What are the advantages of living in a community? A microbial biofilm perspective!

Biofilm formation is the preferred mode of growth lifestyle for many microorganisms, including bacterial and fungal human pathogens. Biofilm is a strong and dynamic structure that confers a broad range of advantages to its members, such as adhesion/cohesion capabilities, mechanical properties, nutritional sources, metabolite exchange platform, cellular communication, protection and resistance to drugs (e.g., antimicrobials, antiseptics, and disinfectants), environmental stresses (e.g., dehydration and ultraviolet light), host immune attacks (e.g., antibodies, complement system, antimicrobial peptides, and phagocytes), and shear forces. Microbial biofilms cause problems in the hospital environment, generating high healthcare costs and prolonged patient stay, which can result in further secondary microbial infections and various health complications. Consequently, both public and private investments must be made to ensure better patient management, as well as to find novel therapeutic strategies to circumvent the resistance and resilience profiles arising from biofilm-associated microbial infections. In this work, we present a general overview of microbial biofilm formation and its relevance within the biomedical context.

Dimensionamento da força de trabalho no sus: o trabalho (e trabalhador) vivo no planejamento do cuidado em saúde / Dimensioning of workforce in sus: work (and worker) live in health care planning

O dimensionamento tem sido evidenciado na literatura como importante dispositivo para o planejamento e desenvolvimento da força de trabalho no Sistema Único de Saúde. Enquanto vinculado a modelos de atenção, expressa características sobre incorporação tecnológica, processos decisórios, relação entre profissionais e a própria compreensão do ato de cuidar, conferindo diferentes possibilidades de sentidos para o processo de dimensionamento e sua operacionalização. Assim, este estudo visa, a partir da análise de nove experiências, a caracterização dos processos de dimensionamento desenvolvidos no cotidiano de gestão do trabalho no SUS e análise compreensiva de acordo com o debate dos modelos tecnoassistenciais em saúde. Os resultados indicam a incorporação do dimensionamento como uma agenda das instituições de gestão descentralizadas do SUS, afirmando o planejamento a partir das realidades locais de cada território. As ações de dimensionamento em 77,8% dos casos envolveram todas as categorias profissionais dos serviços, sendo os tipos de serviços dimensionados de acordo com a lógica de redes e linhas de cuidado. A importância do dimensionamento enquanto um processo contínuo e integrado ao processo de trabalho é evidenciada. O planejamento da força de trabalho é indicado como ato político atravessado por disputas de projetos assistenciais, se configurando a partir de processos mais centrados nas relações ou mais presos à lógica dos instrumentos duros, com desdobramentos na forma de organização do cuidado. Afirma-se a proposta do dimensionamento articulado a espaços de decisão mais públicos, implicados com a construção coletiva do trabalho e com a dimensão cuidadora na produção de saúde.

Dimensioning of health workers has been portrayed in articles as an important tool for planning and developing human resources in the Unified Health System (SUS). While bound to health care models, it expresses characteristics concerning such as the incorporation of technological resources, decision-making, the relationship between professionals and even the comprehension of care, thus delivering different possibilities for the organization and operationalizing processes of dimensioning. Therefore, this study aimed to characterize the dimensioning processes developed at the SUS, and to elaborate a thorough analysis according to the debate of assistance models in health care based on the perspective of nine projects. The results indicate that the dimensioning has been incorporated as part of the agenda of the decentralized management institutions of SUS, affirming that planning built upon local realities is a need. Dimensioning activities involved all the diverse set of professional categories in 77.8% of the cases analyzed, and the services were scaled according to the logic of networks and lines in health care. The importance of dimensioning as a continuous and integrated process in the work setting is highlighted. Planning workforce is recognized as a political act in which occur social welfare projects disputes, designed from processes focused on relations or attached to the logic of hard instruments, with developments in the form of the organization of health care. An intricate dimensioning process, interconnected with public decision spaces and involved with the public construction of labor, with care as the central dimension in health, appears as an indisputable proposal.

First description of Candida nivariensis in Brazil: antifungal susceptibility profile and potential virulence attributes

This study evaluated the antifungal susceptibility profile and the production of potential virulence attributes in a clinical strain of Candida nivariensis for the first time in Brazil, as identified by sequencing the internal transcribed spacer (ITS)1-5.8S-ITS2 region and D1/D2 domains of the 28S of the rDNA. For comparative purposes, tests were also performed with reference strains. All strains presented low planktonic minimal inhibitory concentrations (PMICs) to amphotericin B (AMB), caspofungin (CAS), and voriconazole. However, our strain showed elevated planktonic MICs to posaconazole (POS) and itraconazole, in addition to fluconazole resistance. Adherence to inert surfaces was conducted onto glass and polystyrene. The biofilm formation and antifungal susceptibility on biofilm-growing cells were evaluated by crystal violet staining and a XTT reduction assay. All fungal strains were able to bind both tested surfaces and form biofilm, with a binding preference to polystyrene (p < 0.001). AMB promoted significant reductions (≈50%) in biofilm production by our C. nivariensis strain using both methodologies. This reduction was also observed for CAS and POS, but only in the XTT assay. All strains were excellent protease producers and moderate phytase producers, but lipases were not detected. This study reinforces the pathogenic potential of C. nivariensis and its possible resistance profile to the azolic drugs generally used for candidiasis management.

Em busca de um paradigma de programaçäo local em saúde bucal mais resolutivo no SUS / In search of more efficient paradigm of planning oral health services within the Unified Health System

Discute a história dos modelos assistenciais e de programaçäo nos serviços públicos de saúde bucal, e aponta propostas que em novos moldes, visem o aumento da resolutividade. Faz um resgate histórico apontando para a necessidade de uma nova postura programática articulada politico-gerencialmente no nível local, que provoque mudanças no esgotado paradigma de programaçäo sanitário-bucal instituido a mais de quarenta anos, fortalecendo as possibilidades de desenvolvimento do paradigma assistencial vigente nas experiências mais avançadas