Administração na América portuguesa: a expansão das fronteiras meridionais do Império (1680-1808)

O estudo da administração colonial voltou a adquirir importância nos últimos anos, tendo gerado um profícuo debate historiográfico, que tem renovado este campo dos estudos históricos. O conceito de "pacto colonial" vem sendo revisto, enfatizando-se a dinâmica da negociação entre os colonos e a Coroa portuguesa. O próprio "antigo sistema colonial" vem sendo confrontado com a noção de um "Antigo Regime nos trópicos", o que levou a que fossem repensados vários aspectos da fase inicial da história do Brasil. Um dos pontos centrais a ser investigado no artigo refere-se à natureza das relações que eram estabelecidas entre as principais autoridades régias da colônia (vice-reis, governadores, provedores e ouvidores) e os poderes locais (câmaras e ordenanças), procurando verificar como se viabilizava a governabilidade da América lusa. Dentro desse vasto espaço geográfico, o foco da análise irá recair sobre o processo de integração na estrutura administrativa colonial dos espaços de fronteira, particularmente o Rio Grande de São Pedro e a Colônia do Sacramento.

Household members and health care workers as supervisors of tuberculosis treatment

OBJECTIVE: To compare tuberculosis cure rates among patients supervised by household members or health care workers. METHODS: Prospective cohort study of 171 patients treated by the program in Vitoria, Southeastern Brazil, from 2004 to 2007. Each patient was followed-up for six months until the end of the treatment. Of the patients studied, a household member supervised 59 patients and healthcare workers supervised 112 patients. Patients' sociodemographic and clinic data were analyzed. Differences between groups were assessed using chi-square test or Student's t-test. Significance level was set at 5%. RESULTS: Most patients had smear positive, culture confirmed pulmonary tuberculosis. Two patients were HIV-positive. There were more illiterate patients in the healthcare-supervised group, in comparison to those supervised by their families (p=0.01). All patients supervised by a household member were cured compared to 90% of the patients supervised by health care workers (p = 0.024). CONCLUSIONS: Successful tuberculosis treatment was more frequent when supervised by household members.

KPC-PRODUCING Serratia marcescens IN A HOME-CARE PATIENT FROM RECIFE, BRAZIL

SUMMARY In this brief communication we describe the occurrence of a KPC-producing Serratia marcescensisolate in a home-care patient from Recife, Brazil. The blaKPC, blaSPM, blaIMP, blaVIMblaOXA, blaCTX-M, blaSHV, blaTEM and blaGES genes were investigated by Polymerase Chain Reaction (PCR) and DNA sequencing. The isolate was positive for blaKPC-2 and blaTEM-1 and was resistant to aztreonam, cefepime, cefotaxime, imipenem, meropenem, gentamicin, ciprofloxacin and cefazidime, and susceptible only to amikacin, tigecycline and gatifloxacin. This is the first report in Brazil of KPC-producing S. marcescens clinical isolate outside of a hospital environment. Caregivers should be alert for the presence of this isolate in the community setting.

ANTIFUNGAL ACTIVITY OF Cymbopogon nardus (L.) Rendle (CITRONELLA) AGAINST Microsporum canis FROM ANIMALS AND HOME ENVIRONMENT

Dermatophytosis is a common zoonosis in urban centers. Dogs and cats have played an important role as its disseminators. Environmental decontamination is essential for the prevention of its propagation to humans and animals. However, sanitizers or disinfectants with antifungal activity, currently available, have high toxicity. The present study evaluated the in vitro effects of an extract of citronella (Cymbopogon nardus) on 31 Microsporum canis isolates from animals and home environments. Susceptibility tests were performed based on document M38-A2 (2008) of the Clinical and Laboratory Standards Institute with modifications for natural products. Although susceptibility variation was observed between the fungus tested, the concentrations that inhibited the growth of 50 and 90% of the microorganisms were low (19.5 and 78 µg/mL, respectively). Thus, this citronella extract showed potent fungistatic and fungicide activities against M. canis isolated from animals and home environments. Therefore, it could be an alternative for dermatophytosis prophylaxis in the home environment.

The role of integrated home-based care in patient adherence to antiretroviral therapy

Non-adherence is one of the primary obstacles to successful antiretroviral therapy in HIV+ patients worldwide. In Brazil, the Domiciliary Therapeutic Assistance is a multidisciplinary and integrated home-based assistance program provided for HIV+ patients confined in their homes due to physical deficiency. This study investigated ADT's ability to monitor and promote appropriate adherence to ARV therapy. Fifty-six individuals were recruited from three study groups: Group 1 - patients currently in the ADT program, Group 2 - 21 patients previously treated by the ADT program, and Group 3 - 20 patients who have always been treated using conventional ambulatory care. Using multivariable self-reporting to evaluate adherence, patients in the ADT program had significantly better adherence than patients in ambulatory care (F = 6.66, p = 0.003). This effect was independent of demographic and socioeconomic characteristics as well as medical history. Patients in the ADT program also showed a trend towards greater therapeutic success than ambulatory patients. These results suggest the incorporation of characteristics of ADT in conventional ambulatory care as a strategy to increase adherence to ARV therapy.

Ocorrência de aflatoxinas em castanhas do Pará (Bertholletia excelsa, Humb. & Bonpl., 1808)

Foi investigada a ocorrência de aflatoxinas em 100 amostras de castanhas do Pará (Bertholletia excelsa HUMB. BONPL.) provenientes de produtores e de diversos pontos de comercializacão das sementes na região de Manaus, Estado do Amazonas e de São Pauto, Estado de São Paulo. As amostras foram classificadas em 4 tipos de apresentação do produto (natural em casca, desidratada com e sem casca, desidratada com e sem casca e em ouriço) . Três amostras apresentaram-se contaminadas por aflatoxinas com níveis de toxidez considerados: em termos deB1médio (0,1 ppm) e muito elevado (2,25 ppm) e, em G1, baixo (0,075 ppm) e muito elevado (1,5 ppm).

Fungos contaminantes e produtores de aflatoxinas em castanha do Pará (Bertholletia excelsa HUMB. & BONPL 1808)

Cem amostras de castanhas do Para, procedentes dos Estados do Amazonas e Sao Paulo, foram analisadas micológico e toxicologicamente para aflatoxinas B1 e G1. Isolou-se 312 colônias de fungos, sendo 91 do gênero Aspergillus, 83 do gênero Penicillium e as restantes incluídas em 23 gêneros diferentes. Entre as amostras de Aspergillus, 26 foram aflatoxigênicos, distribuídos em 3 espécies: Aspergillus flavas Link (18); Aspergillus parasiticus Speare (7) e Aspergillus fresenii Subram (1). Dos 100 extratos de castanhas analisados 3 foram positivos para aflatoxina.

Relevance to Home Blood Pressure Monitoring Protocol of Blood Pressure Measurements Taken Before First- Morning Micturition and in the Afternoon

Background: The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers. Methods: After undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU). Result: Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively. Conclusions: The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.