Infección de piel y partes blandas por Vibrio vulnificus. Comunicación de un caso diagnosticado en Argentina / Vibrio vulnificus infection of the skin and soft parts. Communication of a case diagnosed in Argentina

Resumen Vibrio vulnificus es una de las especies de Vibrio más virulentas que se conocen. Es una bacteria de distribución universal. El primer caso registrado en Uruguay se produjo en 2001, y desde entonces ocurren varias infecciones por año. Recientemente, en ese país, V. vulnificus fue responsable de una infección de partes blandas de curso letal. Aunque no han sido comunicados casos de infección humana por esta especie en Argentina, se ha identificado recientemente Vibrio vulnificus en muestras asociadas con microplancton en el estuario del Río Negro. Presentamos el caso de una infección grave de piel y partes blandas por V. vulnificus a partir de una herida abierta en un paciente en contacto con medio acuático marino en la costa de Uruguay del Río de la Plata. El aislamiento de vibrios en muestras de heridas puede causar un daño en los tejidos con rápida progresión, en particular V. vulnificus, que tiene una alta mortalidad sin la precoz y apropiada intervención. En nuestro caso, la rápida identificación del microorganismo permitió avalar el tratamiento empírico utilizado, con una buena evolución clínica.

Abstract Vibrio vulnificus is one of the most virulent Vibrio species known. It is a bacterium with universal distribution. The first case registered in Uruguay occurred in 2001 and, since then, several infections have occurred per year. Recently, in this country, V. vulnificus was responsible for a fatal soft tissue infection. Although no cases of human infection with this species have been reported in Argentina, researchers have recently identified V. vulnificus in samples associated with microplankton in the Rio Negro estuary. We present the case of a severe skin and soft tissue infection by V. vulnificus from an open wound in a patient in contact with a marine aquatic environment on the coast of the River Plate, in Uruguay. Isolation of vibrios from wound specimens can cause rapidly progressing tissue damage, particularly V. vulnificus which has a high mortality rate without early and appropriate intervention. In our case, the rapid identification of the microorganism allowed us to support the empirical treatment used, which a good clinical evolution.

Recomendaciones en el abordaje del hematoma intracerebral espontáneo durante la internación / Recommendations for the management of spontaneous intracerebral hemorrhage during hospitalization

Resumen El accidente cerebrovascular (ACV) constituye la principal causa de discapacidad de origen neuro- lógico en los adultos mayores a 40 años y la cuarta causa de muerte en Argentina. En los últimos diez años las publicaciones indexadas relacionadas al tratamiento del ACV isquémico fueron más numerosas que las de ACV hemorrágico. El objetivo de este material es proporcionar recomendaciones locales y actualiza- das del abordaje de pacientes con hematoma intraparenquimatoso espontáneo durante la internación. Para la redacción de este manuscrito se convocó a especialistas en esta enfermedad que conformaron grupos de trabajo. Se plantearon 10 tópicos centrales expresados como epidemiologia, atención inicial, imágenes, tratamiento de la presión arterial, reversión de antitrombóticos, indicación de cirugía, profilaxis anticonvulsivante, pronóstico, prevención de complicaciones y reinicio de antitrombóticos. De cada tópico se plantearon mediante preguntas PICO los interrogantes más frecuentes de la práctica diaria. Luego de una revisión sistemática de la literatura, se generaron recomendaciones evaluadas mediante sistema GRADE y consensuadas entre autores y pacientes.

Abstract Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracere- bral hemorrhage during hospitalization. For the writing of this manuscript, diferent specialists were convened to form working groups. Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.

Avaliação e comparação entre métodos de mensuração de pressão arterial sistólica em gatos hígidos conscientes / Evaluation and comparison between methods of measurement of systolic blood pressure in healthy conscious cats

Após validação de dois diferentes métodos de mensuração de pressão arterial sistólica (PAS) não invasivos ou indiretos (oscilométrico e Doppler vascular) com o invasivo ou direto (cateterização arterial - padrão ouro) em 12 gatos hígidos anestesiados de mesma faixa etária, os métodos não invasivos foram avaliados e comparados em 24 gatos hígidos e conscientes, divididos em quatro grupos de idade. Em cada animal, procedeu-se à mensuração da pressão pelos métodos Doppler e oscilométrico. O método oscilométrico foi o primeiro a ser realizado, e, logo em seguida, o método Doppler. Os valores considerados foram obtidos das médias de sete medidas consecutivas para cada método, com intervalo de 30 segundos entre elas. A primeira medida e as medidas discrepantes (variação ˃ 20% PAS), obtidas com sinais óbvios de estresse e/ou com movimentação do animal, foram descartadas. Os métodos de mensuração oscilométrico e Doppler, embora tenham apresentado médias estatisticamente diferentes em todos os grupos, quando comparados em cada grupo, apresentaram uma correlação significativa, alta e positiva. Ou seja, sempre que for obtido um valor elevado por um método, o mesmo fato ocorrerá com o outro método e vice-versa. Clinicamente, a diferença observada não é relevante, uma vez que a diferença média dos valores obtida pelos dois métodos, em cada grupo, foi menor que 1,1%.(AU)

After two different validation systolic blood pressure measurement methods (PAS), not invasive or indirect (oscillometric and doppler vascular) with invasive or direct (arterial catheterization - Gold Standard) in 12 anesthetized healthy cats of the same age group, not invasive methods were evaluated and compared in 24 healthy conscious cats, divided into four age groups. In each animal, we proceeded to measure the pressure by Doppler and oscillometric methods. The oscillometric method was the first to be performed, and, shortly thereafter, the doppler method. The values considered were obtained from averages from seven consecutive measurements for each method with an interval of thirty seconds between them. The first measurement and disparate measurements (range ˃ 20% PAS) obtained with obvious signs of stress and / or animal movement were discarded. Methods of oscillometric and doppler measurement, although statistically different averages were shown in all groups when compared, each group showed a significant high positive correlation, meaning that when a high value is obtained by a method, the same occurs with the other method, and vice versa. Clinically, the observed difference is not relevant since the mean difference values obtained by the two methods, in each group was lower than 1.1%.(AU)

Morphology and vascularization of the corpus luteum of peccaries (Pecari tajacu, Linnaeus, 1758) throughout the estrous cycle / Morfologia e vascularização do corpo lúteo de catetos (Pecari tajacu, Linnaeus, 1758) ao longo do ciclo estral

The current paper characterizes the changes in morphology and vascularization of the corpus luteum of collared peccaries during the estrous cycle and correlates progesterone synthesis (P4). Twenty females were subjected to a treatment for estrus synchronization; an ear implant containing 1.5 mg of norgestomet was implanted on D0, whereas on D9 the peccaries received an IM injection of eCG 200UI and 50g of PGF2a. The animals were divided into four groups (G1, G2, G3 and G4) and euthanized on post-ovulation days 3, 12, 18 and 22. The ovaries were collected and the corpora lutea were measured and processed for histological and vascular density (Dv). Blood was collected for dosage of P4 serum. The morphology of the ovaries, the corpora lutea and P4 varied significantly during the estrous cycle (P<0.001). There was a significant co-relationship between weight and length of the ovaries and CL (r = 0.66, r = 0.52, P<0.05, respectively) and between weight, length and width of the CL and P4 (r = 0.51, r = 0.54 and r = 0.68, P<0.05, respectively). The luteal Dv was highly influenced by the estrous cycle phase (P<0.0001). The P4 and luteal Dv concentrations were higher in G2 and evidenced maximum secretory activity, with a highly significant correlation (P<0.0001). Assessed lutein parameters may estimate the phase of the estrous cycle in peccaries and the functional activity of the corpus luteum.

Objetivou-se caracterizar as variações na morfologia e vascularização do corpo lúteo (CL) de catetos durante ciclo estral (CE) e correlacioná-las com a concentração de progesterona (P4). Vinte fêmeas de cateto foram submetidas a tratamento de sincronização do estro; no D0 receberam implante auricular contendo 1,5mg de norgestomet, no D9 injeção via IM de 200UI de eCG e 50µg de PGF2α. Os animais foram divididos em quatro grupos (G1, G2, G3 e G4) e eutanasiados nos dias três, 12, 18 e 22 pós-ovulação. Os ovários foram coletados e os CL foram mensurados e processados para avaliação histológica e da densidade vascular (Dv). O sangue foi coletado para dosagem da P4 sérica. A morfologia dos ovários, CL e a concentração de P4 variaram significativamente durante o CE (P<0,001). Houve correlação significativa entre peso e comprimento dos ovários e CL (r = 0,66, r = 0,52, P<0,05, respectivamente) e entre peso, comprimento e largura do CL e a concentração de P4 (r=0,51, r=0,54 e r=0,68; P<0,05, respectivamente). A Dv do CL se mostrou muito influenciada pela fase do CE (P<0,001) e apresentou alta correlação significativa (P< 0,001). No G2 os maiores valores de P4 e Dv confirmaram máxima atividade secretória do CL nesse estádio. Os parâmetros luteínicos avaliados podem ser usados para estimar a fase do ciclo estral em catetos e a atividade funcional do CL.

Avaliação e comparação entre métodos de mensuração de pressão arterial sistólica em gatos hígidos anestesiados / Evaluation and comparison between methods of measurement of systolic blood pressure in healthy anesthetized cats

Foram avaliados e comparados, para fins de validação, dois diferentes métodos de mensuração de pressão arterial sistólica (PAS), não invasivos ou indiretos (oscilométrico e Doppler vascular) com o invasivo ou direto (cateterização arterial - padrão ouro), em 12 gatos hígidos anestesiados de idade variando entre sete meses e dois anos. Em cada animal, procedeu-se à mensuração simultânea da pressão não invasiva e da invasiva. O método oscilométrico foi comparado, por meio de sete medidas consecutivas, com intervalo de 30 segundos entre elas, com o método invasivo, e, logo em seguida, o método Doppler foi comparado ao método invasivo da mesma maneira. Concluiu-se que o método oscilométrico é estatisticamente igual ao método invasivo, enquanto o Doppler difere de ambos. Entretanto, pela forte correlação positiva entre os métodos Doppler e invasivo, foi possível criar um fator de correção (equação de regressão linear) para se determinar o valor da pressão invasiva, a partir do valor obtido pelo método Doppler. Para obtenção de valores mais fidedignos, recomenda-se a utilização desse fator de correção quando o método Doppler for utilizado para mensuração de PAS em gatos anestesiados.

For validation purposes, two different methods of measurement of systolic blood pressure (SBP), noninvasive or indirect (oscillometric and vascular doppler), direct or invasive (arterial catheterization - the gold standard) were evaluated and compared in 12 healthy anesthetized cats, varying between seven months to two years old. In each animal, we proceeded to the simultaneous noninvasive and invasive measurement of pressure. The oscillometric method was compared by means of seven consecutive measurements with an interval of 30 seconds between them, with the invasive method, and soon after, the doppler method was compared to the invasive method in the same way. It was concluded that the oscillometric method is statistically equal to the invasive method, whereas doppler differs from both. However, due to the strong positive correlation between doppler and invasive methods, it was possible to create a correction factor (linear regression) to determine the value of invasive pressure from the value obtained by the doppler method. To obtain more reliable figures, it is recommended to use this correction factor when the doppler method is used to measure SBP in anesthetized cats.

Placa ateromatosa calcificada en radiografía panorámica: aspectos radiográficos y diagnósticos diferenciales / Calcified atheromatous plaque in panoramic radiography: radiographic aspects and differential diagnosis

Las placas de ateroma son conformadas por depósitos de lípidos en las camadas más profundas de las arterias y que siendo estructuras calcificadas pueden ser vistas en radiografías panorámicas. Su aspecto radiográfico debe ser diferenciado de las imágenes que pertenecen a diversas estructuras anatómicas y patológicas radiopacas, puesto que en dicho examen es posible observar asimismo otros hallazgos radiográficos en región cervical. Calcificaciones más a menudo descriptas en la literatura y que consisten en diagnóstico diferencial para las placas ateromatosas son el hueso hioides, cartílago tritícea, el cuerno superior de calcificación del cartílago tiroides calcificada, la epiglotis, los ganglios linfáticos calcificados, los flebolitos, los submaxilares de glándulas salivales y los tonsiolitos. Este estudio tiene como objetivo realizar una revisión de la literatura relativa a las placas ateromatosas y su diferencial diagnóstico con el fin de orientar mejor al dentista en la interpretación de estas imágenes. De esta manera, permite el reenvío de la paciente a un tratamiento preventivo, contribuyendo al desarrollo de la salud pública...

The atheromatous plaques consist of deposits of fat in the inner layers of the arteries and as they are calcified, can be detected on panoramic radiographs. Its radiographic appearance should be differentiated from others anatomical and pathological radiopaque structures, since this examination can also detect other radiographic findings in the neck. The calcifications most frequently described in the literature between anatomical and pathological conditions, and which constitute the differential diagnosis for atheromatous plaques are the hyoid bone, cartilage triticeous, the superior horn of the calcified thyroid cartilage, epiglottis, calcified lymph nodes, the phleboliths, submandibular salivary gland sialoliths and tonsilloliths. This study aims to conduct a review of literature related to atheromatous plaques and their differential diagnoses in order to provide better guidance to the dentist in the interpretation of those images. Thus, the patient can properly receive an early treatment, contributing to the development of public health...

Efeito do extrato aquoso de camomila (Chamomilla recutita L. ) na prenhez de ratas e no desenvolvimento dos filhotes / Effect of aqueous extract of chamomile (Chamomilla recutita L. ) on rat pregnancy and offspring development

As plantas medicinais possuem substâncias ativas e, muitas vezes, o efeito tóxico sobre o organismo é desconhecido ou ignorado pelos usuários. A camomila é muito utilizada pela população, porém, contra-indicada para gestantes por possuir indícios de atividade emenagoga e relaxante da musculatura lisa. Por esses motivos, o objetivo do presente estudo foi avaliar os efeitos do extrato aquoso de camomila na gestação e nos filhotes gerados. Foram utilizadas 9 ratas da linhagem Wistar, divididas em 3 grupos, D1 e D2 que receberam infusão de camomila a 5% e 10% respectivamente, e o grupo controle que recebeu soro fisiológico. Os tratamentos foram administrados por via oral, desde o 1º ao 7º dia após o cruzamento. Os parâmetros estudados foram: prevalência de abortos, ganho de peso materno durante a prenhez, morte fetal e materna, malformações fetais grosseiras, número de recém-nascidos, peso dos filhotes, e análise de reflexos neurológicos dos filhotes (postural, preensão e orientação) no 1º, 3º, 5º e 10º dias de vida. Houve gestação em 70% do grupo controle, 40% do D1 e 80% do D2. Não houve diferença no ganho de peso materno no 7º e 21º dia, porém, os grupos tratados obtiveram ganho de peso menor em relação ao controle no 14º dia de gestação (p=0,04). As diferenças entre o número de recém-nascidos não foram significantes. Quanto ao peso dos recém-nascidos, os animais tratados apresentaram menor ganho de peso aos dias 1, 3, 5, e 10 após o nascimento (p=0,005; p=0,001; p<0,001; p<0,001; respectivamente). Ocorreram diferenças no reflexo postural no 1º dia, ocorrendo aceleração (p=0,005); já no reflexo de preensão (p=0,006), e no reflexo de orientação (p=0,01) houve retardo no desaparecimento, sem alteração nos demais dias sobre os outros parâmetros avaliados. A camomila pode influenciar, tanto no ganho de peso materno durante a gestação, como no dos filhotes após o nascimento, e pode provocar alterações nos reflexos neurológicos. Não se observou alteração nos demais parâmetros estudados.

Medicinal plants have active substances and their toxic effect on the organism is often unknown or ignored by users. Chamomile has been widely used by the population; however, it is contraindicated for pregnant women due to evidence of its emmenagogue and relaxing activity on smooth muscles. For these reasons, the aim of this study was to evaluate the effects of aqueous extract of chamomile on pregnancy and generated offspring. Nine Wistar rats were divided into three groups, D1 and D2, which received chamomile infusion at 5% and 10%, respectively, and the control group which received saline solution. Treatments were administered from the 1st to the 7th day after breeding. The studied parameters were abortion prevalence, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number, weight and neurological reflexes of the offspring on the 1st, 3rd, 5th and 10th days of life. There was pregnancy in 70% of control group, 40% of D1 and 80% of D2. There was no difference in maternal weight gain on the 7th and 21st days; however, treated groups had smaller weight gain, compared to control, on the 14th day of pregnancy (p=0.04). The differences among newborn numbers were not significant. As to weight of newborns, treated animals had smaller weight gain on days 1, 3, 5 and 10 after birth (p=0.005; p=0.001; p<0.001; p<0.001; respectively). For neurological effects, there were differences in postural reflex on the 1st day, resulting in acceleration; on the other hand, for grasp (p=0.006) and orienting reflex (p=0.01), there was a delay in disappearing, and no changes occurred on the remaining days for the other assessed parameters. Chamomile may influence maternal weight gain during pregnancy, as well as offspring weight gain after birth, and may cause changes in neurological reflexes. There was no alteration in the remaining studied parameters.

Ocorrência do vírus da leucemia felina em Felis cattus em Belo Horizonte / Occurrence of feline leukemia virus in Felis cattus in Belo Horizonte

Blood samples from 1,072 domestic cats of nine administrative regions of Belo Horizonte, MG, were collected and tested using PCR nested for the occurrence of feline leukemia virus (FeLV). Overall occurrence was 47.5 percent (507/1072) being North (68.1 percent) and East (54.4 percent) the most prevalent areas. Epidemiological data showed that FeLV infection was very common among examined cats and breed neither gender nor were predisposing factors for FeLV. The results suggest that the agglomeration of a large number of cats in the same environment can be an important factor for the increase in the rate of transmission of this retrovirus among domestic cats in the studied city.

Atividade in vitro do extrato hidroalcoólico de Lippia sidoides Cham sobre larvas de terceiro estádio de nematódeos gastrintestinais (família Trichostrongylidae) de caprinos / In vitro activity of the hydroalcoholic extract of Lippia sidoides Cham on buoyant larvae of third-stage gastrointestinal nematodes (family Trichostrongylidae) of goats

Avaliou-se in vitro a atividade larvicida do extrato hidroalcóolico de alecrim pimenta (Lippia sidoides Cham) sobre larvas de terceiro estádio de nematoides gastrintestinais de caprinos. Os resultados encontrados demonstraram que a concentração de 500 mg mL-1 apresentou atividade efetiva e com capacidade de ação de 95,89%, demonstrando desta forma a possibilidade do uso terapêutico anti-helmíntico para esse extrato.

The in vitro larvicidal activity of the hydroalcoholic extract of rosemary pepper (Lippia sidoides Cham) was evaluated on buoyant larvae of third-stage gastrointestinal gastrointestinal nematodes of goats. The results demonstrated that the concentration of 500 mg mL-1 presented effective activity, with a capacity of action of 95.89%, thus demonstrating the possibility of anthelmintic therapeutic use for this extract.

Avaliação in vitro do extrato hidroalcoólico (EHA) de alecrim pimenta (Lippia sidoides Cham. ) sobre o desenvolvimento de ovos de nematódeos gastrointestinais (Trichostrongylidae) / In vitro evaluation of alecrim pimenta (Lippia sidoides Cham. ) hydroalcoholic extract (HAE) on the development of gastrointestinal nematode (Trichostrongylidae) eggs

Atualmente a fito medicina vem sendo usada no controle de diversas doenças parasitárias particularmente as parasitoses gastrointestinais. Objetivou-se com este estudo avaliar a eficácia do extrato hidroalcoólico (EHA) de Lippia sidoides Cham sobre o desenvolvimento de ovos de nematódeos gastrointestinais. O efeito ovicida foi determinado através de análise probabilística, modelo logístico, utilizados os softwares R versão 2.2.1 e EPI6. Foram obtidos ovos embrionados em fezes de cabras naturalmente infectadas com nematóides Trichostrongylidae e o número de ovos fecais foi determinado usando-se a técnica modificada de McMaster. Cinquenta μL da suspensão contendo 40 ovos foram transferidas a placas de poliestireno e incubadas com 12 concentrações diferentes do EHA sendo avaliada durante 72 horas a temperatura ambiente. Os resultados demonstraram diferentes eficácias para o fito medicamento com menor taxa de desenvolvimento de ovos na concentração de 500 mg mL-1 . Conclui-se que o EHA pode ter papel importante sobre o desenvolvimento in vitro de ovos de nematóides gastrintestinais, revelando atividade ovicida.

Phytomedicine has been currently used in the control of several parasitic diseases, particularly gastrointestinal ones. The aim of this study was to evaluate the efficacy of the hydroalcoholic extract (HAE) from Lippia sidoides Cham. on the development of gastrointestinal nematode eggs. The ovicidal effect was determined through probabilistic analysis, logistic model, by using the programs R version 2.2.1 and Epi InfoTM 6. Embryonated eggs were obtained from feces of goats naturally infected with Trichostrongylidae nematodes and the fecal egg count was determined by using the modified McMaster technique. Fifty microliters of the suspension containing 40 eggs were transferred to polystyrene plates and incubated with 12 different HAE concentrations, and evaluations were performed during 72h at room temperature. The results demonstrated different efficacy of extracts, with lower egg development rate at 500 mg mL-1. In conclusion, HAE may play an important role on the in vitro development of gastrointestinal nematode eggs, indicating ovicidal activity.

Quantitative evaluation of experimental choroidal neovascularization by confocal scanning laser ophthalmoscopy: fluorescein angiogram parallels heparan sulfate proteoglycan expression

The objective of the present study was to develop a quantitative method to evaluate laser-induced choroidal neovascularization (CNV) in a rat model using Heidelberg Retina Angiograph 2 (HRA2) imaging. The expression of two heparan sulfate proteoglycans (HSPG) related to inflammation and angiogenesis was also investigated. CNV lesions were induced with argon laser in 21 heterozygous Zucker rats and after three weeks a fluorescein angiogram and autofluorescence exams were performed using HRA2. The area and greatest linear dimension were measured by two observers not aware of the protocol. Bland-Altman plots showed agreement between the observers, suggesting that the technique was reproducible. After fluorescein angiogram, HSPG (perlecan and syndecan-4) were analyzed by real-time RT-PCR and immunohistochemistry. There was a significant increase in the expression of perlecan and syndecan-4 (P < 0.0001) in retinas bearing CNV lesions compared to control retinas. The expression of these two HSPG increased with increasing CNV area. Immunohistochemistry demonstrated that the rat retina damaged with laser shots presented increased expression of perlecan and syndecan-4. Moreover, we observed that the overexpression occurred in the outer layer of the retina, which is related to choroidal damage. It was possible to develop a standardized quantitative method to evaluate CNV in a rat model using HRA2. In addition, we presented data indicating that the expression of HSPG parallels the area of CNV lesion. The understanding of these events offers opportunities for studies of new therapeutic interventions targeting these HSPG.

Use of antibacterial agents in an intensive care unit in a hospital in Brazil

It is essential to monitor the utilisation of antibacterial drugs in order to establish appropriate measures for their control. The pattern of usage of antibacterial drugs, and its association with indicators of hospital infection, has been investigated in a non-specialized adult intensive care unit (ICU) located in Santa Luzia Hospital (Brasília, DF, Brazil). The study was conducted between January 2001 and June 2004. Data concerning the utilisation of systemic antibacterial drugs, classified according to the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) system, and indicators of hospital infection, defined according to the National Nosocomial Infections Surveillance (NNIS) system, were obtained from appropriate hospital archives. During the study period, the average utilisation of antibacterial drugs was 1918.5 DDD units per 1000 patient-day (DDD1000). The three most used drugs were penicillins/beta-lactamase inhibitors (535.3 DDD1000), third generation cephalosporins (239.1 DDD1000) and quinolones (212.5 DDD1000). The total utilisation of antibacterial drugs was correlated significantly with the incidence of hospital infection (R = 0.62; p < 0.01) and the index of invasive procedures (R = 0.41; p < 0.01). Furthermore, the latter two indicators were significantly and positively correlated with the use of recently commercialised, broad spectrum antibacterial drugs (except for carbapenems). It is concluded that improved infection control procedures, together with more rigorous criteria regarding the use of invasive procedures, should be implemented by the ICU studied in order to diminish the utilisation of antibacterial drugs.

Y chromosome microdeletions in Brazilian fertility clinic patients

Microdeletions in Yq are associated with defects in spermatogenesis, while those in the AZF region are considered critical for germ cell development. We examined microdeletions in the Y chromosomes of patients attended at the Laboratory of Human Reproduction of the Clinical Hospital of the Federal University of Goiás as part of a screening of patients who plan to undergo assisted reproduction. Analysis was made of the AZF region of the Y chromosome in men who had altered spermograms to detect possible microdeletions in Yq. Twenty-three patients with azoospermia and 40 with severe oligozoospermia were analyzed by PCR for the detection of six sequence-tagged sites: sY84 and sY86 for AZFa, sY127 and sY134 for AZFb, and sY254 and sY255 for AZFc. Microdeletions were detected in 28 patients, including 10 azoospermics and 18 severe oligozoospermics. The patients with azoospermia had 43.4% of their microdeletions in the AZFa region, 8.6% in the AZFb region and 17.4% in the AZFc region. In the severe oligozoospermics, 40% were in the AZFa region, 5% in the AZFb region and 5% in the AZFc region. We conclude that microdeletions can be the cause of idiopathic male infertility, supporting conclusions from previous studies.

Determinação de atividade antimicrobiana de extratos de plantas de uso popular como antiflamatório

Antimicrobial activities of “babaçu” (Orbignya martiana), “cardo santo” (Argemone mexicana), “mentrasto” (Ageratum conyzoides), “cavalinha” (Equisetum yeamalis) and “terramicina” (Alternanthera brasiliana), used by Brazilian population as antiinflamatory medicine, were studied on Staphylococcus aureus. The freezer dried hydroalcoholic extracts solutions were tested for 7 strains of Staphylococcus aureus, which two of those are methicillin resistant (MRSA). The diffusion method on agar-agar, using holes technique, with tetracycline chlorydrate as standard. “Babaçu”, “cardo santo” and “terramicina” showed antimicrobial activity, within of those “terramicina” inhibited 6 strains, presenting zone inhibition of 22 mm compared to standard antibiotic (34 mm), except the seventh strain which was also tetracycline resistant.

Controle de infecção em cirurgia geral: resultado de um estudo prospectivo de 23 anos e 42.274 cirurgias / Infection control in general surgery: results of a prospective study in 42, 274 surgeries during 23 years

OBJETIVO: O objetivo deste trabalho foi de avaliar uma metodologia simples adotada há 23 anos em um hospital público universitário no controle das infecções pós-cirúrgicas. MÉTODO: A casuística estudada compreende um total de 42.274 cirurgias realizadas no Serviço de Cirurgia Geral do Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE) (janeiro de 1977 a dezembro de 1999). Os dados foram obtidos através um sistema de busca ativa de infecção e de um sistema de vigilância epidemiológica de seguimento pós-operatório, no ambulatório de egressos. A Comissão de Controle de Infecção Hospitalar (CCIH) do Hospital das Clínicas (HC) da UFPE concentrou sua atuação na prevenção, dando ênfase ao: diagnóstico preciso dos casos de infecção; higiene corporal; controle das afecções associadas; internamento pré-operatório; cuidados com tricotomia; anti-sepsia e assepsia; técnica cirúrgica adequada; divulgação dos resultados e da relação infecção/cirurgião/anestesista e rigoroso controle de antimicrobianos. RESULTADOS: A taxa de infecção de ferida passou de índices em torno de 15-20 por cento para os atuais 7,7 por cento. A infecção urinária foi reduzida de 18,2 por cento para 0,4 por cento, e a infecção respiratória de 22,9 por cento para 2,7 por cento. A mortalidade em decorrência de infecção foi reduzida de 2,8 por cento para os atuais 0,9 por cento e a taxa de infecção de ferida em cirurgia limpa de 12,8 por cento para 3,4 por cento. Na cirurgia ambulatorial, das 27.580 operações a taxa de infecção de ferida foi de 0,4 por cento e a mortalidade de 0,007 por cento. CONCLUSÃO: O que tentamos comprovar com a divulgação de nossos resultados é que controle de infecção se faz com decisão política, força de vontade e motivação em controlar o problema da infecção hospitalar.

BACKGROUND: The aim of this study was evaluate a methodology during 23 years in a public hospital used infection for control of surgeries. METHODS: A total of 42,274 surgeries in the General Surgery Division of the Clinics Hospital of the Pernambuco Federal University (January of 1977 until December 1999) were evaluated. The data were acquired through a active search system by the infection control nurse and an epidemiological search during the postoperative period, in the outpatient clinic that centralized all surgical patients after discharge. The infection control committee concentrated its action in the prevention emphasizing precise diagnosis of infections cases; corporal cleaning, control of associated infection, minimal preoperative period, care with the shaving; rigorous asepsia and antisepsia; adequate surgical technique; notification of the infection control results and the infection/surgeon/anesthetist rates; and a rigorous antimicrobial control. RESULTS: Wound infection rate dropped from 15-20 percent to the actual rate of 7.7 percent. Urinary infection was reduced from 18.2 percent to 0.4 percent, and the respiratory infection from 22.9 percent to 2.7 percent. The mortality related to infection was reduced from 2.8 percent to 0.9 percent and the rate of wound infection in clean surgeries from 12.8 percent to 3.4 percent. In the outpatient surgeries (27,580) the wound infection was 0.4 percent and the global mortality was 0.007 percent. CONCLUSION: The authors demonstrated that infection control is not made by expensive investments and equipaments, or computadorized ambient. Infection control is made, in our view, by political decision, manpower and motivation to control the infection control problem.

Avaliaçäo da limpeza da sala cirúrgica com detergente / Cleanness valuation of surgery room with detergent

Foram avaliados 1843 pacientes submetidos a intervençÖes cirúrgicas do tipo limpa no período de janeiro de 1988 a março de 1990, operados em 2 diferentes esquemas de preparo de salas de cirurgia, envolvendo apenas o uso de germicidas ou de detergentes. A eficácia do preparo foi avaliada pela incidência da infecçäo de ferida cirúrgica nos dois esquemas, näo havendo diferenças estatísticas entre os grupos

Anticorpos anti-HBs obtidos em coelhos e sua utilizacao como reagentes para testes sorologicos no diagnostico da hepatite B. / Anti-HBs antibodies obtained in rabbits and its use as reagents for serological tests in the diagnosis of hepatitis B

Pela tecnica de cromatografia de afinidade utilizando-se a resina de Sepharose 4B ligada ao anti-HBs, obteve-se na passagem de plasma de portador assintomatico de antigeno HBs, um antigeno parcialmente purificado. Este antigeno foi utilizado para a inoculacao em coelhos, num esquema de cinco doses, sendo a primeira dose de 1 mg e as quatro subsequentes de 0,5 mg, com intervalos aproximadamente de quinze dias.Obsevando-se que os titulos nao mais variaram apos a quinta inoculacao os animais foram sangrados no 62o dia e os anticorpos anti-HBs obtidos foram padronizados atraves dos seguintes metodos para deteccao de antigeno HBs: a) Hemaglutinacao passiva reversa (HAPR) - utilizando-se a gamaglobulina especifica obtida de soro imune dos coelhos atraves de cromatografia de afinidade, alcancando uma concentracao otima de apenas 10 micros/ml para a sensibilizacao de hemacias de carneiro a 5%, fixadas com glutaraldeido. b) Contraimunoeletroforese (CIEF) - utilizando-se o soro imune diluido ate 1/20 como reagente para a deteccao do antigeno HBs. O soro imune anti-HBs foi tambem utilizado para a conjuncao com uma nova resina de Sepharose 4B tendo uma captacao aproximada de 0,5 a 1,0 mg de antigeno HBs por ml de resina apos completa saturacao