Pyrexia of Unknown Origin: A High Suspicion of COVID-19

We report a case of pyrexia of unknown origin (PUO) in a 19-year-old male, who was admitted with a history of pyrexia for 2 weeks. The diagnosis remained uncertain despite multiple investigations and the patient subsequently had various clinical manifestations similar to those seen in coronavirus disease 2019 (COVID-19). Since it was initially presumed to be pyrexia due to viral origin or enteric fever, patient was started on empirical treatment. The diagnosis of COVID-19 was confirmed by corroborating various biochemical markers that had a greater association with COVID-19. Patient was discharged after 21 days with empirical antibiotics, anticoagulants and other supportive medications. He required no further hospital admissions and has been on regular follow-up.

Methicillin resistant Staphylococcus aureus-importance of appropriate empirical therapy in serious infections

India has been titled the capital of antimicrobial resistance in the world with the centre for disease dynamics, economics andpolicy (CDDEP) predicting two million deaths in India by 2050. As per the World Health Organisation抯 global priority pathogen list of 2017, methicillin resistant Staphylococcus aureus(MRSA)has been classified as a 慼igh priority� pathogen due to its association with increased mortality rate, rising prevalence of resistance and increased burden on healthcare settings. A recent report by Indian Council of Medical Research signifies the exponential rise in the prevalence of MRSA in India, from 29% in 2009 to 39% in 2018. Serious MRSA infections are commonly associated with poor clinical outcomes coupled with increased hospitalisation stay and cost. Therefore, early identification and appropriate empiric treatment of MRSA plays a crucial role in healthcare settings. However, the constant rise in multi-drug resistance to the currently available anti-MRSA agents as well as their compromised safety profile limits its clinical use to manage severe MRSA infections. This review article explores the implications of severe MRSA infections and inappropriate empirical therapy on the clinical as well as economic outcomes. In addition, it also highlights limitations of the currently available anti-MRSA agentsand the need for newer agents to manage multi drug resistant (MDR)gram positive infections.

Factors affecting the outcome of adult patients with Methicillin-resistant Staphylococcus aureus and Non- Methicillin resistant Staphylococcus aureus pneumonia: A retrospective, cross-sectional cohort study

@#<p style="text-align: justify;"><strong>Introduction:</strong> Pneumonia continues to be a leading cause of morbidity and mortality worldwide. Locally, pneumonia is the 3rd cause of death (2016). Currently, one of the concerns is the rise of resistant microorganisms particularly MRSA. Knowledge regarding MRSA pneumonia is mostly from international data. This study aims to determine the factors that may affect the outcome of MRSA and non-MRSA pneumonia as well as describe the susceptibility patterns of its etiologic agents.</p><p style="text-align: justify;"><strong>Methods:</strong> This is a retrospective, cross-sectional cohort study. The setting is a tertiary government hospital. The target subjects are patients 18 y/o and above, with bacteriologically-confirmed pneumonia, and were admitted in 2017.</p><p style="text-align: justify;"><strong>Results:</strong> The results revealed a high rate of MRSA pneumonia (88.2%), most are community-acquired (90%), and factors associated with mortality were: male, Type 2 DM, smoking history, radiographic findings of congestion, and significant difference was noted. For Non-MRSA pneumonia factors associated with mortality were: erythrocytosis, kidney and liver disease, cancer, previous cerebrovascular disease, previous admission (ARMMC), number of comorbidities, findings of altered sensorium, chest retractions, DBP ? 60 mmHg, radiographic findings of pulmonary congestion, and classification of CAP-MR. Morbidity factors included: anemia, trauma, multiple comorbidities, radiographic findings of bilateral infiltrates, unilateral/bilateral consolidation, unilateral/bilateral minimal pleural effusion, subcutaneous emphysema, congestion, and infection with multiple bacteria. The first antibiogram for the institution revealed a poor susceptibility pattern for the usually used empiric treatment.</p><p style="text-align: justify;"><strong>Conclusion:</strong> This study reveals a high rate of MRSA pneumonia, with several factors associated with its mortality. In terms of morbidity, no significant difference was noted from the variables measured. For Non-MRSA pneumonia which is seen in the majority of the subjects, several factors associated with mortality were noted and unlike MRSA pneumonia the morbidity is affected by the presence of anemia, trauma, multiple comorbidities, etc.<br />The antibiogram showed a poor susceptibility to the usually used empiric treatment.</p>

Drug use evaluation of vancomycin at medical ward of Yekatit 12, hospital medical college, Addis Ababa, Ethiopia, 2018

Background:Drug use evaluation is an ongoing systematic process designed to maintain the appropriate medication during & after dispensing in order to assure appropriate therapeutic decision making andpositive patient outcome. Methods:An institutional based cross-sectional study design was conducted to analyze drug use of vancomycin by using medication charts and medical note of patients that were admitted in the medical ward of Yekatit 12 Hospital Medical College. Data was analyzed using SPSS version 20. Patients who were admitted from medical ward and whose age were≥18years were eligible provided that they take Vancomycin during the study period were included and Patients with medical records of insufficient or illegible information’s were excluded. Structured check list was used for data collection, and the samplesize was 169. Convenience sampling technique was used.Results:Among 169 patients 136(80.5%) had empiric treatments, the remaining 33(19.5%) had specific treatments. Among 169 patients 61(36.1%) hadInfection during his/her stay in hospital of which 47(77%) were hospital acquired pneumonia, 169 patients 39(23.08%) had Vancomycin indication for hospital acquired pneumoniafollowed by 21 (12.4%), 21(12.4%), meningitis and PCP respectively. The finding indicated that only 135(79.9%) were appropriate regarding frequency, 124(73.4%) were appropriate regarding dose, 104(61.6%)were appropriate regarding duration, and the appropriate indication were only 128(75.7%).Conclusions:Vancomycinewas mostly indicated as empiric therapy and only 135(79.9%) were appropriately prescribed with respect to frequency, 128(75.7%) were appropriate regarding indication and 124(73.4%) were appropriate regarding to dose, 104(61.6%) were appropriate regarding to duration. All physicians should prescribe drugs according to the guidelines.

Uso de beta-lactámicos como alternativa del tratamiento empírico actual de sepsis neonatal tardía: revisión temática / Use of beta-lactams as an alternative to the current empirical treatment of late neonatal sepsis: review

OBJETIVO: Analizar el uso de beta-lactámicos en sepsis neonatal tardía, en comparación con el tratamiento empírico actual con vancomicina, mediante la revisión de artículos científicos. METODOLOGÍA: Revisión temática en Bases LILACS y PubMed. La selección de los artículos se realizó mediante la lectura de título, abstract y texto completo. Criterios de búsqueda: Estudios en humanos, artículos por abstract y texto completo, en inglés y español, y de no más de 10 años. RESULTADOS: No hay relación en la duración ni en la mortalidad de la sepsis al utilizar un betalactámico, o al utilizar vancomicina. Además, cepas resistentes a beta-lactámico, respondieron bien al usar un beta-lactámico como terapia empírica inicial, sin la necesidad de recurrir a vancomicina, excepto en casos de no mejoría clínica. CONCLUSIONES: Beta-lactámicos pueden ser utilizados como terapia empírica inicial en sepsis neonatal tardía como alternativa al tratamiento actual con vancomicina, restringiendo el uso de vancomicina a casos de resistencia, o cuando no haya mejoría clínica del recién nacido que está utilizando un beta-lactámico como tratamiento.

OBJECTIVE: To analyze the use of beta-lactams in late- onset neonatal sepsis, compared with empirical treatment with vancomycin used currently, through the revision of scientific articles. METHODOLOGY: Thematic review in LILACS and PubMed. The articles were selected by reading the title, abstract and full text. Searching criteria: Human studies, articles by abstract and full text, in English and Spanish, and no more than 10 years since published. RESULTS: There is no relationship in duration or mortality in Sepsis when using beta-lactam, or using vancomycin. In addition, resistant strains to beta-lactam responded well in using betalactam as initial empirical therapy, without the need to resort to vancomycin, except in cases of non-clinical improvement. CONCLUSIONS: Beta-lactams may be used as initial empirical therapy in late-onset neonatal sepsis as an alternative to current vancomycin therapy, restricting the use of vancomycin to resistance cases, or when there is no clinical improvement in the neonate, who is using a beta-lactam as a treatment.

Infecciones en pie diabético: Elección del tratamiento antibiótico empírico / Infections in diabetic foot. Choice of empirical antibiotic regimen

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Clinical characteristics and anti-infective treatment in Listeria monocytogenes meningitis / 中国感染控制杂志

Objective To describe clinical characteristics and anti-infective treatment of Listeria monocytogenes(L.monocytogenes)meningitis.Methods Clinical manifestations and cerebrospinal fluid(CSF)examination results of 6 patients with L.monocytogenes meningitis in a hospital were analyzed retrospectively.Evaluation methods were developed according to relevant guidelines and literatures,anti-infective treatment and prognosis of patients with L.monocytogenes meningitis were evaluated.Results Two of 4 adults with L.monocytogenes meningitis had triad of fever,stiff neck,and altered mental status,the mean white blood cell count(WBC)of the initial CSF detection was 997×106/L,CSF/blood glucose ratio was 0.32,CSF protein was 1.43g/L;the other 2 neonates had fever,epilepsy,and hyponatremia,WBC were both>1 000×106/L,CSF protein were both>1 g/L,CSF/blood glucose ratio was<0.5.Of 6 patients,none were treated with appropriate initial empiric anti-infection therapy,confirmed by CSF or blood culture,5 cases were treated with ampicillin anti-infective therapy,1 used compound sulfamethoxazole due to penicillin allergy;1 neonate died,1 elderly patient was with moderate disability,the remaining 4 cases were all recovered and discharged from hospital.Conclusion Clinical manifestations and CSF findings of L.monocytogenes meningitis are not different from other purulent meningitis,commonly used antimicrobial agents for the treatment of purulent meningitis are not sensitive to L.monocytogenes,which should be paid attention in clinic.

Progress in the diagnosis and treatment of non-responding community acquired pneumonia / 天津医药

Non-responding pneumonia describes the situation, in which an inadequate clinical response is present de-spite antibiotic treatment. The incidence of treatment failure in community acquired pneumonia (CAP) can range up to 31%. At present, the diagnosis and treatment of this kind of disease remain a great challenge to CAP. For this reason, several stud-ies have attempted to establish risk factors and new strategies for the treatment of non-responding pneumonia. This article re-views the progress of the pathogeny and treatment of non-responding CAP.

Solitary staphylococcal liver abcess in a neonate.

28 days old neonate presented with high fever, abdominal distension, poor feeding and lethargy. Sepsis screen was positive; ultrasound and computed tomography of the abdomen demonstrated a multiloculated hepatic abcess in the right lobe of the liver. The baby was treated with intravenous antibiotics for 6 weeks and percutaneous aspiration of the abcess, resulting in excellent recovery.

Survey on de-escalation of empiric broad-spectrum antibiotics treatment for patients in intensive care unit / 中华临床感染病杂志

Objective To investigate de-escalation of empiric broad-spectrum antibiotics treatment for patients in intensive care unit (ICU).Methods Data of the patients discharged from ICU in the Second Affiliated Hospital of Zhejiang University from July 1 to December 31 of 2012 and from July 1 to December 31 of 2013 were retrospectively reviewed.Patients with initial use of empirical broad-spectrum antibiotics within 3 d after ICU admission were included in the study.Clinical data including status of infection,the initial empiric antimicrobial therapy,pathogens culture and adjustment of antibiotics in 5 days were analyzed.Results A total of 841 patients were discharged from ICU during the study periods and antibiotics were used in 786 (93.5％) patients.Among 786 patients,389 (49.5％) were treated empirically with broad-spectrum antibiotics,but only 269 (69.2％) had evidences of bacterial infections.Of the 389 patients with empiric antibiotics use,de-escalation of antibiotics was applied only in 6 (1.54％) patients within 5 days after the initiation of treatment.In 269 patients with evidence of infection,specimen sampling and culture were performed in 248 (92.2％) patients within 3 days,among which 165 samples were positive,and the clinical isolates were mainly multi-drug resistant gram negative bacilli and colonized bacteria in oropharyngeal cavity.De-escalation was applied only in 4 (1.49％,4/269) patients with evidences of bacterial infections.Conclusion Broad-spectrum antibiotics as initial empiric therapy is common for patients in ICU,however de-escalation of empiric therapy is rarely applied even in patients with positive results in pathogen isolation and culture.

Ciências sociais e saúde pública/coletiva: a produção do conhecimento na sua interface / Social sciences and public health: creating knowledge at its interface

O artigo trata das relações entre ciências sociais e saúde na produção doe conhecimento em Saúde Pública/Coletiva. Aborda os desafios de se articular as várias áreas do conhecimento que compõem esse campo; as dificuldades de construção de uma agenda de pesquisa frente às demandas das políticas públicas de saúde, da marca de seu surgimento enquanto um campo de conhecimento não só empírico mas também militante a favor da construção da saúde como um direito e um bem público.

Estimação de sub-registros de óbitos em pequenas áreas com os métodos bayesiano empírico e algoritmo EM / Estimation of death underreporting at small areas using empiric Bayesian and EM algorithm methods / /Estimación de subregistros de fallecimientos en pequeñas áreas con los métodos bayesiano empírico y algoritmo EM

Um grande problema em estimativas demográficas no Brasil diz respeito ao nível e padrão da mortalidade. Os demógrafos que trabalham com mortalidade, no país, ainda não se sentem tão seguros sobre o real comportamento desta componente da dinâmica populacional. Por outro lado, necessita-se da disponibilidade de indicadores de mortalidade para níveis geográficos mais desagregados, sobretudo municípios. O problema é que quanto mais desagregado, mais complexo se torna o trabalho de estimar qualquer indicador social ou demográfico. Neste trabalho, objetiva-se estimar e propor correção de sub-registros de óbitos no nível municipal, segundo grupos etários, por meio de dois métodos: estimador bayesiano empírico (BE) e algoritmo EM (Expectation-Maximization). Para que os dois métodos fossem operacionalizados entre municípios semelhantes, foram realizados dois exercícios: agruparam-se os municípios segundo a mesorregião; e agruparam-se os municípios em grupos homogêneos, gerados a partir de uma análise de cluster utilizando as variáveis grau de urbanização, proporção de óbitos por causas externas e a população de cada município. Foram utilizados dados do Estado do Rio Grande do Norte, referentes a 2000. Para o total do Estado, estimou-se um sub-registro de 11% com o estimador BE e de 12,9% com o algoritmo EM. Outro resultado importante é a possibilidade de avaliar o grau de cobertura de óbitos por grupos etários em municípios e em qualquer nível de agregação a partir deste.

Level and standard of mortality are major demographic estimation problems in Brazil. Demographists dealing with mortality in Brazil still do not fell assured of the real behavior of this population dynamics component. On the other hand, there is a need for mortality indicators available for more disaggregated geographic levels, mostly municipalities. The difficulty is that the more disaggregated, the more complex is the task for estimating any social or demographic indicator. In this study, we aimed to estimate and to propose the correction of death underreporting at the municipal level, according to age, using two methods: the empiric Bayesian estimator (BE) and the EM (Expectation-Maximization) algorithm. For the two methods to be operational within comparable municipalities, two steps were performed: we grouped the municipalities according to a mesoregion; and we grouped them into two homogeneous groups, created from a cluster analysis using the variables level of urbanization, proportion of death from external causes and the population of each municipality. We used data collected in 2000 from the State of Rio Grande do Norte. For the entire State, we estimated underreporting to be 11% using the BE estimator, and 12.9 % using the EM algorithm. Another important finding was the capability to assess the level of death coverage by age groups in the municipalities and, at any level of aggregation.

Un gran problema, en lo que se refiere a estimativas demográficas en Brasil, está relacionado con el nivel y patrón de la mortalidad. Los demógrafos que trabajan con mortalidad en el país todavía no se sienten muy seguros sobre el comportamiento real de este componente de la dinámica poblacional. Por otro lado, es necesario que se disponga de indicadores de mortalidad para niveles geográficos más desagregados, sobre todo municipios. El problema es que cuanto más desagregado, más complejo se hace el trabajo de estimar cualquier indicador social o demográfico. Este trabajo tiene por objetivo estimar y proponer una corrección de subregistros de fallecimientos en el nivel municipal, según grupos de edad, por medio de dos métodos: estimador bayesiano empírico (BE) y algoritmo EM (Expectation-Maximization). Con el objeto de que los dos métodos fueran puestos en funcionamiento entre municipios semejantes, se realizaron dos ejercicios: se agruparon los municipios según la mesorregión; y se agruparon los municipios en grupos homogéneos, generados a partir de un análisis de cluster, utilizando las variables grado de urbanización, proporción de óbitos por causas externas y la población de cada municipio. Se utilizaron datos del Estado de Río Grande do Norte, referentes al año 2000. Para el total del Estado, se estimó un subregistro de un 11% con el estimador BE y de un 12,9% con el algoritmo EM. Otro resultado importante es la posibilidad de evaluar el grado de cobertura de óbitos por grupos de edad en municipios y en cualquier nivel de agregación a partir de este nivel.

Desempenho de diferentes métodos de estimativa da evapotranspiração de referência diária em Uberlândia, MG / Performance of different methods of estimating the daily reference evapotranspiration in Uberlandia, MG

Muitas são as metodologias de estimativas da evapotranspiração de referência e o seu conhecimento é base fundamental para dimensionar e manejar adequadamente a irrigação. Neste trabalho foram avaliados alguns métodos de estimativa da evapotranspiração de referência para as condições climáticas de Uberlândia. Os métodos avaliados foram os de Thornthwaite, Camargo, Hargreaves-Samani, Priestley-Taylor e do Tanque Classe A. As evapotranspirações diárias estimadas por esses métodos foram correlacionadas com as obtidas pelo método padrão (Penman-Monteith FAO-56) por meio de índices estatísticos. O método de Priestley-Taylor apresentou ótimo desempenho enquanto que Thornthwaite e Hargreaves-Samani apresentaram bom desempenho. O método de Camargo obteve desempenho apenas regular enquanto que o do Tanque Classe A apresentou péssimo desempenho. Os métodos de Thornthwaite e Hargreaves-Samani apresentam-se como uma alternativa para se estimar a evapotranspiração de referência quando se dispõe apenas dos dados de temperatura do ar.

Many are the methods to estimate the reference evapotranspiration (ETo) and your knowledge is essentially to plan and to manage irrigation correctly. This present work evaluated some ETo methods under climate conditions of Uberlandia, Minas Gerais State, Brazil. The methods tested were: Thornthwaite, Camargo, Hargreaves- Samani, Priestley-Taylor and Class A Pan evaporation. The daily ETo estimated by these methods were correlated with by the standard method (Penman-Monteith FAO-56) through statistical indexes. The method of Priestley-Taylor showed good performance, while Hargreaves-Samani and Thornthwaite were considered as good performance. The Camargo method had regular performance whereas Class A pan showed poor performance. The methods of Thornthwaite and Hargreaves- Samani are alternatives to estimate ETo especially when only the temperature data are available

Recent Trends of Laryngopharyngeal Reflux Disease / 대한이비인후과학회지

Laryngopharyngeal reflux disease (LPRD) refers to the retrograde flow of gastric content to the laryngopharynx, where it comes in contact with tissues of the upper aerodigestive tract. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. In the absence of definite diagnostic criteria, LPRD is suspected when the history and laryngoscopy findings are suggestive of the diagnosis. A diagnosis of LPRD is usually based on response of symptoms to empirical treatment. Most patients with LPRD are treated with proton pump inhibitor with education of life style modification, but there is still little or no solid evidence on the treatment as well as the diagnosis. Failure to respond to a usual treatment suggests the need for confirmatory studies and consideration of alternative diagnoses. LPRD appears to be a common but controversial disorder, with conflicting data on pathophysiology, diagnosis, and treatment. Whereas trends are observed and many clinical practices are accepted widely on the basis of experience, we need definitive, prospective, evidence-based studies. In this article, we will review current concept of diagnosis and treatment of LPRD.

Hospital antibiogram: A necessity.

The hospital antibiogram is a periodic summary of antimicrobial susceptibilities of local bacterial isolates submitted to the hospital's clinical microbiology laboratory. Antibiograms are often used by clinicians to assess local susceptibility rates, as an aid in selecting empiric antibiotic therapy, and in monitoring resistance trends over time within an institution. Antibiograms can also used to compare susceptibility rates across institutions and track resistance trends. Some hospitals have adequate support from the computer department to be able to extract data from their reporting module. The WHONET software can be freely downloaded and used for analysis. Consensus guidelines have been developed by the Clinical and Laboratory Standards Institute (CLSI) to standardise methods used in constructing antibiograms. These guidelines can be incorporated into the WHONET software for analysis. Only the first isolate from the patient is to be included in the analysis. The analysis should be done on the basis of patient location and specimen type. The percentage susceptibility of the most frequently isolated bacteria should be presented in the antibiogram, preferably in a tabular form. The antibiogram must be printed or put up in the intranet for easy access to all clinicians. Antibiotic policy is one of the mandatory requirements for accreditation, and making an antibiogram is the first step before framing the antibiotic policy. The future of antibiograms would be the incorporation of patient related data to make information more reliable and for predicting outbreaks.

Chronic cough with multiple causes

This case reports a 57-year-old lady presented with cough of two months duration despite repeated treatments from multiple general practitioners. It took her another two months to know her diagnoses and a further couple of months to be relieved of her cough and became asymptomatic. Chronic cough management in primary care often needs an empiric integrative approach and requires good doctor-patient rapport with informed follow ups and continuity of care to be successful

Un nuevo sesgo en la racionalidad: el impacto de las neurociencias en las teorías filosóficas de la racionalidad humana: [revisión] / A new bias in human rationality: the impact of neurosciences in the philosophical theories of human rationality: [review]

Los psicólogos experimentales creen que la investigación sobre los sesgos en la racionalidad humana permite mostrar las estructuras primigenias de la mente, de manera más clara que el estudio sobre los razonamientos válidos. En esta comunicación indago sobre estos sesgos con el propósito de detectar cuáles son los límites reales del funcionamiento racional humano. En la literatura filosófica tradicionalmente se consideró tres tipos de sesgos, a saber: en el razonamiento lógico, en el uso de las leyes probabilísticas y del “pensamiento cálido”. Tomando como referencia los resultados de los estudios neurofisiológicos de A. Damasio propongo un nuevo tipo de sesgo en la racionalidad humana que aún no ha sido considerado en la literatura filosófica. Al mismo lo denomino sesgos del “pensamiento frío”, pues es consecuencia de la falta de emociones y sentimientos en el proceso de toma de decisiones. A su vez, muestro de qué manera estos estudios neurofisiológicos impactan en el pensamiento filosófico pues permiten contar con nueva evidencia empírica acerca de los sesgos en la racionalidad y posibilitan una evaluación y corrección de algunas teorías de la racionalidad humana.

Experimental psychologists believe that research on human rationality biases allow for a better understanding of the primordial structures of the mind than studies on valid reasoning do. In this communication I inquire into human rationality biases to better understand the true limits of the functioning of human rationality. Three types of human rationality biases were typically considered in the philosophical literature: logical reasoning biases, biases in the use of probabilistic laws and biases related to the “hot-thinking”. Here I propose a new type of bias in human rationality, not considered before in philosophical literature, and taking the results of neurophysiologic studies carried out by A. Damasio as a reference. I refer to this new bias as “cold-thinking”, since it results from the lack of emotions and feelings in the decision making process. In addition, I show how the mentioned neurophysiologic studies impact on philosophical thinking, since the studies provide new empiric evidence on human rationality biases, enabling the assessment and adjustment of human rationality theories.

Upper gastrointestinal bleeding in children in southern Iran.

Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.

The History of the Study of On Ancient Medicine / 의사학

The treatise On Ancient Medicine is nowadays one of the most admired, and most studied, of those making up the Corpus Hippocraticum. But this favored position is not a ancient phenomenon, but a modern phenomenon. The treatise contributed to the establishment of the Empiric school of medicine. Empiricists seem to have written commentaries of Hippocratic works. But the attention paid to this work in antiquity was short-lived. In the second century A.D., Galen knew the work, but he did not devote a commentary to it. He almost totally ignored it and his powerful influence made the treatise drop out of sight from later antiquity to early modern times. On Ancient Medicine was not regarded as one of the major works of the Corpus Hippocraticum until in 1939, Emile Littre was a strong advocate of the view that the work was a genuine work of Hippocrates, and placed it first in his ten-volume edition of 1839-1861. Later, some scholars advocated Littre' view, but much more scholars rose against his position. Most of studies of the work motivated by the desire to answer the Hippocratic question reached conclusions that was vague. After all to conclude that Hippocrates was the author of this work would be rash.

Informações sobre acidentes com transporte rodoviário de produtos perigosos no Estado de São Paulo: os desafios para a Vigilância em Saúde Ambiental / Informations about road transport of dangerous substances in the State of São Paulo: challenges for environmental health surveillance

O estudo dos acidentes com produtos perigosos é uma das áreas de atuação da vigilância em saúde ambiental. Os riscos envolvidos no transporte rodoviário de produtos perigosos são grandes e estão diretamente relacionados às propriedades das substâncias envolvidas, à qualidade da malha viária, à presença de áreas densamente povoadas no entorno, à presença de pedestres na via, entre outros, e suas conseqüências podem ser muito severas. Um dos requisitos básicos para a vigilância em saúde ambiental é a existência de sistemas de informação adequados. Este artigo tem por objetivo analisar os dados de acidentes com transporte de produtos perigosos no Estado de São Paulo, registrados pela Cetesb, pela Polícia Rodoviária e pelo Corpo de Bombeiros do Estado de São Paulo. Também foram analisados e comparados entre si o conteúdo dos respectivos relatórios de registros das ocorrências: RAA, RATPP e RACB. Foram analisados o número de acidentes, o número de óbitos e feridos e a razão de óbito por acidente no período de 1996 a 2003. Os resultados indicaram uma diferença significativa nos números e também na representatividade e facilidade de acesso aos dados. Foi possível verificar também que os conceitos de tipo, causa e conseqüência utilizados pelas instituições são bastante distintos. Por essas razões, a realização de estudos empíricos, a partir de dados históricos de acidentes, é inviabilizada. Vale ressaltar que a estruturação de bancos de dados de registros de acidentes com produtos perigosos deve ser iniciada com a discussão e a uniformização dos seus conceitos fundamentais.

The study of accidents with dangerous products is one of the areas of environmental health surveillance. The risks involved in the road transport of dangerous products are large and they depend on the properties of the involved substances, of the quality of the road network, of the presence of areas densely populated, of passengers in the road, among others, and their consequences can be very severe. One of the basic requirements for the surveillance in environmental health is the existence of appropriate systems of information. This article has as objective to analyze the data of accidents with transport of dangerous products in the State of São Paulo, registered by Cetesb, by the Traffic Police and by the Fire Brigade of the State of São Paulo. The contents of the respective reports of registrations of the occurrences: RAA, RATPP AND RACB were also analyzed and compared. The number of accidents, number of deaths and of persons wounded and the relation death / accident were verified for the period 1996 2003. The results indicated a significant difference, not just in quantitative terms as of representativeness and access easiness. It was also verified that the concepts of type of accident, causes and consequences used by the institutions are quite different. For these reasons, the accomplishment of empiric studies, starting from historical data of accidents is unfeasible. The structuring of databases of registrations of accidents with dangerous products should be initiated by the discussion and the uniformization of their fundamental concepts.