Experiencia de 10 años en pacientes operados por rinosinusitis fúngica invasiva aguda / 10-year experience in patients operated for acute invasive fungal rinosinusitis

INTRODUCCIÓN: La rinosinusitis fúngica invasiva aguda (RSFIA) es una enfermedad poco frecuente, de alta mortalidad. Se presenta principalmente en pacientes inmunocomprometidos con múltiples comorbilidades, lo que dificulta su manejo. El objetivo de este trabajo es describir una cohorte de pacientes operados por RSFIA, sus características clínicas y mortalidad, los agentes etiológicos y el rendimiento de los métodos de diagnóstico. MATERIAL Y MÉTODO: Estudio prospectivo no concurrente de pacientes operados por RSFIA entre el 2005 y 2015 en nuestro centro. RESULTADOS: Se incluyeron 32 pacientes, 62,5% (20/32) hombres, con una edad promedio de 39,4 años (16-65 años). La mortalidad global fue del 71,9%, correspondiendo un 46,9% a mortalidad en agudo y un 25% a tardía. Las neoplasias hematológicas fueron la enfermedad de base más frecuente, correspondiendo al 84,4% (27/32) de los casos, seguida de la diabetes mellitus en un 9,4% (3/32). El 62,5% (20/32) de los pacientes presentó neutropenia al diagnóstico, y un 80% (16/20) de ellos, neutropenia febril. El síntoma más frecuente fue la fiebre en un 65,6% (21/32), luego dolor facial o cefalea en un 53,1% (17/32). Se identificó Aspergillus en el 37,5% (12/32), seguido por Rhizopus en el 31,3% (10/32). No se encontró asociación entre las variables estudiadas y un mayor riesgo de mortalidad. CONCLUSIONES: La RSFIA es una enfermedad agresiva con una alta mortalidad, siendo fundamental el diagnóstico oportuno. Es necesario optimizar los criterios de sospecha para un diagnóstico precoz que permita mejorar el pronóstico

INTRODUCTION: Acute invasive fungal rhinosinusitis (AIFRS) is rare but has high mortality. It is more frequent in immunocompromised patients with multiple comorbidities, which make their management more difficult. The aim of this study is to describe a cohort of patients operated due to AIFRS, their clinical characteristics, mortality, aetiological agent and efficacy of diagnostic tests. MATERIAL AND METHOD: Non-concurrent prospective study of patients with AIFRS who were operated between 2005 and 2015 in our centre. RESULTS: Thirty-two patients were included, 62.5% (20/32) men, with an average age of 39.4 years (16-65 years). Overall mortality was 71.9%; acute mortality 46.9% and late mortality 25%. Haematological malignancies were the most common underlying disease, present in 84.4% (27/32) of cases, followed by diabetes mellitus in 9.4% (3/32). On diagnosis, 62.5% (20/32) of patients were neutropenic, 80% (16/20) of them with febrile neutropenia. Fever was the most frequent symptom, present in 65.6% (21/32) of patients, followed by facial pain or headache in 53.1% (17/32). Aspergillus was identified in 37.5% (12/32) of cases and Rhizopus in 31.3% (10/32). There was no association between the analysed variables and increased risk of mortality. CONCLUSIONS: AIFRS is an aggressive disease with a high mortality rate, therefore a timely diagnosis is fundamental. It is necessary to optimise suspicion criteria for an early diagnosis in order to improve the prognosis

Metahemoglobinemia secundaria a inhalación de "poppers": caso clínico y revisión de la literatura / Methemoglobinemia secondary to amyl nitrite inhalation. A case report and literature review

El nitrito de amilo, conocida como "poppers", se ha masificado como droga recreacional en parte por sus efectos con objetivos sexuales. Su consumo se asocia a complicaciones psiquiátricas y médicas. Reportamos el caso de un paciente que se presenta con metahemog-lobinemia moderada secundaria a la inhalación de nitrito de amilo asociado a alcohol. Al ingreso presenta cianosis peribucal y en extremidades, disociación entre oximetría de pulso y presión parcial de oxígeno en gases arteriales, además de metahemoglobinemia 29,9%. Se descartan otras intoxicaciones y causas primarias de metahemoglobinemia. Se maneja con oxigenoterapia, hidratación y ácido ascórbico, presentando una evolución favorable. Presentamos el primer caso en Chile de metahemoglobinemia secundaria al consumo de nitrito de amilo con fines recreativos.

Amyl nitrite, known as "poppers", has become popular as a recreational drug for sexual purposes. Its consumption is associated with psychiatric and medical complications. We report the case of a patient presenting with moderate methemoglobinemia secondary to amyl nitrite inhalation associated with alcohol. At admission, perioral and extremities cyanosis, a dissociation between pulse oximetry and partial pressure of oxygen in arterial gases, and methemoglobinemia 29.9% were present. Other intoxications and primary causes of methemoglobinemia were ruled out. The patient receives oxygen therapy, hydration, and ascorbic acid, presenting a favorable evolution. We report the first Chilean's case of methemoglobinemia secondary to amyl nitrite consumption for recreational purposes

10-year experience in patients operated for acute invasive fungal rhinosinusitis. / Experiencia de 10 años en pacientes operados por rinosinusitis fúngica invasiva aguda.

INTRODUCTION: Acute invasive fungal rhinosinusitis (AIFRS) is rare but has high mortality. It is more frequent in immunocompromised patients with multiple comorbidities, which make their management more difficult. The aim of this study is to describe a cohort of patients operated due to AIFRS, their clinical characteristics, mortality, aetiological agent and efficacy of diagnostic tests. MATERIAL AND METHOD: Non-concurrent prospective study of patients with AIFRS who were operated between 2005 and 2015 in our centre. RESULTS: Thirty-two patients were included, 62.5% (20/32) men, with an average age of 39.4 years (16-65 years). Overall mortality was 71.9%; acute mortality 46.9% and late mortality 25%. Haematological malignancies were the most common underlying disease, present in 84.4% (27/32) of cases, followed by diabetes mellitus in 9.4% (3/32). On diagnosis, 62.5% (20/32) of patients were neutropenic, 80% (16/20) of them with febrile neutropenia. Fever was the most frequent symptom, present in 65.6% (21/32) of patients, followed by facial pain or headache in 53.1% (17/32). Aspergillus was identified in 37.5% (12/32) of cases and Rhizopus in 31.3% (10/32). There was no association between the analysed variables and increased risk of mortality. CONCLUSIONS: AIFRS is an aggressive disease with a high mortality rate, therefore a timely diagnosis is fundamental. It is necessary to optimise suspicion criteria for an early diagnosis in order to improve the prognosis.

High-Intensity Interval Training Combined With Vibration and Dietary Restriction Improves Body Composition and Blood Lipids in Obese Adults: A Randomized Trial.

This study aimed to compare the effect of high-intensity interval training (HIIT) with additional whole-body vibration (WBV) on body composition and lipid profile in obese/overweight adults on a hypocaloric diet. Forty adults were randomly assigned to (a) HIIT and vibration and hypocaloric diet (HIITWBV, n = 13), (b) HIIT and diet (HIIT, n = 14), and (c) diet only (control [CON], n = 13). High-intensity interval training WBV participants trained 3 times per week for 8 weeks (6 sets × 1 minute of HIIT, cycling at 90% heart rate peak followed by 1 minute of interset vibration, at a frequency of 18 Hz increasing until 25 Hz with a peak-to-peak displacement of 4 mm. Training volume increased 1 set every 2 weeks until 10 sets). The HIIT group performed HIIT training followed by 2 minutes of passive recovery, while the CON continued with their daily activities combined with calorie restriction. Body composition (body fat and fat-free mass) and biochemical indices (glucose, total cholesterol, high-density lipoprotein cholesterol, and triglycerides) were determined. Following 8 weeks, body fat was significantly reduced by 7.5% and both triglycerides and total cholesterol decreased in the HIITWBV group only (-16.5% and -11.7% respectively). This study suggests that HIIT in combination with WBV and a hypocaloric diet can improve overall lipid profile in overweight/obese individuals.

Reconstruction of medial orbital wall using a retrocaruncular approach.

The purpose of the study was to analyze and describe the retrocaruncular approach to access medial orbital wall. A retrospective analysis was performed in patients referred for the treatment of orbital fractures between January 1st 2011 and July 31st 2017. The study included patients over 18 years old with isolated fractures of the medial orbital wall or combined with the orbital floor who underwent a transconjunctival approach with retrocaruncular extension and lateral canthotomy, and with a minimum follow-up of 6 months. Patients with fractures to the roof and/or lateral orbital wall were excluded. From a total of 319 orbits, 30 medial wall fractures were treated using a retrocaruncular approach, transconjunctival extension and lateral canthotomy. 7 of them were pure medial wall fractures and 23 were combined with orbital floor. Except for one case that required delayed reconstruction with customized orbital implant, all orbital reconstructions were successful in the first surgery. Only one patient developed a conjunctival granuloma in relation to the caruncle. No others patients had complications. This study concluded that this approach is a successful access for surgical treatment of medial orbital wall fractures because of their broad visibility without damaging structures, allowing adequate orbital reconstruction and excellent aesthetic results.

Stress response and communication in surgeons undergoing training in endoscopic management of major vessel hemorrhage: a mixed methods study.

BACKGROUND: Major vessel hemorrhage in endoscopic, endonasal skull-base surgery is a rare but potentially fatal event. Surgical simulation models have been developed to train surgeons in the techniques required to manage this complication. This mixed-methods study aims to quantify the stress responses the model induces, determine how realistic the experience is, and how it changes the confidence levels of surgeons in their ability to deal with major vascular injury in an endoscopic setting. METHODS: Forty consultant surgeons and surgeons in training underwent training on an endoscopic sheep model of jugular vein and carotid artery injury. Pre-course and post-course questionnaires providing demographics, experience level, confidence, and realism scores were taken, based on a 5-point Likert scale. Objective markers of stress response including blood pressure, heart rate, and salivary alpha-amylase levels were measured. RESULTS: Mean "realism" score assessed posttraining showed the model to be perceived as highly realistic by the participants (score 4.02). Difference in participant self-rated pre-course and post-course confidence levels was significant (p < 0.0001): mean pre-course confidence level 1.66 (95% confidence interval [CI], 1.43 to 1.90); mean post-course confidence level 3.42 (95% CI, 3.19 to 3.65). Differences in subjects' heart rates (HRs) and mean arterial blood pressures (MAPs) were significant between injury models (p = 0.0008, p = 0.0387, respectively). No statistically significant difference in salivary alpha-amylase levels pretraining and posttraining was observed. CONCLUSION: Results from this study indicate that this highly realistic simulation model provides surgeons with an increased level of confidence in their ability to deal with the rare but potentially catastrophic event of major vessel injury in endoscopic skull-base surgery.

Tromboembolismo Pulmonar / Pulmonary Thromboembolism

Se realizó un estudio descriptivo y retrospectivo de pacientes con diagnóstico de tromboembolismo pulmonar en el periodo de 1 de enero 2005 hasta el 31 de diciembre 2008, en el Hospital Carlos Manuel de Céspedes de Bayamo, con el objetivo de identificar los aspectos clínicos y epidemiológicos presentes en ellos. Para el procesamiento de los datos se utilizó la estadística descriptiva. El grupo etáreo más afectado fue de 71 a 85 años (39 casos, 48,7 por ciento). Observamos un predominio del sexo femenino, 41 casos, 51,2 por ciento. En 51 pacientes (63,8 por ciento) no se sospechó en vida el diagnóstico, en 56 (70,0 por ciento) no se empleó anticoagulante profiláctico y en igual número no existió correlación clínico-patológica. Solo 20 pacientes (25,0 por ciento) presentaron infarto pulmonar. Concluimos que la enfermedad se vio con mayor frecuencia en pacientes de edad avanzada, del sexo masculino, con antecedentes de Cardiopatía Isquémica y de Hipertensión Arterial, con un promedio de estadía corta. En la mayoría no se sospechó el diagnóstico en vida, por lo que no llevaron tratamiento anticoagulante, existiendo pobre correlación clínico-patológica. El pulmón derecho se afectó más al igual que las ramas arteriales medianas y sin infarto pulmonar(AU)

It was performed a descriptive and retrospective study of patients with pulmonary thromboembolism in the period of January 1, 2005 to December 31, 2008, at Carlos Manuel de Céspedes hospital in Bayamo, with the aim of identifying the clinical and epidemiological aspects of them. Descriptive statistics was used for the processing of the data. The most affected age group was 71-85 years (39 cases, 48.7 percent). We observed a predominance of females, 41 cases, 51.2 percent. In 51 patients (63.8 percent) the diagnosis was not suspicious when they were alive, in 56 (70.0 percent) of them there was not applied anticoagulant prophylaxis, and in equal number there was no clinical correlation. Only 20 patients (25.0 percent) had pulmonary infarction. We concluded that the disease was more frequent in patients of advanced age, male sex, with ischemic heart disease antecedents and arterial hypertension, with an average of short stay. Most of them did not suspected the diagnosis in life, so they did not have anticoagulant treatment, existing a poor clinical pathological correlation. The right lung was more affected as well as the medium-sized arterial branches and without pulmonary infarction(EU)

Trauma raquimedular en la Unidad de Cuidados Intensivos / Raquimedular trauma in the Intensive Care Unit

Se realizó un estudio descriptivo y retrospectivo de los pacientes con diagnóstico de Trauma raqui-medular que ingresaron en la Unidad de Cuidados Intensivos del Hospital Universitario Carlos Manuel de Céspedes de Bayamo, con el objetivo de identificar los aspectos clínicos y epidemiológicos presentes en ellos. El procesamiento estadístico se realizó teniendo en cuenta la estadística descriptiva. Se ingresaron un total de 8 pacientes con este diagnóstico, todos del sexo masculino. Predominaron las edades entre 36 a 45 años, 3 pacientes (37,5 por ciento), media de 44,38 +/-17,4 años. Necesitaron ventilación mecánica 6 pacientes (75,0 por ciento), 3 casos (37,5 por ciento) presentaron bronconeumonía bacteriana. El tratamiento la metilprednisolona se usó en 5 casos (62.5 por ciento), y necesitaron fijación quirúrgica 4 enfermos (50,0 por ciento). Fallecieron 5 pacientes (62,5 por ciento). Concluimos que esta afección fue más frecuente en adultos jóvenes del sexo masculino. El uso de ventilación mecánica fue necesario en la mayoría de los casos, la bronconeumonía fue la complicación que se evidenció aislándose gérmenes propios del medio hospitalario. El esteroide más usado fue la metilprednisolona, y la fijación quirúrgica la necesitaron la mitad de los pacientes. Predominan los casos de estadía hospitalaria prolongada(AU)

It was performed a descriptive and retrospective study of patients with a diagnosis of raquimedular Trauma who were hospitalized in the Intensive Care Unit of the University Hospital Carlos Manuel de Céspedes in Bayamo, with the aim of identifying the clinical and epidemiological aspects presented in them. Statistical processing was carried out taking into account the descriptive statistics. There were hospitalized an amount of 8 male patients with this diagnosis. The ages from 36 to 45 years prevailed, 3 patients (37.5 percent), average of 44,38 +/-17.4 years. 6 patients (75.0 percent) needed mechanical ventilation, 3 cases (37.5 percent) presented bacterial-bronchopneumonia. Methylprednisolone treatment was used in 5 cases (62.5 percent), and the surgical fixation was needed by 4 patients (50.0 percent). 5 patients (62.5 percent) deceased. We concluded that this condition was more frequent in young male adults. The use of mechanical ventilation was required in the majority of cases and bronchopneumonia was the complication that was evidenced, isolating the germs proper from the hospital environment. The most commonly used steroid was methylprednisolone and surgical fixation was needed by half of the patients. The cases of prolonged hospital stay prevailed(EU)

Síndrome de Guillain-Barré en la Unidad de Cuidados Intensivos / Guillain-Barre Syndrome in the Intensive Care Unit

Se realizó un estudio descriptivo y retrospectivo de pacientes con diagnóstico de Síndrome de Guillain-Barré que ingresaron en la Unidad de Cuidados Intensivos del Hospital Universitario Carlos Manuel de Céspedes, con el objetivo de identificar los aspectos clínicos y epidemiológicos presentes en ellos. Se incluyeron 28 pacientes, de ellos 53,6 por ciento con edad entre 30 y 44 años y 64,3 por ciento del sexo masculino. El 50,0 por ciento tenía antecedentes de infección de vías respiratorias altas. Los síntomas motores predominantes fueron la toma de miembros superiores e inferiores con 11 casos (39,3 por ciento), el tratamiento con Intaglobín fue implantado en 19 enfermos (67,9 por ciento). Presentaron complicaciones el 42,9 por ciento. El 35,7 por ciento necesitó ventilación mecánica y el 57,1 por ciento tuvo estadía de 15 días o más. La mayoría de los casos egresaron vivos sin secuelas motoras del servicio (60,7 por ciento). Se concluyó que la enfermedad predominó en pacientes jóvenes, del sexo masculino. Fueron más frecuentes los antecedentes de infección de vías respiratorias altas, los síntomas motores y el tratamiento con Intaglobín. La Insuficiencia Respiratoria Aguda y la Bronconeumonía Bacteriana fueron las complicaciones predominantes. Egresaron vivos y sin secuelas motoras la mayoría de los casos, aunque la estadía se prolongó en ellos(AU)

It was performed a descriptive and retrospective study of patients with a diagnosis of Guillain-Barré Syndrome which were hospitalized in the Intensive Care Unit of the University Hospital Carlos Manuel de Cespedes from January 1st, 2005 to December 31, 2008, with the aim of identifying the present clinical and epidemiological aspects. 28 patients were included, 53.6 percent between 30 and 44 years old and 64.3 percent of the male sex. The 50.0 percent of them presented antecedents of upper respiratory tract infection. The predominant motor symptoms were the capture of upper and lower extremities with 11 cases (39.3 percent). The treatment with Intaglobín was implemented in 19 patients (67.9 percent). The complications were presented by 42.9 percent. 35.7 percent needed mechanical ventilation and 57.1 percent had to stay 15 days or more at the hospital. The majority of cases graduated alive without motor sequels of the service (60.7 percent). It was concluded that the disease predominated in young male patients. The antecedents of upper respiratory infections, motor symptoms and treatment were more common with Intaglobín. Acute respiratory failure and bacterial-bronchopneumonia were predominant complications. The majority of cases graduated alive without motor sequels, although the stay was prolonged in them(EU)

Estado de Mal Asmático / State of Asthma

Se realizó un estudio descriptivo y retrospectivo, de 74 pacientes que ingresaron con el diagnóstico de Estado de Mal Asmático en la Unidad Cuidados Intensivos, del Hospital Carlos Manuel de Céspedes de Bayamo, con el objetivo de identificar los aspectos clínicos y epidemiológicos presentes en ellos. El procesamiento estadístico se realizó teniendo en cuenta la estadística descriptiva. El grupo etáreo más frecuente fue el de 26 a 34 años con 23 casos (31,1 por ciento) y la edad media fue 36,0 +/- 4,6 años. La mayoría de los pacientes, 44 casos (59,4 por ciento), no sufrieron complicaciones, y en los enfermos que las presentaron, la que con más frecuencia se vio fue la bronconeumonía, con 23 casos (31,0 por ciento). La estadía promedio fue de 4,51+/-1,2 días, esta estuvo en relación con la presencia o no de complicaciones. La mayoría de los pacientes eran de procedencia urbana, 54 casos (72,9 por ciento). Se concluye que la enfermedad se vio con más frecuencia en pacientes jóvenes del sexo femenino, de procedencia urbana; predominando los enfermos sin complicaciones y con estadía corta(AU)

It was performed a descriptive retrospective research, with 74 patients that were hospitalized with the state of Asthma in the Intensive Care Unit at Carlos Manuel de Cespedes hospital from Bayamo, with the objective to identify the clinical and epidemiological aspects that were presented in them. The statistical process was performed taking into account the descriptive statistics. The most frequent etharian group was between 26 to 34 years old with 23 cases (31.1 percent) and the middle age was about 36.0+/-4.6 years. Most of the cases, 44 cases (59.4 percent), did not suffer from complications and in the sick persons who presented them, the most frequent one was bronchopneumonia, with 23 cases (31.0 percent). The average stay was about 4.51+-/1.2 days , it was related to the presence and lack of complications. Most of the patients were urbans, 54 cases (72.9 percent). Finally the disease was mainly evidenced in young female urban patients, prevailing the patients with no complications and short stay(EU)

Necrólisis epidérmica tóxica por penicilina: presentación de un caso / Toxic epidermal necrolysis due to penicillin. A case presentation

La necrólisis epidérmica tóxica es un desorden de la piel que pone en peligro la vida y se caracteriza por la formación de vesículas y la exfoliación de la piel. Puede ser provocado por la reacción a un fármaco, frecuentemente antibiótica o anticonvulsionante. Aproximadamente en un tercio de los casos de Necrólisis Epidérmica Tóxica, no es posible identificar la causa. La mortalidad es elevada, alrededor del 35-40 por ciento. No se conoce un tratamiento totalmente efectivo, aunque se han probado diferentes terapéuticas con resultados dispares. Presentamos un caso de un joven de 21 años saludable ocasionado el cuadro por penicilina, que requirió múltiple terapia, incluyendo inmunoglobulina intravenosa con evolución satisfactoria.(AU)

The toxic epidermal necrolysis is a skin disorder that can risk life and it is characterized by the formation of vesicles and skin exfoliation. It may be provoked by drugs reaction, mainly antibiotics or anti-convulsing. Approximately in a third of cases of Toxic Epidermal Necrolysis it is not possible to identify the cause. The mortality is high, about 35-40 percent. It is not known the effective treatment for it yet, although there have been proved different therapies with uneven results. We present a case of a healthy 21- year -old man with this disorder provoked by penicillin, who required multiple therapy, including intravenous immunoglobuline with satisfactory evolution.(EU)

Factores predisponentes para la muerte por infarto agudo del miocardio / Predisposing factors for acute myocardial infarct death

Se realizó un estudio de casos y controles, en pacientes que ingresaron en el Hospital General Universitario Carlos Manuel de Céspedes de Bayamo desde el 1 enero al 31 julio del 2006 con el diagnóstico de infarto agudo del miocardio, con el objetivo de identificar los factores predisponentes para la muerte por esta enfermedad. La edad ≥60 años sextuplico el riesgo de morir (OR = 6,96; IC = 2,05-26,00; p 0,0002) y el sexo femenino mostró relación con la muerte (OR = 6,30; IC =2,18-18,80; p 0,0000). Los antecedentes patológicos personales que se relacionaron con mayor riesgo de morir fueron la diabetes mellitus (OR = 8,77; IC =2,89-27,22; p 0,0000), la hipertensión arterial (OR = 8,61; IC =2,24-38,76; p 0,0001) e insuficiencia cardíaca (OR = 8,52; IC =2,88-25,72; p 0,0000). Las manifestaciones clínicas al ingreso del enfermo relacionadas de forma significativa con la muerte encontramos al shock (OR = 11,45; IC =3,69-36,65; 0,0000), la fibrilación ventricular (OR = 10,21; IC = 2,01-57,49; p 0,0002) y el edema agudo del pulmón (OR = 9,33; IC =2,95-30,35; p 0,0000). Concluimos que la senectud se asoció a la muerte, además la comorbilidad (la hipertensión arterial, diabetes mellitus e insuficiencia cardiaca) y algunas manifestaciones clínicas, así como la fibrilación ventricular puede predecir una evolución desfavorable en los pacientes con infarto agudo del miocardio(AU)

A study of cases and controls was made in patients with a diagnostic of acute myocardial infarct who were hospitalized at the Universitarian General Hospital in Bayamo since January 1st to July 31th of the year 2006; with the purpose of identifying the factors that predispose death due to this illness. For people who were 60 years old or older, the risk of death was six time bigger (OR=6,96, IC =2, 05-26, 00, p 0, 0002) and for women a relation with death was shown ( OR= 6,30;IC= 2,18-18,80; p 0,0000) the personal pathological antecedents that were related to a bigger risk of dying were diabetes mellitus (OR=8,77; IC= 2,89-27; p 0,0000) the arterial hypertension (OR= 8,61; IC= 2,24-38,76; p 0,0001) and the heart failure (OR=8,52; IC= 2,88-25,72;p 0,0000. At the time of the hospitalization the symptoms of the patients that were related to death in a significative way were, shock (OR= 11, 45; IC= 3,69-36,65; p 0,0000) ventricular fibrillation (OR= 10,21; IC= 2, 01-54,49; p 0,0002) and acute pulmonary edema (OR= 9,33; IC =2, 95-30,35; p 0,0000). As a conclusion it can be stated that senescence was associated to death and that comorbility (arterial hypertension, diabetes mellitus and heart failure some symptoms and ventricular fibrillation can predicted an unfavorable evolution in patients with an acute myocardial infarction(EU)

Sepsis Nosocomial en pacientes ventilados / Nosocomial Sepsis in ventilated patients

Se realizó un estudio descriptivo retrospectivo en pacientes ventilados en la Unidad de Cuidados Intensivos del Hospital General Universitario Carlos Manuel de Céspedes, en el período comprendido desde 1ro de enero 2007 hasta 31 de diciembre 2009, con el objetivo de determinar el comportamiento de la sepsis nosocomial en ellos. En los pacientes estudiados 35 (36,8 por ciento) se encontraron en el grupo de 60 años o menos, la edad media fue de 49,72 +/- 18,96 años. De ellos 51 era del sexo masculino (53,6 por ciento). En 72 casos, (75,8 por ciento), presentaron una estadía de más de 7 días, en 50 pacientes (52,6 por ciento), presentaron más de 7 días ventilados, en 66 casos, (69,5 por ciento) comenzó la infección en los primeros 7 días del ingreso. La sepsis respiratoria baja se produjo en 78 casos (82,2 por ciento), en 28 casos (29,4 por ciento) se aisló el Enterobacter. Fallecieron 35 pacientes, (36,8 por ciento). Se concluyó que la mayoría de los pacientes eran adultos jóvenes del sexo masculino, predominando una estadía mayor de 7 días, un número de días ventilados mayor de 7 días, y el comienzo de la infección en los primeros 7 días del ingreso, la sepsis respiratoria baja fue el diagnostico más frecuente, siendo el Enterobacter el germen que más se aisló. La mayoría de los enfermos egresaron vivos de la sala(AU)

A retrospective-descriptive study was performed for ventilated patients in the Intensive Care Unit of Carlos Manuel de Cespedes University General Hospital. This research was developed with the purpose to determine the behavior of the nosocomial sepsis in the above mentioned patients during the attended period from January 1rst 2007 to December 31rst, 2009. From the totality of the patients, 51 were men (53, 6 percent). Hospitalization was for more than 7 days with 72 cases (75,8 percent). 50 patients were ventilated for more than 7 days and in 66 cases the infection began in the first 7 days of the admission. 78 cases suffered from the low repiratory sepsis and in 28 cases the Enterobacter was isolated. The number of deceased patients was 35 (36, 8 percent). To conclude it was stated that most of the patients were young men, prevailing a prolonged admission, with more than 7 days and the same for the ventilated days. It can also be stated that the beggining of the infection was on the first seven days, the low respiratory sepsis was the most frequent diagnosis and the Enterobacter germ was isolated and recurrent. Most of the patients discharged alived(EU)

Intervención educativa sobre planificación familiar en una Comuna de Haití / Educative intervention about family planning in Commune of Haiti

Se realizó un estudio de intervención educativa en la comuna de Ouanamenthe departamento Nord-Este del país de Haití con el objetivo de incrementar el control en las mujeres con riesgo preconcepcional de enero-junio del 2006. Se usó el método estadístico Epinfo 6.0. Se estudiaron 160 pacientes mediante el método aleatorio simple de un total de 346 mujeres en edad fértil con riesgo preconcepcional del área dispensarizada. Se determinó que el desconocimiento y el temor a su utilización fueron las principales causas de su no utilización así como la falta de conocimiento de la existencia de un programa de planificación familiar a nivel nacional en este país. Se logró que el 78,1 por ciento de las pacientes incluidas usaran al menos un método anticonceptivo (AU)

A study of educative intervention in the commune of Ouanamenthe, Northeastern Department of Haiti, was carried out with the purpose of increasing the control of women with preconceptional risk from January to June 2006. The statistical method Epinfo 6.0 was used. 160 patients were studied by means of the simple random method of a total of 346 women in fertil age with preconceptional risk from the area of the classified patients. It was determined that ignorance and fear of its use were the main causes of not using it as well as the lack of knowledge about the existence of a program of family plan at national scale in this country. It was achieved that the 78,1 percent of the patients included in the study used, at least, one contraceptive method (AU)

Intervención educativa sobre planificación familiar en una Comuna de Haití / Educative intervention about family planning in Commune of Haiti

Se realizó un estudio de intervención educativa en la comuna de Ouanamenthe departamento Nord-Este del país de Haití con el objetivo de incrementar el control en las mujeres con riesgo preconcepcional de enero-junio del 2006. Se usó el método estadístico Epinfo 6.0. Se estudiaron 160 pacientes mediante el método aleatorio simple de un total de 346 mujeres en edad fértil con riesgo preconcepcional del área dispensarizada. Se determinó que el desconocimiento y el temor a su utilización fueron las principales causas de su no utilización así como la falta de conocimiento de la existencia de un programa de planificación familiar a nivel nacional en este país. Se logró que el 78,1 por ciento de las pacientes incluidas usaran al menos un método anticonceptivo.

A study of educative intervention in the commune of Ouanamenthe, Northeastern Department of Haiti, was carried out with the purpose of increasing the control of women with preconceptional risk from January to June 2006. The statistical method Epinfo 6.0 was used. 160 patients were studied by means of the simple random method of a total of 346 women in fertil age with preconceptional risk from the area of the classified patients. It was determined that ignorance and fear of its use were the main causes of not using it as well as the lack of knowledge about the existence of a program of family plan at national scale in this country. It was achieved that the 78,1 percent of the patients included in the study used, at least, one contraceptive method.

Los colectivos morales de la salud y la dirección estratégica de los servicios: un problema del trabajo político ideológico

El trabajo político ideológico se conceptualiza como un sistema de influencias formativas que modulan la comprensión de la realidad desde la conciencia y la actividad del sujeto social, con arreglo a una concepción del mundo(AU)