Infección del sitio de salida de los catéteres venosos centrales y su asociación con bacteriemia relacionada con catéter / Infection of the exit site central venous catheters and its association with bacteremia related to catheter

Introducción: Los catéteres venosos centrales (CVC) plantean un alto riesgo de infección. La infección del sitio de salida (ISS-CVC) es la menos estudiada, y se desconoce su asociación con la bacteriemia asociada a catéter (BAC) y su impacto en la evolución del paciente. Objetivo: Evaluar la asociación entre ISS-CVC, BAC y mortalidad. Materiales y métodos: Estudio prospectivo, de observación. Pacientes internados en una Unidad de Terapia Intensiva médico/quirúrgica que requirieron la colocación de CVC desde el 01/06/2010 hasta el 01/04/2012. Se evaluaron datos epidemiológicos, BAC (según criterios de los CDC) y gérmenes. Se utilizaron media ± DE, mediana y rango intercuartílico, y porcentajes. Resultados: Durante este período, ingresaron 575 pacientes, el 98% requirió CVC. Datos de los pacientes: edad 41 ± 26 años, APACHE II 15 ± 7, 96% con ventilación mecánica, días de ventilación mecánica 41 (33-63), días de internación 43 (25-67). Todos los CVC con ISS fueron retirados y cultivados. Se observaron 51 ISS: 5,5/1000-días-catéter: 33% subclavia, 38% yugular, 29% femoral. Seis pacientes con ISS (12%) tuvieron BAC (0,65/1000-días-catéter): 3 subclavias, 2 yugulares, 1 femoral; 2 con halo y 8 con secreción purulenta. Tiempo de permanencia del CVC: 7,5 días (5-10). Clínica al momento de la ISS: shock 50%, fiebre 83%, SOFA 6 ± 3. El 83% de las infecciones fueron monomicrobianas: 83% por bacilos gramnegativos (2 Klebsiella, 2 Pseudomonas, 1 Serratia y 1 Acinetobacter), 17% por enterococos resistentes a vancomicina. La mortalidad fue del 50%. Conclusión: Aunque la ISS provocó una baja incidencia de BAC, la mortalidad fue alta. Al parecer, la ISS no es un factor predictivo de BAC.(AU)

Introduction: Central venous catheters (CVC) are widely used and pose a high risk of infection. There are few studies on insertion site infection (ISI-CVC), and both its association with catheter-associated bloodstream infection (CABSI) and the outcome of patients are unknown. Objective: To determine the association between ISI-CVC, the presence of CABSI and mortality. Materials and methods: Prospective observational study. All patients admitted to a medical/surgical Intensive Care Unit requiring CVC insertion from 06/01/2010 to 04/01/2012 were included. Epidemiological data, CABSI (according to CDC criteria) and microorganisms involved were evaluated. Mean ± SD, median and interquartile range, and percentages were used. Results: During the period study, 575 patients were admitted, 98% required CVC. Patient´s data: age 41 ± 26 years, APACHE II 15 ± 7, 96% on mechanical ventilation, days on mechanical ventilation: 41 (33-63), length of stay 43 (25-67) days. All CVCs with ISI were removed and cultured. Fifty one ISI were observed (5.5/1000-catheter-day). Six patients with ISI (12%) presented CABSI (0.65/1000-catheter-day): 3 in subclavian, 2 in jugular, 1 femoral; 2 with erythema and 8 with purulent secretion. CVC permanence: 7.5 day (5-10). Signs and/or symptoms at the moment of ISI: shock 50%, fever 83%, SOFA 6 ± 3. The 83% of infections were caused by one microorganism: 83% due to gram-negative bacilli (2 Klebsiella, 2 Pseudomonas, 1 Serratia, and 1 Acinetobacter), 17% due to vancomycin-resistant enterococci. The mortality rate was 50%. Conclusion: Although ISI-CVC presented a low incidence of CABSI, mortality rate was high. The ISI-CVC might have a little predictable value for CABSI.(AU)

[Sexual behaviour among school adolescents in Córdoba]. / Comportamiento sexual de los escolares adolescentes en la ciudad de Córdoba.

OBJECTIVE: To know sexual behaviour among school teenagers and to determine different risk behaviors and groups with specific needs of health education. DESIGN: Cross-sectional study. SETTING: High-schools from Córdoba. PARTICIPANTS: 893 teenagers students selected by random sample. MAIN MEASUREMENTS: Anonymous self-rated survey about sexual behaviour and uses of contraceptives methods. MAIN RESULTS: The average age was 17.16 years (95% CI, 17.05-17.26), 48% males. 22.9% have had completed sexual relations; there were mainly girls (P=.001). The average age for the first relation was 16.64 years (95% CI, 16.45-16.82), with no difference between gender. Among girls, first sexual intercourse use to be with their regular partners (P<.001). 48% of the girls have had one or more sexual intercourse per week, that was only a 19.5% among boys (P<.001). 82% had used a contraceptive method at the first time, and the condom was the method more frequently used. CONCLUSIONS: 20% of school teenagers have had complete sexual intercourse, most of them before 18 years. Girls have more frequently sexual relations, usually with their regular partners. Condom is the contraceptive method more frequently used.

[Knowledge about AIDS and sexually transmitted diseases among adolescents]. / Conocimientos de los adolescentes sobre el sida y las enfermedades de transmisión sexual.

OBJECTIVE: To determine knowledge about AIDS and sexually transmitted diseases (STD) among school adolescent in order to define their lacks, and those aspects to include in programs of health education. DESIGN: Cross-sectional study. SETTING: Secondary schools from Córdoba. PARTICIPANTS: 893 teen students. Stratified random sample. MAIN MEASUREMENTS: Anonymous self administered survey. Dates related with knowledge about AISD, STD and its mechanism of transmission. MAIN RESULTS: The mean age of the sample was 17.16 years (95% CI, 17.05-17.26) and 48% was men. 56.7% (95% CI, 53.46-59.94) recognize to be very informed about AIDS and STD, finding significant differences among public (58.9%) and private schools (51.6%) (P=.045). About AIDS, the mean of successes was 8.81 (95% CI, 8.69-8.92; limits 0-12), finding positive differences among men (P=.048); older students (P=.003); public schools (P=.025), and the students non believers (P=.021). About STD, the mean of successes was of 2.47 (95% CI, 2.35-2.78; limits 0-12), with significant differences among women (P=.045); older students (P=.001) and public schools (P=.001). About AIDS sexual transmission, the mean of successes was of 13 (95% CI, 12.87-13.12; limits 0-16), without differences between sex, classrooms or type of schools. CONCLUSIONS: Level of knowledge shown by adolescents for aspects related to STD is poor. Likewise, the information about AIDS can be consider as enough, being men those that to present a bigger degree of knowledge.

Characteristics of missed lung cancer on chest radiographs: a French experience.

The purpose of this study was to report 30 cases of missed lung cancers and describe characteristics of each case. Reasons for misdiagnosis were analyzed from the report. Each radiograph was subsequently reviewed by a panel of two experts who quantified several parameters regarding image analysis and film quality. Lesions were not described in 67% of the cases and were misinterpreted as benign processes in 33% of cases. Comparison to previous chest radiographs and clinical information were seldom available on the report. Size of the lesions varied between 1 and 7 cm, location was primarily apical and paramediastinal, normal anatomy was highly or moderately complex in 87%, and distracting lesions were present in 63% of the cases. Image quality was considered perfect in 3 cases only. Among all the factors responsible for missed lung cancer, certain factors can be improved as film quality, comparison with previous radiographs, and better awareness of clinical information.

[Tobacco consumption among school children and its relation to the environment]. / Consumo de tabaco entre escolares de E.G.B. y su relación con el entorno.

OBJECTIVE: The aim of our study was to know the prevalence of tobacco consumption and the influence of the immediate environment in schoolchildren. PATIENTS AND METHODS: Participants were a random sample of 1,195 sixth and eighth grade schoolchildren from our rural area (N = 14,537) with a mean age of 12.7 +/- 1.27 years. Data were collected from a confidential and anonymous survey about tobacco consumption. RESULTS: We found that 18.6% of children are currently smokers and 22% of them smoke daily. Forty-four percent of schoolchildren had tried tobacco occasionally. The mean age to start tobacco consumption was 11 years old. Regarding family environment, 56% of the fathers consumed tobacco daily in contrast to 22% of mothers. Logistic-regression analyses showed an independent association between smoking habits, alcohol and coffee consumption and smoking (habit in the best friend). CONCLUSIONS: A great number of schoolchildren had consumed tobacco occasionally. Group of friends had an important influence in the smoking habit, unlike the family environment. Moreover, tobacco consumption showed an independent association with bad habits like drinking alcohol and coffee.

[Alcohol consumption and environmental influence among school children]. / Consumo de alcohol e influencia del entorno entre escolares de E.G.B.

OBJECTIVE: The objective of this study was to know the attitude towards alcohol and its consumption among schoolchildren. We also studied the influence of the immediate environment. PATIENTS AND METHODS: Participants were a random sample of sixth and eight grade schoolchildren during the 1995 school year from our rural area (n = 14,537). Data were collected from a confidential and anonymous survey about attitude and alcohol consumption. RESULTS: We found that 63% of children had tried alcohol occasionally. Forty-seven percent of them drank on a regular basis. Furthermore, 8% of this group consumed beer daily. Among frequent drinkers, 20.4% had gotten drunk at some time and this was more frequent among boys (p < 0.01) and older students. Forty percent of children did not think alcohol was a drug. Regarding family environment, 37% of fathers consumed alcohol daily in contrast to 4% of mothers. Logistic-regression analyses showed an independent association between alcohol consumption and smoking habits. CONCLUSIONS: A great number of schoolchildren and consumed alcohol occasionally. Boys and older students had gotten drunk more frequently than girls. Moreover, they believe that alcohol is not a drug and cannot perceive it as a harmful substance.

[Spontaneous bacterial peritonitis from Campylobacter fetus]. / Peritonitis bacteriana espontánea por Campylobacter fetus.

A patient with cirrhosis and ascites who developed spontaneous bacterial peritonitis due to Campylobacter fetus is described herein. This organism has been increasingly associated with bacteremia and localized infections in patients with cirrhosis and other immunocompromised states, but spontaneous bacterial peritonitis has been rarely reported. We review Campylobacter fetus infections and their relationship to development of spontaneous bacterial peritonitis, and we emphasize that prolonged antimicrobial therapy is required.

[Small intestine adenocarcinoma with Crohn's disease]. / Adenocarcinoma de intestino delgado y enfermedad de Crohn.

We report a 57-year-old male with a 11-years history of Crohn's disease who developed small bowel adenocarcinoma. The patient was admitted with intestinal partial obstruction and he underwent a laparotomy because an abscess in right lower quadrant was suspected. He was successfully treated with resection and adjuvant chemotherapy, without evidence of recurrence after a 2-year follow-up. A review of the literature reveals that about 100 cases have been reported. We describe the distinguishing features of small bowel adenocarcinoma arising in Crohn's disease and we emphasize the difficulty in making an early diagnosis.

[Value of laparoscopy in ascites of undetermined origin]. / Valor de la laparoscopia en la ascitis de origen indeterminado.

OBJECTIVE: To assess the diagnostic accuracy of laparoscopy in the study of patients with ascites of unknown cause, and the frequency of laparoscopy use for that indication after the advent of ultrasonography and computed tomography. DESIGN: A retrospective study of 4.536 laparoscopies performed in 16 years, in two periods of 8 years, and the correlation with the pathologic diagnosis. PATIENTS: 137 patients in whom laparoscopy was indicated for the study of ascites of unknown cause. RESULTS: 63.5% of laparoscopies were performed over the first 8-year period, and 36.5% in the second (p = 0.0001), and for the study of ascites 2.6 and 3.8% respectively. Laparoscopy and biopsy were diagnostic in 98.5% of cases; 51% carcinomatosis, 17.5% liver cirrhosis, 11.7% hepatic neoplasm and others. Two of five cases of peritoneal tuberculosis were considered carcinomatosis at laparoscopy. There were no serious complications. CONCLUSIONS: The advent of new imaging method has reduced the use of laparoscopy, although it is still employed frequently for the study of ascites. Laparoscopy with biopsy when necessary has an excellent effectiveness and accuracy for the diagnosis of ascites of unknown cause.

[Pelvic emergencies in women]. / Urgences pelviennes de la femme.

Emergency pelvic imaging is currently based on transabdominal and transvaginal sonography. Life threatening emergencies such as ectopic pregnancy and annexial torsion can be diagnosed by these technics. Doppler imaging (pulsed Doppler and color encoded) improve the diagnostic efficacy in an emergency context. Evaluation of pelvic inflammatory disease, cyst bleeding and placental disruption in best obtained by US because of its simplicity, safety and low cost.

[Interventional radiology and abdominal emergencies]. / Radiologie interventionnelle et urgences abdominales.

Interventional radiology used in acute abdominal diseases has demonstrated its efficacy in most emergency cases especially in patients at high risk for surgery. Percutaneous drainage is a reference standard for abscesses located within the abdomen and pelvis with high success rates of up to 80%. The diagnosis and treatment of gastrointestinal hemorrhage have changed over the past two decades, with decreased diagnostic examinations and advances in pharmacologic therapy and improved endoscopic techniques. On the other hand, embolization techniques and new procedures such as trans jugular intra hepatic porto systemic shunt have been developed. Arterial embolisation in many situations such as blunt or direct trauma, obstetric or post operative hemorrhage, can be used as an effective easy and relatively safe technique with high success rates to stop bleeding and save the organ. Percutaneous drainage and angiographic techniques adapted to biliary and urinary tree have also been developed as well as endoscopic procedures, allowing treatment of stenoses by balloon dilatation, or plastic or metal prostheses. Indications, technical aspects, complications and limits of these various procedures are presented.

[Digestive perforations and occlusions]. / Perforations et occlusions digestives.

Acute abdominal disorders are common reasons for consultation at the emergency department. The diagnosis of all acute abdominal disorders begins with a careful history and physical examination. When appropriate, the clinical examination should be supplemented by conventional plain abdominal radiography. Gastrointestinal perforation and obstruction are very commonly encountered in the diagnosis of acute abdomen. Plain abdominal radiographs are the initial diagnostic methods of choice. In some circumstances, ultrasonography and CT may be valuable for the evaluation of the cause of abdominal disorder.

[Abdominal emergencies of infectious origin]. / Urgences abdominales d'origine infectieuse.

Infectious disease is a common cause of acute abdomen. The diagnosis is based on clinical examination and basic laboratory tests. However, medical imaging routinely performed according to the clinical findings is frequently useful. Hepatic and splenic abscesses are correctly demonstrated by ultrasonography and computed tomography. Ultrasonography is the reference standard for the diagnosis of acute cholecystitis. The US examination is also performed for the diagnosis of appendicitis and its complications. Ultrasonography and barium enerna are commonly performed for the evaluation of signoid diverticulitis. Computed tomography is the reference standard to determine medical or surgical procedures.