Infective endocarditis due to Citrobacter koseri following testicular trauma: case report and literature review.

Infective endocarditis (IE) is a condition with low prevalence but high mortality rates within intensive care units. Microbiologically, most cases are attributed to Gram-positive cocci, while Gram-negative bacilli are less commonly involved. This case report describes a patient with IE caused by Citrobacter koseri (C. koseri) with secondary bacteremia due to blunt testicular trauma and epididymitis. We conducted a review of the literature to assess the clinical and associated risk factors of this underreported condition. Elderly and urinary tract infections could be associated with this entity. Cefazolin was used as the final targeted treatment. The use of precision medicine in IE is required for specific interventions.

Infection of the heart valve from testicular injury: a case study and review of medical literature Infective endocarditis (IE) is a serious but rare infection that can lead to death, especially in intensive care units. Typically, it's caused by certain types of bacteria, but our case study focuses on a patient whose IE was caused by a less common bacterium called Citrobacter koseri (C. koseri). This infection occurred after the patient experienced blunt trauma to the testicles, leading to a bloodstream infection. We looked at other similar cases in medical literature and found that older age and urinary tract infections might increase the risk of this type of IE. In this case, IE caused by this unusual bacteria was treated with cefazolin.

Outcomes of ECMO support with polypropylene membrane during pandemic times: a retrospective cohort study.

BACKGROUND: The SARS-CoV-2 pandemic resulted in shortages of supplies, which limited the use of extracorporeal membrane oxygenation (ECMO) support. As a contingency strategy, polypropylene (PP) oxygenation membranes were used. This study describes the clinical outcomes in patients on ECMO with PP compared to poly-methylpentene (PMP) oxygenation membranes. METHODS: Retrospective cohort of patients in ECMO support admitted between 2020 and 2021. RESULTS: A total of 152 patients with ECMO support were included, 71.05% were men with an average age of 42 (SD 9.91) years. Veno-venous configuration was performed in 75.6% of cases. The PP oxygenation membranes required more changes 22 (63.1%), than the PMP Sorin® 24 (32,8%) and Euroset® 15 (31,9%) (p.0.022). The main indication for membrane change was low oxygen transfer for PP at 56.2%, Sorin® at 50%, and Euroset® at 14.8%. Renal replacement therapy was the most frequent complication with PP membrane in 22 patients (68.7%) Sorin® 25 patients (34.2%), and Euroset® 15 patients (31.9%) (p 0.001) without statistically significant differences in mortality. CONCLUSION: PP oxygenation membranes was a useful and feasible strategy. It allowed a greater disponibility of ECMO support for critically ill in a situation of great adversity during the SARS-CoV-2 pandemic.

Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study.

Background: Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO2) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. Methods: A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. Results: 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. Conclusions: DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.

Neurological outcomes and quality of life in post-cardiac arrest patients with return of spontaneous circulation supported by ECMO: A retrospective case series.

Post-cardiac arrest brain injury constitutes a significant contributor to morbidity and mortality, leading to cognitive impairment and subsequent disability. Individuals within this patient cohort grapple with uncertainty regarding the potential advantages of extracorporeal life support (ECMO) cannulation. This study elucidates the neurological outcomes and quality of life of post-cardiac arrest patients who attained spontaneous circulation and underwent ECMO cannulation. This is a retrospective case study within a local context, the research involved 32 patients who received ECMO support following an intrahospital cardiac arrest with return of spontaneous circulation (ROSC). An additional 32 patients experienced cardiac arrest with ROSC before undergoing cannulation. The average age was 41 years, with the primary causes of cardiac arrest identified as acute coronary syndrome (46.8%), pulmonary thromboembolism (21.88%), and hypoxemia (18.7%). The most prevalent arrest rhythm was asystole (37.5%), followed by ventricular fibrillation (34.4%). The mean SOFA score was 7 points (IQR 6.5-9), APACHE II score was 12 (IQR 9-16), RESP score was -1 (IQR -1 to -4) in cases of respiratory ECMO, and SAVE score was -3 (IQR -5 to 2) in cases of cardiac ECMO. Overall survival was 71%, and at 6 months, the Barthel score was 75 points, modified Rankin score was 2, cerebral performance categories score was 1, and the SF-12 had an average score of 30. Notably, there were no significant associations between the time, cause, or rhythm of cardiac arrest and neurological outcomes. Importantly, cardiac arrest is not a contraindication for ECMO cannulation. A meticulous assessment of candidates who have achieved spontaneous circulation after cardiac arrest, considering the absence of early signs of poor neurological prognosis, is crucial in patient selection. Larger prospective studies are warranted to validate and extend these findings.

l-Threonine production from whey and fish hydrolysate by E. coli ATCC® 21277TM.

In this work production of l-threonine by Escherichia coli ATCC® 21277™ has been studied using a mixture of alternative low-cost substrates, which are recognized to be a major pollution problem. Whey was used as the primary carbon source, whereas Red Tilapia (Oreochromis sp.) viscera hydrolysates constituted the nitrogen source. A Box-Behnken Design was used for optimizing l-threonine and biomass production, using temperature and glucose, whey, and Red Tilapia (Oreochromis sp.) viscera hydrolysate contents as factors. Results indicate that biomass production is affected by the concentration of hydrolysate and temperature. On the other hand, l-threonine production is affected by concentration of whey, hydrolysate, and temperature. In this context, it was possible to maximize l-threonine production, but with a detriment on biomass production. The optimal conditions for biomass and l-threonine maximization (after 24 h) were identified and validated experimentally, resulting in biomass and l-threonine production of 0.767 g/L and 0.406 g/L, respectively. This work has shown the technical feasibility of using whey and Red Tilapia (Oreochromis sp.) viscera hydrolysates for the production of l-threonine by E. coli ATCC® 21277TM. Finally, the complications associated to the use of these low-cost complex substrates for the production of l-threonine by E. coli, suggest that more in detail studies (i.e. at the metabolic level) are required in order to propose strategies to increase the process productivity, before its scale up. This is a first step in our long-term goal of developing a production process for i) dealing with the pollution problems caused by those wastes, and ii) strengthen the milk and fish industries which are important poles of the Colombian economy.

System metabolic engineering of Escherichia coli W for the production of 2-ketoisovalerate using unconventional feedstock.

Replacing traditional substrates in industrial bioprocesses to advance the sustainable production of chemicals is an urgent need in the context of the circular economy. However, since the limited degradability of non-conventional carbon sources often returns lower yields, effective exploitation of such substrates requires a multi-layer optimization which includes not only the provision of a suitable feedstock but the use of highly robust and metabolically versatile microbial biocatalysts. We tackled this challenge by means of systems metabolic engineering and validated Escherichia coli W as a promising cell factory for the production of the key building block chemical 2-ketoisovalerate (2-KIV) using whey as carbon source, a widely available and low-cost agro-industrial waste. First, we assessed the growth performance of Escherichia coli W on mono and disaccharides and demonstrated that using whey as carbon source enhances it significantly. Second, we searched the available literature and used metabolic modeling approaches to scrutinize the metabolic space of E. coli and explore its potential for overproduction of 2-KIV identifying as basic strategies the block of pyruvate depletion and the modulation of NAD/NADP ratio. We then used our model predictions to construct a suitable microbial chassis capable of overproducing 2-KIV with minimal genetic perturbations, i.e., deleting the pyruvate dehydrogenase and malate dehydrogenase. Finally, we used modular cloning to construct a synthetic 2-KIV pathway that was not sensitive to negative feedback, which effectively resulted in a rerouting of pyruvate towards 2-KIV. The resulting strain shows titers of up to 3.22 ± 0.07 g/L of 2-KIV and 1.40 ± 0.04 g/L of L-valine in 24 h using whey in batch cultures. Additionally, we obtained yields of up to 0.81 g 2-KIV/g substrate. The optimal microbial chassis we present here has minimal genetic modifications and is free of nutritional autotrophies to deliver high 2-KIV production rates using whey as a non-conventional substrate.

Lesión cerebral post paro cardiaco: aspectos médicos, éticos y legales / Brain injury after cardiac arrest: Medical, ethical and legal issues disorder

RESUMEN Los sobrevivientes de la reanimación cardiopulmonar posterior a un paro cardiaco pueden tener un amplio rango de desenlaces y van desde recuperación neurológica completa, estado de vigilia sin respuesta, compromiso cognoscitivo diverso o la muerte. La lesión del tejido cerebral se presenta inmediatamente después del paro cardíaco, durante la reanimación y al retornar la circulación espontánea. La severidad y duración de la noxa isquémica determinarán el devenir neurológico. El examen clínico es el punto de partida en el abordaje multimodal del neuropronóstico. Se debe complementar con electroencefalograma, potenciales evocados somatosensoriales, neuroimágenes y biomar-cadores séricos. Entre un 10 a 15% de los pacientes con lesión cerebral posterior al paro cardiaco evolucionan hacia muerte por criterios neurológicos y son potenciales candidatos a la donación de órganos. Un retiro temprano de las terapias de sostenimiento de vida puede malograr la posibilidad de un potencial donante de órganos. Se puede estimar de manera temprana qué pacientes tienen mayor riesgo de evolucionar a muerte por criterios neurológicos. El neurólogo tiene un papel protagónico en el manejo de pacientes con lesión cerebral post paro cardiaco y sus decisiones tienen implicaciones éticas y legales.

ABSTRACT People who survive cardiopulmonary resuscitation (CPR) after cardiac arrest, have a wide range of outcomes including complete neurological recovery, coma, compromised cognitive function and death. Injury of the brain parenchyma starts immediately after a cardiac arrest, during CPR and return of spontaneous circulation. The severity of the ischemic injury will define the neurological outcome. The first step needed to determine a neurological prognosis is the clinical exam, with the help of electroencephalography, somatosensory evoked potentials, neuroimaging, and serum biomarkers. Between 10 and 15% of patients with brain injury after a cardiac arrest, develop brain death and become potential candidates for organ donation. A premature withdrawal of vital support can hamper the possibility of organ donation. The patients with higher risk of developing brain death can be identified early based on neurological criteria. The neurologist has a major role in the approach of patients with brain injury after cardiac arrest and the decision making with legal and ethical consequences.

Experiencia de cuatro años con la cinta reajustable para incontinencia urinaria de esfuerzo / 4-year experience with the use of readjustable tape for stress urinary incontinence

Resumen OBJETIVO: Describir la experiencia con el cabestrillo reajustable Remeex® en pacientes con incontinencia urinaria de esfuerzo recurrente, como una alternativa de tratamiento. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, de serie de casos llevado a cabo en un solo centro de la ciudad de Medellín, Colombia, en pacientes atendidas en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. Criterios de inclusión: mujeres mayores de 18 años, con diagnóstico de incontinencia urinaria recidivante después de una o más cirugías fallidas para corregir la incontinencia urinaria o con diagnóstico de deficiencia intrínseca del esfínter a las que se les practicó el procedimiento de cabestrillo reajustable (Remeex Female Neomedic) entre el 2016 y el 2019. RESULTADOS: Se evaluaron 19 pacientes con media de edad de 62 años (DE ± 9). La mediana de seguimiento fue de 19.4 meses (RIQ 10-26.5). Todas las pacientes tenían urodinamia prequirúrgica que confirmó el diagnóstico de incontinencia urinaria de esfuerzo. Las 19 pacientes tuvieron diagnóstico de incontinencia urinaria moderada-severa-recurrente, 4 con hipoactividad del detrusor y 1 con deficiencia intrínseca del esfínter. De las 19 pacientes, a 10 se les intervino para corrección de prolapso de órganos pélvicos concomitante, que se distribuyeron en: 6 pacientes con colporrafia anterior o posterior, 3 colpocleisis y 1 sacrocolpopexia por laparotomía. CONCLUSIONES: El cabestrillo reajustable es una buena opción para mujeres con intervenciones previas antiincontinencia con recidiva en quienes se demostró la mejoría en el grado de incontinencia en relación con el inicial, beneficio que se reflejó en mejor calidad de vida.

Abstract OBJECTIVE: To describe the experience with the readjustable sling Remeex® in patients with recurrent stress urinary incontinence as a treatment alternative. MATERIALS AND METHODS: Retrospective, observational, case series study carried out in a single center in the city of Medellin, Colombia, in patients attended at the Urogynaecology Unit of the Bolivarian University Clinic. Inclusion criteria: women over 18 years of age, with a diagnosis of recurrent urinary incontinence after one or more failed surgeries to correct urinary incontinence or with a diagnosis of intrinsic sphincter deficiency who underwent the readjustable sling procedure (Remeex Female Neomedic) between 2016 and 2019. RESULTS: Nineteen patients were evaluated with mean age 62 years (SD ± 9). The median follow-up was 19.4 months (RIQ 10-26.5). All patients had preoperative urodynamics that confirmed the diagnosis of stress urinary incontinence. All 19 patients had a diagnosis of moderate-severe-recurrent urinary incontinence, 4 with detrusor hypoactivity and 1 with intrinsic sphincter deficiency. Of the 19 patients, 10 underwent surgery for correction of concomitant pelvic organ prolapse, which were distributed as follows: 6 patients with anterior or posterior colporrhaphy, 3 colpocleisis and 1 sacrocolpopexy by laparotomy. CONCLUSIONS: The readjustable sling is a good option for women with previous anti-incontinence interventions with recurrence in whom improvement in the degree of incontinence in relation to the initial one was demonstrated, a benefit that was reflected in better quality of life.

Severe gastrointestinal injury associated with SARS-CoV-2 infection: Thrombosis or Inflammation?: A retrospective case series study.

OBJECTIVES: Acute gastrointestinal injury (AGI) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a low incidence of complications in patients admitted to the intensive care unit (ICU). Pathophysiological knowledge related to AGI is limited, as few studies have been published on this topic. Therefore, this study was carried out to identify the clinical and histopathological features of patients with SARS-CoV-2 infection and grade IV AGI. METHODS: This is a retrospective case study of fifteen patients with SARS-CoV-2 infection and grade IV AGI who underwent emergency surgery. RESULTS: This study revealed a mortality rate of 62.5%. The most frequent gastrointestinal symptoms were abdominal distension (100%) and increased gastric residual volume (93.3%). Distended bowel loops on plain abdominal radiography (90%) and intestinal pneumatosis on computed tomography (50%) were the most frequent imaging findings. Surgical exploration revealed intestinal ischemia (66.6%) and necrosis (46.6%), and histopathology showed ischemic and liquefactive necrosis with mixed inflammatory involvement and absence of thrombosis as the cause of AGI. CONCLUSIONS: AGI associated with severe SARS-CoV-2 infection has a high mortality rate and poses a diagnostic challenge in the ICU. The complex pathophysiology and histopathological findings indicate an associated inflammatory phenomenon as the main alteration in the absence of thrombosis, as per the intestinal biopsies of the cases studied. Further clinical studies are required to gain a better understanding of this pathology.

Kinetic analysis and modeling of L-valine production in fermentation batch from E. coli using glucose, lactose and whey as carbon sources.

In this study the effect of the carbon source on L-valine production kinetics using genetically modified E. coli was researched. Glucose, lactose, Whey (W) and deproteinized whey (DW) were tested as carbon sources, keeping the carbon/nitrogen (C/N) ratio constant. Biomass generation and substrate consumption were modeled with Contois and Mass Conservation models, respectively, whereas Mass Conservation Balance and Luedeking-Piret models were used for product obtaining. Results showed that L-valine production is partially associated to growth, with values of 0.485 g L-valine/(g dry cell weight.h), and a product loss effect at a specific rate (ß) of 0.019 g L-valine/(g dry cell weight.h) with W. The yield of this product increased 36 % using W concerning glucose or lactose as carbon sources. On the other hand, Mass Balance and Luedeking-Piret models adjust properly to experimental data (R2 >0.90). In conclusion whey is a promising substrate for obtaining L-valine using genetically-modified E. coli.

Queratosis seborreica en el fondo de saco de Douglas: reporte de un caso / Seborrheic keratoses in the recto-uterine pouch: Case report

Resumen ANTECEDENTES: Existen pocos reportes de neoplasias epiteliales con apariencia escamosa originadas en el cuello uterino o la vagina. Estas lesiones se clasifican, por su similitud morfológica, en lesiones similares a queratosis seborreica. Cuando ésta aparece en la mucosa de la vulva o vagina debe establecerse la diferenciación con lesiones intraepiteliales escamosas de bajo y alto grado. OBJETIVO: Describir un caso de queratosis seborreica en el saco de Douglas. CASO CLÍNICO: Paciente de 70 años, con pérdida involuntaria de orina con los esfuerzos; se le colocó una cinta suburetral para resolver este problema. Durante el procedimiento se detectó una lesión en la mucosa vaginal, a las seis del reloj, en el fondo del saco de Douglas, de 1.2 x 1 cm, color pardo y consistencia blanda. Durante el procedimiento se tomó una muestra para estudio histopatológico que se reportó como: epidermis con marcada hiperqueratosis, acantosis regular, ensanchamiento y anastomosis de las crestas con formación de perlas córneas, dermis con infiltrado inflamatorio crónico perivascular, negativo para malignidad. Se estableció el diagnóstico de queratosis seborreica hipertrófica, positiva para tinción de P16 que orientó a infección de virus del papiloma. El tratamiento fue: escisión con evolución satisfactoria y seguimiento. CONCLUSIONES: La queratosis seborreica en el fondo de saco de Douglas se reporta de manera excepcional, su comportamiento es benigno y casi siempre se asocia con tipos de virus del papiloma humano de bajo riesgo.

Abstract BACKGROUND: Thera are few repots of intraepithelial neoplasms with origins in the cervix or vagina with squamous appearance. This kind of lesions have been classified because of their morphologic similarities, in the category of "seborrheic keratoses like". When seborrheic keratoses appears in the vaginal or vulvar mucosa, it has to be differentiated from low and high grade intraepithelial squamous lesions. OBJECTIVE: To describe a case of seborrheic keratoses in the recto-uterine pouch. CLINICAL CASE: 70 years old patient, who underwent surgery for stress urinary incontinence with a sub-urethral sling. During the procedure, a lesion in the vaginal mucosa was detected, specifically in the recto-uterine pouch, of 1.2 x 1 cm length, with a light brown color and soft consistency. A specimen was taken from the lesion during the procedure for histopathological study, which reported: hyperkeratosis in the epidermis, regular acanthosis, thickening and anastomosis of the crests with formation of corneal pearls, dermis with inflammatory, chronic, perivascular infiltration, with no signs of malignancy. The diagnosis was hypertrophic seborrheic keratoses, positive for P16 stain which orients to HPV infection. The lesion was removed and the patient continued follow up with her primary care provider. CONCLUSIONS: Seborrheic keratoses in this location is uncommon, with few reports in literature. These lesions are usually benign and are associated to HPV of low risk.

Nanopartículas para materiales antibacterianos y aplicaciones del dióxido de titanio / Nanoparticles for antibacterial materials and titanium dioxide applications

La aparición constante de microorganismos multiresistentes (bacterias, virus, hongos), ha elevado el esfuerzo por la búsqueda de materiales antibacterianos, que sean efectivos para su aplicación en áreas tan diversas como la industria textil, alimentación animal, el tratamiento de aguas, industria médica, farmacéutica y cosmética. Es bien conocido que agentes antibacterianos inorgánicos tales como las nanopartículas de plata, de cobre, de óxido de zinc y de óxido de cobre, han atraído una atención especial a lo largo del tiempo, debido a su estabilidad y a que no presentan problemas de bioseguridad. Aun así, recién las nanopartículas de dióxido de titanio han venido ganando atención para aplicaciones biomédicas, dado que estas partículas se vuelven antibacteriales mediante un proceso de fotoactivación y presentan absorción de ciertas longitudes de onda que dependen de su fase inorgánica (anatasa, rutilo o brookita). No obstante, la actividad fotocatalítica del dióxido de titanio oscila en la región UV (ƛ>387nm), y ello ha representado el mayor esfuerzo en investigación, en búsqueda de conseguir que el dióxido de titanio tenga función de autodesinfección en la región de luz visible, aumentándose así sus aplicaciones en la industria biomédica. En este artículo se realizó una revisión crítica de la literatura disponible, sobre el uso de nanopartículas para materiales antibacterianos y aplicaciones del dióxido de titanio, haciéndose énfasis en el mecanismo de acción de estas partículas con sistemas biológicos y posibles modificaciones para mejorar su actividad fotocatalítica mediante la interacción con luz visible.

The constant occurrence of multiresistant microorganisms (bacteria, viruses, fungi) has increased the search for antibacterial materials that may be effective to be applied in various areas such as textile industry, animal feeding, water treatment, medical, drug and cosmetic industry. It is well known that inorganic antibacterial agents as silver, copper, zinc oxide and copper oxide nanoparticles have attired special attention in the course of time due to their stability and the absence of biosafety problems. Despite this, just recently, have the titanium dioxide nanoparticles been gaining more attention for biomedical application, since these particles become antibacterial agents through a process of photo-activation and present absorption of certain wavelengths depending on their inorganic phase (anatase, rutile or brookite). Nevertheless, the photocatalytic activity of the titanium dioxide ranges in the UV zone ((?>387nm), and this has required greater efforts in terms of research, to make the titanium dioxide have the auto-disinfection function in the visible light zone, so as to increase the number of uses in the biomedical industry. This article was aimed at making a critical literature review on the use of nanoparticles for antibacterial materials, and the applications of titanium dioxide, thus making emphasis on the mechanism of action of these particles with the biological systems and the possible changes with a view to improving its photocatalytic activity by means of the interaction with the visible light.

Adherencia a la guía de manejo de sepsis severa y choque séptico en pacientes mayores de 65 años que ingresan a UCI / Adherence to the guidelines for the management of severe sepsis and septic shock in patients over 65 years of age admitted to the ICU

Introduction: The use of guidelines for goal-oriented resuscitation in patients with severe sepsis and septic shock has a positive impact on multiple organ failure and mortality outcomes. However, in patients over 65, adherence to the guidelines may be less stringent because of considerations of lower functional, cardiac, pulmonary and renal reserve. This study compares adherence to the guidelines and compliance with resuscitation goals by the healthcare staff in populations over and under 65 years of age. Objective: To determine adherence to the guidelines by the healthcare staff in the treatment of severe sepsis and septic shock in the group over 65 years of age, compared with patients under 65. Materials and methods: Observational, analytical, cross-sectional study of patients under and over 65 years of age admitted to the Intensive Care Unit (ICU) after having been diagnosed with severe sepsis and septic shock. Frequency of adherence to the guidelines was determined and a comparison of the different resuscitation goals in relation to adherence to the guidelines was made. Results: Except for adherence to early initiation of antibiotic therapy, there was better adherence to the other goals in the patients under 65 when compared to patients over 65. Adherence to the guidelines declined progressively as the number of goals increased. Conclusions: There was a lower adherence to resuscitation guidelines in the group of patients over 65 with severe sepsis and septic shock when compared with the group of patients under 65.

Introducción: El uso de guías de reanimación por metas en los pacientes con sepsis severa y choque séptico, genera un impacto benéfico en los desenlaces de disfunción orgánica múltiple y de la mortalidad, sin embargo en los pacientes mayores de 65 años, la adherencia a las guías puede ser menor, por la menor reserva funcional, cardíaca, pulmonar y renal. En el presente estudio comparamos la adherencia a la guía y el cumplimiento de las metas de reanimación por parte del personal de salud en la población mayor y menor de 65 años. Objetivo: Determinar la adherencia a las guías para el tratamiento de la sepsis severa y choque séptico por parte del personal de salud en el grupo mayor de 65 años comparado con el grupo de pacientes menores de 65 años.. Materiales y métodos: Estudio observacional analítico de corte transversal de los pacientes menores y mayores de 65 años ingresados a la Unidad de Cuidados Intensivos (UCI), con diagnóstico de sepsis severa y choque séptico, se determinó la frecuencia de adherencia a la guía para cada grupo de edades y se compararon las diferentes metas de reanimación en relación a la adherencia. Resultados: Excepto por la adherencia del inicio temprano de la antibiótico terapia, las demás metas presentaron una mejor adherencia, en el grupo de pacientes menores de 65 años cuando se compararon con los pacientes mayores de 65 años, la adherencia para ambos grupos disminuyo progresivamente a medida que se consideraron mayor número de metas. Conclusiones: Existe una menor adherencia a las guías de reanimación, en el grupo de grupo de pacientes mayores de 65 años con sepsis severa y choque séptico cuando se compara con el grupo de pacientes menores de 65 años.

Tiempo de crecimiento bacteriano en hemocultivos en neonatos / Time bacterial growth in blood cultures in neonates Abstract

Introducción: La sepsis es causa importante de morbimortalidad neonatal. Objetivos: Detectar el tiempo en que la curva de crecimiento bacteriano es evidenciada en la muestra de sangre inoculada en los hemocultivos y comparar estos tiempos de crecimiento bacteriano entre bacterias gramnegativas y grampositivas, entre los tipos de sepsis neonatal y determinar las bacterias más frecuentemente aisladas entre neonatos prematuros y de término. Pacientes y método: Estudio descriptivo de recién nacidos en riesgo de sepsis o con sospecha de sepsis por manifestaciones clínicas o de laboratorio, en que se evaluaron 114 hemocultivos positivos entre 1.932 hemocultivos tomados entre mayo de 2010 y mayo de 2014. Los datos se analizaron con Stata® 11.0. Resultados: El 5,9% de los hemocultivos tuvieron crecimiento bacteriano. La mediana y rango intercuartílico de tiempos de crecimiento bacteriano para gramnegativos fue 11 h (10-13 h), para grampositivos diferentes a Staphylococcus coagulasa negativo (SCoN) 12 h (12-18 h) y para SCoN 42h (36-44h). El 95,8% de las bacterias grampositivas y el 96% de las gramnegativas tuvieron tiempos de crecimiento bacteriano ≤ 24 h de incubación, mientras que en los SCoN el 100% de los hemocultivos fue positivo en ≤ 62 h de incubación. Conclusión: El 100% de sepsis por bacterias gramnegativas, grampositivas no SCoN y 90% de las ocasionadas por SCoN, son identificadas en los hemocultivos en las primeras 48 h, por lo cual podemos concluir que para descartar una sepsis, un período de incubación en hemocultivos de 48 h es suficiente.

Introduction: Sepsis is a major cause of neonatal morbidity and mortality. Objectives: To detect the time when the bacterial growth curve is evidenced in the blood sample inoculated blood cultures and comparing the times of bacterial growth between Gram negative and Gram positive bacteria, among the types of neonatal sepsis and identifying microorganisms more often isolated from preterm and term. Patients and method: A descriptive study. 114 positive blood cultures from 1,932 blood cultures taken from 01-May-2010 and 31-May-2014 were evaluated. Data were analyzed with Stata® 11.0. Results: 5.9% of blood cultures had bacterial growth. The median and interquartile range of Gram negative times of bacterial growth was 11 h (10-13 h), for Gram positive coagulase-negative Staphylococcus different (CoNS) 12h (12-18h) and CoNS 42h (36-44h). 95.8% of Gram positive and 96% of Gram negative, were the times of bacterial growth ≤ 24 h incubation, whereas the 100% CoNS was positive ≤ 62 h of incubation. Conclusion: 100% of sepsis by Gram negative and Gram positive no CoNS and 90% of those caused by CoNS are identified in blood cultures in 48 h, so we can conclude that to rule out sepsis, an incubation period of 48 h in blood cultures is sufficient.

[Time bacterial growth in blood cultures in neonates]. / Tiempo de crecimiento bacteriano en hemocultivos en neonatos.

INTRODUCTION: Sepsis is a major cause of neonatal morbidity and mortality. OBJECTIVES: To detect the time when the bacterial growth curve is evidenced in the blood sample inoculated blood cultures and comparing the times of bacterial growth between Gram negative and Gram positive bacteria, among the types of neonatal sepsis and identifying microorganisms more often isolated from preterm and term. PATIENTS AND METHOD: A descriptive study. 114 positive blood cultures from 1,932 blood cultures taken from 01-May-2010 and 31-May-2014 were evaluated. Data were analyzed with Stata(®) 11.0. RESULTS: 5.9% of blood cultures had bacterial growth. The median and interquartile range of Gram negative times of bacterial growth was 11h (10-13h), for Gram positive coagulase-negative Staphylococcus different (CoNS) 12h (12-18h) and CoNS 42h (36-44h). 95.8% of Gram positive and 96% of Gram negative, were the times of bacterial growth≤24h incubation, whereas the 100% CoNS was positive≤62h of incubation. CONCLUSION: 100% of sepsis by Gram negative and Gram positive no CoNS and 90% of those caused by CoNS are identified in blood cultures in 48h, so we can conclude that to rule out sepsis, an incubation period of 48h in blood cultures is sufficient.

Síndrome del uno y medio secundario a ataque cerebrovascular isquémico vertebrobasilar / One and half syndrome after ischemic vertebrobasilar stroke

El síndrome del uno y medio es una entidad que se caracteriza por parálisis de la mirada conjugada horizontal y alteración del fascículo longitudinal medial (FLM) ipsilateral secundario a diversas etiologías, entre las que se incluye el ataque cerebrovascular (ACV). Se describen dos casos de pacientes que consultaron por hemiparesia, incapacidad para realizar movimientos horizontales en uno de los ojos y abducción forzada del ojo contralateral e imposibilidad para la aducción. En ambos casos los estudios demostraron la presencia de un ACV isquémico vertebrobasilar como origen del síndrome; el reconocimiento de la fisiología de la mirada conjugada es fundamental en el abordaje del paciente y permite realizar un diagnóstico exacto a partir de una historia clínica detallada y una evaluación física minuciosa.

The One and a Half Syndrome is a condition characterized by paralysis of the horizontal conjugate gaze and a ipsilateral internuclear ophthalmoplegia secondary to other processes such as a stroke. We describe two cases of patients that had hemiparesis, inability to perform horizontal movements in one eye and forced abduction of the contralateral eye with inability to adduct it. With the corresponding study of both cases it was possible to diagnose a vertebrobasilar ischemic stroke as the origin of the syndrome; the recognition and understanding of the physiology of the conjugate gaze is crucial in the approach of the patients and allow an accurate diagnosis using a detailed history and a thorough physical evaluation.

Infecciones fúngicas emergentes: fungemia por Sporobolomyces salmonicolor. Reporte de un caso / Emerging fungal infections: Sporobolomyces salmonicolor fungemia. Case Report

En los últimos años, la emergencia de infecciones por hongos se ha dado en parte por el aumento en las infecciones por microrganismos que normalmente no son patógenos. El siguiente reporte describe la fungemia y meningoencefalitis por Sporobolomyces salmonicolor, una levadura frecuente en el medio ambiente y las plantas, en un paciente sin factores de riesgo conocidos, con desenlace fatal a pesar del manejo con antifúngicos. Este caso nos recuerda que dentro de las infecciones micóticas emergentes se encuentra el S. salmonicolor y se debe tener en cuenta dentro del diagnóstico diferencial de levaduras en sangre, como causa infrecuente, potencialmente mortal.

The emergence of pathogens, mainly fungi, in recent years has been partly due to overappearance of organisms that normally are not pathogenic in humans. The following report describes Sporobolomyces salmonicolor fungaemia and proven meningoencephalitis in a patient not showing risk factors who suffers a fatal outcome despite management with antifungal agents. The said yeast lives mainly in tree environments and plants. This case reminds us that there is S. salmonicolor within the emerging fungal infections, and this fact should be taken into account in the differential diagnosis of yeasts in blood as a rare and lifethreatening cause.

Estado nutricional materno de las mujeres indígenas de Río Sucio Caldas 2004-2005 y la asociación directa con el peso de sus recién nacidos / Maternal nutritional state of indigenous women of Riosucio, Caldas 2004-2005 and its direct association with the body weight of the newborns / Estado nutricional materno das mulheres indígenas de rio sucio caldas 2004-2005 e a associação direta com o peso se seus recém nascidos

El presente estudio se llevo a cabo a partir del análisis de los datos rutinarios de las historias clínicas de gestantes indígenas que asistieron a control prenatal y tuvieron parto de nacidos-vivos en el Hospital San Juan de Dios en Riosucio (Caldas), entre Agosto de 2004 y Julio de 2005. Para ello, se examinó la relación existente entre el estado nutricional materno, -el cual es estimado por el Índice de Masa Corporal (IMC) presente en el control prenatal inicial, en dos grupos de comparación (expuestos-no expuestos)-, con el crecimiento fetal, expresado como peso promedio del recién nacido a término, Entre los embarazos seleccionados, consideramos la siguiente información relevante: la edad gestacional conocida por ecografía y/o amenorrea, partos a término (38 - 42 semanas), gestaciones únicas sin enfermedad diagnosticada asociada. De la muestra estudiada el 63.5 por ciento de las gestantes tenían peso normal; sin embargo, el 44.7 por ciento de los recién nacidos del total de la muestra tuvieron peso por debajo de 3.000 g., de los cuales el 13.9 por ciento correspondían a recién nacidos, hijos de madres de bajo peso. Se obtuvieron datos de gestantes con sobrepeso y obesidad (53 casos), de los cuales 4.6 por ciento tuvieron bebes catalogados con peso deficiente. Con base en estos resultados, se pudo concluir que, no existe una relación directa, es decir, estadísticamente significativa, entre el estado nutricional materno y el peso de los recién nacidos. En esta muestra de población (X2 mayor que 3,841, cruza el alfa de 5 por ciento); se pudo establecer un riesgo relativo, a saber: del 3,8 de cada recién nacido de peso deficiente o bajo, hijo de madre de peso normal/sobrepeso/obesidad, hay un 3,8 de recién nacidos de peso bajo o deficiente hijos de madres con bajo peso (IC 95 por ciento= 3,18 – 5,18)

A descriptive and retrospective study about the case histories of pregnant women was realized, analyzing the existent relation between the nutricional condition of the mother estimated by Corporal Mass Rate (CMR) which represented an initial prenatal control, along with the fetal growth refered as average weight of the newborn, in indigenous mothers who attended a prenatal control and delivered alive innates at San Juan de Dios Hospital in Riosucio (Caldas) within August 2004 and July 2005 with selected pregnancies: gestational age known by ecography and /or amenorrhoea deliveries between (38 and 42 weeks) unique gestations and without any associated diagnosed illnesses. From the sample studied, 63.5% of the pregnant women had normal weight. However 44.7% of the newborns from the whole total of the sampling had weight under 3.000 g. From which 13.9% were newborns from low weight mothers, equally some important data were obtained from the overweight mothers (53 cases) from which 4.6% had babies considered to have insufficient weight. You could conclude that a direct relationship doesn't exist statistically significant between the maternal nutritional state and the weight of the newly born ones in population's sample (bigger X2 that 3,841, it crosses the alpha of 5%), however he/she put on to establish a relative risk of 3, 8, this is that for each newly born of weight insufficient or low son of mother of weight Normal/sobrepeso/obesidad, there are 3, 8 newly born of weight under or insufficient children of mothers with under weight (IC 95% = 3, 18 - 5, 18).

O presente estudo leva-se a seu fim a partir duma análise retrospectivo baseado em dados rotineiros das historias clinicas de gestantes. Para isso examino-se a relação existente entre o estado nutricional materno, o qual é estimado por o Indice de Massa Corporal (IMC) presente no controle pré-natal inicial, em dois grupos de comparação (expostos- não expostos)-, com o crescimento fetal, expressado como peso meio do recém nascido a termino, em mulheres indígenas que assistiram ao controle pré-natal e tiveram partos de nascidos- vivos no Hospital São João de Deus em Riosucio (Caldas), entre Agosto de 2004 e Julho de 2005. Entre os embaraços selecionados, consideramos a seguinte informação relevante: A idade gestacional conhecida por ecografia e/ou amenorréia, partos a termino (38 ­ 42 semanas), gestacionais únicas sem enfermidade diagnosticada associada. Da amostra estudada 63.5% das gestantes tinham peso normal; sem embargo, 44.7% dos recém nascidos do total da amostra tiveram peso por debaixo de 3.000 g. dos quais 13.9% correspondiam a recém nascidos, filhos de mães de baixo peso. Obtiveram ­ se dados de gestantes com sobrepeso e obesidade (53 casos), dos quais 4.6% tiveram bebês catalogados com peso deficiente. Com base em estes resultados, pode-se concluir que, não existe uma relação direta, é dizer estadisticamente significativa, entre o estado nutricional materno e o peso dos recém nascidos. Em esta amostra de povoação (X2 maior que 3,841, cruza o alfa de 5%); pode-se estabelecer um risco relativo, a saber: do 3,8 de cada recém nascido de peso deficiente ou baixo, filho de mãe de peso normal/ sobrepeso/obesidade, têm um 3,8 recém nascidos de peso baixo ou deficiente filhos de mães com baixo peso (IC 95%=3,18 ­ 5,18)