Candida spp. isolated from inpatients, the environment, and health practitioners in the pediatric unit at the Universitary Hospital of the Jundiaí Medical College, state of São Paulo, Brazil

INTRODUCTION: This study aimed to isolate and identify Candida spp. from the environment, health practitioners, and patients with the presumptive diagnosis of candidiasis in the Pediatric Unit at the Universitary Hospital of the Jundiaí Medical College, to verify the production of enzymes regarded as virulence factors, and to determine how susceptible the isolated samples from patients with candidiasis are to antifungal agents. METHODS: Between March and November of 2008 a total of 283 samples were taken randomly from the environment and from the hands of health staff, and samples of all the suspected cases of Candida spp. hospital-acquired infection were collected and selected by the Infection Control Committee. The material was processed and the yeast genus Candida was isolated and identified by physiological, microscopic, and macroscopic attributes. RESULTS: The incidence of Candida spp. in the environment and employees was 19.2%. The most frequent species were C. parapsilosis and C. tropicalis among the workers, C. guilliermondii and C. tropicalis in the air, C. lusitanae on the contact surfaces, and C. tropicalis and C. guilliermondii in the climate control equipment. The college hospital had 320 admissions, of which 13 (4%) presented Candida spp. infections; three of them died, two being victims of a C. tropicalis infection and the remaining one of C. albicans. All the Candida spp. in the isolates evidenced sensitivity to amphotericin B, nystatin, and fluconazole. CONCLUSIONS: The increase in the rate of hospital-acquired infections caused by Candida spp. indicates the need to take larger measures regarding recurrent control of the environment.

Study of the risk factors related to acquisition of urinary tract infections in patients submitted to renal transplant

INTRODUCTION: Urinary tract infections (UTI) among transplant recipients are usually caused by gram-negative microorganisms and can provoke a high incidence of morbidity and mortality. The aim of this study was to evaluate the risk factors associated with the acquisition of UTIs during the first year after renal transplantation. METHODS: Here, we report a single-center retrospective cohort study of 99 renal transplant patients followed for the first year after surgery. The definition of a UTI episode was a urine culture showing bacterial growth and leucocyturia when patients presented with urinary symptoms. The absence of infection (asymptomatic bacteriuria) was defined as an absence of symptoms with negative urine culture or bacterial growth with any number of colonies. RESULTS: Ninety-nine patients were included in the study. During the study, 1,847 urine cultures were collected, and 320 (17.3%) tested positive for bacterial growth. Twenty-six (26.2%) patients developed a UTI. The most frequent microorganisms isolated from patients with UTIs were Klebsiella pneumoniae (36%), with 33% of the strains resistant to carbapenems, followed by Escherichia coli (20%). There were no deaths or graft losses associated with UTI episodes. CONCLUSIONS: Among the UTI risk factors studied, the only one that was associated with a higher incidence of infection was female sex. Moreover, the identification of drug-resistant strains is worrisome, as these infections have become widespread globally and represent a challenge in the control and management of infections, especially in solid organ transplantation.

Factors associated with seropositivity for APGL-Iamong household contacts of leprosy patients

Abstract: INTRODUCTION: Leprosy is mainly transmitted among family members who share genetic and ambient factors. The clinical form of leprosy in the index case and kinship could be risk factors for leprosy transmission. High antibody levels in household contacts (HC) in the absence of neural or skin lesions may characterize latent infection. This study aimed to evaluate the association between seropositivity for anti-phenolic glycolipid-I immunoglobulin M antibodies (APGL-I) in HC and the clinical classification of the index case and to analyze the association between APGL-I positivity with other factors such as age, kinship, and gender. METHODS: We performed a survey among 320 HC of 120 leprosy patients who were evaluated and followed-up in a leprosy outpatient clinic of a university hospital. All HC underwent complete skin examination, peripheral nerve palpation, skin sensory tests, and serologic tests for the detection and quantification of APGL-I. RESULTS: The overall seropositivity rate was 20%, and was greatly affected by kinship. APGL-I seropositivity was higher in siblings (41%), followed by parents (28%), spouses (26%), other (19%), and offspring (14%). Independent risk factors for seropositivity were being siblings (OR 3.3) and being a HC of an index case with indeterminate leprosy (OR 5.3). APGL-I seropositivity was associated with index cases with a bacillary index of 4 (88%; p<.001). Seropositivity among HC was not significantly associated with their gender and age. There was no statistical difference in the seropositivity rates of HC of index patients with paucibacillary and multibacillary leprosy. CONCLUSIONS: Strict evaluation and follow-up of HC with positive results for APGL-I is recommended. Special attention should be paid during the screening of siblings of the index cases, HC of patients with a high bacillary index, and HC of patients with indeterminate leprosy.

Endovascular techniques for placement of long-term chemotherapy catheters

PURPOSE: To analyze the results from using endovascular techniques to place long-term chemotherapy catheters when advancing the catheter using the external jugular vein is difficult due to obstructions or kinking. METHODS: Between July 1997 and August 2000, 320 long-term chemotherapy catheters were placed, and in 220 cases the external jugular vein was used as the primary venous approach. In 18 of these patients, correct positioning was not achieved and several endovascular techniques were then utilized to overcome these obstacles, including manipulation of a J-wire with a moveable core, venography, and the exchange wire technique. RESULTS: In 94.5% of the patients with difficulties in obtaining the correct positioning, we were able to advance the long-term catheter to the desired position with the assistance of endovascular techniques. CONCLUSIONS: Venography and endovascular guidance techniques are useful for the placement of long-term catheters in the external jugular vein.

Propriedades antioxidantes e compostos bioactivos em vinhos portugueses monocasta

Tem sido atribuída ao vinho a designação de alimento antioxidante, devido ao seu alto teor em compostos polifenólicos, pelo que o seu consumo moderado pode apresentar efeitos benéficos para a saúde do consumidor. Neste trabalho foram estudados 228 vinhos portugueses monocastas (190 tintos, 30 brancos e 8 rosés), produzidos em 8 regiões do país, (Alentejo, Algarve, Península de Setúbal, Lisboa, Tejo, Verdes, Dão e Trás-os-Montes e Alto Douro) a partir de 12 castas tintas (Alfrocheiro, Alicante Bouschet, Aragonez-Tinta Roriz, Cabernet Sauvignon, Castelão, Merlot, Petit Verdot, Syrah, Tinta Miúda, Touriga Nacional, Trincadeira e Vinhão) e 6 castas brancas (Antão Vaz, Arinto, Chardonnay, Fernão Pires, Malvasia Fina e Verdelho). Estes vinhos foram avaliados quanto à sua composição fenólica por HPLC-DAD, propriedades antioxidantes (reacção de Folin-Ciocalteu, poder de redução férrica, FRAP e capacidade de sequestração do radical DPPH) e foram caracterizados por UV-VIS. Observaram-se correlações fortes entre as actividades antioxidantes dos vinhos e as suas características cromáticas, nomeadamente as suas absorvâncias a 420, 520 e 620 nm, mas também com as absorvâncias a 280 nm, 320 nm ou 360 nm que correspondem a compostos fenólicos não corados. As castas Alicante Bouschet e Petit Verdot destacaram-se quanto às suas propriedades antioxidantes, enquanto as regiões da Península de Setúbal e do Dão revelaram ter características que favorecem a actividade antioxidante dos vinhos nelas produzidos, por comparação com vinhos das mesmas castas produzidos noutras regiões. A análise de HPLC permitiu detectar 52 compostos fenólicos (17 ácidos hidroxibenzóicos ou derivados, 8 flavanóis ou procianidinas, 12 ácidos hidroxicinâmicos e 7 flavonóis) presentes na maior parte dos vinhos tintos analisados. Os resultados obtidos neste trabalho evidenciam a complexidade de factores que determinam as propriedades biológicas e composição fenólica dos vinhos tintos, rosés ou brancos, e que incluem casta, parâmetros edafo-climáticos e características do processo de vinificação.

The persistence of ant-following birds in small amazonian forest fragments

SUMMARYMist-net captures of army ant-following bird were monitored during the isolation of central Amazonian forest fragments of 1 ha (n = 5), 10 ha (n = 4) and 100 ha (n = 1). Post-isolation captures of the three obligate ant-following birds Dendrocinela merula, Pithys albifrons, and Gymnopithys rufigula decreased significantly in all fragments. post-isolation captures of four facultative ant-following species were not significantly different in forest fragments of 1 ha and 10 ha, although two species decreased significantly in the 100 ha fragment. Experimental introductions of obligate species into small forest fragments in the absence and presence of introduced Eciton burchelli army ant colonies resulted in significantly greater recaptures of introduced birds when active army ant colonies were present. Of the 105 birds introduced, 58 ' 55%) crossed 100-320 m od dedorested area an were recaptured in continuous forest.

ABUNDÂNCIA E DISTRIBUIÇÃO VERTICAL DE COLEÓPTEROS DO SOLO EM CAPOEIRA DE TERRA FIRME NA REGIÃO DE MANAUS - AM, BRASIL

Na região Amazônica, pouco se conhece sobre a fauna de Coleópteros do solo. Efetuou-se o presente trabalho para conhecer sua abundância e distribuição vertical no solo de terra firme, com cobertura florística de capoeira. O estudo compreendeu 13 coletas mensais de amostras de solo na reserva Tarumã-Mírim, 20 km ao norte de Manaus. As 156 amostras, provenientes de uma área de 1.320 m2, media 21 cm de diâmetro por 7 cm de profundidade, e foram divididas em sub-amostras de 0-3,5 cm e 3,5 - 7 cm; para extrair os coleópteros em laboratório usou-se o método de Kempson modificado. Dos 2.828 adultos capturados (524 ind/m2), encontrou-se 81% na camada superficial. As famílias mais abundantes foram Scydmaenidae (22%), Ptiliidae (22%) e Pselaphldae (21%). Do Total dos adultos, 52% foram capturados na época seca e fêz-se correlações entre o número de Indivíduos das principais famílias com fatores climáticos. As larvas (1.138 Indivíduos) não foram classificadas.

Efeito do cálcio no controle da Hypsipila grandella em mudas de mogno cultivadas em hidroponia

Este trabalho teve como objetivo avaliar o teor de cálcio e o efeito do ataque da lagarta H. grandella em plantas jovens de mogno (S. macrophylla), cultivadas em função de diferentes épocas de aplicação de doses crescentes de cálcio no substrato sílica moída, utilizando sistema hidropônico. O experimento foi instalado em casa de vegetação na Universidade Federal Rural da Amazônia (UFRA), Belém-PA, de setembro de 2004 a fevereiro de 2005. Utilizou-se cinco doses de cálcio (0, 80, 160, 240, 320 mg Ca.L-1), em solução nutritiva proposta por Hoagland & Arnon, modificada por Epstein (1975). O delineamento experimental foi inteiramente casualizado (DIC), as variáveis utilizadas para avaliação foram a susceptibilidade do mogno ao ataque da broca H. grandella, comprimento da galeria da broca e o teor de cálcio no caule. Foi realizado um DIC com cinco doses de cálcio, cinco repetições cada, e duas épocas de inoculação da broca. Utilizou-se regressões lineares simples para interpretação dos dados. Através da pesquisa, conclui-se que a aplicação de doses de cálcio, em solução nutritiva, reduziu o comprimento da galeria de infecção e exerce eficiente ação no controle do ataque da praga em plantas de mogno.

Ranking procedure based on mechanical, durability and thermal behavior of mortars with incorporation of phase change materials

Nowadays, considering the high variety of construction products, adequate material selection, based on their properties and function, becomes increasingly important. In this research, a ranking procedure developed by Czarnecki and Lukowski is applied in mortars with incorporation of phase change materials (PCM). The ranking procedure transforms experimental results of properties into one numerical value. The products can be classified according to their individual properties or even an optimized combination of different properties. The main purpose of this study was the ranking of mortars with incorporation of different contents of PCM based in different binders. Aerial lime, hydraulic lime, gypsum and cement were the binders studied. For each binder, three different mortars were developed. Reference mortars, mortars with incorporation of 40% of PCM and mortars with incorporation of 40% of PCM and 1% of fibers, were tested. Results show that the incorporation of PCM in mortars changes their global performance.

Fatores sociodemográficos e econômicos associados ao tabagismo na população idosa

Objetivos Identificar a condição tabágica dos idosos e verificar os fatores sociodemográficos e econômicos associados ao hábito de fumar nessa população. Métodos Trata-se de um estudo quantitativo, transversal, observacional e analítico, com 980 idosos da zona urbana do município de Uberaba-MG. Utilizaram-se os instrumentos Miniexame do Estado Mental (MEEM) e Questionário Brasileiro de Avaliação Funcional e Multidimensional (BOMFAQ). Os idosos foram classificados como tabagistas, ex-tabagistas e não tabagistas de acordo com as Diretrizes para Cessação do Tabagismo. As análises procederam por meio do software SPSS-17. A condição tabágica dos idosos foi descrita por meio de frequências simples e absolutas. Aplicou-se o teste Cramer’s V (p ≤ 0,05) na análise bivariada e em seguida a Regressão Logística Multinomial Múltipla (p ≤ 0,05) ajustados para sexo e faixa etária de acordo com a classificação tabágica. Resultados Encontraram-se 122 (12,4%) idosos tabagistas, 320 (32,7%) ex-tabagistas e 538 (54,9%) não tabagistas. Os idosos tabagistas apresentaram-se com 3,57, 2,36 e 1,82 mais riscos de chances de ser do sexo masculino (p < 0,001), estar na faixa etária de 60 a 69 anos (p = 0,004) e não ter companheiro(a) (p = 0,008), respectivamente. Para os idosos ex-tabagistas, também foi encontrada maior chance de risco (5,34) para o sexo masculino (p < 0,001). Conclusão Os resultados evidenciam que o sexo, a faixa etária e a situação conjugal são fatores associados ao tabagismo na população idosa.

Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%); left anterior descending in 102 patients (27.35%); circumflex artery in 39 patients (10.46%); and diagonal artery in 14 patients (3.74%). We used 320 (85.79%) venous grafts and 53 (14.21%) arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003). Cause of death was related to acute myocardial infarction in 18 (54.55%) patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168), left main disease (<0.001; 9.283), female sex (0.01; 3.111), acute myocardial infarction (0.02; 3.546), ejection fraction <35% (<0.001; 5.89), and previous myocardial revascularization (<0.001; 4.295). CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.

Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children

OBJECTIVE - A prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal pH in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. METHODS - We studied 10 children, during the immediate postoperative period after elective cardiac surgery. Sequential intramucosal pH measurements were taken, without dobutamine (T0) and with 5mcg/kg/min (T1) and 10 (T2) mcg/kg/min. In the pediatric intensive care unit, intramucosal pH measurements were made on admission and 4, 8, 12, and 24 hours thereafter. RESULTS - The patients had an increase in intramucosal pH values with dobutamine 10mcg/kg/min [7.19± 0.09 (T0), 7.16±0.13(T1), and 7.32±0.16(T2)], (p=0.103). During the hospitalization period, the intramucosal pH values were the following: 7.20±0.13 (upon admission), 7.27±0.16 (after 4 hours), 7.26±0.07 (after 8 hours), 7.32±0.12 (after 12 hours), and 7.38±0.08 (after 24 hours), (p=0.045). No deaths occurred, and none of the patients developed multiple organ and systems dysfunction. CONCLUSION - An increase in and normalization of intramucosal pH was observed after dobutamine use. Measurement of intramucosal pH is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.

A multicenter, open-label study of the efficacy and safety of telmisartan in mild to moderate hypertensive patients

OBJECTIVE: To evaluate the efficacy and tolerability of telmisartan, given once a day to patients with mild to moderate hypertension, as well as to assess the 24-hour blood pressure profile with ABPM. METHODS: Initially, 163 patients over 18 were selected, regardless of sex, with blood pressure levels >140/90mmHg at visit 1, which was confirmed at visit 2. One hundred thirty-four patients completed the study. After a 4-week placebo run-in phase, telmisartan 40mg/daily was given for 6 weeks. In those patients whose blood pressure (BP) levels were lower than 140/90mmHg, the same dosage was kept for an additional period of 6 weeks. For those who had BP higher than 140/90mmHg, the dosage was increased to 80mg/daily. Sixty-two patients were included in a subgroup that underwent ABPM 3 different times during the study. RESULTS: In the overall group, blood pressure reduction ranged from 162.3±14.5/101.3±5.75 mmHg (baseline) to 147.3±20.1/90.8±10.9 mmHg (week 12) (p<0.05). Mean blood pressure decreases were 14.4mmHg for systolic BP and 10.3mmHg for diastolic BP, after 12 weeks of active treatment. A subanalysis showed that 47 (35%) patients took telmisartan 40mg throughout the study and 81 (65%) had the dosage increased to 80mg daily. Using ABPM, an 8-mmHg reduction in systolic BP as well as a 5-mmHg reduction in diastolic BP were observed, when compared with baseline values in the final 6 hours (18-24 hours after the last dose of study medication). CONCLUSION: Our results confirm that telmisartan given once a day is effective in reducing blood pressure levels in mild to moderate hypertensive patients. This reduction occurs in a sustained and gradual manner during a 24-hour period confirmed by ABPM.

A administração precoce de hormônio de crescimento resulta em efeitos deletérios na remodelação ventricular após o infarto agudo do miocárdio

OBJETIVO: Verificar a ação do hormônio de crescimento (GH) sobre a remodelação miocárdica em ratos infartados. MÉTODOS: Ratos Wistar foram submetidos ao infarto e tratados com GH (IAM-GH; n=8), ou com o veículo (IAM; n=8). Ratos controles foram submetidos ao infarto simulado (C; n=8). Após 30 dias, os animais foram submetidos ao estudo funcional por meio de ecocardiograma e as alterações da contratilidade miocárdica estudadas no músculo papilar isolado do ventrículo esquerdo (VE). RESULTADOS: O ecocardiograma identificou aumento nos diâmetros (mm) diastólico (C=7,32±0,49; IAM=8,50±0,73; IAM-GH= 9,34± 0,73; P<0,05) e sistólico (C=3,38±0,47, IAM= 5,16±1,24; IAM-GH=5,96±1,54; P<0,05) no VE dos animais com infarto. Os animais do grupo IAM-GH apresentaram menor fração (%) de ejeção (C=0,9±0,03; IAM=0,76±0,12; IAM-GH=0,72±0,14; P<0,05 para C vs IAM-GH) em relação aos controles. O estudo do músculo papilar isolado do ventrículo esquerdo mostrou que o grupo IAM-GH apresentou alterações (C=1,50±0,59; IAM= 1,28±0,38; IAM-GH=1,98±0,41; P<0,05 para C vs IAM-GH) somente na tensão de repouso (TR - g/mm²) e no delta do tempo para a tensão desenvolvida decrescer 50% (TR50, ms) após estimulação com cálcio (C=23,75±9,16; IAM=-16,56±14,82; IAM-GH=-4,69±8,39; P<0,05 para C vs IAM-GH) e no delta da tensão desenvolvida (TD, g/mm²) após estimulação com isoproterenol (C=0,99±0,17; IAM=0,54±0,62; IAM-GH= 0,08±0,75; P<0,05 para C vs IAM-GH), em relação aos animais controle. CONCLUSÃO: A administração precoce do GH no modelo de infarto experimental em ratos pode resultar em efeitos adversos no processo de remodelação ventricular.

Análise de custos do tratamento de episódios de descompensação aguda de insuficiência cardíaca: levosimendan versus dobutamina

OBJETIVO: Verificar se o tratamento com levosimendan seria mais dispendioso que o usual com dobutamina, uma vez que o preço dos medicamentos não representa a maior despesa no tratamento da descompensação cardíaca. MÉTODOS: Comparou-se o custo do tratamento de 18 pacientes hospitalizados devido a descompensação cardíaca, 9 tratados com dobutamina (grupo dobuta) e 9 com levosimendan (grupo levo). Os grupos foram semelhantes quanto à idade, sexo, classe funcional e função cardíaca. RESULTADOS: O custo do tratamento foi semelhante para os dois grupos. No grupo levo as despesas com medicamentos foram maiores, mas as relativas ao período de terapia intensiva e do material empregado foram menores. Levo - medicamentos: R$ 5.414,00; materiais: R$ 399,90; diárias hospitalares: R$ 5.061,20; serviços profissionais: R$ 3.241,80; final: R$ 14.117,00. Dobuta - medicamentos: R$ 2.320,10; materiais: R$ 1.665,70; diárias hospitalares: R$ 6.261,90; serviços profissionais: R$ 3.894,30; final: R$ 14.142,00. CONCLUSÃO: Apesar do preço mais elevado da droga, o custo global do tratamento foi semelhante para os pacientes tratados com dobutamina ou levosimendan. O paciente tratado com levosimendan permaneceu menos tempo em terapia intensiva.