Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.

Epidemiological profile of meningococcal disease in the State of Minas Gerais and in the Central, North, and Triângulo Mineiro regions, Brazil, during 2000-2009

INTRODUCTION: Infection by Neisseria meningitidis, termed as meningococcal disease, can cause meningococcal meningitis and septicemia with or without meningitis. Meningococcal disease is endemic in Brazil and has a high potential to cause large-scale epidemics; therefore, it requires the immediate notification of cases to the Information System for Notifiable Diseases (SINAN) in Brazil. The aim of this study was to describe an epidemiological profile using data from notified and confirmed cases in the State of Minas Gerais, Brazil, from January 2000 to December 2009, obtained from the investigation records of individuals with meningitis registered with SINAN. METHODS: This was a retrospective, population-based study. Descriptive analysis of the data was made using the simple and relative frequencies of the categorical variables in the investigation records. RESULTS: There were 1,688 confirmed patients in Minas Gerais of which 45.5% lived in the Central, North, and Triângulo Mineiro regions. The highest frequencies of cases were in the 1-4-years age group (26.3%), males (54.7%), caucasian (36.4%), and lived in an urban area (80%). In the patients with specified education, 650 (60.9%) patients had secondary education. Serogrouping of meningococci had been performed in 500 (29.6%) patients by age and gender; 285 (57%) belonged to serogroup C, 67 (13.4%) were in the 1-to 4-years age group, and 168 (33.6%) were male. CONCLUSIONS: The epidemiological profiles of patients in the Central, North, and Triângulo Mineiro regions were not significantly different from the profile of patients in Minas Gerais.

Evaluation of the therapeutic response of hepatitis C in coinfected patients (HIV/HCV): a study of cases from a hospital for chronic liver diseases in the Eastern Brazilian Amazon

INTRODUCTION: The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS: A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Pará (Fundação Santa Casa de Misericórdia do Pará - FSCMPA) from April 2004 to June 2009. Patients were treated with 180µg PEG interferon-α2a in combination with ribavirin (1,000 to 1,250mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS: The mean age of the patients was 40±9.5 years, of which 89% (n=17) were male, and the HCV genotypes were genotype 1 (55%, n=11/20), genotype 2 (10%, n=2/20) and genotype 3 (35%, n=7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS: The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.

Dor e parentalidade : A vinculação na criança hospitalizada

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário

Larvicidal activity of the methanol extract and fractions of the green fruits of Solanum lycocarpum(Solanaceae) against the vector Culex quinquefasciatus (Diptera: Culicidae)

IntroductionThe larvicidal activity of Solanum lycocarpumagainst Culex quinquefasciatus is unknown.MethodsWe evaluated the larvicidal activity of extracts of the green fruits of Solanum lycocarpum against third and fourth instar larvae of C. quinquefasciatus.ResultsDichloromethane and ethyl acetate fractions showed the greatest larvicidal effect at 200mg/L (83.3% and 86.7%, respectively). The methanol and dichloromethane, ethyl acetate, and hydromethanolic fractions demonstrated larvicidal effects against C. quinquefasciatus, with LC50 values of 126.24, 75.13, 83.15, and 207.05mg/L, respectively.ConclusionsThus, when considering new drugs with larvicidal activity from natural products, S. lycocarpum fruits may be good candidate sources.

Histological and endoscopic features of the stomachs of patients with Chagas disease in the era of Helicobacter pylori

Introduction Most studies that have evaluated the stomachs of patients with Chagas disease were performed before the discovery of Helicobacter pylori and used no control groups. This study compared the gastric features of chagasic and non-chagasic patients and assessed whether gastritis could be associated with Chagas disease. Methods Gastric biopsy samples were taken from patients who underwent endoscopy for histological analysis according to the Updated Sydney System. H. pylori infection was assessed by histology, 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR), serology and the 13C-urea breath test. Patients were considered H. pylori-negative when all of these diagnostic tests were negative. Clinical and socio-demographic data were obtained by reviewing medical records and using a questionnaire. Results The prevalence of H. pylori infection (70.3% versus 71.7%) and chronic gastritis (92.2% versus 85%) was similar in the chagasic and non-chagasic groups, respectively; such as peptic ulcer, atrophy and intestinal metaplasia. Gastritis was associated with H. pylori infection independent of Chagas disease in a log-binomial regression model. However, the chagasic H. pylori-negative patients showed a significantly higher grade of mononuclear (in the corpus) and polymorphonuclear (PMN) (in the antrum) cell infiltration. Additionally, the patients with the digestive form of Chagas disease showed a significantly lower prevalence of corpus atrophy than those with other clinical forms. Conclusions The prevalence of H. pylori infection and of gastric histological and endoscopic features was similar among the chagasic and non-chagasic patients. Additionally, this is the first controlled study to demonstrate that H. pylori is the major cause of gastritis in patients with Chagas disease.

Urinary tract infection in full-term newborn infants: value of urine culture by bag specimen collection

OBJETIVE: to evaluate the efficacy of urine culture by bag specimen for the detection of neonatal urinary tract infection in full-term newborn infants. Retrospective study (1997) including full-term newborn infants having a positive urine culture (>100,000 CFU/ml) by bag specimen collection. The urinary tract infection diagnosis was confirmed by positive urine culture (suprapubic bladder aspiration method). The select cases were divided into three groups, according to newborn infant age at the bag specimen collection: GI (< 48 h, n = 17), GII (48 h to 7 d, n = 35) and GIII (> 7 d, n = 9). Sixty one full-term newborn infants were studied (5.1 % of total infants). The diagnosis was confirmed on 19/61 (31.1 %) of full-term infants born alive. Distribution among the groups was: GI = 2/17 (11.8 %), GII = 10//35 (28.6 %), and GIII = 7/9 (77.7 %). The most relevant clinical symptoms were: fever (GI - 100 %, GII - 91.4 %) and weight loss (GI - 35.3 %, GII - 45.7 %). Urine culture results for specimens collected by suprapubic aspiration were: E. coli GI (100 %), GII (40 %) and GIII (28.6 %), E. faecalis GI (30%), Staphylococcus coagulase-negative GII (20 %) and GIII (42.8 %), and Staphylococcus aureus GII (10 %). Correlation between positive urine culture collection (bag specimen method) and urinary tract infection diagnosis, using relative risk analysis, produced the following results: GI=0.30 (CI95% 0.08-1.15), GII=0.51 (CI 95% 0.25-1.06) and GIII=3.31 (CI95% 1.8-6.06) The most frequent urinary tract infection clinical signs in the first week were fever and weight loss, while non-specific symptomatology occurred later. E. coli was most frequent infectious agent, although from the 7th day of life, staphylococcus was noted. The urine culture (bag specimen method) was effective in detecting urinary tract infection only after the 7th day of life.

Hormone replacement therapy and the risk of breast cancer: assessment of therapy acceptance in a cohort of previously treated breast cancer patients

INTRODUCTION: In the postmenopausal period, an average of 25% of women will present symptomatic ovarian failure requiring hormonal replacement therapy. Estrogen can relieve vasomotor symptoms. Hormonal replacement therapy is generally not recommended for breast cancer patients due to the potential risk of tumor recurrence. To answer the questions about the safety of hormonal replacement therapy in this subgroup of women, it is necessary to establish the acceptance of treatment. METHODS: Between September 1998 and February 2001, a cohort of 216 breast cancer patients were asked to complete a questionnaire. All patients had completed their treatment and were informed about survival rates after breast cancer and hormonal replacement therapy. RESULTS: Among the 216 patients, 134 (62%) would refuse hormonal replacement therapy. A hundred patients were afraid of relapse (74.6%). Adjuvant tamoxifen therapy was the only statistically significant variable (70.3% versus 29.7% p=0.003). Understanding clinical stage (p= 0.045) and type of medical assistance (private versus public , p=0.033) also seemed to influence the decision. Early stage disease (p= 0.22), type of surgical procedure (radical versus conservative, p=0.67), adjuvant chemotherapy (p=0.082) or marital status (p=0.98 ) were not statistically significant in decision making. Several patients submitted to adjuvant chemotherapy (41.6%) would accept hormonal replacement therapy under medical supervision, as did most of advanced clinical stage patients (58.3%; p=0.022). CONCLUSION: There is a high level of rejection for hormonal replacement therapy among breast cancer patients when current data on tumor cure rates, and potential risks of estrogen use is available. Adverse effects of tamoxifen in the adjuvant setting may be the reason for refusal of hormonal replacement therapy .

Antiphospholipid antibodies in 57 children and adolescents with systemic lupus erythematosus

OBJECTIVE: To investigate the frequencies and behavior of antiphospholipid antibodies in 57 children and adolescents with systemic lupus erythematosus. METHODS: Anticardiolipin antibodies were investigated by ELISA and lupus anticoagulant antibodies by the international tests recommended. The antiphospholipid antibodies analyses were performed in frozen samples (mean of 5.3 samples per patient obtained during a mean follow-up period of 3 years and 7 months) and on blood samples collected between January 1997 and November 1998 (mean of 2.5 samples per patient during a 2-year follow-up period). RESULTS: The frequencies of antiphospholipid antibodies (anticardiolipin and lupus anticoagulant) were similar in the samples collected prospectively and in the frozen samples (retrospective study): 63.2% and 75.4% respectively. Positivity for these antibodies fluctuated during the follow-up period and was not associated with any clinical or laboratory parameters of lupus erythematosus, including autoantibodies and also including disease activity and/or severity scores. CONCLUSIONS: The frequencies of antiphospholipid antibodies in children and adolescents with lupus erythematosus were similar to those observed in adults. The positivity fluctuated during the follow-up and was not correlated with clinical and/or laboratory disease parameters.

Estudo farmacológico do extrato bruto do Datura arborea L

O trombeteiro é uma solanacea arbustiva comum na ilha de São Luís. Suas flores e Folhas são utilizadas popularmente na forma de cigarros durante as crises asmáticas agudas. Como no Maranhão são freqüentes as crises asmáticas relacionadas com a exploração de jaborandi para a produção de pilocarpina, procura-se neste trabalho, relacionar a atividade farmacológica das folhas com sua utilização popular. As folhas verdes foram extraídas a frio com etanol e o extrato bruto (EB) concentrado a vácuo. Para os testes farmacológicos e EB era disperso em salina/tween-80 (0,03ml100mg EB) e injetado i.p. ou e.v. Os testes gerais de atividade em ratos não indicaram ação farmacológica específica do EB (10 a 100 mg/kg i.p) além de midríose acentuada com as maiores doses. No jejuno isolado de ratos as curvas dose-efeito de acetilcolina (ACh) foram deslocadas para a direita na presença do EB sem alterar o efeito contrátil máximo da ACh. Na presença de EB (2 e 5 ug/ml) a DE50 da ACh foi deslocada de 46 e 160 vezes respectivamente. No íleo isolado de cobaia, a incubação de EB (2 ug/ml) por 3 min, bloqueou as contrações produzidas pela ACh (3 x 10-7 M) e pela histamina (3 x 10-7 M). Após a lavagem as respostas foram recuperadas em 35 e 15 min. respectivamente. Na pressão arterial de rato o EB / 1 a 5 mg/kg) não produziu efeitos constantes mas inibiu a hipotensão produzida pela ACh (1 a 5 ug/kg) deslocando paralelamente a curva dose-resposta. Doses maiores do EB (10 a 50 mg/kg) produziram hipertensão proporcional à dose. A hipertensão correspondente à dose mais elevada foi reduzida de 80% na presença de yoimbina (3 mg/kg), dose suficiente para reduzir de 95% a resposta pressórica à noradrenalina (2 ug/kg). Estes dados comprovam que a ação predominante da Datura arborea L. é parassimpaticolítica. No extrato da folha a substância com esta ação parece estar associada a outra(s) substância(s) de atividade alfa-simpaticomimética cujas ações vasoconstritoras poderiam ser sinérgicas na atividade anti-asmática.

Caulinita em solo da Amazônia: caracterização e permutabilidade

O presente trabalho descreve, basicamente a caracterização dos constituintes da fração argila, principalmente da caulinita e sua permutabilidade com alguns cátions metálicos, em solo Amazônico. Para tanto, amostras de Latossolo Amarelo foram coletadas em um perfil de estrada da Usina Hidrelétrica Balbina, Km 12, próximo ao município de Presidente Figueiredo (AM). Estas foram secadas ao ar (TFSA), desagregadas e separadas granulometricamente nas frações areia, silte e argila. As amostras da fração argila foram tratadas com H2O2/HC1 para eliminar a matéria orgânica e óxido de ferro. As amostras da fração argila sem tratamento e tratada foram caracterizadas por difração de raios X de pó e espectroscopia no infravermelho. Os constituintes químicos da fração argila tratada foram determinados por espectrometria de absorção atômica, volumetria e gravimetria. Os resultados obtidos mostraram que as amostras da fração argila sem tratamento apresentaram a seguinte constituição: gibsita goethita, quartzo, matéria orgânica e caulinita. A fração argila tratada apresentou basicamente quartzo c caulinita, sendo a caulinita membro final da série caulinítica, com pouca distribuição de cargas negativas. Nas amostras tratadas foram efetuados também experimentos de permutabilidade com Na+, K+ e Fe3+ e os teores determinados por espectrofotometria na região do ultravioleta-visível e fotometria de chama. Os resultados mostram que a fração argila tratada possui capacidade de retenção de 2,21% de água de absorção, no caso de cátions monovalentes: 1,3 e 2,7 meq/100 g de amostra, para o K+ e Na+, respectivamente. No entanto, essa fração retêm cerca de 21,7 meq/100 g de amostra para o Fe3+. Esse valor elevado para a retenção de Fe3+ é provavelmente atribuído ao fenômeno de permutabilidade entre o Fe3+ e a caulinita acompanhado dc redução no valor de pH para 2,2, seguida de substituição de Fe3+ por Al3+, no sítio octaédrico, revelada pela espectroscopia no infravermelho.

Métodos de extração e limpeza de sementes de araçá-boi (Eugenia stipitata)

O araçá-boi (Eugenia stipitata McVaugh, Myrtaceae), espécie de origem amazônica, possui frutos de aroma e sabor agradáveis, com alto rendimento em polpa. O presente trabalho objetivou avaliar a qualidade física e fisiológica das sementes após extrações manual e mecânica, limpeza por fricção com diferentes materiais (areia, serragem, areia+serragem, cal hidratada, em peneira e sem fricção) e limpeza por fermentação natural (com e sem substituição diária da água, por 0, 1, 2, 3, 4 e 7 dias). Com o método mecânico obteve-se a maior quantidade de polpa (78% do peso e 81% do volume dos frutos). A fricção com cal hidratada proporcionou as maiores percentagem (98 %) e velocidade de emergência (0,989). Na fermentação natural, a manutenção da mesma água por mais de 1 dia afetou negativamente a qualidade fisiológica das sementes.

Seismic vulnerability of existing masonry buildings: Nonlinear parametric analysis

Existing masonry structures are usually associated to a high seismic vulnerability, mainly due to the properties of the materials, weak connections between floors and load-bearing walls, high mass of the masonry walls and flexibility of the floors. For these reasons, the seismic performance of existing masonry structures has received much attention in the last decades. This study presents the parametric analysis taking into account the deviations on features of the gaioleiro buildings - Portuguese building typology. The main objective of the parametric analysis is to compare the seismic performance of the structure as a function of the variations of its properties with respect to the response of a reference model. The parametric analysis was carried out for two types of structural analysis, namely for the non-linear dynamic analysis with time integration and for the pushover analysis with distribution of forces proportional to the inertial forces of the structure. The Young's modulus of the masonry walls, Young's modulus of the timber floors, the compressive and tensile non-linear properties (strength and fracture energy) were the properties considered in both type of analysis. Additionally, in the dynamic analysis, the influences of the vis-cous damping and of the vertical component of the earthquake were evaluated. A pushover analysis proportional to the modal displacement of the first mode in each direction was also carried out. The results shows that the Young's modulus of the masonry walls, the Young's modulus of the timber floors and the compressive non-linear properties are the pa-rameters that most influence the seismic performance of this type of tall and weak existing masonry structures. Furthermore, it is concluded that that the stiffness of the floors influences significantly the strength capacity and the collapse mecha-nism of the numerical model. Thus, a study on the strengthening of the floors was also carried out. The increase of the thickness of the timber floors was the strengthening technique that presented the best seismic performance, in which the reduction of the out-of-plane displacements of the masonry walls is highlighted.

Masonry macro-block analysis

The structural analysis involves the definition of the model and selection of the analysis type. The model should represent the stiffness, the mass and the loads of the structure. The structures can be represented using simplified models, such as the lumped mass models, and advanced models resorting the Finite Element Method (FEM) and Discrete Element Method (DEM). Depending on the characteristics of the structure, different types of analysis can be used such as limit analysis, linear and non-linear static analysis and linear and non-linear dynamic analysis. Unreinforced masonry structures present low tensile strength and the linear analyses seem to not be adequate for assessing their structural behaviour. On the other hand, the static and dynamic non-linear analyses are complex, since they involve large time computational requirements and advanced knowledge of the practitioner. The non-linear analysis requires advanced knowledge on the material properties, analysis tools and interpretation of results. The limit analysis with macro-blocks can be assumed as a more practical method in the estimation of maximum load capacity of structure. Furthermore, the limit analysis require a reduced number of parameters, which is an advantage for the assessment of ancient and historical masonry structures, due to the difficult in obtaining reliable data.

A proactive intelligent decision support system for predicting the popularity of online news

"Lecture notes in computer science series, ISSN 0302-9743, vol. 9273"