[Effect on the time of admission to the Intensive Care Unit of the start-up of an Critical Care Outreach Team]. / Efecto sobre el momento del ingreso en la unidad de cuidados intensivos de la puesta en marcha de un servicio extendido de medicina intensiva.

INTRODUCTION: The implementation of the Critical Care Outreach Teams can influence the time of admission of patients to the Intensive Care Unit (ICU). MATERIAL AND METHODS: Retrospective, descriptive, quasi-experimental "before-after" cohort study. All patients admitted to the unit urgently from Monday to Friday for two periods (between February 1, 2022 and June 30 and between February 1, 2023 and June 30, 2023) are included. The patients were divided into regular shift admissions (08-15h) and on-call (15-08h). The secondary objective was to assess whether there were differences in mortality between the two periods. RESULTS: During the first period of the study, 239 patients were admitted. 29.29% entered the ordinary shift and 70.71% on duty shift. During the second period, 211 patients were included with 43.13% of admissions in the ordinary shift. The comparison between the two periods observed a significant increase in the percentage of admissions in the morning hours in the second period (P=.0031). Mortality in the first period was 13.80% and in the second period 9.95%. The comparison between the two periods did not reveal significant differences. CONCLUSIONS: The start-up of the Critical Care Outreach Teams is associated with an increase in the proportion of ICU admissions in the morning period without any observed changes in mortality.

Colgajo en cometa como tratamiento de secuelas de quemadura en pulgar / Kite flap for correction of thumb deformities after burn

Introducción. Múltiples técnicas han sido descriptas para la reconstitutición de la función del pulgar quemado, aunque sin relación costo-beneficio. El colgajo en cometa, descripto por Foucher en 1979, aporta cobertura cutánea, sensibilidad y permite mejoría funcional. El objetivo de este trabajo es presentar nuestra experiencia y resultados utilizando el kite flap. Materiales y métodos. Se realiza un estudio restrospectivo, descriptivo, de 4 casos de secuelas de quemaduras en pulgar de la mano atendidas en el Servicio de Cirugía Plástica y Reparadora del Hospital de Quemados de la Ciudad de Buenos Aires en un periodo comprendido desde el año 2016 al 2019. Se realizan colgajos en cometa en isla o tunelizados y posterior rehabilitación kinésica. El seguimiento mínimo de la serie es de 3 meses y se toman registros fotográficos pre-, intra- y posoperatorios. Las variables analizadas incluyen: sufrimiento de colgajos, dehiscencia, congestión venosa, prendimiento de injertos en zona dadora, reintervenciones y mejoría en la función de abducción del pulgar y pinza de la mano. Resultados. Se realizaron 3 colgajos en cometa tunelizados y 1 en isla. La totalidad se presentaron vitales aunque con congestión venosa en las primeras 72 hs. No se registraron complicaciones y no fueron necesarias reintervenciones. La mejoría en la función de pinza y de abducción del pulgar fue objetivable mediante la observación y referida por los pacientes y/o familiares según correspondiera. Conclusiones. Creemos que el colgajo en cometa es la mejor opción de tratamiento para las secuelas de quemadura en pulgar por aportar adecuada cobertura cutánea, ser técnicamente sencillo y poder hallar el pedículo en el 100% de la población. La congestión venosa es la regla, aunque también la supervivencia, siendo la morbilidad de la zona dadora mínima y la mejoría en la función de pinza y abducción del pulgar francamente objetivable.

Introduction. Multiple techniques have been described for repair the burned thumb function, although without cost-benefit ratio. The kite flap described by Foucher in 1979, provides skin coverage, sensitivity and allows functional improvement. The goal of this study it to present our experience and results obtained using the kite flap Materials and methods. A retrospective, descriptive study of 4 cases of burned hand's thumb treated in the Plastic Surgery Unit of the Hospital de Quemados on Buenos Aires in a three year's period from 2016 to 2019. Island or tunneled's kite flaps and subsequent kinesic rehabilitation are performed. The minimum follow-up of the series is 3 months and fotographic records pre, intra and postoperative are taken. The variables analyzed include: suffering from flaps, dehiscence, venous congestion, grafting losts on the donor zone, reinterventions and improvement in the function of thumb abduction and hand clamp . Results. 3 tunelled kite flaps and 1 on island were made. All of them were vital, although with venous congestion in the first 72 hours. No complications were recorded and no reinterventions were necessary. The improvement in hand clamp function and thumb abduction was marked through observation and when it posible, referred by patients. Conclusions. We believe that kite flap is the best option of treatment for sequelae of burns affecting hand's thumb for providing adequate skin coverage, being technically simple and being able to find the pedicle at 100% of the population. Venous congestion is the rule, although survival is also. Donor zone´s morbidity is minimal and the improvement in thumb function is clear

Comparison of different NAT assays for the detection of microorganisms belonging to the class Mollicutes.

BACKGROUND: Mollicutes detection can be cumbersome due to their slow growth in vitro. For this reason, the use of DNA based on generic molecular tests represents an alternative for rapid, sensitive and specific detection of these microorganism. For this reason, six previously described nucleic acid testing assays were compared to evaluate their ability to detect microorganisms belonging to the class Mollicutes. METHODS: A panel of 61 mollicutes, including representatives from the Mycoplasma, Acholeplasma, Mesoplasma, Spiroplasma and Ureaplasma genus, were selected to evaluate the sensitivity and specificity of these assays. A total of 21 non-mollicutes, including closely related non-mollicutes species, were used to evaluate specificity. Limits of detection were calculated to determine the analytical sensitivity of the assays. The two best performing assays were subsequently adapted into real-time PCR format, followed by melting curve analysis. RESULTS: Both assays performed satisfactorily, with a 100% specificity described for both assays. The detection limits were found to be between 10-4 and 10-5 dilutions, equivalent to 15 to 150 genome copies approximately. Based on our work, both van Kuppeveld and Botes real-time PCR assays were found to be the best performing tests in terms of sensitivity and specificity. Furthermore, Botes real-time PCR assay could detect phytoplasmas as well. CONCLUSIONS: These assays can be very useful for the rapid, specific and sensitive screening cell line contaminants, clinical samples as well as detecting non-culturable, unknown species of mollicutes or mollicutes whose growth is slow or difficult.

Transferencia de genes plasmídicos de resistencia a antibióticos mediante conjugación entre cepas de Escherichia coli provenientes de procesos diarréicosde niños menores a 3 años de edad. Hospital Materno Infantil de la ciudad de La Paz / Transfer of plasmid genes of resistance to antibiotics through conjugation between strains of escherichia coli from processes diarréicos de smaller children than 3 years of edad. Hospital Maternal and Child of the city of La Paz

Escherichia coli es el agente etiológico enterobacteriano más común causante de enfermedades diarreicas en lapoblación infantil. Por este motivo se estudió la transferencia por conjugación de genes plasmídicos de resistencia a antibióticos de bacterias E. coli provenientes de heces de niños menores de 3 años con procesos diarreicos que asistieron al laboratorio clínico delHospital materno infantil durante abril y diciembre del 2003. Se analizó el antibiograma de 44 cepas de E. colique presentó altos porcentajes de resistencia (Amoxicilina 95.55%, cotrimoxazol 68.88%, cloranfenicol51.11%). Por otra parte, las asociaciones más comunes de antibióticos fueron amoxicilina-cotrimoxazol (65%), y amoxicilina-cotrimoxazol-cloranfenicol (47,73%). Los experimentos de conjugación presentaron frecuencias entre 10-5 a 1 0-7, siendo de mayor valor para latransferencia de amoxicilina y menor para la amikacina. Los porcentajes de resistencia y las frecuencias deconjugación demuestran que la mayoría de los genes de resistencia son capaces de ser transferidos por conjugación. Lo que implica probablemente que muchosde estos genes están localizados en elementos genéticos como plásmidos y transposones.

Trastorno psicótico por exposición a disolventes. A propósito de un caso / Solvent-induced psychosis: a case report

La mejora en las condiciones de salud de los trabajadores es el resultado de un trabajo multidisciplinario y coordinado entre profesionales más allá del ámbito estrictamente laboral. Presentamos un caso en el que la intervención de la atención primaria y especializada en coordinación con la inspección médica de salud laboral propiciaron el estudio de la exposión de un trabajador a agentes químicos probablemente responsables de la patología psiquiátrica que presentaba. Finalmente se produjo el reconocimiento del origen profesional de la enfermedad y la adopción por parte de la empresa de medidas para evitar nuevas exposiciones (AU)

Movimiento de ganado en la Provincia de Buenos Aires: un aporte a la vigilancia epidemiológica desde la perspectiva comercial

[Introducción] Este trabajo pretende realizar una aproximación al conocimiento de la intensidad y la dirección de los flujos de vacunos en pie a través de la caracterización y cuantificación de los movimientos de bovinos registrados por zonas y canales comerciales en la provincia de Buenos Aires durante 1994.

La producción familiar y las estratégias de salud animal / Family production and animal health strategies

Los programas de erradicación de la fiebre aftosa se encuentran en fase avanzada en varios países de América del Sur. Asimismo, otras regiones del continente libres de la enfermedad desarrollan actividades de prevención, emprescindibles pra evitar la introducción del virus. En ambas situaciones existe un amplio sector de tenedores de ganado, caracterizados genéricamente como pequeños productores. Sin embargo, la prevención y erradicación de la fiebre aftosa se sustentará en bases débiles si no se estimula una participación más activa de estos productores. Para tal fin, es preciso que los programas de fiebre aftosa se incoporen como un componente más en el conjunto de las actividades de desarrollo previstas para ese sector

La producción familiar y las estrategias de salud animal

Los programas de erradicación de la fiebre aftosa se encuenta en fase avanzada en varios países de América del Sur. Asimismo, otras regiones del continente libres de la enfermedad desarrollan actividades de prevención, imprescindibles para evitar la introducción del virus. En ambas situaciones existe un amplio sector de tenedores de ganado, caracterizados genéricamente como pequeños productores. Ellos han acompañado en buena medida el esfuerzo continental por eliminar este flagelo. Sin embargo, la prevención y erradicación de la fiebre aftosa se sustentará en bases débiles si no se estimula una participación más activa de estos productores. Para tal fin, es preciso que los programas de fiebre aftosa se incorporen como un componente más en el conjunto de las actividades de desarrollo previstas para ese sector. Esta perspectiva demanda un mayor conocimiento sobre las características de las producciones familiares pecuarias en el continente y el curso de las políticas institucionales implementadas para el sector.

The foot-and-mouth disease eradication programs have reached and advanced phase in several countries of South America. Likewise, other regions of the continent are free of the disease and engaged in developing prevention activities indispensable o prevent the introduction of the virus. In both situation there exists a broad setor of livestock reaisers generically characterized as "small producers". These producers have, in good measure, accompanied the continental effort to eliminate the scourage. However, foot-and-mouth disease prevention and eradication will rest on weak bases if a more active participation, by these procuders is not encouraged. To this, end it is necessary to incorporate the foot-and-mouth disease programs as one more component of the development activities envisaged fot the sector. This perspective demands a greater understanding of the characteristics of the family-level livestock production system on the continent and the course of the institutional policies implemented for the sector.

[Multi-infarct dementia in giant cell arteritis (temporal arteritis)]. / Demencia multiinfarto en la arteritis de células gigantes (arteritis de la temporal).

Dementia is an infrequent and little known manifestation of giant cell arteritis or temporal arteritis (GCA-TA). The cases of 2 women with histologically proven GCA-TA are presented in which, together with the most classical symptoms, they presented a brusque mental deterioration on initiation of the disease. One patient developed a severe irreversible dementia which coincided with a rapid reduction in the doses of corticoids; while the other patient demonstrated improvement in cognitive function with steroid treatment and control of the disease. Magnetic resonance studies revealed multiple areas of infarction in both hemispheres in the two patients. The importance of treating multi-infarct dementia is underlined in the context of GCA-TA with high doses of corticoids. It is also emphasized that GCA-TA should be considered in the evaluation of older patients with mental alterations.

[Neuroleptic malignant syndrome. Analysis of 9 cases]. / Síndrome neuroléptico maligno. Análisis de 9 casos.

The malignant neuroleptic syndrome (MNS) is an idiosyncratic reaction to neuroleptic drugs. Although it was described in the sixties, it is still a poorly known condition. Controversy still exists about its conceptual frame, and its true incidence is still unknown. We have evaluated 9 cases of MNS seen in a 37 month period. There were 5 females, with a mean age of 50 years. Haloperidol, either single or in association, was the most commonly implicated drug. The estimated frequency of MNS in our population at risk was 1.5%. Eight patients had complications and 5 died from them (55%). We discuss the pathogenetic mechanisms, the conceptual characterization and the current diagnostic criteria. We evaluate the causes of the high mortality in our series. We think that a higher suspicion index of this condition would be desirable, and we recommend early treatment with vigorous supportive measures and drug therapy. We think that prospective studies are required to assess the true incidence of MNS.

Blink reflex in Parkinson's disease with levodopa-induced dyskinesia.

We have studied the electrically evoked blink reflex (R1 and R2 components) in 40 parkinsonian patients with levodopa-induced dyskinesia (15 with facial dyskinesia, 13 with limb-truncal dyskinesia and 12 with mixed dyskinesia). R2 latencies (both ipsilateral and contralateral) were significantly prolonged in dyskinetic patients. These findings are indicative of decreased excitability of brainstem interneurones in the dyskinetic parkinsonians. We found no correlation between the neurophysiological pattern of blink reflex and the localization of dyskinesia.

Blink reflex in dyskinetic and nondyskinetic patients with Parkinson's disease.

An electrophysiological study of the blink Reflex was undertaken in 40 dyskinetic and 20 nondyskinetic patients with Parkinson's disease, who were matched for age, stage of disease, duration of illness and amount and nature of antiparkinsonian medication. We found that latencies of R2 responses (both ipsilateral and contralateral) were prolonged in the dyskinetic group compared to the nondyskinetic group. Moreover, the late response was more easily inhibited by conditioning stimulation in dyskinetic patients. This behavior of late response in dyskinetic parkinsonians may be attributed to the reinstatement of dopaminergic suppressive control over the segmental multisynaptic systems belonging to the reflex.