Síndrome compartimental: una presentación atípica como causa de la púrpura de Henoch-Schönlein / Compartment syndrome: an atypical presentation as a cause of Henoch-Schönlein purpura

Resumen: Introducción: en la literatura existen escasos reportes de caso del desarrollo de síndrome compartimental como una potencial complicación de la púrpura de Henoch-Schönlein. Caso clínico: se presenta el caso clínico de una paciente de 17 años con un cuadro de síndrome compartimental bilateral en pies como presentación atípica de la púrpura de Henoch-Schönlein, nunca antes descrita en la literatura. Conclusión: con una rápida sospecha diagnóstica y un tratamiento quirúrgico con fasciotomías, se consiguió preservar la viabilidad de las extremidades y su funcionalidad a los seis meses de seguimiento, a pesar de tratarse de una presentación sumamente atípica de la patología en cuestión.

Abstract: Introduction: there are few case reports available that describe compartment syndrome as a complication of Henoch-Schönlein purpura. Case report: we report the case of a 17-year-old patient with bilateral compartment syndrome of the foot as an atypical presentation of Henoch-Schönlein purpura. A case like this has not been reported before. Conclusion: although the patient had an extremely rare clinical presentation, the viability and functionality of the limbs was preserved even after six months of follow-up thanks to an early diagnosis and surgical treatment.

A comparison of the antimicrobial resistance patterns of gram-negative bacilli isolated from community-private and university-affiliated hospitals from Puerto Rico

Few studies have been performed in Puerto Rico concerning the antimicrobial resistance pattern of clinically significant Gram-negative bacilli. The antimicrobial resistance patterns of 5,590 Gram-negative bacteria obtained from three Community-Private Hospitals (CPH) and three University-Affiliated Hospitals (UAH) were evaluated utilizing the institutions' antimicrobial susceptibility reports for the year 2000. The objectives of this study were: to retrospectively evaluate the reported in vitro resistance of clinical isolates of E. coli, K. pneumoniae, E. cloacae, S. marcescens, P. aeruginosa and A. baumannii to selected standard antibiotics and to compare the antimicrobial resistance patterns between Community-Private (CPH) and University Affiliated hospitals (UAH). E. coli was the most common Gram-negative enteric bacilli in both CPH and UAH. In UAH, E. coli demonstrated a statistically significant higher resistance to the selected beta lactams and amikacin antibiotics but not to ciprofloxacin or gentamicin. For K. pneumoniae, the antimicrobial resistant pattern showed that UAH isolates were significantly more resistant to the tested antibiotics with the exception of ceftriaxone. In CPH, E. cloacae isolates were significantly more resistant to piperacillin-tazobactam, ciprofloxacin and gentamicin, while in UAH this organism was more resistant to amikacin. In UAH, S. marcescens isolates demonstrated a statistically significant higher resistance to all tested antibiotics with the exception of imipenem, which was similar in both hospitals group. Pseudomonas aeruginosa demonstrated a statistically significant higher resistance in UAH to all selected antibiotics with the exception of ciprofloxacin and gentamicin, which was similar in both hospitals group. Acinetobacter baumannii was the most resistant organisms in both hospitals group. UAH isolates were significantly more resistant than CPH isolates for all tested antibiotics. When compare with other large-scale antimicrobial resistance studies, the present study results suggest an apparent higher resistance in the Puerto Rican isolates. The high numbers of antimicrobial resistant Gram-negative bacilli in our study strongly suggest multiple mechanisms of antimicrobial resistance including the presence of extended spectrum and chromosomally derepressed beta-lactamases.

A comparison of the antimicrobial resistance patterns of gram-positive cocci isolated from community-private and university-affiliated hospitals from Puerto Rico

The antimicrobial resistance patterns of 2,462 selected Gram-positive cocci obtained from three Community-Private Hospitals (CPH) and three University-Affiliated Hospitals (UAH) were evaluated utilizing the institutions' antimicrobial susceptibility reports for the year 2000. The objectives of this study were: 1) to evaluate the in vitro resistance to selected standard antibiotics of Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium and Streptococcus pneumoniae clinical isolates, and 2) to compare the antimicrobial resistance patterns between community-private (CPH) and university-affiliated hospitals (UAH). Staphylococcus aureus was the most common Gram-positive isolated organism in CPH (63.3 per cent) followed by E. faecalis (31.0 per cent). In UAH, the most prevalent cocci were E. faecalis (51.7 per cent) followed by S. aureus (43.9 per cent). Enterococcus faecium represented 2.3 per cent and 4.4 per cent of CPH and UAH isolates, respectively. Streptococcus pneumoniae represented 3.4 per cent of the total Gram-positive isolates from CPH, no S. pneumoniae was reported in UAH. The antimicrobial susceptibility results showed that for Staphylococcus aureus there was a statistically significant higher resistance to methicillin and thrimethoprim sulfamethoxazole in UAH, while resistance to erythromycin was significantly higher in CPH. There was no difference in the resistance of S. aureus to other antimicrobial agents between hospitals groups. A statistically significant resistant to vancomycin was found between enterococcal isolates from UAH (43 per cent) and CPH (12.7 per cent). High-level aminoglycoside resistance (HLAR) was observed among UAH enterococcal isolates with E. faecium showing a higher resistance than E. faecalis, no data for HLAR in CPH could be obtained. For pneumococci 46 per cent of CPH isolates were resistant to penicillin. In summary, there are important differences in the prevalence and antimicrobial resistance between the Gram-positive bacteria isolated from community and teaching hospitals.

Prospective study using standardized methodology for antimicrobial susceptibility of gram-positive cocci isolated from the Puerto Rico Medical Center

The Gram-positive cocci (GPC), Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium, have become important causes of community and nosocomial-acquired infections. The prevalence of multiple resistant isolates to standard antimicrobial drugs has significantly increased over the past decades. Few prospective studies have been performed in Puerto Rico (PR) concerning the GPC antimicrobial susceptibilities pattern. The purpose of this study was to evaluate the in vitro susceptibility of GPC clinical isolates from PR to selected standard antibiotics and to the new antimicrobial agents, linezolid (LZ), quinupristin/dalfopristin (Q/D) and gemifloxacin (GM). The in vitro susceptibility utilizing disk diffusion and Etest methods to selected antibiotics was determined for a total of 429 isolates obtained during a period of 5 months from the Puerto Rico Medical Center Bacteriology Laboratory. The distribution of GPC collected was as follows: 213 S. aureus isolates, 162 E. faecalis, 16 E. faecium and 38 S. pneumoniae. The results of the susceptibility test demonstrated: 1) that in S. aureus, 100 per cent of the isolates were susceptible to vancomycin (VAN), LZ and Q/D; 93 per cent to GM; and 61 per cent to methicillin/oxacillin; 2) in S. pneumoniae, 100 per cent were susceptible to LN and GM; 87 per cent to Q/D; and 53 per cent to penicillin; 3) in E. faecalis, 99 per cent were susceptible to ampicillin; 93 per cent to LZ; 79 per cent to GM; 78.6 per cent to VAN; and 0 per cent to Q/D. Sixty eight and 66 per cent of the E. faecalis isolates were susceptible to gentamicin and streptomycin respectively; and 4) in E. faecium, 100 per cent were susceptible to LZ; 94 per cent to Q/D; 69 per cent to GM; 37.5 per cent to VAN and 20 per cent to ampicillin. In E. faecium isolates, 50 per cent and 31 per cent were susceptible to gentamicin and streptomycin, respectively. Of the vancomycin resistant enterococci, 88.9 per cent and 21 per cent of E. faecium and faecalis showed VanA phenotypic resistance, respectively...

Estudio comparativo entre los métodos de hemaglutinación indirecta e inmunoanálisis enzimatico en el diagnóstico de la toxoplasmosis / Comparative study between the methods of indirect hemaglutination and enzime linked inmunosorbent assa in diagnostic of toxoplasmosis

En el presente trabajo se realizó un estudio comparartivo entre los métodos de Hemaglutinación Indirecta (HAI) e Inmunoanálisis Enzimatico IgG (ELISA IgG), para investigar anticuerpos antitoxoplasma en 103 muestras de suero sanguíneo. Este estudio reveló un porcentaje de positividad para anticuerpos antitoxoplasma de 29,12 por ciento (30 sueros) y 43,69 por ciento (45 sueros) por ELISA y HAI respectivamente. Los resultados obtenidos muestran una concordancia entre estos métodos de 83,4 por ciento. Las discordancias observadas entre las reacciones, sólo comprometieron títulos (<1:64), los cuales se deben tomar en cuenta, cuando se utiliza el método de HIA, para el seguimiento serológico de estos casos, ya que , podría tratarse de una infección reciente en ascenso. El análisis estadístico mediante el chi cuadrado reveló que las diferencias observadas en los resultados de las pruebas son significantes cuando se compararon todos los títulos para HAI y todos los índices para ELISA. IgG. En cambio, las diferencias de los resultados no fueron significantes cuando se consideraron los títulos del HAI iguales o por encima de 1:64 y los índices de ELISA iguales o por encima de 0.500. Por lo anterior, se concluyó que HAI sólo es igual a ELISA. IgG como método diagnóstico de toxoplasmosis, en el caso de que se tomen como títulos positivos aquellos iguales o por encima de 1:64

Que instruccion debe recibir el personal auxiliar de enfermeria para la atencion del paciente geriatrico institucionalizado en el Hospital Local Nuestra Senora del Carmen, El Colegio enero-julio 1984 / What instruction should be received by the nursing auxiliary personnel for the institutionalized geriatric patient in Hospital Local Nuestra Senora del Carmen, El Colegio january-july 1987

En Colombia las personas mayores de 60 anos seran el 75% del total de la poblacion para el ano 2025, entre enero y julio de 1987 ingresaron al servicio de medicina interna 128 personas mayores de 50 anos, de las cuales 69 eran mujeres y 59 hombres. El 32.5% por ICC; el 7.5% por fracturas; el 6.6% por bronconeumonia; el 41% por ACV, el 3.3% por hernia inguinal; el 3.3% por celes y el 16-17% por otras causas, por lo cual se considero importante instruir al personal auxiliar de enfermeria sobre la fisiopatologia del envejecimiento y el cuidado basico del anciano. Para ello se diseno un modulo instrumental anexo..

Tumores malignos de los conductos biliares extrahepaticos. / Malign tumors of extrahepatic bile ducts

A proposito de la incidencia creciente del cancer de la via biliar extrahepatica se revisan las caracteristicas clinicopatologicas, el tratamiento y el pronostico de este particular tumor en base a los datos obtenidos de la serie de pacientes de los autores y a las referidas en la bibliografia

Pancreatitis aguda. Revision de 64 observaciones. / Acute pancreatitis.Review of 64 obervations

Se analiza la experiencia clinica sobre 64 casos de pancreatitis aguda, asistidos por grupo de cirujanos del Hosptipal Dr. Bernardo Houssay, completada por una serie practicamente paralela del Hospital Aleman presentada por el relator

Cancer de la via biliar extrahepatica / Extrahepatic bile duct cancer

A proposito de la incidencia creciente del cancer de la via biliar extrahepatica se revisan las caracteristicas clinicopatologicas, el tratamiento y el pronostico de este particular tumor en base a los datos obtenidos de la serie de pacientes de los autores y a las referidas en la bibliografia

Informaciones sobre la biologia y el ciclo de vida de Triatoma maculata (Erichson, 1848) (Hemiptera, Reduviidae, Triatominae), en condiciones de laboratorio. / Biology and the life cycle of Triatoma maculata (Erichson, 1848) (Hemiptera, Reduviidae, Triatominae) under laboratory conditions

El ciclo biologico del Triatoma maculata ha sido estudiado en condiciones de laboratorio.La evolucion de huevo a adulto se completo en un periodo minimo de 129 dias, un maximo de 281 con un promedio de 200,1 dias produciendo entonces 1,3 a 2,8 generaciones por ano. Algunas informaciones adicionales sobre la biologia de esa especie en el laboratorio fueron tambien sacadas de los experimentos y eso permitio estimar que una hembra fecundada podria producir de algunas decenas varios millares de adultos al final de un ano, resguardadas las condiciones en que se desarrollo el experimento