Incidencia de cefalea postpunción dural con la utilización de agujas quincke (Traumáticas) No. 27 vs agujas No. 25 en pacientes obstétricas

Postdural puncture headache is one of the most feared anesthetics complications due to its frequency and its intensity. In this study we asses the frecuency of this pathology in our obstetric population and the incidence comparing the diameter of the needle used in spinal anesthesia . For this purpose we analyzed the total of the obstetric population that received spinal anesthesia for c-section in Carlos Andrade Marin Hospital, ASA I-II risk score from January to June 2012, identifying the diameter of the needle used Quincke 27 vs Quincke 25and identifying those with post lumbar puncture headache classified in the electronic record or or well described as so in it with the criteria (headache that develops within 5 days after a lumbar puncture, that intensifies 15 minutes after sitting or standing and disappears or diminishes within 15 minutes assuming dorsal 9 position and has one of the following: nucal rigidity, tinitus, hipoacusia, photophopia or nausea; and that resolves spontaneously in the course of a week or adequate treatment of CSF leakage (blood patch). Results: There were identified 622 obstetric patients that underwent cesarean section surgery with spinal anesthesia; of these, 51 had criteria for PDPH, that correspond to 8,2% of the studied population. Of these patients, 45,1% were done with No 27 needle; 35,29% with needle No 25 and 19,6% of the patients the type of needle wasn’t registered. The mean age of the general population was 29,4 years with a SD of 5,8. The percentage of PDPH was 8,6 with needle No 27 and 8,8 with needle No 25; OR of 1,02; a confidence interval: 0,53-1,94, and P value: 0,94. This P value clearly indicates a non estadistic diference with the use of needles 27 vs 25, so the hypothesis ofthe study in wich the incidence of PDPH was lesss with the use of No 27 needle was rejected.La cefalea post-punción dural es una de las comlicaciones de la anestesia raquídea más temidas debido a su frecuencia y a su intensidad, ya que puede llegar a ser incapacitante. Para valorar uno de los factores que puede contribuir a dicho fenómeno como es el diámetro de la aguja utilizada para la punción espinal y su incidencia en nuestro medio, se realizó un estudio de cohorte retrospectivo en pacientes obstétricas ASA I-II en el Hospital Carlos Andrade Marín en el periodo enero a junio 2012, se identificó el diámetro de la aguja utilizada: tipo Quincke no 25, y tipo Quincke no 27, tomando en cuenta la totalidad de la población sometida a operación cesárea durante el periodo descrito y se valoró la presencia de cefalea post-punción dural, tomando en cuenta a las pacientes a las que se las clasificó como tal en el registro de la historia clínica o que cumplieron los criterios descritos para la misma (dolor de cabeza que se desarrolla dentro de los 5 días posteriores a una punción lumbar, que se intensifica en el plazo de 15 minutos después de sentarse o pararse y desaparece o mejora después de 15 minutos de asumir la posición dorsal; y que se acompaña de al menos de uno de los siguientes síntomas: rigidez nucal, tinnitus, hipoacusia, fotofobia o nausea; y que resuelve espontáneamente en el curso de una semana o dentro de las 48 horas posteriores al tratamiento adecuado de la fuga de LCR (Parche hemático). Resultados: Se identificaron 622 pacientes obstétricas sometidas a operación cesárea con anestesia espinal; de ellas, 51 presentaron los criterios para cefalea post punción dural, que corresponde al 8,2% de la población estudiada. De las pacientes con cefalea 45,1% fueron realizadas con aguja No 27; 35,29% con aguja No 25 y en un 19,6% de pacientes no se registró el tipo de aguja. Las media de edad de la población general fue 29,4 años con una DE de 5,8. El porcentaje de CPPD fue de 8,6% con aguja 27 y 8,8% con aguja no 25, un OR de 1,02; un INTERVALO DE CONFIANZA: 0,53-1,94, un VALOR DE P: 0,94. El valor de p claramente indica una diferencia no estadísticamente significativa con el uso de aguja 27 vs 25, con lo cual se rechaza la hipótesis planteada en el estudio que la incidencia de CPPD es menor con aguja No 27

Vivencias de las personas adultas y adultas mayores con diálisis peritoneal, Hospital II, EsSalud, Jaén - 2014

El presente trabajo es un estudio de naturaleza cualitativa de abordaje fenomenológico tiene como informantes a los adultos y adultos mayores del Hospital II EsSalud, Jaén. El objetivo de la investigación fue, comprender el fenómeno de las vivencias de las personas adultas y adultas mayores con tratamiento de diálisis peritoneal, Hospital Il, EsSalud, Jaén, 2014, donde la muestra estuvo representada por ocho entre adultos y adultos mayores quienes reunían los requisitos para la recolección de datos haciendo uso de la técnica de saturación por categorías realizando la entrevista con la siguiente pregunta orientadora ¿Qué siente, ser una persona con diálisis peritoneal?, se considera que la entrevista con la pregunta orientadora permitió la expresión de los adultos y adultos mayores develando aspectos y matices sobre su experiencia vivida al realizarse el tratamiento de diálisis peritoneal, a partir de la descripción, reducción y comprensión fenomenológica se obtuvo las siguientes convergencias: desesperación, cansancio, estrés, depresión, rechazo al diagnóstico, miedo a morir, apoyo familiar y cambio de vida; sus divergencias: desesperación vs tranquilidad, negación vs aceptación y angustia vs tranquilidad; y sus idiosincrasias fueron: abandono de Dios y fe en Dios. Concluyendo que los pacientes que experimentan esta enfermedad cuando reciben el apoyo de sus familiares todo les parece posible, aceptan el diagnóstico y ponen su fe en Dios, se reconcilian con Él obteniendo una calidad de vida mucho mejor y saludable, en los ámbitos físicos, psicológicos, emocionales, sociales y familiares.Tesi

Spontaneous Hemomediastinum and Hemothorax Caused by a Ruptured Bronchial Artery Aneurysm

A bronchial artery aneurysm (BAA) is uncommon and usually associated with chronic inflammatory lung disease or a systemic vascular condition, which is rarely the etiology of mediastinal hemorrhage. A middle-aged person presented with spontaneous hemothorax and hemomediastinum. A diagnostic evaluation identified a bronchial artery aneurysm as the source. To prevent further rupture, we performed a bronchial artery embolization. In the absence of trauma or other causes for hemothorax and mediastinal hemorrhage, the possibility of a BAA should be considered. A bronchial artery aneurysm can be managed by interventional techniques as well as surgery

Factores motivacionales y el desempeño laboral en el personal de salud de consultorios externos del hospital de Bagua Grande

La presente investigación tuvo como objetivo determinar la relación entre los factores motivacionales y el desempeño laboral en el personal de salud de consultorio externo del hospital de Bagua Grande, durante el primer semestre del año 2023. La metodología que se utilizó fue un enfoque cuantitativo de tipo básico con un diseño no experimental de alcance descriptivo correlacional. La muestra estuvo conformada por 55 trabajadores del hospital de Bagua Grande, a quienes se les aplicó un cuestionario validado por expertos, con una confiabilidad de 0.835 y 0.820. Los resultados evidenciaron que el 63.9% del personal se encuentran en un nivel medio en los factores motivacionales, en el desempeño laboral 54.5% del personal indicaron un nivel medio. Así mismo, se evidenció que los factores extrínsecos obtuvieron una mayor correlación (0.756) con el desempeño. Se concluyó que existe relación entre las variables factores motivacionales y desempeño laboral, debido a que obtuvo una correlación positiva alta (0.833)

Effect of hydrogen peroxide production and the Fenton reaction on membrane composition of Streptococcus pneumoniae

AbstractAs part of its aerobic metabolism, Streptococcus pneumoniae generates high levels of H2O2 by pyruvate oxidase (SpxB), which can be further reduced to yield the damaging hydroxyl radicals via the Fenton reaction. A universal conserved adaptation response observed among bacteria is the adjustment of the membrane fatty acids to various growth conditions. The aim of the present study was to reveal the effect of endogenous reactive oxygen species (ROS) formation on membrane composition of S. pneumoniae. Blocking carbon aerobic metabolism, by growing the bacteria at anaerobic conditions or by the truncation of the spxB gene, resulted in a significant enhancement in fatty acid unsaturation, mainly cis-vaccenic acid. Moreover, reducing the level of OH· by growing the bacteria at acidic pH, or in the presence of an OH· scavenger (salicylate), resulted in increased fatty acid unsaturation, similar to that obtained under anaerobic conditions. RT-PCR results demonstrated that this change does not originate from a change in mRNA expression level of the fatty acid synthase II genes. We suggest that endogenous ROS play an important regulatory role in membrane adaptation, allowing the survival of this anaerobic organism at aerobic environments of the host

DhhP, a Cyclic di-AMP Phosphodiesterase of Borrelia burgdorferi, Is Essential for Cell Growth and Virulence

Cyclic di-AMP (c-di-AMP) is a recently discovered second messenger in bacteria. Most of work on c-di-AMP signaling has been done in Gram-positive bacteria, firmicutes, and actinobacteria, where c-di-AMP signaling pathways affect potassium transport, cell wall structure, and antibiotic resistance. Little is known about c-di-AMP signaling in other bacteria. Borrelia burgdorferi, the causative agent of Lyme disease, is a spirochete that has a Gram-negative dual membrane. In this study, we demonstrated that B. burgdorferi BB0619, a DHH-DHHA1 domain protein (herein designated DhhP), functions as c-di-AMP phosphodiesterase. Recombinant DhhP hydrolyzed c-di-AMP to pApA in a Mn2+- or Mg2+-dependent manner. In contrast to c-di-AMP phosphodiesterases reported thus far, DhhP appears to be essential for B. burgdorferi growth both in vitro and in the mammalian host. Inactivation of the chromosomal dhhP gene could be achieved only in the presence of a plasmid-encoded inducible dhhP gene. The conditional dhhP mutant had a dramatic increase in intracellular c-di-AMP level in comparison to the isogenic wild-type strain. Unlike what has been observed in Gram-positive bacteria, elevated cellular c-di-AMP in B. burgdorferi did not result in an increased resistance to β-lactamase antibiotics, suggesting that c-di-AMP's functions in spirochetes differ from those in Gram-positive bacteria. In addition, the dhhP mutant was defective in induction of the σS factor, RpoS, and the RpoS-dependent outer membrane virulence factor OspC, which uncovers an important role of c-di-AMP in B. burgdorferi virulence

Cyclic DI-GMP Phosphodiesterases RmdA and RmdB are involved in regulating colony morphology and development in Streptomyces coelicolor. Journal of Bacteriology

Cyclic dimeric GMP (c-di-GMP) regulates numerous processes in Gram-negative bacteria, yet little is known about its role in Gram-positive bacteria. Here we characterize two c-di-GMP phosphodiesterases from the filamentous high-GC Gram-positive actinobacterium Streptomyces coelicolor, involved in controlling colony morphology and development. A transposon mutation in one of the two phosphodiesterase genes, SCO0928, hereby designated rmdA (regulator ofmorphology and development A), resulted in decreased levels of spore-specific gray pigment and a delay in spore formation. The RmdA protein contains GGDEF-EAL domains arranged in tandem and possesses c-di-GMP phosphodiesterase activity, as is evident from in vitro enzymatic assays using the purified protein. RmdA contains a PAS9 domain and is a hemoprotein. Inactivation of another GGDEF-EAL-encoding gene, SCO5495, designated rmdB, resulted in a phenotype identical to that of the rmdA mutant. Purified soluble fragment of RmdB devoid of transmembrane domains also possesses c-di-GMP phosphodiesterase activity. ThermdA rmdB double mutant has a bald phenotype and is impaired in aerial mycelium formation. This suggests that RmdA and RmdB functions are additive and at least partially overlapping. The rmdA and rmdB mutations likely result in increased local pools of intracellular c-di-GMP, because intracellular c-di-GMP levels in the single mutants did not differ significantly from those of the wild type, whereas in the double rmdA rmdB mutant, c-di-GMP levels were 3-fold higher than those in the wild type. This study highlights the importance of c-di-GMP-dependent signaling in actinomycete colony morphology and development and identifies two c-di-GMP phosphodiesterases controlling these processes

Cyclic di-GMP-dependent Signaling Pathways in the Pathogenic Firmicute Listeria Monocytogenes

We characterized key components and major targets of the c-di-GMP signaling pathways in the foodborne pathogen Listeria monocytogenes, identified a new c-di-GMP-inducible exopolysaccharide responsible for motility inhibition, cell aggregation, and enhanced tolerance to disinfectants and desiccation, and provided first insights into the role of c-di-GMP signaling in listerial virulence. Genome-wide genetic and biochemical analyses of c-di-GMP signaling pathways revealed that L. monocytogenes has three GGDEF domain proteins, DgcA (Lmo1911), DgcB (Lmo1912) and DgcC (Lmo2174), that possess diguanylate cyclase activity, and three EAL domain proteins, PdeB (Lmo0131), PdeC (Lmo1914) and PdeD (Lmo0111), that possess c-di-GMP phosphodiesterase activity. Deletion of all phosphodiesterase genes (ΔpdeB/C/D) or expression of a heterologous diguanylate cyclase stimulated production of a previously unknown exopolysaccharide. The synthesis of this exopolysaccharide was attributed to the pssA-E (lmo0527-0531) gene cluster. The last gene of the cluster encodes the fourth listerial GGDEF domain protein, PssE, that functions as an I-site c-di-GMP receptor essential for exopolysaccharide synthesis. The c-di-GMP-inducible exopolysaccharide causes cell aggregation in minimal medium and impairs bacterial migration in semi-solid agar, however, it does not promote biofilm formation on abiotic surfaces. The exopolysaccharide also greatly enhances bacterial tolerance to commonly used disinfectants as well as desiccation, which may contribute to survival of L. monocytogenes on contaminated food products and in food-processing facilities. The exopolysaccharide and another, as yet unknown c-di-GMP-dependent target, drastically decrease listerial invasiveness in enterocytes in vitro, and lower pathogen load in the liver and gallbladder of mice infected via an oral route, which suggests that elevated c-di-GMP levels play an overall negative role in listerial virulence

The Listeria monocytogenes exopolysaccharide significantly enhances colonization and survival on fresh produce

Fresh produce contaminated with Listeria monocytogenes has caused major listeriosis outbreaks in the last decades. Our knowledge about components of the listerial biofilms formed on fresh produce and their roles in causing foodborne illness remains incomplete. Here, we investigated, for the first time, the role of the listerial Pss exopolysaccharide (EPS) in plant surface colonization and stress tolerance. Pss is the main component of L. monocytogenes biofilms synthesized at elevated levels of the second messenger c-di-GMP. We developed a new biofilm model, whereby L. monocytogenes EGD-e and its derivatives are grown in the liquid minimal medium in the presence of pieces of wood or fresh produce. After 48-h incubation, the numbers of colony forming units of the Pss-synthesizing strain on pieces of wood, cantaloupe, celery and mixed salads were 2−12-fold higher, compared to the wild-type strain. Colonization of manmade materials, metals and plastics, was largely unaffected by the presence of Pss. The biofilms formed by the EPS-synthesizing strain on cantaloupe rind were 6−16-fold more tolerant of desiccation, which resembles conditions of whole cantaloupe storage and transportation. Further, listeria in the EPS-biofilms survived exposure to low pH, a condition encountered by bacteria on the contaminated produce during passage through the stomach, by 11−116-fold better than the wild-type strain. We surmise that L. monocytogenes strains synthesizing Pss EPS have an enormous, 102−104-fold, advantage over the non-synthesizing strains in colonizing fresh produce, surviving during storage and reaching small intestines of consumers where they may cause disease. The magnitude of the EPS effect calls for better understanding of factors inducing Pss synthesis and suggests that prevention of listerial EPS-biofilms may significantly enhance fresh produce safety