Impact of rapid, culture-independent diagnosis of candidaemia and invasive candidiasis in a community health system.

Background: Delay in treatment of candidaemia and invasive candidiasis remains a cause of significant morbidity and mortality in high-risk patients. Widespread empirical utilization of antifungal therapy often occurs in an effort to minimize this risk. Objectives: This study assessed the impact of the T2Candida Panel in a multi-hospital community health system on time to initiation of antifungal therapy in candidaemic patients as well as the utilization of micafungin. Methods: Outcomes were compared between those patients with candidaemia prior to T2Candida implementation and those after implementation. Micafungin utilization for patients with suspected candidaemia/invasive candidiasis was compared with that for patients with a negative T2Candida Panel post-implementation. Results: There was a significant decrease in time to appropriate therapy in the post-T2Candida group (34 versus 6 h, P = 0.0147). Empirical antifungal therapy was avoided in 58.4% of T2Candida-negative patients. Conclusions: These results support the implementation of T2Candida to improve time to appropriate therapy for candidaemic patients while simultaneously expanding antimicrobial stewardship efforts to appropriately utilize antifungals.

Cutaneous pseudolymphoma secondary to exogenous pigment in a polychrome tattoo

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Expresión de TGFß1 por fibroblastos de mucosa oral expuestos a radiación ultravioleta B / TGF1 expression by oral mucosa fibroblasts exposed to ultraviolet ß1 radiation

El objetivo de este estudio fue evaluar el efecto de la radiación ultravioleta (UV) B sobre la expresión del factor de crecimiento transformante (TGF) ß1 por fibroblastos de mucosa oral, con el objetivo de dilucidar si este tipo celular puede contribuir a la expresión de TGFß1 en bermellón labial sobreexpuesto a la radiación UV. Se obtuvieron cultivos primarios de fibroblastos desde explantes de mucosa bucal, los que fueron irradiados con una dosis única de luz UVB (60 mJ/cm2). Se midió proliferación celular con el método MTT, y la expresión de TGFß1, a nivel de ARN mensajero (normalizado a GAPDH) por RT-PCR y a nivel de proteína mediante inmunofluorescencia. Se observó una disminución de la proliferación celular de los fibroblastos de mucosa oral a las 24 hrs post-irradiación en relación a los fibroblastos no irradiados (P<0,05, Mann Whitney). No se encontraron diferencias entre los fibroblastos control y los irradiados en la expresión de TGFß-1 ni a nivel de mensajero (0,5 y 6 h post-irradiación), ni de proteína (24 h post-irradiación). Los resultados sugieren que los fibroblastos de mucosa oral presentan una disminución de su proliferación en respuesta a una dosis única de radiación UVB, sin que se afecte la expresión de TGFß-1, la que fue similar a los fibroblastos no irradiados. Esto sugiere que los fibroblastos contribuirían a la producción de TGFß-1 en respuesta a la exposición crónica a UVB del bermellón labial.

The objective of this study was to characterize the effect of Ultraviolet (UV) B irradiation on the expression of transforming growth factor (TGF) ß1 by oral mucosa fibroblasts, in order to assess if these cells contribute to the production of TGFß-1 in UV-irradiated lip vermillion. Primary cultures of fibroblasts were obtained from oral mucosa explants, and were irradiated with a single dose of UVB light (60 mJ/cm2). The effects of UVB radiation on cell proliferation was evaluated by the MTT method. The effects of UVB on the expression of TGF-ß1 was analyzed by RT-PCR (normalized to GAPDH) and by immunofluorescence. The results showed a decrease in the proliferation of UVB-irradiated fibroblasts as compared to controls at 24h post-irradiation (p<0.05). No variations in the expression of TGFß1, both at the mRNA and protein level, were observed between control and UVB-irradiated fibroblasts during the first 24 h after irradiation. Oral mucosa fibroblasts have reduced proliferation in response to a single dose of UVB, but their expression of TGFß1 was not affected. This suggests that oral mucosa fibroblasts may contribute to the production of TGFß1 in the lip vermillion independent of UVB exposure.

Ergonomics principles to design clothing work for electrical workers in Colombia.

The recent development of the Colombian legislation, have been identified the need to develop protective clothing to work according to specifications from the work done and in compliance with international standards. These involve the development and design of new strategies and measures for work clothing design. In this study we analyzes the activities of the workers in the electrical sector, the method analyzes the risks activity data in various activities, that activities include power generation plants, local facilities, industrial facilities and maintenance of urban and rural networks. The analyses method is focused on ergonomic approach, risk analysis is done, we evaluate the role of security expert and we use a design algorithm developed for this purpose. The result of this study is the identification of constraints and variables that contribute to the development of a model of analysis that leads to the development the work protective clothes.

Soleus neurotomy for treatment of the spastic equinus foot. Groupe d'Evaluation et de Traitement de la Spasticité et de la Dystonie.

OBJECTIVE: This prospective, nonrandomized, noncontrolled study was performed to evaluate the results of a new type of neurotomy, namely the soleus neurotomy, for treatment of the spastic equinus foot. METHODS: Between May 1996 and March 1998, 46 patients were treated for a spastic equinus foot. Clinical status, spasticity (Ashworth Scale score), and kinematic parameters of the gait were determined before and after surgery. The neurotomy was performed on the upper nerve of the soleus in all cases and was associated with other neurotomies (lower nerve of the soleus, 21 patients; gastrocnemius, 9 patients, tibialis posterior, 18 patients; flexor hallucis longus, 16 patients; and flexor digitorum longus, 17 patients). RESULTS: The mean follow-up period was 15 months (range, 8-28 mo). The equinus deformity disappeared clinically in all patients. Before the operation, all patients had an Ashworth Scale score of 2, with an inexhaustible clonus present on knee extension and persisting with knee flexion (Tardieu Scale score, 4), which was abolished in 95% of the patients after surgery. Two patients still had some clonus on knee extension; this did not interfere with their clinical improvement. Knee recurvatum disappeared in eight patients. Analysis of kinematic parameters demonstrated a statistically significant increase in joint motion of the second rocker (P = 0.0026) of the ankle during stance. The duration of the stance or swing phase, length of the walking cycle, and velocity or rate of spontaneous walking were not significantly modified. CONCLUSION: The study demonstrated that soleus neurotomy is effective for the treatment of spastic equinus foot, leading to abolition of spasticity and improvement in the range of ankle motion during the stance phase of gait.

[Application of RUG-T18 classification system to elderly patients admitted to a university hospital]. / Resultados al aplicar el sistema de clasificación de pacientes "RUG-T18" en ancianos ingresados a un hospital universitario.

BACKGROUND: Among case mix classifications, the best for hospitalized elders is the Resource Utilization Groups (RUG) system, which allows a better location of patients, resource administration and the design of health care strategies for elderly people. AIM: To report the results of RUG-T18 classification of elderly patients admitted to an university hospital. PATIENTS AND METHODS: RUG-T18 classification was applied to 210 patients aged 75.2 +/- 7.2 years old, 108 male, admitted to the Clinical Hospital of the Catholic University of Chile. RESULTS: The clinical classification of assessed patients was rehabilitation in 50.9% of cases, special care in 10.5%, clinically complex in 37.1% and reduced physical functions in 0.5%. None had behavioral alterations. There were no differences between subjects older or younger than 75 years old. Daily life activities showed that help was required for sphincter control in 46% of patients, for feeding in 44% and for mobilization in 64% (28% of patients required help from two or more people). Geriatric assessment showed that, since 1993, the proportion of elders with greater functional derangement increased from 18 to 28%, and the proportion of those with mental disturbances from 4 to 12%, specially among those over 75 years old. CONCLUSIONS: Most elders admitted to the hospital are classified in the superior categories of the RUG-T18 system and have severe mental and functional limitations. These patients require a multidisciplinary approach with a great emphasis in rehabilitation.

[Geriatric evaluation of elderly patients at a university hospital]. / Evaluación geriátrica de adultos mayores en un hospital universitario.

The aim of this work was to evaluate general aspects, medical diagnoses, degree of disability, mental status and social support of hospitalized elders using a Geriatric Assessment Scale, devised at the Catholic University. Ninety eight hospitalized subjects (58 female, aged 60 to 74 years old) were surveyed before discharge. Results showed that 34% had serious handicaps in their daily living and required third party help, 14% had a moderate cognitive impairment and that 12% lacked social or family support. We conclude that the scale is useful, easy to use and allows to obtain a thorough diagnosis of hospitalized elders.

[Hypomagnesemia associated with hypokalemia, hyponatremia and metabolic alkalosis. Possible complication of gentamycin therapy]. / Hipomagnesemia asociada con hipokalemia, hiponatremia y alcalosis metabolica. Posible complicacion del uso de gentamicina.

Hypomagnesemia is a serious abnormality with different causes and usually associated to other disorders of electrolyte metabolism. We report a female patient developing hypomagnesemia after administration of gentamycin. This was associated to severe hypokalemia, hyponatremia and metabolic alkalosis. Possible pathogenetic mechanisms and therapeutic measures are discussed.

[Active rheumatoid arthritis: effect of dietary supplementation with omega-3 oils. A controlled double-blind trial]. / Artritis reumatóidea activa: efecto de la suplementación dietética con aceites omega 3. Estudio doble ciego controlado.

We evaluated the effect of dietary supplementation with eicosapentaenoic acid in 8 patients with active rheumatoid arthritis. An appropriate placebo was given in a randomized double blind fashion to 8 control subjects. After 12 weeks of therapy a significant improvement in prehensile function was detected in patients receiving active treatment, other clinical parameters remaining unchanged. No significant side effects were detected. A larger trial may help define a possible therapeutic role for omega-3 fatty acids in patients with rheumatoid arthritis.