Feasibility of Using New Sustainable Mineral Additions for the Manufacture of Eco-Cements

Due to a continuously developing population, our consumption of one of the most widely used building materials, concrete, has increased. The production of concrete involves the use of cement whose production is one of the main sources of CO2 emissions; therefore, a challenge for today's society is to move towards a circular economy and develop building materials with a reduced environmental footprint. This study evaluates the possibility of using new sustainable supplementary cementitious materials (SCMs) from waste such as recycled concrete aggregates (RCAs) and mixed recycled aggregates (MRAs) from construction and demolition waste, as well as bottom ash from olive biomass (BBA-OL) and eucalyptus biomass ash (BBA-EU) derived from the production of electricity. A micronisation pre-treatment was carried out by mechanical methods to achieve a suitable fineness and increase the SCMs' specific surface area. Subsequently, an advanced characterisation of the new SCMs was carried out, and the acquired properties of the new cements manufactured with 25% cement substitution in the new SCMs were analysed in terms of pozzolanicity, mechanical behaviour, expansion and setting time tests. The results obtained demonstrate the feasibility of using these materials, which present a composition with potentially reactive hydraulic or pozzolanic elements, as well as the physical properties (fineness and grain size) that are ideal for SCMs. This implies the development of new eco-cements with suitable properties for possible use in the construction industry while reducing CO2 emissions and the industry's carbon footprint.

Wrist Level Tendon Repairs Utilizing a Novel Tendon Stapler Device: An Efficiency and Biomechanical Study

BACKGROUND

A novel tendon stapler device (TSD) was recently developed and FDA-approved to improve the strength and consistency of primary tendon repairs. We hypothesized this TSD would demonstrate faster and superior biomechanical properties compared to a standard suture coaptation. We also hypothesized that the TSD biomechanical properties would be consistent across participants with differing tendon repair experience.

METHODS

Participants included a novice, intermediate, and expert in tendon repairs. Timed comparisons were performed in flexor zones IV-V and extensor zones VI-VII on human cadaver arms. Suture repairs were performed with a modified Kessler with a horizontal mattress. TSD repairs were performed on the matched donor arms. Biomechanical testing included 2-mm gap force, ultimate failure load, and mode of failure.

RESULTS

In total, 228 tendon coaptations from 12 donor arms were performed and analyzed. TSD coaptations were three times faster and withstood nearly 50% higher forces on the 2-mm gap testing and roughly 30% higher forces on ultimate failure testing. These findings did not change when the repair times were analyzed by individual participants. The suture coaptations failed from suture pull-through, suture breakage, and knot failure. The TSD coaptation failures only occurred from device pull-through.

CONCLUSION

The TSD produces significantly faster and stronger primary tendon coaptations compared to a standard 4-strand core suture repair in human donor arms. These findings also demonstrated minimal variability among participants with differing tendon repair experience. Although further investigation is needed, this device has potential to revolutionize tendon repairs.

Learning Curve of Wrist-level Tendon Repairs Using a Novel Tendon Stapler versus Traditional Suture Methods

Numerous effective techniques for primary tendon coaptations exist. However, these techniques are complex and require a substantial amount of training to become proficient. Recently, a novel tendon stapler device (TSD) was developed that could potentially diminish the discrepancies among surgeons of varying levels of training. We hypothesized that the TSD would be easier to learn and would demonstrate improved learning curve efficiencies across participants of differing tendon repair experience compared with traditional suture methods. Participants included a novice, intermediate, and expert in tendon repairs. Comparisons were performed on wrist-level flexors and extensors from human donor arms. The suture repairs were performed with a modified Kessler with a horizontal mattress and were performed in one session on two donor arms by each participant. In a second session, each participant performed the TSD repairs on the matched, contralateral donor arms. Scatterplots fitted with Loess curves, one-way analysis of variance, Tukey pairwise comparisons, two-sided independent samples t test, and Fisher exact test were used to analyze findings. Results of our study showed that TSD repair times did not vary significantly by experience level. Suture repairs reached a stable "learned" level around repair #30, whereas the TSD repairs showed a more efficient curve that stabilized around repair #23. The TSD required less educational time, demonstrated a more efficient learning curve, and showed less variability across participants and repair order. Overall, the TSD is easy to adopt and may carry positive implications for surgeons and patients.

An Evaluation of Racial Disparities in Online Marketing of Academic Plastic Surgery Practices

BACKGROUND

Racial disparities in plastic surgery limit health care accessibility and quality. The aim of this study is to determine if racial disparities exist within patient-targeted advertising materials on academic plastic surgery practice (APSP) Web sites and if disparities are more pronounced in specific categories within plastic surgery.

METHODS

Throughout May 2021, 3 independent reviewers analyzed the Web sites for APSPs and identified all photos, videos, and graphics with visible skin. For each image, the Fitzpatrick skin tone scale was used to classify the skin tone as "White" (I-III) or "non-White" (IV-VI). The images were further categorized based on the type of procedure depicted. Comparisons were made to publish US census data using χ 2 tests and linear mixed effects models.

RESULTS

In total, 4615 images were analyzed from 100 APSP Web sites. Seven hundred eighty (16.9%) portrayed non-White skin tone, which was significantly less than expected based on US census data (23.7% non-White race) ( P < 0.001). Online representation had the starkest disparity in hand surgery (8.65% non-White) and adult craniofacial (9.74% non-White). The only categories that showed no significant difference between representation and demographics included implant-based breast reconstruction ( P = 0.32) and pediatric craniofacial ( P = 0.93). Overall, the marketing materials demonstrated significantly lower representation of non-White skin compared with the census demographics by an absolute difference of -4.71% ( P < 0.001).

CONCLUSIONS

Non-White patients are significantly underrepresented in advertising materials published by APSPs, indicating systemic racial biases. Patient-targeted advertising can be improved to promote equality in representation for patients seeking plastic and reconstructive surgery.

A Nationwide Analysis Evaluating the Safety of Using Acellular Dermal Matrix with Tissue Expander-Based Breast Reconstruction

Background  In March 2021, the United States Food and Drug Administration (FDA) safety communication cautioned against the use of acellular dermal matrix (ADM) products in breast reconstruction and reiterated that the FDA does not approve ADM use in breast surgery. This study aims to assess the safety of ADM use in breast reconstruction. Methods  Women who underwent ADM and non-ADM assisted tissue expander (TE)-based breast reconstruction were identified using the National Surgical Quality Improvement Program database (2012-2019). Trends of ADM use over time, and 30-day outcomes of surgical site infection (SSI), dehiscence, and unplanned reoperation were assessed. Results  Of the 49,049 TE-based breast reconstructive cases, 42.4% were ADM assisted and 57.6% non-ADM assisted. From 2012 to 2019, the use of ADM increased from 26.1 to 55.6% (relative risk [RR] =1.10; p  < 0.01). Higher rates of SSI (3.9 vs. 3.4%; p  = 0.003) and reoperation (7.4 vs. 6.0%; p  < 0.001) were seen in the ADM cohort. There was no significant difference seen in dehiscence rates (0.7 vs. 0.7%; p  = 0.73). The most common reoperation within 30 days for the ADM group (17.6%) was removal of TE without insertion of implant (current procedural terminology: 11,971). ADM-assisted breast reconstruction was associated with increased relative risk of SSI by 10% (RR = 1.10, confidence interval [CI]: 1.01-1.21; p  = 0.03) and reoperation by 15% (RR = 1.15, CI: 1.08-1.23; p  < 0.001). Conclusions  ADM-assisted breast reconstruction more than doubled from 2012 to 2019. There are statistically higher complication rates of SSI (0.5%) and reoperation (1.4%) with ADM use in TE-based breast reconstruction, suggesting that reconstruction without ADM is safe when comparing immediate postoperative outcomes.

Hospitalization, mechanical ventilation, and case-fatality outcomes in US veterans with COVID-19 disease between years 2020-2021

PURPOSE

Although veterans represent a significant proportion (7%) of the USA population, the COVID-19 disease impact within this group has been underreported. To bridge this gap, this study was undertaken.

METHOD

A total of 419,559 veterans, who tested positive for COVID-19 disease in the Veterans Affairs hospital system from March 1st, 2020 to December 31st, 2021 with 60-days follow-up, was included in this retrospective review. Primary outcome measures included age-adjusted incidences and relative incidences of COVID-19 hospitalization, mechanical ventilation, and case-fatality outcomes.

RESULTS

Of this veteran cohort with COVID-19 disease, predominately 85.7% were male, 59.1% were White veterans, 27.5% were ages 50-64, and 40.5% were obese. Although Black veterans were at 63% higher relative risk (RR) for hospitalization incidences, they had a similar risk RR for in-hospital deaths compared to the White-veteran referent. Asian, American Indian/Alaska Native races, advanced age ≥65, and the underweight were at high RR for mechanical ventilator and/or in-hospital deaths compared to respective referent groups. Veterans who are ≥85 years old had a nearly 5-fold higher incidence of death compared respective referent group. The monthly outcomes for hospitalization, ventilation, and case-fatality data showed decreasing trends with time.

CONCLUSION

An increased incidence of death was associated with age ≥65 years and underweight veterans compared to the referent group. Age-adjusted data, however, did not show any increased incidence of death in Black veterans compared to White veterans.

RATINGS OF THE QUALITY OF THE EVIDENCE

3 (Case-control studies; retrospective cohort study).

Characteristics of Nonelderly Adult Health Care Persistent Super Utilizers in Utah

In the United States, the top 1% and top 5% of health care spenders account for 23% and 50% of total health care spending, respectively. These high spenders have been coined the term super utilizers (SU). The aim of this study was to identify the characteristics associated with these patients to aid in developing public health interventions aimed at transitioning patients out of the SU category and thus ultimately helping to control health care costs. The authors utilized the Utah All-Payer Claims Database and Utah Population Database from 2013 to 2015 to identify demographics, comorbid conditions, health care utilization, and cost characteristics of persistent super utilizers (PSU) (≥3 hospitalizations per year for 3 years) of health care compared with persistent nonsuper utilizers (PNSU) (<3 hospitalizations per year for 3 years). Multivariable logistic regression was utilized to identify the characteristics associated with PSU versus PNSU. Higher outpatient/Emergency Department/noninpatient (eg, visits with imaging and Centers for Medicare & Medicaid Services preventive visits) health care utilization and spending, and prevalence of comorbid disease and psychosocial conditions were associated with PSU. In multivariable analysis, factors such as heart disease, chronic kidney disease (CKD), diabetes, alcohol abuse, and depression were statistically significantly associated with higher odds of PSU, with the most noteworthy being CKD (odds ratio [OR] 6.85, 95% confidence interval [95% CI] 5.84-8.02; P < 0.001), alcohol abuse (OR 5.90, 95% CI 4.49-7.69; P < 0.001), and heart diseases (OR 4.41, 95% CI 3.74-5.18; P < 0.001). The annual health care cost of a PSU is about 11.5 times greater than a PNSU ($54,776 vs. $4801; P < 0.001).

Reversible control of Co magnetism by voltage-induced oxidation

We demonstrate that magnetic properties of ultrathin Co films adjacent to Gd2O3 gate oxides can be directly manipulated by voltage. The Co films can be reversibly changed from an optimally oxidized state with a strong perpendicular magnetic anisotropy to a metallic state with an in-plane magnetic anisotropy or to an oxidized state with nearly zero magnetization, depending on the polarity and time duration of the applied electric fields. Consequently, an unprecedentedly large change of magnetic anisotropy energy up to 0.73 erg/cm(2) has been realized in a nonvolatile manner using gate voltages of only a few volts. These results open a new route to achieve ultralow energy magnetization manipulation in spintronic devices.

A cross-cultural validation of patient-reported outcomes measures: a study of breast cancers survivors

PURPOSE

Psychometric inadequacy interferes with the assessment of patient-reported health outcomes. This study examined the psychometric properties of several standardized measures in health research.

METHODS

Participants completed health outcomes measures including the FACT-G, SF-36, MOS Social Support Survey, and CES-D. Psychometric properties examined include reliability, and construct and concurrent validity.

RESULTS

320 BCS including 88 African-, 95 English-proficient Latina-, and 137 Limited English-proficient Latina-Americans participated. The findings demonstrate acceptable reliability (α > 0.70) and consistent factor structures for most measures with the variance ranging from 56 to 84%. The FACT-G physical well-being and SF-36 role limitations subscales had the best fitting structures. Concurrent validity showed the FACT-G subscales correlated with their appropriate counterparts.

CONCLUSIONS

Despite being commonly used instruments in HRQOL (e.g., FACT-G, SF-36) and QOL (e.g., CES-D, MOS) research, few studies reported the psychometric properties of these and when applied cross-culturally. However, evaluating the psychometric properties of measures in health outcomes research should be done routinely.

Iris yellow spot virus in Onion in Chile

Iris yellow spot virus (IYSV) (genus Tospovirus, family Bunyaviridae) has become endemic in several parts of the world. Between 2000 and 2004, the virus was reported from several states in the United States and the most recent report was from Georgia (2). In South America, IYSV was first reported from Brazil (3). Symptoms indicative of IYSV infection (1), such as diamond-shaped and irregular chlorotic and necrotic lesions, were observed during 2004 and 2005 in onion fields in Colina and Tiltil (Chacabuco Province) and Rengo (Cachapoal Province) located in central Chile. In the sampled fields, as much as 50% of the crop showed symptoms. In all three locations, the crop was destined for bulb production and the cultivar was a long-day Valenciana-type. Approximately 50 and 5 ha in Chacabuco and Cachapoal provinces, respectively, were surveyed. Symptomatic plants were collected and tested in the laboratory for confirmation of IYSV infection. A commercially available IYSV-specific enzyme-linked immunosorbent assay kit was used (Adgen Limited, Ayr, Scotland, UK) that confirmed the samples were infected with IYSV. Total nucleic acids were extracted, and using primers flanking the nucleoprotein (NP) gene of IYSV, reverse transcription-polymerase chain reaction was used to verify virus identity. Primer sequences were 5'-TAA AAC AAA CAT TCA AAC AA-3' and 5'-CTC TTA AAC ACA TTT AAC AAG CAC-3'. The resulting 1.2-kb DNA amplicons from five samples were cloned and sequenced (GenBank Accession No. DQ150107). Nucleotide sequence comparisons with known IYSV NP gene sequences showed 95 to 98% identity, confirming the virus as IYSV. The presence of IYSV in Brazil and now in Chile indicates its potential to become established in onion crops in the region. References: (1) L. J. du Toit et al. APSnet Image of the Week. http://apsnet.org/online/archive/2003/IW000030.asp , 2003. (2) S. W. Mullis et al. Plant Dis. 88:1285, 2004. (3) L. Pozzer et al. Plant Dis. 83:345, 1999.

98CONCEPTION RATES USING BRAHMAN BULL SEMEN FROZEN IN MILK BASED EXTENDER CONTAINING EGG YOLK OR SOYBEAN LIPIDS; A FIELD STUDY IN A TROPICAL ENVIRONMENT

The objective of this study was to examine the substitution of soybean-origin phospholipids for egg yolk in Brahman bull semen extender. Semen was frozen in 3 different low-fat milk (1%) based extenders containing 10mgmL−1 of fructose and supplemented with: 8% of whole egg yolk (Extender 1, control), 8% rectified egg yolk (egg yolk granules were removed by double centrifugation at 3000g for 1h at 5°C; Extender 2), and 7.3mgmL−1 of phospholipids of soybean-origin containing 10% of phosphatidyl choline (Extender 3). All 3 extenders were supplemented with 1000IU of penicillin, 1mgmL−1 streptomycin and 150μgmL−1 lincomycin. The semen was collected by means of artificial vagina from 3 Brahman bulls, and AI was performed during the dry season between December and April in a tropical forest environment. The mean temperature for the region was 26–30°C, with mean rainfall of 900–1500mm/year and the relative humidity of 60–70%. Ejaculates with at least 60% motility were diluted in 2 steps as follows: in step 1, each ejaculate was split into 3 even parts and diluted at 26°C with each of the extenders containing no glycerol, and in step 2, 14% of glycerol was added in 15-minute intervals to a final glycerol concentration of 7%. Semen was aspirated into 0.5mL plastic straws (20×106 sperm/per straw), frozen 7cm above liquid nitrogen (LN2) for 8min, and then plunged into LN2. Straws were thawed in a water bath at 37°C for 30s. Each experiment was replicated 3 times (different collection days). Sperm viability was tested within artificial insemination trials. Results are based on the pregnancy rates of crossbreed Brahman cows determined by palpation 45 Days after AI and by calving rates. Data were compared by chi-square analysis. In Experiment I, a total of 157 cows were inseminated with semen collected from 3 different bulls (A, B and C) and frozen in 3 different extenders (1, 2 and 3; 3×3 factorial design). Bull A, Extender 1, 2 and 3 (n=19, 20 and 22); Bull B, Extender 1, 2 and 3 (n=20, 20 and 20) and Bull C, Extender 1, 2 and 3 (n=22, 15 and 24), respectively. Although semen from all 3 bulls frozen in Extenders 2 and 3 fostered numerically higher pregnancy rates (from 30% for Bull B and Extender 2 to 50% for Bull C and Extender 3) than in Extender 1 (from 23.5% for Bull C to 40% for Bull B), there were no differences (P&lt;0.05) between bulls with any of 3 extenders on the pregnancy rates. In Experiment II, a total of 117 cows were inseminated with semen collected from Bull B and frozen in Extender: 1 (n=37), 2 (n=48) and 3 (n=39). There were significantly higher (P&lt;0.05) calving rates for cows inseminated with semen frozen in Extender 2 and 3 (41.6% and 46.1%, respectively) than in Extender 1 (24.3%). It can be concluded that rectified egg yolk may improve viability of frozen semen, and that phospholipids of soybean origin can be successfully substituted for egg yolk in Brahman bull milk based semen extender. Supported by Bioniche Inc, Belleville, Ontario, Canada.

[Lung cancer in the health care area of A Coruña (Spain): incidence, clinical approach and survival]

OBJECTIVE

To determine the incidence, clinical approach, diagnostic delay and survival for bronchogenic carcinoma (BC) in the public health area of A Coruña (Spain).

PATIENTS AND METHOD

This was a retrospective study of patients with a diagnosis of BC made in 1995 and 1996 in a health care area with 509,000 inhabitants. For analysis we gathered demographic, clinical and cyto-histologic data and analyzed diagnostic delay, extension of disease and time of death. Crude, age-specific and age-standardized incidences were calculated.

RESULTS

BC was diagnosed in 378 patients (95% men and 5% women). The crude incidence was 37 per 100,000 inhabitants (73.7 per 100,000 men and 3 per 100,000 women) and the age-standardized incidence was 21.7 per 100,000. Diagnosis was by cyto-histology in 87% of the cases, and the most frequent biopsy finding was epidermoid carcinoma. Diagnosis was by clinical or radiologic findings for 13.7%, and patients in that group were older and had greater comorbidity. No symptoms were present in 13% and in those patients diagnosis was earlier, with non-small BC predominating and 60% treated surgically. The diagnostic delay (time from the first symptom to histologic confirmation) was 2.5 months (median, 2.1), and length of delay did not affect survival. Surgery was performed in 23% of the patients with non-small BC. The median survival was 7.1 months (5.2 months for patients who were not treated surgically, and 37.6 for those who were).

CONCLUSIONS

The incidence of BC in men in our study is consistent with that reported for other Spanish regions, although the incidence we observed for women is much lower. Diagnostic delay did not affect survival. The percentage of patients with surgical-stage disease is very low and survival is very short. These findings support the need for early diagnosis.

Airborne outbreak of nosocomial Scedosporium prolificans infection

We describe six inpatients with acute non-lymphocytic leukaemia who developed invasive infection with Scedosporium prolificans resistant to amphotericin B, flucytosine, ketoconazole, fluconazole, and itraconazole. All six patients died. Phenotypic and genotypic assessment of samples from clinical material and ambient air from the isolation rooms where the patients were being treated showed that the epidemic was caused by a single strain. After implementation of aerial control measures, there were no further infections with this organism. We conclude that fatal multidrug-resistant S prolificans epidemics can be aerially transmitted and can be prevented with implementation of appropriate infection-control measures.

Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients

OBJECTIVE

To determine the prevalence of sleep apnea in morbidly obese patients and its relationship with cardiac arrhythmias.

RESEARCH METHODS AND PROCEDURES

Fifty-two consecutive morbidly obese (body mass index > or = 40 kg/m2) outpatients from the Obesity Clinic of the National Institute of Nutrition Salvador Zubirán underwent two nights of polysomnography with standard laboratory techniques. Electrocardiographic polysomnography signals (Lead II) were evaluated by two experienced cardiologists, and sleep complaints were measured with a standard sleep questionnaire (Sleep Disorders Questionnaire). In order to make comparisons between groups with different severities of sleep-disordered breathing, we classified the patients in four groups using the apnea-hypopnea index (AHI): Group 1, AHI 5 < 15 (n = 10); Group 2, AHI 15 < 30 (n = 10); Group 3, AHI 30 < 65 (n = 14); Group 4, AHI > or = 65 (n = 17).

RESULTS

A wide range of sleep-disordered breathing, ranging from AHI of 2.5 to 128.9 was found. Ninety-eight percent of the sample (n = 51) had an AHI > or = 5 (mean = 51 +/- 37), and 33% had severe sleep apnea with AHI > or = 65 with a mean nocturnal desaturation time of <65% over 135 minutes. Electrocardiographic abnormalities were present in 31% of the patients. Cardiac rhythm alterations showed an association with the level of sleep-disordered breathing and oxygen desaturation.

DISCUSSION

We conclude that there is a high prevalence of sleep apnea in morbidly obese patients and that the risk for cardiac arrhythmias increases in this population in the presence of a severe sleep apnea (AHI > or = 65) with severe oxygen desaturation (SaO2 < or = 65%).

Thyroid profile modifications during oral hormone replacement therapy in postmenopausal women

There are few data available about changes in thyroid hormone profiles after hormone replacement therapy (HRT). We analyzed the effect of two different oral estrogens/progestins (E/P) associations on thyroid hormones and thyroxine-binding globulin (TBG) levels in 14 postmenopausal normal women distributed at random into two groups. Both groups received daily for a year 2 mg of estradiol valeriante per os. In Group A (n = 7), estrogen was associated with norethisterone acetate. In Group B, estrogen was associated with promegestone in a similar schedule to Group A. Blood samples were withdrawn to measure estradiol (E2), thyroxine (T4), triiodothyronine (T3), free T4 (fT4), thyroid-stimulating hormone (TSH) and TBG before and after 3, 6 and 12 months of treatment. Estradiol level increased significantly in both groups, being higher in Group A than in B. Under therapy, T4 and TBG levels were increased in both groups, but within the normal range. T4 mean level increased by 34% in Group A and 20% in Group B. TBG increment was slightly significant for Group A (p < 0.02); with only a trend in Group B (p = 0.08). T3, fT4 and TSH levels did not change significantly and remained within the normal range. Oral therapy with associated E/P produces moderate increases in T4 and TBG levels. Our results suggest that in postmenopausal women on oral HRT, fT4 and TSH levels are the most useful tools to evaluate the thyroid axis status.

[Evaluation of the effectiveness of a program of detection of asymptomatic Chlamydia trachomatis infection in women]

BACKGROUND

Chlamydia Trachomatis is at present the most prevalent pathogenic agent among the causes of sexually transmitted diseases in developed countries, and has reached epidemic proportions in some of them. These infections can give rise to a considerable number of complications, many with very serious consequences. Given that, in addition, a great number of cases are asymptomatic, a general consensus exists about the convenience of carrying out screening programmes. The aim of this study is to accomplish the first stage of the screening programme of asymptomatic infection by C. trachomatis in women who seek help at a family planning centre.

METHODS

A descriptive study to determine the prevalence each year of the period studied, an analysis of its temporal tendency and the assessment of the programme effectiveness in terms of a proportional reduction in prevalence. A total number of 6.746 women were included, who attended the family planning centre for a regular checkup or contraceptive advice between January 1991 and December 1993.

RESULTS

The programme showed a global effectiveness rate of 80%, with a reduction in prevalence from 5.1% in 1990 to 1.0% in 1993. A significant fall was observed in all the categories analyzed, except for women using prophylactics and those with higher education.

CONCLUSIONS

The programme achieves its objectives very effectively. Nevertheless, it would be advisable to evaluate its efficiency together with a cost-analysis, since by reducing prevalence, the positive estimated value of the test considerably decreases, which raises the cost of a single case detection.

Early hospital discharge of preterm very low birth weight infants

OBJECTIVE

The objective of this study was to investigate whether early discharge from the hospital was feasible for selected very low birth weight (VLBW) infants.

STUDY DESIGN

A randomized clinical trial of discharge of VLBW infants from the neonatal intensive care unit at 1300 gm versus 1800 gm was done comparing weight gain and incidence of infection. Forty-three VLBW infants treated in the neonatal intensive care unit and follow-up clinics of the Hospital Universitario del Valle, Cali, Colombia, were entered into the study at 1300 to 1350 gm when they met behavioral criteria for discharge and the family home was approved.

RESULTS

There were no differences in weight gain or incidence of infection in the home group compared with the hospital group. A significant saving in hospital days and hospital costs was realized for the home group. Family cooperation was heightened in the home group.

CONCLUSIONS

Early discharge from the hospital at weights as low as 1300 to 1350 gm is safe for the VLBW infant when properly selected on the basis of behavioral criteria and environmental approval. The potential savings in hospital costs should be considered when resources are allocated for continued support for these infants.

[Incidence and risk factors for nosocomial infections in a neonatology unit]

OBJECTIVE

Neonatal nosocomial infection is a very important cause of morbidity and death in the hospital setting. The aim of our work is to study the incidence and risk factors associated with nosocomial infection in a neonatal unit.

METHOD

We followed 321 patients in a 6-month-long prospective, observational study. As units of measurement we used Incidence Density and Accumulative Incidence. For the statistical analysis we used chi-square and the logistic regression.

RESULTS

Nosocomial infection incidence density for the whole neonatal unit was 39.63% infections per 100 patients per month, while the accumulative incidence was 16.19%. Using a logistic regression method, the umbilical cord artery catheterization and days of stay variables both showed a statistically significant difference with nosocomial infection.

CONCLUSIONS

We conclude that minimizing length of stay, if possible below 10 days could be a key element to achieve a reduction in the neonatal unit's infection rate. However, new studies must be performed to ascertain if a strict enforcement of the rules pertaining to hand-washing and umbilical catheters manipulation would achieve further reductions in the infection rate associated with the umbilical cord catheterization.

Treatment of Staphylococcus aureus nasal carriers in continuous ambulatory peritoneal dialysis with mupirocin: long-term results

We present the clinical results of a prospective protocol of the treatment of Staphylococcus aureus nasal carriers (SANCs) in our continuous ambulatory peritoneal dialysis unit with mupirocin (Bactroban, SmithKline Beecham Pharmaceuticals, Philadelphia, PA). We monitored the incidence of peritonitis and catheter exit-site infection, the rate of infection-related catheter loss, and the degree of association between SANC state and S aureus infection. The study group included 94 patients with a follow-up of 1,097 patient-months (phase B). The same information was retrospectively collected among 74 continuous ambulatory peritoneal dialysis patients treated during the 24 months preceding the study period (follow-up of 1,043 patient-months) (phase A). S aureus nasal carriage was observed in 47.5% of the patients. Mupirocin was very effective in eradicating S aureus from the nares, but most patients required periodic retreatment. The incidence of S aureus peritonitis decreased from 1 episode/58 patient-months in phase A to 1 episode/548 patient-months in phase B, and the incidence of exit-site infection decreased from one episode/55 patient-months in phase A to 1 episode/137 patient-months in phase B. However, there was a simultaneous increase in the incidence of infections by other gram-positive and -negative bacteria. The rate of catheter loss after peritonitis (P = not significant) or exit-site infection (P < 0.05) tended to decrease from phase A to phase B. Seventy-seven percent of the peritonitis infections and 74% of the exit-site infections by S aureus occurred in SANCs.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiology of Chlamydia trachomatis in a population attending a family planning center]

OBJECTIVE

To know the prevalence of Chlamydia trachomatis in a population attending a Family Planning Center, as well as the distribution of said prevalence in relationship with different variables.

METHODS

This was a prevalence study, population-based. So all females over 14 years old who consulted the Planning Center were admitted into the study. We used enzyme-immune assay and DNA probe to identify the microorganism. The statistical analysis used chi 2 and Fisher's exact test when needed. For the confidence intervals, Cornfield's test was used.

RESULTS

Of the 2,408 female who participated in the study we found a prevalence of 5.1% this percentage was even higher on the 15 to 21 years old segment: 7.47% p < 0.05. Being single and belonging to the group of non-qualify workers yielded a relative risk of 1.49 and 1.66 respectively.

CONCLUSIONS

The prevalence we have found is higher to the one found in different publications in our country, a study to determine Chlamydia trachomatis should be performed in all sexually active women between 15 and 30 years old.

[Roxithromycin versus doxycycline in the treatment of Chlamydia trachomatis cervicitis in asymptomatic women]

We have performed an experimental open study, non randomized, in a population of women pertaining to a family planning center, and who have been diagnosed of Chlamydia trachomatis infection through EIA and DNA probe. 75 patients were included in the study, 50 of them received roxitromycine; 150 mg every 12 hours during 10 days, the other 25 being treated with doxycycline, 100 mg each 24 hours during 10 days. All women underwent a control after treatment using both techniques a month later, to asses the efficacy of the treatment. Mean age of women treated with roxitromycine was 28.6 years, and 30 years the ones treated with doxycycline. Efficacy in the eradication of Chlamydia trachomatis was 91.7% in the group treated with macrolide, and 92% in the group treated with doxycycline. Comparison through Chi-square did not yield statistical significance with a p < 0.05. Only a patient treated with doxycycline showed gastric intolerance. Roxitromycine shows an in vivo activity similar to doxycycline, and is an alternative to the use of doxycycline, being the first choice in those women in whom tetracycline are contraindicated.

[Rapid diagnosis of Chlamydia trachomatis using a DNA probe in a population with low risk of infection]

BACKGROUND

To assess the efficacy of a newer diagnostic technique for Chlamydia trachomatis and its usefulness as screening method in populations at low-risk for Chlamydia trachomatis infection.

METHODS

Open comparative trial between the EIA technique (Abbott Laboratories) and DNA gene probe (Gen Probe Diagnostic). A total of 1683 individuals (1630 women and 53 men) were screened with the two different techniques using samples obtained simultaneously.

RESULTS

Among women, 66 give a positive result either by one or another technique. The prevalence was 4.04%. Sensitivity of DNA probe when compared with EIA assay was 64% and specificity was 98.9%.

CONCLUSIONS

The DNA probe technique is faster than actual techniques and easy to do without major laboratory equipment. However, its price is high and its sensitivity poor in low-risk populations.

Treatment of Staphylococcus aureus nasal carriers in CAPD with mupirocin

We have studied the efficacy of topical Mupirocin for elimination of Staphylococcus aureus (Staph. aureus) nasal carriage in CAPD patients. Staph. aureus nasal carriers in our CAPD program were randomized to one of two groups: Group 1, treated with Mupirocin, and Group 2, treated with neomycin sulphate nasal ointment. The prevalence of Staph. aureus nasal colonization was 44% for patients (24/54) and 17% for dialysis partners (5/29). Group 1 included 11 patients and 1 partner, and Group 2, 8 patients and 2 partners. In Group 1, the eradication rate was 100%, and the recolonization rate was 0, 8, 41, 55 and 66% at 1, 2, 3, 6 and 10 months. In Group 2, the eradication rate was 40%, with a recolonization rate of 0.25 and 75% at 1, 2 and 3 months. Re-treatment with mupirocin was successful in 66% of the cases, compared to 20% for neomycin. The MIC90 of mupirocin for Staph. aureus was 0.5 mcg/mL, with an increase to 4 mcg/mL towards the end of the study. During the study period, there was a very low incidence of Staph. aureus peritonitis or catheter-related infections in patients treated with mupirocin. Secondary effects of mupirocin were negligible. Mupirocin is more effective than neomycin sulphate for the elimination of Staph. aureus nasal colonization in patients undergoing CAPD. Periodic re-treatment is frequently necessary, given the significant recolonization rate.