Epidemiologic analysis: Prophylaxis and multidrug-resistance in surgery. / Análisis epidemiológico: profilaxis y multirresistencia en cirugía.

BACKGROUND: Surgical site infection is defined as an infection related to the surgical procedure in the area of manipulation occurring within the first 30 postoperative days. The diagnostic criteria include: purulent drainage, isolation of microorganisms, and signs of infection. AIMS: To describe the epidemiologic characteristics and differences among the types of prophylactic regimens associated with hospital-acquired infections at the general surgery service of a tertiary care hospital. MATERIAL AND METHODS: The electronic case records of patients that underwent general surgery at a tertiary care hospital within the time frame of January 1, 2013 and December 31, 2014 were reviewed. A convenience sample of 728 patients was established and divided into the following groups: Group 1: n=728 for the epidemiologic study; Group 2: n=638 for the evaluation of antimicrobial prophylaxis; and Group 3: n=50 for the evaluation of multidrug-resistant bacterial strains in the intensive care unit. The statistical analysis was carried out with the SPSS 19 program, using the Mann-Whitney U test and the chi-square test. RESULTS: A total of 728 procedures were performed (65.9% were elective surgeries). Three hundred twelve of the patients were males and 416 were females. Only 3.98% of the patients complied with the recommended antimicrobial prophylaxis, and multidrug-resistant bacterial strains were found in the intensive care unit. DISCUSSION: A single prophylactic dose is effective, but adherence to this recommendation was not adequate. CONCLUSIONS: The prophylactic guidelines are not strictly adhered to in our environment. There was a significant association between the development of nosocomial infections from multidrug-resistant germs and admission to the intensive care unit.

Cannabinoid receptor agonists reduce the short-term mitochondrial dysfunction and oxidative stress linked to excitotoxicity in the rat brain.

The endocannabinoid system (ECS) is involved in a considerable number of physiological processes in the Central Nervous System. Recently, a modulatory role of cannabinoid receptors (CBr) and CBr agonists on the reduction of the N-methyl-d-aspartate receptor (NMDAr) activation has been demonstrated. Quinolinic acid (QUIN), an endogenous analog of glutamate and excitotoxic metabolite produced in the kynurenine pathway (KP), selectively activates NMDAr and has been shown to participate in different neurodegenerative disorders. Since the early pattern of toxicity exerted by this metabolite is relevant to explain the extent of damage that it can produce in the brain, in this work we investigated the effects of the synthetic CBr agonist WIN 55,212-2 (WIN) and other agonists (anandamide or AEA, and CP 55,940 or CP) on early markers of QUIN-induced toxicity in rat striatal cultured cells and rat brain synaptosomes. WIN, AEA and CP exerted protective effects on the QUIN-induced loss of cell viability. WIN also preserved the immunofluorescent signals for neurons and CBr labeling that were decreased by QUIN. The QUIN-induced early mitochondrial dysfunction, lipid peroxidation and reactive oxygen species (ROS) formation were also partially or completely prevented by WIN pretreatment, but not when this CBr agonist was added simultaneously with QUIN to brain synaptosomes. These findings support a neuroprotective and modulatory role of cannabinoids in the early toxic events elicited by agents inducing excitotoxic processes.

Evaluación de la atención a víctimas de la violencia sexual: experiencia en tres hospitales de Bogotá / Assessment of the medical care provided to victims of sexual violence: the experience of three hospitals in Bogotá

Objetivo: evaluar la atención de las víctimas de violencia sexual en hospitales en convenio con la facultad de medicina de la Universidad Militar Nueva Granada (umng) en Bogotá. Metodología: diseño multimétodo para la evaluación (estructura, procesos, resultados) y la identificación de dimensiones de conocimiento y actitudinal de los profesionales de la salud. Se aplicaron listas de chequeo, entrevistas para el líder de la red del Buen Trato y cuestionarios de conocimientos y actitudes entre septiembre de 2009 y septiembre de 2010. Resultados: se identificaron limitaciones en los insumos, espacio físico y recurso humano; en los procesos, por el no reconocimiento de la actividad como institucional y según los resultados, demostraron vacíos en los diagnósticos, registros y la orientación interdisciplinaria de los casos. Las dimensiones de conocimiento y actitudinal mostraron actitudes favorables para la atención pero falta de entrenamiento. Discusión: la atención de la violencia sexual en los hospitales evaluados no evidenció un enfoque diferencial. La atención presentó debilidades relacionadas con la inexistencia de un equipo interdisciplinario, la falta de entrenamiento del personal y una deficiente coordinación intersectorial. Se evidenció la necesidad de entrenar periódicamente al personal de salud, apoyar la constitución de una red del Buen Trato sostenible, y adecuar espacios físicos e insumos garantizando la calidad de la atención...

Objective: to evaluate the medical care that the hospitals in partnership with the Medical School of the umng university (Universidad Militar Nueva Granada) provide to victims of sexual violence. Methodology: a multi-design method was used to assess (structure, process and results) and identify the knowledge and attitudes of the healthcare providers. Similarly, the researchers used check lists, interviews with the leader of the assistance network (Red de Buen Trato) and a knowledge and attitudes questionnaire. The study took place from September 2009 to September 2010. Results: a lack of supplies, space, and human resources was detected in the process due to the lack of recognition of the activity as institutional. The results clearly showed gaps in diagnosis, patient records and in the interdisciplinary support provided to the cases. The knowledge and attitude dimensions showed a favorable result in regards to the service provided, yet there is still an evident lack of training. Discussion: the healthcare provided by the assessed hospitals to the sexually assaulted patients did not show a differential approach. It was deficient due to an inexistent interdisciplinary team, a lack of training and an insufficient inter-sectorial coordination. This demonstrates the need to periodically train the healthcare providers, support the creation of a sustainable assistance network, and provide adequate physical spaces and supplies to guarantee that high quality medical care is provided to these patients...

On the antioxidant properties of kynurenic acid: free radical scavenging activity and inhibition of oxidative stress.

Kynurenic acid (KYNA) is an endogenous metabolite of the kynurenine pathway for tryptophan degradation and an antagonist of both N-methyl-D-aspartate (NMDA) and alpha-7 nicotinic acetylcholine (α7nACh) receptors. KYNA has also been shown to scavenge hydroxyl radicals (OH) under controlled conditions of free radical production. In this work we evaluated the ability of KYNA to scavenge superoxide anion (O(2)(-)) and peroxynitrite (ONOO(-)). The scavenging ability of KYNA (expressed as IC(50) values) was as follows: OH=O(2)(-)>ONOO(-). In parallel, the antiperoxidative and scavenging capacities of KYNA (0-150 µM) were tested in cerebellum and forebrain homogenates exposed to 5 µM FeSO(4) and 2.5 mM 3-nitropropionic acid (3-NPA). Both FeSO(4) and 3-NPA increased lipid peroxidation (LP) and ROS formation in a significant manner in these preparations, whereas KYNA significantly reduced these markers. Reactive oxygen species (ROS) formation were determined in the presence of FeSO(4) and/or KYNA (0-100 µM), both at intra and extracellular levels. An increase in ROS formation was induced by FeSO(4) in forebrain and cerebellum in a time-dependent manner, and KYNA reduced this effect in a concentration-dependent manner. To further know whether the effect of KYNA on oxidative stress is independent of NMDA and nicotinic receptors, we also tested KYNA (0-100 µM) in a biological preparation free of these receptors - defolliculated Xenopus laevis oocytes - incubated with FeSO(4) for 1 h. A 3-fold increase in LP and a 2-fold increase in ROS formation were seen after exposure to FeSO(4), whereas KYNA attenuated these effects in a concentration-dependent manner. In addition, the in vivo formation of OH evoked by an acute infusion of FeSO(4) (100 µM) in the rat striatum was estimated by microdialysis and challenged by a topic infusion of KYNA (1 µM). FeSO(4) increased the striatal OH production, while KYNA mitigated this effect. Altogether, these data strongly suggest that KYNA, in addition to be a well-known antagonist acting on nicotinic and NMDA receptors, can be considered as a potential endogenous antioxidant.

Climate-based health monitoring systems for eco-climatic conditions associated with infectious diseases.

Despite a century of confidence and optimism in modern medicine and technology inspired by their often successful prevention and control efforts, infectious diseases remain an omnipresent, conspicuous major challenge to public health. Effective detection and control of infectious diseases require predictive and proactive efficient methods that provide early warning of an epidemic activity. Of particular relevance to these efforts is linking information at the landscape and coarser scales to data at the scale of the epidemic activity. In recent years, landscape epidemiology has used satellite remote sensing and geographic information systems as the technology capable of providing, from local to global scales, spatial and temporal climatic patterns that may influence the intensity of a vector-borne disease and predicts risk conditions associated with an epidemic. This article provides a condensed, and selective look at classical material and recent research about remote sensing and GIS (geographic information system) applications in public health.

Complications of common selective spinal injections: prevention and management.

Selective spinal injections are being performed with increasing frequency in the management of acute and chronic pain syndromes. Because these procedures require a needle to be placed in or around the spine, there is always a risk of complications. For this reason, prevention, early recognition, and management of complications are paramount to patient care. Physician training and patient preparation and monitoring are required to maximize the safety and efficacy of the specific spinal procedures. This focused review article discusses the primary general and specific complications of spinal injection procedures as well as treatments.

Late facilitation of the human soleus H reflex induced by sustained isometric maneuver.

Studying the effect of spinal cord reinforcement maneuvers (SCRMs) on H reflex assists in understanding aspects of motor control. Our objective was as follows: (1) to elucidate the effects of four neck positions (neck resting at neutral position (control); passive hyperflexion of the neck; hyperextension of the neck with simultaneous abdominal contraction; and sustained active neck hyperflexion); (2) to evaluate the temporal changes of soleus H reflexes repeatedly evoked after a period of sustained neck flexion. We used a prospective, intrinsically controlled trial of the effects of these SCRMs on the H reflexes and M-responses in ten healthy volunteers. Pre- and postmaneuver measures included H reflex and M-response latencies and amplitudes, H/M maximum amplitude ratio, and H threshold. The four maneuvers showed no significant effect on the H reflex or M-response measures. To investigate temporal changes in the H reflex amplitude, H reflexes were repeatedly evoked at two-minute intervals after a one-minute period of active neck flexion. The amplitude of the H reflex was enhanced (P = 0.0356; analysis of variance), and the post hoc least significant difference test was significant at four minutes postmaneuver. Peak magnitude of the H reflex occurred at four minutes after relaxation, and the response returned to pretest baseline at eight minutes. The results of this study document the time course of repeated H reflexes after SCRM, and the timing of the H reflex was found to be a contributing variable that should be considered in future study designs.