Detecção e caracterização de patotipos diarreiogênicos de Escherichia coli por métodos fenotípicos e genotípicos em indivíduos de todas as idades atendidos nas unidades de saúde de Vitória-ES

A diarreia é a segunda causa de mortalidade em <5 anos e é responsável pela diminuição da produtividade na população economicamente ativa. Dentre os agentes infecciosos envolvidos, seis patotipos diarreiogênicos de Escherichia coli (DEC) merecem destaque: E. coli enteropatogênica (EPEC), E.coli enteroinvasora (EIEC), E. coli enterotoxigênica (ETEC), E. coli enteroemorrágica ou produtora de toxina de Shiga (EHEC/STEC), E. coli enteroagregativa (EAEC) e E. coli de aderência difusa (DAEC). O objetivo deste estudo foi determinar a frequência dos patotipos de DEC e caracterizar fenotípica e genotipicamente EAEC, DAEC, aEPEC e E. coli chain-like adhesion (CLA) isolados de fezes indivíduos de todas as idades atendidos nas Unidades de Saúde do município de Vitória, ES, entre janeiro de 2008 e junho de 2011. Os isolados de E. coli foram submetidos à: (i) PCR para detecção dos genes eae, bfpA, aat, lt, st, ipaH, stx1 e stx2; (ii) hibridização de colônia com as sondas eae, aat e daaC; (iii) adesão em cultura de células HEp-2 para evidenciar padrão de aderência agregativa (AA), difusa (DA) e chain-like adhesion (CLA). PCR para detecção de genes de virulência foi realizado em isolados de EAEC, CLA, DAEC e aEPEC. Isolados de EAEC e CLA, foram submetidos a testes de formação de biofilme e de película. Foram obtidos 328 espécimes fecais e E. coli foi isolada de 85,7%. Os seguintes patotipos foram identificados: EAEC (18,3%), DAEC (11%), aEPEC (2,6%), ETEC (0,7%). CLA foi identificada em 4,9% e EIEC, tEPEC e STEC não foram detectados. Dos 60 isolados de EAEC (AA) (25% aat+ por PCR e 35% por hibridização), fímbrias de aderência agregativa foram evidenciadas em baixa frequência (aggA- 1,7%, aafA- 0%, agg3A- 11,7%, hdA- 8,3%). EAEC típica correspondeu a 31,7% dos isolados de EAEC (aggR+), e foram significantes nestas a formação de biofilme, escore 3+ de produção de película e presença dos genes aat, agg3A, hdA, aap, sat, pet, set1A e iucA. Todos os isolados CLA apresentaram o gene pet, 87,5%, foram aggR-, formaram película e nenhum produziu biofilme. Dentre dos 42 isolados de DAEC (DA), a sonda daaC detectou 52,4%. PCR evidenciou adesinas afa/Dr (daaD e afa) em 59,5% e adesina AIDA-I não foi encontrada, sugerindo que outras adesinas estejam envolvidas na adesão da DAEC. Isolados de DAEC afa/Dr + foram estatisticamente mais isolados de <5 anos. Em aEPEC, os genes da ilha de patogenicidade OI-122 pesquisados, nleE, efa1/lifA e paa foram evidenciados em 30% dos isolados, todos provenientes de <5 anos. Características de virulência de tEAEC e DAEC Afa/Dr sugerem que sejam subpopulações relacionadas com diarreia. CLA não parece ser variante de EAEC.

Claustrophobia and adherence in magnetic resonance imaging procedure

Claustrophobia causes a huge discomfort to those who need to perform Magnetic Resonance examinations mainly due to the physical design of most equipment. This study aimed to maximize the success rate of Magnetic Resonance Imaging (MRI) clinical studies in claustrophobic patients by the identification of facilitative strategies.

Diffuse liver disease classification from ultrasound surface characterization, clinical and laboratorial data

In this work liver contour is semi-automatically segmented and quantified in order to help the identification and diagnosis of diffuse liver disease. The features extracted from the liver contour are jointly used with clinical and laboratorial data in the staging process. The classification results of a support vector machine, a Bayesian and a k-nearest neighbor classifier are compared. A population of 88 patients at five different stages of diffuse liver disease and a leave-one-out cross-validation strategy are used in the classification process. The best results are obtained using the k-nearest neighbor classifier, with an overall accuracy of 80.68%. The good performance of the proposed method shows a reliable indicator that can improve the information in the staging of diffuse liver disease.

Cardiorespiratory fitness is negatively associated with metabolic risk factors independently of the adherence to a healthy dietary pattern

Background and aim: Cardiorespiratory fitness (CRF) and diet have been involved as significant factors towards the prevention of cardio-metabolic diseases. This study aimed to assess the impact of the combined associations of CRF and adherence to the Southern European Atlantic Diet (SEADiet) on the clustering of metabolic risk factors in adolescents. Methods and Results: A cross-sectional school-based study was conducted on 468 adolescents aged 15-18, from the Azorean Islands, Portugal. We measured fasting glucose, insulin, total cholesterol (TC), HDL-cholesterol, triglycerides, systolic blood pressure, waits circumference and height. HOMA, TC/HDL-C ratio and waist-to-height ratio were calculated. For each of these variables, a Z-score was computed by age and sex. A metabolic risk score (MRS) was constructed by summing the Z scores of all individual risk factors. High risk was considered when the individual had 1SD of this score. CRF was measured with the 20 m-Shuttle-Run- Test. Adherence to SEADiet was assessed with a semi-quantitative food frequency questionnaire. Logistic regression showed that, after adjusting for potential confounders, unfit adolescents with low adherence to SEADiet had the highest odds of having MRS (OR Z 9.4; 95%CI:2.6e33.3) followed by the unfit ones with high adherence to the SEADiet (OR Z 6.6; 95% CI: 1.9e22.5) when compared to those who were fit and had higher adherence to SEADiet.

Non-adherence to telemedicine interventions for drug users: systematic review

OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug addiction. METHODS A systematic review was conducted of randomized controlled trials investigating different telemedicine treatment methods for drug addiction. The following databases were consulted between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library), Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated were: appropriate sequence of data generation, allocation concealment, blinding, description of losses and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions evaluated were of at least three months duration and, although they all used telemedicine as support, treatment methods differed. Regarding the quality of the studies, the values also varied from very poor to high quality. High quality studies showed better adherence rates, as did those using more than one technique of intervention and a limited treatment time. Mono-user studies showed better adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving telemedicine on the part of users of psycho-active substances differed considerably, depending on the country, the intervention method, follow-up time and substances used. Using more than one technique of intervention, short duration of treatment and the type of substance used by patients appear to facilitate adherence.

Simplification of Immune Adherence Hemagglutination test for detection of rabies antibodies in human serum

In the present work the immune adherence hemagglutination test (IAHA) was standardized in a simplified procedure. This test showed good reproducibility, better than the classical mice serum neutralization test (SN). The tests showed high correlation degree: high titers in one test corresponded to high titers in the other one, and the same occured with low titers. The IAHA test is extremely simple, fast to perform, and of low cost when compared to tests such as SN or indirect immunofluorescense (IIF). It also proved to be useful in less sophisticated laboratories or even as a screening test for the titration of rabies antibodies.

Adherence to health-related behaviors: effectiveness of implementation intentions and posthypnotic suggestion in college students

Resumo: Com base no conceito de implementação de intenções (Gollwitzer, 1993, 1999) e na teoria do contexto de resposta de Kirsch & Lynn (1997), o presente trabalho testou a eficácia de uma intervenção combinada de implementação de intenções com hipnose e sugestão pós-hipnótica na promoção da adesão a uma tarefa simples (avaliação do humor) e uma tarefa difícil (actividade física). Os participantes são estudantes universitários de uma universidade na Nova Jérsia, (N=124, Estudo 1, EUA) e em Lisboa (N=323, Estudo 2, Portugal). Em ambos os estudos os participantes foram seleccionados a partir de uma amostra mais vasta baseado num escrutínio da sua sugestibilidade hipnótica avaliada por meio da Escala de Grupo de Sugestibilidade Hipnótica de Waterloo-Stanford (WSGC): Forma C. O Estudo 1 usou um desenho factorial do tipo 2x2x3 (tipo de intenção formada x hipnose x nível de sugestionabilidade) e o Estudo 2 usou um desenho factorial do tipo 2 x 2x 2 x 4 (tipo de tarefa x tipo de intenção formada x hipnose x nível de sugestionabilidade). No Estudo 1 foi pedido aos participantes que corressem todos os dias e durante três semanas durante 5 minutos, que medissem a sua pulsação antes e depois da actividade física e que mandassem um e-mail ao experimentador, fornecendo assim uma medida comportamental e uma medida de auto-relato. Aos participantes no grupo de intenções de meta foi apenas pedido que corressem todos os dias. Aos participantes no grupo de implementação de intenções foi pedido que especificasses com exactidão quando e onde iriam correr e enviar o e-mail. Para além disso, cerca de metade dos participantes foram hipnotizados e receberam uma sugestão pós-hipnótica em que lhes foi sugerido que o pensamento de correr todos os dias lhes viria à mente sem esforço no momento apropriado. A outra metade dos participantes não recebeu qualquer sugestão hipnótica. No Estudo 2 foi seguido o mesmo procedimento, mas a cerca de metade dos participantes foi atribuída uma tarefa fácil (enviar um Adherence to health-related behaviors ix SMS com a avaliação diária do seu estado de humor naquele momento) e à outra metade da amostra foi atribuída a tarefa de exercício físico atrás descrita (tarefa difícil). Os resultados do estudo 1 mostraram uma interacção significativa entre o nível de sugestionabilidade dos participantes e a sugestão pós-hipnótica (p<.01) indicando que a administração da sugestão pós-hipnótica aumentou a adesão nos participantes muito sugestionáveis, mas baixou a adesão nos participantes pouco sugestionáveis. Não se encontraram diferenças entre os grupos que formaram intenções de meta e os que formaram implementação de intenções. No Estudo 2 os resultados indicaram que os participantes aderiram significativamente mais à tarefa fácil do que à tarefa difícil (p<.001). Os resultados não revelaram diferenças significativas entre as condições implementações de intenções, hipnose e as duas estratégias combinadas, indicando que a implementação de intenções não foi eficaz no aumento da adesão às duas tarefas propostas e não beneficiou da combinação com as sugestões pós-hipnóticas. A utilização da hipnose com sugestão pós-hipnótica significativamente reduziu a adesão a ambas as tarefas. Dado que não existiam instrumentos em Português destinados a avaliar a sugestionabilidade hipnótica, traduziu-se e adaptou-se para Português Escala de Grupo de sugestibilidade hipnótica de Waterloo-Stanford (WSGC): Forma C. A amostra Portuguesa (N=625) apresentou resultados semelhantes aos encontrados nas amostras de referência em termos do formato da distribuição dos padrões da pontuação e do índice de dificuldade dos itens. Contudo, a proporção de estudantes portugueses encontrada que pontuaram na zona superior de sugestionabilidade foi significativamente inferior à proporção de participantes na mesma zona encontrada nas amostras de referência. No sentido de lançar alguma luz sobre as razões para este resultado, inquiriu-se alguns dos participantes acerca das suas atitudes face à hipnose utilizando uma versão portuguesa da Escala de Valência de Atitudes e Crenças face à Hipnose e comparou-se com a opinião de Adherence to health-related behaviors xAbstract: On the basis of Gollwitzer’s (1993, 1999) implementation intentions’ concept, and Kirsch & Lynn’s (1997) response set theory, this dissertation tested the effectiveness of a combined intervention of implementation intentions with hypnosis with posthypnotic suggestions in enhancing adherence to a simple (mood report) and a difficult (physical activity) health-related task. Participants were enrolled in a university in New Jersey (N=124, Study 1, USA) and in two universities in Lisbon (N=323, Study 2, Portugal). In both studies participants were selected from a broader sample based on their suggestibility scores using the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility and then randomly assigned to the experimental groups. Study 1 used a 2x2x3 factorial design (instruction x hypnosis x level of suggestibility) and Study 2 used a 2 x 2x 2 x 4 factorial design (task x instructions x hypnosis x level of suggestibility). In Study 1 participants were asked to run in place for 5 minutes each day for a three-week period, to take their pulse rate before and after the activity, and to send a daily email report to the experimenter, thus providing both a self-report and a behavioral measure of adherence. Participants in the goal intention condition were simply asked to run in place and send the e-mail once a day. Those in the implementation intention condition were further asked to specify the exact place and time they would perform the physical activity and send the e-mail. In addition, half of the participants were given a post-hypnotic suggestion indicating that the thought of running in place would come to mind without effort at the appropriate moment. The other half did not receive a posthypnotic suggestion. Study 2 followed the same procedure, but additionally half of the participants were instructed to send a mood report by SMS (easy task) and half were assigned to the physical activity task described above (difficult task). Adherence to health-related behaviors vii Study 1 result’s showed a significant interaction between participant’s suggestibility level and posthypnotic suggestion (p<.01) indicating that posthypnotic suggestion enhanced adherence among highly suggestible participants, but lowered it among low suggestible individuals. No differences between the goal intention and the implementation intentions groups were found. In Study 2, participants adhered significantly more (p<.001) to the easy task than to the difficult task. Results did not revealed significant differences between the implementation intentions, hypnosis and the two conditions combined, indicating that implementation intentions was not enhanced by hypnosis with posthypnotic suggestion, neither was effective as single intervention in enhancing adherence to any of the tasks. Hypnosis with posthypnotic suggestion alone significantly reduced adherence to both tasks in comparison with participants that did not receive hypnosis. Since there were no instruments in Portuguese language to asses hypnotic suggestibility, the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility was translated and adapted to Portuguese and was used in the screening of a sample of college students from Lisbon (N=625). Results showed that the Portuguese sample has distribution shapes and difficulty patterns of hypnotic suggestibility scores similar to the reference samples, with the exception of the proportion of Portuguese students scoring in the high range of hypnotic suggestibility, that was found lower than the in reference samples. In order to shed some light on the reasons for this finding participant’s attitudes toward hypnosis were inquired using a Portuguese translation and adaptation of the Escala de Valencia de Actitudes y Creencias Hacia la Hipnosis, Versión Cliente, and compared with participants with no prior hypnosis experience (N=444). Significant differences were found between the two groups with participants without hypnosis experience scoring higher in factors indicating misconceptions and negative attitudes about hypnosis.

Factors that Influence Adherence to Exercise among Patients Attending a Cardiac Rehabilitation Program

Objective: The aim of this study was to compare the factors of adherence to physical activity in subjects attending a cardiac rehabilitation program, and subjects who have withdrawal this same program using the Transtheoretical Model of behavior change. Methods: We conducted an observational, cross sectional type study, with a sample of 33 individuals (15 currently participating in the Cardiac Rehabilitation Program and 18 who no more attended the same program), with the questionnaires being personally delivered or sent by mail. For data analysis, we used the computer program SPSS® version 16.0. The significance level was set at 0.05. Results: There were no significant differences in the states of Change, Self-efficacy, Decisional Balance and Change Processes in both groups. We obtained a high Spearman correlation between States of Change and Self-efficacy (r2 = 0.778) and the Pros (r2 = 0.764) and Againsts (r2 = -0.744) in Decisional Balance. However, there were no significant evidence to affirm that States of Change and experiential processes of change (p = 0.465) andbehavioral (p = 0.300) had a correlation. A relationship was found, in terms of proportions between physical activity incorporated or not in a Cardiac Rehabilitation Program and age (p = 0.003), occupation (p = 0.010) and the entity paying the costs of program (p = 0.027). Conclusion: It was concluded that perceived self-efficacy and Pros and Againsts of the Decisional Balance are related to adherence to physical activity. Results also point out that age, profession and the entity paying the costs of the program influences the dropout of Cardiac Rehabilitation Programs.

Transformation of a Cutaneous Follicle Center Lymphoma to a Diffuse Large B-Cell Lymphoma - An Unusual Presentation

Primary cutaneous follicle center lymphoma (PCFCL) is characterized by a proliferation of follicle center cells in the skin. A definitive diagnosis is frequently delayed because of difficulties in interpretation of the histopathologic findings. It has an excellent prognosis with a 5-year survival over 95% and its risk of transformation has not been established. We describe a case report of man with a gastric diffuse large B-cell lymphoma (DLBCL) referred to our clinic because of nodules in the back that had gradually developed over a period of 10 years. A biopsy performed 3 years before was interpreted as reactive follicular hyperplasia. A new skin biopsy revealed a diffuse large B-cell lymphoma and immunoglobulin heavy chain gene rearrangements from the initial skin biopsy (PCBCL) and the DLBCL gastric biopsy were studied by polymerase chain reaction and an identical clonal rearrangement was detected which was highly suggestive of a transformation lymphoma.

Cell surface hydrophobicity and adherence of a strain of group B streptococci during the post-antibiotic effect of penicillin

The minimum inhibitory concentration and post-antibiotic effects of an antimicrobial agent are parameters to be taken into consideration when determining its dosage schedules. The in vitro post-antibiotic effects on cell surface hydrophobicity and bacterial adherence were examined in one strain of group B streptococci. Exposure of the microorganism for 2 h at 37 °C to 1 x MIC of penicillin induced a PAE of 1.1 h. The cell surface charge of the Streptococcus was altered significantly during the post-antibiotic phase as shown by its ability to bind to xylene: hydrophobicity was decreased. Bacterial adherence to human buccal epithelial cells was also reduced. The results of the present investigation indicate that studies designed to determine therapeutic regimens should evaluate the clinical significance of aspects of bacterial physiology during the post-antibiotic period.

Predictors of adherence to the Mediterranean diet from the first to the second trimester of pregnancy

Background: Although changes in eating patterns may occur during gestation, predictors of these changes have not been explored. This study aimed to identify predictors of adherence to the Mediterranean diet (MD) from the first to second trimester of pregnancy. Methods: A prospective study was conducted with 102 pregnant women aged 18-40, from the city of Porto, Portugal. Socio-demographic and lifestyle characteristics were assessed through a questionnaire. Food consumption was assessed with a three-day food diary completed during the first and second trimesters. Participants were categorized according to their change in adherence to the MD into the negative change group (i.e., women who had low adherence in each trimester or had high adherence in the first trimester and then low adherence in the second) and the positive change group (i.e., women who had high adherence in both trimesters or had low adherence in the first trimester and then high adherence in the second). Conditional stepwise logistic regression models were performed to assess the potential predictors of negative MD change. Results: Among the 102 women, 39.2% had negative change from the first to the second trimester. The logistic model´s results show that being married (OR=0.26, 95%CI: 0.10, 0.76) and having a higher intake of vegetables in the first trimester (OR=0.17, 95%CI: 0.10, 0.43) were associated with lower odds of having a negative change in adherence to the MD from the first to second trimester. Conclusion: Marital status and vegetable consumption seem to be associated with a lower occurrence of negative change in adherence to the MD from early to middle pregnancy.

Risk-factors for non-adherence to antiretroviral therapy

Cross-sectional study analyzed as case-control to identify risk factors for non-adherence to antiretroviral therapy. We studied 412 out-clinics HIV infected subjects of three public hospitals of Recife, Pernambuco. The objective was to examine the association between non-adherence to the antiretroviral therapy and biological, social-behavior and demographics and economic factors, factors related to the disease and/or treatment, factors related to life habits and depression symptoms. Variables significantly associated with non-adherence to antiretroviral therapy were: time elapsed since HIV diagnosis (p = 0.002), daily dose (p = 0.046), use of alcohol (p = 0.030) and past drug use (p = 0.048), and borderline p-values were found for educational level (p = 0.093) and family monthly income (p = 0.08). In the multivariable analysis, the factors that remained in the final model were family monthly income, time period with HIV infection and use of alcohol. No association was observed between non-adherence to antiretroviral therapy and gender, age, sexual orientation, marital status, educational level and place of residence. Based on our results and the local situation we suggest: assessment of social needs; training of partners and/or families on supporting adherence, creation of "adherence groups" to motivate and to reassure patients on the benefits of treatment; counseling and/or psychotherapy for alcohol drinkers.

Differences in exoenzyme production and adherence ability of Candida spp. isolates from catheter, blood and oral cavity

Phospholipase and proteinase production and the ability of adhesion to buccal epithelial cells (BEC) of 112 Candida isolates originated from oral cavity of HIV infected patients and from blood and catheter of intensive care unit patients were investigated. The proteinase production was detected by inoculation into bovine serum albumin (BSA) agar and the phospholipase activity was performed using egg yolk emulsion. A yeast suspension of each test strain was incubated with buccal epithelial cells and the number of adherence yeast to epithelial cells was counted. A percentage of 88.1% and 55.9% of Candida albicans and 69.8% and 37.7% of non-albicans Candida isolates produced proteinase and phospholipase, respectively. Non-albicans Candida isolated from catheter were more proteolytic than C. albicans isolates. Blood isolates were more proteolytic than catheter and oral cavity isolates while oral cavity isolates produced more phospholipase than those from blood and catheter. C. albicans isolates from oral cavity and from catheter were more adherent to BEC than non-albicans Candida isolates, but the adhesion was not different among the three sources analyzed. The results indicated differences in the production of phospholipase and proteinase and in the ability of adhesion to BEC among Candida spp. isolates from different sources. This study suggests that the pathogenicity of Candida can be correlated with the infected site.