Síndrome urémico hemolítico del adulto / Adult hemolytic uremic syndrome

El síndrome urémico hemolítico (SUH), descripto en 1955, se caracteriza por la tríada de anemia hemolítica no inmunomediada, trombocitopenia y lesión renal aguda. En su patogenia interviene la toxina Shiga, producida con mayor frecuencia por E. coli O157:H. Puede manifestarse a cualquier edad, aunque es infrecuente en adultos, y se desarrolla en forma esporádica o en brote. Se presenta con un cuadro de dolor abdominal, diarrea, fiebre y vómitos. Puede afectar el sistema nervioso central, pulmones, páncreas y corazón. En adultos, el síndrome evoluciona tras un período de incubación de 1 semana posterior a la diarrea y tiene alta morbimortalidad, a diferencia de los casos pediátricos. Presentamos el caso de una paciente adulta, que cursó internación por síndrome urémico hemolítico. (AU)

Hemolytic uremic syndrome (HUS), described in 1955, is characterized by the triad of non-immune mediated hemolytic anemia, thrombocytopenia, and acute kidney injury. Shiga toxin, produced most frequently by E coli O157:H, is involved in its pathogenesis. Hus can manifest at any age, although it is rare in adults and develops sporadically or in outbreaks. HUS presents with a picture of abdominal pain, diarrhea, fever and vomiting. It can affect the central nervous system, lungs, pancreas, and heart.In adults, the syndrome evolves after an incubation period of 1 week after diarrhea, with high morbidity and mortality, unlike pediatric cases.We present the case of an adult patient who was hospitalized for hemolytic uremic syndrome. (AU)

Contenido de sodio en antimicrobianos parenterales: Una fuente extra de sodio a considerarse en pacientes hospitalizados / Sodium content in parenteral antibiotics: An extra source of sodium to be considered in hospitalized patients

Los antimicrobianos parenterales son esenciales en el tratamiento de infecciones intrahospitalarias, sin embargo, es importante considerar la carga de sodio y volumen que pueden aportar, especialmente, en pacientes con restricción sódica. En el presente estudio se identificaron los antimicrobianos parenterales usados en uno de los hospitales más grandes del Perú. Se revisó la cantidad de sodio intrínseco y se calculó la cantidad de sodio total por día de tratamiento según el régimen frecuentemente usado en adultos. Como resultado, se encontró que 22% de las terapias antimicrobianas superaban el requerimiento de sodio diario, lo que podría ser perjudicial para pacientes con insuficiencia cardiaca, enfermedad renal crónica, con cirrosis hepática, entre otros.

Parenteral antibiotics are essential in the treatment of nosocomial infections; however, their sodium load and volume should be considered as an extra source, especially, in patients with sodium restriction. In this study, we identified the parental antibiotics used in one of the largest hospitals in Peru. We reviewed the amount of intrinsic sodium and we calculated the sodium load per day of treatment according to the commonly used regimen in adults. As a result, we found that 22% of the antibiotic treatment regimens exceed the daily sodium requirement, which could be harmful for patients with heart failure, chronic kidney disease, liver cirrhosis, among others.

Segurança do paciente na administração de medicações parenterais: conhecimento de acadêmicos de Enfermagem / Seguridad del paciente en la administración de medicamentos parenterales: conocimiento de los estudiantes de enfermería / Patient safety in the administration of parenteral medications: knowledge of nursin students

Objetivo: avaliar o conhecimento de acadêmicos de enfermagem sobre a administração de medicações parenterais. Método: estudo descritivo de abordagem quantitativa. Desenvolvido em duas instituições de ensino superior, no curso de enfermagem. A pesquisa foi feita através de uma entrevista com questionário estruturado, contendo questões divididas por via de administração parenteral. Resultados: na via intradérmica, 48,1% erraram sobre a indicação e 57,4% erraram sobre o ângulo de introdução da agulha. Na via intramuscular, 66,7% erraram sobre os locais de aplicação e 57,4% acertaram sobre o ângulo de punção em 90° graus. Na via subcutânea, 55,6% erraram sobre a dose indicada e 85,2% erraram sobre os locais de aplicação. Na via endovenosa, 87,0% acertaram sobre a definição da via e 90,7% acertaram sobre a finalidade da via. Conclusão: os acadêmicos de enfermagem possuem conhecimento insuficiente sobre as medicações parenterais, denotando a necessidade de englobar mais conhecimento e evitando eventos adversos.(AU)

Objective: to verify the knowledge of nursing students about the administration of parenteral medications. Method: descriptive study of quantitative approach. Developed in two higher education institutions, in the nursing course, through an interview with a structured questionnaire, containing questions divided by parenteral administration. Results: in the intradermal route, 48.1% were wrong about the route indication and 57.4% were wrong about the needle introduction angle. In the intramuscular route, 66.7% were wrong about the application sites and 57.4% were right about the puncture angle at 90 degrees. In the subcutaneous route, 55.6% were wrong about the indicated dose and 85.2% were wrong about the application sites. In the intravenous route, 87.0% were right about the definition of the route and 90.7% were right about the purpose of the route. Conclusion: nursing students have insufficient knowledge about parenteral medications, denoting the need to encompass more knowledge and avoid adverse events.(AU)

Objetivo: verificar el conocimiento de los estudiantes de enfermería sobre la administración de medicamentos parenterales. Método: estudio cuantitativo desarrollado en curso de enfermería de dos instituciones de educación superior, con cuestionario estructurado con preguntas por tipo de administración parenteral. Resultados: en la vía intradérmica el 48,1% se equivocó en la indicación y el 57,4% en el ángulo de introducción de la aguja. En la vía intramuscular el 66,7% se equivocó en los sitios de aplicación y el 57,4% acertó en el ángulo de punción. En la vía subcutánea, el 55,6% se equivocó en la dosis indicada y el 85,2% en los sitios de aplicación. En la vía intravenosa, el 87,0% acertó en la definición y el 90,7% acertó en la finalidad. Conclusión: los estudiantes de enfermería tienen conocimientos insuficientes sobre medicamentos parenterales, denotando la necesidad de abarcar más conocimientos y evitar eventos adversos.(AU)

Intervención con probióticos para la prevención de enterocolitis necrotizante en prematuros extremos menores de 1500 gramos o de 32 semanas / Probiotic intervention to prevent necrotizing enterocolitis in extremely preterm infants born before 32 weeks of gestation or with a birth weight of less than 1500 g

Introducción. Existe evidencia del beneficio de los probióticos en prevenir enterocolitis necrotizante en prematuros extremos. Desde 2015, se usa probiótico preventivo en el Servicio de Neonatología, Hospital Hernán Henríquez Aravena, Temuco, Chile.Objetivo. Evaluar el impacto de este probiótico en la incidencia, gravedad, necesidad de terapia quirúrgica y letalidad por enterocolitis necrotizante en prematuros extremos. Pacientes y método. Estudio retrospectivo de cohortes. Datos analizados con Stata. Se aplicó la prueba exacta de Fisher para comparar porcentajes y, para los promedios, la prueba t para varianzas distintas. Los egresados entre 2015 y 2017 recibieron Lactobacillus reuteri Protectis (LRP), dosis única (1 x 108 unidades formadora de colonias) desde los primeros días de vida hasta cumplir las 36 semanas de edad gestacional corregida. Los controles egresados entre 2012 y 2014 no recibieron LRP.Resultados. El 3,45 % de los casos tuvo algún grado de enterocolitis: grado i (el 64 %), ii (el 18 %), iii (el 18 %); requirió cirugía el 18 % y no hubo letalidad. El 3,75 % de los controles históricos presentaron enterocolitis: grado i (el 12 %), ii (el 35 %), iii (el 53 %); el 64,7 % requirió cirugía, y el 47 % falleció. El grupo intervenido presentó grado ii o iii en un 36 %; en el grupo control, la sumatoria de estos estadios fue del 88 %.Conclusión.LRP administrado en dosis única diaria al prematuro extremo no modificó la incidencia de enterocolitis, pero disminuyó su gravedad, la letalidad y necesidad de tratamiento quirúrgico.

Introduction. There is evidence of the beneficial effects of probiotics to prevent necrotizing enterocolitis in extremely preterm infants. Probiotic prevention has been used since 2015 in the Division of Neonatology of Hospital Hernán Henríquez Aravena, Temuco, Chile.Objective. To assess the impact of this probiotic on the incidence, severity, surgical treatment requirement, and fatality rate of necrotizing enterocolitis in extremely preterm infants.Patients and methods. Retrospective, cohort study. Data were analyzed using Stata. Fisher's exact test was used to compare percentages, and the unequal variances t-test, for averages. Infants discharged between 2015 and 2017 received Lactobacillus reuteri Protectis (LRP), in a single dose (1 x 108 colony forming units), since the first days of life until 36 weeks of corrected gestational age. Controls discharged between 2012 and 2014 did not receive LRP.Results. Some degree of enterocolitis was observed in 3.45 % of cases: stage I (64 %), stage II (18 %), stage III (18 %); 18 % required surgery, and there were no deaths. Among historical controls, 3.75 % had enterocolitis: stage I (12 %), stage II (35 %), stage III (53 %); 64.7 % required surgery, and 47 % died. In the intervention group, stage II or III accounted for 36 % of cases, whereas in the control group, for 88 %.Conclusion. Administering a single daily dose of LRP to extremely preterm infants did not affect the incidence of enterocolitis, but reduced its severity, fatality rate, and surgical treatment requiremen

Antimicrobial stewardship in the outpatient parenteral antimicrobial therapy (OPAT) setting: the impact of prescription assessment by an infectious diseases specialist

ABSTRACT Objective: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. Method: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. Results: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. Conclusion: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.

Aspectos clínicos del tratamiento de la hiperglucemia no complicada en la unidad de cuidados intensivos / Clinical aspects of the treatment of uncomplicated hyperglycemia in the intensive care unit

Resumen Introducción: La glucosa es una variable dinámica en el paciente crítico. La hiperglucemia (mayor a 140 mg/dL) es frecuente en este grupo de pacientes, existiendo distintos enfoques terapéuticos para el control adecuado de la misma. Objetivo: Revisar los aspectos clínicos de la glucemia y la importancia del control glucémico en el paciente crítico adulto. } Metodología de búsqueda: En base de datos Pubmed, utilizando los términos MeSH: "critical illness", "insulin infusion", "insulin protocol", "hyperglycemia". Se incluyeron artículos de revisión y originales, en inglés y español. Conclusiones: El manejo de la hiperglucemia en el paciente crítico es un objetivo primordial en el enfoque integral del paciente de la unidad de cuidados intensivos, dada su asociación con mortalidad, morbilidad y estancia hospitalaria. MÉD. UIS.2020;33(2): 49-54.

Abstract Introduction: Glucose is a dynamic variable in the critically ill patient. Hyperglycemia (greater than 140 mg/dL) is frequent in this group of patients, and there are different therapeutic treatments for its adequate control. Objectives: To evaluate the clinical aspects of glycemia and the importance of glycemic control in the critically ill adult patient. Methodology: Search in Pubmed database using the MeSH terms: "critical illness", "insulin infusion", "insulin protocol", "hyperglycemia". Original and review articles are included, in English and Spanish. Conclusions: The management of hyperglycemia in the critically ill patient is a primary objective in the comprehensive approach of the patient in the intensive care unit due to its association with mortality, morbidity and hospital stay.MÉD.UIS.2020;33(2): 49-54.

Nivel de conocimientos y prácticas del profesional de enfermería en la administración de medicamentos parenterales en el servicio de Urgencias del Hospital General Materno Infantil San Pablo; año 2019 / Nivel de conocimientos y prácticas del profesional de enfermería en la administración de medicamentos parenterales en el servicio de Urgencias del Hospital General Materno Infantil San Pablo año 2019 / Level of knowledge and practices of the nursing professional in the administration of parenteral drugs in the Emergency Department of the Hospital General Materno Infantil San Pablo; year 2019 / Level of knowledge and practices of the nursing professional in the administration of parenteral drugs in the Emergency Department of the Hospital General Materno Infantil San Pablo; year 2019

El objetivo de esta investigación fue Identificar el Nivel de conocimientos y prácticas del profesional de enfermería en la administración de medicamentos parenterales en el servicio de Urgencias del Hospital General Materno Infantil San Pablo, 2019. Se realizó un estudio descriptivo de corte transversal, en el Hospital General Materno Infantil San Pablo, la muestra estuvo conformada por profesionales de enfermería en el servicio de Urgencias de los diferentes turnos. Se utilizó como técnica la encuesta y como instrumento de estudio el cuestionario. Los resultados se presentaron en gráficos, en cuanto al conocimiento de los profesionales de enfermería sobre la administración de medicamentos parenterales. Se concluye que los profesionales de enfermería del área de urgencias poseen bastante conocimiento y prácticas sobre la administración de medicamentos parenterales.

The objective of this research was to identify the level of knowledge and practices of the nursing professional in the administration of parenteral medications in the Emergency Department of the Hospital General Materno Infantil San Pablo, 2019. A descriptive crosssectional study was carried out at the Hospital General Materno Infantil San Pablo, the sample was made up of nursing professionals in the Emergency service of the different shifts. The survey was used as a technique and the questionnaire as a study instrument. The results were presented in graphs, regarding the knowledge of nursing professionals about the administration of parenteral drugs. It is concluded that nursing professionals in the emergency area have enough knowledge and practices on the administration of parenteral drugs.

Effects of intraperitoneal glutamine in the treatment of experimental sepsis / Efeitos da glutamina intraperitoneal no tratamento da sepse experimental

ABSTRACT Background: Sepsis is an important public health issue and is associated with high treatment costs and high mortality rates. Glutamine supplementation has proven to be beneficial to the functions of the immune system, acting beneficially in the evolution of patients in severe catabolic states. Aim: To evaluate the effect of glutamine supplementation via intraperitoneal in rats, induced sepsis, considering the following organs: intestines, liver, kidneys and lungs. Methods: Male Wistar rats subjected to sepsis by ligature and cecal puncture were divided into two groups: control C (n=6) and glutamine G (n=11), in which were administered dipeptiven 20% at a dose of 2 ml/kg/day (equivalent to 0.4g N(2)-L-alanyl-L-glutamine/kg) intraperitoneally 48 h prior to sepsis induction. After 48 h they were euthanized and intestine, liver, lung and kidney were removed for histological analysis. Results: Intestinal epithelial desquamation of the control group was more intense compared to the glutamine group (p=0.008). In the kidneys, degenerative tubular epithelial changes were less severe in the animals that received glutamine (p=0.029). Regarding to the liver, glutamine group showed lower levels of cell swelling than the control group (p=0.034). In the lung there were no results with statistical significance. Conclusion: Prior intraperitoneal supplementation with glutamine in experimental animals is able to reduce the damage to the intestinal mucosa, to the kidneys and liver's histoarchitecture.

RESUMO Racional: A sepse é importante problema de saúde pública, sendo relacionada com altos custos de tratamento e elevadas taxas de mortalidade. A suplementação de glutamina tem provado ser benéfica às funções do sistema imune, atuando em estados catabólicos graves. Objetivo: Avaliar o efeito da suplementação de glutamina via intraperitoneal em ratos induzidos à sepse. Método: Foram utilizados ratos Wistar submetidos à sepse por ligadura e punção do ceco, separados em grupo controle C (n=6) e glutamina G (n=11), aos quais foram administrados dipeptiven a 20% com dose de 2 ml/kg/dia (equivalente a 0,4 g N(2)-L-alanil-L-glutamina/kg), via intraperitoneal, 48 h antes da indução da sepse. Após 48 h todos os animais foram submetidos à eutanásia e intestino, fígado, pulmão e rim foram retirados para análise histológica. Resultados: No intestino a descamação epitelial do grupo controle foi mais intensa em comparação ao da glutamina (p=0,008). Nos rins, houve menor degeneração do epitélio tubular nos animais que receberam glutamina (p=0,029). No fígado, o grupo glutamina apresentou índices menores de tumefação celular do que o grupo controle (p=0,034). No pulmão não houve resultados com significância estatística. Conclusão: A suplementação prévia de animais experimentais com glutamina via intraperitoneal é capaz de reduzir os danos causados à mucosa intestinal, histoarquitetura dos rins e do fígado.

Terapia intraperitoneal paliativa en ascitis maligna fîlcrossMark refractaria / Intraperitoneal palliative therapy in refractory malignant ascites

Resumen El tratamiento convencional de la ascitis maligna refractaria es un reto oncológico pues provee mejoría sintomática poco duradera. La terapia intraperitoneal ha sido evaluada principalmente en reportes y series de casos, y en algunos ensayos clínicos, estudiados principalmente en la ascitis por cáncer ovárico y gastrointestinal. Esta terapia incluye: isótopos radioactivos, quimioterapia con hipertermia y sin esta, terapia inmunológica, biológica y otras. Los tratamientos más exitosos con respuestas variables, y aunque la comparación directa no es posible, son: la quimioterapia intraperitoneal hipertérmica (respuesta global entre 85,7% y 100%) y el catumaxomab, que frente a la paracentesis demostró una supervivencia libre de punción de 46 vs 11 días (HR 0,254) y una mediana a la próxima paracentesis de 77 vs 13 días (HR 0,169), con impacto positivo en la calidad de vida, principal fin en el escenario paliativo. La investigación en este campo continúa buscando resultados más duraderos, seguros y costo-efectivos.

Abstract Conventional treatment of refractory malignant ascites is an oncological challenge since it provides little lasting symptomatic improvement. Intraperitoneal therapy, evaluated mainly through series and case reports, and some clinical trials include the use of radioisotopes, chemotherapy, with and without hyperthermia, immunological and biological therapy and others. It has been studied mainly in ascites from ovarian and gastrointestinal cancer. With variable response rates, and although direct comparison is not possible, the most successfully treatments are hyperthermic intraperitoneal chemotherapy (overall response rate between 85.7% and 100%), and catumaxomab, which compared to paracentesis, demonstrated a puncture-free survival of 46 vs. 11 days (HR 0.254) and a median time to next paracentesis of 77 vs. 13 days (HR 0.169). This had a positive impact on quality of life, which is the main goal in the palliative setting. Research in this field continues looking for more lasting, safe, and cost-effective results.

Recommendations for outpatient parenteral antimicrobial therapy in Brazil

ABSTRACT A panel of national experts was convened by the Brazilian Infectious Diseases Society in order to determine the recommendations for outpatient parenteral antimicrobial therapy (OPAT) in Brazil. The following aspects are covered in the document: organization of OPAT programs; patient evaluation and eligibility criteria, including clinical and sociocultural factors; diagnosis of eligibility; venous access and antimicrobial infusion devices; protocols for antimicrobial use and monitoring and cost-effectiveness.

Sulfato de magnesio inhalado en el tratamiento del asma aguda / INHALED MAGNESIUM SULFATE FOR THE TREATMENT OF ACUTE ASTHMA

Antecedentes: Las exacerbaciones del asma pueden ser frecuentes y variar en gravedad, desde relativamente leves hasta el estado asmático. El uso del sulfato de magnesio (MgSO4) es una de las muchas opciones de tratamiento disponibles para las exacerbaciones agudas que no se ha estudiado vía inhalada. Objetivo: Determinar la utilidad del sulfato de magnesio inhalado, administrado en el asma aguda, sobre la función pulmonar y en las horas de estancia intrahospitalaria. Métodos: Previa firma de consentimiento informado se incluyó a los pacientes con asma ingresados a urgencias los cuales respondieron un cuestionario sobre cuestiones generales. Por aleatorización simple 1:1 se formaron 2 grupos: a) al que se le aplicó el tratamiento estándar para este padecimiento b) al que además del tratamiento estándar se le administró 500mcgrs de S. Magnesio inhalado por 3 dosis con intervalo de 20 minutos. Se realizaron mediciones clínicas y por flujometría al ingreso, 20, 40 y 60 minutos. Resultados: No se observaron diferencias estadísticamente significativas iniciales entre los grupos de tratamiento con el género, turno o mortalidad. En cuanto a las horas de estancia intrahospitalaria se vio una disminución significativa en el grupo de casos. El Tiempo de Apnea Voluntaria de forma inicial en el grupo tratado con Sulfato de Magnesio alcanzaron mayores tiempos en mayor cantidad de participantes, con una diferencia significativa (p=0.01). Los valores de la FEM se comportaron de forma similar, siendo mayores y con diferencia significativa (0.05) en el grupo de casos. Conclusiones: El magnesio nebulizado no ha sido ampliamente probado, sin embargo en nuestro estudio, parece ser eficaz al mejorar la función pulmonar de los pacientes que ingresan con crisis asmática, disminuir el tiempo de estancia intrahospitalaria y mejoría en la clínica del paciente

Background: Asthma exacerbations can be frequent and range in severity from relatively mild to asthmatics status. The use of magnesium sulphate (MgSO4) is one of the many treatment options available during acute exacerbations has not been studied inhaled. Objective: To determine the utility of inhaled magnesium sulfate, administered in acute asthma on lung function and hours of hospital stay. Methods: After obtaining informed consent were included patients admitted to the emergency department with asthma who answered a questionnaire on general issues. For simple randomization 1: 1 2 groups were formed: a) to which was applied the standard treatment for this condition b) that in addition to standard treatment was administered 500mcgrs S. Magnesium inhaled by 3 doses with an interval of 20 minutes. Clinical measurements were made and flowmetry at admission, 20, 40 and 60 minutes. Results: No statistically significant differences between initial treatment group gender, shift or mortality were observed. As for the hours of hospital stay was a significant decrease in the case group. The Apnea Time Volunteer initial shape in the treated group achieved Magnesium Sulfate older times more participants, with a significant difference (p = 0.01). EMF values behaved similarly, with higher and significant difference (0.05) in the case group. Conclusions: nebulized magnesium has not been extensively tested, but in our study, appears to be effective in improving lung function in patients admitted with acute asthma, decrease hospital stay time and improvement in clinical patient

Residual volume in vials of antibiotics used in pediatrics / Volumen residual de antibióticos en frascos-ampolla utilizados en pediatría / Volume residual de antibióticos em frascos-ampola utilizados na pediatria

Abstract OBJECTIVE Quantifying residual volume contained in vials of antibiotics used in pediatrics. METHOD This is an experiment involving samples from vials of antibiotics used in a pediatric hospital. Residual volume was identified by calculating the difference in weight measurement before and after the vials were washed. Evaluation of the residual volume difference in the vials was determined by the Wilcoxon non-parametric test for a sample and established at a significance level of 5%. RESULTS 105 samples of antibiotics were selected. The correct use of the antibiotics oxacillin (88.57%) and ceftriaxone (94.28%) predominated with low residual values. The same did not occur for procaine benzylpenicillin + potassium benzylpenicillin, since a greater residual volume was discarded in 74.28% of the vials. CONCLUSION We highlight the need for improvements in managing antibiotics in the institution under study, so that the excess volume of the antibiotics in the vials is used within the acceptable stable time. It is also necessary that the disposal of the residual volume be adequately disposed, since it presents a risk to public health and the environment.

Resumen OBJETIVO Cuantificar el volumen residual contenido en frascos-ampolla de antibióticos utilizados en pediatría. MÉTODO Se trata de un experimento con muestras de frascos-ampolla de antibióticos utilizados en hospital pediátrico. El volumen residual fue identificado calculándose la diferencia de la verificación del peso antes y después del lavado del frasco-ampolla. La evaluación de la diferencia de los volúmenes residuales en los frascos-ampolla fue determinada por la prueba no paramétrica de Wilcoxon para una muestra y establecido el nivel de significación del 5%. RESULTADOS Fueron seleccionadas 105 muestras de antibióticos. Predominó el correcto aprovechamiento de los antibióticos oxacilina (88,57%) y ceftriaxona (94,28%), con bajos valores residuales. Lo mismo no ocurrió con la bencilpenicilina procaína + potásica, pues en el 74,28% de los frascos hubo descarte de volumen residual superior. CONCLUSIÓN Se destaca la necesidad de mejorías en la gestión de los antibióticos en la institución en estudio, a fin de que el volumen excedente del antibiótico en frasco-ampolla se aproveche hasta el tiempo de estabilidad permitido, así como es necesario que haya la adecuación de la manera de descarte del volumen residual, que presenta riesgo a la salud pública y al medio ambiente.

Resumo OBJETIVO Quantificar o volume residual contido em frascos-ampola de antibióticos utilizados na pediatria. MÉTODO Trata-se de um experimento com amostras de frascos-ampola de antibióticos utilizados em hospital pediátrico. O volume residual foi identificado calculando-se a diferença da aferição do peso antes e após a lavagem do frasco-ampola. A avaliação da diferença dos volumes residuais nos frascos-ampola foi determinada pelo teste não paramétrico de Wilcoxon para uma amostra e estabelecido o nível de significância de 5%. RESULTADOS Foram selecionadas 105 amostras de antibióticos. Predominou o correto aproveitamento dos antibióticos oxacilina (88,57%) e ceftriaxona (94,28%), com baixos valores residuais. O mesmo não ocorreu com a benzilpenicilina procaína + potássica, pois em 74,28% dos frascos houve descarte de volume residual superior. CONCLUSÃO Destaca-se a necessidade de melhorias na gestão dos antibióticos na instituição em estudo, para que o volume excedente do antibiótico em frasco-ampola seja aproveitado até o tempo de estabilidade permitido, assim como é necessário que haja a adequação da forma de descarte do volume residual, que apresenta risco à saúde pública e ao meio ambiente.

Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

Abstract Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.

Direct intraperitoneal resuscitation with lidocaine, methylene blue and pentoxiphylline combination does not decreases inflammation after intestinal ischemia-reperfusion injury in rats

ABSTRACT PURPOSE: To evaluate the effects of an intraperitoneal solution of methylene blue (MB), lidocaine and pentoxyphylline (PTX) on intestinal ischemic and reperfusion injury METHODS: Superior mesenteric artery was isolated and clamped in 36 adult male Sprague Dawley rats. After 60 minutes, clamp was removed and a group received intraperitoneally UNITO solution (PTX 25mg/kg + lidocaine 5mg/kg + MB 2mg/kg), while the other group was treated with warm 0.9% NaCl solution. Rats were euthanized 45 min after drug administration. Lung and bowel were collected for histological evaluation (using Park's score) and determination of myeloperoxidase (MPO) and malondialdehyde (MDA) levels. RESULTS: Control samples showed lymphoplasmocytic infiltrate and crypt necrosis of villi. MPO and MDA measurements shown no differences between treated and control groups. CONCLUSION: The combination of lidocaine, methylene blue and pentoxyphylline administered intraperitoneally at the studied dose, did not decreased histological lesion scores and biochemical markers levels in intestinal ischemia/reperfusion injury.

Hidratación parenteral en Pediatría. Cambios de paradigmas? / Parenteral Hydration in Children, is the Paradigm Shifting ?

Los fluidos de mantenimiento intravenosos (IV) son diseñados para mantener la homeostasis cuando el paciente es incapaz de ingerir el agua requerida, electrolitos, y energía. La tradicional determinación de fluidos de volumen y su composición data del artículo de Hollyday y Segar del año 1957, el cuál describe la relación entre peso, gasto energético, pérdidas fisiológicas y niños sanos. Basados en estas estimaciones de requerimientos diarios de electrolitos, esta información apoya el uso de fluidos hipotónicos que fueron ampliamente usados en pediatría. Sin embargo el uso de los fluidos hipotónicos en pacientes hospitalizados quienes pueden tener desarreglos fisiológicos, menos gasto calórico, disminución del ritmo diurético, y elevados niveles de hormona antidiurética no constituye una alternativa óptima. Varios trabajos han demostrado en las 2 últimas décadas que las soluciones hipotónicas pueden llevar a un aumento de la incidencia de hiponatremia. Está alteración electrolítica puede ser muy dañina y peligrosa para el organismo desde graves patologías neurológicas hasta la muerte. Esta revisión presenta la evidencia para el uso de fluidos isotónicos más que hipotónicos como solución intravenosa de mantenimiento .

Maintenance intravenous (IV) fluid share designed to maintain homeostasis in patients unable to ingest required water, electrolytes, and calories. The traditional criteria for determining fluid volume and composition date from a 1957 article by Holliday and Segar that describes the relation shipsbet ween weight ,energy consumption, physiologic loss, and healthy children.Their estimates of daily electrolyte requirements support the use of the hypotonic solutions that were once much used in pediatric cases. How everinhos pitalized patients who may have physiologic disorders, reduced caloric requirements and urine output,and high levels of antidiuretic hormone,the use of hypotonic fluids is not ideal. Various studies over the last two decades have demonstrated that hypotonic solutions may cause increased incidence of hyponatremia. This dy selectrolytemia can be very harmful and cause severe pathologies ranging from neurological disorders to death. This review provides evidence supporting the use of isotonic rather than hypotonic fluids for maintenance intrav enous therapy.

Administración parenteral de antibioticoterapia en ocho instituciones de cuidado domiciliario de Bogotá D. C. / Parental administration of antibiotics in eight homecare institutions in Bogotá D. C. / Uso parenteral de antibioticos em oito principal instituições de cuidados de Bogotá D. C.

El presente trabajo describe la administración de antimicrobianos por vía endovenosa en ocho instituciones de hospi\r\n-\r\ntalización domiciliaria de la ciudad de Bogotá (Colombia) durante los meses de enero a diciembre de 2012. Se diseñó \r\nun estudio descriptivo de corte transversal para registrar los hallazgos de la revisión de los criterios relacionados \r\ncon estructura, proceso y resultado de la atención de enfermería en la administración de antimicrobianos por vía \r\nparenteral. La fuente de información fueron los registros de la estructura organizacional y los registros clínicos y \r\nasistenciales. Se utilizaron medidas de tendencia central y coeficiente de determinación para identificar las variables \r\nde mayor impacto en la gestión clínica de enfermería. Se analizaron 11440 dosis de antimicrobianos. \r\nSegún los resultados, la edad media de los usuarios era de 45,3 años, la duración media del tratamiento antibiótico \r\nintravenoso en domicilio fue de 8,6 días (límites: 1-42 días), el diagnóstico de ingreso más frecuente fue la infección \r\nde vías urinarias (41,47%) y el servicio de procedencia más frecuente fue hospitalización (62,36%). El catéter venoso \r\nperiférico fue el dispositivo de administración más usado (64%) y tuvo un tiempo medio de utilidad de 4,75 días. \r\nLa administración de betalactámicos alcanzó un 33,26%, aun cuando el fármaco utilizado con mayor periodicidad \r\nfue el ertapenen (25,62%). El 93% de las dosis se administró por técnico auxiliar de enfermería, con una adherencia \r\nal tiempo de infusión del 7% y al volumen de infusión del 11% (R2 0,15). En conclusión, se documentaron cuatro \r\nvariables a intervenir con relación a la atención de enfermería: la existencia de protocolos de atención específicos, la \r\nrazón entre enfermeros y auxiliares de enfermería, la adherencia a planes de cuidado de enfermería y la tasa de dosis \r\nno administradas de medicamentos, las cuales contribuyen a garantizar un cuidado de enfermería de calidad y con \r\ncontrol sistemático de los riesgos

This study describes the intravenous administration of \r\nantimicrobials in eight homecare programs in Bogotá, \r\nColombia. Objective: to describe the parenteral admi\r\n-\r\nnistration of antibiotics in a sample group of homecare \r\nprograms in Bogotá DC, from January to December of \r\n2012. Methods: a descriptive cross-sectional study was \r\ndesigned to record the findings of a criteria review of the \r\nstructure, process and outcome of nursing care in the \r\nadministration of parenteral antimicrobials. The records \r\nof the organizational structure and clinical records \r\nand care were used, measuring the central tendency \r\nand determination coefficient in order to determine \r\nthe highest impact variables on clinical nursing mana\r\n-\r\ngement. Results: 11,440 doses of antimicrobials were \r\nanalyzed, the average age of users was 45.3 years, mean \r\nduration of intravenous antibiotic therapy at home was \r\n8.6 days (range: 1-42 days), the most frequent admis\r\n-\r\nsion diagnosed was urinary tract infection (41.47%) and \r\nthe most frequent referral service was hospitalization \r\n(62.36%). The peripheral venous catheter constituted a \r\n64% of total delivery devices, with a mean utility of 4.75 \r\ndays. The administration of beta-lactams was 33.26 % \r\nalthough Ertapenen was used more regularly (25.62%). \r\nA nursing assistant technician in 93% of the cases admi\r\n-\r\nnistrated the dose; the adherence to infusion time was \r\n7%, and the infusion volume 11% (R2 0.15). Conclu\r\n-\r\nsions: four variables relating to nursing care which help \r\nensure quality nursing care and systematic risk control \r\nwere documented: the existence of specific care proto\r\n-\r\ncols, the ratio of nurses to nursing assistants, adherence \r\nto nursing care plans, and the rate of dosage not adminis\r\n-\r\ntered in medication.

Este estudo e sobre o administração de antimicrobianos \r\nintravenosa em oito instituições de assistência domici\r\n-\r\nliar na cidade de Bogotá, Colômbia. Objetivo: Descreve \r\nadministração parenteral de antibióticos em uma amostra \r\nde instituições de internação domiciliar em Bogotá \r\nDC, durante os meses de janeiro a dezembro de 2012. \r\nMétodos: Um estudo transversal foi projetado para \r\ngravar os resultados da revisão da estrutura, processo e \r\nresultado do cuidado de enfermagem na administração \r\nde antimicrobianos parenterais. Os registros da estrutura \r\norganizacional e os registros clínicos foram utilizadas \r\nmedidas de tendência central e coeficiente de determi\r\n-\r\nnação para determinar as variáveis mais influente sobre \r\na gestão de enfermagem clínica. Resultados: 11.440 doses \r\nde antimicrobianos foram analisados. A idade média dos \r\nusuários era 45,3 anos e a duração da antibioticoterapia \r\nendovenosa em casa foi de 8,6 dias (variação: 1-42 dias), \r\no diagnóstico de mais frequente foi a infecção do trato \r\nurinário (41,47 %) e o serviço da referencia mais frequente \r\nfoi a hospitalização (62,36 %). O cateter periférico venoso \r\natingiu 64% do total de dispositivos de entrega, com uma \r\nutilidade média de 4,75 dias. O administração de beta-\r\nlactâmicos atingiram 33,26%, mas a droga mais usada \r\nregularmente foi o Ertapenen (25,62%). 93% das doses \r\nforam administrada por um Enfermeiro Técnico Auxi\r\n-\r\nliar, com a adesão ao tempo de infusão 7% e o volume de \r\ninfusão era 11 % (R2 0,15). Conclusões : Quatro variáveis \r\npara intervir em relação aos cuidados de enfermagem que \r\najudam a garantir cuidados de enfermagem de qualidade \r\ne controle de risco sistemático foram documentados: a \r\nexistência de protocolos de atendimento específicos, a \r\nproporção de enfermeiros assistentes a enfermagem, a \r\nadesão aos planos de cuidados de enfermagem e a taxa de \r\ndose dos remédios não gerenciados

Nueva metodología para la formulación de la vacuna Heberpenta-L / New methodology for the formulation of the vaccine Heberpenta-L

La vacuna Heberpenta-L, está indicada para la inmunización activa contra la difteria, tétanos, tos ferina (pertussis), hepatitis B y Haemophilus influenzae tipo b. En el Centro Nacional de Biopreparados se diseñó una nueva planta de producción de productos parenterales, resultando la vacuna pentavalente uno de los productos recién introducidos. Con tal propósito se diseñó una nueva metodología para la formulación de la vacuna, adecuando los procedimientos normalizativos de operación vigentes a esta nueva instalación. La validación con medio de cultivo caldo triptona soya, resultó una de las etapas más importantes para garantizar, tanto las operaciones de esterilización y enfriamiento de las soluciones, como todos los pasos críticos en la formulación y operaciones asépticas para futuros productos. Se estableció una nueva metodología en el proceso de formulación para la preparación de las soluciones, la cual tuvo lugar en un área independiente al área de la formulación final del producto. Los resultados satisfactorios obtenidos en la formulación de tres lotes de consistencia de la vacuna Heberpenta-L, no solo garantizaron el cumplimiento de los requisitos de calidad establecidos para esta vacuna, sino que además constituyeron la base preliminar a largas campañas de otros productos.

The vaccine Heberpenta-L, is suitable for the active immunization against the diphtheria, tetanuses, ferocious cough (pertussis), hepatitis B and Haemophilus influenzae type b. In the National Center of Bioproducts a new plant of production of products parenterals was designed, being the vaccine pentavalent one of the recently introduced products. With such a purpose a new methodology was designed for the formulation of the vaccine, adapting the procedures effective operation normalizative to this new installation. The validation with cultura medium broth triptone soy was one of the most important stages to guarantee, so much the sterilization operations and cooling of the solutions, as all the critical steps in the formulation and aseptic operations for future products. A new methodology settled down in the formulation process for the preparation of the solutions, which took place in an independent locate to the locate of the final formulation of the product. The satisfactory results obtained in the formulation of three batch of consistency of the vaccine Heberpenta-L, they guaranteed the execution of the established requirements of quality for this vaccine and constituted the preliminary base to long campaigns of other products.

Cambios en la actividad de algunas enzimas séricas en ratas con hipervitaminosis E / Changes in activity of some serum enzymes in rats with hypervitaminosis E

Poco se sabe sobre los cambios en la actividad de las enzimas séricas relacionadas con la función hepática durante la hipervitaminosis E. En el presente trabajo se estudió el efecto de la administración intraperitoneal de 50, 100, 200 y 400 mg de vitamina E/día, durante 20 días sobre la actividad enzimática sérica en 60 ratas Wistar machos, de 12 semanas de edad, con pesos entre 180 y 200 gramos. El grupo control estuvo integrado por 15 ratas Wistar sanas, con edad y peso similares a los animales tratados. Al final del estudio, se tomaron muestras de sangre para la determinación de la vitamina E y la actividad de las enzimas: alanina aminotransferasa (ALT), aspartato aminotransferasa (AST), α-amilasa (AMS), arginasa (ARG), fosfohexosaisomerasa (PHI), fosfatasa alcalina (ALP), γ-glutamiltransferasa (γ-GT) y 5´-nucleotidasa (5´-N). La administración de vitamina E en exceso incrementó de manera significativa (p<0,05) el contenido sérico de la vitamina E y la actividad de todas las enzimas valoradas (p< 0,05); mientras que la α-amilasa disminuyó (p< 0,05) al ser comparada con los controles no tratados. Nuestros resultados proporcionan evidencia que la administración a corto plazo de dosis altas de vitamina E, produce un incremento en la actividad de las enzimas marcadoras de daño hepático (como aminotransferasas, ARG y PHI) y de colestasis (como ALP, 5´-N y γ-GT), que se corresponde con la forma mixta de enfermedad hepática (daño+colestasis).

Little is known about the possible changes in blood enzyme activity related to liver function during hypervitaminosis E. In the present work the effects of intraperitoneal administration of 50, 100, 200 and 400 mg of vitamin E (α-tocopherol) daily for 20 days, respectively, on the serum enzyme activity in 60 white male Wistar rats, aged 12 weeks and weighing 180-200 g, were studied. The group control was integrated by 15 healthy rats with similar characteristics (age and weight) to treated animals. Excess of vitamin E produced a significant (p<0.05) increase in the serum content of vitamin E and in the activity (p<0.05) of the following enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), arginase (ARG), phosphohexosaisomerase (PHI), alkaline phosphatase (ALP), γ-glutamyltransferase (γ-GT) and 5´-nucleotidase (5´-N) while α-amylase (AMS) decreased (p<0.05) on comparing with the control group. These changes depend on the doses given of vitamin E. In conclusion, our results provide evidence that short-term administration of high doses of vitamin E produces an increase in the activity of the enzymes marker of liver damage (as aminotransferases, ARG and PHI) and of cholestasis (as ALP, γ-GT and 5´-N) that correspond to the mixed form of liver disease (injury+cholestasis).

Estudo experimental do aquecimento adequado de solução cristaloide por micro-ondas e dedução de equação para seu cálculo / Experimental study of adequate microwave warming of crystalloids and derivation of an equation for calculating heating parameters", "_e": "n

INTRODUÇÃO: Fluidos cristaloides são comumente aquecidos em forno de micro-ondas, para uso endovenoso ou subcutâneo (em lipoaspirações). A literatura médica é pobre em trabalhos estabelecendo parâmetros científicos para esse processo. O objetivo deste estudo foi estudar experimentalmente o aquecimento de solução salina (cloreto de sódio a 0,9%), a partir de diferentes temperaturas iniciais, deduzir uma equação para permitir o cálculo de parâmetros de aquecimento e estudar o decréscimo de temperatura da solução aquecida. MÉTODO: Frascos para infusão endovenosa (500 ml e 1.000 ml) de solução salina tiveram sua temperatura inicial ajustada para 15°C, 20°C e 25°C, sendo aquecidos por micro-ondas até 60 segundos (500 ml) e 120 segundos (1.000 ml). A temperatura da solução salina foi medida durante e ao final do aquecimento e até 30 minutos após esse processo. A partir dos resultados, foi deduzida uma equação. RESULTADOS: O aquecimento por 60 segundos elevou a temperatura de frascos de 500 ml de solução salina em cerca de 20°C. Foram necessários 120 segundos para a mesma elevação de temperatura de frascos de 1.000 ml. A equação deduzida foi: TIF = TII + [0,165 x Tempo (segundos) / Volume (litros)], onde TIF = temperatura interna final e TII = temperatura interna inicial. Não foram encontradas diferenças significantes entre as temperaturas interna e externa após o aquecimento. CONCLUSÕES: A determinação da temperatura inicial é fundamental na obtenção da temperatura final desejada, após o aquecimento de fluidos cristaloides por micro-ondas. Uma equação pôde ser deduzida, tornando possível o cálculo da temperatura final a partir de várias temperaturas iniciais. A temperatura externa dos frascos reflete adequadamente sua temperatura interna.

BACKGROUND: Crystalloids are commonly heated in microwave ovens for intravenous or subcutaneous usage (e.g., in liposuction). However, few studies have empirically determined the parameters for this procedure. This study experimentally evaluated the heating of saline solution (sodium chloride 0.9%) at different initial temperatures to derive an equation to calculate heating parameters as well as the temperature decrease in saline solutions after heating. METHODS: The initial temperature of intravenous pouches containing saline solution (500 and 1,000 mL) was adjusted to 15°C, 20°C, or 25°C. The 500 and 1,000 mL pouches were then warmed in a microwave (900 W) for 60 and 120 seconds, respectively. The temperature of the saline solution was measured during heating and immediately and 30 minutes after heating. An equation was derived from the results. RESULTS: Warming the 500 and 1,000 mL pouches for 60 and 120 seconds, respectively, at 900 W increased the temperature of these pouches by 20°C. The derived equation was as follows: final temperature = initial temperature + [0.165 × time (s)/volume (L)]. No significant differences were found between the internal and external temperatures of the pouches after heating. CONCLUSIONS: Determining the initial temperature of crystalloid solutions is essential for obtaining the desired temperature after microwave warming. The equation derived in the present study enables calculation of the final temperature of solutions with various initial temperatures. The external temperature of the pouches accurately reflects their internal temperature.