Differences Between ""Classical"" Risk Factors for Infections Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) and Risk Factors for Nosocomial Bloodstream Infections Caused by Multiple Clones of the Staphylococcal Cassette Chromosome mec Type IV MRSA Strain

OBJECTIVE. To identify risk factors associated with nosocomial bloodstream infections caused by multiple clones of the staphylococcal cassette chromosome mec (SCCmec) type IV strain of methicillin-resistant Staphylococcus aureus (MRSA). DESIGN. An unmatched case-control study (at a ratio of 1 : 2) performed during the period from October 2002 through September 2003. SETTING. A 2,000-bed tertiary care teaching hospital affiliated with the University of Sao Paulo in Sao Paulo, Brazil. METHODS. Case patients (n = 30) were defined either as patients who had a bloodstream infection due to SCCmec type IV strains of MRSA diagnosed at least 48 hours after hospital admission or as neonates with the infection who were born in the hospital. Control patients (n = 60) were defined as patients with SCCmec type III MRSA infection diagnosed at least 48 hours after hospital admission. Genes n = 60 encoding virulence factors were studied in the isolates recovered from case patients, and molecular typing of the SCCmec type IV MRSA isolates was also done by pulsed-field gel electrophoresis and multilocus sequence typing. RESULTS. In multivariate analysis, the following 3 variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: an age of less than 1 year, less frequent use of a central venous catheter (odds ratio [OR], 0.07 [95% confidence interval {CI}, 0.02-0.28]; P = .001), and female sex. A second analysis was performed that excluded the case and Pp. 001 control patients from the neonatal unit, and, in multivariate analysis, the following variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: less frequent use of a central venous catheter (OR, 0.12 [95% CI, 0.03-0.55]; P = .007), lower Acute Physiology and Chronic Health Evaluation II score on admission (OR, 0.14 [95% CI, 0.03-0.61];), less frequent surgery (OR, 0.21 [95% CI, 0.06-0.83];), and female sex (OR, 5.70 [95% CI, 1.32-24.66]; P =.020). P = .009 Pp. 025 Pp). Of the 29 SCCmec type IV MRSA isolates recovered from case patients, none contained the Panton-Valentine leukocidin, gamma-hemolysin, enterotoxin B or C, or toxic shock syndrome toxin-1. All of the isolates contained genes for the LukE-LukD leukocidin and alpha-hemolysin. Genes for enterotoxin A were present in 1 isolate, and genes for beta-hemolysin were present in 3 isolates. CONCLUSIONS. ""Classical"" risk factors do not apply to patients infected with the SCCmec type IV strain of MRSA, which is an important cause of nosocomial bacteremia. This strain infects a patient population that is less ill and has had less frequent invasive procedures than a patient population infected with the multidrug-resistant strain of SCCmec type III MRSA. We found that virulence factors were rare and that Panton-Valentine leukocidin was absent. There were multiple clones of the SCCmec type IV strain in our hospital. Children under 1 year of age were at a higher risk. There was a predominant clone ( sequence type 5) in this patient population.

Sistema e-Mec:reinven????o processual da educa????o superior em tr??s dimens??es da gest??o p??blica: jur??dica, organizacional e tecnol??gica

Com o objetivo de elevar a qualidade do ensino superior do pa??s, em 2006 o Minist??rio da Educa????o (MEC) iniciou um movimento de ???reinven????o processual??? em tr??s dimens??es: i) jur??dica, com a reformula????o da legisla????o aplic??vel aos processos regulat??rios da educa????o superior; ii) organizacional, implementando mudan??as na din??mica e no desenho das rotinas de trabalho; e iii) tecnol??gica, com a implementa????o do sistema eletr??nico e-MEC de operacionaliza????o dos procedimentos de regula????o. A tr??plice iniciativa permitiu, a um s?? tempo, trazer seguran??a jur??dica, transpar??ncia, credibilidade e celeridade ao processo. Isso possibilitou a cria????o de ambiente prop??cio ao salto qualitativo que o MEC pretendia dar em rela????o tanto ao condicionamento do funcionamento de institui????es e cursos superiores quanto ?? comprova????o da excel??ncia de sua opera????o. O objetivo final??stico foi atingido de maneira satisfat??ria, podendo-se dizer que est?? em curso a institucionaliza????o de uma cultura da qualidade da educa????o superior

Informatiza????o do MEC

Ciente de que o modelo centralizado de processamento de dados causava uma s??rie de problemas, a equipe da Coordena????o-Geral de Inform??tica do MEC criou um novo modelo tecnol??gico de gest??o da informa????o. Este projeto desencadeou uma s??rie de transforma????es tanto no que se refere ?? estrutura????o quanto ?? forma de gerenciamento de atividades e pessoas. A implementa????o do novo processo de informatiza????o teve como princ??pio norteador o Planejamento Estrat??gico. Os resultados alcan??ados possibilitaram informa????es precisas e atualizadas, disponibilizadas em tempo real e em sintonia com os fatos verificados na base do sistema educacional brasileiro

Estudo da Mecânica Cardíaca pelo Speckle Tracking

Speckles, ou marcadores naturais do miocárdio, originam se da interferência construtiva e destrutiva do feixe de ultrassom que incide sobre os tecidos, podem fornecer um diagnóstico precoce das alterações miocárdicas e atuar na predição de certos eventos cardíacos. Devido à sua relativa estabilidade temporal, os speckles podem ser rastreados durante o ciclo cardíaco por software dedicados, promovendo a análise da função sistólica e diastólica. São identificados tanto pela escala de cinza da ecocardiografia 2D convencional quanto pela ecocardiografia 3D, sendo independentes do ângulo de incidência do ultrassom, permitindo assim a avaliação da mecânica cardíaca nos três planos espaciais: longitudinal, circunferencial e radial. O objetivo do presente artigo é discutir o papel e o significado da deformação cardíaca obtida por meio do speckle tracking durante a avaliação da fisiologia cardíaca, e discutir as aplicações clínicas desta tecnologia ecocardiográfica inovadora.

El Bienestar del hogar y los funcionamientos elementales de la Infancia y juventud en edad escolar: aplicación de un Modelo de Estructura de Covarianza (MEC) al caso del departamento de Antioquia- Colombia

En la investigación planteo que el logro de las capacidades de los niños y jóvenes está sujeto a su entorno familiar, de manera que el bienestar del hogar en el espacio de los funcionamientos influye en los niveles de salud y de educación de los niños y jóvenes en edad escolar. La primera parte, es el marco basado en el enfoque de capacidades, donde se establece un soporte teórico entre el bienestar de la infancia y las capacidades. La segunda, es la aplicación de un Modelo de Estructura de Covarianza (MEC), aplicado al caso de Antioquia-Colombia. Palabras

Excision of the Staphylococcal Cassette Chromosome mec (SCCmec) and its crucial role in the horizontal transfer of methicillin resistance in staphylococci.

Staphylococcus aureus est un pathogène humain majeur ayant développé des résistances contre la quasi totalité des antibiotiques disponibles, incluant la très importante famille des β- lactamines. La résistance à cette classe d'antibiotiques est conférée par la « Staphylococcal Cassette Chromosome mec » (SCCmec), qui est un élément génétique mobile capable de s'insérer dans le chromosome bactérien et capable d'être transféré horizontalement chez d'autres staphylocoques. Le mécanisme moléculaire impliqué dans ce transfert horizontal demeure largement inconnu. L'une des premières étapes du transfert est l'excision du SCC mec du chromosome bactérien. Cette excision est promue par des enzymes codées par l'élément SCCmec lui- même et appelées de ce fait « Cassette Chromosome Recombinases » (Ccr). L'un des buts de ce travail de thèse a été de comprendre la régulation de l'expression des gènes codant pour les Ccr recombinases. En utilisant des outils moléculaires originaux, nous avons été en mesure de démontrer en premier lieu que les Ccr recombinases étaient exprimées de façon « bistable », c'est à dire qu'uniquement quelques pourcents de cellules dans une population exprimaient ces gènes à un temps donné. Dans un deuxième temps, nous avons également démontré que l'expression de ces gènes était régulée par des facteurs étrangers au SCC mec. L'expression bistable des recombinases est un concept important. Effectivement, cela permet à la majorité des cellules d'une population de conserver l'élément SCC mec, alors que seulement une petite fraction le perd afin de le rendre disponible pour un transfert. Ainsi, alors que l'élément SCC mec continue de se propager avec la multiplication des bactéries Staphylococcus aureus résistant à la méticilline (SARM), il peut être simultanément transmis à des souches susceptibles (Staphylococcus aureus susceptible à la méticilline, SASM), entraînant l'apparition de nouveaux SARM. De façon très intéressante, le fait que cette bistabilité est contrôlée par les bactéries, et non le SCCmec lui-même, montre que la décision de transférer ou non la cassette SCC mec appartient à la bactérie. En conséquence, il doit exister dans la nature des souches qui sont plus ou moins aptes à effectuer ce transfert. En nous appuyant sur ces observations, nous avons montré que l'excision du SCC mec était effectivement régulée de façon très étroite au cours de la division cellulaire, et ne se passait que pendant un temps limité au début de la croissance. Ce résultat est compatible avec une régulation génétique commandée par la densité cellulaire, qui pourrait être dépendante de la production de signaux extracellulaires, du type que l'on rencontre dans le quorum sensing. Les signaux hypothétiques entraînant l'excision du SCC mec restent inconnus à l'heure actuelle. La connaissance de ces signaux pourrait se révéler très importante afin de développer des stratégies pour interférer avec la dissémination de la résistance au β-lactamines. Deux sujets additionnels ont été logiquement investigués au vu de ces premiers résultats. Premièrement, si certaines souches de SARM sont plus ou moins aptes à déclencher l'excision du SCC mec, de même certaines souches de SASM devraient être plus ou moins aptes à acquérir cet élément. Deuxièmement, afin d'étudier ces mécanismes de transfert au niveau épidémiologique, il nous a été nécessaire de développer des outils nous permettant d'explorer le phénomène à une plus large échelle. Concernant le premier point, il a été postulé que certains SASM seraient réfractaires à l'intégration génomique d'un SCC mec en raison de polymorphismes particuliers à proximité du site d'insertion chromosomique (attB). En étudiant plus de 40 isolais de S. aureus, provenant de porteurs sains, nous avons confirmé ce polymorphisme dans l'environnement à'attB. De plus, nous avons pu montrer que ces régions polymorphiques ont évolué parallèlement à des groupes phylogénétiques bien connus. Ainsi, si des telles régions réfractaires à l'intégration de SCC mec existent, celles-ci devraient ségréger dans des complexes clonaux bien définis qui devraient être facilement identifiables au niveau épidémiologique. Concernant le second point, nous avons été capables de construire un système rapporteur de l'excision du SCCmec, en utilisant un plasmide à faible copie. Ce système consistait en un promoteur fort et un gène codant pour une protéine verte fluorescente (GFP) sous le contrôle d'un promoteur fort séparés à l'aide d'un élément SCC artificiel portant trois terminateurs de transcription. Ainsi, la fluorescence ne s'exprime que si l'élément SCC est excisé du plasmide. Ce système a été testé avec succès dans plusieurs types de staphylocoques, et est actuellement évalué dans d'autres souches et conditions stimulant ou inhibant l'excision. De manière générale, cette dissertation représente parcours scientifique à travers plusieurs aspects d'un problème de santé publique majeur en rapport avec la résistance bactérienne aux antibiotiques. Ce travail s'attaque à des problèmes fondamentaux concernant le transfert horizontal de l'élément SCC mec. De plus, il s'intéresse à des aspects plus généraux de cet élément génétique mobile qui pourraient se révéler très importants en terme de mouvement de gènes au sein des staphylocoques, voir d'autres bactéries gram-positives. Finalement ce travail de thèse met en place le fondamentaux requis pour des recherches futures visant à interférer avec le transfert horizontal de la résistance aux β-lactamines. - Staphylococcus aureus is a major human pathogen. Moreover, S. aureus have developed resistance to almost all available antibiotics, including the important family of β-lactam molecules. Intrinsic resistance to β-lactams is conferred by the Staphylococcal Cassette Chromosome mec (SCCmec), which is a mobile genomic island that inserts into the staphylococcal chromosome and can be horizontally transferred into other staphylococci. However, little is known about the molecular mechanisms involved in this horizontal transfer into naïve strains. One of the first steps in SCC mec horizontal transfer is its excision from the chromosome. Excision is mediated by recombinase enzymes that are encoded by SCC mec itself, and named accordingly Ccr recombinases - for Cassette Chromosome recombinases. One goal of this thesis was to understand the regulation these recombinase genes. By using original molecular tools we could demonstrate first that the Ccr recombinases were expressed in a "bistable" manner, i.e. in only few percentages of the bacterial cells at a given time, and second that they were regulated by determinants that were not encoded on the SCC mec element, but elsewhere on the staphylococcal genome. "Bistable" expression Ccr recombinases is an important concept. It allows SCC mec to be excised and thus available for horizontal transfer, while ensuring that only some cells, but not the whole population, loose their valuable SCC mec genes. Thus, while the SCC mec element expands with the multiplication of the MRSA colony, it can simultaneously be transmitted into methicillin-susceptible S. aureus (MSSA), which convert into new MRSA. Most interestingly, the fact that bistability was regulated by the cells, rather than by SCC mec, indicates that it was the choice of the bacteria to trigger or not SCC mec transfer. As a consequence, there must be, in nature, staphylococcal strains that are more or less prone to sustain SCC mec transfer. Following these seminal observations we found that excision was indeed tightly regulated during bacterial division, and occurred only during a limited period of time at the beginning of bacterial growth. This is compatible with cell-density mediated gene regulation, and may depend on the production of extracellular signal molecules that transmit appropriate orders to neighboring cells, such as in quorum sensing. The potential signal triggering SCCmec excision is as yet unknown. However, it could be critical in promoting the horizontal transfer of methicillin resistance, or for the possible development of means to interfere with it. Two additional hypothesis were logically investigated in the view of these first results. First, if some strains of MRSA might be more prone than others to promote SCC mec excision, then some strains of MS SA might be more or less prone to acquire the element as well. Second, to investigate these multiple mechanisms at an epidemiological level, one would need to develop tools amenable to explore S. aureus strains at a larger scale. Regarding the first issue, it was postulated by others that some MSSA might be refractory to SCC mec integration because they had peculiar DNA polymorphisms in the vicinity of the site-specific chromosomal entry point {attB) of SCC mec. By studying >40 S. aureus isolates from healthy carriers, we confirmed the polymorphism of the attB environment. Moreover, we could show that these polymorphic regions co-evolved with well-known phylogenic clonal clusters. Therefore, if SCCwec-refractory attB environments exist, then they would segregate in well- defined S. aureus clonal clusters that would be easy to identify at the epidemiological level. Regarding the second issue, we were able to construct a new excision reporter system in a low copy number S. aureus plasmid. The reporter system consists in a strong promoter driving a green fluorescent protein {gfp) gene, separated by an artificial SCC-like element carrying three transcriptional terminators. Thus, fluorescence is not expressed unless the SCC-like element is excised. The system has been successfully tested in several aureus and non- aureus staphylococci, and is now being applied to more strains and various excision- triggering or inhibiting conditions. Altogether the dissertation is a scientific journey through various aspects of a salient medical problem with regard to antibiotic resistance and public health threat. The research work tackles fundamental issues about the mechanisms of horizontal transfer of the SCC mec element. Moreover, it also addresses more general features of this mobile element, which could be of larger importance with regard to gene trafficking in staphylococci, and maybe other gram-positive bacteria. Finally, the dissertation sets the fundamentals for future work and possible new ways to interfere with the horizontal transfer of methicillin resistance.

Diversity of staphylococcal cassette chromosome mec elements in predominant methicillin-resistant Staphylococcus aureus clones in a small geographic area.

Recent population genetic studies suggest that staphylococcal cassette chromosome mec (SCCmec) was acquired much more frequently than previously thought. In the present study, we aimed to investigate the diversity of SCCmec elements in a local methicillin-resistant Staphylococcus aureus (MRSA) population. Each MRSA isolate (one per patient) recovered in the Vaud canton of Switzerland from January 2005 to December 2008 was analyzed by the double-locus sequence typing (DLST) method and SCCmec typing. DLST analysis indicated that 1,884/2,036 isolates (92.5%) belong to four predominant clones. As expected from the local spread of a clone, most isolates within clones harbored an identical SCCmec type. However, three to seven SCCmec types have been recovered in every predominant DLST clone, suggesting that some of these elements might have been acquired locally. This pattern could also be explained by distinct importations of related isolates into the study region. The addition of a third highly variable locus to further increase the discriminatory power of typing as well as epidemiological data suggested that most ambiguous situations were explained by the second hypothesis. In conclusion, our study showed that even if the acquisition of new SCCmec elements at a local level likely occurs, it does not explain all the diversity observed in the study region.

Characterization of the staphylococcal cassette chromosome mec insertion site in 108 isolates lacking the mecA gene and identified as methicillin-resistant Staphylococcus aureus by the Xpert MRSA assay.

During a 3-year period, 848 patients were detected as carriers of methicillin-resistant Staphylococcus aureus (MRSA) by the Xpert MRSA assay (Cepheid). Among them, 108 patients (12.7 %) were colonized with strains showing methicillin-susceptible phenotypes and absence of the mecA gene, despite being positive with the rapid polymerase chain reaction (PCR) assay. DNA sequences of the staphylococcal cassette chromosome mec (SCCmec) insertion site of these "false-positive" strains was determined by direct sequencing of the genomic DNA. More than half (53.7 %) of the strains had DNA sequences unrelated to either SCC or SCCmec and one-third had DNA sequences related to non-mec SCC. Only 10.2 % of the strains carried sequences related to SCCmec, suggesting that a sequence containing the mecA gene was lost from an SCCmec. These findings differ from the general idea that all methicillin-susceptible S. aureus having positive Xpert MRSA assay results are essentially MRSA that lost the mecA gene.

Desenvolvimentismo e pragmatismo: o ideário do MEC nos anos 1950

Este artigo tem como objetivo mostrar como o desenvolvimentismo e o pragmatismo, dois pensamentos de natureza distinta, contribuem, cada um à sua maneira, para fundamentar uma política de reconstrução nacional nos anos 1950, em particular no âmbito do Ministério da Educação e Cultura - MEC. A idéia central é que, por circularem nos mesmos espaços institucionais, esses dois pensamentos acabam por interagir um com o outro, de tal modo que a ideologia desenvolvimentista se transforma em um solo fértil para a retomada e expansão do pragmatismo. Para explicar esse fenômeno, recorda-se que ambos se ancoram em uma concepção de cunho prático baseada na política. Chama-se a atenção para a maneira como o Instituto Superior de Estudos Brasileiros - Iseb - e o Instituto Nacional de Estudos Pedagógicos - Inep -, dois órgãos do MEC responsáveis por fomentar um pensamento nacional, se apropriam desses ideários para a formulação e a implementação de políticas de reconstrução nacional.

Caracterización del casete cromosómico estafilocócico mec de staphylococcus hominis.

Tesis (Maestría en Ciencias con Especialidad en Microbiología Médica) UANL, 2012.

Réquiem por el territorio MEC.

Resumen basado en el que aporta la revista

La desaparici??n del 'territorio MEC'

El art??culo forma parte de un dossier titulado 'Diez a??os de transferencias'

La optatividad en el territorio MEC.

El Ministerio de Educación y Cultura pretende recoger y desarrollar los criterios establecidos en la LOGSE haciendo especial hincapié en las funciones del sistema educativo en las que contribuyen de manera especial las materias optativas. Se reflexiona sobre las opciones del alumnado de primer y segundo ciclo de ESO y en el bachillerato..

Los periódicos como actualización y renovación del sistema educativo : el programa Prensa-Escuela del MEC (1985-90).

Estudiar el proceso seguido en España por el uso innovador de la prensa escrita en la enseñanza. Analiza la situación en que se encuentra la prensa en los centros educativos de otros países, presenta el programa Prensa-Escuela del Ministerio de Educación, y hace un balance de las principales actividades y la formación del profesorado. Encuesta personal a más de 2.000 docentes de centros de enseñanza pública y privada de enseñanza básica sobre lectura de periódicos. El 91 por ciento de los docentes españoles leen la prensa habitualmente, todos los días o varías veces a la semana. Los periódicos son un instrumento de gran utilidad para la actualización y renovación del sistema educativo. El profesor es el principal impulsor de esta práctica educativa.

El dominio del idioma a través de la lecto-escritura en el proyecto bilingüe MEC-British Council.

El artículo forma parte de un monográfico de la revista dedicado a las lenguas extranjeras