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Global surface temperatures are projected to increase in the future; this will modify regional precipitation regimes and increase global atmospheric drying. Despite many drought studies examining the consequences of reduced precipitation, there are few experimental studies exploring plant responses to atmospheric drying via relative humidity and vapor pressure deficit (VPD). We examined eight native California perennial grass species grown in pots in a greenhouse in Los Angeles, California for 34 weeks. All pots were well-watered for 21 weeks, at which point we reduced watering to zero and recorded daily growth and dormancy for 3 weeks. We used this information to better understand the drought tolerance of our species in a larger soil drying × atmospheric drying experiment. In this larger experiment, we grew all eight species together in outdoor mesocosms and measured changes in community composition after 4 years of growth. Soil drying in our small pot experiment mirrored compositional shifts in the larger experiment. Namely, our most drought-tolerant species in our pot experiment was Poa secunda, due to a summer dormancy strategy. Similarly, the grass community shifted toward P. secunda in the driest soils as P. secunda was mostly unaffected by either soil drying or atmospheric drying. We found that some species responded strongly to soil drying (Elymus glaucus, Festuca idahoensis, and Hordeum b. californicum), while others responded strongly to atmospheric drying (Bromus carinatus and Stipa cernua). As result, community composition shifted in different and interacting ways in response to soil drying, atmospheric drying, and their combination. Further study of community responses to increasing atmospheric aridity is an essential next step to predicting the future consequences of climate change.
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Poaceae , Solo , Secas , Plantas , Estações do AnoRESUMO
Resumen En este artículo se presentan los resultados de un proceso de revisión bibliográfica sobre rehabilitación de miembro superior basada en ambientes virtuales. El estudio parte de los siguientes interrogantes sobre el estado actual del conocimiento en el área mencionada: ¿cómo inciden los entornos virtuales frente a la rehabilitación tradicional?, ¿qué métricas de desempeño se han aplicado en la rehabilitación virtual de miembro superior? y ¿qué dispositivos hardware se utilizan en rehabilitación virtual?. Para responder las anteriores preguntas se realizó una búsqueda de artículos científicos en el motor de búsqueda Google Scholar y en las bases de datos PubMed, HINARI, ProQuest y Science Direct. De la revisión realizada se concluyó que pese a la existencia de decenas de índices de desempeño para cuantificar la habilidad motriz, no existen criterios para seleccionar el indice que mejor se adapta a los objetivos de un determinado proceso de rehabilitación.
Abstract This article gives the results of a literature review process about upper limb rehabilitation based on virtual environments. The study borns of the following questions about the current state of knowledge in this subject: how virtual environments influence traditional rehabilitation?, Which performance metrics have been aplied in upper limb virtual rehabilitation? and which hardware devices are used in virtual rehabilitation? To answer the above questions a search for scientific articles was made in the search engine Google Scholar and databases PubMed, HINARI, ProQuest and Science Direct. The conducted review concluded that despite the existence of dozens of performance indicators to quantify the driving ability, there are no criteria to select a better index that best suits the objectives of a rehabilitation process.
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Se presenta un método para el procesamiento de señales en aplicaciones médicas que utilizan técnicas de diagnóstico basadas en ultrasonido Doppler. El método está orientado a obtener una mejor representación de la señal de flujo sanguíneo, a partir de la identificación y exclusión de los ciclos, de dicha señal, que se encuentran afectados por distorsiones eventuales. Esto permite, de manera robusta y confiable, estimar parámetros y extraer información clínicamente útil con el objetivo de formular diagnósticos precisos sobre la funcionalidad del objeto examinado. Se muestran los resultados de la aplicación del método sobre señales reales de flujo sanguíneo obtenidas durante procedimientos de revascularización coronaria y se demuestra que la estimación de los índices clínicos de interés mejora considerablemente cuando los ciclos detectados como afectados por ruido eventual son excluidos del análisis.
This paper aims to implement a method for signals processing in biomedical applications based on Doppler ultrasound techniques. The method is aimed to obtain a better representation of the blood flow signal, and it is based on the detection and exclusion of signal cycles detected as affected by eventual noise. This allows, in robust and reliable way, to estimate parameters and extract useful clinical information, in order to make accurate diagnoses on the functionality of the scanned object. The results of applying the method to two blood flow signals in coronary implants are presented, and it is observed that the estimation of the clinical indices improve when affected cycles are excluded of the signal analysis.
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Invasive candidiasis (IC) epidemiology has changed in critically ill patients and limited data are available in Chile. Objective: To describe the epidemiological and microbiological profile of IC in critically ill patients. Methods: Observational prospective study conducted from October 2001 to August 2003 in critically ill adults with suspected or confirmed IC. Results: 53 patients met criteria for IC, finding 18 (33.9 percent) candidemias, 22 (41.5 percent) disseminated IC, and 13 (24.5 percent) local IC. We identified 8 (44.4 percent) C. albicans and 10 (55.6 percent) non-albicans Candida in candidemias. C. tropicalis was the predominant non-albicans species (27.7 percent). An 88.8 percent of Candidas sp recovered in candidemias were fluconazole susceptible. Overall hospital mortality was 24.5 percent. Mortality in candidemia was significantly lower than in disseminated IC (16.6 vs 31.8 percent, p = 0.02). Conclusions: A higher proportion of non-albicans Candida was observed in candidemias from critically ill patients. However, most of these strains were fluconazole susceptible. A lower overall mortality was observed in candidemias.
La epidemiología de candidiasis invasora (CI) ha cambiado, lo cual no ha sido suficientemente estudiado en Chile. Objetivo: Describir el perfil epidemiológico y microbiológico de CI en pacientes críticos. Métodos: Estudio observacional prospectivo entre octubre 2001 y agosto 2003, en pacientes críticos adultos con sospecha o confimnación de CI. Resultados: 53 pacientes cumplieron criterios de CI. De ellos, 18 (33,9 por ciento) tuvieron candidemia, 22(41,5 por ciento) CI diseminada y 13(24,5 por ciento) CI local. Entre las candidemias, hubo 8 C. albicans (44,4 por ciento) y 10 Candida no albicans (55,6 por ciento), predominando C. tropicalis (27,7 por ciento). Un 88,8 por ciento de las candidemias fueron susceptibles a fluconazol. La mortalidad hospitalaria global fue 24,5 por ciento, significativamente menor en pacientes con candidemias vs CI diseminada (16,6 vs 31,8 por ciento, p = 0,02). Conclusiones: Se observó una mayor proporción de Candida no albicans en candidemias de pacientes críticos. Sin embargo, la mayoría de estas cepas fue susceptible a fluconazol. La mortalidad global fue menor en candidemias.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Candidíase Invasiva/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/microbiologia , Mortalidade Hospitalar , Hospitais Universitários , Estudos Prospectivos , Fatores de RiscoRESUMO
Background: Quality indicators are tools used to monitor specific activities within a process and improve it. In the area of clinical laboratories, the National Accreditation Standards for Providers of Health and the ISO 15189 standard recommend the implementation of indicators that monitor the test cycle with emphasis on those that contribute to a safer health care. Aim: To describe the implementation of nine indicators in a hospital clinical laboratory and their measurement during one year. Material and Methods: The indicators implemented and measured were four of the pre-analytical phase (number of rejected samples, times of transport, blood culture contamination and blood cultures inoculated with adequate blood volumes), two of the analytical phase (coherence of Gram stains of blood culture with microorganism cultured and correct results in external quality control surveys) and three of the post-analytical phase (compliance with order to report lapse goals, corrected reports and alert values report). Results: Two indicators of pre-analytical phase did not meet the per determined targets: number of rejected samples and blood cultures inoculated with adequate blood volume. All indicators of the analytical and post analytical phases were within thepre-determined targets. Conclusions: Coordinated work should be initiated especially with the nursing service to correct the two indicators that did not meet the target. The incorporation of quality indicators to monitor critical processes within the laboratory was undoubtedly an opportunity to identify areas for improvement.
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Humanos , Laboratórios Hospitalares/normas , Indicadores de Qualidade em Assistência à Saúde , Acreditação/organização & administração , Serviço Hospitalar de Emergência/normas , Hospitais Universitários , Garantia da Qualidade dos Cuidados de Saúde/normasRESUMO
Introduction: Toxoplasmosis (T) is a major chronic parasitic infection in immunocompromised patients and pregnant women. It is important to discriminate between acute phase (AT) and chronic phase (CT). Diagnosis is serological in immunocompetent patients (concentration of IgG and IgM). Objective: To evaluate the utility of an IgG avidity test (A-IgG) to identify the acute and chronic stage. Avidity is the strength of affinity between a specific immunoglobulin and the protein antigenic epitope of the infecting agent, an affinity that increases over time. Patients and Methods: We used a qualitative kit that measures the avidity of IgG, discriminating the two phases. In 35 patients with clinical diagnosis of AT and/or CT, IgG, IgM and IgG A (VIDAS®) were performed. Results: Patients with AT were positive for IgM and IgG, but presented weak avidity. In the 21 cases with CT, 52 percent (n: 11) were IgM positive and 100 percent (n: 21) had positive IgG with strong avidity. Discussion: The results confirm that the test of A-IgG may be useful in the diagnosis of AT, and has 100 percent concordance with reference test (qualitative IgM + quantitative IgG). The result is available within 24 hrs, and may be useful in diagnosis of AT in pregnant women.
Introducción: Toxoplasmosis (T) es una infección parasitaria crónica importante en pacientes inmunocompro-metidos y mujeres embarazadas. Es relevante discriminar entre fase aguda (TA) y fase crónica (TC). Su diagnóstico es serológico en inmunocompetentes (detección de IgG e IgM). Objetivo: Evaluar la utilidad del test de avidez IgG (A-IgG) para identificar la fase aguda y o crónica. Avidez es la fuerza de afinidad entre una inmunoglobulina específica y el epítope de la proteína antigénica del agente infectante, afinidad que aumenta con el tiempo. Pacientes y Métodos: Se usó un test cualitativo que mide la avidez de IgG, discriminando las dos fases. A 35 pacientes con diagnóstico clínico de TA y o TC, se les realizó IgG, IgM e A-IgG en Equipo VIDAS®. Resultados: Los pacientes con TA fueron positivos para IgM e IgG y presentaron avidez débil. Los 21 casos con TC 52 por ciento (n: 11) tuvieron IgM positivo y 100 por ciento (n: 21) tuvo IgG positiva con avidez fuerte. Discusión: Los resultados confirman que el test de A-IgG puede ser de gran utilidad en el diagnóstico de TA, concordancia: 100 por ciento con test de referencia (IgM cualitativa + IgG cuantitativa). El resultado está disponible en menos de 24 hrs, pudiendo ser útil en el diagnóstico de TA en mujeres embarazadas.
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Adolescente , Adulto , Criança , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Adulto Jovem , Anticorpos Antiprotozoários/imunologia , Afinidade de Anticorpos/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Kit de Reagentes para Diagnóstico , Toxoplasma/imunologia , Toxoplasmose/diagnóstico , Doença Aguda , Anticorpos Antiprotozoários/sangue , Doença Crônica , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/imunologia , Toxoplasmose/imunologiaRESUMO
Sources of variation between two serial tests must be considered in interpreting if there was a clinically significant change. The main causes of variation are the biological variation coefficient (CVB) of the test in question, which must be obtained from the literature, and the analytical coefficient of variation (CVA) of the same test, which must be obtained from the internal quality control laboratory data. With both data we can calculate the critical difference or reference change value which helps us to decide whether there was a real change in the patients health.
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Adulto , Humanos , Masculino , Biomarcadores , Testes de Química Clínica/normas , Colesterol/sangue , Reprodutibilidade dos TestesRESUMO
Among the many biomarkers studied to evaluate myocardial damage, troponin is considered the most sensitive and specific. However, current methodologies present pre-analytical, analytical and post-analytical problems, of which the more significant are the lack of standardization and a high uncertainty in the level of decision or cut-off. It is hoped that a new generation of assays called "ultra sensitive" will improve analytical performance characteristics of the technique and achieve compliance with the internationally recommended quality specifications.
Entre los múltiples biomarcadores estudiados para evaluar daño miocárdico, la troponina se considera el más sensible y específico. Sin embargo, la mayoría de las metodologías actuales utilizadas para su determinación presentan problemas tanto pre-analíticos, analíticos como post-analíticos, de los cuales los más relevantes son la falta de estandarización y una imprecisión alta en el nivel de decisión o de corte. Se espera que una nueva generación de ensayos para la determinación de troponina, denominados ultrasensibles, mejoren las características de desempeño de la técnica y logren cumplir con las especificaciones de calidad recomendadas internacionalmente.
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Humanos , Imunoensaio/normas , Infarto do Miocárdio/diagnóstico , Troponina/sangue , Biomarcadores/sangue , Imunoensaio/métodos , Infarto do Miocárdio/sangue , Sensibilidade e EspecificidadeRESUMO
Background: An alert value is a result suggesting that the patient is at imminent danger unless appropriate remedial actions begin promptly. Report of alert values (AV) by the clinical laboratories has taken special relevance in recent years due to its contribution to patient's care. Aim: To report results of AV informed during 2007 within the Health Network of the Pontificia Universidad Católica de Chile. Material and methods: Analysis of AV recorded in a centralized database of the laboratories of the health network, between January and December, 2007. Results: Total number of AV was 5.366, which represented 0.3 percent of total examinations and corresponded mainly to the clinical chemistry area. Potassium levels generated the higher number of AV detected, followed by positive blood cultures. Eighty two percent of AV corresponded to hospitalized patients. The greater number of AV was reported to intermediate and intensive care services. Thirty two percent of AV was informed to the physician or professional in charge of the patient within 5 minutes of obtaining the results and 79 percent within 30 minutes. Conclusions: To obtain a real impact on patient management, it is fundamental to shorten the ¡apse between the obtainment of tests results and the warning, supported on appropriate computerized systems, and to spread the procedure to all personnel involved in patient's care (RevMéd Chile 2009; 137: 1137-44).
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Humanos , Sistemas de Informação em Laboratório Clínico , Cuidados Críticos , Laboratórios Hospitalares , Técnicas de Laboratório Clínico , Centros Médicos Acadêmicos/organização & administração , Chile , Sistemas de Informação em Laboratório Clínico/normas , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Hospitais Universitários , Laboratórios Hospitalares/organização & administração , Pessoal de Laboratório/organização & administração , Estudos RetrospectivosRESUMO
Examinations performed beside the bed of patients ("Point-ofcare testing, POCT") provide immediate results and are simple to perform. The most common of these tests is the self control of blood glucose levels in diabetic patients. The use of these devices at the hospital level, introduces a new set of requirements to health institutions, which should monitor all aspects of the process, including training of final users, proper quality control, development of written procedures for use and even participation in surveys of external quality control, avoiding the generation of errors and guaranting patient safety (Rev Méd Chile 2009; 137:1261-4).
Los exámenes realizados al lado de la cama del enfermo ("Point of care testing, POCT") tienen como mayor ventaja la rapidez en la entrega de resultados y la simplicidad de uso, siendo su principal aplicación el autocontrol de la glicemia en pacientes diabéticos. El uso de estos equipos a nivel hospitalario introduce exigencias a las instituciones de salud, las cuales deben monitorizar todos ¡os aspectos del proceso, incluyendo la capacitación de los usuarios, el adecuado control de calidad, el desarrollo de procedimientos escritos para su uso e inclusive la participación en encuestas de control de calidad externo, evitando la generación de errores y colaborando así con la seguridad del paciente.
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Idoso de 80 Anos ou mais , Humanos , Glicemia/análise , Diabetes Mellitus/diagnóstico , Erros de Diagnóstico/prevenção & controle , Sistemas Automatizados de Assistência Junto ao Leito/normas , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/normas , Equipamentos e Provisões Hospitalares/normas , Reprodutibilidade dos TestesRESUMO
The use of techniques for the detection of nucleic acids such as the polymerase chain reaction (PCR) has had a major impact on microbiological analysis, playing an important role in the clinical laboratory. Most of the techniques currently used are designed for specific detection of a particular microorganism. However, infectious agents can also be identified even if genus or species are unknown, using universal primers to amplify bacterial or fungal DNA and then identify the species by sequency (universal or wide spectrum PCR). This methodology is applied in cultures that are difficult to identify usingphenotypic techniques, and more recently it is also being used directly in clinical samples, where the detection and identification of the infectious agent by traditional techniques is difficult or not possible.
El uso de técnicas para la detección de ácidos nucleicos como la reacción en cadena de la polimerasa (PCR) ha tenido un gran impacto en el diagnóstico microbiológico, ocupando un lugar importante en el laboratorio clínico. La mayoría de ¡as técnicas en uso han sido diseñadas para la detección específica de un microorganismo. Sin embargo, también es posible identificar el agente etiológico aunque se desconozca la especie o el género, utilizando partidores universales para amplificar el ADN de bacterias y hongos, y luego secuenciar para identificar la especie (PCR universal o de amplio espectro). Esta metodología se aplica en cultivos difíciles de clasificar por técnicas fenotípicas, pero también se ha comenzado a utilizar directamente en muestras clínicas, en las que la detección e identificación del agente infeccioso por técnicas tradicionales resulta difícil o no es posible.
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Humanos , Bactérias/genética , Técnicas de Laboratório Clínico/métodos , Fungos/genética , Reação em Cadeia da Polimerase/métodos , Bactérias/isolamento & purificação , Fungos/isolamento & purificaçãoRESUMO
Introduction: Invasive fungal disease (IFD) is a severe complication occurring mostly in haemato-oncological (H-O) patients and hematopoietic stem cell transplant (HSCT) receptors. Our aim was to describe the IFD occurring in our H-O and HSCT patients according to the EORTC/MSG revised criteria. Patients and Methods: IFD surveillance was performed in adult patients of the Hospital Clínico Universidad Católica, Santiago, Chile, from January 2004 to January 2008. Results: A total of 41 IFD episodes were identified in 39 patients; mean age was 46.6 ± 9.9 years, and 87.8 percent and 12.2 percent occurred in H-O and HCTS patients respectively. 15/41(36.6 percent) episodes were proven, 36.6 percent probable and 11/41 (26.8 percent) possible. In 26 (63.4 percent) episodes aspergillosis was diagnosed (20 pulmonary, 3 sinus, 1 laryngeal and 1 case with pulmonary and cerebral involvement). In 7 patients (17.1 percent) candidiasis was diagnosed, 5 with a proven bloodstream infection and 2 with possible hepatosplenic candidiasis; mucormyeosis was diagnosed in 4 (9.8 percent) Fusarium infection was demonstrated in 2 patients (4.9 percent), and Mucor and Aspergillus pulmonary coinfection and Alternaría sp rhino-sinusitis in one patient each. The frequency of IFD among febrile neutropenic patients was 26.2 percent and 6.4 percent in H-O and HSCT receptors respectively. The overall mortality was 36 percent. Conclusions: Aspergillosis is the most common IFD infection among H-O patients and HSCT receptors in our center. Candidiasis followed although only in H-O patients most probably because of routine use of antifungal prophylaxis in HSCT recipients. Continuous surveillance is required to develop local guidelines and to evaluate antifungal strategies in different clinical scenarios.
Introducción: La enfermedad fúngica invasora (EFI) es una complicación grave en pacientes hemato-oncológicos (H-O) y receptores de trasplante de precursores hematopoyéticos (TPH). Objetivo: Describir las EFI diagnosticadas en pacientes adultos H-O y receptores de TPH de nuestro centro, bajo los criterios diagnósticos revisados de EORTC/MSG. Pacientes y Métodos: Estudio de vigilancia de EFI en pacientes adultos del Hospital Clínico de la Pontificia Universidad Católica de Chile entre enero 2004 y enero 2008. Resultados: Se identificaron 41 episodios de EFI, correspondientes a 39 pacientes: 46,6 ± 9,9 años, 87,8 por ciento H-Oy 12,2 por ciento TPH. Se documentaron 15/41 (36,6 por ciento) EFI demostrada, 36,6 por ciento probable y 11/41 (26,8 por ciento) posible. En 26/41 (63,4 por cientoo) se diagnosticó aspergilosis (20 pulmonar, 3 rinosinusal, 1 laríngeo y un caso cerebral-pulmonar). En 7/41 (17,1 por ciento) se diagnosticó candidiasis, 5 candidemias y 2 candidiasis hepato-esplénica posibles; 4/41 (9,8 por cientoo) correspondió a mucormicosis demostrada (2 rinosinusal, 1 oral y 1 pulmonar); en 2/41 (4,9 por cientoo) fusariosis; 1/41(2,4 por ciento)) coinfección pulmonar por mucoral y Aspergillus sp y 1 caso de rinosinusitis por Alternaría sp. La frecuencia de EFI entre pacientes H-O con neutropenia febril fue 26,2 por ciento) y 6,4 por ciento) en los receptores de TPH. La mortalidad global fue de 36 por ciento). Conclusiones: Aspergilosis es la EFI más frecuente en H-O y receptores de TPH de nuestro centro. Candidiasis es la segunda EFI en frecuencia; sin embargo, no se documentó entre los pacientes receptores de TPH, lo que puede relacionarse al uso de antifúngicos profilácticos en este grupo. Es necesaria la vigilancia continua para desarrollar guías clínicas locales y evaluar estrategias de uso de antifúngicos en distintos escenarios clínicos.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Leucemia/terapia , Linfoma/terapia , Micoses/microbiologia , Hospedeiro Imunocomprometido , Micoses/diagnósticoRESUMO
The results of a determination performed in two different laboratories can only be compared if the techniques used are comparable, independently of the methodology or manufacturer. For this purpose, methods must be traceable to common materials and methods. Despite the common sense of this statement, only few laboratory determinations fulfill this requisite. In general, during the follow up of a patient, the physician must try to use the same laboratory or at least laboratories that use the same method. Moreover, laboratories should define the method used for determinations in their reports as indispensable information for attending physicians.
Los resultados de un mismo examen realizado en dos laboratorios diferentes, sólo se pueden comparar si las técnicas utilizadas son comparables, independientemente del fabricante o metodología. Para que ello ocurra, ios métodos deben ser trazabies a un material y a un método de referencia común. A pesar de que esto parece obvio, sólo unos pocos exámenes de laboratorio logran esta condición. En general, y especialmente en el seguimiento o control de los pacientes, el médico debe optar por usar siempre el mismo laboratorio o laboratorios que utilicen el mismo método. Además, los laboratorios clínicos deben expiicitar el método utilizado en su informe de Resultados, como información indispensable para la correcta interpretación por parte del médico tratante.
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Humanos , Laboratórios/normas , Controle de Qualidade , Padrões de Referência , Valores de ReferênciaRESUMO
Background: Macroprolactin is biologically inactive but may be detected by immnoassays. This leads to errors in diagnosis and inadequate treatment of patients with hyperprolactinemia. Aim:To assess two techniques to detect the presence of macroprolactin. Material and Methods: Prolactin was measured by immunoassay in 57 serum samples (from 4 males and 53 females aged33 +/- 13 years), before and after precipitation with polyethyleneglycol (PEG) and separation by ultrafiltration. A significant level of macroprolactin was considered to be present when prolactin detected in the supernatant after PEG precipitation or in the ultrafiltrate was less than 40 percent of the initial concentration of prolactin. Results: Prolactin levels fluctuated from 5 to 411 ng/ml. The percentages of recuperation were independent of the initial prolactin concentration. In 12 and 14 percent of samples, using polyethyleneglycol and ultrafiltration respectively, there was a prolactin recuperation of less than 40 percent. Eight and 11 percent of samples with a prolactin concentration of more than 30 ng/ml, had a recuperation of less than 40 percent using polyethyleneglycol and ultrafiltration respectively. Conclusions: Approximately 10 percent of samples with a prolactin concentration over 30ng/ml have recuperation values suggestive of the presence of macroprolactin. There is a good concordance between precipitation using polyethyleneglycol or ultrafiltration.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Hiperprolactinemia/sangue , Imunoensaio/métodos , Prolactina/sangue , Precipitação Química , Hiperprolactinemia/diagnóstico , Polietilenoglicóis , UltrafiltraçãoRESUMO
The Chilean Autonomous Commission for Medical Specialties Certification recognized Clinical Laboratory as a specialty in 1994. This decision was based on the great development of the specialty that incorporated new methodologies and developed automatic computerized methods. The main objective of the Clinical Laboratory specialist is to work as a consultant to define the laboratory diagnostic strategies that have the best cost effectiveness ratio. He must also select and assess diagnostic methods, supervise their implementations and assure the quality of the results generated. He must also be an efficient laboratory director and administrator.
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Humanos , Técnicas de Laboratório Clínico , Educação Médica , Chile , Publicações Periódicas como Assunto , EspecializaçãoRESUMO
Critical values are those laboratory values that are so abnormal that may threaten the life of a patient unless immediate corrective or therapeutic actions are undertaken. Among laboratory procedures, this definition has been incorporated to standards that watch over patients' safety. Health institutions should incorpórate this practice and monitor its effectiveness.
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Humanos , Sistemas de Informação em Laboratório Clínico , Cuidados Críticos/organização & administração , Gestão da Segurança , ComunicaçãoRESUMO
Introducción: La amigdalitis aguda recurrente es una patología de frecuente consulta, es una de las indicaciones de amigdalectomía. No se sabe con exactitud el origen de esta patología. Objetivo: Identificar la microbiología y patrones de susceptibilidad de las bacterias en la amigdalitis aguda recurrente bacteriana (AARB) a los antimicrobianos más comúnmente en el medio nacional, usados en su tratamiento. Material y método: Se planificó un estudio prospectivo, controlado y ciego. Se evaluaron pacientes (casos) con antecedentes de AARB con indicación quirúrgica. Los criterios de inclusión de los casos fueron niños de ambos sexos entre 4 y 10 años, sin historia de inmunodeficiencias, no haber recibido antibióticos en los 15 días previos a la cirugía. Se definió como controles a los pacientes con antecedentes de apnea del sueño con indicación quirúrgica y sin antecedentes de AARB o cuadros sugerentes de amigdalitis en los últimos 6 meses. En todos los pacientes se utilizó la misma técnica de toma de muestra de tejido para cultivo y antibiograma. Para el estudio de sensibilidades se realizó un antibiograma de las cepas aisladas y se evaluó la presencia de beta lactamasas. Los datos fueron analizados con el programa S-plus para análisis univariado. Para evaluar proporciones se utilizó el test de chi-cuadrado o el test exacto de Fisher Las variables continuas fueron evaluadas con el test de Wilcoxon Two sample. Resultados: No se encontraron diferencias estadísticamente significativas entre las cepas encontradas en el grupo de casos y de controles. La bacteria aislada con más frecuencia fue Haemophilus influenzae en 26 muestras en cada grupo (81 por ciento), seguido por S. Aureusy Streptococccus beta hemolítico grupo A (SBHGA). En cuanto a las asociaciones de patógenos más frecuentes, se encontró que las mayores asociaciones fueron H. influenzae + S. aureusyH. influenzae + SBHGA. Tampoco hubo diferencias esrtadísticamente significativas en frecuencia de estas...
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Tonsila do Cerebelo , Haemophilus influenzae/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Tonsilite/diagnóstico , Tonsilite/microbiologia , Antibacterianos/farmacologia , Doença Aguda , Estudos Prospectivos , Estudos de Casos e Controles , Haemophilus influenzae , Haemophilus influenzae/enzimologia , Macrolídeos/farmacologia , Método Duplo-Cego , Testes de Sensibilidade Microbiana , Recidiva , Farmacorresistência Bacteriana , Staphylococcus aureus , Staphylococcus aureus/enzimologia , beta-Lactamases/metabolismoRESUMO
Malaria is a protozoan infection caused by four Plasmodia species transmitted by female Anopheles mosquito. Nearly 40% of the world population is at risk of acquiring the disease because of increasing resistance to treatment, climate changes and travels to endemic zones. We report twelve patients with diagnosis of malaria, supported by the identification of parasites on blood smear. All cases had traveled to endemic zones (Peru, Ecuador, Central America, Africa), but only three used chemoprophylaxis. Seven cases were infected with Plasmodium vivax and five cases with P. falciparum. Three of latter required intensive care. All patients were treated with standard drugs according to the severity and Plasmodium specie, with excellent results and no mortality.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Malária Falciparum/diagnóstico , Malária Vivax/diagnóstico , Antimaláricos/uso terapêutico , Diagnóstico Diferencial , Malária Falciparum/tratamento farmacológico , Malária Falciparum/transmissão , Malária Vivax/tratamento farmacológico , Malária Vivax/transmissão , Quinidina/uso terapêutico , Quinina/uso terapêutico , Estudos RetrospectivosRESUMO
El comportamiento epidemiológico del virus influenza (FLU) en la comunidad se refleja en el hospital, es planteable que la actividad comunitaria de otros virus respiratorios también se traduzca en un alza de las internaciones por estos agentes. Objetivo: describir la presencia y características clínico-epidemiológicas de infecciones por virus respiratorios no-FLU (virus respiratorio sincicial-VRS, parainfluenza y adenovirus-ADV) entre adultos hospitalizados durante la temporada de influenza y establecer una comparación con virus influenza-A (IA) o -B (IB). Pacientes y Método: Adultos internados en Hospital Clínico Universidad Católica, de mayo a julio de 2004, con infección por IA o IB, y VRS, parainfluenza (1-2-3) o ADV demostrada por test rápido o inmunofluorescencia directa. Resultados: Se identificaron 86 casos: 73,5 por ciento FLU (48,2 por ciento, IA y 25,3 por ciento IB) y 26,5 por ciento no-FLU. (15,7 por ciento parainfluenza-2; 8,4 por ciento VRS, 1,2 por ciento parainfluenza-3 y 1,2 por ciento ADV). El grupo con FLU presentó más frecuentemente mialgias, tos, hospitalización por síndrome febril, mayores valores de PCR y porcentaje de baciliformes (p < 0,05). Conclusiones: Durante la temporada de influenza 2004, 26,5 por ciento de las infecciones entre adultos hospitalizados fueron causadas por virus no-FLU. La dificultad en diferenciar infecciones por virus FLU de no-FLU, plantea la necesidad de ampliar el estudio de la etiología viral incluso durante la temporada de FLU.