Microbiological performance and adherence in blood culture protocols: The role of a second anaerobic bottle.

Background: Bacteremia represents high rates of morbidity and mortality, especially in developing countries, highlighting the need for a diagnostic method that allows prompt and appropriate patient treatment. This study compared microbiological performance and adherence of two blood culture protocols for the diagnosis of bacteremia. Methods: Quasi-experimental study conducted between June 2022 and February 2023. Two blood culture protocols were evaluated. Protocol 1 included two aerobic bottles and one anaerobic bottle. Protocol 2 included two aerobic and two anaerobic bottles. Protocols were analyzed in three phases: evaluation of protocol 1 (Phase 1); evaluation of protocol 1 plus educational activities for healthcare staff (Phase 2) and evaluation of protocol 2 (Phase 3). Results: 342 patients and 1155 blood culture bottles (732 aerobic and 423 anaerobic) were included. Positivity was 17.6 %, 22.8 % and 19.4 % in phases 1, 2 and 3, respectively. Among patients with bacteremia, 84.5 % had positive anaerobic bottles, with 9.9 % showing growth only in this bottle. The contamination rates were 1.9 %, 0.3 %, and 0.8 % for each phase, mainly in aerobic bottles. Median positivity time was 11 h for both bottes aerobic and anaerobic. Overall nursing adherence increased from 13.1 % in Phase 1, 25.9 % in Phase 2, and 28.1 % in Phase 3 (p = 0.009). Conclusions: The findings indicate that adding a second anaerobic bottle does not enhance blood culture positivity. Rather than increasing bottle quantity, staff training might be a more effective approach to optimize results.

Mastocytic Enterocolitis: An Overlooked Diagnosis for Unexplained Chronic Diarrhea in a Patient With Colon Polyps and a Family History of Colon Cancer.

Chronic intractable diarrhea is a common presenting complaint that is often clinically worked up for a wide variety of diseases including inflammatory bowel disease, celiac disease, and hyperthyroidism. When lab results come back normal, patients are often diagnosed with irritable bowel disease-diarrheal subtype, overlooking the potential diagnosis of mastocytic enterocolitis. Mastocytic enterocolitis is an uncommon diagnosis where patients can benefit from mast cell stabilizers that directly target the underlying pathology. Given the broad differential diagnosis of nonspecific diarrhea presentation, a histopathological examination is warranted for definitive diagnosis. We hope to raise awareness of this potentially treatable disease that can be effectively managed with antihistamines. We describe the case of a 63-year-old male patient with a family history significant for colon cancer who presented with intractable diarrhea and was ultimately diagnosed with mastocytic enterocolitis by histopathology. His symptoms were relieved by antihistamine treatment.

Genotype imputation performance of three reference panels using African ancestry individuals.

Genotype imputation estimates unobserved genotypes from genome-wide makers, to increase genome coverage and power for genome-wide association studies. Imputation has been successful for European ancestry populations in which very large reference panels are available. Smaller subsets of African descent populations are available in 1000 Genomes (1000G), the Consortium on Asthma among African ancestry Populations in the Americas (CAAPA) and the Haplotype Reference Consortium (HRC). We compared the performance of these reference panels when imputing variation in 3747 African Americans (AA) from two cohorts (HCV and COPDGene) genotyped using Illumina Omni microarrays. The haplotypes of 2504 (1000G), 883 (CAAPA) and 32,470 individuals (HRC) were used as reference. We compared the number of variants, imputation quality, imputation accuracy and coverage between panels. In both cohorts, 1000G imputed 1.5-1.6× more variants than CAAPA and 1.2× more than HRC. Similar findings were observed for variants with imputation R2 > 0.5 and for rare, low-frequency, and common variants. When merging imputed variants of the three panels, the total number was 62-63 M with 20 M overlapping variants imputed by all three panels, and a range of 5-15 M variants imputed exclusively with one of them. For overlapping variants, imputation quality was highest for HRC, followed by 1000G, then CAAPA, and improved as the minor allele frequency increased. 1000G, HRC and CAAPA provided high performance and accuracy for imputation of African American individuals, increasing the number of variants available for subsequent analyses. These panels are complementary and would benefit from the development of an integrated African reference panel.

Caracterización de los procedimientos para la realización de hemocultivos en pacientes adultos, en instituciones hospitalarias del Área Metropolitana del Valle de Aburrá / Characterization of procedures for performing blood cultures in adult patients, in hospitals of the Metropolitan Area of Aburrá Valley

Objetivo: Caracterizar procedimientos para la toma, análisis, reporte y aseguramiento de la calidad en hemocultivos en pacientes adultos, en instituciones hospitalarias. Material Y método: Estudio descriptivo en 15 Hospitales de Medellín y alrededores. Se empleó un formulario semiestructurado para recolectarla información, se utilizó SPSS(r) para el análisis. Resultados: Todas las instituciones tienen protocolos basados en fuentes de autoridad reconocida; con diferencias importantes en procesos pre-analíticos y postanalíticos. Los Productos más empleados para la antisepsia fueron gluconato declorhexidina al 2-4%(66,7%) Y alcohol isopropílico o etílico al 70% (20,0%),Con discrepancias en los tiempos de acción. El 73,3% emplea guantes estériles y la misma proporción usa sistema abierto (jeringa) para la venopunción. En el 46,6% se toman dos botellas aerobias y una anaerobia por episodio y en 33,3% dos botellas aerobias. El 66,6% lleva un indicador de contaminación, 53,3% de positividad y 26,6% de volumen de sangre. La tasa promedio de hemocultivos contaminados durante el semestre de seguimiento fue 1,61%. Conclusión: Se observa heterogeneidad en los procedimientos, especialmente en fases pre-analítica y post-analítica. En La búsqueda de la excelencia y la seguridad del paciente son necesarios protocolos estandarizados e indicadores para medir y controlar el desempeño de los hemocultivos.

Objective: To characterize the procedures that are performed for the collection, analysis, reporting and quality assurance of blood cultures in adult patients in hospital institutions. Material and Methods: Descriptive study in 15 hospitals of Medellin and its surroundings. A semi-structured collection instrument was used to collect the information provided by each hospital; SPSS(r) was used for the analysis. Results: All Institutions have protocols based o nauthorized sources; there were important differences in the pre-analytic and post-analytic processes. The Products employed for skin antisepsis were2-4% Chlorhexidine gluconate (66.7%)And70% Isopropyl or ethyl alcohol(20.0%), with discrepancies in product action times. 73.3% use sterile gloves and an equal proportion uses an open system (syringe) for venipuncture. Two aerobic and one anaerobic bottles are taken per episode in adult patients in 46.6% of institutions and only two aerobic bottles in 33.3% of them. Indicators of contamination were used by 66.6 % of institutions, of positivity in 53.3% and of blood volume in 26.6%. The average rate of contaminated blood cultures during the follow-up period was 1.61%. Conclusion: Heterogeneity in the procedures was observed especially in the pre-analytic and post-analytical phases. In the pursuit of excellence and patient safety, standardized protocols and the use of indicators to measure and control the performance of blood cultures are needed.

Caracterización clínica del dengue y variables predictoras de gravedad en pacientes pediátricos en un hospital de segundo nivel en Chilpancingo, Guerrero, México: serie de casos / Clinical profile of dengue and predictive severity variables among children at a secondary care hospital of Chilpancingo, Guerrero, Mexico: case series

Resumen: Introducción: El dengue sigue en incremento a nivel mundial y actualmente la mayor incidencia de primera infección ocurre en población pediátrica. El dengue grave es potencialmente letal en menores de edad. Este estudio caracteriza el perfil clínico de pacientes pediátricos con dengue atendidos en un hospital de segundo nivel en Chilpancingo, Guerrero, México. Métodos: Serie de casos conformada por 133 pacientes pediátricos hospitalizados con diagnóstico de dengue no grave y dengue grave, de acuerdo a criterios clínicos. Los resultados del análisis univariado de los signos y síntomas clínicos fueron expresados como promedios o porcentajes, y se consideró nivel de significancia estadística de 0.05. Mediante GLMM (Generalised Linear Mixed Models) se estimó la predicción de dengue grave con la presencia de signos y síntomas clínicos. Resultados: El 58% (77/133) de los pacientes fue clasificado como dengue grave. Hubo diferencias significativas entre los grupos de dengue en los signos y síntomas siguientes: fiebre, dolor abdominal, epistaxis y cuenta plaquetaria. El dengue grave se presentó en mayor proporción en los pacientes mayores de cuatro años de edad (p<0.05). El GLMM identificó un conjunto de cuatro signos y síntomas clínicos (fiebre ≥39 °C, mialgias, artralgias y dolor abdominal) como predictores de la gravedad del dengue. Conclusiones: Los resultados de este estudio exploratorio sugieren cambios en la frecuencia de síntomas y signos clínicos del dengue en la población pediátrica. Pacientes pediátricos con diagnóstico presuntivo de dengue que presenten fiebre ≥39 °C, mialgias, artralgias y dolor abdominal deben considerarse como potenciales casos de dengue grave.

Abstract: Background: Dengue continues to increase globally. Currently, the highest incidence of first infection occurs in paediatric population, where severe dengue fever is potentially lethal. This study characterizes the clinical profile of paediatric patients with dengue fever in the South of Mexico. Methods: We undertook a series case study of 133 paediatric inpatients who presented clinical diagnosis of non-severe dengue and severe dengue fever. We described univariate analysis as means or percentages, using 0.05 as significance level. We estimated the prediction of severe dengue considering clinical signs and symptoms only using GLMM (Generalised Linear Mixed Models). Results: 58% (77/133) patients had severe dengue. There were significant differences among the dengue groups, in the following signs and symptoms: Fever, abdominal pain, epistaxis and platelet count. Children older than four years old had a higher proportion of severe dengue (p<0.05). GLMM identified a group of four clinical signs and symptoms (fever ≥39 °C, myalgia, arthralgia and abdominal pain) as predictors of severe dengue. Conclusions: The results of this exploratory study suggest changes in the frequency of clinical signs and symptoms among paediatric inpatients. Paediatric patients with a presumptive diagnosis of dengue, showing fever of ≥39° C, myalgia, arthralgia and abdominal pain should be considered as potential cases of severe dengue.

[Clinical profile of dengue and predictive severity variables among children at a secondary care hospital of Chilpancingo, Guerrero, Mexico: case series]. / Caracterización clínica del dengue y variables predictoras de gravedad en pacientes pediátricos en un hospital de segundo nivel en Chilpancingo, Guerrero, México: serie de casos.

BACKGROUND: Dengue continues to increase globally. Currently, the highest incidence of first infection occurs in paediatric population, where severe dengue fever is potentially lethal. This study characterizes the clinical profile of paediatric patients with dengue fever in the South of Mexico. METHODS: We undertook a series case study of 133 paediatric inpatients who presented clinical diagnosis of non-severe dengue and severe dengue fever. We described univariate analysis as means or percentages, using 0.05 as significance level. We estimated the prediction of severe dengue considering clinical signs and symptoms only using GLMM (Generalised Linear Mixed Models). RESULTS: 58% (77/133) patients had severe dengue. There were significant differences among the dengue groups, in the following signs and symptoms: Fever, abdominal pain, epistaxis and platelet count. Children older than four years old had a higher proportion of severe dengue (p<0.05). GLMM identified a group of four clinical signs and symptoms (fever ≥39°C, myalgia, arthralgia and abdominal pain) as predictors of severe dengue. CONCLUSIONS: The results of this exploratory study suggest changes in the frequency of clinical signs and symptoms among paediatric inpatients. Paediatric patients with a presumptive diagnosis of dengue, showing fever of ≥39° C, myalgia, arthralgia and abdominal pain should be considered as potential cases of severe dengue.

Análisis de la mortalidad en enfermedades Hemato-oncológicas malignas en pediatría en hospitales públicos de Argentina / Analysis of Mortality due to Hemato-Oncological Pediatrics Malignancies in Public Hospitals in Argentina

INTRODUCCION: En Argentina, la mortalidad por enfermedades malignas en edad pediátrica ocupa un lugar relevante y sus causas todavía no han sido estudiadas en el país. OBJETIVO: Analizar las tasas, causas y etapas de los fallecimientos relacionados con neoplasias en centros públicos seleccionados, desde enero de 2000 a diciembre de 2010. METODOS: Se analizaron las historias clínicas de los pacientes fallecidos por cáncer en centros registrados en el Registro Oncopediátrico Hospitalario Argentino (ROHA) y en los registros individuales de los servicios de Hemato-Oncología. Se clasificaron las causas de mortalidad, la etapa en la cual se produjo el óbito y su relación con el tratamiento o con la patología de base. Se pesquisaron las causas de comorbilidad y las demoras en el diagnóstico y tratamiento. RESULTADOS: En 13 centros se analizó exitosamente un promedio >70...(AU)

INTRODUCTION: In Argentina, the mortality of pediatric malignant diseases occupies an important place causes have not yet been studied in the country. OBJECTIVE:To analyze mortality rates, causes and moment of death related to neoplasias in selected public centers from January 2000 until December 2010. METHODS: The analysis was conducted in clinical records of patients who died due to cancer. The cases were registered in the Argentine Hospital Oncopediatric Registry (ROHA)and by different registries belonging to hemato-oncological departments. Mortality causes were classified according to the phase of therapy when the event occurred and the relation shipof death with the treatment or underlying disease. Causes of comorbility and delays in diagnosis/treatment were also analyzed. RESULTS: In 13 centers, more than 70...(AU)

Análisis de la mortalidad en enfermedades Hemato-oncológicas malignas en pediatría en hospitales públicos de Argentina / Analysis of Mortality due to Hemato-Oncological Pediatrics Malignancies in Public Hospitals in Argentina

INTRODUCCIÓN: En Argentina, la mortalidad por enfermedades malignas en edad pediátrica ocupa un lugar relevante y sus causas todavía no han sido estudiadas en el país. OBJETIVO: Analizar las tasas, causas y etapas de los fallecimientos relacionados con neoplasias en centros públicos seleccionados, desde enero de 2000 a diciembre de 2010. MÉTODOS: Se analizaron las historias clínicas de los pacientes fallecidos por cáncer en centros registrados en el Registro Oncopediátrico Hospitalario Argentino (ROHA) y en los registros individuales de los servicios de Hemato-Oncología. Se clasificaron las causas de mortalidad, la etapa en la cual se produjo el óbito y su relación con el tratamiento o con la patología de base. Se pesquisaron las causas de comorbilidad y las demoras en el diagnóstico y tratamiento. RESULTADOS: En 13 centros se analizó exitosamente un promedio >70...

INTRODUCTION: In Argentina, the mortality of pediatric malignant diseases occupies an important place causes have not yet been studied in the country. OBJECTIVE:To analyze mortality rates, causes and moment of death related to neoplasias in selected public centers from January 2000 until December 2010. METHODS: The analysis was conducted in clinical records of patients who died due to cancer. The cases were registered in the Argentine Hospital Oncopediatric Registry (ROHA)and by different registries belonging to hemato-oncological departments. Mortality causes were classified according to the phase of therapy when the event occurred and the relation shipof death with the treatment or underlying disease. Causes of comorbility and delays in diagnosis/treatment were also analyzed. RESULTS: In 13 centers, more than 70...

CC8 MRSA strains harboring SCCmec type IVc are predominant in Colombian hospitals.

BACKGROUND: Recent reports highlight the incursion of community-associated MRSA within healthcare settings. However, knowledge of this phenomenon remains limited in Latin America. The aim of this study was to evaluate the molecular epidemiology of MRSA in three tertiary-care hospitals in Medellín, Colombia. METHODS: An observational cross-sectional study was conducted from 2008-2010. MRSA infections were classified as either community-associated (CA-MRSA) or healthcare-associated (HA-MRSA), with HA-MRSA further classified as hospital-onset (HAHO-MRSA) or community-onset (HACO-MRSA) according to standard epidemiological definitions established by the U.S. Centers for Disease Control and Prevention (CDC). Genotypic analysis included SCCmec typing, spa typing, PFGE and MLST. RESULTS: Out of 538 total MRSA isolates, 68 (12.6%) were defined as CA-MRSA, 243 (45.2%) as HACO-MRSA and 227 (42.2%) as HAHO-MRSA. The majority harbored SCCmec type IVc (306, 58.7%), followed by SCCmec type I (174, 33.4%). The prevalence of type IVc among CA-, HACO- and HAHO-MRSA isolates was 92.4%, 65.1% and 43.6%, respectively. From 2008 to 2010, the prevalence of type IVc-bearing strains increased significantly, from 50.0% to 68.2% (p = 0.004). Strains harboring SCCmec IVc were mainly associated with spa types t1610, t008 and t024 (MLST clonal complex 8), while PFGE confirmed that the t008 and t1610 strains were closely related to the USA300-0114 CA-MRSA clone. Notably, strains belonging to these three spa types exhibited high levels of tetracycline resistance (45.9%). CONCLUSION: CC8 MRSA strains harboring SCCmec type IVc are becoming predominant in Medellín hospitals, displacing previously reported CC5 HA-MRSA clones. Based on shared characteristics including SCCmec IVc, absence of the ACME element and tetracycline resistance, the USA300-related isolates in this study are most likely related to USA300-LV, the recently-described 'Latin American variant' of USA300.

Amerind ancestry, socioeconomic status and the genetics of type 2 diabetes in a Colombian population.

The "thrifty genotype" hypothesis proposes that the high prevalence of type 2 diabetes (T2D) in Native Americans and admixed Latin Americans has a genetic basis and reflects an evolutionary adaptation to a past low calorie/high exercise lifestyle. However, identification of the gene variants underpinning this hypothesis remains elusive. Here we assessed the role of Native American ancestry, socioeconomic status (SES) and 21 candidate gene loci in susceptibility to T2D in a sample of 876 T2D cases and 399 controls from Antioquia (Colombia). Although mean Native American ancestry is significantly higher in T2D cases than in controls (32% v 29%), this difference is confounded by the correlation of ancestry with SES, which is a stronger predictor of disease status. Nominally significant association (P<0.05) was observed for markers in: TCF7L2, RBMS1, CDKAL1, ZNF239, KCNQ1 and TCF1 and a significant bias (P<0.05) towards OR>1 was observed for markers selected from previous T2D genome-wide association studies, consistent with a role for Old World variants in susceptibility to T2D in Latin Americans. No association was found to the only known Native American-specific gene variant previously associated with T2D in a Mexican sample (rs9282541 in ABCA1). An admixture mapping scan with 1,536 ancestry informative markers (AIMs) did not identify genome regions with significant deviation of ancestry in Antioquia. Exclusion analysis indicates that this scan rules out ~95% of the genome as harboring loci with ancestry risk ratios >1.22 (at P < 0.05).

Análisis de la mortalidad en enfermedades hemato-oncológicas malignas en pediatría: estudio multicéntrico en 14 hospitales públicos argentinos / Study of mortality due to hemato-oncological malignancies during childhood: multicenter study in 14 public hospitals in Argentina

INTRODUCCION: La mortalidad producida de forma temprana y durante diferentes fases del tratamiento de los niños con enfermedades hemato-oncológicas malignan es una de las causas de fracaso de los tratamientos actuales. Las tasas de mortalidad y sus causas no han sido estudiadas en Argentina.OBJETIVO: Analizar las tasas, causas y etapas de los fallecimientos relacionados con neoplasias en 14 centros públicos desde enero de 2000 a diciembre de 2010.METODOS: Se analizaron las historias clínicas de los pacientes fallecidos por cáncer en 14 centros identificados en el Registro Onco-Hematológico Argentino y en los registros individuales de los servicios de Hemato-Oncología. Se clasificaron las causas de muerte, la etapa en la cual se produjo el óbito y su relación con el tratamiento o con la patología de base. Se pesquisaron las causas de co-morbilidad y las demoras en el diagnóstico y tratamiento, así como las particularidades de cada centro.RESULTADOS: En 13 centros se analizó exitosamente un promedio >70% de los óbitos, y en el restante se obtuvieron datos del 35%. La tasa de mortalidad fue >40% en 3 centros, ≥30% en 7 y 30% de mortalidad en los primeros 5 años analizados, la tasa disminuyó a 20% de los pacientes fallecidos. La principal causa de muerte en las etapas tempranas del diagnóstico y tratamiento correspondió a infecciones severas.CONCLUSIONES: Es indispensable desarrollar políticas de salud para revertir la elevada mortalidad en niños con cáncer en Argentina. Para ello, se deben aplicar programas que incluyan reformas estructurales, formación de recursos humanos y equipamiento, además de un trabajo colaborativo continuo y eficiente.

INTRODUCTION:The early mortality occurred at different stages of the treatment agains hemato-oncological malignancies during childhood is one of the causes of failure of modern therapies. In Argentina, the mortality rates and their causes have not been studied yet.OBJECTIVE: To analyze mortality rates, causes and moment of death in children with malignant diseases in 14 public centers from January 2000 until December 2010.METHODS: The analysis was conducted in clinical records of patients who died due to malignant diseases in 14 centers. The cases were identified by the national register for hematology and oncology diseases (ROHA) and by different registers belonging to hemato-oncological departments. Causes were classified according to the phase of therapy when the event occurred and the relationship of death with the treatment or underlying disease. Causes of co-morbility, delays in diagnosis/during treatment and particular features of the centers were also analyzed.RESULTS: In 13 centers, more than 70% of the deaths were successfully analyzed, while there was information of 35% for the remaining one. The mortality rate was >40% in 3 centers, ≥30% in 7 and 30% of mortality during the first 5 years of the analyzed period, the rate decreased to <25% as a hemato-oncologist joined the medical staff. The access to information was difficult in all the centers. In 5 of them there were delays during the diagnostic evaluation and treatment in about 20% of the dead patients. The main cause of death during early phases of diagnosis and treatment was related to severe infectious complications.CONCLUSIONS: It is fundamental to develop appropriate health policies in order to decrease mortality rates among children with cancer in Argentina. They should include programs for structural reform, human resource development and equipment supply, as well as continuous cooperative work.

Análisis de la mortalidad en enfermedades hemato-oncológicas malignas en pediatría: estudio multicéntrico en 14 hospitales públicos argentinos / Study of mortality due to hemato-oncological malignancies during childhood: multicenter study in 14 public hospitals in Argentina

INTRODUCCION: La mortalidad producida de forma temprana y durante diferentes fases del tratamiento de los niños con enfermedades hemato-oncológicas malignan es una de las causas de fracaso de los tratamientos actuales. Las tasas de mortalidad y sus causas no han sido estudiadas en Argentina.OBJETIVO: Analizar las tasas, causas y etapas de los fallecimientos relacionados con neoplasias en 14 centros públicos desde enero de 2000 a diciembre de 2010.METODOS: Se analizaron las historias clínicas de los pacientes fallecidos por cáncer en 14 centros identificados en el Registro Onco-Hematológico Argentino y en los registros individuales de los servicios de Hemato-Oncología. Se clasificaron las causas de muerte, la etapa en la cual se produjo el óbito y su relación con el tratamiento o con la patología de base. Se pesquisaron las causas de co-morbilidad y las demoras en el diagnóstico y tratamiento, así como las particularidades de cada centro.RESULTADOS: En 13 centros se analizó exitosamente un promedio >70% de los óbitos, y en el restante se obtuvieron datos del 35%. La tasa de mortalidad fue >40% en 3 centros, ≥30% en 7 y <25% en 4. En un centro con >30% de mortalidad en los primeros 5 años analizados, la tasa disminuyó a <25% con la incorporación de una hemato-oncóloga. El acceso a los datos fue dificultoso en todos los centros. En 5 de ellos, hubo demoras en el diagnóstico y/o tratamiento en >20% de los pacientes fallecidos. La principal causa de muerte en las etapas tempranas del diagnóstico y tratamiento correspondió a infecciones severas.CONCLUSIONES: Es indispensable desarrollar políticas de salud para revertir la elevada mortalidad en niños con cáncer en Argentina. Para ello, se deben aplicar programas que incluyan reformas estructurales, formación de recursos humanos y equipamiento, además de un trabajo colaborativo continuo y eficiente.

INTRODUCTION:The early mortality occurred at different stages of the treatment agains hemato-oncological malignancies during childhood is one of the causes of failure of modern therapies. In Argentina, the mortality rates and their causes have not been studied yet.OBJECTIVE: To analyze mortality rates, causes and moment of death in children with malignant diseases in 14 public centers from January 2000 until December 2010.METHODS: The analysis was conducted in clinical records of patients who died due to malignant diseases in 14 centers. The cases were identified by the national register for hematology and oncology diseases (ROHA) and by different registers belonging to hemato-oncological departments. Causes were classified according to the phase of therapy when the event occurred and the relationship of death with the treatment or underlying disease. Causes of co-morbility, delays in diagnosis/during treatment and particular features of the centers were also analyzed.RESULTS: In 13 centers, more than 70% of the deaths were successfully analyzed, while there was information of 35% for the remaining one. The mortality rate was >40% in 3 centers, ≥30% in 7 and <25% in 4. At a center which had >30% of mortality during the first 5 years of the analyzed period, the rate decreased to <25% as a hemato-oncologist joined the medical staff. The access to information was difficult in all the centers. In 5 of them there were delays during the diagnostic evaluation and treatment in about 20% of the dead patients. The main cause of death during early phases of diagnosis and treatment was related to severe infectious complications.CONCLUSIONS: It is fundamental to develop appropriate health policies in order to decrease mortality rates among children with cancer in Argentina. They should include programs for structural reform, human resource development and equipment supply, as well as continuous cooperative work.

Calidad del programa detección temprana y control de cáncer de cuello uterino en hospitales públicos de municipios con altas tasas de mortalidad, Antioquia, Colombia, 2010 / Quality of the program for timely detection and control of cervical cancer in public hospitals located in municipalities with high mortality, Antioquia, Colombia, 2010

Introducción: en Colombia se creó el Programa Detección temprana y control cáncer de cuello uterino para intervenir esta enfermedad. Aunque la reforma del Sistema General de Seguridad Social en Salud incluye la calidad de la atención en salud entre sus componentes, la prestación de los servicios de prevención de la enfermedad se realiza mediante actividades desarticuladas, deteriorándose los procesos de atención y control. Objetivo: evaluar la calidad del Programa Detección temprana y control de cáncer de cuello uterino, en hospitales públicos de nueve municipiosde Antioquia, Colombia con altas tasas de mortalidad. Materiales y métodos: estudio descriptivo transversal; se incluyeron nueve municipios con tasas de mortalidad más altas que el promediode Antioquia durante 2000 a 2006...

Introduction: the program for timely detection and control of cervical cancer was created in Colombia to intervene in this disease. Although the reform of the General System of Social Security in Health includes the quality of health care among its components, the provision of disease prevention services is made through unarticulated activities, which disrupts the processes of health care and control. Objective: to assess the quality of the program for timely detection and control of cervical cancer in public hospitals of nine municipalities of Antioquia with high mortality rates. Materials and methods: a descriptive study was conducted. It included ninemunicipalities with mortality rates higher than the mean in Antioquia between 2000 and 2006...

[Frequencies of congenital malformations: assessment and prognosis of 52,744 births in three cities of Colombia]. / Frecuencia de malformaciones congénitas: evaluación y pronóstico de 52.744 nacimientos en tres ciudades colombianas.

INTRODUCTION: The Instituto de Genética Humana of the Pontificia Universidad Javeriana conducted an epidemiological surveillance of congenital malformations as defined by criteria provided by the Latin American Collaborative Study of Congenital Malformations. OBJECTIVE: The frequency of the main congenital malformations were tabulated for major urban centers in Colombia. MATERIALS AND METHODS: Information was gathered from 52,744 newborns between April 2001 and January 2008 in three cities of Colombia (Bogotá, Ubaté and Manizales). Data included the age of mother, gestational age, gender and weight of the newborn and the congenital malformation. Cases were classified according to a prognostic scale to assess the impact of health team interventions in the recovery process. RESULTS: Congenital defects were noted in 3.1% of the newborns. The most frequent congenital defects were those of the ears. Clubfoot, polydactyly and cleft lip or palate were more common amongst males. The weight and gestational age were lower in the congenitally affected in comparison with the control group. The prognostic scale of congenital malformations indicated that most of these patients are at high risk of death or disability and that the intervention of the health team changed the patient's prognosis in approximately 80% of the cases. CONCLUSION: Frequencies of congenital malformations in Colombia were similar to those reported in other countries. The interventions of the health team in treating patients with congenital malformations directly affected patient prognosis. Therefore, early diagnosis and adequate interdisciplinary treatment were recommended by these data in order to reduce disability and improve the quality of life of these patients.

Aminoguanidine administered during the induction of oral tolerance alters the systemic response of the tolerised rats.

Herewith we investigated the role of nitric oxide synthase (NOS)-II in the establishment of oral tolerance induced by low antigen dose. To accomplish this, we used a rat model of oral tolerance induced by intragastric administration of low doses of ovalbumin (OVA). NOS-II was inhibited in vivo during the onset of tolerance by intraperitoneal (i.p.) treatment with aminoguanidine (AMG), a selective NOS-II inhibitor. Four experimental groups were generated: (TOL), tolerised rats, receiving OVA but no AMG; (TAG), rats tolerised with OVA and simultaneously receiving AMG i.p.; (CAG), controls treated with AMG but no oral antigen; and (CONT), controls receiving neither OVA nor AMG treatment. The state of oral tolerance was evaluated in all groups by analysing several immune parameters upon subcutaneous administration of OVA in Freund's complete adjuvant. First, we were able to determine that NOS-II inhibition altered the TH1/TH2 balance in tolerised rats, driving the TH2 anti-OVA response in TOL rats towards TH1 in TAG animals, which showed enhanced delayed hypersensitivity responses. Second, splenocyte cultures from TAG rats showed lower levels of IL-10 production compared to TOL samples as determined by ELISA analysis. Last, we detected the presence of a functional distinct Tr1 regulatory T cell population in spleen samples recovered from TAG animals. Contrary to what happened with TOL Tr1 cells, the levels of Tr1 cells in TAG samples were modified by in vitro stimulation with OVA. All together, these data indicate a preponderant role for NOS-II in the process of oral tolerance induced by low antigen dose.

Frecuencia de malformaciones congénitas: evaluación y pronóstico de 52.744 nacimientos en tres ciudades colombianas / Frequencies of congenital malformations: assessment and prognosis of 52, 744 births in three cities of Colombia

Introducción. El Instituto de Genética Humana, de la Pontificia Universidad Javeriana, desarrolla un programa de vigilancia de malformaciones congénitas con metodologías modificadas del Estudio Colaborativo Latinoamericano de Malformaciones Congénitas. Objetivo. Describir la frecuencia de las principales malformaciones congénitas en el país.Materiales y métodos. Entre abril de 2001 y enero de 2008, se obtuvo información sobre los pacientes con malformaciones congénitas y se analizaron la edad materna, la edad de gestación, el sexo y el peso del neonato, y la malformación congénita. Se clasificaron los casos según una escala de pronóstico para evaluar el impacto de la intervención del equipo de salud en la evolución de estos pacientes.Resultados. De 52.744 nacimientos en tres ciudades, 3,12% presentó alguna malformación congénita. Las anomalías de la oreja fueron las más frecuentes. El pie equino varo, la polidactilia y el labio y paladar hendidos, afectaron más a los pacientes de sexo masculino. El peso y la edad de gestación fueron menores en el grupo de los casos que en el de los controles. La escala de pronóstico mostró un alto riesgo de mortalidad o discapacidad en 54% de los pacientes y reveló que la intervención del equipo de salud cambia el pronóstico en más de 80% de los casos. Conclusión. Las frecuencias encontradas son similares a las del resto del mundo. La intervención del equipo de salud debe influir en el pronóstico de estas patologías. Un manejo temprano, adecuado e interdisciplinario es vital para disminuir la discapacidad y mejorar la calidad de vida de estos pacientes.

Introduction. The Instituto de Genética Humana of the Pontificia Universidad Javeriana conducted an epidemiological surveillance of congenital malformations as defined by criteria provided by the Latin American Collaborative Study of Congenital Malformations. Objective. The frequency of the main congenital malformations were tabulated for major urban centers in Colombia. Materials and methods. Information was gathered from 52,744 newborns between April 2001 and January 2008 in three cities of Colombia (Bogotá, Ubaté and Manizales). Data included the age of mother, gestational age, gender and weight of the newborn and the congenital malformation. Cases were classified according to a prognostic scale to assess the impact of health team interventions in the recovery process. Results. Congenital defects were noted in 3.1% of the newborns. The most frequent congenital defects were those of the ears. Clubfoot, polydactyly and cleft lip or palate were more common amongst males. The weight and gestational age were lower in the congenitally affected in comparison with the control group. The prognostic scale of congenital malformations indicated that most of these patients are at high risk of death or disability and that the intervention of the health team changed the patient´s prognosis in approximately 80% of the cases. Conclusion. Frequencies of congenital malformations in Colombia were similar to those reported in other countries. The interventions of the health team in treating patients with congenital malformations directly affected patient prognosis. Therefore, early diagnosis and adequate interdisciplinary treatment were recommended by these data in order to reduce disability and improve the quality of life of these patients.

Nosocomial Plasmodium falciparum infections confirmed by molecular typing in Medellín, Colombia.

Three cases of nosocomial malaria are reported from patients of the Internal Medicine Ward of a tertiary University teaching hospital in Medellin, Colombia. Epidemiological research, based on entomological captures, medical records review and interviews of nursery staff about patient care practices potentially involving contact with blood, were carried out. Molecular characterization of Plasmodium falciparum was based on the amplification of MSP1, MSP2 and GLURP genes. This method enabled confirmation of the same P. falciparum genotype in all three patients as well as in a fourth one (index case). The presence of nosocomial malaria was confirmed and it was concluded that the most likely source of transmission was through multi-dose preparations of heparin applied to heparin locks.

Enterococo resistente a vancomicina en un hospital universitario: características clínicas y epidemiológicas de 100 casos, 1998-2003 / Vancomycin resistent Enterococcus in a teaching hospital: clinical and epidemiological features of 100 cases, 1998-2003

Introducción: el enterococo resistente a vancomicina (ERV) se ha convertido en una causa importante de infección Nosocomial, especialmente en unidades de cuidado intensivo y unidades hematooncológicas. Se hace entonces necesario conocer la dinámica epidemiológica en cada institución con el fin de implementar medidas de control. El propósito de este estudio fue caracterizar desde el punto de vista epidemiológico, microbiológico y clínico, 100 pacientes con ERV en un hospital universitario, en el período comprendido entre junio de 1998 y marzo de 2003. Materiales y métodos: se realizó un estudio descriptivo prospectivo en 100 pacientes con aislamiento de ERV en sitio diferente a materia fecal, hospitalizados durante el período de estudio. El proceso microbiológico se hizo por método automatizado Vitek (Biomerieux) y en algunos casos por método manual, difusión en disco. Los datos de las variables fueron tomados directamente por los investigadores a medida que se iban presentando los casos; la información se organizó y se tabuló en una base de datos en Epi Info 6.04, a partir de la cual se hizo el análisis. A lo largo del estudio implementaron varias medidas de control. Resultados: la edad promedio de los pacientes fue de 45 años. ERV se aisló con más frecuencia en secreciones purulentas de cavidad abdominal o herida quirúrgica (36 por ciento), orina (30 por ciento), y sangre (19 por ciento). La especie más frecuente fue E. faecium (87 por ciento), con fenotipo VanA. Los posibles factores de riesgo fueron el uso previo de antibióticos, la hospitalización en UCI, los días estancias, las cirugías previas, y la neutropenia. La respuesta al tratamiento fue buena y aparantemente las medidas de control han permitido mantener la endemia a niveles aceptables dada la complejidad del hospital. Conclusiones: ERV afecta con más frecuencia a pacientes crónicamente enfermos, con estancia prolongada, hospitalizados en UCI, con uso previo de antibióticos y con cirugía abdominal. Estos hallazgos son similares a los informados por otros autores en la literatura