Description of changes in clinical outcomes following the implementation of an antibiotic stewardship program in a level IV hospital / Descripción del cambio en desenlaces clínicos posteriores a la implementación de un programa de gestión de antibióticos en un hospital de cuarto nivel de atención en salud.

INTRODUCTION: Inadequate prescription of antibiotics has been recognized as a public health problem by the World Health Organization. In this context, antibiotic stewardship programs have been implemented as a tool to mitigate its impact. OBJETIVE: To describe the changes in clinical outcomes after the implementation of an antibiotic stewardship program in a level IV hospital. MATERIALS AND METHODS: We conducted a unique cohort study of patients hospitalized for infectious pathologies that were treated with antibiotics in an advanced medical facility. We collected the clinical history before the implementation of the antibiotic stewardship program (2013 to 2015) and then we compared it to the records from 2018 to 2019 collected after the implementation of the program. We evaluated changes in clinical outcomes such as overall mortality, and hospital stay, among others. RESULTS: We analyzed 1,066 patients: 266 from the preimplementation group and 800 from the post-implementation group. The average age was 59.2 years and 62% of the population was male. Statistically significant differences were found in overall mortality (29% vs 15%; p<0.001), mortality due to infectious causes (25% vs 9%; p<0.001), and average hospital stay (45 days vs 21 days; p<0.001); we also observed a tendency to decrease hospital readmission at 30 days for infectious causes (14% vs 10%; p=0.085). CONCLUSIONS: The antibiotic stewardship program implemented was associated with a decrease in overall mortality and mortality due to infectious causes, as well as in average hospital stay. Our results evidenced the importance of interventions aimed at mitigating the impact of inadequate prescription of antibiotics.

Introducción: La inadecuada prescripción de antibióticos es un problema de salud pública, reconocido por la Organización Mundial de la Salud. Los programas de gestión de antibióticos son implementados como una herramienta para mitigar su impacto. Objetivo: Describir los cambios observados en los desenlaces clínicos después de la implementación de un programa de gestión de antibióticos en un hospital de IV nivel de atención. Materiales y métodos. Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Materiales y métodos: Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Resultados: Se analizaron las historias clínicas de 1.066 pacientes: 266 con historia previa a la implementación del programa y 800 con historia posterior a la implementación. El promedio de edad fue 59,2 años y 62 % de la población era masculina. Se encontraron diferencias estadísticamente significativas en mortalidad global (29 Vs. 15 %; p<0,001), mortalidad por causa infecciosa (25 % Vs. 9 %; p<0,001) y promedio de estancia hospitalaria (45 Vs.21 días; p<0,001), con tendencia a disminuir nuevas hospitalizaciones en 30 días por patología infecciosa (14 Vs.10 %; p=0,085). Conclusiones: El desarrollo del programa de gestión de antibióticos se asoció con a una disminución en la mortalidad global, la mortalidad por causa infecciosa y la estancia hospitalaria. Esto demuestra la importancia de desarrollar intervenciones dirigidas a mitigar el impacto de la prescripción inadecuada de antibióticos.

Description of changes in clinical outcomes following the implementation of an antibiotic stewardship program in a level IV hospital / Descripción del cambio en desenlaces clínicos posteriores a la implementación de un programa de gestión de antibióticos en un hospital de cuarto nivel de atención en salud

Introduction. Inadequate prescription of antibiotics has been recognized as a public health problem by the World Health Organization. In this context, antibiotic stewardship programs have been implemented as a tool to mitigate its impact. Objective. To describe the changes in clinical outcomes after the implementation of an antibiotic stewardship program in a level IV hospital. Materials and methods. We conducted a unique cohort study of patients hospitalized for infectious pathologies that were treated with antibiotics in an advanced medical facility. We collected the clinical history before the implementation of the antibiotic stewardship program (2013 to 2015) and then we compared it to the records from 2018 to 2019 collected after the implementation of the program. We evaluated changes in clinical outcomes such as overall mortality, and hospital stay, among others. Results. We analyzed 1,066 patients: 266 from the preimplementation group and 800 from the post-implementation group. The average age was 59.2 years and 62% of the population was male. Statistically significant differences were found in overall mortality (29% vs 15%; p<0.001), mortality due to infectious causes (25% vs 9%; p<0.001), and average hospital stay (45 days vs 21 days; p<0.001); we also observed a tendency to decrease hospital re- admission at 30 days for infectious causes (14% vs 10%; p=0.085). Conclusions. The antibiotic stewardship program implemented was associated with a decrease in overall mortality and mortality due to infectious causes, as well as in average hospital stay. Our results evidenced the importance of interventions aimed at mitigating the impact of inadequate prescription of antibiotics.

Introducción. La inadecuada prescripción de antibióticos es un problema de salud pública, reconocido por la Organización Mundial de la Salud. Los programas de gestión de antibióticos son implementados como una herramienta para mitigar su impacto. Objetivo. Describir los cambios observados en los desenlaces clínicos después de la implementación de un programa de gestión de antibióticos en un hospital de IV nivel de atención. Materiales y métodos. Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Resultados. Se analizaron las historias clínicas de 1.066 pacientes: 266 con historia previa a la implementación del programa y 800 con historia posterior a la implementación. El promedio de edad fue 59,2 años y 62 % de la población era masculina. Se encontraron diferencias estadísticamente significativas en mortalidad global (29 Vs. 15 %; p<0,001), mortalidad por causa infecciosa (25 % Vs. 9 %; p<0,001) y promedio de estancia hospitalaria (45 Vs.21 días; p<0,001), con tendencia a disminuir nuevas hospitalizaciones en 30 días por patología infecciosa (14 Vs.10 %; p=0,085). Conclusiones. El desarrollo del programa de gestión de antibióticos se asoció con a una disminución en la mortalidad global, la mortalidad por causa infecciosa y la estancia hospitalaria. Esto demuestra la importancia de desarrollar intervenciones dirigidas a mitigar el impacto de la prescripción inadecuada de antibióticos.

Percutaneous doxycycline sclerotherapy in a horse with a mandibular aneurysmal bone cyst.

OBJECTIVE: To describe the use and outcome of sclerotherapy with intralesional doxycycline foam in a horse with a mandibular aneurysmal bone cyst. STUDY DESIGN: Case report. ANIMALS: Client-owned 1 year old Standardbred filly. METHODS: The horse presented for progressive mandibular swelling. A 10 mg/mL doxycycline foam was prepared for intralesional injection. Three doses were injected into the lesion under computed tomographic guidance at 6 and 15 weeks after initial treatment. Volume reduction was monitored after each treatment with 3D volumetric rendering and region of interest segmentation using commercially available software. RESULTS: The volume of the lesion decreased from 458.7455 cm3 before treatment, to 363.3101 cm3 at 6 weeks, 273.5855 cm3 at 15 weeks, and 247.2316 cm3 6 months later, resulting in a total reduction of 54% of the initial volume. Bone formation was noted in the lesion. No adverse effects related to doxycycline foam injections were noted. The mandibular swelling was resolved after treatment. CONCLUSION: Intralesional doxycycline sclerotherapy was shown to be efficacious in reducing the volume of the aneurysmal bone cyst in the horse presented in this report. There was complete resolution of mandibular swelling with no side effects related to the intralesional injections.

Guía de práctica clínica para el manejo de la neumonía adquirida en la comunidad / Clinical Practice Guideline for the management of community-acquired pneumonia

Resumen La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.

Abstract Pneumonia continues to be one of the main causes of consultation and hospitalization to which, besides its high impact on morbidity and mortality, the current problem of antimicrobial resistance is added; thus, establishing guidelines that allow its adequate diagnosis and treatment is of great importance to obtain better clinical outcomes and promote a rational use of antibiotics in these patients. This clinical practice guideline (CPG) contains evidence-based recommendations for the diagnosis and treatment of community-acquired pneumonia in adult population; these recommendations were made by means of the process of adaptation of evidence-based CPGs for the Colombian context.

Clinical Outcomes of Noninvasive Ventilation in Asthma, Bronchiectasis, and Other COPD.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and disability worldwide. Use of noninvasive ventilation (NIV) appears to be associated with a significant decrease in frequency of exacerbation, hospital admissions, and mortality in patients with COPD. In this study, we sought to determine clinical outcomes, prevalence, patient profiles and systems characteristics associated with the use of NIV in patients with asthma, bronchiectasis, and other COPD. METHODS: In this retrospective study, the Nationwide Inpatient Sample dataset was used to evaluate patient characteristics for adult hospitalizations for asthma, bronchiectasis, and other COPD between January 2002 and December 2017. Using the adjusted survey logistic regression model, the association between NIV and in-hospital mortality for asthma, bronchiectasis, and other COPD was ascertained. RESULTS: Other COPD hospitalization prevalence was nearly two times higher among non-Hispanic Black patients compared with non-Hispanic White patients (8.32/1000 vs 4.46/1000). There was a 4.3% average annual decrease in the rates of NIV among hospitalized patients with other COPD during the study period. Furthermore, nonusage of NIV was associated with increased in-hospital mortality for asthma (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.50-1.57), bronchiectasis (OR 2.01, 95% CI 1.69-2.41), and other COPD (OR 1.24, 95% CI 1.16-1.32), respectively. CONCLUSIONS: Inpatient use of NIV has a clear mortality benefit in asthma, bronchiectasis, and COPD. These findings support a signal for potential benefit, particularly among certain populations and warrant further investigation.

Melioidosis con endocarditis de válvula protésica / Prosthetic valve endocarditis in melioidosis: case report

Resumen La melioidosis es endémica en varias regiones, con predominio en el Sudeste Asiático, norte de Australia, sur de Asia, China y Taiwán. En Sudamérica, Colombia ocupa el segundo lugar de casos de melioidosis, después de Brasil. Su manifestación clínica es variable, desde una infección asintomática hasta un compromiso multiorgánico con formación de abscesos múltiples y choque séptico. El compromiso cardiaco es inusual, con una incidencia menor del 1%. Se presenta el caso de un varón de 51 años, colombiano, con antecedente de una valvula aórtica mecánica, quien presentó un absceso en la pierna derecha y en la válvula cardiaca protésica, aislándose Burkholderia pseudomallei en hemocultivos y en el cultivo de secreción de la pierna. Fue tratado con meropenem y cotrimoxazol, con una adecuada respuesta clínica, requiriendo un reemplazo valvular aórtico.

Abstract Melioidosis is an endemic disease to several regions and occurs predominantly in Southern Asia, Northern Australia, China and Taiwan. In South America, Colombia is second after Brazil in number of melioidosis cases reported. Clinical manifestation varies from asymptomatic infection to multiorgan compromise involving multiple abscesses and septic shock. Cardiac compromise is infrequent, with an incidence of <1%. We report the case of a 51-year-old patient from Colombia with a mechanical aortic valve who had an abscess in right leg and in the prosthetic valve. Burkholderia pseudomallei was isolated in blood cultures and drained pus from the leg cultures. Patient was treated with meropenem and cotrimoxazole and required aortic valve replacement, resulting in adequate improvement in clinical symptoms.

Predictors of failure of high flow nasal cannula failure in acute hypoxemic respiratory failure due to COVID-19.

Hypoxemic respiratory failure is a common manifestation of COVID-19 pneumonia. Early in the COVID-19 pandemic, patients with hypoxemic respiratory failure were, at times, being intubated earlier than normal; in part because the options of heated humidified high flow nasal cannula (HFNC) and non-invasive ventilation (NIV) were considered potentially inadequate and to increase risk of virus aerosolization. To understand the benefits and factors that predict success and failure of HFNC in this population, we evaluated data from the first 30 sequential patients admitted with COVID-19 pneumonia to our center who were managed with HFNC. We conducted Cox Proportional Hazards regression models to evaluate the factors associated with high flow nasal cannula failure (outcome variable), using time to intubation (censoring variable), while adjusting for comorbidities and immunosuppression. In the majority of our patients (76.7%), the use of HFNC failed and the patients were ultimately placed on mechanical ventilation. Those at increased risk of failure had a higher sequential organ failure assessment score, and at least one comorbidity or history of immunosuppression. Our data suggest that high flow nasal cannula may have a role in some patients with COVID-19 presenting with hypoxemic respiratory failure, but careful patient selection is the likely key to its success.

Standing trans-nasal endoscopic guided CO2 laser fenestration of the palatine bone to access the sphenopalatine sinus in a horse.

OBJECTIVE: To describe a novel standing trans-nasal endoscopic guided CO2 laser fenestration approach to access the sphenopalatine sinus (SPS) in the horse. STUDY DESIGN: Case report. ANIMALS: Cadaver study and client-owned 20-year-old Warmblood gelding. METHODS: The rostral palatine bone within the nasopharynx was investigated as a possible site for fenestration to access the SPS in cadavers. The ability to fenestrate the SPS was tested in cadavers using a flexible endoscope and CO2 laser fiber inserted via biopsy channel. The fenestration procedure was then performed in a clinical case presented for unilateral epistaxis where a soft tissue attenuating mass in the right SPS was identified with standing computed tomography (CT). RESULTS: The cadaver study demonstrated the appropriate site within the nasopharynx midway between the vomer and dorsal conchal wall. The CO2 laser successfully ablated the mucosa and palatine bone to enable endoscopic access to the palatine portion of the SPS. The endoscopic procedure was performed as a two-step process via standing sedation due to mucosal bleeding obscuring visualization. Access to the SPS through fenestration allowed biopsy under direct endoscopic visualization with long-handled bronchoesophageal forceps inserted via the ipsilateral middle meatus. The mass within SPS was determined to be an undifferentiated carcinoma. Further treatment was declined and the horse euthanized 6 months following the procedure due to acute onset of neurologic symptoms. CONCLUSION: Endoscopically guided fenestration of the rostral palatine bone within the nasopharynx using CO2 laser in the standing horse provided good access and visualization of the palatine portion of the SPS.

[Prosthetic valve endocarditis in melioidosis. Case report]. / Melioidosis con endocarditis de válvula protésica.

Melioidosis is an endemic disease to several regions and occurs predominantly in Southern Asia, Northern Australia, China and Taiwan. In South America, Colombia is second after Brazil in number of melioidosis cases reported. Clinical manifestation varies from asymptomatic infection to multiorgan compromise involving multiple abscesses and septic shock. Cardiac compromise is infrequent, with an incidence of <1%. We report the case of a 51-year-old patient from Colombia with a mechanical aortic valve who had an abscess in right leg and in the prosthetic valve. Burkholderia pseudomallei was isolated in blood cultures and drained pus from the leg cultures. Patient was treated with meropenem and cotrimoxazole and required aortic valve replacement, resulting in adequate improvement in clinical symptoms.

Prognostic factors in hospitalized patients diagnosed with SARS-CoV-2 infection, Bogotá, Colombia / [Factores pronósticos en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2 en Bogotá, Colombia].

Introduction: Infection with the new SARS-Cov-2 coronavirus is a worldwide public health emergency; its diagnosis is based on molecular tests, while its prognosis depends on the patient's history and on some paraclinical tests. In Colombia, forecasts are not yet counted. Objective: To assess the factors associated with the development of severe disease in hospitalized patients diagnosed with SARS-CoV-2 infection, as well as the prognostic factors for the outcome of mortality. Materials and methods: We conducted an ambispective cohort study in hospitalized patients at the Fundación Cadioinfantil from March to June, 2020. Results: Of the 104 patients analyzed, 31.7% (n=33) had a severe presentation and 9.6% (n=10) had a mortality outcome. For mortality, the most important prognostic factor was the development of severe disease followed by age over 60 years and malnutrition. For the development of the severe disease, prognostic factors were a history of hemodialysis (HR=135), diabetes (HR=4.4), and an increased level of lactate dehydrogenase (LDH) (HR=1,004), while the lymphocyte count over 1,064 was a protective factor (HR=0.9). In the classification of patients, the National Early Warning Score (NEWS2) score in the high and low-risk categories corresponded to the best performance. There was no difference between the treatments administered. Conclusions: The most important prognostic factors for mortality were being over 60 years of age, hypertension, diabetes, and cirrhosis, while for the development of severe disease they were chronic kidney disease with hemodialysis, NEWS2 with high risk at admission, increased levels of LDH and C reactive protein (CRP), and leukocytosis.

Introducción. La infección por el nuevo coronavirus SARS-Cov-2 es una emergencia de salud pública en todo el mundo; su diagnóstico se basa en pruebas moleculares, en tanto que su pronóstico depende de los antecedentes del paciente y de algunos exámenes paraclínicos. En Colombia aún no se cuenta con datos de pronóstico en una población local. Objetivo. Evaluar los factores asociados con el desarrollo de la enfermedad grave en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2, así como los factores pronósticos de la mortalidad. Materiales y métodos. Se hizo un estudio de cohorte ambispectivo en pacientes hospitalizados en la Fundación Cardioinfantil entre marzo y junio de 2020. Resultados. De los 104 pacientes analizados, en el 31,7 % (n=33) la infección fue grave y en el 9,6 % (n=10) se produjo la muerte. El factor pronóstico más importante de la mortalidad fue el desarrollo de la enfermedad grave, seguido de una edad de más de 60 años y la desnutrición. Para el desarrollo de la enfermedad grave los factores pronósticos fueron los antecedentes de hemodiálisis (hazard ratio, HR=135), diabetes (HR=4,4) y el aumento en el nivel de la lactato deshidrogenasa (LDH) (HR=1,004), en tanto que un conteo de linfocitos superior a 1.064 fue un factor protector (HR=0,9). El puntaje del National Early Warning Score (NEWS2) correspondiente a las categorías de alto y bajo riesgo fue el que mejor rendimiento tuvo. No hubo diferencia entre los tratamientos administrados. Conclusiones. Los factores pronósticos más importantes para la mortalidad fueron tener más de 60 años, hipertensión, diabetes y cirrosis, en tanto que para el desarrollo de la enfermedad grave fueron la enfermedad renal crónica con hemodiálisis, un puntaje de NEWS2 de alto riesgo al ingreso, y aumento en los niveles de LDH y proteína C reactiva, y leucocitosis.

Factores pronósticos en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2 en Bogotá, Colombia / Prognostic factors in hospitalized patients diagnosed with SARS-CoV-2 infection, Bogotá, Colombia

Introducción. La infección por el nuevo coronavirus SARS-Cov-2 es una emergencia de salud pública en todo el mundo; su diagnóstico se basa en pruebas moleculares, en tanto que su pronóstico depende de los antecedentes del paciente y de algunos exámenes paraclínicos. En Colombia aún no se cuenta con datos de pronóstico en una población local. Objetivo. Evaluar los factores asociados con el desarrollo de la enfermedad grave en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2, así como los factores pronósticos de la mortalidad. Materiales y métodos. Se hizo un estudio de cohorte ambispectivo en pacientes hospitalizados en la Fundación Cardioinfantil entre marzo y junio de 2020. Resultados. De los 104 pacientes analizados, en el 31,7 % (n=33) la infección fue grave y en el 9,6 % (n=10) se produjo la muerte. El factor pronóstico más importante de la mortalidad fue el desarrollo de la enfermedad grave, seguido de una edad de más de 60 años y la desnutrición. Para el desarrollo de la enfermedad grave los factores pronósticos fueron los antecedentes de hemodiálisis (hazard ratio, HR=135), diabetes (HR=4,4) y el aumento en el nivel de la lactato deshidrogenasa (LDH) (HR=1,004), en tanto que un conteo de linfocitos superior a 1.064 fue un factor protector (HR=0,9). El puntaje del National Early Warning Score (NEWS2) correspondiente a las categorías de alto y bajo riesgo fue el que mejor rendimiento tuvo. No hubo diferencia entre los tratamientos administrados. Conclusiones. Los factores pronósticos más importantes para la mortalidad fueron tener más de 60 años, hipertensión, diabetes y cirrosis, en tanto que para el desarrollo de la enfermedad grave fueron la enfermedad renal crónica con hemodiálisis, un puntaje de NEWS2 de alto riesgo al ingreso, y aumento en los niveles de LDH y proteína C reactiva, y leucocitosis.

Introduction: Infection with the new SARS-Cov-2 coronavirus is a worldwide public health emergency; its diagnosis is based on molecular tests, while its prognosis depends on the patient's history and on some paraclinical tests. In Colombia, forecasts are not yet counted. Objective: To assess the factors associated with the development of severe disease in hospitalized patients diagnosed with SARS-CoV-2 infection, as well as the prognostic factors for the outcome of mortality. Materials and methods: We conducted an ambispective cohort study in hospitalized patients at the Fundación Cadioinfantil from March to June, 2020. Results: Of the 104 patients analyzed, 31.7% (n=33) had a severe presentation and 9.6% (n=10) had a mortality outcome. For mortality, the most important prognostic factor was the development of severe disease followed by age over 60 years and malnutrition. For the development of the severe disease, prognostic factors were a history of hemodialysis (HR=135), diabetes (HR=4.4), and an increased level of lactate dehydrogenase (LDH) (HR=1,004), while the lymphocyte count over 1,064 was a protective factor (HR=0.9). In the classification of patients, the National Early Warning Score (NEWS2) score in the high and low-risk categories corresponded to the best performance. There was no difference between the treatments administered. Conclusions: The most important prognostic factors for mortality were being over 60 years of age, hypertension, diabetes, and cirrhosis, while for the development of severe disease they were chronic kidney disease with hemodialysis, NEWS2 with high risk at admission, increased levels of LDH and C reactive protein (CRP), and leukocytosis.

Daylight saving time: an American Academy of Sleep Medicine position statement.

None: The last several years have seen intense debate about the issue of transitioning between standard and daylight saving time. In the United States, the annual advance to daylight saving time in spring, and fall back to standard time in autumn, is required by law (although some exceptions are allowed under the statute). An abundance of accumulated evidence indicates that the acute transition from standard time to daylight saving time incurs significant public health and safety risks, including increased risk of adverse cardiovascular events, mood disorders, and motor vehicle crashes. Although chronic effects of remaining in daylight saving time year-round have not been well studied, daylight saving time is less aligned with human circadian biology-which, due to the impacts of the delayed natural light/dark cycle on human activity, could result in circadian misalignment, which has been associated in some studies with increased cardiovascular disease risk, metabolic syndrome and other health risks. It is, therefore, the position of the American Academy of Sleep Medicine that these seasonal time changes should be abolished in favor of a fixed, national, year-round standard time.

Electrical performance of PEDOT:PSS-based textile electrodes for wearable ECG monitoring: a comparative study.

BACKGROUND: Wearable textile electrodes for the detection of biopotentials are a promising tool for the monitoring and early diagnosis of chronic diseases. We present a comparative study of the electrical characteristics of four textile electrodes manufactured from common fabrics treated with a conductive polymer, a commercial fabric, and disposable Ag/AgCl electrodes. These characteristics will allow identifying the performance of the materials when used as ECG electrodes. The electrodes were subjected to different electrical tests, and complemented with conductivity calculations and microscopic images to determine their feasibility in the detection of ECG signals. METHODS: We evaluated four electrical characteristics: contact impedance, electrode polarization, noise, and long-term performance. We analyzed PEDOT:PSS treated fabrics based on cotton, cotton-polyester, lycra and polyester; also a commercial fabric made of silver-plated nylon Shielde® Med-Tex P130, and commercial Ag/AgCl electrodes. We calculated conductivity from the surface resistance and, analyzed their surface at a microscopic level. Rwizard was used in the statistical analysis. RESULTS: The results showed that textile electrodes treated with PEDOT:PSS are suitable for the detection of ECG signals. The error detecting features of the ECG signal was lower than 2% and the electrodes kept working properly after 36 h of continuous use. Even though the contact impedance and the polarization level in textile electrodes were greater than in commercial electrodes, these parameters did not affect the acquisition of the ECG signals. Fabrics conductivity calculations were consistent to the contact impedance.

Measurement of satisfaction with anesthetic recovery in a high-complexity postanesthetic care unit: a patient perspective / Medición de la satisfacción en la recuperación anestésica en una Unidad de Cuidados Post-anestésicos de alta complejidad: Perspectiva del paciente

Abstract Introduction: Quality assessment of anesthetic recovery requires patient-centered measurements such as satisfaction. In Colombia, a validated Quality of Recovery Scale (QRS), which includes the perspective of the user, was applied in the Post-anaesthetic Care Unit of Hospital Universitario de la Samaritana (HUS) in the city of Bogotá. Objectives: To determine patient satisfaction with postoperative care for 11 specialties at HUS as a quality indicator of postanesthetic recovery, and to assess the internal consistencyor validity of the QRS applied in a high-complexity hospital. Materials and methods: Cross-sectional descriptive study which included patients of the HUS postanesthetic care unit. A population size of 379 patients was estimated, with a final sample of 154. Following the application of the QRS, bivariate analyses were performed using control variables and clinical characteristics. In addition, internal consistency was analyzed using Chronbach's Alpha and Spearman's Rho. Results: Overall, 154 patients were analyzed, 48.7% females and 51.3% males. Median age was 52 years (interquartile range: 35-64); 91.56% belong to the subsidized health insurance regime, and 8.44% to the contributive regime. Of the total number of patients surveyed, 7.14% are satisfied with the quality of recovery (QRS> 56). Internal consistency is high (Cronbach's Alpha=0.854) and interitem correlation is average (Rho=0.295). Conclusion: The test is highly reliable, allowing to identify the strengths and weaknesses of the postanesthetic service at HUS. This input contributes to decision-making and to the selection of strategies for improving the quality of recovery in high-complexity patients.

Resumen Introducción: La evaluación de la calidad en la recuperación requiere mediciones centradas en el paciente como la satisfacción. En Colombia, se validó la escala CdR que incluye la perspectiva del usuario, el cual fue aplicado en la Unidad de Cuidados Post-anestésicos del Hospital Universitario de la Samaritana (HUS) de la ciudad de Bogotá. Objetivos: Determinar la satisfacción de los pacientes en cuidado post-operatorio del HUS como indicador de calidad de la recuperación post-anestésica, así como, evaluar la consistencia interna y validez de la escala CdR en 11 especialidades aplicada en un hospital de alta complejidad. Materiales y métodos: Estudio descriptivo transversal que incluyó pacientes de la Unidad de Cuidados Post-anestésicos del HUS. Se estimó un tamaño poblacional de 379 pacientes, con una muestra final de 154. Se aplicó la escala CdR, posteriormente, se realizaron análisis bivariados con las variables de control y las características clínicas. Adicionalmente, se analizó la consistencia interna con el Alpha de Cronbach y el rho de Spearman. Resultados: Se analizaron 154 pacientes, 48.7% son mujeres y 51.3% son hombres. La mediana de la edad fue 52 años (RIQ: 3564). 91.56% pertenecen al régimen subsidiado y 8.44% al contributivo. Del total de encuestados el 7,14% de los pacientes están satisfechos con la calidad de la recuperación (puntaje >56 de CdR). La consistencia interna es alta (Alpha de Cronbach=0,854) y una correlación inter-ítem promedio (rho = 0,295). Conclusiones: La prueba tiene una alta confiabilidad, lo que permite identificar las fortalezas y debilidades en la prestación del servicio en cuidados post-anestésicos del HUS, siendo un insumo que permite tomar decisiones y generar estrategias para mejorar la calidad en la recuperación de los pacientes de alta complejidad.

MÉTODO ALTERNATIVO DE CONTROL DE INTENSIDAD LUMÍNICA PARA PULSIOXIMETRÍA EN TIEMPO REAL / AN ALTERNATIVE METHOD FOR POWER CONTROL OF LUMINICINTENSITY IN PULSEOXIMETRY ON REAL TIME / MÉTODO ALTERNATIVO DE CONTROLE DE INTENSIDADE DALUZ PARÁGRAFO OXIMETRIATEMPO REAL

El pulsioxímetro es una herramienta no invasiva esencial para el monitoreo de la saturación arterial de oxígeno. Utiliza la espectrofotometría para detectar sobre la piel dos intensidades de luz (600 y 900 nm) que proporcionan información de la perfusión tisular y cantidad de oxígeno transportada. Depende de un circuito de manipulación de corriente, dos diferentes fuentes emisoras de luz, un foto-detector y una unidad de procesamiento que permiten ajustar las intensidades de luz ante tejidos de diferentes características. En el presente trabajo, se propone un método de modulación por ancho de pulso alternativo para el control de la intensidad lumínica media, cuyo principio es la conmutación on/off de la corriente aplicada a los LEDs en la etapa de emisión. Este sistema permite modificar tanto el nivel de CD como la amplitud de la señal de CA de la onda fotopletismográfica e implica la reducción del número de componentes analógicos y consumo de energía. La metodología presentada permite regular la resolución de la señal muestreada y ofrece disminuciones del 21 % y 40 % en potencia comparado con los esquemáticos propuestos por Freescale Semiconductor, Inc. y Texas Instruments Incorporated respectivamente. El uso de señales sincronizadas moduladas en ancho de pulso con frecuencias por encima de 333 kHz y pasos de 50 ns para emitir luz, permitió una reducción 41% de potencia, respecto al sistema con modulación analógica del módulo MDK pulse oximeter.

Pulse oximetry is an essential optical based non-invasive tool for monitoring blood oxygen saturation. It uses spectrophotometry to detect two light intensities (600 and 900 nm) through the skin; it provides information on tissue perfusion and quantity of transported oxygen. The process relies on a current control circuit, two light emitting sources, a photodetector, and a digital signal processor that adjusts the light intensities for different tissue characteristics. This paper proposes an alternative method of pulse width modulation for controlling the mean light intensity level, whose principle is a pulse width nodulation of the current applied to the LEDs in the emitting stage. This system allows modifying the DC level and the amplitude of the AC signal of the photopletismographic wave. The results is the reduction of the number of analog components and power consumption. The methodology presented, it allows adjusting the definition of the sample signal and offers power reductions of 21% and 40% compared to schematics given by Freescale Semiconductor, Inc. and Texas Instruments Incorporated, respectively. Thus, by using synchronized signal pulse width modulation to emit light, with frequencies above 333 kHz and steps of 50 ns, it will allow power reductions of 41%, compared to the conventional analog modulation module MDK pulse oximeter.

O oxímetro de pulso é uma ferramenta não invasiva essencial para o monitoramento da saturação de oxigênio no sangue. Usa espectrofotometria para detectar a pele duas intensidades de luz (600 nm e 900) para fornecer informações de perfusão tecidual ea quantidade de oxigênio transportado. Depende de manuseamento corrente do circuito, duas fontes diferentes emissores de luz, um fotodetector e uma unidade de processamento para ajustar a intensidade da luz nos tecidos com características diferentes. Neste trabalho, um método de modulação de largura de pulso alternativa para controlar a intensidade de luz média, o princípio é o de ligar/desligar da corrente aplicada aos LEDs no palco questão é proposto. Este sistema permite modificar tanto o nível DC e a amplitude do sinal AC da forma de onda fotoplestimográfico e envolve a redução do número de componentes analógicos e consumo de energia. A metodologia apresentada permite ajustar a resolução do sinal de amostragem e oferece reduções de 21% e 40% da potência em comparação com o esquema proposto pela Freescale Semicondutor, Inc. e Texas Instruments Incorporated, respectivamente. Sinais sincronizados usando freqüências moduladas por largura de pulso acima de 333 kHz e 50 ns passos para emitir luz, permitiu uma redução de 41% de energia em comparação com módulo de oxímetro de pulso MDK sistema de modulação analógica.

Efectos de múltiples exposiciones a sevoflurano a dosis sub-CAM en la neuroapoptosis y la función cognitiva en el periodo neonatal / Effects of multiple exposures to sevoflurane at sub-MAC doses on neuroapoptosis and cognitive function during the neonatal period

Introducción: Recientes estudios han sugerido que los niños con múltiples exposiciones anestésicas tienen un mayor riesgo de deterioro neurocognitivo. Objetivo: Analizar los efectos neurodegenerativos a nivel histológico, cognitivo y del comportamiento posterior a exposiciones repetidas al sevoflurano a dosis inferiores a la concentración alveolar minina en ratas neonatales. Métodos: Se expusieron ratas Wistar de 5-7 días durante una hora a sevoflurano al 2,3%; una, 2 o 3 veces con intervalos de 24 h entre exposición. Posteriormente se determinó el efecto del anestésico en la neuroapoptosis mediante marcación inmunohistoquímica con caspasa-3, Fox-3 y CD95. El aprendizaje fue evaluado con el laberinto acuático de Morris, y el comportamiento relacionado a ansiedad, con laberinto elevado en cruz. Resultados: En todos los grupos experimentales se evidenció apoptosis neuronal medida por caspasa-3, siendo más marcada en el grupo de sevoflurano y en grupos de primera exposición. En laberinto elevado en cruz se encontró un tiempo total de permanencia en brazos abiertos (t test p = 0,113) estadísticamente no significativo con respecto al grupo control. En el laberinto acuático de Morris se encontró diferencia estadísticamente significativa (t test p < 0,001) cuando se compara el tiempo de realización de la prueba con respecto al grupo control. Conclusiones: La exposición a sevoflurano en ratas neonatales durante periodos cortos y repetidos induce muerte neuronal posiblemente por apoptosis a través de la activación de caspasa-3. Como consecuencia produce déficit de aprendizaje, principalmente en la adquisición de memoria espacial.

Introduction: Recent studies have suggested that children who are exposed multiple times to anesthesia have an increased risk of neurocognitive impairment. Objective: To analyze at a histological level the neurodegenerative, cognitive and behavioral effects following repeated exposures to sevoflurane at doses below the minimum alveolar concentration in neonatal rats. Methods: Wistar rats were exposed to 2.3% sevoflurane, one, two or three times for 1 h, in the course of 5-7 days, with 24-h intervals between each exposure. The neuroapoptotic effect of the anesthetic agent was subsequently determined using immunohistochemical labeling with caspase-3, Fox-3 and CD95. Learning was assessed with the Morris Water Maze, and the anxiety-related behavior was assessed with the Elevated Plus-Maze. Results: Every experimental group showed evidence of neuronal apoptosis measured withcaspase-3; however, the apoptosis was more evident in the sevoflurane group and in the first exposure groups. The total time spent in the open arms of the Elevated Plus-Maze (t test p = 0.113) was not statistically significant as compared to the control group. When comparing the test time vs. the control group, the Morris Water Maze showed a statistically significant difference (t test p < 0.001). Conclusions: Sevoflurane exposure of neonate rats for short and repeated time intervals induces neuronal death probably due to apoptosis, through caspase-3 activation. This results in learning deficit, particularly in terms of spatial memory acquisition.

SISTEMA DE TOCOCARDIOGRAFÍA DIGITAL CON PROCESAMIENTO EN UNA FPGA PARA EL MONITOREO MATERNO-FETAL / DIGITAL CARDIOTOCHOGRAPHY SYSTEM WITH PARALLEL FPGA PROCESSING FOR MATERNAL FETAL MONITORING / SISTEMA DE TOCOCARDIOGRAFÍA DIGITAL COM PROCESSAMENTO EM UM FPGA PARA MONITORAMENTO MATERNO-FETAL

El estudio clínico fetal relaciona aspectos críticos como la intensidad de las contracciones uterinas, movimientos del feto y frecuencia cardiaca de manera simultánea para evaluar el bienestar fetal. Los cambios periódicos o transitorios de la frecuencia cardiaca son objeto de estudio y aparecen en relación a diversos estímulos fetales como movimientos espontáneos o provocados, contracciones uterinas, hipo fetal, etc. Con este propósito, en una valoración de los mismos es necesario disponer de una constante monitorización, en la que se exprese la frecuencia y la variabilidad cardiaca fetal de manera eficiente. En este artículo se presenta el desarrollo de un sistema de tococardiografía para el registro de la frecuencia cardiaca fetal y la intensidad de las contracciones uterinas compuesto por tres tarjetas electrónicas, una unidad de procesamiento digital paralela, una campana acústica y una pantalla para adquirir y procesar de manera no invasiva las señales tococardiográficas.

Clinical evaluation on fetuses is related to simultaneous critical aspects such as intensity of uterine contractions, fetal movements, and heart rate. Periodic or transient changes in heart rate are studied and appear in relation to various fetal stimuli as spontaneous or induced movements, uterine contractions, fetal hiccups, and so on. Thus, their evaluation is necessary to obtain constant monitoring in which the frequency and variability are expressed efficiently. This paper presents the development of a cardiotochography system for recording fetal heart rate and intensity of uterine contractions, which is composed by three electronic boards, a digital parallel processing unit, a sounds bell and a screen to acquire non-invasively and process tococardiography’s signals.

O estudo clinico fetal relaciona aspectos críticos, como a intensidade das contrações uterinas, movimentos fetais e batimentos cardíacos simultaneamente para avaliar o bem-estar fetal. As mudanças periódicas ou transitórias da frequência cardíaca são estudados e aparecem em relação a vários movimentos fetais espontâneas ou induzidas, as contrações uterinas, soluços fetais, etc. Para este efeito, em uma revisão do mesmo é necessário ter monitoramento constante, na que se exprese a freqüência e variabilidade do ritmo cardíaco fetal de forma eficiente. Este artigo é apresentado o desenvolvimento de um sistema de tococardiografía para registar o ritmo cardíaco fetal e intensidade das contrações uterinas composto por três placas eletrônicas, uma unidade de processamento digital paralelo, uma cabine acústica e uma tela para adquirir e processar de maneira não invasiva as sinais tococardiográficas.

Calciflaxis y enfermedad renal crónica / Calciphylaxis and chronic renal disease

Es una vasculopatía caracterizada por calcificación de la capa media de los vasos y proliferación de la íntima de los mismos, asociado a fibrosis y trombosis luminal, llevando a necrosis de los tejidos circundantes, en especial de los tejidos blandos. La fisiopatología de la calciflaxis está relacionada con múltiples factores, siendo una condición que lleva a la calcificación vascular acelerada y que se ha asociado a una serie de factores de riesgo como la enfermedad renal crónica en terapia de reemplazo y en trasplante renal. Se han relacionado otros factores no urémicos como son anormalidades en el metabolismo del calcio, hiperparatiroidismo primario, estados de hipercoagulabilidad como malignidad, déficit de proteína C y S, hepatopatía alcohólica, terapia con warfarina, hipoalbuminemia, terapias con calcio y vitamina D, obesidad y producto calcio/fósforo superior a 70. A continuación se reporta el caso de una paciente a quien se le documenta un cuadro clínico de calciflaxis, describiendo la presentación clínica de esta patología, los factores de riesgo identificados y las complicaciones presentadas durante su atención (Acta Med Colomb 2011; 36: 149-152).

Calciphylaxis is a vasculopathy characterized by calcification of the tunica media and proliferation of the tunica intima of blood vessels, in association with fibrosis and thrombosis of the lumen, which lead to necrosis of surrounding (especially soft) tissues. The pathophysiology of calciphylaxis is related with multiple factors. This condition leads to accelerated vascular calcification and has been associated with a number of risk factors, such as chronic renal disease, kidney replacement therapy, and renal transplantation. It has also been related with other, non-uremic, factors, such as calcium deregulation, primary hyperparathyroidism, hypercoagulability states (such as malignancy and deficiency of proteins C and S), alcoholic hepatopathy, warfarin therapy, hypoalbuminemia, therapy with calcium and vitamin D, obesity, and a Calcium/Phosphorus product above 70. We report the case of a patient with calciphylaxis by describing the clinical presentation, the associated risk factors, and the complications seen during the care of the patient (Acta Med Colomb 2011; 36: 149-152).

Avicins, natural anticancer saponins, permeabilize mitochondrial membranes.

Avicins are a class of natural saponins with selective pro-apoptotic activity in cancer cells. In this work, we studied the influence of avicins on metabolic state of rat liver mitochondria. Avicin-treated mitochondria underwent a significant decrease in oxygen consumption rate that was completely restored by addition of exogenous cytochrome c. On the other hand, avicins increased the rotenone-insensitive oxidation of external NADH in the presence of exogenous cytochrome c, long before high amplitude swelling of mitochondria was observed. The increase in external NADH oxidation was cyclosporin A-insensitive. Avicin G significantly accelerated hydroperoxide-induced oxidation of mitochondrial endogenous NAD(P)H, the drop of the inner membrane potential and the high amplitude swelling of mitochondria. The obtained data might explain selective induction of apoptosis in tumor cells by avicins. Based on other studies showing that tumor cells generate hydroperoxides with a very high rate, avicins could provide a new strategy of anticancer therapy by sensitizing cells with high levels of reactive oxygen species to apoptosis.