Revista Medica Herediana

The problem of methicillin-resistant Staphylococcus aureus

**Methicillin resistant Staphylococcus aureus isolates acquired in the community in three hospitals in Lima, Peru**

Staphylococcus aureus es un importante patógeno involucrado en una serie de infecciones e intoxicaciones, presenta múltiples factores de virulencia y su impacto se incrementa por su notable resistencia a los antimicrobianos. Objetivo: Determinar la frecuencia de Staphylococcus aureus meticilino resistente adquiridos en la comunidad, en hospitales de Lima- Perú. Material y métodos: Se realizó un estudio descriptivo multicéntrico. La resistencia a meticilina se determinó por el método Oxacillin Agar Screen. El origen de la cepa fue determinado mediante los criterios de los CDC; la Leucocidina de Panton Valentine fue identificada por métodos moleculares. Resultados: Se aislaron 276 cepas de Staphylococcus aureus, 160 fueron resistentes a meticilina (58%), 9 de ellas fueron identificadas como adquiridas en la comunidad (5,6%). La PVL fue identificada en 25 cepas (9,1%), 14 fueron MSSA y 11 MRSA, de éstas últimas solo 4 fueron MRSAcom, 7 fueron MRSAhosp (p<0,001). Conclusiones: El estudio revela niveles elevados de resistencia a meticilina, pero niveles bajos de MRSAcom. En nuestro medio la presencia de PVL no constituiría un marcador para la identificación de los MRSAcom. (Rev Med Hered 2010;21:4-10).

Background : Staphylococcus aureus is an important pathogen involved in a series of infections and toxin mediated syndromes, has many virulence factors and its impact increases its resistance to antimicrobial agents. Objectives: To determine the frequency of community acquired methicillin resistant Staphylococcus aureus among hospitals in Lima -Peru. Material and Methods: We performed a prospective multicenter study. The resistance to methicillin was determined by the Oxacillin Agar Screen method. The origin of the strain was determined using CDC criteria, the Panton Valentine Leucocidin was identified by molecular methods. Results: We isolated 276 strains of Staphylococcus aureus, 160 were resistant to methicillin (58%). 9 strains were identified as community acquired MRSA (5.6%). The Panton Valentine Leucocidin was identified in 25 strains (9.1%), 14 were MSSA and 11 MRSA, only 4 of the latter were CA MRSA, 7 were HA MRSA (p <0.001). Conclusions: The study showed frequencys of methicillin resistance, but low CA MRSA. In our environment the presence of PVL would not be a marker for the identification of CA MRSA. (Rev Med Hered 2010;21:4-10).

Types of peritoneal membrane and its survival according to the peritoneal equilibration test in patients in CAPD

Conocer el tipo de transporte de la membrana peritoneal (MP) permite prescribir la modalidad de diálisis y podría predecir la sobrevida de la membrana. Desconocemos el impacto del tipo de transportador de la MP en pacientes en Diálisis Peritoneal Continua Ambulatoria (DPCA) en nuestro medio. Objetivo: Determinar la frecuencia del tipo de transportador de membrana según el Test de Equilibrio Peritoneal (TEP) y su impacto en la sobrevida de la membrana peritoneal y de los pacientes en DPCA. Material y Métodos: Estudio retrospectivo de pacientes con Insuficiencia Renal Crónica terminal en el programa de DPCA del Hospital Nacional Cayetano Heredia entre el 2002 y el 2008. Se evaluaron características clínicas, demográficas y de transporte de la MP y su relación con la pérdida de la membrana y supervivencia del paciente. Resultados: El tipo de transportador promedio alto fue el más frecuente según el TEP de creatinina (42%) y de glucosa (33%). Ser transportador alto según el último TEP de glucosa (p<0,05) y la presencia de al menos 1 hospitalización (p<0,001) tuvieron relación con menor sobrevida de la membrana. La presencia de peritonitis se relacionó con menor riesgo de muerte (p=0,01). La sobrevida de la membrana al primer y quinto año fue 94% y 64% y la supervivencia general al primer y quinto año fue 97% y 73% respectivamente. Conclusiones: El tipo de transportador promedio alto fue el más frecuente. La sobrevida de la MP disminuyó en pacientes que tenían al menos una hospitalización y en los transportadores altos según el último TEP de glucosa, mientras que la presencia de episodios de peritonitis se relacionó con menor riesgo de muerte. (Rev Med Hered 2010;21:11-17).

Knowing the types of peritoneal transportation categories permits to prescribe the dialysis modality and would be able to predict the survival of the membrane. We do not know the impact of the peritoneal transporting type in patients in Continuous Ambulatory Peritoneal Dialysis (CAPD) in our country. Objective: To determinate the frequency of the membrane transporting type according to the Peritoneal Equilibration Test (PET) and to know the impact in peritoneal membrane and DPCA patient survival. Material and Methods: Retrospective study of patients with chronic kidney disease at the CAPD program of the Hospital Nacional Cayetano Heredia between 2002 and 2008. Demographic, clinical and peritoneal transportation characteristics were evaluated in search of the variables related with membrane and patient survival. Results: The high average type was the most frequent category according to creatinine PET (42%) and glucose PET (33%). Being high transporting type according to the last glucose PET (p<0,05) and at least one hospitalization (p<0,001) were related with poor membrane survival. The peritonitis episodes were related with better patient survival (p= 0,01). The membrane survival during the first and fifth year was 94% and 64% and the general survival during the first and fifth year was 97% and 73% respectively. Conclusions: The high average transporting type was the most frequent one. The peritoneal membrane survival was diminished in patients that had at least one hospitalization and in those that had high peritoneal transport status according to the last glucose PET, mean while the peritonitis episodes were related with better patient survival. (Rev Med Hered 2010;21:11-17).

Avaliação da independência funcional e da qualidade de vida de idosos institucionalizados

Objetivos: Investigar a independência funcional e a qualidade de vida (QV) de idosos institucionalizados e a relação entre estes conceitos. Método: A pesquisa foi conduzida na Vila dos Velhinhos de Sorocaba (São Paulo, Brasil) no período de maio a agosto de 2008, com 63 sujeitos de ambos os sexos, com idade > ou = 60 anos, residentes há pelo menos três meses. Foram utilizados os instrumentos: Caracterização Sociodemográfica e Clínica, MEEM, WHOQOL-OLD e MIF. Resultados: Dos sujeitos 63,5% (40/63) eram mulheres, com média de idade de 79,2 ±8,7 anos, 44,5% (28/63) viúvos, escolaridade média de 4 anos e 73% (43/63) aposentados. As doenças cardiovasculares prevaleceram (27,98%) seguidas pelas osteoarticulares (15,39%). Foram constatadas médias elevadas dos escores da MIF (103±15,3) e do WHOQOL-OLD (69,81±14,81) indicando pouco comprometimento da independência funcional e da QV. A confiabilidade dos dois instrumentos avaliada pelo Alfa de Cronbach foi satisfatória (0,70 a 0,94). Constataram-se correlações significantes de forte magnitude entre a MIF (total e subescalas) e o WHOQOL-OLD (total) e as facetas Autonomia e Participação Social. As facetas Funcionamento Sensório, Atividades Passadas e Futuras e Intimidade apresentaram correlações significantes e de moderada magnitude entre a MIF (total e subescalas). Não houve correlação significante entre a MIF (total e subescalas) e a faceta Morte e Morrer. Conclusão: As correlações apontam que a independência funcional está diretamente correlacionada com a QV, sugerindo que todas as ações voltadas para a promoção da independência funcional podem otimizar a QV dos idosos institucionalizados. (Rev Med Hered 2010;21:18-26).

Objectives: Investigate institutionalized elderly people functional independence and quality of life (QOL) and the relationship between these concepts. Material and Methods: Research was conducted in a elder care facility in the city of Sorocaba (São Paulo, Brasil) between May and August/2008, with a sample of 63 man and women, 60 years old or more and residents for at least three months in this facility. The following survey instruments were used: social demographic and clinical characterization, MMSE, WHOQOL-OLD and FIM. Results: 63.5% were women, had an average age of 79.2 ± 8.7 years, 44.5% were widows, studied for an average of 4 years and 73% were retired. Cardiovascular diseases prevailed (27.98%), followed by osteochondropathies (15.39%). High averages were found for FIM (103±15.3) and WHOQOL-OLD (69.81±14.81) scores, indicating low functional independence and QOL losses. The reliability of the two instruments evaluated by Cronbachs Alpha were satisfactory (0.70 to 0.94). High magnitude significant correlations were found between FIM (total and subscales) and WHOQOL-OLD (total) and Autonomy and Social Participation facets. Sensory Functioning, Past and Future Activities and Intimacy facets displayed moderate magnitude significant correlations between FIM (total and subscales). There were no significant correlation between FIM (total and subscales) and Death and Die facet. Conclusions: Correlations indicate that functional independence is directly correlated with QOL, suggesting that all actions aimed to promote functional independence may improve institutionalized elderly people QOL. (Rev Med Hered 2010;21:18-26).

Biosecurity knowledge, aptitude and attitude among medical students in the last years of medical school

Objetivo: Determinar el conocimiento, aptitud y actitud sobre enfermedades transmisibles por sangre y las precauciones universales de bioseguridad en estudiantes de medicina de los últimos años de estudios. Material y Métodos: Se realizó una encuesta a estudiantes de medicina del quinto año, (Grupo A), en diciembre del 2005 y luego a estudiantes de medicina del último año (grupo B), de enero a agosto del 2006. Resultados: Se realizaron 214 encuestas: 110 pertenecían al grupo A y 104 pertenecían al grupo B. El grupo A tuvo una edad promedio de 23 años (22,24) y el grupo B de 24 años (23,25). El 54,13% del grupo A fueron varones y del grupo B fueron 56,73%. El 61,73% de grupo B obtuvo calificación aprobatoria en la encuesta en comparación con 38,27% del grupo A (p=0,003). El grupo B tuvo 70% más probabilidad de tener buena información en comparación con el grupo A. Asimismo el grupo B tuvo 5,32 veces más accidentes que el grupo A. Conclusiones: Se encontró que tener mayor experiencia en la práctica clínica predice mayor conocimiento de bioseguridad. Se observó menor aplicación de medidas de bioseguridad en el uso de material de protección en los estudiantes con mayor experiencia. (Rev Med Hered 2010;21:34-38)

Objective: To determine the change in the knowledge, aptitude and attitude towards transmissible diseases caused by blood, and universal biosafety precautions in medical students. Materials and Methods: In December of 2005, the students of the 5th year (Group A) were evaluated by means of a survey elaborated to collect information about knowledge, aptitude and attitude in biosafety norms. Afterwards this survey was taken by last year medical students (Group B) from January to august of 2006. Results: A total of 214 surveys were obtained. 110 belonging to group A and 104 to group B. Group A had an average age of 23 (22.24) and group B and average of 24 (23,25). 54,13% of group A were male and 56,73% in group B. 61,73% of group B obtained good results in the survey compared to the 38,27% of group A (p=0,003). Group B had 70% more chances of getting good information in comparison to group A. Moreover group B had 5,32 times more accidents than group A. Conclusion: To have more experience in clinical practice predicts a better knowledge in biosafety. Students with more experience in clinical practice were more careless using protective materials. (Rev Med Hered 2010;21:34-38)

Bacterial vaginosis in female sex workers attending a Specialized Reference Center of sexually transmitted diseases and AIDS

Objetivo: Determinar la frecuencia de vaginosis bacteriana (VB) en trabajadoras sexuales (TS) que acuden a un centro especializado de referencias de enfermedades de transmisión sexual y SIDA (CERETSS) en Lima, Perú; y su asociación con características gineco-obstétricas. Material y Métodos: Estudio transversal realizado en 322 TS que acudieron a la consulta médica en un CERETSS de diciembre del 2008 a enero del 2009. Se obtuvieron muestras de flujo vaginal y se emplearon los métodos de Amsel y Nugent para el diagnóstico de VB. Resultados: La frecuencia de VB fue 26,1%. La VB estuvo asociada con el conocimiento de VB, antecedentes de VB y Enfermedades de Transmisión Sexual (ETS), número de partos, número de abortos y número de parejas sexuales por día. Conclusiones: La frecuencia de VB en esta población es elevada, siendo necesaria la implementación de medidas que conduzcan a su control. (Rev Med Hered 2010;21:32-38).

Objective: To determine the frequency of bacterial vaginosis (BV) in female sex workers (SW) attending a specialized reference centers for Sexually Transmitted Diseases and AIDS (CERETSS) in Lima - Peru, and its association with gynecological and obstetric characteristics. Material and Methods: We conducted a cross-sectional study between December 2008 to January 2009. We studied 322 SW who were seen as outpatients at a CERETSS. Vaginal secretion samples were obtained and Amsel and Nugent methods were used for the diagnosis of BV. Results: The frequency of BV was 26.1%. BV was associated with awareness of VB, VB background and Sexually Transmitted Diseases (STD), parity, number of abortions and number of sexual partners per day. Conclusions: The frequency of BV in this population is high, therefore it is necessary to implement measures to prevent and control them.(Rev Med Hered 2010;21:32-38).

Endocrine impact of Obstructive sleep apnea

Las alteraciones en la oxigenación que ocurren en el Sindrome Obstructivo del Apnea de sueño comprometen el funcionamiento tisular de todos los órganos del ser humano; con relación a la disfunción endocrinológica, los aspectos concernientes a esta no son bien conocidos. La intención de este trabajo fue revisar la información existente al respecto, a través de una búsqueda en las referencias MEDLINE entre los años 1995 y 2009.(Rev Med Hered 2010;21:39-45).

The obstructive sleep apnea cause and intermmitent decreased oxigenation in all the organs, compromising the function of all of them; in relation with the endocrine dysfunction they are not well known. This review consists in a search of references in Medline, between 1995 and 2009.(Rev Med Hered 2010;21:39-45).

Clinical Case at the Hospital Nacional Arzobispo Loayza_2010-1

Sarcoidosis: A case report and review of the topic

Se describe el caso de una mujer de 37 anos, procedente de la ciudad de Lima, con cuadro clínico caracterizado por artralgias, sensación de alza térmica no cuantificada, presencia de nódulos eritematosos en miembros inferiores y de pápulas eritematosas en la región dorsal de los dedos de las manos. En la Rx de tórax y en la TAC se encontró linfoadenopatia mediastinal. La biopsia ganglionar fue compatible con sarcoidosis ganglionar. (Rev Med Hered 2010;21:51-55)

We describe the case of a 37 year old woman, from Lima, with a clinical presentation characterized by arthralgia, not quantified fever, presence of erythematous nodules on lower limbs and erythematous papules on the dorsal region of fingers. A mediastinal lymphadenopathy was found on chest x-ray and CT scan. Lymph node biopsy was compatible with sarcoidosis. (Rev Med Hered 2010;21:51-55)