Rendimiento de dos índices predictores de mortalidad (PSI y CURB-65) en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad / Yield of two mortality predictors in immunocompetent patients with community acquired pneumonia

Background: The severity of community acquired pneumonia (CAP) can be evaluated by the PSI and CURB-65 scales. However, it is unknown whether their predictive capacity varies according to the etiology of the disease. Aim: To compare the performance of these scales in adults with viral, bacterial, mixed, and no agent detected CAP. Material and Methods: We studied 725 patients hospitalized for CAP aged 18 to 95 years (47% females) Urinary S. pneumoniae and Legionella antigens were detected by immuno-chromatography (Binax®). Respiratory viruses and bacteria were detected by PCR in nasopharyngeal smears. The proportions of deaths, admission to the intensive care unit (ICU), and oxygen therapy were compared between mild and non-severe patients defined by PSI (I/II and I-III) and CURB-65 (1 and 1-2), according to the causative agent. Results: Ten percent of patients died. A causative agent was detected in 65%. The proportion of mild and non-severe patients according to PSI and CURB-65, and of deceased patients, admitted to the ICU and with oxygen therapy was similar in the four categories per agent. There were no deaths among non-severe patients with bacterial CAP. However, 6% of patients with CAP caused by virus or without causative agents, died. No deaths occurred among mild patients with bacterial CAP. In viral CAP, no deaths occurred among patients classified as mild only by PSI. The yields of PSI were greater than those of CURB-65 in non-severe patients who died and were admitted to the ICU with bacterial and viral CAP (5 and 14%; 7 and 12% respectively, p = 0.04). Conclusions: The prognostic performance of PSI in CAP varies according to the causative agent in adults. It is higher in non-severe bacterial cases, and superior to CURB-65.

Estimación del número reproductivo efectivo del brote de sarampión 2018-2019 en Chile / Estimation of the effective reproduction number of measles 2018-2019 in Chile

Resumen Introducción: Los casos de sarampión están resurgiendo en muchos países del mundo. Hubo un brote de sarampión importado entre noviembre de 2018 y febrero de 2019 en Chile, lo que generó preocupación entre el público y las autoridades sanitarias. Muchos se preocuparon por la tasa de inmunización contra el sarampión de la población, un factor que se relaciona con la capacidad reproductiva del virus (medida de transmisibilidad de un patógeno). Objetivo: Aquí estimamos el número reproductivo efectivo (Re) de este brote de sarampión. Resultados: Aunque la estimación tiene mucha incertidumbre por el bajo número de casos y la ausencia de mezcla homogénea de la población, encontramos que Re fue aproximadamente 1,5. Discusión y Conclusiones: En consecuencia estimamos que aproximadamente 90,3% de la población tiene inmunidad al sarampión, lo que coincide con las estimaciones del Ministerio de Salud. Estos resultados sugieren que la población chilena ha establecido la inmunidad colectiva contra la introducción de casos importados de sarampión, lo que refleja un manejo preventivo adecuado de esta enfermedad.

Abstract Background: Measles cases are reemerging in many countries across the globe. There was an outbreak of imported measles between November 2018 and February 2019 in Chile, raising concern among the public and health authorities. Many were worried about the Chilean measles herd immunity, a factor that relates to the reproductive capacity of the virus (measure of transmissibility of a pathogen). Aim: Here we estimate the effective reproductive number (Re) of this measles outbreak. Results: Although the estimate is highly uncertain due to the low number of cases and the absence of homogeneous mixing of the population, we found Re was approximately 1.5. Discussion and Conclusions: Consequently we estimated about 90,3 % had measles immunity, consistent with administrative estimates from the Ministry of Health. These results suggest the Chilean population has established herd immunity against the introduction of imported measles cases, reflecting adequate preventive management of this disease.

Artificial cooling as an alternative to increase productivity and welfare of steers under heat stress / Resfriamento artificial como alternativa para aumentar o bem-estar de novilhos sob estresse térmico

The effects of a cooling system on productive efficiency and welfare of Holstein steers were evaluated during the summer. Sixty steers in the finishing phase were randomly allotted to one of two treatment-groups. Animals of control group were only provided with shade (non-cooled group) and a group of animals under a cooling system were installed in the shaded area (cooled group), which were operated daily from 09am to 6pm during the 69d of the study. The averages of environmental temperature and relative humidity were 35.4ºC and 35.3 percent, respectively, with a temperature-humidity index average of 81.4 during the study. Individual body weight was recorded every two weeks, while body surface temperature and respiratory frequency were recorded three times per week. Blood samples were biweekly taken from coccygeal vein for determination of T3 and T4. The average daily gain in the cooled group gain (1.46kg/d) was similar (P=0.21) to non-cooled group (1.37kg/d). Body surface temperature (35.9ºC vs 38.7ºC) and respiratory frequency per minute (77 vs 104) were lower (P<0.01) in the cooled group than in non-cooled group, respectively. Triiodotironine levels were similar (P=0.30) in cooled (0.80ng/mL) and non-cooled (0.87ng/mL) groups, while, tiroxine level was lower (P<0.01) in cooled group (44.0ng/mL) compared to non-cooled group (56.6ng/mL). The cooling system did not improve productive parameters but the welfare in the cooled group was increased.

Avaliou-se um sistema de resfriamento para aumentar a eficiência produtiva e o bem-estar de novilhos durante o verão. Utilizaram-se 60 animais em fase de acabamento, distribuídos aleatoriamente em dois grupos: os do grupo-controle permaneceram somente sob sombra (grupo não resfriado) e os do grupo sob sistema de resfriamento, sob área sombreada, diariamente, das 9 às 18h, durante 69 dias de estudo. As médias registradas de temperatura ambiente e umidade relativa foram 35,4ºC e 35,3ºC, respectivamente, com índice de temperatura-umidade de 81,4 durante o período de estudo. O peso individual foi anotado a cada duas semanas, e a temperatura da superfície corporal e a frequência respiratória foram registrados três vezes por semana. Amostras de sangue foram tomadas da veia coccígea duas vezes por semana para determinação de T3 e T4. O ganho médio diário no grupo sob resfriamento (1,46kg/dia) foi similar (P=0,21) ao do grupo-controle (1,37kg/dia). A temperatura da superfície corporal (35,9ºC versus 38,7ºC) e a frequência respiratória/minuto (77 versus 104) foram mais baixas (P<0,01) no grupo sob resfriamento do que no grupo-controle (P<0,01), respectivamente. Níveis de triiodotironina foram similares (P=0,30) em animais com resfriamento (0,80ng/mL) e sem resfriamento (0,87ng/mL), enquanto o nível de tiroxina foi mais baixo (P<0,01) no grupo com resfriamento (44,0ng/mL versus 56,6ng/mL). O sistema de resfriamento não afetou parâmetros produtivos, porém o bem-estar dos animais do grupo com resfriamento foi melhor.

Impacto en salud infantil del invierno 2002: disociación entre factores ambientales y virus respiratorio sincicial, en Santiago / The influence of winter 2002 in pediatric health: dissociation between environmental factors and respiratory syncytial viruses, in Santiago

BACKGROUND: The increase in winter related health pediatric demand is associated with three factors: cold and rainy weather, air pollution and respiratory viral epidemics. During the winter of 2002 there was, successively, heavy rain, air pollution, cold weather and a respiratory syncytial virus (RSV) epidemic in Santiago. AIM: To study the influence of environmental factors and RSV epidemic on pediatric health care demand. PATIENTS AND METHODS: The number of hospital admissions and outpatient consultations for acute lower respiratory infections (ALRI) from April to October 2002 (Autumn to Spring in Chile), were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (RSV, adenovirus influenza and parainfluenza virus) was carried out among children admitted for ALRI. Climate conditions and air pollution (number of particles of more than 10 microns/mm3) values were provided by local environmental health services. RESULTS: As expected, a rise in winter hospital admissions and outpatient consultations was detected, that peaked in week 29. This rise coincided with the higher RSV detection week. There was heavy rain in weeks 22, 23 and 30, as well as cold weather in June-July (weeks 23, 24, 26, 27 and 30; mid Winter), that did not increase health care demand. Likewise, high air pollution, registered from weeks 24 to 26, did not increase health care demand. CONCLUSIONS: RSV epidemic is the principal factor associated to the increase in health burden during winter in Santiago.

Transmisión vertical del virus de la inmunodeficiencia humana: experiencia preliminar con el uso de protocolo ACTG 076 en el Hospital San Juan de Dios / Vertical transmission of HIV: preliminary experience with the use of protocol ACTG 076 at the San Juan de Dios hospital

Durante el período comprendido entre septiembre de 1995 y octubre de 1998, 6 pacientes embarazadas con diagnóstico de VIH, controladas en el Policlínico de VIH dependiente del Servicio de Medicina del Hospital San Juan de Dios, fueron atendidas en el Servicio de Obstetricia y Ginecología de dicho Hospital. Todas ellas recibieron AZT según el protocolo ACTG 076. Se constató un solo parto vía vaginal, el resto se llevó a cabo por cesárea electiva. Todos los recién nacidos recibieron AZT postparto y ninguno fue alimentado con leche materna. Se realizó seguimiento de los niños confirmándose VIH en uno de ellos, 2 estaban sanos y 3 se encontraban en etapa de estudio. Las madres continúan en control en el Policlínico de VIH; 4 de ellas asintomáticas hasta la fecha y 2 etapa C

Deteccion de rotavirus en lactantes con diarrea aguda, hospitalizados y ambulatorios, en Santiago de Chile. / Detection of rotavirus in infant newborn with acute diarrhea, in hospitals and outpatient clinics in Santiago de Chile

Se investiga la presencia de rotavirus en 215 lactantes menores de dos anos con diarrea aguda, procedentes del area norte de salud de Santiago de Chile. Se compara un grupo de ninos hospitalizados por diarrea severa (111 casos) y otro de ninos con cuadros mas benignos tratados en forma ambulatoria (104 casos). Los enfermos se recolectan durante una epoca fria (otono-invierno: 77 casos) y durante una estacion calurosa (verano: 139 casos). Se detecto rotavirus - mediante tecnica de electroforesis del acido nucleico viral - en 14,4% de los casos ambulatorios y en 20.1% de los hospitalizados; en la epoca fria hubo mayor aislamiento (28.6%) que en el verano (11.6%). Durante el invierno se observo una diferencia significativa de aislamiento de rotavirus en los hospitalizados (37.5%) en relacion a los ambulatorios (18.9%). Se concluye que los rotavirus pueden causar tanto cuadros diarreicos severos que requieren de hospitalizacion como diarreas benignas que se manejan en forma ambulatoria, con frecuencia variables dependiendo de la edad, estacion del ano y otros factores no conocidos

Rotavirus y sindrome diarreico prolongado del lactante. / Rotavirus and protracted diarrhea syndrome of the infant

Se investiga la presencia de rotavirus en muestras de deposiciones de 44 ninos menores de 1 ano en los que se planteo el diagnostico de sindrome diarreico de evolucion prolongada. El agente fue encontrado en 14 casos (31.8%). Al comparar los ninos en los que se aislo el virus con los restantes, se demuestra que ambos grupos son comparables en todos los rubros analizados excepcion hecha de la frecuencia de intolerancia a hidratos de carbono que es significativamente mayor en aquellos del primer grupo. Este hallazgo es interpretado en el sentido que el rotavirus es capaz de originar la prolongacion de un cuadro diarreico sin poder definir si actua como patogeno en el momento de su aislamiento y/o lo hace solamente a traves de la generacion de intolerancia de hidratos de carbono