Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study

Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.

Multiresistance and virulence factors of Staphylococcus aureus isolated from pigs / [Multirresistência e fatores de virulência de Staphylococcus aureus isolados de suínos]

The emergence of livestock-associated methicillin-resistant Staphylococcus aureus strains (LA-MRSA) and the potential role of pigs in the evolution of these strains has led to increased interest in research of these microorganisms. However, this has contributed to a lack of research in the isolation and characterization of methicillin-susceptible S. aureus strains (MSSA). In this study, the prevalence of S. aureus in pigs in the nursery and finishing stages were analyzed. The susceptibility profiles to antibiotics, tolerance to heavy metals, and biofilm production of the isolates were evaluated using phenotypic and genotypic techniques. A total of 1,250 colonies suggestive of Staphylococcus spp. were isolated from 128 pigs, of which 63.6% (n = 795) belonged to this microbial genus. Sixty-seven colonies isolated from 34 animals (26.5%) were confirmed as S. aureus (8.4%). No strains resistant to copper, zinc, or methicillin were detected; however, all strains presented a resistance profile to at least three different classes of antimicrobials and 21 produced biofilms. These data are of concern, as they indicate the need for increased surveillance in the use of antimicrobials as well as reinforce the importance of studies on MSSA strains.(AU)

A emergência de cepas de Staphylococcus aureus resistentes à meticilina associadas à pecuária (LA-MRSA) e o papel potencial dos suínos na evolução dessas cepas têm levado ao aumento do interesse na pesquisa desses microrganismos. No entanto, isso tem contribuído para a falta de estudos sobre o isolamento e a caracterização de cepas de S. aureus sensíveis à meticilina (MSSA). Neste estudo, foi analisada a prevalência de S. aureus em suínos nas fases de creche e terminação. Os perfis de suscetibilidade aos antibióticos, a tolerância a metais pesados e a produção de biofilme dos isolados foram avaliados por meio de técnicas fenotípicas e genotípicas. Um total de 1.250 colônias sugestivas de Staphylococcus spp. foi isolado de 128 suínos, das quais 63,6% (n = 795) pertenciam a esse gênero microbiano. Sessenta e sete colônias isoladas de 34 animais (26,5%) foram confirmadas como S. aureus (8,4%). Nenhuma cepa resistente ao cobre, ao zinco ou à meticilina foi detectada; entretanto, todas as cepas apresentaram perfil de resistência a pelo menos três classes diferentes de antimicrobianos e 21 produziam biofilme. Esses dados são preocupantes, pois indicam a necessidade de maior vigilância no uso de antimicrobianos, bem como reforçam a importância de estudos com cepas de MSSA.(AU)

Ovarian follicular dynamic and plasma progesterone concentration in Alpine goats on the breeding season / Dinâmica folicular ovariana e concentração plasmática de progesterona em cabras Alpinas durante a estação reprodutiva

Os objetivos deste estudo foram relatar a dinâmica folicular ovariana e a concentração plasmática de progesterona durante ciclos estrais de duração irregular em cabras da raça Alpina. Vinte e nove cabras tiveram sua atividade ovariana monitorada diariamente por ultrassonografia transretal durante um, dois ou três períodos interovulatórios consecutivos. Amostras de sangue foram coletadas para análise da concentração plasmática de progesterona. Dos 47 ciclos avaliados, 28 (59,57%) foram de duração normal (17 a 25 dias), sete (14,89%) de curta duração (<17 dias) e 12 (25,53%) de longa duração (>25 dias). Os ciclos estrais de curta duração tiveram 6,14±0,69 dias e uma onda folicular que emergiu no dia 0,43±1,13. Os ciclos estrais de longa duração tiveram entre 26 e 79 dias, com duas a nove ondas foliculares. Os ciclos estrais de curta duração ocorreram durante a estação reprodutiva e foram associados à regressão prematura do corpo lúteo (CL). Os ciclos estrais de longa duração ocorreram na transição entre o anestro e a estação reprodutiva e foram associados principalmente à persistência do CL ou à fase folicular prolongada.(AU)

Cocaine/levamisole-induced systemic vasculitis with retiform purpura and pauci-immune glomerulonephritis

Levamisole has been increasingly used as an adulterant of cocaine in recent years, emerging as a public health challenge worldwide. Levamisole-associated toxicity manifests clinically as a systemic vasculitis, consisting of cutaneous, hematological, and renal lesions, among others. Purpura retiform, cutaneous necrosis, intravascular thrombosis, neutropenia, and less commonly crescentic nephritis have been described in association with anti-neutrophil cytoplasmic antibodies (ANCAs) and other autoantibodies. Here we report the case of a 49-year-old male who was a chronic cocaine user, and who presented spontaneous weight loss, arthralgia, and 3 weeks before admission purpuric skin lesions in the earlobes and in the anterior thighs. His laboratory tests on admission showed serum creatinine of 4.56 mg/dL, white blood count 3,800/μL, hemoglobin 7.3 g/dL, urinalysis with 51 white blood cells/μL and 960 red blood cells/μL, and urine protein-to-creatinine ratio 1.20. Serum ANCA testing was positive (>1:320), as well as serum anti-myeloperoxidase and anti-proteinase 3 antibodies. Urine toxicology screen was positive for cocaine and levamisole, with 62.8% of cocaine, 32.2% of levamisole, and 5% of an unidentified substance. Skin and renal biopsies were diagnostic for leukocytoclastic vasculitis and pauci-immune crescentic glomerulonephritis, respectively. The patient showed a good clinical response to cocaine abstinence, and use of corticosteroids and intravenous cyclophosphamide. Last serum creatinine was 1.97 mg/dL, white blood cell count 7,420/μL, and hemoglobin level 10.8 g/dL. In levamisole-induced systemic vasculitis, the early institution of cocaine abstinence, concomitant with the use of immunosuppressive drugs in severe cases, may prevent permanent end organ damage and associate with better clinical outcomes.

Multiple facets of HIV-associated renal disease

HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

Contribuição ao estudo farmacognóstico da Piper ovatum Vahl / Contribution to the pharmacognostic study of Piper ovatum Vahl

RESUMO: O presente estudo descreve as características morfo-anatômicas dos órgãos vegetativos e do pó da Piper ovatum Vahl de modo que os dados obtidos possam ser utilizados como referência em análises de controle de qualidade de amostras de fármacos, a fim de verificar sua autenticidade. As raízes, caules, pecíolos e folhas foram fixadas, seccionadas à mão livre e coradas, as secções transversais e paradérmicas foram analisadas por microscopia óptica e a superfície do limbo foi observada, também, por microscopia eletrônica de varredura (MEV). Os órgãos vegetativos da P. ovatum apresentam morfologia e anatomia similar às outras espécies de Piper. No entanto, não foram observadas inclusões celulares nas folhas de P. ovatum. Análises por MEV mostraram a presença de tricomas glandulares constituídos de pedúnculo unicelular e porção secretora globóide igualmente unicelular recoberto por cutícula, na epiderme abaxial das folhas. Também foi observada a presença de uma cutícula espessa e que origina crostas no limite entre uma célula e outra, em ambas as superfícies foliares. No mesófilo foi observada a presença de idioblastos oleíferos característica marcante de outras espécies de Piperaceae. Além disso, na microscopia do pó foram observados hipoderme e idioblastos oleíferos em fragmentos do limbo, fragmentos de fibras esclerenquimáticas do caule, além de células esclerosas isoladas ou em grupos no pecíolo. O perfil cromatográfico do extrato hidroetanólico das folhas de P. ovatum foi obtido por cromatografia líquida de alta eficiência (CLAE). Nas análises por CLAE foram identificados como substâncias majoritárias do extrato as amidas piperovatina e piperlonguminina nos tempos de retenção de 10,25 e 10,81 min., respectivamente.

ABSTRACT: The present study describes the morphological and anatomical characteristics of vegetative organs and powder of the Piper ovatum Vahl, in order to use the obtained data as reference in the quality control tests of pharmaceutical samples, investigating their authenticity. The roots, stems, petioles and leaves were fixed, freehand sectioned and stained according to usual microtechniques. The transverse and paradermal sections were analyzed by optical microscopy and the leaf surface was also observed by scanning electron microscopy (SEM). The vegetative organs of the P. ovatum show morphology and anatomy similar to other species of Piper. However, cellular inclusions were not observed in the P. ovatum leaves. The SEM analysis showed the presence of glandular trichomes consisting of a unicellular stalk and globular secretory portion covered by cuticle on the abaxial surface of the leaves. The SEM also had shown one thick cuticle forming crusts in the limit of the epidermal cells, on both leaf surfaces. In the mesophyll, we observed oil idioblasts, which are typical features of other species of Piperaceae. Moreover, in the powder of the P. ovatum we observed hypodermis and oil idioblasts in leaf fragments, fragments of sclerenchyma fibers from the stem and isolated sclereids or in petiole groups. The chromatographic profile of the hydroethanolic extract of the P. ovatum leaves was obtained by high performance liquid chromatography (HPLC). In this analysis, we identified the amides piperovatine and piperlonguminine in the retention times of 10.25 and 10.81 min., respectively, as majority compounds present in the extract.

Comparação do isolamento microbiológico e da reação em cadeia da polimerase no diagnóstico de salmonelose em bezerros infectados experimentalmente com Salmonella Typhimurium / Comparison of microbiological culture and polymerase chain reaction in the diagnosis of salmonellosis in Salmonella Typhimurium-infected calves

The efficiency of microbiological culture and polymerase chain reaction (PCR) for detection of Salmonella Typhimurium is compared in fecal samples of Holstein calves experimentally infected with 10(9) CFU of Salmonella Typhimurium. Seventy-two fecal samples were analyzed by microbiological culture and PCR associated with selenite cystine (SC) and Muller-Kauffmann tethrationate (TMK) selective enrichment broths. Regardless of the selective enrichment broth, the microbiological culture was significantly better than PCR for detection of positive samples of Salmonella Typhimurium. The selective enrichment broths SC and TMK had no effect on the efficiency of the microbiological culture. The SC broth was the best option as selective enrichment associated to PCR.

Avaliação da reação em cadeia da polimerase e do isolamento bacteriológico convencional na detecção de Salmonella Dublin em amostras de fezes de bezerros infectados experimentalmente / Evaluation of polymerase chain reaction and standard microbiological techniques for detection of Salmonella Dublin in fecal samples of infected calves

The efficiency of the Polymerase Chain Reaction (PCR) combined with selective enrichment broth was compared with the standard microbiological techniques for detection of Salmonella Dublin in fecal samples of 10 to 15-days-old Holstein calves, experimentally infected with 10(8) CFU of Salmonella Dublin. Seventy-six fecal samples were analyzed using PCR associated with selenite cystine (SC) and Muller-Kauffmann tetrathionate (TMK) broths and standard microbiological techniques. Regardless of the selective enrichment broth used, the standard microbiological techniques were significantly better than PCR in detection of positive samples of Salmonella Dublin. However, the simultaneous use of both techniques provided detection of a larger number of positive samples. The SC broth was the best option as selective enrichment in both techniques.

Aerobic bacterial microflora of Broad-snouted caiman (Caiman latirostris) oral cavity and cloaca, originating from Parque Zoológico Arruda Câmara, Paraíba, Brazil / Microflora bacteriana aeróbica da cavidade oral e cloaca de jacaré-de-papo-amarelo (Caiman latirostris) procedentes do Zoológico de João Pessoa, PB, Brasil

The objective of this study was to isolate and identify the aerobic bacterial microflora from the oral cavity mucosa and cloaca's samples, collected from Broad-snouted caiman (Caiman latirostris), born and bred in captivity at Parque Zoológico Arruda Câmara, João Pessoa, Paraíba, Brazil. The most common bacteria were Staphylococcus sp. (14.74%), Corynebacterium sp. (13.68%), Escherichia coli (13.68%) and Shigella sp. (11.58%), and the less common were Citrobacter sp. (1.05%), Klebsiella pneumoniae (1.05%) and Salmonella sp. (1.05%).This emphasizes the importance of these microorganisms' participation in infectious processes (sepsis) and injuries caused by crocodilians.

O presente estudo teve como objetivo isolar e identificar a microflora bacteriana aeróbica presente na mucosa da cavidade oral e da cloaca de exemplares de jacarés-de-papo-amarelo(Caiman latirostris) nascidos e criados em cativeiro no Parque Zoológico Arruda Câmara, localizado na cidade de João Pessoa - PB. As bactérias mais freqüentes foram Staphylococcus sp.(14,74%), Corynebacterium sp. (13,68%), Escherichia coli (13,68%) e Shigella sp. (11,58%), e as menos prevalentes foram Citrobacter sp.(1,05%), Klebsiella pneumoniae (1,05%) e Salmonella sp. (1,05%). Ressalta-se a importância da participação desses microrganismos em processos infecciosos (septicemias) e em feridas provocadas por crocodilianos.