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We previously conducted two randomized controlled trials with bovine lactoferrin (bLF) for the prevention of late-onset sepsis (LOS) in infants with a birth weight –1·day–1], and used the same control (maltodextrin). We fitted multivariate Cox regression models to estimate the effect of bLF on the risk of development of the composite outcome, adjusting for covariates. We included 335 neonates with a mean birth weight of 1162 ± 244 g; 27.5% were

Objectives The aim of our study was to determine the incidence of late onset sepsis and the most frequent microorganisms causing it in the Neonatal Unit (Neonatal Intensive Care Unit ie NICU and Level 2 nursery) at Hospital Cayetano Heredia, in Lima, Peru. Methods Descriptive and retrospective study. We reviewed all positive blood cultures and cultures of cerebrospinal fluid drawn from inborn patients beyond 72 hours of life, admitted to the NICU or our Level 2 nursery from January 2015 to December 2019. Results The incidence of late onset sepsis in our unit was 7.4% of admitted patients and 10.04 per 1000 live births. 234 episodes of LOS occurred in 204 patients through our study period. The incidence was higher in very low birth weight infants, reaching 36.2% and even higher in extremely-low birth weight infants (40.7%). The most frequent causative microorganisms were: coagulase-negative Staphylococcus, followed by Klebsiella spp. The most frequent cause of late onset sepsis in very low birth weight infants was gram negative bacteria (Klebsiella spp, being the most frequent microorganism). Conclusions Late onset neonatal sepsis is prevalent in our Neonatal Unit. It is important to know which are the most prevalent causative microorganisms in order to be able to choose an adequate antibiotic coverage and to design strategies to prevent them.

Introduction: Very low-birth weight (VLBW) infants represent a high-risk population for morbidity and mortality in the neonatal period. Variability in practices and outcomes between centers has been acknowledged. Multicenter benchmarking studies are useful to detect areas of improvement and constitute an interesting research tool. Objectives: The aim of the study was to determine the perinatal variables and interventions associated with survival and survival without major morbidity in VLBW infants and compare the performance of 2 large networks. Methods: This is a prospective study analyzing data collected in 2 databases, the Spanish SEN1500 and the South American NEOCOSUR networks, from January 2013 to December 2016. Inborn patients, from 240 to 306 weeks of gestational age (GA) were included. Hazard ratios for survival and survival without major morbidity until the first hospital discharge or transfer to another facility were studied by using Cox proportional hazards regression. Results: A total of 10,565 patients, 6,120 (57.9%) from SEN1500 and 4,445 (42.1%) from NEOCOSUR, respectively, were included. In addition to GA, birth weight, small for gestational age (SGA), female sex, and multiple gestation, less invasive resuscitation, and the network of origin were significant independent factors influencing survival (aHR [SEN1500 vs. NEOCOSUR]: 1.20 [95% CI: 1.15–1.26] and survival without major morbidity: 1.34 [95% CI: 1.26–1.43]). Great variability in outcomes between centers was also found within each network. Conclusions: After adjusting for covariates, GA, birth weight, SGA, female sex, multiple gestation, less invasive resuscitation, and the network of origin showed an independent effect on outcomes. Determining the causes of these differences deserves further study.

Introduction: Lactoferrin (LF) is a protective protein present in milk with anti-infective and immune-modulating properties. Objectives: The aim of this study was to determine the association of maternal LF intake and mother’s own milk intake in the first 10 days of life on the prevention of late-onset sepsis (LOS), necrotizing enterocolitis (NEC), or death in the first 8 weeks of life in newborns with a birth weight Methods: A retrospective cohort study was conducted, with the exposure being the consumption of mother’s own LF and mother’s own milk in the first 10 days of life, and the outcome being LOS, NEC, or death during days 11 and 56 of life, analyzed by Cox regression. Results: Two hundred and ninety-nine infants were enrolled, including 240 with human LF intake information. The average daily human LF intake over days 4–10 of life was 283 mg/kg/day (IQR 114–606 mg/kg/day). The hazard ratio (HR) of mother’s own milk LF intake ≥100 mg/kg/day in days 4–10 for LOS, NEC, or death was 0.297 (95% CI 0.156–0.568, p < 0.001); the adjusted HR was 0.752 (95% CI 0.301–1.877, p = 0.541). The adjusted HR of mother’s own milk cumulative intake (days 4–10) of 54–344 mL/kg (25–75 quartiles) for LOS, NEC, or death was 0.414 (95% CI 0.196–0.873, p = 0.02). Infants who developed an event (LOS, NEC, or death) had significantly less median daily human LF intake than those that did not (89 vs. 334 mg/kg/day, respectively, p < 0.0001). Conclusion: Consumption of higher amounts of mother’s own milk in the first days of life is associated with less infection, NEC, and death. Early human milk intake should be strongly encouraged in all newborns.

OBJECTIVE: To evaluate the combined prognostic value of neurological examination, head circumference and cranial ultrasound for neurodevelopmental delay (NDD) in very low birth weight (VLBW

Objectives To determine the effect of bovine lactoferrin on prevention of late-onset sepsis (LOS) and neurodevelopment delay. Study design Randomized, double-blind, controlled trial in neonates with a birth weight of 500-2000 g in 3 neonatal units in Lima, Peru, comparing bovine lactoferrin 200 mg/kg/day with placebo administered for 8 weeks. The primary outcome was the first episode of culture-proven LOS or sepsis-associated death. Neurodevelopment delay was assessed by the Mullen Scales at 24 months corrected age. Results Of the 414 infants enrolled, 209 received bovine lactoferrin and 205 received placebo. LOS or sepsis-associated death occurred in 22 infants (10.5%) in the bovine lactoferrin group vs 30 (14.6%) in the placebo group; there was no difference after adjusting for hospital and birth weight; hazard ratio 0.73 (95% CI, 0.42-1.26). For infants with birth weights of Conclusions Supplementation with bovine lactoferrin did not decrease the incidence of sepsis in infants with birth weights of Trial registration ClinicalTrials.gov : NCT01525316 .

Metformina es una biguanida usada como agente antihiperglicemiante, que promueve la euglicemia; su principal toxicidad es acidosis láctica. Se reporta el caso de un varón, adulto mayor, diabético e hipertenso quien se automedicó con 10 tabletas de metformina 850 mg; presentando acidosis láctica severa y choque distributivo requiriendo soporte y manejo en la Unidad de Cuidados Intensivos

OBJECTIVES: Lactoferrin (LF) is a breast milk glycoprotein with protective effects against neonatal infections, mainly in premature and low-birth-weight (LBW) neonates. The aims of this study were to determine LF concentration in breast milk of mothers of LBW infants during the first 2 months postpartum, and to identify the factors associated with LF concentration. STUDY DESIGN: Prospective study conducted as a part of an ongoing clinical trial in three Neonatal Units in Peru. We included 346 mothers of neonates with a birth weight

Several cytokines have been detected in human milk but their relative concentrations differ among women and vary over time in the same person. The drivers of such differences have been only partially identified, while the effect of luminal cytokines in the fine-regulation of the intestinal immune system is increasingly appreciated. The aim of this study was to investigate the associations between obstetrical complications and human milk cytokine profiles in a cohort of Peruvian women giving birth to Low Birth Weight (LBW) infants. Colostrum and mature human milk samples were collected from 301 Peruvian women bearing LBW infants. The concentration of twenty-three cytokines was measured using the Luminex platform. Ninety-nine percent of women had at least one identified obstetrical complication leading to intra-uterine growth restriction and/or preterm birth. Median weight at birth was 1,420g; median gestational age 31 weeks. A core of 12 cytokines, mainly involved in innate immunity and epithelial cell integrity, was detectable in most samples. Maternal age, maternal infection, hypertensive disorders, preterm labor, and premature rupture of membranes were associated with specific cytokine profiles both in colostrum and mature human milk. Mothers of Very LBW (VLBW) neonates had significantly higher concentrations of chemokines and growth factor cytokines both in their colostrum and mature milk compared with mothers of larger neonates. Thus, maternal conditions affecting pregnancy duration and in utero growth are also associated with specific human milk cytokine signatures.

Preterm neonates are at risk to acquire infections. In addition to the high mortality associated with sepsis, these patients are at risk for long-term disabilities, particularly neurodevelopment impairment. Several interventions have been evaluated to reduce rates of infections in neonates but have not proven efficacy. Lactoferrin (LF), a milk glycoprotein with anti-inflammatory, immunomodulatory and anti-microbial properties, has the potential to prevent infections in young children. We performed a review of current and ongoing clinical trials of LF for prevention of neonatal sepsis, and found eleven registered clinical trials that include more than 6,000 subjects. Few of these trials have finished; despite their small sample size, the preliminary results show a trend towards a positive protective effect of LF on neonatal infections. Larger trials are underway to confirm the findings of these initial studies. This information will help to define LF's role in clinical settings and, if proven effective, would profoundly affect the treatment of low birth weight neonates as a cost-effective intervention worldwide.

Con el objetivo de describir la frecuencia y severidad de la hemorragia intraventricular y leucomalacia periventricular en neonatos de bajo peso en tres hospitales de Lima, Perú se evaluaron 385 neonatos menores de 2000 g de peso al nacer durante mayo del 2012 a julio del 2014. Se obtuvo ultrasonidos cerebrales a las 40 semanas de gestación, 3-5 días de vida y 3-4 semanas de vida. Hemorragia intraventricular se presentó en 19,2% neonatos con menos de 1500 g y fue severa (grado III o con infarto hemorrágico periventricular) en 9,6% neonatos menores de 1500 g. La mortalidad en neonatos con hemorragia intraventricular fue de 47,1%, se encontró leucomalacia periventricular en 5,4% de los neonatos menores de 1500 g. Ambos diagnósticos fueron más frecuentes en neonatos con menor peso. La frecuencia de hemorragia intraventricular es similar a lo reportado en otros países; sin embargo, la severidad y mortalidad es mayor.

Los desórdenes hipertensivos del embarazo son una de las complicaciones más serias que se presentan durante la gestación, pues repercuten en la madre y en el feto. Se hace una revisión somera sobre los efectos de esta enfermedad en los neonatos, incluyendo la restricción del crecimiento intrauterino y repercusiones en el sistema hematopoyético, aparato respiratorio y sistema nervioso central, así como alteraciones metabólicas.

When microbial communities colonize in the developing intestinal tract after birth, microorganisms interact with specific apical surface receptors on the enterocytes. This interaction triggers a response that prevents overexpression of inflammatory cytokines, thus providing protection from pathogen-induced mucosal damage. Multiple immune modulatory factors in human milk and innate humoral factors also control inflammatory responses, providing additional protective effects. Our understanding of the role of the luminal microbial communities or microbiota is growing rapidly as novel technologies provide new insights into their taxonomy, function during early development, and impact on life-long health. Multiple studies have evaluated the effects of the specific nutrients, glutamine, arginine, nucleotides, polyunsaturated fatty acids, and lactoferrin, on disease outcomes in premature infants. These studies support a role for nutrients to modulate host defense mechanisms in premature infants, to develop normal digestive function, to protect from bacterial translocation, and to preserve mucosal barrier integrity. These effects are clearly important. However, not enough is yet known to design specific clinical care practices that support a healthy microbiota.

The interplay between microorganisms and the intestine of newborn infants is associated with diverse functional and clinical outcomes that result from the specific interactions among microbial communities, their products, and the unique characteristics of the gastrointestinal tract. Multiple mechanisms of action for infant formula ingredients with probiotic activity appear to exist. These mechanisms are thought to protect the host not only from intestinal diseases but also from systemic infection. However, questions about the safety of probiotics for preterm infants remain unanswered, particularly with regard to sepsis, immunomodulatory effects, and microbial resistance. Few well-designed studies have been conducted to evaluate the effects of probiotic, prebiotic, and synbiotic ingredients on relevant clinical outcomes in preterm infants. Although existing data are encouraging, there is insufficient evidence to recommend the routine use of these ingredients in all preterm infants.

Objetivo: Determinar la morbilidad y mortalidad de los pacientes con síndrome de distress respiratorio agudo (SDRA)/injuria pulmonar aguda (IPA) por Influenza A H1N1 que requirieron soporte cardiopulmonar en un hospital general. Material y métodos: Estudio retrospectivo, descriptivo, tipo serie de casos. Se revisaron las historias clínicas, las hojas de monitoreo ventilatorio y hemodinámico de los pacientes con SDRA/IPA secundario a Influenza A H1N1 atendidos en el Servicio de Cuidados Intensivos Generales (SCIG) del Hospital Nacional Cayetano Heredia entre mayo y setiembre de 2009. El diagnóstico de Influenza A H1N1 se realizó por PCR-RT. Resultados: Se atendieron 99 pacientes con Influenza A H1N1, 9 ingresaron al SCIG por SDRA/IPA; cinco requirieron ventilación mecánica invasiva (VMI), tres ventilación mecánica no invasiva y uno no requirió soporte ventilatorio. La edad promedio fue 43,3 ± 18,3 años; el tiempo de enfermedad 8 ± 3 días. Al ingreso, el 100% tuvo fiebre y disnea, el score APACHE II fue 10,5 ± 4,1 y el SOFA 5,6 ± 3,2; el Pa02/Fi02 96,74 ± 28,6. En 4/5 pacientes en VMI el Pa02/Fi02 a las 12 h y al final de la ventilación mecánica fue < 200. La presión en cuña estimada fue 15,69 ± 3,6 y el índice cardiaco por doppler esofágico 2,4 ± 0,34. La TGO fue 160 ± 152,15, DHL 2366,33 ± 1862,13 y CPK 216 ± 298,25. Todos los pacientes recibieron Oseltamivir 150 mg cada 12 h por 10 días. Cuatro pacientes fallecieron. Conclusiones: Los pacientes con SDRA/IPA por Influenza A H1 N1, fueron adultos jóvenes, con tiempo de enfermedad prolongado; con fiebre, disnea y linfopenia; sin compromiso cardiovascular y con hipoxemia refractaria como causa de muerte. Objective: To determine the morbidity and mortality patterns of patients with acute respiratory distress syndrome (ARDS)/acute pulmonary injury (API) due to influenza A H1N1 who required cardiopulmonary support in a general hospital. Methods: Retrospective case series. Clinical charts, mechanical ventilation and hemodynamic monitoring charts of patients with ARDS/API due to influenza A H1N1 admitted to the general intensive care unit (GICU) of Hospital Nacional Cayetano Heredia from May to September 2009 were reviewed. The diagnosis of influenza H1N1 was confirmed with RT-PCR. Results: 99 patients with influenza A H1N1 were attended; 9 were admitted in the GICU with ARDS/API; five patients required invasive mechanical ventilation (IMV); three non-invasive mechanical ventilation (NIMV) and one did not require ventilatory support. Mean age was 43.3 ± 18.3 years; mean duration of symptoms was 8 ± 3 days. On admission, 100% of patients had fever and dyspnea; mean APACHE II score was 10.5 ± 4.1 and mean SOFA score was 5.6 ± 3.2; the mean Pa02/Fi02 was 96.74 ± 28.6. In 4/5 of patients requiring IMV the Pa02/Fi02 at 12 hours and at the end of mechanical ventilation was < 200. Estimated pulmonary wedge pressure was 15.69 ± 3.6 and the cardiac index estimated by esophageal doppler ultrasound was 2.4 ± 0.34. AST was 160 ± 152.15, LDH was 2366.33 ± 1862.13 and CK was 216 ± 298.25. All patients received oseltamivir 150 mg every 12 hours per 10 days. Four patients died. Conclusions: Patients with ARDS/API due to influenza A H1N1 were young adults with protracted disease with fever and lymphopenia, without cardiovascular involvement and with refractory hypoxemia as the main cause of death.

To determine the actual nutritional intake of very low birth weight infants and their growth outcome during the first month of life. Additionally, we identified factors that account for a negative neonatal outcome in this population.A case-series study was conducted in a tertiary hospital in Lima, Peru between 2011 and 2012 and the data was obtained from medical records. No feeding protocol was used during this study. Daily fluids, energy and protein intakes were documented and weekly weight z-scores were calculated. A logistic regression analysis was used to identify factors for an adverse outcome, defined as neonatal mortality or extra-uterine growth restriction, during the first 28 days of life.After applying selection criteria, 76 participants were included. The nutritional intakes were similar to standard values seen in the literature, but protein intakes were suboptimal in all of the four weeks. Birth weight z-score was associated with an adverse outcome (p=0.035). It was determined that having a birth weight z-score under -1.09 predicted a negative outcome with an area under the curve of 96.8% [93.5%, 100%] with a 95% confidence interval.Protein intakes are widely deficient in the population of this study. Nevertheless, an adverse outcome during the neonatal period is more associated with a poor birth weight z-score than nutrition-related factors.Determinar las ingestas nutricionales en los recién nacidos de muy bajo peso al nacer y su respectivo crecimiento en el primer mes de vida. Adicionalmente, identificar factores para un desenlace negativo en el periodo neonatal de esta población.Estudio de serie de casos desarrollado en un hospital de tercer nivel en Lima, Perú desde 2011 a 2012. La información se obtuvo de las historias médicas. No se utilizó un protocolo de nutrición durante el estudio. La ingesta diaria del volumen, la energía y las proteínas fue registrada al igual que el puntaje z del peso de manera semanal. Se utilizó regresión logística para identificar factores asociados a un desenlace adverso, que se define como mortalidad neonatal o restricción de crecimiento extrauterino en los primeros 28 días de vida.Luego del criterio de selección, se incluyeron a 76 participantes. Las ingestas nutricionales fueron similares a los valores descritos en la literatura, pero la ingesta proteica fue sub óptima durante las cuatro semanas. El puntaje z del peso al nacer se asocia con un desenlace adverso (p=0,035). Se determinó que un puntaje z menor de 1,09 predice un desenlace negativo con un área bajo la curva ROC de 96,8% (93,5%, 100%), con un intervalo de confianza del 95%.Las ingestas proteicas fueron sumamente deficientes en este estudio. Sin embargo, un desenlace adverso se asocia más a un pobre puntaje z al nacer que a factores relacionados a la nutrición.

BACKGROUND: Lactoferrin (LF) is a broad-spectrum antimicrobial and immunomodulatory milk glycoprotein. OBJECTIVE: To determine the effect of bovine LF on the prevention of the first episode of late-onset sepsis in Peruvian infants. METHODS: We conducted a pilot randomized placebo-controlled double blind study in infants with a birth weight (BW) less than 2500g in 3 Neonatal Units in Lima. Patients were randomized to receive bovine LF 200mg/kg/d or placebo for 4 weeks. RESULTS: One hundred and ninety neonates with a BW of 1591 +/- 408 g and a gestational age of 32.1 +/- 2.6 weeks were enrolled. Overall, 33 clinically defined first late-onset sepsis events occurred. The cumulative sepsis incidence in the LF group was 12/95 (12.6%) versus 21/95 (22.1%) in the placebo group, and 20% (8/40) versus 37.5% (15/40) for infants less than or equal to 1500 g. The hazard ratio of LF, after adjustment by BW, was 0.507 (95% CI: 0.249-1.034). There were 4 episodes of culture-proven sepsis in the LF group versus 4 in the placebo group. Considering that children did not received the intervention until the start of oral or tube feeding, we ran a secondary exploratory analysis using time since the start of the treatment; in this model, LF achieved significance. There were no serious adverse events attributable to the intervention. CONCLUSIONS: Overall sepsis occurred less frequently in the LF group than in the control group. Although the primary outcome did not reach statistical significance, the confidence interval is suggestive of an effect that justifies a larger trial.

Fiebre amarilla es una enfermedad viral aguda causada por un virus de la familia Flaviviridae transmitida por vectores, caracterizada por síndrome ictérico febril hemorrágica y que puede cursar con disfunción multiorgánica,con alta mortalidad. Se reportan tres casos de pacientes que viajaron a La Merced, Chanchamayo, que cursaron con síndrome ictérico febril hemorrágico con disfunción multiorgánica, con diagnóstico serológico de fiebre amarilla; uno sobrevivió y dos fallecieron.

El objetivo del estudio fue analizar el uso de la punción lumbar (PL) en las sospechas de sepsis neonatal tardía. Se utilizó una cohorte de 414 neonatos con peso al nacer

Objetivo: Determinar la morbimortalidad de los pacientes mayores de 60 años que ingresan a la unidad de cuidados intensivos (UCI) de un hospital general. Material y métodos: Estudio descriptivo transversal. Se incluyeron pacientes que ingresaron a la UCI del Hospital Nacional Cayetano Heredia entre julio 2006 a diciembre 2009. Se recopilaron datos del archivo existente conformado por las hojas de epicrisis y las hojas de monitoreo ventilatorio y hemodinámico de la unidad. Resultados: La ocupación de camas por mayores de 60 años en UCI fue 38% comparado con 62% en menores de 60 (p=0,0001). La principal causa de ingreso a la unidad fue la insuficiencia respiratoria en 30,5%, las diez principales causas de ingreso y la intensidad del manejo fueron similares en ambos grupos. Existió más comorbilidad en adultos mayores [78,6%] que en jóvenes [54,5%] (p=0,071). La mortalidad en > 60 años fue 29%, en < 60 años 23,6%, en los subgrupos de 60-69 años fue 22,4%, de 70-79 años 35,9% y en >80 años 31,4% (p=0,04). Conclusiones: El 38% de pacientes en UCI son mayores de 60 años y éste porcentaje disminuye a medida que aumenta la edad. Las principales causas de ingreso son similares a los del grupo menor de 60 años, pero existe mayor mortalidad en los pacientes mayores especialmente en el grupo que ingresó con enfermedad más severa Objective: To determine the morbidity and mortality of patients older than 60 years of age admitted into an intensive care unit (ICU) of a general hospital. Methods: Descriptive cross-sectional study. Patients admitted from July 2006 to December 2009 were included. Data were gathered from the clinical charts and from registers of mechanical ventilation and hemodynamic monitoring of the unit. Results: Bed utilization was 38% for patients above 60 years of age compared to 62% for younger patients (p=0.0001). The main cause of admission was respiratory insufficiency in 30.5%. No age difference was observed in the tenth main causes of admission. Elder patients had more co-morbid conditions: 78.6% vs. 54.5%, p=0.071. Mortality rate in patients 80 years age group (p=0.04). Conclusions: 38% of patients admitted to the ICU were older than 60 years of age. There is no age difference in the main reasons for admission, but there is more mortality in older patients.

Objetivo: Determinar la morbilidad y mortalidad de los pacientes con infarto agudo de miocardio ST elevado (IMA STE) atendidos en un hospital general y describir sus características demográficas, clínicas y epidemiológicas. Material y métodos: Estudio descriptivo, serie de casos, retrospectivo, en pacientes con IMA STE en el Hospital Nacional Cayetano Heredia, del 1 de enero a 31 de diciembre del 2007. Se registraron variables clínicas y de laboratorio. Resultados: Se incluyeron 30 casos. El 86,7% fueron varones. La edad media fue de 62,8±12,6 años. El antecedente de hipertensión arterial se encontró en 57%, obesidad en 40%, tabaquismo en 40%, y de diabetes mellitus en 30%. El dolor torácico típico ocurrió en 75% de pacientes. El 50% de pacientes tuvieron hipertensión no controlada a la admisión, 33% leucocitosis, y 46% glicemia >110 mg/dl. Sólo 25% recibió terapia de reperfusión, 33,3% de casos de forma exitosa, siendo el tiempo puerta-aguja de 250 ± 114 minutos. Las complicaciones ocurrieron en 26,6% de pacientes, siendo la mortalidad de 13,3%. El 76% ingresó al hospital con un tiempo de dolor menor de 3 horas, Conclusiones: Los pacientes con IMA ST elevado fueron predominantemente varones, mayores de 60 años, ingresaron al hospital con un tiempo de dolor torácico menor de tres horas y un mínimo porcentaje recibió terapia de repercusión. Las arritmias fueron las complicaciones más frecuentes y la mortalidad post IMA alcanzó 13,3 % de los casos.(Rev Med Hered 2010;21:202-207). Objective: To determine the morbidity and mortality of patients with acute myocardial infarction ST elevation (STE AMI) treated in a general hospital. To describe demographic, clinical and epidemiological data related. Material and Methods: Descriptive retrospective case series, in patients with STE AMI at the Hospital Nacional Cayetano Heredia, from January 1 to December 31, 2007. We recorded clinical and laboratory variables. Results: 30 cases were included. 86.7% were male. The mean age was 62.8 ± 12.6 years. History of hypertension was found in 57%, obesity in 40%, 40% smoking, and diabetes mellitus in 30%. Typical chest pain occurred in 75% of patients, 50% had uncontrolled hypertension at admission, 33% leukocytosis, 46% blood glucose greater than 110 mg/dl. Only 25% received reperfusion therapy, 33.3% of cases successfully, the door-needle time of 250 ± 114 minutes. Complications occurred in 26.6% of patients, mortality was 13.3%. 76% of cases had pain less than 3 hours, at admission. Conclusions: Patients with STE AMI were predominantly male, aged 60, chest pain less than three hours at admision and a minimum percentage received reperfusion therapy. Arrhythmias are the most common complications and mortality post STE AMI reached 13.3% of cases.(Rev Med Hered 2010;21:202-207).

Objetivo: Determinar las características clínicas y epidemiológicas de los pacientes con intoxicación inducida e intencional, atendidos en un hospital general. Material y métodos: Se incluyeron pacientes con intoxicación inducida e intencional; de ambos sexos, mayores de 14 años. La información se obtuvo de la historia clínica de ingreso, entrevista personal, test de Hamilton y evaluación toxicológica en orina en los intoxicados inducidos. Resultados: De marzo a diciembre del 2006 hubo 45 pacientes con intoxicación inducida y 382 pacientes con intoxicación intencional, de estos últimos se tuvo información completa en 104. Los pacientes con intoxicación inducida en comparación a los intoxicados intencionales fueron varones (p=0,001); de mayor edad (31,62 ± 9,38 vs 26,85 ± 12,18 años) (p=0,011), mayor nivel de instrucción (p=0,04), empleados (p=0,01) y mayor nivel socioeconómico (p=0.01); los intencionales fueron mayormente estudiantes (34,62%), amas de casa (19,23%) y pobres no extremos (p=0,02). Los pacientes con intoxicación inducida a diferencia de los intencionales ingresaron a Emergencia los días domingos (p=0,001), trasladados por la Policía Nacional (p=0,001); los intencionales ingresaron trasladados por la madre (p=0,001). Los pacientes inducidos a diferencia de los intencionales estuvieron expuestos al alcohol (p=0,001), relacionados con amigos (33,33%), taxistas (28,89%) ó desconocidos (33,33%), ingresaron en estado de estupor (p=0,001), con Glasgow > 8 y < 13 (p=0,03), Hamilton normal (p=0,001) y toxicológico positivo a benzodiacepinas en el 11,11%; mientras los intencionales ingresaron con síntomas y signos colinérgicos (p=0,001), con Glasgow >13 (0,001), y con depresión mayor (p=0,001).Conclusión: Los pacientes con intoxicación inducida a diferencia de los intencionales fueron varones, con nivel de instrucción superior, empleados, no pobres, ingresaron los días domingo, trasladados por la Policía Nacional y en estado de estupor, y los intoxicados intencionales fueron mujeres, estudiantes o amas de casa, ingresaron trasladados por la madre, con síntomas y signos colinérgicos, y con depresión mayor. (Rev Med Hered 2009;20:183-189) Objectives: To determine clinical and epidemiological characteristics of patients with self and non-self intentional poisoning admitted at the emergency room (ER) of general hospital. Material and methods: Prospective evaluation of patients with self and non-self intentional poisoning in 2006, demographic and clinical data were assessed; patient interviewed, Hamilton’ scale and urine toxic screen were performed. Results: Forty five patients with non-self intentional poisoning (NSP) and 382 patients with self intentional poisoning (SP), were evaluated from March to December of 2006; One hundred four of 382 clinical charts from patients with SP were fully available only, NSP patients were older than SP patients (mean age: 31.62 ± 9.38 years and 26.85 ± 12.18 years; p=0.011); most of patients with NSP were males (p=0.001) and females (p=0.001) in the group of SP; high educational level (p=0.04), employer (p=0.01) and high income (p=0.01) were more frequent in NSP than in SP patients. SP patients were students (34.62%), housewife (19.23%) and had low income (p=0.02); most of NSP patients were admitted on Sunday (p=0.001), and transferred by the police (p=0.001); SP patients were transferred by their mother (p=0.001). NSP was related with drinking alcohol (p=0.001), meeting with friends (33.33%), been in a taxi (28.89%) and meeting unknown people during the episode. Admitted in stupo mental status (p=0.001), Glasgow coma scale > 8 and < 13 (p=0.03), and normal Hamilton’ scale (p=0.001) were more frequent in NSP than in SP patients; urine toxic screen for benzodiazepines was positive in 11.11% of NSP patients; at admission, cholinergic signs and symptoms (p=0.001), Glasgow coma scale > 13 (p=0.001) and mayor depression (p=0.001) were more frequent in SP than in NSP patients. Conclusions: Patients with NSP were males with high education level, employers, had high income, most of them were admitted on Sundays, transferred by the police to the ER and were admitted in stupor mental status, SP patients were females, students and housewife, mostly transferred by their mother to the ER and at admission had cholinergic signs and symptoms and mayor depression.(Rev Med Hered 2009;20:183-189).

Objective To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants. Methods Prospectively collected data in infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia. Results 1,825 very low birth weight infants survivors were analyzed. Mean birth weight and gestational age were 1085+/-279 g and 29+/-3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. A higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91+/-27 vs. 51+/-19), of mechanical ventilation (19+/-20 vs. 4+/-7) and oxygen therapy (72+/-30 vs. 8+/-14) in comparison with non BPD infants. Conclusions Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide useful information in the design of effective preventive perinatal strategies.

OBJETIVO: Determinar a incidência de displasia broncopulmonar, os fatores de risco e a utilização de recursos em uma ampla população sul-americana de recém-nascidos de muito baixo peso ao nascer MÉTODOS: Dados prospectivamente registrados de crianças com peso ao nascer entre 500 a 1.500 g, nascidas em 16 centros neonatais pertencendo à rede NEOCOSUR entre 10/2000 a 12/2003. A análise multivariada de Poisson com variância robusta foi utilizada para determinar os fatores de risco relativo e intervalo de confiança de 95% que afetam o risco de apresentação de displasia broncopulmonar RESULTADOS: Foram analisados 1.825 recém-nascidos de muito baixo peso ao nascer. As médias de peso ao nascer e a idade gestacional foram de 1.085±279g e 29±3 semanas, respectivamente. A incidência de displasia broncopulmonar foi de 24,4%, e a sobrevida sem displasia broncopulmonar aumentou quanto maior foi a idade gestacional. Maior peso ao nascer, maior idade gestacional e sexo feminino estiveram associados a um menor risco de displasia broncopulmonar. Aumentaram o risco de displasia broncopulmonar: ventilação mecânica, necessidade de surfactante, escape aéreo, persistência do canal arterial, sepse tardia e enterocolite necrotizante. As crianças com displasia broncopulmonar requerem um maior tempo hospitalização (91±27 versus 51±19), de ventilação mecânica (19±20 versus 4±7) e de oxigenioterapia (72±30 versus 8±14). CONCLUSÕES: A incidência de displasia broncopulmonar foi de 24,4% em uma ampla população sul-americana e se relaciona com uma maior utilização de recursos. Os fatores de risco associados à displasia broncopulmonar encontrados nesse estudo foram: ventilação mecânica, necessidade de surfactante, escape aéreo, persistência do canal arterial, sepse tardia e enterocolite necrotizante. As informações contidas neste estudo podem ser úteis para o delineamento de estratégias perinatais de prevenção da morbidade. OBJECTIVE: To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants. METHODS: Data were prospectively collected from infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia. RESULTS: 1,825 very low birth weight infant survivors were analyzed. Mean birth weight and gestational age were 1085+279 g and 29+3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. Higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91±27 vs. 51±19), on mechanical ventilation (19±20 vs. 4±7) and oxygen therapy (72±30 vs. 8±14) in comparison with non BPD infants. CONCLUSIONS: Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide information useful to the design of effective preventive perinatal strategies.

A 48 year-old male presented with a 6 month history of a dementia syndrome, memory deficit, impairment of judgement, and right sligth hemiplegia, and sexual promiscuity. ELISA for HIV was negative; the VDRL and FTA-abs for syphilis were positive (1/8 and 3+ respectively); VDRL int the CSF was positive (1/8) making the diagnosis of neurological syphilis. In addition, significant NMR images are presented. The patient received penicilin I.V. with clinical, neurological and radiological improvement.