Repercusiones psicológicas relacionadas con el proceso de alta de pacientes ingresados en la unidad de cuidados intensivos

El ingreso de un paciente en la Unidad de Cuidados Intensivos (UCI) provoca una crisis tanto en el paciente como entre sus familiares, que se ven obligados a realizar un cambio drástico en su vida. Hasta un tercio de los pacientes que ingresan en la UCI desarrollan síntomas de estrés postraumático, depresión y otras alteraciones emocionales. Estas alteraciones, no solo afectan a la salud del paciente, sino que también obstaculizan su proceso de recuperación. La ansiedad es uno de los diagnósticos más habituales que se relaciona principalmente con el proceso de ingreso y con la hospitalización en UCI. Las secuelas psicológicas, tanto de pacientes como de familiares, pueden cronificarse llegando a desarrollar alteraciones psicoemocionales importantes. Los profesionales de enfermería tienen un gran papel en la detección precoz de alteraciones psicoemocionales y constituyen una estrategia de prevención de dichas secuelas tras el alta. El objetivo principal de este proyecto de investigación es explorar los efectos psicológicos que un paciente puede sufrir después de su estancia en la UCI del Hospital Universitario Nuestra Señora de la Candelaria. Se trata de un estudio de tipo descriptivo cuyas variables principales son, niveles de ansiedad de pacientes dados de alta de UCI y de su cuidador principal y factores de riesgo relacionados con la aparición de ansiedad. La recogida de datos se basa en facilitar cuestionarios autoadministrados. Para el análisis estadístico de los datos utilizaremos estadística descriptiva empleando el paquete estadístico SPSS 21.0.The admission of a patient to the Intensive Care Unit (ICU) causes a crisis both in the patient and among his relatives, who are forced to make a drastic change in their lives. Up to a third of patients admitted to the ICU develop symptoms of post-traumatic stress, depression, and other emotional disturbances. These changes not only affect the patient's health, but also hinder the recovery process. Anxiety is one of the most common diagnoses that is mainly related to the admission process and hospitalization in the ICU. The psychological sequelae, both of patients and of family members, can be chronic, leading to the development of important psycho-emotional disorders. Nursing professionals have a great role in the early detection of psycho-emotional disorders and constitute a strategy for the prevention of these sequelae after discharge. The main objective of this research project is to explore the psychological effects that a patient may suffer after their stay in the ICU of the University Hospital Nuestra Señora de la Candelaria. This is a descriptive study whose main variables are, anxiety levels of patients discharged from the ICU and their main caregiver, and risk factors related to the appearance of anxiety. Data collection is based on providing self-administered questionnaires. For the statistical analysis of the data, we will use descriptive statistics using the statistical package SPSS 21.0

Ecuador y Alianza Pais

En el artículo se realiza un análisis de la sociedad ecuatoriana y del profundo caos en que vivía antes del 2006. En ese año, tomó el poder por las urnas la Revolución Ciudadana y el Movimiento Alianza País (Patria Altiva y Soberana). Se explica brevemente alguno de los rasgos de este Movimiento y cómo ha tratado de unir a todos los partidos de izquierda del país en un frente, UNIDOS. También nos acerca a la experiencia del Encuentro Latinoamericano de Amistad con los Pueblos (ELAP) que se celebró en Quito el septiembre del 2014 y los acuerdos que se tomaron para unir también a la izquierda Latinoamericana, así  como su continuidad en 2015

La Dirección en el desarrollo de las empresas cubanas: dirigentes y dirigidos / The Management in the Development of Cuban Companies: Leaders and Led

En el presente artículo se explica qué es la Dirección Estratégica y cómo ese enfoque se utiliza en una gran cantidad de empresas estatales cubanas, a partir de ser un enfoque a largo plazo que permite diseñar el futuro. Hace un resumen de los diferentes sistemas de dirección implantados en Cuba y se pretende valorar el lugar que ocupa el directivo en el sistema empresarial, así como las funciones de dirección fundamentales. Analiza la importancia del proceso de Dirección para la gerencia empresarial y la utilidad de las Habilidades Gerenciales en la labor del directivo y su repercusión en los dirigidos. In this article explains what the Strategic Management and how this approach is used in a lot of Cuban state enterprises from being a long-term approach that allows you to design the future. Summarizes the different management systems implanted in Cuba and is intended to assess the place of the manager in the business system and key leadership functions. It analyzes the importance of the process of Management for corporate management and utility of the Management Skills in the work of management and its impact on the target

Extracção de conhecimento a partir do software Open-Source de Business Intelligence Pentaho em Unidade de Cuidados Intensivos

Dissertação de mestrado integrado em Engenharia BiomédicaAs organizações de saúde têm como principal objectivo a prestação de serviços de qualidade à população, e a tomada de decisões de forma rápida e e caz é essencial para que tais objectivos sejam atingidos. Deste modo, neste sector, a adopção de ferramentas tecnológicas automatizadas que facilitam este processo tem vindo a aumentar ao longo dos anos. Neste contexto, surge o conceito de Business Intelligence (BI) que auxilia a tomada de decisão por parte dos pro ssionais de saúde, uma vez que estes sistemas se baseiam na Extracção de Conhecimento (EC) gerado pelos sistemas de informação transaccionais, sendo capazes de integrar uma enorme quantidade de dados provenientes de diversas fontes, normalmente de bases de dados que se encontram em diferentes tecnologias, plataformas e totalmente desintegradas. Assim, ultrapassando-se a heterogeneidade das bases de dados, através da estruturação dos dados, extrai-se informação que permitirá atingir conhecimento importante para as decisões clínicas. Especi camente, a Unidade de Cuidados Intensivos (UCI) de um hospital é a unidade mais cara e que mais recursos exige, de tal forma que os sistemas de BI podem desempenhar um papel preponderante não só na racionalização dos custos, mas também na melhoria da qualidade dos cuidados prestados, através da monitorização dos dados clínicos dos pacientes. Deste modo, este projecto pioneiro incidiu na análise da aplicação do Pentaho, um software Open-Source (OS) de BI, nos processos de EC a estas unidades hospitalares, tendo como fonte os dados dos pacientes de um hospital localizado no Norte de Portugal, avaliando o conhecimento obtido e o seu impacto na tomada de decisão. Este software disponibiliza ferramentas que analisam, sintetizam, assimilam e dão sentido às enormes quantidades de informação, sendo capaz de estabelecer ligações so sticadas e discernir padrões, dando oportunidade para tirar conclusões e agir de forma preventiva.Health organizations have as their main objective the provision of quality services to the population, so making decisions in a fast and e ective way is essential to achieve these objectives. Thus, in this sector, the adoption of technological and automated tools that facilitate this process has been increasing over the past few years. In this context, it arises the concept of BI which assists decision making by physicians, since these systems are based on the knowledge extraction generated by transactional information systems, being able to integrate a huge amount of data from various sources - tipically databases which are in di erent technologies, platforms, and completely disintegrated. Thus, passing up the databases' heterogeneity, by structuring the data, it is possible to extract important and useful information for clinical decisions. Speci cally, the Intensive Care Unit (ICU) of a hospital is the most expensive unit and the one that requires more resources, such that BI systems can play an important role not only in streamlining costs, but also improving the quality of care provided, through constant patients monitoring. Thus, this pioneering project focused on reviewing the implementation of Pentaho, an OS BI tool, in the knowledge extract processes at the ICUs, having as data source clinical data of patients from an hospital located in the north of Portugal, assessing the knowledge gained and its impact on decision making. This software provides tools that analyze, synthesize, assimilate and make sense of massive amounts of information, being able to discern and to liaise sophisticated standards, giving an opportunity to draw conclusions and act preventively

Molecular characterization of Streptococcus pneumoniae invasive serotype 19A isolates from adults in two Spanish regions (1994-2009)

From 1994 to 2009, the incidence of invasive serotype 19A pneumococci isolated from adults in Barcelona and San Sebastian almost doubled every 4 years. Genotyping of the 167 invasive isolates studied showed serotype 19A to be highly heterogeneous, with 35 different sequence types (STs) and a different clonal structure in each region and time period. Multiresistance, defined as non-susceptibility to three or more antimicrobials, was found in 86 (51.5%) isolates. The most frequent ST was the multidrug-resistant ST276 (n = 28), which is a single-locus variant of the Denmark14-ST230 global clone. The ST276 clone, only present in San Sebastian before 2001, was successfully disseminated from 2002 in both cities and was the main contributor to the overall increase of serotype 19A infections

Aldehyde Dehydrogenase 2 (ALDH2) in Rat Fatty Liver Cold Ischemia Injury

Institut George Lopez-1 (IGL-1) and Histidine-tryptophan-ketoglutarate (HTK) solutions are proposed as alternatives to UW (gold standard) in liver preservation. Their composition differs in terms of the presence/absence of oncotic agents such as HES or PEG, and is decisive for graft conservation before transplantation. This is especially so when fatty (steatotic) livers are used since these grafts are more vulnerable to ischemia insult during conservation. Their composition determines the extent of the subsequent reperfusion injury after transplantation. Aldehyde dehydrogenase-2 (ALDH2), a mitochondrial enzyme, has been reported to play a protective role in warm ischemia-reperfusion injury (IRI), but its potential in fatty liver cold ischemic injury has not yet been investigated. We evaluated the relevance of ALDH2 activity in cold ischemia injury when fatty liver grafts from Zucker Obese rats were preserved in UW, HTK, and IGL-1 solutions, in order to study the mechanisms involved. ALDH2 upregulation was highest in livers preserved in IGL-1. It was accompanied by a decrease in transaminases, apoptosis (Caspase 3 and TUNEL assay), and lipoperoxidation, which was concomitant with the effective clearance of toxic aldehydes such as 4-hydroxy-nonenal. Variations in ATP levels were also determined. The results were consistent with levels of NF-E2 p45-related factor 2 (Nrf2), an antioxidant factor. Here we report for the first time the relevance of mitochondrial ALDH2 in fatty liver cold preservation and suggest that ALDH2 could be considered a potential therapeutic target or regulator in clinical transplantation

Cross neutralization of SARS‐CoV‐2 omicron subvariants after repeated doses of COVID‐19 mRNA vaccines

We have measured the humoral response to messenger RNA (mRNA) vaccines in COVID-19 naïve and convalescent individuals. Third doses of mRNA COVID-19 vaccines induced a significant increase in potency and breadth of neutralization against SARS-CoV-2 variants of concern (VoC) including Omicron subvariants BA.1, BA.2, and BA.2.12.1, that were cross-neutralized at comparable levels and less for BA.4/5. This booster effect was especially important in naïve individuals that only after the third dose achieved a level that was comparable with that of vaccinated COVID-19 convalescents except for BA.4/5. Avidity of RBD-binding antibodies was also significantly increased in naïve individuals after the third dose, indicating an association between affinity maturation and cross neutralization of VoC. These results suggest that at least three antigenic stimuli by infection or vaccination with ancestral SARS-CoV-2 sequences are required to induce high avidity cross-neutralizing antibodies. Nevertheless, the circulation of new subvariants such as BA.4/5 with partial resistance to neutralization will have to be closely monitored and eventually consider for future vaccine developments

Cytoprotective Mechanisms in Fatty Liver Preservation against Cold Ischemia Injury: A Comparison between IGL-1 and HTK

Institute Goeorges Lopez 1 (IGL-1) and Histidine-Tryptophan-Ketoglutarate (HTK) preservation solutions are regularly used in clinical for liver transplantation besides University of Wisconsin (UW) solution and Celsior. Several clinical trials and experimental works have been carried out comparing all the solutions, however the comparative IGL-1 and HTK appraisals are poor; especially when they deal with the underlying protection mechanisms of the fatty liver graft during cold storage. Fatty livers from male obese Zücker rats were conserved for 24 h at 4 °C in IGL-1 or HTK preservation solutions. After organ recovery and rinsing of fatty liver grafts with Ringer Lactate solution, we measured the changes in mechanistic target of rapamycin (mTOR) signaling activation, liver autophagy markers (Beclin-1, Beclin-2, LC3B and ATG7) and apoptotic markers (caspase 3, caspase 9 and TUNEL). These determinations were correlated with the prevention of liver injury (aspartate and alanine aminostransferase (AST/ALT), histology) and mitochondrial damage (glutamate dehydrogenase (GLDH) and confocal microscopy findings). Liver grafts preserved in IGL-1 solution showed a marked reduction on p-TOR/mTOR ratio when compared to HTK. This was concomitant with significant increased cyto-protective autophagy and prevention of liver apoptosis, including inflammatory cytokines such as HMGB1. Together, our results revealed that IGL-1 preservation solution better protected fatty liver grafts against cold ischemia damage than HTK solution. IGL-1 protection was associated with a reduced liver damage, higher induced autophagy and decreased apoptosis. All these effects would contribute to limit the subsequent extension of reperfusion injury after graft revascularization in liver transplantation procedures

High Genetic Diversity among Community-Associated Staphylococcus aureus in Europe: Results from a Multicenter Study

Background: Several studies have addressed the epidemiology of community-associated Staphylococcus aureus (CA-SA) in Europe; nonetheless, a comprehensive perspective remains unclear. In this study, we aimed to describe the population structure of CA-SA and to shed light on the origin of methicillin-resistant S. aureus (MRSA) in this continent. Methods and Findings: A total of 568 colonization and infection isolates, comprising both MRSA and methicillin-susceptible S. aureus (MSSA), were recovered in 16 European countries, from community and community-onset infections. The genetic background of isolates was characterized by molecular typing techniques (spa typing, pulsed-field gel electrophoresis and multilocus sequence typing) and the presence of PVL and ACME was tested by PCR. MRSA were further characterized by SCCmec typing. We found that 59 % of all isolates were associated with community-associated clones. Most MRSA were related with USA300 (ST8-IVa and variants) (40%), followed by the European clone (ST80-IVc and derivatives) (28%) and the Taiwan clone (ST59-IVa and related clonal types) (15%). A total of 83 % of MRSA carried Panton-Valentine leukocidin (PVL) and 14 % carried the arginine catabolic mobile element (ACME). Surprisingly, we found a high genetic diversity among MRSA clonal types (ST-SCCmec), Simpson’s index of diversity = 0.852 (0.788–0.916). Specifically, about half of the isolates carried novel associations between genetic background and SCCmec. Analysis by BURP showed that some CA-MSSA and CA-MRS