Acidente Vascular Encefálico: Doença do adulto com origem na infância / Stroke: Disease of Adult Life with Childhood basis

Durante a última década tem se consolidado o conceito de que diversas doenças apresentadas na vida adulta iniciamse e relacionam-se com condições da gestação, nascimento einfância. A doença vascular cerebral - intimamente ligada à aterosclerose e hipertensão arterial – também parece ter suas origens na infância. Esse estudo revê a literatura em línguainglesa, de 2000 ao presente, relatando as principais evidênciasque dão suporte a esse conceito, incluindo estudos queinvestigam o a) papel da posição socioeconômica familiar, b) distribuição demográfica, c) índice de massa corpórea, d) peso ao nascer e e) inteligência, f) fatores de risco tradicionais mensurados na infância sobre a elasticidade da carótidae g) as tendências seculares na ocorrência desses eventos.

Comparison of phenotypic and genotypic taxonomic methods for the identification of dairy enterococci.

The purpose of the study was to assess the phenotypic and genotypic taxonomic congruence in order to allow species allocation of dairy enterococci. A total of 364 enterococci isolated from ewes'milk and cheese from four Portuguese Registered Designation of Origin areas and 25 type and reference strains of Enterococcus spp. were characterized by a polyphasic taxonomical approach involving 40 physiological and biochemical tests, whole-cell protein profiles, amplification of 16S-23S intergenic spacer regions (ITS-PCR) and subsequent restriction analysis (ARDRA). Ribotyping was also performed with reference strains and a subset of 146 isolates. Numerical hierarchic data analysis showed that single-technique identification levels increase from the physiological and biochemical tests to the protein approach, being lower with ITS/ARDRA and ribotyping. Cross-analysis confirmed a higher unmatching level in all pairwise combinations involving physiological and biochemical data. Whole-cell protein profiles followed by ITS/ARDRA identified 89% of the enterococci. Reliable identification of enterococci from milk and cheese could be obtained by analysis of whole-cell protein profiles. ITS-PCR can be used to confirm E. durans and E. faecium and ARDRA further confirms E. faecalis. Results revealed E. faecalis, E. durans, E. hirae and E. faecium as the prevalent species, although species prevalence showed some degree of variation among the areas.

Gentamicin resistance in dairy and clinical enterococcal isolates and in reference strains.

Enterococci isolated from Portuguese dairy products (milk and cheese) and clinical settings (hospitals and veterinary clinics), together with reference strains from the genus Enterococcus, were screened for low- and high-level gentamicin resistance using the standard disc diffusion method (10 and 120 microg gentamicin discs). MICs were also determined using both the macrodilution method and the Etest. Four genes [aac(6')-Ie-aph(2")-Ia, aph(2")-Ib, aph(2")-Ic and aph(2")-Id] responsible for high- and mid-level gentamicin resistance were sought using PCR. Although enterococci generally are regarded as being intrinsically resistant to low levels of gentamicin, results revealed that many dairy enterococci (around 30% of the isolates used) are not intrinsically resistant to gentamicin, showing MICs of < or = 4 mg/l. High-level gentamicin resistance was not detected in any of the dairy isolates studied, except for aph(2")-Ib, which was found in one. Therefore, gentamicin resistance should be monitored in dairy enterococci, although it does not seem to be a problem at present. In contrast, all clinical isolates studied were, as expected, intrinsically resistant to low levels of gentamicin, presenting MICs > 8 mg/l. Fifteen percent of these clinical isolates showed high-level gentamicin resistance (MICs > 512 mg/l), with the bifunctional gene aac(6')-aph(2") being detected in four of them. However, discs with gentamicin 120 microg failed to detect some isolates with high-level gentamicin resistance.