Estudio de prescripción-indicación de antibióticos de mayor espectro en las unidades de terapia intensiva de los hospitales de la ciudad de Buenos Aires: análisis de los patrones de utilización / Prescription-indication study of major spectrum antibiotic in intensive care units of Buenos Aires City hospitals: analysis of utilisation patterns

Los ATB de mayor espectro se utilizan más frecuentemente en Unidades de Terapia Intensiva (UTI). Objetivos: Evaluar los patrones de utilización de piperacilina/tazobactam (PIP/T), imipenem (IMP), meropenem (MRP), colistina (COL), ceftazidima (CAZ) y vancomicina (VAN) en las UTI de hospitales públicos de la Ciudad de Buenos Aires. Diseño: Estudio multicéntrico prospectivo. Métodos: Análisis de los episodios de infección en pacientes internados en UTI de ocho hospitales que recibieron estos ATB entre octubre 12 y diciembre 12 de 2005. La recolección de datos la realizó el infectólogo, y para el procesamiento se utilizó Excel. Resultados: 116 pacientes (edad X 55.6; 62.4% hombres) presentaron 143 episodios. Hubo 216 prescripciones (1.86/ pte): PIP/T 22, IMP 60, MRP 5, COL 14, CAZ 40 y VAN 75. Los diagnósticos principales fueron neumonía asociada a ARM (NptARM) 29, infección abdominal postquirúrgica (POPabd) 21, catéter (Cat) 17, neumonía sin ARM (Npt) 15, infección abdominal secundaria (Abd) 13 y sepsis sin foco (SepSF) 13. Las prescripciones según indicación más frecuentes fueron (n): PIP/T: NptARM 6, Npt 4 y Abd 3; IMP: NptARM 11, POPabd 9 y Abd 8; COL: POPabd 5 y NptARM 4; CAZ: NptARM 7 y POPabd 7; VAN: Cat 14 y NptARM 12. Período medio entre ingreso a UTI e inicio del ATB: 12 días (0-133; p = 0,0038 entre hospitales; p = 0,063 entre ATB). Duración media de tratamientos: 8 días(1-32). El 45% de las prescripciones se basaron en hallazgos bacteriológicos. Fallecieron 51 pacientes: 25/59 (42%) de tratados empíricamente y 26/77(34%) de documentados (p = 0,7). Conclusiones: El estudio de los patrones de prescripción permite establecer diferencias entre hospitales y evaluar la necesidad de intervenciones correctivas.

Nutrition research gaps addressed to medical school

This paper illustrated important gaps in nutrition research that lends themselves well for medical schools to undertake. Medical schools have the distinct opportunity to contribute to the research effort since they have clinical materials for study in the hospital or the community with which they are associated; most have adequate laboratory facilities and even access to biopsy and autopsy materials and most importantly, all have the medical expertise to back the research effort. All it takes is to awaken them to opportunities interest them in research and prod them to start. The area of basic and applied nutrition research is so vast and fertile that researchers in medical school will have no difficulty in seeking topics that suit their own professional interests and at the same time fill gaps that are of practical importance in clinical and community nutrition. What it needs is a measure of inquisitiveness, patience and a scientific frame of mind. A great deal of personal fullfilment not to mention professional advancement awaits him or her who ventures into scientific pursuit of new knowledge

Vitamin A status of Filipino preschool children given a massive oral dose.

The protection period of a 200,000 IU of vitamin A on Filipino children was determined. Subjects were 105 children aged 1-5 years given a single massive dose during the "Araw ng Sangkap Pinoy" (ASAP) in March 1995. Serum retinol was measured by HPLC at baseline, one, two, four and six months after the administration of the dose. Results showed that baseline serum retinol levels were significantly lower than all follow-up values. Serum retinol values were maintained at levels higher than pre-supplementation values although the values decreased on the second month after supplementation. The proportions of deficient and low (< 20 microg/dl) levels were significantly lower one and six months after supplementation. All follow-up serum retinol levels of children with deficient and low values at baseline were significantly lower (p < 0.001) than those with normal values. The WHO recommendation of 200,000 IU was effective in increasing serum retinol concentrations and maintaining it above pre-supplementation levels up to 6 months after administration of the dose. It also replenished organic vitamin A reserves as shown by the dose response (S30DR) approach. Incidence of infection also decreased among the children. Supplementation with vitamin A has likewise resulted in an increase in hemoglobin values and a decrease in the proportion of anemics (Hb < 11.0 g/dl) among the children.

Nutrition situation in metro Manila.

Summarizing the general characteristics of food consumption pattern and dietary status of the country's central urban region, the following are brought to focus: Metro Manila as compared to all urban and rural areas consumes less cereal grains but more sugars and fats and oils; consumes more of the high quality protein foods such as meat, poultry, eggs, milk and dried beans; and consumes less of fruits and vegetables. Availability and affordability of foods in the respective sectors could have affected to a large extent the magnitude of consumption differences. Although urban households had the advantage of a more varied and quantitatively higher food consumption, their nutrient intake was not really very different from rural households. Metro Manila still had a 13.7 percent calorie gap in its intake in 1987, and intake of ascorbic acid was notably lower than the rural sector. However, intake of thiamin and riboflavin as well as fat was appreciably higher in the metropolis. Briefly identifying the trends in food consumption with reference to six survey year periods from 1974 to 1987 (excluding 1984 and 1985), Metro Manila diet disclosed the following: increasing trend for sugars and syrups as well as dried beans, nuts and seeds and decreasing trend for cereal products, fruits and vegetables and condiments and others. There was a decrease in overall food consumption among Metro Manila households during the economic crisis that transpired in 1984 and 1985. However, there was a steady consumption of rice which was under price control, and a significant increase in the intake of some food items particularly green leafy and yellow vegetables which were among the cheapest food items available in Metro Manila markets. Some food adjustments were evidently resorted to during the period of economic dislocation showing the resiliency of the urban population. Metro Manila has been apparently drawing inordinately large amounts of the food supply from the rest of the country. There is therefore an "urban bias" of food supply to Metro Manila, that is, there is a much higher demand capacity for Metro Manila to draw food supply because of its higher income level and bigger population. The impact of this situation in terms of nutrition and food supply in the rural areas should be carefully examined so as not to put the rural areas in extreme disadvantage. FNRI nutrition surveys have shown that dietary energy inadequacy remains rampant in Metro Manila, while protein continues to be a marginal problem.(ABSTRACT TRUNCATED AT 400 WORDS)