Niños intoxicados en la unidad de cuidado intensivo: riesgos de la medicina popular, complicaciones y costos

Introduction: The Hospital Universitario del Valle (HUV) at the Pediatrics Intensive Care Unit (PICU) admits intoxicated patients, erroneously medicated by «teguas» or family members with serious aggravation of basic diseases or generating severe intoxications. Absent reports of these practices in Colombia motivated the publication of this case series Objective: To report a series of pediatric intoxication cases secondary to oral or dermatological application of varied substances by healers («teguas») or family members, leading to admission at the PICU, and to describe complications and hospital costs of these events. Methodology: Clinical charts of patients admitted to the PICU with diagnosis of exogenous intoxication during May 2001 to September 2004, were reviewed. Of 28 registered cases during that time, only 14 clinical charts were recovered. Variables evaluated included: age, gender, proceeding, administered substance, person responsible for the administration, complications, days of mechanical ventilation, total days at the intensive care unit and average costs. Of the 14 medical records with exogenous intoxications only 5 cases were involuntary and 9 were related to the administration of substances by quacks or family members; these are the ones reported in this series. Results: We report a total of 9 intoxicated patients, 5 girls and 4 boys, with an age range from 1 to 24 months, all from Cali. Topical administered substances: alcohol 6/9, vinegar 1/9; oral: aspirin 2/9, paico 1/9, and unidentified herbs 1/9. Administered substances by teguas: 6 patients; 3 by family members. All patients had metabolic acidosis with an increased anion gap: 27 in average (range from 21 to 32). All required mechanical ventilation (2 to 32 day range). Average hospital day costs were $6’657,800 pesos (around U$3,000.oo). Three patients died and 4 presented acute renal failure, 2 convulsions, 2 nosocomial infections, 1 subglotic stenosis. Conclusions and recommendations: Those practices are a high risk for children and have high health costs. Mortality and severe complications are high. Educational campaigns should be started in the community to prevent these cases. Introducción: A la Unidad de Cuidado Intensivo Pediátrico (UCIP) del Hospital Universitario del Valle (HUV) ingresan pacientes intoxicados, que antes han sido medicados de manera errónea por teguas o familiares con grave empeoramiento de las enfermedades de base o con intoxicaciones severas. La ausencia de informes sobre estas prácticas en Colombia motivó la publicación de esta serie de casos. Objetivo: Informar una serie de casos pediátricos con intoxicaciones, secundarias a la administración oral o dérmica de sustancias administradas por curanderos (teguas) o familiares conducta que implicó hospitalización en UCIP, describir las complicaciones y sus costos hospitalarios. Materiales y métodos: Se revisaron las historias clínicas de los niños que ingresaron a la UCIP del HUV con diagnóstico de intoxicación exógena, en el período de mayo 2001 a septiembre 2004. De los 28 casos registrados en tiempo sólo se recuperaron 14 historias clínicas. Se aplicó un formulario para obtener información de ellas que permitiera evaluar características socio-demográficas (edad, género, procedencia), tóxico administrado, persona responsable de la administración, complicaciones, días y costos de la hospitalización. De estas 14 historias, solamente 5 fueron intoxicaciones accidentales y 9 se asociaron con administración de sustancias por teguas o familiares, que son las que se comunican en esta serie. Resultados: Se informa un total de 9 pacientes intoxicados, 5 de género femenino con rango de edad 1 a 24 meses todos provenientes de Cali. Las sustancias administradas fueron por vía tópica: alcohol, 6/9; vinagre, 1/9; por vía oral: aspirina, 2/9; paico, 1/9; y otras hierbas no identificadas, 1/9. La administración de las sustancias fue hecha por teguas en 6 pacientes, y en 3 por familiares. Todos los pacientes presentaron acidosis metabólica con brecha aniónica aumentada con promedio 27 (rango 21 a 32), todos requirieron ventilación mecánica (rango 2 a 30 días), el promedio de estancia en la UCI fue 12 días (rango 2-34 días), y el promedio de costos de hospitalización fue $6’567,800. Murieron 3 pacientes, 4 presentaron falla renal aguda, 2 tuvieron convulsiones, hubo 2 infecciones nosocomiales, y 1 estenosis subglótica. Conclusiones y recomendaciones: Estas prácticas tienen alto riesgo para los niños y costos a los servicios de salud. La mortalidad y las complicaciones son altas. Se deben emprender campañas educativas en la comunidad para prevenir estos casos

Semiología renal y genitourinaria en pediatría. Segunda parte

Entre las patologías renales en niños, se encuentra la injuria renal aguda; que es la pérdida súbita de la función renal; el síndrome nefrótico que es el espectro más grave de proteinuria; el síndrome nefrítico caracterizado por la triada edema, hematuria macro o microscópica e hipertensión arterial

Semiología renal y genitourinaria en pediatría.

A pesar de los avances tecnológicos, la historia clínica y el examen físico continúan y continuarán siendo la base de un buen enfoque y aproximación diagnóstica correcta, por ésto, la semiología sigue siendo un área muy importante en la medicina. En ésta revisión se plantea una guía sistemática e integral para la evaluación del sistema nefro-urológico en el niño desde las herramienta básicas y fundamentales como la historia clínica, el examen físico con sus componentes semiológicos en lo normal y lo patológico, integrando además los métodos diagnósticos de laboratorio e imagen disponibles en la actualidad, para lograr un buen enfoque y aproximación diagnóstica en niños con enfermedad renal

Agenesia renal unilateral : revisión de casos de la consulta nefrológia pediátrica en centros asistenciales de Cali.

Introduction: Unilateral renal agenesis is a frequent renal malformation with incidence of 1 per 1000 live born children. There are no statistics nor protocols to manage and follow-up these patients. Usually asymptomatic, it can be early detected by prenatal ultrasound, allowing opportune detection and adequate follow up. The goal is to describe main features found in children with renal agenesis at four ambulatory pediatric nephrology clinics in Cali, Colombia: Hospital Universitario del Valle (HUV), Club Noel Children’s hospital and the private practice of two pediatric nephrologists. Methods: This is a retrospective descriptive study in a series of cases with congenital renal agenesis diagnosed between January, 1995 and December 2007, of patients under 18 years of age and based on a review of clinical records. Results: 43 patients were found, 51.2% males, 88% from the department of Valle del Cauca. Prenatal diagnoses were conducted in only 21% of these patients; agenesis was right in 48.8% and left in 51.2%. In 46.5%, association with other pathologies was found: occult spinal bifida, congenital scoliosis, and Klippel-Feil sequence. Compensatory renal hypertrophy was reported in 39.5% of the patients, 42% had episodes of urinary tract infection, 31% vesicoureteral reflux and 10% proteinuria. Four male patients (9.3%) developed renal failure. The average follow-up was 6.6 years. Conclusions: Prenatal diagnose was not very frequent in our set of cases. Urinary tract infection and vesicoureteral reflux were common, increasing the risk of renal deterioration. Prolonged follow up is suggested, with unified protocols to prevent renal failure. Introducción: La agenesia renal unilateral (ARU) es una malformación con una incidencia de 1 por 1000 nacidos vivos. En Colombia no hay estadísticas ni protocolos para el manejo y seguimiento de estos pacientes. La ARU casi siempre es asintomática y se puede descubrir temprano por ecografía prenatal, que permite el adecuado seguimiento. El objetivo es describir las características principales encontradas en la revisión de historias clínicas de niños con agenesia renal que se examinaron en dos servicios de nefrología pediátrica de la ciudad de Cali: Hospital Universitario del Valle (HUV), Hospital Infantil Club Noel (HICN) y en los consultorios de dos nefrólogas pediatras. Metodología: Es un estudio descriptivo retrospectivo de tipo serie de casos basado en la revisión de historias clínicas, de pacientes menores de 18 años con diagnóstico de agenesia renal congénita atendidos entre enero de 1995 y diciembre de 2007. Resultados: Se encontraron 43 pacientes, 51.2% masculinos. El 88% procedía del departamento del Valle. El diagnóstico prenatal sólo se hizo en 21% de los casos. En 48.8% de los pacientes la agenesia renal fue derecha y en el resto izquierda. En 46.5% hubo asociación con otras entidades (espina bífida oculta, escoliosis congénita y secuencia de Klippel Feil). En 39.5% de los pacientes se vio hipertrofia renal compensatoria, 42% presentaron algún episodio de infección urinaria, 31% reflujo vésico-ureteral y 10% proteinuria; en 4 pacientes (9.3%), todos varones desarrollaron falla renal. El promedio de seguimiento fue 6.6 años. Conclusiones: El diagnóstico prenatal fue poco frecuente en esta serie de casos. La infección urinaria y el reflujo vésicoureteral son altos y aumentan el riesgo de daños renales. Se recomienda el seguimiento extendido en niños con ARU, mediante protocolos unificados para prevenir el deterioro renal

Exploiting lattice structures in shape grammar implementations

The ability to work with ambiguity and compute new designs based on both defined and emergent shapes are unique advantages of shape grammars. Realizing these benefits in design practice requires the implementation of general purpose shape grammar interpreters that support: (a) the detection of arbitrary subshapes in arbitrary shapes and (b) the application of shape rules that use these subshapes to create new shapes. The complexity of currently available interpreters results from their combination of shape computation (for subshape detection and the application of rules) with computational geometry (for the geometric operations need to generate new shapes). This paper proposes a shape grammar implementation method for three-dimensional circular arcs represented as rational quadratic Bézier curves based on lattice theory that reduces this complexity by separating steps in a shape computation process from the geometrical operations associated with specific grammars and shapes. The method is demonstrated through application to two well-known shape grammars: Stiny's triangles grammar and Jowers and Earl's trefoil grammar. A prototype computer implementation of an interpreter kernel has been built and its application to both grammars is presented. The use of Bézier curves in three dimensions opens the possibility to extend shape grammar implementations to cover the wider range of applications that are needed before practical implementations for use in real life product design and development processes become feasible

Desafios da implantação do atendimento educacional especializado no Ensino Superior

This work aimed to make a clipping on the Educational Service Specializing in higher education, using as a base, theorists who deal with the implementation of the EEA, from the 1950s to the present. Also some successful experiences were presented, in relation to the implementation of programs for assistive technology and accessibility, which have contributed to the entry, stay and completion of higher education for people with special educational needs. From the foregoing, this study was retrospective, descriptive and documented about the experience of the implementation process of the ESA in a higher education institution. For this, we used records in field notebooks and written documents wich recorded the content of informal interviews, through the technique of conversation held with managers, directors, employees, teachers and students with and without disabilities of this institution. Participated in this work step, 238 people with 167 people identified as having a disability and 71 teachers, managers and directors. From this study, we present the possibility of developing several actions of teaching, research and extension, on university campuses, targeted to people with special educational needs, despite the many bureaucratic obstacles that still exist.http://dx.doi.org/10.5902/1984686X9037 Este trabalho teve como objetivo fazer um recorte sobre o Atendimento Educacional Especializado no Ensino Superior, utilizando como base, teóricos que versam sobre a implantação do AEE, desde os anos de 1950 à atualidade. Além disso, apresentaram-se algumas experiências de sucesso, no que se refere à implantação de programas de tecnologias assistivas e de acessibilidade, os quais têm contribuído para entrada, permanência e conclusão do ensino superior por pessoas com necessidades educacionais especiais. A partir do exposto, esta pesquisa teve caráter retrospectivo, descritivo e documentado a respeito da experiência do processo de implantação do AEE em uma instituição de ensino superior. Para tanto, foram utilizados registros em cadernos de campo e documentos escritos, que registraram o conteúdo de entrevistas informais, por meio da técnica da conversação, realizadas com os gestores, diretores, funcionários, professores e alunos, com e sem deficiência desta instituição. Participaram desta etapa de trabalho 238 pessoas, sendo 167 pessoas identificadas como apresentando algum tipo de deficiência e 71 professores, gestores e diretores. A partir deste trabalho, foi possível apresentar a possibilidade de desenvolver diversas ações de ensino, pesquisa e extensão, nos campi da universidade, direcionados às pessoas com necessidades educacionais especiais, apesar dos diversos entraves burocráticos ainda existentes

Evaluation of Commercial Probiotic Products

Although there is a vast number of probiotic products commercially available due to their acceptability and increasing usage, their quality control has continuously been a major concern. This study aimed to assess some commercially available probiotics on the UK market for content in relation to their label claim. Seven products were used for the study. The bacteria content were isolated, identified and enumerated on selective media. The results revealed that all products evaluated contained viable probiotic bacteria but only three out of the seven products (43%) contained the claimed culture concentration or more. None of the multispecies product contained all the labelled probiotic bacteria. Misidentification of some species occurred. The results concurred with previous studies and showed that quality issues with commercial probiotics remain. Since probiotic activity is linked with probiotic concentration and is strain specific, the need exist for a global comprehensive legislation to control the quality of probiotics whose market is gaining huge momentum