Non-biting flying insects as carriers of pathogenic bacteria in a Brazilian hospital

IntroductionInsects have been described as mechanical vectors of nosocomial infections.MethodsNon-biting flying insects were collected inside a pediatric ward and neonatal-intensive care unit (ICU) of a Brazilian tertiary hospital.ResultsMost (86.4%) of them were found to carry one or more species of bacteria on their external surfaces. The bacteria isolated were Gram-positive bacilli (68.2%) or cocci (40.9%), and Gram-negative bacilli (18.2%).ConclusionsInsects collected inside a hospital were carrying pathogenic bacteria; therefore, one must consider the possibility they may act as mechanical vectors of infections, in especially for debilitated or immune-compromised patients in the hospital environments where the insects were collected.

Polymerase chain reaction and nested-PCR approaches for detecting Cryptosporidium in water catchments of water treatment plants in Curitiba, State of Paraná, Brazil

Introduction Cryptosporidium is an important protozoan cause of waterborne disease worldwide of concern to public health authorities. To prevent outbreaks of cryptosporidiosis, the monitoring of this parasite in drinking water is necessary. In the present work, the polymerase chain reaction (PCR) and nested-PCR techniques were used to detect Cryptosporidium in raw water from catchment points of four water treatment plants (WTP) in Curitiba, Paraná, Brazil. Methods First, DNA extraction techniques were tested in samples containing decreasing amount of oocysts in reagent water, and PCR and nested-PCR with specific primers for 18SSU rDNA of Cryptosporidium were conducted to determine their sensitivity. In reagent water, a commercial extraction kit provided the best analytical sensitivity, and PCR and nested-PCR allowed the detection of five and two oocysts, respectively, with the primers XIAOR/XIAOF and XIAO1F/XIAO2R. Results In the spiking experiments, only the PCR with the primers AWA995F/AWA1206R was successful at detecting concentrations of 0.1 oocysts/mL. Two catchments samples of raw water and/or water sludge from four WTPs were contaminated with Cryptosporidium. Conclusions The application of the techniques to monitor Cryptosporidium in water and detect contamination in water catchments of WTPs in Curitiba are discussed in the present work.

Antifungal susceptibility and distribution of Candida spp. isolates from the University Hospital in the municipality of Dourados, State of Mato Grosso do Sul, Brazil

Introduction Hospital infections caused by Candida spp. are a leading cause of morbidity and mortality in hospitalized patients, particularly those that are critically ill or immunocompromised. In this study, the distribution of Candida species in isolates from the University Hospital of the Federal University at Grande Dourados and their in vitro susceptibility to antifungal drugs were analyzed. Methods Yeasts were phenotypically identified using classical methodologies. Antifungal susceptibility tests to amphotericin B and fluconazole were performed using the broth microdilution technique. Results A total of 50 Candida isolates were obtained from hospitalized patients during the study period. We analyzed yeast isolates from urine (n=31; 62%), blood (n=12; 24%), and tracheal secretions (n=7; 14%). The following Candida species were identified: C. tropicalis (n=21; 42%), C. albicans (n=18; 36%), C. glabrata (n=10; 20%), and C. krusei (n=1; 2%). Antifungal susceptibility tests demonstrated that C. albicans was susceptible to both antifungal agents. However, 31.2% of the non-C. albicans Candida isolates displayed dose-dependent susceptibility to fluconazole, and 3.1% were resistant to amphotericin B. Conclusions In contrast to previous reports, our results indicated that C. tropicalis was the most commonly isolated yeast species among the hospital patients. The predominance of non-C. albicans Candida infections confirms the importance of species-level identification for implementing appropriate antifungal therapies.

Choosing the gender and skill of politicians: List composition and electability across Brazilian municipalities

This work project studies the effect of variations in the proportion of female candidates on the quality of politicians. This effect was divided between nominated and elected body. Cross-sectional data was used for two elections, and an OLS as an IV approach. Results show that the existence of female candidates on parties’ list increases the quality of the nominated body. Moreover, contrary to what many advocate, increasing the presence of female candidates either increases or has no effect on the quality of the elected body. Results that were confirmed for the overall data and controlling for region factors only.

Calibração de filtros de fator de transmissão regular em espectrofotometria

A garantia de exatidão e de precisão, assim como da reprodutibilidade, da repetibilidade e da produtividade dos processos de medição, tornaram-se metas da metrologia, visando desta forma uma garantia da qualidade de produtos e serviços. A presente dissertação foi desenvolvida no âmbito de estágio curricular realizado no Departamento de Metrologia (DMET) do Instituto Português da Qualidade (IPQ). O objetivo inicial do estágio visava a participação na calibração de espectrofotómetros. Entretanto, no decorrer do estágio, também foi possível elaborar uma proposta de melhoria aos procedimentos técnicos de calibração existentes na altura, para medições de fatores de transmissão regular, com dois instrumentos de medição de elevada qualidade. Esta proposta de melhoria integra-se na busca de melhoria contínua dos processos no Laboratório de Espectrofotometria (LE), pertencente ao Laboratório Central de Metrologia (LCM) do IPQ. Visando a rastreabilidade metrológica dos resultados obtidos, foi feita a adaptação dos procedimentos existentes. Para a calibração de ambos os espectrofotómetros, utilizaram-se filtros padrão de vidro de tamanho standard (33 mm x 10 mm) e de tamanho superior ao standard (50 mm x 50 mm) certificados pelo Laboratório Primário de Espectrofotometria do Instituto Nacional de Metrologia do Reino Unido, o National Physical Laboratory (NPL). Com o objetivo de otimização de tempo, procedeu-se também à comparação entre resultados obtidos de fator de transmissão para os materiais de referência de tamanho superior, quando corrigidos de acordo com a reta de calibração obtida com filtros padrão de tamanho idêntico, e quando corrigidos de acordo com a reta de calibração obtida com filtros padrão de tamanho standard. No decurso do estágio, surgiu ainda a oportunidade de aplicar a experiência obtida ao caso prático de um filtro de opacímetro fornecido pelo LabMetro do ISQ. Assim, na presente dissertação, apresentam-se também os resultados de medição de fator de transmissão, para esse filtro, obtidos com ambos os espectrofotómetros.

Evaluation of the Chagas Disease Control Program in Açucena Municipality, Rio Doce Valley, State of Minas Gerais, Brazil

Introduction Açucena Municipality, Rio Doce Valley, State of Minas Gerais, Brazil temporarily (2001-2005) interrupted epidemiological surveillance for Chagas disease. The objective of this work was to evaluate the Chagas Disease Control Program (CDCP) in Açucena and to offer suggestions for improving local epidemiological surveillance. Methods This study was conducted in three phases: I) a serological investigation of schoolchildren aged 5 to 15 years using an enzyme-linked immunosorbent assay (ELISA) test performed on blood collected on filter paper followed by ELISA, indirect immunofluorescence (IIF) and indirect hemaglutination (IHA) on venous blood for borderline cases and those in the gray zone of reactivity; II) vector evaluation using the data obtained by local health agents during 2006-2010; and III) examination by ELISA, IIF and IHA of serum samples from the inhabitants of houses where infected Triatoma vitticeps was found and evaluation of their knowledge about Chagas disease. Results Five individuals had inconclusive results in the ELISA screening but were seronegative for Chagas disease. The triatomine evaluation revealed the presence of three species: Triatoma vitticeps, Panstrongylus megistus and Panstrongylus diasi. Triatoma vitticeps was the most prevalent and widespread, with a higher (67%) index of Trypanosoma cruzi flagellates and evidence of colonization. Most of the inhabitants of the infested houses recognized triatomines and had basic knowledge about Chagas disease. Conclusions Although T. vitticeps is not clearly associated with Chagas disease transmission, these results highlight the importance of maintaining CDCP in endemic areas and the need for greater emphasis on epidemiological surveillance, especially in areas with important vectorial changes or that have been modified by human intervention.

Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.

Hematologic profile of hematophagous Desmodus rotundus bats before and after experimental infection with rabies virus

Introduction Hematophagous Desmodus rotundus bats play an important role in the rabies lifecycle. This study describes the hematological profile of these bats before and after experimental infection with rabies virus. Methods Cells counts were performed in a Neubauer chamber. Results The average values of erythrocytes and leucocytes counts in blood before experimental infections were 9.97 × 106mm3 and 4.80 × 103mm3, respectively. Neutrophils represented 69.9% of white blood cells and the lymphocytes represented 26.9%. Following the experimental infections, the average numbers of erythrocytes and leucocytes was 9.43 × 106mm3 and 3.98 × 103mm3, respectively. Neutrophils represented 40% of white blood cells and the lymphocytes represented 59%. Conclusions The hematological profile given in this study can serve as reference values for D. rotundus bats.

Otimização da técnica de micro Fluorescência de Raios- X para o estudo de ossos

Nos países desenvolvidos, as doenças reumáticas são o grupo de doenças mais fre-quentes da espécie humana, sendo por isso o primeiro motivo de consulta nos cuidados de saúde primários e a principal causa de incapacidade temporária para o trabalho e de reformas antecipadas por doença/invalidez (Canhão & Branco, 2013). O estudo destas doenças torna-se cada vez mais urgente visto que estas têm tendência crescente, tendo em conta os atuais esti-los de vida e o aumento da longevidade da população. Nesta dissertação foi estudada e otimi-zada a técnica de Micro Fluorescência de Raios-X (μ-XRF) de forma a permitir um estudo de elementos maioritários e elementos traço em ossos com doenças reumáticas, tendo em espe-cial atenção a razão Ca/P, já que, por estudos até agora efetuados, esta razão é considerada um biomarcador adequado para a avaliação da saúde dos ossos. Foram então verificados os erros aleatórios e sistemáticos existentes nesta técnica e concluiu-se quais os tipos de parâme-tros que devem ser tidos em conta para este estudo, tais como corrente, tensão do tubo, filtros, entre outros. As amostras foram ainda analisadas com a técnica de PIGE (Particle Induced Gamma-ray Emission) e comparados os resultados com os de μ-XRF de forma a avaliar a in-fluência da topologia da amostra. Pretende-se que este estudo seja o início do desenvolvimen-to de um método alternativo de diagnóstico precoce de doenças reumáticas, conduzindo a um tratamento mais eficaz e melhorando assim a qualidade de vida da população.

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.

Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital

INTRODUCTION : In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS : A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS : OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.

Evaluation of the cytokine mannose-binding lectin as a mediator of periportal fibrosis progression in patients with schistosomiasis

INTRODUCTION : We hypothesized higher mannose-binding lectin level and classic factors (i.e., age, sex, alcohol consumption, exposure, and specific treatment) are associated with the severity of periportal fibrosis in schistosomiasis. METHODS : This cross-sectional study involved 79 patients infected with Schistosoma mansoni with severe or mild/moderate periportal fibrosis. Serum concentrations of mannose-binding lectin were obtained by enzyme-linked immunosorbent assay (ELISA). RESULTS: Higher serum level of mannose-binding lectin was significantly associated with advanced periportal fibrosis. CONCLUSIONS: Mannose-binding lectin may contribute to liver pathology in schistosomiasis and may represent a risk factor for advanced periportal fibrosis in the Brazilian population studied.

The absence of the human platelet antigen polymorphism effect on fibrosis progression in human immunodeficiency virus-1/hepatitis C virus coinfected patients

AbstractINTRODUCTION:Hepatic fibrosis progression in patients with chronic hepatitis C virus infections has been associated with viral and host factors, including genetic polymorphisms. Human platelet antigen polymorphisms are associated with the rapid development of fibrosis in HCV-monoinfected patients. This study aimed to determine whether such an association exists in human immunodeficiency virus-1/hepatitis C virus-coinfected patients.METHODS:Genomic deoxyribonucleic acid from 36 human immunodeficiency virus-1/hepatitis C virus-coinfected patients was genotyped to determine the presence of human platelet antigens-1, -3, or -5 polymorphisms. Fibrosis progression was evaluated using the Metavir scoring system, and the patients were assigned to two groups, namely, G1 that comprised patients with F1, portal fibrosis without septa, or F2, few septa (n = 23) and G2 that comprised patients with F3, numerous septa, or F4, cirrhosis (n = 13). Fisher's exact test was utilized to determine possible associations between the human platelet antigen polymorphisms and fibrosis progression.RESULTS:There were no deviations from the Hardy-Weinberg equilibrium in the human platelet antigen systems evaluated. Statistically significant differences were not observed between G1 and G2 with respect to the distributions of the allelic and genotypic frequencies of the human platelet antigen systems.CONCLUSION:The greater stimulation of hepatic stellate cells by the human immunodeficiency virus and, consequently, the increased expression of transforming growth factor beta can offset the effect of human platelet antigen polymorphism on the progression of fibrosis in patients coinfected with the human immunodeficiency virus-1 and the hepatitis C virus.

Agregação e formação de amilóides por proteínas neuroinflamatórias S100A8 e S100A9 e implicações em processos neurodegenerativos

Uma caraterística comum a muitas doenças neurodegenerativas é a formação de agregados proteicos e amilóides, no que se designa a cascata amiloíde. O foco deste trabalho é o estudo do homodímero S100A9 e do heterodímero S100A8/A9, duas das proteínas da resposta neuroinflamatória, que se encontram elevadas na vizinhança de depósitos proteicos, nomeadamente na doença de Alzheimer. Estas proteínas pertencem à família das S100, que possuem dois domínios EF-hand de ligação a Ca2+, e ligam também cobre e zinco. Este estudo visa contribuir esclarecer se as proteínas S100A8 e A100A9 estarão envolvidas na cascata de agregação amilóide, por formação direta de agregados das S100, ou mediante a associação com iões metálicos, cuja disfunção é característica em doenças neurodegenerativas. O primeiro passo do trabalho consistiu em expressar e purificar a S100A9 e a S100A8/A9, optimizando o processo. Os estudos de estabilidade térmica na presença e ausência de Ca2+, Cu2+ e Zn2+, revelaram que a S100A8/A9 é termodinamicamente mais estável que a S100A9. Os três iões metálicos são destabilizadores da S100A9, diminuindo a sua estabilidade térmica. Para a estabilidade térmica da S100A8/A9 os mesmos iões não mostraram ter um efeito significativo, pelo que se sugere uma conformação diferente com o core hidrofóbico mais blindado, aumentando a estabilidade. Realizaram-se também ensaios cinéticos de agregação, que revelram que a S100A9 apresenta uma agregação heterogénea, não dependente de nucleação na presença dos metais. No caso da S100A8/A9, os três iões metálicos potenciam a agregação. Por fim, analisou-se a hipótese de S100A9 e S100A8/A9 como moduladores de agregação do péptido Aβ1-42. O Aβ1-42 mostrou ter influência na agregação da S100A9 e da S100A8/A9, podendo estas proteínas ser potenciadoras da agregação. Este trabalho revelou que a agregação das proteínas em estudo é influenciada e potenciada pela ligação dos iões metálicos, pelo que se sugere que estes tenham um papel crucial na formação de agregados de S100A8/A9 e de S100A9.

Double pylorus: case report and review of the literature

Double pylorus is an unusual condition in which a double communication between the gastric antrum and the duodenal bulb occurs. It may be congenital, or it may be acquired complication of peptic ulcer disease. We present a case of double pylorus in a gentleman with epigastric pain and previous history of peptic ulcer disease. The relationship between Helicobacter pylori and this disease was assessed. A review of the literature, the role of associated diseases and the role of H. pylori are discussed.