Usefulness of thoracic CT to diagnose tuberculosis disease in patients younger than 4 years of age.

BACKGROUND: There is controversy over the need of using thoracic CT (TCT) systematically for differentiating disease from tuberculosis infection in young children. This distinction is important when making a diagnosis of TB as the treatment changes from a single drug to a multidurug regimen with reported side-effects. AIM: To determine the usefulness of using TCT to diagnose pulmonary tuberculosis (PTB) in patients younger than 4 years of age who have TB infection (IBI). MATERIALS AND METHODS: After the simultaneous detection of four cases of PTB in children who attended the same class, a study on the contact among workers and children was carried out. One hundred sixteen children younger than 4 years and 20 adults were included. The tuberculin skin test (TST) was performed on all of them. CHEST XR (CXR) and TCT were performed on children with positive TST and three samples of gastric acid were taken. CXR and sputum testing were performed on adults with positive TST. RESULTS: TST was positive in 28 children (24.1%). In 92.8% of children with positive TST and normal CXR, TCT showed features compatible with PTB. Out of the 28 children with positive TST, 27 (96.4%) were diagnosed with PTB and only one with latent TBI (4%). CONCLUSIONS: In children younger than 4-year old with positive TST and normal CXR, it would be advisable to perform a TCT since the findings could change the diagnosis from TBI to TB disease.

Rotura espontánea de esófago en un recién nacido / Spontaneous esophageal perforation in a preterm neonate

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Utilidad del Pediatric Appropriateness Evaluation Protocol para detectar deficiencias de circuitos asistenciales hospitalarios / Utility of the pediatric appropriateness evaluation protocol (pAEP) to detect deficiencies in the healthcre circuit

Objetivos Cuantificar el porcentaje de ingresos inadecuados según el Pediatric Appropriateness Evaluation Protocol (pAEP), sus causas, la utilidad clínica del pAEP y detectar deficiencias en los circuitos asistenciales en los pacientes pediátricos hospitalizados.Material y métodos Estudio descriptivo, prospectivo de 236 pacientes hospitalizados en el Servicio de Pediatría. Entre las variables analizadas destacan: edad del paciente, protocolo pAEP, causas de ingresos inadecuados, diagnóstico principal y secundario al ingreso del paciente, prueba diagnóstica motivo del ingreso, día de la semana y mes del ingreso.Resultados El 13,6 por ciento (IC 95 por ciento, 9,5-18 por ciento) de las hospitalizaciones pediátricas son inadecuadas según el protocolo pAEP. Las causas de ingresos inadecuados son: pruebas diagnósticas (2,5 por ciento de los ingresos pediátricos) y tratamientos (11 por ciento de los ingresos pediátricos) que podrían haberse realizado como paciente externo. El 90,6 por ciento de los ingresos inadecuados según el pAEP también son considerados inadecuados cuando son evaluados por pediatras expertos.Conclusiones Observamos deficiencias en los circuitos asistenciales cuya mejora podría disminuir el porcentaje de ingresos inadecuados (mayor coordinación atención primaria y hospitalizada y mejor accesibilidad desde urgencias a consultas externas especializadas pediátricas). Para mejorar la calidad en la asistencia pediátrica, el pAEP nos permite identificar ingresos inapropiados y sus causas, así como detectar deficiencias en los circuitos asistenciales (AU)

[Utility of the Pediatric Appropriateness Evaluation Protocol (pAEP) to detect deficiencies in the healthcare circuit]. / Utilidad del Pediatric Appropriateness Evaluation Protocol para detectar deficiencias de circuitos asistenciales hospitalarios.

OBJECTIVES: To quantify the number of inappropriate pediatric hospital admissions using the Pediatric Appropriateness Evaluation Protocol (pAEP), the causes of inappropriate admissions, and the clinical utility of the paep, as well as to detect deficiencies in the healthcare circuit in hospitalized pediatric patients. MATERIAL AND METHODS: A prospective, descriptive study was carried out in a sample of 236 pediatric admissions. We analyzed several items such as age, pAEP, factors associated with inappropriate admission, main and secondary diagnoses, the diagnostic tests motivating admission, and day of the week and month of admission. RESULTS: A total of 13.6 % (CI: 9.5 %-18 %) of pediatric admissions were inappropriate. The most frequent reasons for inappropriate admissions were diagnostic tests (2.5 %) and treatment (11 %) that could have been performed on an outpatient basis. Most (90.6 %) of the admissions deemed inappropriate by the pAEP were also considered inappropriate when evaluated by experienced pediatricians. CONCLUSIONS: Improvement of healthcare circuits could decrease inappropriate admissions (better coordination between primary care and hospitals and improved access from the emergency unit to the specialized pediatric outpatient service). The pAEP allows identification of inappropriate admissions and their causes, as well as detection of deficiencies in the healthcare circuit.

[Ventilation in special situations. Neonatal mechanical ventilation]. / Ventilación en situaciones especiales. Ventilación mecánica neonatal.

Severe respiratory failure is a common problem in premature neonates. We review the various ventilation modes available in the neonatal intensive care unit, as well as their indications, settings, and complications.

Paro cardiorrespiratorio relacionado con examen oftalmológico en prematuros / Cardiorespiratory arrest after retinopathy of prematurity screening

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[Biliary lithiasis in childhood: apropos of 10 cases]. / Litiasis biliar en el niño: a propósito de 10 casos.

Ten cases of cholelithiasis in children are reviewed. Mean age was seven years. Abdominal pain was the main symptom leading to diagnosis. In all the cases, the diagnosis was made by ultrasonography. Risk factors were found in two cases. Surgical treatment was performed in four cases.

[Hemodynamic course in relation to mechanical ventilation in the postoperative period of extracorporeal surgery in children]. / Evolución hemodinámica en relación con la ventilación mecánica durante el postoperatorio de cirugía extracorpórea en niños.

Hemodynamic evolution and its relationship with the factors that have an effect upon gaseous exchange, during the early phase after extracorporeal circulation in sixty nine children, are reviewed. They are divided into three groups: group I (APH), arterial pulmonary hypertension; group II (OF), overflow, and group III (C), control. Results in the three phases of mechanical ventilation (IPPV, IMV and CPAP), are compared. We found that only in group I (APH), the pulmonary mechanics was altered. The programmed hyperventilation (IPPV) in group III (C), underlie the results of correlation between ventilatory and hemodynamic parameters with the oxygenation. There are high pulmonary vascular resistance in group I (APH); this explains the positive correlation between diastolic pulmonary arterial pressure and cardiac output. There are a good right ventricle function in I (APH) and III (C) groups. The hemodynamic patterns in IPPV are not depending on the pulmonary state.