Factores de riesgo asociados a falla en la extubación en pacientes prematuros en la unidad de cuidados intensivos neonatales / Risk factors associated with extubation failure in premature patients in the neonatal intensive care unit

Resumen Antecedentes: En la unidad de cuidados intensivos neonatales el 47% de prematuros requieren ventilación mecánica (VM), cuyo uso prolongado se asocia con secuelas a largo plazo. Objetivo: Identificar los factores de riesgo para falla en la extubación en prematuros. Material y métodos: Estudio de casos y controles; se tomó como casos las extubaciones fallidas (EF) y como controles las extubaciones exitosas (EE). El fracaso de la extubación se definió como la reintubación dentro de las primeras 72 horas. Resultados: El 46% de prematuros ingresados requirió VM. Se presentaron 12 EF y 27 EE. La proporción de EF fue del 31%. La VM más de 7 días fue del 17% en los casos y del 11% en los controles (OR: 0.6; IC 95%: 0.09-4.32; p = 0.634). La principal causa de reintubación fue por apnea (50%). Conclusiones: Los parámetros establecidos para este estudio no se determinaron como factores de riesgo para extubación fallida. Debido a los números de casos en este estudio, no podemos identificar un buen valor de corte para los factores de riesgo y predictores. Se requieren más estudios a gran escala para confirmar nuestros hallazgos y determinar los valores de corte.

Abstract Background: In the neonatal intensive care unit, 47% of premature infants require mechanical ventilation (MV); its prolonged use is associated with long-term sequelae. Objective: To identify the risk factors for extubation failure in premature infants. Material and methods: Case-control study, taking failed extubations (FE) as cases and successful extubations (SE) as controls. Extubation failure was defined as reintubation within the first 72 hours. Results: 46% of hospitalized premature infants required MV; twelve FE and 27 SE were presented. The proportion of FE was 31%. MV over 7 days was 17% in cases and 11% in controls (OR: 0.6; 95% CI: 0.09-4.32; p = 0.634). The main cause of reintubation was apnea (50%). Conclusions: The parameters established for this study were not determined as risk factors for failed extubation. Due to the case numbers in this study, we are unable to identify a good cut-off value for risk factors and predictors. More large-scale studies are required to confirm our findings and determine cut-off values.

Octreótida en el tratamiento de quilotórax congénito. Reporte de caso / Octreotide in the treatment of congenital chylothorax. A case report

Resumen El quilotórax congénito es la causa más común de derrame pleural en neonatos. Se caracteriza por el acúmulo de quilo en el espacio pleural. Se presenta el caso de un paciente con diagnóstico clínico de síndrome de Down y quilotórax congénito. Se detalla el uso de octreótida, lo cual reduce el volumen y la duración del drenaje de manera más rápida que únicamente con el manejo convencional. Todavía hay poca experiencia con el uso de la terapia con octreótida para esta afección y se desconoce la duración óptima del tratamiento para la evaluación de la respuesta.

Abstract Congenital chylothorax is the most common cause of pleural effusion in neonates. It is characterized by the accumulation of chyle in the pleural space. The case of a patient with a clinical diagnosis of Down syndrome and congenital chylothorax is presented. The use of octreotide is detailed, which reduces the volume and duration of drainage more quickly than with conventional management alone. There is little experience with the use of octreotide therapy for this condition and the optimal duration of treatment for assessment of response is unknown.

Efectividad de una metodología de aprendizaje profesional basada en proyectos en la asignatura Biología Molecular / Effectiveness of a project-based professional learning methodology in the Molecular Biology subject

Fundamento: la asignatura Biología Molecular ha presentado insuficiencias en el proceso enseñanza aprendizaje en la Facultad de Ciencias Médicas de Holguín, las que requieren solución. Objetivo: valorar la efectividad de una metodología de aprendizaje profesional basada en proyectos en la asignatura Biología Molecular como forma de perfeccionar el proceso de enseñanza aprendizaje. Métodos: se realizó una investigación de desarrollo en la Facultad de Ciencias Médicas de Holguín durante el curso 2021. Se emplearon los métodos teóricos: histórico-lógico, analítico-sintético y el inductivo-deductivo; empíricos: el análisis documental y el registro de las calificaciones de las preguntas de la primera convocatoria del examen final de la asignatura. Se realizaron pruebas estadísticas a los resultados de la evaluación final. Se utilizó una metodología de aprendizaje basada en proyectos para la implementación de la Biología Molecular, aplicada a una parte del contenido del programa analítico de la asignatura, que utilizó guías didácticas para los estudiantes y orientaciones metodológicas a los profesores, con el soporte de videos complementarios a las conferencias y a contenidos de currículo oculto, relacionados con la vinculación básico-clínica con orientación profesionalizante. Resultados: las preguntas del examen final cuyo contenido fue tratado según la metodología de proyecto de aprendizaje mostraron significativamente mejores resultados que aquellas tratadas de forma convencional. Conclusiones: la metodología de aprendizaje basada en proyectos para la asignatura Biología Molecular se determinó factible para su aplicación y proporcionó la flexibilidad necesaria para el tránsito de la docencia presencial a la modalidad a distancia.

Background: the Molecular Biology subject has presented insufficiencies in the teaching-learning process Holguín Faculty of Medical Sciences, which require a solution. Objective: to assess the effectiveness of a project-based professional learning methodology in the Molecular Biology subject as a way to improve the teaching-learning process. Methods: a development investigation was carried out at the Holguín Faculty of Medical Sciences during the 2021 academic year. Theoretical methods were used: historical-logical, analytical-synthetic and inductive-deductive; Empirical ones: the documentary analysis and the record of the qualifications of the questions of the first call of the final exam of the subject. Statistical tests were performed on the results of the final evaluation. A project-based learning methodology was used for the implementation of Molecular Biology, applied to a part of the content of the analytical program of the subject, which used didactic guides for students and methodological orientations for teachers, with the support of complementary videos to the lectures and hidden curriculum contents, related to the basic-clinical link with a professional orientation. Results: the final exam questions where its content was treated according to the learning project methodology showed significantly better results than those treated conventionally. Conclusions: the project-based learning methodology for the Molecular Biology subject was determined feasible for its application and provided the necessary flexibility for the transition from face-to-face teaching to distance learning.

Standardization of the PCR Technique for the Detection of the Toxoplasma gondii B1 Gene in Meat and Water Samples and Cloning of the Product for Use as Control.

INTRODUCTION: Toxoplasmosis is caused by the parasite Toxoplasma gondii. The infection is generally asymptomatic and the most severe cases occur in immunosuppressed patients. The main route of transmission is the ingestion of water or food contaminated with cysts of the parasite. The objective of this work was the standardization of the PCR for the detection of the T. gondii B1 gene in meat and water samples and cloning of the product for use as a control. METHODS: The optimal reaction conditions of the different components of the PCR were determined and the technique was used to detect DNA from meat and water samples. Bands were purified and cloned into a pGEM-T-Easy vector and used as a control in the PCR. RESULTS: Optimal PCR conditions were; 100 µM dNTP, 0.4 µM primers, and 0.5 U Taq polymerase. The product obtained from the PCR was cloned with a simple cloning strategy with efficient results. With the standardized PCR and using the cloned DNA as a control, T. gondii DNA was detected in 90% of the positives samples of meat and water and there was no amplification in the negative samples. CONCLUSIONS: The PCR assay standardized in this study was demonstrated to be an effective technique to detect T. gondii DNA in meat and water samples. The cloning of PCR product and its application as a control in molecular diagnosis of toxoplasmosis might improve the reproducibility of this method and avoid the use of patient samples or cultures, which present several limitations.

Case Report: Cerebral Phaeohyphomycosis Due to Chaetomium strumarium in a Child with Visceral Heterotaxy Syndrome.

Chaetomium sp. is a mold, member of the phylum Ascomycota. Clinical disease in humans is rare, particularly in children, for which only five cases have been reported. We report a 7-months-old female patient with a diagnosis of visceral heterotaxy syndrome who was admitted to a private center in Mexico. After two episodes of focal myoclonic seizure, a brain magnetic resonance imaging (MRI) revealed a right porencephalic cyst and a right frontal abscess with ventriculitis. Seventy-two hours after temporal abscesses drainage procedure, the culture showed a rapidly growing pale white fungal colony. Sequencing of internal transcribed spacer (ITS) and D1/D2 led to the identification of Chaetomium strumarium. Although Chaetomium sp. is a rare fungal infection in humans, clinicians should consider it as a plausible etiologic agent that can form brain abscess.

Infant Feeding and Information Sources in Chilean Families Who Reported Baby-Led Weaning as a Complementary Feeding Method.

Baby-Led Weaning (BLW) is a new and emerging method of introducing complementary feeding in solid consistency, without the use of a spoon and entirely guided by the baby. This study aims to analyze the implementation of the BLW approach in relation to compliance with basic components and sources of information in Chilean families. Using a cross-sectional design, we assessed early nutrition, including breastfeeding and foods offered, maternal/child characteristics and sources of information on BLW among a non-probabilistic sample of mothers of children <24 months who reported practicing BLW (n = 261, median age = 28 years) in Chile. We found that 57.5% of mothers reported their child ate the same food as the family, 44.1% shared ≥3 meals with the family, 84.7% offered ≥3 foods at each meal and 75.6% reported only occasionally offering food with a spoon. The majority reported obtaining information on BLW from social media (82%). Moreover, 56% had offered cookies, 32% added salt and 9% sugar in the first 2 years. Exclusive breastfeeding for 6 months related to higher odds of consuming family foods (OR = 2.45, 95% CI 1.24-4.84), while having received information from professional sources and social media related to lower odds (OR = 0.45, 95% CI 0.22-0.88 and OR = 0.31, 95% CI 0.15-0.66, respectively). Those who had appropriate weight gain had lower odds of consuming ≥3 foods in meals (OR = 0.35, 95% CI 0.13-0.96). Among mothers who reported practicing BLW with their children, we observed a wide variety of feeding habits, sources of information and low compliance with the studied components. Eating the same food as the family was the most prevalent component and social media was the main source of information on BLW.

Prevalencia de caries de infancia temprana severa y factores de riesgo asociados en un grupo de niños del área metropolitana de Guatemala / Prevalência de cárie precoce na infância e fatores de risco associados em um grupo de crianças na região metropolitana da Guatemala / Prevalence of severe early childhood caries and associated risk factors in a group of children in the metropolitan area of Guatemala

Objetivo: Determinar la prevalencia y severidad de caries de infancia temprana severa y factores de riesgo asociados en una poblaciónn de niños de 6-36 meses de edad, que asisten a guarderías estatales del área metropolitana de la ciudad de Guatemala. Materiales y métodos: Diseño analítico transversal. Se examinaron clínicamente 110 niños de 13 a 36 meses de edad para determinar el estado de caries según los criterios del Sistema Internacional de Detección y Valoración de Caries (Kappa 0.69). Además, se determinaron las características sociodemográficas, hábitos de alimentación e higiene dental a través de una entrevista a las madres de los participantes y se realizó análisis descriptivo de estas variables. Para determinar la relación entre variables se aplicaron las pruebas estadísticas U de Man Whitney y Tau-b de Kendall. Resultados: Se encontró una prevalencia de caries de infancia temprana severa de 81.8%. En promedio cada individuo presentó 6.74 lesiones cariosas (IC 95% 5.62 - 7.92). El número promedio de lesiones no cavitadas fue 6.06 y de lesiones cavitadas fue 2.51. Se encontró que la edad y el porcentaje de superficies dentarias con presencia de placa están significativamente asociados con las caries de infancia temprana severa. Conclusiones: La alta prevalencia de caries (81.8%) y el carácter reversible de 2/3 de las lesiones encontradas demanda intervenciones preventivas de salud dental en esta población.

Objetivo: Determinar a prevalência e a gravidade de cáries precoce na infância e fatores de risco associados em uma população de crianças de 6 a 36 meses que frequentam creches estaduais na região metropolitana da Cidade da Guatemala.Material e métodos: Projeto analítico transversal 110 crianças de 13 a 36 meses de idade foram examinadas clinicamente para determinar o status de cárie de acordo com os critérios do Sistema Internacional de Detecção e Avaliação de Cárie (Kappa 0,69). Além disso, as características sociodemográficas, hábitos alimentares e higiene dental foram determinadas por meio de entrevista com as mães dos participantes e análise descritiva dessas variáveis. Para determinar a relação entre as variáveis, foram aplicados os testes estatísticos U de Man Whitney e Tau-b de Kendall. Resultados: A prevalência de cárie na primeira infância foi de 81,8%. Em média, cada indivíduo apresentou 6,74 lesões de cárie (IC95 % 5,62 - 7,92). O número médio de lesões não cavitadas foi de 6,06 e as cavitadas foram de 2,51. Verificou-se que a idade e a porcentagem de superfícies dentárias com presença de placa estão significativamente associadas à cárie precoce. Conclusões: A alta prevalência de cárie encontrada (81,8 %) e do tipo reversível foi de 2/3 das lesões encontradas demandam intervenções preventivas de saúde bucal nessa população

Objective: To determine the prevalence and severity of early childhood caries and the associated risk factors, in a population of 6 to 36 months old children that attend governmental daycares in the metropolitan area of Guatemala City. Methods: Cross-sectional analytical design 110 children from 13 to 36 months of age were clinically examined to determine caries status according to the criteria of the International Caries Detection and Assessment System (Kappa 0.69). In addition, sociodemographic characteristics, eating and dental hygiene habits were established through a survey done to the mothers of the participants. To determine the relationship between variables, the statistical tests U of Man Whitney and Tau-b of Kendall were applied. Results: There was an 81.8% of prevalence found of severe early childhood caries. In average, each subject showed 6.74 carious lesions (IC 95% 5.62 ­ 7.92). The average number of non-cavitated lesions was 6.06 and 2.51 for cavitated lesions. It was found that age (τb = .224, p = .001) and the percentage of dental surface with plaque (τb = 0.352 p = .002) are significantly associated with severe early childhood caries. Conclusion: The high prevalence from found caries (81.8%) and the reversible type of 2/3 from the found lesions, show a need of preventive interventions of dental health in this population

Feasibility of Multilevel Pregnancy Tests for Telemedicine Abortion Service Follow-Up: A Pilot Study.

CONTEXT: Telemedicine clients wishing to confirm a successful medication abortion outside of a clinic setting are commonly instructed to use high-sensitivity urine pregnancy tests, which can take up to four weeks to yield accurate results. Multilevel urine pregnancy tests (MLPTs), which provide accurate results in one week, are a promising alternative, but their use has not been evaluated within telemedicine services. METHODS: From November 2017 to May 2018, 165 eligible and consenting pregnant people who contacted safe2choose-an organization providing telemedicine abortion services internationally-for medication abortion were enrolled in a pilot study and mailed a package containing medication abortion drugs, two MLPTs and instructions. Data on 118 participants who completed a web-based evaluation survey two weeks after the package was sent were analyzed to examine participant experiences and satisfaction with the service. RESULTS: Responding participants were from 11 countries, including Mexico, the Philippines and Singapore. Ninety-three percent used both MLPTs, and 91% of those who used both tests used them at the correct time intervals. Among the 95% of participants whose MLPT results indicated that their pregnancy hormone levels decreased from before to after medication abortion, 86% correctly interpreted the results to mean that they were no longer pregnant. Satisfaction was high, with all indicating that the supplied information was helpful; more than nine out of 10 noted that they would want to use the MLPTs again. CONCLUSIONS: Incorporating MLPTs into telemedicine abortion services is feasible and associated with high client satisfaction. Enabling people to manage their own abortion follow-up care could greatly improve their overall abortion experience.

RESUMEN Contexto: Las clientas de telemedicina que desean confirmar el éxito de un aborto con medicamentos fuera del entorno de una clínica, generalmente reciben instrucciones para usar pruebas de alta sensibilidad de embarazo en orina, que pueden tomar hasta cuatro semanas para producir resultados precisos. Las pruebas multinivel de embarazo en orina (PMEO), que brindan resultados precisos en una semana, son una alternativa prometedora, pero su uso no ha sido evaluado en el contexto de los servicios de telemedicina. Métodos: De noviembre de 2017 a mayo de 2018, 165 mujeres embarazadas elegibles y que dieron su consentimiento se comunicaron con safe2choose ­organización que brinda servicios de aborto por telemedicina a nivel internacional­para obtener un aborto con medicamentos y se inscribieron en un estudio piloto que les envió por correo un paquete que contenía medicamentos para el aborto, dos PMEO e instrucciones. Se analizaron los datos de 118 participantes que completaron una encuesta de evaluación en línea dos semanas después de que se envió el paquete para examinar las experiencias de las participantes y la satisfacción con el servicio. Resultados: Las participantes que respondieron eran de 11 países, incluidos México, Filipinas y Singapur. El 93% utilizó ambos PMEO y el 91% de quienes utilizaron ambas pruebas las utilizaron en los intervalos de tiempo correctos. Del 95% de las participantes cuyos resultados de PMEO indicaron que sus niveles de hormonas del embarazo disminuyeron desde antes hasta después del aborto con medicamentos, el 86% interpretó correctamente los resultados en el sentido de que ya no estaban embarazadas. La satisfacción fue alta, y todas indicaron que la información proporcionada fue útil; más de nueve de cada 10 señalaron que querrían volver a utilizar los PMEO. Conclusiones: La incorporación de PMEO en los servicios de aborto por telemedicina es factible y está asociada con una alta satisfacción del cliente. Permitir que las mujeres manejen su propia atención de seguimiento del aborto podría mejorar en gran medida su experiencia general del aborto.

RÉSUMÉ Contexte: Les patientes en télémédecine soucieuses de confirmer la réussite d'un avortement médicamenteux effectué en dehors d'une clinique sont généralement invitées à utiliser les tests urinaires de grossesse à haute sensibilité, qui peuvent produire des résultats inexacts jusqu'à quatre semaines après l'intervention. Les tests urinaires de grossesse multiniveaux (TGMN), qui produisent des résultats exacts en l'espace d'une semaine, offrent une autre solution prometteuse, mais leur utilisation n'a pas été évaluée en télémédecine. Méthodes: De novembre 2017 à mai 2018, 165 personnes enceintes admises et consentantes qui s'étaient adressées à l'organisation safe2choose ­ prestataire de services d'avortement par télémédecine à l'échelle internationale ­ pour un avortement médicamenteux ont été inscrites à une étude pilote et un colis contenant des médicaments abortifs, deux TGMN et les instructions à suivre leur a été envoyé. Les données relatives à 118 participantes ayant répondu à un questionnaire d'évaluation en ligne deux semaines après l'envoi du colis ont été analysées pour examiner leur expérience et leur satisfaction concernant le service. Résultats: Les participantes qui avaient répondu au questionnaire étaient originaires de 11 pays, dont le Mexique, les Philippines et Singapour. Quatre-vingt-treize pour cent avaient utilisé les deux TGMN et, parmi elles, 91% les avaient utilisés aux intervalles adéquats. Parmi les 95% de participantes dont les TGMN indiquaient des niveaux d'hormone de grossesse en baisse entre les moments où elles avaient effectué les tests avant et après l'avortement médicamenteux, 86% avaient interprété correctement leurs résultats comme indiquant qu'elles n'étaient plus enceintes. Le niveau de satisfaction était élevé, toutes les participantes indiquant que l'information fournie leur avait été utile. Plus de neuf sur 10 faisaient remarquer qu'elles seraient disposées à réutiliser les TGMN. Conclusions: L'incorporation des TGMN dans les services d'avortement par télémédecine est faisable et associée à un haut degré de satisfaction. L'habilitation à gérer ses propres soins de suivi après avortement pourrait améliorer grandement l'expérience générale de l'intervention.

Odontogenic cutaneous sinus tracts due to infection with nontuberculous mycobacteria: a report of three cases.

BACKGROUND: Soft tissue or skin infections due to nontuberculous mycobacteria (NTM) have been reported frequently and are mostly associated with trauma or cosmetic interventions like plastic surgery. However, infection with NTM as a result of a dental procedure have rarely been described and the lack of clinical suspicion and a clear clinical manifestation makes diagnosis challenging. CASE PRESENTATION: We report on three patients with a facial cutaneous sinus tract of dental origin, due to an infection with respectively Mycobacterium fortuitum, M. abscessus and M. peregrinum. The infection source was the dental unit waterlines (DUWLs), which were colonized with NTM. CONCLUSIONS: Water of the DUWL can pose a health risk. This report emphasizes the need for quality control and certification of water flowing through DUWLs, including the absence of NTM. Our report also shows the need for a rapid recognition of NTM infections and accurate laboratory diagnosis in order to avoid long-term ineffective antibiotic treatment.

Cateterización venosa umbilical guiada por ultrasonografía: un análisis de coste-efectividad / Ultrasound-guided umbilical venous catheterisation: A cost-effectiveness análisis

INTRODUCCIÓN: El uso de ultrasonografía para la inserción de catéteres centrales ha mostrado ser coste-efectivo en adultos; en neonatos se desconoce esta información. El objetivo del estudio fue comparar el coste-efectividad de la cateterización venosa umbilical guiada por ultrasonografía con la cateterización convencional en un servicio de cuidados intensivos neonatales de un hospital universitario y público. PACIENTES Y MÉTODOS: Estudio observacional retrospectivo en recién nacidos que requirieron catéter venoso umbilical antes de cumplir las primeras 24 h de vida extrauterina; se conformaron 2 cohortes históricas, una con cateterización guiada por ultrasonografía y otra con cateterización convencional. La efectividad se midió con 2 variables: colocación de posición ideal e inserción sin complicaciones. Se estimó el coste de recursos humanos y materiales (fungibles y no fungibles), la razón coste-efectividad y la razón coste-efectividad incremental; y se realizó análisis de sensibilidad. RESULTADOS: La obstrucción del catéter fue más frecuente en la cateterización guiada que en la convencional (7,7 vs. 0%, p = 0,04) y la disfunción del catéter fue superior en esta última (79 vs. 3,8%, p < 0,0001). La razón coste-efectividad de la cateterización guiada fue 153,9 euros y de la convencional 484,6 euros; la razón coste-efectividad incremental fue 45,5 euros. El análisis de sensibilidad incrementó 2,6 euros en la razón coste-efectividad de la cateterización guiada y 47 euros, en la convencional. CONCLUSIONES: El uso de la ultrasonografiacute;a para guiar la cateterización umbilical es más eficiente ya que, a pesar de suponer un mayor consumo de recursos económicos, ofreció una mayor efectividad

INTRODUCTION: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p = .04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p < .0001). The cost-effectiveness ratio of the guided catheterisation was € 153.9, and €484.6 for the conventional one. The incremental cost-effectiveness ratio was € 45.5. The sensitivity analysis showed a € 2.6 increase in the cost-effectiveness ratio of the guided catheterisation and € 47 in the conventional one. CONCLUSIONS: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness

Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates.

BACKGROUND: Poor positioning of a central venous catheter (CVC) can cause severe complications. The objective is to create a formula that predicts the optimal insertion depth of a real time ultrasound-guided CVC in the right internal jugular vein (RIJV) in newborns. METHODS: Between 2015 and 2017, 91 newborns that required a CVC were included in a prospective observational study. Variables such as gestational age, gender, weight, height, and neck length were studied. On the chest x-ray, the distance between the insertion site on the skin and the catheter tip was measured. RESULTS: Of the patients included, 50 (54.9%) were males and 40 (44.4%) females; 64 (70.3%) were preterm. Mean gestational age was 33.44 (25 to 41) weeks, weight 2020 (580 to 3980) g, and height 43.04 (26 to 53) cm. Variables were correlated with catheter length and an algorithm was modeled for the introduction method, in which the highest corrected determination coefficient was obtained for weight (R2 = 0.723). CONCLUSION: This study demonstrated that the weight of the newborn was the most significant individual predictor of optimal insertion depth of a CVC in the RIJV. The formula Y = 2.6 + 0.7 (weight in kg) that we suggest is practical and reproducible. LEVEL OF EVIDENCE: Level IV.

[Ultrasound-guided umbilical venous catheterisation: A cost-effectiveness analysis]. / Cateterización venosa umbilical guiada por ultrasonografía: un análisis de coste-efectividad.

INTRODUCTION: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p=.04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p<.0001). The cost-effectiveness ratio of the guided catheterisation was €153.9, and €484.6 for the conventional one. The incremental cost-effectiveness ratio was €45.5. The sensitivity analysis showed a €2.6 increase in the cost-effectiveness ratio of the guided catheterisation and €47 in the conventional one. CONCLUSIONS: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness.

Leptin, IL-6 and TNF-α levels in umbilical cord blood of healthy term newborns in relation to mode of delivery.

In the development of the foetal immune system, cytokines play an important role in its function. Therefore, we sought to determine whether the mode of delivery affects the expression of leptin, IL-6 and TNF-α in umbilical cord blood in healthy term newborns. We collected 125 samples of umbilical cord blood to analyse leptin, IL-6 y TNF-α levels with multiplex immunoassay (MIA). The samples were classified according to mode of delivery: vaginal delivery (VD) and caesarean section (CS). Leptin and IL-6 had higher concentrations in umbilical cord blood in VD than in CS: 42.55 ng/ml (11.92-104.28) versus 35.20 ng/ml (3.26-9326.76), p = 0.039; 9.32 pg/ml (1.13-2020.31) versus 3.81 pg/ml (0.52-834.69) p < 0.001, respectively. Also, a weak correlation between TNF-α and IL-6 was found (r = 0.238, p = 0.007). The most important finding in our study was the differential concentrations of leptin and IL-6 according to mode of delivery.

Gland excision in submandibular sialolithiasis: a case report / Escisión glandular en sialolitiasis submandibular: reporte de un Caso

It has been shown that about 1 percent of the population suffers from calculi of the salivary glands; 80 percent of them occur in the submandibular gland. The aim of this paper is to present a clinical case of a 34-year-old patient, who was diagnosed with submandibular sialolithiasis and treated surgically for the total removal of the lesion and of the salivary gland, removing the swelling and acute pain. The diagnosis and treatment protocol for sialolithiasis of submandibular gland was carried out according to the latest guidelines, resulting in complete remission of the disease, without functional sequelae during the three months of postoperative follow-up...

Se ha demostrado que alrededor del 1 por ciento de la población padece de cálculos de las glándulas salivales, donde el 80 por ciento de ellos ocurren en la glándula submaxilar. El objetivo de este artículo es dar a conocer un caso clínico de una paciente de 34 años de edad, quien fue diagnosticada de sialolitiasis submandibular y tratada quirúrgicamente para la remoción total de la lesión, junto con la glándula salival, en donde se obtuvo como resultado la eliminación del aumento de volumen y el dolor agudo. El protocolo de diagnóstico y tratamiento para la sialolitiasis de la glándula submandibular fue llevado a cabo de acuerdo a los últimos lineamientos, obteniendo la remisión total de la patología, sin presentar secuelas funcionales durante los tres meses de seguimiento postoperatorio...

Seguridad y efectividad del nimotuzumab en los pacientes con tumores gliales malignos / Security and effectiveness of nimotuzumab in patients with malign glial tumors

Objetivo: Evaluar en la práctica médica los patrones de uso de nimotuzumab, perfil de seguridad y efectividad en términos de supervivencia en pacientes con gliomas de alto grado de malignidad.Métodos: Se diseñó un estudio de cohorte, prospectivo, multicéntrico longitudinal, en pacientes adultos con confirmación histológica de glioma de nuevo diagnóstico de alto grado de malignidad que recibieran nimotuzumab según las recomendaciones de prescripción. Lospacientes se siguieron durante 3 años. Se colectaron datos sobre modalidades de uso, dosis y tiempo de exposición a nimotuzumab. Los eventos adversos reportados se clasificaron según tipo, intensidad y gravedad y también se evaluó el tiempo de supervivencia en meses.Resultados: Entre Diciembre del 2005 y Agosto del 2012, setenta pacientes recibieron nimotuzumab agrupados según histología en 44 glioblastoma, 24 astrocitoma anaplásico y 2 oligoastrocitoma anaplásico. Todos los pacientes recibieron nimotuzumab en combinación con radioterapia, mayoritariamente concurrente (78,6 por ciento). El resto lo recibió de forma secuencial (21,4 por ciento). Completaron la fase de inducciónplanificada el 94,3 por ciento y continuaron el mantenimiento más allá de 1 año el 21,4 por ciento. El 24,1 por ciento de los eventos se relacionaron con nimotuzumab, siendo los más comunes: fiebre, escalofríos y eritema cutáneo de intensidad ligera y moderada. No se encontró asociaciónentre la toxicidad y modalidad terapéutica, tampoco con el número de dosis recibida. Los pacientes con astrocitoma anaplásico tuvieronuna supervivencia al diagnóstico sobre los 45 meses y con glioblastoma de 14,8 meses, con una tasa de supervivencia a 3 años del 50,8por ciento y 20,2 por ciento respectivamente.Conclusiones: Los resultados de este estudio observacional complementan los descritos en los estudios controlados. Nimotuzumab puede ser una alternativa terapéutica segura, ventajosa y factible como parte del tratamiento convencional en las(AU)

Objective: To evaluate usage patterns for nimotuzumab, safety and effectiveness in terms of survival in patients with high–grade gliomastreated in medical practice.Methods: A cohort prospective, longitudinal, multicenter study was designed in adult patients with histological confirmation of high grademalignant glioma newly diagnosis to receive nimotuzumab according to prescription recommendations. Patients were followed for 3 years.We collected data on patterns of use, dosage and time of exposure to nimotuzumab. Reported adverse events were classified acc ording totype, intensity and seriousness and also it was evaluated the survival time in months.Results: Between December 2005 and August 2012, seventy patients received nimotuzumab grouped according to histology in 44 glioblastoma, 24 astrocytoma, anaplastic and 2 anaplastic oligoastrocytoma. All patients received nimotuzumab in combination with radiation, mostly concurrent (78.6 per cent); the remainder received it sequentially (21.4 per cent). Completed the induction phase planned 94.3 per cent of patients and continued in maintenance beyond 1 year 21.4 per cent. The events related to nimotuzumab were 24.1per cent. The most common were fever, chills, and cutaneous erythema of light and moderate intensity. It was founded no association between toxicity and therapeutic modality, neither with the number of doses received. Patients with anaplastic astrocytoma had a survival at diagnosis over 45 months and with glioblastoma of 14.8 months; with a survival rate at 3 years the 50.8 per cent and 20.2 per cent respectively.Conclusions: The results of this observational study accompaniment those described in controlled studies. Nimotuzumab can be a therapeutic alternative safe, advantageous and feasible as part of conventional treatment in health care conditions(AU)

Síndrome de Nijmegen: una enfermedad genética a considerar en un paciente con microcefalia, retardo mental y lesiones de la piel / Nijmegen breakage syndrome

Se presenta el caso de un paciente masculino que a los 6 años de edad es derivado a Neurología Infantil para su estudio por presentar microcefalia y retardo mental. Tras ser evaluado por Inmunología y Genética se realiza en el Laboratorio de citogenética humana, programa de genética ICBM, Facultad de Medicina Universidad de Chile, PCR para deleción 657 del5 que confirma el diagnóstico de Nijmegen dando como resultado deleción nucleótido 5, mutación 657 del5, característico del Síndrome de Nijmegen. Actualmente el niño tiene 13 años y es tratado en el Servicio de Oncología infantil por el desarrollo de linfoma difuso de células grandes B, patología frecuente en este sindrome.

A case of a male patient at 6 years old was referred to child neurology for study due to microcephaly and mental retardation. After being evaluated for Immunology and Genetics Laboratory is performed in human cytogenetics, genetic program ICBM, Faculty of Medicine University of Chile, PCR for deletion 657 of the 5 that confirms the diagnosis of Nijmegen nucleotide deletion resulting in 5, 657 mutation del 5 Characteristic of the syndrome of Nijmegen. Currently the child is 13 and is treated at the Children’s Oncology Service in the development of lymphoma diffuse large B cell, common pathology in this syndrome.

Anticuerpo monoclonal h-R3 en el tratamiento de tumor de tallo cerebral: presentación de un caso / Monoclonal antibody h-R3 in the therapy of brainstem tumour: a case presentation

Niño de 6 años edad, masculino con diagnóstico clínico e imagenológico de tumor de tallo cerebral que debuta con manifestaciones neurológicas y signos de hipertensión intracraneal. Comienza tratamiento con radioterapia, quimioterapia e inmunoterapia con CIMAher, Anticuerpo Monoclonal h-R3. La evolución clínica fue satisfactoria y actualmente se encuentra asintomático en remisión parcial...(AU)

A 6 year - old boy suffering from a brainstem tumour presenting neurological manifestations and intracranial hypertension signs according to the clinical and imaging diagnosis is presented. Treatment starts with radiotherapy, chemotherapy and immunotherapy with CIMAher, Monoclonal antibody h-R3.Clinical course was satisfactory and patient is asymptomatic with partial remission at present...(AU)

Anticuerpo monoclonal h-r3 en el tratamiento de tumor de tallo cerebral: presentación de un caso / Monoclonal antibody h-R3 in the therapy of brainstem tumour: a case presentation

Niño de 6 años edad, masculino con diagnóstico clínico e imagenológico de tumor de tallo cerebral que debuta con manifestaciones neurológicas y signos de hipertensión intracraneal. Comienza tratamiento con radioterapia, quimioterapia e inmunoterapia con CIMAher, Anticuerpo Monoclonal h-R3. La evolución clínica fue satisfactoria y actualmente se encuentra asintomático en remisión parcial.

A 6 year - old boy suffering from a brainstem tumour presenting neurological manifestations and intracranial hypertension signs according to the clinical and imaging diagnosis is presented. Treatment starts with radiotherapy, chemotherapy and immunotherapy with CIMAher, Monoclonal antibody h-R3. Clinical course was satisfactory and patient is asymptomatic with partial remission at present.