Infectious etiology and indicators of malabsorption or intestinal injury in childhood diarrhea. / Etiología infecciosa e indicadores de malabsorción o daño intestinal en diarrea infantil

INTRODUCTION: The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease. OBJECTIVE: To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity. MATERIALS AND METHODS: The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests. RESULTS: We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method. CONCLUSIONS: Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.

Introducción. La etiología multifactorial de la gastroenteritis enfatiza la necesidad de usar diferentes métodos de laboratorio para identificar o excluir agentes infecciosos y evaluar la gravedad de la enfermedad diarreica. Objetivo. Diagnosticar la etiología infecciosa de la diarrea en niños y evaluar algunos marcadores fecales asociados con la integridad intestinal. Materiales y métodos. Se estudiaron 45 niños con enfermedad diarreica, en los cuales se evaluaron la presencia de enteropatógenos y los marcadores de malabsorción. Se analizaron las muestras fecales de 76 niños, mediante las pruebas de esteatocrito tradicional y esteatocrito ácido, para la cuantificación de la grasa. Resultados. Se observó diarrea aguda en el 80 % de los niños y diarrea persistente en el 20 %. De los individuos con diarrea, el 40 % fue positivo para enteropatógenos; los más diagnosticados fueron rotavirus (13,3 %) y Giardia duodenalis (11,1 %). Entre los pacientes infectados, la sangre oculta fue más evidente en aquellos portadores de bacterias patógenas (40 %) o enterovirus (40%), mientras que la esteatorrea se observó en infecciones por el protozoo G. duodenalis (35,7 %). Los niños con diarrea excretaron significativamente más lípidos en las heces que aquellos sin diarrea, según lo determinado por los métodos de esteatocrito tradicional (p<0,0003) y esteatocrito ácido (p<0,0001). Conclusiones. La diarrea infantil puede provocar deficiencias graves de nutrientes. La esteatorrea es distintiva de la malabsorción intestinal y puede detectarse mediante la estimación del esteatocrito ácido. Esta prueba podría utilizarse de forma rutinaria como una herramienta de laboratorio para la evaluación semicuantitativa de la malabsorción de grasas en niños con diarrea.

Peri-implantitis: Knowledge and attitudes of implantology clinicians regarding the disease management: Peri-implantitis knowledge.

OBJECTIVES: Since peri-implantitis is an increasing and prevalent concern in clinical practice and there is no consensus regarding the best therapeutic protocol, this study evaluated the knowledge and behaviours of dentists working in Implantology regarding implant-related infections modulating factors and therapeutic protocols used in the management of peri-implantitis. METHODS: Cross-sectional study was conducted with 86 Brazilian Implantology clinicians. Data were collected using a structured and online questionnaire evaluating socioeconomic characteristics, education, work/clinical practice, knowledge and attitudes regarding the risk factors and management of peri-implantitis. The reliability of the questionnaire was evaluated by test-retest technique. The questionnaire was developed based on the last consensus on peri-implant diseases (2018) and the current evidence related to implant-related infections. Descriptive, bivariate and logistic regression analyses were conducted adopting a significance level of 5%. RESULTS: In this study, 89.5% of included dentists reported that already treated patients with peri-implantitis. Approximately 80% of dentists use antibiotics and mouth rinses during the treatment, and surgical procedures seem the main choice to treat peri-implantitis (91.8%) by dentists. As a preventive approach, 94.2% of dentists reported that routinely assessed biofilm accumulation in the follow-up visits after implant placement. Logistic regression showed that the self-reported ability to treat peri-implantitis was statistically (p < 0.05) higher among dentists who reported abilities to diagnose the disease and use laser for peri-implantitis treatment. CONCLUSION: Dentists working in Implantology have a good level of knowledge and behaviors in the management of peri-implantitis. However, the lack of consensus regarding the best treatment protocols may reflect dentist's behaviours because different treatment protocols have been used by evaluated clinicians.

Local Antimicrobial Resistance Trends in Pediatric Urinary Tract Infection: The Importance of Local Surveillance of a Global Problem.

Introduction Urinary tract infections (UTIs) are one of the most common pediatric bacterial infections and consequently a major reason for antibiotic treatment. Despite being a global problem, antimicrobial resistance is often geographically heterogeneous. Thus, it is fundamental to know local epidemiology and practice frequent surveillance of each hospital's antibiograms. The aims of this study are to determine the local antimicrobial resistance profile in pediatric UTIs, to understand its evolution over 14 years, and finally, to infer if the currently instituted antibiotic empirical therapy remains effective. Materials and methods A retrospective observational study was performed through the analysis of urine cultures and respective antibiograms of children diagnosed with UTI from 2017 to 2019 in Centro Hospitalar Universitário do Algarve (Faro's unit, Portugal), followed by a comparison of the obtained data with the results of a similar study performed between 2003 and 2005. Results A total of 784 urine cultures were selected. Escherichia coli was the most frequent microorganism (n = 561; 71.56%), followed by Proteus mirabilis (n = 117; 14.92%) and Klebsiella pneumoniae (n = 40; 5.10%). The most commonly prescribed antibiotic was cefuroxime axetil (66.28%). Escherichia coli had an increase in resistance to amoxicillin-clavulanate of 6.16% to 34.76% and cefuroxime axetil of 0.73% to 4.46%. Proteus mirabilis had an increase in resistance to amoxicillin-clavulanate of 1.64% to 11.11%. Klebsiella pneumoniae had an increase in resistance to cefuroxime axetil (0%-27.50%) and nitrofurantoin (0%-47.50%). The three microorganisms showed a decrease in trimethoprim-sulfamethoxazole resistance profiles, as well as low resistance profiles to fosfomycin. In fifty cases in which antibiotic empirical therapy was instituted, the isolated microorganism revealed in vitro resistance; 37 of these cases had a good evolution, maintaining the antibiotic empirical therapy. Discussion Local surveillance of antimicrobial resistance allows monitoring of the resistance trends and adequacy of empirical antibiotic therapy. This study's local resistance profile was distinct from other regions of the country and the world. Continuous local surveillance also potentiates the dissemination of the results to the concerned healthcare providers and the initiation of timely responsive measures, containing the increase in antimicrobial resistance. As Escherichia coli was the commonest isolated microorganism, its antimicrobial profile should dictate antibiotic empirical therapy. This study supports that in vitro is not equivalent to in vivo resistance. Conclusion There was a significant increase in antimicrobial resistance profiles, especially to amoxicillin-clavulanate. Cefuroxime axetil remains the recommended antibiotic for empirical therapy in this hospital, although fosfomycin should be considered as an alternative in non-complicated cystitis in adolescent females. This study reinforces the importance of continuous local resistance surveillance as a preventive measure against the global increase in antimicrobial resistance.

[Eating Habits of People with Type 2 Diabetes Mellitus in Portugal: A Cross-Sectional Study]. / Hábitos Alimentares das Pessoas com Diabetes Mellitus Tipo 2 em Portugal: Um Estudo Transversal.

INTRODUCTION: Nutrition is a cornerstone of diabetes mellitus prevention and management; therefore, it is essential to enable patients to adopt healthy eating habits. Previous studies have not yet documented the main errors in the eating habits of Portuguese people with type 2 diabetes mellitus. This study aims to identify the main errors in the eating habits of people living with type 2 diabetes mellitus in Portugal and to evaluate its associations with sociodemographic variables. METHODS: Cross-sectional multicentric study in a convenience sample of people with type 2 diabetes mellitus in Primary Health Care Units. The UK Diabetes and Diet Questionnaire (UKDDQ) - translated and adapted, was applied from July to October 2022. Descriptive and inferential statistical analyses were conducted. RESULTS: Of the 550 participants, 52.2% were female, 68.3% were 65 years or over, 55.8 % had an education level up to the fourth grade, 24.7% had economic deprivation, and the mean time since diagnosis was 10.60 ± 8.13 years. Only 36.2% of the sample had a healthy UKDDQ score. Less than 50% of the sample had healthy scores for the items "high-fiber rice or pasta", "high-fiber bread", "butter, margarine and vegetable oils" and "vegetables and pulses". Only 8.9% of the sample had a healthy consumption of fiber. About 70.4% reported healthy scores for the consumption of "high-added-sugar foods" and 54.7% for "high-saturated fat". A statistically significant weak positive correlation was found between the UKDDQ score and age (ρ = 0.201, p < 0.001) with a more frequent choice of healthy foods with increasing age. Female respondents reported healthier habits, particularly in the consumption of "high-saturated fat" and "high-fiber foods". CONCLUSION: The majority of our sample did not take advantage of the potential benefits of healthy eating habits. The main food groups whose consumption should be emphasized or discouraged were individualized, particularly the need to encourage the consumption of high-fiber foods. Targeted educational actions must focus especially on younger and/or male patients.

Introdução: A nutrição é uma área de intervenção na prevenção e gestão da diabetes mellitus; por isso, é fulcral promover a capacitação da população para a adoção de hábitos alimentares saudáveis. Ainda que existam alguns estudos nesta área, não se conhecem os principais erros nos hábitos alimentares das pessoas com diabetes em Portugal. Os objetivos deste estudo foram identificar os principais erros nos hábitos alimentares das pessoas com diabetes mellitus tipo 2 em Portugal e avaliar a sua relação com variáveis sociodemográficas. Métodos: Estudo transversal multicêntrico, em amostra de conveniência de pessoas com diabetes mellitus tipo 2 seguidas em Unidades de Cuidados de Saúde Primários. Aplicação do UK Diabetes and Diet Questionnaire (UKDDQ) ­ traduzido e adaptado, de julho a outubro de 2022. Análise estatística descritiva e inferencial. Resultados: Amostra de 550 participantes, 52,2% do sexo feminino, 68,3% com 65 anos ou mais, 55,8% com nível de escolaridade igual ou inferior ao 1.º ciclo do ensino básico, 24,7% com insuficiência económica e tempo desde o diagnóstico médio de 10,60 ± 8,13 anos. Apenas 36,2% da amostra obteve um score UKDDQ considerado saudável. Menos de 50% obteve scores saudáveis para os itens "arroz ou massa ricos em fibras", "pão integral", "manteiga, margarina e óleos vegetais" e "vegetais e leguminosas". Somente 8,9% da amostra obteve score saudável para o consumo de fibras. Cerca de 70,4% obteve score saudável para o consumo de açúcares livres e 54,7% para o consumo de ácidos gordos saturados. Verificou-se a existência de uma correlação com significado estatístico positiva fraca entre o score UKDDQ e a idade (ρ = 0,201, p < 0,001), com escolha mais frequente de alimentos saudáveis com o aumentar da idade. As pessoas do sexo feminino reportaram hábitos alimentares mais saudáveis, particularmente no consumo de fibras e ácidos gordos saturados. Conclusão: A maior parte da nossa amostra não usufruiu do potencial efeito positivo de uma alimentação saudável. Individualizam-se grupos de alimentos cujos consumos devem ser enfatizados ou desencorajados, particularmente, a necessidade de incentivar o consumo de alimentos ricos em fibra. Ações educacionais dirigidas devem ter especial foco em pessoas mais jovens e/ou do sexo masculino.

Unraveling the signs and symptoms of oral conditions that affect daily life activities and oral health-related quality of life.

OBJECTIVES: Since oral conditions negatively affect oral health-related quality of life (OHRQoL), this study evaluated which oral clinical condition, signs, and symptoms are associated with the impact on OHRQoL, its domains, and specific daily life activities among adults. MATERIALS AND METHODS: Data from a probabilistic sample of adults (35-44 years old) was used. The Oral Impacts on Daily Performance (OIDP) was used to evaluate OHRQoL, its domains (physical, psychological, and social), and nine daily life activities. Signs and symptoms of oral diseases (dental caries, periodontal disease, need for dental prothesis, and tooth loss) and oral self-perception were considered. Descriptive, bivariate, and multi-level analyses were conducted. RESULTS: A total of 5,834 adults were included, of which 52.9% had some negative impact of oral conditions on OHRQoL. Difficulty in eating was the most affected daily life activity. For multiple models, dental caries lesions (cavities), filled teeth with caries, gingival bleeding, periodontal pocket, dental pain, need for upper or lower dental prosthesis, and oral health self-perception were associated (p < 0.05) with overall OHRQoL or at least one of its domains. The impact on daily life activities of each individual was associated with at least one oral condition. Dental caries lesions (cavity) and dental pain were associated (p < 0.05) with the impact on most daily life activities evaluated. CONCLUSIONS: Different signs and symptoms of prevalent oral diseases are associated with the impact on specific daily life activities among adults, which may compromise the OHRQoL. CLINICAL RELEVANCE: Knowledge of how signs, symptoms, and oral conditions affect OHRQoL and daily life activities can provide essential information for clinicians to establish proper disease management and preventive strategies focusing on improving patients' lives.

A narrative exploratory study on the perspectives about physical exercise practise in a sample of Portuguese elderly.

The overall prevalence of inactivity among individuals aged 55 or older in Portugal is the highest in Europe therefore it's important to develop effective strategies to increase adherence to structured exercise programs by older adults (Picorelli et al., 2014a). The purpose of this paper is to characterise different perspectives on barriers and facilitators to the practise of physical exercise in a sample of the Portuguese elderly. Two groups of enrolled and non-enrolled in a community exercise program were recruited. Each group had 6 participants that were included in the study if they were ≥ 60 years of age. Two focus groups were conducted via Zoom and lasted ≤ 60 min. Participants were asked about five domains regarding physical exercise. Data analysis occurred in three phases by 2 trained and experienced examiners. While the enrolled group highlighted benefits (n = 6) and facilitators (n = 6), and shared strategies to overcome some barriers (n = 2) the non-enrolled group focused on the barriers (n = 6) instead and shared more excuses to justify their non-practice of physical exercise (n = 3). To overcome the barriers considered by the participants in the non-enrolled group, some education strategies focused on physical literacy might be crucial. The high number of barriers felt by the less active older people makes it more complicated for them to adopt and maintain an exercise program. Narratives-based methodologies are interesting methodologies to collect patient-centred perspectives about exercise practise and therefore design adequate programs.

Concomitant Nitrofurantoin-Induced Autoimmune Hepatitis and Interstitial Lung Disease.

Antibiotics are known to cause adverse reactions, but multiple organ involvement associated with nonspecific symptoms can lead to a delay in diagnosis. A definitive correlation between each toxin and its effects is difficult to establish due to concomitant potential toxins in the circulation. This article highlights an uncommon case of concomitant nitrofurantoin-induced autoimmune hepatitis and lung fibrosis that fulfills the definitive clinical criteria for diagnosis, presenting histological, imagiological, and immunological evidence of nitrofurantoin-induced toxicity. It occurred in a 68-year-old woman with extended nitrofurantoin intake for urinary tract infection prophylaxis who presented with progressive exercise dyspnea and jaundice. Similar published cases are also reviewed in this article.

Os antibióticos são causas conhecidas de reações adversas, mas o envolvimento multiorgânico associado à sintomatologia inespecífica pode conduzir ao atraso diagnóstico. Devido às potenciais toxinas concomitantemente em circulação, é muitas vezes difícil estabelecer uma correlação definitiva entre cada toxina e os seus efeitos.Este artigo salienta um caso incomum de hepatite autoimune e fibrose pulmonar induzidas pela nitrofurantoína e que cumpre critérios definitivos de diagnóstico, apresentando-se dados histológicos, imagiológicos e imunológicos da toxicidade induzida pela nitrofurantoína.O caso ocorre numa mulher de 68 anos de idade, com toma prolongada de nitrofurantoína como profilaxia de infeção urinária, e que se apresenta com dispneia de esforço progressiva e icterícia. O artigo faz ainda uma revisão de casos semelhantes publicados.

Nursing in hemotherapy services: considerations on public policies associated with blood and blood components.

OBJECTIVE: Reflect on how the evolution of legislation related to blood and blood-based products has shaped the role of nurses in hemotherapy services. METHODS: A reflective study, carried out employing surveys in databases, about the evolution of the nurse's role in hemotherapy services. RESULTS: Several legislations, published since 1950, have encouraged blood donation and shaped the work of nurses in hemotherapy services, being the most relevant Law #10.205/2001 (Lei nº 10.205/2001), about blood collection, processing, storage, distribution, and blood transfusion; and COFEN's resolution # 629/2020 (COFEN nº 629/2020), which addresses in detail the practice of these services. FINAL CONSIDERATIONS: The evolution of legislation related to blood and blood-based products contributed to the consolidation of nurses' attributions in hemotherapy services since it guaranteed legal support and defined the practices in these services.

Nursing in hemotherapy services: considerations on public policies associated with blood and blood components / Enfermería en servicios de hemoterapia: reflexiones acerca de las políticas públicas vueltas a la sangre y hemocomponentes / Enfermagem em serviços de hemoterapia: reflexões acerca das políticas públicas voltadas ao sangue e hemocomponentes

ABSTRACT Objective: Reflect on how the evolution of legislation related to blood and blood-based products has shaped the role of nurses in hemotherapy services. Methods: A reflective study, carried out employing surveys in databases, about the evolution of the nurse's role in hemotherapy services. Results: Several legislations, published since 1950, have encouraged blood donation and shaped the work of nurses in hemotherapy services, being the most relevant Law #10.205/2001 (Lei nº 10.205/2001), about blood collection, processing, storage, distribution, and blood transfusion; and COFEN's resolution # 629/2020 (COFEN nº 629/2020), which addresses in detail the practice of these services. Final considerations: The evolution of legislation related to blood and blood-based products contributed to the consolidation of nurses' attributions in hemotherapy services since it guaranteed legal support and defined the practices in these services.

RESUMEN Objetivo: Reflejar sobre como la evolución de las legislaciones dirigidas a la sangre y hemoderivados moldeó la actuación del enfermero en los servicios de hemoterapia. Métodos: Estudio reflexivo, realizado mediante levantamientos en bases de datos, sobre la evolución de la actuación del enfermero en servicios de hemoterapia. Resultados: Verificado que las diversas legislaciones, publicadas desde 1950, fomentaron la donación de sangre y moldaron la actuación del enfermero en servicios de hemoterapia, siendo las de mayor relevancia: la Ley nº 10.205/2001, sobre la recolecta, procesamiento, almacenaje, distribución y aplicación de la sangre; y la resolución del COFEN n.º 629/2020, que aborda en detalhes la actuación en eses servicios. Consideraciones finales: La evolución de las legislaciones relacionadas a la sangre y hemoderivados contribuyó en la consolidación de las atribuciones de los enfermeros en servicios de hemoterapia, pues garantizó el amparo legal y definió las prácticas a ser realizadas en eses servicios.

RESUMO Objetivo: Refletir sobre como a evolução das legislações ligadas a sangue e hemoderivados moldou a atuação do enfermeiro nos serviços de hemoterapia. Métodos: Estudo reflexivo, realizado mediante levantamentos em bases de dados, sobre a evolução da atuação do enfermeiro em serviços de hemoterapia. Resultados: Verificou-se que as diversas legislações, publicadas desde 1950, fomentaram a doação de sangue e moldaram a atuação do enfermeiro em serviços de hemoterapia, sendo as de maior relevância: a Lei nº 10.205/2001, sobre a coleta, processamento, estocagem, distribuição e aplicação do sangue; e a resolução do COFEN nº 629/2020, que aborda detalhadamente a atuação nesses serviços. Considerações finais: A evolução das legislações relacionadas a sangue e hemoderivados contribuiu na consolidação das atribuições dos enfermeiros em serviços de hemoterapia, pois garantiu o amparo legal e definiu as práticas a serem realizadas nesses serviços.

Modes of disciplinary interaction as a line of escape in Family Health practice: a cartographic analysis / Modos de interação disciplinar como linha de escape no trabalho em Saúde da Família: uma análise cartográfica

Abstract The present study aims to discuss the knowledge and practices of Primary Health Care professionals about the modes of disciplinary interaction. It is a descriptive study, with qualitative approach following the methodological proposal of cartography, in which we ran four focus groups with the participation of 33 professionals, among them doctors, nurses and dental surgeons who are part of Family Health teams (FHt). With a cartographic mapping, it was possible to see that the work context of the FHt can be represented by the plan of form, which is affected by the plan of forces, generating interrelationships. From this, the modes of disciplinary interaction emerge as a line of escape, producing new assemblages characterized by the perspectives and proposals listed by the professionals. Through this mapping, the importance of the modes of disciplinary interaction in the FHt practice was evident, mainly as a response to the micropolitics of living labor in health with a focus on lightweight technologies.

Resumo O presente estudo objetiva discutir o conhecimento e as práticas dos profissionais da Atenção Primária à Saúde sobre os modos de interação disciplinar. Trata-se de um estudo descritivo, de abordagem qualitativa, com a proposta metodológica da Cartografia, em que foram realizados quatro grupos focais com a participação de 33 profissionais, dentre eles médicos, enfermeiros e cirurgiões-dentistas, de equipes de Saúde da Família (eSF). A partir de um mapeamento cartográfico, foi possível perceber que o contexto do trabalho das eSF pode ser representado pelo plano de forma, que é afetado pelo plano de forças, gerando inter-relações. A partir destas, emergem os modos de interação disciplinar como linha de escape, produzindo novos agenciamentos, caracterizados pelas perspectivas e proposições elencadas pelos profissionais. Por meio desse mapeamento, ficou evidente a importância dos modos de interação disciplinar na prática das eSF como resposta, principalmente, à micropolítica do trabalho vivo em saúde, com centralidade nas tecnologias leves.

Infecção relacionada à assistência à saúde e sepse na hospitalização em pediatria / Infección relacionada con la atención a la salud y sepsis en hospitalización en pediatría / Infection related to health care and sepsis in hospitalization in pediatrics

RESUMO Introdução: as infecções em pediatria são entraves no tratamento da criança hospitalizada, pois surgem com maior frequência, sendo um fator desencadeante de complicações no tratamento da criança hospitalizada. Objetivo: investigar a frequência das infecções relacionadas à assistência à saúde e sepse em crianças hospitalizadas. Método: trata-se de um estudo quantitativo prospectivo e descritivo. A coleta de dados ocorreu de julho a dezembro de 2015, por meio de 173 prontuários físicos e eletrônicos dos pacientes. Os dados foram analisados via Microsoft Office Excel® e análise descritiva. Resultados: identificou-se uma alta prevalência de infecções relacionadas à assistência à saúde com 31% (n= 54), tendo como principal causa a pneumonia, e destas 55% evoluíram para sepse (n=32). Conclusão: os achados permitem uma visão sobre a gravidade da ocorrência de infecções em crianças hospitalizadas, destacando a necessidade de capacitação da equipe de saúde para o reconhecimento precoce, com vistas à diminuição dos índices de infecção dentro dos serviços de saúde e melhoria na qualidade da assistência ofertadaà população pediátrica.

RESUMEN Introducción: las infecciones en pediatría son obstáculos en el tratamiento del niño hospitalizado, pues surgen con mayor frecuencia, siendo un factor desencadenante de complicaciones en el tratamiento del niño hospitalizado. Objetivo: investigar la frecuencia de las infecciones relacionadas con la atención a la salud y sepsis en niños hospitalizados. Método: se trata de un estudio cuantitativo prospectivo y descriptivo. La recolección de datos tuvo lugar de julio a diciembre de 2015, a través de 173 registros médicos, físicos y electrónicos, de los pacientes. Los datos fueron analizados vía Microsoft Office Excel® y análisis descriptivo. Resultados: se identificó una alta prevalencia de infecciones relacionadas con la atención a la salud con 31% (n=54), teniendo como principal causa la neumonía, y de estas 55% evolucionaron para sepsis (n=32). Conclusión: los hallazgos permiten una visión sobre la gravedad de la ocurrencia de infecciones en niños hospitalizados, destacando la necesidad de capacitación del equipo de salud para el reconocimiento precoz, con vistas a reducir los índices de infección dentro de los servicios sanitarios y mejorar la calidad de la atención ofrecida a la población pediátrica.

ABSTRACT Introduction: cross-infections are obstacles in the treatment of hospitalized children, as they are more frequently, and may be a triggering factor for complications in the treatment of hospitalized children. Objective: to investigate the frequency of healthcare-related infections and sepsis in hospitalized children. Method: this is a prospective and descriptive quantitative study. The data collection took place from July to December 2015, using 173 physical and electronic patient records. The data were analyzed using Microsoft Office Excel® and descriptive analysis. Results: a high prevalence of cross-infections was identified with 31% (n=54), having pneumonia as the main cause, and out of these 55% have progressed to sepsis (n=32). Conclusion: the findings allow an insight into the severity of the occurrence of infections in hospitalized children, highlighting the need for training the health team for early recognitionfor reducing infection rates within health services, and improving the quality of assistance offered to the pediatric population.

Can Qigong improve attention in adolescents? A prospective randomised controlled trial.

INTRODUCTION: The ability to direct and maintain attention is a prerequisite for learning. Qigong exercises are already commonly practiced in many developed countries to increase attention and memory. The main goal of this study was to examine whether Qigong would improve the attention levels of adolescents (12-14 years of age) when practiced as part of their physical education course. METHOD: Three groups of 22 individuals were considered: the verum group, which performed true Qigong; the control group, which performed sham, or placebo Qigong; and the waiting list group. In order to evaluate Qigong effects, attention tests (d2) were applied to all groups before the intervention period (t1) and after two and four weeks of practice (t2 and t3, respectively). RESULTS: At t1, there was no significant difference between the verum, control and waiting list groups in all measurable features. After 4 weeks of exercise, the verum group was significantly superior in all measurable features in comparison to the control group and the waiting list group. Values in the waiting list group were generally worse than in the control group (placebo Qigong), but there was no significant difference between the control and waiting list group, showing that the placebo offered an effect that was not significantly greater than the effect of no intervention at all. CONCLUSION: 'White Ball' Qigong was able to improve attention in adolescents after 4 weeks of practice, leading us to conclude that it may be a useful tool when integrated into physical education classes.

Mondor's Disease: A Rare Cause of Chest Pain.

INTRODUCTION: Chest pain is a very frequent reason for seeking medical care. When there is no obvious cause, patients are sometimes subjected to tests and treatments that may be unnecessary and potentially harmful. Mondor's disease is a rare but usually benign and self-limited entity characterized by thrombophlebitis in a specific region. CASE REPORT: We report the clinical case of a 51-year-old man admitted to the emergency department with a 24-hour history of left chest pain with no other symptoms. Physical examination revealed a palpable subcutaneous cord-like structure that ultrasound confirmed to be thrombophlebitis of a superficial vein in the mammary region. Secondary causes were ruled out, and the condition resolved with ibuprofen and the application of local ice. DISCUSSION: Mondor's disease can be associated with neoplasms, trauma or hyperviscosity states, but it is mostly idiopathic. Usually, it resolves completely in 4-8 weeks without specific treatment. Because this infrequent diagnosis mainly relies on clinical findings, it is important that clinicians can recognize the syndrome. LEARNING POINTS: Mondor's disease is a rare but benign disease, with no proof that specific treatment, such as anticoagulation, is beneficial.It may be secondary to underlying disease as malignancy, vasculitis, trauma or hyperviscosity states, which should be excluded.Treatment in the majority of the cases is symptomatic, but if it is secondary Mondor's disease, the underlying problem should be investigated. Physicians should be aware of this condition in order to address patient concerns and avoid unnecessary treatments or investigations.

Cefepime and Amoxicillin Increase Metabolism and Enhance Caspofungin Tolerance of Candida albicans Biofilms.

It is well known that prolonged antibiotic therapy alters the mucosal microbiota composition, increasing the risk of invasive fungal infection (IFI) in immunocompromised patients. The present study investigated the direct effect of ß-lactam antibiotics cefepime (CEF) and amoxicillin (AMOX) on biofilm production by Candida albicans ATCC 10231. Antibacterials at the peak plasmatic concentration of each drug were tested against biofilms grown on polystyrene surfaces. Biofilms were evaluated for biomass production, metabolic activity, carbohydrate and protein contents, proteolytic activity, ultrastructure, and tolerance to antifungals. CEF and AMOX enhanced biofilm production by C. albicans ATCC 10231, stimulating biomass production, metabolic activity, viable cell counts, and proteolytic activity, as well as increased biovolume and thickness of these structures. Nevertheless, AMOX induced more significant changes in C. albicans biofilms than CEF. In addition, it was shown that AMOX increased the amount of chitin in these biofilms, making them more tolerant to caspofungin. Finally, it was seen that, in response to AMOX, C. albicans biofilms produce Hsp70 - a protein with chaperone function related to stressful conditions. These results may have a direct impact on the pathophysiology of opportunistic IFIs in patients at risk.

Farnesol inhibits planktonic cells and antifungal-tolerant biofilms of Trichosporon asahii and Trichosporon inkin.

Trichosporon species have been considered important agents of opportunistic systemic infections, mainly among immunocompromised patients. Infections by Trichosporon spp. are generally associated with biofilm formation in invasive medical devices. These communities are resistant to therapeutic antifungals, and therefore the search for anti-biofilm molecules is necessary. This study evaluated the inhibitory effect of farnesol against planktonic and sessile cells of clinical Trichosporon asahii (n = 3) andTrichosporon inkin (n = 7) strains. Biofilms were evaluated during adhesion, development stages and after maturation for metabolic activity, biomass and protease activity, as well as regarding morphology and ultrastructure by optical microscopy, confocal laser scanning microscopy, and scanning electron microscopy. Farnesol inhibited Trichosporon planktonic growth by 80% at concentrations ranging from 600 to 1200 µM for T. asahii and from 75 to 600 µM for T. inkin. Farnesol was able to reduce cell adhesion by 80% at 300 µM for T. asahii and T. inkin at 600 µM, while biofilm development of both species was inhibited by 80% at concentration of 150 µM, altering their structure. After biofilm maturation, farnesol decreased T. asahii biofilm formation by 50% at 600 µM concentration and T. inkin formation at 300 µM. Farnesol inhibited gradual filamentation in a concentration range between 600 and 1200 µM. Farnesol caused reduction of filament structures of Trichosporon spp. at every stage of biofilm development analyzed. These data show the potential of farnesol as an anti-biofilm molecule.

Carcinoma de células escamosas cutâneo-invasivo - relato de caso / Invasive cutaneous squamous cell carcinoma - Case report

O carcinoma de células escamosas cutâneo é resultante da proliferação maligna dos queratinócitos. Costuma surgir da evolução de lesões precursoras, mas pode crescer espontaneamente na pele normal ou cronicamente inflamada. O carcinoma de células escamosas invasivo corresponde à segunda forma mais comum de câncer da pele não melanoma e representa 20% de todas as neoplasias cutâneas. Este trabalho relata um caso clínico de carcinoma de células escamosas cutâneo, rapidamente progressivo e com metástases regionais, que mesmo com a ressecção completa e esvaziamento ganglionar, apresentou pouca resposta terapêutica e evoluiu a óbito.

Cutaneous squamous cell carcinoma (SCC) results from malignant proliferation of keratinocytes. It usually arises from the development of precursor lesions, however it may grow spontaneously on normal or chronically inflamed skin. Invasive SCC is the second most common type of non-melanoma skin cancer and accounts for 20% of all cutaneous neoplasms. The present paper reports a clinical case of cutaneous SCC, rapidly progressive and with regional metastases, which, even after complete resection of the tumor and regional lymph nodes, showed little therapeutic response and evolved to death.

ß-lactam antibiotics & vancomycin increase the growth & virulence of Candida spp.

AIM: To investigate the direct effect of antibiotics on growth and virulence of the major Candida species associated with invasive infections. MATERIALS & METHODS: Cefepime, imipenem, meropenem, amoxicillin and vancomycin were tested at twofold the peak plasma concentration (2× PP) and the peak plasma concentration (PP). The effects of antibiotics on Candida albicans, Candida parapsilosis, Candida krusei and Candida tropicalis were investigated by colony counting, flow cytometry, proteolytic activity and virulence in Caenorhabditis elegans. RESULTS: Antibiotics increase growth and proteolytic activity of Candida spp; In addition, amoxicillin potentiates virulence of C. krusei and C. tropicalis against Caenorhabditis elegans. CONCLUSION: These results suggest that antimicrobial therapy may have a direct effect on the pathophysiology of invasive fungal infections in patients at risk.

Glucose alteration and insulin resistance in asymptomatic obese children and adolescents / Alteração de glicose e resistência à insulina em crianças e adolescentes obesos assintomáticos

Abstract Objective Obesity is associated with the abnormal glucose metabolism preceding type 2 diabetes mellitus. Thus, further investigation on the prediction of this lethal outcome must be sought. The objective was the profile glycemic assessment of asymptomatic obese children and adolescents from Salvador, Brazil. Method A fasting venous blood sample was obtained from 90 consecutive obese individuals aged 8-18 years, of both sexes, for laboratory determinations of glycated hemoglobin, basal insulin, and the Homeostasis Model Assessment Insulin Resistance index. The clinical evaluation included weight, height, waist circumference, assessment of pubertal development, and acanthosis nigricans research. The body mass index/age indicator was used for the severity of overweight assessment. Results Glycemic alterations were evidenced clinically and biochemically, although these individuals had no complaints or symptoms related to blood sugar levels. Quantitative and qualitative variables were respectively expressed measures of central tendency/dispersion and simple/relative frequency, using the SPSS, version 20.0. A p-value <0.05 was considered significant. Conclusion Notably, this study found a high prevalence of glucose and insulin disorders in asymptomatic obese children and adolescents.

Resumo Objetivo A obesidade está associada ao metabolismo da glicose anormal que antecede o diabetes mellitus tipo 2. Assim, uma investigação adicional sobre a predição desse resultado letal deve ser antecipada. O objetivo era a avaliação do perfil glicêmico de crianças e adolescentes obesos assintomáticos de Salvador, Brasil. Método Uma amostra de sangue venoso em jejum foi obtida de 90 indivíduos obesos consecutivos entre 8-18 anos, de ambos os sexos, para determinações laboratoriais de hemoglobina glicosilada, insulina basal e Índice do Modelo de Avaliação da Homeostase de Resistência à Insulina (HOMA-IR). A avaliação clínica incluiu peso, estatura, circunferência da cintura, avaliação do desenvolvimento puberal e pesquisa sobre a acantose nigricans. Utilizamos o indicador de índice de massa corporal/idade referente à gravidade da avaliação de sobrepeso. Resultados Alterações glicêmicas foram comprovadas clínica e bioquimicamente, apesar de esses indivíduos não apresentarem queixas ou sintomas relacionados a níveis de açúcar no sangue. Variáveis quantitativas e qualitativas foram, respectivamente, medidas expressas de tendência central/dispersão e amostra/frequência relativa, com o software Pacote Estatístico para as Ciências Sociais, versão 20.0. O valor de p < 0,05 foi considerado significativo. Conclusão Observamos, contudo, alta prevalência de distúrbios de glicose e insulina em crianças e adolescentes obesos assintomáticos.