Twenty-three multiprogrammable pacemakers and four implantable cardioverter defibrillators (ICDs) containing either complementary metal-oxide semiconductor (CMOS) or CMOS/Bipolar integrated circuit (IC) technology were exposed to 6-MV photon and 18-MeV electron radiation at various dose levels. Of the 17 pacemakers exposed to photon radiation eight failed before 50 Gy, whereas four of the six pacemakers exposed to electron radiation failed before 70 Gy. Photon scatter doses were well tolerated. For the ICDs detection and charging time increased with accumulated radiation dose, the charging time increased catastrophically at less than 50 total pulses delivered when compared with the charging time of six implanted ICDs. Sensitivity and output energy delivered by the ICD pulse were constant during the test. It was found that devices using the shorter channel length IC technology (i.e., 3 microns CMOS) were per se harder to ionizing radiation than the devices using larger channel length IC technologies (i.e., either 8 microns CMOS or combined 5 microM CMOS/20 V Bipolar). In fact, none of the devices based on 3 microns CMOS IC technology failed before 76 Gy, which is above the highest dose level (70 Gy) normally used in radiation oncology treatments.

Background Skin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. However, separation at birth is common with negative impact on breastfeeding. The aim was to determine the effect of immediate SSC compared to early SSC on the duration of exclusive breastfeeding. Methods A randomized multicentre parallel clinical trial was conducted in two hospitals in Cundinamarca (Colombia) between November 2018 and January 2020. Low-risk full term newborns at birth were included. Neonates were assigned to immediate (in the first minute after birth) or early onset (start exactly at 60 min of life) skin to skin contact. Monthly follow-up was performed until 6 months of age. The primary outcome was the percentage of exclusively breastfed infants at 6 months (time in months with human milk as the only source of food). Secondary outcomes were the percentage of infants with exclusive breastfeeding at 3 months, duration in months of exclusive breastfeeding, neonate’s breastfeeding ability, percentage of weight change between birth and the first week of life and hospitalization in the neonatal unit in the first week. A bivariate analysis was performed to determine the variables associated with exclusive breastfeeding at 6 months. A survival analysis was performed to evaluate the effect of the onset of SSC on exclusive breastfeeding duration. Results A total of 297 newborns were included: 49.8% (n = 148) in the immediate SSC group, and 50.2% (n = 149) in the early SSC group. The mean duration of exclusive breastfeeding in both groups was 5 months. There were no differences between the groups in the percentage of exclusive breastfeeding at 6 months (relative risk [RR] 1.06, 95% CI 0.72, 1.58) or in the duration of exclusive breastfeeding (hazard ratio [HR] 0.98, 95% CI 0.74, 1.28). Conclusions The percentage of infants and the duration of exclusive breastfeeding in the first 6 months of age were the same between the two groups of SSC interventions. Given the current barriers to its implementation, the results of this study could positively impact the use of SSC at birth and standardize the intervention and improve breastfeeding indicators. Trial registration ClinicalTrials.gov NCT02687685.

BackgroundHuman lactancy is a simple and cost-effective strategy that influences infant and maternal mortality rates. Skin-to-skin contact (SSC) is an immediate postpartum period strategy that has proven to benefit the initiation and continuation of human lactation and to decrease hospitalization during the first week of life. This study aims to determine the effect of SSC initiation at birth (immediate versus early) in healthy, full-term newborns treated at the Universidad de La Sabana Clinic on the duration of exclusive human lactation.Methods/designA randomized, blind clinical trial will be performed with full-term healthy newborns born at the Universidad de La Sabana Clinic. The blind trial participants will be those persons measuring the results and analyzing the data. The sample size will be calculated for a type I error of 5 %, a two-tailed type II error of 20 %, and an estimated percentage loss of 30 %; 150 infants will be included in each group. Randomization will be performed using permuted, size-6 blocks. Descriptive analysis will be conducted using central tendency and dispersion measurements. A bivariate analysis will be performed to determine which variables are associated with exclusive lactancy at 6 months. For continuous variables, Student’s t test will be used for independent samples, and the Wilcoxon rank sum test will be used if the assumptions of normality for the t tests are not fulfilled. The assumption of normality will be evaluated using the Shapiro-Wilk and Kolmogorov-Smirnov tests. Categorical variables in contingency tables will be constructed to assess the independence between variables using the chi-square test, or Fisher’s exact test when the assumption of the number of cases is not met by the values in the contingency tables multiplied by two. This will be calculated as a measurement of the effect of relative risk (RR) with confidence intervals; the adjusted measurements will be calculated using a multivariate regression Poisson model. Variables with significant results will be used in the bivariate analysis, and those with biological plausibility will be used for the adjustment. The analysis will be carried out for a two-tailed type I error level of 5 %. The Stata 11 program will be used for data analysis. An interim analysis will be performed upon the submission of half the expected events (106), setting limits for the early termination of the trial according to the method proposed by Pampallona and Tsiatis (1994). Intervention: There will be two SSC randomization groups: early versus immediate. After completing the neonatal adaptation process and based on the group assignment, the mother will be left with her newborn child in hospital accommodation. Prior to discharge, the Infant Breast-Feeding Assessment Tool (IBFAT) will be applied. Monitoring will initially be performed with a face-to-face assessment between 3 and 10 days of life, followed by monthly telephone calls for 6 months to verify lactation status.DiscussionSSC at birth has shown benefits in the short and long term fo...

La gravedad de la infección respiratoria aguda (IRA) es mayor en países en desarrollo, sobre todo entre grupos social y económicamente pobres. Las neumonías virales son las más comunes, especialmente en niños. Con el fin de medir algunos factores asociados con formas graves de infección respiratoria baja realizamos un estudio de casos y controles prospectivo y de base hospitalaria en Bogotá entre noviembre de 2000 y agosto de 2001. Los casos fueron niños entre 2 meses y 5 años que llenaban los criterios de la OMS para IRA grave o muy grave. Los controles eran niños con IRA en el mismo rango de edad, que consultaban al mismo hospital y que no presentaban tirajes. Se estudiaron 638 niños entre los 2 meses y los 5 años de edad (277 casos y 361 controles). Los factores más importantes fueron: vivienda en préstamo (OR=2,7; IC95%: 1,06-7,07), compartir la cama (OR=1,88; IC95%: 1,0-3,7), más de 9 personas en la misma casa (OR=1,82; IC95%: 1,0-3,51) y fumadores en la vivienda (OR=1,4; IC95%: 1,0-2,05). Se tomaron 114 muestras nasofaríngeas (niños con 3 días de haber iniciado síntomas) y se obtuvieron virus en 98 de ellas, y se identificó el virus sincitial respiratorio en 41,8%, virus influenza A en 3,1% y virus influenza B en 1%. El 100% de los aislamientos positivos para influenza A y B fueron enviados al CDC en Atlanta, donde fueron clasificados como influenza A/PANAMA/2007/99-like e influenza B/SICHUAN/379/99-like, respectivamente.

Background Several environmental factors favour the occurrence of acute respiratory disease, which is the main reason for paediatric consultations in our country (Colombia). Tobacco smoke is considered a significant environmental pollutant with a great impact on health. The objective of this study is to estimate the prevalence of cotinine levels measured in urine, in children between 1 to 60 months of age who attended an emergency department with acute respiratory disease. Methods A cross-sectional study was conducted that included children between 1 and 60 months of age with acute respiratory disease who were admitted to the emergency department of the Universidad de La Sabana Clinic between April and July 2016. Results We included 268 patients and 36% were female. Of the total population examined, 33.96% showed positive results for urinary cotinine, of whom 97.8% had values between 10 and 100 ng/ml, which is considered positive for exposure to second-hand smoke. The principal pathology was recurrent wheezing in 43.96% of these cases. Regarding the presence of smokers at home, it is important to mention that in 54.95% of the children with positive urinary cotinine test was no related with smokers at home. And in 45.05% of positive urinary cotinine was evidence of smokers at home, being associated with the positive result P <  0.001 and smoking within the house P = 0.018; smoking when children were present did not have significant P = 0.105. The activities performed after smoking such as hand washing, change of clothes, eating, brushing teeth, did not influence the test result P = 0.627. Conclusions A high prevalence of urinary cotinine was observed, which is associated with the presence of a smoker at home, and this relationship was independent of the activities performed by the smoker after smoking. In addition, a positive test for urinary cotinine was presented in some children without documented exposure to cigarette smoke inside the home, which may be explained by the presence of environmental cotinine. Therefore, it is necessary to perform educational interventions aimed at parents and caregivers who smoke.

Introduction. Lactate is an important indicator of tissue perfusion. The objective of this study is to evaluate if there are significant differences between the arterial and central venous measurement of lactate in pediatric patients with sepsis and/or septic shock. Methods. Longitudinal retrospective observational study. Forty-two patients were included between the age of 1 month and 17 years, with a diagnosis of sepsis and septic shock, who were admitted to the intensive care unit of a university referral hospital. The lactate value obtained from an arterial blood sample and a central venous blood sample drawn simultaneously, and within 24 hours of admission to the unit, was recorded. Results. The median age was 2.3 years (RIC 0,3–15), with a predominance of males (71.4%), having a 2.5 : 1 ratio to females. Most of the patients had septic shock (78.5%) of pulmonary origin (50.0%), followed by those of gastrointestinal origin (26.1%). Using Spearman's Rho, a 0.872 (p < 0.001) correlation was found between arterial and venous lactate, which did not vary when adjusted for age (p < 0.05) and the use of vasoactive drugs (p < 0.05). Conclusion. There is a good correlation between arterial and venous lactate in pediatric patients with sepsis and septic shock, which is not affected by demographic variables or type of vasoactive support.

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Ensayo clínico aleatorizado de la comparación entre método de enseñanza tradicional y escenario simulado para la adquisición de competencias en el reconocimiento de signos de enfermedad respiratoria aguda en pacientes pediátricos Sergio I. Agudelo, Diana S. López, Evelyn P. Obando, Ivon A. Paredes, Rafael Milanés, Fabio Rodríguez, Ángel A. García, Lina A. BuitragoIntroducción. La infección respiratoria aguda es un problema de salud pública en menores de 5 años; la detección e identificación tempranas de sus signos disminuye la mortalidad en este grupo de edad y es una meta de la formación médica.Objetivo. Comparar en estudiantes de medicina el método educativo tradicional y el escenario simulado para el reconocimiento de signos de enfermedad respiratoria aguda en niños de 2 meses a 5 años. Sujetos y métodos.Se realizó un ensayo clínico para estudiantes de medicina, aleatorizados en dos grupos: A (clase teóri-ca y ayudas audiovisuales) y B (escenario simulado). El desenlace primario fue el desempeño en la evaluación global. Se realizó prueba de Mann-Withney Wilcoxon para comparación entre grupos y Mann-Withney Wilcoxon pareada para análi-sis intragrupo (antes y después de la intervención).Resultados. Mediante prueba de Mann-Withney Wilcoxon pareada intragrupo pre y postintervención, el grupo A mostró mejor un desarrollo de competencias en el desenlace primario (p = 0,02) y en la evaluación global del escenario simulado (p = 0,04). El grupo B logró cambios significativos en el desenlace primario (p = 0,00), la anamnesis (p = 0,00) y la evaluación global del escenario simulado (p = 0,00). En la evaluación postintervención no se encontraron diferencias significativas en el desenlace primario ni secundario.Conclusiones. La comparación postintervención entre los grupos A y B no mostró diferencias significativas en ninguna de las variables estudiadas entre ambos grupos.Palabras clave. Dificultad respiratoria. Educación médica. Enfermedad respiratoria aguda. Insuficiencia respiratoria. Simulación médica.