[Changes in prescriptions and antibiotic consumption after the implementation of recommendations for use: experience in a university hospital]. / Cambios en las prescripciones y el consumo de antimicrobianos, luego de la implementación de recomendaciones de uso: experiencia en un hospital universitario.

BACKGROUND: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of ß-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. AIM: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. METHODS: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. RESULTS: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. CONCLUSIONS: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.

Cambios en las prescripciones y el consumo de antimicrobianos, luego de la implementación de recomendaciones de uso: experiencia en un hospital universitario / Changes in prescriptions and antibiotic consumption after the implementation of recommendations for use: experience in a university hospital

Resumen Introduccion: Actualmente cerca de la mitad de las prescripciones de antimicrobianos son inadecuadas, lo que aumenta la resistencia bacteriana. Tanto cefalosporinas como fluoroquinolonas se asocian con este fenomeno: aumento de bacterias productoras de β-lactamasas e infecciones por Clostridioides difficile, por lo que las agencias reguladoras buscan racionalizar su uso. Objetivo: Evaluar el efecto de recomendaciones para el uso adecuado de antimicrobianos en la proporcion de prescripciones inadecuadas de ceftriaxona y fluoroquinolonas. Metodologia: Se desarrollo un estudio de antes y despues, prospectivo e intervencional, que comparo la calidad y la cantidad de uso de ceftriaxona y fluoroquinolonas antes y despues de la implementacion de recomendaciones de uso para tratamientos de enfermedades infecciosas adquiridas en la comunidad. Los parametros medidos fueron: proporcion de prescripciones inadecuadas y DDD. Los datos se analizaron por medio del test de χ2, correccion de Fisher y test de Student. Resultados: Se evaluaron 206 pacientes, observandose una disminucion de 35% en las prescripciones inadecuadas, una reduccion del consumo de ceftriaxona y levofloxacina y un aumento significativo de la utilizacion de ampicilina/sulbactam. Conclusiones: La implementacion de recomendaciones de uso basadas en evidencia cientifica y susceptibilidad local, permitieron disminuir la proporcion de prescripciones inadecuadas y reducir el consumo de ceftriaxona y fluoroquinolonas.

Background: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of β-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. Aim: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. Methods: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. Results: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. Conclusions: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.

[Laparoscopic ureterovesical repair for megaureter treatment]. / Plastia ureterovesical laparoscópica para el tratamiento del megauréter.

BACKGROUND: An alternative treatment for obstructive and refluxing obstructive megaureter with ureterovesical junction maintenance through laparoscopy is proposed. MATERIAL AND METHODS: The series consists of 8 cases, all of them studied because of prenatal hydronephrosis or febrile urinary tract infection. Seven were diagnosed with obstructive megaureter and one with obstructive refluxing megaureter. The procedure consisted in incising the stenotic portion of the ureter longitudinally and maintaining its posterior wall attached to the bladder, the anterior wall of the ureter was anastomosed transversally to the bladder mucosa in order to liberate the obstruction. RESULTS: Two of the 8 cases were women and 6 were male. They were aged between 5 months and 11 years (average age of 2.9 years). The surgical time varied between 90 and 120min, with a 48h hospital stay. The permanence of the vesical catheter and the double J stent was of 48h and 6 weeks, respectively. A female patient developed febrile urinary tract infection one week after the surgical procedure. The rest of the patients remained asymptomatic, with normal urinalysis and quarterly urine culture results. Six months after the procedure, the ultrasound showed improvement of the ureteral diameter and of the pyelocaliceal ectasia. The average follow-up was of 2 years. DISCUSSION: The handling of stenosis with longitudinal incision of the ureter and transverse anastomosis to the bladder mucosa, seems promising. The laparoscopic approach allows to identify clearly the longitude of the stenotic segment and join with relative precision such opening with the one of the vesical mucosa.

Maternal Deaths Databases Analysis: Ecuador 2003-2013.

Background: Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate. Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC). Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC's website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences. Results: The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women's socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications. Conclusions: Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks. A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet.

Factor de riesgo suicida según dos cuestionarios, y factores asociados en estudiantes de la universidad nacional de Colombia sede Manizales / Suicide risk factors measured with two questionnaires, and associated factors among students of the universidad nacional de Colombia of Manizales

Objetivo: Determinar el factor de riesgo (FR) suicida según dos cuestionarios y factores asociados que presentan los estudiantes de la Universidad Nacional de Colombia, sede Manizales (Caldas, Colombia) en la jornada diurna. Materiales y métodos: La investigación fue de tipo corte transversal; la población estuvo constituida por 255 estudiantes de 3 facultades de la Universidad. Resultados: Prevalencia de riesgo suicida: 6,7 %, según Plutchik; 19,7 %, según Beck. Buena funcionalidad familiar: 39,8 %. Depresión ausente: 55,7 %. Se encontró una relación significativa entre el FR suicida, según Plutchik, y factores como el género, el gusto por el metal y la balada, la práctica de un deporte, hacer aeróbicos, la presencia de cuadros depresivos y la funcionalidad familiar. Según Beck, dichos factores son género musical metal, depresión y funcionalidad familiar. Conclusiones: La prevalencia de riesgo suicida en esta población es inferior a la encontrada en otros estudios en poblaciones similares.

Objective: to determine suicide risk and other related factors according to two surveys conducted at the Universidad Nacional de Colombia of Manizales (Caldas, Manizales). Materials and Methods: cross-sectional design with 255 students of 3 programs of the Universidad Nacional. Results: prevalence of suicide tendency according to Plutchik: 6,7 %; according to Beck: 19,7 %. Good family functioning: 39,8 %; absent depression: 55,7 %. A significant correlation was found between suicide risk factor (Plutchnik) and gender, metal musical, exercise, depression, and family functioning. According to Beck, these factors are metal musical gender, depression and family functioning. Conclusions: The prevalence of suicide risk in this population is below the average when compared to other research.

Toluene impairs learning and memory, has antinociceptive effects, and modifies histone acetylation in the dentate gyrus of adolescent and adult rats.

Toluene misuse usually initiates at an early age when the central nervous system is still immature, causing deleterious effects such as cognitive impairment. Epigenetic regulatory mechanisms have been proposed to explain long-term changes involved not only in memory, but also in toluene's actions. The aim of this study was to evaluate the effects of acute and chronic toluene exposure on learning, memory and histone acetylation in the rat hippocampus during two stages of life: adolescence and young adulthood. Because the memory tests used in this work involved object exploration and the perception of a noxious stimulus, general activity and nociception tests were also conducted. Acute and chronic toluene inhalation impaired learning, short-term and long-term memory in an object-recognition test and in an inhibitory avoidance task in both groups of age. This effect was concentration-dependent and occurred even at low toluene concentrations (1000, 2000 ppm) that were otherwise non-effective. Acute toluene inhalation produced antinociception, and tolerance to this effect developed after chronic exposure. Histone acetylation in the dentate gyrus showed differences depending on the histone, treatment and age: a single toluene exposure increased H4 acetylation in adolescents and young adult rats, whereas chronic exposure decreased H3 acetylation, but only in adults. In conclusion, this work provides evidence of toluene-induced impairment on learning, short- and long-term memory in adolescent and young adult rats, and shows that even a single toluene exposure can induce epigenetic modifications in the rat hippocampus.