Factores asociados a infección de fracturas abiertas de extremidades por accidentes de tránsito. Bogotá, 2012-2013

Los traumatismos por accidentes de tránsito, constituyen un problema de salud pública, a nivel mundial. Las lesiones más frecuentes son las fracturas de extremidades (84.3%). Las fracturas tienen un elevado riesgo de presentar infecciones, secuelas e incapacidades permanentes. Objetivo : Determinar si los factores asociados con la patología (lugar de fractura, clasificación de fractura, comorbilidades del paciente) y/o los factores relacionados con la atención médica (uso de profilaxis antibiótica diferente al protocolo institucional, tiempo prolongado para remisión, demoras en manejo quirúrgico) se asocian a mayor probabilidad de presentar infección de fracturas abiertas, en población mayor a 15 años, atendidos por accidente de tránsito, en una clínica de Bogotá de tercer nivel especializada en atención de SOAT, durante el período Octubre de 2012 a Octubre de 2013. Metodología: Estudio de casos y controles no apareado, relación 1:3, conformado por 43 casos (fracturas abiertas infectadas) y 129 controles (fracturas abiertas no infectadas). Resultados: La edad media de los casos fue de 39.42 +/- 16.82 años (med=36 años) y la edad media de los controles fue de 33.15 +/- 11.78 años (med=30 años). El 83.7% de los casos y el 78.3% de los controles corresponden al sexo masculino. Predominaron los accidentes en motocicleta en el 81.4% de los casos y el 86% de los controles. En el análisis bivariado se encuentra que la edad mayor a 50 años (p=0.042), una clasificación de la fractura grado IIIB o IIIC (p=0.02), cumplimiento del protocolo antibiótico institucional según el grado de fractura (p=0.014) y un tiempo mayor a 24 horas desde el momento del accidente al centro especializado en trauma (p=0.035) se asociaron significativamente con infección de la fractura abierta. En el análisis multivariado se encuentra únicamente que la clasificación de la fractura grado IIIB o IIIC se asocia con infección de la fractura OR 2.6 IC95% (1.187 – 5.781) (p=0.017). La duración de hospitalización fue mayor en los casos (32.37+/- 22.92 días, med=26 días) que en los controles (8.81 +/- 7.52 días, med=6 días) (p<0.001). El promedio de lavados quirúrgicos fue mayor en los casos (4.85±4.1, med=4.0) que en el grupo control (1.94±1.26, med=2) (p<0.001). Conclusiones: La infección posterior a una fractura abierta, implica costos elevados de atención con hospitalizaciones prolongadas y mayor frecuencia de intervenciones quirúrgicas como se evidencia en el presente estudio. Se debe fortalecer el sistema de remisión y contra remisión para acortar los tiempos de inicio de manejo especializado de los pacientes con fracturas abiertas. Se debe incentivar dentro de las instituciones, el cumplimiento de protocolos de profilaxis antibiótica según el grado de la fractura para disminuir el riesgo de complicación infecciosa.

Trombosis asociada a cateter venoso central en pediatría de la Fundación Cardioinfantil julio 2013 a julio 2015

La trombosis relacionada al uso del catéter es un problema que cobra cada vez mayor importancia. Se han descrito factores de riesgo para su presentación en la población pediátrica pero aún no se han realizado estudios en nuestro medio. Objetivo: Determinar los factores de riesgo y la prevalencia de la trombosis asociada a catéter venoso central en los pacientes pediátricos de la Fundación Cardioinfantil hospitalizados durante el periodo comprendido entre Julio 2013 a Julio 2015. Metodología: Se realizó un estudio de corte transversal de asociación. Se incluyeron pacientes clasificados en 4 grupos: trombosis y catéter, trombosis sin catéter, catéter sin trombosis y sin trombosis ni catéter. Se estimaron OR como medidas de asociación utilizando el estadístico mantel haenszel. Resultados: En total se incluyeron 221 pacientes. La prevalencia de la trombosis y uso del catéter fue del 22%. La edad inferior a los 36 meses (OR 2,27 IC95% 1,16-4,44,p<0.001), profilaxis antitrombótica (OR 34,4 IC95% 4,18-282,92, p<0.01), hospitalización en la UCI (OR 3,82, IC95% 1,69-8,65, p<0.001) y el tiempo de hospitalización (OR 16,83 IC95% 7,8-36,27, p<0.001) están asociadas con un mayor riesgo de presentación de la trombosis. Conclusión: La edad, hospitalización en UCI, uso de profilaxis antitrombótica y el tiempo de hospitalización son factores de riesgo que estan relacionados con la presentación de la trombosis en pacientes con cateter.

Análisis de supervivencia en pacientes con prótesis valvular biológica, Fundación Cardioinfantil-Instituto de Cardiología, Colombia, 2005-2013

Introducción: A partir de la década de los cincuenta el manejo de la enfermedad valvular presenta cambios significativos cuando se incorporan los reemplazos valvulares tanto mecánicos como biológicos dentro de las opciones de tratamiento quirúrgico (1). Las válvulas biológicas se desarrollaron como una alternativa que buscaba evitar los problemas relacionados con la anticoagulación y con la idea de utilizar un tejido que se comportara hemodinámicamente como el nativo. Este estudio está enfocado en establecer la sobrevida global y la libertad de reoperación de la válvula de los pacientes sometidos a reemplazo valvular aórtico y mitral biológicos en la Fundación Cardioinfantil - IC a 1, 3, 5 y 10 años. Materiales y métodos: Estudio de cohorte retrospectiva de supervivencia de pacientes sometidos a reemplazo valvular aórtico y/o mitral biológico intervenidos en la Fundación Cardioinfantil entre 2005 y 2013. Resultados: Se obtuvieron 919 pacientes incluidos en el análisis general y 876 (95,3%) pacientes con seguimiento efectivo para el análisis de sobrevida. La edad promedio fue 64años. La sobrevida a 1, 3, 5 y 10 años fue 95%,90%,85% y 69% respectivamente. El seguimiento efectivo para el desenlace reoperación fue del 55% y se encontró una libertad de reoperación del 99%, 96%, 93% y 81% a los 1, 3, 5 y 10 años. No hubo diferencias significativas entre la localización de la válvula ni en el tipo de válvula aortica empleada. Conclusiones: La sobrevida de los pacientes que son llevados a reemplazo valvular biológico en este estudio es comparable a grandes cohortes internacionales. La sobrevida de los pacientes llevados a reemplazo valvular con prótesis biológicas en posición mitral y aortica fue similar a 1, 3, 5 y 10 años.

Incidencia y factores asociados a infecciones bacterianas en el primer mes postrasplante hepático en la Fundación Cardioinfantil

Introducción: El trasplante hepático ortotópico es la colocación de un nuevo hígado en la misma ubicación del explantado. El objetivo es prolongar la duración y la calidad de vida en pacientes con enfermedades hepáticas terminales. Sin embargo, las infecciones bacterianas son una complicación en los pacientes receptores del trasplante, comprometiendo el éxito del procedimiento. El objetivo fue determinar los factores asociados a infecciones bacterianas en el primer mes tras realizada la intervención y describir las características demográficas de esa población. De 332 trasplantes realizados, que 262 cumplieron criterios para el análisis. Métodos: Se realizó un estudio observacional analítico de casos y controles anidado en una cohorte, en mayores de 18 años, receptores de trasplante hepático primario, de la FCI-IC de 2005 a 2014; excluyendo trasplante combinado hígado riñón, retrasplantes o fallecidos por causa diferente a la infecciosa durante el primer mes. Resultados: Se encontró que la ventilación mecánica por más de 1 día, el catéter venoso central mayor de 3 días son los principales factores de riesgo para infecciones bacterianas. La albúmina mayor de 2,6gr/dl se asoció a menor infección. Los agentes etiológicos predominantes fueron gérmenes gram negativos como E. coli, K. pneumonia y E. cloacae. Mientras que bacteremia, infección urinaria y peritonitis fueron las infecciones más frecuentes. La incidencia de infección bacteriana en esta población fue 24%. Discusión: Se recomienda por tanto extubación antes de 24 horas, uso de catéter central menor de 3 días y limitar el uso del catéter vesical.

Adsorció d'or i zinc amb resines impregnades XAD-2. Superfície d'Equilibri, un nou concepte per a l'adsorció

Dins dels processos de recuperació de metalls de dissolucions diluïdes s'ha realitzat un estudi del procés d'extracció d'or i de zinc mitjançant resines amberlite XAD-2 impregnades amb sulfur de triisobutil fosfina (TIBPS) i àcid di-(2-etilhexil) fosfòric (DEHPA) respectivament. S'ha realitzat un estudi de l'equilibri de l'adsorció d'espècies metàl·liques d'aquests metalls amb les resines indicades anteriorment. Amb la metodologia emprada per a la determinació dels punts d'equilibri dels experiments en batch i en columna, s'ha vist que una única isoterma no podia descriure el fenomen global d'equilibri i que en funció de la metodologia emprada s'obtenien isotermes diferents. Es va introduir una nova variable per poder explicar el fenomen observat, i per tant, amb aquesta nova variable l'equació de la isoterma es converteix amb l'equació d'una supèrfície que s'ha definit com a Superfície d'Equilibri. S'han determinat les equacions de les Suprfícies d'Equilibri dels sistemes d'adsorció estudiats (Au(III) TIBPS/XAD-2 i Zn(II) DEHPA/XAD-2) observan una bona coincidència de tots els punts d'equilibri obtinguts sobre la superfície, així com, un bon ajust de totes les isotermes obtingudes en funció de les diferents metodologies emprades sobre les respectives superfícies d'equilibri. Aquest nou concepte generalitza el concepte d'isoterma d'un procés d'adsorció. Fimalment, s'ha plantejat un model matemàtic d'adsorció per a determinar el coeficient efectiu de difusió (De) i el coeficient de transferància de matèria (kf) per ambdós sistemes d'adsorció estudiats mitjançant l'aplicació del model de difusió de sòlid homogeni (HSDM), utilitzant com a condició de contorn en el model la isoterma de Langmuir obtinguda mitjançant els experiments en columna de llit fix i emprant també l'equació obtinguda mitjançant el nou concepte de Superfície d'Equilibri. Els resultats obtinguts són molt satisfactoris, per tant, es pot concloure que la Superfície d'Equilibri és una bona eina per a descriure l'equilibri en els processos d'adsorció d'or i zinc amb les resines amberlite XAD-2 impregnades amb TIBPS i DEHPA respectivament.

The new professional: underdog or expert? New Museology in the 21th century

For a long time, museum’s form and function were impregnated with social exclusion, only accessible for a prosperous and educated minority. It held the monopoly on the past and therefore in a way on the present and the future. However times have changed and different perspectives on museum practices have been taken. In 1989 the British Peter Vergo mentioned as quoted below, a number of possible museologies, including a ‘new’, and therefore presumably an ‘old’ type of museology: “At the simplest level I would define it, as a state of widespread dissatisfaction with the ‘old’ museology, both within and outside the museum profession; and though the reader may object that such a definition is not merely negative, but circular, I would retort that what is wrong with the ‘old’ museology is that it is too much about museum methods, and too little about purposes of museums; that museology has in the past only frequently been seen, if it has been seen at all, as a theoretical and humanistic discipline.” (Vergo, 1989)

Velocities of compressional and shear waves in limestones

Carbonate rocks are important hydrocarbon reservoir rocks with complex textures and petrophysical properties (porosity and permeability) mainly resulting from various diagenetic processes (compaction, dissolution, precipitation, cementation, etc.). These complexities make prediction of reservoir characteristics (e.g. porosity and permeability) from their seismic properties very difficult. To explore the relationship between the seismic, petrophysical and geological properties, ultrasonic compressional- and shear-wave velocity measurements were made under a simulated in situ condition of pressure (50 MPa hydrostatic effective pressure) at frequencies of approximately 0.85 MHz and 0.7 MHz, respectively, using a pulse-echo method. The measurements were made both in vacuum-dry and fully saturated conditions in oolitic limestones of the Great Oolite Formation of southern England. Some of the rocks were fully saturated with oil. The acoustic measurements were supplemented by porosity and permeability measurements, petrological and pore geometry studies of resin-impregnated polished thin sections, X-ray diffraction analyses and scanning electron microscope studies to investigate submicroscopic textures and micropores. It is shown that the compressional- and shear-wave velocities (V-p and V-s, respectively) decrease with increasing porosity and that V-p decreases approximately twice as fast as V-s. The systematic differences in pore structures (e.g. the aspect ratio) of the limestones produce large residuals in the velocity versus porosity relationship. It is demonstrated that the velocity versus porosity relationship can be improved by removing the pore-structure-dependent variations from the residuals. The introduction of water into the pore space decreases the shear moduli of the rocks by about 2 GPa, suggesting that there exists a fluid/matrix interaction at grain contacts, which reduces the rigidity. The predicted Biot-Gassmann velocity values are greater than the measured velocity values due to the rock-fluid interaction. This is not accounted for in the Biot-Gassmann velocity models and velocity dispersion due to a local flow mechanism. The velocities predicted by the Raymer and time-average relationships overestimated the measured velocities even more than the Biot model.

Effects of volatile fatty acid supply on their absorption and on water kinetics in the rumen of sheep sustained by intragastric infusions

Three sheep fitted with a ruminal cannula and an abomasal catheter were used to study water kinetics and absorption of VFA infused continuously into the rumen. The effects of changing VFA concentrations in the rumen by shifting VFA infusion rates were investigated in an experiment with a 3 x 3 Latin square design. On experimental days, the animals received the basal infusion rate of VFA (271 mmol/h) during the first 2 h. Each animal then received VFA at a different rate (135, 394, or 511 mmol/h) for the next 7.5 h. Using soluble markers (polyethylene glycol and Cr-EDTA), ruminal volume, liquid outflow, apparent water absorption, and VFA absorption rates were estimated. There were no significant effects of VFA infusion rate on ruminal volume and water kinetics. As the VFA infusion rate was increased, VFA concentration and osmolality in the rumen were increased and pH was decreased. There was a biphasic response of liquid outflow to changes in the total VFA concentration in the rumen, as both variables increased together up to a total VFA concentration of 80.1 mM, whereas, beyond that concentration, liquid outflow remained stable at an average rate of 407 mL/h. There were significant linear (P = 0.003) and quadratic (P = 0.001) effects of VFA infusion rate on the VFA absorption rate, confirming that VFA absorption in the rumen is mainly a concentration-dependent process. The proportion of total VFA supplied that was absorbed in the rumen was 0.845 (0.822, 0.877, and 0.910 for acetate, propionate, and butyrate, respectively). The molar proportions of acetate, propionate, and butyrate absorbed were affected by the level of VFA infusion in the rumen, indicating that this level affected to a different extent the absorption of the different acids.

Using a water-soluble melamine-formaldehyde resin to improve the hardness of Norway spruce wood

Samples of Norway spruce wood were impregnated with a water-soluble melamine formaldehyde resin by using short-term vacuum treatment and long-term immersion, respectively. By means of Fourier transform infrared (FTIR) spectroscopy and UV microspectrophotometry, it was shown that only diffusion during long-term immersion leads to sufficient penetration of melamine resin into the wood structure, the flow of liquids in Norway spruce wood during vacuum treatment being greatly hindered by aspirated pits. After an immersion in aqueous melamine resin solution for 3 days, the resin had penetrated to a depth > 4 mm, which, after polymerization of the resin, resulted in an improvement of hardness comparable to the hardwood beech. A finite element model describing the effect of increasing depth of modification on hardness demonstrated that under the test conditions chosen for this study, a minimum impregnation depth of 2 mm is necessary to achieve an optimum increase in hardness. (C) 2004 Wiley Periodicals, Inc.

Assessment of long chain n-3 polyunsaturated fatty acid status and clinical outcome in adults receiving home parenteral nutrition

Background & aims: Long term parenteral nutrition rarely supplies the long chain n-3 polyunsaturated fatty acids (PUFA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA). The aim of this study was to assess long chain n-3 PUFA status in patients receiving home parenteral. nutrition (HPN). Methods: Plasma phospholipid fatty acids were measured in 64 adult HPN patients and compared with 54 age, sex and BMI matched controls. Logistic regression analysis was used to identify factors related to plasma fatty acid fractions in the HPN patients, and to identify factors associated with the risk of clinical. complications. Results: Plasma phospholipid fractions of EPA, DPA and DHA were significantly tower in patients receiving HPN. Factors independently associated with tow fractions included high parenteral energy provision, tow parenteral lipid intake, tow BMI and prolonged duration of HPN. Long chain n-3 PUFA fractions were not associated with incidence of either central venous catheter associated infection or central venous thrombosis. However, the fraction of EPA were inversely associated with plasma alkaline phosphatase concentrations. Conclusions: This study demonstrates abnormal long chain n-3 PUFA profiles in patients receiving HPN. Reduced fatty acid intake may be partly responsible. Fatty acid metabolism may also be altered. (C) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Modelling the uptake and growth kinetics of Penicillium glabrum in a tannic acid-containing solid-state fermentation for tannase production

A mathematical growth model for the batch solid-state fermentation process for fungal tannase production was developed and tested experimentally. The unstructured model describes the uptake and growth kinetics of Penicillium glabrum in an impregnated polyurethane foam substrate system. In general, good agreement between the experimental data and model simulations was obtained. Biomass, tannase and spore production are described by logistic kinetics with a time delay between biomass production and tannase and spore formation. Possible induction mechanisms for the latter are proposed. Hydrolysis of tannic acid, the main carbon source in the substrate system, is reasonably well described with Michaelis-Menten kinetics with time-varying enzyme concentration but a more complex reaction mechanism is suspected. The metabolism of gallic acid, a tannase-hydrolysis product of tannic acid, was shown to be growth limiting during the main growth phase. (c) 2004 Elsevier Ltd. All rights reserved.

Isopimaric acid from Pinus nigra shows activity against multidrug-resistant and EMRSA strains of Staphylococcus aureus

The diterpene isopimaric acid was extracted from the immature cones of Pinus nigra (Arnold) using bioassay. guided fractionation of a crude hexane extract. Isopimaric acid was assayed against multidrug-resistant (MDR) and methicillin-resistant Staphylococcus aureus (MRSA). The minimum inhibitory concentrations (MIC) were 32-64 mu g/mL and compared with a commercially obtained resin acid, abietic acid, with MICs of 64 mu g/mL. Resin acids are known to have antibacterial activity and are valued in traditional medicine for their antiseptic properties: These results show that isopimaric acid is active against MDR an MRSA strains of S. aureus which are becoming, increasingly resistant to antibiotics. Both compounds were evaluated for modulation activity in combination with antibiotics, but did not potentiate the activity of the antibiotics tested. However, the compounds were also assayed in combination with the efflux pump inhibitor reserpine, to ice if inhibition of the TetK or NorA efflux pump increased their activity. Interestingly, rather than a potentiation of activity by a reduction in MIC, a two to four-fold increase in MIC was seen. It may he that isopimaric acid and abietic acid are not substrates for these efflux pumps, but it is also possible that an antagonistic interaction with reserpine may render the antibiotics inactive. H-1-NMR of abietic acid and reserpine taken individually and in combination, revealed a shift in resonance of some peaks for both compounds when mixed together compared with the spectra of the compounds on their own. It is proposed that this may he due to complex formation between abietic acid and reserpine and that this complex formation is responsible for a reduction in activity and elevation of MIC. Copyright (c) 2005 John Wiley & Sons, Ltd.

Avaliação da biocompatibilidade e da propriedade bactericida de nanotubos de dióxido de titânio impregnados com lectina e nanopartículas de prata para aplicações biomédicas

O titânio e suas ligas são os materiais mais comumente utilizados na substituição de tecidos duros por possuírem resistência mecânica, biocompatibilidade, resistência à corrosão e fácil manipulação. Embora o titânio possua várias vantagens sobre outros biomateriais, seu uso em longo prazo pode ocasionar problemas de rejeição. A modificação da superfície do titânio a fim de criar microrrugosidades é uma estratégia efetiva para melhorar a adesão e proliferação celular sobre implantes. Quando um implante danifica ou invade as barreiras epitelial e das mucosas, pode servir como reservatório para microrganismos e desta forma predispor à infecção. Neste sentido, o objetivo deste trabalho foi modificar a superfície do titânio, utilizando nanopartículas de prata (Ag) e lectina, a fim de melhorar a sua biocompatibilidade e conferir propriedades antimicrobianas a este material. O racional por trás destas mudanças é que a criação de uma topografia em nanoescala pode contribuir para mimetizar o ambiente celular melhorando a osseointegração e diminuindo o risco de infecção. Em nosso estudo, nanotubos de dióxido de titânio (NTs-TiO2) com estrutura bem distribuída e organizada, com diâmetro em torno de 70–80nm, foram sintetizados por anodização eletroquímica e decorados com nanopartículas de Ag usando a técnica de layer-by-layer (LbL), enquanto a lectina do peixe Oreochromis niloticus (OniL) foi incorporada aos NTs-TiO2 por spin coating. Estas amostras foram caracterizadas e avaliadas quanto a sua citotoxidade, adesão celular, potencial osteogênico e atividade bactericida. Nossos resultados mostraram que tanto as nanopartículas de Ag, como a Onil foram incorporadas com sucesso à superfície dos NTs-TiO2. Entretanto nossas preparações de LbL não foram capazes de melhorar a biocompatibilidade ou inibir o crescimento de bactérias nos NTs-TiO2. Por outro lado, a funcionalização dos NTs-TiO2 com a OniL induziu eficientemente a adesão e proliferação dos osteoblastos. Nossos resultados apontam para o uso da lectina OniL para melhorar a qualidade dos implantes de NT-TiO2 existentes.

A nipple shield delivery system for oral drug delivery to breastfeeding infants : Microbicide delivery to inactivate HIV

A new drug delivery method for infants is presented which incorporates an active pharmaceutical ingredient (API)-loaded insert into a nipple shield delivery system (NSDS). The API is released directly into milk during breastfeeding. This study investigates the feasibility of using the NSDS to deliver the microbicide sodium dodecyl sulfate (SDS), with the goal of preventing mother-to-child transmission (MTCT) of HIV during breastfeeding in low-resource settings, when there is no safer alternative for the infant but to breastfeed. SDS has been previously shown to effectively inactivate HIV in human milk. An apparatus was developed to simulate milk flow through and drug release from a NSDS. Using this apparatus milk was pulsed through a prototype device containing a non-woven fiber insert impregnated with SDS and the microbicide was rapidly released. The total SDS release from inserts ranged from 70 to 100% of the average 0.07 g load within 50 ml (the volume of a typical breastfeed). Human milk spiked with H9/HIVIIIB cells was also passed through the same set-up. Greater than 99% reduction of cell-associated HIV infectivity was achieved in the first 10 ml of milk. This proof of concept study demonstrates efficient drug delivery to breastfeeding infants is achievable using the NSDS.

Antimicrobial and mechanical properties of acrylic resins with incorporated silver-zinc zeolite - part I

Objective: The purpose of this in vitro study was to evaluate the antimicrobial activity of acrylic resins containing different percentages of silver and zinc zeolite, and to assess whether the addition of zeolite alters the flexural and impact strength of the resins. Background: The characteristics of acrylic resins support microorganism development that can threaten the health of the dentures user. Material and methods: A microwave-polymerised (Onda-Cryl) and two heat-polymerised (QC20 and Lucitone 550) acrylic resins were used. The materials were handled according to the manufacturers` instructions. Fifty rectangular-shaped specimens (8 x 10 x 4mm) were fabricated from each resin and assigned to 5 groups (n = 10) according to their percentage of Irgaguard B5000 silver-zinc zeolite (0%- control, 2.5%, 5.0%, 7.5% and 10%). Flexural strength and Izod impact strength were evaluated. The antimicrobial activity against two strains of Candida albicans and two strains of Streptococcus mutans was assessed by agar diffusion method. Data were analysed statistically by one-way ANOVA and Tukey`s test at 5% significance level. Results: The addition of 2.5% of Irgaguard B5000 to the materials resulted in antimicrobial activity against all strains. Flexural strength decreased significantly with the addition of 2.5% (QC20 and Lucitone 550) and 5.0% (Onda-Cryl) of Irgaguard B5000. The impact strength decreased significantly with the addition of 2.5% (Lucitone 550) and 5.0% (QC20 and Onda-Cryl) of zeolite. Conclusion: The addition of silver-zinc zeolite to acrylic resins yields antimicrobial activity, but may affect negatively the mechanical properties, depending on the percentage of zeolite.