Recognition of Grasping Patterns Using Deep Learning for Human-Robot Collaboration.

Recent advances in the field of collaborative robotics aim to endow industrial robots with prediction and anticipation abilities. In many shared tasks, the robot's ability to accurately perceive and recognize the objects being manipulated by the human operator is crucial to make predictions about the operator's intentions. In this context, this paper proposes a novel learning-based framework to enable an assistive robot to recognize the object grasped by the human operator based on the pattern of the hand and finger joints. The framework combines the strengths of the commonly available software MediaPipe in detecting hand landmarks in an RGB image with a deep multi-class classifier that predicts the manipulated object from the extracted keypoints. This study focuses on the comparison between two deep architectures, a convolutional neural network and a transformer, in terms of prediction accuracy, precision, recall and F1-score. We test the performance of the recognition system on a new dataset collected with different users and in different sessions. The results demonstrate the effectiveness of the proposed methods, while providing valuable insights into the factors that limit the generalization ability of the models.

Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique.

The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.

Diagnosis, evolution, and treatment of a patient with pyomyositis / Diagnóstico, evolução e tratamento de paciente com piomiosite

Pyomyositis is a deep muscle infection of bacterial origin and subacute, which can evolve with multiple intramuscular abscesses. Despite being characterized as an affection of tropical zones, its incidence in temperate zones has been increasing due to immunosuppression factors, such as infection by the human immunodeficiency virus (HIV) and some types of immunosuppressive treatments. Even though it has been known for over a century, it is a rare and potentially serious condition that can lead to septic shock and death. This is a case report of a descriptive nature, which found the relevance of knowledge about this condition for an early diagnosis, enabling positive prognostic repercussions.

A piomiosite é uma infecção muscular profunda, de origem bacteriana e caráter subagudo, que pode evoluir com abcessos intramusculares múltiplos. Apesar de ser caracterizada como uma afecção de zonas tropicais, sua incidência em zonas temperadas vem aumentando por fatores de imunossupressão, como a infecção pelo vírus da imunodeficiência humana (HIV) e alguns tipos de tratamentos imunossupressivos. Mesmo sendo conhecida há mais de um século, é uma condição rara e potencialmente grave, podendo levar ao choque séptico e óbito. Trata-se de um relato de caso de caráter descritivo, que constatou a relevância do conhecimento desta afecção para um diagnóstico precoce, possibilitando repercussões prognósticas positivas.

Explaining the stickiness of supply chain relations in the Brazilian soybean trade.

The global trade of agricultural commodities has profound social-ecological impacts, from potentially increasing food availability and agricultural efficiency, to displacing local communities, and to incentivizing environmental destruction. Supply chain stickiness, understood as the stability in trading relationships between supply chain actors, moderates the impacts of agricultural commodity production and the possibilities for supply-chain interventions. However, what factors determine stickiness, that is, how and why farmers, traders, food processors, and consumer countries, develop and maintain trading relationships with specific producing regions, remains unclear. Here, we use data on the Brazilian soy supply chain, a mixed methods approach based on extensive actor-based fieldwork, and an explanatory regression model, to identify and explore the factors that influence stickiness between places of production and supply chain actors. We find four groups of factors to be important: economic incentives, institutional enablers and constraints, social and power dimensions, and biophysical and technological conditions. Among the factors we explore, surplus capacity in soy processing infrastructure, (i.e., crushing and storage facilities) is important in increasing stickiness, as is export-oriented production. Conversely, volatility in market demand expressed by farm-gate soy prices and lower land-tenure security are key factors reducing stickiness. Importantly, we uncover heterogeneity and context-specificity in the factors determining stickiness, suggesting tailored supply-chain interventions are beneficial. Understanding supply chain stickiness does not, in itself, provide silver-bullet solutions to stopping deforestation, but it is a crucial prerequisite to understanding the relationships between supply chain actors and producing regions, identifying entry points for supply chain sustainability interventions, assessing the effectiveness of such interventions, forecasting the restructuring of trade flows, and considering sourcing patterns of supply chain actors in territorial planning.

Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique / Endoscopic Mini or Less Open Sublay Repair (E/MILOS) na correção das hérnias ventrais: uma alternativa técnica minimamente invasiva

ABSTRACT The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.

RESUMO O tratamento cirúrgico ideal para correção das hérnias ventrais ainda é motivo de grande discussão1. O fechamento do defeito associado a utilização de telas para reforço da parede abdominal são passos fundamentais da terapia cirúrgica, podendo ser realizados tanto pela via aberta quanto pelas técnicas minimamente invasivas2. A via aberta apresenta maiores taxas de infecção de sítio cirúrgico, enquanto o reparo laparoscópico IPOM (intraperitoneal onlay mesh) acarreta um risco aumentado de lesões intestinais, aderências e obstruções intestinais, além de requerer uso de telas de dupla face e dispositivos de fixação que encarecem o procedimento e não raro aumentam a dor no pós-operatório3-5. A técnica eTEP (extended/enhanced view totally extraperitoneal), tem ganhado importância, mostrando-se uma boa opção para a correção das hérnias ventrais também2. A fim de se evitar as desvantagens das técnicas abertas e laparoscópicas "clássicas" o conceito MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair), desenvolvido por W. Reinpold et al. em 2009, 3 anos antes do advento do eTEP, possibilita ao cirurgião o uso de telas de grandes dimensões no plano retromuscular através de uma pequena incisão na pele e dissecção laparoscópica deste espaço, conforme modificação realizada em 2016, evitando a colocação de uma tela no espaço intraperitoneal6-7. Esta nova técnica passou a se chamar EMILOS (Endoscopic Mini or Less Open Sublay Repair)8 Este artigo tem como objetivo relatar nossa experiência inicial no emprego da técnica E-MILOS no Brasil, na Santa Casa de Misericórdia de São Paulo.

Polymyxin B Activity Rescue by (-)-Camphene-Based Thiosemicarbazide Against Carbapenem-Resistant Enterobacterales.

Due to the significant shortage of therapeutic options for carbapenem-resistant Enterobacterales (CRE) infections, new drugs or therapeutic combinations are urgently required. We show in this study that (-)-camphene-based thiosemicarbazide (TSC) may act synergistically with polymyxin B (PMB) against CRE, rescuing the activity of this antimicrobial. With the specific aim of a better molecular understanding of this effect caused by the presence of TSC, theoretical calculations were also performed in this study. Based on these findings, it is concluded that the presence of TSC moieties contributes to significant changes in the hydrogen atom charge of PMB structure, which trend more positives for the PMB/TSC system studied. This could lead to the formation of stronger hydrogen bonds in the Enterobacterales active site and, thus contribute to a molecular understanding of the PMB rescue of activity promoted by the presence of TSC moiety. As such, the clinical potential of these drug combinations requires further evaluation.

Robotic re-TAPP: a minimally invasive alternative for the failed posterior repair.

OBJECTIVE: to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. METHODS: patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. RESULTS: nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. CONCLUSIONS: on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.

Undetected αKlotho in serum is associated with the most aggressive phenotype of breast cancer.

Klotho, a cellular anti-senescence protein, is related to antitumor actions, growth regulation, proliferation and invasiveness in several types of tumor, including breast cancer. The present study aimed to analyze the serum levels of αKlotho in patients with breast cancer according to histopathological and immunohistochemical variables. A total of 74 patients and 60 healthy controls were recruited. Peripheral blood samples were collected and serum levels were assessed by sandwich ELISA. Clinical and diagnostic data were obtained from medical records and databases of the Clinical Hospital of the Federal University of Uberlândia (Uberlândia, Brazil). The results indicated no difference in the levels of αKlotho between patients and controls (P=0.068); however, the number of patients with breast cancer with undetectable αKlotho was high (n=52). Thus, the variables that were associated with the lowest survival rates were analyzed, relating them to undetectable αKlotho. Among cases of metastatic tumors or tumors with poor differentiation, positive lymph node status and triple-negative status, patients with undetectable αKlotho predominated and had unfavorable overall survival. Due to the significant results obtained in triple-negative patients, an in vitro analysis was performed to determine whether estrogen receptors (ERs) have a role in αKlotho production. Treatment of MCF-7 cells with ER agonists, estradiol (E2) and diarylpropionitrile (DPN), resulted in increases in αKlotho expression and supernatant levels of both agonists, demonstrating a direct association between the ER and Klotho production; of note, the ERß-specific agonist DPN tripled αKlotho expression when compared to E2 (P=0.078). These data suggested that undetectable αKlotho in the serum of patients with breast cancer is related to unfavorable histopathological variables and poor prognosis and ERs possibly have an important role in maintaining adequate quantities of αKlotho.

Robotic re-TAPP: a minimally invasive alternative for the failed posterior repair / re-TAPP robótico: uma alternativa minimamente invasiva para falha da via posterior

ABSTRACT Objective: to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. Methods: patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. Results: nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. Conclusions: on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.

RESUMO Objetivo: descrevemos nossa experiência com uso da plataforma robótica no tratamento das recidivas operadas previamente por laparoscopia, mantendo assim uma proposta minimamente invasiva a esses pacientes, apesar de haver uma predileção pela via anterior e aberta nestes casos. Métodos: foram incluídos pacientes submetidos a hernioplastia inguinal robótica transabdominal pré-peritoneal como tratamento de recidiva e que foram operados previamente por laparoscopia, entre dezembro de 2015 e setembro de 2020 e mantidos em uma base de dados ambulatorial prospectiva. Variáveis de interesse incluíram dados demográficos, características herniárias, detalhes operatórios, ocorrências do sítio cirúrgico em 30 dias (com ou sem necessidade de intervenção), infeção do sítio cirúrgico, tempo de seguimento e taxa de recidiva. Resultados: dezenove pacientes (95% masculino, média de idade de 55 anos, média de índice de massa corporal 28kg/m2) e 27 hérnias operadas (N=8 bilaterais). Média de tempo cirúrgico 168.9±49.3 min (variando 90-240). N=2 complicações intraoperatórias por lesão de vasos epigástricos inferiores. N=2 seromas e N=1 hematoma foram identificados no pós-operatório; N=1 paciente apresentou dor crônica pós operatória. Após um tempo de seguimento médio de 35.7 meses (intervalo entre quartis 13-49), nenhuma recidiva foi diagnosticada. Conclusões: o uso da plataforma robótica parece ser seguro e efetivo no tratamento das recidivas operadas previamente laparoscopia, nesse pequeno grupo de pacientes selecionados, apesar de requerer expertise em cirurgia robótica. Outros estudos com maiores casuísticas são necessários para estabelecer o papel desta técnica no cenário das hérnias inguinais recidivadas.

Emergency Care Gap in Brazil: Geographical Accessibility as a Proxy of Response Capacity to Tackle COVID-19.

Background: The new coronavirus disease (COVID-19) has claimed thousands of lives worldwide and disrupted the health system in many countries. As the national emergency care capacity is a crucial part of the COVID-19 response, we evaluated the Brazilian Health Care System response preparedness against the COVID-19 pandemic. Methods: A retrospective and ecological study was performed with data retrieved from the Brazilian Information Technology Department of the Public Health Care System. The numbers of intensive care (ICU) and hospital beds, general or intensivist physicians, nurses, nursing technicians, physiotherapists, and ventilators from each health region were extracted. Beds per health professionals and ventilators per population rates were assessed. A health service accessibility index was created using a two-step floating catchment area (2SFCA). A spatial analysis using Getis-Ord Gi* was performed to identify areas lacking access to high-complexity centers (HCC). Results: As of February 2020, Brazil had 35,682 ICU beds, 426,388 hospital beds, and 65,411 ventilators. In addition, 17,240 new ICU beds were created in June 2020. The South and Southeast regions have the highest rates of professionals and infrastructure to attend patients with COVID-19 compared with the northern region. The north region has the lowest accessibility to ICUs. Conclusions: The Brazilian Health Care System is unevenly distributed across the country. The inequitable distribution of health facilities, equipment, and human resources led to inadequate preparedness to manage the COVID-19 pandemic. In addition, the ineffectiveness of public measures of the municipal and federal administrations aggravated the pandemic in Brazil.

Reversal of unstable atrial fibrillation after surgical correction of hiatus hernia: A case report.

INTRODUCTION: The presence of Atrial Fibrillation (AF) with herniation of abdominal content through the esophageal hiatus can be explained by the compression of the cardiac tissue by the viscera and, consequently, of its electrical transmission network, compromising the correct propagation of stimuli. Due to the causal relationship, hernia correction is almost always able to reverse the arrhythmic picture. PRESENTATION OF THE CASE: A 75-year-old male with atrial fibrillation with a large hiatal hernia causing clinical decompensation was successfully treated after a laparocopic correction- primary closure of the defect was made with barbed surgical thread plus and placing a biological mesh (porcine small intestine submucosa, non-cross-linked), fixed with cyanoacrylate; after the procedure, he was discharged asymptomatic and with sinus heart rhythm. DISCUSSION: It is noticed that for cases in which the patient presents with a type IV hiatal hernia associated with atrial fibrillation, the laparoscopic correction of hernia using a mesh for the correction of the defect has good results in the literature. In the present case, it is noted that despite the severity of the condition denoted by hemodynamic instability and the need for electrical cardioversion, the surgical correction of the hiatal hernia was able to reverse the arrhythmic picture definitively. CONCLUSION: the concomitance of AF and hiatal hernia can explain the difficulty to control the arrhythmic picture and is necessary to consider, as soon as possible, the surgical correction of the defect as part of the treatment.

Evaluation of Wear Behaviour in Metallic Binders Employed in Diamond Tools for Cutting Stone.

A type of disc-on-plate test methodology was used to determine the wear behavior of metallic binders employed in the manufacturing of diamond impregnated tools. The disc consists of a special circular wheel that allows the binder materials alone (i.e., without diamond, but sintered under conditions identical to those of the complete tool) to be tested against a plate of stone material under pre-determined testing conditions. The testing conditions are intended to be equivalent to those used in the industrial processes. Using plates of five types of granite and one type of marble, this work comprises wear tests of 15 different types of metallic binders and two sintering modes conducted under, at least, three different values of contact-force. The analysis of the results demonstrated that the wear of the binders can be related to their mechanical properties through an empirical expression. The larger the difference between the characteristics of the tribological pair (binder versus stone), the higher is the correlation between the experimental wear data and the values given by the empirical expression. The relationships presented in this work allow predicting the wear behavior of the binder, and therefore may help in the design process of diamond tools. There was a clear difference between the wear behavior of metallic binders when they were employed against the two main classes of stone under analysis (marble and granite).

Autoimmune [auto-inflammatory] syndrome induced by adjuvants (ASIA): Case report after inguinal hernia repair with mesh.

INTRODUCTION: There has been a great advance in the treatment of inguinal hernias with a significant reduction in recurrences with the use of polypropylene mesh. Local complications such as infections, rejection, and chronic pain are widely studied and reported in the literature. The Autoimmune [Auto-inflammatory] Syndrome Induced by Adjuvants (ASIA) is little known and can be triggered by using polypropylene mesh. PRESENTATION OF THE CASE: 33-year-old female patient, married, and an administrative manager. History of smoking, previous breast surgery with silicone prosthesis, appendectomy. One year and four months ago, she underwent bilateral inguinal hernioplasty by laparoscopy. Shortly after the inguinal hernia surgery, systemic, urinary symptoms, and chronic local pain appeared. She reported low back pain, fatigue, memory loss, and mood swings associated with limiting pelvic pain, dysuria, and dyspareunia. We performed a robotic surgical procedure to remove the meshes bilaterally. Three days after surgery, the patient was discharged with adequate pain control, without the need for opioids. During outpatient follow-up, there was a significant improvement in symptoms, both local and systemic. DISCUSSION: Local complications with the use of polypropylene mesh to repair inguinal hernias are well described in the literature, highlighting chronic postoperative pain that can affect 10-20% of patients. Recently, polypropylene prostheses have been found to act as adjuvants and may be the trigger for an exacerbated immune response adaptive to an autoantigen. Thus, being capable of causing an autoimmune disease variant of the Autoimmune [Auto-inflammatory] Syndrome Induced by Adjuvants (ASIA), described by Shoenfeld and Agmon-Levin in 2011. CONCLUSION: In addition to local complications, systemic symptoms related to the use of polypropylene mesh can also occur. In the Autoimmune [Auto-inflammatory] Syndrome Induced by Adjuvants (ASIA), systemic symptoms, for being nonspecific, make diagnosis difficult and are often not attributed to the use of mesh.

Geographic access to COVID-19 healthcare in Brazil using a balanced float catchment area approach.

The rapid spread of COVID-19 across the world has raised concerns about the responsiveness of cities and healthcare systems during pandemics. Recent studies try to model how the number of COVID-19 infections will likely grow and impact the demand for hospitalization services at national and regional levels. However, less attention has been paid to the geographic access to COVID-19 healthcare services and to hospitals' response capacity at the local level, particularly in urban areas in the Global South. This paper shows how transport accessibility analysis can provide actionable information to help improve healthcare coverage and responsiveness. It analyzes accessibility to COVID-19 healthcare at high spatial resolution in the 20 largest cities of Brazil. Using network-distance metrics, we estimate the vulnerable population living in areas with poor access to healthcare facilities that could either screen or hospitalize COVID-19 patients. We then use a new balanced floating catchment area (BFCA) indicator to estimate spatial, income, and racial inequalities in access to hospitals with intensive care unit (ICU) beds and mechanical ventilators while taking into account congestion effects. Based on this analysis, we identify substantial social and spatial inequalities in access to health services during the pandemic. The availability of ICU equipment varies considerably between cities, and it is substantially lower among black and poor communities. The study maps territorial inequalities in healthcare access and reflects on different policy lessons that can be learned for other countries based on the Brazilian case.

Pancreatoduodenal Artery Aneurism rupture post colonoscopy - Case report.

INTRODUCTION: Complications related to colonoscopy is considered low and in most cases involves intestinal perforation. Vascular complications involving aneurysm rupture are rare in the literature and may occur after colonoscopy. PRESENTATION OF THE CASE: We report a case of a 58-year-old male patient that ruptured pancreatoduodenal artery aneurysm after colonoscopy, successfully submitted to endovascular treatment. DISCUSSION: Colonoscopy is frequently used as a diagnostic procedure. The risk of complication inherent to the procedure is considered low, and intestinal perforation is one of the most frequent. Other complications may present similar clinical symptoms, and it is necessary to complement the diagnostic investigation to offer the most appropriate treatment for the patient. Among the complications, there is one report of aneurysm rupture after performing colonoscopies and no case involving aneurysm rupture of pancreatoduodenal artery has been reported to date. CONCLUSION: A patient with ruptured pancreatoduodenal artery aneurysm is a rare entity that can be adequately treated with endovascular intervention. This is the first report of rupture related to colonoscopy.

Análise Microbiológica do Colostro em Lactantes de um Município de Minas Gerais/Brasil / Microbiological Analysis of Colostrum in Lactating Women in a Municipality of Minas Gerais/Brazil

Introdução: A cesárea é realizada em condições maternas e/ou fetais que impeçam o nascimento via vaginal. Devido ao risco de complicações infecciosas, o procedimento é precedido de antibioticoprofilaxia, o que pode provocar a seleção de cepas multirresistentes e alterar a flora nativa do indivíduo. O colostro é um fator determinante para a colonização do trato digestivo por ser fonte probiótica, além de apresentar papel importante na modulação do sistema imunológico e desenvolvimento do neonato. Objetivo: Este estudo visa avaliar possíveis interferências da antibioticoprofilaxia realizada previamente à cesárea na flora materna. Métodos: Selecionou-se 140 lactantes após aplicação dos critérios de exclusão, divididas em grupos estudo (realizaram parto cesáreo com antibioticoprofilaxia) e controle (realizaram parto vaginal sem antibioticoprofilaxia) para coleta das amostras ­ colostro e esfregaço areolar ­ com intuito de realizar a análise microbiológica das mesmas no Laboratório de Microbiologia da Faculdade de Medicina de Barbacena. Resultados: 94 lactantes pertencem ao grupo estudo e 46 ao controle. O microrganismo mais prevalente em todas as amostras foi a Candida sp. Ao se discriminar os grupos, a mesma também apresentou maior prevalência, seguida de Enterococcus sp. Em relação à detecção de Staphylococcus aureus pelo esfregaço mamilar, ele foi encontrado em 24 amostras do grupo controle e em 34 do grupo estudo. Na análise comparativa da prevalência de microrganismos entre os grupos, não se observou diferença estatisticamente relevante. Conclusão: A antibioticoprofilaxia peri-operatória mostrou-se segura em não alterar a composição da flora materna. Entretanto, mais estudos sobre o tema devem ser realizados.

Introduction: The C-section is performed under maternal and / or fetal conditions that prevent vaginal birth. Because of the infectious complications, the procedure is preceded by antibiotic prophylaxis, which can cause the selection of multidrug-resistant strains and shift the individual's native flora. Colostrum is a determining factor for colonization of the digestive tract being a probiotic source, along with playing an important role in the modulation of the immune system and development of the newborn. Objective: This study aims to assess possible interferences of antibiotic prophylaxis performed prior to cesarean section on maternal flora. Methods: 140 lactating women were selected after applying the exclusion criteria, divided into study groups (94 lactating women who underwent cesarean delivery with antibiotic prophylaxis) and control groups (46 lactating women who underwent vaginal delivery without antibiotic prophylaxis) for sample collection - colostrum and areolar swab - therefore perform the microbiological analysis at the Laboratório de Microbiologia da Faculdade de Medicina de Barbacena. Results: The most prevalent microorganism in all samples was Candida sp. Discriminating the groups, it also had the highest prevalence, followed by Enterococcus sp. Regarding the detection of Staphylococcus aureus by the areolar swab, it was found in 24 samples from the control group and 34 from the study group. In the comparative analysis of prevalence of microorganisms, between the groups, there was no statistically significant difference. Conclusion: Perioperative antibiotic prophylaxis proved to be safe not changing the composition of the maternal flora. However, further studies on the subject should be carried out.

(-)-Camphene-based derivatives as potential antibacterial agents against Staphylococcus aureus and Enterococcus spp.

Aim: To evaluate the activity of (-)-camphene-based thiosemicarbazide (TSC) and 4-hydroxy-thiosemicarbazone (4-OH-TSZ), alone and in combination against Gram-positive. Material & methods: MIC were determined for Staphylococcus aureus, Enterococcus spp. reference strains and clinical isolates. Drug combination, time-kill and cytotoxicity assays were also performed. Results: TSC and 4-OH-TSZ demonstrated potent inhibitory activity against S. aureus and Enterococcus spp., including multidrug-resistant isolates (MIC ranging from 1.9 to 31.2 µg/ml), and were bactericidal for the reference strains of both Gram-positive tested. The derivatives proved to be selective for the bacteria and synergistic with oxacillin and vancomycin. Conclusion: (-)-Camphene-based derivatives can represent promising drug candidates against critical pathogens, such as S. aureus and Enterococcus spp., including MRSA and vancomycin resistance Enterococcus spp. isolates.

COVID-19 and Cytomegalovirus Co-infection: A Challenging Case of a Critically Ill Patient with Gastrointestinal Symptoms.

COVID-19 is a severe disease that has reached pandemic status. To the best of our knowledge, we describe the first case of COVID-19 and cytomegalovirus (CMV) co-infection in a critically ill patient. We discuss the challenge of establishing the diagnosis as well as the management of tissue-invasive gastrointestinal CMV infection (TI-GI CMV) simulating vascular involvement and intestinal obstruction in a critically ill patient. LEARNING POINTS: We describe a case of COVID-19 and cytomegalovirus (CMV) co-infection in a critically ill patient.Clinical symptoms simulated mesenteric vascular involvement and intestinal obstruction.The successful management of invasive CMV colitis in a patient with COVID-19 with atypical symptoms is described.

Synthesis and biological evaluation of 12 novel (-)-camphene-based 1,3,4-thiadiazoles against Mycobacterium tuberculosis.

Aim: To evaluate the activity, cytotoxicity and efflux pumps inhibition of a series of 12 novels (-)-camphene-based 1,3,4-thiadiazoles (TDZs) against Mycobacterium tuberculosis (Mtb). Materials & methods: The minimum inhibitory concentration (MIC), cytotoxicity for three cell lines, ethidium bromide accumulation and checkerboard methods were carried out. Results: Compounds (6a, 6b, 6c, 6g, 6h and 6j) showed significant anti-Mtb activity (MIC 3.9-7.8 µg/ml) and no antagonism with anti-TB drugs already used in the TB treatment. Selectivity index (SI) was also determined, with values reaching 42.9 for H37Rv strain and 97.1 for clinical isolate. Five compounds also showed bacterial efflux pumps inhibition and one showed modulator effect with three drugs. Conclusion: These six TDZs should be considered as new scaffolds to develop anti-TB drugs.

Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach.

OBJECTIVE: The objective of this study was to better understand how the lack of emergency child and obstetric care can be related to maternal and neonatal mortality levels. METHODS: We performed spatiotemporal geospatial analyses using data from Brazilian municipalities. An emergency service accessibility index was derived using the two-step floating catchment area (2SFCA) for 951 hospitals. Mortality data from 2000 to 2015 was used to characterize space-time trends. The data was overlapped using a spatial clusters analysis to identify regions with lack of emergency access and high mortality trends. RESULTS: From 2000 to 2015 Brazil the overall neonatal mortality rate varied from 11,42 to 11,71 by 1000 live births. The maternal mortality presented a slightly decrease from 2,98 to 2,88 by 100 thousand inhabitants. For neonatal mortality the Northeast and North regions presented the highest percentage of up trending. For maternal mortality the North region exhibited the higher volume of up trending. The accessibility index obtained highlighted large portions of the rural areas of the country without any coverage of obstetric or neonatal beds. CONCLUSIONS: The analyses highlighted regions with problems of mortality and access to maternal and newborn emergency services. This sequence of steps can be applied to other low and medium income countries as health situation analysis tool. SIGNIFICANCE STATEMENT: Low and middle income countries have greater disparities in access to emergency child and obstetric care. There is a lack of approaches capable to support analysis considering a spatiotemporal perspective for emergency care. Studies using Geographic Information System analysis for maternal and child care, are increasing in frequency. This approach can identify emergency child and obstetric care saturated or deprived regions. The sequence of steps designed here can help researchers, and policy makers to better design strategies aiming to improve emergency child and obstetric care.