Ambulatory Basis Research Articles

Outpatient consolidation chemotherapy in pediatric acute myeloid leukemia: a retrospective analysis

Background: To assess the outcomes of outpatient high dose cytosine arabinoside consolidation cycles in pediatric acute myeloid leukemia (AML) patients in comparison to inpatient treatment.Methods: We retrospectively analyzed 90 cycles of AML consolidation given to 30 patients between July 2003 and July 2007.Results: Median age was 8 years (range 1·5–15) and 22/30 (73·3%) were males. Sixty-nine of 90 (76·7%) cycles were given on an ambulatory basis; readmission occurred in 25/69 (36·2%) and there was one death. The outpatient cycles in comparison to the inpatient cycles required significantly fewer invasive blood investigations (p<0·001) but had comparable number of blood products administered as supportive therapy. There was no significant difference in the frequency of granulocyte colony stimulating factor usage and recovery time of absolute neutrophil count and platelet count. The incidence of febrile neutropenia though was comparable in the groups (72·5% outpatient versus 76·2% inpatient), but the duration (p=0·003) and subsequent therapeutic antifungal usage (p=0·001) was significantly more in inpatient administered cycles. Second line antibiotics were needed in 16/50 (32%) outpatient episodes of febrile neutropenia in contrast to 10/16 (72·5%) episodes of febrile neutropenia in inpatient courses (p=0·030).Conclusions: Outpatient AML consolidation therapy is safe and feasible in children. It appears to result in less frequent invasive blood studies; shorter duration of febrile neutropenia and consequently less antimicrobial and antifungal usage as compared to inpatient consolidation cycles. To our knowledge, this report is the first of its kind looking specifically at outpatient consolidation chemotherapy in AML.

UP-2.156: Laparoscopic Radical Prostatectomy on a Major Ambulatory Surgery Basis: Early Results

UP-2.156: Laparoscopic Radical Prostatectomy on a Major Ambulatory Surgery Basis: Early Results

KTP/532 YAG Laser Treatment for Allergic Rhinitis

The purpose of this study was to investigate the efficacy of the KTP/532 YAG laser to reduce nasal congestion and discharge in patients with allergic rhinitis. Forty-eight patients with symptoms of allergic rhinitis were treated with the KTP/532 laser. All had positive skin tests for common allergens. Treatments were provided on an ambulatory basis in one to three sessions under local anesthesia with lidocaine nose spray. Outcome was determined by daily symptom reports and regular endoscopy examination and interviews for 12 months. Treatment was very well tolerated. There were no major side effects. At examination after 1 year, nasal obstruction was improved in 69% and nasal discharge in 40% of cases. The KTP/532 YAG laser is effective for the treatment of nasal obstruction and discharge. Comparison with other techniques showed it to be the most effective in reducing nasal discharge. It can be done as an office procedure and does not damage the nasal mucous membrane. The KTP/532 YAG laser is effective as an additional treatment for patients refractory to medication.

4214 Resilience scores in a cohort of cancer patients in chemotherapy treatment on ambulatory basis

4214 Resilience scores in a cohort of cancer patients in chemotherapy treatment on ambulatory basis

Outpatient administration of high-dose methotrexate for osteosarcoma treatment in Brazil

10038 Background: We describe the experience with outpatient administration of high dose methotrexate (HDMTX) and leucovorin rescue for osteosarcoma treatment at Instituto de Oncologia Pediátrica. Methods: HDMTX (12g/m2) is administered as part of the Brazilian Osteosarcoma Treatment Group Protocol in an ambulatory basis. Daily MTX serum levels and fluid controls follows until the serum level is &lt;0,2 μ/L. Families were oriented to measure urinary pH and volume, PO intake and to adjust leucovorin dose as needed. To achieve treatment adherence, a family education program was developed. Concomitantly to HD chemotherapy, low dose oral cyclophosphamide and MTX (metronomic treatment) were provided to metastatic (M) patients. This is a retrospective analysis of the HDMTX courses administered between 2006 and 2008. Results: Out of 341 HDMTX infusions, administered to 42 patients, 42.5% had abnormal serum levels at hour 24, 8.8% at hour 48 and 33.2% at hour 72. After required interventions, 2.9% (n = 8) had serum levels &gt;0.2 μ/L at hour 72 leading to delayed excretion. Of these, 7 had also creatinine elevation and main adverse events were mucositis, reversible transaminasis elevation and one sepsis. In the overall analysis, other toxicities included mucositis grade II (20%), nefrotoxicity (5.6%) and neutropenia grades III and IV (25.4%). Serious adverse events of seizure, allergic reaction, and Steven Johnson's Syndrome lead to suspension of future HDMTX administration in 4 patients (01 metastatic). The main differences found between M and non-M patients were 16.8% versus 8.7% of leucopenia grade IV and 12.1% versus 6.6% of anemia grades III and IV. Conclusions: Similar to other authors’ experience, outpatient administration of HDMTX lead to elevated serum levels in 42.5% of the infusions, demonstrating the importance of a well trained staff and early introduction of supportive therapies to avoid associated toxicities. To a developing country, this approach helps lowering treatment costs and infection risks and increases patient adherence to treatment, with acceptable toxicities, even with the introduction of metronomic treatment. No significant financial relationships to disclose.

Resistance to weight gain during overfeeding: a NEAT explanation.

Individuals vary in susceptibility to weight gain in response to overeating; however, the reason for such variation has never been clear. A recent study of 16 nonobese young adults followed on an ambulatory basis for 8 weeks found that changes in nonexercise activity thermogenesis (NEAT) account for the variations in fat storage that occur in response to experimentally controlled overeating. NEAT is the thermogenesis that accompanies physical activity other than volitional exercise. Individuals in whom overeating effectively activates NEAT dissipate as much as 69% of the excess energy as heat. Those less able to activate NEAT store a higher proportion of the excess calories as fat. Other studies have shown that genotype is an important determinant of resistance to overfeeding-induced weight gain. Spontaneous weight gain is accompanied by rises in plasma norepinephrine, insulin, and leptin levels, suggesting that a change in autonomic nervous system activity or in pattern of hormonal secretion might play a role in the activation of overeating-induced NEAT

The Pediatric Infectious Disease Journal Newsletter

The Pediatric Infectious Disease Journal Newsletter

Iatrogenic hyperkalemia as a serious problem in therapy of cardiovascular diseases in elderly patients

The therapy of cardiovascular diseases has improved rapidly over the past 20 years. The most commonly used medications in cardiac patients are drugs affecting potassium homeostasis in the kidneys or the gastrointestinal tract, particularly inhibitors of renin-angiotensin-aldosterone (RAA) axis. They all can lead to hyperkalemia. This disorder may cause severe damage to the muscles and both the nervous and cardiovascular systems. The aim of this study was to evaluate the incidence and clinical course of moderate and severe iatrogenic hiperkalemia in patients hospitalized for cardiovascular disease. The present study analyzed a history of 26 patients with severe or moderate iatrogenic hyperkalemia, selected from among 5553 patients hospitalized in the years 2005-2006 in the Department of Clinical Cardiology of the Swietokrzyskie Cardiology Center, Kielce. They accounted for 0.46% of all patients treated at that time at the Ward. The concentration of potassium on admission to hospital was > 6.0 mmol/l. Before admission all patients were treated in out-patient clinics with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, spironolactone, amiloride, triam-terene, beta-blockers, or potassium supplements administered in monotherapy or in combination. A mean age of patients was 79 years, most of them (80%) were women. The average blood potassium level was 7.3 mmol/l on admision and 5.1 mmol/l at discharge. Severe bradyarrhythmia and complete atrioventricular block requiring temporary pacing (n = 13) were observed in 21 patients (81%). Twenty-four patients (85%) had elevated levels of renal function parameters on admission. The average creatinine level on admission was 2.64 mg/dl, and 2.06 mg/dl on discharge. Ten (38%) out of 26 patients suffered from diabetes and 21 patients (81%) had arterial hypertension. Three out of 26 patients died in the hospital despite intensive therapy. Polypharmacy should be used with particular caution in subjects treated on the ambulatory basis. During administration of inhibitors of RAA system, particularly in elderly out patients, renal function and serum electrolytes should be appropriately monitored both prior to and during the treatment.

Anaesthesia for Ophthalmic Procedures in a Teaching Hospital

Objectives: To study the pattern of anaesthesia for ophthalmic procedures in order to improve the scheduling of cases in the ophthalmic operating room. Methods: The surgical register of the operating room from August 01, 1999 to July 31, 2004 was examined, to document the types of procedure, timing of surgery (elective or emergency), methods of anaesthesia, and involvement of anaesthesia personnel. Results: A total of 970 patients (506 males, 464 females) had ophthalmic surgery in the five-year period under review. General anaesthesia was employed for 119 (12.3%) patients and regional anaesthesia for 851 (87.7%). 400 patients had their procedures on ambulatory basis (LA = 397, GA = 3). Local blocks were the favoured technique for both the outpatient and inpatient settings. Cataract extraction, repair of corneal/scleral/conjunctival/lid lacerations, excision biopsy, trabeculectomy and evisceration were the leading indications. General anaesthesia was the more commonly employed anaesthetic technique in younger patients and for emergency ophthalmic procedures. The general anaesthesia was administered by the registrar and senior registrar grades of anaesthetists. Conclusion: The study shows that the use of general anaesthesia appeared largely restricted to paediatric patients and emergency situations. However, evolving techniques – like sub-tenon block, total intravenous anaesthesia (TIVA), monitored anaesthesia care – should be encouraged. Keywords : ophthalmic anaesthesia, paediatric anaesthesia, regional blocks, outcome Nigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 1-4

Trends in colorectal day case surgery in NHS Trusts between 1998 and 2005

Day case surgery is safe and offers potential benefits to both patients and healthcare providers. This study aimed to describe national changes in colorectal day case workload between 1998 and 2005. Admission data relating to Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) coloproctology operation codes were analysed using the Hospital Episode Statistics (HES) database. Day case rates (DCRs) were calculated as the proportion of elective cases performed on an ambulatory basis. In total, 3 119 058 colorectal admissions were recorded on the HES database between 1998 and 2005; 1 891 474 (61%) of these were for lower gastrointestinal endoscopies. Emergency cases accounted for 527 665 (17%), elective inpatient cases for 406 368 (13%) and elective day cases for 293 551 (9%) admissions. Throughout the study period the DCRs for five commonly performed elective colorectal procedures were: 0.70 for anal lesion excisions (OPCS-4 codes: H48.1, H48.2 and H48.3); 0.16 for haemorrhoidectomy (OPCS-4 code: H51.1); 0.63 for anal fissure procedures (OPCS-4 codes: H56.2 and H56.4); 0.39 for elective procedures for anal fistula (OPCS-4 codes: H55.1, H55.2, H55.3 and H55.4); 0.37 for elective pilonidal surgery (OPCS-4 codes: H59 and H60.2). Two emergency operations, drainage of perianal and pilonidal abscesses (OPCS-4 codes: H58.2 and H60.3 respectively), were identified as operations potentially amenable to day surgery. Over the seven study years, an annual average of 8559 (+/-SD 307) admissions were coded to drainage of a perianal abscess and 4676 (+/-SD 478) admissions to drainage of pilonidal abscess. The average annual bed usage associated with these procedures was 18 831 (+/-SD 718) and 7623 (+/-SD 436) bed days respectively. Colorectal day case surgery is currently under-exploited in the NHS. By lifting some of the barriers to day case surgery significant resource savings may be possible.

Percutaneous Endoscopic Gastrostomy in Diabetic Patients

Purpose: Percutaneous Endoscopic Gastrostomy (PEG) is a procedure of choice for enteral nutrition in patients with functional gastrointestinal tract. PEG has been performed in patients with multiple co morbidities with a low morbidity and mortality including patients with Diabetes. Review of literature shows that there are very few published studies analyzing the complications of PEG placement in diabetic patients. The aim of our study was to compare complications of PEG placement in diabetic patients with non diabetic patients to find any possible difference in mortality or morbidity between the two groups. Methods: All patients who underwent percutaneous endoscopic gastrostomy in IMC as inpatients from January 2005 to March 2007 were included in the study. All patients who had PEG placement on ambulatory basis were excluded from this study. There were total 104 patients out of whom 91 were women and 13 men. Group 1 (DM group) consist of 36 patients, Male 5, Female 31. Group 2 (non DM group) consists of 68 patients, (Male 8, Female 60). Indications for PEG placement in DM group included various neurologic impairment like Alzheimer's dementia 8 (22.2%), Cerebrovascular accident 21 (58.3%) and chronic ventilator dependent 7 (19.4%). Indications for PEG in non DM patients were neurological impairment like Alzheimer's Dementia 33 (48.5%), Cerebrovascular accident 26 (38.2%) and chronic vent dependent 10 (14.7%). Patients received preoperative antibiotics as short-term prophylaxis. Results: All PEG complications were compared between DM (group1) and non DM (group2) patients. Wound infection (group1) 2, (group2) 5 (P 0.54), peristomal leakage (group1) 1, (group2) 2 (P 0.3), inadvertent PEG removal (group1) 10, (group2) 16 (P 0.402). Mortality unrelated to PEG placement in (group1) 12, (group2) 8 (P 0.432). There were no significant differences in mortality or morbidity between diabetic and non diabetic patients. In addition there was no statistically significant difference in complications among diabetic patients whether on insulin or oral hypoglycemic agents. Other complications of PEG like bleeding, necrotizing fasciitis, esophageal/gastric perforation, colocutaneous fistula, buried bumper syndrome, peritonitis, pneumoperitoneum, paralytic ileus, gastric outlet obstruction and death secondary to PEG placement were not reported in either group. Conclusion: Although diabetes mellitus is considered to be associated with more post operative wound complications, our study did not show any statistically significant increase in morbidity or mortality of PEG in diabetic patients when compared to non diabetics. It is suggested that PEG is a safe procedure in diabetic patients.

Laparoscopic Incisional Hernia Repair as a Day Surgery Procedure

Findings have shown that laparoscopic incisional hernia repair is superior to conventional open techniques. The objective of the current study was to evaluate the results of laparoscopic surgery on incisional hernias in an outpatient surgery unit in a university hospital. Data were gathered prospectively for all laparoscopic incisional hernia repairs from January 1997 to December 2006. A total of 127 patients were operated in an outpatient surgery unit. The patients' clinical features, hernia type, intraoperative and postoperative complications, and reasons for hospital admission are studied. None of the patients required readmission to hospital, 15 had no need for analgesic treatment (11.8%) and the mean requirement was 6 days. The mean time of return to normal activity was less than 10 days and all the patients expressed their satisfaction with the procedure they received. During follow-up we detected 5 recurrences (4.4%). The statistical study showed no significant differences between the hospitalized patients and those treated on an ambulatory basis with regard to morbidity and recurrence rate (P<0.05). We do find a lower intraoperative and early postoperative (<30 d) complication rate in favor of the ambulatory patients (P<0.001). Laparoscopic repair of incisional hernias can be performed as a highly efficient ambulatory procedure with igual morbidity and recurrences than hospitalized patients.

A comprehensive approach to fast tracking in cardiac surgery: ambulatory low-risk open-heart surgery

Ambulatory surgery, where the processes of admission, surgery and discharge are completed within 24h, is an increasingly important part of many surgical specialties. The aim of this study was to evaluate suitability of ambulatory approach for low-risk open-heart procedures. A retrospective analysis of 48 patients who had undergone atrial septal defect (ASD) closure at our centre (from October 2005 through November 2006) suggested that this open-heart procedure was optimally suited for treatment with ambulatory approach. Based on this, 15 patients with ostium secundum ASD underwent surgical closure as ambulatory patients, with targeted discharge within 24h of admission. Twenty patients receiving conventional surgery in the other two units of the department served as the control group. Fourteen of the 15 patients were successfully discharged within 24h of admission. One patient remained in the hospital for excess incision site pain and was discharged on the 2nd postoperative day. Mean hospital stay for the entire cohort of 15 patients was 1583+/-669 min, whereas the mean hospital stay in the control group was 9.8 days. Follow-up was 100% complete at 30 days. There were no in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from the procedure. This study suggests that sufficient advancement in cardiac surgery has occurred to permit low-risk open-heart procedures (with an expected uneventful postoperative course) to be performed on an ambulatory basis. Once such a practice is firmly established, expanding its horizon may provide considerable improvement in patient satisfaction, more patient turnover per bed, and significant financial savings.

A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy

Laparoscopic cholecystectomy is increasingly used on an ambulatory basis. This study aimed to examine its effectiveness for carefully selected patients. A systematic review of Cochrane, Embase, and Medline using the keywords "ambulatory," "laparoscopic," and "cholecystectomy" was performed. Postoperative complications leading to admissions and readmissions were compared between day care and inpatient laparoscopic cholecystectomy groups. Postoperative quality of life, patient satisfaction, and cost effectiveness also were analyzed. The search process identified seven clinical trials suitable for meta-analysis. These trials, consisting of 598 patients, compared day care and inpatient procedures. The unplanned admission rate in the ambulatory group was comparable with the prolonged hospitalization of inpatients (odds ratio [OR], 1.979; 95% confidence interval [CI], 0.846-4.628). There was no significant difference between the readmission rates of the two groups (OR, 0.964; 95% CI, 0.318-2.922). The quality-of-life indicators were similar for the ambulatory and overnight-stay patients (p = 0.195). The cost effectiveness was better for the day care procedures because of the shorter mean hospital stay. Ambulatory laparoscopic cholecystectomy can be performed safely for selected patients, with reduced cost and a high level of patient satisfaction.

Lower extremity endovascular interventions: Can we improve cost-efficiency?

Management of lower extremity arterial disease with endovascular intervention is on the rise. Current practice patterns vary widely across and within specialty practices that perform endovascular intervention. This study evaluated reimbursement and costs of different approaches for offering endovascular intervention and identified strategies to improve cost-efficiency. The medical records of all patients admitted to a university health system during 2005 for an endovascular intervention were retrospectively reviewed. Procedure type, setting, admission status, and financial data were recorded. Groups were compared using analysis of variance, Student t test for independent samples, and chi2. A total of 296 endovascular interventions were completed, and 184 (62%) met inclusion criteria. Atherectomy and stenting were significantly more costly when performed in the operating room than in the radiology suite: atherectomy, dollars 6596 vs dollars 4867 (P = .002); stent, dollars 5884 vs dollars 3292, (P < .001); angioplasty, dollars 2251 vs dollars 1881 (P = .46). Reimbursement was significantly higher for inpatient vs ambulatory admissions (P < .001). Costs were lowest when the endovascular intervention was done in the radiology suite on an ambulatory basis and highest when done as an inpatient in the operating room (dollars 5714 vs dollars 12,278; P < .001). Contribution margins were significantly higher for inpatients. Net profit was appreciated only for interventions done as an inpatient in the radiology suite. Reimbursement, contribution margins, and net profit were significantly lower among private pay patients in both the ambulatory and inpatient setting. The 30-day hospital readmission after ambulatory procedures was seven patients (6%). Practice patterns for endovascular interventions differ considerably. Costs vary by procedure and setting, and reimbursement depends on admission status and accurate documentation; these dynamics affect affordability. Organizing vascular services within a hub will ensure that care is delivered in the most cost-efficient manner. Guidelines may include designating the radiology suite as the primary venue for endovascular interventions because it is less costly than the operating room. Selective stenting policies should be considered. Contracts with private insurers must include carve-outs for stent costs and commensurate reimbursement for ambulatory procedures, and Current Procedural Terminology (CPT; American Medical Association, Chicago, Ill) coding must be proficient to make ambulatory endovascular interventions fiscally acceptable.

Radioguided occult lesion localization (ROLL) versus wire‐guided lumpectomy for non‐palpable breast lesions: A randomized prospective evaluation

It is important to optimize the localization technique for non-palpable breast lesions. One hundred consecutive women with non-palpable breast lesions were randomized to radioguided occult lesion localization (ROLL) or wire localization (WL). For ROLL technique (99m)Tc-labeled particles of human serum albumin were injected under breast-imaging control. Localization of the lesion was done in the operating room with the aid of a gamma-probe. All lesions were identified in an X-ray control of the surgical specimen. Categorical variables were analyzed with the Chi-square method. Significance was considered at P < 0.05. All procedures were performed on the same day of excision, on ambulatory basis. Both techniques resulted in 100% retrieval of the lesions. Localization time was reduced with ROLL (P < 0.001). Clear margins were achieved in 88.9% ROLLs and 62.5% WLs (P < 0.05) reducing the requirement of re-excision. There were significant differences in the subjective ease of the procedures in favor of ROLL technique as rated by surgeons and radiologists. ROLL technique is as effective as WL for excision of non-palpable breast lesions, reduce localization time and probably the incidence of pathologically involved margins of excision. ROLL appears to improve the learning curve for surgical residents and cosmesis. ROLL is an attractive alternative to WL.

Clinical Pathway for Laparoscopic Gastric Bypass

Patients undergoing bariatric surgery are ideal candidates for a clinical pathway, as it is a standardized, common, and elective procedure and most patients have a predictable clinical course. The aim of developing this clinical pathway is the result of a wide consolidated experience with patients undergoing laparoscopic Roux-en-Y gastric bypass, the purpose of which is to minimize complications without affecting patient care or the outcome of the procedure. The clinical pathway was applied to the 311 patients that received a laparoscopic Roux-en-Y gastric bypass. The clinical pathway includes a temporary matrix, which shows the sequence of events that will occur on each of the days between patient admission and discharge. It also includes medical interventions, nursing care, medication, determinations, physical activity, diet, and information for the patient. Complications occurred in 36 patients (11.5%): 14 patients (4.5%) during admission and 22 patients (7%) after discharge. Of the 22 patients presenting with complications after discharge, 12 required readmission to hospital (3.8%), and the other 10 were treated on an ambulatory basis. We can say that, because of its frequency and predictability, laparoscopic Roux-en-Y gastric bypass is nowadays a procedure for systematization using a clinical pathway, providing it is controlled by a team with a wide experience in bariatric surgery. This clinical pathway is to offer our patients with morbid obesity a laparoscopic Roux-en-Y gastric bypass with the smallest possible range of complications.

Epidemiología clínica y molecular de las infecciones por Shigella spp en niños de la Región Metropolitana durante el verano 2004-2005

Shigella spp is a frequent cause of diarrhea in children. Antimicrobials decrease the duration of diarrhea and pathogen excretion. However, the increasing resistance limits their therapeutic value.To study Shigella serotype distribution in the Metropolitan Region in Chile, and its relationship with severity of disease, antimicrobial resistance pattern and clonality.During summer 2004-2005, stool samples from children with diarrhea were collected in Cary Blair transpon medium and cultured. Shigella isolates were serotyped using monoclonal and polyclonal commercial antibodies. In vitro activity of ampicillin, amoxicillin/clavulanic acid, chloramphenicol, cotrimoxazol, nalidixic acid, ciprofloxacin, ceftriaxone and azythromycin was determined by minimal inhibitory concentration (MIC). Clonality was studied by pulsed-field gel electrophoresis (PFGE) using Xbal as restriction enzyme.One hundred thirty nine Shigella strains were isolated (77 S sonnei and 62 S flexneri). S sonnei and S flexneri 2a serotypes were responsible for 95% of episodes. Children aged 2-4 years, showed a greater incidence of Shigella infections and 77% of episodes were treated on an ambulatory basis. High resistance levels were observed for ampicillin, cotrimoxazole, amoxicillin-clavulanic acid and chloramphenicol (67%, 60%, 56% and 45%, respectively). We found 11 resistance patterns and 61,2% of strains were multiresistant. There were multiple clones without a strict relationship with resistance patterns.Shigella infections in Metropolitan Region in Chile are associated to a restricted number of serotypes, representing a clonal expansion associated to different antimicrobial resistant patterns.

Shigella spp infections in children living in the Metropolitan Region, Chile, during summer of 2004-2005

Shigella spp is a frequent cause of diarrhea in children. Antimicrobials decrease the duration of diarrhea and pathogen excretion. However, the increasing resistance limits their therapeutic value. To study Shigella serotype distribution in the Metropolitan Region in Chile, and its relationship with severity of disease, antimicrobial resistance pattern and clonality. During summer 2004-2005, stool samples from children with diarrhea were collected in Cary Blair transpon medium and cultured. Shigella isolates were serotyped using monoclonal and polyclonal commercial antibodies. In vitro activity of ampicillin, amoxicillin/clavulanic acid, chloramphenicol, cotrimoxazol, nalidixic acid, ciprofloxacin, ceftriaxone and azythromycin was determined by minimal inhibitory concentration (MIC). Clonality was studied by pulsed-field gel electrophoresis (PFGE) using Xbal as restriction enzyme. One hundred thirty nine Shigella strains were isolated (77 S sonnei and 62 S flexneri). S sonnei and S flexneri 2a serotypes were responsible for 95% of episodes. Children aged 2-4 years, showed a greater incidence of Shigella infections and 77% of episodes were treated on an ambulatory basis. High resistance levels were observed for ampicillin, cotrimoxazole, amoxicillin-clavulanic acid and chloramphenicol (67%, 60%, 56% and 45%, respectively). We found 11 resistance patterns and 61,2% of strains were multiresistant. There were multiple clones without a strict relationship with resistance patterns. Shigella infections in Metropolitan Region in Chile are associated to a restricted number of serotypes, representing a clonal expansion associated to different antimicrobial resistant patterns.

"White coat hypertension" in type 2 diabetic patients

"White coat hypertension" is a phenomenon in which patients exhibit elevated blood pressure in clinical setting, but not recorded by themselves at home. The aim of this study was to evaluate frequency of "white coat hypertension" in type 2 diabetic patients, in which high blood pressure values in clinical setting were observed for the first time. The study comprised 52 type 2 diabetic patients with newly diagnosed high blood pressure values in measurements with the use of mercurial sphygmomanometer during ambulatory visit (mean "office blood pressure" values > or =140/90 mmHg). In all patients ambulatory blood pressure measurements (ABPM) were conducted. "White coat hypertension" was detected when the mean blood pressure value in ABPM during the day was <135/85 mmHg and the mean "office blood pressure" was > or =140/90 mmHg. Arterial hypertension was detected when the mean "office blood pressure" values were > or =140/90 mmHg and the mean blood pressure value in ABPM during the day were > or =135/85 mmHg. In forty-four percent of the studied patients "white coat hypertension" was diagnosed (group 1). Group 2 consisted of patients with arterial hypertension (56% of all studied patients). Blood pressure values estimated on the ambulatory basis with the use of ABPM were lower in group 1 than in group 2 (p <0.05). There were no differences between the study groups in blood pressure values estimated by traditional method with the use of mercurial sphygmomanometer during clinic visit (p >0.05). In above 2/5 of type 2 diabetic patients with newly detected high blood pressure during clinic visits, "white coat hypertension" was diagnosed.