Características del almacenamiento de antibióticos en una población suburbana de México

Objetivo: Determinar las características de almacenamiento de los antibióticos de las familias en una población suburbana en México. Metodología: El enfoque del estudio es cuantitativo, observacional, de corte transversal y alcance descriptivo. La unidad de estudio fueron las familias que vivían en el área de estudio de una zona suburbana en México. Resultados: Se encuestaron un total de 235 familias, dentro de las cuales existen diversos grupos etarios, de los cuales predominaron las edades de entre 36 a 64 años en 153 familias. Se obtuvo que más del 70 % presentaban enfermedades y, respecto a la posibilidad de que tuviesen almacenados medicamentos antibióticos caducados o próximos a caducar, el 68.1 % mencionó que no era probable. Conclusiones: El importante número de población adulta, la amplia presencia de comorbilidades y diversos factores sociodemográficos impactan en las prácticas y actitudes en relación con las formas en que las familias obtienen, usan, almacenan y desechan los medicamentos dentro de sus hogares. Esta investigación busca contribuir a la concientización y creación de diversos programas para la adopción de medidas de seguridad para el almacenamiento de medicamentos dentro del hogar, así como servir de guía en la identificación de procedimientos óptimos, eficientes y eficaces para tratar este fenómeno.

Objetivo: Determinar as características do armazenamento de antibióticos das famílias em uma população suburbana no México. Metodologia: A abordagem do estudo é quantitativa, observacional, transversal e de escopo descritivo. A unidade de estudo foram as famílias que viviam na área de estudo de uma zona suburbana no México. Resultados: Foram pesquisadas 235 famílias, de diversas faixas etárias, das quais predominaram as idades de 36 a 64 anos em 153 famílias. Verificou-se que mais de 70% apresentavam enfermidades, e com relação à possibilidade de terem medicamentos antibióticos vencidos ou prestes a vencer armazenados, 68,1 % mencionaram que não era provável. Conclusões: O significativo número de população adulta, a ampla presença de comorbidades e vários fatores sociodemográficos impactam nas práticas e atitudes relativas às formas como as famílias obtêm, usam, armazenam e descartam medicamentos em suas residências. Esta pesquisa busca contribuir para a conscientização e a criação de vários programas para a adoção de medidas de segurança para o armazenamento de medicamentos em casa, bem como servir de guia na identificação de procedimentos ideais, eficientes e eficazes para lidar com esse fenômeno.

Objective: To determine the antibiotic storage characteristics of families in a suburban population in Mexico. Methodology: The study approach is quantitative, observational, cross-sectional and descriptive in scope. The unit of study was families living in the area under study in a suburban zone of Mexico. Results: A total of 235 families were surveyed, within which there are different age groups, with 153 families predominantly aged between 36 and 64 years old. It was obtained that more than 70 % presented illnesses and, regarding the possibility that they had stored expired or soon to expire antibiotic drugs, 68.1 % mentioned that it was not likely. Conclusions: The significant number of adult population, the wide presence of comorbidities and various sociodemographic factors impact practices and attitudes regarding the ways in which families obtain, use, store and dispose of medications within their homes. This research seeks to contribute to the awareness and creation of various programs for the adoption of safety measures for the storage of medicines within the home, as well as to serve as a guide in the identification of optimal, efficient and effective procedures to deal with this phenomenon.

In vitro susceptibility of fosfomycin in uropathogens with emerging resistance in Enterococcus isolates

Background: Urinary tract infection is a very common clinical entity and are the leading causes of nosocomial infections. The options for antibiotics especially for nosocomial infections are very limited. Fosfomycin a good drug to be used in UTI and is recommend as first line agents for acute uncomplicated UTIs. The emergence of resistance to fosfomycin is a concern. Limited resistance data for fosfomycin is available from India. This study was conducted in order to monitor the trends of resistance to fosfomycin in E coli and Enterococcus faecalis causing UTI. Methods: Urine samples received in the laboratory from all patients were included in the study. Microscopy of uncentrifuged urine sample was done. Culture and sensitivity was done as per the CLSI guidelines. Susceptibility testing of the isolates to fosfomycin was performed interpretation done as per CLSI. Results: Total 150 isolates were taken for the study which included 100 isolates of E. coli and 50 isolates of Enterococcus faecalis. None of the E. coli isolates were resistant to fosfomycin and 82.0% of the isolates were found to be sensitive to nitrofurantoin. None of the Enterococcus faecalis isolates were resistant to linezolid. The percentage susceptibility was 52 % and 70 % for nitrofurantoin and fosfomycin respectively. Conclusions: The increasing resistance to fosfomycin is a matter of concern. An increased fosfomycin resistance rate in E. faecalis was observed. Performing antimicrobial susceptibility testing should be the most important criteria before starting the antibiotic to avoid undue usage and more such studies need to be conducted.

Resistencia a la Insulina en adultos con sobrepeso y obesidad / Insulin resistance in overweight and obese adults

Resumen El objetivo de esta investigación fue analizar la relación de resistencia a la insulina, sobrepeso y obesidad. Con una población de 2574 pacientes con diagnóstico de obesidad y sobrepeso, se obtuvo una muestra de 334 pacientes. Se realizó un estudio de tipo descriptivo, documental, retrospectivo, transversal y correlacional. Para la recolección de datos se empleó las historias clínicas registradas en el sistema operativo AS400 de IBM, de atención médica del Instituto Ecuatoriano de Seguridad Social. El resultado total de los pacientes perteneció al sexo femenino con un porcentaje del 77.84 %, residencia urbana (73.65 %) e instrucción superior (60.5 %). El 52.8 % de los individuos registró un IMC >30kg/m2. Los pacientes adultos jóvenes de instrucción superior, sexo masculino y sector urbano registraron la mayor prevalencia de resistencia a la insulina, siendo ésta del 61.7 %. En el análisis bivariado los pacientes con obesidad mórbida presentaron mayor riesgo de resistencia a la insulina (RP:1.5; IC95 %:1. 29; 1.77). Se estableció una relación significativa entre el antecedente familiar de diabetes mellitus tipo 2 y el riesgo de presentar resistencia a la insulina (p<0.001; RP: 1.32; IC 95 %: 1.12: 1.56). Los valores de hiperglucemia, hiperinsulinemia e hiperuricemia, así como de AST Y ALT elevadas registraron una relación significativamente con HOMA-IR >3. Se concluye que la resistencia a la insulina es una entidad frecuente en pacientes con sobrepeso y obesidad, identificándose una mayor prevalencia en el género masculino, misma que predispone a la progresión de enfermedades crónicas.

Abstract This research aimed to analyze the relationship between insulin resistance, overweight and obesity. A population of 2,574 patients diagnosed with obesity and overweight was obtained, considering a sample of 334 patients. A descriptive, documentary, retrospective, cross-sectional, and correlational study was conducted. For data collection, the medical records recorded in the IBM AS400 operating system for the Ecuadorian Social Security Institute's medical care were used. The total result of the patients belonged to the female sex with a percentage of 77.84%, urban residence (73.65%), and higher education (60.5%). 52.8% of the individuals registered a BMI > 30kg/m2. Young adult patients with higher education, male sex, and urban sector registered the highest insulin resistance prevalence, 61.7%. In the bivariate analysis, patients with morbid obesity presented a higher risk of insulin resistance (PR: 1.5; 95% CI: 1. 29, 1.77). A significant relationship was established between family history of type 2 diabetes mellitus and the risk of developing insulin resistance (p<0.001; PR: 1.32; 95% CI: 1.12: 1.56). The values of hyperglycemia, hyperinsulinemia, hyperuricemia, and elevated AST and ALT were significantly related to HOMA-IR > 3. It was concluded that insulin resistance is a frequent entity in overweight and obese patients, with a higher prevalence identified in the male gender, which predisposes to the progression of chronic diseases.

Utilidad de diversos parámetros hemodinámicos como marcadores pronósticos en la hipertensión pulmonar / Prognostic Value of Various Hemodynamic Parameters in Pulmonary Hypertension

RESUMEN Introducción . La hipertensión pulmonar (HP) se asocia con elevada morbimortalidad y su pronóstico está determinado por la función del ventrículo derecho y el acople ventrículo-arterial pulmonar. Diversos parámetros hemodinámicos han sido propuestos para caracterizar el riesgo de evolución adversa. Objetivos . Determinar la capacidad de predicción de eventos graves, de diversos parámetros hemodinámicos medidos por cateterismo derecho. Material y métodos . Estudio multicéntrico, descriptivo, de cohorte retrospectiva de pacientes con HP. Se dividió a los datos hemodinámicos en alto o bajo riesgo según lo definido por las recomendaciones europeas de 2022, o según media o mediana de nuestra población. Resultados . Fueron incluidos 324 pacientes con HP, con edad media 61,5 años y 69% de sexo femenino; 62,1 % de los pacientes del Grupo 1 y 19,2 % del Grupo 3. La tasa de eventos (muerte o internaciones) en un seguimiento mediano de 23 (RIC 14-44) meses fue 60 % y la mortalidad global 24,5 %. Los valores de corte para definir riesgo de las diferentes variables fueron. índice cardíaco (IC) 2,72 L/min/m2, índice de volumen sistólico (IVS) 33,1 mL/lat./m2, resistencia vascular pulmonar (RVP) 6 unidades Wood (UW), índice de pulsatilidad de la arteria pulmonar (IPAP) 3,76, índice de trabajo sistólico del ventrículo derecho (ITSVD) 11,6 g.m/m2, compliance vascular pulmonar 1,84 mL/mmHg. La RVP elevada se asoció a mayor frecuencia de eventos combinados, mientras que valores de alto riesgo de IC, IVS, RVP y compliance presentaron asociación con mayor mortalidad en el seguimiento. Conclusiones . Si bien el IC y el IVS presentaron una adecuada predicción de riesgo, variables como la RVP y la compliance mostraron similar, e incluso mejor predicción de eventos graves en HP. Se necesitan nuevos estudios que validen estos parámetros en el seguimiento.

ABSTRACT Background. Pulmonary hypertension (PH) is associated with high morbidity and mortality and its prognosis is determined by the right ventricular function and right ventricular-pulmonary artery coupling. Several hemodynamic parameters have been proposed to better characterize the risk for adverse disease progression. Objective. The aim of this study was to determine the predictive ability of various hemodynamic parameters that can be calculated during RHC to predict serious events. Methods. In this retrospective multicenter and descriptive cohort study of patients with PH, hemodynamic variables values were divided as high or low risk based on the 2022 European guidelines, or mean or median values in our population. Results. A total of 324 patients with PH were included; mean age was 61.5 years and 69% were women; 62.1 % of the patients were in Group 1 and 19.2 % in Group 3. In a median (IQR) follow-up of 23(14-44) months, the event rate (death or hospitalization for heart failure) was 60.6% and all-cause mortality was 24.5%. The cut-off values associated with risk for the different hemodynamic variables were: cardiac index (CI) 2.72 L/min/m2, systolic volume index (SVI) 33.1 ml/m2, pulmonary vascular resistance (PVR) 6 Wood units (WU), pulmonary artery pulsatility index (PAPI) 3.76, right ventricle systolic work index (RVSWI) 11.6 g.m/m2, and pulmonary arterial compliance 1.84 mL/mm Hg. Elevated PVR was associated with a higher rate of composite events, while high-risk CI, SVI, PVR, and compliance were associated with higher mortality at follow-up. Conclusions. While CI and SVI are adequate predictors of risk, PVR and compliance demonstrate similar or even better risk prediction in patients with PH. Additional research is necessary to validate these parameters during follow-up.

Determinantes estructurales de la salud y resistencia a los antibióticos en América Latina: revisión sistemática

Objetivo: Determinar la influencia de los determinantes sociales de la salud en la resistencia antibiótica, en los países de América Latina. Metodología: Estudio documental de tipo revisión sistemática, con análisis interpretativo de la información, se incluyeron a artículos publicados entre 2018 y 2023 de las bases de datos: PubMed, ScienceDirect, Cochrane, Dialnet, Google académico, BVS, LilaCs, Scielo, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost y CONRICYT; en los idiomas español, inglés y portugués, que tuvieran como población comunidades y países de América Latina; se excluyeron aquellos con enfoque veterinario o agropecuario. Resultados: Se obtuvieron 4,625 en la búsqueda inicial y posterior a la aplicación de criterios de selección, se analizaron 28 artículos analizó la calidad metodológica, la bibliometría y el análisis temático a través de la interpretación de la información contenida. Conclusión: Los determinantes sociales de la salud estructurales asociados con la resistencia antimicrobiana fueron las políticas públicas, el género, los factores macroeconómicos, el nivel socioeconómico familiar, educativo y la gobernanza.

Objective: Determine the influence of social determinants of health on antibiotic resistance in Latin American countries. Methodology: Systematic review type documentary study with interpretive analysis of the information, articles published between 2018 and 2023 from the following databases were included: PubMed, ScienceDirect, Cochrane, Dialnet, Google scholar, BVS, LilaCs, SciELO, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost and CONRICYT; in the Spanish, English and Portuguese languages, which had Latin American communities and countries as their population; Those with a veterinary or agricultural focus were excluded. Results: 4,625 were obtained in the initial search and after the application of selection criteria, 28 articles were analyzed that analyzed the methodological quality, bibliometrics and thematic analysis through the interpretation of the information contained. Conclusion: The social determinants of structural health associated with antimicrobial resistance were public policies, gender, macroeconomic factors, family socioeconomic level, education, and governance.

A prática do autocuidado no tratamento do diabetes mellitus tipo II por usuários de insulina / The practice of self-care in the treatment of Type II Diabetes Mellitus by insulin users

Este estudo objetivou avaliar o nível de aderência ao autocuidado no tratamento do DMII entre pacientes usuários de insulina atendidos em uma unidade de saúde da família em Palmas, Tocantins, em 2023. Trata-se de uma pesquisa com abordagem quantitativa com 24 portadores de DMII em uso de insulina que responderam a dois questionários, um com perguntas sociodemográficas e o outro sobre atividades de autocuidado relacionadas ao diabetes. Os resultados mostraram que os entrevistados demonstraram baixa adesão ao exercício e à atividade física, com uma média abaixo de 2, o que representou o pior resultado obtido no QAD. Em contrapartida, a adesão ao uso dos medicamentos orais e insulina foi satisfatória, com médias superiores a seis dias por semana. A maioria dos entrevistados apresentou melhor adesão ao tratamento medicamentoso, seja de forma isolada ou associada com cuidados específicos, como cuidado com os pés, ou baixa ingestão de doces. No entanto, a prática de exercício e a atividade física e a adesão às orientações alimentares foram as áreas de menor comprometimento. Diante disso, recomenda-se que os profissionais da saúde desenvolvam estratégias clínico-educativas direcionadas aos portadores de DMII, com o intuito de promover a saúde e incentivar o uso correto dos fármacos e a adesão aos autocuidados, objetivando prevenir complicações relacionadas a essa patologia, além de reforçar a importância do autocuidado para prevenir complicações associadas à doença.

This study aimed to evaluate the level of adherence to self-care in the treatment of DMII among insulin-using patients treated at a family health unit in Palmas, Tocantins, in 2023. This is a quantitative study with 24 DMII patients using insulin who answered two questionnaires, one with sociodemographic questions and the other about self-care activities related to diabetes. The results showed that the interviewees demonstrated low adherence to exercise and physical activity, with an average below 2, which represented the worst result obtained in the QAD. In contrast, adherence to the use of oral medications and insulin was satisfactory, with averages of more than six days per week. The majority of interviewees showed better adherence to medication treatment, whether alone or associated with specific care, such as foot care, or low intake of sweets. However, exercise and physical activity and adherence to dietary guidelines were the areas of least impairment. Therefore, it is recommended that health professionals develop clinical-educational strategies aimed at people with DMII, with the aim of promoting health and encouraging the correct use of drugs and adherence to self-care, aiming to prevent complications related to this pathology, and reinforces the importance of self-care to prevent complications associated with the disease.

Bacterial profiling, sensitivity and resistance pattern of neonatal sepsis in neonatal intensive care unit of tertiary care hospital

Background: This study aimed to identify the distribution of pathogens and their antimicrobial resistance patterns in the neonates admitted to the NICU of a tertiary care hospital in northern India.Methods: After obtaining written informed consent, neonates with confirmed or suspected cases of neonatal sepsis (n=167) aged 0-28 days were included. As soon as the baby arrived, all the clothes were removed and kept in a pre-heated warmer. Before administering I/V antibiotics, all the routine and culture samples were taken. The clinical data were collected and analysed using SPSS.Results: Most of the neonates were from lower middle class, out-born, LSCS, early preterm, and low birth weight (LBW). 167 neonates had culture-confirmed infections [blood culture positive (13.8%) and sepsis screen positive (86.2%)]. Gastric aspirate cytology was positive in 61.7% of patients. Maximum cytology-positive cases were seen in neonates with EOS. The most common risk factors were birth asphyxia. 142 individuals were discharged, with 72.5% diagnosed with EOS and 89% with LOS. There was a significant difference in gastric aspirate cytology when associated with expiry and discharge. Out of 167 neonates, 13.77% were culture-positive for neonatal sepsis. Out of 23 organisms, 82.6% were resistant, while, 17.4% were not. Staph aureus was the major causative organisms. Among the Gram Positive and Negative bacteria, the highest sensitivity was observed for imipenum. All gram-positive bacteria were resistant to cotrimazole, tobramycin, and erythromycin.Conclusions: Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.

Antimicrobial utilization pattern in indoor patients of obstetrics and gynecology ward of a tertiary care hospital

Background: Rational prescribing of antimicrobials is fundamentally necessary to reduce incidence of antimicrobial resistance. To evaluate the rationality of antimicrobial prescribing practices in patients admitted to obstetrics and gynecology ward of a tertiary care hospital using ICMR guidelines and to check how many drugs were prescribed from NLEMI. Methods: It was a prospective observational study. Study included newly admitted patients in obstetrics and gynecology ward receiving antimicrobial therapy. Drugs prescribed to the patients during their hospital stay were noted from case sheets in case record form. WHO core and economic indicators were used to analyze prescribing patterns. Medguideindia.com was referred for prices of drugs. Results: Average number of drugs prescribed for a patient admitted in the obstetrics and gynecology ward were 3.22 and 4.31 respectively. Percentage of drugs prescribed by their generic name were 37.11% and 39.42% in obstetrics and gynecology ward respectively. 26.85% and 34.14% of patients received drugs through parenteral route in obstetrics and gynecology wards respectively. All antimicrobials were prescribed from NLEMI. Conclusions: WHO recommends prescribing all drugs by their generic names. Average duration of antimicrobial treatment was higher than recommended average duration suggested by ICMR. ICMR recommends use of 2nd generation cephalosporins but in the present study 3rd generation cephalosporins were used. For rational use of antimicrobials and to reduce their cost it is recommended to prescribe antimicrobials by their generic names and reduce treatment duration by referring to ICMR Guidelines and NLEMI.

Knowledge, attitude and practices regarding antimicrobial use and resistance among community members of Mtendere Township in Lusaka, Zambia: findings and implications on antimicrobial stewardship

Background: Antibiotic resistance is a public health problem affecting all countries and leads to an increase in morbidity and mortality rates. In Zambia, there is little information on the knowledge, attitude, and practices of community members about antibiotic use and resistance. This study assessed the knowledge, attitude and practices (KAP) regarding antimicrobial use (AMU) and antimicrobial resistance (AMR) among community members in Mtendere township of Lusaka Zambia. Methods: This was a cross-sectional study that was conducted from May 2020 to August 2020 using a structured questionnaire among 369 Mtendere residents. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: Of the 369 participants, 50.9% were male and 62.1% were aged between 18 and 29 years. Overall, this study found a poor KAP (38% good knowledge, 58% positive attitudes, and 52% good practices) regarding AMU and AMR. More than half of the participants 66.7% (246/369) had heard of antibiotics, 33.6% heard of AMR, and 23% heard of antimicrobial-resistant infections. Most of the participants 48.2% were not aware that AMR is a public health issue. A total of 52.8% (195/369) of the participants said they did not take antibiotics without consulting a doctor or pharmacist, translating into a prevalence of self-medication of 47.2%. Conclusions: This study showed that Mtendere residents had poor KAP towards antibiotic use and resistance. There is a need to implement community-based interventional campaigns including antimicrobial stewardship programmes address the gaps in KAP identified in this study.

Tuberculosis: a narrative review on epidemiology, risks, implications, preventions and treatments

Tuberculosis (TB) is an airborne disease that generally affects the pulmonary portion of the human body leading to severe coughing, fever and chest pain. It is caused by a bacterium known as Mycobacterium tuberculosis, which kills human beings each and every year globally more than the death toll of combined HIV and malaria. However, it is preventable, treatable, and curable. The world is suffering due to this dreaded disease with an approximate number of 11 million TB cases and 1.6 million deaths annually. Tuberculosis increases the public health attention because of its high mortality rates after HIV/AIDS. World Health Organisation (WHO) and Centre for Chronic Disease Control (CCDC) are the leading organizations playing an important role to combat against TB by publishing proper health guidelines and treatments through reliable awareness campaigns whenever there is sudden outbreaks of TB, COVID-19 and related diseases. A wide range of research findings, clinical reports and new treatment methods like multi-drug therapy have been developed to combat TB. It is still necessary to develop new research and innovative ideas and proper implementations of the treatment and prevention guidelines of WHO and CCDC to fight against this fatal disease. In countries having higher increase of populations due to immunosuppressed chronic diseases like HIV, diabetes and pandemics like COVID-19, eradication of TB infection is a very difficult and challenging task. This mini review is based on the critical analyses of the data available from the official websites of WHO (Global Tuberculosis Report), CCDC, and search engines like Medline, PubMed, Google Scholar, and research findings of selected articles, textbooks were used as additional sources which are cited in the reference section.

A comparative study of clinical profile of diabetic tuberculosis patients with non diabetic tuberculosis patients of outpatient department of tertiary healthcare centre

Background: The global increase in type 2 DM is recognized re-emerging risk and challenge to TB control in India. TB-T2D association is again at the frontline of risk factors for TB, with an estimated worldwide population attributable fraction of 34.5%. T2D not only increases TB risk 3-fold, but also TB treatment failure including death. And prognosis of diabetic tuberculosis patients as compared to non diabetic ones is poorer. Methods: An comparative analytical study was done in microbiologically confirmed 50 diabetic and 50 non diabetic TB patients registered in RNTCP OPD of tertiary healthcare hospital who were followed up for 3 months. Results: In our study we found that elderly (above 65 age group) male diabetic patients were affected more with tuberculosis as compared to young patients and data was statistically significant. Extrapulmonary involvement was seen more in diabetic patients as compared to non diabetic patients. Radiologically diabetic tuberculosis patient showed predominantly lower lobe of lung involvement as oppose to non diabetic tuberculosis patients who showed upper lobe of lung involvement and data was statistically significant. Outcomes like Multidrug Resistance and prolonged sputum positivity after intensive phase treatment was seen more with diabetic tuberculosis patients but this was not statistically significant. Conclusions: Early screening of TB patients for DM and vice versa and early initiation of treatment will prevent unfavourable outcomes of these patients.

Antimicrobial Resistance and its Impact on Public Health

Aim of the Study: The current study addresses the increasing threat of AMR and its direct impact on global public health.It aims to contribute to the existing knowledge about the key challenges of AMR, bringing attention to the need for further research and creating a combined effort in the battle with antimicrobial resistance.Background & Methods: Antimicrobial resistance (AMR) has been considered one of the key problems that humankind has come across, showing a massive impact on public health globally. The continuous emergence of new microbial strains complicates it further by reducing the efficacy of the available antimicrobial drugs. For the current study, various scientific journals were studied from multiple resources. Furthermore, the websites of policymakers and agencies associated with this cause were studied and referred to.Results & Conclusions:The study has revealed a concerning trend of a steep increase in resistance of pathogens to antimicrobial agents. The major contributing factors which were identified during this study include misuse and overuse in the healthcare sector, inadequate prevention of infections and disease control, overuse in agriculture and the lack of novel antimicrobial agents. Several policies like the “One Health” approach by the Centers for Disease Control and Prevention (CDC) and the United Nations Sustainable Development Goals (SDGs) have been put in place as a means to combat the global public health problem. The study also highlights the need for policymakers, stakeholders and researchers to work in unison to combat the global issue.

Presentation of the ATLETAS DA VOZ™ Conditioning Program

Objectives: To present a simple form of vocal and breathing conditioning for voice professionals based on concepts from vocal science. The vocal conditioning program called Voice Athletes Conditioning uses the principles of exercise physiology to gradually improve vocal and respiratory overload to achieve endurance, power, and flexibility. Methods: Due to our personal experience with high voice users, we synthesized a vocal conditioning program (AVCP) that combines voice science, exercise physiology, sports science and physical therapy principles. This is an 8-week program of daily vocal and breathing exercises with overload enhancement each week using different types of breathing devices and semi-occluded vocal tract exercises, designed and developed according to the specific requirements and performance of the voice professional. Reflections: Professional voice users often experience episodes of vocal fatigue that can directly affect their performance and vocal health. As with physical training for athletes, voice exercises can also contribute to improving vocal conditioning, preventing voice disorders, as well as helping to obtain better performance, greater tolerance to fatigue and shorter recovery time. Conclusions: AVCP is an approach that considers the principles of muscle training aimed objectively at the respiratory and vocal muscles, carried out with a variety of breathing devices and specific vocal exercises in search of greater performance time, less physiological stress, and shorter recovery time in the professional use of the voice.

Objetivos: Presentar una forma sencilla de acondicionamiento vocal y respiratorio para profesionales de la voz, basada en conceptos de la ciencia vocal. El programa de acondicionamiento vocal denominado Voice Athletes Conditioning utiliza los principios de la fisiología del ejercicio para mejorar gradualmente la sobrecarga vocal y respiratoria, con el fin de lograr resistencia, potencia y flexibilidad. Métodos: Debido a nuestra experiencia personal con usuarios de voz aguda, sintetizamos un programa de acondicionamiento vocal (AVCP) que combina principios de la ciencia de la voz, la fisiología del ejercicio, las ciencias del deporte y la fisioterapia. Se trata de un programa de 8 semanas de ejercicios vocales y respiratorios diarios con realce de sobrecarga cada semana utilizando diferentes tipos de dispositivos respiratorios y ejercicios semioclusivos del tracto vocal, diseñado y desarrollado de acuerdo con los requerimientos específicos y el rendimiento del profesional de la voz. Reflexiones: Los usuarios profesionales de la voz experimentan a menudo episodios de fatiga vocal que pueden afectar directamente su rendimiento y salud vocal. Al igual que ocurre con el entrenamiento físico de los deportistas, los ejercicios vocales también pueden contribuir a mejorar el acondicionamiento vocal, prevenir trastornos de la voz, además de ayudar a obtener un mejor rendimiento, una mayor tolerancia a la fatiga y un menor tiempo de recuperación. Conclusiones: El AVCP es un enfoque que considera los principios del entrenamiento muscular dirigido objetivamente a la musculatura respiratoria y vocal, realizado con diversos aparatos respiratorios y ejercicios vocales específicos en busca de un mayor tiempo de actuación, menor estrés fisiológico y menor tiempo de recuperación en el uso profesional de la voz.

Efectos del entrenamiento cluster sobre la hipertrofia muscular: una revisión sistemática / Effects of cluster training on muscle hypertrophy: a systematic review / Efeitos do treinamento em cluster na hipertrofia muscular: uma revisão sistemática

Resumen Objetivo: El objetivo de la presente revisión sistemática fue determinar los efectos del entrenamiento cluster sobre la hipertrofia muscular. Metodología: Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Pubmed, Scopus y Web of Science, utilizando las siguientes palabras clave: 'cluster training', 'rest Interval', 'rest pause', 'hypertrophy', 'resistance training' y 'cross sectional area'. Se incluyeron ensayos clínicos que utilizaron el entrenamiento cluster como intervención en personas mayores de 18 años de ambos sexos. Resultados: La revisión sistemática obtenida durante la búsqueda de las bases de datos consultadas arrojó un total de 23 artículos, potencialmente elegibles, de los cuales se tomó una muestra de 9, con los que se podían obtener resultados que respondían al objetivo de esta revisión. La cantidad de participantes de los 9 artículos elegibles fue de 172 sujetos. Los entrenamientos cluster permiten aumentar el volumen de entrenamiento y la intensidad sin provocar elevados niveles de fatiga, favoreciendo así el desarrollo de la hipertrofia muscular. Conclusiones: Los resultados de esta revisión sistemática sugieren que los entrenamientos cluster pueden ser una herramienta eficaz para el desarrollo de la hipertrofia muscular.

Abstract Objective: The aim of this systematic review was to determine the effects of cluster training on muscle hypertrophy. Methodology: A literature search was performed in the electronic databases Pubmed, Scopus and Web of Science, using the following keywords: 'cluster training', 'rest interval', 'rest pause', 'hypertrophy', 'resistance training' and 'cross sectional area'. We included clinical trials that used cluster training as an intervention in people over 18 years of age of both sexes. Results: The systematic review obtained during the search of the databases consulted yielded a total of 23 potentially eligible articles, of which a sample of 9 was taken from which results could be obtained that responded to the objective of this review. The number of participants from the 9 eligible articles was 172 subjects. Cluster workouts allow for increased training volume and intensity without causing high levels of fatigue, thus favoring the development of muscle hypertrophy. Conclusions: The results of this systematic review suggest that cluster training can be an effective tool for the development of muscle hypertrophy.

Resumo Objetivo: O objetivo desta revisão sistemática foi determinar os efeitos do treinamento em cluster na hipertrofia muscular. Metodologia: Realizou-se uma busca na literatura nas bases de dados eletrônicas Pubmed, Scopus e Web of Science, utilizando as seguintes palavras-chave: 'cluster training', 'rest interval', 'rest pause', 'hypertrophy', 'resistance training' e 'cross sectional area'. Foram incluídos ensaios clínicos que utilizaram o treinamento em cluster como intervenção em pessoas com mais de 18 anos de ambos os sexos. Resultados: A revisão sistemática realizada durante a busca nas bases de dados consultadas resultou em um total de 23 artigos potencialmente elegíveis, dos quais uma amostra de 9 foi selecionada para obter resultados que respondessem ao objetivo desta revisão. O número de participantes nos 9 artigos elegíveis foi de 172 indivíduos. Os treinos em cluster permitem um aumento no volume e na intensidade do treinamento sem causar altos níveis de fadiga, favorecendo assim o desenvolvimento da hipertrofia muscular. Conclusões: Os resultados desta revisão sistemática sugerem que o treinamento em cluster pode ser uma ferramenta eficaz para o desenvolvimento da hipertrofia muscular.

Herbicidas pós-emergentes para o controle do capim-pé-de-galinha (Eleusine indica L.) nos estádios de pré-perfilhamento e em perfilhamento

RESUMO Eleusine indica é uma planta daninha de difícil controle com herbicidas pós-emergentes devido ao curto intervalo entre a emergência e o perfilhamento, em que o controle é mais limitado. Ademais, o surgimento de biótipos resistentes motiva realizar trabalhos desta natureza para encontrar mais opções de controle químico. O objetivo desta investigação foi avaliar a eficiência de herbicidas pós-emergentes no controle do capim-pé-de-galinha em dois estádios fenológicos. O trabalho foi realizado em vasos a céu aberto num delineamento inteiramente casualizado, com onze herbicidas aplicados em dois experimentos: um experimento na espécie com quatro folhas (pré-perfilhamento) e outro na planta com oito folhas (em perfilhamento). Foram atribuídas notas visuais de controle aos 7, 14 e 21 dias após a aplicação, coletando a parte aérea da planta na última avaliação para obter a massa seca. Com esses dados foi realizada a análise de variância e a comparação de médias com o teste Tukey a um nível de significância de 0,05. Dos herbicidas testados, pyroxsulam, mesotrione y nicossulfuron controlaram menos do 80 % da população com quatro folhas. No perfilhamento, pyroxsulam, mesotrione, nicossulfuron y tembotrione mostraram controle menor ou igual a 65 %. Independentemente do estádio fenológico, clethodim, haloxifop, amônio-glufosinato, glyphosate, paraquat, indaziflam e ametrina foram efetivos, com mais de 88 % de controle da espécie.

ABSTRACT Eleusine indica is difficult to control with post-emergence herbicides due to the short interval between emergence and tillering, which control is more limited. Furthermore, the emergence of resistant biotypes motivates research on this type to find more options for chemical control. The objective of this work was to evaluate the efficiency of post-emergence herbicides in the goosegrass control in two phenological stages. The work was carried out in pots in a completely randomized design with eleven herbicides applied in two experiments: one with plants of four leaves (pre-tillering) and another with plants of eight leaves (in tillering). Visual control notes were assigned at 7, 14, and 21 days after application, collecting the aerial part of the plant in the last evaluation to obtain the dry weight. With these data, variance analysis and means comparison were performed using Tukey's test at a significance level of 0,05. As a principal result, pyroxsulam, mesotrione, and nicosulfuron controlled less than 80 % of the four-leaf population. At tillering, pyroxsulam, mesotrione, nicosulfuron, and tembotrione showed less than or equal to 65 % of control. Regardless of phenological stage, clethodim, haloxyfop, glufosinate ammonium, glyphosate, paraquat, indaziflam, and ametrine were effective, with more than 88 % of control of the species.

Saberes da contaminação bacteriana em panos de louça e os meios de descontaminação / Knowledge of bacterial contamination in dishcloths and means of decontamination

Panos de louça, também conhecidos como panos de prato, são comuns nas cozinhas domésticas, mas podem se tornar fontes de contaminação devido à umidade, favorecendo o desenvolvimento microbiano. O objetivo deste estudo foi avaliar a contaminação por Staphylococcus aureus, Coliformes e Salmonella spp. em panos de louça utilizados em cozinhas domésticas. Foram coletadas 30 amostras de panos de louça, e analisados para o cultivo e a identificação bacteriana, em meios de cultura específicos e realizada a análise do perfil de resistência aos Beta-Lactâmicos. Após isso foi feito o estudo de métodos para descontaminação dos panos de louça. Os resultados mostraram que os panos analisados estavam contaminados principalmente com bactérias da família Enterobacteriaceae, dos gêneros Enterobacter, Citrobacter e Klebsiella, além de Escherichia coli e uma amostra contaminada com Salmonella spp. O melhor meio de descontaminação dos panos de louça foi o Hipoclorito de Sódio à 0,1%. Independente da quantidade de dias de uso e atividades realizadas, faz-se necessária uma higienização correta dos panos de louça. Além de separar panos para cada utilização nas cozinhas.(AU)

Dish towels, also referred to as dishcloths, that have many uses in domestic kitchens, yet they can serve as reservoirs of contamination due to moisture, facilitating microbial proliferation. The aim of this study was to assess the presence of Staphylococcus aureus, coliforms, and Salmonella spp. in dishcloths utilized within domestic kitchens. A total of 30 dishcloth samples were collected and subjected to bacterial cultivation and identification using specific culture media, alongside an evaluation of the resistance profile to Beta-Lactams. Subsequently, methods for decontaminating dishcloths were investigated. Findings indicated that the analyzed cloths were primarily contaminated with bacteria belonging to the Enterobacteriaceae family, including genera such as Enterobacter, Citrobacter, and Klebsiella, in addition to Escherichia coli, and one sample was contaminated with Salmonella spp. The most effective means of decontaminating dishcloths was 0.1% Sodium Hypochlorite. Irrespective of the duration of use and activities performed, proper cleaning of dishcloths is imperative. Moreover, it is recommended to designate separate cloths for distinct kitchen tasks.(AU)

Characterization of vancomycin resistance mechanisms in Enterococcus faecium isolates from a Brazilian tertiary hospital / Caracterização dos mecanismos de resistência à vancomicina em isolados de Enterococcus faecium de um hospital terciário brasileiro / Caracterización de los mecanismos de resistencia a la vancomicina en aislamientos de Enterococcus faecium de un hospital terciario brasileño

Background and Objectives: Vancomycin-resistant Enterococcus faecium (VREf) is an opportunistic pathogen responsible for hospital infections, characterized by increasing prevalence and a lack of comprehensive epidemiological studies. We aimed to assess the occurrence of VREf and vancomycin resistance genetic elements vanA and vanB in strains isolated from clinical samples of patients treated at a tertiary hospital in Brazil. Methods: The isolates were obtained from convenience sampling according to routine medical requests for nine months. Enterococcus faecium strains were identified by routine biochemical tests, BD Phoenix® Automated Microbiology System and confirmed by MALDI-TOF Mass Spectrometry. The antimicrobial sensitivity profile was determined by disk-diffusion method and BD Phoenix® Automated Microbiology System. Vancomycin resistance was specially assessed and confirmed by the conventional microdilution technique. Molecular detection of vanA and vanB resistance genes was investigated by polymerase chain reaction (PCR) and confirmed by Sanger DNA sequencing. Results: A total of 8,376 cultures was performed, of which 19 (0.22%) were identified as Enterococcus sp. and nine (47%) as vancomycin-resistant E. faecium. The antimicrobial susceptibility testing analysis of E. faecium showed high resistance to antimicrobial agents. The analysis to determine the genetic profile of E. faecium isolates by PCR showed that all of them carried the vanA gene associated with vancomycin resistance. Conclusion: During the study period, there was low occurrence of Enterococcus species observed. However, all VREf isolates carried the vanA gene associated with vancomycin resistance and showed resistance to commonly used antimicrobial agents, highlighting concerns about the effectiveness of available antimicrobial treatments for infections caused by these isolates.(AU)

Justificativa e Objetivos: Enterococcus faecium resistente à vancomicina (VREf) é um patógeno oportunista responsável por infecções hospitalares, caracterizado por crescente prevalência e falta de estudos epidemiológicos abrangentes. O objetivo foi avaliar a ocorrência de VREf e dos elementos genéticos de resistência à vancomicina vanA e vanB em cepas isoladas de pacientes atendidos em um hospital terciário no Brasil. Métodos: Os isolados foram obtidos por amostragem de conveniência de acordo com as solicitações médicas de rotina durante nove meses. As cepas foram identificadas por testes bioquímicos, Sistema de Microbiologia Automatizada BD Phoenix®, e confirmadas por MALDI-TOF. O perfil de sensibilidade aos antimicrobianos foi determinado por difusão em disco e pelo BD Phoenix®. A resistência à vancomicina foi avaliada e confirmada pela técnica de microdiluição. A detecção molecular dos genes de resistência vanA e vanB foi investigada por reação em cadeia da polimerase (PCR) e sequenciamento de DNA. Resultados: Um total de 8.376 culturas foi realizado, sendo 19 (0.22%) identificadas como Enterococcus sp., e nove (47%), como Enterococcus faecium resistente à vancomicina. A análise do teste de sensibilidade aos antimicrobianos do E. faecium mostrou alta resistência aos antimicrobianos. A análise para determinar o perfil genético dos isolados de E. faecium por PCR mostrou que todos eles carregavam o gene vanA associado à resistência à vancomicina. Conclusão: Durante o período de estudo, observou-se baixa ocorrência de espécies de Enterococcus. No entanto, todos os isolados de VREf apresentaram o gene vanA associado à resistência à vancomicina e mostraram resistência aos antimicrobianos comumente utilizados, alertando sobre a eficácia dos tratamentos antimicrobianos disponíveis para infecções causadas por esses isolados.(AU)

Justificación y Objetivos: Enterococcus faecium resistente a vancomicina (VREf) es un patógeno oportunista responsable de infecciones hospitalarias, caracterizado por su creciente prevalencia y la falta de estudios epidemiológicos exhaustivos. El objetivo fue evaluar la ocurrencia de VREf y los elementos genéticos de resistencia a vancomicina vanA y vanB en cepas aisladas de muestras clínicas de pacientes tratados en un hospital terciario en Brasil. Métodos: Los aislamientos se obtuvieron mediante muestreo de conveniencia según las solicitudes médicas de rutina durante nueve meses. Las cepas fueron identificadas mediante pruebas bioquímicas, utilizando el BD Phoenix® y MALDI-TOF. El perfil de sensibilidad a los antimicrobianos se determinó mediante difusión en disco y el BD Phoenix®. La resistencia a vancomicina se evaluó mediante microdilución. La detección molecular de los genes de resistencia vanA y vanB se investigó mediante reacción en cadena de la polimerasa (PCR) y secuenciación de ADN. Resultados: Se realizaron un total de 8,376 cultivos, identificándose 19 (0.22%) como Enterococcus sp., de las cuales 9 (47%) fueron VREf. El análisis de la sensibilidad a los antimicrobianos mostró una alta resistencia. El análisis para determinar el perfil genético de los aislados de E. faecium mediante PCR mostró que todos portaban el gen vanA asociado a la resistencia a la vancomicina. Conclusión: Durante el período de estudio, se observó una baja incidencia de especies de Enterococcus. Sin embargo, todos los aislamientos de VREf presentaron el gen vanA asociado con resistencia a la vancomicina y mostraron resistencia a los antimicrobianos comúnmente utilizados, lo cual alerta sobre la eficacia de los tratamientos antimicrobianos disponibles para infecciones causadas por VREf.(AU)

Presencia de integrones y su correlación con la multirresistencia en Salmonella entérica serovar Typhimurium: revisión sistemática exploratoria / Presence of integrons and their correlation with multidrug resistance in Salmonella entérica serovar Typhimurium: Exploratory systematic review

La multirresistencia a los antibióticos en Salmonella entérica serovar Typhimurium (Typhimurium) se asocia con integrones que portan genes de resistencia y que son dispersados por elementos genéticos móviles. En esta revisión sistemática exploratoria, se buscó identificar los tipos de integrones y sus genes de resistencia en aislamientos de Typhimurium multirresistentes a antibióticos. Se realizó una búsqueda de artículos en Medline, PubMed, SciELO, ScienceDirect, Redalyc y Google Académico, publicados entre el 2012 y el 2020, en español o inglés, con las palabras claves: "integrons", "antibiotic resistance" y "Salmonella Typhimurium". En el análisis se incluyeron 38 artículos que reportaron multirresistencia a cinco familias de antibióticos. Los integrones de clase 1 con casetes de genes aadA2 y blaPSE-1 fueron los predominantes, algunos probablemente relacionados con la isla genómica de Salmonella 1. No se encontraron integrones de clase 1 y 2 en un mismo aislamiento, ni se reportaron integrones de clase 3. La presencia de integrones explica en gran medida los perfiles de resistencia encontrados en aislamientos de diferentes fuentes de 15 países.

In Salmonella enterica serovar Typhimurium (Typhimurium), multidrug resistance is associated with integrons carrying resistance genes dispersed by mobile genetic elements. This exploratory systematic review sought to identify integron types and their resistance genes in multidrug resistance Typhimurium isolates. We used Medline, PubMed, SciELO, ScienceDirect, Redalyc, and Google Scholar as motor searchers for articles in Spanish or English published between 2012 and 2020, including the keywords "integrons", "antibiotic resistance", and "Salmonella Typhimurium". We included 38 articles reporting multidrug resistance up to five antibiotic families. Class 1 integrons with aadA2 and blaPSE-1 gene cassettes were predominant, some probably related to the Salmonella genomic island 1. We did not find studies detailing class 1 and 2 integrons in the same isolate, nor class 3 integrons reported. The presence of integrons largely explains the resistance profiles found in isolates from different sources in 15 countries.

Resistencia a la Fractura de Premolares Según el Diseño de Cavidad de Acceso Endodóntico. Estudio in vitro

La preparación de la cavidad de acceso es el primer paso y un requisito esencial, para la instrumentación y obturación de los conductos radiculares durante el tratamiento endodóntico. El objetivo del presente estudio fue comparar la resistencia a la fractura in vitro de premolares con cavidad de acceso tradicional (CAT), cavidad de acceso conservador (CAC) y cavidad de acceso ultraconservador (CAU). Esta fue una investigación transversal, prospectiva y experimental pura. Se realizó con 40 segundos premolares superiores, divididos en 4 grupos. Todas las muestras fueron desinfectadas y almacenadas en recipientes con suero fisiológico al 0,9 %. Al primer grupo se designó como el control, al segundo grupo CAT, al tercer grupo CAC y al cuarto grupo CAU. Se realizaron todos los accesos endodónticos con una pieza de mano de alta velocidad con refrigeración respetando el protocolo de cada uno de los diseños, posterior a ello se realizó el tratamiento endodóntico y restauración de los especímenes. Una vez preparadas todas las muestras, estas fueron sometidas a una prueba de fatiga en una máquina de ensayo universal y los resultados se registraron en Newtons. La prueba estadística usada fue ANOVA con un nivel de significancia de 5 %. Las CAT obtuvieron el menor valor de resistencia a la fractura en comparación con el grupo control. Sin embargo, no se observaron diferencias estadísticamente significativas entre los grupos CAT, CAC Y CAU. Entre los grupos CAC y CAU, no se encontraron diferencias estadísticamente significativas en comparación con el grupo control.

The preparation of the access cavity is the first step and an essential requirement for the instrumentation and obturation of the root canals during endodontic treatment. The objective of the present study was to compare the in vitro fracture resistance of premolars with traditional access cavity (CAT), conservative access cavity (CAC) and ultraconservative access cavity (CAU). This was a cross-sectional, prospective and pure experimental research. It was carried out with 40 upper second premolars, divided into 4 groups. All samples were disinfected and stored in containers with 0.9 % physiological saline. The first group was designated as the control, the second group CAT, the third group CAC and the fourth group CAU. All endodontic accesses were carried out with a high-speed handpiece with refrigeration, respecting the protocol of each of the designs, after which the endodontic treatment and restoration of the specimens was carried out. Once all the samples were prepared, they were subjected to a fatigue test in a universal testing machine and the results were recorded in Newtons. The statistical test used was ANOVA with a significance level of 5 %. The CAT obtained the lowest fracture resistance value, presenting statistically significant differences with the control group. However, no statistically significant differences were observed between the CAT, CAC, and CAU groups. Furthermore, between the CAC and CAU groups, no statistically significant differences were found compared to the control group.

Screening of essential oils against oxacillin - resistant Staphylococcus aureus strains isolated from bovine mastitis / Screening de aceites esenciales frente a Staphylococcus aureus oxacilino - resistentes extraidos de aislados de mastitis bovina

Bovine mastitis is a disease wi th far - reaching consequences for the dairy industry. Staphylococcus aureus is a pathogen that is especially resistant to antibiotics. The objective of this study was to evaluate the antimicrobial activity of the essential oils Lippia citriodora (Lam.), Thy mus vulgaris (L), and a mixture of the essential oils Lippia citriodora and Thymus vulgaris (50/50 v/v), against isolates of oxacillin - resistant Staphylococcus aureus (n=15) of positive cases of bovine mastitis. For the statistical analysis, the IBM SPSS s tatistical package was used. The mixture of essential oils ( Lippia citriodora and Thymus vulgaris (50/50 v/v)) obtained the most significant antimicrobial activity in relation to pure essential oils. It is therefore concluded that the mixture of these oils boosts their antimicrobial activity ( p <0.05). The minimum inhibitory and bactericidal concentration of this mixture for the total isolations was 12 µL/L and 25 µL/mL, respectively.

La mastitis bovina es una enfermedad de gran impacto para la industria lechera. El Staphylococcus aureus es uno de los principales patógenos, especialmente aquellos resistentes a los antibióticos. El objetivo de este estudio fue evaluar la actividad antimicrobiana de los aceites esenciales de Lippia citriodora (Lam.), Thymus vulgaris (L), y una mezcla de aceites esenciales de Lippia citriodora y Thymus vulgaris (50/50 v/v), frente a aislamientos clínicos de Staph ylococcus aureus oxacilino - resistentes (n=15) de mastitis bovina. Se utilizó p rograma estadístico IBM SPSS y se concluyó la diferencia significativa a un p <0.05. La mezcla de aceites esenciales ( Lippia citriodora y Thymus vulgaris (50/50 v/v)), obtuvo la m ayor actividad antimicrobiana en relación a los aceites esenciales puros, se concluye que la mezcla de estos aceites potencia su actividad antimicrobiana ( p <0.019). La concentración mínima inhibitoria y bactericida de esta mezcla fue del 12 µL/mL y 25 µL/m L, respectivamente, y puede ser una alternativa terapéutica.