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Introducción. El perímetro cefálico (PC) es un indicador del crecimiento cerebral y es necesario contar con referencias de crecimiento que permitan determinar variaciones normales o patológicas. Objetivos. Presentar las primeras referencias argentinas de perímetro cefálico entre el nacimiento y los 19 años, y compararlas con las referencias de Nellhaus, utilizadas en nuestro país hasta la actualidad. Población y métodos. Para la construcción de estas referencias, se combinaron datos de la Encuesta Nacional de Nutrición y Salud 2018 y estudios transversales realizados entre 2004 y 2007 en las provincias de Buenos Aires y La Pampa, que incluyeron 8326 niños, niñas y adolescentes sanos. Las curvas de crecimiento fueron ajustadas con el método LMS. Para evaluar la magnitud de las diferencias entre estas referencias y las de Nellhaus, a diferentes edades, se graficaron los centilos 2, 50 y 98. Resultados. El PC mostró un incremento de tamaño variable con la edad, de mayor magnitud en los primeros años de vida, y un ligero incremento en la pubertad. Los valores del centilo 98 de las referencias argentinas fueron mayores que los de Nellhaus en todas las edades. Los valores del centilo 2 de la referencia nacional fueron menores que los de Nellhaus durante los primeros 2 años de vida, similares entre los 3 y 7 años, y mayores a partir de esta edad. Conclusiones. Las curvas argentinas describen adecuadamente el patrón de crecimiento del PC. Las diferencias halladas con la referencia de Nellhaus pueden atribuirse a cambios seculares.

Introduction. Head circumference (HC) is an indicator of brain growth; growth charts are necessary to determine normal or pathological variations. Objectives. To present the first Argentine HC reference charts between birth and 19 years of age and to compare them with the Nellhaus charts, which have been used in our country to date. Population and methods. These references were developed based on combined data from the National Survey on Nutrition and Health of 2018 and cross-sectional studies conducted between 2004 and 2007 in the provinces of Buenos Aires and La Pampa, which included 8326 healthy children and adolescents. Growth curves were adjusted using the LMS method. To assess the differences between these reference charts and the Nellhaus charts, at different ages, the 2nd, 50th, and 98th percentiles were plotted. Results. HC showed a variable increase in size with age, which was greater in the first years of life, and a slight increase at puberty. The values for the 98th percentile of the Argentine reference charts were higher than those of the Nellhaus charts at all ages. The values for the 2 nd percentile of the national reference were lower than those of the Nellhaus charts during the first 2 years of life, similar between 3 and 7 years of age, and higher after this age. Conclusions. The Argentine curves adequately describe the growth pattern of HC. The differences found with the Nellhaus charts may be attributed to secular changes.

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Introduction. Head circumference (HC) is an indicator of brain growth; growth charts are necessary to determine normal or pathological variations. Objectives. To present the first Argentine HC reference charts between birth and 19 years of age and to compare them with the Nellhaus charts, which have been used in our country to date. Population and methods. These references were developed based on combined data from the National Survey on Nutrition and Health of 2018 and cross-sectional studies conducted between 2004 and 2007 in the provinces of Buenos Aires and La Pampa, which included 8326 healthy children and adolescents. Growth curves were adjusted using the LMS method. To assess the differences between these reference charts and the Nellhaus charts, at different ages, the 2nd, 50th, and 98th percentiles were plotted. Results. HC showed a variable increase in size with age, which was greater in the first years of life, and a slight increase at puberty. The values for the 98th percentile of the Argentine reference charts werehigher than those of the Nellhaus charts at all ages. The values for the 2nd percentile of the national reference were lower than those of the Nellhaus charts during the first 2 years of life, similar between 3 and 7 years of age, and higher after this age. Conclusions. The Argentine curves adequately describe the growth pattern of HC. The differences found with the Nellhaus charts may be attributed to secular changes.

Introducción. El perímetro cefálico (PC) es un indicador del crecimiento cerebral y es necesario contar con referencias de crecimiento que permitan determinar variaciones normales o patológicas. Objetivos. Presentar las primeras referencias argentinas de perímetro cefálico entre el nacimiento y los 19 años, y compararlas con las referencias de Nellhaus, utilizadas en nuestro país hasta la actualidad. Población y métodos. Para la construcción de estas referencias, se combinaron datos de la Encuesta Nacional de Nutrición y Salud 2018 y estudios transversales realizados entre 2004 y 2007 en las provincias de Buenos Aires y La Pampa, que incluyeron 8326 niños, niñas y adolescentes sanos. Las curvas de crecimiento fueron ajustadas con el método LMS. Para evaluar la magnitud de las diferencias entre estas referencias y las de Nellhaus, a diferentes edades, se graficaron los centilos 2, 50 y 98. Resultados. El PC mostró un incremento de tamaño variable con la edad, de mayor magnitud en los primeros años de vida, y un ligero incremento en la pubertad. Los valores del centilo 98 de las referencias argentinas fueron mayores que los de Nellhaus en todas las edades. Los valores del centilo 2 de la referencia nacional fueron menores que los de Nellhaus durante los primeros 2 años de vida, similares entre los 3 y 7 años, y mayores a partir de esta edad. Conclusiones. Las curvas argentinas describen adecuadamente el patrón de crecimiento del PC. Las diferencias halladas con la referencia de Nellhaus pueden atribuirse a cambios seculares.

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Introducción: la gastrosquisis congénita (GC) es una patología con creciente demanda asistencial. Atentos a esto, en el Centro Hospitalario Pereira Rossell (CHPR) se implementó un protocolo de cuidados llevado adelante por un equipo multidisciplinario. En este trabajo nos proponemos evaluar el impacto en la sobrevida y morbilidad a partir de su aplicación. Material y método: estudio comparativo tipo antes y después de pacientes portadores de GC (n = 47), 29 de una cohorte histórica (GH) y 18 de una cohorte posaplicación de protocolo (GP). Con edad gestacional ≥ 36 semanas y peso al nacer ≥ 2500 g, asistidos en el CHPR entre los años 2016 y 2021. Resultados: no se observaron diferencias perinatales entre ambos grupos, ni en la incidencia de GQ complicadas. En el GP se observó mayor incidencia de cierre abdominal precoz (p < 0,01), menor necesidad de realización de silo quirúrgico (p < 0,01), menor tiempo de administración de ventilación mecánica (p = 0,03), de uso total de opioides (p < 0,01), de administración de nutrición parenteral (p = 0,03), e inicio más temprano de la alimentación enteral (p = 0,03). Sin diferencias en la sobrevida al egreso hospitalario. Conclusiones: la aplicación de un protocolo estandarizado se asoció a una reducción significativa en el tiempo de cierre abdominal, de ventilación mecánica, nutrición parenteral y de opioides, con inicio más precoz de la nutrición enteral.

Introduction: congenital gastroschisis is an increasingly demanded pathology, therefore a care protocol was implemented at the Pereira Rossell Pediatric Hospital (CHPR), and it has been carried out by a multidisciplinary team. In this paper, we aim at assessing the morbidity and mortality impact of survival and morbidity of this application. Materials and Methods: comparative before and after study of a historical cohort (GH, n=29) versus a post-protocol application cohort (GP, n=18), in patients with a gestational age ≥36 weeks and birth weight ≥2500 grams assisted in CHPR between 2016-2021. Results: no perinatal differences were observed between both groups or in the incidence of complicated GQ. In the GP, a higher incidence of early abdominal closure was decreased (GH 3.4% vs GP 67%, p<0.01), less need to perform a surgical silo (GH 100% vs GP 33%, p<0.01 ), shorter mechanical ventilation administration time (GH 2 days vs GP 0.5 days, p=0.03), total use of opioids (GH 3.5 days vs GP 7 days, p<0.01) , of administration of parenteral nutrition (GH 24.5 days vs GP 20 days, p=0.03), and earlier start of enteral feeding (GH 11 days vs GP 7 days, p=0.03). No differences in survival after hospital discharge (93% vs 89%, p=0.63). Conclusions: the application of a standardized protocol was linked to a significant reduction in the time of abdominal closure, mechanical ventilation, parenteral nutrition, and opioids, with earlier initiation of enteral nutrition.

Introdução: a gastrosquise congênita (GC) é uma patologia com demanda crescente de atendimento e, porém, foi implementado um protocolo de atendimento por equipe multidisciplinar no Centro Hospitalar Pediátrico Pereira Rossell (CHPR). Neste trabalho propomos avaliar o impacto na mortalidade e morbidade depois de sua aplicação. Material e Métodos: estudo comparativo antes e depois de pacientes com CG (n=47), sendo 29 de uma coorte histórica (GH) e 18 de uma coorte pós-aplicação de protocolo (GP). Idade gestacional ≥ 36 semanas e peso ao nascer ≥ 2.500 gramas atendidos no CHPR entre os anos de 2016-2021. Resultados: não foram observadas diferenças perinatais entre os dois grupos ou na incidência de QG complicada. No GP observou-se maior incidência de fechamento abdominal precoce (p<0,01), menor necessidade de silos cirúrgicos (p<0,01), menor tempo de administração de ventilação mecânica (p=0,03) e uso total de opioides. (p<0,01), administração de nutrição parenteral (p=0,03) e início mais precoce da alimentação enteral (p=0,03). Não houve diferenças na sobrevivência até a alta hospitalar. Conclusões: a aplicação de protocolo padronizado foi associada à redução significativa do tempo de fechamento abdominal, ventilação mecânica, nutrição parenteral e opioides, com início mais precoce da nutrição enteral.

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Introdução: As Doenças Crônicas Não Transmissíveis são as principais causas de morbimortalidade no mundo, responsáveis por 70% das mortes globais e 74% das causas de mortes no Brasil e, pelo fato de estarem associadas ao elevado número de mortes prematuras, perda de qualidade de vida e impactos econômicos negativos para indivíduos, famílias e a sociedade em geral, desde 2003, a Organização Mundial de Saúde têm destacado a necessidade de atenção para mudanças no cenário epidemiológico, com a relevância da atenção às crianças e aos adolescentes. O instrumento DISABKIDS Chronic Generic Measure long form 37 utilizado para mensuração da Qualidade de Vida de crianças e adolescentes com Doenças Crônicas Não Transmissíveis, tem sido traduzido e adaptado para várias culturas e idiomas de forma a ser aplicado por pesquisadores e por profissionais da saúde. Pesquisadores do Grupo de Pesquisa sobre Medidas em Saúde cadastrado no diretório dos Grupos de Pesquisa do Conselho Nacional de Desenvolvimento Científico e Tecnológico, disponibilizaram a versão brasileira denominada Medida Genérica DISABKIDS-37 para Doenças Crônicas Não Transmissíveis, objeto deste estudo. Objetivos: Disponibilizar os escores para Interpretabilidade da Medida Genérica DISABKIDS-37 para crianças e adolescentes brasileiros com Doenças Crônicas Não Transmissíveis, versões Patient Reported Outcomes e Observer Reported Outcomes. Método: Estudo transversal com população constituída de crianças e adolescentes brasileiros com Doenças Crônicas Não Transmissíveis e seus respectivos pais ou cuidadores. A amostra foi composta por 306 participantes. Os dados foram coletados em instituições de saúde do estado de São Paulo e Maranhão. Para os resultados, são apresentados os escores brutos, escores padronizados, percentis e t-escores dos escores de Qualidade de Vida nas dimensões Independência, Emocional, Inclusão Social, Exclusão Social, Limitação, Tratamento e Total, respectivamente, das versões do Instrumento, segundo adaptação e validação para o Brasil e Grupo DISABKIDS Europa. Resultados: De forma global, a Medida Genérica DISABKIDS - 37 para Doenças Crônicas Não Transmissíveis discriminou o impacto negativo das Doenças Crônicas Não Transmissíveis, nos atributos Qualidade de Vida, de crianças e de adolescentes, na sua percepção ou na percepção de seus pais ou cuidadores, sendo maior no Brasil do que na Europa. Este resultado foi observado na maioria das dimensões, para crianças e adolescentes e em 50% das dimensões para seus pais ou cuidadores. Considerações Finais: Este trabalho é um avanço no conhecimento científico e finaliza o longo e produtivo caminho da adaptação do DISABKIDS Chronic Generic Measure long form 37 para o Brasil. Os resultados apresentados mostram escores de fácil interpretação que podem ser agora utilizados na produção de resultados válidos e fidedignos pelos envolvidos no cuidado à saúde da população de crianças e adolescentes no Brasil.

Introduction: Chronic Non-Communicable Diseases are the main causes of morbidity and mortality in the world, responsible for 70% of global deaths and 74% of the causes of deaths in Brazil and, because they are associated with a high number of premature deaths, loss of quality of life and negative economic impacts for individuals, families and society in general, since 2003 the World Health Organization has highlighted the need to pay attention to changes in the epidemiological scenario, with the relevance of attention to children and adolescents. The DISABKIDS Chronic Generic Measure long form 37 used to measure the Quality of Life of children and adolescents with Chronic Non-Communicable Diseases, has been translated and adapted to various cultures and languages to be applied by researchers and health professionals. Researchers from the Research Group on Health Measures, registered in the directory of Research Groups of the Brazilian National Council for Scientific and Technological Development, have made available the Brazilian version called the DISABKIDS-37 Generic Measure Scores for Chronic Noncommunicable Diseases, which is the subject of this study. Objectives: To make available the DISABKIDS-37 Generic Measure Scores for Brazilian children and adolescents with Chronic Noncommunicable Diseases, Patient Reported Outcomes and Observer Reported Outcomes versions. Method: Cross-sectional study with a population consisting of Brazilian children and adolescents with Chronic Non-Communicable Diseases and their respective parents or caregivers. The sample consisted of 306 participants. Data were collected in health institutions in the states of São Paulo and Maranhão. For the results, it was showed the raw scores, standardized scores, percentiles and t-scores of the Quality of Life scores in the Independence, Emotional, Social Inclusion, Social Exclusion, Limitation, Treatment and Total dimensions, respectively, of the versions of the Instrument, according to adaptation and validation for Brazil and DISABKIDS Group Europe. Results: In general, the DISABKIDS-37 Generic Measure Scores for Chronic Noncommunicable Diseases discriminated the negative impact of Chronic Non-Communicable Diseases on the attributes of Quality of Life of children and adolescents, in their perception or their parents or caregivers' perception, being higher in Brazil than in Europe. This result was observed in most dimensions for children and adolescents and in 50% of the dimensions for their parents or caregivers. Final considerations: This study is an advance in scientific knowledge and completes the long and productive journey of adapting the DISABKIDS Chronic Generic Measure long form 37 to Brazil. The results showed easy-to-interpret scores that can now be used to produce valid and reliable results for those involved in the health care of children and adolescents in Brazil.

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OBJECTIVE: To compare estimates of spatiotemporal variations of surface PM2.5 concentrations in Colombia from 2014 to 2019 derived from two global air quality models, as well as to quantify the avoidable deaths attributable to the long-term exposure to concentrations above the current and projected Colombian standard for PM2.5 annual mean at municipality level. METHODS: We retrieved PM2.5 concentrations at the surface level from the ACAG and CAMSRA global air quality models for all 1,122 municipalities, and compare 28 of them with available concentrations from monitor stations. Annual mortality data 2014-2019 by municipality of residence and pooled effect measures for total, natural and specific causes of mortality were used to calculate the number of annual avoidable deaths and years of potential life lost (YPLL) related to the excess of PM2.5 concentration over the current mean annual national standard of 25 µg/m3 and projected standard of 15 µg/m3. RESULTS: Compared to surface data from 28 municipalities with monitoring stations in 2019, ACAG and CAMSRA models under or overestimated annual mean PM2.5 concentrations. Estimations from ACAG model had a mean bias 1,7 µg/m3 compared to a mean bias of 4,7 µg/m3 from CAMSRA model. Using ACAG model, estimations of total nationally attributable deaths to PM2.5 exposure over 25 and 15 µg/m3 were 142 and 34,341, respectively. Cardiopulmonary diseases accounted for most of the attributable deaths due to PM2.5 excess of exposure (38%). Estimates of YPLL due to all-cause mortality for exceeding the national standard of 25 µg/m3 were 2,381 years. CONCLUSION: Comparison of two global air quality models for estimating surface PM2.5 concentrations during 2014-2019 at municipality scale in Colombia showed important differences. Avoidable deaths estimations represent the total number of deaths that could be avoided if the current and projected national standard for PM2.5 annual mean have been met, and show the health-benefit of the implementation of more restrictive air quality standards.

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RESUMEN Introducción. Los índices antropométricos son combinaciones de medidas utilizadas para evaluar el crecimiento normal del niño desde el nacimiento, entre ellos el perímetro cefálico (PC). Objetivo. Medir las concordancias entre las curvas de crecimiento de la OMS, los aplicativos Anthro WHO e Intergrowth 21st, en un grupo de recién nacidos (RN) diagnosticados con microcefalia. Metodología. estudio analítico transversal a 329 RN con microcefalia de un hospital regional. Se tomó como parámetro oro a las curvas de referencia de la OMS comparándolo con el puntaje Z obtenido con los aplicativos Anthro WHO e Intergrowth 21st. Se clasificó a la población según sexo; se calcularon los promedios con desviación estándar para edad gestacional, peso, talla, perímetro cefálico. Se estimó el coeficiente Kappa de Cohen y se utilizó la escala cualitativa Landis y Koch para medir la concordancia. Estadísticos con SPSS. Resultados. De 329 nacimientos, 195 (59%) fueron niñas. Sin diferencias significativas entre los promedios de edad gestacional, peso, talla y PC. Entre OMS/Anthro WHO Kappa=0,813 para las niñas y Kappa=0,804 para los niños (Landis-Koch= casi perfecto y considerable respectivamente). Entre OMS/Intergrowth 21st Kappa=0,030 para niñas y Kappa=0,305 para los niños (Landis-Koch= leve y aceptable respectivamente). Conclusión. El grado de acuerdo entre el parámetro oro OMS y Anthro WHO estuvieron entre considerable y casi perfecto por lo que ambos se pueden utilizar indistintamente. Se sugieren estudios adicionales para evaluar el impacto que pudiera tener las diferencias de acuerdos encontradas entre los parámetros de OMS e Intergrowth 21st.

ABSTRACT Introduction. Anthropometric indices are combinations of measures used to evaluate the normal growth of the child from birth; including head circumference (PC). Objetive. to measure the concordances between the WHO growth curves, the Anthro WHO and Intergrowth 21st applications, in a group of newborns (NB) diagnosed with microcephaly. Methodology. cross-sectional analytical study to 329 NBs with microcephaly from a regional hospital. The WHO reference curves were the gold parameter, comparing it with the Z score obtained with the Anthro WHO and Intergrowth 21st applications. Classified the population according to sex; the averages with standard deviation were calculated for gestational age, weight, height, head circunsfenere. The Cohen Kappa coefficient was estimated and Landis and Koch qualitative scale was used to measure the concordance. Statisticians with SPSS. Results. Of 329 births, 195 (59%) were girls. No significant differences between the means of gestational age, weight, size and CP. Between WHO / Anthro WHO Kappa = 0.813 for girls and Kappa = 0.804 for boys (Landis-Koch = almost perfect and considerable respectively). Between OMS / Intergrowth 21st Kappa = 0.030 for girls and Kappa = 0.305 for boys (Landis-Koch = mild and acceptable respectively). Conclusion. The degree of agreement between WHO gold parameter and the Anthro WHO parameter was between considerable and almost perfect, so both can be used interchangeably. Additional studies are suggested to assess the impact that the differences in agreement found between the WHO and Intergrowth 21st parameters could have.

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Abstract Objective Antenatal recognition of severe cases of congenital diaphragmatic hernia (CDH) by ultrasound (US) and magnetic resonance imaging (MRI) may aid decisions regarding the indication of fetal endoscopic tracheal occlusion. Methods An integrative review was performed. Searches in MEDLINE and EMBASE used terms related to CDH, diagnosis, MRI, and US. The inclusion criteria were reviews and guidelines approaching US and MRI markers of severity of CDH published in English in the past 10 years. Results The search retrieved 712 studies, out of which 17 publications were included. The US parameters were stomach and liver positions, lung-to-head ratio (LHR), observed/expected LHR (o/e LHR), and quantitative lung index. The MRI parameters were total fetal lung volume (TFLV), observed/expected TFLV, relative fetal or percent predicted lung volumes, liver intrathoracic ratio, and modified McGoon index. None of the parameters was reported to be superior to the others. Conclusion The most mentioned parameters were o/e LHR, LHR, liver position, o/e TFLV, and TFLV.

Resumo Objetivo A identificação pré-natal de casos graves de hérnia diafragmática congênita (HDC) por ultrassonografia (US) e ressonância magnética (RM) pode ajudar a decidir sobre a indicação de oclusão traqueal endoscópica fetal. Métodos Uma revisão integrativa foi realizada pesquisando nas bases MEDLINE e EMBASE comtermos relativos a HDC, diagnóstico, RM, e US. Os critérios de inclusão foram revisões e diretrizes abordando marcadores ultrassonográficos e de ressonância para a gravidade de HDC publicados em inglês nos últimos 10 anos. Resultados Foram obtidos 712 estudos, dos quais 17 foram incluídos. Os parâmetros de US foram posições do estômago e do fígado, relação pulmão-cabeça (LHR, na sigla em inglês), LHR observada/esperada (o/e LHR), e índice pulmonar quantitativo (QLI, na sigla em inglês). Os parâmetros de RM foram volume pulmonar fetal total (TFLV, na sigla em inglês), o/e TFLV, volume pulmonar fetal relativo e porcentagem predita, razão do fígado intratorácico (LiTR, na sigla em inglês) e índice de McGoon modificado. Nenhum dos parâmetros foi mencionado como superior aos demais. Conclusão Os parâmetros mais citados foram o/e LHR, LHR, posição do fígado, o/e TFLV, e TFLV.

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Las mediciones confiables, trazables metrológicamente y comparables proporcionan la base racional para la evaluación de la calidad de un resultado y el fortalecimiento de las redes de laboratorios clínicos, lo cual permite mejorar la calidad de atención y la seguridad del paciente. En este documento se revisan los principios básicos que deben seguirse para garantizar la trazabilidad de las mediciones del laboratorio clínico, las ventajas de utilizar métodos trazables, el impacto de no hacerlo, y se discuten las principales limitaciones para relacionar las mediciones con los estándares de medición de referencia apropiados

Reliable, metrologically traceable, and comparable measurements provide the rationale for evaluating the quality of a result and strengthening clinical laboratory networks, thereby improving quality of care and patient safety. This document reviews the basic principles that must be followed to ensure the traceability of clinical laboratory results, the advantages of using traceable methods, the impact of not doing so, and the main limitations in relating measurements to appropriate reference standards

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INTRODUCTION: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. METHODS: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. RESULTS: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). CONCLUSION: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.

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The adherence to accreditation programs proves the institutions' voluntary effort to pursue the quality and safety of their products and services by meeting internationally accepted standards audited by experts in the field, external to the service. Meeting such standards often exceeds domestic legal requirements. However, service providers are not released from complying with the legal requirements, both local and international, pertinent to the field. Accreditation programs use the precepts of the quality management system to validate and standardize processes, monitor results through quality control, proficiency testing, and indicators, and perform risk management. For cellular therapy services, the assessing agencies available in our field are the AABB/ABHH (American Association of Blood Banks/Brazilian Association of Hematology, Hemotherapy and Cellular Therapy) and FACT-JACIE (Foundation for the Accreditation of Cellular Therapy-Joint Accreditation Committee, ISCT/EBMT). Both agencies require that the accredited organization meets all the standards defined in each program. Applying services also have to establish and comply with a quality management standard that demonstrates procedural interrelationship to ensure product and service quality. This paper aims to concisely outline the essential features of those two accreditation programs, along with a brief overview of the accreditation process under each of them.

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Abstract Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.

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La trazabilidad es la capacidad para rastrear la historia, aplicación o ubicación de un objeto bajo consideración. En el ámbito farmacéutico, el rastreo y seguimiento de los medicamentos, incluyendo las vacunas y otros medicamentos biológicos, a lo largo de la cadena de suministro constituye un requisito obligatorio establecido por las autoridades sanitarias a nivel internacional, que se exige en mayor o menor magnitud en las reglamentaciones vigentes. En este artículo se analiza el sistema de codificación y clasificación en el sector de la salud y su estado actual en la cadena de suministro de medicamentos de Cuba. Se presenta un procedimiento para la implementación de las tecnologías de auto-identificación e intercambio electrónico de datos, mediante el uso de GS1 en el sistema de codificación y clasificación empleado en el sector de salud, que permita la trazabilidad en toda la cadena de suministro en Cuba(AU)

Traceability is the capability to track the history, application or location of an object under consideration. In the pharmaceutical field, the tracking and monitoring of medicines, including vaccines and other biological medicines, along the supply chain constitutes a mandatory requirement established by the sanitary authorities at an international level, which is demanded to a greater or lesser extent in the regulations in force. This research was carried out involving different links in the drug supply chain in Cuba, ranging from drug suppliers, drug distribution company, to healthcare centers and pharmacies. An analysis is carried out on the current coding and classification system, detecting the ineffectiveness of the identification of the drugs as the main deficiency. A procedure is proposed for the implementation of the auto-identification and electronic data interchange technologies using GS1 in the coding and classification system used in the health sector that allows traceability throughout the supply chain in Cuba(AU)

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Background: Cesarean section increases four times the risk of venous thromboembolism compared to vaginal delivery. The Royal College of Obstetricians and Gynecologists guidelines are used at our service. A written alert was designed to stratify patients at high, intermediate or low risk making a suggestion for thromboprophylaxis. Aim: To assess the compliance with the guidelines and to evaluate the impact of a written alert in the thromboprophylaxis compliance in women subjected to caesarean section. Patients and Methods: Review of medical records of 233 women aged 19 to 32 years, subjected to a caesarean section in a Gynecology Service, between 2016-2017. Results: Compliance with recommendations was observed in 29% of patients (68/233), 86% in the low-risk group, 26% in the intermediate risk group and 100% in the high risk group. In 41/233 (18%) of patients, a written alert was included in the medical record. Compliance with recommendations in the presence of the written alert was 61% (25/41 women) compared to 22% (43/192) in those lacking the alert (p < 0.01). In women whose emergency caesarean section was the only risk factor, the compliance with the recommendation was 8%, compared with 30% among those who had at least one thrombotic risk factor associated with caesarean section (p < 0.01). Conclusions: In this cross-sectional study, we observed a low compliance with thromboprophylaxis guidelines in cesarean women. We observed that the use of a written alert improved the compliance with thromboprophylaxis.

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Objetivo. Evaluar la reproductibilidad de las pruebas de competencia motriz (CM) de transposición lateral y salto lateral, y estimar percentiles por edad y sexo para niños que viven a altitud modera del Perú.Método. Se efectuó un estudio descriptivo transversal en la provincia de Arequipa (Perú). Se evaluó el peso, la estatura y la circunferencia de cintura. Se calculó el índice de masa corporal e índice ponderal. Se evaluó la prueba de transposición lateral y salto lateral (ambas de la batería Kopfer test für Kinder).Resultados. La muestra estuvo constituida por 885 niñas y 897 niños de 6,0 a 16,9 años. El error técnico de medida intraevaluador para ambas pruebas de CM oscilaron entre 1,75 y 3,9 repeticiones en ambos sexos, mientras que el coeficiente de correlación intraclase fue de 0,77 a 0,99. Los límites de acuerdo oscilaron entre -7,3 y 6,8 repeticiones en ambas pruebas. Se estimaron percentiles 5º, 15º, 50º, 85º y 95º por el método Least-Mean-Square algorithm. Los puntos de corte adoptados para las pruebas CM fueron bajo: < p15; regular: de p15 a p85; y alto: > p85.Conclusión. Las pruebas de transposición lateral y salto lateral mostraron una elevada capacidad de reproductibilidad. Los percentiles propuestos pueden servir para valorar la CM y podrían ser incluidos y adaptados como indicadores de desempeño en la educación física.

Objective. To assess the reproducibility of two motor competence (MC) tests: moving sideways and jumping sideways, and to estimate age and sex percentiles for children living at moderate altitude in Peru.Method. This was a descriptive, cross-sectional study conducted in the province of Arequipa, Peru. Weight, height, and waist circumference were assessed. Body mass index and ponderal index were estimated. The moving sideways and jumping sideways tests were assessed (both from the Körper test für Kinder test battery).Results. The sample was made up of 885 girls and 897 boys aged 6.0-16.9 years. The intra-evaluator technical error of measurement for both MC tests ranged between 1.75 and 3.9 repetitions in both males and females, whereas the intraclass correlation coefficient was 0.77-0.99. Agreement limits ranged between -7.3 and 6.8 repetitions for both tests. The 5th, 15th, 50th, 85th, and 95th percentiles were estimated using the Least-Mean-Square algorithm. The cut-off points for MC tests were low: < p15; medium: p15-p85; and high: > p85. Conclusion. Moving sideways and jumping sideways showed a high capacity for reproducibility. The proposed percentiles may be useful to assess MC and could be included and adapted as performance indicators in physical education

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OBJECTIVE: To assess the reproducibility of two motor competence (MC) tests: moving sideways and jumping sideways, and to estimate age and sex percentiles for children living at moderate altitude in Peru. METHOD: This was a descriptive, cross-sectional study conducted in the province of Arequipa, Peru. Weight, height, and waist circumference were assessed. Body mass index and ponderal index were estimated. The moving sideways and jumping sideways tests were assessed (both from the Körper test für Kinder test battery). RESULTS: The sample was made up of 885 girls and 897 boys aged 6.0-16.9 years. The intraevaluator technical error of measurement for both MC tests ranged between 1.75 and 3.9 repetitions in both males and females, whereas the intraclass correlation coefficient was 0.77- 0.99. Agreement limits ranged between -7.3 and 6.8 repetitions for both tests. The 5th, 15th, 50th, 85th, and 95th percentiles were estimated using the Least-Mean-Square algorithm. The cut-off points for MC tests were low: < p15; medium: p15-p85; and high: > p85. CONCLUSION: Moving sideways and jumping sideways showed a high capacity for reproducibility. The proposed percentiles may be useful to assess MC and could be included and adapted as performance indicators in physical education.

Objetivo. Evaluar la reproductibilidad de las pruebas de competencia motriz (CM) de transposición lateral y salto lateral, y estimar percentiles por edad y sexo para niños que viven a altitud modera del Perú. Método. Se efectuó un estudio descriptivo transversal en la provincia de Arequipa (Perú). Se evaluó el peso, la estatura y la circunferencia de cintura. Se calculó el índice de masa corporal e índice ponderal. Se evaluó la prueba de transposición lateral y salto lateral (ambas de la batería Kopfer test für Kinder). Resultados. La muestra estuvo constituida por 885 niñas y 897 niños de 6,0 a 16,9 años. El error técnico de medida intraevaluador para ambas pruebas de CM oscilaron entre 1,75 y 3,9 repeticiones en ambos sexos, mientras que el coeficiente de correlación intraclase fue de 0,77 a 0,99. Los límites de acuerdo oscilaron entre -7,3 y 6,8 repeticiones en ambas pruebas. Se estimaron percentiles 5º, 15º, 50º, 85º y 95º por el método Least-Mean-Square algorithm. Los puntos de corte adoptados para las pruebas CM fueron bajo: < p15; regular: de p15 a p85; y alto: > p85. Conclusión. Las pruebas de transposición lateral y salto lateral mostraron una elevada capacidad de reproductibilidad. Los percentiles propuestos pueden servir para valorar la CM y podrían ser incluidos y adaptados como indicadores de desempeño en la educación física.

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BACKGROUND: Monitoring gestational weight gain (GWG) is fundamental to ensure a successful pregnancy for the mother and the offspring. There are several international GWG charts, but just a few for low- and middle-income countries. OBJECTIVES: To construct GWG charts according to pre-pregnancy BMI for Brazilian women. METHODS: This is an individual patient data analysis using the Brazilian Maternal and Child Nutrition Consortium data, comprising 21 cohort studies. External validation was performed using "Birth in Brazil," a nationwide study. We selected adult women with singleton pregnancies who were free of infectious and chronic diseases, gestational diabetes, and hypertensive disorders; who delivered a live birth at term; and whose children were adequate for gestational age, and with a birth weight between 2500-4000 g. Maternal self-reported pre-pregnancy weight and weight measured between 10-40 weeks of gestation were used to calculate GWG. Generalized Additive Models for Location, Scale and Shape were fitted to create GWG charts according to gestational age, stratified by pre-pregnancy BMI. RESULTS: The cohort included 7086 women with 29,323 weight gain measurements to construct the charts and 4711 women with 31,052 measurements in the external validation. The predicted medians for GWG at 40 weeks, according to pre-pregnancy BMI, were: underweight, 14.1 kg (IQR, 10.8-17.5 kg); normal weight, 13.8 kg (IQR, 10.7-17.2 kg); overweight, 12.1 kg (IQR, 8.5-15.7 kg); obesity, 8.9 kg (IQR, 4.8-13.2 kg). The 10th, 25th, 50th, 75th, and 90th percentiles were estimated. Results for internal and external validation showed that the percentages below the selected percentiles were close to those expected. CONCLUSIONS: The charts proposed provide a description of GWG patterns according to gestational age and pre-pregnancy BMI among healthy Brazilian women with good neonatal outcomes. The external validation indicates that this new tool can be used to monitor GWG in the primary health-care setting and to test potential recommended values.

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Resumen: La transfusión de sangre ha sido identificada como uno de los procedimientos médicos más sobreutilizados en pacientes hospitalizados. Una estrategia que permitiría reducir la exposición de los pacientes a la sangre es a través de la implementación de una política de transfusión de una sola unidad, en lugar de dos, para pacientes estables, sin hemorragia y con anemia sintomática. La decisión de transfundir sangre es compleja y depende de varios factores, además, los riesgos de la transfusión se deben sopesar contra los beneficios esperados. La transfusión de dos unidades de sangre a la vez ya no se considera una forma de tratamiento "estándar" para pacientes anémicos sin sangrado activo. Existe una gran oportunidad para reducir el uso excesivo de la transfusión y fomentar las transfusiones de una sola unidad.

Summary: Blood transfusion has been identified as one of the most overused medical procedures in hospitalized patients. One strategy that would reduce the exposure of patients to blood is through the implementation of a single-unit regime for stable patients without bleeding and with symptomatic anemia. The decision to transfuse blood is complex and depends on several factors, in addition, the risks of transfusion must be weighed against the expected benefits. Transfusion of two units of blood at the same time is no longer considered a "standard" form of treatment for anemic patients without active bleeding. There is a great opportunity to reduce the overuse of transfusion and encourage single-unit transfusions.

Resumo: A transfusão de sangue foi identificada como um dos procedimentos médicos usados de mais em pacientes hospitalizados. Uma estratégia que reduziria a exposição dos pacientes ao sangue é por meio da implantação de uma política transfusional de unidade única para pacientes estáveis, sem sangramento e com anemia sintomática. A decisão de transfundir sangue é complexa e depende de vários fatores, além disso, os riscos da transfusão devem ser analisados em relação aos benefícios esperados. A transfusão de duas unidades de sangue ao mesmo tempo não é mais considerada uma forma "padrão" de tratamento para pacientes anêmicos sem sangramento ativo. Há uma grande oportunidade de reduzir o uso excessivo de transfusões e incentivar as transfusões de uma única unidade.

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ABSTRACT Objective: To verify the agreement between PHYSICAL BEST and FITNESSGRAM health-related criteria for muscle strength and endurance. Methods: This agreement study had a sample of 81 children and adolescents. Participants were submitted to the PHYSICAL BEST (Sit-up and Pull-up) and FITNESSGRAM (Curl-up and Modified Pull-up) test batteries. Additionally, FITNESSGRAM also proposed criteria for Pull-up test. Results of tests were classified in accordance with their respective criteria. Each group had an interval of seven days between the first and second battery of tests. Statistical analysis used the Kappa index (p<0.05). Results: Sit-up and Curl-up tests among the boys agreed in 72.2% (Kappa=0.368; p=0.004) of cases, and for the girls, in 64.4% (Kappa=0.130; p=0.076). Pull-up (PHYSICAL BEST versus FITNESSGRAM) agreed in 83.3% (Kappa=0.599; p<0.001) for boys. The agreement between Pull-up and Modified Pull-up (PHYSICAL BEST versus FITNESSGRAM) for boys was 47.2% (Kappa=0.071; p=0.533), and for girls, 44.5% (Kappa=0.102; p=0.120). The agreement between the Pull-up and Modified Pull-up tests (FITNESSGRAM) for boys was 58.4% (Kappa=0.215; p=0.143), and for girls, 44.5% (Kappa=0.102; p=0.120). Conclusions: For individual analysis over time, as well as for the comparison of passing rates between different populations, caution is advised when using different criterion-referenced standards for strength and endurance, particularly if using different tests.

RESUMO Objetivo: Verificar a concordância entre os critérios relacionados à saúde para força e resistência muscular da PHYSICAL BEST e FITNESSGRAM. Métodos: Estudo de concordância com amostra composta de 81 crianças e adolescentes. Os participantes foram submetidos à bateria da PHYSICAL BEST (Abdominal e Flexão de cotovelos na barra) e da FITNESSGRAM (Abdominal modificado e Flexão de cotovelos na barra modificada). Adicionalmente, a FITNESSGRAM também propôs critérios para a Flexão de cotovelos na barra. Os resultados dos testes foram classificados de acordo com seus respectivos critérios. Houve um intervalo de sete dias entre as aplicações das baterias para cada grupo. A análise estatística utilizou o índice Kappa (p<0,05). Resultados: Os testes Abdominal e Abdominal modificado concordaram em 72,2% (Kappa=0,368; p=0,004) entre os meninos e 64,4% (Kappa=0,130; p=0,076) entre as meninas. Flexão de cotovelos na barra (PHYSICAL BEST versus FITNESSGRAM) concordou em 83,3% (Kappa=0,599; p<0,001) para os meninos. A concordância entre Flexão de cotovelos na barra e Flexão de cotovelos na barra modificada (PHYSICAL BEST versus FITNESSGRAM) foi de 47,2% (Kappa=0,071; p=0,533) para os meninos e 44,5% (Kappa=0,102; p=0,120) para as meninas. A concordância entre o teste de Flexão de cotovelos na barra e de Flexão de cotovelos na barra modificada (fitnessgram) foi de 58,4% (Kappa=0,215; p=0,143) para os meninos e 44,5% (Kappa=0,102; p=0,120) para as meninas. Conclusões: Para análises individuais ao longo do tempo, bem como para a comparação do atendimento entre diferentes populações, recomenda-se cautela ao usar diferentes critérios para a força e resistência, particularmente se forem usados testes diferentes.

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BACKGROUND Chagas disease, caused by Trypanosoma cruzi, affects nearly six million people worldwide. Various serological tests have been developed for its diagnosis. OBJECTIVE Examine the performance of a set of commercial immunological assays in relation to the geographical origin of the patient sample comparing four states of Brazil: Amazonas (AM), Mato Grosso do Sul (MS), Minas Gerais (MG) and Piauí (PI). METHODS Seven immunoassays were employed to detect anti-T. cruzi IgG antibodies in 379 patient samples that had been previously diagnosed using the two-step protocol required by the Brazilian Ministry of Health. FINDINGS A significant variation in the percent reactive was calculated for the samples from AM and MS, while the PI and MG showed a significant variation in the percent non-reactive. The average reactivity index was significantly higher for samples from the states of PI and MG states than AM and MS. MAIN CONCLUSIONS All tests presented a satisfactory performance overall. Yet, variations were observed that were associated to the region of origin of the samples. Our analyses suggest that future evaluations of immunoassays should include a sampling of sera from regions where the test will be applied in addition to the available International Biological Reference Standards.