Perfil de resistencia a la tetraciclina de Cutibacterium acnes en pacientes con acné vulgar en un centro dermatológico de Colombia / Cutibacterium Acnes Tetracycline Resistance Profile in Patients with Acne Vulgaris, in a Colombian Dermatologic Center

Introducción El acné es una enfermedad inflamatoria crónica, en cuya patogenia intervienen diferentes actores, siendo Cutibacterium acnes (C. acnes) uno de ellos. La resistencia de esta bacteria a los diferentes fármacos antimicrobianos utilizados en su tratamiento ha sido descrita en diferentes regiones del mundo. El objetivo de este estudio fue estimar la resistencia de C. acnes a las ciclinas en pacientes mayores de 18 años con acné de moderado a severo. Materiales y métodos Se realizó un estudio transversal analítico. Se obtuvieron muestras de las lesiones inflamatorias con un extractor de comedones. Se incubó el contenido de las muestras en ambiente anaeróbico para aislar C. acnes. Por último, se estimó la susceptibilidad de C. acnes a la tetraciclina, minociclina y doxiciclina. Resultados Se obtuvieron muestras de 147 pacientes, observándose crecimiento de C. acnes en 129 de ellos, y encontrándose que el 5,43% de las cepas era resistente a tetraciclina, el 5,43% a doxiciclina, el 0,78% a minociclina, y una resistencia cruzada entre doxiciclina y tetraciclina en todos los casos. Se encontró una asociación entre resistencia y edad igual o superior a 25 años. No se encontró asociación con el uso previo de antibióticos, historia de mal uso de antibióticos orales o tópicos y otras características demográficas y clínicas evaluadas. Conclusiones La resistencia a las ciclinas encontrada en C. acnes fue menor que la reportada en otros estudios. Aunque no se encontró relación con el uso previo de antibióticos, se trata de un factor descrito en estudios previos, por lo que el uso correcto de los mismos es imperativo para evitar la aparición de resistencia (AU)

Introduction Acne is a chronic inflammatory disease, in which different events intervene in its pathogenesis, one of which is Cutibacterium acnes (C. acnes). Resistance of this bacteria to different antimicrobials used in treatment has been described in different regions of the world. The purpose of the study is to estimate the resistance of C. acnes to cyclins in patients with moderate and severe acne over 18 years of age. Materials and Methods An analytical cross-sectional study was carried out. Samples were taken from inflammatory lesions with a comedone extractor. The content of the samples was incubated in an anaerobic atmosphere to grow C. acnes. Finally, the susceptibility of C. acnes to tetracycline, minocycline and doxycycline was determined. Result Samples were taken from 147 patients, of which 129 showed growth of C. acnes, finding that 5.43% of the strains were resistant to tetracycline, 5.43% to doxycycline, 0.78% to minocycline and cross resistance between doxycycline and tetracycline in all the cases. An association was found between resistance and being 25 years of age or older. No association was found with the prior use of antibiotics, a history of misuse of oral or topical antibiotics, and other demographic and clinical characteristics evaluated. Conclusions The resistance found of C. acnes to cyclines was lower than that reported in other studies. Although no relationship was found with the previous use of antibiotics, it is a factor described in previous studies, which is why the proper use of antibiotics is imperative to avoid the appearance of resistance (AU)

Cutibacterium Acnes Tetracycline Resistance Profile in Patients with Acne Vulgaris, in a Colombian Dermatologic Center. / Perfil de resistencia a la tetraciclina de Cutibacterium acnes en pacientes con acné vulgar en un centro dermatológico de Colombia.

INTRODUCTION: Acne is a chronic inflammatory disease, in which different events intervene in its pathogenesis, one of which is Cutibacterium acnes (C. acnes). Resistance of this bacteria to different antimicrobials used in treatment has been described in different regions of the world. The purpose of the study is to estimate the resistance of C. acnes to cyclins in patients with moderate and severe acne over 18 years of age. MATERIALS AND METHODS: An analytical cross-sectional study was carried out. Samples were taken from inflammatory lesions with a comedone extractor. The content of the samples was incubated in an anaerobic atmosphere to grow C. acnes. Finally, the susceptibility of C. acnes to tetracycline, minocycline and doxycycline was determined. RESULTS: Samples were taken from 147 patients, of which 129 showed growth of C. acnes, finding that 5.43% of the strains were resistant to tetracycline, 5.43% to doxycycline, 0.78% to minocycline and cross resistance between doxycycline and tetracycline in all the cases. An association was found between resistance and being 25 years of age or older. No association was found with the prior use of antibiotics, a history of misuse of oral or topical antibiotics, and other demographic and clinical characteristics evaluated. CONCLUSIONS: The resistance found of C. acnes to cyclines was lower than that reported in other studies. Although no relationship was found with the previous use of antibiotics, it is a factor described in previous studies, which is why the proper use of antibiotics is imperative to avoid the appearance of resistance.

[A structural model to measure effectiveness of hospital services]. / Un modelo estructural para medir la efectividad de los servicios hospitalarios: aplicación en hospitales públicos del sur de Chile.

BACKGROUND: One of the main determinants of quality in the public health care services is the perceived user satisfaction. AIM: To analyze the relationship between supply (User Orientation of Management) (UO), demand (User Satisfaction with service components) (US) and subjective indicators of effectiveness, such as Perceived Global Quality (PGQ) and Global Satisfaction (GS) among hospital service users. MATERIAL AND METHODS: A survey was applied to users of hospital services, asking about management and quality of hospital services and satisfaction with the service provided. Data was analyzed with exploratory and confirmatory factorial analyses. Structural Equation Models were used to test the hypotheses implied in the theoretical model of effectiveness. RESULTS: The cause-effect relationship between UO and US was confirmed. There was also a direct relationship between PGQ and GS. CONCLUSIONS: Efficient nursing and administrative personnel are of highest importance to improve user satisfaction. The hospital management must pay extreme attention to this kind of staff in order to be effective from the point of view of their patients.

Un modelo estructural para medir la efectividad de los servicios hospitalarios: aplicación en hospitales públicos del sur de Chile / A structural model to measure effectiveness of hospital services

Background: One of the main determinants of quality in the public health care services is the perceived user satisfaction. Aim: To analyze the relationship between supply (User Orientation of Management) (UO), demand (User Satisfaction with service components) (US) and subjective indicators of effectiveness, such as Perceived Global Quality (PGQ) and Global Satisfaction (GS) among hospital service users. Material and Methods: A survey was applied to users of hospital services, asking about management and quality of hospital services and satisfaction with the service provided. Data was analyzed with exploratory and confirmatory factorial analyses. Structural Equation Models were used to test the hypotheses implied in the theoretical model of effectiveness. Results: The cause-effect relationship between UO and US was confirmed. There was also a direct relationship between PGQ and GS. Conclusions: Efficient nursing and administrative personnel are of highest importance to improve user satisfaction. The hospital management must pay extreme attention to this kind of staff in order to be effective from the point of view of their patients.

Gestión y satisfacción en servicios de salud de Chile: contraste entre las percepciones de los funcionarios y los usuarios / Perceptions of providers and clients about management and satisfaction with services in two public hospitals

Background: Clients and providers of health care can have contrasting perceptions about the quality of service. Provider perceptions are mostly devoted to design and delivery of services while those of clients are focused in the attention received. Aim: To assess perceptions of health care providers and clients about client management and satisfaction with services provided. Material and Methods: Two public hospitals were surveyed. A qualitative analysis was performed first, reviewing reports and patient data bases and through informal meetings with providers and clients. In a second phase, an enquiry with Likert type questions was devised and answered by a total of 377 providers and 400 clients from both hospitals. Results: The median perception of clients about the quality of service was better than that of providers in both hospitals. The communication of hospitals with clients to offer timely information received a poor evaluation both from providers and clients. However the concern of hospitals about health care of the community was considered adequate. The degree of satisfaction with concrete issues such as information panels and physical infrastructure received similar evaluation both by providers and clients. Conclusions: This analysis can be useful for management decision making, identifying strengths and weaknesses of health care provided by these two public hospitals. This type of assessment can be replicated in other public and private health care facilities.

[An enquiry on client opinions about quality of care in a public hospital]. / Análisis de la opinión de usuarios sobre calidad percibida y satisfacción con hospitales públicos: Estudio de caso desde la perspectiva de la aplicación del marketing.

BACKGROUND: The level of satisfaction of patients with the services provided by public hospitals is becoming an important issue for health authorities. AIM: To analyze an enquiry applied to patients, about the level of satisfaction with the service provided by a public regional hospital in Chile. MATERIAL AND METHODS: An enquiry was applied to 150 ambulatory (76% women) and 50 hospitalized patients (56% women). It included 28 questions about management aspects of health care and 20 questions about client satisfaction. Data was analyzed using factorial analysis and multiple regressions. RESULTS: The manners of hospital personnel were the factor with the highest impact on the perception of patients about global quality of services. Attention timing was the most influential aspect on global satisfaction. CONCLUSIONS: There results confirm those from abroad and can orient an adequate management of public hospital.

Análisis de la opinión de usuarios sobre calidad percibida y satisfacción con hospitales públicos: Estudio de caso desde la perspectiva de la aplicación del marketing / An enquiry on client opinions about quality of care in a public hospital

Background: The level of satisfaction of patients with the services provided by public hospitals is becoming an important issue for health authorities. Aim: To analyze an enquiry applied to patients, about the level of satisfaction with the service provided by a public regional hospital in Chile. Material and methods: An enquiry was applied to 150 ambulatory (76 percent women) and 50 hospitalized patients (56 percent women). It included 28 questions about management aspects of health care and 20 questions about client satisfaction. Data was analyzed using factorial analysis and multiple regressions. Results: The manners of hospital personnel were the factor with the highest impact on the perception of patients about global quality of services. Attention timing was the most influential aspect on global satisfaction. Conclusions: There results confirm those from abroad and can orient an adequate management of public hospital.

[Mediastinal hydatid cyst. Case report and review]. / Quiste hidatídico mediastínico. Reporte de un caso y revisión de la literatura.

Hydatid disease is caused by the larval stages of a cestodes belonging to the genus Echinococcus. In humans, hydatid larva and cysts are located >90% in the liver and/or lungs. Primary mediastinal location, with absence of documented lung infection, is extremely rare and has not been previously reported in Chile. We report the first case of a primary mediastinal hydatid cyst in Chile and review the literature. A 38 year old woman was admitted because of a painful right supraclavicular mass, dyspnea on exertion and logical dysphagia. Presurgical evaluation evidenced a mediastinal tumor extending to the cervical region that was successfully removed. The diagnosis of mediastinal hydatid cyst was confirmed macroscopically and by biopsy.

Quiste hidatídico mediastínico: Reporte de un caso y revisión de la literatura / Mediastinal hydatid cyst: Case report and review

Hydatid disease is caused by the larval stages of a cestodes belonging to the genus Echinococcus. In humans, hydatid larva and cysts are located > 90 percent in the liver and/or lungs. Primary mediastinal location, with absence of documented lung infection, is extremely rare and has not been previously reported in Chile. We report the first case of a primary mediastinal hydatid cyst in Chile and review the literature. A 38 year old woman was admitted because of a painful right supraclavicular mass, dyspnea on exertion and logical dysphagia. Presurgical evaluation evidenced a mediastinal tumor extending to the cervical region that was successfully removed. The diagnosis of mediastinal hidatyd cyst was confirmed macroscopically and by biopsy.

La hidatidosis es una parasitosis producida por la larva o quiste del cestodes del género Echinococcus. Una vez que el parásito infecta al hombre se ubica, en más de 90 por ciento de los casos, en hígado o pulmón. La localización mediastínica sin afección pleuropulmonar previa es extremadamente infrecuente. En Chile no hay reporte de casos con tal ubicación. Se presenta el primer caso en Chile de un quiste hidatídico (QH) mediastínico: el caso de una mujer de 38 años que consultó por aumento de volumen doloroso supraclavicular derecho, asociado a disnea de esfuerzo y disfagia lógica, cuyo estudio preoperatorio mostró un tumor de mediastino con extensión cervical de aspecto nodal y de naturaleza incierta. Se operó con éxito en nuestro hospital, comprobándose durante la operación y por la biopsia, el diagnóstico de QH mediastínico. Adjuntamos las imágenes más relevantes y las fotografías de la operación y la pieza quirúrgica, como también una revisión de la literatura médica.

[Application of marketing strategies for the management of public hospitals from the viewpoint of the staff members]. / La aplicación del marketing en hospitales públicos desde la perspectiva de los funcionarios: el caso de un hospital del sur de Chile.

BACKGROUND: The implementation of the marketing strategies in public hospitals provides management advantages and improves the relationship between customers and staff. AIM: To analyze the application of marketing strategies in a public hospital, from the perspective of the staff. MATERIAL AND METHODS: A structured survey that asked about perceptions in 50 items about communication between personnel and customers/users, customer satisfaction, participation in the development of new policies and incentives for efficiency was applied to a stratified sample of the staff. Factorial and regression analyses were performed to define the impact of marketing strategies on the degree of preoccupation and orientation of the organization towards the satisfaction of customer needs. RESULTS: The survey was applied to 74 males and 122 females. The survey showed that the orientation of the hospital towards the satisfaction of its beneficiaries basically depends on the generation of an organizational culture oriented towards them and the implementation of adequate policies in staff management and quality of service. These basic aspects can be accompanied with practices associated to the new marketing approaches such as a market orientation, customer orientation and relational marketing. All these factors presented positive and significant relations. CONCLUSIONS: New marketing strategies should be applied, to achieve an efficient and customer oriented hospital management.

La aplicación del marketing en hospitales públicos desde la perspectiva de los funcionarios: El caso de un hospital del sur de Chile / Application of marketing strategies for the management of public hospitals from the viewpoint of the staff members

Background: The implementation of the marketing strategies in public hospitals provides management advantages and improves the relationship between customers and staff. Aim: To analyze the application of marketing strategies in a public hospital, from the perspective of the staff. Material and methods: A structured survey that asked about perceptions in 50 items about communication between personnel and customers/users, customer satisfaction, participation in the development of new policies and incentives for efficiency was applied to a stratified sample of the staff. Factorial and regression analyses were performed to define the impact of marketing strategies on the degree of preoccupation and orientation of the organization towards the satisfaction of customer needs. Results: The survey was applied to 74 males and 122 females. The survey showed that the orientation of the hospital towards the satisfaction of its beneficiaries basically depends on the generation of an organizational culture oriented towards them and the implementation of adequate policies in staff management and quality of service. These basic aspects can be accompanied with practices associated to the new marketing approaches such as a market orientation, customer orientation and relational marketing. All these factors presented positive and significant relations. Conclusions: New marketing strategies should be applied, to achieve an efficient and customer oriented hospital management.

El difícil tratamiento de una adolescente limítrofe / A difficult treatment on a borderline teenager

El presente trabajo nos muestra, a través de material clínico de tres momentos distintos, la evolución del proceso analítico de una adolescente que consulta a los 12 años de edad. Presenta una estructura de personalidad limítrofe, con componentes sadomasoquistas y obsesivos, con síntomas fóbicos, impulsividad, angustia difusa y conductas auto agresivas. A través del material, especialmente una serie de dibujos, podemos seguir el proceso terapéutico a lo largo de un período de cuatro años, hasta la actualidad. Esta paciente requirió la intervención de un equipo multidisciplinario, con farmacoterapia, intervenciones vinculares con la madre, supervisiones para la analista. Destaca en el trabajo analítico, el uso de la contratransferencia como herramienta fundamental para ubicar el nivel de las intervenciones de la analista, permitiéndole una contención y una comprensión del material, que va determinando un progreso lento pero sostenido en la expresión de la ansiedad, desde acting out hacia la aparición de un espacio para el pensamiento.

[Thrombosed cavernous hemangioma of the anterior mediastinum. A report of one case]. / Hemangioma cavernoso trombosado de mediastino anterior. A propósito de un caso.

Mediastinum hemangioma is a rare benign tumor. We performed surgery and present the first reported case in Chile. The patient is a 24-year-old symptomatic woman, referred to our hospital from a rural health center. The patient had all routine preoperative studies, chest radiographs and computed tomography of the thorax. We performed a median sternotomy with a complete resection of the mass. During the 36-month follow-up, she was well, asymptomatic and without relapse evidence. A review of the most outstanding characteristics of this rare tumor is presented.

Genotipo E3/3 de APO E y su relación con la respuesta de los lípidos séricos al colesterol dietario / APO E genotype and its relationship to the response of serum cholesterol to dietary cholesterol

Introducción: Se ha descrito que el colesterol dietario produce modestos cambios en los niveles de colesterol sérico. Diversos estudios han mostrado que existe una marcada heterogeneidad en la respuesta individual frente a una dieta baja en colesterol. El polimorfismo de la apo E y sus diferentes isoformas descritas, ha sido reconocido como un factor involucrado en la variación de la respuesta y también como marcador de riesgo cardiovascular en la población. Los estudios que evalúan la respuesta dietaria en relación al gen de la apo E no han sido realizados en la población chilena. Objetivo: Evaluar la respuesta de los lípidos séricos en individuos con genotipo E3/3, frente a una intervención con colesterol dietario en la forma de un huevo sobre su dieta normal. Materiales y Métodos: Se realizó un estudio de diseño prospectivo, randomizado y crossover en 36 hombres provenientes de una institución bancaria de 25 a 55 años de edad. Se determinó colesterol plasmático total, LDL-col, HDL-col, TG, apo B y polimorfismo de apo E. Resultados: Las isoformas de apo E encontradas fueron un 79 por ciento de E3/3 y un 16 por ciento de E4/3. Los individuos E3/3 modificaron las concentraciones de colesterol total en un 0.1 por ciento luego de la adición de un huevo a la dieta por 4 semanas (209,6 ± 5,1 v/s 209,8 ± 5,6 mg/dl respectivamente, IC [- 5,0; 6,8] ). Individuos E4/3 modificaron en un 0,8 por ciento la concentración de colesterol total bajo las mismas condiciones experimentales (200,3 ± 9,4 v/s 201,8 ± 6,0 mg/dL, IC [-10,0; 13,0] ). La concentración de Apo B sérico tuvo una variación porcentual de + 5,5 por ciento para individuos E3/3 y - 2,1 por ciento para individuos E4/3, sin diferencias significativas intra y entre grupos. Conclusión: Individuos con genotipo E3/3 de apo E no modificaron significativamente sus concentraciones de colesterol total luego de la intervención con colesterol dietario, así como también los individuos E4/3 analizados. Nuestros resultados refuerzan la noción que la mayoría de la población es capaz de compensar a un aumento moderado de colesterol. Estos resultados tienen implicancia en las recomendaciones dietarias a la población.

Actividad bactericida del ácido hipocloroso / Bactericidal activity of hipochlorous acid (HCLO) against five strains in nosocomial infection

El aumento de las infecciones nosocomiales ha llevado a las instituciones de salud a mejorar las medidas de asepsia y antisepsia; dentro de estas, la búsqueda de un desinfectante eficaz que contribuya a este problema. El ácido hipocloroso (HC10) es un ion no disociado del cloro, responsable de la acción bactericida de los compuestos derivados del cloro, no es corrosivo ni cáustico y es conocido como un potente desinfectante. Este estudio evalúo la efectividad bactericida del HC10 sobre cinco cepas bacterianas causantes de infección intrahospitalaria, utilizando la técnica de Kelsey Maurer en condiciones controladas de temperatura, concentración del HC10 y tiempo de acción; se realizo una modificación con adición de albúmina al 5 por ciento. Se determinó que el HC10 es efectivo a concentraciones iguales o mayores a 900 ppm, luego de 10 minutos de acción para todas las cepas estudiadas con o sin la adición de proteínas

Helicobacter pylori in gastric cancer and peptic ulcer disease in a Colombian population. Strain heterogeneity and antibody profiles.

BACKGROUND: Helicobacter pylori infection is associated with peptic ulcer disease and gastric cancer. The aim of this work was to describe, to compare H. pylori antigenic profiles, and to characterize the antibody response against Colombian strains in gastric cancer and peptic ulcer patients. MATERIALS AND METHODS: Liquid culture supernatants were used to determine the antigenic profiles of 35 H. pylori strains by immunoblotting using a pool of positive sera. Characterization of strains included the evaluation of cytotoxic and vacuolating activities. The serologic antibody profiles of 124 patients (54 duodenal ulcer and 70 gastric cancer) were analyzed against two native strains (Hpu24, Hpc29) and NCTC11638. Antibodies to specific antigenic bands in each strain were related with presentation. RESULTS: Differences among antigenic profiles were observed between native isolates with each serum recognizing a wide range of antigens (30-120 Kd). A 68 Kd band in Hpu24 strain was recognized by 50% of sera from peptic ulcer patients but not by gastric cancer sera (p =.000). The immune profiles differed according to the strain used (i.e. a given sera did not recognize the same bands in different strains). Detection of H. pylori in gastric mucosa was associated with the presence of antibodies against low molecular weight antigenic bands. CONCLUSIONS: The heterogeneity in the antibody response to H. pylori and the prevalence specific anti-H. pylori antibodies in a specific disease depend on the strain used as antigen. The results support the hypothesis that there may be a differential antibody response to carcinogenic and ulcerogenic strains and suggest that there are antigenic bands that could be useful as markers of disease.

Timectomías en miastenia gravis / Thymectomy in myasthenia gravis

Se revisaron las fichas médicas de todos los pacientes timectomizados por miastenia gravis (MG) desde enero de 1985 hasta abril de 1997. Se intervinieron 22 pacientes, 82 por ciento de ellos mujeres. La edad promedio fue de 28 años. El 68 por ciento fueron tipo IIb de Osserman, no hubo tipo I ni III. el 63,6 por ciento de los pacientes se operaron antes del año desde el diagnóstico. el promedio de estada hospitalaria fue de 8,4 días. Las complicaciones fueron: la lesión de los recesos pleurales anteriores en el intraoperatorio (27,3 por ciento), la neumonía intrahospitalaria (13 por ciento) y la infección de la herida operatoria en 1 paciente. Al estado actual de los pacientes el 63,6 por ciento están mejor, el 27,3 por ciento están igual y un 9,1 por ciento están peor que antes de la cirugía. El estudio histopatológico mostró 2 timomas benignos, 7 timos involutivos y 13 hiperplasias tímicas. La timectomía por esternotomía media tiene buenos resultados quirúrgicos y terapéuticos, requiriendo apoyo ventilatorio mecánico. La mayoría de los pacientes sometidos a ella se benefician al extirpar la fuente inmunológica anormal

Cirugía del timo / Thymus surgery

Las lesiones tímicas son la causa más común de masa primaria mediastínica. Muchos de estos tumores se asocian a enfermedades sistémicas. El timoma afecta a ambos sexos por igual, aproximadamente el 15% de los pacientes con miastenia gravis tiene timoma maligno o benigno, mientras el 10 a 50% de los pacientes con timoma tienen miastenia gravis. En el tratamiento del timoma la cirugía deber ser agresiva e intentar la exéresis total. En la presente comunicación analizamos las timectomías efectuadas en nuestro servicio desde octubre 1982 a octubre 1989, intervenimos a 8 pacientes, seis mujeres y dos hombres de los cuales 5 presentaban miastenia gravis (4 mujeres, 1 hombre). Se abordan por esternotomía media sin que tuviéramos morbimortalidad ni fuese necesario el drenaje pleural. El diagnóstico oportuno de masa tímica, asociado o no a miastenia gravis, brinda la oportunidad de solución a un problema que si se deja estar se va a transformar en inoperable por crecimiento e invasión de estructuras vecinas