Latin America: Should We Be Worried about Zika Virus

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Meningitis neonatal: estudio multicéntrico en Lima, Perú

Antecedentes: La meningitis es una causa importante de morbimortalidad neonatal. Sin embargo, no se conoce bien el comportamiento epidemiológico y clínico de la enfermedad en nuestra población. Objetivo: Determinar la incidencia, características clínicas y del LCR, etiología y complicaciones de la enfermedad. Materiales y métodos: Se realizó un estudio multicéntrico prospectivo en 6 hospitales en la ciudad de Lima durante un año. Resultados: La incidencia hospitalaria fue de 1.4 casos por mil nacidos vivos. Fueron incluidos 60 casos, 30% (18/60) fueron tempranos y 70% (42/60) tardíos. Los factores de riesgo maternos asociados fueron líquido amniótico meconial e infección de tracto urinario. El 58.8% (30/51) presentó controles prenatales insuficientes. El factor neonatal más asociado fue sepsis (50%). Los síntomas principales fueron fiebre, irritabilidad, hipoactividad y dificultad respiratoria. En el LCR destacó la pleocitosis, sin predominio de PMN, hipoglicorraquia y proteinorraquia. Los patógenos aislados con mayor frecuencia fueron E. coli y L. monocytogenes. Del total de casos que desarrollaron complicaciones, el 73.3% corresponde a pretérminos. Conclusiones: La incidencia hospitalaria fue 1.4 por mil nacidos vivos, siendo diez veces superior la ocurrencia en prematuros. La dificultad respiratoria fue el síntoma más frecuente en la forma temprana, mientras que fiebre e irritabilidad en los casos tardíos. El LCR mostró pleocitosis sin predominio de PMN. Los gérmenes más frecuentes fueron E. coli y L. monocytogenes. La ventriculitis e hidrocefalia fueron las complicaciones neurológicas más comunes

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Latin America: Should We Be Worried about Zika Virus

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A retrospective analysis of medications associated with pityriasis rosea reported in the FDA adverse events reporting system

Pityriasis rosea (PR) is an acute exanthematous disease with an uncertain physiopathology, increasingly recognized as potentially drug induced. This study aims to investigate medication triggers associated with PR by analyzing cases reported in the FDA Adverse Event Reporting System (FAERS) database. A retrospective review of 343 PR cases reported in the FAERS database from January 1, 1998, to March 31, 2024, was conducted. Reporting odds ratios (ROR) were calculated to assess associations between PR and specific drug classes, including tumor necrosis factor (TNF) inhibitors and angiotensin-converting enzyme (ACE) inhibitors. Logistic regression analysis evaluated the influence of factors such as sex, age group, and seriousness of outcomes on the occurrence of PR. Females represented 56.3% of cases and the 18-64 age group comprised 55.4% of cases. TNF inhibitors were significantly associated with PR (ROR = 4.1881 [3.1970-5.4865], P < 0.0001), particularly infliximab (ROR = 6.5284 [3.9523-10.7837], P < 0.0001), etanercept (ROR = 3.4921 [2.2873-5.3315], P < 0.0001), and adalimumab (ROR = 3.086 [2.0213-4.7115], P < 0.0001). ACE inhibitors were also associated with PR (ROR = 9.9808 [6.0423-16.4864], P < 0.0001), with higher odds in older patients (OR 14.08 [4.2-47.2], P < 0.0001) and those reporting serious outcomes (OR 9.53 [1.24-72.99], P = 0.03). Based on the FAERS, there has been a consistent rise in PR cases, with TNF inhibitors and ACE inhibitors being associated medication classes tied to PR. Given the limited literature on drug-related triggers and patient demographics, we aimed to highlight the characteristics of PR cases that could enhance awareness and inform better clinical outcomes for affected patients

Meningitis neonatal: estudio multicéntrico en Lima, Perú

Objetivo: Determinar la incidencia y las características clínicas, bacteriológicas y del líquido cefalorraquídeo de la meningitis neonatal en hospitales de Lima. Materiales y métodos: Se realizó un estudio observacional, multicéntrico en seis hospitales de la ciudad de Lima, con una vigilancia epidemiológica durante un año. Resultados: La incidencia acumulada hospitalaria fue de 1,4 casos por mil nacidos vivos. Fueron incluidos 53 casos de meningitis neonatal, 34% (18/53) fueron tempranos y 66% (35/53) tardíos. Los factores maternos asociados fueron líquido amniótico meconial e infección de tracto urinario. El 58,8% (30/51) presentó controles prenatales insuficientes. El factor neonatal más asociado fue sepsis. Los principales síntomas fueron fiebre, irritabilidad, hipoactividad y dificultad respiratoria. En el líquido cefalorraquídeo (LCR) se destacó la pleocitosis, sin predominio de polimorfonucleares (PMN), hipoglucorraquia y proteinorraquia. Los patógenos aislados con mayor frecuencia fueron Escherichia coli y Listeria monocytogenes. Conclusiones: La incidencia hospitalaria de meningitis neonatal fue de 1,4 por mil nacidos vivos, siendo diez veces mayor en prematuros. La dificultad respiratoria fue el síntoma más frecuente en la forma temprana, mientras que la fiebre e irritabilidad en la forma tardía. El LCR mostró pleocitosis sin predominio de PMN. Los gérmenes más frecuentes fueron Escherichia coli y Listeria monocytogenes. La ventriculitis e hidrocefalia fueron las complicaciones neurológicas más comunes.</jats:p