Exposure to Zika and chikungunya viruses impacts aspects of the vectorial capacity of Aedes aegypti and Culex quinquefasciatus.

Zika (ZIKV) and chikungunya (CHIKV) are arboviruses that cause infections in humans and can cause clinical complications, representing a worldwide public health problem. Aedes aegypti is the primary vector of these pathogens and Culex quinquefasciatus may be a potential ZIKV vector. This study aimed to evaluate fecundity, fertility, survival, longevity, and blood feeding activity in Ae. aegypti after exposure to ZIKV and CHIKV and, in Cx. quinquefasciatus exposed to ZIKV. Three colonies were evaluated: AeCamp (Ae. aegypti-field), RecL (Ae. aegypti-laboratory) and CqSLab (Cx. quinquefasciatus-laboratory). Seven to 10 days-old females from these colonies were exposed to artificial blood feeding with CHIKV or ZIKV. CHIKV caused reduction in fecundity and fertility in AeCamp and reduction in survival and fertility in RecL. ZIKV impacted survival in RecL, fertility in AeCamp and, fecundity and fertility in CqSLab. Both viruses had no effect on blood feeding activity. These results show that CHIKV produces a higher biological cost in Ae. aegypti, compared to ZIKV, and ZIKV differently alters the biological performance in colonies of Ae. aegypti and Cx. quinquefasciatus. These results provide a better understanding over the processes of virus-vector interaction and can shed light on the complexity of arbovirus transmission.

Atención de enfermería en adultos jóvenes con insuficiencia renal aguda: Revisión narrativa / Nursing care in young adults with acute kidney failure: Narrative review

El daño renal está reconocido como la reducción de la función renal, el cual se ve generalmente reflejado por una caída en la diuresis. A nivel mundial, el porcentaje de personas que padece daño renal va en aumento, esto debido a múltiples aspectos. En este sentido, se reconoce que el personal de enfermería es quien idóneamente tiene un gran rol en la educación de la población, para la prevención del daño renal agudo, previniendo con ello el daño renal crónico. De esta manera, en el escrito se abordan aspectos generales más relevantes, de la hidratación, la alimentación, la actividad física, el consumo de alcohol, la automedicación y la prevención de infecciones de las vías urinarias, como parte de los aspectos modificables y en los que las personas tienen directa injerencia en sus acciones, con la debida información, con los que el personal de enfermería puede reforzar sus recursos en materia de educación a la población. De la misma manera, se muestran estudios de diseño cuasiexperimental, como una manera de resaltar que puede medirse el impacto de la educación en la población en una época en donde requerimos tener mayor evidencia de la efectividad de las intervenciones que realicemos.

Renal insufficiency it is recognized as the reduction of the renal function, reflected by the decreased urine output. Worldwide, the amount of people whom have renal insufficiency it is growing, by many reasons. Because of this, is recognized that nursing staff is the best option at the population education, in order to prevent acute renal insufficiency, preventing with this, chronical renal insufficiency. In this document, it is possible to review, the most important general aspects of hydration, feeding, physical activity, alcohol consumption, self-medication and prevention of urinary tract infections, as part of modifiable aspects that people handle as part of their personal health actions, with the proper information, with which nursing staff can strengthen their resources in health education to the population. In this way, this paper shows some quasi-experimental studies, as a way to highlight that it is possible to measure the impact of population education, in a moment that the health system requires more evidence of the effectiveness of the interventions.

Aedes aegypti continuously exposed to Bacillus thuringiensis svar. israelensis does not exhibit changes in life traits but displays increased susceptibility for Zika virus.

BACKGROUND: Aedes aegypti can transmit arboviruses worldwide, and Bacillus thuringiensis svar. israelensis (Bti)-based larvicides represent an effective tool for controlling this species. The safety of Bti and lack of resistance have been widely reported; however, little is known regarding the impact of the extensive use of these larvicides on the life traits of mosquitoes. Therefore, this study investigated biological parameters, including susceptibility to arbovirus, of an Ae. aegypti strain (RecBti) subjected to 29 generations of exposure to Bti compared with the RecL reference strain. METHODS: The biological parameters of individuals reared under controlled conditions were compared. Also, the viral susceptibility of females not exposed to Bti during their larval stage was analysed by oral infection and followed until 14 or 21 days post-infection (dpi). RESULTS: RecBti individuals did not display alterations in the traits that were assessed (fecundity, fertility, pupal weight, developmental time, emergence rate, sex ratio and haematophagic capacity) compared to RecL individuals. Females from both strains were susceptible to dengue serotype 2 (DENV-2) and Zika virus (ZIKV). However, RecBti females showed significantly higher rates of ZIKV infection compared with RecL females at 7 (90% versus 68%, Chi-square: χ2 = 7.27, df = 1, P = 0.006) and 14 dpi (100% versus 87%, Chi-square: χ2 = 7.69, df = 1, P = 0.005) and for dissemination at 7 dpi (83.3% versus 36%, Fisher's exact test: P < 0.0001, OR = 0.11, 95% CI 0.03-0.32). Quantification of DENV-2 and ZIKV viral particles produced statistically similar results for females from both strains. CONCLUSIONS: Prolonged exposure of Ae. aegypti larvae to Bti did not alter most of the evaluated biological parameters, except that RecBti females exhibited a higher vector susceptibility for ZIKV. This finding is related to a background of Bti exposure for several generations but not to a previous exposure of the tested females during the larval stage. This study highlights mosquito responses that could be associated with the chronic exposure to Bti in addition to the primary larvicidal effect elicited by this control agent.

Beneficios de un programa de formación y de un algoritmo clínico de soporte nutricional mixto para mejorar la nutrición del paciente crítico: estudio antes-después / Benefits of an education program and a clinical algorithm in mixed nutritional support to improve nutrition for the critically ill patient: a before-and-after study

Introducción: la nutrición óptima del paciente crítico es clave para su recuperación. Objetivos: promover la formación y difusión del conocimiento acerca del soporte nutricional mixto (SNM) mediante un algoritmo clínico entre los intensivistas para mejorar el estado nutricional de los pacientes críticos. Métodos: estudio antes-después con la participación de 19 unidades de cuidados intensivos (UCI) polivalentes en 10 comunidades autónomas. Cinco miembros del comité científico formaron a los formadores mediante presentaciones orales y el algoritmo de SNM. Los formadores fueron responsables de la formación de los intensivistas en sus propias UCI. El cuestionario de 30 ítems fue completado por 179 y 105 intensivistas antes y después de la intervención, respectivamente. Resultados: se observó un aumento del conocimiento en seis (20 %) preguntas específicas relacionadas con el SNM. En 11 ítems (36,6 %), el conocimiento adecuado sobre diferentes aspectos del soporte nutricional que ya estaban presentes antes de la formación se mantuvieron, y en cinco ítems (16,7 %) hubo un aumento de la tasa de respuestas correctas. En cuatro ítems (13,3 %), las respuestas correctas no mejoraron y en otros cuatro (13,3 %), los porcentajes de respuestas correctas disminuyeron. Conclusiones: el algoritmo de SNM ha logrado una sólida consolidación de los principales conceptos de esta estrategia. Algunos aspectos referentes a cómo manejar al paciente desnutrido, cómo identificarlo y qué tipo de nutrición pautar desde el inicio del ingreso en la UCI, los aportes nutricionales en situaciones especiales y el seguimiento de posibles complicaciones como la realimentación, son áreas que requerirían estrategias formativas adicionales. (AU)

Introduction: optimal nutrition in the critically ill patient is a key aspect for recovery. Objectives: to promote training in and knowledge of mixed nutrition support (MNS) by means of a clinical algorithm among intensivists for improving the nutritional status of critically ill patients. Methods: a before-and-after study with the participation of 19 polyvalent intensive care units (ICUs) in 10 autonomous communities. Five members of the scientific committee trained the trainers by means of oral presentations and a clinical algorithm on MNS. Then, trainers were responsible for explaining the algorithm to local intensivists in their ICUs. The 30-item study questionnaire was completed before and after the intervention by 179 and 105 intensivists, respectively. Results: a clear improvement of knowledge was found in six (20 %) specific MNS-related questions. In 11 items (36.6 %), adequate knowledge on different aspects of nutritional support that were already present before the intervention were maintained, and in five items (16.7 %) an improvement in the rate of correct responses was recorded. There were no improvements in correct responses for four items (13.3 %), and for four (13.3 %) additional items the percentage of correct responses decreased. Conclusions: the use of the MNS algorithm has achieved a solid consolidation of the main concepts of MNS. Some aspects regarding how to manage the malnourished patient, how to identify them and what type of nutrition to guide from the beginning of admission to the ICU, nutritional contributions in special situations, and the monitoring of possible complications such as refeeding are areas for which further training strategies are needed. (AU)

[Benefits of an education program and a clinical algorithm in mixed nutritional support to improve nutrition for the critically ill patient: a before-and-after study]. / Beneficios de un programa de formación y de un algoritmo clínico de soporte nutricional mixto para mejorar la nutrición del paciente crítico: estudio antes-después.

INTRODUCTION: Introduction: optimal nutrition in the critically ill patient is a key aspect for recovery. Objectives: to promote training in and knowledge of mixed nutrition support (MNS) by means of a clinical algorithm among intensivists for improving the nutritional status of critically ill patients. Methods: a before-and-after study with the participation of 19 polyvalent intensive care units (ICUs) in 10 autonomous communities. Five members of the scientific committee trained the trainers by means of oral presentations and a clinical algorithm on MNS. Then, trainers were responsible for explaining the algorithm to local intensivists in their ICUs. The 30-item study questionnaire was completed before and after the intervention by 179 and 105 intensivists, respectively. Results: a clear improvement of knowledge was found in six (20 %) specific MNS-related questions. In 11 items (36.6 %), adequate knowledge on different aspects of nutritional support that were already present before the intervention were maintained, and in five items (16.7 %) an improvement in the rate of correct responses was recorded. There were no improvements in correct responses for four items (13.3 %), and for four (13.3 %) additional items the percentage of correct responses decreased. Conclusions: the use of the MNS algorithm has achieved a solid consolidation of the main concepts of MNS. Some aspects regarding how to manage the malnourished patient, how to identify them and what type of nutrition to guide from the beginning of admission to the ICU, nutritional contributions in special situations, and the monitoring of possible complications such as refeeding are areas for which further training strategies are needed.

INTRODUCCIÓN: Introducción: la nutrición óptima del paciente crítico es clave para su recuperación. Objetivos: promover la formación y difusión del conocimiento acerca del soporte nutricional mixto (SNM) mediante un algoritmo clínico entre los intensivistas para mejorar el estado nutricional de los pacientes críticos. Métodos: estudio antes-después con la participación de 19 unidades de cuidados intensivos (UCI) olivalentes en 10 comunidades autónomas. Cinco miembros del comité científico formaron a los formadores mediante presentaciones orales y el algoritmo de SNM. Los formadores fueron responsables de la formación de los intensivistas en sus propias UCI. El cuestionario de 30 ítems fue completado por 179 y 105 intensivistas antes y después de la intervención, respectivamente. Resultados: se observó un aumento del conocimiento en seis (20 %) preguntas específicas relacionadas con el SNM. En 11 ítems (36,6 %), el conocimiento adecuado sobre diferentes aspectos del soporte nutricional que ya estaban presentes antes de la formación se mantuvieron, y en cinco ítems (16,7 %) hubo un aumento de la tasa de respuestas correctas. En cuatro ítems (13,3 %), las respuestas correctas no mejoraron y en otros cuatro (13,3 %), los porcentajes de respuestas correctas disminuyeron. Conclusiones: el algoritmo de SNM ha logrado una sólida consolidación de los principales conceptos de esta estrategia. Algunos aspectos referentes a cómo manejar al paciente desnutrido, cómo identificarlo y qué tipo de nutrición pautar desde el inicio del ingreso en la UCI, los aportes nutricionales en situaciones especiales y el seguimiento de posibles complicaciones como la realimentación, son áreas que requerirían estrategias formativas adicionales.

Zika virus detection, isolation and genome sequencing through Culicidae sampling during the epidemic in Vitória, Espírito Santo, Brazil.

BACKGROUND: Zika virus (ZIKV) has been isolated from many mosquito species in nature, but it is believed that the main vectors in urban environments are species of the genus Aedes. Here, we detected and isolated ZIKV in samples from Aedes aegypti, Aedes taeniorhynchus and Culex quinquefasciatus, collected during the Zika epidemic in Vitória, southeast Brazil. Using quantitative real-time polymerase chain reaction, ZIKV detection was performed in mosquito samples collected from February to April 2016. RESULTS: Overall, six pools of mosquitoes were positive for ZIKV: four of Cx. quinquefasciatus, one of Ae. aegypti and one of Ae. taeniorhynchus. Their genomes were sequenced. CONCLUSIONS: These results support and strengthen the hypothesis that other mosquito species can also be involved in ZIKV transmission.

Long-term exposure of Aedes aegypti to Bacillus thuringiensis svar. israelensis did not involve altered susceptibility to this microbial larvicide or to other control agents.

BACKGROUND: Bacillus thuringiensis svar. israelensis (Bti) is an effective and safe biolarvicide to control Aedes aegypti. Its mode of action based on four protoxins disfavors resistance; however, control in endemic areas that display high mosquito infestation throughout the year requires continuous larvicide applications, which imposes a strong selection pressure. Therefore, this study aimed to investigate the effects of an intensive Bti exposure on an Ae. aegypti strain (RecBti), regarding its susceptibility to Bti and two of its protoxins tested individually, to other control agents temephos and diflubenzuron, and its profile of detoxifying enzymes. METHODS: The RecBti strain was established using a large egg sample (10,000) from Recife city (Brazil) and more than 290,000 larvae were subjected to Bti throughout 30 generations. Larvae susceptibility to larvicides and the activity of detoxifying enzymes were determined by bioassays and catalytic assays, respectively. The Rockefeller strain was the reference used for these evaluations. RESULTS: Bti exposure yielded an average of 74% mortality at each generation. Larvae assessed in seven time points throughout the 30 generations were susceptible to Bti crystal (resistance ratio RR ≤ 2.8) and to its individual toxins Cry11Aa and Cry4Ba (RR ≤ 4.1). Early signs of altered susceptibility to Cry11Aa were detected in the last evaluations, suggesting that this toxin was a marker of the selection pressure imposed. RecBti larvae were also susceptible (RR ≤ 1.6) to the other control agents, temephos and diflubenzuron. The activity of the detoxifying enzymes α- and ß-esterases, glutathione-S-transferases and mixed-function oxidases was classified as unaltered in larvae from two generations (F19 and F25), except for a ß-esterases increase in F25. CONCLUSIONS: Prolonged exposure of Ae. aegypti larvae to Bti did not evolve into resistance to the crystal, and no cross-resistance with temephos and diflubenzuron were recorded, which supports their sustainable use with Bti for integrated control practices. The unaltered activity of most detoxifying enzymes suggests that they might not play a major role in the metabolism of Bti toxins, therefore resistance by this mechanism is unlikely to occur. This study also highlights the need to establish suitable criteria to classify the status of larval susceptibility/resistance.

Insecticide susceptibility of Aedes albopictus and Ae. aegypti from Brazil and the Swiss-Italian border region.

BACKGROUND: Aedes aegypti and Ae. albopictus are two highly invasive mosquito species, both vectors of several viruses, including dengue, chikungunya and Zika. While Ae. aegypti is the primary vector in the tropics and sub-tropics, Ae. albopictus is increasingly under the public health watch as it has been implicated in arbovirus-transmission in more temperate regions, including continental Europe. Vector control using insecticides is the pillar of most control programmes; hence development of insecticide resistance is of great concern. As part of a Brazilian-Swiss Joint Research Programme we set out to assess whether there are any signs of existing or incipient insecticide resistance primarily against the larvicide Bacillus thuringiensis svar. israelensis (Bti), but also against currently applied and potentially alternative insecticides in our areas, Recife (Brazil) and the Swiss-Italian border region. METHODS: Following World Health Organization guidelines, dose-response curves for a range of insecticides were established for both colonized and field caught Ae. aegypti and Ae. albopictus. The larvicides included Bti, two of its toxins, Cry11Aa and Cry4Ba, Lysinibacillus sphaericus, Vectomax CG®, a formulated combination of Bti and L. sphaericus, and diflubenzuron. In addition to the larvicides, the Swiss-Italian Ae. albopictus populations were also tested against five adulticides (bendiocarb, dichlorodiphenyltrichloroethane, malathion, permethrin and λ-cyhalothrin). RESULTS: Showing a similar dose-response, all mosquito populations were fully susceptible to the larvicides tested and, in particular, to Bti which is currently used both in Brazil and Switzerland. In addition, there were no signs of incipient resistance against Bti as larvae were equally susceptible to the individual toxins, Cry11Aa and Cry4Ba. The field-caught Swiss-Italian populations were susceptible to the adulticides tested but DDT mortality rates showed signs of reduced susceptibility. CONCLUSIONS: The insecticides currently used for mosquito control in Switzerland and Brazil are still effective against the target populations. The present study provides an important reference as relatively few insecticide susceptibility surveys have been carried out with Ae. albopictus.

Zika virus replication in the mosquito Culex quinquefasciatus in Brazil.

Zika virus (ZIKV) is a flavivirus that has recently been associated with an increased incidence of neonatal microcephaly and other neurological disorders. The virus is primarily transmitted by mosquito bite, although other routes of infection have been implicated in some cases. The Aedes aegypti mosquito is considered to be the main vector to humans worldwide; however, there is evidence that other mosquito species, including Culex quinquefasciatus, transmit the virus. To test the potential of Cx. quinquefasciatus to transmit ZIKV, we experimentally compared the vector competence of laboratory-reared Ae. aegypti and Cx. quinquefasciatus. Interestingly, we were able to detect the presence of ZIKV in the midgut, salivary glands and saliva of artificially fed Cx. quinquefasciatus. In addition, we collected ZIKV-infected Cx. quinquefasciatus from urban areas with high microcephaly incidence in Recife, Brazil. Corroborating our experimental data from artificially fed mosquitoes, ZIKV was isolated from field-caught Cx. quinquefasciatus, and its genome was partially sequenced. Collectively, these findings indicate that there may be a wider range of ZIKV vectors than anticipated.

Does Zika virus infection affect mosquito response to repellents?

The World Health Organization (WHO) recommends that people travelling to or living in areas with Zika virus (ZIKV) outbreaks or epidemics adopt prophylactic measures to reduce or eliminate mosquito bites, including the use of insect repellents. It is, however, unknown whether repellents are effective against ZIKV-infected mosquitoes, in part because of the ethical concerns related to exposing a human subject's arm to infected mosquitoes in the standard arm-in-cage assay. We used a previously developed, human subject-free behavioural assay, which mimics a human subject to evaluate the top two recommended insect repellents. Our measurements showed that DEET provided significantly higher protection than picaridin provided against noninfected, host-seeking females of the southern house mosquito, Culex quinquefasciatus, and the yellow fever mosquito, Aedes aegypti. When tested at lower doses, we observed a significant reduction in DEET-elicited protection against ZIKV-infected yellow fever mosquitoes from old and recent laboratory colonies. The reduction in protection is more likely associated with aging than the virus infection and could be compensated by applying a 5x higher dose of DEET. A substantial protection against ZIKV-infected and old noninfected mosquitoes was achieved with 5% DEET, which corresponds approximately to a 30% dose in the conventional arm-in-cage assays.

Nanoparticulate STING agonists are potent lymph node-targeted vaccine adjuvants.

Cyclic dinucleotides (CDNs) are agonists of stimulator of IFN genes (STING) and have potential as vaccine adjuvants. However, cyclic di-GMP (cdGMP) injected s.c. shows minimal uptake into lymphatics/draining lymph nodes (dLNs) and instead is rapidly distributed to the bloodstream, leading to systemic inflammation. Here, we encapsulated cdGMP within PEGylated lipid nanoparticles (NP-cdGMP) to redirect this adjuvant to dLNs. Compared with unformulated CDNs, encapsulation blocked systemic dissemination and markedly enhanced dLN accumulation in murine models. Delivery of NP-cdGMP increased CD8+ T cell responses primed by peptide vaccines and enhanced therapeutic antitumor immunity. A combination of a poorly immunogenic liposomal HIV gp41 peptide antigen and NP-cdGMP robustly induced type I IFN in dLNs, induced a greater expansion of vaccine-specific CD4+ T cells, and greatly increased germinal center B cell differentiation in dLNs compared with a combination of liposomal HIV gp41 and soluble CDN. Further, NP-cdGMP promoted durable antibody titers that were substantially higher than those promoted by the well-studied TLR agonist monophosphoryl lipid A and comparable to a much larger dose of unformulated cdGMP, without the systemic toxicity of the latter. These results demonstrate that nanoparticulate delivery safely targets CDNs to the dLNs and enhances the efficacy of this adjuvant. Moreover, this approach can be broadly applied to other small-molecule immunomodulators of interest for vaccines and immunotherapy.

Liposomal vaccines incorporating molecular adjuvants and intrastructural T-cell help promote the immunogenicity of HIV membrane-proximal external region peptides.

An HIV vaccine capable of inducing high and durable levels of broadly neutralizing antibodies has thus far proven elusive. A promising antigen is the membrane-proximal external region (MPER) from gp41, a segment of the viral envelope recognized by a number of broadly neutralizing antibodies. Though an attractive vaccine target due to the linear nature of the epitope and its highly conserved sequence, MPER peptides are poorly immunogenic and may require display on membranes to achieve a physiological conformation matching the native virus. Here we systematically explored how the structure and composition of liposomes displaying MPER peptides impacts the strength and durability of humoral responses to this antigen as well as helper T-cell responses in mice. Administration of MPER peptides anchored to the surface of liposomes induced MPER-specific antibodies whereas MPER administered in oil-based emulsion adjuvants or alum did not, even when combined with Toll-like receptor agonists. High-titer IgG responses to liposomal MPER required the inclusion of molecular adjuvants such as monophosphoryl lipid A. Anti-MPER humoral responses were further enhanced by incorporating high-Tm lipids in the vesicle bilayer and optimizing the MPER density to a mean distance of ∼10-15 nm between peptides on the liposomes' surfaces. Encapsulation of helper epitopes within the vesicles allowed efficient "intrastructural" T-cell help, which promoted IgG responses to MPER while minimizing competing B-cell responses against the helper sequence. These results define several key properties of liposome formulations that promote durable, high-titer antibody responses against MPER peptides, which will be a prerequisite for a successful MPER-targeting vaccine.

Antigen delivery by lipid-enveloped PLGA microparticle vaccines mediated by in situ vesicle shedding.

Lipid-coated poly(lactide-co-glycolide) microparticles (LCMPs) consist of a solid polymer core wrapped by a surface lipid bilayer. Previous studies demonstrated that immunization with LCMPs surface-decorated with nanograms of antigen elicit potent humoral immune responses in mice. However, the mechanism of action for these vaccines remained unclear, as LCMPs are too large to drain efficiently to lymph nodes from the vaccination site. Here, we characterized the stability of the lipid envelope of LCMPs and discovered that in the presence of serum the lipid coating of the particles spontaneously delaminates, shedding antigen-displaying vesicles. Lipid delamination generated 180 nm liposomes in a temperature- and lipid/serum-dependent manner. Vesicle shedding was restricted by inclusion of high-TM lipids or cholesterol in the LCMP coating. Administration of LCMPs bearing stabilized lipid envelopes generated weaker antibody responses than those of shedding-competent LCMPs, suggesting that in situ release of antigen-loaded vesicles plays a key role in the remarkable potency of LCMPs as vaccine adjuvants.

Neumonía asociada a ventilación mecánica. Influencia de la aplicación de medidas enfermeras preventivas en pacientes críticos / Ventilator-Associated Pneumonia. Influence of the implementation of preventive nursing measures in critical patients

La neumonía es la segunda complicación infecciosa en el medio hospitalario y la primera en los servicios de medicina intensiva. La neumonía asociada a ventilación mecánica (NAVM) representa un 33,53% de las infecciones controladas en estas unidades. Por ello, se han desarrollado programas de control y protocolos de prevención para reducir su incidencia, en los que el enfermero tiene un papel protagonista. Objetivo: analizar la influencia de las medidas enfermeras preventivas en el control de NAVM en pacientes críticos. Metodología: revisión narrativa mediante búsqueda bibliográfica en las bases de datos PubMed y Cinahl, el buscador Google Académico, en el Ministerio de Sanidad, Servicios Sociales e Igualdad y publicaciones periódicas relacionadas con la temática, sobre las cuatro medidas seleccionadas del proyecto Neumonía Zero (NZ): higiene estricta de manos con productos de base alcohólica (PBA) antes de manipular la vía aérea, higiene bucal utilizando clorhexidina (0,12%-0,2%), control y mantenimiento de la presión del neumotaponamiento por encima de 20 cm H2Oy evitar, siempre que sea posible, la posición de decúbito supino a 0o.Resultados y conclusiones: se presentan en relación con cuatro de las medidas propuestas por el protocolo NZ, concluyéndose que el correcto cumplimiento de las mismas disminuye la incidencia de NAVM, sibien no se observa una práctica sistemática en todas las unidades, por lo que sería recomendable la formación continuada de los profesionales (AU)

Pneumonia is the second infectious complication within the hospital setting, and the first one in Intensive Care Units. Ventilator-Associated Pneumonia (VAP) represents 33.53% of the infections controlled in said units. For this reason, control programs and prevention protocols have been developed in order to reduce their incidence; nurses play a leading role in their implementation. Objective: to analyze the influence of preventive nursing measures in VAP control for critical patients. Methodology: narrative review through bibliographic search in the PubMed and Cinahl databases, the Academic Google search-engine, in the Ministry of Health, Social Services and Equality, and in periodical publications associated with the subject, about the four measures selected from the Zero Pneumonia (ZP) Project: strict hand hygiene with alcohol-based products (ABPs) before handling the airways; mouth hygiene using chlorhexidine (0.12%-0.2%), control and maintenance of the end tracheal tube cuff pressure above 20 cm H2O and preventing, whenever possible, the supine position at 0o .Results and conclusions: presented regarding four of the measures suggested by the PZ protocol; the conclusion is that their correct implementation reduces the incidence of VAP. However, a systematic practice is not observed in all units, and therefore, it is recommended to implement a continued training for professionals (AU)

Robust IgG responses to nanograms of antigen using a biomimetic lipid-coated particle vaccine.

New subunit vaccine formulations with increased potency are of interest to improve immune responses against poorly immunogenic antigens, to avoid vaccine shortages in pandemic situations, and to promote dose-sparing of potent adjuvant molecules that can cause unacceptable side effects in prophylactic vaccination. Here we report strong class-switched, high avidity humoral immune responses elicited by a vaccine system based on poly(lactide-co-glycolide) micro- or nano-particles enveloped by PEGylated phospholipid bilayers, with protein antigens covalently anchored to the lipid surface and lipophilic adjuvants inserted in the bilayer coating. Strikingly, these particles elicited high endpoint antigen-specific IgG titers (>10(6)) sustained for over 100 days after two immunizations with as little as 2.5 ng of antigen. At such low doses, the conventional adjuvant alum or the molecular adjuvants monophosphoryl lipid A (MPLA) or α-galactosylceramide (αGC) failed to elicit responses. Co-delivery of antigen with MPLA or αGC incorporated into the particle bilayers in a pathogen-mimetic fashion further enhanced antibody titers by ~12-fold. MPLA provided the highest sustained IgG titers at these ultra-low antigen doses, while αGC promoted a rapid rise in serum IgG after one immunization, which may be valuable in emergencies such as disease pandemics. The dose of αGC required to boost the antibody response was also spared by particulate delivery. Lipid-enveloped biodegradable micro- and nano-particles thus provide a potent dose-sparing platform for vaccine delivery.

Teorías y prácticas de género una conversación dialéctica / Theories and practices of gender a dialectic conversation

A lo largo del texto se manifiesta un proceso dailéctico de reflexión y práctica que da lugar a cuestionamientos sobre las primeras experiencias de género y críticas sobre los conceptos y metodologías difundidos en el país en la última década. El proceso se dirige hacia un manejo del género que sea más adecuada a las realidades andinas y amazónicas, más integral e interdisciplinario, y más balanceado entre lo masculino y lo femenino.

Elementos metodológicos y contextualización para la planificación y evaluación de proyectos productivos relativos a mujer, género y desarrollo

I.Objerivos y metodología de trabajo II.Los conceptos operativos básicos. La planificación y el potenciamiento de la mujer III.escenario etnico ambiental: Los Guarani-izoceño del Chaco Boliviano IV.El escenario del sistema agropastiril: Las comunidades de pastores de altura V.El escenario de producción artesanal: Los grupos de artesanos textiles VI. conclusiones generales sobre la planificación de género

Mujeres campesinas

Desde niñas, las mujeres campesinas trabajan en muchas actividades, en la familia y en la comunidad. Las mujeres campesinas se casan muy jóvenes y en el matrimonio aumenta el trabajo. Desde muy temprano preparan la comida, limpian la casa y la ropa, atienden a las wawas y al marido y a veces también a sus padres. también se ocupan de la chacra al igual que el hombre, a desyerbar, a arar, a sembrar, y a cosechar. Porque de este trabajo depende de la producción que tenga la tierra. La cría de animales, el cuidado y el pastoreo también está a cargo de la mujer. La venta de lo que se produce, a veces está también a cargo de la mujer, llevan sus productos a las ferias de las comunidades y pueblos, donde los campesinos venden barato y compran caro. También se ocupan de hilar y tejer para la familia, y a veces también el producto, aguayos, phullus