Impact of rapid, culture-independent diagnosis of candidaemia and invasive candidiasis in a community health system.

Background: Delay in treatment of candidaemia and invasive candidiasis remains a cause of significant morbidity and mortality in high-risk patients. Widespread empirical utilization of antifungal therapy often occurs in an effort to minimize this risk. Objectives: This study assessed the impact of the T2Candida Panel in a multi-hospital community health system on time to initiation of antifungal therapy in candidaemic patients as well as the utilization of micafungin. Methods: Outcomes were compared between those patients with candidaemia prior to T2Candida implementation and those after implementation. Micafungin utilization for patients with suspected candidaemia/invasive candidiasis was compared with that for patients with a negative T2Candida Panel post-implementation. Results: There was a significant decrease in time to appropriate therapy in the post-T2Candida group (34 versus 6 h, P = 0.0147). Empirical antifungal therapy was avoided in 58.4% of T2Candida-negative patients. Conclusions: These results support the implementation of T2Candida to improve time to appropriate therapy for candidaemic patients while simultaneously expanding antimicrobial stewardship efforts to appropriately utilize antifungals.

Cutaneous pseudolymphoma secondary to exogenous pigment in a polychrome tattoo

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Expresión de TGFß1 por fibroblastos de mucosa oral expuestos a radiación ultravioleta B / TGF1 expression by oral mucosa fibroblasts exposed to ultraviolet ß1 radiation

El objetivo de este estudio fue evaluar el efecto de la radiación ultravioleta (UV) B sobre la expresión del factor de crecimiento transformante (TGF) ß1 por fibroblastos de mucosa oral, con el objetivo de dilucidar si este tipo celular puede contribuir a la expresión de TGFß1 en bermellón labial sobreexpuesto a la radiación UV. Se obtuvieron cultivos primarios de fibroblastos desde explantes de mucosa bucal, los que fueron irradiados con una dosis única de luz UVB (60 mJ/cm2). Se midió proliferación celular con el método MTT, y la expresión de TGFß1, a nivel de ARN mensajero (normalizado a GAPDH) por RT-PCR y a nivel de proteína mediante inmunofluorescencia. Se observó una disminución de la proliferación celular de los fibroblastos de mucosa oral a las 24 hrs post-irradiación en relación a los fibroblastos no irradiados (P<0,05, Mann Whitney). No se encontraron diferencias entre los fibroblastos control y los irradiados en la expresión de TGFß-1 ni a nivel de mensajero (0,5 y 6 h post-irradiación), ni de proteína (24 h post-irradiación). Los resultados sugieren que los fibroblastos de mucosa oral presentan una disminución de su proliferación en respuesta a una dosis única de radiación UVB, sin que se afecte la expresión de TGFß-1, la que fue similar a los fibroblastos no irradiados. Esto sugiere que los fibroblastos contribuirían a la producción de TGFß-1 en respuesta a la exposición crónica a UVB del bermellón labial.

The objective of this study was to characterize the effect of Ultraviolet (UV) B irradiation on the expression of transforming growth factor (TGF) ß1 by oral mucosa fibroblasts, in order to assess if these cells contribute to the production of TGFß-1 in UV-irradiated lip vermillion. Primary cultures of fibroblasts were obtained from oral mucosa explants, and were irradiated with a single dose of UVB light (60 mJ/cm2). The effects of UVB radiation on cell proliferation was evaluated by the MTT method. The effects of UVB on the expression of TGF-ß1 was analyzed by RT-PCR (normalized to GAPDH) and by immunofluorescence. The results showed a decrease in the proliferation of UVB-irradiated fibroblasts as compared to controls at 24h post-irradiation (p<0.05). No variations in the expression of TGFß1, both at the mRNA and protein level, were observed between control and UVB-irradiated fibroblasts during the first 24 h after irradiation. Oral mucosa fibroblasts have reduced proliferation in response to a single dose of UVB, but their expression of TGFß1 was not affected. This suggests that oral mucosa fibroblasts may contribute to the production of TGFß1 in the lip vermillion independent of UVB exposure.

Ergonomics principles to design clothing work for electrical workers in Colombia.

The recent development of the Colombian legislation, have been identified the need to develop protective clothing to work according to specifications from the work done and in compliance with international standards. These involve the development and design of new strategies and measures for work clothing design. In this study we analyzes the activities of the workers in the electrical sector, the method analyzes the risks activity data in various activities, that activities include power generation plants, local facilities, industrial facilities and maintenance of urban and rural networks. The analyses method is focused on ergonomic approach, risk analysis is done, we evaluate the role of security expert and we use a design algorithm developed for this purpose. The result of this study is the identification of constraints and variables that contribute to the development of a model of analysis that leads to the development the work protective clothes.

Soleus neurotomy for treatment of the spastic equinus foot. Groupe d'Evaluation et de Traitement de la Spasticité et de la Dystonie.

OBJECTIVE: This prospective, nonrandomized, noncontrolled study was performed to evaluate the results of a new type of neurotomy, namely the soleus neurotomy, for treatment of the spastic equinus foot. METHODS: Between May 1996 and March 1998, 46 patients were treated for a spastic equinus foot. Clinical status, spasticity (Ashworth Scale score), and kinematic parameters of the gait were determined before and after surgery. The neurotomy was performed on the upper nerve of the soleus in all cases and was associated with other neurotomies (lower nerve of the soleus, 21 patients; gastrocnemius, 9 patients, tibialis posterior, 18 patients; flexor hallucis longus, 16 patients; and flexor digitorum longus, 17 patients). RESULTS: The mean follow-up period was 15 months (range, 8-28 mo). The equinus deformity disappeared clinically in all patients. Before the operation, all patients had an Ashworth Scale score of 2, with an inexhaustible clonus present on knee extension and persisting with knee flexion (Tardieu Scale score, 4), which was abolished in 95% of the patients after surgery. Two patients still had some clonus on knee extension; this did not interfere with their clinical improvement. Knee recurvatum disappeared in eight patients. Analysis of kinematic parameters demonstrated a statistically significant increase in joint motion of the second rocker (P = 0.0026) of the ankle during stance. The duration of the stance or swing phase, length of the walking cycle, and velocity or rate of spontaneous walking were not significantly modified. CONCLUSION: The study demonstrated that soleus neurotomy is effective for the treatment of spastic equinus foot, leading to abolition of spasticity and improvement in the range of ankle motion during the stance phase of gait.

[Application of RUG-T18 classification system to elderly patients admitted to a university hospital]. / Resultados al aplicar el sistema de clasificación de pacientes "RUG-T18" en ancianos ingresados a un hospital universitario.

BACKGROUND: Among case mix classifications, the best for hospitalized elders is the Resource Utilization Groups (RUG) system, which allows a better location of patients, resource administration and the design of health care strategies for elderly people. AIM: To report the results of RUG-T18 classification of elderly patients admitted to an university hospital. PATIENTS AND METHODS: RUG-T18 classification was applied to 210 patients aged 75.2 +/- 7.2 years old, 108 male, admitted to the Clinical Hospital of the Catholic University of Chile. RESULTS: The clinical classification of assessed patients was rehabilitation in 50.9% of cases, special care in 10.5%, clinically complex in 37.1% and reduced physical functions in 0.5%. None had behavioral alterations. There were no differences between subjects older or younger than 75 years old. Daily life activities showed that help was required for sphincter control in 46% of patients, for feeding in 44% and for mobilization in 64% (28% of patients required help from two or more people). Geriatric assessment showed that, since 1993, the proportion of elders with greater functional derangement increased from 18 to 28%, and the proportion of those with mental disturbances from 4 to 12%, specially among those over 75 years old. CONCLUSIONS: Most elders admitted to the hospital are classified in the superior categories of the RUG-T18 system and have severe mental and functional limitations. These patients require a multidisciplinary approach with a great emphasis in rehabilitation.

[Geriatric evaluation of elderly patients at a university hospital]. / Evaluación geriátrica de adultos mayores en un hospital universitario.

The aim of this work was to evaluate general aspects, medical diagnoses, degree of disability, mental status and social support of hospitalized elders using a Geriatric Assessment Scale, devised at the Catholic University. Ninety eight hospitalized subjects (58 female, aged 60 to 74 years old) were surveyed before discharge. Results showed that 34% had serious handicaps in their daily living and required third party help, 14% had a moderate cognitive impairment and that 12% lacked social or family support. We conclude that the scale is useful, easy to use and allows to obtain a thorough diagnosis of hospitalized elders.

[Hypomagnesemia associated with hypokalemia, hyponatremia and metabolic alkalosis. Possible complication of gentamycin therapy]. / Hipomagnesemia asociada con hipokalemia, hiponatremia y alcalosis metabolica. Posible complicacion del uso de gentamicina.

Hypomagnesemia is a serious abnormality with different causes and usually associated to other disorders of electrolyte metabolism. We report a female patient developing hypomagnesemia after administration of gentamycin. This was associated to severe hypokalemia, hyponatremia and metabolic alkalosis. Possible pathogenetic mechanisms and therapeutic measures are discussed.

Characterisation of strains of infectious bronchitis virus isolated in Chile.

Nine isolates of infectious bronchitis (IB)-like viruses were made from 23 flocks (broilers or layers) in Chile experiencing the types of disease problems commonly associated with IBV. Their identity as IB viruses was confirmed. The histological changes they caused in tracheal organ cultures (OC) are described. Serum neutralisation tests performed in embryonated eggs (alpha-method) suggested that four of the isolates were serologically related to the Massachusetts (Mass) serotype of IBV and one to Connecticut. The four other strains were examined further by a serum neutralisation test in OC (ss-method). One was found to be of the Mass serotype but the others were found to be unrelated antigenically to a wide range of IBV serotypes isolated in many countries over a number of years. One of these three strains and the Mass strain, when given intranasally to 8-day-old specified pathogen free chickens together with pathogenic serotypes of E.coli, caused some mortality and considerable morbidity. The H120 vaccine strain was found not to protect completely against challenge with these four strains 21 days later.

[Active rheumatoid arthritis: effect of dietary supplementation with omega-3 oils. A controlled double-blind trial]. / Artritis reumatóidea activa: efecto de la suplementación dietética con aceites omega 3. Estudio doble ciego controlado.

We evaluated the effect of dietary supplementation with eicosapentaenoic acid in 8 patients with active rheumatoid arthritis. An appropriate placebo was given in a randomized double blind fashion to 8 control subjects. After 12 weeks of therapy a significant improvement in prehensile function was detected in patients receiving active treatment, other clinical parameters remaining unchanged. No significant side effects were detected. A larger trial may help define a possible therapeutic role for omega-3 fatty acids in patients with rheumatoid arthritis.

[Experimental vaccines against avian inclusion body hepatitis. I. Serological evaluation]. / Vacunas experimentales contra hepatitis A cuerpo de inclusión aviar. I. Valoración serológica.

Two Inclusion Body Hepatitis (IBH) vaccines (Vac-19 and Vac-28) were elaborated from serotypes 4, 10 and 11, isolated from country field outbreaks. The strains were attenuated by passages in embryonating SPF chicken eggs (16 and 22 passages for both vaccines) and in kidney cell culture (3 and 6 passages respectively). Four experimental groups (G) were used: G I and G II of 8 chickens each, vaccinated orally (4,4 TCID50/ml) with Vac-19 and Vac-28 respectively, at the third week and re-vaccinated 35 days later with the same dose and method. Groups G III and G IV with 5 chickens each were the positive and negative controls, both group were not vaccinated, the first only challenged wit a pool of the 4, 10 and 11 serotypes on 45 days old and the last was not challenged. Prior and afterward, vaccination and challenge, clinical and serological exams were performed. The immune response was determined trough Agar Gel Precipitin (AGP) and serum neutralization (SN) test in chicken kidney cells (CKC) using the beta method (200 TCID50/50 microliters). Positive response (100%) was detected from day 43 onward in the vaccinated group, to AGP test. This situation occurred on day 55 for the challenged group (G III). Geometric mean titres (GMT) were, prior to challenge, 1.194 for G I and 23.525 for G II. After challenge, GMT were 7.760 and > or = 305.736 respectively. The GMT for G III was 640. No clinical signs or mortality were observed during the experiment. The conclusion is that only Vac-28 provided a partial protection to the fowl, measured through the lesions observed.

[Prospect of avian encephalomyelitis antibodies in breeding farms in Chile]. / Prospección de anticuerpos contra encefalomielitis aviar en planteles de reproductoras en Chile.

Ten different layer and broiler breeding farms, located in the central part of the country were sampled to detect antibodies against the Avian Encephalomyelitis Virus (AEV). Fifty embrionated eggs, per house, were examined using the Embryo Susceptibility Test. Samples of eggs from 21 houses of broiler breeder hens and 9 of breeder layers were collected from all the poultry farms studied. The antigen used in the Embryo Susceptibility Test was prepared from the van Roekel strain for AEV. The results indicated a high degree of specific immunity against the AEV in 86.7% of the sections checked. This immunity could be due to the presence of the causal of AEV in natural form, since the birds in these farms had not been vaccinated against this ornithopathy. This is the first study carried out in Chile which detected the presence of antibodies against AEV in layer and broiler breeding farms, leading to a massive vaccination program against the disease in the country.

[Changes in the nutritional status of the lactating women during exclusive lactation]. / Cambios en el estado nutricional de la nodriza durante lactancia exclusiva.

In order to evaluate the influence of breast feeding upon selected nutritional parameters of lactating women, several anthropometric and biochemical measurements were performed during the interval between 40 and 180 postpartum days in 54 women in full and satisfactory nursing. Only one significant change was detected in measurements done for nutritional assessment: loss of body weight. No changes were detected in hemoglobin levels or in serum protein and albumin. There was high variability in body weight changes with a mean loss of 1.5 kg due especially to a loss in fat body mass and, in a lesser proportion, to loss in lean body mass. The mean food intake did not change during the observation period. The mean caloric intake was 2,771 cal/day at the beginning and 2,737 cal/day in the end of the study. A significant correlation was established between the individual energetic intake and the body weight changes of lactating women. The allowance of 2,750 cal/day suggested by FAO/WHO for lactating women seems adequate for the health of women in a normal nutritional condition, but apparently insufficient to overcome undernutrition in women who initiate lactation with this condition. In spite of the small nutritional impact observed, our results support the need for food supplementation programs destined to lactating women, with special orientation to undernourished women of low socioeconomic level.

[Combination of rapeseed (Brassica napus) and barley in the feeding of broilers. I. Nutritional aspects]. / Combinación de semilla de colza (Raps) (Brassica napus) y cebada en la alimentación de pollos de engorde (broilers). I. Aspectos nutricionales.

A total of 160 chicks were distributed into three experimental and control groups. Each group had two blocks, males and females, and during their two growing periods of 0-40 and 41-70 days, the four groups received isocaloric and isoproteic diets. The metabolic energy of sorghum (2,000 kcal) in the control groups was replaced by the combination of rapeseed and barley, in the proportions of 34.0, 67.0 and 83.5%, respectively, in the experimental groups. The results obtained by the treatments did not show any significant difference (P less than or equal to 0.05) in weight gains, feed consumption and feed conversion during the whole growing period of the chickens. On the other hand, throughout the two development stages of the animals, there were differences (P less than or equal to 0.05 and P less than or equal to 0.01) in average weight gains between the male and female blocks in the experimental and control groups. The results of the present trial suggest that the association of rapeseed and barley may have a place as a satisfactory energy source in the formulation of broiler diets. Considering the constant increase of rapeseed production in the southern part of Chile, and the deficiency of energetic foods in chicken rations, rape has shown to be a good substitute and has been found to meet the basic requirements.