Genetic regulation of the ompX porin of Salmonella Typhimurium in response to hydrogen peroxide stress

BACKGROUND: Salmonella Typhimurium is a Gram negative pathogen that causes a systemic disease in mice resembling typhoid fever. During its infective cycle, S. Typhimurium is phagocytized by macrophages and proliferates inside a Salmonella containing vacuole where Salmonella is exposed and survives oxidative stress induced by H2O2 through modulation of gene expression. After exposure of Salmonella to H2O2, the expression of the porin encoding gene ompX increases, as previously shown by microarray analysis. Expression of ompX mRNA is regulated at a post transcriptional level by MicA and CyaR sRNAs in aerobiosis. In addition, sequence analysis predicts a site for OxyS sRNA in ompX mRNA. RESULTS: In this work we sought to evaluate the transcriptional and post transcriptional regulation of ompX under H2O2 stress. We demonstrate that ompX expression is induced at the transcriptional level in S . Typhimurium under such conditions. Unexpectedly, an increase in ompX gene transcript and promoter activity after challenges with H2O2 does not translate into increased protein levels in the wild type strain, suggesting that ompX mRNA is also regulated at a post transcriptional level, at least under oxidative stress. In silico gene sequence analysis predicted that sRNAs CyaR, MicA, and OxyS could regulate ompX mRNA levels. Using rifampicin to inhibit mRNA expression, we show that the sRNAs (MicA, CyaR and OxyS) and the sRNA:mRNA chaperone Hfq positively modulate ompX mRNA levels under H2O2 induced stress in Salmonella during the exponential growth phase in Lennox broth. CONCLUSIONS: Our results demonstrate that ompX mRNA is regulated in response to H2O2 by the sRNAs CyaR, MicA and OxyS is Salmonella Typhimurium.

Eficacia de la viscosuplementación con ácido hialurónico de alto y de mediano peso molecular en pacientes con gonartrosis sintomática grados II-III / Efficacy of viscosupplementation with high and medium molecular weight hyaluronic acid in patients with symptomatic gonarthrosis grades II-III

Resumen: Introducción: La osteoartrosis es actualmente la quinta causa de discapacidad en el adulto. Su prevalencia aumenta a partir de los 40 años. La viscosuplementación es un tratamiento para las etapas iniciales de la osteoartrosis de rodilla. Objetivo: Comparar la eficacia y la calidad de vida en pacientes con gonartrosis sintomática tratados con ácido hialurónico de alto y mediano peso molecular. Material y métodos: Estudio analítico, retrospectivo, transversal, observacional de expedientes clínicos de pacientes con diagnóstico de gonartrosis grado II y grado III, de Octubre de 2017 a Junio de 2018, tratados con viscosuplementación con ácido hialurónico de alto o de mediano peso molecular; se analizó la calidad de vida y la escala de WOMAC de manera previa a la primera aplicación y con seguimiento a los dos, cuatro y seis meses. Resultados: 194 pacientes, con edades entre 30 y 87 años (promedio 61.85; DE = 11.3); 134 mujeres (69.1%) y 60 hombres (30.9%). En ambos grupos la evolución fue hacia la mejoría, con disminución en el puntaje WOMAC, sin diferencia significativa entre grupos. El puntaje de WOMAC tuvo un aumento mínimo pasados seis meses de la aplicación en ambos grupos, lo que se interpreta como disminución del efecto terapéutico. Dos pacientes tuvieron reacciones adversas mínimas localizadas, las cuales se resolvieron con medidas generales. Conclusión: El ácido hialurónico en ambas presentaciones, de alto y de bajo peso molecular, es efectivo en el tratamiento de la gonartrosis sintomática sin diferencia con el peso molecular.

Abstract: Introduction: OA is currently the fifth leading cause of adult disability, its prevalence increases from age 40. Viscosupplementation is a treatment for the early stages of knee OA. Objective: To compare efficacy and quality of life in patients with symptomatic gonartrosis, treated with high and low molecular weight hyaluronic acid. Material and methods: Analytical, retrospective, cross-sectional, observational study of clinical records of patients diagnosed with grade II and grade III gonarthrosis, October 2017 to June 2018, treated with viscosupplementation with high molecular weight hyaluronic acid or low molecular weight; WOMAC quality of life and scale were analyzed prior to the first application and tracked at two, four and six months. Results: 194 patients, aged between 30 to 87 years (promedio 61.85; SD = 11.3); 134 women (69.1%), 60 men (30.9%). In both groups the evolution was towards improvement, with a decrease in the WOMAC score, with no significant difference between groups. The WOMAC score had a minimum increase after 6 months of application in both groups, which is interpreted as decreasing the therapeutic effect. Two patients had localized minimal adverse reactions which were resolved with general measures. Conclusion: Hyaluronic acid in both presentations, high and low molecular weight, are effective in the treatment of symptomatic goonarthrosis without difference to molecular weight.

Factores de riesgo psicosociales asociados a preeclampsia en mujeres mexicanas: análisis comparado en tres Estados / Psychosocial risk factors associated to pre-eclampsia among mexican women: a comparative analysis in three States / Fatores de risco psicossociais associados a pré-eclâmpsia em mulheres mexicanas: análise comparada em três Estados

Objetivo Analizar comparativamente los factores de riesgo psicosociales asociados con preeclampsia en mujeres mexicanas residentes de tres Estados. Método Estudio de casos y controles en 336 mujeres puérperas con y sin preeclampsia (130 del Estado de México, 114 de Yucatán y 92 de Veracruz). Se aplicaron dos cuestionarios y 5 escalas tipo Likert previamente validadas. Se llevó a cabo análisis estadístico comparativo mediante el software SPSS ver 20. Las variables cuantitativas se analizaron con Kruskal Wallis, las categóricas con frecuencias, el riesgo con razón de Momios (OR); IC de 95%. El riesgo se ajustó con regresión logística con a= 0.05. Resultados El análisis reveló violencia leve en los 3 Estados, con mayor frecuencia en el Estado de México y Veracruz (OR: 3.53; IC 95%: 1.13 - 10.97). La depresión, fue un hallazgo significativo para preeclampsia. Existe de 1 a 2 veces más riesgo para esta enfermedad en embarazadas del Estado de México que sufren algún grado de depresión (OR: 1.66; IC 95%: 1.058 - 2.607) y de 3 a 4 veces más riesgo cuando hay trastorno depresivo mayor (OR: 3.67; IC 95%: 1.23 - 10.89). En mujeres veracruzanas que reportaron algunas veces sintomatología depresiva está presente 3 veces más el riesgo de preeclampsia (OR: 3.12; IC 95%: 1.077 - 9.083) y 7.4 veces más riesgo cuando tienen menos de 5 consultas prenatales (OR: 7.42; IC 95%: 2.85 - 19.33). Conclusiones Se identificaron la depresión, sintomatología depresiva, violencia y el número de consultas prenatales menor a 5 como factores de riesgo psicosociales asociados a preeclampsia. Estos resultados permitirán proponer un modelo de intervención integral de enfermería para disminuirlos.

Objective To comparatively analyze the psychosocial risk factors associated to pre-eclampsia among Mexican women living in three States. Method This is a cases and controls study with 336 pregnant women with and without pre-eclampsia (130 from the State of Mexico, 114 from the state of Yucatan, and 92 from the state of Veracruz). Two questionnaires were administered, and 5 previously validated Likert type scales were used. A statistical comparative analysis was performed using SPSS v.20 software. Quantitative variables were analyzed with the Kruskal-Wallis procedure, categorical variables with frequencies calculation, and the associated risk with odds ratios in the 95% confidence interval. The associated risk was further adjusted through logistic regression a = 0.05). Results The analysis revealed a mild level of violence in all three States. States which reflected more frequency of violence risks were Mexico and Veracruz (OR: 3.53; IC 95%: 1.13 - 10.97). Depression was a significant finding associated to pre-eclampsia. A 1 to 2 times higher risk of associated pre-eclampsia was found among pregnant women with some degree of depression in the State of Mexico (OR: 1.66; IC 95%: 1.058 - 2.607), and this risk was 3 to 4 times higher in the presence of major depressive disorder (OR: 3.67; IC 95%: 1.23 - 10.89). Among women from the state of Veracruz who sometimes reported having depressive symptoms, the risk of pre-eclampsia association was 3 times higher (OR: 3.12; IC 95%: 1.077 - 9.083), while this risk was 7.4 times higher when these women had less than 5 prenatal assessment visits (OR: 7.42; IC 95%: 2.85 - 19.33). Conclusions Depression, depressive symptomatology, violence, and less-than-5 prenatal assessment visits were all identified as psychosocial risk factors associated to pre-eclampsia. These findings will support proposals for a corresponding nursing integral intervention model to address the related risk factors.

Objetivo Analisar comparativamente os fatores de risco psicossociais associados com pré-eclâmpsia em mulheres mexicanas residentes de três Estados. Método Estudo de casos e controles em 336 mulheres puérperas com e sem pré-eclâmpsia (130 do Estado do México, 114 de Yucatán e 92 de Veracruz). Aplicaram-se dois questionários e 5 escalas tipo Likert previamente validadas. Levou-se a cabo análise estatística comparativa mediante o software SPSS ver 20. As variáveis quantitativas analisaram-se com Kruskal Wallis, as categóricas com frequências, o risco com razão de Momios (OR); IC de 95%. O risco ajustou-se com regressão logística com a = 0.05. Resultados A análise revelou violência leve nos 3 Estados, com maior frequência no Estado de México e Veracruz (OR: 3.53; IC 95%: 1.13 -10.97). A depressão foi um achado significativo para pré-eclâmpsia. Existe de 1 a 2 vezes mais risco para esta doença em grávidas do Estado do México que sofrem algum grau de depressão (OR: 1.66; IC 95%: 1.058 - 2.607) e de 3 a 4 vezes mais risco quando tem transtorno depressivo maior (OR: 3.67; IC 95%: 1.23 - 10.89). Em mulheres veracruzanas que reportaram algumas vezes sintomatologia depressiva está presente 3 vezes mais o risco de pré-eclâmpsia (OR: 3.12; IC 95%: 1.077 -9.083) e 7.4 vezes mais risco quando têm menos de 5 consultas pré-natais (OR: 7.42; IC 95%: 2.85 - 19.33). Conclusões Identificaram-se a depressão, sintomatologia depressiva, violência e o número de consultas pré-natais menor a 5 como fatores de risco psicossociais associados à pré-eclâmpsia. Estes resultados permitiram propor um modelo de intervenção integral de enfermagem para diminuilos.

Síndrome de Vogt-Koyanagi-Harada en niños / Vogt-Koyanagi-Harada syndrome in children

Vogt-Koyanagi-Harada (VKH) syndrome is a systemic inflammatory disease that causes chronic and bilateral granulomatous panuveitis, usually described in adults. Objectives: To describe manifestations and complications of VKH in pediatric patients. Methods: Retrospectivedescriptive study upon patients <14 years-old with VKH, attended from January 1985 to July 2010 in three different centers. Results: A total of 17 patients (34 eyes) were studied; 9 (53%) female. The mean age was 10.8 years-old. Among extraocular manifestations; neurological (71%), dermatological (29%) and auditive (24%) signs were observed. Ocular findings included optic-disc involvement (94%), anterior uveitis (79%), choroiditis (77%), serous retinal detachment (71%) and vitritis (71%). Initial visual acuity (VA) was ≤0.05 in 47% of cases and ≥0.6 in 12% of patients. 71% presented complications: glaucoma (20 eyes), sinechiae (10 eyes), maculopathy (6 eyes) cataract (5 eyes) and ptisis bulbi (1 eyes). 35% received only corticosteroids and 65% inmunosupressive drugs. After treatment, 6% had VA ≤0.05 and 59% ≥0.6. Ten patients (59%) recurred: 30% compromising posterior pole, and 50% recurred >3 times. Conclusions: VKH in children is infrequent. It presents with optic-disc involvement and complications of posterior pole. It requires a high degree of suspicion, quick evaluation and early treatment, which include inmunosupressive and extended corticosteroid therapy. Nevertheless, a high rate of recurrence is seen among this group of patients. (AU)

Vida cotidiana y preeclampsia: Experiencias de mujeres del Estado de México / Daily life and pre-eclampsia: Experiences of women at the State of Mexico / Vida cotidiana e pré-eclâmpsia: Experiências de mulheres do Estado do México

Objetivo: Analizar la experiencia de vivir con preeclampsia en el contexto de la vida cotidiana de un grupo de mujeres del Estado de México que asisten al Hospital General de Chimalhuacán. Método: Investigación cualitativa de abordaje fenomenológico, hermenéutico con enfoque teórico de Alfred Schütz. La muestra fue definida por medio del criterio de saturación teórica. Los datos fueron recolectados a través de una entrevista semiestructurada y analizados con el método de van Manen. Seis criterios de rigor científico se utilizaron: Credibilidad, transferibilidad, consistencia, confirmabilidad, relevancia y adecuación teórico epistemológica. Resultados: Emergieron 5 categorías: 1) significado de la preeclampsia en la vida cotidiana; 2) experiencia de la dimensión física y emocional de vivir con preeclampsia; 3) interpretación del autocuidado en la vida cotidiana de la mujer con preeclampsia; 4) redes de apoyo que ayudan a sobrevivir la experiencia de tener preeclampsia; y 5) significado de los servicios de salud. Conclusiones: La preeclampsia es una enfermedad del embarazo de origen multifactorial y una de las principales causas de muerte materna en México, con impacto significativo en los servicios de salud. Se demuestra que en las mujeres con preeclampsia se potencializa su vulnerabilidad y riesgo de morir, al vivir en crisis, pues se ve trastocada y alterada su vida cotidiana, no solo en los aspectos biológicos al sentir malestares físicos y corporales, sino también en la parte emocional. Se observó la capacidad de auto-eco-socio-organización para equilibrar su entorno y vida cotidiana. Se ratificó que las redes de apoyo familiar y social son dadoras de bienestar e indispensables para fortalecer el cuidado.

Objective: To analyze the experience of living with pre-eclampsia among women at the State of Mexico who are attended at the General Hospital of Chimalhuacan. Method: This is a qualitative research with a phenomenological and hermeneutic approach with the theoretical focus of Alfred Schütz. The sample was defined using the criteria of theoretical saturation. Data were collected through a semi-structured interview and analyzed using the Van Manen method. Six scientific rigor criteria were used: credibility, transferability, consistency, confirmability, relevance, and theoretical and epistemological adequacy. Results: Five categories emerged: 1) meaning of pre-eclampsy in daily life, 2) physical and emotional experience of living with pre-eclampsy, 3) interpretation of self-care in the daily life of women with pre-eclampsy, 4) supporting networks which help women survive the experience of having pre-eclampsy, and 5) meaning of the Health Services. Conclusions: Pre-eclampsy, a multi-factorial pregnancy illness with a high impact on Health Services, is one of the main causes of maternal deaths in Mexico. Because of their living in constant crisis, women with pre-eclampsy have higher vulnerability and risk of death, and their lives are affected both physically and emotionally. Here, it was ratified that supporting networks are critical to address this problem and strengthen these women's capacity to achieve a balance in their environment and daily life.

Objetivo: Analisar a experiência de viver com pré-eclâmpsia no contexto da vida cotidiana de um grupo de mulheres do Estado do México que assistem ao Hospital General de Chimalhuacán. Método: Pesquisa qualitativa de abordagem fenomenológica, hermenêutica com enfoque teórico de Alfred Schütz. A amostra foi definida utilizando o critério de saturação teórica. Os dados foram coletados a través de uma entrevista semiestruturada e analisados com o método de Van Manen. Seis critérios de rigor científico utilizaram-se: credibilidade, transferibilidade, consistência, confirmação, relevância e adequação teórico epistemológica. Resultados: emergiram 5 categorias: 1) significado da pré-eclâmpsia na vida cotidiana, 2) experiência da dimensão física e emocional de viver com pré-eclâmpsia, 3) interpretação do autocuidado na vida cotidiana da mulher com pré-eclâmpsia, 4) redes de apoio que ajudam a sobreviver a experiência de ter pré-eclâmpsia, e, 5) significado dos serviços de saúde. Conclusões: a pré-eclâmpsia é uma doença de gravidez de origem multifatorial e uma das principais causas de morte materna no México com impacto significativo nos serviços de saúde. Mostra-se que nas mulheres com pré-eclâmpsia potencializa-se sua vulnerabilidade e risco de morrer, no viver em crise, pois vê-se modificada e alterada sua vida cotidiana, não só nos aspectos biológicos ao sentir mal-estares físicos e corporais, senão também na parte emocional. Observou-se a capacidade de auto-eco-sócio-organização para equilibrar o seu entorno e vida cotidiana. Ratificou-se que as redes de apoio familiar e social são dadoras de bem-estar e indispensáveis para fortalecer o cuidado.

Nivel de riesgo y aparición de úlceras por presión en pacientes en estado crítico / Risk level and pressure ulcer in patients in critical status / Nível de risco e aparição de úlceras por pressão em pacientes em estado crítico

La úlcera por presión es un evento constante en salud pública, un problema persistente en las unidades críticas y una preocupación de enfermería al verse involucrada en el cuidado que demanda el 50% más del tiempo utilizado. Objetivo: Describir el riesgo de aparición de las úlceras por presión en los pacientes ingresados en la unidad de cuidados críticos, con relación al tiempo de medición y estadio. Métodos: Estudio cuantitativo, observacional, descriptivo y longitudinal. Muestra: conformada por 31 pacientes. El instrumento fue aplicado en 4 momentos: Al ingreso, a las 24 y 72 h y al séptimo día de estancia. En cada medición se determinó el riesgo con la escala Braden y se valoró la piel. Resultado: El 100% de los pacientes tuvo alto riesgo al ingreso y 24 h; se redujo en un 71% a los 7 días. El 6.4% desarrolló úlcera por presión al ingreso, el 12.9% a las 24 h y el 35.5% a las 72 h. En general el 45.2% de los pacientes considerados como de alto riesgo manifestaron úlcera por presión a los 7 días de estancia hospitalaria. Se observó una correlación entre las variables nivel de riesgo y aparición de úlcera por presión a las 72 h (rs p = 0.04). Conclusión: A pesar de que se reduce el riesgo a la mitad en las primeras 72 h, aumenta la incidencia de úlcera por presión en ese mismo lapso; así, es importante que se realicen evaluaciones y revaloraciones desde el ingreso y durante los 7 primeros días de estancia hospitalaria en los pacientes críticamente enfermos utilizando un instrumento de valor predictivo.

Pressure ulcer are a constant event in public health, a persistent problem in units of critical care, and a nursing concern due to the longtime of care they need to be addressed. Objective To describe the risk of developing pressure ulcer which patients admitted into the critical care taking in consideration the time of measurement and stay. Methods This is a quantitative, observational, descriptive, and longitudinal study with a sample of 31 patients. The instrument was administered at four times: At entry, during the 24 and 72 hours, and at the seventh day of stay. In each measurement, the risk was assessed through the Braden scale. The skin status was also assessed. Result: 100% of patients were at high risk during the first 24 hours; and 71% of them were at high risk at the seventh day of admission. 6.4% developed a pressure ulcer during admission, 12.9% at 24 hours, and 35.5% at 72 hours. In general, 45.2% of the patients considered in high risk developed some pressure ulcer at the seventh day of stay. A correlation was observed among the variables risk level and pressure sores at 72 hours (rs P = .04>). Conclusion: Although the risk is reduced to the half during the first 72 hours, the incidence of pressure ulcer increases in the same period; thus, it is important to perform assessments and re-appraisements to the critically ill patients using a predictive instrument since hospital admission and during the first seven days of stay.

A úlcera por pressão é um evento constante em saúde pública, um problema persistente nas unidades críticas e uma preocupação de enfermagem ao ser envolvida no cuidado que demanda 50% mais do tempo utilizado. Objetivo: Descrever o risco de aparição das úlceras por pressão nos pacientes internados na unidade de cuidados críticos, em relação ao tempo de medição e estádio. Métodos: Estudo quantitativo, observacional, descritivo e longitudinal. Amostra conformada por 31 pacientes. O instrumento foi aplicado em quatro momentos: à entrada, às 24 e 72 horas e ao sétimo dia da permanência. Em cada medição determinou-se o risco com a escala Braden e avaliou-se a pele. Resultado: 100% dos pacientes teve alto risco à entrada e 24 horas; diminuiu em um 71% aos sete dias. 6.4% desenvolveu úlcera por pressão à entrada, 12.9% às 24 horas e 35.5% às 72 horas. Em geral 45.2% dos pacientes considerados como de alto risco manifestaram úlcera por pressão aos sete dias de permanência hospitalar. Observou-se uma correlação entre as variáveis nível de risco e aparição de úlcera por pressão às 72 horas (rs = 0.04>). Conclusão: Apesar de que se reduz o risco à metade nas primeiras 72 horas, aumenta a incidência de úlcera por pressão no mesmo período, assim, é importante que se realizem avaliações e reavaliações desde a entrada e durante os sete primeiros dias de permanência nos pacientes criticamente doentes, utilizando um instrumento de valor preditivo.

Factores sociodemográficos y hospitalarios relacionados con el nivel de ansiedad en familiares con pacientes pediátricos / Social, demographic, and hospital factors related to anxiety levels among relatives of pediatric patients / Fatores sociodemográficos e hospitalares relacionados com o nível de ansiedade em familiares com pacientes pediátricos

Introducción: La asistencia al niño hospitalizado y su familia es uno de los ámbitos que hoy requiere un esfuerzo por investigar. Conocer los factores relacionados con la ansiedad que viven los familiares en la UCIP, abre caminos para desarrollar modelos de intervención y Planes de Cuidados de Enfermería dirigidos a favorecer el afrontamiento y mejorar el bienestar familiar intrahospitalario. Objetivo: Determinar la relación de los factores sociodemográficos y hospitalarios con el nivel de ansiedad que presentan los familiares con pacientes hospitalizados en la unidad de cuidados intensivos pediátricos (UCIP). Metodología: Estudio cuantitativo, descriptivo y transversal. Se utilizó un instrumento de elaboración propia para la identificación de factores sociodemográficos y hospitalarios; y la escala de Inventario de Ansiedad Estado-Rasgo de Spielberger (IDARE) para la medición del nivel de ansiedad. Resultados: 34 familiares que participaron -11.8% (4) hombres; y 88.2% (30) mujeres- la edad promedio fue de 29 años, las puntuaciones de ansiedad estado y ansiedad rasgo indican que al no conocer algún albergue se presenta una diferencia significativa en el nivel de ansiedad estado de los familiares (X

Introduction: Aid to hospitalized children and their relatives is an issue which requires further research. Knowing the factors related to the anxiety that these children's relatives experience in the PIUC can broaden the scope to develop intervention models and Nursing Care Plans to address these issues and improve the intra-hospital family wellbeing. Objective: To determine the relationship between the social, demographic, and hospital factors with the levels of anxiety experienced by the relatives of hospitalized patients in the Pediatric Intensive Care Unit (PICU). Methodology: Quantitative, descriptive, and transversal study. An own-designed instrument to identify social, demographic, and hospital factors, and the Spielberger's State-Trait Anxiety Inventory (STAI) to estimate the levels of anxiety were used. Results: Thirty four relatives participated, 11.8% (4) were male and 88.2% (30) female. The average age was 29 years old. The anxiety state and trait scores suggest that, when information on shelters in not available, there are significant differences in the state of anxiety (X

Introduçãoa: assistência da criança hospitalizada e da sua família, é um dos âmbitos que na atualidade requer um esforço para pesquisar. Conhecer os fatores relacionados com a ansiedade que experimentam os familiares na UCIP, abre caminhos para desenvolver modelos de intervenção e Planos de Cuidados de Enfermagem dirigidos a favorecer o enfrentamento e melhorar o bem-estar familiar intra-hospitalar. Objetivo: Determinar a relação dos fatores sociodemográficos e hospitalares com o nível de ansiedade que apresentam os familiares com pacientes hospitalizados na Unidade de Cuidados Intensivos Pediátricos (UCIP). Metodologia: Estudo Quantitativo, descritivo e transversal. Utilizou-se um instrumento de elaboração própria para a identificação de fatores sociodemográficos e hospitalares; e a escala de Inventário de Ansiedade Estado-Traço de Spielberger (IDARE) para a medição do nível de ansiedade. Resultados: 34 familiares participaram, 11.8% (4) homens e 88.2% (30) mulheres, a média da idade foi de 29 anos, as pontuações de ansiedade estado e ansiedade traço, indicam que quando conhecer algum abrigo se apresenta uma diferença significativa no nível de ansiedade estado dos familiares (X

Validación psicométrica de escalas PSS-14, AFA-R, HDRS, CES-D, EV en puérperas mexicanas con y sin preeclampsia / Psychometric validation of scales PSS-14, AFA-R, HDRS, CES-D, EV in postpartum Mexican women with and without preeclampsia / Validação das escalas PSS, AFA-R, HDRS, CES-D e EV em puérperas mexicanas com e sem pré-eclâmpsia

Objetivo: Validar las escalas psicométricas: Estrés percibido (PSS), Apoyo familiar y de amigos (AFA-R), Depresión de Hamilton (HDRS), Sintomatología depresiva (CES-D), Violencia e índice de severidad (EV) en mujeres mexicanas puérperas con y sin preeclamsia. Método: Estudio descriptivo que valida las propiedades psicométricas de las escalas PSS, AFA-R, HDRS, CES-D y EV. Las escalas fueron seleccionadas a través de una búsqueda en la web de los últimos 5 años. Las escalas fueron aplicadas por enfermeras mediante entrevista a 104 puérperas hospitalizadas con y sin preeclampsia. Para la confiabilidad se aplicó el alfa de Cronbach. La validez fue confirmada por un grupo de expertos y prueba piloto. Se utilizó análisis factorial por los métodos componentes principales, Káiser y Varimax. Resultados: Cada escala tuvo consistencia interna; calificaron con nivel aceptable (PSS 0.718 y EV 0.740) y nivel bueno (AFA-R 0.911, CES-D 0.869 y HDRS 0.806). La validez de contenido fue aprobada con: PSS 96.42%; EV 100%; AFA 100%; CES-D 98.75%, y HDRS 92.64%. La estructura factorial estuvo bien distribuida: cada factor obtuvo algunos pesos altos y los demás, próximos a cero. Cada variable estuvo saturada en uno o en 2 factores, por lo que casi no compartieron varianzas. PSS, con 6 factores, tuvo poder explicativo de la varianza total del 72.23%; AFA-R, con 3 factores y poder explicativo del 74.19%; HDRS, con 6 factores y poder explicativo del 70.58%; CES-D, con 6 factores y poder explicativo del 72.87%, y la escala EV tuvo varianza de cero. Conclusiones: Los hallazgos señalan que las escalas PSS, AFA-R, HDRS y CES-D por su confiabilidad, validez y utilidad funcionan teóricamente bien para medir las variables en el grupo de mujeres estudiadas; sin embargo para la escala EV debe considerarse un análisis factorial diferente en otra muestra similar.

Objective: To assess the following scales' psychometric characteristics: Perceived Stress (PSS), Family and Friends Support (AFA-R), Depression-Hamilton (HDRS), Depressive Symptomatology (CES-D), Violence and Index of Severity (EV) among Mexican populations, with and without pre-eclampsia. Method: Descriptive and psychometric study. A web search was conducted to decide on which scales use. Nurses applied the scales to 104 hospitalized post-partum women with and without pre-eclampsia. Cronbach alpha was measured to assess reliability. Validity was confirmed by a group of experts and by a pilot study. Principal components, Kaiser, and varimax factor analyses were carried out.ResultsEach scale had internal consistency-acceptable level: PSS .718 and EV .740; good level: AFA-R .911, CES-D .869 and HDRS .806. Content validity was assessed as PSS: 96.42%, EV: 100%, AFA 100%, CES-D: 98.75% and HDRS: 92.64%. The factor structure was well distributed. Each factor had few important weights, and the rest were close to zero. Each variable was not saturated except in one, and barely in two, factors, thus variance was almost not shared. PSS, with 6 factors, had an explicative power of the total variance of 72.23%; AFA-R, with 3 factors and explicative power of 74.19%; HDRS with 6 factors and explicative power of 70.58%; while CES-D, with 6 factors too, had an explicative power of 72.87%. The EV scale had a variance of zero. Conclusions: Findings suggest that the scales PSS, AFA-R, HDRS, and CES-D, due to their reliability, validity, and usefulness, theoretically work well to assess the different variables among the group of studied women. Another factor analysis on the EV scale should be considered for a similar sample.

Objetivo: Validar as escalas psicométricas: Estrese Percebido (PSS), Apoio Familiar e de Amigos (AFA-R), Depressão de Hamilton (HDRS), Sintomatologia Depressiva (CES-D), Violência e Índice DE Severidade (EV) em mulheres mexicanas puérperas com e sem pré-eclâmpsia. Método: Estudo descritivo que valida as propriedades psicométricas das escalas PSS, AFA-R, HDRS, CES-D e EV. As escalas foram escolhidas a través de uma busca na web dos últimos 5 anos. As escalas foram aplicadas por enfermeiras mediante entrevista a 104 puérperas hospitalizadas com e sem pré-eclâmpsia. Para a confiabilidade aplicou-se alfa de Crombach. A validade foi confirmada por um grupo de experientes e prova piloto. Utilizou-se analise fatorial pelos métodos componentes principais, Káiser e Varimax. Resultados: Cada escala teve consistência interna; qualificaram com nível aceitável (PSS 0.718 y EV 0.740) e com nível bom (AFA-R 0.911, CES-D 0.869 y HDRS 0.806). A validade de conteúdo foi aprovada com: PSS 96.42%; EV 100%; AFA 100%; CES-D 98.75%, e HDRS 92.64%. A estrutura fatorial esteve bem distribuída, cada fator obteve alguns pesos altos e os outros próximos a zero. Cada variável esteve saturada em um ou em outros fatores, pelo que quase não compartilharam variâncias. PSS, com 6 fatores, teve poder explicativo da variância total do 72.23%; AFA-R, com 3 fatores e poder explicativo do 74.19%; HDRS, com 6 fatores e poder explicativo do 70.58%; CES-D, com 6 fatores e poder explicativo do 72.87%, e a escala EV teve variância de zero. Conclusões: As descobertas assinalam que as escalas PSS, AFA-R, HDRS e CES-D por sua confiabilidade, validade e utilidade funcionam teoricamente bem para medir as variáveis no grupo de mulheres estudadas; porém, para a escala EV deve se considerar uma análise fatorial diferente em outra amostra semelhante.

Porocarcinoma ecrino: reporte de un caso / Eccrine porocarcinoma: a case report

Los tumores anexiales de la piel representan un grupo heterogéneo de entidades de baja frecuencia de presentación. Su origen es controvertido, quizás a partir de células madres pluripotenciales, aceptándose principalmente dos líneas embriológicas: pilosebáceo-apócrina y ecrina. Se los clasifica en cuatro grupos principales: tumores del folículo piloso, tumores sebáceos, tumores apócrinos y tumores ecrinos. Su distribución anatómica refleja áreas con mayor densidad de anexos cutáneos, presentándose en forma única o múltiple.

Skin adnexal tumors are represented as a heterogeneous group of entities of low frequency range. Its origin is controversial, perhaps from pluripotent stem cells, mainly from two embryological lines: pilosebaceous-apocrine and eccrine. They are classified as four main groups: tumors of the hair follicle, sebaceous tumors, apocrine tumors and eccrine tumors. Their anatomic distribution reflects areas with the highest density of cutaneous adnexal, arising in either single or multiple forms.

Acoplamiento cibernético paciente-máquina-enfermera / Coupling Cybernetic Machine-Patient-Nursing

El presente estudio cualitativo tuvo como objetivos describir y analizar los estilos de cuidar/cuidado que realizan las enfermeras para el paciente adulto con ventilación mecánica asistida en un Hospital Regional Mexicano. Maturana y Varela, Figueiredo y Boff fueron los autores que dieron soporte teórico-filosófico al estudio desde la perspectiva del pensamiento complejo. Participaron diez enfermeras (os) asistenciales de la Unidad de Cuidados Intensivos adultos, del Hospital General Dr. Agustín O'Horán de Mérida Yucatán, México. Los datos fueron obtenidos a través de la entrevista a profundidad y observación participante. La categoría temática principal del estudio fue: Acoplamientoª cibernético paciente-máquina-enfermería con las subcategorias, acoplamiento paciente-máquina, acoplamiento paciente-enfermera(o) y acoplamiento familiar al sistema hospitalario. Se destaca cómo el cuidar-cuidado de enfermería se hace imprescindible para que dicho acoplamiento se pueda llevar a cabo. Los resultados obtenidos permiten contribuir en la construcción de un cuerpo de conocimientos científicos específicos sobre el cuidar/cuidado de enfermería para pacientes ventilados a partir de la práctica. Este estudio subraya la importancia del cuidado que proveen cotidianamente las enfermeras en la unidad de cuidados intensivos para que pueda desarrollarse un acoplamiento cibernético exitoso entre las máquinas vivientes y las máquinas mecánicas.

This qualitative study aimed to describe and analyze the styles of care/caring given by nurses to adult patients under assisted mechanical ventilation in a Mexican regional hospital The works from the approach of Complex Thought by Maturana and Varela, and Figueiredo and Boff, provide its theoretical and philosophical foundations. A total of ten nurses from the adult intensive care unit of the Dr. Agustin O'Horán General Hospital in Merida Yucatan, Mexico participated in the study. Data were obtained through in-depth interviews and participant observation. The main subject of the study was; Coupling cybernetic machine-patient-nursing with subcategories, coupling patient-machine, coupling patient-nurse, and coupling family the hospital system. Highlighting the essential role of nurses care/caring in this coupling, the results obtained contribute to the construction of a specific body of scientific knowledge on nursing care/caring for patients under assisted mechanical ventilation. This study underlines the importance of nurses' daily care in the intensive care units for a successful cybernetic coupling between living and mechanical machines can take place.

Características epidemiológicas y factores de riesgo relacionados con la infección en el sitio operatorio en procedimientos de cirugía general / Epidemiological characteristics and risk factors related to infection in surgical sites

Objective: To identify the risk factors for infections in surgical sites, calculate length of procedures and validate the risk score National Nosocomial Infections Surveillance System (NNISS). Material and Methods: A cross-sectional study was conducted in a third level institution in 2009-2010 in 486 surgeries. Infections were classified according to criteria of the Centers for Disease Control and prevention: primary superficial incisional, deep incisional and organ/space. NNISS risk was classified by adding a point to ASA 3 or higher and/or contaminated or dirty wound and/or the time t above the 75 percentile. Results: The time t for the whole surgery was 107 minutes, the infection frequency was 10.9 percent. Infection were associated with anemia (OR: 3.0), diabetes (OR: 2.8), smoking (OR: 2.6), the stay prior to surgery (OR: 2.6) and single dose of prophylactic antibiotics (OR: 1.03), the index NNISS 3 (OR: 3.6), contamination of the surgical wound (OR: 2.0) and ASA(OR: 2.3). Conclusions: the NNISS index has been validated; underlying problems must be controlled before elective surgery and should be reduced pre-surgical stay.

Objetivo: Determinar factores de riesgo para infección en el sitio operatorio, calcular la duración de los procedimientos y validar el índice del National Nosocomial Infections Surveillance System (NNISS). Material y Método: Se realizó un estudio de corte transversal, se incluyeron 486 procedimientos ambulatorios y hospitalarios realizados en un año. Se clasificaron las infecciones según los criterios de los Centros de Control de Enfermedades de Atlanta en: Incisional superficial primaria, incisional profunda y de órgano/ espacio. El índice de riesgo NISS se clasificó sumando un punto para ASA de 3 o superior y/o para la herida contaminada o sucia y/o para el tiempo t por encima del percentil 75. Resultados: El tiempo t para el total de cirugías fue de 107 minutos; la frecuencia de infección fue de 10,9 por ciento. Se encontraron asociadas con infección anemia (RP: 3,0), diabetes (RP: 2,8), cigarrillo (RP: 2,6), la hospitalización (RP: 2,6), la estancia previa a la cirugía (RP: 2,6) y dosis única de antibióticos profilácticos (RP: 1,03), el índice de riesgo NNISS 3 (RP: 3,6), el grado de contaminación de la herida quirúrgica (RP: 2,0) y el ASA (RP: 2,3). Conclusiones: Se validó el índice NNISS; es necesario controlar problemas subyacentes antes de las cirugías electivas y disminuir la estancia pre-quirúrgica.

Proceso estiloides elongado: criterios diagnósticos y diagnóstico diferencial: a propósito de un caso / Elongated styloid process: diagnostic criteria and differential diagnosis: a case review

La elongación del proceso estiloides puede presentarse como una entidad patológica en el territorio craneocervical. Existe controversia en relación a los criterios para su diagnóstico, así como sus diagnósticos diferenciales. En el presente reporte se relata el caso de una paciente de 45 años con lumbagos crónicos, cefalea intermitente, dolor cervical y articular agudo, sin historia de quirúrgica o traumática craneocervical. Radiográficamente, destaca la elongación bilateral del proceso estiloides, determinando un diagnóstico presuntivo de Síndrome de Eagle. Se preconiza que los pacientes deben haber sido sometidos a tonsilectomía o trauma para padecer esta patología, condición ausente en este caso. La correcta discriminación de los signos y síntomas permite diferenciar la patología como síndrome estilohioideo. El presente reporte entrega los criterios a considerar en un paciente con el proceso estiloides elongado asociado a patología, con el fin de canalizar esa información hacia un diagnóstico certero.

The elongation of the styloid process may occur as a pathologic entity in the craniocervical area. There is controversy regarding the criteria for its diagnosis and its differential diagnosis. In this report we present the case of a 45 year old female with chronic low back pain, intermittent headache, neck pain and acute articular, no history of surgical or traumatic in the craniocervical area. Radiographically, bilateral elongation of the styloid process were detected, determining a presumptive diagnosis of Eagle syndrome. It requires that patients must have undergone tonsillectomy or trauma to suffer this disease, a condition absent in this case. The correct discrimination of the signs and symptoms distinguish this condition as stylohyoid syndrome. This report delivers the criteria to consider in a patient with elongated styloid process associated with pathology, to use that information and give an accurate diagnosis.

Carcinoma subseroso de la vesícula biliar: expresión del complejo caderina-catenina / Subserous gallbladder carcinoma: expression of cadherine-catenine complex

BACKGROUND: Subserous gallbladder carcinoma is difficult to diagnose and treat. There are no tissue markers with prognostic value in this type of tumor. AIM: To study the immunohistochemical expression of E-cadherin alpha and beta catenin in subserous gallbladder carcinoma. PATIENTS AND METHODS: One hundred seventeen subjects (103 women and 14 men aged 62 and 69 years as a mean, respectively), were studied. Thirty five gallbladder samples without evidence of cancer were used as controls. Expression of markers was studied with standard immunohistochemical techniques for formalin fixed and paraffin embedded tissue. RESULTS: Ninety seven percent of tumors were adenocarcinoma. A lower or absent expression of E-cadherin, alpha catenin and beta catenin was observed in 26, 33 and 29 per cent, respectively. Actuarial five years survival was 37 per cent. No association between macroscopic features of the tumor and survival was observed. Well differentiated tumors had a 73 per cent survival, whereas less differentiated tumors had a 30 per cent survival. Tumors with a normal expression of the markers had a slightly better survival, although not significant (p = 0.06). CONCLUSIONS: Approximately 30 per cent of subserous gallbladder carcinoma have an abnormal expression of E-cadherin, alpha catenin and beta catenin. This abnormal expression has no relationship with prognosis and is probably secondary to the aberrant genic expression of the tumor.

Paquimetría en el diagnóstico de galucoma / Pakimetry in the diagnosis of glaucoma

El control de la PIO (presión intraocular) en pacientes en los que se realizó cirugía refractiva, fue quizás el mayor incentivo para la valoración del espesor corneal en el diagnóstico del glaucoma. Este puede influir la medición de la PIO (tomada con tonómetro aplanárico de Goldmann), aunque hay que tomar en cuenta las variaciones individuales. En diversos trabajos se vió que la PIO aumenta o disminuye según las variaciones del espesor corneal, en forma directamente proporcional. Debido a esto el espesor corneal central es considerado un importante predictor para el desarrollo de glaucoma primario de ángulo abierto, además de tener influencia en el diagnóstico, seguimiento y manejo de pacientes con glaucoma e hipertensión ocular. Se consideran valores normales de espesor corneal hasta a 520 micrones.

Distribución del zooplancton durante flujos de marea opuestos en el complejo lagunar de Chelem, Yucatán, México / Distribution of zooplankton during opposite tide fluxes in the lagoon complex of Chelem, Yucatan, Mexico

Zooplankton was surveyed in a tropical lagoon system of the northern coast of the Yucatan Peninsula in high tide, December (1998) and low tide, March 1999 (northerlies season). Zooplankton biomass was measured, zooplankters were counted, and copepods were identified and quantified. Despite the fact that both months were influenced by winds from the North, they showed a different salinity gradient which developed a particular structure of the zooplankton community. Biomass tended to be accumulated in certain areas apparently because of the high residence time of water in Chelem, the forcing effect of the northerlies, and of the tidal current. Biomass values suggest a relatively high secondary production when compared with other systems of the Yucatan Peninsula. The distribution of the copepods Acartia lilljeborgii and A. tonsa is related to saline conditions and tidal flow. The overall faunistic and hydrologic data suggest that even during a single climatic season, the zooplankton community shows strong changes due to mesoscale hydrological processes.

Simultaneous occurrence of Hodgkin's disease and chronic lymphocyte leukemia: a unique presentation

Chronic lymphocytic leukemia (CLL) is a chronic, low-grade hematologic malignancy that can transform to a large cell non-Hodgkin's lymphoma (Richter's syndrome), which is associated with an unfavorable prognosis. A distinct Hodgkin's disease subgroup of lymphomatous CLL transformation has been well characterized. We describe a patient presenting with simultaneous manifestations of CLL and Hodgkin's disease. This patient is unique, presenting with separate sites of involvement of each disease within the same organ, in this case the bone marrow. The morphologic and immunohistochemical findings at diagnosis are correlated with the findings of the postmortem examination

Síndrome de Vogt-Koyanagi-Harada: experiencia clínica / Vogt-Koyanagi-Harada syndrome: clinical experience

Objetivos: Evaluar clínica, manejo, seguimiento pacientes portadores de Síndrome de Volgt-Koyanagi-Harada (VKH). Material y método: Se estudió retrospectivamente a 51 pacientes con VKH atendidos, por los autores, entre los años 1986 y 1998, incluyendo edad, sexo, tipo clínico, hallazgos en el ingreso, visión inicial y final, tratamiento sistémico usado y complicaciones en cada caso. Resultados: Los pacientes se distribuyeron en 39 mujeres y 12 hombres, cuya edades fluctuaron entre 5 y 60 años, promedio de 37,3 años. Los hallazgos a su ingreso fueron: visión menor de 0,3 en 59,8 por ciento de los ojos, uveítis difusa en el 100 por ciento, desprendimiento de retina seroso en 68,6 por ciento, edema papilar en 59,8 por ciento, compromiso del sistema nervioso central en 59 por ciento. La visión final fue igual o superior a 0,7 en el 70 por ciento de los ojos. El seguimiento promedio de los pacientes fue de 45,8 meses. El tratamiento se hizo con corticoesteroides sistémico en el 98 por ciento de los pacientes y se prolongó en un promedio de 27,8 meses. En el 66,6 por ciento de los pacientes agregamos inmunosupresores, habitualmente ciclosfamida, en un promedio de 12,7 meses. Las complicaciones oculares consistieron en visión inferior a 0,3 en el 23,8 por ciento, maculopatía-membrana neovascular macular en 20,6 por ciento, catarata en 13,7 por ciento y glaucoma en 8,8 por ciento de los ojos. 33,3 por ciento de los ojos sufrieron recurrencias inflamatorias, principalmente de uveítis anterior. Conclusiones: El síndrome de VKH es una veítis anterior difusa bilateral grave acompañada frecuentemente de compromiso del sistema nervioso central. Se requiere tratar con esteroides sistémicos, lo que mejora notoriamente su curación, pese a que, en muchos de nuestros casos, dicho tratamiento fue insuficiente, debiendo necesariamente que recurrir además a los inmunosupresores, logrando un resultado visual de 0,7 o más en el 70 por ciento de los ojos