Community respiratory viruses and healthcare-associated infections: epidemiological and clinical aspects.

BACKGROUND: Healthcare-associated infections (HAIs) impact morbidity, mortality, and hospitalization costs. The contribution of viruses to the overall burden of HAIs is not well described. AIM: To evaluate the prevalence and clinical findings in patients with HAIs caused by respiratory viruses. METHODS: An observational, analytical, cross-sectional study was conducted to evaluate patients with a viral nosocomial respiratory infection, occurring between January 2013 and December 2019. Outcomes, comorbidities, cause of hospitalization, seasonality, and presence of bacterial co-infection were assessed. FINDINGS: In all, 161 cases of HAIs with community respiratory viruses (CRVs) were identified through six years; 76.4% of patients had a median age of 2.8 years (interquartile range: 0.28-15.4 years). The main comorbidities in immunosuppressed patients were haematologic neoplasia (46.5%), myelodysplastic syndrome (33.8%), and haematopoietic stem cell transplantation (18.3%). In non-immunosuppressed patients, the most prevalent comorbidities were prematurity (49.1%), respiratory tract diseases (21.0%), and congenital malformations (19.3%). The viruses detected were human rhinovirus (36.6%), respiratory syncytial virus (21.7%), and the parainfluenza group (18.6%). The fatality rate was low (4.6%), and a higher incidence of HAIs occurred in the CRV seasonality period in southern Brazil. CONCLUSION: CRV circulation in the hospital environment is frequent, and likely involves healthcare workers and visitors as well as patients. More guidance on preventive measures in healthcare settings is required. In addition, care teams should consider these aetiologic agents in the differential diagnosis of patients with nosocomial pneumonia, giving opportunities to limit antibiotic use.

Nanofiller Particles and Bonding Durability, Water Sorption, and Solubility of Universal Adhesives.

The aim of this study was to evaluate the influence of nanofiller particles in simplified universal adhesive on the long-term microtensile bond strength and silver nitrate up-take, as well as water sorption and solubility. Commercial adhesives Ambar Universal (FGM) in nanofilled-containing version (filled) and same lot without fillers (unfilled) were donated and applied by means of etch-and-rinse strategy. Microtensile bond strength was surveyed after 24-hours or 1-year water storage. Silver nitrate uptake was assayed using scanning electron microscopy (SEM). Water sorption and solubility experiments were performed based on ISO 4049:2009. Statistical analysis was performed using two-way ANOVA and Tukey test (p<0.05). The bond strength of both the adhesives were statistically similar at 24 hours (p>0.05), but the filled group attained significant bond strength reduction after aging when compared to initial bond strength (p<0.001). Conversely, unfilled adhesive presented stable adhesion after 1-year storage (p=0.262). Silver nitrate uptake was similar for both adhesives, with little silver impregnation at the hybrid and adhesive layers. Water sorption was higher with filled adhesive compared to the unfilled one (p=0.01). Conversely, solubility was higher in unfilled in comparison to filled one (p=0.008). The presence of nanofillers in universal adhesive achieves higher water sorption and dentin bond degradation, which did not occur in the unfilled adhesive.

Improved function and strength in patients with knee osteoarthritis as a result of adding a two-day educational program to usual care. Prospective randomized trial.

Objective: The primary aim was to quantify the improvements on function and pain of patients with knee osteoarthritis (KOA), short education and low income by a two-day self-management program. Secondary aims were verifying if the program improves clinically relevant measures of weight and strength. Design: A prospective randomized clinical trial was conducted in a tertiary hospital in Brazil with 191 patients with Kellgren & Lawrence grades II and III KOA who were allocated to two groups: control (usual care- CG) and intervention (usual care and two days of an OA self-management program with a multiprofessional team - IG). Western Ontario and McMaster Universities Index (WOMAC), weight, body mass index (BMI), Timed up and go (TUG) and five Times Sit to Stand Test (FTSST) were assessed at baseline, six, 12 and 24 months. Results: Groups were similar at baseline (p â€‹> â€‹0.05). Both groups exhibited improved WOMAC total and subsets scores throughout the study (p â€‹< â€‹0.001). However, only IG improved WOMAC total and subsets in all follow-ups above 20% (minimally clinically important difference), with differences in WOMAC pain, function and total scores (p â€‹= â€‹0.001, p â€‹< â€‹0.001, and p â€‹< â€‹0.001, respectively) and best effect sizes at 1 year (0.355, 0.651 and 0.770, respectively). IG group lost weight (p â€‹< â€‹0.001) and BMI (p â€‹< â€‹0.01). Both groups exhibited improvements in TUG and FTSST (p â€‹< â€‹0.001) that remained in all evaluations. FTSST results favored the IG, p â€‹= â€‹0.032. Conclusions: An educational program to patients with KOA, short schooling and low income improves clinically important measures of pain and function.

Sulfadiazine removal using green zero-valent iron nanoparticles: A low-cost and eco-friendly alternative technology for water remediation.

In this work, the effectiveness of green zero-valent iron nanoparticles (gnZVIs) for the removal of the antibiotic sulfadiazine (SDZ) from water via adsorption and reduction was tested. Additionally, the effectiveness of this material as a catalyst for the Fenton and photo-Fenton processes was also investigated. This represents the first study concerning the use of gnZVIs for the degradation of a sulfonamide antibiotic. The results obtained indicate that gnZVIs were able to remove up to 58% of SDZ via adsorption and up to 69% via adsorption plus reduction using a SDZ/Fe3+ molar ratio of 1:61.6. Furthermore, gnZVIs showed strong effectiveness as a catalyst for the Fenton and photo-Fenton reactions, with complete SDZ removal in 8 h and 5 min, respectively, using a SDZ/Fe3+/H2O2 molar ratio of 1:38.4:38.4. These results demonstrate that the use of gnZVIs constitutes an attractive and potential alternative technology for water remediation, reducing environmental impact and operational costs.

Review of the Pollination System by Small Diverse Insects.

Many studies have evaluated and categorized the pollination systems of plants in different regions. These studies resulted in the definition of new pollination systems, such as that by small diverse insects (SDI). Although SDI systems are frequent in tropical communities, we know little about the species of plants and pollinators that compose these systems. This study synthesized knowledge of SDI systems through a systematic review of the literature, in order to characterize the composition of plants and pollinator species related to this pollination system. Most studies of SDI systems were carried out in tropical rainforest communities, and used a variety of terminologies and concepts. We found 362 plant species assigned to the SDI system, distributed in 76 families and 35 orders. These species are mainly trees and have inconspicuous greenish flowers, and most are hermaphroditic or dioecious. Few studies provided information on the composition of pollinators, which encompassed small and large insects; beetles, wasp, flies, and bees were the most frequent groups. We suggest adoption of the term "pollination system by diverse insects" instead of "small diverse insects." We discuss conceptual aspects and questions for studies with this pollination system.

Influence of collagen cross-linkers addition in phosphoric acid on dentin biomodification and bonding of an etch-and-rinse adhesive.

OBJECTIVE: To investigate the effects of natural collagen cross-linkers incorporation in phosphoric acid etchant on dentin biomodification, microtensile bond strength (µTBS) and nanoleakage (NL) of a two-step etch-and-rinse adhesive. METHODS: Experimental aqueous solution of 37% ortho-phosphoric acid were prepared with the addition of 2% biomodification agents: Lignin (LIG) from industrial paper production residue, Cardanol (CARD) from cashew-nut shell liquid, and Proanthocyanidin (PAC) from grape-seed extract. Negative control (NC) was acid solution without cross-linker whilst commercial control (CC) was Condac 37 gel (FGM). Dentin specimens were assayed by FTIR after 15s etching to detect collagen cross-linking. Extracted third molars were used for µTBS (n=7) and fracture mode analysis of Optibond S (Kerr), tested after 24h or 1000 thermal cycles. NL was surveyed by SEM. Statistical analysis was performed with two-way ANOVA and Tukey's test (p<0.05). RESULTS: FTIR confirmed cross-linking for all agents. µTBS of CC was the highest (46.6±6.2MPa), but reduced significantly after aging (35.7±5.2MPa) (p<0.001). LIG (30.6±3.7MPa) and CARD (28.3±1.8MPa) attained similar µTBS which were stable after aging (p>0.05). Fracture mode was predominantly adhesive. At 24h, all groups showed presence of silver uptake in hybrid layer, except CARD. After aging, CARD- and LIG-treated specimens exhibited little amount of silver penetration. CC, PAC and NC showed gaps, great nanoleakage at hybrid layer and presence of water channels in adhesive layer. SIGNIFICANCE: Altogether, ortho-phosphoric acid incorporated with LIG and CARD promotes stable resin-dentin bond strength with minor nanoleakage after aging, thereby achieving therapeutic impact without additional clinical steps.

Glycerol-dimethacrylate as alternative hydrophilic monomer for HEMA replacement in simplified adhesives.

OBJECTIVES: Hydroxyethyl-methacrylate (HEMA) is still widely used in simplified adhesives. Indeed, several shortcomings occur with this monomer, such as water uptake and formation of linear polymers. This study aimed to compare the effects of HEMA replacement by glycerol-dimethacrylate (GDMA) on selected physicochemical properties and bonding performance of simplified model adhesives. MATERIALS AND METHODS: Experimental simplified etch-and-rinse and self-etch adhesives were formulated containing 20 wt% HEMA or GDMA. Three-point bending test was used to obtain the elastic modulus of bar-shaped specimens, and water sorption and solubility were attained by ISO-4049 (ISO, 2009) method. Degree of conversion was surveyed by Micro-Raman spectroscopy, and microtensile bond strength was tested after 24 h or 6 months simulated pulpal pressure aging. Statistical analysis was realized with two-way ANOVA and Tukey's test (p < 0.05). RESULTS: GDMA promoted higher elastic modulus to the self-etch adhesive, and GDMA-containing etch-and-rinse adhesive achieved overall lower water sorption and solubility. The degree of conversion was statistically higher for GDMA adhesives than for HEMA etch-and-rinse one. All bond strengths dropped significantly after aging, except that of GDMA self-etch adhesive. The nanoleakage was higher and gaps were found in the interface of HEMA-containing adhesives, which were less present in GDMA equivalents. CONCLUSIONS: GDMA is a feasible hydrophilic dimethacrylate monomer to replace HEMA in simplified adhesives, thereby providing better polymerization, mechanical properties and dentin adhesion as well as lower water uptake and solubility.

Volumetric capnography for the evaluation of pulmonary disease in adult patients with cystic fibrosis and noncystic fibrosis bronchiectasis.

This study was designed to use volumetric capnography to evaluate the breathing pattern and ventilation inhomogeneities in patients with chronic sputum production and bronchiectasis and to correlate the phase 3 slope of the capnographic curve to spirometric measurements. Twenty-four patients with cystic fibrosis (CF) and 21 patients with noncystic fibrosis idiopathic bronchiectasis (BC) were serially enrolled. The diagnosis of cystic fibrosis was based on the finding of at least two abnormal sweat chloride concentrations (iontophoresis sweat test). The diagnosis of bronchiectasis was made when the patient had a complaint of chronic sputum production and compatible findings at high-resolution computed tomography (HRCT) scan of the thorax. Spirometric tests and volumetric capnography were performed. The 114 subjects of the control group for capnographic variables were nonsmoker volunteers, who had no respiratory symptoms whatsoever and no past or present history of lung disease. Compared with controls, patients in CF group had lower SpO(2) (P < 0.0001), higher respiratory rates (RR) (P < 0.0001), smaller expiratory volumes normalized for weight (V(E)/kg) (P < 0.028), smaller expiratory times (Te) (P < 0.0001), and greater phase 3 Slopes normalized for tidal volume (P3Slp/V(E)) (P < 0.0001). Compared with controls, patients in the BC group had lower SpO(2) (P < 0.0001), higher RR (P < 0.004), smaller V(E)/kg (P < 0.04), smaller Te (P < 0.007), greater P3Slp/V(E) (P < 0.0001), and smaller VCO(2) (P < 0.0002). The pooled data from the two patient groups compared with controls showed that the patients had lower SpO(2) (P < 0.0001), higher RR (P < 0.0001), smaller V(E)/kg (P < 0.05), smaller Te (P < 0.0001), greater P3Slp/V(E) (P < 0.0001), and smaller VCO(2) (P < 0.0003). All of the capnographic and spirometric variables evaluated showed no significant differences between CF and BC patients. Spirometric data in this study reveals that the patients had obstructive defects with concomitant low vital capacities and both groups had very similar abnormalities. The capnographic variables in the patient group suggest a restrictive respiratory pattern (greater respiratory rates, smaller expiratory times and expiratory volumes, normal peak expiratory flows). Both groups of patients showed increased phase III slopes compared with controls, which probably indicates the presence of diffuse disease of small airways in both conditions leading to inhomogeneities of ventilation.

Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism.

The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 +/- 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 +/- 8.64 to 39.14 +/- 6.77 mmHg) and alveolar air (from 92.97 +/- 2.14 to 63.91 +/- 8.27 mmHg). The effective alveolar ventilation exhibited a significant reduction (from 199.62 +/- 42.01 to 84.34 +/- 44.13) consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio) also presented a significant reduction after embolization (from 0.96 +/- 0.34 to 0.33 +/- 0.17 fraction). The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 +/- 1.71 to 60.76 +/- 6.62 mmHg), but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 +/- 1.22 to 23.15 +/- 8.24 mmHg). Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 +/- 1.36 to 37.61 +/- 12.79 mmHg), as also did the calculated alveolar (from 56.38 +/- 22.47 to 178.09 +/- 37.46 mL) and physiological (from 0.37 +/- 0.05 to 0.75 +/- 0.10 fraction) dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution induced by hypocapnic bronchoconstriction.

Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism

The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 ± 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 ± 8.64 to 39.14 ± 6.77 mmHg) and alveolar air (from 92.97 ± 2.14 to 63.91 ± 8.27 mmHg). The effective alveolar ventilation exhibited a significant reduction (from 199.62 ± 42.01 to 84.34 ± 44.13) consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio) also presented a significant reduction after embolization (from 0.96 ± 0.34 to 0.33 ± 0.17 fraction). The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 ± 1.71 to 60.76 ± 6.62 mmHg), but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 ± 1.22 to 23.15 ± 8.24 mmHg). Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 ± 1.36 to 37.61 ± 12.79 mmHg), as also did the calculated alveolar (from 56.38 ± 22.47 to 178.09 ± 37.46 mL) and physiological (from 0.37 ± 0.05 to 0.75 ± 0.10 fraction) dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution induced by hypocapnic bronchoconstriction.

[Health education in 1st grade public schools at the periphery of Belo Horizonte, MG, Brazil. II. Knowledge, opinion and prevalence of helminthiasis among students and teachers]. / Educação em saúde em escolas públicas de 1. grau da periferia de Belo Horizonte, MG, Brasil. II - Conhecimentos, opiniões e prevalencia de helmintíases entre alunos e professores.

As part of a wide ranging project concerning education and health, aiming both to update and develop new materials and methods for 1st Grade schools, the present study investigated the state of knowledge and prevalence of helminthic diseases in school populations. Interviews and parasitological exams undertaken in four schools (two experimental and two controls) on the outskirts of Belo Horizonte showed: a. that both teachers and pupils have little information concerning helminthic diseases as well as incorrect notions and ignorance of the mechanisms of transmission; b. high prevalence in the school: 69.0% and 76.0% (Bairro Gorduras) and 46.0% and 24.0% (Vale do Jatobá and Barreiro de Cima) in the first year of study (1988). Comparing the four schools, there is a direct relationship between the living conditions of the pupils and the indices of prevalence. Considering the fact that such helminthic diseases are known to have been present for a long time, it is a striking how removed the school is from the problems and realities of its pupils.

[Plasma levels of alpha-fetoprotein and carcinoembryonic antigen in patients with malignant gastrointestinal tumors]. / Níveis plasmáticos da alfa-fetoproteína e do antigénico carcino-embrionário em doentes com tumores malignos gastro-intestinais.

Levels of alpha-fetoprotein (AEP) and carcinoembryonic antigen (CEA) were determined in the plasma of 142 patients with malignant gastrointestinal tumours. AEP was raised in only four patients (2.8%); two patients with carcinoma of the stomach showed relatively elevated levels. Abnormal CEA levels were found in 82 patients (57.7%). The patients' age with positive CEA levels was a greater than that of the patients with normal levels (p less than 0.05). In patients with gastric tumours CEA positivity was correlated with clinico-pathological stage (pTNM) and with the resectability rate (p less than 0.05). In patients with carcinoma of colon and rectum a greater incidence of elevated plasma CEA levels, as well as higher levels, were found in patients with carcinoma of the left colon than in those with right colon tumours. Statistically significant differences were found between the positivity rate and Dukes' grading (p less than 0.05), as well as between CEA levels in Dukes' stages C and 'D' (p less than 0.005). It is concluded that AFP has a very limited clinical role in patients with malignant extra-hepatic gastrointestinal tumours and that CEA may have a clinical role in tumours of the digestive tract, other than carcinoma of colon and rectum.

[The population dynamics of the northeast, 1960-1980]. / Dinamica demografica do Nordeste--1960-1980.

PIP: Recent demographic trends in the northeast region of Brazil are examined for the period 1960-1980. The authors note both a decline in fertility and an exodus of population due to migration to the southeast of the country. They conclude that these trends threaten both the economy and national status of the northeast region.^ieng