Vector competence of Culex mosquitoes (Diptera: Culicidae) in Zika virus transmission: an integrative review / Competencia de los mosquitos Culex (Diptera: Culicidae) como vectores en la transmisión del virus del Zika: una revisión integradora / Competência vetorial de mosquitos Culex (Diptera: Culicidae) na transmissão do vírus Zika: revisão integrativa

ABSTRACT Objective. To identify studies on the competence of Culex mosquitoes as vectors for the transmission of Zika virus (ZIKV) around the globe. Methods. We performed an integrative review to identify relevant articles on specific experiments to determine whether Culex mosquitoes are vectors for ZIKV. The sources we used for our research were the Brazilian Periódicos CAPES electronic portal (MEDLINE/PubMed, ScienceDirect Journals, Nature Publishing Group, SciELO, Springer Link, and 250 other databases) and gray literature. Results. We identified 344 studies, of which 36 were considered for this review. In 8 studies, infection in salivary glands of Culex quinquefasciatus, Culex restuans, Culex tarsalis, and Culex coronator was detected. Cx. quinquefasciatus was the most studied among those confirmed as potential ZIKV vectors, and only strains of Asian lineages (THA/2014/SV0127-14; SZ01 (2016)) and American lineages (BRPE243 (2015); PRVABC59 (2015)) can infect the salivary glands of Culex mosquitoes. The tested African strains (MR766 and DAK AR 41525) were unable to infect salivary glands. Conclusions. There is still a lack of compelling evidence that indicates Culex spp. are a competent ZIKV vector, but they should remain a target for further monitoring studies, especially regarding ZIKV transmission to other species. Furthermore, studies should not be limited to studying whether their salivary glands are infected.(AU)

RESUMEN Objetivo. Identificar estudios sobre la competencia de los mosquitos Culex como vectores de la transmisión del virus del Zika en todo el mundo. Métodos. Se realizó una revisión integradora para identificar artículos relevantes sobre experimentos específicos dirigidos a determinar si los mosquitos Culex son vectores del virus del Zika. Se emplearon fuentes obtenidas a partir del portal electrónico de revistas CAPES (MEDLINE/PubMed, ScienceDirect Journals, Nature Publishing Group, SciELO, Springer Link, y otras 250 bases de datos) y la literatura gris. Resultados. Se identificaron 344 estudios, 36 de los cuales fueron considerados para esta revisión. En 8 estudios se detectó infección en las glándulas salivales de Culex quinquefasciatus, Culex restuans, Culex tarsalis y Culex coronator. Cx. quinquefasciatus fue la especie más estudiada entre las confirmadas como potenciales vectores del virus del Zika, y solo las cepas de linajes asiáticos (THA/2014/SV0127-14; SZ01 [2016]) y americanos (BRPE243 [2015]; PRVABC59 [2015]) pueden infectar las glándulas salivales de los mosquitos Culex. Las cepas africanas analizadas (MR766 y DAK AR 41525) no fueron capaces de infectar las glándulas salivales. Conclusiones. Aunque faltan pruebas convincentes que indiquen que las especies de Culex spp. son un vector competente del virus del Zika, estas deben seguir monitoreándose mediante estudios adicionales, especialmente respecto de su capacidad para transmitir el virus del Zika a otras especies. Esta vigilancia no debería limitarse solamente a determinar la infección en las glándulas salivales.(AU)

RESUMO Objetivo. Identificar estudos sobre a competência dos mosquitos Culex como vetores da transmissão do vírus Zika em todo o mundo. Métodos. Uma revisão integrativa foi realizada para identificar artigos relevantes sobre experimentos específicos para determinar se os mosquitos Culex são vetores do vírus Zika. As fontes utilizadas na pesquisa foram o portal eletrônico CAPES (MEDLINE/PubMed, ScienceDirect Journals, Nature Publishing Group, Sci-ELO, Springer Link, e outras 250 bases de dados) e a literatura cinza. Resultados. Foram identificados 344 artigos, dos quais 36 foram considerados para esta revisão. Oito artigos relataram infecção nas glândulas salivares de Culex quinquefasciatus, Culex restuans, Culex tarsalis e Culex coronator. Culex quinquefasciatus foi a espécie mais estudada entre as confirmadas como vetores potenciais do vírus Zika. Apenas as linhagens asiáticas (THA / 2014 / SV0127-14; SZ01 [2016]) e americanas (BRPE243 [2015]; PRVABC59 [2015]) podem infectar as glândulas salivares dos mosquitos Culex. As cepas africanas analisadas (MR766 e DAK AR 41525) não foram capazes de infectar as glândulas salivares. Conclusões. Ainda não há evidências convincentes para indicar que os mosquitos Culex são um vetor competente do vírus Zika. Contudo, estudos adicionais de monitoramento devem ser realizados, especialmente no que diz respeito à transmissão do vírus Zika para outras espécies de mosquitos. Além disso, os estudos não devem se limitar a estudar a infecção nas glândulas salivares.(AU)

Clinical trials on drug repositioning for COVID-19 treatment / Ensayos clínicos de reposicionamiento de medicamentos para el tratamiento de la COVID-19 / Ensaios clínicos de reposicionamento de medicamentos para o tratamento do COVID-19

ABSTRACT The World Health Organization (WHO) was informed on December 2019 about a coronavirus pneumonia outbreak in Wuhan, Hubei province (China). Subsequently, on March 12, 2020, 125,048 cases and 4,614 deaths were reported. Coronavirus is an enveloped RNA virus, from the genus Betacoronavirus, that is distributed in birds, humans, and other mammals. WHO has named the novel coronavirus disease as COVID-19. More than 80 clinical trials have been launched to test coronavirus treatment, including some drug repurposing or repositioning for COVID-19. Hence, we performed a search in March 2020 of the clinicaltrials.gov database. The eligibility criteria for the retrieved studies were: contain a clinicaltrials.gov base identifier number; describe the number of participants and the period for the study; describe the participants' clinical conditions; and utilize interventions with medicines already studied or approved for any other disease in patients infected with the novel coronavirus SARS-CoV-2 (2019-nCoV). It is essential to emphasize that this article only captured trials listed in the clinicaltrials.gov database. We identified 24 clinical trials, involving more than 20 medicines, such as human immunoglobulin, interferons, chloroquine, hydroxychloroquine, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, methylprednisolone, bevacizumab, and traditional Chinese medicines (TCM). Although drug repurposing has some limitations, repositioning clinical trials may represent an attractive strategy because they facilitate the discovery of new classes of medicines; they have lower costs and take less time to reach the market; and there are existing pharmaceutical supply chains for formulation and distribution.(AU)

RESUMEN En diciembre de 2019 fue informado a la Organización Mundial de la Salud (OMS) un brote de neumonía por coronavirus en Wuhan, provincia de Hubei, China. Al 12 de marzo de 2020, se habían notificado 125 048 casos y 4 614 muertes. El coronavirus es un virus ARN envuelto del género Betacoronavirus distribuido en aves, seres humanos y otros mamíferos. La OMS ha denominado a la nueva enfermedad por coronavirus COVID-19. Se han puesto en marcha más de 80 ensayos clínicos para evaluar un tratamiento para el coronavirus, que incluyen algunos ensayos de reposicionamiento de medicamentos para la COVID-19. En marzo de 2020 se llevó a cabo una búsqueda de los ensayos clínicos registrados en la base de datos clinicaltrials.gov. Los criterios de elegibilidad para los estudios recuperados fueron tener un número de identificación de la base de datos clinicaltrials.gov; describir el número de participantes y el período del estudio; describir las condiciones clínicas de los participantes; y emplear intervenciones con medicamentos ya estudiados o aprobados para cualquier otra enfermedad en pacientes infectados con el nuevo coronavirus SARS-CoV-2 (2019-nCoV). Es esencial destacar que este artículo solo recoge los ensayos que figuran en la base de datos clinicaltrials. gov. Se identificaron 24 ensayos clínicos relacionados con más de 20 medicamentos, como inmunoglobulina humana, interferones, cloroquina, hidroxicloroquina, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, metilprednisolona, bevacizumab y medicina tradicional china. Aunque el reposicionamiento de medicamentos tiene algunas limitaciones, el reposicionamiento de los ensayos clínicos puede representar una estrategia atractiva porque facilita el descubrimiento de nuevas clases de medicamentos; estos tienen costos más bajos y tardan menos en llegar al mercado; y existen cadenas de suministro farmacéutico que apoyan la formulación y la distribución.(AU)

RESUMO A Organização Mundial da Saúde (OMS) foi informada, em dezembro de 2019, sobre um surto de pneumonia por coronavírus em Wuhan, província de Hubei (China). Posteriormente, em 12 de março de 2020, 125 048 casos e 4 614 mortes haviam sido registrados. O coronavírus é um vírus RNA envelopado do gênero Betacoronavírus, distribuído em aves e em humanos e outros mamíferos. A OMS designou a nova doença por coronavírus como COVID-19. Mais de 80 ensaios clínicos foram iniciados para testar tratamentos para o coronavírus, incluindo alguns de reposicionamento de medicamentos para o COVID-19. Assim, em março de 2020 realizou-se uma busca na base de dados clinicaltrials.gov. Os critérios de elegibilidade para os estudos recuperados foram: conter o número identificador da base de dados clinicaltrials.gov; descrever o número de participantes e o período do estudo; descrever as condições clínicas dos participantes; e utilizar intervenções para tratamento de doentes infectados com o novo coronavírus SARS-CoV-2 (2019-nCoV) com medicamentos já estudados ou aprovados para qualquer outra doença. É essencial salientar que este artigo apenas capturou ensaios listados na base de dados clinicaltrials.gov. Foram identificados 24 ensaios clínicos envolvendo mais de 20 medicamentos, tais como imunoglobulina humana, interferons, cloroquina, hidroxicloroquina, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, metilprednisolona, bevacizumabe e medicamentos chineses tradicionais. Embora o reposicionamento de medicamentos tenha algumas limitações, os ensaios clínicos de reposicionamento podem representar uma estratégia atraente, porque facilitam a descoberta de novas classes de medicamentos, têm custos mais baixos, levam menos tempo para chegar ao mercado e se beneficiam de cadeias de fornecimento farmacêutico já existentes para formulação e distribuição.(AU)

Factors and characteristics of physical violence among healthcare workers of a tertiary hospital in Enugu, Nigeria

Background: Healthcare workers (HCWs) especially those involved in patients’ care are at high risk of violence. The study is aimed at determining factors and characteristics of physical violence among HCWs in a tertiary hospital in Nigeria.Methods: The descriptive cross-sectional study was carried out among 412 HCWs from March to July, 2018. Data entry and analysis were done using Epi InfoTM 3.5.4 and Chi square and Fischer’s exact test where applicable were used to ascertain factors associated with physical workplace violence.Results: Respondents included 111 (26.9%) doctors and 301 (73.1%) nurses. Prevalence of physical violence was 12.6%. Of those who experienced workplace violence, the perpetrators were mainly patients’ relatives 37 (71.2%) and patients 8 (15.4%). In majority of cases, 28 (53.8%), no action was taken against the assailant. Prevalence of physical violence was significantly higher among nurses (15.3%) than doctors (5.4%) p=0.007. It is also higher among females (14.2%) than males (7.8%), although not significantly. Furthermore, HCWs who work in newborn units were most likely to experience physical violence.Conclusions: The study revealed that physical violence is prevalent among HCWs and violence prevention programs should be instituted to address it.

Biological Activity of Piper aduncum extracts on Anticarsia gemmatalis (Hübner) (Lepidoptera: Erebidae) and Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae)

ABSTRACT Piper aduncum found naturally in the Amazon and southeastern Brazil, is known for its secondary metabolites that have activity on insects. Anticarsia gemmatalis and Spodoptera frugiperda are among the major insect pests associated with agricultural production. This research evaluated the biological activity of hexane, ethyl acetate, and ethanol extracts of P. aduncum leaves on mortality and duration of larval and pupal periods, as well as weight, width, and length of A. gemmatalis and S. frugiperda pupae. The mortality of A. gemmatalis larvae in trials with P. aduncum extracts were 93.3% (hexane) and 90% (ethyl acetate), estimating LC50 of 6.35 and 5.79 mg/mL, respectively. Mortality in S. frugiperda submitted to the hexane extract ranged from 3.33% to 96.66% (LC50 of 8.22 mg/mL). The ethanol extract induced low mortality (3.33% to 23.33%). The P. aduncum extracts did not affect the development of S. frugiperda pupae. In A. gemmatalis differences in weight and length occurred. The chemical characterization was by GC-MS, which revealed that the major constituent in the hexane extract of P. aduncum was apiol (90.7%). P. aduncum extracts are important and promising components to manage A. gemmatalis and S. frugiperda, which cause extensive production losses.

Mecanismos da imunoterapia alérgeno-específica / Mechanisms of allergen-specific immunotherapy

A imunoterapia alérgeno-específica tem sido usada há mais de 100 anos como um tratamento de dessensibilização para doenças alérgicas, representando um método potencialmente curativo e específico. O presente estudo tem como objetivo revisar os mecanismos da imunoterapia alérgeno-específica, através de revisão bibliográfica com base em artigos publicados entre 1998 e 2016, disponíveis no banco de dados PubMed. Os mecanismos de ação da imunoterapia incluem modulação de linfócitos T e B, produção de IgG4 alérgeno-específica e redução de IgE alérgenoespecífica, migração de eosinófilos, basófilos e mastócitos nos tecidos, bem como a liberação de seus mediadores. As células T reguladoras (Treg) suprimem as células dendríticas responsáveis pela geração de células T efetoras, inibindo TH1, TH2 e TH17. As células Treg foram identificadas como peças-chave no processo de indução de tolerância periférica aos alérgenos.

Allergen-specific immunotherapy has been used for more than 100 years as a desensitizing therapy for allergic diseases, representing a potentially curative and specific method. The aim of the present study was to review the mechanisms of allergenspecific immunotherapy based on papers published between 1998 and 2016 and available in the PubMed database. The mechanisms of action of immunotherapy include modulation of T-and B-cell responses, induction of allergen-specific IgG4 and suppression of allergen-specific IgE production, migration of eosinophils, basophils, and mast cells to tissues, as well as release of their mediators. Regulatory T cells (Treg) suppress dendritic cells that support the generation of effector T cells, inhibiting TH1, TH2, and TH17 cells. Treg cells have been identified as key regulators of the induction process of peripheral allergen tolerance.

Protease with collagenolytic activity produced by Bacillus sp. DPUA 1728 from Amazonian soil

Qualitative analyses were carried out on solid medium with insoluble collagen 0.25% (w/v) to detect proteases with collagenolytic activity produced by Bacillus sp. In cultures incubated for 24 h, a 23 full factorial design with four repetitions at the center point was developed to analyze the effects and interactions between initial pH, temperature and the concentration of gelatin. Based on the results of the first 23 full factorial design, a successive 23 full factorial design was performed. The most favorable production conditions were found to be 1.5% (w/v) gelatin, pH 9.0 and 37 °C with enzymatic activity of 86.27 U/mL. The enzyme showed optimal activity at 50 °C and pH 9.0, and it was stable over wide pH (7.2-10.0) and temperature (45 °C-60 °C) ranges. These results indicate that Bacillus sp DPUA 1728 is a potential source for producing collagenolytic protease with possible biotechnological applications, such as in the food, cosmetics and leather industries.

Atypical presentations of congenital cutaneous candidiasis- presenting a cohort of 8 cases.

Congenital cutaneous candidiasis is an extremely rare disorder that usually presents within the first 6 days of life. We report 8 neonates who presented with generalized skin eruptions within first 6 days of life, characterized by erythematous macules, papules, vesicles, bullae and pustules. Candida albicans was demonstrated on direct KOH smear, fungal culture and skin biopsy. The disease implies a congenital intrauterine infection and is different from neonatal candidiasis, which manifests as thrush or diaper dermatitis.Although congenital cutaneous candidiasis is a rare diagnosis and the predisposing factors like prematurity,candidial infection in the mother are not obvious, a high index of suspicion is required to diagnose the neonates with this condition and it is very evident that congenital cutaneous candidiasis has got a good prognosis. This article apart from revealing the atypical presentations of cutaneous congenital candidiasis, also emphasizes the need to screen all pregnant women for vaginal candidiasis .

A severe pneumonia due to methicillin resistant Staphylococcus aureus clone USA 300: implications of vertical transmission / Pulmonía severa debido al clon USA 300 del estafilococo dorado resistente a la meticilina: implicaciones de la transmisión vertical

Staphylococcus aureus is an important pathogen in both community and healthcare associated pneumonia. We describe a case of severe pneumonia caused by the methicillin resistant Staphylococcus aureus (MRSA) clone USA 300 in a 44-year old post-partum woman and the subsequent vertical transmission of this virulent organism to her neonate.

El estafilococo dorado (Staphylococcus aureus) es un patógeno importante tanto en la atención a las comunidades como en el cuidado de la salud en relación con la pulmonía. Se describe un caso de pneumonia severa causada por el clon USA 300 del estafilococo dorado resistente a la meticilina (EDRM) en una mujer de 44 anos en periodo de post-parto, y la posterior transmisión vertical de este virulento organismo a su neonato.

Augmentation of catecholamine release elicited by an Eugenia punicifolia extract in chromaffin cells

Plant extracts of Eugenia punicifolia (Kunth) DC., Myrtaceae, are used in Amazon region of Brazil to treat diarrhea and stomach disturbances, and as hypoglycemic medicine. We have recently shown that an aqueous extract of E. punicifolia augmented cholinergic neurotransmission in a rat phrenic nerve-diaphragm preparation. In this study, we investigated the effects of an E. punicifolia dichloromethane extract (EPEX) in a neuronal model of cholinergic neurotransmission, the bovine adrenal chromaffin cell. EPEX augmented the release of catecholamine triggered by acetylcholine (ACh) pulses but did not enhance ACh-evoked inward currents, which were inhibited by 30 percent. Since EPEX did not cause a blockade of acetylcholinesterase or butyrylcholinesterase, it seems that EPEX is not directly activating the cholinergic system. EPEX also augmented K+-elicited secretion without enhancing the whole-cell inward calcium current. This novel and potent effect of EPEX in enhancing exocytosis might help to identify the active component responsible for augmenting exocytosis. When elucidated, the molecular structure of this active principle could serve as a template to synthesise novel compounds to regulate the exocytotic release of neurotransmitters.

Tratamiento quirúrgico de fractura cervical en el Hospital Regional Rancagua: análisis de un periodo de 4 años / Surgical treatment of cervical fracture in the Rancagua Regional Hospital: analysis of a period of 4 years

Introducción: La gravedad, las implicancias neurológicas y el alto costo del tratamiento de la fractura cervical, hacen de esta lesión un tema de suma importancia. Esta injuria provoca graves limitaciones e invalidez a los afectados, en su mayoría en plena actividad laboral, impactando en lo médico, social y económico. Objetivos: Describir los pacientes tratados quirúrgicamente de fractura cervical traumática en el Hospital Regional Rancagua, por el equipo de Neurocirugía dentro de un periodo de 4 años. Materiales y Métodos: Se evaluó - 24 pacientes con antecedente de fractura cervical el mecanismo del trauma, el tiempo transcurrido desde el ingreso hospitalario hasta la cirugía, nivel y compromiso de la lesión medular, tipo de abordaje quirúrgico, complicaciones médicas, quirúrgicas y seguimiento post-operatorio, entre otros. Resultados: 5 mujeres y 19 hombres, edad promedio 39 años (rango de edad 14 a 75 años), principales mecanismos de trauma fueron los accidentes automovilísticos-atropello (58 por ciento). El nivel medular más frecuentemente lesionado fue C4-C5 (25 por ciento). En el 50 por ciento de los pacientes se clasificó de entrada como Frankel A, por lo que un 50 por ciento de todos los pacientes ingresaron tetrapléjicos, y de estos, un 33 por ciento egresó tetraparéticos. Del ingreso a cirugía hubo un tiempo de espera promedio 5 días. Dentro de las complicaciones médicas la causa respiratoria (46 por ciento) fue la más frecuente, necesitando 64 por ciento de estos pacientes ventilación mecánica. Se registró 1 infección de herida operatoria donde el abordaje fue posterior. El Índice de Barthel promedio de 14 pacientes fue de 49 puntos. De 6 pacientes con puntaje Cero, 85 por ciento de estos ingresaron como Frankel A y 50 por ciento egresaron tetrapléjicos. Los pacientes se rehabilitaron en promedio de 2.5 meses. Discusión: Logramos objetivar nuestra realidad. La técnica quirúrgica fue prácticamente uniforme entre los pacientes, sin complicaciones...

Introduction: Gravity, neurological implications and high costs of treating cervical fracture, makes of this injury an issue of most importance. This injury causes severe limitations and disability to those affected, mostly in full working activity, impacting on the medical, social and economic. Objectives: To describe patients surgically treated for traumatic cervical fracture at the Rancagua Regional Hospital, by the team of Neurosurgery Department, within a period of 4 years. Materials and Methods: We evaluated 24 patients with an history of cervical fracture mechanism of trauma, the time from hospital admission to surgery, and commitment level of spinal cord injury, type of surgery, medical and surgical complications and follow-up post -operation, among others. Results: 5 women and 19 men, average age 39 years (ranging age from 14 to 75 years), major trauma mechanisms were motor vehicle accidents (58 percent). The most frequently injured spinal level was C4-C5 (25 percent). 50 percent of patients were classified as Frankel A at the admission, so that 50 percent of all patients admitted were quadriplegics, and of these, 33 percent were discharged as tetraparétic. Admission to the surgery were an average of 5 days. Within cause respiratory medical complications (46 percent) was the most frequent, requiring 64 percent of these patients mechanical ventilation. There was only 1 wound infection where the approach was posterior. The average Barthel Index of 14 patients was 49 points. In 6 patients with zero score, 85 percent were admitted as Frankel A and 50 percent egressed as tetraplejic. Patients were rehabilitated an average of 2.5 months. Conclusions: We were able to objectify our reality. The surgical technique was nearly uniform among patients without severe postoperative surgical complications...

The management of Clostridium difficile-associated diarrhoea in a community hospital / Tratamiento de diarreas asociadas con Clostridium difficile en un hospital comunitario

OBJECTIVES: To review the management of patients with Clostridium difficile-associated diarrhoea (CDAD). METHODS: A retrospective study was conducted on 26 patients with clinical symptoms of CDAD and positive tests for C difficile toxins A and/or B in stool samples, over a 12- month period. Demographic and clinical data on the patients including use ofproton pump inhibitors (PPI), management of CDAD, and compliance with local Infection Prevention and Control Guidelines were examined. RESULTS: The majority ofpatients were over 45 years of age (24/26, 92.4%) and 42% (11/26) were over 80 years of age. At least 50% (13/26) of the patients had acquired CDAD in hospital, 15% (4/26) were community acquired and symptomatic at admission while the onset of diarrhoea following admission to hospital was not documented in 35% (9/26). Three (11%) patients had used PPI. Fifteen per cent (4/26) of patients had no history of previous antibiotic therapy; 40% (10/26) were treated with a cephalosporin, fluoroquinolone or a combination of at least two different classes of antibiotics; one (3%) patient was on augmentin and the antibiotic regime used was not documented in 42% (11/26) who also had previous antibiotic therapy. The conditions for which antibiotics were prescribed could not be ascertained in 58% (15/26) but among the remaining cases antibiotics had been prescribed for urinary tract infection, wound respiratory tract infections and sepsis. Metronidazole (18/26, 70%) was the preferred drug of choice for first line therapy in patients with CDAD. None of the patients in the study received the recommended 10 to 14 days of antimicrobial therapy for CDAD. Recurrent CDAD was observed in 40% of those who were treated with metronidazole. The study also showed that there was timely reporting oflaboratory results and good compliance with the hospital Infection Prevention and Control Guidelines. CONCLUSION: The findings of this study can be used as a process improvement measure in the management of patients with CDAD.

OBJETIVO: Revisar el tratamiento de pacientes con diarrea asociada con Clostridium difficile (DACD). MÉTODO: Se llevó a cabo un estudio retrospectivo de 26 pacientes aquejados por síntomas clínicos de DACD. Dichos pacientes resultaron positivos a pruebas de detección de toxinas A y/o B de C difficile en muestras de heces fecales por un período de 12 meses. Se examinaron los datos demográficos y clínicos de los pacientes, incluyendo el uso de inhibidores de la bomba de protones (IBP), tratamiento de la DACD, y el cumplimiento con las guías para el control de la infección local. RESULTADOS: La mayoría de los pacientes tenían más de 45 años de edad (24/26, 92.4%) y 42% (11/26) estaban por encima de los 80 años de edad. Al menos 50% (13/26) de los pacientes habían adquirido DACD en el hospital; el 15 % (4/26) la adquirió en la comunidad y presentaba síntomas al momento del ingreso; el comienzo de la diarrea tras el ingreso al hospital no se documentó en 35% (9/26) de los casos. Tres pacientes (11%) habían usado IBP. El 15% (4/26) de los pacientes no tenían antecedente alguno de terapia con antibióticos; un 40% (10/26) fue tratado con cefalosporina, fluoroquinolona, o una combinación por lo menos dos clases diferentes del antibióticos; un paciente (3%) se hallaba bajo tratamiento con augmentina y el régimen antibiótico usado no se documentó en el 42% (11/26) de los casos, que también tuvieron terapia antibiótica previa. No pudieron determinarse las condiciones para las que se prescribieron los antibióticos en el 58% (15/26), pero entre los casos restantes, se habían prescrito antibióticos para la infección de las vías urinarias, heridas, infecciones de las vías respiratorias, y sepsis. El metronidazol (18/26, 70%) fue el medicamento de opción preferida para la terapia de primera línea en los pacientes con DACD. Ninguno de los pacientes en el estudio recibió los 10 a 14 días de terapia antimicrobiana, recomendados para la DACD. Se observó DACD recurrente en 40% de aquéllos que fueron tratados con metronidazol. El estudio también mostró que hubo reportes oportunos de resultados de laboratorio y buen cumplimiento de las guías hospitalarias para el control de las infecciones. CONCLUSIÓN: Los hallazgos de este estudio pueden usarse como medida para mejorar el proceso encaminado a tratar a los pacientes con DACD.

Treinamento muscular inspiratório em crianças com leucemia aguda: resultados preliminares / Inspiratory muscle training in patients with acute leukemia: preliminary results

OBJETIVO: Avaliar o efeito do treinamento muscular inspiratório em crianças com leucemia aguda. MÉTODOS: Trata-se de um estudo quase experimental com grupo controle. Quatorze pacientes com diagnóstico de leucemia aguda e idade entre cinco e 14 anos foram submetidos à avaliação da mobilidade torácica e da força muscular respiratória e divididos em dois grupos (A e B). Os pacientes do grupo A realizaram treinamento muscular inspiratório domiciliar por 15 minutos, duas vezes por dia, durante dez semanas, através do aparelho Threshold®, com carga de 30 por cento da pressão inspiratória máxima, reajustada após reavaliações semanais. O grupo B (controle) realizou uma avaliação das pressões respiratórias máximas inicialmente e após dez semanas. Os dados foram analisados com o SPSS 15.0. Aplicou-se o teste t para analisar as diferenças entre as pressões inspiratória máxima e expiratória máxima entre os dois grupos e o teste de correlação de Pearson para analisar associações das medidas de pressão inspiratória e pressão expiratória com as diferentes cargas utilizadas. RESULTADOS: Constatou-se ganho significativo de 35 por cento nas pressões inspiratória máxima e expiratória máxima no grupo A ao término do treinamento. Houve correlação positiva entre os níveis de carga utilizada e a pressão inspiratória máxima (p<0,0001) e a pressão expiratória máxima (p=0,0001). CONCLUSÕES: O treinamento muscular inspiratório pode ser eficaz no ganho de força muscular em crianças em tratamento de leucemia aguda.

OBJECTIVE: To evaluate the effect of inspiratory muscle training in children with acute leukemia. METHODS: This is a quasi-experimental study with a control group. Fourteen patients with 5-14 years old and a diagnosis of acute leukemia were evaluated regarding their thoracic mobility and respiratory muscle strength. They were divided in two groups (A and B). Group A received domiciliary inspiratory muscle training during 15 minutes, twice a day, for ten weeks, with a Threshold® device using a load of 30 percent of the maximal inspiratory pressure, readjusted after weekly evaluations. Group B patients were tested regarding their maximum respiratory pressures in their first evaluation and after ten weeks. Student t-test was used to evaluate maximum inspiratory and expiratory pressures between groups Pearson's correlation test examined the association of inspiratory and expiratory pressures with the different loads, using SPSS 15.0 software. RESULTS: A significant improvement of 35 percent was observed in the maximum inspiratory and expiratory pressures in group A at the end of the training. There was a strong positive correlation between the used load levels and maximal inspiratory (p<0.0001) and expiratory (p=0.0001) pressures. CONCLUSIONS: Inspiratory muscle training can be effective for improving inspiratory muscle strength in children beeing treated for acute leukemia.

Staphylococcus aureus colonization of anterior nares of school going children.

Objective. To determine the colonization rates of S. aureus in anterior nares of school going children, evaluate the antimicrobial resistance of such isolates against various antibiotics. Methods. Nasal swabs taken for S.aureus in 392 healthy school going children aged between 5 and 15 yr belonging to three schools surrounding Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India. Swabs were inoculated in to Mannitol Salt Agar (MSA) and incubated at 37o C for 24hr, Staphylococcus aureus isolates were identified by standard microbiological methods such as Gram’s stain, catalase and coagulase. MICs were determined by Agar dilution technique against Vancomycin, Ciprofloxacin, Sparfloxacin, Sparfloxacin ß Cyclodextrin. Antimicrobial resistance patterns of all the isolates against Oxacillin (1 μg) Penicillin (10units), Ampicillin (10μg), Co-trimoxazole (23.75 μg), Erythromycin (15 μg), Tetracycline (30 μg) and Gentamicin (10 μg) were tested using Kirby-Bauer disk diffusion method in accordance with CLSI standards. Results. Of the 392 samples screened 63(16%) showed the growth of Staphylococcus aureus. Twelve (19%) isolates were found to be MRSA. Antimicrobial susceptibility testing using Agar dilution method against Vancomycin, ciprofloxacin , Sparfloxacin, and Sparfloxacin β Cyclodextrin revealed MICs in the range of 0.52 μg/ml, 0.51 μg/ml, 0.5 μg/ml and <0.0312- 0.250 μg/ml respectively. Disk diffusion method showed that all the isolates were resistant to Penicillin and Ampicillin. A resistance of 14.3%, 25% and 22.2% was observed against Co-trimoxazole, Erythromycin and Tetracycline respectively. Gentamiicin was the only antibiotic against which most of the isolates were sensitive. Conclusion. Our results suggest that healthy school going children under 16 yr of age are potential carriers of S. aureus and in particular MRSA and multi-drug resistant strains.

Contribuição da tomografia computadorizada em pacientes com metástases pulmonares de carcinoma diferenciado de tireóide não-aparentes na radiografia e tratados com radioiodo / Contribution of computed tomography in patients with lung metastases of differentiated thyroid carcinoma not apparent on plain radiography who were treated with radioiodine

A tomografia computadorizada (TC) de tórax é mais sensível que a radiografia na detecção de metástases pulmonares do carcinoma diferenciado de tireóide (CDT), sendo importante conhecer melhor o valor agregado desse método. Este estudo avaliou a resposta ao tratamento com 131I em pacientes com metástases pulmonares de CDTs não-aparentes na radiografia e o valor da TC nesses casos. Foram avaliados 25 pacientes com metástases pulmonares não-aparentes na radiografia, que receberam inicialmente 100 a 200 mCi de 131I. Naqueles com pesquisa de corpo inteiro (PCI) pós-dose com captação pulmonar, um novo tratamento era realizado após seis a 12 meses, e assim sucessivamente. A chance do encontro de captação pulmonar na PCI pós-dose não foi diferente em pacientes com TC negativa ou positiva (100 por cento versus 91,5 por cento). Os valores médios de tireoglobulina (Tg) sérica foram maiores naqueles com TC positiva (108 ng/mL versus 52 ng/mL). PCI pós-dose negativa foi alcançada em 82 por cento dos pacientes com TC positiva e em 92,3 por cento com TC negativa, e a atividade acumulada de 131I para alcançar essa resposta não foi diferente nos dois grupos (em média, 300 mCi). Quarenta e sete por cento dos pacientes com TC negativa ao final do tratamento apresentaram Tg estimulada indetectável, mas nenhum daqueles que permaneceu com TC positiva apresentou-a. Em pacientes com Tg elevada, o resultado da TC aparentemente não altera a indicação da terapia e a atividade de 131I a ser administrada. Nos casos com metástases pulmonares, a permanência de micronódulos na TC nos pacientes com PCI pós-dose negativa após o tratamento foi associada à persistência de Tg detectável.

Computed tomography (CT or CAT Scan) of the chest is more sensitive than radiography in the detection of lung metastases of differentiated thyroid cancer (DTC), but little information is available regarding the aggregated value of this method. The present study evaluated the response of patients with lung metastases of DTC not apparent on radiography to treatment with 131I and the value of CT in these cases. Twenty-five patients with lung metastases not apparent on radiography, who initially received 100-200 mCi I151, were evaluated and those presenting pulmonary uptake on post-therapy WBS were submitted to a new treatment after 6 to 12 months, and so on. The chance of detection of pulmonary uptake on post-therapy WBS did not differ between patients with negative and positive CT (100 percent versus 91.5 percent). Mean serum Tg levels were higher in patients with positive CT (108 ng/ml versus 52 ng/ml). Negative post-therapy WBS was achieved in 82 percent of patients with positive CT and in 92.3 percent with negative CT and the cumulative I131 activity necessary to achieve this outcome did not differ between the two groups (mean = 300 mCi). Stimulated Tg was undetectable in 47 percent of patients with negative CT at the end of treatment, but in none of the patients whose CT continued to be positive. In patients with elevated Tg, the CT result apparently did not change the indication of therapy or the I131 activity to be administered. In cases with lung metastases, the persistence of micronodules on CT was associated with the persistence of detectable Tg in patients presenting negative post-therapy WBS.

Perfil de sensibilização a aeroalérgenos e alimentos em pacientes com dermatitie atópica do HSPE-SP / Sensitization profile in atopic dermatitis patients from HSPE-SPto airborne and food allergens

Objetivos: Avaliar o perfil de sensibilização a aeroalérgenos e alimentos de pacientes com dermatite atópica do ambulatório de alergia e imunologia do Hospital do Servidor Público Estadual de São Paulo (HSPE-SP) e estabelecer sua associação com alergia alimentar. Método: Estudo prospectivo de pacientes que preencheram os critérios para dermatite atópica do ambulatório de alergia e imunologia do (HSPE-SP) entre 2004 a 2006. Os participantes responderam questionário específico e foram avaliados quanto à gravidade das lesões conforme o SCORAD pelo médico e por ele mesmo através de 'uma escala visual analógica de sintomas. Foram solicitados IgE sé rica total, IgE sé rica específica e teste cutâneo de leitura imediata com aeroalérgenos e alimentos. Resultados: Foram avaliados 110 pacientes, com idades entre 1 e 66 anos (média 15,8 anos), predominando a fase de .escolar (29). Vinte e seis (23,6...

Emprego da ultra-sonografia cervical no seguimento de pacientes com carcinoma diferenciado de tireóide / Usefulness of neck ultrasonography in the follow-up of patients with differentiated thyroid cancer

A ultra-sonografia (US) cervical é recomendada na avaliação de todos pacientes com carcinoma de tireóide após a terapia inicial, pois mesmo indivíduos de baixo risco com tireoglobulina (Tg) estimulada indetectável podem apresentar metástases cervicais. Para estas metástases, a US é o método mais sensível, superior à pesquisa de corpo inteiro (PCI) com 131I. Linfonodos cervicais com diâmetro > 5 mm com calcificações finas e/ou degeneração cística quase sempre são de etiologia maligna. Na ausência destas características, o formato arredondado e a ausência do hilo ecogênico são achados "suspeitos", enquanto linfonodos alongados e com hilo ecogênico visível são considerados benignos. A avaliação do fluxo, através do doppler, auxilia no diagnóstico diferencial, usualmente revelando hipervascularização periférica ou mista nos casos malignos. Na presença de linfonodos "suspeitos" na US, a avaliação citológica do material obtido através da punção aspirativa por agulha fina (PAAF) e a dosagem da Tg, obtida do lavado da agulha, são testes úteis e complementares para definir a etiologia, com elevada sensibilidade quando combinados e especificidade de 100 por cento. A US também é útil antes da tiroidectomia, auxiliando e até, em alguns casos, modificando o planejamento cirúrgico; e antes da ablação, para mensuração dos remanescentes tireoidianos e pesquisa de metástases linfonodais persistentes. Outra aplicação desse método de imagem é guiar a injeção de etanol (escleroterapia) ou a introdução de eletrodos para ablação com radiofreqüência em casos selecionados de metástases linfonodais isoladas, como alternativa às terapias convencionais.

Neck ultrasonography (US) is recommended for the assessment of all patients with thyroid carcinoma after initial therapy, since even low-risk patients with undetectable stimulated thyroglobulin (Tg) may present cervical metastases. In the case of these metastases, US is the most sensitive method and is superior to whole-body 131I scanning. Cervical lymph nodes with a diameter > 5 mm presenting thin calcifications and/or cystic degeneration have almost always a malignant etiology. In the absence of these characteristics, a round shape and the absence of an echogenic hilum are "suspicious" findings, whereas elongated lymph nodes with a visible echogenic hilum are considered benign. Doppler flow analysis helps with the differential diagnosis, usually revealing peripheral or mixed hypervascularization in malignant cases. In the presence of "suspicious" lymph nodes upon US, fine-needle aspiration cytology and measurement of Tg in the needle lavage fluid are useful and complementary exams for the definition of the etiology, with the combination of the two methods showing elevated sensitivity and 100 percent specificity. US is also useful before thyroidectomy, even contributing in some cases to modify the surgical planning, and before ablation for the measurement of thyroid remnants and detection of persistent lymph node metastases. Another application of this imaging method is to guide the injection of ethanol (sclerotherapy) or the introduction of electrodes for radiofrequency ablation in selected cases of isolated lymph node metastases as an alternative to traditional therapies.

Polymerase chain reaction in rapid diagnosis of neonatal sepsis.

In a prospective study a total of hundred neonates who fulfilled the American College of Obstetrics and Gynecology's (ACOG) criteria for probable sepsis admitted to NICU of tertiary care armed forces hospital were investigated for evidence of sepsis. The investigation protocol included sepsis screen, blood culture and 1 mL of venous blood for molecular analysis by polymerase chain reaction (PCR) for bacterial DNA component encoding 16 s RNA in all cases. 100 newborns with probable sepsis were studied to evaluate the molecular diagnosis of sepsis using PCR amplification of 16 S RNA in newborns with risk factors for sepsis or those who have clinical evidence of sepsis. We compared the results of PCR with blood culture and other markers of sepsis screen (total leucocyte count (TLC), absolute neutrophil count (ANC), immature/total neutrophil count ratio (I/T ratio), peripheral blood smear, micro ESR and C reactive protein (CRP). Controls consisted of 30 normal healthy newborns with no overt evidence of sepsis. Sepsis screen was positive in 24 (24%) of cases in study group with sensitivity and specificity of 100% and 83.5% respectively. Blood culture was positive in 09(9%t) with sensitivity of 69.2% and specificity of 100%. PCR was positive in 13(13%) of cases (9% are both blood culture and sepsis screen positive and 4% are positive by sepsis screen); the sensitivity of PCR was 100% and specificity was 95.6%. Blood culture is the most reliable method for diagnosis of neonatal sepsis. Polymerase chain reaction is useful and superior to blood culture for early diagnosis of sepsis in neonates.