El apiñamiento dental es una de las alteraciones más comunes debido a que el espacio disponible en las bases óseas es menor que la suma total del tamaño de los dientes, ocasionando un proble- ma ...oclusal, periodontal y estético, lo cual acrecienta la necesidad de un tratamiento ortodóncico. El objetivo de este caso clínico es dar una opción de tratamiento eficaz para conseguir la liberación del apiñamiento, clase canina I bilateral, una correcta intercuspidación, mejorar la sonrisa y perfil labial. Se reporta un caso clínico de paciente femenino de 16 años de edad, que acude a la clínica de ortodoncia de la FEBUAP, con motivo de consulta «no me gustan mis dientes». Presenta una clase II esquelética, crecimiento hiperdi- vergente, perfil facial ortognático, perfil labial convexo, clase molar I bilateral, clase canina II bilateral, con apiñamiento severo en ambas arcadas, no refiere ningún hábito, ni problema articular. El plan de tratamiento fue con extracciones de órganos dentarios 14, 24, 34, 44 y 41, se colocó aparatología MBT slot 0.022”, se inició con arcos seccionales con loop de titanio molibdeno (TMA) 0.016” × 0.022”, se prosiguió a la fase de alineación y nivelación, cierre de espa- cios, control de torque, asentamiento y retención removible. Comoresultado se cumplieron los objetivos planeados con un tiempo de un año seis meses. La técnica no friccional en cuanto reabsorción radicular no presenta diferencia significativa con la técnica friccional. Se concluye que el uso de arcos seccionales como alternativa para distalizar caninos en pacientes con apiñamiento severo en el segmento anterior ofrece beneficios adicionales al controlar la fuerza, el tipping (TIP) y la liberación del apiñamiento progresivo de los incisivos anteriores sin provocar daños permanentes en los dientes y tejidos de soporte.
Comparison of routine hospital indicators (consults at the Emergency Room (ER) and hospital admissions) during the 2009 pandemic of the influenza AH1N1 virus at the national referral hospital for ...respiratory diseases in Mexico City.
The outbreak was from April to mid-May 2009 and two control periods were used:2009 (before and after the outbreak),and during April-May from 2007 and 2008.
During the outbreak total consultation at the ER increased six times compared with the 2007-2008 control period and 11 times compared with the 2009 control period. Pneumonia- or influenza-related ER consultations increased 23.2 and 15.3%, respectively. The rate of nosocomial infection during the outbreak was 13.6 and that of nosocomial pneumonia was 6 per/100 hospital discharges, a two-fold and three-fold increase compared to the control periods respectively.
During the outbreak,mean severity of admitted patients increased,with a rise in in-hospital mortality and nosocomial infections rate, including nosocomial pneumonia.
Our objectives were to describe the incidence, clinical characteristics, and risk factors for Clostridium difficile infection (CDI) in critically ill patients and to determine C. difficile ...PCR-ribotypes.
Prospective, observational study in 26 Spanish ICUs. Patients with diarrhea meeting ESCMID criteria for CDI were included. Molecular characterization of isolates was performed using PCR ribotyping.
Of 4258 patients admitted to the ICUs, 190 (4.5%) developed diarrhea. Only 16 patients (8.4%) were diagnosed with CDI. Ribotype 078/126 (25.0%) was the most frequently identified. The mortality rate was similar in patients with ICD compared to patients with diarrhea not caused by C. difficile (p=0.115). Chronic renal insufficiency was identified as the only factor independently associated with the development of CDI (OR 5.87, 95% CI 1.24–27.83; p=0.026).
The incidence of CDI in Spanish ICUs is low. Only chronic renal insufficiency was observed to be a risk factor for CDI development.
Pretendemos describir la incidencia, las características clínicas y los factores de riesgo de la infección por Clostridium difficile (ICD) en pacientes ingresados en unidades de cuidados intensivos, así como los ribotipos identificados.
Estudio observacional, prospectivo, realizado en 26 unidades de cuidados intensivos de España. Se incluyeron pacientes con diarrea y criterios clínicos de la ESCMID por sospecha de ICD. La caracterización molecular se realizó mediante PCR.
De 4.258 pacientes ingresados, 190 (4,5%) presentaron diarrea; en 16 causada por ICD. El ribotipo más frecuentemente aislado fue 078/126 (25%). La tasa de mortalidad cruda fue similar en pacientes con ICD y en pacientes con diarrea no causada por Clostridium difficile (p=0,115). La insuficiencia renal crónica fue identificada como factor independientemente asociado a desarrollo de ICD (OR: 5,87; IC 95%: 1,24-27,83; p=0,026).
La incidencia de ICD en las unidades de cuidados intensivos españolas es baja. La insuficiencia renal crónica es el único factor identificado para desarrollo de ICD.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Introduction. Cholestatic hepatitis is a rare entity characterized by a bile flow obstruction,and it has a multi-factorial etiology. It can be acute or chronic and occasionally triggers
fibrosis, ...cirrhosis and severe hepatitis. The current pharmacological management is based on corticosteroids and azathioprine or other drugs, such as, methotrexate, cyclosporine, budesonide, ursodeoxycholic acid, mefenamic acid, and pentoxifylline (PTX). We report two patients with autoimmune cholestatic hepatitis treated with pentoxifylline.
Clinical cases. Two cases with diagnosis of cholestatic hepatitis confirmed by ultrasound and
serological and histological studies. In both cases, corticosteroids were used as a pharmacological treatment without a favorable response. The therapy was replaced by pentoxifylline plus symptomatic treatment at base of ursodeoxycholic acid, vitamin E and cholestyramine. Both patients showed a remarkable improvement after two weeks of treatment. One of the patients showed a total bilirubin of 22.30 mg/dL with a decreased
of direct bilirubin from 22.23 mg/dL to 2.10 mg/ dL; meanwhile, the second patient showed a total bilirubin of 63.7 mg/dL with a decreased of direct bilirubin levels from 60.2 mg/dL to 2.33 mg/ dL. In both patients the levels of transaminases decreased and an improvement of their clinical conditions were observed.
Discussion. Our results showed that there was a favorable response in two patients treated with pentoxifylline. This drug has anti-inflammatory, anti-oxidant and anti-fibrotic effects as well as inhibitors effects of the transcription factor NF- κβ, so that it could be considered as an alternative treatment in patients with cholestatic hepatitis after validating its actual effectiveness.
Introducción. La hepatitis colestásica es una entidad poco frecuente que se caracteriza
por obstrucción del flujo biliar y presentar etiología multifactorial; puede ser aguda
o crónica y, ocasionalmente, desencadena fibrosis, cirrosis y hepatitis grave. El manejo
farmacológico habitual es a base de corticoides y azatioprina, así como otros medicamentos como el metotrexate, la ciclosporina, la budesonida, el ácido ursodesoxicólico, el ácido micofenólico y la pentoxifilina (PTX); dentro de los medicamentos citados, utilizamos pentoxifilina en dos pacientes con hepatitis colestásica autoinmune.
Casos clínicos. Se reportan dos casos con diagnóstico de hepatitis colestásica, corroborada
a través de estudios ecosonográfico, serológicos e histológicos. Se utilizaron corticoides para el tratamiento farmacológico en ambos casos; sin embargo, al no obtener resultados favorables, la terapia fue sustituida por pentoxifilina, más tratamiento sintomático a base de ácido ursodesoxicólico, vitamina E y colestiramina. Ambos pacientes mostraron una mejoría después de dos semanas de tratamiento; una paciente con bilirrubina total (BT) de 22.30 mg/dL disminuyó bilirrubina directa (BD) de 22.23 mg/dL a 2.10 mg/dL; en el segundo caso con BT de 63.7 mg/ dL disminuyó sus cifras de BD de 60.2 mg/dL a 2.33 mg/dL; además, redujo transaminasemia y las condiciones de ambas pacientes presentaron mejoría.
Discusión. Nuestros resultados mostraron que hubo respuesta favorable en los dos pacientes tratados con pentoxifilina; considerando que este fármaco ha demostrado efectos antiinflamatorios, antioxidantes, antifibróticos e inhibidores del factor de transcripción NF-κβ, podría ser utilizado como un tratamiento alternativo en los pacientes con hepatitis colestásica, aclarando que se necesitan más estudios clínicos para validar su
real eficacia.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The hemodynamic monitoring is a fundamental part of the patient in the perioperative period, during the last decade the monitoring at the patient's bedside has grown at giant steps, from the ...emergency area, operating room, to the Intensive Care area. One of its most important advances is the decrease in the use of pulmonary artery catheter, which is being replaced by ultrasound and less invasive monitoring techniques, in this article we will review from the beginning of the monitoring to the most used less invasive monitors currently.
We report the synthesis of cerium oxide, cobalt oxide, mixed cerium, and cobalt oxides and a Ce-Co/Al₂O₃ membrane, which are employed as catalysts for the catalytic wet oxidation (CWO) reaction ...process and the removal of formaldehyde from industrial effluents. Formaldehyde is present in numerous waste streams from the chemical industry in a concentration low enough to make its recovery not economically justified but high enough to create an environmental hazard. Common biological degradation methods do not work for formaldehyde, a highly toxic but refractory, low biodegradability substance. The CWO reaction is a recent, promising alternative that also permits much lower temperature and pressure conditions than other oxidation processes, resulting in economic benefits. The CWO reaction employing Ce- and Co-containing catalysts was carried out inside a slurry batch reactor and a membrane reactor. Experimental results are reported. Next, a mixed Ce-Co oxide film was supported on an γ-alumina membrane used in a catalytic membrane reactor to compare formaldehyde removal between both types of systems. Catalytic materials with cerium and with a relatively large amount of cerium favored the transformation of formaldehyde. Cerium was present as cerianite in the catalytic materials, as indicated by X-ray diffraction patterns.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Carbapenemase-producing Enterobacterales (CPE) have emerged as a substantial cause of morbi-mortality worldwide, with a prevalence of approximately 5% in areas with high endemicity. However, ...available data may not be representative of developing countries, such as Ecuador. In this study, the incidence of CPE in Ecuador and risk factors for infection/colonisation were evaluated.
A prospective cohort study was performed from February to April 2016 in seven intensive-care units of Guayaquil, Ecuador. Samples were processed according to the Centers for Disease Control and Prevention laboratory protocol and the CHROMagar mSuper CARBA agar method. Resistance to carbapenems was defined according to Clinical and Laboratory Standards Institute breakpoints. A modified carbapenemase inactivation method was used to identify carbapenamase production phenotypically with molecular confirmation by multiplex polymerase chain reaction.
In total, 640 patients were enrolled. The incidence of CPE was 36.4% (N = 233). A multivariate analysis indicated that several factors were associated with CPE acquisition, included a long intensive care unit stay (OR 1.05; 95% CI 1.03-1.08; p < 0.01), tracheostomy (OR 3.52; 95% CI 1.90-6.75; p < 0.01), hospitalisation 3 months prior to admission (OR 2.07; 95% CI 1.17-3.71; p < 0.01), vancomycin use (OR 3.31; 95% CI 2.02-5.18; p < 0.01), and macrolide use (OR 3.31; 95% CI 1.43-7.76; p < 0.01).
Macrolide use was a risk factor for CPE acquisition. This association should be evaluated further, especially in developing countries.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Although early institution of adequate antimicrobial therapy is lifesaving in sepsis patients, optimal antimicrobial strategy has not been established. Moreover, the benefit of combination therapy ...over monotherapy remains to be determined. Our aims are to describe patterns of empiric antimicrobial therapy in severe sepsis, assessing the impact of combination therapy, including antimicrobials with different mechanisms of action, on mortality.
This is a Spanish national multicenter study, analyzing all patients admitted to ICUs who received antibiotics within the first 6 hours of diagnosis of severe sepsis or septic shock. Antibiotic-prescription patterns in community-acquired infections and nosocomial infections were analyzed separately and compared. We compared the impact on mortality of empiric antibiotic treatment, including antibiotics with different mechanisms of action, termed different-class combination therapy (DCCT), with that of monotherapy and any other combination therapy possibilities (non-DCCT).
We included 1,372 patients, 1,022 (74.5%) of whom had community-acquired sepsis and 350 (25.5%) of whom had nosocomial sepsis. The most frequently prescribed antibiotic agents were β-lactams (902, 65.7%) and carbapenems (345, 25.1%). DCCT was administered to 388 patients (28.3%), whereas non-DCCT was administered to 984 (71.7%). The mortality rate was significantly lower in patients administered DCCTs than in those who were administered non-DCCTs (34% versus 40%; P = 0.042). The variables independently associated with mortality were age, male sex, APACHE II score, and community origin of the infection. DCCT was a protective factor against in-hospital mortality (odds ratio (OR), 0.699; 95% confidence interval (CI), 0.522 to 0.936; P = 0.016), as was urologic focus of infection (OR, 0.241; 95% CI, 0.102 to 0.569; P = 0.001).
β-Lactams, including carbapenems, are the most frequently prescribed antibiotics in empiric therapy in patients with severe sepsis and septic shock. Administering a combination of antimicrobials with different mechanisms of action is associated with decreased mortality.
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