Impact of an Antimicrobial Stewardship Strategy on Surgical Hospital Discharge: Improving Antibiotic Prescription in the Transition of Care.

Antimicrobial stewardship programs (AMSPs) are essential elements in reducing the unnecessary overprescription of antibiotics. Most of the actions of these programs have focused on actions during acute hospitalization. However, most prescriptions occur after hospital discharge, which represents a necessary and real opportunity for improvement in these programs. We present an AMSP multifaceted strategy implemented in a surgical department which was carried out by a multidisciplinary team to verify its reliability and effectiveness. Over a 1-year post-implementation period, compared to the pre-intervention period, a significant reduction of around 60% in antibiotic exposure occurred, with lower economic cost and greater safety.

Factores de riesgo y protección de conducta suicida en adolescentes: encuesta en primer nivel público (diciembre 2016 - setiembre 2017) / Risk and protective factors of suicidal behavior in adolescents: first public primary care survey (december 2016 - september 2017) / Fatores de risco e proteção para comportamento suicida em adolescentes: inquérito em primeiro nível público de saúde (dezembro 2016 - setembro 2017)

Introducción: el intento de autoeliminación (IAE) y el suicidio han aumentado en adolescentes, es un problema de alta prioridad. Objetivo: establecer la epidemiología y su relación con factores de riesgo (FR) y protección (FP) de conducta suicida en usuarios de un Espacio Adolescente en el primer nivel de atención del subsector público (diciembre 2016-setiembre 2017). Material y método: encuesta anónima a adolescentes de ambos sexos, entre 12 y 19 años. Se compararon FR y FP entre: franjas etarias (12 a 14 años y 15 a 19 años); sexo; IAE previo versus su ausencia e institucionalización o no. Se consideró p menor a 0,05 como estadísticamente significativa. Los datos se ingresaron en Excel y se analizaron con Epi Info 7.2.0.1. Resultados: 107 entrevistados, 60 mujeres, edad: 13,3 (media); IAE previo más frecuente entre 15 y 19 años y sexo femenino (p 95%). FP p 95%: actividad recreativa, autoestima elevada, y buena resolución de problemas. FR p 95%: maltrato, abuso sexual, muerte de ser querido, consumo de sustancias y enfermedad psiquiátrica. Comparando edades, FP: familia unida, proyectos y amigos (p 95%); FR: consumo de sustancias, enfermedad psiquiátrica, maltrato, abuso sexual, familiar con enfermedad psiquiátrica, muerte de ser querido, trastorno del sueño, institucionalización, ideación y planificación suicidas (p 95%). Al comparar sexos, no se encontraron FP p 95% FR. Conclusiones: se deben estimular actividades recreativas en adolescentes y ofrecer asistencia en salud mental a aquellos que presentan FR de conducta suicida.

Introduction: self-harm (SH) and suicide have increased in adolescents, and they have become a high health priority. Objective: to establish the epidemiology and its relationship with risk factors (RF) and protection (PF) of suicidal behavior in users of a Primary Care Adolescent Center of the State Health Sector (December 2016 - September 2017). Materials and methods: confidential survey of adolescents of both sexes, between 12 and 19 years of age. We carried out a descriptive analysis in order to compare RF and PF between ages (12 to 14 and 15 to 19); sex; previous SH self-harm versus its absence and institutionalization or not. p less than 0.05 was considered statistically significant. Data were entered into Excel and analyzed using Epi Info 7.2.0.1. Results: 107 interviewees, 60 females, age: 13.3 (mean); Most frequent previous SH between 15 and 19 years and female sex (p 95%). PF p 95 %: recreational activity, high self-esteem, and good problem-solving skills. RF p 95 %: child abuse, sexual abuse, death of a loved one, substance use and mental illness. Comparing ages, PF: close family, projects and friends (p 95%); RF: substance use, mental illness, child abuse, sexual abuse, family with mental illness, death of loved one, sleep disorder, institutionalization, suicidal ideation and suicidal planning (p 95%). When comparing sexes, PF were not found p 95% as RF. Conclusions: recreational activities should be encouraged in adolescents and Mental Health assistance should be provided to those who present RF of suicidal behavior.

Introdução: tentativa de suicídio e suicídio tem aumentado na adolescência, adquirindo alta prioridade. Objetivo: estabelecer a epidemiologia e sua relação com fatores de risco (FR) e proteção (FP) de comportamento suicida em usuários do chamado "Espaço Adolescente" no Primeiro Nível de Atenção no Subsetor Público do Sistema de Saúde (dezembro 2016-setembro 2017). Materiais e métodos: inquérito anônimo aos adolescentes de ambos os sexos, entre 12 e 19 anos de idade. Foram comparados FR e FP entre: grupos de idades (12 a 14 e 15 a 19); sexo; tentativa de suicídio anterior versus sua ausência e institucionalização ou não. Considerou-se p menor a 0,05 como estatisticamente significativa. Os dados foram processados no programa Excel e utilizando-se o programa Epi Info 7.2.0.1. Resultados: 107 entrevistados, 60 do sexo feminino, idade: 13,3 (média); antecedentes de tentativa de suicídio mais frequentes entre 15 e 19 anos e sexo feminino (p 95%). FP p 95%: atividade recreativa, autoestima elevada, e boas habilidades de resolução de problemas. FR p 95%: maltrato, abuso sexual, perda de pessoa querida, consumo de substâncias e doença psiquiátrica. Comparadas as idades, FP: família unida, projetos e amigos (p 95%); FR: consumo de substâncias, doença psiquiátrica, maltrato, abuso sexual, familiar com doença psiquiátrica, perda de pessoa querida, transtorno do sono, institucionalização, ideação suicida e planejamento suicida (p 95%). Comparados ambos os sexos, não se encontraram FP p 95% FR. Conclusões: atividades recreativas devem ser estimuladas nos casos de adolescentes e assistência à Saúde Mental deve ser fornecida aos portadores de FR suicida.

Análisis del ejercicio físico en la Insuficiencia Cardíaca / Analysis of physical exercise in Heart Failure

La rehabilitación cardiaca (RC) ha demostrado ser una intervención eficaz y segura para mejorar el pronóstico de los pacientes con insuficiencia cardiaca (IC). Sin embargo, existen dudas sobre cuál es el mejor método de entrenamiento en estos pacientes. Actualmente, el más recomendado es el entrenamiento aeróbico continuo de intensidad moderada (MICT). En este trabajo se compara este tipo de entrenamiento con el entrenamiento de alta intensidad basado en intervalos (HIIT). La variable de estudio principal es la capacidad física, medida con el Vo2max. Además, también se valoran la función cardiaca y la calidad de vida relacionada con la salud. Se obtiene una ligera mejoría con HIIT, pero ambos métodos son eficaces y válidos, por lo que lo más importante será la individualización en función de las características, contexto y preferencias de cada paciente. Por otro lado, también se compara el entrenamiento basado en MICT en solitario con el entrenamiento concurrente, es decir, la combinación de MICT y entrenamiento de fuerza (EF), obteniendo conclusiones favorables para el segundo grupo. De esta manera, el EF no sustituye al entrenamiento aeróbico, pero si es fundamental para complementarlo ya que las adaptaciones son diferentes y el aumento de la fuerza y masa muscular en pacientes con IC es altamente beneficioso.(AU)

Cardiac rehabilitation (CR) has proven to be an effective and safe intervention to improve the prognosis of patients with heart failure (HF). However, there are doubts as to which is the best training method in these patients. Currently, the most recommended is the continuous moderate intensity aerobic training (MICT). In this work, this type of training is compared with high intensity interval training (HIIT). The study variableThe main one is physical capacity, measured with the Vo2max. In addition, heart function and health-related quality of life are also assessed. A slight improvement is obtained with HIIT, but both methods are effective and valid, so the most important thing will be individualization based on the characteristics, context and preferences of each patient. On the other hand, training based on MICT alone is also compared with concurrent training, that is, the combination of MICT and resistance training (PE), obtaining favorable conclusions for the second group. In this way, PE is not a substitute for aerobic training, but it is essential to complement it since the adaptations are different and the increase in strength and muscle mass in patients with HF is highly beneficial.(AU)

A thermodynamic study of F108 and F127 block copolymer interactions with liposomes at physiological temperature.

The interactions of egg yolk phosphatidylcholine liposomes with F108 and F127 triblock copolymers, in the monomer state, were analyzed by isothermal titration calorimetry (ITC) at 37 °C. According to the results, the critical micelle concentration was determined to be 0.4 and 0.04 wt.% for F108 and F127, respectively, by surface tension at 37 °C. According to the results, liposomes/poloxamers were not favoured energetically, since endothermic interactions were observed. However, positive changes in entropy promoted a spontaneous process. F127 had a greater partition coefficient (51.97 ± 1.77 × 104), stronger affinity, than F108 (8.19 ± 0.37 × 104) towards the vesicle lipid bilayer due to its larger hydrophobic block. After the ITC experiments, an increased vesicle size (within about 1-3 nm average) by dynamic light scattering and the formation of bilayer discs by electron microscopy (EM) was observed at low copolymer concentrations (0.57 mol% of F108 and 1.01 mol% of F127). The EM and ITC results confirmed the intimate association of the copolymers with the membrane instead of being simply absorbed onto the bilayer surface. Our results indicate that the temperature of the system (37 °C), the copolymer concentration and hydrophobic chain length are important factors for the interaction of poloxamers with lipid bilayers and the stability of liposomes.

Amiloidosis pulmonar: un desafío diagnóstico / Pulmonary amyloidosis: A diagnostic challenge

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Fractional crystallization of oil droplets in O/W emulsions dispersed by Synperonic F127.

The aim of this works is to study an oil-in-water emulsion stabilized with a triblock copolymer Synperonic F127 which presents a double size distribution of oil droplets. The emulsions were studied experimentally by means of differential scanning calorimetry (DSC) and dynamic light scattering (DLS). The DSC analysis was carried out focusing on the cooling behavior of the emulsion. The cooling thermograms of the oil-in-water emulsion revealed two crystallization peaks with Gaussian profile; the interesting characteristic is that both peaks are separated in temperature. In accordance to previous works for a single oil dispersed within an aqueous phase, the DSC technique must show a single Gaussian peak of crystallization attributable to a size distribution of droplets. In the present case of emulsions stabilized with 1 g/L of Synperonic F127, the aggregation behavior of triblock as a function of temperature allows to produce an emulsion with a double size droplet distribution. Comparison with emulsions stabilized with 2 and 4 wt% of non-ionic Tween 20 are also presented.

Dolor abdominal persistente / Persistent abdominal pain

El dolor abdominal es un motivo frecuente de consulta en atención primaria y urgencias, y constituye el síntoma más común en patología digestiva. La invaginación intestinal consiste en la introducción de una porción de intestino en otro distal y constituye una causa poco habitual de dolor abdominal en adultos, no obstante supone la causa mas frecuente de obstrucción intestinal en lactantes y niños menores de 5 años. Se presenta el caso de una mujer de 14 años con dolor abdominal persistente por invaginación intestinal(AU)

Abdominal pain is a frequent complain in primary care and emergency departments, and is the most common symptom in gastrointestinal disorders. Intussusception occurs when a segment of bowel invaginates into the distal bowel and it is not a common cause of abdominal pain in adults, however, it is the most common cause of intestinal obstruction in infants and children under 5 years. We report a case of a fourteen year old girl with persistent abdominal pain due to intussusception(AU)

Corea inducida por Antiparkinsonianos / Chorea induced by Parkinson’s disease treatment

La corea constituye un trastorno del movimiento hipercinético caracterizado por movimientos breves, irregulares, rápidos e impredecibles, que cambian de una parte corporal a otra. Puede ser hereditaria, siendo la Enfermedad de Huntington su principal causa, o adquirida, donde los fármacos representan su origen más común en la práctica clínica. La levodopa puede originar corea como una complicación del tratamiento prolongado en pacientes con Enfermedad de Parkinson. Su tratamiento precisa disminución de dosis y control sintomático en función de la intensidad y repercusión funcional de la corea (AU)

Chorea is a hyperkinetic movement disorder characterized by brief movements, irregular, rapid and unpredictable changing of a body part to another. It may be hereditary, being Huntington’s disease the main cause, or acquired, where drugs represent the most common cause in clinical practice. Levodopa may cause chorea as a complication of prolonged treatment in patients with Parkinson’s disease. Its treatment required dose reduction and symptom control in function of the intensity and functional impact of chorea (AU)

Cervicotomía lateral como abordaje selectivo del tiroides / Lateral cervicotomy as selective thyroid access

Introducción. Los objetivos de este trabajo son exponer los resultados de la utilización de la incisión de cervicotomía lateral como vía de abordaje selectiva a un lóbulo tiroideo para la realización de hemitiroidectomías. Métodos. Durante 2 años seleccionamos de forma prospectiva 66 pacientes con lesiones unilobares tiroideas para la realización de hemitiroidectomía a través de una vía de acceso lateral. Se descartó la patología contralateral, mediante ecografía, así como la malignidad por la PAAF. La incisión se practica en el hueco supraclavicular, verticalizándola por detrás del borde interno del músculo esternomastoideo si sobrepasa los 4 cm. Se han determinado tiempos operatorios, y resultados cosméticos según una encuesta de grado de satisfacción. Resultados. Entre las 66 intervenciones por esta vía, la edad media fue de 45 años (23-76); la distribución por sexos, de 55 mujeres y 11 varones; lado: 36 derecho y 30 izquierdo; lesiones: 10 multinodulares y 56 uninodulares (tamaño de los nódulos, 1,8-8 cm); función tiroidea: 54 normofuncionales y 12 tóxicos o pretóxicos. Conclusiones. La cervicotomía lateral puede constituir una alternativa a la incisión de Kocher para la realización de hemitiroidectomías, con resultados cosméticos satisfactorios y gestos quirúrgicos similares.Su gran ventaja es la nula manipulación del área cervical correspondiente al lóbulo tiroideo sano y la ausencia de colgajos (AU)