outstanding achievements in health biotechnology are a source of inspiration for the developing world. They are all the more impressive considering that the island is a small, relatively poor country that has suffered serious economic difficulties for more than a decade. These eco- nomic problems arose in the wake of the Soviet Union's disintegration and the political changes in Eastern Europe in the early 1990s, resulting in the collapse of Cuba's export markets, and the imposition since 1961 of a US trade embargo against Cuba, which has limited opportunities for the country's agri- culturally based economy. Despite these diffi- culties, Cuba's strong and continued emphasis on science since shortly after the 1959 revolution has resulted in a highly devel- oped health biotechnology sector. includes research on recombinant Dengue vaccine, preventative and therapeutic AIDS vaccines, cholera vaccine and a cancer therapeutic vaccine. The sector has also suc- cessfully produced diagnostic tests and therapeutics, as can be seen in Tab le 1 .I n addition, Cuba is devel- oping natural products based on the island's flora. An example is the natural anticholes- terol drug policosanol (PPG), an 8-alcohol extract derived from the wax of one of the country's main crops, sugarcane. Cuba began development of its health biotechnology sector by imitating products developed elsewhere, such as interferon-α 2b (IFN-α ), but in recent years greater empha- sis has been placed on innovation from within Cuba. The perception that innova- tion is increasing is supported by biotech- nology experts, such as James Larrick, an entrepreneur in Palo Alto, CA, who says: "Their pipeline is very, very deep now.… It's gone into an adolescence and it's looking pretty good." 1 Indeed, researchers in Cuba have filed about 500 patent applications in the health biotechnology sector based on more than 200 inventions (according to an analysis of the European Patent Office's (Munich, Germany) database, the European Network of Patent Databases, May 2003, http://www.european-patent-office.org/). These have been filed in several countries throughout the world, including the United States, Europe, Brazil, India, China and South Korea. Cuba exports biotechnology products to more than 50 countries, mainly in Latin America, Eastern Europe and Asia. Cuba's hepatitis B vaccine has been certified by the World Health Organization (Geneva, Switzerland) and is prequalified for use by United Nations purchasing agencies. The primary focus of Cuba's health biotechnology has been on developing products, rather than basic

Cuba: innovation through synergy

Ultrasonography of acute abdominal pain in children

Carbon monoxide (CO) is a gas product of combustion, considered highly poisonous. Prolonged CO exposure is responsible for more than half of fatal poisonings and is also one of the leading causes of poisoning in Western countries. We aimed to compare the effectiveness of therapy with hyperbaric oxygen (HBO) versus normobaric oxygen (NBO) in the setting of carbon monoxide poisoning (COP). We independently searched the National Library of Medicine's Medline (PubMed™), ScienceDirect™, and Scielo™ for any relevant studies published from 1989 to 2017, using the following keywords: hyperbaric therapy, hyperbaric oxygenation, normobaric therapy, carbon monoxide poisoning, carboxyhemoglobin, Haldane effect. We analyzed the studies that suggested the effectiveness of HBO or NBO. Also, we searched for studies related to COP; including history, epidemiology (risk factors, incidence, demographics), pathophysiology, clinical manifestations, diagnosis, and treatment. Sixty-eight articles were found, sixteen of which dealt with either HBO or NBO or both. Twelve suggested HBO as the treatment of choice in COP; four studies indicated that NBO was an adequate treatment due to its cost-effectiveness and availability in the emergency department (ED). HBO has been shown in several studies to be effective in moderate to high-risk COP situations, being the therapy of choice to avoid sequelae, especially neurologically. NBO can be considered as a reasonable alternative due to its cost-effectiveness. The availability and understanding of different therapeutic interventions are critical in the management of patients with COP in ED and the Critical Care unit.

/pdf/effectiveness-of-hyperbaric-oxygenation-versus-normobaric-1ih239ksz6.pdf

Effectiveness of Hyperbaric Oxygenation Versus Normobaric Oxygenation Therapy in Carbon Monoxide Poisoning: A Systematic Review.

OBJECTIVE: Few studies have focused on the characteristic features of drug overdose in children and adolescents who have attempted suicide in Korea. The present study examined the characteristics of drug overdose in children and adolescents who visited the emergency room following drug ingestion for a suicide attempt. METHODS: The medical records of 28 patients who were treated in the emergency room following a drug overdose from January 2008 to March 2011 were analyzed. Demographic and clinical variables related to the suicide attempts were examined. RESULTS: The mean age of the patients was 16.6±1.7 years (range 11-19 years), and 20 of the patients (71.4%) were female. Most of the patients (n=23, 82.1%) overdosed on a single drug; acetaminophen-containing analgesics were the most common (n=12, 42.9%). Depression was the most common psychiatric disorder (n=22, 78.6%), and interpersonal conflict was the most common precipitating factor of the suicide attempts (n=11, 39.3%). This was the first suicide attempt for approximately 80% of the patients. About one fourth of the patients (n=7, 25%) had follow-up visits at the psychiatric outpatient clinic. CONCLUSION: Early screening and psychiatric intervention for depression may be an important factor in preventing childhood and adolescent suicide attempts. Developing coping strategies to manage interpersonal conflicts may also be helpful. Moreover, policies restricting the amount and kind of drugs purchased by teenagers may be necessary to prevent drug overdose in this age group. Language: en

Characteristics of drug overdose in young suicide attempters

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) emerged at the Pediatric Hospital of Misiones Province, north Argentina, in 2003 as a cause of community-acquired (CA) infections, mostly associated with skin and soft tissue infections (SSTIs). This study aimed to assess the microbiological, epidemiological, and clinical features of CA-MRSA SSTIs treated at the hospital. Methodology: From 2003 through 2006, a longitudinal study on CA-MRSA SSTIs was conducted. Clinical, bacteriological, and molecular data were collected and analyzed by multiple correspondences and cluster analysis (MCCA). Results: A total of 138 children were enrolled; 55.8% of the children required hospitalization. The main clinical presentation was abscesses (51%). Antibiotic therapy in the previous six months was registered in 41% of the patients, and 72% of the patients had relatives with similar symptoms. Resistance to non-b-lactam antibiotics was found in less than 12% of patients. All 44 isolates carried staphylococcal cassette chromosome mec (SCC mec ) type IV, and 30/44 had Panton-Valentine leucocidin (PVL) coding genes. Six pulsed-field gel electrophoresis (PFGE) patterns were detected from 17 isolates. MCCA hierarchic classification resulted in four distinctive patient classes (new variable). No relationship could be observed regarding the PVL detection, as PVL (+) isolates were detected in all classes; the same lack of significance was observed concerning the distribution of resistance to non-β-lactam antibiotics. Conclusions: This study increases the understanding and knowledge about CA-MRSA skin and soft tissue infections in pediatric patients. Continuous efforts should be made to control this significant public health problem.

/pdf/community-associated-methicillin-resistant-staphylococcus-3ls3ai3tja.pdf

Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in a pediatric hospital in Argentina.

/pdf/fosfomicina-en-el-tratamiento-de-la-infeccion-urinaria-baja-1llld6gf53.pdf

Fosfomicina en el tratamiento de la infección urinaria baja en niños mayores de 6 años. Evolución clínico-microbiológica

Introduccion: En la ultima decada se ha informado a nivel mundial la emergencia de infecciones causadas por cepas de Staphylococcus aureus meticilino-resistente (SAMR) sin los factores de riesgo clasicos descritos para portar este germen, con un patron de susceptibilidad diferente a los antibioticos y adquirido en la comunidad. En nuestro pais las primeras comunicaciones de infecciones producidas por este germen fueron en el ano 2001 en ninos con infecciones de piel y partes blandas internados en el Centro Hospitalario Pereira Rossell (CHPR). Objetivo: 1) Analizar las caracteristicas clinicas y la etiologia de las infecciones de piel y partes blandas en pacientes ambulatorios; 2) Determinar en estas infecciones la prevalencia de Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-com) y su sensibilidad a los antibioticos. Sujetos y Metodo: Se realizo un estudio descriptivo, prospectivo, de pacientes que consultaron en el Departamento de Emergencia Pediatrica del CHPR por infecciones de piel y partes blandas adquiridas en la comunidad, en el periodo 24 de marzo de 2004 al 31 de julio de 2004, tratados en forma ambulatoria y en los que se aislo una bacteria de las muestras obtenidas para estudio bacteriologico. Se incluyeron pacientes con impetigo, forunculo, absceso, celulitis a punto de partida cutaneo, panadizo y herida o quemadura sobreinfectada. Se analizaron datos demograficos, factores de riesgo para portar SAMR, caracteristicas clinicas de los pacientes y analisis bacteriologico de los resultados de las muestras obtenidas de acuerdo al informe realizado por el Laboratorio Central del CHPR, seccion Bacteriologia. Resultados: Se incluyeron 297 pacientes. Los diagnosticos clinicos realizados fueron: impetigo 122 (48,4%), forunculo 29 (11,5%), celulitis 19 (7,5%), absceso 30 (11,9%), panadizo ocho (3,2%), heridas o quemaduras infectadas seis (2,4%) y coexistencia de algunas de las anteriores 38 (15%). Se identifico Staphylococcus aureus (SA) en el 71,8% del total las infecciones, ya sea como unico germen o asociado a Streptococcus pyogenes, de los cuales el 47% correspondieron a SAMR-com. En las infecciones cutaneas profundas (forunculo, absceso y celulitis) se aislo SAMR-com en el 73% de las infecciones estafilofocicas, en tanto que en las infecciones superficiales (impetigo) estuvo presente en el 10%; diferencia estadisticamente significativa (p 0,10). En cuanto a la sensibilidad de SAMR-com a los antibioticos, no se informo de ningun caso de resistencia a vancomicina y trimetoprim-sulfametoxazol (TMP-SMX). Hubo un caso de resistencia a gentamicina. Ninguno tenia resistencia consititutiva a clindamicina y se observo resistencia inducible al grupo macrolidos, lincosaminas y streptograminas (MLS) en el 54%. Conclusiones: en las infecciones cutaneas superficiales el germen mas frecuente fue Streptococcus pyogenes, en tanto que en las infecciones mas profundas predomina SA. El germen mas frecuente, ya sea solo o asociado, en el total de las infecciones cutaneas es SA. La presencia de SAMR-com fue del 47% del total de las infecciones estafilococicas, en tanto que en las profundas fue mayor (73%), mientras que en las superficiales tiene poca frecuencia (10%). No se detecto resistencia de SAMR-com a vancomicina ni a TMP-SMX. Uno solo fue resistente a gentamicina y no se detecto resistencia constitutiva a clindamicina. La presencia de resistencia inducible al grupo MLS fue de 54%

/pdf/infecciones-de-piel-y-partes-blandas-en-pacientes-1jtjgvcszy.pdf

Infecciones de piel y partes blandas en pacientes ambulatorios

/pdf/infecciones-de-piel-y-partes-blandas-en-pacientes-12w2tysur9.pdf

/pdf/etiologia-y-presentacion-clinica-de-las-infecciones-vv5itue3nn.pdf

Etiología y presentación clínica de las infecciones osteoarticulares en niños hospitalizados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell 2003-2005

Objetivo: estudiar en forma prospectiva, durante un ano, en todo el pais, la incidencia de invaginacion intestinal en menores de 2 anos. Se considera importante contar con datos de la incidencia de invaginacion intestinal para la posible introduccion de una vacuna para rotavirus que en su primera experiencia demostro un incremento de esta enfermedad. Material y metodo: en cada uno de los 19 departamentos en que esta dividido politicamente el pais, se encargo a un pediatra la vigilancia de casos de invaginacion intestinal en menores de dos anos. Se utilizo una ficha de recoleccion de datos precodificada; el diagnostico se baso en las evidencias clinicas e imagenologicas y se confirmo con la intervencion quirurgica o con los procedimientos de desinvaginacion. Resultados: en el periodo comprendido entre el 1 de julio de 2003 y el 30 de junio de 2004, se constataron 26 casos de invaginacion intestinal. Las edades de los pacientes oscilaron entre los 3 y los 21 meses; la mediana de edad fue de 7,5 meses; cinco fueron mayores de 12 meses. El 58% fueron varones; no se observo distribucion estacional. La mayor cantidad de pacientes fue de Montevideo (14), capital del pais. En 23 de los casos el tratamiento se realizo en el Centro Hospitalario Pereira Rossell (Montevideo); un caso se resolvio en el interior del pais. La resolucion de la invaginacion fue en el 69% de los casos quirurgica; en cinco casos hubo un segundo episodio de invaginacion. Todos fueron dados de alta. No hubo relacion temporal con la vacunacion previa; en cuatro casos hubo diarrea en los 10 dias previos a la invaginacion, de etiologia desconocida. Se encontro un caso de invaginacion intestinal cada 3.903 menores de dos anos, o 25 casos por 100.000 ninos/ano. Comentarios: la incidencia de los casos de invaginacion intestinal es menor a la descrita en la mayoria de los paises de la region. No se encontro relacion temporal con la vacuna de la poliomielitis que es la unica de utilizacion oral. Predomino en varones y la mayoria de los casos se resolvieron por cirugia, lo que probablemente este en relacion a que muchos pacientes del interior fueron derivados a la capital para su resolucion.

/pdf/invaginacion-intestinal-estudio-de-su-incidencia-durante-un-3agmd0s4hq.pdf

Invaginación intestinal: estudio de su incidencia durante un año en Uruguay

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Fosfomicina en el tratamiento de la infección urinaria baja en niños mayores de 6 años. Evolución clínico-microbiológica

Infecciones de piel y partes blandas en pacientes ambulatorios

Infecciones de piel y partes blandas en pacientes ambulatorios

Etiología y presentación clínica de las infecciones osteoarticulares en niños hospitalizados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell 2003-2005

Invaginación intestinal: estudio de su incidencia durante un año en Uruguay