Impact of Helicobacter pylori resistance in unsuccessfully pluritreated patients in a Department of Infectious Diseases in Rome

Twenty-five pluritreated patients were examined. Fifty-six percent yielded Helicobacter pylori (H. Pilory); of these, 9 patients showed a concomitant colonization of the three gastric regions. The highest resistance rate was found for metronidazole (71.8%) followed by chlaritromycin (53.1%). Amoxycillin showed the best susceptibility (only 6% of resistance), tetracycline showed 12% of resistant strains and levofloxacin appeared to be a promising antibacterial agent (18% of resistance). The E-test method was shown to be more suitable than disk diffusion technique for resistance testing. Combined resistance to both chlaritromycin and metronidazole appeared in 50% of the strains. The isolates showing this dual resistance are known to be difficult to eradicate. Resistotypes were shown to be genotypically different even if the strains with the resistance to both chlaritromycin and metronidazole are more likely to belong to genotype cagA+ and vacA s1m1. Heteroresistance (different susceptibility of the isolated strains in a single stomach) resulted in 36% of patients with pangastritis. Indeed, the concomitant presence of H. pylori strains in the same subject, either susceptible or resistant or vice versa, may interfere with the eradication outcomes. In our study, antibiotic resistant H. pylori typically develops from pre-existing susceptible strains rather than from co-infection with a different and unrelated strain. In fact, each pair of isolates detected in our 4 patients with heteroresistance belonged to the same genotype (cagA+ s1m2 in patient 1 and cagA+ s1m1 in patients 2, 3 and 4). In conclusion, H. pylori antibiotic resistance does present several issues in pluritreated patients owing to the rapid emergence of multi-resistant strains

Living Wills in functioning: A legal tool with therapeutic aims

A pesar de los importantes avances en la curación y/o tratamiento de enfermedades, la muerte sigue siendo un hecho irremediable para el ser humano. Por tanto, conviene recordar que ayudar a bien morir es también uno de los fi nes de la Medicina actual. Desde la Psicooncología, las Instrucciones Previas (IIPP) se conceptualizan como una herramienta legal con objetivos psicoterapéuticos. Se trata de una vía para abrir el diálogo sobre cuestiones relacionadas con la muerte y un instrumento para la deliberación moral y toma de decisiones. Realizadas dentro de un contexto terapéutico de confi anza mutua, las IIPP se convierten en un facilitador, a medio plazo, del bienestar del paciente y de su familia.In spite of important advances in diseases treatment, death is still unavoidable for humanbeing. Therefore, it should be taken into account that “well-dying” is one of the goals of Medicine. From Psychooncology, Living Wills (LV) are a legal tool with therapeutic aims. They are a way to open dialogue about topics related to death and a valious instrument for moral deliberation and decision making process. If LV are developed in a therapeutic context of mutual trust, they become a helper of well-being for patient and family

Social threat exposure in juvenile mice promotes cocaine-seeking by altering blood clotting and brain vasculature

Childhood maltreatment is associated with increased severity of substance use disorder and frequent relapse to drug use following abstinence. However, the molecular and neurobiological substrates that are engaged during early traumatic events and mediate the greater risk of relapse are poorly understood and knowledge of risk factors is to date extremely limited. In this study, we modeled childhood maltreatment by exposing juvenile mice to a threatening social experience (social stressed, S-S). We showed that S-S experience influenced the propensity to reinstate cocaineseeking after periods of withdrawal in adulthood. By exploring global gene expression in blood leukocytes we found that this behavioral phenotype was associated with greater blood coagulation. In parallel, impairments in brain microvasculature were observed in S-S mice. Furthermore, treatment with an anticoagulant agent during withdrawal abolished the susceptibility to reinstate cocaine-seeking in S-S mice. These findings provide novel insights into a possible molecular mechanism by which childhood maltreatment heightens the risk for relapse in cocaine-dependent individuals

Development and characterization of fermented soy beverages containing encapsulated or non-encapsulated vaginal probiotics

Human microbial niches such as the healthy vagina, are recently emerging as “unconventional” sources of candidate probiotics capable of preventing from different vaginal diseases. These microorganisms could be provided as oral preparations since they can reach the vaginal niche passing through the gastrointestinal tract. However, their use in food would be challenging. The aim of this work was to develop and characterize fermented soy beverages with encapsulated and non-encapsulated vaginal lactobacilli, namely Lactobacillus crispatus BC4 and Lactobacillus gasseri BC9, as future dietary strategies for vaginal dysbiosis. The viability of vaginal strains remained stable at 7 log CFU/mL of product during the entire 28 days of storage, despite the use of encapsulated or non-encapsulated bacteria. Samples containing encapsulated bacteria, especially E-BC4+BC9, showed higher Water Holding Capacity (62.29%), lactic acid content (1.43%), and a remarkable antagonistic activity against enteropathogens. Moreover, encapsulation protected the strains from simulated GIT conditions (>1 Log) but reduced the acceptability of the final products. Overall, strain BC4 and BC9, alone or in mix, demonstrated to be promising co-starter cultures providing a characteristic flavor (pleasant smell and taste) and aroma (lower hexanal, benzaldehyde and higher diacetyl, and 2,3-pentanedione, compared to control) to the fermented soy beverages

Actitud de los docentes frente a la inclusión escolar en la I.E.P “Signos de fe la Salle”, Trujillo 2018

Esta investigación ha tenido como objetivo principal es comprobar si los docentes de la escuela regular que tienen incluidos en sus aulas a niños y niñas con Trastornó del Espectro Autista (TEA) manifiestan una actitud asertiva o no frente a ellos, ya que en ocasiones pudimos observar a varios docentes de aula que nos los trataban como al resto de los alumnos, tampoco se interesaban por su forma de aprender, estos niños pasaban mucho tiempo fuera del aula y si estaban en ella eran ignorados. La presente investigación se realizó en el Centro Educativo Particular “Signos de fe la Salle” donde observamos a catorce docentes de tercero de primaria y secundaria que tienen niños y adolescentes con TEA por las mañanas durante las clases de inglés, expresión artística y el recreo. Los datos fueron recogidos mediante la técnica de la encuesta, para la variable actitud de los docentes, con un método de análisis estadístico inferencial. La investigación fue de tipo descriptiva y nuestros resultados refiere que El Centro Educativo Particular, atiende a niños con discapacidad, pero debería de tener una preparación más profunda sobre las prácticas pedagógicas de los docentes que tienen alumnos incluidos en su aula. Concluimos que más de la mitad de docentes sostiene que es insuficiente el apoyo pedagógico que se brinda a los docentes inclusivos, por otro lado, el 35% de docentes manifiestan que si reciben apoyo necesario.Tesi

From traumatic childhood to cocaine abuse: the critical function of the immune system

Background: Experiencing traumatic childhood is a risk factor for developing substance use disorder (SUD), but the mechanisms that underlie this relationship have not been determined. Adverse childhood experiences affect the immune system and the immune system mediates the effects of psychostimulants. However, whether this system is involved in the etiology of SUD in individuals who have experience early life stress is unknown. Methods:In this study, we performed a series of ex vivo and in vivo experiments in mice and humans to define the function of the immune system in the early-life stress-induced susceptibility to the neurobehavioral effects of cocaine. Results: We provide evidence that exposure to social-stress (S-S) at an early age permanently sensitizes the peripheral (splenocytes) and brain (microglia) immune responses to cocaine in mice. In the brain, microglial activation in the ventral tegmental area (VTA) of S-S mice was associated with functional alterations in dopaminergic neurotransmission, as measured by whole-cell voltage clamp recordings in dopamine (DA) neurons. Notably, preventing immune activation during the S-S exposure reverted the effects of DA in the VTA and the cocaine-induced behavioral phenotype to control levels. In humans, cocaine modulated Toll-like receptor 4-mediated innate immunity, an effect that was enhanced in cocaine addicts who had experienced a difficult childhood. Conclusions Collectively, our findings demonstrate that sensitization to cocaine in early-life-stressed individuals involves brain and peripheral immune responses and that this mechanism is shared between mice and humans

Implement a model of a fair culture of patient safety in the internal medicine service of the Hospital Universitario de Santander HUS

Con este trabajo se implementó las herramientas de Rondas de Seguridad y Sesiones breves de Seguridad en el Servicio de Medicina Interna del Hospital Universitario de Santander HUS para mejorar la cultura de seguridad del paciente. La metodología utilizada fue descriptiva de corte transversal donde se tomó como población, 23 profesionales y 23 pacientes que se encontraban en el momento de realizar la ronda de seguridad en el servicio. Dentro de los resultados se encontró que: El personal sanitario del servicio de medicina interna no sigue a cabalidad el protocolo establecido por la institución (HUS) sobre el manejo de medicamentos, en cuanto a su almacenamiento y rotulación; ya que se encontraron algunos sin rotulo y en lugares inadecuados. Cabe destacar que los medicamentos se encontraban clasificados según la identidad del paciente. Se identificó que el hospital universitario en donde se llevó a cabo la investigación le falta reforzar y consolidar una cultura de seguridad del paciente al interior del servicio de medicina interna, ya que el 61% de los encuestados dice no saber los eventos adversos que se han presentado ese año en el servicio. Existen varios aspectos por mejorar en el servicio que requieren ser trabajados por la institución en el corto tiempo para mejorar la seguridad del paciente; con un 39% se afirma que es necesario mejorar la seguridad en las habitaciones, y en menor proporción incrementar el personal sanitario de planta, mejorar la disponibilidad de insumos y contar con un stock permanente de medicamentos. 12 Es necesario reforzar el concepto, procedimiento y/o protocolo para el reporte de eventos adversos y la compresión de su obligatoriedad en el hospital, ya que solamente el 43% lo reporta en el formato institucional, los demás lo hacen de forma verbal y algunos no lo reportan y el 4% de los encuestados dice no saber que un evento adverso. Conclusiones: Se evidenció la necesidad de sensibilizar y capacitar al personal sobre los lineamientos institucionales de la política de seguridad del paciente implementada en el HUS y la importancia de la adherencia del servicio de medicina interna al mismo. El Hospital Universitario de Santander con la implementación de las dos herramientas de rondas de seguridad y sesiones breves de seguridad en el servicio de medicina interna, logrará promover la cultura justa, en donde se reconozca que los errores siempre van a existir porque hacen parte de los riesgos cuando se presta atención en salud y que el sistema de reporte de eventos adversos es un mecanismo que ayuda a los profesionales de la salud a minimizarlos. En el estudio realizado en el Servicio de Medicina Interna del Hospital Universitario de Santander se puede concluir que las situaciones inseguras que más implican riesgo para los pacientes son las infecciones nosocomiales, la atención no oportuna del paciente, demora en los trámites administrativos y en la autorización de procedimientos por parte de la EPS. En el Servicio de Medicina Interna del Hospital Universitario de Santander el compromiso sobre la seguridad de los pacientes deberá empezar desde la gerencia, que trazarán estrategias para sensibilizar a los trabajadores, que comprendan la importancia de medir y evaluar los procesos, porque esa cultura del reporte, medición y evaluación permitirá el mejoramiento continuo de las organizaciones y será el comienzo de un cambio en la cultura de las mismas. El estudio realizado fue una experiencia muy enriquecedora para nosotras a nivel profesional como personal porque en esta práctica pudimos vivenciar el papel del auditor en servicios de salud a través de la respuesta asertiva de los profesionales en todo el proceso de la implementación de la herramientaUniversidad CESRESUMEN 11 ABSTRACT 14 1 FORMULACIÓN DEL PROBLEMA 16 1.1 PLANTEAMIENTO DEL PROBLEMA 16 1.2 JUSTIFICACIÓN DE LA PROPUESTA 18 1.3 PREGUNTA(S) DE INVESTIGACIÓN 21 2 MARCO TEÓRICO 22 2.1 MARCO LEGAL 22 2.1.1 Ley 100 de 1993 22 2.1.2. Resolución 1474 de 2002 23 2.1.3 Decreto 2309 de 2002 23 2.1.4 Decreto 1011 de 2006 24 2.1.5 Resolución 1043 de 2006 25 2.1.6 Resolución 1445 de 2006 25 2.1.7 Resolución 1446 de 2006 26 2.2 ANTECEDENTES Y CONCEPTOS FUNDAMENTALES 27 2.3 SEGURIDAD DEL PACIENTE 31 2.3.1 Lineamientos para la implementación de la política de seguridad 32 2.3.1.1 Los Principios orientadores de la Política 33 2.3.1.2 Objetivos de la política de seguridad del paciente. 34 2.3.1.3 Modelo conceptual de la politica de seguridad del paciente 35 2.3.2 Los elementos conceptuales de la estrategia institucional de seguridad 35 2.4 CULTURA JUSTA 39 2.4.1 Rondas de Seguridad 42 2.4.1.1 Propósito 43 2.4.1.2 ¿Quién debe liderarlas? 43 2.4.1.5 Introducción 44 2.4.1.6 Preguntas 44 2.4.1.7 Cierre 45 2.5.2 Sesiones Breves de Seguridad 45 3 OBJETIVOS 47 3.1 OBJETIVO GENERAL 47 3.2 OBJETIVOS ESPECÍFICOS 47 4 METODOLOGÍA 48 4.1 ENFOQUE METODOLÓGICO DE LA INVESTIGACIÓN 48 4.2 TIPO DE ESTUDIO 48 4.3 POBLACIÓN 48 4.4 DISEÑO MUESTRAL 48 4.5 DESCRIPCIÓN DE LAS VARIABLES 49 4.5.1 Diagrama de variables 49 4.5.2 Tabla de variables 50 4.6 TÉCNICAS DE RECOLECCIÓN DE INFORMACIÓN 54 4.6.1 Fuentes de información 54 4.6.2 Instrumento de recolección de información 54 4.6.3 Proceso de obtención de la Información (qué, quién, cómo, cuándo) 55 4.6.3. Instructivo Rondas de Seguridad. 56 4.6.3.2 Sesiones breves de seguridad. 59 4.7 PRUEBA PILOTO 59 4.8 CONTROL DE ERRORES Y SESGOS 60 4.9 TÉCNICAS DE PROCESAMIENTO Y ANÁLISIS DE LOS DATOS 60 5 CONSIDERACIONES ÉTICAS 61 6 RESULTADOS 62 6.1 RESULTADOS DE LA LISTA DE CHEQUEO 62 6.2 RESULTADOS DE LA ENCUESTA AL PERSONAL SANITARIO 64 6.3 RESULTADOS DE LA ENCUESTA AL PACIENTE 86 6.4 RESULTADOS DE LAS SESIONES BREVES DE SEGURIDAD 88 6.5 FOTOGRAFÍAS 91 7 DISCUSIÓN 95 7.1 LISTA DE CHEQUEO 95 7.2 ENCUESTA DEL PACIENTE 96 7.3 ENCUESTA AL PERSONAL SANITARIO 96 7.4 SESIONES BREVES DE SEGURIDAD 97 8 CONCLUSIONES 99 REFERENCIAS BIBLIOGRÁFICAS 100 ANEXOS 103EspecializaciónWith this work, the tools for Safety Rounds and Short Safety Sessions were implemented in the Internal Medicine Service of the Santander University Hospital HUS to improve the culture of patient safety. The methodology used was descriptive, cross-sectional, where 23 professionals and 23 patients who were at the time of the security round in the service were taken as the population. Among the results it was found that: The health personnel of the internal medicine service do not fully follow the protocol established by the institution (HUS) on the handling of medications, in terms of their storage and labeling; since some were found without a label and in inappropriate places. It should be noted that the drugs were classified according to the identity of the patient. It was identified that the university hospital where the research was carried out lacks reinforcing and consolidating a culture of patient safety within the internal medicine service, since 61% of those surveyed say they do not know the adverse events that have occurred. presented that year in service. There are several aspects to improve in the service that need to be worked on by the institution in a short time to improve patient safety; 39% affirm that it is necessary to improve room security, and to a lesser extent increase the plant health personnel, improve the availability of supplies and have a permanent stock of medicines. It is necessary to reinforce the concept, procedure and / or protocol for the reporting of adverse events and the understanding of its obligation in the hospital, since only 43% report it in the institutional format, the rest do it verbally and some do not. they report it and 4% of those surveyed say they do not know that an adverse event is. Conclusions: The need to sensitize and train staff on the institutional guidelines of the patient safety policy implemented in the HUS and the importance of adherence by the internal medicine service to it was evidenced. The Santander University Hospital with the implementation of the two tools of security rounds and brief security sessions in the internal medicine service, will be able to promote a fair culture, where it is recognized that errors will always exist because they are part of the risks when providing health care and that the adverse event reporting system is a mechanism that helps health professionals to minimize them. In the study carried out in the Internal Medicine Service of the University Hospital of Santander, it can be concluded that the unsafe situations that imply the most risk for patients are nosocomial infections, untimely care of the patient, delay in administrative procedures and authorization procedures by the EPS. In the Internal Medicine Service of the Santander University Hospital, the commitment to patient safety must start from the management, who will draw up strategies to sensitize workers, who understand the importance of measuring and evaluating processes, because that culture of reporting , measurement and evaluation will allow continuous improvement of organizations and will be the beginning of a change in their culture. The study carried out was a very enriching experience for us on a professional and personal level because in this practice we were able to experience the role of the auditor in health services through the assertive response of professionals throughout the process of implementing the toolModalidad Presencia

Neurogenic Processes Are Induced by Very Short Periods of Voluntary Wheel-Running in Male Mice

Even in the adult mammalian brain progenitor cells proliferate and give rise to young neurons which integrate into the neuronal network. The dentate gyrus possesses such a neurogenic niche reactive to external stimuli like physical activity. In most studies mice or rats have been exposed to wheel running for periods of several weeks to activate neurogenesis while early neurogenic processes induced by very short running periods are less well understood. To address this issue, we allowed male C57Bl/6 mice free access to a running wheel for 2 or 7 days. We injected bromodeoxyuridine (BrdU) before the last running night, respectively, and quantified cell proliferation with immunocytochemistry for BrdU and Ki-67. Furthermore, we performed immunocytochemistry for doublecortin (DCX) and real-time RT-qPCR for NeuroD1 to characterize and quantify changes in neurogenesis on the protein and mRNA level. Real-time RT-qPCR for neurogenic niche factors (BDNF, FGF-2, BMP4, Noggin) was used to detect changes in the molecular composition of the neurogenic niche. Interestingly, we observed that cell proliferation was already affected after 2 days of running showing a transient decrease, which was followed by a rebound with increased proliferation after 7 days. Neurogenesis was stimulated after 2 days of running, reflected by elevated NeuroD1 mRNA levels, and it was significantly increased after 7 days as indicated by DCX immunostaining. On the level of niche factors we observed changes in expression in favor of neuronal differentiation (increased BDNF mRNA expression) and proliferation (decreased BMP4 mRNA expression) already after 2 days, although increased proliferation is reflected on the cellular level only later. In summary, our data show that 2 days of running are sufficient to activate neurogenic processes and we hypothesize that a strong pressure toward differentiation privileges neurogenesis while proliferation lags behind

Per una nuova rubrica: dal Network dalle sedi ai Cluster tecnologici.

A partire da questo numero, la rivista Techne, raccogliendo le proposte avanzate dalla comunità scientifica in occasione dell'ultima Assemblea dei Soci tenutasi lo scorso ottobre al MADE-Expo di Milano, trasforma la rubrica “Network SITdA”, oggi rassegna dei contributi dalle sedi universitarie, nella sezione “Cluster”, espressione di un modello organizzativo delle sinergie tra ricerca, formazione, impresa, finalizzato ad un dialogo più efficace con i vari livelli delle Istituzioni. Catalizzatori di nuove risposte alle sfide ambientali, economiche e sociali, i cluster hanno valenze interdisciplinari ed internazionali, per la creazione di 'nuova imprenditorialità dai saperi'. I cluster potrebbero aprire, pertanto nuove opportunità per la società e il mercato, in termini di prodotti, servizi, settori produttivi, modalità di organizzazione e interazione. Il numero 5 della rivista è occasione per introdurre una svolta nell'impegn

Sistema de Contabilidad De Costos y Su Relación Con Los Estados Financieros De La Empresa Industrias Kael Sac, Con Sede En El Distrito De San Luis, Año 2015

El presente trabajo de investigación se realizó en la empresa Industrias Kael S.A.C, ubicado en el Distrito de San Luis. Se analizó el sistema de contabilidad de costos y su relación con los estados financieros del ejercicio 2015. El objetivo del estudio responde a conocer la relación que tiene un sistema de contabilidad de costos en la elaboración de la información financiera porque incide de forma directa, la empresa al no contar con dicha herramienta enfrenta un gran problema ya que la información contable no refleja realidad , apartándose del principio de objetividad de la ciencia contable. Después de realizar la investigación concluimos que el sistema contabilidad de costos por procesos tiene una relación directa con los estados financieros porque suministra información como los consumos de materia prima, suministros diversos, envases y embalajes, gastos indirectos de fabricación que se usan en una determinada área, departamento o actividad, dicha información es primordial para conocer el costo de venta, los saldos y poder estructurar los estados financieros con saldos reales. Recomendamos implementar el sistema de costos por proceso desde su organización estructural, funcional, instrumentos de gestión (centro de costo) documentario y reportes de gestión y contables. El sistema de costos por procesos debe desarrollarse mediante un software debidamente diseñado para el tamaño de la empresa, y su uso debe ser permanente.The present research work was carried out in the company Industrias Kael S.A.C, located in the District of San Luis. The cost accounting system and its relation to the financial statements for the year 2015 was analyzed. The objective of the study is to know the relationship that has a cost accounting system in the preparation of financial information because it affects directly, the company does not have such a tool facing a big problem because the accounting information does not reflect reality , departing from the principle of objectivity of accounting science. After carrying out the investigation, we conclude that the process cost accounting system has a direct relationship with the financial statements because it provides information such as the consumption of raw materials, diverse supplies, packaging and packaging, indirect manufacturing expenses that are used in a certain area. , department or activity, this information is essential to know the cost of sale, the balances and to be able to structure the financial statements with real balances. We recommend implementing the cost system by process from its structural, functional organization, management instruments (cost center), documentary and management and accounting reports. The process cost system must be developed through software duly designed for the size of the company, and its use must be permanent.Trabajo de investigació