Should prophylaxis against Pneumocystis jirovecii pneumonia be considered in selected patients with leprosy reactions?

Leprosy reactions often require prolonged high-dose steroids or immunosuppressive drugs, putting patients at risk of Pneumocystis jirovecii pneumonia (PJP). However, no PJP cases are reported, possibly due to dapsone treatment for leprosy. In patients with leprosy reactions not receiving dapsone because of toxicity or resistance and requiring long-term immunosuppression, PJP prophylaxis should be considered.

Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry.

Objective: Evaluate the impact of multi-component quality improvement for pediatric asthma care focusing on serial use of an evidence-based clinical pathway via paper order sets, pathway integration into computerized provider order entry (CPOE), use of a clinical respiratory score (CRS) and a discharge checklist. Methods: Outcomes were assessed over three intervention periods and 50 months on: time to beta-agonist and steroid first administration, frequency of readmissions and hospital length of stay. A general linear model estimated mean log(LOS) over time and between study periods. Time to discharge was transformed using the natural logarithm. Results: No improvements in time to first beta-agonist or steroid administration were observed. There was a reduction in 100-day readmissions (p = 0.008): decreasing from 7.4 to 2.1% after introduction of paper order sets and CRS (adjusted p = 0.04); to 3.9% after CPOE implementation (adjusted p = 0.53) and to 2.2% when a discharge checklist was added (adjusted p = 0.01). There was a statistically significant reduction in LOS between study periods (p = 0.015). The geometric mean LOS in hours during study periods 1-4 were: 34.8 (95% CI: 32.2, 37.6), 29.3 (95% CI: 27.5, 31.3), 29.0 (95% CI: 27.0, 31.3) and 23.1 (95% CI: 22.1, 24.2). Pair-wise comparisons between periods were statistically significant (adjusted p ≤ 0.003), except for Periods 2 and 3 (adjusted p = 0.83). Conclusions: Hospital length of stay and 100-day readmissions rate in a predominantly Hispanic, Medicaid patient population were reduced by utilization of an evidence-based best practices asthma management pathway and CRS within CPOE, combined with a checklist to expedite discharge.

Late development of a lamellar macular hole after the spontaneous separation of vitreoretinal traction: case report.

PURPOSE: To report a case of epiretinal macular membrane and a lamellar macular hole developing after the spontaneous separation of an idiopathic vitreoretinal traction. METHODS: Retrospective, observational, long follow-up of a case evaluated and documented with optical coherence tomography and managed with current therapies including pars plana vitrectomy. RESULTS: Good anatomic and functional results with stable 20/30 best-corrected visual acuity. CONCLUSIONS: The natural course of idiopathic vitreomacular traction has been documented during prolonged observation after its spontaneous separation from the fovea leading to the development of an epiretinal membrane and a lamellar macular hole.

Ruptura coroidea y neovascularización coroidea secundarias a trauma con seguimiento de 24 años. Reporte de caso / Choroidal rupture with choroidal neovascularization secondary to trauma. Case report with 24 years follow-up

Objetivo: describir el seguimiento clínico por 24 años de una ruptura coroidea y su neovascularización coroidea secundaria a trauma ocular cerrado. Efectuar una revisión bibliográfica de esta patología. Destacar la importancia de observaciones prolongadas para completar su historia natural. Diseño: reporte de caso no intervencionista. Método: retrospectivo, en caso de trauma ocular cerrado y sus consecuencias estudiadas en seguimiento cuidadoso de 24 años y la ayuda diagnóstica de la tomografía óptica coherente, la fluoroangiografía y el campo visual. Resultado: reconocimiento de glaucoma y catarata que disminuyeron la visión a 20/120 veinticuatro años después de la contusión ocular. Conclusión: La neovascularizacion coroidea secundaria a ruptura coroidea traumática subfoveal aparece en tiempo variable luego de trauma ocular contuso, compromete la recuperación anatómica y visual, y es de pronóstico reservado de acuerdo con su localización según hallazgos en observación prolongada.

Purpose: to describe findings and follow-up for 24 years in a choroidal rupture with secondary choroidal neovascularization following closed ocular trauma. To perform a literature review on this topic. To remark the importance of long follow-up to complete natural history of disease. Design: non-interventional case report. Methods: retrospective, in a case ofbclosed ocular trauma and sequels on a follow-up of 24 years using optical coherence tomography and fl uorescein angiography as diagnostic techniques. Results: recognition of glaucoma, cataract and decreased visual acuity to 20/120. Conclusion: choroidal neovascularization following indirect subfoveal traumatic choroidal rupture may occur in variable time after blunt trauma, affecting ocular structures and visual function with poor prognosis demonstrated on long follow-up.

Bilateralidad en agujeros maculares. Reporte de serie de casos / Bilateral macular holes. A case series

Propósito. Reportar la bilateralidad de los agujeros maculares, su patogenia, manejo e implicaciones. Método. Retrospectivo, observacional en Institución Oftalmológica en Colombia con reporte de seis pacientes bilateralmente afectados, en quienes se realizó examen ocular completo utilizando técnicas diagnósticas vitreo-retinianas como fluoroangiografía y tomografía óptica coherente de dominio en tiempo y espectral. Resultados. En ausencia de cirugías vitreo-retinianas, los resultados fueron de tipo observacional en el seguimiento que se detalla en las historias clínicas. Conclusiones. El agujero macular lamelar puede ser bilateral, siendo importante reconocer su incidencia, patogénesis, manejo e implicaciones.

Purpose. To report bilaterality of macular holes, pathogenesis, management and implications. Method. Retrospective, observational, case series design in a Colombian Ophthalmological Institution, reporting five patients bilaterally affected. Th ey underwent to complete ocular examination and vítreo-retinal imaging diagnostic techniques as fluorescein angiography, time domain and spectral domain optical coherence tomography. Results. In absence of ocular surgeries, results were mainly observed on long time follow-up of five cases of bilateral lamellar macular holes. Conclusions. Macular holes can be bilateral and it is important the recognition of their incidence, pathogenesis, management and future implications.

Caracterización de los pacientes diagnosticados con enfermedades de transmisión sexual atendidos en una institución pública de 1° nivel de la ciudad de Manizales (Colombia), 2009-11 / Characterization of patients diagnosed with sexually transmitted diseases attended at a public health institution in Manizales (Caldas) during the years 2009-11

Objetivo: Caracterizar pacientes diagnosticados con enfermedades de transmisión sexual atendidos en ASSBASALUD ESE en Manizales (Colombia) entre los años 2009 a 2011. Materiales y métodos: Es un estudio de corte transversal, que recolectó información de la base de datos de centros de atención de ASSBASALUD ESE, se analizaron 933 historias clínicas, de las cuales 503 cumplieron los criterios de inclusión. Dentro de las variables estudiadas se encuentran el género, edad de inicio de las relaciones sexuales, uso del preservativo, estado civil y diagnóstico de ETS. Resultados: El año con más frecuencia de ETS fue el 2010 con 55%, mayor proporción en género femenino 87,5%, edad promedio de 28,64 años. El motivo de consulta más frecuente fue el de síntomas inespecíficos en un 34,8%. La patología más frecuente en mujeres fue la candidiasis vulvovaginal con 60,3%, en hombres el herpes genital con 33,3%. Personas con unión no estable fueron quienes presentaron mayor proporción de ETS. Conclusiones: Las ETS se diagnostican con mayor frecuencia en las mujeres, porque son ellas quienes acuden más a los servicios de salud. Aunque el número de pacientes atendidos por ETS disminuyó año tras año, es notorio que se requiere de más y mejores métodos de diagnóstico y tratamiento adecuados para dicha población...

Antibiotic resistance of periodontal pathogens obtained from frequent antibiotic users.

The occurrence of bacterial strains resistant to different antimicrobials is a growing problem in Latin American countries. The aim was to measure the antimicrobial susceptibility of Fusobacterium nucleatum, Prevotella intermedia and Prophyromona gingivalis, isolated from chronic periodontitis patients. Twenty-five patients diagnosed with generalized- moderate or advanced- chronic periodontitis were consecutively recruited from patients attending the Periodontal Specialist Program, Javeriana University, according to specific criteria, including no recent antibiotic consumption. All patients filled out a questionnaire on antibiotic intake. The deepest periodontal pocket in each quadrant was sampled. Pooled samples were mixed, diluted and plated on enriched brucella agar plates. After anaerobic incubation, identification of the target bacteria was performed, based on colony morphology, gram staining, aerotolerance and biochemical reactions (RapID Ana II, Remel, U.S.A.). Following identification, the bacteria were subjected to antimicrobial testing, using amoxicillin, tetracycline, doxycicline, azithromycin and metronidazole (E-test, AbBiodisk, Sweden). The minimal inhibitory concentrations obtained were compared with a reference standard to determine antimicrobial resistance. Amoxicillin-resistant species were tested for beta-lactamase production. Forty-four percent of the patients used antibiotics without any medical prescription, 40% used antibiotics at least once a year. The presence of eleven species was confirmed after a series of biochemical tests: four Fusobacterium nucleatum, five Prevotella intermedia and two Prophyromona gingivalis. All strains were resistant to metronidazole, five were resistant to tetracycline and azithromicin, and two strains were resistant to doxycicline and amoxicillin. The strains resistant to amoxicillin were positive for beta-lactamase production, Antimicrobial resistance, particularly against metronidazole, was a common phenomenon for the bacterial isolates analyzed in this Colombian sample.

Antibiotic resistance of periodontal pathogens obtained from frequent antibiotic users

The occurrence of bacterial strains resistant to different antimicrobials is a growing problem in Latin American countries. The aim was to measure the antimicrobial susceptibility of Fusobacterium nucleatum, Prevotella intermedia and Prophyromona gingivalis, isolated from chronic periodontitis patients. Twenty-five patients diagnosed with generalized- moderate or advanced- chronic periodontitis were consecutively recruited from patients attending the Periodontal Specialist Program, Javeriana University, according to specific criteria, including no recent antibiotic consumption. All patients filled out a questionnaire on antibiotic intake. The deepest periodontal pocket in each quadrant was sampled. Pooled samples were mixed, diluted and plated on enriched brucella agar plates. After anaerobic incubation, identification of the target bacteria was performed, based on colony morphology, gram staining, aerotolerance and biochemical reactions (RapID Ana II, Remel, U.S.A.). Following identification, the bacteria were subjected to antimicrobial testing, using amoxicillin, tetracycline, doxycicline, azithromycin and metronidazole (E-test, AbBiodisk, Sweden). The minimal inhibitory concentrations obtained were compared with a reference standard to determine antimicrobial resistance. Amoxicillin-resistant species were tested for β- lactamase production. Forty-four percent of the patients used antibiotics without any medical prescription, 40% used antibiotics at least once a year. The presence of eleven species was confirmed after a series of biochemical tests: four Fusobacterium nucleatum, five Prevotella intermedia and two Prophyromona gingivalis. All strains were resistant to metronidazole, five were resistant to tetracycline and azithromicin, and two strains were resistant to doxycicline and amoxicillin. The strains resistant to amoxicillin were positive for β-lactamase production. Antimicrobial resistance, particularly against metronidazole, was a common phenomenon for the bacterial isolates analyzed in this Colombian sample.

La presencia de especies bacterianas que demuestran resistencia a múltiples antimicrobianos es un problema creciente en Latinoamérica. El objetivo de este estudio fue el medir la susceptibilidad antibiótica de las bacterias Fusobacterium nucleatum, Prevotella intermedia y Prophyromona gingivalis aisladas de pacientes afectados por Periodontitis Crónica. Un total de venti-cinco pacientes diagnosticados con Periodontitis Crónica Generalizada con severidad de Moderada a Avanzada fueron incluidos en el estudio siguiendo criterios específicos, todos los pacientes respondieron una encuesta acerca de su patrón de uso de antibióticos. En la bolsa mas profunda de cada cuadrante dental se tomo una muestra microbiológica, la cual fue procesada siguiendo procedimientos de: Mezcla, dilución y siembra en platos de agar Brucela enriquecidos. Después de un periodo de incubación anaeróbica las bacterias objeto de estudio fueron identificadas de acuerdo a las siguientes técnicas: Morfología de las colonias, coloración de Gram, prueba de aero-tolerancia y la aplicación de un kit de identificación bacteriana que utiliza diversas pruebas bioquimicas (RapID Ana II, Remel, U.S.A.). Después de la identificación, las bacterias fueron sometidas a pruebas de antibiograma usando los siguientes antibióticos: Amoxicilina, tetraciclina, doxiciclina, azitromicina y metronidazol (E-test, AbBiodisk, Suecia). La concentración inhibitoria mínima se comparo con la referencia estándar para determinar la presencia de la resistencia antibiótica. En las especies bacterianas que mostraron resistencia a la amoxicilina se realizo una prueba de laboratorio para establecer la presencia de β-lactamasa. Un 44% de los pacientes encuestados refirió haber utilizado antibióticos sin prescripción medica, un 40% de ellos usa antibióticos al menos una vez al ano. La presencia de once especies bacterianas pudo ser confirmada después de realizar las pruebas de identificación: Cuatro aislamientos de Fusobacterium nucleatum, cinco de Prevotella intermedia y dos de Prophyromona gingivalis. Todas las especies bacterianas mostraron resistencia al metronidazol, cinco fueron resistentes a la tetraciclina y a la azitromicina, finalmente dos especies fueron resistentes a la doxiciclina y la amoxicilina. Las especies que mostraron resistencia a la amoxicilina demostraron producción de β-lactamasa. La presencia de resistencia a los antibióticos fue un fenómeno común para las bacterias analizadas, en especial la resistencia al metronidazol.