Nurses' perceptions of preceptorship of undergraduate students in clinical context.

BACKGROUND: Nurses' perceptions of preceptorships for undergraduate nursing students are crucial for designing effective and tailor-made strategies to improve nurses' involvement, motivation, commitment, and satisfaction in preceptorships. OBJECTIVES: The aim of this study was to determine nurses' perceptions of preceptorships for nursing students in two hospitals located in northern Spain. SETTINGS: This study was conducted in two highly specialized, medium-large, university tertiary care hospitals, including one public and one private hospital, located in northern Spain. PARTICIPANTS: The participants of this study were clinical nurses in private and public health centers who had been preceptors for at least one year. METHODS: A descriptive cross-sectional study was carried out between October 2021 and April 2022, with a total sample of 307. The validated "Involvement, Motivation, Satisfaction, Obstacles and Commitment" (IMSOC) questionnaire was used. Descriptive statistics and bivariate analysis were carried out. The variables included sex, age, educational level, preceptorship training, professional experience, work sector, work setting, and type of contract. RESULTS: The mean global questionnaire score was 115.25 ± 33.86 (95 % CI: 111.62-123), with the highest score obtained for the "Involvement" dimension (29.96; SD: 9.23; 95 % CI: 29.01-34.87). Age showed statistically significant negative correlations with the overall and dimension scores (p < 0.05). Comparisons by work sector and type of contract reflected that nurses working in the private sector and those with permanent contracts had higher motivation and commitment scores. CONCLUSIONS: Preceptors had positive perceptions of their role in undergraduate nursing students' education. Age, work sector, type of contract and time allocation should be considered when designing strategies to enhance the involvement, motivation, commitment, and satisfaction of nurses in their experiences as preceptors for undergraduate nursing students. Improving the preceptorship experience will benefit both nurses and students by improving preparation, satisfaction, and retention.

Induction of trefoil factor (TFF)1, TFF2 and TFF3 by hypoxia is mediated by hypoxia inducible factor-1: implications for gastric mucosal healing.

BACKGROUND AND PURPOSE: Mucosal microcirculation is compromised during gastric damage induced by non-steroidal anti-inflammatory drugs, such as aspirin. Consequently, oxygen supply to epithelial cells is decreased. The trefoil factor (TFF) peptides are involved in mechanisms of defence and repair in the gastrointestinal tract but their regulation at sites of gastric injury is unknown. EXPERIMENTAL APPROACH: Hypoxia and expression of TFF genes and peptides were measured in the damaged stomach of aspirin-treated rats. In a human gastric cell line (AGS cells), the effects of hypoxia and of hypoxia inducible factor (HIF)-1 (through transient transfection of HIF-1alpha siRNA or over-expression of HIF-1alpha) on TFF gene expression were evaluated. KEY RESULTS: Hypoxyprobe immunostaining, up-regulation of TFF2 (1.9-fold) and TFF3 (1.8-fold) and a non-significant increase of TFF1 (1.5-fold) mRNA were observed in the damaged stomach of aspirin-treated rats, compared with control animals. Hypoxia (3% O(2), 16 h) induced mRNA for TFF1 (5.8-fold), TTF2 (9.1-fold) and TFF3 (9.3-fold) in AGS cells, an effect mediated by HIF-1, as transient transfection of HIF-1alpha siRNA reduced the effects of hypoxia. Over-expression of HIF-1alpha by transfection in non-hypoxic epithelial cells produced a similar pattern of TFF induction to that observed with hypoxia and transactivated a TFF1 reporter construct. CONCLUSIONS AND IMPLICATIONS: Hypoxia inducible factor-1 mediated the induction of TFF gene expression by hypoxia in gastric epithelial cells. Low oxygen levels and up-regulation of TFF gene expression in the damaged stomach of aspirin-treated rats suggest that hypoxia induced expression of TFF genes at sites of gastric injury.

Previous cognitive impairment and failure to thrive syndrome in patients who died in a geriatric convalescence hospitalization unit.

Cognitive impairment and depression are commonly associated with poor outcomes in geriatric patients. Both are part of the "failure to thrive syndrome" (FTS), that is a combined group of symptoms as a result from progressive functional, mental and nutritional impairment status in older patients. This paper was aimed at evaluating the presence of FTS in the patients who died in a geriatric convalescence unit (GCU) (intermediate care facility) and comparing the characteristics of patients with primary FTS (not associated with an evident identifiable disease) and secondary FTS (associated with an evident identifiable disease). Finally, we wanted to analyze if the presence of cognitive impairment before admission was associated with the type of FTS. We analyzed 78 patients retrospectively. The presence of the next three conditions was necessary to define the FTS: (i) Impaired functional status and malnutrition. (ii) Cognitive impairment and/or depression. (iii) Absence of improvement, after a specific geriatric intervention program during the hospitalization. Functional status for basic and instrumental activities of daily living (ADL and IADL) and the presence of symptoms cognitive impairment before admission were evaluated. Of the 78 analyzed patients, there were 30 (38.4%) with symptoms of FTS. Seventeen of them (56.6%) had a secondary FTS and 13 (43.3%) a primary one. This last group of patients had a significantly higher mean age (84.7 +/- 5.8 vs. 78.6 +/- 7.2; p < 0.02) and before admission they were significantly more dependent for ADL: 10 patients (76.9%) vs. 7 (41.0%) chi2 = 3.833, p < 0.05. A higher proportion of subjects with cognitive impairment before admission was found in the group of patients with primary FTS, than in those secondary FTS, although this difference did not reach statistical significance. Patients with primary FTS seem to be older and more dependent for ADL before admission, than those with secondary FTS.

Clinical impact of different scores of the mini nutritional assessment (MNA) in the diagnosis of malnutrition in patients with cognitive impairment.

It was aimed at evaluating the clinical usefulness of the mini nutritional assessment (MNA) to identify malnutrition in elderly patients with cognitive impairment, admitted to a geriatric convalescence unit (intermediate care facility). Sixty-three patients with cognitive impairment were studied. Cognitive impairment was considered when mini mental state examination (MMSE) scores were below 21. MNA and a nutritional evaluation according to the sequential model of the American Institute of Nutrition (AIN) were performed at admission. According to the AIN criteria, malnutrition was considered, if there were abnormalities in at least one of the following parameters: albumin, cholesterol, body mass index (BMI), and branchial circumference. Based on these criteria, 27 patients (42.8%) proved to be undernourished at admission, whereas if taking the original MNA scores, 39 patients (61.9%) were undernourished, 23 (36.5%) were at risk of malnutrition, and 1 (1.5%) was normal. The analyzed population was divided in four categories (quartiles) of the MNA scores: very low ( 13.5 and 16 and 18.5). Likelihood ratios of each MNA quartile were obtained by dividing the percentage of patients in a given MNA category who were undernourished (according to AIN) by the percentage of patients in the same MNA category who were not undernourished. In the very low MNA quartile, this likelihood ratio was 2.79 and for the low MNA quartile it was 0.49. For intermediate and high MNA categories, likelihood ratios were 1.0 and 0.07 respectively. In the present study, MNA identified undernourished patients with a high clinical diagnostic impact value only, when very low scores (

Evaluation of functional improvement in older patients with cognitive impairment, depression and/or delirium admitted to a geriatric convalescence hospitalization unit.

Cognitive impairment, depression and delirium are problems of high prevalence in older patients. The geriatric convalescence unit (GCU) is a hospitalization facility offering an interdisciplinary geriatric intervention program that may be more appropriate for these patients. This study intended to analyze the functional improvement (FI) in older patients with cognitive impairment, depression and/or delirium admitted to a GCU. A group of 107 patients received specific nurse care, habitually performed in GCU and they also were included in a rehabilitation program. Cognitive impairment, depression and delirium were diagnosed according to standardized protocols. The analyzed variables were: age, functional status (Barthel index) before admission (BBA), at admission (BA) and at discharge(BD), diagnostic categories, cognitive function (mini mental state examination: MMSE) and post-discharge destination. The corrected Heinemann index (CHI) was used to evaluate FI obtained during GCU-stay, where CHI = 100 x (BD-BA)/(BBA-BA), and the efficiency index(El) was used to analyze the relationship between FI and the length of stay in the GCU,where El = (BD-BA)/(days in GCU). According to CHI, patients were divided in three groups. Group I: CHI = 0 or negative (patients who lost functional capacity during hospitalization,those who died or were transferred to hospital owing to acute deterioration. Group II: CHI < 35 % (high FI). Mean age was 77.6 +/- 9.1 years, the diagnostic categories were: fractures/orthopedics 49 (45.7 %), neurological 27(25.2 %), pulmonary/cardiologic 6 (5.6 %) and other cases 25 (23.3 %). Mean MMSE and BA scores were 16.9 +/- 9.4 and 29.6 +/- 18.9, respectively. Post-discharge destinations were:63 patients (58.8 %) returned home, 28 (26.1 %) were definitively institutionalized, 11 (10.2%) died and finally 5 (4.6 %) were transferred to acute care hospital. In-Group I, there were 35 patients (32.7 %) with a mean value of the El = 0.12 +/-1.1; in Group II, 13 (12.1 %) and 0.26 +/- 0.38; in Group III, 59 (55.1 %) and 0.94 +/- 0.97, respectively. In spite of the presence of cognitive impairment, depression and/or delirium, a high proportion of patients (67.2 %)obtained a significant improvement in their functional capacity.35 % (moderate FI). Group III: CHI >/=

Validation of a modified version of the Gijon's social-familial evaluation scale (SFES): the "Barcelona SFES Version", for patients with cognitive impairment.

The aim was to validate an abbreviated version of the Gijon's social-familial evaluation scale (SFES) (Barcelona-SFES version), on patients with cognitive impairment. A group of 34 patients with cognitive impairment, admitted to an intermediate-long-term-care facility, were analyzed. Mean age was 80.2 +/- 7.4 years. Gijón's SFES was abbreviated and only the first three item groups corresponding to family conditions, social contacts and assistance from the social network were selected. Barcelona-SFES version had a range score between 3 to 15 points, in which low scores identify older patients who live with their family, have good contacts, and participate in community activities. In contrast, high scores identify older persons who live alone and have poor social support and little participation with community activities. Three social risk categories were established according to the Barcelona-SFES score: low social risk (>/= 7 points), intermediate social risk (8-9 points) and high social points). Validation criteria used in the present study were: predictive value of Barcelona-SFES score of post-discharge destination (home or institution), and patient's (or family's) request for a definitive institutionalization in a nursing home. There were 9 patients with low social risk (26.4 %), 8 with intermediate social risk (23.5 %) and 17 with high social risk (50 %). A significant relationship between Barcelona-SFES scores and post-discharge destination was found. Eighty percent of patients discharged to an institution(nursing and residential homes), they had high social risk SFES scores (>/= 10) Also, a significant correlation was found between the number of patients for which a definitive institutionalization request was performed and the Barcelona-SFES scores. Fifteen (88.2 %) of the 18 patients for whom the request was done, were in the high social risk group. The lowest scores from SFES were predictive of home discharge, while the highest scores were predictive of a definitive institutionalization.

Prevalence of delirium in a geriatric convalescence hospitalization unit: patient's clinical characteristics and risk precipitating factor analysis.

The aim was to evaluate the prevalence of delirium among patients discharged from an acute care hospital and admitted to a geriatric convalescence unit (GCU), and to analyze patient's characteristics and risk precipitating factors. Sixty-eight patients were analyzed during a 2-week period. The confusion assessment method (CAM) was used to detect delirium. The precipitating factors evaluated were: major surgery-intensive care unit(ICU) stay, pulmonary and heart failure, acute infections, metabolic disorders/anemia,psychoactive medications, other drugs, severe pain, changing environmental influences and others. According to CAM, fifteen patients presented delirium (22%), and in 14 of them(93.3 %) the delirium was developed before admission at GCU. The precipitating factors in the studied population were the following: changing environmental influences in 66 patients(97%) (15 with delirium and 51 without delirium); other drugs 56 (82.3 %) (11 vs. 45);others 56 (82.3%) (9 vs. 24); psychoactive medications 50 (73.5%) (12 vs. 38); acute infections 48 (70.5 %) (13 vs. 35); metabolic disorders/anemia 40 (58.8 %) (9 vs. 31); major surgery-ICU stay 28 (41 .1%) (8 vs. 20); severe pain 26 (38.2%) (6 vs. 20); pulmonary and heart failure 22 (32.3%) (5 vs. 17). The univariant analysis showed that, none of the precipitating factors studied was significantly related to delirium. Seventy-two patients (91.1%) had simultaneously >3 precipitating factors. There were 16 patients with >6 precipitating factors, 7 of 15 with delirium and 9 of the 53 without delirium (46.6 % vs 16.9 %) (p < 0.05). The prevalence of delirium has been 22 %. Most of the patients had developed delirium before the admission at GCU. A high proportion of patients had >3 precipitating factors. In the study the presence of > 6 precipitating factors simultaneously has been significantly related to delirium.

Observational scale and geriatric depression scale of Yesavage to identify depressive symptoms in older patients.

The diagnosis of depression by clinical interview may be difficult in the patients with communication problems (aphasia, severe cognitive impairment or severe deafness). In these cases, depressive symptoms may be observed by others (nurses and caregivers). The aim of this study was to evaluate the clinical usefulness of an observational scale to identify depression in older patients. Seventy-six institutionalized patients in an intermediate-long-term care center were evaluated. Of them, 39 were excluded because they were unable to perform a clinical interview, needed to diagnose depression. Of the excluded patients, 18 had aphasia, 7 showed severe cognitive impairment: their mini mental state examination (MMSE) score < 14, and 14 collaborated very poorly. Thus 37 patients were analyzed, mean age was 83 +/- 0.86 years (30 women and 7 men). Diagnostic categories were: neurological 16 patients (43.2%), fractures/orthopedics 6 (16.2%), pulmonary/cardiology 5 (13.5%) and others 10 (27.1%). The mean Barthel index was 57.0 +/- 31.6 and mean MMSE score was 21.1 +/- 4.3. The observational scale (OS) designed with six items, was applied to all patients. Each item was scored as never (0 points), sometimes (1 point) and always (2 points). Thus total OS score ranged from 0 to 12. Two observers, who knew the patients (nurses), applied the OS. A trained geriatrician, using the 15-item geriatric depression scale (GDS) performed detection of depressive symptoms. There were 15 patients (40.5 %) with depression on the GDS. OS scale score with a cutoff point of 5 or more was present in 13 patients; nine of them had depression (69.2 %). In the remaining 24 patients with an OS score < 5, depression was present only in 6 cases (25%) (chi2 = 6.844; p < 0.01). The OS >/= 5, in the present study, obtained a sensitivity of 60 %, a specificity of 81 %, a positive predictive value of 69 %, and a negative predictive value of 75 %.We concluded that (i) the OS has been useful for identifying depressive symptoms with an acceptable sensitivity and specificity, and (ii) the OS may be an alternative to detect depression in patients who are unable to perform a clinical interview.

[Impact of aging on hospital caseload]. / El impacto del envejecimiento sobre la casuística del hospital.

PURPOSE: The progressive ageing of the population has led to a rise in the number of hospital admissions among people older than 64 years. The present study analyses the impact of this phenomenon comparing the case-mix of patients older and younger than 65 years. METHODS: An analysis of the case-mix of all patients admitted to two acute hospitals of Barcelona Spain has been performed using the minimum basic data set of hospital discharges during 1997. The patients were grouped according to diagnosis-related groups (DRG). The characteristics of disease severity and complexity (admissions through emergencies department, DRG average weight, Charlson comorbidity index, average length of stay adjusted by case-mix, percentage of patients with an abnormal length of stay, readmissions and mortality rates were compared between the group of patients of 0-64 years and the group of 65 years and over. A further analysis was carried out for three subgroups of the aged patient population: 65-74, 75-84 and > 84 years. RESULTS: The patients group of 65 years and over presented, in comparison with the younger than 65 qulaction, a higher average weight (1.16 vs 0.96), a higher percentage of admissions through emergency department (49.2% vs 44.4%), more comorbidity (Charlson's Index of 0.98 vs 0.66), a higher average length of stay adjusted DRG (9.4 vs 8.1), a higher percentage of patients with an abnormal length of stay (4.7% vs 3.2%), a higher readmissions percentage (8.6% vs 7.5%) and a higher mortality (6.3% vs 1.6%). All observed differences between the two groups were statistically significant. The analysis of the three subgroups of patients of 65 years and over showed that the variables admissions through the emergency department, length of stay and rate of mortality were significantly related to ageing, while the factor of complexity of comorbidity remained stable for all the subgroup of patients. CONCLUSIONS: The case-mix of patients older than 65 years presents some characteristics associated with a higher complexity, severity and comorbidity, which imply more hospitalization days in relation to younger patients. Hospitals and the health care system at large should design specific strategies to face the fast and progressive ageing of patients admitted to hospitals, since this means a relevant change of the case-mix and the profile of health care requirements.

El impacto del envejecimiento sobre la casuística del hospital / The impact of ageing on the hospital case-mix

Objetivo: El progresivo envejecimiento de la población ha comportado el incremento de los ingresos hospitalarios de personas mayores de 64 años. En el presente trabajo se analiza el impacto de este fenómeno comparando la casuística de los pacientes mayores y menores de 65 años. Métodos: Se realizó un análisis de la casuística de los pacientes ingresados en el ámbito de dos hospitales de agudos de la ciudad de Barcelona a través del conjunto mínimo básico de datos del alta hospitalaria del año 1997, agrupado según los grupos relacionados con el diagnóstico (GRD). Se compararon características asociadas a la severidad y complejidad de la patología (presión de urgencias, peso medio, índice de comorbilidad de Charlson, estancia media ajustada por casuística, porcentaje de pacientes con estancia media extrema, tasa de reingresos y tasa de mortalidad) en el grupo de pacientes ingresados de 0 a 64 años con el de 65 o más años. También se realizó un análisis específico para tres subgrupos de edad: de 65 a 74 años, de 5 a 84 y más de 84 años. Resultados: El grupo de pacientes de 65 o más años, en comparación con los pacientes de 0 a 64 años, presentó un peso medio superior (1,16 vs 0,96), un porcentaje superior de ingresos procedentes de urgencias (49,2 por ciento vs 44,4 por ciento), más comorbilidad (índice de Charlson de 0,98 vs 0,66), una estancia media ajustada por GRD superior (9,4 vs 8,1), un mayor porcentaje de estancias extremas (4,7 por ciento vs 3,2 por ciento), un mayor porcentaje de reingresos (8,6 por ciento vs 7,5 por ciento) y una mortalidad superior (6,3 por ciento vs 1,6 por ciento). Todas las diferencias fueron estadísticamente significativas entre ambos grupos. El análisis de los tres subgrupos de 65 o más años mostró que la presión de urgencias, el consumo de estancias hospitalarias y la mortalidad estaban significativamente relacionadas con el sobreenvejecimiento, mientras que la complejidad y la comorbilidad eran estables para todos los subgrupos. Conclusiones: La casuística de los pacientes mayores de 65 años presenta unas características asociadas a mayor complejidad, severidad y comorbilidades que suponen una mayor necesidad de días de estancia con relación a pacientes de menor edad. Los hospitales y el conjunto de los sistemas de salud deberían diseñar estrategias específicas para afrontar el rápido y progresivo incremento del envejecimiento de los pacientes ingresados, en la medida que suponen un cambio relevante de la casuística y por tanto del perfil de atención necesaria (AU)

Trastornos depresivos en una unidad de convalecencia: experiencia y validación de una versión española de 15 preguntas de la escala de depresión geriátrica de Yesavage / Depressive mood disorders in an inpatient convalescence unit: Experience and validation of a 15-items spanish version of the Yesavage geriatric depression scale

OBJETIVO: Conocer la prevalencia de trastornos depresivos y sus variables asociadas en ancianos ingresados en una unidad de convalecencia. Validación de una versión en castellano de la escala de depresión geriátrica de Yesavage de 15 preguntas (GDS-15). MATERIAL Y MÉTODO: El diagnóstico de depresión se efectuó mediante entrevista aplicando los criterios de trastornos depresivos del DSM IV. A todos los pacientes se les practicó la GDS-15, y posteriormente se calculó la sensibilidad y especificidad para cada una de las puntuaciones obtenidas, con respecto al diagnóstico de depresión según DSM IV. Se registró también: edad, sexo, diagnóstico principal, enfermedades crónicas (índice de comorbilidad de Charlson), capacidad funcional al ingreso (índice de Barthel), grado de pérdida de capacidad funcional (diferencia entre el Barthel previo y al ingreso), función cognitiva (mini-mental de Folstein), escolarización y situación social (escala de valoración socio-familiar de Gijón modificada). RESULTADOS: De los 131 pacientes estudiados, 41 (31,3 por ciento) presentaron trastornos depresivos según DSM IV, de ellos 33 (80,4 por ciento) eran trastornos adaptativos. La edad media de los pacientes con depresión fue de 71,7 (DE 9,8) y la de los restantes 75,9 (DE 11) (p= 5 de la versión utilizada en castellano de la GDS-15, mostró una sensibilidad del 85,3 por ciento y una especificidad del 85,5 por ciento, respecto al diagnóstico de trastorno depresivo según DSM IV. CONCLUSIONES: La prevalencia de trastornos depresivos en una unidad de convalecencia ha sido alta y únicamente se ha visto asociada a tener una menor edad. La versión traducida de la GDS-15 de Yesavage ha mostrado una buena sensibilidad y especificidad en nuestro medio, para la detección de trastornos depresivos en el anciano (AU)

[Factors predicting return home of hospitalized aged patients]. / Factores predictivos de retorno al domicilio en pacientes ancianos hospitalizados.

BACKGROUND: The identification of predictors of return home and nursing home placement in elderly patients, at the moment of admission to a Geriatric Convalescence Unit, may allow to make a discharge planning for these patients, and also may improve efficiency in the unit. PATIENTS AND METHODS: A number of 445 patients over 65 years were consecutively admitted to the unit. Analyzed variables at admission were; age, sex, diagnostic, comorbidity, functional status prior to admission, degree of independence in activities of daily living (Barthel index), cognitive function (Folstein Mini-Mental) and social support (modified version of social-familiar evaluation scale of Gijón). All these variables were used in two models of logistic regression analysis: 1 [symbol: see text] (dependent variable: return home after discharge versus other destinations), and 2 [symbol: see text] (dependent variable: nursing home placement on discharge versus other destinations). RESULTS: The variables significatively associated with greater probability of at home discharge were: moderate dependency for activities of daily living (Barthel index = 31-59), odds ratio (OR) = 2.46 (95% confidence interval: 1.43-4.22); mild dependency (Barthel index > or = 60), OR = 3.67 (1.96-6.87); normal cognitive function (Mini-Mental > or = 21), OR = 3.14 (1.76-5.60), and a favourable social support (social-familiar scale < 12), OR = 7.33 (3.18-16.91). The only variable significatively associated with the probability of nursing home placement after discharge was an impaired social function (social-familiar scale > or = 12), OR = 4.53 (2.25-9.12). CONCLUSIONS: Probability of return home after discharge is associated with functional status, cognitive function and social support. Definitively nursing home placement was only related with de degree of familiar support.

Factores predictivos de retorno al domicilio en pacientes ancianos hospitalizados / Predictors of return home on discharge in hospitalized elderly patients

Fundamento: La identificación de aquellos factores relacionados con la probabilidad de ser dado de alta al domicilio, en una Unidad Geriátrica de Convalecencia, permitiría planificar el alta de estos pacientes y mejorar la eficiencia en la gestión de las camas. Pacientes y métodos: Se analizaron 445 pacientes con edad =65 años, que ingresaron de forma consecutiva en la unidad. Las variables estudiadas en el momento del ingreso fueron: edad, sexo, diagnóstico, comorbilidad, situación funcional antes del ingreso actual, nivel de independencia para las actividades de la vida diaria (índice de Barthel), función cognitiva (Mini-Mental de Folstein) y la situación social (escala de valoración socio-familiar de Gijón modificada). Todas estas variables se introdujeron en dos modelos de regresión logística múltiple: 1º (variable dependiente: alta a domicilio versus otros destinos) y 2º (variable dependiente: alta a una institución versus otros destinos). Resultados: Variables significativas asociadas con mayor probabilidad de retorno al domicilio : dependencia moderada para actividades de la vida diaria (índice de Barthel=31-59), odds ratio (OR)=2,46 (intervalo de confianza al 95%: 1,43-4,22); dependencia leve (índice de Barthel =60), OR =3,67 (1,96-6,87); función cognitiva conservada (Mini-Mental =21), OR= 3,14 (1,76-5,60) y situación social favorable (escala socio-familiar<12), OR=7,33 (3,18-16,91). La única variable significativa asociada con mayor probabilidad de institucionalización definitiva tras el alta fue la situación social deteriorada (escala socio-familiar =12), OR=4,53 (2,25-9,12). Conclusiones: La probabilidad de retorno al domicilio esta relacionada con la capacidad funcional, la función cognitiva y la situación social. El ingreso definitivo en una institución, está relacionado únicamente con el grado de soporte familiar (AU)

Molecular cloning and characterization of a Candida albicans gene coding for cytochrome c haem lyase and a cell wall-related protein.

Immunoscreening of a Candida albicans cDNA library with a monoclonal antibody (mAb 4C12) recognizing an epitope present in high-molecular-weight mannoprotein (HMWM) components specific for the mycelial cell walls (a 180 kDa component and a poly-dispersed 260 kDa species) resulted in the isolation of the gene CaCYC3 encoding for cytochrome c haem lyase (CCHL). The CaCYC3 gene was transcribed preferentially in mycelial cells in which two mRNA transcripts of 0.8 and 1 kb were found. The nucleotide and the deduced amino acid sequences of this gene displayed 45% homology and 46% identity, respectively, to the Saccharomyces cerevisiae CYC3 gene and shared common features with other reported genes encoding for CCHL. The CaCYC3 gene restored the respiratory activity when transformed in a S. cerevisiae cyc3- mutant strain. A C. albicans CYC3 null mutant was constructed after sequential disruption using the hisG::URA3::hisG ('ura-blaster') cassette. Null mutant cells were unable to use lactate as a sole carbon source and had a reduced ability to form germ tubes. Western immunoblotting analysis of subcellular fractions from wild-type and null mutant strains demonstrated the presence of two gene products, a 33kDa mitochondrial protein and a 40 kDa cell wall-associated moiety reacting with antibodies against CCHL, in both yeast cells and germ tubes. mAb 4C12 still reacted with the CaCYC3 null mutant (by immunofluorescence and immunoblotting) but showed an altered pattern of immunoreactivity against cell wall HMWM species, indicating a relationship between these moieties and the CaCYC3 gene products. The results suggest that the CaCYC3 gene encodes two proteins, one targeted to the mitochondria and the other to the cell wall.

Hemin induces germ tube formation in Candida albicans.

Hemin induced germination of Candida albicans blastoconidia when cells grown up to the early exponential phase were shifted from 28 to 37 degrees C (70 to 75% of cells exhibited germ tubes). N-Acetyl-D-glucosamine (GlcNAc), another inducer of myceliation in this fungus, caused a similar effect. The combination of hemin and GlcNAc resulted in a higher percentage (95%) of blastoconidial germination. These results suggest that in addition to temperature, hemin levels and carbon source may coordinately regulate the expression of subsets of genes involved in the yeast-to-mycelium transition in C. albicans.

Molecular cloning of a Candida albicans gene (SSB1) coding for a protein related to the Hsp70 family.

We have cloned and sequenced a Candida albicans gene (SSB1) encoding a potential member of the heat-shock protein seventy (hsp70) family. The protein encoded by this gene contains 613 amino acids and shows a high degree (85%) of sequence identity to the ssb subfamily (ssb1 and ssb2) of the Saccharomyces cerevisiae hsp70 family. The transcribed mRNA (2.1 kb) is present in similar amounts both in yeast and germ tube cells of C. albicans.

Cloning of a cDNA fragment encoding part of the protein moiety of the 58-kDa fibrinogen-binding mannoprotein of Candida albicans.

Immunoscreening of a Candida albicans expression library with antibodies against the 58 kDa fibrinogen-binding mannoprotein (mp58) of the fungus resulted in the isolation of clones encoding the protein moiety of this molecule. Sequence of the 0.9 kb cDNA of one of the clones selected for further analysis, revealed an open reading frame coding for 292 amino acids, which displays sequence similarity to proteins belonging to a family of immunodominant antigens of Aspergillus spp. The gene corresponding to this cDNA was named FBP1 (fibrinogen-binding protein). These results represent the first report on the identification of C. albicans genes encoding surface receptors for host proteins.

Molecular cloning and characterization of a Candida albicans gene (EFB1) coding for the elongation factor EF-1 beta.

A Candida albicans gene homologous to Saccharomyces cerevisiae elongation factor 1 beta was isolated by screening a genomic DNA library using a C. albicans cDNA as a probe. This cDNA was previously obtained by immunoscreening of an expression library with polyclonal antibodies raised against candidal cell wall components. Sequence analysis of the cDNA and the whole C. albicans gene (EMBL accession number X96517) revealed an intron-interrupted open reading frame of 639 base pairs that encodes a 213 amino acid protein. Exon sequences are highly homologous (74%) to S. cerevisiae EFB1, whereas intron sequence is less conserved (34% identity), and the predicted amino acid sequence shares about 73% identity.