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PURPOSE: The PAINESD risk score was developed in 2015 as a tool to stratify the risk of acute hemodynamic decompensation during ventricular tachycardia (VT) ablation in structural heart disease patients and further then used for post procedure 30-day mortality prediction. The original cohort however did not include Chagas disease (ChD) patients. We aim to evaluate the relevance of the score in a ChD population. METHODS: The PAINESD risk score gives weighted values for specific characteristics (chronic obstructive pulmonary disease, age > 60 years, ischemic cardiomyopathy, New York Heart Association [NYHA] functional class 3 or 4, ejection fraction less than 25%, VT storm, and diabetes). The score was applied in a retrospective cohort of ChD VT ablations in a single tertiary center in Brazil. Data were collected by VT study reports and patient record analysis at baseline and on follow-up. RESULTS: Between January 2013 and December 2018, 157 VT catheter ablation procedures in 121 ChD patients were analyzed. Overall, 30-day mortality was 9.0%. Multivariate analysis correlated NYHA functional class (HR 1.78, 95% CI 1.03-3.08, P 0.038) and the need for urgent surgery (HR 31.5, 95% CI 5.38-184.98, P < 0.001), as well as a tendency for VT storm at presentation (HR 2.72, 95% CI 0.87-8.50, P 0.084) as risk factors for the primary endpoint. The median PAINESD risk score in this population was 3 (3-8). The area under the receiver operating characteristic (ROC) curve was 0.64 (95% CI 0.479-0.814). CONCLUSIONS: The PAINESD risk score did not perform well in predicting 30-day mortality in ChD patients. Pre-procedure NYHA functional class and the need for urgent surgery due to refractory pericardial bleeding were independently associated with increased 30-day mortality. Prospective studies are needed to take final conclusions in Chagas disease when using PAINESD score.

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Human strongyloidiasis is caused by helminth Strongyloides stercoralis. It has a worldwide distribution, often neglected and cause of severe morbidity. The parasitological diagnosis is hindered by the low and irregular amount of larvae in feces. The goal of the present study was to detect IgG and IgG immune complex using conventional serum samples and saliva as alternative samples. We collected samples from 60 individuals, namely: group I composed of 30 healthy individuals; and group II composed of 30 individuals eliminating S. stercoralis larvae in feces. We calculated the area under the curve, general index of diagnostic accuracy, Kappa index and determined the correlations between different diagnostic tests. The detection of IgG levels was performed by an immunoenzymatic assay with alkaline extract of S. venezuelensis larvae as antigen. Positivity of anti-S. stercoralis IgG in serum samples from group I was 3·3%, and from group II 93·3%. The detection of immune complex indicated that group I exhibited 3·3% and group II 56·7%. In the saliva samples, IgG detection was 26·7% for group I and 43·3% for group II. Immune complex was detected in 20% of group I, and 30% of group II. IgG immune complex in conventional serum samples and saliva as alternative samples can be considered biomarkers for the diagnosis of active strongyloidiasis.

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In the present study, antigens from parthenogenetic females and eggs of Strongyloides venezuelensis, or anti-parthenogenetic-female and anti-egg antigens were used to detect specific IgG and immune complex responses, respectively. Serum samples from experimentally infected immunocompetent and immunosuppressed rats were analysed on days 5, 8, 13 and 21 post-infection (dpi). An enzyme-linked immunosorbent assay (ELISA) was performed using alkaline parasite extract for specific IgG detection, and anti-parthenogenetic-female or anti-egg antigens for immune complex detection. The data were analysed using analysis of variance (ANOVA), followed by a Bonferroni test. When parthenogenetic female or egg extracts were used as antigens, specific IgGs were not detected in either immunocompetent or immunosuppressed rats. When anti-parthenogenetic-female or anti-S. venezuelensis-eggs were used, immune complexes were detected for the duration of the infection in immunosuppressed animals and were only detected between 5 and 13 dpi in immunocompetent animals. The duration of infection was not significantly different between the immunocompetent and immunosuppressed groups when anti-parthenogenetic-female or anti-S. venezuelensis-eggs were used. Parthenogenetic female extracts yielded significant differences between antibody and immune complex responses in immunocompetent rats from 5 to 13 dpi, but only on day 5 dpi in immunosuppressed rats. Exposure to S. venezuelensis egg extract yielded significant differences in both antibody and immune complex detection between immunocompetent and immunosuppressed rats for the duration of the infection. In conclusion, ELISA using alternative antigens may be a successful strategy for identifying immune complexes in serum samples and diagnosing active strongyloidiasis, particularly under conditions of immunosuppression.

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Little is known about the actin cytoskeleton architecture in female Strongyloides venezuelensis and thus to investigate the distribution and concentration of actin, female worms were labelled with phalloidin-rhodamine and visualized under confocal microscopy. Our results demonstrate that filamentous actin accumulates in the vulva and the concentration of F-actin at this site suggests its important role, especially during oviposition, in the life cycle of S. venezuelensis.

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Infections caused by resistant microorganisms often fail to respond to conventional therapy, resulting in prolonged illness, increased treatment costs and greater risk of death. Consequently, the development of novel antimicrobial drugs is becoming more demanding every day since the existing drugs either have too many side-effects or they tend to lose effectiveness due to the selection of resistant strains. In view of these facts, a number of new strategies to obstruct vital biological processes of a microbial cell have emerged; one of these is focused on the use of metal-chelating agents, which are able to selectively disturb the essential metal metabolism of the microorganism by interfering with metal acquisition and bioavailability for crucial reactions. The chelation activity is able to inhibit the biological role of metal-dependent proteins (e.g., metalloproteases and transcription factors), disturbing the microbial cell homeostasis and culminating in the blockage of microbial nutrition, growth and development, cellular differentiation, adhesion to biotic (e.g., extracellular matrix components, cell and/or tissue) and abiotic (e.g., plastic, silicone and acrylic) structures as well as controlling the in vivo infection progression. Interestingly, chelating agents also potentiate the activity of classical antimicrobial compounds. The differences between the microorganism and host in terms of the behavior displayed in the presence of chelating agents could provide exploitable targets for the development of an effective chemotherapy for these diseases. Consequently, metal chelators represent a novel group of antimicrobial agents with potential therapeutic applications. This review will focus on the anti-fungal and anti-protozoan action of the most common chelating agents, deciphering and discussing their mode of action.

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The aim of this study was to use larval, parasitic female and egg antigens from Strongyloides venezuelensis to detect parasite-specific IgG and immune complexes in human serum samples by enzyme-linked immunosorbent assay (ELISA). In total, 95 serum samples were analysed, consisting of 30 patients harbouring S. stercoralis larvae, 30 healthy subjects and 35 patients with other parasites. Sensitivity, specificity and diagnostic efficiency were calculated. A significant statistical difference was found in the detection of immune complexes and antibodies in patients harbouring S. stercoralis larvae from larval and eggs antigens, with higher positivity using larval antigen. The larval antigen showed the highest values for sensitivity, specificity and diagnostic efficiency in ELISA from detection of immune complexes. For the first time we used IgG anti-larvae, IgG anti-parasitic females or IgG anti-eggs for immune complex detection. We concluded that the association of antibody and immune complex detection could be used in the diagnosis of human strongyloidiasis.

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O Programa Aprendendo com Saúde (APD) têm como objetivo a promoção, prevenção e a assistência à saúde do escolar, sendo normatizado em setembro de 2007 com o objetivo de ampliar e aperfeiçoar o Programa Municipal de Atenção á Saúde do Escolar

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O Programa Aprendendo com Saúde (APD) têm como objetivo a promoção, prevenção e a assistência à saúde do escolar, sendo normatizado em setembro de 2007 com o objetivo de ampliar e aperfeiçoar o Programa Municipal de Atenção á Saúde do Escolar.

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O Programa Aprendendo com Saúde (APD) têm como objetivo a promoção, prevenção e a assistência à saúde do escolar, sendo normatizado em setembro de 2007 com o objetivo de ampliar e aperfeiçoar o Programa Municipal de Atenção á Saúde do Escolar(AU)

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The present study, investigated the mechanisms involved in the immune responses of Major Histocompatibility Complex class I or class II knockout mice, following Strongyloides venezuelensis infection. Wild-type C57BL/6 (WT), MHC II(-/-) and MHC I(-/-) mice were individually inoculated with 3000 larvae (L3) of S. venezuelensis and sacrificed on days 1, 3, 5, 8, 13 and 21 post-infection (p.i.). Samples of blood, lungs and small intestines were collected. The tissue samples were stained with hematoxylin-eosin for the pathological analysis. The presence of the parasite was demonstrated by immunoperoxidase analysis. MHC II(-/-) mice presented a significantly higher number of adult worms recovered from the small intestine on day 5p.i. and presented elevated numbers of eggs in the feces. The infection by S. venezuelensis was completely eliminated 13 days after infection in WT as well as in MHC I(-/-) mice. In MHC II(-/-) mice, eggs and adult worms were still found on day 21 p.i., however, there was a significant reduction in their numbers. In the lung, the parasite was observed in MHC I(-/-) on day 1 p.i. and in MHC II(-/-) mice on days 1 and 5 p.i. In the small intestine of WT mice, a larger number of parasites were observed on day 8 p.i. and their absence was observed after day 13 p.i. Through immunohistochemistry analysis, the parasite was detected in the duodenum of WT on days 5 and 8 p.i., and in knockout mice on days 5, 8 and 13 p.i.; as well as in posterior portions of the small intestine in MHC I(-/-) and MHC II(-/-) on day 13 p.i., a finding which was not observed in WT mice. We concluded that immunohistochemistry analysis contributed to a more adequate understanding of the parasite localization in immunodeficient hosts and that the findings aid in the interpretation of immunopathogenesis in Strongyloides infection.

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Chronic migraine (CM) has been associated with idiopathic intracranial hypertension without papilloedema (IIHWOP), a significant percentage of these cases occurring in obese patients with intractable headache. A prospective study from February 2005 to June 2006 was made of 62 CM patients who fulfilled International Headache Society diagnostic criteria and had cerebral magnetic resonance venography (MRV) and lumbar puncture (LP) done. Two patients were excluded, six (10%) with elevated cerebrospinal fluid (CSF) open pressure (OP), five with body mass index (BMI) > 25. None of the patients had papilloedema or abnormal MRV. BMI and CSF OP were significantly correlated (r = 0.476, P < 0.001, Pearson's correlation test). Obesity (defined as BMI > 30) was a predictor of increase in intracranial pressure (defined as OP > 200 mmH(2)O) (f = 17.26, 95% confidence interval 6.0, 8.6; P < 0.001). From our study we strongly recommend that not only intractable CM patients with high BMI, but also first diagnosed patients with BMI > 30 should be systematically evaluated by a LP to rule out IIHWOP.

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Plasma amino acid levels have never been studied in the placental intervillous space of preterm gestations. Our objective was to determine the possible relationship between plasma amino acids of maternal venous blood (M), of the placental intervillous space (PIVS) and of the umbilical vein (UV) of preterm newborn infants. Plasma amino acid levels were analyzed by ion-exchange chromatography in M from 14 parturients and in the PIVS and UV of their preterm newborn infants. Mean gestational age was 34 +/- 2 weeks, weight = 1827 +/- 510 g, and all newborns were considered adequate for gestational age. The mean Apgar score was 8 and 9 at the first and fifth minutes. Plasma amino acid values were significantly lower in M than in PIVS (166%), except for aminobutyric acid. On average, plasma amino acid levels were significantly higher in UV than in M (107%) and were closer to PIVS than to M values, except for cystine and aminobutyric acid (P < 0.05). Comparison of the mean plasma amino acid concentrations in the UV of preterm to those of term newborn infants previously studied by our group showed no significant difference, except for proline (P < 0.05), preterm > term. These data suggest that the mechanisms of active amino acid transport are centralized in the syncytiotrophoblast, with their passage to the fetus being an active bidirectional process with asymmetric efflux. PIVS could be a reserve amino acid space for the protection of the fetal compartment from inadequate maternal amino acid variations.

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Plasma amino acid levels have never been studied in the placental intervillous space of preterm gestations. Our objective was to determine the possible relationship between plasma amino acids of maternal venous blood (M), of the placental intervillous space (PIVS) and of the umbilical vein (UV) of preterm newborn infants. Plasma amino acid levels were analyzed by ion-exchange chromatography in M from 14 parturients and in the PIVS and UV of their preterm newborn infants. Mean gestational age was 34 ± 2 weeks, weight = 1827 ± 510 g, and all newborns were considered adequate for gestational age. The mean Apgar score was 8 and 9 at the first and fifth minutes. Plasma amino acid values were significantly lower in M than in PIVS (166 percent), except for aminobutyric acid. On average, plasma amino acid levels were significantly higher in UV than in M (107 percent) and were closer to PIVS than to M values, except for cystine and aminobutyric acid (P < 0.05). Comparison of the mean plasma amino acid concentrations in the UV of preterm to those of term newborn infants previously studied by our group showed no significant difference, except for proline (P < 0.05), preterm > term. These data suggest that the mechanisms of active amino acid transport are centralized in the syncytiotrophoblast, with their passage to the fetus being an active bidirectional process with asymmetric efflux. PIVS could be a reserve amino acid space for the protection of the fetal compartment from inadequate maternal amino acid variations.

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Strongyloides stercoralis is an intestinal nematode with worldwide distribution, particularly in tropical and subtropical regions. Due to the low sensitivity of traditional parasitological methods, the detection of serum specific antibodies may serve as an alternative test for the diagnosis. The aims of the present study were to verify the occurrence of S. stercoralis and the presence of specific IgG antibodies to the parasite in kennel dogs and keepers, using parasitological and serological assays. A total of 181 dogs were examined from 7 breeding kennels in the city of Uberlândia, southeastern region of Brazil and distributed as follows: kennel A (n=41), kennel B (n=16), kennel C (n=11), kennel D (n=63), kennel E (n=11), kennel F (n=18) and kennel G (n=21). Fecal and serum samples from 11 keepers responsible for kennel cleaning and dog control were also collected in five of the seven kennels (two from kennel A, one from kennel B, four from kennel D, two from kennel E and two from kennel G). Overall, enteroparasites were detected by parasitological assays in 66, 36.5% (95% CI: 2.5-43.4%) of the 181 dogs tested. Only one (0.6%) dog was copropositive for S. stercoralis. Among the keepers only one fecal sample, 9.1% (95% CI: 8.6-9.4%) was positive for hookworm by the Lutz method. Serological assays showed that 44 (24.3%) of the 181 dogs were seropositive for S. stercoralis in at least one of the tests in the following kennels: 21 (11.6%) in kennel A; 1 (0.6%) in kennel B; 5 (2.7%) in kennel C; 6 (3.3%) in kennel D; 1 (0.6%) in kennel E; 9 (4.9%) in kennel F and 1 (0.6%) in kennel G. Among the keepers no S. stercoralis seropositive samples were identified using IFAT but 2 (18.2%) of the keepers from kennel D and 1 (9.1%) from kennel G were seropositive by ELISA. The present study demonstrated that the occurrence of S. stercoralis infection in kennel dogs and keepers is low in the city of Uberlândia and that serological assays can contribute to the diagnosis of canine as well as human strongyloidiasis.

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The prevalence of metallo-beta-lactamase (MBL) production among Pseudomonas aeruginosa nosocomial isolates from a Brazilian teaching hospital was determined. A total of 512 P. aeruginosa isolates were recovered from 245 patients during a 10-month period. Ninety-four (38.4%, 95% CI 32.2-44.8%) isolates were MBL producers. Most resistance to beta-lactams was mediated by MBL. Forty-one (16.7%) were resistant to all drugs except polymyxin B and 33 (80.5%) of these were MBL producers. Clonal dissemination, documented by DNA macrorestriction, played a major role for the spread of MBL isolates. The blaSPM-1 gene was demonstrated by PCR in 14 randomly selected MBL isolates. The extremely high prevalence of MBL production found challenges the choice of therapeutics for P. aeruginosa, and measures to control horizontal dissemination of MBL producers are urgently required.

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Canine strongyloidiasis is a parasitic infection caused by the nematode Strongyloides stercoralis and presents a great zoonotic potential. Its confirmation, using coproparasitological methods, is difficult. The detection of serum specific antibodies, however, may facilitate the diagnosis. The aims of this study were to determine the presence of S. stercoralis through the use of parasitological methods and to detect specific antibodies to the parasite in serum samples from domestic dogs by using the indirect fluorescent antibody test (IFAT) on slides and the enzyme-linked immunosorbent assay (ELISA). A total of 215 dogs of various breeds, from the cities of Uberlândia, Araxá and Campo Belo in the State of Minas Gerais, were examined and distributed according to age into the following groups: (I) 19 males and 20 females of 1-2 months old; (II) 11 males and 20 females of 2-month- to 1-year-old and (III) 41 males and 104 females, from 1 to 7 years old. Coproparasitological results showed that 63/215 (29.3%) of the dogs presented some kind of parasite, with two (0.9%) dogs (one from Araxá and the other from Uberlândia) passing S. stercoralis larvae in the feces. Serological results revealed antibodies to S. stercoralis in 45/215 (20.9%) of the dogs, with seropositivity rates of 0% (0/39) in Group I, 22.6% (7/31) in Group II, and 26.2% (38/145) in Group III. No serological cross-reactivity between S. stercoralis and hookworms or Ascaridae was found. Hookworm infections were seen in 31 dogs, but only one of these dogs (infected with both hookworm and Cystoisospora spp.) was S. stercoralis seropositive by IFAT. The present study demonstrated, for the first time, natural S. stercoralis infections in dogs diagnosed by coproparasitological and serological methods. It was concluded that the detection of specific antibodies to S. stercoralis by IFAT and ELISA may contribute to the diagnosis of canine strongyloidiasis.

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RESUMO Diversas propriedades medicinais como antibacteriana, antifúngica, cicatrizante e antioxidante são popularmente relatadas ao mel. Poucos estudos têm sido realizados sobre atividade antimicrobiana (AA) do mel de abelhas sociais da subfamília Meliponinae. O objetivo deste estudo foi investigar a AA do mel de Nannotrigona testaceicornis, uma espécie de abelha indígena sem ferrão. Para a avaliação da AA do mel foi empregado o método da difusão em ágar, utilizando-se discos de 6 mm de diâmetro em presença de 10 diferentes microrganismos, obtidos de focos de infecções clínicas. Os testes indicaram resistência em: Enterobacter aerogenes, Enterobacter cloacae, Proteus mirabilis, Staphylococcus aureus, Streptococcus ? -hemolítico; e indicaram sensibilidade em: Escherichia coli, Proteus spp., Pseudomonas aeruginosa, Streptococcus pyogenes, bem como Staphylococcus spp. coagulase. Vinte e três antibióticos comerciais distintos foram também avaliados no presente estudo. Os resultados obtidos até o momento apontam para um excelente potencial terapêutico deste produto apícola.

ABSTRACT Several medicinal properties, such as antibacterial, antifungal, healing and antioxidant activities, are popularly reported for honey. Few studies have been done on the antimicrobial activity (AA) of honey produced by social bees from the sub-family Meliponinae. The objective of this study was to investigate the AA of honey produced by Nannotrigona testaceicornis, a native stingless bee. For the honey AA evaluation, the agar diffusion method was assayed against 10 different microorganisms isolated from inoculi obtained from clinically infected sites. Tests indicated resistance in Enterobacter aerogenes, Enterobacter cloacae, Proteus mirabilis, Staphylococcus aureus, ? hemolytic Streptococcus. Susceptibility was observed in Escherichia coli, Proteus spp., Pseudomonas aeruginosa, Streptococcus pyogenes as well as in negativecoagulase Staphylococcus spp. Twenty-three distinct commercial antibiotics were also assayed in the present study. Results obtained up to this date indicate an excellent therapeutical potential for this natural product.

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RESUMO Este estudo avaliou as atividades antimicrobianas (AA) de extratos hidro-alcoólicos, obtidos de 17 espécies de árvores nativas do Brasil. Para os ensaios de antibiose foi utilizado o método da difusão em ágar, frente a 10 diferentes microrganismos, isolados de inóculos obtidos de focos de infecções clínicas. Dos 170 testes realizados, 25% mostraram alta AA, destacando-se extratos de Bixaorellana, Psidiumguajava e Anacardium occidentale. Excepcional AA foi observada em Mimosa tenuiflora contra Streptococcus pyogenes, Proteus mirabilis, Shigella sonnei, Staphylococcus aureus e Staphylococcus spp. coagulase-negativa, e os extratos de Stryphnodendron adstringens e Eugenia uniflora contra Escherichia coli, Providencia spp., Streptococcus pyogenes, Proteus mirabilis, Shigella sonnei, Staphylococcus aureus e Staphylococcus spp. coagulase-negativa. Ensaios de antibiose com antibióticos comerciais foram realizados contra estas bactérias, com a finalidade de se comparar o potencial de AA de extratos destas árvores.

ABSTRACT This study evaluated the antimicrobial activities (AA) of hydroalcoholic extracts obtained from 17 species of native Brazilian trees. The agar diffusion method was used against 10 different microorganisms isolated from inoculi obtained from clinically infected spots, for antibiosis assay purposes. Of the 170 tested carried out, 25% exhibited high AA, with Bixa orellana, Psidium guajava and Anacardium occidentale showing the most outstanding extract qualities. Exceptional AA was observed for Mimosa tenuiflora against Streptococcus pyogenes, Proteus mirabilis, Shigella sonnei, Staphylococcus aureus and coagulase-negative Staphylococcus spp. and Stryphnodendron adstringens, and for Eugenia uniflora extracts against Escherichia coli, Providencia spp., Streptococcus pyogenes, Proteus mirabilis, Shigella sonnei, Staphylococcus aureus and coagulase-negative Staphylococcus spp. Antibiosis essays with commercially available antibiotics were simultaneously conducted against the above-mentioned bacteria to compare with the AA potential of the trees extracts studied.

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The performance of a new version of an automated system panel, the Positive Combo Panel Type 11 of MicroScan WalkAway 96 (WA96; Dade Behring) was evaluated and compared to that of reference methods for the identification and for antimicrobial susceptibility testing of the different enterococcal species. A total of 376 enterococcal isolates were tested. The MicroScan WA96 correctly identified 99.6% (266/267), 78.3% (18/23) and 68.6% (59/86) of Enterococcus faecalis, Enterococcus faecium and species other than E. faecalis and E. faecium, respectively. Although low probability of accurate identification was obtained for 37 (9.8%) strains, the system indicated that supplementary tests were necessary for precise identification of 8 (9.3%) among the 86 strains included in the non-faecalis/non-faecium group and of 3 (13.0%) among the E. faecium isolates. In comparison to the agar screening method, the percentage of agreement for detection of resistance markers by the automated system was 90.2% (37/41) for ampicillin, 90.6% (48/53) for high-level resistance to streptomycin (HLRS), 96.4% (80/83) for high-level resistance to gentamicin (HLRG), and 100% (14/14) for vancomycin. The results indicate that the MicroScan WA96 performed well for the identification of E. faecalis and typical E. faecium isolates, and for the detection of resistance to vancomycin and HLRG. However, the system still needs further improvement in order to provide reliable results for the characterization of the other enterococcal species, including atypical variants of E. faecium.

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OBJECTIVE: Considering the rarity and the significance of early diagnosis for planning appropriate treatment, a case of congenital tuberculosis is reported.CASE REPORT: After a prolonged stay in the Neonatal Intensive Care Unit (NICU) of a male pre-term infant without improvement, the diagnosis of tuberculosis was suspected when his mother underwent thoracotomy for valve replacement due to a subacute endocarditis. At this time, multiple pleural granulomas were detected and the diagnosis of tuberculosis was confirmed by histology. His mother seldom went to the NICU to see the baby and she was rarely very close to him in these occasions. After tuberculosis therapy, the baby gradually improved. CONCLUSION: Among the possible ways of transmission, the reported case was probably transmitted by aspiration of contaminated amniotic fluid in utero or at the time of delivery.