Synergistic interaction of polymyxin B with carvacrol: antimicrobial strategy against polymyxin-resistant Klebsiella pneumoniae.

Objective: The antimicrobial activities of the synergistic combination of carvacrol and polymyxin B against polymyxin-resistant Klebsiella pneumoniae were evaluated. Methods: The methods employed checkerboard assays to investigate synergism, biofilm inhibition assessment and membrane integrity assay. In addition, the study included in vivo evaluation using a mouse infection model. Results: The checkerboard method evaluated 48 combinations, with 23 indicating synergistic action. Among these, carvacrol 10 mg/kg plus polymyxin B 2 mg/kg exhibited in vivo antimicrobial activity in a mouse model of infection, resulting in increased survival and a significant decrease in bacterial load in the blood. Conclusion: Polymyxin in synergy with carvacrol represents a promising alternative to be explored in the development of new antimicrobials.

In this study, we wanted to find a new way to fight a bacteria called Klebsiella pneumoniae, which is not easily killed by medication. We mixed two drugs, carvacrol and polymyxin B, to see if they would work together to fight the bacteria. We found that the mixed treatment helped to kill the bacteria. We also tried this mixed treatment in sick mice, and they got better. Our study shows that this mixed treatment might be a new way to fight bacteria that are hard to kill with regular drugs. Next, we hope to learn more about how it works.

Antimicrobial activity of cinnamaldehyde against multidrug-resistant Klebsiella pneumoniae: an in vitro and in vivo study.

The emergence and spread of multidrug-resistant (MDR) Klebsiella pneumoniae strains have increased worldwide, posing a significant health threat by limiting the therapeutic options. This study aimed to investigate the antimicrobial potential of cinnamaldehyde against MDR-K. pneumoniae strains in vitro and in vivo assays. The presence of resistant genes in MDR- K. pneumoniae strains were evaluated by Polymerase Chain Reaction (PCR) and DNA sequencing. Carbapenem-resistant K. pneumoniae strains show the blaKPC-2 gene, while polymyxin-resistant K. pneumoniae presented blaKPC-2 and alterations in the mgrB gene. Cinnamaldehyde exhibited an inhibitory effect against all MDR- K. pneumoniae evaluated. An infected mice model was used to determine the in vivo effects against two K. pneumoniae strains, one carbapenem-resistant and another polymyxin-resistant. After 24 h of cinnamaldehyde treatment, the bacterial load in blood and peritoneal fluids decreased. Cinnamaldehyde showed potential effectiveness as an antibacterial agent by inhibiting the growth of MDR-K. pneumoniae strains.

Antimicrobial and antibiofilm activities of desloratadine against multidrug-resistant Acinetobacter baumannii.

Aim: The antimicrobial and antibiofilm activities of the antihistamine desloratadine against multidrug-resistant (MDR) Acinetobacter baumannii were evaluated. Results: Desloratadine inhibited 90% bacterial growth at a concentration of 64 µg/ml. The combination of desloratadine with meropenem reduced the MIC by twofold in the planktonic state and increased the antibiofilm activity by eightfold. Survival curves showed that combinations of these drugs were successful in eradicating all bacterial cells within 16 h. Scanning electron microscopy also confirmed a synergistic effect in imparting a harmful effect on the cellular structure of MDR A. baumannii. An in vivo model showed significant protection of up to 83% of Caenorhabditis elegans infected with MDR A. baumannii. Conclusion: Our results indicate that repositioning of desloratadine may be a safe and low-cost alternative as an antimicrobial and antibiofilm agent for the treatment of MDR A. baumannii infections.

Exploring the Bacteriome and Resistome of Humans and Food-Producing Animals in Brazil.

The epidemiology of antimicrobial resistance (AMR) is complex, with multiple interfaces (human-animal-environment). In this context, One Health surveillance is essential for understanding the distribution of microorganisms and antimicrobial resistance genes (ARGs). This report describes a multicentric study undertaken to evaluate the bacterial communities and resistomes of food-producing animals (cattle, poultry, and swine) and healthy humans sampled simultaneously from five Brazilian regions. Metagenomic analysis showed that a total of 21,029 unique species were identified in 107 rectal swabs collected from distinct hosts, the highest numbers of which belonged to the domain Bacteria, mainly Ruminiclostridium spp. and Bacteroides spp., and the order Enterobacterales. We detected 405 ARGs for 12 distinct antimicrobial classes. Genes encoding antibiotic-modifying enzymes were the most frequent, followed by genes related to target alteration and efflux systems. Interestingly, carbapenemase-encoding genes such as blaAIM-1, blaCAM-1, blaGIM-2, and blaHMB-1 were identified in distinct hosts. Our results revealed that, in general, the bacterial communities from humans were present in isolated clusters, except for the Northeastern region, where an overlap of the bacterial species from humans and food-producing animals was observed. Additionally, a large resistome was observed among all analyzed hosts, with emphasis on the presence of carbapenemase-encoding genes not previously reported in Latin America. IMPORTANCE Humans and food production animals have been reported to be important reservoirs of antimicrobial resistance (AMR) genes (ARGs). The frequency of these multidrug-resistant (MDR) bacteria tends to be higher in low- and middle-income countries (LMICs), due mainly to a lack of public health policies. Although studies on AMR in humans or animals have been carried out in Brazil, this is the first multicenter study that simultaneously collected rectal swabs from humans and food-producing animals for metagenomics. Our results indicate high microbial diversity among all analyzed hosts, and several ARGs for different antimicrobial classes were also found. As far as we know, we have detected for the first time ARGs encoding carbapenemases, such as blaAIM-1, blaCAM-1, blaGIM-2, and blaHMB-1, in Latin America. Thus, our results support the importance of metagenomics as a tool to track the colonization of food-producing animals and humans by antimicrobial-resistant bacteria. In addition, a network surveillance system called GUARANI, created for this study, is ready to be expanded and to collect additional data.

Conselhos de fiscalização profissional e proteção da sociedade / Professional supervisory boards and protection of society / Consejos de supervisión profesional y protección de la sociedad

Resumo A República Federativa do Brasil, ao reconhecer o valor da liberdade do exercício profissional e o dever de proteger a sociedade, delegou aos conselhos profissionais atividades típicas de poder de fiscalização ética e técnica de pessoas que exercem determinadas profissões. A essa função típica de Estado são somados ainda o exercício de um serviço público e o papel de zelar pelo bom prestígio da profissão. Os conselhos de fiscalização profissional cumprem essas funções de forma legítima, democrática, eficaz e com incontestável valor social. Para que essas entidades continuem exercendo suas missões institucionais, é necessário defender seu reconhecimento como pessoas jurídicas de direito público, detentoras do poder de fiscalização.

Abstract The Federative Republic of Brazil, in recognizing the value of freedom of professional practice and the duty to protect society, delegated to professional councils activities typical of ethical and technical supervision of people who exercise certain professions. To this typical function of the State are also added the exercise of a public service and the role of ensuring the good prestige of the profession. Professional supervisory boards fulfill these functions in a legitimate, democratic, effective way and with undeniable social value. For these entities to continue exercising their institutional missions, it is necessary to defend their recognition as legal entities of public law, holders of supervisory power.

Resumen La República Federativa de Brasil, reconociendo el valor de la libertad de ejercicio profesional y el deber de proteger a la sociedad, delegó en los consejos profesionales actividades típicas de poder de supervisión ética y técnica de las personas que ejercen ciertas profesiones. A esta función típica del Estado se añaden el ejercicio de un servicio público y el papel de velar por el buen prestigio de la profesión. Los consejos profesionales de supervisión desempeñan estas funciones de manera legítima, democrática, efectiva y con un valor social innegable. Para que estas entidades puedan continuar ejerciendo sus misiones institucionales, es necesario defender su reconocimiento como personas jurídicas de Derecho Público, titulares de la facultad de supervisión.

In vitro and in vivo antibacterial activity assays of carvacrol: A candidate for development of innovative treatments against KPC-producing Klebsiella pneumoniae.

Dissemination of carbapenem-resistant Klebsiella pneumoniae poses a threat to the successful treatment of bacterial diseases and increases the need for new antibacterial agents development. The objective of this study was to determine the antimicrobial activity of carvacrol against multidrug-resistant K. pneumoniae. Carbapenemase production was detected by MALDI-TOF. The PCR and sequencing showed that the blaKPC-2, blaOXA-48, blaNDM-1, blaCTX-M-8 genes were present in carbapenem-resistant K. pneumoniae strains. The polymyxin-resistant K. pneumoniae strain exhibited alterations in mgrB gene. The antimicrobial activity of carvacrol was evaluated in vitro using broth microdilution and time-kill methods. For this, carbapenem-resistant K. pneumoniae and polymyxin-resistant strains, were evaluated. The in vitro results showed that carvacrol had antimicrobial activity against all isolates evaluated. The survival curves showed that carvacrol eradicated all of the bacterial cells within 4 h. The antimicrobial effect of carvacrol in vivo was determined using a mouse model of infection with Klebsiella pneumoniae carbapenemase (KPC). The treatment with carvacrol was associated with increased survival, and significantly reduced bacterial load in peritoneal lavage. In addition, groups treated with carvacrol, had a significant reduction in the total numbers of white cell and significantly increased of platelets when compared to the untreated group. In vivo and in vitro studies showed that carvacrol regimens exhibited significant antimicrobial activity against KPC-producing K. pneumoniae, making it an interesting candidate for development of alternative treatments.

Antimicrobial activity of plant extracts against carbapenem-producing Klebsiella pneumoniae and in vivo toxicological assessment.

The global spread of multidrug-resistant strains has prompted the scientific community to explore novel sources of chemicals with antimicrobial activity. The aim of the study was to examine the antimicrobial activity in vitro of 28 extracts against carbapenem-producing Klebsiella pneumoniae, individually and in combination with antibiotics and in vivo toxicological assessment of the most active product. The multi-resistant K. pneumoniae strain was submitted for phenotypic and molecular characterization. The antibacterial activity of 28 plant extracts was evaluated alone and in combination with antibiotics against this strain through the agar disk diffusion. Of these, 16 extracts showed synergism against carbapenem-producing K. pneumoniae, being that B. crassifolia extract exhibited synergism with three antibiotics. Based on this assessment, B. crassifolia-extract-induced toxicity on Swiss male mice was evaluated by administering this extract and subsequently determining apoptosis and splenic phagocytosis using the comet and micronucleus assays. The results of this study showed that B. crassifolia extract had synergistic activity promising and groups treated with B. crassifolia exhibited no genotoxic or mutagenic activity, indicating that B. crassifolia extract exerted beneficial effects and appeared safe to use at the studied concentrations.

Partially Hydrolyzed Guar Gum Increases Ferroportin Expression in the Colon of Anemic Growing Rats.

Studies have reported a positive effect of prebiotics on the bioavailability of iron. This study evaluated the effect of partially hydrolyzed guar gum (PHGG) on iron absorption mechanisms in anemic rats. Male Wistar rats were fed 75g American Institute of Nutrition Rodent Diets for growth, pregnancy and lactation (AIN93-G) without iron for three weeks in order to induce iron deficiency anemia. Then they were fed a control diet (n = 12; without fiber) or a diet with 7.5% of PHGG (n = 12), both without iron. Food intake, body growth and the feed efficiency coefficient (FEC) were measured. The animals were euthanized after two weeks of treatment. The weight of the organs, the pH of the cecal content, and the hepatic iron and ferroportin expression in the cecum, duodenum, and liver were assessed. The intake of PHGG reduced food intake without affecting body growth, and there was a difference between the groups regarding the FEC (p = 0.026), with the highest value found in the PHGG group. The weight of the cecal content increased (p ≤ 0.001) and the pH of the cecal content was significantly lower in the PHGG group. The intake of PHGG significantly increased ferroportin expression in the cecum; however, the difference was not significant in the duodenum and the liver. PHGG seems to have a positive influence on iron absorption through transporter expression, and structural and physiological changes in the colon of anemic growing animals.

Evaluation of the toxicokinetics and apoptotic potential of ethanol extract from Echinodorus macrophyllus leaves in vivo.

This study evaluates the toxicological, genotoxic, mutagenic and apoptotic potential of an in vivo assay from Echinodorus macrophyllus extract (EEM). The acute toxicity test used 02 groups (n = 5) of female Wistar rats: negative control group (saline) and experimental group (2000 mg/kg b.w. EEM), both orally administered (gavage) at single doses and monitored for 14 days. To assess the genotoxic, mutagenic and apoptotic potential, 50 male Swiss mice were divided into 5 groups (n = 10): Group I: negative control (saline solution 0.1 ml/10 g b.w.); Group II: positive control (cyclophosphamide 100 mg/kg b.w.) intraperitoneally administered; groups III-V received EEM at 500, 1000 and 2000 mg/kg b.w., respectively. Groups I, III-V received oral administrations (gavage). The results showed that there was no acute lethality or any signs of acute toxicity, indicating that LD50 is greater than 2000 mg/kg b.w. The groups treated with EEM showed no genotoxic or mutagenic activity and did not induce apoptosis in the liver and kidney. Therefore, EEM showed no acute toxicity and at doses of 500, 1000 and 2000 mg/kg b.w. absence of genotoxicity, mutagenicity and no apoptotic events were observed.

Toxicological analysis and anti-inflammatory effects of essential oil from Piper vicosanum leaves.

This study assessed the anti-inflammatory effects of the essential oil from Piper vicosanum leaves (OPV) and evaluated the toxicological potential of this oil through acute toxicity, genotoxicity and mutagenicity tests. The acute toxicity of OPV was evaluated following oral administration to female rats at a single dose of 2 g/kg b.w. To evaluate the genotoxic and mutagenic potential, male mice were divided into five groups: I: negative control; II: positive control; III: 500 mg/kg of OPV; IV: 1000 mg/kg of OPV; V: 2000 mg/kg of OPV. The anti-inflammatory activity of OPV was evaluated in carrageenan-induced pleurisy and paw edema models in rats. No signs of acute toxicity were observed, indicating that the LD50 of this oil is greater than 2000 mg/kg. In the comet assay, OPV did not increase the frequency or rate of DNA damage in groups treated with any of the doses assessed compared to that in the negative control group. In the micronucleus test, the animals treated did not exhibit any cytotoxic or genotoxic changes in peripheral blood erythrocytes. OPV (100 and 300 mg/kg) significantly reduced edema formation and inhibited leukocyte migration analyzed in the carrageenan-induced edema and pleurisy models. These results show that OPV has anti-inflammatory potential without causing acute toxicity or genotoxicity.

Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats / Fibroplasia após implante de tela de polipropileno para correção de hérnia da parede abdominal em ratos

PURPOSE: This study assessed the collagen deposition and correlated it with local inflammatory responses to evaluate the length of time required for fibroplasia when polypropylene meshes are used to repair incisional abdominal wall hernias in rats. METHODS: Thirty-six male Wistar rats underwent longitudinal resection of a peritoneal and musculoaponeurotic tissue segment (3x2 cm) of the abdominal wall followed by defect reconstruction with polypropylene mesh bridging over aponeurosis. The animals were divided into 6 groups according to the time points for the analysis of fibroplasia: 1, 2, 3, 7, 21 and 30 days post-implantation. Animals were sacrificed at each time point, and the site where the polypropylene mesh was implanted was evaluated histologically to assess inflammatory response and percentage of collagen using computer-assisted videomorphometry. RESULTS: Total collagen was found at the mesh site on the 3rd day post-implantation, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st days, when it reached its highest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days; it reached its highest percentage on the 21st day and then remained stable until the 30th day. The type I to type III collagen ratio increased significantly and progressively up to the 30th day (p<0.001). Neutrophils were found at the mesh site from the 1st to the 21st day post-implantation. Macrophages, giant cells and lymphocytes were seen on the 2nd day. Thirty days after mesh implantation, neutrophils disappeared, but the percentages of macrophages, giant cells and lymphocytes remained stable (p<0.001). CONCLUSIONS: This study showed that total collagen was first seen on the 3rd day post-implantation, with a higher percentage of type I collagen...

OBJETIVO: Avaliar o tempo de fibroplasia em tela de polipropileno na correção de hérnias incisionais da parede abdominal, em ratos, através da quantidade de colágeno, correlacionando-o com a resposta inflamatória local. MÉTODOS: Trinta e seis ratos machos da linhagem Wistar foram submetidos à ressecção longitudinal de um segmento músculo-aponeurótico e peritoneal (3x2 cm) da parede abdominal, seguida por reforço com tela de polipropileno, em forma de ponte sobre a aponeurose. Os animais foram distribuídos em seis grupos, de acordo com o tempo de fibroplasia a ser estudado (1, 2, 3, 7, 21 e 30 dias de pós-operatório). Após os prazos estabelecidos para estudo da fibroplasia, os animais foram submetidos à eutanásia, e a área de fixação da tela de polipropileno foi avaliada histologicamente quanto à reação inflamatória e à percentagem de colágeno pela técnica videomorfométrica assistida por computador. RESULTADOS: Houve aparecimento de colágeno total junto à tela no 3º dia pós-implante, com aumento progressivo na sua proporção em todos os dias subseqüentes até o 21º dia, quando atingiu sua proporção máxima (p<0,001). A partir do dia 3, o colágeno III sofreu um aumento progressivo até o dia 21, quando atingiu sua proporção máxima (p<0,001), e no 30º dia apresentou uma redução significativa (p<0,001). O colágeno tipo I surgiu entre o 7º e o 21º dia, apresentou sua máxima proporção no 21º dia e manteve-se inalterado até o final do período de observação. A relação colágeno tipo I/tipo III aumentou progressivamente e inverteu-se no 30º dia de observação (p<0,001). Os neutrófilos foram identificados no 1º dia pós-implante, mantendo-se junto à tela até o 21º dia. Os macrófagos, gigantócitos e linfócitos foram identificados no 2º dia. Trinta dias após a implantação da tela, desapareceram os neutrófilos e mantiveram-se estáveis as proporções de macrófagos, gigantócitos e linfócitos (p<0,001). CONCLUSÕES: Os resultados do presente estudo evidenciaram...

Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats.

PURPOSE: This study assessed the collagen deposition and correlated it with local inflammatory responses to evaluate the length of time required for fibroplasia when polypropylene meshes are used to repair incisional abdominal wall hernias in rats. METHODS: Thirty-six male Wistar rats underwent longitudinal resection of a peritoneal and musculoaponeurotic tissue segment (3x2 cm) of the abdominal wall followed by defect reconstruction with polypropylene mesh bridging over aponeurosis. The animals were divided into 6 groups according to the time points for the analysis of fibroplasia: 1, 2, 3, 7, 21 and 30 days post-implantation. Animals were sacrificed at each time point, and the site where the polypropylene mesh was implanted was evaluated histologically to assess inflammatory response and percentage of collagen using computer-assisted videomorphometry. RESULTS: Total collagen was found at the mesh site on the 3rd day post-implantation, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st days, when it reached its highest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days; it reached its highest percentage on the 21st day and then remained stable until the 30th day. The type I to type III collagen ratio increased significantly and progressively up to the 30th day (p<0.001). Neutrophils were found at the mesh site from the 1st to the 21st day post-implantation. Macrophages, giant cells and lymphocytes were seen on the 2nd day. Thirty days after mesh implantation, neutrophils disappeared, but the percentages of macrophages, giant cells and lymphocytes remained stable (p<0.001). CONCLUSIONS: This study showed that total collagen was first seen on the 3rd day post-implantation, with a higher percentage of type I collagen at the last observational time point. The prolonged healing inflammatory response and the persistence of chronic inflammation surrounding to the mesh did not affect the length of time required for fibroplasia.

The experience of the Forensic Anthropology Service of the Medical Examiner's Office in Porto Alegre, Brazil.

The Forensic Anthropology Service of the Medical Examiner's Office of Porto Alegre was created in September 1997 to examine human skeletons, establish identification and identify lesions that may explain death. From September 1997 to December 2006, 344 skeletons were examined (mean: 37 examinations/year), and 322 were human remains. Most skeletal remains belonged to men (61%) whose age was estimated at 21-50 years (61%). The most frequent bone lesions were caused by fractures (71%), firearm projectiles (11%) and the effects of weather (10%). Antemortem bone changes due to consolidated fractures, degenerative bone processes, congenital bone diseases, and medical procedures were found in 38 skeletal remains (14%). Identification was possible in 83 cases (26%); of these, 78% were identified by DNA analysis, 16% by dental examination, and 6% by anatomic changes associated with healed fractures.

Conhecimento dos acadêmicos de enfermagem sobre o processo de transplante e doação de órgãos e tecidos / Nursing Student's knowledge about transplant process of organs and tissues donation

Trata-se de um estudo transversal exploratório descritivo, de natureza prospectiva numa abordagem quantitativa visando avaliar o conhecimento dos acadêmicos do Curso de Graduação em Enfermagem da Universidade Federal de Pernambuco sobre o processo de transplante e doação de órgãos e tecidos. A população desse estudo se constitui por graduandos do 6º, 7º e 8º períodos e a amostragem não probabilística internacional correspondeu a 95 estudantes dos referidos períodos. A coleta de dados foi feita entre maio e junho de 2004. Após responderem a um questionário elaborado com 13 questões. Os dados tabulados, organizados em tabelas, apresentados em frequências absoluta e relativa e analisados á luz da literatura pesquisada. Os resultados totalizaram 41 estudantes correspondentes ao 6º período, 26 ao 7º período e 28 ao 8º período; a maior parte da amostra (82,1%) definiu corretamente o transplante de órgãos e tecidos, entretanto, foi surpreendente o fato de 17,9% apontarem esse procedimento como tratamento definitivo. Partindo-se do pressuposto que o conhecimento desse assunto direcionará a assistência prestada aos pacientes que necessitam de um transplante, aos potenciais doadores de órgãos e tecidos e às famílias de ambos, estes resultados sugerem déficit de conhecimento sobre conceitos básicos do tema abordado, o que poderá trazer dificuldades à futura prática profissional destes graduandos.

This is a cohort, exploratory descriptive study of prospective nature in a quantitative approach with the purpose of evaluating the student's knowledge from the Nursing Course of the University Federal of Pernambuco about transplant process of organs and tissues donation. The population corresponded to nursing students from 6º, 7º and 8º semesters and sample not probabilistic intentional corresponded to 95 students of those semesters had answered a questionnaire with 13 questions from May to June 2004. The data had been tabulated, organized in tables, presented in frequencies absolute and relative and analyzed in accordance with searched literature. The results had totalizaed 41 students correspondents to the 6º period, 26 to the 7º period and 28 to the 8º period; most of the sample (82,1%) defined transplant process of organs and tissues donation correctly, however, the 17,9% fact was preoccupyng pointed this procedure as definitive treatment. The results proves that the sample didn't show knowledge about basic concepts about the the theme, starting from the point that the knowledge about the subject will point to a assistence given, to patients who need transplant, to potential organs and tissues donator and to families of both. According to the results, the authors understand that the improvement of data, transplant and organs tissues donation's process divulgation and donation of organs and tissues in the academy will result in better prepared professionals to lead with this reality.

Cuidar da 3º idade: um desafio no cotidiano hospitalar / Taking care of the elderly: A challenge in the Hospital daily

Estudo de natureza qualitativa que trata as dificuldades encontradas pelos técnicos de enfermagem no cotidiano hospitalar quando prestam cuidados aos idosos. Os objetivos foram identificar quais as dificuldades encontradas pelos técnicos de enfermagem da Unidade de Pacientes internados de uma Organização Militar de Saúde quando cuidam dos idosos internados e analisar como elas repercutem nos cuidados de enfermagem prestados. Os dados foram obtidos a partir de um formulário entregue a 40 (quarenta) técnicos de enfermagem que atuam em regime de plantão naquela Unidade. Após a interpretação dos dados, o resultado foi a identificação destas categorias: necessidades de participação consciente e ativa dos familiares de recursos humanos qualificados e em maior número de "tempo hábil"de prevenir úlceras de decúbito de conheceram algumas características do processo de envelhecimento e de ofertar afeto. Conclui-se que, apesar da maioria dos participantes não possuir conhecimentos específicos sobre o processo do envelhecimento e suas implicações biopsicossociais, eles percebem que deve haver uma diferenciação nessa abordagem. Percebem que os idosos possuem peculiaridades em todos os seus aspectos, necessitando, portanto, de cuidados especializados, consequentemente mais qualificados visando a melhoria das condições de vida desse idoso no ambiente hospitalar. Portanto deve-se estar atento á inserção de questões geriátricas e gerontológicas no Programa de Educação Continuada da OMS com o objetivo de instruir a equipe eficazmente para que haja a construção de uma Enfermagem mais apta e habilitada no cuidado da clientela em questão.

Study of quality nature which treats for the difficulties found by the sick-pay technicist in the hospital daily when they assit the old people. The purposes were to identify the difficulties fiund by the sick-pay technicist of the Intern Patient Unity of the Health soldier Organization when they care of intern old-aged and analyze how they reverberate in the sichen care rendered. The informations were obtained from a form delivered to 40 (forty) sick-pay technicist who actuate in regime of duty in that Unity. After the interpretation of the informations, the results was the identification of these categories: necessity of conscious and active participation of the family, more qualified humans appeal, "Skiful time", to prevent ulceration's side, to know some characteristic of the grow old process and ofter friendship. It follows that, in spite of the majoroty of the participants don'ttown specif knowledge about the grow old process and their biological, psychological and social implications, they perceive that must have any difference in this approach. Perceive the old-aged have peculiarity in all the aspects, needing, thus, special cares, consequentially more qualified, seeking the betterment of the life conditions of these old-aged in the hospital ambient. Thus, they have to be attend of the application for the geriatrics and gerontology questions in the Continue Education Program of HSO with the purpose to instruct the staff efficacious to have the construction of a sick-pay more able and qualified in the care of clientele in the matter.

Controle epidemiológico da tuberculose na cidade de Pelotas, Rio Grande do Sul, Brasil: adesäo ao tratamento / Epidemiological control of tuberculosis in Pelotas, Rio Grande do Sul, Brazil: treatment compliance

Verifica fatores de risco para näo-adesäo ao tratamento para tuberculose nos pacientes inscritos no Programa de Controle da Tuberculose, residentes na zona urbana da cidade de Pelotas. O estudo estendeu-se de julho de 1994 a dezembro de 95. Uma coorte de pacientes com diagnóstico incidente de tuberculose, entre vinte e oitenta anos de idade, foi acompanhada no Centro de Saúde da cidade, onde säo centralizados todos os pacientes com tuberculose. Cada paciente foi acompanhado desde o diagnóstico da doença até o término do tratamento, seis meses após. Um questionário padronizado e pré-codificado foi aplicado a todos os pacientes. Foi diagnosticado um total de 152 casos novos de tuberculose no ano em estudo; destes, aproximadamente 20 por cento dos mesmos abandonaram o tratamento. Em relaçäo aos fatores de risco estudados para näo-adesäo ao tratamento näo se encontrou significância estatística para fatores sócio-econômicos, trabalho do chefe da família, idade, sexo, alcoolismo e presença de sintomas. O único fator de risco que esteve estatisticamente associado com nä0-adesäo ao tratamento foi cor näo branca. Isto provavelmente ocorreu pela falta de poder do estudo em razäo do tamanho da amostra.

A influência de três técnicas anestésicas na resposta imunológica do idoso / Influence of three anaesthetic techniques in the immunologic answer of old people

A pesquisa realiza dois estudos: um experimental e outro de intervençäo. Buscou-se a influência que as técnicas de anestesia geral; peridural e combinada possam trazer à resposta imunológica do idoso e se os radicais livres säo preditivos desta alteraçäo. Compuseram o estudo experimental 45 ratos Wistar idosos, que foram divididos em três grupos (n=15), denominados: Hipnótico (H) (propofol); Analgésico (A) (propofol e fentanil) e Controle (C) (sem medicaçäo). Durante o ato anestésico sem estímulo álgico, foram mensurados os lipoperóxidos nas hemácias e a explosäo respiratória. O estudo de intervençäo foi composto de 90 idosos, homens e mulheres, com idade entre 60-90 anos, para a cirurgia de Herniorrafia Inguinal. Estes foram divididos em três grupos de 30 componentes. O grupo geral (G) (propofol, fentanil, isoflurano); o grupo peridural (P) (bupivacaína) e técnica combinada (TC) (bupivacaína, propofol, isoflurano) sendo mensurados, antes e após a intervençäo, os leucócitos totais; CD4; CD8; linfócitos T e B; interleucinas1 beta e interleucina2; cortisol; lipoperóxidos nas hemácias; radicais livres e explosäo respiratória. Os resultados evidenciaram: no estudo experimental que o grupo H (propofol) obteve uma reduçäo dos lipoperóxidos nas hemácias e a explosäo respiratória näo teve alteraçöes nos grupos estudados. No estudo de intervençäo, o grupo geral foi o que resultou em maior número de influências após a intervençäo; ocorreu reduçäo de leucócitos totais; linfócitos T, e o cortisol aumentou, assim como os radicais livres. O grupo peridural apresentou aumento da explosäo respiratória e de radicais livres. Há correlaçöes entre o aumento de radicais livres e decréscimo de CD8 no grupo peridural, assim como no grupo TC, o aumento de radicais livres reduziu o CD4 e LB. A explosäo respiratória aumentou no grupo TC e reduziu a interleucina1 beta. O grupo peridural desenvolveu um percentual menor de infecçäo, (23,3 por cento contra 26,7 por cento), que os grupos geral e técnica combinada. Conclui-se, no estudo experimental, que a anestesia só com propofol, sem estímulo álgico, promoveu reduçäo da peroxidaçäo lipídica nas hemácias. A técnica peridural foi a que menos influenciou a resposta imune no idoso, apesar de ter aumento de radicais livres (quimioluminescência) e apresentou o menor percentual de infecçäo pós-operatória tardia.

Cirurgia de tireoide no Hospital de Clinicas de Porto Alegre / Thyroide surgery in the Hospital de Clinicas de Porto Alegre

Estudo retrospectivo de 431 cirurgias sobre a glandula tireoide, realizadas de marco de 1975 a abril de 1986, em um hospital geral - 83,9% em pacientes do sexo feminino e idade media de 45,6 anos. O tempo medio de permanencia hospitalar foi de 7,3 dias. A indicacao cirurgia deveu-se em 54,5% a presenca de nodulo frio a cintilografia; 54,5% dos pacientes nao realizaram nenhum tipo de tratamento previo a cirurgia. O bocio coloide foi o diagnostico mais frequente enquanto a lobectomia o procedimento mais realizado. Em 86,0% das cirurgias foram utilizados drenos. Hipoparatireoidismo transitorio (9,9%), seroma de ferida operatoria (7,2%), hipotireoidismo (5,6%) e lesao do nervo laringeo inferior (5,6%) foram as complicacoes mais encontradas

Melanoma cutâneo com metástases intestinais: relato de dois casos / Cutaneous melanoma with intestinal metastasis: report of 2 cases

O melanoma é um tumor infreqüente que comumente metastatiza para linfonodos regionais e órgäos à distância. As metástases no aparelho gastrointestinal säo freqüentes apesar de serem diagnosticadas pré-operatoriamente em somente cerca de 4% dos casos. Dois casos de melanoma cutâneo com metástases intestinais, um em ceco-íleo terminal e outro em intestino delgado, säo descritos. Discutem-se os aspectos clínicos desta entidade patológica e seu comportamento metastático para o trato gastrointestinal, enfatizando-se a importância de um tratamento cirúrgico agressivo nestes casos

Medicolegal Identification of Skeletal Remains Through Antemorten Bone Changes: The experience of the Medical Examinaner´s Office in Porto Alegre, Brazil.

Apresentação que traz algumas considerações a respeito da experiência de trabalho dos legistas de Porto Alegre. Destaca a importância de fraturas e de alterações anatômicas para identificação de ossadas, ou de características de fenótipo ou genótipo como a etnia, a altura, o sexo, etc. Salienta que a identificação de ossadas só pode ser considerada plena e conclusiva se houver elementos de comparação, isto é referências como raio-X e arcada dentária que sejam capazes de concretizar as especulações. Cita as metodologias e as linhas de trabalho utilizadas pela equipe do Instituto Médico Legal no Rio Grande do Sul.