Intervención educativa para mejorar conocimientos sobre úlceras por presión en enfermeros de Veracruz, México / Educational intervention aimed at improving knowledge on pressure ulcers in nurses from Veracruz, Mexico / Intervenção educativa para melhorar o conhecimento sobre úlceras por pressão em enfermeiros de Veracruz, México

Resumen Introducción: En México, las úlceras por presión (UPP) son un indicador de calidad en el Sistema Nacional de Salud, se otorga relevancia a los conocimientos de los profesionales de la salud en cuanto al abordaje integral de las úlceras para el mejoramiento de la seguridad del paciente. Objetivo: Evaluar la efectividad de una intervención educativa como herramienta para mejorar los conocimientos de enfermería en la prevención y tratamiento de las UPP. Método: Estudio pre-experimental basado en una intervención educativa aplicada a un grupo con medición pre y post. La muestra estuvo constituida por 90 licenciados de enfermería que laboran en hospitales públicos de segundo y tercer nivel de atención, ubicados en el puerto de Veracruz. Se diseñaron doce sesiones de 120 minutos cada una para la intervención; en estas se abordaron tópicos de prevención, cuidado y tratamiento de las úlceras. Resultados: La variable prevención, en el indicador adecuado según tus conocimientos, obtuvo un promedio inicial de 74±15 que incrementó en la segunda medición a 91±9. t (p=.003). En la variable tratamiento, el indicador adecuado según tus conocimientos, obtuvo un promedio inicial de 57±16 y en la segunda medición pasó a 76±9. t (p=.002). Conclusión: La aplicación de la intervención educativa permitió mejorar el conocimiento sobre prevención y tratamiento de las UPP, aunque la utilización en la práctica asistencial fue menor.

Abstract Introduction: In Mexico, pressure ulcers are a quality indicator of the National Health System. In order to improve patient security, health professionals need to demonstrate adequate knowledge regarding the handling and addressing of pressure ulcers. Objective: To assess the effectiveness of an educational intervention aimed at improving the knowledge of nursing professionals regarding the prevention and treatment of pressure ulcers. Method: This is a pre-experimental study based on an educational intervention with pre and post measurements. The sample was constituted by 90 graduate nurses working in public hospitals of second and third level located at the port of Veracruz, Mexico. Twelve 120 minutes educational sessions were designed to address the topics of prevention, care, and treatment of pressure ulcers. Results: The variable prevention had a score of 74±15 at pre measurement and 91±9 at post measurement t (p=.003). The variable treatment had an initial score of 57±16, which then increased to 76±9, t (p=.002) after the intervention. Conclusion: The educational intervention improved the knowledge on prevention and treatment of pressure ulcers, without evidence of improving nursing care practice.

Resumo Introdução: No México, as úlceras por pressão (UPP) são um indicador de qualidade no Sistema Nacional de Saúde, sendo relevantes os conhecimentos dos professionais de saúde quanto à abordagem integral das úlceras para o melhoramento da segurança do paciente. Objetivo: Avaliar a efetividade de uma intervenção educativa como ferramenta para melhorar os conhecimentos de enfermagem na prevenção e tratamento das UPP. Método: Estudo pré-experimental baseado em uma intervenção educativa aplicada a um grupo com pré e post medição. A amostra esteve constituída por 90 graduados de enfermagem que laboram em hospitais públicos de segundo e terceiro nível de atenção, localizados no porto de Veracruz. Desenharam-se doze sessões de 120 minutos cada uma para a intervenção; nestas foram abordados tópicos de prevenção, cuidado e tratamento das úlceras. Resultados: A variável prevenção, no indicador adequado segundo com seus conhecimentos, obteve uma média inicial de 74±15 que incrementou na segunda medição para 91±9. t (p=.003). Na variável tratamento, o indicador adequado conforme seus conhecimentos, obteve uma média inicial de 57±16 e na segunda medição passou a 76±9. t (p=.002). Conclusão: A aplicação da intervenção educativa possibilitou melhorar o conhecimento sobre a prevenção e o tratamento das UPP, embora a utilização na prática assistencial tenha sido menor.

Simulation of the gas density distribution in the accelerator of the ELISE test facility.

In multiaperture electrostatic accelerators of negative ion sources, the plasma discharge is sustained by injecting gas in the plasma source, in a dynamic equilibrium with the gas flowing out through the accelerator. In this work, we present a three-dimensional numerical simulation of the gas flow inside the accelerator system of the large negative ion source ELISE at Max-Planck-Institut für Plasmaphysik Garching. ELISE has 640 apertures per electrode and lateral gaps between the electrode support structures that also contribute to the total gas conductance. Assuming molecular regime, we estimated the gas conductance, the gas density profile along the path of the ion beams from upstream of the plasma grid to downstream of the ground grid, and the transverse nonuniformities in the accelerator. The simulation included the most relevant geometrical features, while the results are compared to analytical results.

Rol de enfermería en educación para la salud de los menonitas desde el interaccionismo simbólico / The role of nursing in the health education of the Mennonites from the symbolic interactionism approach / O papel da enfermagem na educação para a saúde dos menonitas desde o interacionismo simbólico

Este trabajo deriva de una investigación cualitativa etnográfica cuyo objeto de estudio es la educación para la salud de personas pertenecientes a la cultura menonita, así como la descripción de sus percepciones y creencias acerca del proceso salud-enfermedad. A partir del conocimiento que se obtuvo en el análisis de los datos surge la necesidad de indagar la relación entre los usuarios menonitas y el personal de enfermería en los centros de salud de la comunidad mestiza en Cuauhtémoc, Chihuahua, México. Objetivo: Develar la importancia de enfermería como agente educador para la salud cuando existe un acercamiento a culturas diferentes a la propia, se considera la interacción enfermera-paciente-familia como núcleo central conforme al modelo enfermero de Joan Riehl Sisca. Método: Estudio con enfoque cualitativo fenomenológico. La recolección de datos fue a través de entrevistas a profundidad a enfermeras y el análisis de los diarios de campo de estudiantes de enfermería en su práctica clínica en el hospital de ginecoobstetricia de la ciudad, generándose categorías que permitieron describir sus percepciones cuando deben atender a pacientes de cultura diferente a la propia. Los criterios de validación se hicieron a través de la triangulación de los datos obtenidos de confiabilidad y confirmabilidad. Resultados: Se presentan los datos analizados a partir de dos categorías: 1) desconocimiento de la cultura menonita, 2) deseo de brindar cuidado holístico. Conclusiones: Los estudiantes y personal de enfermería refieren que cuando logran la comprensión de la cosmovisión menonita obtienen un alto grado de satisfacción por el cuidado que brindan y descubren un sentido de autoeficacia elevado.

This work derives from an ethnographic qualitative research; and its object of study is the health education to persons belonging to the Mennonite culture, as well as these persons' beliefs and perceptions on the health-illness process. From the data analysis, a need surges to explore the relationship between the Mennonite users and the nursing staff at the health centers of the Coloured community in Cuauhtemoc, Chihuahua, México. Objective: To show the importance of nursing as a health education agent for different cultures. The interaction nurse-patient-family as proposed from the Joan Riehl Sisca nursing model is considered as the central core. Method: Study with a phenomenological qualitative focus. Data were obtained by means of in-depth interviews to nurses and the analysis of the field diaries of nursing students in their clinical practice at the gynecology and obstetrics city hospital. The categories found allowed a description of the participants' perceptions about treating patients from a different culture. The validation criteria were conformed by triangulation of the reliability and confirmability data. Results: The analyzed data are shown through two categories: 1) lack of knowledge of the Mennonite culture, and 2) desire to offer holistic care. Conclusions: Students and nursing staff referred that when they achieve an understanding of the Mennonite cosmos-vision, they get a high degree of satisfaction for the offered care, and they discover a sense of high self-efficacy.

Este trabalho procede de uma pesquisa qualitativa etnográfica cujo objeto de estudo é a educação para a saúde de pessoas pertencentes à cultura menonita, bem como a descrição das suas percepções e crenças relativas ao processo de saúde-doença. A partir do conhecimento que se obteve na análise de dados, aparece a necessidade de procurar a relação entre os usuários menonitas e o pessoal de enfermagem nos centros de saúde da comunidade mestiça em Cuauhtémoc, Chihuahua, México. Objetivo: Revelar a importância da enfermagem como agente educador para a saúde quando existe uma aproximação de culturas diferentes à própria, considera-se a interação enfermeira-paciente-família como núcleo central conforme ao modelo da enfermagem de Joan Riehl Sisca. Método: Estudo com abordagem qualitativa fenomenológica, a coleta de dados se deu através de entrevistas em profundidade com enfermeiras e com a análise dos diários de campo de estudantes de enfermagem na sua prática clínica no hospital de gineco obstetrícia da cidade, produziram-se categorias que permitiram descobrir as percepções sobre quando devem atender aos pacientes de cultura diferente à própria. Os critérios de validação realizaram-se através da triangulação dos dados obtidos de confiabilidade e confirmação. Resultados: Presentam-se os dados analisados a partir de duas categorias: 1) desconhecimento da cultura menonita, 2) desejo de oferecer cuidado holístico. Conclusões: Os estudantes e o pessoal de enfermagem atribuem que no caso de atingir a compreensão da cosmovisão menonita, eles obtêm um alto grau de satisfação pelo cuidado que oferecem e descobrem um sentido de auto-eficácia elevado.

Functional evaluation of TNFAIP3 (A20) in rheumatoid arthritis.

OBJECTIVES: To determine the protein expression of TNFAIP3 in synovium and to show the capability of 6q23 intergenic SNPs, associated with rheumatoid arthritis (RA) susceptibility, to influence TNFAIP3 gene transcription. METHODS: Immunohistochemistry for TNFAIP3, NF-kB p65 and phosphorylated NF-kB p65 protein expression was performed in 6 RA knee joint synovium samples compared to 9 osteoarthritis (OA) samples. Luciferase reporter gene assays were used to examine the regulatory ability of RA associated SNP variants on TNFAIP3 promoter activity. Sense and antisense constructs were prepared for rs6920220 alleles, together with each of the 4 SNPs in r2=1 with it (rs6933404, rs2327832, rs6927172 and rs17264332), coupled to the TNFAIP3 promoter. Transient transfections were performed in a human T lymphoblastoid (CEMC7A) cell line. Bioinformatic software was utilised to prioritise SNPs for further investigation. Electrophoretic mobility shift assays (EMSA), using CEMC7A nuclear extracts, were conducted for the rs6927172 SNP alleles. RESULTS: TNFAIP3 protein expression was seen in the synovium samples and differential TNFAIP3 protein expression between RA vs. OA synoviocytes observed. Within RA synoviocytes TNFAIP3 expression is predominately cytoplasmic, whereas in OA its expression is strongly nuclear and cytoplasmic. For 3 of the 5 SNPs investigated (rs6920220, rs6933404, rs6927172) evidence of repressor activity of TNFAIP3 transcription was seen and EMSA data showed evidence of differential transcription factor binding to rs6927172 alleles. CONCLUSIONS: This is the first observation of TNFAIP3 protein expression in RA and OA synovium. In vitro analysis of 6q23 intergenic SNPs supports the possibility of the functional regulation of TNFAIP3.

Patterns of constitutive and IFN-gamma inducible expression of HLA class II molecules in human melanoma cell lines.

Major histocompatibility complex (MHC) class II proteins (HLA-DR, HLA-DP and HLA-DQ) play a fundamental role in the regulation of the immune response. The level of expression of human leukocyte antigen (HLA) class II antigens is regulated by interferon-gamma (IFN-gamma) and depends on the status of class II trans-activator protein (CIITA), a co-activator of the MHC class II gene promoter. In this study, we measured levels of constitutive and IFN-gamma-induced expression of MHC class II molecules, analysed the expression of CIITA and investigated the association between MHC class II transactivator polymorphism and expression of different MHC class II molecules in a large panel of melanoma cell lines obtained from the European Searchable Tumour Cell Line Database. Many cell lines showed no constitutive expression of HLA-DP, HLA-DQ and HLA-DR and no IFN-gamma-induced increase in HLA class II surface expression. However, in some cases, IFN-gamma treatment led to enhanced surface expression of HLA-DP and HLA-DR. HLA-DQ was less frequently expressed under basal conditions and was less frequently induced by IFN-gamma. In these melanoma cell lines, constitutive surface expression of HLA-DR and HLA-DP was higher than that of HLA-DQ. In addition, high constitutive level of cell surface expression of HLA-DR was correlated with lower inducibility of this expression by IFN-gamma. Finally, substitution A-->G in the 5' flanking region of CIITA promoter type III was associated with higher expression of constitutive HLA-DR (p<0.005). This study yielded a panel of melanoma cell lines with different patterns of constitutive and IFN-gamma-induced expression of HLA class II that can be used in future studies of the mechanisms of regulation of HLA class II expression.

Genetic basis of rheumatoid arthritis.

Rheumatoid arthritis (RA) is a clinically heterogeneous condition with a complex aetiology in which environmental and genetic factors are implicated. The contribution of human leukocyte antigen (HLA) genes, particularly the HLA-DRB1 gene, to RA genetic predisposition was the first described, and remains as the best characterised single genetic risk factor contributing to RA. However, it has been estimated that only 30% of the genetic contribution to RA can be attributed to HLA genes and it is suggested that other non-HLA genes may play a relevant role in RA susceptibility. Linkage studies and association studies are the two main strategies used in the investigation of genetic factors contributing to complex genetic traits. In this work we review the progress made in the field of RA genetics, focusing mainly on the contribution of candidate gene association studies to the dissection of RA genetic risk factors.

Study of the role of functional variants of SLC22A4, RUNX1 and SUMO4 in systemic lupus erythematosus.

BACKGROUND: Functional polymorphisms of the solute carrier family 22, member 4 (SLC22A4), runt related transcription factor 1 (RUNX1) and small ubiquitin-like modifier 4 (SUMO4) genes have been shown to be associated with several autoimmune diseases. OBJECTIVE: To test the possible role of these variants in susceptibility to or severity of systemic lupus erythematosus (SLE), on the basis that common genetic bases are shared by autoimmune disorders. METHODS: 597 SLE patients and 987 healthy controls of white Spanish origin were studied. Two additional cohorts of 228 SLE patients from Sweden and 122 SLE patients from Colombia were included. A case-control association study was carried out with six single nucleotide polymorphisms (SNP) spanning the SLC22A4 gene, one SNP in RUNX1 gene, and one additional SNP in SUM04 gene. RESULTS: No significant differences were observed between SLE patients and healthy controls when comparing the distribution of the genotypes or alleles of any of the SLC22A4, RUNX1, or SUMO4 polymorphisms tested. Significant differences were found in the distribution of the SUMO4 genotypes and alleles among SLE patients with and without nephritis, but after multiple testing correction, the significance of the association was lost. The association of SUMO4 with nephritis could not be verified in two independent SLE cohorts from Sweden and Colombia. CONCLUSIONS: These results suggest that the SLC22A4, RUNX1, and SUMO4 polymorphisms analysed do not play a role in the susceptibility to or severity of SLE.

The functional genetic variation in the PTPN22 gene has a negligible effect on the susceptibility to develop inflammatory bowel disease.

The aim of this study was to assess the possible association between the protein tyrosine phosphatase non-receptor 22 (PTPN22) gene 1858C-->T (rs2476601, encoding R620W) polymorphism and inflammatory bowel disease (IBD). Our study population consisted of 1113 IBD [544 ulcerative colitis (UC) and 569 Crohn's disease (CD)] patients and 812 healthy subjects. All the individuals were of Spanish white origin. Genotyping of the PTPN22 gene 1858C-->T polymorphism was performed by real time polymerase chain reaction technology, using TaqMan 5'-allelic discrimination assay. The frequency of the PTPN22 1858T allele in healthy subjects was 6.2% compared with 6.7% in the UC patients and 5.1% in Crohn's patients. No statistically significant differences were observed when the PTPN22 1858C-->T allele and genotype distribution among CD patients, UC patients and healthy controls were compared. These results indicate that the PTPN22 1858C-->T polymorphism does not appear to play a major role in IBD predisposition in our population.

Cytotoxic T-lymphocyte antigen-4-CT60 polymorphism in rheumatoid arthritis.

Cytotoxic T-lymphocyte antigen-4 (CTLA-4) is a functional candidate gene with susceptibility to rheumatoid arthritis (RA). The aim of this work was to investigate the possible influence of the recently described CT60A/G dimorphism of the CTLA-4 gene in the susceptibility to RA in Spanish patients. A total of 433 RA patients and 398 control subjects were included in the study. Genotyping of CTLA-4 CT60 was performed using two different methods: polymerase chain reaction restriction fragment length polymorphism system using an amplification-created restriction site and a TaqMan 5'-allelic discrimination assay. In order to validate results obtained by different methods, a quality-control exercise was performed. No significant deviation in the distribution of the alleles or genotypes of the CT60 was found when we compared RA patient and control groups. In addition, no differences in CTLA-4 CT60 genotypic distribution was found when RA patients and controls were stratified by the presence or absence of the shared epitope. In conclusion, our results do not support an association between CT60A/G polymorphism and susceptibility to RA in the Spanish population, although the contribution of other positions located within the 3' region of the CTLA-4 gene to RA susceptibility cannot be discarded.

Pharmacokinetic parameters of genotoxic activity inferred from the comparison of the kinetics of MN-PCE induced by chemical agents and ionizing radiation.

Some kinetic parameters of clastogenic activity of cyclophosphamide were inferred by means of the comparison of its kinetics of micronucleated polychromatic erythrocytes (MN-PCE) formation with the kinetics induced by radiation. The same reasoning was also applied to the kinetics obtained by treatment with mitomycin C (MMC), arabinocyl cytosine (Ara-C) and 6-mercaptopurine (6-MOP), based on previously reported data from the literature. The results indicate that the latency period (LP) and half-lives (HL) vary from one mutagen to another. For MMC, they are very similar to radiation indicating a rapid distribution and reaction. CP presents very long LP and HL which agree with the requirement of mutagen activation. Ara-C showed a very short LP which suggests a rapid activation and fast induction of damage in DNA. 6-MOP presented a very long LP which agreed with the requirement of its incorporation into DNA to cause micronucleus (MN). From the data obtained in the present work, it can be concluded that the comparison of the kinetics of MN-PCE formation induced by chemical agents with that obtained by the exposure to an acute dose of radiation permits one to estimate some parameters of the kinetics of clastogenic activity of chemical agents, like the LP and the HL. This seems to be valid for agents that act through the induction of DNA lesions; in the case of agents whose clastogenic activity is through other mechanisms, such as the inhibition or alteration of the process of duplication of the DNA, the kinetic parameters are not equivalent to the LP and HL; however, they could provide information on their possible mechanism of action.

Colgajos de fascia lata en la cirugía reconstructiva de la pared abdominal inferior / Fascia lata myocutaneos flaps in reconstruction of inferior abdominal wall

Los grandes defectos de la pared abdominal inferior por anomalías congénitas, o por secuelas de traumas o infecciones con esfacelos, se pueden reconstruir con facilidad y excelentes resultados aportando tejidos vascularizados de los muslos. Los colgajos miofasciales y miofasciocutáneos del músculo tensor de la facia lata, han sido usados con éxito y sin complicaciones con este fin. Se presentan tres casos clínicos cuya buena evolución a largo plazo, nos permite recomendar este recurso en situaciones similares

[Perinatal mortality risk factors in a case-control study]. / Los factores de riesgo de la mortalidad perinatal en un estudio de casos y controles.

PIP: This work describes a cross-sectional case-control study conducted in a marginal area of the city of Leon, Guanajuato, Mexico, to identify risk factors for perinatal mortality. 104 deaths identified in the civil register as occurring during 1982 in the study area were each matched to 2 controls selected from the same district and with birth dates within 30 days of the case. Perinatal mortality was defined as occurring between the 27th week of pregnancy and the 7th day after birth. 39 factors were stuided, including 10 socioeconomic factors, 6 maternal factors such as weight, height, and smoking, 10 factors concerning obstetrical history, 4 factors related to pathology during pregnancy, 6 factors referring to labor and delivery, and 2 concerning medical attention. In the univariate analysis, 18 factors were significant: unmarried or illiterate mother, maternal age under 17 or over 35, more than 7 previous births, previous perinatal death, less than 30 weeks or more than 200 weeks between pregnancies, hypertension, hemorrhage in the 2nd half of pregnancy, morning edema of pregnancy, no prenatal care, and birth attended by midwife. Some factors were eliminated because they were found to be dependent on a 2nd factor, and factors linked to perinatal events were also eliminated. A final model achieved after discriminant function analysis included 8 risk factors for perinatal mortality: 1) less than 30 weeks between pregnancies 2) more than 200 weeks between pregnancies 3) hypertension during pregnancy 4) maternal age under 18 5) maternal age over 35 6) unmarried mother 7) previous fetal deaths and 8) no prenatal care.^ieng

Illeo biliar. Presentacion de 18 pacientes. / Biliary ileus. Report of 18 patients

Se presentan 18 casos de ileo biliar estudiados en un periodo de 7 anos en el Hospital General del Centro Medico Nacional.Existio predominio del sexo femenino (94, 4%), con edades de 46 a 85 anos. Todos los pacientes presentaron cuadro de obstruccion intestinal, tanto clinica como radiologicamente. El diagnostico preoperatorio de ileo biliar solo se realizo en el 16.7% pero al efectuar un analisis retrospectivo de los estudios radiologicos se llego a la conclusion que debio ser mas elevado. El tipo de fistula biliar interna mas frecuente fue la colecistoduodenal (66,6%).Diez y siete enfermos fueron tratados quirurgicamente y la mortalidad global fue de 5.6%. La operacion con la que se obtuvieron mejores resultados fue la enterotomia y extraccion del calculo, no se recomienda el cierre de la fistula de primera intencion. En los pacientes con ileo biliar debe tratarse de llegar a un diagnostico correcto lo mas pronto posible, para efectuar el tratamiento oportuno y disminuir la morbimortalidad