RESUMO
Syphilis and gonorrhea are two sexually transmitted diseases (STD) which still persist in spite of the existence of effective treatment. In this paper the incidence of these two diseases was evaluated between 1985-1994, a decade during which the problem of HIV infection arose. Every patient who attended the STD Program at the Hospital and was suspected of having syphilis and/or gonorrhea was clinically evaluated and was subjected to the following tests: a) search for Neisseria gonorrhoeae (Ng) and penicinilase producers (PPNG) identification, b) search for Treponema pallidum (Tp) by darkfield microscopy, c) serological studies for syphilis. From 1985 to 1991 the average of positive cases for Ng was 14.8% while from 1992 to 1994 it was 4.0% (p < 0.0001) showing a dramatic decrease between 1991 and 1992. PPNG increased from 8.7% in 1985 to 44.6% in 1988 and then slowly decreased down to 26.9% in 1994. From 1985 to 1990 the average of positive darkfield examinations was 20.7% while from 1991 to 1994 it was 12.2% (p < 0.0001). Between 1985 to 1988 syphilis serological studies showed 45.7% positive cases dropping to 34.3% between 1989 and 1994 (p < 0.0001). HIV infection appearance had a wide repercussion throughout the world generating behavioral and sexual habit changes which have probably helped to prevent these two STD. Gonorrhea incidence was also influenced by the appearance of new effective treatments, even against PPNG, such as fluorated quinolones and third generation cephalosporines. The population studied belongs to the most crowded area in Argentina, so that these observations should not be extrapolated to the rest of the country.
Assuntos
Gonorreia/epidemiologia , Infecções por HIV/complicações , Sífilis/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Gonorreia/complicações , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sífilis/complicaçõesRESUMO
Enteral nutrition is used as a routine therapy in patients with caloric-protein malnutrition, severe dysphagia, major burns, intestinal resection, and enterocutaneous fistulae, as long as a portion of the digestive tract still has an active absorptive function. The administration takes place by means of surgical (ostomies) or non-surgical (nasogastric) tubes. In our country, a significant number of hospitalized patients with various diseases receive this type of nutrition. Given that the colonization of the digestive tract by hospital flora is the first step towards developing intra-hospital infections, the contamination implies serious risks. The objective of this study was to study the most appropriate conditions for the manufacturing, storage and administration of the mixture of nutrients of enteral nutrition, to guarantee nutrition with a lower contamination risk. This study was conducted by the Unit of Nutritional Assistance of the Mater Dei Clinic, by means of bacteriological controls, from January 1991 to December 1992, and in 1993 in which the work systematics were reviewed. The study was prospective, and those solutions whose bacteriological counts were lower than 100.000 colony forming units (CFU), and which showed an absence of enteropathological micro-organisms, were considered acceptable, and those solutions which had a bacteriological count greater than or equal to 100.000 CFU and or the presence of enteropathological micro-organisms, were considered unacceptable. During the first period, "usual working conditions", we analyzed the infra-structure, the personnel, the constituents, and the apparatus used in the manufacturing, for which 36 samples were studied at t0 (moment of preparation). Afterwards, in the second period "special working conditions", we analyzed the manufacturing procedures, the storage and the administration of 103 solutions, corresponding to 36 patients, taking samples at t0 and t24 (after 24 hours of preparing). In the first phase, we found a 53% contamination. In the second phase, 99.03% of the solutions were within the limits of acceptability, and only 0.07% were unacceptable. We conclude that it is necessary to have access to a working area which meets the biosecurity norms, to use sterile technique in the preparation, to prefer pharmacologically sterile products for the preparation, to store the prepared mixture between 4 and 8 degrees C, and to keep it cooled during the administration. Lastly, we saw the need to continuously capacitate the nursing, dietary (ABSTRACT TRUNCATED)
Assuntos
Nutrição Enteral/efeitos adversos , Contaminação de Alimentos/prevenção & controle , Argentina , Nutrição Enteral/normas , Nutrição Enteral/estatística & dados numéricos , Seguimentos , Contaminação de Alimentos/estatística & dados numéricos , Humanos , Estudos Prospectivos , Fatores de Risco , SoluçõesRESUMO
Two fatal sepsis cases in two male patients (58 and 14 years old) due to Vibrio cholerae non 01 are described. Their original diseases were hepatic cirrhosis and acute lymphoblastic leukemia in its third complete remission. In this last case, gastroenteritis due to V. cholerae non 01 was also diagnosed. These sepsis presented a rapid evolution and positive hemoculture after 24 and 48 hours of incubation. Both strains isolated presented similar biochemical characteristics and did not agglutinate in the presence of the specific serum against V. cholerae. Both strains were susceptible to most of the antibiotics available. Sepsis due to V. cholerae non 01 is usually associated to other original diseases and to immunodepression. Management of these sepsis is difficult and mortality rates are very high.
Assuntos
Cólera/etiologia , Gastroenterite/etiologia , Vibrio cholerae , Adolescente , Cólera/complicações , Cólera/mortalidade , Gastroenterite/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Vibrio cholerae/classificação , Vibrio cholerae/isolamento & purificaçãoRESUMO
Se describen 2 sepsis mortales causadas por Vibrio cholerae no 01 en 2 pacientes varones (58 y 14 años) cuyas enfermedades de base eran: cirrosis hepática y leucemia linfoblástica aguda en tercera remisión completa. En el último caso también se diagnosticó gastroenteritis por V. cholerae no 01. Las sepsis fueron de evolución rápida y los hemocultivos fueron positivos entre las 24 y 48 horas de incubación. Ambas cepas tuvieron idénticas propiedades bioquímicas y no aglutinaron con el antisuero específico del V. cholerae 01. Ambas cepas fueron muy sensibles a la mayoría de los antibióticos disponibles. La sepsis spor V. cholerae no 01 usualmente está asociada a enfermedades de base e inmunodepresión; su manejo se hace muy difícil y su mortalidad es muy elevada
Assuntos
Adolescente , Pessoa de Meia-Idade , Humanos , Masculino , Cólera/etiologia , Gastroenterite/etiologia , Vibrio cholerae/patogenicidade , Cólera/complicações , Cólera/mortalidade , Gastroenterite/diagnóstico , Vibrio cholerae/isolamento & purificaçãoRESUMO
Two fatal sepsis cases in two male patients (58 and 14 years old) due to Vibrio cholerae non 01 are described. Their original diseases were hepatic cirrhosis and acute lymphoblastic leukemia in its third complete remission. In this last case, gastroenteritis due to V. cholerae non 01 was also diagnosed. These sepsis presented a rapid evolution and positive hemoculture after 24 and 48 hours of incubation. Both strains isolated presented similar biochemical characteristics and did not agglutinate in the presence of the specific serum against V. cholerae. Both strains were susceptible to most of the antibiotics available. Sepsis due to V. cholerae non 01 is usually associated to other original diseases and to immunodepression. Management of these sepsis is difficult and mortality rates are very high.
RESUMO
Se describen 2 sepsis mortales causadas por Vibrio cholerae no 01 en 2 pacientes varones (58 y 14 años) cuyas enfermedades de base eran: cirrosis hepática y leucemia linfoblástica aguda en tercera remisión completa. En el último caso también se diagnosticó gastroenteritis por V. cholerae no 01. Las sepsis fueron de evolución rápida y los hemocultivos fueron positivos entre las 24 y 48 horas de incubación. Ambas cepas tuvieron idénticas propiedades bioquímicas y no aglutinaron con el antisuero específico del V. cholerae 01. Ambas cepas fueron muy sensibles a la mayoría de los antibióticos disponibles. La sepsis spor V. cholerae no 01 usualmente está asociada a enfermedades de base e inmunodepresión; su manejo se hace muy difícil y su mortalidad es muy elevada (AU)