Lacticaseibacillus rhamnosus CRL 2244 secreted metabolites display killing and antibiotic synergistic activity against multi-drug resistant pathogens.

A growing increase in the number of serious infections caused by multidrug resistant bacteria (MDR) is challenging our society. Despite efforts to discover novel therapeutic options, few antibiotics targeting MDR have been approved by the Food and Drug Administration (FDA). Lactic acid bacteria have emerged as a promising therapeutic alternative due to their demonstrated ability to combat MDR pathogens in vitro. Our previous co-culture studies showed Lacticaseibacillus rhamnosus CRL 2244 as having a potent killing effect against carbapenem-resistant Acinetobacter baumannii (CRAB) strains. Here we report that cell-free conditioned media (CFCM) samples obtained from Lcb. rhamnosus CRL 2244 cultures incubated at different times display antimicrobial activity against 43 different pathogens, including CRAB, methicillin-resistant Staphylococcus aureus (MRSA) and carbapenemase Klebsiella pneumoniae (KPC)-positive strains. Furthermore, transwell and ultrafiltration analyses together with physical and chemical/biochemical tests showed that Lcb. rhamnosus CRL 2244 secretes a <3 kDa metabolite(s) whose antimicrobial activity is not significantly impaired by mild changes in pH, temperature and various enzymatic treatments. Furthermore, sensitivity and time-kill assays showed that the bactericidal activity of the Lcb. rhamnosus CRL 2244 metabolite(s) enhances the activity of some current FDA approved antibiotics. We hypothesize that this observation could be due to the effects of Lcb. rhamnosus CRL 2244 metabolite(s) on cell morphology and the enhanced transcriptional expression of genes coding for the phenylacetate (PAA) and histidine catabolic Hut pathways, metal acquisition and biofilm formation, all of which are associated with bacterial virulence. Interestingly, the extracellular presence of Lcb. rhamnosus CRL 2244 induced the transcription of the gene coding for the CidA/LgrA protein, which is involved in programmed cell death in some bacteria. Overall, the findings presented in this report underscore the promising potential of the compound(s) released by Lcb. rhamnosus CRL2244 as an alternative and/or complementary option to treat infections caused by A. baumannii as well as other MDR bacterial pathogens.

Draft genome sequence of Lacticaseibacillus rhamnosus CRL 2244, a strain with strong killing effect on carbapenem-resistant Acinetobacter baumannii.

We report here a draft genome assembly of Lacticaseibacillus rhamnosus CRL 2244, recovered from wastewater in Argentina. The genome has a size of 2,898,100 bp, with G + C content of 46.73%. Comparative analysis reveals that its closest relative is L. rhamnosus 1.0320 (GCF_006151905.1), with an average nucleotide identity of 97.46%.

Crypsis by background matching and disruptive coloration as drivers of substrate occupation in sympatric Amazonian bark praying mantises.

Background matching and disruptive coloration are common camouflage strategies in nature, but few studies have accurately measured their protective value in living organisms. Amazon's Bark praying mantises exhibit colour patterns matching whitish and greenish-brown tree trunks. We tested the functional significance of background matching and disruptive coloration of different praying mantis morphospecies (white, grey and green) detected by DNA barcoding. Through image analysis, avian visual models and field experiments using humans as potential predators, we explored whether the background occupation of mantises provides camouflage against predation. Data were obtained for individuals against their occupied tree trunks (whitish or greenish-brown) and microhabitats (lichen or bryophyte patches), compared to non-occupied trunks. White and grey mantises showed lower colour contrasts against occupied trunks at the scale of tree trunk, with no differences in luminance contrasts. Conversely, green mantises showed lower colour and luminance contrasts against microhabitats and also exhibited high edge disruption against greenish-brown trunks. The camouflage of white and green mantis models against colour-matching trunks increased search time and reduced encounter distance of human predators. We highlight the importance of camouflage strategies at different spatial scales to enhance individual survival against predators. Specifically, we present a stunning study system to investigate the relationship of phylogenetically related species that use camouflage in sympatry.

Antimicrobial activity of the Lacticaseibacillus rhamnosus CRL 2244 and its impact on the phenotypic and transcriptional responses in carbapenem resistant Acinetobacter baumannii.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a recognized nosocomial pathogen with limited antibiotic treatment options. Lactic acid bacteria (LAB) constitute a promising therapeutic alternative. Here we studied the antibacterial properties of a collection of LAB strains using phenotypic and transcriptomic analysis against A. baumannii clinical strains. One strain, Lacticaseibacillus rhamnosus CRL 2244, demonstrated a potent inhibitory capacity on A. baumannii with a significant killing activity. Scanning electron microscopy images showed changes in the morphology of A. baumannii with an increased formation of outer membrane vesicles. Significant changes in the expression levels of a wide variety of genes were also observed. Interestingly, most of the modified genes were involved in a metabolic pathway known to be associated with the survival of A. baumannii. The paa operon, Hut system, and fatty acid degradation were some of the pathways that were induced. The analysis reveals the impact of Lcb. rhamnosus CRL 2244 on A. baumannii response, resulting in bacterial stress and subsequent cell death. These findings highlight the antibacterial properties of Lcb. rhamnosus CRL 2244 and its potential as an alternative or complementary strategy for treating infections. Further exploration and development of LAB as a treatment option could provide valuable alternatives for combating CRAB infections.

Phenotypic and transcriptional analysis of the antimicrobial effect of lactic acid bacteria on carbapenem-resistant Acinetobacter baumannii: Lacticaseibacillus rhamnosus CRL 2244 an alternative strategy to overcome resistance?"

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a recognized nosocomial pathogen with limited antibiotic treatment options. Lactic acid bacteria (LAB) constitute a promising therapeutic alternative. Here we studied the antibacterial properties of a collection of LAB strains using phenotypic and transcriptomic analysis against A. baumannii clinical strains. One strain, Lacticaseibacillus rhamnosus CRL 2244, demonstrated a potent inhibitory capacity on A. baumannii with a significant killing activity. Scanning electron microscopy images showed changes in the morphology of A. baumannii with an increased formation of outer membrane vesicles. Significant changes in the expression levels of a wide variety of genes were also observed. Interestingly, most of the modified genes were involved in a metabolic pathway known to be associated with the survival of A. baumannii . The paa operon, Hut system, and fatty acid degradation were some of the pathways that were induced. The analysis reveals the impact of Lcb. rhamnosus CRL 2244 on A. baumannii response, resulting in bacterial stress and subsequent cell death. These findings highlight the antibacterial properties of Lcb. rhamnosus CRL 2244 and its potential as an alternative or complementary strategy for treating infections. Further exploration and development of LAB as a treatment option could provide valuable alternatives for combating CRAB infections.

Síndrome de hipotensión endocraneana espontánea: reporte de un caso clínico / Spontaneous intracranial hypotension syndrome: clinic case report

La hipotensión intracraneal espontánea (SIH) es una patología con una incidencia anual aproximada de 5 por cada 100.000 personas al año, caracterizada clásicamente por cefalea ortostática comúnmente secundaria a una fuga espontánea de líquido cefalorraquídeo (LCR), pudiendo existir a su vez una amplia gama de síntomas asociados. El diagnóstico se centra en la clínica y en hallazgos típicos en la resonancia nuclear magnética (RM), sin embargo, según diversos estudios, puede corresponder a una patología subdiagnosticada por la dificultad que ha existido en definir criterios diagnósticos universales y un manejo terapéutico estandarizado, el cual varía inicialmente entre manejo médico conservador y/o parches de sangre epidural (PHE). Reportamos el caso de una paciente femenina de 51 años quien fue atendida en el Hospital Herminda Martin de Chillán donde se realizó el diagnóstico y tratamiento sintomático con PHE.

Spontaneous intracranial hypotension (SIH) is a pathology with an annual incidence of approximately 5 per 100,000 people per year, classically characterized by orthostatic headache commonly secondary to a spontaneous cerebrospinal fluid (CSF) leak, and there may also be a wide range of of associated symptoms. The diagnosis is centered on the clinic and on typical findings in magnetic resonance imaging (MRI), however, according to various studies, it may correspond to an underdiagnosed pathology due to the difficulty that has existed in defining universal diagnostic criteria and standardized therapeutic management. which initially varies between conservative medical management and/or epidural blood patches (PHE). We report the case of a 51-year-old female patient who was treated at the Herminda Martin de Chillán Hospital where the diagnosis and symptomatic treatment with PHE were made.

[Skin manifestations in patients with COVID-19. A prospective study]. / Manifestaciones cutáneas en pacientes con COVID-19. Estudio prospectivo.

As of March 2020, skin lesions associated with COVID-19 have been described. The objectives of the study were to characterize the skin lesions in these patients, analyze their temporal relationship, association with the severity of the disease, extracutaneous symptoms and laboratory parameters. A prospective, observational, analytical and cross-sectional study was conducted in hospitalized patients diagnosed with COVID-19. Dermatoses were classified as primary and secondary. Forty-five patients were included, 44.4% with primary dermatoses and 53.3% with secondary lesions. The mean age was 46 years (SD: 17), with a male predominance (68.9%). The primary lesions appeared after a median of 5 days (IQR: 3-10) from the onset of COVID-19 symptoms and the secondary ones after 14.5 days (IQR: 7-20). The primary dermatoses found were maculopapular rash (65%), urticarial (20%, half with vesicular lesions), livedo reticular (10%) and purpura (5%). The most frequent secondary dermatoses were adverse drug reactions (37.1%) and infectious dermatoses (25.9%). Maculopapular rash was associated with moderate COVID-19 and pressure injuries with severe COVID-19 (p < 0.05). The finding of neutrophilia was higher among those with secondary infectious dermatoses (p < 0.05). No significant differences were found when evaluating other laboratory parameters. This work shows the skin manifestations in patients hospitalized with COVID-19 in our environment. The most prevalent pattern was the maculopapular rash that was associated with the moderate form of the disease. The appearance of lesions 2 weeks after the onset of COVID-19 symptoms was associated with secondary dermatoses.

Desde marzo 2020 se describieron lesiones cutáneas asociadas a COVID-19. Los objetivos del estudio fueron caracterizar las lesiones cutáneas en estos pacientes, analizar su relación temporal, asociación con la gravedad de la enfermedad, los síntomas extracutáneos y parámetros de laboratorio. Es un estudio prospectivo, observacional, analítico y de corte transversal, en internados con diagnóstico de COVID-19. Se catalogaron las dermatosis en primarias y secundarias. Se incluyeron 45 pacientes, 44.4% con dermatosis primarias y 53.3% con lesiones secundarias. La edad media fue de 46 años (DS: 17), con predominio del sexo masculino (68.9%). Las lesiones primarias aparecieron luego de una mediana de 5 días (RIC: 3-10) del inicio de los síntomas de COVID-19 y las secundarias luego de 14.5 días (RIC: 7-20). Las dermatosis primarias fueron: exantema maculopapuloso (65%), urticariforme (20%, la mitad con lesiones vesiculosas), livedo reticular (10%) y púrpura (5%). Las dermatosis secundarias más frecuentes fueron reacciones adversas a fármacos (37.1%) y dermatosis infecciosas (25.9%). El exantema maculopapuloso se asoció a COVID-19 moderado y las lesiones por presión a COVID-19 grave (p < 0.05). El hallazgo de neutrofilia fue mayor entre aquellos con dermatosis infecciosas secundarias (p < 0.05). No se encontraron diferencias significativas al evaluar otros parámetros de laboratorio, ni síntomas extracutáneos. Este trabajo muestra las manifestaciones cutáneas en internados con COVID-19. El patrón más prevalente fue el exantema maculopapuloso que se asoció con la forma moderada de la enfermedad. La aparición de lesiones luego de las 2 semanas del inicio de los síntomas de COVID-19 se asoció a dermatosis secundarias.

Manifestaciones cutáneas en pacientes con COVID-19. Estudio prospectivo / Skin manifestations in patients with COVID-19. A prospective study

Resumen Desde marzo 2020 se describieron lesiones cutáneas asociadas a COVID-19. Los objetivos del estudio fueron caracterizar las lesiones cutáneas en estos pacientes, analizar su relación temporal, asociación con la gravedad de la enfermedad, los síntomas extracutáneos y parámetros de laboratorio. Es un estudio prospectivo, observacional, analítico y de corte transversal, en internados con diagnóstico de COVID-19. Se catalogaron las dermatosis en primarias y secundarias. Se incluyeron 45 pacientes, 44.4% con dermatosis primarias y 53.3% con lesiones secundarias. La edad media fue de 46 años (DS: 17), con predominio del sexo masculino (68.9%). Las lesiones primarias aparecieron luego de una mediana de 5 días (RIC: 3-10) del inicio de los síntomas de COVID-19 y las secundarias luego de 14.5 días (RIC: 7-20). Las dermatosis primarias fueron: exantema maculopapuloso (65%), urticariforme (20%, la mitad con lesiones vesiculosas), livedo reticular (10%) y púrpura (5%). Las dermatosis secundarias más frecuentes fueron reacciones adversas a fármacos (37.1%) y dermatosis infecciosas (25.9%). El exantema maculopapuloso se asoció a COVID-19 moderado y las lesiones por presión a COVID-19 grave (p < 0.05). El hallazgo de neutrofilia fue mayor entre aquellos con dermatosis infecciosas secundarias (p < 0.05). No se encontraron diferencias significativas al evaluar otros parámetros de laboratorio, ni síntomas extracutáneos. Este trabajo muestra las manifestaciones cutáneas en internados con COVID-19. El patrón más prevalente fue el exantema maculopapuloso que se asoció con la forma moderada de la enfermedad. La aparición de lesiones luego de las 2 semanas del inicio de los síntomas de COVID-19 se asoció a dermatosis secundarias.

Abstract As of March 2020, skin lesions associated with COVID-19 have been described. The objectives of the study were to char acterize the skin lesions in these patients, analyze their temporal relationship, association with the severity of the disease, extracutaneous symptoms and laboratory parameters. A prospective, observational, analytical and cross-sectional study was conducted in hospitalized patients diagnosed with COVID-19. Dermatoses were clas sified as primary and secondary. Forty-five patients were included, 44.4% with primary dermatoses and 53.3% with secondary lesions. The mean age was 46 years (SD: 17), with a male predominance (68.9%). The primary lesions appeared after a median of 5 days (IQR: 3-10) from the onset of COVID-19 symptoms and the secondary ones after 14.5 days (IQR: 7-20). The primary dermatoses found were maculopapular rash (65%), urticarial (20%, half with vesicular lesions), livedo reticular (10%) and purpura (5%). The most frequent secondary dermatoses were adverse drug reactions (37.1%) and infectious dermatoses (25.9%). Maculopapular rash was associated with moderate COVID-19 and pressure injuries with severe COVID-19 (p < 0.05). The finding of neutrophilia was higher among those with secondary infectious dermatoses (p < 0.05). No significant differences were found when evaluating other laboratory parameters. This work shows the skin manifestations in patients hospitalized with COVID-19 in our environment. The most prevalent pattern was the maculopapular rash that was associated with the moderate form of the disease. The appearance of lesions 2 weeks after the onset of COVID-19 symptoms was associated with secondary dermatoses.

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review.

BACKGROUND: Among the treatments for type 1 diabetes mellitus (T1DM), Continuous Subcutaneous Insulin Infusion (CSII) is a device that infuses insulin through the subcutaneous tissue in an uninterrupted manner and that comes closest to the physiological secretion of insulin. The use of CSII can provide the family with greater security and children and adolescents have more autonomy in relation to the treatment of T1DM. There is a lack of reviews that systematically gather the mounting evidence about the use of CSII in children and adolescents with T1DM. Therefore, the aim of this review was to group and describe primary and secondary studies on the use of CSII in children and adolescents with T1DM. METHODS: A systematic mapping review was performed based on searches in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, using a combination of descriptors and keywords. The screening of the studies was carried out with the aid of the Rayyan software and reading in full was conducted independently by two reviewers. The data extraction of the studies was performed using an extraction tool adapted and validated by researchers specialized in diabetes. The data were analyzed according to the content analysis technique. The map from geocoding of the studies was produced using the ArcGis 10.5 software. RESULTS: A total of 113 studies were included in the review, including primary studies, literature reviews and gray literature publications. The content analysis of the results of the studies allowed for the identification of four categories: 1) metabolic control; 2) support networks; 3) benefits of using CSII; and 4) challenges of using CSII, each category having its respective subcategories. The review also made it possible to conduct a rigorous mapping of the literature on the use of CSII considering the location of development and the design of the studies. CONCLUSIONS: The use of CSII should be indicated by health professionals able to prepare children, adolescents, and their families for the treatment of T1DM, and, despite being a technological device, it may not be suitable for the entire pediatric population.

Burnout académico como factor predictivo del riesgo suicida en estudiantes de enfermería / Academic burnout as a predictive factor of suicide risk in nursing students

Objetivo principal: Relacionar el síndrome de burnout académico con el riesgo suicida en los estudiantes de enfermería de una universidad del norte de Chile. Metodología: enfoque cuantitativo, correlacional, y de corte transversal, de diseño no experimental. Resultados principales: los participantes reportaron un 10 % de la muestra con riesgo suicida moderado y severo, y ambas variables presentaron relaciones estadísticamente significativas (r=,501, p<,000). Conclusión principal: Existe relación entre el burnout académico y el riesgo suicida. Asimismo, la detección oportuna y precoz de la relación entre el burnout académico y el riesgo suicida puede ayudar a prevenir el comportamiento suicida e incluso el suicidio en estudiantes de enfermería. Urge que las universidades busquen estrategias de pesquisa precoz del síndrome de burnout y así evitar tragedias como las de un suicidio asociado.(AU)

Objective: To relate the academic burnout syndrome with the suicide risk in nursing students at a university in the north of Chile. Methodology: quantitative, correlational, and cross-sectional approach, of non-experimental design. Main results: the participants reported 10 % of the sample with moderate and severe suicide risk, and both variables presented statistically significant relationships (r = ,501; p<,000). Main conclusion: There is a relationship between academic burnout and suicide risk. Likewise, the timely and early detection of the relationship between academic burnout and suicidal risk can help prevent suicidal behavior and even suicide in nursing students. It is urgent that universities seek early screening strategies for burnout syndrome and thus avoid tragedies such as associated suicide.(AU)

Evidências de validade da estrutura interna da versão brasileira do Needs of Parents Questionnaire (NPQ) / Internal structure validity evidence of the Brazilian version of the Needs of Parents Questionnaire (NPQ)

A valorização da permanência, participação e envolvimento dos pais nos cuidados à criança hospitalizada tem sido um qualificador para a assistência de enfermagem pediátrica. Esta tríade representa em fonte de proteção, apoio e segurança para a criança, pois contribui para aproximar a díade criança/adolescente-pais/cuidadores, reduzir o estresse emocional de ambos, além de fortalecer vínculos. O processo de hospitalização demanda adaptações dos pais/cuidadores e da criança/adolescente a uma nova realidade, que evoluirá de forma equilibrada se os recursos forem adequados. Nesse processo, os pais/cuidadores vivenciam diversos sentimentos, o que gera necessidades de várias ordens. Identificar essas necessidades de forma sistematizada, por meio, por exemplo, de um questionário para esse fim, pode auxiliar a equipe de saúde, particularmente a de enfermagem, a planejar intervenções que qualifiquem o cuidado prestado. Assim, este estudo objetivou avaliar as evidências de validade da estrutura interna da versão brasileira do Needs of Parents Questionnaire (NPQ). Esse questionário avalia a perspectiva de pais/cuidadores sobre suas necessidades no contexto da hospitalização de seus filhos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa das instituições proponente e coparticipante. O estudo de campo foi realizado com uma amostra de 510 pais e/ou cuidadores que acompanhavam a hospitalização de seus filhos, por um período de no mínimo 48h, independentemente do diagnóstico. Métodos estatísticos rigorosos e contemporâneos da psicometria foram utilizados para a análise dos dados, em busca de um modelo de melhor ajustamento ao questionário original. As primeiras análises evidenciaram índices de adequabilidade para a análise fatorial: determinante da matriz de correlação < 0.000001; KMO= 0,71024; esfericidade de Bartlett= 5677,8 (df = 528; P = 0,000010). A dimensionalidade apresentou critérios de UNICO (0,911), ECV (0,799), MIREAL (0,244). As comunalidades variaram de 0.216 a 0.665, e a variância explicada foi de 44,68%. A confiabilidade demonstrou valores de 0.93 para Alpha de Cronbach, 0.92 para Omega McDonald's e 0.98 para GLB. O G-H latente obteve escores de 0.94 e 0.87, o que sugere uma latente variável bem definida. O NPQ-Brasil conformou-se no modelo bidimensional, bem-estar parental (20 itens) e cuidado parental (13 itens), totalizando 33 itens. Tais resultados indicam o ajuste do modelo e sustentam que o NPQ-Brasil está adequado para sua aplicação na população alvo, no contexto brasileiro. A enfermagem pediátrica, a enfermagem familiar e áreas afins se beneficiarão da versão validada do NPQ-Brasil, na medida em que apoiará enfermeiros e profissionais de saúde a acessar e planejar intervenções que atendam às necessidades de pais/cuidadores durante a hospitalização de seus filhos, com vistas à qualificação do cuidado

The valuation of the permanence, participation and involvement of parents in the care of hospitalized children has been a qualifier for pediatric nursing care. This triad constitutes a source of protection, support and security for the child, contributing to bring the dyad child/adolescent-parents/caregivers closer, reducing emotional stress for both, in addition to strengthening bonds. The hospitalization process demands adaptations from parents/caregivers and the child/adolescent to a new reality, which will evolve in a balanced way if the resources are adequate. In this process, parents/caregivers experience different feelings, which generates different types of needs. Identifying these needs in a systematic way, through, for example, a questionnaire for this purpose can help the health team, particularly the nursing team, to plan interventions that qualify the care provided. Thus, this study aimed to assess the evidence of validity of the internal structure of the Brazilian version of the Needs of Parents Questionnaire (NPQ). This questionnaire assesses the perspective of parents/caregivers about their needs in the context of their children's hospitalization. The Research Ethics Committee of the proposing and co-participating institutions approved the study. The field study was carried out with a sample of 510 parents and/or caregivers who accompanied their children's hospitalization for a period of at least 48 hours, regardless of diagnosis. Rigorous and contemporary psychometrics statistical methods were used to analyze the data, in search of a better fit model to the original questionnaire. The first analyzes showed suitability indices for the factor analysis: determinant of the correlation matrix < 0.000001; KMO=0.71024; Bartlett's sphericity = 5677.8 (df = 528; P = 0.000010). Dimensionality presented criteria of UNICO (0.911), ECV (0.799), MIREAL (0.244). The commonalities ranged from 0.216 to 0.665, and the explained variance was 44.68%. Reliability showed values of 0.93 for Cronbach's Alpha, 0.92 for Omega McDonald's and 0.98 for GLB. The latent G-H obtained scores of 0.94 and 0.87, which suggests a well-defined latent variable. The NPQ-Brazil was based on the two-dimensional model, parental well-being (20 items) and parental care (13 items), totaling 33 items. These results indicate the adjustment of the model and support that the NPQ-Brazil is suitable for its application in the target population, in the Brazilian context. Pediatric nursing, family nursing and related areas will benefit from the validated version of the NPQ-Brazil, as it will support nurses and health professionals to access and plan interventions that meet the needs of parents/caregivers during their children's hospitalization, with a view to qualifying care

Exantema asociado a COVID-19 / COVID-19 skin rash

A partir de marzo de 2020 se han empezado a describir lesiones cutáneas asociadas a COVID-19 que fueron agrupadas en patrones y se relacionaron con la severidad y la temporalidad de la enfermedad. Se presenta el caso de un paciente con COVID-19 leve y lesiones cutáneas que pueden atribuirse a la infección. Se realiza una revisión de las manifestaciones cutáneas asociadas a COVID-19 y la interpretación de los diagnósticos diferenciales que se pensaron en el paciente

Since March 2020, skin lesions associated with COVID-19 have begun to be described. These were grouped into patterns, and were related to the severity and temporality of the disease. A patient with mild COVID-19 and skin lesions that can be attributed to the infection is presented. A review of the cutaneous manifestations associated with COVID-19 and the interpretation of the differential diagnoses that were thought of in the patient is carried out.

Mothers living with HIV: replacing breastfeeding by infant formula / Madres viviendo con VIH: la sustitución de la lactancia por una fórmula láctea infantil / Mães vivendo com HIV: a substituição do aleitamento por fórmula láctea infantil

ABSTRACT Objective: To explore factors that interact and shape the meaning and experience of mothers of HIV-exposed children in relation to replacing breastfeeding by infant formula. Method: A qualitative study was carried out with 23 mothers living with HIV, whose children were up to 18 months of age and under follow-up in a specialized care service. Symbolic Interactionism, semi-structured interviews and content analysis were adopted as theoretical framework. Results: The social symbols of breastfeeding, the (un)availability of the milk formula and the (lack of)support of health professionals influenced the mothers' experience with formula feeding. Social, cultural and economic constraints have proved capable of undermining the conditions necessary for the replacement of breastfeeding. Final considerations: The availability of infant formula, access to lactation inhibitor and quality of health services still represent challenges to eradicate new HIV infections in children.

RESUMEN Objetivo: Explorar los factores que interactúan y moldean el significado y la experiencia de madres de niños expuestos al VIH en relación a la sustitución de la lactancia por una fórmula láctea infantil. Método: Estudio cualitativo, con 23 madres viviendo con VIH, cuyos hijos tenían hasta 18 meses de edad y estaban bajo seguimiento en servicio de asistencia especializada. Se adoptaron el Interaccionismo Simbólico como referencial teórico, entrevistas semiestructuradas y el análisis de contenido. Resultados: Los símbolos sociales de la lactancia, la (in) disponibilidad de la fórmula láctea y el (des) apoyo de los profesionales de la salud influenciaron a la experiencia de las madres con la alimentación por una fórmula láctea. Los cercos sociales, culturales y económicos se mostraron capaces de perjudicar las condiciones necesarias para la sustitución de la lactancia materna. Consideraciones finales: La disponibilidad de la fórmula láctea infantil, el acceso al inhibidor de la lactancia y la calidad de los servicios de salud todavía representan desafíos para eliminar nuevas infecciones por el VIH en niños.

RESUMO Objetivo: Explorar os fatores que interagem e moldam o significado e a experiência de mães de crianças expostas ao HIV em relação à substituição do aleitamento por fórmula láctea infantil. Método: Estudo qualitativo, com 23 mães vivendo com HIV, cujos filhos tinham até 18 meses de idade e estavam sob acompanhamento em serviço de assistência especializado. Foram adotados o Interacionismo Simbólico como referencial teórico, entrevistas semiestruturadas e análise de conteúdo. Resultados: Os símbolos sociais da amamentação, a (in)disponibilidade da fórmula láctea e o (des)apoio dos profissionais de saúde influenciaram a experiência das mães com a alimentação por fórmula láctea. Cerceamentos sociais, culturais e econômicos mostraram-se capazes de prejudicar as condições necessárias para a substituição do aleitamento materno. Considerações finais: A disponibilidade da fórmula láctea infantil, o acesso ao inibidor de lactação e a qualidade dos serviços de saúde ainda representam desafios para eliminar novas infecções pelo HIV em crianças.

Mothers living with HIV: replacing breastfeeding by infant formula.

OBJECTIVE: To explore factors that interact and shape the meaning and experience of mothers of HIV-exposed children in relation to replacing breastfeeding by infant formula. METHOD: A qualitative study was carried out with 23 mothers living with HIV, whose children were up to 18 months of age and under follow-up in a specialized care service. Symbolic Interactionism, semi-structured interviews and content analysis were adopted as theoretical framework. RESULTS: The social symbols of breastfeeding, the (un)availability of the milk formula and the (lack of)support of health professionals influenced the mothers' experience with formula feeding. Social, cultural and economic constraints have proved capable of undermining the conditions necessary for the replacement of breastfeeding. FINAL CONSIDERATIONS: The availability of infant formula, access to lactation inhibitor and quality of health services still represent challenges to eradicate new HIV infections in children.

Domain structure and expression along the midgut and carcass of peritrophins and cuticle proteins analogous to peritrophins in insects with and without peritrophic membrane.

Most insects have a peritrophic membrane (matrix) (PM) surrounding the food bolus. This structure, similarly to the cuticle, is mainly composed of chitin and proteins. The main proteins forming PM are known as peritrophins (PMP), whereas some of the cuticle proteins are the cuticle proteins analogous to peritrophins (CPAP). Both proteins are composed of one or more chitin binding peritrophin-A domain (CBD) and no other recognized domain. Furthermore, insects containing PM usually have two chitin synthase (CS) genes, one mainly expressed in carcass and the other in midgut. In this work we identified PMP, CPAP and CS genes in the genome of insects from the Polyneoptera, Paraneoptera and Holometabola cohorts and analyzed their expression profile in different species from each group. In agreement with the absence of PM, we observed less CBD-containing proteins and only one CS gene in the genome of Paraneoptera species, except for the Phthiraptera Pediculus humanus. The lack of PM in Paraneoptera species was also confirmed by the micrographs of the midgut of two Hemiptera species, Dysdercus peruvianus and Mahanarva fimbriolata which agreed with the RNA-seq data of both species. Our analyses also highlighted a higher number of CBD-containing proteins in Holometabola in relation to the earlier divergent Polyneoptera group, especially regarding the genes composed of more than three CBDs, which are usually associated to PM formation. Finally, we observed a high number of CBD-containing proteins being expressed in both midgut and carcass tissues of several species, which we named as ubiquitous-CBD-containing proteins (UCBP), as their function is unclear. We hypothesized that these proteins can be involved in both cuticle and PM formation or that they can be involved in immune response and/or tracheolae formation.

Prevalência de flebite relacionada ao uso de dispositivos intravenosos periféricos em crianças / Prevalence of phlebitis related to the use of peripheral intravenous devices in children / Prevalencia de flebitis relacionada al uso de dispositivos intravenosos periféricos en niños

Objetivo: Avaliar a prevalência de flebite relacionada ao uso de dispositivos intravenosos periféricos em crianças em um hospital universitário. Método: Estudo descritivo e retrospectivo, quantitativo, com base em dados provenientes da ficha de notificação de flebite relacionada à terapia intravenosa periférica, no período de junho de 2011 a junho de 2014, da unidade de terapia intensiva pediátrica, na cidade de Curitiba-PR. Resultados: De um total de 1306 cateteres, foram notificados 339 casos de flebite (prevalência de 26%) no período de três anos. A prevalência de flebite foi de 34% nas crianças de 0 a 2 anos e de 30,2% (n=179) no sexo feminino. Quanto à classificação das flebites 82,6% (n=280) eram de Grau 1 e o tempo médio de permanência do dispositivo foi de 49,92 ± 43,19 horas. Conclusão: Os dados apresentados demonstram alta prevalência de flebite em pacientes pediátricos e a necessidade de buscar medidas que reduzam esses eventos (AU).

Objective: To assess the prevalence of phlebitis, related to the use of peripheral intravenous devices in children in a teaching hospital. Method: A quantitative, descriptive and retrospective study, based in data taken from the phlebitis notification form related to peripheral intravenous therapy, in June 2011 ­ June 2014, in a pediatric intensive care unit in the city of Curitiba, in the Brazilian state of Paraná (PR). Results: Of a total of 1306 catheters, 339 cases of phlebitis were notified (prevalence of 26%) in the three- year period. The prevalence of phlebitis was 34% in children aged from 0 to 2 years and was 30.2% (n=179) among female children. Regarding the classification of the cases of phlebitis, 82.6% (n=280) were Grade 1, and the mean dwell-time of the device was 49.92 ± 43.19 hours. Conclusion: The data presented here demonstrate a high prevalence of phlebitis in pediatric patients, and the need to seek measures capable of reducing these events (AU).

Objetivo: Evaluar la prevalencia de flebitis relacionada al uso de dispositivos intravenosos periféricos en niños, en un hospital universitario. Métodos: Estudio descriptivo y retrospectivo, cuantitativo, basado en datos obtenidos de ficha de notificación de flebitis relacionada a terapia intravenosa periférica, desde junio de 2011 a junio de 2014, en unidad de terapia intensiva pediátrica, ciudad de Curitiba-PR. Resultados: Sobre un total de 1306 catéteres, fueron notificados 339 casos de flebitis (prevalencia del 26%) en un lapso de tres años. La prevalencia de flebitis fue del 34% en niños de 0 a 2 años y de 30,2% (n=179) en el sexo femenino. Respecto a la clasificación de las flebitis, 82,6% (n=280) fueron de Grado 1, y el tiempo medio de permanencia del dispositivo fue de 49,92 ± 43,19 horas. Conclusión: Los datos presentados demuestran alta prevalencia de flebitis en pacientes pediátricos, y la necesidad de buscar medidas reductoras de tales eventos (AU).

Quality of life in dementia: the role of non-cognitive factors in the ratings of people with dementia and family caregivers.

BACKGROUND: The validity of self-reported quality-of-life (QoL) assessments of people with dementia (PWD) is a critical issue. We designed this study to determine the non-cognitive factors that are associated with self-reported QoL and PWD QoL as rated by family caregivers. METHODS: Using a cross-sectional study, we assessed QoL of 41 people with mild Alzheimer's disease (AD). The individuals with AD and their family caregivers completed the Quality of Life in Alzheimer's Disease Scale (QoL-AD), the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR) scale, the Cornell Scale for Depression in Dementia (CSDD), the Pfeffer Functional Activities Questionnaire (FAQ), and the Zarit Burden Interview (ZBI). Univariate and multivariate regression analyses were conducted to examine the contribution of the various cofactors. RESULTS: We observed a significant difference (t = 3.292, p < 0.01, d = 0.727) in the QoL measures of PWD after comparing self-reported assessments with the assessments of family caregivers. Linear regression analysis demonstrated that awareness of disease was related to PWD QoL-AD scores. Both the education levels of family caregivers and the depressive symptoms in PWD were related to the family caregivers' ratings of PWD QoL. CONCLUSIONS: The difference between self-reported QoL and family caregivers' ratings of QoL in people with mild dementia indicated that cognitive impairment was not the primary factor that accounted for the differences in the QoL assessments. Our findings suggested that non-cognitive factors, such as awareness of disease and depressive symptoms, played an important role in the differences between the self-reported AD QoL ratings and the caregivers' AD QoL ratings. A major implication is that discrete measures such as cognition or level of function are likely to miss important factors that influence QoL.