[Clinical and microbiological characteristics of skin and soft tissue infections caused by Staphylococcus aureus in children in a hospital in Medellin from 2013 to 2015]. / Características clínicas y microbiológicas de las infecciones de piel y tejidos blandos por Staphylococcus aureus en niños de un hospital en Medellín durante los años 2013 a 2015.

BACKGROUND: Skin and soft tissue infections (SSTI) are very common in children and Staphylococcus aureus is the main agent, with an increase of methicillin resistant strains (MRSA) in recent years. AIM: To identify the frequency of MRSA in skin and soft tissue infections (SSTI) in children from a high complex hospital in Medellin, Colombia. METHODS: This is a descriptive, retrospective study, information was obtained from medical records. We included patients younger than 18 years with SSTI due to S. aureus who did not meet criteria for invasive disease. RESULTS: The prevalence of MRSA in this population was 31%. The main diagnosis was cutaneous abscess (68%), followed by surgical site infection (15%) and non-purulent cellulitis (6%). Eighty five percent of the patients had at least 1 comorbidity. All isolates were sensitive to rifampicin and cotrimoxazole and 8% of the isolates were resistant to clindamycin. There was a higher prevalence of MRSA in patients under 2 years compared to older (60 vs 23%, p = 0,0109). CONCLUSION: In view of the high prevalence of MRSA in SSTI, empirical treatment with adequate coverage for MRSA is recommended, especially for patients under 2 years of age.

Case report. Unusual presentation of a pancreatic mass in an infant: pancreatic haemangioendotheliomatosis.

Primary pancreatic tumours are extremely rare in children. We report a case of a 5-month-old male with a diffuse invasive tumour of the head of the pancreas. The tumour demonstrated peripancreatic extension into the porta hepatis, which occluded the portal vein and invaded the superior mesenteric artery. It was found to be haemangioendotheliomatosis of the pancreas. Imaging, pathological findings and a brief relevant classification of haemangioma are discussed.

Diatoms and rotifers in cytological smears.

We describe several uncommon contaminants presumably derived from the tap water used in the staining procedure of cytological specimens. We would like to draw attention to the occasional presence of diatoms and fragments of rotifers in cytological specimens. Whilst most of these entities are harmless curiosities, they may cause concern as to their nature and significance.

Comparison of lignocaine 2% with adrenaline, bupivacaine 0.5% with or without hyaluronidase and a mixture of bupivacaine, lignocaine and hyaluronidase for peribulbar block analgesia.

PURPOSE: Each of the freely available local analgesic agents may be used, alone or in combination, with or without hyaluronidase, epinephrine and sodium bicarbonate for peribulbar block analgesia (PBA). A prospective audit of four solutions was undertaken to rationalize choice of local analgesic agent for PBA. METHODS: A randomized, prospective study on 200 middle-aged to elderly patients undergoing cataract extraction was undertaken to compare the efficacy of: (1) bupivacaine 0.5% (bup 0.5% plain); (2) bupivacaine 0.5% plus hyaluronidase 100 i.u. ml-1 (bup 0.5% hyalase); (3) lidocaine 2% plus epinephrine 1:200 000 (lido 2% epi); or (4) a mixture of lidocaine 2% and bupivacaine 0.5% (2:3 volume per volume mix) containing hyaluronidase 25 i.u. ml-1 (lido/bup/hyalase). A standardized deep peribulbar block technique, akinesia scoring system (each 5 minx4), and supplemental protocol was followed. Onset of block and supplementation rates to achieve akinesia were recorded by a blinded observer; the requirement for augmentation with topical oxybuprocaine or subconjunctival lidocaine during surgery and the time from first PBA injection to the completion of surgery (the duration of surgical access) were also recorded. RESULTS: Groups (N=50) were comparable. Akinesia scores were similar after each agent at 5 min, better with lido 2% epi compared with bup 0.5% plain at 10 min (P<0.05), and better with bup 0.5% hyalase, lido 2% epi, and lido/bup/hyalase, than with bup 0.5% plain at 15 min (P<0.01, <0.01, <0.05, respectively) and at 20 min (P<0.05, <0.05, <0.025, respectively). The supplementation rate at 5 min was least with lido 2% epi, greater with bup 0.5% plain (P<0.01) and bup 0.5% hyalase (P<0.0005) and greatest with lido/bup/hyalase (P<0.0005), but similar in each group at 10, 15 and 20 min. Overall, those given lido 2% epi required the least number of supplemental injections to achieve globe akinesia. Mean supplemental injectate volumes, augmentation rates during surgery and the durations of surgical access provided by each agent were similar. CONCLUSION: All four agents provided adequate analgesia during cataract extraction lasting approximately 95-100 min after PBA injection. Lido 2% epi demonstrated most rapid onset and required least number of injections to establish block. A hyaluronidase effect was evident only after 15 min in the bup 0.5% hyalase and lido/bup/hyalase groups. Bup 0.5% plain was overall the least satisfactory, and the greatest supplementation rate occurred with lido/bup/hyalase, suggesting that either lido 2% epi or bup 0.5% hyalase are the most suitable of the agents tested for this type of surgery.

An evaluation study of the Lippes loop D in the City of Cebu

A 16-month evaluation study of the Lippes loop D is presented. The data is based on 236 insertions done in a partially subsidized private clinic in Cebu City. The data was processed, analyzed, and computerized by the Pathfinder International IUD Evaluation Program, using the Tietze Life Table approach. Based on 1013.5 women month of use and on a 94.8% follow-up Loop D wearers who had been followed up for one year, had an expulsion rate of 11.1%. The removal for bleeding and/or pain was 2.8% and the incidence of pregnancy with the device in situ was 1.2%. The actual total continuation rate was 84% at the end of one year. The study is being continued with a larger series and a longer follow-up data. Because of the favorable acceptance and technical efficiency of the Lippes Loop D in preventing pregnancy among the low socio-economic group served in a private clinic set-up, it is hoped that the intrauterine device can be adopted more widely and actively in this country, among women in need of contraception regardless of their socio-economic and educational level. (Author)

Effects of intraperitoneal injections of "Tungog" in white sprague rats-inquiry on "Tungog" (an additive of tuba)

A 30-minutes infusion of "tungog" in normal saline was injected intraperitoneally to 59 white Sprague rats. Marked clinical and anatomic changes developed in animals which received 10 to 20 serial injections of 0.5 cc of the infusion 1 to 2 times a week plus a single additional dose of 0.75 cc per 100-gram body weight. The liver and spleen were contracted and deformed in more than 50% of the subjects. The hepatic cells showed varying degrees of hyaline and feathery degeneration which sometimes proceeded to necrosis. Concomitantly, there was secondary regenerating hyperplasia often to a marked degree. The changes in the spleen were described. (Author)

Analgesia for adenotonsillectomy in children and young adults: a comparison of tramadol, pethidine and nalbuphine.

A prospective, double-blind, randomized, controlled study was undertaken to compare the perioperative analgesic and recovery characteristics of equipotent doses of tramadol, pethidine and nalbuphine (3.0 mg kg-1, 1.5 mg kg-1 and 0.3 mg kg-1 respectively) with placebo (saline 0.02 ml kg-1) given at induction of anaesthesia in 152 ASA 1 children and young adults undergoing tonsillo-adenoidectomy. Premedication (temazepam and diclofenac), induction and maintenance of anaesthesia (thiopentone, atracurium, nitrous oxide and isoflurane), with controlled ventilation, were standardized. Variables monitored were heart rate (HR) and systolic arterial pressure (SAP) during surgery, time to recovery of spontaneous respiration at the termination of anaesthesia and restlessness, time to awakening, sedation and emesis in the recovery unit. Increases in HR or SAP > 33% of baseline during surgery were treated with esmolol 2.0 mg kg-1 intravenously (i.v.) and restlessness during recovery was treated with the same opioid i.v. given with an aesthesia, or pethidine i.v. in the placebo group. With placebo, there was a high requirement for esmolol during surgery and for pethidine in the recovery ward. Tramadol did not reduce the rate of intra-operative treatment with esmolol, but reduced the tramadol requirement during recovery (P < 0.05). Pethidine and nalbuphine reduced the intra-operative esmolol requirement more significantly (P < 0.025 and P < 0.005 respectively) and the need for treatment during recovery with opioids (P < 0.005 each). The time to recovery of spontaneous respiration at the end of anaesthesia was only delayed by pethidine. Other recovery variables were similar, except that restlessness-pain scores were reduced by tramadol (P < 0.02), pethidine (P < 0.005) and nalbuphine (P < 0.005). These results suggest that pethidine 1.5 mg kg-1 and nalbuphine 0.3 mg kg-1 given with induction of anaesthesia provide better analgesia during and after tonsillo-adenoidectomy than does tramadol 3.0 mg kg-1. The delay to recovery of spontaneous respiration with pethidine suggests a greater safety profile of nalbuphine and tramadol.