Clinical and Microbiological Profile of Diabetic Foot Ulcers Infected With Staphylococcus aureus in a Regional General Hospital in Bahia, Brazil.

It is necessary to know the resistance profile of Staphylococcus aureus to better control diabetic foot ulcer infections, to establish rational antibiotic therapy, and to avoid the development of resistant strains. This cross-sectional study evaluated the clinical parameters, virulence, and antimicrobial resistance profiles of S aureus in patients with diabetic foot disease admitted to a public hospital. S aureus strains were identified in patients with diabetes with amputation indication. Infected tissue samples were collected, microbes were isolated and identified. The microbial resistance profile was determined. Samples were also analyzed for biofilm formation and other virulence markers. The 34 individuals examined were mostly men, black, aged 60 years on average, and generally had a low income and education level. Most individuals had type 2 diabetes, and the mean time since diagnosis was 13.9 years. On an SF-36 (the Medical Outcomes Study 36-item short-form health survey) quality-of-life questionnaire, 75% of individuals obtained a score equal to 0 for physical impairment. S aureus specimens from 17 patients were isolated, corresponding to 50% of samples. Five isolates were classified as methicillin-resistant S aureus (MRSA). Molecular typing revealed that 20% of MRSA strains were SCCmec type V and 80% were type I. All isolates were sensitive to doxycycline; 61.5% were resistant to erythromycin, 38.5% to cefoxitin, 30.7% to clindamycin and ciprofloxacin, 23% to meropenem, 15.3% to gentamicin, 38.5% to oxacillin, and 7.7% (one strain) to vancomycin. Regarding biofilm production, 53% of samples were able to produce biofilms, and 84.6% had icaA and/or icaD genes. Additionally, the following enterotoxin genes were identified in the isolates: seb, sec, seg, and sei (5.9%, 5.9%, 11.8%, and 23.9%, respectively) and agr types 1 (5.9%) and 2 (11.8%). Genotypic evaluation made it possible to understand the pathogenicity of S aureus strains isolated from the diabetic foot; laboratory tests can assist in the monitoring of patients with systemic involvement.

Endovascular and open repair for blunt aortic injury, treated in one clinical institution in Brazil: a case series.

OBJECTIVE: The objective of this retrospective study is to analyze and compare the results of conventional surgical repair and endovascular treatment of blunt aortic injury over the past 8 years. METHODS: Twenty-eight patients (25 male; mean age, 35 years) were treated for blunt aortic injury between April 2001 and March 2009 in a university hospital in Brazil. Twenty-six patients were included in the study: five were treated with operative repair (OR) and 21 with endovascular treatment (TEVAR). Two patients were excluded from analysis: one was managed conservatively, and one was treated with endovascular treatment for chronic dissection related to aortic trauma. RESULTS: Mean age was lower in the OR group than in the endovascular treatment group (17.8 vs. 38 years, P = .003). There was one death in the OR group and four deaths in the endovascular treatment group. Mean follow-up for the overall group was 33.6 months, with 48.7 months (range 8-83 months) for the OR group, and 29.8 months (range 2-91 months) for the TEVAR group. Mean time elapsed from injury to repair was 23.4 hours (range 8-48 h, median 20 h) for the OR group and 30.3 hours (range 2-240 h, median 18 h) for the TEVAR group (P = .374). The duration of surgery was shorter in the endovascular treatment group (142 versus 237 minutes; P = .005). There were no significant differences with respect to the number of postoperative days requiring mechanical ventilation, duration of ICU stay or duration of hospital stay. CONCLUSION: In this retrospective analysis, endovascular treatment was a safe method for repair of blunt aortic trauma, with immediate and midterm results that were comparable to those results obtained with operative repair. No complications from the stent graft were identified during follow-up. Nevertheless, long-term follow-up is necessary to confirm the effectiveness of this treatment.

Endovascular and open repair for blunt aortic injury, treated in one clinical institution in Brazil: a case series

OBJECTIVE: The objective of this retrospective study is to analyze and compare the results of conventional surgical repair and endovascular treatment of blunt aortic injury over the past 8 years. METHODS: Twenty-eight patients (25 male; mean age, 35 years) were treated for blunt aortic injury between April 2001 and March 2009 in a university hospital in Brazil. Twenty-six patients were included in the study: five were treated with operative repair (OR) and 21 with endovascular treatment (TEVAR). Two patients were excluded from analysis: one was managed conservatively, and one was treated with endovascular treatment for chronic dissection related to aortic trauma. RESULTS: Mean age was lower in the OR group than in the endovascular treatment group (17.8 vs. 38 years, P = .003). There was one death in the OR group and four deaths in the endovascular treatment group. Mean follow-up for the overall group was 33.6 months, with 48.7 months (range 8-83 months) for the OR group, and 29.8 months (range 2-91 months) for the TEVAR group. Mean time elapsed from injury to repair was 23.4 hours (range 8-48 h, median 20 h) for the OR group and 30.3 hours (range 2-240 h, median 18 h) for the TEVAR group (P = .374). The duration of surgery was shorter in the endovascular treatment group (142 versus 237 minutes; P = .005). There were no significant differences with respect to the number of postoperative days requiring mechanical ventilation, duration of ICU stay or duration of hospital stay. CONCLUSION: In this retrospective analysis, endovascular treatment was a safe method for repair of blunt aortic trauma, with immediate and midterm results that were comparable to those results obtained with operative repair. No complications from the stent graft were identified during follow-up. Nevertheless, long-term follow-up is necessary to confirm the effectiveness of this treatment.

Tratamento endovascular de aneurismas da aorta em pacientes com doença de Behçet: relato de dois casos / Endovascular treatment of aortic aneurysms in patients with Behcet's disease: report of two cases

A doença de Behçet, uma vasculite sistêmica de causa desconhecida, pode ser causa de doença aneurismática da aorta em alguns portadores dessa patologia. Nós apresentamos nossa experiência com dois casos de aneurismas aórticos em pacientes com doença de Behçet submetidos à terapêutica endovascular, descrevendo seus respectivos seguimentos. A terapêutica atual, a patofisiologia e os critérios diagnósticos vigentes foram revisados. Concluímos que a técnica endovascular é uma excelente opção terapêutica para certos pacientes com doença de Behçet e que esta deve ser acompanhada de tratamento imunossupressivo adequado.

Behcet's disease, a systemic vasculitis of unknown etiology, may be the cause of aortic aneurysmal diseases in some patients. We report our experience with two Behcet's disease patients who presented with aortic aneurysms and were submitted to endovascular therapy, and describe their respective follow-ups. Current pathophysiology, diagnosis, and treatment approaches were reviewed. Our experience suggests that the endovascular approach, combined with adequate immunosuppressive treatment, is an excellent therapeutic option for some patients with Behcet's disease suffering from aneurysms.

[Blood lead levels in children and environmental legacy of a lead foundry in Brazil]. / Chumbo no sangue de crianças e passivo ambiental de uma fundição de chumbo no Brasil.

OBJECTIVE: To determine the blood lead levels in children living near an inactive lead foundry in the city of Santo Amaro da Purificação, state of Bahia, in September of 1998; and to identify factors associated with differences in these levels. METHODS: Cross-sectional study with children between 1 and 4 years of age living within 1 km of the lead foundry. Mothers or guardians of 47 children answered a questionnaire concerning ingestion of clay, soil, plaster and/or other materials (pica), and other relevant epidemiological aspects. The concentration of lead in blood was determined by atomic absorption espectrophotometry. RESULTS: The mean blood lead level was 17.1 +/- 7.3 micro g/dL. Blood lead levels were approximately 5 micro g/dl greater among children with pica, regardless of age, visible presence of scum surrounding the home, employment status of the father, family history of lead poisoning, and malnutrition. CONCLUSIONS: The environmental legacy of the lead foundry, which was shut down in 1993, continues to represent a relevant risk factor for increased blood lead levels in children, especially those presenting pica.

Chumbo no sangue de crianças e passivo ambiental de uma fundição de chumbo no Brasil / Blood lead levels in children and environmental legacy of a lead foundry in Brazil

OBJETIVO: Determinar os níveis de chumbo no sangue de crianças que moravam próximo a uma fundiçäo de chumbo desativada na Cidade de Santo Amaro da Purificaçäo, Estado da Bahia, em setembro de 1998; e identificar fatores associados à variaçäo destes níveis. MÉTODOS: Estudo de corte transversal com crianças de 1 a 4 anos de idade que residiam a menos de 1 km da fundiçäo. Mäes ou responsáveis por 47 crianças responderam questionários sobre transtornos do hábito alimentar (comer barro, terra, reboco ou outros materiais) e outros aspectos epidemiológicos relevantes. A concentraçäo de chumbo no sangue foi determinada por espectrofotometria de absorçäo atômica. RESULTADOS: O nível médio de chumbo foi de 17,1 ± 7,3 mig/dL. Os níveis de chumbo no sangue foram cerca de 5 mig/dL mais elevados em crianças que tinham transtorno do hábito alimentar, independentemente da idade, presença de escória visível no peridomicílio, situaçäo de emprego do pai, história familiar de intoxicaçäo pelo chumbo e desnutriçäo. CONCLUSÖES: O passivo ambiental da fundiçäo de chumbo, desativada em 1993, permanece como um fator de risco relevante para elevar os níveis desse metal no sangue de crianças, particularmente aquelas que apresentam transtornos do hábito alimentar

Hipertensäo arterial em adultos de um bairro de Salvador, Bahia / Arterial hypertension in adults from a borough of Salvador city, Bahia, Brazil

Foi realizado estudo para caracterizar a situaçäo da hipertensäo arterial na populaçäo do bairro de Alto das Pombas, em Salvador. Aferiu-se a pressäo aretrial (PA) de 491 indivíduos acima de 20 anos de idade, numa amostra de domicílios do bairro, em agosto de 1996. Foram considerados hipertensos os adultos que apresentaram PA sistólica igual ou superior a 140mmHg e/ou diastólica igual ou superior a 90mmHg, acrescidos daqueles indivíduos que informaram serem portadores dadoença. Obteve-se uma prevalência de hipertensäo de 41,1 porcento, mais elevada no sexo feminino e na faixa de 50 e mais anos. Chamou a atençäo, o alto percentual de indivíduos hipertensos com PA näo controlada, no momento da pesquisa. Os hipertensos foram revisitados após três meses, quando se detectou que 68 porcento continuavam com os níveis pressóricos elevados. Foi referido pelos hipertensos, maior grau de adesäo à reduçäo do sal na dieta e ao tratamento medicamentoso, em relaçäo a outras medidas de controle. O uso de medicamentos näo se mostrou efetivo no controle da doença, sugerindo irregularidades e inadequaçöes no seu uso. Concluiu-se que a hipertensäo arterial constitui-se num problema de saúde pública relevante na área, o qual requer intervençäo através de açöes educativas e organizaçäo da assistência.