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Introducción: Dentro del proceso del laboratorio clínico, la fase preanalítica es la fuente más frecuente de errores que pueden impactar en la fiabilidad de los resultados y su utilidad en la práctica clínica. Los indicadores de calidad son herramientas útiles para monitorear y mejorar todos los pasos del proceso de análisis. Objetivo: Evaluar el nivel de desempeño de indicadores preanalíticos en las áreas de química y hematología para identificar errores en el proceso de preanálisis. Métodos: Investigación de tipo descriptiva, de corte transversal, se desarrolló en 11 laboratorios clínicos utilizando seis indicadores preanalíticos del modelo de la International Federation of Clinical Chemistry and Laboratory medicine (IFCC). Resultados: La prevalencia de errores en solicitudes para el área de hematología fue 42,88% y en el área de química 36,37%, observándose que el indicador con mayor registro fue solicitudes con identificación incompleta del paciente 1920 (20,86%) en hematología y en el área de química 1600 (16,09%) (p more...

Investigative competencies are necessary to carry out an optimal and efficient research process. Descriptive research is presented whose general objective is to design a proposal of investigative competencies in the areas of the study plan of the medical career. The specific objectives are: to characterize the teachers and students of the medical career, identify the research activities in progress, describe the scientific and technical competences for the performance of the research and design a proposal of investigative competences in the three areas of the plan of study of the medical career of an Ecuadorian university. more...

The proposal to strengthen scientific production at the university level has dimensions, components and characteristics and a structure designed based on the theoretical contributions of this research and the results obtained in each objective addressed, considering that scientific research is an indicator of the quality of the processes in the university environment, so it must be increased by virtue of the results of the work carried out by the research professors and students. more...

Research is considered a function aimed at obtaining new knowledge and its application for the solution to problems or questions of a scientific nature. Management is defined as the set of actions aimed at the development and fulfillment of an activity. Thus, research management is conceptualized as the institutional activity oriented to search, study, knowledge of reality, systematization of this knowledge and its transfer to meet needs and contribute to solving society's problems. University research management must have a continuous improvement approach based on methodologies that although they are different have as a common denominator: the identification, characterization, evaluation and improvement of the process. The objective of this work is to characterize the management of research in the Faculty of Medical Sciences of an Ecuadorian university. more...

Nowadays the reforms in the health sector have focused all processes in the satisfaction of the user of services. To achieve this, every institution must have a motivated and satisfied staff who provides a care service of high quality. All clinical laboratories should have a management system designed to assess the expectations of both internal and external users. The objective of this study was to evaluate the quality aspects that affect the degree of satisfaction of the staff who works in clinical laboratories of public attention of Zulia state. The study is descriptive and transversal. To identify aspects related with the employee satisfaction, an analysis of variance (Anova) and the mean as a measure of central tendency, were used. There were 160 employees surveyed, distributed among 103 university professionals and 57 technicians. Considering social and labor aspects, the employees were mostly females (80.0%), between 20 and 40 years old, with university academic level (68.1%). The degree of satisfaction was related to the academic level and the aspects or quality areas that affect it are those pertaining to incentives and motivation, supply of materials and reagents, participation in scientific and community activities, quality assurance and provision of safety equipment. It is essential that programs be established for a continuous improvement of the quality of laboratory services so that employees feel the responsibility to make them health promotion centers and places of excellence more...

Dentro del ámbito clínico asistencial el personal del área de enfermería al desempeñar sus actividades, se expone a factores de riesgos de diversa naturaleza, biológicos, químicos, físicos, mecánicos, disergonómicos y psicosociales, cuya dinámica determina la ocurrencia de enfermedades y accidentes de trabajo. A propósito de accidentes laborales, estos son sucesos imprevistos que producen en el trabajador lesiones resultantes de una acción determinada en el curso o en ocasión del trabajo; son numerosos los factores que contribuyen en su aparición y pocas veces, por no decir ninguna, los accidentes ocupacionales son el resultado de una única causa o acción (1). La exposición al riesgo de accidentes dentro del contexto clínico asistencial, no es la misma para todo el colectivo de trabajadores, sea en centros hospitalarios o extra hospitalarios, varía en función del tipo de trabajo desempeñado por cada categoría profesional, destacándose la mayor incidencia en el personal que presta asistencia sanitaria directa. La enfermería representa una de las ocupaciones dentro del sector sanitario que, en términos de exposición a riesgos ocupacionales, dominan entre las demás profesiones del área de la salud. Un recorrido entre las numerosas evidencias científicas publicadas en la literatura reciente muestra un perfil de accidentalidad en profesionales y técnicos de la enfermería , muy variado, en los que destacan los siguientes : exposición accidental percutánea y mucocutánea a sangre y otros fluidos biológicos potencialmente infecciosos; lesiones por sobreesfuerzos físicos; resbalones y caídas; lesiones por violencia; traumas físicos por contacto con fuentes de energía; quemaduras térmicas o químicas; asfixia y lesiones por contacto accidental con agentes químicos tóxicos (2-9). El accidente que continua observándose con la mayor prevalencia en enfermeras es el contacto percutáneo a sangre y otros fluidos biológicos ( pinchazos, cortaduras y laceraciones, con agujas y objetos punzo cortantes), seguido de contacto muco-cutáneo ( salpicaduras y splash de sangre o fluidos biológicos en membranas mucosas y piel no intacta); las lesiones musculo esqueléticas por sobre esfuerzo en la asistencia de pacientes, lesiones por resbalones , tropiezos y caídas y violencia verbal y física ocupan frecuencias que engrosan la tasa de accidentalidad en las enfermeras (2,4-5,8- 10). En relación a la exposición a sangre y fluidos corporales, es bien reconocido en entornos sanitarios como un peligro ocupacional que impacta a miles de trabajadores del cuidado de la salud por su potencial para transmitir patógenos sanguíneos, entre ellos, virus de la hepatitis B (VHB), hepatitis C (VHC) o virus de inmunodeficiencia humana (VIH), debido a contacto percutáneo y contacto de mucosas o piel no intacta, con sangre, tejidos u otros fluidos biológicos potencialmente infecciosos (11-12). more...

The increase in lipid plasma values is an important cardiovascular risk factor. Lipoprotein lipase (LPL) plays an important role in the lipoprotein metabolism and metabolic and genetic factors may influence its levels and functions. The S447X variant of the lipoprotein lipase gene is associated with changes in plasma lipids in different populations. The objective of this research was to analyze the S447X variant of the LPL gene and its relation with plasma lipids of individuals in Zulia state, Venezuela. With this purpose, we studied 75 individuals (34 men and 41 women) between 20 and 60 years of age. Each subject had a medical history which included family history, anthropometric characteristics, nutritional status evaluation and biochemical tests. Genomic DNA was extracted for the molecular study and the polymerase chain reaction was used, followed by enzyme digestion, for restriction fragments length polymorphisms using the Hinf I enzyme. The individuals studied had normal levels of blood glucose, triglycerides, total cholesterol and low density lipoproteins (LDL-C) and slightly decreased levels of high density lipoproteins (HDL-C). The genotypic distribution of the LPL gene S447X variant in the studied population was 90.6% for the homozygous genotype SS447 and 9.4% for the heterozygote SX447. The genotype 447XX was not identified. The population was found in Hardy Weinberg genetic equilibrium. No association between the S447X polymorphism of lipoprotein lipase gene and plasma lipids was observed. more...

Evaluating how clinical laboratories' quality was being managed according to the view of external users, thereby determining the dimensions of quality related to their satisfaction and sociodemographic characteristics.The study was descriptive; the sample consisted of 1,875 outpatients attending the laboratories of type 3 and 4 care level public hospitals located in the metropolitan area of Zulia State in Venezuela between October and December 2008. A previously validated survey was applied. Frequency allocation, multivariate analysis and variance analysis were used for analysing data.The results showed that the most users were female (72.7 %), of local origin (87.9 %), aged between 15 and 45 (65.7 %) and had received primary and secondary education (70.5 %). Multivariate analysis showed that quality management could be evaluated in terms of accessibility, tangible elements, response ability, safety and professional competence. There were highly significant differences (p0.001) between educational level and age when evaluating management quality. Weaknesses were revealed concerning time spent waiting in reception, waiting room comfort and safety measures used by technical staff.The results should lead to establishing action aimed at evaluating the degree of improvement in service and proposed targets for improving the quality of attention; such measures will form part of a quality assurance programme in accordance with international standards. more...

Objetivo Determinar la exposicion laboral accidental a fluidos biologicos por contacto percutaneo en el personal Bioanalista de Laboratorios Clinicos publicos, sus factores asociados y el cumplimiento de medidas post exposicion biologica. Metodos Se realizo un estudio descriptivo transversal, la muestra fue de 156 bioanalistas adscritos a laboratorios clinicos del area metropolitana del estado Zulia. Para la recoleccion de datos se aplico un instrumento de escalas que exploro la exposicion percutanea, los factores vinculados y el cumplimiento de medidas post exposicion biologica. Resultados Se evidencio exposicion por accidentes percutaneos, representados principalmente por pinchazos y cortaduras, detectados en razon de su ocurrencia en un nivel moderado (media entre 2-3,99). Como factores vinculados a la accidentabilidad percutanea, se registra la ocurrencia en nivel moderado con diversas agujas huecas, con sangre y hemoderivados, en manos y dedos, con una severidad superficial, en areas de toma y procesamiento de muestras durante el re-encapuchado de objetos punzo cortantes. Un nivel de mediano cumplimiento se obtuvo para el manejo post exposicion. Existe relacion entre la exposicion percutanea con el nivel de cumplimiento detectado para el manejo post exposicion p more...

Objetivo Evaluar la gestion de calidad de los laboratorios segun la perspectiva de sus usuarios externos, determinandose las dimensiones de la calidad relacionadas con su satisfaccion y con las caracteristicas sociodemograficas. Metodos El estudio es descriptivo, la muestra estuvo conformada por 1 875 pacientes de consulta externa que asistieron a laboratorios de hospitales publicos tipo III y IV nivel de atencion ubicados en el area metropolitana del Estado Zulia, entre Octubre a Diciembre de 2008. Se aplico una encuesta previamente validada. Para el analisis, se empleo distribucion de frecuencias, analisis multivariante y analisis de la varianza. Resultados Los resultados mostraron que la mayoria de los usuarios son pacientes de sexo femenino (72,7 %), de procedencia local (87,9 %); en edades entre 15 y 45 anos (65,7 %) y con grado de instruccion primaria y secundaria (70,5 %). El analisis multifactorial demostro que el componente Gestion de Calidad, puede ser valorado por las dimensiones: Accesibilidad, Elementos tangibles, Capacidad de Respuesta, Competencias profesionales y Seguridad. Hubo diferencias altamente significativas (p more...

Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures.This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures.There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p001) between percutaneous exposure and level of compliance with post-exposure management.The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control. more...

Rabies is a zoonotic viral disease and in Zulia State, it constitutes a public health problem of a high social impact, due to the report of cases in human beings. In this study, the presence of urban rabies was determined in Zulia's State and its distribution was identified according to municipalities and affected species during 1996-2006. In the scope of a descriptive study, a documented revision of Zulia's State Zoonosis Regional Coordination registries for the period in study was carried out. A total occurrence of 1.033 rabies cases was observed, 1.017 were in animals and 16 in human beings. The biggest incidences were for Maracaibo (31.40%) and San Francisco (15.68%) municipalities. The type of predominant rabies was the urban one; the principal reservoir and transmitter was the canine one (91.60%). Of the reported cases in human beings, the biggest incidence was in in Maracaibo Municipality (37.5%) and the most affected age group was15 years (81.2%). A low percentage in the coverage of vaccination was presented (33%). A high incidence of rabies is demonstrated in Zulia's State in spite of this being a preventable immune disease. A positive correlation was determined between the number of admissions and cases (rs=0.948 P0.01). It is necessary to implement an effective control of the sources of infection and to support a minimal coverage of vaccination of 80% in canines and furthermore, to implement community education programs, to diminish the risk of infection and the occurrence of cases. more...

Microsporidia are recognized as a cause of morbidity among patients infected with the human immunodeficiency virus (HIV). Infection rates for intestinal microsporidiosis in HIV-infected patients from Venezuela are unknown. To determine the prevalence and pathogenic role of microsporidia in these patients in northwestern Venezuela, a case control study was conducted in 103 outpatients (mean +/- SD age = 37.3 +/- 5.6 years). Microsporidia were detected using unconcentrated formalin-fixed stools examined by Weber's chromotrope-based staining method. For identification of coccidia, modified Ziehl-Neelsen carbolfuchsin staining of formalin-ether concentrates were used, and for other pathogenic parasites, iron hematoxylin-stained smears and formalin-ether concentrates were examined. Microsporidial infections were detected in 14 (13.6%) of 103 patients and 39 (37.9%) had other parasitic pathogens. No significant difference was noted in the occurrence of the infection in patients with diarrhea (13 of 74, 17.6%) and controls (1 of 29, 3.4%) (P = 0.118). Nevertheless, this result may be due to the small sample size (n = 14) of infected individuals. The proportions of other pathogens in patients with or without diarrhea were not significantly different (P = 0.828). Microsporidiosis is common among the HIV-infected population in northwestern Venezuela. However, its pathogenic role in these patients is uncertain and warrants further investigation. more...