Adherencia al lavado de manos antes de comer en niños internados / Adherence to hand hygiene before eating in inpatients

Objetivo: Valorar la adherencia al lavado de manos (LM) en pacientes internados previo a la ingesta de alimentos y la efectividad de los medios de información. Métodos: Se estudiaron 100 pacientes de 6 meses a 18 años, internados en el Hospital de Pediatría Juan P. Garrahan en las salas de Cuidados Intermedios (CIM) 41,74,32,73 durante marzo 2014 y noviembre de 2015, que realizaban al menos 1 comida al día. Se realizaron encuestas y observaciones no participativas durante el momento en que se servía la comida, para evaluar el LM previo a la ingesta de alimentos. Resultados: El 87% de la población estudiada consideró que el LM antes de comer es importante. Los resultados obtenidos en cuanto a la frecuencia del lavado de manos, más del 73% refirió lavar sus manos al menos 4 veces al día. Los pacientes habían obtenido la información a través de los médicos, enfermeros y nutricionistas y por los medios gráficos (instructivo de consumo y carteles). En los CIM 41/74 se observó un porcentaje levemente mayor (23.8%) de lavado de manos comparado con las observaciones de los CIM 32/73 (20.6%). Discusión: Si bien el 97% de la población encuestada dice lavar sus manos antes de comer, las observaciones realizadas arrojaron que el 23.8% (CIM 41/74) y 20.6 (CIM 32/73) lo hace. Conclusión: La población estudiada revelo haber sido instruida en el lavado de manos antes de ingerir alimentos sin embargo se observó baja adherencia a este habito antes de comer (AU)

Aim: To evaluate adherence to hand hygiene (HH) in inpatients previously to food intake as well as the effectivity of means of information. Methods: We studied 100 patients between 6 months and 18 years of age, hospitalized at Hospital de Pediatría Juan P. Garrahan on Intermediate care (CIM) wards 41,74,32,73 from March 2014 to November 2015, who had at least 1 meal a day. Questionnaires were administered and non-participating observations were performed at meal time to evaluate HH previous to food intake. Results: 87% of the study population considered that HH prior to eating is important. As to frequency of hand washing, more than 73% reported they washed their hands at least 4 times a day. Patients had received information on HH from physicians, nurses, nutritionists and through infographics (instructions and signs). In the CIMs 41/74 a slightly higher percentage (23.8%) of HH was observed compared to CIMs 32/73 (20.6%). Discussion: Although 97% of the population reported to wash their hands before a meal, observations show that 23.8% (CIM 41/74) and 20.6% (CIM 32/73) actually do so. Conclusion: The study population had been instructed in HH before food intake, however, low adherence to hand washing before eating was observed (AU)

Polymorphisms, haplotypes and mutations in the protamine 1 and 2 genes.

Protamines are the most abundant nuclear proteins and alterations in their expression have been described in infertile patients. Also, protamine haplo-insufficient mice have been described as infertile. Therefore, the protamine 1 and 2 genes have been considered important candidates in different mutational studies. In this article, we review all published articles related to protamine gene mutations and report new data on mutations from patients and controls drawn from the Spanish and Swedish populations. Sequencing of the protamine 1 and 2 genes in a total of 209 infertile patients and 152 fertility-proven controls from the Spanish and Swedish populations identified two novel and rare non-pathogenic missense mutations (R17C and R38M) in the protamine 1 gene and several additional polymorphisms. Furthermore, we have identified and we report for the first time five novel rare haplotypes encompassing the protamine 1 and 2 genes. A review of all available protamine gene mutational studies indicates that none of the reported missense mutations can be considered of proven pathogenicity. However, it is interesting to note that rare protamine 1 promoter variants have been reported only in infertile patients, but not in fertile control groups. Pathogenic high penetrance protamine gene missense mutations, if any, must be extremely rare. However, the detected presence of rare variants and haplotypes in infertile patients deserves further investigation.

Fatal lipoid pneumonia due to bronco-aspiration of isoparaffin after ingestion of an organophosphate insecticide.

A 66-year-old-male patient with a history of depression voluntarily ingested around 400 ml of an insecticide composed of 5% methylparathion, 75% isoparaffin, 8% etoxylated oleic acid, 4% 1,2,4-trimethylbenzene, 6% naphtha, 1% 1,3,5- trimethylbenzene, 0.4% propylbenzene and 0.3% xylene. The patient was conscious and alert at admission. Gastric lavage was performed and activated charcoal administered. There were no clinical symptoms of organophospate ingestion despite reduced concentrations of erythrocyte and plasma cholinesterase. Chest X-ray showed pulmonary infiltrate compatible with bronco-aspiration. The patient evolved to respiratory failure refractory to treatment and died from multiorganic failure 23 days after ingesting the insecticide. The pathological findings included a pulmonary fibrosis in the alveolar spaces which caused enlargement of the intra-alveolar septa. Abundant lipin-laden macrophages were observed within the alveolar spaces. We review the most relevant aspects of cases of fatal lipoid pneumonia and point out that on occasion severe or fatal intoxication is due to the substances accompanying the active ingredients.

[Diagnosis and localization of hyperparathyroidism by nuclear medicine procedures]. / Contribución de las técnicas de medicina nuclear al diagnóstico y localización del hiperparatiroidismo.

Primary hyperparathryoidism is a PTH hypersecretion caused by the parathyroid glands. In most cases (85%), the origin is to be due to the existence of a parathyroid adenoma, despite the intrinsic difficulty in being localized under certain circumstances. From some time now, we can count with the invaluable help of a nuclear medicine technique, namely the parathyroid scintigraphy with Technetium 99m-sestamibi (Tc99m-MIBI), a technique which is easy to perform, cheap and with excellent results, and which additionally can provide us with the above mentioned necessary information regarding location. We present here the case of a patient suffering from primary hyperparatyiroidism, in whom both the disease and the precise location of the hyperfunctioning tissue were identified by means of the parathyroid scintigraphy. Another nuclear medicine procedure, the one known as bone scintigraphy, also contributed meaningfully to the correct diagnosis in the same patient.

[Impact in the quality of health care and cost-effectiveness analysis of the reform of an emergency medicine service]. / Evaluación del impacto en la calidad asistencial y análisis coste-efectividad de la reforma de un servicio de urgencias de medicina.

BACKGROUND: To determine the effects that the reform of an emergency department (ED) have on efficacy, health care quality and efficiency. MATERIAL AND METHOD: Reforms consisted of 50% and 34% increases in structural and human resources, respectively. Roles of each ED member were redetermined, new assistance pathways were implemented, and the relationship between ED and the remaining hospital departments was reassessed. As efficacy markers, we determined the number of patients waiting to be attended (Pesp), the waiting time of patients to receive medical assistance (T(esp)),and the total waiting time of patients staying in the ED (T(total)). As health-care quality markers, we determined the percentage of patients leaving ED without having been visited by a physician(IPNV), the percentage of patients who were visited again (IPR),and the percentage of mortality (IPF). We also quantified the number of visits to the ED. All these data were obtained daily over 3 weeks, before (February 1999) and after (February 2000)the reforms. Effectiveness was estimated from the ratio P(total)/T(esp)(E1) and P(total)/P(esp) (E2). Costs were recorded for both periods and a cost-effectiveness analysis was performed to study the efficiency. RESULTS: In 2000, the number of visits increased by +12% (CI 95%: 2% to 22%). Despite this increase, we observed an improvement of most efficacy and health-care quality markers after the ED reforms. E1 increased by 996% (CI 95%: 335% to 1,658%) and E2 increased by 186% (CI 95%: -23%to 395%). Cost-effectiveness analysis showed 70% (CI 95%: 33%to 107%) and 56% (CI 95%: 18% to 94%) increases regarding E1 and E2, respectively, after the reforms. CONCLUSIONS: Providing ED with the necessary resources leads to an objective improvement of its efficacy and health-care quality and, consequently, the service and quality perceived by users improve. Despite the total cost increase after the ED reforms, efficiency also improves.

Globoid cells, glial nodules, and peculiar fibrillary changes in the cerebro-hepato-renal syndrome of Zellweger.

In addition to a distinct malformation (pachymicrogyria, heterotaxic lamination of the cerebellar cortex, olivary dysplasia), unusual degenerative changes were found in the nervous system of 2 unrelated babies with the Zellweger syndrome. Cerebral clefts were present in 1 case. In both infants there was neuron loss and accumulation of glial nodules and globoid cells in the gray matter as well as degeneration of the white matter. There was fatty change in astrocytes and diffuse gliosis. Neurons in the column of Clarke and the lateral cuneate nucleus showed peculiar fibrillary changes. Cytoplasmic inclusion bodies were seen in the spinal ganglia. Swelling of cortical astrocytes was remarkable in the older infant. The combination of a rare malformation with the cell changes described here gives the syndrome a unique neuropathological profile.

Cerebellar microgyria.

The histological features of cerebellar microgyria are described in a 15 month old infant. The bizarre appearance of this malformation seems to be the result of two basic factors: secondary fusion between preformed folia, and deficient and disorderly formation of the internal granule cell layer. The findings support the view according to which cerebellar microgyria is probably due to a pathological process involving the external granule cell layer during a relatively late period of cerebellar development.