Pulse Spray Drying for Bovine Skimmed Milk Powder Production.

Pulse Spray Drying (PSD) has potential as a sustainable means of skimmed milk powder (SMP) production. In this study, powders were obtained from PSD using different drying outlet temperatures (70, 80, 90 and 100 °C), and their characteristics were compared to those of traditional Spray Drying (SD). Native whey proteins were well preserved and Solubility Indexes were over 98% in all cases, despite powders obtained by PSD displaying lower solubility than the SD ones. No visual difference was observable in the powders (ΔE < 2); however, PSD powders were found to be yellower with a higher Browning Index. The drying technology did not have a significant effect on powder moisture content and bulk density. Particle size distribution and scanning electron microscopy images confirmed the presence of fine particles (<10 µm) in all samples that might have provided poor flowability and wetting behavior (overall Carr Index and Hausner ratio were 33.86 ± 3.25% and 1.52 ± 0.07, respectively). Higher amounts of agglomerated particles were found at low temperatures in the products processed with both technologies, but PSD samples showed a narrower particle size distribution and hollow particles with more wrinkles on the surface (probably due to the fast evaporation rate in PSD). Overall, PSD provided SMP with comparable physicochemical characteristics to SD and, once optimized at the industrial level, could offer significant advantages in terms of thermal efficiency without significant modification of the final product quality.

People in Ecuador and the United States conceptualize compassion differently: The role of avoided negative affect.

Even people from frequently studied cultural contexts differ in how they conceptualize compassion, partly because of differences in how much they want to avoid feeling negative. To broaden this past work, we include participants from an understudied cultural context and start to examine the process through which culture shapes compassion. Based on ethnographic and empirical studies that include Ecuadorians, we predicted that Ecuadorians would want to avoid feeling negative less compared to U.S. Americans. Furthermore, we hypothesized that because of these differences in avoided negative affect, compared to U.S. Americans, for Ecuadorians, a compassionate response would contain more emotion sharing, which in turn would be associated with conceptualizing a compassionate face as one that mirrors sadness more and expresses happiness (e.g., a kind smile) less. Using a reverse correlation task, participants in the United States and Ecuador selected the stimuli that most resembled a compassionate face. They also reported how much they wanted to avoid feeling negative and described what a compassionate response would entail. As predicted, compared to U.S. Americans, Ecuadorians wanted to avoid feeling negative less, they conceptualized a compassionate response as one that focused more on emotion sharing, and visualized a compassionate face as one that contained more sadness and less happiness. Furthermore, exploratory analyses suggest that wanting to avoid feeling negative and conceptualizations of a compassionate response as emotion sharing partly sequentially explained the cultural differences in conceptualizations of a compassionate face. What people regard as compassionate differs across cultures, which has important implications for cross-cultural counseling. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor.

Background: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate. Objectives: The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA). Design and methods: We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months. Results: PSAD showed a significant association with PSM (p < 0.0001), PSA persistence (p < 0.0001), and Gleason ⩾ 7 (p < 0.0001), without being statistically significant in predicting BCR (p = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 versus 0.771) and Gleason ⩾ 7 (AUC 0.683 versus 0.649). Conclusion: PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems.

Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor Prostate-specific antigen density (PSAD) has an established role in the diagnostic process of prostate cancer (PCa). However, controversy remains on the assessment of its value as a pretreatment prognostic factor. The aim of our study was to evaluate the predictive ability of PSAD for oncological outcomes in PCa patients treated with robot-assisted radical prostatectomy (RARP) and to compare with the value of preoperative PSA (pPSA). The present analysis showed a significant association of PSAD with positive surgical margins (PSM), Gleason Score >=7 and prostate-specific antigen (PSA) persistence after RARP. Moreover, PSAD demonstrated to perform comparably to pPSA in predicting the outcomes of clinically significant PCa (csPCa) and post-RARP PSA persistence. Therefore, PSAD is considered a preoperative predictive factor potentially useful in conjunction with other previously established prognostic criteria and clinical features.

Comparative study of two retrograde locked intramedullary nail designs for ankle arthrodesis: A finite element analysis.

Ankle arthrodesis is the gold standard for treatment of end-stage arthritis. The goal of ankle arthrodesis is to obtain bony union between the tibia and the talus. Retrograde intramedullary nailing is typically reserved for ankle and subtalar joints arthrodesis. The purpose of this study is to evaluate the effect of two different materials, two locking pin configurations and two nail designs of a retrograde locked intramedullary nail used for ankle arthrodesis. Using the finite element analysis, a numerical study of ankle arthrodesis was developed to evaluate the effect of materials: TI-6Al-4V and stainless steel AISI 316 LVM; two locking pin configurations: five and six pins, on two intramedullary nails: Ø10 × 180 mm and Ø11 × 200 mm. A model of a healthy foot was created from tomographic scans. It was found that the mechanical stimulus required to achieve bone fusion were higher for Ø10 × 180 nails (6.868 ± 0.047) than the Ø11 × 200 nails (5.918 ± 0.047; p < 0.001; mean ± SEM). We also found that six-pin configuration had a higher mechanical stimulus (6.470 ± 0.047) than the five-pin configuration (6.316 ± 0.046; p = 0.020). Similarly, it was higher for titanium (6.802 ± 0.047) than those for stainless steel (5.984 ± 0.046; p < 0.001). Finally, the subtalar zone presented higher values (7.132 ± 0.043) than the tibiotalar zone (5.653 ± 0.050; p < 0.001). The highest mechanical stimulus around the vicinity of tibiotalar and subtalar joint was obtained by Ø10 × 180 nails, made of titanium alloy, with 6P.

Fusion crystallization reveals the behavior of both the 1TEL crystallization chaperone and the TNK1 UBA domain.

Human thirty-eight-negative kinase-1 (TNK1) is implicated in cancer progression. The TNK1 ubiquitin-associated (UBA) domain binds polyubiquitin and plays a regulatory role in TNK1 activity and stability. No experimentally determined molecular structure of this unusual UBA domain is available. We fused the UBA domain to the 1TEL variant of the translocation ETS leukemia protein sterile alpha motif (TELSAM) crystallization chaperone and obtained crystals diffracting as far as 1.53 Å. GG and GSGG linkers allowed the UBA to reproducibly find a productive binding mode against its host 1TEL polymer and crystallize at protein concentrations as low as 0.2 mg/mL. Our studies support a mechanism of 1TEL fusion crystallization and show that 1TEL fusion crystals require fewer crystal contacts than traditional protein crystals. Modeling and experimental validation suggest the UBA domain may be selective for both the length and linkages of polyubiquitin chains.

Increasing the bulk of the 1TEL-target linker and retaining the 10×His tag in a 1TEL-CMG2-vWa construct improves crystal order and diffraction limits.

TELSAM-fusion crystallization has the potential to become a revolutionary tool for the facile crystallization of proteins. TELSAM fusion can increase the crystallization rate and enable crystallization at low protein concentrations, in some cases with minimal crystal contacts [Nawarathnage et al. (2022), Open Biol. 12, 210271]. Here, requirements for the linker composition between 1TEL and a fused CMG2 vWa domain were investigated. Ala-Ala, Ala-Val, Thr-Val and Thr-Thr linkers were evaluated, comparing metrics for crystallization propensity and crystal order. The effect on crystallization of removing or retaining the purification tag was then tested. It was discovered that increasing the linker bulk and retaining the 10×His purification tag improved the diffraction resolution, likely by decreasing the number of possible vWa-domain orientations in the crystal. Additionally, it was discovered that some vWa-domain binding modes are correlated with scrambling of the 1TEL polymer orientation in crystals and an effective mitigation strategy for this pathology is presented.

Fusion crystallization reveals the behavior of both the 1TEL crystallization chaperone and the TNK1 UBA domain.

Human thirty-eight-negative kinase-1 (TNK1) is implicated in cancer progression. The TNK1-UBA domain binds polyubiquitin and plays a regulatory role in TNK1 activity and stability. Sequence analysis suggests an unusual architecture for the TNK1 UBA domain, but an experimentally-validated molecular structure is undetermined. To gain insight into TNK1 regulation, we fused the UBA domain to the 1TEL crystallization chaperone and obtained crystals diffracting as far as 1.53 Å. A 1TEL search model enabled solution of the X-ray phases. GG and GSGG linkers allowed the UBA to reproducibly find a productive binding mode against its host 1TEL polymer and to crystallize at protein concentrations as low as 0.1 mg/mL. Our studies support a mechanism of TELSAM fusion crystallization and show that TELSAM fusion crystals require fewer crystal contacts than traditional protein crystals. Modeling and experimental validation suggest the UBA domain may be selective for both the length and linkages of polyubiquitin chains.

Separation of α-Lactalbumin-Enriched Fractions from Caprine and Ovine Native Whey Concentrate by Combining Membrane and High-Pressure Processing.

Whey from goat and sheep have been gaining attention in the last few years for their nutritional properties. Unfortunately, ß-Lg, not found in human milk, may trigger infant allergies if used in infant food formulations, so there is a growing interest in developing ingredients derived from whey with higher α-La/ß-Lg ratios. The objective of this work was to study the effect of high-pressure processing (HPP) on caprine and ovine native whey concentrates (NWC) in order to obtain α-Lactalbumin (α-La)-enriched fractions. NWCs were treated at 600 MPa (23 °C) for 2, 4, and 15 min and two pH conditions were studied (physiological pH and pH 4.60). The concentration of ß-Lg in supernatant fraction after HPP significantly decreased after 2 min of treatment, while the concentration of α-La was unchanged in both goat and sheep samples. Longer HPP processing times (up to 15 min) progressively increased α-La purification degree but also decreased the α-La yield. Caprine and ovine NWCs treated at physiological pH provided better α-La yield, α-La purification degree, and higher ß-Lg precipitation degrees than the corresponding acidified samples, while the corresponding NWC supernatant (NWCsup) showed lower values for both surface hydrophobicity and total free thiol indices, suggesting a higher extent of protein aggregation. Effects of sample acidification and the HPP treatment were opposite to those previously reported on bovine NWC, so further characterization of caprine and ovine ß-Lg should be carried out to understand their different behavior.

Decreasing the flexibility of the TELSAM-target protein linker and omitting the cleavable fusion tag improves crystal order and diffraction limits.

TELSAM crystallization promises to become a revolutionary tool for the facile crystallization of proteins. TELSAM can increase the rate of crystallization and form crystals at low protein concentrations without direct contact between TELSAM polymers and, in some cases, with very minimal crystal contacts overall (Nawarathnage et al ., 2022). To further understand and characterize TELSAM-mediated crystallization, we sought to understand the requirements for the composition of the linker between TELSAM and the fused target protein. We evaluated four different linkers Ala-Ala, Ala-Val, Thr-Val, and Thr-Thr, between 1TEL and the human CMG2 vWa domain. We compared the number of successful crystallization conditions, the number of crystals, the average and best diffraction resolution, and the refinement parameters for the above constructs. We also tested the effect of the fusion protein SUMO on crystallization. We discovered that rigidification of the linker improved diffraction resolution, likely by decreasing the number of possible orientations of the vWa domains in the crystal, and that omitting the SUMO domain from the construct also improved the diffraction resolution. Synopsis: We demonstrate that the TELSAM protein crystallization chaperone can enable facile protein crystallization and high-resolution structure determination. We provide evidence to support the use of short but flexible linkers between TELSAM and the protein of interest and to support the avoidance of cleavable purification tags in TELSAM-fusion constructs.

Spirometry and respiratory oscillometry: Feasibility and concordance in schoolchildren with asthma.

OBJECTIVE: The purpose of this study was to describe the feasibility of respiratory oscillometry (RO) in schoolchildren with asthma, and the concordance of its results with those of spirometry, to determine its clinical usefulness. METHODS: RO and spirometry were performed in 154 children (6 to 14-year-old) with asthma, following strict quality criteria for the tests. Their feasibility (probability of valid test, time of execution, number of maneuvers needed to achieve a valid test, and perceived difficulty) was compared. The factors that influence feasibility were analyzed with multivariate methods. FEV1, FEV1/FVC, FVC and FEF25-75 for spirometry, and R5, AX and R5-19 for RO, were converted into z-scores and their concordance was investigated through intraclass correlation coefficients (ICC) and kappa indices for normal/abnormal values. RESULTS: There were no differences in the probability of obtaining a valid RO or spirometry (83.1% vs. 81.8%, p = 0.868). RO required a lower number of maneuvers [mean (SD) 4.2 (1.8) versus 6.0 (1.6), p < 0.001] and less execution time [5.1 (2.7) versus 7.6 (2.4) minutes, p < 0.001], and patients considered it less difficult. Age increased the probability of obtaining valid RO and spirometry. The concordance of results between RO and spirometry was low, and only between zFEV1 and zAX could it be considered moderate (ICC = 0.412, kappa = 0.427). CONCLUSION: RO and spirometry are feasible in children with asthma. RO has some practical advantages, but the concordance of its results with spirometry is low.

Separation of α-Lactalbumin Enriched Fraction from Bovine Native Whey Concentrate by Combining Membrane and High-Pressure Processing.

Whey exhibits interesting nutritional properties, but its high ß-Lactoglobulin (ß-Lg) content could be a concern in infant food applications. In this study, high-pressure processing (HPP) was assessed as a ß-Lg removal strategy to generate an enriched α-Lactalbumin (α-La) fraction from bovine native whey concentrate. Different HPP treatment parameters were considered: initial pH (physiological and acidified), sample temperature (7-35 °C), pressure (0-600 MPa) and processing time (0-490 s). The conditions providing the best α-La yield and α-La purification degree balance (46.16% and 80.21%, respectively) were 4 min (600 MPa, 23 °C), despite the significant decrease of the surface hydrophobicity and the total thiol content indexes in the α-La-enriched fraction. Under our working conditions, the general effects of HPP on α-La and ß-Lg agreed with results reported in other studies of cow milk or whey. Notwithstanding, our results also indicated that the use of native whey concentrate could improve the ß-Lg precipitation degree and the α-La purification degree, in comparison to raw milk or whey. Future studies should include further characterization of the α-La-enriched fraction and the implementation of membrane concentration and HPP treatment to valorize cheese whey.

Marine Actinobacteria a New Source of Antibacterial Metabolites to Treat Acne Vulgaris Disease-A Systematic Literature Review.

Acne vulgaris is a multifactorial disease that remains under-explored; up to date it is known that the bacterium Cutibacterium acnes is involved in the disease occurrence, also associated with a microbial dysbiosis. Antibiotics have become a mainstay treatment generating the emergence of antibiotic-resistant bacteria. In addition, there are some reported side effects of alternative treatments, which indicate the need to investigate a different therapeutic approach. Natural products continue to be an excellent option, especially those extracted from actinobacteria, which represent a prominent source of metabolites with a wide range of biological activities, particularly the marine actinobacteria, which have been less studied than their terrestrial counterparts. Therefore, this systematic review aimed to identify and evaluate the potential anti-infective activity of metabolites isolated from marine actinobacteria strains against bacteria related to the development of acne vulgaris disease. It was found that there is a variety of compounds with anti-infective activity against Staphylococcus aureus and Staphylococcus epidermidis, bacteria closely related to acne vulgaris development; nevertheless, there is no report of a compound with antibacterial activity or quorum-sensing inhibition toward C. acnes, which is a surprising result. Since two of the most widely used antibiotics for the treatment of acne targeting C. acnes were obtained from actinobacteria of the genus Streptomyces, this demonstrates a great opportunity to pursue further studies in this field, considering the potential of marine actinobacteria to produce new anti-infective compounds.

Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain.

OBJECTIVE: Serratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit. METHODS: In order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens. RESULTS: During this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens. CONCLUSION: A unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.

Usefulness of Tissue Tracking by Cardiac Magnetic Resonance to Predict Events in Patients With Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HC) is the most common cardiovascular inherited disease, and it is associated with arrhythmic events, heart failure, and death. Strain analysis by tissue tracking (TT) techniques on cardiac magnetic resonance (CMR) is a novel noninvasive diagnostic tool. However, the usefulness of CMR-TT to identify patients with HC at risk of adverse outcomes remains unknown. CMR strain parameters by CMR-TT were prospectively measured in a cohort of 136 consecutive patients with HC. Clinical (death or readmission for heart failure) and arrhythmic (any ventricular tachycardia) events during follow-up were prospectively recorded. Global radial systolic strain rate and global radial diastolic strain rate showed the best area under the receiver operating characteristic curve (ROC curve) to predict adverse clinical events. On Cox multivariate regression models, a global radial systolic strain rate value <1.4/s and a global radial diastolic strain rate value ≥ -1.38/s were independently associated with clinical events at follow-up (adjusted hazard ratio 6.57, 95% confidence interval [CI] 2.01 to 21.49, p = 0.002; adjusted hazard ratio 5.96, 95% CI 1.79 to 19.89, p = 0.004, respectively). Regarding arrhythmic events, global radial peak strain <27% showed the best area under the ROC curve and remained independently associated with ventricular tachycardia after adjustment for confounders (odds ratio 7.33, 95% CI 1.07 to 50.41, p = 0.043). CMR strain parameters by TT predict clinical and arrhythmic events in patients with HC.

Crystals of TELSAM-target protein fusions that exhibit minimal crystal contacts and lack direct inter-TELSAM contacts.

While conducting pilot studies into the usefulness of fusion to TELSAM polymers as a potential protein crystallization strategy, we observed novel properties in crystals of two TELSAM-target protein fusions, as follows. (i) A TELSAM-target protein fusion can crystallize more rapidly and with greater propensity than the same target protein alone. (ii) TELSAM-target protein fusions can be crystallized at low protein concentrations. This unprecedented observation suggests a route to crystallize proteins that can only be produced in microgram amounts. (iii) The TELSAM polymers themselves need not directly contact one another in the crystal lattice in order to form well-diffracting crystals. This novel observation is important because it suggests that TELSAM may be able to crystallize target proteins too large to allow direct inter-polymer contacts. (iv) Flexible TELSAM-target protein linkers can allow target proteins to find productive binding modes against the TELSAM polymer. (v) TELSAM polymers can adjust their helical rise to allow fused target proteins to make productive crystal contacts. (vi). Fusion to TELSAM polymers can stabilize weak inter-target protein crystal contacts. We report features of these TELSAM-target protein crystal structures and outline future work needed to validate TELSAM as a crystallization chaperone and determine best practices for its use.

Aprotinin treatment against SARS-CoV-2: A randomized phase III study to evaluate the safety and efficacy of a pan-protease inhibitor for moderate COVID-19.

BACKGROUND: SARS-CoV-2 virus requires host proteases to cleave its spike protein to bind to its ACE2 target through a two-step furin-mediated entry mechanism. Aprotinin is a broad-spectrum protease inhibitor that has been employed as antiviral drug for other human respiratory viruses. Also, it has important anti-inflammatory properties for inhibiting the innate immunity contact system. METHODS: This was a multicentre, double-blind, randomized trial performed in four Spanish hospitals comparing standard treatment versus standard treatment + aprotinin for patients with COVID-19 between 20 May 2020 and 20 October 2021. The primary efficacy outcomes were length of hospital stay and ICU admission. The secondary endpoints were each of the primary efficacy outcomes and a composite of oxygen therapy, analytical parameters and death. Safety outcomes included adverse reactions to treatment during a 30-day follow-up period. Treatment was given for 11 days or till discharge. RESULTS: With almost identical analytical profiles, significant differences were observed in treatment time, which was 2 days lower in the aprotinin group (p = .002), and length of hospital admission, which was 5 days shorter in the aprotinin group (p = .003). The incidence of discharge was 2.19 times higher (HR: 2.188 [1.182-4.047]) in the aprotinin group than in the placebo group (p = .013). In addition, the aprotinin-treated group required less oxygen therapy and had no adverse reactions or side effects. CONCLUSION: Inhaled aprotinin may improve standard treatment and clinical outcomes in hospitalized patients with COVID-19, resulting in a shorter treatment time and hospitalization compared with the placebo group. The administration of aprotinin was safe.

Hemicellulolytic bacteria in the anterior intestine of the earthworm Eisenia fetida (Sav.).

Tropical agriculture produces large amounts of lignocellulosic residues that can potentially be used as a natural source of value-added products. The complexity of lignocellulose makes industrial-scale processing difficult. New processing techniques must be developed to improve the yield and avoid this valuable resource going to waste. Hemicelluloses comprise a variety of polysaccharides with different backbone compositions and decorations (such as methylations and acetylations), and form part of an intricate framework that confers structural stability to the plant cell wall. Organisms that are able to degrade these biopolymers include earthworms (Eisenia fetida), which can rapidly decompose a wide variety of lignocellulosic substrates. This ability probably derives from enzymes and symbiotic microorganisms in the earthworm gut. In this work, two substrates with similar C/N ratios but different hemicellulose content were selected. Palm fibre and coffee husk have relatively high (28%) and low (5%) hemicellulose contents, respectively. A vermicomposting mixture was prepared for the earthworms to feed on by mixing a hemicellulose substrate with organic market waste. Xylanase activity was determined in earthworm gut and used as a selection criterion for the isolation of hemicellulose-degrading bacteria. Xylanase activity was similar for both substrates, even though their physicochemical properties principally pH and electrical conductivity, as shown by the MANOVA analysis) were different for the total duration of the experiment (120 days). Xylanolytic strains isolated from earthworm gut were identified by sequence analysis of the 16S rRNA gene. Our results indicate that the four Actinobacteria, two Proteobacteria, and one Firmicutes isolated are active participants of the xylanolytic degradation by microbiota in the intestine of E. fetida. Most bacteria were more active at pH 7 and 28 °C, and those with higher activities are reported as being facultatively anaerobic, coinciding with the microenvironment reported for the earthworm gut. Each strain had a different degradative capacity.

Carga laboral en personal de salud asistencial y administrativo en una institución de II nivel en Colombia / Workload of Health Care and Administrative Personnel in a Level II Institution in Colombia / Carga laboral em pessoal de saúde assistencial e administrativo em uma instituição de II nível na Colômbia

Introducción: la carga laboral es un elemento de interés a ser evaluado en el área de la salud, debido a que puede influir en la calidad de atención en salud. Objetivo: determinar la carga laboral del personal de salud asistencial y administrativo en una institución de salud de II nivel en Colombia, 2019. Método: estudio observacional de corte transversal. Se estudió a 108 trabajadores, de los cuales 76 fueron asistenciales y 32 administrativos; se diseñó y validó un instrumento mediante ronda de expertos en investigación en salud. La carga laboral se evalúo mediante un instrumento validado y adaptado al español denominado NASA-TLX. Resultados: en personal asistencial predominó el sexo femenino 58,7 % y administrativo el masculino 68,8 %, el rango de edad que prevaleció fue de 28 a 34 años con 49,6 %. El 42 % del personal asistencial tenía estudios técnicos, en el personal administrativo el 43,8 % tenía título universitario. En cuanto a jornada laboral asistencial se evidenció dedicación de 48 horas en un 52 % y 83,3 % en administrativos. Tipo de vinculación: temporal asistencial 72 % y el 59,4 % de los administrativos de planta. Evaluación de la carga laboral: en la dimensión de exigencia mental, los dos grupos presentaron promedios mayores de 10 puntos. Se encontró diferencia estadísticamente significativa en la mediana de exigencia física para los dos grupos de estudio (p= 0,00). Conclusión: los trabajadores del área asistencial y administrativa presentan carga laboral en las dimensiones de exigencia mental y exigencia física, de ahí la necesidad de mejorar la planificación de los recursos humanos dentro de las organizaciones de salud.

Introduction: workload is an element of interest to be evaluated in the health area, because it can influence the quality of health care. Objective: to determine the workload of health care and administrative personnel in a second level health care institution in Colombia, 2019. Method: cross-sectional observational study. A total of 108 workers were studied, of which 76 were assistential and 32 administrative; an instrument was designed and validated by means of a round of experts in health research. Workload was assessed by means of a validated instrument adapted to Spanish called NASA-TLX. Results: 58.7% of the assistants were female and 68.8% were male; the predominant age range was 28 to 34 years with 49.6%. 42% of the assistants were female. Forty-two percent of the health care personnel had technical studies, while 43.8% of the administrative personnel had a university degree. In terms of working hours, 52% of the assistants worked 48 hours a day and 83.3% of the administrative staff worked 83.3% of the time. Type of contract: 72 % of temporary assistance and 59.4 % of administrative staff. Evaluation of workload: in the dimension of mental demands, both groups presented averages higher than 10 points. A statistically significant difference was found in the median physical demand for the two study groups (p= 0.00). Conclusion: workers in the health care and administrative areas present workload in the dimensions of mental and physical demands, hence the need to improve human resources planning within health care organizations.

Introdução: a carga laboral é um elemento de interesse a ser avaliado na área da saúde, pois pode influenciar na qualidade da atenção em saúde. Objetivo: determinar a carga laboral do pessoal de saúde assistencial e administrativo em uma instituição de saúde de II nível na Colômbia, 2019. Método: estudo observacional de corte transversal. Foram estudados 108 trabalhadores, dos quais 76 foram assistenciais e 32 administrativos; um instrumento foi desenhado e avaliado mediante rodada de especialistas em pesquisa em saúde. A carga laboral foi avaliada mediante instrumento validado e adaptado para o espanhol denominado NASA-TLX. Resultados: na equipe assistencial predominou o sexo feminino 58,7 % e na administrativa o masculino 68,8 %, a faixa etária prevalecente foi de 28 a 34 anos com 49,6 %. O 42 % do pessoal assistencial tinha estudos técnicos, no pessoal administrativo o 43,8 % tinha título universitário. Em quanto à jornada laboral assistencial mostrou-se dedicação de 48 horas em um 52 % e 83,3 % em administrativos. Tipo de vinculo: temporal assistencial 72 % e o 59,4 % dos administrativos plantonistas. Avaliação da carga de trabalho: na dimensão de exigência mental, os dois grupos presentaram médios maiores de 10 pontos. Encontrou-se diferença estatisticamente significativa na mediana de exigência física para os dois grupos de estudo (p= 0,00). Conclusão: os trabalhadores da área assistencial e administrativa apresentam carga de trabalho nas dimensões de exigência mental e exigência física, daí a necessidade de melhorar o planejamento dos recursos humanos dentro das organizações de saúde.

Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain.

OBJECTIVE: Serratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit. METHODS: In order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens. RESULTS: During this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens. CONCLUSION: A unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.

Diagnosis of von Willebrand disease in Western Mexico.

INTRODUCTION: Von Willebrand disease (VWD) is the most common inherited bleeding disorder with a prevalence of 0.1%, characterised by quantitative or functional deficiency of von Willebrand factor (VWF). VWD diagnosis is based on symptomology, biochemical and genetic tests, but limited laboratory resources and VWD heterogeneity still generate an important subdiagnosis gap worldwide and in our country. AIM: To identify the type and subtype of VWD in a cohort of patients with a history of excessive bleeding in Western Mexico. METHODS: This prospective cohort study from 2012 to 2019 included patients with mucocutaneous bleeding or abnormal laboratory tests. A standardised questionnaire and confirmatory tests were applied: FVIII:C, VWF activity, VWF antigen, and VWF multimeric analysis. RESULTS: Of the 297 patients recruited, 207 (69.7%) were excluded because their values exceeded 50% in VWF activity and VWF antigen. Of those 90 remaining, 54 (18.2%) had low VWF, and only 36 patients (12.1%) were diagnosed with VWD. Among them, 17 (47.2%) had quantitative deficiencies, of whom 14 were assigned as type 1 and 3 as type 3.The remaining 19 cases were diagnosed as type 2 (52.8%): type 2A and 2B were the most frequent with 6 and 7 cases respectively; 4 cases were possible type 2M and two suggestive of 2N, however, this was not confirmed. CONCLUSION: This study highlights the challenges of VWD diagnosis using a comprehensive panel of diagnostic tests which should extend to supplemental tests of VWF:CB, VWF:FVIIIB, and sequencing the VWD gene to confirm the results from the panel assays.