Antimicrobial resistance of Pseudomonas aeruginosa isolated from patients with pneumonia during the COVID-19 pandemic and pre-pandemic periods in Northeast Brazil

Healthcare-related infections caused by resistant microorganisms are a severe public health problem and are becoming increasingly prevalent in the hospital environment, especially Pseudomonas aeruginosa. This work aimed to evaluate the resistance profile of Pseudomonas aeruginosa to antimicrobials before the COVID-19 pandemic and during the pandemic period. Bacteria strains were obtained from tracheal aspiration, sputum, and bronchoalveolar lavage for diagnosis and phenotypic characterization. Matrix assisted laser-desorption ionization-time of flight mass spectrometry (MALD-TOF MS) was used to identify strains. Automated Phoenix and VITEK® 2 Compact system and the disc diffusion method were performed to determine the antimicrobial susceptibility profile. A total of 41,000 medical reports from adult patients with pneumonia were analyzed. Of these, 951 patients were positive for P. aeruginosa, of which 373 were related to the pre-pandemic period and 578 to the pandemic period. Older men (≥60 years) were more prevalent in both periods. P. aeruginosa strains were resistant to imipenem in both periods: 38.8 and 42.5%, respectively, followed by meropenem (34.2 and 39.2%), ciprofloxacin (33.6 and 36.7%), and levofloxacin (34.9 and 43.5%). Intensive care units had the highest percentage of affected patients (62 and 65%) compared with other sectors, with a prevalence of 71% in the public network before COVID-19 and 59% during the pandemic. Our data showed a prevalence of P. aeruginosa in elderly patients in both the pre-pandemic and pandemic periods. In addition, an increase in P. aeruginosa resistance to beta-lactams, quinolones, carbapenems, and cephalosporins was observed during the COVID-19 pandemic compared with the period before the pandemic, especially in ICUs.

Profiling of antioxidant potential and phytoconstituents of Plantago coronopus / Avaliação do potencial antioxidante e perfil fitoquímico do Plantago coronopus

Abstract The halophyte species Plantago coronopus has several described ethnomedicinal uses, but few reported biological activities. This work carried out for the first time a comparative analysis of P. coronopus organs in terms of phenolic composition and antioxidant activity of organic and water extracts from roots, leaves and flowers. The leaves contents in selected nutrients, namely amino acids and minerals, are also described. Roots (ethyl acetate and methanol extracts) had the highest radical scavenging activity (RSA) towards 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radicals, while leaves (hexane extract) had higher RSA on nitric oxide radical and iron chelating ability. High performance liquid chromatography (HPLC) analysis identified eighteen phenolics from which salicylic acid and epicatechin are here firstly described in Plantago species. Leaves had mineral levels similar to those of most vegetables, proving to be a good source for elements like calcium, sodium, iron and magnesium, and also for several of the essential amino acids justifying it use as food. Our results, especially those regarding the phenolics composition, can explain the main traditional uses given to this plantain and, altogether, emphasize the potential of P. coronopus as a source of bioactive molecules particularly useful for the prevention of oxidative stress-related diseases.

Resumo A espécie halófita Plantago coronopus tem vários usos etnomedicinais já descritos, mas em relação à bioatividade a informação é escassa. Este trabalho efetuou, pela primeira vez, uma análise comparativa dos órgãos de P. coronopus em termos de compostos fenólicos e atividade antioxidante de extratos orgânicos e aquosos provenientes das raízes, folhas e flores da planta, bem como o conteúdo de determinados nutrientes, aminoácidos e minerais, nas folhas da planta. As raízes (extratos de acetato de etila e metanol) apresentaram a maior atividade de captação para os radicais 1,1-difenil-2-picril hidrazil (DPPH) e 2,2'-azino-bis(3-etilbenzotiazolina-6-ácido sulfónico) (ABTS), enquanto as folhas (extrato de hexano) mostraram maior atividade captadora para o radical óxido nítrico bem como maior capacidade quelante do ferro. A análise por cromatografia liquida de alta eficiência (CLAE) identificou dezoito compostos fenólicos e, destes, o ácido salicílico e a epicatequina são aqui descritos pela primeira vez em espécies de Plantago. As folhas desta planta halófita mostraram ainda conter minerais em níveis semelhantes aos da maioria dos vegetais, provando ser uma boa fonte de elementos como o cálcio, sódio, ferro e magnésio, bem como de vários dos aminoácidos essenciais o que justifica seu uso na alimentação. Os resultados, particularmente aqueles relacionados à composição fenólica, podem justificar os principais usos medicinais atribuídos a esta espécie e, na sua totalidade, demonstram o potencial de P. coronopus como fonte de moléculas bioativas particularmente úteis na prevenção de doenças relacionadas com estresse oxidativo.

Assessment of antimicrobial activity in vitro of ethanolic extracts of Banisteriopsis anisandra (A. Juss. ) B. Gates (Malpighiaceae) / Avaliação da atividade antimicrobiana in vitro de extratos etanólicos de Banisteriopsis anisandra (A. Juss. ) B. Gates (Malpighiaceae)

The aim of this study was to evaluate the antimicrobial activity in vitro of ethanolic extracts of Banisteriopsis anisandra. Tests were performed using the extracts overlay method in the culture medium for phytopathogenic fungi Rhizoctonia solani and Fusarium oxysporum, and disk diffusion for the microorganisms Staphylococcus aureus and Candida albicans. Ethanolic extracts from leaves were prepared by maceration (extract I) and decoction (extract II) at 430.0, 215.0 and 107.5 mg/mL. The growth inhibition of R. solani and F. oxysporum was determined by calculating the mycelia growth speed rate (MGSR) and, in relation C. albicans and S. aureus, it was determined by measuring the inhibition halos. Extracts that caused significant inhibition were also tested at 86.0, 64.5, 43.0 and 21.5 mg/mL for C. albicans and S. aureus. Both extracts showed inhibitory activity on the microorganisms studied. Rizoctonia solani showed lower MGSR in the presence of extract II (107.5 mg/mL) and Fusarium oxysporum showed slight MGSR reduction in the presence of extract I (107.5 mg/mL) and II (107.5 and 215 mg/mL). Ethanolic extracts I and II inhibited the growth of C. albicans, with the highest rates of inhibition observed in the presence of extract II (215.0 mg/mL). For S. aureus, the highest inhibitory activity was observed in the presence of ethanolic extract II, prepared by decoction at 430.0 mg/mL. Results showed a promising antimicrobial activity of extracts of B. anisandra, which may contribute to further studies leading to a future development of medicines to treat human and plant diseases caused by these organisms.

O objetivo deste estudo foi avaliar a atividade antimicrobiana in vitro de extratos etanólicos de Banisteriopsis anisandra. Os testes foram realizados utilizando o método de sobreposição de extratos em meio de cultura para fungos fitopatogênicos Rhizoctonia solani e Fusarium oxysporum e de difusão em disco para os microrganismos Staphylococcus aureus e Candida albicans. Foram testados de extratos etanólicos de folhas preparados por maceração (extrato I) e decocção (extrato II), nas concentrações de 430,0; 215,0 e 107,5 mg/mL. A inibição do crescimento de R. solani e F. oxysporum foi determinada pelo cálculo do índice de velocidade de crescimento micelial (IVCM) e de C. albicans e S. aureus, por meio da medida da halos de inibição. Os extratos que causaram inibição significativa também foram testados nas concentrações de 86,0; 64,5; 43,0 e 21,5 mg/mL para C. albicans e S. aureus. Ambos os extratos mostraram atividade inibitória sobre os microrganismos estudados. Rizoctonia solani apresentou menor IVCM na presença do extrato II (107,5 mg/mL) e Fusarium oxysporum apresentou discreta redução no IVCM na presença do extrato I (107,5 mg/mL) e II (107,5 e 215 mg/mL). Extratos etanólicos I e II inibiram o crescimento de C. albicans, com as maiores taxas de inibição observadas na presença do extrato II (215,0 mg/mL). Para S. aureus a maior atividade inibitória foi observada na presença do extrato II, na concentração de 430 mg/mL. Os resultados mostraram promissora atividade antimicrobiana de extratos de B. anisandra, o que pode contribuir para estudos futuros visando o desenvolvimento de medicamentos para doenças humanas e de plantas causadas por estes microrganismos.

Evaluation of biofilm production by Pseudomonas Aeruginosa isolates recovered from cystic fibrosis and non-cystic fibrosis patients

Cystic fibrosis (CF) patients typically suffer of persistent and recurrent lung infections caused by Pseudomonas aeruginosa that many times possess ability for the biofilm production. Here, biofilm production among P. aeruginosa isolates recovered from sputum of CF and non-CF patients was evaluated. Most isolates were biofilm-producing independently of the patient's condition.

Alpinia zerumbet (Pers.) B. L. Burtt & R. M. Sm. (Zingiberaceae): levantamento de publicações nas áreas farmacológica e química para o período de 1987 a 2008 / Alpinia zerumbet (Pers.) B. L. Burtt & R. M. Sm. (Zingiberaceae): survey of publications in pharmacological and chemical areas from 1987 to 2008

Espécie muito encontrada no nordeste do Brasil, Alpinia zerumbet (Pers.) B. L. Burtt & R. M. Sm. é conhecida popularmente como colônia. Na medicina popular é utilizada como antihipertensiva, diurética e febrífuga. Alguns estudos com óleos essenciais mostram sua atividade antimicrobiana, hipotensiva e um leve efeito diurético. Visando contribuir para o maior conhecimento da espécie realizou-se uma revisão de publicações envolvendo estudos nas áreas farmacológica e química para o período de 1987 a 2008.

Normally found in the northeast of Brazil, Alpinia zerumbet (Pers.) B. L. Burtt. & R. M. Sm. is commonly known as "colônia". In folk medicine, it has been used as antihypertensive, diuretic and febrifuge. Some studies with essential oils have shown its antimicrobial and hypotensive activities, besides a slight diuretic effect. Aimed at improving the knowledge of such species, a survey of publications involving studies in pharmacological and chemical areas was conducted from 1987 to 2008.

Utilização do óleo de alho e da amoxilina, metronidazol e omeprazol no controle de Helicobacter spp. em cães / Use of garlic oil and amoxicillin, metronidazole, and omeprazol in the control of Helicobacter spp. in dogs

Avaliaram-se a eficácia do óleo de alho e da terapia tripla (amoxicilina, metronidazol e omeprazol) no tratamento de 21 cães infectados por Helicobacter spp., que apresentavam alterações histológicas nas biopsias endoscópicas da mucosa gástrica e reação positiva ao teste de urease. Os animais foram distribuídos, aleatoriamente, em três grupos de sete cães, os quais receberam os seguintes tratamentos: grupo 1 - cápsulas vazias; grupo 2 - 500mg de óleo de alho em cápsulas, diariamente, por um período de 30 dias; grupo 3 - amoxicilina, metronidazol e omeprazol, respectivamente, nas doses de 20mg/kg a cada 12 horas, 25mg/kg e 20mg/kg a cada 24 horas, durante 15 dias. Ao final dos tratamentos, os cães foram submetidos à endoscopia com realização de biopsias da mucosa gástrica. O tratamento com amoxicilina, metronidazol e omeprazol resultou em erradicação de Helicobacter spp. tanto na região fúndica quanto na pilórica. No grupo 2, houve redução da degeneração glandular na região fúndica em dois animais e em outros dois na pilórica. O tratamento com óleo de alho não foi eficaz em erradicar Helicobacter spp., apenas reduziu a sua colonização em quatro dos animais tratados.

The efficacy of garlic oil and triple therapy (amoxicillin, metronidazole, and omeprazol) were evaluated in the treatment of 21 dogs infected by Helicobacter spp., which presented histological alterations of the gastric mucosa according to endoscopic biopsies and positive reaction to urease test. The animals were randomly distributed into three groups of seven dogs each, and received the following treatment, group 1 - empty capsules; group 2 - 500mg of garlic oil capsules daily for a period of 30 days; and group 3 - amoxicillin, metronidazole, and omeprazol, in doses of 20mg/kg every 12 hours, 25mg/kg and 20mg/kg every 24 hours, respectively, for 15 days. By the end of the treatment, the dogs were subjected to new endoscopic procedure with gastric mucosa biopsies. Treatment with amoxicillin, metronidazole, and omeprazol resulted in eradication of Helicobacter spp. both in fundic and pyloric regions. The garlic oil treatment reduced glandular degeneration in the fundic region in two animals and in the pylorus region in two other animals, and it was inefficient in eradicating Helicobacter spp. in dogs as it only reduced the colonization in some of the treated animals.

Blood parasites, total plasma protein and packed cell volume of small wild mammals trapped in three mountain ranges of the Atlantic Forest in Southeastern Brazil

A study of blood parasites in small wild non-flying mammals was undertaken in three areas of the Atlantic Forest in Southeastern Brazil: Serra de Itatiaia, RJ, Serra da Bocaina, SP and Serra da Fartura, SP, from June 1999 to May 2001. A total of 450 animals (15 species) were captured in traps and it was observed in 15.5 percent of the blood smears the presence of Haemobartonella sp. and Babesia sp. in red blood cells. There was no statistically significant difference between parasited and non-parasited specimens regarding total plasma protein, packed cell volume and body weight, which strongly suggests that these specimens might be parasite reservoirs.

A presença de hemoparasitos em pequenos mamíferos silvestres não voadores foi pesquisada em animais de três áreas serranas do Sudeste brasileiro, pertencentes ao complexo da Serra do Mar e da Serra da Mantiqueira, nos Estados de São Paulo, Rio de Janeiro e Minas Gerais. Foram capturados 420 animais de 15 espécies, durante dois anos, dos quais, 15,5 por cento apresentaram Haemobartonella sp. e Babesia sp., observadas em lâmina de esfregaço sangüíneo no interior de suas hemácias. Os níveis de proteína total plasmática e de volume globular não apresentaram diferença estatisticamente significativa entre os indivíduos parasitados e não parasitados, assim como o peso corporal, o que sugere fortemente que esses animais possam ser reservatórios desses parasitos.

Endoscopia gastroduodenal após administração de nimesulida, monofenilbutazona e meloxicam em cães / Gastroduodenal endoscopy after nimesulide, monophenylbutazone and meloxicam administration in dogs

Avaliaram-se os aspectos da mucosa gastroduodenal em cães tratados experimentalmente com nimesulida, monofenilbutazona e meloxicam. Foram formados quatro grupos com oito cães. Os grupos 1, 2 e 3 receberam, respectivamente, tratamento com nimesulida, monofenilbutazona e meloxicam durante 21 dias, e o grupo 4 foi utilizado como controle. Todos os animais foram avaliados por exames endoscópicos do estômago e duodeno antes do experimento e aos 10 e 21 dias de tratamento. Os cães não manifestaram qualquer alteração clínica ou laboratorial durante o período de estudo. A avaliação endoscópica da mucosa gastroduodenal apresentou apenas lesões consideradas de baixo grau. Esses antiinflamatórios mostraram-se seguros para o trato gastrintestinal de cães clinicamente saudáveis

The gastroduodenal mucosa in dogs experimentally treated with nimesulide, monophenylbutazone and meloxicam was evaluated. There were four groups with eight dogs in each. Groups one, two and three were given nimesulide, monophenylbutazone and meloxicam, respectively, during 21 days and group four was used as control. All animals were evaluated by gastroduodenoscopy before the study and on the 10th and 21st days. The dogs did not show any clinical or laboratorial changes during the study. The endoscopic evaluation of gastroduodenal mucosa showed only low degree lesions. These anti-inflammatory drugs showed to be safe for the gastrointestinal tract in healthy dogs

Identification of Glomerella cingulata f. sp phaseoli recombinants by RAPD markers

We examined the capacity of strains of Glomerella cin-gulata f. sp phaseoli fungus (Colletotrichum lindemuthianum sexual stage) to form recombinants, using random amplified polymorphic DNA (RAPD). Crosses of all possible combinations between strains 40, 42, 20, 21, 22, 23, 24, 25, and 26 were made on Petri dishes using M3 culture medium. The 42 x 21 cross produced the largest number of perithecia and five asci; the respective ascospores were isolated. RAPD analysis was performed on the parents and descendants. The 62 polymorphic RAPD bands obtained were used to assess the genetic similarity using the method of Sorence and Dice and clustering analysis in the form of a dendrogram by the UPGMA method. The RAPD markers allowed identification of recombinants from the cross between strains 42 and 21 of G. cingulata f. sp phaseoli and 40 ascospores presented 63 and 49% genetic similarity with parents 2 (strain 42) and 1 (strain 21), respectively.

Occurrence of Haplometroides odhneri (Trematoda, Digenea, Plagiorchüdae) infecting Leptotyphlops koppesi (Serpentes, Leptotyphlopidae)

Descreveu-se a ocorrência de Haplometroides odhneri (Trematoda, Digenea, Plagiorchiidae) na traquéia e esôfago de Leptotyph1ops koppesi (Serpentes, Leptotyphlopidae) proveniente da Usina Hidrelétrica Corumbá I, município de Caldas Novas, Goiás. Este é o primeiro relato sobre a ocorrência de H. odhneri parasitando L. koppesi.

Epidemiologia do dengue em Salvador-Bahia, 1995-1999 / Epidemiology of dengue in Salvador-Bahia, 1995-1999

Since 1981, Brazil has registered dengue epidemic and simultaneous circulation of the DEN-1 and DEN-2 serotypes in over 2,700 municipalities. In Salvador- Bahia, located in the Northeastern region of the Country, two epidemic outbreaks occurred in the years of 1995 and 1996, with further endemic spread of the disease. This study analyses the incidence of the virosis within this municipal area, from 1995 to 1999, considering, among other variables, its distribution in the Sanitary Districts and density of Aedes aegypti. Registers of notified cases and the city's Vectorial Control Program were used as data source. The incidence rate of notified cases of dengue in 1995 and 1996, which were 691.4 and 393.5 per 100,000 inhabitants, respectively, decreased to 65 per 100,000 inhabitants in 1998. In the poorer Sanitary Districts, this index reached figures of over 800 per 100,000 inhabitants. The Premise Index for Aedes aegypti reached 54.1% in one of the Districts. Bearing in mind the relevance of the re-emergence of dengue in the world, the authors discuss the possible factors which condition the virus introduction, its epidemiological presentation over the course of four years, and the effectiveness of the vectorial combat (eradication) program.

Desde 1981, o Brasil tem registrado epidemias de dengue de grande magnitude e atualmente circulam simultaneamente dois sorotipos DEN-1 e DEN¾2, em mais de 2.700 municípios. Em Salvador - Bahia, situada na Região Nordeste do país, ocorreram duas epidemias nos anos de 1995 e 1996, e posterior endemização da doença. Este estudo analisa a incidência desta virose nesse município, no período de 1995 a 1999, considerando entre outras variáveis, sua distribuição nos Distritos Sanitários e a situação de densidade do Aedes aegypti. Utiliza como fonte de dados registros oficiais de notificação e do programa de combate vetorial da cidade. A taxa de incidência de dengue foi de 691,4 e 393,5 por 100.000 habitantes, respectivamente, em 1995 e 1996, reduziu-se para 65 por 100.000 em 1998. Nos Distritos Sanitários mais carentes, este indicador alcançou valores superiores a 800 por 100.000 habitantes. O Índice de Infestação Predial pelo Aedes chegou a atingir 54,1% em um dos seus bairros. Considerando a importância da reemergência do dengue no mundo os autores discutem os possíveis fatores que condicionaram a introdução do vírus, as suas apresentações epidemiológicas no curso de 4 anos, e a efetividade do programa de combate vetorial.

Monitoring human cytomegalovirus viral load in peripheral blood leukocytes of renal transplant recipients by a simple limiting dilution-PCR assay

To assess the clinical relevance of a semi-quantitative measurement of human cytomegalovirus (HCMV) DNA in renal transplant recipients within the typical clinical context of a developing country where virtually 100 per cent of both receptors and donors are seropositive for this virus, we have undertaken HCMV DNA quantification using a simple, semi-quantitative, limiting dilution polymerase chain reaction (PCR). We evaluated this assay prospectively in 52 renal transplant patients from whom a total of 495 serial blood samples were collected. The samples scored HCMV positive by qualitative PCR had the levels of HCMV DNA determined by end-point dilution-PCR. All patients were HCMV DNA positive during the monitoring period and a diagnosis of symptomatic infection was made for 4 of 52 patients. In symptomatic patients the geometric mean of the highest level of HCMV DNAemia was 152,000 copies per 106 leukocytes, while for the asymptomatic group this value was 12,050. Symptomatic patients showed high, protracted HCMV DNA levels, whereas asymptomatic patients demonstrated intermittent low or moderate levels. Using a cut-off value of 100,000 copies per 106 leukocytes, the limiting dilution assay had sensitivity of 100 per cent, specificity of 92 per cent, a positive predictive value of 43 per cent and a negative predictive value of 100 per cent for HCMV disease. In this patient group, there was universal HCMV infection but relatively infrequent symptomatic HCMV disease. The two patient groups were readily distinguished by monitoring with the limiting dilution assay, an extremely simple technology immediately applicable in any clinical laboratory with PCR capability.

Immunological properties of gene vaccines delivered by different routes

Gene vaccines represent a new and promising approach to control infectious diseases, inducing a protective immune response in the appropriate host. Several routes and methods of genetic immunization have been shown to induce antibody production as well as T helper (Th) cell and cytotoxic T lymphocyte activation. However, few studies have compared the nature of the immune responses generated by different gene vaccination delivery systems. In the present study we reviewed some aspects of immunity induced by gene immunization and compared the immune responses produced by intramuscular (im) DNA injection to gene gun-mediated DNA transfer into the skin of BALB/c mice. Using a reporter gene coding for ß-galactosidase, we have demonstrated that im injection raised a predominantly Th1 response with mostly IgG2a anti-ßgal produced, while gene gun immunization induced a mixed Th1/Th2 profile with a balanced production of IgG2a and IgG1 subclasses. Distinct types of immune responses were generated by different methods of gene delivery. These findings have important implications for genetic vaccine design. Firstly, a combination between these two systems may create optimal conditions for the induction of a broad-based immune response. Alternatively, a particular gene vaccine delivery method might be used according to the immune response required for host protection. Here, we describe the characteristics of the immune response induced by gene vaccination and the properties of DNA involved in this process

Avaliaçäo da imunidade cruzada entre Leptospira hardjo e L. Wolffi / Evaluation of cross-immunity between Leptospira hardjo and L. Wolffi

Avaliou-se a imunidade cruzada entre hardjo e wolffi, em quatro grupos de hamsters adultos e sadios. A proteçäo conferida pelas vacinas foi avaliada mediante pesquisa direta de leptospira (métodos de cultura de macerado de órgäos em meios de Fletcher e EMJH modificado e histopatologia com coloraçäo pela prata) e pesquisa indireta de leptospiras (avaliaçäo de sinais clínicos e estudo histopatológico de fígado, rins e pulmäo, pela coloraçäo hematoxilina-eosina dos cortes histológicos). O título sorológico dos hamsters foi avaliado pela microaglutinaçäo rápida em placas. Os resultados revelaram que a vacinaçäo dos hamsters tanto com hardjo quanto com wolffi conferiram imunidade ante o desafio com hardjo

Intratypic differentiation of polioviruses isolated from suspected cases of poliomyelitis in Brazil during the period of 1990 to 1993

This study analyzed 3129 fecal samples derived from 1626 patients with sudden onset acute flaccid paralysis clinically compatible with poliomyelitis. The samples were collected in the period ranging from January 1990 to September 1993 in all regions of Brazil. Among the 1626 cases studied, 196 had isolation of poliovirus. Nevertheless, it was observed that some factors influenced the isolation rate and the intratypic characterization of these polioviruses. No cases of acute flaccid paralysis has been found to be etiologically related with wild polioviruses.

Diferenças na medida da pressäo arterial em primeiras consultas pré e pós-implantaçäo do Programa Nacional de Controle da Hipertensäo / Differences in blood pressure measurement in first consultations pre and post implementation of the National Program of Hypertension Control

Considerando a implantaçäo do Programa Nacional de Educaçäo e Controle da Hipertensäo Arterial em Salvador, em 1990, e a disponibilidade de dados sobre a freqüência da medida da pressäo arterial em primeiras consultas de adultos para o ano de 1982, foram determinadas as diferenças entre estas medidas e as obtidas em 1991, pós-implantaçäo do programa. Os dados foram obtidos dos prontuário médicos dos pacientes adultos de diferentes modalidades assistenciais em censo parcial no dia 15/5/91. Dos 846 adultos atendidos, a PA foi medida em 29,1//, porém, em relaçäo aos mesmos serviços analisados em 1982, a freqüência de medidas atingiu 35,9//, resultando num incremento de 92,0// na freqüência, quando comparada aos 18,7// observados em 1982. Os serviços do Estado, vinculados ao Sistema Unico de Saúde (SUS), apresentaram o pior desempenho, com freqüências reduzidas em 10,7//, em relaçäo a 1982. Também os hospitais sem fins lucrativos, conveniados ao SUS, apresentram baixo desempenho. Pacientes com diagnósticos mal-definidos e os questionados sobre história prévia de hipertensäo arterial tiveram a PA medida em 85,4// e 83,3// dos casos, respectivamente. Os autores discutem a baixa freqüência das medidas pós-implantaçäo do programa e sugerem estratégias para reverter a situaçäo

The osmosedimentation effect: its application to chemical and biochemical separation

1. The fundamentals of the osmosedimentation effect are reviewed and its applications to chemical and biochemical separation problems are presented. 2. The osmosedimentation effect (solute sedimentation enhanced by osmotic and reverse-osmotic solvent mass spontaneously generated within a vertical dialysis cell) may be described by using standard treatment of non-equilibrium thermodynamics. 3. This allows many hitherto unfeasible or very difficult experiments to be performed: polymer and particle MW determination, under gravity or low-speed (1000-5000 rpm) centrifugation; dissolved protein concentration, by low-speed centrifugation; density gradient generation, at low centrifugation speeds; fast separation of line particles, particle concentration and fractionation, under gravity and low speed centrifugation. 4. Osmocentrifugation methods may be easily implemented in any laboratory, as their requirents are: the availability of standard centrifuges and rotors, inexpensive dialysis cells and cellulose acetate membranes, which can be prepared in the laboratory

Dez anos depois: o "projeto Creche" na residencia de pediatria. / 10 years later: the \"project Creche\" in residency of pediatrics

A autora descreve e comenta diferentes momentos do "Projeto Creche", uma das atividades do programa de Residencia do Departamento de Pediatria da Faculdade de Medicina da Universidade de Sao Paulo. O projeto existe ha dez anos e tem oferecido oportunidade de aprendizado em puericultura aplicada a coletividade, mediada pela instituicao (creche) e nao pelos adultos responsaveis (pais)

Reacao tuberculinica e vacina contra o sarampo. / Tuberculin reaction and vaccine against measles

Sao analisadas as publicacoes sobre a reacao tuberculinica e a vacina do sarampo e apresentados os resultados de uma investigacao a proposito de 20 criancas tuberculino-positivas, que nao haviam sido vacinadas com o BCG intradermico e que receberam a vacina contra o sarampo. Trinta dias apos, as criancas foram retestadas tendo sido comprovado em 65% dos casos diminuicao significativa da reacao de Mantoux. Em 35% dos casos poderia haver erro diagnostico de tuberculose por ser a reacao de Mantoux negativa ou duvidosa em que pese serem todas as criancas comprovadamente infectadas pelo bacilo de Koch