Antibiotic resistance in enterobacteriaceae isolated from Portuguese deli meats

This study aimed to identify the presence of β-lactam-resistant bacteria in different types of Portuguese deli meats. The numbers of ampicillin resistant bacteria varied from negative in 25 g to 1.0 × 108colony-forming units/g. Within 78 randomly selected β-lactam-resistant bacteria, 24 different resistant phenotypes were found and 35.9% were multidrug resistant (MDR). The majority (87.2%) of the isolates identified belonged to the Enterobacteriaceae family. The presence of the blaTEM gene was detected in 23 out of 67 isolates (34.3%) and 16 of them presented MDR phenotypes. Four Klebsiella oxytoca isolates (6%) harbored a gene for the CTX-M/OXY-type enzyme. The direct sequencing of their purified amplicons confirmed the presence of three types of blaOXYgenes (blaOXY-1, blaOXY-2 and blaOXY-5). These results suggest that without good hygienic practices, deli meats may act as a vehicle of transfer of β-lactam-resistant bacteria to the gastrointestinal tract of consumers.

Influência da Motilidade Gastrintestinal no processo de desintegração de comprimidos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of ≥1 year

Backgroung - Bariatric surgery is indicated as the most effective treatment for morbid obesity; the Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice. However, nutritional deficiency may occur in the postoperative period as a result of reduced gastric capacity and change in nutrients absorption in the gastrointestinal tract. The prescription of vitamin and mineral supplementation is a common practice after RYGB; however, it may not be sufficient to prevent micronutrient deficiencies. The aim of this study was to quantify the micronutrient intake in patients undergoing RYGB and verify if the intake of supplementation would be enough to prevent nutritional deficiencies. Methods - The study was conducted on 60 patients submitted to RYGB. Anthropometric, analytical, and nutritional intake data were assessed preoperatively and 1 and 2 years postoperatively. The dietary intake was assessed using 24-h food recall; the values of micronutrients evaluated (vitamin B12, folic acid, iron, and calcium) were compared to the dietary reference intakes (DRI). Results - There were significant differences (p < 0.05) between excess weight loss at the first and second year (69.9 ± 15.3 vs 9.6 ± 62.9 %). In the first and second year after surgery, 93.3 and 94.1 % of the patients, respectively, took the supplements as prescribed. Micronutrient deficiencies were detected in the three evaluation periods. At the first year, there was a significant reduction (p < 0.05) of B12, folic acid, and iron intake. Conclusions - Despite taking vitamin and mineral supplementation, micronutrient deficiencies are common after RYGB. In the second year after surgery, micronutrient intake remains below the DRI.

Avaliação do efeito de um probiótico na performance zootécnica e microbiota entérica em coelhos (Oryctolagus cuniculus) de produção

A cunicultura é uma atividade pecuária em crescente desenvolvimento e isso traduz-se em novos desafios. Durante muitos anos a criação de coelhos recorreu em demasia ao uso de antimicrobianos com o objetivo de tratar e prevenir o aparecimento de diversas doenças. Paralelamente, estes compostos foram também usados como “promotores de crescimento”, visando essencialmente uma melhoria da eficiência digestiva. Porém, o uso indiscriminado destas substâncias levantou questões de saúde pública, como a emergência de estirpes bacterianas multirresistentes e a inerente disseminação de genes de resistência, possivelmente transferíveis ao Homem através da cadeia alimentar. No presente, existe uma enorme pressão para a adoção de estratégias que possibilitem uma redução massiva na quantidade de antimicrobianos administrados a espécies pecuárias. Este trabalho visou contribuir para o estudo de uma alternativa ao uso de antimicrobianos - os probióticos – enquanto suplementos alimentares constituídos por microrganismos vivos capazes de equilibrar a microbiota intestinal do hospedeiro. Para tal, foram constituídos dois grupos de coelhos com base na alimentação: i) grupo antibiótico, com acesso a um alimento composto suplementado com antibióticos e ii) o grupo probiótico alimentado com a mesma dieta, mas sem antibióticos e inoculado com um probiótico constituído por Escherichia coli e Enterococcus spp.. Ao longo de 22 dias de estudo foram monitorizados alguns indicadores produtivos e efetuadas recolhas periódicas de fezes para estudo microbiológico. A análise dos resultados zootécnicos permitiram verificar que o uso de probióticos em detrimento de antibióticos parece promover o crescimento de coelhos, tornando-se um método mais rentável na produção cunícula. Através de genotipagem por ERIC-PCR e PFGE, pretendeu-se verificar se as estirpes estranhas ao trato gastrointestinal dos coelhos seriam capazes de coloniza-lo, permanecendo ao longo do tempo de estudo. O facto de as estirpes inoculadas no probiótico terem sido encontradas ao longo dos dias de estudo nos coelhos aos quais foram administradas, sugere que os efeitos observados na performance zootécnica estejam relacionados com as estirpes administradas no probiótico, pelo que este poderá ser um sistema viável na substituição de antibióticos na alimentação de coelhos de produção.

Gastric acid secretion response in the Cebus apella: a monkey model of chronic Chagas disease

The objective was to study the secretory pattern, both basal and stimulated either by histamine (0.1 mg/kg) or pentagastrin (64 ug/kg) in eighteen Cebus apella monkeys chronically infected with different T. cruzi strains (CA1, n=10; Colombian, n=4 and Tulahuen, n=4) and to describe the morphological findings in the gastrointestinal tract in twelve infected (6 sacrificed and 6 spontaneously dead) and four healthy monkeys. All infected monkeys and 35 healthy ones were evaluated by contrast X-ray examination. No differences were observed in basal acid output between control and infected groups. Animals infected with the Tulahuen and Colombian strains showed significant lower values of peak acid output in response to histamine or pentagastrin (p<0.01 and p<0.05 respectively; "t" test) in comparison to the controls. Barium contrast studies showed enlargement and dilatation of the colon in three infected animals. Histopathological lesions were seen in 75% of the autopsied animals either in colon alone (33%) or both, in colon and esophagus (42%). The normal secretion observed in the CA1 infected group could be due to a lower virulence of the strain, a lower esophagic tropism or the necessity of a longer post-infection time to cause lesions.

Estudo da exposição profissional a formaldeído em laboratórios hospitalares de anatomia patológica

RESUMO - A exposição a formaldeído é reconhecidamente um dos mais importantes factores de risco presente nos laboratórios hospitalares de anatomia patológica. Neste contexto ocupacional, o formaldeído é utilizado em solução, designada comummente por formol. Trata-se de uma solução comercial de formaldeído, normalmente diluída a 10%, sendo pouco onerosa e, por esse motivo, a eleita para os trabalhos de rotina em anatomia patológica. A solução é utilizada como fixador e conservante do material biológico, pelo que as peças anatómicas a serem processadas são previamente impregnadas. No que concerne aos efeitos para a saúde do formaldeído, os efeitos locais parecem apresentar um papel mais importante comparativamente com os efeitos sistémicos, devido à sua reactividade e rápido metabolismo nas células da pele, tracto gastrointestinal e pulmões. Da mesma forma, a localização das lesões correspondem principalmente às zonas expostas às doses mais elevadas deste agente químico, ou seja, o desenvolvimento dos efeitos tóxicos dependerá mais da intensidade da dose externa do que da duração da exposição. O efeito do formaldeído no organismo humano mais facilmente detectável é a acção irritante, transitória e reversível sobre as mucosas dos olhos e aparelho respiratório superior (naso e orofaringe), o que acontece em geral para exposições frequentes e superiores a 1 ppm. Doses elevadas são citotóxicas e podem conduzir a degenerescência e necrose das mucosas e epitélios. No que concerne aos efeitos cancerígenos, a primeira avaliação efectuada pela International Agency for Research on Cancer data de 1981, actualizada em 1982, 1987, 1995 e 2004, considerando-o como um agente cancerígeno do grupo 2A (provavelmente carcinogénico). No entanto, a mais recente avaliação, em 2006, considera o formaldeído no Grupo 1 (agente carcinogénico) com base na evidência de que a exposição a este agente é susceptível de causar cancro nasofaríngeo em humanos. Constituiu objectivo principal deste estudo caracterizar a exposição profissional a formaldeído nos laboratórios hospitalares de anatomia patológica Portugueses. Pretendeu-se, ainda, descrever os fenómenos ambientais da contaminação ambiental por formaldeído e explorar eventuais associações entre variáveis. Considerou-se uma amostra de 10 laboratórios hospitalares de anatomia patológica, avaliada a exposição dos três grupos profissionais por comparação com os dois referenciais de exposição e, ainda, conhecidos os valores de concentração máxima em 83 actividades. Foram aplicados simultaneamente dois métodos distintos de avaliação ambiental: um dos métodos (Método 1) fez uso de um equipamento de leitura directa com o princípio de medição por Photo Ionization Detection, com uma lâmpada de 11,7 eV e, simultaneamente, realizou-se o registo da actividade. Este método disponibilizou dados para o referencial de exposição da concentração máxima; o outro método (Método 2) traduziu-se na aplicação do método NIOSH 2541, implicando o uso de bombas de amostragem eléctricas de baixo caudal e posterior processamento analítico das amostras por cromatografia gasosa. Este método, por sua vez, facultou dados para o referencial de exposição da concentração média ponderada. As estratégias de medição de cada um dos métodos e a definição dos grupos de exposição existentes neste contexto ocupacional, designadamente os Técnicos de Anatomia Patológica, os Médicos Anatomo-Patologistas e os Auxiliares, foram possíveis através da informação disponibilizada pelas técnicas de observação da actividade da análise (ergonómica) do trabalho. Estudaram-se diversas variáveis independentes, nomeadamente a temperatura ambiente e a humidade relativa, a solução de formaldeído utilizada, as condições de ventilação existentes e o número médio de peças processadas por dia em cada laboratório. Para a recolha de informação sobre estas variáveis foi preenchida, durante a permanência nos laboratórios estudados, uma Grelha de Observação e Registo. Como variáveis dependentes seleccionaram-se três indicadores de contaminação ambiental, designadamente o valor médio das concentrações superiores a 0,3 ppm em cada laboratório, a Concentração Média Ponderada obtida para cada grupo de exposição e o Índice do Tempo de Regeneração de cada laboratório. Os indicadores foram calculados e definidos através dos dados obtidos pelos dois métodos de avaliação ambiental aplicados. Baseada no delineado pela Universidade de Queensland, foi ainda aplicada uma metodologia de avaliação do risco de cancro nasofaríngeo nas 83 actividades estudadas de modo a definir níveis semi-quantitativos de estimação do risco. Para o nível de Gravidade considerou-se a informação disponível em literatura científica que define eventos biológicos adversos, relacionados com o modo de acção do agente químico e os associa com concentrações ambientais de formaldeído. Para o nível da Probabilidade utilizou-se a informação disponibilizada pela análise (ergonómica) de trabalho que permitiu conhecer a frequência de realização de cada uma das actividades estudadas. A aplicação simultânea dos dois métodos de avaliação ambiental resultou na obtenção de resultados distintos, mas não contraditórios, no que concerne à avaliação da exposição profissional a formaldeído. Para as actividades estudadas (n=83) verificou-se que cerca de 93% dos valores são superiores ao valor limite de exposição definido para a concentração máxima (VLE-CM=0,3 ppm). O “exame macroscópico” foi a actividade mais estudada e onde se verificou a maior prevalência de resultados superiores ao valor limite (92,8%). O valor médio mais elevado da concentração máxima (2,04 ppm) verificou-se no grupo de exposição dos Técnicos de Anatomia Patológica. No entanto, a maior amplitude de resultados observou-se no grupo dos Médicos Anatomo-Patologistas (0,21 ppm a 5,02 ppm). No que respeita ao referencial da Concentração Média Ponderada, todos os valores obtidos nos 10 laboratórios estudados para os três grupos de exposição foram inferiores ao valor limite de exposição definido pela Occupational Safety and Health Administration (TLV-TWA=0,75 ppm). Verificou-se associação estatisticamente significativa entre o número médio de peças processadas por laboratório e dois dos três indicadores de contaminação ambiental utilizados, designadamente o valor médio das concentrações superiores a 0,3 ppm (p=0,009) e o Índice do Tempo de Regeneração (p=0,001). Relativamente à temperatura ambiente não se observou associação estatisticamente significativa com nenhum dos indicadores de contaminação ambiental utilizados. A humidade relativa apresentou uma associação estatisticamente significativa apenas com o indicador de contaminação ambiental da Concentração Média Ponderada de dois grupos de exposição, nomeadamente com os Médicos Anatomo-Patologistas (p=0,02) e os Técnicos de Anatomia Patológica (p=0,04). A aplicação da metodologia de avaliação do risco nas 83 actividades estudadas permitiu verificar que, em cerca de dois terços (35%), o risco foi classificado como (pelo menos) elevado e, ainda, constatar que 70% dos laboratórios apresentou pelo menos 1 actividade com a classificação de risco elevado. Da aplicação dos dois métodos de avaliação ambiental e das informações obtidas para os dois referenciais de exposição pode concluir-se que o referencial mais adequado é a Concentração Máxima por estar associado ao modo de actuação do agente químico. Acresce, ainda, que um método de avaliação ambiental, como o Método 1, que permite o estudo das concentrações de formaldeído e simultaneamente a realização do registo da actividade, disponibiliza informações pertinentes para a intervenção preventiva da exposição por permitir identificar as actividades com a exposição mais elevada, bem como as variáveis que a condicionam. As peças anatómicas apresentaram-se como a principal fonte de contaminação ambiental por formaldeído neste contexto ocupacional. Aspecto de particular interesse, na medida que a actividade desenvolvida neste contexto ocupacional e, em particular na sala de entradas, é centrada no processamento das peças anatómicas. Dado não se perspectivar a curto prazo a eliminação do formaldeído, devido ao grande número de actividades que envolvem ainda a utilização da sua solução comercial (formol), pode concluir-se que a exposição a este agente neste contexto ocupacional específico é preocupante, carecendo de uma intervenção rápida com o objectivo de minimizar a exposição e prevenir os potenciais efeitos para a saúde dos trabalhadores expostos. ---------------- ABSTRACT - Exposure to formaldehyde is recognized as one of the most important risk factors present in anatomy and pathology laboratories from hospital settings. In this occupational setting, formaldehyde is used in solution, typically diluted to 10%, and is an inexpensive product. Because of that, is used in routine work in anatomy and pathology laboratories. The solution is applied as a fixative and preservative of biological material. Regarding formaldehyde health effects, local effects appear to have a more important role compared with systemic effects, due to his reactivity and rapid metabolism in skin, gastrointestinal tract and lungs cells. Likewise, lesions location correspond mainly to areas exposed to higher doses and toxic effects development depend more on external dose intensity than exposure duration. Human body formaldehyde effect more easily detectable is the irritating action, transient and reversible on eyes and upper respiratory tract (nasal and throat) membranes, which happen in general for frequent exposure to concentrations higher than 1 ppm. High doses are cytotoxic and can lead to degeneration, and also to mucous membranes and epithelia necrosis. With regard to carcinogenic effects, first assessment performed by International Agency for Research on Cancer in 1981, updated in 1982, 1987, 1995 and 2004, classified formaldehyde in Group 2A (probably carcinogenic). However, most recent evaluation in 2006, classifies formaldehyde carcinogenic (Group 1), based on evidence that exposure to this agent is likely to cause nasopharyngeal cancer in humans. This study principal objective was to characterize occupational exposure to formaldehyde in anatomy and pathology hospital laboratories, as well to describe formaldehyde environmental contamination phenomena and explore possible associations between variables. It was considered a sample of 10 hospital pathology laboratories, assessed exposure of three professional groups for comparison with two exposure metrics, and also knows ceiling concentrations in 83 activities. Were applied, simultaneously, two different environmental assessment methods: one method (Method 1) using direct reading equipment that perform measure by Photo Ionization Detection, with 11,7 eV lamps and, simultaneously, make activity description and film. This method provided data for ceiling concentrations for each activity study (TLV-C). In the other applied method (Method 2), air sampling and formaldehyde analysis were performed according to NIOSH method (2541). This method provided data average exposure concentration (TLV-TWA). Measuring and sampling strategies of each methods and exposure groups definition (Technicians, Pathologists and Assistants) was possible by information provided by activities (ergonomic) analysis. Several independent variables were studied, including temperature and relative humidity, formaldehyde solution used, ventilation conditions, and also anatomic pieces mean value processed per day in each laboratory. To register information about these variables was completed an Observation and Registration Grid. Three environmental contamination indicators were selected has dependent variables namely: mean value from concentrations exceeding 0,3 ppm in each laboratory, weighted average concentration obtained for each exposure group, as well each laboratory Time Regeneration Index. These indicators were calculated and determined through data obtained by the two environmental assessment methods. Based on Queensland University proposal, was also applied a methodology for assessing nasopharyngeal cancer risk in 83 activities studied in order to obtain risk levels (semi-quantitative estimation). For Severity level was considered available information in scientific literature that defines biological adverse events related to the chemical agent action mode, and associated with environment formaldehyde concentrations. For Probability level was used information provided by (ergonomic) work analysis that helped identifies activity frequency. Environmental assessment methods provide different results, but not contradictory, regarding formaldehyde occupational exposure evaluation. In the studied activities (n=83), about 93% of the values were above exposure limit value set for ceiling concentration in Portugal (VLE-CM = 0,3 ppm). "Macroscopic exam" was the most studied activity, and obtained the higher prevalence of results superior than 0,3 ppm (92,8%). The highest ceiling concentration mean value (2,04 ppm) was obtain in Technicians exposure group, but a result wider range was observed in Pathologists group (0,21 ppm to 5,02 ppm). Concerning Method 2, results from the three exposure groups, were all lower than limit value set by Occupational Safety and Health Administration (TLV-TWA=0,75ppm). There was a statistically significant association between anatomic pieces mean value processed by each laboratory per day, and two of the three environmental contamination indicators used, namely average concentrations exceeding 0,3 ppm (p=0,009) and Time Regeneration Index (p=0,001). Temperature was not statistically associated with any environmental contamination used indicators. Relative humidity had a statistically significant association only with one environmental contamination indicator, namely weighted average concentration, particularly with Pathologists group (p=0,02) and Technicians group (p=0,04). Risk assessment performed in the 83 studied activities showed that around two thirds (35%) were classified as (at least) high, and also noted that 70% of laboratories had at least 1 activity with high risk rating. The two environmental assessment methods application, as well information obtained from two exposure metrics, allowed to conclude that most appropriate exposure metric is ceiling concentration, because is associated with formaldehyde action mode. Moreover, an environmental method, like Method 1, which allows study formaldehyde concentrations and relates them with activity, provides relevant information for preventive information, since identifies the activity with higher exposure, as well variables that promote exposure. Anatomic pieces represent formaldehyde contamination main source in this occupational setting, and this is of particular interest because all activities are focused on anatomic pieces processing. Since there is no prospect, in short term, for formaldehyde use elimination due to large number of activities that still involve solution use, it can be concluded that exposure to this agent, in this particular occupational setting, is preoccupant, requiring an rapid intervention in order to minimize exposure and prevent potential health effects in exposed workers.

Pancreatic involvement in co-infection visceral leishmaniasis and HIV: histological and ultrastructural aspects

The involvement of the gastrointestinal tract in the co-infection of HIV and Leishmania is rarely reported. We report the case of an HIV-infected adult man co-infected with a disseminated form of leishmaniasis involving the liver, lymph nodes, spleen and, as a feature reported for the first time in the English literature, the pancreas. Light microscopy showed amastigote forms of Leishmania in pancreatic macrophages and immunohistochemical staining revealed antigens for Leishmania and also for HIV p24. Microscopic and ultrastructural analysis revealed severe acinar atrophy, decreased zymogen granules in the acinar cytoplasm and also nuclear abnormalities such as pyknosis, hyperchromatism and thickened chromatin. These findings might correspond to the histologic pattern of protein-energy malnutrition in the pancreas as shown in our previous study in pancreas with AIDS and no Leishmania. In this particular case, the protein-energy malnutrition may be due to cirrhosis, or, Leishmania or HIV infection or all mixed. We believe that this case represents the morphologic substratum of the protein energy malnutrition in pancreas induced by the HIV infection. Further studies are needed to elucidate these issues.

Case Report: Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) was first reported in 1978. PUBS is rare, occurs predominantly in constipated women, chronically catheterized and associated with some bacterial urinary infections that produce sulphatase/phosphatase. The etiology is due to indigo (blue) and indirubin (red) or to their mixture that becomes purple. A chain reaction begins in the gastrointestinal tract with tryptophan as described in the article.

Enterococcus gallinarum meningitis in an immunocompetent host: a case report

We describe a rare case of a 53-year-old man with a long history of alcohol abuse, with Enterococcus gallinarum meningitis, an organism that rarely causes human infection and is primarily found in the gastrointestinal tract of poultry. The patient improved with high-dose ampicillin and gentamicin therapy. To our knowledge, this is the first Brazilian reported case of E. gallinarum meningitis and probably the first case described in an immunocompetent host.

Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study

Involvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS) is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV) and the importance of these lesions to death. Of these, 90 (96.8%) patients had AIDS. We reviewed medical records, autopsy reports and histological sections from tongue to rectum stained with hematoxylin-eosin. When necessary, we analyzed special stains and immunohistochemistry to investigate infections. There was damage to the digestive system in 73 (78.5%) cases. The most common infections were candidiasis (42%), cytomegalovirus (29%), histoplasmosis (11.8%), toxoplasmosis (9.7%) and mycobacterial infection (9.7%). Malignancies were rare, present in four (4.3%) cases (two Kaposi's sarcoma, one adenocarcinoma and one metastatic embryonal carcinoma). All segments showed lesions: tongue (48.6%), esophagus (44.8%), stomach (44.7%), colon (43.2%) and small intestine (28.9%). The lesions found were immediate cause of death in five (5.4%) cases. In another 36 (38.7%) cases the basic disease was systemic and also compromised the digestive system.

Enterococcus faecium AND Enterococcus faecalis IN BLOOD OF NEWBORNS WITH SUSPECTED NOSOCOMIAL INFECTION

Enterococci are Gram-positive cocci saprophyte of the human gastrointestinal tract, diners who act as opportunistic pathogens. They can cause infections in patients hospitalized for a long time or who have received multiple antibiotic therapy. Enterococcus faecalis and Enterococcus faecium are the most common species in human infections. To evaluate the possibility of rapid detection of these species and their occurrence in the blood of newborns with suspected nosocomial infection, blood samples were collected from 50 newborns with late infections, admitted to the Neonatal Care Unit of the University Hospital Federal de Mato Grosso do Sul (UFMS-HU), from September 2010 to January 2011. The samples were subjected to conventional PCR and real time PCR (qPCR) to search for Enterococcus faecium and Enterococcus faecalis, respectively. The PCR results were compared with respective blood cultures from 40 patients. No blood cultures were positive for Enterococci, however, eight blood samples were identified as genomic DNA of Enterococcus faecium by qPCR and 22 blood samples were detected as genomic DNA of Enterococcus faecalis by conventional PCR. These findings are important because of the clinical severity of the evaluated patients who were found positive by conventional PCR and not through routine microbiological methods.

Automatic Small Bowel Tumor Diagnosis by Using Multi-Scale Wavelet-Based Analysis in Wireless Capsule Endoscopy Images

BACKGROUND: Wireless capsule endoscopy has been introduced as an innovative, non-invasive diagnostic technique for evaluation of the gastrointestinal tract, reaching places where conventional endoscopy is unable to. However, the output of this technique is an 8 hours video, whose analysis by the expert physician is very time consuming. Thus, a computer assisted diagnosis tool to help the physicians to evaluate CE exams faster and more accurately is an important technical challenge and an excellent economical opportunity. METHOD: The set of features proposed in this paper to code textural information is based on statistical modeling of second order textural measures extracted from co-occurrence matrices. To cope with both joint and marginal non-Gaussianity of second order textural measures, higher order moments are used. These statistical moments are taken from the two-dimensional color-scale feature space, where two different scales are considered. Second and higher order moments of textural measures are computed from the co-occurrence matrices computed from images synthesized by the inverse wavelet transform of the wavelet transform containing only the selected scales for the three color channels. The dimensionality of the data is reduced by using Principal Component Analysis. RESULTS: The proposed textural features are then used as the input of a classifier based on artificial neural networks. Classification performances of 93.1% specificity and 93.9% sensitivity are achieved on real data. These promising results open the path towards a deeper study regarding the applicability of this algorithm in computer aided diagnosis systems to assist physicians in their clinical practice.

Stress-Related Mucosal Disease: Incidence of Bleeding and the Role of Omeprazole in its Prophylaxis

BACKGROUND: Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis. METHODS: We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance. RESULTS: Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6+/-7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding. CONCLUSION: In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole.

Precious transition metals: the importance of Zn2+, Mn2+ and Cu2+ in the human pathogen Enterococcus faecalis

Dissertation presented to obtain the Ph.D degree in Biology

Non-clinical isolates bring new findings on enterococcal virulence

Dissertation presented to obtain the PhD degree in Biology