Trans-spinal magnetic stimulation combined with kinesiotherapy as a new method for enhancing functional recovery in patients with spinal cord injury due to neuromyelitis optica: a case report.

BACKGROUND: Experimental studies have shown that repetitive trans-spinal magnetic stimulation (TsMS) decreases demyelination and enables recovery after spinal cord injury (SCI). However, the usefulness of TsMS in humans with SCI remains unclear. Therefore, the main objective of this study is to evaluate the effects of TsMS combined with kinesiotherapy on SCI symptoms. We describe a protocol treatment with TsMS and kinesiotherapy in a patient with SCI due to neuromyelitis optica (NMO)-associated transverse myelitis. CASE PRESENTATION: A 23-year-old white male with NMO spectrum disorders started symptoms in 2014 and included lumbar pain evolving into a mild loss of strength and sensitivity in both lower limbs. Five months later, the symptoms improved spontaneously, and there were no sensorimotor deficits. Two years later, in 2016, the symptoms recurred with a total loss of strength and sensitivity in both lower limbs. Initially, physiotherapy was provided in 15 sessions with goals of motor-sensory recovery and improving balance and functional mobility. Subsequently, TsMS (10 Hz, 600 pulses, 20-seconds inter-trains interval, at 90% of resting motor threshold of the paravertebral muscle) was applied at the 10th thoracic vertebral spinous process before physiotherapy in 12 sessions. Outcomes were assessed at three time points: prior to physiotherapy alone (T-1), before the first session of TsMS combined with kinesiotherapy (T0), and after 12 sessions of TsMS combined with kinesiotherapy (T1). The patient showed a 25% improvement in walking independence, a 125% improvement in balance, and an 18.8% improvement in functional mobility. The Patient Global Impression of Change Scale assessed the patient's global impression of change as 'much improved'. CONCLUSION: TsMS combined with kinesiotherapy may safely and effectively improve balance, walking independence, and functional mobility of patients with SCI due to NMO-associated transverse myelitis.

Green-Synthesized Silver Nanoparticles in the Prevention of Multidrug-Resistant Proteus mirabilis Infection and Incrustation of Urinary Catheters BioAgNPs Against P. mirabilis Infection.

This study aimed to assess the activity of AgNPs biosynthesized by Fusarium oxysporum (bio-AgNPs) against multidrug-resistant uropathogenic Proteus mirabilis, and to assess the antibacterial activity of catheters coated with bio-AgNPs. Broth microdilution and time-kill kinetics assays were used to determine the antibacterial activity of bio-AgNPs. Catheters were coated with two (2C) and three (3C) bio-AgNPs layers using polydopamine as crosslinker. Catheters were challenged with urine inoculated with P. mirabilis to assess the anti-incrustation activity. MIC was found to be 62.5 µmol l-1, causing total loss of viability after 4 h and bio-AgNPs inhibited biofilm formation by 76.4%. Catheters 2C and 3C avoided incrustation for 13 and 20 days, respectively, and reduced biofilm formation by more than 98%, while the pristine catheter was encrusted on the first day. These results provide evidence for the use of bio-AgNPs as a potential alternative to combat of multidrug-resistant P. mirabilis infections.

Clonal relationship, virulence genes, and antimicrobial resistance of Morganella morganii isolated from community-acquired infections and hospitalized patients: a neglected opportunistic pathogen.

Morganella morganii is a bacterium belonging to the normal intestinal microbiota and the environment; however, in immunocompromised individuals, this bacterium can become an opportunistic pathogen, causing a series of diseases, both in hospitals and in the community, being urinary tract infections more prevalent. Therefore, the objective of this study was to evaluate the prevalence, virulence profile, and resistance to antimicrobials and the clonal relationship of isolates of urinary tract infections (UTI) caused by M. morganii, both in the hospital environment and in the community of the municipality of Londrina-PR, in southern Brazil, in order to better understand the mechanisms for the establishment of the disease caused by this bacterium. Our study showed that M. morganii presents a variety of virulence factors in the studied isolates. Hospital strains showed a higher prevalence for the virulence genes zapA, iutA, and fimH, while community strains showed a higher prevalence for the ireA and iutA genes. Hospital isolates showed greater resistance compared to community isolates, as well as a higher prevalence of multidrug-resistant (MDR) and extended-spectrum beta lactamase (ESBL)-producing isolates. Several M. morganii isolates from both sources showed high genetic similarity. The most prevalent plasmid incompatibility groups detected were FIB and I1, regardless of the isolation source. Thus, M. morganii isolates can accumulate virulence factors and antimicrobial resistance, making them a neglected opportunistic pathogen.

Epidemiology and characterization of Providencia stuartii isolated from hospitalized patients in southern Brazil: a possible emerging pathogen.

This study aimed to characterize the virulence factors and antimicrobial resistance of Providencia stuartii , an opportunistic pathogen that causes human infections. We examined 45 isolates of P. stuartii both genotypically and phenotypically by studying their adherence to HeLa cells, biofilm formation, cytotoxicity and antimicrobial resistance, and analysed their genomes for putative virulence and resistance genes. This study found that most isolates possessed multiple virulence genes, including fimA, mrkA, fptA, iutA, ireA and hlyA, and were cytotoxic to Vero cells. All the isolates were resistant to amoxicillin plus clavulanic acid, levofloxacin and sulfamethoxazole plus trimethoprim, and most were resistant to ceftriaxone and cefepime. All isolates harboured extended-spectrum beta-lactamase coding genes such as bla CTX-M-2 and 23/45(51.11 %) of them also harboured bla CTX-M-9. The gene KPC-2 (carbapenemase) was detected in 8/45(17.77 %) isolates. This study also found clonality among the isolates, indicating the possible spread of the pathogen among patients at the hospital. These results have significant clinical and epidemiological implications and emphasize the importance of a continued understanding of the virulence and antimicrobial resistance of this pathogen for the prevention and treatment of future infections.

Resistance and Virulence Surveillance in Escherichia coli Isolated from Commercial Meat Samples: A One Health Approach.

Escherichia coli is a key indicator of food hygiene, and its monitoring in meat samples points to the potential presence of antimicrobial-resistant strains capable of causing infections in humans, encompassing resistance profiles categorized as serious threats by the Centers for Disease Control and Prevention (CDC), such as Extended-Spectrum Beta-Lactamase (ESBL)-a problem with consequences for animal, human, and environmental health. The objective of the present work was to isolate and characterize ESBL-producing E. coli strains from poultry, pork, and beef meat samples, with a characterization of their virulence and antimicrobial resistance profiles. A total of 450 meat samples (150 chicken, 150 beef, and 150 pork) were obtained from supermarkets and subsequently cultured in medium supplemented with cefotaxime. The isolated colonies were characterized biochemically, followed by antibiogram testing using the disk diffusion technique. Further classification involved biofilm formation and the presence of antimicrobial resistance genes (blaCTX-M, AmpC-type, mcr-1, and fosA3), and virulence genes (eaeA, st, bfpA, lt, stx1, stx2, aggR, iss, ompT, hlyF, iutA, iroN, fyuA, cvaC, and hylA). Statistical analysis was performed via the likelihood-ratio test. In total, 168 strains were obtained, with 73% originating from chicken, 22% from pork, and 17% from beef samples. Notably, strains exhibited greater resistance to tetracycline (51%), ciprofloxacin (46%), and fosfomycin (38%), apart from ß-lactams. The detection of antimicrobial resistance in food-isolated strains is noteworthy, underscoring the significance of antimicrobial resistance as a global concern. More than 90% of the strains were biofilm producers, and strains carrying many ExPEC genes were more likely to be biofilm formers (OR 2.42), which increases the problem since the microorganisms have a greater chance of environment persistence and genetic exchange. Regarding molecular characterization, bovine samples showed a higher prevalence of blaCTX-M-1 (OR 6.52), while chicken strains were more likely to carry the fosA3 gene (OR 2.43, CI 1.17-5.05) and presented between 6 to 8 ExPEC genes (OR 2.5, CI 1.33-5.01) compared to other meat samples. Concerning diarrheagenic E. coli genes, two strains harbored eae. It is important to highlight these strains, as they exhibited both biofilm-forming capacities and multidrug resistance (MDR), potentially enabling colonization in diverse environments and causing infections. In conclusion, this study underscores the presence of ß-lactamase-producing E. coli strains, mainly in poultry samples, compared to beef and pork samples. Furthermore, all meat sample strains exhibited many virulence-associated extraintestinal genes, with some strains harboring diarrheagenic E. coli (DEC) genes.

Water quality monitoring in southern Brazil and the assessment of risk factors related to contamination by coliforms and Escherichia coli.

The potability of water, including underground sources, is constantly affected by human activities. To assess water quality and water security in rural and urban areas of southern Brazil, a quantitative, retrospective analysis of water samples collected monthly by the Brazilian health authorities (19,687 samples from 2013 to 2021) was performed. In rural areas, 5,979 water samples (77.54%) were found to be contaminated by coliform bacteria and 3,431 (44.50%) by Escherichia coli. In addition, 1,616 (20.95%) of the contaminated samples were significantly correlated with rainfall amount. In urban areas, 1,268 (10.95%) of the samples contained coliform bacteria and 293 (2.53%) of these samples contained E. coli, with the factor of rainfall associated with 1,081 samples (9.33%) with bacterial contamination. In terms of physicochemical parameters, turbidity exceeded the national standard (5 uT) in 448 (2.32%) samples and fluoride fell below the required level (0.8 mg/L) in 106 samples (0.54%). The presence of free residual chlorine (0.2-2.0 mg/L) was verified in 846 samples (14.38%) in rural areas and in 10,825 samples (56.13%) in urban areas. These results suggest a strong association between rainfall factors and physicochemical alterations, as well as the risk of greater microbial contamination of water for human consumption.

Topical formulations containing Trichilia catigua extract as therapeutic options for a genital and an acyclovir-resistant strain of herpes recurrent infection.

Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infect, respectively, 67% and 13% of the world population, most commonly causing mild symptoms, such as blisters/ulcers. However, severe conditions such as keratitis, encephalitis, and systemic infections may occur, generally associated with the patient's immunological condition. Although Acyclovir® (ACV) and its analogs are the reference drugs for herpetic infections, the number of ACV-resistant HSV infections is growing exponentially. Therefore, new natural products' bioactive compounds have been studied to develop novel effective anti-herpetics. Trichilia catigua is a plant widely used in traditional medicine, including the treatment of skin diseases and sexual infections. In our study, 16 extracts from the bark of T. catigua, obtained with different solvents and their combinations, were evaluated against HSV-1 AR and HSV-2, respectively, ACV resistance and genital strains in vitro. The extracts with the highest selectivity index were used to prepare new topical anti-herpetic formulations and confirmed in vivo. Two new topical formulations were suggested to treat cutaneous and genital herpetic recurrent lesions. The cytotoxicity and antiviral activity were tested using the MTT method. The cytotoxic (CC50) and inhibitory (IC50) concentrations of 50% and the selectivity index (SI: CC50/IC50) were determined. Tc12, Tc13, and Tc16 were added to the formulations. Infected BALB/c mice were treated for 8 days, and the severity of the herpetic lesions was analyzed daily. All CEs showed a CC50 value ranging from 143 to 400 µg/mL, except for Tc3 and Tc10. Tc12, Tc13, and Tc16 showed the best SI in the 0 h, virucidal, and adsorption inhibition assays. In the in vivo test against HSV-1 AR, the infected animals treated with creams were statistically different from the infected non-treated animals and similar to ACV-treated mice. In HSV-2-infected genitalia, similar effects were found for Tc13 and Tc16 gels. The present study demonstrated that extracts from the bark of T. catigua, traditionally used in folk medicine, are a valuable source of active compounds with anti-herpetic activity. The extracts showed a virucidal mechanism of action and prevented the initial stages of viral replication. The cutaneous and genital infections were strongly inhibited by the Tc12, Tc13, and Tc16 extracts. New topical therapeutic alternatives using Trichilia catigua extracts are suggested for patients infected with ACV-resistant strains of HSV.

Indexing of Left Atrial Volume by Body Surface Area and Height in a Brazilian Population without Previous Heart Disease and with a Normal Heart on Echocardiography. Behavior in Obese and Overweight Patients.

Background: Left atrial (LA) volume indexing for body surface area (BSA) may underestimate LA size in obese and overweight people. Since LA volume is a risk marker for some cardiovascular events, it is suggested that indexing for height would be an alternative more appropriate method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for height in our population. Methods: Echocardiograms from 2018 to 2021 were reviewed and patients without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAvol) measured by biplane Simpson's method were included. LAvol was indexed by BSA (ml/m2), by height (LAvol/m), by height raised to exponent 2.7 (ml/ m2.7) and by height squared (ml/h2). Results: A total of 545 patients, 50.5 ± 13.4 y., 335 females (61,5%) were analyzed. There were 145 normal weight (26.6%), 215 overweight (39.4%), 154 obese (28.3%) and 31 low weight (5.7%) patients. To establish normal values we included only the normal weight group and considered normal values from 2SD below to 2SD above the mean. Mean and normal values were: LAvol/h 26.0 ±4.5, 17 - 35 ml/m, LAvol/ht2 16 ± 2.8, 10.4 - 21.6 ml/ ht2 and LAvol/ht2.7 11.4 ± 2.2, 7.0 - 15.8 ml/m2.7. The normal LAvol/ht2.7 differed between male and female (11.4 ± 2.4 and 12.8 ± 2.6, p < 0.001). LA diameter, LAvol, LAvol/h, LAvol/h2 and LAvol/ht2.7 increased progressively from low-weight, normal weight, overweight and obese patients (p< 0.0001), but not LAvol/BSA. When indexing LAvol for height, for height2 and for height2.7 20.8%, 22.7% and 21.4% of the obese patients, respectively, were reclassified as enlarged LA, and 7.4%, 8.8% and 8.4% of the overweight patients as well. Using ROC curve analysis, LAvol/h2 had the highest AUC ant the best predictive value to identify LA enlargement and LAvol/BSA the worst one. Conclusions: Normal values for LAvol indexed for height by three different methods are described in normal individuals. We reinforce that LAvol indexation for BSA underestimates LA size in obese and overweight patients and in these groups, specially, indexing for height2 is probably the best method to evaluate LAvol.

Prevalence of Antimicrobial Resistance and Clonal Relationship in ESBL/AmpC-Producing Proteus mirabilis Isolated from Meat Products and Community-Acquired Urinary Tract Infection (UTI-CA) in Southern Brazil.

The present study aimed to evaluate the prevalence of antimicrobial resistance and clonal relationships in Proteus mirabilis isolated from chicken meat, beef, pork, and community-acquired urinary tract infections (UTI-CA). Chicken meat isolates showed the highest multidrug resistance (MDR), followed by those from pork and UTI-CA, whereas beef had relatively few MDR strains. All sources had strains that carried blaCTX-M-65, whereas blaCTX-M-2 and blaCMY-2 were only detected in chicken meat and UTI-CA isolates. This indicates that chicken meat should be considered an important risk factor for the spread of P. mirabilis carrying ESBL and AmpC. Furthermore, ESBL/AmpC producing strains were resistant to a greater number of antimicrobials and possessed more resistance genes than non-producing strains. In addition, the antimicrobial resistance genes qnrD, aac(6')-Ib-cr, sul1, sul2, fosA3, cmlA, and floR were also found. Molecular typing showed a genetic similarity between chicken meat and UTI-CA isolates, including some strains with 100% similarity, indicating that chicken can be a source of P. mirabilis causing UTI-CA. It was concluded that meat, especially chicken meat, can be an important source of dissemination of multidrug-resistant P. mirabilis in the community.

Detection of high antibodies titers against rat leukemia virus in an outbreak of reproductive disorders and lymphomas in Wistar rats.

Young female Wistar rats from a specific pathogen free breeding colony presented an outbreak of infertility along with neurological symptoms and malignant lymphomas. We evaluated the presence and the potential role of the rat leukemia virus (RaLV) in the disease because these clinical signs could be compatible with a retrovirus. RaLV is a mammalian type C endogenous retrovirus initially isolated from in vitro Sprague-Dawley rat embryo cultures. There are no reports of clinical disease in rats associated with this virus, and little is known about its interaction with the host. Using reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay, we studied the synthesis of the viral particles and the development of an immune response against the virus in this rat colony. The results showed that healthy and diseased Wistar rats synthetized viral RNA but only diseased animals developed a detectable immune response against RaLV envelop protein. Furthermore, rats with lymphomas tended to have higher titers of antibodies against RaLV epitopes than those with infertility or neurological symptoms. The results suggest that increases in the RaLV infectious particle loads could be involved in the development of lymphomas in young rats. The potential causes of RaLV reactivation are discussed.

Sexual maturity of Callinectes danae and C. ornatusfrom Paraguaçu river estuary, Bahia state, Brazil / Maturidade sexual de Callinectes danaee C. ornatusno estuário do rio Paraguaçu, Bahia, Brasil

Callinectes danae and C. ornatus are economically important species in several countries, including Brazil. Therefore, this study aimed to estimate the L50 of these species using morphological, morphometric, and physiological data. The estimated values were statically compared and results from previous studies were analyzed to verify latitudinal variations among the sizes of sexual maturity at different latitudes of the Brazilian coast. Individuals were monthly collected in the Paraguaçu River estuary from August 2013 to July 2014, using cage traps. L50 estimates for C. danae were morphological=55.80 mm, morphometric=59.04, mm, and physiological=60.41 mm for males and morphological=54.63 mm, morphometric=55.33 mm, and physiological=57.29 mm for females. Considering C. ornatus, estimates were morphological=42.63 mm, morphometric=50.81 mm, and physiological=43.95 mm for males and morphological=42.33 mm, mor-phometric=42.75 mm, and physiological=40.43 mm for females. Our results indicated that the minimum catch sizes should be equal to 61.00 mm for C. danae and 51.00 for C. ornatus and that the mesh of traps used by fishermen must be adjusted to prevent the capture of immature animals.

Callinectes danae e C. ornatus são siris economicamente importantes em vários países, incluindo o Brasil. O presente estudo objetivou determinar o L50 dessas espécies com base em dados morfológicos, morfométricos e fisiológicos. Os valores estimados foram comparados estatisticamente e os resultados de estudos anteriores no Brasil foram analisados para verificar variações latitudinais nos tamanhos de maturidade sexual em diferentes regiões da costa brasileira. Os exemplares foram coletados mensalmente, de agosto de 2013 a julho de 2014, por meio de armadilhas do tipo gaiola. As estimativas de L50 em C. danae foram morfológica=55,80 mm, morfométrica=59,04 mm e fisiológica=60,41 mm para machos e morfológica=54,63 mm, morfométrica=55,33 mm e fisiológica=57,29 mm para fêmeas. Considerando C. ornatus, as estimativas foram: morfológica=42,63 mm, morfométrica=50,81 mm e fisiológica=43,95 mm para machos e morfológica=42,33 mm, morfométrica=42,75 mm e fisiológica=40,43 mm para fêmeas. Nossos resultados indicaram que os tamanhos mínimos de captura deveriam ser iguais a 61,00 mm para C. danae e 51,00 mm para C. ornatus e a malha das armadilhas usadas pelos pescadores ajustada para impedir a captura de animais imaturos.

O impacto das atividades cognitivas no desempenho no Mini-Mental de idosos octogenários de São João del Rei/MG: um estudo piloto / The impact of cognitive activities in the Mini-Mental performance of octogenarian elderly in the city of São João del Rei/MG: a pilot study

O aumento da população idosa mundial em torno de 600% nos últimos 50 anos trouxe vários desafios. O principal é a adoção de políticas que possam oferecer um envelhecimento saudável, preservando a autonomia dos sujeitos. Entre essas estratégias, a estimulação cognitiva é uma que possui baixo custo operacional e pode otimizar as funções que ainda se encontram preservadas. O objetivo desse estudo piloto retrospectivo foi avaliar o impacto protetivo das práticas de estimulação cognitiva em octogenários da cidade de São João del Rei. Para tanto foram aplicados dois instrumentos de avaliação: o Mini-Mental e um Questionário de Práticas Cognitivas. Os resultados preliminares indicam uma tendência de as práticas cognitivas impactarem positivamente no desempenho no Mini-Mental dos octogenários (p<0.01). Tais resultados têm implicações diretas, sobretudo nas estratégias de baixo custo a serem implementadas com o objetivo de se construírem reservas cognitivas na população recém adentrada na 3ª idade, visando uma maior autonomia na 4ª idade.

The increase in the world's elderly population of around 600% in the last 50 years has brought many challenges. The main one is adopting policies that can offer healthy aging, preserving the subjects' autonomy. Among these strategies, the cognitive stimulation is one that has a low operational cost and can optimize the functions which are still preserved. This retrospective pilot study aimed at evaluating the impact of cognitive stimulation practices on octogenarian elderly in the city of São João del Rei. Therefore, two evaluation instruments were applied: Mini-Mental and a Cognitive Practice Questionnaire. The preliminary results indicate a tendency that the cognitive practices impact positively on the octogenarians' cognitive performance(p<0.01). Such results have direct implications especially on the low-coststrategies to be implemented aiming at building cognitive reserves in the population of the recent 3rd age viewing a bigger autonomy in the 4th age.

Intrahemispheric EEG: A New Perspective for Quantitative EEG Assessment in Poststroke Individuals.

The ratio between slower and faster frequencies of brain activity may change after stroke. However, few studies have used quantitative electroencephalography (qEEG) index of ratios between slower and faster frequencies such as the delta/alpha ratio (DAR) and the power ratio index (PRI; delta + theta/alpha + beta) for investigating the difference between the affected and unaffected hemisphere poststroke. Here, we proposed a new perspective for analyzing DAR and PRI within each hemisphere and investigated the motor impairment-related interhemispheric frequency oscillations. Forty-seven poststroke subjects and twelve healthy controls were included in the study. Severity of upper limb motor impairment was classified according to the Fugl-Meyer assessment in mild/moderate (n = 25) and severe (n = 22). The qEEG indexes (PRI and DAR) were computed for each hemisphere (intrahemispheric index) and for both hemispheres (cerebral index). Considering the cerebral index (DAR and PRI), our results showed a slowing in brain activity in poststroke patients when compared to healthy controls. Only the intrahemispheric PRI index was able to find significant interhemispheric differences of frequency oscillations. Despite being unable to detect interhemispheric differences, the DAR index seems to be more sensitive to detect motor impairment-related frequency oscillations. The intrahemispheric PRI index may provide insights into therapeutic approaches for interhemispheric asymmetry after stroke.

Proteus mirabilis from community-acquired urinary tract infections (UTI-CA) shares genetic similarity and virulence factors with isolates from chicken, beef and pork meat.

Proteus mirabilis is an opportunistic pathogen associated with a variety of infections in humans, especially those in the urinary tract. The isolation of this pathogen in foods of animal origin such as meat is poorly documented and should not be neglected, in view of the zoonotic risk that this can pose to human health. Thus, the objective of this study was to evaluate the prevalence, virulence profile, and similarity between P. mirabilis strains isolated from chicken, beef, and pork meat and those causing community-acquired urinary tract infections (UTI-CA), in order to better understand the role of this bacterium as a zoonotic pathogen. P. mirabilis was isolated from the three types of meat and was found to be more prevalent in chicken. All isolates exhibited several genotypic and phenotypic virulence characteristics, such as adhesion capacity in HEp-2 cell culture, biofilm formation, cytotoxicity in Vero cells and genes that express fimbriae (mrpA, pmfA, ucaA, atfA), hemolysin (hpmA), proteases (zapA and ptA) and siderophore receptor (ireA). UTI-CA strains showed a higher prevalence of ucaA and ireA genes, whereas those from the chicken meat had a higher prevalence of the atfA gene compared with the isolates from the beef and pork meat. It was observed that chicken meat and UTI-CA strains mainly formed very strong biofilms, whereas strains isolated from beef and pork formed more weak and moderate biofilms. Several strains from meat showed close genetic similarity to those from UTI-CA and had the same virulence profiles. Thus, meats may be an important source of the dissemination of P. mirabilis responsible for causing UTIs in the community.

BAR, SOFT AND DRI POST-HEPATIC TRANSPLANTATION: WHAT IS THE BEST FOR SURVIVAL ANALYSIS?

BACKGROUND: Liver transplantation is the treatment of choice for patients with terminal liver disease. The Balance of Risk Score (BAR), Survival Outcomes Following Liver Transplantation (SOFT) and Donor Risk Index (DRI) scores are predictive systems for post-transplant survival. AIM: To evaluate the most accurate score and the best cutoff point for each predictor in the brazilian population. METHOD: Retrospective cross-sectional study of 177 patients. Data on the recipient, donor and transplant were analyzed and the prognostic scores BAR, SOFT and DRI were calculated for each transplant. To determine the BAR and SOFT cutoff points associated with death in three months, ROC curves were adjusted. Results : The best cutoff point for BAR was 9 points with an area under the ROC curve=0.69 and for SOFT it was 12 points with an area under the ROC curve=0.73. The DRI score did not discriminate survival (p = 0.139). CONCLUSION: The SOFT score proved to be better than BAR for survival analysis post-hepatic transplantation and the DRI was not effective.

Antiviral therapies: advances and perspectives.

Viral infections cause high morbidity and mortality, threaten public health, and impose a socioeconomic burden. We have seen the recent emergence of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), the causative agent of COVID-19 that has already infected more than 29 million people, with more than 900 000 deaths since its identification in December 2019. Considering the significant impact of viral infections, research and development of new antivirals and control strategies are essential. In this paper, we summarize 96 antivirals approved by the Food and Drug Administration between 1987 and 2019. Of these, 49 (51%) are used in treatments against human immunodeficiency virus (HIV), four against human papillomavirus, six against cytomegalovirus, eight against hepatitis B virus, five against influenza, six against herpes simplex virus, 17 against hepatitis C virus and one against respiratory syncytial virus. This review also describes future perspectives for new antiviral therapies such as nanotechnologies, monoclonal antibodies and the CRISPR-Cas system. These strategies are suggested as inhibitors of viral replication by various means, such as direct binding to the viral particle, blocking the infection, changes in intracellular mechanisms or viral genes, preventing replication and virion formation. We also observed that a large number of viral agents have no therapy available and the majority of those approved in the last 32 years are restricted to some groups, especially anti-HIV. Additionally, the emergence of new viruses and strains resistant to available antivirals has necessitated the formulation of new antivirals.

Virulence, resistance and clonality of Proteus mirabilis isolated from patients with community-acquired urinary tract infection (CA-UTI) in Brazil.

Urinary tract infections (UTIs) are among the most common human infections, both in hospitals and in communities. Proteus mirabilis is known to cause community-acquired urinary tract infection (CA-UTI) and is an important causative agent of nosocomial UTIs. The pathogenesis of this species is related to its ability to manifest virulence factors, such as biofilms, adhesion molecules, urease, proteases, siderophores, and toxins. In this study, we investigated the virulence, sensitivity to antimicrobials, and clonal relationship of 183 strains isolated from the urine of CA-UTI patients in Londrina, Paraná State, Brazil. A total of 100% of the strains were positive for hpmA, ptA, zapA, mrpA, pmfA, ireA, and atfA virulence genes. The ucaA gene was positive in 81.4% of the cases. The strains showed high rates of sensitivity to the evaluated antimicrobials, and only one was ESBL-positive. All the tested bacteria showed the capacity to form biofilms: 73.2% had a very strong intensity, while 25.7% had a strong intensity, and 1.1% had a moderate intensity. Regarding clonality, 40 clonal clusters were found among the microorganisms tested. Our results showed that strains of P. mirabilis isolated from CA-UTI patients have several virulence factors. Although the urinary clinical isolates studied showed high sensitivity to antimicrobials, the strains showed a strong capacity to form biofilms, making antibiotic therapy difficult. In addition, it was observed that there were clones of P. mirabilis circulating in the city of Londrina.

Bar, soft and dri post-hepatic transplantation: what is the best for survival analysis? / Bar, soft e dri pós-transplante hepático: qual é o melhor para análise da sobrevida?

ABSTRACT Background: Liver transplantation is the treatment of choice for patients with terminal liver disease. The Balance of Risk Score (BAR), Survival Outcomes Following Liver Transplantation (SOFT) and Donor Risk Index (DRI) scores are predictive systems for post-transplant survival. Aim: To evaluate the most accurate score and the best cutoff point for each predictor in the brazilian population. Method: Retrospective cross-sectional study of 177 patients. Data on the recipient, donor and transplant were analyzed and the prognostic scores BAR, SOFT and DRI were calculated for each transplant. To determine the BAR and SOFT cutoff points associated with death in three months, ROC curves were adjusted. Results: The best cutoff point for BAR was 9 points with an area under the ROC curve=0.69 and for SOFT it was 12 points with an area under the ROC curve=0.73. The DRI score did not discriminate survival (p = 0.139). Conclusion: The SOFT score proved to be better than BAR for survival analysis post-hepatic transplantation and the DRI was not effective.

RESUMO Racional: Transplante hepático é tratamento de escolha para pacientes com doença hepática terminal. Os escores Balance of Risk Score (BAR), Survival Outcomes Following Liver Transplantation (SOFT) e o Donor Risk Index (DRI) são sistemas preditores de sobrevida após o transplante. Objetivo : Avaliar o escore de maior acurácia e o melhor ponto de corte de cada preditor na população brasileira. Método : Estudo retrospectivo transversal de 177 pacientes. Foram analisados dados sobre o receptor, doador e o transplante e calculados os escores prognósticos BAR, SOFT e DRI para cada transplante. Para a determinar os pontos de corte de BAR e SOFT, associados a óbito em três meses, foram ajustadas curvas ROC. Resultados : O melhor ponto corte para BAR foi 9 pontos com área sob a curva ROC=0,69 e para SOFT foi 12 pontos com área sob a curva ROC=0,73. O escore DRI não discriminou a sobrevida (p=0,139). Conclusão: O escore SOFT mostrou-se melhor do que o BAR para análise de sobrevida pós-transplante hepático, e o DRI não foi efetivo.

Dificuldades enfrentadas pelos enfermeiros para a realização das consultas de pré-natal / Difficulties faced by nurses for carrying out risk pre-christ consultations / Dificultades enfrentadas por las enfermeras para realizar consultas previas al cristo de riesgo

Objetivo: analisar na literatura as dificuldades enfrentadas pelos enfermeiros na realização das consultas de pré-natal de risco habitual. Método: trata-se de uma revisão integrativa que utilizou a questão norteadora: quais as dificuldades enfrentadas pelos enfermeiros para a realização das consultas de pré-natal de risco habitual (baixo risco)? Aplicou-se como critérios de inclusão o período de corte desde o ano 2000 até 2018, nos idiomas português, inglês e espanhol. A busca de artigos realizou-se em seis bases e bancos de dados. Resultados: foram incluídos no estudo 13 artigos, sendo elencados duas categorias: Dificuldades enfrentadas na realização das consultas de pré-natal de risco habitual (baixo risco) e Estratégias adotadas para minimizar as dificuldades enfrentadas na realização das consultas de pré-natal de risco habitual (baixo risco). Identificaram-se 13 dificuldades e 09 estratégias para minimiza-las. Conclusão: é necessário a conscientização dos profissionais enfermeiros quanto a um pré-natal de forma qualificada, humanizada e integral

Objective: to analyze in the literature the difficulties faced by nurses in carrying out prenatal consultations of usual risk. Method: this is an integrative review that used the guiding question: what are the difficulties faced by nurses in carrying out prenatal consultations of usual risk (low risk)? The cut-off period from the year 2000 to 2018 was applied as inclusion criteria, in Portuguese, English and Spanish. The search for articles was carried out in six databases and databases. Results: 13 articles were included in the study, with two categories being listed: Difficulties faced in carrying out the usual risk prenatal consultations (low risk) and Strategies adopted to minimize the difficulties faced in carrying out the usual risk prenatal consultations (low risk). Conclusion: it is necessary to raise awareness among professional nurses about prenatal care in a qualified, humanized and comprehensive way

Objetivo: analizar en la literatura las dificultades que enfrentan las enfermeras para realizar consultas prenatales de riesgo habitual. Método:esta es una revisión integradora que utilizó la pregunta guía: ¿cuáles son las dificultades que enfrentan las enfermeras para llevar a cabo consultas prenatales de riesgo habitual (bajo riesgo)? El período de corte del año 2000 al 2018 se aplicó como criterio de inclusión, en portugués, inglés y español. La búsqueda de artículos se realizó en seis bases de datos y bases de datos. Resultados: se incluyeron 13 artículos en el estudio, con dos categorías en la lista: Dificultades enfrentadas para llevar a cabo las consultas prenatales de riesgo habitual (bajo riesgo) y Estrategias adoptadas para minimizar las dificultades enfrentadas para llevar a cabo las consultas prenatales de riesgo habitual (riesgo bajo). Se identificaron 13 dificultades y 09 estrategias para minimizarlas. Conclusión: es necesario sensibilizar a las enfermeras profesionales sobre la atención prenatal de manera calificada, humanizada e integral