Conducta suicida en niños y adolescentes ingresados en un hospital general: Análisis descriptivo / Features of adolescents hospitalized for a suicide attempt in a general hospital

Background: Worldwide, suicide is the third cause of death among adolescents. Aim: To determine the socio-demographic context and clinical characteristics of children and adolescents hospitalized for suicidal behavior in a general hospital. Material and Methods: Between 2007 and 2009, we evaluated 47 patients with a mean age of 15.3 years (87% women) admitted for suicidal behavior at the Clinical Hospital of the Catholic University of Chile. Demographic data of the participants were registered. Clinical interviews were done by a child and adolescent psychiatrist. Results: Fifty seven percent of patients lived with both parents. Fifty one percent had previous suicide attempts and 68% had a previous psychiatric treatment. The main trigger was a conflict with parents in 66%. The psychiatric diagnoses were major depressive episode in 74.5% and pathological development of personality in 43%. All suicide attempts were with drugs and 6.4% were associated with cuts. Seventeen percent of attempts were classified as medically serious and they were more common in older age groups. Non severe attempts were observed mainly in women (92.3%). Acetaminophen intake was recorded in 8.5% of cases. Admission to hospital increased in the final quarter of the year. High costs of hospitalization were observed associated to stays in high complexity units. Conclusions: The population studied shows a high incidence of prior suicidal behavior. Most of the studied patients had attempts that were not classified as serious. These occurred predominantly in women in all age ranges. Medically serious suicidal behavior is mainly observed in older adolescents.

[Features of adolescents hospitalized for a suicide attempt in a general hospital]. / Conducta suicida en niños y adolescentes ingresados en un hospital general. Análisis descriptivo.

BACKGROUND: Worldwide, suicide is the third cause of death among adolescents. AIM: To determine the socio-demographic context and clinical characteristics of children and adolescents hospitalized for suicidal behavior in a general hospital. MATERIAL AND METHODS: Between 2007 and 2009, we evaluated 47 patients with a mean age of 15.3 years (87% women) admitted for suicidal behavior at the Clinical Hospital of the Catholic University of Chile. Demographic data of the participants were registered. Clinical interviews were done by a child and adolescent psychiatrist. RESULTS: Fifty seven percent of patients lived with both parents. Fifty one percent had previous suicide attempts and 68% had a previous psychiatric treatment. The main trigger was a conflict with parents in 66%. The psychiatric diagnoses were major depressive episode in 74.5% and pathological development of personality in 43%. All suicide attempts were with drugs and 6.4% were associated with cuts. Seventeen percent of attempts were classified as medically serious and they were more common in older age groups. Non severe attempts were observed mainly in women (92.3%). Acetaminophen intake was recorded in 8.5% of cases. Admission to hospital increased in the final quarter of the year. High costs of hospitalization were observed associated to stays in high complexity units. CONCLUSIONS: The population studied shows a high incidence of prior suicidal behavior. Most of the studied patients had attempts that were not classified as serious. These occurred predominantly in women in all age ranges. Medically serious suicidal behavior is mainly observed in older adolescents.

Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia.

BACKGROUND: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza. OBJECTIVE: To evaluate the role of CAP severity scores as predictors of mortality. METHODS: This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality. RESULTS: Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality. CONCLUSIONS: The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.

Influenza pneumonia: a comparison between seasonal influenza virus and the H1N1 pandemic.

We compared clinical presentation, complications and outcome in patients with influenza A (H1N1) and seasonal influenza pneumonia. The group of patients with influenza A (H1N1) pneumonia consisted of 75 patients. 52 patients with pneumonia associated with seasonal influenza were included for comparison. Patients with pneumonia associated with novel H1N1 influenza were younger (mean age 39.7 yrs versus 69.6 yrs) and had fewer chronic comorbidities and less alcoholism. Infiltrates were more extensive and frequently interstitial. Respiratory failure was more frequent (those with an arterial oxygen tension/inspiratory oxygen fraction ratio <200 28% versus 12%, p = 0.042), leading to a higher rate of intensive care unit (ICU) admission and mechanical ventilation (29.3% versus 7.7% (p<0.0030) and 18.7% versus 2% (p<0.0045)). Mortality was twice as high in patients with novel H1N1 (12% versus 5.8%; p = 0.238), although this was not significant, and was attributable to pneumonia in most instances (77.8% versus 0%; p = 0.046). Younger age, fewer comorbidities, more extensive radiographic extension and more severe respiratory compromise, and ICU admissions are key features of the clinical presentation of patients with novel H1N1-associated pneumonia compared with seasonal influenza pneumonia.

Characteristics of hospitalised patients with 2009 H1N1 influenza in Chile.

As the pandemic of 2009 H1N1 influenza A virus progressed, more patients required hospitalisation. The objective of this study is to describe the characteristics and clinical course of hospitalised patients with 2009 H1N1 virus infection in Chile. This was a prospective, observational study of 100 consecutive hospitalised patients with RT-PCR-confirmed 2009 H1N1 influenza A, admitted to Puerto Montt General Hospital (Puerto Montt, Chile). Information was obtained regarding contact history, demographics, laboratory values and clinical course. The primary reason for hospitalisation was pneumonia, in 75% of patients. Rapid influenza A test was positive in 51% of patients. Prior exposure to 2009 H1N1 virus was documented in 21% of patients. Clinical failure, documented in 18% of cases, was characterised by respiratory failure and acute respiratory distress syndrome. Failure was more common in patients with obesity, tachypnoea, confusion and multilobar infiltrates. When evaluating a patient hospitalised with influenza-like illness, a negative rapid test for influenza A or negative contact with a suspected case should not alter physicians' considerations regarding the likelihood of 2009 H1N1 virus infection. Patients with 2009 H1N1 virus infection with obesity, tachypnoea, confusion and multilobar infiltrates should be closely monitored since they are at high risk for clinical failure.

Diabetes mellitus tipo 1 y psiquiatría infanto-juvenil / Type 1 diabetes mellitus and child-adolescent psychiatry

Objective: To review the psichological effects of DM1 on children and adolescents, and review a clinical case. Method: SIBUC (Electronic System of PUC Lybrary) Bibliographic search. Clinical Case: 13 year old adolescent diagnosed with DM1 since the age of 3, with poor treatment adherence, and poor social relationships. History of Anxiety Disorders diagnosed at age 10, partially treated with medications and psychotherapy. Currently anxious, hopeless regarding illness outcome. Treated with Sertraline and psychotherapy, presented behavioral and autonomy issues. Review: The relationship between DM1 and psychiatric topics is reviewed, including some hypotheses, issues such as attachment, body-self relationship, separation-individuation. Suggestions are made for parents and treatment teams for systematic follow up of these patients and in preventing and treating psychological complications of DM1. Conclusions: DM1 is associated to significant psychopathology in children and adolescents. Due to its complications, it needs to be prevented and treated promptly to improve the outcome of these patients.

Objetivo: Revisar los efectos psicológicos de la DM1 sobre los niños y adolescentes; comentar un caso clínico. Métodos: Búsqueda en la base de datos de SIBUC (Sistema Electrónico de Bibliotecas de la Pontificia Universidad Católica de Chile) de artículos que incluyeran "Diabetes Mellitus Insulino Dependiente" y "Patología Psiquiátrica en la Infancia y Adolescencia". Caso clínico: Adolescente de 13 años con diagnóstico de DM1 desde los 3 años, con mala adherencia al tratamiento y problemas relaciónales. Antecedentes de trastorno ansioso, diagnosticado a los 10 años, cuya terapia, farmacológica y terapéutica, fue parcialmente cumplida. Al consultar, angustiado y desesperanzado respecto al pronóstico de su enfermedad. Se inició Sertralina y psicoterapia, con regular evolución, presentando problemas conductuales y de autonomía. Revisión: Se revisa la asociación entre DM1 y patología psiquiátrica, la hipótesis de la génesis de estas asociaciones y temas como el apego, la relación cuerpo-self y la individuación. Se realizan sugerencias para los padres y para el equipo médico, respecto del seguimiento sistemático de estos pacientes, y así contribuir a una mejor prevención y tratamiento de la psicopatología asociada a la DM1. Conclusión: La DM1 se asocia a importante psicopatología en la infancia y adolescencia. Por sus importantes implicancias esta debe ser estudiada en mayor profundidad y la enfermedad prevenida y tratada oportunamente para mejorar el abordaje de estos pacientes.

[Suprahepatic vein catheterization in 4 cases of severe septic shock]. / Cateterización venosa suprahepática en cuatro casos de shock séptico severo.

Splanchnic hypoperfusion, with pathogenic implications for multiple organ failure, can occur during septic shock. We report four patients with septic shock in whom regional hepatosplenic splanchnic perfusion was monitored through suprahepatic vein catheterization and gastric tonometry. Suprahepatic lactate and oxygen saturation showed splanchnic hypoperfusion in all patients. These parameters improved only in the patient that survived. Gastric tonometry was more inconsistent. We conclude that suprahepatic vein catheterization could have a role in the management of septic shock.

Analgesia epidural continua postoperatoria en niños / Postsurgical epidural continous analgesia in children

Ofrecer una analgesia postoperatoria de calidad superior es un requisito fundamental en los pacientes pediátricos sometidos a cirugías cruentas y dolorosas. Se estudiaron prospectivamente 30 niños operados de cirugía de tórax, abdomen y genitourinaria, los cuales recibieron analgesia epidural continua durante su postoperatorio. La edad promedio fue de 5.6 años y el peso promedio de 19,2 kg. En el intraoperatorio, una vez inducida la anestesia general, se realizó una punción epidural lumbar e inyectó a través del trócar una dosis de carga de bupivacaína al 0,375 por ciento en dosis de 1 mg/kg más morfina 30 ug/kg en un volumen de 0.25 ml/kg. Luego se introdujo un catéter epidural y se infundió a través de él, una solución de bupivacaína al 0.0625 por ciento en dosis de 0.15 mg/kg/h más morfina 3 ug/kg/h más adrenalina 0.25 mg en 250 ml de solución analgésica, a razón de 0.25 ml/kg/h. En el postoperatorio se evaluó el score de dolor separando a los pacientes en dos grupos. El grupo A incluyó a los niños de 2 a 6 años, comprendió 18 pacientes, y se otorgó 1 punto: niño tranquilo, 2 puntos: llorando, 3 puntos: gritando y en movimiento. El grupo B fue de niños de 7 a 10 años, incluyó 1 pacientes, y se usó una escala verbal numérica de 0 a 10 puntos. El score del dolor en el grupo A fue de 1 punto en 15 pacientes (83,3 por ciento) y en el grupo B el puntaje promedio fue de 0.75 puntos. Las complicaciones registradas fueron vómitos en 14 (46.6 por ciento) niños, retención urinaria en 9 (30 por ciento), prurito en 4 (13.3 por ciento) y flictena por decúbito en 1 (3,3 por ciento). Concluimos que esta técnica de analgesia postoperatoria en niños es efectiva y segura

Hipocalciuria en preeclampsia / Hypocalciuria in preeclampsia

Estudios recientes han asociado a la preeclampsia con hipocalciuria, otros estudios no muestran esta asociación. Con el propósito de determinar si existe tal asociación se estudiaron 25 pacientes con embarazo de término; 13 normotensas, 7 hipertensas transitorias y 5 preeclámpticas. No se encontró diferencias significativas en el hematocrito, calcemia, creatininemia, recuento de plaquetas y diuresis de 24 horas entre los 3 grupos estudiados. La uricemia en las normotensas 3,5 ñ 0,8 mg/dl fue significativamente menor que las preeclámpticas 4,9 ñ 0,8 mg/dl, mediana ñ DS, p<0,05. La calciuria de 24 horas en el grupo de preeclámpticas 121 ñ 78 mg/24 horas fue significativamente menor que en el grupo de normotensas 256 ñ 71 mg/24 horas e hipertensas transitorias 229 ñ 93 mg/24 horas, p<0,05. Determinamos el clearance de creatinina y fracción de excreción del calcio en las hipertensas transitorias y preeclámpticas, encontrándose diferencias significativas sólo en la fracción de excreción del calcio 2,5 ñ 0,8 por ciento y 1,1 ñ 0,8 por ciento , p<0,05 respectivamente. La evolución clínica de las pacientes fue favorable, con un período medio de normalización de presiones arteriales postparto menor de 1 semana. Fueron catalogados como pequeños para la edad gestacional 3 recién nacidos, 1 en el grupo de hipertensas transitorias y 2 en el grupo de preeclámpticas. Las diferencias encontradas en la calciuria de 24 horas y fracción de excreción del calcio se correlacionan con los hallazgos de otros autores y sugieren la necesidad de nuevos estudios que permitan dilucidar el metabolismo del calcio en pacientes con embarazo normal, hipertensión transitoria y preeclampsia

Omisión del registro de defunciones neonatales en recién nacidos / Omission of neonatal deaths registration for vital statistics

Se analiza la omisión de la inscripción de defunciones neonatales en 74 nacidos vivos en la maternidad del hospital de Chillán, con peso inferior a 1.500 g al nacer, entre el 1§ de enero y 31 de diciembre de 1986. Se adoptan las definiciones recomendadas por la OMS para defunción fetal, neonatal y nacido vivo. El porcentaje de omisión alcanza a 30,6%, es mayor en las defunciones de la primera hora de vida (75%) y en los neonatos con peso menor de 750 g (58%). No existen diferencias significativas en la inscripción de la defunción neonatal con respecto a la edad, estado civil, nivel de instrucción de la madre y orden de paridad del producto, pero sí en el promedio de peso del nacimiento: 731 g en el grupo con inscripción de la defunción. El factor determinante en la no inscripción de la defunción neonatal parece ser el inadecuado registro de los hechos vitales y no la deficiente aplicación de las definiciones recomendadas por la Organización Mundial de la Salud. Las tasas de mortalidad según peso, corregidas de acuerdo a la omisión de nacimientos y defunciones, no difiere mayormente de otras series nacionales