RESUMO
BACKGROUND: There is no information on the use of live varicella vaccine in Mexican children. Our objective was to evaluate antibody response and safety of the live varicella vaccine in both healthy and immunocompromised Mexican children. METHODS: One hundred children with no history of varicella/zoster were vaccinated with a live attenuated varicella vaccine. According to their immune status, patients were divided into either a compromised (leukemia, solid tumors, chronic renal failure, and cirrhosis) or a healthy children group. Serum IgG antibodies against VZV were measured by ELISA at baseline and at 3 and 6 months after vaccination. RESULTS: A positive VZV-ELISA at baseline was detected in 36 of 67 (53.7%) immunocompromised children and in 22 of 33 (66%) healthy children. Among VZV-seronegative children, seroconversion at 6 months post-vaccination was observed in 90.3% of compromised children and in 100% of healthy children. Increases in serum antibody levels at 3 and 6 months post-vaccination was similar in both groups. VZV vaccine-related adverse reactions, mostly mild and local, were detected in 29% of the children. Three compromised children had a mild rash symptomatic of varicella after vaccination. CONCLUSIONS: About 50% of immunosuppressed children (mean age 8.8 +/- 3.6 years) with no varicella history were VZV-seronegative. Almost all of these compromised VZV-seronegative patients seroconverted 6 months after vaccine. In addition, antibody titers were similar in both compromised and healthy children.
Assuntos
Vacina contra Varicela/administração & dosagem , Hospedeiro Imunocomprometido , Adolescente , Anticorpos Antivirais/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , MasculinoRESUMO
A system of evaluation applied to pediatric residents at the Mexican Institute of Social Security (IMSS) is presented. Historical precedents; deficiencies and modifications of the system are commented. Also institutional system of evaluation is described, with emphasis in education strategies: teaching-attendance-research. Usefulness of knowledge tests, supervision, and assessment of evaluation, are mentioned. Finally extrainstitutional evaluation strategies are considered.
Assuntos
Academias e Institutos , Educação Médica , Avaliação Educacional/métodos , Pediatria/educação , Previdência Social , Especialização , Avaliação Educacional/normas , Medicina/normas , México , Pediatria/normas , Ensino/normasRESUMO
A description is made of the situation of neonates and their families during hospitalization in the Neonatal Intensive Care Unit (NICU). Emphasis is made on the stressful situations faced by the infants, the families and the caregivers as well as on potential interventions to ameliorate their negative impact and to promote a favorable outcome. With the infants, the situation is one of overwhelming aversive stimulation, noncontingent responses and painful procedures, coupled with deprivation of normative experiences, propiciated by their illness and the structure of the unit. With the families, their feelings of impotence, guilt, and separation from their infant are highlighted, and interventions are described that may help them in this situation of crisis. With the staff the intervention consists on education and sensitization to the infant's needs. The liaison psychiatrist is the infant's voices with the families and the staff. The literature is reviewed in terms of the potential effects of favorable stimulation and of the negative experiences of neonates while at the NICU.
Assuntos
Recém-Nascido/psicologia , Unidades de Terapia Intensiva Neonatal , Corpo Clínico Hospitalar/psicologia , Pais/psicologia , Psiquiatria , HumanosRESUMO
Mortality Committees are multidisciplinary teams whose function is to analyze preventable causes of death in order to decrease the death rate, to contribute to the education of medical and paramedical staff and also to advise the hospital authorities in medical and administrative decision-making. In this paper we discuss the activities of the Mortality Committee of the Hospital de Pediatria from May 1989 to May 1991. The review comprised 202 death cases occurred during this period, and was carried out by the medical personnel involved in attending those cases while alive. In 42.5% of these cases the review was supplemented by the necropsy results. Patients' personal data, referral source, status on admission, principal disease, direct cause of death, adequacy of laboratory test and other studies, clinical/pathological correlation and suggestions to improve medical care are discussed. We suggest for every hospital the convenience of having this committee in order to improve the quality of medical care.
Assuntos
Causas de Morte , Mortalidade Hospitalar , Hospitais/normas , Comitê de Profissionais , Atestado de Óbito , Humanos , México , Comitê de Profissionais/organização & administraçãoRESUMO
In Pediatric Hospital, from the National Medical Center, of the Mexican Institute of Social Security were analyzed 96 histological pieces: 59 biopsies, 21 surgical material and 16 slides. There were showed the agreement rate between clinical diagnosis and the end histopathological report from the Pathology Department. The higher correlation rate were with biopsies (83%) and surgical material (81%) and the lowest rate were with slides samples (69%). There were not statistical difference in the 3 study groups (P greater than 0.05). The overall concordance with the clinical diagnosis were 82%. The overall concordance with the 3 study groups were 80%. It is concluded what agreement rate was satisfactory in biopsies and surgical material and the agreement rate measure is an actual parameter in evaluation of clinical competence and also in the evaluation of medical care quality.
Assuntos
Diagnóstico , Hospitais Pediátricos/normas , Qualidade da Assistência à Saúde , Biópsia/normas , Biópsia/estatística & dados numéricos , Criança , Erros de Diagnóstico , Técnicas de Diagnóstico por Cirurgia/normas , Técnicas de Diagnóstico por Cirurgia/estatística & dados numéricos , Estudos de Avaliação como Assunto , Hospitais Pediátricos/estatística & dados numéricos , Humanos , México , Qualidade da Assistência à Saúde/estatística & dados numéricos , Sensibilidade e EspecificidadeRESUMO
Blood and its products are valuable therapeutic resources for the pediatrician who care for newborns with severe illnesses. The use of blood and its products requires for the hospital personnel working at neonatal care units to be precise and up to date on the indications and complications of total blood, the globular package, albumin, plasma, the concentration of granulocytes, platelets and immunoglobulins for intravenous use. This review gathers, on the one hand, accumulated experiences by the members of the Commission of Blood and its Products from the Pediatric Hospital of the National Medical Center and on the other hand, a selection of the more important concepts which have been judged so by the authors and expressed in the current medical literature.