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BACKGROUND: Weeksella virosa pneumonia is an infection that has been described as a healthcare-associated infection. This is a rare gram-negative anaerobic bacterium associated with the use of mechanical ventilation for a long period of time and is more frequent in immunosuppressed patients. This is the first case reported in the state of Veracruz and the second in Mexico. CASE PRESENTATION: We present the case of a 64-year-old female from Veracruz, Mexico who developed an infectious process in the right pelvic limb after a transcatheter aortic valve replacement procedure and subsequently developed sudden cardiorespiratory arrest requiring mechanical ventilation, with subsequent imaging studies demonstrating a pneumonic process associated with a nosocomial infection. DISCUSSION AND CONCLUSIONS: We should take into consideration that this pathogen affects not only adults with multiple comorbidities but also children with renal, hepatic, or oncological pathologies, as well as immunocompromised patients, who should be considered high-risk populations for W. virosa infection.
Assuntos
Infecção Hospitalar , Pneumonia Associada à Ventilação Mecânica , Adulto , Feminino , Criança , Humanos , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Composição de Bases , Filogenia , RNA Ribossômico 16S , Análise de Sequência de DNA , Bactérias Aeróbias , Infecção Hospitalar/diagnósticoRESUMO
Resumen Introducción La fimosis es una condición en la que el prepucio no puede ser retraído sobre el glande. La fimosis fisiológica afecta hasta a 96% de los recién nacidos y persiste hasta los tres o cuatro años de vida; es motivo común de consulta en la atención médica primaria y el tratamiento principal es la circuncisión. Diversos estudios han valorado el uso de esteroides tópicos en la liberación del prepucio fimótico. Objetivo Determinar la efectividad del tratamiento con esteroide tópico para la liberación del prepucio en lactantes con fimosis fisiológica en el Hospital Naval de Especialidades de Veracruz (HOSNAVESVER). Material y métodos Ensayo clínico aleatorizado controlado en lactantes de 30 a 60 días de edad con fimosis fisiológica. Se formaron mediante la aleatorización de tres grupos: A (hidrocortisona 1%/fisioterapia), B (vaselina/fisioterapia) y C (hidrocortisona 1% sola); se comparó su efectividad mediante la escala de Kayaba antes y después del tratamiento. El análisis estadístico se efectuó con pruebas de χ2 y Kruskal-Wallis. Resultados Se incluyeron 61 lactantes. Al inicio, 17 (85.0%) del grupo A, 14 (70.0%) del B y 17 (81.0%) del C estaban en categoría I de Kayaba; al final del tratamiento, 19 (95.0%) del grupo A estaban en categoría III y IV, 18 (90.0%) del grupo B y 19 (90.5%) del grupo C estaban en categoría II y III (p < 0.05). La hidrocortisona/fisioterapia tuvo RR de -93.8%, IC 95% (-99.1 a -57.2%) y NNT de 1, IC 95% (1 a 2). Conclusión La hidrocortisona 1% con fisioterapia mostró mayor efectividad para el tratamiento de la fimosis fisiológica en lactantes de 30 a 60 días de vida.
Abstract Introduction Phimosis is a condition in which the foreskin cannot be retracted on the glans. Physiological phimosis affects up to 96% of newborns, persisting until three or four years of age. It is a common reason for consultation in primary medical care, with the main treatment being circumcision. Several studies have evaluated the use of topical steroids in the release of the foreskin. Objective To determine the effectiveness of topical steroid treatment for the liberation of the prepuce in infants with physiological phimosis in the Naval Hospital of Specialties of Veracruz (HOSNAVESVER). Material and methods Randomized controlled clinical trial in infants between 30 and 60 days of age with physiological phimosis. Three groups were randomized: A (hydrocortisone 1%/physiotherapy), B (petrolatum/physiotherapy) and C (only hydrocortisone 1%), comparing their effectiveness using the Kayaba scale before and after treatment. A statistical analysis was made with χ2 and Kruskal-Wallis tests. Results 61 infants were included. At the beginning, 17 (85.0%) of group A, 14 (70.0%) of B and 17 (81.0%) of C were in category I of Kayaba; at the end of the treatment, 19 (95.0%) of group A were in category III and IV, 18 (90.0%) of group B, and 19 (90.5%) of group C were in category II and III (p < 0.05). Hydrocortisone/physiotherapy had RR of -93.8%, 95% CI (-99.1% to -57.2%) and NNT of 1, 95% CI (1 to 2). Conclusion Hydrocortisone 1% with physiotherapy showed greater effectiveness for the treatment of physiological phimosis in infants between 30 and 60 days of age.
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Resumen Introducción La hiperplasia prostática benigna es el padecimiento urológico más frecuente en hombres mayores de 50 años; sus síntomas afectan la calidad de vida. Los bloqueadores alfa-adrenérgicos son una opción para mejorarla. Objetivo Determinar la calidad de vida de pacientes con hiperplasia prostática benigna antes y después del tratamiento con un bloqueador alfa-adrenérgico. Material y métodos Estudio pretest-retest en hombres de 45 a 75 años con hiperplasia prostática benigna. Se administró tamsulosina (0.4 mg/día) por tres meses y se evaluó la severidad de los síntomas y la calidad de vida con el International Prostate Symptom Score (IPSS) y EuroQol 5-D. Se usaron X2 y prueba de rangos y signos de Wilcoxon. Resultados Se incluyeron 50 pacientes de 63.3 ± 10.3 años, 34 (68.0%) tenían síntomas severos antes del tratamiento y 19 (38.0%) después de tres meses (p < 0.05). Con el IPSS, 33 (66.0%) pacientes estaban en categorías de «tan insatisfecho como insatisfecho¼ a «muy insatisfecho¼ antes de la intervención y seis (12.0%) después de ella. La escala visual análoga (EVA) del EuroQol 5-D mostró puntuación basal de 72.9 ± 11.2 versus 83.4 ± 7.6 después (p < 0.05). Conclusión La tamsulosina reduce la severidad de los síntomas y mejora la calidad en de vida en la hiperplasia prostática benigna después de administrarla tres meses.
Abstract Introduction Benign prostatic hyperplasia is an urological disorder most common in men over 50 years old; the symptoms affect the quality of life. Alpha-adrenergic blockers are an option to improve it. Objective To determine the quality of life of patients with benign prostatic hyperplasia before and after treatment with an alphaadrenergic blocker. Material and methods Pretest-retest study in men of 45 to 75 years with benign prostatic hyperplasia. Tamsulosin was administered (0.4 mg/day) for three months; the severity of symptoms and quality of life were assessed with IPSS and EuroQol 5-D. Ranges and sign of Wilcoxon test and X2 were used. Results Fifty patients were included of 63.3 ± 10.3 years of age, 34 (68.0%) had severe symptoms before the treatment and 19 (38.0%) after three months (p < 0.05). With IPSS, 33 (66.0%) patients were in the categories of «as dissatisfied as unsatisfied¼ and «very dissatisfied¼ before the intervention and six (12.0%) after. The VAS of the EuroQol 5-D showed a baseline score of 72.9 ± 11.2 versus 83.4 ± 7.6 after (p < 0.05). Conclusion Tamsulosin reduces severity of symptoms and improves quality of life in benign prostatic hyperplasia after giving it three months.
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Introduction Burnout syndrome is one of the most studied manifestations of job stress. The burnout concept was used by the first time in the area of psychology by Freudenberger in 1974. This psychologist defined it as a condition of fatigue or frustration that is produced by the commitment to a reason, lifestyle or relationship that does not produce the expected effort. Afterwards, Maslach and Jackson proposed three interrelated dimensions: emotional weariness (EW) which estimates the experience of emotional fatigue for the demands of work; the depersonalization (DP) which measures the answers of impersonal type and negative attitudes towards the patients; and the personal accomplishment (PA) which reflects the personal satisfaction and the competition in the practice of the daily work. These dimensions are joined in the Maslach Burnout Inventory (MBI) that is used to measure the afore mentioned syndrome. Several studies have demonstrated the presence of burnout syndrome among medical and paramedic personnel. The close contact with the patients and the work overload are the main reasons of this syndrome. In a multicentre study carried out among 248 doctors of the United States, 40% presented the syndrome with emotional detriment, which coincides with another study carried out with nurses attending patients with palliative care and marrow transplants. Also, in a study carried out among residents of internal medicine of the University of Washington, there was a prevalence of 76% of professional wear, with an autoperception of a lower quality in the professional care of the patients, after comparing them with non-affected residents. In Mexico, a study that investigated burnout level in a group of 450 medical practitioners, nurses and paramedics of 12 institutions revealed the following information: 10.9% presented emotional weariness, 19.6%, depersonalization, and 74.9, low personal accomplishment. Palmer et al. determined a general prevalence of 44% of the syndrome in anesthesiologists. The work overload and the conflict of values were variables that influenced the presence of this syndrome. At the Instituto Mexicano del Seguro Social, Aranda et al., carried out a study among family physicians, where the prevalence of burnout syndrome was 42.3%. Likewise, Cabrera et al., found that, out of 236 studied nurses, 92 (39%) had information compatible with burnout syndrome, with statistically significant differences for the age and the antiquity in the place after comparing them with nurses without burnout syndrome. The burnout syndrome was considered by the World Health Organization as work risk. Its trascendence is rooted in the impact it has in the labor relation between medical and/or paramedic personnel and the health institutions. For this reason, we considered it important to investigate the presence of this syndrome among the medical and paramedic personnel working at hospital of the Mexican social security. Material and Methods Design: Transversal comparative survey. Population: Of a total population of 240 workers of the health area assigned to a general hospital a sample of 160 was obtained that included doctors, nurses and medical assistants based on an average prevalence of the syndrome in 30%, with an alpha level of 0.05 and a power of 90%. Instrument of evaluation: The survey was based on the following sociodemographic and labor variables: age, marital status, academic level, labor antiquity, antiquity of adscript ion to the hospital, category, service and labor shift. To evaluate the burnout syndrome, the MBI questionnaire was used in its previously validated Spanish version. The afore mentioned instrument is an objective way of measuring and determining the burnout level that a person experiences, in its three subscales: EW, DP and PA. The survey consists of 22 items with a Likert type punctuation scale (0-6), of which 9 valued EW, 5, DP, and 8, PA. With regard to the EW, which values the sensation of being emotionally exhausted by the daily contact with people to whom it is necessary to attend as object of work, a punctuation of 27 or higher indicated a high level; between 19 and 26, moderated; and lower than 19, low. In the subscale DP, which measures the degree in which the response towards the patients is cold, distant and impersonal, punctuations above 10 indicated a high level; from 6 to 9, moderated; lower than 6, low. In the subscale PA, which values the feelings of competition and efficiency for the accomplishment of the work and the relation with the people who are being attended, values above 40 indicated personal high accomplishment; from 34 to 39, intermediate; and under 33, low. In the case of obtaining a low emotional depletion, a low depersonalization and a high personal accomplishment, it was considered that no burnout was present. In the rest of the cases, the presence of burnout syndrome was established. Compilation of the information: From August to December, 2005, the survey was applied to each of the workers, indicating them that they should answer and return it in a term not longer than five days. They were all informed previously about the general objectives of the study and its confidential and anonymous character. The head investigator integrated later on the database. Statistical tests: Descriptive and inferential statistics were carried out. The odds ratio and confidence intervals of 95% were calculated to measure the association between the sociodemographic and labor factors with the professional wear. Results Of 160 workers to whom the survey MBI was applied, only 146 returned it in a complete form. Regarding the frequency and the percentages of the three categories studied with the qualifications of low, average and high for every subscale that composes the burnout syndrome, it was observed that the highest evaluations fit the medical assistants. There was a 19.6% prevalence of burnout syndrome among the groups of doctors with at least one of three disturb subscales. Likewise, it was observed that all medical assistants had an alteration of a minimum of two subscales. The nursing personnel did not present information that constitutes a risk for the development of burnout syndrome. Only four sociodemographic and labor variables were found as risk factors for the presence of burnout syndrome, as well as their relation with each of the subscales composing it. When the variables compared age, labor antiquity and time of adscript ion in the service with each of the subscales of the burnout, we observed that depersonalization appeared in older workers and longer antiquity in the position and the lack of personal accomplishment in workers with longer time in the service. There were no statistically significant differences in the subscale of emotional weariness. Discussion In the last years, burnout syndrome has acquired special relevance, mainly because of the series of repercussions that it has in the labor and personal area. Numerous studies exist on the prevalence of this syndrome in different health professionals, but in present work incorporated medical assistants, since they are those who have the first contact with the patients in our institution.
Introducción El concepto de burnout fue utilizado por primera vez en el ámbito de la psicología por Freudenberger en el año de 1974. Este psicólogo lo definió como un estado de fatiga o frustración que se produce por la dedicación a una causa, forma de vida o relación que no produce el esperado esfuerzo. Más tarde, Maslach y Jackson propusieron tres dimensiones interrelacionadas: el cansancio emocional (CE), la despersonalización (DP) y la realización personal (RP). Estas dimensiones se integran en el cuestionario Maslach Burnout Inventory (MBI) que se utiliza para medir dicho síndrome. Material y métodos Diseño: Encuesta transversal comparativa. Población: Se entregó el cuestionario MBI a 160 trabajadores del área de la salud adscritos al Hospital General de Zona con Medicina Familiar 36 de la Ciudad de Cardel, Veracruz. Instrumento de evaluación: Se construyó una encuesta sobre las siguientes variables sociodemográficas y laborales: edad, estado civil, nivel académico, antigüedad laboral, antigüedad de adscripción al hospital, categoría, servicio y turno laboral. Para evaluar el síndrome de burnout se utilizó el cuestionario MBI en su versión en español. Dicho instrumento consta de 22 ítems con escala de puntuación tipo Likert (0-6), de los cuales 9 valoran CE, 5 la DP y 8 la RP. Recolección de la información: Durante el periodo comprendido de agosto a diciembre del 2006 se entregó el cuestionario a cada uno de los trabajadores de la salud. Pruebas estadísticas: Se realizó estadística descriptiva e inferencial. Se calculó la razón de momios e intervalos de confianza de 95% para medir la asociación entre los factores sociodemográficos y laborales con el desgaste profesional. Resultados De 160 trabajadores a quienes se les entregó el cuestionario MBI, sólo 146 lo regresaron en forma completa. En lo que respecta a la frecuencia y los porcentajes de las tres categorías estudiadas se observó que las evaluaciones más altas corresponden a las asistentes médicas. Hubo una prevalencia del síndrome de burnout entre el grupo de médicos del 19.6% con al menos una de las tres subescalas alteradas. Asimismo se observa que en todas las asistentes médicas hubo alteración de un mínimo de dos subescalas. Sólo se encontraron cuatro variables sociodemográficas y laborales como factores de riesgo para la presencia del síndrome de burnout, así como su relación con cada una de la subescalas que lo componen. Discusión Existen numerosos estudios sobre la prevalencia de este síndrome en diferentes profesionales de la salud, pero en el presente trabajo se incorpora a las asistentes médicas, ya que son quienes tienen un primer contacto con los pacientes en nuestra institución. Las cifras de prevalencia del síndrome de burnout reportadas por otros estudios realizados en México entre el personal médico van desde el 42.3% y 44% hasta 50%; en esta investigación la prevalencia fue menor y la dimensión de cansancio emocional es la más afectada. Entre las variables que se consideraron factores de riesgo en nuestro estudio se encuentra el estado civil. Asimismo, el trabajar en el turno vespertino y ofrecer sus servicio en la consulta externa también estuvieron relacionados con mayor predisposición al síndrome de burnout. Al igual que otros estudios, en esta investigación se encontró un mayor nivel de Burnout en profesionales con mayor edad. En lo que respecta a la DP y RP, éstas se presentaron en trabajadores cuya antigüedad laboral era mayor. En conclusión, la prevalencia del síndrome de burnout entre las asistentes médicas es muy alta y es necesario adoptar medidas para evitar el desarrollo de esta patología.