Multi-intervención para disminuir el estrés agudo del cuidador familiar del paciente en la UCI / Multi-intervention to reduce the acute stress of the family caregiver of the patient in the ICU

El internamiento de un familiar en la Unidad de Cuidados Intensivos (UCI) causa estrés en la familia por el alto riesgo de muerte e incertidumbre sobre el pronóstico, lo cual dificulta la toma de decisiones del Cuidador Familiar (CF) e incrementa el riesgo de anular la atención de sus necesidades. La información publicada sobre intervenciones para disminuir el estrés agudo en los CF son limitadas y controvertidas, por lo que se propone una intervención basada en la mejor evidencia disponible adaptado al contexto del CF de la UCI en México. Objetivo: Evaluar el efecto de una multi-intervención que involucra una plática estructurada, información impresa y consultoría sobre el estrés agudo del CF del paciente en la UCI. Metodología: Se trata de un estudio cuasi-experimental, pre y post-test, que incluyó a 64 CF para evaluar la Ansiedad Estado-Rasgo, se utilizó el inventario IDARE, se comparó el nivel de estrés entre los grupos y al interior de cada grupo pre y post-test. Resultados: en la Ansiedad-Estado hubo diferencias significativas entre los grupos control y experimental en el postest, mediana=48 (P25-P75=44.2-60.7), mediana= 45.5 (P25-P75=38.2-49) respectivamente. Así mismo se observó una disminución en el grupo experimental antes y después de la intervención, mediana=54 (P25-P75= 48-60.7), mediana=45.5 (P25-P75=38.2-49), (p=0.005). Conclusiones/implicaciones: Implementar una multi-intervención multidisciplinar que involucre la educación, información impresa y consultoría, reduce los niveles de estrés agudo del CF comparado con quienes reciben una información rutinaria. Se observó que los CF tienen niveles elevados de ansiedad en especial las mujeres, jefe de familia, residentes del Estado de México y cuando la probabilidad de muerte es alta. La investigación refrenda el tema que el desempleo y el desarrollo de enfermedades en el CF son condiciones que sin duda inciden en el desarrollo de la ansiedad.

The placement of a relative in the Intensive Care Unit (ICU), may cause family stress due to the high risk of death and uncertainty about the prognostic, which hampering decision-making by the Family Caregiver (FC), and could increases the risk of cancel the attention of their needs. Interventions to reduce acute stress in FC are limited and controversial, so an intervention based on the best available evidence adapted to the context of FC UCI in Mexico is proposed. Objective: To evaluate the effect of a multi-intervention involving a structured discussion, printed information and consultancy on the acute stress of CF of patient in the ICU. Methodology: This is a quasi-experimental study, pre and post-test, that includes 64 CF to assess the State-Trait Anxiety, with IDARE inventory, stress level was compared between and within groups, pre and post-test. Results: Anxiety-State showed significant differences between the control and experimental group in the posttest, median = 48 (P25-P75 = 44.2-60.7), median = 45.5 (P25-P75 = 38.2-49) respectively. Likewise, a signifcant decrease of Anxiety-State was observed after the intervention in the experimental group, median = 54 (P25-P75 = 48-60.7), median = 45.5 (P25-P75 = 38.2-49), (p = 0.005). Conclusions / Implications: a multidisciplinary multi-intervention involving education, printed information and consulting, reduces acute stress levels of FC compared with those receiving routine information. It was noted that the FC have elevated levels of anxiety especially women, household head, residents of the State of Mexico and in those with a high likelihood of death. This investigation authenticates that the unemployment and the development of diseases in the CF are conditions that have a direct influence on the develompent of anxiety.

Comparación de métodos diagnósticos de diarreas asociadas a Clostridium difficile / Comparison of diagnostic methods for Clostridium difficile-associated diarrhea

Para comparar diferentes métodos de diagnóstico de diarreas asociadas a Clostridium difficile desarrollados en el marco de un estudio colaborativo, se analizaron filtrados de materia fecal de pacientes con sintomatología compatible con esta patología. Se evaluó la actividad biológica sobre células Vero (ensayo biológico), la reactividad frente a anticuerpos anti-TcdA y anti-TcdB (dot blot) y la presencia de secuencias del gen tcdB por PCR. De 177 muestras analizadas por el ensayo biológico, 44 tuvieron títulos mayores o iguales que 64. Diecinueve muestras fueron a la vez positivas en el ensayo biológico y en el análisis por PCR. Se analizaron 149 muestras por dot blot utilizando anticuerpos anti-TcdA y anti-TcdB; 46 muestras resultaron positivas para ambas toxinas, 12 muestras fueron positivas sólo para TcdB y 5 muestras sólo para TcdA. Las divergencias entre los diferentes métodos podrían estar relacionadas con la presencia de genes truncados, con un bajo número de microorganismos en las muestras analizadas o con la degradación de las toxinas. Los resultados presentados demuestran la necesidad de implementar alternativas diagnósticas que se adapten a la compleja realidad epidemiológica de este importante patógeno intestinal.

In order to compare different methods for the diagnosis of Clostridium difficile-associated diarrhea, fecal filtrates from patients presenting symptoms compatible with this condition, were analyzed. Biological activity on Vero cells (biological assay), dot blot with antibodies anti-TcdA and anti-TcdB, and a PCR assay for the tcdB gene, were evaluated. Titles of biological assays were ≥ 64 for 44 out of 177 samples. Nineteen samples were positive in both biological and PCR assays. The analysis by dot blot using anti-TcdA and anti-TcdB antibodies showed that 46 samples out of 149 were positive for both toxins whereas 12 samples were only positive for TcdB, and 5 samples only positive for TcdA. Discrepancies in the different methods could be related to truncated genes, low number of microorganisms in the samples and toxin degradation. The results herein presented show the need for developing diagnostic approaches compatible with the complex epidemiological situation of this clinically relevant intestinal pathogen.

Evaluación de un método colorimétrico para el estudio de la interacción entre micoorganismos y células de epitelio intestinal / [Evaluation of a colorimetric method for studying the interaction between microorganisms and intestinal epithelial cells]

The aim of the present study was to gain further insight on the reliability of the colorimetric determination of the activity of bacterial nitrate reductase to evaluate bacterial concentrations and interaction between microorganisms and enterocyte-like cells. Nitrite produced after incubation of the samples with a nitrate-formate solution was determined with a diazotization reaction with sulphanilic acid and N-naphthyl-ethylene-diamonium dichloride. Cell association assays were performed with differentiated Caco-2 cells. A biphasic relationship was found between nitrite concentration and bacterial densities. This behavior seems to be due to the sigmoideal character of the kinetics of nitrate reduction. Association to Caco-2 cells was strongly strain dependent being Staphylococcus aureus ATCC 25923 the strain showing the highest values of association. For some strains, percentages of association calculated on the basis of the colorimetric assay were significantly higher than those calculated in terms of viable counts. Bacterial association with enterocyte-like cells can be evaluated by measures of the activity of bacterial nitrate reductase provided that the biphasic relationship between bacterial and nitrite concentrations is taken into account for the calculations. Results presented in this paper show the applicability of the colorimetric method to assess the amount of microorganisms associated to human enterocytes in culture.

Aislamiento de Escherichia coli resistentes a antibióticos a partir de aguas del Río de la Plata / [Isolation of antibiotic-resistant Escherichia coli from the water of the Río de la Plata]

Water of a recreational zone of the Río de la Plata was analyzed. Levels of total heterotrophic bacteria ranged from 1.5 x 10(3) to 6.2 x 10(3) CFU/ml and total coliforms were between 5.0 x 10(2) and 7.0 x 10(3) per 100 ml. Values of fecal coliforms were between 1.0 x 10(2) and 1.3 x 10(3) per 100 ml. Among 131 E. coli strains isolated, 20.6

of cephalothin resistance was found, followed by nitrofurantoin, ampicillin, sulfisoxazole and the trimethoprim sulfamethoxazole combination. Resistance to more than one antibiotic was found in 36.7

of the strains isolated and 9.2

were resistant to three or more antibiotics. Three strains resistant to four antibiotics and one resistant to five were isolated. The highest percentage of combined resistance occurred for the pairs cephalothin-nitrofurantoin and cephalothin-ampicillin.