Prevalencia del síndrome de burnout en el personal asistencial de salud del servicio urgencias de la Unidad Integrada de Servicios de Salud de Fontibón Subred SurOccidente E.S.E y de la Unidad Integrada de Servicios de Salud Engativá Subred Norte E.S.E de la ciudad de Bogotá, en el primer semestre del año 2018

84 páginas : gráficasBurnout syndrome is currently defined as the burnout syndrome, it is characterized by an extreme response to chronic stress within the work context generating physical and mental exhaustion, progressive organizational and social maladjustment, affecting the worker and his environment. In Latin America, little information is found on the presentation of the syndrome2, although in Colombia it has been studied mainly in the emergency department, finding that the nursing population is one of the groups most susceptible to suffering from this pathology. Previous studies worldwide reveal that health personnel are one of the most vulnerable populations to suffer from this condition, which is linked to the performance areas11; One of the areas that has been investigated mainly in the emergency area is that it is the service with the greatest daily exposure to situations that generate stress, which are not mitigated by the protocols of action and the adequate preparation of professionals12. When considering that the prevalence of burnout syndrome varies in the territories depending on the variability of the established health systems and the factors of the health centers13 and in the absence of evidence of the exploration of this in public entities in the city of Bogotá; In view of the reorganization of the health sector due to the issuance of the 641 agreement, the objective of this project is to determine the prevalence of Burnout syndrome in the health care personnel of two integrated services units of the city of Bogotá in the emergency area. A descriptive, observational, cross-sectional study was conducted, a population sample was obtained equivalent to eighty-four people for a distribution of forty-two people for each institution involved and a socio-demographic survey and the questionnaire were used as measuring instruments. Maslach Burnout Inventory. The results obtained in the present study show a prevalence of burnout syndrome equivalent to 5% in the total population studied and by institutions involved, corresponding to 2% for the Integrated Health Services Unit - Fontibón-Subred Subreccidente y el 8 % for Integrated Unit of Health Services-Engativá- Subred Norte; results that resemble the prevalence values obtained in other studies, whose values range between 5 and 57% and that contemplate similar population groups46, but which differ in terms of the values obtained in the Maslach variables of other publications47. Results were found that reflect the absence of statistically significant differences in each institution involved in the study and that the workplace according to conditions may not determine the development of the syndrome, but the importance of generating optimal environments for workers in the health in the emergency department, given that this syndrome puts at risk the quality of care of people in care centers, so it is recommended to each of the integrated units of health service to identify the stress to which they are subjected workers daily and in this way implement methods that reduce work overload and that favor adequate work environmentsEl síndrome de Burnout es definido en la actualidad como el síndrome de desgaste profesional, se caracteriza por una respuesta extrema al estrés crónico dentro del contexto laboral generando agotamiento físico, mental, desajuste organizacional y social progresivo, afectando al trabajador y a su entorno. En Latinoamérica, se encuentra poca información acerca de la presentación del síndrome2, aunque en Colombia se ha estudiado principalmente en el servicio de urgencias encontrándose que la población de enfermería es uno de los grupos mayormente susceptibles a padecer dicha patología. Estudios previos a nivel mundial revelan que el personal sanitario es una de las poblaciones con mayor vulnerabilidad de sufrir este padecimiento, el cual está vinculado en función de las áreas de desempeño11; siendo una de las áreas que se ha investigado principalmente el área de urgencias ya que se constituye como el servicio de mayor exposición diaria a situaciones generadoras de estrés, que no son mitigadas a partir de los protocolos de actuación y de la preparación adecuada de profesionales12. Al considerar que la prevalencia del síndrome de burnout varia en los territorios dependiendo de las variabilidades de los sistemas de salud establecidos y de los factores propios de los centros de salud13 y ante la inexistente evidencia de la exploración de este en entidades públicas de la ciudad de Bogotá; ante la reorganización del sector salud por la expedición del acuerdo 641, se establece como objetivo del presente proyecto determinar la prevalencia del síndrome de Burnout en el personal asistencial de salud de dos unidades integradas de servicios de la ciudad de Bogotá en el área de urgencias. Se realizó un estudio de tipo descriptivo, observacional, de corte transversal, se obtuvo una muestra poblacional equivalente a ochenta y cuatro personas para una distribución de cuarenta y dos personas por cada institución involucrada y se usaron como instrumentos de medición una encuesta sociodemográfica y el cuestionario Maslach Burnout Inventory. En los resultados obtenidos en el presente estudio se puede evidenciar una prevalencia del síndrome de burnout equivalente al 5% en la población total estudiada y por instituciones implicadas correspondiente al 2% para la Unidad Integrada de Servicios de Salud- Fontibón- Subred Suroccidente y el 8% para Unidad Integrada de Servicios de Salud-Engativá- Subred Norte; resultados que se asemejan a los valores de prevalencia obtenidos en otros estudios, cuyos valores oscilan entre el 5 y 57% y que contemplan grupos poblacionales similares46, pero que discrepan en cuanto a los valores obtenidos en las variables de Maslach de otras publicaciones47. Se hallaron resultados que reflejan la no existencia de diferencias estadísticamente significativas en cada institución involucrada en el estudio y que el lugar de trabajo según condiciones puede no determinar el desarrollo del síndrome, pero se hace evidente la importancia de generar ambientes óptimos para los trabajadores de la salud en el servicio de urgencias, dado que este síndrome pone en riesgo la calidad de la atención de las personas en los centros asistenciales, por lo que se recomienda a cada una de las unidades integradas de servicio de salud identificar el estrés al que están sometidos los trabajadores diariamente y de esta manera implementar métodos que reduzcan la sobrecarga laboral y que favorezcan adecuados ambientes de trabajoIncluye bibliografíaPregradoMédico(a) Cirujan

Pros and cons of different therapeutic antibody formats for recombinant antivenom development.

Antibody technologies are being increasingly applied in the field of toxinology. Fuelled by the many advances in immunology, synthetic biology, and antibody research, different approaches and antibody formats are being investigated for the ability to neutralize animal toxins. These different molecular formats each have their own therapeutic characteristics. In this review, we provide an overview of the advances made in the development of toxin-targeting antibodies, and discuss the benefits and drawbacks of different antibody formats in relation to their ability to neutralize toxins, pharmacokinetic features, propensity to cause adverse reactions, formulation, and expression for research and development (R&D) purposes and large-scale manufacturing. A research trend seems to be emerging towards the use of human antibody formats as well as camelid heavy-domain antibody fragments due to their compatibility with the human immune system, beneficial therapeutic properties, and the ability to manufacture these molecules cost-effectively

Antivenoms for the treatment of snakebite envenomings: The road ahead

The parenteral administration of antivenoms is the cornerstone of snakebite envenoming therapy. Efforts are made to ensure that antivenoms of adequate efficacy and safety are available world-wide. We address the main issues to be considered for the development and manufacture of improved antivenoms. Those include: (a) A knowledge-based composition design of venom mixtures used for immunization, based on biochemical, immunological, toxicological, taxonomic, clinical and epidemiological data; (b) a careful selection and adequate management of animals used for immunization; (c) well-designed immunization protocols; (d) sound innovations in plasma fractionation protocols to improve recovery, tolerability and stability of antivenoms; (e) the use of recombinant toxins as immunogens to generate antivenoms and the synthesis of engineered antibodies to substitute for animal-derived antivenoms; (f) scientific studies of the contribution of existing manufacturing steps to the inactivation or removal of viruses and other zoonotic pathogens; (g) the introduction of novel quality control tests; (h) the development of in vitro assays in substitution of in vivo tests to assess antivenom potency; and (i) scientifically-sound pre-clinical and clinical assessments of antivenoms. These tasks demand cooperative efforts at all main stages of antivenom development and production, and need concerted international partnerships between key stakeholders.Universidad de Costa Rica//UCR/Costa RicaInternational Foundation for Science//IFS/SueciaCiencia y Tecnología para el Desarrollo//CYTED/EspañaConsejo Superior de Investigaciones Científicas//CRUSA-CSIC/EspañaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP

Los asentamientos Ticuna de hoy en la ribera del río Amazonas colombiano

Este artículo describe la configuración actual de los asentamientos de población Ticuna en la ribera del río Amazonas colombiano. Un asentamiento Ticuna, esta conformado por dos sectores claramente establecidos, el primero corresponde a la cabecera, lugar donde se localizan las viviendas y las pequeñas infraestructuras estatales y el segundo corresponde al entorno de esta, donde se localizan las chagras o zonas de cultivo y los sitios de pesca, caza y recolección. La manera en que estos grupos han conformado sus asentamientos corresponde a las estructuras económica, social y político administrativa que han  desarrollado en respuesta a sus necesidades como grupo étnico, en contacto permanente con la otra cultura

Full Neutralization of Centruroides sculpturatus Scorpion Venom by Combining Two Human Antibody Fragments

A fundamental issue of the characterization of single-chain variable fragments (scFvs), capable of neutralizing scorpion toxins, is their cross-neutralizing ability. This aspect is very important in Mexico because all scorpions dangerous to humans belong to the Centruroides genus, where toxin sequences show high identity. Among toxin-neutralizing antibodies that were generated in a previous study, scFv 10FG2 showed a broad cross-reactivity against several Centruroides toxins, while the one of scFv LR is more limited. Both neutralizing scFvs recognize independent epitopes of the toxins. In the present work, the neutralization capacity of these two scFvs against two medically important toxins of the venom of Centruroides sculpturatus Ewing was evaluated. The results showed that these toxins are recognized by both scFvs with affinities between 1.8 × 10−9 and 6.1 × 10−11 M. For this reason, their ability to neutralize the venom was evaluated in mice, where scFv 10FG2 showed a better protective capacity. A combination of both scFvs at a molar ratio of 1:5:5 (toxins: scFv 10FG2: scFv LR) neutralized the venom without the appearance of any signs of intoxication. These results indicate a complementary activity of these two scFvs during venom neutralization

Characterization of Sodium Channel Peptides Obtained from the Venom of the Scorpion <i>Centruroides bonito</i>

Five peptides were isolated from the venom of the Mexican scorpion Centruroides bonito by chromatographic procedures (molecular weight sieving, ion exchange columns, and HPLC) and were denoted Cbo1 to Cbo5. The first four peptides contain 66 amino acid residues and the last one contains 65 amino acids, stabilized by four disulfide bonds, with a molecular weight spanning from about 7.5 to 7.8 kDa. Four of them are toxic to mice, and their function on human Na+ channels expressed in HEK and CHO cells was verified. One of them (Cbo5) did not show any physiological effects. The ones toxic to mice showed that they are modifiers of the gating mechanism of the channels and belong to the beta type scorpion toxin (β-ScTx), affecting mainly the Nav1.6 channels. A phylogenetic tree analysis of their sequences confirmed the high degree of amino acid similarities with other known bona fide β-ScTx. The envenomation caused by this venom in mice is treated by using commercially horse antivenom available in Mexico. The potential neutralization of the toxic components was evaluated by means of surface plasmon resonance using four antibody fragments (10FG2, HV, LR, and 11F) which have been developed by our group. These antitoxins are antibody fragments of single-chain antibody type, expressed in E. coli and capable of recognizing Cbo1 to Cbo4 toxins to various degrees

The three-dimensional structure of the toxic peptide Cl13 from the scorpion Centruroides limpidus

International audienceCl13 is a toxin purified previously from the venom of the Mexican scorpion Centruroides limpidus. This toxin affects the function of voltage gated Na+-channels, human subtypes Nav1.4, Nav1.5 and Nav1.6 in a similar manner as other known β-toxins from scorpion venoms. Here, we report a correction of the primary structure of Cl13, previously published. The peptide does contain 66 amino acids, but residue 58 is a tryptophan and the last C-terminal amino acid is an amidated lysine, instead of arginine. The main contribution of this communication is the determination of the 3D-structure of Cl13, by solution NMR, showing that Cl13 has the classical cysteine-stabilized α/β (CSα/β) folding. It has a triple stranded antiparallel beta sheet commonly present in scorpion sodium channel β-toxins. In addition, we report and discuss a comparison of Cl13 structure with two other toxins (Cn2 and Css2) from scorpions of the same genus Centruroides, which shows important surface similarities with the structure reported here. Finally, the lack of neutralization of Cl13 toxin by two single-chain antibody fragments (scFvs), named LR and 10FG2, which are capable of neutralizing various toxins from Mexican scorpions, is revised. In particular, 10FG2 is capable of neutralizing toxins Cll1 and Cll2 of the same scorpion C. limpidus. The reasons why LR and 10FG2 are unable of neutralizing Cl13 toxin are discussed

Characterization of Four Medically Important Toxins from Centruroides huichol Scorpion Venom and Its Neutralization by a Single Recombinant Antibody Fragment

Centruroides huichol scorpion venom is lethal to mammals. Analysis of the venom allowed the characterization of four lethal toxins named Chui2, Chui3, Chui4, and Chui5. scFv 10FG2 recognized well all toxins except Chui5 toxin, therefore a partial neutralization of the venom was observed. Thus, scFv 10FG2 was subjected to three processes of directed evolution and phage display against Chui5 toxin until obtaining scFv HV. Interaction kinetic constants of these scFvs with the toxins were determined by surface plasmon resonance (SPR) as well as thermodynamic parameters of scFv variants bound to Chui5. In silico models allowed to analyze the molecular interactions that favor the increase in affinity. In a rescue trial, scFv HV protected 100% of the mice injected with three lethal doses 50 (LD50) of venom. Moreover, in mix-type neutralization assays, a combination of scFvs HV and 10FG2 protected 100% of mice injected with 5 LD50 of venom with moderate signs of intoxication. The ability of scFv HV to neutralize different toxins is a significant achievement, considering the diversity of the species of Mexican venomous scorpions, so this scFv is a candidate to be part of a recombinant anti-venom against scorpion stings in Mexico