Impact of the COVID-19 Pandemic on Elective and Emergency Surgical Procedures in a University Hospital / Impacto da Pandemia por COVID-19 nos Procedimentos Cirúrgicos Eletivos e Emergenciais em Hospital Universitário

ABSTRACT Objective: to assess the impact of the COVID-19 pandemic on abdominal wall hernia repair surgeries and cholecystectomy in a referral center hospital. Methods: a retrospective, observational, cross-sectional study carried out at Hospital Universitário Evangélico Mackenzie (HUEM), in Curitiba, Paraná, Brazil. Data obtained through electronic medical records of patients who underwent cholecystectomy and abdominal wall hernia repair from March to December 2019 and 2020 at HUEM were included. Data were analyzed using Pearsons Chi-Square test and analysis of variance (ANOVA). Results: a total of 743 medical records were analyzed, with a 63.16% drop in the total number of surgeries in 2020. There was a 91.67% increase in the number of ICU admissions in 2020, as well as a 70% increase in average length of stay. A greater number of complications was observed (in 2020, 27% had complications, while in 2019 this figure was 18.8%) and an increase in mortality (in 2019, this rate was 1.3% and in 2020, 6.5%). There were 6 cases of COVID-19 in 2020, so that of these, 5 patients died. Conclusion: during the COVID-19 pandemic, an important reduction in the number of abdominal wall hernia repair surgeries and cholecystectomy was observed. In addition, there was a statistically significant increase in postoperative complications, mortality rate and length of stay in 2020.

RESUMO Objetivo: avaliar o impacto da pandemia da COVID-19 em cirurgias de reparo de hérnias de parede abdominal e colecistectomia em hospital centro de referência. Métodos: estudo transversal retrospectivo observacional realizado no Hospital Universitário Evangélico Mackenzie (HUEM), em Curitiba, Paraná, Brasil. Foram incluídos os dados obtidos através de prontuários eletrônicos de pacientes que realizaram colecistectomia e reparo de hérnias de parede abdominal no período de março a dezembro de 2019 e 2020 no HUEM. Os dados foram analisados por meio do teste Qui-Quadrado de Pearson e aplicação da Análise de Variância (ANOVA). Resultados: Foram analisados 743 prontuários ao todo, sendo constatada uma queda de 63,16% no número total de cirurgias no ano de 2020. Verificou-se um aumento de 91,67% no número de internações em UTI em 2020, bem como um aumento de 70% no tempo médio de internação. Foi observado um maior número de complicações (em 2020, 27% apresentaram complicações, enquanto em 2019 este valor foi de 18,8%) e um aumento em relação à mortalidade (em 2019, esta taxa foi de 1,3% e em 2020, 6,5%). Observaram-se 6 casos de COVID-19 em 2020, de modo que destes, 5 pacientes vieram a óbito. Conclusão: durante a pandemia da COVID-19, observou-se uma importante redução na quantidade de cirurgias de reparo de hérnia de parede abdominal e colecistectomia. Além disso, houve aumento estatisticamente relevante quanto às complicações pós-operatórias, taxa de mortalidade e tempo de internamento em 2020.

Seleção de fungos isolados do ambiente com atividade lipolítica / Isolation and selection of lipolytic enzymes-producing fungi

Neste estudo, foram isolados e selecionados os micro-organismos produtores de enzimas lipolíticas, e foi avaliada sua ação sobre diferentes substratos. A enzima foi produzida pela fermentação semi sólida com farelo de trigo a 50% de umidade e 120 horas de incubação a 35 °C. A atividade da lipase foi medida por titulação utilizando-se um sistema de reação composto por 4 mL de tampão acetato 50 mM, pH 5,6, 1 g de substrato e 1 mL de extrato bruto enzimático. Uma unidade de atividade enzimática foi definida como a quantidade de enzima necessária para liberar 1 μmol de ácido graxo. Os substratos testados foram creme de leite, óleo de soja e gordura de coco. Foram isoladas 33 linhagens de fungos, separadas em quatro grupos (A, B, C e D) de acordo com extratos enzimáticos. Os fungos do grupo C apresentaram os maiores valores para atividade lipolítica, sendo de 10,41 e 9,49 μmol/mL no creme de leite; 8,96 e 7,51 μmol/mL no óleo de soja; e 8,52 e 8,14 μmol/mL na gordura de coco. A técnica empregada neste trabalho foi eficiente para efetuar o isolamento de fungos filamentosos com elevada atividade lipolítica. O estudo das linhagens de fungos será relevante para possíveis aplicações biotecnológicas.

Avaliação do conhecimento geral de médicos emergencistas de hospitais de Salvador - Bahia sobre o atendimento de vítimas com parada cardiorrespiratória / Assessment of the general knowledge of emergency physicians from the hospitals of the city of Salvador (Brazil) on the care of cardiac arrest patients

OBJETIVO: Identificar a proporção de médicos emergencistas com habilitação em cursos de imersão (SAVC - Suporte Avançado de Vida em Cardiologia e SAVT - Suporte Avançado de Vida no Trauma), relacionando variáveis: idade, sexo, especialidade médica, titulação e tipo de hospital com o grau de conhecimento teórico no atendimento de vítimas de parada cardiorrespiratória. MÉTODOS: Foram avaliados de forma consecutiva, de novembro/2003 a julho/2004, os emergencistas de hospitais públicos e privados da cidade de Salvador - Bahia, que voluntariamente aceitaram participar do estudo. Esses responderam a um questionário construído de informações das variáveis de interesse: perfil do profissional, realização ou não dos cursos de imersão SAVC e SAVT, avaliação cognitiva com 22 questões objetivas sobre ressuscitação cardiopulmonar. Calculou-se para cada participante um valor de acertos indicado como variável escore. Esse questionário foi validado a partir do resultado do escore dos instrutores do curso SAVC em Salvador - BA. RESULTADOS: Dos 305 médicos que responderam ao questionário, 83 (27,2 por cento) haviam realizado o curso SAVC, tendo como média da variável escore o valor de 14,9+3,0, comparada com os 215 médicos (70,5 por cento) que não o haviam feito e cuja média foi de 10,5+3,5 (p=0,0001). A média do escore dos 65 cardiologistas (21,5 por cento) foi de 14,1+3,3, comparada com os 238 médicos (78,5 por cento) que eram de outras especialidades, com média de 9,7+3,7(p=0,0001). Não foi identificada diferença da média do escore entre os médicos que haviam ou não realizado o curso SAVT (p=0,67). CONCLUSÃO: Na amostra avaliada, o conhecimento teórico sobre ressucitação cárdio-pulmonar (RCP) foi superior naqueles profissionais que realizaram o SAVC, diferente do que ocorreu naqueles que realizaram o SAVT. Os especialistas em Cardiologia que realizaram o SAVC demonstraram um conhecimento teórico superior, sobre o atendimento de vítimas de parada cárdio-respiratória (PCR), quando...

OBJECTIVE: To identify the proportion of emergency physicians certified in immersion courses (ACLS - Advanced Cardiac Life Support and ATLS - Advanced Trauma Life Support) correlating the variables of age, gender, medical specialty, academic title, and type of hospital with the level of theoretical knowledge on the care of Cardiac Arrest (CA) victims. METHODS: Emergency physicians from public and private hospitals of the city of Salvador, State of Bahia - Brazil, were consecutively evaluated from November, 2003 to July, 2004. They volunteered to participate in the study, and responded to a questionnaire consisting of information on the following variables of interest: professional profile, participation or not in ACLS and ATLS immersion courses, and cognitive assessment with 22 objective questions on Cardiopulmonary Resuscitation (CPR). A score of correct answers was calculated for each participant, and then designated as score variable. This questionnaire was validated based on the result of the score obtained by ACLS course instructors in Salvador, BA. RESULTS: Of the 305 physicians who responded to the questionnaire, 83 (27.2 percent) had attended the ACLS course and had a mean score variable of 14.9+3.0 compared with the 215 physicians (70.5 percent) who had not attended the course and whose mean was 10.5+ 3.5 (p=0.0001). The mean score of the 65 cardiologists (21.5 percent) was 14.1+3.3 compared with the mean of 9.7+3.7(p=0.0001) of the 238 physicians (78.5 percent) from other specialties. No difference was observed in the mean scores between physicians who had attended the ATLS course or not (p=0.67). CONCLUSION: In the sample studied, theoretical knowledge on CPR was higher among physicians who had attended the ACLS course, as opposed to those who had attended the ATLS course. Cardiologists who had attended the ACLS demonstrated a higher theoretical knowledge on the care of CA patients when compared to physicians from other specialties taken as whole - Internal...

Properties of a new fungal ß-Galactosidase with potential application in the dairy industry

ß-Galactosidase or ß-D-galactohydrolase (EC.3.2.1.23) is an important enzyme industrially used for the hydrolysis of lactose from milk and milk whey for several applications. Lately, the importance of this enzyme was enhanced by its galactosyltransferase activity, which is responsible for the synthesis of transgalctosylated oligosaccharides (TOS) that act as functional foods, with several beneficial effects on consumers. Penicillium simplicissimum, a strain isolated from soil, when grown in semi-solid medium showed good productivity of ß-galactosidase with galactosyltransferase activity. The optimum pH for hydrolysis was in 4.0-4.6 range and the optimum pH for galactosyltransferase activity was in the 6.0-7.0 range. The optimum temperature for hydrolysis and transferase activity was 55-60§C and 50§C, respectively, and the enzyme showed high thermostability for the hydrolytic activity. The enzyme showed a potential for several industrial applications such as removal of 67 (per cent) of the lactose from milk and 84 (per cent) of the lactose from milk whey when incubated at their original pH (4.5 and 6.34, respectively) under optimum temperature conditions. When incubated with a 40 (per cent) lactose solution in 150 mM McIlvaine buffer, pH 4.5, at 55§C the enzyme converted 86.5 (per cent) of the lactose to its component monosaccharides. When incubated with a 60 (per cent) lactose solution in the same buffer but at pH 6.5 and 50§C, the enzyme can synthetize up to 30.5 (per cent) TOS, with 39.5 (per cent) lactose and 30 (per cent) monosaccharides remaining in the preparation.

Production and action pattern of inulinase from "Aspergillus niger"-245: hydrolysis of innulin from several sources

A strain of Aspergillus niger isolated from soil samples showed great capacity to produce extracellular inulinase. Although the enzyme has been synthesized in presence of monosaccharides, sucrose and sugar cane molasse, the productivity was significantly higher (p<0.05) when the microorganism was inoculated in media formulated with dahlia extract and pure inulin, as carbon sources. With regard to the nitrogen source, the best results were obtained with casein and other sources of proteic nitrogen, comparatively to the mineral nitrogen. However, statistic significance (p<0.01) only was found between the productivity obtained in the medium prepared with casein amonium sulphate. The optimum pH of the purified enzyme for inulin hydrolysis was found between 4.0 and 4.5 and the optimum tempereature at 60ºC. When treated by 30 minutes u=in this temperature no loss of activity was observed. The enzyme showed capacity to hydrolyse sucrose, raffinose and inulin from which it liberated only fructose units showing, therefore, an exo-action mechanism. Acting on inulins from several sources, the enzyme showed larger hydrolysis speed on the polissaccharide from chicory ("Cichorium intibus"), comparatively, to the inulins from dahlia ("Dahlia pinnata") and Jerusalem astichoke ("Helianthus tuberosus") roots.

Purification and characterization of β-Fructosidase with inulinase activity from Aspergillus niger - 245

Aspergillus niger - 245, a strain isolated from soil samples showed good β-fructosidase activity when inoculated in medium formulated with dahlia extract tubers. The enzyme was purified by precipitation in ammonium sulphate and percolated in DEAE-Sephadex A-50 and CM-cellulose columns, witch showed a single peack in all the purification steps, maintaining the I/S ratio between 0.32 to, 0.39. Optimum pH for inulinase activity (I) was between 4.0 - 4.5 and for invertase activity (S) between 2.5 and 5.0. The optimum temperature was 60O.C for both activities and no loss in activity was observed when it was maintained at this temperature for 30 min. The Km value was 1.44 and 5.0, respectively, for I and S and Vm value 10.48 and 30.55, respectively. The I activity was strongly inhibited by Hg2+ and Ag+ and 2 x 10-3 M of glucose, but not by fructose at the same concentration. The enzyme showed an exo-action mechanism, acting on the inulin of different origins. In assay conditions total hydrolysis of all the frutans was obtained, although it has shown larger activity on the chicory inulin than that one from artichoke Jerusalem and dahlia, in the first 30 min. The obtained results suggested that the enzyme presented good potential for industrial application in the preparing the fructose syrups.

Aspergillus niger - 245, isolado do solo mostrou boa atividade de b-frutosidase meio formulado com extrato de tubérculos de dahlia. A enzima foi purificada por precipitação em sulfato de amônia e percolada em colunas de DEAE-Sephadex A-50 e CM-celulose, produzindo um único pico em todas as fases de purificação e mantendo a relação I/S entre 0,32 a 0,39. O pH ótimo para a atividade de inulinase (I) foi encontrado entre 4,0 - 4.5 e para a atividade de invertase (S) em 2,5 e 5,0. A temperatura ótima foi de 60O.C para ambas as atividades e nenhuma perda foi observada quando mantida nesta temperatura por 30 min. Os valores de Km foram de 1,44 e 5,0, respectivamente, para I e S e os valores de Vm de 10,48 e 30,55, respectivamente. A atividade I foi fortemente inibida por Hg2+, Ag+ e 2 x 10-3 M de glicose, mas não por frutose na mesma concentração. A enzima mostrou um mecanismo de exo-ação, atuando sobre a inulina de diferentes origens. Em condições de ensaio foi obtida hidrólise total de frutanas, apesar de ter mostrado maior atividade sobre a inulina de chicória que sobre as de alcachofra de Jesrusalém e dahlia, nos primeiros 30 minutos de reação. Os resultados obtidos sugerem que a enzima apresenta bom potencial para aplicações industriais na preparação de xaropes de frutose.

Produçäo e caracterizaçäo de alfa-amilase produzida por Rhizopus sp / Production and characterization of alfa-amilase from Rhizopus sp

A strain of Rhizopus sp. screened among more than 800 filamentous fungi showed great ability to produce a thermostable alfa-amylase by solid state fermentation. The best production was obtained with a bran moisture content of 40 per cent when the enzyme activity reached 60 EU/g. of medium. During the purification procedures, a column of DEAE- Sephadex A-50 separeted the enzyme in two fractions and the larger (85 per cent of the total activity) showed optimum pH in a range from 4.0 to 5.6. Optimum temperature was found at 60-65§ C and in this range no loss of activity was observed after 60 min. of treatment in pH 5,0. Its Km and Vm are, respectively, of 5.0 mg/ml of starch and 10,01 uMol of reducing sugar/min./mg. of protein. Its molecular weight was calculated in 64.000 by gel filtration in Sephadex G-200. The dextrinization power of the enzyme was observed preferentialy on substrates compound by chain with higher ramifications, traht is: amylopectin > starch> amylose. Other aspects of the enzyme pattern action are also discussed