José Raymundo Rodríguez-Moctezuma

Construcción y validación inicial de un instrumento para medir el estilo de vida en pacientes con diabetes mellitus tipo 2

OBJETIVO: Construir y validar un instrumento especifico para medir el estilo de vida en los pacientes con diabetes mellitus tipo 2. MATERIAL Y METODOS: Entre marzo de 2001 y abril de 2002 se hizo un estudio observacional, longitudinal y prospectivo en unidades de medicina familiar de la delegacion Estado de Mexico Oriente, del Instituto Mexicano del Seguro Social. Se diseno un instrumento de autoadministracion, denominado instrumento para medir el estilo de vida en diabeticos, el cual fue sometido a revision por un panel multidisciplinario de expertos para determinar su validez logica y de contenido. Se aplico el instrumento en dos dias diferentes a 412 sujetos adultos con diabetes mellitus. Fueron depurados los items considerando la frecuencia de seleccion de sus opciones de respuesta, su correlacion item-total y su carga significativa en los dominios durante el analisis factorial. RESULTADOS: Completaron el estudio 389 (94.7%) sujetos. Los coeficientes de correlacion intra-clase para la validez logica y de contenido fueron de 0.91 y 0.95, respectivamente. Despues de la depuracion de items se obtuvo un instrumento conformado por 25 preguntas cerradas, distribuidas en siete dominios: nutricion, actividad fisica, consumo de tabaco, consumo de alcohol, informacion sobre diabetes, emociones y adherencia terapeutica. El a de Cronbach para la calificacion total fue de 0.81 y el coeficiente de correlacion test-retest de 0.84. CONCLUSIONES: El instrumento para medir el estilo de vida en diabeticos es el primer cuestionario especifico para sujetos con diabetes mellitus tipo 2 y tiene validez aparente, validez de contenido y buen nivel de consistencia.

Frequency and expression of ALS and HWP1 genotypes in Candida albicans strains isolated from Mexican patients suffering from vaginal candidosis.

To detect the frequency and expression of eight ALS (agglutinin‐like sequence) genes and the HWP1 genotype in a group of Candida albicans strains isolated from Mexican women suffering from vaginal candidosis. A group of 264 women (age 15–57 years) with vaginal infections were evaluated. C. albicans was identified by PCR amplification of the rRNA internal transcribed spacer regions ITS1 and ITS2. The ALS and HWP1 genes were identified by conventional PCR, and their expression levels were determined by real‐time PCR after growing C. albicans strains in reconstituted human vaginal epithelium (RHVE). C. albicans was identified in 50 women (18.9%). The genotypic frequencies were ALS1 100%, ALS2 60%, ALS3 36%, ALS4 54%, ALS5 70%, ALS6 56%, ALS7 64%, ALS9 66% and HWP1 92%. The most frequently expressed genes in the strains harbouring all of the genes were ALS4 (100%), ALS1 (87.5%), ALS2 (87.5%), ALS3 (87.5%), ALS5 (87.5%), ALS7 (87.5%) and HWP1 (75.0%). Nineteen per cent of the vaginal infections were caused by C. albicans, and a high proportion of the strains carried genes encoding proteins involved in adhesion to epithelia. The ALS and HWP1 genes were expressed in RHVE, suggesting that the Als and Hwp1 proteins play an important role in the pathogenesis of the infection.

Factores asociados a la gestión de quejas contra médicos que laboran en hospitales del Instituto Mexicano del Seguro Social

OBJETIVO: Identificar los factores asociados a la gestion de quejas contra los medicos que trabajan en hospitales generales del Instituto Mexicano del Seguro Social. MATERIAL Y METODOS: Se revisaron las quejas presentadas y los expedientes clinicos correspondientes, en los nueve hospitales de la Delegacion Estado de Mexico Oriente, del Instituto Mexicano del Seguro Social. Por cada expediente clinico con queja se seleccionaron como controles dos expedientes sin queja, de la misma unidad y servicio. Se buscaron asociaciones por medio de razon de momios y regresion logistica. RESULTADOS: Se incluyeron 130 expedientes motivo de queja y 260 expedientes control. Se identificaron siete factores asociados a queja de 14 investigados: complicaciones durante la atencion RM 2.8 (IC 95% 1.3-5.8), error diagnostico RM 3.18 (IC 95% 1.7-5.6), utilizacion de estudios de gabinete RM 3.7 (IC 95% 1.2-11.3), informacion deficiente por parte del medico RM 2.64 (IC 95% 1.2-5.7), alta voluntaria RM 7.2 (IC 95% 2.2-23.6), falta de vigilancia durante la hospitalizacion RM 19.12 (IC 95% 2.2-162.6) y revisiones vaginales multiples durante el trabajo de parto RM 5.17 (IC 95% 1.5-17.07). Hubo tendencia a la presentacion de quejas cuando se reportaron: mala relacion medico-paciente, deficiente atencion del trabajo de parto, error terapeutico y diferimiento de cirugia, sin significancia estadistica. CONCLUSIONES: Las quejas contra medicos de hospitales del Instituto Mexicano del Seguro Social en el Estado de Mexico se asocian con aspectos tecnicos en el diagnostico y con la percepcion del derechohabiente de recibir informacion y vigilancia deficientes durante la hospitalizacion.

Virulence factors, antibiotic resistance phenotypes and O-serogroups of Escherichia coli strains isolated from community-acquired urinary tract infection patients in Mexico.

BACKGROUND/PURPOSE Uropathogenic Escherichia coli (UPEC) strains isolated from patients with community-acquired urinary tract infections (UTIs) were assessed to determine the prevalence of virulence genes, antibiotic resistance, and the O-serogroup of the strains. METHODS Consenting patients with community-acquired UTI were enrolled at Unidad Médica Familiar Number 64 (Instituto Mexicano del Seguro Social, Estado de Mexico, Mexico) and 321 urine samples were collected. Polymerase chain reaction (PCR) was used to assess 24 virulence genes and 14 O-serogroups. The Kirby-Bauer method was used to evaluate the antibiotic susceptibility of the isolated strains to 12 commonly used antibiotics. RESULTS A total of 194 strains were identified as E. coli using standard biochemical tests, followed by PCR amplification of 16S ribosomal RNA gene. Only 58.2% of the strains belonged to the assessed 14 O-serogroups. The serogroups O25, O15, O8, and O75 were present in 20.6%, 17%, 6.1%, and 4.6% of strains, respectively. The most frequently occurring virulence genes among UPEC strains included kpsMT (92.2% strains), usp (87.1%), irp2 (79.3%), iha (64.9%), fim (61.3%), set (36%), astA (33.5%), pap (24.7%), and papGII (21.1%). In addition, 97% of the strains were multi-drug resistant (coresistance to 3-11 antibiotics). CONCLUSION The isolated UPEC strains predominantly belonged to three serogroups (O25, O15, and O8), harboured numerous virulence genes, and are multiresistant to antibiotics. The findings of this study could be used to orient UTI treatment strategies and in epidemiological studies in Mexico.

Implementation of a novel in vitro model of infection of reconstituted human epithelium for expression of virulence genes in methicillin-resistant Staphylococcus aureus strains isolated from catheter-related infections in Mexico

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) are clinically relevant pathogens that cause severe catheter-related nosocomial infections driven by several virulence factors.MethodsWe implemented a novel model of infection in vitro of reconstituted human epithelium (RHE) to analyze the expression patterns of virulence genes in 21 MRSA strains isolated from catheter-related infections in Mexican patients undergoing haemodialysis. We also determined the phenotypic and genotypic co-occurrence of antibiotic- and disinfectant-resistance traits in the S. aureus strains, which were also analysed by pulsed-field-gel electrophoresis (PFGE).ResultsIn this study, MRSA strains isolated from haemodialysis catheter-related infections expressed virulence markers that mediate adhesion to, and invasion of, RHE. The most frequent pattern of expression (present in 47.6% of the strains) was as follows: fnbA, fnbB, spa, clfA, clfB, cna, bbp, ebps, eap, sdrC, sdrD, sdrE, efb, icaA, and agr. Seventy-one percent of the strains harboured the antibiotic- and disinfectant-resistance genes ermA, ermB, tet(M), tet(K), blaZ, qacA, qacB, and qacC. PFGE of the isolated MRSA revealed three identical strains and two pairs of identical strains. The strains with identical PFGE patterns showed the same phenotypes and genotypes, including the same spa type (t895), suggesting hospital personnel manipulating the haemodialysis equipment could be the source of catheter contamination.ConclusionThese findings help define the prevalence of MRSA virulence factors in catheter-related infections. Some of the products of the expressed genes that we detected in this work may serve as potential antigens for inclusion in a vaccine for the prevention of MRSA-catheter-related infections.

Expression of enterotoxin-coding genes in methicillin-resistant Staphylococcus aureus strains isolated from Mexican haemodialysis patients

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) causes severe catheter-related infections in haemodialysis patients ranging from local-site infections and septic thrombophlebitis to bacteraemia but the associated virulence factors and exotoxins remain unclear.FindingsWe employed an in vitro infection model using reconstituted human epithelium (RHE) to analyse the expression profiles of 4 virulence genes and 12 exotoxin-coding virulence genes in 21 MRSA strains isolated from catheter-related infections in 21 Mexican patients undergoing haemodialysis.All 21 strains (100%) expressed the seg, seh, sei, eta, etb, or hla genes coding staphylococcal toxins. Eleven MRSA strains (52.3%) expressed the sea gene coding staphylococcal enterotoxin A, and two strains (9.5%) expressed the v8 gene coding serine protease. The tst, chp, and arcA genes coding toxic shock syndrome toxin 1, chemotaxis inhibitory protein, and arginine deiminase, respectively, were expressed in separate single strains (4.7%). The most frequent expression profile (42.8% of the strains) comprised seg, seh, sei, eta, etb, and hla.ConclusionIt is likely that the SEG, SEH, SEI, ETA, ETB, and Hla toxins may play a role in MRSA catheter-related infections. Consideration of these toxins in the development of a vaccine or as targets for monoclonal antibody therapy could provide an improved therapeutic strategy for the treatment of catheter-related infections in haemodialysis patients.