Clinical and Sociodemographic Features of Alopecia Areata in Five Colombian Cities: An Analysis of the RENAAC Registry.

BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by non-scaring hair loss and preservation of hair follicles. The information available on disease course, and clinical features of AA is scarce worldwide, and almost nonexistent in Colombia. OBJECTIVE: To determine the clinical and sociodemographic characteristics of patients diagnosed with AA who presented to a dermatology consultation in five Colombian cities. MATERIAL AND METHODS: This was a retrospective and multicenter study on data from an ongoing National Registry of Alopecia Areata in Colombia (RENAAC) collected in Bogota, Cali, Cartagena, Barranquilla, and Medellin, Colombia from March 2022 through April 2023. Data was recorded in a standardized form by trained physicians. The variables were expressed as measures of central tendency and dispersion, and absolute and relative frequencies. RESULTS: A total of 562 patients were included, 59.4% of whom were women, aged between 15 and 49 years (63.9%) with a mean disease course of 1.7 years. The most common finding was multiple plaque (53.2%), the predominant AA subtype was patchy (71.4%), and 29.5% of the patients had a past dermatological history, 18.3% had a past endocrinological history, and 8.9% had a past psychiatric history. The treatments most widely used were steroid injections (76.4%), 5% topical minoxidil (46.4%), followed by high-potency corticosteroids (42.5%). STUDY LIMITATIONS AND CONCLUSIONS: AA was slightly predominant in women. As seen in other populations, this disease had an earlier onset in men vs women. Presentation in pediatric age was uncommon. The previous history of other dermatological diseases was checked in almost one third of the patients. Analysis of the co-presentation of AA with other autoimmune diseases is biased due to excluding patients with systemic erythematous lupus from the study.

Risk factors for methicillin-resistant Staphylococcus aureus and extended-spectrum ß-lactamase producing Enterobacterales in patients with diabetic foot infections requiring hospital admission.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs. METHODS: This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections. RESULTS: S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections. CONCLUSIONS: MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms.

[Clinical relevance of bacterial resistance: a historical approach (1982-2007)]. / Significación clínica de las resistencias bacterianas: una perspectiva histórica (1982-2007).

Bacterial resistance is currently one of the most important problems of infectious pathology. The relation between in vitro and in vivo bacterial resistance is not always well defined because therapeutic failure is also related to other factors (pharmacokinetics and pharmacodynamics). In addition, there are disagreements between the in vitro and in vivo activity of several antimicrobials (especially ciprofloxacin) due to their low bactericidal activity. In infections due to ciprofloxacin susceptible S. pyogenes, S. aureus, S. epidermidis, E. faecalis, E. coli producing extended spectrum beta-lactamase (ESBL), K. pneumoniae and E. cloacae their clinical use is not associated to cure because of the development of resistances that are induced during the antibiotic treatment. Ceftazidime in infections due to susceptible strains of K. pneumoniae and E. cloacae and ceftriaxone in infections due to methicillin susceptible S. aureus also do not have a good correlation between in vitro and in vivo results due to their low bactericidal activity and to the development of resistances during treatment. The main clinical impact of resistant bacteria is related to the failure of empirical treatments, which is associated to a higher mortality, especially in severe infections with methicillin-resistant S. aureus, Enterobacteriae ESBL and multiresistant P. aeruginosa and A. baumannii. One of the main risk factors for the development of bacterial resistances is the increase of the consumption of several antibiotics. The development of protocols agreed upon by consensus may decrease the impact of bacterial resistances. The knowledge of the previous use of antibiotics is an especially relevant issue to suspect that an infection might be due to resistant bacteria. Resistant pathogens are a severe problem in the clinical setting and the question is of such a complexity that it requires a multidisciplinary effort that involves the different professionals of the Internal Medicine-Infectious Diseases, Microbiology, Pharmacology, Pharmacy and Preventive Medicine Departments and hospital directors and that results in unified and protocolized actions regarding the clinical and therapeutical approach for the management of severely infected patients.

[Comparative study of treatment with quinupristin-dalfopristin alone or in combination with gentamicin, teicoplanin, imipenem or levofloxacin in experimental endocarditis due to a multidrug-resistant Enterococcus faecium]. / Comparacion de la eficacia de quinupristina-dalfopristina en monoterapia y combinada con gentamicina, teicoplanina, imipenem o levofloxacino en un modelo experimental de endocarditis por Enterococcus faecium multirresistente.

The incidence of multidrug-resistant Enterococcus faecium is increasing despite advances in antibacterial therapy. Thus, new antibiotics are required to treat hospital- or community-acquired infections caused by these multidrug-resistant organisms. The aim of this study was to compare the therapeutic efficacy of quinupristin-dalfopristin (QD) alone, or in combination with gentamicin (G), teicoplanin (T), imipenem (I) or levofloxacin (L) against a strain of multidrug-resistant E. faecium in an experimental model of aortic valve endocarditis in rabbits. The study group consisted of 28 control animals. Eighty-two animals were treated with one of the following antibiotic regimens: G1: 18 animals QD (30 mg/kg/8 h); G2: 18 animals QD+G (6 mg/kg/12 h); G3: 16 animals QD+T (20 mg/kg/12 h); G4: 14 animals QD+I (60 mg/kg/8 h); and G5: 16 animals QD+L (20 mg/kg/12 h). The response to therapy was determined by the comparison of the number of CFU/g of E. faecium in each vegetation. In vitro, time-kill studies looking for synergy for the combinations that showed better efficacy in vivo were done. The sensitivity of the strain was intermediate to QD, resistant to T and I, and sensitive to L. There was no high-level resistance to G. QD alone revealed a significant decrease (p <0.001) in the CFU/g in the control group (9.49 vs. 7.31). There were no differences in the average of CFU/g between the QD alone (G1), QD+G (G2) and QD+T (G3) groups. These three groups revealed a significant difference in decrease of CFU/g respect of the group control (p <0.001). There were no differences in the average of CFU/g between QD+I (G4) and QD+T (G5). These two groups revealed the greatest decrease in average CFU/g (G4: 4.38 and G5: 4.04) with differences respect of the group control (p <0.0001) and respect of the groups G1, G2 and G3 (p <0.001). We did not detect any alteration of MIC from QD in the course of the treatment for either of the final isolations. Only the time kill corresponding to concentrations of I 32 mg/l (0.25 x MIC) and QD 1 mg/l (0.25 x MIC presents a descending slope in the curve at 4 and 8 h, suggesting an early synergy phenomenon, which was lost after 8 h. In light of these results, the combination QD with I and L may be considered suitable alternatives for the treatment of multiresistant E. faecium.

[Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)]. / Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España).

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 (heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L).

Retinal ganglion cell death after different transient periods of pressure-induced ischemia and survival intervals. A quantitative in vivo study.

PURPOSE: To quantitate in vivo retinal ganglion cell (RGC) survival after transient periods of pressure-induced ischemia of the rat retina and after different survival intervals. METHODS: In adult rats, RGCs were labeled with fluorogold applied to their main targets in the brain. Seven days later, in several groups of rats, the left retinas were subjected to transient periods of ischemia of 30, 45, 60, 75, 90, 105, or 120 minutes, respectively, by increasing the intraocular pressure (IOP) of the left eye above systolic values. Five, 7, 14, and 30 days later, the rats were killed, and their retinas were prepared as wholemounts for examination under fluorescence microscopy to estimate RGC survival. RESULTS: The authors found that periods of ischemia of 30 and 45 minutes do not induce RGC death; longer periods of transient ischemia induce the death of a proportion of RGCs, and the proportion increases with the duration of the ischemia; RGC death, which can be observed as early as 5 days after ischemia, continues during the 30-day study period; and periods of ischemia that last 90 minutes or more cause the death of approximately 95% of the RGC population 30 days later. CONCLUSIONS: Increases of the IOP above systolic levels for periods of 60 minutes or more result in RGC loss in the rat retina. Both the duration of the initial transient period of ischemia and the duration of the survival period influence the proportion of RGC death.

Genotype-specific in vitro amplification of sequences of the wild type 3 polioviruses from Mexico and Guatemala.

The extensive nucleotide sequence heterogeneity among independent genotypes of wild polioviruses permits the systematic design of genotype-specific molecular reagents. We have prepared two sets of polymerase chain reaction (PCR) primer pairs specific for the genotype of wild poliovirus type 3 recently endemic to Mexico and Guatemala. Nucleotide sequences of a representative wild type 3 virus isolated in Mexico in 1989 differed from the corresponding Sabin 3 (Leon 12 a1b) sequences at 167 of 900 positions within the VP1 region. From the sequence data, wild virus-specific primer pairs were designed to complement regions of high mismatch (greater than 33%) with Sabin 3 templates. Primer binding sites were spaced along the genome so that the predicted amplification products (142 bp and 163 bp) could be easily resolved electrophoretically from the products generated with our Sabin strain-specific primers (Sabin 1: 97 bp; Sabin 2: 71 bp; Sabin 3: 53 bp). RNAs of all wild type 3 poliovirus isolates from Mexico and Guatemala obtained over a 13-year period (1977-1990) served as efficient templates for amplification of the 142-bp and 163-bp products. Genomic templates derived from vaccine-related polioviruses and most heterologous wild polioviruses were inactive under equivalent reaction conditions. Amplifications generating a 114-bp product with a broadly reacting primer pair, matching highly conserved sequences in the 5'-noncoding region, provided a positive control for the presence in samples of poliovirus (or enterovirus) RNAs. Selective amplification of wild Mexico-Guatemala type 3 poliovirus sequences was obtained with either primer set in reactions containing large stoichiometric excesses (up to 10(6)-fold) of vaccine-related RNAs. We have used wild genotype-specific PCR primer sets to facilitate identification of wild polioviruses present in both clinical and environmental samples.

[Influence of serious infections due to Gram-negative bacteria on the hospital economy]. / Influencia de las infecciones graves por gramnegativos en la economía hospitalaria.

Nosocomial infections due to Gram-negative bacteria are very important since they are associated with high morbidity and high hospital costs. A prospective study of 250 inpatients was carried out, 200 of whom had Gram-negative bacterial infections. Patients were divided into groups of 50 according to the localization of the infection (urinary, surgical wound, respiratory tract and bacteremia), with a control group of 50 patients with similar characteristics but no infection. We calculated the cost for the different groups by multiplying the average length of hospital stay in days by the daily cost of the stay. Significant differences were observed in the average length of stay per patient according to the type of infection and how it was acquired. In terms of cost, nosocomial infection due to Gram-negative bacteria was 1,049,139 pesetas more expensive than community-acquired infection. The cost of the stay for patients with postsurgical infection due to Gram-negative bacteria was 1,108, 252 pesetas more expensive than for the group of control patients. Nosocomial infection due to Gram-negative bacteria is associated with a prolongation in hospital stay of 9 to 28 days, which is the factor that most reflects the cost that can be attributed to nosocomial infection. Consensual and protocolized measures which allow for better clinical management need to be developed.

[Prospective, comparative study (1994-1998) of the influence of short-term prophylactic treatment with azithromycin on patients with advanced COPD]. / Estudio prospectivo y comparativo (1994-1998) sobre la influencia del tratamiento corto profiláctico con azitromicina en pacientes con EPOC evolucionada.

Despite the advances in therapy, chronic obstructive pulmonary disease (COPD) requires frequent hospital admissions due to acute exacerbations. We carried out a prospective randomized study of two groups of patients with COPD, one (n = 54) treated with azithromycin (500 mg/day) for three days every 21 days during the winter months, and a control group (n = 40) without treatment. A statistically significant reduction in the number of acute infectious episodes (187) and hospital admissions (22) was observed in the treated group versus the control group (249 and 45, respectively). A short prophylactic treatment course with azithromycin is a good alternative in the management of patients with severe, advanced COPD, and could lead to an improvement in social and healthcare costs

[Influence of consensual protocols on the use of antibiotics and bacterial resistance in a general hospital. A prospective study 1995-2000]. / Influencia de la protocolizacion consensuada en el consumo de antibioticos y resistencias bacterianas en un hospital general. Estudio prospectivo 1995-2000.

Reasoned and consensual protocols, by means of diversification of the use of antibiotics, significantly influence their consumption, preventing and reducing the development of bacterial resistance against the Gram-negative microorganisms most frequently isolated in general hospitals. The increase in the consumption of piperacillin-tazobactam was found to be significantly associated with an increased resistance of E. cloacae, but less so in K. pneumoniae and E. coli. Its activity against P. aeruginosa and against P. mirabilis was not affected throughout the study and it maintained a high sensivity to the end against P. aeruginosa and against P. mirabilis and partial recovery of activity against A. baumannii. No statistically significant differences were found between the stable consumption of cefotaxime, ciprofloxacin, ceftazidime and imipenem and bacterial resistance against E. coli, P. aeruginosa, P. mirabilis, K. pneumoniae, E. cloacae and A. baumannii. Imipenem presented greater activity against E. coli, K. pneumoniae, E. cloacae and A. baumannii. Piperacillin-tazobactam showed greater activity against P. aeruginosa, while ciprofloxacin showed the least activity against E. coli and P. mirabilis. Cefotaxime had the least activity against E. cloacae, P. aeruginosa and A. baumannii. Ceftazidime showed stable activity and was similar to piperacillin-tazobactam against E. coli, P. mirabilis, K. pneumoniae, E. cloacae and A. baumannii.

[Prospective and comparative study between cefuroxime, ceftriaxone and amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia]. / Estudio prospectivo y comparativo entre cefuroxima, ceftriaxona y amoxicilia-clavulánico en el tratamiento de la neumonía adquirida en la comunidad.

Among community-acquired infections, pneumonia is still a large health problem which is of great interest mainly due its high mortality and morbidity. From 1991 to 1997, 409 patients who had been diagnosed with community-acquired pneumonia and had been admitted to the internal medicine service of a university hospital were prospectively studied. The patients were classified into three groups according to the random antibiotic treatment they had received (ceftriaxone, cefuroxime or amoxicillin-clavulanic acid). The initial characteristics of the patients with regard to epidemiology, clinical description and critical situation were similar in all the groups studied. A total of 36.9% of the cases were documented microbiologically, with the most frequently isolated pathogens being Streptococcus pneumoniae and Haemophilus influenzae. The recovery rate was 92.2% and three patients had a recurrence of pneumonia. Global mortality was 5.8%. No statistically significant differences were found in the evolution of patients treated with cefuroxime, ceftriaxone or amoxicillin-clavulanic acid, with the latter representing an empirical treatment of choice for community-acquired pneumonia.

[The effect of a rational and consensual protocol for the use of ceftriaxone in a general hospital]. / Influencia del la protocolizatión razonada y consensuada en el uso de ceftriaxona en un hospital general.

In hospitals in Spain there has been a large increase in the use of wide spectrum antibiotics. The objective of this study was to evaluate the influence of a rational, consensual protocol on the use of ceftriaxone. An observational and prospective study was carried out using information provided by the Servicio de Farmacia on the in-hospital prescriptions for ceftriaxone. The study included two groups as follows: a control group (October-December 1995) not taking into account the protocols for antibiotic treatment; and a study group in the same months in 1996 with the consensual protocols taken into account. The criteria for the type of patient, infection, evolution and antibiotic treatment were evaluated according to the criteria in the international literature on this type of study. The initial characteristics of both groups of patients were similar. Following the use of the protocol there was a significantly associated reduction in use (48 cases in the study group vs. 57 cases in the control group), an increase in the appropriate use (31. 57% in the control group vs. 75% in the study group), an increase in the cure rate (70.17% in the control group vs. 91.7% in the study group) and a decrease in hospital stay of 7.53 days (22.59 days in the control group vs. 15.06 in the study group), producing a savings per cured patient of 617.142 pesetas. It was concluded that the consensual protocol and its proper application make for a highly interesting approach given that it allowed for better quality use of ceftriaxone with greater cost-effectiveness.

[Congenital anomalies of coronary artery origin: a diagnostic challenge]. / Anomalías congénitas del origen de las arterias coronarias: un reto diagnóstico.

From a series of 4,313 consecutive patients who underwent a diagnostic coronary angiogram, 16 (0.37%) presented a congenital anomalous origin of the coronary arteries. None of these patients had other congenital cardiac anomalies associated. Age was 57 +/- 9 years and 13 (81%) were male. The diagnostic catheterization was performed for unstable angina in 8 patients (50%), for stable angina in five (32%), for dyspnea in two and for atypical chest pain in the remaining patient. A previous myocardial infarction was present in 6 patients (37%) whereas one patient had apical hypertrophic cardiomyopathy. We observed absence of coronary lesions in 4 patients and severe coronary stenosis lesions in 12 patients (75%), five of those with lesions located in the anomalous vessel. The most frequent abnormality found was an anomalous origin of left circumflex coronary artery in 8 cases (50%), followed by an abnormal origin of the right coronary artery in 5 cases (31%), and an abnormal origin of the left coronary tree in 3 cases (19%) (left anterior descending coronary artery arising from the right coronary artery, a single coronary artery which originated in the left coronary sinus, and a left main coronary artery which originated in the noncoronary sinus). The relationship of the anomalous coronary artery to the great vessels was the following: A retro-aortic course in 11 patient (69%), by the anterior free wall in two (12.5%), interarterial in two (12.5%), and septal in one (6%). Finally, as an index of the difficulty to visualize the anomalous coronary artery, an unusual catheter was needed in six (37%) of the diagnostic procedures to reach the target vessel.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of protected alveolar lavage versus occluded telescopic catheter in patients with suspected pneumonia and under mechanic ventilation]. / Estudio comparativo del lavado alveolar protegido frente al catéter telescópico ocluido en pacientes con sospecha de neumonía y en ventilación mecánica.

BACKGROUND: The pneumonias associated to mechanical ventilation present great difficulty in diagnosis and have a high mortality. The invasive diagnostic technique of choice in these patients is bronchial curettage by a double telescopic catheter with distal occlusion (OTC) based on its good sensitivity/specificity relation. Recently, the use of a variant of the classical bronchoalveolar lavage (BRL), bronchoalveolar lavage or protected alveolar lavage (PAL) has appeared in the diagnosis of conventional bacterial pneumonia. This new technique provides good specificity of OTC by its use with "protected" catheters and a high sensitivity due to exploration of a greater area of the lung. METHODS: Twenty patients receiving mechanical ventilation (MV) suspected of pneumonia in whom 21 fibrobronchoscopies (FB) were performed with OTC and PAL were studied with quantification of the cultures obtained being carried out. The OTC was performed according to the usual technique and PAL by the instillation of 40 ml of saline serum administered through a Combicath type catheter. RESULTS: OTC and PAL provided diagnostic results which coincided in 8 cases: the same germs were isolated at significant concentrations in six patients and in the two remaining cases direct immunofluorescence for Legionella was positive. PAL was diagnosed in 4 more cases with the diagnosis of viral inclusion bodies being possible in one upon cytologic examination. The count of cells with intracellular bacteria (ICB) was greater than 7% and was always related with positivity in the PAL. CONCLUSIONS: A greater sensitivity was observed with the protected alveolar lavage technique. Moreover, this technique makes virologic investigation and the counting of cells with intracellular bacteria, which may be a marker of rapid diagnosis of bacterial pneumonia, possible.

Systematic use of aprotinin in cardiac surgery: influence on total homologous exposure and hospital cost.

To assess the impact of systematic use of aprotinin, 115 consecutive adults undergoing cardiac surgery were randomly allocated with a sealed envelope technique. Treated (T) patients (n = 58) received 2.10(6) Kallikrein Inactivating Units (KIU) before incision, 2.10(6) prior to bypass, and 5.10(5) KIU.hr-1 for 5 hrs, whereas control (C) cases (n = 57) received nothing. Surgeons, perfusionists, ICU and ward physicians were blinded. Postoperative blood loss decreased from 1198 ml (C) to 698 ml (T) (p less than 0.001). Total transfusional needs were 7.25 (C) and 4.9 (T) units (p less than 0.01), where from 65% were autologous in group T, versus 51% in group C (p less than 0.02). Total homologous exposure decreased from 4.5 (C) to 2.7 (T) units on the average, from 3 to 1 units as a median (p less than 0.01). Multiple Stepwise Regression Analysis showed treatment as the most important variable influencing postoperative blood loss, but duration and type of procedures were more important to explain transfusion needs. Both groups were comparable for other pre- and intra-operative variables. For coronary operations (n = 75), aprotinin showed the strongest negative association with blood loss, the number of arterial conduits being the second influencing variable. No evidence was found for increased early graft thrombosis. The average hospital bill was 9% lower in the treated group, an unexplained finding needing independent confirmation.

[Clinical patterns of community acquired pneumonia microbiologically documented compared to the not documented.]Prospective and comparative study between 1991 and 1997]. / Patrones clínicos en neumonías comunitarias con documentación y sin documentación microbiológica. Estudio prospectivo y comparativo 1991-1997.

INTRODUCTION: The diagnostic of the pneumonia is the problems more important for its adequate treatment and best evolution. OBJECTIVES: To study in a prospective way the patron clinic de la NAC compared the documented with the not documented in a microbiological way. PATIENTS Y METHODS: We have studied patients with NAC hospitalized in the HUVA between January of 1991 and May of 1997. The diagnostical criterion of pneumonia and of the hospitable ingress were the classics accepted for this infections, was doing in all cases diagnostical studies not invasive. It was analyzed the clinical patron of the NAC microbiologically documented compare to with the not documented. In the same way, the documented was divided in typical and not typical according to the microorganisms aisled. Besides was realized an statistic study using tables of contingency and test Fisher. RESULTS: It was studied 409 patients with NAC, from which 161 (39.6%) had microbiological documentation, it was found 119 micro organism typical and 42 atypical. On the one hand, the female sex, EPOC, fever, tos and purulence esputum and hyperglucaemia, were associated significantly with the documented NAC. The presence of cardiopaty, seriously initial clinical situation, gastrointestinal disorders and previous infections and use of antibiotics, were associated with not documented. The age more than 65 years, presence of comorbility, purulence sputum, pleural pain, toghether with VSG>50 and lobar infiltrate, were associated significantly to typical pneumonia, while tabaquical habit and extrapulmonary sintoms (artromialgias) were with the atypical. CONCLUSIONS: The knowledge of the clinical patrons of the NAC are great impact in the diagnostic and treatment antibiotic adecuate.

[Staphylococcus aureus bacteremia at a general hospital]. / Bacteriemias por Staphylococcus aureus en un hospital general.

70 cases of bacteremia caused by Staphylococcus Aureus were studied. 49 (70%) males, and 21 (30%) females; 45 (64.5%) cases being nosocomial and 25 (35.4%) community acquired. The complications were significantly associated to the community acquired bacteremia (p less than 0.001), endocarditis and cutaneous abscesses being the most frequent (4). The group of cases with rapidly lethal prognosis was significantly associated to an increase of mortality (p less than 0.001), while lethal and non-lethal groups showed a decrease in mortality (p less than 0.001). We did not find a statistically significant association between nosocomial and community acquired bacteremias nor between antibiotic therapy and the mortality rate, chi 2 = 1.747.303 (N.S.), chi 2 = 1.323.806 (N.S.).

[Malignant cervical adenopathies of unknown origin]. / Adenopatías cervicales malignas de origen desconocido.

A retrospective study of malignant cervical lymph node enlargement of unknown origin was made from 1985-1995. Of 26 cases observed, the primary tumor was found in 8 cases after a complete ENT study in 3 the primary tumor was found in the course of the disease and in 15 the origin remained unknown. Patients were treated with a combination of surgery, chemotherapy and radiation therapy. Only 2 patients survive, one with 6.5 years of follow-up and the other with 20 months. The literature was reviewed for new diagnostic and therapeutic methods for cervical lymph node enlargement of unknown origin.

[Teratomas of the nasopharynx. A report of three cases]. / Teratomas de nasofaringe. A propósito de tres casos.

Teratomas are the most common congenital tumors, but neoplasms of the nasopharynx are rare in neonates. The exact origin of teratomas is unknown and debated. Several theories of embryogenesis are possible. These neoplasms include elements from all three germinal layers (endoderm, mesoderm, and ectoderm). Four histological types of nasopharyngeal teratoma occur. We report three cases of dermoid teratoma. All the patients were siblings and two were twins. A review of several large series of pediatric teratomas confirmed the rarity of this site. The classification, clinical features, differential diagnosis and treatment are reviewed.

[Emphysema in the tonsil surgery. A case report]. / Enfisemas en la cirugía amigdalar. A propósito de un caso.

Subcutaneous peripharyngeal emphysema and pneumomediastinum are rare complications in postoperative patients after several types of surgery (orthognathic, laryngeal, tracheotomy and oropharyngeal). We report a case of subcutaneous and peripharyngeal emphysema after bilateral tonsillectomy in a 43-year-old male. Air or anesthetic gases spread to the neck, mediastinum, abdomen, or pleural cavity.