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Acosta H.F.,South Colombian University | Bayona M.A.,South Colombian University | Zabaleta T.E.,Hospital Universitario Of Neiva | Villar L.A.,Industrial University of Santander | And 3 more authors.
Revista de salud pública (Bogotá, Colombia) | Year: 2012

OBJECTIVE: Dengue is the most important arthropod-borne viral disease in the world; it can be life-threatening because of liver involvement. Aim Determining liver involvement frequency and severity in dengue-infected children.METHODS: This was a descriptive case series study which involved studying 108 dengue-infected children aged less than 13 years old whose infection had been confirmed by the detection of dengue-specific IgM and NS1 in plasma. Clinical and biochemical parameters were used for evaluating liver involvement, including transaminases and albumin. Hepatitis A and leptospira infection were also evaluated by using ELISA to detect pathogen-specific IgM in plasma during acute and convalescence phases. The study was carried out at a teaching hospital in Neiva from June 2009 to May 2010.RESULTS: Ninety-eight of the aforementioned cases were clinically classified as dengue with warning signs (DWS) and 10 as severe dengue (SD). Two out of three DWS patients and all SD patients had some degree of liver involvement, shown clinically and biochemically. Regardless of the clinical classification, hepatomegaly was the main clinical sign of liver involvement and was present in 85% of all the children in the study. It is worth noting that 5 patients had probable dengue and leptospirosis co-infection, this being the first instance of this in Colombia. None of the cases analyzed here had acute hepatitis A.CONCLUSIONS: Liver compromise should be considered in confirmed cases of dengue as shown in this series of children. Leptospirosis must be considered as differential diagnosis and also as causing co-infection in a febrile child. Source


Ortiz Ruiz G.,Santa Clara University | Osorio J.,South Colombian University | Valderrama S.,Pontifical Xavierian University | Alvarez D.,University of Pittsburgh | And 4 more authors.
Medicina Intensiva | Year: 2016

Objectives: Due to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia. Materials and methods: A multicenter matched case-control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded. Results: A total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, C. albicans, C. tropicalis and C. parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay > 25 days (OR 5.33, 95% CI 2.6-10.9), use of meropenem (OR 3.75, 95% CI 1.86-7.5), abdominal surgery (OR 2.9, 95% CI 1.39-6.06) and hemodialysis (OR 3.35, 95% CI 1.5-7.7). No differences in mortality between patients with candidemia and controls were found (39.5 vs. 36.5%, respectively, P = .66) were found. Conclusions: In Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia. © 2015 Elsevier España, S.L.U. and SEMICYUC. Source


Perdomo-Celis F.,South Colombian University | Salgado D.M.,South Colombian University | Salgado D.M.,Hospital Universitario Of Neiva | Castaneda D.M.,South Colombian University | Narvaez C.F.,South Colombian University
Clinical and Vaccine Immunology | Year: 2016

Cryopreserved peripheral blood mononuclear cells (PBMCs) are widely used in studies of dengue. In this disease, elevated frequency of apoptotic PBMCs has been described, and molecules such as soluble tumor necrosis factor (TNF)-related apoptosisinducing ligands (sTRAIL) are involved. This effect of dengue may affect the efficiency of PBMC cryopreservation. Here, we evaluate the viability (trypan blue dye exclusion and amine-reactive dye staining) and functionality (frequency of gamma interferon [IFN-λ-producing T cells after polyclonal stimulation) of fresh and cryopreserved PBMCs from children with dengue (in acute and convalescence phases), children with other febrile illnesses, and healthy children as controls. Plasma sTRAIL levels were also evaluated. The frequencies of nonviable PBMCs detected by the two viability assays were positively correlated (r=0.74; P≤ 0.0001). Cryopreservation particularly affected the PBMCs of children with dengue, who had a higher frequency of nonviable cells than healthy children and children with other febrile illnesses (P≶0.02), and PBMC viability levels were restored in the convalescent phase. In the acute phase, an increased frequency of CD3+ CD8+amine-positive cells was found before cryopreservation (P=0.01). Except for B cells in the acute phase, cryopreservation usually did not affect the relative frequencies of viable PBMC subpopulations. Dengue infection reduced the frequency of IFN-λ-producing CD3+ cells after stimulation compared with healthy controls and convalescent-phase patients (P≤0.003), and plasma sTRAIL correlated with this decreased frequency in dengue (rho=0.56; P≤0.01). Natural dengue infection in children can affect the viability and functionality of cryopreserved PBMCs. © Copyright 2016, American Society for Microbiology. All Rights Reserved. Source


Osorio J.,Hospital Universitario Of Neiva | Alvarez D.,Hospital Universitario Of Neiva | Pacheco R.,Centro Internacional Of Investigaciones Y Entrenamiento Medico Cideim | Gomezy C.A.,University of Pittsburgh | Lozano A.,Hospital Universitario Of Neiva
Revista Chilena de Infectologia | Year: 2013

Background: Central line-associated bloodstream infections (CLABSI) related to insertion and device care in intensive care units are frequent and preventable events. Aim: To evaluate the reduction in the rate of CLABSI through implementation of an insertion bundle. Methods: A study was conducted in the Adult-ICU at the University Hospital of Neiva comparing a pre-interventional period with an interventional one, each lasting 6 months; the intervention consisting of implementing a bundle of measures for the insertion of central venous catheters (CVC). In the pre-intervention period (2010) the rate of CLABSI and the population's characteristics were evaluated. The bundle for the insertion of the CVC consisted in: hands hygiene, use of 2% clorhexidine, maximum sterile barriers and avoiding femoral access. Results: The rate of CLABSI decreased from 5.56 to 3.26 per 1000 catheter days. The length of ICU stay and catheter duration were associated with a higher risk of infection associated to these devices (p < 0.05). Compliance with the bundle is a protective factor against the development of CLABSI (OR 0.45, p = 0.615). The staff adherence to the bundle was over 80%. Conclusion: Implementing a Central Line Insertion Bundle proved to be a useful measure in prevention of CLABSI in our hospital. This strategy could be implemented in other hospitals of similar complexity. Source


Perdomo-Celis F.,South Colombian University | Torres M.A.,South Colombian University | Torres M.A.,Hospital Universitario Of Neiva | Ostos H.,South Colombian University | And 8 more authors.
Biomarker Insights | Year: 2015

Bacterial meningitis (BM) is a pyogenic infection present in the subarachnoid space, potentially fatal and frequently associated with neurological sequelae. During BM, cytokines (CTs) are locally produced. We sought to determine the CTs’ clinical role as disease severity predictors in adults, which is not completely clear. Using a bead-based flow cytometric assay, levels of six CTs were determined in cerebrospinal fluid (CSF) and plasma from 18 adult BM patients and 19 uninfected controls. Long-term neurological sequelae were evaluated using the Glasgow Outcome Scale (GOS). All eval-uated CTs were higher in CSF than in plasma, and the levels of CSF interleukin (IL)-6, IL-8, IL-10, IL-1β, and tumor necrosis factor-α and plasma IL-10 and IL-12p70 were significantly higher in patients with severe sepsis than with sepsis, suggesting an association with clinical severity. There was a strong negative correlation between CSF IL-6 and plasma IL-12p70 with GOS score, supporting the possible role of these CTs in the development of neurological long-term sequelae. These findings could be helpful to identify candidates to receive neuroprotective treatments and early physiotherapy schemes. © the authors, publisher and licensee Libertas Academica Limited. Source

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