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Pathogenic bacteria, introduced in water sources through faecal contamination, have traditionally been investigated as individual species, leading to the establishment of microbial, sanitary, and environmental quality indicators. Recent advancements in our understanding of the microbiome and its intricate interactions within the human-microbiome-environment network advocate for a broader evaluation of the impact of disinfection on the entire microbial community. In this study, we conducted a comprehensive screening experiment involving four disinfection processes; ozone, ultraviolet radiation with wavelengths between 200 - 280 nm (UV-C), photo-Fenton, and chlorination, applied to two distinct water sources; surface (SW) and groundwater (GW). The cells that remained viable after treatment were recovered using Brain Heart Infusion (BHI) broth, and 16S rRNA gene sequencing was used for their identification. Our findings confirmed the presence of faecal contamination in the water sources and revealed distinct effects of each treatment on the recovered bacterial populations. The chlorination of groundwater samples likely had a greater impact on bacteria in a vegetative state than on spores. Consequently, this led to a higher abundance in the BHI cultures of sporulating bacteria such as Bacillus (increasing from 0.36 to 93.62 %), while ozonation led to an elevated recovery of Pseudomonas (increasing from 45.2 to 69.9 %). Conversely, in surface water, calcium hypochlorite and ozone treatments favored the selection of Staphylococcus and Bacillus, whose relative abundance in the cultures increased from 0 to 39.22 % and from 0.35 to 96.6 %, respectively. In groundwater, Pseudomonas was resistant to UV-C radiation and their relative abundance increased from 45.2 % to 93.56 %, while photo-Fenton was effective against this bacterial group decreasing its relative abundance to 0.46 %. However, other genera such as Bacteroides, Aeromonas, and Citrobacter seemed to be less injured by this disinfection process. BHI broth was successful in recovering various bacterial groups that exhibited resistance to sublethal water disinfection.
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BACKGROUND: CKD patients on hemodialysis (HD) with Staphylococcus aureus (SA) bacteremia present high morbidity, mortality and increased risk of MRSA. Vancomycin is the antibiotic of choice in these cases, it has a narrow therapeutic margin and inadequate dosage generates a risk of toxicity, therefore, the recommendation is to dosage it through serum levels. METHODS: This is a retrospective cohort study in 3 hospitals of third level of complexity in the city of Medellin in which there were differences in the measurement and implementation of vancomycin25 dosage based on trough levels (VL) in patients with chronic kidney disease on hemodialysis (CKD- HD) with uncomplicated bacteremia based infection by methilcillin-resistant Staphyloccocus aureus (MRSA). The primary outcome was the composite of hospital mortality, clinical response (fever, hemodynamic instability and altered consciousness), complications associated with bacteremia, or bacteriological response failure (positive cultures at first week follow-up) at 7 days. The composite variables were analyzed individually as secondary outcomes. RESULTS: The main unadjusted outcome (OR 1.3, CI 0.6 - 2.7) and adjusted for age, Charlson index, loading dose, initial dose, dosing frequency and MIC to vancomycin (OR 1.2, CI 0.5 - 2.7). Regarding adjusted secondary outcomes: clinical response (OR 1.4 CI 0.3 - 5.8), death (OR 1.3 CI 0.3 - 4.6) and complications (OR 0.9, CI 0.37 - 2.2). CONCLUSIONS: We conclude that the measurement of trough levels in patients with HD-CKD does not modify the composite outcome. The main limitation is the sample size and type of study, randomized control trials may be required to confirm the results presented.
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Antibacterianos , Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Diálise Renal , Insuficiência Renal Crônica , Infecções Estafilocócicas , Vancomicina , Humanos , Vancomicina/uso terapêutico , Estudos Retrospectivos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Masculino , Diálise Renal/efeitos adversos , Feminino , Insuficiência Renal Crônica/complicações , Idoso , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Antibacterianos/farmacocinética , Antibacterianos/administração & dosagem , Idoso de 80 Anos ou mais , Testes de Sensibilidade MicrobianaRESUMO
PURPOSE: To provide information about which pneumococcal vaccine could have greater coverage in Colombia. METHODS: This is a retrospective analysis of patients diagnosed with invasive pneumococcal disease (IPD) between 2015 and 2019 in Bogotá, Colombia. We compared the theoretical serotype coverage of the available anti-pneumococcal vaccines (i.e., PCV-10, PCV-10 SII, PCV-13, PCV-15, PCV-20, PCV-21, PCV24, PPSV-23) and the non-vaccine-covered serotypes stratified by age. RESULTS: 690 IPD cases were included. In children ≤5 y/o, of the approved vaccines PCV-20 showed the most theoretical protection (71.3 % [149/209]), while in adults aged 18-64 y/o was PCV-20 (61.8 % [164/265]), and in those ≥65 y/o was PPSV-23 (58.1 % [100/172]) followed by PCV-20 (55.2 % [95/172]). The non-covered serotypes represented one-third of the cohort (33.9 % [234/690]), being 6C (20.5 % [48/234]), 15A (12.8 % [30/234]), and 23A (11.5 % [27/234]) the most prevalent. CONCLUSION: Introducing PCV-20 for children and PCV-20 along with a PPSV-23 booster in adults may reduce IPD frequency in all ages in Colombia. The inclusion of non-covered serotypes is required for future vaccines.
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Infecções Pneumocócicas , Streptococcus pneumoniae , Adulto , Criança , Humanos , Lactente , Colômbia/epidemiologia , Estudos Retrospectivos , Vacinação , Vacinas Conjugadas/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , SorogrupoRESUMO
Introducción: Las hernias de la pared abdominal afectan entre el 10% al 15% de la población mundial, siendo hasta el 60% de estas hernias inguinales. Las hernias inguinales gigantes son poco comunes, pero con una gran carga de enfermedad para el paciente. Caso Clínico: Se presenta el caso de un paciente de 51 años, con antecedente de diabetes mellitus tipo II, proveniente de zona rural aislada, por cuatro días de evolución consistente en quemadura escrotal por metal caliente, relacionada a una hernia inguinoescrotal derecha gigante. Es llevado a intervención quirúrgica por cirugía general y urología. Por adecuada evolución clínica se da de alta al 5° día posoperatorio. Discusión: Las hernias inguinales gigantes son raras y frecuentemente se presentan en pacientes de bajo estrato socioeconómico, procedencia rural y cierto grado de negligencia. El reto del equipo quirúrgico consiste en lidiar con los posibles efectos adversos de la reducción del contenido herniario en un abdomen con diversos grados de pérdida del dominio. Se puede requerir resección o debulking del contenido abdominal o la expansión de la cavidad abdominal mediante frenectomía, neumoperitoneo progresivo perioperatorio o la creación de hernias ventrales mediante maniobras avanzadas. La reparación con malla libre de tensión disminuye el riesgo de recurrencia. Conclusión: La hernia inguinal gigante es una patología rara. El cirujano general está llamado a conocer el abanico de opciones que existen en caso de enfrentarse a estos pacientes, lo cual ayuda a reducir la elevada morbimortalidad y altas tasas de recurrencia.
Introduction: Abdominal wall hernias affect between 10% to 15% of the world population and up to 60% of these are inguinal hernias. Giant inguinal hernias are rare, but have high burden of disease for the patients. Clinical Case: We present the case of a 51-year-old patient, with a history of type II diabetes mellitus, from an isolated rural area, with four days of a scrotal burn by hot metal, related to a giant right inguinoscrotal hernia. He is taken to surgical intervention by general surgery and urology. Due to adequate clinical evolution, he was discharged on the 5th postoperative day. Discussion: Giant inguinal hernias are rare and frequently occur in patients of low socioeconomic status, rural origin and a certain degree of neglect. The challenge for the surgical team consist in dealing with the potential adverse effects of reducing hernia contents in an abdomen with varying degrees of loss of normal capacity. Resection or debulking of the abdominal contents or expansion of the abdominal cavity by frenectomy, perioperative progressive pneumoperitoneum, or the creation of ventral hernias by advanced maneuvers may be required. Tension-free mesh repair decreases the risk of recurrence. Conclusion: Giant inguinal hernia is a rare pathology. The general surgeon is called to know the range of options that exist in the event of facing these patients, which helps to reduce the high morbidity and mortality and high rates of recurrence.
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Background Craniofacial fibrous dysplasia (CFD) is an uncommon benign condition in which a bone is replaced by fibrous tissue. An adequate clinical characterization considering the number of affected bones and functional impairment is important to determine the most effective surgical intervention for its management. This study aims to present our institution's experience in the evaluation and management of CFD. Methods This was a retrospective study that included patients with CFD managed at our institution. Data included demographic characteristics, afflicted bones, surgical procedures performed, and recurrence. Results are presented as mean and percentages. Recurrence-free years and association between the type of surgery and recurrence was evaluated. Results Eighteen patients were included (11 females, 61%). The zygomatic, maxillary, and frontal bones were the most commonly affected with eight (18%) cases each. The most common procedure was bone burring, with 36 procedures. Recurrence was more prevalent after burring (58.3%) and occurred earlier than in the bone resection group (13 vs. 15 years, p > 0.05). Conclusion Surgery continues to be the cornerstone of CFD treatment. Bone burring is effective for debulking and contouring but increases the risk for recurrence. An individualized approach should be tailored according to the anatomical location of the disease, type of CFD, behavior of the lesion, and accompanying clinical complaints.
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Introducción: Los medicamentos antiulcerosos son utilizados frecuentemente en pacientes hospitalizados, sin embargo, a menudo este uso no está indicado. Objetivo: Describir la frecuencia de prescripción e indicación de medicamentos para prevenir el sangrado gastrointestinal en pacientes hospitalizados. Materiales y métodos: Estudio de corte trasversal, descriptivo, prospectivo del servicio de Medicina Interna de la Sociedad de Cirugía de Bogotá- Hospital de San José de Bogotá, Colombia. Se excluyeron pacientes con diagnóstico de sangrado gastrointestinal o antecedente de alergia a los medicamentos antiulcerosos. Se recolectaron datos demográficos, así como fármacos prescritos. Se determinó si la indicación del fármaco era adecuada y se identificó el tipo de error de prescripción. Resultados: Se incluyeron 179 pacientes, 102 (57%) mujeres. Promedio de edad de 61,3 años (±20,2). El principal diagnóstico de ingreso fue enfermedad infecciosa 76 (42,4%). Del total de pacientes, 165 (92,17%) recibieron medicamento para prevención del sangrado gastrointestinal. La indicación fue adecuada en 75 pacientes (41,89%). El error más frecuente fue el uso en pacientes de bajo riesgo de sangrado, 101 (97,1%). Conclusión: Un alto porcentaje de los pacientes recibió medicación para la prevención del sangrado gastrointestinal. En aproximadamente la mitad de estos no estaba indicada.
Introduction: Anti-ulcer medications are frequently used in hospitalized patients, yet their use is not usually indicated. Objective: To describe the frequency of prescription and indication of medications to prevent gastrointestinal bleeding in hospitalized patients. Materials and methods: A cross-sectional, descriptive, prospective study was carried out in the Internal Medicine service of the Surgery Society of Bogota-San Jose Hospital of Bogota (Colombia). Excluded patients were those with either a gastrointestinal bleeding diagnosis or a history of allergy to anti-ulcer medications. Demographic data and information regarding prescribed medications were collected. It was determined whether the medicine indication was adequate and the type of prescription error was identified. Results: 179 patients were included in the study, 57% (102) of which were women. The average age was 61.3 (±20.2) years old. Infectious disease was the main admission diagnosis (76; 42.4%). A 92.17% (165) of the total number of patients received medications to prevent gastrointestinal bleeding. This indication was adequate for 75 (41.89%) patients. The most frequent error was their use in bleeding low-risk patients (101; 97.1%). Conclusion: A high percentage of patients received medication to prevent gastrointestinal bleeding. However, in about half of these patients it was not indicated.
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Humanos , Preparações Farmacêuticas , Saúde Pública , Doença , Ranitidina , Omeprazol , Guia , Prevenção de Doenças , Hemorragia GastrointestinalRESUMO
La evaluación del estado ácido base y de la oxigenación de un paciente es fundamental en cualquier escenario clínico, sea en consulta externa, en un servicio de urgencias, hospitalización, en cirugía o en la unidad de cuidado intensivo. El conocimiento de las bases fisiopatológicas es de suma importancia para el entendimiento y adecuada interpretación de estas condiciones. El objetivo de esta revisión es proveer las bases de conocimiento necesarias para el abordaje adecuado de los gases arteriovenosos y proponer un modelo para la compresión e interpretación de estos. Este artículo aborda las bases fisiopatológicas de las alteraciones ácido base, los modelos existentes en su compresión, el modelo propuesto para su abordaje diagnóstico, sus diagnósticos diferenciales, el enfoque de la hipoxemia, la interpretación de los gases arteriovenosos y las variables que se pueden obtener de estos, el enfoque de la acidosis láctica y unos ejemplos del modelo propuesto.
The evaluation of the acid-base status and the oxygenation of a patient is fundamental in any clinical setting, be it in an outpatient clinic, in an emergency service, hospitalization, in surgery or in the intensive care unit. Knowledge of the pathophysiological bases is of the utmost importance for the understanding and adequate interpretation of these conditions. The objective of this review is to provide the necessary knowledge for the adequate understanding of arteriovenous gases and to propose a model for their comprehension and interpretation. This article addresses the pathophysiological bases of acid-base disorders, the existing models in their comprehension, the model proposed for their diagnostic approach, their differential diagnoses, the diagnostic approach to hypoxemia, the interpretation of arteriovenous gases and the variables that can be obtained from them, the diagnostic approach of lactic acidosis and some examples of the proposed model.
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Humanos , Oxigenação , GasometriaRESUMO
Introducción. Los quistes mesentéricos son tumores poco frecuentes y usualmente benignos, que se diagnostican principalmente en la edad pediátrica, de manera incidental.Caso clínico. Se presenta el caso de una paciente de cuatro años de edad, con dificultad para acceso a servicio de salud por localización de su vivienda, quien cursa con un cuadro clínico de dos años de evolución de distensión abdominal progresiva, interpretada y manejada como ascitis. Se realizó una tomografía de abdomen en la que se documentó una lesión quística gigante, por lo que fue llevada a resección por laparotomía, con confirmación histopatológica de un quiste mesentérico. Discusión. Los quistes mesentéricos pueden tener cualquier localización en el mesenterio del tracto gastrointestinal. Su principal etiología es la proliferación anormal y benigna de tejido linfático mesentérico. Las manifestaciones clínicas van desde la ausencia de síntomas hasta el abdomen agudo. Dentro de los síntomas abdominales no agudos se encuentran masa abdominal indolora, dolor abdominal, distensión abdominal y signos clínicos que simulan ascitis. La resección completa del quiste mesentérico es considerada el tratamiento de elección; el abordaje laparoscópico o abierto dependerá de las características clínicas de cada paciente y la experiencia del cirujano tratante. Conclusión. Es importante que los cirujanos conozcan las principales características y el manejo de esta entidad, que una vez presente, puede simular un síndrome ascítico.
Introduction. Mesenteric cysts are rare and usually benign tumors, which are diagnosed incidentally, mainly in children.Clinical case. We present the case of a 4-year-old patient, with difficulty accessing health services due to the location of her home, who has a 2-year history of progressive abdominal distension, interpreted and managed as ascites. An abdominal tomography was performed in which a giant cystic lesion was documented. She underwent resection by laparotomy, with histopathological confirmation of a mesenteric cyst. Discussion. Mesenteric cysts can have any location in the mesentery of the gastrointestinal tract. Its main etiology is the abnormal and benign proliferation of mesenteric lymphatic tissue. Clinical manifestations range from the absence of symptoms to an acute abdomen. Non-acute abdominal symptoms include a painless abdominal mass, abdominal pain, abdominal distension, and clinical signs that mimic ascites. Complete resection of the mesenteric cyst is considered the treatment of choice; laparoscopic or open approach will depend on the clinical characteristics of each patient and the experience of the treating surgeon. Conclusion. It is important for surgeons to know the main characteristics and management of this entity, which once present, can mimic an ascites syndrome
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Humanos , Ascite , Cisto Mesentérico , Omento , Diagnóstico Diferencial , Neoplasias Abdominais , MesentérioRESUMO
Klebsiella pneumoniae is a pathogenic agent able to form biofilms on water storage tanks and pipe walls. This opportunistic pathogen can generate a thick layer as one of its essential virulence factors, enabling the bacteria to survive disinfection processes and thus develop drug resistance. Understanding the metabolic differences between biofilm and planktonic cells of the K. pneumoniae response to NaClO is key to developing strategies to control its spread. In this study, we performed an NMR metabolic profile analysis to compare the response to a sublethal concentration of sodium hypochlorite of biofilm and planktonic cells of K. pneumoniae cultured inside silicone tubing. Metabolic profiles revealed changes in the metabolism of planktonic cells after a contact time of 10 min with 7 mg L-1 of sodium hypochlorite. A decrease in the production of metabolites such as lactate, acetate, ethanol, and succinate in this cell type was observed, thus indicating a disruption of glucose intake. In contrast, the biofilms displayed a high metabolic heterogeneity, and the treatment did not affect their metabolic signature.
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Introduction: Actinomycosis is an unusual chronic granulomatous infectious disease. They are commensals in various sites of the human body but with little pathogenicity. Actinomyces israelii is the most prevalent species but more than 30 species have been described. Infection of the lower respiratory tract is unusual, the involvement of mediastinum being even rarer. Case report: A 63-year-old man, previously healthy and living in a rural area, presented with a 5-month history of hemoptysis, pleuritic pain, weight loss, and night sweats. Community-acquired pneumonia with a mediastinal mass was documented, for which he received antibiotic management. Thoracoscopy was carried out for diagnosis and resection of the mediastinal mass due to inconclusive findings in the percutaneous biopsy. Pathology reported the presence of filamentous Gram-positive bacteria visible in Grocott staining. Due to the pathology findings, and the fact that no other infectious agents were identified, a diagnosis of actinomycosis was established. Treatment with oral amoxicillin 1g TID for 6 months was initiated. Conclusions: As far as we are aware, we present the sixth case of mediastinal actinomycosis. We present this case to bring attention to this rare but clinically relevant presentation to be considered as a differential diagnosis of mediastinal masses and to emphasize the need for specific anaerobic cultures to improve the diagnostic yield.
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Introducción: la insuficiencia suprarrenal primaria (IA) descrita por Thomas Addison en 1855 atribuía como principal causa a la infección por tuberculosis (TBC) diseminada, pero con el paso del tiempo ha disminuido en los países desarrollados. En aquellos en vías de desarrollo se mantiene alta esta etiología infecciosa, en especial en pacientes con VIH. Objetivo: realizar una revisión narrativa de la literatura reciente sobre la adrenalitis por TBC, incluyendo el enfoque, manejo y seguimiento en los casos de insuficiencia suprarrenal primaria (IA). Materiales y métodos: búsqueda y análisis de los artículos disponibles en los últimos 5 años bajo los descriptores en ciencias de la salud (DeCS) enfermedad de Addison, tuberculosis, insuficiencia suprarrenal primaria y adrenalitis en español en las bases de Google scholar y LILACS, y en inglés en PubMed y ClinicalKey. Conclusiones: la insuficiencia adrenal o adrenalitis por TBC ha descendido como causa de IA primaria, pero en el contexto de reemergencia de infección por VIH, continúa siendo una causa importante de IA en países en desarrollo. En estos casos además de la suplencia con corticosteroides el tratamiento de la causa específica es de importancia para impactar en la respuesta clínica, la supervivencia y la calidad de vida.
Introduction: primary adrenal insufficiency (AI) was described by Thomas Addison in 1855, and the vast majority of cases were attributable to disseminated tuberculosis (TB), but TB has decreased in developed countries over time. Conversely, in developing countries, this infectious etiology remains high, especially in patients with HIV infection. Objective: to perform a narrative review of the recent literature on tuberculous adrenalitis, including the approach, management and follow-up in cases of primary adrenal insufficiency (AI). Materials and methods: search and analysis of articles available over the past 5 years, using Health Sciences Descriptors (DeCS), Addison Ìs disease, tuberculosis, primary adrenal insufficiency and adrenalitis, in Spanish in the Google scholar and LILACS databases, and in English in the PubMed and ClinicalKey databases. Conclusions: adrenal insufficiency or adrenalitis due to TB has decreased as a cause of primary AI, but in the context of the resurgence of HIV infection, TB remains an important cause of AI in developing countries. In these cases, in addition to corticosteroid replacement therapy, treatment of the specific cause is important to impact clinical response, survival and quality of life.
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Tuberculose , Doença de Addison , Qualidade de Vida , Insuficiência AdrenalRESUMO
INTRODUCTION: Lemierre's syndrome refers to the septic thrombophlebitis of the internal jugular vein, secondary to a pharyngeal infection. Although it mainly affects the internal jugular vein, isolated cases have been described of involvement of the external jugular vein. The main etiological agent is Fusobacterium necrophorum. CASE REPORT: A 27-year-old male, previously healthy, presented with a 7-day history of sore throat and fever. He was diagnosed with Lemierre's syndrome, coinfection by Bacillus circulans, F. nucleatum and Staphylococcus aureus with an atypical presentation due to the involvement of the external jugular vein and the internal jugular vein. CONCLUSIONS: As far as we are aware, we present the first case of Lemierre's syndrome with these characteristics.
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El síndrome DRESS es una reacción adversa dermatológica que puede presentarse debido a diversos medicamentos, y constituye uno de los diagnósticos más importantes por encima del síndrome de Stevens-Johnson. Se trata de un caso relacionado con una reacción adversa de muy baja frecuencia, que está documentada en la literatura científica, a varios medicamentos, entre ellos la fenitoína. Por lo mencionado, la publicación de estos casos resulta escasa y limitada. Las principales preocupaciones del paciente relacionadas con su cuadro clínico radicaban en el gran compromiso cutáneo que lo llevó a hospitalización, dolor e incomodidad, por el cual recurrió al manejo tópico generalizado con vaselina. Los hallazgos clínicos relevantes fueron: eosinofilia severa, ulceraciones cutáneas, hepatitis química y fiebre. Con los hallazgos del cuadro clínico y la evaluación de la escala RegiSCAR se hace el diagnóstico de síndrome DRESS inducido por fenitoína. Se suspende la fenitoína, se inicia levetiracetam y se administran corticosteroides y acetaminofén con evolución favorable. (AU)
DRESS syndrome is a dermatological adverse reaction can occur due to various medications, being one of the most important diagnoses above Steven-Johnson syndrome. This is a case related to a very low frequency adverse reaction that is documented in the scientific literature to several medicines among those, the phenytoin. Therefore, the publication of these cases is scarce and limited. The main concerns of the patients related to their clinical picture were due to the great cutaneous compromise that lead to hospitalization, pain and discomfort for which they resorted to generalized topical management with vaseline (petrolatum). Relevant clinical findings were severe eosinophilia, skin ulcerations, chemical hepatitis and fever. With clinical picture findings and evaluation of the RegiSCAR scale, the diagnosis of Phenytoin-induced DRESS syndrome is made. Phenytoin is discontinued, levetiracetam is started and corticosteroids and acetaminophen are administrated with favorable evolution. (AU)
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Humanos , Masculino , Pessoa de Meia-Idade , Fenitoína/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Vaselina/uso terapêutico , Fenitoína/administração & dosagem , Albendazol/administração & dosagem , Corticosteroides/administração & dosagem , Eosinofilia/etiologia , Exantema/diagnóstico , Levetiracetam/administração & dosagem , Acetaminofen/uso terapêuticoRESUMO
BACKGROUND: Invasive pneumococcal disease (IPD) is the leading cause of infectious death worldwide. This study aimed to describe the epidemiology of IPD and the impact of pneumococcal conjugate vaccine-10 (PCV-10) over a 10-year period in Bogotá, Colombia. METHODS: This was a laboratory-based surveillance study of Streptococcus pneumoniae isolated from patients with IPD from 82 hospitals over 10 years in Bogotá, Colombia. Data were compared between two periods: 2007-2011 (before the introduction of PCV-10) and 2012-2017 (after the introduction of PCV-10). RESULTS: In total, 1670 patients with IPD were included in the study between 2007 and 2017. Between 2007 and 2011, the most common serotypes were 14, 1, 6B, 6A and 3. Between 2012 and 2017, the most common serotypes were 19A, 3, 14 and 1. A decrease in the incidence of IPD, particularly in children aged 0-4 years, was noted after the introduction of PCV-10. Importantly, this reduction in incidence was not observed in patients aged ≥50 years. CONCLUSIONS: The IPD burden in Bogotá remained stable between 2007 and 2017. The incidence of IPD decreased in children but not in older adults. The introduction of PCV-10 led to a change in the most prevalent serotypes to serotypes that are not included in PCV-10.
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Efeitos Psicossociais da Doença , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Idoso , Pré-Escolar , Colômbia/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sorogrupo , Streptococcus pneumoniae/imunologia , Vacinas ConjugadasRESUMO
El síndrome compartimental agudo del miembro inferior es una urgencia médica, que puede conllevar una importante morbilidad para el paciente y que puede tener implicaciones medico legales para el personal médico. Afecta cerca de 3,1 por 100.000 habitantes en el mundo occidental, con predominio de hombres y jóvenes. Debido a una alteración de la perfusión tisular, por la disposición de los músculos de las extremidades en compartimientos compactos, con poca tolerancia a variaciones en la presión, puede causar isquemia, con cambios irreversibles a nivel muscular y nervioso, falla multiorgánica y la muerte, de no tratarse oportunamente. El trauma de la extremidad inferior asociado a fractura es la principal causa del síndrome compartimental agudo. El diagnóstico puede realizarse por evaluación clínica, mediante las clásicas seis "P" de la isquemia, o de manera objetiva, al medir la presión intracompartimental con dispositivos especializados. La fasciotomía descompresiva es un procedimiento quirúrgico mediante el cual se inciden las fascias de los compartimientos musculares, permitiendo la disminución de las presiones a ese nivel, y se constituye en el único tratamiento eficaz para el síndrome compartimental agudo. Las complicaciones posquirúrgicas no son infrecuentes, siendo la perdida de la extremidad la más grave de todas. Un correcto conocimiento y aplicación de la técnica quirúrgica evitará procedimientos inadecuados, que impliquen mayor riesgo de resultados adversos. Presentamos una revisión de los aspectos fundamentales de esta patología potencialmente catastrófica
Acute compartment syndrome of the lower limb is a medical emergency, which can entail significant morbidity for the patient and which may have medico-legal implications for medical personnel. It affects about 3.1 per 100,000 inhabitants in the Western world, with a predominance of men and young people. Ischemia can be caused after an alteration of tissue perfusion, due to the arrangement of the muscles of the extremities in compact compartments, with little tolerance to variations in pressure, with irreversible changes at the muscular and nervous level, and multiorgan failure and death if not treated promptly. Trauma to the lower extremity associated with fracture is the main cause of acute compartment syndrome. Diagnosis can be made by clinical evaluation, using the classic six "P" of ischemia, or objectively by measuring intracompartmental pressure with specialized devices. Decompressive fasciotomy is a surgical procedure by which the fasciae of the muscle compartments are incised, allowing the pressure to be reduced at that level, and it is the only effective treatment for acute compartment syndrome. Postoperative complications are not uncommon, limb loss being the most serious of all. A correct knowledge and application of the surgical technique will avoid inappropriate procedures, which imply a greater risk of adverse results. We present a review of the fundamental aspects of this potentially catastrophic pathology
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Humanos , Síndromes Compartimentais , Fasciotomia , Amputação Cirúrgica , IsquemiaRESUMO
La pseudodextrocardia se ha definido como un desplazamiento irregular del corazón y sus estructuras vasculares hacia la derecha por causas extracardiacas. Es un hallazgo ocasional en estudios imagenológicos de tórax o abdomen y varía acorde con las diferentes relaciones causales. Se presenta el caso de un paciente con una neumopatía crónica, quien a su ingreso presenta pseudodextrocardia como hallazgo incidental.
Pseudo-dextrocardia has been defined as an unusual displacement of the heart and its vascular structures to the right secondary to extracardiac causes. It is an occasional finding in thoracic or abdominal imaging studies and varies according to the various causal relationships. We report a case of pseudo-dextrocardia as an incidental finding in a patient admitted with chronic pulmonary disease.
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Humanos , Masculino , Idoso de 80 Anos ou mais , Dextrocardia/diagnóstico por imagem , Coração/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Tórax , DextrocardiaRESUMO
RESUMEN Amaranthus hybridus L., conocido como bledo, es una planta maleza en una gran variedad de cultivos en el mundo, que se caracteriza por producir alto número de semillas latentes. Para generar estrategias de manejo sostenibles en esta especie es necesario comprender mejor la fisiología de sus semillas. Por tanto, el objetivo fue evaluar el efecto de la luz, de las giberelinas y la profundidad de la siembra sobre la germinación de semillas de bledo. En un primer experimento, se evaluaron cuatro tratamientos de luz (rojo, azul, sin luz y luz natural «testigo¼); en el segundo, se imbibieron semillas en diferentes concentraciones de ácido giberélico (0, 200, 400 y 800mg L-1 de GA3) y, en un último experimento, se evaluaron ocho profundidades de siembra (10, 20, 30, 40, 50, 60, 70 y 80mm), utilizando turba como sustrato. Se encontró mayor porcentaje de germinación en oscuridad, indicando que son semillas fotoblásticas negativas. Para el experimento de giberelinas, el mejor resultado se obtuvo con 400 y 800mg L-1 de ácido giberélico. En el tercer experimento, se observó alto porcentaje de emergencia de plántulas en las primeras profundidades (10mm a 30mm); a mayor profundidad hubo menor emergencia. La respuesta diferencial a la luz, a la aplicación de las giberelinas y el alto porcentaje de semillas viables que no germinaron permite concluir que semillas de bledo poseen latencia fisiológica.
ABSTRACT Amaranthus hybridus L., known as bledo, is a weed in a wide variety of crops worldwide, characterized by producing high number of seeds with dormancy. To generate sustainable management strategies of this species, it is necessary to better understand the physiology of its seeds. Therefore, the objective was to evaluate the effect of light, gibberellins, and seed burying depth on seed germination of bledo. In the first experiment, four light conditions were evaluated (red, blue, without light and natural light (control)), in the second experiment the seeds were imbibed in different concentrations of gibberellic acid (0, 200, 400 and 800mg L-1 of GA3), and in the last experiment, 8 planting depths were evaluated (10, 20, 30, 40, 50, 60, 70 or 80mm) using peat as a substrate. A higher percentage of seed germination in darkness was found, indicating that this species had negative photoblastic seeds. For the gibberellin experiment, the best result was obtained with treatment with 400 and 800mg L-1 of gibberellic acid. In the third experiment, a high percentage of seedling emergence was observed from the first depths (10mm to 30mm); the greater was the depth, the less emergence was found. The differential responses to light, the application of gibberellins, and the high percentage of non-germinated viable seeds allowed to conclude that bledo seeds possess physiological dormancy.
RESUMO
Resumen La anticoagulación es la terapia de elección para la mayoría de pacientes con fibrilación auricular no valvular; sin embargo, en pacientes con enfermedad renal crónica con alto riesgo de sangrado se deben considerar terapias antitrombóticas locales como el cierre percutáneo de la orejuela izquierda con dispositivo Watchman. A continuación, se reporta el primer caso de implante de este dispositivo llevado a cabo en el Hospital de San José de Bogotá, Colombia, y se hace una revisión narrativa sobre este tema. El uso del dispositivo Watchman se asocia con menos accidentes cerebrovasculares hemorrágicos (0,15 vs. 0,96 eventos / 100 pacientes-año HR=0,22; p=0,004), menos muertes cardiovasculares o inexplicadas (1,1 vs. 2,3 eventos / 100 paciente-año; HR=0,48; p=0,006) y menos casos de sangrado no asociado al procedimiento (6,0 % vs. 11,3 %; HR=0,51; p=0,006) en comparación con la warfarina.
Resumen Anticoagulation remains the therapy of choice for the majority of patients with non-valvular atrial fibrillation, however, in patients with chronic kidney disease at high risk of bleeding, local antithrombotic therapies such as the left atrial closure with Watchman device should be considered. We report the first case of implant of this type device in the Hospital de San José at the City of Bogotá, Colombia, and a narrative review of the literature is made. Watchman's use is associated with fewer hemorrhagic strokes (0.15 versus 0.96 events / 100 patients-year HR: 0.22; p = 0.004), cardiovascular death / unexplained death (1.1 vs. 2.3 events / 100 patient-year; HR: 0.48; p = 0.006), and bleeding not associated with the procedure (6.0 % vs. 11.3 %; HR: 0.51; p = 0.006) compared to warfarin.
Assuntos
Humanos , Masculino , Feminino , Fibrilação Atrial , Pacientes , Diálise Peritoneal , Colômbia , Apêndice Atrial , NarraçãoRESUMO
OBJECTIVE: The aim of this study was to explore the association between MS and vitamin D levels, as well as Epstein-Barr virus (EBV) seropositivity and smoking history in a Colombian population. METHODS: We conducted a cross-sectional study between 2017 and 2018. We measured vitamin D levels and EBV antibody titers and administered a questionnaire to assess dietary habits, smoking, second-hand smoking and duration of smoking, sunlight exposure, physical activity, and personal and family history in individuals with and without multiple sclerosis during adolescence. A multivariable logistic regression model was then performed to explore the association between vitamin D status and MS. RESULTS: A total of 87 individuals with MS (mean age 40.9 years; 65.52% females) and 87 without MS (mean age 55 years; 65.52% females) were included in the analysis. In the multivariable analysis, after controlling for supplementation vitamin D levels did not differ between both groups and no difference was found regarding tobacco smoke exposure. The proportion of individuals who tested positive for anti-EBV nuclear antigen was significantly higher in individuals with MS (95.4% vs 82.76%, p = 0.028) CONCLUSION: : We did not find a statistically significant association between MS and vitamin D levels while anti-EBV nuclear antigen titers behaved as previously described in the literature. This study provides new evidence of the association between MS and different risk factors in our country, reinforcing the hypothesis that the pathogenesis of MS is multifactorial. Further studies are needed to better define the association between environmental factors and the development of MS in low prevalence areas.
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Infecções por Vírus Epstein-Barr/epidemiologia , Antígenos Nucleares do Vírus Epstein-Barr/sangue , Esclerose Múltipla/epidemiologia , Fumar/epidemiologia , Vitamina D/sangue , Adulto , Colômbia/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Luz SolarRESUMO
Objective: The objective of this article was to compare hemodynamic and perfusion parameters as well as the clinical outcomes in critically ill patients with postpartum hemorrhage (PPH) who received treatment with a nonpneumatic antishock garment (NASG) as part of an intervention package, with a group of patients in similar conditions who did not receive an NASG.Methods: This observational study analyzed a historic cohort of 154 patients with PPH, secondary hypovolemic shock and signs of hypoperfusion who were admitted to this institution from 2012 to 2015. Group 1 (n= 77) was managed with NASG and Group 2 (n = 77) received interventions other than NASG. Hypoperfusion markers and maternal outcomes were compared in both groups.Results: Of 154 patients included in the analysis, 36.4% required a total abdominal hysterectomy (TAH) to achieve hemorrhage control, 98.2% of whom belonged to Group 2 and 1.8% to Group 1 (p = .001). The use of blood products was more common in Group 2 (p < .001), as was the administration of vasoactive agents. The mean number of days of hospitalization at the Obstetric High Dependency Unit (OHDU) was significantly lower in Group 1 and reached a statistically significant p value. Only two cases of maternal death occurred in Group 2.Discussion: The use of NASG in the management of PPH is a cost-effective strategy for patients with severe shock and signs of hypoperfusion and is optimal in a limited-resource scenario. In this study, the use of NASG was related to better outcomes in a statistically significant manner with better results regarding maternal outcomes such as uterine preservation and decreased transfusion requirements and hospital days.Conclusions: NASG, associated with the use of uterotonic agents and other strategies for PPH control, is a safe tool that helps reduce morbimortality in critically ill patients with PPH.