Análise das infecções associadas à assistência à saúde antes e durante a pandemia de COVID-19 em um hospital colombiano

Highlights Gram-negative bacilli prevail in Healthcare-Associated Infections, revealing a microbial landscape shaped by COVID-19. Bacteremia emerges as a high-risk factor, especially impacting immunosuppressed or oncologic patients in our Colombian healthcare institution. Cephalosporin and carbapenem resistance pose a significant hurdle, emphasizing the evolving trends amidst the COVID-19 Impact on Healthcare Infections. Our study underscores the transformative impact of COVID-19 on healthcare infections, spotlighting emerging patterns and challenges in a high-complexity Colombian institution. Introduction: Healthcare-associated infections pose a significant challenge, contributing to hospital morbidity and mortality. Objective: To describe the behavior of Healthcare Associated Infections before and during the pandemic reported to a high-complexity health institution in Colombia. Material and Methods: In our retrospective observational study on Healthcare-Associated Infections (HAIs), we analyzed data from all in-patients diagnosed with HAIs between 2018 and 2020. This included clinical, demographic, microbiological, and microbial susceptibility information collected from the Committee on Nosocomial Infections' prospective database. Data from 391 isolates were obtained using Whonet software for antimicrobial resistance surveillance. Results: We found 504 cases of HAIs (2018-2020) with an overall in-hospital infection rate of 2.55/1000 patient-days. The median age for pediatric patients was 5 years, and for adults, 56 years, with 57% male. The leading admission diagnoses were oncologic disease complications (31%). Bacteremia had a 30-day mortality rate of 13%, predominantly catheter-associated (37%). Gram-negative bacilli, notably  Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represented 58% cases of HAI. Discussion: The critical need for specific interventions and antimicrobial management to control HAIs, especially given the challenges posed by the COVID-19 pandemic, is highlighted. Conclusions: This is the first report on HAIs incidence at a tertiary hospital in Bucaramanga, Santander (Colombia). Bacteremia was predominant; 75% of HAIs patients had comorbidities. Gram-negative bacilli prevailed; a notable rise in ICU respiratory infections occurred during the 2020 COVID-19 pandemic. Resistance to cephalosporins and carbapenems was prevalent. How to cite this article: Wintaco Luz M, Quintero-Lesmes Doris C, Vargas-Soler José A, Barrera Diego M, Palacio Laura N, Granados Ulises, Uribe Luis G “Analysis Healthcare Infections before and during of COVID-19 pandemic in a Colombian hospital”. Revista Cuidarte. 2024;15(1):e3624.  http://dx.doi.org/10.15649/cuidarte.3624Introducción: Las infecciones asociadas a la atención en salud (IAAS) representan un reto porque estas contribuyen a la morbilidad y mortalidad hospitalaria.  Objetivo: Describir el comportamiento de las IAAS antes y durante la pandemia, las cuales fueron reportadas a una institución de salud de alta complejidad en Colombia.  Materiales y métodos: En nuestro estudio observacional retrospectivo de las IAAS, analizamos los datos de todos los pacientes hospitalizados que fueron diagnosticados con una IAAS entre 2018 y 2020. Esto incluyó información clínica, demográfica, microbiológica y de susceptibilidad microbiana recabada de la base de datos prospectiva del Comité de Infecciones Nosocomiales. Los datos de 391 aislamientos se obtuvieron utilizando el programa informático Whonet para la vigilancia de la resistencia a los antimicrobianos. Resultados: Encontramos 504 casos de IAAS entre 2018 y 2020 con una tasa global de infección intrahospitalaria de 2,55/1000 pacientes al día. La mediana de edad de los pacientes pediátricos fue de 5 años y la de los adultos de 56 y el 57% de ellos eran varones. Los principales diagnósticos de ingreso fueron complicaciones oncológicas (31%). La bacteriemia tuvo una tasa de mortalidad a los 30 días del 13%, predominantemente asociada al uso de catéter (37%). Los bacilos gramnegativos, sobre todo Klebsiella pneumoniae, Escherichia coli y Pseudomonas aeruginosa, representaron el 58% de los casos de IAAS. Discusión: Se destaca la necesidad crítica de contar con intervenciones específicas y de gestión antimicrobiana para controlar las IAAS, especialmente teniendo en cuenta los retos que planteó la pandemia de Covid-19.  Conclusiones: Este es el primer informe sobre la incidencia de las IAAS en un hospital terciario de Bucaramanga, Santander (Colombia). La bacteriemia predominó y 75% de los pacientes con IAAS presentaban comorbilidades. Predominaron los bacilos gramnegativos y se produjo un notable aumento de las infecciones respiratorias en las UCI durante la pandemia Covid-19 de 2020. Fue prevalente la resistencia a las cefalosporinas y a los carbapenémicos. Como citar este artículo: Wintaco Luz M, Quintero-Lesmes Doris C, Vargas-Soler José A, Barrera Diego M, Palacio Laura N, Granados Ulises, Uribe Luis G “Analysis Healthcare Infections before and during of COVID-19 pandemic in a Colombian hospital”. Revista Cuidarte. 2024;15(1):e3624.  http://dx.doi.org/10.15649/cuidarte.3624Introdução: As infeções associadas aos cuidados de saúde representam um desafio significativo, contribuindo para a morbilidade e mortalidade hospitalar.   Objetivo: Descrever o comportamento das Infecções Relacionadas à Assistência à Saúde antes e durante a pandemia notificadas a uma instituição de saúde de alta complexidade na Colômbia. Material e Métodos: Em nosso estudo observacional retrospectivo sobre Infecções Relacionadas à Assistência à Saúde (IRAS), analisamos dados de todos os pacientes internados com diagnóstico de IRAS entre 2018 e 2020. Isso incluiu informações clínicas, demográficas, microbiológicas e de suscetibilidade microbiana coletadas do Comitê no banco de dados prospectivo de infecções hospitalares. Os dados de 391 isolados foram obtidos utilizando o software Whonet para vigilância da resistência antimicrobiana. Resultados:  Foram encontrados 504 casos de IRAS (2018-2020) com taxa global de infecção hospitalar de 2,55/1.000 pacientes-dia. A idade média para pacientes pediátricos foi de 5 anos, para adultos 56 anos, sendo 57% do sexo masculino. Os principais diagnósticos de admissão foram complicações  de doenças oncológicas (31%). A bacteremia teve uma taxa de mortalidade em 30 dias de 13%, predominantemente   associada ao cateter (37%). Bacilos Gram-negativos, notadamente Klebsiella pneumoniae, Escherichia coli e Pseudomonas aeruginosa, representaram 58% dos casos de IRAS. Discussão: É destacada a necessidade crítica de intervenções específicas e gestão antimicrobiana para controlar as IACS, especialmente tendo em conta os desafios colocados pela pandemia da COVID-19. Conclusões: Este é o primeiro relatório sobre a incidência de IRAS em um hospital terciário em Bucaramanga, Santander (Colômbia). A bacteremia foi predominante; 75% dos pacientes com IRAS apresentavam comorbidades. Prevaleceram bacilos Gram-negativos; um aumento notável nas infecções respiratórias em UTI ocorreu durante a pandemia de COVID-19 de 2020. A resistência à cefalosporina e aos carbapenêmicos foi prevalente. Como citar este artículo: Wintaco Luz M, Quintero-Lesmes Doris C, Vargas-Soler José A, Barrera Diego M, Palacio Laura N, Granados Ulises, Uribe Luis G “Analysis Healthcare Infections before and during of COVID-19 pandemic in a Colombian hospital”. Revista Cuidarte. 2024;15(1):e3624.  http://dx.doi.org/10.15649/cuidarte.362

Spiral arteries in second trimester of pregnancy : when is it possible to define expected physiological remodeling as abnormal?

Q2Q2After undergoing remodeling, uterine spiral arteries turn into wide, flexible tubes, with low resistance. If remodeling does not occur, spontaneous abortions, intrauterine growth restriction, and pregnancy-related hypertensive disorders can ensue. Arterial transformation begins at a very early gestational stage; however, second quarter pregnancy histopathological samples have yet to pinpoint the exact moment when abnormal remodeling transpires. We examined 100 samples, taken from consecutive abortions at 12–23 gestational weeks. Following Pijnenborg and Smith guidelines, blinded pathologists analyzed clinical data on remod eling stages. Lab results showed that arterial remodeling is not synchronic in all vessels; a single sample can include various remodeling stages; neither is remodeling homogenous in a single vessel: change may be occurring in one part of the vessel, but not in another. To our knowledge, no one has published this finding. In the examined age group, Smith stage IV predominates; around week 14, substantial muscle and endothelium loss takes place. After week 17, endovascular or fibrin trophoblast does not usually occur. Although scant consensus exists on what defines preeclampsia etiology, it is clear that it involves abnormal remodeling in decidua vessels. Improved understanding requires further knowledge on both the physiological and pathological aspects of the remodeling process. We observed that muscle and endothelial tissues disappear from weeks 14–17, after which time reendothelization predominates. We list the expected proportion of spiral artery changes for each gestational age which, to date, has not been available.https://orcid.org/0000-0002-7147-425XN/

Función del profesional en enfermería en la atención del acoso escolar en niños, niñas y adolescentes

Actualmente se ha incrementado y visualizado el fenómeno del acoso escolar o bullying(por su traducción al inglés); sin embargo, llama la atención que esta práctica ha  existido durante mucho tiempo, pero es hasta ahora donde se evidencian las consecuencias que genera en los niños, niñas y adolescentes que, según diversos estudios, puede generar suicidios en esta población. Diversas profesiones han profundizado en el tema; a pesar de ello, no se ha visto avance en el manejo y prevención del acoso y se ha incrementado el número de casos que llegan a instituciones de salud relacionados con los daños físicos y psicológicos que se ocasionan en el niño víctima de acoso escolar. Es un reto para enfermería poder abordar esta situación y plantear posibles estrategias de intervención para su manejo y prevención, no solo en la víctima y victimario sino también en la familia, escuelas e instituciones de salud en los diferentes niveles de atención, ya que cuenta con las herramientas para diseñar intervenciones en el manejo de la comunidad y del paciente institucionalizado. &nbsp

Analysis of Healthcare-associated Infections before and during the COVID-19 pandemic in a Colombian hospital

Introduction: Healthcare-associated infections pose a significant challenge, contributing to hospital morbidity and mortality. Objective: To describe the behavior of Healthcare Associated Infections before and during the pandemic reported to a high-complexity health institution in Colombia. Material and Methods: In our retrospective observational study on Healthcare-Associated Infections (HAIs), we analyzed data from all in-patients diagnosed with HAIs between 2018 and 2020. This included clinical, demographic, microbiological, and microbial susceptibility information collected from the Committee on Nosocomial Infections' prospective database. Data from 391 isolates were obtained using Whonet software for antimicrobial resistance surveillance. Results: We found 504 cases of HAIs (2018-2020) with an overall in-hospital infection rate of 2.55/1000 patient-days. The median age for pediatric patients was 5 years, and for adults, 56 years, with 57% male. The leading admission diagnoses were oncologic disease complications (31%). Bacteremia had a 30-day mortality rate of 13%, predominantly catheter-associated (37%). Gram-negative bacilli, notably Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represented 58% cases of HAI. Discussion: The critical need for specific interventions and antimicrobial management to control HAIs, especially given the challenges posed by the COVID-19 pandemic, is highlighted. Conclusions: This is the first report on HAIs incidence at a tertiary hospital in Bucaramanga, Santander (Colombia). Bacteremia was predominant; 75% of HAIs patients had comorbidities. Gram-negative bacilli prevailed; a notable rise in ICU respiratory infections occurred during the 2020 COVID-19 pandemic. Resistance to cephalosporins and carbapenems was prevalent

Diagnosis of embryonic loss and very early detection of non-pregnant cows by Doppler ultrasound Summary

Los productores lecheros enfrentan grandes desafíos que amenazan los resultados económicos del sistema, siendo la eficiencia reproductiva uno de los principales factores para tener en cuenta. Para alcanzar el objetivo de un parto por año/vaca y mantener así la rentabilidad del tambo, es primordial lograr la mayor cantidad de vacas inseminadas en el menor tiempo posible. Tanto las vacas que fallan en la concepción como aquellas que padecen de pérdidas embrionarias son en las que hay que focalizar los esfuerzos para detectarlas e inseminarlas nuevamente en forma rápida y de esta manera acortar el intervalo de tiempo entre el parto y la nueva concepción. Los objetivos de este estudio fueron 1) validar la ultrasonografía (USG) Doppler para la detección de vacas no gestantes a los 19-20 d post-IA y 2) determinar las pérdidas embrionarias entre los 19 y 34 días de gestación en vacas de tambo. Al día 19-20 post IA, se evaluó la perfusión sanguínea del cuerpo lúteo (CL-FS) por USG Doppler en modo color y en modo power en todas las vacas ingresadas en el estudio (n= 131). En la misma visita también se evaluó la ecotextura uterina mediante USG en modo B para determinar si dicha evaluación podría aportar datos que mejoraran el diagnóstico de no-preñez al día 19-20 post IA. Además, se obtuvieron muestras de sangre para la medición de progesterona (P4) y para determinar la expresión de genes relacionados con la gestación temprana (genes estimulados por el interferón tau; ISG) mediante PCR en tiempo real. Finalmente se realizó el diagnóstico de gestación a los 33-34 d post-IA mediante USG en modo B. El modo Color de la USG Doppler mostró alta precisión para detectar vacuidad al pie de la vaca usando la categoría ≤1 (escala 0-4) en todos los cuadrantes del CL. La tasa de no-preñez diagnosticada USG Doppler a los 19-20 d post-IA fue de 38,9 % (51/131), mientras que el 62,6 % (82/131)Dairy producers face important challenges threatening the system's financial results, making reproductive efficiency one of the most important. To achieve the goal of a calving per cow/year and thus maintain the profitability of the dairy, it is essential to achieve a high number of inseminated cows in the shortest possible time. Cows that fail to conceive and those that suffer embryo loss are the ones that we should focus on detecting and inseminating them promptly, shortening the time interval between calving and new conception. The objectives of this study were 1) to assess the ultrasound (USG) Doppler for the detection of non-pregnant cows at 19- 20 d post-IA and 2) to determine the embryo loss between 19-34 d of pregnancy in dairy cows. In all cows included in the study (n=131), the corpus luteum (CL-FS) perfusion was assessed by the color and the power mode of the Doppler USG. In addition, the uterine echotexture was evaluated by USG mode B to predict if, including this information, the precision of the USG Doppler at 19-20 d post AI improved. At the same time, blood samples were collected to measure progesterone (P4) and to determine the expression of genes related to early pregnancy (interferon-stimulated genes; ISG) by real-time PCR. Finally, the pregnancy diagnosis was performed at 33-36 d after IA using USG mode B. Color mode showed higher precision in detecting non-pregnant cows using category ≤1 (scale 0-4) in all CL quadrants. The non-pregnancy rate at 19-20 d post-AI was 38,9% (51/131) by CL-FS Doppler USG. In contrast, the non-pregnancy rate at 33-34d post-AI was 62,6 (82/131) by B-mode USG based on the lack of embryo visualization. The presence of a thick endometrial layer and the visualization of the uterine stratum vascular at 19-20 d post-AI was related to the non-pregnancy diagnosis at 33-34 d post-AI (p1ng/ml at 19-20 d post-AI, we detected that 28,1% of the cows potentially lost the pregnancy between 19-34 d. Doppler USG allowed the detection of non-pregnant cows between 19-20 d post-AI, and the additional B-mode ultrasound evaluation of the uterine echo structure improved the detection of non-pregnant cows. The early diagnosis using these techniques is a valuable and quick tool to be implemented in resynchronization protocols to minimize open days.Fil: Lorenti, N. S.. Practica Privada; ArgentinaFil: Madoz, Laura Vanina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Teriogenología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rearte, Ramiro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Teriogenología; ArgentinaFil: Quintero Rodriguez, Luis Ernesto. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Teriogenología; ArgentinaFil: Migliorisi, Ana Lorena. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Teriogenología; ArgentinaFil: Jaureguiberry, María. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Teriogenología; ArgentinaFil: Gabler, C.. Freie Universität Berlin; AlemaniaFil: Drillich, M.. University of Veterinary Medicine; AustriaFil: de la Sota, Rodolfo Luzbel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Teriogenología; Argentin

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed. Methods: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective. Results: The estimated average cost of ADHD per year per child/adolescent was €5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (€3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (€2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (€7654 versus €5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012). Conclusions: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorde

Seed storage conditions change the germination pattern of clonal growth plants in Mediterranean salt marshes.

8 páginas, 4 tablas, 8 figuras.The effect of salinity level and extended exposure to different salinity and flooding conditions on germination patterns of three saltmarsh clonal growth plants (Juncus subulatus, Scirpus litoralis, and S. maritimus) was studied. Seed exposure to extended flooding and saline conditions significantly affected the outcome of the germination process in a different, though predictable, way for each species, after favorable conditions for germination were restored. Tolerance of the germination process was related to the average salinity level measured during the growth/germination season at sites where established individuals of each species dominated the species cover. No relationship was found between salinity tolerance of the germination process and seed response to extended exposure to flooding and salinity conditions. The salinity response was significantly related to the conditions prevailing in the habitats of the respective species during the unfavorable (nongrowth/nongermination) season. Our results indicate that changes in salinity and hydrology while seeds are dormant affect the outcome of the seed-bank response, even when conditions at germination are identical. Because these environmental-history-dependent responses differentially affect seed germination, seedling density, and probably sexual recruitment in the studied and related species, these influences should be considered for wetland restoration and managementFinancial support from the Spanish Ministry of the Environment (MMA, project 05/99) and the Junta de Andalucía (research group 4086)enabled us to carry out the present work.Peer reviewe

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Seed storage conditions change the germination pattern of clonal growth plants in Mediterranean salt marshes.

8 páginas, 4 tablas, 8 figuras.The effect of salinity level and extended exposure to different salinity and flooding conditions on germination patterns of three saltmarsh clonal growth plants (Juncus subulatus, Scirpus litoralis, and S. maritimus) was studied. Seed exposure to extended flooding and saline conditions significantly affected the outcome of the germination process in a different, though predictable, way for each species, after favorable conditions for germination were restored. Tolerance of the germination process was related to the average salinity level measured during the growth/germination season at sites where established individuals of each species dominated the species cover. No relationship was found between salinity tolerance of the germination process and seed response to extended exposure to flooding and salinity conditions. The salinity response was significantly related to the conditions prevailing in the habitats of the respective species during the unfavorable (nongrowth/nongermination) season. Our results indicate that changes in salinity and hydrology while seeds are dormant affect the outcome of the seed-bank response, even when conditions at germination are identical. Because these environmental-history-dependent responses differentially affect seed germination, seedling density, and probably sexual recruitment in the studied and related species, these influences should be considered for wetland restoration and managementFinancial support from the Spanish Ministry of the Environment (MMA, project 05/99) and the Junta de Andalucía (research group 4086)enabled us to carry out the present work.Peer reviewe