Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes / Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients

Antecedentes y objetivos Existen antecedentes de asociación de la infestación por Demodex sp. y el acné vulgar. El objetivo fue evaluar si la infestación por Demodex sp. se asocia a acné vulgar grave en consultas externas del Hospital Regional Lambayeque. Material y métodos Estudio trasversal en 46 pacientes con acné grave y 92 pacientes con acné no grave. Se definió como acné vulgar grave al de los participantes que tuvieron un grado ≥ 3 con la escala de gravedad del acné en español (EGAE). La infestación por Demodex sp. se determinó mediante biopsia cutánea superficial, considerándose infestación si existieron más de 5 ácaros por cm2. Resultados El 60,9% de los participantes fueron del sexo masculino, con una mediana de edad de 18 años y un rango intercuartílico de 15 a 20 años, provenían del sector urbano (81,9%) y se encontró infestación por Demodex sp. en el 29,7%. En el análisis bivariado, se encontró asociación estadísticamente significativa entre acné vulgar grave e infestación por Demodex sp. (p=0,001), sexo (p=0,003), procedencia (p=0,015), antecedente paterno de acné (p=0,045), antecedente materno de acné (p=0,045) y tipo de piel (p<0,001). En el análisis multivariado la infestación por Demodex sp. estuvo 4,2 veces más asociada a acné vulgar grave (IC 95%: 1,6-10,9; p=0,003) ajustado por sexo, procedencia urbana, tratamiento previo, antecedentes paterno y materno de acné vulgar y presencia de piel grasa. Conclusiones La infestación por Demodex sp. se asocia al acné vulgar grave (AU)

Background and objectives Infestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru. Material and methods We conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm2. Results The patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P=.001), sex (P=.003), residence (P=.015), a paternal history of acne (P=.045), a maternal history of acne (P=.045), and type of skin (P<.001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P=.003). Conclusion Demodex infestation was associated with severe acne vulgaris in outpatients at our hospital (AU)

[Translated article] Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients / Asociación entre la infestación por el Demodex sp. y el acné vulgar grave: estudio transversal de 168 pacientes

Background and objectives Infestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru. Material and methods We conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm2. Results The patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P=.001), sex (P=.003), residence (P=.015), a paternal history of acne (P=.045), a maternal history of acne (P=.045), and type of skin (P<.001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P=.003). Conclusion Demodex infestation was associated with severe acne vulgaris in outpatients at our hospital (AU)

Antecedentes y objetivos Existen antecedentes de asociación de la infestación por Demodex sp. y el acné vulgar. El objetivo fue evaluar si la infestación por Demodex sp. se asocia a acné vulgar grave en consultas externas del Hospital Regional Lambayeque. Material y métodos Estudio trasversal en 46 pacientes con acné grave y 92 pacientes con acné no grave. Se definió como acné vulgar grave al de los participantes que tuvieron un grado ≥ 3 con la escala de gravedad del acné en español (EGAE). La infestación por Demodex sp. se determinó mediante biopsia cutánea superficial, considerándose infestación si existieron más de 5 ácaros por cm2. Resultados El 60,9% de los participantes fueron del sexo masculino, con una mediana de edad de 18 años y un rango intercuartílico de 15 a 20 años, provenían del sector urbano (81,9%) y se encontró infestación por Demodex sp. en el 29,7%. En el análisis bivariado, se encontró asociación estadísticamente significativa entre acné vulgar grave e infestación por Demodex sp. (p=0,001), sexo (p=0,003), procedencia (p=0,015), antecedente paterno de acné (p=0,045), antecedente materno de acné (p=0,045) y tipo de piel (p<0,001). En el análisis multivariado la infestación por Demodex sp. estuvo 4,2 veces más asociada a acné vulgar grave (IC 95%: 1,6-10,9; p=0,003) ajustado por sexo, procedencia urbana, tratamiento previo, antecedentes paterno y materno de acné vulgar y presencia de piel grasa. Conclusiones La infestación por Demodex sp. se asocia al acné vulgar grave (AU)

[Diagnostic protocol for febrile syndrome of respiratory origin in geographical areas of endemic risk of tropical infections]. / Protocolo diagnóstico del síndrome febril con focalidad respiratoria en áreas geográficas de riesgo endémico de infecciones tropicales.

The syndromic surveillance of a group of diseases that have similar signs and symptoms, a common pathophysiology, and diverse etiology is aimed at rapidly detecting the presence of outbreaks which could potentially harm public health. This includes not only known outbreaks of infectious origin but also those of unknown origin. In patients suspected of having SARS-CoV-2/COVID-19, it is recommended to consider other etiologies of tropical fever in the differential diagnosis when these patients live in or come from endemic areas, as is the case of dengue, malaria, leptospirosis, acute Chagas disease, and rickettsiosis, among other endemic diseases. The possibility of SARS-CoV-2/AH1 AH5N1 MERS-CoV coinfection with these pathogens should also be considered.

Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients. / Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes.

BACKGROUND AND OBJECTIVES: Infestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru. MATERIAL AND METHODS: We conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm2. RESULTS: The patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P=.001), sex (P=.003), residence (P=.015), a paternal history of acne (P=.045), a maternal history of acne (P=.045), and type of skin (P<.001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P=.003). CONCLUSION: Demodex infestation was associated with severe acne vulgaris in outpatients at our hospital.

Satisfacción laboral de los profesionales de enfermería en un hospital de segundo nivel, en la Ciudad de México / Job satisfaction of nursing professionals in a second level hospital, in Mexico City

Objetivo: Analizar la satisfacción laboral de los profesionales de enfermería en un hospital de segundo nivel de la Ciudad de México. Marco teórico: La satisfacción laboral es un estado emocional positivo basado en la percepción subjetiva del propio trabajo, de acuerdo con la actitud frente al mismo, así como con las creencias y valores de la persona. Material y métodos: Estudio de carácter cuantitativo, no experimental, transversal, prolectivo, descriptivo y diagnóstico. La variable estudiada fue la satisfacción laboral. El universo se conformó por 530 profesionales de enfermería y la muestra por 200 de ellos. Resultados: 52.50% del personal de enfermería está satisfecho con su trabajo, 63.50% consideran que el trabajo que realizan es de mucho valor y 40% piensan que ocasionalmente carecen del tiempo necesario para realizar sus actividades. Discusión: 52.50% del personal de enfermería está satisfecho con su trabajo, lo que contrasta con la investigación de Pérez Fonseca y cols., en la cual se reporta 83.10% del personal de enfermería insatisfecho. Conclusiones: Los profesionales de enfermería del hospital de segundo nivel están satisfechos con el trabajo que realizan. Sin embargo, conviene monitorear de forma continua las áreas que causan insatisfacción para corregirlas en favor del personal de enfermería y de los pacientes

Objective: To analyze job satisfaction in nursing professionals at a second level hospital in Mexico City. Theoretical Framework: Job satisfaction is a positive emotional state based on the subjective perception of one's own work, according to the attitude toward it, as well as the person's beliefs and values. Material and methods: Quantitative, experimental, transversal, prolective, descriptive and diagnostic study. The variable was job satisfaction. The universe was confirmed by 530 nursing professionals, and the sample by 200 nursing professionals. Results: 52.50% of the nursing staff were satisfied with their work, 63.50% considered that the work they do is of great value, and 40% believed that occasionally they lack the necessary time to carry out their activities. Discussion: 52.50% of the nursing staff were satisfied with their work, which differs from the research by Pérez Ma. y Cols. that report 83.10% of dissatisfied staff. Conclusions: Nursing professionals at a second level hospital were satisfied with the work they do. However, it would be advisable to continuously monitor the areas that cause dissatisfaction in order to improve them in favor of the nursing staff and patient.

Pronación: Tecnología de enfermería que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González en la Ciudad de México / Pronation: A nursing technology that promotes wellbeing among COVID-19 patients at General Hospital Dr. Manuel Gea Gonzalez in México City

Introduction: pronation is a procedure used at the Intensive Care Unit with patients presenting Acute Respiratory Distress Syndrome (ARDS) with severe hypoxemia. Bibliographical references clearly support the application of this procedure due to the improvement it produces in oxygenation and the increased survival rate in patients. The main foundation behind this technology is that Ventral Decubitus (VD) promotes an improved redistribution of ventilation toward the dorsal regions of the lung, which are mainly collapsed during Dorsal Decubitus. Nursing staff have used this procedure because VD has proven to be a strategy with a useful and accessible impact over respiratory physiology. Objective: to analyze Pronation as a nursing technology and its promotion of COVID-19 patients' wellbeing at the General Hospital Dr. Manuel Gea González, in Mexico City. Material and methods: a nonexperimental, quantitative, cross-sectional, prolective, descriptive study to analyze pronation, as a nursing technology that promotes wellbeing in the care of COVID-19 patients at General Hospital Dr. Manuel Gea González, in Mexico City. Pronation as a nursing technology was the variable being measured. The universe was 530 nursing professionals working at the Hospital. The population and sample were 52 nursing specialists working with COVID-19 patients, representing 9.81% of the Universe. Results: as for training and experience with Pronation, 50% of the staff consider they have received sufficient training in regards to the SARS-CoV-2 virus, but they are still under training. Additionally, 84.62 % consider that Pronation promotes a remarkable recovery in the patients, with oxygen saturations between 80 to 100 %; 71.16 % believe that patients do show hemodynamic instability due to the position shift, but not in every case; and 80.77 % consider they make sure their patients do not develop pressure ulcers, given that 65.39 % practice patient hygiene and movement to prevent such ulcers. Discussion: from the interviewed staff, 50.01 % consider they have received sufficient training regarding COVID and the pronation of patients. This is consistent with Hernandez et al., who describe the need of a team trained specifically on the procedure, preferably comprised of Nurses specialized in Intensive Care. Likewise, 84.62% of staff members believe Pronation improves oxygen saturation in patients from 80% to 100%, this is contrasted with Barrantes and Vargas, who indicate that if Pronation does not result in 5% improvement in oxygen saturation, the patient must be returned to dorsal decubitus. Conclusion: ventilation in prone position is a pulmonary protective action used for over 30 years that produces an evident and continuous improvement in blood oxygenation and the respiratory physiology. Therefore, nursing specialists caring for COVID-19 patients recommend its use.

Introducción: la pronación es una maniobra utilizada en las unidades de cuidados intensivos, en pacientes que presentan síndrome de distrés respiratorio agudo (SDRA), cuando la hipoxemia es severa. Apoyada por una sólida evidencia científica, tiene impacto en la forma en que se ventila a los pacientes como parámetro de seguridad, esto aumenta la supervivencia. Objetivo: analizar la pronación, como tecnología de enfermería, que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González, en la Ciudad de México. Material y métodos: estudio de carácter cuantitativo, no experimental, transversal, prospectivo, descriptivo. Variable medida: la pronación, como tecnología de enfermería. El universo 530 profesionales de enfermería que trabajan en el hospital, muestra: 52 especialistas de enfermería que trabajan con pacientes COVID-19. Resultados: en relación a la capacitación y experiencia en pronación, el 50% del personal manifiestan que sí recibieron suficiente capacitación sobre el virus SARS-CoV-2, aunque siguen capacitándose en ésta área; el 84.62 % consideran que en la pronación, los pacientes mejoran bastante, saturando entre el 80 y 100 % de oxígeno y el 80.77 % siempre cuidan que los pacientes no tengan úlceras por presión.Discusión: el 50.01 % del personal entrevistado manifiesta que sí recibió suficiente capacitación sobre la COVID-19 para pronar a los pacientes, lo que es semejante a la investigación de Hernández GD., et al.¹ Conclusión: la ventilación en posición prono es una medida de protección pulmonar utilizada hace más de 30 años que produce una mejoría evidente y sostenida de la oxigenación de la sangre y en la fisiología respiratoria, por lo que los especialistas de enfermería que atiende pacientes COVID-19 recomiendan su aplicación, pues está asociada al aumento de probabilidad de supervivencia.

Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial.

OBJECTIVE: Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries. DESIGN: Cluster randomised trial. SETTING: Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) METHODS: Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds. MAIN OUTCOME MEASURES: The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. RESULTS: During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components. CONCLUSIONS: Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced. TWEETABLE ABSTRACT: Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.

Gestión de mantenimiento y producción más limpia en tres instituciones de salud de medellín, colombia / Cleaner maintenance and production management in three health institutions in medellín, colombia / Gestão de manutenção e produção mais limpa em três instituições de saúde de medellín, colômbia

Objetivo: Realizar un diagnóstico del estado de la gestión del mantenimiento de equipos biomédicos en el área de urgencias de tres (3) instituciones de nivel tres de complejidad médica de la ciudad de Medellín, Colombia, dentro del proyecto de investigación producción más limpia en salud. Metodología: Se diseñó una encuesta a partir de la Guía Sectorial de Producción más Limpia, en hospitales, clínicas y centros de salud, donde se obtuvo una lista de chequeo para la revisión del estado de la gestión de mantenimiento de los equipos biomédicos más complejos utilizados en urgencias. Resultados: La gestión de mantenimiento de los equipos biomédicos más complejos es muy buena en el hospital 1 y excelente en los hospitales 2 y 3; la metrología y gestión de mantenimiento en los equipos biomédicos del área de urgencias de los tres hospitales es excelente. Conclusión: La gestión de mantenimiento es muy importante para el ahorro económico en las instituciones, ya que se pueden reducir tiempos muertos de los equipos sin afectar la prestación de los servicios, aparte de que se reducen gastos en la compra de repuestos, y generación de residuos causantes de impactos negativos al medio ambiente.

Objective: to perform a diagnosis of the state of biomedical equipment maintenance management in the emergency areas of three (3) institutions of level three of medical complexity in the city of Medellín, Colombia. The realm is within the cleaner production in health research project. Methodology. A survey was designed based on the Cleaner Production Sector. Guide: in hospitals, clinics and health centers, where a check list was obtained to review the state of maintenance management of the most complex biomedical equipment used in the emergency room. Results: maintenance management of the most complex biomedical equipment is very good in hospital 1 and excellent in hospitals 2 and 3. Metrology and maintenance management in the biomedical equipment of the emergency area of all three hospitals is excellent. Conclusion: maintenance management is very important for financial savings in institutions, since they can thus reduce equipment downtime without hindering the provision of services, along with reducing costs in the purchase of spare parts and generation of waste, which causes a negative impact on the environment.

Objetivo: Realizar um diagnóstico do estado da gestão da manutenção de equipamentos biomédicos na área de urgências de três (3) instituições de nível três de complexidade médica da cidade de Medellín, Colômbia, dentro do projeto de investigação produção mais limpa em saúde. Metodologia: Desenhou-se uma pesquisa a partir da Guia Setorial de Produção mais limpa, em hospitais, clínicas e centros de saúde, onde se obteve uma lista de verificação para a revisão do estado da gestão de manutenção dos equipamentos biomédicos mais complexos utilizados em urgências. Resultados: A gestão de manutenção dos equipamentos biomédicos mais complexos é muito boa no hospital 1 e excelente nos hospitais 2 e 3; a metrologia e gestão de manutenção nos equipamentos biomédicos da área de urgências dos três hospitais é excelente. Conclusão: A gestão de manutenção é importantíssima para a poupança económica nas instituições, já que podem-se reduzir tempos mortos dos equipamentos sem afetar a prestação dos serviços, aparte de que se reduzem despesas na compra de repostos, e geração de resíduos causantes de impactos negativos ao meio ambiente.

How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?

Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08-50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835-429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015-2016 could be, given the timeframe of median time of occurrence.

A comparative study of automatic thresholding approaches for 3D x-ray microtomography of trabecular bone.

PURPOSE: This paper presents a comparative study of automatic thresholding algorithms for segmenting trabecular bone volume in x-ray microtomography (µCT). METHODS: First, a preprocessing stage was established, which considered noise reduction by applying anisotropic diffusion filtering and contrast enhancement by using morphological top-hats. Next, four automatic thresholding algorithms were implemented: clustering, maximum entropy, moment preservation, and concavity-based. These approaches analyze the preprocessed 3D µCT image histogram to optimize some parameters to find the best gray-level threshold. Thirty-eight vertebra bone samples were acquired from 19 normal Wistar rats, specifically the L3 and L4 vertebrae. The µCT images were acquired with a microfocus x-ray device at 100 slices/sample. Next, three human operators segmented the entire 3D µCT images manually to establish ground-truth segmentations so as to associate the segmentation problem with perceptual grouping. The normalized probabilistic Rand index (NPRI) was used to quantify the agreement between each computerized segmentation and the corresponding set of three ground-truth segmentations. Hence, the NPRI value should tend toward unity for an acceptable performance. Finally, a statistical analysis was done to determine which thresholding approach achieved the best performance. Besides, 3D morphometric indices were also measured. RESULTS: The Games-Howell test (α = 0.05) was used to compare the equality of means from the NPRI results considering the four thresholding algorithms (multiple comparisons). This statistical analysis indicated that the clustering and moment preservation techniques performed similarly, with NPRI values of 0.594 ± 0.126 and 0.607 ± 0.127, respectively. CONCLUSIONS: The main advantage of computerized segmentation is that it is fully automatic; that is, no interaction with the user is required. Thus, the method could be considered objective. Besides, the proposed preprocessing stage plays an important role in enhancing the µCT image quality to achieve better separation between the background volume and the trabecular bone volume.

Analysis of co-occurrence texture statistics as a function of gray-level quantization for classifying breast ultrasound.

In this paper, we investigated the behavior of 22 co-occurrence statistics combined to six gray-scale quantization levels to classify breast lesions on ultrasound (BUS) images. The database of 436 BUS images used in this investigation was formed by 217 carcinoma and 219 benign lesions images. The region delimited by a minimum bounding rectangle around the lesion was employed to calculate the gray-level co-occurrence matrix (GLCM). Next, 22 co-occurrence statistics were computed regarding six quantization levels (8, 16, 32, 64, 128, and 256), four orientations (0° , 45° , 90° , and 135°), and ten distances (1, 2,...,10 pixels). Also, to reduce feature space dimensionality, texture descriptors of the same distance were averaged over all orientations, which is a common practice in the literature. Thereafter, the feature space was ranked using mutual information technique with minimal-redundancy-maximal-relevance (mRMR) criterion. Fisher linear discriminant analysis (FLDA) was applied to assess the discrimination power of texture features, by adding the first m-ranked features to the classification procedure iteratively until all of them were considered. The area under ROC curve (AUC) was used as figure of merit to measure the performance of the classifier. It was observed that averaging texture descriptors of a same distance impacts negatively the classification performance, since the best AUC of 0.81 was achieved with 32 gray levels and 109 features. On the other hand, regarding the single texture features (i.e., without averaging procedure), the quantization level does not impact the discrimination power, since AUC = 0.87 was obtained for the six quantization levels. Moreover, the number of features was reduced (between 17 and 24 features). The texture descriptors that contributed notably to distinguish breast lesions were contrast and correlation computed from GLCMs with orientation of 90° and distance more than five pixels.

Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.

Bone quality analysis using X-ray microtomography and microfluorescence.

Bone quality is an evaluation index often applied in order to interpret clinical observations made upon bone health, such as bone mineral density, micro and macro architecture, and mineral content. Conventional inspection techniques do not provide full information on trabecular bone quality. This study shows the high resolution potential and the non-destructive character of X-ray microtomography and microfluorescence upon the application of such techniques for evaluating bone quality. The mineral content assessment was performed by two-dimensional concentration mappings of calcium, zinc, and strontium. The results showed significant changes in bone morphology.