Percepción del equipo de salud sobre los beneficios del calostro como factor protector de enterocolitis necrotizante en recién nacidos prematuros / Health professionals perception about the use of human colostrum, as preventive measure for necrotizing enterocolitis in preterm newborns

INTRODUCCIÓN: La incidencia de enterocolitis necrotizante (ECN), en Chile es de 0,3 a 2,4 por mil recién nacidos vi vos, siendo principalmente afectados los neonatos prematuros, y de 8 a 12 por ciento en prematuros menores a 1.500 gramos. OBJETIVO: Describir la percepción de profesionales de salud sobre el uso de calostro en recién nacidos prematuros, como factor protector de enterocolitis necrotizante. SUJETOS Y MÉTODO: Estudio cualitativo, mediante entrevista semiestructurada a 18 profesionales de la salud en tres hospitales públicos de la región de Valparaíso. La pauta de entrevista incluyó 3 temas: Conocimientos, percepción del suministro temprano de calostro y opinión acerca de la extensión de la medida, y 6 subtemas, 2 para cada tema respectivamente: Autopercepción del nivel de conocimiento y fuentes de información; Experiencia: aspectos positivos/eventos adversos y opinión del calostro como factor protector de enterocolitis; aspectos facilitadores u obstaculizadores y opinión acerca de la medida como política nacional. Procesamiento de datos mediante análisis de contenido cualitativo, temático. RESULTADOS: El uso de calostro en prematuros se da de modo protocolizado en dos de las tres unidades de alta complejidad neonatal de la región de Valparaíso. Los participantes opinan positivamente acerca de los resultados preventivos de esta medida. Aun cuando en un tercer estable cimiento no se aplique, hay una percepción favorable acerca de su potencial beneficio y su bajo costo de implementación. Se señala, no obstante, que ésta requiere de mayor evidencia y de un protocolo de aplicación. Otras limitantes serían la insuficiente dotación y formación del personal, y la necesidad de adquirir equipamiento e insumos. CONCLUSIONES: Profesionales que han aplicado un protocolo de administración de calostro en neonatos prematuros en la Región de Valparaíso, reportan buenos resultados de salud, y promueven la motivación del equipo hacia esta praxis. Sin embargo, se considera relevante la difusión y discusión de protocolos nacionales e internacionales, así como el desarrollo de investigación local. Dadas las experiencias en curso en Chile, y el debate internacional, se considera oportuno que el tema sea abordado y discutido en la comunidad sanitaria nacional.

INTRODUCTION: In Chile, necrotizing enterocolitis (NEC) mainly affects preterm infants, with an incidence of 0.3 to 2.4 per 1,000 live births, and 8 to 12% in preterm infants weighing less than 1,500 grams. OBJECTIVE: To describe health professionals perceptions on the use of human colostrum as a preventive measu re against necrotizing enterocolitis in preterm newborns. SUBJECTS AND METHOD: Qualitative study, using 18 semi-structured individual interviews of health professionals in three public hospitals of the Valparaíso Region. The interview included 3 topics: Knowledge, Perception of early colostrum supply and Opinion about the extent of the measure, and 6 subtopics, 2 for each topic respectively: Self-perception of knowledge level and Sources of information; Experience: positive aspects/adverse events and Opinion of colostrum as a protective factor for enterocolitis; Facilitating or hindering aspects and Opinion about the measure as national policy. Data were processed through qualitative content analysis. RESULTS: Two of the three high-complexity neonatal units of the Valparaíso Re gion have a protocol for administrating colostrum in premature infants. Participants have a positive opinion about the preventive results of this measure. Even in the third hospital where there is no protocol, they have a favorable perception of its potential benefit and its low cost of implementa tion. However, we observed that this procedure requires more evidence and an application protocol. Other limitations would be the lack of staffing and training and the need for equipment and supplies. CONCLUSIONS: Professionals who have applied a colostrum administration protocol in preterm infants in the Valparaíso Region report good health outcomes and promote team motivation towards this practice. However, it is relevant to the dissemination and discussion of national and international protocols, as well as the development of local research. Given the ongoing experiences in Chile and the international debate, we considered appropriate to address and discuss the topic within the na tional health community.

[Health professional's perception about the use of human colostrum, as preventive measure for necrotizing enterocolitis in preterm newborns]. / Percepción del equipo de salud sobre los beneficios del calostro como factor protector de enterocolitis necrotizante en recién nacidos prematuros.

INTRODUCTION: In Chile, necrotizing enterocolitis (NEC) mainly affects preterm infants, with an incidence of 0.3 to 2.4 per 1,000 live births, and 8 to 12% in preterm infants weighing less than 1,500 grams. OBJECTIVE: To describe health professionals perceptions on the use of human colostrum as a preventive measu re against necrotizing enterocolitis in preterm newborns. SUBJECTS AND METHOD: Qualitative study, using 18 semi-structured individual interviews of health professionals in three public hospitals of the Valparaíso Region. The interview included 3 topics: Knowledge, Perception of early colostrum supply and Opinion about the extent of the measure, and 6 subtopics, 2 for each topic respectively: Self-perception of knowledge level and Sources of information; Experience: positive aspects/adverse events and Opinion of colostrum as a protective factor for enterocolitis; Facilitating or hindering aspects and Opinion about the measure as national policy. Data were processed through qualitative content analysis. RESULTS: Two of the three high-complexity neonatal units of the Valparaíso Re gion have a protocol for administrating colostrum in premature infants. Participants have a positive opinion about the preventive results of this measure. Even in the third hospital where there is no protocol, they have a favorable perception of its potential benefit and its low cost of implementa tion. However, we observed that this procedure requires more evidence and an application protocol. Other limitations would be the lack of staffing and training and the need for equipment and supplies. CONCLUSIONS: Professionals who have applied a colostrum administration protocol in preterm infants in the Valparaíso Region report good health outcomes and promote team motivation towards this practice. However, it is relevant to the dissemination and discussion of national and international protocols, as well as the development of local research. Given the ongoing experiences in Chile and the international debate, we considered appropriate to address and discuss the topic within the na tional health community.

The Progressive Approach to EMDR Group Therapy for Complex Trauma and Dissociation: A Case-Control Study.

Eye Movement Desensitization and Reprocessing is a psychotherapeutic approach with recognized efficiency in treating post-traumatic stress disorder (PTSD), which is being used and studied in other psychiatric diagnoses partially based on adverse and traumatic life experiences. Nevertheless, there is not enough empirical evidence at the moment to support its usefulness in a diagnosis other than PTSD. It is commonly accepted that the use of EMDR in severely traumatized patients requires an extended stabilization phase. Some authors have proposed integrating both the theory of structural dissociation of the personality and the adaptive information processing model guiding EMDR therapy. One of these proposals is the Progressive Approach. Some of these EMDR procedures will be evaluated in a group therapy format, integrating them along with emotional regulation, dissociation, and trauma-oriented psychoeducational interventions. Patients presenting a history of severe traumatization, mostly early severe and interpersonal trauma, combined with additional significant traumatizing events in adulthood were included. In order to discriminate the specific effect of EMDR procedures, two types of groups were compared: TAU (treatment as usual: psychoeducational intervention only) vs. TAU+EMDR (the same psychoeducational intervention plus EMDR specific procedures). In pre-post comparison, more variables presented positive changes in the group including EMDR procedures. In the TAU+EMDR group, 4 of the 5 measured variables presented significant and positive changes: general health (GHQ), general satisfaction (Schwartz), subjective well-being, and therapy session usefulness assessment. On the contrary, only 2 of the 5 variables in the TAU group showed statistically significant changes: general health (GHQ), and general satisfaction (Schwartz). Regarding post-test inter-group comparison, improvement in subjective well-being was related to belonging to the group that included EMDR procedures, with differences between TAU and TAU+EMDR groups being statistically significant [χ2(1) = 14.226; p < 0.0001]. In the TAU+EMDR group there was not one patient who got worse or did not improve; 100% experienced some improvement. In the TAU group, 70.6% referred some improvement, and 29.4% said to have gotten worse or not improved.

Immune activation response in chronic HIV-infected patients: influence of Hepatitis C virus coinfection.

OBJECTIVES: We have analyzed the parameters (bacterial translocation, immune activation and regulation, presence of HCV coinfection) which could be implicated in an inappropriate immune response from individuals with chronic HIV infection. The influence of them on the evolution of CD4+ T cell count has been investigated. PATIENTS AND METHODS: Seventy HIV-infected patients [monoinfected by HIV (n = 20), HCV-coinfected (with (n = 25) and without (n = 25) liver cirrhosis)] and 25 healthy controls were included. Median duration of HIV infection was 20 years. HIV- and HCV-related parameters, as well as markers relative to bacterial translocation, monocyte and lymphocyte activation and regulation were considered as independent variables. Dependent variables were the increase of CD4+ T cell count during the follow-up (12 months). RESULTS: Increased values of bacterial translocation, measured by lipopolysaccharide-binding protein, monocyte and lymphocyte activation markers and T regulatory lymphocytes were detected in HIV-monoinfected and HIV/HCV coinfected patients. Serum sCD14 and IL-6 were increased in HIV/HCV-coinfected patients with liver cirrhosis in comparison with those with chronic hepatitis or HIV-monoinfected individuals. Time with undetectable HIV load was not related with these parameters. The presence of cirrhosis was negatively associated with a CD4+ T cell count increase. CONCLUSION: In patients with a chronic HIV infection, a persistent increase of lipopolysaccharide-binding protein and monocyte and lymphocyte modifications are present. HCV-related cirrhosis is associated with more elevated serum concentrations of monocyte-derived markers. Cirrhosis influences the continued immune reconstitution of these patients.

Reflexiones sobre el borrador del programa formativo de la especialidad de Enfermería en Cuidados Médico-Quirúrgicos / Reflections on the draft of the Nursing in Medical-Surgical Care speciality training program

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La valoración de RNA del virus de la hepatitis C realizada a las 12 semanas de finalizar el tratamiento predice la respuesta virológica sostenida en enfermos con coinfección por VIH y VHC / Measurement of hepatitis C virus RNA 12 weeks after treatment predicts sustained virological response in HIV-HCV co-infected patients

Objetivo El objetivo de este estudio fue evaluar si la determinación de RNA del virus de la hepatitis C (VHC-RNA) a las 12 semanas tras la finalización del tratamiento podía predecir la respuesta viral sostenida al tratamiento anti-VHC (interferón pegilado alfa-2a y ribavirina) en enfermos coinfectados por el virus de la inmunodeficiencia humana (VIH).Enfermos y métodos Fueron incluidos los pacientes coinfectados por VIH y VHC que completaron un curso completo de tratamiento anti-VHC y que fueron evaluados a las semanas +12 y +24 tras la finalización del tratamiento para determinación del HCV-RNA sérico (RealTime HCV (Abbott, Wiesbaden, Alemania) (límite inferior de detección, 12 U/ml).Resultados Cuarenta de los 66 enfermos tratados (61%) presentaron una respuesta al final del tratamiento. Se les realizó una valoración a las 12 y 24 semanas tras el fin de la terapia. El VHC-RNA sérico fue indetectable en 28 de ellos a la semana +12, y el 100% de ellos permaneció indetectable a la semana +24 (el patrón de referencia de respuesta viral sostenida). El valor predictivo positivo fue 100% (intervalo de confianza al 95% 98,21-100%).Conclusión La evaluación posterior al tratamiento de la hepatitis crónica C en enfermos coinfectados por VIH para detectar la presencia de recaída virológica puede ser realizada a la semana +12, en lugar de a la semana +24, proporcionando así una nueva definición de respuesta virológica sostenida (AU)

Objective The aim of this study was to assess whether measurement of hepatitis C virus RNA (HCV-RNA) at 12 weeks post-treatment could predict sustained virological response (SVR) to antiviral therapy for chronic hepatitis C (pegylated interferon alfa-2a and ribavirin) in HIV-co-infected patients. Patients and methods HIV-HCV co-infected patients were included if they completed a full course of anti-HCV therapy, achieved an end-of-treatment response and complied with the week +12 and +24 post-treatment follow-up schedule for serum HCV-RNA determination (Real-time HCV (Abbott, Wiesbaden, Germany) (lower limit of detection, 12 IU/ml).Results Forty out of 66 patients (61%) showed an end-of-treatment response. They were assessed in a follow-up visit at +12 and at +24 weeks post-treatment. Serum HCV-RNA was undetectable in 28 of them at +12 weeks, and 100% of these remained undetectable at 24 weeks post-treatment (the gold standard of (SVR). The positive predictive value was 100% (95% confidence interval, 98.21-100%).Conclusion Post-treatment follow-up to identify virological relapse could be shortened to 12 weeks, providing a new definition of sustained virological response (AU)

[Measurement of hepatitis C virus RNA 12 weeks after treatment predicts sustained virological response in HIV-HCV co-infected patients]. / La valoración de RNA del virus de la hepatitis C realizada a las 12 semanas de finalizar el tratamiento predice la respuesta virológica sostenida en enfermos con coinfección por VIH y VHC.

OBJECTIVE: The aim of this study was to assess whether measurement of hepatitis C virus RNA (HCV-RNA) at 12 weeks post-treatment could predict sustained virological response (SVR) to antiviral therapy for chronic hepatitis C (pegylated interferon alfa-2a and ribavirin) in HIV-co-infected patients. PATIENTS AND METHODS: HIV-HCV co-infected patients were included if they completed a full course of anti-HCV therapy, achieved an end-of-treatment response and complied with the week +12 and +24 post-treatment follow-up schedule for serum HCV-RNA determination (Real-time HCV (Abbott, Wiesbaden, Germany) (lower limit of detection, 12 IU/ml). RESULTS: Forty out of 66 patients (61%) showed an end-of-treatment response. They were assessed in a follow-up visit at +12 and at +24 weeks post-treatment. Serum HCV-RNA was undetectable in 28 of them at +12 weeks, and 100% of these remained undetectable at 24 weeks post-treatment (the gold standard of (SVR). The positive predictive value was 100% (95% confidence interval, 98.21-100%). CONCLUSION: Post-treatment follow-up to identify virological relapse could be shortened to 12 weeks, providing a new definition of sustained virological response.

Fungemia por Candida lipolytica: a propósito de 2 casos / Fungemia caused by Candida lipolytica: speaking of two cases

Candida lipolytica es un patógeno humano infrecuente. A continuación se presentan 2 casos de fungemia por C. lipolytica, uno de ellos en un niño de 12 años con fibrosis quística pancreática en fase avanzada y el otro en una mujer de 86 años que presentaba neoformación vesical con fibrosis peritoneal, hidronefrosis bilateral e infecciones del tracto urinario de repetición. Tras la administración de antifúngicos y la retirada del catéter, la fungemia se resolvió y los hemocultivos fueron negativos en ambos casos(AU)

Candida lipolytica has rarely been reported as a human pathogen. We observed two cases of fungemia caused by C. lipolytica, one of them in a 12-year-old child with cystic pancreatic fibrosis in advanced phase and another in a 86-year-old woman who presented vesical neoformation with peritoneal fibrosis, bilateral hydronephrosis and recurrent urinary tract infections. After antifungal treatment and catheter removal, the fungemia appeared to be finished and blood cultures were negative(AU)

[Fungemia caused by Candida lipolytica: Speaking of two cases]. / Fungemia por Candida lipolytica: a propósito de 2 casos.

Candida lipolytica has rarely been reported as a human pathogen. We observed two cases of fungemia caused by C. lipolytica, one of them in a 12-year-old child with cystic pancreatic fibrosis in advanced phase and another in a 86-year-old woman who presented vesical neoformation with peritoneal fibrosis, bilateral hydronephrosis and recurrent urinary tract infections. After antifungal treatment and catheter removal, the fungemia appeared to be finished and blood cultures were negative.

Reuse of waste materials as growing media for ornamental plants.

The use of different waste materials: pine bark, coconut fibre and sewage sludge as substrates in the production of ornamental plants was studied, with an special interest on the suitability of coconut fibre as growing substrate for conifer plants. The plant species tested were Pinus pinea, Cupressus arizonica and C. sempervirens and the substrate mixtures were: (1) pine bark, (2) pine bark with 15% of sewage sludge compost, (3) pine bark with 30% of sewage sludge compost, (4) coconut fibre, (5) coconut fibre with 15% of sewage sludge compost and (6) coconut fibre with 30% of sewage sludge compost. Substrates were physically and chemically well characterized, and 75-cm plants were grown on them for one year. Plant and substrate status were periodically tested along the experiment. As biosolid recycling is the main objective of the present work, the mixtures with 30% of composted sewage sludge will be the most convenient substrate to use. For C. sempervirens and C. arizonica, a mixture between pine bark or coconut fibre and 30% of biosolid compost in volume gave the best results, but the lower cost of the pine bark than the coconut fibre substrate indicated the use of the PB+30% CSS. For P. pinea the research of new combinations between waste products is recommended to attain better results.

Integrated evaluation of soil quality after the incorporation of organic matter and microorganisms

The soil quality was evaluated following the addition of organic matter and microorganisms to a clay loam soil collected in Aranjuez (Madrid) under controlled conditions of temperature and moisture, and over a period of three months. The following treatments were carried out: soil (control); soil + 50 t/ha of animal manure (E50); soil + 50 t/ha of animal manure + 30l/ha of effective microorganisms (E50EM); soil + 30 t/ha of combination of various green crop residues and weeds (RC30) and soil + 30 t/ha of combination of various green crop residues and weeds + 30l/ha of effective microorganisms (RC30EM). The soil samples were taken before and after the incubation and analysed using physical, chemical and microbiological parameters. A significant increase in the production of polysaccharides and alkaline phosphatase and esterase enzymes in the treatments E50EM and RC30EM was observed, being in direct correlation with the humification of the organic matter, with the water retention at field capacity, and with the cationic exchange capacity (CEC). It can be concluded that the incorporation of microorganisms EM potentialized the soil biological activity and improved physico-chemical soil properties, contributing to a quick humification of fresh organic matter. Those findings were proved by microbiological activities of exopolysaccharides by alcaline phosphatase and esterase enzymes, which can be used as earlier and integral soil health indicators.