Características clínicas y microbiológicas de pacientes con neutropenia febril en un hospital Universitario / Clinical and microbiological characteristics of patients with febrile neutropenia in one Colombian Universitary Hospital

Objetivo: Describir las características clínicas, demográficas, frecuencia, tipo de aislamientos microbiológicos y resistencia a los antimicrobianos de pacientes con neoplasias hematológicas que presentaron como complicación neutropenia febril en el Hospital Universitario de San Ignacio Métodos: Estudio descriptivo observacional, se tomaron datos de historias clínicas de los pacientes adultos hospitalizados en la Unidad de Hematología y Trasplante de Médula Ósea, que cumplieron criterios de neutropenia febril entre enero de 2013 y diciembre de 2014 Resultados: se recolectaron 345 episodios de neutropenia febril, correspondientes a 193 pacientes. Se documentó foco infeccioso en el 68,1% de los episodios, con aislamiento microbiológico en el 62.9% de los episodios, con predominio de bacilos gram negativos, en 63,7% de los casos, seguido por los cocos gram positivos en 27,9% y hongos en 4,9%. En cuanto a los mecanismos de resistencia, en los aislamientos Escherichia coli y Klebsiella peumoniae se encontró producción de Beta Lactamasas de Espectro Extendido (BLEEs) en 17,5 y 13,8%; Carbapenemasas tipo KPC en 1,25 y 2,8% respectivamente. En cuanto a Staphylococcus aureus, se encontró resistencia a meticilina en 6,8% de los aislamientos. Mortalidad asociada a infección en 16,5% de los casos. Conclusión: En pacientes con Neoplasias Hematológicas con neutropenia febril post quimioterapia en el Hospital Universitario de San Ignacio encontramos alta probabilidad de documentación de foco infeccioso, con predominio de microorganismos gram negativos, especialmente enterobacterias; con comportamiento similar en pacientes post trasplante de precursores hematopoyéticos.

Objective: To describe the demographic and clinical characteristics, as well as frequency and type of bacterial isolate and resistance patterns in patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital Methods: This is a retrospective observational study. Data were collected from medical records of adult patients admitted in the Hemato-oncology and Bone Marrow Transplant Unit. Inclusion criteria was presence of febrile neutropenia in the setting of a hematological neoplasm from January 2013 to December 2014. Results: 345 episodes of febrile neutropenia from 193 patients were studied. An infectious focus was identified in 68.1% of episodes, and a bacterial isolate was obtained in 62.9% of episodes. The predominant microorganisms were gram-negative rods, gram-positive cocci, and fungi with a frequency of 63.7%, 27.9%, and 4.9% respectively. In term of resistance patterns, Escherichia coli and Klebsiella peumoniae isolates had a frequency of ESBL susceptibility pattern of 17.5% and 13.8% respectively; and a frequency of KPC susceptibility pattern of 1.25% and 2.8% respectively. The frequency of methicillin resistant Staphylococcus aureus was 6.8%. Death associated to infection ocurred in 16.5% of episodes. Conclusions: In patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital, we found a high rate of documentation of infectious focus, with a predominance of gram-negative rods, specially Enterobacteriacea; with a similar pattern in receptors of hematopoietic stem cell transplantation.

Left ventricular assist device (LVAD) program in Chile: first successful experience in South America.

BACKGROUND: The need to have a variety of tools to deal with end-stage heart failure (ES-HF), along with the limited heart transplantation availability encouraged us to create a pilot Left ventricular assist device (LVAD) program in a public health care system hospital in Chile. METHODS: A retrospective analysis of the first nine patients of an ongoing LVAD program initiated on August 2013 was performed, completing an average of 30 months of follow-up. The most important events regarding to morbidity and mortality are described. RESULTS: Nine patients with ES-HF underwent LVAD implantation surgery; one of them died 23 days after surgery and another died after 11 months. One patient successfully underwent heart transplantation after 16 months of HeartWare ventricular assist device (HVAD) support; the other six patients remain in the program and have an average follow-up of 846 days at the time of this study (range, 23-1,481 days). The survival rate at 6, 12 and 18 months follow-up was 89%, 78% and 78% respectively. CONCLUSIONS: This new pioneering LVAD program in Chile has been successful and now constitutes a vital adjunct to all who work in heart transplantation and ES-HF programs. It offers an effective therapeutic alternative when there is a severe donor shortage, in cases of atypical blood types, emergencies, exceptional cases with contraindication for heart transplantation or when there is important donor-receiver size mismatch.

Fiebre tifoidea en Chile 1977-1990: una enfermedad emergente / Typhoid fever in Chile 1977-1990: an emergent disease

The emergence of old and new communicable diseases is becoming an importanty public health problem in industrialized and developing countries worldwide. Chile experienced at the end of the seventies and during the eighties, epidemics of several emergent communicable infectious diseases whose relevance as public health problems had steadily decreased in the previous 25 years. The most strinking of these epidemics was a severe outbreak of typhoid fever that lasted at least 10 years. The majority of the cases ocurred in the urban setting of Santiago. Several investigators suggested, in light of apparently good sanitation statistics, that factors responsible for this outbreak of typhoid were an increase in the number of chronic carriers of salmonella typhi, the lack of microbiological food controls and the consumption of vegetables irrigated with waste water contaminated with S typhi. However, there is a dearth of epidemiological information and field work confirming the role of these factors in this typhoid outbreak. Moreover, the sudden, massive and urban characteristics of this epidemic, coupled to contemporary information regarding shortcoming on the preparation of drinking water and on decreased availability of drinking water to the population in Santiago regardless of good sanitation statistics, suggest that this outbreak may have been partially waterborne. The beginning of this typhoid outbreak also coincided with increased rain fall, with rapidly deteriorating economic and social conditions manifested in high rates of unemployment, and with decreased government investment on social services, including sanitation and health. Al these factors are known to influence the epidemiology of typhoid and other emergent diseases worldwide

Enfermedades emergentes: antiguas y nuevas enfermedades: aspectos ecológicos, climáticos e influencias culturales y socioeconómicas / Emergent diseases: old and new diseases: ecological and climatic aspects and cultural and socioeconomical influences

During recent years the world has experienced the reemergence of old communicable diseases and the emergence of new ones caused by novel pathogens such as the HIV virus and Borrelia burgdorfei. The problem consists mostly in the reemergence of old diseases but specially in industrialized countries new pathogens have also been described. Although the emergence of these infections in rare instances is due to genetic changes of pathogens to more virulent forms, most commonly they are due to changes in the environment and the host. Rapidly deteriorating living standards, desintegration of sanitation and public health infrastructure, cultural changes, migration and variations in behavior are some of the factors involved in the worldwide increase of infectious diseases. The degradation of natural habitats including forests and marine niches accompanied by climatic changes, are also playing an increasing role in the detrimental evolution of these diseases. The global emergence of these diseases calls into question the doctrine of epidemiological transition and directs us to scrutunize the paradigm that bases the prevention of this diseases solely vaccination. The current situation also highlights the limitations of classical epidemiology in dealing with unexpected problems and strongly suggests that this discipline should incorporate into its analysis findings from other fields, including ecological, climatological and economical information. As most of the negative social and economical developments that impinge on the detrimental evolution of these diseases are increasing world-wide, it can be predicted that the problems posed by these infections will continue and perhaps worsen in the near future

Tratamiento conservador (no quirúrgico) de la ruptura hepática del recién nacido: importancia de la correción de los trastornos de la coagulación sanguínea / Conservative (non surgical) treatment of liver rupture in the newborn: the significance of correcting blood coagulation disorders

En 18 recién nacidos con ruptura hepática, de los cuales 15 tuvieron hemoperitoneo y la mayoría, manifestaciones hemorrágicas en otras localizaciones, se estudió el tiempo de protrombina (TP), los factores de la coagulación sanguínea, o ambos, y se encontró una alteración de los mismos pacientes. Todos los niños con esta afección recibieron inicialmente transfusión de sangre y vitamina k: Cuatro se operaron, después que a 3 de ellos se les había realizado una exanguinotransfusión (EST), falleciendo dos. Once pacientes recibieron EST y no se operaron; fallecieron dos; uno por una hemorragia intraventricular y otro en el acto de la EST. Otros 3 enfermos sólo recibieron transfusiones de sangre y evolucionaron bien. La EST elevó significativamente la hemoglobina y la concentración de protrombina, así como disminuyó las hemorragias. Los resultados fueron mejores en los pacientes tratados conservadoramente; la complicación encontrada con más frecuencia fue la hiperbilirrubinemia (5/14)(AU)

Hipertensión portal en la infancia: análisis de 15 casos / Portal hypertension in childhood: analysis of 15 cases

La hipertensión portal se una entidad que se observa con relativa frecuencia en pediatría y que requiere un manejo muy juicioso. La variedad prehepática representa aproximadamente dos terceras partes de los casos y tiene un pronóstico muy favorable, ya que habitualmente el higado es normal......(AU)

Tumores pulmonares en la infancia: presentación de dos casos / Pulmonary tumors in childhood: presentation of two cases

La incidencia de los tumores pulmonares en la infancia es baja, pero es necesario pensar en esta entidad, ya que si el diagnóstico es precoz y el tratamiento adecuado, el pronóstico es habitualmente favorable. Sus síntomas fundamentales son: tos crónica, esputos hemoptoicos e infecciones respiratorias bajas a repetición. Con frecuencia presentan localización endobronquial, debiendo sospechar su posibilidad frente a un bloque neumónico o atelectástico, aocmpañado de poca reacción general y de resolución lenta. Se pueden confundir con: neumonías bacterianas, cuerpos extraños endobronquiales o tuberculosis pulmonar. La broncoscopia y la broncografía son elementos de gran ayuda para establecer el diagnóstico positivo. La cirugía broncopulmonar conservadora está indicada en el tratamiento de muchos de estos tumores, entre ellos el adenoma bronquial y el liomiosarcoma bien diferenciado. Se presentan dos casos tratados mediante cirugía broncopulmonar conservadora(AU)

Tumores de la celda parotidea en el niño

Presentamos una gran variedad de afecciones encontradas en la región parotídea en una serie de 15 casos...(AU)