Chlamydia pneumoniae and atherosclerosis. Identification of bacterial DNA in the arterial wall.

OBJECTIVE: The intracellular Gram-negative bacterium Chlamydia pneumoniae has been associated with atherosclerosis. The presence of Chlamydia pneumoniae has been investigated in fragments of the arterial wall with a technique for DNA identification. METHODS: Arterial fragments obtained from vascular surgical procedures in 58 patients were analyzed. From these patients, 39 were males and the mean age was 65+/-6 years. The polymerase chain reaction was used to identify the bacterial DNA with a pair of primers that codify the major outer membrane protein (MOMP) of Chlamydia pneumoniae. The amplified product was visualized by electrophoresis in the 2% agarose gel stained with ethidium bromide, and it was considered positive when migrating in the band of molecular weight of the positive controls. RESULTS: Seven (12%) out of the 58 patients showed positive results for Chlamydia pneumoniae. CONCLUSION: DNA from Chlamydia pneumoniae was identified in the arterial wall of a substantial number of patients with atherosclerosis. This association, which has already been described in other countries, corroborates the evidence favoring a role played by Chlamydia pneumoniae in atherogenesis.

[Urinary tract infection associated with indwelling bladder catheter: incidence and risk factors]. / Infecção do trato urinário relacionada ao cateter vesical de demora: incidência e fatores de risco.

BACKGROUND: To determine the incidence and risk factors associated with urinary tract infection (UTI) in patients submitted to long-term urinary (bladder) catheterization. One hundred and thirty-six patients who had urinary catheterization during the period of may to december 1993 at an University Hospital in Brazil. MATERIAL AND METHOD: Observational prospective cohort non-controlled study. Patients receiving bladder catheter were followed from insertion to removal of the catheter, looking for the development of a positive culture. Urine cultures were done using conventional media for aerobic organisms and biochemical tests for identification. Material from a urethral meatus swab was also examined for bacteria. Statistical analysis using parametric tests for cathegorical and continuous variables, and multivariate analysis for determination of risk factors for UTI were performed. RESULTS: Incidence of UTI associated with urinary catheter was 11.0%. Univariate analysis showed 3 factos as predictors: the nature of his disease (clinical or surgical) (p = 0.01), stayed during hospitalization in one clinic (p = 0.02) and duration of catheterization (p = 0.00003). In the multivariate analysis only the duration of catheterization was statistically significant. (p = 0.03). CONCLUSIONS: Incidence of UTI associated with urinary catheters in the analysed sample was 11.0%, because in the University Hospital there is a control of the alterable risk. Catheterization duration is an important risk factor for this problem. It is recommended to limit to the minimum the time of catheterization in hospitalized patients.

Infecçäo do trato urinário relacionada ao cateter vesical de demora: incidência e fatores de risco / Urinary tract infection associated with indwelling bladder catheter: incidence and risk factors

Objetivo. Determinar a incidência e os fatores de risco relacionados a infecçao do trato urinário (ITU) em pacientes submetidos à sondagem vesical de demora (SVD). Métodos e Casuística. Cento e trinta e seis pacientes submetidos à SVD entre maio e dezembro de 1993 no Hospital Universitário (HU) da Universidade Federal de Santa Catarina (UFSC). Estudo observacional de coorte contemporânea, nao-controlado, em pacientes submetidos a SVD, que foram seguidos desde a inserçao até a remoçao da sonda. Culturas de urina no ato da inserçao e da retirada foram realizadas em meios convencionais para bactérias aeróbicas; também foi cultivado material obtido com swab do meato uretral. Na análise estatística usou-se métodos paramétricos para variáveis categóricas e contínuas, e análise multivariada para determinaçao de fatores de risco para ITU. Resultados. A incidência de ITU associada a SVD nesta amostra foi de 11%. Na análise univariada três fatores foram significativos estatisticamente: a doença de base (clínica ou cirúrgica) (p=0,01), a permanência em uma clínica durante a internaçao (p=0,02) e a duraçao (em dias) da caterizaçao (p=0,00003). Na análise multivariada, somente a duraçao da sondagem vesical foi preditiva para ITU (p = 0,03). Conclusoes. A incidência de ITU relacionada a SVD na amostra analisada foi de 11,0% porque no HU da UFSC existe um controle dos fatores de risco alteráveis. A duraçao da sondagem vesical é um importante fator de risco para este problema. Recomenda-se limitar ao mínimo necessário o tempo de cateterizaçao em pacientes internados.

Infecçöes relacionadas ao cateter venoso central em terapia intensiva / Central venous catheter-related infections in critically-ill-patients

OBJETIVO. Determinar a incidência, a etiologia e os fatores de risco das infecçoes relacionadas ao cateter venoso central em terapia intensiva. METODOLOGIA. Estudo observacional de coorte, prospectivo, em pacientes criticamente enfermos submetidos à cateterizaçao venosa profunda por punçao percutânea. Realizadas culturas quantitativa da pele, semiquantitativa da ponta e quantitativa do canhao do cateter, e hemocultura periférica. Os possíveis fatores de risco foram submetidos à análise univariada e multivariada. RESULTADOS. Foram estudados 57 períodos de cateterizaçao em 51 pacientes. A incidência de infecçao local foi de 21,1 por cento (33,8/1.000 dias-cateter), e de bacteremia, 8,7 por cento (l4,1/1.000 dias-cateter). A pele no local de inserçao estava colonizada em 32,7 por cento dos pacientes e o canhao, em 29,1 por cento. A origem dos microrganismos causadores de infecçao foi a pele em 41,2 por cento, o canhao em 29,4 por cento, infecçao a distância em 5,9 por cento, e nao ficou esclarecida em 23,5 por cento dos casos. Estafilococos coagulase-negativa foram os agentes etiológicos predominantes. Identificou-se, como variáveis independentemente associadas à infecçao local, a purulência no orifício de inserçao e a utilizaçao de outro dispositivo intravascular. As variáveis independentemente associadas à bacteremia foram a inserçao na veia jugular interna e a colonizaçao do canhao do cateter. CONCLUSOES. A bacteremia é uma complicaçao importante do cateterismo venoso central em terapia intensiva. Os estafilococos coagulase-negativa predominam nesta modalidade de infecçao hospitalar. A inserçao do cateter na veia jugular interna e a colonizaçao do canhao aumentam o risco de bacteremia relacionada à linha venosa central.

[Central venous catheter-related infections in critically ill patients]. / Infecções relacionadas ao cateter venoso central em terapia intensiva.

BACKGROUND: To determine incidence rate, etiology and risk factors for central venous catheter (CVC)-related infections in critically-ill patients, a prospective cohort study was conducted in the general Intensive Care Unit (ICU) of a 212 bed Hospital in Florianópolis, Brazil. MATERIAL AND METHOD: Patients admitted to ICU between May 1993 and February 1994, exposed to short-term CVC, were included in the study. Quantitative skin culture at CVC insertion site, semi-quantitative CVC tip culture, quantitative hub culture, and peripheral blood-culture were done. Results were submitted to univariate and multivariate analysis. RESULTS: Fifty-seven catheterization periods were analysed in 51 patients. The incidence rate was 21.1% (33.1 per 1,000 catheter-days) for local infection, and 8.7% (14.1 per 1,000 catheter-days) for catheter-associated bacteremia. The skin at the insertion site was colonized in 32.7% and the hub in 29.1% of the patients respectively. Potential sources of infection were the skin in 41.2% of the cases, the hub in 29.4%, remote site in 5.9% and unknown in 23.5%. The hub was implicated in 60% of the catheter-associated bacteremias. Coagulase-negative staphylococci were the main isolates. Another intravascular device and purulence at the insertion site were independently associated with local infection. Insertion at internal jugular site and hub colonization were independently associated with bacteremia. CONCLUSIONS: Catheter-associated bacteremia is a major complication of central venous catheterization in critically-ill patients. Internal jugular insertion and CVC hub colonization are important risk factors for significant catheter-related infections.

[Physical exercise and serum lipids]. / Exercício físico e lipídios séricos.

The physical activity shows an inverse correlation with Ischaemic Cardiopathy, with evidence that lipids and lipoproteins blood levels are favourably modified by exercise. In this way, this study compared the different degrees of physical activity and the levels of blood lipids/lipoproteins, as well as the anthropometric and physiological variants. One hundred fifty seven non smoking males, aged 15 to 31 years old, average 21 years, were divided in two groups: G1 comprises 88 athletes individuals and G2, 69 non-athletes. The G1 individuals showed less corporal fat and better aerobic capacity than the G2 individuals. The levels of cholesterol, triglycerides, and the VLDL/cholesterol ratio were lower in the G1 individuals, as well as the risk rate 1 and 2, respectively the ratio of cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol. There was no difference in both groups regarding the LDL and HDL cholesterol. In the G2 individuals the percentage of corporal fat had a direct correlation to the blood levels of triglycerides and VLDL cholesterol, and an inverse correlation to the HDL cholesterol blood level. Also, in this group there was a significative correlation to the risk rate 1 and 2. However, in G1 individuals the lipidic/lipoprotein levels were more favourable, which suggests a lower risk of developing Ischaemic Cardiopathy. Statistical analysis was obtained through "t"-Student, X2 and Spearman methods, with significance level of 0.05.