RESUMO
We present results of four years in oral rehydration therapy (ORT) in the Hospital Infantil del Estado de Sonora. There was 10.2 consults by diarrhoea for day. Children lower of one year old received oral rehydration therapy in 86.8%, were included 11% of prolonged diarrhoea and 32.3% of children with malnutrition. During the procedure diarrhoea there was complicated in 3% with paralytic ileus sepsis and pneumonia. Effectivity of ORT was in 90.9%; 92.8% in light dehydration and 78.7% moderate. Failure in 8.6% was due to vomitus, no acceptation of the oral solution, abundant evacuations and other complication presented. Were observed reduction in hospitalization, rate of 19.2% in 1986 to 38.4% in 1989. The diarrheal mortality decreased in the Urgence Department in 42% and in the Infectology Department in 54%. We considered these results as satisfactory, but are susceptible to better when we diffuse more the oral rehydration therapy in own region.
PIP: A retrospective study was conducted of the daily reports of the Outpatient Emergency Service of the Children's Hospital of the State of Sonora. Records of children receiving oral rehydration therapy between January 1986 and December 1989 were reviewed to assess the efficacy of the treatment and its impact on hospital admissions and mortality. Children of any age and nutritional status with diarrhea of any etiology and duration were included. Children in shock or with contraindications to oral therapy were excluded. 975 of the 14,893 children consulting for diarrhea in the four years (6.5%) received oral rehydration therapy. 868 of the children (89.0%) had acute diarrhea and 107 (11%) had prolonged diarrhea defined as over two weeks duration. The average patient age was 7.4 months and 847 (86.9%) were under one year old. 754 of the children had mild and 221 had moderate dehydration. 315 of the children (32.3%) were malnourished. 123 of the 975 children were hospitalized. Treatment was considered to have failed in 84 cases (8.6%), including 29 with persistent vomiting, 20 who did not accept oral rehydration solution, 18 with fecal output exceeding 10 ml/kg/h, and 17 with complications of diarrhea. The 847 children successfully rehydrated by the oral route represented a reduction of 29.1% in hospitalizations for diarrhea over the four years, during which 2062 children were hospitalized for intravenous rehydration. The magnitude of the reduction in hospital admissions increased from 19.2% in 1986 to 38.4% in 1989. The case fatality rate from diarrhea declined from an average of 7.0% between 1980 and 1985 to an average of 4.0% between 1986 and 1989. Mortality from prolonged diarrhea averaged 6.0% between 1984 and 1989.
Assuntos
Diarreia Infantil/terapia , Diarreia/terapia , Hidratação , Hospitalização , Adolescente , Criança , Pré-Escolar , Diarreia/mortalidade , Diarreia Infantil/mortalidade , Feminino , Hidratação/métodos , Hidratação/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Estudos Retrospectivos , Falha de TratamentoAssuntos
Diarreia Infantil/terapia , Hidratação , Pré-Escolar , Feminino , Humanos , Lactente , MasculinoAssuntos
Lactente , Pré-Escolar , Criança , Adolescente , Humanos , Masculino , Feminino , Anfotericina B , CoccidioidomicoseRESUMO
Se revisaron los expedientes clinicos de cinco pacientes con coccidioidomicosis meningea, internados en el Hospital del Nino del Noroeste DIF. La edad de los pacientes vario de cuatro meses a 13 anos, todos eran residentes de area endemica y cursaron con sintomatologia neurologica cronica y vaga. El diagnostico etiologico no fue posible establecerlo en base a los hallazgos clinicos, radiologicos ni aun con las alteraciones descritas en el estudio citoquimico del liquido cefalorraquideo, por lo que fue necesario realizar pruebas inmunologicas especificas en este y buscar intencionadamente el hongo para llegar al diagnostico de certeza. El tratamiento en tres de los casos fue medicoquirurgico mediante la administracion de anfotericina B intravenosa e intratecal y colocacion de reservorio subcutaneo craneal y/o derivacion ventriculoperitoneal. La respuesta al tratamiento fue mala, interviniendo varios factores para ello, principalmente la tardanza para establecer la etiologia del padecimiento. De los casos tratados, un solo paciente vive (33%); no ha presentado recaidas y lleva una vida normal. Se concluye que la coccidioidomicosis meningea no es rara en areas endemicas, debiendose investigar en todos aquellos pacientes con manifestaciones neuropsiquiatricas de evolucion prolongada y que residan en dichas areas, ya que la tardanza en su diagnostico se acompana de una alta morbilidad y letalidad. Coccidioidomicosis meningea