Mortalidad Materna en Venezuela: aspectos médicos y Políticas (1940 - 2016) / Materna Mortality in Venezuela: medical issues and Public Policy (1940 - 2016)

En la actualidad Venezuela se encuentra en una crisis social y económica sin precedentes. La mortalidad materna(MM) es un indicador en salud importante, debido a que permite tener idea de la atención médica de un país; se mide a través de dos indicadores: Razón de Mortalidad Materna (RMM) y Tasa de Mortalidad Materna (TMM). Objetivo: Revisar y compararla evolución de ambos indicadores de MM desde la década de 1930 hasta la década 2000. Métodos: Se realizó una revisión de la literatura y de informes técnicos de organismos gubernamentales y no gubernamentales para el análisis de la situación previa y reciente de esta situación en Venezuela. Los resultados señalan que existe una notable disminución de las cifras de MM como ha de esperarse con el mejoramiento de la tecnología desde la década de 1930 hasta el año 2000; posteriormente ocurre un retroceso de la sanidad pública con cifras comparables a la década de 1960. Concluimos que la MM ha sido desde tiempos pasados un problema constante en la salud pública; al pasar los años y gobiernos, se han implementado numerosas políticas públicas para mejorar esta situación, muchas de estas estrategias han sido fallidas debido a la falta de su continuidad y de su cumplimiento pleno.

Venezuela is currently in an unprecedented socialand economic crisis. Maternal mortality is an important health indicator because it provides an idea of a country's medical care. Maternal mortality is usually measured through two indicators: Maternal Mortality Ratio (MMR) and Maternal Mortality Rate. Objective: Review and compare the evolution of both healthindicators from the 1930s to 2016. Methods: A review of the literature and technical reports from governmental andnon-governmental organizations was carried out to analyze theprevious and recent situation. of this situation in Venezuela. Theresults indicate that there is a notable decrease in the figures ofmaternal mortality, as should be expected with the improvementof technology from the 1930s to the year 2000. Subsequently, there is a decline in public health with figures comparable to the1960s. We conclude that maternal mortality has been a constant problem in public health since ancient times. Over the years and governments, numerous public policies have been implementedto improve this situation. Many of these strategies have beenfailed due to lack of continuity and in the absence of its full compliance.

Disbiosis bacteriana y su efecto en enfermedades bucales: una revisión bibliográfica / Bacterial dysbiosis and its effect on oral diseases: a review bibliographic

Objetivo: actualizar la información sobre la disbiosis bacteriana oral y su efecto en enfermedades bucales. Material y métodos: se realizó una revisión bibliográfica detallada, donde la búsqueda de artículos comenzó desde el 2014 con trabajos de investigación relacionados con el tema. Se aplicaron palabras clave para facilitar y delimitar el tema. En los resultados obtenidos se observa información específica de disbiosis bacteriana y los problemas y enfermedades que causan en la cavidad bucal. Conclusión: la cavidad oral es un ecosistema muy complejo e interactivo donde se desarrollan variedades de hábitats que establecen relaciones entre los microorganismos en los distintos medios bucales. Por lo general, el cuerpo humano vive en simbiosis con dichas bacterias, esta relación hospedador-huésped es producto de años de evolución y convivencia para poder tolerar a dichas especies y por medio de años de investigación, determinar a los agentes patógenos y a los simbióticos, lo que permitirá en un futuro tener enfoques terapéuticos y científicos, para así solucionar, mejorar y evitar problemas relacionados con la salud (AU)

Objective: this review aimed to update the information on oral bacterial dysbiosis and its effect on oral diseases. Material and methods: a detailed literature review was performed, where the search for articles began in 2014 with research papers related to the topic. Keywords were applied to facilitate and delimit the topic. The results obtained show specific information on bacterial dysbiosis and the problems and diseases they cause in the oral cavity. Conclusion: the oral cavity is a very complex and interactive ecosystem where a variety of habitats develop and establish relationships between microorganisms in different oral environments. Generally, the human body lives in symbiosis with these bacteria, this host-guest relationship is the product of years of evolution and coexistence to be able to tolerate these species and through years of research to determine the pathogens and symbiotics, which will allow in the future to have therapeutic and scientific approaches, to solve, improve and avoid health-related problems (AU)

Secondary bacterial infections in patients with coronavirus disease 2019-associated pneumonia

SUMMARY OBJECTIVE: The vast majority of patients who hospitalized with coronavirus disease 2019 are given empirical antibiotic therapy. However, information on the frequency, microorganism species, and resistance rates of secondary bacterial infections in coronavirus disease 2019 patients are insufficient. We aimed to show the frequency of secondary infections and resistance conditions in patients with coronavirus disease 2019 hospitalized in the intensive care unit. METHODS: The results of tracheal aspirate culture, blood culture, and urine culture obtained from coronavirus disease 2019 patients - at least 2 days after their admission to the intensive care unit - were examined microbiologically. RESULTS: A total of 514 patients hospitalized in intensive care unit were included in our study. Tracheal aspirate, blood, or urine cultures were collected from 369 patients (71.8%). Bacterial reproduction was detected in at least one sample in 171 (33.3%) of all patients. The rate of respiratory tract infection and/or bloodstream infection was found to be 21%. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa in tracheal aspirate culture; Coagulase-negative staphylococci, K. pneumoniae, and A. baumannii in blood culture; and Escherichia coli, K. pneumoniae, and Enterococcus faecalis in urine culture were the most common microorganisms. A. baumannii was resistant to most antibiotics except colistin and P. aeruginosa strains were resistant to most antibiotics except amikacin, colistin, cefepime, and imipenem. In K. pneumoniae, the highest meropenem sensitivity (73%) was observed; there was a strong resistance to most of the remaining antibiotics. CONCLUSIONS: We think that our study can be useful in choosing empirical antibiotic therapy in the coronavirus disease 2019 pandemic and reducing the mortality that may occur with secondary infection.

Impact of bacterial infection and intestinal microbiome on colorectal cancer development / 中华医学杂志(英文版)

Accumulating evidence suggests that intestinal bacteria play an important role in the pathogenesis of colorectal cancer (CRC). Due to the complexity of the intestinal microbiome, identification of the specific causative microbial agents in CRC remains challenging, and the search for the causative microbial agents is intense. However, whether bacteria or their products can induce inflammation that results in tumorigenesis or directly causes CRC in humans is still not clear. This review will mainly focus on the progress of bacterial infection and CRC, and introduce the microbial contribution to the hallmarks of cancer. This article uses Salmonella and its chronic infection as an example to investigate a single pathogen and its role in the development of CRC, based on laboratory and epidemiological evidence. The bacterial infection leads to an altered intestinal microbiome. The review also discusses the dysfunction of the microbiome and the mechanism of host-microbial interactions, for example, bacterial virulence factors, key signaling pathways in the host, and microbial post-translational modifications in the tumorigenesis. Colonic carcinogenesis involves a progressive accumulation of mutations in a genetically susceptible host leading to cellular autonomy. Moving forward, more human data are needed to confirm the direct roles of bacterial infection in CRC development. Insights into the inhibiting infection will help to prevent cancer and develop strategies to restore the balance between host and microorganisms.

Tratamiento quirúrgico de la endocarditis infecciosa activa / Active infective endocarditis: surgical treatment

Resumen: La endocarditis infecciosa, la infección cardiovascular en general, es una enfermedad médico-quirúrgica compleja que requiere un tratamiento multidisciplinario precoz, específico y agresivo. A pesar de los avances médicos, ésta sigue siendo una enfermedad con una morbi-mortalidad elevada, por lo que el tratamiento antibiótico se complementa en un 40-50% de los pacientes mediante intervención quirúrgica. Por lo tanto, es necesario conocer las opciones que pueden llegar a ser utilizadas para extirpar el tejido infectado. El objetivo de este trabajo es discutir aspectos de interés en la cirugía de la endocarditis infecciosa.

Abstract: Infective endocarditis (IE) is a complex disease that requires a multidisciplinary approach and early and aggressive treatment. Despite médical and surgical advances, this disease still has high morbidity and mortality. The antibiotic treatment is complemented in 40-50% of the cases with surgical intervention. Thus, it is useful to be aware of the possibilities that might be contemplated in order to excise the infected tissues. The aim of this work is to discuss current surgical aspects of interest in the surgery IE.

Implementación del método de FilmArrayTM en pacientes pediátricos con infecciones severas / Implementation of the FilmArrayTM method in pediatric patients with severe infections / Implementação do método de matriz do FilmArrayTM em pacientes pediátricos com infecções graves

Se evaluó la implementación del método de PCR múltiple FilmArrayTM (Biofire Diagnostics, LLC, EE.UU.) en 21 niños con infección respiratoria aguda baja, 3 con meningoencefalitis, y un caso de sepsis. Se registraron el tiempo de demora hasta obtener el resultado y adecuar el tratamiento, los días de internación, los patógenos detectados y el costo de la incorporación de esta metodología. En los niños estudiados con FilmArrayTM el resultado estuvo disponible a los 90 minutos desde la toma de la muestra. Se detectaron patógenos no demostrados por los métodos disponibles, como Rhinovirus, además de diagnosticar coinfección viral; el tiempo promedio de estadía resultó 5 días. Se estimó reducir un 40% el costo global de internación. La implementación de FilmArrayTM resultó sencilla y se pudo incorporar a la sistemática de trabajo. Si bien esta experiencia incluyó un bajo número de pacientes, aportó información que demuestra el potencial de esta metodología para un mejor manejo del paciente crítico.

The implementation of multiple PCR FilmArrayTM (Biofire Diagnostics, LLC, USA) for 21 children with low acute respiratory infection, 3 with meningoencephalitis, and 1 case of sepsis was evaluated. Delay time until the result was obtained and the treatment adapted, hospitalization days, pathogens detected and the cost of incorporating this methodology were all recorded. In the children studied with FilmArrayTM the result was available 90 minutes after the sample was taken. Pathogens were not demonstrated by the available methods, such as Rhinovirus, apart from diagnosing viral coinfection, the average length of stay was 5 days. It was estimated to reduce the overall cost of hospitalization by 40%. The implementation of FilmArrayTM was simple and could be incorporated into the work system. Although this experience included a low number of patients, it provided information that demonstrates the potential of this methodology for better management of the critical patient.

Foi avaliada a implementação do método de PCR múltiplo FilmArrayTM (Biofire Diagnostics, LLC, EUA) em 21 crianças com infecção respiratória aguda baixa, 3 com meningoencefalite e um caso de sepse. O tempo de atraso foi registrado até a obtenção do resultado e a adaptação do tratamento, dias de internação, patógenos detectados e o custo da incorporação dessa metodologia. Nas crianças estudadas com o FilmArrayTM, o resultado ficou disponível 90 minutos após a coleta da amostra; foram detectados os patógenos não demonstrados pelos métodos disponíveis, como o Rinovírus, além de diagnosticar a coinfecção viral; o tempo médio de permanência foi de 5 dias. Foi estimado reduzir o custo total da hospitalização em 40%. A implementação do FilmArrayTM foi simples e pôde ser incorporada à sistemática de trabalho. Embora essa experiência tenha incluído um número de pacientes baixo, forneceu informações que demonstram o potencial dessa metodologia para um melhor gerenciamento do paciente crítico.

Patología infecciosa del vestíbulo nasal / Infectious diseases of the nasal vestibule

El vestíbulo nasal corresponde a la primera porción de la fosa nasal, éste se encuentra delimitado lateralmente por los cartílagos alares y medialmente por el borde caudal del septum nasal y la columela. Las enfermedades infecciosas del vestíbulo nasal son patologías frecuentes en la práctica clínica; su diagnóstico se realiza en base a sospecha clínica y examen físico, requiriendo habitualmente solo manejo médico ambulatorio. Desde el punto de vista etiológico pueden ser virales, bacterianas y fúngicas. Las principales especies bacterianas involucradas corresponden a Staphylococcus coagulasa negativa, S. epidermidis, S. hominis y S. haemolyticus, difteroides spp y S. aureus. Su manejo es esencialmente médico con casos excepcionales requiriendo manejo quirúrgico. En la actualidad existe escasa información epidemiológica al respecto, lo que dificultad la clasificación de los dichos cuadros clínicos. Se realizó una revisión de la literatura sobre cuadros infecciosos que afectan el vestíbulo nasal para lograr sistematizar y clarificar las distintas patologías y sus tratamientos.

The nasal vestibule corresponds to the first portion of the nasal passage, limited laterally by the lateral crus and medially by the caudal edge of the nasal septum and columella. Infectious diseases of the nasal vestibule are frequent in clinical practice, diagnosis is made based on clinical suspicion and physical examination, usually requiring only ambulatory medical management. In terms of etiology, they can be viral, bacterial and fungal. The main bacterial species involved correspond: Coagulase-negative Staphylococcus, S. epidermidis, S. hominis and S. haemolyticus, difteroides spp and S. aureus. Management is essentially medical and only exceptionally requires surgery. Currently, there is a lack of epidemiological information in this regard, which makes it difficult to classify these clinical conditions. A review of the literature on infectious conditions that affect the nasal vestibule was performed, to systematize and clarify the different pathologies and their management.

Utilidad de los parámetros clínicos y de laboratorio básicos para predecir infección bacteriana seria en menores de 3 meses que se hospitalizan por síndrome febril sin foco / Utility of basic clinical and laboratory parameters to predict Serious Bacterial Infection in children younger than 3 months old hospitalized for Febrile Syndrome without Source

Resumen: Introducción: Un 20% de los niños con síndrome febril se presenta como síndrome febril sin foco (SFSF). Las es trategias de manejo en este grupo presentan alta sensibilidad, pero baja especificidad. Objetivos: Ca racterizar las infecciones bacterianas serias (IBS) en menores de 3 meses hospitalizados por SFSF, y evaluar utilidad de parámetros clínicos y de laboratorio en la identificación de pacientes con alto riesgo de IBS. Pacientes y Método: Estudio prospectivo en pacientes < 3 meses hospitalizados entre enero 2014 y noviembre 2015 por SFSF en dos hospitales pediátricos de la Región Metropolitana. Criterios de inclusión: edad 4 días - 3 meses, fiebre > 38°C de < 72 h de evolución sin causa demostra ble. Criterios de exclusión: uso de antimicrobianos hasta 7 días previo a su ingreso, prematuros < 34 semanas, peso de nacimiento < 2 kg e inmunocomprometidos. Se registraron datos demográficos, clínicos, y exámenes de laboratorio, hemograma y PCR, diagnóstico de egreso, IBS descartada, IBS probable o confirmada. Resultados: 32% de los pacientes egresó con diagnóstico de IBS, 28% con diagnóstico de infección viral o probablemente viral, 34% con diagnóstico de SFSF no especificado y 6% SFSF por otras causas. No se encontraron diferencias significativas en PCR, leucocitosis, aspecto tóxico ni horas de fiebre al ingreso al comparar los grupos con y sin IBS (p > 0,05). La combinación de parámetros clínicos y de laboratorio mostro sensibilidad de 27%, especificidad de 90%, VPP 60% y VPN 71%. Conclusión: No fue posible establecer que parámetros clínicos y de laboratorio permitan identificar menores de 3 meses con alto riesgo de IBS, manteniendo su utilidad como indicadores de bajo riesgo. Es necesario contar con otros elementos clínicos y de laboratorio que permitan discrimi nar IBS de infecciones virales.

Abstract: Introduction: In 20% of children with febrile syndrome, it appears as fever of unknown origin (FUO) syndrome. Management strategies in this group have high sensitivity but low specificity. Objectives: To cha racterize serious bacterial infections (SBI) in children younger than three months old hospitalized because of FUO syndrome and to evaluate the utility of clinical and laboratory parameters in the identification of patients that are at high risk of SBI. Patients and Method: Prospective study in patients aged < 3 months hospitalized due to FUO syndrome between January 2014 and November 2015 in two pediatric hospitals in the Metropolitan Region. Inclusion criteria: age 4 days - 3 months, fever > 38°C longer than 72 hours after onset without demonstrable cause. Exclusion criteria: anti microbial use up to 7 days before admission, preterm infants < 34 weeks, birth weight < 2 kg, and im munocompromised. Demographic, clinical, and laboratory tests data were recorded as well as blood count and CRP, discharge diagnosis, and ruled out, probable or confirmed SBI. Results: 32% of the patients were discharged with diagnosis of SBI, 28% with diagnosis of viral or probably viral infec tion, 34% with diagnosis of not specified FUO syndrome, and 6% due to other causes. There were no significant differences in the CRP value, altered WBCs count, toxic aspect, or hours of fever at the admission when comparing groups with and without SBI (p < 0.05). The combination of clinical and laboratory parameters showed 27% of sensitivity, 90% of specificity, 60% of PPV, and 71% of NPV. Conclusion: It was not possible to establish clinical and laboratory parameters that allow the identifi cation of children younger than 3 months old at high risk of SBI, however, they maintain their value as low risk indicators. It is necessary further investigation of other clinical and laboratory elements that allow discriminating SBI from viral infections.

Câncer de colo uterino associado a fatores de risco ocupacional* / Cervical cancer related to occupational risk factors: review

Introdução: Fatores de risco associados ao trabalho podem causar, entre outros, câncer de colo uterino. Objetivo: Identificar na literatura especializada a associação entre câncer de colo de útero e a exposição aos fatores ocupacionais de risco. Métodos: Realizou-se um levantamento bibliográfico em bases de dados eletrônicos com os seguintes descritores: câncer de colo uterino e riscos ocupacionais. Resultados: Trabalhadores expostos ao tabaco nas fábricas de cigarro, fluidos de motores, exposição ocupacional a fungos e bactérias e ao tetracloroetileno, presente em produtos de limpeza usados em lavanderias e para desengraxar metais, estariam mais susceptíveis ao desenvolvimento de câncer de colo uterino. Conclusão: Há poucos estudos que identificam a relação entre o câncer de colo de útero e os fatores de risco ocupacional, dificultando a associação entre o carcinogênese e o fator de risco.

Background: Occupational risk factors are associated with many types of neoplasms including cervical cancer. Objective: To review the specialized literature for evidence on the relationship between cervical cancer and exposure to occupational hazards. Methods: Literature search in electronic databases using keywords cervical cancer and occupational risk. Results: Workers occupationally exposed to tobacco, fungi or bacteria, metalworking fluids and tetrachloroethylene used in dry cleaning and for metal degreasing exhibited higher susceptibility to cervical cancer. Conclusion: Few studies sought to investigate relationships between cervical cancer and occupational hazards, which hinders the attempts at establishing a causal link.

The impact of small intestinal bacterial overgrowth on the growth of children and adolescents / Impacto do sobrecrescimento bacteriano no intestino delgado sobre o peso e a estatura de crianças e adolescentes

ABSTRACT Objective: To evaluate the association between small intestinal bacterial overgrowth (SIBO) and weight and height impairment in children and adolescents with gastroenterology diseases. Methods: Observational and retrospective study. All 162 patients aged less than 19 years old who underwent breath test in search of SIBO between 2011 and 2016 were studied. Breath test was collected after the intake of 10 grams of lactulose. The concentration of hydrogen and methane was measured for 180 minutes after the beginning of the test by 12i QuinTronMicroLyzer device. Results: SIBO was identified in 51 (31.5%) patients. There was no difference between the age of those with (mean=8.7y.o; 25th and 75th percentile: 4.6 and 11.3) and without (mean=7.9y.o 25th and 75th percentile: 4.8 and 12.2) SIBO (p=0.910). There was no association between gender and SIBO (male 26.3% vs. female 36.3%, p=1.00). A lower median of height-for-age Z score (mean=-1.32; 25th and 75th percentile: -2.12 and -0.08 vs. mean=-0.59; 25th and 75th percentile: -1.57 and 0.22; p=0.04) was demonstrated in children with SIBO when compared with children without it. There was no difference between the BMI-for-age Z score of patients with (mean=-0.48) and without SIBO (mean=-0.06) (p=0.106). The BMI of patients with SIBO (median=15.39) was lower than of those without it (median=16.06); however, the statistical analysis was not significant (p=0.052). The weight-for-age Z score was lower in patients with SIBO (mean=-0.96) than in those without SIBO (mean=-0.22) (p=0.02) Conclusions: Children and adolescents with SBIO associated with diseases of the gastrointestinal tract have lower weight and height values.

RESUMO Objetivo: Avaliar a existência de associação entre sobrecrescimento bacteriano no intestino delgado (SBID) e comprometimento de peso e estatura em crianças e adolescentes com doenças do aparelho digestivo. Métodos: Estudo observacional e retrospectivo em ambulatório de gastroenterologia pediátrica. Foram incluídos todos os 162 pacientes com idade inferior a 19 anos que realizaram teste respiratório para pesquisa de SBID entre 2011 e 2016. O teste respiratório foi realizado após ingestão de dez gramas de lactulose. Foram determinadas as concentrações de hidrogênio e metano em aparelho 12i QuinTron MicroLyzer até 180 minutos após o início do teste respiratório. Resultados: SBID foi caracterizado em 51 (31,5%) dos 162 pacientes. Não houve diferença na idade das crianças com (mediana=8,7 anos; percentil 25-75: 4,6-11,3) e sem (mediana=7,9 anos; percentil 25-75: 4,8-12,2) SBID (p=0,910). Não se observou associação entre SBID e sexo (masculino 27,4% e feminino 36,6%; p=0,283). O escore Z da estatura-idade nos pacientes com SBID (mediana=-1,32; percentil 25-75: -2,12—0,08) foi menor (p=0,040) do que naqueles sem SBID (mediana=-0,59; percentil 25-75: -1,57-0,22). Na comparação do escore Z de índice de massa corpórea-idade não foi observada diferença entre os grupos com (média=-0,489±1,528) e sem (média=-0,067±1,532) SBID (p=0,106). Nos pacientes com menos de 10 anos de idade, o escore Z de peso-idade foi menor nos pacientes com SBID (média=-0,968±1,359) do que nos sem SBID (média=-0,223±1,584) (p=0,026). Conclusões: Crianças e adolescentes com SBID associado a doenças do trato gastrintestinal apresentam menores valores de peso e estatura.

Causes of equine abortion, stillbirth, and perinatal mortality in Brazil / Causas de abortamento, natimortalidade e mortalidade em equinos no Brasil

Abortion and complications in reproduction are important causes of economic loss in horse breeding. Studies of its causal agents can help to identify the primary pathogens or other factors involved and define appropriate measures to reduce its occurrence. This research aimed to investigate the primary causes of equine abortion, stillbirth, and perinatal mortality in regions of Brazil. Tissue from aborted fetuses, stillbirths, neonates and foals submitted to the Biological Institute of São Paulo, Brazil, from January 2010 to July 2013 were processed for viral and bacterial isolation, polymerase chain reaction (PCR), histology, and immunohistochemistry. Bacterial infection was the primary detected cause of abortion, found in 16 of the 53 animals submitted for bacterial analysis followed by viruses analysis in 2 of 105 animals, and noninfectious causes (neonatal isoerythrolysis) in 2 of 105 animals. Fungi were found in a single sample of 53 tested. The most frequent bacteria recovered were Escherichia coli, Enterobacter aerogenes, combined E. coli and Streptococcus spp., Staphylococcus spp., and Bacillus spp. The following agents were each observed in a single sample: Arcanobacterium pyogenes, Streptococcus spp., Corynebacterium spp., Actinobacillus spp., and Rhodococcus equi. The predominant identification of fecal and other opportunistic bacteria as opposed to pathogens commonly associated with equine abortion, such as Leptospira spp. and equine herpesvirus type 1 (EHV-1), suggests the need of improving hygiene management of breeding mares to prevent bacterial infection that may cause fetal loss, stillbirth, and perinatal mortality.(AU)

Abortamento e complicações na reprodução são importantes causas de perda econômica na equideocultura. Estudos dos agentes causais podem ajudar a identificar patógenos ou outros fatores envolvidos e definir medidas apropriadas para reduzir sua ocorrência. Esta pesquisa investigou as causas primárias de aborto, natimortalidade e mortalidade perinatal em equinos de diversas regiões do Brasil. Tecidos de fetos abortados, natimortos e potros submetidos ao Instituto Biológico de São Paulo, Brasil, no período de janeiro de 2010 a julho de 2013, foram processados por meio de técnicas de isolamento viral e bacteriano, PCR, histologia e imuno-histoquímica. Infecção bacteriana foi a causa mais detectada, encontrada em 16 de 53 amostras submetidas à análise bacteriana, seguida de causa viral em 2 de 105 amostras, e causas não infecciosas (isoeritrólise neonatal) em 2 de 105 amostras. Fungo foi encontrado em uma única amostra de 53 testadas. As bactérias isoladas mais frequentemente foram Escherichia coli, Enterobacter aerogenes, E. coli associada a Streptococcus spp., Staphylococcus spp. associado a Bacillus spp. Os seguintes agentes foram observados em uma única amostra cada: Arcanobacterium pyogenes, Streptococcus spp., Corynebacterium spp., Actinobacillus spp. e Rhodococcus equi. A identificação predominante de bactérias fecais e outras bactérias oportunistas, ao invés de outros patógenos comumente associados a quadros de abortamento equino, tais como Leptospira spp. e Herpesvírus equino tipo 1, sugere a necessidade de maior atenção no manejo higiênico das éguas em reprodução, a fim de prevenir infecções bacterianas que possam causar perda fetal, natimortalidade e mortalidade perinatal.(AU)

Trueperella pyogenes como causa de aborto em uma vaca - relato de caso / Trueperella pyogenes as an abortion cause in a cow - case report

Trueperella pyogenes é uma bactéria oportunista que causa mastite, metrite e abortos esporádicos em bovinos. Este trabalho relata um caso incomum de abort em uma vaca por Trueperella pyogenes. Um feto bovino, fêmea, mestiço Brahman, com oito meses de gestação, foi encaminhado para exame anatomopatológico e exames complementares. Na necropsia, evidenciou-se grande quantidade de líquido serossanguinolento e moderada quantidade de fibrina recobrindo a pleura visceral e o saco pericárdico. Os pulmões estavam difusamente avermelhados e consolidados, com áreas firmes esbranquiçadas ao corte de não mais de 1cm. No exame histopatológico, observou-se pneumonia necrossupurativa, pleurite fibrinopurulenta e placentite purulenta. No exame microbiológico, isolou-se T. pyogenes nas amostras de fígado, pulmões, conteúdo abomasal do feto e placenta. O feto foi negativo na PCR para Neospora caninum, Toxoplasma gondii e vírus da diarreia viral bovina (BVDV). Trueperella pyogenes geralmente causa broncopneumonia supurativa com formação de abscessos, porém, no presente feto abortado, observaram-se lesões macro e microscópicas comumente descritas em casos de aborto por Brucella abortus. Este estudo constata, então, a importância dessa bactéria como causa de aborto em bovinos, com lesões semelhantes à brucelose, destacando sua relevância dentro das causas de aborto em bovinos e o potencial zoonótico pouco explorado.(AU)

Trueperella pyogenes is an opportunistic bacterium associated with mastitis, metritis and occasional abortion in bovines. Here we report an uncommon case of abortion by T. pyogenes in a cow. An aborted female Brahman bovine fetus, at 8 months of gestational age was submitted for anatomopathological examination and complementary diagnostic tests. Macroscopic findings at necropsy included large amounts of free serum-blood fluid and moderate fibrin deposition covering both the visceral pleura and pericardial sack. The lungs were diffusely reddened and markedly consolidated, showing widespread smaller than 1cm, hard, white nodules. Necrosuppurative pneumonia, fibrinopurulent pleuritis, and purulent placentitis were the main histopathologic alterations observed. Trueperella pyogenes was isolated from liver, lungs, abomasa contents and placental samples. All tissue samples were PCR-negative for Neospora caninum, Toxoplasma gondii and bovine viral diarrhea virus (BVDV). Although T. pyogenes is often involved in suppurative bronchopneumonia and abscesses formation, macro and microscopic lesions in the present report were compatible with those commonly attributed to Brucella abortus fetal infections. Trueperella pyogenes is an important bovine pathogen with a neglected zoonotic potential being responsible for infections that can mimic other diseases' typical presentations.(AU)

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Predictores de infección y mortalidad en pacientes con cirrosis hepática en el hospital de alta complejidad Virgen de la Puerta de Trujillo, Perú / Predictors of infection and mortality in patients with liver cirrhosis in the high complexity hospital Virgen de la Puerta from Trujillo, Peru

Introducción: La cirrosis hepática descompensada por infecciones bacterianas es uno de los principales diagnósticos de admisión a hospitalización, teniendo en cuenta que el riesgo per se en ello es más alto que en pacientes no cirróticos, conllevando a cifras altas de mortalidad. Objetivo: El presente estudio buscó determinar los predictores de infección y mortalidad en pacientes con cirrosis hepática, así como las características epidemiológicas-clínicas de los pacientes con cirrosis. Materiales y métodos: De manera prospectiva se recolectaron los datos de los pacientes cirróticos hospitalizados en el servicio de Gastroenterología y Medicina interna del hospital de alta complejidad Virgen de la Puerta desde el 2015 a Junio del 2018. Resultados: El estudio incluyó 66 pacientes. La frecuencia de infección fue de 37,88%, siendo más frecuente la peritonitis bacteriana espontánea (21,2%) y la mortalidad total fue de 12,12%. Al realizar regresión logística binaria y curva ROC se obtuvieron como predictores de mortalidad, el valor de MELD >13,5 (p=0,003), TP >18,26 (p=0,003) y el estadio Child Pugh C (p=0,02, IC 95% EXP(B) 0,13-0,365). Las variables que predicen ausencia de mortalidad fueron un valor de plaquetas ≥ 74 500 /mm3 (p=0,01) y Sodio ≥133 mEq/l (p=0,019). Los predictores de infección, valor de MELD ≤14,5 (p=0,0004) y el nivel de sodio ≥134,5 mEq/l (AUC 0,696, p=0,028), para predecir ausencia de infección. Conclusiones: El MELD alto es un factor predictor tanto de mortalidad como de infección. El Child Pugh C y los valores de tiempo de Protrombina altos son predictores de mortalidad. El nivel de sodio normal es un predictor de ausencia de mortalidad e infección, así como el valor de plaquetas discretamente disminuido es predictor de ausencia de mortalidad.

Introduction: Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates. Objective: The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis. Material and methods: Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018. Results: The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection. Conclusions: High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.

Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology

Abstract: Evidence shows the polymicrobial etiology of endodontic infections, in which bacteria and their products are the main agents for the development, progression, and dissemination of apical periodontitis. Microbial factors in necrotic root canals (e.g., endotoxin) may spread into apical tissue, evoking and supporting a chronic inflammatory load. Thus, apical periodontitis is the result of the complex interplay between microbial factors and host defense against invasion of periradicular tissues. This review of the literature aims to discuss the complex network between endodontic infectious content and host immune response in apical periodontitis. A better understanding of the relationship of microbial factors with clinical symptomatology is important to establish appropriate therapeutic procedures for a more predictable outcome of endodontic treatment.

Beneficios obtenidos con el empleo de bacteriófagos en el tratamiento de infecciones crónicas / Benefits obtained with the use of bacteriophages in the treatment of chronic infections

Para todos aquellos facultativos, sean cirujanos o clínicos, el control de una infección en cualquier localización, es motivo de una alta preocupación. Hoy en día, la resistencia bacteriana aumenta debido al uso desmedido e indebido de los antibióticos que llegan a nuestras manos. Inclusive, el uso de la tecnología avanzada ha provocado que muchos pacientes y sus familiares se automediquen con antibioticoterapias no indicadas por médico alguno, lo que provoca que avance la resistencia a dichos medicamentos. Unos meses atrás tuve la oportunidad de conversar con mi colega y amigo David Armstrong sobre el tema de las infecciones en ulceras crónicas, y actualizamos cómo la resistencia a los antibióticos se ha acrecentado, e inclusive, cómo surgen cada día más publicaciones sobre el tema de la metil resistencia del estafilococos áureos. Me remití, después de oirlo, a otra colega de ambos, aconsejada por él, la Dra Elizabeth Kutter, quien estaba haciendo avances en el uso de los bacteriófagos...

Serie parasitosis en dermatología: tungiasis / Dermatology iconography: tungiasis

La tungiasis es una ectoparasitosis causada por la penetración en la piel de la pulga hembra Tunga penetrans. Esta enfermedad no es específica del hombre y se distribuye en regiones cálidas y secas alrededor del mundo. Se adquiere por contacto directo con el suelo en donde habitan los parásitos adultos. En zonas endémicas, su alta prevalencia se asocia a pobreza y falta de acceso al sistema de salud. Además es frecuente entre viajeros que visitan regiones endémicas y que regresan a sus lugares de origen. Presentamos un caso típico de tungiasis en un paciente 39 años que había realizado un viaje reciente a zona endémica. (AU)

Tungiasis is an ectoparasitosis caused by penetration into the skin of the female flea Tunga penetrans. This disease is not human-specific and is distributed worldwide in warm, dry regions. It is acquired by direct contact with the soil where the adult parasites live. In endemic areas, its high prevalence is associated with poverty and lack of access to the health system. It is also frequent among travelers visiting endemic regions and returning to their places of origin. We present a typical case of tungiasis in a 39 year old patient who had made a recent trip to an endemic area. (AU)

Trombocitopenia inmune primaria aguda presentación clínica y manejo en pacientes pediátricos, Hospital Mario Catarino Rivas / Acute primary immune thrombocytopenia clinical presentation and management in pediatric patients, Hospital Mario Catarino Rivas

Antecedentes: La trombocitopenia inmune primaria, conocida como púrpura trombocito-pénica idiopática (PTI), es un trastorno autoin-mune adquirido que afecta adultos y niños. Objetivo: Caracterizar los pacientes pediátri-cos con PTI aguda mediante su identi cación y seguimiento en el Hospital Nacional Mario Catarino Rivas (HNMCR) entre 1 febrero del 2016 al 31 enero del 2017. Pacientes y Méto-dos: Estudio cuantitativo, diseño no experi-mental longitudinal ­ prospectivo, alcance descriptivo. La población es todo paciente menor de 18 años de edad, que acudió al HNMCR con PTI aguda. La muestra 47 pacien-tes. Excluidos pacientes previamente diagnos-ticados con PTI, con segundos episodios o recaídas, con patologías sobre agregadas. Información recopilada mediante un instru-mento tipo encuesta: situación demográ ca, área geográ ca y revisión del expediente clíni-co, los datos fueron analizados con el progra-ma EPIINFO y EXCEL. Resultados: En cuanto al grupo etario el 56% fueron menores de cinco años de edad, la distribución por sexos hubo predominio del sexo masculino. 81% de los niños fueron hospitalizados, el resto recibió manejo ambulatorio; sin embargo en el 100% se inició alguna terapia con resolución de la trombocitopenia a los 3 meses. Luego del seguimiento, el diagnóstico nal de los casos captados fue PTI aguda 58%(n=27), evolucio-naron a la cronicidad 20% (n=9), el 22% (n=10) abandonaron seguimiento. Conclusiones: La mayoría de los pacientes con PTI son admitidos al hospital, aunque su conteo de plaquetas no los ponga en riesgo claro de hemorragias espontáneas, por no haber guías de manejo en nuestro hospital...(AU)

Caracterización clínica de la meningitis aguda de la comunidad causada por Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae y Listeria monocytogenes en adultos en el Hospital Carlos van Buren entre los años 2013 y 2016 / Clinical characteristics of community-acquired acute meningitis caused by Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae and Listeria monocytogenes in adults in Carlos van Buren Hospital between 2013-2016

INTRODUCCIÓN: la meningitis bacteriana es una enfermedad infecciosa aguda grave, que por su letalidad y costos en atención de salud genera un alto impacto en Salud Pública. Los agentes causales más frecuentes son Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae y Listeria monocytogenes, pero poco conocemos de nuestra realidad local. MATERIALES Y MÉTODOS: estudio descriptivo, con revisión de base de datos del laboratorio de microbiología del Hospital Carlos Van Buren, obteniendo datos de los cultivos de líquido céfalo raquídeo de pacientes mayores de 15 años entre marzo de 2013 y noviembre de 2016. RESULTADOS: 128 casos de meningitis bacteriana aguda, de los cuales 17 fueron por los microorganismos objetivos del estudio, siendo el más frecuente S. pneumoniae, clínicamente un 58% se presentó sin signos meníngeos. A 30 días del diagnóstico un 35% había fallecido, la mitad de ellos inició el tratamiento antibiótico pasadas las 24 horas desde su ingreso al hospital. En el 46% la tinción gram no evidenció bacterias. DISCUSIÓN: los microorganismos clásicamente descritos como agentes causales parecen no explicar la totalidad de los cuadros de meningitis bacteriana aguda en la población adulta estudiada, la ausencia de signos meníngeos no permite descartar la sospecha diagnóstica. La mitad de los pacientes fallecidos inició el tratamiento antibiótico pasadas las primeras 24 horas.

INTRODUCTION: bacterial meningitis is a serious acute infectious disease whose lethality and elevated health costs have a serious impact on public health. The most frequent causes are Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenza and Listeria monocytogenes, but we know little of the local situation. MATERIALS AND METHODS: A descriptive study reviewing Carlos van Buren Hospital´s microbiology laboratory data base, and obtaining the details of cerebrospinal fluid cultures of patients over the age of 15 between March 2013 and November 2016. RESULTS: 128 cases of acute bacterial meningitis of which 17% were caused by the micro-organisms of study, the most frequent being Streptococcus pneumoniae. 58% of patients had no meningeal signs. At 30 days from diagnosis 35% had died, half of these having started antibiotic treatment over 24 hours after admission. 46% of the Gram stains showed no bacteria. DISCUSSION: the classical infectious agents do not appear to account for the totality of acute bacterial meningitis in the population studied. The absence of meningeal signs should not rule out the diagnosis. Half of the patients who died started antibiotic treatment after the first 24 hours.