Prevalencia de hipoglucemia grave en una cohorte de pacientes con diabetes tipo 1 / Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes

INTRODUCCIÓN: La hipoglucemia es el principal factor limitante para alcanzar los objetivos de control glucémico en pacientes con diabetes tipo 1. La hipoglucemia grave conlleva riesgo de daño, e incluso de muerte. Tener hipoglucemias repetidas se relaciona con la aparición de hipoglucemias inadvertidas, las cuales incrementan el riesgo de hipoglucemias graves. Algunos metaanálisis recientes estiman una prevalencia del 35% de hipoglucemia grave en pacientes con diabetes tipo 1. OBJETIVO: Conocer la prevalencia de hipoglucemia grave en una cohorte de pacientes con diabetes tipo 1 y evaluar la dependencia entre las variables hipoglucemia grave e inadvertida evaluada mediante el test de Clarke. PACIENTES Y MÉTODOS: Se ha estudiado una cohorte de pacientes con diabetes tipo 1 para analizar la edad, sexo, tiempo de evolución de diabetes, tratamiento (múltiples dosis o infusión subcutánea continua de insulina), autocontrol glucémico, HbA1c, episodios de hipoglucemia grave sin pérdida de conciencia, episodios de hipoglucemia grave con pérdida de conciencia e hipoglucemias inadvertidas. RESULTADOS: El 39,8% de los pacientes presentaron hipoglucemias graves sin pérdida de conciencia (últimos 6 meses) y el 11,4%, con pérdida de conciencia (últimos 12 meses). El 40,9% presentaban hipoglucemias inadvertidas y se descartó la independencia entre estas y las hipoglucemias graves. La presencia de hipoglucemias graves con pérdida de conciencia se asoció a mayor edad y mayor tiempo de evolución; las hipoglucemias inadvertidas, con una mayor edad y una menor HbA1c. CONCLUSIÓN: Se confirma el elevado porcentaje de pacientes con diabetes tipo 1 afectos de hipoglucemia grave e inadvertida

INTRODUCTION: Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES: To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS: The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS: Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS: Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes

Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes. / Prevalencia de hipoglucemia grave en una cohorte de pacientes con diabetes tipo 1.

INTRODUCTION: Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES: To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS: The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS: Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS: Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes.

Differential expression of coxsackievirus and adenovirus receptor in endomyocardial tissue of patients with myocarditis.

Recent studies demonstrated that the expression of coxsackievirus and adenovirus receptor (CAR) is implicated in the pathophysiology of myocarditis. The aim of the present study was to assess the association between active and borderline myocarditis and CAR expression in endomyocardial tissues, and analyze the association between CAR expression and treatment response. An analytic, cross­sectional, retrospective study was performed in 26 patients with myocarditis and 10 control subjects without heart disease. Myocardial biopsies were obtained and CAR transcription was measured by reverse transcription­quantitative polymerase chain reaction analysis. The association between CAR mRNA levels and the response to immunosuppressive or conventional therapy (treatment responders, n=17; non­responders, n=9) or with the type of histological myocarditis (active myocarditis, n=16; borderline myocarditis, n=10) was analyzed. CAR transcription levels were significantly lower (P=0.012) in patients with myocarditis compared with controls, and a significant decrease was observed (P=0.023) in CAR mRNA levels among patients with borderline myocarditis compared with the no myocarditis group. Patients responding to therapy exhibited higher CAR mRNA levels (P=0.036) compared with patients not responding to treatment, as evaluated based on clinical and echocardiographic criteria (immunosuppressive therapy, n=8; conventional therapy, n=1). Myocarditis in non­responders was associated with fewer clinical manifestations and lower CAR mRNA levels. A significant difference was only found regarding the use of oral steroids in patients with active myocarditis who responded to treatment (P=0.02), with no difference in borderline myocarditis. In conclusion, the transcriptional level of CAR is low in the endomyocardial tissue of patients with myocarditis, and it is lower in borderline myocarditis and in non­responder patients. These findings may enable early identification of patients who may benefit from treatment and timely determination of prognosis.

Epistatic and allelic interactions control expression of ribosomal RNA gene clusters in Arabidopsis thaliana.

BACKGROUND: Ribosomal RNA (rRNA) accounts for the majority of the RNA in eukaryotic cells, and is encoded by hundreds to thousands of nearly identical gene copies, only a subset of which are active at any given time. In Arabidopsis thaliana, 45S rRNA genes are found in two large ribosomal DNA (rDNA) clusters and little is known about the contribution of each to the overall transcription pattern in the species. RESULTS: By taking advantage of genome sequencing data from the 1001 Genomes Consortium, we characterize rRNA gene sequence variation within and among accessions. Notably, variation is not restricted to the pre-rRNA sequences removed during processing, but it is also present within the highly conserved ribosomal subunits. Through linkage mapping we assign these variants to a particular rDNA cluster unambiguously and use them as reporters of rDNA cluster-specific expression. We demonstrate that rDNA cluster-usage varies greatly among accessions and that rDNA cluster-specific expression and silencing is controlled via genetic interactions between entire rDNA cluster haplotypes (alleles). CONCLUSIONS: We show that rRNA gene cluster expression is controlled via complex epistatic and allelic interactions between rDNA haplotypes that apparently regulate the entire rRNA gene cluster. Furthermore, the sequence polymorphism we discovered implies that the pool of rRNA in a cell may be heterogeneous, which could have functional consequences.

Complete Genome Sequencing of a Multidrug-Resistant and Human-Invasive Salmonella enterica Serovar Typhimurium Strain of the Emerging Sequence Type 213 Genotype.

Salmonella enterica subsp. enterica serovar Typhimurium strain YU39 was isolated in 2005 in the state of Yucatán, Mexico, from a human systemic infection. The YU39 strain is representative of the multidrug-resistant emergent sequence type 213 (ST213) genotype. The YU39 complete genome is composed of a chromosome and seven plasmids.

Predictores preoperatorios de evento cerebrovascular postoperatorio en cirugía de revascularización miocárdica / Perioperative predictors of stroke after coronary artery bypass grafting

El evento cerebrovascular postoperatorio en cirugía de revascularización miocárdica es una entidad catastrófica que aumenta la morbimortalidad y los costos por atención médica. La literatura muestra una disminución en la incidencia del evento cerebrovascular posterior a cirugía cardiaca en la última década, sin embargo no se dispone de datos sobre la prevalencia de esta entidad en Latinoamérica ni en Colombia. Objetivos: Identificar los factores de riesgo para el desarrollo de evento cerebrovascular temprano, en pacientes sometidos a cirugía de revascularización miocárdica en un centro de referencia colombiano. Métodos: Estudio de casos y controles anidado en una cohorte retrospectiva. Resultados: Se incluyeron 876 pacientes, con edad promedio de 63,6 años ± 9,25 años, de los cuales el 74,5% eran hombres. La incidencia de evento cerebrovascular postoperatorio fue 1,3%. Los factores de riesgo fueron: cirugía valvular ( OR 43,92 { IC 95% 1,26-1527,05} , p = 0,037) ; evento cerebrovascular previo ( OR 14,78 { IC 95% 2,96-73,68} p = 0,01) ; calcificación aórtica ( OR 8,23 { IC 95% 2,18-31,12} , p = 0,02) . Conclusiones: La incidencia de evento cerebrovascular postoperatorio de cirugía de revascularización miocárdica en un centro de referencia colombiano es inferior a la que se reporta en la literatura mundial. Los factores predictivos son la cirugía valvular, el antecedente de evento cerebrovascular y la identificación de calcificación aórtica.

Introduction: Perioperative stroke after coronary artery bypass grafting is a catastrophic complication that increases mobility, mortality and the cost for medical attention. Recently a global decrease in perioperative stroke has been reported, however, there is a lack of data about the prevalence of perioperative stroke in Latin-American and Colombia. Objective: To identify the risk factors for early stroke after coronary artery bypass grafting in a Colombian cardiovascular center. Methods: A retrospective case and control study nested in a cohort was performed. Results: 876 patients were included with a mean age of 63.6 ± 9.25 years, 74.5% were male. The incidence of perioperative stroke was 1.3%. The risk factors identified were: previous valvular surgery OR 43.92 ( 1.26-1527.05) , p:.037, past medical history of stroke OR 14.78 ( 2.96-73.68) , p:.01 and the presence of aortic calcification OR 8.23 ( 2.18-31.12) , p:.02. Conclusions: The incidence of perioperative stroke after coronary artery bypass grafting in a Colombian cardiovascular center is lower than reported in the literature, the perioperative predictors identified in the present study were previous valvular surgery, the past medical history of stroke and aortic calcification.

Niveles de plomo en sangre conservada en bancos de sangre para transfundir a pacientes pediátricos hospitalizados / Levels of lead in preserved blood in blood banks for pediatric inpatients

Antecedentes: El plomo no cumple ninguna función vital en el organismo humano y resulta tóxico incluso en dosis bajas, dando lugar a efectos agudos y crónicos. En los niños, la intoxicación aguda por plomo es un problema importante; los estudios realizados en Latinoamérica han mostrado la presencia de daños secundarios a diferentes formas de exposiciones. No se han establecido niveles máximos permisibles en los cuales se pueda garantizar la seguridad a largo plazo. Tipo de estudio: Estudio transversal, analítico, realizado bajo muestreo por conveniencia. Metodología: El CINVESTAV realizó la determinación de plomo en muestras de sangre de bolsas almacenadas en el Banco de Sangre del Hospital General de Ecatepec; en el periodo diciembre 2012 a enero de 2013 emitió resultados tomando en consideración criterios emitidos en la NOM-047-SSA1-2011. Resultados: Se analizaron 225 muestras, encontrando 163 de donantes en niveles bajos (< 5 µg/dL); 46 muestras en el rango de 5 a 10 µg/dL y 15 con valores entre 10 a 19 µg/dL. Recomendaciones: 1. Es indispensables determinar los valores de plomo en la sangre de donantes antes de transfundir a pacientes. 2. Incluir un escáner de plomo en sangre en donantes permite transfundir sangre segura. 3. Es indispensable limitar este factor de riesgo que coadyuva al daño neurológico en recién nacidos.

Background: Lead has not any vital function in the human body, but is toxic even at low doses, leading to acute and chronic effects. Studies in Latin Americans children have showed that lead poisoning is a major health problem, because there are different forms of exposure. There are no established maximum permissible serum levels which can guarantee long-term security. Type of study: Cross-sectional, analytical, performed with a convenience sample. Methodology: CINVESTAV made the determination of lead in blood samples from bags stored in the blood bank of the General Hospital of Ecatepec, in the period from December 2012 to January 2013. Results was given according with the criteria of the norm NOM-047 -SSA1-2011. Results: 225 samples were analyzed, finding 163 donor samples at low levels (<5 µg/dL), 46 samples in the range of 5 to 10 µg/dL and 15 samples with values between 10 to 19 µg/dL. Recommendations: 1. It is essential to determine the values of lead donor blood before transfusing patients. 2. Include a screening of the donor blood lead levels. 3. It is essential to limit this risk factor that contributes to neurological damage in newborns, like the high lead serum levels.

Importance of clinical variables in the diagnosis of MODY2 and MODY3

La diabetes tipo MODY (del inglés maturity onset diabetes of the young) constituye un grupo de patologías bien definidas y caracterizadas por su aparición antes de los 25 años, herencia autosómica dominante y por el hecho de que no precisan un tratamiento con insulina (al menos, inicialmente) para evitar la formación de cuerpos cetónicos. A pesar de la importancia de una clasificación precisa del paciente diabético, no siempre resulta sencillo clasificar el diagnóstico de un paciente joven con diabetes, y los estudios genéticos, a menudo, se usan de forma inadecuada. Métodos Se describen las características clínicas de pacientes cuyo estudio para MODY2 y MODY3 resultó negativo, y se comparan con las características de pacientes con resultado de estudio positivo. Resultados Todos los pacientes con MODY3 habían sido diagnosticados antes de los 25 años de edad y requerían algún tratamiento farmacológico para controlar la glucemia. Los pacientes con MODY2 fueron diagnosticados a partir de la primera analítica realizada, bien de forma accidental o dentro de un contexto de cribado de diabetes gestacional. La descripción clínica de los 19 pacientes cuyo estudio para MODY2 y MODY3 resultó negativo, mostró que sólo dos pacientes presentaban un cuadro clínico compatible con MODY3 y solo un paciente con MODY2.ConclusionesLas características clínicas pueden ser utilizadas para excluir el diagnóstico de MODY2 y MODY3, y ello puede reducir la necesidad de estudios genéticos (AU)

MODY (maturity onset diabetes of the young) is a group of well-defined diseases clinically characterised by onset before age 25 years that does not require insulin treatment (at least initially)to prevent the formation of ketone bodies and autosomal dominant inheritance. Despite the importance of accurate classification, it is not always simple to catalogue the diagnosis of a young patient with diabetes, and genetic studies are often improperly used. Methods: We describe the clinical features of patients negative for MODY2 and MODY3 and compared them to patients positive for these subtypes. Results: All patients with MODY3 had been diagnosed before age 25 years and required drug therapy for blood glucose control. MODY2 patients were diagnosed at the first laboratory workup either incidentally or as part of gestational diabetes screening. The clinical description of the19 patients negative for MODY2 and MODY3 showed that only two patients presented a clinical picture consistent with MODY3 and one patient with MODY2.Conclusions: Clinical features can be used for early exclusion of a MODY2 or MODY3 diagnosis and may reduce the need for genetic testing (AU)

Importance of clinical variables in the diagnosis of MODY2 and MODY3.

AIMS: MODY (maturity onset diabetes of the young) is a group of well-defined diseases clinically characterised by onset before age 25 years that does not require insulin treatment (at least initially) to prevent the formation of ketone bodies and autosomal dominant inheritance. Despite the importance of accurate classification, it is not always simple to catalogue the diagnosis of a young patient with diabetes, and genetic studies are often improperly used. METHODS: We describe the clinical features of patients negative for MODY2 and MODY3 and compared them to patients positive for these subtypes. RESULTS: All patients with MODY3 had been diagnosed before age 25 years and required drug therapy for blood glucose control. MODY2 patients were diagnosed at the first laboratory workup either incidentally or as part of gestational diabetes screening. The clinical description of the 19 patients negative for MODY2 and MODY3 showed that only two patients presented a clinical picture consistent with MODY3 and one patient with MODY2. CONCLUSIONS: Clinical features can be used for early exclusion of a MODY2 or MODY3 diagnosis and may reduce the need for genetic testing.

Anatomical cardiac alterations in liver cirrhosis: an autopsy study.

BACKGROUND: It has been suggested that liver cirrhosis (LC), regardless of etiology, may be associated with anatomical cardiac alterations. OBJECTIVE: To describe the frequency and type of macroscopical anatomic cardiac abnormalities present in alcoholic and non-alcoholic cirrhotic patients in an autopsy series. MATERIAL AND METHODS: The autopsy records performed at our institution during a 12-year period (1990-2002) were reviewed. All cases with final diagnosis of LC were included, their demographic characteristics as well as cirrhosis etiology and macroscopic anatomical cardiac abnormalities (MACA) analyzed. Patients with any known history of heart disease prior to diagnosis of cirrhosis were excluded. RESULTS: A total of 1,176 autopsies were performed, of which 135 cases (11.5%) were patients with LC. Two patients with cardiac cirrhosis were excluded. Chronic alcohol abuse (29%) and chronic hepatitis due to hepatitis C virus (HCV) infection (20%) were the most common causes of cirrhosis. The etiology was not identified in 35% of the cases, even after exhaustive clinical, serological and/or radiological assessment. In the postmortem analysis, 43% of the cases were informed to have MACA (47% in the group of patients with alcoholic cirrhosis and 41% in other types of cirrhosis); this rate increased to 62% in patients with ascites. The most frequent alterations were cardiomegaly and left ventricular hypertrophy (LVH). CONCLUSION: The results confirm the high frequency of cardiac abnormalities in patients with cirrhosis, regardless of cirrhosis etiology.

Clinical differences between patients with MODY-3, MODY-2 and type 2 diabetes mellitus with I27L polymorphism in the HNF1alpha gene.

OBJECTIVE: The aim of our study was to describe and evaluate the clinical and metabolic characteristics of patients with MODY-3, MODY-2 or type 2 diabetes who presented I27L polymorphism in the HNF1alpha gene. METHODS: The study included 31 previously diagnosed subjects under follow-up for MODY-3 (10 subjects from 5 families), MODY-2 (15 subjects from 9 families), or type 2 diabetes (6 subjects) with I27L polymorphism in the HNF1alpha gene. The demographic, clinical, metabolic, and genetic characteristics of all patients were analyzed. RESULTS: No differences were observed in distribution according to sex, age of onset, or form of diagnosis. All patients with MODY-2 or MODY-3 had a family history of diabetes. In contrast, 33.3% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene had no family history of diabetes (p < 0.05). No differences were observed in body mass index, prevalence of hypertension, or microvascular or macrovascular complications. Drug therapy was required by 100% of MODY-3 patients, but not required by 100% of MODY-2 patients or 16.7% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene (p < 0.05). CONCLUSIONS: Occasional difficulties may be encountered when classifying patients with MODY-2, MODY-3 or type 2 diabetes of atypical characteristics, in this case patients who present I27L polymorphism in the HNF1alpha gene.

Clinical differences between patients with MODY-3, MODY-2 and type 2 diabetes mellitus with I27L polymorphism in the HNF1alfa gene

Objective: The aim of our study was to describe and evaluate the clinical and metabolic characteristics of patients with MODY-3, MODY-2 or type 2 diabetes who presented I27L polymorphism in the HNF1α gene. Methods: The study included 31 previously diagnosed subjects under follow-up for MODY-3 (10 subjects from 5 families), MODY-2 (15 subjects from 9 families), or type 2 diabetes (6 subjects) with I27L polymorphism in the HNF1α gene. The demographic, clinical, metabolic, and genetic characteristics of all patients were analyzed. Results: No differences were observed in distribution according to sex, age of onset, or form of diagnosis. All patients with MODY-2 or MODY-3 had a family history of diabetes. In contrast, 33.3% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1α gene had no family history of diabetes (p < 0.05). No differences were observed in body mass index, prevalence of hypertension, or microvascular or macrovascular complications. Drug therapy was required by 100% of MODY-3 patients, but not required by 100% of MODY-2 patients or 16.7% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1α gene (p < 0.05). Conclusions: Occasional difficulties may be encountered when classifying patients with MODY-2, MODY-3 or type 2 diabetes of atypical characteristics, in this case patients who present I27L polymorphism in the HNF1α gene

Objetivos: El objetivo de este estudio es describir y evaluar las características clínicas y metabólicas de pacientes diabéticos MODY 3, MODY 2 y con diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α. Métodos: Se incluyó a 31 pacientes diagnosticados previamente y en seguimiento en consultas externas por diabetes tipo MODY 3, MODY 2 y diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α: 10 pacientes diagnosticados de diabetes MODY 3 (pertenecientes a 5 familias); 15 pacientes con diabetes MODY 2 (pertenecientes a 9 familias) y 6 pacientes diagnosticados de diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α. Se analizan las características clínicas, antropométricas y metabólicas de los pacientes. Resultados: No se objetivaron diferencias en la distribución por sexos y edad o forma de diagnóstico de la diabetes. Todos los pacientes con diabetes MODY 2 y MODY 3 tenían antecedentes familiares de diabetes. El 33,3% de los pacientes con diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α no tenían antecedentes familiares de diabetes (p > 0,05). No se encontraron diferencias en el IMC, la prevalencia de hipertensión arterial o la incidencia de complicaciones microvasculares o macrovasculares. En cuanto al tratamiento, el 100% de los pacientes con diabetes MODY 3 necesitaban tratamiento farmacológico. El 100% de los pacientes con diabetes MODY 2 y el 16,7% de los pacientes con diabetes tipo 2 y el polimorfismo I27L en el gen HNF1α no necesitaban tratamiento farmacológico (p > 0,05). Conclusiones: Este artículo realza la dificultad en la correcta clasificación clínica de los pacientes con diabetes MODY 2, MODY 3 y diabéticos tipo 2 con características clínicas atípicas, en este caso portadores del polimorfismo I27L en el gen HNF1α

Early infant feeding decisions in low-income Latinas.

Breastfeeding rates remain low, especially among low-income minority women. The objective of this qualitative study was to assess barriers to breastfeeding and reasons for combination feeding among low-income Latina women and their families. Meetings were held with key informants to inform the sampling plan and develop questions for focus groups. Data were collected from eight qualitative focus groups with primiparous mothers postpartum, mothers breastfeeding at 4 to 6 months, mothers formula feeding at 4 to 6 months, grandmothers and fathers, and 29 individual interviews with formula- and combination-feeding mothers. Transcripts of focus groups and interviews were content coded and analyzed for thematic domains and then compared for concurrence and differences. Four main domains with 15 categories were identified: (a) Best of both: Mothers desire to ensure their babies get both the healthy aspects of breast milk and "vitamins" in formula. (b) Breastfeeding can be a struggle: Breastfeeding is natural but can be painful, embarrassing, and associated with breast changes and diet restrictions. (c) Not in Mother's Control: Mothers want to breastfeed, but things happen that cause them to discontinue breastfeeding. (d) Family and cultural beliefs: Relatives give messages about supplementation for babies who are crying or not chubby. Negative emotions are to be avoided so as to not affect mother's milk. Those counseling Latina mothers about infant feeding should discourage and/or limit early supplementation with formula, discuss the myth of "best of both," understand the fatalism involved in problem-solving breastfeeding issues, and enlist the altruism embedded in the family unit for support of the mother-infant pair.

Aislamiento de Klebsiella pneumoniae productora de Beta-Lactamasa de Espectro Extendido (BLEE) en recién nacidos en el Hospital Infantil Dr. Robert Reid Cabral de Santo Domingo, República Dominicana / Extended-spectrum B-lactamase-producing Klebsiella pneumoniae isolated from neonates in the Dr. Robert Reid Cabral Children’s Hospital, Santo Domingo, Dominican Republic

Desde los años 80 ha aumentado la tasa de los aislamientos de Klebsiella pneumoniae productoras de Beta-Lactamasas de Espectro Extendido-KpBLEE- a nivel mundial. La Kp BLEE ha sido aislada en recién nacidos de la UCIN del principal hospital pediátrico de Rep. Dominicana. Fueron incluidos en este estudio 212 niños menores de 28 días de edad, hospitalizados en la UCIN del Hospital Infantil Dr. Robert Reid Cabral en un período de cuatro meses. Se tomaron hemocultivos a cada niño a su ingreso y en cualquier momento, cuando se sospechara infección. Para la identificación de los aislamientos se utilizó el sistema API 20-E (BioMerieux). La detección de BLEE se realizó por el método de difusión del doble disco. Para la confirmación de BLEE se usaron los discos de cefotaxime: cefotaxime/ácido clavulánico y ceftazidime:ceftazidime/ácido clavulánico. Toda Kp con una diferencia mayor de 5 mm entre ambos pares de discos se consideró una KpBLEE. La diferencia entre las proporciones se determinó usando las pruebas de Chi cuadrado y Fisher exacto. Ocurrieron 26 casos de infección nosocomial entre los 212 neonatos (26/212 = 12.3). De estos, en 15 se aisló K. pneumoniae (15/26 = 57.7), de las cuales 10 (67) fueron cepas productoras de BLEE. La tasa de fatalidad fue de 80 (8/10). La condición de riesgo más importante fue la prematuridad y el bajo peso al nacer. Se observó una elevada prevalencia de KpBLEE durante el período de estudio. En República Dominicana se necesitan medidas preventivas urgentes para reducir la transmisión de estas infecciones

[Microbiological profiling of isolates from the neonatal unit of a third-level hospital in Bogotá, Colombia]. / Perfil microbiológico de aislamientos en unidades neonatales en un hospital de tercer nivel de Bogotá, Colombia.

OBJECTIVES: Investigating the prevalence and sensitivity of germs isolated from newborn in a referral hospital in Bogotá. Suggesting an empirical antibiotic treatment for neonatal infection. METHODS: Cultures taken between February and December 2002 were analysed. Blood cultures were processed using BacT/ALERT (Durham, NC), urine cultures by UROCULT (Bio-Bacter) and catheter tips in thioglycollate. BBL CRYSTAL identification system (BD, Sparks, MD) was used for identifying germs. Antibiotic sensitivity was determined by disk diffusion. RESULTS: There were 1,097 positive aerobic and facultative aerobic germ cultures; 64.3% were Gram-positive, 30.6% Gram-negative and 4.9% were yeasts. Gram-positive germs consisted of coagulase-negative staphylococci (64.2%), enterococcus (13.8%) and coagulase-positive staphylococci (13.3%). The most frequent Gram-negatives were Klebsiella (45.2%), Eschericha coli (30.9%) and Serratia (10.1%). Staphylococcus epidermidis accounted for 64% of the coagulase-negative staphylococci. S. epidermidis susceptibility to vancomycin was 100%. Coagulase-negative staphylococci susceptibility to rifampin and amikacin was 59% and 67.4% (respectively). Coagulase-negative staphylococci resistance to beta-lactams was 86.4% (95% CI: 82.3-89.9). Coagulase-positive staphylococci sensitivity to vancomycin was 100%. Gram-negative susceptibility to imipenem was 98.1% (95% CI: 89.9-99.9), 78.1% to gentamicin (95% CI: 64.9-88.2) and 46.6% to amikacin (95% CI: 28.3-65.7). CONCLUSIONS: There was high coagulase-negative staphylococci prevalence in neonatal infection (particularly S. epidermidis). All S. epidermidis and coagulase-positive staphylococci were sensitive to vancomycin. There was increasing coagulase-negative staphylococci and Gram-negative resistance to oxacillin and amikacin, respectively.

Onfalocele: analisis de 25 casos

Se presentaron los resultados de una revisión retrospectiva de 25 expedientes de pacientes ingresados en el Hospital Infantil Dr. Robert Reid Cabral, de santo Domingo, en el período comprendido entre 1977 y 1985 con el diagnóstico de Onfalocele. Se observó que el 16% fueron niños nacidos de pretérmino, el peso promedio del total de ingresados fue de tres kilos y el 48% presentaban un defecto abdominal grande (mayor de 5 cm). El 24% tenía el defecto roto. Las anomalías congénitas se anotaron el el 28% de los casos, pero sólo el 16% se consideraron importantes en la evolución de la patología. La complicación postoperatoria más importante fue la sepsis, seguida de compromisso respiratório. La mortalidad fue de 56%, constituyendo la sepsis la principal causa aparente de muerte. Se hace énfasis en las técnicas pre y postoperatoria que pueden tener repercusión en un mejor pronóstico para estos casos

Atresia intestinal

Se presenta la incidencia de Atresia Intestinal (AI) en la Unidad de Cuidados Intensivos Neonatal (UCIN) del Hospital Infntil Dr. Robert Reid Cabral, constituyendo el 1.6% de los ingresos a ésta unidad. La mortalidad fue de 81.3%, habiéndose intervenido quirúrgicamente el 75%

Toxoplasmosis congénita

Presentamos el caso de un recién nacido con Toxoplasmosis Congénita la cual se presentó con pseudoquistes del pulmón. Se discuten los aspectos clínicos y de laboratorio de la enfermedad y se enfatiza sobre su importancia como causa de aborto y de mortalidad neonatal

Sindrome de megavejiga-microcolon e hipoperistaltismo intestinal: a propósito del primer caso comunicado en Republica Dominicana

Se presenta una recién nacida con Síndrome de megavejiga-microcolon e hipoperistaltismo intestinal. Este es el primer caso descrito en la literatura médica dominicana