Effect of the inadequacy of antibiotic therapy in the Emergency Department on hospital stays. / Efecto de la inadecuación de la antibioterapia en Urgencias sobre la eficiencia en la hospitalización.

INTRODUCTION: The main objective of the study was to determine the frequency of patients receiving inappropriate empiric antibiotic therapy and to assess the impact in terms of increase length of hospital stay, 30-day re-admissions, and 30-day mortality. METHODS: An observational retrospective cohort study was conducted over a one-month period that included all patients hospitalised from an Emergency Department (ED) due to infection. Demographic variables, comorbidity, multi-resistance risk factors, site of infection, microbiological findings, and antibiotic prescribed in ED were collected. Outcomes were length of hospital stay, 30-day re-admissions, and 30-day mortality. RESULTS: A total of 376 patients were included, with a mean age of 71.1 (SD 21) years. The most frequent causes were respiratory (45.7%) and urine (23.9%) infections. The number of patients with length of stay over the median (≥9 days) was 165 (46.1%), with re-admissions 74 (19.7%), and mortality at 30 days 44 (11.7%). There was inappropriate antibiotic treatment in 42 (11.2%) cases. After adjusting for demographic data, comorbidity, risk factors for multidrug resistant organism, presence of sepsis criteria in ED, and site of infection, inappropriate treatment was associated with an extended length of hospital stay (OR 2.22; 95% CI; 1.07-4.60; P=.032), but did not to an increase in mortality (P=.271) or re-admission (P=.784) at 30 days. CONCLUSION: The inappropriate empirical antibiotic therapy in patients admitted from the ED leads to an extended hospital stay, but did not increase mortality or readmission.

[Incidence and severity of pertussis in infants with a respiratory syncytial virus infection]. / Incidencia y gravedad de la tosferina en lactantes coinfectados por el virus respiratorio sincitial.

INTRODUCTION: Pertussis is a re-emerging disease that mostly affects infants. At this age, the severity can be affected by intercurrent infections such as respiratory syncytial virus (RSV). OBJECTIVES: To estimate the incidence of RSV infection during an epidemic period in patients hospitalized due to pertussis. The impact on the severity was also observed during hospitalization. PATIENTS AND METHOD: A descriptive study of cases diagnosed with pertussis admitted to a tertiary hospital over a 3year period, where the presence of co-infection with RSV was analyzed. The estimate of severity was estimated using the incidence of complications and the level of care required. RESULTS: From a total of 73 infants with pertussis, 34 occurred in a bronchiolitis season epidemic. A co-infection due to RSV was detected in 17 patients. The mean age was not significantly different compared to the non co-infected. The mean stay and the need for intensive care was similar in both groups. The need for oxygen therapy care and nutritional support was higher in the coinfected patients. CONCLUSIONS: Coinfection with RSV in infants hospitalized with pertussis occurred in ono in 2 patients during a RSV epidemic season, in infants of similar age. Severity in terms of stay, presence of apnea and admission to intensive care was similar, but more need for respiratory care and nutritional support was found.

A population-based controlled experiment assessing the epidemiological impact of digital contact tracing.

While Digital contact tracing (DCT) has been argued to be a valuable complement to manual tracing in the containment of COVID-19, no empirical evidence of its effectiveness is available to date. Here, we report the results of a 4-week population-based controlled experiment that took place in La Gomera (Canary Islands, Spain) between June and July 2020, where we assessed the epidemiological impact of the Spanish DCT app Radar Covid. After a substantial communication campaign, we estimate that at least 33% of the population adopted the technology and further showed relatively high adherence and compliance as well as a quick turnaround time. The app detects about 6.3 close-contacts per primary simulated infection, a significant percentage being contacts with strangers, although the spontaneous follow-up rate of these notified cases is low. Overall, these results provide experimental evidence of the potential usefulness of DCT during an epidemic outbreak in a real population.

Characteristics and Hospital Activity of Elderly Patients Receiving Admission Avoidance Home Visits: A Population-Level Record Linkage Study.

As pressures on healthcare systems increase, due to an ageing population, hospital admission avoidance interventions have been emphasised. These interventions can be difficult to objectively evaluate due to non-randomised roll-out, requiring observational methods with carefully selected control groups. This study aims to identify the defining characteristics of elderly patients receiving admission avoidance home visits. We conducted a record linkage study using routinely collected data to compare characteristics and outcomes of the general elderly population and a subset of high-risk patients. Intervention patients were found to have significantly different demographics and admission rates compared to the general population, having four times higher admission rates at baseline. However, they share similarities with high-risk patients, particularly in that after a period of increased admissions, both groups experienced a reduction in the following year. Identifying defining characteristics of the target intervention population can guide the careful selection of a control group for evaluation.

Utility of Radiologic Variables to Predict the Result of Lumbar Infusion Test in the Diagnosis of Idiopathic Normal Pressure Hydrocephalus.

BACKGROUND: Diagnosis of idiopathic normal pressure hydrocephalus is based in clinical data, radiologic variables, and invasive cerebrospinal fluid (CSF) testing, such as the lumbar infusion test. Several neuroimaging findings are inconclusively related to improvement after CSF shunt surgery. CSF tests are invasive and have complications. The aim of this study was to select radiologic variables related to a positive lumbar infusion test so as to avoid this test in patients. METHODS: Patients with possible idiopathic normal pressure hydrocephalus were reviewed. The collected radiologic data were cingulate sulcus sign, disproportionately enlarged subarachnoid space, callosal angle, and width of temporal horns. Two groups were established: group 1, comprising patients with resistance to CSF outflow <12 mm Hg/mL/minute, and group 2, comprising patients with resistance to CSF outflow >12 mm Hg/mL/minute. Negative and positive predictive values were determined. RESULTS: The study included 43 patients in group 1 and 64 patients in group 2. Group 2 significantly showed more acute callosal angle with higher accuracy cutoff value of 90.6°, lower width of temporal horns with higher accuracy cutoff value of 8 mm, and higher percentage of cingulate sulcus sign and disproportionately enlarged subarachnoid space. Matching the radiologic variables, positive predictive values were >80%; however, negative predictive values were low. CONCLUSIONS: Owing to high positive predictive values of matched radiological variables, the lumbar infusion test could be avoided in the diagnosis of idiopathic normal pressure hydrocephalus. However, when 1 or 2 of the variables are negative, this invasive test should be performed.

Estado de situación de las áreas de investigación provinciales / Progress report on provincial health research areas

INTRODUCCIÓN: A través de la Red Ministerial de Investigación en Salud (REMINSA) se actualizó el estado de situación de las áreas provinciales de investigación en salud pública. MÉTODOS: Se realizaron reuniones virtuales de debate con los referentes REMINSA y una encuesta en Google Forms® sobre funcionamiento normativo, organizacional, presupuestario, alcance de tareas y necesidades de mejoras. RESULTADOS: Se recibieron 21 respuestas de un total de 21 provincias con referentes. Se verificó la existencia de un amplio marco de normativas regulatorias de la investigación en salud humana y, en menor medida, para impulsar la investigación en el marco de la salud pública. El 71% tiene cierta estructura institucional, el 20% ofrece becas de investigación, y el 20% posee residencias con perfil en investigación. La principal actividad es la regulación o participación en comités de ética. La promoción, difusión de resultados y elaboración de proyectos de investigación basada en evidencia quedaron relegadas (20%). Las áreas de investigación están consolidadas en la mayoría de las provincias. DISCUSIÓN: El desafío consiste en promover el desarrollo de estos sistemas en las provincias que no cuentan con áreas ministeriales y fortalecer las provincias que sí las poseen. REMINSA ha identificado oportunidades de mejorar la comunicación entre jurisdicciones, las normativas de promoción de la investigación y el trabajo en red para la investigación, la gestión y la toma de decisiones.

Re-Evaluating Simpson Grade I, II, and III Resections in Neurosurgical Treatment of World Health Organization Grade I Meningiomas.

BACKGROUND: Since 1957, the Simpson grading system has been considered a predictive system for meningioma recurrence. However, since then, surgical equipment and neurosurgical technique have developed extensively, so this grading system should be re-evaluated. This study aims to assess if the recurrence rate and recurrence-free survival (RFS) are different after Simpson grade I, II, and III resections in World Health Organization (WHO) grade I meningiomas. METHODS: We retrospectively reviewed the data of patients who underwent surgical treatment of WHO grade I meningiomas located in the convexity (group 1), falx/parasagittal (group 2), skull base, and tentorium (group 3) between June 1991 and December 2011. We compared the recurrence rates and RFSs between Simpson grade I, II, and III resections in both overall cases and tumor subsets according to their localization. RESULTS: A total of 224 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson grades I, II, and III. In each of the location groups, no significant differences were noted between the different degrees of Simpson. CONCLUSIONS: We have shown that complete resection of WHO grade I meningiomas achieves excellent tumor control, regardless of Simpson grades. More aggressive attempts at tumor resection (ie, Simpson grade I) must be balanced against the risks of removing dura or damaging critical neurovascular structures.

Proceso de actualización de la Agenda Nacional de Investigación Salud Pública 2021-2022 / Update process of the National Agenda for Public Health Research 2021-2022

INTRODUCCIÓN: Una Agenda Nacional de Investigación en Salud Pública (ANISP) participativa y con priorización temática constituye un elemento estratégico para generar recomendaciones y políticas públicas basadas en evidencia, que impacten positivamente en la salud de las poblaciones y permitan lograr los objetivos sanitarios. En la actualización de la ANISP participaron la Dirección de Investigación en Salud (DIS) del Ministerio de Salud de la Nación (MSAL), a través de la Red Ministerial de Investigación en Salud (REMINSA), y actores de los niveles gubernamentales provinciales y nacionales pertenecientes a los sectores público, privado, de la salud, académico y de investigación. Se adaptó la herramienta original propuesta por la Organización Panamericana de la Salud, utilizada en el proceso en 2019. La actualización abarcó diferentes etapas. La selección de los temas contó con la legitimidad, reconocimiento y participación de los actores vinculados a la salud, a la gestión gubernamental y privada y a la investigación científica; se trabajó de manera federal y transversal, por consenso con las redes provinciales y un Comité Central Asesor en el MSAL. A partir de los lineamientos preliminares obtenidos, se elaboró una encuesta en línea semiestructurada, que fue distribuida a todos los actores federales y recibió 431 respuestas. El proceso resultó en 55 lineamientos priorizados, divididos en 6 áreas temáticas y 33 subtemas, seleccionados por votación según importancia, impacto y factibilidad

Update process ofthe National Agenda for Public Health Research 2021-2022 / Proceso de actualización de la agenda nacional de investigación en salud pública 2021-2022

RESUMEN INTRODUCCIÓN : Una Agenda Nacional de Investigación en Salud Pública (ANISP) participativa y con priorización temática constituye un elemento estratégico para generar recomendaciones y políticas públicas basadas en evidencia, que imparten positivamente en la salud de las poblaciones y permitan lograr los objetivos sanitarios. En la actualización de la ANISP participaron la Dirección de Investigación en Salud (DIS) del Ministerio de Salud de la Nación (MSAL), a través de la Red Ministerial de Investigación en Salud (REMINSA), y actores de los niveles gubernamentales provinciales y nacionales pertenecientes a los sectores público, privado, de la salud, académico y de investigación. Se adaptó la herramienta original propuesta por la Organización Panamericana de la Salud, utilizada en el proceso en 2019. La actualización abarcó diferentes etapas. La selección de los temas contó con la legitimidad, reconocimiento y participación de los actores vinculados a la salud, a la gestión gubernamental y privada y a la investigación científica; se trabajó de manera federal y transversal, por consenso con las redes provinciales y un Comité Central Asesor en el MSAL. A partir de los lineamientos preliminares obtenidos, se elaboró una encuesta en línea semiestructurada, que fue distribuida a todos los actores federales y recibió 431 respuestas. El proceso resultó en 55 lineamientos priorizados, divididos en 6 áreas temáticas y 33 subtemas, seleccionados por votación según importancia, impacto y factibilidad.

ABSTRACT INTRODUCTION : A participatory National Public Health Research Agenda (ANISP) with thematic prioritization is a strategic element to generóte evidence-based recommendations and public policies that have a positive impact on the health of populations and enable to achieve health objectives. The Directorate of Health Research (DIS) ofthe Argentine Ministry of Health (MSAL), through the Ministerial NetWork of Health Research (REMINSA), along with adors from the provincial and national government levels belonging to public, privóte, health, academic and research sectors participated in the update of the ANISP. They adapted the original tooI proposed by the Pan American Health Organizatlon and used in the process in 2019. The update included different stages. The selection ofthe topics had the legitimacy, recognition and participation ofthe actors involved, related to health, to government and privóte management and to scientific research; the work was conducted in a federal and transversal manner by consensus with the provincial networks and a Central Advisory Committee in the MSAL. Based on the preliminary guidelines obtained, a semi-structured online survey was developed and distributed to all federal actors, receiving 431 responses. The process resulted in 55 priorilized guidelines, divided into 6 thematic oreas and 33 sub-themes, selected by voting according to importance, impact and feasibility.

El estado del sistema de evaluación ética de las investigaciones en Argentina y su adaptación a la pandemia de la COVID-19 / Research ethics review system state in Argentina and the adaptation in response to the COVID-19 pandemic

INTRODUCCIÓN: un sistema de evaluación ética de las investigaciones en seres humanos es esencial para proteger los derechos de los participantes. Los desafíos impuestos por la pandemia de la COVID-19 para conducir investigaciones éticas que produzcan resultados con rapidez demuestran la necesidad de fortalecerlo. El objetivo de este estudio fue describir el estado de situación de los sistemas de evaluación ética de las provincias de Argentina y las adaptaciones realizadas por la pandemia. MÉTODOS: se realizó una encuesta a los comités provinciales de ética en investigación o áreas similares de los ministerios de Salud que ejercen la vigilancia sobre la evaluación ética de las investigaciones de su jurisdicción. RESULTADOS: respondieron 16 de las 17 provincias encuestadas. El 93,7% de los comités provinciales evalúa investigaciones en seres humanos y tiene procedimientos operativos estandarizados (POE). El 68,7% lleva un registro de los comités de ética en investigación (CEI) de su jurisdicción. Un 75% acredita a los CEI y un 68,7% los supervisa. El 100% tiene un registro de las investigaciones en salud; en 56,2% de los casos este registro es público. Del total, 81,2% realizan actividades de capacitación. El 100% adaptó los POE para evaluar estudios sobre la COVID-19. DISCUSIÓN: los resultados muestran sistemas provinciales consolidados. Se requiere fortalecer la transparencia en la investigación mediante el registro público de las investigaciones. Se identificaron posibilidades de mejora para proponer acciones a futuro

INTRODUCTION: a research ethics system is essential to protect the rights of research participants. The challenges posed by the COVID-19 pandemic to conduct research ethically to produce rapid results have demonstrated the need to strengthen this system. The objective of this study was to describe the state of the research ethics system of the Provinces of Argentina and the adaptations made due to the pandemic. METHOD: a survey was conducted with provincial research ethics committees or similar areas within the Ministries of Health of the provinces responsible for the oversight of research ethics review under their jurisdiction. RESULTS: sixteen of the 17 provinces surveyed responded. 93.7% of the provincial committees review human research and have standard operating procedures (SOPs). 68.7% register the research ethics committees (REC) in their jurisdiction. Seventy-five percent accredit RECs and 68.7% supervise them. 100% have a registry of health research in the jurisdiction, only 56.2% have public access. 81.2% carry out training activities. 100% adapted the SOPs to evaluate studies on COVID-19. DISCUSSION: the results show consolidated provincial systems. Transparency in research needs to be strengthened through public registration of research. Possibilities for improvement were identified to propose future actions.

El estado del sistema de evaluación ética de las investigaciones en Argentina y su adaptación a la pandemia de la COVID-19 / Research ethics review system state in Argentina and the adaptation in response to the COVID-19 pandemic

RESUMEN INTRODUCCIÓN un sistema de evaluación ética de las investigaciones en seres humanos es esencial para proteger los derechos de los participantes. Los desafíos impuestos por la pandemia de la COVID-19 para conducir investigaciones éticas que produzcan resultados con rapidez demuestran la necesidad de fortalecerlo. El objetivo de este estudio fue describir el estado de situación de los sistemas de evaluación ética de las provincias de Argentina y las adaptaciones realizadas por la pandemia. MÉTODOS se realizó una encuesta a los comités provinciales de ética en investigación o áreas similares de los ministerios de Salud que ejercen la vigilancia sobre la evaluación ética de las investigaciones de su jurisdicción. RESULTADOS respondieron 16 de las 17 provincias encuestadas. El 93,7% de los comités provinciales evalúa investigaciones en seres humanos y tiene procedimientos operativos estandarizados (POE). El 68,7% lleva un registro de los comités de ética en investigación (CEI) de su jurisdicción. Un 75% acredita a los CEI y un 68,7% los supervisa. El 100% tiene un registro de las investigaciones en salud; en 56,2% de los casos este registro es público. Del total, 81,2% realizan actividades de capacitación. El 100% adaptó los POE para evaluar estudios sobre la COVID-19. DISCUSIÓN los resultados muestran sistemas provinciales consolidados. Se requiere fortalecer la transparencia en la investigación mediante el registro público de las investigaciones. Se identificaron posibilidades de mejora para proponer acciones a futuro.

ABSTRACT INTRODUCTION a research ethics system is essential to protect the rights of research participants. The challenges posed by the COVID-19 pandemic to conduct research ethically to produce rapid results have demonstrated the need to strengthen this system. The objective of this study was to describe the state of the research ethics system of the Provinces of Argentina and the adaptations made due to the pandemic. METHOD: a survey was conducted with provincial research ethics committees or similar areas within the Ministries of Health of the provinces responsible for the oversight of research ethics review under their jurisdiction. RESULTS sixteen of the 17 provinces surveyed responded. 93.7% of the provincial committees review human research and have standard operating procedures (SOPs). 68.7% register the research ethics committees (REC) in their jurisdiction. Seventy-five percent accredit RECs and 68.7% supervise them. 100% have a registry of health research in the jurisdiction, only 56.2% have public access. 81.2% carry out training activities. 100% adapted the SOPs to evaluate studies on COVID-19. DISCUSSION the results show consolidated provincial systems. Transparency in research needs to be strengthened through public registration of research. Possibilities for improvement were identified to propose future actions.

Efecto de la inadecuación de la antibioterapia en Urgencias sobre la eficiencia en la hospitalización / Effect of the inadequacy of antibiotic therapy in the Emergency Department on hospital stays

INTRODUCCIÓN: El objetivo principal fue determinar la frecuencia de pacientes que reciben terapia antibiótica inapropiada y evaluar los resultados en términos de estancia media, reingreso y mortalidad a 30 días. MÉTODOS: Estudio observacional de cohortes retrospectivo que incluyó a todos los pacientes ingresados por infección desde un Servicio de Urgencias (SU) durante un mes. Se recogieron variables demográficas, comorbilidad, factores de riesgo de multirresistencia, foco de infección, resultados microbiológicos y antibiótico prescrito en el SU. Las variables de resultado fueron el tiempo de estancia, y la mortalidad y el reingreso a 30 días. RESULTADOS: Se incluyeron 376 pacientes con una edad media de 71,1 (DE 21) años. Las infecciones más frecuentes fueron respiratoria (45,7%) y urinaria (23,9%). El número de pacientes con una estancia superior a la mediana (≥9 días), reingreso y mortalidad a los 30 días fue de 165 (46,1%), 74 (19,7%) y 44 (11,7%) pacientes, respectivamente. La prescripción inapropiada del tratamiento antibiótico en el SU se produjo en 42 (11,2%) casos. Tras ajustar por los datos demográficos, la comorbilidad, los factores de riesgo para patógenos resistentes, la presencia de sepsis en el SU y el foco de infección, la prescripción inapropiada se asoció a una estancia prolongada (OR 2,22; IC95% 1,07-4,60; p = 0,032), pero no a un aumento de la mortalidad (p = 0,271) o de los reingresos (p = 0,784) a los 30 días. CONCLUSIÓN: La prescripción inapropiada del tratamiento antibiótico empírico en los pacientes ingresados por un proceso infeccioso desde el SU provoca una estancia prolongada, pero no un incremento de la mortalidad o del reingreso

INTRODUCTION: The main objective of the study was to determine the frequency of patients receiving inappropriate empiric antibiotic therapy and to assess the impact in terms of increase length of hospital stay, 30-day re-admissions, and 30-day mortality. METHODS: An observational retrospective cohort study was conducted over a one-month period that included all patients hospitalised from an Emergency Department (ED) due to infection. Demographic variables, comorbidity, multi-resistance risk factors, site of infection, microbiological findings, and antibiotic prescribed in ED were collected. Outcomes were length of hospital stay, 30-day re-admissions, and 30-day mortality. RESULTS: A total of 376 patients were included, with a mean age of 71.1 (SD 21) years. The most frequent causes were respiratory (45.7%) and urine (23.9%) infections. The number of patients with length of stay over the median (≥9 days) was 165 (46.1%), with re-admissions 74 (19.7%), and mortality at 30 days 44 (11.7%). There was inappropriate antibiotic treatment in 42 (11.2%) cases. After adjusting for demographic data, comorbidity, risk factors for multidrug resistant organism, presence of sepsis criteria in ED, and site of infection, inappropriate treatment was associated with an extended length of hospital stay (OR 2.22; 95% CI; 1.07-4.60; P=.032), but did not to an increase in mortality (P=.271) or re-admission (P=.784) at 30 days. CONCLUSION: The inappropriate empirical antibiotic therapy in patients admitted from the ED leads to an extended hospital stay, but did not increase mortality or readmission

Púrpura y artritis, ¿siempre púrpura de Schönlein-Henoch? / Purpura and arthritis: Is it always Henoch-Schönlein purpura?

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Factores de riesgo laboral para tenosinovitis del miembro superior / Tenosynovitis upper extremity occupational risk factors

OBJETIVOS: Identificar los factores de riesgo desencadenantes de tenosinovitis en los trabajadores verificando qué casos pueden ser considerados de origen laboral y reconocer las formas de presentación más frecuentes en relación al ámbito laboral. METODOLOGÍA: Se realiza una revisión bibliográfica de la literatura científica publicada en MedlinePubMed, Cochrane Library, EMBASE, CISDOC-ILO/OSH UPDATE, Scopus, LILACS e IBECS en el período comprendido entre 2007 a 2014. RESULTADOS: Se obtiene un total de 14 artículos entre los cuales 10 eran transversales y 4 son casos y controles. Todos ellos muestran una elevada probabilidad de desarrollar tenosinovitis en el ámbito laboral. La relación con movimientos repetitivos fue el factor de riesgo más importante con OR > 2, seguido de posturas forzadas y el uso de herramientas vibratorias. Respecto a los factores psicosociales la depresión presenta una OR = 3,04 (IC95% 2,43-3,81) y la combinación de movimiento repetitivo y el estrés, OR = 4,94 (IC95% 3,532-6,91). CONCLUSIÓN: Movimientos repetitivos, posturas forzadas y mantenidas, herramientas vibratorias, edad, ser mujer, raza blanca, estrés fueron los factores de riesgo encontrados sin poder demostrar en ninguno causalidad, siendo los trastornos musculoesqueléticos más prevalentes el síndrome del manguito de los rotadores, la enfermedad de De Quervain, dedo en gatillo y la epicondilitis lateral y medial

OBJECTIVES: To identify the workers tenosynovitis triggering risk factors verifying which can be considered work-related cases and recognizing the most frequently occurring form in the workplace. METHODS: A literature review of the scientific literature published in PubMed-Medline, Cochrane Library, EMBASE, CISDOC-ILO/OSH UPDATE, Scopus, LILACS and IBECS over the period 2007-2014 is performed. RESULTS: A total of 14 items were obtained, among which 10 were cross-sectional items and 4 cases and controls. They all show a high probability of developing tenosynovitis at the workplace. The relationship with repetitive movements was the most important risk factor with OR > 2 followed by awkward postures and vibrating tools use. Regarding psychosocial factors of depression in an OR = 3.04 (CI95% 2.43-3.81) and the combination of repetitive motion and stress, OR = 4.94 (CI95% 3.532 to 6.91). CONCLUSION: Repetitive movements, enforced and maintained postures, vibrating tools, age, being female, white race, stress were the risk factors found, however it was not possible to demonstrate if it was merely coincidence. The most prevalent musculoskeletal disorders were rotator cuff syndrome, Quervain's disease, trigger finger and the lateral and medial epicondylitis

Incidencia y gravedad de la tosferina en lactantes coinfectados por el virus respiratorio sincitial / Incidence and severity of pertussis in infants with a respiratory syncytial virus infection

INTRODUCCIÓN: La tosferina es una enfermedad reemergente que afecta sobre todo a lactantes. A esta edad la gravedad se puede afectar por infecciones intercurrentes como la del virus respiratorio sincitial (VRS). OBJETIVOS: Estimar la incidencia de la infección por el VRS durante su época epidémica en pacientes ingresados por tosferina. Asimismo, estudiar su repercusión sobre la gravedad observada durante el ingreso. Pacientes y método: Estudio descriptivo de casos con diagnóstico de tosferina ingresados en un hospital terciario durante 3 años donde se analizó la presencia de coinfección por el VRS. La estimación de la gravedad se confrontó por la incidencia de complicaciones y el nivel de cuidados requeridos. RESULTADOS: De un total de 73 lactantes con tosferina, 34 acontecieron en época epidémica de bronquiolitis. En 17 de los 34 se detectó coinfección por el VRS. La edad media no mostró diferencias significativas respecto a los no coinfectados. La estancia media y la necesidad de cuidados intensivos fue semejante. La necesidad de cuidados de oxigenoterapia y soporte nutricional fue superior en los coinfectados. CONCLUSIONES: La coinfección por el VRS en lactantes ingresados con tosferina aconteció en uno de cada 2 pacientes en época epidémica para el VRS, en lactantes de edad similar. La gravedad en términos de estancia, presencia de apneas e ingreso en cuidados intensivos fue semejante, pero con mayor necesidad de cuidados respiratorios y soporte nutricional

INTRODUCTION: Pertussis is a re-emerging disease that mostly affects infants. At this age, the severity can be affected by intercurrent infections such as respiratory syncytial virus (RSV). OBJECTIVES: To estimate the incidence of RSV infection during an epidemic period in patients hospitalized due to pertussis. The impact on the severity was also observed during hospitalization. PATIENTS AND METHOD: A descriptive study of cases diagnosed with pertussis admitted to a tertiary hospital over a 3 year period, where the presence of co-infection with RSV was analyzed. The estimate of severity was estimated using the incidence of complications and the level of care required. RESULTS: From a total of 73 infants with pertussis, 34 occurred in a bronchiolitis season epidemic. A co- infection due to RSV was detected in 17 patients. The mean age was not significantly different compared to the non co-infected. The mean stay and the need for intensive care was similar in both groups. The need for oxygen therapy care and nutritional support was higher in the coinfected patients. CONCLUSIONS: Coinfection with RSV in infants hospitalized with pertussis occurred in ono in 2 patients during a RSV epidemic season, in infants of similar age. Severity in terms of stay, presence of apnea and admission to intensive care was similar, but more need for respiratory care and nutritional support was found

Group B streptococcal neonatal infections in Rio Grande do Sul, Brazil

Group B Streptococcus is the most common pathogen found in neonatal sepsis in North America. OBJECTIVES: We describe 15 cases of neonatal infections by Group B Streptococcus (Streptococcus agalactiae) at a Neonatal Intensive Care Unit of a public and teaching hospital. METHODS: We conducted a study at Hospital de Clínicas de Porto Alegre, from January 1st, 1996 to June 30, 1999. Diagnosis of neonatal infection was established according to the findings of Group B Streptococcus in blood culture associated with alterations resembling sepsis on the basis of clinical picture and laboratory findings. RESULTS: Fifteen cases of neonatal infections by Group B Streptococcus were detected. Eleven cases consisted of early-onset sepsis, 2 cases of occult bacteremia and 2 cases of late-onset sepsis. Eight cases had septic shock (53 percent), 8 cases had pneumonia (53 percent), and 4 cases had meningitis (27 percent). Fourteen cases were diagnosed from a positive blood culture, and 1 case from evidence of these bacteria in pulmonary anatomopathological examination. Thirteen cases (87 percent) were diagnosed before 72 hours of life. We had 3 deaths (20 percent), and 3 cases of meningitis developing neurological deficits. CONCLUSIONS: Streptococcus Group B is one of the most important pathogens in the etiology of early-onset neonatal sepsis at our hospital, with high mortality and morbidity. However, we do not know the incidence of GBS neonatal infections at other hospitals. More data are needed to establish a basis for trials of different strategies to reduce these infections