Epidemiological profile of patients hospitalized with candiduria in the Central-Western region of Brazil / Perfil epidemiológico de pacientes hospitalizados con candiduria en la región centro-oeste de Brasil

Background: Candida yeasts are considered the main agents of nosocomial fungal infections. Aims: This study aimed to establish the epidemiological profile of patients with candiduria hospitalized in the capital of the State of Mato Grosso, in the Central-Western region of Brazil. Methods: Patients from three private hospitals and a public hospital participated in the study. This was an observational and cross-sectional study including analysis of patients mortality. It was carried out from March to August 2015. Results: A total of 93 patients with candiduria were evaluated. Candida tropicalis was found most commonly (37.6%; n=35), followed by Candida albicans (36.6%; n=34), Candida glabrata (19.3%; n=18), psilosis complex (4.3%; n=4), Candida lusitaniae (1.1%; n=1) and Candida krusei (1.1%; n=1). Antibiotic therapy (100%) and the use of an indwelling urinary catheter (89.2%; n=83) were the most frequent predisposing factors. Antifungal treatment was given to 65.6% of the patients, and anidulafungin was the most used antifungal. Mortality rates were 48% higher among patients with candiduria who had renal failure. Micafungin was the antifungal most prescribed among the patients who died. Candidemia concomitant with candiduria occurred in eight (8.6%; n=8) cases. Considering the species recovered in the blood and urine, only one patient had genetically distinct clinical isolates. Conclusions: Non-C. albicans Candida species were predominant, with C. tropicalis being the most responsible for most cases of candiduria

Antecedentes: Las levaduras del género Candida están consideradas los principales agentes de infecciones micóticas nosocomiales. Objetivos: El objetivo del presente estudio fue establecer el perfil epidemiológico de los pacientes con candiduria hospitalizados en la capital de Mato Grosso, estado situado en la Región centro-oeste de Brasil. Métodos: Participaron en el estudio pacientes de tres hospitales privados y un hospital público. Se trataba de un estudio observacional y transversal que incluía el análisis de la mortalidad de los pacientes. Se llevó a cabo de marzo a agosto de 2015. Resultados: Se incluyó en el estudio a un total de 93 pacientes con candiduria. Candida tropicalis se encontró con mayor frecuencia (37,6%; n=35), seguida por Candida albicans (36,6%; n=34), Candida glabrata (19,3%; n=18), Candida psilosis complex (4,3%; n=4), Candida lusitaniae (1,1%; n=1) y Candida krusei (1,1%; n=1). El tratamiento antibiótico (100%) y el uso de una sonda urinaria permanente (89,2%; n=83) fueron los factores predisponentes más frecuentes. Se prescribió tratamiento antimicótico al 65,6% de los pacientes y la anidulafungina fue el antimicótico utilizado con más frecuencia. Las tasas de mortalidad fueron un 48% superiores entre los pacientes con candiduria con insuficiencia renal. Los pacientes que murieron presentaron la mayor proporción de prescripción del antimicótico micafungina. La candidemia concomitante con candiduria se produjo en ocho casos (8,6%; n=8). Si se tienen en cuenta las especies recuperadas en sangre y orina, solo en un paciente se encontraron aislamientos clínicos genéticamente diferentes. Conclusiones: Las especies de Candida no C. albicans fueron predominantes. C. tropicalis fue la responsable de la mayoría de los casos de candiduria

Epidemiological profile of patients hospitalized with candiduria in the Central-Western region of Brazil.

BACKGROUND: Candida yeasts are considered the main agents of nosocomial fungal infections. AIMS: This study aimed to establish the epidemiological profile of patients with candiduria hospitalized in the capital of the State of Mato Grosso, in the Central-Western region of Brazil. METHODS: Patients from three private hospitals and a public hospital participated in the study. This was an observational and cross-sectional study including analysis of patients mortality. It was carried out from March to August 2015. RESULTS: A total of 93 patients with candiduria were evaluated. Candida tropicalis was found most commonly (37.6%; n=35), followed by Candida albicans (36.6%; n=34), Candida glabrata (19.3%; n=18), psilosis complex (4.3%; n=4), Candida lusitaniae (1.1%; n=1) and Candida krusei (1.1%; n=1). Antibiotic therapy (100%) and the use of an indwelling urinary catheter (89.2%; n=83) were the most frequent predisposing factors. Antifungal treatment was given to 65.6% of the patients, and anidulafungin was the most used antifungal. Mortality rates were 48% higher among patients with candiduria who had renal failure. Micafungin was the antifungal most prescribed among the patients who died. Candidemia concomitant with candiduria occurred in eight (8.6%; n=8) cases. Considering the species recovered in the blood and urine, only one patient had genetically distinct clinical isolates. CONCLUSIONS: Non-C. albicans Candida species were predominant, with C. tropicalis being the most responsible for most cases of candiduria.

Importance of Species Sorting and Immigration on the Bacterial Assembly of Different-Sized Aggregates in a Full-Scale Aerobic Granular Sludge Plant.

In aerobic granular sludge (AGS) systems, different-sized microbial aggregates having different solids retention time (SRT) coexist in the same reactor compartment and are subjected to the same influent wastewater. Thus, the AGS system provides a unique ecosystem to study the importance of local (species sorting) and regional (immigration) processes in bacterial community assembly. The microbial communities of different-sized aggregates (flocs <0.2 mm, small granules (0.2-1.0 mm) and large granules >1.0 mm), influent wastewater, excess sludge and effluent of a full-scale AGS plant were characterized over a steady-state operation period of 6 months. Amplicon sequencing was integrated with mass balance to determine the SRT and net growth rate of operational taxonomic units (OTUs). We found strong evidence of species sorting as opposed to immigration, which was significantly higher at short SRT (i.e., flocs and small granules) than that at long SRT (large granules). Rare OTUs in wastewater belonging to putative functional groups responsible for nitrogen and phosphorus removal were progressively enriched with an increase in microbial aggregates size. In contrast, fecal- and sewage infrastructure-derived microbes progressively decreased in relative abundance with increase in microbial aggregate size. These findings highlight the importance of AGS as a unique model ecosystem to study fundamental microbial ecology concepts.

Left atrial and left atrial appendage functional recovery after cardioversion in patients with recent atrial fibrillation: Serial echocardiographic study.

BACKGROUND: The aim of this study is to point out timing of left atrium and its appendage functional recovery after cardioversion (CV) in recent onset atrial fibrillation (AF). METHODS: Fifty patients; 27 within 48-h (group I) and 23 after 48-h (group II), of AF onset, who had successful CV underwent transthoracic echocardiography (TTE), before and immediately after CV, then 15, 30 and 90 days later. Transesophageal echocardiography (TEE) was performed for group II before and for all patients immediately after CV and 1 month later. Mitral peak A velocity and left atrial (LA) reversal (Ar) velocity, tissue Doppler imaging (TDI) of septal mitral annular velocity (A1) and LA free wall velocity (A3) were recorded. Absence or peak A velocity < 50 cm/s was taken as a cut off value for atrial stunning. Intra-atrial conduction time (IACT) was measured. LA appendage late emptying (LAALE) velocity was measured by TEE-pulsed TDI of LA appendage. RESULTS: Post CV, all group II and 34% of group I experienced stunning. In both groups, peak A, Ar, A1, A3 and LAALE velocities increased (p = 0.000), while IACT decreased (p = 0.000) progressively over time. Partial recovery occurred after 15 and 30 days, while full recovery occurred 30 and 90 days post CV in groups I and II, respectively. IACT1 and IACT2 correlated with LA diameter (r = 0.2778 and r = 0.227, respectively, p < 0.01). CONCLUSIONS: Stunning and functional recovery of the LA and its appendage are strongly determined by the duration being in AF. Serial IACT by TDI was a good new parameter for detection of functional recovery of LA and LA appendage.

A propidium monoazide-quantitative PCR method for the detection and quantification of viable Enterococcus faecalis in large-volume samples of marine waters.

The development of rapid detection assays of cell viability is essential for monitoring the microbiological quality of water systems. Coupling propidium monoazide with quantitative PCR (PMA-qPCR) has been successfully applied in different studies for the detection and quantification of viable cells in small-volume samples (0.25-1.00 mL), but it has not been evaluated sufficiently in marine environments or in large-volume samples. In this study, we successfully integrated blue light-emitting diodes for photoactivating PMA and membrane filtration into the PMA-qPCR assay for the rapid detection and quantification of viable Enterococcus faecalis cells in 10-mL samples of marine waters. The assay was optimized in phosphate-buffered saline and seawater, reducing the qPCR signal of heat-killed E. faecalis cells by 4 log10 and 3 log10 units, respectively. Results suggest that high total dissolved solid concentration (32 g/L) in seawater can reduce PMA activity. Optimal PMA-qPCR standard curves with a 6-log dynamic range and detection limit of 10(2) cells/mL were generated for quantifying viable E. faecalis cells in marine waters. The developed assay was compared with the standard membrane filter (MF) method by quantifying viable E. faecalis cells in seawater samples exposed to solar radiation. The results of the developed PMA-qPCR assay did not match that of the standard MF method. This difference in the results reflects the different physiological states of E. faecalis cells in seawater. In conclusion, the developed assay is a rapid (∼5 h) method for the quantification of viable E. faecalis cells in marine recreational waters, which should be further improved and tested in different seawater settings.

Recruitment of HIV-Positive Women in Research: Discussing Barriers, Facilitators, and Research Personnel's Knowledge.

BACKGROUND: Women have historically been under-represented in HIV research, partly due to ineffective recruitment strategies. OBJECTIVE: To improve the existing understanding of recruitment for HIV-positive women based on a province-wide cross-sectional study. METHODS: A survey was emailed to all site coordinators who recruited participants in a study involving 490 HIV-positive women living in Ontario, Canada. The survey consisted of questions regarding the important recruitment barriers and successes. Quantitative data were then contextualized within extensive knowledge from research personnel and team members. RESULTS: Completed surveys were received from (89%) site coordinators (34/38) and 98% (31/34) were women. The highest ranked recruitment barriers identified were: sensitivity of the research topic (59%), time/availability constraints (59%), language barriers (53%), HIV disclosure/stigma issues (47%), lack of trust of research personnel (41%), fear of research (41%) and inaccessibility to child care and transportation (41%). The respondents felt that the most important personal attributes for recruitment were research personnel who were respectful (97%), skilled (91%), flexible (88%) and empathetic (88%) and had good communication skills (88%). The most successful recruitment strategies identified were: developing a strong rapport (88%) that was facilitated by an empathetic relationship (100%), acknowledging the sensitive nature of the research topic (94%), providing cash financial compensation (88%), and developing recruitment strategies unique to women (88%). CONCLUSION: There are differences in the approaches needed for the recruitment of HIV-positive women in research. For successful recruitment of HIV-positive women, a strong rapport between the research personnel and study participants is important. This rapport is facilitated by having study personnel who are respectful, trustworthy, empathetic, and flexible. Population-specific recruitment strategies are important to ensure adequate recruitment of minority groups in research with greater gender consideration for women requiring specific attention.

"Speaking the dialect": understanding public discourse in the aftermath of an HIV vaccine trial shutdown.

OBJECTIVES: We investigated how persons from key populations at higher risk of HIV exposure interpreted the process and outcomes of the Step Study HIV-1 vaccine trial, which was terminated early, and implications for willingness to participate in and community support for HIV vaccine research. METHODS: We used qualitative methods and a community-based approach in 9 focus groups (n = 72) among ethnically and sexually diverse populations and 6 semistructured key informant interviews in Ontario, Canada, in 2007 to 2008. RESULTS: Participants construed social meaning from complex clinical and biomedical phenomena. Social representations and mental models emerged in fears of vaccine-induced infection, conceptualizations of unfair recruitment practices and increased risk behaviors among trial participants, and questioning of informed consent. Narratives of altruism and the common good demonstrated support for future trials. CONCLUSIONS: Public discourse on HIV vaccine trials is a productive means of interpreting complex clinical trial processes and outcomes in the context of existing beliefs and experiences regarding HIV vaccines, medical research, and historical disenfranchisement. Strategic engagement with social representations and mental models may promote meaningful community involvement in biomedical HIV prevention research.

Coronary artery bypass grafting on beating heart. Does it provide superior myocardial preservation than conventional technique?

OBJECTIVE: To compare myocardial injury caused by 3 commonly used methods for coronary artery bypass grafting (CABG). METHODS: A prospective randomized study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The study started in February 2003 and concluded in April 2004 after including 45 patients (15 patients in each of 3 sub-groups) who fulfilled the inclusion and exclusion criteria. The subgroups included coronary artery bypass surgery performed by: a) conventional technique, b) off-pump technique, and c) on-pump beating-heart techniques. All patients had similar operative risk profiles. Their ages were 70 years or less with an ejection fraction of 30-50%. The creatine kinase, myocardial band (CKMB) levels were determined 2 hours after arrival from the operating room then, at 4 hours, 6 hours, and 12 hours. The comparison of creatine phosphokinase and CKMB levels was carried out using analysis of variance with repeated measures. The p-values were used to evaluate the significance of differences. RESULTS: The pre-operative characteristics including age, gender, ethnic origin, diabetes mellitus, hypertension, and left ventricular function, were similar in the 3 groups. All groups had a median number of 3 bypass grafts. The stay in the intensive care unit and the duration of inotropes were shortest in the off-pump group, but the difference was not significant. There was a peak of CKMB levels at 6 hours in all groups. The trend of CKMB level showed significantly higher values in the conventional CABG group as compared with the other 2 groups. CONCLUSION: This study indicates that the off-pump technique provides better myocardial preservation than other methods.

Avaliaçao dos níveis de interferon-gama (citocina tipo 1), interleucina-10 (citocina tipo 2) e fator de necrose tumoral-alfa induzidos em células mononucleares do sangue periférico de pacientes com paracoccidioidomicose com estímulos específico e inespecíficos, durante atividade e após remissão da doença / Evaluation of interferon-gamma (type 1 cytokine), interleukin 10 (type 2 cytokine) and tumor necrosis factor levels induced in peripheral blood mononuclear cells of patients with paracoccidioidomycosis with specific and inespecific antigens, during a

Diversos estudos tem demonstrado participação de citocinas na fisiopatogenia da Pbm. Parte destas avaliações demonstram que o IFN-g, citocina tipo 1, participa na ativiadde fungicida dos macrófagos. Alguns estudos inferiram que citocinas tipo 2 poderiam participar da progressão da doença. Com o intuito de avaliar esta dicotomia de citocinas na Pbm foi proposto investigar a produção a produção de citocinas 1 e 2 em PBMC dos pacientes com Pbm, sob estímulo inespecífico e específico. O primeiro grupo constituiu de oito pacientes com a forma crônica de Pbm em atividade da doença e sem tratamento prévio. O segundo grupo foi constituído de nove pacientes com Pbm forma crônica tratados previamente com alta medicamentosa. O terceiro grupo foi constituído de dez pessoas sadias com teste cutâneo de hipersensibilidade à paracoccidioidina negativo. Foram obtidas células mononucleares do sangue periférico dos pacientes e incubadas com meio RPMI suplementado com soro autólogo. As células foram estimuladas com antígenos inespecíficos (LPS-Sae e Pha) e específico (AgPb). Foram realizadas as padronizações das curvas de cinética e dose-resposta para os estímulos in vitro deste estudo. Foram estimuladas as celulas com LPS-Sae por 18h para a quantificação de TNF-a. A estimulação com Pha foi realizada com 48h para avaliação do INF-g e da IL-10. Foi utilizada a estimulação com antígeno específico-AgPb por 6h para quantificação de TNF-a, por 18h para quantificação de IL-10 e 96h para o IFN-g. As citocinas dos sobrenadantes de PBMC foram quantificadas por ELISA. Foram realizadas análises não paramétricas para comparação dos níveis das citocinas entre os diferentes grupos de pacientes, aceitando-se diferenças significantes com risco a<5(por cento). Os níveis de IFN-g, citocina tipo 1, nos sobrenadantes de PBMC estimuladas com antígeno inespecífico-Pha foram significantemente menores nos pacientes em atividade da Pbm. Também foi observado o mesmo comportamento com o estímulo com antígeno específico-AgPb. Os níveis de IL-10, citocina tipo 2, nos sobrenadantes das PBMC estimuladas com antígenos específicos e inespecíficos não tiveram alterações significantes entre os grupos de pacientes estudados. Também não foi observado diferença na produção de TNF-a entre os grupos estudados. Os baixos níveis de citocina do tipo 1 (IFN-g) decorrente do estímulo com antígenos inespecíficos ou específicos, observados durante a atividade da Pbm, sugerem um ...(au)