Double Product and Autonomic Function as Predictors of Quality of Life in Heart Transplant Recipients: A Cross-Sectional Study

ABSTRACT Introduction: Heart rate control by the autonomic nervous system (ANS) is impaired in heart transplant (HT) recipients, leading to increased resting heart rate, metabolic demand, and fatigue, which can impair their quality of life (QoL). In this study, we hypothesized the association of hemodynamics and autonomic function as predictors of QoL in HT recipients. Methods: This is a cross-sectional study conducted with HT recipients aged ≥ 18 years at ambulatorial accompaniment. Blood pressure was used for hemodynamics assessment, and heart rate variability (HRV) was used for ANS assessment. QoL was assessed by the 36-item Short Form Health Survey. The significance level was set as P≤0.05. Results: Twenty-two volunteers were included in the study. Systolic blood pressure (SBP) and double product (DP) were significantly negatively associated with the physical functioning domain of QoL. DP, the number of consecutive normal RR interval differences > 50 ms (NN50), and the percentage of normal RR intervals that differed by > 50 ms from the adjacent interval (PNN50) exhibited negative association with the physical role domain. NN50 and PNN50 were significantly associated with bodily pain, social functioning, and emotional role domains. SBP was negatively associated with the vitality domain. Considering general and mental health domains, no variable demonstrated significant association. DP, NN50, and PNN50 were negatively associated with the total score of QoL. Conclusion: This study demonstrated DP and HRV as predictors of QoL in HT recipients. These innovative results can become a relevant therapeutic target for improving QoL in HT recipients prior to its deterioration.

Parasitic contamination in the soil of beaches from Mosqueiro Island, Pará State, Brazil / Contaminação parasitária no solo de praias da Ilha do Mosqueiro, Estado do Pará, Brasil

Objective: We aimed to evaluate the prevalence of intestinal parasitic in the soil of three beaches of Mosqueiro Island, located in the State of Pará, Brazil, as well as to compare the frequency of helminths and protozoa, pathogenic and non-pathogenic parasites according to the beaches analyzed. Methods: This is a cross-sectional analytical study conducted during August and September 2019, in which 155 soil samples were analyzed by Hoffman's method. Results: The results showed that 16.1% of samples were contaminated from 61.3% of collection points. Murubira beach and Farol beach presented the highest prevalence of parasites, however, there was no significant difference between beaches. Also, it was observed a predominance of protozoa (63%) and non-pathogenic parasites (55.6%) in analyzed samples, but there was no statistically significant difference according to the investigated location. Endolimax nana 25.9% (7/27) and hookworms 18.5% (5/27) were the most detected parasites on the beaches. Conclusion: Thus, this study showed parasitic contamination on the beaches from Mosqueiro Island, which may be associated with a lack of sanitation infrastructure and personal hygiene in these places. Therefore, these results reinforce the need to adopt educational and preventive measures to reduce parasitic agents.

Objetivo: Avaliar a prevalência de parasitos intestinais no solo de três praias da Ilha de Mosqueiro, localizada no estado do Pará, Brasil, além de comparar a frequência de helmintos e protozoários, parasitos patogênicos e não patogênicos de acordo com as praias analisadas. Metdodos: Este é um estudo transversal, analítico, realizado durante agosto e setembro de 2019, no qual 155 amostras do solo foram analisadas pelo método de Hoffman. Resultados: Os resultados revelaram que 16,1% das amostras estavam contaminadas em 61,3% dos pontos de coleta. As praias do Murubira e do Farol apresentaram a maior prevalência de parasitos, porém não houve diferença significativa entre os diferentes locais de coleta. Além disso, foi observada a predominância de protozoários (63%) e parasitas não patogênicos (55.6%) nas amostras analisadas, mas não houve diferença estatística significativa entre os locais investigados. Endolimax nana 25,9% (7/27) e Ancilostomídeos 18,5% (5/27) foram os parasitas mais detectados nas praias. Conclusao: Desse modo, este estudo mostrou contaminação parasitária nas praias da Ilha de Mosqueiro, o que pode estar associada à falta de infraestrutura de saneamento e higiene pessoal nesses locais. Além disso, esses resultados reforçam a necessidade de se adotar medidas educacionais e preventivas para a redução desses agentes parasitários.

Preventing diseases in round-the-world travelers: a contemporary challenge for travel medicine advice

Abstract Providing advice for travelers embarking on long-term trips poses a challenge in travel medicine. A long duration of risk exposure is associated with underuse of protective measures and poor adherence to chemoprophylaxis, increasing the chances of acquiring infections. Recently, in our clinic, we observed an increase in the number of travelers undertaking round-the-world trips. These individuals are typically aged around 32 years and quit their jobs to embark on one-to-two-year journeys. Their destinations include countries in two or more continents, invariably Southeast Asia and Indonesia, and mostly involve land travel and visiting rural areas. Such trips involve flexible plans, increasing the challenge, especially with regard to malaria prophylaxis. Advising round-the-world travelers is time-consuming because of the amount of information that must be provided to the traveler. Advisors must develop strategies to commit the traveler to his/her own health, and verify their learnings on disease-prevention measures. Contacting the advisor after the appointment or during the trip can be helpful to clarify unclear instructions or diagnosis made and prescriptions given abroad. Infectious diseases are among the most frequent problems affecting travelers, many of which are preventable by vaccines, medicines, and precautionary measures. The dissemination of counterfeit medicines, particularly antibiotics and antimalarial medicines, emphasizes the need for travelers to carry medicines that they may possibly need on their trip. Additional advice on altitude, scuba diving, and other possible risks may also be given. Considering the difficulties in advising this group, we present a review of the main recommendations on advising these travelers.

Antimicrobial resistance in Neisseria gonorrhoeae: history, molecular mechanisms and epidemiological aspects of an emerging global threat

ABSTRACT Neisseria gonorrhoeae is the agent of gonorrhea, a sexually transmitted infection with an estimate from The World Health Organization of 78 million new cases in people aged 15-49 worldwide during 2012. If left untreated, complications may include pelvic inflammatory disease and infertility. Antimicrobial treatment is usually effective; however, resistance has emerged successively through various molecular mechanisms for all the regularly used therapeutic agents throughout decades. Detection of antimicrobial susceptibility is currently the most critical aspect for N. gonorrhoeae surveillance, however poorly structured health systems pose difficulties. In this review, we compiled data from worldwide reports regarding epidemiology and antimicrobial resistance in N. gonorrhoeae, and highlight the relevance of the implementation of surveillance networks to establish policies for gonorrhea treatment.

Modified Carba NP test for the detection of carbapenemase production in gram-negative rods: optimized handling of multiple samples

Abstract The modified Carba NP test presented here may be a valuable tool for laboratories interested in investigating a large number of carbapenemase-producing bacteria in a less-costly way. The test was evaluated against 48 carbapenemase-producing and carbapenemase-non-producing gram-negative bacteria. No false–positive results were obtained, but false-negative results were observed with OXA-23- and GES-carbapenemase-producing isolates. Aeromonas sp. are not testable by Modified Carba NP.

The Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) identification versus biochemical tests: a study with enterobacteria from a dairy cattle environment

Abstract Mastitis adversely affects milk production and in general cows do not regain their full production levels post recovery, leading to considerable economic losses. Moreover the percentage decrease in milk production depends on the specific pathogen that caused the infection and enterobacteria are responsible for this greater reduction. Phenotypic tests are among the currently available methods used worldwide to identify enterobacteria; however they tend to misdiagnose the species despite the multiple tests carried out. On the other hand The Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) technique has been attracting attention for its precise identification of several microorganisms at species level. In the current study, 183 enterobacteria were detected in milk (n = 47) and fecal samples (n = 94) from cows, and samples from water (n = 23) and milk lines (n = 19). All these samples were collected from a farm in Rio de Janeiro with the specific purpose of presenting the MALDI-TOF MS technique as an efficient methodology to identify Enterobacteriaceae from bovine environments. The MALDI-TOF MS technique results matched the biochemical test results in 92.9% (170/183) of the enterobacteria species and the gyrB sequencing confirmed 100% of the proteomic technique results. The amino acid decarboxylation test made the most misidentifications and Enterobacter spp. was the most misidentified genus (76.9%, 10/13). These results aim to clarify the current biochemical errors in enterobacteria identification, considering isolates from a bovine environment, and show the importance for more careful readings of phenotypic tests which are often used in veterinary microbiology laboratories.

Mechanisms of carbapenem resistance in endemic Pseudomonas aeruginosa isolates after an SPM-1 metallo-β -lactamase producing strain subsided in an intensive care unit of a teaching hospital in Brazil

Carbapenem-resistance mechanisms are a challenge in the treatment of Pseudomonas aeruginosa infections. We investigated changes in P. aeruginosa carbapenem-resistance determinants over a time period of eight years after the emergence of São Paulo metallo-β-lactamase in a university hospital in Rio de Janeiro, Brazil. Patients admitted to the intensive care unit (ICU) were screened for P. aeruginosa colonisation and followed for the occurrence of infections from April 2007 to April 2008. The ICU environment was also sampled. Isolates were typed using random amplified polymorphic DNA, pulsed-field gel electrophoresis and multilocus sequence typing. Antimicrobial susceptibility was determined by disk diffusion and E-test, production of carbapenemases by a modified-CarbaNP test and presence of carbapenemase-encoding genes by polymerase chain reaction. Non-carbapenemase resistance mechanisms studied included efflux and AmpC overexpression by PAβN and cloxacillin susceptibility enhancement, respectively, as well as oprD mutations. From 472 P. aeruginosa clinical isolates (93 patients) and 17 isolates from the ICU environment, high genotypic diversity and several international clones were observed; one environment isolate belonged to the blaSPM-1 P. aeruginosa epidemic genotype. Among isolates from infections, 10 (29%) were carbapenem resistant: none produced carbapenemases, three exhibited all non-carbapenemase mechanisms studied, six presented a combination of two mechanisms, and one exclusively displayed oprD mutations. Carbapenem-resistant P. aeruginosa displayed a polyclonal profile after the SPM-1 epidemic genotype declined. This phenomenon is connected with blaSPM-1 P. aeruginosa replaced by other carbapenem-resistant pathogens.

Rastreamento do câncer do colo do útero na região ampliada oeste de Minas Gerais, Brasil / Seguimiento de cáncer cervicouterino en ampliado región occidental de Minas Gerais / Cervical cancer screening in the enlarged west region of Minas Gerais

Analisar os indicadores do rastreamento do câncer do colo do útero na Região Ampliada Oeste de Minas Gerais, no período de 2007 a 2013. Método: trata-se de um estudo epidemiológico descritivo, com análise ecológica. Utilizou-se dados disponíveis no Sistema de Informação do Câncer de Colo do Útero de 54 municípios. A população elegível foram mulheres, usuárias do Sistema Único de Saúde, com idade entre 25 e 64 anos, que realizaram o exame Papanicolaou. A tabulação e a análise descritiva dos dados foram realizadas no software Statistical Package for the Social Sciences 20.0. Aprovado no comitê de ética pelo parecer número 718.783. Resultados: a cobertura de exames variou de 61,0% a 74,0%. A maioria tinha entre 35 e 54 anos. Foram consideradas insatisfatórias 0,86% das lâminas analisadas. O epitélio escamoso foi o mais evidenciado (99,1%) nas amostras. Observou-se a presença de inflamação em 41,9% dos exames. Prevalência de células atípicas escamosas de significado indeterminado, possivelmente não neoplásico, e as lesões intraepiteliais de baixo grau. Algumas variáveis apresentaram incompletude. Conclusão: a cobertura de exames Papanicolaou encontra-se baixa na região e a qualidade da informação insuficiente para monitorar a situação do câncer do colo do útero, pressupondo-se fragilidades na organização dos serviços...

Analyze tracking indicators of Uterine Cervical Cancer in the West Expanded region of Minas Gerais from 2007 to 2013. Method: This descriptive epidemiological study was conducted using ecologic analysis. Available data from Uterine Cervical Cancer Information System from 54 municipalities. The eligible population was women, users of Brazilian Unified National Health System (SUS), aged from 25 to 64 years which had undergone the Pap Test. The tabulation and descriptive analysis were performed using Statistical Package for the Social Sciences 20.0 software. Approved by the ethics committee for the number 718.783. Results: Exams coverage in the region ranged from 61.0% to 74.0%. Most were between 35 and 54 years. About the analyzed blades, 0.86% was considered unsatisfactory. The squamous epithelial was the most evidenced (99.1%). The presence of inflammation was observed in 41.9% of performed tests. Prevalence of atypical squamous cells of undetermined significance, possibly non-neoplasic and low-grade intraepithelial lesions. Some variables were incompleteness. Conclusion: The Pap test coverage is still low in the region and the information quality is insufficient to monitor the situation of cervical cancer. It is presupposed the existence of weaknesses in the organization of services...

Analizar los indicadores del rastreo del cáncer de cuello uterino en la Región Ampliada Oeste de Minas Gerais, en el periodo de 2007 a 2013. Método: Se trata de un estudio epidemiológico descriptivo, con análisis ecológico. Se utilizó datos disponibles en el Sistema de Información del Cáncer del cuello uterino de 54 municipios. La población elegível fueron mujeres, usuarias del SUS, com 25 a 64 años que realizaron el examen Papanicolaou. La tabulación y análisis descriptivo de los datos se realizaron en el software SPSS 20.0. Aprobado por el comité de ética para el número 718783. Resultados: La cobertura de las pruebas varió de 61,0% a 74,0%. La mayoría tenían 35-54 años. Se consideraron insatisfactoria 0,86% de las cuchillas analizadas. El epitélio escamoso fue el más evidenciado (99,1%) en las muestras. Se observó la presencia de inflamación en 41,9% de los exámenes realizados. Prevalencia de células escamosas atípicas de significado incierto, posiblemente no neoplásico y lesiones intraepiteliales de bajo grado. Algunas variables presentado incompletitud. Conclusión: La cobertura de exámenes Papanicolaou aún se encuentra baja y la calidad de la información insuficiente para monitorear la situación del cáncer de cuello uterino, asumiendo fragilidad en la organización de los servicios...

Widespread distribution of CTX-M and plasmid-mediated AmpC β-lactamases in Escherichia coli from Brazilian chicken meat

The dissemination of plasmid-mediated antimicrobial resistance genes may pose a substantial public health risk. In the present work, the occurrences of blaCTX-M and plasmid-mediated ampC and qnr genes were investigated in Escherichia coli from 16 chicken carcasses produced by four commercial brands in Brazil. Of the brands tested, three were exporters, including one of organic chicken. Our study assessed 136 E. coli isolates that were grouped into 77 distinct biotypes defined by their origin, resistance profiling, the presence of β-lactamase and plasmid-mediated quinolone resistance genes and enterobacterial repetitive intergenic consensus-polimerase chain reaction typing. The blaCTX-M-15, blaCTX-M-2 and blaCTX-M-8 genes were detected in one, 17 and eight different biotypes, respectively (45 isolates). Twenty-one biotypes (46 isolates) harboured blaCMY-2. Additionally, blaCMY-2 was identified in isolates that also carried either blaCTX-M-2 or blaCTX-M-8. The qnrB and/or qnrS genes occurred in isolates carrying each of the four types of β-lactamase determinants detected and also in oxyimino-cephalosporin-susceptible strains. Plasmid-mediated extended-spectrum β-lactamase (ESBL) and AmpC determinants were identified in carcasses from the four brands tested. Notably, this is the first description of blaCTX-M-15 genes in meat or food-producing animals from South America. The blaCTX-M-8, blaCTX-M-15 and blaCMY-2 genes were transferable in conjugation experiments. The findings of the present study indicate that plasmid-mediated ESBL and AmpC-encoding genes are widely distributed in Brazilian chicken meat.

Cuida-me Percepções de pessoas com úlceras de perna sobre as orientações de enfermagem / Take care of me Perceptions of people with leg ulcers on the nursing guidelines / Cuidame Percepciones de personas con úlceras de pierna bajo las directrices de enfermería

O objetivo do presente estudo foi conhecer as percepções das pessoas com úlceras de perna sobre as orientações de enfermagem para a promoção do autocuidado. Trata-se de uma pesquisa qualitativa realizada em um município de Minas Gerais com nove usuários. Os dados foram coletados por meio de entrevista semiestruturada, realizada nos meses de fevereiro a abril de 2013. As entrevistas foram gravadas e transcritas na íntegra e utilizou-se a Análise de Conteúdo na modalidade temática para análise dos dados. Os resultados permitiram evidenciar mudanças após a educação em saúde no cotidiano dos participantes por meio das práticas educativas capazes de desenvolver o autocuidado, favorecendo a cicatrização e cuidados com a saúde no pós-alta. A percepção das pessoas com úlceras crônicas sobre as orientações de enfermagem traduz na importância de pautá-las em conhecimentos técnicos e científicos...

The aim of this study was to understand the perceptions of people with leg ulcers on nursing guidelines for the promotion of self-care. It is a qualitative research, carried out in a municipality of the State of Minas Gerais, Brazil, with nine members. Data were collected through a semi-structured interview, conducted in February and April 2013. The interviews were recorded and transcribed and content analysis in the thematic mode was used for data analysis. The results show changes, after health education, in the daily lives of participants through educational practices to develop self-care, promoting healing and health care in post-discharge. The perception of people with chronic ulcers on the nursing guidelines reflects the importance of giving them a basis of technical and scientific knowledge...

El objetivo de este estudio fue comprender las percepciones de las personas con úlceras en las piernas sobre las directrices de enfermería para la promoción del autocuidado. Se trata de una investigación cualitativa, realizada en un municipio de Minas Gerais, con nueve miembros. Los datos se recolectaron a través de entrevista semiestructurada, realizada de febrero a abril de 2013. Las entrevistas se grabaron y transcribieron por entero y se utilizó el análisis de contenido en la modalidad temática para el análisis de datos. Los resultados muestran cambios después de la educación sanitaria en la vida cotidiana de los participantes a través de las prácticas educativas para desarrollar el auto-cuidado, lo que promueve la curación y la atención a la salud en la post alta. La percepción de las personas con úlceras crónicas bajo las directrices de enfermería refleja la importancia de apoyarlas en conocimientos técnicos y científicos...

Time-based distribution of Staphylococcus saprophyticus pulsed field gel-electrophoresis clusters in community-acquired urinary tract infections

The epidemiology of urinary tract infections (UTI) by Staphylococcus saprophyticus has not been fully characterised and strain typing methods have not been validated for this agent. To evaluate whether epidemiological relationships exist between clusters of pulsed field gel-electrophoresis (PFGE) genotypes of S. saprophyticus from community-acquired UTI, a cross-sectional surveillance study was conducted in the city of Rio de Janeiro, Brazil. In total, 32 (16%) female patients attending two walk-in clinics were culture-positive for S. saprophyticus. Five PFGE clusters were defined and evaluated against epidemiological data. The PFGE clusters were grouped in time, suggesting the existence of community point sources of S. saprophyticus. From these point sources, S. saprophyticus strains may spread among individuals.

Identification of uropathogenic Escherichia coli clonal group A (CgA) in hospitalised patients

This study provides the first description of healthcare-associated infections with Escherichia coli clonal group A (CgA) isolates in Latin America. Isolates were typed by enterobacterial repetitive intergenic consensus-PCR, pulsed-field gel electrophoresis, E. coli phylogenetic grouping, multilocus sequence typing and fimH single nucleotide polymorphism analysis. Out of 42 E. coli hospital isolates studied, three belonged to E. coli phylogenetic group D and ST69 and had fimH sequences identical to that of the CgA reference strain ATCC BAA-457. E. coli CgA is another potential source of resistant infections in hospitals.

blaGES carrying Pseudomonas aeruginosa isolates from a public hospital in Rio de Janeiro, Brazil

Previous analysis of Pseudomonas aeruginosa class-1 integrons from Rio de Janeiro, Brazil, revealed the blaGES gene in one isolate. We screened isolates of two widespread PFGE genotypes, A and B, at a public hospital in Rio, for the presence of blaGES. The gene was detected in all seven P. aeruginosa isolates belonging to genotype B. Three of the seven genotype-B isolates were resistant to amikacin, aztreonam, ceftazidime, cefepime, ciprofloxacin, gentamicin, imipenem, meropenem, piperacillin-tazobactam and ticarcillin-clavulanic acid. The other four isolates were resistant to all these agents, except gentamicin, imipenem, meropenem and piperacillin-tazobactam. A synergistic effect between ceftazidime and imipenem or clavulanic acid suggested the production of GES-type ESBL.

Application of molecular techniques in the study of Staphylococcus aureus clonal evolution - A Review

Staphylococcus aureus is an important agent of healthcare-associated and community-acquired infections. A major characteristic of this microorganism is the ability to develop resistance to antimicrobial agents. Several molecular techniques have been applied for the characterization of S. aureus in epidemiological studies. In the present review, we discuss the application of molecular techniques for typing S. aureus strains and describe the nomenclature and evolution of epidemic clones of this important pathogen.

Evolución de los casos que ameritaron estudios complementarios: trabajo realizado en la policlínica mamaria del Hospital Florida en el marco del PRONACAM / Evolution of the cases that needed complementary studies: paper carried out in the Florida Hospital Breast Polyclinic

Se analizó la población de 500 casos que consultaron en los 20 meses de existencia de la policlínica mamaria del Hospital Florida en el marco del PRONACAM. Teniendo en cuenta edad, FR y exámen físico, se seleccionaron 79 mujeres que ameritaron estudios. Los FR estuvieron presentes en más de la mitad de la población seleccionada. El exámen físico alterado (normal o dudoso) se presentó en el 81 por ciento de los casos. Mientras que la asociación exámen físico alterado más FR, se presentó en el 40.5 por ciento de los casos. En 76 casos se solicitó mamografía. La confirmación de cáncer tuvo una sensibilidad del 100 por ciento. En los casos en que fue dudosa, no se constató cáncer por otros medios diagnosticados y sí, patología benigna en 80 por ciento de ellos. Tampoco en los casos en que fue negativa y se dudó por la clínica. Los autores siguen pensando que se trata de un excelente método diagnóstico. La incidencia de cáncer en la población de mujeres que concurren a una policlínica creada para despistaje de cáncer de mama, fue de 0,8 por ciento. No se detectaron canceres en Estadios precoces sino por el contrario en etapas avanzadas. Los FR estuvieron presentes en 3 de los 4 cánceres encontrados

Quimioterapia da malaria I / Drug therapy of malaria I

Apresenta diagnostico, tratamento e incidencia da malaria no Brasil. Atualmente, inumeros medicamentos reunem alta eficiencia, alta especificidade e baixos efeitos colaterais, viabilizando um tratamento seguro e preciso. Aborda as diversas situaçoes nas quais estes recursos terapeuticos exercem oseu papel