Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study.

BACKGROUND: Acute respiratory infections are the leading cause of mortality in children worldwide, especially in developing countries. Pneumonia accounts for 16% of all deaths of children under 5 years of age and was the cause of death of 935000 children in 2015. Despite its frequency and severity, information regarding its etiology is limited. The aim of this study was to identify respiratory viruses associated with community-acquired pneumonia (CAP) in children younger than 5 years old. METHODS: One thousand four hundred and four children younger than 5 years of age with a clinical and/or radiological diagnosis of CAP in 11 hospitals in Mexico were included. Nasal washes were collected, placed in viral medium, and frozen at -70°C until processing. The first 832 samples were processed using the multiplex Bio-Plex/Luminex system and the remaining 572 samples using the Anyplex multiplex RT-PCR. Clinical data regarding diagnosis, clinical signs and symptoms, radiographic pattern, and risk factors were obtained and recorded. RESULTS: Of the samples tested, 81.6% were positive for viruses. Respiratory syncytial virus (types A and B) was found in 23.7%, human enterovirus/rhinovirus in 16.6%, metapneumovirus in 5.7%, parainfluenza virus (types 1-4) in 5.5%, influenza virus (types A and B) in 3.6%, adenovirus in 2.2%, coronavirus (NL63, OC43, 229E, and HKU1) in 2.2%, and bocavirus in 0.4%. Co-infection with two or more viruses was present in 22.1%; 18.4% of the samples were negative. Using biomass for cooking, daycare attendance, absence of breastfeeding, and co-infections were found to be statistically significant risk factors for the presence of severe pneumonia. CONCLUSIONS: Respiratory syncytial virus (types A and B), human enterovirus/rhinovirus, and metapneumovirus were the respiratory viruses identified most frequently in children younger than 5 years old with CAP. Co-infection was present in an important proportion of the children.

Normocaloric diet improves asthma-related quality of life in obese pubertal adolescents.

BACKGROUND: Restrictive, very low-energy diets focused on rapid weight loss have proven to be effective in improving asthma outcome in obese patients, but their use in children and pubescents is controversial due its potential consequences in growth. More conservative, normocaloric schemes are suggested as a more suitable dietary approach for these patients. METHODS: A randomized clinical trial was run of 51 pubertal adolescents with asthma and obesity, who were allocated to either an interventional 28-week program of normocaloric diet based on normal requirements for height and meal planning (n = 26) or a non-interventional (free diet) control group (n = 25). Asthma-related quality of life (AR-QOL, assessed by the Standardized Pediatric Asthma Quality of Life Questionnaire, PAQLQ[S]) and clinical indicators of asthma control were measured before and after the intervention period. RESULTS: Diet intervention was associated with a significant improvement in AR-QOL in relation to baseline (Δ PAQLQ[S] scores) compared with controls, both in overall score (p < 0.001) and its subdomains (activity limitation, p < 0.001; symptoms, p < 0.002; emotional function, p < 0.001). The group with normocaloric diet observed a significant decrease in body mass index z-score, which correlated positively with the improvement in AR-QOL (Spearman's r = 0.51, p < 0.01), in addition to have significantly fewer events of acute attacks of asthma and nighttime awakenings, plus a non-significant reduction in the use of inhaled corticosteroids. No significant changes were observed in the pulmonary function tests. CONCLUSION: The normocaloric dietary intervention was associated with improvement of AR-QOL and some aspects of asthma control. Such structured dietary programs could probably have a role as a complementary non-pharmacological therapeutic strategy in obese pubertal adolescents with asthma.

[Adverse events in patients from a pediatric hospital.] / Eventos adversos en pacientes de un hospital pediátrico.

Background: detection of adverse events is part of the safety management in hospitalized patients. The objective of this study was to describe the incidence of adverse events that occurred in a pediatric hospital. Methods: cross-sectional study of the adverse events occurred in a pediatric hospital from 2007 to 2009. Factors associated with their developmental causes were identified. The statistical analysis was descriptive and bivariate, with contingency tables to estimate the relationship between those factors. A p value = 0.05 was considered significant. Results: a total of 177 adverse events were registered. When they began, human factor occurred in 23 cases (13 %, OR = 1.41, p = 0.001), organizational factor was present in 71 cases (40 %, OR = 1.91, p = 0.236) and technical factor in 46 cases (26 %, OR = 0.87, p = 0.01). Blows or bruises from falls as a result of adverse events occurred in 71 cases (40 %, 95 % CI = 64-78). Conclusions: we found 1.84 events per 100 hospital discharges during the study period. The fall of patients ranked first of the adverse events identified.

Introducción: la detección de los eventos adversos es parte de la gestión de la seguridad en los pacientes hospitalizados. El objetivo de este estudio fue describir la incidencia de los eventos adversos ocurridos en un hospital de pediatría del Instituto Mexicano del Seguro Social entre 2007 y 2009. Métodos: estudio transversal analítico de los eventos adversos ocurridos en pacientes pediátricos. El análisis estadístico fue descriptivo y bivariado, con tablas de contingencia para estimar la relación entre los factores. Un valor de p = 0.05 fue significativo. Resultados: se identificaron 177 eventos adversos en el periodo de estudio. En su génesis, el factor humano se relacionó en 23 casos (13 %, RM = 1.41, p = 0.001), el factor organizacional en 71 (40 %, RM = 1.91, p = 0.236) y el factor técnico en 46 (26 %, RM = 0.87, p = 0.01). Las contusiones como consecuencia de las caídas se presentaron en 71 pacientes (40 %, IC 95 % = 64-78). Conclusiones: encontramos 1.84 eventos por cada 100 egresos hospitalarios durante el periodo de estudio. La caída ocupó el primer lugar de los eventos adversos identificados.

La investigación sobre calidad de la atención en el Instituto Mexicano del Seguro Social: estudio bibliométrico / Research on quality of health care from the Mexican Social Security Institute: a bibliometric study

Objetivo. Identificar las investigaciones sobre calidad de la atención en el IMSS. Material y métodos. Estudio bibliométrico, transversal, retrospectivo y descriptivo, sobre las publicaciones del IMSS de 1992 a 2011. Resultados. Se identificaron 881 investigaciones sobre calidad de la atención (11% IC95% 10.6-12.0) de 7 762 trabajos. Se publicaron 946 artículos (8.9% IC95% 8.4-9.5) relacionados con la calidad. Conclusiones. Se identificó interés en realizar investigación sobre calidad del servicio. Habrá que establecer cuál ha sido el impacto en la mejora de la atención, y su contribución a la toma de decisiones en materia de salud.

Objective. To identify studies on quality of health care in the IMSS. Materials and methods. A bibliometric, descriptive cross-sectional and retrospective study was conducted, from 1992 to 2011. Results. We identified 881 research studies related to the issue of quality (CI95% 10.6-12.0) of 7 762 studies presented at the annual research meetings. 10 521 articles were published in this period of time and only 946 (CI95% 8.4-9.5) were linked to the issue of quality. Conclusions. The results of this study allowed us to identify the interest about research on quality. Further research is needed to establish what has been the impact on the improvement of quality in health care.

[Research on quality of health care from the Mexican Social Security Institute: a bibliometric study]. / La investigación sobre calidad de la atención en el Instituto Mexicano del Seguro Social: estudio bibliométrico.

OBJECTIVE. To identify studies on quality of health care in the IMSS. MATERIALS AND METHODS. A bibliometric, descriptive cross-sectional and retrospective study was conducted, from 1992 to 2011. RESULTS. We identified 881 research studies related to the issue of quality (CI95% 10.6-12.0) of 7 762 studies presented at the annual research meetings. 10 521 articles were published in this period of time and only 946 (CI95% 8.4-9.5) were linked to the issue of quality. CONCLUSIONS. The results of this study allowed us to identify the interest about research on quality. Further research is needed to establish what has been the impact on the improvement of quality in health care.

Abordaje epidemiológico de un brote de trastorno conversivo epidémico en adolescentes

resumen está disponible en el texto completo

Abstract: Introduction Several outbreaks of Epidemic Conversión Disorder are occurring in different groups of people in the world. Rather than being viewed as a number of people suffering from individual conversion disorder, epidemic hysteria is considered as a social phenomenon involving otherwise healthy people. We received a report letter from Dirección General de Epidemiología, about the existence of a large number of possible food poisoning cases among students, attending morning sessions at a technical high school, located in the downtown area of Mexico City. Twelve students were driven to the Mexican Red Cross Hospital due to fainting. The aims of this study were to determine the cause of such outbreak in a group of adolescents; to get an adequate explanation about the origin of the event; to identify the event dissemination ways and associates risk factors. Methods Study design: A matched case-control study was carried out to identify factors associated with the illness. Two control cases were randomly selected from the list of nonill students for each case. Fifty two cases and 104 controls were included. Hypotheses: Following the good health status determined by the physician at the hospital, we started the initial interview with the students. We reached the following possible hypotheses regarding the origin of this outbreak: first, the event was due to food poisoning; second, to the inhalation of a toxic gas such as carbon monoxide and thirdly, by exposure to high levels of contaminants. Finnaly, it might be a mass event of conversion disorder. Variables: Among the variables included in the study were: sex, age, class group, location of the student at the time of the out-break, and foods eaten during recess and immediately before the outbreak. All the students present at the time of the outbreak were interviewed using a standard questionnaire. Laboratory Simultaneously, samples of the food-products sold in and around the school that day were collected for bacteriologic and chemical analyses, the existence of a gas leak, carbon monoxide source, or any other airborne pollutant was investigated by the research team. Analyses: The demographic characteristics were analyzed by descriptive statistic; association between risk factors as possible causes of the event was determined by multivariate analysis at 95% confidence interval. Results: The outbreak occurred in the building of a downtown public school in Mexico City. The school has three floors, surrounding a central yard. There are 11 classrooms, two laboratories, an art workshop and a school medical clinic. The total duration of outbreak was 15 minutes. There were 455 students enrolled in the morning program, all of them were interviewed. A total of 52 cases was identified, among the 455 students, for an attack rate of 11.4%. There were three groups in which no cases were found. The attack rate in girls was 3.9 times higher than in boys. Sixty five percent of the cases occurred in two of the nine classrooms (1° B and 2° A). All the students of one group had been waiting at the patio for over an hour during an interclass break. Case cero was a girl from this group with a previous history of fainting. The outbreak occurred outside class-room in the central yard. Five female classmates of case cero fainted while they were with her in the yard. Cases then spread rapidly to the first floor with an attack rate of 13.2 percent, the second floor had 7.7 percent, and finally the third floor had 2.1 percent. All cases had fainted as per case definition. Additionally, headache was a prominent symptom occurring in 88 percent, paresthesias in 56 percent, and perceived difficulty in moving arms or legs in 35 percent. Also almost a quarter of the cases complained of irritation of the eyes and nose. Within one hour, all had completely recovered. Five days after the problem, three girls fainted; no outbreak occurred. Being a girl or belonging to class groups 1°B or 2°A, were the most significant risk factors, with (p 0.001). Also being less than 15 years of age was a significant risk factor for illness. The analysis of food preference data in the cases and controls showed that drinking a fruit beverage "X" was not related to the illness. Foods such as sandwiches, brought from home and cookies, candies and popcorn bought from street venders, had a borderline significant association with the illness. However, the number of cases attributable to these foods was very low. Also, it was difficult to figure out how sandwiches were prepared by mothers of individual students and how this factor could be implicated. No pathogen toxin or toxic chemical were identified in the food samples. Some foods studied in the crude analysis were ruled out in the multivariate analysis. A thorough environmental was negative, there being no evidence of a continuing gas leak or other causes. The pollution levels during that week were reported as being within the normal range, by the Metropolitan Index of Air Quality (IMECA). In order to evaluate psychological factors, individual interviews were carried out. The psychologist found that the cases tended to have one or both parents absent from home due to divorce or death, and their family have been damaged by eco-nomic problems. In addition, psychological testing showed that these cases had higher anxiety levels than controls. Discussion According to our findings, this outbreak appears as a Epidemic Conversion Disorder. First, no biologic cause was found for the cases. In addition, there was not any evidence to implicate food poisoning, no source of toxic gas could be identified at the school, and the levels of air pollution were not above normal levels. The clinical presentation was not different from the fainting and paresthesia reported in others studies, nor was sex distribution. One possible explanation for the initial case was the time of sun exposure in the schoolyard. Subsequent spread of the outbreak was due to psychological and extra-medical factors, including publicity by the mass media. Interestingly the spread was stopped immediately after closure of the school for one day. All the findings of the psychological reports, applied by another researcher group add further weight to this conclusion. In support to our results, many studies has been reported in which the clinical manifestations are the same that we found. In these reports, the outbreak occurred frequently among women, teenagers, students of elementary and secondary schools and chorus, in whom no organic etiology or precipitant causes can be identified. Some authors have reported that the phenomena is more evident in groups with hormonal changes, rigid discipline used in music bands, and during periods of exams or situations under stress. Such circumstances are more related to the outbreak. Some studies have demonstrated that dysfunctional families, divorced or dead parents, play a mayor role in comparison with other factors such as socioeconomic level, religion or ethnicity. The mechanisms of these events have not been clearly identified. The typical course of a psychogenic epidemic at a workplace progresses from sudden onset, often with dramatic symptoms, to a rapidly attained peak that draws much publicity and is followed by quick disappearance of the symptoms. Over 90% of the affected people are women, and the signs range from dizziness, vomiting, nausea, and fainting to epileptic type seizures, and hyperventilation. Predisposing factors include boredom, physical stressors, poor labor-management relations, impaired interpersonal communications and lack of social support. The rapid spread in the conversion disorder, is by visual contact; the treatment should be directed towards the underlying stressors but the out-break may be prolonged. In Epidemic Conversion Disorder the abnormality is confined to group interactions. This outbreak shows the importance of psychological support in populations with risk factors of presenting the illness. The social problems among large populations produce an unforgettable painful experience, mainly among teenagers who dealt with the psychological damage with-out any support.

Consistencia y validez en la evaluación del expediente clínico / Consistence and validity in clinical record evaluation

Objetivo: investigar el grado de consistencia y validez que posee el instrumento EXP-CLIN, utilizado para medir la calidad de la información contenida en los expedientes. Material y método: se llevó a cabo una encuesta transversal comparativa, en donde se incluyeron al azar, 212 expedientes clínicos de pacientes atendidos en un hospital de pediatría de tercer nivel. Dichos expedientes fueron evaluados con el instrumento EXP-CLIN, en tres fases: 1ª.) antes de aplicar el EXP-CLIN en los expedientes, éste se sometió a revisión por un grupo de médicos provenientes de otros hospitales, para saber si encontraban algún error en dicho instrumento, 2ª.) evaluación interna por personal perteneciente al mismo hospital donde se realizó el estudio, y 3ª.) evaluación externa realizada por personal de otros hospitales. Los resultados fueron analizados a través del método de concordancia ponderada. Resultados: los porcentajes de concordancia ponderada se encontraron por arriba del 76 por ciento, para las notas de historia clínica, notas médicas relacionadas con el proceso diagnóstico - terapéutico, así como para las características 'generales del expediente clínico. El promedio de los porcentajes de concordancia ponderada fue de 88 por ciento, lo cual apoya la idea de que cuando el instrumento EXP-CLIN se aplica en dos ocasiones al mismo expediente, se obtiene buena concordancia entre las dos mediciones obtenidas. Conclusiones: dado que la aplicación del instrumento documentó un buen nivel de consistencia externa, se justifica continuar con su uso como instrumento de evaluación de la calidad de la información contenida en los expedientes clínicos.

Farmca: programa diseñado para vigilar la prescripción de antimicrobianos en hospitales / Farmac: program desinged for keeping watch on the prescription of antimicrobians in hospitals

Introducción: la aplicación de programas de computación para vigilar la prescripción de antimicrobianos en hospitales, se fundamenta en la incorporación de bases electrónicas de datos, creadas y alimentadas por diversos comités como el de infecciones intrahospitalarias y calidad de la atención médica o, departamentos como patología, farmacia, microbiología, radiología o administración.Objetivo: describir el desarrollo y aplicación de un "sistema de información" utilizado para la vigilancia de la prescripción de antimicrobianos controlados en área de hospitalización.Material y métodos: se diseñó un formato impreso mediante el cual los médicos solicitaran la autorización de antimicrobianos restringidos y controlados por el Departamento de infectología (incluyendo cefalosporinas de tercera generación y otros beta lactámicos nuevos, antivirales, antimicóticos, fluoroquinolonas, etc.) Se diseñó el sistema de cómputo FARMAC, tomando como plataforma el programa Dbase IV. Este sistema contempla la presentación en pantalla, en donde se observa un menú principal, que permite utilizar las siguientes opciones de trabajo: altas, cambios, consultas, bajas, exportar, reportes y salida. Los reportes se generan desde el menú y aparecen en pantalla o, son impresos en cuadros y figuras representativas. De forma general, el sistema procesa información sobre el uso de antimicrobianos, mantiene archivos, permite la consulta de la información y produce reportes, de forma ágil y rápida. Resultados: se definieron las presentaciones en pantalla, tomando en cuenta el espacio de la misma, para evitar así, una mala distribución de los mensajes y, con esto tener una imagen más aceptable. Se elaboró la base de datos, definiendo los campos que se utilizarían para almacenar la información referente a los pacientes y al control de antimicrobianos. Discusión: el desarrollo de un sistema de información y vigilancia sobre la prescripción de antimicrobianos permite contar con datos actualizados facilitando el análisis de la información, para la posterior toma de decisiones. Su implantación permite vigilar tendencias y patrones de uso de antimicrobianos bajo control o sin el mismo y fomentar el uso racional de antimicóticos.

Vigilancia y costos relacionados con la prescripción de antimicrobianos en un hospital pediátrico / Vigilance and costs related with the prescription of antimicrobians in a pediatric hospital

Introducción. En la práctica médica, la selección de antimicrobianos, debe de incluir consideraciones sobre su indicación, eficacia, toxicidad y costos. Sin embargo, se ha observado que hasta 50 por ciento de las prescripciones de estos fármacos son inapropiados. Objetivo. Conocer el patrón de prescripción y los costos de fármacos antimicrobianos, bajo control de prescripción por el servicio de infectología en un hospital pediátrico, mediante la utilización de un programa de cómputo para la vigilancia de fármacos diseñados por los investigadores. Material y métodos. Mediante una encuesta longitudinal descriptiva y prolectiva, a lo largo de un año, se capturo toda la información sobre consumo y costos de antibióticos, tomando en cuenta el expediente clínico y los registros de farmacia en la que se incluyeron todos los pacientes que requirieron tratamiento anti-microbiano durante su internamiento. Resultados. Un total de 748 pacientes recibieron la prescripción de al menos un antimicrobiano bajo control, correspondiendo esto a 9.6 por ciento del total de pacientes ingresados y 63.4 por ciento del gasto en antibióticos en el hospital donde se realizó el estudio. Conclusiones. La evaluación de costos es de utilidad para detectar tendencia en el consumo y patrón de prescripción de antimicrobiano, es además barato y rápido cuando se cuenta con un registro computarizado en la farmacia

Improved serological response to human diploid cell rabies vaccine when given simultaneously with antirabies hyperimmune globulin

Background. The prevention of rabies in Mexico continues to be an importan goal for the health sector. Although the prevalence of this disease continues to fall, between 1990 and 1995 a total of 238 cases were registred (an average of 40 cases annually), with a mean annual incidence of 0.04 cases per 100,000 inhabitants and a mortality of almost 100 percent, so that it is important to rely on highly effective vaccines with few side effects. The objective of this work was to evaluate seroconversion and tolerance to the human diploid cell antirabies vaccine administered to individuals with a history of exposure to rabies, to compare these results with those reported in the literature for the Fuenzalida vaccine, a rabies vaccine produced in the brain tissues of suckling mice, and to find the role antirabies hyperimmune gamma globulin plays in the concentration of post-vaccination antibody concentrations. Methods. An analytical transverse study was carried out in 40 children and adults with a history of rabies exposure who were given a complete, five-dose intramuscular schedule of the human diploid cell rabies vaccine. Subjects were followed daily, and local and systemic signs and symptoms were recorded. Two blood samples (at baseline-and at the end of the ELISA technique, were measured. Results. Adverse side effects produced by the human diploid cell antirabies vaccine, such as frequency of pain, erythema itching, and regional adenopathy were fewer than those reported in the literature for the Fuenzalida vaccine (p < 0.05), and of induration and local pain (p <0.05) in relation to the latter vaccine. All patients seroconverted, producing geometric mean antibody titers of 6.22 IU/mL, an arithmetic mean titer of 9.66 IU/mL with a SD of 9.1 IU/mL. The level of tolerance to the diploid cell vaccine was good and its adverse effects were minimal and fewer than those reported for the Fuenzalida rabies vaccine. Patients receiving the diploid cell vaccine plus antirabies hyperimmune gamma globulin developed higher antibody titers (measured by ELISA test) at the end of the vaccination schedule than those only receiving the vaccine. Conclusions. These results are important in order to achieve an adequate and opportune level of protection provided by prophylactic vaccine to patients with exposure to rabies

Malnutrition in Childhood lymphoblastic leukemia: A predictor of Early mortality during the induction-to-remission phase of the treatment

Background. Previous reports have shown that undernourished children with acute lymphoblastic leukemia (ALL) have a poorer long-term survival as compared withchildren with normal nourishment status. It has been shown that both the relapse and mortality rates of undernourished children with ALL are higher during the continuation phase of the chemotherapy and are apparently related to a poor tolerance of ablative chemotherapy. No previous artichles have analyzed the aerly mortality rate of these patients. Methods. We carried out a case-control study, and have studied the effect of severe malnutrition on the mortality of 17 children with ALL during the initial induction-to-remission phase of the treatment. These 17 cases were compared with 76 controls who had survived at least the phases of induction and consolidation. Results. It was found that the chance of dying during the initial phase of the treatment was 2.6 times higher (confidence interval 95 percent: 0.55-11.89) in undernourished children with ALL than in those children with normal nourishment status. The risk of death increades with the severity of undernorisment (p= 0.04). Conclusions. These data confirm the prognostic value of malnutrition in children with ALL and suggest that undernourishment may also influence aerly mortality during the induction-to-remission phase of the treatment

Costos secundarios por infecciones nosocomiales en dos unidades pediátricas de cuidados intensivos / Secondary costs due to nosocomial infections in two pediatric intensive care units

Objetivo. Estimar los costos asociados a infecciones nosocomiales en niños tratados en dos unidades de terapia intensiva. Material y métodos. Se realizó un estudio parcial de costos en la Unidad de Cuidados Intensivos Neonatales (UCIN) y en la Unidad de Cuidados Intensivos Pediátricos (UTIP) de un hospital infantil de tercer nivel de atención médica. Se investigaron los costos de las pruebas diagnósticas y de los recursos terapéuticos empleados, así como el exceso de estancia hospitalaria debida a la presencia de una infección nosocomial. Resultados. Se detectaron 102 infecciones, 46 en UCIN y 56 en UTIP, en el lapso de un año, tiempo que duró el estudio. El costo promedio por infección fue de 91 698 pesos y el gasto global fue de 9.3 millones de pesos. Neumonía, flebitis y septicemia abarcaron 65 por ciento de los costos. En los niños infectados se registró una estancia hospitalaria extra de 9.6 días, 13.7 exámenes de laboratorio y 3.3 cultivos en promedio, debido a la presencia de una infección intrahospitalaria. La estancia hospitalaria representó 97 por ciento del gasto total. Conclusiones. Esta evaluación representa una estimación de costos directos de infección. Los resultados justifican el establecimiento de programas preventivos agresivos para reducir las complicaciones dentro de los hospitales

Las infecciones nosocomiales y la calidad de la atención médica / The nosocomial infections and the quality of medical care

El obejtivo más importante de un programa de control de calidad en hospitales es reducir el riesgo de adquirir una infección, la morbilidad y los costos asociados. Es indispensable la organización de un equipo con liderazgo técnico y humanístico que permita: a) identificar los problemas, b) determinar la importancia de cada uno de ellos, c) encontrar sus causas d) proponer soluciones y e) evaluar continuamente todo el programa. El desarrollo de estas cualidades técnicas y humanísticas por parte del líder y los miembros del programa, así como el uso continuo de las herramientas mencionadas, han producido el único programa validado y altamente efectivo de control de calidad en los hospitales

Defunciones inesperadas en un hospital pediátrico / Mortality in a pediatrics hospital. Some considerations about unexpected deaths

Objetivo: conocer algunas características hospitalarias e identificar su asociación con las defunciones calificadas como inesperadas. Material y métodos: se trata a un estudio transversal en el que fueron evaluados los expedientes de las defunciones ocurridas entre 1994 y 1995 en un hospital pediátrico de tercer nivel, sin distinción del sexo, edad o enfermedad del paciente. Una vez valoradas, las defunciones fueron calificadas como esperadas, inesperadas o súbitas por el Subcomité de Mortalidad del hospital. El análisis se realizó con medidas de frecuencia y estimación de pruebas de hipótesis para muestras independientes con intervalo de confianza de 95 por ciento (IC 95 por ciento). Resultados: se estudiaron 411 defunciones evaluadas por el Subcomité de Mortalidad, que representaron 79.5 por ciento del total. De acuerdo con la evolución del padecimiento, 67.6 por ciento fue calificado como defunción esperada a corto plazo, 11.9 por ciento como esperada a largo plazo, 15.6 por ciento inesperada y 4.9 por ciento súbita. Los pacientes evaluados como estables al ingreso tuvieron mayor frecuencia de defunciones inesperadas que los muy graves (OR = 8.4, IC 95 por ciento = 3.9-18). La identificación de problemas en el diagnóstico (OR = 2.3, IC 95 por ciento 1.3-3.8) y en el tratamiento (OR = 3.8, IC 95 por ciento = 2.3-6.2) fueron variables que presentaron diferencias significativas. Conclusiones: la evaluación de las condiciones en que se presentaron las defunciones respecto a la atención hospitalaria permite tomar medidas que pueden prevenir problemas en la atención médica futura

Cytomegalovirus infection in children: frequency, anatomopathologic characteristics and underlying risk factors in 1618 autopsies

The aim of this study was to determine the frequency of cytomegalovirus (CMV) infection in children with postmortem study. The records of 1618 autopsies performed during 1980 - 1989 at the Hospital Infantil de Mexico Federico Gomez were reviewed. Characteristic cytomegalovirus inclusion bodies were identified, in one or several organs, in 47 cases (2.9 per cent of the autopsies). None of these cases was cultured for viruses prior to ar at the time of autopsy. Of the 47 cases, 24 (51 per cent) with CMV were younger than 3 months of age. In eight cases, the infection was juged as generalized and considered the cause of death. Two of these patients were premature and the infection was most probably intrauterine. The risk factor most frequently identified was secondary immunosuppression. The lung was the most common affected organ, followed by kidney, adrenals, pancreas, liver, brain and salivary glands. In seven cases the inclusion bodies were seen in the brain and in three others periventricular calcifications without inclusion bodies were observed. Although not a rarity in Mexico, CMV infection is not often suspected. Additional studies are needed in order to determine the prevalence of CMV infection in Mexico

El trabajador de salud y la consejería sobre el VIH y SIDA / The health care workers and the counseling about HIV and AIDS

En México, en diciembre de 1993, había más de 17 000 casos de SIDA declarados. Sin embargo, ciertas estimaciones indican que aproximadamente 100 000 individuos están infectados con el VIH. El ser seropositivo al VIH o padecer el SIDA, implica una gran carga emocional, por lo que apoyo psicosocial es crucial en este tipo de pacientes. En este documento se subraya la importancia de la consejería en el trabajo clínico y de salud pública en la batalla contra la epidemia de VIH y SIDA. Se presenta en forma resumida la experiencia sobre técnicas de consejería en la formación de 89 trabajadores de la salud (TDS), y se muestra la efectividad de la intervención educativa. Entre los hallazgos destaca el descubrimiento de actitudes homofóbicas entre estos profesionales, particularmente aquéllos sin experiencia previa en el manejo de pacientes infectados por el VIH. En el estudio se identificaron las necesidades educativas de los TDS. El número de casos estimados de infección por VIH y la tendencia de la epidemia ponen de manifiesto la necesidad de entrenamiento en consejería médica sobre VIH, pues más de 73 000 médicos en México habrán de enfrentar este problema en un futuro no muy lejano

By December 1993, more than 17 000 AIDS cases had been reported in Mexico and some estimates indicate approximately 100 000 individuals currently infected with HIV. From the patient's perspective, being HIV positive or having AIDS, places an enormous burden on psychosocial coping mechanisms. Thus, psychosocial support is required for all of these patients. This paper summarizes our educational intervention on counseling techniques and provides information of our demonstration project on the effectiveness of the educational intervention among 89 Mexican health care workers. Overall, these professionals showed improvement in their knowledge and goals of providing counseling. One of the more striking was the discovery of homophobic attitudes among them, particularly those with no previous experience in the care of HIV infected people. This exploratory study allowed us to identify research and educational needs of health care workers. The overwhelming number of estimated cases of HIV infections and the current trends of the epidemic reveal the necessity for training in medical counseling that over 73 000 physicians in Mexico will face in the immediate future.

El tamaño de muestra: un enfoque práctico en la investigación clínica pediátrica / Sample size: a practical viewpoint in pediatric clinical research

El obejtivo del presente artículo es proporcionar al médico las bases conceptuales y prácticas que le permitan calcular el tamaño de muestra en estudios clínicos. Se presentan las definiciones de los diferentes diseños clínicos, incidencia, prevalencia, error tipo I y II, riesgo relativo y razón de momios. Se desarrolla la respuesta a 4 preguntas: 1) ¿Cuando es necesario calcular un tamaño de muestra?, 2) ¿Qué significa la representatividad de una muestra?. 3) ¿Cuál es el tamaño de muestra mínimo que se necesita para probar una determinada hipótesis?, y 4) ¿Cómo saber si el tamaño de muestra que ya se obtuvo era suficiente para el propósito del estudio? Se presentan también las fórmulas para el cálculo del tamaño de la muestra para los ensayos clínicos aleatorizados, estudios de cohortes, casos y controles y transversales. Finalmente se muestra la utilidad de calcular el poder de la muestra cuando se ha terminado un estudio y no se encontró una asociación estadísticamente significativa

Deficiencia de vitamina A: frecuencia y características clínicas en dos poblaciones del Estado de Chiapas / Deficiency of vitamina A: frequency and clinic characteristics in two populations in Chiapas

Introducción. La deficiencia de vitamina A ha sido bien reconocida como un problema de salud pública en el mundo. Existen pocos estudios en nuestro país acerca de la seroprevalencia de deficiencia de esta vitamina. Los objetivos de este estudio fueron: a) determinar la prevalencia de deficiencia de vitamina A en niños menores de cinco años de edad, de dos poblaciones chiapanecas, b) establecer que relación existe entre los niveles séricos de retinol con signos clínicos de deficiencia de vitamina A, estado nutricional (de acuerdo a peso y talla) e historia de hábitos nutricionales. Material y métodos. Se realizó un estudio transversal en dos en dos poblaciones, una rural y otra urbana del estado de Chiapas. El cuestionario de recolección de datos incluyó: datos antropométricos del niño, evaluación clínica de éstos y los resultados de la serología sobre retinol. Se contempló la posibilidad de administrar vitamina A (200,000 UI por dosis) a todos aquellos niños que mostraran deficiencia. Resultados. La prevalencia de hipovitaminosis A en la población estudiada fue del 25 por ciento. No existieron nihiperqueratosis ni xeroftalmia. Los datos sobre el estado nutricional revelaron la presencia de una desnutrición leve a moderada en ambas poblaciones. Conclusiones. El cálculo de la ingesta de retinol contenido en la dieta diaria, mostró una ingesta muy baja de este último, todo lo cual hace suponer que los hábitos dietéticos inadecuados pudieran ser la principal causa de la deficiencia de vitamina; por lo tanto los programas de educación nutricional son muy importantes en estas poblaciones

Estudio epidemiológico de un brote de tosferina en Rincón Grande, Veracrúz / Outbreak of whooping cough in Rincon Grande, Veracruz

En febrero de 1988 se presentó un brote de tosferina en el poblado de Rincón Grande, Veracruz. Los ojtetivos del estudio fueron: conocer la etiología de la infección respiratoria, realizar una encuesta de cobertura de vacunación en la población, identificar el agente etiológico involucrado y las características epidemiológicas principales del brote. Se realizó un estudio descriptivo de casos con base poblacional y un estudio de casos y controles para identificar factores de riesgo aosciados a la enfermedad. Se detectaron 85 casos, locual dio unat asa de ataque de 18.4 por 100 habitantes. El grupo de edad más afectado fue el de 7 a ll meses, con una tasa de ataque del 85%. La tasa de ataque secundario fue mayor a nivel intrafamiliar que en la escuela. La principal sintomatología fue: tos paroxística, fiebre, estridor, epistaxis y hemorragia conjuntival. Entre las complicaciones se encontraron: neumonía, hemotímpano y deshidratación. La letalidad fue del 1.2% y la mortalidad del 0.2%. Se presentó leucocitosis y linfocitosis en el 84% de los enfermos. Se realizaron determinaciones séricas de niveles de anticuerpos contra Bordetella pertussis, encontrándose títulos elevados en el 60% de las muestras pareadas. EN el 14% de los pacientes hubo evidencia serológica de asociación con infeción por adenovirus. El estudio de casos y controles reveló que el vonvivir 10 personas o más en la misma habitción y el tener uncontacto intrafamiliar representaron un mayor riesgo para adquirir la enfermedad (R.M!=21) (P<0.05). La encuesta reveló una cobertura del 6% en la localidad.