Characterization of unconventional pathogenic Escherichia coli isolated from bloodstream infection: virulence beyond the opportunism.

Extraintestinal pathogenic Escherichia coli (ExPEC) is the leading cause of urinary tract infection worldwide and a critical bloodstream infection agent. There are more than 50 virulence factors (VFs) related to ExPEC pathogenesis; however, many strains isolated from extraintestinal infections are devoid of these factors. Since opportunistic infections may occur in immunocompromised patients, E. coli strains that lack recognized VFs are considered opportunist, and their virulence potential is neglected. We assessed eleven E. coli strains isolated from bloodstream infections and devoid of the most common ExPEC VFs to understand their pathogenic potential. The strains were evaluated according to their capacity to interact in vitro with human eukaryotic cell lineages (Caco-2, T24, HEK293T, and A549 cells), produce type 1 fimbriae and biofilm in diverse media, resist to human sera, and be lethal to Galleria mellonella. One strain displaying all phenotypic traits was sequenced and evaluated. Ten strains adhered to Caco-2 (colon), eight to T24 (bladder), five to HEK-293 T (kidney), and four to A549 (lung) cells. Eight strains produced type 1 fimbriae, ten adhered to abiotic surfaces, nine were serum resistant, and seven were virulent in the G. mellonella model. Six of the eleven E. coli strains displayed traits compatible with pathogens, five of which were isolated from an immune-competent host. The genome of the EC175 strain, isolated from a patient with urosepsis, reveals that the strain belonged to ST504-A, and serotype O11:H11; harbors thirteen VFs genes, including genes encoding UpaG and yersiniabactin as the only ExPEC VFs identified. Together, our results suggest that the ExPEC pathotype includes pathogens from phylogroups A and B1, which harbor VFs that remain to be uncovered.

Unveiling the Virulent Genotype and Unusual Biochemical Behavior of Escherichia coli ST59.

Extraintestinal pathogenic Escherichia coli (ExPEC) is a leading cause of human and animal infections worldwide. The utilization of selective and differential media to facilitate the isolation and identification of E. coli from complex samples, such as water, food, sediment, and gut tissue, is common in epidemiological studies. During a surveillance study, we identified an E. coli strain isolated from human blood culture that displayed atypical light cream-colored colonies in chromogenic agar and was unable to produce ß-glucuronidase and ß-galactosidase in biochemical tests. Genomic analysis showed that the strain belongs to sequence type 59 (ST59) and phylogroup F. The evaluation in silico of 104 available sequenced lineages of ST59 complex showed that most of them belong to serotype O1:K1:H7, are ß-glucuronidase negative, and harbor a virulent genotype associated with the presence of important virulence markers such as pap, kpsE, chuA, fyuA, and yfcV. Most of them were isolated from extraintestinal human infections in diverse countries worldwide and could be clustered/subgrouped based on papAF allele analysis. Considering that all analyzed strains harbor a virulent genotype and most do not exhibit biochemical behavior typical of E. coli, we report that they could be misclassified or underestimated, especially in epidemiological studies where the screening criteria rely only on typical biochemical phenotypes, as happens when chromogenic media are used. IMPORTANCE The use of selective and differential media guides presumptive bacterial identification based on specific metabolic traits that are specific to each bacterial species. When a bacterial specimen displays an unusual phenotype in these media, this characteristic may lead to bacterial misidentification or a significant delay in its identification, putting a patient at risk depending on the infection type. In the present work, we describe a virulent E. coli sequence type (ST59) that does not produce beta-glucuronidase (GUS negative), production of which is the metabolic trait widely used for E. coli presumptive identification in diverse differential media. The recognition of this unusual metabolic trait may help in the proper identification of ST59 isolates, the identification of their reservoir, and the evaluation of the frequency of these pathogens in places where automatic identification methods are not available.

Phenylketonuria Diagnosis by Massive Parallel Sequencing and Genotype-Phenotype Association in Brazilian Patients.

Phenylketonuria (PKU) is a common inborn error of amino acid metabolism in which the enzyme phenylalanine hydroxylase, which converts phenylalanine to tyrosine, is functionally impaired due to pathogenic variants in the PAH gene. Thirty-four Brazilian patients with a biochemical diagnosis of PKU, from 33 unrelated families, were analyzed through next-generation sequencing in the Ion Torrent PGM™ platform. Phenotype-genotype correlations were made based on the BioPKU database. Three patients required additional Sanger sequencing analyses. Twenty-six different pathogenic variants were identified. The most frequent variants were c.1315+1G>A (n = 8/66), c.473G>A (n = 6/66), and c.1162G>A (n = 6/66). One novel variant, c.524C>G (p.Pro175Arg), was found in one allele and was predicted as likely pathogenic by the American College of Medical Genetics and Genomics (ACMG) criteria. The molecular modeling of p.Pro175Arg indicated that this substitution can affect monomers binding in the PAH tetramer, which could lead to a change in the stability and activity of this enzyme. Next-generation sequencing was a fast and effective method for diagnosing PKU and is useful for patient phenotype prediction and genetic counseling.

O caminho para a especialização no cuidar / RELATÓRIO DE ESTÁGIO: O CAMINHO PARA A ESPECIALIZAÇÃO NO CUIDAR / The path to specialization in care

Este relatório explica todo processo de desenvolvimento de competências especializadas em Enfermagem à Pessoa em Situação Crítica. Para que a prestação de cuidados à Pessoa em Situação Crítica seja possível é necessário reunir um conjunto de competências científicas, éticas, relacionais e técnicas que culminam numa especialização nas áreas de prestação de cuidados, de gestão, de formação e de investigação operacionalizando uma abordagem qualificada do doente crítico. Os relatos neste documento compõem uma análise critico reflexiva das atividades desenvolvidas na prática clínica, bem como do processo de aquisição de competências especializadas em diferentes cenários de cuidados de enfermagem, nomeadamente, num Serviço de Urgência Polivalente, numa Unidade de Cuidados Intensivos e num Bloco Operatório. Esta aprendizagem por dentro das competências comuns e específicas demonstrou ser muito proveitosa e enriquecedora no caminho para a especialização no cuidar, colaborando no crescimento pessoal e profissional e determinando assim o futuro como Enfermeira Especialista, na procura da excelência dos cuidados de enfermagem. Na segunda parte deste trabalho apresenta-se uma Revisão Sistemática da Literatura que pretende avaliar quais são os benefícios da utilização de protocolos/check-lists pelos enfermeiros na segurança do doente durante o transporte intra-hospitalar.

This report explains the entire process of developing specialized skills in Nursing for People in Critical Situations. For the provision of care to the Person in Critical Situation to be possible, it is necessary to gather a set of scientific, ethical, relational and technical skills that culminate in a specialization in the areas of care provisioning, management, training and research, operating a qualified approach to a critical patient. The reports in this document comprised a critical-reflexive analysis of the activities developed in clinical practice, as well as the process of acquiring specialized skills in different nursing care settings, namely, in a Multipurpose Emergency Department, an Intensive Care Unit and an Operating Room. This learning within the common and specific competences proved to be very profitable and enriching on the way to specialization in care, collaborating in personal and professional growth and thus determining the future as a Specialist Nurse, aiming to excellence in nursing care. In the second part of this work, a Systematic Literature Review is presented, which aims to evaluate what are the benefits of using protocols/checklists by nurses in patient safety duringintra-hospital transport.

Diversity of Hybrid- and Hetero-Pathogenic Escherichia coli and Their Potential Implication in More Severe Diseases.

Although extraintestinal pathogenic Escherichia coli (ExPEC) are designated by their isolation site and grouped based on the type of host and the disease they cause, most diarrheagenic E. coli (DEC) are subdivided into several pathotypes based on the presence of specific virulence traits directly related to disease development. This scenario of a well-categorized E. coli collapsed after the German outbreak of 2011, caused by one strain bearing the virulence factors of two different DEC pathotypes (enteroaggregative E. coli and Shiga toxin-producing E. coli). Since the outbreak, many studies have shown that this phenomenon is more frequent than previously realized. Therefore, the terms hybrid- and hetero-pathogenic E. coli have been coined to describe new combinations of virulence factors among the classic E. coli pathotypes. In this review, we provide an overview of these classifications and highlight the E. coli genomic plasticity that results in some mixed E. coli pathotypes displaying novel pathogenic strategies, which lead to a new symptomatology related to E. coli diseases. In addition, as the capacity for genome interrogation has grown in the last few years, it is clear that genes encoding some virulence factors, such as Shiga toxin, are found among different E. coli pathotypes to which they have not traditionally been associated, perhaps foreshowing their emergence in new and severe outbreaks caused by such hybrid strains. Therefore, further studies regarding hetero-pathogenic and hybrid-pathogenic E. coli isolates are necessary to better understand and control the spread of these pathogens.

Draft Whole-Genome Sequence of a Uropathogenic Escherichia coli Strain Carrying the eae Gene.

Uropathogenic Escherichia coli (UPEC) strains are responsible for most cases of urinary tract infections worldwide. We present the draft whole-genome sequence of the UPEC 252 strain, which carries the eae gene that encodes the intimin adhesin. Intimin promotes intimate adherence of enteropathogenic E. coli and enterohemorrhagic E. coli to intestinal cells.

Phenotypic characterization and virulence-related properties of Escherichia albertii strains isolated from children with diarrhea in Brazil.

Escherichia albertii are emerging enteropathogens, whose identification is difficult, as they share biochemical characteristics and some virulence-related genes with diarrheagenic Escherichia coli (DEC). Studies on phylogeny, phenotypic characteristics and potential virulence factors of human E. albertii strains are scarce. In this study, we identified by multiplex PCR five E. albertii among 106 strains isolated from diarrheic children in São Paulo, Brazil, which were previously classified as atypical enteropathogenic E. coli. All strains were investigated regarding their phylogeny, biochemical properties, virulence-related properties, antimicrobial resistance and presence of putative virulence-related genes. All strains belonged to different E. albertii lineages and adhered to and produced attaching and effacing lesions on HeLa cells. Three strains invaded Caco-2 cells, but did not persist intracellularly, and three formed biofilms on polystyrene surfaces. All strains were resistant to few antibiotics and only one carried a self-transmissible resistance plasmid. Finally, among 38 DEC and 18 extraintestinal pathogenic E. coli (ExPEC) virulence-related genes searched, six and three were detected, respectively, with paa and cdtB being found in all strains. Despite the limited number of strains, this study provided additional knowledge on human E. albertii virulence potential, showing that they share important virulence factors with DEC and ExPEC.

Alpha 1-antitrypsin deficiency in patients with chronic obstructive pulmonary disease patients: is systematic screening necessary?

OBJECTIVE: Alpha-1-antitrypsin deficiency is a relatively prevalent, but under-diagnosed, genetic disease. The objective of this study was to assess whether the systematic screening for alpha-1-antitrypsin deficiency in all patients with chronic obstructive pulmonary disease from a tertiary service has an impact on the number of patients being diagnosed with this condition. RESULTS: Chronic obstructive pulmonary disease patients were screened for alpha-1-antitrypsin deficiency using immunonephelometry. The presence of a mutation was confirmed by molecular study of the SERPINA1 gene or by genetic sequencing, as needed. A total of 551 patients with chronic obstructive pulmonary disease were analyzed. Among these, 40 (7.2%) had some genetic mutation, while 11 (2%) had a Pi*ZZ genotype, resulting in severe respiratory illness. The systematic evaluation of chronic obstructive pulmonary disease patients revealed that screening is an effective method to diagnose alpha-1-antitrypsin deficiency. Early diagnosis may facilitate smoking cessation and initiation of treatment to maintain lung function.

Draft whole-genome sequence of a uropathogenic Escherichia coli strain carrying the eae gene

Uropathogenic Escherichia coli (UPEC) strains are responsible for most cases of urinary tract infections worldwide. We present the draft whole-genome sequence of the UPEC 252 strain, which carries the eae gene that encodes the intimin adhesin. Intimin promotes intimate adherence of enteropathogenic E. coli and enterohemorrhagic E. coli to intestinal cells.

Draft whole-genome sequence of a uropathogenic Escherichia coli strain carrying the eae gene

Uropathogenic Escherichia coli (UPEC) strains are responsible for most cases of urinary tract infections worldwide. We present the draft whole-genome sequence of the UPEC 252 strain, which carries the eae gene that encodes the intimin adhesin. Intimin promotes intimate adherence of enteropathogenic E. coli and enterohemorrhagic E. coli to intestinal cells.

Uropathogenic Escherichia coli pathogenicity islands and other ExPEC virulence genes may contribute to the genome variability of enteroinvasive E. coli.

BACKGROUND: Enteroinvasive Escherichia coli (EIEC) may be the causative agent of part of those million cases of diarrhea illness reported worldwide every year and attributable to Shigella. That is because both enteropathogens have many common characteristics that difficult their identification either by traditional microbiological methods or by molecular tools used in the clinical laboratory settings. While Shigella has been extensively studied, EIEC remains barely characterized at the molecular level. Recent EIEC important outbreaks, apparently generating more life-threatening cases, have prompted us to screen EIEC for virulence traits usually related to extraintestinal pathogenic E. coli (ExPEC). That could explain the appearance of EIEC strains presenting higher virulence potential. RESULTS: EIEC strains were distributed mainly in three phylogroups in a serogroup-dependent manner. Serogroups O124, O136, O144, and O152 were exclusively classified in phylogroup A; O143 in group E; and O28ac and O29 in group B1. Only two serogroups showed diverse phylogenetic origin as follows: O164 was assigned to groups A, B1, C, and B2 (one strain each), and O167 in groups E (five strains), and A (one strain) (Table 1). Eleven of 20 virulence genes (VGs) searched were detected, and the majority of the 19 different VGs combinations found were serogroup-specific. Uropathogenic E. coli (UPEC) PAI genetic markers were detected in all EIEC strains. PAIs IJ96 and IICFT073 were the most frequent (92.1 and 80.4%, respectively). PAI IV536 was restricted to some serogroups from phylogroups A, B1 and E. PAI ICFT073 was uniquely detected in phylogroups B2 and E. A total of 45 (88%) strains presented multiple PAI markers (two to four). PAIs IJ96 and IICFT073 were found together in 80% of strains. CONCLUSIONS: EIEC is a DEC pathovar that presents VGs and pathogenicity island genetic markers typically associated with ExPEC, especially UPEC. These features are distributed in a phylogenetic and serogroup-dependent manner suggesting the existence of stable EIEC subclones. The presence of phylogroups B2 and E strains allied to the presence of UPEC virulence-associated genes may underscore the ongoing evolution of EIEC towards a hypervirulent pathotype.

Elder abuse within the family environment in the Azores Islands / Maus-tratos no ambiente familiar contra idosos nas Ilhas dos Açores / Maltrato en el entorno familiar a las personas mayores en las Islas Azores

ABSTRACT Objectives: to dimension abuse against vulnerable adults within the family and community environment in the Azores Islands, identify risk factors for abuse and describe the profile of an abused elder. Method: descriptive cross-sectional study. Random sampling. The instruments used were: clinical histories of the users, Mini-Mental State Examination, Index of Independence in Basic Activities of Daily Living, Family APGAR Scale, Elder Abuse Suspicion Index and Social Work Assessment Form. Descriptive statistical analysis was used for qualitative and quantitative variables and multiple logistic regression was used to identify factors associated with elder mistreatment. Results: abuse suspicion was identified in 24.5% of elderly participants. Psychological abuse was the most common type of abuse and sons were the main abusers. Conclusion: being a woman and belonging to a dysfunctional family is associated with an increased risk of becoming a victim of abuse; the high level of domestic violence against the elderly in the Azores Islands is in line with the rest of Portugal.

RESUMO Objetivos: dimensionar os maus-tratos contra as pessoas idosas vulneráveis no ambiente familiar e comunitário nas Ilhas dos Açores, identificar fatores de risco para maus-tratos e definir o perfil do idoso maltratado. Método: estudo descritivo transversal. Amostragem aleatória. Os instrumentos utilizados foram: prontuários dos usuários, Mini Exame do Estado Mental, teste de autonomia para as Atividades Básicas da Vida Diária, Escala APGAR Familiar, Índice de Suspeição de Abuso no Idoso e Formulário de Avaliação de Trabalho Social. Análise estatística descritiva foi usada para as variáveis qualitativas e quantitativas e regressão logística múltipla foi usada para identificar os fatores associados aos maus-tratos. Resultados: suspeita de maus-tratos foi identificada em 24,5% dos idosos participantes. O abuso psicológico foi o tipo de maus-tratos mais comum e os responsáveis por esses maus-tratos foram principalmente os filhos. Conclusão: ser mulher e pertencer a uma família disfuncional está associado com uma maior probabilidade de sofrer maus-tratos; o alto nível de violência doméstica contra os idosos nas Ilhas dos Açores segue o mesmo padrão do resto de Portugal.

RESUMEN Objetivos: dimensionar el maltrato a personas mayores vulnerables en el entorno familiar y comunitario de las Islas Azores, identificar factores de riesgo de maltrato y definir el perfil del anciano maltratado. Método: estudio descriptivo de corte transversal. Muestreo aleatorio. Los instrumentos utilizados fueron: historias clínicas de los usuarios, Mini-Examen Cognitivo, test de autonomía para las Actividades Básicas de la Vida Diaria, Test de APGAR Familiar, Índice de Sospecha de Maltrato hacia Personas Mayores y Formulario de Evaluación de Trabajo Social. El análisis estadístico fue descriptivo para las variables cualitativas y cuantitativas y una regresión logística múltiple para identificar los factores asociados al maltrato. Resultados: se identificó sospecha de maltrato en el 24,5% de los ancianos participantes. El maltrato psicológico fue el tipo de maltrato más común y los desencadenantes de ese maltrato fueron principalmente los hijos. Conclusión: se asocia ser mujer y pertenecer a familia disfuncional con mayor probabilidad de padecer maltrato; el alto nivel de la violencia domestica a los ancianos en las Islas Azores sigue la línea que en el resto de Portugal.

Diagnóstico de enfermagem "tensão do papel de cuidador": revisão integrativa / Nursing diagnosis "stress in the role of caregiver": an integrative review

O envelhecimento tornou-se um desafio político-social e, nesse contexto, emerge a determinação correta de sobrecarga dos cuidadores. O objetivo deste trabalho foi identificar e analisar as características definidoras e os fatores relacionados, mediante revisão de literatura integrativa, do diagnóstico de enfermagem "tensão do papel de cuidador", publicado no período 2005-2011. Foram seguidas seis etapas: formulação da questão norteadora; processo de busca na literatura; categorização; avaliação dos estudos; interpretação dos resultados e síntese do conhecimento. Foram pesquisadas as bases LILACS e MEDLINE, e das 66 publicações identificadas, apenas quatro tratavam diretamente do diagnóstico. Evidenciaram-se 24 características definidoras das 34 existentes e 17 fatores relacionados dos 58 referenciados. A tensão do cuidador esteve relacionada aos aspectos físicos, emocionais e socioeconômicos. Assim, o diagnóstico atende às especificidades do cuidador, mas aponta a necessidade de agrupar os indícios clínicos que deem objetividade e clareza necessária para sua identificação na prática de enfermagem.

Aging has become a political and social challenge, and in this context emerges the correct determination of caregiver burden. This work aimed to identify and analyze the defining characteristics and related factors, through integrative literature review, nursing diagnosis "stress in the role of caregiver", published in years 2005-2011. Six steps were followed: formulation of the research question; literature search process; categorization; assessment of studies; interpretation of results and synthesis of knowledge. LILACS and MEDLINE databases were searched, and of 66 publications identified, only four dealt directly with the diagnosis. We found 24 defining characteristics of the existing 34 and 17 of the 58 factors referenced. The stress of the caregiver was related to physical, emotional and socioeconomic aspects. Thus, the diagnosis meets the specificity of caregivers, but points to the need to group the clinical signs that give objectivity and clarity to their identification in the nursing practice.

Adsorción de Cr(VI) por Cocos nucífera L. en residuales de Fibrocemento en Santiago de Cuba / Cr(VI) adsorption by Cocos nucífera L. in wastewater of fibrocement from Santiago de Cuba

La adsorción y/o formación de complejos de metales pesados basados en la actividad química de la biomasa, es el proceso conocido como biosorción y es la base de una nueva tecnología para su remoción en efluentes industriales y su posterior recuperación. En esta tecnología se pueden utilizar diferentes tipos de biomasas tales como: algas, microorganismos y sub-productos agrícolas. Este trabajo estudió la adsorción de Cr(VI) utilizando la cáscara del fruto de la planta Cocos nucífera L. como biomasa orgánica. Los valores óptimos de adsorción de Cr(VI) son: pH de 3 unidades; tamaño de partícula menor que 0,074 mm; dosis de adsorbente de 5 g.dm-3 y tiempo contacto de 1 hora. A valores bajos de concentración del metal (1,0; 1,5 y 1,84 mg.dm-3) se obtuvo porcentaje de remoción superiores a 90, sin embargo a altos valores de concentración (2,5 y 3 mg.dm-3), se obtienen valores inferiores al 90 %. El proceso pudo ser estudiado a través de los modelos de Langmuir y de Freundlich, ya que el coeficiente de correlación para ambos modelos fue de 0,994 y 0,991 respectivamente. Se logra remover los iones Cr(VI) a valores de pH de 3 y 7 unidades en una matriz real, alcanzando valores de remoción de 96,85 % y 93,71 % respectivamente.

Adsorption and/or formation of complexes of heavy metals based on the chemical activity of the biomass, it is the process known as biosorption and it is the base of a new technology for its removal in industrials effluent and its posterior recuperation. In this technology, different kinds of biomasses can be utilized such as: algae, microorganisms and agricultural subproducts. In this work, the adsorption of Cr(VI) was studied utilizing the nutshell of the fruit of the plant Cocos nucífera L as organic biomass. The optimal values of adsorption of Cr(VI) are: pH of 3 units, size of particle smaller than 0.074 mm, doses of adsorbent of 5 g.dm-3 and contact time of 1 hour. At low values of concentration of the metal (1.0, 1,5 and 1.84 mg.dm-3) percentage of removal superior to 90% were obtained, however, at high values of concentration (2.5 and 3 mg.dm-3) values inferior to 90 % are obtained. The process can be studied by the models of both, Langmuir and of Freundlich, because the , coefficient of correlation for these two models was 0.994 and 0.991 respectively. The ions Cr(VI) can be removed at values of 3 and 7 units in a real matrix, reaching removal values of 96.85% and 93.71% respectively.

Promoção do bem-estar ao acompanhante no ambiente hospitalar: intervenção de enfermagem grupal / Promotion of the well-being to the companion in the hospital environment: nursing intervention group

Objetivo: caracterizar os acompanhantes de clientes hospitalizados; identificar o bem-estar do cuidador prée pós-grupo de acompanhantes utilizando a Classificação dos Resultados de Enfermagem (NOC); analisar oslimites e as possibilidades de integração dos acompanhantes ao ambiente hospitalar. Método: estudo deabordagem quanti-qualitativa, do tipo quase-experimental, utilizando-se da técnica grupo focal com 140acompanhantes de pacientes internados nas unidades clínicas e cirúrgicas de um hospital geral, emNiterói/RJ/Brasil, após aprovação do projeto pelo Comitê de Ética em Pesquisa, sob protocolo0102.0.258.000-08. Para a análise dos dados foi empregada a Técnica Análise de conteúdo e descritivasimples. Resultados: estabeleceu-se o perfil do acompanhante; os fatores implicados na formação do papelde acompanhante; a atuação do acompanhante no processo de cuidar; reflexos e nexos da relaçãoacompanhante-cuidador; e o significado do ser acompanhante. Conclusão: houve melhora no bem-estar apósa intervenção grupal, e a inclusão do acompanhante na prática requer adequação do cenário hospitalar.

Avaliação de dor e do perfil epidemiológico, de pacientes atendidos no pronto-socorro de um hospital universitário / Pain and epidemiologic evaluation of patients seen by the first aid unit of a teaching hospital

JUSTIFICATIVA E OBJETIVOS: Dor é um dos principais motivos de procura por pronto-atendimento. No entanto, nem sempre é bem avaliada, documentada e tratada. O objetivo deste estudo foi descrever o perfil epidemiológico, caracterização da dor, tratamento analgésico instituído e satisfação de pacientes atendidos no pronto-socorro (PS) de um Hospital Universitário (HC). MÉTODO: Estudo prospectivo, transversal, realizado com 309 pacientes atendidos no PS/HC da Universidade Federal do Triângulo Mineiro (UFTM). As informações foram coletadas a partir de instrumento contendo identificação, dados sócio-demográficos, avaliação de dor pela escala numérica de dor (END), prescrição de analgésicos, satisfação com a analgesia. RESULTADOS: Houve predomínio do sexo masculino, cor branca e com ensino fundamental. Média de idade 46,7 anos. Desempregados: 10% e 15% aposentados. Prevalência de dor 45,6%. Principais causas: traumatismos, dor abdominal, cefaleia, picada por animais peçonhentos, vasculopatias. Cerca de 5% dos pacientes foram atendidos com menos de 1h de dor e 40% com mais de 72h. A localização mais comum foi abdômen (25,2%) e membros inferiores (MMII) (23,4%). A dor foi intensa em dois terços dos pacientes, com intensidade média na admissão de 7,8 ± 2,1 pela END. Tempo de melhora após analgesia: menor que 30 minutos para 25% dos pacientes. Em 17,7% dos casos de dor, não houve prescrição analgésica. O analgésico mais prescrito foi a dipirona, com ou sem associação. Apenas 30% tiveram resolução da dor. Apesar destes dados, metade dos pacientes, disseram-se satisfeitos com a analgesia. CONCLUSÃO: A dor foi altamente prevalente no pronto-atendimento, pouco valorizada, mal avaliada e subtratada, com baixa resolutividade e prescrição inadequada de analgésicos.

BACKGROUND AND OBJECTIVES: Pain is s major reason for seeking emergency care. However it is not always accurately evaluated, documented and managed. This study aimed at describing the epidemiologic profile, the characterization of pain, the analgesic treatment instituted and the satisfaction of patients seen by the first aid unit (FA) of a Teaching Hospital (TH). METHOD: This is a prospective transversal study carried out with 309 patients seen by the FA/TH of the Federal University, Triângulo Mineiro (UFTM). Information was collected as from a tool with identification, socio-demographic data, pain evaluation by the pain numerical scale (PNS), analgesics prescription and satisfaction with analgesia. RESULTS: There has been predominance of Caucasian males with basic education. Mean age was 46.7 years. Unemployed were 10% and retired 15%. Pain prevalence was 45.6%. Major causes: traumas, abdominal pain, headache, bites by venomous animals and vasculopathies. Approximately 5% of patients were seen with less than 1 hour of pain and 40% with more than 72 hours. Most common sites were abdomen (25.2%) and lower limbs (MMII) (23.4%). Pain was severe in two thirds of patients, with mean intensity at admission of 7.8 ± 2.1 by PNS. Improvement time after analgesia: less than 30 minutes for 25% of patients. There has been no analgesic prescription for 17.7% of cases. Most prescribed analgesic was dipirone, with or without association. Only 30% had pain resolution. In spite of these data, half the patients reported being happy with analgesia. CONCLUSION: Pain was highly prevalent during first aid visits, was poorly valued and undertreated, with low resolution rate and inadequate analgesics prescription.

First description of natural and experimental conjugation between Mycobacteria mediated by a linear plasmid.

BACKGROUND: In a previous study, we detected the presence of a Mycobacterium avium species-specific insertion sequence, IS1245, in Mycobacterium kansasii. Both species were isolated from a mixed M. avium-M. kansasii bone marrow culture from an HIV-positive patient. The transfer mechanism of this insertion sequence to M. kansasii was investigated here. METHODOLOGY/PRINCIPAL FINDINGS: A linear plasmid (pMA100) was identified in all colonies isolated from the M. avium-M. kansasii mixed culture carrying the IS1245 element. The linearity of pMA100 was confirmed. Other analyses suggested that pMA100 contained a covalently bound protein in the terminal regions, a characteristic of invertron linear replicons. Partial sequencing of pMA100 showed that it bears one intact copy of IS1245 inserted in a region rich in transposase-related sequences. These types of sequences have been described in other linear mycobacterial plasmids. Mating experiments were performed to confirm that pMA100 could be transferred in vitro from M. avium to M. kansasii. pMA100 was transferred by in vitro conjugation not only to the M. kansasii strain from the mixed culture, but also to two other unrelated M. kansasii clinical isolates, as well as to Mycobacterium bovis BCG Moreau. CONCLUSIONS/SIGNIFICANCE: Horizontal gene transfer (HGT) is one of most important mechanisms leading to the evolution and diversity of bacteria. This work provides evidence for the first time on the natural occurrence of HGT between different species of mycobacteria. Gene transfer, mediated by a novel conjugative plasmid, was detected and experimentally reproduced.

Riesgo químico en el Laboratorio de Análisis del Centro de Estudios de Biotecnología Industrial / Chemical risk in the analysis laboratory of the Industrial Biotechnology Studies Center

Se llevó a cabo un ensayo clínico para evaluar el riesgo químico en el laboratorio de análisis del Centro de Estudios de Biotecnología Industrial de la Facultad de Ciencias Naturales de la Universidad de Oriente, con vista a lo cual se identificaron, entre otros aspectos, las características generales del local y de las 20 técnicas establecidas para el análisis de aguas residuales y residuales agroindustriales (11 de estas se aplican 200 veces al año como promedio), frecuencia de los análisis, reactivos químicos empleados y su categoría de peligro (fundamentalmente ácidos minerales, álcalis, solventes orgánicos y oxidantes fuertes), así como se evaluaron los riesgos químico-físicos y las medidas laborales de seguridad, incluido el tratamiento de los residuos antes de ser eliminados. Se observó que los analistas están expuestos a fuentes de calor y vapores de solventes y ácidos a través de la piel y el sistema respiratorio, pero en un trienio solo se produjeron 3 accidentes leves y no hubo certificados médicos por enfermedades ocupacionales en este tipo de instalación

A clinical trial to evaluate the chemical risk was carried out at the analysis laboratory of the Industrial Biotechnology Studies Center in the Natural Sciences Faculty at Oriente University. For this purpose, aspects such as the general characteristics of the site and of the 20 established techniques for the analysis of waste waters and agroindustrial residual were identified, (11 of these were applied 200 times a year as average), frequency of the analyses, chemical reagents used and their danger category (fundamentally mineral acids, alkalis, organic solvents and strong oxidizers), as well as the chemical-physical risks and the security working measures were evaluated, including the treatment of residuals before being eliminated. It was observed that the analysts are exposed to sources of heat and steam of solvents and acids through the skin and the respiratory system, but just 3 mild accidents took place in a triennium, and there were no medical certifications due to occupational diseases in this type of facility

Natural occurrence of horizontal transfer of Mycobacterium avium- specific insertion sequence IS1245 to Mycobacterium kansasii.

Mycobacterium kansasii carrying IS1245, a highly prevalent insertion sequence among Mycobacterium avium isolates, was detected in a mixed culture of M. avium and M. kansasii. The insertion sequence was stable and able to transpose by a replicative mechanism in M. kansasii. These findings may have significant implications for molecular diagnosis and treatment outcome.