Cleavage of an engulfment peptidoglycan hydrolase by a sporulation signature protease in Clostridioides difficile.

In the model organism Bacillus subtilis, a signaling protease produced in the forespore, SpoIVB, is essential for the activation of the sigma factor σK, which is produced in the mother cell as an inactive pro-protein, pro-σK. SpoIVB has a second function essential to sporulation, most likely during cortex synthesis. The cortex is composed of peptidoglycan (PG) and is essential for the spore's heat resistance and dormancy. Surprisingly, the genome of the intestinal pathogen Clostridioides difficile, in which σK is produced without a pro-sequence, encodes two SpoIVB paralogs, SpoIVB1 and SpoIVB2. Here, we show that spoIVB1 is dispensable for sporulation, while a spoIVB2 in-frame deletion mutant fails to produce heat-resistant spores. The spoIVB2 mutant enters sporulation, undergoes asymmetric division, and completes engulfment of the forespore by the mother cell but fails to synthesize the spore cortex. We show that SpoIIP, a PG hydrolase and part of the engulfasome, the machinery essential for engulfment, is cleaved by SpoIVB2 into an inactive form. Within the engulfasome, the SpoIIP amidase activity generates the substrates for the SpoIID lytic transglycosylase. Thus, following engulfment completion, the cleavage and inactivation of SpoIIP by SpoIVB2 curtails the engulfasome hydrolytic activity, at a time when synthesis of the spore cortex peptidoglycan begins. SpoIVB2 is also required for normal late gene expression in the forespore by a currently unknown mechanism. Together, these observations suggest a role for SpoIVB2 in coordinating late morphological and gene expression events between the forespore and the mother cell.

Clostridioides difficile Sporulation.

Some members of the Firmicutes phylum, including many members of the human gut microbiota, are able to differentiate a dormant and highly resistant cell type, the endospore (hereinafter spore for simplicity). Spore-formers can colonize virtually any habitat and, because of their resistance to a wide variety of physical and chemical insults, spores can remain viable in the environment for long periods of time. In the anaerobic enteric pathogen Clostridioides difficile the aetiologic agent is the oxygen-resistant spore, while the toxins produced by actively growing cells are the main cause of the disease symptoms. Here, we review the regulatory circuits that govern entry into sporulation. We also cover the role of spores in the infectious cycle of C. difficile in relation to spore structure and function and the main control points along spore morphogenesis.

The impact of YabG mutations on C. difficile spore germination and processing of spore substrates.

YabG is a sporulation-specific protease that is conserved among sporulating bacteria. C. difficile YabG processes cortex destined proteins preproSleC into proSleC and CspBA to CspB and CspA. YabG also affects synthesis of spore coat/exosporium proteins CotA and CdeM. In prior work that identified CspA as the co-germinant receptor, mutations in yabG were found which altered the co-germinants required to initiate spore germination. To understand how these mutations in the yabG locus contribute to C. difficile spore germination, we introduced these mutations into an isogenic background. Spores derived from C. difficile yabG C207A (catalytically inactive), C. difficile yabG A46D, C. difficile yabG G37E, and C. difficile yabG P153L strains germinated in response to TA alone. Recombinantly expressed and purified preproSleC incubated with E. coli lysate expressing wild type YabG resulted in the removal of the pre sequence from preproSleC. Interestingly, only YabGA46D showed any activity towards purified preproSleC. Mutation of the YabG processing site in preproSleC (R119A) led to YabG shifting its processing to R115 or R112. Finally, changes in yabG expression under the mutant promoters were analyzed using a SNAP-tag and revealed expression differences at early and late stages of sporulation. Overall, our results support and expand upon the hypothesis that YabG is important for germination and spore assembly and, upon mutation of the processing site, can shift where it cleaves substrates.

A one-step low-cost molecular test for SARS-CoV-2 detection suitable for community testing using minimally processed saliva.

The gold standard for coronavirus disease 2019 diagnostic testing relies on RNA extraction from naso/oropharyngeal swab followed by amplification through reverse transcription-polymerase chain reaction (RT-PCR) with fluorogenic probes. While the test is extremely sensitive and specific, its high cost and the potential discomfort associated with specimen collection made it suboptimal for public health screening purposes. In this study, we developed an equally reliable, but cheaper and less invasive alternative test based on a one-step RT-PCR with the DNA-intercalating dye SYBR Green, which enables the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directly from saliva samples or RNA isolated from nasopharyngeal (NP) swabs. Importantly, we found that this type of testing can be fine-tuned to discriminate SARS-CoV-2 variants of concern. The saliva RT-PCR SYBR Green test was successfully used in a mass-screening initiative targeting nearly 4500 asymptomatic children under the age of 12. Testing was performed at a reasonable cost, and in some cases, the saliva test outperformed NP rapid antigen tests in identifying infected children. Whole genome sequencing revealed that the antigen testing failure could not be attributed to a specific lineage of SARS-CoV-2. Overall, this work strongly supports the view that RT-PCR saliva tests based on DNA-intercalating dyes represent a powerful strategy for community screening of SARS-CoV-2. The tests can be easily applied to other infectious agents and, therefore, constitute a powerful resource for an effective response to future pandemics.

Spores of Clostridioides difficile are toxin delivery vehicles.

Clostridioides difficile causes a wide range of intestinal diseases through the action of two main cytotoxins, TcdA and TcdB. Ingested spores germinate in the intestine establishing a population of cells that produce toxins and spores. The pathogenicity locus, PaLoc, comprises several genes, including those coding for TcdA/B, for the holin-like TcdE protein, and for TcdR, an auto-regulatory RNA polymerase sigma factor essential for tcdA/B and tcdE expression. Here we show that tcdR, tcdA, tcdB and tcdE are expressed in a fraction of the sporulating cells, in either the whole sporangium or in the forespore. The whole sporangium pattern is due to protracted expression initiated in vegetative cells by σD, which primes the TcdR auto-regulatory loop. In contrast, the forespore-specific regulatory proteins σG and SpoVT control TcdR production and tcdA/tcdB and tcdE expression in this cell. We detected TcdA at the spore surface, and we show that wild type and ΔtcdA or ΔtcdB spores but not ΔtcdR or ΔtcdA/ΔtcdB spores are cytopathic against HT29 and Vero cells, indicating that spores may serve as toxin-delivery vehicles. Since the addition of TcdA and TcdB enhance binding of spores to epithelial cells, this effect may occur independently of toxin production by vegetative cells.

Primary Tumor Resection Before Systemic Therapy in Patients With Colon Cancer and Unresectable Metastases: Combined Results of the SYNCHRONOUS and CCRe-IV Trials.

PURPOSE: Chemotherapy is established as primary treatment in patients with stage IV colorectal cancer and unresectable metastases. Data from nonrandomized clinical trials have fueled persistent uncertainty if primary tumor resection (PTR) before chemotherapy prolongs survival. We investigated the prognostic value of PTR in patients with newly diagnosed stage IV colon cancer who were not amenable to curative treatment. PATIENTS AND METHODS: Patients enrolled in the multicenter, randomized SYNCHRONOUS and CCRe-IV trials were included in the analysis. Patients with colon cancer with synchronous unresectable metastases were randomly assigned at 100 sites in Austria, Germany, and Spain to undergo PTR or up-front chemotherapy (No PTR group). The chemotherapy regimen was left at discretion of the local team. Patients with tumor-related symptoms, inability to tolerate surgery and/or systemic chemotherapy, and history of another cancer were excluded. The primary end point was overall survival (OS), and the analyses were performed with intention-to-treat. RESULTS: A total of 393 patients were randomly assigned to undergo PTR (n = 187) or no PTR (n = 206) between November 2011 and March 2017. Chemotherapy was not administered to 6.4% in the No PTR group and 24.1% in the PTR group. The median follow-up time was 36.7 months (95% CI, 36.6 to 37.3). The median OS was 16.7 months (95% CI, 13.2 to 19.2) in the PTR group and 18.6 months (95% CI, 16.2 to 22.3) in the No PTR group (P = .191). Comparable OS between the study groups was further confirmed on multivariate analysis (hazard ratio, 0.944 [95% CI, 0.738 to 1.209], P = .65) and across all subgroups. Patients with serious adverse events were more common in the No PTR group (10.2% v 18.0%; P = .027). CONCLUSION: Among patients with colon cancer and synchronous unresectable metastases, PTR before systemic chemotherapy was not associated with prolonged OS.

Desafíos de la educación en enfermería en pandemia: percepción y experiencia de los estudiantes de enfermería sobre la incorporación de la simulación virtual / Challenges of nursing education in a pandemic: perception and experience of nursing students on the incorporation of virtual simulation

Introducción: en el contexto de la pandemia mundial por COVID-19 se incorporan nuevas metodologías de enseñanza-aprendizaje para contribuir al logro de los objetivos de aprendizaje frente al cierre de las universidades y de los campos clínicos. Esta investigación evalúa la percepción y la experiencia de los estudiantes de tercer y cuarto año de pregrado de enfermería, frente al uso de escenarios de simulación virtual como complemento de la práctica clínica. Materialesy métodos: un total de 68 estudiantes (26%) respondieron la encuesta de percepción sobre su experiencia del uso de la simulación virtual a través del softwarevSim for Nursing™. Se realizó un análisis cuantitativo y cualitativo de los datos. Resultados: un 89,7% de los estudiantes consideraron que la simulación virtual es útil para el aprendizaje y que contribuye principalmente para la comprensión de los contenidos y desarrollo de las habilidades de valoración clínica.Discusión: la experiencia en la simulación virtual es realista y útil tanto para aprender nuevos conocimientos,para reforzar los saberes previos y así también como una buena preparación para la práctica clínica. Se visualiza su incorporación desde el inicio al término de la carrera. Sin embargo, para áreas como salud mental otras metodologías podrían ser más adecuadas para mejorar las habilidades de comunicación.

Introduction: in the context of the global pandemic due to COVID-19, new teaching-learning methodologies were incorporated to contribute to learning objectives in the face of the closure of the university and clinical fields. This research assesses the perception and experience of third and fourth-year undergraduate nursing students regarding using virtual simulation scenarios as a to complement clinical practice. Materials and methods: 68 students (26%) responded to the perception survey about their experienceusing virtual simulation through the vSim for Nursing™ software. A quantitative and qualitative analysis of the data was carried out. Results: 89.7% of the students considered that virtual simulation is rewarding for learning and that it contributes mainly to the understanding of the contents and the development of clinical assessment skills. Discussion: the experience in virtual simulation is realistic and practical both to learning new knowledge, reinforce previous one and thus also as good preparation for clinical practice. Their incorporation is visualized from the beginning to the end of the degree. However, for areas such as mental health, other methodologies might be more suitable to improve communication skills.

Estudio piloto: contacto padre-hijo(a) y oxitocina en varones preparados especialmente para el nacimiento / Pilot study: father-child contact and oxytocin in males with a special education for childbirth

INTRODUCCÍON: Los padres se han involucrado cada vez más en el embarazo y el nacimiento de sus hijos, pero aún se requieren intervenciones paternas que permitan reubicar al padre en su rol de corresponsabilidad en la crianza. OBJETIVO: Observar el comportamiento-actitud paterna hacia el/la hijo(a) y la cantidad de oxitocina (OT) secretada en el nacimiento, en padres preparados de un modo especial para el parto. Método: Estudio piloto de 8 meses, parte de una investigación mayor cuali-cuantitativa de dos fases. La fase cualitativa inicial desarrolló una intervención preparatoria de padres para el nacimiento, con énfasis en la vinculación padre-hijo(a). La fase cuantitativa correspondió al piloto de la intervención paterna antenatal. RESULTADOS: Los padres presenciaron activamente el momento del expulsivo y el encuentro madre-hijo(a). Posteriormente, todos optaron por el contacto físico piel-piel con su hijo(a). La OT paterna experimentó un aumento (no significativo) durante el contacto padre-hijo(a) en comparación con la OT basal (momento inmediato al nacimiento). CONCLUSIONES: Padres preparados, sensibilizados y vinculados con su hijo(a) desde el embarazo experimentarían variaciones de la cantidad de OT cuando realizan contacto piel-piel con su hijo(a) en el nacimiento. Se requiere investigación experimental con una muestra mayor de participantes para concluir de manera categórica.

INTRODUCTION: Fathers have been increasingly involved in the pregnancy and birth of their children, but paternal interventions are still required to relocate the father in his role of co-responsibility in parenting. OBJECTIVE: To observe the paternal behavior-attitude towards the child and the amount of oxytocin (OT) secreted at birth in parents prepared (in a special way) for childbirth. METHOD: Pilot study of 8 months, part of a larger qualitative-quantitative research of two phases. The initial qualitative phase developed a male preparatory intervention for the birth, with emphasis on the father-child bonding. The quantitative phase corresponded to the pilot of the antenatal paternal intervention. RESULTS: Fathers actively witnessed the moment of delivery and the mother-child attachment. Subsequently, all of them opted for physical skin-to-skin contact with their child. Paternal OT experienced a (non-significant) increase during father-child contact, compared to baseline OT (immediately after birth). CONCLUSIONS: Males prepared, sensitized and involved with their child since pregnancy would experience variations in the amount of OT when they make father-child skin-to-skin contact at childbirth. Experimental research with a larger sample of participants is required to categorically reach a conclusion.

Father Committed to Early Parenting from the First Father-child Contact Experienced at Birth / Padre comprometido con la crianza temprana desde el primer contacto padre-hijo/a vivido en el nacimiento / Pai comprometido em criar seu filho/a desde o primeiro contato pai-filho/a vivenciado com o parto

ABSTRACT Objective: To know how the phenomenon of active paternal upbringing is shown from the father-child contact experience during birth. Method: Analysis of secondary information from a qualitative study of a phenomenological nature. Transcripts of interviews and focus groups of all the fathers who participated in a father-child contact protocol for a doctoral thesis. Results: The study revealed the global structure of the phenomenon, whose central axis corresponds to "father who advances towards the integral connection with his child and is committed with parenting", and its three comprehensive categories: expectations of being a father and actor in parenting; the experience of being a father at birth time; and the everyday of the upbringing. Conclusion: Prenatal preparation and skin-to-skin contact during birth mobilize the father towards commitment and involvement with the upbringing of his child from the beginning.

RESUMEN Objetivo: conocer cómo se muestra el fenómeno de la crianza paterna activa a partir de la experiencia de contacto padre-hijo/a, vivida durante el nacimiento. Método: análisis de información secundaria de un estudio cualitativo de naturaleza fenomenológica. Transcripciones de entrevistas y grupos focales de todos los padres que participaron de un protocolo de contacto padre-hijo/a para una tesis doctoral. Resultados: el estudio reveló la estructura global del fenómeno, cuyo eje central corresponde a "padre que transita hacia la conexión integral con su hijo/a y se compromete con la crianza", y sus tres categorías comprensivas: expectativas de ser padre y actor en la crianza; la vivencia de ser padre en el momento del nacimiento; el día a día de la crianza. Conclusión: la preparación antenatal y el contacto piel con piel durante el nacimiento movilizan al padre hacia el compromiso e involucramiento con la crianza de su hijo/a desde el comienzo.

RESUMO Objetivo: conhecer como o fenômeno da educação paterna ativa é demonstrado a partir da experiência de contato pai-filho/a vivida durante o nascimento. Método: análise de informações secundárias a partir de um estudo qualitativo de natureza fenomenológica. Transcrições de entrevistas e grupos focais de todos os pais que participaram de um protocolo de contato pai-filho para uma tese de doutorado. Resultados: o estudo revelou a estrutura global do fenômeno, cujo eixo central corresponde ao "pai que transita em direção à conexão integral com o filho / a e está comprometido em criar", e suas três categorias abrangentes: expectativas de ser pai e ator na criação; a experiência de ser pai ao nascer; o dia a dia no processo de criação. Conclusão: o preparo pré-natal e o contato pele a pele durante o parto mobilizam o pai para o comprometimento e o envolvimento com a criação do filho desde o início.

Padre preparado y comprometido en su rol de acompañante durante el proceso de parto / Fathers Prepared For and Committed to Their Role as Companions during the Birth Process / Pai preparado e comprometido em seu papel como acompanhante durante o processo de nascimento

RESUMEN Objetivo: identificar las necesidades de preparación del padre acompañante para brindar apoyo a su pareja durante el proceso de parto. Método: metodología cualitativa: investigación-acción con la participación de doce padres y sus parejas, con quienes se exploraron las necesidades educativas por medio de grupos focales y entrevistas estructuradas. Se desarrolló, implementó y evaluó la preparación antenatal del padre en su rol de acompañante durante los años 2015 y 2016. Resultados: una expectativa que se constituyó en un gran tema emergente fue "conocer más acerca del proceso de parto" y "estar ahí con ella y para ella", como beneficio para su rol de acompañante preparado y sensible a las necesidades de la mujer. Conclusión: es indispensable considerar estrategias que fortalezcan el rol del padre y aumenten sus competencias para la integración, empoderamiento y acompañamiento durante el proceso de parto.

ABSTRACT Objective: To identify fathers' needs in their preparation as a companion to provide emotional support to mothers during childbirth. Materials and methods: An action research project was carried out involving twelve men and their wives. Their educational needs were explored using focus groups and structured interviews during 2015 and 2016. Results: The main emerging themes were "knowing more about the birth process" and "being there with her and for her" as benefits that contribute to the role of a sensitive companion prepared to understand the woman's needs. Considering one of the major emerging themes, antenatal training for fathers as companions and support during childbirth was developed, implemented and evaluated. Conclusion: It is essential to consider different strategies to strengthen the father's role by increasing their skills for integration, empowerment and support during birth, and to enhance their satisfaction in meeting the needs felt in a family birth scenario.

RESUMO Objetivo: identificar as necessidades de preparação do pai acompanhante para oferecer suporte e continência para a sua parceira durante o processo de parto. Método: trata-se de uma metodologia qualitativa de pesquisa, que contou com a participação de 12 pais e suas parceiras, com os quais foram exploradas as necessidades educativas, por meio da utilização de técnicas de grupo focal e entrevistas estruturadas. Foi desenvolvida, implementada e avaliada a preparação pré-natal para o desempenho de seus papéis de acompanhante durante 2015 e 2016. Resultados: expectativas que se constituíram como grandes temas emergentes foram "conhecer mais sobre o processo de parto" e "'estar aí' com ela e para ela" como benefícios para seus papéis de acompanhantes preparados e sensíveis às necessidades da mulher. Conclusão: é indispensável considerar estratégias que permitam relevar o papel do pai, aumentando suas competências para a integração, empoderamento e acompanhamento durante o processo de parto, para promover a satisfação da necessidade sentida de um genuíno nascimento em família.

Factores asociados a consumo de tabaco durante el último año en estudiantes de educación superior / Smoking associated factors in students during their last year of higher education / Fatores associados a consumo do cigarro durante o último ano em estudantes de educação superior

Objetivo. Determinar los factores de riesgo asociados al consumo de tabaco en el último año en una población universitaria chilena. Metodología. Estudio observacional analítico, de corte transversal. Se realizó muestreo aleatorio estratificado según unidad académica y año de carrera, siendo el tamaño muestral de 2045 estudiantes de cuatro Campus de la Universidad Católica de Chile. La toma de la información se hizo con ayuda de un cuestionario autoaplicado. Se realizaron análisis descriptivo, bivariado y de regresión logística. Resultados. El promedio de edad fue 20.4±1,6 años, el 46.6% eran de sexo masculino y el70.3% tenían nivel socioeconómico alto. Un 91.0% había iniciado el consumo después de los 18 años. La prevalencia mensual de consumo de tabaco fue de 40.5%, un 20.0% de los encuestados estaría a riesgo de tener diagnóstico de tabaquismo. Se encontró asociación positiva entre consumo de tabaco durante último año y: la edad (p<0.05), el sexo femenino (p<0.001), el nivel socioeconómico (p<0.05) y la percepción de consumo de droga por parte de padres (p<0.001). Se encontró asociación negativa entre consumo de tabaco y la religiosidad (p<0.001).Conclusión. En el grupo universitario en el que se realizó el estudio se encontró que el problema de tabaquismo merece especial atención por su magnitud, estando asociado a factores de riesgo como la edad, el sexo femenino, el estrato socioeconómico y una baja religiosidad.

Objective. To determine the risk factors associated to smokingin the last year of school in a Chilean university population. Methodology. Analytical, observational, transversal cut study. Stratified randomized sampling was conducted according to academic unit and year of career; the size of the sample was of 2045 students from four campuses of the catholic university of Chile. The information was collected with a self-applied questionnaire. A descriptive, bivariate and logistic regression analysis was made. Results. The average age was 20.4±1.6,46% were males and 70.3% had a high socioeconomic status. 91% had started cigarette consumption before the age of 18. The smoking monthly prevalence was of 40.5%, 20% of the surveyed would be atrisk of having diagnosis of smoking. A positive association was found between smoking during the last year of university and: age (p<0.05), female sex (p<0.001), socioeconomic status (p<0.05) and parents drugconsumption perception (p<0.001). A negative association was found between smoking and religiosity(p<0.001). Conclusion. In the studied university group it was found that the smoking problem requires special attention due to its magnitude and association to risk factors as age, female gender, socioeconomic status and a low religiosity.

Objetivo. Determinar os fatores de risco associados ao consumo do cigarro no último ano numa população universitária chilena. Metodologia. Estudo observacional analítico, de corte transversal. Realizou-se amostra gemaleatória estratificado segundo unidade acadêmica e ano de carreira, sendo o tamanho da mostra de2 045 estudantes de quatro Campus da Universidade Católica de Chile. A tomada da informação se fez comajuda de um questionário auto-aplicado. Realizaram-se análise descritiva, bivariado e de regressão logística. Resultados. A média de idade foi 20.4±1,6 anos, o 46.6% eram de sexo masculino e o 70.3% tinham nível socioeconômico alto. Um 91% tinha iniciado o consumo depois dos 18 anos. A prevalência mensal de consumo do cigarro foi de 40.5%, um 20% dos interrogados estaria a risco de ter diagnóstico de tabagismo. Encontrou-se associação positiva entre consumo de fumo durante último ano e: a idade (p<0.05), o sexo feminino (p<0.001), o nível socioeconômico (p<0.05) e a percepção de consumo de droga por parte de pais (p<0.001). Encontrou-se associação negativa entre consumo de fumo e a religiosidade (p<0.001). Conclusão. No grupo universitário no que se realizou o estudo se encontrou que o problema de tabagismo merece especial atendimento por sua magnitude, estando sócio a fatores de risco como a idade, o sexo feminino,o estrato socioeconômico e uma baixa religiosidade.

Vías de comunicación preferidas por profesionales de la salud para acceder a programas de formación continua en una escuela de enfermería chilena / Health professionals' preferred ways of receiving information related to continuing education in a chilean school of nursing

Comunicar es una función básica y en salud tiene como uno de sus propósitos informar respecto de programas que promuevan la actualización permanente de sus profesionales. El objetivo del estudio fue conocer las vías de difusión preferidas por profesionales de la salud para obtener información acerca de los programas de formación continua de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile. Fue un estudio descriptivo de corte transversal, con una muestra de 93 profesionales de la salud. Se diseñó un cuestionario de autoapli-cación revisado por jueces, aplicado previo consentimiento informado. Como resultado se obtuvo que los profesionales accedían a programas de formación continua principalmente a través del lugar de trabajo (36 por ciento, n=42). En relación a las vías de comunicación preferidas para utilizar a futuro, el uso de e-mail personal aparece como primera opción (40 por ciento, n=38) y el e-mail laboral en segunda preferencia (20 por ciento, n=19). Destaca como sugerencia de otra vía de comunicación los medios masivos. Se concluye que la vía de comunicación preferida por los profesionales es la Internet a través de e-mail personalizados. Una base de datos on-line se convierte en una herramienta clave en comunicación que requiere un uso cuidadoso para prevenir su saturación y no constituirse en un elemento de interferencia comunicativa. Resulta importante además el uso de varias vías alternativas para fijar el mensaje enviado.

Motivaciones y expectativas para participar en una asociacion de ex-alumnos de enfermeria / Motivations and expectations to participate in a university graduate association of nursing

Esta investigación pretende conocer motivaciones y expectativas de egresados de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile para participar en una Asociación de Ex-alumnos (AEA). Estudio descriptivo, de corte transversal, en 97 egresados de las generaciones 1970-2000. El muestreo fue probabilístico aleatorio (intervalo de confianza 10 por ciento). Para la recolección de datos se utilizó un cuestionario validado por expertos. Para el análisis se utilizó SPSS 8.0. Como resultado se obtuvo que el 71,1 por ciento de los egresados refiere interés por pertenecer en la AEA. Los motivos más mencionados para participar son asociatividad (33,6 por ciento), posibilidad de perfeccionamiento (23,8 por ciento) y crecimiento de la profesión (16,8 por ciento). Entre los beneficios que esperan recibir destacaron interés por perfeccionarse (43,4 por ciento) y asociatividad (30,2 por ciento). Del grupo de egresados que no desea participar, el 70,4 por ciento refiere falta de tiempo y el 14,8 por ciento alejamiento de la profesión. Se puede concluir que el mayor porcentaje de los egresados estaría motivado para participar en la AEA y la asociatividad y la posibilidad de perfeccionamiento son las principales motivación y expectativa del grupo respectivamente.

Insuficiencia respiratoria y sindrome de distress respiratorio del adulto en una unidad de cuidado intensivo pediátrico

Es un estudio prospectivo de Insuficiencia Respiratoria Aguda (IRA) entre enero y agosto de 1993. De un total de 179 pacientes que ingresaron a la UCI del Hospital de Niños Baca Ortiz de la ciudad de Quito, 39 tuvieron diagnóstico de IRA. La edad de los pacientes fluctua entre 1 mes y 14 años. La IRA es uan de las principales causas de ingreso a la UCI. Presenta una alta mortalidad (mayor al 30 por ciento) y el Síndrome de distress respiratorio del adulto (SDRA), una forma severa de lesión pulmonar, es una complicación frecuente. Los criterios de selección de los pacientes fueron: radiografía de torax, índice de hipoxemia, utilización de presión positiva al final de la espiración (PEEP) y compliance pulmonar. En cada uno de éllos se dio un puntaje de 0 a 4. Con estos criterios los pacientes se dividieron en tres grupos cada uno de los cuales tiene un puntaje que determina el grado de lesión. Todos los pacientes fueron sometidos a ventilación mecánica. El objetivo del estudio fue determinar la incidencia de IRA y SDRA en la UCI de acuerdo a grados de lesion pulmonar.

O Sistema Único de Saúde e suas diretrizes constitucionais / The Health System and its constitutional guidelines

Trata-se de trabalho voltado à análise do sistema único de saúde e de suas diretrizes constitucionais. A Constituição de 1988 determinou que todas as ações e recursos públicos em matéria de saúde fossem organizados sob a forma de um sistema regionalizado, hierarquizado e orientado por três diretrizes: descentralização com direção única em cada esfera de governo, assistência integral e participação da comunidade. Desvendar o significado e o alcance dessas definições foi o objetivo que orientou a autora em suas reflexões. Procuradora do Estado de São Paulo, com mais de dez anos de atuação junto à Procuradoria de Assistência Judiciária, a autora, além de sólida pesquisa, aportou ao trabalho reflexões oriundas do contato profissional cotidiano que teve com o tema.