Pulmonary imaging of pandemic influenza H1N1 infection: relationship between clinical presentation and disease burden on chest radiography and CT.

The potential for pulmonary involvement among patients presenting with novel swine-origin influenza A (H1N1) is high. To investigate the utility of chest imaging in this setting, we correlated clinical presentation with chest radiographic and CT findings in patients with proven H1N1 cases. Subjects included all patients presenting with laboratory-confirmed H1N1 between 1 May and 10 September 2009 to one of three urban hospitals. Clinical information was gathered retrospectively, including symptoms, possible risk factors, treatment and hospital survival. Imaging studies were re-read for study purposes, and CXR findings compared with CT scans when available. During the study period, 157 patients presented with subsequently proven H1N1 infection. Hospital admission was necessary for 94 (60%) patients, 16 (10%) were admitted to intensive care and 6 (4%) died. An initial CXR, carried out for 123 (78%) patients, was abnormal in only 40 (33%) cases. Factors associated with increased likelihood for radiographic lung abnormalities were dyspnoea (p<0.001), hypoxaemia (p<0.001) and diabetes mellitus (p = 0.023). Chest CT was performed in 21 patients, and 19 (90%) showed consolidation, ground-glass opacity, nodules or a combination of these findings. 4 of 21 patients had negative CXR and positive CT. Compared with CT, plain CXR was less sensitive in detecting H1N1 pulmonary disease among immunocompromised hosts than in other patients (p = 0.0072). A normal CXR is common among patients presenting to the hospital for H1N1-related symptoms without evidence of respiratory difficulties. The CXR may significantly underestimate lung involvement in the setting of immunosuppression.

[Mortality risk factors in ventilator associated pneumonia]. / Factores de riesgo para mortalidad en neumonía asociada a ventilación mecánica.

OBJECTIVE: to identify lethality and mortality rates and, mortality risk factors in ventilator associated pneumonia (VAP) on 114 patients treated between 2000 and 2007. METHOD: Twenty five risk factors were analyzed, emphasizing age, gender, APACHE score, associated diseases, hypotension at intake, coma, hospitalization time, length of time of ventilation, emergency intubation, reintubation, previous antibiotics, and resistant microrganisms. RESULTS: Lethality was 25.4 %, and mortality was 2.4 %. Association between lethality, and APACHE score was found (p: 0.04). Critical APACHE value was 22. Also, in early pneumonia, association between lethality and nasogastric tube (p: 0.01, I.C. 95 % 1.39 - 6.35) was found. No association with late pneumonia was found among mortality and clinical practices. Death's RR (relative risk) increase in following values with: previous neurological disease 2.7 (p: 0.15, IC 95 % 1.15 - 6.5), neurological comaRR 2 (p: 0.2, IC 95 % 0.54 - 7.53). Nevertheless, at multivariate analysis no mortality risk factors were identified. Fair association with time in ICU (p: 0.051 IC 95 % 0.99 - 1.17) and, male sex (p: 0.051, IC 95 % 0.99 - 6.72) was found. CONCLUSIONS: We observed multiple factors associated to mortality in VAP: use of nasogastric catheter, longer stay in ICU and male sex.

Factores de riesgo para mortalidad en neumonía asociada a ventilación mecánica / Mortality risk factors in ventilator associated pneumonia

Objective: to identify lethality and mortality rates and, mortality risk factors in ventilator associated pneumonia (VAP) on 114 patients treated between 2000 and 2007. Method: Twenty five risk factors were analyzed, emphasizing age, gender, APACHE score, associated diseases, hypotension at intake, coma, hospitalization time, length of time of ventilation, emergeney intubation, reintubation, previous antibiotics, and resistant microrganisms. Results: Lethality was 25.4 percent, and mortality was 2.4 percent. Association between lethality, and APACHE score was found (p: 0.04). Critical APACHE valué was 22. Also, in early pneumonia, association between lethality and nasogastric tube (p: 0.01, I.C. 95 percent 1.39 - 6.35) was found. No association with late pneumonia was found among mortality and clinical practices. Death's RR (relative risk) increase in following valúes with: previous neurological disease 2.7 (p: 0.15, IC 95 percent 1.15 - 6.5), neurological comaRR2 (p: 0.2, IC 95 percent 0.54 - 7.53). Nevertheless, at multivariate analysis no mortality risk factors were identified. Fair association with time in ICU (p: 0.051 IC 95 percent 0.99 - 1.17) and, male sex (p: 0.051, IC 95 percent 0.99 - 6.72) was found. Conclusions: We observed múltiple factors associated to mortality in VAP: use of nasogastric catheter, longer stay in ICU and male sex.

Objetivo: Identificar la tasa de letalidad, mortalidad y factores de riesgo de mortalidad en neumonía asociada a ventilación mecánica (NAVM) en 114 pacientes de la cohorte 2000-2007. Se estudiaron 25 factores de riesgo del paciente y de las prácticas clínicas. Resultados: La tasa de letalidad fue 25,4 por ciento) y la tasa de mortalidad de 2,4 por ciento>. Se encontró asociación entre el puntaje APACHE al momento del diagnóstico de neumonía y mortalidad (p: 0,04). El valor crítico de APACHE de alto riesgo fue igual o mayor a 22. En neumonía precoz se identificó como factor de letalidad la presencia de sonda naso-gástrica (p: 0,01, IC 95 por ciento> 1,39-6,35). Para las variables categóricas no se encontró asociación significativa entre la exposición y mortalidad. El RR en presencia de enfermedad neurológica previa (accidente vascular encefálico) fue 2,7 (p: 0,15, IC 95 por ciento 1,15-6,5), coma al ingreso 2 (p: 0,2, IC 95 por ciento 0,54-7,53). En neumonía tardía, no se identificaron factores de riesgo asociados a la atención. El análisis multivariado de todas esas exposiciones no identificó factores significativos asociados a mortalidad. Identificamos una asociación débil con días de estada en UCI (p: 0,051 IC 95 por ciento 0,99-1,17) y sexo masculino (p: 0,051, IC 95 por ciento 0,99-6,72). Conclusiones: Los resultados muestran una relación multifactorial de prácticas clínicas y del paciente para fallecer por NAVM. Como factor de prácticas clínicas encontramos asociado a mortalidad el uso de sonda nasogástrica y mayor permanencia en UCI. Dependiente del paciente encontramos una débil asociación entre mortalidad y sexo masculino.

[Cost and outcome of hip's arthroplasty nosocomial infection. Case and control study]. / Costo y desenlace de la infección de artroplastía de cadera. Estudio de caso y control.

Case-control study for evaluation of cost and outcome of nosocomial surgical site infection in primary hip arthroplasty during a period of 5 years. Mean hospitalization time in the orthopedic service was 54 days for cases, and 13 days for control (p<0.05). Mean hospitalization time in Intensive Care Unit (ICU) was 1.1 days for cases. There were 0.83 post primary surgery interventions in cases, and a mean of 2.08 bacteriological cultures in each case. Controls didn't have hospitalizations in the ICU surgical reinterventions nor cultures necessary. The mean cost of infected patients was US $: 6,174.8. Mean cost in controls was US $: 2,354.7. The excess of cost due to infections was US $: 2,354.7 on the average. Outcomes in cases were: normal function 30.8%; moderate or serious sequelae 46.2%; death rate 15, 4%. The measured parameters contributed to raise case costs, and they caused an unsatisfactory outcome for two third of the patients.

Costo y desenlace de la infección de artroplastía de cadera: Estudio de caso y control / Cost and outcome of hip's arthroplasty nosocomial infection: Case and control study

Case-control study for evaluation of cost and outcome of nosocomial surgical site infection in primary hip arthroplasty during a period of 5 years. Mean hospitalization time in the orthopedic service was 54 days for cases, and 13 days for control (p < 0.05). Mean hospitalization time in Intensive Care Unit (ICU) was 1.1 days for cases. There were 0.83 post primary surgery interventions in cases, and a mean of 2.08 bacteriological cultures in each case. Controls didn't have hospitalizations in the ICU surgical reinterventions nor cultures necesary. The mean cost of infected patients was US $: 6,174.8. Mean cost in controls was US $: 2,354.7. The excess of cost due to infections was US $: 2,354.7 on the average. Outcomes in cases were: normal function 30.8 percent; moderate or serious sequelea 46.2 percent; death rate 15, 4 percent. The measured parameters contributed to raise case costs, and they caused an unsatisfactory outcome for two third of the patients.

Estudio de casos y controles efectuado para evaluar el costo y desenlace de la infección del sitio quirúrgico en artroplastía primaria de cadera en cinco años. La media de hospitalización en el Servicio de Traumatología fue de 54 días para los casos y 13 días para los controles (p < 0,05). La media de hospitalización en UCI de los casos fue 1,1 días; hubo 0,83 reintervenciones en los casos y una media de 2,08 cultivos por cada caso. Los controles no tenían hospitalización en UCI, reintervenciones, ni cultivos. El costo promedio de los pacientes infectados fue $ 3.241.800 (US $ 6.174,8). El costo promedio de los controles, alcanzó a $1.236.244 (US $ 2.354,7). El exceso promedio de costo por la infección fue de $ 2.005.556 (US $ 3.820,1). El desenlace fue el siguiente: función normal 30,8 por ciento; secuelas medianas y graves 46,2 por ciento; letalidad 15,4 por ciento. Los factores medidos contribuyeron a encarecer los costos de los casos y produjeron un desenlace insatisfactorio para dos tercios de los pacientes.

¿Las construcciones y obras civiles aumentan el riesgo de infección de herida operatoria? / The constructions and building site increase the risk of surgical wound infection?

Objetivo: El propósito de este trabajo es informar sobre los efectos de los trabajos de construcción en las tasas de infección de herida en hernioplastia y artroplastia de cadera, la evolución de las tasas y las medidas de intervención para prevenir la ocurrencia de brotes de infección de herida operatoria, durante las obras en el Hopital de Coquimbo durante los años 2001-2002. Finalmente, se proponen recomendaciones sobre medidas de protección para pacientes en riesgo de infecciones cuando se realizan obras dentro de un hospital. Método: Estudio prospectivo, longitudinal, descriptivo y analítico, desarrollado entre enero de 2001 y marzo de 2003. Se midió el material particulado en suspensión dentro de los pabellones quirúrgicos, antes y durante los trabajos de remodelación. El indicador de resultado fue la tasa de infección trimestral de herida operatoria de hernia inguinal con malla y artroplastia de cadera con implante de prótesis. La medida de efecto se midió mediante riesgo relativo (RR). Resultados: La norma sobre el valor máximo de polvo para el funcionamiento de los pabellones es 180 mcg/m³ aire. Antes de los trabajos el valor fue de 60 mcg/m³. Durante los trabajos los valores subieron hasta 1.000 mcg/m³. Luego de instalar filtros HEPA el material particulado disminuyó bajo 100 mcg/m³. Hernioplastia: La tasa de infección antes de los trabajos fue 0,7 y 2,2 durante las obras (p= 0,22); el RR asociado a las obras fue de 3,1. La tasa de infección antes de aire ultra filtrado fue 1,5 y con el uso de aire filtrado en pabellones quirúrgicos fue de 1,8 (p= 0,56). El RR asociado a usar aire filtrado fue de 1,2. Artroplastia de cadera: La tasa de infección antes de los trabajos fue 0,7 y 2,7 durante las obras (p= 0,18), con RR asociado a las obras de 3,8. La tasa de infección antes de aire ultra filtrado fue 2,1 y con el uso de aire filtrado en pabellones quirúrgicos fue de 2,4 (p= 0,61). El RR asociado a usar aire filtrado fue de 1,1. La ausencia de diferencia estadística de los resultados se puede atribuir a tamaño de muestra. Conclusiones: El aumento del material particulado en suspensión y sedimentable se asocian a un aumento de la morbilidad infecciosa de la herida operatoria de hernioplastia inguinal y de artroplastia de cadera. El uso de aire filtrado redujo la polución de material particulado, sin embargo no resultó suficiente para reducir las tasas de infección.

[Lipid profile in newborns with intrauterine growth retardation]. / Perfil lipídico en recién nacidos con retardo del crecimiento intrauterino.

BACKGROUND: The X syndrome, related to coronary disease in adults, could be possibly programmed priory to delivery, in children with intrauterine growth retardation. AIM: To measure serum lipids in newborns with symmetrical or asymmetrical intrauterine growth retardation. PATIENTS AND METHODS: One hundred thirty-five newborns with intrauterine growth retardation and 116 normal term newborns, with 38 to 41 gestational weeks, were studied. Total, HDL, and LDL cholesterol, triglycerides and apoproteins. A1 and B were measured in umbilical cord blood samples. RESULTS: No differences in total, HDL, LDL cholesterol, apoproteins A1 and B were observed between the study groups. Triglycerides were higher in newborns with intrauterine growth retardation, compared to normal term newborns (45 +/- 27 and 36 +/- 19 mg/dl respectively, p < 0.001). Differences in serum triglyceride levels respect to controls were observed in both male and female newborns with asymmetrical growth retardation. Likewise the differences respect to controls were observed in newborns with mild or severe but not with moderate growth retardation. CONCLUSIONS: Newborns with intrauterine growth retardation have higher triglyceride levels than normal term newborns.

Disponibilidad de flúor en pre-escolares de tres áreas geográficas, Región de La Araucanía, Chile / Flouride availability in preschool children of 3 geographical areas, Araucania, Chile

Fueron estudiados los niveles de ingesta y excreción de flúor en una muestra de 105 niños de 2 a 5 años en 6 centros abiertos de la fundación INTEGRA de la Región de La Araucanía escogiéndose dos centros por área geográfica: valle, cordillera y costa. Los niveles de ingesta de flúor fueron medidos en los alimentos y bebidas consumidos durante los almuerzos de 5 días consecutivos. La excreción fue medida en muestras de orina colectadas hasta 4 horas después de la ingesta. Con estos niveles, se obtuvo la disponibilidad de flúor de cada individuo de la muestra. Además, se relacionó la ingesta y el área geográfica de residencia de los pre-escolares. Los resultados indicaron que la disponibilidad de este ión es diferente en las áreas geográficas estudiadas, encontrándose el mayor valor en los pre-escolares de la cordillera, seguido por los residentes de la costa y del valle

[Lipids, lipoproteins and apolipoproteins in normal newborns]. / Lípidos, lipoproteínas y apolipoproteínas en recién nacidos normales.

BACKGROUND: In Chile, there is a high prevalence of cardiovascular diseases. Because atherosclerosis starts in childhood, it is important to assess serum lipid levels in children. AIM: To measure serum lipid levels in normal Chilean newborns. SUBJECTS AND METHODS: A sample of umbilical cord venous blood was obtained from 156 normal newborns (76 male) immediately after delivery. Total and HDL cholesterol, triglycerides, apoprotein A1, B and lipoprotein (a) were measured. RESULTS: Mean values for total cholesterol in males, females and in the total sample were 60.6, 67.8 and 64 mg/dl respectively. The figures for HDL cholesterol were 24.9, 29.3 and 27 mg/dl, for LDL cholesterol were 28.3, 32.4 and 30 mg/dl, for triglycerides were 37.5, 30.3 and 35 mg/dl, for apoprotein A1 were 69, 79 and 74 mg/dl, for apoB were 23, 25 and 24 mg/dl and for lipoprotein (a) were 1.58, 1.79 and 1.69 mg/dl. Total cholesterol, HDL cholesterol, triglycerides and apoprotein A1 were significantly different between sexes. Percentiles 5 and 95 for total cholesterol were 37 and 111, for HDL cholesterol were 14 and 40, for LDL cholesterol were 13 and 57, for triglycerides were 20 and 69, for apoprotein A1 were 53 and 101, for apoprotein B were 11 and 48 and for lipoprotein (a) were 1.3 and 2.1 mg/dl. Five percent of children had apoprotein B values over 48 mg/dl. CONCLUSIONS: The detection of high levels of apoprotein B in newborns, could allow the early identification of individuals with high cardiovascular risk.

[Sneddon's syndrome vasculopathy with antiphospholipid antibodies in a child]. / Vasculopatía asociada a anticuerpos antifosfolípido. Síndrome de Sneddon en la niñez.

We studied a ten-year old girl with livedo reticularis and multiple central nervous system ischemic attacks beginning when she was five. Blood tests were positive for cryoglobulins and antiphospholipid antibodies; superior limb angiography showed occlusion and irregularities of the vessel walls and temporal artery biopsy revealed concentric thickening of the vessel wall due to fibrotic subendothelial proliferation. Sneddon's syndrome was diagnosed. Onset of this syndrome during early childhood has not been previously reported.

[Effect of the prolonged use of intrauterine devices and oral contraceptive on iron nutrition]. / Efecto del uso prolongado de dispositivos intrauterinos y anticonceptivos orales, sobre la nutricion del hierro.

The aim of this work was to study the effect of prolonged use of intrauterine devices (IUD) and oral contraceptives (OCO) normally prescribed at outpatient clinics of the Health Service on iron nutrition. Two hundred twenty three healthy women, aged 20 to 39 years were studied. Of these, 100 were using IUD and 97 OCO for three to five years and 26 were not using any pharmacological or mechanical contraceptive method (control group). Serum ferritin was significantly higher in the OCO group compared to IUD and control groups (58.9 +/- 2.2; 26.2 +/- 2.1 and 21.1 +/- 2.4 ng/ml respectively). There was a positive correlation between serum ferritin and hemoglobin in IUD and control groups and between ferritin and transferrin saturation in the OCO and control groups. The frequency of storage iron depletion (defined as a serum ferritin < 12 ng/ml) was 6.3, 0 and 25% in the IUD, OCO and control groups respectively. The numbers for iron-deficient erythropoiesis (defined as a transferrin saturation < 15%) were 7, 3 and 4% and for iron deficiency anemia, 6.5, 0 and 8%. It is concluded that the chronic use of IUDs leads to iron depletion and that measures to improve iron nutrition among women using them should be adopted.

[Hemoglobin, serum iron and transferrin saturation among users of intrauterine devices and oral contraceptive agents]. / Hemoglobina, hierro sérico y saturación de transferrina en usuarias de dispositivos intrauterinos y anticonceptivos orales.

We studied 60 females using either intrauterine device or taking oral contraceptive pills. Hemoglobin, serum iron, total iron binding capacity and saturation of transferrin were determined before and 4 and 10 months after starting a responsible paternity program. Women with a basal hemoglobin level below 12 g/dl were excluded. Age, parity and hematologic parameters were similar for both groups. A significant decrease in hemoglobin level and saturation of transferrin was observed at 10 months in intrauterine device users (13.6 to 13.1 g/dl and 36.2 to 26.9%, respectively). Use of oral contraceptive pills was not associated to hemoglobin decrease but a significant rise in saturation of transferrin was observed (36.2 to 43.9%, p less than 0.05).