ABSTRACT
El tabaco es uno de los factores de riesgo prevenibles más importante de las enfermedades crónicas no trasmisibles (ECNT). Los efectos de fumar no están limitados a los fumadores activos, involucran además a los individuos que sufren los efectos de los tóxicos del humo del tabaco ambiental (HTA): los fumadores pasivos. Las mujeres embarazadas fumadoras activas o expuestas al HTA son una población muy sensible a los efectos tóxicos del tabaco, ya que los mismos repercuten también sobre el feto en formación. La cotinina es en la actualidad el marcador biológico más adecuado para medir exposición al HTA tanto activa como pasiva. Objetivo: determinar el nivel de cotinina en mujeres embarazadas que manifestaron ser fumadoras pasivas, relacionando los valores obtenidos con los días de exposición manifestados. Materiales y métodos: se trabajó con 443 embarazadas que concurrieron a centros de salud públicos y a un centro privado de Gualeguaychú para su control prenatal, solicitándoles a las que manifestaron estar expuestas al HTA una muestra de orina para el dosaje de cotinina. Se aplicó un diseño de tipo no experimental, retrospectivo y de corte transversal. El dosaje de cotinina se realizó en orina, empleando una metodología quimioluminiscente. Previamente se obtuvo un valor referencial de cotinina urinaria inferior a los 15,2 ng/ml para el 98 % de sujetos no fumadores no expuestos al HTA. Resultados: los análisis de los niveles de cotinina en las embarazadas fumadoras pasivas revelaron que, el 82 % en los centros públicos y el 42 % en el centro privado, presentaron un nivel de cotinina superior a 15,2 ng/ml. Teniendo en cuenta los días de exposición, el registro promedio de cotinina para las que manifestaron estar expuestas los últimos siete días fue de 52,3 ng/ml en el sector público y 64,1 ng/ml en el privado. Discusión y conclusiones: la medición de cotinina resulta de utilidad para tener datos fidedignos de la exposición pasiva al HTA. En los centros públicos el 82 % de las embarazadas que manifestaron estar expuestas tenían valores de cotinina urinaria que coincidían con lo expresado, mientras que en el centro privado el 42 % de las que manifestaron la misma situación presentaba valores del indicador que denotaban exposición al tabaco. Se observó un aumento progresivo del promedio del indicador biológico de acuerdo a los días de exposición en ambos sectores, superando los 50ng/ml cuando la exposición declarada fue durante los últimos 7 días, lo que es indicativo de una exposición al HTA severa. El interés y preocupación manifestados por las embarazadas que participaron en este estudio indica que la implementación de este tipo de diagnóstico puede contribuir a las campañas de prevención contra el consumo de tabaco y promover el derecho de quienes no fuman a vivir en ambientes saludables libres de los compuestos tóxicos del mismo.
Tobacco is one of the preventable risk factors, which is most important in the chronic non-communicable diseases (NCDs). The effects of smoking are not limited to active smokers; it also involves individuals who suffer the effects of environmental tobacco smoke (ETS): passive smokers. Pregnant women who are active smokers or exposed to ETS are a very sensitive population to the toxic effects of snuff, since they also affect the developing fetus. Cotinine is currently the most suitable biomarker for measuring ETS exposure both active and passive. Objective: To determine the level of cotinine in pregnant women who reported being passive smokers, relating the values obtained with the indicated days of exposure. Materials and methods: We worked with 443 pregnant women attending public health centers and a private centre in Gualeguaychú for prenatal care, asking to be exposed to ETS showed a urine sample for cotinine dosage. We performed a non-experimental, retrospective and cross-sectional design. The dosage of cotinine in urine was performed using a chemiluminescent method. Previously we obtained a reference value of urinary cotinine less than 15,2ng/ml for 98% of non smokers unexposed to ETS. Results: The analysis of cotinine levels in passive smoking pregnant women show tHTA in public centers, 82% has a cotinine level greater than 15,2ng/embaml, whereas in the private centre, 42% have the same range values. Considering the days of exposure, the average cotinine log for those who said were exposed for the past seven days, was 52.32 ng/ml in the public sector and 64.17 ng/ml in the private one. Discussion and conclusion: The measurement of cotinine is useful to have reliable data from passive exposure to ETS. In public centers, 82% of pregnant women who said were exposed had urinary cotinine levels consistent with the statement, while in the private centre the 42% who said had the same situation had indicator values denoting exposure to snuff. There was a progressive increase in average biological indicator according to the days of exposure in both sectors, exceeding 50ng/ml when the declared exposure was during the last 7 days, which is indicative of a severe ETS exposure. The interest and concern expressed by the pregnant women who participated in this study indicates HTA the implementation of this kind of diagnosis may contribute to prevention campaigns against snuff consumption and promote the right of nonsmokers to live in healthy environments free of the toxic compounds thereof.
Subject(s)
Humans , Female , Pregnancy , Cotinine/urine , Tobacco Smoke Pollution/adverse effects , Argentina/epidemiology , Cotinine/toxicity , Tobacco Smoke Pollution/statistics & numerical dataABSTRACT
Enterococci are part of the indigenous microbiota of human gastrointestinal tract and food of animal origin. Enterococci inhabiting non-human reservoirs play a critical role in the acquisition and dissemination of antimicrobial resistance determinants. The aim of this work was to investigate the antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium strains recovered from artisanal food of animal origin. Samples of goat cheese (n = 42), cow cheese (n = 40), artisanal salami (n = 30), and minced meat for the manufacture of hamburgers (n = 60) were analyzed. Phenotypic and genotypic tests for species-level identification of the recovered isolates were carried out. Minimum inhibitory concentration (MIC) study for in vitro quantitative antimicrobial resistance assessment was performed, and 71 E. faecalis and 22 E. faecium were isolated. The recovered enterococci showed different multi-drug resistance patterns that included tretracycline, erythromycin, ciprofloxacin, linezolid, penicillin, ampicillin, vancomycin, teicoplanin, gentamicin (high-level resistance), and streptomycin (high-level resistance). VanA-type E. faecium were detected. ß-lactamase activity was not observed. Artisanal foods of animal origin act as a non-human reservoir of E. faecalis and E. faecuim strains, expressing multi-resistance to antimicrobials. In conclusion, the implementation of a continuous antimicrobial resistance surveillance in enterococci isolated from artisanal food of animal origin is important.
Subject(s)
Drug Resistance, Multiple, Bacterial , Enterococcus faecalis/drug effects , Enterococcus faecalis/isolation & purification , Enterococcus faecium/drug effects , Enterococcus faecium/isolation & purification , Food Microbiology , Animals , Anti-Bacterial Agents/pharmacology , Argentina , Bacterial Proteins/genetics , Bacterial Proteins/isolation & purification , Bacterial Proteins/metabolism , Carbon-Oxygen Ligases/genetics , Carbon-Oxygen Ligases/isolation & purification , Carbon-Oxygen Ligases/metabolism , Cattle , Ciprofloxacin/pharmacology , Dairy Products/microbiology , Food Contamination/analysis , Genotype , Gentamicins/pharmacology , Goats , Meat Products/microbiology , Microbial Sensitivity Tests , Penicillins/pharmacology , Phenotype , Streptomycin/pharmacology , Teicoplanin/pharmacology , Vancomycin/pharmacology , beta-Lactamases/metabolismABSTRACT
OBJECTIVE: To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them. DESIGN: This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001. SETTING: The medical-surgical ICU of a tertiary-care, university-affiliated hospital in Argentina. METHODS: We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed. RESULTS: During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1). CONCLUSIONS: A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.
