Clima organizacional en una institución prestadora de salud de Montería - Córdoba, 2015 / Organizational climate in a health providing Institution of Monteria - Cordoba, 2015

Objetivo. Determinar el clima organizacional de una Institución Prestadora de Salud (IPS), con el fin de establecer estrategias que permitan mejorar el ambiente laboral. Materiales y métodos. Estudio Descriptivo de corte transversal, con enfoque cuantitativo. La población la representaron el total de empleados de la institución, la muestra se aplicó una fórmula estadística que permitió establecer el total de 193 empleados a los que se les aplicó el instrumento de recolección de la información. Se utilizó la técnica encuesta mediante el instrumento cuestionario establecido por la Encuesta sobre el Clima Organizacional basado en los 4 pilares propuestos por la Organización Panamericana de Salud (OPS). Finalmente después de haber recolectado toda la información mediante las encuestas, se procedió a tabularlas mediante una hoja de Excel, y finalmente a realizar las tablas, gráficos y análisis correspondiente, según los objetivos y variables de estudio. De acuerdo a la resolución 08430 de 1993, el estudio fue clasificado sin riesgo, se respetó la confidencialidad, la anonimicidad del encuestado y la institución. Resultados. Se encontraron niveles de satisfacción por encima del 80% en factores como la comunicación, relaciones interpersonales y valores comunicativos y por debajo del 20% en factores como el bienestar social, nivel de capacitación y la compensación y reconocimiento. Conclusiones. Se realizó el diagnóstico del clima organizacional, el cual evidenció fortalezas en la comunicación, el trabajo en equipo, la coperación y liderazgo, por el contrario se obtuvierion oportunidad de mejora en factores como la promoción y el ascenso.

Objective. To determine the organizational climate of a Health care Provider Institution (HPI) to establish some strategies to improve the work environment. Materials and Methods. This was a quantitative, descriptive, and cross-sectional study. The population consisted of all the Institution's employees. A statistical formula was applied to choose the sample. This procedure allowed for the use of the data collection instrument with all the employees. A questionnaire for the survey established for the organizational climate based on the four pillars proposed by Health Pan-American Organization was used. Finally, once all the information was obtained through the survey, the tabulation was done through an Excel spreadsheet, tables and graphics were created, and data analysis completed according to the study variables. In line with Resolution08430,1993, the study was classified as risk-free. Also, the confidentiality and anonymity of both the research participants and the Institution were respected. Results. Levels of satisfaction higher than 80% were founding factors, such as communication, interpersonal relationships, and communicative values. Levels lower than 20% were found in factors, such as wellbeing, level of training as well as compensation and recognition. Conclusions. The diagnosis of the organizational climate revealed communication strengths, team work, cooperation, and leadership. Improvement opportunities in factors, such as promotion and raise were discovered as well.

Active tuberculosis patients have high levels of IgA anti-alpha-crystallin and isocitrate lyase proteins.

SETTING: Mexico City, Mexico. OBJECTIVE: To identify proteins synthetised by Mycobacterium tuberculosis in hypoxic culture, which resemble more closely a granuloma environment than aerobic culture, and to determine if they are recognised by antibodies from patients with active pulmonary tuberculosis (PTB). DESIGN: Soluble extracts from M. tuberculosis H37Rv cultured under aerobic or hypoxic conditions were analysed using two-dimensional polyacrylamide gel electrophoresis, and proteins over-expressed under hypoxia were identified by mass spectrometry. The presence of immunoglobulin (Ig) G, IgA and IgM antibodies against these proteins was determined in the serum of 42 patients with active PTB and 42 healthy controls. RESULTS: We selected three M. tuberculosis H37Rv proteins (alpha-crystallin protein [Acr, Rv2031c], universal stress protein Rv2623 and isocitrate lyase [ICL, RV0467]) that were over-expressed under hypoxia. Titres of anti-Acr and anti-ICL IgA antibodies were higher in patients than in healthy controls, with an area under the receiver operating characteristic curve of 0.71 for anti-ICL IgA antibodies. CONCLUSION: ICL could be used in combination with other M. tuberculosis antigens to improve the sensitivity and specificity of current serological TB diagnostic methods.

A novel antigen-carrier system: the Mycobacterium tuberculosis Acr protein carried by raw starch microparticles.

Microparticles have been used as promising carriers for in vivo vaccine delivery. However, the processes for immobilizing peptides or proteins on microparticles usually require the use of undesirable compounds and complex protocols. In this work, we propose a new immobilization and delivery system with raw starch microparticles and a starch binding domain (SBD) tag fusion protein. The heat shock protein alpha crystallin from Mycobacterium tuberculosis was used as model. The immunogenicity of the system was investigated in BALB/c mice inoculated with purified Acr-SBDtag protein (pAcr-SBDtag) and starch immobilized Acr-SBDtag protein (µAcr-SBDtag) by oral and intranasal routes. We demonstrated mucosal immunization with the µAcr-SBDtag protein induced systemic antibodies that were predominantly immunoglobulin G2a (IgG2a). An analysis of the cytokines from spleen cells and lung homogenates revealed that loaded microparticles induced the secretion of interferon-γ (INF-γ), suggesting an adjuvant effect from the immobilization. The immune responses induced by immobilized protein were primarily affected by the route of administration. These results demonstrate that the system exhibits the necessary characteristics to improve antigen release and presentation to antigen presenting cells (APCs) in the mucosae. Because no extra adjuvants were used, we posit that the system may be suitable for delivery and presentation to the field of subunit vaccine development.

Specificity of the tuberculin skin test is modified by use of a protein cocktail containing ESAT-6 and CFP-10 in cattle naturally infected with Mycobacterium bovis.

The mycobacterial immunodominant ESAT-6 and CFP-10 antigens are strongly recognizable in tuberculosis-infected cattle, and they do not elicit a response in cattle without infection. In addition, they are absent in most environmental mycobacterial species, and therefore, their use can be an alternative to purified protein derivative (PPD) tuberculin in the development of a more specific skin diagnostic test in cattle. The aim of the current study was to assess the potential of an ESAT-6 and CFP-10 (E6-C10) protein cocktail in a skin test format in naturally tuberculosis-infected and paratuberculosis-infected cattle. We also included MPB83 as a third component in one of the protein cocktail preparations. The protein cocktail was tested at different dose concentrations (5, 10, and 15 µg per protein). The best skin response to the E6-C10 protein cocktail was obtained with 10 µg. Subsequently, this concentration was tested in 2 herds with high and low bovine tuberculosis prevalence, the latter with paratuberculosis coinfection. Our data show that the E6-C10 cocktail allows identification of an important proportion of animals that PPDB is not able to recognize, especially in low-prevalence herds. The protein cocktail did not induce reactions in tuberculosis-free cattle or in paratuberculosis-infected cattle. Addition of MPB83 to the protein cocktail did not make any difference in the skin reaction.

Duplicación del peroné, fémur corto congénito, luxación atípica de la cadera y polidactilia central del pie ipsilateral: reporte de caso / Ipsilateral fibular duplication, short congenital femur, atypical congenital hip dislocation, and central polidactilia: case report

El compromiso de varios segmentos de la extremidad es un hallazgo frecuente en los pacientes afectados por deficiencias de las extremidades inferiores. Se describe un caso inédito de un niño de dos años con una inusual combinación de deformidades en su extremidad inferior izquierda: duplicación del peroné, fémur corto congénito, luxación atípica de la cadera y polidactilia central.

Detection of bovine tuberculosis in herds with different disease prevalence and influence of paratuberculosis infection on PPDB and ESAT-6/CFP10 specificity.

Bovine tuberculosis (BTB) is a major animal health problem with zoonotic implications. Current control programs are based on test and slaughter strategies utilizing skin tests with tuberculins as antigens. The low specificity and associated operative difficulties of these tests have driven the search for new antigens and diagnostic assays. In this multicenter study, using herds from Argentina, Mexico and Northern Ireland, we selected skin test positive and negative animals from herds with different prevalence's of BTB and compared tuberculin (PPDB) and ESAT-6+CFP10 as antigens ex vivo. In low prevalence herds, crossreactivity of PPDB was apparent since up to 60% of the PPDB skin test and ex vivo positive animals did not responded to ESAT-6+CFP10 ex vivo. The superior specificity of ESAT-6+CFP10 was confirmed in a Mycobacterium avium sp. paratuberculosis infected herd where several of the animals had strong crossreactivity to PPDB and PPDA but not to ESAT-6+CFP10. In high prevalence herds 85% of the skin test-positive animals, were confirmed ex vivo using either PPDB or ESAT-6+CFP10 as antigen. However, within this group 60% of the skin test negative animals were PPDB and ESAT-6+CFP10 positive ex vivo indicating that the skin test can in some herds yield a significant number of false negative results. In conclusion, the ex vivo test is recommended as an ancillary test to accelerate BTB eradication. In high prevalence herds, PPDB or ESAT-6+CFP10 can be used as antigen whereas in low and medium prevalence herds ESAT-6+CFP10 is the preferred choice.

Optimizing antigen cocktails for detection of Mycobacterium bovis in herds with different prevalences of bovine tuberculosis: ESAT6-CFP10 mixture shows optimal sensitivity and specificity.

Bovine tuberculosis is a major problem in many countries; hence, new and better diagnostic tools are urgently needed. In this work, we have tested ESAT6, CFP10, PE13, PE5, MPB70, TB10.4, and TB27.4 for their potentials as diagnostic markers in field animals from Northern Ireland, Mexico, and Argentina, regions with low, medium, and high prevalences of bovine tuberculosis, respectively. At all three sites, ESAT6 and CFP10 were superior diagnostic antigens, while their combination performed even better at the two sites where the combination was tested, providing the best coverage for the detection of diseased populations. The high sensitivity in the skin test reactor groups, combined with the high specificity in the tuberculosis-free groups, indicated that a diagnosis could correctly be made for 85% of the infected animals, based on their responses to these two antigens. Furthermore, TB10.4, PE13, and PE5 have the potential to supplement ESAT6 and CFP10 in a future five-component diagnostic cocktail.

A marked difference in pathogenesis and immune response induced by different Mycobacterium tuberculosis genotypes.

In the last decade, an unprecedented genetic diversity has been disclosed among Mycobacterium tuberculosis strains found worldwide. However, well-conserved genotypes seem to prevail in areas with high incidence of tuberculosis. As this may be related to selective advantages, such as advanced mechanisms to circumvent [M. bovis Bacille Calmette-Guerin (BCG)-induced] host defence mechanisms, we investigated the influence of strain diversity on the course of experimental disease. Twelve M. tuberculosis strains, representing four major genotype families found worldwide today, and the laboratory strain H37Rv were each used to infect BALB/c mice by direct intratracheal injection. Compared with H37Rv, infections with Beijng strains were characterized by extensive pneumonia, early but ephemeral tumour necrosis factor-alpha (TNF-alpha) and inducible isoform of nitric oxide synthetase (iNOS) expression, and significantly higher earlier mortality. Conversely, Canetti strains induced limited pneumonia, sustained TNF-alpha and iNOS expression in lungs, and almost 100% survival. Strains of the Somali and the Haarlem genotype families displayed less homogeneous, intermediate rates of survival. Previous BCG vaccination protected less effectively against infection with Beijing strains than against the H37Rv strain. In conclusion, genetically different M. tuberculosis strains evoked markedly different immunopathological events. Bacteria with the Beijing genotype, highly prevalent in Asia and the former USSR, elicited a non-protective immune response in mice and were the most virulent. Future immunological research, particularly on candidate vaccines, should include a broad spectrum of M. tuberculosis genotypes rather than a few laboratory strains.

Characterization of the Mycobacterium tuberculosis region containing the mpt83 and mpt70 genes.

Like the products of the genes mpt83 and mpt70, the putative protein encoded by the gene located between these genes was undetectable in Mycobacterium tuberculosis with an antiserum raised against the recombinant protein. The protein showed 100% homology with M. tuberculosis Rv2874 and similarities with CcdA and DipZ proteins involved in cytochrome-c biogenesis in bacteria. Expression analysis by RT-PCR and transcriptional fusions of Rv2874 and their neighbor genes Rv2871, Rv2872, mpt83 and mpt70 with lacZ suggest that these genes are part of an operon and their transcription is driven by promoter regions located 5' upstream of mpt83 and of Rv2874 genes.

Binding and activation of human plasminogen by Mycobacterium tuberculosis.

The first evidence of the interaction of Mycobacterium tuberculosis with the plasminogen system is herein reported. By FACScan analysis and affinity blotting, lysine-dependent binding of plasminogen to M. tuberculosis was demonstrated. The binding molecules were 30-, 60-, and 66-kDa proteins present in cell wall and soluble protein extracts. The activation of plasminogen, which occurred only in presence of fibrin and was not inhibited by the host serpin, alpha(2)-antiplasmin, was also demonstrated.

Evaluation of the polymerase chain reaction for the detection of Mycobacterium tuberculosis.

The development of nucleic acid-based technologies has improved the sensitivity, specificity and speed of detection of Mycobacterium tuberculosis in clinical samples. Both commercially available and 'in-house' polymerase chain reaction (PCR) systems are in use, and a significant number of reports compare such systems with more traditional diagnostic tools for tuberculosis. Few studies, however, have focused on the reproducibility of the results when submitting a sample batch to PCR in different laboratories, especially in developing countries. Consequently, PCR results obtained from six laboratories in six different Latin American countries for samples reconstituted with defined amounts of M. tuberculosis cells were evaluated. Each laboratory used specific conditions of sample processing, nucleic acid amplification and amplicon detection. Analysis of results allowed large differences in sensitivity and specificity to be observed. We conclude that in its present setting, in-house PCR cannot be used as a single diagnostic tool for tuberculosis, and that special care needs to be taken upon interpretation of results by inclusion of a proper number of positive and negative controls.

A novel 27 kDa lipoprotein antigen from Mycobacterium bovis.

A novel Mycobacterium bovis antigen was identified from an expression library using sera from naturally infected cattle. The Escherichia coli recombinant clone expressed a 27 kDa protein, named P27. A rabbit serum against the recombinant antigen recognized a protein of 27 kDa in cellular extracts from M. bovis and M. tuberculosis. No protein was recognized in the culture supernatant. Sequence analysis indicated that P27 has a molecular mass of 24 kDa, showing a characteristic signal sequence for lipoprotein modification (a signal peptidase type II site). The gene is identical to a gene identified in the M. tuberculosis genome sequencing project. Cellular fractionation experiments suggested that P27 is an integral membrane protein. The antigen was recognized by individual sera and peripheral blood mononuclear cells (PBMC) from diseased cattle. PCR experiments with specific primers directed to the P27 structural gene indicated that it is only present in the M. tuberculosis species complex. In conclusion, a novel immunogenic lipoprotein in M. bovis/M. tuberculosis has been identified. The results presented here and elsewhere suggest that mycobacterial lipoproteins should be considered in the design of new recombinant vaccines and diagnostic methods.

[Takayasu's arteritis. A seroimmunological test of its relationship to mycobacterial infection]. / Arteritis de Takayasu. Prueba seroinmunológica de su relación con infección por micobacterias.

Takayasu's arteritis is an inflammatory arteritis of unknown origin. It affects the aorta, its main branches and at times the pulmonary artery. Takayasu's arteritis is a worldwide disease, however, there is predilection to affect young women of mongoloid ancestry, therefore most cases do occur in the Far East and Latin America. For more than 50 years a relationship with mycobacterial infection has been sought without definite proof. In this investigation we found a circulating IgG antibody in the sera of Takayasu's arteritis patients, which recognizes a 38 kD glycoprotein of M. tuberculosis. This glycoprotein is an specific antigen in the human immune response against mycobacterial infection.

The antigenic structure of Mycobacterium tuberculosis examined by immunoblot and ELISA. Influence of the age of the culture and of the obtaining method on the composition of the antigenic extracts.

In this study we have examined by immunoblot (IB) and enzyme-linked immunosorbent assay (ELISA) the humoral immune response in pulmonary tuberculosis. As a previous step, in an attempt to obtain the optimal antigen preparation for these studies, the influence of the culture age and of the obtention method on the composition of the extracts was analyzed. The highest number of antigenic bands was found in culture filtrates of 6 and 8 weeks; at these times two thick bands of 65 and 63 kilodaltons (kDa) were identified. These bands were absent from younger and older cultures. When analyzing the source of antigens, we found that culture filtrates contained more antigenic bands than sonic extracts. In view of these findings, culture filtrates of 6 weeks of age were used as test antigens. With 19 tuberculous sera a total of 16 antigenic bands were observed by IB. The response was very heterogeneous with respect to the intensity of the detected reactions and the number of reacting bands. The most frequently recognized bands were those of 31, 32, 38, 58 and 94 kDa. By ELISA with 49 tuberculous sera and with 48 control sera, a specificity of 0.98 and a sensitivity of 0.70 were obtained.