Enfermedad invasiva por Streptococcus pneumoniae, en pacientes adultos. Periodo 2016 al 2018

Introducción: En Paraguay y en otras partes del mundo el Streptococcus pneumoniae es el principal agente causante de neumonía bacteriana, otitis media, meningitis y septicemia. Objetivo: Describir las características clínico-epidemiológicas de pacientes con enfermedad invasiva por Streptococcus pneumoniae atendidos en el Instituto de Medicina Tropical (IMT) durante los años 2016 al 2019. Metodología: Estudio observacional, descriptivo, transversal. Se incluyeron a todos los pacientes con enfermedad invasiva por Streptococcus pneumoniae confirmada. Resultados: Fueron incluidos 34 pacientes, la edad promedio fue de 44años, 76% fueron varones, 61% diagnóstico de infección por VIH. El foco infeccioso predominante fue el pulmonar. De las muestras biológicas con cultivos positivos, el 73% fueron aislados en sangre, y los restantes distribuidos entre muestras de esputo, líquido ceflorraquideo y liquido pleural. El 24% de los pacientes presentaron complicaciones, entre falla orgánica (15%) y empiema (9%). El 59% de los pacientes recibió tratamiento con cefalosporinas. La mortalidad intrahospitalaria registrada fue del 18%.Conclusión: Los pacientes con enfermedad invasiva que acudieron al IMT durante los años 2016 al 2019 fueron en su mayoría adultos jóvenes, inmunosuprimidos, con neumonía.

Introduction: In Paraguay and in other parts of the world, Streptococcus pneumoniae is the main causative agent of bacterial pneumonia, otitis media, meningitis and septicemia. Objective: To describe the clinical-epidemiological characteristics of patients with invasive disease due to Streptococcus pneumoniae treated at the Institute of Tropical Medicine (IMT) during the years 2016 to 2019. Methodology: Observational, descriptive, cross-sectional study. All patients with confirmed invasive disease due to Streptococcus pneumoniae were included. Results: 34 patients were included, the average age was 44 years, 76% were male, 61% diagnosed with HIV infection. The predominant infectious focus was the lung. Of the biological samples with positive cultures, 73% were isolated from blood, and the rest distributed among samples of sputum, cerebrospinal fluid, and pleural fluid. 24% of the patients presented complications, between organic failure (15%) and empyema (9%). 59% of the patients received treatment with cephalosporins. The registered intrahospital mortality was 18%. Conclusion: The patients with invasive disease who attended the IMT during the years 2016 to 2019 were mostly young adults, immunosuppressed, with pneumonia.

[Inappropriate response against Hepatitis B vaccine in health personnel of the National Hospital, Paraguay.] / Respuesta inadecuada a la vacuna contra la hepatitis B en personal de salud del Hospital Nacional, Paraguay.

Introduction: health personnel are a risk group for acquiring hepatitis B. The vaccine against it is effective but requires evaluation of the immune response with the dosage of anti-HBs. Objective: Objectives: to determine the immunological response to the vaccine against hepatitis B in physicians, nurses and medical students of the National Hospital, Paraguay. Methods: an observational, analytical and cross-sectional study was conducted in a sample of 120 health workers during 2017. The level of anti-HBs was determined with quantitative immunoassay and demographic and clinical variables were recorded, with prior informed consent. Results: the sample was integrated with 79 women and 41 men. The mean age was 28±7 years. Physicians (62.5%), nurses (20%) and medical students (17.5%) were included. The mean BMI was 24.7 ± 3.8 kg/m2. Adequate serum levels of anti-HBs (> 100 IU / mL) were detected in 64% of the health personnel. Obesity was a factor associated with poor response to the vaccine (p 0.02). Sex, age, the time elapsed since the last dose and smoking were factors not significantly associated with the lack of response to the vaccine. Conclusion: inadequate response to HB vaccine was found in 36%. Obesity was significantly associated with poor immunological response.

Introducción: el personal de salud es un grupo de riesgo de adquirir la hepatitis B. La vacuna contra la misma es efectiva pero requiere evaluación de la respuesta inmune con el dosaje de antiHBs. Objetivos: determinar la respuesta inmunológica a la vacuna contra la hepatitis B en médicos, enfermeras y estudiantes de Medicina del Hospital Nacional, Paraguay. Métodos: se realizó un estudio observacional, analítico y transversal en una muestra de 120 trabajadores de la salud durante el 2017. Se determinó el nivel de antiHBs con inmunoensayo cuantitativo y se registraron variables demográficas y clínicas, previo consentimiento informado. Resultados: Resultados: la muestra se conformó con 79 mujeres y 41 varones. La edad media fue 30±8 años. Se incluyeron médicos (62,5%), enfermeras (20%) y estudiantes de Medicina (17,5%). El IMC medio fue 24,7±3,8 kg/m2. Los niveles séricos adecuados de antiHBs (>100 UI/mL) se detectaron en 64% del personal de salud. La obesidad fue un factor asociado a mala respuesta a la vacuna (p 0,02). El sexo, la edad, el tiempo trascurrido desde la última dosis y el tabaquismo no resultaron factores significativamente asociados a la falta de respuesta a la vacuna. Conclusión: la respuesta inadecuada a vacuna HB se halló en 36%. La obesidad se asoció significativamente a la mala respuesta inmunológica.

Efficacy of stem cells on the healing of peri-implant defects: systematic review of preclinical studies.

This systematic review considers the evidence from animal studies evaluating the effectiveness of mesenchymal stem cells (MSC) in the treatment of intraoral peri-implant defects. MEDLINE, EMBASE, and LILACS databases were searched for quantitative preclinical controlled animal model studies that evaluated the effect of MSC on bone healing at intraoral peri-implant bone defects. The primary outcome was the amount of (re-)osseointegration reported as bone-to-implant contact in the defect area. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Ten studies met the inclusion criteria. Only one study induced peri-implant inflammation to produce peri-implant bone defects. In all others, defects were surgically created at implant installation. Differences in defect morphology were identified among the studies. Both xenogenous and autogenous MSC were used to treat peri-implant defects. These included bone marrow-derived MSC, periodontal ligament-derived MSC, umbilical cord MSC, bone marrow-derived mononuclear cells, and peripheral blood mononuclear cells. Meta-analysis was not possible because of heterogeneities in study designs. Nonetheless, in most studies, local MSC implantation was not associated with adverse effects and had a positive effect on bone healing around peri-implant defects. Combination of MSC with membranes and bioactive factors appears to provide improved treatment outcomes. In large animal models, intraoral use of MSC may provide beneficial effects on bone healing within peri-implant defects. The various degrees of success of MSC in peri-implant bone healing are likely to be related to the use of cells from various populations, tissues, and donor species. However, human safety and efficacy must be demonstrated before its clinical use can be considered.