Disección aórtica tipo A

Paciente femenina de 63 años de edad con diagnóstico de disección aórtica tipo A.63 year old female patient with type A aortic dissectio

Modelo Méderi de gestión nutricional hospitalaria

Introduction: the need for nutritional care models, to address the problem of malnutrition in hospitals, involves developing mederi Nutrition Care Model in order to raise the quality of health care, and promote good practices of Clinical Nutrition. To describe the process of nutrition and metabolic support, aimed at measuring the effectiveness of the model, which is currently a center of national and international reference. Materials and methods: descriptive, evaluative, transversal and observational. Includes analysis of consolidated since the implementation of the model in 2008 through 2014. Information The number of study subjects was 163 575, variables to test the efficacy measures were: productivity and perceived quality of nutritional care. Results: made analysis of the key processes in which the model is based, nutritional adult and neonatal hospital care, nutritional support, supervision of food services, and teaching and research, is an increase in productivity of the service 591% , increasing the percentage of patient satisfaction from 50% to 95.8%. Conclusion: the success of a model of nutritional care lies in the consolidation of administrative, healthcare facilities, which in turn promotes the development of human talent, teaching and research in nutrition. © 2015, Grupo Aula Medica S.A. All Rights Reserved

Evaluación física matemática de la dinámica cardíaca aplicando la ley de Zipf-Mandelbrot

The law of Zipf-Mandelbrot is a power law, which has been observed in natural languages. A mathematical diagnosis of fetal cardiac dynamics has been developed with this law. Objective: To develop a methodology for diagnostic aid to assess the degree of complexity of adult cardiac dynamics by Zipf-Mandelbrot law. Methodology: A mathematical induction was done for this; two groups of Holter recordings were selected: 11 with normal diagnosis and 11 with acute disease of each group, one Holter of each group was chosen for the induction, the law of Zipf-Mandelbrot was applied to evaluate the degree of complexity of each Holter, searching similarities or differences between the dynamics. A blind study was done with 20 Holters calculating sensitivity, specificity and the coefficient kappa. Results: The complexity grade of a normal cardiac dynamics varied between 0.9483 and 0.7046, and for an acute dynamic between 0.6707 and 0.4228. Conclusions: A new physical mathematical methodology for diagnostic aid was developed; it showed that the degree of complexity of normal cardiac dynamics was higher than those with acute disease, showing quantitatively how cardiac dynamics can evolve to acute state

New insights into Clostridium Difficile (CD) infection in Latin America : Novel description of toxigenic profiles of diarrhea-associated to CD in Bogotá, Colombia

Clostridium difficile (CD) produces antibiotic associated diarrhea and leads to a broad range of diseases. The source of CD infection (CDI) acquisition and toxigenic profile are factors determining the impact of CD. This study aimed at detecting healthcare facility onset- (HCFO) and community-onset (CO) CDI and describing their toxigenic profiles in Bogotá, Colombia. A total of 217 fecal samples from patients suffering diarrhea were simultaneously submitted to two CDI detection strategies: (i) in vitro culture using selective chromogenic medium (SCM; chromID, bioMérieux), followed verification by colony screening (VCS), and (ii) molecular detection targeting constitutive genes, using two conventional PCR tests (conv. PCR) (conv.16S y conv.gdh) and a quantitative test (qPCR.16s). The CD toxigenic profile identified by any molecular test was described using 6 tests independently for describing PaLoc and CdtLoc organization. High overall CDI frequencies were found by both SCM (52.1%) and conv. PCR (45.6% for conv.16S and 42.4% for conv.gdh), compared to reductions of up to half the frequency by VCS (27.2%) or qPCR.16S (22.6%). Infection frequencies were higher for SCM and conv.16S regarding HCFO but greater for CO concerning conv.gdh, such differences being statistically significant. Heterogeneous toxigenic profiles were found, including amplification with lok1/3 primers simultaneously with other PaLoc markers (tcdA, tcdB or tcdC). These findings correspond the first report regarding the differential detection of CDI using in vitro culture and molecular detection tests in Colombia, the circulation of CD having heterogeneous toxigenic profiles and molecular arrays which could affect the impact of CDI epidemiology. © 2018 Muñoz, Ríos-Chaparro, Herrera, Soto-De Leon, Birchenall, Pinilla, Pardo-Oviedo, Josa, Patarroyo and Ramírez

Evaluation in 18 hours of Cardiac Dynamics with the Mathematical Law of Dynamic Systems

Introduction: an exponential law has been found for chaotic dynamic cardiac systems, making it possible to quantify the differences between normal and pathological cardiac dynamics. Methodology: 120 electrocardiographic records were analyzed, 40 corresponded to subjects within the limits of normality and 80 with different pathologies. For each holter the attractors generated with the data during 18 hours and throughout the dynamics were analyzed. The fractal dimension of the attractor and its spatial occupation were calculated. To these measures was applied the diagnosis mathematical evaluation previously developed, comparing the evaluation for 18 hours and for the whole registry; sensitivity, specificity and Kappa coefficient were finally calculated. Results: For the normal dynamics, the occupancy spaces in the Kp grid were between 200 and 381 for the evaluation of the whole holter, and between 201 and 384 in the evaluation during 18 hours, showing the closeness in the measurements, which allows that the decrease in the time of the evaluation is consistent, this same proximity was observed for the diseased and acute dynamics. Conclusion: It was evidenced the clinical applicability in 18 hours of the exponential law in the chaotic cardiac dynamics associated with arrhythmias showing to be useful for the prediction of the evolution towards acute states of the dynamic

Evaluation In 18 Hours Of Cardiac Dynamics With The Mathematical Law Of Dynamic Systems

Introducción: se ha encontrado una ley exponencial para sistemas cardíacos dinámicos caóticos, que permite cuantificar las diferencias entre dinámicas cardíacas normales y patológicas Metodología: Se analizaron 120 registros electrocardiográficos, 40 correspondían a sujetos dentro de los límites de la normalidad y 80 con diferentes patologías. . Para cada holter se analizaron los atractores generados con los datos durante 18 horas y a lo largo de la dinámica. Se calculó la dimensión fractal del atractor y su ocupación espacial. A estas medidas se aplicó la evaluación matemática de diagnóstico previamente desarrollada, comparando la evaluación por 18 horas y para todo el registro; finalmente se calculó la sensibilidad, especificidad y coeficiente Kappa. Resultados: Para la dinámica normal, los espacios de ocupación en la cuadrícula Kp estuvieron entre 200 y 381 para la evaluación del holter completo, y entre 201 y 384 en la evaluación durante 18 horas, mostrando la cercanía en las mediciones, lo que permite que la disminución en el tiempo de la evaluación sea consistente, esta misma proximidad se observó para la dinámica enferma y aguda.Conclusión: Se evidenció la aplicabilidad clínica en 18 horas de la ley exponencial en el caótico dinámica cardíaca asociada a arritmias demostrando ser útil para la predicción de la evolución hacia estados agudos de la dinámica.Introduction: an exponential law has been found for chaotic dynamic cardiac systems, making it possible to quantify the differences between normal and pathological cardiac dynamics.Methodology: 120 electrocardiographic records were analyzed, 40 corresponded to subjects within the limits of normality and 80 with different pathologies. For each holter the attractors generated with the data during 18 hours and throughout the dynamics were analyzed. The fractal dimension of the attractor and its spatial occupation were calculated. To these measures was applied the diagnosis mathematical evaluation previously developed, comparing the evaluation for 18 hours and for the whole registry; sensitivity, specificity and Kappa coefficient were finally calculated.Results: For the normal dynamics, the occupancy spaces in the Kp grid were between 200 and 381 for the evaluation of the whole holter, and between 201 and 384 in the evaluation during 18 hours, showing the closeness in the measurements, which allows that the decrease in the time of the evaluation is consistent, this same proximity was observed for the diseased and acute dynamics.Conclusion: It was evidenced the clinical applicability in 18 hours of the exponential law in the chaotic cardiac dynamics associated with arrhythmias showing to be useful for the prediction of the evolution towards acute states of the dynamics

High frequency of toxigenic Clostridium difficile and Clostridium perfringens coinfection among diarrheic patients at health care facility-onset (HCFO) and community-onset (CO) centers in Bogotá, Colombia

Background: The aim of this study was to evaluate the frequency of toxigenic C. difficile and C. perfringens infections at health care facility-onset (HCFO) and community-onset (CO), in two health care centers (HCC) in Bogotá, Colombia. A total of 220 stool samples from patients presenting diarrhea acquired at HCFO or CO were analyzed by several PCR tests. Results: We found that 65.5% (n = 144) of the population had C. difficile infection, followed by toxigenic C. difficile with 57.3% (n = 126), and finally toxigenic C. perfringens with a frequency of 32.7% (n = 72). Conclusions: This study is the first molecular detection and characterization of C. difficile and C. perfringens in HCFO and CO in Latin America and demonstrates a relevant frequency of these two species, including coinfection and strikingly diverse toxigenic profiles, especially in the CO. © 2019 The Author(s)

Proportional entropy of normal cardiac dynamic and with arrhythmia in the intensive care unit

Antecedentes: Con base en la teoría de la probabilidad y las proporciones de la entropía no equiprobable en el contexto de la teoría de los sistemas dinámicos se desarrolló una metodología de evaluación de la dinámica cardiaca. Objetivo: Confirmar la aplicabilidad clínica de la metodología diagnóstica basada en la probabilidad y la entropía para pacientes con diferentes tipos de arritmia evaluando el grado de agudización en la UCI por medio de sus proporciones características. Métodos: Se analizaron 80 registros Holter de la UCI con diagnóstico de arritmia y 20 normales. Se enmascararon las conclusiones clínicas del Holter y se tomaron de este los valores máximo, mínimo de frecuencia cardiaca y número total de latidos por hora para construir el atractor numérico para cada dinámica. Se calculó la probabilidad, la entropía, la relación S/k, y se evaluaron las proporciones de la entropía, estableciendo su diagnóstico matemático y cuantificando su nivel de gravedad. Resultados: Se demostró que la metodología diferencia en todos los casos dinámicas normales de anormales, obteniendo valores de sensibilidad y especificidad de 100% y coeficiente Kappa de 1, evidenciando que es posible además establecer cuantitativamente el grado de agudización. Conclusiones: La metodología desarrollada es útil en la práctica clínica para correlacionar la gravedad de las arritmias con predicciones de agudización físicas y matemáticas.Background: Based on the theory of probability and not equiprobable entropy ratios in the context of dynamical systems theory, a methodology for cardiac dynamic evaluation was developed. Objectives: To confirm the clinical applicability of the diagnostic methodology based on probability and entropy for patients with different types of arrhythmia assessing the degree of intensification in the ICU through its characteristic proportions. Methods: 80 Holter records from ICU diagnosed with arrhythmia and 20 normal were analyzed. Holter clinical findings were masked and were taken from them the maximum and minimum values of heart rate and total number of beats per minute to build the numerical attractor for each dynamics. Probability, entropy, S/k ratio, and proportions of entropy were evaluated, establishing its mathematical diagnosis and quantifying its severity level. Results: It was shown that the methodology difference in all cases normal of abnormal dynamics, obtaining a sensitivity and specificity of 100 % and Kappa coefficient of 1, showing that it is also possible to establish quantitatively the degree of exacerbation. Conclusions: The methodology developed is useful in clinical practice to correlate the severity of arrhythmias with physical and mathematical predictions of exacerbation

An epidemiological and molecular study regarding the spread of vancomycin-resistant Enterococcus faecium in a teaching hospital in Bogotá, Colombia 2016

Background: Enterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcare-associated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide. Due to molecular biology techniques' higher costs, the approach for identifying and controlling infectious diseases in developing countries has been based on clinical and epidemiological perspectives. Nevertheless, after an abrupt vancomycin-resistant Enterococcus faecium dissemination in the Méderi teaching hospital, ending up in an outbreak, further measures needed to be taken into consideration. The present study describes the vancomycin-resistant Enterococcus faecium pattern within Colombian's largest installed-bed capacity hospital in 2016. Methods: Thirty-three vancomycin-resistant Enterococcus faecium isolates were recovered during a 5-month period in 2016. Multilocus variable-number tandem-repeat analysis was used for molecular typing to determine clonality amongst strains. A modified time-place-sequence algorithm was used to trace VREfm spread patterns during the outbreak period and estimate transmission routes. Results: Four clonal profiles were identified. Chronological clonal profile follow-up suggested a transitional spread from profile 'A' to profile 'B', returning to a higher prevalence of 'A' by the end of the study. Antibiotic susceptibility indicated high-level vancomycin-resistance in most isolates frequently matching vanA gene identification. Discussion: Transmission analysis suggested cross-contamination via healthcare workers. Despite epidemiological control of the outbreak, post-outbreak isolates were still being identified as having outbreak-related clonal profile (A), indicating reduction but not eradication of this clonality. This study supports the use of combined molecular and epidemiological strategies in an approach to controlling infectious diseases. It contributes towards a more accurate evaluation of the effectiveness of the epidemiological measures taken regarding outbreak control and estimates the main cause related to the spread of this microorganism. © 2019 The Author(s)

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030