported to other units. Further work is needed to promote the professional's adherence to the protocol and improve the correct identification of the patient with allergy.

Video discharge instructions for pediatric gastroenteritis in an emergency department: a randomized, controlled trial.

The aim was to evaluate if the addition of video discharge instructions (VDIs) to usual verbal information improved the comprehension of information provided to caregivers of patients who consult for acute gastroenteritis (AGE). We conducted an open-label, parallel, randomized trial, enrolling patients who consulted for AGE at a tertiary hospital. First, caregivers answered a written test concerning AGE characteristics and management. They were randomly allocated to a control group, which received the usual verbal instructions, or to an intervention group, which additionally received VDI. After discharge, caregivers were contacted by telephone and answered the same test, satisfaction questions, and follow-up information. From September 2019 to March 2020, 139 patients were randomized, 118 completed follow-up. The mean score was 3.13 (SD 1.07) over 5 points in the initial test and 3.96 (SD 0.96) in the follow-up test. Patients in the intervention group had a greater improvement (1.17 points, SD 1.11) than those in the control group (0.47 points, SD 0.94, p < 0.001). In the follow-up test, 49.1% in the intervention group and 18.6% in the control group answered all questions correctly (p < 0.001). There were no significant differences in return visits. Caregivers gave high satisfaction scores regardless of the allocation group.Conclusion: Video instructions improve caregivers' understanding of discharge information.Trial registration: [NCT04463355, retrospectively registered July 9, 2020]. What is Known: • Poor comprehension of discharge instructions leads to incorrect treatment after discharge, increased readmissions and a reduction of caregivers' satisfaction. • Video discharge instructions are useful providing concise information independently of the patients' health literacy level or communication skills of the health care provider What is New: • The addition of video discharge instructions to verbal instructions improves caregivers' knowledge about AGE improved with respect to those who only receive verbal instructions • Video instructions do not add extra time to the emergency department visits.

[Evaluation of effectiveness of corrective measures arising from incident notifications in a paediatric emergency department]. / Evaluación de la efectividad de acciones correctivas derivadas de la notificación de incidentes en urgencias pediátricas.

OBJECTIVE: To analyse the effectiveness of corrective measures arising from the analysis of safety incident notifications in the Paediatric Emergency Unit. METHODS: A quasi-experimental, prospective, and single-centre study was carried out between 2015 and 2018. In the first phase, incidents notified throughout one year were analysed. Corrective measures were then implemented for 5 specific kinds of incidents. These incidents were finally compared to those notified within 12 months after the implementation of those measures. Results were expressed as relative risk and relative risk reduction. RESULTS: A total of 1587 safety incidents were notified (0.9% of patients treated) between January 2015 and December 2017. After implementation of corrective measures, there was a decrease in all kinds of incidents notifications analysed. The incidents related to patient identification were reduced by 60.9% (RR 0.39, 95% CI; 0.25-0.60), and those regarding communication between professionals were reduced by 74.5% (RR 0.25, 95% CI; 0.12-0.55). Incidents related to sedation and analgesic procedures totally disappeared. No significant reduction was found in incidents concerning the triage system, or in those related to rapid intravenous rehydration procedures. CONCLUSIONS: The implementation of improvement actions arising from the analysis of voluntary notification of incidents is an effective strategy to improve patient effective strategy to improve.

Capnografía no invasiva: valoración del estado ventilatorio en niños diagnosticados de neumonía / Assessment of ventilatory status with capnography in children diagnosed with pneumonia

Objetivo: Determinar si la medición de la capnografía en los pacientes pediátricos diagnosticados de neumonía tiene valor predictivo sobre la necesidad de ingreso hospitalario y el tiempo de hospitalización. Material y métodos: Estudio observacional de 1 año de duración en el que se incluyeron pacientes de 2-16 años de edad diagnosticados de neumonía en el servicio de urgencias. En todos ellos se determinó la temperatura, la frecuencia respiratoria, la frecuencia cardiaca, la saturación de oxígeno (SatO2) y el dióxido de carbono al final de la espiración (end tidal carbon dioxide [EtCO2]) mediante capnografía con gafas nasales en el momento del diagnóstico y a las 48 horas. Se excluyeron del estudio los pacientes con broncoespasmo asociado, los que habían recibido tratamiento antibiótico en las 48 horas previas y los que tenían alguna enfermedad crónica. Resultados: Se incluyeron 101 pacientes (un 59% mujeres), con una media de edad de 5,7 años. Precisaron ingreso 20 pacientes (19,8%). La media ± desviación estándar del EtCO2 en el momento del diagnóstico fue de 29,2 ± 2,8 mmHg en los pacientes ingresados y de 30 ± 3,6 mmHg en los no ingresados (p >0,05). A las 48 horas del inicio del tratamiento, el EtCO2 fue de 35,5 ± 0,7 mmHg en los pacientes ingresados y de 30,7 ± 3,3 mmHg en los no ingresados (p >0,05). No se encontraron diferencias significativas entre el EtCO2 en el momento del diagnóstico y a las 48 horas de tratamiento en el total de pacientes, ni en el grupo de ingresados ni en el de no ingresados. El EtCO2 en el momento del diagnóstico no se correlacionó significativamente con la duración del ingreso ni con la SatO2. Se observó una correlación inversa significativa entre el EtCO2 y la frecuencia respiratoria, independiente de la temperatura en dicha correlación. Conclusiones: En nuestro estudio, el EtCO2 medido mediante capnografía no invasiva en niños diagnosticados de neumonía no ha demostrado ser un parámetro útil para predecir la necesidad de ingreso ni la evolución clínica de los pacientes (AU)

Objective: To determine whether using capnography for pediatric can predict the need for admission to hospital and length of hospital stay. Material and methods: We performed an observational prospective study for one year, in pediatric patients aged over 2 years with a diagnosis of pneumonia. The parameters measured (at diagnosis and 48 hours later) were: temperature, respiratory rate, heart rate, oxygen saturation, and end tidal carbon dioxide (EtCO2) measured using capnography via a nasal cannula. The exclusion criteria were antibiotic treatment before diagnosis, bronchospasm at the time of diagnosis, and underlying chronic disease. Results: 101 patients were enrolled (mean age, 5.7 years) of whom 59% were girls. Twenty patients (19.8%) were admitted to hospital. The mean ± standar deviation value of EtCO2 was 29.2 ± 2.8 mmHg in admitted patients and 30 ± 3.6 mmHg in those who were not admitted (p >0.05). The mean EtCO2 48 hours after starting antibiotic treatment was 35.5 ± 0.7 mmHg in admitted patients and 30.7 ± 3.3 mmHg in those who were not admitted (p >0.05). No significant differences were found for body temperature. Conclusions: EtCO2 measured in children diagnosed children with pneumonia was not useful for predicting the need for admission in hospital or length of stay (AU)

Infección de orina como manifestación de un absceso pélvico / Urine infection as a sign of a pelvic abscess

No disponible

Structural changes in the kidney induced by coarctation hypertension.

We investigated structural alterations in renal tissue identifying the morphological and histological changes in the non-ischemic kidney (NIK) and their potential significance in aortic coarctation-hypertensive rats (HR). HR's mean arterial pressure (MAP) was higher compared with sham operated rats (SR). An oral 10 mg/kg/day losartan (LOS) dose diminished but not reverted MAP. Hypertrophy was noted in HR NIK's with significant weight increase (p<0.01). The ratio IK/NIK in HR's decreased 22% (p<0.01). LOS proved to cause no ischemic kidney (IK) modification nor did it revert NIK hypertrophy. NIK in HR's presented glomerulosclerosis, mesangial proliferation and arteriolar thickening reverted by LOS. The stereological study of afferent NIK arterioles showed hypertrophy and an increase in the wall/lumen ratio without lumen modification. LOS diminished wall thickness. LOS-induced decrease of NIK alterations might result from arteriosclerosis regression, the media/lumen ratio. glomerulosclerosis and mesangial proliferation dependent on angiotensin 11.

[Long-term course of liver rupture in preeclampsia. A case report]. / Evolución a largo plazo de la ruptura hepática en la preeclampsia. Informe de un caso.

A case report is presented of one preeclamptic patient with rupture of a big right subcapsular hematoma of the liver which was misdiagnosed with cholecystitis. A cesarean delivery was performed, which resulted is stillbirth, with abruptio placentae of 50%. The emergent treatment of the liver rupture was the right hepatic artery ligation, the postoperative development was favorable. Long term follow-up using ultrasound and liver function values were performed for 14 months and showed that the lesion has regressed with a normal hepatic imaging.

[HELLP syndrome. Analysis of 102 cases]. / Síndrome de HELLP. Análisis de 102 casos.

One hundred and two cases of HELLP Syndrome admitted at the Adults Intensive Care Unit since January 1992, to June 1994; 63 with severe preeclampsia, 26 eclamptics and 13 with chronic hypertension more preeclampsia-eclampsia were analysed. The mean age was 24 year (range, 15 to 42). All 102 of the patients had one or more symptoms, those more often were: headache (85), right upper-quadrant tenderness (61), nausea and/or vomiting (31). The diastolic blood pressure maximum before the admission was 100 mm Hg or less in patients and 46 had more than 110 mm Hg. The mean platelets count was 58000 (range, 17000 to 100000). The median of laboratory test were: lactic dehydrogenase (830 u/l), glutamic oxaloacetic transaminase (278 u/l), glutamic pyruvic transaminase (263 u/l), total bilirubin (3.3 mg/dl). There were complications in 37 patients; acute renal failure 20, disseminated intravascular coagulopathy in 11, cerebral hemorrhage in 10 and abruption placentae in 6 patients. During the study period there were 20 death due to preeclampsia-eclampsia and 14 were in patients with HELLP syndrome, cerebral hemorrhage was the main cause (70%). In the group study 11 intrauterine deaths were diagnosed.

Recognition of Trichinella spiralis muscle larvae antigens by sera from human infected with this parasite and its potential use in diagnosis.

Human antibody response to total soluble extract of Trichinella spiralis muscle larvae (TSE) was analyzed by Western blot. The most frequently recognized antigens had molecular weights of 96, 67, 63, 60, 55 and 47 kDa. An antigenic fraction containing two peptides with M.W. of 43, 47 kDa from the parasite (p43, 47 Ts L1) was isolated by elution from polyacrylamide gel slabs. It was used as antigen in an ELISA test and compared to that of TSE. Serum samples from 51 symptomatic trichinellosis patients--43 with high antibody levels to TSE, 5 of them with positive biopsy and 8 with low levels of these antibodies--as well as 38 from asymptomatic individuals from the area where the trichinellosis outbreaks had occurred and 43 from apparently healthy individuals from a non-endemic area, 37 from patients with intestinal parasitic infections caused by helminth and protozoan parasites--11 from recurrent and 26 from non-recurrent disease--were analyzed by ELISA using both antigens. The ELISA using p43, 47 Ts L1 detected all trichinellosis patients with high antibody levels as well as 6 out of 8 of those with low antibody levels. All control groups were negative. Therefore, this purified fraction allowed the ELISA to be more specific and sensitive for human trichinellosis diagnosis.

[Pulmonary valvuloplasty in children with cyanotic cardiopathy]. / Valvuloplastia pulmonar en niños con cardiopatías cianóticas.

We present 5 patients with cyanotic congenital heart disease in whom a pulmonary valvuloplasty was performed as palliative therapy. The patients symptoms were hypoxemic spells, very low oxygen saturation and no weight gain. The oxygenation improved and symptoms disappeared. We believe that in properly selected patients this technique represents a good therapeutic modality.

[Gnathostomiasis in Mexico]. / La gnatostomiasis en México.

Since 1975, increasing numbers of patients with inflammatory, migrant, recidivant nodules were observed in the towns of Temazcal, state of Oaxaca, Tierra Blanca, Veracruz and others along the Papaloapan river. Larvae of Gnathostoma sp. have been obtained from some of them. The local species, although not completely identified, must be very close to G. spinigerum. Infection is related to ingestion of "ceviche", a very popular mexican delicacy made with raw Cyclid fishes of the Miguel Aleman dam. Ecological and social changes provoked by the construction of the dam and hypotheticaly related to the dissemination of the parasite are described. As the Temazcal Fish Culture Center has delivered tilapia fishes to many secondary culture centers, it is feared that the infection could spread through the country, so signs and symptoms of the disease are described in order to help Mexican doctors make the diagnosis if they were to encounter the disease.

Cuatro nuevos casos de triquinosis aguda en Naucalpan.Consideraciones sobre la frecuencia real de la enfermedad n Mexico / Four new cases of acute trichinosis in Naucalpan. Considerations about the real frequency of the disease in Mexico

Se comunica el descubrimiento de cuatro casos de triquinosis en la zona de Ciudad Satelite, Estado de Mexico. En una familia se presento un caso aislado y en otra tres todos simultaneos debido posiblemente a la exposicion a la misma de infeccion, aunque esta no pude identificarse. A proposito de estos hallazgos se revisa la sintomatologia de la enfermedad subrayando los sintomas y signos de interes diagnostico y los examenes que el medico puede utilizar para confirmala. Se exponen argumentos para apoyar la hipotesis de que su incidencia es mas frecuente en nuestro medio de lo que habitualmente se supone, pues no se incluye como posibilidad diagnostica entre los cuadros febriles agudos

Urna olmeca que podria representar la leishmaniasis tegumentaria diseminada / An olmec figure representing diffuse skin leishmaninasis

En el museo Carlos Pellicer de Villahermosa existe una urna olmeca del periodo preclasico con "lesiones cutaneas" que podrian reproducir la leishmaniasis tegumentaria difusa. Se exponen las razones que hacen considerar mas probable que se trate de esta enfermedad y no de diversos padecimientos o de otras cosas que tambien podrian representarse asi. Hay dos pequenas esculturas mas de este mismo pueblo que se pueden interpretar como imagenes de otras formas de esta misma enfermedad. En varias culturas mesoamericanas y aun andinas existen figuras semejantes, algunas de las cuales, del altiplano mexicano, se consideran imagenes de Nanahuatzin, el Dios Buboso. Se sugiere la posibilidad de que se hayan originado en representaciones realistas de esta enfermedad procedentes de regiones de endemia leishmaniasica. Debido a la similitud clinica de sus lesiones, si la leishmaniasis tegumentaria diseminada existio en America Precolombina, esto implicaria entre otras cosas que la presencia de lepra en esos pueblos solo podria probarse encontrando en huesos o en momias lesiones patologicas inconfundiblemente debidas a este padecimiento. Es muy probable que en las poblaciones pequenas de Mexico, incluso actualmente, muchos enfermos de leishmaniasis tegumentaria diseminada sean considerados leprosos, como sucedio en Etiopia