Cocaine Gut: A Rare Case of Cocaine-Induced Esophageal, Gastric, and Small Bowel Necrosis.

Cocaine is an indirect-acting sympathomimetic drug that inhibits norepinephrine and dopamine reuptake in the adrenergic presynaptic cleft. Cocaine use has been associated with strokes, angina, arrhythmias, and agitation. Data on gastrointestinal complications such as mesenteric ischemia, bowel necrosis, ulceration, and perforation are scarce. Here, we present a rare case of cocaine-induced esophageal, gastric, and small bowel necrosis that contributes to the limited literature on this subject. Diagnosis of cocaine-induced gastrointestinal complications involves a combination of imaging studies, laboratory assessments, and histopathological examinations. Timely surgical resection, supported by intravenous fluids, antibiotics, and pain management, is the mainstay of treatment. The prognosis varies but is significantly influenced by the promptness and effectiveness of the intervention, underscoring the importance of vigilant clinical care in such cases.

Sinistral Portal Hypertension Due to a Pancreatic Pseudocyst: A Rare Cause of Upper Gastrointestinal Bleeding.

Sinistral portal hypertension (SPH), also known as segmental portal hypertension, is a complication of pancreatic disorders and an extremely rare cause of upper gastrointestinal (GI) bleeding. SPH is observed in patients without cirrhosis and arises from splenic vein thrombosis. Unmitigated backflow of blood may cause gastric venous congestion and ultimately GI hemorrhage. Herein, we report a rare case of massive hematemesis due to SPH in a male patient with a history of chronic pancreatitis and pancreatic pseudocyst. Our patient was successfully treated with endoscopic necrosectomy followed by open splenectomy, distal pancreatectomy, and partial gastric resection.

Disparities in Diagnostic Imaging for Initial Local Staging for Rectal Cancer.

OBJECTIVE: To assess the presence, quality, and timeliness of initial staging imaging for rectal cancer patients, and to evaluate demographic factors associated with disparities. METHODS: We conducted a chart review of consecutive rectal adenocarcinoma cancer registry cases from a single institution for the period from 2015 to 2020. We recorded whether initial staging MRI or endoscopic ultrasound (EUS) was performed, and whether it was performed in or outside the institution. MRI quality was assessed based on compliance to the Society of Abdominal Radiology rectal cancer disease-focused panel protocol recommendations. The times between diagnosis and imaging were calculated. Patients' age, race, ethnicity, sex, body mass index, address, and primary payer were acquired from the electronic medical record. Descriptive analysis, odds ratios, and Student's t tests were used for analysis. RESULTS: Of 346 patients, 39% were female, and the average age was 59 years. A total of 93 patients (26.8%) had no initial staging MRI or endoscopic ultrasound. Of the 142 MRIs evaluated for image quality, 100 patient exams (72.4%) met the criteria for adequate quality. The mean time interval from diagnosis to imaging was 30.9 days. A lower likelihood of receiving initial local staging was associated with being of Hispanic ethnicity (P < .01), having Medicaid or no insurance (P < .01), and residing in a low-income census block (P < .01). Higher quality of imaging was associated with residence in a census block with high median income (P < 0.01), more recent diagnosis (P < .01), and MRI performed at the institution presented (P < .01). CONCLUSIONS: Although radiologic workup variability was found across all demographics, sociodemographic factors have an effect on local initial imaging of rectal cancer, emphasizing the need to improve image acquisition for underserved patients and improve quality standardization at low-volume centers.

Perfiles de susceptibilidad a los antibióticos en cepas del genero Bacillus aisladas de ambientes acuáticos extremos del Ecuador / Susceptibility profiles to antibiotics in strains of the genus Bacillus isolated from extreme aquatic environments of Ecuador

Introducción: En el agua de los ecosistemas acuáticos considerados extremos, debido a los valores de sus parámetros fisicoquímicos y químicos, tales como altas concentraciones de sales, ambientes oligotróficos, pH extremos, alta radiación y temperaturas extremas, existe una población bacteriana que se ha adaptado a esas condiciones y que pueden ser un reservorio importante de resistomas naturales.Objetivo. Conocer los perfiles de susceptibilidad a diversos antibióticos en cepas del género Bacillus aisladas de balnearios de aguas mineromedicinales y de agua de un lago cratérico volcánico del Ecuador.Materiales y métodos. Se analizaron un total de 16 muestras de agua mineromedicinal y 32 muestras de agua de lago cratérico volcánico. El aislamiento de Bacillus se realizó por la técnica de filtración en membrana, utilizando filtros Millipore de 0,45 μm de poro, un volumen de muestra de 100 mL y el agar R2A. Las cepas aisladas se identificaron siguiendo los esquemas de MacFaddin (2004), complementadas con las pruebas bioquímicas de las galerías Microgen para Bacillus. El perfil de resistencia a los antibióticos se determinó por el método de difusión en placas de Kirby y Bauer (1966) interpretándose según el CLSI (2019).Resultados. Se identificaron 19 cepas de Bacillus. La mayoría de las cepas fueron resistentes y multiresistentes a los antibióticos clindamicina, eritromicina, gentamicina, oxacilina y penicilina.Conclusiones. Los resultados señalan la presencia de especies de Bacillus y de resistomas asociados a este género en el agua de ambientes naturales extremos en el Ecuador, lo cual sugiere que estos ambientes pueden ser un reservorio importante de bacterias resistentes a los antibióticos. (AU)

Introduction: The water of aquatic ecosystems considered extreme, given the values of its physicochemical and chemical parameters, such as high concentrations of salts, oligotrophic environments, extreme pH, high radiation and extreme temperatures, there is a bacterial population that has adapted to these conditions and that they can be an important reservoir of natural resistomes.Objective. The objective of the present work was to know the profiles of susceptibility to various antibiotics in strains of the Bacillus genus isolated from mineromedicinal water spas and water from a volcanic crater lake in Ecuador.Materials and methods. A total of 16 mineromedicinal water samples and 32 samples of crater volcanic lake water were analyzed. The isolation of the Bacillus colonies was carried out by the membrane filtration technique, using Millipore filters of 0.45 μm pore, a sample volume of 100 mL and R2A agar. The isolated strains were identified following the schemes of MacFaddin (2004), complemented with the biochemical tests of the Microgen galleries for Bacillus. The antibiotic resistance profile was determined by the plate diffusion method of Kirby and Bauer (1966), interpreted according to the CLSI (2019).Results. 19 Bacillus strains were identified. Most of the strains were resistant and multi-resistant to the antibiotic clindamycin, erythromycin, gentamicin, oxacillin, and penicillin. Conclusions. The results indicate the presence of Bacillus species and resistomes associated with this genus in the water of extreme natural environments in Ecuador, which suggests that these environments may be an important reservoir of bacteria resistant to antibiotics. (AU)

Assessment of Medical Industry Compensation to US Physicians by Gender.

Importance: It has been well established that female physicians earn less than their male counterparts in all specialties and ranks despite controlling for confounding variables. Objective: To investigate payments made from highest-grossing medical industry companies to female and male physicians and to assess compensation and engagement disparities based on gender. Design, Setting, and Participants: This retrospective, population-based cross-sectional study used data from the Open Payments database for the 5 female and 5 male physicians who received the most financial compensation from each of the 15 highest-grossing medical supply companies in the US from January 2013 to January 2019. Main Outcomes and Measures: The primary outcome was total general payments received by female and male physicians from medical industry over time and across industries. The secondary outcome was trends in industry payment to female and male physicians from 2013 to 2019. Results: Among the 1050 payments sampled, 1017 (96.9%) of the 5 highest earners were men and 33 (3.1%) were women. Female physicians were paid a mean (SD) of $41 320 ($88 695), and male physicians were paid a mean (SD) of $1 226 377 ($3 377 957) (P < .001). On multivariate analysis, male gender was significantly associated with higher payment after adjusting for rank, h-index, and specialty (mean [SD], $1 025 413 [$162 578]; P < .001). From 2013 to 2019, the payment gap between female and male physicians increased from $54 343 to $166 778 (P < .001). Conclusions and Relevance: This study found that male physicians received significantly higher payments from the highest-grossing medical industry companies compared with female physicians. This disparity persisted across all medical specialties and academic ranks. The health care industry gender payment gap continued to increase from 2013 to 2019, with a wider compensation gap in 2019.

Night Radiology Coverage for Trauma: Residents, Teleradiology, or Both?

BACKGROUND: Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients. STUDY DESIGN: A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10 pm to 8 am were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist's interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared. RESULTS: A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001). CONCLUSIONS: This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.

Distinct SARS-CoV-2 antibody reactivity patterns elicited by natural infection and mRNA vaccination.

We analyzed data from two ongoing COVID-19 longitudinal serological surveys in Orange County, CA., between April 2020 and March 2021. A total of 8476 finger stick blood specimens were collected before and after a vaccination campaign. IgG levels were determined using a multiplex antigen microarray containing antigens from SARS-CoV-2, SARS, MERS, Common CoV, and Influenza. Twenty-six percent of specimens from unvaccinated Orange County residents in December 2020 were SARS-CoV-2 seropositive; out of 852 seropositive individuals 77 had symptoms and 9 sought medical care. The antibody response was predominantly against nucleocapsid (NP), full length, and S2 domain of spike. Anti-receptor binding domain (RBD) reactivity was low and not cross-reactive against SARS S1 or SARS RBD. A vaccination campaign at the University of California Irvine Medical Center (UCIMC) started on December, 2020 and 6724 healthcare workers were vaccinated within 3 weeks. Seroprevalence increased from 13% pre-vaccination to 79% post-vaccination in January, 93% in February, and 99% in March. mRNA vaccination induced higher antibody levels than natural exposure, especially against the RBD domain and cross-reactivity against SARS RBD and S1 was observed. Nucleocapsid protein antibodies can be used to distinguish vaccinees to classify pre-exposure to SARS-CoV-2 Previously infected individuals developed higher antibody titers to the vaccine than non pre-exposed individuals. Hospitalized patients in intensive care with severe disease reach significantly higher antibody levels than mild cases, but lower antibody levels compared to the vaccine. These results indicate that mRNA vaccination rapidly induces a much stronger and broader antibody response than SARS-CoV-2 infection.

Calidad microbiológica del agua del lago volcánico Quilotoa. Cotopaxi-Ecuador / Microbiological quality of the water of the Quilotoa volcanic lake. Cotopaxi Ecuador

INTRODUCCIÓN: el agua de los lagos volcánicos no es estéril, en ella se ha adaptado a través de milenios una microbiota con diversas capacidades metabólicas. La diversidad microbiana de los lagos volcánicos en Ecuador ha sido poco estudiada y aún se desconoce su abundancia y riqueza. OBJETIVO: el objetivo del presente estudio fue conocer la calidad microbiológica del agua del lago Quilotoa, situado en la Provincia de Cotopaxi-Ecuador. MATERIALES Y METODOS: se realizaron dos muestreos durante el año 2019, recolectando un total 32 muestras. La calidad microbiológica se cuantifico utilizando la técnica de filtración por membrana en agar R2A para bacterias heterótrofas, agar eosina azul de metileno para coliformes, agar manitol salado para Staphylococcus, agar cetrimide para Pseudomonas y agar Sabouraud con cloranfenicol para hongos. RESULTADOS: los resultados promedios fueron para bacterias heterótrofas de 2,00 x 102 UFC/mL; Pseudomonas 7,00x 10 UFC/mL, Staphylococcus 3,80 x 10 UFC/mL y hongos 1,40 x 10 UFC/mL. No se detectó la presencia de bacterias coliformes. CONCLUSIONES: los grupos microbianos presentes en bajo número son indicativos de una microbiota característica adaptada a las condiciones fisicoquímicas de este lago. Se concluye que se trata de un lago con una población microbiana escasa lo que indicaría una buena calidad microbiológica.

INTRODUCTION: the water of volcanic lakes is not sterile, native microbiota shows different metabolic capabilities established over millennia. The microbial diversity of volcanic lakes in Ecuador have been little studied and their abundance and richness are still unknown. OBJECTIVE: the objective of this study was to know the microbiological quality of water of Lake Quilotoa, located in the Province of Cotopaxi-Ecuador. MATERIALS AND METHODS: two samplings were carried out during 2019, collecting a total of 32 samples. Microbiological quality was quantified using the membrane filtration technique on R2A agar for heterotrophic bacteria, eosin blue methylene agar for coliforms, salty mannitol agar for Staphylococcus, cetrimide agar for Pseudomonas and Sabouraud agar with chloramphenicol for fungi. RESULTS: the average results were for heterotrophic bacteria 2.00 x 102 CFU/mL, Pseudomonas 7.00 x 10 CFU/mL, Staphylococcus 3.80 x 10 CFU/mL and fungi 1.40 x 10 CFU/mL. The presence of coliform was not detected. CONCLUSIONS: the microbial groups present in low numbers are indicative of a characteristic microbiota adapted to the physicochemical conditions of this lake. It is concluded that it is a lake with a few microbial populations, which might indicate a good microbiological quality.

Perfiles de susceptibilidad a los antibióticos en cepas del género Bacillus aisladas de ambientes acuáticos extremos del Ecuador / Susceptibility profiles to antibiotics in strains of the genus Bacillus isolated from extreme aquatic environments of Ecuador

INTRODUCCIÓN: En el agua de los ecosistemas acuáticos considerados extremos, debido a los valores de sus parámetros fisicoquímicos y químicos, tales como altas concentraciones de sales, ambientes oligotróficos, pH extremos, alta radiación y temperaturas extremas, existe una población bacteriana que se ha adaptado a esas condiciones y que pueden ser un reservorio importante de resistomas naturales. OBJETIVO: Conocer los perfiles de susceptibilidad a diversos antibióticos en cepas del género Bacillus aisladas de balnearios de aguas mineromedicinales y de agua de un lago cratérico volcánico del Ecuador. MATERIALES Y MÉTODOS. Se analizaron un total de 16 muestras de agua mineromedicinal y 32 muestras de agua de lago cratérico volcánico. El aislamiento de Bacillus se realizó por la técnica de filtración en membrana, utilizando filtros Millipore de 0,45 μm de poro, un volumen de muestra de 100 mL y el agar R2A. Las cepas aisladas se identificaron siguiendo los esquemas de MacFaddin (2004), complementadas con las pruebas bioquímicas de las galerías Microgen para Bacillus. El perfil de resistencia a los antibióticos se determinó por el método de difusión en placas de Kirby y Bauer (1966) interpretándose según el CLSI (2019). RESULTADOS: Se identificaron 19 cepas de Bacillus. La mayoría de las cepas fueron resistentes y multiresistentes a los antibióticos clindamicina, eritromicina, gentamicina, oxacilina y penicilina. CONCLUSIONES: Los resultados señalan la presencia de especies de Bacillus y de resistomas asociados a este género en el agua de ambientes naturales extremos en el Ecuador, lo cual sugiere que estos ambientes pueden ser un reservorio importante de bacterias resistentes a los antibióticos

INTRODUCTION: The water of aquatic ecosystems considered extreme, given the values of its physicochemical and chemical parameters, such as high concentrations of salts, oligotrophic environments, extreme pH, high radiation and extreme temperatures, there is a bacterial population that has adapted to these conditions and that they can be an important reservoir of natural resistomes. OBJECTIVE: The objective of the present work was to know the profiles of susceptibility to various antibiotics in strains of the Bacillus genus isolated from mineromedicinal water spas and water from a volcanic crater lake in Ecuador. MATERIALS AND METHODS: A total of 16 mineromedicinal water samples and 32 samples of crater volcanic lake water were analyzed. The isolation of the Bacillus colonies was carried out by the membrane filtration technique, using Millipore filters of 0.45 μm pore, a sample volume of 100 mL and R2A agar. The isolated strains were identified following the schemes of MacFaddin (2004), complemented with the biochemical tests of the Microgen galleries for Bacillus. The antibiotic resistance profile was determined by the plate diffusion method of Kirby and Bauer (1966), interpreted according to the CLSI (2019). RESULTS: 19 Bacillus strains were identified. Most of the strains were resistant and multi-resistant to the antibiotic clindamycin, erythromycin, gentamicin, oxacillin, and penicillin. CONCLUSIONS: The results indicate the presence of Bacillus species and resistomes associated with this genus in the water of extreme natural environments in Ecuador, which suggests that these environments may be an important reservoir of bacteria resistant to antibiotics

Prevalencia del Síndrome de Burnout en Estudiantes de Medicina

RESUMEN Introducción: El síndrome de Burnout en estudiantes de Medicina es la sensación de agotamiento, decepción y pérdida de interés por la actividad estudiantil. Objetivo: Analizar la prevalencia del síndrome de Burnout entre los estudiantes de Medicina. Materiales y Métodos: Estudio cuantitativo, observacional, de corte transversal, en el cual se obtuvo informaciones a partir de un cuestionario aplicado a los alumnos del 1° al 4° año de la Carrera de Medicina de la Universidad Internacional Tres Fronteras - UNINTER - Paraguay. Resultados: El 6% de los estudiantes no tiene síntomas del síndrome, 40% tiene la posibilidad de desarrollarlo, 42% presenta una etapa temprana del síndrome, 9% se encuentran con el síndrome instalado y 3% está en fase de agotamiento. Se observó un porcentaje mayor de la presencia de síntomas entre los alumnos del segundo y tercer año. Conclusión: Se percibe que un importante porcentaje de estudiantes de Medicina desarrollan la etapa temprana del síndrome de Burnout, por lo tanto, existe la necesidad de comprender mejor las causas de éste para así poder ayudar en la prevención del síndrome de Burnout en estudiantes de Medicina.

ABSTRACT Introduction: The Burnout syndrome in medical students describes a state of exhaustion, disappointment and loss of interest in student activity. Objective: To analyze the incidence Burnout syndrome among medical students. Methodology: A cross-sectional study in which information was obtained from a questionnaire applied to students from the 1st to 4th year of the course of Medicine of the International University Three Frontiers - UNINTER-PY. Results: 6% of the students do not have symptoms of the syndrome, 40% have the possibility of developing it, 42% present an early stage of the syndrome, 9% find the syndrome installed and 3% are in exhaustion phase. A higher percentage of the presence of symptoms was observed among the second and tree year students Conclusion: It is perceived that a considerable percentage of medical students present early symptoms of Burnout syndrome, therefore there is need to better understand the causes of this and thus be able to help in the prevention of Burnout syndrome.

Systemic Sclerosis at an Intensive Care Unit: A Case Series and Literature Review.

INTRODUCTION: Systemic sclerosis (SSc) is a multisystemic autoimmune disease. Few studies have focused on the outcomes of SSC patients who require intensive care unit (ICU) admission, largely due to the absence of protocols for the optimal management of this disease during an ICU stay. OBJECTIVES: This study aimed to describe the outcomes of a series of SSc patients admitted to the ICU at a single center in Cali, Colombia. METHODS: Case series of SSc patients admitted to the ICU were reviewed. The main outcome was ICU mortality. Statistical analysis was performed with measures of central tendency and proportions. RESULTS: All the patients (n = 14) were female and either middle-aged or elderly; 9 (64%) were diagnosed with diffuse cutaneous sclerosis, and the remaining 5 patients with limited cutaneous sclerosis. Some were readmitted; therefore, the total number of ICU admissions was 21. The principal causes of ICU admissions were non-SSc-related causes (n = 15 [71.4%]). The respiratory system was the most involved on ICU admissions. The ICU mortality rate was 43% (n = 6). CONCLUSIONS: The severity of the disease at ICU admission and comorbidity are independently associated with ICU-related mortality. Furthermore, the optimal management of SSc patients includes accurate detection of SSc-associated organ involvement. More studies involving this category of patients are needed to establish the best effective protocols.

Paciente con vih y co-infectado por el hpv: un estudio de caso

RESUMEN Actualmente las infecciones causadas por el virus y el VPH se consideran un gran problema de salud pública mundial. El objetivo fue analizar el impacto del VIH y el VPH en la vida familiar, sexual y social; Identificar los diagnósticos y relacionar la carga viral y CD4 y evaluar la adhesión a la TARV. Paciente del sexo masculino, 52 años con diagnóstico de VIH y VPH, fue posible identificar los principales diagnósticos multidisciplinarios de acuerdo con la NANDA, siendo un total de 11 diagnósticos. Se sugiere una mirada más reflexiva del médico y su equipo multidisciplinario en lo que se refiere a la salud pública, pues no basta con tratar al paciente infectado, es necesario que el paciente reciba orientaciones sobre el proceso salud-enfermedad del paciente VIH con coinfección por el VIH HPV con el fin de promover la prevención secundaria

ABSTRACT Currently, infections caused by HIV and HPV are considered a major public health problem worldwide. The objective was to analyze the impact of HIV and HPV on family, sexual and social life; To identify the diagnoses and to relate the viral and CD4 load and to evaluate the adherence to ART. A 52-year-old man with a diagnosis of HIV and HPV was able to identify the main multidisciplinary diagnoses according to NANDA, with a total of 11 diagnoses. It is suggested a more reflective look by the physician and his multidisciplinary team regarding public health, since it is not enough to treat the infected patient, it is necessary that the patient receive guidance about the health-disease process of the HIV patient with co-infection by the HPV in order to promote secondary prevention

Características clínicas y paraclínicas de recién nacidos con sepsis en un hospital nivel IV en Cali, Colombia / Clinical and laboratory characteristics of newborns with sepsis in a level IV hospital in Cali, Colombia

Objetivo: Describir las características clínicas y microbiológicas de recién nacidos con sepsis admitidos a UCI neonatal de la Fundación Valle del Lili. Materiales y métodos: estudio retrospectivo descriptivo entre los años 2012 y 2015. Se seleccionaron neonatos con diagnóstico de sepsis con más de tres días de manejo antibiótico. Resultados: Se analizaron datos de las historias de 569 pacientes. El 37.9% (216) de los neonatos tenían peso al nacimiento <1500 g, 29.2% (166) entre 1500-2500 g, y 33.9% (187) >2500 g. Para un total de 396 (69.6%) pacientes con sepsis temprana, 308 (54.1%) con sepsis tardía. Las características clínicas más comunes fueron las respiratorias. El principal diagnóstico de infección en sepsis tardía fue la bacteremia (46.4%), seguido de la infección asociada al catéter (17.8%). El aislamiento más común para sepsis temprana fue Streptococcus agalactiae en el 21.9%, mientras que en sepsis tardía fue Staphylococcus epidermidis en el 22.6%. La mortalidad encontrada en sepsis temprana fue de 8.8% y en tardía de 8.5%. Conclusiones: La sepsis neonatal, a pesar de la mejoría en los controles prenatales, continúa siendo una patología frecuente con un importante porcentaje de morbimortalidad. El Streptococcus agalactiae fue la principal causa de sepsis temprana en nuestros pacientes.

Objective: To describe the clinical and microbiological characteristics of newborns with sepsis admitted to the Neonatal Intensive Care Unit of Fundación Valle del Lili in Cali, Colombia. Methods: Descriptive, observational, retrospective study between 2012 and 2015. We included newborns with diagnosis of sepsis with more than three days of antibiotic management. Results: A total of 569 patients were included, 37.9% (216) of the newborns had a birth weight <1500g, 29.2% (166) between 1500 and 2500g , and 32.9% (187) >2500g. 396 (69.6%) patients with early-onset sepsus, 308 (54.1%) had late-onset sepsis. The most common clinical characteristics were respiratory symptoms. The main diagnosis of infection in late-onset sepsis was bacteremia (46.4%) followed by catheter associated infection (17.8%). The most common blood culture isolation for early-onset sepsis was Streptococcus agalactiae (21.9%) and Staphylococcus epidermidis in late onset sepsis (22.6%). The mortality found in early-onset sepsis was 8.8% and in late-onset sepsis was 8.5%. Conclusions: Neonatal sepsis continue to be a frequent diagnosis with significant morbidity and mortality. Better strategies for the prevention of this entity are required including the prenatal period.

Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States.

Food insecurity, internalized HIV stigma, and depressive symptoms are independently associated with poor HIV outcomes. Food insecurity, stigma, and depression may be interrelated among women living with HIV (WLHIV). We hypothesized that food insecurity would be independently associated with internalized stigma and depressive symptoms among WLHIV in the United States (US), and would partially account for associations between stigma and depressive symptoms. We tested hypotheses using regression models and partial correlation analysis with cross-sectional data among 1317 WLHIV from the Women's Interagency HIV Study. In adjusted models, greater food insecurity was associated with internalized HIV stigma and depressive symptoms (all p < 0.05), exhibiting dose-response relationships. Food insecurity accounted for 23.2% of the total shared variance between depressive symptoms and internalized stigma. Food insecurity is associated with depressive symptoms and internalized HIV stigma among US WLHIV, and may play a role in the negative cycle of depression and internalized stigma.

Clinical outcomes after switch to mTOR inhibitors in kidney transplant recipients / Resultados clínicos en receptores de trasplante renal posterior a la conversión a ImTOR

Abstract Introduction: mTOR inhibitors Sirolimus and Everolimus are an alternative for inmunosuppression in renal transplant recipients. The aim of the study was to describe the experience of patients with switch to mTOR inhibitors, followed up for more than five years. Materials and methods: Patients with renal transplantation from 1995 to 2013, who had indication of calcineurin inhibitor (CNI) withdrawl after the third month post-transplant were included. All patients underwent renal biopsy prior to conversion. No patient had a diagnosis of chronic nephtopathy, IFTA>40 % or proteinuria >350mg/24h. A descriptive analysis for all variables was devoloped. Kaplan-Meier method was used for the patient's and graft survival and graft rejection incidence. Results: From 1273 renal transplants, the switch from CNI to mTOR inhibitors was performed in 166 (13 %), 78 % (n=129) were switched to Sirolimus. 12,6 % of the patients lost graft function and 4,2 % (n=7) died. 37% had mTOR inhibitors withdrawal, and the major cause was pathologic proteinuria. The incidence of graft rejection after switching to mTOR inhibitors was 9,6 %. The one and five year graf survival was 96,6 % and 83,5 %. The patient survival at one and five years was 98 % and 97 %. Conclusions: The use of mTOR inhibitors drugs appears to be safe in the managgement of specific renal transplant recipients, with a low rejection rate and good survival.

Resumen Introducción: los ImTOR, sirolimus y everolimus son una alternativa de inmunosupresión en personas que han recibido transplantes renales. En este artículo, se describe la experiencia de pacientes que han experimentado una conversión a ImTOR, y a los que se les ha hecho un seguimiento por más de cinco años. Materiales y métodos: se incluyeron pacientes con transplantes renales desde 1995 hasta 2013, quienes tuvieron indicación de suspensión del inhibidor de calcineurina (ICN) después del tercer mes posterior al trasplante. Todos los pacientes fueron sometidos a biopsia renal antes de la administración de ImTOR. Ningún paciente tuvo diagnóstico de nefropatía crónica, IFTA >40 % o proteinuria >350 mg/24h. Se elaboró un análisis descriptivo para todas las variables. Para estudiar la supervivencia del paciente y del injerto, y la incidencia de rechazo agudo, se usó el método de Kaplan-Meier. Resultados: de 1273 trasplantes renales, la conversión de ICN a ImTOR se realizó en 166 casos (13 %). Al 78 % (n=129) se le administró sirolimus. El 13 % de los pacientes perdió la función del injerto y 7 pacientes (4,2 %) fallecieron. En el 37 % de los casos, se retiró el ImTOR. La principal causa de retiro fue el hallazgo de proteinuria patológica. La incidencia de rechazo agudo después del cambio a ImTOR fue de 9,6 %. La supervivencia del injerto tras uno y cinco años fue de 96,6 % y 83,5 %, respectivamente; y la supervivencia del paciente a uno y cinco años fue de 98 % y 97 %, respectivamente. Conclusiones: el uso de inhibidores ImTOR parece ser seguro en este grupo de pacientes trasplantados, pues hubo una baja tasa de rechazo y buena supervivencia del injerto.

Growth and micronutrient status in children receiving a fortified complementary food.

Linear growth retardation and anemia are the most prevalent nutritional problems in the world; effective interventions are urgently needed. We evaluated Ecuador's National Food Nutrition Program (PANN 2000) that included a micronutrient-fortified complementary food (FCF), Mi Papilla, in poor periurban and rural communities of Ecuador. The program is preventive and targeted to all infants and young children living in poor communities and receiving government health services. We compared dietary intake, micronutrient status, and growth over 11 mo in a cohort of children from the catchment areas of the PANN 2000 with same-age control children in nearby communities eligible to enter the program 1 y later. PANN 2000 children enrolled in the program when they were age 9-14 mo and were age 20-25 mo at the final survey. They consumed significantly more energy, protein, fat, iron, zinc, vitamin A, and calcium than control children because of their FCF consumption. Anemia, 76% in both groups at baseline, fell to 27% in PANN 2000 children but only to 44% in control children (P < 0.001). The odds of being anemic were 58% lower for PANN 2000 children (P = 0.003). The effects on linear growth and weight were limited to children who were older when the program began (12-14 mo) and were significant for weight (interaction with age, 0.38 kg; P = 0.029) and positive but not significant for length (0.66 cm; P = 0.08). An FCF, including ferrous sulfate, delivered through public health services, is highly effective in improving weight and hemoglobin and reducing anemia.

Prevalencia consumo de tabaco en escolares de 8º básico, mujeres en edad fértil y población en general de la IX Región de la Araucanía / Prevalence of tobacco consumption in 8th grade de schoolchildren, women in fertile age and the general population of the 9th Region of Araucania

La Secretaría Ministerial de Salud IX Región, tuvo la necesidad de medir cuáles eran los actuales índices de consumo de tabaco, para trabajar con mayor precisión en la consecución de las metas sanitarias para el año 2010. Es así como ha realizado un estudio, sobre la Prevalencia del Consumo de Tabaco en la Araucanía. Este estudio, de carácter cuantitativo-descriptivo, tuvo como grupo objetivo a los escolares de 8º básico, mujeres en edad fértil y población en general, de las 31 comunas de la región. Se realizó una encuesta autoaplicada y anónima a una muestra representativa. Los datos fueron almacenados y luego analizados en programa excel 2000, siendo procesadas 8.382 encuestas. A raíz de este análisis fue posible determinar que como Región estamos ubicados bajo el promedio nacional, pero dejó al descubierto preocupantes índices de consumo de tabaco en algunas comunas. Es así, como 19 comunas de la Región, presentan prevalencia de consumo de tabaco sobre línea base nacional, en alguno de los tres grupos objetivos. El primer grupo objetivo, fueron los escolares de octavo año, mostrando un 23.2 por ciento distante del 20 por ciento propuesto por el Ministerio de Salud como meta país para el año 2010. Las mujeres en edad fértil presentaron un promedio regional de 28 por ciento de consumo de tabaco, situándonos más bajo de la meta sanitaria propuesta en un 40 por ciento. La población en general de la Región muestra un 36 por ciento de consumo de tabaco siendo la meta país al 2010 de un 30 por ciento en este segmento de la población. En este estudio además, se contempló el consumo de tabaco en la población Mapuche, registrándose, en la población general, un mayor consumo de cigarrillos con un 26 por ciento.