Promoción de la salud en América Latina: Coherencia en su implementación* / Health promotion in Latin America: Coherence in its implementation / Promoção da saúde na América Latina: coerência em sua implementação

Resumen Objetivo: a la luz de los enfoques y estrategias de promoción de la salud propuesto en la Carta de Ottawa, avalados por la Organización Mundial de la Salud, se analizó cómo las autoridades sanitarias nacionales de Colombia, Brasil y México, que tienen sistemas de salud estructurados de manera distinta, conceptualizan y orientan la promoción de la salud. Metodología: análisis documental de información oficial de las dependencias encargadas de promoción de la salud en cada país; posteriormente, se hizo un análisis de coherencia en torno a ese concepto. Resultados: hay distintos niveles de coherencia respecto a la promoción de la salud: en Colombia el concepto se transmuta en gestión del riesgo individual a través de los documentos que implementan el Plan Decenal de Salud Pública; en Brasil el concepto de promoción de la salud se aplica coherentemente, aunque las prioridades operativas están enfocadas en aspectos individuales, además, cada Estado y municipio lo implementa de acuerdo con sus necesidades y capacidades; en México la promoción de la salud está institucionalizada, pero el acceso de los ciudadanos al servicio depende del aseguramiento y la agencia individual. Conclusiones: la promoción de la salud se hace en un marco de prestación de servicios de salud enfocados en el control del riesgo individual. Oficialmente los tres países evidenciaron coherencia con los postulados de promoción de la salud expuestos en la Carta de Ottawa, sin una adecuada coherencia en su implementación.

Abstract Objective: In light of the health promotion approaches and strategies proposed in the Ottawa Charter, endorsed by the World Health Organization, it was analyzed how the national health authorities of Colombia, Brazil and Mexico, which have health systems structured differently, conceptualize and guide health promotion. Methodology: Documentary analysis of official information from the agencies in charge of health promotion in each country. Subsequently, a coherence analysis around this concept was carried out. Results: There are different levels of coherence regarding health promotion: in Colombia the concept is transmuted into individual risk management through the documents that implement the Ten-Year Public Health Plan; in Brazil, the concept of health promotion is applied coherently although operational priorities are focused on individual aspects, and each state and municipality implements it according to their needs and capabilities; in Mexico, health promotion is institutionalized, but the access of citizens to the service depends on insurance and individual agency. Conclusions: Health promotion is done within a framework of health service provision focused on individual risk control. Officially, the three countries showed coherence with the health promotion postulates set out in the Ottawa Charter, without adequate coherence in its implementation.

Resumo Objetivo: À luz dos enfoques e estratégias de promoção da saúde propostas na Carta de Ottawa, endossada pela Organização Mundial da Saúde, foi analisado como as autoridades nacionais de saúde da Colômbia, Brasil e México, que possuem sistemas de saúde estruturados de forma diferenciada, conceituam e orientam promoção de saúde. Metodologia: Análise documental de informações oficiais dos órgãos responsáveis pela promoção da saúde de cada país; posteriormente, foi feita uma análise de coerência em torno desse conceito. Resultados: Há diferentes níveis de coerência em relação à promoção da saúde: na Colômbia o conceito se transmuta em gestão de risco individual por meio dos documentos que implementam o Plano Decenal de Saúde Pública; No Brasil, o conceito de promoção da saúde é aplicado de forma consistente, embora as prioridades operacionais sejam focadas em aspectos individuais, além disso, cada estado e município implementa de acordo com suas necessidades e capacidades; No México, a promoção da saúde é institucionalizada, mas o acesso dos cidadãos ao serviço depende de seguro e agência individual. Conclusões: A promoção da saúde é feita dentro de uma estrutura de prestação de serviços de saúde com foco no controle de risco individual. Oficialmente, os três países mostraram-se coerentes com os postulados de promoção da saúde previstos na Carta de Ottawa, sem a devida coerência em sua implementação.

Cultura de segurança do paciente na Atenção Primária à Saúde / Patient safety culture in Primary Health Care

A segurança do paciente ainda é uma temática recente na Atenção Primária à Saúde (APS). Contudo, uma vez que os atendimentos realizados nesse nível de atenção crescem e aumentam em complexidade e quantidade de pacientes, o número de eventos adversos, também se torna frequente. Serviços que apresentam uma cultura de segurança do paciente, na qual os profissionais da área da saúde compartilham valores, atitudes e comportamentos que afetam seu potencial de apresentar erros e gerar danos, tendem a prestar um cuidado mais seguro e efetivo aos seus pacientes. Dessa forma, o presente estudo teve o objetivo de realizar um diagnóstico da cultura de segurança do paciente na APS em um município de médio porte do Rio Grande do Sul. Este é um estudo transversal realizado a partir da aplicação do questionário "Pesquisa sobre Cultura de Segurança do Paciente para Atenção Primária" com profissionais que atuam em serviços de APS. A avaliação geral da cultura de segurança do paciente no município apresentou um resultado positivo, ou seja, os profissionais percebem uma cultura favorável a um cuidado seguro dos pacientes. A dimensão "trabalho em equipe" se destacou como um ponto forte na pesquisa. Alguns pontos foram identificados como fracos, dentre eles o "treinamento das equipes de saúde", "apoio dos gestores na segurança do paciente" e "pressão e ritmo de trabalho dos profissionais", sendo essa identificação o primeiro passo para o aprimoramento da segurança do paciente na APS local.

Patient safety is still a recent issue in Primary Health Care (PHC). However, since the care provided at this level of care grows and increases in complexity and number of patients, the number of adverse events also becomes frequent. Services that have a patient safety culture, in which healthcare professionals share values, attitudes and behaviors that affect their potential to make mistakes and generate harm, tend to provide safer and more effective care to their patients. Thus, the present study aimed to carry out a diagnosis of the culture of patient safety in PHC in a medium-sized city in Rio Grande do Sul. This is a cross-sectional study carried out using the questionnaire "Medical Office Survey on Patient Safety Culture" with professionals who work in PHC services. The general assessment of the patient safety culture in the city showed a positive result, that is, professionals perceive a favorable culture for safe patient care. The "teamwork" dimension stood out as a strong point in the research. Some points were identified as weak, such as "team training", "leadership support for patient safety" and "work pressure and pace", this identification being the first step towards improving patient safety in the local PHC.

Perioperative Management of Painful Phantom Limb Syndrome: A Narrative Review and Clinical Management Proposal.

OBJECTIVE: Painful Phantom Limb Syndrome (PPLS) occurs in 50 to 80% of patients undergoing amputation, having a great impact on quality of life, productivity and psychosocial sphere. The objective of this review is to summarize the pharmacological and non-pharmacological strategies, surgical optimization, and provide a multidisciplinary approach aimed at reducing the incidence of chronic pain associated with PPLS in patients undergoing limb amputation. METHODS: A narrative review was carried out using Medline, Pubmed, Proquest, LILACS and Cochrane, searching for articles between 2000 and 2021. Articles describing the epidemiology, pathophysiological considerations, and current treatments were selected after a screening process. RESULTS: A multidisciplinary and multimodal approach is required in PPLS, and should include the use of regional techniques, and adjuvants such as NSAIDs, ketamine, lidocaine and gabapentinoids. In addition, an evaluation and continuous management of risk factors for chronic pain in conjunction with the surgical team is necessary. CONCLUSION: The current literature does not support that a single technique is effective inthe prevention of PPLS. However, adequate acute pain control, rehabilitation and early restoration of the body scheme under a multidisciplinary and multimodal approach have shown benefit in the acute setting.

Depressive symptomatology in adults during the COVID-19 pandemic.

Depression entails changes in the mental health of individuals worldwide. Episodes of depression lead to mood swings and changes in the motivational dimension. Our research focused on the prevalence of depression in the adult population and on how it affected the social and affective dimensions. Owing to the current pandemic, we deemed it necessary to explore how protective measures against COVID-19 infection, such as quarantines, could be related to mental health. Moreover, we found it important to determine the prevalence of depressive and anxious symptomatology in adults from the Valle del Cauca region in Colombia during the social isolation connected to COVID-19. Our study was descriptive, analytical and cross-sectional, and involved 1248 subjects. As tools, we used the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. The data demonstrated that women were more likely to display symptoms of depression and that individuals aged between 24 and 29 were less likely to reveal symptoms of anxiety than those aged between 18 and 23. Moreover, childless or economically dependent individuals proved to be more likely to display symptoms of depression during the pandemic.

In vitro antimicrobial effect of chloroaluminum phthalocyanine nanoemulsion on periodontal bacteria.

CONTEXT: Nowadays, complementary therapies are necessary for a major removal of microbial subgingival biofilm in the conventional treatment of periodontitis. Research has suggested the use of photodynamic therapy (PDT) as a promising therapy to manage oral cavity infections. This project proposes a new combination of photosensitizer chloroaluminum phthalocyanine and nanoemulsion as a strategy for improving bioactivity. The main purpose of this in vitro study was to evaluate the antimicrobial activity of nanoemulsion ClAlPc (ClAlPc-NE) on relevant periodontal bacteria before and after PDT. MATERIALS AND METHODS: The phototoxic and antibacterial effect of ClAlPc-NE was evaluated against epithelial cells derived from an African green monkey kidney using the colorimetric method with salt tetrazolium 3-(4.5-dimethylthiazolyl-2)-2.5-Diphenyltetrazolium bromide (Merck) and periodontopathogen bacteria (Porphyromonas gingivalis (ATCC 33277), Aggregatibacter actinomycetemcomitans (ATCC 33384), and Prevotella intermedia (ATCC 25611) using the plate microdilution method according to Tavares et al., 2018, respectively. The light source used for the PDT was a LED laser (400-700 nm); the cells were irradiated for 2 min using 4.83 joules/cm2. RESULTS: Antibacterial effect of NE-PcAlCl against P. intermedia with minimum inhibitory concentration (MIC) 0.63 µM after TFD was determined. In the case of P. gingivalis and A. actinomycetemcomitans, no biological activity was found after PDT (MIC > 20 µM) under-evaluated experimental conditions. On the other hand, the ClAlPc-free and ClAlPc-NE cells were phototoxic on epithelial cells. CONCLUSION: The results helped to identify the potential use of ClAlPc-NE to inhibit the periodontal bacterial and additional studies are being developed.

Genetic and toxigenic diversity of Bacillus cereus group isolated from powdered foods.

Bacillus cereus is a human pathogenic bacterium that produces emetic and diarrheal foodborne diseases. This study evaluated the genetic and toxigenic diversity in B. cereus group isolates from powdered foods collected in public educational institutions, bakeries and powdered food companies located in Medellín, Colombia. B. cereus was detected in 35 of 305 (11%) powdered food samples and 52 B. cereus were isolated. The presence of ten toxin genes, hblCDAB, nheABC, cytK2, entFM and cesB, was evaluated in the isolates by multiplex PCR. The nheABC operon was found in all isolates (100%), hblCDAB in 22 (42%), hblCDA in 8 (15%) and hblCD in 3 (6%); the cytK2 gene was detected in 32 isolates (62%) and entFM in 32 (62%). Notably, the cesB gene was not detected. According to the presence of toxin genes, fifteen profiles were identified. The predominant toxigenic profile contained all toxin genes but cesB. A large genetic diversity was observed by GTG5 fingerprinting with 46 isolates grouped in seven clusters and the remaining six clustering individually. There was no relationship between toxigenic profiles and genetic clusters, but some genetic clusters seemed to be related to particular powdered food types. In general, the results evidenced high genetic and enterotoxigenic diversity among the B. cereus group isolates.

Enterotoxin Gene Distribution and Genotypes of Bacillus cereussensu lato Isolated from Cassava Starch.

Bacillus cereus is a human pathogenic bacterium found in foods with the potential to cause emesis and diarrhea. This study estimated the presence, toxigenic and genomic diversity of B. cereus s.l. obtained from cassava starch samples collected in bakeries and powdered food companies in Medellín (Colombia). Bacillus cereuss.l. was found in 43 of 75 (57%) cassava starch samples and 98 isolates were obtained. The nheABC, hblCDAB, cytK2, entFM and cesB toxin genes were detected by multiplex PCR and the most frequent operon was nheABC, whereas cesB gene was not found. Twelve toxigenic profiles were determined by the detection of toxin genes, and the most frequent profiles harbored all enterotoxin genes. A broad genomic diversity was detected according to GTG5-PCR fingerprinting results with 76 B. cereus s.l. grouped in sixteen clusters and the 22 isolates clustering separately. No relationship was observed between genomic background and toxigenic profiles. In general, the results showed a high genomic and enterotoxigenic diversity in B. cereus s.l. found in cassava starch. These results should incentive future studies to understand the distribution of B. cereus s.l. isolated on raw materials in comparison with finished products.

A dysfunctional family environment and a high body fat percentage negatively affect telomere length in Mexican boys aged 8-10 years.

AIM: The aim of this study was to determine whether a direct relationship existed between absolute telomere length (aTL), obesity and familial functionality in a group of Mexican children. METHODS: We recruited 134 children (52% boys) aged 8-10 years during regular primary care check-ups in 2016 and evaluated physical activity (PA), feeding practices, anthropometrics, body fat percentage (BF%) and family dysfunction. Optimised quantitative PCR determined aTL from genomic deoxyribonucleic acid isolated from saliva samples. RESULTS: Boys with a healthy BF% showed a higher aTL than their high BF% counterparts (P < .01). aTL was higher in children who performed PA than their sedentary counterparts (P < .05). Alarmingly, 90% of the children belonged to dysfunctional families and a dysfunctional family was correlated with a higher BF% (r = -.57). Negative correlations between the BF% and aTL (r = -.1765) and the BF% and time dedicated to PA (r = -.031) were observed in boys. On the contrary, we found a positive correlation between the aTL and weekly PA (r = .1938). These correlations were not observed in girls. CONCLUSION: Telomere shortening was associated with a high BF% in boys, but not girls. Dysfunctional families were also a key factor. School PA programmes should be mandatory.

Genomic and Toxigenic Heterogeneity of Bacillus cereus sensu lato Isolated from Ready-to-Eat Foods and Powdered Milk in Day Care Centers in Colombia.

Bacillus cereus sensu lato (s.l.) is a group of bacteria commonly found in diverse environments, including foods, with potential to cause emesis and diarrhea. In Colombia, it is one of the main foodborne pathogens. The aim of this study was to determine the genomic and toxigenic heterogeneity of B. cereus s.l. isolated from ready-to-eat foods and powdered milk collected in day care centers of Medellin, Colombia. Of 112 B. cereus s.l. isolates obtained, 94% were ß-hemolytic. Toxigenic heterogeneity was established by the presence of nheABC, hblCDAB, cytK2, entFM, and cesB toxigenic genes. The nheABC operon and entFM gene were most frequently detected in the isolates, whereas the cesB gene was not found. According to the toxin genes content, nine toxigenic profiles were identified. A 44% of isolates had profiles with all genes for nonhemolytic enterotoxin, hemolysin BL, and enterotoxin FM production (profiles II and IV). Pulsed-field gel electrophoresis analysis indicated a high genomic heterogeneity among the B. cereus s.l., with 68 isolates grouping into 16 clusters and 33 placed separately in the dendrogram. This study provides useful information on the safety of ready-to-eat foods and powdered milk in day care centers where children, a susceptible population, are exposed and it should incentive for more studies to understand the distribution of different toxin-encoding genes among B. cereus s.l. isolates, enabling detailed risk assessment.

Semisynthetic eugenol derivatives as antifungal agents against dermatophytes of the genus Trichophyton.

PURPOSE: Eugenol, the main component of clove bud essential oil (Eugenia caryophyllus), has been linked to antimicrobial, anti-inflammatory, insecticidal and immunomodulatory properties. The purpose of this study was to evaluate the antifungal and cytotoxic activity of eugenol, the essential oil of Eugenia caryophyllus, and some semisynthetic derivatives of eugenol against dermatophytes of the genus Trichophyton. METHODOLOGY: We evaluated the antifungal effect of the compounds, determining the minimum inhibitory concentrations (MICs) by the microdilution method and the minimum fungicidal concentrations by cultures from the inhibitions. Additionally, the inhibition of the radial growth of the mycelium of the dermatophyte fungi was tested by poisoned substrate. Cytotoxicity was measured by the colorimetric method on Vero cells. RESULTS: All of the eugenol compounds tested exhibited antifungal properties, showing MICs of 62.5-500 µg ml-1 , determined within three dermatophyte species: Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. Among these derivatives, methyl isoeugenol, at concentrations of 300 and 100 µg ml-1, was found to completely inhibit (100 %) radial growth of the mycelium of all three species after 20 days of treatment. Additionally, phenotypic variations related to the decrease in pigment production of T. rubrum were observed after treatment with O-ethyl and O-butyl isoeugenol derivatives. Meanwhile, all of the tested (iso)eugenol molecules exhibited moderate toxicity in Vero cells [50 % cytotoxic concentration (the concentration required for a 50 % reduction in cell viability; CC50): 54.06-265.18 µg ml-1 ). CONCLUSION: The results suggest that the semisynthetic eugenol derivatives (SEDs) show promising antifungal activity and selectivity against dermatophyte fungi.

In vitro susceptibility of Microsporum spp. and mammalian cells to Eugenia caryophyllus essential oil, eugenol and semisynthetic derivatives.

BACKGROUND: Microsporum spp. are keratinophilic dermatophytes that mainly invade the stratum corneum of the skin and hair causing clinical symptoms associated with tinea. Its treatment has several limitations, and the search for new active molecules is necessary. OBJECTIVE: To evaluate the antifungal and cytotoxic potential of Eugenia caryophyllus essential oil (EO), eugenol, isoeugenol and methylisoeugenol against Microsporum canis, M. gypseum and Vero cells. METHODS: The EO was extracted by conventional heating-assisted hydrodistillation, the eugenol obtained commercially and the derivatives through Williamson synthesis. Minimal inhibitory concentration (MICs), minimum fungicidal concentration, inhibition of radial mycelial growth and germination inhibition were used to evaluate the antifungal activity. In addition, a colorimetric test was conducted to evaluate cytotoxic activity. RESULTS: MIC and MFC values for all compounds were 62.5-500 µg/mL for both of the species of Microsporum evaluated. Also, concentrations of 300 µg/mL of the compounds inhibited 100% of M. canis mycelium. The inhibition of germination was observed after 6 hours of treatment (11.86 ± 3.46-85.31 ± 0%). No cytotoxicity was observed in Vero cells (CC50  > 105 µg/mL), whereas terbinafine showed CC50 31.00 ± 0.61 µg/mL. CONCLUSIONS: Our study indicates an interesting bioactivity of isoeugenol and methylisoeugenol against M. canis, M. gypseum and mammalian cells.

Inhibition of Listeria monocytogenes in Fresh Cheese Using Chitosan-Grafted Lactic Acid Packaging.

A chitosan from biologically obtained chitin was successfully grafted with d,l-lactic acid (LA) in aqueous media using p-toluenesulfonic acid as catalyst to obtain a non-toxic, biodegradable packaging material that was characterized using scanning electron microscopy, water vapor permeability, and relative humidity (RH) losses. Additionally, the grafting in chitosan with LA produced films with improved mechanical properties. This material successfully extended the shelf life of fresh cheese and inhibited the growth of Listeria monocytogenes during 14 days at 4 °C and 22% RH, whereby inoculated samples with chitosan-g-LA packaging presented full bacterial inhibition. The results were compared to control samples and commercial low-density polyethylene packaging.

Direct detection of toxigenic Bacillus cereus in dietary complement for children and cassava starch / Detección directa de Bacillus cereus toxigénicos en complementos dietarios para niños y en almidón de yuca / Detecção direta de Bacillus cereus toxigênicos em suplementos alimentares para crianças e amido de mandioca

Bacillus cereus is a food contaminant and a known human pathogen that can cause emetic and diarrheal syndromes. In this study we evaluated the presence of toxigenic B. cereus by multiplex PCR directly in dietary complement for children and cassava starch samples collected on Medellin, Colombia. Of 75 dietary complement for children samples evaluated, 70.7% were contaminated with toxigenic B. cereus and four different toxigenic consortia were detected: I: nheA, hblC, cytK (9.8%), II: nheA, hblC (2%), III: hblC, cytK (41.2%), IV: hblC (47%). Of 75 cassava starch samples, 44% were contaminated with toxigenic B. cereus and four different toxigenic consortia were determined: I: nheA, hblC, cytK (48.5%), II: nheA, hblC, cytK, cesB (3%), III: hblC, cytK (30.3%), IV: hblC (18.2%). In general, in dietary complement for children only enterotoxigenic consortia were detected while in cassava starch the enterotoxigenic consortia predominated over the emetic. Multiplex PCR was useful to detect toxigenic B. cereus contamination allowing direct and simultaneous detection of all toxin genes in foods. This study is the first in Colombia to evaluate toxigenic B. cereus, providing information of importance for microbiological risk evaluation in dried foods.

Bacillus cereus es un contaminante de alimentos conocido por ser patogénico para los humanos, causando síndromes de vómito y diarrea. En este estudio se evaluó la presencia de B. cereus toxigénicos utilizando PCR múltiple directamente en complementos dietarios para niños y en almidón de yuca colectados en Medellín, Colombia. De 75 muestras de complemento dietario para niños, 70,7% estuvieron contaminadas con B. cereus toxigénicos y se detectaron cuatro diferentes consorcios toxigénicos: I: nheA, hblC, cytK (9,8%), II: nheA, hblC (2%), III: hblC, cytK (41.2%), IV: hblC (47%). De 75 muestras de almidón de yuca, 44% estuvieron contaminadas con B. cereus toxigénicos y se determinaron cuatro diferentes consorcios toxigénicos: I: nheA, hblC, cytK (48.5%), II: nheA, hblC, cytK, cesB (3%), III: hblC, cytK (30,3%), IV: hblC (18.2%). En general, en los complementos dietarios para niños sólo se detectaron consorcios enterotoxigénicos, mientras que en el almidón los consorcios enterotoxigénicos predominaron sobre el emético. La PCR múltiple fue de utilidad para detectar contaminación con B. cereus toxigénicos permitiendo la detección directa y simultánea de todos los genes tóxicos en los alimentos. Este estudio es el primero en Colombia en evaluar B. cereus toxigénicos y proporciona información importante para la evaluación de riesgos microbiológicos en los alimentos pulverizados.

Bacillus cereus é um contaminante de alimentos e é conhecido por ser patogénico nos seres humanos ocasionando síndromes de vômitos e diarreia. Neste estudo foi avaliada a presença de B. cereus toxigênicos por PCR multiplex diretamente em complementos da dieta para crianças e amido de mandioca, em amostras coletadas em Medellín, na Colômbia. De 75 amostras dos complementos da dieta para crianças, 70,7% estiveram contaminadas com B. cereus toxigênicos e foram detectados quatro diferentes consórcios: I: nheA, hblC, cytK (9,8%), II: nheA, hblC (2%), III: hblC, cytK (41,2%), IV: hblC (47%). De 75 amostras de amido de mandioca, 44% estiveram contaminadas com B. cereus toxigênicos e quatro consórcios diferentes foram determinados: I: nheA, hblC, cytK (48,5%), II: nheA, hblC, cytK, cesB (3%) III: hblC, cytK (30,3%), IV: hblC (18,2%). Em geral, nos complementos da dieta para crianças foram detectados apenas consórcios enterotoxigênicos, não obstante no amido os consórcios enterotoxigênicos predominaram sobre o emético. A PCR multiplex foi útil para detectar contaminação com B. cereus toxigênico permitindo a detecção direta e simultânea de todos os genes tóxicos em alimentos. Este estudo é o primeiro na Colômbia em avaliar B. cereus toxigênico e providencia informação importante para a avaliação de riscos microbiológicos em alimentos pulverizados.

Detección directa de genes toxigénicos de Bacillus cereus en fécula de maíz y harina de trigo mediante reacción en cadena de la polimerasa múltiple (mPCR) / Direct detection of toxigenic genes of Bacillus cereus in corn starch and wheat flour using multiplex polymerase chain reaction (mPCR)

Introducción: Bacillus cereus es una bacteria contaminante de alimentos y patógena en humanos, cuya toxina emética o cereúlida (Ces) causa el síndrome emético y las enterotoxinas hemolítica o hemolisina BL (Hbl), no hemolítica (Nhe) y citotoxina K (CytK), el síndrome diarreico. Objetivo: Determinar la presencia de genes toxigénicos de Bacillus cereus en muestras de ADN obtenido directamente de fécula de maíz y de harina de trigo, mediante reacción en cadena de la polimerasa múltiple. Materiales y métodos: Se determinaron los genes toxigénicos de Bacillus cereus en muestras de ADN extraído directamente de fécula de maíz y harina de trigo, utilizando una reacción en cadena de la polimerasa múltiple específica para los genes cesB, hblC, nheA y cytK. Resultados: De 76 muestras de fécula de maíz, el 60,5% presentó los genes toxigénicos de Bacillus cereus, que fueron agrupados en seis consorcios: I: hblC, cytK (30,4%), II: nheA, hblC, cytK (21,7%), III: hblC (19,6%), IV: nheA (15,2%), V: nheA, hblC (10,9%), VI: nheA, hblC, cytK, cesB (2,2%). De 79 muestras de harina de trigo, el 65,8% presentó los genes toxigénicos de Bacillus cereus, que se agruparon en cuatro consorcios: I: nheA, hblC, cytK (80,8%), II: hblC, cytK (11,5%), III: hblC (5,8%), IV: nheA, hblC (1,9%)...

Introduction: Bacillus cereus is a human pathogen that causes two kinds of foodborne diseases, the emetic syndrome caused by emetic toxin or cereulide (Ces), and the diarrheal syndrome caused by three different enterotoxins, the hemolytic enterotoxin or hemolysin BL (Hbl), the nonhemolytic enterotoxin (Nhe) and the cytotoxin K (CytK). Objective: To determine the presence of toxigenic genes of Bacillus cereus in DNA samples directly obtained from corn starch and wheat flour using multiplex polymerase chain reaction. Material and methods: The presence of toxigenic genes of Bacillus cereus were determinedin DNA samples directly extracted from corn starch and wheat flour, using a multiplex polymerase chain reaction technique specific for cesB, hblC, nheA and cytK genes. Results: From a total of 76 corn starch samples, 60.5% had toxigenic genes of Bacillus cereus and were grouped in six consortia: I: hblC, cytK (30.4%), II: nheA, hblC, cytK (21.7%), III: hblC (19.6%), IV: nheA (15.2%), V: nheA, hblC (10.9%) and VI: nheA, hblC, cytK, cesB (2.2%). From 79 wheat flour samples tested, 65.8% had toxigenic genes of Bacillus cereus and were grouped into four consortia: I: nheA, hblC, cytK (80.8%), II: hblC, cytK (11.5%), III: hblC (5.8%) and IV: nheA, hblC (1.9%)...

Actividad antimicrobiana del ácido acético 5% y el cepillo Colgate 360° antibacterial®: un estudio in vitro / Antimicrobial activity of acetic acid and Colgate 360° antibacterial toothbrush®: an in vitro study

Introducción: el cepillo dental se convierte en una fuente potencial de patógenos orales cuando no se hace un proceso de desinfección después de su uso, sobre todo en pacientes con infecciones en el sistema estomatognático o poblaciones que no hacen recambio frecuente de este instrumento. El objetivo de este estudio fue comparar la actividad antimicrobiana del ácido acético 5% con la del cepillo Colgate 360° antibacterial® como posibles estrategias en la desinfección del cepillo dental. Métodos: se utilizaron 48 cabezas de cepillos dentales que fueron inoculadas con Staphylococcus aureus, Streptococcus mutans y Cándida albicans separadamente. Las cabezas fueron divididas en tres grupos: cabezas tratadas con ácido acético 5% (vinagre blanco casero, La Constancia®) por 10 minutos, cabezas 360° con actividad antibacterial y controles tratados con solución salina. Posteriormente se hizo recuento de UFC/ml de los microorganismos remanentes en las cabezas de cepillos después del tratamiento o tiempo de acción. Resultados: frente a S. aureus, el cepillo Colgate 360° antibacterial® mostró mejor efecto antimicrobiano que el ácido acético 5% (PI: 72,11 5). Los dos tratamientos evaluados mostraron capacidad similar para eliminar S. mutans de las cabezas de cepillos (p > 0,05); mientras que para C. albicans, el mejor efecto antimicrobiano lo obtuvo el ácido acético 5% (PI: 99,9%). Conclusión: in vitro el vinagre blanco de uso casero y el cepillo Colgate 360° antibacterial® eliminan microorganismos que colonizan cabezas de cepillos dentales como S. aureus, S. mutans y C. albicans, convirtiéndose en alternativas en diversas poblaciones para mantener el cepillo dental libre de microorganismos.

Introduction: toothbrushes may become a potential source of oral pathogens when not properly disinfected once they have been used, especially in patients with infections of the stomatognathic system or among populations that do not often replace this instrument. The goal of this study was to compare the antimicrobial activity of 5% acetic acid with that of Colgate 360º antibacterial toothbrush® as possible strategies for toothbrush disinfection. Methods: this study included 48 toothbrush heads that were separately inoculated with Staphylococcus aureus, Streptococcus mutans and Cándida albicans. The heads were sorted out into three groups: heads treated with 5% acetic acid (white domestic vinegar, La Constancia®) for 10 minutes; 360º toothbrush heads with antibacterial properties, and control heads treated with saline solution. This was followed by calculations of CFU/ml of the microorganism remaining in the heads after treatment or time of action. Results: in presence of S. aureus, Colgate 360º antibacterial toothbrush® proved to have better antimicrobial activity than 5% acetic acid (PI:72.11 5). The two assessed treatments showed a similar capacity to eradicate S. mutans from the brush heads (p> 0,05); concerning C. albicans, the best antimicrobial activity was observed in the 5% acetic acid (PI: 99,9%). Conclusion: in vitro, both white domestic vinegar and Colgate 360º antibacterial toothbrush® remove microorganisms colonizing toothbrush heads, such as S.aureus, S. mutans y C. albicans, and are therefore considered good alternatives for keeping toothbrushes free of microoorganisms among several populations.

[A case of the calcifying epithelial odontogenic tumor (Pindborg's tumor). Reported and literature review]. / Tumor odontogénico epitelial calcificante (tumor de Pindborg). Informe de un caso y revisión de la literatura.

The calcifying epithelial odontogenic tumor known as Pindborg's tumor, is a rare odontogenic neoplasm of the jaws. One of their characteristics is the cortical expansion and the relationship with a non erupted tooth. Since the original description in 1955, only 200 cases approximately have been described in the world literature. This article reviews the literature and describes a case of patient who presented calcifying epithelial odontogenic tumor in the jaw undergoing surgical excision treatment with an evolution without complications.

Regulación del inicio de la esporulación e histidina cinasas: un análisis comparativo entre bacillus subtilis y el grupo bacillus cereus / Sporulation start and hystidine kinase regulation: a comparative analysis of bacillus subtilis the group of bacillus cereus / Regulamentação do início da esporulação e histidina-cinase: uma análise comparativa entre bacillus subtilis e o grupo bacillus cereus

La esporulación, que es una respuesta de quorum sensing, es un proceso de diferenciación celular mediado por moléculas de señalización, señales fisiológicas y ambientales. Se sabe que Bacillus subtilis detecta las señales metabólicas y ambientales y éstas son integradas a un sistema de transferencia secuencial de fosfatos. Las señales son detectadas por histidina cinasas que se autofosforilan y fosforilan, a su vez, a proteínas que actúan como reguladores de respuesta y activan la expresión de genes específicos de esporulación. Dada la importancia de B. cereus desde el punto de vista epidemiológico, el potencial para bioterrorismo de B. anthracis y la importancia en biotecnología agrícola de B. thuringiensis, la investigación sobre los mecanismos moleculares de señalización y la regulación del inicio de la esporulación en estas bacterias del grupo B. cereus reviste especial interés. En esta revisión se discute la literatura sobre este tema, haciendo hincapié en las histidina cinasas y en el análisis comparativo de los genomas de B. subtilis y del grupo de B. cereus, en cuanto a las secuencias de posibles histidina cinasas y reguladores de respuesta. Cabe destacar que en los genomas del grupo B. cereus hay mayor número de histidina cinasas (10 a 14) y de reguladores de respuesta (7 a 11) putativos que en B. subtilis (6 histidina cinasas y 6 reguladores de respuesta), lo cual sugiere una mayor capacidad para responder a estímulos ambientales y metabólicos en estas bacterias.

Sporulation is a quorum sensing response and a cellular differentiation process regulated by signalling molecules and physiological and environmental signals. The regulation of sporulation initiation has been extensively studied in Bacillus subtilis and occurs through phosphorelay. B. subtilis detects metabolic and environmental signals through histidine kinases that are autophosphorylated and then transfer the phosphate group to response regulators, activating the expression of sporulation genes. However, there are other important sporulated bacilli like those from the B. cereus group. B. cereus toxins are related to food-borne intoxication, B. anthracis may be used as biological weapon in bioterrorism, and B. thuringiensis is an excellent biological control agent. Therefore, it is critical to understand the signalling processes that control sporulation initiation and the toxin synthesis. This review summarizes known literature about regulation of initiation of sporulation in the B. cereus group focusing in the role of histidine kinases and the putative open reading frames of these sensors in B. subtilis and B. thuringiensis. The genomes of the B. cereus group have 10 to 14 putative histidine kinases and 7 to 11 response regulators, compared to 6 histidine kinases and 6 response regulators in B. subtilis, implying that this last bacteria should have a lower capacity to respond to environmental and metabolic signals.

A esporulação, que é uma resposta de quorum sensing, é um processo de diferenciação celular mediado por moléculas de sinalização, sinais fisiológicas e ambientais. Sabe-se que Bacillus subtilis detecta os sinais metabólicos e ambientais e estes são integrados a um sistema de transferência sequencial de fosfatos. Os sinais são detectados por histidina cinase que, por sua vez, se autofosforilam e fosforilam, em proteínas que atuam como reguladores de resposta e que ativam a expresão de genes específicos de esporulação. Devido à importância de B. cereus do ponto de vista epidemiológico, o potencial para bioterrorismo de B. anthracis e a importância em biotecnologia agrícola de B. thuringiensis, a investigação sobre os mecanismos moleculares de sinalização e a regulamentação do início da esporulação em estas bactérias do grupo B. cereus revestem especial interesse. Nesta revisão se discute a literatura sobre este tema, colocando especial atenção nas histidina cinases, e na análise comparativa dos genomas de B. subtilis e do grupo de B. cereus, em relação às sequências de posíveis histidina cinases e reguladores de resposta. Cabe destacar que nos genomas do grupo B. cereus há maior número de histidina cinases (10 a 14) e de reguladores de resposta (7 a 11) putativos que en B. subtilis (6 histidina cinases e 6 reguladores de resposta), o que sugere uma maior capacidade para responder a estímulos ambientais e metabólicos nestas bactérias.

Adenoma pleomórfo en paladar: informe de 10 casos / Pleomorphic adenoma of the palate: report of 10 cases

Objetivo: determinar la frecuencia del adenoma pleomórfico en paladar, en el Departamento de Cirugía Maxilofacial del Hospital de Especialidades, Centro Médico Nacional La Raza.Material y métodos: se revisaron los informes del archivo de anatomía patológica y de 2461 biopsias de cavidad bucal realizadas en el departamento referido durante un periodo de 10 años, se eligieron 10 con diagnóstico de adenoma pleomórfico en paladar. En las laminillas revisadas se utilizó tinción con hematoxilina y eosina.Resultados: las edades de los pacientes a quienes pertenecían las biopsias fluctuaron entre 22 a 76 años; predominó el género masculino con una relación de 1.5 a 1; 50 por ciento de las lesiones se presentó en paladar duro; el tamaño varió de 1 a 6 cm en el diámetro mayor, con una evolución de uno a 35 años; todas fueron tratadas quirúrgicamente con excisión amplia y márgenes libres de tumor; hasta el momento de este informe no se habían presentado recidivas. En los 10 casos el patrón histológico fue congruente con adenoma pleomórfico. Conclusiones: se corroboró que la frecuencia del adenoma pleomórfico en paladar es baja, acorde con lo descrito en la literatura mundial. La excisión amplia con márgenes libres de tumor es el tratamiento correcto, ya que no se presentó ninguna recidiva en los casos estudiados. El adenoma pleomórfico fue más común en el género masculino, a diferencia de lo señalado en la literatura.