Epidemiology and Outcomes of Bloodstream Infections in Patients With Solid Tumors in a Central American Population at Mexico Hospital, San Jose, Costa Rica

Purpose Bloodstream infections (BSIs) are an important cause of mortality in patients with solid tumors. We conducted a retrospective study to evaluate the epidemiologic profile and mortality of patients with solid tumors who have BSIs and were admitted to Mexico Hospital. This is the first study in Costa Rica and Central America describing the current epidemiologic situation. Methods We analyzed the infectious disease database for BSIs in patients with solid tumors admitted to Mexico Hospital from January 2012 to December 2014. Epidemiology and mortality were obtained according to microorganism, antibiotic sensitivity, tumor type, and presence of central venous catheter (CVC). Descriptive statistics were used. Results A total of 164 BSIs were recorded, the median age was 58 years, 103 patients (63%) were males, and 128 cases of infection (78%) were the result of gram-negative bacilli (GNB). Klebsiella pneumoniae (21%), Escherichia coli (21%), and Pseudomonas aeruginosa (15%) were the most common microorganisms isolated. Gram-positive cocci (GPC) were found in 36 patients, with the most frequent microorganisms being Staphylococcus aureus (10%) and Staphyloccocus epidermidis (6%). With respect to tumor type, BSIs were more frequent in the GI tract (57%) followed by head and neck (9%) and genitourinary tract (8%). Regarding antibiotic susceptibility, only 17% (GNB) expressed extended-spectrum beta-lactamase and 12% (GPC) had methicillin resistance. Patients with CVCs (n = 59) were colonized mainly by GNB (78%). Overall the mortality rate at 30 days was about 30%. Conclusion GNB are the most frequent cause of BSIs in solid tumors and in patients with CVCs. GI cancers had more BSIs than other sites. Mortality and antibiotic sensitivity remained stable and acceptable during this observational period in this Latin American population.UCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin

Modernización del Sistema Aduanero y su vinculación con la sociedad civil

Informe de investigación--Universidad de Costa Rica, Vicerrectoría de Acción Social, Trabajo Comunal Universitario. 2012. Para mayor información puede escribir a [email protected] documento es una guía a los agroexportadores para que conozcan información general sobre los formularios exigidos en el tema de exportación, tales como modernización del sistema aduanero costarricense, notificaciones previas, el compendio de leyes en materia aduanera, la inscripción como importador, entre otras. La información del presente documento se complementa con las presentaciones adjuntas en este fichero.Universidad de Costa RicaUCR::Vicerrectoría de Acción Social::Trabajo Comunal Universitario (TCU

Ehrliquiosis granulocitotrópica humana

Las ehrliquiosis humanas son zoonosis emergentes transmitidas por varias especies de garrapatas e infectan gran cantidad de animales silvestres y domésticos. Reportamos el caso de un paciente con un cuadro clínico y hallazgos de laboratorio compatibles con una probable ehrliquiosis granulocitotrópica severa. El paciente se trató con doxicilina y respondió adecuadamente. Fue egresado en buena condición.Human ehrlichiosis are emergent tick-borne zoonoses, affecting many wild and domestic mammals. We report the case of a patient with a clinical picture and laboratory findings compatible with severe granulocytic ehrlichiosis. The patient was treated with doxyciclin and did fine

Decisión de estudiar medicina: Factores determinantes y elección de la especialidad Decision to Study Medicine: Determinants and Specialty Choice

Introducción: La decisión de estudiar medicina depende de múltiples factores incluyendo aspectos internos (personales) y otros externos al individuo. Conocer estos factores puede ser útil para la administración del plan de estudios de la carrera y para la orientación estudiantil. Por tal motivo se propuso un estudio para identificar los factores determinantes para tomar esta decisión, intención de especialización y conocer las principales escogencias para especialidad. Materiales y métodos: Se realizó investigación descriptiva basada en una encuesta aplicada a una muestra de 84 estudiantes activos de la carrera de medicina de una universidad privada (Universidad de Iberoamérica, UNIBE). Resultados: Fueron encuestados 84 estudiantes, 71.4 % del sexo femenino. La relación con familiares médicos fue afirmativa en 39.5 % de los casos. Los principales motivos para estudiar medicina fueron por convicción propia sin influencia externa con motivación especialmente humanitaria y de realización personal. La mayoría escogió esta carrera entre los 16 y 20 años. Un 91.6 % de los encuestados tiene intenciones de seguir una especialidad. Como opción de especialidad predomina la medicina interna y sus especialidades, seguida por la cirugía y sus respectivas ramas. Conclusión: Se determinó un importante predominio del género femenino. Los motivos para estudiar medicina y seguir una especialidad son de predominio humanitario y altruista. Las especialidades de mayor demanda son en el área de la medicina interna y la cirugía. Esta información puede ser útil para la gestión académica a nivel de pregrado y para la orientación de los programas de posgrado en especialidades médicas.Introduction: The decision to study Medicine as a career depends on many factors, including intrinsic (personal) and extrinsic ones to the individual. To be aware of these factors could be useful for curriculum development and student counseling. Therefore, the study was proposed to identify the key factors taken into account to make this decision, intention of specialization and the main areas chosen. Materials and Methods: This is a descriptive research based on a survey applied to a sample of 84 active medical students of a private university (Universidad de Iberoamerica, UNIBE). Results: The survey was applied to 84 students, 28.6 % were male and 71.4 % were female. 39.5 % reported to have physicians as relatives. The main reason to study Medicine was self-conviction without outside influence and motivation due to humanitarian issues. Most of them chose to study this career between 16 and 20 years old. 91.6% of the subjects surveyed has the intention to follow a specialty. The main choices for specialization were Internal Medicine and its specialties; followed by surgery and its related branches. Conclusion: The study determined an important predominance of females. The main motives to study Medicine and follow a specialization are humanitarian and altruistic ones. The areas with the highest demand are Internal Medicine and Surgery. This information might be useful for decision making on undergraduate curriculum management and for planning postgraduate specialization programs

Meningitis por Kluyvera sp. en una paciente con una derivación lumbo-peritoneal: reporte de un caso

Describimos el caso de una paciente portadora de una derivación lumbo- peritoneal, que desarrolló una meningitis bacteriana en la cual Kluyvera sp. se aisló del líquido cefalorraquídeo. En nuestro conocimiento este es el primer caso reportado de infección del SNC por este microorganismo. Esta bacteria era sensible a cefalosporinas de tercera generación y se logró la resolución con Cefotaxime. El Género Kluyvera comprende tres especies infrecuentemente aisladas de muestras clínicas. Se puede asociar a infecciones desde leves a severas y posiblemente se favorece en un huésped inmunocomprometido.We describe the case of a female patient with a previous lumboperitoneal shunt, who developed bacterial meningitis Kluyvera sp. was isolated from the cerebrospinal fluid. To our knowledge this is the first case of CNS infection by this microorganism. This pathogen was very sensitive to third generation cephalosporins; and was treated succesfully with cefotaxime. The Kluyver genus comprises three species who are uncommonly isolated from clinical samples. It can be associated with mild to severe infections and is more common in inmunosuppressed hosts

Brucellosis caused by the wood rat pathogen Brucella neotomae: two case reports

Background: Brucellosis is a chronic bacterial disease caused by members of the genus Brucella. Among the classical species stands Brucella neotomae, until now, a pathogen limited to wood rats. However, we have identified two brucellosis human cases caused by B. neotomae, demonstrating that this species has zoonotic potential. Cases presentation: Within almost 4 years of each other, a 64-year-old Costa Rican white Hispanic man and a 51-year-old Costa Rican white Hispanic man required medical care at public hospitals of Costa Rica. Their hematological and biochemical parameters were within normal limits. No adenopathies or visceral abnormalities were found. Both patients showed intermittent fever, disorientation, and general malaise and a positive Rose Bengal test compatible with Brucella infection. Blood and cerebrospinal fluid cultures rendered Gram-negative coccobacilli identified by genomic analysis as B. neotomae. After antibiotic treatment, the patients recovered with normal mental activities. Conclusions: This is the first report describing in detail the clinical disease caused by B. neotomae in two unrelated patients. In spite of previous claims, this bacterium keeps zoonotic potential. Proposals to generate vaccines by using B. neotomae as an immunogen must be reexamined and countries housing the natural reservoir must consider the zoonotic risk.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Centro de Investigación en Enfermedades Tropicales (CIET)UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP

Update on the epidemiology of carbapenemases in Latin America and the Caribbean

Introduction: Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D. Areas covered: Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean. Expert opinion: Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy

Concurso EcoRide 2013

ResumenEsta iniciativa, en modalidad de concurso de diseño, tuvo como premisa desarrollar una investigación en cuanto a materiales constructivos alternativos que propician la construcción real de módulos de aparcamiento para bicicletas de fácil ensamblaje y construcción, fomentando así el transporte interurbano ecológico y sustentable, y a su vez, logrando solventar las necesidades bioclimática contextuales y de sus usuarios como plan piloto de la Escuela de Estudios Generales de la Universidad de Costa Rica.