Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2 / Analysis of infectious diseases care in Spanish hospitals from 2016–2020, including the first year of the SARS-CoV-2 pandemic

Objetivo Revisar los pacientes atendidos en los hospitales españoles dados de alta con un diagnóstico principal de infección en un periodo de 5 años, incluyendo el primer año de la pandemia por SARS-CoV-2. Material y métodos Se han analizado los datos del Conjunto Mínimo Básico de Datos (CMBD) de los pacientes dados de alta durante el periodo 2016-2020 de los hospitales del Sistema Nacional de Salud de España identificando aquellos que tuvieran un diagnóstico principal de enfermedad infecciosa según el código CIE-10-S. Se han incluido en el análisis todos los pacientes mayores de 14 años que hubieran ingresado en una planta convencional o de cuidados intensivos, excluyendo los partos, y se han evaluado las altas en función del servicio de alta. Resultados Los pacientes dados de alta con patología infecciosa han aumentado del 10% al 19% en los últimos años, y gran parte del crecimiento se debe a la epidemia por SARS-CoV-2. Los servicios de medicina interna atienden a más del 50% de estos pacientes, seguidos de neumología (9%) y cirugía general (5%). En el año 2020 el 57% de los pacientes con diagnóstico principal de infección fueron dados de alta por internistas, que atendieron al 67% de los pacientes con SARS-CoV-2. Conclusiones Actualmente más de la mitad de los pacientes que ingresan con diagnóstico principal de infección son dados de alta en medicina interna. Dada la complejidad creciente de las infecciones, abogamos por un abordaje en el que un área de capacitación permita una especialización, pero dentro de un contexto generalista, para el mejor manejo de estos pacientes (AU)

Aims This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients (AU)

Investigação de marcadores moleculares sanguíneos durante a infecção pelo vírus Chikungunya / Investigation of blood molecular markers during Chikungunya virus infection

A febre Chikungunya (CHIKF) é uma infecção viral causada pelo vírus Chikungunya (CHIKV). Os sintomas agudos incluem febre alta de início súbito, erupção cutânea, poliartrite e poliartralgia. Embora a infecção geralmente seja resolvida em menos de duas semanas, muitos pacientes experenciam recorrente dor e inflamação nas articulações, que podem persistir por anos. Esse estudo buscou marcadores moleculares no sangue de infectados pelo CHIKV que estejam associados a dor articular e cronicidade da CHIKF. O sequenciamento de receptores de células B (BCR) e T (TCR) demonstrou que a infecção por CHIKV diminui a diversidade desses receptores. Essa diversidade é ainda menor, durante a fase aguda da infecção, naqueles pacientes que irão desenvolver cronicidade. A menor diversidade de BCR em infectados está associada a um aumento na expressão de genes envolvidos na diferenciação e ativação de osteoclastos pela sinalização RANK/RANKL. Em adição, a cronicidade pode estar relacionada um aumento na expressão do gene ZBTB7A cuja expressão confere maior resistência a apoptose em precursores de osteoclastos naqueles pacientes que vão se tornar crônicos. Caso o envolvimento dos osteoclastos durante a patogênese de CHIKF seja confirmado, os pacientes poderão se beneficiar de abordagens terapêuticas já existentes como alternativas adicionais ao tratamento de CHIKF

Chikungunya fever (CHIKF) is a viral infection caused by the Chikungunya virus (CHIKV). Acute symptoms include sudden-onset high fever, rash, polyarthritis, and polyarthralgia. Although the infection usually resolves within two weeks, many patients experience recurrent joint pain and inflammation, which can persist for years. This study sought molecular markers in the blood of CHIKV-infected individuals that are associated with joint pain and chronicity of CHIKF. Sequencing of B (BCR) and T (TCR) cell receptors demonstrated that CHIKV infection decreases the diversity of these receptors. The diversity is even lower, during the acute phase of the infection, in those patients who will develop chronicity. The lower diversity of BCR in infected individuals is associated with an increase in the expression of genes involved in the differentiation and activation of osteoclasts by RANK/RANKL signaling. In addition, chronicity may be related to an increase in the expression of the ZBTB7A gene whose expression confers greater resistance to apoptosis in osteoclast precursors in those patients who will become chronic. If osteoclast role during CHIKF pathogenesis is confirmed, patients may benefit from existing therapeutic approaches as additional alternatives to CHIKF treatment

Is Ozone therapy an adjunct treatment for SARS-CoV-2 / COVID-19 infection?

Abstract Up to today, there is no specific treatment against SARS-CoV-2 / COVID-19 infection; there the necessity to search for alternatives that help patients with COVID-19. The objective of this study was to review the use of ozone therapy as adjunct treatment for SARS-CoV-2 / COVID-19 infection, highlighting the mechanisms of action, forms of application and current clinical evidence. A systematic review was conducted in electronic databases, searching the terminology Ozone "or" Ozone therapy "and" SARS-CoV-2 or COVID-19 or Coronavirus. Results: nineteen studies were included; ten were editorials, comments, brief reports or reviews, and nine clinical studies. We found that ozone therapy could be favorable for treating patients infected with SARS-CoV-2 / COVID-19, through a direct antiviral effect, regulation of oxidative stress, immunomodulation and improvement of oxygen metabolism. Patients who were treated with ozone therapy responded favorably; therefore, ozone therapy appears to be a promising treatment for patients infected with SARS-CoV-2 / COVID-19. Its mechanism of action justifies its use as an adjuvant therapy; however, scientific evidence is based on case series and clinical trials are necessary to corroborate its effectiveness and safety.

Tacinga inamoena vegetal drug characterization using phytochemistry, pharmacopoeial methods and thermoanalytical techniques

Tacinga inamoena (K. Schum.) N.P. Taylor & Stuppy, also known as quipá, is a native cactus of the Caatinga used in traditional medicine to treat urethral infections and inflammation. This study aimed to determine the physicochemical characteristics of vegetal drug obtained from the roots of T. inamoena. Analytical techniques and phytochemical tests were used, such as thermal analysis, qualitative and semiquantitative determination of secondary metabolites and spectroscopy at the infrared region. The powder of the vegetal drug met the parameters established by the Brazilian Pharmacopoeia, except for compressibility, which was low. On the thermogravimetric curve, three events related to the mass loss were verified, which correlate with the vegetal drug quality control and play a part in their standardization. The qualitative screening suggested the presence of alkaloids, flavonoids and terpenes. The infrared spectrum reinforced the presence of hydroxyl, carbonyl, and ether groups. In the semiquantitative screening, a concentration for total polyphenols of 65 mg equivalent to gallic acid g-1 to the crude ethanol extract (CEE) was obtained. On the correlation of flavonoid content to seasonality, a concentration was obtained of 3.3 mg equivalent to quercetin g-1 to the CEE obtained during the drought period and of 10.6 mg equivalent to quercetin g-1 to the CCE obtained during the rainy season. In T. inamoena, the presence of important classes of secondary metabolites, which are associated with the pharmacognostic characterization, aids the authentication and quality control of vegetal drugs of importance in traditional Brazilian medicine.

Classificação WifI: o novo sistema de classificação da Society for Vascular Surgery para membros inferiores ameaçados, uma revisão de literatura / WIfI classification: the Society for Vascular Surgery lower extremity threatened limb classification system, a literature review

Resumo A Society for Vascular Surgery propôs nova classificação para o membro inferior ameaçado, baseada nos três principais fatores influenciadores do risco de amputação do membro: ferida (Wound, W), isquemia (Ischemia, I) e infecção do pé (foot Infection, fI): a classificação WIfI. Esta abrange também os diabéticos, anteriormente excluídos do conceito de isquemia crítica do membro devido a seu quadro clínico complexo. O objetivo da classificação era fornecer estratificação de risco precisa e precoce ao paciente com membro inferior ameaçado; auxiliar no manejo clínico, permitindo comparar terapias alternativas; e predizer o risco de amputação em 1 ano e a necessidade de revascularização. O objetivo deste estudo é reunir os principais pontos abordados sobre a classificação WIfI no meio científico. A maior parte dos estudos de validação da classificação demonstram sua associação à predição de salvamento do membro, eventos de reintervenção, amputação e estenose, taxas de amputação maior e menor, sobrevida livre de amputação, e cicatrização de feridas.

Abstract The Society for Vascular Surgery has proposed a new classification system for the threatened lower limb, based on the three main factors that have an impact on limb amputation risk: Wound (W), Ischemia (I) and foot Infection ("fI") - the WIfI classification. The system also covers diabetic patients, previously excluded from the concept of critical limb ischemia because of their complex clinical condition. The classification's purpose is to provide accurate and early risk stratification for patients with threatened lower limbs; assisting with clinical management, enabling comparison of alternative therapies; and predicting risk of amputation at 1 year and the need for limb revascularization. The objective of this study is to collect together the main points about the WIfI classification that have been discussed in the scientific literature. Most of the studies conducted for validation of this classification system prove its association with factors related to limb salvage, such as amputation rates, amputation-free survival, prediction of reintervention, amputation, and stenosis (RAS) events, and wound healing.

Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors

Purpose. The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. Methods. We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. Results. 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. Conclusion. Despite FN’s clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN (AU)

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Manejo de la infección por cándida en el recién nacido / Management of candida infection

A nivel mundial la mortalidad neonatal corresponde al 41% de las que ocurren en menores de cinco años. Dentro de las causas descritas por la OMS la sepsis corresponde a la tercera, después de la prematurez y la asfixia perinatal. La Candida sp es uno de los agentes etiológicos que en el período neonatal genera alta morbilidad y mortalidad, así como secuelas neurológicas a largo plazo en especial en prematuros y de bajo peso. Estos pacientes cuentan con características inmunológicas propias, requerimientos de procedimientos invasivos y mayor sobrevida en estancias hospitalarias prolongadas, que se convierten en factores de riesgo que predisponen a desarrollar candidiasis sistémica. Dado el impacto de esta patología es importante contar con un abordaje integral diagnóstico y terapéutico eficaz que disminuya la morbimortalidad, mejorando el pronóstico vital y funcional. En los últimos años se han generado diferentes guías y protocolos médicos en busca de optimizar el manejo de esta infección, por lo que es importante describir cuales son las mejores recomendaciones actuales para el enfoque, diagnóstico y tratamiento de la candidiasis neonatal...

Worldwide, neonatal mortality accounts for 41% of deaths occurring in children younger than 5 years. Among the causes described by the WHO, sepsis corresponds to the third most common cause of death, after prematurity and perinatal asphyxia. Candida sp is one of the etiologic agents which generate high morbidity and mortality, as well as, long-term neurologic sequelae predominantly in low birth-weight preterm infants. These patients have particular immunological features, require invasive procedures and greater survival in prolonged hospital stays, which become predisposing risk factors for the development of systemic candidiasis. Due to the impact of this condition it is important to count with a comprehensive diagnostic approach which reduces morbidity and mortality improving vital and functional prognosis. Various medical guidelines and protocols seeking candida infection management optimization have been recently developed, thus, it is essential to describe the best current recommendations to address, diagnose and treat neonatal candidiasis...

Estudo da infecção natural de Lutzomyia longipalpis por Leishmania infantum e a flutuação mensal de flebotomíneos coletados no município de Camaçari, Estado da Bahia / Study of natural infection of Lutzomyia longipalpis by Leishmania infantum and the monthly fluctuation of sandflies collected in Camaçari, State of Bahia

No município de Camaçari, considerado área endêmica para leishmaniose visceral (LV), foi realizado estudo objetivando determinar a influência das variáveis climáticas sobre a flutuação mensal da população flebotomínica e a taxa de infecção natural desses flebotomíneos por Leishmania infantum. Para o levantamento entomológico foram realizadas capturas sistemáticas de flebotomíneos utilizando armadilhas tipo HP, tanto no peri como no intradomicílio. As residências foram selecionadas em bairros pertencentes a zona urbana orla e zona urbana sede, onde casos humanos de LV no foram registrados município. As capturas foram realizadas entre dezembro de 2011 e novembro de 2012. A relação entre pluviosidade, umidade relativa do ar e temperatura e a proporção de flebotomíneos foi calculada utilizando o coeficiente de Spearman. Para o estudo da infecção natural dos flebotomíneos foi utilizada a técnica de qPCR. Os pools avaliados foram compostos por flebotomíneos da mesma espécie, distribuídos pelas residências, ás quais foram investigadas no intra e peridomicilio. Além disso, os pools foram distribuídos de acordo com os 12 meses de coleta. Os resultados mostraram que a fauna flebotomínica é diversificada, sendo composta por quatro gêneros com ocorrência de cinco espécies. Espécimes de interesse epidemiológico foram encontrados com predominância para a espécie Lutzomyia (Lutzomyia) longipalpis (98,4%). Foi observada correlação positiva entre a densidade de flebotomíneos e a variável pluviosidade na zona urbana sede durante o período de coleta (r = 0,66, p <0,02). A correlação entre as variáveis bioclimáticas e a densidade dos flebotomíneos também foi avaliada em bairros que se destacaram individualmente pela densidade de flebotomíneos, sendo encontrado correlação positiva para a variável umidade relativa do ar (r = 0,58 p <0,04)...

In Camaçari city, considered an endemic area for visceral leishmaniasis (VL), the study was conducted aiming to determine the climatic variables influence on the sandflies monthly fluctuation and the natural infection rates by Leishmania infantum in the sandflies. The entomological inventory was performed with sandflies systematic captures using HP traps, both in peridomiciliar well as in intradomiciliar. The residences were selected in districts belonging to the coastline urban zone and headquarters urban zone, where human cases of VL were recorded in the city. Captures were performed between December 2011 and November 2012. The correlation between the number of sandflies and the different climatic variables was calculated using Spearman's coefficient. The sandfly natural infection was evaluated by qPCR technique. Pools reviews were composed by sand flies of the same species, distributed among households, which were investigated in peridomiciliare and intradomiciliare. Additionally, pools were distributed according to the 12-month sampling. The results showed that the phlebotomine fauna is diverse, consisting of four genera and five species. Specimens of epidemiological interest were found predominantly for Lutzomyia (Lutzomyia) longipalpis (98.4%). In addition, a positive correlation between sandfly density and pluviosity at headquarters urban zone was observed during the collection period. (r = 0.66, p <0.02). The correlation between bioclimatic variables and density of sandflies was also evaluated in neighborhoods that stood out individually by the sandfly density. A positive correlation was observed for the variable relative humidity during the collection period (r = 0.58 p <0.04)...

Infection and childhood leukemia: review of evidence / Infeccao e leucemia infantil: revisao das evidencias / Infeccion y leucemia infantil: revision de las evidencias

OBJECTIVE : To analyze studies that evaluated the role of infections as well as indirect measures of exposure to infection in the risk of childhood leukemia, particularly acute lymphoblastic leukemia. METHODS : A search in Medline, Lilacs, and SciELO scientific publication databases initially using the descriptors “childhood leukemia” and “infection” and later searching for the words “childhood leukemia” and “maternal infection or disease” or “breastfeeding” or “daycare attendance” or “vaccination” resulted in 62 publications that met the following inclusion criteria: subject aged ≤ 15 years; specific analysis of cases diagnosed with acute lymphoblastic leukemia or total leukemia; exposure assessment of mothers’ or infants’ to infections (or proxy of infection), and risk of leukemia. RESULTS : Overall, 23 studies that assessed infections in children support the hypothesis that occurrence of infection during early childhood reduces the risk of leukemia, but there are disagreements within and between studies. The evaluation of exposure to infection by indirect measures showed evidence of reduced risk of leukemia associated mainly with daycare attendance. More than 50.0% of the 16 studies that assessed maternal exposure to infection observed increased risk of leukemia associated with episodes of influenza, pneumonia, chickenpox, herpes zoster, lower genital tract infection, skin disease, sexually transmitted diseases, Epstein-Barr virus, and Helicobacter pylori . CONCLUSIONS : Although no specific infectious agent has been identified, scientific evidence suggests that exposure to infections has some effect on childhood leukemia etiology. .

OBJETIVO : Analisar estudos que avaliaram o papel de infecções e de medidas indiretas de exposição às infecções no risco de leucemia infantil, principalmente da leucemia linfocítica aguda. MÉTODOS : A busca nas bases de dados Medline, Lilacs e SciELO utilizando-se inicialmente os descritores “leucemia infantil” e “infecção” e, posteriormente, pesquisando-se as palavras “leucemia infantil” e “infecção ou doença materna” ou “aleitamento materno” ou “frequência à creche” ou “vacinação” recuperou 62 publicações que atenderam aos seguintes critérios de inclusão: amostra composta por sujeitos com idade inferior ou igual a 15 anos; análise específica de casos diagnosticados com leucemia linfocítica aguda ou todas as leucemias; avaliação de exposição materna ou infantil a infecções (ou medidas indiretas de exposição à infecção) e risco de leucemia. RESULTADOS : Globalmente, os 23 estudos que avaliaram infecções nas crianças suportam a hipótese de que a ocorrência de infecções no início da infância reduz o risco de leucemia, mas existem discordâncias intra e entre estudos. A avaliação por meio das medidas indiretas de exposição à infecção mostrou evidências de redução do risco de leucemia associado principalmente com frequência à creche. Mais de 50,0% dos 16 estudos que avaliaram exposição materna à infecção observaram aumento do risco de leucemia associado com episódios de gripe, pneumonia, varicela, herpes zoster, infecção do trato genital inferior, doença de pele, doenças sexualmente transmissíveis, vírus Epstein-Barr ...

OBJETIVO : Analizar estudios que evaluaron el papel de infecciones y de medidas indirectas de exposición a las infecciones en el riesgo de leucemia infantil, principalmente de la leucemia linfocítica aguda. MÉTODOS : Se realizó búsqueda en las bases de datos Medline, LILACS y SciELO utilizándose inicialmente los descriptores “leucemia infantil” e “infección” y, posteriormente, investigándose las palabras “leucemia infantil” e “infección o enfermedad materna” o “lactancia materna” o “frecuencia en guardería” o “vacunación” recuperó 62 publicaciones que atendieron los siguientes criterios de inclusión: muestra compuesta por individuos con edad inferior o igual a 15 años; análisis específica de casos diagnosticados con leucemia linfocítica aguda o todas las leucemias; evaluación de exposición materna o infantil a infecciones (o medidas indirectas de exposición a la infección) y riesgo de leucemia. RESULTADOS : Globalmente, los 23 estudios que evaluaron infecciones en los niños soportan la hipótesis de que la ocurrencia de infecciones en el inicio de la infancia reduce el riesgo de leucemia, pero existen discordancias intra y entre estudios. La evaluación por medio de las medidas indirectas de exposición a la infección mostró evidencias de reducción de riesgo de leucemia asociado principalmente con frecuencia a la guardería. Más de 50% de los 16 estudios que evaluaron exposición materna a la infección observaron aumento de riesgo de leucemia asociado con episodios de gripe, neumonía, varicela, herpes zoster, infección del tracto genital inferior, enfermedad de la piel, enfermedades sexualmente transmisibles, virus Epstein-Barr (EBV) y Helicobacter pylori. CONCLUSIONES : A pesar ...

Intuição do médico tem bom valor preditivo negativo para a infecção grave em crianças / Intuition of the physician has good negative predictive value for serious infection in children

Um sentimento instintivo de que a avaliação clínica objetiva de uma criança doente está ocultando uma infecção de maior gravidade geralmente identifica infecções graves em excesso. Em alguns casos, porém, essa sensação é acertada. Nesse estudo, a preocupação não usual dos pais e a presença de sintomas inespecíficos na criança (como sonolência, respiração anormal, perda de peso e convulsões) estiveram associadas à intuição dos médicos quanto à presença de uma doença mais grave.

Documento de consenso sobre el tratamiento de las infecciones en el pie del diabético / Consensus document on the treatment of diabetic foot infections

La infección del pie diabético, sobre todo si se asocia a isquemia, es la causa más frecuente de amputación de la extremidad inferior en la población general, de ingreso hospitalario y de disminución de la calidad de vida en los diabéticos. El 15% de los diabéticos van a sufrir a lo largo de su vida una infección del pie, con una incidencia anual del 1-4%, precedida en más del 80% de los casos de una úlcera en el pie. Son infecciones complejas en cuyo pronóstico influyen muchos factores, dependientes de la úlcera (localización, extensión, cronicidad, amputación previa, grado de isquemia) y del paciente (edad, insuficiencia renal, tiempo de evolución de la diabetes, comorbilidad asociada), lo que hay que tener en cuenta a la hora de plantear su tratamiento. Las infecciones deben clasificarse en función de su gravedad (leves, moderadas-leves, moderadas-graves y graves). Su tratamiento es complejo y debe ser multidisciplinar; debe incluir desbridamiento, descarga, antibioticoterapia adecuada, revascularización y cura de la úlcera.En este documento de consenso, fruto de la colaboración de la Sociedad Española de Angiología y Cirugía Vascular (SEACV), Sociedad Española de Medicina Interna (SEMI), Sociedad Española de Quimioterapia (SEQ), Asociación Española de Cirujanos (AEC), Sociedad Española de Medicina de Urgencias y Emergencias (INFURG-SEMES) y Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), se desarrollan las pautas, basadas en la mejor evidencia disponible, de las infecciones de pie diabético, encaminadas a obtener la mayor eficacia clínica(AU)

Diabetic foot infection, particularly if it is associated to ischaemia, is the most common cause of lower limb amputation, in the general population, of hospital admissions, and a decrease in the quality of life in diabetics. Of all diabetics, 15% of them are going to suffer from a foot infection during their life, with an annual incidence of 1-4%, preceded by a foot ulcer in more than 80% of cases. They are complex infections and the prognosis is influenced by many factors, depending on the ulcer (location, extension, whether chronic or not, previous amputation, ischaemia grade), and the patient (age, renal impairment, time of onset of diabetes, associated comorbidity). All these must be taken into account when establishing its treatment. The infections must be classified according to their severity (mild, moderate-mild, moderate-severe, and severe). Their treatment is complex and must be multidisciplinary and must include debridement, discharge, adequate antibiotic therapy, revascularisation, and treatment of the ulcer. In this consensus document, produced in collaboration with the Spanish Angiology and Vascular Surgery Society (SEACV), the Spanish Society of Internal Medicine (SEMI), the Spanish Chemotherapy Society (SEQ), the Spanish Surgeons Association (AEC), the Spanish Society of Urgent Medicine and Emergencies (INFURG-SEMES) and the Spanish Society of Intensive and Critical Medicine and Coronary Care (SEMICYUC), the guidelines are developed based on the best available evidence on diabetic foot infections, aimed at achieving greater clinical efficacy(AU)

Avaliação por ressonância magnética das fístulas perianais: ensaio iconográfico / Magnetic resonance imaging evaluation of perianal fistulas: iconographic essay

A fístula perianal é uma condição incomum com tendência a recorrência, que usualmente é decorrente de infecção prévia não observada à cirurgia. A ressonância magnética mostra com acurácia a anatomia da região e a relação da fístula com o diafragma pélvico e a fossa isquiorretal, classificando-a em cinco tipos. A ressonância magnética é superior a qualquer outra modalidade para a detecção de focos infecciosos na região perianal, incluindo a exploração cirúrgica. Tem a capacidade de guiar o procedimento cirúrgico, reduzindo a taxa de recorrência em 75 por cento em pacientes com doença complexa.

Fistula in ano is an uncommon condition that has a tendency to recur despite seemingly appropriate surgery. Recurrent fistula in ano is usually caused by infection that was missed during surgical exploration. Magnetic resonance imaging has been shown to accurately demonstrate the anatomy of the perianal region as well as the fistula's relationship with the pelvic diaphragm and ischiorectal fossa, allowing the classification of fistulas into five types. Magnetic resonance imaging depicts infectious foci in the perianal region better than any other investigation modality, including surgical exploration. Magnetic resonance image-guided surgery helps to reduce postoperative recurrence by 75 percent in patients with complex disease.

Contaminação trans-operatória de orientadores do foco cirúrgico / Perioperative contamination of removable handle of surgical lights

Os orientadores de foco cirúrgico (OFC), acessórios instalados em alguns focos cirúrgicos no início das operações e manipulados pela equipe cirúrgica com o objetivo de dirigir a iluminação para o campo operatório, têm sido pouco estudados no que concerne a sua contaminação trans-operatória. OBJETIVO: Avaliar a possível ocorrência de contaminação trans-operatória dos OFC e identificar os germes responsáveis. MÉTODO: Foram analisados 101 OFC, em 60 operações consecutivas, distribuídas em dois grupos: (a) grupo de estudo, 84 OFC de 43 operações limpas, potencialmente contaminadas ou contaminadas; foram registradas a duração e respectivas especialidades dos cirurgiões responsáveis pelas mesmas; (b) grupo controle, 17 OFC de 17 operações vídeo-laparoscópicas, nas quais os OFC não eram manipulados, mas mantidos no mesmo ambiente e durante tempo médio semelhante ao do grupo de estudo, para avaliar contaminação procedente de fontes externas. Ao término das operações os OFC foram recolhidos de maneira asséptica e obtidas três amostras de cada um deles, através de swabs embebidos em água peptonada. Cada amostra era semeada em um dos seguintes meios de cultura: tioglicolato, água peptonada e Casoy. Os resultados foram analisados do ponto vista estatístico considerando-se significantes os valores de p<0,05. RESULTADOS: Não houve contaminação de nenhum OFC no grupo controle e houve contaminação de pelo menos um dos OFC em 22 (51,2 por cento) operações do grupo de estudo. A porcentagem de contaminação dos OFC aumentou à medida que aumentou o potencial de contaminação das operações (p=0,0036) e com o aumento do tempo de duração das operações (p=0,0017). O germe mais comumente isolado foi o Staphylococcus coagulase-negativo em 23 de 26 OFC, 84,6 por cento dos casos de contaminação. CONCLUSÃO: Os OFC podem representar importantes fontes de contaminação, especialmente ao iniciar-se a síntese da ferida operatória, assim nesta fase do procedimento, recomenda-se a troca de luvas por parte dos membros da equipe cirúrgica e a não manipulação dos OFC.

Infecçöes do trato urinário nos homens / Men's urinary tract infections

A ITU é um dos problemas mais freqüêntes na prática médica, sendo responsável por morbidez e custos consideráveis. A maioria das ITU em homens é considerada complicada, visto que grande parte delas ocorre nos recém-natos, lactentes ou idosos, e estäo associadas a anormalidades urológicas. Em homens idosos as infecçöes säo mais freqüêntes devido ao aumento do volume prostático, que leve a uma obstruçäo infravesical.(au)

Down-regulation of Bgp1a viral receptor by interferon-ã is related to the antiviral state and resistance to mouse hepatitis virus 3 infection

Together with the evidence that the reduced virus growth and the antiviral state induced by interferon (IFN)-ã occurring only in macrophages from resistant animals, correlated with the decrease of MHV3 binding to macrophage membrane proteins, we show here the expression of cellular and viral genes in resistant (A/J) and susceptible (BALB/c) mouse macrophages after IFN-ã activation/infection. The expression of interferon response gene 47 and interferon regulatory factor 1 genes takes place after IFN-ã activation in both macrophages, indicating their activation. The expression of the biliary glycoprotein 1a (Bgp1a, the main virus receptor) decreased only in IFN-ã-activated A/J mouse macrophages, in contrast to the expression of the Bgp2 (alternative receptor), which was not influenced by IFN-ã activation. The synthesis of both viral mRNA and virus particles was delayed only in IFN-ã-activated A/J mouse macrophages compared with susceptible BALB/c macrophages. Besides the evidence that IFN-ã may modulate the expression of the Bgp1a isoform of carcinoembryonic antigen family, these data show that IFN-ã, which induces resistance against MHV3 infection, may be involved in the down-regulation of the main viral receptor expression, a key step forward in our understanding of the molecular basis of resistance against virus infection.