Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients. / Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes.

BACKGROUND AND OBJECTIVES: Infestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru. MATERIAL AND METHODS: We conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm2. RESULTS: The patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P=.001), sex (P=.003), residence (P=.015), a paternal history of acne (P=.045), a maternal history of acne (P=.045), and type of skin (P<.001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P=.003). CONCLUSION: Demodex infestation was associated with severe acne vulgaris in outpatients at our hospital.

Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial.

OBJECTIVE: Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries. DESIGN: Cluster randomised trial. SETTING: Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) METHODS: Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds. MAIN OUTCOME MEASURES: The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. RESULTS: During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components. CONCLUSIONS: Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced. TWEETABLE ABSTRACT: Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.

How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?

Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08-50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835-429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015-2016 could be, given the timeframe of median time of occurrence.

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.

Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

[Diagnostic protocol for febrile syndrome of respiratory origin in geographical areas of endemic risk of tropical infections]. / Protocolo diagnóstico del síndrome febril con focalidad respiratoria en áreas geográficas de riesgo endémico de infecciones tropicales.

The syndromic surveillance of a group of diseases that have similar signs and symptoms, a common pathophysiology, and diverse etiology is aimed at rapidly detecting the presence of outbreaks which could potentially harm public health. This includes not only known outbreaks of infectious origin but also those of unknown origin. In patients suspected of having SARS-CoV-2/COVID-19, it is recommended to consider other etiologies of tropical fever in the differential diagnosis when these patients live in or come from endemic areas, as is the case of dengue, malaria, leptospirosis, acute Chagas disease, and rickettsiosis, among other endemic diseases. The possibility of SARS-CoV-2/AH1 AH5N1 MERS-CoV coinfection with these pathogens should also be considered.

Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC.

PURPOSE: To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs). METHODS: Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries. DA-HAIs were defined using criteria formulated by the Centers for Disease Control and Prevention. Country socioeconomic status was defined using World Bank criteria. RESULTS: Central-line-associated bloodstream infection (CLA-BSI) rates in NICU patients were significantly lower in private than academic hospitals (10.8 vs. 14.3 CLA-BSI per 1,000 catheter-days; p < 0.03), but not different in public and academic hospitals (14.6 vs. 14.3 CLA-BSI per 1,000 catheter-days; p = 0.86). NICU patient CLA-BSI rates were significantly higher in low-income countries than in lower-middle-income countries or upper-middle-income countries [37.0 vs. 11.9 (p < 0.02) vs. 17.6 (p < 0.05) CLA-BSIs per 1,000 catheter-days, respectively]. Ventilator-associated-pneumonia (VAP) rates in NICU patients were significantly higher in academic hospitals than in private or public hospitals [13.2 vs. 2.4 (p < 0.001) vs. 4.9 (p < 0.001) VAPs per 1,000 ventilator days, respectively]. Lower-middle-income countries had significantly higher VAP rates than low-income countries (11.8 vs. 3.8 per 1,000 ventilator-days; p < 0.001), but VAP rates were not different in low-income countries and upper-middle-income countries (3.8 vs. 6.7 per 1,000 ventilator-days; p = 0.57). When examined by hospital type, overall crude mortality for NICU patients without DA-HAIs was significantly higher in academic and public hospitals than in private hospitals (5.8 vs. 12.5%; p < 0.001). In contrast, NICU patient mortality among those with DA-HAIs was not different regardless of hospital type or country socioeconomic level. CONCLUSIONS: Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.

Computerized lesion segmentation of breast ultrasound based on marker-controlled watershed transformation.

PURPOSE: This paper presents a computerized segmentation method for breast lesions on ultrasound (US) images. METHODS: It consists of first applying a contrast-enhanced approach, i.e., a contrast-limited adaptive histogram equalization. Then, aiming at removing speckle and enhancing the lesion boundary, an anisotropic diffusion filter, guided by texture descriptors derived from a set of Gabor filters, is applied. To eliminate the distant pixels that do not belong to the tumor, the resulting filtered image is multiplied by a constraint Gaussian function. By doing so, both the segmentation and the marker functions are generated and could be used in the marker-controlled watershed transformation algorithm to create potential lesion boundaries. Finally, to determine the lesion contour, the average radial derivative function is evaluated. The proposed method was tested with 50 breast US images and 60 simulated "ultrasound-like" images. Accuracy and precision of the segmentation method were then assessed. For the accuracy, three parameters were used: Overlap ratio (OR), normalized residual value (nrv), and proportional distance (PD) between contours. RESULTS: The average results for US images were OR = 0.86 +/- 0.05, nrv = 0.16 +/- 0.06, and PD = 6.58 +/- 2.52%. For simulated ultrasound-like images, a better performance (OR = 0.92 +/- 0.01, nrv = 0.08 +/- 0.01, and PD = 3.20 +/- 0.53%) was achieved. CONCLUSIONS: The segmentation method proposed was capable of delineating the lesion contours with high accuracy in comparison to both the radiologists' delineations and the true delineations of simulated images. Moreover, this method was also found to be robust to human-dependent parameters variations.

[MRI and prostatic cancer: measurements of kinetic perfusion parameters of gadolinium with a computerized-aided diagnostic tool (CAD)]. / IRM et cancer prostatique: mesure de la cinétique du gadolinium avec un système CAD.

OBJECTIVES: To assess with a CAD in the peripheral (ZP) and transitional (ZT) zones the areas with modifications of the kinetic parameter Kep (ratio of exchanges between vascular compartment and extravascular extracellular spaces) in prostatic cancers with DCE MRI before radical prostatectomy. METHODS: Forty-two consecutive patients (mean age 67 years, mean PSA: 8.9 ng/ml) with a prostatic cancer proved after a set of 12 biopsies underwent, before radical prostatectomy, a dynamic MRI (1.5T) with a surface coil after injection of gadolinium. We look with a CAD for foci of voxels with an abnormal Kep in ZP and/or in ZT. Foci of abnormal voxels computerized were compared with histological results of radical prostatectomies: prostates were shared in 12 sectors (six peripheral and six central) and a total of 504 sectors were studied. The links between prostatic capsule and foci of voxels with elevated Kep were systematically evaluated. The location and the local extension of the various cancerous foci were estimated. A comparison with the results of the T2W and T1 DCE MRI sequences without use of the CAD was made. RESULTS: Eighty-eight percent of investigated patients revealed at least a cancerous focus associated with a group of pathological voxels. Hundred and seventy-eight of the 504 investigated prostatic sectors revealed a cancerous lesion after radical prostatectomy (RP) and 116 a focus of voxels with a pathological Kep being linked to 71 isolated lesions, some of them filling several sectors (47 peripheral and 24 transitional). The automatic research with the software of foci of voxels with a parameter Kep more than 2,2 per minute to detect a cancerous lesion had a sensitivity by sector less than the reading without CAD (69% in ZP and 58% in ZT against respectively, 85 and 66% (p<0.01) but seemed more specific: 98% in PZ and 95% in ZT against respectively, 80 and 82% (p<0.01). After RP, 16 cancers were classified Pt2, 10 Pt2R+ and 16 Pt3. The CAD had a better accuracy (74%) than T2W MRI (60%) to look for an extracapsular extension (EPE) or a risk of positive margins: 86% of extraprostatic extension and 60% of positive margins were near a focus of pathological voxels. CONCLUSIONS: CAD allowed a computerized qualitative and quantitative study of DCE MRI. It identified and localized with a good specificity the significant foci. A focus of voxels with elevated Kep against the capsule increased significantly the risk of an extraprostatic extension or a positive margin after radical prostatectomy.

Cost and implementation analysis of a personal digital assistant system for laboratory data collection.

SETTING: One hundred and twenty-six public health centers and laboratories in Lima, Peru, without internet. BACKGROUND: We have previously shown that a personal digital assistant (PDA) based system reduces data collection delays and errors for tuberculosis (TB) laboratory results when compared to a paper system. OBJECTIVE: To assess the data collection efficiency of each system and the resources required to develop, implement and transfer the PDA-based system to a resource-poor setting. DESIGN: Time-motion study of data collectors using the PDA-based and paper systems. Cost analysis of developing, implementing and transferring the PDA-based system to a local organization and their redeployment of the system. RESULTS: Work hours spent collecting and processing results decreased by 60% (P < 0.001). Users perceived this decrease to be 70% and had no technical problems they failed to fix. The total cost and time to develop and implement the intervention was US$26092 and 22 weeks. The cost to extend the system to cover nine more districts was $1125 and to implement collecting patient weights was $4107. CONCLUSION: A PDA-based system drastically reduced the effort required to collect TB laboratory results from remote locations. With the framework described, open-source software and local development, organizations in resource-poor settings could reap the benefits of this technology.

Laparoscopic cholecystectomy in a patient with an implantable left ventricular assist device.

Left ventricular assist devices (LVADs) provide mechanical support for left ventricular ejection in the failing heart. We describe the anaesthetic management of a patient with an LVAD requiring laparoscopic cholecystectomy. A 51-yr-old female patient with severe heart disease had a Heartmate II LVAD implanted 4 months before this proposed elective surgery. Maintaining haemodynamic stability in the perioperative period is essential in such patients. The case was managed successfully using invasive monitoring and anaesthesia with sevoflurane and remifentanil. The potential problems in management of patients with LVADs are highlighted and discussed. A team approach is essential.

Satisfacción laboral de los profesionales de enfermería en un hospital de segundo nivel, en la Ciudad de México / Job satisfaction of nursing professionals in a second level hospital, in Mexico City

Objetivo: Analizar la satisfacción laboral de los profesionales de enfermería en un hospital de segundo nivel de la Ciudad de México. Marco teórico: La satisfacción laboral es un estado emocional positivo basado en la percepción subjetiva del propio trabajo, de acuerdo con la actitud frente al mismo, así como con las creencias y valores de la persona. Material y métodos: Estudio de carácter cuantitativo, no experimental, transversal, prolectivo, descriptivo y diagnóstico. La variable estudiada fue la satisfacción laboral. El universo se conformó por 530 profesionales de enfermería y la muestra por 200 de ellos. Resultados: 52.50% del personal de enfermería está satisfecho con su trabajo, 63.50% consideran que el trabajo que realizan es de mucho valor y 40% piensan que ocasionalmente carecen del tiempo necesario para realizar sus actividades. Discusión: 52.50% del personal de enfermería está satisfecho con su trabajo, lo que contrasta con la investigación de Pérez Fonseca y cols., en la cual se reporta 83.10% del personal de enfermería insatisfecho. Conclusiones: Los profesionales de enfermería del hospital de segundo nivel están satisfechos con el trabajo que realizan. Sin embargo, conviene monitorear de forma continua las áreas que causan insatisfacción para corregirlas en favor del personal de enfermería y de los pacientes

Objective: To analyze job satisfaction in nursing professionals at a second level hospital in Mexico City. Theoretical Framework: Job satisfaction is a positive emotional state based on the subjective perception of one's own work, according to the attitude toward it, as well as the person's beliefs and values. Material and methods: Quantitative, experimental, transversal, prolective, descriptive and diagnostic study. The variable was job satisfaction. The universe was confirmed by 530 nursing professionals, and the sample by 200 nursing professionals. Results: 52.50% of the nursing staff were satisfied with their work, 63.50% considered that the work they do is of great value, and 40% believed that occasionally they lack the necessary time to carry out their activities. Discussion: 52.50% of the nursing staff were satisfied with their work, which differs from the research by Pérez Ma. y Cols. that report 83.10% of dissatisfied staff. Conclusions: Nursing professionals at a second level hospital were satisfied with the work they do. However, it would be advisable to continuously monitor the areas that cause dissatisfaction in order to improve them in favor of the nursing staff and patient.

[Power Doppler Imaging and prostate cancer: optional or necessary technique?]. / Echo-Doppler et cancer de la prostate: option ou nécessité?

PURPOSE: To evaluate the value of power Doppler sonography (PDS) in patients with a serum PSA level greater than 3.5 ng/ml and note the advantages of PDS in management of biopsy cores and staging in prostate cancer. MATERIAL AND METHODS: A group of 579 patients with a serum PSA level greater than 3.5 ng/ml underwent sextant biopsies. PDS of the prostate was performed in all patients before biopsy indication. Patients underwent six initial sextant biopsies without Doppler. In 141 patients who retained an elevated serum PSA level, an additional series of six to eight ultrasound-guided biopsies with Doppler were indicated. A total of 299 cancers were diagnosed (126 palpable) after initial biopsies and 85 (13 palpable) after additional biopsies. One hundred seven patients with localized cancer (48 palpable) underwent a radical prostatectomy. RESULTS: An echographic or vascular anomaly was detected in 335 patients; after biopsies this anomaly corresponded to 260 cancers, 39 of which were not visible (false-negative Doppler results). The negative predictive value was 84% and there was no significant relation between PSA level and negative predictive value. After initial biopsies, if an abnormal Doppler signal was present the risk of having positive additional biopsies was 83%. Abnormal disoriented irregular vessels were present in 69% of patients with a Gleason score of 7 or higher versus 31% in patients with a Gleason score less than 7 (p<0.01). Twenty out of 39 patients with T1c cancer invisible with PDS and not palpable (13% of all cancers) underwent a radical prostatectomy. Eleven of 16 cancers with a Gleason score of 6 or less were found insignificant, but in two cases the lesion was advanced (p<0.01). Of cancers with a tumor vessel crossing the capsule, 71% presented an extraprostatic extension (Se: 37.5%, Spe: 93%, PPV: 71%, NPV: 78%) (p<0.01). CONCLUSION: In prostatic cancer, PDS allows evaluation of aggressiveness features and can optimize the number of useful biopsy cores.

Pronación: Tecnología de enfermería que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González en la Ciudad de México / Pronation: A nursing technology that promotes wellbeing among COVID-19 patients at General Hospital Dr. Manuel Gea Gonzalez in México City

Introduction: pronation is a procedure used at the Intensive Care Unit with patients presenting Acute Respiratory Distress Syndrome (ARDS) with severe hypoxemia. Bibliographical references clearly support the application of this procedure due to the improvement it produces in oxygenation and the increased survival rate in patients. The main foundation behind this technology is that Ventral Decubitus (VD) promotes an improved redistribution of ventilation toward the dorsal regions of the lung, which are mainly collapsed during Dorsal Decubitus. Nursing staff have used this procedure because VD has proven to be a strategy with a useful and accessible impact over respiratory physiology. Objective: to analyze Pronation as a nursing technology and its promotion of COVID-19 patients' wellbeing at the General Hospital Dr. Manuel Gea González, in Mexico City. Material and methods: a nonexperimental, quantitative, cross-sectional, prolective, descriptive study to analyze pronation, as a nursing technology that promotes wellbeing in the care of COVID-19 patients at General Hospital Dr. Manuel Gea González, in Mexico City. Pronation as a nursing technology was the variable being measured. The universe was 530 nursing professionals working at the Hospital. The population and sample were 52 nursing specialists working with COVID-19 patients, representing 9.81% of the Universe. Results: as for training and experience with Pronation, 50% of the staff consider they have received sufficient training in regards to the SARS-CoV-2 virus, but they are still under training. Additionally, 84.62 % consider that Pronation promotes a remarkable recovery in the patients, with oxygen saturations between 80 to 100 %; 71.16 % believe that patients do show hemodynamic instability due to the position shift, but not in every case; and 80.77 % consider they make sure their patients do not develop pressure ulcers, given that 65.39 % practice patient hygiene and movement to prevent such ulcers. Discussion: from the interviewed staff, 50.01 % consider they have received sufficient training regarding COVID and the pronation of patients. This is consistent with Hernandez et al., who describe the need of a team trained specifically on the procedure, preferably comprised of Nurses specialized in Intensive Care. Likewise, 84.62% of staff members believe Pronation improves oxygen saturation in patients from 80% to 100%, this is contrasted with Barrantes and Vargas, who indicate that if Pronation does not result in 5% improvement in oxygen saturation, the patient must be returned to dorsal decubitus. Conclusion: ventilation in prone position is a pulmonary protective action used for over 30 years that produces an evident and continuous improvement in blood oxygenation and the respiratory physiology. Therefore, nursing specialists caring for COVID-19 patients recommend its use.

Introducción: la pronación es una maniobra utilizada en las unidades de cuidados intensivos, en pacientes que presentan síndrome de distrés respiratorio agudo (SDRA), cuando la hipoxemia es severa. Apoyada por una sólida evidencia científica, tiene impacto en la forma en que se ventila a los pacientes como parámetro de seguridad, esto aumenta la supervivencia. Objetivo: analizar la pronación, como tecnología de enfermería, que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González, en la Ciudad de México. Material y métodos: estudio de carácter cuantitativo, no experimental, transversal, prospectivo, descriptivo. Variable medida: la pronación, como tecnología de enfermería. El universo 530 profesionales de enfermería que trabajan en el hospital, muestra: 52 especialistas de enfermería que trabajan con pacientes COVID-19. Resultados: en relación a la capacitación y experiencia en pronación, el 50% del personal manifiestan que sí recibieron suficiente capacitación sobre el virus SARS-CoV-2, aunque siguen capacitándose en ésta área; el 84.62 % consideran que en la pronación, los pacientes mejoran bastante, saturando entre el 80 y 100 % de oxígeno y el 80.77 % siempre cuidan que los pacientes no tengan úlceras por presión.Discusión: el 50.01 % del personal entrevistado manifiesta que sí recibió suficiente capacitación sobre la COVID-19 para pronar a los pacientes, lo que es semejante a la investigación de Hernández GD., et al.¹ Conclusión: la ventilación en posición prono es una medida de protección pulmonar utilizada hace más de 30 años que produce una mejoría evidente y sostenida de la oxigenación de la sangre y en la fisiología respiratoria, por lo que los especialistas de enfermería que atiende pacientes COVID-19 recomiendan su aplicación, pues está asociada al aumento de probabilidad de supervivencia.

A double-'blind' placebo-controlled study of nitazoxanide in the treatment of cryptosporidial diarrhoea in AIDS patients in Mexico.

Sixty-six patients with human immunodeficiency virus infection and diarrhoea caused by Cryptosporidium parvum were enrolled in a double-'blind' placebo-controlled study to evaluate the safety and efficacy of nitazoxanide in the treatment of cryptosporidiosis related to the acquired immune deficiency syndrome. Patients were randomly assigned to one of 3 treatment groups and received either 500 mg twice daily of nitazoxanide, 1000 mg twice daily of nitazoxanide, or placebo orally for 14 d; the patients on nitazoxanide then crossed over to placebo while the placebo patients crossed over to nitazoxanide therapy at either the high or low dose depending on their randomization. Three post-treatment faecal examinations were conducted on days 15, 22 and 29 following initiation of treatment: patients were considered 'cured' if none revealed any C. parvum oocysts. Both doses of nitazoxanide produced parasitological cure rates superior to the placebo responses (12/19 [63%, P = 0.016] for patients receiving 1 g/d and 10/15 [67%, P = 0.013] for those receiving 2 g/d). Parasitological cure was correlated with the complete resolution of the diarrhoeal syndrome in 19 of the 22 treated patients who were considered parasitologically cured (86%). Both doses of nitazoxanide were well tolerated by the patients.

Hypocomplementemic urticarial vasculitic syndrome, asthma and anaphylactic reaction with ampicillin.

A patient with hypocomplementemic urticarial vasculitic syndrome (HUV) is presented. This is an immunological pathology, limited to skin or multisystemic, that requires a differential diagnosis with erythematosus systemic lupus on the same occasions. The ever-present symptom is skin participation, such as urticaria-angioedema or fixed exanthema; biopsy shows necrotizing venulitis with polymorphonuclear infiltration and leukocytoclastic powder. Typical laboratory data are: diminished C3, C4 and C1q; C1 inhibition can be low or normal; the more characteristic finding is the presence of C1q associated immunocomplexes. Leukocytoclastic necrotizing vasculitis was found in the skin biopsy. During the course of illness (three years) the patient presented moderate cutaneous symptoms and asthma, without other systemic participation. During this period, antihistamines and, occasionally, corticoids were administered with improvement. Moreover, the patient presented urticaria related to ampicillin ingestion, and furthermore, the presence of anaphylaxis to beta-lactam was diagnosed in vivo and specific IgE was found in the laboratory study. This feature was previously observed by other authors; however, we cannot determine why the IgE-mediated allergy to beta-lactam and a complement pathology like HUV are related.