Resistência antimicrobiana em pacientes coma infecção do trato urinário

ABSTRACTThe alarming increase in bacterial resistance to antibiotics in patients with urinary tract infection is one of the biggest current problems in world public health; being Escherichia coli, the main pathogen in this infection, resistant to most antibiotics. With the aim of determining the microbiological pattern of antimicrobial resistance of the germs most frequently isolated in positive urine cultures, in the microbiology laboratory of the Celia Sánchez Manduley Provincial Teaching Hospital, Manzanillo, during 2018, an observational, descriptive cut-off study was carried out. cross-sectional to all urine cultures performed on patients with the order of bacteriological study, in the institution and period of time declared. The variables were evaluated: positivity of the culture, isolated germs, antimicrobial resistance of isolated microorganisms in general and Escherichia coli in particular. The data were analyzed using descriptive statistics. 2482 urine cultures were analyzed, 714 were positive; As a germ, Escherichia coli predominated in 58.12% of the cases. The total of isolated germs showed resistance to: cefotaxime (46.08%), ciprofloxacin (44.67%), nalidixic acid (44.11%), cotrimoxazole (42.99%) and ceftazidime (42.85%). In the case of Escherichia coli, the same resistance pattern was maintained with slightly higher values. The lowest resistance of these microorganisms was for nitrofurantoin, around 1.44%. The microbiological pattern of antimicrobial resistance of the most frequent germs isolated in the positive urine cultures of this study was determined.RESUMENEl alarmante incremento de la resistencia bacteriana a los antibióticos, en pacientes con infección del tracto urinario, es uno de los mayores problemas actuales de la salud pública mundial; siendo la Escherichia coli, principal patógeno en esta infección, resistente a la mayoría de los antibióticos. Con el objetivo de determinar el patrón microbiológico de resistencia antimicrobiana de los gérmenes más frecuentemente aislados en urocultivos positivos, en el laboratorio de microbiología del Hospital Provincial Docente Celia Sánchez Manduley, Manzanillo, durante el año 2018, se realizó un estudio observacional, descriptivo de corte transversal a todos los urocultivos realizados a los pacientes con la orden de estudio bacteriológico, en la institución y período de tiempo declarados. Se evaluaron las variables: positividad del cultivo, gérmenes aislados, resistencia antimicrobiana de los microorganismos aislados en general y de la Escherichia coli en particular. Los datos fueron analizados utilizando la estadística descriptiva. Se analizaron 2482 urocultivos, 714 fueron positivos; como germen predominó Escherichia coli en 58.12% de los casos. El total de gérmenes aislados mostró resistencia a: cefotaxima (46.08 %), ciprofloxacino (44.67 %), ácido nalidíxico (44.11 %), cotrimoxazol (42.99 %) y ceftazidima (42.85 %). Para el caso de la Escherichia coli se mantuvo el mismo patrón de resistencia con valores discretamente superiores. La menor resistencia de estos microorganismos fue para la nitrofurantoina, alrededor de un1.44 %. Se determinó el patrón microbiológico de resistencia antimicrobiana de los gérmenes más frecuentes aislados en los urocultivos positivos de este estudio. RESUMOO alarmante aumento da resistência bacteriana aos antibióticos em pacientes com infecção do trato urinário é um dos maiores problemas atuais de saúde pública mundial; sendo Escherichia coli, o principal patógeno dessa infecção, resistente à maioria dos antibióticos. Com o objetivo de determinar o padrão microbiológico de resistência antimicrobiana dos germes mais freqüentemente isolados em uroculturas positivas, no laboratório de microbiologia do Hospital Universitário Provincial Celia Sánchez Manduley, Manzanillo, durante 2018, foi realizado um estudo observacional descritivo de corte. out. transversal a todas as culturas de urina realizadas em pacientes com a ordem de estudo bacteriológico, na instituição e período de tempo declarado. Foram avaliadas as variáveis: positividade da cultura, germes isolados, resistência antimicrobiana dos microrganismos isolados em geral e Escherichia coli em particular. Os dados foram analisados por meio de estatística descritiva. 2.482 culturas de urina foram analisadas, 714 foram positivas; Como germe, a Escherichia coli predominou em 58,12% dos casos. O total de germes isolados apresentou resistência a: cefotaxima (46,08%), ciprofloxacina (44,67%), ácido nalidíxico (44,11%), cotrimoxazol (42,99%) e ceftazidima (42,85%). No caso da Escherichia coli, o mesmo padrão de resistência foi mantido com valores ligeiramente superiores. A menor resistência desses microrganismos foi para a nitrofurantoína, em torno de 1,44%. Foi determinado o padrão microbiológico de resistência antimicrobiana dos germes mais frequentes isolados unas uroculturas positivas deste estudo.

Las infecciones de transmisión sexual y los estudiantes de Medicina

We present the results of the first stage of an intervention study that was carried out through anonymous surveys, with the characterization of a sample selected randomly, from 33 medical students of the Faculty of Medical Sciences of Granma (12 second-year-students and 21 third-year-students), in aspects concerning the knowledge and prevention of sexually transmitted infections. Although the sample was not representative, what is expressed by the respondents reflects that despite the curricular contents received and the actions that are carried out in this way, they have a low level of knowledge about STIs, low risk perception and behavior about sexual responsibility that makes them susceptible to contracting these infections. From the professional point of view, they do not yet have the tools to act as health promoters in their community. For this reason, an action plan is designed whose implementation will solve the insufficiencies detected in students and transform them into agents of change in their community.Se presentan los resultados de la primera etapa de un estudio de intervención que se realizó a través de encuestas anónimas, con la caracterización de una muestra seleccionada al azar, de 33 estudiantes de medicina de la Facultad de Ciencias Médicas de Granma, (12 de segundo año y 21 de tercero), en aspectos concernientes al conocimiento y prevención de las infecciones de transmisión sexual. Aunque la muestra no fue representativa, lo expresado por los encuestados refleja, que a pesar de los contenidos curriculares recibidos y las acciones que integralmente se realizan en este sentido, poseen un bajo nivel de conocimientos sobre las ITS, baja percepción de riesgo y una conducta sexual no responsable que los hace susceptibles de contraer estas infecciones. Desde el punto de vista profesional, aún no cuentan con las herramientas suficientes para actuar como promotores de salud en su comunidad. Por esta razón, se diseña un plan de acción cuya implementación permitirá solucionar las insuficiencias detectadas en los estudiantes y transformarlos en agentes de cambio en su comunidad

Las infecciones de transmisión sexual y los estudiantes de Medicina

Introduction: the diseases transmitted by sexual intercourse, called sexually transmitted diseases (STD), are known since ancient times. They are mentioned in writings of Platoon, Aristotle and Hippocrates, and Moses alludes to their contagiousness in the Old Testament. 1 These infections are closely related with the human behaviour, for this reason it is worthwhile to emphasize the character of this phenomenon. Objective: to design a plan of actions whose implementation will allow to solve the insufficiencies detected in the students and turn them into changing agents in their community. Method: it was performed an intervention study in the academic course 2013-2014, with the aim to characterize the students of Medicine according to their behaviour on the STDs. The universe of study was integrated by the 33 Medicine students of the Faculty of Medical Sciences in Granma. For the initial diagnostic it was applied an anonymous survey with the purpose to obtain the general data like age, sex, year of the course, birth place and the data in regards to the STDs´ knowledge, sexual behaviour and suffering from these infections.Results: although the sample was not representative, the expressed ideas by the surveyed students showed that in spite of the curricular contents received and the actions that were fully developed in this respect, they had a low level of knowledge on STDs, low risk perception and a non- responsible sexual behaviour, what made them susceptible to contract these infections. From the professional point of view, they still do not have the sufficient tools to act like health promoters in their community. Conclusions: it will be designed an action plan whose implementation will allow to solve the insufficiencies detected in the students, turning them into changing agents in their community, at the time of offering them the necessary qualification in a way that they can perform with quality and efficiency, the community educational intervention.Introducción: las enfermedades  transmitidas por contacto sexual, llamadas infecciones de  transmisión sexual (ITS), son conocidas por el hombre desde tiempos inmemoriales. Así se les menciona en escritos de  Platón, Aristóteles e Hipócrates y Moisés alude a su contagiosidad  en el antiguo  testamento.  Estas infecciones están muy relacionadas con el comportamiento humano, por tal razón vale la pena subrayar el carácter de este fenómeno. Objetivo: diseñar un plan de acción cuya implementación permitirá solucionar las insuficiencias detectadas en los estudiantes y transformarlos en agentes de cambio en su comunidad. Método: se realizó un estudio de intervención en el curso académico 2013-2014, con el objetivo de caracterizar a los estudiantes de Medicina según su comportamiento sobre las ITS. El universo de estudio estuvo integrado por los 33 estudiantes de Medicina de la Facultad de Ciencias Médicas de Granma. Para el diagnóstico inicial se aplicó una encuesta anónima con la finalidad de obtener los datos generales como edad, sexo, año que cursa, municipio de procedencia y los datos referentes al conocimiento de las ITS, conducta sexual y padecimiento de estas infecciones. Resultados: aunque la muestra estudiada no es representativa, lo expresado por los encuestados refleja, que a pesar de los contenidos curriculares recibidos y las acciones que integralmente se realizan en este sentido, poseen un bajo nivel de conocimientos sobre las ITS, baja percepción de riesgo y una conducta sexual no responsable que los hace susceptibles de contraer estas infecciones. Desde el punto de vista profesional, aún no cuentan con las herramientas suficientes para actuar como promotores de salud en su comunidad. Conclusiones: se diseñará un plan de acción cuya implementación, permitirá solucionar las insuficiencias detectadas en los estudiantes y transformarlos en agentes de cambio en su comunidad, al brindarles la capacitación necesaria para realizar con calidad y eficiencia la intervención educativa comunitaria

Las infecciones de transmisión sexual y los estudiantes de Medicina

RESUMEN Se presentan los resultados de la primera etapa de un estudio de intervención que se realizó a través de encuestas anónimas, con la caracterización de una muestra seleccionada al azar, de 33 estudiantes de medicina de la Facultad de Ciencias Médicas de Granma, (12 de segundo año y 21 de tercero), en aspectos concernientes al conocimiento y prevención de las infecciones de transmisión sexual. Aunque la muestra no fue representativa, lo expresado por los encuestados refleja, que a pesar de los contenidos curriculares recibidos y las acciones que integralmente se realizan en este sentido, poseen un bajo nivel de conocimientos sobre las ITS, baja percepción de riesgo y una conducta sexual no responsable que los hace susceptibles de contraer estas infecciones . Desde el punto de vista profesional, aún no cuentan con las herramientas suficientes para actuar como promotores de salud en su comunidad. Por esta razón, se diseña un plan de acción cuya implementación permitirá solucionar las insuficiencias detectadas en los estudiantes y transformarlos en agentes de cambio en su comunidad. ABSTRACT We present the results of the first stage of an intervention study that was carried out through anonymous surveys, with the characterization of a sample selected randomly, from 33 medical students of the Faculty of Medical Sciences of Granma (12 second-year-students and 21 third-year-students), in aspects concerning the knowledge and prevention of sexually transmitted infections. Although the sample was not representative, what is expressed by the respondents reflects that despite the curricular contents received and the actions that are carried out in this way, they have a low level of knowledge about STIs, low risk perception and behavior about sexual responsibility that makes them susceptible to contracting these infections. From the professional point of view, they do not yet have the tools to act as health promoters in their community. For this reason, an action plan is designed whose implementation will solve the insufficiencies detected in students and transform them into agents of change in their community

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Coxsakievirus, agente causal del Síndrome boca-pie-mano (Original)

An increase of Coxachievirus´s infection in Manzanillo and another province of Cuba took place during October-November 2017. For this reason, insufficient knowledge about this biologic agent was detected in the curriculum of the Medicine career. In response the generated demands in the educational process, a didactic material was made for the subject of medical microbiology and parasitology. This material showed the results of an extensive investigation about the behavior of syndrome mouth-hand-foot caused by this virus. The didactical proposition was a source of knowledge, systematization and upgrade in this topic.The subject of  Medical Microbiologic and Parasitology program with their objective and abilities necessaries from the Topic III: Medical Virology were considered to elaborate the didactic material. The result achieved with this research has a positive impact on the process of training health professionals in the Primary Care settings.Durante los meses de octubre a noviembre de 2017 hubo un alza en las infecciones causadas por los Coxsakievirus en Manzanillo y otros municipios del país, detectándose insuficiencias en los conocimientos sobre este agente biológico en los estudiantes de la carrera de Medicina, al recibir en su plan de estudio, solo una breve información. En respuesta a las exigencias generadas por el proceso docente educativo se decide en la asignatura Microbiología y Parasitología Médicas, elaborar un material didáctico contentivo de los resultados de la investigación desarrollada en este municipio acerca del comportamiento del síndrome boca-pie-mano causado por este agente biológico. Se empleó como fuente de conocimiento, la sistematización y actualización de estos contenidos. El empleo de métodos teóricos y empíricos en la elaboración de este material, junto a la calidad del diseño; asequibilidad, accesibilidad, aplicabilidad, pertinencia y utilización por profesores y estudiantes, contribuyen a resolver el problema práctico y científico que sustenta esta investigación al tiempo que pueden elevar la calidad del proceso enseñanza-aprendizaje de la asignatura. El resultado alcanzado con esta investigación impacta en términos positivos en el proceso de formación de profesionales de la salud en los escenarios de la Atención Primaria

Newborn Screening for SCID. Experience in Spain (Catalonia)

Newborn screening (NBS) for severe combined immunodeficiency (SCID) started in Catalonia in January-2017, being the first Spanish and European region to universally include this testing. In Spain, a pilot study with 5000 samples was carried out in Seville in 2014; also, a research project with about 35,000 newborns will be carried out in 2021-2022 in the NBS laboratory of Eastern Andalusia. At present, the inclusion of SCID is being evaluated in Spain. The results obtained in the first three and a half years of experience in Catalonia are presented here. All babies born between January-2017 and June-2020 were screened through TREC-quantification in DBS with the Enlite Neonatal TREC-kit from PerkinElmer. A total of 222,857 newborns were screened, of which 48 tested positive. During the study period, three patients were diagnosed with SCID: an incidence of 1 in 74,187 newborns; 17 patients had clinically significant T-cell lymphopenia (non-SCID) with an incidence of 1 in 13,109 newborns who also benefited from the NBS program. The results obtained provide further evidence of the benefits of early diagnosis and curative treatment to justify the inclusion of this disease in NBS programs. A national NBS program is needed, also to define the exact SCID incidence in Spain