La transformation des enquêtes policières due à l’influence des technologies : perspective d’une unité policière spécialisée en analyse judiciaire informatique

La popularité des technologies de l’information et des communications entraîne l’augmentation de la preuve retrouvée sous forme numérique lors d’enquêtes policières. Les organisations policières doivent innover afin d’analyser, gérer et tirer profit de cette preuve numérique. En réponse, elles ont constitué des unités spécialisées en criminalité technologique et en analyse judiciaire informatique. La présente étude utilise les théories de l’innovation afin de déterminer comment l’évolution des technologies et des tendances en matière de criminalité technologique influencent les enquêtes et les organisations policières. Cette recherche vise à augmenter les connaissances sur ces unités spécialisées en quantifiant et en qualifiant leur travail quotidien. Avec la collaboration d’une unité policière canadienne spécialisée en analyse judiciaire informatique, une analyse détaillée des demandes d’expertise adressées à leur service a été effectuée. Les résultats indiquent une augmentation de la preuve numérique avec la prévalence de certaines formes de criminalité et de certains appareils électroniques. Les facteurs influençant le délai de traitement sont soulignés ainsi que les stratégies mises de l’avant afin de gérer efficacement l’accroissement des demandes de service. Finalement, des entrevues ont été menées avec certains membres de l’équipe afin de mettre en lumière les défis et les enjeux relatifs à l’implantation et au fonctionnement d’une telle unité. Les principaux enjeux soulevés concernent les environnements technologiques et juridiques, la formation du personnel, la gestion des ressources et les priorités organisationnelles.

Studies on Fluxon Dynamics in Coupled Josephson Junctions

The thesis deals with detailed theoretical analysis of fluxon dynamics in single and in coupled Josephson junctions of different geometries under various internal and external conditions. The main objective of the present work is to investigate the properties of narrow Long Josephson junctions (LJJs) and to discuss the intriguing physics. In this thesis, Josephson junctions of three types of geometries, viz, rectangular, semiannular and quarter annular geometries in single and coupled format are studied to implement various fluxon based devices. Studies presented in this thesis reveal that mulistacked junctions are extremely useful in the fabrication of various super conducting electronic devices. The stability of the dynamical mode and therefore the operational stability of the proposed devices depend on parameters such as coupling strength, external magnetic fields, damping parameters etc. Stacked junctions offer a promising way to construct high-TC superconducting electronic components. Exploring the complex dynamics of fluxons in coupled junctions is a challenging and important task for the future experimental and theoretical investigations

Ethylene-Propylene-Diene Terpolymer/Hexafluoropropylene-Vinylidinefluoride Elastomeric Composites: Thermal, Mechanical and Microwave Properties

In the present study, an attempt has been made to prepare composites by incorporating expanded graphite fillers in insulating elastomer matrices and to study its DC electrical conductivity, dielectric properties and electromagnetic shielding characteristics, in addition to evaluating the mechanical properties. Recently, electronic devices and components have been rapidly developing and advancing. Thus, with increased usage of electronic devices, electromagnetic waves generated by electronic systems can potentially create serious problems such as malfunctions of medical apparatus and industry robots and can even cause harm to the human body. Therefore, in this work the applicable utility of the prepared composites as electromagnetic interference (EMI) shielding material are also investigated. The dissertation includes nine chapters

Synthesis, characterization and properties of Conductive elastomeric composites based on Polypyrrole and short Nylon-6 fiber

The search for new materials especially those possessing special properties continues at a great pace because of ever growing demands of the modern life. The focus on the use of intrinsically conductive polymers in organic electronic devices has led to the development of a totally new class of smart materials. Polypyrrole (PPy) is one of the most stable known conducting polymers and also one of the easiest to synthesize. In addition, its high conductivity, good redox reversibility and excellent microwave absorbing characteristics have led to the existence of wide and diversified applications for PPy. However, as any conjugated conducting polymer, PPy lacks processability, flexibility and strength which are essential for industrial requirements. Among various approaches to making tractable materials based on PPy, incorporating PPy within an electrically insulating polymer appears to be a promising method, and this has triggered the development of blends or composites. Conductive elastomeric composites of polypyrrole are important in that they are composite materials suitable for devices where flexibility is an important parameter. Moreover these composites can be moulded into complex shapes. In this work an attempt has been made to prepare conducting elastomeric composites by the incorporation of PPy and PPy coated short Nylon-6 fiber with insulating elastomer matrices- natural rubber and acrylonitrile butadiene rubber. It is well established that mechanical properties of rubber composites can be greatly improved by adding short fibers. Generally short fiber reinforced rubber composites are popular in industrial fields because of their processing advantages, low cost, and their greatly improved technical properties such as strength, stiffness, modulus and damping. In the present work, PPy coated fiber is expected to improve the mechanical properties of the elastomer-PPy composites, at the same time increasing the conductivity. In addition to determination of DC conductivity and evaluation of mechanical properties, the work aims to study the thermal stability, dielectric properties and electromagnetic interference shielding effectiveness of the composites. The thesis consists of ten chapters.

Synthesis, Characterization and Applications of Modified TiO2 Systems

This thesis is divided in to 9 chapters and deals with the modification of TiO2 for various applications include photocatalysis, thermal reaction, photovoltaics and non-linear optics. Chapter 1 involves a brief introduction of the topic of study. An introduction to the applications of modified titania systems in various fields are discussed concisely. Scope and objectives of the present work are also discussed in this chapter. Chapter 2 explains the strategy adopted for the synthesis of metal, nonmetal co-doped TiO2 systems. Hydrothermal technique was employed for the preparation of the co-doped TiO2 system, where Ti[OCH(CH3)2]4, urea and metal nitrates were used as the sources for TiO2, N and metals respectively. In all the co-doped systems, urea to Ti[OCH(CH3)2]4 was taken in a 1:1 molar ratio and varied the concentration of metals. Five different co-doped catalytic systems and for each catalysts, three versions were prepared by varying the concentration of metals. A brief explanation of physico-chemical techniques used for the characterization of the material was also presented in this chapter. This includes X-ray Diffraction (XRD), Raman Spectroscopy, FTIR analysis, Thermo Gravimetric Analysis, Energy Dispersive X-ray Analysis (EDX), Scanning Electron Microscopy(SEM), UV-Visible Diffuse Reflectance Spectroscopy (UV-Vis DRS), Transmission Electron Microscopy (TEM), BET Surface Area Measurements and X-ray Photoelectron Spectroscopy (XPS). Chapter 3 contains the results and discussion of characterization techniques used for analyzing the prepared systems. Characterization is an inevitable part of materials research. Determination of physico-chemical properties of the prepared materials using suitable characterization techniques is very crucial to find its exact field of application. It is clear from the XRD pattern that photocatalytically active anatase phase dominates in the calcined samples with peaks at 2θ values around 25.4°, 38°, 48.1°, 55.2° and 62.7° corresponding to (101), (004), (200), (211) and (204) crystal planes (JCPDS 21-1272) respectively. But in the case of Pr-N-Ti sample, a new peak was observed at 2θ = 30.8° corresponding to the (121) plane of the polymorph brookite. There are no visible peaks corresponding to dopants, which may be due to their low concentration or it is an indication of the better dispersion of impurities in the TiO2. Crystallite size of the sample was calculated from Scherrer equation byusing full width at half maximum (FWHM) of the (101) peak of the anatase phase. Crystallite size of all the co-doped TiO2 was found to be lower than that of bare TiO2 which indicates that the doping of metal ions having higher ionic radius into the lattice of TiO2 causes some lattice distortion which suppress the growth of TiO2 nanoparticles. The structural identity of the prepared system obtained from XRD pattern is further confirmed by Raman spectra measurements. Anatase has six Raman active modes. Band gap of the co-doped system was calculated using Kubelka-Munk equation and that was found to be lower than pure TiO2. Stability of the prepared systems was understood from thermo gravimetric analysis. FT-IR was performed to understand the functional groups as well as to study the surface changes occurred during modification. EDX was used to determine the impurities present in the system. The EDX spectra of all the co-doped samples show signals directly related to the dopants. Spectra of all the co-doped systems contain O and Ti as the main components with low concentrations of doped elements. Morphologies of the prepared systems were obtained from SEM and TEM analysis. Average particle size of the systems was drawn from histogram data. Electronic structures of the samples were identified perfectly from XPS measurements. Chapter 4 describes the photocatalytic degradation of herbicides Atrazine and Metolachlor using metal, non-metal co-doped titania systems. The percentage of degradation was analyzed by HPLC technique. Parameters such as effect of different catalysts, effect of time, effect of catalysts amount and reusability studies were discussed. Chapter 5 deals with the photo-oxidation of some anthracene derivatives by co-doped catalytic systems. These anthracene derivatives come underthe category of polycyclic aromatic hydrocarbons (PAH). Due to the presence of stable benzene rings, most of the PAH show strong inhibition towards biological degradation and the common methods employed for their removal. According to environmental protection agency, most of the PAH are highly toxic in nature. TiO2 photochemistry has been extensively investigated as a method for the catalytic conversion of such organic compounds, highlighting the potential of thereof in the green chemistry. There are actually two methods for the removal of pollutants from the ecosystem. Complete mineralization is the one way to remove pollutants. Conversion of toxic compounds to another compound having toxicity less than the initial starting compound is the second way. Here in this chapter, we are concentrating on the second aspect. The catalysts used were Gd(1wt%)-N-Ti, Pd(1wt%)-N-Ti and Ag(1wt%)-N-Ti. Here we were very successfully converted all the PAH to anthraquinone, a compound having diverse applications in industrial as well as medical fields. Substitution of 10th position of desired PAH by phenyl ring reduces the feasibility of photo reaction and produced 9-hydroxy 9-phenyl anthrone (9H9PA) as an intermediate species. The products were separated and purified by column chromatography using 70:30 hexane/DCM mixtures as the mobile phase and the resultant products were characterized thoroughly by 1H NMR, IR spectroscopy and GCMS analysis. Chapter 6 elucidates the heterogeneous Suzuki coupling reaction by Cu/Pd bimetallic supported on TiO2. Sol-Gel followed by impregnation method was adopted for the synthesis of Cu/Pd-TiO2. The prepared system was characterized by XRD, TG-DTG, SEM, EDX, BET Surface area and XPS. The product was separated and purified by column chromatography using hexane as the mobile phase. Maximum isolated yield of biphenyl of around72% was obtained in DMF using Cu(2wt%)-Pd(4wt%)-Ti as the catalyst. In this reaction, effective solvent, base and catalyst were found to be DMF, K2CO3 and Cu(2wt%)-Pd(4wt%)-Ti respectively. Chapter 7 gives an idea about the photovoltaic (PV) applications of TiO2 based thin films. Due to energy crisis, the whole world is looking for a new sustainable energy source. Harnessing solar energy is one of the most promising ways to tackle this issue. The present dominant photovoltaic (PV) technologies are based on inorganic materials. But the high material, low power conversion efficiency and manufacturing cost limits its popularization. A lot of research has been conducted towards the development of low-cost PV technologies, of which organic photovoltaic (OPV) devices are one of the promising. Here two TiO2 thin films having different thickness were prepared by spin coating technique. The prepared films were characterized by XRD, AFM and conductivity measurements. The thickness of the films was measured by Stylus Profiler. This chapter mainly concentrated on the fabrication of an inverted hetero junction solar cell using conducting polymer MEH-PPV as photo active layer. Here TiO2 was used as the electron transport layer. Thin films of MEH-PPV were also prepared using spin coating technique. Two fullerene derivatives such as PCBM and ICBA were introduced into the device in order to improve the power conversion efficiency. Effective charge transfer between the conducting polymer and ICBA were understood from fluorescence quenching studies. The fabricated Inverted hetero junction exhibited maximum power conversion efficiency of 0.22% with ICBA as the acceptor molecule. Chapter 8 narrates the third order order nonlinear optical properties of bare and noble metal modified TiO2 thin films. Thin films were fabricatedby spray pyrolysis technique. Sol-Gel derived Ti[OCH(CH3)2]4 in CH3CH2OH/CH3COOH was used as the precursor for TiO2. The precursors used for Au, Ag and Pd were the aqueous solutions of HAuCl4, AgNO3 and Pd(NO3)2 respectively. The prepared films were characterized by XRD, SEM and EDX. The nonlinear optical properties of the prepared materials were investigated by Z-Scan technique comprising of Nd-YAG laser (532 nm,7 ns and10 Hz). The non-linear coefficients were obtained by fitting the experimental Z-Scan plot with the theoretical plots. Nonlinear absorption is a phenomenon defined as a nonlinear change (increase or decrease) in absorption with increasing of intensity. This can be mainly divided into two types: saturable absorption (SA) and reverse saturable absorption (RSA). Depending on the pump intensity and on the absorption cross- section at the excitation wavelength, most molecules show non- linear absorption. With increasing intensity, if the excited states show saturation owing to their long lifetimes, the transmission will show SA characteristics. Here absorption decreases with increase of intensity. If, however, the excited state has strong absorption compared with that of the ground state, the transmission will show RSA characteristics. Here in our work most of the materials show SA behavior and some materials exhibited RSA behavior. Both these properties purely depend on the nature of the materials and alignment of energy states within them. Both these SA and RSA have got immense applications in electronic devices. The important results obtained from various studies are presented in chapter 9.

Synthesis, Characterization and Applications of Hybrid Nanocomposites of TiO2 With Conducting Polymers

A nanocomposite is a multiphase solid material where one of the phases has one, two or three dimensions of less than 100 nanometers (nm), or structures having nano-scale repeat distances between the different phases that make up the material. In the broadest sense this definition can include porous media, colloids, gels and copolymers, but is more usually taken to mean the solid combination of a bulk matrix and nano-dimensional phase(s) differing in properties due to dissimilarities in structure and chemistry. The mechanical, electrical, thermal, optical, electrochemical, catalytic properties of the nanocomposite will differ markedly from that of the component materials. Size limits for these effects have been proposed, <5 nm for catalytic activity, <20 nm for making a hard magnetic material soft, <50 nm for refractive index changes, and <100 nm for achieving superparamagnetism, mechanical strengthening or restricting matrix dislocation movement. Conducting polymers have attracted much attention due to high electrical conductivity, ease of preparation, good environmental stability and wide variety of applications in light-emitting, biosensor chemical sensor, separation membrane and electronic devices. The most widely studied conducting polymers are polypyrrole, polyaniline, polythiophene etc. Conducting polymers provide tremendous scope for tuning of their electrical conductivity from semiconducting to metallic region by way of doping and are organic electro chromic materials with chemically active surface. But they are chemically very sensitive and have poor mechanical properties and thus possessing a processibility problem. Nanomaterial shows the presence of more sites for surface reactivity, they possess good mechanical properties and good dispersant too. Thus nanocomposites formed by combining conducting polymers and inorganic oxide nanoparticles possess the good properties of both the constituents and thus enhanced their utility. The properties of such type of nanocomposite are strongly depending on concentration of nanomaterials to be added. Conducting polymer composites is some suitable composition of a conducting polymer with one or more inorganic nanoparticles so that their desirable properties are combined successfully. The composites of core shell metal oxide particles-conducting polymer combine the electrical properties of the polymer shell and the magnetic, optical, electrical or catalytic characteristics of the metal oxide core, which could greatly widen their applicability in the fields of catalysis, electronics and optics. Moreover nanocomposite material composed of conducting polymers & oxides have open more field of application such as drug delivery, conductive paints, rechargeable batteries, toners in photocopying, smart windows, etc.The present work is mainly focussed on the synthesis, characterization and various application studies of conducting polymer modified TiO2 nanocomposites. The conclusions of the present work are outlined below, Mesoporous TiO2 was prepared by the cationic surfactant P123 assisted hydrothermal synthesis route and conducting polymer modified TiO2 nanocomposites were also prepared via the same technique. All the prepared systems show XRD pattern corresponding to anatase phase of TiO2, which means that there is no phase change occurring even after conducting polymer modification. Raman spectroscopy gives supporting evidence for the XRD results. It also confirms the incorporation of the polymer. The mesoporous nature and surface area of the prepared samples were analysed by N2 adsorption desorption studies and the mesoporous ordering can be confirmed by low angle XRD measurementThe morphology of the prepared samples was obtained from both SEM & TEM. The elemental analysis of the samples was performed by EDX analysisThe hybrid composite formation is confirmed by FT-IR spectroscopy and X-ray photoelectron spectroscopyAll the prepared samples have been used for the photocatalytic degradation of dyes, antibiotic, endocrine disruptors and some other organic pollutants. Photocatalytic antibacterial activity studies were also performed using the prepared systemsAll the prepared samples have been used for the photocatalytic degradation of dyes, antibiotic, endocrine disruptors and some other organic pollutants. Photocatalytic antibacterial activity studies were also performed using the prepared systems Polyaniline modified TiO2 nanocomposite systems were found to have good antibacterial activity. Thermal diffusivity studies of the polyaniline modified systems were carried out using thermal lens technique. It is observed that as the amount of polyaniline in the composite increases the thermal diffusivity also increases. The prepared systems can be used as an excellent coolant in various industrial purposes. Nonlinear optical properties (3rd order nonlinearity) of the polyaniline modified systems were studied using Z scan technique. The prepared materials can be used for optical limiting Applications. Lasing studies of polyaniline modified TiO2 systems were carried out and the studies reveal that TiO2 - Polyaniline composite is a potential dye laser gain medium.

Determinantes de la gestión clínica en atención médica domiciliaria de personas con secuelas de enfermedad cerebro-vascular

La atención domiciliaria constituye hoy una modalidad de atención que permite solventar las dificultades derivadas de la sobreocupación hospitalaria y la cronicidad, los cuales constituyen un problema de interés en salud pública en los países desarrollados y que pueden ser manejados en el domicilio del paciente como una opción costo-efectiva y segura. Para lo cual es necesario buscar estrategias que permitan su desarrollo, gestión de riesgos y modelos de atención, logrando mejorar las condiciones de salud de la población. Uno de los principales retos de la gestión de programas de atención en salud, se encuentra en definir los aspectos donde intervenir para potenciar la eficacia y la calidad en la prestación del servicio, por lo que dichos aspectos se constituyen como determinantes de la atención del paciente y su familia. En este documento se abordan los principales determinantes en la atención de personas con secuelas de Enfermedad cerebrovascular, que reciben manejo medico domiciliario, con el objetivo de identificar las áreas prioritarias de intervención, garantizando una mejor gestión clínica en tres áreas específicas: sobrecarga del cuidador, Polimedicación y ulceras por decúbito.

Factores de riesgo para el desarrollo de complicaciones: infecciones en varicosafenectomia

La enfermedad venosa periférica de miembros inferiores se considera una de las afecciones más prevalentes, con morbilidad considerable, deterioro de la calidad de vida, e importante demanda de recursos de salud, que en la mayoría de casos requiere manejo quirúrgico como parte del tratamiento. Este estudio busca analizar si la técnica quirúrgica es un factor de riesgo, que incrementa la aparición de infección de sitio quirúrgico en 257 pacientes a quienes se les realizó varicosafenectomia. Metodología: Se realizó un estudio de cohorte retrospectiva; se recolectaron los datos a partir de los registros clínicos y quirúrgicos de pacientes que cumplieron con los criterios de inclusión, registrando factores de riesgo, descripción quirúrgica, complicaciones, y evolución post operatoria hasta 8 semanas. El análisis estadístico se realizó mediante el cálculo de riesgo relativo y regresión logística binomial. Resultados: Se demostró asociación entre la presencia de infección de sitio quirúrgico y tipo de cirugía con un RR = 3,05 (P= 0,01), clasificación CEAP con 29% menos riesgo en varicosafenectomia total (P= 0,008). Conclusiones: Existen variables clínicas y quirúrgicas que influyen en la probabilidad de desarrollar infección del sitio quirúrgico.

Evaluación de una herramienta educativa en conocimiento de donación y trasplante de órganos y tejidos en Colombia

El trasplante de órganos es considerado uno de los avances más significativos de la medicina moderna y es un procedimiento cada vez más exitoso en términos de supervivencia de los pacientes, siendo actualmente la mejor opción de tratamiento para los pacientes con innumerables patologías. El proceso de donación es insuficiente para cubrir las necesidades de trasplante de la población, por lo tanto, se hace necesario el desarrollo de nuevas estrategias para fortalecer la experiencia y efectividad de los programas existentes. La falta de conocimiento de los profesionales de la salud, su percepción y actitud hacia temas relacionados con el proceso de donación, pueden convertirlos en facilitadores o barreras para la identificación de potenciales donantes. Por esta razón, los recursos disponibles, las actitudes hacia la donación, la legislación y conocimiento de los procesos involucrados en la donación de tejidos y órganos son críticos. Dada la influencia de los profesionales de salud se definen los objetivos de este proyecto de tesis: determinar cuál es el conocimiento y las habilidades de los profesionales de la salud encargados de los trasplantes de órganos y de tejidos en la regional 1, evaluados mediante una herramienta educativa para contribuir a mejorar un programa eficiente de Donación de Órganos y tejidos y así mismo, fijar recomendaciones en aras de aumentar las tasas de donación, con especial énfasis en la actividad hospitalaria en el país. METODOLOGIA Se realizó un estudio basado en el análisis de la evaluación de conocimientos del proceso donación- trasplante de órganos y tejidos en el personal de salud participante en la herramienta educativa llamada “Curso taller primer respondiente del potencial donante de órganos y tejidos”. Este curso incluía un formato evaluativo que fue diligenciado de manera anónima por los participantes antes y después de recibir el contenido del curso. El estudio se desarrolló en personal de la Salud de IPS pertenecientes a la Regional I, de la Red Nacional de donación y trasplantes de órganos y tejidos. Con el fin de evidenciar si existen diferencias en el conocimiento de los participantes del curso antes y después de asistir al mismo, se utilizó la prueba de McNemar (p< 0.05). RESULTADOS Entre julio del 2011 y junio del 2012, se realizó el “Curso taller primer respondiente del potencial donante de órganos y tejidos” y se obtuvieron 303 encuestados incluidos médicos, enfermeras y auxiliares de enfermería. Al inicio del curso las respuestas acertadas con relación a legislación, selección del donante, muerte encefálica y mantenimiento del donante estuvieron alrededor del 50%. No fue posible detectar la profesión que pudiese generar riesgo en la detección del donante y los procesos asociados. Posterior al curso, el 72% de las preguntas se respondieron de manera correcta, lo que representa un incremento estadísticamente significativo. Este cambio evidenció significancia estadística al usar la prueba de McNemar y arrojar un valor de p=0.00. .DISCUSIÓN El personal de salud participante en el curso taller proveniente de unidades involucradas como generadoras de donantes muestra un déficit de conocimientos del proceso donación trasplantes lo que puede convertirlos en limitantes para dicho proceso

Desenlaces de las infecciones respiratorias en la unidad de cuidado intensivo de la fundación neumologica colombiana

Las infecciones asociadas a ventilación mecánica (VM) son frecuentes en la unidad de cuidado intensivo (UCI). Existen dos infecciones: neumonía (NAV) y traqueobronquitis (TAV). NAV genera impacto negativo en los desenlaces de los pacientes al aumentar la morbilidad, mortalidad y los tiempos en UCI y VM, pero no se conoce el impacto de TAV. El objetivo de este estudio fue identificar si hay diferencias entre NAV y TAV. Materiales y métodos: Se realizó un estudio de cohortes entre 2009 y 2013 en la UCI de la Fundación Neumológica Colombiana. De los pacientes con NAV y TAV se obtuvieron datos demográficos, epidemiológicos, microbiológicos y desenlaces como tiempos de estancia en UCI, VM y de hospitalización y mortalidad. Se compararon estadísticamente mediante t de Student y Chi2 para datos normales y prueba de Mann-Whitney para datos no normales. Resultados: Los pacientes con NAV y TAV fueron similares en la condición de ingreso a UCI. Al diagnóstico de la infección hubo diferencias significativas entre grupos en la oxigenación y tiempo de estancia hospitalaria, en UCI y VM. La microbiología fue con predominio de gérmenes Gram negativos y presencia de multirresistencia en el 52.5% de casos, sin diferencias significativas entre grupos. En los desenlaces, se observó diferencias en los tiempos totales de estancia en UCI, hospitalización y VM, pero sin diferencia en ellos después del diagnóstico. No hubo diferencias significativas en mortalidad. Conclusiones: NAV y TAV son similares en el impacto sobre la evolución de los pacientes en cuanto a morbilidad, estancias y mortalidad.

Factores asociados con infección por catéter central en UCI Clínica San Pedro Claver de junio a diciembre de 2004.

La infección asociada a inserción de catéter vascular, es un problema cotidiano en las UCI a nivel mundial, a pesar del manejo de protocolos que se han implementado de manera independiente en las distintas instituciones para frenar este fenómeno. El estudio, de tipo observacional, analítico y cohorte concurrente, con 151 pacientes, a los cuales se insertó catéter en la UCI de la Clínica San Pedro Claver.Para el análisis se realizó estadística descriptiva, análisis de sobrevida, pruebas de asociación y regresión de Cox.

Eficacia de la limpieza corporal con clorhexidina en prevenir la sepsis neonatal en cuidado intensivo revisión sistemática

ANTECEDENTES. La mortalidad neonatal se debe principalmente a procesos infecciosos y a prematurez. Se ha sugerido que el lavado corporal total con clorhexidina podría reducir la mortalidad neonatal relacionada con infección. No existen revisiones sistemáticas que exploren la eficacia de esta intervención. Objetivo. Evaluar la eficacia y seguridad de la limpieza corporal total con clorhexidina en la prevención de las infecciones asociadas al cuidado de la salud en neonatos de alto riesgo hospitalizados en cuidado intensivo neonatal. Metodología. Se realizó una revisión sistemática de la literatura. La búsqueda se hizo a través de las bases de datos Medline, Embase, LilaCS, Cochrane library y el registro de ensayos clínicos del Instituto Nacional de Salud de Estados Unidos. Se incluyeron ensayos clínicos publicados en los últimos 15 años hasta el 30 de enero del 2015. Las variables cualitativas se estimaron mediante OR o RR con sus IC95%. Las variables cuantitativas mediante diferencias de promedios o diferencias estandarizadas de promedios con sus IC95%. Resultados: Se incluyeron 3 estudios en el análisis cualitativo y cuantitativo. No se encontró evidencia concluyente que permita recomendar el uso de la limpieza corporal total con clorhexidina en los recién nacidos hospitalizados en cuidado intensivo neonatal. Conclusión: No existe evidencia que permita concluir que la limpieza corporal total con clorhexidina al 0.25% es mejor respecto a otras intervenciones en la prevención de sepsis neonatal asociada al cuidado de la salud . Es una intervención segura sin efectos adversos significativos.

Perfil de resistencia microbiológico en ciudados intensivos adultos en la fundación Santa Fe de Bogotá año 2014

Se realizó un estudio descriptivo, retrospectivo; se usó la base de datos de los aislamientos microbiológicos documentados en las UCI de la Fundación Santa fe de Bogotá para el año 2014. La prevalencia de bacterias resistentes en los aislamientos de la FSFB no es baja, por lo que se requiere una terapia empírica acertada acorde con la flora local. Se requieren estudios analíticos para evaluar factores asociados al desarrollo de gérmenes multi resistentes y mortalidad por sepsis

Osteomielitis esternal: utilidad de las pruebas de diagnóstico por imágenes con enfoque en medicina nuclear

Introducción: El diagnóstico de osteomielitis esternal post-esternotomía resulta difícil empleando síntomas clínicos o de laboratorio y las imágenes morfológicas orientan a sospecha más que al diagnóstico. Un diagnóstico precoz ofrece calidad de vida y el mejor tratamiento para reducir una mortalidad que oscila entre 14% y 47%. La gammagrafía con leucocitos marcados ofrece el mejor rendimiento diagnóstico para infecciones y se destaca como el patrón de oro diagnóstico. Objetivo: Identificar el desempeño y utilidad de la gammagrafía con leucocitos autólogos marcados con 99mTc-HMPAO en los estudios realizados para la evaluación de osteomielitis esternal. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo de prueba diagnóstica en la Fundación Cardioinfantil de Bogotá entre enero/2010 y mayo/2015 evaluando gammagrafías con leucocitos marcados ante la sospecha de osteomielitis posterior a esternotomía. Resultados: Se evaluaron 52 pacientes, en los que la gammagrafía con leucocitos mostró 23 pacientes (44,2%) con osteomielitis esternal, logrando una sensibilidad y especificidad del 88,46% y 100% respectivamente. El valor predictivo positivo fue de 100%, y el valor predictivo negativo fue de 89,66%. El impacto de una prueba negativa no modificó el manejo médico inicial en el 93% de los casos mientras que una prueba positiva lo modificó en el 83%. Conclusiones: La gammagrafía con leucocitos autólogos radiomarcados con 99mTc-HMPAO continúa siendo el patrón de oro de referencia no invasiva para el diagnóstico de osteomielitis, y en el caso de osteomielitis esternal se convierte en la prueba de elección pertinente en la selección de pacientes que ameritan una re-intervención quirúrgica.