Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings.

PURPOSE: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

Associated factors for mortality in a COVID-19 colombian cohort: is the third wave relevant when Mu variant was predominant epidemiologically?

OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.

Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries.

BACKGROUND: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. METHODS: From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). RESULTS: About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. CONCLUSIONS: Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.

Gonococcal arthritis in a healthy adult. Is it that possible?

A case report is presented of a 50-year-old woman who was seen in Accident and Emergency because of pain in the lumbar area. She was subsequently diagnosed with septic arthritis of the left hip due to being Neisseria gonorrhoeae positive for beta-lactamase. She responded to treatment with ceftriaxone, but later required a total hip replacement.

Presentamos el caso de una mujer de 50 arios, sin antecedentes de importancia, a quien se le diagnosticó inicialmente lumbago e infección de vías urinarias. Por persistencia del dolor y limitación de la movilidad en la cadera izquierda se inicia el estudio de artritis séptica, que fue provocada por Neisseria gonorrhoeae betalactamasa positiva, sensible a tratamiento con ceftriaxona, con posterior deterioro articular, el cual requirió reemplazo total de cadera.

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.

Bacteriemia por Clostridium sordellii en paciente con neoplasia gastrointestinal. Reporte de caso y revisión de literatura / Clostridium sordellii bacteremia in a patient with gastrointestinal neoplasia. Case report and review of the literatura

La bacteriemia por Clostridium sordellii es infrecuente y usualmente se origina a partir de infecciones de etiología generalmente ginecológica y puerperal, con una mortalidad de aproximadamente el 70%. Existen pocas herramientas para el diagnóstico rápido y oportuno, siendo así la experiencia de tratamiento para este germen muy limitada en otros escenarios, lo que probablemente sea la causa de su alta mortalidad. Presentamos una paciente con antecedente de masa abdominal expansiva de larga data, con diagnóstico por histopatología e inmunohistoquimica compatibles con tumor del estroma gastrointestinal (GIST por sus siglas en inglés) y estudios de extensión que confirman compromiso metastásico hepático, en quien se documenta bacteriemia por Clostridium sordellii.

Clostridium sordellii bacteriemia is infrequent and usually comes from infections of gynecological and puerperal etiology, with mortality near 70%. There are few tools for rapid and timely diagnosis. Thus, treatment experience for this pathogen is very limited in other scenarios, which is probably the cause of high mortality rates. We describe a patient with a history of expansive abdominal mass, diagnosed with metastasic Gastrointestinal Stromal Tumor (GIST), with Clostridium sordellii bacteremia.

Correlation between videothoracoscopy and biopsy in patients with pleural effusion and suspected tuberculosis in a high complexity military hospital / Correlación entre videotoracoscopia y biopsia en pacientes con derrame pleural y sospecha de tuberculosis en Hospital Militar de alta complejidad

Background: In the diagnostic process of pleural tuberculosis, the findings from video-assisted thoracoscopy (VATS) can be highly suggestive for the diagnosis of infection. Methods: We reviewed VATS records between the years 2012 to 2016 of patients over 16 years of age with pleural effusion and suspected pleural tuberculosis. Symptoms, macroscopic and chemical characteristics of the fluid, surgical descriptions and visual diagnosis of the surgeon were recorded and were compared with the histopathology. Results: 106 patients were selected, most of them men (71.7%), of whom approximately half were active military (51.3%). The predominant symptoms were dyspnea, pleuritic pain, fever and evolution time greater than 15 days (94.3%, 80.2%, 50% and 46,2%, respectively). These symptoms, in turn, were present more frequently in pleural tuberculosis patients than in non-tuberculosis patients. The fluid was mostly turbid yellow (44%) and lymphocytic cellularity exudate (77.4%). The VATS findings in patients with confirmed TBC included nodules (96.9%), adhesions (87.5%) and thickening (78.1%). The diagnosis made by the surgeon in relation to the histopathological diagnosis showed a sensitivity of 88.6% and a specificity of 98.4%. Conclusion: There are highly suggestive characteristics of the macroscopic report of VATS that would allow a quicker diagnosis of pleural tuberculosis.

Antecedentes: Los hallazgos de toracoscopia asistida por video (VATS) durante el diagnostico de tuberculosis pleural, que son altamente sugestivos de la infección han sido poco descritos. Metodos: Se revisaron los registros de VATS entre los años 2012 a 2016 of de pacientes mayores de 16 años con efusión pleural y sospechosos de etiología tuberculosa. Se analizaron los síntomas, las características macroscópicas y bioquímicas del líquido, la descripción quirúrgica y el diagnostico visual y se compararon con los resultados de la histopatologia. Resultados: Se estudiaron los registros de 106 pacientes, la mayoría fueron sexo masculino (71.7%), y aproximadamente la mitad en servicio militar activo (51.3%). Los síntomas predominantes fueron disnea, dolor pleuritico, fiebre y tiempo de evolución mayor a 15 días (94.3%, 80.2%, 50% y 46,2%, respectivamente). Estos sintomas a su vez fueron más frecuentes en tuberculosis pleural que en no tuberculosis. El liquido fue más amarillo turbio (44%) y con exudado de tipo linfocitario (77.4%). Los hallazgos de VATS en pacientes con tuberculosis confirmada incluyeron nodulos (96.9%), adhesiones (87.5%) y engrosamiento (78.1%). El diagnóstico hecho por el cirujano con relación al histopatológico, tuvo una sensibilidad de 88.6% y una especificidad de 98.4%. Conclusion: Existen características en el VATS altamente sugestivas de tuberculosis pleural.

Caracterización de neumonía por Staphylococcus aureus meticilino resistente en hospital militar de alta complejidad / Characterization of Methicillin-resistant Staphylococcus aureus pneumonia in high complex militar hospital

Introducción: Por su capacidad de resistencia, las cepas de Staphylococcus aureus resistentes a la meticilina (SAMR) representan un reto importante en la terapéutica. Se desarrolló este estudio con el fin de caracterizar la población con neumonía por SAMR del Hospital Militar Central. Métodos: Se condujo un estudio descriptivo de corte transversal, en pacientes con diagnóstico de neumonía bacteriana con aislamiento microbiológico positivo para SAMR. El análisis de los datos se realizó a través de medidas de tendencia central y de dispersión. Resultados: Durante el periodo de 4 años de estudio hubo 211 aislamientos correspondientes a S. aureus de los cuales 22 correspondieron a neumonía bacteriana por SAMR. La neumonía nosocomial fue la forma más frecuente de presentación (54,5%), seguida por neumonía adquirida en la comunidad (36,3%). El 36,3% de los pacientes eran militares activos, el 31,8% militares retirados o civiles. La frecuencia de comorbilidades fue del 92,3% siendo la enfermedad renal crónica y malignidad las más frecuentes. Conclusión: Desde el punto de vista clínico la neumonía por SAMR se caracterizó por una mayor cantidad de pacientes jóvenes y sin comorbilidades contrastando con neumonía nosocomial que se caracterizó por una población de más edad y con mayor prevalencia de comorbilidades.

Introduction: Strains methicillin-resistant Staphylococcus aureus (MRSA), to be resistant to most beta-lactam available and different families of antibiotics, represent a major challenge in therapeutics; for this reason, it is necessary to conduct studies to characterize better patients with MRSA infection. Methods: A descriptive study of cross section of patients diagnosed with bacterial pneumonia with positive microbiological isolation for MRSA was conducted by reviewing medical records and susceptibility testing relevant demographic and clinical data were extracted. The data analysis was conducted through measures of central tendency and dispersion. Results: During the period of 4 years of study; there were 211 isolates corresponding to S. aureus; of which 22 were for MRSA bacterial pneumonia. Nosocomial pneumonia was the most common presentation (54,5%); followed by community-acquired pneumonia (36,3%). 36,3% of patients were military personnel, 31,8% retired military or civilians. The frequency of comorbidities was 92,3% being chronic kidney disease and the most common malignancy. Conclusion: From the clinical point of view MRSA pneumonia it was characterized by a greater number of young patients without comorbidities; which contrasted with nosocomial pneumonia was characterized by an aging population and higher prevalence of comorbidities.

Predicción espacio-temporal probabilista de la epidemia de dengue total y grave en Colombia / Probabilistic spatial-temporal prediction of total and severe epidemic of dengue in Colombia / Previsão probabilística espaço-temporal da epidemia de dengue total e grave na Colômbia

RESUMEN Objetivo Establecer una nueva metodología predictiva de la proporción de dengue grave respecto al total anual de infectados de dengue por departamento con base en la teoría de la probabilidad. Métodos Con base en los datos anuales de número de infectados por departamentos en el periodo 2005 -2010, se calculó la proporción entre casos de dengue grave respecto al total para cada año, y se construyeron espacios de probabilidad que evalúan estos eventos en rangos de 0,5 y 0,3. Se determinaron conjuntos de rangos y se calculó probabilidad, desviación media cuadrática y la diferencia entre ellas. Se realizó una predicción del rango de infectados para el 2011 con el promedio aritmético de los valores de los últimos dos años. Resultados Se predijo correctamente el rango en el que se encuentra incluida la proporción de número de infectados de dengue grave sobre el total en cada departamento con una efectividad del 93,3% para el rango de 0,5 y de 86,7% para el de 0,3. Conclusión Se evidenció una autoorganización matemática espacio temporal en la proporción de dengue grave respecto al total que permite establecer predicciones de utilidad para la toma de decisiones de salud pública.(AU)

ABSTRACT Objective To establish a new predictive methodology to determine the proportion of severe dengue with respect to the annual total of dengue infections per department based on the probability theory. Materials and Methods Based on annual data on the number of infected persons by department in the period 2005-2010, the proportion of cases of severe dengue was calculated with respect to the total for each year. Probability spaces were constructed to evaluate these events in the ranges 0.5 and 0.3. Sets of ranges were determined and probability, mean square deviation and the difference between them were estimated. A prediction of the range of infected people for 2011 was made using the arithmetic average of the values of the last two years. Results The range in which the proportion of the number of people infected with severe dengue is included with respect to the total amount in each department was correctly predicted, with an effectiveness of 93.3% for the 0.5 range and 86.7% for the 0.3 range. Conclusion A mathematical spatial-temporal self-organization was found in the proportion of severe dengue with respect to the total, which allows establishing useful predictions for decision-making in public health.(AU)

RESUMO Objetivo Estabelecer uma nova metodologia preditiva para a proporção de dengue grave em relação ao dengue total anual infectado por departamento com base na teoria da probabilidade. Métodos Com base nos dados anuais do número de infectados por departamentos no período 2005-2010, a proporção entre os casos de dengue grave em relação ao total foi calculada para cada ano, e foram construídos espaços de probabilidade que avaliam esses eventos em intervalos de 0, 5 e 0,3. Conjuntos de intervalos foram determinados e a probabilidade, o desvio médio quadrático e a diferença entre eles foram calculados. A previsão da faixa de infectados para 2011 foi feita com a média aritmética dos valores dos últimos dois anos. Resultados A faixa na qual a proporção do número de infectados por dengue grave sobre o total está incluída em cada departamento foi corretamente prevista com uma eficácia de 93,3% para a faixa de 0,5 e 86,7% para aquela de 0,3. Conclusão Evidenciou-se uma auto-organização matemática espaço-temporal na proporção de dengue grave em relação ao total, o que permite estabelecer previsões úteis para a tomada de decisões em saúde pública.(AU)

[Probabilistic spatial-temporal prediction of total and severe epidemic of dengue in Colombia]. / Predicción espacio-temporal probabilista de la epidemia de dengue total y grave en Colombia.

OBJECTIVE: To establish a new predictive methodology to determine the proportion of severe dengue with respect to the annual total of dengue infections per department based on the probability theory. MATERIALS AND METHODS: Based on annual data on the number of infected persons by department in the period 2005-2010, the proportion of cases of severe dengue was calculated with respect to the total for each year. Probability spaces were constructed to evaluate these events in the ranges 0.5 and 0.3. Sets of ranges were determined and probability, mean square deviation and the difference between them were estimated. A prediction of the range of infected people for 2011 was made using the arithmetic average of the values of the last two years. RESULTS: The range in which the proportion of the number of people infected with severe dengue is included with respect to the total amount in each department was correctly predicted, with an effectiveness of 93.3% for the 0.5 range and 86.7% for the 0.3 range. CONCLUSION: A mathematical spatial-temporal self-organization was found in the proportion of severe dengue with respect to the total, which allows establishing useful predictions for decision-making in public health.

OBJETIVO: Establecer una nueva metodología predictiva de la proporción de dengue grave respecto al total anual de infectados de dengue por departamento con base en la teoría de la probabilidad. MÉTODOS: Con base en los datos anuales de número de infectados por departamentos en el periodo 2005 -2010, se calculó la proporción entre casos de dengue grave respecto al total para cada año, y se construyeron espacios de probabilidad que evalúan estos eventos en rangos de 0,5 y 0,3. Se determinaron conjuntos de rangos y se calculó probabilidad, desviación media cuadrática y la diferencia entre ellas. Se realizó una predicción del rango de infectados para el 2011 con el promedio aritmético de los valores de los últimos dos años. RESULTADOS: Se predijo correctamente el rango en el que se encuentra incluida la proporción de número de infectados de dengue grave sobre el total en cada departamento con una efectividad del 93,3% para el rango de 0,5 y de 86,7% para el de 0,3. CONCLUSIÓN: Se evidenció una autoorganización matemática espacio temporal en la proporción de dengue grave respecto al total que permite establecer predicciones de utilidad para la toma de decisiones de salud pública.

Pielonefritis enfisematosa en paciente con infección por virus de inmunodeficiencia humana: reporte de caso / Emphysematous pyelonephritis in patient with human immunodeficiency virus infection: A case report

La pielonefritis enfisematosa es una infección necrosante del parénquima renal que puede afectar los tejidos perirrenales y cuyo espectro de presentación clínica, por esa razón, es variable (choque séptico, acidosis metabólica, hiperglucemia, hipoglucemia, falla renal, delirio, entre otros); la mayoría de los casos se han informado en pacientes con diabetes mellitus o presencia de uropatía obstructiva. Reportamos el caso de una paciente joven no diabética quien presentó pielonefritis enfisematosa como condición clínica que lleva al diagnóstico inicial de infección por VIH, sin otras comorbilidades relacionadas, exitosamente tratada con manejo quirúrgico y antibioticoterapia. Se realizó una búsqueda sistemática de la literatura, en la cual no se ha informado esta enfermedad como manifestación clínica que lleve al diagnóstico inicial de la infección por VIH.

Emphysematous pyelonephritis is a necrotising infection of the renal parenchyma that may affect the perirenal tissue. Thus, the spectrum of clinical presentation is variable (septic shock, metabolic acidosis, hyperglycaemia, hypoglycaemia, renal failure, delirium); most cases have been reported in patients with diabetes mellitus or obstructive uropathy. We report the case of a young female patient without diabetes who presented emphysematous pyelonephritis as the condition that led to the diagnosis of HIV infection, without related comorbidities, and who was successfully treated with surgical and antibiotical therapy. A systematic search of the literature revealed that this disease as a condition leading to an initial diagnosis of HIV infection has not been previously reported.

Predicción de la concentración de linfocitos T CD4, con base en la teoría de conjuntos aplicada al seguimiento de pacientes con VIH / Prediction of the concentration of CD4 T lymphocytes based on set theory applied to the monitoring of patients with HIV

Introducción: se desarrolló una metodología predictiva de CD4 a partir del recuento de leucocitos y linfocitos del hemograma para pacientes con VIH/sida, buscando una medida alternativa a la citometría de flujo.Métodos: se evaluó la pertenencia a cuatro conjuntos: A, B, C y D, de tripletas de linfocitos/mm³, leucocitos/mm³ y CD4/μL, tomados de 33 pacientes, recopilando de 4 a 5 muestras por paciente, 144 en total. La evaluación de (A ( C) , (B (D) y (A( C) ∩ (B ( D) permite establecer las predicciones a partir del porcentaje de pertenencia a estos conjuntos. Los resultados fueron ordenados de manera descendente dentro de nueve rangos de 1000 leucocitos. Se estableció el número de pacientes con predicciones acertadas y los rangos de mayor efectividad en la predicción.Resultados: la intersección (A ( C) ∩ (B ( D) mostró una efectividad en la predicción de CD4 del 85,71% en el rango de 4999-4000 leucocitos, del 83,33% en el de 3999-3000 y del 100% en el de menos de 3000.Conclusión: la capacidad predictiva y la utilidad clínica de la metodología desarrollada fueron confirmadas para la predicción de linfocitos T CD4, permitiendo disminuir costos frente a la citometría de flujo en el seguimiento de pacientes en el tiempo.

Introduction: A CD4 predictive methodology from the white cell blood count and lymphocyte blood counts was developed in patients with HIV/AIDS, seeking an alternative measure to flow cytometry.Methods: Membership to four sets: A, B, C and D, of triplets of: cells/mm³, leukocytes/mm³, and CD4 cells/μL, was assessed in samples taken from 33 patients, collecting 3 to 5 samples per patient, for a total of 144 samples. The assessment of (A ( C) , (B ( D) y (A ( C) ∩ (B ( D) allows for predictions based on the percentage of belonging to these groups. The results were arranged in descending order in nine ranges of 1000 leukocytes. The number of patients with accurate predictions and the ranges of greater effectiveness in prediction were established.Results: The intersection (A ( C) ∩ (B ( D) showed effectiveness of 85.71% in predicting CD4 in the range of 4999-4000 leukocytes, 83.33% for 3999-3000, and 100% in the range lesser than 3,000.Conclusion: The predictive ability and clinical usefulness of the methodology developed were confirmed for the prediction of T CD4 lymphocites, allowing to lower costs compared to flow cytometry in monitoring patients with HIV/AIDS over time.

Occupational exposure to blood borne pathogens among healthcare workers: a cross-sectional study of a registry in Colombia.

BACKGROUND: Occupational exposure to blood borne pathogens caused by percutaneous injuries or mucosal contamination is frequent among Healthcare Workers (HCW). METHODS: A cross-sectional analysis of HCW with an occupational exposure to blood reported to professional risk insurance agencies between 2009 and 2014 was performed. Comparisons between groups according to exposure level (mild, moderate, and severe) were evaluated. RESULTS: Two thousand, four hundred three reports were classified according exposure as mild 2.7 %, moderate 74.8 %, severe 21.9 %. Factors related: health sciences student with mild exposure events [adjusted odds ratio (AOR) 11.91, 95 % CI 5.13-27.61, p < 0.00001], and physician with moderate exposure events (AOR 1.90, 95 % CI 1.17-3.07, p = 0.009). Factors inversely related: physician with severe exposure events (AOR 0.54, 95 % CI 0.32-0.91, p = 0.02) and health sciences student with moderate exposure events (AOR 0.08, 95 % CI 0.04-0.15, p < 0.00001). It was found an important relationship between severe events with infectious diseases specialist assessment, and follow-up adherence. Additionally, a case of Human Immunodeficiency Virus seroconversion was presented (0.0004 %), no other seroconversions were observed. CONCLUSIONS: Occupational exposure events must be managed according to established protocols, but adherence failure was evident with the exception of severe exposure cases. Thus, interventions to enhance occupational safety are required. Occupation must be considered as a risk factor during initial assessment of events.

Giant Molluscum Contagiosum in an HIV positive patient.

Molluscum Contagiosum (MC) is a skin infection caused by a double-stranded DNA virus of the family Poxviridae that replicates in the human epidermis, affecting mainly children and young sexually active adults and causing flesh colored papular lesions with central umbilication with an average size of 3-5mm, although atypical lesions that reach great size (Giant Molluscum Contagiosum), 10-15mm, can be seen in almost any immunodeficiency condition. We report the case of a 35 year old male patient with C3 HIV disease with an abdominal pathology associated to skin lesions predominantly in the forehead and scalp that reached sizes over 5mm, diagnosed as Giant Molluscum Contagiosum by skin biopsies.

Colección cornell intraestromal y queratitis po fusarium spp: presentación de dos casos y revisión de la literatura / Collection ntrasstromal corneal and keratits by fusarium spp: report of twwo cases and review of the literature / Recolha cornano intra-estromal e ceratite pr fusarium spp: relato de dois casos e revisão da literatura

Las infecciones oculares por hongos filamentosos han aumentado su incidencia con el pasar de los años. Los traumas corneales, la terapia inmunosupresora y el uso de lentes de contacto han hecho que éstas aumenten su incidencia, pero existe un pequeño porcentaje de paciente que sin ningún factor de riesgo presentan infecciones por estos mohos. En este artículo reportamos dos casos de infección ocular por Fusarium spp. en dos pacientes de 21 y 30 años de edad respectivamente, inmunocompetentes, pertenecientes a las Fuerzas Militares y sin factores de riesgo asociados.

The filamentous fungal eye infections have been increasing in incidence in the last years. Corneal trauma, immunosuppressive therapy and use of contact lenses have increased their incidence, nonetheless a small percentage of patients with no risk factors still present with these mold infections. In this article we report a case of ocular infection by Fusarium spp. in two patients, a 21-year-old and a 30-year-old males. They work with the Military Forces, and were immunocompetent with no risk factors associated to the problem.

As infecções oculares por fungos filamentosos têm aumentado a sua incidência com o passar dos anos. Os traumas da córnea, a terapia imunossupressora e o uso de lentes de contato têm feito que estas aumentem a sua incidência, mas existe uma pequena percentagem de pacientes que semnenhumfator de riscoapresentam infecções por estes bolores. Em este artigo reportamos dois casos de infecção ocular por Fusarium spp. em dois pacientes de 21 e 30 anos de idade respectivamente, imunocompetentes, pertencentes às Forças Militares e semfatores de risco associados.

Microorganismosppresentes en fonendoscopios, maos, cavidad oral y nasal de esttudiantes de una facultad de medicina / Microorganiss inn stethoscopes, hands,oral ad nasal cavity from students inn a school of medicine / Microorganimos ppresentes em estetoscópios, mãos, cavidade ral e nasal de estudantes de uma faculdade de medicnaa

La formación académica de estudiantes de medicina implica interacción con pacientes y superficies del entorno hospitalario, los microorganismos presentes allí pueden ser adquiridos y transmitidos con los riesgos consecuentes para la comunidad hospitalaria. El presente es un estudio descriptivo cuantitativo donde se analizan muestras provenientes de estudiantes de medicina (n= 155) en rotaciones de 3 semanas, tomando hisopados de nariz, boca, manos y fonendoscopio, gram y cultivo en agar sangre, incubación 24 horas a 37°C y 5% de CO2. Se hizo la identificación mediante gram y pruebas de biotipificación convencionales y susceptibilidad antibiótica según técnica de kirbybauer. Los hallazgos aquí presentados evidencian alta frecuencia de bacterias patógenas en las fuentes de aislamiento, siendo relevante la presencia del Staphylococcus aureus en un 41,7% y la resistencia a antibióticos tanto por gram positivos como por gram negativos; por tanto, es de considerar la implementación de estrategias que minimicen la circulación de estos microorganismos en el ambiente hospitalario. El objetivo de este estudio es establecer la frecuencia de los microorganismos aislados en estudiantes de una Facultad de Medicina.

The academic training of medical students involves interaction with patients, where microorganisms in contact with different surfaces can be acquired and transmitted with the consequent risk to the community hospital.This is a quantitative descriptive study on students of medicine (n = 155) with clinic rotations of 3 weeks, swabs were taking from the nose, mouth, hands and stethoscope, following by gram and blood agar cultures, incubation 24 hours at 37° C and 5% CO2, final Identification was performed by gram, biotyping tests and antibiotic susceptibility by kirbybauer technique.The findings presented here show high frequency of bacterial pathogens in source isolation, to be relevant the presence of Staphylococcus aureus in 41.7% and resistan cetoantibiotics both grampositive andgramnegative, therefore is to consider the implementation of strategies to minimize the movement of these microorganisms in the hospital environment.The objective of this study is to establish the frequency of microorganisms isolated from students at a medical school.

A formação acadêmica dos estudantes de medicina implica interação com pacientes e superfícies do entorno hospitalar, os microorganismos presentes ali podem ser adquiridos e transmitidos com os riscos consequentes para a comunidade hospitalar. O presente é um estudo descritivo quantitativo onde foram analisadas amostras provenientes de estudantes de medicina (n= 155) em rotações de 3 semanas, colhidas do nariz, da boca, das mãos e de estetoscópios, gram e cultivo em ágar sangue, incubação 24 horas a 37°C e 5% de CO2, foi feita a identificação mediante gram e testes de biotipificação convencionais e suscetibilidade antibiótica segundo técnica de kirbybauer. Os descobrimentos aqui apresentados evidenciam alta frequência de bactérias patógenas nas fontes de isolamento, sendo relevante a presença do Staphylococcus aureus em 41,7% e a resistência a antibióticos tanto por gram positivos como por gram negativos; portanto, é necessário considerar a implementação de estratégias que minimizem a circulação destes microorganismos no ambiente hospitalar. O objetivo deste estudo foi estabelecer a frequência dos microorganismos isolados em estudantes de uma Faculdade de Medicina.