Cobertura vacinal e o movimento antivacina: o impacto na saúde pública no Brasil / Vaccination coverage and anti-vaccine movement: the impact on public health in Brazil / Cobertura de vacunación y movimiento antivacuna: el impacto en la salud pública en Brasil

A vacina constitui um dos principais métodos de prevenção contra doenças. Em 1973, o Brasil criou o Programa Nacional de Imunizações a fim de promover a imunização gratuita para a população, o que mais tarde tornou o país em referência mundial em vacinação. No entanto, a recusa vacinal ainda é um grande problema de saúde pública, sendo o movimento antivacina um dos destaques dessa realidade. Dessa forma, o objetivo deste artigo é avaliar como o movimento antivacina impacta na saúde pública no Brasil através da diminuição da cobertura vacinal. Trata-se de uma pesquisa de metodologia mista, com uma primeira etapa qualitativa, composta de uma revisão integrativa nas plataformas PubMed, LILACS e SciELO, no período de 2010 a 2020, e uma pesquisa documental em portais de movimentos antivacina; e uma segunda etapa quantitativa, em que foi realizado um estudo epidemiológico do tipo ecológico, com consulta nas bases eletrônicas do Datasus e no Sistema de Informações do Programa Nacional de Imunizações (SI-PNI), no período de 2010 a 2022. No período investigado, apenas em 2015 o Brasil alcançou a meta preconizada de cobertura vacinal, diferentemente dos anos seguintes, que apresentaram oscilações preocupantes. As publicações apresentam argumentos utilizados pelos grupos antivacina, evidenciados entre 2015 e 2019, período em que os dados de cobertura vacinal oscilaram. Assim, conclui-se que a ascensão do movimento antivacina é um dos fatores que influenciaram na queda da vacinação no Brasil, a exemplo do sarampo e da febre amarela.

The vaccine is one of the main methods of preventing diseases. Since 1973, Brazil created the National Immunization Program to ensure free immunization to the population, which later made the country a world reference in vaccination. However, vaccine refusal is still a great public health issue, and the anti-vaccine movement stand out in this reality. Thus, the purpose of this article is to evaluate how the anti-vaccine movement affects public health in Brazil with vaccination coverage reduction. This is a mixed methodology study, with first a qualitative step, composed of an integrative review in the platforms PubMed, LILACS, and SciELO, in the period from 2010 to 2020,and a documental research in portals of anti-vaccination movements; and a second quantitative step, where an epidemiological study of the ecological type was carried out, with consultation in the electronic databases of DATASUS and in the Information System of the National Immunization Program (SI-PNI) in the period of 2010 to 2022. In the investigative period, only in 2015 Brazil managed to reach the recommended vaccination coverage goal, unlike in the following years, which showed worrying fluctuations. The publications summarize arguments used by the anti-vaccination groups, evidenced between 2015 and 2019, a period in which the vaccination coverage data fluctuated. Therefore, it is clear that the rise of the anti-vaccination movement is a factor that influenced the drop in vaccination numbers in Brazil, with yellow fever and measles as examples.

La vacuna es uno de los principales métodos de prevención de enfermedades. En 1973, Brasil creó el Programa Nacional de Inmunización con el fin de promover la inmunización gratuita para la población, lo que luego convirtió al país en un referente mundial en vacunación. Sin embargo, la negativa de la vacuna sigue siendo un problema importante en la salud pública, y el movimiento antivacunas es uno de los aspectos más destacados de esta realidad. Así, el objetivo de este artículo es evaluar cómo el movimiento antivacunas impacta en la salud pública en Brasil mediante la disminución de la cobertura de vacunación. Se trata de un estudio epidemiológico mixto, con una primera etapa cualitativa, consistente en una revisión integradora en las plataformas PubMed, Lilacs y SciELO, en el período de 2010 a 2020, y una investigación documental en portales de movimientos antivacunas; y una segunda etapa cuantitativa, en la que se realizó un estudio epidemiológico de tipo ecológico, con consulta en las bases de datos electrónicas de DATASUS y en el Sistema de Información del Programa Nacional de Inmunización (SI-PNI), en el período de 2010 a 2022. Entre eses años, solo el año 2015 logró alcanzar la meta recomendada, a diferencia de los años siguientes, que mostraron fluctuaciones preocupantes en la cobertura de vacunación. Las publicaciones mostraron los argumentos utilizados por los grupos antivacina, evidenciados entre 2015 y 2019, período en que los datos de cobertura de la vacuna fluctuaron. Así, se concluye que la asunción del movimiento antivacunación es uno de los factores que influye en la caída de la vacunación en Brasil, como en el sarampión y la fiebre amarilla.

Cultura de segurança do paciente em maternidade da Amazônia Ocidental / Culture of patient safety in maternity in the western amazon / Cultura de seguridad del paciente en maternidad en la amazonia occidental

Objetivo: analisar a cultura de segurança do paciente entre os profissionais de saúde de maternidade pública da Região Norte do Brasil. Método: estudo transversal, realizado em 2019, com 70 profissionais atuantes na gestão ou assistência à saúde. Analisaram-se 12 dimensões da cultura de segurança do paciente, por meio do questionário Hospital Survey on Patient Safety Culture. Procedeu-se à análise descritiva e aplicou-se o teste Qui-quadrado de Pearson para verificar associação estatística entre as variáveis do estudo. Resultados: a maioria dos participantes era do sexo feminino, média de idade 39 anos e com cursos de pós-graduação. Na avaliação das 12 dimensões da cultura de segurança do paciente, verificou-se uma área de fortaleza com mais de 75% de respostas positivas ­ "Expectativas e ações do supervisor/chefe para a promoção da segurança do paciente". Houve diferença estatisticamente significativa entre o tempo de trabalho na instituição e o modo com que o participante qualificou a segurança do paciente. Conclusão: substituir a cultura punitiva pelo aprendizado com os erros e estimular a comunicação interprofissional são ações que podem ser trabalhadas pelo serviço na busca de uma cultura positiva. Descritores: Estudos transversais; Segurança do Paciente; Cultura organizacional; Saúde materno-infantil; Maternidades; Profissionais de saúde.(AU)

Objective: to analyze the patient safety culture among health professionals in a public maternity hospital in the North region of Brazil. Method: cross-sectional study, conducted in 2019 with 70 professionals working in management or health care. The 12 dimensions of patient safety culture were analyzed using the Hospital Survey on Patient Safety Culture questionnaire. Descriptive analysis and Pearson's chi-square test were performed to verify statistical association among the study variables. Results: most participants were female, mean age of 39 years and had postgraduate degrees. In the evaluation of the 12 dimensions of Patient Safety Culture there was only one area of strength with more than 75% of positive answers - "Expectations and actions of the supervisor/chief for the promotion of patient safety". There was a statistically significant difference between the length of time working at the institution and the way this participant rated patient safety. Conclusion: replacing the punitive culture by learning from mistakes and stimulating interprofessional communication are actions that can be worked on by the service in the search for a positive culture.(AU)

Objetivo: analizar la cultura de seguridad del paciente entre los profesionales de la salud en una maternidad pública de la región Norte de Brasil. Método: estudio transversal realizado en 2019 con 70 profesionales que trabajan en la gestión de la salud o en la atención sanitaria. Las 12 dimensiones de la cultura de seguridad del paciente se analizaron mediante el cuestionario Hospital Survey on Patient Safety Culture. Se realizó un análisis descriptivo y la prueba de Chi-cuadrado de Pearson para verificar la asociación estadística entre las variables del estudio. Resultados: la mayoría de los participantes eran mujeres, tenían una edad media de 39 años y contaban con títulos de postgrado. En la evaluación de las 12 dimensiones de la Cultura de Seguridad del Paciente se verificó sólo un área de fortaleza con más del 75% de respuestas positivas - "Expectativas y acciones del supervisor/jefe para la promoción de la seguridad del paciente". Hubo una diferencia estadísticamente significativa entre el tiempo de trabajo en la institución y la forma en que este participante calificó la seguridad del paciente. Conclusión: reemplazar la cultura punitiva por el aprendizaje de los errores y estimular la comunicación interprofesional son acciones que pueden ser trabajadas por el servicio en la búsqueda de una cultura positiva.(AU)

Voiced High-Frequency Oscillation or Lax Vox Technique? Immediate Effects in Dysphonic Individuals.

OBJECTIVES: To analyze the immediate effects of voiced high-frequency oscillation (VHFO) and Lax Vox technique on vocal quality and self-reported intensity of vocal and laryngeal symptoms in individuals with behavioral dysphonia. METHODS: This experimental, prospective, randomized cross-over study, investigated thirty adults (15 women and 15 men) with behavioral dysphonia (vocal complaints, altered voice on auditory-perceptual evaluation, vocal nodules or mucosal thickening, and incomplete glottic closure). The outcome variables analyzed were auditory-perceptual analysis, acoustic analysis (voice quality characteristics), and self-reported intensities of vocal and laryngeal symptoms. Each participant performed two exercises-VHFO and Lax Vox technique-in a random sequence for 3 minutes. A 7-day washout period was provided between the exercises. The data were analyzed using the paired t-test and Wilcoxon test (P < 0.05). RESULTS: After VHFO, no significant difference was observed on auditory-perceptual evaluation in all participants, whereas the Lax Vox technique worsened breathiness among women (P = 0.027). VHFO significantly increased the fundamental frequency (P = 0.014) and decreased the noise harmonic ratios for women (P = 0.026). Among men, there was a decrease in shimmer parameter (P = 0.035). Moreover, symptoms such as "lump in the throat" (P = 0.005), "voice loss" (P = 0.017), and "high-pitched voice" (P = 0.023) decreased in women after VHFO, whereas in men, "itchiness" and "hoarseness" (P < 0.001) decreased after VHFO. The Lax Vox technique decreased "hoarseness" (P = 0.003) in women, without any effect in men. CONCLUSION: The VHFO exercise provided more positive immediate effects results than the Lax Vox technique regarding vocal quality and self-reported symptom intensity in participants with behavioral dysphonia.

Ultrasound Protocols to Assess Skeletal and Diaphragmatic Muscle in People Who Are Critically Ill: A Systematic Review.

This study aims to review published studies that use protocols and ultrasound measurements to evaluate skeletal and diaphragmatic muscles in patients who are critically ill. We searched for references on databases through September 2020 and included in our systematic review studies that used muscular ultrasound to assess skeletal or diaphragm muscles in patients who are critically ill. Seventy-six studies were included, 32 (1720 patients) using skeletal-muscle ultrasound and 44 (2946 patients) using diaphragmatic-muscle ultrasound, with a total of 4666 patients. The population is predominantly adult men. As for designs, most studies (n = 62) were cohort studies. B-mode B was dominant in the evaluations. Medium-to-high frequency bands were used in the analysis of peripheral muscles and medium-to-low frequency bands for diaphragmatic muscles. Evaluation of the echogenicity, muscle thickness and pennation angle of the muscle was also reported. These variables are important in the composition of the diagnosis of muscle loss. Studies demonstrate great variability in their protocols, and sparse description of the important variables that can directly interfere with the quality and validity of these measures. Therefore, a document is needed that standardizes these parameters for ultrasound assessment in patients who are critically ill.

Cytotoxicity of glucoevatromonoside alone and in combination with chemotherapy drugs and their effects on Na+,K+-ATPase and ion channels on lung cancer cells.

Cardiac glycosides (CGs) are useful drugs to treat cardiac illnesses and have potent cytotoxic and anticancer effects in cultured cells and animal models. Their receptor is the Na+,K+ ATPase, but other plasma membrane proteins might bind CGs as well. Herein, we evaluated the short- and long-lasting cytotoxic effects of the natural cardenolide glucoevatromonoside (GEV) on non-small-cell lung cancer H460 cells. We also tested GEV effects on Na+,K+ -ATPase activity and membrane currents, alone or in combination with selected chemotherapy drugs. GEV reduced viability, migration, and invasion of H460 cells spheroids. It also induced cell cycle arrest and death and reduced the clonogenic survival and cumulative population doubling. GEV inhibited Na+,K+-ATPase activity on A549 and H460 cells and purified pig kidney cells membrane. However, it showed no activity on the human red blood cell plasma membrane. Additionally, GEV triggered a Cl-mediated conductance on H460 cells without affecting the transient voltage-gated sodium current. The administration of GEV in combination with the chemotherapeutic drugs paclitaxel (PAC), cisplatin (CIS), irinotecan (IRI), and etoposide (ETO) showed synergistic antiproliferative effects, especially when combined with GEV + CIS and GEV + PAC. Taken together, our results demonstrate that GEV is a potential drug for cancer therapy because it reduces lung cancer H460 cell viability, migration, and invasion. Our results also reveal a link between the Na+,K+-ATPase and Cl- ion channels.

Modulação da variabilidade da frequência cardíaca em praticantes de CrossFit® / Modulation of heart rate variability in CrossFit® practitioners

INTRODUÇÃO: O CrossFit® é um tipo de exercício físico que afeta a homeostase do corpo exigindo ajustes pela via autonômica. Devido sua intensidade de treino ocorre uma modificação no tônus vagal e adaptações fisiológicas cardiovasculares. OBJETIVO: Verificar a variabilidade da frequência cardíaca em praticantes de CrossFit®. MATERIAIS E MÉTODOS: Corte transversal em praticantes de CrossFit® no período de março a junho de 2017, com idade ≥18 anos, tempo de prática ≥3 meses e uma frequência ≥2 vezes na semana. Excluídos: fumantes, gestantes, comorbidades auto referidas (Diabetes Mellitus, hipertensão, doenças cardiorrespiratórias e disfunção na tireoide), mulheres no período menstrual, menopausa, ou aqueles que tiveram dificuldade na compreensão do teste proposto. Para a mensuração da variabilidade da frequência cardíaca (VFC) foi utilizado o cardiofrequencimetro da marca Polar® modelo V800 heart rate monitor, para a sua análise foi utilizado KUBIOS HRV versão 2.0. Aprovação do CEP-BAHIANA (CAAE 46685415.0.0000.5544). RESULTADOS: Foram pesquisados 16 participantes, com idade média de 32,11 ± 6,44 anos, 10 (62, 5%) homens. O IMC encontrado foi de 26,39±3,80 kg/m², classificando 9 (56,3%) indivíduos como sobrepeso e 6 (37,5%)com peso normal. Os valores obtidos da VFC no domínio do tempo:VLFms2: 1544(859-3640); LFms2:827(550-2115); HFms2:661(335-1577);LF/ HF:1,18(0,86-1,8). CONCLUSÃO: Na amostra estudada, observou-se que praticantes de CrossFit® possuem leve predomínio da atividade simpática, especialmente o sexo masculino e naqueles que praticam atividade física cinco ou mais vezes por semana.

INTRODUCTION: CrossFit® is a type of physical exercise that affects the homeostasis of the body requiring adjustments through the autonomic pathway. Due to its intensity of training there is a modification in vagal tone and cardiovascular physiological adaptations. OBJECTIVE: To verify heart rate variability in CrossFit® practitioners. MATERIALS AND METHODS: Cross-section in CrossFit® practitioners from March to June 2017, aged ≥18 years, practice time ≥3 months and a frequency ≥2 times in the week. Excluded: smokers, pregnant women, self-referenced comorbidities (Diabetes Mellitus, hypertension, cardiorespiratory diseases and thyroid dysfunction), women in the menstrual period, menopause, or those who had difficulty understanding the proposed test. For the measurement of heart rate variability (HRV), the heart rate monitor model V800 heart rate monitor was used for its analysis was KUBIOS HRV version 2.0. Approval of CEP-BAHIANA (CAAE 46685415.0.0000.5544). 5544. RESULTS: 16 participants were studied, with a mean age of 32.11 ± 6.44 years, 10 men (62.5%). The mean BMI found was 26.39 ± 3.80 kg/ m², classifying 9 (56.3%) individuals as overweight and 6 (37.5%) with normal weight. The values obtained from HRV in the time domain: VLF:1544 (859-3640), LF: 827 (550-2115), HF: 661 (335-1577), LF / HF: 1.18 (0.86-1,8). CONCLUSION: In the studied sample, it was observed that CrossFit® practitioners have a slight predominance of sympathetic activity, especially males and those who practice physical activity five or more times per week.

High Frequency of Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Nosocomial Strains Isolated from a Teaching Hospital in Brazil.

The aim of this study was to investigate the frequency, antimicrobial sensitivity profile, and genetic characteristics of nosocomial strains of extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae isolated from inpatients at a teaching hospital in Brazil. The bacterial identification, phenotypic detection of ESBL, and antimicrobial susceptibility profile were performed by the VITEK 2 automated system. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) mass spectrometry was used to confirm the identity of the species and genotyping of ESBL-producing K. pneumoniae was performed by pulsed-field gel electrophoresis (PFGE). Thirty-six ESBL-producing K. pneumoniae nosocomial strains isolated from November 2013 to August 2014 were analyzed. High resistance rates were observed for ceftriaxone, ceftazidime, cefepime, gentamicin, and ciprofloxacin. However, all isolates were susceptible to amikacin and meropenem. All strains harbored blaCTX-M-like and blaSHV-like genes. Molecular typing by PFGE showed a diversity of genotypes distributed among 25 clusters, but two isolates collected in different wards had the same genotypic profile and carried the same bla genes, so they were considered clones. The data showed that there was a high frequency of ESBL-producing K. pneumoniae multidrug-resistant among patients in the studied hospital. Furthermore, the detection of blaCTX-M-like genes in all isolates suggests that these enzymes are the major ESBL responsible for the beta-lactam resistance phenotypes among the analyzed strains.

Effectiveness of Voice Therapy Associated With Electromyographic Biofeedback in Women With Behavioral Dysphonia: Randomized Placebo-Controlled Double-Blind Clinical Trial.

OBJECTIVE: To analyze the effectiveness of vocal therapy associated with electromyographic biofeedback in women with behavioral dysphonia. MATERIALS AND METHODS: This is a randomized placebo-controlled double-blind clinical trial. Twenty-two adult women with behavioral dysphonia were randomly divided into two groups: Experimental Group-11 women participated in vocal therapy associated with the application of electromyographic biofeedback; Placebo Group-11 women participated in vocal therapy associated with the application of placebo electromyographic biofeedback. Both groups performed eight therapy sessions, twice a week, lasting 30 minutes. The vocal therapy of both groups was composed of semioccluded vocal tract exercises (trill, humming, and fricative). The evaluations were performed at four time points-before, after, one, and three months after the vocal therapy-and will consist of the following assessments: auditory-perceptual evaluation of voice, acoustic evaluation of voice, and surface electromyographic. The data were analyzed statistically comparing the groups and the time of evaluation (P < 0.05). RESULTS: The proposed vocal therapy promoted positive results in vocal quality and muscular electrical activity during rest in women with behavioral dysphonia for both groups. Electromyographic biofeedback promoted additional positive results in muscle electrical activity during phonatory tasks in women with behavioral dysphonia. CONCLUSION: In this study, the vocal therapy associated with electromyographic biofeedback had equivalent efficacy to traditional therapy in the voice. The biofeedback was more effective than traditional therapy on muscular electrical activity and had effects that remained for a longer time in women with behavioral dysphonia.

A high mortality rate associated with multidrug-resistant Acinetobacter baumannii ST79 and ST25 carrying OXA-23 in a Brazilian intensive care unit.

The global spread of carbapenem-resistant Acinetobacter baumannii (A. baumannii) strains has restricted the therapeutic options available to treat infections due to this pathogen. Understanding the prevalence of such infections and the underlying genetic mechanisms of resistance may help in the implementation of adequate measures to control and prevent acquisition of nosocomial infections, especially in an intensive care unit setting. This study describes the molecular characteristics and risk factors associated with OXA-23-producing A. baumannii infections. A case-control study was undertaken from September/2013 to April/2015. Acquisition of OXA-23-producing A. baumannii was found to be associated with the use of nasogastric tubes, haemodialysis, and the use of cephalosporins. These isolates were only susceptible to amikacin, gentamicin, tigecycline, and colistin, and contained the ISAba1 insertion sequence upstream ofblaOXA-23 and blaOXA-51 genes. Twenty-six OXA-23-producing A. baumannii strains belonged to the ST79 (CC79) clonal group,and patients infected or colonised by these isolates had a higher mortality rate (34.6%). In conclusion, this study showed a dissemination of OXA-23-producing A. baumannii strains that was associated with several healthcare-related risk factors and high mortality rates among intensive care unit patients.

Cytotoxicity of AMANTADIG - a semisynthetic digitoxigenin derivative - alone and in combination with docetaxel in human hormone-refractory prostate cancer cells and its effect on Na+/K+-ATPase inhibition.

Cardiac glycosides (CGs) are natural compounds used to treat congestive heart failure. They have garnered attention as a potential cancer treatment option, especially because they bind to Na+/K+-ATPase as a target and activate intracellular signaling pathways leading to a variety of cellular responses. In this study we evaluated AMANTADIG, a semisynthetic cardenolide derivative, for its cytotoxic activity in two human androgen-insensitive prostate carcinoma cell lines, and the potential synergistic effects with docetaxel. AMANTADIG induced cytotoxic effects in both cell lines, and a combination with docetaxel showed a moderate and strong synergism in DU145 and PC-3 cells, respectively, at concentrations considerably lower than their IC50 values. Cell cycle analyses showed that AMANTADIG and its synergistic combination induced G2/M arrest of DU145 and PC-3 cells by modulating Cyclin B1, CDK1, p21 and, mainly, survivin expression, a promising target in cancer therapy. Furthermore, AMANTADIG presented reduced toxicity toward non-cancerous cell type (PBMC), and computational docking studies disclosed high-affinity binding to the Na+/K+-ATPase α subunit, a result that was experimentally confirmed by Na+/K+-ATPase inhibition assays. Hence, AMANTADIG inhibited Na+/K+-ATPase activity in PC-3 cells, as well as in purified pig kidney at nanomolar range. Altogether, these data highlight the potent effects of AMANTADIG in combination with docetaxel and offer important insights for the development of more effective and selective therapies against prostate cancer.

Benefits of a memory game as a didactic strategy in the learning of human physiology / Benefícios de um jogo de memorização como estratégia didática no aprendizado da fisiologia humana

The diversification of teaching strategies helps students to learn by a more effective way of understanding and assimilating the themes seen in the classroom. This study aimed to develop an educational model of human physiology, based on memory stimulation, and evaluate the effectiveness of this model for undergraduate and high school students. The effectiveness of the model was evaluated by the application of two questionnaires in order to verify the assimilation of the theme seen in the classroom and the perception of the individuals about the model. The results confirm the effectiveness of this model pointing out the importance of these resources as motivational educational devices as well as the need to use innovative methodologies. Furthermore, the use of models with visual appeal and which do the learning in a playful way could improve the efficiency in the process of teaching and learning together with the traditional classroom model

A diversificação das estratégias de ensino ajuda os alunos a aprender através de uma forma mais eficaz para compreender e assimilar os temas vistos em sala de aula. Este trabalho teve por objetivo conceber e avaliar o uso de um jogo de memorização como estratégia auxiliar no processo de ensino e aprendizagem de alunos do ensino médio e do ensino superior, abordando o conteúdo de Fisiologia Humana, com foco no Sistema Excretor e Fisiologia Renal, respectivamente. A eficácia do modelo foi avaliada por meio da aplicação de dois questionários para verificar a assimilação dos conteúdos abordados em sala de aula e a percepção dos indivíduos sobre o modelo. Os resultados confirmam a eficiência do modelo apontando para a importância destes recursos como dispositivos educativos motivacionais, bem como a necessidade de utilizar metodologias inovadoras. Ademais, a utilização de modelos com apelo visual e que trabalhem o aprendizado de forma lúdica, podem agregar eficiência ao processo de ensino e aprendizagem ao tradicional modelo de sala de aula

Rapid detection of blaKPC directly from surveillance rectal swabs by EasyQ KPC.

The performance of EasyQ KPC assay was evaluated for the first time for blaKPC detection directly from surveillance rectal swabs without broth enrichment. Using conventional polymerase chain reaction as gold standard method, EasyQ KPC and culture-based molecular tests demonstrated a sensitivity/specificity of 100%/87.3% and 83.3%/98.2%, respectively.

Dissemination of Multidrug-Resistant Proteus mirabilis Clones Carrying a Novel Integron-Borne blaIMP-1 in a Tertiary Hospital.

This study aimed to characterize multidrug-resistant Proteus mirabilis clones carrying a novel class 1 integron-borne blaIMP-1 In1359 was inserted into a large conjugative plasmid that also carried blaCTX-M-2 The production of carbapenemases in Enterobacteriaceae that are intrinsically resistant to polymyxins and tigecycline is very worrisome, representing a serious challenge to clinicians and infection control teams.

Cytotoxic and cytostatic effects of digitoxigenin monodigitoxoside (DGX) in human lung cancer cells and its link to Na,K-ATPase.

Cardiac glycosides (CGs) are natural compounds widely used to treat several cardiac conditions and more recently have been recognized as potential antitumor agents. They are known as Na,K-ATPases ligands, which is a promising drug target in cancer. In this study, the short and long-lasting cytotoxic effects of the natural cardenolide digitoxigenin monodigitoxoside (DGX) were evaluated against two non-small cell lung cancer lines (A549 and H460 cells). It was found that DGX induced cytotoxic effects in both cells and the apoptotic effects were more pronounced on H460 cells. In long-term analysis, using the clonogenic and the cumulative population doubling (CPD) assays, DGX showed a reduction of cell survival, after 15days without re-treatment. To better understand DGX effects in A549 cells, several assays were conducted. In cell cycle analysis, DGX caused an arrest in S and G2/M phases. This compound also increased the number of cells in subG1 phase in a concentration- and time-dependent manner. The presence of ß-galactosidase positive cells, large nucleus and flattened cells indicated senescence. Additionally, DGX inhibited Na,K-ATPase activity in A549 cells, as well as in purified pig kidney and in human red blood cell membrane preparations, at nanomolar range. Moreover, results of molecular docking showed that DGX binds with high efficiency (-11.4Kcal/mol) to the Na,K-ATPase (PDB:4HYT). Taken together, our results highlight the potent effects of DGX both in A549 and H460 cells, and disclose its link with Na,K-ATPase inhibition.

Musculoskeletal Pain and Voice-related Quality of Life in Dysphonic and Non-dysphonic Subjects.

PURPOSE: This study aimed to compare and correlate musculoskeletal pain and voice-related quality of life of dysphonic and non-dysphonic individuals. METHOD: This is a retrospective case-control study. A total of 74 adults were divided into two groups: the experimental group (EG) comprising 37 individuals with vocal complaints and hyperfunctional dysphonia, and the control group (CG) comprising 37 individuals without vocal complaints and with healthy voices. Both groups presented similar gender and age (28 females and 9 males for each group; average age = 31.5). All the participants answered the protocols: Voice-Related Quality of Life and Musculoskeletal Pain Questionnaire. Statistical data were analyzed by Mann-Whitney U test (P ≤ 0.05) and Spearman correlation test (P ≤ 0.05). RESULTS: It was observed that the EG presented significantly lower scores of voice-related quality of life in the social-emotional (P < 0.001), physical (P < 0.001), and total (P < 0.001) fields. Concerning musculoskeletal pain, it was observed in the EG that there was a higher intensity in pain in the region of the larynx (P < 0.001), and a higher frequency of pain in the submandibular (P = 0.013), larynx (P < 0.001), and front of the neck (P = 0.002) regions, when compared with the CG. CONCLUSION: In the group of individuals studied, worst indexes of voice-related quality of life and higher frequency and intensity of pain in the larynx were observed, in addition to higher frequency of pain in regions near the larynx in dysphonic subjects. There was correlation between voice-related quality of life and the frequency and intensity of musculoskeletal pain.

Detection and analysis of different interactions between resistance mechanisms and carbapenems in clinical isolates of Klebsiella pneumoniae

Abstract Carbapenems are considered last-line agents for the treatment of serious infections caused by Klebsiella pneumoniae, and this microorganism may exhibit resistance to β-lactam antibiotics due to different mechanisms of resistance. We evaluated 27 isolates of K. pneumoniae resistant to carbapenems recovered from inpatients at the University Hospital of Santa Maria-RS from July 2013 to August 2014. We carried out antimicrobial susceptibility, carbapenemase detection, testing for the presence of efflux pump by broth microdilution and loss of porin by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Genetic similarity was evaluated by ERIC-PCR. High levels of resistance were verified by the minimum inhibitory concentration for the antimicrobials tested. The blaKPC gene was present in 89% of the clinical isolates. Blue-Carba and combined disk with AFB tests showed 100% concordance, while the combined disk test with EDTA showed a high number of false-positives (48%) compared with the gold-standard genotypic test. Four isolates showed a phenotypic resistance profile consistent with the overexpression of the efflux pump, and all clinical isolates had lost one or both porins. The ERIC-PCR dendrogram demonstrated the presence of nine clusters. The main mechanism of resistance to carbapenems found in the assessed isolates was the presence of the blaKPC gene.

Identification of São Paulo metallo-beta-lactamase-1-producing Pseudomonas aeruginosa in the Central-West region of Brazil: a case study.

Metallo-beta-lactamase production is an important mechanism for carbapenem resistance of Pseudomonas aeruginosa , which represents an emerging public health challenge. We report the case of a patient admitted to an intensive care unit, with sepsis caused by multidrug-resistant São Paulo Metallo-beta-lactamase-1-producing P. aeruginosa . This is the first case of infection by this pathogenic strain in the State of Mato Grosso do Sul, Brazil. Thus, infection control measures are required for preventing future spread and outbreaks.