Prevención de infecciones asociadas a cuidados de la salud en pacientes quemados / Prevention of healthcare-associated Infections in burn patients

Las infecciones asociadas a cuidados de la salud (IACS) son una de las complicaciones más importantes que presentan los pacientes gran quemados. Aumentan su morbimortalidad, la duración de su estadía, el consumo de antimicrobianos y los costos hospitalarios. Las tasas reportadas de IACS son muy variables entre los distintos países y centros de atención.El ánimo de esta publicación es brindar el material necesa-rio y actualizado de las medidas de control de infecciones que se deben implementar en la atención de los quemados ya que no es fácil disponer de información sobre este tema.En la presente revisión se analizaron estudios de distin-tas poblaciones, adultos y niños, con diferentes tipos que-maduras y diversos lugares de atención. Se utilizó como material de referencia las recomendaciones vigentes de la Sociedad Internacional de injurias por Quemaduras (ISBI, por su sigla inglés) y se adicionaron publicaciones y expe-riencias de grupos de trabajo local e internacional referen-tes en el tema.Se describen cinco tipos de medidas de control y preven-ción de IACS: medidas generales, medidas de higiene am-biental, prevención de la infección de los lechos de las que-maduras, profilaxis antibiótica y medidas de prevención de neumonía, infecciones asociadas a catéteres vasculares y vesicales en quemados. Es esencial implementar un enfoque proactivo y multidisci-plinario del control de infecciones en la atención de estos pacientes, generando recomendaciones adaptadas a la realidad de cada centro de salud, destinadas a disminuir las transmisión cruzada de microorganismos, utilizar los antimicrobianos tópicos y sistémicos en forma adecuada, disminuir la multirresistencia, reducir las IACS y su mor-talidad

Healthcare-associated infections (HAIs) are one of the most important complications of severe burn patients. They increase their morbidity and mortality, length of stay, antimicrobial consumption, and hospital costs. Re-ported rates of IACS vary widely across countries and care settings.The purpose of this publication is to provide the nec-essary and up-to-date material on the infection control measures that should be implemented in the care of burn patients, since it is not easy to have information on this subject.In this review, we analysed studies of different popula-tions, adults and children, with different types of burns and different places of care. The current recommenda-tions of the International Society of Burn Injuries (ISBI) were used as reference material, and publications and experiences of local and international working groups on the subject were added. Five types of IACS control and prevention measures are described: General mea-sures, Environmental hygiene measures, Prevention of infection of burn injuries, Antibiotic prophylaxis and pre-vention measures for pneumonia, infections associated with vascular and bladder catheters in burn patients.Conclusion: It is essential to implement a proactive and multidisciplinary approach to infection control in the care of these patients, generating recommendations adapted to the reality of each health center, aimed at reducing cross-transmission of microorganisms, using typical and systemic antimicrobials appropriately, reduc-ing multiresistance, reducing HAIs and their mortality

Implementation of physiotherapy telerehabilitation before and post Covid-19 outbreak: A comparative narrative between South American countries and Australia.

The continuous development in telecommunication tech-nologies has created opportunities for health professionals to optimise healthcare delivery by adopting digital tools into rehabilitation programs (i.e., telerehabilitation). These tech-nological advances, along with the demographic and social characteristics of each country, have made the implementa-tion of telerehabilitation a disparate process across regions. We have gathered the experience of four countries (Australia, Chile, Brazil, and Colombia) in two different regions (Ocea-nia and South America) to recompile the history pre- and post-Covid-19 outbreak until January of 2021, the barriers to, and facilitators of telerehabilitation, and outline the future challenges for these countries.

Report of two events of nosocomial outbreak and pseudo-outbreak due to contamination with Achromobacter spp / Comunicación de 2 eventos de brote y seudobrote nosocomial debido a contaminación con Achromobacter spp

Abstract Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.

Resumen Achromobacter spp. son reconocidas con mayor frecuencia como patógenos emergentes en pacientes con fibrosis quística e inmunodeprimidos, pero son inusuales en hospedadores inmunocompetentes o quirúrgicos. En este estudio describimos 2 eventos simultáneos atribuibles a 2 fuentes contaminadas con Achromobacter spp. Uno correspondió a un episodio de seudobacteriemia por tubos de citrato de sodio contaminados con Achromobacter insuavis y el otro a infecciones y colonizaciones debidas al uso de solución jabonosa de clorhexidina intrínsecamente contaminada con Achromobacter genogrupo 20. Ambos episodios pusieron en peligro el uso apropiado de antimicrobianos. Los enfoques moleculares fueron fundamentales para lograr la identificación precisa de las especies y evaluar la relación clonal de los aislamientos, lo que refuerza la necesidad del trabajo perseverante y multidisciplinario de microbiólogos, especialistas en enfermedades infecciosas, epidemiólogos y enfermeras en el control de infecciones para el esclarecimiento de estas situaciones epidemiológicas.

Resistencia antimicrobiana y producción porcina de cría intensiva / Antimicrobial resistance and intensive swine production: mini review

Introducción: el impacto de la resistencia antimicrobiana (RAM) generará un aumento de las muertes relacionadas de 10 millones anuales hacia 2050. El 70% de la dispensación de antimicrobianos (ATB) se utiliza en la agroveterinaria y no en salud humana. Es fundamental conocer la portación de RAM en trabajadores de cría de animales y en los animales, para acciones tempranas de salud pública. Métodos: bajo metodología PRISMA se realizó la búsqueda bibliográfica en distintas fuentes disponibles hasta octubre de 2020. Se priorizaron revisiones sistemáticas, metanálisis, ensayos clínicos y estudios observacionales para determinar la RAM en trabajadores de cría de cerdos. De 990 artículos identificados se incluyeron 8 estudios. Resultados: la tasa de colonización por Staphylococcus aureus resistente a la meticilina (SAMR) en trabajadores fue mayor que la de la población general. La prevalencia de SAMR fue significativamente mayor en trabajadores en contacto directo con animales y los de granjas de cría intensiva con respecto a los de extensiva. En cerdos, la prevalencia de RAM en cría intensiva fue significativamente mayor que la de los de cría extensiva. También fue significativa la asociación entre el suministro de antibióticos en la cría intensiva y la presencia de RAM. Las granjas de más de 1250 cerdos presentaron mayor prevalencia de RAM (p < 0,001). El fenotipo de SAMR en cerdos, trabajadores y el ambiente fue el mismo. Conclusiones: existe evidencia de asociación entre la producción agrícola de cría intensiva y la RAM en cerdos y trabajadores. No se encontraron estudios de vigilancia epidemiológica en la Argentina en trabajadores de cría de animales. (AU)

Introduction: it is estimated that the impact of antimicrobial resistance (AMR) will generate an increase of 10 million deaths by 2050, being reflected to a greater extent in low-income countries. 70% of the annual use of antimicrobials is concentrated in agroveterinary but not in human health. Considering the presence of AMR in ranchers and agricultural workers is essential for early public health actions. Methods: using the PRISMA methodology, bibliography was searched in different sources until October 2020. Systematic reviews, meta-analyses, clinical trials and observational studies were prioritized to determine AMR in pig workers. Eight studies of the 990 found have been included. Results: the rate of colonization by methicillin-resistant Staphylococcus aureus (MRSA) in farming workers was higher than the general population. MRSA prevalence was significantly higher in workers who reported direct contact with animals. And also in those workers of intensive farms compared to those of extensive farms. The same situation is observed in swines, in which the prevalence of AMR in intensive farming was significantly higher than in extensive farming. The association between the supply of antibiotics in intensive farming workers and the presence of AMR was also significant. Farms with more than 1,250 swines had a higher prevalence of AMR (p<0.001). The MRSA phenotype found in swine, agricultural workers, and the environment was the same. Conclusions: there is scientific evidence of an association between agricultural production in intensive livestock farming and AMR in swine and farming workers. There aren't Argentine studies of epidemiological surveillance in farming workers. (AU)

Impact of Three Safety Interventions Targeting Off-Label Use of Immediate-Release Fentanyl on Prescription Trends: Interrupted Time Series Analysis.

Background: The Spanish health authorities are concerned by the off-label use of immediate-release formulations of fentanyl (IRF) in noncancer pain and cancer pain in patients with no chronic pain therapy. Aim: To evaluate the impact of different interventions to improve appropriateness of IRF prescription on off-label prescription. Patients and methods: We used interrupted time series (ITS) to estimate immediate and trend changes of IRF prescription for noncancer pain (NCP) and breakthrough cancer pain (BCP) in patients with and without chronic cancer pain therapy associated with two medication reviews (I1 and I2) and the issue of a safety warning letter (I3) with data from a Spanish region with 5 million inhabitants, from 2015 to 2018. Results: The use of IRF for NCP in the region Valencia was reduced from about 1,800 prescriptions per week to around 1,400. The first medication review was followed by an immediate level change of -192.66 prescriptions per week (p < 0.001) and a downward trend change of -6.75 prescriptions/week (p < 0.001), resulting in a post-intervention trend of -1.99 (p < 0.001). I2 was associated with a trend change of -23.07 (p < 0.001) prescriptions/week. After I3, the trend changed markedly to 27.23 additional prescriptions/week, for a final post-intervention trend of 2.17 (p < 0.001). Controlled-ITS provided comparable results. For potentially inappropriate BCP use, the second medication review was followed by a downward, immediate level change of -10.10 prescriptions/week (p = 0.011) and a trend change of 2.31 additional prescriptions/week (p < 0.001) and the issue of the safety warning (I3) was followed by a downward trend change of -2.09 prescriptions/week (p = 0.007). Conclusion: Despite IRF prescription for NCP decreased, the interventions showed modest and temporary effect on off-label prescription. Our results call for a review of the design and implementation of safety interventions addressing inappropriate opioid use.

Report of two events of nosocomial outbreak and pseudo-outbreak due to contamination with Achromobacter spp.

Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.

12 pasos para reducir la incidencia de carbapenemasas / 12 steps to mitigate the incidence of carbapenemases

La resistencia a los antimicrobianos es un grave problema para la salud mundial. Es aún más crítico en los hospitales debido a la aparición de bacterias Gram negativas resistentes a múltiples fármacos, asociadas a una alta mortalidad. Las opciones de tratamiento en estos casos son escasas, en general de alto costo. La alta densidad de consumo de antibióticos y la transmisión cruzada en este entorno amplifican este problema.Hay más evidencia del impacto de las medidas de control de infecciones que de las intervenciones de comités de antimicrobianos para mitigarlo. Además, pocos países cuentan con programas sólidos de control de infecciones para enfrentar este problema. En la presente revisión se propone una serie de 12 pasos a adoptar para mitigar la prevalencia de resistencia antimicrobiana y reducir la incidencia de carbapenemasas en las instituciones de salud. Estas recomendaciones deben interpretase como un ̈bundle ̈o paquete de medidas, en el cual todas son importantes. Aquellas que involucran la prevención de infecciones y/o colonizaciones y su diseminación son las de mayor impacto demostrado hasta ahora. Es esencial que los programas de optimización de uso de antimicrobianos cuenten con el empoderamiento de la conducción de las instituciones donde se lleven a cabo, así como también que estén constituidos por un equipo multidisciplinario eficiente, sólidamente entrenado, con metas y métricas objetivas y auditorias periódicas. También es recomendable que se incluyan recomendaciones para los tratamientos en pacientes en cuidados de fin de vida.

Antimicrobial resistance is a serious global health problem. It is even more critical in hospitals due to the emergence of multi-drug resistant Gram negative bacteria, associated with high mortality. The treatment options in these cases are scarce, generally high cost. The high density of antibiotic consumption and cross-transmission in this environment amplifies this problem.There is more evidence of the impact of Infection Control measures than of Antimicrobial Committee interventions to mitigate it. Furthermore, few countries have solid Infection Control programs to deal with this problem.This review proposes a series of 12 steps to adopt to mitigate the prevalence of antimicrobial resistance and reduce the incidence of carbapenemases in health institutions. These recommendations should be interpreted as a ̈Bundle ̈ or package of measures, in which all are important. Those that involve the prevention of infections and / or colonizations and their dissemination are the ones with the greatest impact demonstrated so far. It is essential that antimicrobial use optimization programs have the empowerment of the leadership of the institutions where they are carried out, as well as that they are constituted by an efficient multidisciplinary team, solidly trained, with objective goals and metrics and periodic audits. It is also recommended that recommendations be included for treatments in patients in end-of-life care.

Factores asociados al miedo y ansiedad en pacientes que asisten a consulta odontológica: Estudio Transversal / Factors associated with fear and anxiety in patients attending a dental care: A cross-sectional study

Antecedentes: Las personas que sienten miedo y ansiedad muestran peores condiciones de salud bucal, postergando las citas odontológicas hasta tal punto de evitarlas. Objetivo: Determinar los factores asociados al miedo y la ansiedad en pacientes atendidos en las clínicas de la Facultad de Odontología de la Universidad Cooperativa de Colombia. Materiales y métodos: Se realizó un estudio cuantitativo tipo descriptivo transversal con 198 pacientes atendidos en las clínicas de la facultad de Odontología. Se aplicaron las encuestas: Dental Fear Survey (DFS), Escala de Ansiedad Dental de Corah Modificada (MDAS) y una tercera encuesta para identificar: características sociodemográficas y elementos, situaciones y sensaciones asociados a miedo a la ansiedad durante la consulta. Resultados: El 92,4% de los participantes presentaron algún grado de miedo en la consulta odontológica. El 48,7% presento ansiedad en algún grado. La presencia del miedo y ansiedad se encontró asociada con la evaluación de las experiencias previas en la consulta odontológica (Vp <0,001), evidenciado en la mayor proporción de individuos con miedo alto y ansiedad severa cuya experiencia fue negativa en comparación con las frecuencias observadas para aquellos con clasificación de ansiedad leve o moderada y miedo nulo o bajo. Conclusiones: Las experiencias traumáticas previas están relacionadas con el miedo y la ansiedad dental y pueden influir en el adecuado desarrollo de la consulta odontológica, por lo que se recomienda indagar al paciente acerca de estas antes de iniciar atención odontológica.

Background: People who feel fear and anxiety show worse oral health conditions than those who not, thus delaying dentist appointments to the point of cancelling all together. Aim: Determine the degree of fear, anxiety and associated factors in patients seen in the clinics of the Faculty of Dentistry of the Universidad Cooperativa de Colombia. Materials and methods: A quantitative cross-sectional descriptive study was conducted with patients treated in clinics of the Faculty of Dentistry, for a universe of 941, a sample of 198 participants were calculated, not randomly selected. Three surveys were applied by the DFS (Dental Fear Survey), the MDAS (Anxiety Scale Modified Corah Dental) and a third survey to identify sociodemographic variables and factors associated with fear and anxiety. Results: The 92.4% of the participants presented some degree of fear in the dental practice. 48.7% have anxiety to some degree. The presence of fear and anxiety was found associated with the evaluation of previous experiences in dental practice (Vp <0.001), evidenced in the highest proportion of individuals with high fear and anxiety whose experience was negative compared to the frequencies observed for those with mild or moderate anxiety and zero or low fear. Conclusion: Previous traumatic experiences are related to fear and dental anxiety and can influence the proper development of the dental appointments, so it is recommended to inquire about these before starting with a dental treatment.

[Multicenter study of adherence to guidelines on surgical prophylaxis and the determinants of non-adherence in ArgentinaEstudo multicêntrico sobre a adesão a diretrizes de profilaxia cirúrgica e seus determinantes na Argentina]. / Estudio multicéntrico de adherencia a guías de profilaxis quirúrgica y sus determinantes en Argentina.

OBJECTIVE: Evaluate the level of adherence to guidelines on surgical prophylaxis in health facilities in Argentina and the determinants of non-adherence. METHODS: Cross-sectional multicenter study in 35 centers in Argentina. The level of adherence to guidelines and the forms of non-adherence were determined and these were compared based on the characteristics of the indicated antibiotic, anesthesiologist, surgery, and facility, as well as patient age. An adjusted logistic regression model was used. RESULTS: A total of 1,083 surgical procedures were reviewed. Adherence to guidelines was 67%. The most frequent forms of non-adherence were: incorrect antibiotic (28.9%), unnecessary prophylaxis (25.5%), and prolonged prophylaxis (24.4%). Adherence to guidelines was higher in persons under 18 years of age (84.9% compared to 65.5%, p < 0.001). According to the type of health coverage (social welfare, private insurance, public coverage, or community coverage), adherence was 33.3%, 64.4%, 78.8%, and 83.3%, respectively; p < 0.001. According to population (maternal and child, pediatric, specific pathologies, and general pathologies), adherence was 97.9%, 97.2%, 89.4%, and 63.2%, respectively; p < 0.001. Adherence was highest in neurosurgery (91.1%), obstetrics (82.4%), and cardiovascular surgery (72.9%), and lowest in otorhinolaryngology (47.8%), ophthalmology (50%), and urology (55.9%) (p < 0.001). The adjusted analysis showed the highest adherence to guidelines in persons under 18 (odds ratio [OR]: 4.97; 95% confidence interval [CI 95]: 1.13-21.80); emergency surgery (OR: 2.18; CI 95: 1.11-4.26); and public, private, and community facilities (OR: 9.35; CI 95: 3.85-22.70). Adherence was also higher in facilities for maternal and child care and specific pathologies (OR: 10.52; CI 95, 1.30-85.12), cardiovascular surgery, neurosurgery, obstetrics (OR: 2.73; CI 95: 1.55-4.78), and facilities with programs to optimize the use of antimicrobial drugs (OR 1.95; CI 95, 1.10-3.45). CONCLUSIONS: Adherence to guidelines was 67%. Incorrect, unnecessary, and prolonged use of antibiotics were the most frequent forms of non-adherence. Adherence was higher with younger patients, where programs exist to optimize the use of antimicrobial drugs, where there is private or public health coverage, with the pediatric population, for specific pathologies, in emergency surgery, and in certain specialties.

OBJETIVO: Avaliar o nível de adesão às diretrizes (AD) de profilaxia cirúrgica em instituições de saúde da Argentina e os determinantes da não adesão (NA). MÉTODOS: Estudo multicêntrico transversal realizado em 35 centros na Argentina. Determinamos o nível de AD e as formas de NA, comparados segundo as características das seguintes variáveis: indicação antibiótica, anestesista, cirurgia, instituição e idade do paciente. Aplicamos um modelo de regressão logística ajustado. RESULTADOS: Revisamos um total de 1083 procedimentos cirúrgicos. A taxa de AD foi de 67%. As formas mais frequentes de NA foram: antibiótico incorreto (28,9%), profilaxia desnecessária (25,5%) e profilaxia prolongada (24,4%). A AD foi mais elevada em pacientes com menos de 18 anos (84,9% vs. 65,5%, p<0,001); também houve variações segundo o tipo de instituição (instituição de seguridade social, privada, pública ou comunitária, com adesão de 33,3%, 64,4%, 78,8% e 83,3%, respectivamente; p<0,001) e segundo a população (materno-infantil, pediátrica, com patologia específica ou geral, com adesão de 97,9%, 97,2%, 89,4% e 63,2%, respectivamente; p<0,001). A AD foi maior em neurocirurgia (91,1%), obstetrícia (82,4%) e cirurgia cardiovascular (72,9%) e menor em otorrinolaringologia (47,8%), oftalmologia (50%) e urologia (55,9%) (p<0,001). A análise ajustada mostrou uma AD mais elevada em pacientes com menos de 18 anos (odds ratio [OR]: 4,97, intervalo de confiança de 95% [IC95%]: 1,13-21,80), em cirurgias de emergência (OR: 2,18, IC95%: 1,11-4,26) e em instituições públicas, privadas ou comunitárias (OR: 9,35, IC95%: 3,85-22,70). A AD também foi superior em instituições para população materno-infantil ou para populações específicas (OR: 10,52; IC95%: 1,30-85,12), cirurgia cardiovascular, neurocirurgia, obstetrícia (OR: 2,73; IC95%: 1,55-4,78) e em instituições com programas para a otimização do uso de antimicrobianos (OR: 1,95; IC95%: 1,10-3,45). CONCLUSÕES: A AD foi de 67%; as formas mais frequentes de NA foram o uso incorreto, desnecessário e prolongado de antibióticos. A AD foi maior em pacientes mais jovens, em instituições com programas para a otimização do uso de antimicrobianos, em instituições privadas ou públicas e em populações pediátricas ou específicas, nos procedimentos cirúrgicos de emergência e em certas especialidades.

Estudio multicéntrico de adherencia a guías de profilaxis quirúrgica y sus determinantes en Argentina

[RESUMEN]. Objetivo. Evaluar el nivel de adherencia a las guías de profilaxis quirúrgica (AG) en instituciones de salud de Argentina y los determinantes de la falta de adherencia (NA). Métodos. Estudio multicéntrico de corte transversal en 35 centros de Argentina. Se determinaron el nivel de AG y las formas de NA y se comparó según características de la indicación antibiótica, anestesista, cirugía, institución y edad del paciente. Se ajustó un modelo de regresión logística. Resultados. Se revisaron 1 083 procedimientos quirúrgicos (PQ). La AG fue de 67%. Las formas más frecuentes de NA fueron: antibiótico incorrecto (28,9%), profilaxis innecesaria (25,5%) y profilaxis prolongada (24,4%). La AG fue mayor en menores de 18 años (84,9% frente a 65,5%, P < 0,001); según la dependencia (obra social, privada, pública o comunitaria) fue de 33,3%, 64,4%, 78,8% y 83,3%, respectivamente; P < 0,001) y según la población (maternoinfantil, pediátrica, con patología específica y general) fue de 97,9%, 97,2%, 89,4% y 63,2%, respectivamente; P < 0,001). La AG fue mayor en neurocirugía (91,1%), obstetricia (82,4%) y cirugía cardiovascular (CCV) (72,9%) y menor en otorrinolaringología (ORL) (47,8%), oftalmología (50%) y urología (55,9%) (P < 0,001). El análisis ajustado mostró mayor AG en menores de 18 años (odds ratio [OR]: 4,97; intervalo de confianza de 95% [IC95]: 1,13-21,80), cirugía de urgencia (OR: 2,18; IC95: 1,11-4,26) e institución pública, privada o de comunidad (OR: 9,35; IC95: 3,85-22,70). La AG también fue mayor en instituciones para población maternoinfantil o específica (OR: 10,52; IC95, 1,30-85,12), CCV, neurocirugía, obstetricia (OR: 2,73; IC95: 1,55-4,78) e instituciones con programas para la optimización del uso de antimicrobianos (PROA) (OR 1,95; IC95, 1,10-3,45). Conclusiones. LA AG fue de 67%; el uso incorrecto, innecesario y prolongado del antibiótico fueron las formas más frecuentes de NA. La AG fue mayor con menor edad, PROA, dependencia privada o pública y población pediátrica o específica, PQ de urgencia y ciertas especialidades.

[ABSTRACT]. Objective. Evaluate the level of adherence to guidelines on surgical prophylaxis in health facilities in Argentina and the determinants of non-adherence. Methods. Cross-sectional multicenter study in 35 centers in Argentina. The level of adherence to guidelines and the forms of non-adherence were determined and these were compared based on the characteristics of the indicated antibiotic, anesthesiologist, surgery, and facility, as well as patient age. An adjusted logistic regression model was used. Results. A total of 1,083 surgical procedures were reviewed. Adherence to guidelines was 67%. The most frequent forms of non-adherence were: incorrect antibiotic (28.9%), unnecessary prophylaxis (25.5%), and prolonged prophylaxis (24.4%). Adherence to guidelines was higher in persons under 18 years of age (84.9% compared to 65.5%, p < 0.001). According to the type of health coverage (social welfare, private insurance, public coverage, or community coverage), adherence was 33.3%, 64.4%, 78.8%, and 83.3%, respectively; p < 0.001. According to population (maternal and child, pediatric, specific pathologies, and general pathologies), adherence was 97.9%, 97.2%, 89.4%, and 63.2%, respectively; p < 0.001. Adherence was highest in neurosurgery (91.1%), obstetrics (82.4%), and cardiovascular surgery (72.9%), and lowest in otorhinolaryngology (47.8%), ophthalmology (50%), and urology (55.9%) (p < 0.001). The adjusted analysis showed the highest adherence to guidelines in persons under 18 (odds ratio [OR]: 4.97; 95% confidence interval [CI 95]: 1.13-21.80); emergency surgery (OR: 2.18; CI 95: 1.11-4.26); and public, private, and community facilities (OR: 9.35; CI 95: 3.85-22.70). Adherence was also higher in facilities for maternal and child care and specific pathologies (OR: 10.52; CI 95, 1.30-85.12), cardiovascular surgery, neurosurgery, obstetrics (OR: 2.73; CI 95: 1.55-4.78), and facilities with programs to optimize the use of antimicrobial drugs (OR 1.95; CI 95, 1.10-3.45). Conclusions. Adherence to guidelines was 67%. Incorrect, unnecessary, and prolonged use of antibiotics were the most frequent forms of non-adherence. Adherence was higher with younger patients, where programs exist to optimize the use of antimicrobial drugs, where there is private or public health coverage, with the pediatric population, for specific pathologies, in emergency surgery, and in certain specialties.

[RESUMO]. Objetivo. Avaliar o nível de adesão às diretrizes (AD) de profilaxia cirúrgica em instituições de saúde da Argentina e os determinantes da não adesão (NA). Métodos. Estudo multicêntrico transversal realizado em 35 centros na Argentina. Determinamos o nível de AD e as formas de NA, comparados segundo as características das seguintes variáveis: indicação antibiótica, anestesista, cirurgia, instituição e idade do paciente. Aplicamos um modelo de regressão logística ajustado. Resultados. Revisamos um total de 1083 procedimentos cirúrgicos. A taxa de AD foi de 67%. As formas mais frequentes de NA foram: antibiótico incorreto (28,9%), profilaxia desnecessária (25,5%) e profilaxia prolongada (24,4%). A AD foi mais elevada em pacientes com menos de 18 anos (84,9% vs. 65,5%, p<0,001); também houve variações segundo o tipo de instituição (instituição de seguridade social, privada, pública ou comunitária, com adesão de 33,3%, 64,4%, 78,8% e 83,3%, respectivamente; p<0,001) e segundo a população (materno-infantil, pediátrica, com patologia específica ou geral, com adesão de 97,9%, 97,2%, 89,4% e 63,2%, respectivamente; p<0,001). A AD foi maior em neurocirurgia (91,1%), obstetrícia (82,4%) e cirurgia cardiovascular (72,9%) e menor em otorrinolaringologia (47,8%), oftalmologia (50%) e urologia (55,9%) (p<0,001). A análise ajustada mostrou uma AD mais elevada em pacientes com menos de 18 anos (odds ratio [OR]: 4,97, intervalo de confiança de 95% [IC95%]: 1,13-21,80), em cirurgias de emergência (OR: 2,18, IC95%: 1,11-4,26) e em instituições públicas, privadas ou comunitárias (OR: 9,35, IC95%: 3,85-22,70). A AD também foi superior em instituições para população materno-infantil ou para populações específicas (OR: 10,52; IC95%: 1,30-85,12), cirurgia cardiovascular, neurocirurgia, obstetrícia (OR: 2,73; IC95%: 1,55-4,78) e em instituições com programas para a otimização do uso de antimicrobianos (OR: 1,95; IC95%: 1,10-3,45). Conclusões. A AD foi de 67%; as formas mais frequentes de NA foram o uso incorreto, desnecessário e prolongado de antibióticos. A AD foi maior em pacientes mais jovens, em instituições com programas para a otimização do uso de antimicrobianos, em instituições privadas ou públicas e em populações pediátricas ou específicas, nos procedimentos cirúrgicos de emergência e em certas especialidades.

Consenso Argentino intersociedades de Infección Urinaria 2018-2019 - Parte II / Argentine Intersociety Consensus on Urinary Infection 2018-2019 - Part II

La segunda parte del Consenso Argentino Intersociedades de Infección Urinaria incluye el análisis de situaciones especiales. En pacientes con sonda vesical se debe solicitar urocultivo solo cuando hay signo-sintomatología de infección del tracto urinario, antes de instrumentaciones de la vía urinaria o como control en pacientes post-trasplante renal. El tratamiento empírico recomendado en pacientes sin factores de riesgo es cefalosporinas de tercera generación o aminoglucósidos. Las infecciones del tracto urinario asociadas a cálculos son siempre consideradas complicadas. En caso de obstrucción con urosepsis, deberá realizarse drenaje de urgencia por vía percutánea o ureteral. En pacientes con stents o prótesis ureterales, como catéteres doble J, el tratamiento empírico deberá basarse en la epidemiología, los antibióticos previos y el estado clínico. Antes del procedimiento de litotricia extracorpórea se recomienda pesquisar la bacteriuria y, si es positiva, administrar profilaxis antibiótica según el antibiograma. Cefalosporinas de primera generación o aminoglúcosidos son opciones válidas. Se recomienda aplicar profilaxis antibiótica con cefalosporinas de primera generación o aminoglúcosidos antes de la nefrolitotomía percutánea. La biopsia prostática trans-rectal puede asociarse a complicaciones infecciosas, como infecciones del tracto urinario o prostatitis aguda, principalmente por Escherichia coli u otras enterobacterias. En pacientes sin factores de riesgo para gérmenes multirresistentes y urocultivo negativo se recomienda realizar profilaxis con amikacina o ceftriaxona endovenosas. En pacientes con urocultivo positivo, se realizará profilaxis según antibiograma, 24 horas previas a 24 horas post-procedimiento. Para el tratamiento dirigido de la prostatitis post-biopsia trans-rectal, los carbapenémicos durante 3-4 semanas son el tratamiento de elección.

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.

[Argentine Intersociety Consensus on Urinary Infection 2018-2019 - Part II]. / Consenso Argentino Intersociedades de Infección Urinaria 2018-2019 - Parte II.

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.

La segunda parte del Consenso Argentino Intersociedades de Infección Urinaria incluye el análisis de situaciones especiales. En pacientes con sonda vesical se debe solicitar urocultivo solo cuando hay signo-sintomatología de infección del tracto urinario, antes de instrumentaciones de la vía urinaria o como control en pacientes post-trasplante renal. El tratamiento empírico recomendado en pacientes sin factores de riesgo es cefalosporinas de tercera generación o aminoglucósidos. Las infecciones del tracto urinario asociadas a cálculos son siempre consideradas complicadas. En caso de obstrucción con urosepsis, deberá realizarse drenaje de urgencia por vía percutánea o ureteral. En pacientes con stents o prótesis ureterales, como catéteres doble J, el tratamiento empírico deberá basarse en la epidemiología, los antibióticos previos y el estado clínico. Antes del procedimiento de litotricia extracorpórea se recomienda pesquisar la bacteriuria y, si es positiva, administrar profilaxis antibiótica según el antibiograma. Cefalosporinas de primera generación o aminoglúcosidos son opciones válidas. Se recomienda aplicar profilaxis antibiótica con cefalosporinas de primera generación o aminoglúcosidos antes de la nefrolitotomía percutánea. La biopsia prostática trans-rectal puede asociarse a complicaciones infecciosas, como infecciones del tracto urinario o prostatitis aguda, principalmente por Escherichia coli u otras enterobacterias. En pacientes sin factores de riesgo para gérmenes multirresistentes y urocultivo negativo se recomienda realizar profilaxis con amikacina o ceftriaxona endovenosas. En pacientes con urocultivo positivo, se realizará profilaxis según antibiograma, 24 horas previas a 24 horas post-procedimiento. Para el tratamiento dirigido de la prostatitis post-biopsia trans-rectal, los carbapenémicos durante 3-4 semanas son el tratamiento de elección.

Rhizopus microsporus Infections Associated with Surgical Procedures, Argentina, 2006-2014.

Rhizopus spp. fungi are ubiquitous in the environment and a rare but substantial cause of infection in immunosuppressed persons and surgery patients. During 2005-2017, an abnormally high number of Rhizopus infections in surgery patients, with no apparent epidemiologic links, were reported in Argentina. To determine the likelihood of a common source of the cluster, we performed whole-genome sequencing on samples collected during 2006-2014. Most isolates were separated by >60 single-nucleotide polymorphisms, and we found no evidence for recombination or nonneutral mutation accumulation; these findings do not support common source or patient-to-patient transmission. Assembled genomes of most isolates were ≈25 Mbp, and multiple isolates had substantially larger assembled genomes (43-51 Mbp), indicative of infections with strain types that underwent genome expansion. Whole-genome sequencing has become an essential tool for studying epidemiology of fungal infections. Less discriminatory techniques may miss true relationships, possibly resulting in inappropriate attribution of point source.

The role of parental social class, education and unemployment on child cognitive development / El rol de la clase social, la educación y el desempleo parentales en el desarrollo cognitivo infantil

OBJECTIVE: Assessing the association between socioeconomic gradient and cognitive development among children of a Spanish birth cohort aged 5-6 years from a gender perspective. METHOD: Cognitive development was assessed on 525 children aged 5-6 years in the INMA-Valencia cohort, with the Global Cognitive Score (GCS) from McCarthy Scales of Children's Abilities. Information on social class, education level and employment was collected for both parents in addition to other sociodemographic factors, parental, family and child characteristics. The relationship between maternal and paternal socioeconomic gradient and cognitive development was assessed by linear regressions and comparing the variance explained by each indicator measured in the mother and father. RESULTS: Maternal socioeconomic gradient indicators explained more variance on GCS than paternal. Maternal education and paternal social class had an important individual effect that stayed after adjusting by other parental, child and family determinants. In the multivariable analysis, maternal education, age and intelligence, paternal social class and the child's age and sex were significantly associated with cognitive development. CONCLUSIONS: Diverse socioeconomic gradient factors have an important influence on cognitive development, maternal education being the strongest determinant. Policies should be implemented to mitigate the negative effects of this gradient on child development

OBJETIVO: Evaluar la asociación del gradiente socioeconómico y el desarrollo cognitivo en niños y niñas de una cohorte española a los 5-6 años de edad desde una perspectiva de género. MÉTODO: Se evaluó el desarrollo cognitivo en 525 niños/as de 5-6 años de la cohorte INMA-Valencia, mediante la Puntuación Global Cognitiva (PGC) de las Escalas McCarthy para niños y niñas. Se recogió información de ambos progenitores sobre clase social, nivel de estudios y empleo, además de otros factores sociodemográficos, características parentales, de la familia y del niño o la niña. La relación entre el gradiente socioeconómico materno y paterno y el desarrollo cognitivo se evaluó mediante modelos de regresión lineal y comparando la varianza explicada por cada uno de los indicadores medidos en la madre y en el padre. RESULTADOS: Los indicadores de gradiente socioeconómico de la madre explicaron más varianza del índice de PGC que los del padre. La educación materna y la clase social paterna tuvieron un importante efecto individual, que se mantuvo tras ajustar por otros determinantes de los progenitores, del niño o de la niña, y del entorno familiar. En el análisis multivariante, la educación, la edad y la inteligencia maternas, la clase social paterna, y la edad y el sexo del infante se asociaron significativamente con el desarrollo cognitivo. CONCLUSIONES: Distintos factores del gradiente socioeconómico tienen influencia en el desarrollo cognitivo, siendo la educación materna el determinante más fuerte. Deberían implementarse políticas para paliar los efectos negativos de este gradiente en el desarrollo infantil

The role of parental social class, education and unemployment on child cognitive development.

OBJECTIVE: Assessing the association between socioeconomic gradient and cognitive development among children of a Spanish birth cohort aged 5-6 years from a gender perspective. METHOD: Cognitive development was assessed on 525 children aged 5-6 years in the INMA-Valencia cohort, with the Global Cognitive Score (GCS) from McCarthy Scales of Children's Abilities. Information on social class, education level and employment was collected for both parents in addition to other sociodemographic factors, parental, family and child characteristics. The relationship between maternal and paternal socioeconomic gradient and cognitive development was assessed by linear regressions and comparing the variance explained by each indicator measured in the mother and father. RESULTS: Maternal socioeconomic gradient indicators explained more variance on GCS than paternal. Maternal education and paternal social class had an important individual effect that stayed after adjusting by other parental, child and family determinants. In the multivariable analysis, maternal education, age and intelligence, paternal social class and the child's age and sex were significantly associated with cognitive development. CONCLUSIONS: Diverse socioeconomic gradient factors have an important influence on cognitive development, maternal education being the strongest determinant. Policies should be implemented to mitigate the negative effects of this gradient on child development.

COVID-19 y tiroxicosis / COVID-19 and thyrotoxicosis. Case report

La epidemia por COVID-19, causada por el nuevo coronavirus-2 del síndrome respiratorio agudo severo (SARS-CoV-2) ha enfrentado al equipo de salud a un abanico de presentaciones clínicas y alteraciones de las funciones órganicas a las que diagnosticar y tratar. Dentro de estas se encuentra la disfunción tiroidea.En este reporte se presenta el caso de una paciente con taquicardia persistente luego de pasado el cuadro de COVID-19, que derivó en múltiples consultas hasta que se arribó al diagnóstico de tirotoxicosis de etiología autoinmune.La tirotoxicosis asociada a COVID-19 es infrecuente, pero agrega morbilidad a la convalecencia de los pacientes, por lo que su sospecha clínica y diagnóstico rápido serían beneficiosos

The infection by the new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has challenged the health care system with a new spectrum of clinical manifestations and organ disfuntions, that require proper diagnosis and treatment.In this case we report a patient with persistent tachycardia after COVID-19 acute illness. This finding led to multiple medical visits until final diagnosis of thyrotoxicosis of autoimmune etiology.Thyrotoxicosis is an unusual complication of COVID-19, that results in higher morbility in patients during the convalescent phase of the disease. Opportune clinical suspicion and early diagnosis seems to be beneficial in terms of clinical outcome

Antibioticoterapia en estadios finales de la vida / Antibioticotherapy in final stages of life

Introducción: El uso indiscriminado de antibióticos se asocia al incremento de la resistencia. En el cuidado de pacientes en estadios finales de enfermedades avanzadas, el manejo de antibióticos es objeto de controversias. Esta revisión evaluará la evidencia publicada sobre este tema, intentando responder a tres interrogantes. ¿Por qué se indican antibióticos en pacientes terminales? ¿Cuáles son las consecuencias potenciales? ¿Hay una única perspectiva? Discusión: La indicación de antibióticos en estadios finales de la vida obedece muchas veces a la inseguridad de los médicos con respecto a las ventajas y las desventajas de su utilización en este escenario, preferencias de pacientes y familiares, posibilidad de confort o control de síntomas y temor a problemas legales. Sin embargo, no está claro el beneficio de los antibióticos en el control de síntomas ni su impacto en la supervivencia.Conclusiones: La Comisión de Uso Adecuado de Recursos de SADI propone analizar y considerar en cada caso: 1) La decisión de prescribir antibióticos deber ser consensuada con el paciente y sus familiares; 2) Al ingreso de pacientes con enfermedades terminales se deben establecer las posibles conductas a adoptar ante un cuadro infeccioso; 3) Las instituciones deben desarrollar programas tendientes a proteger al paciente y empoderar a los profesionales en la toma de determinaciones; 4) Los programas institucionales de antibióticos deben intervenir en la toma de decisiones en este escenario; 5) El Equipo de Cuidados Paliativos debe ser involucrado en el proceso. Evitar el sobreuso de antibióticos es una consideración esencial de salud pública para minimizar la resistencia antimicrobiana

ntroduction: The indiscriminate use of antibiotics is associated with increased resistance. In the care of patients in late stages of advanced diseases, antibiotic management is the subject of multiple controversies. In this review we will evaluate the published evidence on this topic, based on the answer to three questions: why are antibiotics indicated in terminal patients? What are the potential consequences? Is there a single perspective?Discussion: The indication of antibiotics in the final stages of life is often due to doctors' insecurity regarding the advantages and disadvantages of their use in this scenario, patient and family preferences, possibility of comfort or symptom control, and fear of legal problems. However, the benefit of antibiotics in symptom control or their impact on survival is not clear.Conclusions: The SADI Appropriate Use of Resources Commission proposes to analyze in each case: 1) The decision of prescribing antibiotics must be taken together with the patients and/or his family; 2) At the entrance of patients with terminal illnesses, the possible behaviors to be adopted before an infectious condition must be established; 3) Institutions should develop programs aimed at protecting the patient and empowering professionals in making determinations; 4) The Institutional Antibiotic Program must intervene in decision-making in this scenario; 5) The Palliative Care Team must be involved in the process. Avoiding antibiotic overuse is an essential public health consideration to minimize antimicrobial resistance.

Procesos determinantes del acceso a odontología en niños y niñas durante primera infancia / Determinants for access to dental care in early childhood / Determinações dos processos de acesso à odontologia em crianças durante a primeira infância

Resumen (Analítico): El propósito del estudio fue comprender los procesos estructurales, particulares y singulares que determinan el acceso a la atención odontológica durante la primera infancia a partir del enfoque de la determinación social de la salud. Se utilizó un método mixto desde lo cualitativo de orientación etnográfica y cuantitativo de tipo descriptivo. Incluyó observación no participante, entrevistas grupales e individuales y encuestas. Se encontró que el acceso está determinado por procesos generales como inequidad social, fallas estructurales del sistema y procesos particulares como los patrones de trabajo y consumo de las familias, el sistema de creencias de madres y profesionales, y políticas institucionales. Para mejorar el acceso es necesario realizar procesos tendientes a la transformación de la sociedad, del sistema de salud y de las instituciones, profesionales y cuidadores.

Abstract (analytical): The purpose of this study was to understand structural, specific and singular processes that determine access to dental care in early childhood using a social determinant of health approach. The authors used mixed methods involving qualitative ethnographic and quantitative descriptive techniques. Non-participant observations, group interviews and interviews with coordinators and parents were conducted. We found that the access to this group is determined by inequalities in society, a health system with structural failures and specific processes such as work and consumption patterns, the belief systems of parents and professionals and institutional policies. In order to improve the access it is necessary to carry out processes that contribute to in the general transformation of society and the health system, as well as specific processes with institutions, staff, and providers.

Resumo (analítico): O objetivo do estudo foi compreender os processos estruturais, específicos e singulares que podem determinar o acesso ao atendimento da consulta de medicina dentária na primeira infância a partir de um enfoque da determinação social da saúde. Utilizou-se um método misto com orientação etnográfica e quantitativo de tipo descritivo. Incluíram-se observação não participante, entrevistas em grupo e individuais. Encontrou-se que o acesso a saúde na primeira infância é determinado por processos gerais como desigualdade social, falhas estruturais do sistema de saúde, e pelos processos específicos como os modos de trabalho e de consumo das famílias, as crenças das mães e profissionais e as políticas institucionais. Para obter uma melhoria do acesso das crianças a saúde é preciso fazer uma transformação da sociedade, do sistema de saúde, das instituições, dos profissionais e dos responsáveis pelas crianças.

Efecto agudo del ejercicio físico de intensidad moderada sobre las variables espirométricas en sujetos asmáticos broncodilatados. Prueba piloto / Acute effect of moderate-intensity exercise on spirometric variables in broncodilated asthmatic subjects. A pilot study

RESUMEN Introducción: el broncoespasmo inducido por el ejercicio (BIE) ocurre entre el 70 y 80 % de los asmáticos y su aparición es más frecuente al terminar una sesión de ejercicio físico, principalmente de intensidad vigorosa. Objetivo: evaluar el efecto agudo que puede tener el ejercicio físico de intensidad moderada sobre las variables espirométricas en sujetos asmáticos broncodilatados. Metodología: se realizó un estudio cuasi-experimental de tipo antes y después. Se incluyeron diez sujetos (edad promedio = 23 ± 4 años), los cuales fueron divididos en dos grupos: cinco sujetos asmáticos y cinco sanos. Los dos grupos realizaron 10 minutos de calentamiento, 20 minutos de ejercicio en banda sin fin al 60 % de la frecuencia cardíaca de entrenamiento, seguido de 5 minutos de recuperación. La función pulmonar fue evaluada antes del ejercicio y 15 minutos después del ejercicio. Resultados: se encontraron diferencias estadísticamente significativas entre grupos (con asma 6 % vs. sin asma -1 %, p = 0,03) en los cambios pre y pos del ejercicio de la relación del volumen espiratorio forzado en el primer segundo (VEF1) sobre la capacidad vital forzada (CVF). El análisis multivariado mostró que la CVF post ejercicio en el grupo con asma fue significativamente menor que el del grupo sin asma, ajustado por evaluación basal y masa corporal total. Conclusión: el ejercicio de intensidad moderada en banda sin fin, no mostró diferencias clínicamente significativas sobre los cambios del pre y post ejercicio de las variables espirométricas estudiadas, puesto que estos cambios en VEF1 o CVF no superaron el 10 % teniendo como referencia la evaluación basal.

SUMMARY Background: Exercise-Induced Bronchospasm (BIE) occurs in 70 % to 80 % of asthmatics and its occurrence is more frequent at the end of a session of physical exercise, mainly of vigorous intensity. Objective: To evaluate the acute effect of moderateintensity physical exercise on spirometric variables in asthmatic subjects. Methodology: A before-and-after type quasi-experimental design. Ten subjects were included (mean age= 23 ± 4 years), which were divided into two groups: five asthmatic subjects and five healthy subjects. Both groups performed 10 min of warm-up, 20 min of treadmill exercise at an intensity of 60 % of the Heart Rate Reserve, and a final cool-down of 5 minutes. Lung function was assessed before and 15 minutes after exercise. Results: There were statistically significant differences between groups (with asthma = 6 % vs. without asthma = -1 %, p = 0.03) in the pre-post-exercise changes of the ratio of the forced expiratory volume in one second and the forced vital capacity (FEV1/FVC). The multivariate analysis showed that post-exercise FVC in subjects with asthma was significantly lower than in subjects without asthma, after adjusting for the baseline assessment and total body mass. Conclusion: Moderate-intensity exercise on a treadmill did not shows clinically significant differences on the changes pre-post exercise of the studied spirometric variables, since the changes on FEV1 or FVC did not exceed 10 % having as reference the baseline evaluation.

[Intra-abdominal infections. Update and recommendations]. / Infecciones intraabdominales. Puesta al día y recomendaciones de la Sociedad Argentina de Infectología.

Intra-abdominal infections represent a group of intra and retroperitoneal processes, ranging from localized infections to complicated ones, sepsis and septic shock, associated with a significant mortality rate. They are the third most commonly identified cause of sepsis and the second cause of death in the intensive care unit. Although antimicrobial therapy must be started as soon as possible, especially in critically ill patients, the source control procedure is highly relevant. On account of the importance of this subject, members of the Argentine Society of Infectious Diseases (SADI) and intensive care specialists joined to develop recommendations on diagnosis, treatment, and prevention of intra-abdominal infections. The literature published within the last 10 years was reviewed and analyzed, in addition of expert opinions and local data. This statement provides a basic tool for diagnosis based on clinical and microbiological criteria, orientation on empirical antimicrobial therapy schemes according to source, acquisition place (community or healthcare associated infections), infection severity, treatment duration, importance of source control, and preventive measures aimed to reduce surgical site infection risk. Likewise, it provides a simple algorithm for diagnosis and treatment for use in clinical practice. The work reveals the concern about the management of intra-abdominal infections, establishing local guidelines to optimize diagnosis, treatment and prevention, with the aim of reducing morbidity, mortality, length of stay, costs and antimicrobial resistance.