[Impact of early follow-up from primary care on 30days readmission after heart failure hospitalization]. / Impacto del seguimiento precoz desde atención primaria en el reingreso a 30días tras el alta hospitalaria por insuficiencia cardiaca.

INTRODUCTION: Reducing heart failure (HF) admissions is one of the main objectives in disease control, due to its impact on prognosis and costs. The transitional models at discharge are imposed as a strategy capable of reducing hospitalizations, most of them based on specific hospital units. We analyzed the impact of the primary care (PC) post-discharge follow-up. MATERIAL AND METHODS: Retrospective observational study at the referral area of a tertiary hospital. Linear regression analysis was performed between early follow-up from the PC center after HF admission rate and the 30-day all-cause readmission rate throughout 2021. RESULTS: The degree of follow-up from PC after hospital discharge for heart failure is associated with fewer 30-day readmissions for all causes (Pearson's R=0.53, P=.02); with a decrease of 20%, similar to that observed when it is performed from other care facilities and which is maintained when adjusting for the complexity of the patients. CONCLUSIONS: PC heart failure post-discharge follow-up could be effective in reducing hospitalizations, and is complementary to that carried out by hospital units.

Costs of healthcare-associated infections to the Brazilian public Unified Health System in a tertiary-care teaching hospital: a matched case-control study.

BACKGROUND: Little is known about the economic burden of healthcare-associated infections (HAIs) in Brazil. AIM: To analyse the costs of hospitalization by reimbursement from the Brazilian government, via the Brazilian Unified Health System (SUS) affiliation, and direct costs in the adult Intensive Care Unit (ICU). METHODS: The matched-pairs case-control study (83 patients with HAIs and 83 without HAIs) was performed at a referral tertiary-care teaching hospital in Brazil in January 2018. In order to calculate the HAI costs from the perspective of the payer, the total cost for each hospitalization was obtained through the Hospital's Billing Sector. Direct costs were calculated annually for 949 critical patients during 2018. FINDINGS: The reimbursement cost per hospitalization of patients with HAIs was 75% (US$2721) higher than patients without HAIs (US$1553). When a patient has an HAI, in addition to a longer length of stay (15 days), there was an extra increase (US$996) in the reimbursement cost per hospitalization. An HAI in the ICU was associated with a total direct cost eight times higher compared with patients who did not develop infections in this unit, US$11,776 × US$1329, respectively. The direct cost of hospitalization in the ICU without HAI was 56.5% less than the reimbursement (US$1329 × US$3052, respectively), whereas for the patient with an HAI, the direct cost was 111.5% above the reimbursement (US$11,776 × US$5569, respectively). CONCLUSION: HAIs contribute to a longer stay and an eight-fold increase in direct costs. It is necessary to reinforce programmes that prevent HAIs in Brazilian hospitals.

Arginine for gestating sows and foetal development: A systematic review.

The use of functional amino acids during pregnancy has been linked to improved reproduction in mammals. In this context, arginine is a precursor in the synthesis of numerous molecules, such as nitric oxide and polyamines, which play an important role during reproduction. However, contradictory studies are found in the literature, particularly regarding the amount of supplementation and the period of pregnancy in which it is used. The objective of this study was to evaluate the effects of dietary arginine supplementation for pregnant sows on foetal development via a systematic review. The search for papers was performed during the month of December 2015, in the databases ISI Web of Science, Science Direct, Scopus, and SciELO. From a total of 5675 returned studies, only 13 papers were selected after applying selection criteria. Most (47%) of the studies that evaluated the effects of dietary arginine supplementation on foetal development in pigs used 1% arginine. Supplementation was initiated in the first third of pregnancy in 47% of tests, including in both primiparous and multiparous sows. These studies showed positive results for embryo survival and foetal development, evidenced by the increase in placental weight and the number and weight of piglets born alive. Of all evaluated studies, 53% showed benefits on foetal development. It is concluded that supplementing dietary arginine in gestating sows can benefit embryo survival and foetal development. However, to establish a supplementation plan with this amino acid, aspects related to the period of pregnancy, supplementation levels, and source of arginine must be well defined.

Verifying the geographic origin of mahogany (Swietenia macrophylla King) with DNA-fingerprints.

Illegal logging is one of the main causes of ongoing worldwide deforestation and needs to be eradicated. The trade in illegal timber and wood products creates market disadvantages for products from sustainable forestry. Although various measures have been established to counter illegal logging and the subsequent trade, there is a lack of practical mechanisms for identifying the origin of timber and wood products. In this study, six nuclear microsatellites were used to generate DNA fingerprints for a genetic reference database characterising the populations of origin of a large set of mahogany (Swietenia macrophylla King, Meliaceae) samples. For the database, leaves and/or cambium from 1971 mahogany trees sampled in 31 stands from Mexico to Bolivia were genotyped. A total of 145 different alleles were found, showing strong genetic differentiation (δ(Gregorious)=0.52, F(ST)=0.18, G(ST(Hedrick))=0.65) and clear correlation between genetic and spatial distances among stands (r=0.82, P<0.05). We used the genetic reference database and Bayesian assignment testing to determine the geographic origins of two sets of mahogany wood samples, based on their multilocus genotypes. In both cases the wood samples were assigned to the correct country of origin. We discuss the overall applicability of this methodology to tropical timber trading.

Mendelian inheritance, linkage and genotypic disequilibrium in microsatellite loci isolated from Hymenaea courbaril (Leguminosae).

The Neotropical tree Hymenaea courbaril, locally known as Jatobá, is a valuable source of lumber and also produces comestible and medicinal fruit. We characterized Mendelian inheritance, linkage and genotypic disequilibrium at nine microsatellite loci isolated from H. courbaril, in order to determine if they would provide accurate estimates of population genetic parameters of this important Amazon species. The study was made on 250 open-pollinated offspring originated from 14 seed trees. Only one of nine loci presented significant deviation from the expected Mendelian segregation (1:1). Genotypic disequilibrium between pairwise loci was investigated based on samples from 55 adult and 56 juvenile trees. No genetic linkage between any paired loci was observed. After Bonferroni's corrections for multiple tests, we found no evidence of genotypic disequilibrium between pairs of loci. We conclude that this set of loci can be used for genetic diversity/ structure, mating system, gene flow, and parentage analyses in H. courbaril populations.

Do the antiherbivore traits of expanding leaves in the Neotropical tree Inga paraensis (Fabaceae) vary with light availability?

Treefall gaps in tropical forests have a profound effect on plants growing in the understory, primarily due to increased light availability. In higher light, mature leaves typically have increased anti-herbivore defenses. However, since the majority of herbivory occurs while leaves are expanding, it is important to determine whether defense expression during the short period of leaf expansion is canalized (invariant) or plastic in response to variation in light. Therefore, we examined young leaves of Inga paraensis (Fabaceae) saplings growing along a light gradient in a terra-firme forest in Central Amazonia. We quantified leaf production and expansion time, dry mass of phenolics, saponins, and nitrogen, ants attracted to extrafloral nectaries, and leaf consumption. Over the entire light gradient, the number of leaves produced per flush increased by 50 % and the mass of phenolic compounds by 20 %, but no other traits changed. On average, 39 % of leaf area was consumed with no difference across the light gradient. Alone, none of the leaf traits was a significant predictor of leaf consumption, except for phenolics, which showed a positive relationship. Multiple regressions showed that leaf consumption was positively related to more leaves per flush and a higher concentration of phenolics in leaves. Unlike studies of mature leaves, young leaves of I. paraensis show low plasticity in defense traits across a light gradient, suggesting that leaf development is canalized.

Monitoring genetic diversity in tropical trees with multilocus dominant markers.

Since no universal codominant markers are currently available, dominant genetic markers, such as amplified fragment length polymorphism (AFLP), are valuable tools for assessing genetic diversity in tropical trees. However, the measurement of genetic diversity (H) with dominant markers depends on the frequency of null homozygotes (Q) and the fixation index (F) of populations. While Q can be estimated for AFLP loci, F is less accessible. Through a modelling approach, we show that the monolocus estimation of genetic diversity is strongly dependent on the value of F, but that the multilocus diversity estimate is surprisingly robust to variations in F. The robustness of the estimate is due to a mechanistic effect of compensation between negative and positive biases of H by different AFLP loci exhibiting contrasting frequency profiles of Q. The robustness was tested across contrasting theoretical frequency profiles of Q and verified for 10 neotropical species. Practical recommendations for the implementation of this analytical method are given for genetic surveys in tropical trees, where such markers are widely applied.

Optimal sampling strategy for estimation of spatial genetic structure in tree populations.

Fine-scale spatial genetic structure (SGS) in natural tree populations is largely a result of restricted pollen and seed dispersal. Understanding the link between limitations to dispersal in gene vectors and SGS is of key interest to biologists and the availability of highly variable molecular markers has facilitated fine-scale analysis of populations. However, estimation of SGS may depend strongly on the type of genetic marker and sampling strategy (of both loci and individuals). To explore sampling limits, we created a model population with simulated distributions of dominant and codominant alleles, resulting from natural regeneration with restricted gene flow. SGS estimates from subsamples (simulating collection and analysis with amplified fragment length polymorphism (AFLP) and microsatellite markers) were correlated with the 'real' estimate (from the full model population). For both marker types, sampling ranges were evident, with lower limits below which estimation was poorly correlated and upper limits above which sampling became inefficient. Lower limits (correlation of 0.9) were 100 individuals, 10 loci for microsatellites and 150 individuals, 100 loci for AFLPs. Upper limits were 200 individuals, five loci for microsatellites and 200 individuals, 100 loci for AFLPs. The limits indicated by simulation were compared with data sets from real species. Instances where sampling effort had been either insufficient or inefficient were identified. The model results should form practical boundaries for studies aiming to detect SGS. However, greater sample sizes will be required in cases where SGS is weaker than for our simulated population, for example, in species with effective pollen/seed dispersal mechanisms.

Multiplexed systems of microsatellite markers for genetic analysis of mahogany, Swietenia macrophylla King (Meliaceae), a threatened neotropical timber species.

Mahogany (Swietenia macrophylla King [Meliaceae]) is the most valuable hardwood species in the neotropics. Its conservation status has been the subject of increasing concern due to overexploitation and habitat destruction. In this work we report the development and characterization of 10 highly variable microsatellite loci for S. macrophylla. Twenty-nine percent of the 126 sequenced mahogany clones yielded useful microsatellite loci. Three high-throughput genotyping systems were developed based on polymerase chain reaction (PCR) multiplexing of these mahogany loci. We identified a total of 158 alleles in 121 adult individuals of S. macrophylla, with an average of 15.8 alleles (range 11-25) per locus. All loci showed Mendelian inheritance in open-pollinated half-sib families. The mean expected heterozygosity was 0.84 and the mean observed heterozygosity was 0.73. The combined probability of identity-the probability that two individuals selected at random from a population would have identical genotypes--was 7.0 x 10(-15), and combined probability of paternity exclusion was 0.999998 overall loci. These microsatellite loci permit precise estimates of parameters such as gene flow, mating system, and paternity, thus providing important insights into the population genetics and conservation of S. macrophylla.

Löwenstein-Jensen media. No longer necessary for mycobacterial isolation.

Isolation of mycobacteria on Löwenstein-Jensen media (LJ) and in the BACTEC MB9000 (MB) system was compared. Of 2,271 specimens, 317 were positive for 331 mycobacteria isolated in 1 or both media. The MB was positive in 238 isolates, and LJ was positive for 239 isolates; 92 isolates were detected by MB only and 93 by LJ only. Of the 331 isolates, 146 were recovered by both media. MB recovered 38 of 38 Mycobacterium tuberculosis complex isolates, while LJ recovered 23. MB recovered 94.1% (96/102) of Mycobacterium avium complex isolates and LJ 69.6% (71/102). The MB recovered 81% (65/80) Mycobacterium fortuitum-chelonae isolates and LJ 68% (54/80). Of the remaining species, MB isolated 39, while LJ isolated 91. Only 1 organism that was isolated on LJ alone was medically significant based on medical record review. The addition of LJ media to the MB9000 system is not warranted, as it causes clinically irrelevant workload, increased expenditures for the laboratory, and could cause the inappropriate treatment of patients.

A comparison of the Bactec 9000MB system and the Septi-Chek AFB system for the detection of mycobacteria.

The Bactec MB9000 (MB) continuous monitoring system was compared to the Septic-Chek AFB (SC) for the detection of Mycobacterium species from all patient sources. A total of 1485 specimens were evaluated. Two hundred forty-eight specimens grew mycobacteria in one or both systems. The isolates recovered were 18 Mycobacterium tuberculosis (MTB), 109 M. avium complex (MAC), 59 M. fortuitum-chelonae complex (MFC), 51 pigmented mycobacteria (PGM), and 11 nonpigmented mycobacteria, not MTB/MAC (NP). Of the 248 positive specimens, 157 were positive in both systems; 73 in the SC only; and 18 in the MB only. The mean times to detection for specimens were 11.5 days for MB versus 16.4 days for SC. The false positivity rate in the MB was 5.8%. Contamination rates for the MB and the SC were 12.7% and 19.8%, respectively. These data suggest that the automated MB system has clear advantages over the manual SC system in terms of earlier time to detection of significant mycobacteria, less technical hands-on time, and a lower contamination rate.

Evaluation of the mycobacteria growth indicator tube compared to Septi-Chek AFB for the detection of mycobacteria.

The Mycobacteria Growth Indicator Tube (MGIT) and the AFB Septi-Check (SC) systems were compared for the ability to detect myobacterial isolates, time to detection, and rate of bacterial contamination. Fifty-eight mycobacterial culture positive specimens were studied. MGIT and SC were both positive in 30 of the 58 specimens (52%); SC alone was positive in 22 (38%), and MGIT alone was positive in 6 (10%) of the 58 specimens. Among the 30 isolates identified in both systems, there were 7 Mycobacterium tuberculosis, 14 M. avium, 6 M. fortuitum-chelonae complex, and 3 other mycobacterial species. MGIT detected Mycobacterium tuberculosis faster; SC detected M. avium complex faster and more often; and M. fortuitum-chelonae isolates were detected at the same rate. MGIT showed more contamination (12.6%) than did the SC (7.8%). MGIT is comparable to SC for the detection of MTB, but MAC isolates were detected more often and faster in the SC system.

Fascioliasis en la República Oriental del Uruguay / Fasciolasis in Uruguay

Se realizó una revisión y puesta al día de la situación médica y veterinaria de la distomatosis en Uruguay. Se trata de una zoonosis parasitaria altamente prevalente, producida por el trematode Fasciola hepatica actuando como huésped intermediario el molusco Limnaea viatrix. Afectca a los rumiantes de importancia económica para el país y en forma accidental al ser humano. La prevalencia en el ganado bovino es de 57 por ciento, encontrándose focalmente distribuida en todos los departamentos del país. Los casos humanos han sido esporádicos, y en su mayoría relacionados con la ingestión de berro (Nasturtium officinale). El diagnóstico se hacía accidentalmente durante el acto quirúrgico o por examen coproparasitario. Desde 1991 se ha podido detectar mayor número de casos mediante la aplicación de pruebas serológicas sensibles y específicas. Las medidas de control implementadas para el ganado son la dosificación con fasciolicidas y prácticas de manejo. No existen aún fármacos específicos eficaces para casos humanos. Se revisan las bibliografías nacionales sobre el tema

Evaluation of the crossed-over electrophoresis test for the immunodiagnosis of human hydatid disease.

The crossed-over electrophoresis (COE) test for hydatidosis was evaluated with sera from preoperative, surgically-confirmed hydatidosis cases, postoperative hydatidosis patients, healthy donors and persons with other parasitic and non-parasitic diseases. The sensitivity and specificity of the test varied with the use of concentrated or unconcentrated serum and when test positivity was based on readings carried out before or after citrate treatment of slides or after their staining. Although the sensitivity of the COE test was higher than that obtained by the immunoelectrophoresis (IEP) test, it was not possible to differentiate hydatid from non-hydatid sera by the former technique. The IEP test based on the detection of the Echinococcus granulosus arc 5 as criterion of positivity was found to be the test of choice for this purpose. No false positive results were obtained in non-hydatid sera.

Application of the immunoelectrophoresis test for hydatidosis in patients with a presumptive diagnosis of the disease.

The Echinococcus granulosus diagnostic arc 5 was detected by the immunoelectrophoresis (IEP) test in 43 of 51 sera from patients with a presumptive clinical diagnosis of hydatid disease when stained slides were examined. In 22 of these, however, the arc 5 was readily recognized in the reading following citrate treatment of the slide. The routine reading of slides after 24 and 48 hours of incubation is recommended in an attempt to provide the clinician with an earlier immunological confirmation of hydatidosis by the IEP test. The definitive reading of the stained slide has the added advantage of detecting a larger number of uncharacterized precipitation bands which may be of value in preoperative lydatid sera lacking the diagnostic arc and in the post-operatory serological monitoring of hydatid cases.

Comparative sensitivity and specificity of the Casoni intradermal and the immunoelectrophoresis tests for the diagnosis of hydatid disease.

The Casoni intradermal (ID) test, using two antigens, was compared with the immunoelectrophoresis (IEP) test for diagnosis in 47 surgically confirmed cases of hydatid disease and 73 non-hydatid persons. An antigen prepared from boiled hydatid cyst fluid (HF) was markedly more sensitive in the ID test than another prepared from whole HF but both produced false-positive reactions in three persons with other disease conditions. The IEP test yielded no false positives and its sensitivity was similar to the ID test using the more sensitive boiled HF antigen. Some patients were ID-positive and IEP-negative and vice-versa. Diagnostic sensitivity of both tests varied according to the localization and condition of the cyst. A detectable immune response was more frequent in patients with liver cysts than in those with lung cysts. Regardless of cyst localization, lowest diagnostic sensitivity was observed in patients whose cysts were intact and of the hyaline type, whereas recently broken cysts were associated with the most consistently detectable immune response. The limitations of the ID test are discussed and it is suggested that, until more specific antigens are available, there appears to be little value in utilizing this test where the more specific serological techniques are available.

[Reactivity of a purified antigen of Paracoccidioides brasiliensis with paracoccidioidomycosis and histoplasmosis sera]. / Evaluación de la reactividad de un antígeno purificado de Paracoccidioides brasiliensis frente a sueros de paracoccidioidomicosis e histoplasmosis

The immunoelectrophoretic reactivity of a "crude" and a "purified" antigens of Paracoccidiodes brasiliensis against the sera of confirmed cases of paracoccidioidomycosis and histoplasmosis was evaluated. The "crude" antigen revealed precipitating antibodies in both the homologous and the heterologous human sera; the number of precipitating systems being higher with the former. The "purified" antigen reacted only with the homologous sera. It is postulated that the use of such "purified" antigen may significantly reduce the non specificity of the serologic tests in the immunodiagnosis of paracoccidioidomycosis.

[Correlation between intradermal reaction and immunoelectrophoresis in human hydatidosis]. / Estudio sobre la correlación entre la intradermorreaccion y la immunoelectroforésis en la hidatidósis humana

The results obtained by the immunoelectrophoresis (IEP) aand Casoni intradermal (IDR) tests in a group of 50 hydatidosis patients in which the presence of cysts was later confirmed at surgery, are analyzed. The sensitivity of the IEP test was 74%; the IDR test was positive in 54% of these patients and there was no correlation between the results of the two tests in 24% of the cases. The low sensitivity observed for the IDR test, its known nonspecificity and its poor correlation with IEP test results do not enable us to recommend its use for the diagnosis of hydatid disease or for the selection of cases in which an immunodiagnostic confirmation is feasible. This recommendation would be possible if appropriate antigens regarding specificity and reactivity were available, and could be employed with standardized methods to read and evaluate cutaneous reactivity.