Pressure-controlled microfluidics for automated single-molecule sample preparation.

Sample preparation is a crucial step in single-molecule experiments and involves passivating the microfluidic sample chamber, immobilizing the molecules, and setting experimental buffer conditions. The efficiency of the experiment depends on the quality and speed of sample preparation, which is often performed manually and relies on the experience of the experimenter. This can result in inefficient use of single-molecule samples and time, especially for high-throughput applications. To address this, a pressure-controlled microfluidic system is proposed to automate single-molecule sample preparation. The hardware is based on microfluidic components from ElveFlow and is designed to be cost-effective and adaptable to various microscopy applications. The system includes a reservoir pressure adapter and a reservoir holder designed for additive manufacturing. Two flow chamber designs Ibidi µ-slide and Grace Bio-Labs HybriWell chamber are characterized, and the flow characteristics of the liquid at different volume flow rates V˙ are simulated using CFD-simulations and compared to experimental and theoretical values. The goal of this work is to establish a straightforward and robust system for single-molecule sample preparation that can increase the efficiency of experiments and reduce the bottleneck of manual sample preparation, particularly for high-throughput applications.

Long-term cardiology outcomes in children after early treatment for Chagas disease, an observational study.

BACKGROUND: Parasite persistence after acute infection with Trypanosoma cruzi is an important factor in the development of Chagas disease (CD) cardiomyopathy. Few studies have investigated the clinical effectiveness of CD treatment through the evaluation of cardiological events by long term follow-up of treated children. Cardiological evaluation in children is challenging since features that would be diagnosed as abnormal in an adult's ECG may be normal, age-related findings in a pediatric ECG trace. The objective was to evaluate cardiac involvement in patients with Chagas disease with a minimum follow-up of 6 years post-treatment. METHODOLOGY: A descriptive study of a cohort of pediatric patients with CD treated with benznidazole (Bz) or nifurtimox (Nf) was conducted. Children (N = 234) with at least 6 years post CD treatment followed at the Parasitology and Chagas Service, Buenos Aires Children's Hospital (Argentina) were enrolled. By convenience sampling, children who attended a clinical visit between August 2015 and November 2019 were also invited to participate for additional cardiovascular studies like 24-hour Holter monitoring and speckle-tracking 2D echocardiogram (STE). Benznidazole was prescribed in 171 patients and nifurtimox in 63 patients. Baseline parasitemia data was available for 168/234 patients. During the follow-up period, alterations in routine ECG were observed in 11/234 (4.7%, 95% CI [2-7.4%]) patients. In only four patients, with complete right bundle branch block (cRBBB) and left anterior fascicular block (LAFB), ECG alterations were considered probably related to CD. During follow-up, 129/130 (99%) treated patients achieved persistent negative parasitemia by qPCR. Also decrease in T.cruzi antibodies titers was observed in all patients and negative seroconversion occurred in 123/234 (52%) patients. CONCLUSIONS: A low incidence of cardiological lesions related to CD was observed in patients treated early for pediatric CD. This suggests a protective effect of parasiticidal treatment on the development of cardiological lesions and highlights the importance of early treatment of infected children. TRIAL REGISTRATION: ClinicalTrials.gov NCT04090489.

Utilización de medicinas tradicionales en la población que asiste a un hospital pediátrico de la Ciudad Autónoma de Buenos Aires / Use of traditional medicine in the population attending a children's hospital in the City of Buenos Aires

Introducción. Existen estudios que dan cuenta del uso extendido de la medicina tradicional (MT) en diversos países. La formación del pediatra es escasa en este campo. Objetivo. Describir las características de la MT utilizada por los pacientes de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Población y métodos. Diseño cualitativo, basado en la teoría fundada. Entrevista a cuidadores de niños de 0 a 11 años. Resultados. Se entrevistaron 30 personas de diferentes colectividades, la gran mayoría mujeres amas de casa. Casi la totalidad refirió haber utilizado la MT. La fuente de recomendación más utilizada fue la familia. En general, el uso de la MT precede a la consulta a un médico del sistema de salud. Se acude a la MT por entidades definidas por la medicina convencional, pero también por otras propias, como pata de cabra, ojeo y empacho. Las prácticas terapéuticas incluyen la administración de preparados a base de plantas, infusiones, caldos, como también rituales conducidos por curanderos. Todos los usuarios refirieron una valoración positiva de la MT. Una gran parte de los entrevistados consideró importante que el médico conozca y pregunte sobre ella. Todos refirieron que su uso no fue abordado en consultas previas. Conclusiones. La MT se extiende como conocimiento y/o práctica en toda la población estudiada y forma parte de su vida cotidiana. Los métodos utilizados son muy diversos, así como las situaciones para las que se utiliza; las principales causas son de origen gastrointestinal y respiratoria. No es abordada en la consulta pediátrica, pero sus usuarios desearían que lo fuera.

Introduction. Several studies have reported on the widespread use of traditional medicine (TM) in different countries. Pediatricians receive scarce training in this field. Objective. To describe the characteristics of TM used by patients attending a children's hospital in the City of Buenos Aires. Population and methods. Qualitative design based on grounded theory. Interview with caregivers of children aged 0-11 years. Results. Thirty people from different communities were interviewed, mostly homemakers. Almost all referred having used TM. The most common source of recommendation was the family. In general, TM use precedes the visit to a physician in the health system. TM is used to manage conditions defined by conventional medicine, but also to treat folk illnesses such as Simeon's disease, evil eye, and indigestion. Therapeutic practices include plant-based preparations, infusions, broths, as well as other rituals performed by folk healers. All users had a positive opinion about TM. Most interviewees considered that physicians should know and ask about TM. All participants referred that its use had not been addressed in prior visits. Conclusions. TM spreads as knowledge and/ or practice across the studied population and is part of everyday life. TM methods vary greatly, as well as the conditions for which it is used; the main reasons for use included gastrointestinal and respiratory conditions. It is not addressed in pediatric visits, but users wish it was.

Use of traditional medicine in the population attending a children's hospital in the City of Buenos Aires. / Utilización de medicinas tradicionales en la población que asiste a un hospital pediátrico de la Ciudad Autónoma de Buenos Aires.

INTRODUCTION: Several studies have reported on the widespread use of traditional medicine (TM) in different countries. Pediatricians receive scarce training in this field. OBJECTIVE: To describe the characteristics of TM used by patients attending a children's hospital in the City of Buenos Aires. POPULATION AND METHODS: Qualitative design based on grounded theory. Interview with caregivers of children aged 0-11 years. RESULTS: Thirty people from different communities were interviewed, mostly homemakers. Almost all referred having used TM. The most common source of recommendation was the family. In general, TM use precedes the visit to a physician in the health system. TM is used to manage conditions defined by conventional medicine, but also to treat folk illnesses such as Simeon's disease, evil eye, and indigestion. Therapeutic practices include plant-based preparations, infusions, broths, as well as other rituals performed by folk healers. All users had a positive opinion about TM. Most interviewees considered that physicians should know and ask about TM. All participants referred that its use had not been addressed in prior visits. CONCLUSIONS: TM spreads as knowledge and/ or practice across the studied population and is part of everyday life. TM methods vary greatly, as well as the conditions for which it is used; the main reasons for use included gastrointestinal and respiratory conditions. It is not addressed in pediatric visits, but users wish it was.

uso extendido de la medicina tradicional (MT) en diversos países. La formación del pediatra es escasa en este campo. OBJETIVO: Describir las características de la MT utilizada por los pacientes de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Población y métodos. Diseño cualitativo, basado en la teoría fundada. Entrevista a cuidadores de niños de 0 a 11 años. RESULTADOS: Se entrevistaron 30 personas de diferentes colectividades, la gran mayoría mujeres amas de casa. Casi la totalidad refirió haber utilizado la MT. La fuente de recomendación más utilizada fue la familia. En general, el uso de la MT precede a la consulta a un médico del sistema de salud. Se acude a la MT por entidades definidas por la medicina convencional, pero también por otras propias, como pata de cabra, ojeo y empacho. Las prácticas terapéuticas incluyen la administración de preparados a base de plantas, infusiones, caldos, como también rituales conducidos por curanderos. Todos los usuarios refirieron una valoración positiva de la MT. Una gran parte de los entrevistados consideró importante que el médico conozca y pregunte sobre ella. Todos refirieron que su uso no fue abordado en consultas previas. CONCLUSIONES: La MT se extiende como conocimiento y/o práctica en toda la población estudiada y forma parte de su vida cotidiana. Los métodos utilizados son muy diversos, así como las situaciones para las que se utiliza; las principales causas son de origen gastrointestinal y respiratoria. No es abordada en la consulta pediátrica, pero sus usuarios desearían que lo fuera.

Acquired Syphilis by Nonsexual Contact in Childhood.

BACKGROUND: Children may acquire syphilis by nonsexual contact as a consequence of close and repetitive contact with mucosal or skin lesions of people with active syphilis. METHODS: Prospective cohort study of pediatric patients with acquired syphilis by nonsexual contact. Demographics, clinical findings, posttreatment serology development and general laboratory data were collected. Sexual transmission was ruled out after a careful medical and psychosocial evaluation of the patient and his/her family. RESULTS: Twenty-four patients were included in the study. Mean age at diagnosis was 4.2 years old. All of them came from overcrowded households with poor hygiene conditions. The most frequent reason for consultations was secondary syphilis skin lesions (79.2%). The psychosocial evaluation of children and their families did not reveal signs of sexual abuse in any of the cases. Seventy-eight families and their cohabitants were evaluated, 23 (29.5%) resulted positive for rapid plasma reagin and treponemal test of hemagglutination; 60.9% of the cases were asymptomatic. The symptomatic relatives showed lesions of secondary syphilis. A sustained fall on nontreponemal antibodies titer (rapid plasma reagin) was observed after treatment, becoming negative in 6/24 (25%) cases within 12 months posttreatment. DISCUSSION: Following evaluation, it was considered that sexual abuse was unlikely. However, if examination and psychosocial evaluation do not support it, other ways of transmission must be considered. Overcrowded and poor household conditions boost the risks for nonsexual treponema transmission. An infected member of the family or a caretaker are a particular risk to an infant due to common practices such as using saliva to moisten the rubber nipples of the milk bottles or trying the food temperature using the lips before feeding the infants.

Congenital syphilis in Argentina: Experience in a pediatric hospital.

In spite of being preventable, Congenital syphilis (CS) is still an important, and growing health problem worldwide. Fetal infection can be particularly aggressive, but newborns can be asymptomatic at birth and, if left untreated, develop systemic compromise afterwards with poor prognosis. We analyzed 61 CS diagnosis cases between 1987-2019 presenting at the Buenos Aires Children' Hospital. The distribution of cases showed a bimodal curve, with a peak in 1992-1993 and in 2014-2017. Median age at diagnosis was 2 months (IQ 1-6 months). The main clinical findings were: bone alterations (59%); hepatosplenomegaly (54.1%); anemia (62.8%); skin lesions (42.6%) and renal compromise (33.3%). Cerebrospinal fluid (CSF) was abnormal in 5 patients, normal in 45 and was not available for 11 patients. Remarkably, spinal lumbar puncture did not modify therapeutic decisions in any case. Between mothers, only 46% have been tested for syphilis during pregnancy and 60.5% patients had non-treponemal titers equal to or less than fourfold the maternal titer. Intravenous penicillin G was prescribed for all except one patient, who received ceftriaxone with good therapeutic response. During follow-up, 1.6% infants died, 6.5% had persistent kidney disorders and 1.6% showed bone sequelae damage. RPR titers decreased after treatment, reaching negative seroconversion in 43% subjects at a median of 26.4 months. Low adherence to follow up was observed due to inherent vulnerable and low-income population characteristics in our cohort. Our results highlight a rising tendency in cases referred for CS in our population with high morbidity related to delayed diagnosis. A good therapeutic response was observed. CS requires a greater effort from the health system to adequately screen for this disease during pregnancy, and to detect cases earlier, to provide an adequate diagnosis and treatment.

Modificación de la profundidad de las compresiones cardíacas durante la reanimación cardiopulmonar en un simulador pediátrico / Changes in the depth of chest compressions during cardiopulmonary resuscitation in a pediatric simulator

Introducción. Las compresiones cardíacas (CC) de alta calidad son el principal componente de la reanimación cardiopulmonar (RCP). Objetivos: Evaluar la profundidad de las CC durante las maniobras de RCP realizadas sobre un simulador pediátrico. Secundariamente, explorar la asociación entre la profundidad de las CC con respecto al género, nivel de formación, índice de masa corporal y entrenamiento físico periódico. Material y métodos. Trabajo prospectivo de observación experimental. Se incluyeron médicos residentes de Pediatría, pediatras, enfermeros y otros profesionales capacitados en RCP que asistían a niños. Se registró, mediante un software, la profundidad de las CC mientras realizaban maniobras de RCP durante 2 minutos. Se definió como equivalente a cansancio el deterioro en el número de CC adecuadas en profundidad (> 50 mm) mayor de 3 entre el primero y el último ciclo. Resultados. Participaron 137 sujetos (85,4 % de mujeres). Solamente 48 (35,8 %) presentaron un desempeño adecuado en cuanto a la profundidad. Se observaron diferencias significativas en favor del género masculino (p < 0,0001) y de los pediatras formados por sobre el resto (p 0,038). El 36,5 % de los participantes empeoraron su desempeño en cuanto a la profundidad a los dos minutos. No se observaron diferencias significativas en cuanto al índice de masa corporal y actividad física. Conclusiones. Las CC disminuyeron en profundidad al cabo de dos minutos. No hubo asociación con el índice de masa corporal ni la actividad física habitual de los reanimadores, pero sí en cuanto a género y nivel de formación.

Introduction. High-quality chest compressions (CCs) are the main component of cardiopulmonary resuscitation (CPR). Objectives. T o assess the depth of CCs during CPR using a pediatric patient manikin. A secondary objective was to explore the association between CC depth and sex, level of training, body mass index, and periodic physical training. Material and methods. Prospective study with experimental observation. Pediatric residents, pediatricians, nurses, and other health care providers trained in CPR and who attended children were included. A software program was used to record the depth of CCs while performing CPR during 2 minutes. Tiredness was defined as a deterioration in the number of adequately deep CCs (> 50 mm) by more than 3 CCs between the first and the last cycles. Results. A total of 137 subjects participated (85.4 % were women). Only 48 participants (35.8 %) showed an adequate performance in terms of depth. Significant differences were observed for men (p < 0.0001) and trained pediatricians compared to the rest (p = 0.038). A worsening was observed in performance in terms of depth after 2 minutes in 36.5 % of participants. No significant differences were observed in relation to body mass index and physical activity. Conclusions. Depth rate reduced after 2 minutes. No association was observed with the body mass index or regular physical activity of resuscitators but with their sex and level of training.

Changes in the depth of chest compressions during cardiopulmonary resuscitation in a pediatric simulator. / Modificación de la profundidad de las compresiones cardíacas durante la reanimación cardiopulmonar en un simulador pediátrico.

INTRODUCTION: High-quality chest compressions (CCs) are the main component of cardiopulmonary resuscitation (CPR). Objectives. T o assess the depth of CCs during CPR using a pediatric patient manikin. A secondary objective was to explore the association between CC depth and sex, level of training, body mass index, and periodic physical training. MATERIAL AND METHODS: Prospective study with experimental observation. Pediatric residents, pediatricians, nurses, and other health care providers trained in CPR and who attended children were included. A software program was used to record the depth of CCs while performing CPR during 2 minutes. Tiredness was defined as a deterioration in the number of adequately deep CCs (> 50 mm) by more than 3 CCs between the first and the last cycles. RESULTS: A total of 137 subjects participated (85.4 % were women). Only 48 participants (35.8 %) showed an adequate performance in terms of depth. Significant differences were observed for men (p < 0.0001) and trained pediatricians compared to the rest (p = 0.038). A worsening was observed in performance in terms of depth after 2 minutes in 36.5 % of participants. No significant differences were observed in relation to body mass index and physical activity. CONCLUSIONS: Depth rate reduced after 2 minutes. No association was observed with the body mass index or regular physical activity of resuscitators but with their sex and level of training.

Introducción. Las compresiones cardíacas (CC) de alta calidad son el principal componente de la reanimación cardiopulmonar (RCP). Objetivos: Evaluar la profundidad de las CC durante las maniobras de RCP realizadas sobre un simulador pediátrico. Secundariamente, explorar la asociación entre la profundidad de las CC con respecto al género, nivel de formación, índice de masa corporal y entrenamiento físico periódico. Material y métodos. Trabajo prospectivo de observación experimental. Se incluyeron médicos residentes de Pediatría, pediatras, enfermeros y otros profesionales capacitados en RCP que asistían a niños. Se registró, mediante un software, la profundidad de las CC mientras realizaban maniobras de RCP durante 2 minutos. Se definió como equivalente a cansancio el deterioro en el número de CC adecuadas en profundidad (> 50 mm) mayor de 3 entre el primero y el último ciclo. Resultados. Participaron 137 sujetos (85,4 % de mujeres). Solamente 48 (35,8 %) presentaron un desempeño adecuado en cuanto a la profundidad. Se observaron diferencias significativas en favor del género masculino (p < 0,0001) y de los pediatras formados por sobre el resto (p 0,038). El 36,5 % de los participantes empeoraron su desempeño en cuanto a la profundidad a los dos minutos. No se observaron diferencias significativas en cuanto al índice de masa corporal y actividad física. Conclusiones. Las CC disminuyeron en profundidad al cabo de dos minutos. No hubo asociación con el índice de masa corporal ni la actividad física habitual de los reanimadores, pero sí en cuanto a género y nivel de formación.

Eficacia de una tabla de referencia de drogas. Una herramienta para reducir errores en la medicación durante la emergencia pediátrica / Efficacy of a drug reference table for emergencies. A tool to reduce errors in medication

Introducción. Se diseñó una tabla de referencia de drogas para emergencias (TRDE) especificando utilidad, dosis, vía de administración y dilución de las drogas más utilizadas durante emergencias pediátricas. El objetivo de este trabajo fue evaluar su utilidad para reducir errores en medicación. Materiales y métodos. Se realizó un estudio controlado aleatorizado con residentes de un hospital general pediátrico durante jornadas de simulación médica de alta fidelidad. Participaron 79 médicos divididos en 12 equipos; 6 asignados aleatoriamente, tuvieron la TRDE disponible y un instructivo para utilizarla. Se analizaron cantidad total de errores en la prescripción de medicación, y tipo de error (elección de la droga, dosis, dilución y vía de administración). Resultados. La media de indicaciones por equipo fue 7,08 drogas (DS 6,25-7,92). Los equipos sin TRDE cometieron 5,17 errores totales más que los que la usaron (IC 90% 0,21-10,12; P=0,08). En el análisis diferenciado por tipo de error aquellos sin TRDE cometieron 2,5 errores más de dilución (IC 90% 0,87-4,13; P=0,02). No hubo diferencias significativas de errores de elección, dosificación y vía de administración de drogas. Conclusión. La TRDE determinó una disminución global de errores en la prescripción de medicación durante situaciones de emergencia, principalmente en la dilución

Background. A drug reference table for emergencies (TE) was designed specifying utility, dose, route of administration and dilution of the drugs used during pediatric emergencies. The aim of this work was to evaluate its utility to reduce errors in medication. Methods. A randomized controlled study was conducted with residents of a pediatric general hospital during high-fidelity medical simulation. 79 residents were divided into 12 teams, 6 randomly assigned teams had the TE available and instructions on how to use it. We analyzed the total number of errors in the prescription of medication, and type of error (choice of drug, dose, dilution and route of administration). Results. The mean of indications per team was 7.08 drugs (DS 6.25-7.92). Teams without TE performed 5.17 total errors more than those who used it (IC 90% 0.21-10.12, P = 0.08). Analyzing by type of error those without TE made 2.5 more dilution errors (IC 90% 0.87-4.13, P = 0.02). There were no significant differences in errors of choice, dosage and route of drug administration. Conclusion. The TE produced overall decrease in medication prescription errors during emergency situations, particularly in dilution errors