Revista Clínica Escuela de Medicina UCR-HSJD, Volumen 3, Número 1

URI permanente para esta colecciónhttps://hdl.handle.net/10669/14765

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    INCIDENCIA Y MICROBIOLOGÍA DE LAS SEPTICEMIAS ASOCIADAS A CATÉTER VENOSO CENTRAL EN LOS PACIENTES INGRESADOS EN LA UNIDAD DE CUIDADOS INTENSIVOS Y EL EDIFICIO DE MEDICINA DEL HOSPITAL SAN JUAN DE DIOS, DURANTE EL PRIMER BIMESTRE 2011.
    (2012-03-01 00:00:00) Ramírez Cardoce, Manuel Enrique; Quesada Aguilar, Carlos I.
    Background: Many patients with a central venous catheter (CVC) presents with an associated complication (mechanic, infectious or thrombotic), and most of the bloodstream infections are catheter-related (CR-BSI), with a high mortality rate and increased costs due to hospitalization and treatment. The risk of a CR-BSI depends on several factors, including type of catheter, site of insertion, length, aseptic technic and hostspecific factors. Methods: It is an observationalcohort study without comparison group, from January 1st thru February 28th, 2011. It included every hospitalized patient in need for a CVC as part of his/her treatment. Through an Epi Info 3.5.2 formulary, data was analyzed and frequencies and proportions of qualitative variables were determined first, and then, for the general variables, a description by departments was made. Rate of CR-BSI per 1000 catheter-days was determined. All analysis was made using the Stata 10.0 statistical software. Results: A total of 133 cases were analyzed: 85 (63.9%) in Medicine and 48 (36.1%) in the ICU. In 82 (96.5%) Medicine patients, and 41 (85.4%) ICU patients, the subclavian approach were used. All the CVC used were double-lumen and made of polyurethane. In 13 (15.3%) Medicine patients, and 36 (75%) ICU patients, chlorhexidine was used as the preferred skin-preparation solution. Maximum barriers and aseptic technic were used in 63.5% cases of Medicine, and in 81.2% cases of the ICU. Immunosuppression was present in 26 (19.5%), being the most frequent ones neutropenia and post chemotherapy bone-marrow suppression. There were 17 cases of CR-BSI (12.8% -17/133-) (6.8% -9/133- in Medicine, and 6.0% -8/133- in the ICU), which represents 52.9% (9/17) in Medicine, and 47.1% (8/17) in the ICU. The staphylococci coagulase-negative were the most prevalent pathogens (22.3% in Medicine, and 37.5% in the ICU). CR-BSI rate (per 1000/catheter-days) was 11.6 in Medicine, and 15.3 in the ICU. Interpretation: Local CR-BSI rate exceeds by 4 or 5 the average accepted rate described in current medical literature (2.7 per 1000/catheter-days), even taking in consideration its variability according placement site, catheter type and management, and hospital type, size and ward. Within the risk factors involved, the ones related to hospital ward and maximal barriers and aseptic technic were the main responsibleof this difference.
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    ENFERMEDADES DERMATOLÓGICAS QUE REQUIEREN UN MANEJO SIMILAR A LAS QUEMADURAS.
    (2012-03-01 00:00:00) Leitón Chaves, Andrés; Navarro Coto, José Francisco
    Stevens Johnson Syndrome, the Toxic Epidermal Necrolysis and the Staphylococcal Scalded Skin Syndrome correspond to dermatological pathologies presented with skin lost in large body areas, therefore they require a second degree burns handling and expediently controlled in a Burn Unit.
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    Síndome De Löfgren
    (2012-03-01 00:00:00) Antillón Flores, Fabián; Molina Guevara, Erick; Pacheco Salazar, Adolfo
    Sarcoidosis is a systemic and immunologic disease of unknown etiology, characterized by the presence of noncaseating granulomas. Any tissue can be affected, but the lung is the most frequently compromised organ, followed by lymph nodes, skin, eyes, musculoskeletal and nervous system. Usually it has an acute or subacute course that heals itself, but it may also have a chronic and progressive course, causing serious consequences. Diagnosis is based on the combination of clinical, radiological and histological studies, along with the exclusion of other granulomatosus diseases. Löfgren´s Syndrome is an acute presentation of sarcoidosis, characterized by the presence of arthritis, arthralgia erythema nodosum and lymphadenopathy. We present thecase of a young male in the Calderon Guardia Hospital, San José Costa Rica