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Lock therapy is useful for preserving indwelling catheters. Few lock therapy studies have been published in Latin America. OBJECTIVE: To describe the clinical characteristics of pediatric patients using therapeutic and prophylactic lock therapy for six years in a high-complexity hospital in Colombia. PATIENTS AND METHOD: Cross-sectional descriptive study of patients aged < 18 years who received lock therapy. Collected variables included demographic data, clinical characteristics, blood test results, therapeutic interventions, frequency of admission to the pediatric critical care unit, and mortality. Descriptive analysis was performed. RESULTS: 54 patients were included in the study, most of them males, with 67 episodes of therapeutic lock therapy use. The most frequent diagnosis was hematological neoplasm (61%). Among these patients, 88% presented neutropenia while receiving lock therapy. Catheter preservation was achieved in 75% of the cases. Aminoglycosides were the most commonly used antibiotics (38%). Mortality due to catheter-related bacteremia was 6%. Catheter preservation using ethanol solution 70% was achieved in 62% of the patients with prophylactic lock therapy, all of whom had chronic gastrointestinal pathology. CONCLUSION: Catheter preservation rates were 75% and 62% in patients with therapeutic and prophylactic lock therapy, respectively, with a higher rate achieved among cancer patients with neutropenia (80%). Aminoglycosides and vancomycin were the most commonly used antibiotics.
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Cateteres Venosos Centrais , Neutropenia , Masculino , Humanos , Criança , Cateteres Venosos Centrais/efeitos adversos , Estudos Transversais , Antibacterianos/uso terapêutico , AminoglicosídeosRESUMO
Introducción. La intususcepción del apéndice corresponde a su invaginación en el ciego. Existen varias causas, pero la endometriosis ha sido informada pocas veces. Aunque el diagnóstico se debe sospechar clínicamente, por lo general su causa solo se determina en el intraoperatorio, donde se deben tener en cuenta causas oncológicas que requieran una resección amplia. Caso clínico. Mujer de 21 años que consultó por dolor abdominal agudo generalizado. Se practicó una tomografía computarizada de abdomen, observando una intususcepción del apéndice en el ciego, estriación de la grasa pericecal y adenomegalias. Se realizó laparoscopia diagnóstica encontrando intususcepción casi completa del apéndice cecal, de aspecto neoplásico. Se convirtió a laparotomía para proceder a hemicolectomía derecha, con vaciamiento ganglionar y anastomosis del íleon al colon transverso. Discusión. La sospecha clínica de intususcepción debe corroborarse mediante ecografía, tomografía o estudios baritados. El tratamiento siempre es quirúrgico, como en el caso de nuestra paciente, quien evolucionó de forma adecuada y continuó asintomática después de un año de seguimiento. Conclusión. El diagnóstico temprano de la intususcepción permite realizar tratamientos quirúrgicos menos agresivos y disminuye el riesgo de filtración de la anastomosis. Se debe tener en cuenta el diagnóstico de endometriosis como posible causa. Se debe realizar el manejo complementario por parte de ginecología.
Introduction. The intussusception of the appendix corresponds to its invagination in the cecum. There are several causes, endometriosis being rarely reported. Although the diagnosis must be suspected clinically, its cause is generally only determined intraoperatively, where oncological causes that require extensive resection must be taken into account. Clinical case. A 21-year-old woman who consulted due to acute generalized abdominal pain, an abdominal tomography was performed, finding an intussusception of the appendix in the cecum, striation of pericecal fat, and lymph nodes. A diagnostic laparoscopy was performed, finding almost complete intussusception of the appendix, with a neoplastic appearance. She was converted to laparotomy to perform a right hemicolectomy, with lymph node dissection and ileal to transverse anastomosis. Discussion. Clinical suspicion of intussusception should be confirmed by ultrasound, abdominal tomography, or barium studies. Treatment is always surgical, as in the case of our patient, who evolved adequately and remained asymptomatic after one year of follow-up. Conclusion. Early diagnosis of intussusception allows for less aggressive surgical treatment and decreases the risk of anastomosis leakage. The diagnosis of endometriosis should be taken into account as a possible cause. Complementary management by gynecologists should be performed.
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Humanos , Apendicite , Endometriose , Neoplasias do Apêndice , Colectomia , IntussuscepçãoRESUMO
Background and Purpose: Disseminated fusariosis is an opportunistic infection caused by the hyaline fungus Fusarium spp. and occurs mainly in patients with leukemia. Case report: Two cases of disseminated fusariosis in pediatric patients are presented. Profound and prolonged neutropenia, fever, myalgia, and skin lesions in the legs were present in two girls with leukemia undergoing chemotherapy. In the first case, infection by Fusarium spp. was confirmed by anatomopathological findings, pathogen isolation, and polymerase chain reaction. In the second case, Fusarium solani infection was confirmed by mass spectrometry using blood cultures and skin lesion samples. Conclusion: It is important to consider disseminated fusariosis in high-risk patients who present with profound and prolonged neutropenia and persistent fever that does not resolve after broad-spectrum antibiotics to initiate antifungal therapy in a timely manner.
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Purple passion fruit is one of the most important fruit exports of Colombia, but its productivity is being compromised by the emergence of several viral diseases. High-throughput sequencing (HTS) surveys of viruses in purple passion fruit fields in the province of Antioquia suggested infection by a new member of the family Tymoviridae. In this work, we characterize the complete genome sequence of this virus, tentatively named purple passionfruit leaf deformation virus (PpLDV), and evaluate its distribution in Antioquia. PpLDV was assembled at high coverage in four datasets from different regions. The 6.1 kb genome of PpLDV encodes a single polyprotein with domains characteristic of the family Tymoviridae, contains a marafibox-like promoter and the 3'-UTR can fold into a tRNA-like secondary structure with a valine anti-codon. Phylogenetic analysis of the polyprotein revealed that PpLDV is a distinct member of the family Tymoviridae, more closely related to the genus Tymovirus and the unclassified Poinsettia mosaic virus (PnMV). The presence of PpLDV was confirmed by RT-qPCR and RT-PCR in samples from commercial purple passion fruit fields, plantlets and seed sprouts collected in Antioquia using primers designed in this study. Keywords: high-throughput sequencing; Marafivirus; Passifloraceae; plant virology; RT-qPCR; Tymovirus.
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Passiflora , Tymoviridae , Colômbia , Frutas , Genoma Viral , Passiflora/genética , Filogenia , Poliproteínas/genética , Tymoviridae/genéticaRESUMO
OBJECTIVE: To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). STUDY DESIGN: Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. RESULTS: Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. CONCLUSIONS: Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.
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Países em Desenvolvimento , Encefalite , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.
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Resumen La limitación del esfuerzo terapéutico (LET) es toda acción que implique suspender o no iniciar tratamientos o medidas terapéuticas en pacientes que no se beneficiarán clínicamente. En Latinoamérica, las investigaciones realizadas dejan en evidencia la falta de familiarización y discordancia que hay alrededor del tema y sus prácticas. El presente estudio buscó objetivizar el conocimiento en LET del personal de salud de una institución de Medellín, a partir de una encuesta autoaplicada que permitió el desarrollo de un estudio descriptivo de tipo transversal, con muestreo no probabilístico. Dentro de los resultados se encontró que el 56,5 % de los encuestados refirió conocer el concepto, y el 90 % manifestó aplicarlo. Sin embargo, había discordancias dentro de los conceptos clave de la definición y el ejercicio.
Abstract Limitation of therapeutic effort (LTE) is any action that involves suspending or not initiating medical treatment or therapeutic measures in patients who will not receive any clinical benefit. In Latin America, some research has proven a lack of familiarization and disagreement with the subject and its practices. The present study tried to objectify the knowledge of LTE of healthcare personnel at an institute in Medellín using a self-administered survey that allowed conducting a cross-sectional descriptive study with non-probabilistic sampling. Within the results, 56.5 % of respondents understood the concept of LTE, and 90 % applied it actively. However, there were discrepancies regarding the core concepts of the definition and practice.
Resumo A limitação de esforço terapêutico (LET) é toda ação que implique suspender ou não iniciar tratamentos ou medidas terapêuticas em pacientes que não se beneficiarão clinicamente. Na América Latina, as pesquisas realizadas evidenciam a falta de familiarização e a discordância que há ao redor do tema e suas práticas. O presente estudo procurou objetivar o conhecimento em LET da equipe de saúde de uma instituição de Medellín, utilizando um questionário auto aplicado que permitiu o desenvolvimento de um estudo descritivo de tipo transversal, com amostragem não probabilística. Dentro dos resultados constatou-se que 56,5 % dos pesquisados disseram conhecer o conceito, e 90 % manifestaram aplicá-lo. No entanto, havia discordâncias dentro dos conceitos chave da definição e da prática.
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Autonomia Pessoal , Temas Bioéticos , Ética Médica , OncologiaRESUMO
PURPOSE: CARD9 deficiency is an inborn error of immunity that predisposes otherwise healthy humans to mucocutaneous and invasive fungal infections, mostly caused by Candida, but also by dermatophytes, Aspergillus, and other fungi. Phaeohyphomycosis are an emerging group of fungal infections caused by dematiaceous fungi (phaeohyphomycetes) and are being increasingly identified in patients with CARD9 deficiency. The Corynespora genus belongs to phaeohyphomycetes and only one adult patient with CARD9 deficiency has been reported to suffer from invasive disease caused by C. cassiicola. We identified a Colombian child with an early-onset, deep, and destructive mucocutaneous infection due to C. cassiicola and we searched for mutations in CARD9. METHODS: We reviewed the medical records and immunological findings in the patient. Microbiologic tests and biopsies were performed. Whole-exome sequencing (WES) was made and Sanger sequencing was used to confirm the CARD9 mutations in the patient and her family. Finally, CARD9 protein expression was evaluated in peripheral blood mononuclear cells (PBMC) by western blotting. RESULTS: The patient was affected by a large, indurated, foul-smelling, and verrucous ulcerated lesion on the left side of the face with extensive necrosis and crusting, due to a C. cassiicola infectious disease. WES led to the identification of compound heterozygous mutations in the patient consisting of the previously reported p.Q289* nonsense (c.865C > T, exon 6) mutation, and a novel deletion (c.23_29del; p.Asp8Alafs10*) leading to a frameshift and a premature stop codon in exon 2. CARD9 protein expression was absent in peripheral blood mononuclear cells from the patient. CONCLUSION: We describe here compound heterozygous loss-of-expression mutations in CARD9 leading to severe deep and destructive mucocutaneous phaeohyphomycosis due to C. cassiicola in a Colombian child.
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Ascomicetos , Proteínas Adaptadoras de Sinalização CARD/genética , Predisposição Genética para Doença , Heterozigoto , Infecções Fúngicas Invasivas , Mutação , Feoifomicose/epidemiologia , Feoifomicose/etiologia , Fatores Etários , Idade de Início , Ascomicetos/genética , Ascomicetos/imunologia , Biomarcadores , Pré-Escolar , Colômbia/epidemiologia , Biologia Computacional/métodos , Análise Mutacional de DNA , Feminino , Humanos , Imuno-Histoquímica , Imunofenotipagem , Imageamento por Ressonância Magnética , Linhagem , Feoifomicose/diagnóstico , Feoifomicose/imunologia , Fenótipo , Tomografia Computadorizada por Raios X , Sequenciamento do ExomaRESUMO
Edible films are among the most promising fields in food science over the last decade due to their versatility (they can be made from a wide array of materials) and because they can be used as carriers of different active substances, like antioxidants, antimicrobial agents, and essential oils from plants. In the case of the essential oils, their inclusion in edible films is limited by their low water solubility. Nanoemulsions are thermodynamically stable and transparent systems that can be used as a way of incorporating essential oils into edible film matrices. In this paper, we developed lemongrass and rosemary essential oil nanoemulsions by using a low-energy method, observing the effect of the surfactant/oil ratio in their physicochemical properties. Then we studied the effect of the nanoemulsions concentration incorporated into banana starch edible films. We observed that essential oils' nanoemulsions have a plasticizing effect increasing the film's water vapor permeability, transparency, and elongation at break, while the hydrophobic nature of the essential oils lead to a decrease in their water solubility.
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Cymbopogon/química , Emulsões , Embalagem de Alimentos/métodos , Musa/química , Óleos Voláteis , Rosmarinus/química , Amido/química , Anti-Infecciosos , Interações Hidrofóbicas e Hidrofílicas , Nanoestruturas , Permeabilidade , Plastificantes , Solubilidade , VaporRESUMO
PURPOSE: Mendelian susceptibility to mycobacterial disease is a rare clinical condition characterized by a predisposition to infectious diseases caused by poorly virulent mycobacteria. Other infections such as salmonellosis and candidiasis are also reported. The purpose of this article is to describe a young boy affected with various infectious diseases caused by Mycobacterium tuberculosis complex, Salmonella sp, Klebsiella pneumonie, Citrobacter sp., and Candida sp, complicated with severe enteropathy and transient hypogammaglobulinemia. METHODS: We reviewed medical records and performed flow cytometry staining for lymphocyte populations, lymphocyte proliferation in response to PHA, and intracellular IFN-γ production in T cell PHA blasts in the patient and a healthy control. Sanger sequencing was used to confirm the genetic variants in the patient and relatives. RESULTS: Genetic analysis revealed a bi-allelic mutation in IL12RB1 (C291Y) resulting in complete IL-12Rß1 deficiency. Functional analysis demonstrated the lack of intracellular production of IFN-γ in CD3+ T lymphocytes from the patient in response to rhIL-12p70. CONCLUSIONS: To our knowledge, this is the third patient with MSMD due to IL-12Rß1 deficiency complicated with enteropathy and hypogammaglobulinemia and the first case of this disease to be described in Colombia.
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Agamaglobulinemia/genética , Candidíase/genética , Enterite/genética , Infecções por Bactérias Gram-Negativas/genética , Receptores de Interleucina-12/deficiência , Receptores de Interleucina-12/genética , Agamaglobulinemia/tratamento farmacológico , Vacina BCG , Candidíase/tratamento farmacológico , Farmacorresistência Bacteriana , Enterite/tratamento farmacológico , Predisposição Genética para Doença , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Lactente , Mutação , Mycobacterium tuberculosisRESUMO
Fungal infections have become an important cause of morbidity and mortality in hospitalized children due to many complicating and underlying conditions. We present the case of a newborn infant with fungemia due to Kodamaea ohmeri who had a good outcome of the infection after using the combination of antifungal treatment and central venous catheter removal.
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BACKGROUND: Multidrug-resistant Gram-negative infections represent a growing problem and a serious global threat. Data in children are scarce. Klebsiella pneumoniae carbapenemases (KPC) are the most common mechanism of resistance this organism has developed. We report the clinical characteristics and outcomes from a cohort of children infected or colonized with carbapenem-resistant K. pneumoniae (CRKp) at a tertiary care center in Medellín, Colombia. METHODS: We performed a retrospective chart review of all pediatric cases from whom CRKp isolates were obtained from 2008 to 2013. Clinical characteristics and outcomes were recorded. RESULTS: A total of 34 infected children (median age, 22.8 months) with 43 episodes and 55 colonized patients (median age, 33 months) were identified. All patients had at least 1 risk factor previously related with multidrug-resistant Gram-negative infections (premorbid conditions, previous exposure to antibiotics, prolonged length of stay and use of indwelling devices). Urinary tract infections, abdominal infections and bacteremia were the most common clinical presentations. Overall mortality was 38%, and it was lower when a meropenem-containing regimen was used. Colistin was the most used antibiotic either alone or in combination and was associated with 8.8% of nephrotoxicity. CONCLUSION: CRKp infections have high mortality in children and usually occur in children with comorbidities, prolonged hospital stay and prior antibiotic exposure. Combined therapy with meropenem-containing regimens seems to be the best option in severely ill children.
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Carbapenêmicos/farmacologia , Portador Sadio/epidemiologia , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Resistência beta-Lactâmica , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Centros de Atenção TerciáriaAssuntos
Educação em Saúde/métodos , Viagem , Colômbia , Controle de Doenças Transmissíveis , Humanos , VacinaçãoRESUMO
Carbapenem-resistant Pseudomonas aeruginosa has become a serious health threat worldwide due to the limited options available for its treatment. Understanding its epidemiology contributes to the control of antibiotic resistance. The aim of this study was to describe the clinical and molecular characteristics of infections caused by carbapenem-resistant P. aeruginosa isolates in five tertiary-care hospitals in Medellín, Colombia. A cross-sectional study was conducted in five tertiary-care hospitals from June 2012 to March 2014. All hospitalized patients infected by carbapenem-resistant P. aeruginosa were included. Clinical information was obtained from medical records. Molecular analyses included PCR for detection of bla(VIM), bla(IMP), bla(NDM), bla(OXA-48), and bla(KPC) genes plus pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) for molecular typing. A total of 235 patients were enrolled: 91.1% of them were adults (n = 214), 88.1% (n = 207) had prior antibiotic use, and 14.9% (n = 35) had urinary tract infections. The bla(VIM-2) and bla(KPC-2) genes were detected in 13.6% (n = 32) and 11.5% (n = 27), respectively, of all isolates. Two isolates harbored both genes simultaneously. For KPC-producing isolates, PFGE revealed closely related strains within each hospital, and sequence types (STs) ST362 and ST235 and two new STs were found by MLST. With PFGE, VIM-producing isolates appeared highly diverse, and MLST revealed ST111 in four hospitals and five new STs. These results show that KPC-producing P. aeruginosa is currently disseminating rapidly and occurring at a frequency similar to that of VIM-producing P. aeruginosa isolates (approximately 1:1 ratio) in Medellín, Colombia. Diverse genetic backgrounds among resistant strains suggest an excessive antibiotic pressure resulting in the selection of resistant strains.
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Proteínas de Bactérias/metabolismo , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/enzimologia , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Bactérias/genética , Criança , Análise por Conglomerados , Colômbia/epidemiologia , Infecção Hospitalar/patologia , Infecção Hospitalar/transmissão , Estudos Transversais , DNA Bacteriano/química , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase , Infecções por Pseudomonas/patologia , Infecções por Pseudomonas/transmissão , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Centros de Atenção Terciária , Adulto Jovem , beta-Lactamases/genéticaRESUMO
INTRODUCTION: Hand hygiene is the most cost-effective and simple measure of preventing healthcare associated infections (HAI). The approach to improve low compliance must be through multimodal interventions such as the "Clean Care is Safer Care" strategy (WHO). AIM: To estimate the efficacy of a multimodal strategy in improving hand hygiene in five wards of a tertiary care hospital in Medellín, Colombia (2008-2010). METHODS: Quasi-experimental before-after study. RESULTS: Hand hygiene compliance significantly increased after the intervention (82 to 89%, p = 0.007). The knowledge score increased from a median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand rub consumption increased significantly from 10.5 liters to 58.1 liters per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88]. Monthly HAI rates showed no significant variations during the same period [IR = 0.90, 95% CI = 0.71; 1.13]. DISCUSSION: This and other recent studies demonstrate that implementing a multimodal strategy for hand hygiene significantly increases compliance with this measure, irrespective of type of health worker or hospital department. CONCLUSIONS: Implementing a multimodal strategy we achieved significant increases in hand hygiene compliance but mild or no significant variations in monthly HAI rates.
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Infecção Hospitalar/prevenção & controle , Desinfecção das Mãos/normas , Pessoal de Saúde/educação , Controle de Infecções/métodos , Avaliação de Resultados em Cuidados de Saúde , Colômbia , Fidelidade a Diretrizes , Implementação de Plano de Saúde , Hospitais Universitários , Humanos , Centros de Atenção TerciáriaRESUMO
Introduction: Hand hygiene is the most cost-effective and simple measure of preventing healthcare associated infections (HAI). The approach to improve low compliance must be through multimodal interventions such as the "Clean Care is Safer Care" strategy (WHO). Aim: To estimate the efficacy of a multimodal strategy in improving hand hygiene in five wards of a tertiary care hospital in Medellín, Colombia (2008-2010). Methods: Quasi-experimental before-after study. Results: Hand hygiene compliance significantly increased after the intervention (82 to 89%, p = 0.007). The knowledge score increased from a median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand rub consumption increased significantly from 10.5 liters to 58.1 liters per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88]. Monthly HAI rates showed no significant variations during the same period [IR = 0.90, 95% CI = 0.71; 1.13]. Discussion: This and other recent studies demonstrate that implementing a multimodal strategy for hand hygiene significantly increases compliance with this measure, irrespective of type of health worker or hospital department. Conclusions: Implementing a multimodal strategy we achieved significant increases in hand hygiene compliance but mild or no significant variations in monthly HAI rates.
Introducción: La higiene de manos es una medida costo-efectiva para prevenir las infecciones asociadas a la atención de salud (IAAS). Para mejorar el cumplimiento se recomienda implementar estrategias multimodales como "atención limpia es atención segura" de la OMS. Objetivo: Estimar el efecto de la estrategia multimodal en cinco unidades de un hospital de tercer nivel en Medellín, Colombia (2008-2010). Métodos: Estudio cuasi-experimental antes y después. Resultados: El cumplimiento general con la higiene de manos aumentó de forma significativa en el período posterior a la implementación (82 a 89%, p = 0,007). El puntaje de conocimientos aumentó entre los dos períodos de tiempo (Mediana = 26, RIC = 22-28 vs Mediana = 30, RIC = 26-32; p = 0,001). El consumo de alcohol aumentó de 10,5 litros a 58,1 litros por 1.000 pacientes/día [razón de incidencias (RI) = 2,39; 95% CI = 1,99; 2,88]. Las tasas mensuales de IAAS no mostraron variaciones [RI = 0,90; 95% CI = 0,71; 1,13]. Discusión: Este estudio demuestra que la implementación de una estrategia multimodal para la higiene de manos aumenta significativamente el cumplimiento con esta medida, independientemente del tipo de trabajador y el servicio hospitalario. Conclusión: Con la estrategia multimodal se aumentó significativamente el cumplimiento con la higiene de manos.
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Humanos , Infecção Hospitalar/prevenção & controle , Desinfecção das Mãos/normas , Pessoal de Saúde/educação , Controle de Infecções/métodos , Avaliação de Resultados em Cuidados de Saúde , Colômbia , Fidelidade a Diretrizes , Implementação de Plano de Saúde , Hospitais Universitários , Centros de Atenção TerciáriaRESUMO
Currently medical information flows at great speed, bombarding medical students. Students are unfamiliar with fundamental aspects of biomedical literature appraisal. We assert that research performed during medical school will help to reduce the gap between the information available and comprehension by the student. The goal of the present review is to expound the importance of performing research during the undergraduate medical years and the relevance of research in other fields of medicine. We performed a literature review searching MEDLINE with terms consistent with our objective. We discuss the conduct of research projects during medical school training. The analysis of the articles retrieved proves that research is feasible and that it is a critical process during the undergraduate period for medical students.
La información médica en la actualidad fluye a una gran velocidad y en cantidades nunca antes vistas. Los estudiantes de medicina son sometidos a una avalancha de información constante con pocos conocimientos del tema. Creemos que durante el pregrado la investigación en medicina es una posibilidad de cerrar esta brecha de conocimiento. El objetivo del presente estudio es demostrar la importancia de la realización de investigación durante el pregrado de medicina, así como la importancia que esta cobra en otras áreas de la medicina. Realizamos una revisión narrativa de la literatura de la base de datos de MEDLINE mediante términos correspondientes al tema. De forma adicional se discutieron otros temas relevantes para la adecuada realización de proyectos de investigación durante el pregrado. El análisis de los artículos encontrados demostró cómo la investigación es factible y fundamental en el pregrado de medicina para un adecuado desarrollo de los médicos en formación.
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Educação de Graduação em Medicina/métodos , Pesquisa , Estudantes de Medicina , HumanosRESUMO
Toxoplasmosis is a common disease in Latin America. The infection has a major impact on public health worldwide. Congenital toxoplasmosis is part of the spectrum of the disease and the consequences for the newborn are devastating. In this article, we present a case of brain calcifications and hydrocephalus secondary to infection with Toxoplasma gondii in a newborn, as well as the outcome during follow-up and long-term sequelae. It is of high importance for the clinician to think about this disease, due to its high prevalence in Latin America, and to adopt adequate measures for its prevention and timely management in order to reduce long-term sequelae.
La toxoplasmosis es una enfermedad común en la población latinoamericana. Esta infección tiene un gran impacto en la salud pública a nivel mundial. Dentro del espectro de la infección, se encuentra la toxoplasmosis congénita. Las consecuencias de la infección intrauterina por Toxoplasma gondii, son nefastas para el recién nacido. En este artículo se presenta un caso de calcificaciones en el cerebro e hidrocefalia secundarias a infección por Toxoplasma gondii en un recién nacido, así como el desenlace durante el seguimiento y secuelas a largo plazo. Es de importancia que el clínico no olvide la alta prevalencia de toxoplasmosis en la población latinoamericana y que tome medidas adecuadas para su prevención y manejo oportuno que logren disminuir las secuelas a largo plazo.
Assuntos
Encefalopatias/parasitologia , Calcinose/parasitologia , Hidrocefalia/parasitologia , Toxoplasmose Congênita/complicações , Encefalopatias/patologia , Calcinose/patologia , Feminino , Seguimentos , Humanos , Recém-Nascido , América LatinaRESUMO
Most studies on Staphylococcus aureus have focused on the molecular epidemiology of methicillin-resistant S. aureus (MRSA) infections. In contrast, little information is available regarding the molecular epidemiology of currently circulating methicillin-susceptible S. aureus (MSSA) isolates in hospital settings, an epoch when the epidemiology of S. aureus has undergone significant changes. We conducted a cross-sectional study to compare the clinical, epidemiological, and genetic characteristics of MSSA and MRSA isolates at 3 tertiary-care hospitals in Medellín, Colombia, from February 2008 to June 2010. The infections were classified according to the Centers for Disease Control and Prevention (CDC) definitions. Genotypic analysis included spa typing, multilocus sequence typing (MLST) and staphylococcal cassette chromosome (mec) (SCCmec) typing. A total of 810 patients was enrolled. One hundred infections (12.3%) were classified as community-associated (31 CA-MSSA, 69 CA-MRSA), 379 (46.8%) as healthcare-associated community-onset (136 HACO-MSSA, 243 HACO-MRSA), and 331 (40.9%) as healthcare-associated hospital-onset (104 HAHO-MSSA, 227 HAHO-MRSA). Genotype analyses showed a higher diversity and a more varied spa type repertoire in MSSA than in MRSA strains. Most of the clinical-epidemiological characteristics and risk factors evaluated did not allow for discriminating MRSA- from MSSA-infected patients. The lack of equivalence among the genetic backgrounds of the major MSSA and MRSA clones would suggest that the MRSA clones are imported instead of arising from successful MSSA clones. This study emphasizes the importance of local surveillance to create public awareness on the changing S. aureus epidemiology.