Caracterización de las readmisiones precoces en la hospitalización psiquiátrica / Characterization of early readmissions in psychiatric hospitalization

Objetivos: Describir y comparar las características clínicas y demográficas asociadas con la readmisión temprana comparada con las asociadas a readmisiones tardías y las personas que tienen solo una hospitalización. Método: Se revisó de forma retrospectiva los registros clínicos de los pacientes admitidos en un servicio de psiquiatría en Santiago de Chile, desde el 1 de julio de 2001 hasta el 30 de junio de 2010. Se comparan y analizan las características de las hospitalizaciones asociadas con readmisión temprana, readmisión tardía y aquellos con sólo una admisión. Resultados: La readmisión temprana fue precedida por hospitalizaciones más cortas en comparación con los pacientes que tenían una readmisión tardía. No hubo diferencias de género y edad, pero cuando se comparan los diagnósticos entre el grupo sin readmisión v/s el grupo con reingresos, encontramos que los trastorno psicóticos y el trastorno bipolar tienen una mayor representación en el grupo de la readmisión tardía, y el trastorno bipolar en el caso de reingreso precoz. Conclusiones: La readmisión temprana estaría relacionada principalmente con las características particulares de la enfermedad en cada individuo y se agrupan en los trastornos que por su naturaleza tienden a ser más crónicos y recurrentes.

Aims: Describe and compare clinical and demographic characteristics associated with early readmissions compared with those associated with delayed rehospitalizations and individuals having only one hospitalization. Methods: We retrospectively reviewed clinical and demographic records of all patients admitted to a psychiatric service in Santiago, Chile, from July 1, 2001 to June 30, 2010. We compare and analyze the characteristics of hospitalizations associated with early readmission, delayed readmision and no readmission. Results: Early readmission was preceded by shorter hospitalizations compared with patients who had a delayed admission in the period. There were no gender and age differences, but when comparing the diagnoses between the group without rehospitalization with the group with readmissions, we found that psychotic and bipolar disorder have greater representation in the group with delayed readmission, and bipolar disorder in the case of early readmission. Conclusions: Early readmission would be primarily related to the particular characteristics of each individual disease and disorders are grouped by their nature tend to be chronic and recurrent.

Estrategias para implementar un programa de escritura en estudiantes de enfermería: experiencia piloto / Strategies to implement a writing syllabus for nursing students: a pilot experience

Introducción: la implementación de programas de "Escritura a través del Currículum" (del inglés Writing across the curriculum, WAC) ha demostrado mejorar las habilidades de escritura y los conocimientos de la propia disciplina en estudiantes universitarios. El objetivo del presente trabajo fue evaluar algunas de las estrategias identificadas como efectivas para mejorar la escritura de los estudiantes, en un curso piloto de una Escuela de Enfermería. Métodos: se conformó una comunidad de WAC, integrada por profesores, una asesora lingüística y ayudantes de escritura, y se implementaron estrategias probadamente efectivas. Para evaluar las estrategias implementadas se utilizó una actividad de escritura libre y el instrumento "Evaluación de las tareas de escritura". Resultados: tanto los profesores como los estudiantes estuvieron satisfechos con las estrategias utilizadas. Por otro lado, aunque los estudiantes no mostraron cambios en la percepción de sus habilidades para escribir, disminuyeron significativamente los errores en los informes que elaboraron. Conclusión: fue posible identificar estrategias que serían parte de un programa de WAC replicable que permitiría incrementar las habilidades de escritura en los estudiantes(AU)

Introduction: Implementation of "Writing across the curriculum" (WAC) syllabuses has shown to improve writing skills and knowledge about the discipline among university students. A pilot course was implemented in a nursing school to evaluate some of the strategies identified as effective to improve writing skills among students. Methods: A WAC community was constituted, made up of teachers, a linguistic advisor and writing assistants. Proven effective strategies were implemented. Evaluation of the strategies implemented was based on a free writing activity and the tool "Evaluation of writing assignments". Results: Both teachers and students were pleased with the strategies used. Even though students' perception of their own writing skills did not change, there was a significantly lower number of errors in the reports they wrote. I Conclusion: It was possible to identify the strategies to be included in a replicable WAC program allowing to improve writing skills among students(AU)

[Etiology of febrile neutropenia episodes among cancer patients from Hospital Clinico Universidad Catolica, Santiago-Chile]. / Etiología de episodios de neutropenia febril en pacientes adultos con cáncer hematológico y de órganos sólidos en el Hospital Clínico Universidad Católica, Santiago-Chile.

INTRODUCTION: The surveillance of febrile neutropenia (FN) episodes in every center allows adapt the antibiotic therapy guidelines to local epidemiology. AIM: To characterize clinical features and compare the FN etiology between hematological cancer (HC) and solid organ cancer (SOC) in our center. PATIENTS AND METHODS: Surveillance study in adult patients with FN admitted to Hospital Clinico Universidad Católica, in Santiago, Chile, from January 2004 to August 2007. RESULTS: 154 FN episodes corresponding to 87 patients were included. Mean age: 47 +/- 6 years-old; 71% had HC and 29% SOC. A clinical and/or microbiologically documented infection was recognized in 76%. Gastrointestinal 31.5%, upper respiratory 30.3% and lower respiratory 16.9% were the more frequent clinical focus. In 30.5% blood culture resulted positive: gram negative rods 51%, gram positive cocci 41% and yeasts 8%; being Escherichia coli 22%, S. coagulase negative (SCoN) 20% and Klebsiella pneumoniae 12% most frequent bacteria; 22.2% Enterobacteriaceae were ESBL producers and 55.6% 5CoN were methicillin resistant. In 18.3% of FN episodes the etiology was not established. Highest mortality was observed in episodes with microbiologically documented infection (14.5% vs 1.3%, p < 0.005). A clinical observed focus and positive blood cultures were more frequently obtamed among HC than SOC associated episodes: 37.3% vs 13.6%; (p < 0.01) and 67.2% vs 50%; (p = 0.045), respectively. CONCLUSIONS: The etiological profile of FN in our center and the necessity to continue the surveillance was described. Future studies are needed regarding risk factors of invasive infection that have worst prognosis.

[Invasive fungal disease in hemato-oncological and hematopoietic stem cell transplantation patients from Hospital Clinico Universidad Católica, Santiago-Chile using revised EORTC/MSG diagnostic criteria]. / Enfermedad fúngica invasora en pacientes hemato-oncológicos y receptores de trasplante de precursores hematopoyéticos bajo la perspectiva de los criterios diagnósticos EORTC/MSG.

INTRODUCTION: Invasive fungal disease (IFD) is a severe complication occurring mostly in haematooncological (H-O) patients and hematopoietic stem cell transplant (HSCT) receptors. Our aim was to describe the IFD occurring in our H-O and HSCT patients according to the EORTC/MSG revised criteria. PATIENTS AND METHODS: IFD surveillance was performed in adult patients of the Hospital Clínico Universidad Catolica, Santiago, Chile, from January 2004 to January 2008. RESULTS: A total of 41 IFD episodes were identified in 39 patients; mean age was 46.6 +/- 9.9 years, and 87.8% and 12.2% occurred in H-O and HCTS patients respectively. 15/41(36.6%) episodes were proven, 36.6% probable and 11/41 (26.8%) possible. In 26 (63.4%) episodes aspergillosis was diagnosed (20 pulmonary, 3 sinus, 1 laryngeal and 1 case with pulmonary and cerebral involvement). In 7 patients (17.1%) candidiasis was diagnosed, 5 with a proven bloodstream infection and 2 with possible hepatosplenic candidiasis; mucormyeosis was diagnosed in 4 (9.8%) Fusarium infection was demonstrated in 2 patients (4.9%), and Mucor and Aspergillus pulmonary coinfection and Alternaria sp rhino-sinusitis in one patient each. The frequency of IFD among febrile neutropenic patients was 26.2% and 6.4% in H-O and HSCT receptors respectively. The overall mortality was 36%. CONCLUSIONS: Aspergillosis is the most common IFD infection among H-O patients and HSCT receptors in our center. Candidiasis followed although only in H-O patients most probably because of routine use of antifungal prophylaxis in HSCT recipients. Continuous surveillance is required to develop local guidelines and to evaluate antifungal strategies in different clinical scenarios.

Enfermedad fúngica invasora en pacientes hemato-oncológicos y receptores de trasplante de precursores hematopoyéticos bajo la perspectiva de los criterios diagnósticos EORTC/MSG / Invasive fungal disease in hemato-oncological and hematopoietic stem cell transplantation patients from Hospital Clinico Universidad Católica, Santiago-Chile using revised EORTC/MSG diagnostic criteria

Introduction: Invasive fungal disease (IFD) is a severe complication occurring mostly in haemato-oncological (H-O) patients and hematopoietic stem cell transplant (HSCT) receptors. Our aim was to describe the IFD occurring in our H-O and HSCT patients according to the EORTC/MSG revised criteria. Patients and Methods: IFD surveillance was performed in adult patients of the Hospital Clínico Universidad Católica, Santiago, Chile, from January 2004 to January 2008. Results: A total of 41 IFD episodes were identified in 39 patients; mean age was 46.6 ± 9.9 years, and 87.8 percent and 12.2 percent occurred in H-O and HCTS patients respectively. 15/41(36.6 percent) episodes were proven, 36.6 percent probable and 11/41 (26.8 percent) possible. In 26 (63.4 percent) episodes aspergillosis was diagnosed (20 pulmonary, 3 sinus, 1 laryngeal and 1 case with pulmonary and cerebral involvement). In 7 patients (17.1 percent) candidiasis was diagnosed, 5 with a proven bloodstream infection and 2 with possible hepatosplenic candidiasis; mucormyeosis was diagnosed in 4 (9.8 percent) Fusarium infection was demonstrated in 2 patients (4.9 percent), and Mucor and Aspergillus pulmonary coinfection and Alternaría sp rhino-sinusitis in one patient each. The frequency of IFD among febrile neutropenic patients was 26.2 percent and 6.4 percent in H-O and HSCT receptors respectively. The overall mortality was 36 percent. Conclusions: Aspergillosis is the most common IFD infection among H-O patients and HSCT receptors in our center. Candidiasis followed although only in H-O patients most probably because of routine use of antifungal prophylaxis in HSCT recipients. Continuous surveillance is required to develop local guidelines and to evaluate antifungal strategies in different clinical scenarios.

Introducción: La enfermedad fúngica invasora (EFI) es una complicación grave en pacientes hemato-oncológicos (H-O) y receptores de trasplante de precursores hematopoyéticos (TPH). Objetivo: Describir las EFI diagnosticadas en pacientes adultos H-O y receptores de TPH de nuestro centro, bajo los criterios diagnósticos revisados de EORTC/MSG. Pacientes y Métodos: Estudio de vigilancia de EFI en pacientes adultos del Hospital Clínico de la Pontificia Universidad Católica de Chile entre enero 2004 y enero 2008. Resultados: Se identificaron 41 episodios de EFI, correspondientes a 39 pacientes: 46,6 ± 9,9 años, 87,8 por ciento H-Oy 12,2 por ciento TPH. Se documentaron 15/41 (36,6 por ciento) EFI demostrada, 36,6 por ciento probable y 11/41 (26,8 por ciento) posible. En 26/41 (63,4 por cientoo) se diagnosticó aspergilosis (20 pulmonar, 3 rinosinusal, 1 laríngeo y un caso cerebral-pulmonar). En 7/41 (17,1 por ciento) se diagnosticó candidiasis, 5 candidemias y 2 candidiasis hepato-esplénica posibles; 4/41 (9,8 por cientoo) correspondió a mucormicosis demostrada (2 rinosinusal, 1 oral y 1 pulmonar); en 2/41 (4,9 por cientoo) fusariosis; 1/41(2,4 por ciento)) coinfección pulmonar por mucoral y Aspergillus sp y 1 caso de rinosinusitis por Alternaría sp. La frecuencia de EFI entre pacientes H-O con neutropenia febril fue 26,2 por ciento) y 6,4 por ciento) en los receptores de TPH. La mortalidad global fue de 36 por ciento). Conclusiones: Aspergilosis es la EFI más frecuente en H-O y receptores de TPH de nuestro centro. Candidiasis es la segunda EFI en frecuencia; sin embargo, no se documentó entre los pacientes receptores de TPH, lo que puede relacionarse al uso de antifúngicos profilácticos en este grupo. Es necesaria la vigilancia continua para desarrollar guías clínicas locales y evaluar estrategias de uso de antifúngicos en distintos escenarios clínicos.

Etiología de episodios de neutropenia febril en pacientes adultos con cáncer hematológico y de órganos sólidos en el Hospital Clínico Universidad Católica, Santiago-Chile / Etiology of febrile neutropenia episodes among cancer patients from Hospital Clinico Universidad Catolica, Santiago-Chile

Introduction: The surveillance of febrile neutropenia (FN) episodes in every center allows adapt the antibiotic therapy guidelines to local epidemiology. Aim: To characterize clinical features and compare the FN etiology between hematological cáncer (HC) and solid organ cancer (SOC) in our center. Patients and Methods: Surveillance study in adult patients with FN admitted to Hospital Clinico Universidad Católica, in Santiago, Chile, from January 2004 to August 2007. Results: 154 FN episodes corresponding to 87 patients were included. Mean age: 47 ± 6 years-old; 71 percent had HC and 29 percent SOC. A clinical and/or microbiologically documented infection was recognized in 76 percent. Gastrointestinal 31.5 percent, upper respiratory 30.3 percent and lower respiratory 16.9 percent were the more frequent clinical focus. In 30.5 percent blood culture resulted positive: gram negative rods 51 percent, gram positive cocci 41 percent and yeasts 8 percent; being Escherichia coli 22 percent, S. coagulase negative (SCoN) 20 percent and Klebsiella pneumoniae 12 percent most frequent bacteria; 22.2 percent Enterobacteriaceae were ESBL producers and 55.6 percent 5CoN were methicillin resistant. In 18.3 percent of FN episodes the etiology was not established. Highest mortality was observed in episodes with microbiologically documented infection (14.5 percent vs 1.3 percent, p < 0.005). A clinical observed focus and positive blood cultures were more frequently obtamed among HC than SOC associated episodes: 37.3 percent vs 13.6 percent; (p < 0.01) and 67.2 percent vs 50 percent; (p = 0.045), respectively. Conclusions: The etiological profile of FN in our center and the necessity to continue the surveillance was described. Future studies are needed regarding risk factors of invasive infection that have worst prognosis.

Introducción: La vigilancia de la etiología de los episodios de neutropenia febril (NF) en cada centro permite adaptar guías de antibioterapia a la epidemiología local. Objetivo: Caracterizar y comparar la etiología de la NF en pacientes con cáncer hematológico (CH) y de órganos sólidos (COS). Pacientes y Métodos: Estudio de vigilancia de NF de pacientes adultos en el Hospital Clínico Universidad Católica, en Santiago, Chile, entre enero 2004 y agosto 2007. Resultados: 154 episodios de NF correspondientes a 87 pacientes: 47 ± 6 años; 71 por ciento CH y 29 por ciento COS. Se documentó infección clínica y/o microbiológicamente en 76 por cientoo. Más frecuente fueron: foco gastrointestinal 31,5 por ciento, respiratorio alto 30,3 por cientoo y respiratorio bajo 16,9 por cientoo. En 30,5 por cientoo hubo hemocultivos positivos: bacilos gramne-gativos en 51 por ciento, cocáceas grampositivas en 41 por ciento, levaduras en 8 por cientoo; predominando: Escherichia coli 22 por cientoo, Staphylococcus coagulasa negativa (SCoN) 20 por cientoo y Klebsiella pneumoniae 12 por ciento; 22,2 por cientoo de las entero-bacterias eran productoras de (3-lactamasa de espectro expandido y 55,6 por cientoo >SCoN meticilina resistentes. En 18,3 por cientoo de los episodios no se identificó causa de fiebre. Hubo mayor mortalidad en episodios con documentación microbiológica (14,5 por ciento vs 1,3 por ciento, p < 0,005). En los pacientes con CH fue más frecuente obtener hemocultivos positivos (37,3 por cientoo vs 13,6 por ciento; p < 0,01) e identificar foco clínico (67,2 por ciento vs 50 por ciento; p = 0,045). Conclusiones: Se establece el perfil etiológico de las NF en nuestro centro y la necesidad de mantener vigilancia. En futuros estudios será necesario evaluar factores de riesgo de pacientes con infecciones invasores que tendrían peor pronóstico.

Diversity and distribution of ferns in sub-Saharan Africa, Madagascar and some islands of the South Atlantic.

Aim This paper reports the diversity and endemism patterns of African ferns, and explores the potential role of diversity refuges and environmental and historical factors in the shaping of these patterns. Material and locations The extant fern taxa occupying Africa south of the Sahara, Madagascar and some islands of the South Atlantic. Methods The number of taxa in each area or operational geographical unit (OGU) was scored, and the correlation between this number and physical and climatic variables analysed by standard pairwise and stepwise multiple regression analysis (SPR and SMR). The effects of biological factors such as dispersal capacity, reproductive biology, genetic features and certain physiological adaptations were evaluated by comparing the number of species in each OGU. Floral affinities among OGUs were analysed using non-metric multi-dimensional scaling (NMS) and parsimonic analysis of dispersion (PAD), and compared with ß-turnover and inter-OGU distances. Results OGU area, elevation and the distance between refuges determined the composition of local floras, but only greater OGU area and the existence of higher maximum elevations increased species richness. The distance between refuges also affected the number of endemic species, especially on islands. The biological features studied only slightly influenced fern distribution. The main climatic predictor of species number was humidity. SPR and SMR revealed three main groups of ferns with different ecological trends. NMS and PAD analyses separated the four areas of highest diversity in Africa, three of which are inhabited by ferns with distinct ecological requirements. The fourth area was Madagascar, which shows an accumulation of endemic and relict diversity that is not easy to explain. Main conclusions The distribution of ferns in Africa has been influenced by refuges. These probably allowed many species to recolonize the neighbouring areas after the extinctions of the Pleistocene. Three major components were detected in the African flora: Guinea-Congolian thermophilous, cold-tolerant Afro-montane, and Southern drought-tolerant elements. These are related to the three main refuge areas, i.e. the Gulf of Guinea area, the eastern tropical region, and the Cape region. Endemicity in ferns was found to be lower than that of seed plants due to the higher dispersability of fern spores. The distance between OGUs seems to be the main predictor of the number of endemic fern species these areas contain.

Impacto de la eclampsia en la morbimortalidad materna y perinatal / Impact of the eclampsia in maternal and perinatal morbimortality

Objetivo: Determinan la incidencia de la eclampsia y evaluar su impacto sobre la morbilídad y mortalidad materna y perinatal. Material y método: Se realizó un estudio retrospectivo desde 1988 a 1998 en el hospital Guillermo Grant Benavente Concepción, Chile. Se analizaron 117 pacientes con eclampsia y sus recién nacidos, incluidos 6 gemelares, fueron excluidas de este estudio todas las pacientes con convulsiones no eclámpticas, el análisis estadístico se efectuó mediante la obtención de promedios, medianas y tasas. Resultados: La incidencia fue de 0.17 por ciento La mayoría de las pacientes eran primigestas (76 por ciento) y el 45,3 por ciento adolescentes El 82 por ciento tuvieron control prenatal. Los signos más frecuentes de eclampsia fueron aumento de los reflejos osteotendinosos 50,4 por ciento, cefalea 37,6 por ciento y vómitos 11,1 por ciento. El promedio de la presión arterial fue de 206/110 mmHg. El 68,4 por ciento convulsionó durante la gestación, 5,1 por ciento intraparto y 9,4 por ciento postparto. Los pacientes tuvieron un promedio de 2,4 convulsiones. La mayoría (82,9 por ciento) recibió terapia medicamentosa con sulfato de magnesio, Las patologías asociadas más frecuentemente fueron parto prematuro (34,2 por ciento), retardo del crecimiento intrauterino (25,2 por ciento) y DPPNI (5,2 por ciento). La cesárea se presentó en el 87,2 por ciento de los casos. Las complicaciones multisistémicas ocurrieron principalmente en los territorios cardiorespiratorio 19,7 por ciento, neurológico 13.7 por ciento, hematológico 11.1 por ciento y renal 2,6 por ciento. El 34,2 por ciento de los recién nacidos presentó asfixia al nacer, el 43,9 por ciento eran prematuros y el 25,2 por ciento presentó RCIU. Hubo 8 muertes maternas (6,8 por ciento) por complicaciones multisistémicas. La tasa de mortalidad materna fue de 1,17x 10.000 Nacidos Vivos (N.V), la tasa de mortalidad fetal tardía de 1,32 x 10.000 N.V (9 casos) y la neonatal precoz de 0,44 x 10.000 N.V (3 casos). La mortalidad perinatal fue de 1,76 X 10.000 N.V. Conclusión: La eclampsia tiene un impacto negativo en la morbimortalidad materna y perinatal (AU)