Risk factors for acquisition of Methicillin-resistant Staphylococcus aureus among patients from a burn unit in Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) is an important agent of colonization and infection in burn units. in order to identify risk factors for MRSA acquisition in a Brazilian burn unit, we performed two retrospective studies. In the first ("cohort" study), 175 patients who were not colonized with MRSA on admission were followed to assess risk factors for MRSA acquisition. in the second ("case-case-control" study), 143 individuals from the previous study who were negative for both MRSA and Methicillin-susceptible S. aureus (MSSA) on admission were followed. Case-control studies were performed to investigate risk factors for MRSA and MSSA acquisition. MRSA and MSSA were recovered from 75 and 23 patients, respectively. In the "cohort" study, only the number of wound excisions (Odds Ratio [OR] = 1.55, 95% Confidence Interval [CI] = 1.21-1.98, P = 0.001) was associated with MRSA acquisition. in the "case-case-control" study, burns involving head (OR=3.43, 95%CI = 1.50-7.81, P = 0.003) and the number of wound excisions (OR = 1.83, 95%CI = 1.27-2.63, P = 0.001) were significant risk factors for MRSA. Burns involving perineum were negatively associated with MSSA acquisition (OR = 0.16, 95%CI = 0.03-0.75, P = 0.02). In conclusion, the acquisition of MRSA was related to the site of the burn and to the surgical manipulation of tissues, but not to the use of antimicrobials. (C) 2009 Elsevier Ltd and ISBI. All rights reserved.

Prevalence and Risk Factors of Chlamydia trachomatis Cervicitis in Pregnant Women at the Genital Tract Infection in Obstetrics Unit Care at Botucatu Medical School, São Paulo State University - UNESP, Brazil

Objective. To evaluate the prevalence of and risk factors for Chlamydia trachomatis cervicitis in pregnant women seen at the Genital Tract Infection in Obstetrics Unit Care in Botucatu Medical School, São Paulo State University - UNESP.Materials and Methods. Between June 2006 and February 2008, 101 pregnant women were included in this study. During the gynecologic examination, cervical secretions were collected using cytobrush Plus GT (CooperSurgical Inc) to assess C. trachomatis using polymerase chain reaction. Vaginal flora were examined by Gram stain, and socio-demographic data were extracted from medical records.Results. of the 101 patients, 26 (25.7%) were positive for C. trachomatis. The median age of the infected group was 24 years (range = 13-40 y), and 48.5% of them had abnormal vaginal flora. The presence of chlamydial infection was associated with smoking (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 1.01-7.19), residing in a city with fewer than 100,000 inhabitants (OR = 2.86, 95% CI = 1.03-7.94), presence of condyloma acuminatum (p = .03), and presence of discreet inflammation on Pap smear (p = .02).Conclusions. The prevalence of C. trachomatis is high in pregnant women seen at the Genital Infection Unit Care, UNESP, and is related to many risk factors. Therefore, its screening is extremely important in reducing obstetrical and neonatal complications.

Caring for organ donors: the intensive care unit physicians' view

This study examined the meanings that the intensive care unit (ICU) physicians attribute to their practice when caring for brain-dead organ donors. It is a phenomenological study, a qualitative method that searches for describing and understanding the experiences lived. Data were collected through recorded individual interviews made with 10 ICU physicians who work in a university hospital in the interior of São Paulo, Brazil. Three categories emerged from data: (1) providing care for brain-dead organ donors; (2) relating to donors and their families; and (3) the ethical concerns and self-awareness of the physicians. There is consensus as to-many aspects: demand of technical qualification and excellence in practice; need of investing in technology of organ transplant; and donors seen as human beings and holders of human rights. Participants understand that family participation is decisive in the donation process, although interactions between the family members and the physicians are difficult because of the sensitive nature of the situation. The physicians often felt ill-prepared to openly discuss the topic of brain death and organ donation. Educational programs for physicians and family members may assist with this difficult process.

Influence of the Light-Curing Unit, Storage Time and Shade of a Dental Composite Resin on the Fluorescence

The aim of this study was to determine the influence of three light-curing units, storage times and colors of the dental composite resin on the fluorescence. The specimens (diameter 10.0 +/- 0.1 mm, thickness 1.0 +/- 0.1 mm) were made using a stainless steel mold. The mold was filled with the microhybrid composite resin and a polyethylene film covered each side of the mold. After this, a glass slide was placed on the top of the mold. To standardize the top surface of the specimens a circular weight (1 kg) with an orifice to pass the light tip of the LCU was placed on the top surface and photo-activated during 40 s. Five specimens were made for each group. The groups were divided into 9 groups following the LCUs (one QTH and two LEDs), storage times (immediately after curing, 24 hours, 7 and 30 days) and colors (shades: A(2)E, A(2)D, and TC) of the composite resin. After photo-activation, the specimens were storage in artificial saliva during the storage times proposed to each group at 37 C and 100% humidity. The analysis of variance (ANOVA) and Tukey's post-hoc tests showed no significant difference between storage times (immediately, 24 hours and 30 days) (P > 0.05). The means of fluorescence had difference significant to color and light-curing unit used to all period of storage (P < 0.05). The colors had difference significant between them (shades: A2D < A2E < TC) (P < 0.05). The Ultraled (LED) and Ultralux (QTH) when used the TC shade showed higher than Radii (LED), however to A2E shade and A2D shade any difference were found (P > 0.05).

Population biology of Uca thayeri Rathbun, 1900 (Brachyura, Ocypodidae) in a subtropical South American mangrove area: Results from transect and catch-per-unit-effort techniques

The population biology of Uca thayeri was studied in a subtropical mangrove in Ubatuba, State of São Paulo, Brazil. Two sampling techniques were used: transect sampling and catch-per-unit-effort. Size frequency distribution, sex-ratio, and reproductive period were analysed. For juvenile crabs (CW < 4.6 mm), the transect procedure was most efficient, while ovigerous females were most collected during the capture effort. Males were most numerous in the transect technique, while in the catch-per-unit-effort there was no difference between sexes. The species showed a different size frequency distribution for each sampling procedure. The reproduction of U. thayeri is seasonal, being more pronounced in the warmer months of the year. However, juveniles occurred all over the year, although more numerous in the colder months. The success of the species in reproductive activity and the constant colonization of the area can be attributed to the availability of food resources and differential occupation of the habitat by ovigerous females.

Catch-per-unit-effort: which estimator is best?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Comparison between univariate and bivariate geostatistical models for estimating catch per unit of effort (cpue): A simulation study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Comparing three indices of catch per unit effort using Bayesian geostatistics

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Feeding of Oligosarcus hepsetus (Cuvier, 1829) (Characiformes) in the Serra do Mar State Park - Santa Virgínia Unit, São Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Condition factor of Astyanax intermedius Eigenmann, 1908 (OSTEICHTHYES, CHARACIDAE) parasitised by Paracymothoa astyanaxi Lemos de Castro, 1955 (CRUSTACEA, CYMOTHOIDAE) in the Grande River, Serra do Mar State Park - Santa Virgínia Unit, São Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of Cement Shade and Light-curing Unit on Bond Strength of a Ceramic Cemented to Dentin

Purpose: To evaluate the effect of cement shade, light-curing unit, and water storage on tensile bond strength (a) of a feldspathic ceramic resin bonded to dentin.Materials and Methods: The dentin surface of 40 molars was exposed and etched with 37% phosphoric acid, then an adhesive system was applied. Forty blocks of feldspathic ceramic (Vita VM7) were produced. The ceramic surface was etched with 10% hydrofluoric acid for 60 s, followed by the application of a silane agent and a dual-curing resin cement (Variolink II). Ceramic blocks were cemented to the treated dentin using either A3 or transparent (Tr) shade cement that was activated using either halogen or LED light for 40 s. All blocks were stored in 37 degrees C distilled water for 24 h before cutting to obtain non-trimmed bar-shaped specimens (adhesive area = 1 mm(2) +/- 0.1) for the microtensile bond strength test. The specimens were randomly grouped according to the storage time: no storage or stored for 150 days in 37 degrees C distilled water. Eight experimental groups were obtained (n = 30). The specimens were submitted to the tensile bond strength test using a universal testing machine at a crosshead speed of 1 mm/min. The data were statistically analyzed using ANOVA and Tukey's post-hoc tests (alpha = 0.05).Results: The mean bond strength values were significantly lower for the corresponding water stored groups, except for the specimens using A3 resin cement activated by halogen light. There was no significance difference in mean bond strength values among all groups after water storage.Conclusion: Water storage had a detrimental effect under most experimental conditions. For both cement shades investigated (Tr and A3) under the same storage condition, the light-curing units (QTH and LED) did not affect the mean microtensile bond strengths of resin-cemented ceramic to dentin.

Distribution transformers modeling with angular displacement: actual values and per unit analysis

In this work a detailed modeling of three-phase distribution transformers aimed at complementing well-known approaches is presented. Thus, incidence of angular displacement and tapping is taken into account in the proposed models, considering both actual values and per unit. The analysis is based on minimal data requirement: solely short-circuit admittance is needed since three-phase transformers are treated as non-magnetically-coupled single-phase transformers. In order to support the proposed methodology, results obtained through laboratory tests are presented.

Nasopharyngeal colonization with methicillin-resistant staphylococcus aureus and mortality among patients in an intensive care unit

A colonização de nasofaringe por Staphylococcus aureus, resistente à meticilina (Methicillin-resistant S.aureus - MRSA), é comum em pacientes criticamente doentes, mas seu significado prognóstico não é inteiramente conhecido. Realizou-se estudo de coorte retrospectivo com 122 pacientes de uma unidade de terapia intensiva que realizaram triagem semanal para colonização por MRSA. Os desfechos de interesse foram: mortalidade geral e mortalidade por infecção. Diversas variáveis de exposição (gravidade, procedimentos, intercorrências e colonização nasofaríngea por MRSA) foram analisadas em modelos univariados e multivariados. Fatores significativamente associados à mortalidade geral ou por infecção foram: APACHE II e doença pulmonar. A colonização por MRSA não foi preditora de mortalidade geral (OR=1,02; IC95%=0,35-3; p=0,97) ou por infecção (OR=0,96; IC95%=0,33-2,89; p=0,96). Os resultados sugerem que, na ausência de fatores de gravidade, a colonização por MRSA não caracteriza pior prognóstico.

Case-case-control study of risk factors for nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus in a medical-surgical intensive care unit

Nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus (MRSA) often precedes the development of nosocomial infections. In order to identify risk factors for MRSA colonization, we conducted a case-case-control study, enrolling 122 patients admitted to a medical-surgical intensive care unit (ICU). All patients had been screened for nasopharyngeal colonization with S. aureus upon admission and weekly thereafter. Two case-control studies were performed, using as cases patients who acquired colonization with MRSA and methicillin-susceptible S. aureus (MSSA), respectively. For both studies, patients in whom colonization was not detected during ICU stay were selected as control subjects. Several potential risk factors were assessed in univariate and multivariable (logistic regression) analysis. MRSA and MSSA were recovered from nasopharyngeal samples from 27 and 10 patients, respectively. Independent risk factors for MRSA colonization were: length-of-stay in the ICU (Odds Ratio [OR]=1.12, 95%Confidence Interval[CI]=1.06-1.19, p<0.001) and use of ciprofloxacin (OR=5.05, 95%CI=1.38-21.90, p=0.015). The use of levofloxacin had a protective effect (OR=0.08, 95%CI=0.01-0.55, p=0.01). Colonization with MSSA was positively associated with central nervous system disease (OR=7.45, 95%CI=1.33-41.74, p=0.02) and negatively associated with age (OR=0.94, 95%CI=0.90-0.99, p=0.01). In conclusion, our study suggests a role for both cross-transmission and selective pressure of antimicrobials in the spread of MRSA.

Influence of sedation on morbidity and mortality in the intensive care unit

CONTEXTO: Embora cerca de 30% a 50% dos pacientes hospitalizados em unidades de terapia intensiva (UTI) recebam algum tipo de sedativo, existe escassez de informações sobre efeitos adversos desta prática, especialmente no Brasil. Estes efeitos podem ser significantes e o uso de sedativos é associado a elevação de infecção e mortalidade, mesmo sendo difícil avaliar o impacto clínico deste procedimento. OBJETIVO: Avaliar o impacto da sedação sobre incidência de complicações e mortalidade em doentes graves durante internação em unidade de terapia intensiva. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Unidade de Terapia Intensiva Cirúrgica da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina. PARTICIPANTES: Após excluídos pacientes que permaneceram menos de 24 horas ou sem exames indispensáveis para o cálculo do índice de gravidade (APACHE II), restaram 307 pacientes. Estes foram divididos em dois grupos: Grupo Sedado e Grupo Não Sedado. Constatada heterogeneidade com relação ao APACHE II, foram pareados 97 sedados e 97 não sedados com idênticos índices de gravidade. VARIÁVEIS ESTUDADAS: Impacto da sedação e das técnicas sobre a mortalidade, tempo de internação, além da incidência de escara de decúbito ou pressão, trombose venosa profunda e infecção. RESULTADOS: Não houve diferença na incidência de trombose venosa profunda, entre os grupos Sedado e Não Sedado, enquanto que escara de decúbito foi significativamente maior nos sedados (p = 0,03). Infecção foi detectada em 45,4% dos pacientes com sedação e em 21,6% dos pacientes sem sedação (p = 0,006). A mortalidade para os pacientes que não receberam qualquer tipo de sedativo foi de 20,6% e, para aqueles que foram sedados durante a internação, foi de 52,6% (p < 0,0001). CONCLUSÕES: Conclui-se que a sedação está associada a maior duração da internação, morbidade e mortalidade significativas. Apesar da intensidade das associações encontradas, não é possível estabelecer relação causal entre sedação e mortalidade.