The prognostic value of neutrophile/lymphocyte ratio and serum chemerin to predict maternal-fetal complications in pregnant systemic lupus erythematosus patients.

BACKGROUND: Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed. OBJECTIVE: To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups. METHODS: Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25 weeks of gestation. Patients were evaluated every 4-6 weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values. RESULTS: Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women (p = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6 ng/mL (15.3-47.4) in the healthy group (p = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) p = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43 ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, p = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43 ng/mL have or will have preeclampsia. CONCLUSION: The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.

Genomic analysis of virulence factors and antimicrobial resistance of group B Streptococcus isolated from pregnant women in northeastern Mexico.

INTRODUCTION: Group B Streptococcus (GBS) causes infections in women during pregnancy and puerperium and invasive infections in newborns. The genes lmb, cylE, scpB, and hvgA are involved with increased virulence of GBS, and hypervirulent clones have been identified in different regions. In addition, increasing resistance of GBS to macrolides and lincosamides has been reported, so knowing the patterns of antibiotic resistance may be necessary to prevent and treat GBS infections. This study aimed to identify virulence genes and antibiotic resistance associated with GBS colonization in pregnant women from northeastern Mexico. METHODS: Pregnant women with 35-37 weeks of gestation underwent recto-vaginal swabbing. One swab was inoculated into Todd-Hewitt broth supplemented with gentamicin and nalidixic acid, a second swab was inoculated into LIM enrichment broth, and a third swab was submerged into a transport medium. All samples were subcultured onto blood agar. After overnight incubation, suggestive colonies with or without hemolysis were analyzed to confirm GBS identification by Gram staining, catalase test, hippurate hydrolysis, CAMP test, and incubation in a chromogenic medium. We used latex agglutination to confirm and serotype GBS isolates. Antibiotic resistance patterns were assessed by Vitek 2 and disk diffusion. Periumbilical, rectal and nasopharyngeal swabs were collected from some newborns of colonized mothers. All colonized women and their newborns were followed up for three months to assess the development of disease attributable to GBS. Draft genomes of all GBS isolates were obtained by whole-genome sequencing. In addition, bioinformatic analysis to identify genes encoding capsular polysaccharides and virulence factors was performed using BRIG, while antibiotic resistance genes were identified using the CARD database. RESULTS: We found 17 GBS colonized women out of 1154 pregnant women (1.47%). None of the six newborns sampled were colonized, and no complications due to GBS were detected in pregnant women or newborns. Three isolates were serotype I, 5 serotype II, 3 serotype III, 4 serotype IV, and 2 serotype V. Ten distinct virulence gene profiles were identified, being scpB, lmb, fbsA, acp, PI-1, PI-2a, cylE the most common (3/14, 21%). The virulence genes identified were scpB, lmb, cylE, PI-1, fbsA, PI-2a, acp, fbsB, PI-2b, and hvgA. We identified resistance to tetracycline in 65% (11/17) of the isolates, intermediate susceptibility to clindamycin in 41% (7/17), and reduced susceptibility to ampicillin in 23.5% (4/17). The tetM gene associated to tetracyclines resistance was found in 79% (11/14) and the mel and mefA genes associated to macrolides resistance in 7% (1/14). CONCLUSIONS: The low prevalence of colonization and the non-occurrence of mother-to-child transmission suggest that the intentional search for GBS colonization in this population is not justified. Our results also suggest that risk factors should guide the use of intrapartum antibiotic prophylaxis. The detection of strains with genes coding virulence factors means that clones with pathogenic potential circulates in this region. On the other hand, the identification of decreased susceptibility to antibiotics from different antimicrobial categories shows the importance of adequately knowing the resistance patterns to prevent and to treat GBS perinatal infection.

Innovando en tiempos de pandemia: estrategias de enseñanza enriquecidas con tecnologías dirigido a estudiantes de ciencias de la salud en redes sociales / Innovating in times of a pandemic: teaching strategies enriched with technologies aimed at students of health sciences in social networks / Inovando em tempos de pandemia: estratégias de ensino enriquecidas com tecnologias voltadas para estudantes de ciências da saúde nas redes sociais

La experiencia que relatamos corresponde al re-diseño y dictado de una Unidad Curricular Optativa de Licenciatura de Facultad de Enfermería, y electiva para otras Facultades del área de ciencias de la salud de la Universidad de la República, Uruguay. Con el nombre Uso adecuado de redes sociales: una responsabilidad ciudadana, se plantea conformar el perfil de egreso contribuyendo a la comprensión epistemológica de la disciplina e interacción con la sociedad en la era digital a partir del intercambio y producción de contenidos en y para los espacios donde se encuentra y comunica la sociedad. Diseñada en modalidad semipresencial y a través de redes sociales, debió ser codiseñada ante el contexto de Pandemia que caracterizó el año 2020 para dictarse en línea. El Entorno Virtual de Aprendizaje, designado por la Universidad de la República, dio soporte a los intercambios y al trabajo grupal. La asignatura se dictó en línea con un sistema de asesoramiento pedagógico por parte de los docentes a cargo durante todo el proceso. La metodología de enseñanza se basó en una dinámica de participación-acción y trabajo colaborativo. Los resultados cuantitativos indican que el 73% de los estudiantes aprobaron el curso. A su vez el alcance cualitativo muestra alto interés por la mejora de las prácticas en redes sociales como ciudadanos y futuros profesionales, alcanzado a partir de la reflexión de esta práctica al ocupar el lugar de prosumidores de contenidos en redes sociales.

The experience that we relat corresponds to the re-design and delivery of an Optional Curriculum Unit of the Bachelor of the Faculty of Nursing, and elective for other Faculties of the area of health sciences of the University of the Republic, Uruguay. With the name Proper use of social networks: a civic responsibility, it is proposed to shape the graduation profile contributing to the epistemological understanding of the discipline and interaction with society in the digital age from the exchange and production of content in and for spaces where society meets and communicates. Designed in a blended mode, with face-to-face meetings outside the academic field and online through social networks, it had to be co-designed in the context of the Pandemic that characterized the year 2020 to be dictated online. The Virtual Learning Environment, designated by the University of the Republic, gave support to exchanges and group work. The subject was taught online with a pedagogical advisory system by the teachers in charge throughout the process. Regarding the teaching methodology, it was based on a dynamic of participation-action and collaborative work. The quantitative results indicate that 73% of the students passed the course. At the same time, the qualitative scope shows a high interest in improving practices in social networks as citizens and future professionals, achieved from the reflection of this practice by occupying the place of content prosumers for social networks.

A experiência que relatamos corresponde ao redesenho e entrega de uma Unidade Curricular Opcional do Bacharelado da Faculdade de Enfermagem e eletiva para outras Faculdades da área de ciências da saúde da Universidade da República, Uruguai. Com a denominação Uso adequado das redes sociais: uma responsabilidade cívica, propõe-se moldar o perfil da graduação contribuin-do para a compreensão epistemológica da disciplina e interação com a sociedade na era digital a partir da troca e produção de conteúdos nos e para os espaços onde a sociedade se encontra e se comunica. Projetado de forma mista, com encontros presenciais fora do campo acadêmico e online por meio de redes sociais, teve que ser co-projetado no contexto da Pandemia que caracterizou o ano de 2020 para ser ditado online. O Ambiente Virtual de Aprendizagem, designado pela Universidade da República, deu suporte a intercâmbios e trabalhos de grupo. A disciplina foi ministrada online com sistema de aconselhamento pedagógico pelos professores responsáveis ao longo do processo. Quanto à metodologia de ensino, esta se baseou em uma dinâmica de participação-ação e trabalho colaborativo. Os resultados quantitativos indicam que 73% dos alunos foram aprovados no curso. Ao mesmo tempo, o escopo qualitativo mostra um alto interesse em aprimorar as práticas nas redes sociais como cidadãos e futuros profissionais, conquistado a partir da reflexão dessa prática por ocupar o lugar de prossumidores de conteúdo para as redes sociais.

Formación docente en programas de posgrado / Teacher training in graduate programs / Formação de professores em programas de pós-graduação

Para dar soporte al Programa de Especialidades, la Facultad de Enfermería de la Universidad de la República del Uruguay, introdujo la figura de los docentes asistenciales como soporte académico a estos programas que iniciaban. Es en la formación de estos Licenciados en Enfermería, que guiarían a los futuros especialistas, en quienes se basa el presente artículo. Describiremos como se los acompañó a introducirse en el modelo de enseñanza y de aprendizaje, en base a la educación de adultos en un contexto de práctica profesional.La formación se hizo por medio de un curso diseñado y dictado en modalidad semipresencial. Se buscó estimular el uso de metodologías participativas centradas en el aprendizaje basado en problemas y el empleo de las evidencias.Los resultados finalizada la formación, permitieron ver un elevado cumplimiento de las actividades del curso a pesar de no ser obligatorias, mostrando un alto compromiso de los participantes con la formación brindada. Las prácticas propuestas y tareas asignadas buscaban enseñar diferentes actividades que podrían replicar luego como docentes de las Especialidades. Los participantes evaluaron el curso destacando la calidad y practicidad, además de considerar adecuada la modalidad y de gran utilidad en su actividad docente, pues sus futuros estudiantes compartían sus características. Las acertadas consecuencias de esta formación se vieron al desempeñarse como docentes en las Especialidades, donde la mayoría cumplió diversos roles tanto en la clínica como en las aula virtuales. Los aprendizajes se traducen en una serie de actividades que se pudieron implementar al iniciar su actuación docente.

To give support to the Specialties's program, the University Nursing' school of the Republic of Uruguay, introduced the concept of care teachers as academic support to these programs that was initiated. This is article is based on the graduates in Nursing's formation, whose would guide future specia-lists. We are going to describe how accompanied them to enter the teaching model and apprenticeship, based on adult education in a context of professional practice. The training was done through a course designed and delivered in a distance learning format. It sought to encourage the use of participatory methodologies focused on apprenticeship based on problems and used of evidence. The results completed education, allowed to see a high compliance of the course activities despite not being mandatory, showing a high commitment of the participants to the education provided. The practices proposals and activities assigned, teach diff erent activities that could then replicate as teachers of specialties. Participants assessed the course highlighting the quality and practicality, in addition to consider appropriate mode and useful in their teacher's activity, well their future students shared their characteristics. Successful consequences of this education were to serve as teachers in specialties where most fulfilled various roles so in the clinical as in the virtual classroom. The apprenticeships are translated into a series of activities that could be implemented to start their teaching performance.

Para apoiar o Programa de Especialidades, a Faculdade de Enfermagem da Universidade da República do Uruguai, apresentou a fi gura dos assistentes de ensino como apoio acadêmico a esses programas que eles iniciaram. É no treinamento desses Graduados em Enfermagem que eles orietariam os futuros especialistas, nos quais o presente artigo se baseia. Descreveremos como elas foram introduzidas no modelo de ensino e aprendizagem, com base na educação de adultos em um contexto de prática profissional. O treinamento foi realizado através de um curso projetado e entregue em modalidade mista. O objetivo foi estimular o uso de metodologias participativas focadas na aprendizagem baseada em problemas e no uso de evidências. Os resultados concluíram o treinamento, permitiram observar um alto grau de cumprimento das atividades do curso, apesar de não serem obrigatórios, demonstrando um alto comprometimento dos participantes com o treinamento ministrado. As práticas propostas e tarefas atribuídas procuravam ensinar diferentes atividades que poderiam então ser replicadas como professores das especialidades. Os participantes avaliaram o curso com ênfase na qualidade e praticidade, além de considerarem a modalidade adequada e de grande utilidade em sua atividade de ensino, uma vez que seus futuros alunos compartilhavam suas características. As conseqüências bem sucedidas desse treinamento foram vistas como professores nas Especialidades, onde a maioria desempenhava vários papéis, tanto na clínica quanto na sala de aula virtual. Os aprendizados são traduzidos em uma série de atividades que podem ser implementadas no início de seu desempenho docente.

Nivel de conocimiento sobre soporte vital básico del personal no médico de una institución de salud, Pasto- Colombia, 2017 / Level of knowledge about basic life support of non-medical workers of a health institution at Pasto city- Colombia, 2017

Objetivo: el objetivo de la presente investigación es describir el nivel de conocimiento acerca de soporte vital básico, del personal asistencial no médico del servicio de urgencias de una institución de salud, en la ciudad de Pasto-Colombia,en el año 2017. La parada cardiorrespiratoria corresponde a la interrupción brusca, inesperada y potencialmente reversible de la respiración y la actividad mecánica cardíaca; que requiere de la implementación de medidas de reanimación,cuyo éxito depende del nivel conocimiento y habilidades del personal que la lleva a cabo Materiales y métodos: se realizó un estudio descriptivo de corte transversal. El nivel de conocimiento se determinó mediante un cuestionario diseñado para tal fin. Resultados: se reclutaron en total 58 participantes. En 39,65% de los casos el nivel de conocimiento fue aceptable, mientas que se consideró adecuado en un 41,37% de los casos. Los puntajes fueron más altos en el grupo con capacitación en soporte vital básico o avanzado en los dos años previos. Conclusiones: la capacitación continua en soporte vital, representa una estrategia que conlleva a la obtención de mejores niveles de conocimiento en reanimación cardiopulmonar que, posiblemente impacten, en los desenlaces del paro cardíaco intrahospitalario..(AU)

Objective: the aim of the present investigation is to describe the level of knowledge of non-medical workers of the emergency service of a health institution at city of Pasto-Colombia in 2017. Cardiorespiratory arrest is the abrupt, unexpected and potentially reversible interruption of respiration and the mechanical activity of the heart; which requires the implementation of resuscitation measures, whose success depends on the level of knowledge and skill level of the staff that carries it out. Materials and methods: a cross-sectional study was permormed. The level of knowledge was determined through a questionnaire designed for that purpose. Results: a total of 58 participants were recruited. In 39.65% of cases, the level of knowledge was acceptable, while it was considered adequate in 41.37% of the cases. Scores were higher in the group with basic or advanced life support training in the previous two years. Conclusions: continuous training in life support represents a strategy that leads to obtaining better levels of knowledge in cardiopulmonary resuscitation that, possibly, impacts the outcomes of in-hospital cardiac arrest..(AU)

Selected Physiological Effects of a Garcinia Gummi-Gutta Extract in Rats Fed with Different Hypercaloric Diets.

Garcinia gummi-gutta (GGG) rind extract is effective for reducing appetite, body weight and adiposity of obese rodents fed high-fat (HF), high-sugar (HS) or high fat/sugar (HFS)-based diets, but these effects have not been simultaneously evaluated. Thirty obese (~425 g) male Wistar rats were fed for eleven weeks with six hypercaloric diets (4.1 kcal/g; five rats/diet) non-supplemented (HF, HS, HFS), or supplemented (HF+, HS+, HFS+) with GGG extract (5.9%), while rats from the control group (375 g) were fed a normocaloric diet (3.5 kcal/g). Body weight, dietary intake, body fat distribution, and histological and biochemical parameters were recorded. Compared to control rats, non-supplemented and supplemented groups consumed significantly less food (14.3% and 24.6% (−4.3 g/day), respectively) (p < 0.05). Weight loss was greater in the HF+ group (35⁻52 g), which consumed 1.9 times less food than the HS+ or HFS+ fed groups. The HF and HFS groups showed 40% less plasma triacylglycerides and lower glucose levels compared to the HF+. GGG-supplemented diets were associated with lower ketonuria. The HF+ diet was associated with the best anti-adiposity effect (as measured with the dual X-ray absorptiometry (DXA) and Soxhlet methods). The severity of hepatocyte lipidosis was HF > control > HF+, and no signs of toxicity in the testes were observed. The results indicate that GGG is more effective when co-administered with HF diets in obese rats.

Optimization of a recombinant human growth hormone purification process using quality by design.

This work describes a strategy to optimize a downstream processing of a recombinant human growth hormone (rhGH) by incorporating a quality by design approach toward meeting higher quality specifications. The optimized process minimized the presence of impurities and degradation by-products during manufacturing by the establishment of in-process controls. Capillary zone electrophoresis, reverse phase, and size-exclusion chromatographies were used as analytical techniques to establish new critical process parameters for the solubilization, capture, and intermediate purification steps aiming to maintain rhGH quality by complying with pharmacopeial specifications. The results indicated that the implemented improvements in the process allowed the optimization of the specific recovery and purification of rhGH without compromising its quality. In addition, this optimization facilitated the stringent removal of the remaining impurities in further polishing stages, as demonstrated by the analysis of the obtained active pharmaceutical ingredient.

Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia.

PURPOSE: Ongoing armed conflicts, like the one in Colombia, have forcibly displaced millions of people including many young children. This study aimed to assess the mental health of internally displaced preschoolers in Bogotá Colombia and to identify correlates of mental health in these children. METHODS: Cross-sectional study conducted among 279 children attending four kindergartens in a deprived neighbourhood in Bogotá. Child mental health was assessed with the Child Behaviour Checklist (CBCL) 1.5-5 years, a parent-report. Univariate analyses and multivariate logistic regressions were performed to assess the association between displacement and child mental health and to identify correlates of mental health in displaced children. RESULTS: Displaced children (n = 90) more often met borderline cut-off scores for the CBCL scales than non-displaced children (n = 189) (e.g. total problems 46.7 vs. 22.8 %; p < 0.001). The association between displacement and presence of CBCL total problems remained after adjustment for socio-demographic factors (Adjusted OR 3.3, 95 % CI 1.5; 6.9). Caretaker's mental health partly explained the association. In displaced children, caretaker's mental health (p < 0.01) and family functioning (p < 0.01) were independently associated with child mental health. Exposure to traumatic events and social support was also associated with child mental health; however, associations were not independent. CONCLUSION: In this deprived neighbourhood in Bogotá, preschool children registered as internally displaced presented worse mental health than non-displaced peers. Family functioning and caretaker's mental health were strongly and independently associated with displaced children's mental health.

Los derechos sexuales y reproductivos: estudio de caso de unidades de prestación de servicios / Sexual and reproductive rights: case study of health services

Se aplicó un instrumento cuanti-cualitativo para una aproximación a la garantía de derechos sexuales y reproductivos (DSR) en el sector salud desde la perspectiva de calidad de los usuarios/ as en los servicios de planificación familiar y control prenatal de 5 unidades básicas de prestación de servicios de salud de Bogotá, en Kennedy, Candelaria, Ciudad Bolivar, junio a diciembre de 2004.