Effect of freezing rates on α-amylase enzymatic susceptibility, in vitro digestibility, and technological properties of starch microparticles.

The aim of this study was to evaluate the effect of freezing rates using direct (LF: Liquid nitrogen) and indirect (RF: Cryogenic refrigerator and UF: ultra-freezer) methods at temperatures of (-20, -80, and - 196 °C) on the enzymatic susceptibility with α-amylase for microparticles. In vitro digestibility parameters and technological properties were also analyzed. Lower rates resulted in larger ice crystals, damaging the starch structure. Hydrolysis was more pronounced at slower rates RF: 0.07 °C/min and UF: 0.14 °C/min, yielding maximum values of RDS: 37.63% and SDS: 59.32% for RF. Type A crystallinity remained unchanged, with only a noted increase in crystallinity of up to 6.50% for FR. Starch pastes were classified as pseudoplastic, with RF exhibiting superior textural parameters and apparent viscosity. (RF: 7.18 J g-1 and UF: 7.34 J g-1) also showed lower values of gelatinization enthalpy. Freezing techniques were viable in facilitating the diffusion of α-amylase and reducing RS by up to 81%.

Evaluation of dual modification by high hydrostatic pressure and annealing on the physicochemical properties of bean starch.

This study investigated the physical modifications by high hydrostatic pressure (HHP) at 600 MPa for 30 min/30 °C, annealing (AN) at 50 °C/24 h and the combination of both (HHP + AN and AN + HHP) applied to yellow bean starch to verify changes in morphology, X-ray diffraction, molecular order, thermal properties and pasting properties of native (NS) and modified starches. Morphological analysis showed loss of sphericity and increase in diameter with the appearance of pores on the surface after application of treatments. The AN starch showed lower values of syneresis, degree of double helix (DD), order (DO), and viscosity of the paste obtained by RVA. It exhibited a Vh-type classification with the appearance of the amylose-lipid complex. However, the gelatinization temperatures, as well as the enthalpy of gelatinization, were significantly higher. On the other hand, the starch treated with HHP showed a higher Setback (SB) value. The greatest modifications were found for the starches subjected to the combined treatments (AN + HHP) and (HHP + AN), where the order of the treatments was significant for the morpho-structural changes of yellow bean starch. According to the micrographs, the surface aspect was altered, with AN + HHP showing greater irregularities and flat yet irregular faces, as well as a larger granule diameter (147.05). The X-ray diffractogram showed a reduction in crystallinity from 28.14 % (NS) to 18.09 % (AN + HHP) and classified the starch as type "A". The double modification (HHP + AN and AN + HHP) reduced the gelatinization temperature and the enthalpy of gelatinization but had no effect on the bands of the FT-IR spectrum. There was only a reduction in the degree of order and the double helix. Finally, the treatment with AN + HHP is more effective as the gelatinization with AN facilitates the application of HHP. Both methods used are classified as physical (thermal and non-thermal), aiming to minimize environmental impacts and achieve faster and safer morpho-structural modification without leaving chemical residues in the products.

Red rice starch modification - Combination of the non-thermal method with a pulsed electric field (PEF) and enzymatic method using α-amylase.

The objective of this study was to investigate the dual modification of red rice starch using pulsed electric field (PEF) and α-amylase, focusing on morpho-structural, thermal, and viscoamylographic properties. Native starch (Control) underwent various treatments: PEF at 30 kV cm-1 (PEF30), α-amylase at 9.0 U mg-1 (AA0), and a combination of both (PEF30 + α and α + PEF30). The PEF30 + α treatment exhibited the highest degree of digestion (10.66 %) and resulted in morphological changes in the starch granules, which became elongated and curved, with an increased average diameter of 50.49 µm compared to the control. The starch was classified as type A, with a maximum reduction in crystallinity of up to 21.17 % for PEF30. The deconvolution of FT-IR bands indicated an increase in the double helix degree (DDH) for PEF30 and AA0, while the degree of order (DO) was reduced for PEF30, AA0, and PEF30 + α. DSC analysis revealed significant modifications in gelatinization temperatures, particularly for PEF30, and these changes were supported by a reduction in gelatinization enthalpy (ΔH) of up to 28.05 % for AA0. These findings indicate that both individual and combined treatments promote a decrease in starch gelatinization and facilitate the process, requiring less energy. Differences were observed between the formulations subjected to single and alternating dual treatments, highlighting the influence of the order of PEF application on the structural characteristics of starch, especially when applied before the enzymatic treatment (PEF + α). Regarding the viscoamylographic parameters, it was observed that AA0 presented higher values than the control, indicating that α-amylase enhances the firmness of the paste. The double modification with PEF + α was more effective in reducing syneresis and starch retrogradation, leading to improvements in paste properties. This study provided significant insights into the modification of red rice starch using an efficient and environmentally friendly approach.

Evolution of antibody titers after two doses of mRNA Pfizer-BioNTech vaccine and effect of the third dose in nursing home residents.

OBJECTIVES: We evaluated the IgG antibody titer against SARS-CoV-2 in 196 residents of a Spanish nursing home after the second dose of the BNT162b2 vaccine and the evolution of this titer over time. The role of the third dose of the vaccine on immune-response is also analysed in 115 of participants. METHODS: Vaccine response was evaluated 1, 3 and 6 months after second dose of Pfizer-BioNTech COVID-19 Vaccine and 30 days after booster vaccination. Total anti-RBD (receptor binding domain) IgG immunoglobulins were measured to assess response. Six month after the second dose of vaccine and previously to the booster, T-cell response was also measured in 24 resident with different antibody levels. T-spot Discovery SARS-CoV-2 kit was used to identify cellular immunogenicity. RESULTS: As high as 99% of residents demonstrated a positive serological response after second dose. Only two patients showed no serologic response, two men without records of previous SARS-CoV-2 infection. A higher immune response was associated with prior SARS-CoV-2 infection regardless of the gender or age. The anti-S IgG titers decreased significantly in almost all the participants (98.5%) after six months of vaccination whatever previous COVID-infection. The third dose of vaccine increased antibody titers in all patients, although initial vaccination values were not restored in the majority of cases. CONCLUSION: The main conclusion of the study is that vaccine resulted in good immunogenicity in this vulnerable population. Nevertheless more data are needed on the long-term maintenance of antibody response after booster vaccination.

Clinical Evaluation of Nontuberculous Mycobacteria (NTM) Elite Agar, a New Medium for the Isolation of NTM: a Multicenter Study.

Nontuberculous mycobacteria (NTM) are gaining interest with the increased number of infected patients. NTM Elite agar is designed specifically for the isolation of NTM without the decontamination step. We assessed the clinical performance of this medium combined with Vitek mass spectrometry (MS) matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) technology for the isolation and identification of NTM in a prospective multicenter study, including 15 laboratories (24 hospitals). A total of 2,567 samples from patients with suspected NTM infection were analyzed (1,782 sputa, 434 bronchial aspirates, 200 bronchoalveolar lavage samples, 34 bronchial lavage samples, and 117 other samples). A total of 220 samples (8.6%) were positive with existing laboratory methods against 330 with NTM Elite agar (12.8%). Using the combination of both methods, 437 isolates of NTM were detected in 400 positive samples (15.6% of samples). In total, 140 samples of the standard procedures (SP) and 98 of the NTM Elite agar were contaminated. NTM Elite agar showed a higher performance for rapidly growing mycobacteria (RGM) species than SP (7% versus 3%, P < 0.001). A trend has been noted for the Mycobacterium avium complex (4% with SP versus 3% with NTM Elite agar, P = 0.06). The time to positivity was similar (P = 0.13) between groups. However, the time to positivity was significantly shorter for the RGM in subgroup analysis (7 days with NTM and 6 days with SP, P = 0.01). NTM Elite agar has been shown to be useful for the recovery of NTM species, especially for the RGM. Using NTM Elite agar + Vitek MS system in combination with SP increases the number of NTM isolated from clinical samples.

Surgery combined with intra-operative microwaves ablation for the management of colorectal cancer liver metastasis: A case-matched analysis and evaluation of recurrences.

Background: Hepatic resection is the only chance of cure for a subgroup of patients with colorectal cancer liver metastasis. As the oncologic outcomes of intra-operative microwaves ablation combined with hepatic resection still remain uncertain in this setting, we aimed to compare this approach with surgery alone in patient's candidate to metastases resection with radical intent. Methods: Using a case-matched methodology based on age, gender, American Society of Anesthesiology score, Body Mass Index, and burden that take in consideration the number and maximum size of lesions, 20 patients undergoing hepatic resection plus intra-operative microwaves (SURG + IMW group) and 20 patients undergoing hepatic resection alone (SURG group), were included. Relapse-free Survival and post-resection Overall Survival were compared between patients of two groups. Results: At the median follow up of 22.4 ± 17.8, 12/20 patients (60%) in SURG +IMW group and 13/20 patients (65%) in the SURG group experienced liver metastasis recurrence (p=0.774). None of them had recurrence at the same surgical or ablation site of the first hepatic treatment. 7/12 patients in the SURG+IMW group and 7/13 patients in the SURG group underwent at least one further surgical treatment after relapse (p = 1.000). No difference was reported between the two groups in terms of Relapse-free Survival (p = 0.685) and post-resection Overall Survival (p = 0.151). The use of intra-operative microwaves was not an independent factor affecting Relapse-free Survival and post-resection Overall Survival at univariate and multivariate analysis. Conclusions: Patients with colorectal cancer liver metastasis undergoing surgery plus intra-operative microwaves have similar post-operative results compared with surgery alone group. The choice between the two approaches could be only technical, depending on the site, number, and volume of the metastases. This approach could also be used in patients with liver metastasis relapse who have already undergone hepatic surgery.

Linezolid for therapy of Staphylococcus aureus meningitis: a cohort study of 26 patients.

BACKGROUND: Linezolid has good penetration to the meninges and could be an alternative for treatment of Staphylococcus aureus meningitis. We assessed the efficacy and safety of linezolid therapy for this infection. METHODS: Retrospective multicenter cohort study of 26 adults treated with linezolid, derived from a cohort of 350 cases of S. aureus meningitis diagnosed at 11 university hospitals in Spain (1981-2015). RESULTS: There were 15 males (58%) and mean age was 47.3 years. Meningitis was postoperative in 21 (81%) patients. The infection was nosocomial in 23 (88%) cases, and caused by methicillin-resistant S. aureus in 15 cases and methicillin-susceptible S. aureus in 11. Linezolid was given as empirical therapy in 10 cases, as directed therapy in 10, and due to failure of vancomycin in 6. Monotherapy was given to 16 (62%) patients. Median duration of linezolid therapy was 17 days (IQR 12-22 days) with a daily dose of 1,200 mg in all cases. The clinical response rate to linezolid was 69% (18/26) and microbiological response was observed in 14 of 15 cases evaluated (93%). Overall 30-day mortality was 23% and was directly associated with infection in most cases. When compared with the patients of the cohort, no significant difference in mortality was observed between patients receiving linezolid or vancomycin for therapy of methicillin-resistant S. aureus meningitis (9% vs. 20%; p = .16) nor between patients receiving linezolid or cloxacillin for therapy of methicillin-susceptible S. aureus meningitis (20% vs 14%; p = .68). Adverse events appeared in 14% (3/22) of patients, but linezolid was discontinued in only one patient. CONCLUSIONS: Linezolid appears to be effective and safe for therapy of S. aureus meningitis. Our findings showed that linezolid may be considered an adequate alternative to other antimicrobials in meningitis caused by S. aureus.

Streptococcus bovis endocarditis: Update from a multicenter registry.

BACKGROUND: Infective endocarditis (IE) due to Streptococcus bovis has been classically associated with elderly patients, frequently involving >1 valve, with large vegetations and high embolic risk, which make it a high-risk group. Our aim is to analyze the current clinical profile and prognosis of S bovis IE episodes, in comparison to those episodes caused by viridans group streptococci and enterococci. METHODS: We analyzed 1242 consecutive episodes of IE prospectively recruited on an ongoing multipurpose database, of which 294 were streptococcal left-sided IE and comprised our study group. They were classified into 3 groups: group I (n = 47), episodes of IE due to S bovis; group II (n = 134), episodes due to viridans group streptococci; and group III (n = 113), those episodes due to enterococci. RESULTS: The incidence of enterococci IE has significantly increased in the last 2 decades (6.4% [1996-2004] vs 11.1% [2005-2013]; P = .005), whereas the incidence of IE due to S bovis and viridans streptococci have remained stable (4% and 10%, respectively). Gender distribution was similar in the 3 groups. Patients with S bovis and enterococci IE were older than those from group II. Nosocomial acquisition was more frequent in group III. Concerning comorbidity, diabetes mellitus (36.7% vs 9.2% vs 26.8%; P < .001) was more common in groups I and III. Chronic renal failure was more prevalent in patients from group III (4.2% vs 1.5% vs 19%; P < .001). Prosthetic valve IE was more frequent in enterococcal IE. Infection upon normal native valves was more frequent in S bovis IE. Colorectal tumors were found in 69% of patients from this group. Vegetation detection was similar in the 3 groups. However, vegetation size was smaller in S bovis IE. During hospitalization, in-hospital complications and in-hospital mortality were higher in enterococci episodes. CONCLUSIONS: S bovis IE accounts for 3.8% of all IE episodes in our cohort; it is associated with a high prevalence of colonic tumors, with predominance of benign lesions, and affects patients without preexisting valve disease. It is related to small vegetations and a low rate of in-hospital complications, including systemic embolisms. In-hospital mortality is similar to that of viridans group streptococci.

O "abrasileiramento" das associações esportivas de Teutônia/Estrela no Rio Grande do Sul / The "abrasileiramento" of the sports associations from Teutônia/Estrela in Rio Grande do Sul

As associações esportivas teuto-brasileiras de Teutônia/Estrela no Estado do Rio Grande do Sul sofreram o processo de abrasileiramento no período da Primeira Guerra Mundial (1914-1918) e da Segunda Grande Guerra (1939-1945). Este artigo objetivou identificar os conflitos de identidades culturais nas associações esportivas de Teutônia/Estrela desencadeados pelas ações nacionalizadoras conduzidas pelos interventores do Estado Rio Grande do Sul no período das grandes guerras mundiais. As fontes históricas consultadas revelaram que a prática de esportes tradicionais nas associações teuto-brasileiras enfraqueceu, como no caso do bolão, ao mesmo tempo que outros esportes foram incorporados, principalmente o futebol. A adesão a esta nova prática esportiva significa um movimento na direção do processo de integração às ações nacionalizadoras.

The German-Brazilian sport associations of Teutônia/Estrela in the State of Rio Grande do Sul suffered the process of abrasileiramento in the period of the World War I (1914-1918) and of the World War II (1939-1945). This article aimed to identify the conflicts of cultural identities in the sport associations of Teutônia/Estrela developed by the nationalization actions leaded by the intervenors of the Rio Grande do Sul State in the period of the great world wars. Historical sources revealed that the practice of traditional sports in the German-Brazilian sport associations weakened, asthe bolão, while other sports were incorporated, mainly the soccer. The adhesion to this new sport means a movement in the direction of the process of integration in the nationalization actions.

Criança entre oito e doze anos: uma oportunidade a ser explorada para identificação e abordagem de problemas sociais / Children at age of 8 to 12 years: An opportunity to identify and approach social problems

Objetivo: chamar a atenção para a necessidade de busca ativa que possibilite a identificação de crianças ainda na idade escolar que já apresentem riscos de transgressão, a partir do relato de dois casos. Métodos: no ano de 2009, todas as crianças entre oito e 12 anos atendidas no Projeto Social Conviver no Carmo foram avaliadas pelos alunos de Medicina da UFMG. As crianças eram levadas à consulta médica e atendidas individualmente ou em grupo de três. Foram identificadas algumas com problemas sociais graves e até já iniciando atividades contraventoras. A abordagem das crianças envolveu acompanhamento multidisciplinar: médico, psicológico e com assistente social, além das ações afirmativas (esportes, música, dança, artes). Resultados: a partir da análise do discurso dos pacientes antes e depois da abordagem observou-se que houve mudança da perspectiva de vida, planejamentos para o futuro e comportamento social adequado dos indivíduos abordados. Conclusões: este trabalho demonstra a necessidade e a eficácia de ações voltadas para a criança e o adolescente na idade escolar, especificamente na faixa etária entre oito e 13 anos. Ressalta também a importância de busca ativa por esses jovens em situações de risco social e sugere mais eficácia da intervenção quando realizada precocemente, ao início da adolescência.

Objective: To introduce two case reports to draw the attention to the need of proactively seeking out school-age children that are prone to commit future transgressions. Methods: In 2009 UFMG medicine students assessed all children aging from 8 to 12 years that attended the Social Project ?Conviver?. Children were scheduled medical appointmentsand assessed individually or in groups of three. Some were diagnosed with serious social problems and some had already committed infractions. Children were followed up through a multidisciplinary approach: medical, psychological, and social work, as well as affirmative actions (sports, music, dance, arts). Results: The analysis of patients? discourse before and after intervention pointed to change of perspective of life, development of future plans, and adequate social behavior. Conclusions: This case report shows the need and efficiency of actions aimed at school-age children and teenagers (more specifically those aging from 8 to 13 years). It also points to the importance of proactively seeking out children living at social risk and suggests that intervention tends to be more effective when carried out early in adolescence.

Factores sociodemográficos asociados a la progresión de la infección por VIH e impacto del TARGA en una cohorte de pacientes seroconvertores en Madrid (1986-2009) / Socio-demographic factors associated with the progression of HIV infection and the impact of HAART in a seroconverter cohort in Madrid (1986-2009)

Introducción El objetivo de este trabajo es estudiar el impacto poblacional del TARGA e identificar los factores sociodemográficos que lo modifican, lo que resulta fundamental para orientar las intervenciones. Métodos Cohorte abierta y prospectiva de seroconvertores al VIH reclutados en el Centro Sanitario Sandoval (1986-2009) y seguidos en colaboración con hospitales de referencia de la Comunidad de Madrid. Se calculó la incidencia acumulada de sida y muerte mediante decrementos múltiples y se identificaron factores asociados mediante modelos predictivos de Fine & Gray. El periodo calendario (..) (AU)

Background The objective of this work is to study the impact of HAART at a population level and to identify socio-demographic factors that may affect it, which is essential for deciding interventions. Methods An open, prospective cohort of HIV seroconverters recruited in the Centro Sanitario Sandoval (1986-2009), and followed up in collaboration with referral hospitals in the Comunidad Autónoma de Madrid. Cumulative incidence of AIDS and death was calculated by the multiple decrements method, and predictive Fine & Gray models were developed to identify associated factors. A calendar period (..) (AU)

Methicillin-resistant Staphylococcus aureus meningitis in adults: a multicenter study of 86 cases.

Methicillin-resistant Staphylococcus aureus (MRSA) meningitis is an uncommon disease, and little is known about its epidemiology, clinical features, therapy, and outcome. We performed a multicenter retrospective study of MRSA meningitis in adults. Eighty-six adult patients were included and the following data were obtained: underlying diseases, clinical presentation, analytical and microbiologic data, response to therapy, and outcome.There were 56 men (65%) and the mean age was 51.5 years; 54 of them (63%) had severe comorbidities. There were 78 cases of postoperative meningitis and 8 of spontaneous meningitis. The infection was nosocomial in 93% (80/86) of the cases. Among the 78 patients with postoperative meningitis, the most common predisposing conditions were cerebrospinal fluid (CSF) devices (74%), neurosurgery (45%), CSF leakage (17%), and head trauma (12%). Most patients had fever (89%), altered mental status (68%), headache (40%), and meningeal signs (29%). The most common CSF findings were pleocytosis (90%), elevated protein level (77%), and hypoglycorrhachia (30%). CSF Gram stain and blood cultures were positive in 49% (32/65) and 36% (16/45) of cases, respectively. An associated MRSA infection and polymicrobial meningitis appeared in 33% (28/86) and 23% (20/86) of cases, respectively. Antimicrobial therapy was given to 84 patients. Most of them received vancomycin (92%) either as monotherapy (64%) or in combination with other antibiotics (28%), for a median of 18 days. Overall 30-day mortality was 31% (27/86). Multivariate study identified 2 independent factors associated with mortality: spontaneous meningitis (odds ratio [OR], 21.4; 95% confidence interval [CI], 2.3-195.4; p = 0.007), and coma (OR, 9.7; 95% CI, 2.2-42.3; p = 0.002).In conclusion, MRSA is a relatively uncommon but serious disease. Although most cases are nosocomial infections appearing in neurosurgical patients, spontaneous meningitis may present as a community-onset infection in patients with severe comorbidities requiring frequent contact with the health care system. Most patients have a favorable response to vancomycin, but the beneficial effect of combined and intraventricular therapy, or alternative drugs, remains unclear. MRSA meningitis is associated with a high mortality, and the presence of spontaneous infection and coma are the most important prognostic factors.

[Socio-demographic factors associated with the progression of HIV infection and the impact of HAART in a seroconverter cohort in Madrid (1986-2009)]. / Factores sociodemográficos asociados a la progresión de la infección por VIH e impacto del TARGA en una cohorte de pacientes seroconvertores en Madrid (1986-2009).

BACKGROUND: The objective of this work is to study the impact of HAART at a population level and to identify socio-demographic factors that may affect it, which is essential for deciding interventions. METHODS: An open, prospective cohort of HIV seroconverters recruited in the Centro Sanitario Sandoval (1986-2009), and followed up in collaboration with referral hospitals in the Comunidad Autónoma de Madrid. Cumulative incidence of AIDS and death was calculated by the multiple decrements method, and predictive Fine & Gray models were developed to identify associated factors. A calendar period (<1997; ≥ 1997) was introduced as a proxy of HAART availability. RESULTS: A total of 479 HIV seroconverters were identified. Hazard Ratio (HR) for progression to AIDS was 0.215 (95% CI: 0.11-0.519; P<.01) for the period ≥ 1997. Risk increased with age at the time of seroconversion (for each year older HR=1.071; 95% CI: 1.038-1.105; P<.01), but only prior to 1997. In the following period, only a high educational level showed to be a protective factor (HR=0.982; 95% CI: 0.936-1.031; P=.06). HR for progression to death was 0.134 (95% CI: 0.052-0.346; P<.01) for the period after 1997, 0.383 (95% CI: 0.168-0.875; P=.02) in people with high educational level and 1.048 (95% CI: 1.014-1.084; P<.01) for each year increase in age at seroconversion, both latter effects being homogeneous throughout the two periods. CONCLUSION: HAART has had a great impact on the risk of progression to AIDS and death, but this benefit appears to be influenced by age at HIV infection and educational level of the patient, which highlights the importance of a global approach to case management and of the implementation of policies that address social inequities in health.

Does low dose (13)C-urea breath test maintain a satisfactory accuracy in diagnosing Helicobacter pylori infection?

CONTEXT: The standard doses of (13)C-urea in (13)C-urea breath test is 75 mg. OBJECTIVE: To assess the diagnostic accuracy of (13)C-urea breath test containing 25 mg of (13)C-urea comparing with the standard doses of 75 mg in the diagnosis of Helicobacter pylori infection. METHODS: Two hundred seventy adult patients (96 males, 174 females, median age 41 years) performed the standard (13)C-urea breath test (75 mg (13)C-urea) and repeated the (13)C-urea breath test using only 25 mg of (13)C-urea within a 2 week interval. The test was performed using an infrared isotope analyzer. Patients were considered positive if delta over baseline was >4.0‰ at the gold standard test. RESULTS: One hundred sixty-one (59.6%) patients were H. pylori negative and 109 (40.4%) were positive by the gold standard test. Using receiver operating characteristic analysis we established a cut-off value of 3.4% as the best value of 25 mg (13)C-urea breath test to discriminate positive and negative patients, considering the H. pylori prevalence (95% CI: 23.9-37.3) at our setting. Therefore, we obtained to 25 mg (13)C-urea breath test a diagnostic accuracy of 92.9% (95% CI: 88.1-97.9), sensitivity 83.5% (95% CI: 75.4-89.3), specificity 99.4% (95% CI: 96.6-99.9), positive predictive value 98.3% (95% CI: 92.4-99.4), and negative predictive value 93.0% (95% CI: 88.6-96.1). CONCLUSIONS: Low-dose (13)C-urea breath test (25 mg (13)C-urea) does not reach accuracy sufficient to be recommended in clinical setting where a 30% prevalence of H. pylori infection is observed. Further studies should be done to determine the diagnostic accuracy of low doses of (13)C-urea in the urea breath test.

Does low dose13C-urea breath test maintain a satisfactory accuracy in diagnosing Helicobacter pylori infection? / Precisão do teste respiratório com pequenas doses de ureia marcada com carbono-13 no diagnóstico da infecção por Helicobacter pylori

CONTEXT: The standard doses of 13C-urea in 13C-urea breath test is 75 mg. OBJECTIVE: To assess the diagnostic accuracy of 13C-urea breath test containing 25 mg of 13C-urea comparing with the standard doses of 75 mg in the diagnosis of Helicobacter pylori infection. METHODS: Two hundred seventy adult patients (96 males, 174 females, median age 41 years) performed the standard 13C-urea breath test (75 mg 13C-urea) and repeated the 13C-urea breath test using only 25 mg of 13C-urea within a 2 week interval. The test was performed using an infrared isotope analyzer. Patients were considered positive if delta over baseline was >4.0‰ at the gold standard test. RESULTS: One hundred sixty-one (59.6 percent) patients were H. pylori negative and 109 (40.4 percent) were positive by the gold standard test. Using receiver operating characteristic analysis we established a cut-off value of 3.4 percent as the best value of 25 mg 13C-urea breath test to discriminate positive and negative patients, considering the H. pylori prevalence (95 percent CI: 23.9-37.3) at our setting. Therefore, we obtained to 25 mg 13C-urea breath test a diagnostic accuracy of 92.9 percent (95 percent CI: 88.1-97.9), sensitivity 83.5 percent (95 percent CI: 75.4-89.3), specificity 99.4 percent (95 percent CI: 96.6-99.9), positive predictive value 98.3 percent (95 percent CI: 92.4-99.4), and negative predictive value 93.0 percent (95 percent CI: 88.6-96.1). CONCLUSIONS: Low-dose 13C-urea breath test (25 mg 13C-urea) does not reach accuracy sufficient to be recommended in clinical setting where a 30 percent prevalence of H. pylori infection is observed. Further studies should be done to determine the diagnostic accuracy of low doses of 13C-urea in the urea breath test.

CONTEXTO: A dose convencional de 13C-ureia para a realização do teste respiratório com 13C-ureia é 75 mg. OBJETIVO: Determinar a precisão diagnóstica do teste respiratório contendo 25 mg de 13C-ureia comparada com a dose convencional de 75 mg para o diagnóstico de infecção por H. pylori. MÉTODOS: Duzentos e setenta pacientes adultos (96 homens, 174 mulheres, idade mediana de 41 anos) realizaram o teste respiratório convencional (75 mg 13C-ureia) e repetiram o teste respiratório usando apenas 25 mg de 13C-ureia dentro de 2 semanas de intervalo. O teste respiratório foi realizado empregando-se analisador de isótopos por infravermelho. Os pacientes foram considerados positivos quando apresentavam valor delta acima da linha de base >4.0 no teste respiratório convencional (padrão-ouro). RESULTADOS: Cento e sessenta e um pacientes (59,6 por cento) eram H. pylori negativos e 109 (40,4 por cento) eram positivos aos testes respiratórios convencionais. Para definição do melhor ponto de corte discriminatório entre positivos e negativos pelo teste respiratório com 25 mg, foi utilizado a curva ROC, obtendo-se o valor de 3,4 por cento, considerando-se a prevalência de 30,2 por cento (IC 95 por cento: 23.9-37.3) da infecção por H. pylori no laboratório, onde se realizou este estudo. Desta forma, para o teste respiratório com 25 mg foi obtida uma precisão diagnóstica de 92,9 por cento (IC 95 por cento: 88,1-97,9), sensibilidade de 83,5 por cento (IC 95 por cento: 75,4-89,3) e especificidade de 99,4 por cento (IC 95 por cento: 96,6-99,9). CONCLUSÕES: Teste respiratório com dose baixa (25 mg) de 13C-ureia não proporciona precisão suficiente para ser recomendado em ambientes clínicos, onde a prevalência de H. pylori está situada em torno de 30 por cento.

A participação das mulheres no automobilismo de rua em Porto Alegre_de coadjuvantes a protagonistas / The women participation on street automobilism in Porto Alegre_coadjuvants to protagonists

A chegada do primeiro automóvel na cidade sinalizava as transformações dos hábitos da sociedade porto-alegrense no princípio do século XX. O ato de dirigir um automóvel pelas ruas simbolizava um modo de ser moderno, e competir ao volante era o ápice da modernidade. As competições de automobilismo foram incrementadas nas ruas da cidade na década de 1920. Neste período, a participação das mulheres era restrita, basicamente, a sinalizar a largada das competições e entregar a premiação aos vencedores. Nas décadas seguintes, quando Porto Alegre se transforma em um pólo do automobilismo nacional, as mulheres passam a ocupar outros espaços no cenário da prática automobilística. Esta pesquisa tem por objetivo identificar como ocorreu o processo histórico de participação das mulheres no automobilismo de rua em Porto Alegre. Para tanto, foram coletados depoimentos orais de mulheres pilotos e dirigentes esportivos do automobilismo de rua em Porto Alegre. Além disso, foi realizada uma pesquisa documental em revistas, jornais, arquivos do Automóvel Clube do Rio Grande do Sul e da Federação Gaúcha de Automobilismo. A história do automobilismo feminino em Porto Alegre está diretamente ligada ao esforço individual de um pequeno grupo de mulheres. A notoriedade das mulheres no cenário esportivo do automobilismo iniciou, na década de 1930, através da atuação da gaúcha Nilza Ruschel, a primeira mulher a se tornar piloto de automóvel. Considera-se que o incentivo e patrocínio da família foi um fator determinante para o ingresso da mulher no automobilismo, uma vez que este é um esporte de elevado custo financeiro e de domínio masculino.

The arriving of the first car in the city showed the habits in Porto Alegre society in the beggining of XX century. The act of to drive a car through the streets simbolized a way of been modern, but to complete on the steering wheels was the top of modernity. In the following decades, Rio Grande do Sul state was transformed in the national automobilism pole. At that time, women who were participating in competitions, in the start of competitions and awards of car competitions, started to be involved in other activities. This research has its aim at to understand wich representation were formed in Porto Alegre city by the street automobilism in the decades of 1930 to 1950. In order to this, were collected oral depositions from women pilots and sports managers of the street automobilism besides, it has been achieved a documental research in magazines, news papers, from the “Automóvel Clube do Rio Grande do Sul”, and from “Federação Gaúcha de Automobilismo” achieves. The women automibilism history in Porto Alegre are directly joint to the individual effort from little groups of women. The women notoriety in sport scene of automobilism began in the decade of 1930 with the performance of the women pilot Nilza Ruschel, the first women that became a pilot of race car. The family support with incentive and patronage was a determinate factor to the beggining of the women in the automobilism, a too expensive sport and dominated by men.

[Respiratory infections outside the hospital. DIRA study]. / Estudio de las infecciones respiratorias extrahospitalarias. Estudio DIRA.

INTRODUCTION: Most visits to the primary care center are for infection and particularly respiratory tract infection. Antimicrobial administration for these clinical processes is common and these agents are often used to treat viral infections. La Fundación para el Estudio de la Infección (Foundation for the Study of Infection) designed the DIRA (Día de la Infección Respiratoria del Adulto, Adult Respiratory Infection Day) Project to investigate and assess the impact of this problem. METHODS: The study design consisted of one-day cross sections with the participation of 720 physicians belonging to Primary Health Care Centers from the 17 Autonomic Regions of Spain, establishing a one-day cross section every three months for one year. Epidemiologic, clinical and therapeutic factors were evaluated. RESULTS: The total number of visits attended was 72 929, and 14 426 patients had infectious processes (43.9%). Among these, 9145 (63.4%) had a respiratory infection. The mean age of the patients was 44.6 years and 34.1% had an underlying condition. Common cold was the most frequent diagnosis. Antibiotics were prescribed in 53.2% of patients. Results were compared to those of a previous study. DISCUSSION: Infection in general and respiratory infection in particular is frequently attended in primary care. Antibiotics are widely used in our setting and self-medication is common.

Estudio de las infecciones respiratorias extrahospitalarias. Estudio DIRA / Respiratory infections outside the hospital. DIRA study

INTRODUCCIÓN. La infección es el motivo de consulta más frecuente en atención primaria, y la de localización en aparato respiratorio es la más habitual. El consumo de antimicrobianos en estos cuadros clínicos es muy elevado y en muchas ocasiones empleado para el tratamiento de infecciones virales. La Fundación para el Estudio de la Infección impulsó el Proyecto DIRA (Día de la Infección Respiratoria del Adulto), para conocer y valorar el impacto de este problema. MÉTODOS. Se ha realizado una investigación por el método de corte de un día, con la participación de 720 médicos, pertenecientes a centros de salud de atención primaria de las 17 comunidades autónomas, estableciendo cuatro cortes trimestrales. Se han evaluado los aspectos epidemiológicos, clínicos y terapéuticos de estas infecciones. RESULTADOS. El número total de consultas atendidas fue de 72.929, de los que 14.426 presentaban procesos infecciosos (43,9 por ciento). De ellos, 9.145 (63,4 por ciento) tenían una infección respiratoria. La edad media fue de 44,6 años y en el 34,1 por ciento existía enfermedad de base. El catarro común fue el diagnóstico más frecuente. El 53,2 por ciento de los pacientes recibió tratamiento antibiótico. Se han comparado los resultados con otro estudio realizado con anterioridad. DISCUSIÓN. La infección en general y la infección respiratoria en particular son muy frecuentes en las consultas de atención primaria. Es habitual el uso de antimicrobianos en nuestro medio, en especial en lo que se refiere a la automedicación (AU)

Prognosis and clinical evaluation of infection caused by Rhodococcus equi in HIV-infected patients: a multicenter study of 67 cases.

OBJECTIVE: To assess the clinical characteristics and the factors that influenced the prognosis of patients with HIV and infection caused by Rhodococcus equi. DESIGN: Observational, multicenter study in 29 Spanish general hospitals. SETTING: These hospitals comprised a total of 20,250 beds for acute patients and served a population of 9,716,880 inhabitants. PATIENTS: All patients with HIV and diagnosed R equi infection until September 1998. RESULTS: During the study period, 19,374 cases of AIDS were diagnosed. Sixty-seven patients were included (55 male patients; mean +/- SD age, 31.7 +/- 5.8 years). At the time of diagnosis of R equi infection, the mean CD4+ lymphocyte count was 35/ micro L (range, 1 to 183/ micro L) and the stage of HIV infection was A3 in 10.4% of patients, B3 in 31.3%, C3 in 56.7%, and unknown in 1.5%. R equi was most commonly isolated in sputum (52.2%), blood cultures (50.7%), and samples from bronchoscopy (31.3%). Chest radiographic findings were abnormal in 65 patients (97%). Infiltrates were observed in all of them, with cavitations in 45 patients. The most active antibiotics against the strains isolated were vancomycin, amikacin, rifampicin, imipenem, ciprofloxacin, and erythromycin. After a mean follow-up of 10.7 +/- 12.8 months, 23 patients (34.3%) died due to causes related to R equi infection and 6 other patients showed evidence of progression of the infection. The absence of highly active antiretroviral therapy (HAART) was independently associated with mortality related to R equi infection (relative risk, 53.4; 95% confidence interval, 1.7 to 1,699). Survival of patients treated with HAART was much higher than that of patients who did not receive this therapy. CONCLUSIONS: Infection by R equi is an infrequent, opportunistic complication of HIV infection and occurs during advanced stages of immunodepression. In these patients, it leads to a severe illness that usually causes a bacteremic, cavitary pneumonia, although HAART can improve the prognosis.

[Respiratory infections in adults hospitalized in internal medicine and pneumology departments. DIRA (Adult Respiratory Infection Day) study]. / Estudio de las infecciones respiratorias en el adulto ingresado en servicios de medicina interna y neumología. Estudio DIRA (Día de Infección Respiratoria en el Adulto) .

INTRODUCTION: Respiratory tract infections (RIs) are frequent processes that can require hospitalization or affect already hospitalized patients. The Foundation for the Study of Infection has promoted the DIRA (Adult Respiratory Infection Day) Project, with the aim of investigating and assessing the impact of this problem, particularly in Internal Medicine and Pneumology Departments. METHODS: Prospective prevalence study involving 158 physicians in 100 Internal Medicine and Pneumology Departments. Data were collected on predetermined days, once every three months (total of four data sets) and included information on number of patients attended, number of patients with infection, and epidemiologic, clinical, microbiologic and treatment characteristics of patients with RI. RESULTS: A total of 3,596 patients were hospitalized at the four time points. Among these, 39.1% presented clinical symptoms consistent with infection and 34.3% of these were RIs. The mean age of RI patients was 65.6 years, 68.8% were males, 84.1% had an underlying disease (most frequently chronic obstructive pulmonary disease) and 25.1% had one or more predisposing factors. Pneumonia was the most frequent diagnosis (41.3% of RIs). RI was documented microbiologically in 15.8% of cases. Antibiotic treatment was applied in 99.7% of patients with acute bronchitis and 81.8% of those with upper respiratory tract infection; penicillins were the most frequent treatment. Data are presented by diagnosis. CONCLUSIONS: A substantial rate of respiratory infections was found in patients admitted to hospital Internal Medicine and Pneumology Departments, with pneumonia being the most frequent. There was a paucity of microbiologic documentation. It is likely that antibiotic treatment was not justified in the majority of patients with upper respiratory tract infections. A combination of two or more antimicrobial agents was used in about half of cases.