Revision sistemática: Factores asociados a colonización e infección por bacterias gram negativas resistentes a carbapenemicos

INTRODUCCIÓN: Los carbapenémicos (CP) son una de las últimas líneas de tratamiento para infecciones por microorganismos multirresistentes (MDR), especialmente Gram-negativos productores de betalactamasas de espectro extendido. Es creciente la preocupación a nivel mundial por el aumento de aislamientos resistentes a CP, en EEUU hasta 60% de las infecciones nosocomiales son causadas por bacterias MDR. En la Unión Europea, cerca de 25.000 pacientes mueren anualmente por esta causa. En Latinoamérica hay una tendencia creciente en las tasas de resistencia.OBJETIVO: Identificar y describir factores protectores o de riesgo, relacionados con colonización o infección por Gram negativos resistentes a CP en pacientes adultos hospitalizados, mediante una revisión sistemática de la literatura.MÉTODOS: Revisión sistemática de literatura, búsqueda de estudios observacionales analíticos en las bases de datos PubMed, Embase, Scopus, BVS, Scielo y búsqueda de literatura gris, publicados desde el 01/01/2004 al 15/04/2015. Se evalúo la calidad de los estudios con escala Newcastle-Ottawa y FLC Osteba. RESULTADOS: Se seleccionaron 36 estudios de alta calidad, diseño de casos y controles. Los factores de riesgo estadísticamente significativos observados son estancia en UCI OR:36.46, insuficiencia renal aguda OR:6.23, diálisis OR:10.80 ventilación mecánica OR:17.5, cateterismo vesical OR:14.3, uso de carbapenémicos OR:18,52,quinolonas OR17.30, cefepime OR:28.05, glicopéptidos OR:19.1; metronidazol OR:4.17, p:0.03, colistina OR:12.1, linezolid OR:7 CONCLUSIÓN: Pese a que hay alta heterogeneidad en las variables incluidas en los estudios, se encontró que los factores de riesgo principales para adquirir GNR-CP en pacientes hospitalizados son: antecedente de insuficiencia renal aguda y diálisis, ventilación mecánica, cateterismo vesical, estancia en UCI y uso previo de antibióticos carbapenémicos, quinolonas, cefepime, glicopéptidos, metronidazol, linezolid y colistina. No se hallaron factores protectores. factores de riesgo

Evaluation of an esophageal Doppler probe for the identification of experimental pseudo-electromechanical dissociation: a preliminary study

STUDY OBJECTIVE To determine the effectiveness of an esophageal doppler device to non-invasively detect experimental pseudo-electromechanical dissociation (pseudo-EMD). DESIGN Prospective, controlled, laboratory investigation using an asphyxial canine cardiac arrest model and a newly-developed esophageal flat-flow probe doppler unit. INTERVENTIONS Mongrel dogs (20) were instrumented for hemodynamic monitoring. The esophageal doppler probe was placed in the distal esophagus of each animal. Electromechanical dissociation (EMD) was induced by clamping the endotracheal tube. MEASUREMENTS AND MAIN RESULTS A period of pseudo-EMD was defined as the time where cardiac contractility was present, measured by a micromanometer tipped thoracic aortic catheter, without concurrent femoral pulses by palpation. The pseudo-EMD period could be produced consistently in all 20 animals. The characteristic doppler flow sounds were easily heard using the esophageal device in all animals. The time from endotracheal tube clamping until loss of femoral pulses was 622 +/- 96 s; until loss of radial artery doppler signals was 616 +/- 92 s; until loss of esophageal doppler signals was 728 +/- 88 s; and until loss of aortic fluctuations by thoracic aortic catheter was 728 +/- 82 s. The times to loss of esophageal doppler sounds and loss of aortic fluctuations were not significantly different. However, they were significantly longer than the time to loss of femoral pulses (P < 0.02). CONCLUSIONS The canine asphyxial EMD model can be used for short experimental studies of pseudo-EMD. Pseudo-EMD can be consistently and non-invasively detected with this esophageal doppler device. The device is as reliable as a micromanometer tipped aortic arch catheter in detecting pseudo-EMD. The doppler device could potentially be useful in improving recognition of near cardiac arrest in pre-hospital and emergency department settings. Further research on the utility of this device in other models of low-flow states should be performed.

Brucella Non-Neutrocytic Bacterascites in a Patient with Chronic Liver Disease

Objectives: To report a case of Brucella peritonitis. Patient and methods: We describe the case of a patient and present a brief review of the few published reports. Results: The patient had alcoholic cirrhosis of the liver and was diagnosed with Brucella non-neutrocytic bacterascites. Conclusion: Brucellosis is a common zoonosis with worldwide distribution. It is a systemic disease with the potential to predominantly affect one organ or a specific system (focal brucellosis). However, peritoneal focalization of this disease is a very rare presentation.

The effects of increased endurance training load on biomarkers of heat intolerance during intense exercise in the heat

The effects of increased training (IT) load on plasma concentrations of lipopolysaccharides (LPS), proinflammatory cytokines, and anti-LPS antibodies during exercise in the heat were investigated in 18 male runners, who performed 14 days of normal training (NT) or 14 days of 20% IT load in 2 equal groups. Before (trial 1) and after (trial 2) the training intervention, all subjects ran at 70% maximum oxygen uptake on a treadmill under hot (35 degrees C) and humid (similar to 40%) conditions, until core temperature reached 39.5 degrees C or volitional exhaustion. Venous blood samples were drawn before, after, and 1.5 h after exercise. Plasma LPS concentration after exercise increased by 71% (trial 1, p < 0.05) and 21% (trial 2) in the NT group and by 92% (trial 1, p < 0.01) and 199% (trial 2, p < 0.01) in the IT group. Postintervention plasma LPS concentration was 35% lower before exercise (p < 0.05) and 47% lower during recovery (p < 0.01) in the IT than in the NT group. Anti-LPS IgM concentration during recovery was 35% lower in the IT than in the NT group (p < 0.05). Plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha concentrations after exercise (IL-6, 3-7 times, p < 0.01, and TNF-alpha, 33%, p < 0.01) and during recovery (IL-6, 2-4 times, p < 0.05, and TNF-alpha, 30%, p < 0.01) were higher than at rest within each group. These data suggest that a short-term tolerable increase in training load may protect against developing endotoxemia during exercise in the heat.

Glycemic Control in Diabetic Pregnancies: Effects on Fetal and Maternal Outcome

Background: Both maternal and fetal complications are increased in diabetic pregnancies. Although hypertensive complications are increased in pregnant women with pregestational diabetes, reports on hypertensive complications in women with gestational diabetes mellitus (GDM) have been contradictory. Congenital malformations and macrosomia are the main fetal complications in Type 1 diabetic pregnancies, whereas fetal macrosomia and birth trauma but not congenital malformations are increased in GDM pregnancies. Aims: To study the frequency of hypertensive disorders in gestational diabetes mellitus. To evaluate the risk of macrosomia and brachial plexus injury (Erb’s palsy) and the ability of the 2-hour glucose tolerance test (OGTT) combined with the 24-hour glucose profile to distinguish between low and high risks of fetal macrosomia among women with GDM. To evaluate the relationship between glycemic control and the risk of fetal malformations in pregnancies complicated by Type 1 diabetes mellitus. To assess the effect of glycemic control on the occurrence of preeclampsia and pregnancy-induced hypertension in Type 1 diabetic pregnancies. Subjects: A total of 986 women with GDM and 203 women with borderline glucose intolerance (one abnormal value in the OGTT) with a singleton pregancy, 488 pregnant women with Type 1 diabetes (691 pregnancies and 709 offspring), and 1154 pregnant non-diabetic women (1181 pregnancies and 1187 offspring) were investigated. Results: In a prospective study on 81 GDM patients the combined frequency of preeclampsia and PIH was higher than in 327 non-diabetic controls (19.8% vs 6.1%, p<0.001). On the other hand, in 203 women with only one abnormal value in the OGTT, the rate of hypertensive complications did not differ from that of the controls. Both GDM women and those with only one abnormal value in the OGTT had higher pre-pregnancy weights and BMIs than the controls. In a retrospective study involving 385 insulin-treated and 520 diet-treated GDM patients, and 805 non-diabetic control pregnant women, fetal macrosomia occurred more often in the insulin-treated GDM pregnancies (18.2%, p<0.001) than in the diet-treated GDM pregnancies (4.4%), or the control pregnancies (2.2%). The rate of Erb’s palsy in vaginally delivered infants was 2.7% in the insulin-treated group of women and 2.4% in the diet-treated women compared with 0.3% in the controls (p<0.001). The cesarean section rate was more than twice as high (42.3% vs 18.6%) in the insulin-treated GDM patients as in the controls. A major fetal malformation was observed in 30 (4.2%) of the 709 newborn infants in Type 1 diabetic pregnancies and in 10 (1.4%) of the 735 controls (RR 3.1, 95% CI 1.6–6.2). Even women whose levels of HbA1c (normal values less than 5.6%) were only slightly increased in early pregnancy (between 5.6 and 6.8%) had a relative risk of fetal malformation of 3.0 (95% CI 1.2–7.5). Only diabetic patients with a normal HbA1c level (<5.6%) in early pregnancy had the same low risk of fetal malformations as the controls. Preeclampsia was diagnosed in 12.8% and PIH in 11.4% of the 616 Type 1 diabetic women without diabetic nephropathy. The corresponding frequencies among the 854 control women were 2.7% (OR 5.2; 95% CI 3.3–8.4) for preeclampsia and 5.6% (OR 2.2, 95% CI 1.5–3.1) for PIH. Multiple logistic regression analysis indicated that glycemic control, nulliparity, diabetic retinopathy and duration of diabetes were statistically significant independent predictors of preeclampsia. The adjusted odds ratios for preeclampsia were 1.6 (95% CI 1.3–2.0) for each 1%-unit increment in the HbA1c value during the first trimester and 0.6 (95% CI 0.5–0.8) for each 1%-unit decrement during the first half of pregnancy. In contrast, changes in glycemic control during the second half of pregnancy did not alter the risk of preeclampsia. Conclusions: In type 1 diabetic pregnancies it is extremely important to achieve optimal glycemic control before pregnancy and maintain it throughout pregnancy in order to decrease the complication rates both in the mother and in her offspring. The rate of fetal macrosomia and birth trauma in GDM pregnancies, especially in the group of insulin-treated women, is still relatively high. New strategies for screening, diagnosing, and treatment of GDM must be developed in order to decrease fetal and neonatal complications.

Effect of Size Reduction on Magnetic Ordering in Sm1-x Ca (x) MnO3 (x=0.35, 0.65 and 0.92) Manganites: Magnetic and EMR Studies

We have employed the highly sensitive electron magnetic resonance technique complimented by magnetization measurements to study the impact of size reduction on the magnetic ordering in nanosized Sm1-x Ca (x) MnO3 (x = 0.35, 0.65 and 0.92). In the bulk form, x = 0.35 sample shows a charge ordering transition at 235 K followed by a mixed magnetic phase, the sample with x = 0.65 exhibits charge order below 275 K and shows an antiferromagnetic insulator phase below 135 K while that with x = 0.92 has a ferromagnetic-cluster glass ground state. Thus, a comparative study of magnetic ground states of bulk and nanoparticles (diameter similar to 25 nm) enables us to investigate size-induced effects on different types of magnetic ordering. It is seen that in the bulk samples the temperature dependences of the EPR parameters are quite different from each other. This difference diminishes for the nanosamples where all the three samples show qualitatively similar behavior. The magnetization measurements corroborate this conclusion.

Estudio de observación de ciento doce líneas de arroz (Oryza sativa L.) VIOAL-92, bajo ecosistema de riego en la localidad de Malacatoya

Con el objetivo de evaluar 112 líneas de Arroz de porte semienano, procedentes en su mayoría de Colombia, Vivero IRRI (IIRON), Argentina, Cuba y Perú, y utilizando como testigos internacionales las variedades CICA-8 y ORYZICA-1 y como testigos locales las variedades ALTAM1RA-9, ALTAM1RA-10 y CICA-8 también considerada como testigo local, se llevó a cabo un estudio en la "Finca Venllano", ubicada en Malacatoya, municipio del departamento de Granada, bajo el agroecosistema de riego. A cada línea se le evalúo las características agronómicas (floración, altura, desgrane, senescencia, exerción, acame y aceptabilidad fenotípica) y los componentes del rendimiento ( long de panícula, número de granos por panícula, porcentaje de fertilidad, peso de 1000 granos, rendimiento y rendimiento industrial ( % de arroz integral, % de arroz pulido y % de arroz oro). Se seleccionaron 15 líneas por sus características agronómicas y su potencial de rendimiento, lo que da un 13% de selección del material evaluado. La línea de mejor rendimiento fue la 113 (ECIA 561 con 5980 Kg/ha y la de menor rendimiento fue la línea 30 (CT9508-48-1-1P-2PT) con 3195 Kg/ha. El material de mejor calidad industrial fue la línea 10 (CT8837-1-17-1P-4) con 58.5 % de Arroz Oro y la línea más baja fue la 41 (CT7B05-17-4A-M-4P) con 48.0 % de Arroz Oro.

Sapientia, 1969, Vol. XXIV, nº 92 (número completo)

Contenido: El orden esencial y la inteligencia / Octavio N. Derisi – Las relaciones entre la ciencia y la filosofía / Juan A. Casaubón – Continuidad de la materia y participación / J. E. Bolzán -- Notas y comentarios -- Bibliografía

Preservação ambiental, um discurso de todos da Eco 92 à Rio + 20

Coletânea de discursos e debates realizados no âmbito da Câmara dos Deputados sobre diferentes temas relacionados ao meio ambiente.

Edital nº 3/92 : concurso público para Agente de Segurança Legislativa e Operador de Máquinas

Torna pública a data e os locais de realização das provas de Língua Portuguesa e Legislação para o cargo de Agente de Segurança Legislativa, e a data e local de realização das provas de Conhecimentos Específicos, Língua Portuguesa e Legislação para o cargo de Operador de Máquinas.

Diário da Constituinte [gravação de vídeo] : [programa n. 616 ]

A estabilidade dos servidores é a nova polêmica da constituinte. A votação da emenda que concede a anistia aos microempresários é adiada. O texto que chegou ontem para ser votado na sessão estendia a anistia aos médios empresários, cooperativas agrícolas e entidades filantrópicas, segundo alguns líderes partidários. Os defensores da anistia se reuniram com o presidente da constituinte e decidirem que a emenda será votada na próxima quarta, independente de acordo. Na reunião dos líderes partidários recomeçou uma tentativa de se chegar a um acordo. A dificuldade está em saber quem ficará dentro e quem ficará fora da anistia. Foram discutidos outros pontos das disposições transitórias. A discussão agora é em torno do artigo que trata da estabilidade dos servidores públicos com cinco anos de serviço. Essa emenda beneficia 150 mil funcionários da administração direta e está dividindo os constituintes. Eles se preocupam no estabelecimento de critérios seletivos para o ingresso no serviço. Essa questão poderá ser votada ainda nesta sessão. Foi colocada em votação uma emenda que tentava acabar com o direito de transmissão de imóvel mediante o pagamento de uma quantia anual. A emenda acabou sendo recusada. Também foi rejeitada uma emenda propondo o cancelamento das atividades nucleares da Marinha. Durante a sessão de hoje foi divulgado o novo texto da emenda da anistia. Pela proposta serão anistiados os micros e pequenos empresários que contraíram dívidas entre 28 de fevereiro de 1986 e 31 de dezembro de 1987. A receita anual máxima para ser considerados microempresários é de cinco mil OTNS.

Constituição da República Federativa do Brasil [recurso eletrônico] : texto constitucional promulgado em 5 de outubro de 1988, com as alterações adotadas pelas Emendas constitucionais nos 1/1992 a 92/2016, pelo Decreto legislativo nº 186/2008 e pelas Emendas constitucionais de revisão nos 1 a 6/1994

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