Hospital bronchoscopy-related pseudo-outbreak caused by a circulating Mycobacterium abscessus subsp. massiliense.

Adolfo Lutz Institute in Sao Paolo State performs mycobacterial identification for many healthcare units, and in 2008 identified a possible outbreak involving patients submitted to bronchoscopy at the same hospital. This study aimed to analyse the clonality of isolates. Mycobacterium abscessus subsp. massiliense isolated from 28 patients, water from one bronchoscope and water from four automated endoscope reprocessing machines presented high similarity by pulsed-field gel electrophoresis. This strain was not found in the water supply, and it was hypothesized that an infected patient contaminated the bronchoscope, with further false-positive cultures from subsequent patients.

Dietary fatty acids modulation of human colon cancer cells: mechanisms and future perspectives.

Colorectal cancer (CRC) is one of the most common malignancies worldwide and its pathogenesis is proven to be related with dietary patterns, namely dietary fatty acid (FA) intake. We reviewed the evidences regarding the effect of different dietary FAs on human CRC cell lines proliferation and apoptosis. Altogether, the results obtained from in vitro studies show that monounsaturated FAs lack evidence regarding both proliferation and apoptosis, whereas there is a consensus about the anti-proliferative and pro-apoptotic effects, involving different intracellular targets, of n-3 polyunsaturated FAs, while n-6 series show a similar effect or no effects. The response to these dietary components depends on the cell type as well as the amount and duration of exposure. These results highlight the importance of identifying molecular targets for dietary components aiming to interfere with one of the main risk factors related with CRC incidence and prevalence.

Dissolved organic nitrogen (DON) during batch denitrification of low concentrations of nitrate using suspended and attached biomass.

The occurrence and removal of dissolved organic nitrogen (DON) is an issue of increasing importance for the reclamation of treated wastewater. Effluent DON may act as a precursor of disinfection by-products during wastewater disinfection and may contribute to eutrophication of receiving surface waters. The aim of this study was to understand the effect of the post-denitrification process on final effluent DON (organic nitrogen filtered by 0.45 µm pore size) concentration to further gain knowledge on how to optimize denitrifying filtration, in order to reach the required discharge standards. To evaluate DON variation, denitrification batch experiments were carried out with suspended and attached biomass under different shear conditions. For both conditions, with suspended and attached biomass, DON concentration did not increase or decrease during the denitrification process with addition of an external carbon source. Moreover, the increase of shear rate did not affect the DON concentration. Apparently, there is no direct link between DON evolution and the denitrification process itself.

Biologia floral e sistema reprodutivo da erva-baleeira (Varronia curassavica Jacq. ) / Flowering phenology and reproductive system of the Cordia (Varronia curassavica Jacq. )

RESUMOO conhecimento do sistema reprodutivo é fundamental para a conservação e manejo de uma espécie. O objetivo deste trabalho foi descrever a fenologia da floração, a antese, registrar os insetos visitantes no período de floração, determinar as características morfométricas das flores e o sistema reprodutivo da erva-baleeira, em um ambiente de Cerrado do Norte de Minas Gerais. Entre maio a dezembro de 2012 foi caracterizado o comportamento fenológico da floração. Na análise da fenologia floral foi determinado: o crescimento da inflorescência, o número de flores e frutos por inflorescências. Utilizou-se seis acessos que tiveram dez inflorescências marcadas em cada acesso, totalizando 60 inflorescências. A antese foi determinada utilizando quatro inflorescências em duas plantas. Os visitantes florais foram observados in loco e capturados em três dias consecutivos de coleta. As características morfométricas foram determinadas com paquímetro utilizando 20 flores, sendo cinco flores de quatro acessos. Para determinar o sistema reprodutivo utilizou-se a razão pólen:óvulo (P:O), utilizando 50 flores, sendo 10 flores de cinco acessos em pré-antese. Nas condições de Montes Claros, o crescimento das inflorescências de erva-baleeira ocorreu entre meados de agosto e início de outubro, totalizando 45 dias. O florescimento foi observado entre meados de setembro e final de outubro, enquanto a frutificação ocorreu de meados de outubro a início de dezembro, sendo que ambos ocorreram de forma irregular. A antese floral de erva-baleeira, neste estudo, ocorre entre 7:00 e 11:00 horas. Os insetos visitantes pertencem as ordens Coleoptera, Hemiptera, Diptera e Hymenoptera. As flores apresentaram o diâmetro de 2,13 ± 0,05 (mm), o comprimento de 3,29 ± 0,08 (mm), diâmetro do ovário de 0,70 ± 0,02 (mm), o comprimento do ovário de 2,48 ± 0,12 (mm), o diâmetro da antera de 0,67 ± 0,01(mm) e o comprimento da antera de 0,93 ±0,02 (mm), quatro óvulos e cinco anteras por flor. A razão P:O foi de 576,542, indicando que a espécie é alógama facultativa.

ABSTRACTThe knowledge of the reproductive system is essential for the conservation and management of the species. This study aimed on several procedures, as follows: to describe the phenology of flowering, the anthesis; to record the visiting insects during flowering and to determine the morphometric characteristics of the flowers and the reproductive system of the "erva-baleeira", in an environment of Northern Cerrado in the State of Minas Gerais. From May to December 2012, the flowering phenology of six access was characterized. In the analyzes of floral phenology it were determined the growth of the inflorescence and the number of flowers and fruits per inflorescence by using six access which had ten inflorescences marked in each access l, totalizing sixty inflorescences. The anthensis was assessed using four inflorescences in two plants. The flower`s visitors were observed live and captured in three consecutive days of sampling. The morphometric characteristics were determined with a caliper using 20 flowers, with five flowers from four access. In order to determine the reproductive system it was employed a ratiopollen: ovule (P: O) with 50 flowers and 10 of them belonging to five accesses in the pre-anthesis. Under the conditions of Montes Claros, the growth of inflorescences from Cordia occurred between mid-August and early October, totalizing 45 days. The flowering was observed between mid-September and late October, and the fruiting occurred from mid-October to early December. Both phases happened irregularly. The anthesis of the Cordia, in this study, occurred between 7:00 and 11:00 o`clock.. The visiting insects identified were from the orders of Coleoptera, Hemiptera, Diptera and Hymenoptera. The flowers exhibited a diameter of 2.13 ± 0.05 (mm), length of 3.29 ± 0.08 (mm), diameter of 0.70 ± 0.02 Ovarian (mm), the length of the ovary was 2.48 ± 0.12 (mm), the diameter of the anther 0.67 ± 0.01 (mm) and the length anther was 0.93 ± 0.02 (mm), with five anthers and four ovules per flower. The reason P: O was 576.542, indicating that the species is facultative allogamous.

Guidelines for treatment of patients with diabetes and infected ulcers.

Diabetic foot ulcers and their consequences do not only represent a major tragedy for the patient and his/her family, but also place a significant burden on the healthcare systems and society in general. Diabetic patients may develop foot ulcers due to neuropathy (autonomic, sensory, and motor deficits), angiopathy or both. As a result of the additional immunopathy associated with diabetes, the probability of these wounds to become infected is extremely high. Diabetic foot infections can be classified in mild, moderate and severe according to local and systemic signs. Their identification should lead to a prompt and systematic evaluation and treatment, ideally performed by a multidisciplinary team. Decisions concerning empirical initial antibiotic agent(s), desirable route of administration, duration and need of hospitalization should be based on the more likely involved pathogen(s), the severity of the infection, the ulcer chronicity and the presence of significant ischemia. Wound cultures, ideally from ulcer tissue, are strongly advisable and can help guiding and narrowing the antibiotic spectrum. Appropriate wound care and off-loading should not be neglected. When revascularization is required, the correct timing can be crucial for limb salvage. Since the recurrence of ulcer and infection is high, the implementation of appropriate preventive measures can be critical. Ultimately, the definitive goal in the treatment of diabetic foot infections is to prevent the amputation catastrophe.

Utilização de plantas medicinais com atividade antimicrobiana por usuários do serviço público de saúde em Campina Grande - Paraíba / Use of medicinal plants with antimicrobial activity by users of the Public Health System in Campina Grande - Paraíba, Brazil

O estudo avalia a utilização de plantas medicinais com atividade antimicrobiana pelos usuários do Sistema Único de Saúde do município de Campina Grande- PB, Brasil. Trata-se de um estudo descritivo, transversal, com abordagem quantitativa, cuja amostra constituiu-se de 220 usuários conduzido no período de Agosto de 2008 a Janeiro de 2009. A pesquisa foi realizada através de um roteiro de entrevistas não estruturada. Dentre os participantes do estudo, 65,0% utilizavam plantas medicinais, das quais Punica granatum L., Anacardium occidentale L., e Stryphnodendron adstringens foram as mais citadas. Observou-se que houve prevalência do gênero feminino na utilização. A maioria dos indivíduos obtém plantas medicinais no comércio local utilizando-as por indicação de familiares. Foi observado que 5,0% dos entrevistados afirmam já ter sofrido algum evento adverso decorrente do uso de plantas medicinais. Assim sugere-se que as informações sobre o uso da flora medicinal adquiridas nas comunidades locais, combinadas a estudos químicos/farmacológicos realizados em laboratórios especializados e a capacitação da equipe de saúde favorecerá a implementação da Portaria nº 971/2006, que tem como objetivo a garantia de acesso a plantas medicinais e fitoterápicos com segurança, eficácia e qualidade.

This study evaluates the use of medicinal plants with antimicrobial activity by users of the Unified Health System in Campina Grande Municipality, Paraíba, Brazil. This is a descriptive and transversal study with a quantitative approach, the sample of which consisted of 220 users, and was carried out from August 2008 to April 2009. The research was developed through an unstructured interview process. Among the study participants, 65.0% used medicinal plants, of which Punica granatum L., Anacardium occidentale L. and Stryphnodendron adstringens were most cited. There was prevalence of females. Most individuals obtain medicinal plants in the local market, using them as suggested by relatives. Results indicated that 5.0% of the interviewees stated to have suffered adverse event resulting from the use of medicinal plants. Thus, information about the use of medicinal plants, acquired in local communities, combined to chemical/pharmacological studies performed in specialized laboratories and the qualification of health professionals, will favor the implementation of Decree no. 971/2006, which aims to ensure access to medicinal plants and herbal medicines with safety, efficacy and quality.

Possibilities for reuse of treated domestic wastewater in the Netherlands.

The implementation of wastewater reuse is becoming an increasingly important means of supplementing water supply needs and/or reducing costs. The present paper provides examples of possible uses of treated domestic effluent for the three sectors, i.e. public water supply, industrial and agricultural uses with the aim to address the feasibility of these applications. It is concluded that, although The Netherlands as a whole is considered to be a low water stressed country, regional fresh water scarcity and costs can result in the need for applications of domestic wastewater reuse.

Endogenous vascular endothelial growth factor and angiopoietin-2 expression in critical limb ischemia.

AIM: The aim of this paper was to contribute to a better understanding of the angiogenesis in peripheral arterial disease (PAD); we evaluated the expression of vascular endothelial growth factor (vegf) and angiopoietin-2 (Ang-2) in critical limb ischemia (CLI). METHODS: Skin and muscle biopsies were collected from 12 patients submitted to major amputation for CLI, proximal samples from amputation level and distal ones from the more ischemic region. Three controls were obtained from orthopedic patients. Capillary density was determined in random selected high-power fields. Expression pattern of VEGF and Ang-2 was studied by immunohistochemistry and quantification was performed by enzyme-linked immunosorbent assay. RESULTS: In skin, capillary density and levels of VEGF and Ang-2 were higher in distal samples when compared to proximal (capillary density, P=0.003, VEGF, P=0.008, Ang-2, P=0.041). Distal muscle had also elevated capillary number (P=0.005) and Ang-2 concentration (P=0.023). VEGF concentration in distal muscle was found to be similar to proximal muscle (P=1). Immunohistochemical expression of VEGF was clearly more evident in distal samples and was predominantly present in epidermis and skeletal myocytes. Ang-2 was essentially detected distally and only observed in endothelial cells. CONCLUSION: The capillary density is enhanced in distal samples, suggesting an effective angiogenic drive in CLI. In addition, the observed increase of VEGF expression in ischemic skin and Ang-2 in ischemic skin and muscle may contribute to clarify the potential role of VEGF and Ang-2 supplementation for therapeutic angiogenesis in CLI.

Acute ischemia of the lower limb after injury by gunshot: case report and review of literature.

INTRODUCTION: Civilian and military vascular trauma has evolved dramatically. It is estimated that 80% of all cases of vascular injuries are due to peripheral vascular trauma, most involving the lower extremities. Arterial below-knee injuries by gunshot still remain a challenge, with an associated rate of amputation of 20-54%. MATERIAL AND METHODS: This case reports a 48 year-old male patient who sustained a gunshot below his left knee. At hospital admission, loss of substance and hemorrhage at the medial and lateral faces of the upper third of his left leg were present with signs of distal ischemia. Arteriography revealed infra-popliteal arterial lesions of the three arterial axes. Two reversed great saphenous vein interposition grafts were performed into the anterior and posterior tibial arteries with immediate revascularization of the left leg and foot. Later, soft tissue reconstruction was accomplished by a split-thickness skin graft. RESULTS: At the fifth month of follow-up, the left leg and foot were viable with good healing, without limitations and with controlled pain. Posterior tibial and dorsalis pedis pulses were palpable. CONCLUSION: This case report shows the importance of an adequate team approach for treatment of a gunshot extremity injury with vascular lesion. The authors want to highlight the scientific background evidence and the value of comparing worldwide civilian trauma center outcomes, mostly reported previously from the military field.

Thrombosed popliteal aneurysm - first manifestation of bilateral popliteal entrapment syndrome.

Popliteal artery entrapment syndrome is a rare and underdiagnosed cause of claudication in the young adult. One of its rare and potentially limb threatening complications is aneurysmal degeneration. We present a case of a fifty years old man with a bilateral popliteal entrapment syndrome admitted with an acutely thrombosed aneurysm at the right inferior limb. An urgent bypass was required. The contralateral limb presented with a type III entrapment and an elective section of a musculotendinous structure was performed. This case suggests that an early diagnosis is mandatory to avoid a dramatic clinical outcome and to limit the surgical treatment to a myotomy.

Estudo comparativo entre os sistemas de umidificação aquoso aquecido e trocador de calor e de umidade na via aérea artificial de pacientes em ventilação mecânica invasiva / Comparative study between heated water humidifiers and hygroscopic heat and moisture exchangers in artificial airways for patients undergoing invasive mechanical ventilation

CONTEXTO: Nos pacientes recebendo suporte ventilatório invasivo através de tubos endotraqueais é essencial o uso de umidificadores. OBJETIVO: avaliar os níveis de temperatura (TºC) e de umidade relativa (UR) do gás administrado ao paciente em ventilação mecânica através da umidificação aquosa aquecida (UAA) e do filtro trocador de calor e de umidade (FTCU). MÉTODO: Este foi um estudo prospectivo, randomizado, onde foram estudados 20 pacientes divididos em dois grupos: um grupo usou a UAA (n=10) e o outro grupo (n=10) usou FTCU Hygrobac "S", marca Mallinckrodt®. As variáveis analisadas foram: níveis de temperatura (T) e umidade relativa (UR) do gás, volume minuto (VM), volume corrente (VC) e volume de condensação. RESULTADOS: Verificou-se que o sistema de umidificação aquosa aquecida atingiu temperaturas mais baixas que o filtro trocador (29,01 ± 1,33 ºC, versus 30,14 ± 1,24 ºC; p<0,001). A umidade relativa foi maior na UAA do que no FTCU (97,45 ± 5,22 por cento, versus 89,87 ± 11.04 por cento, p < 0,021). O volume de condensação do circuito do grupo usando UAA foi maior que o do grupo usando o FTCU (p < 0,05). CONCLUSÃO: Os resultados demonstram que ambos os sistemas, UAA e o FTCU forneceram umidades absolutas abaixo do valor recomendado, sendo que o sistema de UAA ofereceu uma umidade relativa maior, enquanto que o aquecimento do gás com o FTCU obteve um melhor desempenho.

BACKGROUND: In patients receiving invasive mechanical ventilation through endotracheal tubes, the use of humidifiers is essential. OBJECTIVE: To evaluate temperature and relative humidity levels in the gas administered to patients undergoing mechanical ventilation by means of heated water humidifiers (HWH) and hygroscopic heat and moisture exchangers (HHME). METHOD: This was a prospective randomized study on 20 patients divided into two groups: one group using HWH (n=10) and the other using the Hygrobac "S" model of HHME, made by Mallinckrodt® (n=10). The variables analyzed were: temperature and relative humidity levels of the gas, minute volume (MV), tidal volume (V T) and condensation volume. RESULTS: It was found that HWH attained lower temperatures than did HHME (29.01 ± 1.33 ºC versus 30.14 ± 1.24 ºC; p<0.001). The relative humidity was higher in HWH than in HHME (97.45 ± 5.22 percent versus 89.87 ± 11.04 percent; p<0.021). The condensation volume in the ventilator circuit for the group using HWH was greater than for the HHME group (p<0.05). CONCLUSION: The results demonstrate that both systems (HWH and HHME) supplied absolute humidity that was below recommended values, while the HWH offered higher relative humidity. On the other hand, HHME produced better performance regarding gas heating.

p63 correlates with both BRCA1 and cytokeratin 5 in invasive breast carcinomas: further evidence for the pathogenesis of the basal phenotype of breast cancer.

AIMS: To study the expression of p63, cytokeratin (CK) 5 and CK8/18 in invasive ductal carcinomas and their relationship with BRCA1 and other pathological and immunohistochemical features of clinical significance. METHODS AND RESULTS: Immunohistochemistry with the antibodies p63, CK5, CK8/18, BRCA1, oestrogen receptor, progesterone receptor, p53, c-erbB-2 and Ki67 was performed in 102 formalin-fixed paraffin-embedded samples of invasive ductal carcinomas. The CK5+ cases were submitted to a double-immunolabelling study with p63. There was a strong relationship between CK5 and p63 expression and both markers were associated with hormonal receptor-negative high-grade carcinomas with high proliferative rate. Furthermore, there was coexpression of CK5 and p63 in neoplastic cells, indicating that p63, like CK5, is a marker of the basal phenotype of breast cancer. There was a strong relationship between reduced expression of BRCA1 with both p63 and CK5 expression as well as an inverse correlation between p63 and CK8/18 expression, suggesting that loss of p63 expression is required for the transition between a basal to a luminal phenotype of breast carcinoma. CONCLUSIONS: Since p63 is thought to be a marker of stem cells and may act as an oncogene, our data support the idea that BRCA1 acts as stem cell regulator.

Ergasilus thatcheri n. sp. (Copepoda, Poecilostomatoida, Ergasilidae) from the gills of Rhamdia quelen (Teleostei, Siluriformes, Pimelodidae) from southern Brazil.

The female of Ergasilus thatcheri n. sp. (Copepoda, Poecilostomatoida, Ergasilidae) is described from the gills of the "jundiá," Rhamdia quelen (Teleostei, Siluriformes, Pimelodidae), from fish ponds in the State of Rio Grande do Sul, Brazil. The new species has a falciform semipinnate terminal seta on the first exopod, which suggests phylogenetic affinity to 10 other congeners, all from fishes of the Amazon Basin. Based on general morphology, the new species shows great similarity to E. callophysus Thatcher and Boeger, 1984, a parasite of another pimelodid fish Callophysus macropterus. Ergasilus thatcheri n. sp., however, can be easily differentiated from E. callophysus in its possession of a more distal sensillum not located on a cuticular elevation, and a row of spinules on the inner margin of the second antennal segment (first endopodal segment).

Regulation of succinic dehydrogenase activity of heart mitochondria by anti-arrhythmic drugs.

It was observed that either propranolol or iproveratril could increase the succinate oxidation activity by rat heart mitochondria to 444% and to 371% respectively. Both drugs decreased the respiratory control coefficient and ADP/O ratio. No effect on mitochondrial succinic dehydrogenase, succinic dehydrogenase-Co Q-reductase and malic dehydrogenase was observed. It was pointed out that these drugs would act preventing the reoxidation of NADH+ + H+ through the respiratory chain.