Rocío Elvira Fortanelli-Rodríguez’s scientific contributions

Background: Procalcitonin is a diagnostic marker useful to discern infections and non-infectious complications in heart surgeries. The aim is to describe risk factors related to nosocomial pneumonia and the predictive value of serum procalcitonin in pediatric patients undergoing heart surgery. Methods: During a year a nested case-control study was carried out in a third level hospital. All patients undergoing open-heart surgery were followed and clinical data searching for pneumonia were registered every day. Blood samples for determination of procalcitonin were taken 48 hours after surgery. Those patients who developed pneumonia based on CDC clinical criteria were defined as cases; and controls were those patients who did not developed pneumonia. Results: 188 patients underwent heart surgery (15 % developed pneumonia). Ninety-seven patients were submitted to open-heart surgery: 24 cases and 73 controls. Seventy-eight % of cases developed pneumonia between second and fifth day after surgery. The average time of surgery, extracorporial bypass, aortic cross-clamp, and mechanical ventilation were greater in control patients. The frequency of open sternotomy, reintubation, and surgical wound infections was greater in case patients. Conclusions: Some of the events related to heart surgery and their subsequent management are associated significantly to the development of hospital-acquired pneumonia.

Objective. To describe clinical characteristics of ependimitis in patients from Hospital de Pediatría del Centro Médico Nacional Siglo XXI during 2005. Patients and methods. We review the clinical records of children with diagnosis of ependymitis during 1 year. We defined ependymitis as those patients with ventriculoperitoneal shunt that developed clinical signs of ependymitis and isolation of a microorganism in the culture. Results. We reviewed 30 episodes of ependymitis in 22 patients, 15 children had one episode, 6 had two episodes and 1 developed three episodes. Children 1 to 18 months were the more affected group. The main cause of hydrocephalus was intraventricular haemorrhage within the first month after ventriculoperitoneal shunt insertion. Microorganisms more frequently isolated were Staphylococcus coagulasa negative, Enterococos spp and enterobacteriaceae. Treatment response was observed in 60% of the cases. Systemic treatment response was observed in 67% of the cases whereas local treatment response was observed only in 50% of the cases. Conclusions. Clinical manifestations and etiology is similar to other studies efficacy of systemic treatment was 67% this represents a change as compared to previous years therefore we most think in changes in therapeutic schemes.

Resumen Objetivo. Describir el comportamiento de las ependimitis en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI en el 2005. Material y métodos. Serie de casos. Se revisaron los expedientes de pacientes con diagnóstico de ependimitis durante un año, definiéndose como ependimitis aquellos pacientes con antecedente de derivación ventrículo peri- toneal (DVP), cuadro sugestivo y aislamiento de microorganismo en cultivo de líquido cefalorraquídeo. Resultados. Se revisaron 30 casos de ependimitis en 22 pacientes: quince con un episodio, seis con dos episo- dios y uno con tres episodios. Los lactantes fueron el grupo más afectado, la principal causa de hidrocefalia fue hemorragia intraventricular, el tiempo de presentación en relación con la colocación de DVP fue al primer mes, la principal manifestación clínica fue disfunción valvular, dentro de los agentes implicados se encontraron Staphylo- coccus coagulasa negativa, Enterococos spp y enterobacterias. En cuanto al tratamiento el porcentaje de éxito fue de 60%, la terapia sistémica logró curación en 67% de los casos y la terapia local en 50%. Conclusiones. La presentación y los agentes etiológicos son similares a lo reportado en la literatura mundial. Respecto al tratamiento en este estudio la eficacia de la terapia sistémica fue de 67%, existiendo un cambio epide- miológico respecto a años anteriores, lo cual llevará a plantear opciones terapéuticas diferentes. Palabras clave: ependimitis, hidrocefalia, terapia sistémica, terapia local.