Neumonía grave en pediatría a propósito de un caso / Severe pneumonia in pediatrics a case report

La neumonía adquirida en la comunidad (NAC) es primera causa de muerte infantil a nivel mundial y una de las principales causas de morbilidad en los países subdesarrollados. Los niños que desarrollan Neumonía grave son aquellos que dentro su evolución precisa internación y los casos de presentación muy grave son aquellos que precisan ingresos en la unidad de cuidados intensivos pediátricos. Existen distintos y numerosos factores de riesgo dependiente del huésped y ambientales que se han asociado con una mayor incidencia de NAC Grave por lo que es importante el rápido diagnóstico y abordaje terapéutico en los pacientes tomando en cuenta a los microorganismos causales más frecuentes en los diferentes grupos pediátricos. Se debe tomar en cuenta al Estreptococos neumonía como la principal causa de Neumonía grave y de acuerdo a la evolución inicial el tratamiento antibiótico empírico, a pesar de no detectarlo en los estudios disponibles en nuestro medio, con el objetivo de evitar complicaciones y mayor mortalidad.

Immunoproteomics of cow's milk allergy in Mexican pediatric patients.

Immunological mechanisms of non-IgE-mediated cow's milk protein allergy (CMPA) are not well understood. Such a circumstance requires attention with the aim of discovering new biomarkers that could lead to better diagnostic assays for early treatment. Here, we sought both to investigate the mechanism that underlies non-IgE-mediated CMPA and to identify cow's milk immunoreactive proteins in a Mexican pediatric patient group (n = 34). Hence, we determined the IgE and IgG1-4 subclass antibody levels against cow's milk proteins (CMP) by ELISA. Then, we performed 2D-Immunoblots using as first antibody immunoglobulins in the patients'serum that bound specifically against CMP together with CMP enrichment by ion-exchange chromatography. Immunoreactive proteins were identified by mass spectrometry-based proteomics. The serological test confirmed absence of specific IgE in the CMPA patients but showed significant increase in antigen-specific IgG1. Additionally, we identified 11 proteins that specifically bound to IgG1. We conclude that the detection of specific IgG1 together with an immunoproteomics approach is highly relevant to the understanding of CMPA's physiopathology and as a possible aid in making a prognosis since current evidence indicates IgG1 occurrence as an early signal of potential risk toward development of IgE-mediated food allergy. SIGNIFICANCE: Allergies are one of the most studied topics in the field of public health and novel protein allergens are found each year. Discovery of new principal and regional allergens has remarkable repercussions in precise molecular diagnostics, prognostics, and more specific immunotherapies. In this context, specific IgE is widely known to mediate physiopathology; however, allergies whose mechanism does not involve this immunoglobulin are poorly understood although their incidence has increased. Therefore, accurate diagnosis and adequate treatment are delayed with significant consequences on the health of pediatric patients. The study of type and subtypes of immunoglobulins associated with the immunoreactivity of cow's milk proteins together with an immunoproteomics approach allows better comprehension of physiopathology, brings the opportunity to discover new potential cow's milk protein allergens and may help in prognosis prediction (IgG1 occurrence as an early signal of possible risk toward development of IgE-mediated food allergy).

Factores asociados con hospitalización prolongada en lactantes con bronquiolitis moderada

RESUMEN Introducción: La bronquiolitis es una entidad clínica que se presenta antes de los dos años y constituye una causa frecuente de hospitalización en ese grupo de edad. La hospitalización prolongada se define como un tiempo hospitalario mayor a 5 días. Esta situación demanda uso de recursos y tiene un impacto económico sobre el sistema de salud. En el contexto peruano no se ha abordado los factores asociados con la hospitalización prolongada en pacientes con bronquiolitis. Objetivo: Determinar los factores asociados con hospitalización prolongada en pacientes con bronquiolitis moderada. Métodos: Estudio descriptivo, transversal, retrospectivo. La unidad de análisis fue la historia clínica de lactantes hospitalizado por bronquiolitis moderada atendidos en el Instituto Nacional de Salud del Niño-Breña, entre los años 2018 y 2019. Se consideraron 160 lactantes. Para establecer la relación entre los factores asociados a la hospitalización prolongada tanto de la madre como los aspectos clínicos del lactante, se utilizó la prueba JI-cuadrada con un nivel de significancia de 0,05. Resultados: La hospitalización prolongada se asoció con un mayor número de días con oxígeno suplementario con p= 0,000; además de presentarse con mayor frecuencia en lactantes que no recibieron lactancia materna exclusiva con p= 0,000; finalmente, también se asoció con atelectasia y neumonía, ambos casos con p= 0,040. Conclusiones: La hospitalización prolongada en los lactantes con bronquiolitis se asocia con el número de días con oxígeno suplementario, con el no disfrute de la lactancia materna exclusiva y con la aparición de complicaciones como bronquiectasias y neumonías.

ABSTRACT Introduction: Bronchiolitis is a clinical entity that occurs before the age of two and is a frequent cause of hospitalization in this age group. Prolonged hospitalization is defined as a hospital time greater than 5 days. This situation demands the use of resources and has an economic impact on the health system. In the Peruvian context, the factors associated with prolonged hospitalization in patients with bronchiolitis have not been addressed. Objective : etermine the factors associated with prolonged hospitalization in patients with moderate bronchiolitis. Method : Descriptive, cross-sectional, retrospective study. The unit of analysis was the clinical history of infants hospitalized due to moderate bronchiolitis treated at Niño -Breña National Institute of Health, between 2018 and 2019. 160 infants were included. To establish the relationship between the factors associated with prolonged hospitalization of both the mother and the clinical aspects of the infant, the JI-square test with a significance level of 0.05 was used. Results : rolonged hospitalization was associated with a greater number of days with supplemental oxygen with p= 0.000; in addition to presenting more frequently in infants who did not receive exclusive breastfeeding with p = 0.000 . Finally, it was also associated with atelectasis and pneumonia, both cases with p= 0.040. Conclusions: Prolonged hospitalization in infants with bronchiolitis is associated with the number of days on supplemental oxygen, with the non-enjoyment of exclusive breastfeeding and with the appearance of complications such as bronchiectasis and pneumonia.

Impact of Mindfulness Training on the Well-Being of Educators.

Objective: As awareness of educator stress and burnout is at the forefront of issues faced in the education system, programs are being implemented to focus on the well-being and betterment of educators. Mindfulness is one such practice that has been found to increase wellness and, in many cases, decrease negative outcomes. In this study, the effects of a Mindfulness-Based Stress Reduction Program were measured in grade-school (K-12) educators. Design: A longitudinal noncontrolled trial of educators who completed baseline and short- and long-term postintervention surveys. Location: Miami-Dade County. Subjects: Two hundred thirty-six educators who worked in K-12 public and private schools. Intervention: An 8-week Mindfulness-Based Stress Reduction Program. Outcome measures: Five Facet Mindfulness Questionnaire, Self-Compassion Scale, Maslach Burnout Inventory-Educators, Patient-Reported Outcome Measurement Information System (PROMIS-29) for measuring physical and mental health functionality. Results: The multiple linear regression analysis of the short-term cohort data yielded statistically significant improvements in mindfulness, self-compassion, and personal accomplishment and decreases in isolation, anxiety, fatigue, and emotional exhaustion. In the long-term cohort, repeated measures regression showed self-compassion and mindfulness continued to improve significantly, whereas negative outcomes of fatigue and sleep disturbance showed statistically significant decreases. Effect sizes were calculated for all the measures, many of which were medium sized, total mindfulness (0.69), self-compassion (0.051), and sleep disturbance (0.49). Conclusion: Findings are consistent with previous literature and support the need for such programs that impact the educator's personal and professional experience.

El amparo económico para mejorar el tratamiento de la tuberculosis / Economic protection law for improved tuberculosis treatment

Regulatory Decree 170/91 of Law 10436 created a legal framework designed to ensure the socio-economic protection of patients suffering from TB. It consisted of the monthly payment of a minimum salary for employees in the local public administration. The evaluation criteria employed by the health team assessed who could be included in the protection law, their social situation and permanent residence of at least two years in the province of Buenos Aires, Argentina. The aim of our study was to analyze the differences in clinical and epidemiological data between patients included in the law and those not included, and whether the benefit was a factor in the outcome of the treatment. We describe a retrospective observational study that took place from January 1, 2004 to December 31, 2016. People receiving the benefit showed a good outcome in 93.1% of the total cases, 91.1% in confirmed lung cases, 83.7% in the TB-HIV association / AIDS and 81.5% in MDR-TB. In patients not receiving the benefit the success rates were 74.4%, 73.9%, 53.6% and 58.9%, respectively. The differences were statistically significant between both groups. The economic protection law was essential in motivating the patients and in following those cases of difficult management, thus improving treatment adherence. Overcoming TB means not only improving the use of current tools and interventions but also considering the possibility of extending or approving similar laws in Argentina.

Mediante la aprobación del Decreto Reglamentario 170/91 de la Ley 10436, se crea un régimen de amparo, destinado a asegurar la protección socioeconómica del paciente afectado de tuberculosis (TB). Consiste en el pago mensual de un salario básico de la administración pública provincial. El equipo de salud es el que evalúa quiénes se encuentran en condiciones de ser incluidos en la ley de amparo. Los criterios de evaluación contemplan la situación social y una residencia permanente, como mínimo de dos años en la Provincia de Buenos Aires. El objetivo de nuestro estudio es analizar las diferencias de los datos clínicos y epidemiológicos entre pacientes con y sin inclusión en el régimen de amparo y si el subsidio fue factor de éxito en el tratamiento. Este es un estudio observacional retrospectivo, realizado entre el 1º de enero de 2004 al 31 de diciembre de 2016. Las personas con subsidio mostraron éxito en 93.1% en el total de los casos, 91.1% en los casos pulmonares confirmados, 83.7% en la asociación TB-VIH/SIDA y 81.5% en tuberculosis multirresistente (MDR-TB). Sin subsidio el éxito fue 74.4%, 73.9%, 53.6% y 58.9% respectivamente. Las diferencias fueron estadísticamente significativas entre ambos grupos. El régimen de amparo económico, fue primordial para motivar y retener los casos de difícil manejo, mejorando la adhesión al tratamiento. Poner fin a la TB, consistirá, en mejorar el uso de las herramientas e intervenciones actuales y considerar la posibilidad de extender o aprobar leyes similares en el ámbito de nuestro país.

Azacitidine improves outcome in higher-risk MDS patients with chromosome 7 abnormalities: a retrospective comparison of GESMD and GFM registries.

Treatment with azacitidine (AZA) has been suggested to be of benefit for higher-risk myelodysplastic syndrome (HR-MDS) patients with chromosome 7 abnormalities (Abn 7). This retrospective study of 235 HR-MDS patients with Abn 7 treated with AZA (n = 115) versus best supportive care (BSC; n = 120), assessed AZA treatment as a time-varying variable in multivariable analysis. A Cox Regression model with time-interaction terms of overall survival (OS) at different time points confirmed that, while chromosome 7 cytogenetic categories (complex karyotype [CK] versus non-CK) and International Prognostic Scoring System risk (high versus intermediate-2) retained poor prognosis over time, AZA treatment had a favourable impact on OS during the first 3 years of treatment compared to BSC (Hazard ratio [HR] 0·5 P < 0·001 at 1 year, 0·7 P = 0·019 at 2 years; 0·73 P = 0·029 at 3 years). This benefit was present in all chromosome 7 categories, but tended to be greater in patients with CK (risk reduction of 82%, 68% and 53% at 1, 3 and 6 months in CK patients; 79% at 1 month in non-CK patients, P < 0·05 for all). AZA also significantly improved progression-free survival (P < 0·01). This study confirms a time-dependent benefit of AZA on outcome in patients with HR-MDS and cytogenetic abnormalities involving chromosome 7, especially for those with CK.

Fractura de L2 (AOSpine A3) en un paciente con diastematomielia asintomática. Reporte de caso / L2 (AOSpine A3) fracture in a patient with asymptomatic diastematomyelia. Case report

La diastematomielia es una anomalía del desarrollo del tubo neural, caracterizada por una división sagital de la médula espinal. Los síntomas son variados y puede cursar con dolor, trastornos de la marcha, escoliosis, deformidad de los pies, alteraciones del control de esfínteres, estigmas cutáneos, aumento de la tensión muscular e hidrocefalia, entre otros. En ocasiones es asintomática. Se presenta un caso clínico de un varón de 24 años, que sufre caída desde 4 m de altura y sufre fractura en columna lumbar L2 (AOSpine A3, N0), con diastematomielia en L1 de tipo I como hallazgo incidental y hemivértebra en T12. Se manejó con estabilización con tornillos pediculares con buena evolución. El manejo de estos pacientes debe ser individualizado. Los tornillos pediculares ofrecen resultados satisfactorios con bajo riesgo de lesión neurológica. Nivel de evidencia clínica Nivel IV.

Diastematomyelia is an abnormality of the development of the neural tube, and is characterised by a sagittal division of the spinal cord. is the symptoms vary and may include pain, gait disorders, scoliosis, deformity of the feet, changes in sphincter control, skin stigmas, increased muscle tension, and hydrocephalus, among others. It is occasionally asymptomatic. The case is reported of a 24-year-old male, suffering a 4-metre fall and a lumbar spine fracture L2 (AOSpine A3, N0), with L1 type I diastematomyelia as an incidental finding and hemivertebra in T12. It was managed with stabilisation with pedicle screws, with a good outcome. The management of these patients must be individualised, the pedicle screws offer satisfactory results with low risk of neurological damage.

Ulcera duodenal dolor típico y atípico, historia natural, revisión: 1987 - 2014 / Duodenal Ulcer Typical and Atypical Pain, Natural History, Review: 1987 - 2014

Introducción: El dolor típico de la ulcera duodenal, se refiere a epigastralgia urente, que alivia con las comidas, se exacerba 60 o 90 minutos después. Pacientes que presentan dolor atípico, tienen retardo en su diagnóstico. Materiales y Métodos: Se realizó un estudio observacional descriptivo que registró, las características de la ulcera duodenal en pacientes mayores de 18 años, con dolor típico y atípico, atendidos en la consulta de Gastroenterología del Centro Clínico Marcial Ríos, entre los años: 1987 - 2014. Resultados: 331 pacientes 74,9% se incluyeron como dolor típico y 25,1% como dolor atípico. Las variables edad, sexo, procedencia y ocupación no mostraron diferencias significativas. El dolor atípico, su localización en el CSD y sordo fue lo mas llamativo, con una p<0.05. Ubicación e n cara anterior y úlcera única, se asociaron con el tipo de dolor. Conclusiones: El dolor atípico, estuvo presente en el 25,1% de los pacientes. Su localización en el CSD y su carácter sordo fue lo más importante. En pacientes con ulcera duodenal, la edad, sexo, procedencia y ocupación, no influenciaron en el tipo de dolor. Desde 1996 hubo un descenso en el diagnóstico y recurrencia de la úlcera duodenal.

Introduction: The typical pain of duodenal ulcer is epigastric burning, which relieved with meals, to 60 or 90 minutes exacerbated after. In patients with consultation atypical pain there was slow clinical diagnosis. Materials and methods: Realized a observational de scriptive study that resgistred the characterize of the duodenal ulcer in patients 18 years old, with typical and atypical pain, who attended the consultation Gastroenterology of Marcial Ríos Center between 1987 - 2014 years. Results: 331 patients 74,9% was include how typical pain and 25,1% how atypical pain. The variables age, sex, origin and occupation showed no significant differences. Patients with atypical pain location in DSC and deaf was the most striking, with p <0.05. Ubication in anterior face, si ngle ulcer; had association with the type of pain. Conclusions: The atypical abdominal pain was present in 25,1% of patients Its location in the DSC and deaf character was most important. In patients with duodenal ulcer the age, sex, origin, occupation, did not influence the type of pain. Since 1996 there was progressive down in diagnostic and relapse of duodenal ulcer.

Prevalencia y factores asociados a la presencia de reacciones adversas a medicamentos en los pacientes tratados por medicina interna en el Hospital Universitario Hernando Moncaleano Perdomo / Prevalence and risk factors related with adverse reactions to drugs in patients from Hospital Universitario Hernando Moncaleano Perdomo

Objetivo: Estimar la prevalencia y factores asociados para presentar reacciones adversas a medicamentos en los pacientes tratados por medicina interna del Hospital Universitario Hernando Moncaleano Perdomo (HUHMP) durante un período de 2 meses. Materiales y métodos: Estudio prospectivo de corte transversal. El análisis estadístico se realizó con Epi info v7.0 Resultados: De los 284 pacientes, se obtuvieron 89 reacciones adversas a medicamentos (RAM) que corresponde al 31.34 porciento de la muestra, el 52.4 porciento eran del género masculino con una edad media de 58.5 años. Las RAM se clasificaron segúnsu mecanismo de producción en tipo A en 79 porciento, tipo B 14 porciento y tipo C 5 porciento; la mayoría fueron leves en el 88 porciento de los casos. El principal sistema farmacológico afectado fue el gastrointestinal seguido por el hematológico en un 22 porciento y 19 porciento respectivamente; la enoxaparina fue el principal fármaco relacionado con la producción de RAM en el 17 porciento; al igual es el fármaco con más interaccionesmedicamentosas junto con el ácido acetilsalicílico en el 26 porciento de los casos. Entre los factores asociados para la producción de RAM son la polifarmacia IC: 1.96-5.57, p 0.000027 y las interacciones medicamentosas IC: 1.32 – 3.81, p 0.0011.Conclusiones: Las interacciones medicamentosas y la polifarmacia son los factores asociados a la presencia de reacciones adversas a medicamentos enpacientes de medicina interna.

Aneurisma del septo interventricular membranoso ¿Qué hacer con él? / How to deal with aneurysms of the membranous interventricular septum

Resumen Se expone el caso de un paciente con diagnóstico incidental de aneurisma del septo membranoso interventricular, una entidad extremadamente rara en ausencia de defecto septal interventricular asociado. Los pacientes asintomáticos con aneurisma del septo membranoso interventricular deben recibir control periódico debido a las potenciales complicaciones cardiovasculares que acarrea esta entidad.

Abstract We report the case of a patient incidentally diagnosed of aneurysm of the membranous interventricular septum, an extremely rare condition, in the absence of associated ventricular septal defect. Patients with membranous interventricular septal aneurysm who are asymptomatic should be monitored on a regular basis due to potential cardiovascular complications of this entity.

Gastroduodenitis eosinofilica: a propósito de un caso / EOSINOPHILIC GASTRODUODENITIS: CASE REPORT

Introducción: La Gastroenteritis eosinofilica, se refiere a la eosinofilia en cualquiera de las capas de la pared del tracto gastrointestinal, es una patología rara, con incidencia no reportada y de patogenia desconocida, asociada a antecedentes de atopias y alergias alimentarias. Se requiere para su diagnóstico la evidencia histológica de eosinofilia, la ausencia de ésta en órganos extraintestinales y sin presencia de infección parasitaria. Caso clínico: Se reporta el caso de una paciente femenina de 39 años de edad, con clínica de 4 meses que inició posterior a intoxicación alimentaria y caracterizada por dolor abdominal difuso con predominio de epigástrico, opresivo, de fuerte intensidad, que mejoraba con uso de antiespasmódicos y se intensificaba con la ingestión de alimentos, acompañado de náuseas y vómitos. Se planteó el diagnóstico por imágenes de litiasis vesicular, siendo sometida a colecistectomía laparoscópica. Por persistencia de la sintomatología se realizó endoscopia digestiva superior con hallazgos sugestivos de: gastroduodenitis parasitaria y la biopsia reportó: gastroduodenitis crónica severa eosinofilica. Se indicó tratamiento a base de prednisona, obteniendo resolución completa del cuadro clínico.

Background: eosinophilic gastroenteritis, refers to eosino- philia in any of the layers of the wall of the gastrointestinal tract, it is a rare condition, with no reported incidence and unknown pathogenesis associated with a history of atopy and food allergies. It required for diagnosis histologic evidence of eosinophilia, its absence in intestinal organs without presence of parasitic infection. Case report: The case of a female patient of 39 years old, with clinical started 4 months after food poisoning, characterized by a predominance of diffuse abdominal pain epigastric, oppressive, strong intensity, which improved with use is reported antispasmodics and intensified with food intake, with nausea and vomiting. The imaging of gallstones was raised, undergoing laparoscopic cholecystec- tomy. Persistence of symptoms upper endoscopy is performed with suggestive findings: parasitic gastroduodenitis and biop- sy reported: severe chronic eosinophilic gastroduodenitis. Treatment with prednisone was indicated, obtaining complete resolution of symptoms.

Role of minimal residual disease and chimerism after reduced-intensity and myeloablative allo-transplantation in acute myeloid leukemia and high-risk myelodysplastic syndrome.

We evaluated the impact of detection of minimal residual disease by flow cytometry (FCMRD) and CD3 chimerism in relapse in a cohort of 87 patients with acute myeloid leukemia or myelodysplastic syndrome undergoing stem cell transplantation. Patients with a positive FCMRD at day +100 after transplantation showed higher relapse rates and worse overall survival. In multivariate analysis, a positive FCMRD after transplantation was a significant predictor of relapse. Mixed chimerism showed a trend to statistical signification. We conclude that FCMRD at day 100 after SCT is the best predictor of relapse after SCT in patients with aggressive myeloid malignancies.

Transfusion dependence development and disease evolution in patients with MDS and del(5q) and without transfusion needs at diagnosis.

Patients with isolated del(5q) and MDS are considered to have good prognosis as compared to other MDS subtypes. Most patients suffered of anemia and 50% of them required transfusions at diagnosis. It is known that for patients with MDS and del(5q) in transfusion dependence(TD), Lenalidomide is the first choice treatment. However, there are no data regarding natural evolution of anemia in patients diagnosed in MDS and del(5q) without TD, factors that may impact on the development of TD or disease outcome. In the present study we have performed a retrospective multicenter analysis on 83 patients with low-int 1 MDS and del(5q) without TD. During the study 61 patients became TD at a median of 1.7 years and only the Hb level 9 g/dL was associated with poorer TFS (p = 0.007) in the multivariate analysis. Among these 61 TD patients, 49 received treatment (19 Lenalidomide). Median follow up was 48 months, estimated OS at 2 and 5 year was 92% and 50% respectively. In the multivariate analysis for OS, platelets <100,000 mm(-3) and Lenalidomide treatment retained the statistical significant impact. LFS at 2 and 5 years was 86% and 73% respectively, and median time to sAML was 8.16 years (CI 95%: 6.05-10.27). In the multivariate analysis only thrombocytopenia retained statistical significance. In summary, this retrospective study show that level of Hb is an important parameter in order to determine the time until TD, it should be also stressed the importance of an early treatment in order to prevent TD development and shorter survival.

Características clínico-epidemiológicas de pacientes con diagnóstico de fiebre de origen desconocido hospitalizados en el Servico de Infectología del Instituto Nacional de Salud del Niño, 2006-2010 / Clinical and epidemiological characteristics of patients with diagnosis of fever of unknown origin hospitalized in the Service of Infectious Diseases at the National Institute of Child Health, 2006-2010

Candela Herrera, Jorge Luis Objetivos: Describir las características clínico-epidemiológicas de pacientes con diagnóstico de Fiebre de Origen Desconocido hospitalizados en el Servicio de Infectología del Instituto Nacional de Salud del Niño, 2006-2010. Material y métodos: Estudio retrospectivo, se incluyeron a todos los pacientes de 1 mes a 17 años, 11meses 29 días con diagnóstico de Fiebre de Origen Desconocido. Resultados: El grupo etáreo más comprometido fue los menores de un año (49 por ciento), en el 40 por ciento de los pacientes la etiología de la FOD no se pudo determinar. En el 51 por ciento de los pacientes la causa fue infecciosa, de este grupo el diagnóstico más común fue la enfermedad por arañazo de gato (8 por ciento) y la infección urinaria (7 por ciento). En el 77 por ciento de los casos la enfermedad se auto limitó o remitió con el tratamiento empírico. Conclusiones: Existió un alto porcentaje de casos en los cuales el diagnóstico no se pudo determinar (40 por ciento), esto reflejaría deficiencias en la complejidad de pruebas de apoyo necesarias para un adecuado diagnóstico en nuestro país. Coincidiendo con la bibliografía internacional las enfermedades infecciosas fueron las causas más comunes de FOD en los niños evaluados.

Objectives: To describe the clinical epidemiological characteristics of hospitalized patients diagnosed with fever of unknown origin at the Instituto Nacional de Salud del Niño Infectious Disease Ward, 2006-2010. Methods: Retrospective study; patients from ages 1 month to 17 years, 11 months and 29 days and diagnosed with fever of unknown origin were included. Results: The largest age group was comprised by those younger than one year of age (49 per cent); in 40 per cent of patients, the etiology of FUO could not be determined. In 51 per cent of patients, the cause was from infectious origin. From this group, the most common diagnosis was cat scratch disease (8 per cent) and urinary tract infection (7 per cent). 77 per cent of cases autolimited or remitted with empirical treatment. Conclusion: There was a high percentage of cases in which a clear diagnosis could not be determined (40 per cent); this reflects the deficiencies in the complexity of auxiliary laboratory tests needed in order to reach an adequate diagnosis in our country. Concurring with the international literature, infectious disease was the most common cause of FUO in children.

Enseñanza de la Cirugía: nuevos tiempos, nuevos métodos / Teaching surgery: new times, new methods

Introducción La organización, seguimiento y calidad de la docencia postgrado es probablemente una asignatura pendiente en nuestro medio. Este proyecto se plantea un objetivo claro: utilizar una herramienta docente más práctica y eficaz que las disponibles hasta el momento. No solo nos planteamos evaluar al residente, sino aportar el material de estudio ya consensuado y revisado por sus responsables. Todo esto mediante un método fácil, accesible y gratuito que garantice su formación básica. Material y método Primeramente identificamos los problemas prácticos de la residencia de cirugía general en nuestro medio. Confeccionamos una encuesta y la enviamos por correo electrónico a todos los residentes a partir de segundo año de la Comunidad Autónoma del País Vasco. Con los resultados diseñamos un sistema de carpetas con Google Documents™ y lo comenzamos a aplicar en los de tercer y cuarto años. Resultados Los métodos tradicionales de la enseñanza de la Cirugía han quedado en parte obsoletos por el empuje tecnológico de las Ciencias de la Información. Las nuevas generaciones dominan de forma natural tanto la red como las aplicaciones informáticas más comunes. A nuestro alcance tenemos una serie de herramientas que por desconocimiento o falta de tiempo no utilizamos. Este trabajo pretende aportar una opción de trabajo que facilite la labor del tutor como figura docente, ya que la actividad asistencial frecuentemente no deja sitio para la interacción con el residente (AU)

Introduction The organisation, follow-up and quality of post-graduate teaching may be in need of appraisal in our area. This study sets out a clear objective: to use a more practical and effective teaching tool than we currently have available. Not only will it set out to assess the resident, but also provide material already approved and reviewed by their tutors. All this will be achieved using an easy, accessible and free method which ensures their basic training. Material and method Firstly, we identified the practical problems in the general surgery residency in our area. We prepared a questionnaire and sent it by e-mail to all second year and over residents of the Basque Country Autonomous Community. From the results obtained, we designed a file system with Google Documents™ and we started to apply it the third and fourth years. Results The teaching methods in Surgery have partly become obsolete due to the initiative of Information Sciences Technology. The new generations naturally dominate the Internet along with the more common computer applications. Within our reach we have a series of tools that, due to lack of knowledge or lack of time, we do not use. This article attempts to provide a working option that will help the job of the tutor as a teaching figure, since the health care activity often has no place for interaction with the resident (AU)

Evaluación del riesgo quirúrgico de 1.000 episodios consecutivos con el sistema POSSUM. Comparación entre cirugía gastrointestinal programada y urgente / Assessment of the surgical risk of 1, 000 consecutive episodes using the POSSUM system. Comparison between elective and emergency gastrointestinal surgery

Introducción El objetivo del presente estudio fue evaluar la capacidad predictiva del sistema POSSUM en nuestro medio y determinar su comportamiento en cirugía gastrointestinal programada y compararla con la urgente. Pacientes y método Se analizaron 1.000 episodios quirúrgicos correspondientes a 909 pacientes intervenidos con anestesia general o loco-regional, de forma programada (n=547 episodios) o urgente (n=453), que precisaron ingreso hospitalario. Resultados La morbilidad total fue 31,9% (32,9% en cirugía programada y 30,7% en cirugía urgente). La capacidad discriminativa de la escala POSSUM evaluada mediante curva ROC fue mayor para la mortalidad Portsmouth (área bajo la curva [ABC] =0,92) que para la morbilidad (ABC=0,74). La bondad de ajuste o grado de calibración entre los valores esperados usando la escala POSSUM y los observados fue reducida para la morbilidad (Hosmer-Lemeshow [H-L] =164,1; p<0,05). La escala POSSUM predijo un número considerablemente mayor de muertes a las observadas, aunque la variante Portsmouth predijo mejor la mortalidad. El grado de calibración de la morbilidad fue mejor para la cirugía gastrointestinal programada (H-L=27,7) que para la cirugía gastrointestinal urgente (H-L=177,3). Mediante análisis de regresión logística se identificó, además del riesgo estimado mediante la propia escala POSSUM, las variables complejidad quirúrgica, tipo de cirugía y edad del paciente como factores significativos predictivos de la aparición de morbilidad y mortalidad. Conclusiones En nuestro medio, el sistema POSSUM predice adecuadamente el riesgo de morbilidad de la cirugía gastrointestinal programada, y sobreestima el riesgo de morbilidad de la cirugía gastrointestinal urgente (AU)

Introduction The aim of the present study was to assess the predictive capacity of the POSSUM system in a Spanish university hospital, and to determine its behaviour in elective gastrointestinal surgery and compare it with emergency gastrointestinal surgery (operation < 24 hours).Patients and method A total of 1,000 surgical episodes corresponding to 909 patients who required hospital admission, operated on under general or loco-regional anaesthesia, either in the elective (n= 547 episodes) or the emergency setting (n= 453), were included in the study. Results The overall morbidity was 31.9% (32.8% in elective surgery; 30.7% in emergency surgery). The discriminatory capacity of the POSSUM scale, evaluated using receiver operating characteristic (ROC) curves, was higher for the Portsmouth variant of mortality (Area Under the Curve [AUC] = 0,92) than for morbidity (AUC= 0,74). The goodness of fit between the expected values using the POSSUM scale and those observed was reduced for morbidity (Hosmer-Lemeshow [H-L] = 164.1; p< 0.05). The POSSUM scale predicted a higher number of deaths than those observed, although the Portsmouth variant was better at predicting mortality. The goodness of fit for morbidity was better for elective gastrointestinal surgery (H-L= 27.7) than emergency gastrointestinal surgery (H-L= 177.3). The logistic regression analysis identified (besides the estimated risk using the POSSUM scale itself), surgical complexity, surgery type (elective, emergency), and age of patient, as significant predictive factors of morbidity and mortality. Conclusions In a Spanish university hospital, the POSSUM system adequately predicts morbidity risk in elective gastrointestinal surgery, and over-estimates morbidity risk in emergency gastrointestinal surgery (AU)

[Assessment of the surgical risk of 1,000 consecutive episodes using the POSSUM system. Comparison between elective and emergency gastrointestinal surgery]. / Evaluación del riesgo quirúrgico de 1.000 episodios consecutivos con el sistema POSSUM. Comparación entre cirugía gastrointestinal programada y urgente.

INTRODUCTION: The aim of the present study was to assess the predictive capacity of the POSSUM system in a Spanish university hospital, and to determine its behaviour in elective gastrointestinal surgery and compare it with emergency gastrointestinal surgery (operation < 24 hours). PATIENTS AND METHOD: A total of 1,000 surgical episodes corresponding to 909 patients who required hospital admission, operated on under general or loco-regional anaesthesia, either in the elective (n= 547 episodes) or the emergency setting (n= 453), were included in the study. RESULTS: The overall morbidity was 31.9% (32.8% in elective surgery; 30.7% in emergency surgery). The discriminatory capacity of the POSSUM scale, evaluated using receiver operating characteristic (ROC) curves, was higher for the Portsmouth variant of mortality (Area Under the Curve [AUC] = 0,92) than for morbidity (AUC= 0,74). The goodness of fit between the expected values using the POSSUM scale and those observed was reduced for morbidity (Hosmer-Lemeshow [H-L] = 164.1; p< 0.05). The POSSUM scale predicted a higher number of deaths than those observed, although the Portsmouth variant was better at predicting mortality. The goodness of fit for morbidity was better for elective gastrointestinal surgery (H-L= 27.7) than emergency gastrointestinal surgery (H-L= 177.3). The logistic regression analysis identified (besides the estimated risk using the POSSUM scale itself), surgical complexity, surgery type (elective, emergency), and age of patient, as significant predictive factors of morbidity and mortality. CONCLUSIONS: In a Spanish university hospital, the POSSUM system adequately predicts morbidity risk in elective gastrointestinal surgery, and over-estimates morbidity risk in emergency gastrointestinal surgery.

Asma ocupacional en la Asociación Chilena de Seguridad 1990 a 2006 / Occupational asthma in the Asociación Chilena de Seguridad, 1990 - 2006

El asma bronquial es la enfermedad respiratoria más frecuente en el mundo. Su prevalencia va en aumento. El asma debida a causas y condiciones atribuibles al ambiente de trabajo es un subconjunto dela anterior, cuya importancia en Chile es desconocida. Se describen los casos diagnosticados entre 1990 y 2006 en el Hospital del Trabajador Santiago (ACHS). Se diagnosticaron 136 casos de asma ocupacional, con una mediana de edad de 40 años. El 85,3 por ciento de los casos es de género masculino. Las tasas de prevalencia anual oscilan entre 0 y 14 casos por millón de trabajadores, ubicándose muy por debajo de la frecuencia esperada. Los agentes causantes de la enfermedad son variados, pero predominan las harinas de trigo y cebada, los isocianatos y los aserrines de madera. La exposición promedio oscila entre 12 y 14 años y la latencia entre 8 y 9 años. Los agentes de alto peso molecular presentan una latencia mayor que la de aquellos de bajo peso.

Bronchial asthma is the most frequent respiratory disease in the world. Its prevalence is increasing. Asthma due to causes and conditions attributable to the occupational environment is a subset of the latter, whose importance in Chile is unknown. This article describes cases diagnosed between 1990 and 2006 at the Hospital del Trabajador in Santiago (ACHS). 136 cases of occupational asthma were diagnosed, with a median age of 40 years. An 85,3% of the cases correspond to the masculine gender. Annual prevalence rates vary between 0 and 14 cases per million workers, being well below the expected frequency. Causal agents of the disease are diverse, but wheat and barley flours, isocyanates and saw dusts predominate. Mean exposure varies between 12 and 14 years and latency between 8 and 9 years. High molecular weight agents show a higher latency than those of low molecular weight.