Twenty-nine cases of neutropenic enterocolitis (NEC) were identified from 1992 to June 1996, and their clinical, microbiological, and radiologic characteristics were reviewed. Eighteen of 29 episodes were considered to be definite NEC since abdominal computed tomographic or ultrasonographic findings (n = 14) and/or pathological findings (n = 7) were consistent with the diagnosis, whereas 11 were classified as possible NEC since these findings were normal or nondiagnostic. Abdominal pain, diarrhea, and fever occurred in nearly all cases in both groups, whereas bloody stools were more frequent and the duration of diarrhea was longer in definite cases. Other clinical, laboratory, and microbiological findings were of variable frequencies, with no apparent differences between groups. All 29 patients received medical/supportive treatment, and only five deaths were related to NEC. We conclude that NEC has a broad spectrum of clinical presentation, but patients whose imaging studies are positive appear to have a more serious form of the disease. Medical management appears appropriate in most cases, as the associated mortality rate is < 20%.

The group Streptococcus milleri (SM) includes several species of pathogenic streptococci associated with pyogenic infections. In 1956 O. Guthof was the first to use the name SM when referring to nonhaemolytic species of streptococci found in the oral cavity [1]. WHILEY and coworkers [2,3], through phenotypic and deoxyribonucleic acid (DNA)-DNA hybridization studies, affirmed the existence of at least three well-differentiated species: S. constellatus, S. intermedius and S. anginosus. Many authors prefer to continue using the term SM for the three species for two reasons: firstly, because the term is useful to the clinician, since it warns of the presence of a suppurative process [4,5] and secondly, because the three species appear to be equally represented as a cause of thoracic infection [6,7].The SM group is part of the usual flora of the mouth, but its true prevalence is unknown. It is also found among normal faecal flora in 16-67% of healthy adults and has been isolated from normal appendix and from vaginal secretions [3,[8][9][10]. The most important clinical feature of these micro-organisms is their tendency to cause suppurative infections at various sites, ranging from dental abscesses to deep visceral abscesses [1,4,8,[11][12][13][14][15].The purpose of this study was to contribute to a better understanding of the importance of members of the SM group as respiratory pathogens, by studying the epidemiological and clinical features of thoracic infections caused by SM and contrasting the features of empyema caused by SM with those in cases of pneumococcal aetiology. Patients and methodsA review was undertaken of the clinical histories and microbiological reports of episodes of infection by SM isolated from clinically significant samples in our institution, an acute care general hospital serving around 250,000 inhabitants, between January 1988 and December 1995. Only those cases in which some type of thoracic infection was diagnosed were analysed. The cases of pneumococcal empyema that occurred during the same period were also analysed. For the purposes of this study, thoracic infection was defined as all processes of an infectious nature localized to any of the organs, systems or anatomical structures in the thoracic cavity, except intravascular lesions with endothelial infection. Infections were considered to be acquired The clinical histories and microbiology reports were reviewed in 27 cases of thoracic infection caused by SM over a period of 8 yrs. Cases of pneumococcal empyema that occurred during the same period were also analysed.Diagnoses were made of cases of empyema, including six with pneumonia and one with pulmonary abscess, three cases of pneumonia and two of mediastinitis. In 17 cases, SM was the only pathogen isolated. There was a history of instrument or surgical procedures on the digestive or respiratory tract in 59%. Secondary bacteraemia was documented in three cases. The treatment administered, a combination of antibiotics and surgery, was successful in 22 of 27 (81%) of cases. All strai...

The Streptococcus milleri group is associated with a spectrum of serious suppurative infections that have not been well defined. The purposes of this study were to ascertain the clinical significance of Streptococcus milleri bacteremia and to determine the epidemiological, clinical, and microbiological features of these infections compared to those caused by other viridans streptococci. All cases of streptococcal bacteremia observed in a Spanish hospital in the period from January 1988 to December 1994 were reviewed. Of 137 cases of Streptococcus milleri infection, 33 (24%) were documented cases of bacteremia. Twenty-four patients were men (mean age 57.8 +/- 17.4 years). The majority of infections were abdominal in origin (20/33), the most frequent diagnoses being cholangitis/cholecystitis (18%) and appendicitis (12%). The origin of infection could not be established in three cases. Nine cases of bacteremia (27%) were polymicrobial. Six patients (18%) had septic shock; in four the infection was polymicrobial, and in two the infection was of abdominal origin. Eighteen of the 33 patients (54%) required surgery. Five patients died. All 33 Streptococcus milleri isolates were susceptible to penicillin. Twenty-two cases of bacteremia caused by other viridans streptococci were observed during the same period. There were no statistically significant differences between the two groups in terms of age, sex, mortality, rate of polymicrobial infection, rate of nosocomial acquisition of bacteremia, or the occurrence of shock. An abdominal origin of infection was more frequent in Streptococcus milleri bacteremia (p = 0.0001); a cardiovascular origin was more frequent in the viridans group (p = 0.01), as was a diagnosis of endocarditis (p = 0.004). Four patients with viridans streptococci bacteremia required surgery versus 18 patients with Streptococcus milleri bacteremia (p = 0.01). Viridans streptococci were notably less susceptible to penicillin (89%), clindamycin (79%), and erythromycin (79%).

A high seroprevalence for Leptospira spp was found in the groups at risk, people working on pig-farms and fish-farms being those most affected. There was a 1,86 relative risk in both groups indicated as having a greater risk of contagion amongst the population suffering occupational exposure.

El objetivo del artículo es describir el rol del docente para el desarrollo de la resiliencia y el fortalecimiento de las habilidades sociales en la primera infancia, identificando los factores de resiliencia desarrollados en estos niños. El estudio se orienta desde una metodología cualitativa para generar procesos de comprensión de la realidad, desde las voces de los actores, específicamente docentes de preescolar en relación a su mediación para desarrollar resiliencia en los estudiantes de este nivel educativo. Se conforman grupos de interés con niños de preescolar conn edades comprendidas entre 4 y 5 años. Se trabaja con instrumentos como el guión de entrevista a docentes y el sociodrama y registro de observación a estudiantes. Los resultados evidencian el rol que cumple el maestro en la implementación de estrategias pedagógicas para fortalecen la resiliencia en los niños, la cual se concibe en atención a las necesidades y etapa de desarrollo del estudiante, con el fin de favorecer su introyección. Se concluye en la importancia de un tutor resiliente en la escuela, representado especialmente en personas significativas como el docente cuyo perfil de competencias, contribuya a la mediación del proceso de acompañamiento en la formación inicial de los niños.