Healthcare-associated infections: challenges to public health in Brazil

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

Small hospitals matter: insights from the emergence and spread of vancomycin-resistant enterococci in 2 public hospitals in inner Brazil

Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their impact over settings of different complexity are scarce. We performed a study aimed at identifying determinants ofVRE emergence and spread in a public hospital consortium (comprising 2 hospitals, with 318 and 57 beds) in inner Brazil. Molecular typing and case-control studies (addressing predictors of acquisition or clonality) were performed. Among 122 authocthonous isolates, 106 were Enterococcus faecium (22 clones), and 16, Enterococcus faecalis (5 clones). Incidence was greater in the small-sized hospital, and a previous admission to this hospital was associated with greater risk of VRE colonization or infection during admission to the larger one. Overall risk factors included comorbidities, procedures, and antimicrobials (piperacillin-tazobactam, cefepime, and imipenem). Risk factors varied among different hospitals, species, and clones. Our findings demonstrate that VRE can spread within low-complexity facilities and from these to larger hospitals. (C) 2015 Elsevier Inc. All rights reserved.

Nothing too much: reflecting about the role of contextualization in science teaching

The contextualization and discussion about the science role in the social and economical development are unquestionably important for the science teaching process. It doesn't mean, however, that the scientific-theoretic knowledge and the strategies involved in its construction and application might be neglected. In this way, a dangerous situation is created when the contextualization is assumed as a unique and primordial target in science education. This paper presents a research carried out with 15 future chemistry teachers and the results show a worrying "supervalorization", of the contextualization beside other equally important aspects of the chemical knowledge.

Filamentous fungi vectored by ants (Hymenoptera: Formicidae) in a public hospital in north-eastern Brazil

Background: The increase in opportunistic fungal infections has led to the search for putative sources of contamination in hospital environments. Aim: Ants in a public hospital in Itabuna, north-eastern Brazil were examined for carriage of filamentous fungi. Methods: During a year-long survey, ants from different hospital areas were sampled. Preference was given to locations where it was possible to observe ants actively foraging. The fungi found on the ants' integument were cultured and identified. Findings: A total of 106 ant workers belonging to 12 species in 11 genera were collected. A total of 47 fungal strains was isolated from 40% of the ants (. N = 42). We found 16 fungal species in 13 genera associated with the ant workers. The prevalent fungal genera were . Aspergillus, . Purpureocillium and . Fusarium. The ants . Tapinoma melanocephalum, . Paratrechina longicornis and . Pheidole megacephala were associated with six fungal genera; and four genera of fungi were associated with . Solenopsis saevissima workers. Fungal diversity was higher in the following hospital areas: nursery, hospital beds, breastmilk bank and paediatrics. Conclusion: Ants act as carriers of soil and airborne fungal species, and ant control in hospital areas is necessary to prevent the dissemination of such micro-organisms. © 2012 The Healthcare Infection Society.

High genetic diversity among Pseudomonas aeruginosa and Acinetobacter spp. isolated in a public hospital in Brazil

In Brazil and other regions of the world, Pseudomonas aeruginosa and Acinetobacter spp. have emerged as important agents of nosocomial infection and are commonly involved in outbreaks. The main objective of the present study was to evaluate the genetic relationship among P. aeruginosa and Acinetobacter spp. isolated from patients in a public university hospital in northwestern Parana, Brazil, and report their antimicrobial resistance profile. A total of 75 P. aeruginosa and 94 Acinetobacter spp. isolates were phenotypically identified and tested for antibiotic susceptibility using automated methodology. Polymyxin B was tested by disk diffusion for P. aeruginosa. Metallo-beta-lactamase (MBL) was detected using a disk approximation test. Genotyping was performed using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Approximately 55% of the P. aeruginosa isolates and 92% of the Acinetobacter spp. isolates were multiresistant, but none were MBL-producers. ERIC-PCR revealed the presence of small clusters of carbapenem-resistant Acinetobacter spp., most likely OXA-type carbapenemase producers. Furthermore, high genetic diversity in P. aeruginosa and Acinetobacter spp. clinical isolates was observed, suggesting that cross-transmission is not very frequent in the studied hospital.

Pension legislation for federal public servants in Brazil

This paper addresses the creation of pension funds for federal civil servants in Brazil, analyzing the existing legislation and regulation on this issue. To this end, it takes off based on the genesis of the Brazilian private pension plans, logging the emergence of private funds as well as the existence of various laws and constitutional amendments prior to Law 12.618/2012, which provided for the pension funds system for Brazilian federal public servants. It also identifies proponents and opponents to the Foundation for Pension Funds of Federal Civil Servants (FUNPRESP), signaling the discursive construction of the pension fund schemes as central character in contemporary welfare capitalism. Finally, presents controversial aspects of the new pension fund law developments in Brazil.

Endovascular repair of a juxtarenal saccular aneurysm using the Multilayer Flow Modulator: report of the first case performed in a Public Hospital in Brazil

Endovascular aortic aneurysm repair (EVAR) involving renal and visceral arteries remains a great challenge. Several techniques have been developed over the time to treat juxtarenal, pararenal and thoracoabdominal aneurysms, highlighting the fenestrated and branched endografts, parallel prostheses as Chimney, Periscope and Sandwich Techniques and the use of flow modulation by multilayer stent. We report a case of saccular juxtarenal aortic aneurysm with high surgical risk for complex airway access due to a history of radical laryngectomy for laryngeal neoplasm. Due to chronic aorto-iliac obstructive disease, ostial stenosis of renal artery and limited diameter of the suprarenal aorta, we discarded options involving fenestrated/branched endografts and involving parallel prostheses techniques. We present this case as a therapeutic challenge and a successful treatment option in the short-term evaluation.