Prevalencia de Neuropatía Periférica en una Unidad de Diabetes / Prevalence of Peripheral Neuropathy in a Diabetes Unit / Prevalência de neuropatia periférica em uma unidade de diabetes

Resumen: La principal complicación crónica de la diabetes mellitus es la neuropatía, en particular la polineuropatía diabética. El objetivo de este estudio fue evaluar la prevalencia de polineuropatía y su asociación a factores de riesgo y complicaciones crónicas en una unidad de diabetes. En una población de 81 pacientes diabéticos, se encontró una prevalencia de polineuropatía de 34.6%. Es más frecuente y severa en la población de DM2, y se asoció con mayor tiempo de evolución de la enfermedad y complicaciones microangiopáticas. La polineuropatía sintomática predominó en el sexo femenino. Se concluye que la población diabética debe ser sometida a screening oportuno de polineuropatía.

Abstract: The main chronic complication of diabetes mellitus is neuropathy, in particular diabetic polyneuropathy. The objective of this study was to evaluate the prevalence of polyneuropathy and its association with risk factors and chronic complications in a diabetes unit. In a population of 81 diabetic patients, a polyneuropathy prevalence of 34.6% was found. It is more frequent and severe in the T2DM population, and was associated with longer disease progression and microangiopathic complications. Symptomatic polyneuropathy predominated in the female sex. It is concluded that the diabetic population should undergo timely screening for polyneuropathy.

Resumo: A principal complicação crônica do diabetes mellitus é a neuropatia, em particular a polineuropatia diabética. O objetivo deste estudo foi avaliar a prevalência de polineuropatia e sua associação com fatores de risco e complicações crônicas em uma unidade de diabetes. Em uma população de 81 pacientes diabéticos, foi encontrada uma prevalência de polineuropatia de 34,6%. É mais frequente e grave na população com DM2 e esteve associada a maior progressão da doença e complicações microangiopáticas. A polineuropatia sintomática predominou no sexo feminino. Conclui-se que a população diabética deve ser submetida a uma triagem oportuna da polineuropatia.

Control glicémico del paciente quirúrgico / Glycemic control of the surgical patient / Controle glicêmico do paciente cirúrgico

Resumen: Introducción: La diabetes mellitus es una patología de alta prevalencia, con mayor morbimortalidad en el paciente quirúrgico, tanto por la hipo como la hiperglicemia. Objetivos. Determinar si el control metabólico glicémico cumple las recomendaciones internacionales. Metodología: Se realizó un estudio descriptivo de todos los pacientes internados en áreas quirúrgicas. Se analizaron todas las glicemias capilares registradas en la historia clínica. Resultados : Se captaron 34 pacientes (predomina sexo masculino y con diabetes mellitus tipo 2), 21 fueron sometidos a una intervención quirúrgica, la mortalidad fue del 6%. La glicemia promedio fue superior a la recomendada internacionalmente, constituye episodios de hiperglicemia. Asimismo, se detectó la presencia de hipoglicemia. Conclusiones: Es deseable establecer estrategias para optimizar el control metabólico en la población con diabetes mellitus internada en áreas quirúrgicas.

Abstract: Introduction: Diabetes mellitus is a highly prevalent pathology, with higher morbidity and mortality in the surgical patient, both due to hypo and hyperglycemia. Goals. Determine if glycemic metabolic control meets international recommendations. Methodology: A descriptive study of all patients admitted to surgical areas was carried out. All capillary blood glucose levels recorded in the clinical history were analyzed. Results: 34 patients were captured (predominantly male and with type 2 diabetes mellitus), 21 underwent surgical intervention, mortality was 6%. The average glycemia was higher than the internationally recommended, it constitutes episodes of hyperglycemia. Likewise, the presence of hypoglycemia was detected. Conclusions: It is desirable to establish strategies to optimize metabolic control in the population with diabetes mellitus admitted to surgical areas.

Resumo: Introdução: O diabetes mellitus é uma patologia de alta prevalência, com maior morbimortalidade no paciente cirúrgico, tanto por hipo quanto por hiperglicemia. Metas. Determine se o controle metabólico glicêmico atende às recomendações internacionais. Metodologia: Foi realizado um estudo descritivo de todos os pacientes admitidos em áreas cirúrgicas. Todos os níveis de glicose no sangue capilar registrados na história clínica foram analisados. Resultados: 34 pacientes foram capturados (predominantemente do sexo masculino e com diabetes mellitus tipo 2), 21 foram submetidos a intervenção cirúrgica, a mortalidade foi de 6%. A média da glicemia foi superior ao recomendado internacionalmente, constituindo episódios de hiperglicemia. Da mesma forma, foi detectada a presença de hipoglicemia. Conclusões: É desejável estabelecer estratégias para otimizar o controle metabólico na população com diabetes mellitus admitida em áreas cirúrgicas.

Opening the "black box" of nodD3, nodD4 and nodD5 genes of Rhizobium tropici strain CIAT 899.

BACKGROUND: Transcription of nodulation genes in rhizobial species is orchestrated by the regulatory nodD gene. Rhizobium tropici strain CIAT 899 is an intriguing species in possessing features such as broad host range, high tolerance of abiotic stresses and, especially, by carrying the highest known number of nodD genes--five--and the greatest diversity of Nod factors (lipochitooligosaccharides, LCOs). Here we shed light on the roles of the multiple nodD genes of CIAT 899 by reporting, for the first time, results obtained with nodD3, nodD4 and nodD5 mutants. METHODS: The three nodD mutants were built by insertion of Ω interposon. Nod factors were purified and identified by LC-MS/MS analyses. In addition, nodD1 and nodC relative gene expressions were measured by quantitative RT-PCR in the wt and derivative mutant strains. Phenotypic traits such as exopolysaccharide (EPS), lipopolysaccharide (LPS), swimming and swarming motilities, biofilm formation and indole acetid acid (IAA) production were also perfomed. All these experiments were carried out in presence of both inducers of CIAT 899, apigenin and salt. Finally, nodulation assays were evaluated in up to six different legumes, including common bean (Phaseolus vulgaris L.). RESULTS: Phenotypic and symbiotic properties, Nod factors and gene expression of nodD3, nodD4 and nodD5 mutants were compared with those of the wild-type (WT) CIAT 899, both in the presence and in the absence of the nod-gene-inducing molecule apigenin and of saline stress. No differences between the mutants and the WT were observed in exopolysaccharide (EPS) and lipopolysaccharide (LPS) profiles, motility, indole acetic acid (IAA) synthesis or biofilm production, either in the presence, or in the absence of inducers. Nodulation studies demonstrated the most complex regulatory system described so far, requiring from one (Leucaena leucocephala, Lotus burtii) to four (Lotus japonicus) nodD genes. Up to 38 different structures of Nod factors were detected, being higher under salt stress, except for the nodD5 mutant; in addition, a high number of structures was synthesized by the nodD4 mutant in the absence of any inducer. Probable activator (nodD3 and nodD5) or repressor roles (nodD4), possibly via nodD1 and/or nodD2, were attributed to the three nodD genes. Expression of nodC, nodD1 and each nodD studied by RT-qPCR confirmed that nodD3 is an activator of nodD1, both in the presence of apigenin and salt stress. In contrast, nodD4 might be an inducer with apigenin and a repressor under saline stress, whereas nodD5 was an inducer under both conditions. CONCLUSIONS: We report for R. tropici CIAT 899 the most complex model of regulation of nodulation genes described so far. Five nodD genes performed different roles depending on the host plant and the inducing environment. Nodulation required from one to four nodD genes, depending on the host legume. nodD3 and nodD5 were identified as activators of the nodD1 gene, whereas, for the first time, it was shown that a regulatory nodD gene-nodD4-might act as repressor or inducer, depending on the inducing environment, giving support to the hypothesis that nodD roles go beyond nodulation, in terms of responses to abiotic stresses.

Different and new Nod factors produced by Rhizobium tropici CIAT899 following Na+ stress.

The root nodule bacterium Rhizobium tropici strain CIAT899 is highly stress resistant. It grows under acid conditions, in large amounts of salt, and at high osmotic pressure. An earlier study reported a substantial qualitative and quantitative effect of acid stress on the biosynthesis of Nod factors. The aim of the present work was to investigate the effect of high salt (NaCl) concentrations, another common stress factor, on Nod factor production. For this purpose, thin-layer chromatography, HPLC and MS analyses were carried out. The expression of nodulation genes was also studied using a nodP:lacZ fusion. High concentrations of sodium enhanced nod gene expression and Nod factor biosynthesis. The effect is sodium specific because high potassium or chloride concentrations did not have this effect. Under salt stress conditions, 46 different Nod factors were identified in a CIAT899 culture, compared with 29 different Nod factors under control conditions. Only 15 Nod factor structures were common to both conditions. Under salt stress conditions, 14 different new Nod factor structures were identified that were not observed as being produced under neutral or acid conditions. The implications of our results are that stress has a great influence on Nod factor biosynthesis and that new, very interesting regulatory mechanisms, worth investigating, are involved in controlling Nod factor biosynthesis.

Gerencia de calidad del Instituto Nacional de Higiene Rafael Rangel: avances y logros / Quality management of the National Institute of Higiene Rafael Rangel

La reestructuración institucional, desarrollada durante el año 1990, impulsa la creación de la Gerencia de Calidad con el objeto de diseñar y establecer los procesos para mejorar la calidad de los bienes y servicios que presta el Instituto Nacional de Higiene Rafael Rangel. A partir del año 2002, se le asignan a esta Gerencia los re cursos para que desarrolle e implante el Sistema de Gestión de la Calidad (SGC), en los procesos que se ejecutan en la Institución. En el año 2004, se establece la Política de la Calidad de la Institución. Entre el año 2004 y 2008, se ha desarrollado un programa de formación para el personal de la Institución, que incluye cursos Internos y Externos, con el fin de sensibilizar, capacitar y comprometer al talento humano en el desarrollo e implantación del SGC. Del mismo modo, el equipo de trabajo realizó la normalización de la documentación, lo que se logra con el diseño e implantación de un Sistema de Control para la elaboración, revisión y aprobación de la documentación de los procesos administrativos y técnicos de la Institución, a través del establecimiento de Procedimientos y Documentos Normalizados. La Gerencia de Calidad brinda apoyo a los laboratorios de ensayo de la División de Alimentos, con el propósito de optar a la Acreditación de Métodos de ensayo y reconocimiento formal de su competencia. En el año 2006, se lleva a cabo un programa documentado y permanente de auditorías técnicas para verificar el cumplimiento de las normas nacionales e internacionales. Estas auditorías internas se ejecutan en todas las unidades operativas y de apoyo administrativo, así como a proveedores de bienes y servicios, para garantizar la calidad de las auditorias programadas. Los principales impactos y beneficios, al implementarel SGC, para los procesos que desarrolla el Instituto Nacional de Higiene Rafael Rangel, emprendiendo la certificación y acreditación de los mismos con la finalidad de producir mejores productos y servicios...

The institutional restructuring, developed in 1990, has impulsed the creation of the Quality Management with the pur pose of designing and establishing the procedures for improving the supplies and services of “The National Institute of Hygiene (Instituto Nacional de Higiene) Rafael Rangel. Since 2002, the resources have been assigned, to this Management, to develop and implement a Quality Control System (Q.C.S.), in the procedures undertaken in the Institution. In the year of 2004, the Institution Policy of Quality was established for. Between 2004 and 2008, a training program For the institutional personnel, including Internal and External courses, has been applied with the purpose of sensitizing, preparing, and committing the human talent in the development of Q.C.S. In the same way, the quality team developed the standardization of the document with the design and implementation of a Control System for the elaboration, revision and approving of the documentation of administrative and technical procedures of the Institution, by means of creating the Standardized Procedures and Documents. The Quality Control Management gives support to Food Division Laboratories with the purpose of selecting certification methods for validating their competition. In 2006, the institution began a permanent program oftechnical audits to verify the fulfillment of the national and international rules.This internal audits are applied to all of the functioning supporting units, as administrative back-up, as well as to suppliers of goods and services as guarantee of quality on behalf of the programmed audits. The main benefits and impacts, in implementing Q.C.S., to the process developed in The National Institute of Hygiene (Instituto Nacional de Higiene) Rafael Rangel, are described as follows produce better supplies and services be efficient and reduce production costs obtain satisfied Internal and External Users-Clients...

Epidemiological and clinical profile of burn victims Hospital Universitario San Vicente de Paúl, Medellín, 1994-2004.

OBJECTIVES: To describe the clinical and epidemiological profile of the patients in the Burn Unit of the Hospital Universitario San Vicente de Paúl (HUSVP) de Medellín, Colombia, from 1994-2004. METHODS: Retrospective descriptive study of all pediatric and adult burn patients. The following were recorded: age, gender, cause, extent and severity of the burns, time in the hospital, operations, complications and death rate. Statistica 6.0 (Stafsoft Inc.) was used. RESULTS: Two thousand three hundred and nineteen patients were admitted, 66.8% were males and 62.9% were less than 15 years old. Burns caused by scalding were the most frequent (45.9%) followed by flames (38.5%) The average burn area was 26.9%. Average hospital stay was 26.9 days. In 2004, 40.4% of the patients required surgery; 13.4% of the patients had complications. 7.4% of the patients died, with an average burn area of 62%; burns caused by flames accounted for 63% of the deaths. CONCLUSIONS: There is a continuing improvement in hospital stay, survives burn sizes, with figures comparable to others without access to a tissue bank or skin cultivation.

Low pH changes the profile of nodulation factors produced by Rhizobium tropici CIAT899.

Rhizobium tropici CIAT899 has been cataloged as a nodulator of bean, a plant often growing in areas characterized by highly acidic soils. The purpose of this work was to explore the effects of acidity on the production of Nod factors by this strain and their impact on the establishment of effective symbioses. We report that acidity increases rhizobial Nod factors production, and we exhaustively study the nodulation factor structures produced under abiotic stress. Significant differences were observed between the structures produced at acid and neutral pH: 52 different molecules were produced at acid pH, 29 at neutral pH, and only 15 are common to bacteria grown at pH 7.0 or 4.5. The results indicate that R. tropici CIAT899 has successfully adapted to life in acidic soils and is a good inoculant for the bean under these conditions.

NolR regulates diverse symbiotic signals of Sinorhizobium fredii HH103.

We have investigated in Sinorhizobium fredii HH103-1 (=HH103 Str(r)) the influence of the nolR gene on the production of three different bacterial symbiotic signals: Nod factors, signal responsive (SR) proteins, and exopolysaccharide (EPS). The presence of multiple copies of nolR (in plasmid pMUS675) repressed the transcription of all the flavonoid-inducible genes analyzed: nodA, nodD1, nolO, nolX, noeL, rhcJ, hesB, and y4pF. Inactivation of nolR (mutant SVQ517) or its overexpression (presence of pMUS675) altered the amount of Nod factors detected. Mutant SVQ517 produced Nod factors carrying N-methyl residues at the nonreducing N-acetyl-glucosamine, which never have been detected in S. fredii HH103. Plasmid pMUS675 increased the amounts of EPS produced by HH103-1 and SVQ517. The flavonoid genistein repressed EPS production of HH103-1 and SVQ517 but the presence of pMUS675 reduced this repression. The presence of plasmid pMUS675 clearly decreased the secretion of SR proteins. Inactivation, or overexpression, of nolR decreased the capacity of HH103 to nodulate Glycine max. However, HH103-1 and SVQ517 carrying plasmid pMUS675 showed enhanced nodulation capacity with Vigna unguiculata. The nolR gene was positively identified in all S. fredii strains investigated, S. xinjiangense CCBAU110, and S. saheli USDA4102. Apparently, S. teranga USDA4101 does not contain this gene.

El curso de parto psicoprofiláctico como factor protector al momento del parto, Policlínica Presidente Remón, C.S.S., 1995 / The curse of psicoprofilactic childbirth course as a protecting factor at the birth moment

El parto es una experiencia natural que demanda mucho esfuerzo sobre el organismo femenino, pero no es necesariamente doloroso. El dolor se presenta cuando una madre entra en estado de tensión y paradójicamente su organismo trabaja en contra de la fuerza natural en vez de a favor de las mismas. En la Policlínica Presidente Remón, de la Caja de Seguro Social de la República de Panamá, los cursos que preparan a las futuras madres al parto natural, utilizando el método psicoprofiláctico, han sido ofrecidos desde 1994. Estos cursos se imparten cada tres meses durante los doce meses del año y estan disponible para todas las mujeres embarazadas. En el presente estudio, se le dió seguimiento a 33 embarazadas que recibieron el curso de parto psicoprofiláctico hasta el momento del parto en 1995 y se comparó con una cohorte de 66 embarazadas las cuales no participaron en el curso psicoprofiláctico. Probamos estadísticamente que las mujeres que fueron preparadas para el parto natural, a través del método psicoprofiláctico, estaban en mejores condiciones físicas y psicológicas al momento del parto, ya que presentan buen nivel de hemoglobina, ganancia de peso aceptable y estaban alertas y cooperadoras durante los diferentes estadíos de la labor y los recién nacidos, con un buen Apgar, al igual que buen peso y talla. Por lo anteriormente expuesto, consideramos que el parto natural, previa preparación psicoprofiláctica es beneficiosa, tanto para la madre como para el hijo, por lo cual creemos necesario que dicho curso sea de implementación en todas las unidades ejecutoras de la Caja de Seguro Social