Minor malformations and other morphological abnormalities in series of fetal and perinatal necropsies in Bogota

OBJETIVO: Revisar las definiciones de los cambios morfológicos y clasificaciones de las alteraciones observadas en necropsias fetales y neonatales y analizar su relación con la causa de muerte y los demás padecimientos fetales y maternos conocidos. MATERIALES Y MÉTODOS: Estudio observacional y descriptivo de necropsias fetales y perinatales para detallar las características anatómicas de fetos y recién nacidos excluidas de los criterios de normalidad y su correlación con los factores placentarios, las condiciones clínicas maternas, y los desenlaces fetales y del recién nacido. RESULTADOS: En 87 necropsias perinatales se observó predominio de los hallazgos de malformaciones en el sexo femenino, en madres entre 18 y 35 años y en individuos con maceración severa. Las malformaciones mayores más frecuentes ocurrieron en la cara, el abdomen y el esqueleto. En las malformaciones menores predominaron las esqueléticas (clinodactilia (36.75%), braquidactilia (23.52%), brecha de la separación entre el primer y segundo dedos del pie (Sandal gap) (14.7%); faciales (puente nasal deprimido (58.24%), glosoptosis (16.64%) hipertelorismo (8.32%)) y de cuello (alado (31.25%), corto (37.5%) y elongado (18.75%)). Como rupturas se encontraron bandas amnióticas que abarcaban amplios segmentos (2.29%). La deformidad más frecuente fue el pie en equino varo (6.89%). CONCLUSIÓN: En nuestra observación interdisciplinaria enfocada a las muertes perinatales se encontró relación entre cromosomopatía y aborto retenido. Los cambios morfológicos más frecuentes correspondieron a malformaciones menores. Todo cambio en la morfología de un recién nacido o de un feto puede ser la clave del diagnóstico principal, por ello deben reconocerse y distinguirse entre sí para orientar el futuro obstétrico de las familias, brindar consejería genética y lograr que trasciendan a la salud pública.1-10BACKGROUND: During autopsy morphological abnormalities should be classified in major or minor malformations, disruptions, sequences, deformities, trauma, changes attributable to fixation, intrauterine death, or manipulation, among others. Appropriate counseling in genetics and obstetrics is going to depend on this approach. In the current study we want to know the frequencies of morphological changes and their association with clinical presentations. MATERIALS AND METHODS: Observational descriptive study carried out on consecutive perinatal autopsies product from natural deaths in which morphological changes were classified. RESULTS: In 87 perinatal autopsies a female predominance was observed, as well as a major occurrence in mothers between 18 and 35 years and in individuals with severe maceration. The most frequent major malformations were found in the face, abdomen and skeleton. Among minor malformations, the skeletal ones were the most predominant (clinodactyly (36.75%), brachydactyly (23.52%), sandal gap (14.7%)); followed by facial anomalies (depressed nasal bridge (58.24%), glossoptosis (16.64%), hypertelorism (8.32%); and, neck defects (winged neck (31.25%), short (37.5%), elongated (18.75%). Among disruptions, amniotic bands were found covering large segments (2.29%). The most frequent deformity was equinovarus foot (6.89%). CONCLUSIONS: In the present interdisciplinary observation focused on perinatal deaths, a relation between cromosomopathies and severe maceration was identified. The most frequent morphological features corresponded to minor malformations. Any change in the morphology of a newborn or a fetus may be the key to the main diagnosis. For this reason, morphological changes must to be recognized and distinguished among them to guide the reproductive future of the families, provide genetic counseling and achieve a positive impact on public health

Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals : Findings of the International Nosocomial Infection Control Consortium

Q2Q1Artículo original349-356Objective. To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium. Methods. We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days. Results. During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)–related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P = .002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P = .19). Conclusion. The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia

Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity