Resultados obstétricos y perinatales de la enfermedad materna por COVID-19. Estudio de casos y controles

Introducción: las infecciones virales durante el embarazo pueden provocar complicaciones maternas y fetales. Es importante describir las repercusiones maternas y fetales de la enfermedad COVID-19. Objetivos: describir y analizar las características de las pacientes que presentaron infección a SARS-CoV-2 durante la gestación y los resultados maternos y fetales. Material y método: se realizó un estudio de casos y controles. Se incluyeron todas las pacientes embarazadas que presentaron infección por SARS-CoV-2 y que fueran hospitalizadas en una institución de asistencia privada (casos) en el período 1/3/2021 - 31/7/2021. Los controles se tomaron de pacientes embarazadas que estuvieran ingresadas en igual período de tiempo pero que resultaron negativas para las pruebas de SARS-CoV-2. Se incluyeron dos controles por cada caso. Las variables maternas consideradas fueron: trabajo de parto prematuro, diabetes gestacional, estado hipertensivo del embarazo, preeclampsia (severa o no severa), muerte fetal, restricción del crecimiento fetal, abruptio placentae. Las variables neonatales consideradas fueron: estado vital, peso del recién nacido (RN), Apgar al minuto y a los cinco minutos, necesidad de ingreso a una unidad especializada en cuidados neonatales y días de estadía. Se registraron las pruebas para COVID-19 y la condición del RN al alta. Resultados: las características demográficas maternas fueron comparables en ambos grupos. Se observaron 21 (55%) complicaciones obstétricas en el grupo casos y 117 (44,7%) en el grupo controles; OR = 4,2 (IC 95%: 1,9-9,7). Se identificaron 12 (30,8%) complicaciones neonatales en el grupo casos y 3 (3,8%) en el grupo control; OR = 11,2 (IC 95%: 2,9-42,9). El grupo casos estuvo asociado con una menor probabilidad de estar vacunados; OR = 0,3 (IC 95%: 0,13-0,75). Conclusiones: reportamos un riesgo aumentado de resultados maternos y neonatales adversos relacionados con la infección por el virus SARS-CoV-2. La vacunación confirma ser una herramienta valiosa contra esta infección viral.

Introduction: Viral infections during pregnancy can lead to maternal and fetal complications. It is important to describe the maternal and fetal implications of COVID-19 disease. Objetives: To describe and analyze the characteristics of patients who experienced SARS-CoV-2 infection during gestation, and maternal and fetal outcomes. Method: A case-control study was conducted. All pregnant patients who presented SARS-CoV-2 infection and were hospitalized in a private healthcare institution (cases) during the period 1/03/2021 - 31/07/2021 were included in the study. Controls were selected from pregnant patients who were admitted during the same time but tested negative for SARS-CoV-2. Two controls were included for each case. The maternal variables considered were preterm labor, gestational diabetes, preeclampsia, (severe or non-severe) preeclampsia, fetal death, fetal growth restriction, placental abruption. The neonatal variables considered were vital status, newborn weight, one-minute and five-minute Apgar scores, need for admission to a specialized neonatal care unit, and length of stay in days. COVID-19 tests for the newborn and their condition at discharge were recorded. Results: Maternal demographic characteristics were comparable in both groups. Twenty-one (55%) obstetric complications were observed in the case group, and 117 (44.7%) in the control group; OR= 4.2 (95% CI: 1.9-9.7). Twenty-one (30.8%) neonatal complications were observed in the case group, and 3 (3.8%) in the control group; OR= 11.2 (95% CI: 2.9-42.9). The case group was associated with a lower likelihood of being vaccinated; OR = 0.3 (95% CI: 0.13-0.75). Conclusions: We report an increased risk of adverse maternal and neonatal outcomes associated with SARS-CoV-2 virus infection. Vaccination proves to be a valuable tool against this viral infection.

Introdução: as infecções virais durante a gravidez podem causar complicações maternas e fetais. É importante descrever as repercussões maternas e fetais da COVID-19. Objetivos: descrever e analisar as características das pacientes que apresentaram infecção por SARS-CoV-2 durante a gravidez e os desfechos maternos e fetais. Material e métodos: foi realizado um estudo caso-controle. Foram incluídas todas as gestantes que apresentaram infecção por SARS-CoV-2 e que estiveram internadas em instituição privada (casos) no período de 01 de março a 31 de julho de 2021. Os controles foram pacientes grávidas hospitalizadas durante o mesmo período de tempo, mas com teste negativo para SARS-CoV-2. Dois controles foram incluídos para cada caso. As variáveis maternas consideradas foram: trabalho de parto prematuro, diabetes gestacional, estado hipertensivo da gravidez, pré-eclâmpsia (grave ou não grave), óbito fetal, restrição do crescimento fetal, descolamento prematuro da placenta. As variáveis neonatais consideradas foram: estado vital, peso do recém-nascido (RN), Apgar de um e cinco minutos, necessidade de internação em unidade especializada em cuidados neonatais e dias de internação. Os resultados dos testes para COVID-19 e a condição do recém-nascido na alta foram registrados. Resultados: As características demográficas maternas foram comparáveis em ambos os grupos. 21 (55%) complicações obstétricas foram observadas no grupo caso e 117 (44,7%) no grupo controle; OR= 4,2 (IC 95%: 1,9-9,7). 12 (30,8%) complicações neonatais foram identificadas no grupo caso e 3 (3,8%) no grupo controle; OR = 11,2 (IC 95%: 2,9-42,9). O grupo de casos foi associado a uma menor probabilidade de ser vacinado; OR = 0,3 (IC 95%: 0,13-0,75). Conclusões: Relatamos um risco aumentado de resultados maternos e neonatais adversos relacionados à infecção pelo vírus SARS-CoV-2. A vacinação confirma ser uma ferramenta valiosa contra esta infecção viral.

Vertical transmission of HIV to neonates in a reference hospital in Northeastern Brazil from 2013 to 2017

ABSTRACT The aim of this study was to estimate the rate of Mother-to-child Transmission (MTCT) of HIV to neonates in a reference university hospital in Sao Luis city, the capital of Maranhao State (MA), evaluating MTCT-associated factors. A retrospective cohort study based on data from the Notifiable Diseases Data System (SINAN) was carried out and included all HIV-exposed neonates notified from 2013 to 2017 by the university hospital. The study population comprised 725 HIV-exposed neonates, of whom 672 neonates were exposed and uninfected, and 53 were exposed and infected. The estimated rate of MTCT in the period of 2013 to 2017 was 7.3%. Most pregnant women were ≥ 20 years old (86.9%), reported ≥ 8 years of schooling (53.2%), reported full-time or independent paid work (46.9%) and were residents in other cities of the state (61.7%). Regarding healthcare, 86.3% received prenatal care, 74.6% received Antiretroviral Therapy (ART) as prophylaxis during pregnancy, 81.8% received ART prophylaxis during childbirth and 78.1% underwent cesarean section. Among the neonates, 92.8% received ART prophylaxis and 94.3% were not breastfed. Despite these variables, the 7.3% MTCT rate found in this study makes it clear that the interventions recommended by the Ministry of Health were not fully adopted.

Hanseníase virchowiana e eritema nodoso hanseníco em gestante de 34 semanas sem diagnóstico prévio / Virchowian leprosy and erythema nodosum leprosum in a 34-week pregnant woman without any previous diagnosis

Relatamos um caso de uma paciente feminina, gestante de terceiro trimestre, em acompanhamento pré-natal regular na unidade básica de saúde, com boa evolução gestacional, porém apresentando lesões de pele há cerca de um ano, acompanhadas de alteração de sensibilidade, além de fáscies infiltrada e madarose. Sendo o Brasil um país endêmico em Hanseníase, ocupando o 2º lugar no mundo em número de novos casos, chama a atenção o diagnóstico tardio da paciente em questão. Aproveitamos este emblemático relato de caso para discutir aspectos importantes em relação à terapêutica no período gestacional (poliquimioterapia conforme manual do ministério, sem nenhuma alteração por conta da gestação), desfecho obstétrico, orientações quanto à lactação (não contra-indicada com a mãe em tratamento; pelo contrário, devendo ser estimulada) e cuidado ao recém nato. [au]

We report a case of a pregnant female patient in the third trimester undergoing regular prenatal care at a Basic Health Unit, with good gestational evolution, but presenting skin lesions for approximately a year accompanied by changes in sensitivity, in addition to facial infiltration and madarosis. Considering Brazil as an endemic country for leprosy, ranking 2nd in the world concerning the number of new cases, late diagnosis of the patient in question stands out. We use this emblematic case report to discuss important aspects concerning the treatment of leprosy during the gestational period (multidrug therapy according to the Ministry of Health manual, without any changes due to pregnancy), obstetric outcome, guidelines regarding breastfeeding (not contraindicated with the mother in treatment; on the contrary, it should be stimulated) and care for the newborn. [au]

Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário / Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre

Resumo Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.

Background: Neurological complications are common in patients with infective endocarditis (IE). Recent data suggest that neurologic events are a major determinant of prognosis, and that surgery is critical in improving the outcome. Objective: To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and mortality. Methods: Retrospective analysis of patients admitted to a tertiary center with the diagnosis of IE from 2006 to 2016. Statistical significance was defined by a p-value < 0.05. Results: We identified 148 episodes of IE, 20% of which had evidence of CNS embolization. In patients with CNS embolization, 76% presented with ischemic stroke. During follow-up, 35% were submitted to surgery and both in-hospital and one-year mortality were 39%. These patients had longer hospitalizations, but there were no significant differences regarding mortality in patients with and without CNS embolization. The independent predictors of neurological complications were diabetes (p=0.005) and the absence of fever at presentation (p=0.049). Surgery was associated with lower mortality (0 vs. 58%; p=0.003), while patients with septic shock had a poorer prognosis (75 vs. 25%; p=0.014). In multivariate Cox regression, human immunodeficiency virus (HIV) infection was the only independent predictor of in-hospital and 1-year mortality (p=0.011 in both). Conclusions: In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without significant differences in mortality. In patients with CNS embolization, those submitted to surgery had a good clinical evolution, while patients with septic shock and HIV infection had a worse outcome. These results should be interpreted with caution, taking into consideration that patients with more severe complications or more fragile were probably less often considered for surgery, resulting in selection bias.

Severe Acute Respiratory Syndrome by COVID-19 in pregnant and postpartum women / Síndrome Respiratória Aguda Grave em gestantes e puérperas portadoras da COVID-19

Abstract Objectives: to evaluate the morbidity and mortality profile and factors associated with death due to severe acute respiratory syndrome (SARS) by COVID-19 in pregnant and postpartum women. Methods: this is a quantitative and retrospective research that analyzed the SIVEP-gripe Database (Influenza Epidemiological Surveillance Information System), from 01/01/2020 to 04/01/2021. All pregnant women and postpartum women diagnosed with SARS caused by COVID-19 in the State of Minas Gerais were included. After the descriptive analysis of the hospitalizations profile, the association between different exposure variables and the occurrence of death was evaluated. Results: of the 227 records obtained, 94.3% required hospitalization. Among hospitalizations in the Intensive Care Unit, 29.8% used invasive ventilatory support. Fifteen deaths were recorded. The most frequent clinical manifestations were: cough and fever; the predominant comorbidities were cardiovascular disease and diabetes mellitus. The variables "ICU stay", "use of ventilatory support" and "heart disease" were associated with the occurrence of deaths. Conclusions: hospitalization was necessary for most pregnant women with SARS and the presence of previous heart disease increased the risk of death. Knowing the SARS morbidity and mortality profile is important in the definition of public health strategies aimed at reducing the impacts of COVID-19 during pregnancy and the puerperium.

Resumo Objetivos: avaliar o perfil de morbimortalidade e fatores associados ao óbito pela Síndrome Respiratória Aguda Grave (SRAG) por COVID-19 em gestantes e puérperas. Métodos: tratase de urna pesquisa quantitativa e retrospectiva que analisou o Banco de Dados SIVEP-gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe), no período de 01/01/2020 a 04/01/2021. Foram incluídas todas as gestantes e puérperas com diagnóstico de SRAG causada por COVID-19 no Estado de Minas Gerais. Após a análise descritiva do perfil das internações, avaliou-se a associação entre diferentes variáveis de exposição e a ocurrência de óbito. Resultados: dos 227 registros obtidos, 94,3% necessitaram de hospitalização. Dentre as internações em Unidade de Terapia Intensiva, 29,8%fizeram uso de suporte ventilatório invasivo. Quinze óbitos foram registrados. As manifestações clínicas mais frequentes foram: tosse e febre; já as comorbidades predominantes foram doença cardiovascular e diabetes mellitus. As variáveis "internação em UTI", "uso de suporte ventilatório" e "cardiopatia" apresentaram associação com ao corrência de óbitos. Conclusão: a hospitalização foi necessária para a maioria das gestantes com SRAG e a presença de cardiopatia prévia aumentou o risco de óbito. Conhecer o perfil de morbimortalidade por SRAG é importante na definição de estratégias de saúde pública que visem à redução dos impactos da COVID-19 na gestação e puerpério.

La incógnita del coronavirus, la gestante, su niño - Continuación / The coronavirus conundrum, the pregnant woman, her child. Part 2

Resumen Cuando apareció la enfermedad por el coronavirus SARS-CoV-2, no esperábamos su rápida expansión en el mundo y las graves consecuencias que traería. Se ha ido conociendo al virus morfológicamente y su accionar en el ambiente y en el organismo del ser humano, su mayor predisposición de enfermar a poblaciones vulnerables, como el adulto mayor, poblaciones con comorbilidad como obesidad, diabetes, hipertensión e inmunodepresión, predilección por el sexo masculino, mayor prevalencia en países con mayor pobreza, promiscuidad, zonas deprimidas económicamente, entre otros. Se ha tenido que improvisar y descartar diversos tratamientos en aquellos pacientes con enfermedad COVID-19 moderada y severa. Eventualmente se está disminuyendo la frecuencia de muertes con medidas de protección personal, distanciamiento social, cuarentena de emergencia, y combinación de medicamentos y administración de oxígeno. Pero aún no hay cura, y se está a la expectativa en la aparición de la vacuna. Con relación a la mujer, ella es comprometida en menor proporción y severidad por la enfermedad COVID-19, pero debe cumplir las medidas de prevención, especialmente si es frágil y tiene comorbilidades. Se ha postergado temporalmente su evaluación preventiva y las intervenciones quirúrgicas si no son de emergencia. En la gestante se está encontrando aumento de prematuridad, gestaciones frustras, lesiones placentarias y presencia del virus en anexos placentarios, con casos de morbilidad severa y muerte maternas. En este artículo se hace una puesta al día resumida sobre la situación de la enfermedad COVID-19 en el mundo y el Perú, enfatizando el cuidado de la mujer y de la gestante.

Abstract When COVID-19 appeared, we did not expect its rapid expansion throughout the world nor the serious consequences it would bring. We currently understand more about the virus' morphology and its activity in the environment and within the human body, as well as its greater predisposition to affect vulnerable populations, such as the elderly and persons with comorbidities like obesity, diabetes, hypertension and immunosuppression. This virus shows a predilection for men, and a higher prevalence in countries with greater poverty, promiscuity and economically depressed areas, among others. Various treatments have been tested and discarded in patients with moderate and severe disease. The frequency of deaths is decreasing due to personal protection measures, social distancing, emergency quarantine, and combination of medications and supplemental oxygen. However, there is still no cure, and we are waiting for the appearance of the vaccine. Women are less frequently and less severely affected; however, they should follow preventive measures, especially if frail with comorbidities. Preventive medical consultations and non-emergency surgical procedures have been temporarily postponed. Pregnant women are experiencing an increase in prematurity, fetal deaths, placental lesions and presence of the virus in placental adnexa, with cases of severe morbidity and maternal death. This article is an update on the situation of COVID-19 in the world and in Peru, emphasizing the care of women and pregnant women.

COVID-19 y embarazo. Revisión y actualización / COVID-19 and pregnancy. Review and update / COVID-19 and pregnancy. Review and update

RESUMEN Objetivo . Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en estos primeros 4 meses de 2020y el embarazo. Metodología . Revisión sistemática en las bases de datos PubMed y Google Scholar, hasta el 25 de abril de 2020. Se buscó artículos publicados relacionados con mujeres embarazadas infectadas con SARS-CoV-2. No hubo restricción de idioma. La búsqueda se extendió a las referencias de los artículos encontrados. Resultados . La enfermedad COVID-19 en mujeres embarazadas se caracteriza porque más del 90% de las pacientes evoluciona en forma leve, 2% requiere ingresar a las unidades de cuidados intensivos. Una muerte materna ha sido reportada. La prematuridad es alrededor de 25%, con predominio de recién nacidos prematuros tardíos; aproximadamente el 9% se complica con rotura prematura de membranas; la mortalidad perinatal es baja o similar a la de la población general y no se ha demostrado la transmisión vertical. Conclusiones . Los ginecólogos obstetras deben prepararse para atender cada vez más casos con COVID-19 y, por lo tanto, es necesario tener su conocimiento. La enfermedad evoluciona de la misma manera que en las no embarazadas, genera mayor prematuridad, no se ha demostrado la transmisión vertical, pero hay altas posibilidades de transmisión horizontal durante el parto vaginal.

ABSTRACT Objective : To search for all the information and available evidence on infection with SARS-CoV-2, a virus that appeared during the first 4 months of 2020, and pregnancy. Methods : Systematic review in PubMed and Google Scholar databases until April 25, 2020. We searched for published articles related to pregnant women infected with SARS-CoV-2. There was no language restriction. The search was extended to the references of the articles found. Results : In pregnant women with COVID-19, more than 90% of patients evolve mildly, 2% require intensive care. One maternal death has been reported. Prematurity occurs in approximately 25% of the cases, with predominance of late preterm infants; premature rupture of membranes presents in about 9%. Perinatal mortality is lower or similar to that of the general population, and vertical transmission has not been shown. Conclusions : Obstetrician-gynecologists must prepare to attend more cases with COVID-19 and therefore they need to know this disease. COVID-19 progresses similarly in pregnant and non-pregnant women, although it is associated to prematurity. While vertical transmission has not been demonstrated, horizontal transmission during vaginal birth is very likely.

Infections in patients with multiple myeloma treated with conventional chemotherapy: a single-center, 10-year experience in Pakistan

ABSTRACT Introduction: Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality. Objective: We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period. Method and results: Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was the lung, followed by the genitourinary system. The most common infections were bacterial, followed by viral. Escherichia coli were the most common organism. In 160 (65.5%) episodes, the organism was not isolated. Thalidomide with dexamethasone was the most common treatment regimen, followed by melphalan with dexamethasone. Infection was the main cause of death in 26 (6.3%) out of all 412 patients. Conclusion: Infections are a notable cause of morbidity and mortality in the clinical course of MM patients. By considering patient and disease characteristics, a risk-adapted selection of the MM treatment should be employed, with special attention toward patient age and disease-associated organ dysfunction. Patient education, access to healthcare and physician vigilance are also essential. Vaccination and antimicrobial prophylaxis may be considered prior to or during therapy.

Peritonitis bacteriana secundaria a diálisis peritoneal / Bacterial peritonitis secondary to peritoneal dialysis

Resumen La diálisis peritoneal es uno de los métodos de reemplazo renal para pacientes con enfermedad renal crónica avanzada. Las infecciones representan la segunda causa de muerte y corresponden a gran morbilidad en este grupo de pacientes. La peritonitis asociada a diálisis peritoneal es una patología prevenible y es la principal complicación de este procedimiento. En la mayoría de ocasiones, la etiología es secundaria a bacterias Gram positivas colonizadoras de la piel, aunque no se puede subestimar la importancia de las bacterias Gram negativas. El diagnóstico se basa tanto en el criterio clínico como microbiológico. El tratamiento corresponde en antibióticos por un periodo de por lo menos dos semanas. Esta revisión de tema permite informar al personal de salud, pacientes y cuidadores sobre esta frecuente complicación con el fin de prevenirla, y en su defecto, un diagnóstico y tratamiento temprano con el fin de reducir la morbimortalidad y las complicaciones de dicho cuadro clínico.

Abstract Peritoneal dialysis is one of the main renal replacement therapies for end-stage renal disease. Infections represent the second leading cause of death and correspond to great morbidity in this group of patients. Peritonitis associated with peritoneal dialysis is a preventable disease, and it is also the main complication of this procedure. Most cases are secondary to Gram-positive bacteria skin colonizers; although the importance of Gram-negative bacteria cannot be underestimated. Diagnosis is based both on clinical and microbiological criteria. Treatment consists on at least a two-week period antibiotic scheme. This topic review allows health care providers, patients and caregivers to be informed about this usual complication in order to prevent it, diagnose it and initiate early treatment with the intention to minimize its morbidity, mortality and complications.

Etiological prevalence of urinary tract infections in symptomatic pregnant women in a high complexity hospital in Medellín, Colombia, 2013-2015 / Prevalencia etiológica de infección del tracto urinario en gestantes sintomáticas, en un hospital de alta complejidad de medellín, colombia, 2013-2015

RESUMEN Objetivo: determinar la prevalencia de infección del tracto urinario (ITU), el perfil microbiológico y la resistencia a los antibióticos en mujeres gestantes con sospecha de infección del tracto urinario. Materiales y métodos: estudio de corte transversal. Ingresaron gestantes con sospecha de infección del tracto urinario adquirida en la comunidad, remitidas a consulta externa desde su control prenatal o atención por urgencias, y hospitalizadas entre agosto de 2013 y septiembre de 2015 en un hospital universitario de referencia ubicado en Medellín, Colombia. Se excluyeron gestantes que hubieran recibido antibióticos el día anterior a la admisión. Muestreo aleatorio simple. Variables medidas: sociodemográficas, clínicas y bacteriológicos. Se aplicó estadística descriptiva. Resultados: la prevalencia de infección del tracto urinario fue del 29 %. Predominaron los aislamientos de bacterias Gram negativas, principalmente E. coli y K. pneumoniae en un 57,7 y 11,4 % respectivamente. Se observó resistencia a trimetoprim-sulfametoxazol en el 19,5 % y ampicilina-sulbactam en el 17,5 % de los aislamientos. Conclusiones: se requieren estudios de base poblacional para una mejor aproximación a la resistencia de las bacterias causantes de la ITU en la comunidad. Por otra parte, la alta resistencia observada podría sugerir que algunos antibióticos expuestos no sean incluidos en las guías locales de manejo de la ITU.

ABSTRACT Objective: To determine the prevalence of urinary tract infections (UTIs), the microbiological profile and antibiotic resistance in pregnant women with suspected urinary tract infection. Materials and methods: Cross-sectional study of pregnant women with suspected community- acquired urinary tract infection referred to the outpatient clinic by prenatal care practitioners or seen in the emergency room, and hospitalized between August 2013 and September 2015 in a referral teaching hospital located in Medellin, Colombia. Pregnant women who had received antibiotics on the day before admission were excluded. Random sampling. Measured variables: sociodemographic, clinical and bacteriological. Descriptive statistics were applied. Results: The prevalence of urinary tract infections was 29%. Gram negative bacteria isolates were found predominantly, the main ones being E. coli and K. pneumoniae at 57.7 and 11.4%, respectively. Resistance to trimethoprim- sulfamethoxazole and to ampicillin-sulbactam was observed in 19.5% and 17.5% of isolates, respectively. Conclusions: Population-based studies are needed to provide a better approach to bacterial resistance in community-acquired UTIs. On the other hand, the high resistance observed may suggest that some of the exposed antibiotics might not be included in the local guidelines for the management of UTIs.

Congenital syphilis in Mexico. Analysis of national and international standards from the perspective of laboratory diagnosis

Introduction: Congenital syphilis continues to be a public health problem in Mexico. Objective: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. Method Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. Results: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. Conclusions: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.

A study on the non-infectious complications of continuous ambulatory peritoneal dialysis

Introduction: Patients with end-stage renal disease (ESRD) are treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).Non-infectious complications of CAPD are increasing in relative importance due to success in decreasing the rate of peritonitis. Aims and objectives: Our aim was to study the non-infectious complications in patients of ESRD on CAPD and to study the impact of the non-infectious complications in the survival of CAPD catheters. Materials and Methods: A prospective study has been conducted at Regional institute of medical science, Imphal in a total of 71patients of ESRD who are already on CAPD or newly diagnosed ESRD who have undergone CAPD catheter implantation. Their detailed history, clinical examination and relevant laboratory investigations were done and the different non-infectious complications were identified and analysed. Result: Out of the 71 patients studied 39 patients had complications like hypokalemia (15 patients), omental wrap (10 patients), catheter tip migration (6 patients), haemoperitonium (2 patients), hydrothorax (2patients), exit site leak(2patients), abdominal wall edema (1patient), catheter block(1patient). Conclusion: In our study the most common non-infectious complication was hypokalemia followed by omental wrap and catheter tip migration. Knowledge about the common prevalent non-infectious complications of CAPD alerts the treating doctor to take up the specific corrective steps at an earlier stage, thus preventing the morbidity associated with the same. We conclude that the majority of non-infectious complications in these patients were treatable and did not interfere with the catheter survival.

Clinical profile of rheumatic patients with infectious complications

Background: The objective of the present research was to study clinical profile of rheumatic patients having infections including correlation of infection with different parameters and DMARDS and to study incidence pattern of various infections.Methods: All patients of various Rheumatic diseases with infections who fulfil inclusion criteria who were enrolled in this study. Duration of study was six months. A total of 300 patients where studied out of which 50 were cases and the rest were control.Results: Incidence of infection was high in extremes of age. Overall incidence of infection was slightly higher in females. Infection rate was 16.66%. Incidence of infection was highest among vasculitis group. Kidney was the most common organ involved. Incidence of infection was more in patients having anemia and leukopenia. Tuberculosis was the most common infection found in Rheumatic patients.Conclusions: Infection was more common at extremes of age and more common in females. SLE was most common disease encountered while kidney was most common organ to get involve in disease process. Patients with anemia and leukopenia had statistically significant incidence of infections. Tuberculosis is most common infection encountered in Indian rheumatic patients.

Reducción de la morbilidad postoperatoria en el cáncer colorrectal programado: inmunonutrición oral preoperatoria / Reduction of postoperative morbidity in programmed colorectal cancer: Preoperative oral immunonutrition

Resumen Objetivo: Valorar la eficacia de la administración preoperatoria de inmunonutrición oral en pacientes con cáncer colorrectal resecable, en términos de reducción de la incidencia de complicaciones infecciosas posquirúrgicas. Material y métodos: Estudio prospectivo y aleatorizado. Se reclutaron 84 pacientes. En el grupo inmunonutrido (SÍ IN) se administró de forma preoperatoria Impact© Oral durante 8 días (3 envases al día), con respecto del grupo no inmunonutrido (NO IN), que únicamente recibió dieta normal, sin suplementos. Resultados: Del total de pacientes, el 40,5% (17) de los NO IN presentaron complicaciones infecciosas frente a un 33,3% (14) de los SÍ IN. En los pacientes con cáncer rectal NO IN, un 50% (8) tuvieron complicaciones infecciosas menores frente a un 13,6% (3) de los SÍ IN, (p = 0,028). En la regresión logística, la variable proteínas totales en el quinto día posquirúrgico (OR: 2,8 [IC 95%: 1,3-6,3], p = 0,012) fue independiente en relación con la aparición de complicaciones infecciosas. Específicamente, la variable fuga anastomótica se comportó como factor de riesgo en el desarrollo de infección de herida, con una OR de 4,5 (IC 95%: 1,3-16,1) (p = 0,033). Discusión: La desnutrición en los pacientes oncológicos susceptibles de cirugía se traduce en un incremento en la morbimortalidad postoperatoria de los mismos. La utilización de fórmulas enterales con inmunonutrientes en estos sujetos puede atenuar dicha morbilidad, a expensas de la disminución de complicaciones infecciosas. Conclusión: En nuestro análisis, los pacientes NO IN presentaron con mayor frecuencia complicaciones infecciosas posquirúrgicas, sobre todo el subgrupo de pacientes con cáncer rectal.

Abstract Purpose: Assess the efficacy of preoperative administration of oral immunonutrition in patients with resectable colorectal cancer, in terms of reducing the incidence of postoperative infectious complications. Material and methods: Prospective randomized study. A total of 84 patients were recruited. To the group YES IN, Impact© Oral was preoperatively administered for 8 days (3 bricks a day), whereas the NOT IN group only received normal diet, without supplements. Results: Of all patients, 40.5% (17) in the NOT IN group suffered infectious complications against 33.3% (14) in the YES IN group. Among patients with rectal cancer in the NOT IN group, 50% (8) suffered minor infectious complications, compared with 13.6% (3) among those in the YES IN group (P = .028). Using logistic regression, the variable total protein on the fifth postoperative day [OR: 2.8 (95% CI: 1.3 to 6.3) (P = .012)] showed a statistically significant relationship with the occurrence of infectious complications. Specifically, anastomotic leak variable behaved as a risk factor in the development of surgical site infection, with an OR of 4.5 (95% CI: 1.3 to 16.1) (P = .033). Discussion: Malnutrition in cancer patients suitable for surgery results in an increase in postoperative morbidity and mortality. The use of enteral formulas with immunonutrients in these subjects can attenuate this morbidity, decreasing infectious complications. Conclusion: In our analysis, the NOT IN group suffered more postoperative infectious complications, particularly the subset of patients with rectal cancer.

Condiloma acuminado y embarazo. Consideraciones en la atención prenatal / Condyloma Acuminatum and pregnancy. Considerations of the prenatal attention

Fundamento: El condiloma acuminata prevalece en la población mundial elevando su incidencia en los últimos años; afectando proporcionalmente a la población gestante. Un número elevado de embarazadas son sometidas a la operación cesárea por esta causa, elevando los riesgos de morbimortalidad perinatal. El conocimiento del modo de trasmisión durante el embarazo, las consecuencias para la descendencia y la conducta a seguir ante las verrugas genitales durante la gestación, pueden contribuir a modificar el manejo de esta enfermedad durante la atención prenatal. Objetivo: Analizar algunas evidencias necesarias para un adecuado seguimiento prenatal en las gestantes que padecen de condiloma verrucoso genital. Desarrollo: Se realizó una revisión bibliográfica exhaustiva y actualizada acerca de las vías de trasmisión de la madre al hijo y la conducta obstétrica en las gestantes afectadas por condilomas acuminados. Conclusiones: Las evidencias científicas que se sintetizan en la revisión nos muestran que la condilomatosis genital durante el embarazo puede ser trasmitida de la madre al hijo por diferentes vías; no evitando la cesárea electiva la infección viral al recién nacido. Diversos tratamientos aplicados de forma adecuada durante la atención prenatal pueden disminuir este riesgo.

Background: The Condyloma acuminatun prevails in the world population increasing its incidence in the last few years and affecting proportionally to the population in the gestation period. A high number of pregnant women are submissive to a caesarean operation for this cause, increasing the risk of perinatal morbimortality. The knowledge of the way of transmission during the pregnancy, the consequences for the descent and the conduct to follow in the presence of genitals wart during the gestation, can contribute to modify the management of this disease during the prenatal attention. Objective: Analyze some evidences needed for an adequate prenatal pursuit in women that suffer condyloma acuminatum in the gestation period. Development: An exhausted and actual bibliography study was done about the way of transmission from the mother to her child and the obstetric conduct in women in the gestation period affected by the condyloma acuminatum. Conclusions: The scientific evidence summarized in the study showed us that genital condylomatosis during pregnancy can be transmitted from the mother to her child by different ways, not only avoiding the elected caesarean operation the viral infection to the newborn. Different treatments applied correctly during the prenatal attention can decrease this risk.

The correlation between infectious complications after radical resection of gastric cancer and the changes of T lymphocyte subsets in the patients with gastric cancer / 实用肿瘤学杂志

Objective Our retrospective study is aimed to discuss the relationship between the curve changes of T lymphocyte subsets before and after the operation and the infectious complications after radical resec -tion of gastric cancer .Methods Clinical data of patients with gastric cancer received treatment at Central Hospi -tal of Panjin City,Liaoning Province from 2012 to 2014 were retrospectively analyzed .The enrolled patients were divided into two groups according to the infectious complications ,observe group ( patients with infectious complica-tions) and control group ( patients without infectious complications ) .The results of T lymphocyte subsets in two groups were compared .Results A total of 70 patients was retrospective analyzed , including 33 pationts in ob-serve group and 37 pationts in control group.At the 4th day after operation,the levels of CD3,CD4 in the observe group were obviously lower than those in control group .There was no statistical difference at the other time points . At the 4th and 9th day after operation,the levels of CD8,CD4/CD8 rate in the observe group were obviously lower than those in control group .There was no statistical difference at the other time points .Conclusion There is re-markable relationship between the curve changes of T lymphocyte subsets before or after the operation and the in -cidence of infectious complications after radical resection of gastric cancer .

Complicaciones infecciosas de la diálisis peritoneal ambulatoria en niños / Ambulatory peritoneal dialysis-related infectious complications in children

Introducción: la diálisis peritoneal es la mejor alternativa terapéutica para los niños con enfermedad renal crónica terminal, y en las modalidades de diálisis peritoneal ambulatoria ha permitido el tratamiento fuera del hospital, lo que proporciona un mejor estilo y calidad de vida. No es un método exento de riesgos. Las complicaciones infecciosas relacionadas a la diálisis peritoneal son la causa más importante de morbilidad y es la peritonitis su principal complicación. Objetivo: determinar retrospectivamente la frecuencia y las características de complicaciones infecciosas relacionadas al proceder dialítico. Métodos: nuestro hospital es referente como unidad de diálisis pediátrica del país, así que recibe la mayoría de los niños con enfermedad renal crónica terminal de Cuba. Se revisaron los expedientes clínicos de niños con enfermedad renal crónica terminal en programa de diálisis peritoneal ambulatoria en el Hospital Pediátrico de Centro Habana durante el período 2008-2011. Resultados: se estudiaron 12 pacientes con un promedio de edad de 11 años, 58 por ciento del sexo femenino. Se documentaron 24 episodios infecciosos. Las complicaciones encontradas fueron infección del sitio de salida del catéter, con 62,5 por ciento, peritonitis 33,3 por ciento e infección del túnel submucoso 4,2 por ciento. Predominaron cultivos positivos a bacterias grampositivas (66,7 por ciento). Las bacterias más comunes fueron: Staphylococcus coagulasa positivo (48 por ciento) y Staphylococcus coagulasa negativo (22 por ciento). Otros gérmenes identificados fueron E. coli, Enterobacter spp. y Candida spp., con 8,3 por ciento respectivamente. Conclusiones: la infección del sitio de salida del catéter fue la complicación infecciosa más frecuente en nuestra serie. Las bacterias grampositivas son los gérmenes más comunes que causan infección del sitio de salida y peritonitis en pacientes en diálisis peritoneal ambulatoria

Introduction: peritoneal analysis is the best therapeutic alternative for children suffering terminal chronic renal disease and it has allowed, in the ambulatory peritoneal dialysis variant, providing out of hospital treatment to improve life style and quality. It is not risk-free method since the peritoneal dialysis-related infectious complications are the most important cause of morbidity, being peritonitis the main one. Objective: to retrospectively determine the frequency and the characteristics of dialysis-related infectious complications. Methods: our hospital is a point of reference in the country as pediatric dialysis unit where most of children with terminal chronic renal disease in Cuba are referred to. The medical histories of children with this type of disease, who were included in the ambulatory peritoneal dialysis program of Centro Habana pediatric hospital for the 2008-2011 period, were checked over. Results: twelve patients aged 11 years as average were studied. Fifty eight percent were girls. Twenty four infectious events were documented. The most frequent complications were infection at the outlet site of the catheter (62.5 percent), peritonitis (33.3 percent) and submucous tunnel infection (4.2 percent). Positive cultures to Grampositive bacteria (66.7 percent) were predominant. The most common bacteria were positive Staphylococcus coagulase (48 percent) and negative Staphylococcus coagulase (22 percent). Other germs were E E. coli, Enterobacter spp. and Candida spp, with 8.3 percent, respectively. Conclusions: the most frequent complication was infection at the outlet site of the catheter in our sample. The most common germs were Grampositive bacteria that cause this type of infection and peritonitis in patients under ambulatory peritoneal dialysis treatment

Effect of early enteral nutrition combined with synbiotics agents on normal intestinal flora and SIgA in patients with hypertensive intracerebral hemorrhage / 中华临床营养杂志

Objective To investigate the effect of early enteral nutrition combined with synbiotics agents on normal intestinal flora,fecal SIgA and infectious complications in patients with hypertensive intracerebral hemorrhage.Methods Fifty-three patients with hypertensive intracerebral hemorrhage were randomly divided into early enteral nutrition group (control group,n =26) and early enteral nutrition combined with synbiotics group (study group,n =27).The patients in control group started receiving enteral nutrition (RuiSu) within 24 to 48 hours after injury ; Patients in study group received a enteral nutritional support which as well as control group,but added synbiotics (Golden Bifid) in the first 14 days of enteral nutritional support.Stool specimens were Collected on day 0,day 4,day 8,day 15 of enteral nutrition support for quantitative analysis of normal intestinal flora and detection of stool SIgA through enzyme-linked immunosorbent assay.The difference of two groups in infectious complications were observed.Results On nutritional support day 8 and day 15,escherichia coli (P =0.004,P =0.004) and enterococci (P =0.032,P =0.048) expression were lower in study group than the control group,bifidobacteria (P =0.046,P =0.024) expression were higher in study group than the control group.During the study period lactobacillus,bacteroides and clostridium were no statistically significant between the two groups (P ＞ 0.05).Fecal SIgA expression in study group was higher than control group (P =0.035) on nutritional support dayl5.The incidence of infectious complications in study group was lower than the control group (33.33％ vs.46.15％),but there was no significant difference (P =0.230).Conclusion compared with ordinary enteral nutrition,enteral nutrition combined with synbiotics agents can be effective in improving intestinal flora imbalance and increase intestinal immune function in patients with hypertensive intracerebral hemorrhage.

Complicaciones infecciosas en el período inmediato precoz postrasplante de progenitores hematopoyéticos / Infectious complications in the immediate early post-transplantation of hematopoietic stem cells

Se realizó un estudio retrospectivo-descriptivo en el Servicio de Hematología del Hospital Clinicoquirúrgico Hermanos Ameijeiras desde enero de 1985 hasta diciembre de 2008, para determinar las complicaciones infecciosas en pacientes sometidos a trasplante de progenitores hematopoyéticos en el período precoz postrasplante (0-30 d). De los 179 trasplantes realizados, 127 fueron autólogos, 45 alogénicos y 7 mini-trasplantes. Las principales indicaciones fueron linfomas no Hodgkin, en 54 pacientes (30,2 por ciento), leucemias agudas no linfoblásticas, en 53 (29,6 por ciento) y linfomas de Hodgkin, en 26 (14, 5 por ciento). El esquema de acondicionamiento usado mayoritariamente fue ciclofosfamida, con etopósido o sin Úl, + irradiación corporal total. Se detectaron complicaciones infecciosas en 176 de los trasplantes realizados (98,3 por ciento), su aparición fue entre los días 4 y 7 después del trasplante y se relacionó con un conteo promedio de leucocitos menor de 500 x 10(9) /L y un conteo absoluto de neutrófilos menor de 100 x mm³. La forma clínica de presentación más frecuente fue la bacteriemia seguida de infecciones de piel y mucosas. Los gérmenes aislados con mayor frecuencia fueron el estafilococo coagulasa negativo, el género Candida y la Pseudomona aeruginosa. La antibioticoterapia empírica utilizada fue cefalosporina de tercera generación + aminoglucósido + vancomicina. La mortalidad general fue 8,9 por ciento (16/179), la sepsis fue la causa directa del fallecimiento en 7 casos (43,7 por ciento) con mayor incidencia en los trasplantes alogénicos, y las bacterias gramnegativas, las mayormente implicadas

A retrospective and descriptive study was carried out in the hematological service of Hermanos Ameijeiras clinical and surgical hospital from January 1985 to December 2008, in order to determine the infectious complications found in patients with hematopoietic stem cell transplants in the early post-transplantation period (0 to 30 days). Out of 179 transplants, 127 were autologous, 45 allogenic and 7 mini-transplants. The main indications for transplantation were non-Hodgking's lymphomas in 54 patients (30.2 percent), acute non-lymphoblastic leukemia in 53 (29.6 percent) and Hodgkin's lymphomas in 26 patients (14.5 percent). The mostly used conditioning schedule was cyclophosphamide with/without etoposide plus total body irradiation. One hundred seventy six transplants (98.3 percent) presented with infectious diseases; they occurred on the 4th through the 7th days after the transplantation and were related to average leukocyte count below 500 x 10(9)/L and absolute neutrophil count lower than 100 x mm³. The most frequent clinical presentation was bacteremia followed by skin and mucosal infections. The most commonly isolated germs were negative coagulase staphylococci, Candida genus and Pseudomona aeruginosa. The empirical antibiotic therapy was third generation cephalosporine plus aminoglucoside plus vancomycin. The general mortality rate was 8.9 percent (16 out of 179) and sepsis directly caused the death of 7 cases (43.7 percent), being the higher incidence in allogenic transplants, and the Gram negative bacteria were mostly involved