[Prescription pattern in the management of Type I open forearm fractures in pediatric patients]. / Patrón de prescripción en el manejo de las fracturas expuestas tipo I de antebrazo en pediatría.

BACKGROUND: Pediatric open fractures account for more tan 10% of hospital admissions in a Pediatric Trauma Clinical Department. It is important to identify the predominant surgical management prescription pattern in pediatric patients presenting with Type I open forearm fractures at a referral center in an emerging economy. MATERIAL AND METHODS: Observational, cross-sectional, analytical, secondary-source (logs) sampling study of consecutive cases. The cases included subjects under 17 years of age presenting with Type I open forearm fractures at a Pediatric Trauma Clinical Department from January 1st, 2009 to December 31st, 2013. RESULTS: Ninety-two patients with a diagnosis of Type I open forearm fracture were included. All patients received parenteral antibiotics and underwent surgical debridement. However, in 69 (75%) of them a cast was used; in 9 (10%) a splint was used; 9 (10%) underwent fixation with Kirschner nails, and 5 (5.4%) underwent open reduction and internal fixation (ORIF). Eight patients (9%) required reoperation. CONCLUSIONS: Surgical management is the predominant prescription pattern in pediatric patients with Type I open forearm fracture. The latter is the predominant eepidemiology. The type of management was associated with a second surgery (p 0.000); however, this did not have a statistically significant impact on the hospital stay (p = 0.09).

ANTECEDENTES: Las fracturas expuestas en niños comprenden más de 10% de los ingresos hospitalarios a un departamento clínico de traumatología pediátrica. Resulta importante identificar el patrón de prescripción de manejo quirúrgico predominante en pacientes pediátricos atendidos en un centro de referencia de una economía emergente con fractura expuesta tipo I de antebrazo. MATERIAL Y MÉTODOS: Estudio por muestreo de casos consecutivos, observacional, transversal, analítico y de fuentes secundarias (bitácora). Fueron considerados todos los casos de sujetos menores de 17 años con fracturas expuestas tipo I de antebrazo, hospitalizados en un departamento clínico de traumatología pediátrica del 1o de Enero de 2009 al 31 de Diciembre de 2013. RESULTADOS: Noventa y dos personas con diagnóstico de fractura expuesta tipo I de antebrazo fueron incluidas. A todas se les realizó administración de antibiótico parenteral, así como desbridamiento quirúrgico; sin embargo, a 69 también se les colocó aparato de yeso (75%), a nueve se les puso férula (10%), a nueve se les realizó fijación con clavillos Kirschner (10%) y a cinco se les realizó reducción abierta y fijación interna (RAFI), (5.4%). Ocho niños (9%) requirieron una reintervención. CONCLUSIONES: Predomina el patrón de prescripción de manejo quirúrgico en pacientes pediátricos con fractura expuesta tipo I de antebrazo, así como su epidemiología. El tipo de manejo estuvo asociado con una segunda cirugía (p 0.000); sin embargo, esto no tuvo impacto estadísticamente significativo en la estancia hospitalaria (p = 0.09).

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)

Association between ERCC1 and XPA expression and polymorphisms and the response to cisplatin in testicular germ cell tumours.

BACKGROUND: Cisplatin cures over 80% of testicular germ cell tumours (TGCTs), and nucleotide-excision repair (NER) modifies the sensitivity to cisplatin. We explored the association between NER proteins and their polymorphisms with cisplatin sensitivity (CPS) and overall survival (OS) of patients with non-seminomatous (ns)-TGCTs. METHODS: The expression of ERCC1 and XPA and the presence of γH2AX were evaluated in cancer cell lines and in fresh ns-TGCTs. The ERCC1 protein was also determined in ns-TGCTs. The differences between CPS and non-CPS cell lines and patients were analysed by Student's t- or χ(2)-tests. The differences in OS were analysed using the log-rank test, and the hazard ratios (HRs) were calculated using the Cox model. RESULTS: High ERCC1 expression was observed in the non-CPS cells, and both ERCC1 and γH2AX expressions were augmented after cisplatin treatment. Increased ERCC1 expression was also identified in non-CPS patients. Neither polymorphism was associated with either CPS or OS. The presence of ERCC1 was associated with non-CPS (P=0.05) and adjusted in the prognosis groups. The HR in ERCC1-negative and non-CPS patients was >14.43, and in ERCC1-positive and non-CPS patients the HR was >11.86 (P<0.001). CONCLUSIONS: High levels of ERCC1 were associated with non-CPS, suggesting that ERCC1 could be used as a potential indicator of the response to cisplatin and prognosis in ns-TGCTs.