Perfil de uso de tigeciclina en un hospital universitario en Chile

Introducción: El uso de tigeciclina ha ido en aumento en los últimos años, debido al incremento de la resistencia bacteriana y la escasez de alternativas terapéuticas. Objetivo: Caracterizar y evaluar las prescripciones de tigeciclina en pacientes internados en un hospital universitario, durante los años 2017 y 2018. Metodología: Estudio observacional retrospectivo, donde se caracterizaron los pacientes, las terapias, la microbiología asociada, los desenlaces clínicos y las reacciones adversas asociadas a los tratamientos con tigeciclina. Se determinó la proporción de prescripciones apropiadas por un comité de expertos y el consumo de tigeciclina medido en DDD/100 camas-día. Resultados: Se caracterizaron 89 pacientes, de los cuales 67 (75,3%) cumplieron los criterios de selección. El 53,7% de los pacientes eran hombres, con una edad promedio de 60 ± 15 años. El principal motivo de hospitalización fue quirúrgico (65,7%). El 67,1% de los tratamientos con tigeciclina se inició en una Unidad de Paciente Critico y el foco de infección predominante fue abdominal (64,3%). El 50% de las terapias con tigeciclina fueron dirigidas según la microbiología identificada. En 65,7% de los casos se usó tigeciclina como monoterapia en la dosis habitual (62,9%). Náuseas (8,6%), diarrea (7,1%) y vómitos (4,3%) fueron los efectos adversos más reportados. El 84,3% de los tratamientos se consideraron apropiados. El año 2017 se consumió 0,4 DDD/100 camas-día y 0,6 DDD/100 camas/día el 2018, siendo la UCI el servicio que presentó el mayor uso en ambos años. Discusión: Tigeciclina fue utilizada principalmente en monoterapia para el tratamiento de infecciones intraabdominales en pacientes hospitalizados, por motivos quirúrgicos, en una unidad de paciente crítico, en las dosis habituales recomendadas de 100 mg como dosis de carga seguida de 50 mg cada 12 hs IV. En 50% de los casos, la terapia fue dirigida según microbiología. Los eventos adversos más habituales fueron los gastrointestinales. Conclusión: La mayoría de las terapias prescritas fueron consideradas apropiadas por el comité de expertos.

Background: The use of tigecycline has been increasing in recent years, due to increase in bacterial resistance and the scarcity of therapeutics alternatives. Aim: To characterize and evaluate the tigecycline prescriptions of patients hospitalized in a university hospital, during the years 2017 and 2018. Methods: A retrospective observational study was carried out, where the patients, the therapies, the associated microbiology, the clinical outcomes and the adverse reactions associated with tigecycline were characterized. The proportion of appropriate prescriptions was determined by committee of experts and the consumption of tigecycline measure in DDD/100 bed-days. Results: 89 patients who used tigecycline were characterized, of which 67 (75.3%) met the selection criteria. 53.7% of the patients were male, with a mean age of 60 +/- 15 years The main reason for hospitalization was surgical (65.7%). 67.1% of the treatments with tigecycline were started in a critical patient unit and the predominant focus of the infection was the abdomen (64.3%). 50% of the therapies with tigecycline were ordered according to the identified microbiology. In 65.7% of the cases, tigecyclin was used as monotherapy at the usual dose (62.9%). Nausea (8.6%), diarrhea (7.1%) and vomiting (4.3%) were the most reported adverse events. 84.3% of the treatments were considered appropriate. In 2017, 0.4 DDD/100 bed/days were consumed and 0.6 DDD/100 bed/days in 2018, with de ICU being the service that presented the highest use in both years. Discussion: Tigecycline was mainly used as monotherapy for the treatment of intra-abdominal infections in patients hospitalized for surgical reasons in a critical patient unit at the usual doses of 100 mg loading followed by 50 mg every 12 hours IV. In 50% of the case the therapy was directed according to microbiology. The most common adverse events were gastrointestinal. Conclusion: Most of the prescribed therapies were considered appropriate by the expert committee.

Caracterización de la utilización de colistín en un hospital de alta complejidad

Resumen: El aumento de la resistencia y la escasez de nuevos antibacterianos ha requerido la reintroducción de antiguos antimicrobianos entre ellos colistín. Objetivo: Caracterizar la utilización de colistín durante el año 2017 en un hospital universitario, mediante la descripción de los pacientes, los tratamientos, la microbiología asociada y efectos adversos. Pacientes y Métodos: Trabajo observacional retrospectivo. Se revisaron los datos de todos los pacientes que recibieron colistín intravenoso (IV) por al menos 48 horas, durante el año 2017. Resultados: Se incluyeron 53 pacientes, equivalentes a 91 tratamientos. El foco respiratorio fue el principal (46,2%). El 68,1% de los tratamientos fue iniciado en la UCI. La mayoría de los pacientes tenía una hospitalización reciente (83,5%), y presentaban uso previo de antibacterianos (89%). Los dos patógenos mayoritariamente identificados fueron Pseudomonas aeruginosa y Klebsiella spp. El consumo promedio de colistín fue de 2,4 DDD/100 camas/día. El servicio que más consumió colistín fue la UCI, con 45,5 DDD/100 camas/día, usando generalmente la dosis de 3 MUI cada 8 horas IV y con una baja utilización de dosis de carga. Conclusión: Colistín corresponde a un antimicrobiano de uso restringido a infecciones sospechadas o confirmadas por agentes bacterianos multi resistentes. En esta serie, su uso inicial fue principalmente empírico, en pacientes con factores de riesgo para resistencia antibacteriana; se usó en forma asociada a otros antimicrobianos, siendo el foco principal el respiratorio.

Background: The increase in resistance and the shortage of new antibiotics has led to the reintroduction of old antimicrobials such as colistin. Aim: To evaluate the use of colistin during 2017 in a university hospital, through the characterization of patients and treatment, associated microbiology, response to treatment and adverse effects. Methods: Retrospective observational design. The data of all patients who received colistin for at least 48 hours during the year 2017 were reviewed. Results: 55 patients were included, equivalent to 144 treatments. The respiratory focus was the main one (57.9%). 64% of the treatments began in the ICU, while 7% in the ward. Most of the patients has a recent hospitalization (86.8%) and has previous use of antibiotics (90.4%). The two main pathogens identified were Pseudomonas aeruginosa and Klebsiella spp. In 87.1% of the cases with microbiological justifications for the use of colistin, a favorable response was obtained. The average consumption of colistin was 2.4 DDD/100 beds/day. The department that consumed the most colistin was the ICU, with 45,5 DDD/100 beds/day, generally using a dose of 3 MIU every 8 hours IV and with low use of loading doses. Conclusion: Colistin corresponds to an antibiotic whose use is restricted to infections suspected or confirmed by multi-resistant bacterial agents. Its initial use in this serie was mainly empirical, in patients with risk factors for antibiotics resistance, it was used in association with other antimicrobials, being the respiratory the main infectious focus.

Experiencia subjetiva de estudiantes y docentes que vivencian un cambio curricular / Subjective experience of students and teachers who experience a curriculum change

Objetivo: Conocer la experiencia subjetiva de estudiantes y docentes respecto del cambio curricular. Metodología: Estudio transversal, muestra de 169 estudiantes de cuarto año curricular y 32 docentes. Información recogida en cuestionario “Inquietudes y procedimientos para adoptar Innovaciones Educativas” (IPIE) validado y adaptado al estudio. Análisis descriptivo. Estudio respetó normas éticas y consentimiento informado. Resultados: 26,0 por ciento de alumnos correspondió a Tecnología Médica; 22,5 por ciento Enfermería y Nutrición, respectivamente, y 29,0 por ciento Obstetricia. Edad media de 21,3+/-1,43 años. Mujeres 68,1 por ciento. En “Información”, los estudiantes mostraron el promedio más alto en el ítem “Quisiera saber lo que otros están haciendo en esta área” (4,1+/-0,9), y los docentes en “Me gustaría saber si se contará con los recursos para mantener esta innovación en un futuro inmediato” (4,7+/-0,4). En “Funcionalidad”, promedio más alto correspondió a “Me gustaría saber qué es lo que esta innovación va a requerir para mantenerla en el futuro” (4,3+/-0,8) y el más bajo en “Estoy totalmente ocupado/a en otras cosas, para mí la innovación no es prioridad” (2,4+/-1,4). En “Resultados”, los docentes presentaron el promedio más alto en “Me interesa evaluar mi impacto sobre los estudiantes” y “Quisiera que otros equipos de docentes se motiven con los logros que tenemos en este proceso de innovación curricular” (4,6+/-0,4; 4,6+/-0,4). Conclusiones: Estudiantes y docentes se mostraron conformes con la experiencia del cambio curricular. Aún existen dudas respecto de cómo este cambio afectará las competencias del estudiantado y la sustentabilidad en el tiempo. Es necesario continuar esta línea investigativa durante el ejercicio profesional de egresados.

Objective: To determine the subjective experience of students and teachers on curriculum change. Methodology: Cross-sectional study in a sample of 169 Regular fourth-year students and 32 teachers. Information collected in the survey “Concerns and procedures to adopt educational innovations” (IPIE) validated and adapted to the study. Descriptive analysis with means, medians, ranges, percentages and averages compared with t-test and ANOVA. Study respected ethical and informed consent. Results: 26.0 percent of students accounted for Medical Technology, Nursing and Nutrition 22.5 percent, 29.0 percent respectively and Obstetrics. Mean age 21.3 +/- 1.43 years. 68.1 percent women. In “Information”, students showed the highest average item “I want to know what others are doing in this area” (4.1 +/- 0.9), and teachers in “I wonder if they have the resources to keep this innovation in the immediate future “(4.7 +/- 0.4). In “Functionality” highest average corresponded to “I wonder what this innovation will be required to keep it in the future” (4.3 +/- 0.8) and lowest in the scale “I am fully occupied / to other things, for innovation is not my priority “(2.4 +/- 1.4). In teaching, in “Results” highest average “I am interested in evaluating my impact on students” and “I want other teachers to motivate teams with the achievements we have in this curricular innovation process” (4.6 +/- 0, 4, 4.6 +/- 0.4). Conclusions: students and teachers were satisfed with the experience of curriculum change. Still, there are doubts about how this will affect the student skills and sustainability over time. It is necessary to continue this line of research for the professional practice of graduates, to objectively assess the skills of the new student-centered curriculum.

Identification of hemolytic and neuroactive fractions in the venom of the sea anemone Bunodosoma cangicum

Sea anemones are a rich source of biologically active substances. In crayfish muscle fibers, Bunodosoma cangicum whole venom selectively blocks the I K(Ca) currents. In the present study, we report for the first time powerful hemolytic and neuroactive effects present in two different fractions obtained by gel-filtration chromatography from whole venom of B. cangicum. A cytolytic fraction (Bcg-2) with components of molecular mass ranging from 8 to 18 kDa elicited hemolysis of mouse erythrocytes with an EC50 = 14 æg/ml and a maximum dose of 22 æg/ml. The effects of the neuroactive fraction, Bcg-3 (2 to 5 kDa), were studied on isolated crab nerves. This fraction prolonged the compound action potentials by increasing their duration and rise time in a dose-dependent manner. This effect was evident after the washout of the preparation, suggesting the existence of a reversible substance that was initially masking the effects of an irreversible one. In order to elucidate the target of Bcg-3 action, the fraction was applied to a tetraethylammonium-pretreated preparation. An additional increase in action potential duration was observed, suggesting a blockade of a different population of K+ channels or of tetraethylammonium-insensitive channels. Also, tetrodotoxin could not block the action potentials in a Bcg-3-pretreated preparation, suggesting a possible interaction of Bcg-3 with Na+ channels. The present data suggest that B. cangicum venom contains at least two bioactive fractions whose activity on cell membranes seems to differ from the I K(Ca) blockade described previously

Prevalencia de síntomas biológicos y psicológicos en mujeres perimenopáusicas, según estrato socioeconómico, en la ciudad de Temuco / Prevalence of biological and psychological symptoms in perimenopausal women of different socioeconomic levels Temuco city

Background: Psychological and biological symptoms occur in the perimenopausal period. However the real prevalence of these, is not well known in Chile. Aim: To determine the prevalence of biological and psychological symptoms and self care sexual health practices of perimenopausal women of Temuco, Chile. Patients and methods: A random sample of 171 women aged 45 to 55 years old, affiliated to private preventive health institutions and community organizations, were studied. These women were stratified in three income levels. Chi square, Fisher test and ANOVA were used for statistical analysis. Results: Bone and muscle aches were the most frequent referred symptoms in 36 percent of women. Thirty one percent complained of vaginal dryness and 28 percent of headache. No differences in symptom frequency per age or between post or pre menopausal women, were observed. Depressive disorders were found in 39 percent of women, mostly in women not working outside their houses. In the previous two years, 67 percent of women had a PAP smear and 58 percent had a mammography performed. Women of low income levels had a greater prevalence of biological and psychological symptoms and a lower frequency of self care behaviors. Conclusions: The most frequent symptom among the studied women was bone and muscle aches, followed by vaginal dryness. These results differ from other publications that report flushing as the most important symptom among perimenopausal women

Estudio comparativo entre test de Clements y absorbancia a 650nm como indice de madurez pulmonar fetal. / Comparative study between Clements' test and absorbance at 650 nm 25 index of pulmonary fetal maturity

Se analizan 82 liquidos amnioticos determinandoseles absorbancia a 650 nm y test de Clements. Con 3 y 4 tubos encontramos una correlacion r: 0,63 y r:0,73, respectivamente. En cada caso, estudianos los X y sd para cada punto del Clements y los porcentajes de falsos positivos y negativos segun la absorbancia que se elija para limite de madurez pulmonar. Cuando la O.D.es > 0.100 encontramos 12.1% de falsos negativos y 2.4% de falsos positivos. Los 2 falsos positivos nos mostraron problema respiratorio al nacer, siendo las determinaciones hechas 24 hr antes del parto. El test de la absorbancia a 650 nm es un metodo rapido, objetivo y de bajo costo, que puede reemplazar al test de Clements en nuestro medio