Consideraciones anestésicas para cesárea electiva en una paciente con quiste de Tarlov gigante / Anaesthetic considerations for elective cesarean section in a patient with a giant Tarlov cyst

Los quistes de Tarlov son una dilatación patológica de las meninges. Su incidencia es más frecuente en mujeres de edades comprendidas entre 30 y 50 años. La prueba de imagen de elección para su diagnóstico es la RM. De etiología desconocida, la mayoría de los casos son asintomáticos, pero pueden manifestarse síntomas de irritación radicular, entre otros. Las posibilidades terapéuticas son múltiples, reservando la escisión quirúrgica como último escalón. Presentamos un caso en el que se realiza con éxito una anestesia raquídea para una cesárea electiva en una paciente con un quiste de Tarlov gigante, pero con potencial compromiso de la vía aérea, en la que la que los riesgos de una anestesia general podrían estar aumentados. El manejo anestésico presenta un desafío para el anestesiólogo, especialmente en situaciones en las que el paciente presente un riesgo anestésico aumentado para la anestesia general, como es el caso de la paciente obstétrica.(AU)

Tarlov cysts are a pathological dilatation of the meninges. Their incidence is more frequent in women between 30 and 50 years of age. The imaging test of choice for diagnosis is MRI. Of unknown etiology, most cases are asymptomatic, but symptoms of radicular irritation, among others, may occur. The therapeutic possibilities are multiple, reserving surgical excision as the last option. We report a case of successful spinal anaesthesia for elective cesarean section in a patient with a giant Tarlov cyst but with potential airway compromise, in whom the risks of general anaesthesia would be increased. Anaesthetic management presents a challenge for the anesthesiologist, especially in situations where the patient presents an increased anaesthetic risk for general anaesthesia, as is the case in the obstetric patient.(AU)

Anaesthetic considerations for elective cesarean section in a patient with a giant Tarlov cyst.

Tarlov cysts are a pathological dilatation of the meninges. Their incidence is more frequent in women between 30 and 50 years of age. The imaging test of choice for diagnosis is MRI. Of unknown etiology, most cases are asymptomatic, but symptoms of radicular irritation, among others, may occur. The therapeutic possibilities are multiple, reserving surgical excision as the last option. We report a case of successful spinal anaesthesia for elective cesarean section in a patient with a giant Tarlov cyst but with potential airway compromise, in whom the risks of general anaesthesia would be increased. Anaesthetic management presents a challenge for the anesthesiologist, especially in situations where the patient presents an increased anaesthetic risk for general anaesthesia, as is the case in the obstetric patient.

A study of the dental treatment needs of special patients: cerebral paralysis and Down syndrome.

AIM: The aim of the present study was to compare the dental characteristics and the oral health care needs of patients with Cerebral Paralysis (CP) and Down Syndrome (DS). MATERIALS AND METHODS: The selected sample consisted of 28 patients of both sexes between 10 and 20 years of age. STUDY DESIGN: observational, descriptive and cross-sectional study. STATISTICS: The statistical analysis was carried out with the SPSS 19.0 program for Windows. The frequency distribution and contingency tables were analysed, as was interobserver concordance. non mi è chiaro cosa intendono qui. RESULTS: Fifty percent of the patients with CP presented dental traumas, compared to 15% of the patients with DS. Dental prophylaxis was the most prevalent treatment in both groups (77% in CP compared to 86.7% in DS). The most frequent habit was oral breathing, which was found in 69.2% of the patients with CP and 80% of those with DS. CONCLUSIONS: Patients with CP and DS require early dental care in order to prevent and limit the severity of the pathologies observed.

Indicators of jawbone asymmetry through analysis of panoramic radiographs.

AIM: To assess the degree of jawbone asymmetry by drawing vertical lines on digital panoramic radiographs of paediatric patients with right or left unilateral cross-bite. STUDY DESIGN: The sample consisted of 217 paediatric patients of both genders, aged 6-9 years. A set of vertical lines was drawn on the side of the mandible with the cross-bite and on the side without the cross-bite, using software program tpsDigs version 2. Subsequently, the differences in the measurements of the two sides were determined through statistical analysis. RESULTS: Analysis of the vertical jaw lines on the radiographic bite indices indicated, in every case, quantifiable differences between the side with the cross-bite and the side without the cross-bite. The differences between vertical variables, related to the heights of the mandible body and the condyle, were statistically significant (p>0.005) for the whole sample and both genders. Statistically significant differences in the heights of the mandible body were found for all the age groups (6 to 9 years old), except for the 9-year-old group, which registered differences in the variables of condylar height. CONCLUSION: Throughout the sample and regardless of the side affected by cross-bite, the vertical variables corresponding to the total height of the ramus were always smaller on the side with the cross-bite. Gender did not affect the results obtained and age influenced some of the mandible's vertical heights.

[Analysis of factors associated with multiple pregnancies in assisted reproduction treatment complex]. / Análisis de los factores asociados con embarazos múltiples en tratamientos de reproducción asistida compleja.

BACKGROUND: Today, advances in technology provide the best success rates in the reproductive medicine field. One of the biggest concerns about it, is the high risk of achieving multiple pregnancies, which may carry greater health risks for both; the mother and fetuses. Besides that, multiple pregnancies are considered a complication or an adverse effect of assisted reproduction treatments. OBJECTIVES: To compare the factors associated with multiple pregnancy in patients who underwent complex assisted reproduction techniques. MATERIAL AND METHODS: A retrospective and transversal case control study was rolled to compare the factors associated with multiple pregnancy rates, these results were correlated using a logistic regression model. RESULTS: a total of 1063 cases were reviewed, we obtained a pregnancy rate of 35.9%, and a multiple pregnancy rate of 31.5%. We found positive statistical association between patient age, total number of oocytes obtained, total embryos transferred, total vitrified embryos per cycle, total serum cuantitative B-GCH level, endometrial thickness in milimeters, and the Honest of a multiple pregnancy. In the logistic regression model, we found statistical association between the number of embryos transferred, number of embryos obtained, embryo quality, total vitrified embryos and the risk for multiple pregnancies. CONCLUSIONS: The total number of embryos transferred in a cycle of a complex assisted reproduction, is the most important factor for the onset of multiple pregnancies. The age of patients, the number of oocytes, total number of embryos obtained, the number of embryos transferred, the quality of embryos transferred and the number of frozen embryos per cycle, correlate significantly with more risk for multiple pregnancies.

A study on the chronology and sequence of eruption of primary teeth in Spanish children.

AIM: The aim of this study is to determine the timing of primary teeth eruption in Spanish children, and to distinguish gender and arch differences. MATERIALS AND METHODS: A cross-sectional study was performed on primary teeth eruption in a sample of 1,250 children (623 girls and 627 boys) from the Region of Madrid aged between 3 and 42 months. The clinical emergence of teeth was taken to estimate the mean ages of primary teeth eruption. The t test was used to analyse gender and arch differences. RESULTS: The process of primary dentition lasted 22.28 months, and statistically significant differences were found in the eruption of homologous contralateral teeth. The first molars and maxillary lateral incisors erupted earlier in girls than in boys, with no statistically significant chronological differences. The central incisors and second molars erupted first in the mandibular arch, while the lateral incisors, canines and first molars erupted first in the maxilla. A greater chronological difference was found between the lateral incisors, which erupted more than 8 months earlier in the maxilla than in the mandible. CONCLUSIONS: In the overall sample, the first tooth to erupt was the lower right central incisor at 10.96 ± 1.88 months, and the last was the upper left second molar, at 33.24 ± 4.35 months, symmetry was found in the eruption of the deciduous teeth. The greatest chronological difference was observed in the lateral incisors, with the upper ones erupting more than 8 months before the lower ones. Although statistically significant gender differences were found, they were considered clinically irrelevant.

Evidence for adaptive divergence of thermal responses among Bemisia tabaci populations from tropical Colombia following a recent invasion.

There is an increasing evidence that populations of ectotherms can diverge genetically in response to different climatic conditions, both within their native range and (in the case of invasive species) in their new range. Here, we test for such divergence in invasive whitefly Bemisia tabaci populations in tropical Colombia, by considering heritable variation within and between populations in survival and fecundity under temperature stress, and by comparing population differences with patterns established from putatively neutral microsatellite markers. We detected significant differences among populations linked to mean temperature (for survival) and temperature variation (for fecundity) in local environments. A QST  - FST analysis indicated that phenotypic divergence was often larger than neutral expectations (QST  > FST ). Particularly, for survival after a sublethal heat shock, this divergence remained linked to the local mean temperature after controlling for neutral divergence. These findings point to rapid adaptation in invasive whitefly likely to contribute to its success as a pest species. Ongoing evolutionary divergence also provides challenges in predicting the likely impact of Bemisia in invaded regions.

Time and sequence of eruption of permanent teeth in Spanish children.

AIM: This was to investigate permanent teeth emergence in children and teenagers of Madrid (Spain) and to compare the data with those reported in the literature. STUDY DESIGN: cross-sectional descriptive study. This study comprises data from 752 children and adolescents in Madrid (Spain). Sex, age and present permanent teeth were recorded. RESULTS: In our study permanent teeth eruption occurred between 6.99 and 12.45 years in girls and between 7.06 and 12.81 years in boys. Overall we found no statistically significant differences in the timing of emergence between homologous contralateral teeth, however we noted that the lower arch teeth erupt before those of the upper arch and the eruption of permanent teeth occurs earlier in girls than in boys. The sequence of tooth eruption differed in both jaws but was the same in both sexes. CONCLUSION: Clinical examination of teeth is a simple tool to calculate tooth eruption intervals. These findings in a Spanish population are relevant for different dental setting and should be periodically reconfirmed.

[Mechanical restraint: its use in intensive cares]. / Contención mecánica: su uso en cuidados intensivos.

OBJECTIVE: To analyze the impact of the use of mechanical restraint (MR) or physical restraints in a Critical Care unit and to evaluate the procedure. BASIC PROCEDURES: A descriptive, prospective study. INCLUSION CRITERIA: patients who required MR from March to June 2010. VARIABLES: demographic, clinical presentation, indications, techniques and devices. A statistical analysis with mean, standard deviation and percentages using the program SPSS 14.0. RESULTS: A total of 85 cases were studied: 65.9% male, mean age 64.19 (±17.9), NEMS 29.3 (±8.2). Incidence of MR: 15.6%. Main indication for MR: Risk of serious disruption of treatment processes (80%). Decision nurse (94.1%). Urgent action: (85.9%). Registration procedure: 57.6%. Information to the family: 9.4%. Previous actions: verbal containment (100%), pharmacological (48.2%). CONCLUSIONS: There is a relevant incidence of MR. The principal reason is that of avoiding interruption of the therapeutic process. The nurse makes the initial decision. Necessary information/training of professionals for legal and ethical repercussions is needed.

Linfadenitis por mycobacterium incluyendo pacientes infectados por el virus de inmunodeficiencia humana / Mycobacterium lymphadenitis including patients infected with human inmunodefi

El género Mycobacterium provoca infecciones pulmonares y extrapulmonares, de estas últimas predomina la infección ganglionar. Mientras Mycobacterium tuberculosis es el agente causal más importante, en las últimas décadas aumenta la incidencia de otras especies micobacterianas que se han hecho prevalentes en los pacientes positivos al virus de la inmunodeficiencia humana (VIH +) tanto en países desarrollados como en vías de desarrollo. Durante el período enero 2007 hasta diciembre 2009 se procesó en nuestro laboratorio 6540 muestras, 210 muestras fueron obtenidas por biopsia ganglionar, precisamente este constituyó nuestro universo de estudio, 190 (90.4%) muestras se obtuvieron por exéresis quirúrgica, 20 (9.5%) por punción espirativa;17 procedían de pacientes VIH– (8.1%) y 193 procedentes de pacientes VIH+(91.9%). En solo 16 muestras (7.6%) el cultivo BAAR fue positivo; 4 procedentes de pacientes VIH– (25%) y 12 VIH+(75%). La clasificación e identificación micobacteriana demostró la presencia de Mycobacterium tuberculosis en 13 de los casos (81.25%), mientras Mycobacterium avium-intracellulare fue aislado en 3 (18.7%). En los pacientes inmunodeprimidos con linfadenopatía incluidos los pacientes VIH/sida, es muy importante la búsqueda activa de la presencia de BAAR como coinfección oportunista, donde Mycobacterium tuberculosis se mantiene como el agente infeccioso más frecuente, sin embargo la posibilidad de que otras especies micobacterianas también estén presentes no se debe descartar. Nuestro objetivo en este estudio como Laboratorio Nacional de Referencia de TB- Micobacterias fue lograr la caracterización etiológica de linfadenopatías en pacientes en que se sospechaba clínicamente la participación del género Mycobacterium.

Mycobacterium tuberculosis is the most important etiological agent producing pulmonary as well as extrapulmonary infection. During these last decades, the increase in the incidence of infection due to other mycobacteria species is evident. Lymphadenopathy is the most frequent extrapulmonary presentation form of Mycobacterium Genera infection among HIV positive patients either in developed or underdeveloped countries. The aim of this work is to analyze the results obtained during January 2007 - December 2009 in our laboratory. Two hundred ten tissue samples were studied; 190 (90.4%) samples were lymph node biopsied tissues and 20 (9.5%) samples were obtained by fine needle aspiration; 17 were from HIV - patients (8.1%) and 193 from HIV + (91.9%). A total of 16 (7.6%) samples produced a positive culture for BAAR, 4 VIH- (25%) and 12 VIH+ (75%). Classification and identification for mycobacteria confirmed Mycobacterium tuberculosis in 13 of the cases (81.25%), and Mycobacterium avium-intracellulare in three patients (18.7%). The present study once again confirms that BAAR culture has more sensitivity and specificity than histopathologhic studies have. Lymphadenopathy in immunosuppressed patients should by studied for the presence of an BAAR coinfection where M. tuberculosis is still the agent most frequently found, nevertheless, other species of Mycobacteria may be causing infection and should be searched for. Our objective as National Reference Laboratory of Tuberculosis and Mycobacterial was to obtain the etiological characterization of Mycobacterium lymphadenopathy in clinically suspect patients.

Microdeleción 7p14.1 y cefalopolisindactilia de Greig / 7p14.1 microdeletion and Greig cephalopolysyndactyly syndrome

La cefalopolisindactilia de Greig es un síndrome autosómico dominante de baja prevalencia causado por mutaciones en el gen GLI3, localizado en 7p14.1 y caracterizado por la tríada clínica de polisindactilia, macrocefalia e hipertelorismo. En aproximadamente el 20% de los casos se detecta una deleción de tamaño variable. Si la deleción es grande y afecta a otros genes además de GLI3, puede aparecer un fenotipo más severo, aceptándose la denominación de cefalopolisindactilia de Greig-síndrome de genes contiguos para estos casos. Describimos el caso de una niña recién nacida con polisindactilia, hipertelorismo y microcefalia, que presenta una micro deleción en 7p14.1 de 1,5 Mb de origen paterno diagnosticada mediante array-CGH (AU)

Greig cephalopolysyndactyly is a rare autosomic dominant syndrome caused by mutations in GLI3 gene located on cytob and 7p14.1 and characterized by the clinical triad ofpolysyndactyly, macrocephaly and hypertelorism. In approximately 20% of the cases a deletion of variable size is detected. If deletion is large and affects other genes as well as GLI3, a more severe phenotype is expected. Thus, Greig cephalopolysyndactyly contiguous gene syndrome is a multiple malformation syndrome caused by haploinsufficiency of GLI3 and adjacentgenes. We describe the case of a newborn female with polysyndactyly, hypertelorism and microcephaly and a 1.5 Mb 7p14.1 microdeletion of paternal origin diagnosed by array-CGH (AU)

[7p14.1 microdeletion and Greig cephalopolysyndactyly syndrome]. / Microdeleción 7p14.1 y cefalopolisindactilia de Greig.

Greig cephalopolysyndactyly is a rare autosomic dominant syndrome caused by mutations in GLI3 gene located on cytoband 7p14.1 and characterized by the clinical triad of polysyndactyly, macrocephaly and hypertelorism. In approximately 20% of the cases a deletion of variable size is detected. If deletion is large and affects other genes as well as GLI3, a more severe phenotype is expected. Thus, Greig cephalopolysyndactyly contiguous gene syndrome is a multiple malformation syndrome caused by haploinsufficiency of GLI3 and adjacent genes. We describe the case of a newborn female with polysyndactyly, hypertelorism and microcephaly and a 1.5 Mb 7p14.1 microdeletion of paternal origin diagnosed by array-CGH.

Vitreous traction and epiretinal membranes in diabetic macular oedema using spectral-domain optical coherence tomography.

PURPOSE: The purpose of this study was to present an association between diabetic macular oedema (DME) and vitreoretinal interface abnormalities using 3D spectral domain optical coherence tomography (SD-OCT). METHODS: In a retrospective study, charts and SD-OCT of consecutive patients with diffuse or focal DME were reviewed. Only one randomly chosen eye per patient with DME was included, and eyes that had another retinopathy that could affect the study analysis or that underwent vitreoretinal surgery were excluded. RESULTS: Out of 58 eyes (58 patients) with DME, 11 eyes (19.0%) had vitreofoveal traction (Group A), either unifocally (n=6) or multifocally; that is, associated with additional extrafoveal traction site(s). Group B comprised 20 eyes (34.5%) that had sole extrafoveal vitreous traction, at either retinal and/or papillary sites. In each, the retinal oedema underlying extrafoveal traction was in continuum in at least one site with that at the central macula, as verified by the macular maps, thus presented as diffuse macular oedema. In Group C, 13 eyes (22.4%) had an epiretinal membrane (ERM), 1.5 × 3 mm to ≥6 × 6 mm in size that overlaid diffuse oedematous macula. Group D included 14 eyes (24.1%) that had neither vitreous traction nor ERM; 12 (20.7%) of them had DME secondary to leaking microaneurysms with or without leaking capillary beds, and the remaining two had leakage from non-microaneurysms sources. CONCLUSIONS: DME was detected by the SD-OCT to be associated with sole extrafoveal vitreous traction in one-third of the patients. Further studies are required to evaluate the clinical consequences of these observations.

Conducta sexual y riesgo de embarazo temprano en adolescentes de cd. Victoria, Tamaulipas / Sexual behavior and risk of early adolescent pregnancy Cd. Victoria, Tamaulipas

Introducción: La proporción de adolescentes que han iniciado relaciones sexuales va en aumento y la edad de inicio está disminuyendo, sin embargo, la capacidad para evitar el embarazo no acompaña este comportamiento. En la Jurisdicción Sanitaria No. 1 de Cd. Victoria, Tamaulipas, en el año 2008 se atendieron 15,137 embarazadas, y de estas el 22.0% son menores de 20 años,1 afectándoles de manera importante los planes de vida y futuro de las madres adolescentes. El propósito de esta investigación fue describir las características de la conducta sexual de los adolescentes, variables que se relacionan con el inicio de la actividad sexual, y practicas de riesgo para embarazo. Metodología: Se realizo un estudio observacional, descriptivo, transversal, correlacional.2. En 1212 adolescentes de 12 a 19 años ambos sexos, mediante un muestreo no probabilístico, por disponibilidad. Utilizando un instrumento con un alpha de cronbach de 0.82. Resultados. La mitad de los participantes en el estudio se encuentra en el rango de 15 a 17 años con una media de 16 años. El 97% conoce métodos anticonceptivos, mas no su funcionamiento la información la adquirieron de la escuela y amigos. El 22 % tiene vida sexual activa iniciando entre los 14-15 años, no utilizaron método anticonceptivo por no planear la relación sexual. El 50% tiene más de una pareja, no se encontró asociación entre la edad y el número de parejas ni entre la edad y la última vez en que se tuvo relación sexual. Discusión: Los datos obtenidos sobre conducta sexual no difieren con lo reportado en la revisión de la literatura, la actividad sexual inicia más tempranamente entre los hombres que en las mujeres, el uso de métodos anticonceptivos no es generalizable ni en la primera ni en la última relación sexual. Conclusiones: Un porcentaje alto no tiene conocimiento sobre métodos anticonceptivos y su funcionamiento, considerándose estas variables como riesgo para la presentación de embarazo en la adolescencia.

Introduction: The proportion of adolescents who have initiated sexual relations is increasing and they are beginning at an earlier age, nevertheless the ability to avoid pregnancy does not accompany this behavior. At the Sanitary Jurisdiction number 1,in Cd. Victoria, Tamaulipas; year 2008. they took care of 15,137 pregnant women, and of these, 22.0% are pregnancies in subjects who are younger than 20 years, affecting them in a considerable way in relation to life plans and the future of the adolescent mothers. Objetive: The aim of this research was to describe the characteristics of the adolescent sexual behavior, variables related to the beginning of sexual activity and risk practices for pregnancy. Methodology: A correlational, transversal, descriptive and observational study was carried out (Polit & Hungler, 1999) in adolescents of 12 to 19 years of age, both sexes, through a non-probabilistic sampling by availability, using an instrument with a Cronbach's alpha of 0.82 Results: The sampling was of 1212, half of the cases are in the rank of 15 to 17 years and the mean is 16 years. 97% know about contraceptive methods but they do not know how they work. The information was acquired in school and from friends. 22% have active sexual life beginning between 14 and 15 years. They did not use a contraceptive method because the sexual relation was not planned. 50% have more than one couple. There was no association between age and the number of couples or between the age and the last time that they had sexual relations. Discussion: The information that we obtained about sexual behavior do not differ from the one that was reported on the literature revision. Sexual activity begins earlier in men than in women. The use of contraceptive methods is not generalizable, neither in the first nor in the last sexual relation. Conclusions: A high percentage do not know about contraceptive methods and how they work, considering these variables as a risk of pregnancy in adolescents.

[Evaluation of the effect of a cleaning/disinfection intervention on the rate of multiresistant microorganism infections in the Intensive Care Unit]. / Evaluación del efecto de una intervención de limpieza/desinfección sobre la incidencia de infecciones por microorganismos multirresistentes en una Unidad de Cuidados Intensivos.

AIM: Evaluate the effect of an intervention on the rate of nosocomial infections (NI) produced by multiresistant microorganisms in the Intensive Care Units. MATERIAL AND METHODS: A study was conducted before and after an intervention in two ICUs to control an outbreak of multiresistant Acinetobacter baumanii (MRAB). During the outbreak (from 22-12-06 to 12-2-07) the wards were closed and both the wards and the equipment of both ICUs were cleaned and disinfected. A microbiological sampling was also made. The nosocomial infection rate density of the multiresistant microorganisms was compared between hospitalized patients: preintervention (1-3-2006 to 15-12-2006) and postintervention (1-3-2007 to 15-12-2007). To certify if there were any statistically significant differences between them, a rate ratio (RT) was calculated with a 95% confidence interval. The level of statistical significance was established at p < 0.05. We stratified per unit, per type of microorganism and location of the infection. RESULTS: The global NI incidence rate for multiresistant microorganisms significantly declined after the interventions in both units (RT: 1.83, 95% CI: 1.34-2.50), p < 0.005. A significant decrease was also observed on the NI incidence rate for the following microorganisms: P. aeruginosa (RT: 2.36, 95% CI: 1.41-3.96), Enterobacter BLEE (RT: 2.31, 95% CI: 1.11-4.82) and S. maltophilia (RT: 2.77, 95% CI: 1.10-6.99). In regards to the infection location, a significant decrease in respiratory infection rates was observed (RT: 1.96, 95% CI: 1.29-2.99). CONCLUSION: The intervention conducted to control the MRAB outbreak was effective in reducing the NI incidence of multiresistant microorganisms.

Evaluación del efecto de una intervención de limpieza/ desinfección sobre la incidencia de infecciones por microorganismos multirresistentes en una Unidad de Cuidados Intensivos / Evaluation of the effect of a cleaning/disinfection intervention on the rate of multiresistant microorganism infections in the Intensive Care Unit

Objetivo. Evaluar el efecto de una intervención sobre la incidencia de infecciones nosocomiales(IN) por microorganismos multirresistentes en las Unidades de Cuidados Intensivos (UCI).Material y métodos. Se realizó un estudio antes-después de una intervención para el controlde un brote de Acinetobacter baumannii multirresistente (ABMR) en dos UCI. Durante el brote(del 22-12-06 al 12-2-07) se procedió al cierre y limpieza/desinfección de las salas y equipamientode las dos UCI, con muestreo microbiológico antes y después. Se comparó la densidadde incidencia de IN por microorganismos multirresistentes entre los pacientes ingresados: preintervención(del 1-3-2006 al 15-12-2006) y posintervención (del 1-3-2007 al 15-12-2007). Paracomprobar si existían diferencias estadísticamente signifi cativas se calculó la razón de tasas(RT) y su intervalo de confi anza (IC) al 95%. El nivel de signifi cación estadística se estableció enp < 0,05. Se estratifi có por unidad, tipo de microorganismo y localización de la infección.Resultados. La tasa de incidencia global de IN por microorganismos multirresistentes disminuyósignifi cativamente tras la intervención en ambas unidades (RT: 1,83, IC 95% 1,34-2,50), p < 0,005.También existió disminución signifi cativa en la tasa de incidencia de IN para los microorganismos:P. aeruginosa (RT: 2,36, IC 95% 1,41-3,96), enterobacterias BLEE (RT: 2,31, IC 95% 1,11-4,82) y S.maltophilia (RT: 2,77, IC 95% 1,10-6,99). Con respecto a la localización de la infección resultósignifi cativa la disminución en la tasa de infecciones respiratorias (RT: 1,96, IC 95% 1,29-2,99).Conclusión. La intervención realizada para el control del brote de ABMR fue efectiva paradisminuir la incidencia de IN por otros microorganismos multirresistentes(AU)

Aim. Evaluate the effect of an intervention on the rate of nosocomial infections (NI)produced by multiresistant microorganisms in the Intensive Care Units.Material and methods. A study was conducted before and after an intervention in two ICUsto control an outbreak of multiresistant Acinetobacter baumanii (MRAB). During theoutbreak (from 22-12-06 to 12-2-07) the wards were closed and both the wards and theequipment of both ICUs were cleaned and disinfected. A microbiological sampling was alsomade. The nosocomial infection rate density of the multiresistant microorganisms wascompared between hospitalized patients: preintervention (1-3-2006 to 15-12-2006) andpostintervention (1-3-2007 to 15-12-2007). To certify if there were any statisticallysignifi cant differences between them, a rate ratio (RT) was calculated with a 95% confi denceinterval. The level of statistical signifi cance was established at p < 0.05. We stratifi ed perunit, per type of microorganism and location of the infection.Results. The global NI incidence rate for multiresistant microorganisms signifi cantlydeclined after the interventions in both units (RT: 1.83, 95% CI: 1.34-2.50), p < 0.005. Asignifi cant decrease was also observed on the NI incidence rate for the followingmicroorganisms: P. aeruginosa (RT: 2.36, 95% CI: 1.41-3.96), Enterobacter BLEE (RT: 2.31,95% CI: 1.11-4.82) and S. maltophilia (RT: 2.77, 95% CI: 1.10-6.99). In regards to theinfection location, a signifi cant decrease in respiratory infection rates was observed (RT:1.96, 95% CI: 1.29-2.99).Conclusion. The intervention conducted to control the MRAB outbreak was effective inreducing the NI incidence of multiresistant microorganisms(AU)

Hematoma espontáneo del cordón umbilical / Spontaneous haematoma of the umbilical cord

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