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Introduction: Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis., Methods: Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed., Results: The total number of appendicitis cases went down by 25% (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44% (n = 22) versus 37% (n = 22) (p = 0.22) in 2019. No differences were observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42% (n = 21). The incidence of complications was 6% versus 7.5% in the previous period (p = 0.75). One patient was COVID-19 positive., Conclusion: Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission., Competing Interests: None, (Sociedad Argentina de Pediatría.)

The incidence of pediatric cardiac arrest is unknown; its main etiologies are congenital heart diseases, cardiomyopathies, and ventricular arrhythmias. An electrocardiogram (ECG) is a diagnostic method that may allow to detect them in an early manner and reduce morbidity and mortality. The objective of this study was to describe pediatric residents' skills to determine if an ECG was normal or abnormal and make an accurate electrocardiographic diagnosis before and after an educational intervention. First-year pediatric residents participated in this study. An assessment including 12 ECG tracings was done before and after an educational module, and scores were compared using the t-test for paired data. No differences were observed between both assessments regarding the interpretation of ECG as normal or abnormal (p: 0.42). However, a statistically significant difference was observed in definitive diagnoses (p < 0.002). Definitive electrocardiographic diagnoses improved after the implementation of an educational module., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Health care providers' involvement is critical for quality of care improvement. Nevertheless, most residency programs do not include this topic. The objective is to describe an educational experience on quality of care improvement for residents. The development of an improvement cycle was included in the second year syllabus of the pediatric residency program. A handbook and an online course were provided. Over 12 months, 10 proposals were designed on therapeutic and diagnostic approaches, effective communication, patient admission and logistics; they were based on sentinel events, incident reports, direct observation, and patients' complaints. Multidisciplinary working teams were formed. Health care protocols were agreed and processes were standardized. A program based on educational goals for continuous quality improvement allowed residents to acquire theoretical training and practical experience on the topic., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Introduction: Advances in diagnostic methods, surgical techniques and postoperative intensive care have significantly increased the survival rates for children with congenital heart disease. In this context, long term sequelae acquired greater relevance. Health-related quality of life (HRQOL) is a concept that helps to measure the impact of chronic diseases. The purpose of the current study was to describe HRQOL in children with congenital heart disease that undergo cardiac surgery during their first year of life., Methods: A cross-sectional observational study was conducted between August 2017 and December 2018 at a University General Hospital. PedsQL 4.0 Generic Core Scales were used. Children with congenital heart disease between 2 and 4 years old who had cardiac surgery during their first year of life and healthy children were included. Scores were compared with T-test or Wilcoxon according to the observed distribution. p value < 0.05 was considered significant., Results: A total of 31 children with congenital heart disease (26 % with a single ventricle) and 62 healthy children were enrolled. The first surgery was in the neonatal period in 61.3 %. Our study showed no statistical differences (p = 0.10) between HRQOL Total Scale Score of children with congenital heart disease compared to healthy children. However, lower scores were observed with statistically significant differences in social (p = 0.0092) and school (p = 0.0001) scales., Conclusions: Our cohort of children diagnosed with congenital heart disease has a global quality of life comparable with healthy children except in social and school functioning scales., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Ménétrier's disease is a protein losing gastroenteropathy. Defined as a rare entity with an unknown cause, most of the reported cases have been associated with viral infections. In pediatric patients, it is characterized by an acute onset with a benign and self-limiting course. It is characterized by thickened gastric folds that generally involve the body and the gastric fundus, associated with hypoalbuminemia due to the loss of serum protein through the mucosa. The following are two clinical cases of infant Ménétrier syndrome associated with cytomegalovirus infection., (Sociedad Argentina de Investigación Odontológica.)

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.

Introduction: Latex allergy is common in the hospital setting., Objetive: To describe the clinical situation of three pediatric interns with latex allergy and the prevention strategies implemented during clinical clerkships in pediatric and neonatal intensive care units., Patients, Methods, and Outcomes: The three interns referred symptom exacerbation during their internship program. Diagnosis was confirmed based on a compatible history and positive specific immunoglobulin E. A semi-structured interview was done to describe perceptions about prevention strategies, the personnel were trained, and nitrile gloves were provided for carrying out procedures. Interns completed their clinical clerkships without having allergic reactions. Positive aspects referred by interns were that they felt cared for and experienced an improved quality of life; negative aspects were a bad predisposition and resistance against change among some other interns. Strategies designed to this end permitted interns to continue their internship program., (Sociedad Argentina de Pediatría)

Introduction: The educational environment (EE) is related to satisfaction and achievement. A high prevalence of professional burnout (BO) syndrome has been reported in the residency. The objective of this study was to evaluate the correlation between EE and the presence of burnout in residency programs at a university hospital., Population and Methods: Residents from five programs at Hospital Italiano de Buenos Aires were evaluated. The following items were recorded: specialty, year of residency, sex, nationality and coexistence. The Postgraduate Hospital Education Environment Measure (PHEEM) that evaluates autonomy, teaching and social support, was used to measure EE. Burnout was measured with the Maslach Burnout Inventory (MBI) that evaluates exhaustion, depersonalization, and personal accomplishment., Results: Ninety two residents participated. The mean EE was 106.8 (more positive than negative environment). Out of the evaluated residents, 19.6% showed burnout. There were significant differences in the EE between the populations with and without burnout; mean values: 98.7 vs. 108.8 (p= 0.0056). A negative significant correlation was observed between EE and exhaustion (r= -0.24) and EE and depersonalization (r= -0.35) and a positive significant correlation was found between EE and personal accomplishment (r= 0.44). In the same sense, a greater correlation was observed between burnout and PHEEM autonomy subscale (r= -0.58; -0.41 and 0.46, respectively)., Conclusions: In the residency, a significant correlation was found between the EE and burnout (reverse with exhaustion and depersonalization, and direct with personal accomplishment). This correlation had greater strength and the same sense for items evaluating autonomy.

Objectives: To evaluate the distribution and analyze the use of resources and direct medical costs in children and adolescents diagnosed with a chronic disease and compare them with healthy children of the same age from a health insurer perspective., Methods: We analyzed the resources used and direct medical costs generated during 2008 in 21-year-old patients or younger affiliated to a health plan of community hospital in Buenos Aires, Argentina. We compared the outcomes of patients with at least one chronic disease as defined by Stein with healthy patients from a health insurer perspective with a one year time horizon. The costs were expressed in U.S. dollars for 2008., Results: We identified 1885 children and adolescents with chronic illness, accounting for 6.7% of the total pediatric population studied. This group had a greater number and length of hospitalization, greater use of medications, practices and medical consultations than the healthy pediatric population. The mean total annual costs were US$ 501 (95% CI: 419-583) and US$ 212 (95% CI: 188-236), respectively (p < 0.001). Overweight, obesity and asthma, even with relatively low or moderate costs per patient, generated almost 39% of the total costs of chronic diseases due to its high prevalence., Conclusion: The pediatric population with diagnosis of at least one chronic disease had significantly greater utilization of medical services and increased costs in all areas studied. It is also important to recognize that diseases of low or moderate cost per patient, but highly prevalent, generate the largest share of expenditure of chronic diseases in the population.

The present work analyzes the presence of transfer as a strategy for solving problems in students of Compulsory Secondary Education (ESO) and its relation with the course and with academic achievement. To this end, an analysis of variance was performed, obtaining better results for the 4th course of ESO and the higher achieving groups. This work is also meant to be a subject of reflection about the value of transfer in the educational area and the relevance of the teacher as a model in the classroom to promote the search for relations between different areas and disciplines.

Introduction: Musculoskeletal pain is a common symptom in childhood. It is estimated that 5 to 19% of healthy children experience musculoskeletal pain., Aims: To estimate the prevalence of musculoskeletal pain and to describe epidemiological characteristics in children 3 to 12 years of age, who attend a community hospital., Population, Material and Methods: This is an observational transversal study. A self-administered questionnaire was completed in the waiting room of the Pediatric ambulatory area. Children with chronic diseases were excluded. Statistical tests used included chi(2) test, Mc Nemar and a logistic regression model analysis., Results: A total of 240 questionnaires were distributed and 229 were returned. Median age of children was 6 years and 36 (25-50) years in their mothers. Fifty four percent were girls. Pain was present in 21.4% in the last year, and 19.2% in the past 3 months, both groups were concordant (Mc Nemar test not significant). Associated factors with pain in the last year were: age and family history of current pain and during childhood (logistic regression model). No relation was found with sex of the child, mother age, mono-parental family, siblings or stress family factors in the last year. The musculoskeletal pain was localized in: lower limbs (66%), muscles (52%), joints (38%) and was bilateral in 33%. In 40% of children the pain duration was transient (minutes), 55% developed pain, at least, once a month and in 51% was related to exercise. Limitation of daily living activities due to pain was seen in 16%. The pain resolved spontaneously in 50%. Pediatricians were consulted in 63% of the cases and 8% consulted in Orthopedics. When comparing the pain pattern in 2 groups of children (< and > 6 years), we found that older children tended to present pain more than once a month and related to exercise., Conclusions: The prevalence of musculoskeletal pain was 21.4%. Pain was associated to child age and family history of musculoskeletal pain. Pain was referred to lower limbs (mainly muscles), periodic (more than once a month) and related to exercise.

Introduction: Blood pressure measurement (BPM) is a recommended practice at least once a year for all of healthy children starting from 3 years old and before that age in population at risk. Pediatricians fulfilling of this recommendation is irregular. Objective. Identify the prevalence of records of BPM in a pediatric electronic health record (EHR) in patients from 3 to 20 years of age and the prevalence of records of hypertension (HBP) and prehypertension (preHBP) according to sex, age and percentile of height., Population, Material and Methods: A cross-sectional and analytical study was conducted. 8140 patients from 3 to 20 years of age seen by their primary care physician at least in one opportunity between January and June 2005 were evaluated. Hypertension, prehypertension and normal BP was defined based on the recommendation published in Pediatrics 2004 Aug; 114: 555-76., Results: 2.723 of the 8.140 patients had BP registered in the EHR (33.4%), 76% of the records were of normal BP, 17% of preHBP and 7% of HBP. The percentage of preHBP was significantly higher in males (21.7% vs. 13.4%) OR: 1.6 (IC 95% 1.3-1.9), but not in HBP (7.4% vs. 6.8%). 50% of the pediatricians registered 9% or less of their patients BP., Conclusions: The prevalence of BPM was a third; there is a need of generating actions that stimulate this practice.

This study starts out from the general agreement about the explicit memory deficits in children with Down's syndrome. Our aim is to explore the possibilities of the computer as a valuable instrument with which to train memory by teaching cognitive rehearsal strategies. The sample was made up of 40 students with Down's syndrome and was divided into two research groups: control and experimental. The results show a clear tendency towards memory improvement in the experimental group. These results can be considered indicators of the effectiveness of the intervention. They are also very interesting for education, in the sense that teachers can help the students with Down's syndrome to improve their memory capacity.

The objective of this study was to investigate the potential inductive effect of nevirapine (NVP) with methadone. Eight patients on the methadone maintenance programme with anti-retroviral therapy because of their infection with HIV, well maintained with methadone and without symptoms of abstinence were studied. All were included in a study of measurement of plasma levels of methadone. Anti-retroviral medication was changed, including NVP, and patients began with symptoms of abstinence 5 to 10 days later. Our results indicate an inductive effect of NVP on the methadone metabolism which caused symptoms of abstinence in all patients, which prompted an increase in the dose and plasma concentration of methadone was lost; patients continued with significantly low plasma levels (p < 0.01) after a therapy mean duration of 6.5 months, with no full recovery.