Factors associated with the deterioration of intrinsic capacity in older people in Mexico and Colombia.

Background: Intrinsic capacity (IC) is defined as "all the physical and mental attributes possessed by the older person." This concept has gained momentum in recent years because it provides insights into the changes in the functional capacity of individuals during their life. This study examined common factors associated with IC decline among older adults in Mexico and Colombia. Methods: This cross-sectional, correlational study included 348 community-dwelling older adults. Sociodemographic, clinical, and family conditions were assessed as possible associated factors, and IC was analyzed across five domains: cognitive, locomotor, psychological, vitality (malnutrition through deficiency and excess), and sensory (visual and auditory). Parametric and non-parametric statistical analyses were performed. Results: The common factors associated with impairment according to domain were family dysfunctionality (cognitive domain); myocardial infarction, family dysfunctionality, age >80 years, home occupation, and not having a partner (locomotor domain); dysfunctional family and risk of falls (psychological domain); age >80 years and not having a partner (malnutrition by deficiency domain); age 60-79 years, walking <7,500 steps/day, and peripheral vascular disease (malnutrition by excess domain); risk of falling and being female (visual sensory domain); risk of falling (auditory sensory domain); and dysfunctional family and risk of falling (total intrinsic capacity). Conclusion: Both populations had common sociodemographic, clinical, and familial factors that directly affected total IC stocks and their domains.

Effects of Socio-educational Interventions on the Quality of Life of People with a Digestive Ostomy.

Introduction: The creation of digestive stomata is associated with a change in people's lives. Causing a strong impact that influences all dimensions of life. This paper reports on the effects of socio-educational interventions on the quality of life (QOL) of people with a digestive ostomy. Objective: To describe the effect of a nursing intervention on the QOL of people with a digestive ostomy. Methods: A quasiexperimental study was conducted whose sample consisted of 12 people who were ostomized in a public hospital in Colombia. Participants were selected through convenience sampling and randomly assigned to the intervention group and the control group. For the control group, an educational process was carried out through a theoretical session with virtual mediation (educational video). The QOL was evaluated before and after the interventions through the Montreux questionnaire. Results: The average age was 57(+7) years. No statistical differences were found between the groups in the QOL index or for any of the dimensions that make up QOL. Pretest and post-test analysis for each intervention separately showed improvement in two dimensions of QOL for each group; in the intervention group body image dimension (p = .017) and the positive coping dimension (p = .027). In the control group, the physical well-being dimension (p = .037) and social concerns dimension (p = .034). Conclusions: The personalized educational intervention or carried out through virtual pedagogical mediation, generated a clinically significant increase in the dimensions of QOL, without statistical differences. The study adds knowledge about the impact that digestive stomata have on the QOL, which is why it is necessary to establish specialized interdisciplinary teams to care for the person's new condition at home during the following months.

Incidencia de flebitis en pacientes pediátricos con catéter periférico en una institución de Manizales / Incidence of phlebitis in patients with peripheral catheter in a health care institution in Manizales (Colombia)

Introducción: El cuidado de enfermería en áreas clínicas requiere conocimiento, habilidad y experiencia. El tratamiento de una persona hospitalizada usualmente necesita un acceso venoso, en este procedimiento pueden presentarse complicaciones, siendo la flebitis e infiltración las principalmente reportadas. Objetivo: Determinar la incidencia de flebitis en pacientes pediátricos con catéter corto periférico de acuerdo con el grado de la misma y diversos factores implicados en su aparición. Materiales y métodos: Estudio cuantitativo, prospectivo, observacional y documental realizado entre octubre 2018 a febrero 2019. Resultados: Se encontró una tasa de incidencia de flebitis de 18,5%. De 849 niños con catéter venoso periférico, 157 reportaron flebitis; de ellos 52,2% presentaron flebitis grado I; 29,9%, grado II; 15,3% grado III y 2,5% grado IV. El 78% de los niños presentó peso y talla adecuados para la edad. La flebitis identificada se relacionó al catéter preventivo y asociado a medicamentos como cefalotina y dipirona, así como la presentación en la etapa de infancia y adolescencia de flebitis grado I. Conclusiones: La identificación de la flebitis, sus grados y correlación con las variables sociodemográficas y clínicas, permiten establecer acciones de cuidado y fomento de estrategias para mejorar la atención y los estándares de alta calidad.

Introduction: Nursing care in clinical areas requires knowledge, skills, and experience. Treatment of a hospitalized person usually requires venous access, which carries frequently reported complications such as phlebitis and infiltrations. Objective: To determine the incidence of phlebitis in patients with short peripheral catheter according to its grade and various factors involved in its appearance. Materials and methods: Quantitative, prospective, observational, and documentary study carried out between October 2018 and February 2019. Results: An incidence rate of phlebitis of 18.5% was observed. Phlebitis was reported in 157 out of 849 children with peripheral venous catheter. Grade I, II, III, and IV phlebitis was documented in 52.2%, 29.9%, 15.3%, and 2.5%. respectively. 78% of the children showed adequate weight and height for their age group. These cases of phlebitis were related to preventive catheter and associated with the use of medications such as cephalothin and dipyrone. In the case of grade I phlebitis, it was more frequent in childhood and adolescent populations. Conclusions: The identification of phlebitis, its grades, and its correlation with sociodemographic variables is necessary to establish health care actions and promote strategies in order to improve care and achieve high quality standards.

Síntomas espirituales de adultos mayores en tiempos de pandemia por COVID-19 / Spiritual symptoms of aged in times of a COVID-19 pandemic

Resumen: Objetivo: Describir y correlacionar los síntomas espirituales que presentan los adultos mayores del municipio de Caldas, Colombia en tiempos de pandemia COVID-19. Materiales y Método: Estudio cuantitativo, descriptivo, observacional y correlacional, con 300 personas mayores, se aplicó un instrumento validado sobre síntomas espirituales, analizando con estadística descriptiva y utilizando la prueba de Pearson. Resultados: Los síntomas de espiritualidad se evidenciaron moderados en cuanto al dolor espiritual con 34%, autocastigo 35%, búsqueda espiritual proyectada se detectó que en un 36% estaban en severo, al igual que angustia espiritual 42%, incredulidad 45%, desesperanza y desamor 48%, se encontró significancia estadística correlacionando signos espirituales con edad, sexo, ocupación, estado civil, enfermedad, presencia de hijos y necesidad de ayuda para las actividades diarias. Conclusiones: Se concluye que los resultados permiten describir los síntomas espirituales, así como hacer correlaciones entre los síntomas y las diversas características de los participantes. Más aún, estos resultados permiten reflexionar que el cuidado a los adultos mayores, debe considerar además de la cuestión biológica, la situación espiritual, demostrando que hay que cuidarlas de manera integral para mejorar el estado de salud y la calidad de vida de los adultos mayores, por lo que se deben considerar los problemas del proceso de envejecimiento en sus distintos contextos, proponer modelos multidisciplinares y políticas de salud que mejoren la calidad y condiciones de vida de este sector de la población y de sus cuidadores.

Abstract: Objective: To describe and to correlate the spiritual symptoms presented by the elderly in the municipality of Caldas, Colombia in times of the COVID-19 pandemic. Materials and Method: Quantitative, descriptive, observational study, with 300 elderly people, a validated instrument on spiritual symptoms was applied, with descriptive statistics using Pearson test Results: spirituality symptoms were moderate in terms of spiritual pain with 34%, self-punishment 35%, projected spiritual search was found to be severe in 36% as well as spiritual anguish 42%, disbelief 45%, hopelessness and heartbreak 48%, statistical significance was found correlating spiritual signs with age, sex, occupation, marital status, illness, presence of children and need for help with daily activities. Conclusions: It is concluded that the results allow describing the spiritual symptoms, as well as making correlations between the symptoms and the various characteristics of the participants. Furthermore, these results allow us to reflect that the care of the elderly must consider, in addition to the biological dimension, the spiritual dimension, showing that care must be taken in a holistic way to improve the health status and quality of life of the elderly Therefore, the problems of the aging process should be considered in its different contexts, and multidisciplinary models and health policies should be proposed that improve the quality and living conditions of this sector of the population and its caregivers.

Clinical practice guideline for screening of patients at risk of colonization by carbapenemase-producing Enterobacterales and the treatment of infections caused by these bacteria / Guía de práctica clínica para la tamización de pacientes con riesgo de colonización por Enterobacterales productores de carbapenemasasy el manejo de infecciones causadas por estas bacterias

Abstract Carbapenemase-producing Enterobacterales (CPE) infections have increased in recent years. Colombia has become an endemic country for this group of microorganisms, and the infections they cause have a serious impact in terms of morbidity and mortality. The early identification of CPE carriers who are admitted to health care centers as patients is necessary to implement adequate isolation and infection control measures to limit the spread of this type of microorganisms in hospitals. Furthermore, treating these infections is a challenging task due to the limited therapeutic alternatives available and the fact that there are only a few studies proving their effectiveness in this setting. Therefore, the objective of the present work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and the treatment of inpatients with suspected or confirmed infections caused by this type of bacteria through a CPG adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological treatment of CPE infections in this context.

Resumen Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbimortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario. Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por CPE en este escenario.

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae.

INTRODUCTION: There is little information about weigh of factors possibly associated with mortality, in infections caused by Carbapenem-resistant Enterobacteriaceae (CRE) in Latin America. METHODOLOGY: A case-controls study nested in a historical cohort was performed including all patients with CRE infections diagnosed between June 2013 and December 2018 at Hospital Universitario San Ignacio in Bogotá, Colombia. Univariate and multivariate analysis were performed to compare cases of mortality within the first month after the infection diagnosis with surviving patients. RESULTS: A total of 131 patients were included. The overall 30-day mortality rate was 38.17%. In the multivariate analysis, a direct association was found between mortality and septic shock (OR 26.7 CI6.6-107.3 p < 0.01), post-chemotherapy febrile neutropenia (OR 3.3 CI1.06-10.8 p = 0.04) and Charlson Index ≥ 3 (OR 5.5 CI 1.5-20.06 p < 0.01). An inverse association was found with interventions to control the infectious focus (OR 0.3 CI0.1-0.7 p < 0.01). The MIC of different antibiotics and the use of combined antibiotic therapy (triple therapy vs. double therapy or monotherapy) were not associated with mortality. CONCLUSIONS: In patients with CRE infections, septic shock, a Charlson comorbidity index ≥ 3, and post-chemotherapy febrile neutropenia are independently related to an increase in mortality. The control of the infectious focus is a protective factor. A rapid identification of these patients, and the implementation of measures to control infectious focus and to detect CRE colonization in patients who are going to be taken to myelosuppressive chemotherapy could impact positively the prognosis of these patients.

Riesgo de caídas y su relación con la capacidad física y cognitiva, en una residencia de adultos mayores de Santiago de Chile / Fall risk and its relation to physical and cognitive capacity, in a residence of older adults in Santiago de Chile

Introducción El incremento acelerado de la población adulta a nivel global, ha dado un cambio demográfico que impacta en la esperanza de vida al nacer y que se espera que para el 2100 se encuentre en 90 años. Para el adulto mayor el mejor indicador de salud es su estado funcional, el riesgo de perder su autonomía es muy alto lo que genera una alta demanda de atención y cuidado. Objetivo: Describir la relación que existe entre el riesgo de caídas y el estado mental, la autonomía física, la marcha y el equilibrio del adulto mayor residente en el hogar Nuestra señora de los Dolores de Santiago de Chile. Metodología Estudio descriptivo de corte transversal enfoque cuantitativo y correlacional a través de la aplicación de las escalas de Downton, Batrthel, Pfiffer y Tinetti a los 36 residentes del hogar de adultos mayores. Resultados Se evidenció un alto de riesgo de caída del 100%, con factores asociados como nivel alto de dependencia, la alteración en la marcha y el equilibrio, la polifarmacia, tener múltiples comorbilidades. Conclusión Identificar características del adulto mayor y los factores relacionados, permite la planificación de estrategias de seguimiento individualizado para fortalecer la movilidad el equilibrio, nivel de dependencia mejorando la autonomía, a través de procesos enfermeros y planes de cuidados específicos que impacten en la seguridad y calidad de vida de los adultos mayores.

Introduction The accelerated increase of the adult population globally, has given a demographic change that impacts life expectancy at birth and is expected to be 90 years old by 2100. For the elderly, the best health indicator is their functional status, the risk of losing their autonomy is very high, which generates a high demand for care and attention. Objective To describe the relationship that exists between the risk of falls and the mental state, physical autonomy, walking and balance of the elderly resident in the Nuestra Señora de los Dolores home in Santiago de Chile. Methodology Descriptive cross-sectional study with a quantitative and correlational approach through the application of the Downton, Batrthel, Pfiffer and Tinetti scales to the 36 residents of the elderly home. Results A high risk of falling of 100% was evidenced, with associated factors such as high level of dependency, alteration in gait and balance, polypharmacy, having multiple comorbidities. Conclusion Identifying characteristics of the elderly and related factors, allows the planning of individualized follow-up strategies to strengthen mobility, balance, level of dependency, improving autonomy, through nursing processes and specific care plans that impact safety and quality of life of older adults.

Inhibidores de Transferencia de la Cadena de Integrasa: Bases para su uso en la práctica clínica / Integrase Strand Transfer Inhibitors: Bases for its use in the clinical practice

Los inhibidores de transferencia de la cadena de integrasa (INSTI) son medicamentos cuyo mecanismo de acción consiste en bloquear el proceso de integración del ADN proviral al ADN del hospedero mediante la unión al sitio catalítico de la integrasa viral y de esta manera evitar su replicación. Actualmente se cuenta con la aprobación INSTI de primera y segunda generación, presentan similitud en su mecanismo de acción, cambios en su estructura que modifican su barrera genética, pero mantienen su perfil de seguridad y efectividad. Desde su aprobación en el año 2007, se han llevado a cabo múltiples estudios clínicos cuyos resultados han permitido avanzar en el conocimiento de su efectividad en diferentes escenarios clínicos; (pacientes naive, experimentados, esquemas de simplificación y profilaxis, así, como en el conocimiento de su perfil de mutaciones de resistencia). En el presente artículo se hizo una revisión de los miembros de esta familia de antirretrovirales (ARV).

Integrase strand transfer inhibitors (INSTI) are drugs whose mechanism of action consists of blocking the integration process of the proviral DNA to the host DNA by binding to the catalytic site of the viral integration and thus preventing its replication. Currently it has the approval of INSTI of first generation, two of second generation and in process of approval of a third of second generation. The two generations has similitude in its mechanisms of action, changes in its structures that modify its genetic barrier, but keeping his security and effectiveness profile. Since the approval of INSTI´s in 2007 to date, multiple clinical studies have been carried out, whose results have allowed us to advance in the knowledge of their effectiveness in different clinical scenarios; (naive patients, experienced patients, simplification and prophylaxis schemes, as well as in the knowledge of their profile of resistance mutations). In the present article, we made a review of the members of this family of antiretrovirals (ARV).

Percepción del paciente hospitalizado sobre el cuidado brindado por estudiantes de enfermería / Inpatient perception of the care provided by nursing students

Resumen Introducción: La enfermería ha evolucionado su quehacer en torno a los constructos teóricos que la componen, éste crecimiento progresivo incluye el desarrollo de procesos de enseñanza resignificados en los futuros profesionales, que deben ser validados en torno a las respuestas humanas en la relación enfermero - paciente. Objetivo: Describir la percepción del paciente hospitalizado sobre el cuidado brindado por estudiantes de enfermería. Materiales y métodos: Estudio cuantitativo, descriptivo, de corte trasversal, realizado con 356 pacientes que recibieron cuidado por parte de estudiantes de enfermería durante en instituciones de salud, se aplicó el instrumento Percepción del Cuidado Humanizado de enfermería - versión 3. Se analizó con estadística descriptiva y prueba no paramétrica mediante probabilidad Kruskal-Wallis. Resultados: Los pacientes manifestaron que "siempre se percibe un cuidado humanizado", en cuanto a las preguntas relacionadas con instrucciones sobre el autocuidado, identificación de necesidades de tipo físico, psicológico y espiritual se obtuvieron puntajes bajos. Conclusión: Es necesario abordar el tema del cuidado humanizado como fenómeno de interés de la disciplina al identificar fortalezas y debilidades con estudios de pertinencia en torno al cuidado.

Abstract Introduction: Nursing has evolved its work around the theoretical constructs that compose it, this progressive growth includes the development of resignified teaching processes for future professionals, which must be validated around human responses in the nurse-patient relationship. Objective: Describe the perception of the hospitalized patient about the care provided by nursing students. Materials and methods: A quantitative, descriptive, cross-sectional study, conducted with 356 patients who received care from nursing students within health institutions. The Perception of Humanized Nursing Care instrument - version 3 was applied. It was analyzed with descriptive statistics and a non-parametric test using Kruskal-Wallis probability. Results: The patients stated that "humanized care is always perceived", regarding the questions related to instructions on self-care; low scores were obtained in identification of physical, psychological and spiritual needs. Conclusion: It is necessary to address the issue of humanized care as a phenomenon of interest of the discipline when identifying strengths and weaknesses with studies of relevance around care.

Presentation of histoplasmosis as mononucleosis syndrome in an immunocompetent patient.

Histoplasmosis is a fungal disease usually occurring in endemic areas that can affect immuno-impaired patients in whom pulmonary involvement is the rule. We present the case of an 18 year-old immunocompetent, male patient, resident of the State of Florida, who showed signs of mononucleosis syndrome that included odynophagia, cervical adenomegaly, sporadic fever and rash; however, no pulmonary involvement or visceromegaly were present. Faced with this atypical and unexpected clinical picture, histoplasmosis infection was eventually diagnosed following cervical lymph-node biopsy. Disseminated histoplasmosis may have unexpected manifestations, as is pointed out in the case described below.

Lactancia materna: factores que propician su abandono / Breastfeeding: factors that lead to their abandonment

Objetivo: describir la características de la lactancia materna y los factores que propician su abandono en madres de niños pertenecientes a un municipio del departamento de Caldas-Colombia. Materiales y métodos: estudio cuantitativo de tipo descriptivo y de corte transversal realizado con una muestra al azar de 100 madres que asistieron con sus hijos a control de crecimiento y desarrollo en el hospital del municipio. Resultados: la lactancia materna exclusiva en el sexto mes mostró un porcentaje de cumplimiento de 4,8%. En cuanto a la lactancia materna total el 8% lactó a su hijo durante 1 mes, el 12% lo hizo hasta los 3 meses, el 14% hasta los 6 meses y el 65% hasta los 11 meses. El análisis de correspondencias múltiples mostró que las madres que lograron un mayor periodo de lactancia fueron aquellas que se encontraban en el grupo de adultos jóvenes y que vivían en unión libre. Los factores que se asociaron estadísticamente al abandono de la lactancia materna se relacionan con la no salida de suficiente leche (p=0,000), el bebe rechazaba el seno (p=0,001), el uso de biberón (p=0,002) y el reingreso laboral de la madre (p=0,035). Conclusiónes: existe la necesidad de fortalecer las líneas de acción a nivel político y gubernamental para favorecer las metas de lactancia en la primera infancia; así mismo, es importante abordar la población desde sus conductas previas, condicionantes personales, familiares y socioculturales para reducir los factores de abandono..(AU)

Objective: to describe the characteristics of breastfeeding and the factors that favor its abandonment in mothers of children belonging to a municipality of the department of Caldas-Colombia. Materials and methods: a descriptive and cross-sectional quantitative study conducted with a random sample of 100 mothers who attended with their children to control growth and development in the municipality hospital. Results:exclusive breastfeeding in the sixth month showed a compliance rate of 4.8%. In terms of total breastfeeding 8% lactorated their child for 1 month, 12% did so until 3 months, 14% up to 6 months and 65% up to 11 months. The analysis of multiple correspondences showed that the mothers who achieved a longer period of lactation were those who were in the group of young adults and who lived in a free union. The factors that were statistically associated with the abandonment of breastfeeding were related to not leaving enough milk (p = 0.000), the baby rejected the breast (p = 0.001), the use of the bottle (p = 0.002) and the re-entry of the mother (p = 0.035). Conclusions: there is a need to strengthen the lines of action at the political and governmental level to favor the goals of early childhood breastfeeding; likewise, it is important to approach the population from their previous behaviors, personal, family and sociocultural constraints to reduce the factors of abandonment..(AU)

Comparison between MALDI-TOF MS and MicroScan in the identification of emerging and multidrug resistant yeasts in a fourth-level hospital in Bogotá, Colombia.

BACKGROUND: The introduction of MALDI-TOF MS in the clinical microbiology laboratory has modified the approaches for the identification of fungi. Thanks to this tool, it is possible to identify cryptic species, which possess critical susceptibility patterns. Clinical strains were identified using the MicroScan and MALDI-TOF MS systems. Discrepant results from both methods were investigated using ITS rDNA barcoding. Finally, these isolates were also tested for in vitro susceptibility. RESULTS: The percentage of agreement between both methods to 498 yeast isolates was of 93.6% (32 discrepant isolates). The concordance of ITS sequencing with MALDI-TOF MS was higher (99%) than that of MicroScan (94%). Several of these discordant yeasts displayed high MICs for antifungal agents. CONCLUSIONS: Our study highlights the need of the MS and molecular approaches such as MALDI-TOF MS and ITS rDNA barcoding for the correct identification of emerging or cryptic yeast species; besides, some of these could be multidrug resistant. This work was the first experience in the implementation of the MALDI-TOF MS technology in Colombia. We found the first uncommon yeasts including Candida auris and we could identify Trichosporon faecalis. Our work highlights a clear necessity of an accurate yeast identification as a much more pertinent technique than the susceptibility profiles, because the most unusual yeasts exhibit resistance profiles to the few available antifungals.

Loss of T-Cell Multifunctionality and TCR-Vß Repertoire Against Epstein-Barr Virus Is Associated With Worse Prognosis and Clinical Parameters in HIV+ Patients.

Epstein-Barr virus (EBV) is an oncogenic virus associated with the development of aggressive and poor-prognosis B-cell lymphomas in patients infected with human immunodeficiency virus (HIV+ patients). The most important risk factors for these malignancies include immune dysfunction, chronic immune activation, and loss of T-cell receptor (TCR) repertoire. The combination of all these factors can favor the reactivation of EBV, malignant cell transformation, and clinical progression toward B-cell lymphomas. The overarching aim of this study was to evaluate the frequency, phenotype, functionality, and distribution of TCR clonotypes for EBV-specific T-cell subpopulations in HIV+ patients at different clinical stages and for HIV+ patients with B-cell lymphoma, as well as to establish their association with clinical variables of prognostic value. Factors were studied in 56 HIV+ patients at different clinical stages and in six HIV+ subjects with diagnosed B-cell lymphoma. We found a significant decrease in all subpopulations of EBV-specific CD4+ T cells from HIV+ patients at stage 3 and with B-cell lymphoma. EBV-specific effector CD8+ T cells, particularly effector memory cells, were also reduced in HIV+ patients with B-cell lymphoma. Interestingly, these cells were unable to produce IFN-γ and lacked multifunctionality in HIV+ patients. The TCR-Vß repertoire, which is key for protection against EBV in healthy individuals, was less diverse in HIV+ patients due to a lower frequency of TCR-Vß2+, Vß4+, Vß7.1+, Vß9+, Vß13.6+, Vß14+, Vß17+, Vß22+ CD4+, Vß14+, and Vß17+ CD8+ T cells. HIV+ patients with positive plasma EBV loads (EBV+HIV+) had a noteworthy decrease in the levels of both TNF-α+ and multifunctional TNF-α+/IL-2+ and TNF-α+/IFN-γ+ CD8+ T cells. Altogether, our findings demonstrate that HIV+ patients have significant alterations in the immune response to EBV (poor-quality immunity) that can favor viral reactivation, escalating the risk for developing EBV-associated B-cell lymphomas.

Practical Recommendations for Preoperative Skin Antisepsis / Recomendaciones prácticas para la antisepsia preoperatoria de la piel

Abstract The search for strategies for the reduction of Surgical Site infection (SSI) is a priority, given the impact those infections have on the outcome of the patients. The preope rative patient skin antisepsis, has recently gained greater significance in the prevention of SSI, as one of the critical factors, which can be intervened and can reduce the risk of infection. In recent years, comprehensive investigations have been published, not only dedicated to the comparison of antiseptic solutions, application techniques, but also about the importance of preoperative washing, use of surgical tapes and dressings impregnated with antiseptics, and preoperative shaving. This review outlines the key findings related to the preoperative patient's skin antisepsis and offers a protocol with practical recommendations to be implemented in the institutions of our country. It provides evidence based recommendations about the use of antiseptic solutions (povidone iodine, chlorhexidine, chlorhexidine plus alcohol, etc.) with emphasis on the advantages and disadvantages of each one.

First report of sporadic cases of Candida auris in Colombia.

BACKGROUND: Candida auris is a recently reported Candida species that is phenotypically similar to Candida haemulonii and related to hospital outbreaks. This organism can be misidentified as Candida haemulonii, Candida famata, Candida catenulata, or Rhodotorula glutinis by phenotypic approaches. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis using internal transcribed spacer rDNA bar-coding provide an accurate identification. CASE REPORTS: Three cases of C. auris infection in patients with risk factors for fungal infection (one admitted to the intensive care unit, one with lymphoma, and one with HIV; all three with previous antibiotic use) are reported; these infections were not epidemiologically related. Yeast isolates were recovered from blood, ocular secretion, and bronchoalveolar lavage and were misidentified as C. catenulata and Candida albicans by the phenotypic MicroScan method. The isolates were confirmed to be C. auris by means of MALDI-TOF MS and DNA sequence analysis. Antifungal susceptibility testing was performed on these C. auris isolates, which exhibited high minimum inhibitory concentrations to triazoles and amphotericin B. One patient survived and the other two died. Only one of these deaths was related to fungemia. CONCLUSIONS: C. auris is an emerging and opportunistic multidrug-resistant human pathogen. It is necessary to strengthen measures to achieve an accurate and quick identification and also to avoid its dissemination. This will require improvements in health and infection control measures, as well as the promotion of antifungal stewardship in healthcare facilities.

Tigeciclina en infecciones de piel y tejidos blandos complicadas / Tigecycline in complicated skin and soft-tissue infection

Objetivo: evaluar la mejor evidencia actual disponible para generar recomendaciones con respecto a la efectividad y seguridad del uso de tigeciclina en adultos con infección de piel y tejidos blandos (IPTB). Materiales y métodos: se realizó una revisión sistemática de la literatura, seleccionando los metaanálisis y experimentos clínicos controlados (ECCs), los cuales se valoraron utilizando la herramienta SIGN (Scottish Intercollegiate Guidelines Network.), con el fin de generar tablas de evidencia según GRADE de los estudios de tigeciclina en la indicación de IPTB, para posteriormente utilizar un proceso Delphi modificado para calificar las diferentes recomendaciones. Resultados: la revisión sistemática se incluyeron 9 metaanálisis que incluyeron 5 estudios clínicos aleatorizados con 1873 pacientes, y de ellos 952 asignados al brazo de tigeciclina, no mostró inferioridad frente a los comparadores en curación clínica (RR= 0.76 IC95% 0,57 - 1.03), curación microbiológica (RR= 0.92 IC95% 0,61 - 1.38), eventos adversos serios RR 1,41 (IC95%0,97 a 2,35), ni mortalidad RR 1,9 (IC95%0,84 a 4,3). La tigeciclina puede relacionarse con mayor frecuencia de eventos adversos leves de origen gastrointestinal. Conclusión: en pacientes adultos con IPTB, se considera que el uso de tigeciclina en monoterapia en pacientes no críticamente enfermos es equivalente en eficacia a otras opciones terapéuticas antimicrobianas. Se debe considerar especialmente como terapia de ajuste en pacientes con infecciones polimicrobianas.

Objective: To assess current best evidence available to generate recommendations regarding the effectiveness and safety of tigecycline use in adults with skin and soft-tissue infections (SSTIs). Materials and methods: A systematic review of the literature was conducted by selecting meta-analyzes and controlled clinical trials (CCTs), which were assessed using the SIGN tool (Scottish Intercollegiate Guidelines Network) in order to generate evidence tables according to GRADE of studies of tigecycline in the SSTIs indication, and then using a modified Delphi Method to score the different recommendations. Results: Nine meta-analyzes were included compounded by five randomized clinical trials with a sample size of 1873 patients, where 952 patients were assigned to tigecycline. The group of patients with tigecycline showed no inferiority to the comparator in clinical cure (RR = 0.76 95% CI 0.57 - 1.03), microbiologic cure (RR = 0.92 95% CI 0.61 - 1.38), serious adverse events RR 1, 41 (95% CI 0.97 to 2.35) or mortality RR 1.9 (95% CI 0.84 to 4.3). Tigecycline may be related to increased frequency of minor adverse events of gastrointestinal origin. Conclusion: In adult patients with SSTIs, it is considered that the use of tigecycline in monotherapy in non-critically ill patients is equivalent in effectiveness to other antimicrobial treatment options. It should be especially considered as an adjustment therapy in patients with polymicrobial infections.

Tigeciclina en infecciones intraabdominales complicadas / Tigecycline in complicated intra-abdominal infections

Objetivo: evaluar la mejor evidencia actual disponible para generar recomendaciones, con respecto a la efectividad y seguridad del uso de tigeciclina en adultos con infección intraabdominal complicada. Materiales y métodos: se realizó una revisión sistemática de la literatura, seleccionando los metaanálisis y experimentos clínicos controlados, los cuales se valora- ron utilizando la herramienta SIGN, con el fin de generar tablas de evidencia según GRADE de los estudios de tigeciclina en la indicación infección intraabdominal complicada, para posteriormente utilizar un proceso Delphi modificado para calificar las diferentes recomendaciones con el fin de generar un consenso. Resultados: se analizaron los resultados basados en la revisión sistemática de la literatura en la que se incluyeron 5 metaanálisis que cumplieron los criterios de selección comparando tigeciclina con otros tratamientos antibióticos en infección intraabdominal complicada; de los cuales, 2711 pacientes recibieron al menos una dosis del antibiótico (1382 tigeciclina y 1389 el comparador) y en los que no se observaron diferencias estadísticamente significativas en los desenlaces evaluados al comparar tigeciclina con otros antibióticos. Conclusión: en pacientes adultos con infección intraabdominal complicada, se considera que el uso de tigeciclina en monoterapia es equivalente en eficacia y seguridad a otras opciones terapéuticas antimicrobianas y no representa un exceso de mortalidad en comparación a otros antibióticos

Objective: To assess current best evidence available to generate recommendations regarding the effectiveness and safety of tigecycline use in adults with complicated intra-abdominal infection (cIAIs). Materials and methods: We conducted a systematic review of published meta-analysis that evaluated tigecycline compared to other antimicrobials and included the indication of cIAI. Quality of the evidence was evaluated by using the SIGN tool (Scottish Intercollegiate Guidelines Network) according to GRADE, and final recommendations were assessed by a modified Delphi Method in order to develop a consensus. Results: Five meta-analyzes met the selection criteria comparing tigecycline with other antibiotic treatments in complicated intra-abdominal infection. Five randomized clinical trials comprised in these meta-analysis included 2711 patients that received at least one dose of antibiotic (1382 tigecycline and 1389 the comparator regimen), We found no statistically significant differences in the evaluated outcomes by comparing tigecycline with other antibiotics, including clinical and microbiologic efficacy, safety and drug related mortality Conclusion: In adult patients with cIAIs, the use of tigecycline as monotherapy is equivalent in effectiveness to other antimicrobial therapeutic options and does not represent an increase in mortality compared to other antibiotics.

Recomendaciones prácticas para la antisepsia de la piel del paciente antes de cirugía / Practical recommendations for skin preparation of Surgical Site

La búsqueda de estrategias para la disminución de la infección de sitio operatorio (ISO) es una prioridad, dado el impacto que ésta tiene en los resultados de la atención de los pacientes. Recientemente ha tomado gran relevancia en la prevención de la ISO, la preparación prequirúrgica de la piel del paciente como uno de los factores clave, en los que se puede intervenir y disminuir el riesgo. En los últimos años han aparecido revisiones exhaustivas dedicadas no solo a la comparación de las soluciones antisépticas, y técnica de aplicación, también acerca de la importancia del baño pre operatorio, uso de cintas y compresas quirúrgicas impregnadas con antisépticos y el recorte de cabello preoperatorio. En esta publicación se describen los hallazgos más importantes relacionados con la preparación antiséptica de la piel del paciente y se propone un protocolo con recomendaciones prácticas para ser implementado en las instituciones del país. Se incluyen recomendaciones basadas en niveles de evidencia sobre el uso de las soluciones antisépticas (yodopovidona, clorhexidina, clorhexidina mas alcohol, entre otras) con énfasis en las ventajas y desventajas de cada una de ellas.

The search for strategies for reduction of Surgical Site infection (SSI) is a priority, given the impact that infections have on the outcome of the patients. The preoperative patient skin antisepsis, has recently gained greater significance in the prevention of SSI, as one of the critical factors, which can be intervened and can reduce the risk of infection. In recent years, comprehensive investigations have been published not only dedicated to the comparison of antiseptic solutions, application techniques, but also about the importance of preoperative bathing, use of surgical tapes and dressings impregnated with antiseptics, and preoperative shaving. This review outlines the key findings related to the preoperative patient's skin antisepsis and offers a protocol with practical recommendations to be implemented in the institutions of our country. It provides evidence based recommendations about the use of antiseptic solutions (povidone iodine, chlorhexidine, chlorhexidine plus alcohol, etc.) with emphasis on the advantages and disadvantages of each one.

Conocimientos, actitudes y prácticas frente a la toma de citología vaginal en estudiantes universitarias / Cognition, attitude and practices regarding pap smear scrap in university students

RESUMEN Introducción: el cáncer de cérvix es uno de los procesos tumorales más estudiados y conocidos, en el que la citología cervicouterina es la principal prueba de tamizaje para acceder a este diagnóstico. Objetivo: describir los conocimientos, actitudes y prácticas frente la toma de la citología vaginal en las estudiantes de pregrado presencial de una institución universitaria de la ciudad de Manizales-Colombia. Métodos: estudio cuantitativo descriptivo y prospectivo, cuya muestra estuvo constituida por 683 estudiantes. Se aplicó un instrumento que contiene preguntas sobre algunas variables sociodemográficas y otras relacionadas con los conocimientos actitudes y prácticas sobre la citología vaginal. Resultados: se evidencia mayor práctica de la citología vaginal en estudiantes con edades entre los 20-24 años. Se encontró que las estudiantes que más conocimientos presentaban sobre la prueba eran aquellas que cursaban estudios relacionados con el área de la salud. Se observa un promedio alto de actitudes positivas frente a la realización de esta prueba, pero una menor práctica de la misma con relación a los conocimientos y actitudes encontradas. Conclusiones: se evidencia conocimiento general de la prueba de la citología y una actitud favorable frente al interés de conocer más acerca de este examen; sin embargo, es importante que desde enfermería se realicen acciones más focalizadas que permitan mejorar la adherencia y una mayor práctica de esta prueba, considerada como una estrategia de promoción para la salud(AU)

ABSTRACT Introduction: the cervical cancer is one of the most studied and well-known tumoral processes in which the pap smear is the main screening test used to obtain an accurate diagnostic. Objective: To describe the cognition, attitude and performance regarding Pap Smear scrap on students of an undergraduate program at a university in Manizales-Colombia Methods: Quantitative, descriptive and prospective study, whose sample was composed by 683 students. The instrument used as a measuring device has some questions about certain socio-demographic variables and some others related to the information; attitudes and performances students have regarding Pap Smear scrap. Outcomes: There is evidence of a significant number of students between 20-24 years old having a Pap smear scrap. The outcomes showed that the students with more information about this kind of tests were those who were doing studies in the field of health. A high average of positive attitude regarding this test was observed; nevertheless, there was a minor performance of the test strongly related to the information and attitudes shown by some students. Conclusions: there is evidence of a general information about the pap smear test and of a favorable attitude on acquiring new knowledge about it. Nevertheless, it is relevant that the nursing program at the university proposes more targeted actions in order to allow an improvement in the consciousness and in a periodical practice of this test considered as a strategy of promotion of health(AU)

Trastornos neuropsiquiátricos en la población con VIH: una revisión narrativa / Neuropsychiatric Disorders in the People Living with HIV: A Narrative Review

Introducción: el sistema nervioso central es uno de los órganos afectados, de manera directa e indirecta, por el VIH; adicionalmente, los trastornos psiquiátricos son más frecuentes en esta población. Objetivo: comprender la patogénesis, las manifestaciones clínicas y el manejo de las enfermedades neuropsiquiátricas en la población con VIH. Métodos: se realizó una búsqueda en las bases de datos Medline, Embase, SciELO, LILACS y Psychlnfo utilizando término libres y MeSH. Resultados: los trastornos neuropsiquiátricos generan un impacto negativo en el tratamiento y seguimiento de los pacientes con VIH, lo cual disminuye su adherencia al tratamiento y aumenta las dificultades en su manejo integral. Llamativamente, existe una falta de estudios latinoamericanos en esta área.

Introduction: HIV is the infectious disease with the biggest worldwide impact in the last decades. For this reason, the control of this disease was induded in the millennium objectives of the UN. There has been a long time interest for studying the psychiatric comorbidities in these patients due to its impact in survival. Níethods: A research in the data bases Medline, Embase, SciELO, LILACS, and Psychlnfo was made using free terms and MeSH terms. Results: The neuropsychiatric disorders have a negative impact in the treatment and control of HIV positive patients, reducing their adherence and increasing the difficulties in the comprehensive treatment. There is a déficit in studies that could clear up this relationship in Colombian population.