Outcomes and complications of hospitalised patients with HIV-TB co-infection.

BACKGROUND: Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available. METHODS: Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015. RESULTS: Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%. CONCLUSIONS: Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities.

CONTEXTE: La tuberculose (TB) est l'une des causes les plus courantes d'hospitalisation chez les patients VIH positifs. Malgré cela, les résultats hospitaliers des patients atteints de cette coinfection ont rarement été décrits depuis que le traitement antirétroviral est devenu largement disponible. MÉTHODES: Etude de cohorte prospective de patients adultes infectés par le VIH hospitalisés pour TB dans six hôpitaux de référence à Medellin, en Colombie, d'août 2014 à juillet 2015. RÉSULTATS: Sur 128 patients infectés par le VIH hospitalisés pour TB, l'âge moyen était de 38,4 ans; 79,7% étaient des hommes. Le VIH a été diagnostiqué à l'admission chez 28,9% des patients. Le nombre médian de lymphocytes T CD4+ était de 125 (±158 SD) cellules/µL. Seuls 47,3% des patients dont le diagnostic de VIH était connu lors de leur admission étaient sous traitement antirétroviral et 11,1% seulement avaient subi un test cutané à la tuberculine l'année précédente. Une toxicité médicamenteuse due aux médicaments antituberculeux est survenue chez 11,7% des patients. La durée moyenne de séjour était de 23,2 jours et 10,7% des patients ont été réadmis. La mortalité était de 5,5%. CONCLUSIONS: La mortalité hospitalière attribuable à la TB chez les patients VIH positifs est faible dans les hôpitaux de référence en Colombie. Les cas de TB chez les patients infectés par le VIH surviennent principalement chez les patients à un stade avancé du VIH, ou qui ne sont pas sous traitement antirétroviral, malgré un diagnostic connu de VIH. Seul un patient sur 10 de cette cohorte a subi un dépistage actif de la TB latente, ce qui reflète peut-être des opportunités de traitement manquées.

Presencia de Pseudomonas aeruginosas, cepas BLEE y resistencia en Salas del Hospital Solomon Klein, Cochabamba / Presence of Pseudomonas aeruginosas, BLEE strains and resistance in Rooms of the Solomon Klein Hospital, Cochabamba

Las infecciones causadas por Pseudomona aeruginosa y cepas BLEE junto con la resistencia bacteriana, producto del uso exagerado e inapropiado de los antibióticos, han favorecido al aumento importante de microorganismos resistentes a múltiples fármacos por lo que se ha convertido en un problema importante de salud de difícil manejo. OBJETIVO: conocer la presencia de Pseudomona aeruginosa y cepas BLEE junto con su resistencia en la Sala de Maternidad y Neonatología del Hospital Solomon Klein el año 2019. MATERIALES Y MÉTODOS: estudio de tipo descriptivo y transversal, se incluyó porta-sueros, agarrador de las camas, bandeja del material de curación, llave de los sueros, mangueras de los sueros e incubadoras para tomar muestras de estos. RESULTADOS: se tomaron 25 muestras de la sala de maternidad y neonatología de las que 3 (12%) resultaron positivos a Pseudomona aeruginosa en superficies de porta sueros, agarrador de camilla y bandeja de material de curación del servicio de Enfermería de la Sala de Maternidad. En las 21 (84%) muestras restantes prevaleció la presencia de la enterobacteria Hafnia alvei, en el análisis de resistencia resultaron sensibles a Cefotaxima descartando la existencia de cepas BLEE en el hospital. DISCUSIÓN: las infecciones asociadas a servicios de salud ocurren principalmente durante el ingreso y estancia hospitalaria y es por eso que la vigilancia de estos patrones facilita conocer los mecanismos de acción predominantes de los servicios, lo cual, es muy importante al momento de tomar decisiones terapéuticas. (AU)

Infections caused by Pseudomona aeruginosa and BLEE strains together with the bacterial resistance due to exaggerated and incorrect use of antibiotics have favored the increase in the importance of microorganisms resistant to multiple drugs, which has become an important health problem for difficult handling OBJECTIVE: to know the presence of Pseudomona aeruginosa and BLEE strains together with their resistance in the Maternity and Neonatology Room of the Solomon Klein Hospital in 2019. MATERIALS AND METHODS: descriptive study and cross-sectional type include serum-holder, grabber the beds, tray of the healing material, key of the sera, hoses of the sera and incubators to take samples of these. RESULTS: we took 25 samples from the maternity and neonatology ward of which 3 (12%) were positive for Pseudomona aeruginosa on serum carrier surfaces, stretcher gripper and Cure Material Tray of the Nursing Service of the Maternity ward. In the 21 (84%) remaining samples, the presence of Hafnia alvei enterobacteria prevailed, in the resistance analysis they were sensitive to Cefotaxime, ruling out the existence of BLEE strains in the hospital. DISCUSSION: infections associated with health services occur mainly during hospital admission and hospital stay and that is why monitoring these patterns makes it easier to know the predominant mechanisms of action of the services, which is very important at the moment.of making therapeutic decisions.(AU)

Enfermedades hepáticas y embarazo / Liver diseases and pregnancy

Resumen La prevalencia de las enfermedades hepáticas en el embarazo no es despreciable, ya que estas se presentan en 3%-5% de todas las gestaciones. Entre las múltiples causas se encuentran cambios fisiológicos del embarazo; enfermedad hepática preexistente, siendo las más comunes las enfermedades colestásicas (colangitis biliar primaria y colangitis esclerosante primaria), hepatitis autoinmune, enfermedad de Wilson, hepatitis virales crónicas, cirrosis establecida de cualquier etiología y paciente con historia de trasplante hepático; enfermedad hepática adquirida durante el embarazo, siendo las principales las hepatitis virales, la toxicidad inducida por medicamentos y la hepatolitiasis; hepatopatía relacionada con el embarazo, en la cual se encuentran 5 entidades principales: hiperémesis gravídica, colestasis intrahepática del embarazo, preeclampsia, síndrome HELLP e hígado graso del embarazo. La severidad de estas entidades tiene una amplia gama de presentaciones, desde la paciente que es completamente asintomática, hasta la falla hepática aguda e incluso la muerte. La gravedad del cuadro se asocia con una morbilidad y mortalidad significativas tanto para la madre como para el feto, lo cual hace que una evaluación rápida, diagnóstico certero y manejo apropiado por un equipo multidisciplinario (incluida obstetricia de alto riesgo, hepatología, gastroenterología y radiología intervencionista), en un servicio que tenga la posibilidad de ofrecer trasplante hepático, sean fundamentales para obtener buenos desenlaces.

Abstract Liver diseases develop in 3% to 5% of all gestations. Among the causes are: 1. Physiological changes of pregnancy. 2. Pre-existing liver diseases and conditions. The most common are cholestatic diseases such as primary biliary cholangitis and primary sclerosing cholangitis. Others include autoimmune hepatitis, Wilson's disease, chronic viral hepatitis, cirrhosis of any etiology and histories of liver transplantation. 3. Liver disease acquired during pregnancy, especially viral hepatitis, drug-induced toxicity and hepatolithiasis. 4. Pregnancy-related liver diseases including hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, preeclampsia, HELLP syndrome and fatty liver of pregnancy. Severity ranges from absence of symptoms to acute liver failure and even death. Severe cases have significant morbidity and mortality for both mother and fetus. These cases require rapid evaluation, accurate diagnosis and appropriate management by a multidisciplinary team including high-risk obstetrics, hepatology, gastroenterology and interventional radiology. Availability of liver transplantation is also important for obtaining good outcomes.

Venus looks different from day to night across wavelengths: morphology from Akatsuki multispectral images.

Since insertion into orbit on December 7, 2015, the Akatsuki orbiter has returned global images of Venus from its four imaging cameras at eleven discrete wavelengths from ultraviolet (283 and 365 nm) and near infrared (0.9-2.3 µm), to the thermal infrared (8-12 µm) from a near-equatorial orbit. The Venus Express and Pioneer Venus Orbiter missions have also monitored the planet for long periods but from polar or near-polar orbits. The wavelength coverage and views of the planet also differ for all three missions. In reflected light, the images reveal features seen near the cloud tops (~ 70 km altitude), whereas in the near-infrared images of the nightside, features seen are at mid- to lower cloud levels (~ 48-60 km altitude). The dayside cloud cover imaged at the ultraviolet wavelengths shows morphologies similar to what was observed from Mariner 10, Pioneer Venus, Galileo, Venus Express and MESSENGER. The daytime images at 0.9 and 2.02 µm also reveal some interesting features which bear similarity to the ultraviolet images. The nighttime images at 1.74, 2.26 and 2.32 µm and at 8-12 µm reveal features not seen before and show new details of the nightside including narrow wavy ribbons, curved string-like features, long-scale waves, long dark streaks, isolated bright spots, sharp boundaries and even mesoscale vortices. Some features previously seen such as circum-equatorial belts (CEBs) and occasional areal brightenings at ultraviolet (seen in Venus Express observations) of the cloud cover at ultraviolet wavelengths have not been observed thus far. Evidence for the hemispheric vortex organization of the global circulation can be seen at all wavelengths on the day- and nightsides. Akatsuki images reveal new and puzzling morphology of the complex nightside cloud cover. The cloud morphologies provide some clues to the processes occurring in the atmosphere and are thus, a key diagnostic tool when quantitative dynamical analysis is not feasible due to insufficient information.

Atención psicosocial integral en enfermedad catastrófica (Atinar) / Integrative Psychosocial Care in Catastrophic Illness

La enfermedad médico-quirúrgica catastrófica (EMQ-C) se define como una enfermedad aguda o prolongada, usualmente considerada como amenazante para la vida o con el riesgo de dejar discapacidad residual importante. La EMQ-C , a menudo, conlleva trastornos psicosociales que afectan de manera importante su evolución, porque alteran el proceso de rehabilitación, los hábitos saludables y la calidad de vida y, además, limitan la adherencia al tratamiento. Por lo tanto, para ofrecer un tratamiento a la persona quien la padece, es necesario desarrollar modelos que permitan identificar y tratar integralmente todos los aspectos médicos, psicológicos y sociales. La legislación colombiana, desde la aprobación de la Ley 100 de 1993, reglamentó la atención integral de la EMQ-C. No obstante, el desarrollo de programas de atención integral que incluyan lo psicosocial ha sido lento. Se presenta un modelo teórico de atención psicosocial integral en EMQ-C, que sigue los lineamientos de la medicina biopsicosocial de Ángel, junto a un modelo denominado medicina cognitiva , desarrollado previamente por uno de los autores (HR). El modelo incluye aspectos y procedimientos necesarios para su funcionamiento ajustado a la ley colombiana.

Medical Surgical Catastrophic Illness (MSIC) is defined as an acute or chronic lifethreatening disease or with risk of important disability. MSI-C is frequently associated with Psychosocial Disorders influencing the outcome due to effects on the rehabilitation process, quality of life and compliance. The development of integrative models of care that cover medical, psychological and social aspects is necessary in order to offer treatment to the person with MSI-C. Since Law 100 of 1993 was passed, Colombia ruled an integrative model of care for catastrophic illness. Noteworthy, implementation of these programs has been slow. In this article a theoretical model of integrative psychosocial care that follows recommendations of Engel's Biopsychosocial Model and the Cognitive Medicine model developed by one of the authors (HR). The model includes necessary aspects and procedures for its implementation according to Colombian Law.