RESUMO Objetivos: Analisar a associação entre os níveis glicêmicos quando da admissão dos pacientes à unidade de terapia intensiva pediátrica e a mortalidade entre pacientes hospitalizados. Métodos: Estudo retrospectivo de coorte conduzido em pacientes de uma unidade de terapia intensiva, admitidos ao Instituto Nacional de Salud del Niño entre 2012 e 2013. Utilizou-se um modelo de regressão de Poisson com variância robusta para qualificar a associação. Foi feita avaliação do desempenho do exame diagnóstico, para descrever sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e razão de verossimilhança para cada faixa de glicemia. Resultados: Incluíram-se no total 552 pacientes (idade mediana de 23 meses; faixa de variação entre 5 meses e 79,8 meses). O nível glicêmico médio quando da admissão foi de 121,3mg/dL (6,73mmol/L). Faleceram durante a hospitalização 92 (16,6%) pacientes. Na análise multivariada, encontraram-se associações significantes entre glicemia < 65mg/dL (3,61mmol/L) (RR: 2,01; IC95% 1,14 - 3,53), glicemia > 200mg/dL (> 11,1mmol/L) (RR: 2,91; IC95% 1,71 - 4,55), desnutrição (RR: 1,53, IC95% 1,04 - 2,25), ventilação mecânica (RR: 3,71, IC95% 1,17 - 11,76) e mortalidade durante a hospitalização. Ocorreram baixa sensibilidade (entre 17,39% e 39,13%) e alta especificidade (entre 49,13% e 91,74%) para diferentes níveis glicêmicos de corte. Conclusão: Ocorreu maior risco de óbito entre os pacientes que desenvolveram hipoglicemia e hiperglicemia por ocasião da admissão à unidade de terapia intensiva pediátrica. Certas faixas de glicemia (> 200mg/dL (> 11,1mmol/L) e < 65mg/dL (3,61mmol/L)) tiveram uma alta especificidade como preditores de óbito.

ABSTRACT Objectives: To analyze the association between glycemia levels upon pediatric intensive care unit admission and mortality in patients hospitalized. Methods: A retrospective cohort of pediatric intensive care unit patients admitted to the Instituto Nacional de Salud del Niño between 2012 and 2013. A Poisson regression model with robust variance was used to quantify the association. Diagnostic test performance evaluation was used to describe the sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios for each range of glycemia. Results: In total, 552 patients were included (median age 23 months, age range 5 months to 79.8 months). The mean glycemia level upon admission was 121.3mg/dL (6.73mmol/L). Ninety-two (16.6%) patients died during hospitalization. In multivariable analyses, significant associations were found between glycemia < 65mg/dL (3.61mmol/L) (RR: 2.01, 95%CI 1.14 - 3.53), glycemia > 200mg/dL (> 11.1mmol/L) (RR: 2.91, 95%CI 1.71 - 4.55), malnutrition (RR: 1.53, 95%CI 1.04 - 2.25), mechanical ventilation (RR: 3.71, 95%CI 1.17 - 11.76) and mortality at discharge. There was low sensitivity (between 17.39% and 39.13%) and high specificity (between 49.13% and 91.74%) for different glucose cut-off levels. Conclusion: There was an increased risk of death at discharge in patients who developed hypoglycemia and hyperglycemia upon admission to the pediatric intensive care unit. Certain glucose ranges (> 200mg/dL (> 11.1mmol/L) and < 65mg/dL (3.61mmol/L)) have high specificity as predictors of death at discharge.

We report a case of botryomycosis and intestinal strongyloidiasis in a patient with HTLV-1 infection. A 23 year-old female patient from Ayacucho, came with a history of a right foot tumor and chronic foot ulcers. The diagnosis of botryomycosis was established by biopsy of the lesion. Because the mild eosinophilia, a microscopic examination of stools was performed and Strongyloides stercoralis rhabditiform larva were found. HTLV-1 ELISA test, performed in order to discharge association with strongyloidiasis, was positive. The clinical presentation, physiopathology of the botryomycosis and the role of the HTLV-1 infection and strongyloidiasis as predisposing factors for botryomycosis are discussed.(Rev Med Hered 2002; 13: 74-76).

Objective: The aim of this study is to describe the epidemiological and clinical characteristics of the women infected with the Human Inmunodefficiency Virus (HIV) who were seen at the Hospital Nacional Cayetano Heredia from January 1989 to December 1996. Material and Methods: We did a retrospective chart review of their demographic and medical registers. We used the Centres for Disease Control (CDC) classification for the HIV infection. (Stages I-IV). Results: We included 236 women, from 17 to 60 years old, with a mean age of 30.4 years. The number of diagnosed cases per year of infected women increased from 5 in 1989 to 63 in 1996. The probable means of acquisition of infection was heterosexual intercourse in 212 patients (90.2%). Only had one sexual partner in her life 113 (47.8%) of the patients seen. There were 4 (1.6%) sexual workers and there were no intravenous drug users. A percentage of 23.4% have had other Sexually Transmitted Diseases (STD), and these were more prevalent in women who had risky sexual practices (p=0.005). Out of the 236, 69 women had diagnosis of Acquired Inmunodefficiency Syndrome (AIDS) The most frequent AIDS-defining condition was the Wasting Syndrome in 23 women (33.3%). There were 19 deaths within the study period. The mean survival time after the AIDS diagnosis was 10.6 months and the most frequent death cause was Tuberculosis and Pneumocystis carinii Pneumonia. Conclusion: The fact of having a predominantly heterosexual transmission and that there is a high percentage of monogamous women and women with few sexual partners make us suppose that it is probably their partners risk sexual behavior what exposes women to HIV infection. We must underline the importance of an adequate information to women who start their sexual life and of the risks these bring, and the diffusion of the use of condoms to prevent this infection. ( Rev Med Hered 1999; 10:62-68 ).

Objetivo: Describir las características epidemiológicas y clínicas del grupo de mujeres infectadas con el Virus de la Inmunodeficiencia Humana (VIH) que fueron atendidas en el Hospital Nacional Cayetano Heredia de Enero de 1989 a Diciembre de 1996. Material y Métodos: Se hizo una revisión retrospectiva de sus fichas epidemiológicas e historias clínicas. Se utilizó la clasificación de los Centros de Control de Enfermedades (CDC) para infección por el VIH (Estadíos I-IV). Resultados: Se incluyó 236 mujeres, de 17 a 60 años, con una edad media de 30.4 años. El número de mujeres diagnosticadas por año aumentó de 5 en 1989 a 63 en 1996. La vía probable de adquirir la infección fue por relaciones heterosexuales en 212 pacientes (90.2%). Refirieron haber tenido una sola pareja sexual en su vida 113 (47.8%). Hubo 4 (1.6%) de trabajadoras sexuales y no hubo drogadictas por vía endovenosa. Habían tenido otras Enfermedades de Transmisión Sexual (ETSs) el 23.4% y éstas fueron más prevalentes en mujeres que tenían prácticas sexuales riesgosas (p=0.005). Tuvieron diagnóstico de Síndrome de Inmunodeficiencia Adquirida (SIDA) 69 mujeres. La Condición Definitoria de SIDA más frecuente Síndrome Consuntivo en 23 mujeres (33.3%). Hubo 19 muertes en los años de estudio. La sobrevida media en estadío SIDA fue de 10.6 meses y la causa de muerte más frecuente fue Tuberculosis y Neumonía por Pneumocystis carinii. Conclusiones: El hecho de tener una transmisión predominantemente heterosexual y de que haya un alto porcentaje de mujeres con pocas parejas sexuales nos hace suponer que es probablemente la conducta sexual riesgosa de sus parejas lo que expone a las mujeres a la infección por el VIH. Debemos resaltar la importancia de una adecuada educación a las mujeres que comienzan a tener relaciones, de los riesgos que esto implica y la difusión del uso de condones para prevenir esta infección. ( Rev Med Hered 1999; 10:62-68 ).