Factors Associated with Surrogate Self-Efficacy in Decision-Making for Patients with End-Stage Renal Disease.

AIM: The aim of the study is to assess which factors are associated with self-efficacy for making these decisions in surrogates of end-stage kidney disease patients. MATERIALS AND METHODS: Cross-sectional study conducted in the hemodialysis clinic of a private hospital in Mexico City. A total of 124 surrogates of patients in hemodialysis were included in the study. Self-efficacy for decision-making was assessed with the Family Decision-Making Self-Efficacy Scale. As factors related to decision-making self-efficacy, sociodemographic data, health information, and professional help received for dealing with end-of-life issues were assessed in both patients and surrogates. Functional status and advanced directives of the patient as well as prior experience in decision-making of the surrogates were also included. Logistic regression models were used to establish the associations. RESULTS: The mean age of participants was 49.4 years (standard deviation: 14). Factors associated to decision-making self-efficacy were awareness of the surrogate about the terminal disease of the patient (P < 0.001), prior conversation between the surrogate and the patient about end-of-life preferences (P = 0.037), time between the patient was told dialysis was required and accepting it inferior to 1 month (P = 0.016), and visual impairment of the patient (0.040). CONCLUSIONS: This study provides information of which factors are associated with self-effectiveness in surrogates of terminally ill renal patients so that strategies based on these considerations might be implemented in the future.

Restoration of Peripheral Intermediate and Classical Monocytes Expressing HLA-DR in Patients With Lung Adenocarcinoma After Platinum-Based Chemotherapy.

Lung adenocarcinoma represents one of the lung cancer subtypes with major prevalence. Accumulating evidence indicates that the immune system plays an important role in the evolution of the neoplastic process; additionally, several reports suggest that chemotherapy has an immunomodulatory effect. In order to identify the peripheral subpopulations of leukocytes that may change after chemotherapy, we evaluated several peripheral immune subpopulations of monocytes and lymphocytes by multicolor flow cytometry. In addition, we also measured cytokines and growth factors on plasma in order to evaluate the pro-inflammatory context in patients with lung adenocarcinoma after chemotherapy. We found that HLA-DR+ classical and intermediate monocytes were decreased in patients before chemotherapy, compared to controls. After chemotherapy, the relative percentage of those subpopulations was restored. In addition, interleukin 1ß, interleukin 12, and interleukin 5 were increased after chemotherapy compared to prechemotherapy levels, while MIP-1ß was decreased.

Retroperitoneal epithelioid sarcoma: A case report.

Epithelioid sarcoma (ES), a mesenchymatous malign neoformation, is often diagnosed in later stages and associated with high recurrence index, metastasis and mortality. We report a case of a 65 years old male, with history of abdominal pain and upper gastrointestinal bleeding. Endoscopy demonstrated a posterior duodenal wall perforation communicating with a solid retroperitoneal neoformation. Endoscopic biopsy was performed, with a final report of ES. The patient was submitted for surgical palliation due to the tumor's unresectability. Retroperitoneal ES is an extremely rare condition with limited reports in the literature where guidelines for its optimal treatment are not well established.

Extended-spectrum beta-lactamase-producing Salmonella enterica serovar Oranienburg (CTX-M-2 group) in a pediatric hospital in Tucumán, Argentina.

INTRODUCTION: Salmonella sp infections have been reported over recent years in hospitals in Argentina and other countries due to multiresistant strains. The aim of this study was to characterize the extended-spectrum beta-lactamases in third-generation cephalosporin-resistant strains of Salmonella enterica serovar Oranienburg. METHODS: We studied 60 strains isolated from children with gastroenteritis and/or extraintestinal complications. The antibiotic susceptibility patterns of the isolates were analyzed and the beta-lactamases were characterized using phenotyping and genotyping methods. RESULTS: All the strains were resistant to ampicillin, cefotaxime, cefepime and aztreonam and partially susceptible to ceftazidime, thus corresponding well with the resistance phenotype conferred by CTX-M-type beta-lactamases. An isoelectric point enzyme (pI = 7.9) was detected in all of the strains, and this was confirmed by PCR as a member of the CTX-M-2 group. CONCLUSIONS: This is the first report of Salmonella enterica serovar Oranienburg producing beta-lactamases of the CTX-M-2 group in a pediatric hospital in Tucumán, Argentina.

Extended-spectrum B-lactamase-producing Salmonella enterica serovar Oranienburg (CTX-M-2 group) in a pediatric hospital in Tucumán, Argentina / Salmonella enterica serovar Oranienburg produtora de B-lactamase de espectro extendido (grupo CTX-M-2) em um hospital pediátrico de Tucumán, Argentina

INTRODUCTION: Salmonella sp infections have been reported over recent years in hospitals in Argentina and other countries due to multiresistant strains. The aim of this study was to characterize the extended-spectrum β-lactamases in third-generation cephalosporin-resistant strains of Salmonella enterica serovar Oranienburg. METHODS: We studied 60 strains isolated from children with gastroenteritis and/or extraintestinal complications. The antibiotic susceptibility patterns of the isolates were analyzed and the β-lactamases were characterized using phenotyping and genotyping methods. RESULTS: All the strains were resistant to ampicillin, cefotaxime, cefepime and aztreonam and partially susceptible to ceftazidime, thus corresponding well with the resistance phenotype conferred by CTX-M-type β-lactamases. An isoelectric point enzyme (pI = 7.9) was detected in all of the strains, and this was confirmed by PCR as a member of the CTX-M-2 group. CONCLUSIONS: This is the first report of Salmonella enterica serovar Oranienburg producing β-lactamases of the CTX-M-2 group in a pediatric hospital in Tucumán, Argentina.

INTRODUÇÃO: Em recentes anos foram informadas infecções por Salmonella sp em hospitais da Argentina e outros países devido as cepas multiresistentes. O objetivo deste estudo era caracterizar as β-lactamasas de espectro extendido em cepas de Salmonella enterica serovar Oranienburg resistentes às cefalosporinas de terceira geração. MÉTODOS: Nós estudamos 60 cepas obtidas de pacientes com gastroenterites e com complicações extraintestinais. Os padrões de susceptibilidade antibiotica foram estudados em os isolamentos, as β-lactamasas foram caracterizadas por métodos fenotípicos e genotípicos. RESULTADOS: Todas as cepas eram resistentes a ampicillin, cefotaxime, cefepime e aztreonam e parcialmente suscetível a ceftazidime que corresponde bem com o fenótipo de resistência conferido por as β-lactamasas tipo CTX-M. Na totalidade das cepas, se detectou uma enzima de ponto isoelétrico (pI) 7,9, confirmada por PCR como pertencente ao grupo CTX-M2. CONCLUSÕES: Este é o primeiro reporte de Salmonella enterica serovar Oranienburg produtora de β-lactamasa grupo CTX-M2 em um hospital pediátrico de Tucuman, Argentina.

Revelación del estado serológico para VIH/SIDA en niños, niñas y adolescentes: una revisión teórica / Disclosure of HIV serostatus children and adolescents: a theoretical review

El artículo presenta una revisión del estado del arte del proceso de revelación del estado serológico en la población infantil menor de 18 años afectada con VIH/SIDA. Los resultados de la revisión se presentan en torno a las modalidades y factores asociados al proceso revelación y no revelación del diagnóstico de VIH a niños, niñas y adolescentes por parte de sus cuidadores y profesionales que brindan servicios de salud en diversos contextos socioculturales y la situación en Colombia. Se seleccionaron artículos publicados en cinco bases de datos utilizándose como palabras clave para la búsqueda “disclosure”, “disclosure model”, “disclosure in children with HIV/AIDS” y ”pediatric HIV/AIDS”. Para la búsqueda se incluyeron artículos en los idiomas inglés y español entre los años 1990 y 2008.

The article presents a review of HIV serostatus disclosure in the under-18 population living with HIV/AIDS. The results include disclosure models and factors associated with disclosure and non disclosure of children and adolescents' HIV serostatus by their caregivers and health workers.The effects of these factors in various sociocultural contexts were studied, with emphasis on the Colombian context. Articles published in five databases were selected, using the key words “disclosure”, “disclosure model”, “disclosure in children with HIV/AIDS” and “pediatric HIV/AIDS”. Articles published in English and Spanish, and between 1990 and 2008, were included.

Infecciones invasivas por Haemophilus influenzae tipo b (Hib) en Tucumán-Argentina / Invasive infections caused by haemophilus influenzae type b in children in Tucumáan-Argentina, before vaccination

Objetivo: Investigar los "aspectos epidemiológicos" de la patología invasiva Hib (PI Hib) con especial referencia a la meningitis, en niños menores de 5 años. Categorizar el problema dentro de la salud pública en Tucumán. Material y métodos: El estudio se llevó a cabo desde enero de 1985 a diciembre de 1992 en el Hospital del Niño Jesús. Se incluyó a todo paciente con sospecha clínica de PI Hib y confirmada por cultivo o serología obtenida de materiales representativos. Resultados: Se registraron 264 casos de PI Hib: 218 (82,5 por ciento) meningitis y 46 (17,5 por ciento) formas extrameníngeas. El 89 por ciento de las meningitis tuvieron foco único. Las formas extrameníngeas se distribuyeron entre bacteriemias, supuración pleuro-pulmonar, neumonías, celulitis, artritis y otras. La meningitis Hib (M Hib) es endémica en Tucumán, con un aumento en los meses de invierno. El Hib representa el 70 por ciento de las meningitis extrahospitalarias bacterianas. La incidencia anual promedio, en niños menores de 5 años, de la PI Hib fue 20,4/100.000 y de M Hib 16,7/100.000, en menores de 1 año la incidencia de M Hib fue 63/100.000; el 77,5 por ciento de las meningitis suceden a esta edad. La tasa de letalidad: 20,1 por ciento. La resistencia a ampicilina osciló entre 0-17,4 por ciento y la de ampicilina-cloranfenicol entre 2,7-8,7 por ciento. Conclusiones: Al cabo de ocho años de estudio la M Hib mostró en Tucumán un sostenido aumento; es la primera causa de mortalidad dentro de las enfermedades prevenibles por vacunas en niños menores de 2 años y la octava causa de mortalidad infantil

Brote intrahospitalario de salmonella thyphimurium multiresistente / Intrahospitalary outbreak of multiresistent salmonella typhimurium

Se analizó un brote de gastroenteritis (Ge) causado por Samolmonella Typhinurium (ST) multiresistente procedente de la comunidad en el Hospital de Niño Jesús-Tucumán en el período junio-noviembre de 1991. Los casos fueron 64 y la población más afectada fueron los niños de 1 año los que además presentaron mayor número de complicaciones y mortalidad. La mayor incidencia de casos se dio en áreas clínicas. La evolución y severidad de la Ge no estuvo influenciada por la edad, nutrición ni tratamiento antibiótico. La mortalidad fue 1,5 por ciento y 1 solo paciente presentó foco secundario. La resistencia de la cepa abarcó Ampicilina, Cloranfenicol, TMP/5, Cefalosporinas de 3§ generación y Aminoglucósidos, excepto Netilmicina. Las alternativas terapéuticas fueron: Furazolidona, Colistín, Imipenem y Ciprofloxacina. El control del brote se realizó con erradicación de fuentes y aplicación de Medidas de Control