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Osteomyelitis caused by non-Candida species is rare and often neglected, and current recommendations are based on primarily clinical experience and expert opinion. The objective of this study was to describe a case series of non-Candida fungal osteomyelitis. This retrospective study included 10 patients with non-Candida fungal osteomyelitis. Patients with osteomyelitis and microbiologically confirmed non-Candida species from bone fragment cultures were selected from the institution Infection Control Board database. Fusarium spp. were the most commonly isolated fungus from bone fragment cultures in five patients (50%). The majority did not present immunosuppression. The most common etiology was post-traumatic (n = 7, 70%), particularly open fractures. All patients were treated with antifungals associated with surgery. The antifungals used were itraconazole in five patients (50%), and voriconazole in another five patients (50%), with a median duration of antifungal therapy of four weeks (range: 3-25). There were no observed deaths within 30 days and one year. An antifungal approach combined with surgical treatment demonstrated favorable clinical outcomes, including low mortality rates and effective remission.
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Antifúngicos , Osteomielite , Humanos , Osteomielite/microbiologia , Osteomielite/epidemiologia , Osteomielite/tratamento farmacológico , Antifúngicos/uso terapêutico , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Feminino , Adulto , Adulto Jovem , Idoso , Adolescente , Micoses/microbiologia , Micoses/epidemiologia , Micoses/tratamento farmacológico , Micoses/mortalidade , Fungos/isolamento & purificação , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/genética , CriançaRESUMO
Background: Concerns about nosocomial transmission of SARS-CoV-2 have been described since the COVID-19 pandemic was first reported and cases of hospital-acquired (HA) COVID-19 and COVID-19 outbreaks have been reported even in clinical areas not intended for the specific care of COVID-19 and declared as "non-COVID" areas. Methods: Retrospective analysis of measures to prevent of hospital acquisition of COVID-19 in patients admitted to a tertiary referral specialist orthopaedic hospital in Brazil in which emergency care was maintained during the pandemic. Results: The proportion of HA-COVID-19 (0.07%) was lower than the value reported for general healthcare in Brazil (0.72%, P<0.001). The integration of several clinical teams to maintain a constant surveillance system, as well as the immediate isolation of patients with any compatible symptoms of COVID-19 and the restriction from work and the testing of symptomatic healthcare workers, were an important part of the strategies adopted. Conclusion: We suggest that the described strategies for preventing the nosocomial spread of SARS-CoV-2 contributed to the observed proportion of HA-COVID-19 to be significantly lower than the reported national value. Future studies that investigate these and other preventative measures are important so that hospitals are prepared for further periods of a high incidence of COVID-19, as well as for other epidemics associated with respiratory transmission.
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BACKGROUND AND AIMS: First-degree relatives of gastric cancer patients are at increased risk of developing gastric cancer. Increased oxidative stress, including lipid peroxidation, has been associated with gastric carcinogenesis. Whether first-degree relatives of gastric cancer patients have increased oxidative stress remains unknown. We aimed to compare oxidative stress in patients with gastric cancer, their first-degree relatives, and dyspeptic controls. METHODS: A total of 155 patients undergoing upper endoscopy were prospectively enrolled, including 50 with gastric cancer, 49 first-degree relatives of gastric cancer patients, and 56 controls. Serum concentrations of malondialdehyde (MDA) and glutathione) and activities of superoxide dismutase (SOD) and catalase were measured. Multivariate analysis adjusting for sex, age, smoking status, and alcohol consumption was performed. RESULTS: Lipid peroxidation, as measured by concentration of MDA (nmol/mL), was higher (p = 0.04), and glutathione levels were lower (p < 0.001) in the gastric cancer group compared to controls. There was no difference in the catalase activity among the groups. There was no difference in glutathione and MDA concentration or catalase activity between the different stages of gastric cancer based on the TNM classification. Relatives of gastric cancer patients had higher glutathione concentration (µmol/mL) compared to gastric cancer patients (262.5 vs. 144.6; p = 0.018), while there was no difference in MDA concentration. Catalase and superoxide dismutase activity were lower in the gastric cancer group (3.82 vs. 0.91; p < 0.001 and 1.04 vs. 0.6; p < 0.001) compared to their first-degree relatives. Interestingly, MDA concentration in the first-degree relative group was higher than in the control group (7.9 vs. 5.1; p = 0.03). CONCLUSIONS: In this study, similarly to gastric cancer patients, their first-degree relatives were found to have increased oxidative stress compared to controls. Further studies are warranted to validate this observation and to better understand the role of oxidative stress as a possible biomarker in this population.
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Anamnese/métodos , Estresse Oxidativo/fisiologia , Neoplasias Gástricas/fisiopatologia , Adulto , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
BACKGROUND: Peripheral neuropathies (PN) and primary headaches (PH) are common comorbidities in inflammatory bowel disease (IBD) patients. We aimed to evaluate whether PN and PH affect the same subgroups of IBD patients. METHODS: Since 2004, we established a cohort study to evaluate neurological diseases in IBD patients. Over 2 years, all consecutive (N = 155) IBD patients (either Crohn's disease (CD) or ulcerative colitis (UC) were evaluated for the presence of PN and PH. PH were also evaluated in dyspeptic patients (N = 84) and IBD relatives (controls, N = 101). After neurological evaluation, symptomatic patients underwent skin wrinkling test to evaluate small fiber function and/or electromyography. RESULTS: Headaches and migraine were more prevalent in IBD than control patients: 52.3 and 34.2% vs. 40.6 and 20.8% (P < 0.05). Migraine was 2.6 times more common in CD patients than controls (CI = 1.34-5.129) and 8.6 times (13.3 times in the CD group) more common in men with IBD (P < 0.05). Headache and migraine were also more common in dyspeptic patients (P < 0.05). Chi-square, univariate, and multivariate regression analysis did not disclose any association between PN, headache, or PH (P > 0.05). Multivariate regression analysis disclosed that headaches were more prevalent in women, co-existing psychiatric disease, IBD, CD, and UC. After age, gender distribution, and prevalence of hypertension and psychiatric diseases were matched among the groups, there were still differences in the prevalence of headaches and migraine among IBD, CD, and UC versus control patients. CONCLUSION: In summary, PH and PN are common in IBD and do not affect the same subgroups of patients.
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Colite Ulcerativa , Doenças Inflamatórias Intestinais , Doenças do Sistema Nervoso Periférico , Estudos de Coortes , Colite Ulcerativa/complicações , Colite Ulcerativa/epidemiologia , Feminino , Cefaleia/epidemiologia , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , MasculinoRESUMO
OBJECTIVE: To determine the mediating effect of direct preschool and parent nutrition education on changes in skin carotenoids scores over 2 years in children of Mexican heritage. DESIGN: In a quasi-experimental, community-based study, two school districts were randomly assigned to either a comparison group (parent workshops unrelated to nutrition) or a childhood obesity prevention intervention group which included nutrition education at family nights for parents and at school for children. Changes in skin carotenoid intensity scores (diffCAROT, year 2015 minus 2013) were measured in children as a proxy for fruit and vegetable consumption using Resonance Raman Spectroscopy. SETTING: Two rural, low-income, school districts from a county in California's Central Valley. PARTICIPANTS: 316 Mexican heritage families with children aged 3-8 years. RESULTS: Intervention group children improved over 2 years in skin carotenoid scores relative to comparison group children (diffCAROT mean +1419 (sd 9540) v. -3473 (sd 9272), P = 0·0001). Parent attendance at nutrition education classes partially mediated the intervention effect on diffCAROT (P = 0·02). Controlling for child's age and other covariates, participation in preschool during the study had a significant positive effect on diffCAROT among intervention children compared with controls (P < 0·03), whereas no significant difference by group was observed among those not enrolled in preschool or already enrolled in elementary school. CONCLUSIONS: Programmes that combine direct parent and preschool nutrition education may be effective in low-income Mexican heritage families to improve children's intake of fruit and vegetables.
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Carotenoides , Frutas , Educação em Saúde , Verduras , Criança , Pré-Escolar , Comportamento Alimentar , Humanos , México , Política Nutricional , PaisRESUMO
Background: Acinetobacter baumannii complex is an increasingly important cause of osteomyelitis. It is considered a difficult to treat agent, due to increasing antimicrobial resistance and few available therapeutic options. Objective: To compare effectiveness and tolerability of tigecycline and colistin in patients with osteomyelitis caused by carbapenem-resistant A. baumannii complex (CRABC). Methods: This retrospective review included all patients admitted to a 150-bed tertiary hospital from 2007 to 2015 with microbiologically confirmed CRABC osteomyelitis for which they received tigecycline or colistin. Data on demographic and clinical characteristics, adverse events, and outcomes 12 months after the end of antimicrobial treatment were analysed and stratified according to the antimicrobial used. Results: 65 patients were included, 34 treated with colistin and 31 with tigecycline. There were significantly more men (P = 0.028) in the colistin group, and more smokers (P = 0.021) and greater occurrence of chronic osteomyelitis (P = 0.036) in the tigecycline treatment group. Median duration of therapy was 42.5 days for colistin and 42 days for tigecycline, with no significant difference. Overall incidence of adverse events was higher in the colistin group (P = 0.047). In particular, incidence of renal impairment was also higher in this group (P = 0.003). Nausea and vomiting were more frequent with tigecycline (P = 0.046). There were no significant differences between groups in relapse, amputation, or death. Conclusions: Tigecycline had a better safety profile than colistin in the treatment of osteomyelitis due to CRABC, with no significant difference in outcomes after 12 months of follow-up.
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The international spread of infectious diseases is a global problem of health security. Vaccination is one of the most successful and profitable health interventions. Oral immunization has significant advantages over the widely used parental vaccines. Intestinal and free-living protozoa express on their surface a dense layer of proteins that protect them from hostile environmental conditions. The use of variable surface proteins (VSPs), such as those of the intestinal protozoan Giardia lamblia, is a feasible mechanism for the generation of oral vaccines, since they are highly immunogenic as well as resistant to changes in pH and proteases. In a recently published article, we showed that these properties of VSPs can be exploited to protect and enhance the immunogenicity of vaccine antigens, thus enabling their oral administration. We recently generated an oral vaccine against influenza virus composed of virus-like particles (VLPs) containing VSPs of G. lamblia and the HA antigen (viral hemagglutinin) in its envelope. When administered orally to mice, these coated particles elicit HA-specific humoral (systemic and local) and cellular responses, without the need of any additional adjuvant. Treated mice are protected against viral challenge as well as against the development of tumors expressing the HA vaccine antigen.
La propagación internacional de enfermedades infecciosas constituye un problema global de seguridad sanitaria. La vacunación es una de las intervenciones en salud más exitosas y efectivas. La administración por vía oral presenta ventajas significativas sobre la vía parental utilizada comúnmente. Protozoarios intestinales y de vida libre expresan en su superficie una densa capa de proteínas que los protegen de condiciones ambientales hostiles. La utilización de proteínas de superficie variante-específicas o VSPs (del inglés "Variant-specific Surface Proteins") tales como las del protozoario intestinal Giardia lamblia constituye un enfoque eficiente para la generación de vacunas orales, dada su alta inmunogenicidad y su resistencia a cambios de pH y proteasas. En un trabajo reciente mostramos que estas propiedades pueden ser explotadas para proteger antígenos vacunales y potenciar su inmunogenicidad, facilitando así su administración oral. Como modelo inicial, generamos una vacuna oral contra el virus de la influenza compuesta por partículas similares a virus (VLPs, del inglés "virus-like particles") que contienen en su envoltorio VSPs de G. lamblia y el antígeno HA (hemaglutinina del virus de la influenza). La administración oral a ratones de estas partículas recubiertas con VSPs y HA induce una respuesta inmune humoral (sistémica y de mucosa) y celular específica para HA sin la necesidad de adyuvantes externos. La respuesta inmune generada protege frente al desafío con el virus y también frente al desarrollo de tumores que expresan el antígeno vacunal HA.
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Adjuvantes Imunológicos/administração & dosagem , Proteínas de Membrana/imunologia , Proteínas de Protozoários/imunologia , Vacinas de Partículas Semelhantes a Vírus/imunologia , Vacinas/imunologia , Administração Oral , Animais , Giardia lamblia/química , Humanos , Imunidade Humoral/efeitos dos fármacos , Proteínas de Membrana/administração & dosagem , Proteínas de Protozoários/administração & dosagem , Vacinas/administração & dosagem , Vacinas de Partículas Semelhantes a Vírus/administração & dosagemRESUMO
Artisanal Colonial-type cheese is made from raw milk and is the main cheese produced by rural families of the southern region of Brazil. The aim of this study was to investigate, identify problems, and propose solutions for the current situation of small family farms producing and informally selling artisanal Colonial-type cheese located in the western part of Santa Catarina State in Southern Brazil. A semistructured questionnaire was employed in 12 rural properties to analyze the mode of production. Physical-chemical and microbiological analyses of water, raw milk, and cheese were performed, and it was found that 92, 50, and 100% of the samples, respectively, were outside of the current Brazilian regulatory parameters. None of the cheesemakers involved in this study met the requirements, as established by law, for artisanal cheese production from raw milk. This study concluded that technical support and changes in public policy are needed to ensure the preservation of this artisanal cheese, considering the historical importance and cultural traditions of these local communities and the socioeconomic importance of cheesemaking to family farming. Furthermore, more research on the safety of the cheese produced from raw milk is needed as well as the development of specific microbiological standards for artisanal Brazilian cheeses. Public policies aimed at guaranteeing food safety that formalize the commercialization of these cheeses will increase food security in those communities that currently produce artisanal cheese informally.
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Queijo/normas , Microbiologia de Alimentos , Inocuidade dos Alimentos , Legislação sobre Alimentos , Leite/normas , Animais , Brasil , Queijo/análise , Queijo/classificação , Queijo/microbiologia , Fazendas/normas , Humanos , Leite/química , Leite/microbiologia , População Rural , Inquéritos e Questionários , Microbiologia da Água , Abastecimento de Água/normasRESUMO
BACKGROUND: Obesity and overweight have increased dramatically in the United States over the last decades. The complexity of interrelated causal factors that result in obesity needs to be addressed within the cultural dynamic of sub-populations. In this study, we sought to estimate the effects of a multifaceted, community-based intervention on body mass index (BMI) among Mexican-heritage children. METHODS: Niños Sanos, Familia Sana (Healthy Children, Healthy Family) was a quasi-experimental intervention study designed to reduce the rate of BMI growth among Mexican-heritage children in California's Central Valley. Two rural communities were matched based on demographic and environmental characteristics and were assigned as the intervention or comparison community. The three-year intervention included parent workshops on nutrition and physical activity; school-based nutrition lessons and enhanced physical education program for children; and a monthly voucher for fruits and vegetables. Eligible children were between 3 and 8 years old at baseline. Intent-to-treat analyses were estimated using linear mixed-effect models with random intercepts. We ran a series of models for each gender where predictors were fixed except interactions between age groups and obesity status at baseline with intervention to determine the magnitude of impact on BMI. RESULTS: At baseline, mean (SD) BMI z-score (zBMI) was 0.97 (0.98) in the intervention group (n = 387) and 0.98 (1.02) in the comparison group (n = 313) (NS). The intervention was significantly associated with log-transformed BMI (ß = 0.04 (0.02), P = 0.03) and zBMI (ß = 0.25 (0.12), P = 0.04) among boys and log-transformed BMI among obese girls (ß = - 0.04 (0.02), P = 0.04). The intervention was significantly and inversely associated with BMI in obese boys and girls across all age groups and normal weight boys in the oldest group (over 6 years) relative to their counterparts in the comparison community. CONCLUSIONS: A community-based, multifaceted intervention was effective at slowing the rate of BMI growth among Mexican-heritage children. Our findings suggest that practitioners should consider strategies that address gender disparities and work with a variety of stakeholders to target childhood obesity. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01900613 . Registered 16th July 2013.
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Índice de Massa Corporal , Promoção da Saúde/métodos , Americanos Mexicanos , Obesidade Infantil/etnologia , Obesidade Infantil/prevenção & controle , California , Criança , Pré-Escolar , Exercício Físico , Feminino , Humanos , Masculino , México/etnologia , Pais/educação , Avaliação de Programas e Projetos de Saúde , População RuralRESUMO
BACKGROUND: Duchenne muscular dystrophy (DMD) is a disease characterized by progressive loss of functional muscle mass followed by changes in body composition. OBJECTIVE: This study aimed to describe and evaluate bioimpedance parameters in boys with DMD. DESIGN: This cross-sectional, descriptive study investigated children and adolescents diagnosed with DMD. Age, weight, height, resistance, and reactance data were collected. Phase angle and bioelectrical impedance vector analysis were calculated based on resistance and reactance values. RESULTS: We analyzed 43 boys aged between 2.7 and 19.8 years. Low-phase angle values were observed during the investigation of bioimpedance parameters. Bioelectrical impedance vector analysis showed that approximately 87% of the subjects presented vectors outside the tolerance ellipses, and only one patient presented vectors located within the 50% tolerance ellipse, indicating normally hydrated and a good body cell mass. Compared with the reference population, boys with DMD had lower levels of body cell mass. CONCLUSION: Based on the evidence, compared with the reference population, patients with DMD had lower levels of body cell mass. This evidence points to bioimpedance parameters as useful tools for the nutritional evaluation and clinical management of patients with DMD.
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Intestinal and free-living protozoa, such as Giardia lamblia, express a dense coat of variant-specific surface proteins (VSPs) on trophozoites that protects the parasite inside the host's intestine. Here we show that VSPs not only are resistant to proteolytic digestion and extreme pH and temperatures but also stimulate host innate immune responses in a TLR-4 dependent manner. We show that these properties can be exploited to both protect and adjuvant vaccine antigens for oral administration. Chimeric Virus-like Particles (VLPs) decorated with VSPs and expressing model surface antigens, such as influenza virus hemagglutinin (HA) and neuraminidase (NA), are protected from degradation and activate antigen presenting cells in vitro. Orally administered VSP-pseudotyped VLPs, but not plain VLPs, generate robust immune responses that protect mice from influenza infection and HA-expressing tumors. This versatile vaccine platform has the attributes to meet the ultimate challenge of generating safe, stable and efficient oral vaccines.
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Giardia lamblia/química , Vacinas contra Influenza/imunologia , Proteínas de Membrana/imunologia , Infecções por Orthomyxoviridae/prevenção & controle , Proteínas de Protozoários/imunologia , Vacinas de Partículas Semelhantes a Vírus/imunologia , Adjuvantes Imunológicos , Administração Oral , Animais , Apresentação de Antígeno/efeitos dos fármacos , Bioengenharia/métodos , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/imunologia , Células Dendríticas/virologia , Feminino , Expressão Gênica , Glicoproteínas de Hemaglutininação de Vírus da Influenza/genética , Glicoproteínas de Hemaglutininação de Vírus da Influenza/imunologia , Humanos , Imunidade Inata/efeitos dos fármacos , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/genética , Masculino , Proteínas de Membrana/genética , Camundongos , Camundongos Transgênicos , Neuraminidase/genética , Neuraminidase/imunologia , Infecções por Orthomyxoviridae/imunologia , Infecções por Orthomyxoviridae/virologia , Estabilidade Proteica , Proteínas de Protozoários/genética , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/imunologia , Trofozoítos/química , Vacinação , Vacinas de Partículas Semelhantes a Vírus/administração & dosagem , Vacinas de Partículas Semelhantes a Vírus/genéticaRESUMO
Resumen Justificación y objetivo: gran parte de los casos descritos de anemias microcíticas-hipocrómicas corresponden a anemias ferropénicas y síndromes talasémicos. El diagnóstico diferencial se complementa con pruebas de laboratorio como el hierro sérico, ferritina, entre otras; sin embargo, estas son de baja disponibilidad en países en vías de desarrollo. En Nicaragua, el diagnóstico de estas patologías se basa en el historial clínico y análisis hematológicos de rutina. El objetivo de este trabajo fue la implementación de la técnica de cuantificación de hemoglobina A2 en el diagnóstico clínico de β-talasemia. Métodos: se realizó un estudio transversal con 30 pacientes que mostraban microcitosis e hipocromía después de 3 meses de tratamiento con sales de hierro. Se realizó electroforesis de hemoglobina y se utilizó el kit de la casa comercial Beta-Thal HbA2 Quik Column para cuantificar la hemoglobina A2 en cada paciente. El análisis estadístico utilizado fue la prueba de t de student. Se consideraron significativas las diferencias a p<0,05. Esta investigación respetó los principios éticos que conciernen. Se contó con la aprobación del Comité de Ética Institucional, UNAN-Managua. Los participantes dieron su consentimiento informado. Resultados: al aplicar el método para cuantificación de hemoglobina A2, se obtuvo que el 67 % de las muestras presentaron una concentración de hemoglobina A2 mayor al valor de referencia establecido (3,3 %), siendo pacientes diagnosticados para β-talasemia menor. El 33 % restante presentó valores normales de hemoglobina A2 con microcitosis e hipocromía. Se encontraron diferencias estadísticamente significativas entre las medias de glóbulos rojos, volumen corpuscular medio, hemoglobina corpuscular media y hemoglobina A2, entre ambos grupos. Conclusión: el diagnóstico diferencial de anemias microcíticas hipocrómicas refractarias al tratamiento con hierro, se realiza inicialmente por el historial clínico del paciente, pero es necesario contar con pruebas diagnósticas como la cuantificación de hemoglobina A2 que permitan identificar las diversas patologías que cursan con microcitosis e hipocromía.
Abstract Justification and objective: much of the described cases of microcytic-hypochromic anemias are ferropenic anemias and Thalassemia syndromes. The differential diagnosis is complemented by laboratory tests as serum iron, ferritin, among others; However, these are of low availability in developing countries. In Nicaragua, the diagnosis of these diseases is based on clinical history and routine blood analysis. The objective of this work was to implement a technique for quantification of hemoglobin A2 in the clinical diagnosis of β-Thalassemia. Methods: We conducted a cross-sectional study with 30 patients showing hypochromia and microcytosis after 3 months of treatment with iron salts. Hemoglobin electrophoresis was performed, a kit from Beta-Thal HbA2 Quik Column was used to quantify the hemoglobin A2 in each patient. The statistical analysis used was the student's t test. The differences were considered significant at p < 0.05. This research respected ethical principles that concern. It had the approval of the committee of ethics institutional, UNAN-Managua and the participants gave their informed consent. Results: when applying the method for quantification of hemoglobin A2, 67% of samples presented a concentration of hemoglobin A2 greater than the reference value set at 3.3%, these patients were diagnosed with β-Thalassemia minor. The remaining 33% presented normal values of hemoglobin A2 with hypochromia and microcytosis. Statistically significant differences between the averages of red blood cells, mean corpuscular volume, mean corpuscular hemoglobin and hemoglobin A2 between the two groups was observed. Conclusion: The differential diagnosis of microcytic hypochromic anemias refractory to treatment with iron, is initially performed by the clinical history of the patient, but it is necessary to have diagnostic tests such as the quantification of hemoglobin A2, which allow the identification of patients with β-Thalassemia minor within this group. In our study 67% of the studied samples were identified as β-Thalassemia minor.
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Humanos , Talassemia beta , Anemia Ferropriva/sangue , Anemia Hipocrômica/sangue , Anemia Macrocítica/diagnóstico , Ferro/deficiência , NicaráguaRESUMO
BACKGROUND: Diaphyseal fractures of femur and tibia are prominent due to its high incidence and high economic and social impact. Intramedullary nailing (IN) is the surgical procedure of choice. Surgical site infection (SSI) related to this procedure is considered a difficult to treat complication. AIMS: Determine the incidence of SSI after IN of femoral and tibial diaphyseal fractures and evaluate possible risk factors. METHODS: Prospective observational cohort study. SSI was defined according to CDC-NHSN criteria and surveillance period for the occurrence of infection was 12 months. Incidence of SSI was calculated as the ratio between the number of patients with SSI and total number of patients. Analysis of potential risk factors included patients-related factors (age, gender, body mass index, active foci of infection, immunosuppressive conditions, ASA score, alcohol or illicit drug abuse, smoking, polytrauma, etiology of fracture, type of fracture if closed or open, classification of fracture according to Müller AO, Tcherne classification for closed fractures, Gustilo-Anderson classification for open fractures, previous surgical manipulation, use of blood products); environmental and surgical-related factors (surgical wound classification, duration of surgery, hair removal, intraoperative contamination, antimicrobial use, presence of drains, hypothermia or hypoxia in the perioperative period, type of IN used, reaming, need for soft tissue reconstruction, use of negative pressure therapy) and microbiota-related factors (cultures of nasopharyngeal swabs forStaphylococcus aureus and axillary/inguinal/perineal swab for Acinetobacter baumannii). RESULTS: 221 patients were included and completed the 12-month follow-up period. Incidence of SSI was 11.8%. In the initial analysis by unadjusted logistic regression, following factors were associated SSI: Müller AO classification of the fracture morphology groups 2 or 3, previous use of external fixator, presence of drains, use of negative pressure therapy and need for muscle or skin flap repair. In the multiple logistic regression-adjusted analysis, previous use of external fixator and need for muscle or skin flap repair remained associated with SSI. CONCLUSIONS: Incidence of SSI associated with IN for femoral and tibial diaphyseal fractures was 11.8%. Previous use of external fixators and need for muscle or skin flap repair were factors associated with occurrence of infection.
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Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Fraturas do Fêmur/epidemiologia , Consolidação da Fratura/fisiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fraturas da Tíbia/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To examine factors related to attendance of Mexican-heritage parents at community-based nutrition classes to prevent childhood obesity. METHODS: Starting in 2011, interviewers collected baseline data from Niños Sanos Familia Sana (Healthy Children, Healthy Families) participants in rural California. Educators maintained attendance logs from 2012 to 2014. Informed by the Theory of Planned Behavior, interviewers administered an exit survey in 2015 to collect data on attitudes, subjective norms, health motivations, and perceived control related to attendance. Multivariable ordinal logistic regression analysis examined the correlates of attendance (nâ¯=â¯194, intervention group only). RESULTS: Controlling for mother's age, marital status, acculturation, and employment, attitudes and subjective norms were significantly related to attendance (odds ratioâ¯=â¯1.27; 95% confidence interval [CI], 1.18-1.37; P < .001). CONCLUSIONS AND IMPLICATIONS: In these Mexican-heritage participants, attitudes and subjective norms were significant correlates of attendance. The Theory of Planned Behavior may shed light on attendance of high-risk groups but further testing of instruments is needed.
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Ciências da Nutrição Infantil/educação , Educação em Saúde , Americanos Mexicanos , Obesidade Infantil/prevenção & controle , Adulto , Agendamento de Consultas , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , Normas SociaisRESUMO
OBJECTIVE: To examine the presence of HIV in bone tissue of people living with HIV (PLWHIV) with osteonecrosis of femoral head and describe clinical and anatomopathological findings. DESIGN: This is a case series which included 44 PLWHIV with osteonecrosis of femoral head who underwent total hip arthroplasty. METHODS: Clinical data were obtained through analysis of the patients' medical records. Bone tissue obtained during total hip arthroplasty was retrieved and sent for conventional and immunohistochemical analysis. Monoclonal antibodies were used to mark the p24 (HIV), CD31 (vascular endothelial cells), CD68 (macrophages), and D240 (cells of the lymphatic endothelium) antigens. RESULTS: Dyslipidemia was found in 48% of the patients and lipodystrophy in 31%. Histological analysis showed similar characteristics for the entire sample. Degeneration of joint cartilage was visualized with the presence of fissures and fibrillations, as well as subchondral sclerosis and necrosis of the subchondral cancellous bone tissue. Lymphoplasmocytic inflammatory reaction was observed, with the presence of macrophages containing a foamy, vacuolated cytoplasm, as well as the presence of ceroid pigment and occasional granulation tissue. The reaction with the monoclonal anti-p24 antibody was negative in the samples from all 44 PLWHIV undergoing hip arthroplasty. Reactions with the anti-CD31 and anti-D240 antibodies were negative. Staining with CD68 antibody confirmed that the cells visualized with foamy, vacuolated cytoplasm were macrophages. CONCLUSION: p24 HIV antigen was not detected in the bone tissue of PLWHIV and osteonecrosis. The most frequent anatomopathological findings were extensive necrosis of bone tissue, large vacuoles filled with fat cells, inflammatory lymphoplasmocytic reaction with macrophages containing vacuolated cytoplasm, and the presence of ceroid pigment.
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Giardiasis is one of the most common human intestinal diseases worldwide. Several experimental animal models have been used to evaluate Giardia infections, with gerbils (Meriones unguiculatus) being the most valuable model due to their high susceptibility to Giardia infection, abundant shedding of cysts, and pathophysiological alterations and signs of disease similar to those observed in humans. Here, we report cytokine and antibody profiles both during the course of Giardia infection in gerbils and after immunization with a novel oral vaccine comprising a mixture of purified variant-specific surface proteins (VSPs). Transcript levels of representative cytokines of different immune profiles as well as macro- and microtissue alterations were assessed in Peyer's patches, mesenteric lymph nodes, and spleens. During infection, cytokine responses showed a biphasic profile: an early induction of Th1 (gamma interferon [IFN-γ], interleukin-1ß [IL-1ß], IL-6, and tumor necrosis factor [TNF]), Th17 (IL-17), and Th2 (IL-4) cytokines, together with intestinal alterations typical of inflammation, followed by a shift toward a predominant Th2 (IL-5) response, likely associated with a counterregulatory mechanism. Conversely, immunization with an oral vaccine comprising the entire repertoire of VSPs specifically showed high levels of IL-17, IL-6, IL-4, and IL-5, without obvious signs of inflammation. Both immunized and infected animals developed local (intestinal secretory IgA [S-IgA]) and systemic (serum IgG) humoral immune responses against VSPs; however, only infected animals showed evident signs of giardiasis. This is the first comprehensive report of cytokine expression and anti-Giardia antibody production during infection and VSP vaccination in gerbils, a reliable model of the human disease.
Assuntos
Giardia lamblia/genética , Giardíase/prevenção & controle , Proteínas de Membrana/genética , Vacinas Protozoárias/imunologia , Animais , Feminino , Gerbillinae , Giardíase/parasitologia , Humanos , Masculino , Proteínas de Membrana/imunologia , Organismos Geneticamente Modificados , Organismos Livres de Patógenos Específicos , VacinaçãoRESUMO
BACKGROUND: It has been suggested that distal gastric carcinoma (GC) in younger patients has a more aggressive outcome than in older patients, however this is a controversial issue. The aim of this study was to compare clinicopathological features between younger and older patients with GC in Northeastern Brazil. METHODS: A total of 207 patients with distal GC (41 patients ≤45 years, considered younger group, and 166 > 45 years, considered older group) were evaluated prospectively during a 6 year period. RESULTS: The mean patient age in the young group was 37.41 years old and 64.43 years in the older group. No significant difference was found regarding gender, area of residence, history of alcohol consumption, chronic tobacco smoking. Prevalence of first-degree GC history was 12.5% (7.3% in younger group vs. 13.9% in older; p < 0.46). The most frequent symptom was gastric pain and weight loss. Diffuse infiltrative cancer was more frequently seen in younger patients (70.70% vs. 33.70%, respectively; p < 0.01), as was histologically less differentiated tumors (63.40% vs. 33.10%; p < 0.01) and stage IV of GC (48.80% vs. 30.70%; p < 0.015). Five-year survival, evaluated in 82 patients, was lower in younger patients (p = 0.045); however, after adjusting for stage of GC in the multivariate analysis, this association did not remain significant. Family history of GC and gender had no impact on survival. CONCLUSIONS: Younger patients showed higher prevalence of diffuse type of Lauren and lower survival that was attributed to higher rate of advanced stage of GC. Gastric cancer screening strategies should also be considered in younger individuals, especially in areas of high prevalence. Further studies are warranted to determine risk factors associated with gastric cancer in young adults.
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Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Neoplasias Gástricas/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Adulto JovemRESUMO
OBJECTIVE: To evaluate storage time effects in cryopreserved human semen samples, kept in the freezer at a controlled temperature of -80°C, on sperm viability after thawing. METHODS: We used 20 semen samples. Each sample was cryopreserved in 10 fingers, which were divided into five groups: one group was kept in cryogenic canisters throughout the experiment(control), and four groups were kept in a VIP Ultra Low MDF-U76V- PE freezer, with the temperature set at -80°C, for 24, 48, 72 and 96 hours, respectively. After the exposure time, the samples were stored in cryogenic canisters after being thawed. The analyzed parameters were: motility, vitality and mitochondrial activity. RESULTS: After thawing, we noticed decreased sperm motility, vitality and mitochondrial activity, when comparing the tested groups with the control group, as well as a progressive reduction in the analyzed parameters between the times evaluated. CONCLUSIONS: Cryopreservation of semen samples at -80°C is potentially harmful to sperm viability, causing damage when submitted to longer exposure times.
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Criopreservação/métodos , Preservação do Sêmen/métodos , Manejo de Espécimes/métodos , Criopreservação/normas , Humanos , Masculino , Análise do Sêmen , Preservação do Sêmen/normas , Manejo de Espécimes/normasRESUMO
White-rot fungi (WRF) and their ligninolytic enzymes (laccases and peroxidases) are considered promising biotechnological tools to remove lignin related Persistent Organic Pollutants from industrial wastewaters and contaminated ecosystems. A high diversity of the genus Ganoderma has been reported in Cuba; in spite of this, the diversity of ligninolytic enzymes and their genes remained unexplored. In this study, 13 native WRF strains were isolated from decayed wood in urban ecosystems in Havana (Cuba). All strains were identified as Ganoderma sp. using a multiplex polymerase chain reaction (PCR)-method based on ITS sequences. All Ganoderma sp. strains produced laccase enzymes at higher levels than non-specific peroxidases. Native-PAGE of extracellular enzymatic extracts revealed a high diversity of laccase isozymes patterns between the strains, suggesting the presence of different amino acid sequences in the laccase enzymes produced by these Ganoderma strains. We determined the diversity of genes encoding laccases and peroxidases using a PCR and cloning approach with basidiomycete-specific primers. Between two and five laccase genes were detected in each strain. In contrast, only one gene encoding manganese peroxidase or versatile peroxidase was detected in each strain. The translated laccases and peroxidases amino acid sequences have not been described before. Extracellular crude enzymatic extracts produced by the Ganoderma UH strains, were able to degrade model chromophoric compounds such as anthraquinone and azo dyes. These findings hold promises for the development of a practical application for the treatment of textile industry wastewaters and also for bioremediation of polluted ecosystems by well-adapted native WRF strains.
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Resumo O objetivo foi compreender como desigualdades e violações de direitos humanos se articulam em trajetórias de vulnerabilidade à internação por tuberculose. Foram realizadas entrevistas com pessoas internadas para tratamento da tuberculose em um hospital localizado em Porto Alegre, região sul do Brasil, no ano de 2014. Coinfecção tuberculose-HIV/aids, uso nocivo de drogas (especialmente o crack) e estar em situação de rua foram os acontecimentos mais expressivos nas trajetórias estudadas. A análise, orientada pelo quadro da vulnerabilidade e dos direitos humanos, e pelo construcionismo social como uma de suas bases teóricas, fez emergir a reflexão sobre marcadores sociais da diferença - gênero, raça, classe social e estigma relacionado à aids e ao uso de drogas - e suas intersecções na constituição das situações associadas ao adoecimento. A expressividade desses marcadores e seus efeitos na produção de desigualdades, discriminação, exploração e opressão permitiu desvelar o cenário sociocultural em que as trajetórias de internação por tuberculose são construídas. Esse conhecimento pode contribuir com a resposta que a tuberculose demanda, especialmente, ao reconhecer que as propostas em saúde precisam buscar mitigar vulnerabilidades sem negligenciar o enfrentamento às desigualdades sociais e à proteção aos direitos humanos.
Abstract The goal was to understand how inequality and violation of human rights were articulated in trajectories of vulnerability in tuberculosis hospitalization. Interviews were conducted with people hospitalized for tuberculosis treatment in a hospital located in Porto Alegre, southern region of Brazil, in 2014. Tuberculosis-HIV/AIDS co-infection, harmful use of drugs (especially crack), and life on the streets were the most significant events on the trajectories studied. The analysis, guided by the framework of vulnerability and human rights, and by the social constructionism as one of its theoretical basis, brought up the reflection about social markers of difference - genre, race, social class and stigma related to AIDS and use of drugs - and its intersections in building situations associated with illness. The expressiveness of these markers and their effects on the production of inequalities, discrimination, exploitation and oppression allowed revealing the social and cultural scenarios in which trajectories of tuberculosis hospitalization are built. These findings may contribute to the response that tuberculosis demands, especially by recognizing that health proposals must seek to mitigate vulnerabilities without neglecting the need to confront social inequalities and protect human rights.