ABSTRACT
There is little known about the time of the day and the nature of it (business day/non-business day) at which extubation is performed, and whether it is safe during the night. OBJECTIVE: to describe the frequency of nocturnal extubation (NE) and non-business day extubation (nBDE). In addition, to determine the association between these and clinical outcomes. PATIENTS AND METHOD: Retrospective cohort study of patients under 18 years of age who received invasive mechanical ventilation (MV) and underwent an extubation attempt in a high complexity Pediatric Critical Patient Unit (PCPU) between 01/01/2018 to 12/31/2021. Primary exposure: NE, which was defined as that performed between 20:01 and 8:00 hours. Its association with extubation failure (EF), duration of invasive MV, and length of stay in the PCPU was evaluated. RESULTS: 146 patients were included [58.9% males, age 1.14 (0.25 - 5.5) years]. NE was performed in 17.8%. Nocturnal extubation was not associated with EF nor was the day of extubation. The EF was 3.8% in NE and 5% in daytime extubation (DE) (p = 0.80). Duration of invasive MV was shorter in NE than DE [48 (24-73.5) vs. 72 (48-96) h, p = 0.02]. CONCLUSIONS: NE was not associated with EF. Patients with NE had shorter duration of invasive MV, and the latter was associated with EF. Withdrawal of invasive MV should be considered at the first opportunity and be determined by clinical factors, rather than time of day.
Subject(s)
Airway Extubation , Respiration, Artificial , Male , Child , Humans , Adolescent , Infant , Female , Retrospective Studies , Length of Stay , Intensive Care Units, PediatricABSTRACT
The development of nephrotic syndrome in concomitance with Hashimoto's thyroiditis is an in frequent association in the pediatric age. OBJECTIVE: To report an infrequent complication of au toimmune thyroiditis, such as the appearance of nephrotic syndrome. CLINICAL CASE: A 10-year-old patient presenting with nephrotic syndrome and goiter. A history of autoimmune thyroiditis and un treated hypothyroidism was detected. Corticosteroid and hormone replacement therapy (levothyro- xine) is started, achieving a good clinical and laboratory response. CONCLUSION: Autoimmune thyroi ditis impacts renal physiology through immunological and non-immunological mechanisms. At the same time, renal repercussions can affect thyroid function. The importance of this communication lies in reporting an infrequent complication of autoimmune thyroiditis, such as the appearance of nephrotic syndrome.
Subject(s)
Hashimoto Disease , Hypothyroidism , Nephrotic Syndrome , Thyroiditis, Autoimmune , Humans , Child , Thyroiditis, Autoimmune/complications , Nephrotic Syndrome/complications , Nephrotic Syndrome/diagnosis , Hashimoto Disease/complications , Hashimoto Disease/diagnosis , Hypothyroidism/complications , KidneyABSTRACT
Serendipity has played a crucial role in the history of many different areas of science, including modern medicine. This corresponds to the ability to make a discovery, which occurs accidentally or by chance, in combination with the sagacity of the observer. Many of the most important and revolutio nary findings in medical science, specifically pharmacology, involved serendipitous events of a natu re. Some examples related to drug discovery and pharmacological research are briefly reviewed, such as the history of benzodiazepines, chloral hydrate, clonidine, warfarin, Ringer's solution, valproic acid, barbiturates, penicillin and insulin, in which there were events related to serendipity. All these drugs or their derivatives are currently in frequent use in Intensive Care Units.
Subject(s)
Chloral Hydrate , Valproic Acid , Child , Humans , Penicillins , Critical CareABSTRACT
Medical philately, with its diverse themes, is a faithful testimony of the historical events that have affected humanity. Likewise, it allows us to evidence its role as a diffuser of diverse prevention cam paigns carried out to control and eradicate serious infections, together with other achievements of health policy in the child population. Nowadays, the knowledge and collection of postage stamps is an increasingly unusual pastime. On the other hand, sometimes there is a marked historical ignoran ce and lack of appreciation of the effective actions for the control of infectious diseases, forgetting the enormous effect of these on the daily life of the current society. Through the visual testimony offe red by the postage stamps, we review the sanitary, educational, and therapeutic actions destined to control the infections in the pediatric patient, with emphasis on our country. In addition, we discuss the new populations at risk for the appearance of septic episodes. Even today, serious infections and sepsis represent an important public health problem.
Subject(s)
Health Policy/history , Health Promotion/history , Philately , Sepsis/history , Sepsis/prevention & control , Adolescent , Child , Child Health/history , Child, Preschool , Chile , Global Health/history , Health Promotion/methods , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Infant , Infant, Newborn , Latin America , Measles/history , Measles/prevention & control , Patient Acuity , Pediatrics/history , SpainSubject(s)
Poliomyelitis , Humans , Poliomyelitis/epidemiology , Poliomyelitis/prevention & control , United StatesABSTRACT
Se han cumplido doscientos años desde la publicación en la que se dio a conocer la aplicación clínica del estetoscopio. Esta fue realizada en 1819 por René Théophile Hyacinthe Laënnec. El Dr. Laënnec vivió su infancia en la efervescencia social de la Revolución francesa y estudió Medicina en París, donde se graduó en 1804. Su experiencia clínica en el Hospital Necker culminó con la invención del estetoscopio en 1816. Tres años después, la publicación de su obra maestra De l'auscultation médiate enfatizó un enfoque clínico-patológico más racional, en especial, para el entendimiento de las enfermedades cardiorrespiratorias. Sin duda, el Dr. Laënnec revolucionó la medicina al perfeccionar el arte de la semiología torácica, que permitió al médico transformar los sonidos que escuchaba en una imagen, la cual podía visualizar.Con ocasión del bicentenario de este trascendental hito de la medicina moderna, se recuerda su historia
Two hundred years have passed since the publication that revealed the clinical use of the stethoscope. René Théophile Hyacinthe Laënnec published it in 1819. Laënnec spent his childhood in the social effervescence of the French Revolution and studied medicine in Paris, where he graduated in 1804. His clinical experience at Necker Hospital peaked with the invention of the stethoscope in 1816. Three years later, he published his masterpiece De L'Auscultation Médiate, which underlined a more rational clinical-pathological approach, especially in the understanding of cardiopulmonary diseases. Undoubtedly, Laënnec revolutionized medicine by perfecting the art of thoracic semiology, which allowed him to translate the sounds he heard into an image that could be visualized.In the bicentennial of the invention of such fundamental milestone in modern medicine, the purpose of this article is to go over its history
Subject(s)
Humans , Stethoscopes/history , Heart Auscultation/history , History of MedicineABSTRACT
Two hundred years have passed since the publication that revealed the clinical use of the stethoscope. René Théophile Hyacinthe Laënnec published it in 1819. Laënnec spent his childhood in the social effervescence of the French Revolution and studied medicine in Paris, where he graduated in 1804. His clinical experience at Necker Hospital peaked with the invention of the stethoscope in 1816. Three years later, he published his masterpiece De L'Auscultation Médiate, which underlined a more rational clinical-pathological approach, especially in the understanding of cardiopulmonary diseases. Undoubtedly, Laënnec revolutionized medicine by perfecting the art of thoracic semiology, which allowed him to translate the sounds he heard into an image that could be visualized. In the bicentennial of the invention of such fundamental milestone in modern medicine, the purpose of this article is to go over its history.
Se han cumplido doscientos años desde la publicación en la que se dio a conocer la aplicación clínica del estetoscopio. Esta fue realizada en 1819 por René Théophile Hyacinthe Laënnec. El Dr. Laënnec vivió su infancia en la efervescencia social de la Revolución francesa y estudió Medicina en París, donde se graduó en 1804. Su experiencia clínica en el Hospital Necker culminó con la invención del estetoscopio en 1816. Tres años después, la publicación de su obra maestra De l'auscultation médiate enfatizó un enfoque clínico-patológico más racional, en especial, para el entendimiento de las enfermedades cardiorrespiratorias. Sin duda, el Dr. Laënnec revolucionó la medicina al perfeccionar el arte de la semiología torácica, que permitió al médico transformar los sonidos que escuchaba en una imagen, la cual podía visualizar. Con ocasión del bicentenario de este trascendental hito de la medicina moderna, se recuerda su historia.
Subject(s)
Auscultation/history , Physicians/history , Stethoscopes/history , Auscultation/instrumentation , France , History, 18th Century , History, 19th Century , HumansABSTRACT
Resumen: Cada vez es más frecuente la atención médica en la Unidad de Cuidados Intensivos (UCI) de niños o adolescentes inmigrantes como también de aquellos nacidos en nuestro país con padres en tal condición. Esto ha ocasionado, en la actualidad, que el equipo de salud se deba enfrentar con problemas diagnósticos derivados del escaso conocimiento de condiciones genéticas propias de esta población y/o el desarrollo de diversas patologías infrecuentes en nuestro país, algunas resultantes de su condi ción sanitaria. En esta revisión se abordan diversos aspectos de la patología hematológica, infecciosa, parasitaria, respiratoria y cardiovascular, todos tópicos relevantes de conocer durante su estadía en la UCI. Es un deber del equipo de salud actualizarse sobre patologías de baja prevalencia en nuestro país, algunas de ellas muy poco conocidas hasta hace una década, pero que, actualmente, están cada vez más presentes en las UCI del sistema de salud público chileno.
Abstract: It is increasingly common to provide medical care in the Intensive Care Unit (ICU) for immigrant children and adolescents as well as those born in Chile with parents in such condition. Currently, this has caused that the health team has to face diverse infrequent pathologies in our country and/ or diagnostic problems derive from the poor knowledge of genetic conditions of this population, some resulting from their health conditions. This review addresses several aspects of hematological, infectious, parasitic, respiratory, and cardiovascular pathologies, all relevant topics to know during their stay in the ICU. It is a duty of the health team to be updated on pathologies of low prevalence in our country, some of them very little known until a decade ago, but which are currently increasingly present in the ICUs of the Chilean public health system.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Respiratory Tract Diseases/diagnosis , Respiratory Tract Diseases/ethnology , Respiratory Tract Diseases/therapy , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/ethnology , Cardiovascular Diseases/therapy , Critical Care/methods , Emigrants and Immigrants , Hematologic Diseases/diagnosis , Hematologic Diseases/ethnology , Hematologic Diseases/therapy , Infections/diagnosis , Infections/ethnology , Infections/therapy , Intensive Care Units , Chile/epidemiology , PrevalenceABSTRACT
In our country, meningococcal disease has a low endemic and high lethality, with epidemic out breaks; some of them of historical character, like the one happened during the first half of the last century. The action of a group of doctors, pioneers in clinical, research and teaching aspects, together with the health personnel that constituted their team, immersed in a successful public health policy, allowed to consolidate the necessary care of the sick child of this serious pathology, as well as many others, thus enabling the development of a structured and scientific proposal, in the light of the knowledge available at that time. Therefore, after 80 years, it is important to review the various clini cal, pathophysiological and therapeutic aspects, in addition to the hospital and social context, of this successful history of the Chilean public health system.
Subject(s)
Epidemics/history , Meningococcal Infections/history , Shock, Septic/history , Child , Child, Preschool , Chile/epidemiology , History, 20th Century , Hospitalization , Humans , Infant , Meningococcal Infections/diagnosis , Meningococcal Infections/epidemiology , Meningococcal Infections/therapy , Pediatrics/history , Shock, Septic/diagnosis , Shock, Septic/epidemiology , Shock, Septic/therapyABSTRACT
Resumen: En nuestro país, la enfermedad meningocóccica presenta una baja endemia y alta letalidad, con exis tencia de brotes epidémicos, algunos de ellos de carácter histórico, como el acaecido durante la pri mera mitad del siglo pasado. La acción de un grupo de médicos, pioneros en los aspectos clínicos, de investigación y docencia, junto al personal de salud que constituía su equipo, inmersos en una política pública sanitaria exitosa, permitieron consolidar el cuidado necesario del niño enfermo de esta grave patología, como también de muchas otras, posibilitando así el desarrollo de una propuesta estructurada y científica a la luz del conocimiento disponible en aquella época. Por ello, luego de 80 años, es importante revisar los diversos aspectos clínicos, fisiopatológicos y terapéuticos, además del contexto hospitalario y social de esta exitosa historia del sistema de salud público chileno.
Abstract: In our country, meningococcal disease has a low endemic and high lethality, with epidemic out breaks; some of them of historical character, like the one happened during the first half of the last century. The action of a group of doctors, pioneers in clinical, research and teaching aspects, together with the health personnel that constituted their team, immersed in a successful public health policy, allowed to consolidate the necessary care of the sick child of this serious pathology, as well as many others, thus enabling the development of a structured and scientific proposal, in the light of the knowledge available at that time. Therefore, after 80 years, it is important to review the various clini cal, pathophysiological and therapeutic aspects, in addition to the hospital and social context, of this successful history of the Chilean public health system.
Subject(s)
Humans , Infant , Child, Preschool , Child , Shock, Septic/history , Epidemics/history , Meningococcal Infections/history , Pediatrics/history , Shock, Septic/diagnosis , Shock, Septic/therapy , Shock, Septic/epidemiology , Chile/epidemiology , Hospitalization , Meningococcal Infections/diagnosis , Meningococcal Infections/therapy , Meningococcal Infections/epidemiologyABSTRACT
La glomerulonefritis aguda desencadenada por Streptococcus pneumoniae es una patología de baja prevalencia. Existen diversos reportes que comunican distintas cepas nefritogénicas; sin embargo, la 6C ha sido escasamente señalada como tal.Se presenta el caso de un paciente de 4 años, quien ingresó a Terapia Intensiva con pleuroneumonía por Streptococcus pneumoniae serotipo 6C y desarrolló, de modo concomitante, edemas, hipertensión arterial, hematuria, proteinuria, disminución del filtrado glomerular y del nivel de complemento C3. Se diagnosticó glomerulonefritis aguda. Su evolución fue satisfactoria en un breve plazo. Esta patología, por lo general, es de curso transitorio y benigno; sin embargo, en ocasiones, puede complicar la evolución de un paciente críticamente enfermo, por lo cual se hace necesario tenerla entre los diagnósticos diferenciales para considerar.
Acute glomerulonephritis caused by Streptococcuspneumoniaeis a low prevalence pathology. There are several reports communicating different nephritogenic serotypes, however, 6C has been scarcely indicated as such. It is presented the case of a 4-year-old patient who entered Intensive Therapy Unit with pleuropneumonia due to Streptococcuspneumoniae serotype 6C and concomitantly developed edemas, arterial hypertension, hematuria, proteinuria, decreased glomerular filtration rate and C3 complement level. Acute glomerulonephritis was diagnosed. His evolution was satisfactory in a short time. This pathology is usually of a transitory and benign course; however, sometimes it can potentially complicate the evolution of a critically ill patient, so it is necessary to have it among the differential diagnoses to consider.
Subject(s)
Humans , Male , Child, Preschool , Pleuropneumonia/diagnosis , Glomerulonephritis , Pleuropneumonia/drug therapy , Streptococcus pneumoniae , Diagnosis, DifferentialABSTRACT
Acute glomerulonephritis caused by Streptococcus pneumoniae is a low prevalence pathology. There are several reports communicating different nephritogenic serotypes, however, 6C has been scarcely indicated as such. It is presented the case of a 4-year-old patient who entered Intensive Therapy Unit with pleuropneumonia due to Streptococcus pneumoniae serotype 6C and concomitantly developed edemas, arterial hypertension, hematuria, proteinuria, decreased glomerular filtration rate and C3 complement level. Acute glomerulonephritis was diagnosed. His evolution was satisfactory in a short time. This pathology is usually of a transitory and benign course; however, sometimes it can potentially complicate the evolution of a critically ill patient, so it is necessary to have it among the differential diagnoses to consider.
La glomerulonefritis aguda desencadenada por Streptococcus pneumoniae es una patología de baja prevalencia. Existen diversos reportes que comunican distintas cepas nefritogénicas; sin embargo, la 6C ha sido escasamente señalada como tal. Se presenta el caso de un paciente de 4 años, quien ingresó a Terapia Intensiva con pleuroneumonía por Streptococcus pneumoniae serotipo 6C y desarrolló, de modo concomitante, edemas, hipertensión arterial, hematuria, proteinuria, disminución del filtrado glomerular y del nivel de complemento C3. Se diagnosticó glomerulonefritis aguda. Su evolución fue satisfactoria en un breve plazo. Esta patología, por lo general, es de curso transitorio y benigno; sin embargo, en ocasiones, puede complicar la evolución de un paciente críticamente enfermo, por lo cual se hace necesario tenerla entre los diagnósticos diferenciales para considerar.
Subject(s)
Glomerulonephritis/diagnosis , Pleuropneumonia/diagnosis , Pneumococcal Infections/diagnosis , Streptococcus pneumoniae/isolation & purification , Acute Disease , Child, Preschool , Glomerulonephritis/microbiology , Humans , Male , Pleuropneumonia/microbiologyABSTRACT
It is increasingly common to provide medical care in the Intensive Care Unit (ICU) for immigrant children and adolescents as well as those born in Chile with parents in such condition. Currently, this has caused that the health team has to face diverse infrequent pathologies in our country and/ or diagnostic problems derive from the poor knowledge of genetic conditions of this population, some resulting from their health conditions. This review addresses several aspects of hematological, infectious, parasitic, respiratory, and cardiovascular pathologies, all relevant topics to know during their stay in the ICU. It is a duty of the health team to be updated on pathologies of low prevalence in our country, some of them very little known until a decade ago, but which are currently increasingly present in the ICUs of the Chilean public health system.
Subject(s)
Cardiovascular Diseases , Critical Care/methods , Emigrants and Immigrants , Hematologic Diseases , Infections , Intensive Care Units , Respiratory Tract Diseases , Adolescent , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/ethnology , Cardiovascular Diseases/therapy , Child , Child, Preschool , Chile/epidemiology , Hematologic Diseases/diagnosis , Hematologic Diseases/ethnology , Hematologic Diseases/therapy , Humans , Infant , Infant, Newborn , Infections/diagnosis , Infections/ethnology , Infections/therapy , Prevalence , Respiratory Tract Diseases/diagnosis , Respiratory Tract Diseases/ethnology , Respiratory Tract Diseases/therapyABSTRACT
The catastrophic impact of infectious diseases on children's health, as well the transcendental and be neficial role played by the establishment and execution of health measures and immunoprevention, has been a recurrent subject in the history of medicine, although once the disease has been controlled, they are easily forgotten. In view of this, it seems necessary to recall that social scenario through an approach through painting. The pictorial works are witnesses of that since diseases are subject of representation, and at the same time, they have become an invaluable document in the history of me dicine. Pediatric pathologies such as tuberculosis, diphtheria, polio, measles, smallpox, and syphilis, as well as the initiation of vaccination, are analyzed in various paintings with the aim of deepening knowledge of the historical era, the author and his or her link to this disease.
Subject(s)
Communicable Diseases/history , Medicine in the Arts/history , Paintings/history , Vaccination/history , Child , History, 15th Century , History, 16th Century , History, 18th Century , History, 19th Century , History, 20th Century , HumansABSTRACT
Resumen: El impacto catastrófico de las enfermedades infecciosas sobre la salud infantil, como también el rol trascendental y benéfico aportado por la instauración y ejecución de medidas sanitarias y de inmuno- prevención ha sido un tema recurrente en la historia de la medicina, aunque una vez logrado el con trol de la enfermedad, estas pasan fácilmente al olvido. Ante esto, parece necesario rememorar aquel escenario social mediante un acercamiento a través de la pintura. Las obras pictóricas son testigo de aquello, pues las enfermedades son objeto de representación y a su vez se han convertido en un in valuable documento en la historia de la medicina. Patologías pediátricas como tuberculosis, difteria, poliomielitis, sarampión, viruela y sífilis como también el inicio de la vacunación, son analizadas en diversas pinturas con el objetivo de profundizar el conocimiento de la época histórica, el autor y su vínculo con dicha enfermedad.
Abstract: The catastrophic impact of infectious diseases on children's health, as well the transcendental and be neficial role played by the establishment and execution of health measures and immunoprevention, has been a recurrent subject in the history of medicine, although once the disease has been controlled, they are easily forgotten. In view of this, it seems necessary to recall that social scenario through an approach through painting. The pictorial works are witnesses of that since diseases are subject of representation, and at the same time, they have become an invaluable document in the history of me dicine. Pediatric pathologies such as tuberculosis, diphtheria, polio, measles, smallpox, and syphilis, as well as the initiation of vaccination, are analyzed in various paintings with the aim of deepening knowledge of the historical era, the author and his or her link to this disease.
Subject(s)
Humans , Child , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , Paintings/history , Communicable Diseases/history , Vaccination/history , Medicine in the Arts/historyABSTRACT
Many myths and legends have had a profound influence on modern medical language and are exten ded to all specialties as part of their culture and the history of medicine. This article briefly reviews the history of some eponyms which are usually used in medical practice. It is the knowledge of a few the mythological origin in its denomination.
