Non-invasive ventilation versus conventional oxygen therapy in immunocompromised patients: A meta-analysis

INTRODUCTION: Respiratory failure is common in immunocompromised patients. Intubation and mechanical ventilation (MV) is the mainstay of treatment but is associated with increased risk of pneumonia and other complications. Non-invasive ventilation (NIV) is an alternative to MV in a select group of patients and aims to avoid the complications of MV. In these patients, we performed a meta-analysis on the effect of NIV versus conventional oxygen therapy in reducing intubation rates and other important clinical outcomes. METHODS: We performed an extensive online and unpublished data search for relevant studies that met the inclusion criteria. Randomized controlled trials that used NIV versus conventional oxygen therapy in immunocompromised patients with respiratory failure were included in the metaanalysis. Eligbility and risk of bias assessments were performed independently by three authors. The primary outcome of interest was intubation and mechanical ventilation rate. The secondary outcomes were intensive care unit (ICU) and all-cause mortality, ICU length of stay and duration of mechanical ventilation. RESULTS: Out of the twenty initially screened studies, four studies with a total of 553 patients met the criteria for inclusion and were included in the analysis. Patients given NIV were 38% less likely to be intubated vs. those given oxygen, RR 0.62 (95%CI 0.42,0.93); however, this analysis result is significantly heterogenous. After sensitivity analysis, results showed 48% less likelihood of intubation and mechanical ventilation in the group treated with NIV, RR 0.52 [95% confidence interval (CI) 0.35,0.77]. Patients on NIV had 1.18 days less stay in the ICU vs. oxygen group (95%CI -1.84,-0.52 days ). Three studies included ICU mortality in their outcomes and showed a 54% decrease in ICU mortality among patients given NIV, RR 0.46 (95% CI 0.17, 1.29), however this result is non-significant and heterogenous I2=58%. There was no statistically significant decrease in all-cause mortality between the two groups, RR 0.77 (95% CI 0.53,1.11). After a sensitivity analysis performed specifically for this outcome, results showed a 32% reduction in all cause mortality in patients given NIV vs. oxygen therapy, however was not statistically significant RR 0.68 (95% CI 0.53-1.11) and was heterogenous I2=50%. There is no difference in the duration of mechanical ventilation between groups. CONCLUSION: In immunocompromised patients with respiratory failure, NIV reduced intubation rates, and length of ICU stay, compared to standard oxygen therapy. This intervention also showed trend toward ICU and all-cause mortality reduction.

Persistencia en la competencia vectorial de Aedes albopictus de Venezuela a una cepa asiática dengue 2 / Vector competence persistance of Venezuelan Aedes albopictus for an Asian dengue-2 strain

En Venezuela, existen poblaciones de Aedes aegypti (Ae. aegypti) de diferente origen geográfico y estructura genética que difieren en la competencia vectorial para el virus dengue. Debido a que, recientemente, se reportó la presencia de Aedes albopictus (Ae. albopictus), es importante también conocer la competencia vectorial de esta especie para prever el riesgo epidemiológico el cual conlleva a su propagación. Se determinó la persistencia en la competencia vectorial de Ae. albopictus de Maracay, Venezuela a una cepa asiática dengue 2. Las especies de mosquitos Ae. albopictus y Ae. aegypti fueron alimentadas con una suspensión sangre-virus dengue 2 y luego de 20 días post-exposición viral se determinó la presencia del virus por el ensayo de la reacción en cadena de la polimerasa (PCR) en las diferentes partes de los insectos: abdomen (infección), patas/alas (diseminación) y cabeza (transmisión). Los resultados muestran que la cepa Ae. aegypti es más susceptible a la infección del abdomen (60 %) que la cepa de Ae. albopictus (37,5%); sin embargo, sólo en Ae. albopictus se encontró el virus presente en las patas/alas (100%) y cabezas (33%). La cepa de Ae. albopictus estudiada podría ser más competente para la transmisión del virus dengue asiático que la de Ae. aegypti. Este hallazgo es de gran importancia epidemiológica, ya que se demuestra que este vector aún no estando en su continente de origen, puede seguir siendo un vector eficiente y con el tiempo adecuarse a las cepas virales propias.

In Venezuela, there are populations of Aedes aegypti (Ae. aegypti) with different geographic origins and genetic structure that differ in vector competence for dengue virus. Since recently, the presence of Aedes albopictus (Ae. albopictus) was reported, it is also important to know the vector competence of this species to predict the epidemiological risk which would bring its spread. The objective was to determine the vector competence persistance of Ae. albopictus from Maracay, Venezuela for an Asian dengue-2 strain. The two species of mosquitoes were fed with a blood-dengue 2 virus suspension and after 20 days post-exposure to virus, the presence of the virus was determined by the polymerase chain reaction assay in different parts of the insect: abdomen (infection), legs/wings (spread) and head (transmission).The results show that the strain Ae. aegypti is more susceptible to infection in the abdomen (60 %) that the strain of Ae. albopictus (37.5%); however, only in Ae. albopictus this virus was found in the legs /wings (100%) and heads (33%). The studied strain of Ae. albopictus may be more competent vector in the transmission of the dengue 2 virus than Ae. aegypti. This finding is of great epidemiological importance as this shows that even this mosquito not being in its continent of origin, it can still be an efficient vector and eventually become adapted to the native viral strains.

Manejo de las fístulas interlocutoras / Management enterocutaneous fistulas

Estudio retrospectivo, descriptivo, que tiene como propósito describir el actual manejo de pacientes con Fístula Enterocutánea. Material y Métodos: se realizó un análisis retrospectivo, descriptivo, en el Seguro Social en los años 2009 a 2011, se evaluaron los siguientes aspectos: estado nutricional del paciente, características de la FE, manejo que se le proporcionó con respecto a apoyo nutricional, uso de hormonas, terapia presión negativa, cuidados de la piel, evolución de los pacientes según el tratamiento utilizado, si presentó cierre espontáneo, intervención quirúrgica o complicaciones, se realizó un instrumento para recolectar los datos mencionados...

Actitudes de un gupo de jóvenes de enseñanza media frente al uso del condón, Santiago 2005 / Attitudes toward the condom use in adolescent schoolar group, Santiago 2005

El objetivo del estudio fue conocer las actitudes en torno al uso del condón en estudiantes de enseñanza media de cuarto año medio de un colegio público de la Región Metropolitana. Para ello se aplicó metodología cualitativa, exploratoria, de diseño etnográfico. Se seleccionó una muestra intencionada de 7 hombres y 7 mujeres de 17 años de edad y con actividad sexual iniciada. Se realizaron dos Focus Group, uno por cada genero. Entre los hallazgos destacan el no usar condón porque: consideran que reduce la sensibilidad; precio excesivo; descontento de la pareja; dificultad para acceder a éste; vergüenza de solicitarlos en consultorios o farmacias y el considerar que los entregados por los centros de salud son de mala calidad. El uso de condón es siempre en función del embarazo, no en la prevención de Infecciones de Transmisión Sexual . La gran mayoría no usó condón la primera vez, ya que “dificulta más” la iniciación y por reducción del placer sexual y, no creen estar en riesgo actual de contagio de VIH, porque “confían en su pareja”o porque “hay amor”. Las mujeres acceden fácilmente a no usar condón si su pareja se los pide porque “están enamoradas”. Las mujeres no reconocen como de su responsabilidad la adquisición del condón, ya que “de eso se preocupa el hombre” . Lo encontrado sugiere imprescindible reforzar las acciones de promoción, y prevención en los adolescentes por educadores y profesionales de la salud.

This is a study about attitudes towards the condom use in adolescents scholars groups of fourth level of high school. A qualitative and exploratory methodology was used with a ethnographic design. Two focus groups were conducted: one with 7 boys and the other with 7 girls. The sample was determined by investigators. Among the findings were: “do not use condom because it decreases the sensibility”, “excessive cost”, “couple’s discomfort”; “difficulty to obtain it”; “to be ashamed to get condoms at the health centers or at drugstore”. The condom is used to prevent pregnancy and not to prevent Infections Transmmitted Disease. Most of them did not use condom during the first sexual relation because it difficult the initiation of the sexual contact and decreases the sexual pleasure. They do not believe that they could be in real risk of VIH because they “trust their couple” and they are in love. Girl easily accept no using condom, if the couple ask so; because they are in love. They do not recognize their responsibility in getting the condom because this is the man task The findings suggest the reinforcement of the promotion and prevention health activities among adolescent conducted by educators and health professionals.