Genotypic characterization of virulence factors in Escherichia coli strains from patients with cystitis

Adhesins (P-fimbriae, S-fimbriae, type 1 fimbriae and afimbrial adhesin), toxins (α-hemolysin and cytotoxic necrotizing factor type 1), iron acquisition systems (aerobactin) and host defense avoidance mechanisms (capsule or lipopolysaccharide) have been shown to be prevalent in Escherichia coli strains associated with urinary tract infections. In this work, 162 Uropathogenic Escherichia coli (UPEC) strains from patients with cystitis were genotypically characterized by polymerase chain reaction (PCR) assay. We developed three multiplex PCR assays for virulence-related genes papC, papE/F, papG alleles, fimH, sfa/foc, afaE, hly, cnf-1, usp, cdtB, iucD, and kpsMTII, all of them previously identified in UPEC strains. The PCR assay results identified 158 fimH (97.5%), 86 kpsMTII (53.1%), 53 papC/papEF/papG (32.7%), 45 sfa (27.8%), 42 iucD (25.9%), 41 hly (25.3%), 36 usp (22.2%), 30 cnf-1(18.5%) and 10 afa (6.2%) strains. No strain was positive for cdtB. In this work, we also demonstrated that adhesins may be multiple within a single strain and that several virulence genes can occur combined in association.

Manifestações neurológicas nas endocardites infecciosas - revisão de 103 casos estudados - 84 casos do Hospital dos Servidores do Estado-R.J. (1947-1978) e 19 casos do Hospital Estadual São Sebastião-R.J. (1975-1978)

Os autores fazem uma revisão de 103 casos de endocardites infecciosas, dos quais 52 apresentaram manifestações neurológicas. Dos 52 que não tiveram problemas neurológicos, 39 faleceram 175%), enquanto que dos 51 que não tiveram alterações do sistema nervoso, apenas 18 evoluíram para o óbito 135,3%). A endocardite infecciosa com manifestações neurológicas, na presente série, foi dominante no sexo masculino. Os grupos etários mais envolvidos foram as crianças, adolescentes e adultos jovens. Houve outro pico importante em pacientes acima de 50 anos. Os critérios para o diagnóstico de endocardite infecciosa utilizados no presente estudo, foram os clássicos, acrescidos de outros considerados de extrema utilidade, à medida que a experiência foi sendo acumulada, acompanhando paralelamente as modificações dos padrões etiológicos, assim como as alterações dos espectros clínicos da doença, conseqüentes a muitos fatores aqui discutidos. Os principais distúrbios neurológicos observados foram as manifestações meningeias, 25/52 148,1%), alterações do comportamento, 20/52 (38,4%), fenômenos motores (paralisias e paresias), 20/52 (38,4%). Alterações do nível de consciência (torpor ou coma), ao lado de outras menos comuns, como cefaléia 16/52 (26,9%), convulsões, 10/52 (19,2%), afasia 7/52 (13,5%) e manchas de Roth, 7/53 (13,5%). As manifestações neurológicas frequentemente foram múltiplas em um mesmo paciente. Nas formas de endocardite, foram em muitos casos praticamente as alterações que abriram e dominaram a cena clínica. As mais comuns foram: síndrome meningeia, síndrome vascular e encefalopatia tóxica. Foi difícil, em conseqüência de múltiplas manifestações neurológicas num mesmo paciente, estabelecer critérios entre a lesão neurológica e o prognóstico, embora o coma profundo, as convulsões, os distúrbios motores acentuados, a meningite e as alterações do comportamento, isoladamente ou em associação, façam com que o mesmo seja bem mais sério. O germe mais encontrado em nossa série foi oStaphylococcus aureus, relacionado com formas agudas da infecção endocárdica, aliado a processos destrutivos valvulares e a sérias alterações neurológicas tais como meningite, encefalite, infartos, hemorragias e abcessos cerebrais. Os principais achados neurológicos referentes à patologia, no estudo de 15 casos, são apresentados ao lado de conclusões tiradas de reflexões sobre o material analisado e da experiência vivida. Uma revisão da literatura é feita desde os trabalhos iniciais sobre a doença até os dias de hoje, ficando evidenciada a importância do tema pelas grandes contribuições apresentadas pelos diferentes autores.

Enteroparasites and commensals among children in four peripheral districts of Uberlândia, State of Minas Gerais

The aim of this study was to determine the occurrence of intestinal parasites and commensals among children in four peripheral districts located in the northern, southern, eastern and western sectors of Uberlândia, Minas Gerais, using the Baermann methods as modified by Moraes and Lutz. Out of 160 individuals studied, 93 (58.1% CI: 50.4-65.7) were infected, distributed among the sectors as follows: northern (72.5%), southern (47.5%), eastern (57.5%) and western (55%). The positive findings according to age groups were: 0-5 years (26.9%), 5-10 years (21.2%) and 10-15 years (10%). Male children presented 2.7 times higher risk of infection than females did (OR: 2.7; CI: 1052-7001). The parasites and commensals identified were: Giardia lamblia (27.5%), Entamoeba coli (20.6%), Ascaris lumbricoides (14.4%), Enterobius vermicularis (8.8%), Hymenolepis nana (7.5%), Hymenolepis diminuta (5%), hookworms (3.1%), Trichuris trichiura (2.5%), Endolimax nana (2.5%), Entamoeba hartmanni (2.5%), Strongyloides stercoralis (1.3%), Iodamoeba butschlii (1.3%) and Capillaria hepatica (0.6%). The infection rate in these children was high and showed the need to implement prophylactic education programs in the community.

Epidemiological profile of acute bacterial meningitis in the state of Rio Grande do Norte, Brazil

INTRODUCTION: Acute bacterial meningitis (ABM) remains a public health problem in Brazil. To evaluate the epidemiology of ABM cases at Giselda Trigueiro Hospital, Rio Grande do Norte, a descriptive retrospective survey was conducted covering 2005 to 2008. METHODS: Clinical and laboratory data were collected from the epidemiology department of the hospital and analyzed. RESULTS: Out of 168 ABM cases, 24.4%, 10.7%, and 2.4% were, respectively, caused by Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenza b, and 5.4% by other bacteria. The mean age was 22.48 ± 18.7 years old. CONCLUSIONS: Streptococcus pneumoniae was the main causative pathogen in the young urban population.

Oral coinfection can stress peripheral lymphocyte to inflammatory activity in leprosy

INTRODUCTION: This study evaluated the intracellular profile of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon-γ (IFN-γ) in peripheral blood mononuclear cells (PBMCs) from leprosy patients based on oral infections presence to determine whether these coinfections could be associated with pro-inflammatory activity in leprosy. METHODS: Leprosy patients regardless of clinical form and specific leprosy treatment (n=38) were divided into two groups: Group I - leprosy patients with oral infections (n=19), and Group II - leprosy patients without oral infections (n=19). Non-leprosy patients presenting oral infections were assigned to the control Group (n=10). Intracellular IL-2, IL-4, IL-10 and IFN-γ production was evaluated by flow cytometry (FACS) before and 7 days after controlling the oral infection in the Group I, before and 7 days after dental prophylaxis in the Group II, and during oral infection process in control Group. RESULTS: Low percentages of CD3+ lymphocytes bearing IL-2, IL-10 and IFN-γ were observed in the Group I and Group II at baseline and 7 days after therapy or prophylaxis compared to controls. Group I showed reduced percentages of IL-4 at baseline and 7 days after therapy compared to controls, or at baseline of Group II, and the Group II showed reduced percentages of CD3+ cells bearing IL-4 compared to control. An increase of the percentages of CD3+cells bearing IL-4 was observed in the Group I after the oral infections treatment. CONCLUSIONS: The occurrence of oral infections favors the intracellular cytokines expression and, probably, the inflammatory reaction operating as a stimulatory signal triggering the leprosy reactions.

Seroprevalence and seroincidence of Leptospira infection in dogs during a one-year period in an endemic urban area in Southern Brazil

INTRODUCTION: Leptospirosis is a zoonosis that affects both humans and animals. Dogs may serve as sentinels and indicators of environmental contamination as well as potential carriers for Leptospira. This study aimed to evaluate the seroprevalence and seroincidence of leptospirosis infection in dogs in an urban low-income community in southern Brazil where human leptospirosis is endemic. METHODS: A prospective cohort study was designed that consisted of sampling at recruitment and four consecutive trimestral follow-up sampling trials. All households in the area were visited, and those that owned dogs were invited to participate in the study. The seroprevalence (MAT titers ≥100) of Leptospira infection in dogs was calculated for each visit, the seroincidence (seroconversion or four-fold increase in serogroup-specific MAT titer) density rate was calculated for each follow-up, and a global seroincidence density rate was calculated for the overall period. RESULTS: A total of 378 dogs and 902.7 dog-trimesters were recruited and followed, respectively. The seroprevalence of infection ranged from 9.3% (95% CI; 6.7 - 12.6) to 19% (14.1 - 25.2), the seroincidence density rate of infection ranged from 6% (3.3 - 10.6) to 15.3% (10.8 - 21.2), and the global seroincidence density rate of infection was 11% (9.1 - 13.2) per dog-trimester. Canicola and Icterohaemorraghiae were the most frequent incident serogroups observed in all follow-ups. CONCLUSIONS: Follow-ups with mean trimester intervals were incapable of detecting any increase in seroprevalence due to seroincident cases of canine leptospirosis, suggesting that antibody titers may fall within three months. Further studies on incident infections, disease burden or risk factors for incident Leptospira cases should take into account the detectable lifespan of the antibody.

Molecular characterization of Mycobacterium tuberculosis isolates from Tehran, Iran by restriction fragment length polymorphism analysis and spoligotyping

Abstract: INTRODUCTION Characterization of Mycobacterium tuberculosis (MTB) isolates by DNA fingerprinting has contributed to tuberculosis (TB) control. The aim of this study was to determine the genetic diversity of MTB isolates from Tehran province in Iran. METHODS MTB isolates from 60 Iranian and 10 Afghan TB patients were fingerprinted by standard IS6110-restriction fragment length polymorphism (RFLP) analysis and spoligotyping. RESULTS The copy number of IS6110 ranged from 10-24 per isolate. The isolates were classified into 22 clusters showing ≥ 80% similarity by RFLP analysis. Fourteen multidrug-resistant (MDR) isolates were grouped into 4 IS6110-RFLP clusters, with 10 isolates [71% (95% CI: 45-89%)] in 1 cluster, suggesting a possible epidemiological linkage. Eighteen Iranian isolates showed ≥ 80% similarity with Afghan isolates. There were no strains with identical fingerprints. Spoligotyping of 70 isolates produced 23 distinct patterns. Sixty (85.7%) isolates were grouped into 13 clusters, while the remaining 10 isolates (14.2%) were not clustered. Ural (formerly Haarlem4) (n = 22, 31.4%) was the most common family followed by Central Asian strain (CAS) (n = 18, 25.7%) and T (n = 9, 12.8%) families. Only 1strain was characterized as having the Beijing genotype. Among 60 Iranian and 10 Afghan MTB isolates, 25% (95% CI: 16-37) and 70% (95% CI: 39-89) were categorized as Ural lineage, respectively. CONCLUSIONS A higher prevalence of Ural family MTB isolates among Afghan patients than among Iranian patients suggests the possible transmission of this lineage following the immigration of Afghans to Iran.

Kidney function after left renal vein ligation in the dog

The ligature of the left renal vein is an alternative whenever this vessel is injured. The purpose of this study was to evaluate the capacity of the affluents of the left renal vein, proximal to the ligature, to maintain tissue vitality and function of the left kidney. Fifteen mongrel male dogs were divided in 3 groups of 5 dogs: Group I (control) - a laparotomy was performed, and the abdominal structures were only identified; Group II - the left renal vein was tied, close to vena cava; Group III - the same procedure as for Group II and a right nephrectomy. Blood urea nitrogen and serum creatinine levels were measured before the procedure, and every 3 days during 4 weeks in the postoperative period. Renal arteriography and an excretory urogram were performed on the animals that survived 60 days. Thereafter, or immediately after precocious death, the kidneys were removed for histological examination. All the animals of Group III died before two months (mean = 10.5 +-3.2 days), while the animals of Group II survived during that period. There was a complete exclusion of the left kidney in all dogs that underwent renal vein ligature. In the animals of Group II, the renal cortico-medullary limits could not be identified. At microscopy, the aspect was suggestive of nephrosclerosis. In the animals of Group III, the left kidney was enlarged, and a great amount of intravascular and intrapelvic blood clots were observed. At microscopy, extensive areas of necrosis, inflammatory infiltration, and hemorrhage were identified. In conclusion, the tributaries of the renal vein were not sufficient to maintain the tissue vitality and function of the left kidney after ligature of its main vein.

ESTRATIFICAÇÃO E DENSIDADE DE INVERTEBRADOS EM SOLO ARENOSO SOB FLORESTA PRIMÁRIA E PLANTIOS ARBÓREOS NA AMAZÔNIA CENTRAL DURANTE A ESTAÇÃO SECA

Densidade e distribuição vertical de invertebrados foram estudados durante o mês de setembro de 1990 e 1991, em solo de três tipos de cobertura vegetal: floresta primária, plantios de Dipteryx odorata(Leguminosae = cumaru) e Simaruba amara(Simarubaceae = marupá), nos arredores de Manaus, Brasil. Foram encontrados 19 grupos principais da fauna. A maioria desses grupos foram similares para os três tipos de cobertura, sendo Isoptera (40,1%), Formicidae (25,2%), Araneae (6,7%) os grupos mais abundantes que, juntos, representaram 62,4% da fauna de cumaru, 57,0% da fauna de marupá e 84,1% da fauna de floresta. Houve uma diminuição da densidade para todos os grupos (excluídos os cupins) até a profundidade de 20 cm, com subseqüente aumento até 30 cm de profundidade, principalmente pela presença de Isoptera. Cerca de 45% de toda a fauna ocorreu no estrato de 0-5 cm de profundidade, seguido de 9,5% (5-10 cm), 9,1% (10-15 cm), 2,7% (15-20 cm), 20,7% (20-25 cm) e 12,3% (25-30 cm) nos estratos subseqüentes. Isoptera, Diptera e outros invertebrados não apresentaram correlação com a umidade e o pH do solo.

Substituição natural de rainhas fisogástricas e distância de vôo dos machos em Tiuba (Melipona compressipes fasciculata Smith, 1854) e Uruçu (Melipona scutellaris Latreille, 1811) (Apidae, Meliponini)

Este trabalho relata detalhes da vida reprodutiva de duas espécies de abelhas sem ferrão. Rainhas velhas de Melipona compressipes fasciculata, no Maranhão, morrem e são substituídas com sucesso em todos os meses. Rainhas de Melipona scutellaris, trazidas de Lençóis (BA - nordeste do Brasil) para Uberlândia (MG, centro-sudeste do Brasil) morreram durante todos os meses e não mostraram a existência de trimestre preferencial para as novas rainhas iniciarem postura. Quarenta machos de M. scutellaris, após serem marcados no tórax e libertados em grupos de 10 a 100, 400, 800 e 1000 metros do meliponário, tiveram seus retornos observados. Todos os machos libertados a 100 e 400 metros regressaram ao meliponário, 7 de 10 machos e 2 de 10 machos retornaram de 800 e 1000 metros, respectivamente. Os machos esperam constantemente pela saída de uma rainha virgem, próximos às colônias órfãs, o que indica que a maioria das rainhas é inseminada próximo aos seus ninhos, portanto, a dispersão dos genes depende do vôo dos machos e da distância de enxameagem para ocupação de uma cavidade para o novo ninho.

Seasonality of nematode larvae in Iguanodectes spilurus (Characidae) an ornamental fish from northeastern Para, Brazil

The current study presents a parasitological survey of larval nematodes from freshwater ornamental fish Iguanodectes spilurus caught in the watercourse of the Caete River, in the northeast region of the State of Para, Brazil. A total of 176 specimens, 1.36±0.75 g weight and 5.53±0.98 cm total length, were analyzed. Nematode larvae were identified as Capillaria sp., Procamallanus sp. and Anisakidae, with prevalence of 70.45% and infection intensity ranging from 1.81 to 4.70 larvae. The highest prevalence 57.38% occurred in the liver, but no seasonality was observed, indicating high infection throughout the year. Seasonality was observed in fish parasitized in the stomach, intestine and caecum, with prevalence and mean intensity of 17.61% and 2.32 parasites, 12.5% and 1.81 parasites, 10.79% and 2.21 parasites, respectively. The highest degree of infection was observed in the rainy season, probably due to increased availability of intermediate hosts or food.

Comportamentos de risco para transtornos do comportamento alimentar e fatores associados entre estudantes de nutrição do município do Rio de Janeiro

OBJETIVO: Caracterizar práticas alimentares e fatores de risco associados a transtornos do comportamento alimentar entre estudantes de nutrição do município do Rio de Janeiro. MÉTODOS: Estudo seccional junto a um segmento populacional apontado na literatura como de risco para o surgimento de transtornos alimentares. Utilizaram-se o Teste de Investigação Bulímica de Edimburgo (BITE), o Teste de Atitudes Alimentares (EAT-26) e uma variável que considera os dois instrumentos associados (Nunes et al., 2001). RESULTADOS: Analisaram-se 193 estudantes do sexo feminino, com média de idade de 20,9 anos ± 2 anos. Detectou-se resultado positivo em 14% (intervalo de confiança [IC] 95%: 9,4%-20%) no EAT-26. No BITE, para sintomas elevados e gravidade intensa, foram encontradas prevalências de 5,7% (IC 95%: 2,9%-10%) e 3,2% (IC 95%: 1,2%-6,9%), respectivamente. Quando combinados EAT-26 positivo e BITE com gravidade intensa e sintomas elevados, constataram-se correlações positivas com prevalências de 64,7% (p < 0,001) e 36,4% (p < 0,001), respectivamente. Das mulheres que apresentaram EAT-26 positivo, 88,5% encontram-se na faixa de normalidade do índice de massa corporal (IMC) (p < 0,031). CONCLUSÕES: Deve-se atentar para comportamentos de risco para transtornos alimentares no grupo, uma vez que esses distúrbios serão objeto de sua prática profissional, podendo comprometê-la nos casos em que nutricionistas sejam portadores de síndromes instaladas ou comportamentos precursores.

Contribuição do monitor de eventos no diagnóstico de sintomas

OBJETIVO: Avaliar o poder de contribuição do monitor de eventos sintomáticos no esclarecimento de sintomas. MÉTODOS: Foram estudados 64 pacientes encaminhados para esclarecimento de sintomas e que já haviam sido submetidos à gravação com Holter. Foram monitorizados, durante 15 dias, com gravador com memória circular com capacidade de registrar uma derivação do ECG (CM5), antes e após ativado pelo paciente. Na vigência de sintomas, o paciente acionava um comando do gravador que provocava a retenção do sinal do ECG, que era, posteriormente, transmitido a uma central via telefone. RESULTADOS: Em dois pacientes não foi possível a realização completa da monitorização, nos restantes, sintomas que motivaram a indicação do exame foram: palpitações (67,7%), tonturas (32,3%), síncopes (29%) e outros (30,6%). Em 85,5% dos pacientes houve relato de sintomas, sendo que em 62,2% houve registro de alterações eletrocardiográficas, relacionadas aos sintomas: taquicardia sinusal, 45,5%; extra-sístoles, 30,3%; taquiarritmia supraventricular, 21,2%; taquicardia ventricular, 3% e bloqueio atrioventricular, 3%. A 1ª transmissão motivada por sintoma ocorreu: 35,5% no 1º dia, 33,9% do 2° ao 5º, 12,9% do 6º ao 10º e 3,2% do 11º ao 15º. Nos pacientes onde a gravação com Holter não permitiu esclarecimento, o gravador de eventos registrou sintomas em 35,5%. CONCLUSÃO: Trata-se de método bem aceito pelos pacientes e capaz de produzir aumento significativo no esclarecimento de sintomas em relação ao Holter.

Stress During ACLS Courses: Is it Important for Learning Skills?

OBJECTIVE: To determine the influence of stress on teaching medical emergencies in an Advanced Cardiac Life Support (ACLS) course and to verify this influence on learning, and the efficiency of emergency care training. METHODS: Seventeen physicians signed up for an ACLS course. Their pulses were taken and blood pressure (BP) verified on the first day, before the beginning of the course, and on the second day, during the theoretical and practical test (TPT). Variations in pulse rates and BP were compared with students' test grades. Then, students answered a questionnaire of variables (QV) about the amount of sleep they had during the course, the quantity of study material and the time spent studying for the course, and a stress scale graphic. RESULTS: Seven students had a pulse variation less than 10% between the 2 periods and 10 had a 10% or more variation. Grades on TPT were, respectively, 91.4±2.4 and 87.3±5.2 (p<0.05). Six students had a BP variation less than 20 mmHg, and in 11 it varied more than 21 mmHg. Grades on the TPT were 92.3±3.3 and 86.2± 8.1, respectively (p<0.05). The QV dates did not significantly influence grades. CONCLUSION: Stress, as an isolated variable, had a negative influence on the learning process and on the efficiency of emergency training in this situation.

Homoenxerto aórtico criopreservado no tratamento cirúrgico das lesões da valva aórtica: resultados imediatos

OBJETIVO: Analisar os resultados imediatos, clínicos e ecocardiográficos, com o uso do homoenxerto aórtico criopreservado no tratamento cirúrgico da valva aórtica. MATERIAL: Dezoito pacientes com lesão na valva aórtica receberam homoenxerto aórtico criopreservado, sendo 15 homens, 10 com insuficiência aórtica e oito, estenose aórtica. A idade variou de 18 a 65 (média de 44,5 ± 18,14) anos. Quatro pacientes apresentavam endocardite bacteriana em atividade, 12 estavam em classe funcional II, seis em classe funcional III (NYHA). A função ventricular esquerda era normal em 15 pacientes. RESULTADOS: A mortalidade hospitalar foi de 5,5% (um paciente), por insuficiência respiratória, os demais receberam alta hospitalar entre o 5° e 8° dia de pós-operatório em classe funcional I. O gradiente transvalvar aórtico máximo, ao ecocardiograma, variou de zero a 30 mmhg, com média de 10,9 ± 9,2 mmhg. Cinco pacientes não apresentavam nenhum grau de refluxo pelo homoenxerto, 11 (61,1%) tinham refluxo mínimo e dois apresentavam refluxo leve. O tempo de circulação extracorpórea variou de 130 a 220 (média de 183,9 ± 36,7) minutos. O tempo de pinçamento da aorta variou de 102 a 168 (média de 139,14 ± 25,10) minutos. O sangramento no pós-operatório variou 210 a 1220 ml, com média de 511,4 ± 335,1 ml e não houve reoperações. O tempo de intubação orotraqueal variou de 2h e 50min a 17 h com média de 9,14 ± 3,6 h. CONCLUSÃO: O homoenxerto aórtico criopreservado pode ser utilizado rotineiramente com baixa morbi-mortalidade hospitalar.