Macular dystrophy associated with Kjellin’s syndrome: a case report / Distrofia macular associada à síndrome de Kjellin: um relato de caso

Hereditary spastic paraplegia (HSP) is characterized by weakness and spasticity of the lower extremities. Kjellin’s syndrome is a rare syndrome associated with HSP. The syndrome is characterized by the presence of bilateral retinal flecks, similar to the findings in Stargardt disease and fundus flavimaculatus. We report the case of a 34-year-old male who presented with complete features of Kjellin’s syndrome, with typical retinal findings observed on multimodal imaging (spectral domain optical coherence tomography [SD-OCT], near-infrared reflectance and autofluorescence imaging). The ophthalmological changes at early stages of the disease may not impair visual acuity. Therefore, the detection of central retinal degeneration requires thorough fundus examination.

A paralisia espástica hereditária (HSP) é caracterizada por fraqueza e espasticidade das extremidades inferiores. A síndrome de Kjellin é uma rara associação de HSP com a presença de flecks retinianos similares aos encontrados em pacientes com doença de Stargardt ou fundus flavimaculatus. Descrevemos os achados em imagens multimodais da retina (tomografia de coerência óptica de domínio espectral [SD-OCT], reflectância próxima ao infravermelho e autofluorescência) em um paciente de 34 anos que apresenta conjunto completo de sinais e sintomas da síndrome de Kjellin. As alterações retinianas em estágios iniciais da doença podem aparecer, mesmo sem redução da acuidade visual, e por isso, para detecção da degeneração central da retina, é necessário exame minucioso do fundo de olho.

A study on powdering of reusable surgical gloves.

OBJECTIVES: To study the need of powdering surgical gloves and to produce a powdering machine. MATERIAL AND METHOD: The need of powdering surgical gloves was done by questionnaires to directors or chiefs of purchase departments in 29 hospitals across the country. The practice in powdering surgical gloves was given by chiefs of the central sterile supply department (CSSD). A powdering machine was produced by the researchers in consultation with CSSD personnel in a hospital. The quality of powdering surgical gloves was evaluated by infection control nurses in the hospital. Cost comparison was done by a health economist. RESULTS: The study in 2002 revealed that all of the 29 hospitals used recycled surgical gloves. Powdering of surgical gloves was done by hand in 27.6% and by powdering machine in 62.10%. Corn powder was used in 55.2% and talc in 41.4%.Defects in powdering ranged from 1.1% to 51.7%. No defects was found in surgical gloves powdered by the machine produced by the researchers. The costs for powdering and one pair of reused surgical gloves were 0.10 and 5.59 baht respectively. CONCLUSION: Surgical gloves were reused in all hospitals in Thailand The powdering machine was effective and was not difficult to make.

Costos de las Infecciones Intrahospitalarias en la Unidad de Cuidados Intensivos, Hospital Dr. Rafael Estévez, Aguadulce Enero-Julio, 2004 / Costs of the Infections Intrahospitalarias in the Unit of Intensive Cares, Hospital Dr. Rafael Estévez de Aguadulce January-July 2004

No existe información publicada sobre el impacto económico de las infecciones intrahospitalarias en Panamá. Con el objetivo de conocer los costos adicionales que tuvieron los pacientes con infecciones intrahospitalarias en la Unidad de Cuidados Intensivos del Hospital Dr. Rafael Estévez, se analizó una cohorte retrospectiva de pacientes que desarrollaron infección nosocomial comparándola con pacientes que no la desarrollaron. El período de estudio fue de siete meses, comprendido entre el 1 de enero al 31 de julio de 2004. Se revisaron ochenta y cuatro (84) ingresos a la Unidad de Cuidados intensivos identificando diecisiete (17) pacientes con veintiuno (21) episodios de infecciones intrahospitalarias y sesenta y siete (67) pacientes que no las desarrollaron. Se recogió información sobre estancia hospitalaria, consumo de antibióticos, uso de cultivos y los costos respectivos para cada variable. Al comparar los pacientes con infecciones intrahospitalarias versus los pacientes sin infección se encontró que los costos de los pacientes con infección intrahospitalaria fueron mayores. El costo total de estadía hospitalaria fue 1.5 veces mayor, diecisiete (17) veces el costo de cultivos y 4.5 veces el costo ce antibióticos. Las magnitudes en excesos de costos de días de estancia hospitalaria fue de $ 6,580.91 (16.92 días), $ 1,201.36 (109.12 gramos) en antibióticos y $ 56.29 (6.10 cultivos) siendo estas diferencias estadísticamente significativas (p < 0.05). El exceso de costos, por atender un paciente con IIH considerando días de estancia en UCI, cultivos y antibióticos fue en promedio de $ 7,838.56 (p = 0.000) lo que significa un incremento en los costos 7 veces mayor que en los pacientes sin infección nosocomial. Esta evaluación representa una estimación del costo directo de la infecciones intrahospitalarias, lo que justifica el fortalecimiento de programas preventivos.

Socioeconomic burden of nosocomial infections.

Nosocomial infection represents an important public health problem in developing countries as in developed ones. Economic concerns have taken on increasing importance in infection control since the mid 1970s in the USA, however there are few papers on the economics of NI in other countries. Studies on the costs of NI have used different methods, definitions and degrees of stringency when calculating indirect costs and there is therefore still uncertainty over their true economic impact on the community and on the workplace economy. Drug and especially antibiotic acquisition in addition to increased length of stay are the widely and well described parameters. Extra cost of NI include; bed, intensive care unit stay, hematological, biochemical, microbiological and radiological tests, antibiotics, other drugs, extra surgical procedures and working hours. In addition to high morbidity and mortality one of the well described parameters is the extra length of stay in the hospital. High mortality rates and economic expense which NI represents emphasizes the justification for measures of control of this entity. To estimate better the current personnel and financial resources necessary to support infection control activities and to prevent NI, it is imperative that those conducting studies of hospital epidemiology and healthcare outcomes research determine these current costs.

Use of antiseptics and disinfectants in Thailand 1990.

A survey by questionnaire was done in March and April 1990 on the use of antiseptics and disinfectants (A/D). Twenty-seven hospitals with 675 wards were enrolled. Results showed that the cost of A/D was 3.3 to 8.1 per cent of the total expenses for drugs. Essential A/D were available and used in most places. Many low level A/D, which have been excluded from modern hospitals, were still employed. Contamination of A/D was a real threat due to improper preparation, unclean containers and refill practices in many wards. Improper applications of A/D, namely: overuse, underuse, and wrong choices were found in many places. Textbooks and written guidelines were available but it is unlikely that they were referred to in practice. A national policy on the use of A/D and proper education to medical personnel are clearly needed.