Pediatric Emergency Medicine Training: A Survey of Current Status in Latin America.

Pediatric emergency medicine (PEM) is a relatively new and rapidly evolving subspecialty in many countries. The purposes of this study were to describe the characteristics and to find common/shared practices in current available PEM fellowship programs across Latin America. METHODS: An electronic, multicenter survey was created and stored on Google forms. The survey was in Spanish language and included 30 questions about the characteristics of the pediatric emergency program, history of the program, and support expected from the Latin American Pediatric Emergency Society. RESULTS: A total of 11 PEM programs in 6 countries were acknowledged in Latin America. All programs are placed in pediatric tertiary care hospitals. All PEM programs were approved by the local universities and the Ministries of Health in each country. Difficulties to start a PEM program included a lack of physicians properly trained in PEM who could direct the program, physician instructors in specific topics, places to complete rotations of the future fellows, and getting the local health authorities to acknowledge the importance of the program. With regard to the duration of the program, 72.7% (8) have a 2-year curriculum and 27.3% (3) have a 1-year curriculum. Four (36.4%) program directors mentioned an admission examination as a requirement, 4 (36.4%) needed an examination plus an interview, 3 (27.3%) mentioned that it is necessary just like an interview, and 2 (18.2%) mentioned that the physicians are admitted with a scholarship. With regard to the structure of the programs and rotations included, most of the programs have rotations that are compulsory in different pediatric subspecialties. In 80% of the programs, fellows are evaluated based on different technical skill procedures that they need to learn and perform during PEM fellowship training. The PEM fellowship is recognized by different societies in emergency medicine and pediatrics, except in Dominican Republic where it is only recognized by the Ministry of Health and the university. After completion of the program in 90% (10) of the programs, graduates are not guaranteed a job, and in half, there is no mechanism implemented for recertification of the pediatric emergency physicians by the local medical council. CONCLUSIONS: In Latin America, postgraduate programs in pediatric emergencies are a response to a need for health systems. Being an innovative specialty, it surpassed each country's own challenges, until it was able to reach an internationally standardized level, with a great diversity of pedagogical methodology, which the product has been to offer a high quality of emergency care to children.

Unveiling soil temperature reached during a wildfire event using ex-post chemical and hydraulic soil analysis.

Wildfires affect different physical, chemical, and hydraulic soil properties, and the magnitude of their effects varies depending on intrinsic soil properties and wildfire characteristics. As a result of climate change, the frequency and intensity of wildfires have increased, and understanding their impact and predicting the temperature to which soils were exposed in previous events is becoming increasingly critical. Hence, the objectives of this study were to develop a soil-heating laboratory procedure to (a) identify changes in soil properties at different temperatures and (b) to infer the temperature ranges to which heated soils have been exposed. Saturated (Ks) and unsaturated (Ku) hydraulic conductivity, pH, electrical conductivity (EC), wet aggregate stability (WAS), soil water repellency index (RIm), and soil organic matter content (SOM) were measured in six laboratory heated (LH) soils at 300, 500, 700, and 900 °C for 2 h. Bulk density (BD) and soil texture were measured in unheated (UH) and wildfire-unheated (WH) samples. UH samples were used as baselines to quantify changes in soil properties, and WH and LH samples were compared to determine the temperatures to which WH soils were exposed. The results show that in the studied temperature range, WAS exhibited a U-shaped trend, opposite to that of pH and EC. Ks and Ku (negative tension of -3 cm) tend to increase with temperature, reaching a maximum of 1.27·10-4 and 5.62·10-5 (m/s) at 900 °C, respectively. RIm was highly dependent on texture; loam soils had an average minimum and maximum of 1.84 and 2.73, at 900 and 300 °C, respectively, while sandy loam soils had an average minimum and maximum of 1.29 and 2.08 at 300 and 900 °C, respectively. Finally, the parameters that provided laboratory variation and a temperature range consistent with the results observed in naturally heated soils were WAS, RIm, pH, and EC.

Comportamiento de la mortalidad en el hospital infantil Dr. Robert Reid Cabral, Santo Domingo, República Dominicana, período 2013- 2017 / Mortality behavior at Dr. Robert Reid Cabral Children's Hospital. Santo Domingo, Dominican Republic, 2013-2017

Introducción: el análisis de la mortalidad hospitalaria permite evaluar la calidad de la asistencia médica. Las últimas publicaciones sobre mortalidad en el Hospital Infantil Dr. Robert Reid Cabral datan de 1997 Objetivo: conocer el comportamiento de la mortalidad en el Hospital Infantil Dr. Robert Reid Cabral durante el periodo 2013­2017 Métodos: estudio descriptivo. Se revisaron los libros de registro y actas de defunciones de los pacientes fallecidos en el Hospital Dr. Robert Reid Cabral durante el periodo 2013­2017. Resultados: 3,800 pacientes fallecieron, en promedio 760 fallecidos por año (margen 679-868). 79.9 % con menos de 5 años de edad; las muertes en menores de 1 año de edad representaron el 61.3 % y en el periodo neonatal el 26.1 %. La Sepsis/Shock Séptico (43.4 %) y la Hemorragia Pulmonar (15.4 %) fueron los dos principales diagnósticos de defunción; el 34 % de los fallecidos presentaban una morbilidad asociada al diagnóstico de defunción y en el 40 % la morbilidad asociada era una malformación congénita. El 69.5 % fallecieron en la Unidad de Cuidados Intensivos Pediátricos o Neonatal y 40 % de los pacientes fallecieron antes de las 48 horas de su ingreso al hospital. Conclusión: el grupo etario de mayor mortalidad son los menores de 1 año de edad, se evidencia un alto porcentaje de muertes con enfermedad crónica y malformaciones congénitas asociadas. El hecho de que el 40 % de los pacientes fallecieran antes de las 48 horas de su ingreso, indica la condición de gravedad en que estos pacientes llegan al hospital

Introduction: the analysis of hospital mortality allows to evaluate the quality of medical care. The latest publications on mortality at Dr. Robert Reid Cabral Children's Hospital date from 1997. Objective: to know the behavior of mortality in the Dr. Robert Reid Cabral Children's Hospital during the period 2013-2017. Methods: descriptive study. Registration books and death certificates of deceased patients at Dr. Robert Reid Cabral Hospital during 2013-2017 were reviewed. Results: 3,800 patients died, on average 760 deaths per year (margin 679-868). 79.9 % with less than 5 years of age; deaths in children under 1 year of age represented 61.3 % and in the neonatal period 26.1 %. Sepsis / Septic Shock (43.4 %) and Pulmonary Hemorrhage (15.4 %) were the two main diagnoses of death; 34 % of the deceased had a morbidity associated with the diagnosis of death and in 40 % the associated morbidity was a congenital malformation. 69.5 % died in the Pediatric or Neonatal Intensive Care Unit and 40 % of the patients died within 48 hours of admission to the hospital. Conclusion: the age group with the highest mortality are those under 1 year of age, a high percentage of deaths with chronic disease and associated congenital malformations are evident. The fact that 40 % of patients died before 48 hours of admission indicates the serious condition in which these patients arrive at the hospital.

Traumatismo cardíaco penetrante en pediatría: presentación de caso, Hospital Infantil Dr. Robert Reid Cabral (HIRRC), República Dominicana / Penetrating Cardiac Trauma in Children: Case Presentation, Hospital Infantil Dr. Robert Reid Cabral, Dominican Republic.

Introducción: el traumatismo cardíaco es una condición poco frecuente en edad pediátrica, ocurriendo en menos del 5 % de traumatismos torácicos. Afecta más frecuentemente los ventrículos que las aurículas. Según el mecanismo de injuria puede ser: cerrado (como las contusiones torácicas) o penetrante (como las heridas por arma blanca o armas de fuego). El siguiente documento tiene la intención de describir la presentación clínica y el manejo de un paciente pediátrico con traumatismo cardíaco penetrante; se pretendió realizar una revisión de literatura sobre otros casos de traumatismo cardíaco penetrante. Presentación del caso: se expone el caso clínico de un paciente masculino de 14 años de edad, quien es referido al centro por historia de herida de arma blanca en región precordial izquierda. Se recibe con inestabilidad hemodinámica y hemitórax izquierdo hipodinámico; luego de realizar estudios de imagen y laboratorio se decide realizar toracocentesis. Ante evidente deterioro clínico, se decide realizar exploración quirúrgica, donde se halla laceración del ventrículo izquierdo y hematoma pericárdico, y se procede a drenar hematoma y cardiorrafia de ventrículo izquierdo. Conclusión: luego de describir la presentación y manejo de nuestro paciente, llegamos a la conclusión de que la sospecha clínica y el diagnóstico y manejo precoz son imprescindibles para mejorar el pronóstico de estos traumatismos. Asimismo, entendemos pertinente la exploración quirúrgica temprana ante los casos de inestabilidad hemodinámica, evitando el retraso de un tratamiento oportuno

Introduction: Cardiac trauma is a rare condition in pediatrics, occurring in less than 5 % of thoracic trauma. It affects the ventricles more often than the atria. Depending on the mechanism of injury, it may be classified as closed (such as blunt chest traumas) or penetrating (such as wounds with a knife or guns). The following document has the intention to describe the clinical presentation and management of a pediatric patient with a penetrating cardiac trauma, and it was intended to conduct a literature review on other cases of penetrating cardiac trauma. Case presentation: We present the clinical case of a 14-year-old male, who is referred to the center with history of a knife wound in the left precordial region. He is received with hemodynamic instability and hypodynamic left hemithorax, and, after performing imaging and laboratory studies, it was decided to perform thoracentesis. In the presence of evident clinical deterioration, it was decided to perform surgical exploration, where laceration of the left ventricle and pericardial hematoma is evidenced, for which drainage of hematoma and left ventricle cardiorrhaphy were performed. Conclusion: After describing the presentation and management of our patient, we conclude that clinical suspicion and early diagnosis and management are essential to improve the prognosis of these injuries. Likewise, we recognize the pertinence of early surgical exploration in cases of hemodynamic instability, avoiding the delay of a timely treatment.

A comprehensive evaluation of pedotransfer functions for predicting soil water content in environmental modeling and ecosystem management.

Many pedotransfer functions (PTFs) have been developed for predicting the soil water content at different matric potentials. The use of these functions has been encouraged because of the time and work typically required for measuring it, while the PTFs require commonly measured soil properties such as sand, silt, clay, organic matter content, or bulk density for predicting water retention. In addition, several environmental and ecosystem management simulation models such as DRAINMOD, HYDRUS, EPIC, SPAW, and WEPP use PTFs for computing soil hydraulic properties. Because of the increasing use of the PTFs and their effect in many soil water simulation and transport models, this study revised and tested 13 different PTFs for predicting soil water content at -33 and -1500 kPa, values usually known as field capacity and wilting point. Three of these PTFs were derived from tropical soils while the rest were developed with soil samples collected across the United States. These PTFs were evaluated in Chilean soils as an independent dataset and their improvement after calibration was assessed with this new data. The results demonstrate that the PTFs performance depends on the soils used for their development as the estimates showed a significant improvement after calibration. When predicting water content, Rawls et al. (2004) was the best function before calibration (RMSE = 0.08 for -33 and -1500 kPa), while Gupta and Larson (1979) was the best after calibration (RMSE of 0.06 and 0.05, and r2 values of 0.69 and 0.66 at -33 and -1500 kPa, respectively). Nonlinear PTFs performed better than linear PTFs when predicting water content at field capacity. Finally, bulk density proved to be the key variable and can be used as footprint for soils changes through time. Organic matter content was also a significant input but improved the estimates for some specific matric potentials and PTFs.

Theoretical study of the electronic properties of fluorographene.

First-principles calculations were performed for fluorine-decorated graphene (fluorographene). Three different hexagonal clusters were used-circular (C(24)H(12)), triangular (C(23)H(10)) and rectangular (C(24)H(12))-and the fluorine atoms were randomly distributed in the mesh. Graphene is structurally stable in the three geometries, but fluorographene stability is only attained for the circular and triangular clusters. Gaps of the circular graphene and the corresponding fluorographene are 2.94 and 1.13 eV, respectively; in the triangular case, the values are zero and 0.47 eV. Both the circular and triangular structures show a transition from ionic to covalent character.

Varon y hembra con cariotipo 46xy/45xo / Male and femal with cariotype 46xy/45xo

Presentamos dos pacientes con cariotipos 46XY/45XO y fenotipos masculinos y femeninos, que consultaron para evaluación por estatura baja, se discuten las posibles causas de esta alteración cromosómica. Fenotipo en pacientes 46XY/45XO

Carcinoma embrionario de testículo en niños: informe de un caso / Testicular embryonal carcinoma in children : a case report

Comunicamos un caso de carcinoma embrionario de testículo en un niño de 18 meses de edad, documentado clínica y anatomopatológicamente, siendo el primer caso en la literatura dominicana se discuten hallazgos clínicos y procedimientos diagnósticos de la enfermedad

Conocimientos y actitudes sobre la menstruación en el Distrito Nacional

Estudiamos los conocimientos y actitudes sobre la menstruación en una muestra de 300 niñas que estudian en diferentes centros escolares de Santo Domingo, cuyas edades oscilaron entre los 12 y 18 años. Los conocimientos y actitudes sobre la menstruación son mayores y más favorables en las niñas de la zona urbana que en la de la zona rural

Relación entre la edad de la aparición de la menarquia y el nivel socieconomico de las ninas dominicanas

Estudiamos la relación entre la edad de aparición de la menarquia y el nivel socioeconómico en una muestra de 2,700 niñas a nviel nacional. La edad promedio de la menarquia obtenida es de 12.5 años para la población urbana y 13.1 años para la rural; deducimos que el factor socioeconómico es una variable determinante en a edad de aparición de la menarquia

Edad de la menarquia en niñas dominicanas

Estudiamos la edad de la menarquia por el método de Statu Quo en una muestra de 2,700 niñas a nivel nacional, con edades comprendidas entre 8 y 18 años. La edad de la menarquia nacional obtenida es de 12.6 años, correspondiendo a la población urbana una menarquia de 12.5 años y para la rural 13.1 años