RESUMEN

A significant inoculum-size effect has been observed with piperacillin-tazobactam, and has been associated with beta-lactamase production in extended-spectrum beta-lactamase (ESBL) producers. This association has not been previously studied in the case of amoxycillin-clavulanate. Piperacillin-tazobactam and amoxycillin-clavulanate were compared, using high inocula of susceptible strains either harbouring ESBLs or not. Two non-ESBL-producing and 15 amoxycillin-clavulanate-susceptible and piperacillin-tazobactam-susceptible ESBL-producing Escherichia coli isolates, and their respective transconjugants, were tested in dilution susceptibility tests using standard and 100-fold higher inocula. Three ESBL-producing strains and E. coli ATCC 25922 were selected for time-kill studies using standard and high initial inocula. At high inocula, MICs of piperacillin increased >eight-fold for non-ESBL-producing strains, and MICs of piperacillin-tazobactam (8:1 ratio or with tazobactam fixed at 4 mg/L) increased>eight-fold for all ESBL-producing strains. However, amoxycillin MICs were not affected by a high inoculum with non-ESBL-producing strains, whereas the MICs of amoxycillin-clavulanate (2:1 and 4:1) increased

Asunto(s)

RESUMEN

El objetivo del estudio es establecer criterios objetivos en la evaluación de los médicos residentes de cirugía general y digestiva durante su estancia en la UCMA, que tienen establecida en el segundo año de la especialidad y durante 6 meses. La actividad asistencial semanal consta de 9 consultas externas y 9 quirófanos en sesiones de mañana y tarde. Dos residentes como máximo rotan en cada periodo de 6 meses. Como criterios de valoración se estableció un sumatorio de 3dimensiones: conocimientos (30%) + actitudes (20%) + habilidades(50%) + conocimientos: 30%. Grado de formación adquirida(discente 5% + docente 25%). Actitudes: 20%, asistencia, disponibilidad y relaciones. Habilidades: 50%, hábitos científicos y técnicos adquiridos. Consultas externas (5%): asistencia a 10 consultas externas. Actividad quirúrgica (45%): participación en 282 Intervenciones registradas en el Libro del Residente. Entre 2001-2006 15 residentes han rotado por la UCMA, alcanzándolos niveles medios siguientes: conocimientos (5% + 23,6% =28,6%), actitudes (4% asistencia + 5% disponibilidad + 10% relaciones= 19%), habilidades (5% asistencia a consultas + 45% intervenciones quirúrgicas, 327 intervenciones de media = 50%).Grado de cumplimentación: conocimientos: 28,6/30%(98,3%), actitudes: 19/20% (95%), habilidades: 50/50% (100%).Se concluye que la rotación en la UCMA debe ser obligatoria en los programas de formación de la especialidad. Es necesario establecer medidas objetivas para valorar la actividad realizada. Para ello se deben incluir aspectos en relación a la adquisición de conocimientos, actitudes y habilidades. El programa presentado establece criterios objetivos de la evaluación (AU)

The aim of the study is to establish objective criteria in the evaluation of surgical residents in the day surgery unit. Surgical residents stay 6 months in the day surgery unit. Weekly clinical activity consists of 9 consultations and 9 surgical programs. At any given time, 2 surgical residents stay for a period of 6 months. The criteria used for evaluation was a summary of 3 variables: Knowledge(30%), attitude (20%) and surgical skills (50%). Knowledge(30%) included: degree of formation acquired (learning 5% +teaching 25%). Attitude (20%) included: daily assistance + availability+ relationship with team. Surgical skills (50%) included: scientific and surgical abilities acquired: Ten clinical consultations(5%) and a minimum of 282 surgical operations confirmed in the Resident’s Log Book (45%) were obligatory. From 2001 to 2006 a total of 15 residents have passed through the day surgery unit for a period of 6 months each, with the following mean results: knowledge (5% + 23.6% = 28.6%),attitude: (4% daily assistance + 5% availability + 10% relations =19%), surgical skills (5% consultations + 45% surgical operations,327 mean = 50%).Degree of complementation: knowledge: 28.6/30% (98.3%),attitude: 19/20% (95%), surgical skills: 50/50% (100%).In conclusion the permanency in a day surgery unit should be obligatory in postgraduate general surgery programs. Objective criteria are necessary to evaluate the activity of surgical residents. In this way the evaluation must considerer the knowledge, attitude and surgical skills acquired. The present surgical program develops objective criteria for this evaluation (AU)

Asunto(s)

Asunto(s)

RESUMEN

PIP: Although over 300 cases of pelvic actinomycosis have been published, it was not until 1973 that the 1st case of pelvic actinomycosis associated with the new generation of IUDs was described. Data is provided in this article on the causative agent, laboratory procedures, surgical excision, and pathological studies in 1 case of abdominal-pelvic actinomycosis, and the findings are compared to other reports in the English and Spanish literature. A multipara of 25 years with fever, metrorrhagia, and painful tumoration began to suffer dysmenorrhea in June 1980 but attributed the symptoms to the Copper 250 Multiload IUD she had used since July 1979. A laparotomy in December 1980 disclosed the infection, and pathological tests confirmed the diagnosis. The exact incidence of the association of actinomycosis and the IUD is not known, but the microorganism, Actinomyces-Israeli, is more common in wearers of IUDs than in other women. The diagnosis of actinomycosis is confirmed through microbiological study and histological identification. Treatment since 1945 has consisted of large doses of penicillin over long periods of time, but the use of other antibiotics including tetracycline and erythromycin has been introduced. The abscess or abscesses should be excised and the IUD removed in cases where a relationship is suspected.^ieng

Asunto(s)

Asunto(s)