High vs low CPAP strategy with aerosolized calfactant in preterm infants with respiratory distress syndrome.

BACKGROUND: Optimal CPAP strategy to prevent CPAP failure defined as need for endotracheal intubation is unknown. OBJECTIVE: To evaluate the risk of CPAP failure in infants treated with high vs low CPAP strategy while receiving aerosolized calfactant in the AERO-02 clinical trial and AERO-03 expanded access program. METHODS: Infants born between 29 0/7 to 36 6/7 weeks were included. Comparisons were made between low and high CPAP groups (Low, 4-7 cm H2O; High, 8-10 cm H2O). RESULTS: CPAP failure and pneumothorax were not different between the groups. Odds of CPAP failure were not different after adjustment for baseline characteristics (OR = 0.61; 95% CI: 0.29, 1.24). CONCLUSION: We found no difference in CPAP failure among infants who received aerosolized calfactant that were treated with high vs low CPAP strategy. Efficacy of high CPAP strategy with aerosolized surfactant treatment needs to be evaluated in future studies.

Estrongiloidiasis humana: una enfermedad olvidada, un problema vigente / Human Strongyloidiasis: a forgotten disease, an ongoing problem / Estrongiloidiase humana: una doença esquecida, um problema vigente

La estrongiloidiasis humana es una infección del intestino delgado superior que, en la mayoría de hospederos inmunocompetentes, transcurre de forma asintomática. En el mundo se estima que el parásito afecta alrededor de 100 millones de personas que viven en 70 países y las regiones tropicales y subtropicales son las áreas de mayor prevalencia. Una característica del parásito Strongyloides stercoralis es su capacidad para desarrollar ciclos de autoinfección, con la posibilidad de evolucionar a la infección crónica del hospedero inmunocompetente, mientras que en pacientes inmunocomprometidos, principalmente trasplantados e infectados por el Virus Linfotrópico de células T humano tipo 1, desencadena un síndrome de hiperinfección potencialmente letal. Si se considera el aumento, cada vez mayor, de trasplantes de órganos sólidos en Colombia, sumado a la falta de validez diagnóstica que presentan las herramientas de análisis parasitológico disponibles en nuestro medio e, incluidas en la búsqueda rutinaria de parásitos intestinales en los protocolos pre-trasplante o pre-terapia inmunosupresora, es necesario un diagnóstico rápido y preciso en estos pacientes de alto riesgo. La presente revisión temática hace un llamado al personal médico para que adquiera conciencia en el contexto sanitario regional y nacional sobre la estrongiloidiasis como una parasitosis oportunista que debe ser considerada en la sospecha clínica y que está asociada a mortalidad, en los casos del síndrome de hiperinfección por S. stercoralis en pacientes inmunocomprometidos, en especial si no es diagnosticada y tratada de forma oportuna.

Strongyloidiasis is an infection in the upper small intestine that, in most immunocompetent hosts, occurs asymptomatically. It is estimated that this parasite affects 100 million people living in 70 countries around the world, with highest prevalence in tropical and sub-tropical regions. One characteristic of the Strongyloides stercoralis parasite is its ability to develop cycles of auto-infection, with the possibility of evolving to chronic infection in immunocompetent hosts. However, in immunocompromised hosts (mainly transplanted patients and those infected by human T-cell lymphotropic virus type 1), it can lead to a potentially fatal hyperinfection syndrome. Taking into account the increasing number of solid organ transplants in Colombia and the lack of diagnostic validity offered by the parasitological analysis tools available in this setting, which are used in the routine search for intestinal parasites in pre-transplant protocols or those prior to immunosuppressor therapy, a quick and precise diagnosis in these high-risk patients is necessary. This topic review calls for medical personnel to be informed in the regional and national sanitary conditions regarding strongyloidiasis as an opportunistic parasitosis that should be taken into account in clinical diagnosis and which is associated to mortality in the cases of hyperinfection by S. stercoralis in immunocompromised patients, particularly when not diagnosed and treated in a timely manner.

A estrongiloidiase humana é uma infecção do intestino delgado superior que, na maioria de hospedeiros imunocompetentes, transcorre de forma assintomática. No mundo se estima que o parasito afeta ao redor de 100 milhões de pessoas que vivem em 70 países e as regiões tropicais e subtropicais são as áreas de maior prevalência. Uma característica do parasito Strongyloides stercoralis é sua capacidade para desenvolver ciclos de autoinfecção, com a possibilidade de evolucionar à infecção crónica do hospedeiro imunocompetente, enquanto que em pacientes imunocomprometidos, principalmente transplantados e infectados pelo Vírus Linfotrópico de células T humano tipo 1, desencadeia uma síndrome de hiper-infecção potencialmente letal. Se se considera o aumento, cada vez maior, de transplantes de órgãos sólidos na Colômbia, somado à falta de validez diagnóstica que apresentam as ferramentas de análise parasitológico disponíveis em nosso meio e, incluídas na busca rotineira de parasitos intestinais nos protocolos pré-transplante ou pré-terapia imunosupressora, é necessário uma diagnóstico rápido e preciso nestes pacientes de alto risco. A presente revisão temática faz um chamado ao pessoal médico para que adquira consciência no contexto sanitário regional e nacional sobre a estrongiloidiase como uma parasitose oportunista que deve ser considerada na suspeita clínica e que está associada a mortalidade, nos casos da síndrome de hiper-infecção por S. stercoralis em pacientes imunocomprometidos, em especial se não é diagnosticada e tratada de forma oportuna.

HIV testing and counselling in Colombia: evidence from a national health survey and recommendations for health-care services.

The purpose of this study was to assess the prevalence of, and the factors associated with HIV testing and pre- and post-test counselling (PPTC) in Colombia. Cross-sectional data from the National Health Survey carried out during 2007 were analysed. Data were gathered from records of 29,760 individuals between the ages of 18 and 69 from the main regions of the country. Only 19.7% of the sample had taken an HIV test. Men, people with no education, those not affiliated with the health-care system, residents of rural areas and those aged older than 65 were less likely to have been tested for HIV; 42% of those tested did not receive pre-test counselling and 56.9% received no report of the results. Considering the low prevalence of HIV testing among the Colombian population, it is necessary to design and apply guidelines for HIV screening in all health-care settings and to conduct targeted testing in high-risk sub-populations. A national norm of PPTC in those who undergo HIV testing should be examined.

Long-term complications and survival of patients after orthotopic liver transplantation.

INTRODUCTION: The survival rates among patients after orthotopic liver transplantation (OLT) has increased to 83% and 75% at 1 and 5 years, respectively. However, these patients are at increased risk of long-term complications. OBJECTIVE: To identify long-term complications and survivals among patients after OLT. METHODS: From September 1999 to July 2009 we evaluated long-term complications among 78 consecutive patients after OLT including 46 males. RESULTS: Complications de novo after OLT were metabolic (n = 38; 67%), infections (n = 13; 23%), recurrent liver disease (n = 12; 21%), osteopenia/osteoporosis (n = 10; 18%), acute/chronic rejection (n = 8; 14%), renal failure (n = 2; 4%) and Kaposi's sarcoma (n = 1). Their overall survival at 118 months was 55%. CONCLUSIONS: The most common long-term complications after OLT were metabolic, infections, and disease recurrence.

Producción de una bacterina para inmunización de potros frente a Rhodococcus equi / A bacterine output for fouls immunization against Rhodococcus equi

Rhodococcus equi es un importante patógeno causante de neumonía piogranulomatosa muy grave en potros menores de tres meses. En este trabajo se describe un brote de la enfermedad en una Yeguada Militar. Tras el aislamiento e identificación del agente causal y la determinación de su sensibilidad a los antibióticos, se preparó una vacuna inactivada por calor y formaldehído para la inmunización de yeguas gestantes y potrillos de más de 6 semanas de vida. El resultado tras diez años de aplicación sistemática de la misma ha sido satisfactorio, no habiéndose dado ningún nuevo caso de esta patología ni presentado reacciones adversas locales o sistémicas (AU)

Rhodococcus equi is an important pathogen, causing quite serious piogranulomatous pneumonia within less than three months fouls. In this paper, an outbreak in a stud, Military livestock, is described. After isolation and identification of the causing agent, as much as its antimicrobial susceptibility determination, an inactivated vaccine, by heat and formaldehyde, was performed for immunization of pregnant mares and little fouls, with more than six weeks of life. The result, after ten years with systematic application of the vaccine was well satisfactory, without any new case of this pathology and without adverse reactions, local or systemic (AU)

NT-polyplex: a new tool for therapeutic gene delivery to neuroblastoma tumors.

Neurotensin (NT)-polyplex is a nonviral system for the targeted gene delivery to cells that express and internalize the high-affinity NT receptor (NTSR1). In hemiparkinsonian rats, we previously demonstrated the morphological and functional recovery from dopaminergic neurodegeneration using the NT-polyplex as a vehicle to transfect a neurotrophic gene. The main objective of this work was to demonstrate the feasibility of NT-polyplex to transfect reporter or therapeutic genes into neuroblastoma tumors through the blood stream or by intratumoral injection. N1E-115 cells known to express NTSR1 were allografted into athymic mice to generate the neuroblastoma tumor model. Both routes of administration allowed the NT-polyplex to reach and transfect tumoral cells. A low transgene expression was also detected in intestinal tract cells only after the injection into the blood stream. The transfection of the thymidine kinase (HSVTK) suicide gene followed by ganciclovir (GCV) treatment decreased the size and weight of neuroblastoma tumors by 30-50% and increased apoptosis compared to controls. This study shows the potential of the NT-polyplex as specific gene-transfer system for NTSR1 cancer cells.

Contribución del laboratorio de microbiología a la prevención y control de la legionelosis / No disponible

No disponible

No disponible

Legionella: biología y ecología. Análisis microbiológico de muestras de agua / No disponible

No disponible

No disponible

Actuaciones inspectoras relacionadas con el control y prevención de la legionelosis: análisis de muestras (2006) / No disponible

No disponible

Eficacia terapéutica del Nimesulide en el tratamiento de la dorso lumbalgia de origen traumático / Therapeutic effectiveness of the nimesulide in the treatment of the low back pain of traumatic origin

Se realizó un estudio abierto, no controlado, multicéntrico, realizado con intención de tratar, en 60 pacientes con dorsolumbalgia mecánica, en el cual evaluó la efectividad y seguridad de nimesulide 100 mg dos veces al día, administrado durante 15 días. El tratamiento produjo un alivio significativo en los escores de dolor entre el día de inicio del tratamiento y los 5 días, con un alivio adicional importante entre los días 5 y 10, sin alivios adicionales para el día 15. El tiempo medio para la desaparición total del dolor fue de 8,5 días. La limitación funcional fue evaluada el día 0 y el día 15, obteniéndose una mejoría significativa desde el punto de vista estadístico. Se reportaron efectos adversos en 4 de los pacientes, de los cuales sólo uno ameritó la suspensión del tratamiento

Análisis de supervivencia de homoinjertos implantados en posición aórtica / Analysis of survival of homografts implanted in aortic position

Se realizó un análisis exploratorio de la supervivencia de los homoinjertos implantados en posición aórtica en los pacientes sometidos a cirugía de implante, durante el período de 1989 a 1996, a partir de los registros primarios de este evento facilitados por la Clínica Santa María de Medellín. Tomando como referencia, el año en el cual se practicó la cirugía de implante y bajo el supuesto de que la supervivencia del paciente esta determinada por el tiempo de vida de la válvula (homoinjerto), se encontró una disminución paulatina de la supervivencia de esta a medida que transcurre el tiempo, alcanzando una probabilidad de supervivencia del 53,6 por ciento al octavo año. Dado que no se tiene certeza de la causa básica de muerte del paciente sometido a implante sea la falla de la válvula, es de suma importancia realizar estudios para hacer un calculo más ajustado de el tiempo de vida de esta y conocer los factores que contribuyen a su deterioro a partir de la determinación de la causa real de muerte

Comparison of two methods for the discrimination of avoidable perinatal deaths.

This paper analyzes the validity and reliability of a method proposed by HERMAN et al [8] used to classify avoidable neonatal deaths. This method is based on a list of amenable medical conditions with an a priori decision about the avoidance of deaths. The results obtained using this method are compared to those derived from the discussion of individual cases by a committee created ex profeso. The population under study includes all neonatal deaths occurred at a third level hospital in Mexico City, from January 1, 1987 to July 31, 1994 (n = 1337). Only 56% of neonatal deaths could follow HERMAN's classification (n = 749). Poor concordance (Cohen's Kappa = 0.30) between the two methods was found. A high proportion of deaths (72.7%) was classified ambiguously (as possibly preventable), and also a considerable proportion of deaths could not be classified (44%). High sensitivity (96%) was found for the small percentage of cases in which avoidance was determined by the method under assessment (15%). A priori classification is useful for developing rough quality indicators at the regional level but not at hospital settings.

PIP: Two methods for the identification of avoidable perinatal deaths (the first based on a Perinatal Mortality Committee [COMOPer] audit using the Ninth Revision of the International Disease Classification and the second on a computerized list developed by Herman et al.] were compared through use of data from the National Institute of Perinatology in Mexico City, Mexico. While the Herman method entails an a priori determination about the avoidability of deaths by cause, the other is derived from a discussion of individual cases by a committee of experts. Analyzed were the 1337 neonatal deaths occurring at the institution during 1987-94; fetal and infant deaths were excluded because of their lack of fit with the Herman model. Of the 749 neonatal deaths (56%) in which Herman's list could be applied, 173 were classified as avoidable, 541 as possibly avoidable, and 35 as nonavoidable. In contrast, COMOPer designated 230 of these same deaths as avoidable, 514 as nonavoidable, and 5 as undeterminable. Only 38% of neonatal deaths assessed by COMOPer as avoidable and 6% of those judged unavoidable were so classified by the Herman method. This extremely low concordance (Cohen's Kappa, 0.30) indicates the importance of a case-by-case analysis that takes into account the factors underlying the most frequent local pathologies as well as local health policies (e.g., the legality of abortion). Although an a priori classification system can enable the assessment of rough indicators of the quality of medical care at a regional level, a careful analysis of individual deaths by a multidisciplinary group of experts is important to identify deficiencies in the quality of care at the local hospital level.

Congenital cardiac malformations in Adams-Oliver syndrome.

Two patients with Adams-Oliver syndrome and congenital cardiac malformations are described. A literature review revealed at 13.4% occurrence of congenital cardiac malformations in individuals with Adams-Oliver syndrome, suggesting that cardiac anomalies are a frequent manifestation of this syndrome. All patients with Adams-Oliver syndrome (aplasia cutis congenita and terminal digital anomalies) should be evaluated for cardiac anomalies.

[The reproductive characteristics of adolescents and young adults in Mexico City]. / Características reproductivas de adolescentes y jóvenes en la Ciudad de México.

This article presents the preliminary findings of the Survey on Teenagers and Youth Reproductive Behavior in the Metropolitan Area of Mexico City, which contains information on 1,010 teenagers and young adults from 10 to 25 years of age interviewed in 1987. The average age was 17 years; 51.7 per cent of those interviewed were male and 48.3 per cent were female. A total of 14.6 per cent were married, being the average age at marriage 19.2 years for males and 17.8 years for females. Menarche occurred at an average age of 12.4 years, and spermarche at 14. Of those interviewed, 32.7 per cent have had sexual intercourse at least once in their lives. The average age at which sexual activity had begun, in the case of males, was 16 years and for females, 17 years. Of this group, 33.8 per cent stated that they had used some form of contraception during the first sexual intercourse; the contraceptive methods used most often were rhythm and withdrawal. The main source of supply of other methods is the pharmacy, in 67 per cent. 18.4 per cent of women had been pregnant, and 20.4 per cent of men's partners had presented this same condition. The first pregnancy occurred at 17.8 years for women and 18.7 for men. Of those men and women with a pregnancy experience 66.1 per cent and 57.3 per cent, respectively, stated that their first pregnancy was an unplanned one. Also, first pregnancy was related to their first marriage in 48.1 per cent of women and 82.4 per cent of male. The data presented here will reinforce current knowledge and will enable us to obtain a profile of the reproductive behavior of teenagers and young adults in the metropolitan area of Mexico City.

Aberrant right subclavian artery with left aortic arch: associated cardiac anomalies.

Anomalous origin of the right subclavian artery (ARSA) from the aorta distal to the normally positioned left subclavian artery is a relatively frequent congenital anomaly in subjects with left aortic arch. The purpose of this study was to determine the relative frequency of associated cardiovascular anomalies in individuals with this anomaly. From the records of approximately 11,000 pathologic specimens in the Registry of Cardiovascular Disease of United Hospital (St. Paul, MN, USA), we found 128 (1.2%) with ARSA. Of the 128 ARSA, 117 (2.9%) occurred among 4102 instances of congenital heart disease. The 117 cases with congenital heart disease and ARSA were conotruncal anomalies in 38%, septal defects in 28%, obstructive anomalies of the left side of the heart in 21%, right heart anomalies in 5%, and miscellaneous conditions in the other 8%. Down syndrome existed in 14 (12%) of the 117 specimens with ARSA and some congenital cardiac anomaly; nine of the latter had an atrioventricular canal (AVC) malformation.

[The design of a monitoring system for the development of quality assurance programs]. / Diseño de un sistema de monitoría para el desarrollo de programas de garantía de calidad.

The need for the development of a monitoring system as a support emerged in Mexico from the experience acquired during the implementation of Quality Assurance Programs. The monitoring system is designed around the goals, activities performed to achieve the goals and the problems encountered in their achievement. The system conducts to the creation of indicators and standards for the monitoring of the essential activities for an optimal performance. The current article produces the grounds for the development of a quality assurance program through a monitoring system with the characteristics previously described.

[The causes of perinatal death in the health institutions of Mexico City]. / Causas de muerte perinatal en instituciones de salud de la ciudad de México.

We determined the main causes of death in 798 perinatal deaths which took place among 32,701 births at several health institutions in Mexico City during the summer of 1984, in accordance with the Wigglesworth Classification. We evaluated the concordance among the codifiers of the causes, with a 92% result (P less than 0.0001). The main causes of death were: conditions associated to asphyxia and prematurity in all health institutions (public assistance, social security and private hospitals). The distribution according to birth weight showed that, in almost 50% of the deaths due to asphyxiation, the child's birth weight was greater than 2,500 g, which suggests that their were deficiencies in the medical attention given to those children.

[Quality circles as a strategy of a medical care quality assurance program at the Perinatology National Institute]. / Círculos de calidad como estrategia de un programa de garantía de calidad de la atención médica en el Instituto Nacional de Perinatología.

The present article shows the methodology of implantation of a quality guarantee program of medical attention through quality circles at the National Institute of Perinatology and it's results. Among them emphasize the following: organization's structure effects. The optimum on resources in it's own process of attention on the satisfaction of the patients and in the learning implicated in the adaptation of the technology to the hospital environment and the characteristics of a different culture from which that technology emerged. The project, conceived as investigation-action, was advised by Public Health Investigation Center and was created with the purpose to secure that the organized conditions under which the medical attention are given were those permitting to raise the quality as much in the among personal dimension as in the technical, through the participation of the personnel directly responsible of the services given. This led to the use of quality circles as participant technical of quality control and as main quality guarantee program of medical attention. Seven stages can be identified in the implantation of the quality assurance program using the quality circles: 1) to elaborate the proposal document and work protocol; 2) negotiation; 3) drawing of a guide for the elaboration of a quality guarantee manual; 4) selection the point of starting; 5) elaboration of the quality guarantee manual by service; 6) to operate the quality circles; 7) evaluation of the program. This experience has demonstrated it's feasible using the quality circles as fundamental components of a quality guarantee program of medical attention and permits to secure that, in general, it is possible to use this technology in the health services.

[Program of quality assurance at the primary level of health care]. / Programa de garantía de calidad en el primer nivel de atención.

Health care quality assurance is an increasing demand of our social environmental, regarding not only high medical technology centers but, even more so, the services given at the primary care level, that covers the greater part of the population. In this paper we describe a quality assurance program implemented through "quality circles" within the immunization program of a primary health care center. The study was done in several stages. In the first two steps (preliminary diagnosis of the local immunization program, and coverage evaluation) the main problems affecting the program's quality were identified. In turn, these results allowed the implementation of the next phases: integration of the quality circles, elaboration of a quality assurance manual, and actual operation of the quality circles. A methodology first developed in a third level care institution was applied in this quality assurance program, which, on the other hand, showed immediate benefits on the services rendered.