Niveles de hemoglobina en los que se indica transfundir en el Hospital Universitario Fundación Santa Fe de Bogotá

Introducción: En los pacientes críticamente enfermos la terapia transfusional es una práctica común. Dentro de los estudios realizados no se han incluido a las ciudades a mayor altura. Este estudio pretende determinar los niveles de hemoglobina sobre los cuales se está transfundiendo a los pacientes en la unidad de cuidados intensivos del Hospital Universitario Fundación Santa Fe de Bogotá a 2600 metros sobre el nivel del mar, para determinar si los niveles de hemoglobina a los que se transfunde a nuestra altura son los óptimos. Métodos: Se realizó un estudio descriptivo retrospectivo, de los pacientes que fueron hospitalizados en la Unidad de Cuidado Intensivo del Hospital Universitario Fundación Santa Fe de Bogotá a partir del 01 de Junio de 2011 y hasta el 31 de Mayo de 2012. Resultados: Del total de los registros analizados el 13,8% de los pacientes presentaron una hemoglobina ≤ 7 y todos fueron transfundidos con glóbulos rojos; y en el rango de 7,1-9 se presentó el mayor porcentaje de transfusión. Se observó que los pacientes con hemoglobina ≤ 7 tienen 18,8 veces mayor riego de fallecimiento, lo que fue estadísticamente significativo (p:0,000). Conclusiones: Encontramos que la terapia transfusional en la unidad de cuidado intensivo, se realiza de acuerdo a recomendaciones dadas por las guías de manejo universalmente aceptadas. Dentro de los resultados de nuestro estudio podemos resaltar una tasa de mortalidad más alta en los pacientes en los cuales se instaura terapia transfusional con un nivel de hemoglobina por debajo de 7g/dl.

Italian citizenship and the descendants of Italian citizens emigrated in Colombia. Removing a social injustice

Law is often the source of social discriminations, but, at the same time, it can be thekey to delete these social discriminations. The authors try to give an example of thisphenomenon, by analyzing the impact of the Italian citizenship’s rules over the descendantsof the Italian citizens emigrated abroad and, especially, in South America.Indeed, according to the former Italian law, only fathers could transmit iure sanguinisthe citizenship to their children: moreover, women automatically lost theItalian citizenship if they get a foreign citizenship by concluding a marriage witha foreign husband.These rules hardly discriminate the Italian women emigrated abroad and, especially,their descendants who were prevented to get the Italian’s citizenship.These discriminatory rules were finally deleted by the Italian Constitutional Courtin the Seventies and in the Eighties: however, the effects of those rules still persisted,since the decision of the Constitutional Court could not overcome the temporal limit of the entry into force of the Constitution (01.01.1948) and, therefore, could not“cover” the discriminatory facts occurred before that date.Finally in 2009, the Italian Supreme Court, by extending the effects ratione temporisof the decisions of the Constitutional Court, “reopened the doors” of the Italiancitizenship to a huge number of Italian citizenship born from Italian women beforethe 01.01.1948.Therefore, the authors focus on the social impact of this decision for all the potentialItalian citizens living in South America and try to assess its juridical effects overthe Italian law.

Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Evaluación muticéntrica de la actividad antimicrobiana in vitro de tigeciclina en aislados obtenidos de pacientes hospitalizados en Colombia

El aumento en la resistencia bacteriana es un problema global que afecta también a nuestro país y que puede llevar a fracasos terapéuticos, peores desenlaces clínicos, uso de terapia combinada, mayor riesgo de interacciones medicamentosas y de reacciones adversas asi como a aumento de los costos del tratamiento. Tigeciclina, un nuevo antibiótico de la clase de las glicilciclinas ha mostrado una promisoria actividad antibacteriana in vitro contra bacterias comunes incluyendo multiresistentes que cada vez son más prevalentes en nuestro país especialmente a nivel hospitalario. Este estudio fue desarrollado para determinar la actividad de tigeciclina en nuestro medio y conocer su potencial utilidad.

La Hipertensió arterial a la pràctica: optimització de la mesura de la pressió arterial i de l'avaluació de l'afectació dels òrgans diana

Objectius: a) avaluar la utilitat de la mesura de la pressió arterial a la consulta pel diplomat d'infermeria; b) establir quin és el punt de tall pel valor normal de l'automesura de la pressió arterial al domicili del propi malalt; c) determinar si l'exploració del fons d'ull als malalts hipertensos permet una millor estratificació del risc cardiovascular. Resultats: a) primer objectiu: els valors de la PAC de la infermera són molt similars a l'AMPA i les decisions s'han de prendre en funció d'aquesta mesura. b) segon objectiu: el risc de presentar alguna AOD en els hipertensos recent diagnosticats amb hipertensió clínica aïllada passa de forma progressiva d'una OR de 2.5 per un punt de tall de <125/80 mmHg a una OR de 4.0 pel punt de tall <135/85 mmHg. c) tercer objectiu: un nombre significatiu de pacients canvien de grup de risc quan es consideren els resultats de l'exploració del fons d'ull.

Prediction of postprandial blood glucose under intra-patient variability and uncertainty and its use in the design of insulin dosing strategies for type 1 diabetic patients

In this thesis I propose a novel method to estimate the dose and injection-to-meal time for low-risk intensive insulin therapy. This dosage-aid system uses an optimization algorithm to determine the insulin dose and injection-to-meal time that minimizes the risk of postprandial hyper- and hypoglycaemia in type 1 diabetic patients. To this end, the algorithm applies a methodology that quantifies the risk of experiencing different grades of hypo- or hyperglycaemia in the postprandial state induced by insulin therapy according to an individual patient’s parameters. This methodology is based on modal interval analysis (MIA). Applying MIA, the postprandial glucose level is predicted with consideration of intra-patient variability and other sources of uncertainty. A worst-case approach is then used to calculate the risk index. In this way, a safer prediction of possible hyper- and hypoglycaemic episodes induced by the insulin therapy tested can be calculated in terms of these uncertainties.

Cessació de l'hàbit tabàquic en pacients afectats de malaltia vascular cerebral aguda

S'han estudiat 1003 pacients amb el diagnòstic de Malaltia Vascular Cerebral (MVC) aguda ingressats a la unitat de neurologia de l'Hospital Josep Trueta de Girona en el període de gener de 2005 a juliol de 2007. S'ha realitzat un estudi de cohorts prospectiu d'un any en 110 pacients que eren fumadors en el moment de l'ictus. Un elevat percentatge dels pacients afectats de MVC aguda presenten factors de risc vascular que es poden evitar com el consum de tabac o d'alcohol, i factors de risc vascular que cal controlar com la hipertensió, la dislipèmia, la diabetis o la cardiopatia. Només 4 de cada 10 pacients fumadors diagnosticats d'ictus havien abandonat l'hàbit un any després de presentar la MVC aguda. Les variables que millor prediuen la cessació tabàquica en aquests pacients són la localització de la lesió a l'ínsula cerebral i la intenció de deixar de fumar prèvia a l'ictus.

Discoespondilite Canina : Estudo Retrospectivo de 10 Casos Clínicos

A discoespondilite é uma doença infecciosa rara que afecta, de forma crónica, os discos intervertebrais e as extremidades adjacentes dos corpos vertebrais. Geralmente advém de uma infecção disseminada por via hematógena e os agentes mais frequentes são bacterianos e são principalmente Staphylococcus spp., Streptococcus spp., E. Coli e Brucella spp. Também pode ser devida a infecções fúngicas, parasitárias ou migração de corpos estranhos. É caracterizada pela degenerescência do disco intervertebral e lesões escleróticas e proliferativas das extremidades dos corpos vertebrais. O principal sinal clínico desta doença é a hiperestesia paravertebral e alterações da marcha ou relutância ao movimento. Febre e anorexia são menos frequentes do que seria de esperar e os sinais neurológicos são considerados raros. O diagnóstico desta doença é geralmente radiográfico e a determinação do agente pode ser conseguida por cultura de material discal, hemocultura ou urocultura. Podem ser usados meios de imagiologia avançada como TAC e RM para melhor avaliar a extensão das lesões e o envolvimento dos tecidos circunvizinhos. A realização de hemogramas raramente revela alterações significativas embora possa existir leucocitose. O tratamento médico é eficaz em aproximadamente 76% dos casos e deve ser feito com base em cultura e TSA mas, de forma empírica, as cefalosporinas de primeira geração são frequentemente utilizadas. Em alguns casos pode ser necessária a estabilização ou desbridamento cirúrgicos. O estudo retrospectivo realizado no âmbito deste trabalho, teve como objectivo avaliar os sinais clínicos, radiográficos e laboratoriais , assim como o maneio médico e cirúrgico de 10 casos de discoespondilite confirmada radiográfica e clinicamente, num período de 2 anos. Observou-se maior prevalência da doença em machos, em cães jovens e adultos, e raças de grande porte. A região mais afectada foi a junção lombossagrada, e o sinal mais observado foi a dor paraespinhal. No entanto os sinais neurológicos foram mais frequentes do que o descrito. Os agentes isolados em cultura de material discal não foram os mais comuns. O tratamento médico instituído pelos veterinários foi eficaz em 6 dos casos, Foi necessária intervenção cirúrgica em 3 e 1 animal não recuperou totalmente até à conclusão deste estudo.

Avaliação da relação entre contagens de células somáticas e os agentes mais prevalentes de mastite em explorações leiteiras da região de entre Douro e Vouga

Quando um microrganismo patogénico invade a glândula mamária, através do canal do teto, pode ocorrer infecção intramamária, desencadeando uma resposta inflamatória – a mastite. Esta possui diversas etiologias, sendo normalmente de origem bacteriana. Na resposta inflamatória, actuam as células somáticas presentes no leite. O presente estudo teve como principal objectivo avaliar a relação entre as contagens de células somáticas e os agentes causadores de mastite em amostras de leite. Foram utilizados dados referentes aos resultados de análises de leite para diagnóstico de mastite realizadas em amostras de explorações de Entre Douro e Vouga. Os resultados consistem em identificação dos agentes e respectivo antibiograma, CCS, sendo ainda registado o objectivo da análise (Secagem ou Tratamento). Determinaram-se as prevalências dos agentes, avaliando de seguida a relação entre as seguintes variáveis: agentes e CCS; CCS e objectivo da análise; e entre agentes e objectivo da análise. Concluiu-se que os Staphylococcus coagulase-negativa são os mais prevalentes, 14,5%, seguindo, Streptococcus uberis, 7,6%; Escherichia coli, 6,3%; Lactococcus garviae, 5,8% e Staphylococcus aureus, 4,1%. Concluiu-se ainda, a existência de diferenças estatisticamente significativas nas análises realizadas, confirmando a relação entre as demais variáveis.

La construcción de la imagen y el estatuto del inmigrante indocumentado en la España de la época de la Globalización

A pesar del discurso estadístico e instrumental sobre la importancia de la inmigración para el futuro económico de Europa que va de la mano con el de la necesidad de desarrollar políticas (sociales y culturales) de integración del inmigrante, actualmente existe una tendencia regresiva a restringir su acceso a los derechos ciudadanos (civiles, políticos y sociales). Un ejemplo de este proceso es el que se produce en España, en el actual contexto de conformación de la Unión Europea y de la llamada Globalización. El año 2000 constituyó un punto culminante de este fenómeno en España, en cuanto fue el escenario temporal de una lucha social y política en el que se confrontaron dos perspectivas y concepciones contrapuestas de ciudadanía, hecho que evidenció la caducidad del antiguo modelo de ciudadanía comprendida como el vínculo político (estatuto de derechos y obligaciones) entre el individuo y el Estado-nación, que se adquiere de manera preferente a través de la descendencia (ius-sanguinis).

Allobaculum stercoricanis gen. nov., sp nov., isolated from canine feces

Morphological, biochemical, and molecular genetic studies were performed on an unknown anaerobic, catalase-negative, nonspore-forming, rod-shaped bacterium isolated from dog feces. The unknown bacterium was tentatively identified as a Eubacterium species, based on cellular morphological and biochemical tests. 16S rRNA gene sequencing studies, however, revealed that it was phylogenetically distant from Eubacterium limosum, the type species of the genus Eubacterium. Phylogenetically, the unknown species forms a hitherto unknown sub-line proximal to the base of a cluster of organisms (designated rRNA cluster XVI), which includes Clostridium innocuum, Streptococcus pleomorphus, and some Eubacterium species. Based on both phenotypic and phylogenetic criteria, it is proposed that the unknown bacterium be classified as a new genus and species, Allobaculum stercoricanis. Using a specific rRNA-targeted probe designed to identify Allobacultan stercoricanis, in situ hybridisation showed this novel species represents a significant organism in canine feces comprising between 0.1% and 3.7% of total cells stained with DAPI (21 dog fecal samples). The type strain of Allobaculum stereoricanis is DSM 13633(T) = CCUG 45212(T). (C) 2004 Elsevier Ltd. All rights reserved.

Characterization of a Gemella-like organism isolated from an abscess of a rabbit: description of Gemella cunicula sp. nov.

An unknown Gram-positive, catalase-negative, ovoid-shaped bacterium isolated from the submandibular abscess of a rabbit was subjected to a polyphasic taxonomic analysis. Comparative 16S rRNA gene sequencing demonstrated the unknown coccus represents a new subline within the genus Gemella. The unknown isolate was readily distinguished from other recognized members of the genus Gemella, namely Gemella haemolysans, Gemella bergeri, Gemella morbillorum, Gemella palaticanis and Gemella sanguinis, by biochemical tests and electrophoretic analysis of whole-cell proteins. Based on both phylogenetic and phenotypic evidence, it is proposed that the unknown bacterium is classified in the genus Gemella as Gemella cuniculi sp. nov. The type strain is CCUG 42726T.

Antigenotoxicity of probiotics and prebiotics on faecal water-induced DNA damage in human colon adenocarcinoma cells

Six strains of lactic acid producing bacteria (LAB) were incubated (1 x 10(8)cfu/ml) with genotoxic faecal water from a human subject. HT29 human adenocarcinoma cells were then challenged with the resultant samples and DNA damage measured using the single cell gel electrophoresis (comet) assay. The LAB strains investigated were Bifidobacterium sp. 420, Bifidobacterium Bb12, Lactobacillus plantarum, Streptococcus thermophilus, Lactobacillus bulgaricus and Enterococcus faecium. DNA damage was significantly decreased by all bacteria used with the exception of Strep. thermophilus. Bif. Bb12 and Lact. plantarum showed the greatest protective effect against DNA damage. Incubation of faecal water with different concentrations of Bif. Bb12 and Lact. plantarum revealed that the decrease in genotoxicity was related to cell density. Non-viable (heat treated) probiotic cells had no effect on faecal water genotoxicity. In a second study, HT29 cells were cultured in the presence of supernatants of incubations of probiotics with various carbohydrates including known prebiotics; the HT29 cells were then exposed to faecal water. Overall, incubations involving Lact. plantarum with the fructooligosaccharide (FOS)-based prebiotics Inulin, Raftiline, Raftilose and Actilight were the most effective in increasing the cellular resistance to faecal water genotoxicity, whereas fermentations with Elixor (a galactooligosaccharide) and Fibersol (a maltodextrin) were less effective. Substantial reductions in faecal water-induced DNA damage were also seen with supernatants from incubation of prebiotics with Bif. Bb12. The supernatant of fermentations involving Ent. faecium and Bif. sp. 420 generally had less potent effects on genotoxicity although some reductions with Raftiline and Elixor fermentations were apparent.

In vitro evaluation of the antimicrobial activity of a range of probiotics against pathogens: Evidence for the effects of organic acids

The aim of this study was to investigate the antimicrobial properties of fifteen selected strains belonging to the Lactobacillus, Bifidobacterium, Lactococcus, Streptococcus and Bacillus genera against Gram-positive and Gram-negative pathogenic bacteria. In vitro antibacterial activity was initially investigated by an agar spot method. Results from the agar spot test showed that most of the selected strains were able to produce active compounds on solid media with antagonistic properties against Salmonella Typhimurium, Escherichia coli, Enterococcus faecalis, Staphylococcus aureus and Clostridium difficile. These results were also confirmed when cell-free culture supernatants (CFCS) from the putative probiotics were used in an agar well diffusion assay. Neutralization of the culture supernatants with alkali reduced the antagonistic effects. These experiments are able to confirm the capacity of potential probiotics to inhibit selected pathogens. One of the main inhibitory mechanisms may result from the production of organic acids from glucose fermentation and consequent lowering of culture pH. This observation was confirmed when the profile of organic acids was analysed demonstrating that lactic and acetic acid were the principal end products of probiotic metabolism. Furthermore, the assessment of the haemolytic activity and the susceptibility of the strains to the most commonly used antimicrobials, considered as basic safety aspects, were also studied. The observed antimicrobial activity was mainly genus-specific, additionally significant differences could be observed among species.

Genetic relatedness and phenotypic characteristics of Treponema associated with human periodontal tissues and ruminant foot disease

Treponema have been implicated recently in the pathogenesis of digital dermatitis (DID) and contagious ovine digital dermatitis (CODD) that are infectious diseases of bovine and ovine foot tissues, respectively. Previous analyses of treponemal 16S rDNA sequences, PCR-amplified directly from DID or CODD lesions, have suggested relatedness of animal Treponema to some human oral Treponema species isolated from periodontal tissues. In this study a range of adhesion and virulence-related properties of three animal Treponema isolates have been compared with representative human oral strains of Treponema denticola and Treponema vincentii. In adhesion assays using biotinylated treponemal cells, T denticola cells bound in consistently higher numbers to fibronectin, laminin, collagen type 1, gelatin, keratin and lactoferrin than did T. vincentii or animal Treponema isolates. However, animal DID strains adhered to fibrinogen at equivalent or greater levels than T denticola. All Treponema strains bound to the amino-terminal heparin l/fibrin I domain of fibronectin. 16S rDNA sequence analyses placed ovine strain UB1090 and bovine strain UB1467 within a cluster that was phylogenetically related to T vincentii, while ovine strain UB1466 appeared more closely related to T denticola. These observations correlated with phenotypic properties. Thus, T denticola ATCC 35405, GM-1, and Treponema UB1466 had similar outer-membrane protein profiles, produced chymotrypsin-like protease (CTLP), trypsin-like protease and high levels of proline iminopeptidase, and co-aggregated with human oral bacteria Porphyromonas gingivalis and Streptococcus crista. Conversely, T vincentii ATCC 35580, D2A-2, and animal strains UB1090 and UB1467 did not express CTLP or trypsin-like protease and did not co-aggregate with P. gingivalis or S. crista. Taken collectively, these results suggest that human oral-related Treponema have broad host specificity and that similar control or preventive strategies might be developed for human and animal Treponema-associated infections.