Evidence-based guides in tracheostomy use in critical patients

Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)

OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)

Review of HIV prevalence studies in Cameroon; what next?

The number of HIV studies available in Cameroon are wide and varied. The analysis of the HIV seroprevalence data in Cameroon shows that HIV rates are increasing in the surveyed groups as well as in general population. Cameroon it can not be consider any more as HIV low prevalence country. Given the scarce resources and the variety of studies performed a point for reflexion is needed to conduct future epidemiological studies. Priorities need to be done; standard methods need to be established and integration within the health information system is advisable

A review of KABP studies on AIDS and HIV infection in Cameroon

The authors reviewed the studies on knowledge; attitudes; beliefs and practices regarding AIDS and HIV infection in Cameroon. Overall there is a clear increase on knowledge about AIDS among the different groups surveyed although misconceptions are still present which can lead to wrong attitudes towards infected people. The surveys undertaken to date have generally focused on knowledge and practices. More in depth qualitative data is necessary to understand sexual behavior. Behavior research should be linked to interventions to limit the increase of HIV infection

A long term HIV/AIDS projections for Cameroon

Using the data provided by the HIV sentinel surveillance system; since 1989; the HIV prevalence rate among the population sexually active is estimated to vary between 0;8 pour cent and 0;2 pour cent. Taking as hypothesis that Cammeroon is in a preepidemic period; the authors make a long term projections using mathematicals models. Two scenarios are presented. A high scenario which projects the number of HIV infected people to be 220.000 thousand and 14.000 AIDS new cases by the year 2005. A low scenario which projects 140.000 infected persons and 10.000 new AIDS cases by the year 2005

L'experience de filles libres educatrices a Yaounde dans la prevention des MST et du SIDA

Dans le cadre du Programme National de Lutte contre le SIDA au Cameroun; l'utilisation des filles libres educatrices a ete une des strategies adoptees ciblant les groupes a haut risque. Des resultats preliminaires ont ete presentes ailleurs et ont montre son positif impact. Afin d'evaluer cette strategie; une enquete de connaissances; attitudes; croyances et pratiques (ACP) aupres des filles qui pratiquaient la prostitution a Yaounde a ete faite. Cette enquete a eu pour but non seulement de faire le point sur les differentes actions educatrices menees aupres de ce groupe mais aussi de mettre sur pied des methodes d'education plus efficaces

Profil de l'epidemie VIH/SIDA au Cameroun

Les auteurs font le point des resultats du systeme de surveillance sentinelle de l'infection a VIH et du SIDA mis en place au Cameroun depuis 1989. Au 31 decembre 1991; le total cumule des cas declares s'eleve a 763 pour un nombre de cas attendus de 300. Le taux de prevalence de l'infection a VIH1 est d'environ 1;5 pour cent dans la population generale adulte en milieu urbain. La situation en zone rurale demande a etre mieux precisee