RESUMO
Introducción: La neumonía adquirida en la comunidad (NAC) puede ser causada por diferentes gérmenes. En Latinoamérica la principal etiología es Streptococcus pneumoniae , aislado en aproximadamente el 35-40% de los casos. Objetivos: Describir las características de los pacientes hospitalizados con diagnóstico de NAC durante 6 años en la Fundación Santa Fe de Bogotá, los principales agentes etiológicos y el patrón de susceptibilidad antibiótica en los microorganismos más importantes. Materiales y métodos: Estudio descriptivo retrospectivo que incluyó a todos los pacientes mayores de 16 años hospitalizados con diagnóstico de NAC. Se revisaron variables demográficas y clínicas, presencia de pruebas diagnósticas para determinar etiología y los microorganismos aislados. Resultados: Se aisló un germen en 130 pacientes, siendo los más frecuentes Streptococcus pneumoniae , Haemophilus influenzae y Staphylococcus aureus . Encontramos mayor frecuencia de microorganismos atípicos en menores de 65 años y en pacientes sin comorbilidades, y de enterobacterias en mayores de 65 años y en pacientes con comorbilidades. Discusión: Los principales gérmenes aislados son similares a los reportados en otras series. Llama la atención la frecuencia de Staphylococcus aureus y la presencia de SAMR. Es importante conocer la etiología local para adaptar las guías de manejo de acuerdo a los gérmenes encontrados, la susceptibilidad a los antibióticos y la disponibilidad de recursos.
Introduction: Community acquired pneumonia (CAP) can be caused by different microorganisms. In Latin America the main cause is Streptococcus pneumoniae isolated in about 35-40% of cases. Objectives: To describe the characteristics of patients admitted with diagnosis of CAP at Fundación Santa Fe de Bogotá during a 6 years period, the etiological agents isolated and the pattern of antibiotic susceptibility in the most frequent microorganisms. Materials and methods: Retrospective descriptive study; all patients older than 16 years admitted with diagnosis of CAP were included. Demographic and clinical variables, diagnostic tests to evaluate etiology and the microorganisms isolated were reviewed. Results: At least one microorganism was isolated in 130 patients, being the most common Streptococcus pneumoniae , Haemophilus influenzae and Staphylococcus aureus . We found higher frequency of atypical microorganisms in patients under 65 years and without comorbidities, while enteric gram-negative rods were more frequent in patients with comorbidities or older than 65 years. Discussion: Our most common etiologies are similar to those reported in other series. Special attention is drawn to Staphylococcus aureus as one of the major etiologies and the presence of MRSA. It is important to know the local etiology to adjust guidelines according to the isolated microorganisms, antibiotics susceptibility and availability of resources.
Assuntos
Humanos , Feminino , Gravidez , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Pneumonia , Infecções Comunitárias Adquiridas , Streptococcus pneumoniae , Colômbia , Hospitais , AntibacterianosRESUMO
Objetivo: describir las causas de mortalidad de los jóvenes de 15 a 24 años y su contribución en el cambio de la esperanza de vida en la ciudad de Medellín entre los años 1989 y 1999. Métodos: las causas de mortalidad se agruparon en seis categorías, según la lista 6/67 de la OPS para la tabulación de la mortalidad: signos, síntomas y afecciones mal definidas; enfermedades transmisibles; neoplasias (tumores); enfermedades del sistema circulatorio; ciertas afecciones originadas en el periodo perinatal; causas externas; y todas las demás enfermedades. Para su cálculo se utilizó el método desarrollado por J.H. Pollard en 1986. Resultados: los principales grupos de causas de mortalidad fueron: causas externas, neoplasias y enfermedades transmisibles. Discusión: al aplicar el método de Pollard, se encontró una pérdida en dicha esperanza principalmente por enfermedades del sistema circulatorio y por el grupo neoplasias (tumores). De manera contraria, los grupos causas externas y enfermedades transmisibles fueron los grupos responsables de la ganancia en la esperanza de vida juvenil. Se sugieren políticas de promoción y prevención de estilos de vida sanos que mejoren las condiciones de vida de la población joven
Assuntos
Adolescente , Causas de Morte , Expectativa de Vida , MortalidadeRESUMO
Este trabajo tiene como propósito analizar de una forma integral y sistemática las diversas dimensiones conceptuales de los servicios de atención en salud. La utilización de los conceptos básicos de la disciplina económica, la discusión de algunos planteamientos relacionados con el mundo de la política y el reconocimiento de la importancia y el valor moral de los derechos humanos tienen la finalidad no solo de describir la complejidad de un servicio económico que, en muchos casos, está directamente relacionado con la vida, sino también de contribuir con elementos de juicio más rigurosos en el actual debate sobre el derecho a la salud en Colombia, por ejemplo, las sutiles diferencias entre bien público y servicio público y sus implicaciones más destacables desde la perspectiva de la justicia sanitaria
Assuntos
Setor de Assistência à Saúde , Política de Saúde , Qualidade da Assistência à Saúde , Direito à SaúdeRESUMO
Paracoccidioidomycosis (PCM) is one of the most important endemic mycoses in Latin America; it is usually diagnosed by observation and/or isolation of the etiologic agent, Paracoccidioides brasiliensis, as well as by a variety of immunological methods. Although the latter are effective, two circumstances, cross-reactions with other mycotic agents and antigen preparation that is marked by extreme variability among lots, hinder proper standardization of the procedures. To circumvent this lack of reproducibility, molecular biology tools were used to produce a recombinant 27-kDa-molecular-mass antigen from this fungus; a sizable quantity of this antigen was obtained through fermentation of Escherichia coli DH5alpha, which is capable of expressing the fungal protein. The latter was purified by the Prep-Cell System (Bio-Rad); the recovery rate of the pure protein was approximately 6%. A battery of 160 human serum samples, consisting of 64 specimens taken at the time of diagnosis from patients with PCM representing the various clinical forms plus 15 serum specimens each from patients with histoplasmosis and aspergillosis, 10 each from patients with cryptococcosis and tuberculosis, 6 from patients with coccidioidomycosis, and 40 from healthy subjects, were all tested by an indirect enzyme-linked immunosorbent assay with the purified 27-kDa recombinant protein. The latter was used at a concentration of 1.0 microgram/well; there were three serum dilutions (1:1,000, 1:2,000, and 1:4,000). The experiment was repeated at least twice. The average sensitivity for both experiments was 73.4%; in comparison with the healthy subjects, the specificity for PCM patients was 87.5% while for patients with other mycoses, it was 58.7%. Important cross-reactions with sera from patients with aspergillosis and histoplasmosis were detected. The positive predictive value of the test was 90.4%. These results indicate that it is possible to employ recombinant antigenic proteins for the immunologic diagnosis of PCM and, by so doing, achieve high coverage rates. Furthermore, antigen reproducibility can now be ensured, thus facilitating inter- and intralaboratory standardization.
Assuntos
Anticorpos Antifúngicos/sangue , Antígenos de Fungos/imunologia , Paracoccidioides/imunologia , Paracoccidioidomicose/diagnóstico , Antígenos de Fungos/genética , Ensaio de Imunoadsorção Enzimática , Escherichia coli/genética , Escherichia coli/crescimento & desenvolvimento , Escherichia coli/metabolismo , Fermentação , Humanos , Paracoccidioides/genética , Valor Preditivo dos Testes , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Sensibilidade e Especificidade , Transformação GenéticaRESUMO
There is a limited experience with catheter ablation for treatment of ventricular tachycardia (VT) in Chagasic cardiomyopathy. A 30-year-old woman experienced episodes of palpitations and syncope due to attacks of VT. A diagnosis of Chagas disease was established on a biological basis. Two-dimensional echo and contrast ventriculography showed an apical aneurysm with thrombus. Surgery was indicated to resect the aneurysm and ablate the VT. Ventricular tachycardia recurred 1 month later despite therapy, including amiodarone. Two clinical frequent and well-tolerated tachycardias were identified. The site of origin was located in the right ventricular apex and in the apical-lateral wall of the left ventricle, respectively. Catheter ablation was performed at two sites with DC shocks (total energy 600 J) after unsuccessful radiofrequency ablation. Holter recordings performed during the post-operative period showed only infrequent extrasystoles. After follow-up of 24 months the patient remains asymptomatic. Drug-refractory VT in Chagasic cardiomyopathy can be ablated by medium-energy DC shocks after failure of radiofrequency ablation.
Assuntos
Ablação por Cateter/métodos , Cardiomiopatia Chagásica/complicações , Taquicardia Ventricular/cirurgia , Adulto , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologiaRESUMO
Atrial fibrillation (AF) is generally associated with rheumatic valve disease and atrial septal defects (ASD) in young adults. Surgical correction of both disorders fails to convert to sinus rhythm or prevent further episodes of paroxysmal or chronic AF in most patients. The role and efficacy of combining mitral valve surgery or ASD correction with AF surgery in this setting has not been widely addressed and remains to be established. The present study prospectively assessed the recovery of sinus rhythm, functional status, and atrial function in 21 patients (mean age 42 +/- 9.2 years) who underwent a modified Cox-maze procedure concomitant with mitral valve or ASD surgery at our institution between March 1993 and February 1995. Seventeen (81%) had chronic AF, and 4 (19%) had paroxysmal AF, with a mean AF duration of 3.5 +/- 3.6 years (range 0.6 to 15.3). Concomitant surgery was performed in 9 patients (42.9%) with mitral stenosis, 5 (23.8%) with mitral regurgitation, 1 (4.8%) with mitral and aortic regurgitation, and 3 (14.3%) with ASD. Eighteen patients (86%) were in New York Heart Association class II to IV before operation. Doppler echocardiography was performed in all patients before surgery, and 1 week, and 3 and 6 months after surgery in patients maintaining sinus rhythm. One patient with severe mitral stenosis and depressed ventricular function died in the immediate postoperative period. Sinus rhythm was restored in the immediate postoperative period in 7 patients (35%), and in another 10 patients (50%) before discharge (mean 5.8 +/- 2 days). Overall, sinus rhythm was restored before discharge in 17 patients (85%); 3 (15%) patients required antiarrhythmic therapy. Doppler echocardiography performed 3 months after surgery documented atrial contractility (A and E waves) in 12 patients (71%). After a mean follow-up period of 8 months (range 3 to 23), 18 (90%) remained in sinus rhythm. Sinus rhythm was successfully restored and maintained in most patients with drug refractory AF undergoing a concomitant Cox-maze procedure with mitral valve or ASD surgery improving atrial function and New York Heart Association class.
Assuntos
Fibrilação Atrial/cirurgia , Comunicação Interatrial/cirurgia , Valva Mitral/cirurgia , Adulto , Valva Aórtica/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Doppler , Feminino , Comunicação Interatrial/complicações , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
Se presenta un paciente con mediastinitis necrotizante descendente, que fue visto en nuestro servicio 7 dias despues de la extraccion de un molar. La radiografia convencional del torax, el ultrasonido cervical y la tomografia axial computarizada del torax, fueron uliles para decidir la extension del procedimiento quirurgico. El diagnostico temprano y el adecuado desbridamiento cervical, mediastinico y pleural, fueron decisivos en la recuperacion del paciente. Se concluye que el drenaje subxifoideo no es suficiente en el tratamiento de esta enfermedad.
Assuntos
Drenagem , MediastiniteRESUMO
Se presenta la experiencia inicial con 30 pacientes con procedimientos de cirugia cardiaca en quienes se utilizó la administración de Cardioplejia por via retrógrada por el seno coronario. Se describe la tecnica y alternativas en el uso de la canula. Se logró una facil canulacion transatrial del seno coronario y protección miocardica satisfactoria en todos los casos. No se presentaron complicaciones relacionadas con la tecnica. Dos pacientes fallecieron en quienes se documento severa disfunción ventricular en el preoperatorio. Se propone el uso de esta tecnica en situaciones en que la administraci6n anterograda es particularmente engorrosa y en casos de dificil protección miocardica.
Assuntos
Parada Cardíaca Induzida/métodos , Parada Cardíaca Induzida , Valvas Cardíacas/cirurgiaRESUMO
Se revisan 160 casos de aneurisma de la aorta abdominal en un periodo de 10 años en la Fundacion Clinica Shaio. Se encontro una mortalidad muy baja en los casos de cirugia electiva (0.8 por ciento), la cual atribuimos al estudio coronario en todos ellos y carotideo en los que hubo indicacion, previo a la reseccion del aneurisma. El tratamiento iniclal debe individualizarse para cada caso dependiendo de las indicaciones clinicas y la severidad de la enfermedad.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnósticoRESUMO
To search for electrocardiographic clues of infarction of the right ventricle, we recorded the right-thoracic unipolar leads from V3R to V6R and the following abdominal leads: MD, ME and MI, in a group of 40 normals (control group) and in a group of 40 patients with their first acute transmural myocardial infarction (25 posterior-inferior, 15 anterior wall). We described the predominant ECG morphologies in the control waves (more than 0.04 sec. duration) could be registered in the right anterior thoracic wall in healthy subjects. Based on the findings from our control group and those reported from other investigators, we concluded that to suspect right ventricular involvement in the above mentioned leads, it is required to find necrosis and subepicardial injury waves in at least two of those leads. The most frequently affected leads were V4R and MD. This electrocardiographic "positive" pattern to suspect involvement of the right ventricle was found in 32% of the posterior-inferior left ventricular infarctions. In none of the left ventricular anterior wall infarctions we observed right-sided involvement. The clinical-electrocardiographic correlation was statistically significant. Due to the hemodynamic and therapeutic consequences when right ventricular involvement is suspected, it is convenient to record, in every patient with posterior-inferior myocardial infarction, the special leads described above, more so since the ECG is a simple fast, low cost invaluable auxilliary in the evaluation of the extension of necrosis in the right ventricle.