La literatura en los estudios de la salud / Literature in health sciences teaching

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La polio, el largo camino hacia el final de la partida / Polio, the long walk to the endgame

A pesar de que para la OMS la polio debería haber sido erradicada en el año 2000 -gracias a la vacunación y a los recursos institucionales, públicos y privados, destinados a tal fin- en 2013 la enfermedad siguió siendo endémica en tres países, Afganistán, Pakistán y Nigeria y se describieron casos en otros cinco. La circulación de poliovirus tipo 1 salvaje en Israel, Gaza y Cisjordania y los casos de Siria fueron una llamada de atención, como en su momento lo fueron los virus derivados de la vacuna oral que siguen siendo un problema. Los viajes «desde» y «a» zonas endémicas son un factor a tener en cuenta en la exportación de los virus y su difusión cuando llegan a zonas con carencias vacunales. Los conflictos bélicos, las persecuciones, la intolerancia, la incultura y la proliferación de grupos y movimientos «antivacunación» son en gran parte la causa de la ausencia y del abandono de la vacunación. En 2014 la situación se ha complicado, tanto que el Comité de Emergencias de la OMS se reunió en mayo para abordar el problema. Es necesario conocer la enfermedad y su agente causal, en el primer caso porque habrá que pensar en ella a la hora de hacer un diagnóstico diferencial de la parálisis flácida y seguir vacunando y en el segundo porque será imprescindible seguir buscando en muestras ambientales el virus de la polio, del que se desconocen muchos aspectos, pues es un modelo para el estudio de otros muchos virus

Although the WHO original target date for the global eradication of poliomyelitis was the year 2000 –thanks to vaccination and institutional, public and private, resources for that purpose–, in 2013 the disease remained endemic in three countries, Afghanistan, Pakistan and Nigeria, and some cases were described in five others. The circulation of wild type 1 poliovirus in Israel, Gaza and the West Bank and the cases in Syria were a wakeup call, as at that time there were polioviruses derived from the oral vaccine that are still circulating among the human population and can cause the development of the disease. Travelling “from” and “to” endemic areas are factors to consider in poliovirus exportation and in its spread when it reaches areas with poor immunogenicity. Wars, terrorism, intolerance, lack of culture and proliferation of anti-vaccine groups and the rise of the anti-vaccination movement are important factors in the maintenance and expansion of the virus and in the “non-vaccination” against it. Based on the international situation to date, the Emergency Committee of WHO met in May 2014 to address the problem. It is still necessary to enhance the knowledge of the disease and its agent. In the first case to perform a differential diagnosis of flaccid paralysis and to continue vaccination programs, and in the second case to keep studying and looking for the poliovirus in environmental samples, which is a model for the study of many other viruses

[Prevention of an outbreak of Acinetobacter baumannii in intensive care units: study of the efficacy of different mathematical methods]. / Prevención de un brote de Acinetobacter baumannii en una unidad de cuidados intensivos: eficacia de diversos métodos matemáticos.

INTRODUCTION: Although in past decades, Acinetobacter baumanni infections have been sporadically identified in hospitals, nowadays the nosocomial infections due to this pathogen have notably increased. Its importance is due to its multidrug- resistance, morbidity and mortatility in healthcare settings. Consequently, it is important to predict the evolution of these outbreaks in order to stablish the most efficient control measures. There are several experimental studies shown that the compliance with hand and environmental hygiene and the efficient management of the healthcare work help to control the evolution of these outbreaks. The goal of this work is to formally proof these experimental results by means of the analysis of the results provided by the model. METHODS: A stochastic mathematical model based on cellular automata was developed. The variables and parameters involved in it have been identified from the knowledge of the epidemiology and main characteristics of Acinetobacter infections. RESULTS: The model provides several simulations from different initial conditions. The analysis of these results proofs in a formal way that the compliance with hand and environmental hygiene and an efficient plannification of the work of healtcare workers yield a decrease in the colonized patients. Moreover, this is the unique model proposed studying the dynamics of an outbreak of A. baumanni. CONCLUSIONS: The computational implementation of the model provides us an efficient tool in the management of outbreaks due to A. baumanni. The analysis of the simulations obtained allows us to obtain a formal proof of the behaviour of the measures for control and prevention.

Prevención de un brote de Acinetobacter baumannii en una unidad de cuidados intensivos: eficacia de diversos métodos matemáticos / Prevention of an outbreak of Acinetobacter baumannii in intensive care units: study of the efficacy of different mathematical methods

Introducción. Las infecciones nosocomiales por Acinetobacter baumannii han pasado de ser un hecho poco representativo a habitual en muchos servicios de Medicina Intensiva por su frecuencia, mortalidad asociada y resistencia a los antimicrobianos. Cuando se produce un brote es importante poder predecir su evolución y el impacto global e individualizado de los diferentes métodos de control. Se ha demostrado experimentalmente que tomar determinadas medidas (lavado de manos, planificación del trabajo del personal sanitario, etc.) ayuda a controlar y prevenir tanto la aparición como la extensión de dichos brotes. El objetivo es demostrar de manera formal los resultados empíricos comentados anteriormente valiéndonos de un novedoso modelo matemático. Material y Métodos. Se desarrolló un modelo matemático estocástico basado en autómatas celulares. A partir del conocimiento de la epidemiología y de las características de A. baumanii se identificaron las variables y los parámetros del modelo. Resultados. El modelo proporciona múltiples simulaciones usando diferentes condiciones iniciales. Su análisis demuestra formalmente que el cumplimiento con las normas de higiene así como una correcta planificación del trabajo del personal sanitario reduce el número de pacientes colonizados. Asimismo, no existe en la literatura especializada otro modelo matemático que estudie la dinámica de un brote por A. baumannii. Conclusiones. La implementación computacional del modelo proporciona una herramienta de gran utilidad para la comunidad sanitaria en la gestión de brotes por A. baumanii en ambientes hospitalarios. Se prueba matemáticamente como unas eficientes medidas higiénicas y de planificación del trabajo del personal sanitario reducen el número de pacientes colonizados (AU)

Introduction. Although in past decades, Acinetobacter baumanni infections have been sporadically identified in hospitals, nowadays the nosocomial infections due to this pathogen have notably increased. Its importance is due to its multidrug-resistance, morbidity and mortatility in healthcare settings. Consequently, it is important to predict the evolution of these outbreaks in order to stablish the most efficient control measures. There are several experimental studies shown that the compliance with hand and environmental hygiene and the efficient management of the healthcare work help to control the evolution of these outbreaks. The goal of this work is to formally proof these experimental results by means of the analysis of the results provided by the model. Methods. A stochastic mathematical model based on cellular automata was developed. The variables and parameters involved in it have been identified from the knowledge of the epidemiology and main characteristics of Acinetobacter infections. Results. The model provides several simulations from different initial conditions. The analysis of these results proofs in a formal way that the compliance with hand and environmental hygiene and an efficient plannification of the work of healtcare workers yield a decrease in the colonized patients. Moreover, this is the unique model proposed studying the dynamics of an outbreak of A. baumanni. Conclusions. The computational implementation of the model provides us an efficient tool in the management of outbreaks due to A. baumanni. The analysis of the simulations obtained allows us to obtain a formal proof of the behaviour of the measures for control and prevention (AU)

[Polio, the long walk to the endgame]. / La polio, el largo camino hacia el final de la partida.

Although the WHO original target date for the global eradication of poliomyelitis was the year 2000 -thanks to vaccination and institutional, public and private, resources for that purpose-, in 2013 the disease remained endemic in three countries, Afghanistan, Pakistan and Nigeria, and some cases were described in five others. The circulation of wild type 1 poliovirus in Israel, Gaza and the West Bank and the cases in Syria were a wakeup call, as at that time there were polioviruses derived from the oral vaccine that are still circulating among the human population and can cause the development of the disease. Travelling "from" and "to" endemic areas are factors to consider in poliovirus exportation and in its spread when it reaches areas with poor immunogenicity. Wars, terrorism, intolerance, lack of culture and proliferation of anti-vaccine groups and the rise of the anti-vaccination movement are important factors in the maintenance and expansion of the virus and in the "non-vaccination" against it. Based on the international situation to date, the Emergency Committee of WHO met in May 2014 to address the problem. It is still necessary to enhance the knowledge of the disease and its agent. In the first case to perform a differential diagnosis of flaccid paralysis and to continue vaccination programs, and in the second case to keep studying and looking for the poliovirus in environmental samples, which is a model for the study of many other viruses.

[Mathematical modelling of the propagation of infectious diseases: where we came from, and where we are going]. / Modelización matemática de la propagación de enfermedades infecciosas: de dónde venimos y hacia dónde vamos.

This work deals with the study of the use of mathematical models to simulate the spreading of infectious diseases. There is no doubt about the importance of the use of computational tools that allow the health staff to model and predict the spreading of an infectious disease. Using such tools one can establish and simulate disease control strategies. The development of such technologies is a multidisciplinary issue; in this sense, the mathematical algorithms -that must be computationally implemented- play a central role. The main goal of this work is to highlight among health community the increasing importance of the use of mathematical models for epidemic disease spreading. Consequently, the main features of such models are introduced and their classification is stated taking into account the behavior, the basic population unit or the mathematical objects used. An exhaustive search of related papers through the most important databases (Medline and Web of Science) are performed. The main conclusion obtained from this work is the central role that mathematical models can play in the simulation of epidemic spreading; moreover,some ideas about the future research are stated.

Modelización matemática de la propagación de enfermedades infecciosas: de dónde venimos y hacia dónde vamos / Mathematical modelling of the propagation of infectious diseases: where we came from, and where we are going

Es de indudable importancia dotar al gestor sanitario de herramientas que permitan predecir el comportamiento de la propagación de una enfermedad infecciosa, de manera que a partir de las mismas se pueden establecer y simular estrategias de control. El desarrollo de tales herramientas es de carácter pluridisciplinar siendo la base de las mismas, algoritmos o modelos matemáticos que son implementados computacionalmente. En este trabajo se muestra el funcionamiento de estos modelos matemáticos y se detalla su clasificación atendiendo a diferentes factores. Además se lleva a cabo un estudio cuantitativo de los mismos haciendo uso de las principales bases de datos relacionadas con el tema de estudio (Medline y Web of Science). De este trabajo se concluye el importante papel que pueden jugar los modelos matemáticos a la hora de simular los procesos infecciosos y, asimismo, se proponen futuras y eficaces vías de investigación en la modelización matemática de enfermedades infecciosas(AU)

This work deals with the study of the use of mathematical models to simulate the spreading of infectious diseases. There is no doubt about the importance of the use of computational tools that allow the health staff to model and predict the spreading of an infectious disease. Using such tools one can establish and simulate disease control strategies. The development of such technologies is a multidisciplinary issue; in this sense, the mathematical algorithms –that must be computationally implemented- play a central role. The main goal of this work is to highlight among health community the increasing importance of the use of mathematical models for epidemic disease spreading. Consequently, the main features of such models are introduced and their classification is stated taking into account the behavior, the basic population unit or the mathematical objects used. An exhaustive search of related papers through the most important databases (Medline and Web of Science) are performed. The main conclusion obtained from this work is the central role that mathematical models can play in the simulation of epidemic spreading; moreover, some ideas about the future research are stated(AU)

Los carbapenems disponibles: propiedades y diferencias / Available carbapenems: properties and differences

Los carbapenems son los antibióticos β-lactámicos dotados de mayor espectro, actividad y resistencia a las β-lactamasas. Por sus cualidades son imprescindibles en el tratamiento empírico, en monoterapia, de numerosas infecciones nosocomiales graves -incluso algunas de origen comunitario- y en la terapéutica dirigida de las producidas por bacterias gramnegativas multirresistentes. Todos los carbapenems disponibles son similares en cuanto a espectro, aunque con diferencias significativas en la actividad antimicrobiana que, en último término, determinan las indicaciones clínicas de cada carbapenem. Ertapenem no incluye en su espectro a patógenos eminentemente nosocomiales como Pseudomonas aeruginosa y Acinetobacter spp., por lo que está indicado en infecciones adquiridas en la comunidad que precisan ingreso hospitalario. Por el contrario, doripenem muestra más actividad intrínseca que otros carbapenems en enterobacterias productoras de β-lactamasas de espectro extendido y AmpC, P. aeruginosa, Acinetobacter spp. y otros no fermentadores y anaerobios. Además doripenem, como el resto de los carbapenems, posee unas adecuadas características farmacocinéticas y un perfil de seguridad favorable

Carbapenems are β-lactam antibiotics endowed with a broader spectrum, activity and resistance to β-lactamases than other β-lactams. Due to their qualities, these antibiotics are crucial in empirical therapy, in the monotherapy of several severe hospital-acquired infections -and even that of some community-acquired infections- as well as in the directed therapy of infections due to multiresistant Gram-negative bacteria. All the available carbapenems have a similar spectrum, although there are significant differences in their antimicrobial activity, which in the long run determines the clinical indications of each carbapenem. The spectrum of ertapenem does not cover eminently nosocomial pathogens such as Pseudomonas aeruginosa and Acinetobacter spp., and hence this antibiotic is indicated in community-acquired infections requiring hospital treatment. In contrast, doripenem shows greater intrinsic activity than other carbapenems in extended spectrum beta-lactamase-producing enterobacteria and AmpC P. aeruginosa, Acinetobacter spp. and other non-fermentative and anaerobic microorganisms. Additionally, like the remaining carbapenems, doripenem has adequate pharmacokinetic characteristics and a favorable safety profile

Adherence of two strains of Staphylococcus epidermidis to contact lenses.

PURPOSE: To compare the adherence of biofilm-producer and nonbiofilm-producer Staphylococcus epidermidis in vitro to different soft contact lenses (CLs) to study its possible contribution to the pathogenesis of keratitis. METHODS: Strains of S. epidermidis slime-positive ATCC 35984 (biofilm-producer) and slime-negative ATCC 12228 (nonbiofilm-producer) were used with eight types of soft CLs from the four groups determined by the United States Food and Drug Administration (FDA), according to the ionicity and water content. The lenses were incubated overnight with the bacteria, then sonicated and vortexed to separate the adhered bacteria. Quantitative cultures were performed and the results statistically analyzed. RESULTS: Slime-negative strains of S. epidermidis were able to adhere to all CLs but at a lower level than slime-positive strains. There were significant differences in bacterial attachment among the four FDA groups. On the whole, there was higher bacterial adhesion to nonionic and low-water content materials. Contact lenses produced by soft molding were less adherent than CLs produced by either lathe-cutting or spin-casting. CONCLUSIONS: Bacterial biofilm favors bacterial adhesiveness and colonization of soft CLs. Bacterial attachment was less in soft molding CLs (etafilcon A), which provide a more homogeneous and smoother surface.