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The objective of this article was to consider the vaccination challenges in Colombia and Peru and the role of pediatric combination vaccines in overcoming these challenges. Barriers to including new vaccines with more antigens remain apparent in parts of these countries, where vaccine-preventable diseases in infants continue to be a major problem. The challenges include the heterogeneity of vaccine coverage within each country and in neighboring countries, which can contribute to poor rates of vaccination coverage; the adverse impact of the inward migration of unvaccinated individuals, which has favored the re-emergence of vaccine-preventable diseases; vaccine shortages; and the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the associated shifts in health care resources. To improve the coverage of pediatric vaccines in Colombia and Peru, it will be necessary to ensure the widespread integration into vaccine schedules of combination vaccines containing diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b and hepatitis B antigens with a three-dose primary series delivered at 2, 4 and 6 months of age followed by a booster at 18 months of age. Such vaccines play important roles in preventing diphtheria, tetanus and pertussis; eradicating polio; and providing boosting against H. influenzae type b.
El objetivo de este artículo es considerar los desafíos que se enfrentan en Colombia y Perú con respecto a la vacunación y el papel de las vacunas combinadas pediátricas para superar estos desafíos. Los obstáculos para incluir vacunas nuevas con más antígenos siguen siendo evidentes en algunos lugares de estos países, donde las enfermedades prevenibles por vacunación en menores de 1 año continúan siendo un grave problema. Entre los desafíos se incluye la heterogeneidad de la cobertura de vacunación en cada país y en los países vecinos, lo que puede contribuir con que se registren tasas bajas de cobertura de vacunación; el impacto adverso de la migración interna de personas no vacunadas, lo que ha favorecido la reaparición de enfermedades prevenibles por vacunación; la escasez de vacunas, y el impacto de la pandemia del coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y los consiguientes cambios en los recursos de atención médica. Para mejorar la cobertura de las vacunas pediátricas en Colombia y Perú será necesario integrar de manera generalizada en los calendarios de vacunación vacunas combinadas con antígenos de difteria, tétanos, tos ferina acelular, poliovirus inactivados, Haemophilus influenzae tipo b y hepatitis B con una serie primaria de tres dosis administradas a los 2, 4 y 6 meses de edad, seguida de un refuerzo a los 18 meses de edad. Esas vacunas desempeñan un papel esencial en la prevención de la difteria, el tétanos y la tos ferina; la erradicación de la polio; y el refuerzo contra H. influenzae tipo b.
O objetivo deste artigo foi avaliar os desafios da vacinação na Colômbia e no Peru e o papel das vacinas pediátricas combinadas na superação de tais desafios. Os obstáculos para incluir novas vacinas com mais antígenos permanecem visíveis em partes desses países, onde doenças imunopreveníveis em lactentes continuam a ser um grande problema. Os desafios incluem a heterogeneidade da cobertura vacinal dentro de cada país e nos países vizinhos, o que pode contribuir para baixas taxas de cobertura vacinal; o impacto adverso da migração interna de pessoas não vacinadas, o que favoreceu o ressurgimento de doenças imunopreveníveis; a escassez de vacinas; e o impacto da pandemia de síndrome respiratória aguda grave do coronavírus 2 (SARS-CoV-2) e mudanças relacionadas nos recursos de atenção à saúde. Para melhorar a cobertura das vacinas pediátricas na Colômbia e no Peru, será necessário assegurar sua integração generalizada em esquemas de vacinas combinadas contendo antígenos de difteria, tétano, pertussis acelular, poliovírus inativado, Haemophilus influenzae tipo B e hepatite B, com uma série primária de três doses aplicadas aos 2, 4 e 6 meses de idade seguidas de um reforço aos 18 meses de idade. Tais vacinas desempenham papéis importantes na prevenção da difteria, tétano e coqueluche; na erradicação da poliomielite; e no reforço contra H. influenzae tipo b.
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BACKGROUND: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. METHODS: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. RESULTS: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. CONCLUSIONS: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population.
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Infecciones Comunitarias Adquiridas , Neumonía , Adolescente , Niño , Infecciones Comunitarias Adquiridas/epidemiología , Técnicas y Procedimientos Diagnósticos/efectos adversos , Humanos , Lactante , Mycoplasma pneumoniae , Neumonía/complicaciones , Estudios ProspectivosRESUMEN
BACKGROUND: Cancer is a public health problem among women, but preventive actions are effective. AIM: To outline the reasons and factors associated with abstention from pap smears and mammography examinations among women. MATERIAL AND METHODS: Using official databases of the WHO and the Ministry of Social Development of Chile, inferential statistical analyses and modeling of abstention through binomial logistic regression were carried out. RESULTS: Breast and cervical cancer had the highest incidence and mortality among women over 35 years old in Chile, even when there are effective screening methods for their early detection. Abstention is conditioned by personal reasons such as low risk perception. There is a high concomitance of abstention for pap smears and mammography. CONCLUSIONS: Health promotion actions should encourage women to undergo preventive actions for breast and cervical cancer.
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Detección Precoz del Cáncer , Prueba de Papanicolaou , Adulto , Chile/epidemiología , Femenino , Humanos , Mamografía , PrevalenciaRESUMEN
The Personality Assessment Inventory (PAI; Morey, 1991, 2007) is among the most important personality and psychopathology assessment tools. However, its psychometric properties in the Spanish-speaking prison population have not yet been studied. We aimed to explore the factor structure of the Spanish adaptation of the PAI (Ortiz-Tallo et al., 2011) in an Ecuadorian sample of 811 convicted men using exploratory structural equation modeling, with the further objective of confirming its internal consistency. Hoelzle and Meyer (2009) identified three dimensions that are highly congruent across samples: general distress, elevated mood and dominance, and substance abuse and psychopathy. Taking these findings and the internalizing and externalizing dimensions (Ruiz & Edens, 2008) as a theoretical basis, three- and two-factor models were tested for the 22 scales and 11 clinical scales, respectively. We also tested four- and three-factor models that grouped the scales related to substance abuse as an independent factor, leaving intact the distribution presented by the remaining scales in the previous models. Although the original models showed a good fit, the 4- and 3-factor models obtained significantly better fit indexes. With respect to reliability, the Cronbach's alpha coefficients ranged from .49 to .89. This version shows acceptable psychometric properties in correctional settings.
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Trastornos Mentales/diagnóstico , Inventario de Personalidad/normas , Prisioneros , Psicometría/normas , Adulto , Ecuador , Análisis Factorial , Humanos , Masculino , Reproducibilidad de los Resultados , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
Pin-site infections remain a common clinical complication in patients with external fixators. Pin-site care is commonly performed with either chlorhexidine-alcohol solution or povidone-iodine solution. This study aimed to investigate the superiority of chlorhexidine-alcohol solution versus povidone-iodine solution for external fixator pin-site care in pin-site infection. This prospective randomized clinical trial using an open, parallel-group design was conducted in a single Spanish hospital. Eligible consenting patients from November 2018 to May 2019 who underwent placement of an external fixator were included. Patients were randomly assigned to receive pin-site care using either a 2% chlorhexidine-alcohol solution or a 10% povidone-iodine solution. The primary endpoint was the development of a pin-site infection. In total, 568 pins were analyzed (128 patients, with a mean of 4.3 pins per patient). No significant differences were found between groups. However, statistically significant differences were found regarding time and infection variables. The longer the person had the fixator, the higher the risk of infection, t(x) = 5.49, p = .002. Both chlorhexidine-alcohol and povidone-iodine solutions are equally effective antiseptic agents for the prevention of infections in external fixators.
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Antiinfecciosos Locales/uso terapéutico , Clorhexidina/uso terapéutico , Etanol/uso terapéutico , Fijadores Externos/microbiología , Povidona Yodada/uso terapéutico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , España , Resultado del TratamientoRESUMEN
PURPOSE: CARD9 deficiency is an inborn error of immunity that predisposes otherwise healthy humans to mucocutaneous and invasive fungal infections, mostly caused by Candida, but also by dermatophytes, Aspergillus, and other fungi. Phaeohyphomycosis are an emerging group of fungal infections caused by dematiaceous fungi (phaeohyphomycetes) and are being increasingly identified in patients with CARD9 deficiency. The Corynespora genus belongs to phaeohyphomycetes and only one adult patient with CARD9 deficiency has been reported to suffer from invasive disease caused by C. cassiicola. We identified a Colombian child with an early-onset, deep, and destructive mucocutaneous infection due to C. cassiicola and we searched for mutations in CARD9. METHODS: We reviewed the medical records and immunological findings in the patient. Microbiologic tests and biopsies were performed. Whole-exome sequencing (WES) was made and Sanger sequencing was used to confirm the CARD9 mutations in the patient and her family. Finally, CARD9 protein expression was evaluated in peripheral blood mononuclear cells (PBMC) by western blotting. RESULTS: The patient was affected by a large, indurated, foul-smelling, and verrucous ulcerated lesion on the left side of the face with extensive necrosis and crusting, due to a C. cassiicola infectious disease. WES led to the identification of compound heterozygous mutations in the patient consisting of the previously reported p.Q289* nonsense (c.865C > T, exon 6) mutation, and a novel deletion (c.23_29del; p.Asp8Alafs10*) leading to a frameshift and a premature stop codon in exon 2. CARD9 protein expression was absent in peripheral blood mononuclear cells from the patient. CONCLUSION: We describe here compound heterozygous loss-of-expression mutations in CARD9 leading to severe deep and destructive mucocutaneous phaeohyphomycosis due to C. cassiicola in a Colombian child.
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Ascomicetos , Proteínas Adaptadoras de Señalización CARD/genética , Predisposición Genética a la Enfermedad , Heterocigoto , Infecciones Fúngicas Invasoras , Mutación , Feohifomicosis/epidemiología , Feohifomicosis/etiología , Factores de Edad , Edad de Inicio , Ascomicetos/genética , Ascomicetos/inmunología , Biomarcadores , Preescolar , Colombia/epidemiología , Biología Computacional/métodos , Análisis Mutacional de ADN , Femenino , Humanos , Inmunohistoquímica , Inmunofenotipificación , Imagen por Resonancia Magnética , Linaje , Feohifomicosis/diagnóstico , Feohifomicosis/inmunología , Fenotipo , Tomografía Computarizada por Rayos X , Secuenciación del ExomaRESUMEN
PURPOSE: Mendelian susceptibility to mycobacterial disease is a rare clinical condition characterized by a predisposition to infectious diseases caused by poorly virulent mycobacteria. Other infections such as salmonellosis and candidiasis are also reported. The purpose of this article is to describe a young boy affected with various infectious diseases caused by Mycobacterium tuberculosis complex, Salmonella sp, Klebsiella pneumonie, Citrobacter sp., and Candida sp, complicated with severe enteropathy and transient hypogammaglobulinemia. METHODS: We reviewed medical records and performed flow cytometry staining for lymphocyte populations, lymphocyte proliferation in response to PHA, and intracellular IFN-γ production in T cell PHA blasts in the patient and a healthy control. Sanger sequencing was used to confirm the genetic variants in the patient and relatives. RESULTS: Genetic analysis revealed a bi-allelic mutation in IL12RB1 (C291Y) resulting in complete IL-12Rß1 deficiency. Functional analysis demonstrated the lack of intracellular production of IFN-γ in CD3+ T lymphocytes from the patient in response to rhIL-12p70. CONCLUSIONS: To our knowledge, this is the third patient with MSMD due to IL-12Rß1 deficiency complicated with enteropathy and hypogammaglobulinemia and the first case of this disease to be described in Colombia.
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Agammaglobulinemia/genética , Candidiasis/genética , Enteritis/genética , Infecciones por Bacterias Gramnegativas/genética , Receptores de Interleucina-12/deficiencia , Receptores de Interleucina-12/genética , Agammaglobulinemia/tratamiento farmacológico , Vacuna BCG , Candidiasis/tratamiento farmacológico , Farmacorresistencia Bacteriana , Enteritis/tratamiento farmacológico , Predisposición Genética a la Enfermedad , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Lactante , Mutación , Mycobacterium tuberculosisRESUMEN
Hereditary factors have a strong influence on osteoarthritis (OA). The Wnt pathway is involved in bone and cartilage homeostasis. Hence, we hypothesized that allelic variations of WNT16 could influence the OA phenotype. We studied 509 Caucasian patients undergoing joint replacement due to severe primary OA. Radiographs were used to classify the OA as atrophic or hypertrophic. Two nonsynonymous polymorphisms of WNT16 (rs2707466 and rs2908004) were analyzed. The association between the genotypes and the OA phenotype was analyzed by logistic regression and adjusted for age and body mass index. A genotype-phenotype association was found in the sex-stratified analysis. Thus, there was a significant difference in the genotypic frequencies of rs2707466 between hypertrophic and atrophic hip OA in males (p = 0.003), with overrepresentation of G alleles in the hypertrophic phenotype (OR 2.08; CI 1.28-3.38). An association in the same direction was observed between these alleles and the type of knee OA, with G alleles being more common in the hypertrophic than in atrophic knee phenotypes (p = 0.008; OR 1.956, CI 1.19-3.19). Similar associations were found for the rs2908004 SNP, but it only reached statistical significance for knee OA (p = 0.017; OR 0.92, CI 0.86-0.989). This is the first study attempting to explore the association of genetic variants with the OA phenotype. These data suggest the need to consider the OA phenotype in future genetic association studies of OA.
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Articulación de la Cadera/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Osteoartritis de la Cadera/genética , Osteoartritis de la Rodilla/genética , Proteínas Wnt/genética , Factores de Edad , Anciano , Anciano de 80 o más Años , Alelos , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Fenotipo , Polimorfismo de Nucleótido Simple , Factores SexualesRESUMEN
Sclerostin, encoded by the SOST gene, works as an inhibitor of the Wnt pathway and therefore is an important regulator of bone homeostasis. Due to its potent action as an inhibitor of bone formation, blocking sclerostin activity is the purpose of recently developed anti-osteoporotic treatments. Two bone-specific transcription factors, RUNX2 and OSX, have been shown to interact and co-ordinately regulate the expression of bone-specific genes. Although it has been recently shown that sclerostin is targeted by OSX in mice, there is currently no information of whether this is also the case in human cells. We have identified SP-protein family and AML1 consensus binding sequences at the human SOST promoter and have shown that OSX, together with RUNX2, binds to a specific region close to the transcription start site. Furthermore, we show that OSX and RUNX2 activate SOST expression in a co-ordinated manner in vitro and that SOST expression levels show a significant positive correlation with OSX/RUNX2 expression levels in human bone. We also confirmed previous results showing an association of several SOST/RUNX2 polymorphisms with bone mineral density.
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Proteínas Morfogenéticas Óseas/metabolismo , Huesos/metabolismo , Subunidad alfa 1 del Factor de Unión al Sitio Principal/metabolismo , Factor de Transcripción Sp7/metabolismo , Proteínas Adaptadoras Transductoras de Señales , Densidad Ósea/fisiología , Regulación de la Expresión Génica/genética , Marcadores Genéticos , Humanos , Osteoblastos/metabolismo , Osteogénesis/fisiología , Regiones Promotoras Genéticas/genéticaRESUMEN
A subcostal transversus abdominis plane (TAP) phenol injection was performed on a patient with refractory cancer pain due a metastatic involvement of the abdominal wall. A diagnostic block with local anesthetic was performed under ultrasound guidance (USG), resulting in a decrease of 80% and 100% in dynamic and static visual analog scale (VAS) for pain, respectively, for 20 hours. A phenol injection was then performed under USG. The patient reported 70% and 100% reduction in the dynamic and static VAS for pain and had a 50% decrease in the opioid requirement that was maintained for 2 months. TAP blocks offer an interesting tool for either diagnosis or therapeutic purpose in chronic pain management. USG provides an optimal approach to soft-tissue lesions where fluoroscopy techniques are not useful.
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Neoplasias Abdominales/complicaciones , Dolor Abdominal/tratamiento farmacológico , Carcinoma/complicaciones , Fenol/uso terapéutico , Neoplasias Abdominales/secundario , Dolor Abdominal/etiología , Pared Abdominal , Carcinoma/secundario , Femenino , Humanos , Persona de Mediana Edad , Fenol/administración & dosificación , Resultado del Tratamiento , Neoplasias del Cuello Uterino/patologíaRESUMEN
Working memory (WM) and inhibitory control (IC) play a crucial role in learning during early childhood. The literature suggests a non-linear developmental trajectory of executive functions (EFs) with varied results according to gender, usually attributed to environmental factors. However, there is insufficient and inconclusive data on whether this pattern is reproduced in the Latin American preschool population since most studies have been conducted in English-speaking, European, and Asian environments. Thus, objectively comparing children's executive performance across diverse international geographical contexts becomes challenging. This study aimed to conduct a cross-sectional analysis of the performance in WM and IC of 982 Ecuadorian preschoolers aged between 42 and 65 months (M = 53.71; SD = 5.714) and belonging to medium-high, medium, and low-medium socioeconomic strata. The participants consisted of 496 boys (M = 53.77; SD = 5.598) and 486 girls (M = 53.65; SD = 5.834), representing nine cities in Ecuador. To assess the effect of age and gender on performance in these two domains, the sample was divided into four 6-month age intervals. Two tests were administered to the participants, and a survey was conducted with 799 of their usual caregivers. Viewing the cross-sectional mean scores of the WM and IC tests as a temporal continuum reveals an upward trend in each age interval studied. Girls outperformed boys on the IC test, showing statistically significant differences in the earliest age interval. The gender differences in executive performance reported in the literature emphasize the need to explore the modulating effect of environmental variables on early childhood development. This information could offer valuable insights for adapting and optimizing cognitive and didactic strategies in early childhood tailored to the characteristics and needs of the preschool population.
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Desarrollo Infantil , Función Ejecutiva , Memoria a Corto Plazo , Humanos , Masculino , Femenino , Ecuador , Preescolar , Estudios Transversales , Memoria a Corto Plazo/fisiología , Función Ejecutiva/fisiología , Desarrollo Infantil/fisiología , Inhibición Psicológica , Factores Sexuales , Factores de EdadRESUMEN
An epidural hematoma is a rare but devastating complication after interventional pain procedures. The etiology is multifactorial, including anatomical variations, inherited coagulation disorders, and consumption of anticoagulants or antiplatelet substances. Specifically, in regard to platelet aggregation, the consumption of herbal medicine is often forgotten as a potential cause for coagulation profile disorders, potentially leading to an epidural hematoma. We present the case of a patient who developed an epidural hematoma after a cervical epidural block, most likely associated with daily "red clover" consumption.
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Hematoma Espinal Epidural , Humanos , Hematoma Espinal Epidural/etiología , Inyecciones Epidurales/efectos adversos , Trifolium/efectos adversosRESUMEN
Background: Staphylococcus aureus infections are a significant cause of morbidity and mortality in pediatric populations worldwide. The Staphylo Research Network conducted an extensive study on pediatric patients across Colombia from 2018 to 2021. The aim of this study was to describe the epidemiological and microbiological characteristics of S. aureus in this patient group. Methods: We analyzed S. aureus isolates from WHONET-reporting centers. An "event" was a positive culture isolation in a previously negative individual after 2 weeks. We studied center characteristics, age distribution, infection type, and antibiotic susceptibilities, comparing methicillin sensitive (MSSA) and resistant S. aureus (MRSA) isolates. Results: Isolates from 20 centers across 7 Colombian cities were included. Most centers (80%) served both adults and children, with 55% offering oncology services and 85% having a PICU. We registered 8,157 S. aureus culture isolations from 5,384 events (3,345 MSSA and 1,961 MRSA) in 4,821 patients, with a median age of 5 years. Blood (26.2%) and skin/soft tissue (18.6%) were the most common infection sources. Most isolates per event remained susceptible to oxacillin (63.2%), clindamycin (94.3%), and TMP-SMX (98.3%). MRSA prevalence varied by city (<0.001), with slightly higher rates observed in exclusively pediatric hospitals. In contrast, the MRSA rate was somewhat lower in centers with Antimicrobial Stewardship Program (ASP). MRSA was predominantly isolated from osteoarticular infections and multiple foci, while MSSA was more frequently associated with recurrent infections compared to MRSA. Conclusions: This is the largest study of pediatric S. aureus infections in Colombia. We found MSSA predominance, but resistance have important regional variations. S. aureus remains susceptible to other commonly used antibiotics such as TMP-SMX and clindamycin. Ongoing monitoring of S. aureus infections is vital for understanding their behavior in children. Prospective studies within the Staphylored LATAM are underway for a more comprehensive clinical and genetic characterization.
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Most studies on Staphylococcus aureus have focused on the molecular epidemiology of methicillin-resistant S. aureus (MRSA) infections. In contrast, little information is available regarding the molecular epidemiology of currently circulating methicillin-susceptible S. aureus (MSSA) isolates in hospital settings, an epoch when the epidemiology of S. aureus has undergone significant changes. We conducted a cross-sectional study to compare the clinical, epidemiological, and genetic characteristics of MSSA and MRSA isolates at 3 tertiary-care hospitals in Medellín, Colombia, from February 2008 to June 2010. The infections were classified according to the Centers for Disease Control and Prevention (CDC) definitions. Genotypic analysis included spa typing, multilocus sequence typing (MLST) and staphylococcal cassette chromosome (mec) (SCCmec) typing. A total of 810 patients was enrolled. One hundred infections (12.3%) were classified as community-associated (31 CA-MSSA, 69 CA-MRSA), 379 (46.8%) as healthcare-associated community-onset (136 HACO-MSSA, 243 HACO-MRSA), and 331 (40.9%) as healthcare-associated hospital-onset (104 HAHO-MSSA, 227 HAHO-MRSA). Genotype analyses showed a higher diversity and a more varied spa type repertoire in MSSA than in MRSA strains. Most of the clinical-epidemiological characteristics and risk factors evaluated did not allow for discriminating MRSA- from MSSA-infected patients. The lack of equivalence among the genetic backgrounds of the major MSSA and MRSA clones would suggest that the MRSA clones are imported instead of arising from successful MSSA clones. This study emphasizes the importance of local surveillance to create public awareness on the changing S. aureus epidemiology.
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Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Análisis por Conglomerados , Colombia/epidemiología , Infección Hospitalaria/patología , Estudios Transversales , Femenino , Variación Genética , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Resistencia a la Meticilina , Persona de Mediana Edad , Tipificación Molecular , Infecciones Estafilocócicas/patología , Staphylococcus aureus/clasificación , Adulto JovenRESUMEN
BACKGROUND: The suprascapular nerve block is frequently implemented to treat chronic shoulder pain. Although effective the nerve blockade provides only a short-term relief, and more compelling apaproaches have been investigated. Pulsed radiofrequency (pRF) has been anecdotally reported as safe and reliable method. However, formal efficacy study has not been published. Ostensibly evidence-based validation of a new method is necessary for both scholastic and practical purposes. METHODS: This study was designed as a randomized active placebo-control double-blind trial. Because of encountered difficulties in recruitment and high rate of dropout, the study was redesigned as to allow a smaller sample size and statistical analyses were performed utilizing the last observation carry forward method. Lidocaine injections alone or with combination of the pRF were performed. Participants were followed up during 6 months, and multiple subjective and objective outcome variables were recorded. RESULTS: Thirteen of 22 participants completed 6 months follow-up. Dropout rate was higher in the lidocaine group. A significant linear trend (P < 0.05) for improvement on the numeric rating scale, Shoulder Pain and Disability Index and Constant-Murley score was observed in the pRF group, but not in the lidocaine group. Patients in the pRF group were on average more satisfied than the lidocaine group at 1 month (P = 0.041) and at 3 months (P = 0.035). DISCUSSION: Considering limitations of the study design and statistics, it seems plausible to attribute better results in the pRF group to unique properties of this physical modality.
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Tratamiento de Radiofrecuencia Pulsada/métodos , Dolor de Hombro/terapia , Anciano , Anestésicos Locales/uso terapéutico , Dolor Crónico/terapia , Método Doble Ciego , Femenino , Humanos , Lidocaína/uso terapéutico , Masculino , Bloqueo Nervioso , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
Lock therapy is useful for preserving indwelling catheters. Few lock therapy studies have been published in Latin America. OBJECTIVE: To describe the clinical characteristics of pediatric patients using therapeutic and prophylactic lock therapy for six years in a high-complexity hospital in Colombia. PATIENTS AND METHOD: Cross-sectional descriptive study of patients aged < 18 years who received lock therapy. Collected variables included demographic data, clinical characteristics, blood test results, therapeutic interventions, frequency of admission to the pediatric critical care unit, and mortality. Descriptive analysis was performed. RESULTS: 54 patients were included in the study, most of them males, with 67 episodes of therapeutic lock therapy use. The most frequent diagnosis was hematological neoplasm (61%). Among these patients, 88% presented neutropenia while receiving lock therapy. Catheter preservation was achieved in 75% of the cases. Aminoglycosides were the most commonly used antibiotics (38%). Mortality due to catheter-related bacteremia was 6%. Catheter preservation using ethanol solution 70% was achieved in 62% of the patients with prophylactic lock therapy, all of whom had chronic gastrointestinal pathology. CONCLUSION: Catheter preservation rates were 75% and 62% in patients with therapeutic and prophylactic lock therapy, respectively, with a higher rate achieved among cancer patients with neutropenia (80%). Aminoglycosides and vancomycin were the most commonly used antibiotics.
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Catéteres Venosos Centrales , Neutropenia , Masculino , Humanos , Niño , Catéteres Venosos Centrales/efectos adversos , Estudios Transversales , Antibacterianos/uso terapéutico , AminoglicósidosRESUMEN
Neuropsychologists use performance validity tests (PVT) to detect performance invalidity across various populations. Unexpected scores for normative and clinical populations on PVT performance could invalidate the assessment if the poor performance does not have a reasonable explanation. One of the most well-validated and frequently used PVT is the Test of Memory Malingering, whose usefulness has been analyzed in various populations, including the military. Studies on the influence of demographic variables and blast exposure on the performance of military samples have yielded inconclusive results. The current study investigates the influence of age, education, and blast exposure on the TOMM Trial 2 in a military sample that is representative of their demographics. The total sample size was 872 participants between 18-62 years of age (M = 26.35, SD = 6.63), divided into 832 males and 40 females. All participants were on active duty, and they had been deployed in war zones in Afghanistan and Iraq. They were referred to Carolina Psychological Health Services from the Naval Hospital of Camp LeJeune for psychological and/or neurological complaints, such as cognitive difficulties. The results show that age, education, and blast exposure variations do not affect TOMM performance. Further studies on the relationship between these variables should be pursued to elucidate how they are associated with the normative or clinical cognitive functioning of military populations.
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Heparin, a mixture of sulfated polymorphic polysaccharides (glycosaminoglycan) chains of variable lengths and weights and a natural anticoagulant, is widely used in medical practice to prevent intravascular blood coagulation. Heparin has demonstrated antithrombotic and anti-inflammatory activity, and it is mostly administered systemically (intravenously or subcutaneously) for primary or secondary prevention of venous thromboembolism after surgical interventions, or immobilized patients, or on short-term antithrombotic therapy of patients with atrial fibrillation who must undergo treatment. However, since systemic administration of heparin could be, in certain cases, linked to an increased risk of bleeding, topical heparin is widely used for the prevention and treatment of local symptoms of peripheral vascular disorders, such as venous insufficiency, varicose veins, or superficial thrombophlebitis. This review summarizes the main safety and efficacy characteristics of the topical formulation of Heparin in Gel form (1000 International Units of Heparin/g Gel) currently in use, which has demonstrated an excellent efficacy and tolerability profile in reducing signs and symptoms of peripheral vascular disease, e.g., varicose syndromes and their complications, phlebothrombosis, thrombophlebitis, superficial periphlebitis, varicose ulcers, for post-operative varicophlebitis, sequelae of saphenectomy, for traumas and contusions, local edemas and infiltrates, subcutaneous hematoma and for traumatic affections of musculotendinous and capsuloligamentous apparatuses.
RESUMEN
We report the successful use of low-dose ketamine infusion for treating a severe episode of painful myoclonus in the lower extremities, associated with opioid-induced hyperalgesia (OIH), in a patient who was receiving long-term, high dose intrathecal hydromorphone therapy. A low-dose ketamine infusion immediately relieved the painful myoclonus. It also enabled a reduction in the intrathecal opioid dosage leading to a resolution of the acute symptoms attributed to OIH.
Asunto(s)
Hiperalgesia/tratamiento farmacológico , Ketamina/administración & dosificación , Mioclonía/tratamiento farmacológico , Analgésicos Opioides/uso terapéutico , Humanos , Hidromorfona/uso terapéutico , Hiperalgesia/inducido químicamente , Hiperalgesia/complicaciones , Infusiones Intravenosas , Ketamina/uso terapéutico , Masculino , Persona de Mediana Edad , Mioclonía/complicaciones , Dolor/tratamiento farmacológicoRESUMEN
INTRODUCTION: Neutropenia is one of the most common complications in children with cancer, and it's the most important parameter to determine infection risk. In neutropenic patients the signs and symptoms could be scarce and in occasions fever could be the only symptom. For these reasons all patients with febrile neutropenia (FN) should be considered as if they had a possibly severe disease. AIM: To describe the clinical characteristics and laboratory parameters observed in cancer patients with FN attended at our hospital to perform a more rational management of this complication in the future. PATIENTS AND METHODS: The clinical files accumulated during 36 months, belonging to patients aged 0 to 15 years that were hospitalized because of cancer and FN were reviewed. RESULTS: In this series the source of fever was found in 48.6% of 105 NF episodes, and bacteria were isolated from blood or urine culture in 38%. The most frequent bacterial species recovered were methicillin susceptible S. aureus (20.8%) and ESBL negative E. coli (20.8%). Piperacillin/tazobactam was the most used first line antibiotic prescribed (87.6%) and meropenem was the second choice (18%). Granulocyte colony stimulating factor was used in 61.9% of the cases and episodes mortality rate was 6.7%. CONCLUSION: Clinical characteristics and bacteriological findings in our institution do not differ significantly from what has been described for pediatric cancer patients in other series.