Violencia en el lugar de trabajo desde la percepción de profesionales de enfermería en un servicio de emergencia pediátrica / Violence in the workplace from the perception of nursing professionals in a pediatric emergency service

Introducción: Los profesionales de la salud tienen un mayor riesgo de sufrir lesiones físicas, sexuales o psicológicas debido a la violencia en el lugar de trabajo ocupando su rol al brindar cuidados de salud hacia el paciente pediátrico en casos de Emergencia. Los incidentes en los que el profesional es abusado, amenazado o agredido en las circunstancias relacionadas con su trabajo implican un desafío explícito o implícito a su seguridad, bienestar o salud. Objetivo: Explorar la percepción de profesionales de enfermería sobre la violencia laboral en el desempeño y ejecución de actividades orientadas al cuidado de salud de Enfermería en la Emergencia Pediátrica. Método: Investigación cualitativa de diseño fenomenológico, el estudio se realizó en profesionales de Enfermería del servicio de Emergencia Pediátrica con una muestra de 32 participantes, distribuidas en 4 grupos focales. Se diseñó una guía de preguntas semiestructuradas sobre los aspectos percibidos en el ámbito del trabajo del profesional que fueron recopiladas mediante archivos de voz y notas de campo, los resultados fueron analizados identificando las fuentes de la violencia en el lugar de trabajo. Resultados: Con la recopilación de datos de los participantes, la investigadora principal analizará la forma en que se presenta la violencia laboral desde la percepción de profesionales de Enfermería determinando los riesgos presentes para brindar recomendaciones y diseñar un plan de acción que ayuda a prevenir la violencia. (AU)

Introduction: Healthcare professional face a higher risk of experiencing physical, sexual, or psychological injuries due to violence in the workplace fulfilling their role in providing health care to a pediatric patient in emergency cases. Incidents where professionals are abused, threatened, or assaulted in circumstances related to their work pose an explicit or implicit challenge to their safety, well-being, or health.Objective: To explore the perception of nursing professionals regarding workplace violence in the performance and execution of healthcare activities in Pediatric Emergency Nursing. Method: Qualitative research with a phenomenological design. The study was conducted among nursing professionals in the Pediatric Emergency Service, with a sample size of 32 participants divided into 4 focus groups. A semi-structured questions were designed to gather perceptions about various aspects of their work, that were collected through voice recordings and field notes. The results were analyzed to identify the sources of violence in the workplace. Results: Through the data collected from the participants, the lead researcher analyzed the manifestation of workplace violence as perceived by nursing professionals. This analysis determined the existing risks and provided recommendations for designing an action plan to prevent violence. (AU)

Hepatic demethylation of methoxy-bromodiphenyl ethers and conjugation of the resulting hydroxy-bromodiphenyl ethers in a marine fish, the red snapper, Lutjanus campechanus, and a freshwater fish, the channel catfish, Ictalurus punctatus.

Methoxylated bromodiphenyl ethers (MeO-BDEs), marine natural products, can be demethylated by cytochrome P450 to produce hydroxylated bromodiphenyl ethers (OH-BDEs), potentially toxic metabolites that are also formed by hydroxylation of BDE flame retardants. The OH-BDEs may be detoxified by glucuronidation and sulfonation. This study examined the demethylation of 6-MeO-BDE47, 2'-MeO-BDE68 and 4'-MeO-BDE68, in hepatic microsomes from the red snapper, Lutjanus campechanus, a marine fish likely to be exposed naturally to MeO-BDEs, and the channel catfish, Ictalurus punctatus, a freshwater fish in which pathways of xenobiotic biotransformation have been studied. We further studied the glucuronidation and sulfonation of the resulting OH-BDEs as well as of 6-OH-2'-MeO-BDE68 in hepatic microsomes and cytosol fractions of these fish. The three studied biotransformation pathways were active in both species, with high individual variability. The range of activities overlapped in the two species. Demethylation of MeO-BDEs, studied in the concentration range 10-500 µM, followed Michaelis-Menten kinetics in both fish species, however enzyme efficiencies were low, ranging from 0.024 to 0.334 µL min.mg protein. Conjugation of the studied OH-BDEs followed Michaelis-Menten kinetics in the concentration ranges 1-50 µM (glucuronidation) or 2.5-100 µM (sulfonation). These OH-BDEs were readily glucuronidated and sulfonated in the fish livers of both species, with enzyme efficiencies one to three orders of magnitude higher than for demethylation of the precursor MeO-BDEs. The relatively low efficiencies of demethylation of the MeO-BDEs, compared with higher efficiencies for OH-BDE conjugation, suggests that MeO-BDEs are more likely than OH-BDEs to bioaccumulate in tissues of exposed fish.

Time to develop chronic kidney disease in an Ecuadorian Type 2 Diabetes Mellitus cohort: Survival analysis in primary care.

Chronic Kidney Disease (CKD) represents a high burden to health systems. However, the survival time for CKD in a Type 2 Diabetes Mellitus (T2DM) population is unknown. AIMS: Determine the risk factors, survival time and the incidence rate of CKD in T2DM. METHODS: Retrospective clinical cohort study (follow up 10 years). 513 patients with T2DM were included. Numerical variables were compared using the mean difference. Chi squared and odds ratios were calculated for categorical variables. Survival analysis was done through life tables and Kaplan-Meier. RESULTS: The mean difference between the group that developed CKD and those who did not, was significant in: age, age at diagnosis of T2DM and years with T2DM. Risk factors for developing CKD were: the presence of hypertension, albuminuria, retinopathy, high triglycerides and high HbA1c. The incidence rate was 32.07 per 1000 person-years of follow-up and 207 (40.4%) of patients developed CKD during the study. The median for developing CKD was 20.52 years of disease with an increasing risk with time. CONCLUSIONS: Half of the patients with T2DM will develop CKD by the second decade of disease. Time, arterial hypertension, retinopathy, albuminuria and triglycerides are factors associated with CKD in patients with T2DM.

Peripheral Artery Disease in Type 2 Diabetes Mellitus: Survival Analysis of an Ecuadorian Population in Primary Care.

BACKGROUND: Peripheral artery disease (PAD) is associated with cardiovascular risk in type 2 diabetes mellitus (DM). The ankle-brachial index (ABI) is used for diagnosis of PAD. OBJECTIVES: Establish the prevalence and incidence rate for PAD and determine the associated factors and survival time for the development of PAD. METHODS: Retrospective cross-sectional cohort study (follow up: 10 years) in 578 DM patients with at least 1 ABI measurement in a primary level of care diabetes clinic. Data was collected from clinical records. Sociodemographic and laboratory variables were analyzed determining its association (mean difference and bivariate logistic regression). Survival was calculated through life tables and Kaplan-Meier analysis. RESULTS: The prevalence of PAD was 13.98%. The incidence rate through the time of follow up was 23.38 per 1000 person-year (95% CI: 19.91-27.26). The group that developed PAD showed higher glycated hemoglobin levels (P = .025), more years of DM (P < .001) and lower glomerular filtration rate (GFR, P = .003). The median time for developing PAD was 26.97 years (95% CI: 26.89-27.05). The risk for PAD was higher in females (95% CI: 1.51-4.38), GFR <60 mL/min/m2 (95% CI: 1.05-2.22) and use of metformin plus insulin (95% CI: 1.10-2.35). CONCLUSION: Half of a DM patient's population in primary level of care will develop PAD in the third decade of disease. There are identifiable risk factors for PAD development in DM in the primary level of care such as low GFR, female sex, and use of metformin plus insulin.

Evaluating the effectiveness of a support programme for people with type 2 diabetes mellitus in primary care: an observational prospective study in Ecuador.

BACKGROUND: The success of primary health care relies on the integration of empowered practitioners with cooperative patients regardless of socioeconomic status. Using resources efficiently would help to improve healthcare promotion and reduce complications of chronic non-communicable diseases (NCDs). The importance of network support programmes relies on the fact that they allow to accurately deliver medical care by shaping a sense of community and purpose among the patients. AIM: To evaluate the effectiveness of a network support programme for patients with type 2 diabetes mellitus (T2DM). DESIGN & SETTING: A centre-based observational prospective study took place in a primary care setting in Ecuador. METHOD: The impact of the diabetes care programme was assessed by comparing initial and final metabolic characteristics and outcomes of 593 patients with T2DM, followed-up from April 2007 to December 2017, using paired sample t-test. Electrocardiograms (ECGs), ankle-brachial indexes (ABIs), ocular fundus, and monofilament neuropathy tests were assessed with the McNemar test to evaluate complications at the beginning and end of the study. RESULTS: Glycated haemoglobin (HbA1c), lipid profile, and systolic blood pressure (SBP) showed statistically significant decreases between the initial measurement (IMs) and final measurements (FMs). In the FM, significantly lower HbA1c, diastolic blood pressure (DBP), and atherogenic index were found. Despite the length of time since diagnosis, during the follow-up time, long-term micro- and macro-vascular complications, such as ocular fundus, serum creatinine, and ABI, remained unchanged throughout the period of active participation in this healthcare programme. CONCLUSION: This study demonstrates the feasibility of reducing plasma glucose, plasma lipids, and long-term complications in patients with T2DM by implementing a network support programme, which involves the medical team and patients themselves in an environment with limited resources.

Efficacy data of halogenated phenazine and quinoline agents and an NH125 analogue to veterinary mycoplasmas.

BACKGROUND: Mycoplasmas primarily cause respiratory or urogenital tract infections impacting avian, bovine, canine, caprine, murine, and reptilian hosts. In animal husbandry, mycoplasmas cause reduced feed-conversion, decreased egg production, arthritis, hypogalactia or agalactia, increased condemnations, culling, and mortality in some cases. Antibiotics reduce transmission and mitigate clinical signs; however, concerning levels of antibiotic resistance in Mycoplasma gallisepticum and M. capricolum isolates exist. To address these issues, we evaluated the minimum inhibitory concentrations (MICs) of halogenated phenazine and quinoline compounds, an N-arylated NH125 analogue, and triclosan against six representative veterinary mycoplasmas via microbroth or agar dilution methods. Thereafter, we evaluated the minimum bactericidal concentration (MBC) of efficacious drugs. RESULTS: We identified several compounds with MICs ≤25 µM against M. pulmonis (n = 5), M. capricolum (n = 4), M. gallisepticum (n = 3), M. alligatoris (n = 3), M. agassizii (n = 2), and M. canis (n = 1). An N-arylated NH125 analogue, compound 21, served as the most efficacious, having a MIC ≤25 µM against all mycoplasmas tested, followed by two quinolines, nitroxoline (compound 12) and compound 20, which were effective against four and three mycoplasma type strains, respectively. Nitroxoline exhibited bactericidal activity among all susceptible mycoplasmas, and compound 21 exhibited bactericidal activity when the MBC was able to be determined. CONCLUSIONS: These findings highlight a number of promising agents from novel drug classes with potential applications to treat veterinary mycoplasma infections and present the opportunity to evaluate preliminary pharmacokinetic indices using M. pulmonis in rodents as an animal model of human infection.

Sulfonation and glucuronidation of hydroxylated bromodiphenyl ethers in human liver.

Hydroxylated bromodiphenyl ethers (OH-BDEs) can arise from monooxygenation of anthropogenic BDEs or through natural biosynthetic processes in marine organisms, and several OH-BDEs have been shown to be toxic. OH-BDEs are expected to form sulfate and glucuronide conjugates that are readily excreted, however there is little information on these pathways. We examined the human hepatic glucuronidation and sulfonation of 6-OH-BDE47, 2-OH-BDE68, 4-OH-BDE68 and 2-OH-6'methoxy-BDE68. Human liver microsomes and cytosol were from de-identified female and male donors aged 31 to 75 under an exempt protocol. Recombinant human SULT1A1, 1B1, 1E1 and 2A1 enzymes were prepared from bacterial expression systems. Sulfonation and glucuronidation of each OH-BDE were studied using radiolabeled co-substrates, 3'phosphoadenosine-5'phospho-35S-sulfate or uridine diphospho-ß-D-14C-glucuronic acid in order to quantify the sulfated or glucuronidated products. The OH-BDEs studied were more efficiently glucuronidated than sulfonated. Of the compounds studied, 2-OH-BDE68 was the most readily conjugated, and exhibited an efficiency (Vmax/KM) of glucuronidation of 0.274 ±â€¯0.125 mL/min/mg protein, mean ±â€¯S.D., n = 3, while that for sulfonation was 0.179 ±â€¯0.030 mL/min/mg protein. For both pathways, all Km values were in the low µM range. Studies with human SULT enzymes showed that sulfonation of these four substrates was readily catalyzed by SULT1B1 and SULT1E1. Much lower activity was found with SULT1A1 and SULT2A1. Assuming that the glucuronide and sulfate conjugates are non-toxic and readily excreted, as is the case for most such conjugates, these studies suggest that OH-BDEs should not accumulate in people to the same extent as the parent BDEs.

Turning the Tide against Antibiotic Resistance by Evaluating Novel, Halogenated Phenazine, Quinoline, and NH125 Compounds against Ureaplasma Species Clinical Isolates and Mycoplasma Type Strains.

Escalating levels of antibiotic resistance in mycoplasmas, particularly macrolide resistance in Mycoplasma pneumoniae and M. genitalium, have narrowed our antibiotic arsenal. Further, mycoplasmas lack a cell wall and do not synthesize folic acid, rendering common antibiotics, such as beta-lactams, vancomycin, sulfonamides, and trimethoprim, of no value. To address this shortage, we screened nitroxoline, triclosan, and a library of 20 novel, halogenated phenazine, quinoline, and NH125 analogues against Ureaplasma species and M. hominis clinical isolates from urine. We tested a subset of these compounds (n = 9) against four mycoplasma type strains (M. pneumoniae, M. genitalium, M. hominis, and Ureaplasma urealyticum) using a validated broth microdilution or agar dilution method. Among 72 Ureaplasma species clinical isolates, nitroxoline proved most effective (MIC90, 6.25 µM), followed by an N-arylated NH125 analogue (MIC90, 12.5 µM). NH125 and its analogue had significantly higher MICs against U. urealyticum isolates than against U. parvum isolates, whereas nitroxoline did not. Nitroxoline exhibited bactericidal activity against U. parvum isolates but bacteriostatic activity against the majority of U. urealyticum isolates. Among the type strains, the compounds had the greatest activity against M. pneumoniae and M. genitalium, with 8 (80%) and 5 (71.4%) isolates demonstrating MICs of ≤12.5 µM, respectively. Triclosan also exhibited lower MICs against M. pneumoniae and M. genitalium Overall, we identified a promising range of quinoline, halogenated phenazine, and NH125 compounds that showed effectiveness against M. pneumoniae and M. genitalium and found that nitroxoline, approved for use outside the United States for the treatment of urinary tract infections, and an N-arylated NH125 analogue demonstrated low MICs against Ureaplasma species isolates.

Regulation of dichloroacetate biotransformation in rat liver and extrahepatic tissues by GSTZ1 expression and chloride concentration.

Biotransformation of dichloroacetate (DCA) to glyoxylate by hepatic glutathione transferase zeta 1 (GSTZ1) is considered the principal determinant of the rate of plasma clearance of the drug. However, several other organismal and subcellular factors are also known to influence DCA metabolism. We utilized a female rat model to study these poorly understood processes. Rats aged 4 weeks (young) and 42-52 weeks (adult) were used to model children and adults, respectively. Hepatic chloride concentrations, which influence the rate of GSTZ1 inactivation by DCA, were lower in rat than in human tissues and rats did not show the age dependence previously seen in humans. We found GSTZ1 expression and activity in rat brain, heart, and kidney cell-free homogenates that were age-dependent. GSTZ1 expression in brain was higher in young rats than adult rats, whereas cardiac and renal GSTZ1 expression levels were higher in adult than young rats. GSTZ1 activity with DCA could not be measured accurately in kidney cell-free homogenates due to rapid depletion of glutathione by γ-glutamyl transpeptidase. Following oral administration of DCA, 100 mg/kg, to rats, GSTZ1 expression and activity were reduced in all rat tissues, but chloride concentrations were not affected. Together, these data extend our understanding of factors that determine the in vivo kinetics of DCA.

Synthesis and anticancer evaluation of complex unsaturated isosteviol-derived triazole conjugates.

BACKGROUND: For the last two decades, diterpenoid isosteviol and its derivatives have gained significant attention for novel chemical transformation in the drug discovery field. RESULTS: An efficient way towards the synthesis of structurally diverse isosteviol derivatives was described here employing unsaturated functionalities as attractive templates for further transformation such as epoxidation. These structurally diverse compounds exhibited promising cytotoxic activities on different types of cancer cell lines, leading to drug discovery derived from natural products for the treatment of cancer. CONCLUSION: In this work, novel isosteviol derivatives with Michael acceptors were synthesized to expand the diversity and complexity of a class of isosteviol-derived triazole conjugates to facilitate the development of potential antitumor agents.

Determination of antioxidant capacities, α-dicarbonyls, and phenolic phytochemicals in Florida varietal honeys using HPLC-DAD-ESI-MS(n.).

Honeys contain phenolic compounds and α-dicarbonyls with antioxidant and antimicrobial capacities, respectively. The type and concentration of these compounds vary depending on the floral source and geographical location where the honey is produced. Seventeen varietal honeys, including 12 monofloral and 5 multifloral honeys, were sampled from different regions of Florida. The monofloral honeys included those from citrus, tupelo, palmetto, and gallberry. These honeys were evaluated for their antioxidant capacity, total phenolic content, and free radical scavenging capacity and compared with three New Zealand Manuka honeys. Phenolic phytochemicals and α-dicarbonyls were identified and quantified using HPLC-DAD-MS(n). Several honey varieties from gallberry, Manuka, and multifloral displayed a total phenolic content >1000 µg GAE/g. A citrus honey had the lowest total phenolic content of 286 µg GAE/g. The oxygen radical absorbance capacity of the honeys ranged from 1.48 to 18.2 µmol TE/g. All honeys contained 3-deoxyglucosone at a higher concentration than methylglyoxal or glyoxal. Manuka honeys had higher concentrations of methylglyoxal than other varieties. Plant hormones 2-cis,4-trans-abscisic acid and 2-trans,4-trans-abscisic acid were the most abundant phytochemicals in all honeys. Coumaric acid, rutin, chrysin, pinocembrin, quercetin, luteolin, and kaempferol were also found in samples but at lower concentrations.