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.

Caracterización del perfil nutricional de pacientes pediátricos hospitalizados en la Clínica Infantil Colsubsidio

Introducción: La desnutrición intrahospitalaria es variable en los estudios publicados. Tiene impacto en el curso tórpido de la enfermedad, en la prolongación de la estancia hospitalaria y en los altos costos subsecuentes. No existen estudios realizados en Colombia en relación al estado nutricional del paciente pediátrico hospitalizado. Por este motivo se decidió caracterizar el perfil nutricional de pacientes pediátricos hospitalizados en la Clínica Infantil Colsubsidio Materiales y métodos: Se desarrolló un estudio transversal en pacientes pediátricos hospitalizados en un periodo entre Junio 2014 – Marzo 2015. Se realizó descripción de las variables y análisis univariado. Resultados: Se analizaron 320 pacientes: 50% niños y 50% niñas. Edad promedio: 4.6 años, predominio del grupo de los lactantes. Media de estancia hospitalaria: 4,6 días. Baja ingesta, ayuno, dolor de moderada intensidad y factor de estrés grado I fueron las variables más frecuentemente relacionadas con desnutrición. Al ingreso a hospitalización el 57.5 % se encontraron eutróficos, el 17.19% con desnutrición crónica, el 8.44% con desnutrición aguda y el 16.88% con aumento anormal de peso. Al egreso, los eutróficos disminuyeron a 56.25 %, la desnutrición crónica y el aumento anormal de peso se mantuvieron igual y la desnutrición aguda aumento al 10%. Conclusión: Los hallazgos de este estudio están en concordancia con los hallazgos descritos en la literatura. El mayor compromiso nutricional se asoció a patologías respiratorias y gastrointestinales y a mayor estancia hospitalaria.

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

Controlo de qualidade de formas farmacêuticas estéreis

Com o avanço da tecnologia cada vez mais acessível, torna-se imprescindível acompanhar este mesmo desenvolvimento e adotá-lo para a obtenção de um melhor produto. Sendo as formas farmacêuticas estéreis alvo de uma rigorosa avaliação dos seus requisitos, é uma grande vantagem conhecer quais as orientações atuais para o fabrico destes produtos. Uma vez que estamos na era da “aldeia global”, é inquestionável a necessidade de conhecer documentos de outros países, isto porque na indústria farmacêutica, tal como em muitas outras, há o objetivo de expandir a comercialização de produtos para outros países, continentes, mas há que ter em atenção que para esses países os requisitos de qualidade desses produtos podem não ser iguais aos do nosso país. Ao conhecer e aplicar os principais e mais rígidos controlos e normas, é certo que todos os outros serão cumpridos. Como principais documentos que regulam e orientam o processo de fabrico destes produtos existem as Good Manufacturing Practices, as normas da Internactional Standardization Organization e as Farmacopeias de vários países. Na indústria farmacêutica, principalmente no fabrico das formas farmacêuticas estéreis, há controlo não só do processo de fabrico e produto final, como também de todo o ambiente e intervenientes que envolvem a produção. Dentro das formas farmacêuticas em estudo encontram-se as de uso oftálmico, de aplicação nasal, de aplicação auricular e de uso parenteral. Todas estas têm o principal requisito de ser estéreis, variando nos outros parâmetros, como tonicidade e pH de acordo com a localização da administração. Os ensaios realizados tanto em In Process Control como no produto final, estão presentes nas Farmacopeias, que serão discutidos e comparados entre si.

Controlo microbiológico de formulações farmacêuticas parentéricas

O controlo microbiológico de formulações injectáveis visa garantir a isenção de um produto farmacêutico em termos microrganismos, possivelmente patogénicos, que possam induzir sintomas patológicos após a sua administração. Assim, o estudo das técnicas que permitam a eliminação de agentes patogénicos e a sua prevenção é de extrema importância. Nesta área são utilizadas diversas técnicas clássicas para avaliar determinados medicamentos e estão a ser desenvolvidas outras novas técnicas. Estas últimas revelam-se mais vantajosas comparativamente às clássicas uma vez que apresentam maior eficácia e rigor. Este artigo de revisão apresenta uma descrição simples das principais técnicas disponíveis (clássicas e as mais recentes) para o controlo microbiológico de medicamentos injectáveis podendo ser visto como uma ferramenta prática útil para os profissionais que trabalham ou poderão vir a trabalhar nesta área.

Nutrição parentérica em recém-nascidos prematuros

A nutrição parentérica é um importante aliado no crescimento e desenvolvimento de recém-nascidos prematuros. A nutrição parentérica consiste numa solução contendo nutrientes, como glicose, proteínas, lípidos, eletrólitos, vitaminas e oligoelementos, administrada por via endovenosa de modo a garantir um crescimento saudável do recém-nascido. O objetivo deste trabalho é abordar de uma forma discritiva a nutrição dos prematuros desde os seus componentes, as vias de administração, as suas indicações e contra-indicações até à manipulação propriamente dita destas soluções. Para finalizar é apresentado um caso clínico de um recém-nascido do Hospital São Francisco Xavier, evidenciando desta forma, todo o trabalho em contexto real, de farmacêuticos e técnicos hospitalares nesta área.

Nanotecnologia aplicada à pele

A nanotecnologia foi introduzida nas áreas farmacêutica e cosmética, com o propósito de possibilitar o desenvolvimento de sistemas de veiculação de substâncias e para a optimização das formulações já existentes. As preparações de aplicação tópica têm elevada importância nas perspectivas terapêutica e cosmética, uma vez que a pele apresenta uma área de aplicação extensa e acessível, os efeitos sistémicos das substâncias a administrar por via tópica encontram-se geralmente reduzidos, exercendo na maioria das vezes um efeito local. Mais, a esta via estão normalmente associadas menos reacções adversas. Todavia, a pele é um órgão, dotado de um efeito barreira notável, que pode comprometer a administração de moléculas farmacológica/cosmetologicamente activas no alvo. Assim, é evidente a necessidade de conhecer a constituição da pele, pois a permeabilidade cutânea de substâncias é um desafio que só pode ser conseguido através da preparação de formulações capazes de ultrapassar essa mesma barreira. O trabalho exposto aborda sucintamente a nanocosmética, pois esta tem revelado elevados impactos económico, social e científico. A inexistência de informação sobre quais os produtos actualmente comercializados, cuja produção tenha por base a nanotecnologia, suscitaram o interesse em desenvolver uma revisão sobre esses mesmos produtos, assim como esclarecer alguns aspectos relacionados com as características da pele, que justificam o investimento e estudo exaustivo deste tipo de preparações.

The role of uncomposted materials, composts, manures, and compost extracts in reducing pest and disease incidence and severity in sustainable temperate agricultural and horticultural crop production - A review

This review evaluates evidence of the impact of uncomposted plant residues, composts, manures, and liquid preparations made from composts (compost extracts and teas) on pest and disease incidence and severity in agricultural and horticultural crop production. Most reports on pest control using such organic amendments relate to tropical or and climates. The majority of recent work on the use of organic amendments for prevention and control of diseases relates to container-produced plants, particularly ornamentals. However, there is growing interest in the potential for using composts to prevent and control diseases in temperate agricultural and horticultural field crops and information concerning their use and effectiveness is slowly increasing. The impact of uncomposted plant residues, composts, manures, and compost extracts/teas on pests and diseases is discussed in relation to sustainable temperate field and protected cropping systems. The factors affecting efficacy or such organic amendments in preventing and controlling pests and disease are examined and the mechanisms through which control is achieved are described.

Omega-3 fatty acids, cardiovascular disease and stability of atherosclerotic plaques

Long-chain n-3 polyunsaturated fatty acids are found in oily fish and in fish oils and similar preparations. Substantial evidence from epidemiological and case-control studies indicates that consumption of fish, oily fish and long-chain n-3 fatty acids reduces risk of cardiovascular mortality. Secondary prevention studies using long-chain n-3 fatty acids in patients post-myocardial infarction have shown a reduction in total and cardiovascular mortality with an especially potent effect on sudden death. Long-chain n-3 fatty acids have been shown to beneficially modify a range of cardiovascular risk factors, which may result in primary cardiovascular prevention. However, reduced non-fatal and fatal events and a reduction in sudden death probably involve other mechanisms. Reduced thrombosis following long-chain n-3 fatty acids may play a role. A decrease in arrhythmias is a favoured mechanism of action of long-chain n-3 fatty acids and is supported by cell culture and animal studies. However human trials using implantable cardiac defibrillators have produced inconsistent findings and a recent meta-analysis does not support this mechanism of action. An alternative mechanism of action may be stabilisation of atherosclerotic plaques by long-chain n-3 fatty acids. This is suggested by one published human study which showed that incorporation of long-chain n-3 fatty acids into plaques collected at carotid endarterectomy resulted in fewer macrophages in the plaque and a morphology indicative of increased stability. These findings are supported from observations in an animal model and suggest that the primary effect of long-chain n-3 fatty acids might be on macrophages within the plaque.

In vitro evaluation of fibrolytic enzymes as additives for maize (Zea mays L.) silage - III. Comparison of enzymes derived from psychrophilic, mesophilic or thermophilic sources

A completely randomised study was completed to examine the influence of fibrolytic enzymes derived from psychrophilic, (F), mesophilic, (L) or thermophilic (Ta) sources, applied at ensiling, on the chemical characteristics and in vitro rumen fermentation of maize silage, assessed using the Reading Pressure Technique (RPT). Treatments, all in triplicate, consisted of untreated maize forage or treated with preparations F, L, Ta or a mixture (1: 1, v/v) of F and L (FL), at two levels each, and ensiled for 210 days in plastic mini-silos. Addition of enzymes L decreased (P < 0.05) silage pH relative to the control, whereas enzyme Ta tended (P < 0.10) to reduce it. Preparations F, L and Ta tended to reduce (P < 0.10) the fibre contents of the silages, with effects being attributable to a decrease in the cellulose fraction. Starch contents were reduced (P < 0.05) in the treatments including enzyme F. End-point (96 h) gas production (GP) values did not differ among treatments, suggesting that enzymes did not change the total amount of fermentable substrate. However, consistent with the decrease in starch contents, adding enzyme F reduced (P < 0.05) GP at most incubation times. Addition of enzymes increased (P < 0.05) the initial (6 h) organic matter degradation (OMD) levels in all but one treatment (F), with increases of 14, 19, and 26% for preparations L, Ta, and FL, respectively, averaged across levels. Furthermore, the addition of enzymes increased (P < 0.05) the soluble OM losses, however, these increases did not fully account for the initial increase in OMD. The latter suggests that enzymes increased solubility and also altered silage structure, making it more amenable to degradation by ruminal microorganisms. As a result of the increase in OMD, without a concomitant increase in GP, the fermentation efficiency was greatly increased (P < 0.05) in enzyme treatments. Addition of enzymes to maize at ensiling, particularly those from the mesophilic and thermophilic sources used here, have the potential to increase the initial rate of silage OMD. (C) 2003 Elsevier B.V. All rights reserved.

Major advances in fundamental dairy cattle nutrition

Fundamental nutrition seeks to describe the complex biochemical reactions involved in assimilation and processing of nutrients by various tissues and organs, and to quantify nutrient movement (flux) through those processes. Over the last 25 yr, considerable progress has been made in increasing our understanding of metabolism in dairy cattle. Major advances have been made at all levels of biological organization, including the whole animal, organ systems, tissues, cells, and molecules. At the whole-animal level, progress has been made in delineating metabolism during late pregnancy and the transition to lactation, as well as in whole-body use of energy-yielding substrates and amino acids for growth in young calves. An explosion of research using multicatheterization techniques has led to better quantitative descriptions of nutrient use by tissues of the portal-drained viscera (digestive tract, pancreas, and associated adipose tissues) and liver. Isolated tissue preparations have provided important information on the interrelationships among glucose, fatty acid, and amino acid metabolism in liver, adipose tissue, and mammary gland, as well as the regulation of these pathways during different physiological states. Finally, the last 25 yr has witnessed the birth of "molecular biology" approaches to understanding fundamental nutrition. Although measurements of mRNA abundance for proteins of interest already have provided new insights into regulation of metabolism, the next 25 yr will likely see remarkable advances as these techniques continue to be applied to problems of dairy cattle biology. Integration of the "omics" technologies (functional genomics, proteomics, and metabolomics) with measurements of tissue metabolism obtained by other methods is a particularly exciting prospect for the future. The result should be improved animal health and well being, more efficient dairy production, and better models to predict nutritional requirements and provide rations to meet those requirements.

Near infrared reflectance spectroscopy (NIRS) to predict biological parameters of maize silage: effects of particle comminution, oven drying temperature and the presence of residual moisture

Maize silage nutritive quality is routinely determined by near infrared reflectance spectroscopy (NIRS). However, little is known about the impact of sample preparation on the accuracy of the calibration to predict biological traits. A sample population of 48 maize silages representing a wide range of physiological maturities was used in a study to determine the impact of different sample preparation procedures (i.e., drying regimes; the presence or absence of residual moisture; the degree of particle comminution) on resultant NIR prediction statistics. All silages were scanned using a total of 12 combinations of sample pre-treatments. Each sample preparation combination was subjected to three multivariate regression techniques to give a total of 36 predictions per biological trait. Increased sample preparations procedure, relative to scanning the unprocessed whole plant (WP) material, always resulted in a numerical minimisation of model statistics. However, the ability of each of the treatments to significantly minimise the model statistics differed. Particle comminution was the most important factor, oven-drying regime was intermediate, and residual moisture presence was the least important. Models to predict various biological parameters of maize silage will be improved if material is subjected to a high degree of particle comminution (i.e., having been passed through a 1 mm screen) and developed on plant material previously dried at 60 degrees C. The extra effort in terms of time and cost required to remove sample residual moisture cannot be justified. (c) 2005 Elsevier B.V. All rights reserved.

Effect of feeding supplemental fibrolytic enzymes or soluble sugars with malic acid on milk production

Two trials were conducted to evaluate effects of feeding supplemental fibrolytic enzymes or soluble sugars and malic acid on milk production. In trial 1, 257 cows at four sites were fed a basal diet consisting of no more than 60% of forage DM as corn silage and less than 40% as alfalfa hay. Cows were assigned randomly within site, parity, and two stages of lactation to: 1) control; 2) enzyme A; 3) enzyme B; and 4) soluble sugars and malic acid. There was a 14-d pretreatment and an 84-d treatment period. Enzyme solutions were sprayed on either the forage component or the TMR each day while mixing feed. Trial 2 was similar, except 122 cows at one site in the United Kingdom were fed diets containing forage that was 75% corn silage and 25% grass silage, and all cows began the study between 25 to 31 DIM. Mean milk productions for 233 cows that completed trial 1 were 32.9, 32.5, 32.4, and 32.9 kg/d for control, enzyme A, enzyme B, and soluble sugars and malic acid, respectively. Mean milk productions for 116 cows that completed trial 2 were 28.2, 27.9, 28.8, and 28.4 kg/d, respectively. In vitro analyses of the activities of enzyme solutions indicated that all major cellulose and hemicellulose degrading activities were present; however, the pH optima (approximate pH = 4 to 5) were more acidic, and the temperature optimum (approximately 50 C) was greater than normal pH and temperature in the rumen. If fibrolytic activity in the rumen is a major mechanism of action of supplemental fibrolytic enzymes, it appears that considerable activity of these preparations was lost due to conditions in the rumen. In conclusion, feeding supplemental fibrolytic enzymes or malic acid with soluble sugars had no effect on milk production under the conditions used in this study.

Characterization and origin of infection of Rhizoctonia solani associated with Brassica oleracea crops in the UK

An extensive study was conducted to determine where in the production chain Rhizoctonia solani became associated with UK module-raised Brassica oleracea plants. In total, 2600 plants from 52 crops were sampled directly from propagators and repeat sampled from the field. Additional soil, compost and water samples were collected from propagation nurseries and screened using conventional agar isolation methods. No isolates of R. solani were recovered from any samples collected from propagation nurseries. Furthermore, nucleic acid preparations from samples of soil and compost from propagation nurseries gave negative results when tested for R. solani using real-time PCR. Conversely, R. solani was recovered from 116 of 1300 stem bases collected from field crops. All the data collected suggested R. solani became associated with B. oleracea in the field rather than during propagation. Parsimony and Bayesian phylogenetic studies of ribosomal DNA suggested the majority of further classified isolates belonged to anastomosis groups 2-1 (48/57) and AG-4HGII (8/57), groups known to be pathogenic on Brassica spp. in other countries. Many R. solani isolates were recovered from symptomless plant material and the possibilities for such an association are discussed.

The influence of G protein subtype on agonist action at D-2 dopamine receptors

In previous studies, we have shown that agonists influence the ability of D-2 dopamine receptors to couple to G proteins and here we extend this work. The human D-2Short dopamine receptor and a natural polymorphism of this D-2Short(Ser(311)Cys), have been studied by co-expressing the receptors in insect cells with Gbeta(1)gamma(2) and either Galpha(o), Galpha(i1), Galpha(i2) or Galpha(i3) G protein subunits. These preparations have been used to study the G protein coupling profiles of the two receptors and the influence of agonists. Receptor/G protein coupling was analysed in dopamine/[H-3]spiperone competition binding experiments and through stimulation of [S-35]GTPgammaS binding. Although the Ser(311)Cys polymorphism itself had no appreciable effect on the G protein coupling specificity of the D-2 receptor, agonist stimulation of [S-35]GTPgammaS binding, revealed that both dopamine and (+)-3PPP showed a clear preference for Galpha(o) compared to the Galpha(i) subtypes, but quinpirole did not. These results indicate that agonists are able to stabilise different receptor conformations with different abilities to couple to G proteins. (C) 2004 Elsevier Ltd. All rights reserved.