[Experience with the Biofire FilmArray® for infectious meningitis/encephalitis in a high complexity institution in Bogota, Colombia]. / Experiencia con el Biofire FilmArray® para meningitis/encefalitis infecciosa en una institución de alta complejidad en Bogotá, Colombia.

INTRODUCTION: Infectious meningoencephalitis (IME) is a neurological emergency with a significant rate of morbidity and mortality. The Biofire FilmArray® meningitis/encephalitis (FAME) panel for testing in cerebrospinal fluid (CSF) has proven to be a valuable tool for the aetiological diagnosis of IME, facilitating targeted antimicrobial therapy. The aim is to determine the impact of the FAME panel on antimicrobial therapeutic decisions in patients with suspected IME in the first 24 hours of clinical assessment. PATIENTS AND METHODS: This is a descriptive observational study that comments on the clinical manifestations, the neuroimaging and paraclinical findings, and the antibiotic therapy of patients with suspected IME. An analysis was performed to determine the impact of FAME on antimicrobial therapy in the first 24 hours of the clinical assessment of patients. RESULTS: Altogether 44 patients were included. The average time required to obtain the result of the FAME panel for testing in CSF was nine hours, with 20.4% (9/44) of tests yielding positive results. Within 24 hours of clinical assessment, their outcome had an impact on antimicrobial treatment decisions in 75% (33/44) of cases. In patients with a high clinical suspicion of IME, the result of FAME made it possible to change the initial empirical therapy to a targeted therapy in 15% (3/20) of cases and to discontinue the initial empirical therapy in 35% (7/20) of the subjects. In patients with low clinical suspicion of IME, their result allowed 25% (6/24) to have their suspicion confirmed and they were started on targeted antibiotic therapy; in contrast, 70.8% (17/24) had their diagnosis ruled out and were not started on treatment. CONCLUSIONS: The result of the FAME panel for testing in CSF has a high impact on antimicrobial therapeutic decisions within 24 hours of clinical assessment. However, it must be interpreted with the clinical context, local epidemiology and other diagnostic studies.

TITLE: Experiencia con el Biofire FilmArray® para meningitis/encefalitis infecciosa en una institución de alta complejidad en Bogotá, Colombia.Introducción. La meningoencefalitis infecciosa (MEI) es una emergencia neurológica con importante morbimortalidad. El panel Biofire FilmArray? para meningitis/encefalitis (FAME) en el líquido cefalorraquídeo (LCR) ha demostrado ser una valiosa herramienta para el diagnóstico etiológico de la MEI, facilitando una terapia antimicrobiana dirigida. El objetivo es determinar el impacto del panel FAME en las decisiones terapéuticas antimicrobianas en pacientes con sospecha de MEI en las primeras 24 horas de la valoración clínica. Pacientes y métodos. Estudio observacional descriptivo que comenta las manifestaciones cínicas, los resultados de neuroimágenes y paraclínicos, y la antibioticoterapia de pacientes con sospecha de MEI. Se realizó un análisis del impacto que tiene el FAME en la terapia antimicrobiana en las primeras 24 horas de la valoración clínica de los pacientes. Resultados. Se incluyó a 44 pacientes. El tiempo promedio para obtener el resultado del panel FAME en el LCR fue de nueve horas, con un 20,4% (9/44) de pruebas positivas. En las primeras 24 horas de la valoración clínica, su resultado tuvo impacto en las decisiones terapéuticas antimicrobianas en el 75% (33/44) de los casos. En pacientes con alta sospecha clínica de MEI, el resultado del FAME permitió cambiar la terapia empírica inicial a una dirigida en el 15% (3/20) y suspender la terapia empírica inicial en el 35% (7/20) de los sujetos. En pacientes con baja sospecha clínica de MEI, su resultado permitió que al 25% (6/24) se le confirmara la sospecha y se le iniciara antibioticoterapia dirigida; y que al 70,8% (17/24) se le descartara el diagnóstico y no se le iniciara tratamiento. Conclusiones. El resultado del panel FAME en el LCR tiene alto impacto en la toma de decisiones terapéuticas antimicrobianas en las primeras 24 horas de la valoración clínica. Sin embargo, su interpretación debe hacerse con el contexto clínico, la epidemiología local y otros estudios diagnósticos.

Evaluation of laser scanning confocal microscopy as a method for characterizing reef-building coral tissue thickness and Symbiodiniaceae fluorescence.

Predicting the sensitivity of reef-building corals to disturbance, including bleaching, requires an understanding of physiological responses to stressors, which may be limited by destructive sampling and the capacity of common methodologies to characterize early life history stages. We developed a new methodology using laser scanning confocal microscopy (LSCM) to measure and track the physiological condition of corals. In a thermal stress experiment, we used LSCM to track coral condition during bleaching in adults and juveniles of two species, Montipora capitata and Pocillopora acuta Depth of fluorescence in coral tissues provides a proxy measure of tissue thickness, whereas Symbiodiniaceae population fluorescence relates to both population density and chlorophyll a content. In response to thermal stress, there were significant shifts in tissue thickness and Symbiodiniaceae fluorescence with differences between life stages. This method is particularly well suited for detecting shifts in physiological condition of living corals in laboratory studies, especially in small juvenile colonies.

El Sistema de Salud de la ciudad de Buenos Aires en el siglo xix en relación a las enfermedades de transmisión sexual / THE HEALTH SYSTEM IN THE CITY OF BUENOS AIRES DURING THE XIXth CENTURY, RELATED TO THE DISEASES OF SEXUAL TRANSMISSION

The health system of the City of Buenos Aires during the XIX century, related to the diseases of sexual transmission, is presented. The "General Hospital for Acute Diseases Dr. Juan A. Fernandez" of universitary character with a well gained prestige in his influencial zone, accumulates the highest technology in this programmatic area, and is today related with the great epidemic disease of sexual transmission from the XXth. Century: AIDS. Not always is well known the fact that, more than a century ago, this Institution was created to confront also to an epidemic of sexual transmission: syphilis. Is then purpose of this revision to introduce to the reader in the behavioral situation at the time of its foundation, the sanitary problems that conducted to its creation and the history of his former years, all of that related to the evolution of the sexually transmitted diseases at the endings of the XIX century.

Análisis epidemiológico y gestión sanitaria de la epidemia de gripe A H1N1: experiencia en la ciudad de Buenos Aires (invierno de 2009) / Epidemiological analysis and sanitary management of the influenza a H1N1: experience in the city of Buenos Aires (outbreak in winter 2009)

Las pandemias de influenza son eventos impredecibles pero recurrentes, que suponen consecuencias gravosas para las sociedades en todo el mundo. Desde el siglo XV y XVI, con el famoso sudor anglicus, se han descrito pandemias de influenza con intervalos más o menos regulares, entre 10 y 50 años, cuya gravedad y repercusiones han sido variables destacándose en el siglo XX la "gripe española" de 1918/1919, probablemente una de las mayores y más mortíferas pandemias de la historia humana, la influenza asiática entre 1957/1958 y la de Hong Kong entre 1968/1969. En 2003 surgió preocupación mundial ante una posible pandemia de influenza aviar (H5N1) que era sindicada como la gran favorita para un próximo evento de este tipo; no obstante nunca llegó a sortear la imposibilidd de propagarse de humano a humano. En abril de 2009, la OMS (WHO) comenzó a recibir reportes de personas con un nuevo tipo de virus de influenza A (H1N1) en México y EE.UU. La rápida diseminación internacional ulterior llevó a la propia OMS a declarar el 11 de junio de 2009 la primera pandemia de influenza en 41 años. En Argentina y luego del llamado inicial de alerta de Ministerio de Salud de la Nación, el Gobierno de la Ciudad de Buenos Aires inició procesos destinados al reporte, detección y vigilancia epidemiológica de los casos locales. A principios del mes de mayo se difundieron las noticias de los primeros casos de Gripe A confirmados en el país y el 30 de junio se decretó la emergencia sanitaria en la ciudad profundizándose un proceso de análisis sobre las medidas a tomar. Las acciones específicas tomadas por el GCBA y su MSAL pueden agruparse en acciones sobre el sistema de salud y sus efectores y acciones de estrategia comunicacional. Se concluye de este episodio pandémico que la Gripe A desplazó a la gripe estacional siendo la circulación viral en adultos mayormente virus A H1N1...

Influenza pandemics are unpredictable but recurrent events, involving serious consequences for societies worldwide. From the fifteenth and sixteenth century, with the famous anglicus sweat, there have been described pandemics of influenza within more or less regular intervals, between 10 and 50 years, whose severity and impact has been variale, emphasizing in the twentieth century the "Spanish flu" of 1918/1919, probably one of the largest and most dedly pandemics in human history, between 1957/1958 the Asian flu and the Hong Kong flu from 1968 to 1969. In 2003, concern arose about a possible global pandemic of avian influenza (H5N1), which was syndicated as the most probable cause for an upcoming event of this king, yet it never get around the inability to spread from human to human. In April 2009, WHO began to receive reports of Mexico and the U.S. The rapid internatinal spread further les WHO to declare on June 11 th 2009 the first influenza pandemic in 41 years. In Argentina and after the initial warning call of the Ministry of Health of the Nation, the Government of the City of Buenos Aires initiated processes for the reporting, detection and epidemilogical surveillance of local cases. In early May, the news spread of the first confirmed cases of influenza A in the country and on June 30 was declared a health emergency in the city getting stronger a process of discussion of measures to take. The specific actions taken by the GCBA and The Ministry of Health can be grouped into action on the health system and its effectors, and communications strategies and activities. We conclude from this episode of pandemic Influenza that the A virus H1N1 has replace the seasonal flu virus, because influenza virus circulation among adults was mostly H1N1 virus, that in spite of the fact of being getting trough a pandemic episode, the overall death rate was lower of that of the seasonal flu...

Reforma del modelo de atención de la salud mental en la Ciudad Autónoma de Buenos Aires. Ejes conceptuales e instrumentos operativos / Supports for the reformulation of the model for the mental care at the city of buenos Aires

Se presentan las bases operativas del cambio de modelo de atención en salud mental, incluyendo su base de sustentación en la Ley 448, en los documentos nacionales e internacionales en la materia, los cambios programados en infraestructura, equipamiento, recursos humanos y gestión del ingreso a la red de complejidad ascendente.

The aim of this report was to present the supports for the reformulation of the model for the mental health care at the city of Buenos Aires, with conceptual guidelines and the operative instrumentation.

Evaluación de resultados en programas sanitarios: marco conceptual e instrumental oerativo aplicaados en el ámbito del Ministerio de Salud de la Ciudad de Buenos Aires / Evaluation of reults in sanitary programs

Evaluation of results in sanitary programs: conceptual mark and operative instrumentable, applied in the concern of the Ministery of Health from the city of Buenos Aires.

Epidemiología y medicamentos: esenciales, genéricos y el programa Remediar / Epidemiology and pharmaceutical drugs: essential and generics

This report describes the epidemiology and pharmaceutical drugs: essentials and generics.

Análisis epidemiológico georreferencial de la mortalidad infantil en la Ciudad Autónoma de Bs.As. en un período de doce años (19909-2002) / Georeferential epidemiological analysis of the infant mortality rate in Buenos Aires City during a 12-year period (1990-2002)

The objective of this investigation was to determine a georeferential epidemiological analysis of the infant mortality rate in the city of Buenos Aires during a 12 year period (1990-2002). Several facts are evident from this review of the causes of that infant mortality. The overall mortality rate of infants in this city was 9.1 per 1,000, for the 12-years period between 1990 and 2002

Etica y Salud Pública / Ethics and Public Health

This article describes the concepts of ethics and public health, with special reference to conceptual designs and operative tools

Anßlisis epidemiológico y georreferencial de patrones quiquenales de utilización de servicios médicos en una población cautiva de pacientes / Epidemiological and georeferencial analysis of five year patterns of use medical services in captive patient population

La identificación de problemas de salud en la comunidad y la implementación y monitoreo de estrategias de intervención suelen chocar con la dificultad de presentar datos claro, fiables y sobre todo facilmente aprenhensibles por los tomadores politicos de desiciones y es en este sentido que los sistemas de información geogrßfica pueden ser de utilidad. La tecnología de la georreferencia ya es aceptada como una herramienta esencial para el uso efectivo de la información. Teniendo en cuenta ademas que en cualquier entidad que medie y/o provea servicios de salud la información relativa al uso (y costo) de los mismos, asi como las caracteristicas de los usuarios deberia articularse con la incorporación y desarrollo organizacional de sistemas de información, empleando el raciocinio epidemiológico a la administración de la salud...

Aging jejunal vascular ectasia as a cause of persistent intestinal bleeding.

Undiagnosed gastrointestinal bleeding is a major problem in medical practice. This paper describes a patient with vascular intestinal ectasia who had repeated severe intestinal hemorrhages for two years, and required surgery. Vascular intestinal ectasia was demonstrated radiologically, histologically and by electron microscopy in a 25 cm upper jejunum resection. The absence of ultrastructural alterations in intestinal vessels points out that the term "aging vascular ectasia" (Moore Type I) seems preferable, when Rendu Ossler, Von Willebrand and intestinal hemangioma are discarded.