Cumplimiento del lavado de manos por parte del personal del servicio de clínica del Hospital Vicente Corral Moscoso, 2008, Cuenca-Ecuador

Con un diseño descriptivo se incluyó a 74 personas del Departamento de Clínica: 15 médicos tratantes titulares, 5 tratantes asociados, 10 residentes, 12 internos, 9 enfermeras y 23 auxiliares de enfermería, a quienes se observó anónimamente durante 20 minutos para detectar el cumplimiento de lavado de manos y la técnica empleada. Resultados: las mujeres fueron el 54,1% (n = 50) y los varones el 45,9 (n = 34). Los médicos tratantes titulares fueron el 20,3% (n = 15), los tratantes asociados 6,8% (n=5) médicos residentes 13,5% (n =10), los internos el 16.2% (n = 12), las enfermeras el 12,2% (n = 9) y las auxiliares de enfermería el 31,1% (n=23). Cumplieron con el lavado de manos, antes o después de realizar un procedimiento, el 43.24% (n = 32) de los observados y de ellos ningún individuo cumple con la técnica correcta. Las enfermeras fueron las que más cumplieron con el lavado de manos (P menor que 0,05) pero la utilización de la técnica correcta no fue ejecutado por ningún individuo que cumplieron con el lavado de manos. Todos utilizaron jabón líquido en dispensador, único recurso disponible en el hospital, y todos los que utilizaron la técnica correcta se secaron con toalla individual de papel. Conclusión: a pesar de la vigencia del lavado de manos dentro de los hospitales su cumplimiento por parte del personal es muy bajoMédicoCuenc

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Incidencia y factores asociados a apendicitis perforada en menores de 16 años. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, 2014

Objetivo: Determinar la incidencia y factores asociados de apendicitis perforada en menores de 16 años atendidos en el Servicio de Cirugía Pediátrica de los Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Materiales y métodos: estudio descriptivo de corte transversal llevado a cabo en 172 pacientes que fueron atendidos en el servicio de Pediatría del Hospital Vicente Corral Moscoso; los datos fueron recogidos en un formulario; se tabularon en el programa SPSS versión 15 y para el análisis se usaron frecuencias, porcentajes, medidas de tendencia central y de ubicación, la asociación se evaluó mediante el valor de chi cuadrado y para medir el riesgo razón de prevalencias. Resultados: La frecuencia de apendicitis perforada fue de 34,9% siendo más frecuente en los siguientes grupos poblacionales: escolares y lactantes con 45% cada grupo; de sexo masculino 61,7%; residentes en el área urbana 71,7%; con sobrepeso 6,7% y con madres con un nivel de instrucción primaria y secundaria con el 46,7% cada grupo. Se encontró que los factores de riesgo estadísticamente significativos para apendicitis perforada fueron: el haber sido remitido al domicilio tras la valoración inicial RP 1,5 (1,03-2,3) y diagnóstico inicial erróneo RP 1,6 (1,09-2,4). Conclusiones: el retraso en la atención médica sumado al error en el diagnóstico inicial son los principales factores de riesgo para apendicitis perforadaObjective: To determine the incidence and associated factors of perforated appendicitis in children under 16 years old treated at the Pediatric Surgery Department of Vicente Corral Moscoso and José Carrasco Arteaga Hospitals. Materials and Methods: Descriptive study and of cross section conducted on 172 patients who were treated in the Pediatric Department of Vicente Corral Moscoso Hospital; Data was collected on a form; tabulated in version 15 of SPSS program and for the analysis we used: frequencies, percentages, measures of central tendency and location, the association was evaluated using the chi-square value and to measure risk we used prevalence ratio. Results: The frequency of perforated appendicitis was 34,9%, being more frequent in the following population groups: school kids and infants with 45% each group; 61,7% male; 71,7% residing in urban areas; 6,7% with overweight and 46,7% of mothers with a level of primary and secondary education each group. It was found that statistically significant risk factors for perforated appendicitis were: have been sent home after initial assessment RP 1,5 (1,03 to 2,3) and wrong initial diagnosis 1.6 RP (1,09- 2,4). Conclusions: Delay in medical care combined with the error in the initial diagnosis are the main risk factors for perforated appendicitisEspecialista en PediatríaCuenc

Epileptic status on children: diagnostic and therapeutic general aspects

© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. Epileptic status (ES) is a very common neurological pathology in children that requires immediate attention. Seizures are abnormal and excessive synchronous discharges of neurons in the brain that are reflected through an electroencephalogram, these have a classification based on states according to their duration and their clinical expression depends on brain activity extension. Several international guidelines define ES as a clinical or electrographic activity continues for more than 5 minutes, its incidence varies according to age, with children under 5 years being the most affected ones. However, recurrence rates are considerably higher due to central nervous system infections and affect children in developing countries to a greater extent. Specifically, febrile seizures affect infants who have greater exposure to infections of any origin, this in turn implies a mortality rate that is higher in this age group compared to adults. Its diagnosis is focused on identifying the episodes and carrying out complementary studies to discover the underlying cause, which will vary according to the case: laboratory tests, lumbar puncture and / or computed tomogra-phy. On the other hand, the treatment of ES should be aimed at stopping seizures as soon as possible, focusing on general measures with special attention to good airway management and assertive medication use.© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. Epileptic status (ES) is a very common neurological pathology in children that requires immediate attention. Seizures are abnormal and excessive synchronous discharges of neurons in the brain that are reflected through an electroencephalogram, these have a classification based on states according to their duration and their clinical expression depends on brain activity extension. Several international guidelines define ES as a clinical or electrographic activity continues for more than 5 minutes, its incidence varies according to age, with children under 5 years being the most affected ones. However, recurrence rates are considerably higher due to central nervous system infections and affect children in developing countries to a greater extent. Specifically, febrile seizures affect infants who have greater exposure to infections of any origin, this in turn implies a mortality rate that is higher in this age group compared to adults. Its diagnosis is focused on identifying the episodes and carrying out complementary studies to discover the underlying cause, which will vary according to the case: laboratory tests, lumbar puncture and / or computed tomogra-phy. On the other hand, the treatment of ES should be aimed at stopping seizures as soon as possible, focusing on general measures with special attention to good airway management and assertive medication use