Acciones estratégicas sobre prevención de Infecciones Respiratorias Agudas en menores de cinco años / Strategic actions on the prevention of Acute Respiratory Infections in children less than five years old

Introducción: las infecciones respiratorias agudas constituyen un importante problema de salud, tanto por las impresionantes cifras de morbilidad, como por el elevado índice de mortalidad que provocan. Objetivo: el objetivo de este trabajo es evaluar la efectividad de la aplicación de acciones estratégicas para elevar el nivel de conocimientos sobre la prevención de las infecciones respiratorias agudas en padres o tutores de los niños menores de cinco años. Método: se realizó un estudio de intervención, en el que se aplicaron acciones estratégicas para elevar el nivel de conocimientos sobre la prevención de las infecciones respiratorias agudas (IRA) a 82 padres o tutores de niños menores de cinco años en el municipio Plaza, Venezuela, en el año 2010. La investigación se realizó en tres etapas: diagnóstico, intervención o ejecución y evaluación. Se emplearon métodos teóricos: análisis-síntesis, inductivo-deductivo, e histórico-lógico; empíricos: el consentimiento informado, la observación, la encuesta y el método Delphi para validar las acciones y estadísticos: el método porcentual y la Prueba Anova de Friedman: para medir el nivel de conocimientos antes y después de aplicadas las acciones estratégicas. Resultados: todos los expertos consideraron que las acciones estratégicas, eran efectivas para ser aplicadas y generalizadas. Al inicio de la investigación los padres o tutores tenían bajo conocimiento sobre la prevención de las infecciones respiratorias agudas, luego de la intervención se logró un aumento significativo del mismo, por lo que se consideraron efectivas las acciones estratégicas. Conclusiones: La aplicación de acciones estratégicas basadas en la prevención de las infecciones respiratorias agudas en niños menores de cinco años, permitió elevar significativamente el nivel de conocimiento de los padres o tutores que la recibieron(AU)

Introduction: the acute respiratory infections constitute an important health issue, for the high morbidity and mortality index. Objective: the objective of this work is to evaluate the application of the effectiveness of strategic actions to increase the level of knowledge on the prevention of acute respiratory infections in parents or tutors of children less than five years. Method: it was performed an intervention study through which there were applied strategic actions to increase the level of knowledge about the prevention of acute respiratory infections (ARI) to 82 parents or tutors of children under five years old in Plaza municipality, Venezuela, in the year 2010. The research was performed in three stages: diagnosis, intervention or execution and evaluation. There were applied theoretical methods like: analysis-synthesis, induction-deduction, historical and logical; and empirical methods like the informed consent, the observation, survey and the Delphi method to validate the actions and statistics, the percentage method and the Anova test of Friedman to measure the level of knowledge before and after the strategic actions. Results: all the experts considered that the strategic actions were effective to be applied and generalized. At the beginning of the investigation the parents or tutors had a scarce knowledge about the prevention of acute respiratory infections, and after the intervention there was a significant increase of it, for which the strategic actions were effective. Conclusions: the application of strategic actions based on the prevention of Acute Respiratory Infections in children under five years old, allowed the significantly increase of the level of knowledge of parents or tutors(EU)

Acciones estratégicas sobre prevención de Infecciones Respiratorias Agudas en menores de cinco años / Strategic actions on the prevention of Acute Respiratory Infections in children less than five years old

Introducción: las infecciones respiratorias agudas constituyen un importante problema de salud, tanto por las impresionantes cifras de morbilidad, como por el elevado índice de mortalidad que provocan. Objetivo: el objetivo de este trabajo es evaluar la efectividad de la aplicación de acciones estratégicas para elevar el nivel de conocimientos sobre la prevención de las infecciones respiratorias agudas en padres o tutores de los niños menores de cinco años. Método: se realizó un estudio de intervención, en el que se aplicaron acciones estratégicas para elevar el nivel de conocimientos sobre la prevención de las infecciones respiratorias agudas (IRA) a 82 padres o tutores de niños menores de cinco años en el municipio Plaza, Venezuela, en el año 2010. La investigación se realizó en tres etapas: diagnóstico, intervención o ejecución y evaluación. Se emplearon métodos teóricos: análisis-síntesis, inductivo-deductivo, e histórico-lógico; empíricos: el consentimiento informado, la observación, la encuesta y el método Delphi para validar las acciones y estadísticos: el método porcentual y la Prueba Anova de Friedman: para medir el nivel de conocimientos antes y después de aplicadas las acciones estratégicas. Resultados: todos los expertos consideraron que las acciones estratégicas, eran efectivas para ser aplicadas y generalizadas. Al inicio de la investigación los padres o tutores tenían bajo conocimiento sobre la prevención de las infecciones respiratorias agudas, luego de la intervención se logró un aumento significativo del mismo, por lo que se consideraron efectivas las acciones estratégicas. Conclusiones: La aplicación de acciones estratégicas basadas en la prevención de las infecciones respiratorias agudas en niños menores de cinco años, permitió elevar significativamente el nivel de conocimiento de los padres o tutores que la recibieron(AU)

Introduction: the acute respiratory infections constitute an important health issue, for the high morbidity and mortality index. Objective: the objective of this work is to evaluate the application of the effectiveness of strategic actions to increase the level of knowledge on the prevention of acute respiratory infections in parents or tutors of children less than five years. Method: it was performed an intervention study through which there were applied strategic actions to increase the level of knowledge about the prevention of acute respiratory infections (ARI) to 82 parents or tutors of children under five years old in Plaza municipality, Venezuela, in the year 2010. The research was performedin three stages: diagnosis, intervention or execution and evaluation. There were applied theoretical methods like: analysis-synthesis, induction-deduction, historical and logical; and empirical methods like the informed consent, the observation, survey and the Delphi method to validate the actions and statistics, the percentage method and the Anova test of Friedman to measure the level of knowledge before and after the strategic actions. Results: all the experts considered that the strategic actions were effective to be applied and generalized. At the beginning of the investigation the parents or tutors had a scarce knowledge about the prevention of acute respiratory infections, and after the intervention there was a significant increase of it, for which the strategic actions were effective. Conclusions: the application of strategic actions based on the prevention of Acute Respiratory Infections in children under five years old, allowed the significantly increase of the level of knowledge of parents or tutors(EU)

Factores que influyen en la conducta de rechazo a la prueba citológica / Factors that influence in the rejection behaviour to the cytology test

Introducción: El cáncer cérvico-uterino es el más frecuente del aparato genital femenino y ocupa el segundo lugar en frecuencia de cáncer en la mujer, precedido por el de mama. Objetivo: el objetivo de este trabajo es determinar la influencia de factores epidemiológicos en la conducta de rechazo de la prueba citológica en mujeres de 25 a 55 años en las áreas 40 y 41 de Jiguaní durante el periodo 2007 al 2009. Método: se realizó un estudio de casos y controles dirigido a las mujeres incluidas en el programa de citologías pertenecientes a los consultorios 40 y 41 pertenecientes al policlínico Edor de los Reyes Martínez de Jiguaní, en el periodo 2007 al 2009. Resultados: queda claro que la presencia de síntomas desagradables al momento de realizar la prueba son determinantes al momento de crear y promover la conducta de rechazo en la paciente para la siguiente toma, se evidencia así la importancia que se le da, a la “última experiencia” que los psicólogos mencionan sobre la creación de determinados patrones de conducta dirigidos a un determinado evento. Conclusiones: existe alta asociación estadística entre la conducta de rechazo a la prueba citológica y la aparición de síntomas molestos al momento de realizarse el proceder, el temor a la realización de la prueba y a su resultado se relaciona significativamente a la conducta de rechazo, los principales obstáculos que se identificaron son la lejanía del consultorio y la dificultad de dejar la casa sola para ir a hacerse la prueba(AU)

Introduction: The cervical-uterine cancer is the most frequent in the female genital system and it takes the second place of cancer frequency in women, preceded by breast cancer. Objective: the aim of this work is to determine the influence of epidemiological factors in the behavior of rejection towards the cytological test in women about 25 to 55 years in the areas 40 and 41 of Jiguaní municipality during the period of 2007 to 2009. Method: it was performed a case and control study directed to the women included in the cytology program of the medical offices 40 and 41, belonging to Edor de los Reyes Martínez Polyclinic in Jiguaní, since 2007 to 2009. Results: it is clear that the presence of unpleasant symptoms at the moment of the test procedure is a determining factor when creating and promoting the rejection behavior in the patient for the following taking, it is evidenced then the importance of the ¨last experience¨ that psychologists mention about the creation of certain patterns of behavior directed to a certain event. Conclusions: there was a high statistical association between the rejection behavior to the cytological test and the presence of annoying symptoms at the moment of the procedure; the fear for the test and its result were significantly related to the rejection behavior, the main obstacles identified were the distance to the medical office and the difficulty to leave the house alone and go to do the test(EU)

Characterization of a novel Zn²âº-dependent intrinsic imipenemase from Pseudomonas aeruginosa.

OBJECTIVES: Previous work showed that PA5542 inactivation increases Pseudomonas aeruginosa 59.20 susceptibility to carbapenems. The objective of the current study was to purify PA5542, to determine its role in carbapenem resistance and to analyse the kinetic constants of this putative new ß-lactamase. METHODS: PA5542 was cloned and expressed in Escherichia coli. The enzyme was purified by affinity as a GST fusion protein and, after that, cleaved to remove the GST tag. ß-Lactamase activity was measured spectrophotometrically using imipenem as substrate. Susceptibility to antibiotics was determined by Etest. Zn(2+) was added when needed. The expression levels of PA5542, ampC, poxB, mexA and oprD were determined by real-time RT-PCR. RESULTS: Lack of PA5542 increases P. aeruginosa 59.20 susceptibility to carbapenems and its overexpression reduces E. coli susceptibility to these ß-lactams. PA5542 is highly conserved in all sequenced P. aeruginosa strains. The clinical isolate 59.20 is resistant to imipenem (MIC >32 mg/L) and to meropenem (MIC 24 mg/L) and presents high-level expression of PA5542 in comparison with the wild-type strain PAO1. Spectrophotometric analyses showed that PA5542 is a Zn(2+)-dependent imipenemase. Analysis of the PA5542 sequence indicates that it does not belong to the classical categories of ß-lactamases. CONCLUSIONS: PA5542 encodes a new Zn(2+)-dependent imipenemase. The presence of PA5542 in all sequenced P. aeruginosa genomes, maintaining the synteny and without adjacent gene-mobility elements, indicates that it belongs to the P. aeruginosa core genome. High PA5542 expression in 59.20 suggests it may contribute to the resistance to carbapenems of this P. aeruginosa clinical isolate.

Análisis y reflexiones desde una mirada bioética, en la práctica clínica psiquiátrica, a propósito de un caso / Analysis and reflections from a look bioethics, clinical psychiatric practice, a case report

Los autores proponen reflexionar desde una mirada bioética en la práctica clínica en psiquiatría a propósito de un caso, una paciente portadora de psicosis crónica cursando embarazo con feto incompatible con la vida extrauterina. El paciente con trastorno psiquiátrico grave y con declaración de incapacidad psíquica tiene autonomía y respetarla implica un desafío para el equipo de salud. La autonomía refiere a la capacidad que se les reconoce a las personas de participar en la toma de decisiones. El trastorno psiquiátrico grave y la declaración de incapacidad no suponen la pérdida de derechos como sujetos ni como usuarios de los servicios de salud, como lo establece la Ley 18.335. En el análisis de este caso el principio de autonomía es el más comprometido; la paciente no puede consentir pero puede asentir, tomándose en cuenta su opinión para la toma de decisiones. El asentimiento tiene valor desde el punto de vista bioético pero no desde el punto de vista legal. Los avances en el diagnóstico prenatal nos enfrentan a situaciones nuevas, de implicancia bioética que es necesario conocer para proteger a poblaciones vulnerables (pacientes psiquiátricos, entre otros). Queremos enfáticamente resaltar la figura institucional de los comités de Ética Asistencial y la importancia de su creación en las instituciones que asisten pacientes con patología mental. Urge incorporar la bioética en la formación de los psiquiatras. La interdisciplina se genera como resultado de la tarea clínica de un equipo,que se configura en función del planteo de un problema, el caso clínico planteado.

Estrategia educativa para modificar la aparición de las crisis hipertensivas / Educative strategy to modify the appearance of the hypertensive crises

Se aplicó una estrategia educativa para disminuir la aparición de las crisis hipertensivas en los servicios de urgencias. Se realizó un estudio cuasi experimental a 179 pacientes hipertensos de 2 consultorios del policlínico de Jiguaní, estudiados durante el año 2008. Se realizaron entrevistas, para explorar su adherencia al tratamiento tanto no farmacológico como medicamentoso, las causas de aparición de las crisis, y el comportamiento de las mismas en los servicios de urgencia. Posteriormente se aplicó y evaluó la estrategia educativa sobre la base del manejo de la adherencia terapéutica y las causas de aparición de las crisis. Se utilizó el programa estadístico profesional SPSS 11.5 para Windows. Concluyendo que la aplicación de una estrategia educativa en la Atención Primaria de Salud sobre pacientes hipertensos permitió una adherencia al tratamiento en casi la totalidad de los mismos y disminuyó la aparición de crisis hipertensivas en los servicios de urgencia, evaluándose la estrategia propuesta de efectiva y pertinente(AU)

An educational strategy was implemented to decrease the appearance of hypertensive crises in emergency services. A quasi experimental study was conducted to 179 hypertensive patients of 2 clinics of the Jiguani Polyclinic, studied during the year 2008. Some interviews were performed to explore their adherence to non-pharmacological and medicine treatment, the causes of the beginning of the crises and the behavior in emergency services. It was subsequently applied and evaluated the educative strategy on the basis of the management of therapeutic adhesion and the causes of the appearance of the crisis. The professional statistical program SPSS 11.5 for Windows was used. To conclude the application of an educational strategy in the primary health care on hypertensive patients permitted an adherence to treatment in most of them and decreased the appearance of hypertensive crises in emergency services, evaluating the proposed strategy as effective and relevant(EU)

The global regulator Crc modulates metabolism, susceptibility to antibiotics and virulence in Pseudomonas aeruginosa.

The capacity of a bacterial pathogen to produce a disease in a treated host depends on the former's virulence and resistance to antibiotics. Several scattered pieces of evidence suggest that these two characteristics can be influenced by bacterial metabolism. This potential relationship is particularly important upon infection of a host, a situation that demands bacteria adapt their physiology to their new environment, making use of newly available nutrients. To explore the potential cross-talk between bacterial metabolism, antibiotic resistance and virulence, a Pseudomonas aeruginosa model was used. This species is an important opportunistic pathogen intrinsically resistant to many antibiotics. The role of Crc, a global regulator that controls the metabolism of carbon sources and catabolite repression in Pseudomonas, was analysed to determine its contribution to the intrinsic antibiotic resistance and virulence of P. aeruginosa. Using proteomic analyses, high-throughput metabolic tests and functional assays, the present work shows the virulence and antibiotic resistance of this pathogen to be linked to its physiology, and to be under the control (directly or indirectly) of Crc. A P. aeruginosa strain lacking the Crc regulator showed defects in type III secretion, motility, expression of quorum sensing-regulated virulence factors, and was less virulent in a Dictyostelium discoideum model. In addition, this mutant strain was more susceptible to beta-lactams, aminoglycosides, fosfomycin and rifampin. Crc might therefore be a good target in the search for new antibiotics.

Functional role of bacterial multidrug efflux pumps in microbial natural ecosystems.

Multidrug efflux pumps have emerged as relevant elements in the intrinsic and acquired antibiotic resistance of bacterial pathogens. In contrast with other antibiotic resistance genes that have been obtained by virulent bacteria through horizontal gene transfer, genes coding for multidrug efflux pumps are present in the chromosomes of all living organisms. In addition, these genes are highly conserved (all members of the same species contain the same efflux pumps) and their expression is tightly regulated. Together, these characteristics suggest that the main function of these systems is not resisting the antibiotics used in therapy and that they should have other roles relevant to the behavior of bacteria in their natural ecosystems. Among the potential roles, it has been demonstrated that efflux pumps are important for processes of detoxification of intracellular metabolites, bacterial virulence in both animal and plant hosts, cell homeostasis and intercellular signal trafficking.

A global view of antibiotic resistance.

Antibiotic resistance is one of the few examples of evolution that can be addressed experimentally. The present review analyses this resistance, focusing on the networks that regulate its acquisition and its effect on bacterial physiology. It is widely accepted that antibiotics and antibiotic resistance genes play fundamental ecological roles - as weapons and shields, respectively - in shaping the structures of microbial communities. Although this Darwinian view of the role of antibiotics is still valid, recent work indicates that antibiotics and resistance mechanisms may play other ecological roles and strongly influence bacterial physiology. The expression of antibiotic resistance determinants must therefore be tightly regulated and their activity forms part of global metabolic networks. In addition, certain bacterial modes of life can trigger transient phenotypic antibiotic resistance under some circumstances. Understanding resistance thus requires the analysis of the regulatory networks controlling bacterial evolvability, the physiological webs affected and the metabolic rewiring it incurs.

Chronic Pseudomonas aeruginosa infection in chronic obstructive pulmonary disease.

BACKGROUND: Pseudomonas aeruginosa infections are increasingly associated with acute exacerbations in chronic obstructive pulmonary disease (COPD). We aimed to determine whether an underlying chronic infection might be behind this process and to determine the epidemiological characteristics of the isolates involved, to implement useful protocols for preventing and treating these infections. METHODS: P. aeruginosa isolates obtained from respiratory samples of 13 patients with COPD and from blood samples of 10 patients in intensive care units were investigated. In 8 patients with COPD, isolates were obtained during sequential exacerbation episodes. Five patients presented a single infection episode. Production of virulence determinants and genetic relationships were analyzed in all isolates. RESULTS: Patients with COPD were usually infected with 1 P. aeruginosa clone that remained in the lung for years, without evidence of interpatient transmission. During chronic infection, each clone diversified, which led to the coexistence of isolates with different morphotypes and antibiotic susceptibility. Overall, P. aeruginosa evolved toward an increased mutation rate, increased antibiotic resistance, and reduced production of proteases. Isolates from samples of infected lungs tend to be less cytotoxic and motile and to produce more biofilm, compared with isolates from blood samples. CONCLUSION: These results provide the first evidence supporting the hypothesis that P. aeruginosa causes chronic infections in COPD, with patterns of infection and evolution that resemble those observed in cystic fibrosis. Experience gained from treating cystic fibrosis might be useful for implementing new procedures for the prevention, diagnosis, and treatment of infection due to P. aeruginosa in COPD.

Antibiotics as signals that trigger specific bacterial responses.

The ecological and evolutionary roles of antibiotics have been usually inferred from their therapeutical activity. Since those compounds inhibit bacterial growth, it was thought that they should be produced by soil microorganisms to inhibit the growth of competitors in natural habitats. It has been shown however that antibiotics modulate transcription of bacteria in a dose dependent manner. Furthermore, each antibiotic triggers a specific response, and those responses may have adaptive values. From these observations, it has been suggested that antibiotics may have a role as signalling molecules besides inhibitors. The facts that a number of antimicrobials not used for therapy (like lantibiotics) are involved in quorum sensing and that classical quorum sensing autoinducers have antimicrobial activity further support this dual role for antibiotics.

The neglected intrinsic resistome of bacterial pathogens.

Bacteria with intrinsic resistance to antibiotics are a worrisome health problem. It is widely believed that intrinsic antibiotic resistance of bacterial pathogens is mainly the consequence of cellular impermeability and activity of efflux pumps. However, the analysis of transposon-tagged Pseudomonas aeruginosa mutants presented in this article shows that this phenotype emerges from the action of numerous proteins from all functional categories. Mutations in some genes make P. aeruginosa more susceptible to antibiotics and thereby represent new targets. Mutations in other genes make P. aeruginosa more resistant and therefore define novel mechanisms for mutation-driven acquisition of antibiotic resistance, opening a new research field based in the prediction of resistance before it emerges in clinical environments. Antibiotics are not just weapons against bacterial competitors, but also natural signalling molecules. Our results demonstrate that antibiotic resistance genes are not merely protective shields and offer a more comprehensive view of the role of antibiotic resistance genes in the clinic and in nature.