Azithromycin resistance in Escherichia coli and Salmonella from food-producing animals and meat in Europe.

OBJECTIVES: To characterize the genetic basis of azithromycin resistance in Escherichia coli and Salmonella collected within the EU harmonized antimicrobial resistance (AMR) surveillance programme in 2014-18 and the Danish AMR surveillance programme in 2016-19. METHODS: WGS data of 1007 E. coli [165 azithromycin resistant (MIC > 16 mg/L)] and 269 Salmonella [29 azithromycin resistant (MIC > 16 mg/L)] were screened for acquired macrolide resistance genes and mutations in rplDV, 23S rRNA and acrB genes using ResFinder v4.0, AMRFinder Plus and custom scripts. Genotype-phenotype concordance was determined for all isolates. Transferability of mef(C)-mph(G)-carrying plasmids was assessed by conjugation experiments. RESULTS: mph(A), mph(B), mef(B), erm(B) and mef(C)-mph(G) were detected in E. coli and Salmonella, whereas erm(C), erm(42), ere(A) and mph(E)-msr(E) were detected in E. coli only. The presence of macrolide resistance genes, alone or in combination, was concordant with the azithromycin-resistant phenotype in 69% of isolates. Distinct mph(A) operon structures were observed in azithromycin-susceptible (n = 50) and -resistant (n = 136) isolates. mef(C)-mph(G) were detected in porcine and bovine E. coli and in porcine Salmonella enterica serovar Derby and Salmonella enterica 1,4, [5],12:i:-, flanked downstream by ISCR2 or TnAs1 and associated with IncIγ and IncFII plasmids. CONCLUSIONS: Diverse azithromycin resistance genes were detected in E. coli and Salmonella from food-producing animals and meat in Europe. Azithromycin resistance genes mef(C)-mph(G) and erm(42) appear to be emerging primarily in porcine E. coli isolates. The identification of distinct mph(A) operon structures in susceptible and resistant isolates increases the predictive power of WGS-based methods for in silico detection of azithromycin resistance in Enterobacterales.

Multiplex PCR for detection of plasmid-mediated colistin resistance determinants, mcr-1, mcr-2, mcr-3, mcr-4 and mcr-5 for surveillance purposes.

Background and aimPlasmid-mediated colistin resistance mechanisms have been identified worldwide in the past years. A multiplex polymerase chain reaction (PCR) protocol for detection of all currently known transferable colistin resistance genes (mcr-1 to mcr-5, and variants) in Enterobacteriaceae was developed for surveillance or research purposes. Methods: We designed four new primer pairs to amplify mcr-1, mcr-2, mcr-3 and mcr-4 gene products and used the originally described primers for mcr-5 to obtain a stepwise separation of ca 200 bp between amplicons. The primer pairs and amplification conditions allow for single or multiple detection of all currently described mcr genes and their variants present in Enterobacteriaceae. The protocol was validated testing 49 European Escherichia coli and Salmonella isolates of animal origin. Results: Multiplex PCR results in bovine and porcine isolates from Spain, Germany, France and Italy showed full concordance with whole genome sequence data. The method was able to detect mcr-1, mcr-3 and mcr-4 as singletons or in different combinations as they were present in the test isolates. One new mcr-4 variant, mcr-4.3, was also identified. Conclusions: This method allows rapid identification of mcr-positive bacteria and overcomes the challenges of phenotypic detection of colistin resistance. The multiplex PCR should be particularly interesting in settings or laboratories with limited resources for performing genetic analysis as it provides information on the mechanism of colistin resistance without requiring genome sequencing.

[Characteristics and evolution of patients admitted to a public hospital intensive care unit]. / Características y evolución de los pacientes que ingresan a una Unidad de Cuidados Intensivos de un hospital público.

BACKGROUND: The epidemiology of critical patients in Chile could differ from that reported in international studies. AIM: To describe the causes of admission and evolution of patients who were admitted to the ICU (Intensive Care Unit) of a general hospital in Chile in a two-year period (2012-2013). PATIENTS AND METHODS: A retrospective study was carried out using the ICU database. The following variables were registered: admission diagnosis, APACHE II (Acute Physiology and Chronic Health Evaluation), days of mechanical ventilation (MV), ICU length of stay and ICU and hospital survival. RESULTS: We analyzed data from 1075 aged 54 ± 18 years (55% males), representing 75% of the admissions during the study period. The median ICU and MV lengths were 5 and 3 days respectively (92% of patients required MV). APACHE II was 20.5 ± 8.2. The ICU and hospital mortality rate were 19.4% and 31%, respectively. Critical neurological diseases were the most common diagnoses requiring ICU, representing 26.8% of the admissions. No differences were found between 2012 and 2013 in age, APACHE II, ICU or hospital survival. A longer post ICU length of stay was found during 2013, both for patients who survived and those who died at the hospital. CONCLUSIONS: This study highlights the high percentage of patients that required MV and the high percentage critical neurological conditions requiring ICU admission. The characteristics and evolution of patients admitted to the ICU did not differ during 2012 and 2013.

Short N-terminal sequences package proteins into bacterial microcompartments.

Hundreds of bacterial species produce proteinaceous microcompartments (MCPs) that act as simple organelles by confining the enzymes of metabolic pathways that have toxic or volatile intermediates. A fundamental unanswered question about bacterial MCPs is how enzymes are packaged within the protein shell that forms their outer surface. Here, we report that a short N-terminal peptide is necessary and sufficient for packaging enzymes into the lumen of an MCP involved in B(12)-dependent 1,2-propanediol utilization (Pdu MCP). Deletion of 10 or 14 amino acids from the N terminus of the propionaldehyde dehydrogenase (PduP) enzyme, which is normally found within the Pdu MCP, substantially impaired packaging, with minimal effects on its enzymatic activity. Fusion of the 18 N-terminal amino acids from PduP to GFP, GST, or maltose-binding protein resulted in their encapsulation within MCPs. Bioinformatic analyses revealed N-terminal extensions in two additional Pdu proteins and three proteins from two unrelated MCPs, suggesting that N-terminal peptides may be used to package proteins into diverse MCPs. The potential uses of MCP assembly principles in nature and in biotechnology are discussed.

Assessing the impact of a Christmas advertisement campaign on Catalan wine preference using Choice Experiments.

Our paper seeks to assess the impact of information and advertisement on consumers' preference for wines in special occasions (Christmas) in Catalonia (Spain). We apply the Choice Experiments method to study the relative importance of attributes that describe consumers' decision to purchase wine by using the Heteroskedastic Extreme Value (HEV) model. Data were obtained from two questionnaires applied to a pre and post spot samples formed by 299 and 400 individuals, respectively. Results suggest that the proposed spot does not affect the ranking of the preferred attributes, nevertheless this preference is heterogeneous. After advertising preferences scores have revealed significant differences. The relative importance of the "Catalan" wine has increased compared to the "Spanish" wine. The most preferred product is a Catalan wine made from the "Cabernet Sauvignon" variety. Wines that have been previously tasted by the consumer seem to be preferred over recommended or prestigious wines. However, advertising increases the relative importance of prestigious wines.

Getting Ahead: A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population.

Introduction: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year. Methods: We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and compared this to post intervention July 2021 to March 2022 determining the nephropathy screening rates in patients with diabetes. Our interventions included resident education, pre and post surveys to test foundational knowledge, adding UACR in the affordable laboratory order form and establishing normal reference range of UACR in the EMR. Results: We collected 217 patients with diabetes, 27% were uninsured, 38% had Medicare/Medicaid and 90% identified as Hispanic. Comparing pre to post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The correct average score of knowledge-based questions was 82% on the pre survey, which increased to 88% in the post survey. Conclusion: Our study showed promising results on improving diabetic nephropathy screening. The comprehensive approach including resident education about diabetic nephropathy screening with UACR and more so facilitating the order set in the EMR were key to achieve this goal.

International collaborative study on the occurrence of plasmid-mediated quinolone resistance in Salmonella enterica and Escherichia coli isolated from animals, humans, food and the environment in 13 European countries.

OBJECTIVES: This study was initiated to collect retrospective information on the occurrence of plasmid-mediated quinolone resistance (PMQR) in Salmonella enterica and Escherichia coli isolates in Europe and to identify the responsible genes. METHODS: Databases of national reference laboratories containing MIC values for Salmonella and E. coli isolated between 1994 and 2009 in animals, humans, food and the environment from 13 European countries were screened for isolates exhibiting a defined quinolone resistance phenotype, i.e. reduced susceptibility to fluoroquinolones and nalidixic acid. PCR and sequence analysis were performed to identify the responsible PMQR genes. RESULTS: Screening of databases of 13 European countries resulted in a selection of 1215 Salmonella and 333 E. coli isolates. PMQR genes were identified in 59% of the Salmonella isolates and 15% of the E. coli isolates selected. In Salmonella, qnrS1 (n = 125) and variants of qnrB (n = 138) were frequently identified, whereas qnrA1 (n = 3) and aac(6')-1b-cr (n = 3) were rarely found. qnrD was detected in 22 Salmonella isolates obtained from humans and animals. In E. coli, qnrS1 was identified in 19 isolates and qnrB19 was found in one isolate. No qnrC or qepA genes were detected in either Salmonella or E. coli. CONCLUSIONS: This study shows the occurrence and dissemination of PMQR genes in Salmonella and E. coli in Europe with a defined quinolone resistance phenotype. We also report the first detection of qnrD in Salmonella collected in Europe.

Funciones ejecutivas y regulación emocional en obesidad y trastornos alimentarios.

INTRODUCTION: Introduction: eating disorders (ED) such as anorexia nervosa (AN) or bulimia nervosa (BN), as well as obesity (OB), are related to emotional and neuropsychological impairments on measures of cognitive flexibility, central coherence or decision making. However, little is known about the association among emotional regulation, neuropsychological variables and affect. Objectives: to analyze whether neuropsychological and affect variables can predict emotional regulation in ED and in OB. Methods: thirty females with restricting ED (restricting AN) were assessed, 18 with purging ED (purging AN and BN), 33 with OB and 39 healthy controls matched for intelligence. The Wisconsin Card Sorting Test (WCST) assessed cognitive flexibility, the Group Embedded Figures Test (GEFT) assessed central coherence, the Iowa Gambling Task (IGT) assessed decision making, the Positive and Negative Affect Schedule assessed positive (PANAS-PA) and negative (PANAS-NA) affect, and the Difficulties in Emotion Regulation Scale (DERS) assessed emotional regulation. Results: relative to the healthy control group, ED and OB groups performed worse on IGT (p = 0.002) and GEFT (p = 0.003), had lower scores on PANAS-PA (p = 0.001) and higher scores on DERS (p < 0.001). ED groups had higher scores on PANAS-NA tan both OB and healthy controls (p = 0.001). PANAS-PA, PANAS-NA and IGT accounted for 51.4% of the variance of the DERS (p < 0.001). Conclusions: our study shows a significant association between decision making, affect and emotional regulation in the continuum from AN to OB, and also highlights the importance of including programs focused on decision making and affect in cognitive interventions for ED and OB.

INTRODUCCIÓN: Introducción: los trastornos de la conducta alimentaria (TCA) como la anorexia nerviosa (AN) o la bulimia nerviosa (BN), así como la obesidad (OB), se relacionan con alteraciones neuropsicológicas en flexibilidad cognitiva, coherencia central, toma de decisiones y alteraciones emocionales. Sin embargo, se desconoce la asociación entre regulación emocional, variables neuropsicológicas y variables de afecto. Objetivos: analizar si variables neuropsicológicas y afectivas pueden predecir la regulación emocional en los TCA y en la OB. Métodos: se evaluó a 30 mujeres con TCA restrictivo (AN restrictiva), 18 con TCA purgativo (AN purgativa y BN), 33 OB y 39 controles sanas emparejadas por nivel intelectual. El Wisconsin Card Sorting Test (WCST) evaluó la flexibilidad cognitiva; el Group Embedded Figures Test (GEFT), la coherencia central; el Iowa Gambling Task (IGT), la toma de decisiones; el Positive and Negative Affect Schedule, el afecto positivo (PANAS-PA) y negativo (PANAS-NA); y la Difficulties in Emotion Regulation Scale (DERS), la regulación emocional. Resultados: respecto al grupo control, los grupos TCA y OB rindieron peor en IGT (p = 0,002) y GEFT (p = 0,003) y presentaron menores puntuaciones en PANAS-PA (p = 0,001) y mayores en DERS (p < 0,001). Los grupos TCA puntuaron más alto en PANAS-NA que los grupos OB y control (p = 0,001). El 51,4% de la varianza del DERS fue explicado por PANAS-PA, PANAS-NA e IGT (p < 0,001). Conclusiones: nuestro estudio muestra una asociación entre toma de decisiones y afecto con regulación emocional en el continuo de AN a OB e indica la importancia de incluir programas de toma de decisiones y afecto en las intervenciones cognitivas para TCA y para OB.

Illness perception in eating disorders and psychosocial adaptation.

OBJECTIVE: The current study is based on the framework of the Self-Regulatory Model of Illness (SRM). The aim of this work was to examine perception of illness in eating disorder (ED) patients and investigate whether illness perception is related to psychosocial adaptation in these patients. METHOD: A total of 98 female ED patients completed the specific eating disorders Spanish version of the Revised Illness Perception Questionnaire (IPQ-R) and a range of adjustment variables including the Psychosocial Adjustment to Illness Scale (PAIS) and the Hospital Anxiety and Depression Scale (HAD). RESULTS: ED patients reported a moderate number of physical symptoms, and perceived their illness as controllable, treatable, highly distressing, as a chronic condition and with serious consequences. Emotional representation was the most significant dimension related to emotional adjustment. Illness identity and cure dimensions were the most significant dimensions associated with psychosocial adaptation. CONCLUSION: This study shows that patients' illness perceptions are related to illness adaptation. Illness identity was associated with emotional and psychosocial adjustment, and having faith that treatment may control the illness was related to positive benefits for ED. These results suggest that a psychological intervention, which addresses patients' illness representations, may assist in their adjustment to ED.

Manejo de paciente adulto con mordida abierta anterior por deglución atípica. Reporte de caso / Adult patient treatment with previous open bite by atypical deglution. Case report / Gestão de pacientes adultos com mordida aberta anterior por deglução atípica. Relato de caso

La mordida abierta anterior es una maloclusión en que uno o más dientes no alcanzan el plano oclusal y no se establece contacto con sus antagonistas. Su tratamiento es difícil y existe controversia en la necesidad de un abordaje quirúrgico. El presente caso relata el manejo de un paciente femenino de 61 años de edad, atendido en la clínica del Instituto Mexicano de Ortodoncia, que acudió por "separación de sus dientes". La evaluación clínica y radiográfica presentó una clase I esquelética, biprotrusiva, con overbite de -30% con sonrisa baja y no consonante, deglución atípica como factor etiológico que permitió el diagnóstico de mordida abierta ante-rior. El tratamiento consistió en la colocación de brackets prescripción Roth slot .022 con tubos hasta terceros molares superiores e inferiores, colocando brackets más hacia gingival con respecto al centro de la corona anatómica de ambas arcadas para lograr la extrusión y cierre de la mordida abierta y arco de sonrisa; en cen-trales a 1.5mm, laterales a 1mm y caninos a 0.5mm. Fue fundamental el uso de topes oclusales posteriores y también de elásticos anteriores cortos y ligeros desde el primer día del tratamiento. Se consiguió la corrección de la posición de los dientes en un tiempo de 18 meses, que además se indujo un cambio en el patrón de deglución. Mediante el plan de tratamiento propuesto se demostró que se puede dar estabilidad a la oclusión y que no todo paciente con mordida abierta es candidato a tratamiento quirúrgico para la corrección de esta maloclusión.

The previous open bite is a malocclusion in which one or more teeth do not get the occlusal plane and no con-tact is made with their antagonists. Its treatment is difficult and there is controversy in the need for a surgical approach. The present case relates to the management of a 61-year-old female patient, treated at the clinic of the Mexican Institute of Orthodontics, who came for "separation of her teeth." The clinical and radiographic evaluation presented a skeletal class I, biprotrusive, with overbite of -30% with low and non-consonant smile, atypical swallowing as an etiological factor that allowed the diagnosis of anterior open bite. The treatment con-sisted of the placement of Roth slot .022 prescription brackets with tubes up to upper and lower third molars, placing more gingival braces with respect to the center of the anatomical crown of both arches to achieve extrusion and closure of the open bite and arch of smile; in centrals at 1.5mm, laterals at 1mm and canines at 0.5mm. The use of posterior occlusal bumpers and also of short and light anterior elastics from the first day of treatment was essential. Correction of the position of the teeth was achieved in a period of 18 months, which also induced a change in the swallowing pattern. Through the proposed treatment plan it was shown that oc-clusion stability can be given and that not every patient with an open bite is a candidate for surgical treatment for the correction of this malocclusion.

A mordida aberta anterior é uma má oclusão na qual um ou mais dentes não atingem o plano oclusal e não é feito contato com seus antagonistas. Seu tratamento é difícil e há controvérsia na necessidade de uma abord-agem cirúrgica. O presente caso refere-se ao tratamento de uma paciente de 61 anos de idade, atendida na clínica do Instituto Mexicano de Ortodontia, que veio pela "separação dos seus dentes". A avaliação clínica e radiográfica apresentou classe esquelética biprotrusiva I, com sobremordida de -30% com sorriso baixo e não consoante, deglutição atípica como fator etiológico que permitiu o diagnóstico de mordida aberta anterior. O tratamento consistiu na colocação de suportes de prescrição Roth .022 com tubos até os terceiros molares superiores e inferiores, colocando os suportes mais voltados para a gengiva em relação ao centro da coroa anatômica de ambos os arcos para obter extrusão e fechamento da mordida e arco aberto de sorriso; nas centrais a 1,5 mm, laterais a 1 mm e caninos a 0,5 mm. O uso de topes oclusais posteriores e também de elásticos anteriores curtos e leves desde o primeiro dia de tratamento foi essencial. A correção da posição dos dentes foi realizada em um período de 18 meses, o que também induziu uma alteração no padrão da deglutição. Através do plano de tratamento proposto, demonstrou-se que a estabilidade da oclusão pode ser dada e que nem todo paciente com mordida aberta é candidato ao tratamento cirúrgico para correção dessa má oclusão.

Executive functions and emotion regulation in obesity and eating disorders / Funciones ejecutivas y regulación emocional en obesidad y trastornos alimentarios

Introduction: eating disorders (ED) such as anorexia nervosa (AN) or bulimia nervosa (BN), as well as obesity (OB), are related to emotional and neuropsychological impairments on measures of cognitive flexibility, central coherence or decision making. However, little is known about the association among emotional regulation, neuropsychological variables and affect. Objectives: to analyze whether neuropsychological and affect variables can predict emotional regulation in ED and in OB. Methods: thirty females with restricting ED (restricting AN) were assessed, 18 with purging ED (purging AN and BN), 33 with OB and 39 healthy controls matched for intelligence. The Wisconsin Card Sorting Test (WCST) assessed cognitive flexibility, the Group Embedded Figures Test (GEFT) assessed central coherence, the Iowa Gambling Task (IGT) assessed decision making, the Positive and Negative Affect Schedule assessed positive (PANAS-PA) and negative (PANAS-NA) affect, and the Diffi culties in Emotion Regulation Scale (DERS) assessed emotional regulation. Results: relative to the healthy control group, ED and OB groups performed worse on IGT (p = 0.002) and GEFT (p = 0.003), had lower scores on PANAS-PA (p = 0.001) and higher scores on DERS (p < 0.001). ED groups had higher scores on PANAS-NA tan both OB and healthy controls (p = 0.001). PANAS-PA, PANAS-NA and IGT accounted for 51.4% of the variance of the DERS (p < 0.001). Conclusions: our study shows a significant association between decision making, affect and emotional regulation in the continuum from AN to OB, and also highlights the importance of including programs focused on decision making and affect in cognitive interventions for ED and OB

Introducción: los trastornos de la conducta alimentaria (TCA) como la anorexia nerviosa (AN) o la bulimia nerviosa (BN), así como la obesidad (OB), se relacionan con alteraciones neuropsicológicas en flexibilidad cognitiva, coherencia central, toma de decisiones y alteraciones emocionales. Sin embargo, se desconoce la asociación entre regulación emocional, variables neuropsicológicas y variables de afecto. Objetivos: analizar si variables neuropsicológicas y afectivas pueden predecir la regulación emocional en los TCA y en la OB. Métodos: se evaluó a 30 mujeres con TCA restrictivo (AN restrictiva), 18 con TCA purgativo (AN purgativa y BN), 33 OB y 39 controles sanas emparejadas por nivel intelectual. El Wisconsin Card Sorting Test (WCST) evaluó la flexibilidad cognitiva; el Group Embedded Figures Test (GEFT), la coherencia central; el Iowa Gambling Task (IGT), la toma de decisiones; el Positive and Negative Affect Schedule, el afecto positivo (PANAS-PA) y negativo (PANAS-NA); y la Difficulties in Emotion Regulation Scale (DERS), la regulación emocional. Resultados: respecto al grupo control, los grupos TCA y OB rindieron peor en IGT (p = 0,002) y GEFT (p = 0,003) y presentaron menores puntuaciones en PANAS-PA (p = 0,001) y mayores en DERS (p < 0,001). Los grupos TCA puntuaron más alto en PANAS-NA que los grupos OB y control (p = 0,001). El 51,4% de la varianza del DERS fue explicado por PANAS-PA, PANAS-NA e IGT (p < 0,001). Conclusiones: nuestro estudio muestra una asociación entre toma de decisiones y afecto con regulación emocional en el continuo de AN a OB e indica la importancia de incluir programas de toma de decisiones y afecto en las intervenciones cognitivas para TCA y para OB

Fiabilidad y validez de constructo de la versión colombiana del instrumento de calidad de vida Skindex-29© en Medellín, Colombia / Reliability and construct validity of the colombianversion of the quality of life instrumentSkindex-29© in Medellin, Colombia / Fiabilidade e validade de constructo da versão colombianado instrumento de qualidade de vidaskindex-29© em Medellín, Colômbia

Introducción: La adaptación cultural de los instrumentos de calidad de vida y su evaluación psicométrica se deben hacer de forma rigurosa y estandarizada. Objetivo: evaluar la fiabilidad y la validez de constructo de la versión colombiana del instrumento Skindex-29©. Métodos: se incluyeron pacientes con enfermedades cutáneas inflamatorias o generalizadas; con enfermedades no inflamatorias o localizadas, e individuos sanos y se determinó la fiabilidad intraobservador e interobservador. Resultados: se encuestaron 265 individuos. El coeficiente alfa de Cronbach fue de 0,957 para el instrumento total. Los coeficientes de correlación intraclase de la consistencia intraobservador e interobservador fueron superiores al 0,9. Los pacientes con enfermedades dermatológicas generalizadas y con dermatosis inflamatorias tuvieron puntuaciones más altas que las de aquellos con lesiones cutáneas no inflamatorias o aisladas. Conclusiones: los resultados corroboran la validez de constructo del instrumento estudiado. En el futuro es necesario evaluar otras propiedades psicométricas del mismo tales como su validez de contenido y de criterio y su sensibilidad al cambio.

Background: The cultural adaptation of quality of life instruments and their psychometric evaluation should be done rigorously and according to the standards. Objective: This study assessed the reliability and construct validity of the Colombian version of the Skindex-29 instrument. Methods: Patients with inflammatory or generalized skin diseases and with non-inflammatory or localized diseases, and healthy individuals were included. We determined the intra- and inter-observer reliability. Results: We surveyed 265 individuals. Cronbach’s alpha was 0.957 for the total instrument. The intraclass correlation coefficients for intra-observer and inter-observer consistency were higher than 0.9. Patients with generalized or inflammatory diseases had higher scores than those with non-inflammatory or isolated lesions. Conclusions: The results support the construct validity of the studied instrument. In the future, it is necessary to evaluate other psychometric properties such as its content and criteria validity, and its sensitivity to change.

Introdução: A adaptação cultural dos instrumentos de qualidade de vida e sua avaliação psicométrica, deve se fazer de forma rigorosa e padronizada. Objetivo: Avaliar a fiabilidade e a validade de constructo da versão Colombiana do instrumento Skindex-29©. Métodos: Se incluíram pacientes com doenças cutâneas inflamatórias ou generalizadas; com doenças não inflamatórias ou localizadas e indivíduos saudáveis e se determinou a fiabilidade intra e inter-observador. Resultados: Se entrevistaram um total de 265 indivíduos. O coeficiente alfa de Cronbach foi de 0.957 para o instrumento total. Os coeficientes de correlação intra-aula da consistência intra-observador e inter-observador foram superiores a 0.9. Os pacientes com doenças dermatológicas e com dermatose inflamatórias apresentaram pontuações mais altas do que os pacientes com lesões cutâneas não inflamatórias ou isoladas. Conclusões: Mediante este estudo se corroboro a validade de constructo do instrumento. No futuro é necessário avaliar outras propriedades psicométricas do instrumento tais como sua validade de conteúdo, de critério e sua sensibilidade à mudança.

Características y evolución de los pacientes que ingresan a una Unidad de Cuidados Intensivos de un hospital público / Characteristics and evolution of patients admitted to a public hospital intensive care unit

Background: The epidemiology of critical patients in Chile could differ from that reported in international studies. Aim: To describe the causes of admission and evolution of patients who were admitted to the ICU (Intensive Care Unit) of a general hospital in Chile in a two-year period (2012-2013). Patients and Methods: A retrospective study was carried out using the ICU database. The following variables were registered: admission diagnosis, APACHE II (Acute Physiology and Chronic Health Evaluation), days of mechanical ventilation (MV), ICU length of stay and ICU and hospital survival. Results: We analyzed data from 1075 aged 54 ± 18 years (55% males), representing 75% of the admissions during the study period. The median ICU and MV lengths were 5 and 3 days respectively (92% of patients required MV). APACHE II was 20.5 ± 8.2. The ICU and hospital mortality rate were 19.4% and 31%, respectively. Critical neurological diseases were the most common diagnoses requiring ICU, representing 26.8% of the admissions. No differences were found between 2012 and 2013 in age, APACHE II, ICU or hospital survival. A longer post ICU length of stay was found during 2013, both for patients who survived and those who died at the hospital. Conclusions: This study highlights the high percentage of patients that required MV and the high percentage critical neurological conditions requiring ICU admission. The characteristics and evolution of patients admitted to the ICU did not differ during 2012 and 2013.

Metástasis cutánea de un sarcoma epitelioide / Cutaneous metastasis from an epithelioid sarcoma

Se presenta el caso de un hombre de 26 años, a quien se le diagnosticó un sarcoma epitelioide en la pierna derecha con metástasis a pulmón y que cuatro meses después desarrolló un nódulo papilomatoso en la región púbica, el cual resultó ser una metástasis cutánea.Las metástasis cutáneas tienen una frecuencia que oscila entre 0,7 y 10 %, ocupando el decimoctavo lugar como sitio de siembras a distancia. Cuando éstas se presentan, lo hacen generalmente como nódulos cerca del tumor primario. El sarcoma epitelioide es un tumor raro que corresponde a menos del 1 % de todos los sarcomas de tejidos blandos. Estas entidades son de muy baja frecuencia y su asociación es excepcional.

Células reguladoras en cáncer de piel melanoma y no melanoma / Regulatory cells in skin cancer melanoma and nonmelanoma

Las células T reguladoras (Treg) CD4+CD25+FOXP3+ son cruciales para el mantenimiento de la tolerancia y la prevención de la autoinmunidad. Su deficiencia se asocia con enfermedades autoinmunitarias y alergias, y su aumento se relaciona con el cáncer. La manipulación de las Treg es un objetivo de los estudios de inmunología del cáncer, debido a los potenciales efectos antitumorales. Las células Treg se producen en el timo y en la periferia. La radiación ultravioleta es capaz de suprimir la respuesta inmunitaria en la piel, entre otros mecanismos, por la inducción de las Treg, y esto se asocia al desarrollo de cáncer de piel melanoma y no melanoma. En este artículo se revisan los aspectos esenciales de las células Treg, su relación con la radiación ultravioleta y el cáncer, específicamente el cáncer de piel melanoma y no melanoma.

Renal health in Chile.

The prevalence of 20 diseases was studied in a representative sample of 3619 individuals in Chile. Twelve percent of the participants were younger than 25, 63% were 25-64 years old, and 25% were at least 65 years old. Thirty-four percent had high blood pressure, 60% were aware of their condition, 36% received treatment, and 12% reached their goal blood pressure. Renal function was assessed by serum creatinine and glomerular filtration rate, as estimated by the Cockroft-Gault formula. In all, 6.7% had elevated creatinine, 14% showed proteinuria, and 0.2% showed advanced renal damage. The results of this study will contribute to the prevention of renal diseases in Chile.

Mediating integration: latino immigrant organizations in greater Boston / Mediadores do processo de integração: organizações de imigrantes latinos na Grande Boston

In recent years scholars have debated the role of immigrant organizations in the processes of integration, political incorporation, and transnational activities (for example, Huntington 2004; Portes and Rumbault 2006; Bloemraad 2006; Portes, Escolar and Walton 2006). The current research adds to this discussion through a case study of selected immigrant organizations from Greater Boston’s largest Latino immigrant communities. Through qualitative interviews with leaders of immigrant organizations we found that connections and alliances matter for integration. Immigrant-led organizations are unique because of their leadership and proximity to the community. Even groups focused on cultural, religious, and transnational activities serve as informal mediators in the integration process. They provide practical information, support, and connections to mainstream society. Our findings inform how local governments can leverage the position of immigrant organiizations to build social and human capital in marginalized communities. Working with these informal networks allows the government to increase the efficiency and quality of its outreach to immigrants.(AU)

Nos últimos anos, estudiosos têm debatido o papel das organizações de imigrantes no processo de integração, incorporação política e transnacional (por exemplo, Huntington 2004; Portes e Rumbaut 2006; Bloemraad 2006; Portes, Escobar e Walton 2006). Este projeto acrescenta a esta discussão através de um estudo de caso focado num grupo de organizações das maiores comunidades imigrantes latinas da Grande Boston. Através de entrevistas qualitativas com líderes destas organizações; descobrimos que conexões e alianças são fundamentais no processo integração. Organizações de imigrantes têm caracteres únicos devido à sua liderança e proximidade com a comunidade. Mesmo os grupos focados em atividades culturais, religiosas e atividades transnacionais servem como mediadores informais no processo de integração. Eles fornecem informações práticas, apoio e ligações a sociedade mainstream. Os resultados da pesquisa em questão informam como governos locais podem alavancar o trabalho das organizações de imigrantes para construir capital social e humano nas comunidades marginalizadas. Trabalhar com essas redes informais permite ao governo aumentar a eficiência e a qualidade da sua atuação junto à populações imigrantes.(AU)