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Three cases of meningitis due to criptococcus in children infected with HIV are reported. All patients had severe immunodeficiency. The first case occurred before antiretroviral therapy. The second case had poor adherence to treatment. The third case is a teenager with prolonged fever, who did not have a clear source of transmission of HIV and was immunodeficient at the time of diagnosis. Examination of cerebrospinal fluid with India ink dye was essential for making the diagnosis in all three cases. The disease course was adequate in all three patients despite flucytosine not being available.
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Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Cryptococcus neoformans , Meningitis Criptocócica/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adolescente , Niño , Femenino , Humanos , Masculino , Meningitis Criptocócica/tratamiento farmacológicoRESUMEN
OBJECTIVES: To generate a model of intervention, from the National Integrated Health System (NIHS, Uruguay), with school facilitators of health, web resources and approach from the schools to the community. MATERIALS AND METHODS: Descriptive cross-sectional study of population base using a random sampling, non-clustered, during the months of April and December 2016. This was based in the model of schoolchildren health promoters, the use of web resources and community approach with the school as the centre of actions. RESULTS: The prevalence of parasites was 14% for Giardiasis (6,5 and 22%) (IC95%: 11-17) and 26% for Oxiurosis (IC95%: 22-30) (20 and 44%). Soil transmitted helminthiases were geo-referenced: we found 45 clusters, mainly in slums without basic services. CONCLUSIONS: These worrying results show that there are regions in Montevideo (Uruguay) with high levels of faecal home and environmental contamination. Community approaches with prevention activities from NIHS may have a positive impact on these vulnerable populations.
OBJETIVOS: Generar un modelo de intervención en promoción de salud, desde el Sistema Nacional Integrado de Salud (SNIS) de Uruguay, con promotores escolares de salud, recursos web y abordaje desde los centros educativos a la comunidad. MATERIALES Y MÉTODOS: Estudio descriptivo transversal, de base poblacional, mediante un muestreo aleatorio, no agrupado, durante los meses de abril y diciembre de 2016. Se llevó a cabo una capacitación para escolares en promoción de salud, encuesta poblacional, herramientas web, exámenes parasitológicos y georreferenciación. RESULTADOS: Se observaron prevalencias de giardiasis, del 14% (IC95%: 11-17) (6,5 a 22%); y oxiurosis 26% (IC95: 22-30) (20 a 44%). Se visualizaron 45 conglomerados de geohelmintiasis (HTS), la mayoría en zonas con asentamientos poblacionales carentes de servicios básicos. CONCLUSIONES: La existencia de sectores poblacionales vulnerables con índices de contaminación fecal intradomiciliaria y ambientales hace necesario que el SNIS realice de forma sistemática actividades de promoción de salud que puedan aportar datos relevantes para intervenciones gubernamentales intersectoriales y para mejorar la salud de estos sectores desprotegidos.
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Prestación Integrada de Atención de Salud , Helmintiasis , Parasitosis Intestinales , Parásitos , Animales , Humanos , Niño , Salud Pública , Uruguay/epidemiología , Estudios Transversales , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/prevención & control , Helmintiasis/epidemiología , Instituciones Académicas , PrevalenciaRESUMEN
BACKGROUND: Uruguay incorporated the conjugate vaccine against Haemophilus influenzae b (Hib) in 1994. In 2008, the vaccine was changed from one with natural conjugated capsular polysaccharide to one with a synthetic polysaccharide component. We describe the frequency and characteristics of invasive Hib infections in children hospitalized in a Pediatric Reference Hospital (PRH) between January 1st, 2000 and December 31st, 2017. METHODS: Sterile site Hib isolations from hospitalized children were included. Clinical and microbiological characteristics were analyzed. Favorable conditions for the infection were considered: incomplete immunization, immunodeficiencies and associated pathologies. Two periods are described: 1, prior to vaccine change (1/1 st/2000- 12/31/08) and 2, post-change (1/1 st/09- 12/31st/17). RESULTS: 45 children were hospitalized: 5 in the first period and 40 in the second. The hospitalization rate per 10,000 discharges was 0.41 (95% CI 0.05-0.77) and 4.2/10,000 (95% CI 2.89-5.48), respectively (p < 0.01). The diagnoses at discharge were: meningitis/ventriculitis (20), pneumonia (16), bacteremia (3), epiglottitis (1), arthritis (1), cellulitis (3) and obstruction of the upper airway (1). Four children presented comorbidities. Twenty seven received less than 3 doses of anti-Hib vaccination and 18 were properly vaccinated (2 were immunodeficient). The median hospitalization was 14 days, 18 children required intensive therapy. CONCLUSIONS: Observed change may be due to: incomplete primary series, inhomogeneous vaccine coverage and immunogenicity of the synthetic polysaccharide. To reduce this public health problem, epidemiological surveillance.
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BACKGROUND: Primary and secondary antiretroviral (ARV) resistance rates of 15 and 40% respectively have been reported in worldwide. Its prevalence in Uruguay is unknown. AIM: To know the prevalence of ARV resistance in Uruguayan children under 15 years old infected with HIV that are controlled in the Centro Hospitalario Pereira Rossell between 2008 and 2016. Specific objectives: Quantify primary and secondary mutations, to identify variables associated with resistance; to describe if the result of the resistance test contributed to achieve undetectable viral load (VL). Methodos: Observational descriptive, longitudinal follow-up. Only children under 15 years with resistance test done between January first 2008 and December 31th 2016 were included in the study. Maternal and child variables. RESULTS: Fifty six children were included. 36 children (64%) had resistance tests prior to the initiation of ART and the other 20 children (36%) due to therapeutic failure. Total resistance: 28.6% (16 children); 4 (11.1%) children with primary mutations and 12 (60%) secondary mutations. The test result changed the ARV plan in 15 (26.7%) of the 56 children. The change achieved undetectable CV in 8 children at month 6. The ART change was not associated with AIDS or death. DISCUSSION: Prevalence studies are useful in making decisions about initial ARV treatment. The prevalence of primary mutations was similar to that published, while secondary prevalence was higher.
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Fármacos Anti-VIH/uso terapéutico , Farmacorresistencia Viral/genética , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Mutación/genética , Adolescente , Niño , Preescolar , Farmacorresistencia Viral/efectos de los fármacos , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Prevalencia , UruguayRESUMEN
This is the first study showing the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in Latin America; a significant (63.5%) reduction in hospitalization was observed during the first 6 years after starting vaccination. A 90% reduction of pneumococcal conjugate vaccines 7/13 serotypes was observed (P < 0.0001). After vaccination, all strains were penicillin susceptible. Mortality had a reduction of 71%.
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Vacuna Neumocócica Conjugada Heptavalente , Hospitalización/estadística & datos numéricos , Inmunización/estadística & datos numéricos , Meningitis Neumocócica , Vacunas Neumococicas , Vacuna Neumocócica Conjugada Heptavalente/administración & dosificación , Vacuna Neumocócica Conjugada Heptavalente/uso terapéutico , Hospitales Pediátricos , Humanos , Lactante , Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/prevención & control , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/uso terapéutico , Streptococcus pneumoniae , Uruguay/epidemiologíaRESUMEN
Resumen: Introducción: la hipovitaminosis D se encuentra ampliamente extendida a nivel mundial, con consecuencias clínicas a nivel óseo y extraóseo. Entre los factores que la causan se encuentran los antiepilépticos (AE). En Uruguay no se conoce su prevalencia en niños ni en pacientes que reciben AE. Objetivos: conocer la prevalencia de hipovitaminosis D de niños y adultos en un prestador de salud y compararla con la prevalencia en pacientes bajo tratamiento con AE. Método: estudio descriptivo, transversal, realizado entre marzo y diciembre de 2017. Las variables analizadas fueron: niveles de vitamina D, calcio, fósforo, fosfatasa alcalina y parathormona intacta. Se consideró insuficiencia de vitamina D niveles menores de 30 ng/ml y déficit niveles menores de 20 ng/ml. Resultados: se incluyeron 113 pacientes, 60 niños y 53 adultos. La prevalencia global de insuficiencia de vitamina D fue de 89% y déficit de 60%. En niños expuestos a AE, la media de vitamina D fue 17,5 ng/ml, y en niños no expuestos 19,6 ng/ml. En adultos la media de vitamina D fue de 18,1 en expuestos a AE y 16,9 en no expuestos. La diferencia de medias no fue estadísticamente significativa en niños ni en adultos. Se observaron niveles de calcemia significativamente descendidos en niños y adultos con AE. Conclusiones: la insuficiencia de vitamina D fue cercana a 90% y el déficit superó el 50%. No se encontraron diferencias significativas entre grupos en hipovitaminosis D, pero se observaron niveles de calcemia reducidos en los expuestos a AE. Es necesario continuar analizando los factores que la causan y sus consecuencias clínicas.
Summary: Introduction: hypovitaminosis D is a highly spread condition worldwide, with clinical consequences that affect bone directly, among other manifestations. Antiepileptic drugs are among factors that cause this deficiency. In Uruguay, there is no information about hypovitaminosis D in children or patients who receive antiepileptic drugs. Objectives: to learn about the prevalence of hypovitaminosis D in children and adults in a health institution and to compare it with the prevalence in patients receiving antiepileptic drugs. Method: descriptive, transversal study conducted from March through December, 2017. The following variables were analysed: vitamin D, calcium, phosphorous, alkaline phosphatase and intact parathyroid hormone. Vitamin D insufficiency was defined as vitamin D levels of less than 30 ng per mL and deficiency as D levels of less than 20 ng per mL. Results: 113 patients were included in the study, 60 of which were children and 53 adults. Global prevalence of vitamin D insufficiency was 89% and deficiency was 60%. In children taking antiepileptic drugs, the average vitamin D value was 17.5 ng/ml and it was 19.6 ng/ml for those not exposed to those drugs. In adults, the average vitamin D value was 18.1 in the population taking antiepileptic drugs and 16.9 in patients not taking that medication. The difference between average values was not statistically significant in children or adults. Calcemia levels observed were significantly lower in both children and adults taking antiepileptic drugs. Conclusions: vitamin D insufficiency was close to 90% and deficiency was over 50%. No significant differences were found between hypovitaminosis D groups, although reduced calcemia was observed in patients exposed to antiepileptic drugs. Further studies are necessary to analyse factors that cause this condition and its clinical consequences.
Resumo: Introdução: a hipovitaminose D está amplamente difundida em todo o mundo, com consequências clínicas a nível ósseo e extraósseo. Entre os fatores que a causam estão os medicamentos antiepilépticos (AE). No Uruguai, sua prevalência em crianças ou em pacientes adultos recebendo AE não é conhecida. Objetivos: conhecer a prevalência de hipovitaminose D em crianças e adultos em um prestador de serviços de saúde e compará-la com a prevalência em pacientes em tratamento com AE. Método: estudo transversal descritivo realizado entre março e dezembro de 2017. As variáveis analisadas foram: níveis de vitamina D, cálcio, fósforo, fosfatase alcalina e paratormona intacta. Níveis menores que 30 ng / ml e níveis de déficit menores que 20 ng / ml foram considerados como insuficiência de vitamina D. Resultados: foram incluídos 113 pacientes, 60 crianças e 53 adultos. A prevalência global de insuficiência de vitamina D foi de 89% e déficit de 60%. Em crianças expostas à AE, a média de vitamina D foi de 17,5 ng / ml e em crianças não expostas de 19,6 ng / ml. Em adultos, a média de vitamina D foi de 18,1 nos expostos ao AE e de 16,9 nos não expostos. A diferença nas médias não foi estatisticamente significativa nas crianças nem nos adultos. Níveis de cálcio significativamente diminuídos foram observados em crianças e adultos com EA. Conclusões: a insuficiência de vitamina D foi próxima a 90% e o déficit ultrapassou 50%. Não foram encontradas diferenças significativas entre os grupos na hipovitaminose D, mas níveis reduzidos de cálcio foram observados naqueles expostos a EA. É necessário continuar analisando os fatores que o causam e suas consequências clínicas.
Asunto(s)
Deficiencia de Vitamina D , Hipocalcemia , Anticonvulsivantes/efectos adversosRESUMEN
UNLABELLED: A high percentage of Uruguayan pregnant women are not under medical control. As a consequence, vertically transmission of HIV infection reaches to 50%. The aim of this study was to know the prevalence of HIV infection in pregnant women who did not know their serological status and to decrease mother-to-child transmission. PATIENTS AND METHODS: from January 2002 to January 2004 the HIV rapid test was performed to every pregnant woman that assisted to a public Uruguayan hospital unaware of her condition. The proper prophylactic decisions were adopted according to gestational age. The newborn infants were classified according to CDC criteria. HIV infection prevalence in pregnant women and in their newborn infants was calculated. RESULTS: there were 34,338 obstetric consultations and 4,599 rapid tests were performed. Fifty-nine turned out positive in 58 women, 8 of them knew their serological status previously. The HIV infection prevalence was 1.1% (IC95% 0.8-1.4). Five cases were discharged: 1 false positive and 3 miscarriages and 1 abortion. Ten women dropped out in the follow up. Twelve women received TARV during pregnancy for over a week. Thirty-nine infants could be controlled: 33 seroreverted, 4 were exposed and 2 became infected. Mother-to-child transmission was 5.1%. If all patients who dropped out the follow up were infected, the transmission rate should be of 20.4%; therefore the infection would have been prevented in 16 children. As many women and children were lost, other complementary actions as counseling and social worker interview should be adopted in order to improve the yield of rapid test screening strategy.
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Fármacos Anti-VIH/administración & dosificación , Anticuerpos Anti-VIH/sangre , Infecciones por VIH/diagnóstico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/diagnóstico , Adolescente , Adulto , Western Blotting , Ensayo de Inmunoadsorción Enzimática , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Humanos , Recién Nacido , Lamivudine/administración & dosificación , Persona de Mediana Edad , Nevirapina/administración & dosificación , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Resultado del Embarazo , Prevalencia , Uruguay , Zidovudina/administración & dosificaciónRESUMEN
Resumen: Introducción: el acoso escolar es el maltrato continuo y deliberado hacia un niño o adolescente por parte de otro u otros. Es un problema universal, difícil de identificar en la práctica pediátrica. Objetivo: describir el índice global de acoso y sus características en niños y adolescentes de 9 a 11 años hospitalizados o asistidos en policlínicas en Montevideo. Material y método: estudio transversal. Se incluyeron usuarios de 9 a 11 años, procedentes de Montevideo, hospitalizados o asistidos en policlínica de un prestador público y otro privado durante julio a setiembre de 2017. Variables: sexo, edad, prestador de salud, rendimiento escolar, centro educativo, uso de psicofármacos, índice de masa corporal. Mediante autotest Cisneros se determinó el índice global de acoso e intensidad de este. Fue aprobado por los comités de ética de ambas instituciones. Resultados: se incluyeron 83 niños: 52% niñas; 34% 9 años, 38% 10 años, 28% 11 años; prestador de salud privado 54%; educación pública 88%; buen rendimiento escolar 59%; sobrepeso 18%, obesidad 16%; uso de psicofármacos 16%. El índice global de acoso fue bajo 51%, alto 38%. Se encontró asociación entre alto riesgo de bullying con tipo de centro educativo, uso de psicofármacos e ingreso por motivo psicosocial. Intensidad de acoso alta en 73%. Modalidades más frecuentes: exclusión social y hostigamiento verbal. Conclusiones: se encontró alto riesgo de bullying y su intensidad y modalidad constituyen un problema preocupante.
Summary: Introduction: Bullying is a continuous and deliberate abuse of a child or adolescent by another. It is a global problem, and it usually goes undetected during the pediatric practice. Objective: to develop and describe a global bullying index in children and adolescents aged 9-11 years hospitalized or assisted at a public and at a private health institution in Montevideo. Materials and methods: cross-sectional study. Children from 9 to 11 years of age, from Montevideo, hospitalized or assisted at a public and at a private health institution during July to September 2017. Variables: sex, age, health provider, school performance, school center, use of psychotropic drugs, body mass index. The Cisneros Autotest described the Global Bullying Index and the Bullying Intensity. The methods were approved by the Ethics Committees of both participating health institutions. Results: 83 children participated in the study: 52% girls; 34% 9 years old, 38% 10 years old, 28% 11 years old; 54% from private health provider, 88% from public education system. 59% had good school performance; overweight 18%, obesity 16%; use of psychoactive drugs 16%. The global bullying rate was low 51%, high 38%. We found a link between high risk of bullying and type of school, use of psychotropic drugs and psychosocial admission diagnosis. Intensity was high in 73%. The most common type of bullying described was "social exclusion" and "verbal harassment". Conclusions: we found high-risk of bullying, and found that its intensity and modality have become increasingly concerning.
Resumo: Introdução: o bullying é o abuso contínuo e deliberado de uma criança ou adolescente por parte de uma outra. É um problema global, difícil de identificar na prática pediátrica. Objetivo: descrever o índice global de bullying e suas características em crianças e adolescentes de 9 a 11 anos de idade hospitalizados ou assistidos em policlínicas em Montevidéu. Materiais e métodos: estudo transversal. Foram incluídos usuários entre 9 e 11 anos de idade, procedentes de Montevidéu, hospitalizados ou assistidos numa policlínica de prestador público de saúde e numa privada, entre julho e setembro de 2017. Variáveis: sexo, idade, profissional de saúde, desempenho escolar, escola, uso drogas psicoativas, índice de massa corporal. O índice global de assédio e a sua intensidade foram avaliados através do "Autotest Cisneros". Os resultados foram aprovados pelos comitês de ética de ambas as instituições de saúde. Resultados: incluíram-se 83 meninos: 52% meninas; 34% 9 anos, 38% 10 anos, 28% 11 anos; prestador de serviços de saúde privado 54%; educação pública 88%; bom desempenho escolar 59%; sobrepeso 18%, obesidade 16%; 16% usam drogas psicoativas. A taxa de assédio global foi baixa de 51%, alta de 38%. Foi encontrada associação entre alto risco de bullying com o tipo de escola, uso de drogas psicotrópicas e admissão por razões psicossociais. Intensidade de assédio alta em 73%. Modalidades mais frequentes: "Exclusão social" e "Assédio verbal" Conclusões: encontrou-se um alto risco de bullying cuja intensidade e modalidade são um problema preocupante.
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RESUMEN Objetivos Generar un modelo de intervención en promoción de salud, desde el Sistema Nacional Integrado de Salud (SNIS) de Uruguay, con promotores escolares de salud, recursos web y abordaje desde los centros educativos a la comunidad. Materiales y Métodos Estudio descriptivo transversal, de base poblacional, mediante un muestreo aleatorio, no agrupado, durante los meses de abril y diciembre de 2016. Se llevó a cabo una capacitación para escolares en promoción de salud, encuesta poblacional, herramientas web, exámenes parasitológicos y georreferenciación. Resultados Se observaron prevalencias de giardiasis, del 14% (IC95%: 11-17) (6,5 a 22%); y oxiurosis 26% (IC95: 22-30) (20 a 44%). Se visualizaron 45 conglomerados de geohelmintiasis (HTS), la mayoría en zonas con asentamientos poblacionales carentes de servicios básicos. Conclusiones La existencia de sectores poblacionales vulnerables con índices de contaminación fecal intradomiciliaria y ambientales hace necesario que el SNIS realice de forma sistemática actividades de promoción de salud que puedan aportar datos relevantes para intervenciones gubernamentales intersectoriales y para mejorar la salud de estos sectores desprotegidos.
ABSTRACT Objectives To generate a model of intervention, from the National Integrated Health System (NIHS, Uruguay), with school facilitators of health, web resources and approach from the schools to the community. Materials and Methods Descriptive cross-sectional study of population base using a random sampling, non-clustered, during the months of April and December 2016. This was based in the model of schoolchildren health promoters, the use of web resources and community approach with the school as the centre of actions. Results The prevalence of parasites was 14% for Giardiasis (6,5 and 22%) (IC95%: 11-17) and 26% for Oxiurosis (IC95%: 22-30) (20 and 44%). Soil transmitted helminthiases were geo-referenced: we found 45 clusters, mainly in slums without basic services. Conclusions These worrying results show that there are regions in Montevideo (Uruguay) with high levels of faecal home and environmental contamination. Community approaches with prevention activities from NIHS may have a positive impact on these vulnerable populations.
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Resumen: El maltrato infantil y específicamente el abuso sexual infantil constituyen una violación de los derechos humanos y un importante problema de salud mundial. En Uruguay, los Equipos de Referencia en Violencia Doméstica en las instituciones de salud, asisten a niños víctimas de situaciones de violencia. Este trabajo buscó conocer la incidencia en niños, víctimas de situaciones de maltrato moderado a severo y de probable abuso sexual infantil, asistidos en el equipo de referencia en violencia doméstica de la institución CASMU-IAMPP, y sus características epidemiológicas. Se realizó un estudio observacional, descriptivo, con los usuarios menores de 18 años que fueron derivados en el 2016 a dicho equipo. El total de niños asistidos fue 87, la incidencia anual fue 0,2%. El 38% de los niños fueron víctimas de violencia doméstica, 31% sufrieron probable abuso sexual, 22% violencia física, 24% psicológica y 7% negligencia. En 90% de los casos, las situaciones se detectaron en etapa crónica. El 77% fueron derivados por el sector salud, de ellos un tercio por el pediatra tratante. El 50% convivía con el agresor y en el 38% de las situaciones de abuso sexual, el padre fue el victimario. De las escolares víctimas de abuso sexual, el 65% tenía sobrepeso u obesidad. Se destaca la importancia de conocer la epidemiología de los pacientes atendidos por una patología frecuente y grave para mejorar la calidad de su abordaje.
Summary: Child abuse and specifically child sexual abuse is a violation of Human Rights and a major global health problem. In Uruguay, the expert reference team specialized in domestic violence at health medical institutions assists children who are victims of violence. This paper aims at studying the incidence of children victims of moderate to severe abuse and of probable child sexual abuse assisted at the reference specialized center for domestic violence of the CASMU-IAMPP HMO and its epidemiological characteristics. We carried out an observational, descriptive study with patients under 18 years of age who were referred in 2016. The total number of children assisted was 87, the annual incidence was 0.2%. 38% of the children were victims of domestic violence, 31% suffered probable sexual abuse, 22% physical violence, 24% psychological and 7% negligence. In 90% of the cases, these situations of abuse were detected in the chronic stage. 77% were referred by the health sector; 34% by the treating pediatrician. 50% lived with the aggressor. In 38% of situations of sexual abuse, the father was the abuser. Of the schoolchildren victims of sexual abuse, 65% were overweight or obese. We hereby stress the importance of understanding and knowing the epidemiology of patients treated for a frequent and serious pathology in order to improve their quality of the approach used.
Resumo: O abuso infantil e especificamente o abuso sexual infantil são uma violação dos Direitos Humanos e um grande problema de saúde global. No Uruguai, as equipes de referência em violência doméstica das instituições de saúde assistem a crianças vítimas de situações de violência. Este trabalho procurou conhecer a incidência de crianças vítimas de situações de abuso moderado a grave e provável abuso sexual infantil, nas crianças atendidas pela equipe de referência em violência doméstica da instituição CASMU-IAMPP e suas características epidemiológicas. Realizou-se um estudo descritivo e observacional com crianças menores de 18 anos que foram encaminhados em 2016 à referida equipe. O número total de crianças atendidas foi de 87, a incidência anual foi de 0,2%. 38% das crianças foram vítimas de violência doméstica, 31% sofreram provável abuso sexual, 22% violência física, 24% psicológica e 7% negligência. Em 90% dos casos, detectamos os casos em estágio crônico. 77% foram encaminhados pelo setor de saúde, um terço deles pelo pediatra responsável. 50% moravam com o agressor e em 38% das situações de abuso sexual, o pai era o abusador. Das vítimas escolares de abuso sexual, 65% apresentavam sobrepeso ou obesidade. Destaca-se a importância de conhecer a epidemiologia dos pacientes tratados por uma patologia frequente e séria para melhorar a qualidade de sua abordagem.
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Resumen: El absceso hepático (AH) es una patología poco frecuente pero bien definida en la infancia. Requiere un diagnóstico precoz para iniciar el tratamiento adecuado y disminuir su morbimortalidad. Las manifestaciones clínicas son inespecíficas. En la mayoría de los casos la etiología es bacteriana y la vía de acceso es a través de una bacteriemia. El germen más frecuente es Staphylococcus aureus. Se presenta el caso de una niña de 2 años, previamente sana, con el antecedente de una infección de piel que pasó desapercibida. Consultó por un cuadro febril de varios días de evolución, con signo-sintomatología acompañante inespecífica. En la pesquisa diagnóstica se realizaron exámenes imagenológicos que revelaron la presencia de una tumoración en hipocondrio izquierdo. A través de una laparoscopía exploratoria se diagnosticó y drenó un absceso único en el lóbulo izquierdo del hígado. El pus extraído cultivó S. aureus meticilino sensible. Recibió tratamiento antibiótico durante un mes, con excelente evolución posterior. Al mes despareció la cavidad residual por ecografía. El interés de esta comunicación radica en la baja frecuencia de esta patología en niños y las dificultades diagnósticas que genera.
Summary: Liver abscess (LA) is a rare but well-defined child pathology that requires an accurate, adequate and early diagnosis and treatment, in order to prevent further morbidity and mortality. The clinical symptoms are not specific. In most cases, LA has a bacterial etiology and the access way is through bacteremia. The most frequent germ is Staphylococcus aureus. The case presented involves a two-year old girl, previously healthy, with a history of an unnoticed skin infection. She consulted for a several day-long fever, with nonspecific accompanying signs or symptoms. We performed imagenology tests during diagnosis that revealed the presence of a tumor in the left hypochondrium. We were able to perform an exploratory laparoscopy, diagnose and drain a single abscess in the left liver lobe. The extracted pus culture showed methicillin-sensitive S. aureus. She received antibiotic treatment for a month, with excellent further evolution. A month after the procedure, the residual cavity had disappeared when checked via ultrasound. This pathology is interesting due to its low frequency in children and to its diagnostic difficulties.
Resumo: O abscesso hepático (AE) é uma patologia infantil rara, porém bem definida, que requer diagnóstico e tratamento precoces, a fim de evitar morbimortalidade maior. Suas manifestações clínicas não são específicas. Na maioria dos casos, é de etiologia bacteriana e a via de acesso é por bacteremia. O germe mais frequente é o Staphylococcus areus. Apresentamos o caso duma menina de dois anos, previamente saudável, com história de infecção cutânea despercebida. Ela consultou por uma febre de vários dias, com sintomatologia não específica. Durante o diagnóstico realizamos exames imagiológicos que revelaram a presença de um tumor no hipocôndrio esquerdo. Fomos capazes de realizar uma laparoscopia exploratória e diagnosticar e drenar um abscesso único no lobo esquerdo do fígado. O pus extraído cultivou S. aureus sensível à meticilina. Ela recebeu tratamento com antibiótico por um mês, com excelente evolução posterior. Um mês após utilizamos o ultrassom em constatamos que a cavidade residual tinha desaparecido. Essa patologia é interessante devido à baixa frequência em crianças e as suas dificuldades diagnósticas.
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Resumen Introducción: A nivel mundial, la tasa global de resistencia primaria y secundaria a los anti-retrovirales (ARV) es de 15 y 40%, respectivamente. Se desconoce su prevalencia en Uruguay. Objetivo: Conocer la prevalencia de resistencia a los ARV en niños y adolescentes uruguayos bajo 15 años de edad infectados con VIH que se controlan en el Centro Hospitalario Pereira Rossell entre 2008 y 2016. Objetivos específicos: Cuantificar mutaciones de resistencia primarias y secundarias e identificar variables asociadas a resistencias; describir si el resultado del test de resistencia contribuyó a lograr una carga viral (CV) indetectable. Metodología: Descriptivo observacional, seguimiento longitudinal. Se incluyeron menores de 15 años con test de resistencia entre 1 de enero de 2008 y 15 de diciembre de 2016. Variables maternas y del niño. Resultados: Se incluyeron 56 niños. Tenían test de resistencia previo al inicio TARV 36 niños (64%) y por fallo terapéutico 20 (36%). La resistencia total fue 28,6% (16 niños): cuatro (11,1%) con mutaciones primarias y 12 (60%) secundarias. El test modificó el plan ARV en 15 (26,7%) de los 56 niños. El cambio logró CV indetectable a los seis meses en ocho casos. El cambio de TARV no se asoció con sida o muerte. Discusión: Los estudios de prevalencia son útiles para la toma de decisiones sobre la selección inicial de ARV. La prevalencia de mutaciones primarias fue similar a la publicada, mientras que la secundaria fue mayor.
Background: Primary and secondary antiretroviral (ARV) resistance rates of 15 and 40% respectively have been reported in worldwide. Its prevalence in Uruguay is unknown. Aim: To know the prevalence of ARV resistance in Uruguayan children under 15 years old infected with HIV that are controlled in the Centro Hospitalario Pereira Rossell between 2008 and 2016. Specific objectives: Quantify primary and secondary mutations, to identify variables associated with resistance; to describe if the result of the resistance test contributed to achieve undetectable viral load (VL). Methodos: Observational descriptive, longitudinal follow-up. Only children under 15 years with resistance test done between January first 2008 and December 31th 2016 were included in the study. Maternal and child variables. Results: Fifty six children were included. 36 children (64%) had resistance tests prior to the initiation of ART and the other 20 children (36%) due to therapeutic failure. Total resistance: 28.6% (16 children); 4 (11.1%) children with primary mutations and 12 (60%) secondary mutations. The test result changed the ARV plan in 15 (26.7%) of the 56 children. The change achieved undetectable CV in 8 children at month 6. The ART change was not associated with AIDS or death. Discussion: Prevalence studies are useful in making decisions about initial ARV treatment. The prevalence of primary mutations was similar to that published, while secondary prevalence was higher.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Fármacos Anti-VIH/uso terapéutico , Farmacorresistencia Viral/genética , Mutación/genética , Uruguay , Prevalencia , Estudios Longitudinales , Farmacorresistencia Viral/efectos de los fármacosRESUMEN
Resumen: Introducción: la auditoría médica es el análisis crítico y sistemático del proceso de atención que incluye los procedimientos diagnósticos y terapéuticos, el uso de los recursos y los resultados de los mismos. Disponer de un sistema de auditoría constituye un instrumento de mejora continua de la calidad asistencial. Objetivo: evaluar la calidad de las historias clínicas (HC) de los niños hospitalizados. Material y método: estudio de corte transversal mediante revisión de HC de niños egresados de áreas de cuidados moderados de un centro de referencia entre el 1º de enero y el 31 de diciembre de 2015. Variables analizadas: datos patronímicos, cuadrícula, curvas de crecimiento, antecedentes socioeconómicos, ingresos, evolución, prescripción, transcripción, diagnóstico al egreso, resumen de egreso. Se establecieron tres categorías: suficiente puntaje mayor o igual a 80%, aceptable 60%-79%, insuficiente <60%. Se analizó la calidad de las HC en función de la edad, estadía hospitalaria, diagnóstico al egreso y estación del año. Se realizó un muestreo aleatorio (prevalencia esperada de error 50%, precisión 5%, poder 80%) (N=385 HC). Se consideró significativa p <0,05. Resultados: de las 385 HC analizadas, 52% (202) correspondieron a varones, mediana de edad: 3 meses. Fueron suficientes 17%, aceptables 49,6% e insuficientes 33,4%. Las HC suficientes predominaron en menores de 1 año (21,5% vs 14%) y con estadía menor o igual de 3 días (21% vs 11%) p <0,05. Las HC insuficientes predominaron en invierno (43% vs 29%, p <0,05). Conclusión: es necesario profundizar en el estudio de estos resultados mediante un análisis cualitativo. Resulta necesario implementar un sistema de auditoría de HC continuo y avanzar en el desarrollo de los registros electrónicos para mejorar la gestión clínica.
Summary: Introduction: medical audits involve critical and systematic analysis of the medical care process, diagnostic and therapeutic procedures, the use of resources and the results obtained. Auditing systems provide tools for quality continuous improvement. Objective: to assess the quality of medical records (HMR) of hospitalized children. Material and methods: HMR cross-sectional study of of children discharged from moderate care units at a reference hospital center between January 1 and December 31, 2015. Analyzed Variables: patients' personal data, grids, growth curves, socio-economic background, admissions, evolution, prescription, transcription, diagnosis at discharge, discharge Report 3 categories were devised: Sufficient score greater or equal 80%, Acceptable 60-79%, Insufficient < 60%. HMR's quality was analyzed by age, hospitalization time, diagnosis at discharge and season of the year. Random sampling was carried out (expected error prevalence 50%, accuracy 5%, power 80%) (N=385). P < 0,05 was considered significant. Results: Out of 385 HMRs analyzed, 52% (202) were boys, median age 3 months-old. 17% were sufficient, 49.6% were acceptable and 33.4% were insufficient. Sufficient HMRs were predominant in children of less than 1 year-old (21,5% vs 14%) which had a hospitalization time of less or equal 3 days (21% vs 11%) p<0.05. Insufficient HMRs were predominant in Winter (43% vs 29%. p<0.05). Conclusion: A qualitative analysis is needed in order to reinforce the analysis of these results. It is important to implement a continuous HMR auditing system in order to make progress regarding the development of electronic records as a tool to improve the clinical management systems.
Resumo: Introdução: a auditoria médica é a análise crítica e sistemática do processo de cuidado da saúde, e inclui procedimentos diagnósticos e terapêuticos, o uso de recursos e seus resultados. Ter um sistema de auditoria é um instrumento para melhoria contínua da qualidade do cuidado da saúde. Objetivo: avaliar a qualidade dos prontuários eletrônicos das crianças hospitalizadas. Métodos: estudo transversal do Prontuário Eletrônico do Paciente (PEP) de pacientes descarregados das áreas de cuidado moderado dum centro de referência entre 1 de janeiro e 31 de dezembro de 2015. As variáveis analisadas foram: dados pessoais dos pacientes, curvas de crescimento, antecedentes socioeconômicos, renda, evolução, prescrição, transcrição, diagnóstico e resumo no momento da alta hospitalar. Três categorias foram estabelecidas: Escore Suficiente maior ou igual 80%, Aceitável 60-79%, Insuficiente <60%. A qualidade do PEP foi analisada em quanto à idade, permanência hospitalar, diagnóstico na alta e estação do ano. Foi realizada uma amostragem aleatória (prevalência esperada de erro de 50%, precisão de 5%, poder de 80%) (N = 385 PEP). Considerou-se significativo p <0,05. Resultados: dos 385 PEP analisados, 52% (202) foram do sexo masculino, e a mediana da idade 3 meses. Suficientes 17%, Aceitáveis 49,6% e Insuficientes 33,4%. Os PEP foram suficientes maiormente nas crianças menores de 1 ano (21,5% vs. 14%) e que tinham permanecido menor ou igual 3 dias no hospital (21% vs. 11%) p <0,05. Os PEP foram Insuficientes maiormente no inverno (43% vs. 29%, p <0,05). Conclusão: é necessário aprofundar o estudo desses resultados através de uma análise qualitativa. Se deve implementar um sistema contínuo de auditoria de PEP e avançar no desenvolvimento dos Prontuários Eletrônicos para melhorar o gerenciamento clínico dos hospitais.
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Resumen Introducción: la anemia ferropénica es un problema de salud nacional. Existen recomendaciones para su prevención. Para su diagnóstico temprano se incorporó a partir de 2014 la medición de la hemoglobina por punción digital entre los 8-12 meses de edad. Objetivo: determinar la prevalencia de anemia en lactantes usuarios de CASMU-IAMPP e identificar factores asociados. Material y métodos: se estudiaron lactantes entre 8-12 meses, a quienes se realizó medición de hemoglobina por punción digital, entre julio-diciembre 2014. Se describió la prevalencia de anemia. Se describieron las características de los niños con anemia y se compararon con las de un grupo control de niños sin anemia. Resultados: en el período evaluado se realizó hemoglobina digital a 95% de los lactantes entre 8-12 meses, 18,3% presentaba anemia. El 65,9% incorporó carne a la alimentación en forma tardía, 28,6% recibía dosis incorrecta de hierro suplementario y 23,4% no adhería al tratamiento. Los niños con anemia, en comparación con el grupo control, no presentaron mayor prevalencia de prematurez, peso al nacer menor a 3000 g, embarazo gemelar, anemia en el embarazo, suplementación con hierro en el embarazo, pecho directo exclusivo durante 6 meses, o inicio adecuado de alimentación complementaria. En los niños con anemia se detectó una falla en el inicio oportuno de la suplementación con hierro en dosis adecuada así como una mala adherencia al tratamiento. Discusión: debe alertar un 20% de niños con anemia en una población seleccionada en general con recursos económicos adecuados. Se debe insistir en la incorporación temprana de carne a la alimentación e inicio adecuado de la suplementación con hierro en dosis adecuada recomendando una buena adherencia al tratamiento.
Summary Introduction: iron deficiency anemia is a health problem in Uruguay. In 2014, hemoglobin measurement by digital puncture in infants between 8 and 12 months was introduced as a screening method for early diagnosis. Objective: to determine anemia prevalence in infants between 8 and 12 months in the institution (CASMU-IAMPP), and to identify associated factors. Method: infants between 8 and 12 months were studied with hemoglobin measurement by digital puncture from July to December of 2014. The characteristics of the children with anemia were described and compared with the control group. The data were obtained from the medical record and by means of a telephone survey. Results: 804 children were evaluated with hemoglobin measurement by digital puncture, 145 presented anemia (18.03%). The characteristics presented by children with anemia (n=143) were compared with the control group of children without anemia (n=143). There was no significant difference in the distribution by sex, prematurity prevalence, weight under 3.000 g, twin pregnancy, exclusive breastfeeding, and adequate initiation of replacement treatment. Children with anemia presented problems in the initiation of iron supplementation, doses of supplementary iron were adequate, although adherence to treatment was bad (p<0.05). Discussion: the fact that 20% of children from a socio-economic sector with adequate resources have anemia is rather alarming. Early consumption of meat and adequate initiation of iron supplementation in the right doses must be encouraged, as well as a good adherence to treatment.
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Humanos , Masculino , Factores de Riesgo , Anemia Ferropénica/epidemiología , Oligoelementos/uso terapéutico , Hemoglobina A/análisis , Demografía , Prevalencia , Estudios Transversales , Anemia Ferropénica , Anemia Ferropénica/diagnóstico , Hierro/uso terapéuticoRESUMEN
Resumen: El neuroblastoma es un tumor maligno del sistema nervioso simpático periférico con presentación y curso clínico heterogéneo. Es el tercer tumor pediátrico más frecuente y el 90% de los casos se diagnostica antes de los 5 años. Los síntomas más comunes se deben a la compresión por la masa tumoral o al dolor óseo causado por la metástasis. La diarrea como síntoma principal es rara por lo que es difícil de diagnosticar en la etapa temprana de la enfermedad. Se presenta el caso clínico de una paciente de 2 años en la que luego de 8 meses de estudio por diarrea crónica se diagnóstica ganglioneuroblastoma secretor de VIP. Se debe plantear como diagnóstico diferencial en los pacientes menores de 3 años con diarrea crónica intratable luego de haber descartado otras etiologías.
Summary: Neuroblastoma is a malignant tumor of the peripheral sympathetic nervous system with heterogeneous clinical presentation and course. It is the third most frequent pediatric tumor and in 90% of cases it is diagnosed before 5 years of age. The most typical symptoms result from the tumor compression or bone pain caused by methastasis. Diarrhea as the main symptom is unusual, and thus it is hard to diagnose in early stages of the disease. We report the case of a 2-year-old patient who, after 8 months of study for chronic diarrhea was diagnosed with VIP-secreting ganglioneuroblastoma. It is necessary for this condition to be considered as a differential diagnosis in patients younger than 3 years old with chronic diarrhea with no evolution, after other etiologies are ruled out.
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Humanos , Ganglioneuroblastoma/diagnóstico , Disentería/etiología , Péptido Intestinal Vasoactivo/metabolismo , Ganglioneuroblastoma/complicaciones , Diagnóstico DiferencialRESUMEN
Introducción: la tuberculosis (TB) es considerada por la Organización Mundial de la Salud (OMS) una emergencia global en salud pública. En Uruguay se registra un aumento de casos desde el año 2011 con una tasa de incidencia actual de 25,1 por 10(5) habitantes. La investigación de contactos adultos con enfermedad pulmonar activa constituye el método más eficiente para identificar niños infectados con Mycobacterium tuberculosis. Objetivo: describir la prevalencia de pacientes menores de 15 años enfermos de tuberculosis a partir del diagnóstico de un caso índice y sus características clínico-epidemiológicas. Metodología: se realizó un estudio descriptivo entre el 1 de enero de 2012 y el 1 de enero de 2014, utilizando como fuente primaria de datos las historias clínicas de los menores de 15 años con diagnóstico de tuberculosis captados por la Comisión Honoraria de Lucha Antituberculosa a partir de un caso índice. En el niño se analizaron las siguientes variables: edad, sexo, estado nutricional, patología concomitante, escolaridad, prueba tuberculínica, estudio bacteriologico radiografía de tórax, adherencia a los controles, necesidad de hospitalización y presencia de resistencia. En el caso índice las variables fueron: parentesco o relación con el niño, edad, estudio bacteriológico, localización de la enfermedad (pulmonar o extrapulmonar), antecedente de reclusión, adicciones o enfermedades concomitantes que causen inmunodepresión, procedencia y presencia de resistencia. Se calcularon medianas como medida de tendencia central, frecuencias absolutas y porcentajes con su respectivo intervalo de confianza de 95%. Resultados: se identificaron 1672 casos de tuberculosis, 497 con contactos menores de 15 años. De ellos 49 transmitieron tuberculosis a los niños (9,9%). De los 872 contactos estudiados, 60 enfermaron (6,9%, IC 95% 5,3%-8,8%). No se pudieron captar para seguimiento 253 menores de 15 años. De los 49 casos índice, 40 presentaron un solo contacto, enfermo menor de 15 años, el resto dos o más. La mediana de edad fue 30 años y el 49% eran familiares de primer grado. La confirmación bacteriológica se obtuvo en 95% de los casos. La letalidad fue 8% y dos casos presentaron multirresistencia. Los niños enfermos tenían una mediana de edad de 4 años y el 60% tenía un adecuado estado nutricional. La mayoría de los pacientes (75%, n=45) no presentó comorbilidad. El PPD fue positivo en 32 de 51 pacientes, el 93% tuvo radiografía de tórax patológica. La confirmación bacteriológica por examen directo o cultivo se logró en 35% de los casos. La adherencia fue adecuada en el 62% (42% en usuarios del subsector público y 80% en el privado). Ingresaron 70% de los pacientes, 57% para estudio e inicio de tratamiento. Se constató multidrogorresistencia en dos casos y la letalidad fue de 1,7%. Conclusiones: la tuberculosis es un grave problema de salud, con un progresivo aumento del número de casos a nivel nacional. La prevalencia de enfermedad entre los contactos menores de 15 años en este estudio fue 6.9% pero la cifra puede estar sesgada por las dificultades en la captación de los contactos, población con mayor riesgo de enfermar. La radiografía de tórax patológica fue el pilar más importante para decidir el inicio de tratamiento en esta población; el aislamiento del germen es muy inferior al del caso índice (35% vs 95%). La adherencia al tratamiento es mala. La detección, seguimiento y estudio de los contactos son las mayores herramientas en el diagnóstico y prevención.
The WHO considers tuberculosis a global emergency in public health. There has been an increase in cases in Uruguay since 2011, the current rate being 25.1 out of 10(5) inhabitants. Research on adult contact with pulmonary active disease constitutes the most effective method to identify children infected with Mycobacterium tuberculosis. Objective: to describe prevalence in patients under 15 years old with tuberculosis, based on a diagnose of an index case and its clinical-epidemiological characteristics Methodology: we conducted a descriptive study between January 1, 2012 and October 1, 2014, using as a source, the data in the medical records of children under 15 years old with a diagnosis of tuberculosis done at the Comisión Honoraria de Lucha Antituberculosa based on an index case. The following variables were analysed in children: age, sex, nutritional condition, concomitant disease, school years, schooling, tuberculin test, bacteriological study, chest X-rays, follow-up adherence, need for hospitalization and resistance. In the index case the variables were the following: family bond or relationship with child, age, bacteriological study, disease location (pulmonary or extrapulmonary), history of incarceration, addictions or concomitant diseases that result in immunodepression, origin and presence of resistance. The median was calculated as a central trend, the same as absolute frequencies and percentages with their corresponding confidence interval of 95%. Results: 1.672 cases of tuberculosis were identified, 497 with contacts under 15 years old. 49% of them transmitted tuberculosis to children (9.9%). Out of the 872 cases studied: 60 developed the disease (6.9%, confidence interval 95%, 5.5-8.8%). 253 children under 15 years old could not be followed up. Out of the 49 index cases: 40 evidence a single contact with the disease younger than 15 years old, the rest of them evidence two or more contacts. The median of age was 30 years old and 49% were first-degree relatives. Bacteriological confirmation was obtained in 95% of cases. Lethality was 8% and two cases presented multiple resistance. Children with the disease have a median age of 4 years old and 60% of them presented an adequate nutritional condition. Most patients (75% - N:45) showed no comorbidity. PPD was positive in 32 of the 51 patients. 93% had a pathological chest x-ray. Bacteriological confirmation by direct test or culture was possible in 35% of cases. Adherence was adequate in 62% (42% of users in the public sub-sector and 80% in the private one). 70% of patients were admitted in the hospital, 57% of them to be studied and to initiate treatment. Multi-drug resistance was found in 2 cases and lethality was 1.7%. Conclusions: tuberculosis is a serious health problem which evidences a gradual increase in the number of cases at the national level. Prevalence of the disease among contacts younger than 15 years old in this study was 6.9%, although the figure may be biased given the difficulties to reach the contacts, the population with a higher risk of getting the disease. Chest X-ray pathology was the greatest pillar to decide initiation of treatment in this population: isolation of the germ is significantly lower than the index case (35% vs 95%). Adherence to treatment is really bad. Identification, follow-up and study of contacts constitute the most important tools for diagnosis and prevention.
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Humanos , Masculino , Adolescente , Tuberculosis/epidemiología , Tuberculosis/diagnóstico , Uruguay/epidemiología , Epidemiología Descriptiva , Prevalencia , Estudios Retrospectivos , Enfermedades Transmisibles EmergentesRESUMEN
Introducción: la diabetes mellitus es una enfermedad crónica frecuente en pediatría. El análisis de indicadores de calidad asistencial contribuye a mejorar el proceso de asistencia. Objetivo: describir las principales características clínico epidemiológicas de los pacientes diabéticos asistidos en la Unidad de Diabetes (UD) de la Policlínica Pediátrica General de Referencia. Evaluar la calidad asistencial en base a indicadores. Método: estudio descriptivo, retrospectivo, utilizando los registros clínicos de los pacientes controlados en la UD entre el 1º de julio de 2012 y el 1º de julio de 2013. Se definieron indicadores de proceso asistencial e indicadores de resultados. Los resultados se clasificaron en: bueno ? 80%, aceptable 60% - 80% y malo < 80%. Se calcularon medianas y promedios como medida de tendencia central. Los resultados se expresaron en frecuencias absolutas y porcentajes con su respectivo intervalo de confianza de 95%. Resultados: se incluyeron 83 pacientes. La mediana de edad fue de 12 años. El 56% era de sexo masculino. Provenían del interior del país, 66%. La mediana de edad al diagnóstico fue de 6 años. La mediana de evolución de enfermedad fue de 5 años. Tres de los nueve indicadores de calidad tuvieron un resultado bueno, cinco aceptable y uno malo. La principal falla fue el valor promedio de HbA1c. Conclusiones: se encontraron indicadores de calidad aceptables. Se debe mejorar el cumplimiento de la pesquisa microvascular y en particular el control metabólico de la enfermedad. La evaluación periódica de indicadores de calidad permitirá mejorar la calidad de asistencia.
Abstract Introduction: diabetes mellitus is a chronic disease that is most common children. Analysing quality health care indicators contributes to improving the healthcare services. Objective: to describe the main epidemiological and clinical characteristics of diabetic patients seen at the Diabetes Unit of the General Pediatrics Policlinic of Reference. To evaluate healthcare quality based on indicators. Method: descriptive, retrospective study based on clinical records of patients seen at the Diabetes Unit between July 1, 2012 and July 1, 2013. Indicators were defined for healthcare services and results. Results were classified into good ?80%, acceptable 60% - 80% and bad < 80%. Median and averages were calculated to serve as a measure of the central trend. Results were expressed in absolute frequencies and percentages, with their corresponding confidence interval of 95%. Results: 83 patients were included. Median age was 12 years old, 56% of them were male and 66% of them lived in the provinces. Median age upon diagnosis was 6 years old. Median disease evolution was five years. Three out of nine of the quality indicators were evaluated as good, five as acceptable and one as bad. The main flaw was average measurements of HbA1c. Conclusions: quality indicators were acceptable. Microvascular screening needs to be improved, and in particular, the metabolic follow up of the disease. Regular evaluation of quality indicators will enable improving healthcare quality.
Resumo Introdução: a diabetes mellitus é uma doença crônica frequente em Pediatria. A análise de indicadores de qualidade do atendimento contribui a melhoria do processo de atendimento. Objetivo: descrever as principais características clínico epidemiológicas dos pacientes diabéticos atendidos na Unidade de Diabetes (UD) do Ambulatório Pediátrico Geral de Referência. Avaliar a qualidade do atendimento usando indicadores. Material e método: estudo descritivo, retrospectivo, utilizando os prontuários médicos dos pacientes controlados na UD no período 1° de julho de 2012 - 1°de julho de 2013. Foram definidos indicadores de processo de atendimento e de resultados. Os resultados foram classificados como: bom ? 80%, aceitável 60% - 80% e ruim < 60%. Como medidas de tendência central foram calculadas medianas e médias. Os resultados foram expressos em frequências absolutas e porcentagem com intervalo de confiança de 95%. Resultados: foram incluídos 83 pacientes. A mediana de idade foi de 12 anos. 56% eram de sexo masculino. 66% eram do interior do país. A mediana da idade no momento do diagnóstico foi de seis anos. A mediana de evolução da doença foi de cinco anos. Três dos nove indicadores de qualidade obtiveram resultado bom, cinco aceitável e 1 ruim. A principal falha foi o valor médio da HbA1c. Conclusões: foram encontrados indicadores de qualidade aceitáveis. É necessário melhorar o cumprimento da pesquisa microvascular especialmente o controle metabólico da doença. A avaliação periódica de indicadores de qualidade permitirá melhorar a qualidade do atendimento.
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Niño , Calidad de la Atención de Salud , Diabetes MellitusRESUMEN
En los últimos años se ha observado un aumento en la incidencia de Campylobacter spp (CSSP) como agente de diarrea, enteritis y disentería. Constituye una zoonosis así como una enfermedad trasmitida por alimentos. El diagnóstico de GEA por CSPP se realiza por identificación del agente etiológico en las heces del paciente. El objetivo de la siguiente observación es presentar dos casos clínicos de GEA en niños con diagnóstico etiológico de colitis causada probablemente por Campylobacter spp mediante la utilización de examen directo de materia fecal. El cultivo de la bacteria es el gold standard; en Uruguay sólo está disponible con fines de investigación. El método más fácil de poner en práctica en los laboratorios clínicos es la tinción y observación directa con un Gram modificado el cual sumado a la clínica, permite un diagnóstico con alto grado de presunción. En ambos pacientes el resultado motivó la instauración de un tratamiento antibiótico específico que determinó una buena evolución.
In recent years an increase in the incidence of Campylobacter spp (CSSP) as the agent of diarrhea, enteritis and dysentery was observed. It constitutes a zoonosis, as well as a food transmitted disease. Diagnosis of acute gastroenteritis by CSPP is done by identifying the etiological agent on the patients’ feces. The objective of the following observation is to present two clinical cases of acute gastroenteritis in children with an etiological diagnosis of colitis, probably caused by Campylobacter spp by means of a direct study of the stool. Culture of the bacteria is the gold standard, although in Uruguay it is only available for research purposes. The easiest method to put into practice in the clinical laboratories is staining and the direct observation with a modified Gram, which, together with the clinical examination, enables diagnosis with a high degree of presumption. In both patients, the result caused the adoption of a specific antibiotic, which determined a good evolution.