Fetal cardiac function at 35-37 weeks' gestation in pregnancies that subsequently develop pre-eclampsia.

OBJECTIVE: To compare fetal cardiac morphology and function between pregnancies that subsequently developed pre-eclampsia (PE) and those that remained normotensive. METHODS: This was a prospective observational study in 1574 pregnancies at 35-37 weeks' gestation, including 76 that subsequently developed PE. We carried out comprehensive assessment of fetal cardiac morphology and function including novel imaging modalities, such as speckle-tracking echocardiography, and measured uterine artery pulsatility index, mean arterial pressure (MAP), serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and cerebroplacental ratio (CPR). The findings in the group that subsequently developed PE were compared to those in pregnancies that remained normotensive. RESULTS: In fetuses of mothers who subsequently developed PE, compared to those from normotensive pregnancies, there was a more globular right ventricle, as shown by reduced right ventricular sphericity index, reduced right ventricular systolic contractility, as shown by reduced global longitudinal strain, and reduced left ventricular diastolic function, as shown by increased E/A ratio. On multivariable regression analysis, these indices demonstrated an association with PE, independent of maternal characteristics and fetal size. In pregnancies that subsequently developed PE, compared to those that remained normotensive, MAP, sFlt-1 and the incidence of low birth weight were higher, whereas serum PlGF, CPR and the interval between assessment and delivery were lower. These findings demonstrate that, in pregnancies that develop PE, there is evidence of impaired placentation, reflected in low PlGF and reduced birth weight, placental ischemia, evidenced by increased sFlt-1 which becomes apparent in the interval of 2-4 weeks preceding the clinical onset of PE, and consequent fetal hypoxia-induced redistribution in the fetal circulation, reflected in the low CPR. CONCLUSION: Although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop PE remains unclear, it is possible that the reduction in right-heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia-induced redistribution in the fetal circulation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Hybrid Methacrylated Gelatin and Hyaluronic Acid Hydrogel Scaffolds. Preparation and Systematic Characterization for Prospective Tissue Engineering Applications.

Hyaluronic acid (HA) and gelatin (Gel) are major components of the extracellular matrix of different tissues, and thus are largely appealing for the construction of hybrid hydrogels to combine the favorable characteristics of each biopolymer, such as the gel adhesiveness of Gel and the better mechanical strength of HA, respectively. However, despite previous studies conducted so far, the relationship between composition and scaffold structure and physico-chemical properties has not been completely and systematically established. In this work, pure and hybrid hydrogels of methacroyl-modified HA (HAMA) and Gel (GelMA) were prepared by UV photopolymerization and an extensive characterization was done to elucidate such correlations. Methacrylation degrees of ca. 40% and 11% for GelMA and HAMA, respectively, were obtained, which allows to improve the hydrogels' mechanical properties. Hybrid GelMA/HAMA hydrogels were stiffer, with elastic modulus up to ca. 30 kPa, and porous (up to 91%) compared with pure GelMA ones at similar GelMA concentrations thanks to the interaction between HAMA and GelMA chains in the polymeric matrix. The progressive presence of HAMA gave rise to scaffolds with more disorganized, stiffer, and less porous structures owing to the net increase of mass in the hydrogel compositions. HAMA also made hybrid hydrogels more swellable and resistant to collagenase biodegradation. Hence, the suitable choice of polymeric composition allows to regulate the hydrogels´ physical properties to look for the most optimal characteristics required for the intended tissue engineering application.

The effect of synthesis conditions and process parameters on aerogel properties.

Aerogels are remarkable nanoporous materials with unique properties such as low density, high porosity, high specific surface area, and interconnected pore networks. In addition, their ability to be synthesized from various precursors such as inorganics, organics, or hybrid, and the tunability of their properties make them very attractive for many applications such as adsorption, thermal insulation, catalysts, tissue engineering, and drug delivery. The physical and chemical properties and pore structure of aerogels are crucial in determining their application areas. Moreover, it is possible to tailor the aerogel properties to meet the specific requirements of each application. This review presents a comprehensive review of synthesis conditions and process parameters in tailoring aerogel properties. The effective parameters from the dissolution of the precursor step to the supercritical drying step, including the carbonization process for carbon aerogels, are investigated from the studies reported in the literature.

[Evaluation of a program for updating recommendations about hand hygiene]. / Evaluación de un programa de actualización de las recomendaciones sobre la higiene de manos.

BACKGROUND: Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. INTERVENTIONS: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October-November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. RESULTS: The frequency of inadequate answers for evaluating LK has fallen from 57.5% before to 18.9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31.0% to 55.6% (p <0.001). The IP and IPP have risen respectively from 11.4% and 9.6% in 2004 to 9.4% and 8.9% in 2006 (N.S.). CONCLUSION: The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance.

Constitutional duplication 11q23 de novo involving the MLL gene.

We report a child with mental retardation, brain anomalies and congenital heart defect. His karyotype, after G-banding and FISH with a whole chromosome probe for chromosome 11 and a locus-specific probe for the MLL gene, was 46,XY,dup(11)(q23q23).ish dup(11)(q23q23)(wcp11+, MLL++) de novo; i.e., he had a pure partial 11q23 duplication. Clinical and cytogenetic findings of the present case were compared with the 7 previously reported cases with pure partial trisomy 11q; in 6/8 cases the region 11q23 was involved. We conclude that the scarce number of cases and their heterogeneity do not allow to establish a reliable genotype-phenotype correlation.

Polysaccharide-based aerogel microspheres for oral drug delivery.

Polysaccharide-based aerogels in the form of microspheres were investigated as carriers of poorly water soluble drugs for oral administration. These bio-based carriers may combine the biocompatibility of polysaccharides and the enhanced drug loading capacity of dry aerogels. Aerogel microspheres from starch, pectin and alginate were loaded with ketoprofen (anti-inflammatory drug) and benzoic acid (used in the management of urea cycle disorders) via supercritical CO2-assisted adsorption. Amount of drug loaded depended on the aerogel matrix structure and composition and reached values up to 1.0×10(-3) and 1.7×10(-3) g/m(2) for ketoprofen and benzoic acid in starch microspheres. After impregnation, drugs were in the amorphous state in the aerogel microspheres. Release behavior was evaluated in different pH media (pH 1.2 and 6.8). Controlled drug release from pectin and alginate aerogel microspheres fitted Gallagher-Corrigan release model (R(2)>0.99 in both cases), with different relative contribution of erosion and diffusion mechanisms depending on the matrix composition. Release from starch aerogel microspheres was driven by dissolution, fitting the first-order kinetics due to the rigid starch aerogel structure, and showed different release rate constant (k1) depending on the drug (0.075 and 0.160 min(-1) for ketoprofen and benzoic acid, respectively). Overall, the results point out the possibilities of tuning drug loading and release by carefully choosing the polysaccharide used to prepare the aerogels.

[The spectrum of liver disease in infection by the human immunodeficiency virus: a study of 50 liver biopsies]. / El espectro de la hepatopatía en la infección por el virus de la inmunodeficiencia humana: estudio de 50 biopsias hepáticas.

BACKGROUND: The patients with human immunodeficiency virus (HIV) infection have hepatic abnormalities due to infective, neoplastic and toxic disorders. The aim of the present study was to describe the spectrum of liver disease in the HIV infection and to establish the usefulness and indications of hepatic biopsy. METHODS: The hepatic biopsies prospectively carried out in 50 patients infected by HIV with abnormal hepatic biochemical parameters, fever of unknown origin or space occupying lesions were evaluated. RESULTS: Hepatic granulomatosis was found in 37 patients (74%). In 15 (30%) the culture in Löwenstein medium was positive. The strains were typified as Mycobacterium tuberculosis in 14. This finding took place in 8 out of 18 biopsies carried out because of fever of unknown origin (FUO) (44%). The rate of granulomatosis due to mycobacteria was 40%. Other diagnoses were steatosis in 22 patients, chronic active hepatitis in 10, chronic lobular hepatitis in 3, infiltration by Hodgkin's lymphoma in one and metastatic invasion by non-differentiated carcinoma in one. Hepatic biopsy was diagnostic in 8 out of 18 carried out for FUO (44%) and in 24 out of 30 carried out for abnormal hepatic biochemical parameters (80%). CONCLUSIONS: In the evaluated patients with HIV infection, hepatic granulomatosis was the most common finding and was due to mycobacteria in 40%. Hepatic steatosis and chronic active and lobular hepatitis were the most common causes of abnormal hepatic biochemical parameters. Considering the high yield of hepatic biopsy, the authors think that it should be carried out in patients with HIV infection and FUO or unexplained abnormal hepatic biochemical parameters.

[Solitary extramedullary plasmocytoma of oropharynx]. / Plasmocitoma solitario extramedular orofaríngeo.

Report on a solitary extramedullary plasmacytoma case, an entity rarely diagnosed in daily practice, because of its low incidence. When the process occurs is seen fundamentally located at upper aero-digestive tract. Our patient was a 34-year-old man, who was diagnosed as oropharyngeal plasmacytoma with the peculiarity that the lesion feigned a benign one wether for the clinical features or the macroscopical aspect. The patient underwent surgery and postoperative rontgentherapy, after discarding a systemic disease. Till now the evolution proved good.

[Recurrent bilateral paralysis: our 15-year experience]. / Parálisis recurrencial bilateral: nuestra experiencia en quince años.

We report our experience with the treatment of patients with bilateral vocal cord paralysis. The sample was small because the disease is rare. The therapeutic techniques first used were arytenoidopexy using King's technique and Graff-Woodman's arytenoidectomy with cordopexy. Cordectomy was used when other techniques failed. Nine of 11 patients were decannulated successfully. Tracheotomy was maintained in the other 2 for reasons unrelated with the initial picture. Breathing and voice quality were acceptable in all patients. Complications were limited to aspiration pneumonia. Cordectomy was necessary in 3 cases because conservative treatment was insufficient. Although the development of new techniques for treating this problem should continue, classic techniques remain valid. A case of paralysis caused by nitrocuanitin intoxication is reported.

[Complete response in a patient with a metastatic cutaneous melanoma]. / Respuesta completa tras tratamiento con bioquimioterapia en un caso de melanoma cutáneo diseminado.

BACKGROUND: The management of patients with disseminated disease is a difficult problem. There is currently no consensus on the standard first-line treatment for metastatic melanoma. We present a case because of his exceptional evolution. RESULTS: A 43 year old male diagnosed in 1999 with malignant melanoma stage IIA. In May 2000 hepatic and splenic metastases were detected. He received 6 cycles of biochemotherapy (cisplatin and DTIC, plus interleukin-2 and interferon-α) and another 6 cycles with single immunotherapy (interleukin-2 and interferon-α). Today, the patient is still alive and without evidence of disease. CONCLUSION: Metastatic cutaneous melanoma, sometimes presents an unusual, favourable evolution. In the near future, the methods of detection of molecular markers are expected to identify factors involved in this type of response. Furthermore, new targeted therapies may become essential to maintain this positive trend.

Composite fibrous biomaterials for tissue engineering obtained using a supercritical CO2 antisolvent process.

Several techniques have been proposed for producing porous structures or scaffolds for tissue engineering but, as yet, with no optimal solution. With regard to this topic, this paper focuses on the preparation of biocompatible nanometric filler-polymer composites organized in a network of fibers. Titanium dioxide (TiO2) or hydroxyapatite (HAP) nanopowders as the guest particles and poly(lactic acid) (L-PLA) or the blend poly(methylmethacrylate)/poly(epsilon-caprolactone) (PMMA/PCL) as the polymer carrier were selected as model systems for this purpose. A supercritical antisolvent technique was used to produce the composites. In the process developed, the non-soluble particulate filler was suspended in a polymer solution, and both components were sprayed simultaneously into supercritical carbon dioxide (scCO2). Using this technique, polymeric matrices were loaded with approximately 10-20 wt.% of inorganic phase distributed throughout the composite. Two different hybrid materials were prepared: a PMMA/PCL+TiO2 system where either fibers or microparticles were prepared by varying the molecular weight of the used PMMA; and fibers in the case of L-PLA+HAP system. After further post-processing in a three-dimensional network, these nanofibers can potentially be used as scaffolds for tissue engineering.

Application of principal component analysis to the thermal characterization of silanized nanoparticles obtained at supercritical carbon dioxide conditions.

Samples resulting from reaction of TiO(2) with octyltriethoxysilane, developed using a supercritical carbon dioxide procedure, have been studied by infrared and Raman spectroscopies and thermogravimetric analysis. Different reaction conditions have been applied to the preparation of samples in order to study the influence of experimental factors on the sample properties. Vibrational techniques have first been used to verify the presence of silanized structures on the surface of TiO(2) through the detection of specific bands characteristic of the Si-O-Si cross-linking. Thermogravimetric profiles consisting of weight loss values as a function of temperature have been analyzed by principal component analysis to extract information about the characteristics of the linkage between silane and TiO(2) as well as the thermal stability of the prepared materials. The mathematical treatment of data has provided conclusions on the properties of the samples and analogies and differences with respect to the commercial material.

Production of hybrid lipid-based particles loaded with inorganic nanoparticles and active compounds for prolonged topical release.

The production of particulate hybrid carriers containing a glyceryl monostearate (Lumulse GMS-K), a waxy triglyceride (Cutina HR), silanized TiO(2) and caffeine were investigated with the aim of producing sunscreens with UV-radiation protection properties. Particles were obtained using the supercritical PGSS (Particles from Gas Saturated Solutions) technique. This method takes advantages of the lower melting temperatures of the lipids obtained from the dissolution of CO(2) in the bulk mixture. Experiments were performed at 13 MPa and 345 K, according to previous melting point measurements. Blends containing Lumulse GMS-K and Cutina HR lipids (50 wt%) were loaded with silanized TiO(2) and caffeine in percentile proportions of 6 and 4 wt%, respectively. The particles produced were characterized using several analytical techniques as follows: system crystallinity was checked by X-ray diffraction and differential scanning calorimetry, thermal stability by thermogravimetric analysis, and morphology by scanning and transmission electron microscopy. Further, the UV-shielding ability of TiO(2) after its dispersion in the lipidic matrix was assessed by solid UV-vis spectroscopy. Preliminary results indicated that caffeine-loaded solid lipid particles presented a two-step dissolution profile, with an initial burst of 60 wt% of the loaded active agent. Lipid blends loaded with TiO(2) and caffeine encompassed the UV-filter behavior of TiO(2) and the photoaging prevention properties of caffeine.

Revisión de las miopatías inflamatorias a propósito de 3 casos en unidades de recuperación funcional de hospitales de media estancia / Review of inflamatory myopathies based on 3 cases in functional recovery units in long-term care hospitals

Las miopatías inflamatorias idiopáticas son un grupo heterogéneo de enfermedades sistémicas de etiopatogenia autoinmune. Se caracterizan por debilidad muscular, alteraciones miopáticas en el electromiograma y elevación de las enzimas musculares. Pueden darse de forma aislada, o asociarse a otras enfermedades autoinmunes o a neoplasias. Realizamos una aproximación a estos procesos a propósito de 3 pacientes tratados en Unidades de Recuperación Funcional de 2 hospitales de media estancia. En todos se produce debilidad muscular bilateral y simétrica de predominio en cinturas, con grave repercusión funcional. Por este motivo precisan realizar tratamiento en régimen de ingreso hospitalario. El objetivo terapéutico es doble: por un lado, frenar de forma urgente la actividad autoinmune para evitar el daño muscular progresivo y, por el otro, instaurar un tratamiento rehabilitador de forma precoz que minimice el deterioro funcional. En todos los casos se obtiene beneficio de la intervención, ya que permite la vuelta al domicilio con distintos grados de independencia (AU)

Idiopathic inflammatory myopathies are a heterogeneous group of systemic autoimmune diseases characterised by bilateral and symmetric muscle weakness, myopathic alterations on electromyography and elevated muscle enzymes. They can be associated with other autoimmune diseases or neoplastic processes. We provide a review of these processes based on 3 patients in the Functional Recovery Units of 2 long-term care hospitals. All 3 patients had bilateral and symmetrical muscle weakness, predominantly in the waist, with severe functional impairment. Consequently, these patients required hospital admission. The goal of rehabilitation is twofold: on the one hand, to urgently halt the autoimmune activity in order to avoid further muscle damage, and, on the other hand, to start early rehabilitation treatment to minimise functional impairment. All 3 patients benefited from the intervention, allowing discharge to home, with varying degrees of independence (AU)

Respuesta completa tras tratamiento con bioquimioterapia en un caso de melanoma cutáneo diseminado / Complete response in a patient with a metastatic cutaneous melanoma

Fundamento. El pronóstico del melanoma diseminadoes muy sombrío. Actualmente no hay consensosobre el tratamiento estándar en primera línea parael melanoma metastático. Se presenta un caso por sucomportamiento excepcional.Resultados. Varón de 43 años diagnosticado en1999 de melanoma maligno estadio IIA. En mayo de2000 se objetivaron metástasis hepáticas y esplénicas.Recibió 6 ciclos de bioquimioterapia (cisplatino y DTICjunto con interleukina-2 e interferón-α) cada 21 días yotros 6 ciclos con inmunoterapia sola (interleukina-2 einterferón-α). Actualmente el paciente sigue vivo y sinevidencia de enfermedad.Conclusión. El melanoma cutáneo metastático, enocasiones, presenta una inusual evolución favorable. Esde esperar que los métodos de detección de marcadoresmoleculares logren determinar factores implicadosen este tipo de respuesta y que los nuevos tratamientosdirigidos consigan mantener esta tendencia positiva (AU)

Background. The management of patients withdisseminated disease is a difficult problem. Thereis currently no consensus on the standard first-linetreatment for metastatic melanoma. We present a casebecause of his exceptional evolution.Results. A 43 year old male diagnosed in 1999with malignant melanoma stage IIA. In May 2000, hepaticand splenic metastases were detected. He received6 cycles of biochemotherapy (cisplatin andDTIC, plus interleukin-2 and interferon-α) and another6 cycles with single immunotherapy (interleukin-2and interferon-α). Today, the patient is still alive andwithout evidence of disease.Conclusion. Metastatic cutaneous melanoma, sometimes,presents and unusual and favourable evolution. Inthe near future, the methods of detection of molecularmarkers are expected to identify factors involved in thistype of response. Furthermore, new targeted therapiesmay become essential to maintain this positive trend (AU)

Therapy with intermittent pulse cyclophosphamide for pulmonary hypertension associated with systemic lupus erythematosus.

The aim of this study was to compare the efficacy of intravenous cyclophosphamide (IVCYC) versus oral enalapril in mild or moderate pulmonary hypertension (PH) in systemic lupus erythematosus (SLE). Thirty-four patients with SLE who had systolic pulmonary artery pressure (SPAP) > 30 mmHg by Doppler echocardiography were randomized to receive IVCYC (0.5 g/mt2 body surface area, monthly), or oral enalapril (10 mg/day) for six months. The primary outcome was the significant decrease in SPAP. An additional outcome measure included the improvement in the heart functional class (NYHA). Sixteen patients received cyclophosphamide and 18 enalapril. IVCYC decreased the median values of SPAP from 41 to 28 mmHg (P < 0.001), and enalapril from 35 to 27 mmHg (P = 0.02). IVCYC reduced more than twice as much SPAP than enalapril (P = 0.04). In those patients with SPAP > or = 35 mmHg, cyclophosphamide decreased from 43 to 27 mmHg (P = 0.003), but enalapril was not effective (P = 0.14). The NYHA functional class improved only in those with cyclophosphamide (P = 0.021). Also IVCYC had a higher frequency of side effects including infections (RR = 1.6; 95% CI, 1.001-2.47), and gastrointestinal side effects (RR = 14.6; 95% CI, 2.15-99.68). We concluded that IVCYC was effective in mild and moderate PH associated with SLE. Further research is needed to evaluate its long-term efficacy.

Síndrome de Mikity Wilson.

Tras una serie de consideraciones sobre el Síndrome Mikity Wilson, entidad poco frecuente en estos momentos en el período neonatal. Se presenta un caso visto en nuestra Unidad en un recién nacido de 20 días de edad, el cual presenta desde su nacimiento un cuadro de dificultad respiratoria, que se considero como moderado, dado por tiraje, taquipnea transitoria, retracción y cianosis. Todo este cuadro fue evaluado en este momento como una sepsis respiratoria, ya que la madre tenía antecedentes de bolsa rota e infección vaginal durante el embarazo. Así evoluciona en los primeros días de vida con tratamiento de antibiótico y oxigenoterapia, evolucionando de forma estable y suspendiéndose el tratamiento anterior a los 10 días. Pasados ya los 25 días presenta nuevamente un cuadro de dificultad respiratoria, (cianosis, taquipnea, apnea e hiperbilirrubinemia), se realizan complementarios constatándose en el rayos x de tórax imágenes difusas bilaterales con refuerzo grosero de la trama, alternando con diminutos focos de hiperaereación, se inicia nuevamente tratamiento con antibiótico, y otros procederes mejorando paulatinamente hasta los 38 días de vida, donde se concluye el paciente sea portador del síndrome de Mikity Wilson, presentando en el rayos x del tórax las imágenes similares al estudio radiológico anterior. Esta entidad debe tenerse en cuenta en todo niño con antecedente de patología respiratoria al nacer que mejora rápidamente para luego presentar un cuadro respiratorio tardío. Los hallazgos clínicos y complementarios permitieron confirmar el diagnostico [AU]

Evaluación de un programa de actualización de las recomendaciones sobre la higiene de manos / Evaluation of a program for updating recommendations about hand hygiene

Introducción. La higiene de manos (HM) es la medida más importante para prevenir las infecciones nosocomiales. El objetivo es evaluar el programa de actualización de las recomendaciones sobre HM implantado. Material y métodos. Intervenciones: marzo-octubre/2005 se realizaron sesiones de actualización sobre cuándo y cómo realizar la HM y mayo/2006 se repartió un tríptico explicativo a todos los trabajadores informando del grado de cumplimiento de las recomendaciones. Indicadores: nivel conocimientos (NC) medido con un cuestionario de cinco preguntas que se pasaba antes y después de las sesiones y se consideró respuesta inadecuada cuando se fallaban tres o más preguntas; el consumo soluciones alcohólicas (CSA) en ml/estancia agrupado en semestres desde 2004-2006; el grado cumplimiento de recomendaciones (GCR) sobre la HM medida por observación directa en dos momentos (diciembre/2005-febrero/2006 y octubre-noviembre/ 2006) y la prevalencia de infecciones nosocomiales (PI) y de pacientes con infección nosocomial (PPI) a partir estudios EPINE 2004-2005-2006. Resultados. La frecuencia de respuestas inadecuadas para evaluar NC pasó de un 57,5% antes a 18,9% después (p<0,001). El CSA para HM pasó de 3 ml/estancia en 2º semestre/2004 a 17 ml/estancia en 2º semestre/2006 (p<0,001). El GCR ha pasado del 31,0% al 55,6% (p<0,001). La PI y PPI han pasado del 11,4% y el 9,6% respectivamente en el 2004 al 9,4% y 8,9% en 2006 (N.S.). Conclusión. El programa está consiguiendo de manera progresiva sus objetivos ya que los tres indicadores de proceso (NC, CSA, GC) han mejorado de manera estadísticamente significativa, y los de resultado (PI y PPI) han mejorado aunque sin significación estadística

Background. Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. Methods. Interventions: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October- November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. Results. The frequency of inadequate answers for evaluating LK has fallen from 57,5% before to 18,9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31,0% to 55,6% (p <0.001). The IP and IPP have risen respectively from 11,4% and 9,6% in 2004 to 9,4% and 8,9% in 2006 (N.S.). Conclusion. The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance