Can habits and behaviors predict colonization by community-associated MRSA in patients admitted to a Brazilian hospital?

ABSTRACT This study aimed to identify factors associated with colonization by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in adult patients admitted to a Brazilian hospital. This is a cross-sectional study, in which patients underwent a nasal swab and were asked about hygiene behavior, habits, and clinical history. Among the 702 patients, 180 (25.6%) had S. aureus and 21 (2.9%) MRSA. The factors associated with MRSA colonization were attending a gym (OR 4.71; 95% CI; 1.42 - 15.06), smoking habit in the last year (OR 2.37; 95% CI; 0.88 - 6.38), previous hospitalization (OR 2.18; CI 95%; 0.89 - 5.25), and shared personal hygiene items (OR 1.99; 95% CI; 0.71 - 5.55). At the time of admission, colonization by CA-MRSA isolates was higher than that found in the general population. This can be an important public health problem, already endemic in hospitals, whose factors such as those associated with habits (smoking cigarettes) and behaviors (team sports practice and activities in gyms) have been strongly highlighted. These findings may help developing infection control policies, allowing targeting patients on higher-risk populations for MRSA colonization.

Report of a Mental Health Intervention in the Covid-19 Pandemic through the Internet / Relato de uma intervenção em Saúde Mental na Pandemia de Covid-19: intervenção em Saúde Mental baseada na internet / Informe sobre una Intervención de Salud Mental en la Pandemia de Covid-19 Basada en la Internet

This article aims to report the experience of conducting a mental health intervention against Covid-19 using the Internet to discuss issues about psychosocial factors arising from the pandemic. The intervention was directed to health professionals working in the Intensive Care Unit of a University Hospital. The proposal involved 113 employees, including coordinators, physicians, physiotherapists, nurses, nursing technicians, multiprofessional residents, technical level professionals and outsourced employees who perform administrative functions and in cleaning. Videos, posters, and texts were used to work on themes that go through the impacts of the new coronavirus pandemic. The intervention made it possible to access a different and empowering way to face the Covid-19 outbreak period.

Este artigo tem como objetivo relatar a experiência da condução de uma intervenção em saúde mental frente a Covid-19 utilizando a internet para discutir temáticas sobre os fatores psicossociais decorrentes da pandemia. A intervenção foi direcionada aos profissionais de saúde lotados na Unidade de Terapia Intensiva de um Hospital Universitário. Participaram da proposta 113 colaboradores, entre eles, coordenadores, médicos, fisioterapeutas, enfermeiros, técnicos de enfermagem, residentes multiprofissionais, profissionais de nível técnico e colaboradores terceirizados que exercem funções administrativas e na higienização. Foram utilizados vídeos, cartazes e textos para trabalhar temas que atravessam os impactos da pandemia do novo coronavírus. A realização da intervenção possibilitou o acesso a uma forma diferente e potencializadora de enfrentar o período de surto da Covid-19.

Este artículo tiene como objetivo informar de las experiencias en la realización de una capacitación en salud mental ante el COVID-19 utilizando la internet para discutir temas sobre los factores psicosociales resultantes de la pandemia. La intervención fue dirigido a profesionales de la salud asignados a la Unidad de Cuidados Intensivos de un Hospital Universitario. Participaron en la propuesta 113 profesionales, incluidos coordinadores, médicos, fisioterapeutas, enfermeras, técnicos de enfermería, residentes multiprofesionales, profesionales de nivel técnico y empleados externos que ejercen la función administrativas y de higienización. Se utilizaron videos, carteles y textos para trabajar en temas que atraviesan los impactos de la pandemia de COVID-19. La realización de la propuesta permitió el acceso a una forma distinta y poderosa de enfrentar el período de brote del nuevo coronavirus.

Infant Mortality: An Analysis of Avoidable Deaths in a Municipality in the Northeast of Brazil, 2008 to 2016

Introduction: The plan “Every Newborn: an action plan to end preventable deaths” developed by the World Health Organization and the United Nations Children’s Fund has the goal of ending preventable child deaths. Objective: Analyze infant mortality rates in the municipality of Sobral, Ceará, between 2008 and 2016. Methods: This was an observational, cross-sectional study to analyze and compare mortality rates in a middle-sized municipality. This study was made up of all infant deaths less than 1 year of age registered in the Mortality Information System. The deaths were revised and classified as preventable, ill-defined causes and other causes according to the List of Preventable Deaths through Interventions from the Unified Health System. Results: During the study period, the mortality rate varied between 8.36 and 18.93 per 1000 live births, with most infant deaths occurred during the early neonatal period (<7 days of life). Furthermore, most infant deaths were classified as preventable, between 60.0 and 78.3%. Most of the deaths were classified as preventable through adequate assistance to women during pregnancy; adequate assistance during labor; or adequate assistance to the newborn. Conclusion: It was concluded that most of the deaths on infants under 1 year of age in the municipality were preventable with adequate assistance to women during pregnancy; adequate assistance during labor; or adequate assistance to the newborn. The approach used in this study may assist in the development of health plans and programs directed to the health of women during pregnancy and to the newborn.

Daptomycin and vancomycin non-susceptible methicillin-resistant Staphylococcus aureus clonal lineages from bloodstream infection in a Brazilian teaching hospital

ABSTRACT Introduction: This study aimed to characterize Staphylococcus aureus isolates from bloodstream infections in patients attending a teaching hospital, between 2011 and 2015. Methods: The minimum inhibitory concentration for daptomycin, linezolid, oxacillin, teicoplanin, vancomycin, and trimethoprim/sulfamethoxazole was accessed by broth microdilution. SCCmec type and clonal profile were determined by molecular tests. Vancomycin heteroresistance was evaluated using screening tests and by population analysis profile/area under the curve. Results: Among 200 S. aureus isolates, 55 (27.5%) were MRSA, carrying SCCmec II (45.5%) or IV (54.5%). The most frequent MRSA lineages were USA100 (ST5-II) (45.5%) and USA800 (ST5-IV) (30.9%). Six isolates were confirmed as vancomycin heteroresistant, showing area under the curve ratio 1.1, 1.2 or 1.3 (four USA100, one USA800 and one USA1100 isolates). Conclusions: Daptomycin and vancomycin non-susceptible MRSA clonal lineages were found in bloodstream infections over five years, highlighting the importance of continuous surveillance of multiresistant bacteria in hospitals.

Methicillin-resistant Staphylococcus aureus isolated from an intensive care unit in Minas Gerais, Brazil, over a six-year period

ABSTRACT To characterize methicillin-resistant Staphylococcus aureus isolates from an intensive care unit of a tertiary-care teaching hospital, between 2005 and 2010. A total of 45 isolates were recovered from patients admitted to the intensive care unit in the study period. Resistance rates higher than 80% were found for clindamycin (100%), erythromycin (100%), levofloxacin (100%), azithromycin (97.7%), rifampin (88.8%), and gentamycin (86.6%). The SCCmec typing revealed that the isolates harbored the types III (66.7%), II (17.8%), IV (4.4%), and I (2.2%). Four (8.9%) isolates carried non-typeable cassettes. Most (66.7%) of the isolates were related to the Brazilian endemic clone from CC8/SCCmec III, which was prevalent (89.3%) between 2005 and 2007, while the USA100/CC5/SCCmec II lineage emerged in 2007 and was more frequent in the last few years. The study showed high rates of antimicrobial resistance among methicillin-resistant S. aureus isolates and the replacement of Brazilian clone, a well-established hospital lineage, by the USA100 in the late 2000s, at the intensive care unit under study.

Mechanisms of the beneficial effect of sevoflurane in liver ischemia/reperfusion injury

PURPOSE: To evaluate the underlying mechanisms by which sevoflurane protects the liver against ischemia/reperfusion injury evaluate the mechanism by which sevoflurane exerts this protective effect. METHODS: Twenty-six rats were subjected to partial ischemia/reperfusion injury for 1h: one group received no treatment, one group received sevoflurane, and sham group of animals received laparotomy only. Four hours after reperfusion, levels of alanine and aspartate aminotransferases, tumor necrosis factor-a, and interleukins 6 and 10 were measured. Analyses of mitochondrial oxidation and phosphorylation, malondialdehyde content, histology, and pulmonary vascular permeability were performed. RESULTS: Serum levels of alanine and aspartate aminotransferases were significantly lower in the sevoflurane group compared to untreated controls (p<0.05). The sevoflurane group also showed preservation of liver mitochondrial function compared to untreated controls (p<0.05). Sevoflurane administration did not alter increases in serum levels of tumor necrosis factor-a, and interleukins 6 and 10. Sevoflurane treatment significantly reduced the coagulative necrosis induced by ischemia/reperfusion (p<0.05). Pulmonary vascular permeability was preserved in the sevoflurane group compared to untreated controls. CONCLUSION: Sevoflurane administration protects the liver against ischemia/reperfusion injury, via preservation of mitochondrial function, and also preserves lung vascular permeability.

Methicillin-resistant Staphylococcus aureus in HIV patients: Risk factors associated with colonization and/or infection and methods for characterization of isolates - a systematic review

Staphylococcus aureus is an important cause of infections and HIV-infected individuals are frequently susceptible to this pathogen. The aim of this study was to perform a systematic review to identify both the risk factors associated with colonization/infection by methicillin-resistant S. aureus in HIV patients and the methods used for characterization of isolates. An electronic search of articles published between January 2001 and December 2013 was first conducted. Among 116 studies categorized as being at a quality level of A, B or C, only 9 studies were considered to have high methodological quality (level A). The majority of these studies were retrospective (4/9 studies). The risk factors associated with colonization/infection by S. aureus were use of antimicrobials (4/9 studies), previous hospitalization (4/9 studies) and low CD4+ T lymphocyte counts (<200 cells/μl) (3/9 studies). Culture in mannitol salt agar (3/9 studies) and the latex agglutination test (5/9 studies) were the main methods used for bacterial phenotypic identification. Genotypic profiles were accessed by pulsed-field gel electrophoresis (6/9 studies) and USA300 was the most prevalent lineage (5/9 studies). Most isolates were resistant to erythromycin (3/9 studies) and susceptible to vancomycin (4/9 studies). Ultimately, use of antimicrobials and previous hospitalization were the main risk factors for colonization/infection by methicillin-resistant S. aureus in HIV-infected individuals. However, the numbers of evaluated patients, the exclusion and inclusion criteria and the characterization of the S. aureus isolates were not uniform, which made it difficult to establish the characteristics associated with HIV patients who are colonized/infected by S. aureus.

Genotypic study documents divergence in the pathogenesis of bloodstream infection related central venous catheters in neonates

OBJECTIVE: To investigate the pathogenesis of bloodstream infection by Staphylococcus epidermidis, using the molecular epidemiology, in high-risk neonates. METHODS: We conducted a prospective study of a cohort of neonates with bloodstream infection using central venous catheters for more than 24 h. "National Healthcare Safety Network" surveillance was conducted. Genotyping was performed by DNA fingerprinting and mecA genes and icaAD were detected by multiplex-PCR. RESULTS: From April 2006 to April 2008, the incidence of bloodstream infection and central venous catheter-associated bloodstream infection was 15.1 and 13.0/1000 catheter days, respectively, with S. epidermidis accounting for 42.9% of episodes. Molecular analysis was used to document the similarity among six isolates of bloodstream infection by S. epidermidis from cases with positive blood and central venous catheter tip cultures. Fifty percent of neonates had bloodstream infection not identified as definite or probable central venous catheter-related bloodstream infection. Only one case was considered as definite central venous catheter-related bloodstream infection and was extraluminally acquired; the remaining were considered probable central venous catheter-related bloodstream infections, with one probable extraluminally and another probable intraluminally acquired bloodstream infection. Additionally, among mecA+ and icaAD+ samples, one clone (A) was predominant (80%). A polyclonal profile was found among sensitive samples that were not carriers of the icaAD gene. CONCLUSIONS: The majority of infections caused by S. epidermidis in neonates had an unknown origin, although 33.3% appeared to have been acquired intraluminally and extraluminally. We observed a polyclonal profile between sensitive samples and a prevalent clone (A) between resistant samples. .

The testis of the mice C57/BL6 offspring in adulthood have alterations due to maternal caffeine consumption

To investigate the effects of the maternal caffeine consumption during pregnancy to adult male testis mice offspring. METHODS: Twenty pregnant mice were divided into control group (c) and caffeine group (cf). dams received daily saline or 20 mg/kg of caffeine subcutaneously. Male offspring were monitored daily until 13th week. The testis were used to evaluate both the proliferation (pcna) and apoptosis (bax); leptin receptor (ob-r); aromatase; follicle stimulating hormone (fshr), luteinizing hormone (lhr) and androgen receptors (ar); steroidogenic acute regulatory protein (star); vascular endothelial growth factor (vegf) and estrogen receptors (erα and erβ) by western blotting. Serum concentrations of testosterone, estradiol and leptin were measured. RESULTS: There was a significant reduction in food intake and the body mass gain (p<0.05) in the cf ; pcna (p=0.01), fshr (p=0.02), star (p=0.0007), vegf (p=0.009), ar (p=0.03) in the cf. while an increase were note in bax (p=0.01), ob-r (p=0.02), lhr (p=0.04) and in the aromatase (p=0.03) in the cf. only erα and erβ were not changed by maternal caffeine. The serum testosterone levels in the cf offspring were 90% lower than in the c offspring (p=0.04). CONCLUSION: Maternal caffeine consumption has a role and alters the testis of the offspring in adulthood.

Identification of Enterococcus faecalis by PCR in saliva of pediatric patients / Identificação do Enterococcus faecalis por PCR em saliva de pacientes pediátricos

This study aimed to identify E. faecalis in saliva of patients that were divided into two groups: 10 patients with caries lesions and 10 caries-free patients. Material and methods: Saliva samples were collected with a sterile swab and inoculated in enterococcosel media for 48 hours. The positive samples were subcultured in broth agar - blood medium for storage and subsequent PCR analysis. The data were analyzed using the SPSS (÷2). Results: From the 20 cases included in the study, 3 were positive in the Enterococcosel medium, and both tests (culture and PCR) used confirmed that three of them belonged to the species E. faecalis. No samples were positive in Enterococcosel broth in the group of caries-free patients. From the three samples that were identified as Enterococcus in broth (positive bile esculin test), an amplified for E. faecalis PCR analysis (p > 0.005). Conclusion: Through the use of PCR, it was possible to identify the genus Enterococcus and the species E. faecalis in saliva of patients with carious lesions – the pathogen that may influence the prognosis of diseases of the oral cavity...

Este estudo objetivou identificar E. faecalis em saliva de pacientes que foram divididos em dois grupos: 10 pacientes com lesões de cárie e 10 livres de cárie. Material e métodos: Amostras de saliva foram coletadas com um swab estéril e inoculadas em meios Enterococcosel por 48 horas. As amostras positivas foram repicadas em meio de caldo de agar - sangue para armazenamento e análise de PCR subsequente. Os dados foram analisados utilizando o SPSS. Resultados: Dos 20 casos incluídos no estudo, três foram positivos no médio Enterococcosel e ambos os testes (cultura e PCR) utilizados confirmaram que três deles pertenciam à espécie E. faecalis. Nenhuma amostra foi positiva em caldo Enterococcosel no grupo de pacientes livres de cáries. A partir das três amostras que foram identificadas como Enterococcus em caldo (teste positivo esculina biliar), foram amplificados por análise de PCR para o E. faecalis (p>0.005). Conclusão: Através da utilização de PCR, foi possível identificar gênero Enterococcus e a espécie de E. faecalis em saliva de pacientes com lesões de cárie – o agente patogênico que pode influenciar o prognóstico de doenças da cavidade oral...

Tetracycline and trimethoprim/sulfamethoxazole at clinical laboratory: Can they help to characterize Staphylococcus aureus carrying different SCCmec types?

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) can be difficult to detect at the clinical practice. METHODS: We analyzed 140 MRSA isolates from inpatients to correlate the antimicrobial susceptibility with the SCCmec types. RESULTS: Type III (n = 63) isolates were more resistant to ciprofloxacin, clindamycin, cloramphenicol, erythromycin, gentamicin, and rifampin than type IV (n = 65) ones (p < 0.05). Moreover, type IV isolates were susceptible to tetracycline (100%) and trimethoprim/sulfamethoxazole (98%), while type III isolates presented resistance to them. CONCLUSIONS: In regions where these SCCmec types are prevalent, the detection of specific resistant phenotypes could help to predict them, mainly when there are no technical conditions to SCCmec typing.

Administração de cafeína durante a gestação altera parâmetros testiculares na prole de camundongos C57/BL6 na vida adulta / The testis of the mice C57/BL6 offspring in adulthood have alterations due to maternal caffeine consumption

Metabólitos ativos da cafeína apresentam toxicidade, podendo causar efeitos deletérios em muitos órgãos no período fetal pelo consumo materno. O estudo objetivou avaliar o papel da administração de cafeína durante a gestação em vários parâmetros importantes para a função testicular em camundongos adultos C57BL/6. Fêmeas grávidas foram divididas em: grupo controle (C), que receberam injeções de sol. salina (0,9% NaCl) e grupo cafeína (CF), que receberam diariamente injeções subcutâneas de 20 mg / kg de cafeína. Filhotes tiveram livre acesso à ração padrão desde o desmame até três meses de idade, quando foram mortos. O grupo CF apresentou uma redução no consumo alimentar (C = 4,36 ± 0,14; CF = 3,79 ± 0,05/g, p<0,05) e ganho de massa corporal (C = 25,73 ± 0,14; CF = 21,08 ± 0,41/g, p=0,0001). Ainda este grupo, apresentou alterações estruturais nos testículos da prole, como redução no peso relativo (C = 0,078 ± 0,003; CF = 0,063 ± 0,002/g, p=0,002), diâmetro tubular (C = 455,4 ± 2,7; CF = 393,5 ± 3,1/µm, p=0,0001), lume tubular (C = 310,6 ± 2,5; CF = 254,8 ± 2,9/µm², p=0.0001) e altura do epitélio seminífero (C = 144,8 ± 0,9; CF = 138,7 ± 1,3/µm, p=0,0005) observados pela técnica de morfometria. Testosterona sérica avaliada por quimioluminescência foi reduzida (C = 6,6 ± 2,8; CF = 0,5 ± 0,2/ng/ml, p=0.04). Western Blotting foi utilizado para análise de expressão protéica...

Active metabolites of caffeine present toxicity, may cause deleterious effects on many organs in the fetal period by maternal consumption. This study aimed to evaluate the role of caffeine administration during pregnancy on several parameters of adult male testis in C57BL/6 mice. Pregnant C57BL/6 female mice were divided into two groups (n = 10): Control group (C), dams were injected with the vehicle only (saline 0.9 % NaCl); Caffeine group (CF), dams received daily a subcutaneous injection of 20 mg/kg of caffeine/day (1 mg/mL saline). Pups had free access to standard chow since weaning to 3 months of age, when they were killed. Treatment of dams with caffeine did not produce any visible signs of maternal toxicity. At adulthood CF group presented a reduction in the food consumption (C = 4.36 ± 0.14, CF = 3.79 ± 0.05/g, p<0.05) and body weight gain (C = 25.73 ± 0.14, CF = 21.08 ± 0.41/ g, p=0.0001). Several alterations were seen in testis structure sighted by morphometry: testicular weight (C = 0.078 ± 0.003, CF = 0.063 ± 0.002/g, p=0.002), tubular diameter (C = 455.4 ± 2.7, CF = 393.5 ± 3.1/µm, p=0.0001), tubular lumen (C = 310.6 ± 2.5, CF = 254.8 ± 2.9/µm², p=0.0001) and epithelial height (C = 144.8 ± 0.9; CF = 138.7 ± 1.3/µm, p=0.0005). Chemioluminesense was performed to evaluate testosterone serum levels, which was decreased (C = 6.6 ± 2.8, CF = 0.5 ± 0.2/ng/ml, p=0.04). Western blotting showed an increase in the protein expression of leptin’s receptor...

Mielopatia sinalizando o diagnóstico tardio da infecçãopor HtlV: um relato de caso / Myelopathy signaling the late diagnosis of HIV infection: a case report

A infecção pelo vírus T-linfotrópico humano (HTLV) caracteriza-se como uma doença sexualmente transmissível (DST), que pode também ser adquirida pelas vias parenteral e vertical. Subdivide-se em dois tipos: o HTLV-I, relacionado com doenças como mielopatia associada a HTLV/paraparesia espástica tropical (HAM/TSP) e a leucemia/linfoma de células T do adulto (ATL). Já o HTLV-II ainda não foi correlacionado cientificamente com nenhuma patologia na atualidade. Seu diagnóstico é realizado pela triagem sorológica para a detecção de anticorpo anti-HTLV-I/II, sendo o exame confirmatório o western blot. Neste contexto, o objetivo do presente estudo foi descrever um relato de caso em que a mielopatia foi a manifestação clínica sinalizadora da infecção pelo HTLV, em consequência do diagnóstico tardio da infecção por este patógeno, na qual a paciente apresentou os sintomas, progrediu lentamente e recebeu o diagnóstico apenas no último estágio da patologia (HAM/TSP), quando se tornou cadeirante. Embora a paciente realize na atualidade a terapêutica proposta e o acompanhamento ambulatorial segundo o protocolo estabelecido para o manejo desta infecção viral, membros de sua família também foram avaliados e diagnosticados e apenas um se apresentou positivo para a infecção. Este estudo visa demonstrar a importância do rastreio laboratorial para a infecção pelo HTLV, na mesma dimensão do diagnóstico da sífilis e do HIV, de modo que o mesmo não ocorra de forma tardia, quando associado a suas manifestações clínicas nos pacientes ou a infecções oportunistas relacionadas.

The human T-lymphotropic virus (HTLV) is characterized as a sexually transmitted disease (STD), it can also be transmitted by parenteral and vertical routes. It is subdivided into two types: the HTLV-I related diseases such as myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATL). HTLV-II has not been scientifically correlated with pathology yet. This diagnosis is made by serological screening for detection of HTLV antibody, and the western blot confirmatory test. In this context, the objective of this study was to describe a case in which myelopathy was signaling to the clinical manifestation of HTLV, as a result of delayed diagnosis of infection by this pathogen in which the patient had symptoms progressed slowly and received diagnosis only in the last stage of pathology (HAM/TSP), becoming a wheelchair user. Although nowadays the patient performs the therapeutic proposed and outpatient treatment according to the established protocol for the management of this viral infection, members of her family were also diagnosed and only one had a positive diagnosis of infection. This study aims to demonstrate the importance of laboratory screening for HTLV infection, in the same dimension of the diagnosis of syphilis and HIV, so that it does not occur so late, when it is associated to clinical manifestations in patients or related opportunistic infections

Modelo experimental de choque hemorrágico não controlado em porcos / Experimental model of non-controlled hemorrhagic shock in pigs / Modelo experimental de choque hemorrágico no controlado en cerdos

JUSTIFICATIVA E OBJETIVOS: Uma compreensão melhor das alterações fisiopatológicas associadas ao trauma e ao choque hemorrágico pode ajudar no desenvolvimento de terapêuticas capazes de reduzir a mortalidade relacionada ao trauma. O objetivo deste estudo é descrever um modelo de choque hemorrágico não controlado em porcos. MÉTODOS: Como medicação pré-anestésica, os animais receberam cetamina e midazolan. A anestesia foi induzida com propofol e a intubação traqueal foi realizada na vigência de respiração espontânea. Após a intubação, realizou-se bloqueio neuromuscular. Os animais foram mantidos em respiração mecânica controlada e normocapnia. A anestesia foi mantida com propofol e fentanil, de acordo com a necessidade. Solução de soro fisiológico 0,9 por cento foi infundida em todo o período de preparação. MONITORAÇÃO: Foram utilizados cardioscópio, oxímetro de pulso, medida de pressão arterial invasiva, cateter volumétrico de artéria pulmonar e medida de débito urinário por cistostomia. Modelo experimental: após registro inicial de variáveis hemodinâmicas, metabólicas e de coagulação, realizaram-se incisão subcostal direita e biópsia hepática do lobo esquerdo. A infusão de anestésicos foi reduzida, enquanto a de solução de salina isotônica interrompida. Uma incisão de 12 cm de extensão por 2 cm de profundidade foi feita no lobo hepático direito, seguida de divulsão digital do ferimento. Durante a fase de hemorragia, uma sonda de aspiração foi posicionada junto ao ferimento e o volume de sangue aspirado foi registrado. Quando a pressão arterial média chegou a 40 mmHg e o sangramento foi superior a 700 mL, pôde ser iniciada a fase de intervenção de acordo com o tipo de estudo. CONCLUSÃO: É importante continuar o desenvolvimento de modelos experimentais com o objetivo final de reduzir a alta mortalidade e os custos associados ao trauma.

BACKGROUND AND OBJECTIVES: A better understanding of pathophysiologic changes associated to trauma and hemorrhagic shock can help the development of therapies capable of reducing trauma-related mortality. The objective of this study was to describe a model of non-controlled hemorrhagic shock in pigs. METHODS: Animals received ketamine and midazolam as pre-anesthetic medications. Anesthesia was induced with propofol, and tracheal intubation was performed with the animals on spontaneous ventilation. After intubation neuromuscular blockade was performed. Animals were maintained in controlled mechanical ventilation and normocapnia. Anesthesia was maintained with propofol and fentanyl as needed. Saline was infused during the entire preparation period. MONITORING: Cardioscope, pulse oximeter, invasive blood pressure, volumetric catheter in the pulmonary artery, and urine output by cystostomy were used. Experimental model: after the initial recording of hemodynamic, metabolic, and coagulation variables, right subcostal incision and left lobe liver biopsy were performed. Anesthetic infusion was reduced while the infusion of saline was interrupted. An incision 12 cm long 2 cm deep was performed in the right liver lobe followed by digital divulsion of the wound. During the hemorrhagic phase, an aspiration probe was placed close to the wound and the volume of aspirated blood was recorded. When mean arterial pressure reached 40 mmHg and bleeding was above 700 mL the intervention phase was initiated according to the type of study. CONCLUSION: The development of experimental models to reduce high mortality and costs related to trauma is important.

JUSTIFICATIVA Y OBJETIVOS: Una comprensión mejor de las alteraciones fisiopatológicas asociadas al trauma y al choque hemorrágico, puede ayudar en el desarrollo de las terapéuticas capaces de reducir la mortalidad relacionada con el trauma. El objetivo de este estudio es describir un modelo de choque hemorrágico no controlado en cerdos. MÉTODOS: Como medicación preanestésica, los animales recibieron cetamina y midazolan. La anestesia fue inducida con propofol, y la intubación traqueal fue realizada con la respiración espontánea. Después de la intubación, se realizó el bloqueo neuromuscular. Los animales se mantuvieron bajo respiración mecánica controlada y normocapnia. La anestesia se mantuvo con propofol y fentanil, a tono con la necesidad. Una solución de suero fisiológico al 0,9 por ciento fue infundida durante todo el período de la preparación. MONITOREO: Se usaron el cardioscopio, oxímetro de pulso, medida de presión arterial invasiva, catéter volumétrico de arteria pulmonar y medida de débito urinario por cistostomía. Modelo experimental: después del registro inicial de las variables hemodinámicas, metabólicas y de coagulación, se realizaron la incisión subcostal derecha y la biopsia hepática del lóbulo izquierdo. La infusión de anestésicos fue reducida, mientras que la solución de salina isotónica se interrumpió. Una incisión de 12 cm de extensión por 2 cm de profundidad se hizo en el lóbulo hepático derecho, seguida de una divulsión digital de la herida. Durante la fase de hemorragia, una sonda de aspiración fue posicionada junto a la herida, y el volumen de sangre aspirado fue registrado. Cuando la presión arterial promedio llegó a 40 mmHg y el sangramiento fue superior a 700 mL, pudo iniciarse la fase de intervención de acuerdo con el tipo de estudio. CONCLUSIÓN: Es importante continuar desarrollando modelos experimentales con el objetivo final de reducir la alta mortalidad y los costes asociados al trauma.

Recurrent herpes simplex infections: laser therapy as a potential tool for long-term successful treatment / Herpes simplex recorrente: laser terapia como método alternativo para tratamento a longo prazo

Herpes simplex virus types 1 and 2 are the main infectious agents associated with oral and genital ulcerations. These infections are now widely recognized as sexually transmitted diseases. Among treatment options, low-level laser therapy (LLLT) has shown promising clinical results as a longer-lasting suppression therapy. Two clinical cases are described with recurrent labial herpes for which LLLT was used. Following treatment, both patients remained symptom free during the 17-month clinical follow-up period.

Os vírus do herpes simplex tipos 1 e 2 são os principais agentes infecciosos associados às ulcerações orais e vaginais. Estas infecções são amplamente reconhecidas como doenças sexualmente transmissíveis. Entre as opções de tratamento, o laser de baixa intensidade (LBI) mostrou resultados promissores como terapia de supressão de longa duração. Descrevemos dois casos clínicos com herpes labial recorrentes nos quais o LBI foi utilizado que permaneceram assintomáticos durante 17 meses de controle clínico.

Accuracy of phenotypic methicillin susceptibility methods in the detection of Staphylococcus aureus isolates carrying different SCCmec types

A total of 138 isolates, 118 methicillin-resistant Staphylococcus aureus (MRSA) isolates (staphylococcal cassette chromosome type II, 20 isolates, type III, 39 isolates and type IV, 59 isolates) and 20 methicillin-sensitive S. aureus isolates were evaluated by phenotypic methods: cefoxitin and oxacillin disk diffusion (DD), agar dilution (AD), latex agglutination (LA), oxacillin agar screening (OAS) and chromogenic agar detection. All methods showed 100 percent specificity, but only the DD tests presented 100 percent sensitivity. The sensitivity of the other tests ranged from 82.2 percent (OAS)-98.3 percent (AD). The LA test showed the second lowest sensitivity (86.4 percent). The DD test showed high accuracy in the detection of MRSA isolates, but there was low precision in the detection of type IV isolates by the other tests, indicating that the genotypic characteristics of the isolates should be considered.

Liver transplantation for acute liver failure: a 5 years experience / Transplante hepático na hepatite fulminante: uma experiência de 5 anos

BACKGROUND: Fulminant hepatic failure carries a high morbidity and mortality. Liver transplantation has markedly improved the prognosis of patients with fulminant hepatic failure. AIM: To evaluate the outcome of 20 patients with acute liver failure and indication for liver transplantation. METHODS: A retrospective review of 20 patients with acute liver failure and indication for liver transplantation was performed. Patients were divided into two groups: group A with 12 patients who underwent liver transplantation and group B with 8 patients who did not receive liver transplantation. Both groups were analyzed according to age, sex, ABO blood type, etiology of acute liver failure, time on list until transplantation or death, and survival rates. Group A patients were additionally analyzed according to preoperative INR, AST, and ALT peak values and MELD (Model for End-stage Liver Disease) scores; intraoperative red blood cells and plasma transfusion and cold ischemia time; postoperative lenght of intensive care unit and hospital stay, and needed for dialysis. RESULTS: Group A: there were four men and eight women with an average age of 24.6 years. The average liver waiting time period was 3.4 days and MELD score 36. Seven patients are alive with good hepatic function at a medium follow-up of 26.2 months. The actuarial survival rate was 65.2 percent at 1 year. Group B: There were two men and six women with an average age of 30.9 years. The mean waiting time on list until death was 7.4 days. All patients died while waiting for a liver donor. CONCLUSION: Despite the improvements in intensive care management, most patients with acute liver failure and indication for liver transplantation ca not survive long without transplant. Liver transplantation is potentially the only curative modality and has markedly improved the prognosis of those patients.

RACIONAL: OBJETIVO: Avaliar a evolução de 20 pacientes com insuficiência hepática aguda e indicação de transplante hepático. MÉTODOS: Foi realizado estudo retrospectivo de 20 pacientes com insuficiência hepática aguda e indicação de transplante hepático. Os pacientes foram divididos em dois grupos: grupo A com 12 pacientes que foram submetidos a transplante hepático e grupo B com oito pacientes não submetidos a transplante hepático. Ambos os grupos foram analisados de acordo com idade, sexo, tipagem sangüínea, etiologia da insuficiência hepática aguda, tempo em lista até o transplante ou até o óbito e sobrevida. Os pacientes do grupo A foram ainda analisados de acordo com o escore MELD (Model for End-stage Liver Disease), valores de pico pré-operatório de INR, AST e ALT, necessidade de transfusão de concentrado de hemácias e plasma fresco congelado durante o transplante, tempo de isquemia fria, tempo de permanência hospitalar e em unidade de terapia intensiva e necessidade de diálise no pós-transplante imediato. RESULTADOS: Grupo A: o tempo médio de espera em lista até o transplante foi de 3,4 dias e o MELD médio, de 36. Sete pacientes continuam vivos com boa função hepática em um tempo médio de seguimento de 26,2 meses. A sobrevida atuarial em 1 ano foi de 65,2 por cento. Grupo B: foram estudados dois homens e seis mulheres com média de idade de 30,9 anos. O tempo médio de espera em lista até o óbito foi de 7,4 dias. Todos os pacientes foram a óbito esperando por um doador. CONCLUSÃO: Mesmo com todos os avanços nos cuidados de terapia intensiva, a maioria dos pacientes com insuficiência hepática aguda e indicação de transplante hepático não sobrevivem por muito tempo sem o transplante. O transplante hepático é potencialmente a única terapêutica curativa atualmente disponível e melhorou consideravelmente o prognóstico desses pacientes.

Linfangioma cístico abdominal gigante em criança: relato de caso / Gigantic abdominal cystic lymphangioma in a child: a case report

Objetivo: Descrever o caso raro de uma criança do sexo masculino, de nove meses de idade, com linfangioma cístico abdominal gigante, e fazer breve revisão da literatura sobre o tema. Descrição: Lactente de nove meses, com aumento progressivo do volume abdominal havia três meses. Ao exame físico, havia sinais de anemia e presença de grande massa palpável no abdome. Ultra-sonografia abdominal evidenciou grande lesão cística com septações finas. O paciente foi tratado cirurgicamente, com boa evolução. Comentários: O linfangioma cístico abdominal é uma patologia rara na infância. Sua etiologia permanece desconhecida. O aumento do volume abdominal com presença de massa visível ou palpável ocorre em 25-73% dos casos. A resseção cirúrgica é o tratamento de escolha e o prognóstico é, em geral, bom...

Evolução inesperada em um paciente com cirrose hepática, ascite refratária e peritonite bacteriana espontânea de repetição / Unexpected evolution in a patient with liver cirrhosis, refractory acite, and repeated spontaneous bacterial peritonitis

Introdução: A combinação de cirrose hepática, ascite refratária e peritonite bacteriana espontânea (PBE) de repetição tem prognostico ruim e alta mortalidade. O transplante hepático é a única terapeutica atualmente disponível para esses pacientes. O objetivo é decrever uma evolução inesperada, com sobrevida em longo prazo sem transplante hepático, em um paciente com cirrose alcoólica, ascite refratária e PBE de repetição. Descrição: Paciente masculinoa, 44 anos, com cirrose alcoólica, ascite refratária e PEB de repetição. Apresentava MELD 22 e CHILD c12. Nos 18 mese anteriores, havia sido internado 10 vezes devido principalmente a PBE e encefalopatia e havia realizado 56 paracenteses de alívio. Após um mês em lista de espera, o paciente foi admitdio para transplante. Entretanto, durante o procedimento não foi possível abordar a topografia hepatica, devido a multiplas aderências ao redor do fígado. Diante da impossibilidade técnica realizou-se apenas limpeza ampla da cavidade abdominal. Inesperadamente, mais de 50 meses após a tentativa do transplante, o paciente continua vivo, com MELD 17 e CHILD B8 atuais. Discussão: O transplante hepático talvez seja a única terapêutica curativa atualmente disponível em pacientes com cirrose avançada, PBE de repetição e ascite refratária. Contudo, este relato mostra uma evolução inesperada em um paciente com essas co-morbidades que, mesmo sem transplante, evolui bem, com sobreida em longo prazo.