Impacto del tamaño del ámbito de control de las jefas de unidad en los comportamientos laborales de las enfermeras / Impact of charge nurses’ span of control on the work attitudes of nurses

Fundamento: Conocer el número de enfermeras a cargode las jefas de unidades de Enfermería de los hospitalespúblicos generales aragoneses y analizar cómo afecta alos comportamientos organizacionales de la enfermera ya la calidad de las relaciones que se establecen con lajefa de unidad. Método: Estudio descriptivo transversal realizado ennueve hospitales públicos. Se evaluó mediante cuestionarios validados los comportamientos laborales de lasenfermeras y la calidad de las relaciones de la enfermeracon la jefa de unidad y de esta con la enfermera y consu inmediato superior. Se analizó si existía relación entreestas variables y el número de enfermeras por unidad. Resultados: La muestra se compuso de 2541 enfermeras y192 jefas de unidad. La media del ámbito de control fue de29 enfermeras (DE = 22,4). Se obtuvieron puntaciones menores al aumentar el ámbito de control en: empoderamiento (p<0,001), satisfacción (p = 0,027), apoyo organizacionalpercibido (p<0,001) y calidad de las relaciones entre lasenfermeras y las jefas de unidad (p<0,001) y de la jefa deunidad con su inmediato superior (p<0,001). No se observaron asociaciones significativas respecto a la intenciónde rotación, los comportamientos cívicos organizacionales y el compromiso organizacional. Conclusiones: El tamaño del ámbito de control se relaciona con la percepción de los comportamientos organizacionales de las enfermeras, así como con la calidad delas relaciones interpersonales que establecen con la jefade unidad, indicando la necesidad ajustar el ámbito decontrol por unidad con el objetivo mejorar la calidad dela gestión de las unidades de Enfermería.(AU)

Background: To determine the number of nurses whoare supervised by a charge nurse in the Nursing Unitsof Aragonese general public hospitals and to analyzehow this affects the organizational behaviors of nursesand the quality of the relationships established with thecharge nurses. Methods: Cross-sectional study carried out in nine publichospitals. Validated questionnaires were used to assessthe working behavior of nurses and the quality of theirrelationships with charge nurses, and the charge nurse’srelationship with their immediate superior and nursingstaff. We analyzed whether there was an association between these variables and the number of nurses per unit. Results: The study included 2,541 nurses and 192 super-visors. The mean span of control was 29 (SD = 22.4). Statistically significant differences were observed with re-spect to empowerment (p<0.001), satisfaction (p = 0.027),perceived organizational support (p<0.001) and thequality of the nurse’s relationships with the supervisor(p<0.001) and the supervisor with her immediate superior (p<0.001), obtaining lower scores as the span of con-trol increased. No significant associations were observedwith respect to turnover intention, organizational citizenship behavior and organizational commitment. Conclusions: The span of control is related to the perception of nurses’ organizational behaviors and with thequality of interpersonal relationships with the chargenurse, indicating a need to adjust the span of of controlper unit in order to improve the quality of the management of the units.(AU)

[Impact of charge nurses' span of control on the work attitudes of nurses].

BACKGROUND: To determine the number of nurses who are supervised by a charge nurse in the Nursing Units of Aragonese general public hospitals and to analyze how this affects the organizational behaviors of nurses and the quality of the relationships established with the charge nurses. METHODS: Cross-sectional study carried out in nine public hospitals. Validated questionnaires were used to assess the working behavior of nurses and the quality of their relationships with charge nurses, and the charge nurse's relationship with their immediate superior and nursing staff. We analyzed whether there was an association between these variables and the number of nurses per unit. RESULTS: The study included 2,541 nurses and 192 supervisors. The mean span of control was 29 (SD=22.4). Statistically significant differences were observed with respect to empowerment (p<0.001), satisfaction (p=0.027), perceived organizational support (p<0.001) and the quality of the nurse's relationships with the supervisor (p<0.001) and the supervisor with her immediate superior (p<0.001), obtaining lower scores as the span of control increased. No significant associations were observed with respect to turnover intention, organizational citizenship behavior and organizational commitment. CONCLUSIONS: The span of control is related to the perception of nurses' organizational behaviors and with the quality of interpersonal relationships with the charge nurse, indicating a need to adjust the span of of control per unit in order to improve the quality of the management of the units.

Identidad de género y salud mental / Gender identity and mental health

Resumen Este artículo tiene como objetivo revisar las implicaciones de la identidad de género en la construcción psíquica y la salud mental, sin pretender ser una revisión exhaustiva, dada la complejidad del tema. Se realiza un recorrido por las definiciones conceptuales de la identidad de género, pasando por algunos modelos explicativos de la misma, como una forma de comprender esta experiencia. Además, se abordará la realidad transgénero como factor de estrés psicosocial y, desde una perspectiva clínica, sus repercusiones psíquicas, enfatizando la diferenciación de las identidades trans con la entidad diagnóstica llamada disforia de género. Finalmente, se caracterizará la disforia de género, con énfasis en el malestar subjetivo secundario a la discordancia de género, sus relaciones con otros diagnósticos psiquiátricos, sus repercusiones psicosociales y las barreras de atención médica que este grupo de personas experimenta.

This article aims to review the implications of gender identity in psychic construction and mental health, without intending to be an exhaustive review, given the complexity of this issue. A tour of the conceptual definitions of gender identity is made, going through some explanatory models of it, as a way to understand this experience. Also, transgender reality as a psychosocial stress factor will be addressed and, from a clinical perspective, its psychic repercussions, emphasizing the differentiation of trans identities with the diagnostic entity called gender dysphoria. Finally, gender dysphoria will be characterized, focusing on the subjective disconfort secondary to gender discordance, its relationships with other psychiatric diagnoses, its psychosocial repercussions and the health care barriers that this group of people experiences.

Dosage of anti-PD-1 monoclonal antibodies: a cardinal open question

Discovery and clinical development of monoclonal antibodies with the ability to interfere in the regulation of the immune response have significantly changed the landscape of oncology in recent years. Among the active agents licensed by the regulatory agencies, nivolumab and pembrolizumab are paradigmatic as the most relevant ones according to the magnitude of available data derived from the extensive preclinical and clinical experience. Although in both cases the respective data sheets indicate well-defined dosage regimens, a review of the literature permits to verify the existence of many issues still unresolved about dosing the two agents, so it must be considered an open question of potentially important consequences, in which to work to improve the effectiveness and efficiency of use (AU)

Dosage of anti-PD-1 monoclonal antibodies: a cardinal open question.

Discovery and clinical development of monoclonal antibodies with the ability to interfere in the regulation of the immune response have significantly changed the landscape of oncology in recent years. Among the active agents licensed by the regulatory agencies, nivolumab and pembrolizumab are paradigmatic as the most relevant ones according to the magnitude of available data derived from the extensive preclinical and clinical experience. Although in both cases the respective data sheets indicate well-defined dosage regimens, a review of the literature permits to verify the existence of many issues still unresolved about dosing the two agents, so it must be considered an open question of potentially important consequences, in which to work to improve the effectiveness and efficiency of use.

Dual antifungal activity against Candida albicans of copper metallic nanostructures and hierarchical copper oxide marigold-like nanostructures grown in situ in the culture medium.

AIMS: This study aimed to determine in vitro activity of copper nanoparticles and copper nanowires against Candida albicans strains and to assess their effects on morphology and submicron structure. METHODS AND RESULTS: The microdilution method determined the minimal inhibitory concentration (MIC) of copper nanoparticles (CuNPs) and copper nanowires (CuNWs) against three strains of C. albicans: ATCC 10231 and two clinical strains (C and E). Effects on the morphology and ultrastructure of C. albicans strains were examined by scanning electron microscopy and transmission electron microscopy. MIC for CuNPs was 129·7 µg ml-1 for strain ATCC 10231, 1037·5 µg ml-1 for strain C and 518·8 µg ml-1 for strain E. MIC for CuNWs was similar for all strains tested (260·3 µg ml-1 ). SEM and TEM studies showed alterations in morphology, cell wall and the complete collapse of the yeast after incubation with CuNPs. In contrast, most of the yeast cells maintained their structure with an intact cell wall, and only decreased the number and size of fimbriae when C. albicans was exposed to CuNWs. CuNPs and CuNWs formed hierarchical copper oxide nanostructures growing in situ in the culture medium. Results suggest a dual mechanism for antifungal activity: (i) free Cu2+ ions act as a biocide, (ii) sharp edges of marigold-like petal nanostructures could injure the cellular wall and membrane and cause the death of the yeast. CONCLUSIONS: CuNPs and CuNWs inhibited the growth of the three strains of C. albicans tested. Moreover, CuNPs disrupted cell wall with leakage of the cytoplasmic content. Each concentration of the series used for the determination of the activity of CuNPs and nanowires against C. albicans formed copper oxide marigold-like nanostructures. SIGNIFICANCE AND IMPACT OF THE STUDY: This study suggests that CuNPs and CuNWs are good candidates for formulating new therapeutic agents for candidiasis.

Relación entre el consumo de productos lácteos y las enfermedades respiratorias sibilantes en escolares / Relationship between lactic product ingestion and wheezing respiratory diseases in school children

Introducción: Los lácteos son alimentos importantes para el desarrollo, pero muchos padres limitan su consumo para evitar enfermedades respiratorias a pesar de que no existe evidencia científica concluyente al respecto. El objetivo de este estudio es estudiar si el consumo de leche y derivados lácteos se asocia con enfermedades respiratorias sibilantes (asma, síndrome de obstrucción bronquial recurrente, sibi-lancias) en escolares. Material y método: Estudio transversal dentro de la co-horte SENDO. La información sobre el consumo de lácteos se obtuvo mediante cuestionario semicuantitativo de frecuen-cia de consumo de alimentos. Los participantes se dividieron a partir de la mediana de consumo. El diagnóstico de enfer-medades sibilantes referido en los cuestionarios se confirmó mediante revisión de los registros médicos digitalizados. Para estudiar la asociación del consumo de leche, queso, yogur y de los lácteos en conjunto con las enfermedades sibilantes se utilizó un test de regresión logística ajustado por posibles factores de confusión. Resultados: En la muestra de 170 escolares (55,9% niñas, edad media 6,1 años) no se encontró una asociación significativa entre el consumo de lácteos en conjunto y las enfermedades sibilantes estudiadas [OR 0,85; IC 95% (0,44-1,64)]. Al analizar cada alimento por separado (le-che, yogur y queso), se encontró que un mayor consumo de leche se asociaba con un menor riesgo de enfermedades sibilantes. Conclusiones: Los resultados no apoyan la existencia de una asociación directa entre el consumo de leche o derivados lácteos y el riego de enfermedades sibilantes

Background: Milk consumption is important in child development, but some parents are avoiding dairy products as a way to prevent respiratory diseases in their children, even though there is no scientific evidence in this regard. Objective: To examine the association between dairy products consumption and wheezing respiratory diseases (asthma, recurrent wheezing episodes) in school-age chil-dren. Materials and methods: Cross-sectional study within SENDO project. Dairy products consumption was assessed through a semiquantitative food frequency questionnaire (FFQ). Participants were divided based on the median of consumption. Wheezing diseases diagnose referred by pa-rents in the questionnaires was confirmed by medical records review. A logistic regression test, adjusted for possible-con-founding factors was used to study the association between dairy products (milk, cheese, and yoghurt) and wheezing diseases.Results. In the 170 participants included (55.9% girls, mean age 6.1 years), no significant association was found between dairy products consumption and the respiratory di-seases studied [OR 0.85, 95% CI (0.44-1.64)]. When analy-sed separately a higher consumption of milk was associated with a lower risk of wheezing diseases. Conclusions: The results do not support the association between dairy products consumption and an increased risk of wheezing respiratory diseases

Adapting the revised prenatal coping inventory (NuPCI) for use in a Spanish population.

OBJECTIVE: To adapt the Revised Prenatal Coping Inventory (NuPCI) for the evaluation of prenatal stress coping strategies utilised by Spanish women. METHODS: A cross-sectional study was performed to evaluate the psychometric properties of NuPCI adapted for a Spanish population. Two hundred and sixty one puerperium women completed the NuPCI at the time of discharge after childbirth. Instrument construct validity was evaluated using subscale item correlations. Internal consistency was assessed using Cronbach's α test. RESULTS: Items from each subscale (Preparation, Avoidance and Spiritual - Positive Coping) were significantly correlated with the global result (p < .001). The internal reliability of the NuPCI demonstrated suitable values for each of the three coping strategies (α > 0.7). The most frequently used coping strategy was Preparation and the least used was Avoidance. Utilisation of the coping strategies with Preparation decreased with increasing parity (p = .002) and greater prenatal stress was associated with increased use of the Avoidance coping strategy (p < .001). CONCLUSIONS: The NuPCI adapted for Spanish women demonstrates good psychometric properties for evaluating the three types of prenatal stress coping strategies: Preparation, Avoidance and Spiritual - Positive Coping. Results were similar to those presented by the instrument in its English language version.

Assessment of significant psychological distress at the end of pregnancy and associated factors.

The aim of this study is to study the prevalence of mental distress at the end of pregnancy and after birth and the impact of selected socio-demographic and obstetric factors. This is a cross-sectional study. The sample is consisted of 351 puerperal women at the age of 18 and over. Sociodemographic, obstetric variables were collected to detect significant psychological distress; the instrument used was General Health Questionnaire (GHQ-28). Logistic multivariable regressions were used to investigate associations. The prevalence of significant mental distress amounted to 81.2%, mostly related to social relationship and anxiety. The women who affirmed having more stress during pregnancy had too significantly increased emotional distress before the birth as well as during early puerperium, increasing somatic symptoms (p < 0.001; OR 2.685; CI 95% 1.583-4.553), anxiety (p < 0.001; OR 4.676; CI 95% 2.846-7.684), and depressive symptoms (p < 0.01). Somatic symptoms (p < 0.05; OR 2.466; CI 95% 1.100-5.528) and social dysfunction (p < 0.001; OR 1.672; CI 95% 0.711-3.932) occur most frequently in women who already had children. Regarding socio-demographic data, being an immigrant is the only protective factor reducing the social dysfunction in the last weeks of pregnancy (p < 0.01; OR 0.478; CI 95% 0.274-0.832). Psychological distress at the end of a full-term pregnancy and in the postpartum period occurs frequently and was associated mainly with stress experienced during pregnancy and parity. It is advisable to perform proper assessment of stress and significant psychological distress at the early stage of pregnancy and repeatedly later on until delivery. Information and support from professionals can help to decrease and prevent their negative impact on maternal and fetal health, as observed in the current evidence.

Desarrollo de un checklist para la técnica de nefroureterolitototomía endoscópica flexible en un modelo simulado mediante el método de delphi modioficado / Development of a checklist for the technique of flexible endoscopic nephroureterlithotomy in a simulated model by the modifiet delphy method

Introducción: La simulación en medicina está cobrando cada vez mayor importancia, principalmente en el área quirúrgica, ya que nos otorga la posibilidad de lograr el aprendizaje de forma segura, bajo ambiente controlado y reproducible. Nuestro objetivo es establecer una pauta estructurada de realización de ureteroscopía flexible para un procedimiento simulado de nefro-ureterolitotomía endoscópica.Material y métodos. Se utilizó el método de Delphi modificado. Se contactó vía correo electrónico a cinco urólogos a los cuales se les envió un checklist para la evaluación de la técnica del procedimiento de 1 a 7, agregando comentarios. Basado en esto, se modifica el checklist en 2 oportunidades, hasta lograr el consenso.Resultados. Se obtiene una la versión definitiva del checklist. Esta consta de 20 puntos, con una media que fluctúa entre 5,6 y 7, y una mediana entre 6 y 7. El coeficiente de Cronbach para establecer su consistencia interna es de 0,86.Conclusión. Se establece un listado estándar para la realización de nefro-ureterolitotomíaendoscópica flexible utilizando el método de Delphi modificado.(AU)

Introduction: The simulation in medicine is becoming increasingly important, mainly in the surgical area, because it gives us the possibility to achieve learning safely, in a controlled and reproducible environment. Our objective is to establish a structured guideline of flexible ureteroscopy for a simulated endoscopic nephro ureterolithotomy procedure.Material y Methods. The modified Delphi method was used. Five urologists were contacted via email, a checklist was sent for the evaluation of the procedure technique from 1 to 7, adding comments. Based on this, the checklist is modified 2 times, until consensus is reached.Results. A final version of the checklist is obtained. It consists in 20 points, with a mean that fluctuates between 5.6 and 7, and a median between 6 and 7. The Cronbach coefficient to establish its internal consistency is 0, 86.Conclusion. A standard list is established using the modified Delphi method for the performance of flexible endoscopic nephro-ureterolithotomy.(AU)

The effect of different dietary levels of canola meal on growth performance, nutrient digestibility, and gut morphology of broiler chickens.

This study evaluated the effects of different levels of canola meal in broiler diets on growth performance, nutrient digestibility, and duodenal morphometry. A total of 320 one-day-old Cobb broilers were used in a 35-d experiment. A completely randomized design with 5 levels of canola meal (0, 10, 20, 30, and 40%) as a substitute for soybean meal was used with 8 replicates of 8 birds each. The basal diets were formulated based on corn and soybean meal to meet nutrient requirements of broiler chickens. The levels of canola meal were evaluated with a polynomial regression at 5% of significance. Weight gain and average BW showed a quadratic response (P = 0.03 and P = 0.04, respectively), decreasing with the addition of 40% canola meal. The apparent nutrient digestibility of DM (P < 0.0001), CP (P < 0.0001), and nitrogen-free extract (P < 0.0001) decreased linearly with increased levels of canola meal. A quadratic effect was observed for villus height (P = 0.003), decreasing up to a 20% inclusion of canola meal in the diet and increasing beyond that level. In conclusion, canola meal can be added up to 16.7% in diets for broilers without affecting the key variables of growth performance. It can be added up to 20% with no negative effect on the CP digestibility, but there was a linear decrease in the digestibility of DM and nitrogen-free extract with increased inclusion of canola meal. Additionally, a quadratic response to canola was observed for villus height with a maximum at 23.6% canola meal.

'Escaping' the X chromosome leads to increased gene expression in the male germline of Drosophila melanogaster.

Genomic analyses of Drosophila species suggest that the X chromosome presents an unfavourable environment for the expression of genes in the male germline. A previous study in D. melanogaster used a reporter gene driven by a testis-specific promoter to show that expression was greatly reduced when the gene was inserted onto the X chromosome as compared with the autosomes. However, a limitation of this study was that only the expression regulated by a single, autosomal-derived promoter was investigated. To test for an increase in expression associated with 'escaping' the X chromosome, we analysed reporter gene expression driven by the promoters of three X-linked, testis-expressed genes (CG10920, CG12681 and CG1314) that were inserted randomly throughout the D. melanogaster genome. In all cases, insertions on the autosomes showed significantly higher expression than those on the X chromosome. Thus, even genes whose regulation has adapted to the X-chromosomal environment show increased male germline expression when relocated to an autosome. Our results provide direct experimental evidence for the suppression of X-linked gene expression in the Drosophila male germline that is independent of gene dose.

Growth performance, carcass traits, meat chemical composition and blood serum metabolites of broiler chicken fed on diets containing flaxseed oil.

1. This study evaluated the effects of diets with partial and total substitution of soya bean oil (SO) with flaxseed (linseed) oil (FO) on broiler chicken performance, carcass traits, meat chemical composition and blood serum metabolites. 2. A total of 448 one-d-old Cobb 500 broiler chicken were used. They were allotted among 4 treatments with 8 replications, using a completely randomised design, for 35 d. Four diets were compared: T1 = 100% SO (3%, 1-7 d; 4%, 8-21 d; and 5%, 22-35 d); T2 = 50% SO + 50% FO; T3 = 25% SO + 75% FO and T4 = 100% FO. 3. No significant differences were observed in body weight (BW), body weight gain (BWG), feed intake (FI), feed conversion ratio (FCR) and blood serum metabolites (total triglycerides, TRI; total cholesterol, CHO; high-density lipoprotein, HDL; low-density lipoprotein, LDL; glucose, GLU; albumin, ALB; globulin, GLO; and total proteins, TPs). Significant effects were observed for TRI, CHO, HDL, GLU, HDL, LDL, ALB and GLO with regard to the day of collection. 4. Carcass traits did not show significant differences for the treatments. No significant differences were observed for breast and drumstick chemical compositions, with the exception of drumstick fat concentration (quadratic effect). 5. In conclusion, the partial or total substitution of SO with FO did not affect growth performance, carcass traits, meat chemical composition or blood serum profile in broiler chicken. Therefore, FO can be an alternative to SO in the diet formulation for broiler chicken.

Two new phospholipase D isoforms of Loxosceles laeta: cloning, heterologous expression, functional characterization, and potential biotechnological application.

Toxin phospholipases-D present in the venom of Loxosceles spiders is the principal responsible for local and systemic effects observed in the loxoscelism. In this study, we describe the cloning, expression, functional evaluation, and potential biotechnological application of cDNAs, which code for two new phospholipase D isoforms, LIPLD1 and LIPLD2, of the spider Loxosceles laeta. The recombinant protein rLIPLD1 had hydrolytic activity on sphingomyelin and in vitro hemolytic activity on human red blood cells, whereas rLIPLD2 was inactive. The purified recombinant proteins and the venom are recognized by polyclonal anti-rLIPLD1 and rLIPLD2 sera produced in animals and conferred immunoprotection against the venom. These new isoforms reinforce the importance of the multigene family of phospholipases-D present in Loxosceles spiders. A highly immunogenic inactive isoform such as rLIPLD2 raises important expectation for its use as a potential immunogenic inducer of the immunoprotective response to the toxic action of the venom of Loxosceles laeta.

Basurto-IGPP. A manual-directed approach of integrative group psychotherapy in psychosis.

A manual on Integrative Group Psychotherapy for outpatients with schizophrenia and other psychoses (Basurto-PGIP) is presented. The model takes into account group specific therapeutic factors. It integrates influences from other integrative psychotherapeutic models, interpersonal group therapy, group analysis and recent developments in cognitive behavioural therapy for psychotic symptoms. The manual is structured in levels of different complexity that can be applied in a progressive manner. The intervention tries to adapt to patients features, therapists ability and training, and centres resources. It can be applied in two possible settings: a short term closed group and a long term open group. Advantages and disadvantages of the model are described.

Effect of inmersion desinfection with 0, 5 percent sodium hypochlorite and 2 percent glutaraldehyde on alginate and silicone: microbiology and SEM study / Efecto de la desinfección en inmersión con 0, 5 por ciento de hipoclorito sódico y glutaraldehído al 2 por ciento sobre alginato y silicona: estudio de la microbiología y SEM

The disinfection of dental impression materials has become an essential topic of universal concern, as it may be the first instance of microbial contamination during dental care. The purpose of this study is twofold: To determine the effectiveness of disinfection with 0.5 percent sodium hypochlorite and 2 percent glutaraldehyde solutions in irreversible hydrocolloid (alginate) and silicone impressions and to analyze the effect of disinfection on surface quality with a scanning electronic microscope. Atotal of 32 impressions (16 made of irreversible hydrocolloid and 16 made of silicone) were taken from maxillary dentate patients. Samples of 1cm2 (80 , irreversible hydrocolloid, 80 silicone) were obtained and distributed in ten groups: alginate in no disinfectant (control group 1, AL), alginate in 0.5 percent sodium hypochlorite (NaOCl) for 5 (AH5) and 10 minutes (AH10), alginate in 2 percent glutaraldehyde for 5 (AG5) and 10 minutes (AG10), silicone in no disinfectant (control group 2), silicone in 0.5 percent NaOCl for5 (SH5) and 10 minutes (SH10), and silicone in 2 percent glutaraldehyde for 5 (SG5) and 10 minutes (SG10). Each sample was divided into two segments (one for the microbiological and one for the SEM study). Microbiological samples were planted on blood agar, Mac Conkey agar, and Sabouraud agar, and identification was made by Gram´s stain. The samples were then processed by an SEM. Immersion in the 5 percent NaOCl and 2 percent glutaraldehyde for 10 minutes completely eliminated bacteria in the impressions, compared with the control group (P=0.000004). Immersion in 0.5 percent NaOCl and 2 percent glutaraldehyde for 5 and 10 minutes significantly inhibited bacterial growth in both the irreversible hydrocolloid and silicone impressions compared with control group (P<0.05). However, in the SEM study, immersion in both disinfectant solutions for 5 and 10 minutes did not significantly affect the surface quality of the irreversible hydrocolloid...

La desinfección de los materiales de impresión dental se ha convertido en un tema esencial, ya que puede ser el primer caso de contaminación microbiana durante la atención dental. El propósito de este estudio es doble: determinar la eficacia de la desinfección con hipoclorito sódico al 0,5 por ciento y 2 por ciento de glutaraldehído en soluciones de hidrocoloide irreversible (alginato) y las impresiones de silicona, para analizar el efecto de la desinfección en la calidad de la superficie con un microscopio electrónico de barrido. Un total de 32 impresiones (16 hechas de hidrocoloides irreversibles y 16 de silicona) superiores de pacientes dentados fueron estudiadas. Las muestras de 1cm2 (80, hidrocoloide irreversible, el 80 de silicona) fueron obtenidas y distribuidas en diez grupos: alginato sin desinfectante (grupo de control1, AL), alginato en el 0,5 por ciento de hipoclorito sódico (NaOCl) durante 5 (AH5) y 10 minutos (AH10), alginato en glutaraldehído al 2 por ciento durante 5 (GA5) y 10 minutos (AG10), silicona sin desinfectante (grupo de control 2), silicona en 0,5 por ciento de NaOCldurante 5 (SH5) y 10 minutos (SH10) y, en glutaraldehído al 2 por ciento durante 5 (SG5) y 10 minutos (SG10). Cada muestra se dividió en dos segmentos (uno para los análisis microbiológicos y uno para el estudio SEM). Las muestras microbiológicasse sembraron en agar sangre, agar MacConkey y agar Sabouraud, y la identificación se realizó por tinción de Gram. Las muestras fueron procesadas por un SEM. La inmersión en 5 por ciento NaOCl y 2 por ciento de glutaraldehído durante 10 minutos eliminó completamente las bacterias de las impresiones, en comparación con el grupo control (P = 0,000004). La inmersión en 0,5 por ciento de NaOCl y glutaraldehído al 2 por ciento durante 5 y 10 minutos, inhibió el crecimiento de bacterias, tanto en el hidrocoloide irreversible e impresiones de silicona en comparación con el grupo control (P <0,05). Sin embargo, en el estudio SEM...

Tetracycline and penicillin resistant Clostridium perfringens isolated from the fangs and venom glands of Loxosceles laeta: its implications in loxoscelism treatment.

The venom of Loxosceles spiders produces severe dermonecrotic damage, intravascular hemolysis, systemic alterations and risk of death. Clostridium perfringens is present in the microbial flora of the fangs and venom glands of Loxosceles intermedia. Its inoculation with the venom may infect the wound site and exacerbate the dermonecrotic damage. This anaerobic bacterium is widely distributed in nature and capable of damage with similar characteristics and severity to the spider venom. In this study we isolated and characterized species of Clostridium from the fangs and venom glands of Loxosceles laeta, including C. perfringens. The sensitivity patterns of different isolates of C. perfringens were evaluated by minimum inhibitory concentration against penicillin, ampicillin, erythromycin, gentamicin, chloramphenicol, clindamycin and tetracycline, under anaerobic conditions, using the method of microdilution in broth. Strain C. perfringens H28 showed resistance to penicillin, ampicillin, tetracycline and chloramphenicol. Resistance to penicillin and ampicillin was mediated by beta-lactamase. In vivo evaluation of dermonecrosis in rabbits using L. laeta venom co-inoculated with isolate C. perfringens H28 produced an increase in the area of dermonecrotic lesions in the presence of penicillin and tetracycline, but not with gentamicin. Antibiotic therapy Loxosceles poisoning should be re-evaluated, considering the existence of multi-resistant strains of C. perfringens.

Beneficios de la monitorización de la glucemia en pacientes con diabetes mellitus tipo 2 en tratamiento con agentes orales / Benefits of self-monitoring of blood glucose in patients with type 2 diabetes in treatment with oral agents

Los benefi cios de la monitorización de la glucemia en pacientes con diabetesmellitus tipo 2 (DM2) en tratamiento con agentes orales y/o modifi caciones enel estilo de vida han sido cuestionados tras el análisis de los resultados de variosensayos clínicos. La mejora en el control glucémico, que se observa en no pocasocasiones, sólo puede ocurrir si al mismo tiempo que se llevan a cabo los controlesglucémicos tiene lugar un cambio conductual del paciente dirigido por losprofesionales sanitarios. Debemos abogar por el uso de esta herramienta diagnósticade manera sistemática, pero racional, evitando las prácticas derrochadorasque agotan nuestros recursos sanitarios. Para ello, hay que diseñar mejoresprotocolos que exploren las ventajas del autocontrol glucémico cuando se utilizade manera cotidiana en los pacientes con DM2 que no siguen tratamiento coninsulina. Pero de ningún modo se debe negar el acceso al autocontrol glucémicoa estos pacientes, pues ello supondría no tener forma de dirigir la terapiafarmacológica o los cambios en el estilo de vida(AU)

After the analysis of the results of several clinical trials, the benefits of selfmonitoringof blood glucose in type 2 diabetes treated with oral agents and/orlifestyle changes has been questioned. Improvement of glycemic control,which has been often observed, may only be possible if besides glucose monitoringbehaviour modifications guided by health professionals also occurred.We must encourage a systematic but also rational use of this useful diagnostictool, avoiding waste-of-money practices which consume our medical resources.Therefore, better protocols should be designed to demonstrate the advantagesof daily self-monitoring of blood glucose in people with type 2 diabetes treatedwithout insulin. But in any case, self-monitoring of glucose levels should neverbe denied to those patients, because a useful tool to drive pharmacologictherapy or lifestyle changes will be lost(AU)