La neumonía asociada a ventilación mecánica (NAV) es causa de morbimortalidad en la unidad de cuidados intensivos pediátricos (UCIP). Sin embargo, su definición para fines de vigilancia epidemiológica ha presentado diversos cuestionamientos, así como el paquete de medidas tendientes a su prevención. El año 2013 los Centers for Disease Control and Prevention (CDC) de los Estados Unidos incluyó la NAV dentro de la vigilancia epidemiológica de eventos asociados a ventilador (EAV). En esta nueva definición, un EAV incluye a aquellas complicaciones (no necesariamente infecciosas) que precisan un aumento sostenido de los parámetros del ventilador mecánico.

INTRODUCCIÓN. Los leucocitos fecales son utilizados para identificar diarrea invasiva y decidir el uso de antibióticos. Se conoce poco sobre su utilidad en hospitales de países en desarrollo con procesos de laboratorio eficientes. Buscamos evaluar el rendimiento diagnóstico de la prueba en menores de 5 años con diarrea aguda. MATERIAL Y MÉTODOS. Estudio retrospectivo de registros clínicos y de laboratorio en el Hospital de Emergencias Pediátricas, Lima, Perú. Se evaluó los casos a los que se había solicitado sistemática e independientemente leucocitos fecales y coprocultivo. Se calculó sensibilidad, especificidad, valores predictivos, cocientes de probabilidad (CP) y la curva de características operativas del receptor (ROC). RESULTADOS. De 1,804 muestras fecales, 901 (49,9%) fueron positivos para uno o más enteropatógenos bacterianos. La sensibilidad (S), especificidad (E...

The concept of evidence-based medicine (EBM) has been increasingly incorporated in medicine practice and teaching. In the clinical arena it is defined as the use of the best available scientific evidence coming from clinical research for decision-making purposes, when facing individual patients. This paradigm change in the way medicine is taught and practiced has been due in part to the accelerated progress in scientific research, particularly in the last few decades, albeit the increasing costs involved in care of patients also played an important role in its development and consolidation. EBM involves integration of clinical expertise with the available external evidence, and provides a more critical approach to clinical problems, reducing error probabilities in different phases of the clinical process. It is not easy to reach a definitive conclusion about its impact on teaching and pr...

Introducción: La retinopatía diabética (RD) es una complicación microvascular mayormente asintomática que - a pesar de ser prevenible - es la primera causa de ceguera irreversible en personas laboralmente activas. La dislipidemia es un factor de riesgo no concluyente de la RD, a raíz de los resultados de un metaanálisis reciente; siendo pertinente la realización de un estudio en población peruana. Objetivo: Evaluar la relación entre dislipidemia y RD en pacientes diabéticos tipo II atendidos en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú entre el 2018 y el 2020. Métodos: Estudio de casos y controles. Se incluyeron 219 casos y 219 controles. Los pacientes diabéticos se clasificaron según la presencia o ausencia de RD determinado por el especialista. Se recolectaron datos de los parámetros lipídicos (triglicéridos, LDL, HDL, colesterol total) y otras var...

A case of severe rhabdomyolysis associated with multisystem inflammatory syndrome related to COVID-19 (MIS-C) is presented in a one-year 10-month-old boy who presented digestive symptoms, myalgia, weakness, fever, and dark urine. COVID-19 IgM (-) IgG (+) serological test, COVID-19 PCR negative. Initial creatine kinase (CK) presented non-dosable values, with the highest reported level being 517,600 U/L. The creatinine value remained normal throughout the hospitalization. He received human immunoglobulin 2 g/Kg, Methylprednisolone 10 mg/Kg/d, and acetylsalicylic acid to manage MIS-C. Aggressive hydration and urine alkalinization were provided to manage rhabdomyolysis. Positive evolution with discharge after ten days. Few reported cases of rhabdomyolysis are associated with MIS-C and none with such high CK values. Based on the possible complications, performing CK dosing in all patients wit...

Objective: To determine the association between glycemia values and mortality in the Pediatric Intensive Care Unit. The study: Retrospective cohort study in pediatric patients between 1 month and 18 years; hospitalized in the PICU for more than 48 hours. Findings: 184 patients were included. The median age was 33.5 months; mortality was 11.54%. The adjusted analysis showed that maximum glucose in 24 hours and PIM2 scale value could be presented as risk factors for mortality, unlike sex, age, and Glasgow scale value, which were presented as protective factors. Conclusion: In the series evaluated, an association was found between the value of maximum glucose in the first 24 hours and mortality in the PICU. Prospective studies are needed to assess this association.

Background: Septic shock is a common cause of admission to pediatric intensive care units (PICU) and is associated with significant mortality. Our objective was to analyze the association between septic shock diagnosis at PICU admission and mortality during hospitalization. Method: This retrospective cohort study was conducted in the PICU of Hospital Nacional Edgardo Rebagliati Martins (HNERM) in Lima, Peru, from January 2018 to December 2021. The sample size was determined based on annual mortality rates, and randomization was used to create two groups: patients with and without septic shock. To evaluate mortality risk, we performed a Poisson regression with robust variances and 95% confidence intervals (CI) using both crude and adjusted models. Results: Of 1,341 patients admitted to the PICU during the study period, 358 were included in the analysis. The study population was 51.9% fema...