Effect of the modified snorkel mask as noninvasive ventilatory support in patients with acute hypoxemic respiratory failure due to COVID-19.

Background: The shortage of mechanical ventilators during the COVID-19 pandemic led doctors to use alternative noninvasive ventilation systems, including a modified snorkel mask. Data on the use of the modified snorkel mask is limited. Purpose: The study aims to describe the effect and clinical characteristics of patients with COVID-19 treated with a snorkel mask and to investigate the factors associated with the failure to use noninvasive ventilation with a snorkel mask. Methods: In this retrospective observational study, adult patients with COVID-19 who were treated with a snorkel mask at Daniel Alcides Carrion Hospital of Huancayo-Perú were selected. Results: Of the 390 patients included, 158 (20.5%) received noninvasive ventilation with a snorkel, 84 (53.2%) patients were discharged alive without intubation, and the mortality rate was 22%. In the control group that received standard treatment, 129 patients (55.6%) failed (i.e., deceased or admitted to a mechanical ventilator). The mortality rate was 33.2%. ROX index < 4.8, consolidation-type tomographic pattern, and the presence of complications, such as bacterial pneumonia or thromboembolism, were independently associated with a higher risk of noninvasive ventilation failure with snorkels. Conclusions: Using the snorkel system resulted in an absolute mortality reduction of 11%, and recovery increased by 15% compared to the standard treatment system. Therefore, this device can be used as an acceptable alternative in the absence of mechanical ventilators.

Hospitalization and risk of death due to influenza among vaccinated and unvaccinated patients. A 5-year study in the northeastern Mexican population.

In Mexico, seasonal influenza epidemics results in substantial mortality and burden to healthcare resources. The country`s health authority provides vaccination to children <5 years old; adults >60 years of age; those aged 5-60 years with risk factors. Inclusion of school-aged children and adults until 59 years of old with no risk factors in the vaccination program would be highly beneficial. A prospective cohort surveillance study was conducted between the influenza seasons of 2014-2015 and 2018-2019 at the Dr. José Eleuterio González University Hospital. The primary outcome was need for hospitalization in vaccinated and unvaccinated patients with ILI or seasonal influenza. Secondary outcomes included outpatient management, admission to the ICU, and mortality during hospitalization among vaccinated and unvaccinated participants. 361patients (37.44%) had a confirmed influenza diagnosis. Being vaccinated made it more probable to be treated as an outpatient (p = .0001). For unvaccinated patients, the risk for hospitalization (OR = 1.70), ICU admission (OR = 8.46) and in-hospital death (OR = 27.17) was higher. Fifty-two patients died due to complications related to seasonal influenza or ILI, and none of them were vaccinated. Most subjects were between 18 and 49 years old. Influenza vaccination significantly reduced hospitalization, need for ICU admission, and in-hospital mortality in a 5-year study from Monterrey, Mexico.

Experience of the medical personnel of a peruvian public hospital in the face of the COVID-19 pandemic. / Experiencia del personal médico de un hospital público peruano frente a la pandemia por COVID-19.

The arrival of the new coronavirus disease (COVID-19) has challenged and exposed the precarization of health systems in the face of pandemic diseases. Medical personnel has demonstrated their commitment to service and workforce force, despite having inadequate medical equipment, supplies, hospital beds, and personnel, not to mention the risk of being victims of this disease. With this article, we aim to share the experience and capabilities of the medical staff to overcome adversities: their resilience and resourcefulness in the face of traumatic situations, and using and modifying any available equipment in the absence of mechanical ventilators to mitigate the progression of the disease.

La llegada de la enfermedad por el nuevo coronavirus (COVID-19) ha desafiado todos los sistemas de salud y puso en evidencia el precario sistema sanitario frente a enfermedades pandémicas. A pesar de esto, el personal médico ha demostrado la vocación de servicio y la fuerza laboral, aunque trabaje con insumos insuficientes, equipos médicos inadecuados, falta de camas de hospitalización, falta de personal y algunos fallezcan víctimas de esta enfermedad. Con este artículo pretendemos difundir las experiencias y la capacidad del personal médico para vencer estas adversidades, la adaptación positiva a estas situaciones traumáticas, utilizar y modificar todas las herramientas disponibles ante la falta de ventiladores mecánicos que lograron mitigar la progresión de la enfermedad.

Disseminated paracoccidioidomycosis associated with lymph node tuberculosis in a non immunocompromised child.

The association of paracoccidioidomycosis (PCM) and tuberculosis (TB) produces an uncommon hyperinflammatory syndrome, causing multiorgan dysfunction. TB associated PCM is a rare condition, but it is fatal if not treated. Herein, we present a immunocompetent child who is admitted for fever and painful lymphadenopathy, with evidence of acid-alcohol-resistant bacillus (AARB) in cervical lymph node biopsy, antituberculous treatment was started with partial clinical improvement and is given discharge from hospital. At 3 weeks, he was readmitted by fever, weight loss, dyspnea and a greater number of adenopathies, in the new biopsy multiple yeasts were found compatible with PCM, our patient responded well to the combination of antituberculosis therapy(ATT), corticosteroid, and amphotericin B deoxycholate, presenting clinical improvement and subsequently continued with itraconazole.

Comparación clínica y laboratorial de la fiebre amarilla severa versus dengue grave en Perú / Clinical and laboratory differences between severe yellow fever and severe dengue in emergency patients

En los centros de Emergencia con poco apoyo de laboratorio, es difícil diferenciar a los pacientes con dengue grave y fiebre amarilla severa. El objetivo fue comparar el perfil clínico y de laboratorio de los pacientes con dengue grave y fiebre amarilla severa en Urgencias. Se realizó un estudio observacional retrospectivo de pacientes con diagnóstico confirmado de dengue y fiebre amarilla en el período 2018 a 2020 atendidos en la Unidad de Emergencia del Hospital Carrión, Huancayo-Perú. Se evaluaron un total de 35 pacientes, 11 pacientes (31,4%) fueron diagnosticados con fiebre amarilla severa y 24 pacientes (68,5%) con dengue grave. La media de los resultados de laboratorio con fiebre amarilla severa fueron bilirrubina indirecta 4,7 ml/dL, aspartato transaminasa 4463 UI/L, transaminasa aminotransferasa 4329 UI/L, creatinina 4,9 mg/dl. En pacientes con dengue grave el hematocrito promedio fue 51,8, hemoglobina 17,6 g/dl, plaquetas 24 × 103/mm. En pacientes con síndrome ictérico-febril la presencia de bradicardia, bilirrubina indirecta elevada y transaminasas muy elevadas debe hacer sospechar de fiebre amarilla; mientras que los pacientes que acuden por ascitis, derrame pleural, aumento de hematocrito y deficiencia de plaquetas, se debe tratar como dengue grave sobre todo en Unidades de Emergencia con poco apoyo de laboratorio(AU)

In Emergency centers with little laboratory support, differentiating patients with dengue and yellow fever is difficult. The Aim was to compare the clinical and laboratory profile of patients with severe dengue and severe yellow fever in the Emergency unit. We conducted a retrospective observational study of patients with a confirmed diagnosis of dengue and yellow fever in the period 2018 to 2020 treated in the Emergency Unit of the Carrión hospital, Huancayo-Peru. A total of 35 patients were evaluated, 11 patients (31.4%) were diagnosed with severe yellow fever and 24 patients (68.5%) with severe dengue. The mean laboratory results in patients with severe yellow fever were indirect bilirubin 4.7 ml/dL, aspartate transaminase 4463 IU/L, transaminase aminotransferase 4329 IU/L, creatinine 4.9 mg / dl. In patients with severe dengue were hematocrit 51.8, hemoglobin 17.6 g / dl, platelets 24 × 103 / mm. In patients with syndrome jaundice and fever the presence of bradycardia, elevated indirect bilirubin, and very elevated transaminases should be suspicious for yellow fever; while in patients who come for ascites, pleural effusion, increased hematocrit and platelet deficiency, it should be treated as severe dengue especially in Emergency Units with little laboratory support(AU)

Regla de predicción para determinar infestación canina por Echinococcus granulosus / Prediction rule to determine canine infestation by Echinococcus granulosus

Nuestro objetivo fue determinar un score que ayude a predecir la probabilidad de infestación canina por Echinococcus en una zona endémica en hidatidosis. Se realizó un estudio longitudinal en 3 anexos de la provincia de Concepción ubicado en los andes centrales de Perú. La infección canina por Echinococcus granulosus fue definido por la presencia de antígeno identificado en la muestra de heces. El modelo predictivo se obtuvo mediante un análisis de regresión logística basado en los parámetros sociodemográficos, esta regla fue internamente validada por remuestreo de tipo bootstrap. Resultados: De 152 canes que se sometieron al estudio de heces, 76 tuvieron infección por Echinococcus confirmada por antígeno reactivo. Se identificaron 4 factores ponderados dentro de la regla de predicción que, en suma, dieron el puntaje: El can que duerme fuera de casa (3 puntos), alimentar con vísceras crudas al can (3 puntos) y sacrificar al ganado dentro de la casa (2 puntos) y el can se alimenta con croquetas (-2 puntos). Se encontró que esta regla de predicción tuvo valor del área bajo la curva ROC 0,78; (IC 95%: 0,70 ­ 0,86). Estos parámetros de predicción con un puntaje ≥ 3 tenía una sensibilidad del 75% y especificidad del 65,8%, con un valor predictivo positivo del 85,3%. Esta regla ayudará al personal de la salud a identificar a los canes infestados por Echinococcus granulosus, para su intervención anti parasitaria y preventiva en sus dueños(AU)

Cystic hydatidosis is an endemic disease in Andean regions, our objective was to determine a score that helps to predict canine Echinococcus infestation in an endemic area with hydatidosis. A longitudinal study was carried out in 3 annexes of the province of Concepción located in the central Andes of Peru. Canine echinococcosis infection was defined by the presence of E. granulosus antigen identified in the stool sample. The predictive model was obtained through a logistic regression analysis based on the sociodemographic parameters, this rule was internally validated by bootstrap type resampling. Results: Of 152 dogs that underwent the stool study, 76 had an Echinococcus infection confirmed by reactive antigen. Four weighted factors were identified within the prediction rule that, in sum, gave the score: The dog that sleeps outside the home (3 points), feeding raw viscera to the dog (3 points), slaughtering the cattle inside the house (2 points) and the dog is fed with croquettes (-2 points). This prediction rule was found to have a value of the area under the ROC curve 0.78 (95% CI: 0.70 - 0.86). At a cutoff point of ≥ 3 points, the prediction rule was found to have a sensitivity of 75% and a specificity of 65.8%, with a positive predictive value of 85.3%. This rule will help health personnel to identify canes infested by Echinococcus granulosus, for their anti-parasitic and preventive intervention in their owners(AU)

Disease progression velocity as predictor of severity in Guillain-Barre syndrome. / Velocidad de progresión de la enfermedad como predictor de severidad en el síndrome de Guillain-Barré.

OBJECTIVE: To identify the velocity of disease progression as a predictor of severity in patients with Guillain-Barre syndrome (GBS). MATERIALS AND METHODS: Prospective observational study of patients with confirmed diagnosis of GBS between May and August 2019 in four hospitals in Peru. The disease progression velocity (DPV) was defined as the time since the onset of neurological symptoms and the maximum peak of neurological severity. RESULTS: Of 94 cases with GBS, the average age was 42 years; 73 (77.8%) patients presented severe GBS, the average hospital stay was 19 days; 45 (47.8%) patients haddiarrheal symptoms previously, in 63 (67.1%) patients the onset of motor weakness was located in the upper limbs and in 31 (32.9%) it was located in the lower limbs, 9 (10.0%) patients presented some type of dysautonomy; admission to mechanical ventilation was needed in 8 (8.5%) patients, and the deceased were 2 (2.0%). The DPV≤ 1 day has a 79% probability of developing severe disease, the two and three day DPV have the probability of 61% and 38% respectively of progressing to severe forms. CONCLUSION: DPV is a predictor of poor prognosis when it is less than 2 days and with a possible requirement for mechanical ventilation. The speed of progression of neurological disease is a practical and accessible clinical evaluation method that should be evaluated in patients with GBS.

OBJETIVO: Identificar a la velocidad de progresión de la enfermedad como un predictor de severidad en pacientes con síndrome de Guillain-Barré (SGB). MATERIALES Y MÉTODOS: Estudio observacional prospectivo que incluyó pacientes con diagnóstico confirmado de SGB entre mayo y agosto de 2019 en cuatro hospitales del Perú. La velocidad de progresión de la enfermedad (VPE) fue definido como el tiempo transcurrido entre el inicio de los síntomas neurológicos y el pico máximo de la severidad neurológica. RESULTADOS: De 94 casos con SGB, la edad promedio fue 42 años; 73 (77,8%) pacientes presentaron SGB severo, la estancia hospitalaria promedio fue 18,4 días; 45 (47,8%) pacientes presentaron cuadro diarreico previo; 63 (67,1%) pacientes presentaron un inicio de debilidad motora en miembros superiores y 31 (32,9%) en miembros inferiores; 9 (10,0%) pacientes presentaron algún tipo de disautonomía; 8 (8,5%) pacientes debieron usar ventilación mecánica, y 2 (2,0%) pacientes fallecieron. La VPE ≤ 1 día tiene el 79% de probabilidad de desarrollar enfermedad severa, la VPE de dos y tres días tienen el 61% y el 38% de probabilidad, respectivamente, de progresar a las formas severas. CONCLUSIÓN: La VPE es un predictor de mal pronóstico cuando es menor de 2 días. La VPE neurológica es un método de evaluación clínica práctica y accesible que debe evaluarse en pacientes con SGB.

Ethnic disparities in COVID-19 mortality in Mexico: A cross-sectional study based on national data.

INTRODUCTION: Across the world, the COVID-19 pandemic has disproportionately affected racial and ethnic minorities. How ethnicity affects Indigenous peoples in Mexico is unclear. The aim of this cross-sectional study was to determine the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico. METHODS: We used open access data from the Mexican Ministry of Health, which includes data of all confirmed COVID-19 cases in the country. We used descriptive statistics to compare differences among different groups of patients. Logistic regression was used to calculate odds ratios while adjusting for confounders. RESULTS: From February 28 to August 3, 2020, a total of 416546 adult patients were diagnosed with COVID-19. Among these, 4178 were Indigenous peoples. Among all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92). DISCUSSION: In this large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico.

Alternative to traditional noninvasive ventilation using a modified snorkel mask in a patient with SARS-COV2: A case report.

INTRODUCTION: The lack of mechanical ventilators for patients with COVID-19 has necessitated the use of other noninvasive ventilation (NIV) systems. One of these NIV systems is the use of an adapted snorkel mask with inspiration valves and pressure valve (PEEP). CASE AND OUTCOMES: A 48-year-old man with no previous history of lung disease was admitted to the emergency room with a diagnosis of acute respiratory failure due to SARS-COV2. The patient did not improve saturation with the use of the reservoir mask. Oxygenation was started using an adapted snorkel mask with a PEEP valve with an alveolar recruitment function and double oxygen flow. The patient presented clinical and radiological improvement after 2 days of use and was discharged 16 days later. DISCUSSION: The use of a snorkel mask is an important, viable, and simpler NIV modality for the management of patients with COVID-19 with respiratory failure who fail to use a reservoir mask, and it can be an alternative before the use of a mechanical ventilator. CONCLUSION: The use of the adapted snorkel mask with Charlotte valve and PEEP is a feasible alternative for the treatment of patients with COVID-19.

Velocidad de progresión de la enfermedad como predictor de severidad en el síndrome de Guillain-Barré / Disease progression velocity as predictor of severity in Guillain-Barre syndrome

RESUMEN Objetivo: Identificar a la velocidad de progresión de la enfermedad como un predictor de severidad en pacientes con síndrome de Guillain-Barré (SGB). Materiales y métodos: Estudio observacional prospectivo que incluyó pacientes con diagnóstico confirmado de SGB entre mayo y agosto de 2019 en cuatro hospitales del Perú. La velocidad de progresión de la enfermedad (VPE) fue definido como el tiempo transcurrido entre el inicio de los síntomas neurológicos y el pico máximo de la severidad neurológica. Resultados: De 94 casos con SGB, la edad promedio fue 42 años; 73 (77,8%) pacientes presentaron SGB severo, la estancia hospitalaria promedio fue 18,4 días; 45 (47,8%) pacientes presentaron cuadro diarreico previo; 63 (67,1%) pacientes presentaron un inicio de debilidad motora en miembros superiores y 31 (32,9%) en miembros inferiores; 9 (10,0%) pacientes presentaron algún tipo de disautonomía; 8 (8,5%) pacientes debieron usar ventilación mecánica, y 2 (2,0%) pacientes fallecieron. La VPE ≤ 1 día tiene el 79% de probabilidad de desarrollar enfermedad severa, la VPE de dos y tres días tienen el 61% y el 38% de probabilidad, respectivamente, de progresar a las formas severas. Conclusión: La VPE es un predictor de mal pronóstico cuando es menor de 2 días. La VPE neurológica es un método de evaluación clínica práctica y accesible que debe evaluarse en pacientes con SGB.

ABSTRACT Objective: To identify the velocity of disease progression as a predictor of severity in patients with Guillain-Barre syndrome (GBS). Materials and methods: Prospective observational study of patients with confirmed diagnosis of GBS between May and August 2019 in four hospitals in Peru. The disease progression velocity (DPV) was defined as the time since the onset of neurological symptoms and the maximum peak of neurological severity. Results: Of 94 cases with GBS, the average age was 42 years; 73 (77.8%) patients presented severe GBS, the average hospital stay was 19 days; 45 (47.8%) patients had diarrheal symptoms previously, in 63 (67.1%) patients the onset of motor weakness was located in the upper limbs and in 31 (32.9%) it was located in the lower limbs, 9 (10.0%) patients presented some type of dysautonomy; admission to mechanical ventilation was needed in 8 (8.5%) patients, and the deceased were 2 (2.0%). The DPV≤ 1 day has a 79% probability of developing severe disease, the two and three day DPV have the probability of 61% and 38% respectively of progressing to severe forms. Conclusion: DPV is a predictor of poor prognosis when it is less than 2 days and with a possible requirement for mechanical ventilation. The speed of progression of neurological disease is a practical and accessible clinical evaluation method that should be evaluated in patients with GBS.

Velocidad de progresión de la enfermedad como predictor de severidad en el síndrome de Guillain-Barré / Disease progression velocity as predictor of severity in Guillain-Barre syndrome

RESUMEN Objetivo: Identificar a la velocidad de progresión de la enfermedad como un predictor de severidad en pacientes con síndrome de Guillain-Barré (SGB). Materiales y métodos: Estudio observacional prospectivo que incluyó pacientes con diagnóstico confirmado de SGB entre mayo y agosto de 2019 en cuatro hospitales del Perú. La velocidad de progresión de la enfermedad (VPE) fue definido como el tiempo transcurrido entre el inicio de los síntomas neurológicos y el pico máximo de la severidad neurológica. Resultados: De 94 casos con SGB, la edad promedio fue 42 años; 73 (77,8%) pacientes presentaron SGB severo, la estancia hospitalaria promedio fue 18,4 días; 45 (47,8%) pacientes presentaron cuadro diarreico previo; 63 (67,1%) pacientes presentaron un inicio de debilidad motora en miembros superiores y 31 (32,9%) en miembros inferiores; 9 (10,0%) pacientes presentaron algún tipo de disautonomía; 8 (8,5%) pacientes debieron usar ventilación mecánica, y 2 (2,0%) pacientes fallecieron. La VPE ≤ 1 día tiene el 79% de probabilidad de desarrollar enfermedad severa, la VPE de dos y tres días tienen el 61% y el 38% de probabilidad, respectivamente, de progresar a las formas severas. Conclusión: La VPE es un predictor de mal pronóstico cuando es menor de 2 días. La VPE neurológica es un método de evaluación clínica práctica y accesible que debe evaluarse en pacientes con SGB.

ABSTRACT Objective: To identify the velocity of disease progression as a predictor of severity in patients with Guillain-Barre syndrome (GBS). Materials and methods: Prospective observational study of patients with confirmed diagnosis of GBS between May and August 2019 in four hospitals in Peru. The disease progression velocity (DPV) was defined as the time since the onset of neurological symptoms and the maximum peak of neurological severity. Results: Of 94 cases with GBS, the average age was 42 years; 73 (77.8%) patients presented severe GBS, the average hospital stay was 19 days; 45 (47.8%) patients had diarrheal symptoms previously, in 63 (67.1%) patients the onset of motor weakness was located in the upper limbs and in 31 (32.9%) it was located in the lower limbs, 9 (10.0%) patients presented some type of dysautonomy; admission to mechanical ventilation was needed in 8 (8.5%) patients, and the deceased were 2 (2.0%). The DPV≤ 1 day has a 79% probability of developing severe disease, the two and three day DPV have the probability of 61% and 38% respectively of progressing to severe forms. Conclusion: DPV is a predictor of poor prognosis when it is less than 2 days and with a possible requirement for mechanical ventilation. The speed of progression of neurological disease is a practical and accessible clinical evaluation method that should be evaluated in patients with GBS.

[Bacterial colonization after applying an educational program: A quasi-experimental study]. / Colonización bacteriana después de la aplicación de un programa educativo: estudio cuasi experimental.

INTRODUCTION: Educational interventions can raise awareness and understanding in population groups and may help to achieve changes in behavior. OBJECTIVE: To determine if the educational handwashing program applied to high-school students reduces the colonization of infectious bacteria on the hands. METHODS: A non-randomized quasi-experimental study was carried out using consecutive sampling of the students of the last year of high-school who were divided into an intervention group and a control group. Data were obtained before and after the implementation of the educational program. Samples were taken from the dominant hand for bacterial culture, and a questionnaire was applied that assessed knowledge of hand hygiene before and after the program. The program was aimed at improving the level of understanding and attitudes of students regarding hand hygiene. RESULTS: Of 208 samples obtained, the most frequent agents before and after the educational program were Staphylococcus epidermidis (39% versus 23%) and Staphylococcus aureus (21% versus 15%). The average number of colonies was 236 and 183 respectively (p = 0.35). CONCLUSION: The educational program managed to improve the level of understanding about hand hygiene; however, it was not enough to reduce bacterial colonization, so other behaviors such as direct supervision should be considered.

INTRODUCCIÓN: La intervención en poblaciones por medio de programas educativos logra aumentar el conocimiento en un determinado grupo y además, en algunos casos, se logra un cambio de conducta. OBJETIVO: Determinar si el programa educativo de lavado de manos aplicado a los estudiantes de educación secundaria reduce la colonización de bacterias infecciosas en las manos. METODOLOGÍA: Se realizó un estudio cuasi experimental no aleatorizado mediante muestreo consecutivo a los alumnos del último año de secundaria, quienes fueron divididos en dos grupos de intervención y control, analizados en dos etapas antes y después de la aplicación del programa educativo. Se tomaron las muestras de la mano dominante para el cultivo bacteriano. Además, se aplicó un cuestionario que evaluó los conocimientos sobre higiene de manos antes y después de la aplicación del programa, que estuvo dirigido a mejorar el nivel de conocimiento y de las actitudes de los estudiantes en relación a la higiene de manos. RESULTADOS: De 208 muestras obtenidas los agentes más frecuentes antes y después de la aplicación del programa educativo fueron Staphylococcus epidermidis (39% versus 23%) y Staphylococcus aureus (21%versus15%); el promedio del número de colonias fue 236 y 183 respectivamente (p = 0,35). CONCLUSIÓN: La aplicación del programa educativo logró mejorar el nivel de conocimiento sobre la higiene de manos. Sin embargo, no fue suficiente para reducir la colonización bacteriana, por lo que debería agregarse otras conductas como la supervisión directa.

Flora bacteriana resistente al lavado de manos en estudiantes universitarios / Bacterial Flora Resistant to Hand Washing in University Students

Introducción: En la superficie cutánea residen microorganismos responsables del balance bioquímico, algunas son patógenas y persisten a pesar del lavado de manos. Objetivo: Identificar la flora bacteriana resistente al lavado de manos en estudiantes universitarios. Métodos: Se realizó el estudio observacional analítico de tipo longitudinal, para esto se enrolaron a estudiantes universitarios que recibieron previamente charlas educativas sobre higiene de manos, posteriormente se tomaron muestras antes y después del lavado de las manos. Resultados: De 80 muestras analizadas se identificó a Staphylococcus epidermidis como el más frecuente en 95 por ciento de los estudiantes y con el lavado de manos se redujo a 60 por ciento; el segundo agente fue Staphylococcus saprophyticcus, que estuvo presente en 75 por ciento de los casos y después del lavado, en 35 por ciento; E. coli ocupó el tercer lugar, se encontró en 42,5 por ciento de las muestras y tras la higiene de manos se redujo a 17,5 por ciento. Para los agentes transitorios como Klebsiella (p < 0,05) y Pseudomonas, el lavado de manos fue más efectivo; sin embargo, E. coli fue la enterobacteria que permaneció elevada a pesar de la higiene de manos (p = 0,01). Conclusión: Algunas colonias de E. coli son resistentes al lavado de manos, similar a los agentes residentes como Staphylococcus epidermidis, Staphylococcus saprophyticcus y Staphylococcus aureus(AU)

Introduction: The skin surface is inhabited by microorganisms responsible for the biochemical balance; some are pathogenic and persist despite hand washing. Objective: To identify, in university students, the bacterial flora resistant to hand washing. Methods: A longitudinal, analytical and observational study was carried out, for which university students were included who previously received educational talks on hand hygiene. Samples were taken before and after hand washing. Results: Of 80 samples analyzed, Staphylococcus epidermidis was identified as the most frequent in 95 percent of the students and, with hand washing, it was reduced to 60 percent the second agent was Staphylococcus saprophyticcus, present in 75 percent of the cases and, after hand washing, in 35 percent. E. coli occupied the third position, as it was found in 42.5 percent of the samples and, after hand hygiene, it was reduced to 17.5 percent. For transient agents like Klebsiella (P<0.05) and Pseudomonas, handwashing was more effective; however, E. coli was the enterobacterium that remained elevated despite hand hygiene (P=0.01). Conclusion: Some E. coli colonies are resistant to hand washing, similar to resident agents such as Staphylococcus epidermidis, Staphylococcus saprophyticcus and Staphylococcus aureus(AU)

[Lingual ulcer as a manifestation of systemic paracoccidioidomycosis. Case report]. / Úlcera lingual asociada a paracoccidiodomicosis pulmonar.

Paracoccidioidomycosis is a fungal disease of systemic involvement that can invade any organ and is of high mortality if it is not diagnosed in a timely manner. We present the case of a farmer male with a history of diabetes mellitus, who previously develops lingual ulcers and subsequently presents severe lung disease associated with septic shock, without response to antituberculous and antibacterial treatment. The bronchial secretion smear shows evidence of yeasts in multiple budding, compatible with Paracoccidioidomycosis. The patient had a satisfactory recovery to the administration of amphotericin B deoxycholate.

Mexico and the COVID-19 Response.

Mexico has been one of the most affected countries in the world by the COVID-19 pandemic. The true impact of the pandemic has probably been underestimated, and President López Obrador, as well as the Ministry of Health, has struggled to lead the country since the beginning. While cases and deaths continue to rise, stronger leadership and unity are needed to limit the impact of COVID-19 on the health of millions of Mexicans.

Úlcera lingual asociada a paracoccidiodomicosis pulmonar / Lingual ulcer as a manifestation of systemic paracoccidioidomycosis: case report

Resumen La paracoccidioidomicosis (PCM) es una enfermedad fúngica sistémica que puede invadir cualquier órgano. Es de alta mortalidad si no es diagnosticado oportunamente. Presentamos el caso de un varón de ocupación agricultor, con antecedente de diabetes mellitus, que desarrolló inicialmente una úlcera lingual y posteriormente, una neumonía y shock séptico, sin respuesta al tratamiento antituberculoso y antibacteriano. El frotis de la secreción bronquial permitió evidenciar las levaduras en gemación múltiple, compatible con una PCM. Tuvo una respuesta satisfactoria a la administración de anfotericina B deoxicolato.

Abstract Paracoccidioidomycosis is a fungal disease of systemic involvement that can invade any organ and is of high mortality if it is not diagnosed in a timely manner. We present the case of a farmer male with a history of diabetes mellitus, who previously develops lingual ulcers and subsequently presents severe lung disease associated with septic shock, without response to antituberculous and antibacterial treatment. The bronchial secretion smear shows evidence of yeasts in multiple budding, compatible with Paracoccidioidomycosis. The patient had a satisfactory recovery to the administration of amphotericin B deoxycholate.

Medicina Traslacional en el Perú, generación de políticas y mejoras basadas en la evidencia / Translational medicine in Peru, policy making and evidence-based improvement

Introducción: la investigación traslacional es una rama de la ciencia de reciente creación, su objetivo principal es la aplicación del conocimiento que se genera de las investigaciones, que no quede formando parte de la literatura gris, en el papel o para unos pocos, sino que pueda servir a la mayor cantidad posible de individuos y/o poblaciones. Objetivo: determinar los avances que se han dado a lo largo de los últimos años en la aplicación de la medicina traslacional en Perú. Métodos: se realizó una búsqueda por conveniencia en bases de datos (Google Scholar, Pubmed). Se han brindado ejemplos de cómo la investigación traslacional en Perú puede aportar en gran medida a la mejora de realidades y problemáticas específicas, esto refuerza la necesidad de que las decisiones políticas deben basarse en la medicina basada en la evidencia. Resultados: la medicina traslacional en Perú enfrenta muchas dificultades, como lo son los recursos limitados, tiempo escaso para implementar la investigación formativa, carencia de modelos pedagógicos actualizados, docentes preparados en escuelas antiguas y con capacidad limitada para la educación médica continua; obstáculos que deben de superarse para poder asegurar que la ciencia -y por ende la sociedad- progresen. Conclusiones: en Perú, el avance de la medicina traslacional ha derivado en la generación de personal de salud más capacitado que ha proporcionado los medios para el desarrollo de múltiples políticas públicas. Dichas políticas en muchos casos han terminado plasmadas en normas, reglamentos y hasta leyes en el país(AU)

Introduction: translational research is a branch of science of recent creation. Its main aim is the application of the knowledge generated by research so that it will not become grey literature printed on paper or for the use of a chosen few, but serve as many people and/or populations as possible. Objective: determine the progress made in recent years in the application of translational medicine in Peru. Methods: a convenience search was conducted in the databases Google Scholar and PubMed. Examples are offered of the way in which translational research may greatly contribute to improve specific realities and problems in Peru. This reinforces the need that political decisions be based on evidence-based medicine. Results: translational medicine is faced with many difficulties in Peru, such as limited resources, scant time to implement training research, lack of updated pedagogical models, and teachers trained in old schools and with a limited capacity for continuing medical education. These hurdles should be overcome to ensure the progress of science and therefore of society as well. Conclusions: progress of translational medicine in Peru has resulted in the training of more skilled health personnel, providing the means for the development of multiple public policies. In many cases those policies have been included in standards, regulations and even laws in the country(AU)

Disseminated Histoplasmosis and Miliary Tuberculosis Imitating Colon Cancer in Patient with HIV Who Refuses to Antirretroviral Treatment.

Simultaneous infection with histoplasmosis and miliary tuberculosis is rare and mainly affects people with severe immunosuppression, they can present very diverse clinical forms, similar to other infectious and neoplastic pathologies. We present the case of a 27-year-old woman diagnosed with HIV infection for 08 years who refuses to receive antiretroviral treatment (ART) and conceals her diagnosis, comes to the Hospital for pain, abdominal distension and ulcer in the oral cavity. The patient was diagnosed with likely cancer by presenting irregular intestinal thickening with homogeneous gray pattern in colon tomography and signs of intestinal obstruction, that after hemicolectomy was evidenced histoplasmosis in the pathological study, during the treatment with amphotericin B deoxycholate and improvement of the oral ulcer, the patient presented dyspnea, micronodular pattern on the chest radiograph that had not previously existed and the lipoarabinomanan antigen in the urine was positive for tuberculosis. In immunosuppressed patients, intestinal histoplasma infection may have clinical and tomographic characteristics similar to colon cáncer.

Colonización bacteriana después de la aplicación de un programa educativo: estudio cuasi experimental / Bacterial colonization after applying an educational program: A quasi-experimental study

INTRODUCCIÓN: La intervención en poblaciones por medio de programas educativos logra aumentar el conocimiento en un determinado grupo y además, en algunos casos, se logra un cambio de conducta. OBJETIVO: Determinar si el programa educativo de lavado de manos aplicado a los estudiantes de educación secundaria reduce la colonización de bacterias infecciosas en las manos. METODOLOGÍA: Se realizó un estudio cuasi experimental no aleatorizado mediante muestreo consecutivo a los alumnos del último año de secundaria, quienes fueron divididos en dos grupos de intervención y control, analizados en dos etapas antes y después de la aplicación del programa educativo. Se tomaron las muestras de la mano dominante para el cultivo bacteriano. Además, se aplicó un cuestionario que evaluó los conocimientos sobre higiene de manos antes y después de la aplicación del programa, que estuvo dirigido a mejorar el nivel de conocimiento y de las actitudes de los estudiantes en relación a la higiene de manos. RESULTADOS: De 208 muestras obtenidas los agentes más frecuentes antes y después de la aplicación del programa educativo fueron Staphylococcus epidermidis (39% versus 23%) y Staphylococcus aureus (21%versus15%); el promedio del número de colonias fue 236 y 183 respectivamente (p = 0,35). CONCLUSIÓN: La aplicación del programa educativo logró mejorar el nivel de conocimiento sobre la higiene de manos. Sin embargo, no fue suficiente para reducir la colonización bacteriana, por lo que debería agregarse otras conductas como la supervisión directa.

INTRODUCTION: Educational interventions can raise awareness and understanding in population groups and may help to achieve changes in behavior. OBJECTIVE: To determine if the educational handwashing program applied to high-school students reduces the colonization of infectious bacteria on the hands. METHODS: A non-randomized quasi-experimental study was carried out using consecutive sampling of the students of the last year of high-school who were divided into an intervention group and a control group. Data were obtained before and after the implementation of the educational program. Samples were taken from the dominant hand for bacterial culture, and a questionnaire was applied that assessed knowledge of hand hygiene before and after the program. The program was aimed at improving the level of understanding and attitudes of students regarding hand hygiene. RESULTS: Of 208 samples obtained, the most frequent agents before and after the educational program were Staphylococcus epidermidis (39% versus 23%) and Staphylococcus aureus (21% versus 15%). The average number of colonies was 236 and 183 respectively (p = 0.35). CONCLUSION: The educational program managed to improve the level of understanding about hand hygiene; however, it was not enough to reduce bacterial colonization, so other behaviors such as direct supervision should be considered.

Serological screening in donors in Mexico: advances and technology / Tamizaje serológico en donadores de México: avances y tecnología

The residual risk of transfusion-related infections has decreased dramatically in countries that have routinely implemented serological screening. Most of the donation in Mexico is from replacement practice, a risk factor for positive serology. In Mexico, the altruistic donation is only 2.7%. The heterogeneity of technical factors, regional factors and internal policies of each center influences the variability of data on the prevalence of positive screening, as well as the prevalence of confirmed cases. The main advantage of nucleic acid technology is the detection of donors in the period of serological window or occult infections, being occult hepatitis reports in Mexican donors from 1 to 3.4%. The limitation of available technology, the scope of the clinic and perspectives, invites us to improve technology and health policies in the interest of transfusion safety.

El riesgo residual de las infecciones relacionadas a la transfusión ha disminuido drásticamente en los países que han implementado rutinariamente el tamizaje serológico. La mayor parte de la donación en México es de reposición, factor de riesgo para serología positiva, y en donde la donación altruista es de apenas 2.7%. La heterogeneidad de factores técnicos, regionales y políticas internas de cada centro influyen en la variabilidad de datos en prevalencia del tamizaje positivo, así como en la prevalencia de casos confirmados. La principal ventaja de la tecnología de ácidos nucleicos es la detección de donadores en periodo de ventana serológico o de infecciones ocultas, con reportes de hepatitis ocultas en donadores de 1-3.4% en México. Las limitantes de la tecnología disponible, el alcance de la clínica y de las perspectivas, nos invita a la mejora tecnológica y de las políticas sanitarias en aras de la seguridad transfusional.