HER2/neu 655 polymorphism, trastuzumab-induced cardiotoxicity, and survival in HER2-positive breast cancer patients.

PURPOSE: HER2 overexpression in breast cancer correlates with poor outcomes. The incorporation of Trastuzumab into the treatment regimen has notably improved patient prognoses. However, cardiotoxicity emerges in approximately 20% of patients treated with the drug. This study aims to investigate the association between the HER2 655 A > G polymorphism, Trastuzumab-induced cardiotoxicity, and patient survival. METHODS: The study involved 88 patients treated with Trastuzumab. Cardiotoxicity, defined as a reduction in left ventricular ejection fraction (LVEF) from baseline or the emergence of clinical signs of congestive heart failure, was identified during treatment follow-up. Genotyping of HER2 655 A > G employed TaqMan SNP technology. RESULTS: Genotype frequencies of HER2/neu 655 (53 AA, 32 AG, and 3 GG) were consistent with Hardy-Weinberg equilibrium. No significant differences were observed in mean baseline LVEF between patients who developed cardiotoxicity and those who did not. Within these groups, neither AA nor AG genotypes showed an association with changes in mean baseline or reduced LVEF levels. Logistic regression analysis, adjusted for hormonal status and anthracycline treatment, revealed that AG genotype carriers face a significantly higher risk of cardiotoxicity compared to AA carriers (OR = 4.42; p = 0.037). No association was found between the HER2/neu 655 A > G polymorphism and disease-free or overall survival, regardless of whether the data was adjusted for stage or not. CONCLUSION: HER2 655 A > G polymorphism is significantly linked to an increased risk of Trastuzumab-induced cardiotoxicity but does not correlate with variations in disease-free survival or overall survival rates.

Assessment of Cardiac Sarcoidosis: FDG PET and BMIPP SPECT.

PURPOSE OF REVIEW: Cardiac sarcoidosis (CS) is an inflammatory disease of unknown etiology that can lead to life-threatening arrhythmias, heart failure, and death. Advanced cardiac imaging modalities have improved the clinician's ability to detect this disease. The purpose of this review is to discuss the recent evidence of cardiac metabolic imaging as assessed by [18F]FDG PET and [123I]BMIPP SPECT in the evaluation of CS patients. RECENT FINDINGS: [18F]FDG PET is the gold standard to identify myocardial inflammation. [123I]BMIPP SPECT can uncover early myocardial damage as well as advanced stages of CS when fibrosis prevails. In presence of inflammation, myocardial [18F]FDG uptake is increased, but in contrast, BMIPP myocardial uptake is reduced or even suppressed. Thus, a complementary role of cardiac metabolic imaging by [18F]FDG PET and BMIPP SPECT has been proposed to detect the whole spectrum of CS. [18F]FDG PET is considered an important tool to improve the diagnosis and optimize the management of CS. The role of [123I]BMIPP SPECT in diagnosing CS is still under investigation. Further studies are needed to evaluate the clinical utility of combined cardiac metabolic imaging in the diagnosis, prognosis, and for selecting treatments in CS patients.

Imágenes híbridas de tomografía por emisión de positrones y resonancia magnética en el diagnóstico de la sarcoidosis cardíaca: experiencia piloto / Hybrid positron emission tomography and magnetic resonance imaging in cardiac sarcoidosis diagnosis: a pilot experience

RESUMEN Introducción: Estudios recientes sugieren combinar los hallazgos de la resonancia magnética cardíaca (RMC) y los de la tomografía por emisión de positrones (PET) para incrementar la sensibilidad del diagnóstico de la sarcoidosis cardíaca (SC). Objetivo: Evaluar el valor complementario de la RMC y la PET en el diagnóstico de la SC. Material y métodos: Entre diciembre 2018 y Julio 2020, 6 pacientes (4 hombres y 2 mujeres) fueron referidos a nuestro servicio con sospecha de SC para evaluación de inflamación del miocardio. Se efectuó un estudio de perfusión miocárdica en reposo (13N Amonio) y de 18F-Fluordesoxiglucosa (FDG)-PET para evaluar inflamación y/o fibrosis. A todos los pacientes se les realizó previamente una RMC con gadolinio. Resultados: La edad media fue de 60 ± 9 años. El 50% de los pacientes presentaban antecedente de sarcoidosis sistémica y el otro 50% sospecha de SC aislada. Ninguno de los pacientes presentó inflamación activa del miocardio por PET. Con la combinación de los patrones-PET y el realce por RMC se reclasificó a los pacientes: 50% tuvo menos del 10% de probabilidad de padecer SC y el otro 50% se clasificó como posible. Ninguno de los pacientes recibió tratamiento inmunosupresor. Conclusión: En nuestra población de pacientes con sospecha de SC e inflamación, realizamos un estudio PET luego de la RMC para calcular probabilidades de padecer SC. En ausencia de un patrón oro, se sugiere que el diagnóstico de SC se base en probabilidades de acuerdo a patrones de imágenes y cuadro clínico específicos.

ABSTRACT Background: Recent studies suggest combining the findings of cardiac magnetic resonance (CMR) and positron emission tomography (PET) to increase sensitivity in the diagnosis of cardiac sarcoidosis (CS). Objective: To evaluate the complementary value of CMR and PET in the diagnosis of CS. Methods: From December 2018 to July 2020, 6 patients (4 males and 2 females) with suspected CS were referred to our facility for evaluation of myocardial inflammation. A resting 13N Ammonia myocardial perfusion test and a 18F Fluorodeoxyglucose (FDG) PET were performed to evaluate myocardial inflammation and/or fibrosis. All patients had a previous gadoliniumenhanced CMR. Results: The average age was 60 ± 9 years. Fifty percent of the patients had a history of systemic sarcoidosis and the remaining 50% had suspected isolated CS. None of the patients had active myocardial inflammation based on the PET findings. With the combination of PET patterns and enhanced CMR, the patients were reclassified as follows: 50% had less than 10% chance of having CS and the other 50% was classified as possible cases of CS. None of the patients received immunosuppressants. Conclusion: In our patient population with suspected CS and inflammation, we conducted a PET study following a CMR to assess the potential for CS. In the absence of a gold standard, it is suggested that the diagnosis of CS should be based on probabilities according to specific imaging patterns and clinical features.

Avaliação quantitativa e bioatividade de um biofilme perifítico oriundo de piscicultura / Quantitative assessment and bioactivity of a periphytic biofilm from fish farming

Um biofilme perifítico formado em um cultivo de tilápias-do-nilo foi analisado para determinaçãoquantitativa de bactérias e fungos, detecção de substâncias com ação antibacteriana e avaliação de perfis de resistência frente a antibióticos comerciais. Foi empregado o método de contagem padrão em placas por meio da técnica inoculação em profundidade para a quantificação das bactérias heterotróficas cultiváveis (BHC) e a técnica de espalhamento sobre meio de cultura para a de fungos. Investigou-se a produção de substâncias antibacterianas pela comunidade e a susceptibilidade a antibióticos de amplo espectro, ambos por meio da técnica de difusão em ágar.As concentrações de bactérias e fungos cultiváveis na comunidade de perifíton foram, respectivamente, 1,73×106 UFC/mL e 1,45×102 UFC/mL. O biofilme perifítico mostrou ação antibacteriana contra bactéria indicadora Gram positiva. Os antibióticos Cloranfenicol, Tetraciclina e Cefalotina foram eficientes contra os componentes do biofilme. Entretanto, a comunidade apresentou perfil de resistência ao Imipinem. As bactérias são os componentes dominantes no biofilme perifítico em comparação com os fungos contribuindo com a ciclagem de nutrientes e influenciando a qualidade da água de cultivo. O perifíton possui potencial biotecnológico de ação antimicrobiana.

The objective of this work was to quantitatively analyze the cultivable microbiota in isolated periphyton of tilapia cultivation tanks with later prospecting for bioactive substances produced in the biofilm and resistance to the action of antibiotics. The standard plate counting method using the pour plate technique was used to quantify the cultivable heterotrophic bacteria (CHB) and the spread plate technique for fungi. The production of antimicrobial substances by the community and the susceptibility to broad-spectrum antibiotics were investigated, both through the agar diffusion technique. The periphyton sample showed1.73x106 CFU/mL in relation to the count of total cultivable heterotrophic bacteria and 1.45x102 CFU/mL relative to the density of fungi. The periphytic biofilm showed antibacterial action against Gram-positive bacteria. The antibiotics chloramphenicol, tetracycline, and cephalothin were effective against the biofilm components. However, the community showed a profile of resistance to imipenem. Bacteria are the dominant components in periphytic biofilm compared to fungi, contributing to nutrient cycling and influencing the quality of cultivated water. Periphyton has biotechnological potential for antimicrobial action.

Avaliação quantitativa e bioatividade de um biofilme perifítico oriundo de piscicultura / Quantitative assessment and bioactivity of a periphytic biofilm from fish farming

Um biofilme perifítico formado em um cultivo de tilápias-do-nilo foi analisado para determinaçãoquantitativa de bactérias e fungos, detecção de substâncias com ação antibacteriana e avaliação de perfis de resistência frente a antibióticos comerciais. Foi empregado o método de contagem padrão em placas por meio da técnica inoculação em profundidade para a quantificação das bactérias heterotróficas cultiváveis (BHC) e a técnica de espalhamento sobre meio de cultura para a de fungos. Investigou-se a produção de substâncias antibacterianas pela comunidade e a susceptibilidade a antibióticos de amplo espectro, ambos por meio da técnica de difusão em ágar.As concentrações de bactérias e fungos cultiváveis na comunidade de perifíton foram, respectivamente, 1,73×106 UFC/mL e 1,45×102 UFC/mL. O biofilme perifítico mostrou ação antibacteriana contra bactéria indicadora Gram positiva. Os antibióticos Cloranfenicol, Tetraciclina e Cefalotina foram eficientes contra os componentes do biofilme. Entretanto, a comunidade apresentou perfil de resistência ao Imipinem. As bactérias são os componentes dominantes no biofilme perifítico em comparação com os fungos contribuindo com a ciclagem de nutrientes e influenciando a qualidade da água de cultivo. O perifíton possui potencial biotecnológico de ação antimicrobiana.(AU)

The objective of this work was to quantitatively analyze the cultivable microbiota in isolated periphyton of tilapia cultivation tanks with later prospecting for bioactive substances produced in the biofilm and resistance to the action of antibiotics. The standard plate counting method using the pour plate technique was used to quantify the cultivable heterotrophic bacteria (CHB) and the spread plate technique for fungi. The production of antimicrobial substances by the community and the susceptibility to broad-spectrum antibiotics were investigated, both through the agar diffusion technique. The periphyton sample showed1.73x106 CFU/mL in relation to the count of total cultivable heterotrophic bacteria and 1.45x102 CFU/mL relative to the density of fungi. The periphytic biofilm showed antibacterial action against Gram-positive bacteria. The antibiotics chloramphenicol, tetracycline, and cephalothin were effective against the biofilm components. However, the community showed a profile of resistance to imipenem. Bacteria are the dominant components in periphytic biofilm compared to fungi, contributing to nutrient cycling and influencing the quality of cultivated water. Periphyton has biotechnological potential for antimicrobial action.(AU)

Recertificación médica en Uruguay: múltiples miradas de una obligación impostergable / Medical recertification in Uruguay: multiple perspectives of an imperative need / Recertificação médica no Uruguai: múltiplas visões de uma obrigação urgente

Resumen: La recertificación es el resultado de un acto por el que una entidad legalmente acreditada, asegura que el profesional médico (previamente certificado) mantiene actualizados sus conocimientos y destrezas, y que ha desarrollado su actividad dentro del marco ético y científico adecuado al progreso del "saber" y del "hacer" propio de su especialidad. A pesar de un largo camino recorrido, en Uruguay no se ha podido establecer un proceso de recertificación universal. Múltiples actores (usuarios del sistema, médicos, Facultad de Medicina, programas de Desarrollo Profesional Médico Continuo) consideran que es una necesidad, sin embargo es necesario vencer algunas barreras para que se establezca un programa de recertificación. Se recorren algunos de estos aspectos en este documento, desarrollados en el contexto de un grupo de trabajo para el Congreso por los 100 años del Sindicato Médico del Uruguay.

Abstract: Recertification is the result of an act by which a legally accredited entity ensures that medical professionals (previously certified) keep their knowledge and skills up to date, and that they have practiced their profession within the ethical and scientific framework that regulates the process that evolves from "knowing" to "knowing how" in their areas of specialization. Despite a long journey in Uruguay, it has not been possible to establish a universal recertification process. Multiple actors (system users, doctors, the School of Medicine, Continuing Medical Professional Development programs) regard it as a need, although some barriers must be overcome in order to define a recertification program. This document covers a few of these aspects and is the result of a working group created for the Congress held in commemoration of the 100 years of the Uruguayan Medical Association.

Resumo: A recertificação é o resultado de um ato pelo qual uma entidade legalmente credenciada garante que o profissional médico (previamente certificado) mantém os seus conhecimentos e competências atualizados, e que desenvolveu a sua atividade dentro do quadro ético e científico adequado ao progresso do "conhecimento" e o "fazer" da sua especialidade. Apesar do longo caminho percorrido no Uruguai, ainda não foi possível estabelecer um processo de recertificação universal. Múltiplos atores (usuários do sistema, médicos, Faculdade de Medicina, programas de Desenvolvimento Continuado do Profissional Médico) consideram isso uma necessidade, porém é necessário superar algumas barreiras para que um programa de recertificação seja estabelecido. Alguns desses aspectos são abordados neste documento, desenvolvido no contexto de um grupo de trabalho para o Congresso pelos 100 anos do Sindicato Médico del Uruguay.

Levels of Vitamins and Homocysteine in Older Adults with Alzheimer Disease or Mild Cognitive Impairment in Cuba.

INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders. OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults. METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen's criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups. RESULTS Persons with Alzheimer disease presented signifi cantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were signifi cantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not signifi cantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were signifi cantly higher for hyperhomocysteinemia (PR = 3.26; 1.84-5.80) and defi - ciency of all B vitamins: thiamine (PR = 1.89; 1.04-3.43), B-2 (PR = 2.85; 1.54-5.26), folate (PR = 3.02; 1.53-5.95), B-12 (PR = 2.21; 1.17-4.19), vitamin C (PR = 3.88; 2.12-7.10) and A (PR = 5.47; 3.26-9.17). In mild cognitive impairment, prevalence rates were signifi cantly higher for hyperhomocysteinemia (PR = 1.42; 1.08-1.87), vitamin B-2 defi ciency (PR = 1.70; 1.24-2.32) and vitamin A defi - ciency (PR =1.88; 1.05-3.38). CONCLUSIONS Hyperhomocysteinemia and various vitamin defi ciencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies. KEYWORDS Vitamins, homocysteine, geriatrics, Alzheimer disease, cognitive impairment, Cuba.

Cadmium exposure activates NADPH oxidase, renin-angiotensin system and cyclooxygenase 2 pathways in arteries, inducing hypertension and vascular damage.

Exposure to high concentrations of cadmium (Cd), widely used in many industries and found in air, food and contaminated water, is not uncommon. Cd damages the cardiovascular system, but the vascular mechanisms involved are not fully understood. This study investigated the mechanisms involved in cardiovascular damage after exposure to high Cd concentrations. Three-month-old male Wistar rats were treated intraperitoneally for 14 days with distilled water (Untreated group) or 1 mg/kg cadmium chloride (Cd group). We investigated the systolic blood pressure (SBP) and vascular reactivity of mesenteric resistance arteries (MRA) and the aorta by analysing contractile and relaxation responses in the absence and presence of the endothelium; we also evaluated pathways involved in vascular tone regulation. Superoxide anion production, COX-2 protein expression and in situ detection of COX-2, AT-1, and NOX-1 were evaluated. Oxidative status, creatinine level and angiotensin-converting enzyme (ACE) activity in plasma were also evaluated. Fourteen-day exposure to a high Cd concentration induced hypertension associated with vascular dysfunction in MRA and the aorta. In both vessels, there was increased participation of cyclooxygenase 2 (COX2), angiotensin II type 1 (AT1) receptor and NOX1. MRA also presented endothelial dysfunction, denoted by impaired acetylcholine-mediated relaxation. All vascular changes were accompanied by increased reactive oxygen species production and COX2, NOX1 and AT1 receptor expression in vascular tissue. Overall, high Cd concentrations induced cardiovascular damage: hypertension, endothelial dysfunction and vascular damage in conductance and resistance arteries, NADPH oxidase, renin-angiotensin system and COX2 pathway activation.

Pathogenic potential of Vibrio parahaemolyticus isolated from tropical estuarine environments in Ceará, Brazil

Vibrio parahaemolyticus is a potentially pathogenic bacterium that occurs naturally in estuarine environments worldwide. This research aimed to investigate the occurrence of V. parahaemolyticus in estuarine environments and determine the virulence profile in an aquaculture environment by molecular techniques and conventional microbiological methods. Sampling was conducted in four estuaries in the State of Ceará (Pacoti, Choró, Pirangi and Jaguaribe), Brazil, between January and April 2009. The analysis included 64 samples of water (n=32) and sediment (n=32) collected from the estuaries. The samples yielded 64 isolates suspected to be V. parahaemolyticus. The isolates were submitted to biochemical identification using a dichotomous key and PCR for the detection of the species-specific tlh gene. Virulence was assessed by testing for urea hydrolysis and ß-hemolysis in erythrocytes (Kanagawa phenomenon) and simultaneous detection of the tdh and trh genes. All but one of the isolates (63/64) were confirmed to be V. parahaemolyticus by genotypic detection of tlh gene. The tdhand trh genes were detected in 57 and 19 isolates, respectively. The Kanagawa test was positive for 51 isolates. Only one isolate was positive for urease. The incidence of tdh/trh-positivity was very high in isolates recovered from the environment. The present study demonstrates the need to increase knowledge of the ecology and pathogeny of V. parahaemolyticus

Infarto renal: revisión sistemática sobre síntomas de sospecha clínica y repercusión sobre función renal / Renal infarction: systematic review of symptoms of clinical suspicion and repercussion on renal function / Infarto renal: revisão sistemática dos sintomas de suspeita clínica e repercussão na função renal

Resumen: Introducción: El infarto renal es una entidad poco frecuente y está sub-diagnosticada por lo que para su diagnóstico se necesita un alto índice de sospecha clínica. Objetivo: Determinar las características clínicas y paraclínicas más frecuentes en el infarto renal, destacando la repercusión en la función renal. Metodología: Se realizó una revisión sistemática de serie de casos en PUBMED y SciELO con los términos: "renal infarction" y "renal infarct". Se estudiaron variables: demográficas, clínicas y paraclínicas. En el caso de las variables paraclínicas se analizó el porcentaje de pacientes con valores elevados de cada una de las mismas. El análisis estadístico fue realizado con EPI INFO 7. 2. Resultados: Los síntomas y signos más frecuentes fueron oliguria, dolor en flanco y abdominal, nauseas, fiebre y vómitos. Los parámetros paraclínicos alterados fueron: LDH, PCR y glóbulos blancos. Se constató injuria renal aguda en 30.8% de los pacientes, la progresión a enfermedad renal crónica se observó en 17.3% y la progresión a enfermedad renal terminal se observó en 5.2% de los pacientes. Discusión y conclusiones: La determinación de las características clínicas y paraclínicas más frecuentes del infarto renal, se pueden utilizar para disminuir el retraso diagnóstico, lo que tiene consecuencias terapéuticas.

Abstract: Introduction: Renal infarction is a rare entity and is under-diagnosed, so a high index of clinical suspicion is needed for its diagnosis. Objective: To determine the most frequent clinical and paraclinical characteristics in renal infarction, highlighting the impact on renal function. Methodology: A systematic review of a series of cases was carried out in PUBMED and SciELO with the terms: "renal infarction" and "renal infarct". Variables were studied: demographic, clinical and paraclinical. In the case of paraclinical variables, the percentage of patients with high values ​​of each of them was analyzed. The statistical analysis was performed with EPI INFO 7. 2. Results: The most frequent symptoms and signs were oliguria, flank and abdominal pain, nausea, fever and vomiting. Paraclinical parameters altered were: LDH, CRP and white blood cells. Acute renal injury was found in 30.8% of patients, progression to chronic kidney disease was observed in 17.3% and progression to end-stage renal disease was observed in 5.2% of patients. Discussion and conclusions: The determination of the most frequent clinical and paraclinical characteristics of renal infarction can be used to reduce the diagnostic delay, which has therapeutic consequences.

Resumo: Introdução: O infarto renal é uma entidade rara e é subdiagnosticada, portanto, um alto índice de suspeita clínica é necessário para o seu diagnóstico. Objetivo: Determinar as características clínicas e paraclínicas mais frequentes no infarto renal, destacando o impacto na função renal. Metodologia: Uma revisão sistemática de uma série de casos foi realizada em PUBMED e SciELO com os termos: "infarto renal" e "infarto renal". As variáveis ​​foram estudadas: demográficas, clínicas e paraclinicais. No caso de variáveis ​​paraclínicas, foi analisada a porcentagem de pacientes com valores altos de cada um deles. A análise estatística foi realizada com o EPI INFO 7. 2. Resultados: Os sintomas e sinais mais frequentes foram oligúria, dor no flanco e abdominal, náusea, febre e vômitos. Parâmetros clínicos alterados foram: LDH, PCR e glóbulos brancos. A lesão renal aguda foi encontrada em 30,8% dos pacientes, a progressão para doença renal crônica foi observada em 17,3% e a progressão para doença renal terminal em 5,2% dos pacientes. Discussão e conclusões: A determinação das características clínicas e paraclínicas mais frequentes do infarto renal pode ser utilizada para reduzir o retardo no diagnóstico, o que tem consequências terapêuticas.

Ecotypes and virulence factors of Salmonella spp. detected in shrimp farms in Ceara-Brazil / Ecotipos e fatores de virulência de Salmonella spp. detectadas em fazendas de carcinicultura do Ceará, Brasil

Our objective was to group in ecotypes 12 serovars of Salmonella isolated from shrimp farming environments in the State of Ceara (Northeast Brazil). Grouping was done based on genotypic virulence factors. Two groups based on the similarity of the Box-PCR were identified: a group consisting of three strains (01 S. ser. Madelia serovar and 02 S. ser. enterica subs. houtenae) and another group consisting of nine isolates (02 S. ser. Saintpaul serovars; 03 S. ser. Infantis; 02 S. ser. Panama; 01 S. enterica subs. enterica; and 01 S. enterica subs. houtenae). Distribution pattern of the serovars was not influenced by the origin matrices (water and sediment). Plasmid virulence genes pefA and invA were detected, unrelated to the serovar and environmental origin of the isolates. The presence of virulence genes in the isolates underlines the potential to trigger salmonellosis events via shrimp consumption. Biomonitoring of these sources of contamination should be encouraged as a protective measure, minimizing health risks and economic losses for the industry.(AU)

Nosso objetivo foi agrupar em ecotipos 12 sorovares de Salmonella isolados em ambientes decarcinicultura no Estado do Ceará. O agrupamento foi feito a partir da pesquisa de fatores genotípicos devirulência. Constatou-se a formação de dois grupos baseados na similaridade do Box-PCR: um grupo comtrês estirpes (01 sorovar S. ser. Madelia e 02 sorovares S. enterica subs. houtenae) e outro constituído pornove isolados (02 sorovares S. ser. Saintpaul, 03 sorovares S. ser. Infantis, 02 sorovares S. ser. Panama, 01sorovar S. enterica subs. enterica e 01 sorovar S. enterica subs. houtenae). O padrão de distribuição dos sorovaresnão sofreu influência das matrizes de origem (água e sedimento). Os genes de virulência plasmidial pefA einvA foram detectados independente do sorovar e da origem ambiental dos isolados. A presença dessesgenes de virulência nos isolados de carcinicultura evidencia o potencial para desencadear eventos desalmonelose relacionados ao consumo de camarão. O biomonitoramento dessas fontes de contaminaçãodeve ser incentivado como medida protetiva, minimizando os riscos do ponto de vista sanitário e das perdaseconômicas para o setor da carcinicultura.(AU)

Ecotypes and virulence factors of Salmonella spp. detected in shrimp farms in State of Ceara, Brazil / Ecotipos e fatores de virulência de Salmonella spp. detectadas em fazendas de carcinicultura do Ceará, Brasil

Our objective was to group in ecotypes 12 serovars of Salmonella isolated from shrimp farming environments in the State of Ceara (Northeast Brazil). Grouping was done based on genotypic virulence factors. Two groups based on the similarity of the Box-PCR were identified: a group consisting of three strains (01 S. ser. Madelia serovar and 02 S. ser. enterica subs. houtenae) and another group consisting of nine isolates (02 S. ser. Saintpaul serovars; 03 S. ser. Infantis; 02 S. ser. Panama; 01 S. enterica subs. enterica; and 01 S. enterica subs. houtenae). Distribution pattern of the serovars was not influenced by the origin matrices (water and sediment). Plasmid virulence genes pefA and invA were detected, unrelated to the serovar and environmental origin of the isolates. The presence of virulence genes in the isolates underlines the potential to trigger salmonellosis events via shrimp consumption. Biomonitoring of these sources of contamination should be encouraged as a protective measure, minimizing health risks and economic losses for the industry.

Nosso objetivo foi agrupar em ecotipos 12 sorovares de Salmonella isolados em ambientes de carcinicultura no Estado do Ceará. O agrupamento foi feito a partir da pesquisa de fatores genotípicos de virulência. Constatou-se a formação de dois grupos baseados na similaridade do Box-PCR: um grupo com três estirpes (01 sorovar S. ser. Madelia e 02 sorovares S. enterica subs. houtenae) e outro constituído por nove isolados (02 sorovares S. ser. Saintpaul, 03 sorovares S. ser. Infantis, 02 sorovares S. ser. Panama, 01 sorovar S. enterica subs. enterica e 01 sorovar S. enterica subs. houtenae). O padrão de distribuição dos sorovares não sofreu influência das matrizes de origem (água e sedimento). Os genes de virulência plasmidial pefA e invA foram detectados independente do sorovar e da origem ambiental dos isolados. A presença desses genes de virulência nos isolados de carcinicultura evidencia o potencial para desencadear eventos de salmonelose relacionados ao consumo de camarão. O biomonitoramento dessas fontes de contaminação deve ser incentivado como medida protetiva, minimizando os riscos do ponto de vista sanitário e das perdas econômicas para o setor da carcinicultura.

Pathogenic Vibrio species isolated from estuarine environments (Ceará, Brazil) - antimicrobial resistance and virulence potential profiles

ABSTRACT Detection of virulent strains associated with aquatic environment is a current concern for the management and control of human and animal health. Thus, Vibrio diversity was investigated in four estuaries from state of Ceará (Pacoti, Choró, Pirangi and Jaguaribe) followed by antimicrobial susceptibility to different antimicrobials used in aquaculture and detection of main virulence factors to human health. Isolation and identification were performed on TCBS agar (selective medium) and dichotomous key based on biochemical characteristics, respectively. Nineteen strains of genus Vibrio were catalogued. Vibrio parahaemolyticus (Choró River) and V. alginolyticus (Pacoti River) were the most abundant species in the four estuaries. All strains were submitted to disk diffusion technique (15 antimicrobials were tested). Resistance was found to: penicillin (82%), ampicillin (54%), cephalotin (7%), aztreonan (1%), gentamicin, cefotaxime and ceftriaxone (0.5%). Five pathogenic strains were chosen to verification of virulence factors. Four estuaries showed a high abundance of species. High number of tested positive strains for virulence is concerning, since some of those strains are associated to human diseases, while others are known pathogens of aquatic organisms.

Pathogenic Vibrio species isolated from estuarine environments (Ceará, Brazil) - antimicrobial resistance and virulence potential profiles.

Detection of virulent strains associated with aquatic environment is a current concern for the management and control of human and animal health. Thus, Vibrio diversity was investigated in four estuaries from state of Ceará (Pacoti, Choró, Pirangi and Jaguaribe) followed by antimicrobial susceptibility to different antimicrobials used in aquaculture and detection of main virulence factors to human health. Isolation and identification were performed on TCBS agar (selective medium) and dichotomous key based on biochemical characteristics, respectively. Nineteen strains of genus Vibrio were catalogued. Vibrio parahaemolyticus (Choró River) and V. alginolyticus (Pacoti River) were the most abundant species in the four estuaries. All strains were submitted to disk diffusion technique (15 antimicrobials were tested). Resistance was found to: penicillin (82%), ampicillin (54%), cephalotin (7%), aztreonan (1%), gentamicin, cefotaxime and ceftriaxone (0.5%). Five pathogenic strains were chosen to verification of virulence factors. Four estuaries showed a high abundance of species. High number of tested positive strains for virulence is concerning, since some of those strains are associated to human diseases, while others are known pathogens of aquatic organisms.

Vacunación antigripal en personal de salud: cobertura, actitudes y barreras contra la vacunación en dos servicios de un hospital general / Influenza immunization in health care professionals: coverage, attitudes and barriers against immunization in two departments of a general hospital

Con el objetivo de conocer la cobertura y las barreras contra la vacunación antigripal, cuya aceptación estimábamos baja entre el personal de salud(PDS) se realizó un estudio transversal, descriptivo, con la metodología de encuesta, autoadministrada con opciones cerradas para su respuesta. Se utilizó una muestra de 142 PDS integrantes del Hospital Pasteur (MSP-ASSE), aleatorizada y adecuada para extraer conclusiones estadísticamente válidas. Los resultados mostraron que 87/142 (61,3%) de los encuestados conocía la campaña de vacunación antigripal en el Hospital, reconocieron tener indicación de vacunación antigripal 124/142 (87,3%) a pesar de lo cual se vacunaron en 2011 79/142 (55,6%) y en 2012 53/142 (37,3%). Los vacunados en 2012 respondieron como motivos principales de adherencia a la campaña protegerse a sí mismo de la enfermedad, pertenecer al PDS y proteger a su familia. De los no vacunados en 2012 respondieron como motivos principales: percepción de nunca haber contraído gripe, miedo a efectos adversos y descrédito al efecto inmunizador de las vacunas. Se confirmó la baja tasa de vacunación del PDS (37,3% en año 2012) a pesar de reconocer la indicación y tener accesibilidad a la misma; se identificaron como barreras las percepciones erróneas acerca de la vacunación...

Vacunación antigripal en personal de salud: cobertura, actitudes y barreras contra la vacunación en dos servicios de un hospital general / Influenza immunization in health care professionals: coverage, attitudes and barriers against immunization in two departments of a general hospital

Con el objetivo de conocer la cobertura y las barreras contra la vacunación antigripal, cuya aceptación estimábamos baja entre el personal de salud(PDS) se realizó un estudio transversal, descriptivo, con la metodología de encuesta, autoadministrada con opciones cerradas para su respuesta. Se utilizó una muestra de 142 PDS integrantes del Hospital Pasteur (MSP-ASSE), aleatorizada y adecuada para extraer conclusiones estadísticamente válidas. Los resultados mostraron que 87/142 (61,3%) de los encuestados conocía la campaña de vacunación antigripal en el Hospital, reconocieron tener indicación de vacunación antigripal 124/142 (87,3%) a pesar de lo cual se vacunaron en 2011 79/142 (55,6%) y en 2012 53/142 (37,3%). Los vacunados en 2012 respondieron como motivos principales de adherencia a la campaña protegerse a sí mismo de la enfermedad, pertenecer al PDS y proteger a su familia. De los no vacunados en 2012 respondieron como motivos principales: percepción de nunca haber contraído gripe, miedo a efectos adversos y descrédito al efecto inmunizador de las vacunas. Se confirmó la baja tasa de vacunación del PDS (37,3% en año 2012) a pesar de reconocer la indicación y tener accesibilidad a la misma; se identificaron como barreras las percepciones erróneas acerca de la vacunación.

Comportamiento de la depresión en el adulto mayor del policlínico "Cristóbal Labra" / Behaviour of depression in the elderly at \"Cristobal Labra\" Polyclinic

Introducción: la depresión en el anciano constituye un problema de salud. Los cambios biológicos, psicológicos, económicos y sociales que se observan en el proceso de envejecimiento, asociados a las numerosas patologías que aparecen en esta etapa de la vida, conllevan a pensar que irremediablemente los ancianos tengan todas las condiciones creadas para deprimirse.Objetivo: caracterizar la depresión en los adultos mayores y los tratamientos empleados para la misma, en la consulta de psicogeriatría y demencia de un policlínico.Métodos: se realizó un estudio descriptivo, retrospectivo de corte transversal a 112 ancianos, remitidos por los médicos de familia a la consulta de Psicogeriatría y Demencia del Policlínico "Cristóbal Labra", durante el período de julio a diciembre de 2011. Los datos se recogieron de las historias clínicas. Para el diagnóstico de la patología se aplicó el test de Yesavage y el Mini mental de Folstein.Resultados: la depresión se diagnosticó al 25 por ciento de los ancianos remitidos a consulta; la misma se incrementó con la edad, el bajo nivel educacional y la presencia de enfermedades como osteoartritis y alteraciones sensoriales. Los síntomas principales fueron los trastornos del sueño en el hombre y la tristeza y llanto en la mujer. Se usó la Medicina Natural Tradicional con éxito en un 42,9 por ciento de los ancianos.Conclusiones: la depresión es una entidad frecuente y poco diagnosticada, el uso de la Medicina Natural y Tradicional constituye una alternativa de tratamiento para la misma

Background: depression in the elderly is a health problem. The biological, psychological, economic and social changes seen in the aging process, associated to some pathologies appearing in this stage of life, inevitably lead to think that the elderly have created all the conditions to be depressed.Objective: to characterize depression in the elderly and the treatments followed for this condition in the Psychogeriatric and Dementia consultation at a polyclinic.Methods: a retrospective descriptive cross-sectional study was performed in 112 elderly who were referred by their family doctors to the Psychogeriatric and Dementia consultation of "Cristobal Labra" Polyclinic from July to December 2011. The data were collected from medical records. For the diagnosis of the pathology, the Yesavage and the Folstein Mini Mental tests were applied.Results: depression was diagnosed in a 25 per cent of the elderly who were referred to the consultation. This condition increased with age, low educational levels and the presence of diseases such as osteoarthritis and sensory changes. The principal symptoms were sleep disturbances in men and sadness and crying in women. Traditional Herbal Medicine was used which reported good results in a 42.9 per cent of the patients.Conclusions: depression is a frequent entity which is sometimes misdiagnosed. The use of Traditional Herbal Medicine constitutes an alternative treatment for it