Predictors of incorrectness in antimicrobial prescription in the Bauru State Hospital (Bauru city, São Paulo State, Brazil)

The inappropriate use of antimicrobials in hospitals presents a negative impact on patient outcome and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive policies. With this purpose, a study was conducted in the Bauru State Hospital, a teaching hospital with 285 beds affiliated to the Botucatu Medical School, São Paulo State University. The hospital maintains an active ASP since it was opened, in 2002. We selected 25% of the requests for parenteral antimicrobials (RPAs) from 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modified Kunin and Jones categories. Univariate and multivariable analyses were performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as "appropriate'' or "probably appropriate" were selected as controls in all stages of the study. Among 963 RPAs included in our study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR = 1.67, 95% CI = 1.20-2.28, p = 0.002), patient from intensive care unit (OR = 1.57, 95% CI = 1.11-2.23, p = 0.01), peritoneal (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) or urinary tract infection (OR = 1.89, 95% CI = 1.25-2.87, p = 0.002), combined therapy with two or more antimicrobials (OR = 1.72, 95% CI = 1.15-2.57, p = 0.008) and prescriptions including penicillin (OR = 2.12, 95% CI = 1.39-3.25, p = 0.001) or first-generation cephalosporins (OR = 1.74, 95% CI = 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR = 0.34, 95% CI = 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR = 0.04, 95% CI = 0.01-0.26, p = 0.001) and requests for agents with insufficient spectrum (OR = 0.14, 95% CI = 0.03-0.30, p = 0.01). In conclusion, the analysis of factors predictive of inappropriateness in antimicrobial prescription allowed us to identify issues requiring intervention. Also, it provided a positive feedback of the ASP efficacy, demonstrating the importance of previous consultation with an ID specialist to assure the quality of antimicrobial prescriptions.

LIFE QUALITY of PEOPLE INFECTED BY HIV WITH OR WITHOUT ANTIRETROVIRAL TREATMENT

The "HIV/Aids-Quality of Life" (HAT-Qol) is a specific multifunctional instrument used to measure the life quality of HIV infected persons. It is divided into nine domains: general activity, sexual activity, secrecy about HIV seropositivity, concern about health, financial concern, awareness about HIV, satisfaction with life, issues about medications and belief in the doctor. The current study analyzed the life quality of HIV infected individuals-who attended the DST/Aids Program in Maringa city, Parana state-regarding the use or not of antiretroviral therapy (TARV) and their demographic, epidemiological and clinical characteristics. Data were collected by retrospective analysis from 1,200 medical charts of patients registered in the program. The HAT-Qol instrument was applied before routine medical consultation. One hundred and sixty-nine patients, who had HIV infection confirmed, were divided into two groups, G1 with 118 individuals receiving antiretroviral therapy and G2 with 51 individuals who were not under this therapy.Result analysis, regarding social and demographic characteristics, revealed no difference among responses related to gender, educational degree and sexual option. Age influenced satisfaction with sexual activity and marital status. Regarding HIV awareness, the lowest response index or worst quality of life came from, respectively, men between 50 and 69 years old and patients who did not have regular partners compared with the ones who did. Additionally, it was observed that the time of diagnosis influenced general activities, HIV awareness, concern about health and financial issues, satisfaction with life and topics about medications. The variables were compared in both groups. There was no influence on the use or not of antiretroviral therapy regarding age, sexual activity, HIV diagnosis time and the domains that evaluated general activities, financial concern, awareness of HIV and satisfaction with life. In relation to time of diagnosis, there was an influence only in persons who had been diagnosed two or three years before, in which a lower quality of life was observed among individuals who were not under antiretroviral therapy. It was not possible to compare variables about medication use, HIV plasmatic viral rate ant time of diagnosis, because G2 individuals were not receiving the antiretroviral therapy. Furthermore, no comparison was made regarding marital status and HIV awareness, because there were no married individuals in G2. Thus, the analysis of the results showed that the use of antiretroviral treatment did not influence the life quality of HIV patients studied by the HAT-Qol scale.

Oral microbiota of Brazilian captive snakes

The present work aimed to determine the oral microbiotic composition of snakes from Sao Jose do Rio Preto city, São Paulo State, Brazil. Ten snake species, comprising the families Boidae, Colubridae, Elapidae and Viperidae, were submitted to microbiological examination of their oral cavity, which indicated positivity for all buccal samples. Gram-negative bacilli, gram-negative cocci bacilli, gram-positive bacilli and gram-positive cocci were isolated from the snakes. Among isolated bacterium species, the occurrence of coagulase-negative staphylococci in the buccal cavity of Crotalus durissus (Viperiade), Eunectes murinus (Boidae), Mastigodryas bifossatus (Colubridae) and Bacillus subtilis, common to oral cavity of Bothrops alternatus (Viperidae) and Phalotris mertensi (Colubridae), was detected. It was observed higher diversity of isolated bacteria from the oral cavity of Micrurus frontalis (Elapidae) and Philodryas nattereri (Colubridae), as well as the prevalence of gram-positive baccillus and gram-positive cocci. The composition of the oral microbiota of the studied snakes, with or without inoculating fangs, is diverse and also related to the formation of abscesses at the bite site in the victims of the ophidian accidents, and to pathogenic processes in the snakes that host these microorganisms.

Malignant catarrhal fever-like lesions associated with ovine herpesvirus-2 infection in young calves (Bos indicus): a case report

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Neonatal immune response of Brazilian beef cattle to vaccination with Clostridium botulinum toxoids types C and D by indirect ELISA

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Histopathological evaluation in experimental envenomation of dogs with Crotalus durissus terrificus Venom

The present work evaluated histopathological aspects in experimental envenomation of dogs with Crotalus durissus terrificus venom. Twenty-eight mixed breed adult dogs were divided into three groups of seven animals each: Group I only venom; Group II - venom + 50ml antiophidic serum + fluid therapy; Group III venom + 50ml antiophidic serum + fluid therapy + urine alkalization. Lyophilized venom of Crotalus durissus terrificus was reconstituted in saline solution and inoculated subcutaneously at the dose of 1mg/kg body weight. Three animals of each group were subjected to euthanasia, and their muscular tissue, brain, spleen, kidneys, heart, lungs, stomach, small and large intestines, and popliteal lymph node fragments were collected for histopathological evaluation. There was myonecrosis in the inoculated limb, renal tubular degeneration, lymphoid hyperplasia of spleen, and unspecific reactive hepatitis. These results show the antigenicity and action of the venom on the immune system.

EFFECTS of SELENIUM SUPPLEMENTATION on CATTLE ANTI-RABIES HUMORAL IMMUNE RESPONSE and LEVELS of SERUM SELENIUM and CORTISOL

This study evaluated the effect of different concentrations of selenium (Se) supplementation on cattle anti-rabies humoral immune response, serum Se concentrations and cortisol levels. Sixty uncastrated male Nelore calves from 10 to 12 months grazing on Brachiaria decumbens forage were studied. The animals were assigned to one of four groups (n = 15 each), which received non-supplemented diets (Gc) or supplemented with daily and individual Selenium ( Se) concentrations of 3.6 mg (G(3.6)), 5.4 mg (G(5.4)) or 6.4 mg (G(6.4)). The calves were immunized on day 0 with one dose of commercial liquid inactivated rabies vaccination. on days 15, 30, 60, 90 and 120, the cattle underwent the same stressing procedures used for vaccination in the corral. Cattle blood samples were collected after vaccination and stressing procedures to determine serum Se levels, rabies antibody titers and serum cortisol. Se levels were also determined in forage samples collected from the paddocks in which the cattle were held. Se concentration in B. decumbens was 0.04 mg of Se/kg dry matter. Baseline Se levels obtained on day 0 were higher in Gc than in G(5.4) and G(6.4) (P = 0.005). Serum Se levels decreased in Gc throughout the experiment (P < 0.004), increased in G(3.6) (P < 0.000) and G(5.4) (P < 0.000) and were kept high from day 60 on in group G(6.4) (P < 0.002). Rabies antibody titers did not differ among control and supplemented groups. However, 120 days after vaccination rabies antibody titers were kept above protective levels (>= 0.5 UI/mL) only in group G(3.6) (P < 0.00002), whereas they dropped in the other groups (P < 0.05). Serum cortisol levels did not differ among the experimental groups (P = 0.79), reached peak levels on day 90 and returned close to baseline levels on day 120. Se and cortisol levels were not markedly correlated. Serum cortisol and rabies antibody titers were correlated only in group G(6.4), on day 60 (R = 0.513; P = 0.05) and 120 (R = 0.644; P = 0.009). Serum Se and rabies antibody titers were correlated only in group G(6.4), on day 60 (R = -0.580; P = 0.023). In conclusion: a) the profile of Se variation is different among groups receiving different concentrations of this element; b) the supplementation dosage of 3.6 mg Se/animal/day is efficient to treat/prevent marginal Se deficiency; c) individual supplementation with daily concentrations of 3.6 mg Se enhances the maintenance of rabies antibody titers in cattle; d) individual supplementation with daily concentrations of 3.6; 5.4 and 6.4 mg Se are ineffective in reducing serum cortisol; e) repeated cattle handling in corrals stress animals that adapt to these procedures, although serum cortisol does not return to baseline levels by 120 days; and f) the stress generated by repeated management in cattle in the corral does not diminish antibody titers after vaccination against rabies.

Prevalence and risk factors for human toxoplasmosis in a rural community

Toxoplasma gondii infection may lead to important pathological questions, especially in rural areas, where several sources of infection exist. Therefore, it is important to determine risk factors in order to establish adequate prophylactic measures. The present study aimed to assess the prevalence and risk factors involved in human toxoplasmosis infection in a rural community, in Eldorado, Mato Grosso do Sul State, Brazil. This community was composed of 185 farms - with 671 inhabitants - from which 20 were randomly chosen. In these farms, blood samples were collected from rural workers, who also answered a risk factor questionnaire. Serum samples were analyzed by means of direct agglutination test for the detection of anti-Toxoplasma gondii antibodies. From 73 samples collected, 79.45% were positive. None of the studied variables was significantly associated with the prevalence of the infection. However, among the individuals who reported eyesight impairments, 94.4% had anti-T. gondii antibodies, compared with 74.0% who did not report eyesight changes (p = 0.0594). Moreover, most individuals in the study (68.20%) were older than 18 years and presented 84.44% positivity, compared with 66.67% of positive individuals younger than 18 years old. We were able to conclude that a high prevalence of antibodies did not imply significant associations with the risk factors studied.

CLINICAL STUDY of NATURAL INFECTION BY Trypanosoma cruzi IN DOGS RESIDING IN A RURAL AREA IN MATO GROSSO do SUL STATE, BRAZIL

This study was carried out to describe the clinical characteristics of natural infection caused by Trypanosoma cruzi in dogs that reside in a rural area of Mato Grosso do Sul State, Brazil. Conventional and nonconventional diagnostic methods were used for screening T. cruzi infection in 75 dogs that lived in the area. Cardiovascular tests and biochemical examination of sera were also performed in four confirmed positive dogs. The following techniques were employed: indirect immunofluorescence test (IFAT), enzyme-linked immunosorbent assay with T. cruzi epimastigote antigens (EAE-ELISA) and enzyme-linked immunosorbent assay with T. cruzi excreted-secreted trypomastigote antigens (TESA-ELISA) with antibodies detected in 45.33% (n = 34), 24.0% (n = 18) and 12.0% (n = 9) of the dogs, respectively. The current prevalence of the infection was confirmed as 10.7% (n = 8) by immunoblotting test with T. cruzi excreted-secreted antigens (TESA-blot). The test that showed the best concordance index (Kappa; 0.93), sensitivity (100%) and specificity (98.5%) was TESA-ELISA, that when associated with IFAT had the same results as those obtained by TESA-blot (10.7%). Three out of the four chagasic animals showed enlarged cardiac silhouette on X-ray and an increase of the P-wave duration and QRS complex in electrocardiogram. Two dogs presented conduction disturbances, right bundle branch block in one dog and first-degree atrioventricular block and sinus arrest in another. The ecodopplercardiography presented left-ventricular-wall thickness increased during diastole, decrease of the shortening fraction and inversion in the speed peaks of the E and A waves, indicating the presence of systolic and diastolic disorders. The four animals showed enzymatic activities of creatine kinase (221-404 U/L), MB fraction of creatine kinase (189-304 U/L), elevated total proteins (7.6-10.2 g/dL) and total globulins (4.6-7.7g/dL) and reduction of albumin/globulin ratio, which suggested a myocardial injury and continuous antigenic stimulus.

Potential of Brazilian eugenia myrtaceae - As ornamental and as a fruit crop

Brazilian Myrtaceae comprises several genera of trees and shrubs used for ornamental and fruit production. In addition to the well known Guava, Pitanga and Jaboticaba, other species could be used for fruitculture, due the value and quality of their fruits and adaptation to some climate conditions mainly the subtropical one. Nine species of Eugenia were evaluated at Jaboticabal, located at 48° W and 21° S in São Paulo state in a germplasm bank. The average rain by year is 1431 mm and the temperature 22,2° C at an altitude of 575 m. The species are Eugenia klozschiana Berg. (Pero-do-campo), E. stipitata Mc Vaugh (Araça-boi), E. tomentosa Camb. (Cabeludinha), E. dysentherica DC. (Cagaita), E. brasiliensis Berg. (Grumixama), E.pitanga (Pitanga-anã), E. luchsnathiana Berg. (Pitomba), E. uvalha Camb. (Uvaia) and E. involucrata DC. (Cereja-do-rio-grande). The evaluations comprised tree development, fruit quality and leaf and flower morphological studies. The main results are: the trees of Pera-do-campo and Pitanga-anã are small shrubs of 1 to 2 m height, Araça-boi and Cabeludinha are small trees, 3 to 5 m high, and the other species are tall trees, with 5 to 10 m height. The species adapted well to the subtropical conditions, except for Araça-boi, which is native to the Amazonian region and exhibited a severe fungus disease infection. In relation to fruit quality, all the species had edible fruit, some were sweet and juicy, Cabeludinha, Grumixama, Pitomba, Cereja-do-rio grande and Pitanga-anã, while others had high acidity (Araça-boi, Pera-do-campo, Cagaita and Uvaia and were more suitable for processing. Simple, single leaves were characteristic of all species, but with different sizes and shapes., With the addition of color, smell and other characteristics, leaf size and shape were useful for comparative classification. Flower components and structure are described also.

Caracterização biofísica e estrutural da metaloproteinase não-hemorrágica do veneno de Bothrops moojeni e da endo-β-glicanase do Bacillus subtilis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estudo estrutural por RMN do peptídeo policatiônico polybine I de veneno da vespa social Polybia paulista

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)