Acinetobacter en una sala de cuidados intensivos pediátricos: nuestra experiencia / Acinetobacter in a pediatric Intensive care ward: our experience

Objetivo: Describir las características clínicas y epidemiológicas de los pacientes con infecciones por Acinetobacter en Unidad de Terapia Intensiva Pediátrica. Material y Método: Estudio descriptivo y retrospectivo, en el periodo de enero de 2005 a agosto de 2007. Se incluyó a todos los pacientes cuyos cultivos fueron positivos para Acinetobacter. Resultados: De 18 pacientes, 7 de sexo femenino (39%) y 11 del masculino (61%), la edad promedio fue de 4,7 meses con rango entre 4 días a 15 años. La estancia hospitalaria promedio fue de 44 días (10 a 104 días); todos los pacientes utilizaron catéteres venosos centrales, 4 en promedio (1 a 9 catéteres). Previo al aislamiento del germen, en 16/18 pacientes se utilizó antibióticos de amplio espectro por 8,6 días y ARM (89%) con 12 días en promedio. El germen fue aislado en secreción traqueal 10/18 (55%), hemocultivo 5/18 (28%), punta de catéter 2/18 (11%) y secreción ótica 1/18 (6%). Fueron considerados en 16/18 (89%) gérmenes intrahospitalarios y en 2/18 (11%) provenientes de la comunidad. Fue utilizado como tratamiento Colistina en 7/18 (39%), otros antibióticos-ATB en 9/18 (50%) y sin tratamiento 2/18 (11%). La mortalidad relacionada con la infección fue 17% (3/18) y la no relacionada 6% (1/18). Conclusión: Los pacientes con ingreso de urgencia a UTI, con tratamiento antibiótico previo, altamente invadidos y aquellos con sepsis previa estarían más predispuestos a sufrir infecciones por Acinetobacter. La presencia de este germen en la UTI debe ser considerado motivo de preocupación por la capacidad de permanecer e infectar por largos períodos de tiempo. Se debe realizar esfuerzos para la identificación de gérmenes nosocomiales, de manera a establecer medidas rápidas de control. Son necesarios más estudios para establecer factores de riesgo en nuestra población.

Introduction: Acinetobacter is a Gram-negative coccobacillus whose importance lies in its ability to rapidly acquire resistance to broad spectrum antibiotics and cause nosocomial outbreaks. According to the WHONET analysis done by the microbiology department of the central hospital of the Institute of Social Security, the incidence of Acinetobacter in our unit has increased over the years. Acinetobacter is difficult to control because it is capable of surviving for extended periods on dry surfaces, although the most important means of transmission is on the hands of medical personnel. Objective: To describe the clinical and epidemiological characteristics of patients with Acinetobacter infections in the pediatric intensive care unit. Material and Methods: A descriptive and retrospective study done from January 2005 to August 2007. All patients with positive cultures for Acinetobacter were included. Results: Of 18 patients, 7 (39%) were female and 11 (61%) were male, while the average age was 4.7 months, with a range of from 4 days to 15 years. Average hospital stay was 44 days (10 to 104 days). Patients were catheterized with an average of 4 central venous catheters (1 to 9 catheters). Prior to isolation of the germ, 16 of 18 patients received broad-spectrum antibiotics for 8.6 days and 89% received mechanically assisted ventilation for an average of 12 days. From 10 of 18 patients the bacteria was isolated from tracheal secretions, from 5/18 (28%) from blood cultures, from 2/18 (11%) from catheters and 1/18 (6%) from ear discharge. Bacteria were considered to be hospital-acquired in 16/18 cases (89%) and community-acquired in 2/18 (11%). Treatment was with colistin in 7/18 (39%), other antibiotics in 9/18 (50%) and no treatment was received by 2/18 (11%). Infection-related mortality was 17% (3/18) and unrelated mortality 6% (1/18)...

Los padres y la fiebre: ¿qué creen y hacen? / Parents and fever: what do they believe, and what do they do?

Introducción: La presencia de fiebre en el niño representa uno de los motivos más frecuentes de consulta en la práctica pediátrica diaria, y en ocasiones se convierte en una situación de temor y angustia para los padres que consideran la fiebre como el indicador más importante de que su hijo ha adquirido alguna infección seria, lo cual puede conllevar al uso inadecuado del sistema médico de atención y en especial de los servicios de urgencias.Objetivo: Determinar conocimientos, actitudes y prácticas de cuidadores de niños ante la fiebre.Material y Método: Se realizó un trabajo prospectivo, descriptivo de corte trasversal en los meses de julio y agosto del 2006. Fueron incluidos cuidadores de niños que consultaron en el Servicio de Urgencias Pediátricas del Hospital Central de Instituto de Previsión Social, independientemente de la causa que motivara la consulta. Se les proporcionó una encuesta de 26 preguntas de opciones cerradas, donde se midió conocimientos, actitudes y prácticas.Resultados: La mayoría de los encuestados fueron las madres. El nivel instructivo fue 47% secundaria completa, 37% universitarios. 90% conocía las cifras de temperatura consideradas normales.60% usa termómetro de mercurio para medir la temperatura, 33% usa el tacto. La creencia de los padres de que la fiebre ocasiona daño en el niño es generalizada, siendo los mayores daños principalmente convulsiones en 32, 6% y daño cerebral permanente en 12,6%. Este daño podría presentarse independientemente de la edad del niño. El baño (82%) fue el método más frecuente para bajar la fiebre, seguido de uso de fármacos, solos o combinados.Conclusiones: Los conocimientos y prácticas de los padres ante la fiebre de sus hijos fueron adecuados, aunque se precisan más acciones educativas ante las creencias del daño ocasionado por la misma.

Introduction: Fever in children is one of the most common reasons for presenting in daily pediatric practice, and can at times be a source of great anxiety for the parents, who may take the fever as a primary indicator of a serious infection and which may lead to inappropriate use of the healthcare system and emergency services in particular. Objective: To determine the state of knowledge, attitudes, and common practices of childcare providers faced with a feverish child. Materials and Methods:We carried out a prospective, descriptive, cross-sectional study during July and August of 2006. We included caregivers who presented with a child at the pediatric emergency department of the central hospital of the Instituto de Previsión Social (social insurance institute, or IPS) independently of the reason for presenting. They were given a survey including 26 closed option questions measuring their knowledge, attitudes, and practices. Results: Most respondents were mothers, while 47% had completed secondary school and 37% had completed an undergraduate university degree. The temperature considered normal was known by 90%, and 60% used a mercury thermometer for measuring the child's temperature while 33% detected fever using touch. The belief that fever causes harm to children is generalized; with the most commonly cited by parents being seizures (32.6%) and permanent brain damage (12.6%). This damage can occur independently of the age of the child. The most common methods for combating fever were bathing (82%) followed by use of medications alone or in combination. Conclusions: The knowledge and practices of parents confronting fever were adequate, although more education is required concerning beliefs about the harm caused by fever.

Transposições tendinosas e terapia de mão: novos resultados / Tendon transposition and hand therapy: new results

Introdução: o tratamento das patologias da mão através da cirurgia de transposição tendinosa requer pro- fundo conhecimento anatômico e fisiológico do membro superior. O terapeuta de mão deve entender os princípios da cirurgia e compreender a alteração que o procedimento provoca na informação cerebral do paciente em relação à movimentação do músculo. Objetivos: apresentar protocolo de trabalho do Serviço de Microcirurgia Reconstrutiva e Terapia Ocupacional do Hospital Cristo Redentor referente à reabilitação após cirurgia de trans- posição tendinosa. Métodos: centímetros Foram tratados sete pacientes, no período de março de 2006 a janeiro de 2007, sendo seis pacientes com lesão de nervo radial e um de mediano. Todos realizaram dois meses de reabilitação pré-operatória e quatro meses de reabilitação pós-operatória. Resultados: resultados satisfatórios, com período de reabilitação mais rápido e retorno da funcionalidade da mão, permitindo aos pacientes retomarem suas atividades. Discussão: centímetros o grande diferencial deste trabalho está na educa- ção pré-operatória dos pacientes, no treino do mecanismo cirúrgico e na simulação de movimentos. No pós- operatório o ganho de tempo é enorme, pois os pacientes sabem quais comandos devem ser treinados para atingir o movimento desejado. Conclusão: a formação da equipe para realizar este trabalho é importante, per- mitindo a obtenção de bons resultados.

Introduction: the tendon transposition surgery to treat the pathologies of the hand requires a profound knowledge of upper limb anatomy and physiology. The hand therapist must understand the principles of surgery and the changes that it causes in patients cerebral information about muscle movement. Objective: introduce the work protocol of rehabilitation after tendon transposition surgery, currently in use at the Center of Reconstructive Microsurgery and Occupational Therapy of Cristo Redentor Hospital. Methods: between March 2006 and January 2007, seven patients were treated, by the same surgeon and hand therapist. Six patients had radial nerve palsy and one had median nerve palsy. All patients had two months of pre-operatory rehabilitation and four months of pos-operatory rehabilitation. Results: satisfactory results, with faster recovery time and hand function return, allowing patients to resume their daily activities. Discussion: the greatest difference about this work is the pre-operatory rehabilitation, the surgery mechanism training and simulation of movements. The reduction recovery time is impressive, because patients already know wich commands they have to exercise to achieve the desired move. Conclusions: the professionals working with this patient have to be carefully selected, so good results can be achieved.

Contaminación del suero fetal bovino con virus de la diarrea viral bovina / Contamination of bovine fetal serum with bovine viral diarrhea virus

Fetal bovine serum (FBS) used in cell culture may be contaminated with viruses, among them bovine viral diarrhea virus (BVDV) affecting the production of biological reagents and the results of diagnosis. The filtration process used in the preparation of commercial FBS abrogates most viral agents that may be present in raw FBS, but BVDV may pass through the filters because of its small size and its pleomorphism. While detection of bovine herpes virus-1 and parainfluenza-3 (PI-3) is determined by observation of the cytopathic effect, and also by hemadsorption in the case of PI-3, the most frequently isolated BVDV is non cytopathic, and infects cells without morphological alterations, inducing problems that arise after several cell generations. Batches of raw and processed FBS were analyzed. Frequencies of BVDV detection in raw serum in Argentina were similar to those published for USA. By conventional methods for BVDV detection, only 2 of 20 commercial batches of FBS had BVDV. Using cell cultures maintained with high concentrations of the serum under study for at least 2 weeks, with detection of viral antigen by indirect immunofluorescence, the percentage of BVDV detection was 80. This method shows that most lots of commercial FBS contain BVDV. RT-PCR allows faster detection of the viral genome, but it must be validated, as it does not show viral replication. To eliminate the problem of BVDV contamination in FBS, only gamma irradiated FBS is used in our laboratory.

Biología de los priones: actualización / Prion biology: update

The word "prion" was created in 1982 to name the etiological agent of the transmissible spongiform encephalopathies (TSE), a group of degenerative diseases affecting central nervous system of man and animals, including bovine spongiform encephalopathy (BSE) and variant Creutzfeldt-Jakob disease (vCJD). Prions present two isoforms: PrPC, cellular or normal, which exists in all vertebrates and is sensitive to detergents and proteases, and PrPSc, disease associated, partially resistant. The molecular weight of both PrPC and PrPSc is 30-35 kD; after treatment with detergents and proteases PrPSc originates PrP27-30 (27-30 kD). PrPC is also denominated PrPsens, and PrPSc is PrPres. PrPSc and PrP27-30 cause disease. PrPC presents polymorphisms specifically associated with some TSE. The "prion hypothesis" says that PrPSc transmits its characteristic resistance to PrPC through conformational changes, and accumulation of the protein, without involvement of nucleic acids, causes disease. Most of the hypothesis has been demonstrated with transgenic mice, computer models and recombinant proteins, but the existence of strains of the TSE agents has not been explained. The description of similar mechanisms of propagation of protein conformational properties in Saccharomyces cereviseae has extended the meaning of the prion definition. Although the transmission of conformational changes between PrPC and PrPSc was experimentally shown, the pathogenesis of the TSE remains unknown. The relationship between BSE and vCJD is mentioned.

Curso del embarazo en pacientes con diagnostico de esterilidad previa. / The course of pregnancy in patients with diagnosis of previous sterility

Se analizan 80 casos de pacientes con esterilidad primaria y secundaria que lograron embarazarse. No se encontro asociacion entre el factor causal de la esterilidad y las complicaciones observadas durante el embarazo. En 32 pacientes se logro el embarazo sin recibir tratamiento para el factor de esterilidad diagnosticado. Destaca el alto grado de intervenciones: 32 cesareas, nueve partos distocicos y 26 partos eutocicos de un total de 67 nacimientos. Si bien este tipo de pacientes deben manejarse como embarazos de alto riesgo, debe permitirseles parto vaginal en ausencia de contraindicaciones. La esterilidad como factor aislado no debe ser causa de terminacion del embarazo por via abdominal