Excessive dynamic airway collapse in a small cohort of chronic obstructive pulmonary disease patients

The prevalence of EDAC [Excessive Dynamic Airway Collapse] has not been studied specifically in patients with chronic obstructive pulmonary disease [COPD]. The aim of this study was to investigate the prevalence of EDAC in COPD and to determine whether there are clinical factors or functional variables that could influence the degree of expiratory collapse of central airways. Prospective observational study of a group of patients with COPD. The degree of tracheobronchial collapse was evaluated by low-dose dynamic airway computed tomography [CT]. We recorded clinical and pulmonary function tests data, quality of life and BODE index. This study included 53 patients with COPD, 46 [87%] males, mean age 65 [SD, 9] years. The percentage of collapse at each anatomic level was as follows: Aortic arch, 16.1% [SD, 13.6%]; carina, 19.4% [SD, 15.9%]; and bronchus intermedius, 21.7% [SD, 16.1%]. At the point of maximal collapse, the percentage of collapse was 26.8% [SD, 16%]. EDAC was demonstrated at any of the three anatomical points in five patients, corresponding to 9.4% [95% CI, 3.1% to 20.6%] of the sample and affecting the three anatomical points in only two cases. A statistically significant correlation was only found with the total lung capacity [TLC]. The prevalence of EDAC observed in a sample of patients with different levels of COPD severity is low. The degree of dynamic central airway collapse was not related to the patient's epidemiological or clinical features, and did not affect lung function, symptoms, capacity for effort, or quality of life

Infecciones por Staphylococcus aureus resistente a meticilina adquiridas en la comunidad en niños antes sanos y en niños relacionados al hospital en la Argentina / Community onset of methicillin resistant Staphylococcus aureus infections in previously healthy or health care-associated children en Argentina

Introduction: Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA). Objective: To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same communitty. Material and Methods: Prospective, multicentric and comparative study. Children with clinically and microbiologicaly documented CA-MRSA were included. Results: Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68 percent) were community-acquired. Among these 356 (61 percent) were CA-MRSA. In this group, 75 (21 percent) were HCA-MRSA and 281 (79 percent) CA-MRSA. The median age was 36months (range: 1-201). Chronic skindisease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSAhad more frequency of previous antibiotic treatment (63 vs 34 percent) and previous medical consult (76 vs 52 percent), invasive procedures (31 vs 8 percent), surgery (15 vs 0,3 percent) and fever (94 vs 74 percent) (p = <05). Children with CA-MRSAhad subcutaneous abscesses (34 vs 15 percent) (p = <.05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18 percent) and 17 vs 11 percent) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1 percent), trimethoprim-sulphametoxazole (7 vs 1 percent) and clindamycin (25 vs 9 percent) (p = <.05). Four children (5 percent) with HCA-MRSA infections died and 3 (1 percent) mCA-MRSAgroup (p = .05). Conclusión: Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our área.

Introducción: Staphylococcus aureus meticilina-resistente proveniente de la comunidad (SAMRC) es altamente prevalente en diversos países del planeta. Objetivos: Realizar un análisis clínico comparativo entre las infecciones por SAMRC en niños antes sanos (SAMR-CO) y aquellos con S. aureus MR en pacientes con patologías previas (SAMR-RH). Material y Métodos: Estudio multicéntrico, prospectivo y comparativo. Fueron incluidos los niños que tenían infección clínica y microbiológicamente documentada por SAMRC. Resultados: Entre 11/2006 y 11/2007 fueron diagnosticadas 840 infecciones porS. aureus. De ellas 582 (69 por ciento) fueron detectadas en la comunidad. Entre estas 356 (61 por ciento) fueron SAMRC. Entre estas últimas 75 (21 por ciento) fueron SAMR-RH y 281 (79 por ciento) SAMR-CO. La mediana de edad fue de 36 meses (rango: 1-201). Las enfermedades de base más frecuentes fueron: dermatopatías crónicas (13) y enfermedad crónica del SNC (9). Los niños con infección por SAMR-RH presentaron con mayor frecuencia tratamiento antimicrobiano previo (63 vs 34 por ciento), consultas médicas previas (76 vs 52 por ciento), procedimiento invasor previo (31 vs 8 por cientoo), cirugía (15 vs 0,3 por ciento) y fiebre al momento de la consulta (94 vs 74 por ciento) (p < 0,05). Los niños con infección por SAMR-CO tuvieron con mayor frecuencia abscesos subcutáneos (34 vs 15 por ciento) (p < 0,05). La tasa de bacteriemia y se sepsis fue semejante en ambos grupos (21 vs 18 por ciento y 17 vs 11 por ciento)) (p =NS). La resistencia a antimicrobianos fue mayor en niños con SAMR-RH: rifampicina (7 vs l por cientoo), cotrimoxazol (7 vs 1 por ciento) y clindamicina (25 vs 9 por ciento) (p < 0,05). Fallecieron 4 niños con SAMR-RH (5 por ciento) y 3 niños con SAMR-CO (1 por ciento) (p = 0,05). Conclusión: Los niños con SAMR-RH presentan mayor tasa de resistencia a antimicrobianos que SAMR-CO. Debe replantearse el tratamiento antimicrobiano empírico en niños con ...

Corredores endémicos: Una herramienta útil para la vigilancia epidemiológica de la influenza / Endemic corridors: a useful tool for the epidemiological surveillance of influenza

La vigilancia epidemiológica provee información actualizada y oportuna sobre los problemas de salud y sus condicionantes, lo que permite definir acciones de prevención y control. Para la detección de epidemias es útil disponer de corredores endémicos, que indican el número de casos esperados para un cuadro infeccioso en un momento determinado. Con datos de la sección Microbiología del Hospital de Niños "Dr. Pedro de Elizalde" acerca de pacientes internados con diagnóstico de infección respiratoria aguda baja (IRAB) entre el 1/1/96 y el 31/12/2002 se confeccionaron los corredores para influenza A (IA) por semanas epidemiológicas, correspondientes a un período de siete años. En ese período se internaron 10.473 niños con diagnóstico de IRAB y se identificó IA en 411 aspirados nasofaríngeos. Se calcularon la media y el intervalo de confianza de 95% para los límites superior e inferior de incidencia en períodos semanales, y se encontró que el pico estacional ocurre entre las semanas 25 y 32. Al analizar los datos del año 2003, se observó que el pico se produjo antes, entre las semanas 19 y 25, y con valores muy por encima de los esperados para esas semanas. En 2004 aparecen 2 picos, el primero en la semana 20 y sin superar los valores de fluctuación de la parte central de la curva, y el segundo en la semana 26.

Epidemiological surveillance provides updated information about health problems which allows for the establishment of health policy guidelines. The methods for detecting the epidemic frequency of disease require the systematic collection of data on the occurrence of specific diseases. Influenza has cyclic seasonal peaks and its endemic baseline rates are useful for identifying outbreaks: the comparison between baseline and current data supplies epidemiological evidence related to an ongoing outbreak. The upper and lower incidence curves were traced for the data referring to IA detection in the nasopharyngeal aspirates from children hospitalized for acute lower respiratory tract infection from 1996 to 2002. The arithmetic mean and the 95% confidence interval for upper and lower limits of weekly incidence were calculated. The highest incidence was observed between weeks 25 and 32. When analyzing the prepared endemic corridor, it was observed that the highest detection in 2003 occurred between weeks 19 and 25, whereas two peaks occurred in 2004 , the first starting at week 20, at a lower level than the normal epidemic peak, and the second at week 26.

Aneurismas no rotos. Clasificación: análisis de resultados con cirugía en serie de 53 pacientes / Unrupted aneurysms. Classification: analysis of results with surgery in series of 53 patients

La hemorragia subaracnoidea (HSA) por rotura de aneurismas cerebrales sigue siendo una enfermedad con una elevada morbimortalidad a pesar de los continuos avances en diagnóstico y tratamiento. De ahí que cobra gran importancia el manejo de aquellos aneurismas no rotos. Sigue siendo controversial el manejo de estas malformaciones, ya que hay quienes sostienen que los porcentajes de sangrado de un aneurisma no roto son muy bajos. Por el contrario hayn quienes aseveran que dichos porcentajes pueden llegar al cuatro por ciento anual y acumulable, lo que redunda en una disminución de la expectativa de vida en los portadores de aneurismas no rotos. Los autores realizan una división de los aneurismas no rotos en tres grupos, con riesgos diferentes de complicación según el tipo en cuestión. Se hace además un análisis de los resultados quirúrgicos en una serie de cincuenta y tres pacientes con aneurismas no rotos, llegándose a la conclusión que los riesgos quirúrgicos son inferiores a los riesgos naturales de la enfermedad.

Transmisión nosocomial de Candida albicans en recién nacidos / Nosocomial transmission of Candida albicans in newborn infants

Candida spp. colonization in neonates occurs due to vertical or horizontal transmission. Preliminary studies determined that Candida albicans is the principal agent of these infections. In order to establish nosocomial transmission, 26 Candida albicans strains isolated from patients with candidosis hospitalized during a 18-month period in 2 neonatal intensive care units (NICU) from a pediatric hospital were studied. Fourteen isolates from patients and health care workers, involved in possible outbreaks of an intensive care unit (UCI) and a NICU from another pediatric hospital were also studied. All Candida albicans strains were genotyped by Southern blot hybridization with 27A. Isolates for outbreak confirmation were also hybridized with another specific Candida albicans probe, Ca3. Hybridization patterns demonstrated horizontal transmission in all the units studied. In a NICU, transmission among 4 patients during a 10-month period could be established and in the other NICU, 3 cases of transmission among 2 patients each were demonstrated in periods of 2 to 20 days. The outbreak studies showed the same strain isolated from 2 nurses and from one patient at the NICU and at the ICU identical strains were found in 3 patients. In this study, hybridization with Ca3 in addition to 27A probe did not increase discrimination power among isolates. Genotypic analysis allows, not only, determination of transmission and persistence of strains during prolonged periods or in sporadic outbreaks, but also facilitates necessary epidemiological decisions for optimizing nosocomial fungal infection control measures.