Contribution of halloysite as nanotubular clay mineral on mechanism and adsorption rate of Cd(II) onto nanocomposites alginate-halloysite.

In this work nanocomposites based on alginate (Alg) and halloysite as a nanotubular clay (Hy) were developed. Characterization techniques reveal that Hy/Alg nanocomposites are cation exchangers with predominantly negative charge density and good thermal stability. The adsorption equilibrium of Cd(II) in aqueous solution onto Hy/Alg nanocomposites revealed that by increasing the mass of halloysite in the nanocomposite, the adsorption capacity diminished significantly due to the halloysite-alginate interactions. Maximum adsorption capacities of 8, 65, 88, and 132 mg/g of Cd(II) were obtained for samples Hy, Hy/Alg 50%, Hy/Alg 95%, and Alg, respectively. In addition, the adsorption equilibrium of Cd(II) on the Hy/Alg bionanocomposites was affected by the pH and temperature of the solution, demonstrating the presence of electrostatic interactions during adsorption and that this is an exothermic process. The controlling mechanism of adsorption was cation exchange influenced by electrostatic forces. The Cd(II) adsorption rate studies were interpreted by the diffusion-permeation model and reveal that the presence of Hy in the structure of the nanocomposites enhances the permeation coefficient, that is, the adsorption rate was increased. The values of the permeation coefficient varied from 1.95 × 10-7 to 8.50 × 10-7 cm2/s for Hy/Alg 50% and from 1.70 × 10-7 to 3.55 × 10-7 cm2/s for Hy/Alg 95%.

Effects of Drought on Mortality in Macro Urban Areas of Brazil Between 2000 and 2019.

A significant fraction of Brazil's population has been exposed to drought in recent years, a situation that is expected to worsen in frequency and intensity due to climate change. This constitutes a current key environmental health concern, especially in densely urban areas such as several big cities and suburbs. For the first time, a comprehensive assessment of the short-term drought effects on weekly non-external, circulatory, and respiratory mortality was conducted in 13 major Brazilian macro-urban areas across 2000-2019. We applied quasi-Poisson regression models adjusted by temperature to explore the association between drought (defined by the Standardized Precipitation-Evapotranspiration Index) and the different mortality causes by location, sex, and age groups. We next conducted multivariate meta-analytical models separated by cause and population groups to pool individual estimates. Impact measures were expressed as the attributable fractions among the exposed population, from the relative risks (RRs). Overall, a positive association between drought exposure and mortality was evidenced in the total population, with RRs varying from 1.003 [95% CI: 0.999-1.007] to 1.010 [0.996-1.025] for non-external mortality related to moderate and extreme drought conditions, from 1.002 [0.997-1.007] to 1.008 [0.991-1.026] for circulatory mortality, and from 1.004 [0.995-1.013] to 1.013 [0.983-1.044] for respiratory mortality. Females, children, and the elderly population were the most affected groups, for whom a robust positive association was found. The study also revealed high heterogeneity between locations. We suggest that policies and action plans should pay special attention to vulnerable populations to promote efficient measures to reduce vulnerability and risks associated with droughts.

Analysis and gonadal localization of Speedy A mRNA transcript, a novel gene associated with early germline cells in the scallop, Argopecten purpuratus.

The Speedy A (spdya) gene is a member of the Speedy/RINGO family, encoding a spdya protein associated with cellular cycle and meiosis in vertebrates. Results from genetic analyses indicated spdya conditional knockout mice are sterile, suggesting that this protein has essential functions in mammalian reproduction. There, however, are no published reports on the localization of spdya mRNA in the germline or in somatic cell lineages within the gonads from mollusks or other invertebrate species. Using a previously obtained transcriptome assembly from the scallop Argopecten purpuratus, an economically important hermaphroditic scallop species from Chile and Peru, there was identification of a complete coding sequence of the spdya mRNA. Phylogenetically spdya protein has sequence conservation homology with other scallops and mollusks. The relative mRNA transcript abundances at different gametogenic stages was assessed using quantitative PCR procedures. Results indicated there was an increase of spdya mRNA transcript abundance in testicular region samples at the late active stage, followed by a decrease in testis of reproductively mature individuals. To gain insight into the cellular localization of ap-spdya transcript within the gonads, specific RNA probes were synthesized for in situ hybridization analyses of gonad histological sections. Results indicated spdya mRNA is located exclusively in early germline (previtellogenic oocytes and spermatogonia) and somatic proliferative tissues of A. purpuratus ovarian and testicular regions. Overall, these results indicate there are putative functions of spdya in the early oogenesis and spermatogenesis of A. purpuratus and will contribute to furthering the understanding of gametogenesis in this species.

Design of magnetic hybrid nanostructured lipid carriers containing 1,8-cineole as delivery systems for anticancer drugs: Physicochemical and cytotoxic studies.

The development of versatile carriers to deliver chemotherapeutic agents to specific targets with establishing drug release kinetics and minimum undesirable side effects is becoming a promising relevant tool in the medical field. Magnetic hybrid nanostructured lipid carriers (NLC) were prepared by incorporation of 1,8-cineole (CN, a monoterpene with antiproliferative properties) and maghemite nanoparticles (MNPs) into a hybrid matrix composed of myristyl myristate coated with chitosan. Hybrid NLC characterized by DLS and TEM confirmed the presence of positively charged spherical nanoparticles of around 250 nm diameter and +10.2 mV of Z-potential. CN encapsulation into the lipid core was greater than 75 % and effectively released in 24 h. Modification of the crystalline structure of nanoparticles after incorporation of CN and MNPs was observed by XRD, DSC, and TGA analyses. Superparamagnetic NLC behavior was verified by recording the magnetization using a vibrating scanning magnetometer. NLC resulted in more cytotoxic than free CN in HepG2 and A549 cell lines. Particularly, viability inhibition of HepG2 and A549 cells was increased from 35 % to 55 % and from 38 % to 61 %, respectively, when 8 mM CN was incorporated into the lipid NPs at 24 h. Green fluorescent-labeled NLC with DIOC18 showed an enhanced cellular uptake with chitosan-coated NLC. Besides, no cytotoxicity of the formulations in normal WI-38 cells was observed, suggesting that the developed hybrid NLC system is a safe and good potential candidate for the selective delivery and potentiation of anticancer drugs.

Hydrogeological features affecting spatial distribution of glyphosate and AMPA in groundwater and surface water in an agroecosystem. Córdoba, Argentina.

The study area is located in the eastern slope of Las Peñas Mountain and its adjacent oriental fluvio-aeolian-plain. Agriculture is the main activity (soybean, maize, wheat, peanuts and alfalfa) with no-tillage farming and intensive use of agrochemicals (pesticides-fertilizers). Glyphosate (N-phosphono-methylglycine) is the most common used herbicide which suffers microbial biodegradation giving aminomethylphosphonic acid (AMPA), its main metabolite. The objective of this work is to evaluate hydrogeological features which influence the presence of glyphosate and AMPA in waters. In the study area, the main flow direction of surface and groundwater is NW-SE. The unsaturated zone thickness decreases in the same direction from 60 to 0 m, so groundwater surges in low areas in the eastern sector. From the total water samples collected, glyphosate was detected in 66% of surface water samples (0.2 to 167.4 µg/L), in 15.8% of the groundwater samples (1.3 to 2 µg/L) and in the harvested precipitation sample (0.2 µg/L). AMPA was found in 33% of surface water and 15.8% of groundwater. The herbicide detection was related to areas with the shallowest water table (< 4 m), low hydraulic conductivity in the aquifer (K = 1.5 m/d), low hydraulic gradient (i = 0.16%) and very low flow velocity (0.02 m/d). The most outstanding result is that the groundwater presents higher values in comparison with the surface water samples, which can be explained by the greater dilution capacity of streams. The detection of glyphosate and AMPA in the unconfined aquifer shows that the application for decades under the prevailing agricultural model exceeds the degradation potential of the soil and the unsaturated zone, causing groundwater contamination.

Genital morphology and copulatory behavior in triatomine bugs (Reduviidae: Triatominae).

Triatomines (Heteroptera: Reduviidae) include around 139 species, widely known as vectors of Chagas disease. Our aim is to review the existing knowledge of the genital morphology and sexual behavior and provide some functional analysis of these traits in triatomines. A complex set of traits comprise genitalia and these are highly variable among species. The components of the phallus and seminal products (secreted by action of testes and two accessory glands) interact to allow successful sperm transfer to the female spermathecae (usually a pair of blind tubes that emerge from the common oviduct). Seminal products may inhibit female physiology and extend mating duration. Mating behavior in triatomines is best characterized as scramble competition. We suggest that males may evaluate female condition prior to copulation, given that female fitness is largely affected by food (blood) source. Although rearing several triatomine species may be difficult and discourage from undertaking studies on this group, any further investigation on sexual behavior and mating interactions may provide data for applicative studies including Chagas disease vectors control.

Actuación de enfermería en la prevención y control del riesgo reproductivo preconcepcional / Nursing Performance in Prevention and Control of Preconception Reproductive Health

RESUMEN Introducción: La prevención de la enfermedad y la muerte durante el proceso de reproducción es uno de los pilares fundamentales para el desarrollo de la salud reproductiva, donde el rol de la enfermera juega un papel primordial en el empoderamiento del autocuidado de la mujer en edad fértil. Objetivo: Sistematizar la actuación de enfermería en la prevención y control del riesgo reproductivo preconcepcional. Métodos: Revisión bibliográfica sistemática para realizar análisis crítico reflexivo del contenido de artículos originales y de revisión publicados en español entre 2005 y 2015. La búsqueda fue realizada en las bases de datos Medline EMBASE, Current Contents, Science Citation Index, de enero a marzo de 2016, las palabras clave utilizadas fueron "riesgo preconcepcional", "práctica de enfermería", y "atención de enfermería al riesgo preconcepcional". Tras la identificación de los estudios pre-seleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, comprobando la pertinencia con el estudio. Conclusión: Un adecuado conocimiento de la mujer en edad fértil sobre el riesgo preconcepcional permite mantener un estado de salud óptimo para asumir un embarazo con resultados finales satisfactorios. El déficit de conocimientos en la mujer sobre padecimientos o hábitos de riesgo para su salud y para asumir un embarazo satisfactorio, a ello se suma insuficiente trabajo de enfermería en la prevención del riesgo preconcepcional(AU)

ABSTRACT Introduction: Preventing disease and death during the reproduction process is one of the fundamental pillars for the development of reproductive health, in which the nurse plays a key role in empowering the self-care of women at childbearing age. Objective: To systematize the nursing action in prevention and control of preconception reproductive risk. Methods: Systematic bibliographic review to carry out a reflexive critical analysis of the content of original and review articles published in Spanish between 2005 and 2015. The search was carried out in the databases Medline EMBASE, Current Contents, and Science Citation Index, from January to March 2016; the key words used were riesgo preconcepcional [preconception risk], práctica de enfermería [nursing practice], y atención de enfermería al riesgo preconcepcional [nursing care over preconception risk]. After the identification of the pre-selected studies, the titles, summary and key words were read, verifying the relevance with the study. Conclusion: An adequate knowledge of women of childbearing age on preconception risk allows maintaining an optimal state of health to assume a pregnancy with satisfactory final results. The lack of knowledge in women about conditions or habits of risk for their health and for assuming a satisfactory pregnancy, to which insufficient nursing work is added in the prevention of preconception risk(AU)

Mucinous adenocarcinoma on perianal fistula. A rising entity?

INTRODUCTION: Mucinous adenocarcinoma on perianal fistula is a rare entity; it could be underdiagnosed because it behaves often as a regular perianal fistula. MATERIALS AND METHODS: We have recently treated four cases in our unit. We present them and review the literature, emphasizing on clinical characteristic and therapeutic options. The four patients were male with a mean age of 64. Three of them were classified as locally advances cases and therefore treated with neoadjuvant therapy. RESULTS: All of them underwent laparoscopic abdominoperineal escisión. Surgical specimens are described and clinical characteristic specified. Review of the literature shows that this disease has a very high potential risk of local recurrence and we must be aggressive with the resection. Sometimes plastic surgery is needed to reconstruct the perianal wound. CONCLUSIONS: Mucinous adenocarcinoma associated with anal fistula is a rare disease. Neoadjuvant chemoradiotherapy followed by an adequate abdominoperineal excision may result in favourable outcomes.

Litter assessment on 99 Cuban beaches: A baseline to identify sources of pollution and impacts for tourism and recreation.

Litter presence was assessed on the entire Cuban coastline, and includes 99 beaches from all Cuban regions, during field work carried out in 2012 and 2015. A standard method verified in several countries was applied, which classified beaches for nine types of litter into four grades (A-excellent to D-poor). Almost half of the Cuban beaches obtained excellent cleanliness scores, although many needed to be better managed. In this baseline, the most common types of residue were general litter (8% grade D and 35% grades B/C) and potentially harmful litter (<68% with grade A). Resort beaches and those with international visitors showed the best litter management. Tourism Impacts seems to be related to visitor origin therefore choices to develop sustainable tourism in rural and village beaches (64%) appears low, if beach cleaning gross investment is focused on resort beaches (24%). Finally, this paper highlights geographical distribution and types of litter patterns.

Relationships between altitude, triatomine (Triatoma dimidiata) immune response and virulence of Trypanosoma cruzi, the causal agent of Chagas' disease.

Little is known about how the virulence of a human pathogen varies in the environment it shares with its vector. This study focused on whether the virulence of Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae), the causal agent of Chagas' disease, is related to altitude. Accordingly, Triatoma dimidiata (Hemiptera: Reduviidae) specimens were collected at three different altitudes (300, 700 and 1400 m a.s.l.) in Chiapas, Mexico. The parasite was then isolated to infect uninfected T. dimidiata from the same altitudes, as well as female CD-1 mice. The response variables were phenoloxidase (PO) activity, a key insect immune response, parasitaemia in mice, and amastigote numbers in the heart, oesophagus, gastrocnemius and brain of the rodents. The highest levels of PO activity, parasitaemia and amastigotes were found for Tryp. cruzi isolates sourced from 700 m a.s.l., particularly in the mouse brain. A polymerase chain reaction-based analysis indicated that all Tryp. cruzi isolates belonged to a Tryp. cruzi I lineage. Thus, Tryp. cruzi from 700 m a.s.l. may be more dangerous than sources at other altitudes. At this altitude, T. dimidiata is more common, apparently because the conditions are more beneficial to its development. Control strategies should focus activity at altitudes around 700 m a.s.l., at least in relation to the region of the present study sites.

Immune Priming, Fat Reserves, Muscle Mass and Body Weight of the House Cricket is Affected by Diet Composition.

Some insect species are capable of producing an enhanced immune response after a first pathogenic encounter, a process called immune priming. However, whether and how such ability is driven by particular diet components (protein/carbohydrate) have not been explored. Such questions are sound given that, in general, immune response is dietary dependent. We have used adults of the house cricket Acheta domesticus L. (Orthoptera: Gryllidae) and exposed them to the bacteria Serratia marcescens. We first addressed whether survival rate after priming and nonpriming treatments is dietary dependent based on access/no access to proteins and carbohydrates. Second, we investigated how these dietary components affected fat reserves, muscle mass, and body weight, three key traits in insect fitness. Thus, we exposed adult house crickets to either a protein or a carbohydrate diet and measured the three traits. After being provided with protein, primed animals survived longer compared to the other diet treatments. Interestingly, this effect was also sex dependent with primed males having a higher survival than primed females when protein was supplemented. For the second experiment, protein-fed animals had more fat, muscle mass, and body weight than carbohydrate-fed animals. Although we are not aware of the immune component underlying immune priming, our results suggest that its energetic demand for its functioning and/or consequent survival requires a higher demand of protein with respect to carbohydrate. Thus, protein shortage can impair key survival-related traits related to immune and energetic condition. Further studies varying nutrient ratios should verify our results.

Mesenchymal stem cell-derived exosomes from different sources selectively promote neuritic outgrowth.

Mesenchymal stem cells (MSCs) obtained from bone marrow (BM) have been shown to promote neuronal growth and survival. However, the comparative effects of MSCs of different sources, including menstrual MSCs (MenSCs), BM, umbilical cord and chorion stem cells on neurite outgrowth have not yet been explored. Moreover, the modulatory effects of MSCs may be mediated by paracrine mechanisms, i.e. by molecules contained in the MSC secretome that includes soluble factors and extracellular vesicles such as microvesicles and/or exosomes. The biogenesis of microvesicles, characterized by a vesicle diameter of 50 to 1000 nm, involves membrane shedding while exosomes, of 30 to 100 nm in diameter, originate in the multivesicular bodies within cells. Both vesicle types, which can be harvested from the conditioned media of cell cultures by differential centrifugation steps, regulate the function of target cells due to their molecular content of microRNA, mRNA, proteins and lipids. Here, we compared the effect of human menstrual MSCs (MenSCs) mediated by cell-cell contact, by their total secretome or by secretome-derived extracellular vesicles on neuritic outgrowth in primary neuronal cultures. The contact of MenSCs with cortical neurons inhibited neurite outgrowth while their total secretome enhanced it. The extracellular vesicle fractions showed a distinctive effect: while the exosome-enriched fraction enhanced neurite outgrowth, the microvesicle-enriched fraction displayed an inhibitory effect. When we compared exosome fractions of different human MSC sources, MenSC exosomes showed superior effects on the growth of the longest neurite in cortical neurons and had a comparable effect to BM-SC exosomes on neurite outgrowth in dorsal root ganglia neurons. Thus, the growth-stimulating effects of exosomes derived from MenSCs as well as the opposing effects of both extracellular vesicle fractions provide important information regarding the potential use of MenSCs as therapeutic conveyors in neurodegenerative pathologies.

Conocimientos y comportamientos en salud sexual de estudiantes indígenas guatemaltecos residentes en una comunidad rural / Knowledge about and behaviors in sexual health of Guatemalan native students residing in a rural community

Introducción: la adolescencia es una etapa de la vida favorable para modificar enseñanzas rígidas, mitos, tabúes, creencias y formas de conductas que hayan influido en sus conocimientos y comportamientos sobre sexualidad.Objetivo: identificar conocimientos y comportamientos sobre salud sexual de estudiantes indígenas del instituto de Educación Media de Antigua Chinautala, de Guatemala. Métodos: se realizó una investigación descriptiva de corte transversal a una muestra aleatoria de 178 estudiantes de una comunidad rural indígena. Para la recogida de la información se utilizó un cuestionario diseñado a fines similares, adaptado y modificado al contexto sociocultural guatemalteco. Resultados: se observaron deficiencias acerca de conceptos tales como sexualidad, crecimiento, desarrollo, cómo se puede adquirir una Infección de Transmisión Sexual y un embarazo, entre otros aspectos. Tanto en hembras como en varones los conocimientos fueron evaluados de mal. Respecto a los comportamientos, solo un bajo porcentaje declaró haber iniciado las relaciones sexuales, aunque se considera que el dato no refleja la realidad y hay problemas en la protección de las mismas. El método anticonceptivo más usado es el condón, aunque con un porcentaje menor al 50 por ciento. Conclusiones: los estudiantes tienen insuficientes conocimientos y comportamientos de riesgos en relación con la sexualidad, matizados por tabúes, mitos, estereotipos y desinformación, donde las inequidades de género añaden un elemento negativo. Los resultados encontrados ratifican la situación desfavorable que presenta la población indígena de Guatemala en el área de la sexualidad, lo que constituye un grave problema de salud pública a resolver(AU)

Introduction: adolescence is a favorable phase of life for changing rigid learning, myths, taboos, beliefs and ways of behavior that may have influence knowledge and behaviors about sexuality. Objective: to identify those pieces of knowledge and behaviors on sexual health of native students in the high school institute of Antigua Chinautala located in Guatemala.Methods: cross-sectional descriptive research of a random sample of 178 students from a rural native community. For information collection, we used a questionnaire adapted and modified according to the Guatemalan sociocultural context, but designed for similar objectives. Results: poor knowledge about concepts such as sexuality, growth, development, sexually transmitted diseases and how it can be caught, pregnancy, among others, was observed. Both female and male students´ knowledge about these topics were evaluated as deficient. Regarding behaviors, just a low percentage of them pointed out the initiation of sexual relationships, although this data was not considered to be the real figure, and existing problems in individual protection. The most used contraceptive method was condom, being the percentage under 50 percent. Conclusions: the students do not have enough knowledge about and adopt risky behaviors in sexuality, blended with taboos, myths, stereotypes and disinformation to which gender inequities are added to play a negative role. The results found so far ratify the unfavorable situation of the native population of Guatemala in terms of sexuality, a serious public health problem that remains to be solved(AU)

Identification of 17 novel mutations in 40 Argentinean unrelated families with mucopolysaccharidosis type II (Hunter syndrome).

Mucopolysaccharidosis type II (MPSII) is an X-linked lysosomal storage disorder caused by deficiency of the enzyme iduronate-2-sulfatase (IDS). The human IDS gene is located in chromosome Xq28. This is the first report of genotype and phenotype characterization of 49 Hunter patients from 40 families of Argentina. Thirty different alleles have been identified, and 57% were novel. The frequency of de novo mutations was 10%. Overall, the percentage of private mutations in our series was 75%.

Assessing cellular DNA damage from a helium plasma needle.

The aim of the present study is to determine the deoxyribonucleic acid (DNA) damage by cells exposed to atmospheric pressure non-thermal plasma (APNTP). Mouse leukocytes embedded in agarose were exposed to the plasma at two different distances from a helium plasma needle outlet and during three different exposure periods. Damage was assessed by the single cell gel electrophoresis assay. The results indicate that, at 0.1 cm from the plasma needle, the exposure caused complete DNA fragmentation determined by the presence of so called "clouds". Samples exposed at 0.5 cm from the slide sample surface presented damage proportional to the exposure periods in terms of tail intensity, tail moment and "clouds" frequency. Studies performed with alkaline single cell gel electrophoresis assay to determine DNA breaks and alkali-labile sites, indicates that DNA damage produced by exposure to APNTP was caused mainly by oxidative radicals, rather than by UV light which causes cyclobutane pyrimidine dimers. These results allow us to conclude that plasma needle induced DNA breaks in mice leukocytes proportionally to exposure time.

Estado nutricional del paciente críticamente enfermo: implicación en mortalidad / Nutritional status of the critically ill patient: involvement in mortality

En el paciente crítico, la malnutrición puede ser preexistente, manifestarse al ingreso o desarrollarse de forma evolutiva, favorecida por el estado hipercatabólico e hipermetabólico. Por lo que para identificar el estado nutricional del paciente existen parámetros destinado a su valoración. Sin embargo, su aplicación en los pacientes críticos es difícil, debido a la interpretación de los resultados se encuentra alterada por los cambios originados debido a la enfermedad aguda y a las medidas terapéuticas. El objetivo fue determinar si el estado nutricional es un factor pronóstico de mortalidad en el paciente críticamente enfermo...

Serum neuron-specific enolase and S100 calcium binding protein B biomarker levels do not improve diagnosis of acute stroke.

BACKGROUND: The high sensitivities and specificities reported for blood biomarkers as a supportive test in the diagnosis of acute stroke do not correspond with their performance for decision-making in emergency situations. METHODS: Seventy-two patients with suspected stroke were recruited: 44 with ischaemic stroke, 17 with haemorrhagic stroke and 11 stroke mimics, as well as a high-risk control group of 79 individuals. Serum neuron-specific enolase (NSE) and S100 calcium binding protein B (S100B) biomarker levels were determined on admission, using immunoassay kits. The sensitivities and specificities of NSE and S100B for distinguishing acute stroke from stroke mimics and high-risk controls were calculated. RESULTS: For cut-off values (NSE ≤ 14 micrograms per litre and S100B ≤130 nanograms per litre) the sensitivity was 53% and 55% respectively. Specificity was 64 for both versus the stroke mimic group. Specificity was higher (79% and 86% respectively) when calculated on the basis of the control group. CONCLUSIONS: This study supports the evidence indicating that serum levels of NSE and S100B do not improve the diagnosis of acute stroke.

[Rational use of antibiotics in the Department of Internal Medicine from a university hospital: results of a pilot experience]. / Uso racional de antimicrobianos en el departamento de medicina interna de un hospital universitario: resultados de una experiencia piloto.

INTRODUCTION: The programs of rational use of antibiotics are designed to optimize antimicrobial therapy and minimize the emergence of bacterial resistance. In order to optimize the use of antibiotics we implemented an educational program based on the application of a checklist criteria for the rational use of these drugs. METHOD: We performed a cohort study unpaired in the Department of Internal Medicine, during three months. We compared a prospective cohort (A) which used a checklist, with a retrospective cohort (B) in wich prescription was based on usual clinical practice. RESULTS: We included 227 prescriptions of antibiotics. In cohort A compared to B, there was a higher proportion of switch to oral antibiotics agents and adjustment of the antimicrobial therapy to the susceptibility in the antibiogram and reduced use of associated antibiotics. Total antibiotic consumption was 117.7 DDD/100 bed-days (Defined Daily Doses). Consumption in cohorts A and B was 46.1 DDD/100 bed-days and 71.6 DDD/100 bed-days (reduction, 35.6%). There was also a reduction in consumption of ceftriaxone, ceftazidime, quinolones, vancomycin and carbapenems. Costs were reduced by 55%. There was no difference in the average hospital stay. CONCLUSIONS: The implementation of an educational strategy based on a checklist allowed the optimum use of antibiotics.

Uso racional de antimicrobianos en el departamento de medicina interna de un hospital universitario: resultados de una experiencia piloto / Rational use of antibiotics in the department of internal medicine from a university hospital: results of a pilot experience

Introduction: The programs of rational use of antibiotics are designed to optimize antimicrobial therapy and minimize the emergence of bacterial resistance. In order to optimize the use of antibiotics we implemented an educational program based on the application of a checklist criteria for the rational use of these drugs. Method: We performed a cohort study unpaired in the Department of Internal Medicine, during three months. We compared a prospective cohort (A) which used a checklist, with a retrospective cohort (B) in wich prescription was based on usual clinical practice. Results: We included 227 prescriptions of antibiotics. In cohort A compared to B, there was a higher proportion of switch to oral antibiotics agents and adjustment of the antimicrobial therapy to the susceptibility in the antibiogram and reduced use of associated antibiotics. Total antibiotic consumption was 117.7 DDD/100 bed-days (Defined Daily Doses). Consumption in cohorts A and B was 46.1 DDD/100 bed-days and 71.6 DDD/100 bed-days (reduction, 35.6%). There was also a reduction in consumption of ceftriaxone, ceftazidime, quinolones, vancomycin and carbapenems. Costs were reduced by 55%. There was no difference in the average hospital stay. Conclusions: The implementation of an educational strategy based on a checklist allowed the optimum use of antibiotics.

Introducción: Los programas de uso racional de antimicrobianos tienen la finalidad de optimizar la terapia antimicrobiana y minimizar la aparición de resistencia bacteriana. Con el objetivo de optimizar el uso de antimicrobianos se implementó un programa educativo basado en la aplicación de una lista de verificación (check list) conteniendo criterios establecidos de uso racional de estos fármacos. Método: Se realizó un estudio de cohortes no pareadas en el Departamento de Medicina Interna, durante tres meses. Se comparó una cohorte prospectiva (A) en que se aplicó la lista de verificación, con una cohorte retrospectiva (B) con prescripción de acuerdo a la práctica clínica habitual. Resultados: Se incluyeron 227 prescripciones de antimicrobianos. En la cohorte A, hubo mayor proporción de paso a vía oral y adecuación del antimicrobiano al antibiograma y menor uso de asociación de antimicrobianos, con respecto a la cohorte B. El consumo total de antimicrobianos fue de 117,7 DDD/100 días-cama (Dosis Diaria Definida). El consumo en las cohortes A y B fue de 46,1 DDD/100 días-cama y 71,6 DDD/100 días-cama respectivamente (reducción de un 35,6%). También hubo una reducción en el consumo de ceftriaxona, ceftazidima, quinolonas, vancomicina y carbapenem. Los costos se redujeron en 55%. No hubo diferencias en la estadía media hospitalaria. Conclusiones: La aplicación de una estrategia educativa basada en una lista de verificación permitió optimizar el uso de antimicrobianos.