Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: A cost-effectiveness analysis.

BACKGROUND: General anesthesia (GA) is the standard anesthetic approach for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Nonetheless, GA is expensive and can be associated with adverse events. Tumescent local anesthesia (TLA) has been shown to reduce in-room and procedural times and to decrease post-procedural pain, all of which could result in a reduction in procedure-related costs. OBJECTIVE: The purpose of this study is to compare the cost-effectiveness of GA and TLA in patients undergoing S-ICD implantation. METHODS: The present study is a prospective, nonrandomized, controlled study of patients who underwent S-ICD implantation between 2019 and 2022. Patients were allocated to either the TLA or the GA group. We performed a cost analysis for each intervention. As an effectiveness measure, the 0-10 point Numeric Pain Rating Scale at 1, 12, and 24 hours post-implantation was analyzed and compared between the groups. A score of 0 was considered no pain; 1-5, mild pain; 6-7, moderate pain; and 8-10, severe pain. Cost-effectiveness was calculated using incremental cost-effectiveness ratios. RESULTS: Seventy patients underwent successful S-ICD implantation. The total cost of the electrophysiology laboratory was higher in the GA group than in the TLA group (median ± interquartile range US$55,824 ± US$29,411 vs US$37,222 ± US$24,293; P < .001), with a net saving of $20,821 when compared with GA for each S-ICD implantation. There was a significant decrease in post-procedural pain scores in the TLA group when compared with the GA group (repeated measures analysis of variance, P = .009; median ± interquartile range 0 ± 3 vs 0 ± 5 at 1 hour, P = .058; 3 ± 4 vs 6 ± 8 at 12 hours, P = .030; 0 ± 4 vs 2 ± 6 at 24 hours, P = .040). CONCLUSION: TLA is a more cost-effective alternative to GA for S-ICD implantation, with both direct and indirect cost reductions. Importantly, these reduced costs are associated with reduced postprocedural pain.

Briefings: A Tool to Improve Safety Culture in a Pediatric Emergency Room.

BACKGROUND: Safety briefings are short, informative meetings intended to integrate a culture of patient safety into daily clinical practice, which contributes to identifying risks and improving quality. The objective of this study is to present safety briefings as a method for discovering and addressing safety events in a pediatric emergency room, describe how professionals perceive them, and characterize the classification and evolution of the incidents identified. METHODS: This observational, descriptive, analytical study was performed in the pediatric emergency department of a tertiary hospital in 2018-2019. The incidents reported during the briefings were counted, classified, and analyzed. Results of a 10-item survey on the usefulness of the briefings in identifying and managing risks are described. RESULTS: A total of 498 briefings were analyzed, in which 1,180 incidents were reported (1 incident/96 emergency cases; 2.4 incidents/meeting). The category with the most incidents was Communication. The number of incidents fell by 24.4% between 2018 and 2019 (p < 0.01), mostly in the Identification (47.8%) and Communication (33.8%) categories. Seventy-seven surveys were analyzed. In 97.4% of the analyzed surveys, the person surveyed considered the briefings to be useful in improving patient safety; 90.9% considered notification via briefings to be more convenient than through electronic means. In 35.1%, the person surveyed was not satisfied with the information received on incident management. CONCLUSION: Patient safety briefings are perceived as a useful tool to report incidents, and incidents related to communication occur most frequently. Safety briefings are perceived as useful for improving patient safety in pediatric emergency rooms, and this method of notification is considered more convenient than other methods.

A Comparison of Women and Men Undergoing Catheter Ablation for Sustained Monomorphic Ventricular Tachycardia.

INTRODUCTION: Women are underrepresented in clinical studies on catheter ablation (CA) for ventricular tachycardia (VT). The role of gender as a predictor for VT recurrence after CA is unclear and complication rates have not been compared in a large cohort. METHODS AND RESULTS: We analyzed data of consecutive patients undergoing CA for sustained monomorphic VT at our center between 2005 and 2015. A total of 948 patients underwent 1314 ablation procedures: 114 patients without structural heart disease (SHD) (48% female), 486 with coronary artery disease (CAD) (9% female), 301 with nonischemic cardiomyopathy (NICM) (22% female), and 46 with arrhythmogenic right ventricular cardiomyopathy (ARVC) (17% female). Women with CAD and NICM were younger than men at first ablation (63 years vs. 68 years, P = 0.05; resp. 53 years vs. 59 years, P = 0.026) with no other significant differences in baseline characteristics. Age, LVEF, NYHA-class, and VT-recurrence but not gender were independently associated with increased mortality in CAD and NICM. Mortality rates in patients with no SHD and ARVC are low in men (0%, 2.6%) and women (1.8%, 0%). CONCLUSIONS: Although heart disease tends to present later in women, our data do not suggest that women are referred later than men. Women with CAD or NICM and VT present for ablation at younger age with disease severity comparable to men. VT ablation in women can be accomplished with success- and complication rates comparable to male patients in both those with and without SHD.

Left atrial appendage morphology assessment for risk stratification of embolic stroke in patients with atrial fibrillation: A meta-analysis.

BACKGROUND: Thromboembolic event (TE) risk stratification is performed by using CHA2DS2VASc score. It has been suggested that left atrial appendage (LAA) morphology independently influences TE risk in patients with nonvalvular atrial fibrillation. LAA morphology has been classified into 4 types: chicken wing, cauliflower, windsock, and cactus. OBJECTIVE: The purpose of this study was to determine TE risk for each LAA morphology in patients with atrial fibrillation with low to intermediate TE risk. METHODS: A systematic review of MEDLINE, Cochrane Library, and Embase for studies that used computed tomography, tridimensional transesophageal echocardiography, and cardiac magnetic resonance imaging to categorize the LAA morphologies with assessment of TE prevalence. Odds ratio (OR) and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. The fixed effects model was used, and if heterogeneity (I2) was >25%, effects were analyzed using a random model. RESULTS: Eight studies with 2596 patients were included. Eighty-four percent (n=1872) of patients had a CHADS2 score of <2. TE risk was lower in chicken wing morphology than in non-chicken wing morphology (OR 0.46; 95% CI 0.36-0.58). Likewise, chicken wing morphology had lower TE risk than did other morphologies (chicken wing vs cauliflower: OR 0.38; 95% CI 0.26-0.56; chicken wing vs windsock: OR 0.48; 95% CI 0.31-0.73; chicken wing vs cactus: OR 0.49; 95% CI 0.36-0.66). CONCLUSION: Patients with chicken wing LAA morphology are less likely to develop TE than patients with non-chicken wing morphology. LAA morphology may be a valuable criterion in predicting TE and could affect the stratification and anticoagulation management of patients with low to intermediate TE risk.

Costo efectividad del suplemento de calcio para reducir la mortalidad materna asociada a preeclampsia en Colombia / Cost effectiveness of calcium supplement in reducing preeclampsia-related maternal mortality in Colombia

Objetivo Estimar el costo-efectividad de la administración de calcio (1 200 mg diarios) a partir de la semana 14 de gestación a todas las gestantes, comparada con no administrarlo, para reducir la incidencia de preeclampsia. Métodos Se construyó un árbol de decisión en TreeAge® con desenlace en años de vida ganados (AVG). Los costos se incluyeron desde la perspectiva del sistema de salud colombiano, en pesos (COP) de 2014. La tasa de descuento fue de 0%. Se realizaron análisis de sensibilidad univariados y probabilísticos para costos y efectividad. Resultados El suplemento de calcio es una alternativa dominante frente a la no intervención. Si la incidencia de preeclampsia es menor a 51,7 por 1 000 gestantes o el costo por tableta de calcio de 600 mg es mayor a COP$ 507,85, el suplemento de calcio deja de ser una alternativa costo-efectiva en Colombia para un umbral de 3 veces el PIB per cápita de 2013 (COP$ 45 026 379) por AVG. Conclusiones La administración de calcio a todas las gestantes a partir de la semana 14 de gestación es una alternativa dominante frente a la no intervención, que permite ganar 200 años de vida, al tiempo que disminuye costos del orden de COP$ 5 933 millones por 100 000 gestantes.(AU)

Objectives To estimate the cost-effectiveness of administering calcium (1200 mg per day) starting in week 14 of pregnancy to all pregnant women compared to not supplying it to reduce the incidence of preeclampsia. Methods A decision tree was built in TreeAge® with outcome measured in life years gained (LYG) associated with the reduction in maternal deaths. Costs were included from the perspective of the health system in Colombia and expressed in Colombian pesos in 2014 (COP). The discount rate was 0 %. We performed sensitivity univariate and probabilistic analyses for costs and effectiveness. Results Compared to no intervention, calcium supplement is a dominant alternative. If the incidence of preeclampsia is lower than 51.7 per 1 000 pregnant women or the cost per tablet of calcium of 600 mg is greater than COP $507.85, calcium supplement is no longer a cost-effective alternative in Colombia for a threshold of COP $ 45 026 379 (3 times the Colombian per capita GDP of 2013 per LYG). Conclusions Supplying calcium to all pregnant women from week 14 of gestation is a dominant alternative compared to no intervention, which saves 200 LYG, while it decreases costs to the order of COP$5 933 million per 100.000 pregnant women.(AU)

[Cost effectiveness of calcium supplement in reducing preeclampsia-related maternal mortality in Colombia]. / Costo efectividad del suplemento de calcio para reducir la mortalidad materna asociada a preeclampsia en Colombia.

Objectives To estimate the cost-effectiveness of administering calcium (1200 mg per day) starting in week 14 of pregnancy to all pregnant women compared to not supplying it to reduce the incidence of preeclampsia. Methods A decision tree was built in TreeAge® with outcome measured in life years gained (LYG) associated with the reduction in maternal deaths. Costs were included from the perspective of the health system in Colombia and expressed in Colombian pesos in 2014 (COP). The discount rate was 0 %. We performed sensitivity univariate and probabilistic analyses for costs and effectiveness. Results Compared to no intervention, calcium supplement is a dominant alternative. If the incidence of preeclampsia is lower than 51.7 per 1 000 pregnant women or the cost per tablet of calcium of 600 mg is greater than COP $507.85, calcium supplement is no longer a cost-effective alternative in Colombia for a threshold of COP $ 45 026 379 (3 times the Colombian per capita GDP of 2013 per LYG). Conclusions Supplying calcium to all pregnant women from week 14 of gestation is a dominant alternative compared to no intervention, which saves 200 LYG, while it decreases costs to the order of COP$5 933 million per 100.000 pregnant women.

Guía de práctica clínica para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio: sección 3. Infecciones en el embarazo: ruptura prematura de membranas (RPM) / Clinical practice guideline for the prevention, early detection and treatment of pregnancy, delivery and post-partum complications: section 3. Infections in pregnancy: premature rupture of membranes (PROM)

Realizar recomendaciones para la atención del embarazo con ruptura prematura de membranas como parte integral de la Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012, acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC "Preterm prelabour rupture of membranes" (Royal College of Obstetricians and Gynaecologists-2006) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresadas por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se presentan las recomendaciones para la atención de los embarazos con ruptura prematura de membranas. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno fetal exitoso en las gestaciones con esta complicación.Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia de esta sección, que se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación...

Realizar recomendaciones para la atención del embarazo con ruptura prematura de membranas como parte integral de la Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012, acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC "Preterm prelabour rupture of membranes" (Royal College of Obstetricians and Gynaecologists-2006) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresadas por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se presentan las recomendaciones para la atención de los embarazos con ruptura prematura de membranas. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno fetal exitoso en las gestaciones con esta complicación.Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia de esta sección, que se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación...

Non-invasive assessment of low risk acute chest pain in the emergency department: A comparative meta-analysis of prospective studies.

BACKGROUND: The aim of this meta-analysis was to compare the diagnostic accuracy of cardiac computed tomographic angiography (CCTA), stress echocardiography (SE) and radionuclide single photon emission computed tomography (SPECT) for the assessment of chest pain in emergency department (ED) setting. METHODS: A systematic review of Medline, Cochrane and Embase was undertaken for prospective clinical studies assessing the diagnostic efficacy of CCTA, SE or SPECT, as compared to intracoronary angiography (ICA) or the later presence of major adverse clinical outcomes (MACE), in patients presenting to the ED with chest pain. Standard approach and bivariate analysis were performed. RESULTS: Thirty-seven studies (15 CCTA, 9 SE, 13 SPECT) comprising a total of 7800 patients fulfilled inclusion criteria. The respective weighted mean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and total diagnostic accuracy for CCTA were: 95%, 99%, 84%, 100% and 99%, for SE were: 84%, 94%, 73%, 96% and 96%, and for SPECT were: 85%, 86%, 57%, 95% and 88%. There was no significant difference between modalities in terms of NPV. Bivariate analysis revealed that CCTA had statistically greater sensitivity, specificity, PPV and overall diagnostic accuracy when compared to SE and SPECT. CONCLUSIONS: All three modalities, when employed by an experienced clinician, are highly accurate. Each has its own strengths and limitations making each well suited for different patient groups. CCTA has higher accuracy than SE and SPECT, but it has many drawbacks, most importantly its lack of physiologic data.

Cardiac imaging for assessment of left atrial appendage stasis and thrombosis.

Atrial fibrillation (AF) is the most-common arrhythmia in the elderly population (age >65 years). The left atrial appendage (LAA) is the main location of thrombus formation, predominantly in patients with nonvalvular AF. This Review is focused on the pathophysiology, assessment, and clinical implications of stasis (or spontaneous echocardiographic contrast; SEC) and thrombus formation in the LAA. The gold-standard modality for assessment of SEC and thrombus in the LAA is echocardiography, particularly transoesophageal echocardiography (TEE). Cardiac CT (CCT) is an accurate, noninvasive alternative to TEE for the detection of LAA thrombi, distinctly when delayed-imaging acquisition protocols are used. Prospective studies to validate the use of cardiac MRI (CMR) for this purpose are needed, and will avoid the need for radiation and iodinated contrast. CCT or CMR could potentially be implemented to rule out LAA thrombus, avoiding unnecessary preprocedural TEE. Cardiac imaging is also of primary importance in the setting of LAA closure devices and electrophysiological studies. New trials are needed to compare the various imaging modalities, with surgicopathological findings as a reference standard.

Guía de práctica clínica para la detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico / Clinical practice guidelines for early detection of abnormalities during labor, care for normal and dystocic delivery

Objetivo: realizar recomendaciones para detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico. Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta Guía fue adaptada de la “Guía de práctica clínica sobre la atención del parto normal” (País Vasco - 2010) y actualizada por procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresados por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN). Esta guía y sus secciones hacen parte de un grupo de 25 GAI basadas en la evidencia que incorporan consideraciones económicas y de implementabilidad en el contexto del Sistema General de Seguridad Social en Salud colombiano, y que se desarrollaron por iniciativa del Ministerio de Salud y Protección Social y el Departamento de Ciencia, Tecnología e Innovación (Colciencias) en temas prioritarios y de alta prevalencia en el país mediante contrato otorgado a la Universidad Nacional de Colombia en el año 2010. Resultados: se presentan las recomendaciones para la asistencia del trabajo de parto y el parto asociadas con mayor probabilidad de obtener un resultado materno fetal exitoso durante la atención del parto. Conclusiones: se espera que las recomendaciones de esta GPC sean utilizadas por los profesionales de la salud de los programas de atención de la gestación con el fin de disminuir la morbilidad y mortalidad atribuibles a complicaciones del trabajo de parto y el parto.

Objective: To make recommendations for early detection of abnormalities during labor, and care of normal and dystocic delivery. Materials and methods: The Guideline Developer Group (GDG) prepared this CPG during 2011-2012 in accordance with the Methodology Guideline for the development of Comprehensive Care Guidelines of the Colombian General System of Social Security, on the basis of the available scientific evidence, and with the active participation of patient groups, scientific societies and stakeholders. In particular, the evidence for this section was adapted from the “Clinical practice guideline for normal delivery care” (País Vasco – 2010) and adapted through systematic procedures for the search and assessment of the evidence as well as for the generation of recommendations. The level of evidence and the power of the recommendations were expressed using the Scottish Intercollegiate Guidelines Network (SIGN) system. Results: We present the recommendations for labor and delivery care associated with the highest probability of a successful outcome for the mother and the baby. Conclusions: It is expected that the recommendations contained in this CPG will be used by practitioners in pregnancy care programs in order to reduce morbidity and mortality attributable to labor and delivery complications.

Guía de Práctica Clínica para la prevención, detección tempara y tratamiento de las complicaciones del embarazo, parto o puerperio: introducción y metodología / Clinical Practice Guidelines for the prevention, early detection and treatment of complications of pregnancy delivery or the post-partum period: introduction and methodology

Antecedentes: las “Guías de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las alteraciones del embarazo, parto y el puerperio” fueron desarrolladas por la alianza conformada por la Universidad Nacional de Colombia, la Universidad de Antioquia, la Universidad Pontificia Javeriana y el Centro de investigaciones en evaluación de tecnologías en salud (CINETS) dentro de la convocatoria del Ministerio de Salud y Protección Social y Colciencias en el año 2010 para el desarrollo de GPC en temas prioritarios de salud.Materiales y métodos: basados en la “Guía Metodológica para la elaboración de GPC” del Centro de Estudios e Investigación en Salud (CEIS), se conformó el grupo desarrollador, se definieron los tópicos por desarrollar, el alcance, los objetivos y las preguntas por resolver en las GPC. Se realizó una búsqueda sistemática de GPC para los tópicos seleccionados, priorizando la opción de adaptar antes que desarrollar una guía de novo, según la calidad metodológica de las guías identificadas. Se realizó la revisión sistemática de la literatura para responder preguntas huérfanas. Se formularon las recomendaciones con niveles de evidencia graduados bajo el sistema SIGN. Se favoreció la participación de pacientes y de los diferentes grupos de interés. Resultados: se adaptaron seis GPC para responder las preguntas de los tópicos incluidos en la GPC desarrollada. El tópico de toxoplasmosis requirió el desarrollo de recomendaciones de novo.Conclusiones: estas GPC fueron elaboradas con procedimientos sistemáticos y la mejor evidencia disponible. Se espera que contribuya a mejorar la calidad de la atención de las gestantes y a la disminución de la morbilidad y mortalidad materna y perinatal

Background: These Clinical Practice Guidelines (CPG) for the prevention, early detection and treatment of complications during pregnancy, delivery and post-partum period were developed by the alliance between the Universidad Nacional de Colombia, Universidad de Antioquia, Pontificia Universidad Javeriana, and Centre for Research in Health Technologies Assessment (CINETS) in response to the call in 2010 by the Ministry of Health and Social Protection and Colciencias for the development of CPGs in priority healthcare areas. Materials and methods: The development team was created pursuant to the Health Studies and Research Center (CEIS) Methodology Guide for CPG Development. The team then defined the topics, the scope, the objectives and the questions to be answered by the CPG. A systematic search was conducted of CPGs for the selected topics, giving priority to the option of adapting instead of developing a “de novo” guideline, depending on the methodological quality of the guidelines found. A systematic review of the literature was conducted in order to answer orphan questions. The recommendations and evidence levels were expressed in accordance with the SIGN system. Patient participation and that of the various stakeholders was encouraged. Results: Six CPGs were adapted to answer the questions of the topics included in the developed CPG. The topic on toxoplasmosis required the development of “de novo” recommendations. Conclusions: This CPG was prepared using systematic procedures and the best evidence available. It is expected to help improve pregnancy care and reduce maternal and perinatal morbidity and mortality

Tratamiento de aa sífilis gestacional y prevencón de la sífilis congénita en uun hospital público en bogotá, 2010 / Treatment of gestational syphilis and prevention of congenital syphilis in a public hospital in Bogotá, 2010

Antecedentes. La sífilis afecta a la mujer gestante y es transmitida al feto. Hay incremento de su incidencia en países no desarrollados y poblaciones vulnerables. Objetivo. Evaluar el cumplimiento de las recomendaciones del Centro de Control de Enfermedades(CDC) para el tratamiento de casos intrahospitalarios de sífilis gestacional y congénita. Material y métodos. Estudio retrospectivo basado en registros de notificación e historias clínicas de gestantes y neonatos de un hospital público de Bogotá entre enero 1 y octubre 31 de 2010. Resultados Se identificaron 40 casos de sífilis gestacional: 12,5% con diagnóstico de aborto sin control prenatal, 12,5% en gestaciones en curso (una término en aborto), 72,5% durante el parto y 2,5% en puerperio. Sólo 45% estaban afiliadas a la seguridad social, la tasa de analfabetismo fue 12%. El 100% de los casos encontrados latentes y 58% de los compañeros no recibió tratamiento. Se identificaron 25 casos de sífilis congénita. Hubo 2 (8,3%) casos confirmados de neurosífilis congénita. Todos los neonatos recibieron tratamiento para sífilis congénita como escenarios 1 y 2 del CDC independiente del tratamiento materno recibidido. Conclusión. La sífilis gestacional y congénita afecta grupos vulnerables. Se debe tratar integralmente a la gestante y su hijo, ubicar el escenario terapéutico del neonato y realizar el manejo clínico adecuado para curar la enfermedad.

Background. Syphilis affects pregnant women and becomes transmitted to their foetuses. Incidence has risen in underdeveloped countries and vulnerable populations. Objective. Assessing compliance with Center for Disease Control (CDC) recommendations for treating intra-hospital cases of gestational and congenital syphilis. Materials and methods. This was a retrospective study based on registries and medical records of pregnant women and their babies in a public hospital in Bogotá from 1st January to 31st October 2010. Results. Forty cases of gestational syphilis were identified; 12.5% were admitted for abortions without prior prenatal care, 12.5% during prenatal care (one case ending in abortion), 72.5% during labour and 2.5% during postnatal care (puerperium). Only 45% of the women had social security and 12% were illiterate. 100% of the cases were found during latent stage and 58% of their sexual partners remained untreated. Twenty-five cases of congenital syphilis were identified between 36 and 40 weeks pregnancy. 20% of the women had low birth weight and clinical examination was abnormal in only 4 (16%) of them. There were 2 cases (8.3%) of confirmed neurosyphilis. All infants received treatment for congenital syphilis in line with CDC classification stages 1 and 2, regardless of maternal treatment status. Conclusión. Gestational and congenital syphilis affects vulnerable groups. Pregnant women and their children should be managed integrally, according to their infection stage and previous treatment during pregnancy to orientate clinical management and follow-up of the newborn to cure the disease.

[Recommendations for non-occupational postexposure HIV prophylaxis. Spanish Working Group on Non-Occupational Postexposure HIV Prophylaxis of the Catalonian Center for Epidemiological Studies on AIDS and the AIDS Study Group]. / Recomendaciones para la profilaxis postexposición no ocupacional al VIH. Grupo de Consenso Español sobre Profilaxis Postexposición No Ocupacional al VIH de CEESCAT (Centre de Estudis Espidemiològics sobre la Sida a Catalunya) y GESIDA (Grupo de Estudio de SIDA).

Evidence is lacking on the possible efficacy and effectiveness of non-occupational postexposure prophylaxis (PEP). However, because of its biological plausibility, the use of antiretroviral (ARV) drugs to prevent the development of infection in certain cases of accidental or sporadic exposure has begun to be considered as common clinical practice. Previous studies performed in Spain have demonstrated both the demand and the prescription of ARV as PEP and especially the diversity and inconsistency in the criteria used. In this context, in April of 2000 the Centre for Epidemiological Studies on AIDS of Catalonia (CEESCAT) (Department of Health and Social Security of the Autonomous Government of Catalonia), in collaboration with the National AIDS Plan and the AIDS Study Group (GESIDA), promoted the creation of a working group for the drafting of recommendations for PEP against HIV outside the occupational health context. The recommendations have been made bearing in mind the exceptional character of the exposure, the time elapsed since exposure, as well as evaluation of the risk of infection according to the type of exposure and the information available on the source of infection. In addition, the recommendations include the immediate measures necessary, as well as the preventive measures and clinical follow-up required both for HIV and for other infectious agents. All PEP regimens should be started within 72 hours of exposure and appropriate daily doses of two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI), or two NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTIs), should be administered for four weeks, bearing in mind the pharmacological and clinical situation of the source person. These recommendations should be updated periodically.

Rebrote epidémico del cólera en Lima / Epidemic cholera outbreak in Lima

Considerando la magnitud del problema del cólera, no sólo para el Instituto de Seguridad Social del Perú sino para todo el país y aún de Latino América, elaboramos este trabajo sobre el comportamiento del presente rebrote epidémico. Hemos tomado en consideración los datos de diferentes fuentes para compararlas con los nuestros, tanto en el Servicio de Emergencia como en la Unidad de Tratamiento del Cólera (UTC), ubicado en el piso 12-C de nuestro Hospital. En lo que va del verano actual fueron hospitalizados 281 pacientes en el piso 12-C, 112 casos en diciembre de 1991 y 169 en enero de 1992, con una tasa de letalidad intrahospitalaria de 0.46 por ciento y una mortalidad global de pacientes atendidos de 0.25 por ciento, nuestra estancia hospitalaria ha ido declinando paulatinamente con cifras actuales de 3.1 . Encontramos que en este verano la curva de ascenso epidémico es más precoz y de mayor magnitud que la del verano pasado. Del total de pacientes hospitalizados, el 63.6 por ciento correspondió al sexo masculino y el 36.4 por ciento al femenino. Se aprecia también que la mayor parte de pacientes proceden de zonas con deficientes condiciones sanitarias: Cono Sur, Chorrillos, Cono Norte, San Juan de Lurigancho, etc. Podemos concluir que por el comportamiento de la epidemia durante todo el año 1991 y lo que va de 1992, nos hemos convertido en una zona epidémica de este nuevo flagelo en el Perú, mientras no se modifiquen las condiciones epidemiológicas actuales