Analysis of potential nature-based solutions for the Mun River Basin, Thailand.

Despite the growth in research and applications of nature-based solutions (NBS) within the literature, there are limited applications in South East Asia, moreover studies which quantitatively assess the impacts of NBS could have on hazard reduction are scarce. This paper addresses this gap by developing and validating MCDA-GIS analysis to map how potential nature strategies could mitigate flood hazard if applied within the Mun River Basin, Thailand. Through a literature review, the top three solutions for flood and drought hazards were found: wetlands, re/afforestation, and changing crop types. These strategies were reviewed and validated with a MCDA-GIS methodology, through land use change (LUC) maps to depict different future scenarios. The results found that flood hazard did decrease when NBS were implemented in the catchment, especially for A/Reforestation, and to a greater extent when a combination of NBS were applied. This article provides specific insights into the current gaps of NBS publications, specifically considering the case of the Mun River Basin, Thailand.

Understanding the NEEDS for ACTING: An integrated framework for applying nature-based solutions in Brazil.

Nature-based solutions (NBS) support the provision of multiple benefits for the environment and society. First idealised in 2008, NBS are recommended by worldwide reports and guidelines as strategies to protect, sustainably manage and restore ecosystems. However, their operationalisation is still in the early stages, especially in developing countries, and only a few studies consider their full potential. This article contributes to this context by developing an integrated framework, with spatial and participatory tools, for analysing flood risk mitigation in Brazil. The approach enables a deep understanding of the societal challenges and vulnerabilities of the area (i.e., NEEDS) for subsequently planning the appropriate NBS (i.e., ACTIONS), with the participation of 255 stakeholders of Campina Grande municipality. Results show mappings of flood-prone areas, in which approximately 52% of the flooded areas will see an increase in the future. Hotspots (i.e., hazard, vulnerability, and exposure) are shown and discussed with four application cases. Finally, multiple benefits of seven NBS alternatives are analysed in 53 scenarios of application, in which the higher rates of reductions are found to combined alternatives. The discussion emphasizes the importance of spatially assessing the 'needs' and 'multiple benefits' of NBS, including reducing vulnerabilities and increment of resilience.

Characterization of Candida species isolated from the hands of the healthcare workers in the neonatal intensive care unit.

Colonization of health professional hands by potentially pathogenic microorganisms capable to expressing virulence factors, such as Candida spp., is worrisome because of the high contact between patients and professionals. The study aims to evaluate, in vitro, the following virulence factors: hemolytic activity, DNAse expression, biofilm formation, and susceptibility for antifungal agents of Candida species isolated from health professionals hands of a neonatal intensive care unit (NICU). The study includes 50 isolates of Candida spp.: 19 C. parapsilosis sensu stricto, three C. metapsilosis, one C. orthopsilosis, seven C. albicans, six C. famata, five C. lusitaniae, three C. krusei, two C. kefyr, two C. tropicalis, one C. glabrata, and one C. guilliermondii. The hemolytic activity and DNAse were investigated using blood agar and DNAse agar, respectively. Biofilm production was evaluated through XTT sodium salt reduction ability, and the susceptibility of the isolates to antifungals through the microdilution methodology. Forty-nine isolates presented at least one of the three virulence factors investigated. C. albicans showed more intense hemolytic activity. DNAse production was statistically significant between the C. parapsilosis complex and C. albicans, as well as between the C. parapsilosis complex and C. krusei, even as between C. famata and C. albicans, and between C. famata and C. krusei. Forty-three isolates produced biofilm. Seventy-eight percent of the isolates were sensitive to the three antifungals tested. This study demonstrated that Candida isolated from healthcare professionals' hands has virulence.

Variability of systemic and oro-dental phenotype in two families with non-lethal Raine syndrome with FAM20C mutations.

BACKGROUND: Raine syndrome (RS) is a rare autosomal recessive bone dysplasia typified by osteosclerosis and dysmorphic facies due to FAM20C mutations. Initially reported as lethal in infancy, survival is possible into adulthood. We describe the molecular analysis and clinical phenotypes of five individuals from two consanguineous Brazilian families with attenuated Raine Syndrome with previously unreported features. METHODS: The medical and dental clinical records were reviewed. Extracted deciduous and permanent teeth as well as oral soft tissues were analysed. Whole exome sequencing was undertaken and FAM20C cDNA sequenced in family 1. RESULTS: Family 1 included 3 siblings with hypoplastic Amelogenesis Imperfecta (AI) (inherited abnormal dental enamel formation). Mild facial dysmorphism was noted in the absence of other obvious skeletal or growth abnormalities. A mild hypophosphataemia and soft tissue ectopic mineralization were present. A homozygous FAM20C donor splice site mutation (c.784 + 5 g > c) was identified which led to abnormal cDNA sequence. Family 2 included 2 siblings with hypoplastic AI and tooth dentine abnormalities as part of a more obvious syndrome with facial dysmorphism. There was hypophosphataemia, soft tissue ectopic mineralization, but no osteosclerosis. A homozygous missense mutation in FAM20C (c.1487C > T; p.P496L) was identified. CONCLUSIONS: The clinical phenotype of non-lethal Raine Syndrome is more variable, including between affected siblings, than previously described and an adverse impact on bone growth and health may not be a prominent feature. By contrast, a profound failure of dental enamel formation leading to a distinctive hypoplastic AI in all teeth should alert clinicians to the possibility of FAM20C mutations.

Clinical aspects and care production in a Brazilian psychosocial care center of alcohol and other drugs (CAPS AD).

The study aimed to analyze the clinical aspects of the treatment of crack cocaine and excessive alcohol users who were seen in a Psychosocial Care Center of Alcohol and Other Drugs (CAPS AD) in Sobral, Ceará, during the years 2010 and 2011. This is an exploratory descriptive and documentary study, with a retrospective quantitative approach. The sample was composed of 567 medical records of drug users, from which 291 were crack cocaine users, and 276 were alcohol users. For data collection, a form was developed based on the Care Script Service, the data from which was then used to populate a database in an EPI INFO 7, a statistics software system. In both groups of users, males were predominant (85%, n = 482), and were between the ages of 20 and 29 years for crack users (50.9%, n = 148), and between 30 and 39 years for alcohol users (31.9%, n = 88). There were significant differences between crack cocaine users and alcohol users in liver disorders (p < 0.01) and withdrawal syndrome (p < 0.05), however, there were similar signs and symptoms between users. Crack users hospitalized less frequently (OR 0.33 [95% CI 0.23 to 0.47 p < 0.01]). Suicidal ideation and suicide attempts were similar in both crack cocaine and alcohol users. Thus, this research will lead to new proposals for health care professionals in order to enhance and improve the care provided to service customers in CAPS AD.

Discovery of a Novel Bioactive Compound in Orange Peel Polar Fraction on the Inhibition of Trimethylamine and Trimethylamine N-Oxide through Metabolomics Approaches and In Vitro and In Vivo Assays: Feruloylputrescine Inhibits Trimethylamine via Suppressing cntA/B Enzyme.

This study compares the inhibitory effects of orange peel polar fraction (OPP) and orange peel nonpolar fraction (OPNP) on trimethylamine (TMA) and trimethylamine N-oxide (TMAO) production in response to l-carnitine treatment in vivo and in vitro. Metabolomics is used to identify bioactive compounds. The research demonstrates that the OPP effectively regulates atherosclerosis-related markers, TMA and TMAO in plasma and urine, compared to the OPNP. Our investigation reveals that these inhibitory effects are independent of changes in gut microbiota composition. The effects are attributed to the modulation of cntA/B enzyme activity and FMO3 mRNA expression in vitro. Moreover, OPP exhibits stronger inhibitory effects on TMA production than OPNP, potentially due to its higher content of feruloylputrescine, which displays the highest inhibitory activity on the cntA/B enzyme and TMA production. These findings suggest that the OPP containing feruloylputrescine has the potential to alleviate cardiovascular diseases by modulating cntA/B and FMO3 enzymes without directly influencing gut microbiota composition.

Virulence factors, antifungal susceptibility and molecular profile in Candida species isolated from the hands of health professionals before and after cleaning with 70% ethyl alcohol-based gel.

Fungal infections in neonatal intensive care units (NICU) are mainly related to Candida species, with high mortality rates. They are predominantly of endogenous origin, however, cross-infection transmitted by healthcare professionals' hands has occurred. The aim of this study was to identify Candida species isolated from the hands of healthcare professionals in a NICU before and after hygiene with 70% ethanol-based gel and evaluate virulence factors DNase, phospholipase, proteinase, hemolysin, biofilm biomass production, and metabolic activity. In vitro antifungal susceptibility testing and similarity by random amplified polymorphic DNA (RAPD) were also performed. C. parapsilosis complex was the most frequent species (57.1%); all isolates presented at least one virulence factor; three isolates (Candida parapsilosis complex) were resistant to amphotericin B, two (Candida famata [currently Debaryomyces hansenii] and Candida guilliermondii [currently Meyerozyma guilliermondii]) was resistant to micafungin, and six (Candida parapsilosis complex, Candida guilliermondii [=Meyerozyma guilliermondii], Candida viswanathi, Candida catenulata [currently Diutina catenulata] and Candida lusitaniae [currently Clavispora lusitaniae]) were resistant to fluconazole. Molecular analysis by RAPD revealed two clusters of identical strains that were in the hands of distinct professionals. Candida spp. were isolated even after hygiene with 70% ethanol-based gel, highlighting the importance of stricter basic measures for hospital infection control to prevent nosocomial transmission.

Drug interactions in Brazilian type 2 diabetes patients.

The aim of this paper is to identify the prevalence of the most frequent drug interactions in patients using oral antidiabéticos and their association with capillary glucose and medication adherence. In total, 579 type 2 diabetes mellitus patients from 12 health institutions in Fortaleza, Brazil were interviewed in 2009. A form was applied, including questions on medication use, comorbidities, lifestyle, body mass index and random capillary glucose. Results revealed that 26.7% used five or more different drugs simultaneously and daily. Statistically significant drug interactions occurred between antidiabéticos and diuretics, angiotensin-converting enzyme inhibitors, anti-lipidaemics and corticoids. No significant association was found between polypharmacy, medication adherence and glucose. It is important for nurses, in consensus with other health professionals, to consider the possibility of other drugs that mean less risk for diabetes patients' glucose control or of increased antidiabetics doses.

Using multi criteria decision analysis in a geographical information system framework to assess drought risk.

In this study we use the Mun river basin to demonstrate how a Multi Criteria Decision Analysis - Geographical Information Systems (MCDA-GIS) methodology can be used to assess drought risk. This paper not only provides a step forward in considering other elements such as land use change, climate within drought risk but also splits annual risk across three seasons (wet, cool and hot), previously not done. We also investigate how land use change, in the form of a/reforestation and changing crop varieties could potentially mitigate future risk. MCDA rankings from experts found that climatic factors such as rainfall, evapotranspiration and maximum temperature were the most significant. By splitting up the seasons we have been able to observe the temporal and spatial changes in drought risk at an increased detail, an important step in mitigating water security issue in the future. Results for cool months found an increased risk in the north and east (Surin, Si Sa Ket and Rio Et). With hot months finding increased risk in the east (Surin and Si Sa Ket especially) and west in Nakon Ratchasima. Whereas the wet season risk was greatest in the West (Nakon Ratchima, Khon Kean and Mara Sarakham). Differences in future land use scenarios compared to 2017 found that if current trends continued (BAU), the areas at risk from drought will increase. However, by changing land use in the form of a/reforestation (COB) or changing crop types (PRO), drought risk will decrease. Thus, the MCDA-GIS methodology serves as a great starting point, providing a high flexibility in data, meaning the methodology can readily applied to other case studies across the world.

A Three-Monoclonal Antibody Combination Potently Neutralizes BoNT/G Toxin in Mice.

Equine-derived antitoxin (BAT®) is the only treatment for botulism from botulinum neurotoxin serotype G (BoNT/G). BAT® is a foreign protein with potentially severe adverse effects and is not renewable. To develop a safe, more potent, and renewable antitoxin, humanized monoclonal antibodies (mAbs) were generated. Yeast displayed single chain Fv (scFv) libraries were prepared from mice immunized with BoNT/G and BoNT/G domains and screened with BoNT/G using fluorescence-activated cell sorting (FACS). Fourteen scFv-binding BoNT/G were isolated with KD values ranging from 3.86 nM to 103 nM (median KD 20.9 nM). Five mAb-binding non-overlapping epitopes were humanized and affinity matured to create antibodies hu6G6.2, hu6G7.2, hu6G9.1, hu6G10, and hu6G11.2, with IgG KD values ranging from 51 pM to 8 pM. Three IgG combinations completely protected mice challenged with 10,000 LD50s of BoNT/G at a total mAb dose of 6.25 µg per mouse. The mAb combinations have the potential for use in the diagnosis and treatment of botulism due to serotype G and, along with antibody combinations to BoNT/A, B, C, D, E, and F, provide the basis for a fully recombinant heptavalent botulinum antitoxin to replace the legacy equine product.

Inanimate Surfaces and Air Contamination with Multidrug Resistant Species of Staphylococcus in the Neonatal Intensive Care Unit Environment.

BACKGROUND: Contamination of the hospital environment with multi-resistant (MDR) Staphylococcus increases the risk of infection. The aim of this study is to identify the MDR species of Staphylococcus on inanimate surfaces, in air, and in clinical samples, and analyze the risk factors that correlate with the occurrence of infections in a Neonatal Intensive Care Unit. METHODS: Samples of inanimate surfaces and air were taken using a premoistened swab (0.9% sodium chloride) and spontaneous air sedimentation, respectively. The clinical isolates were recovered from infected neonates. The isolates (environmental and clinical) were identified by matrix-assisted laser desorption ionization-time of flight and the resistance profile was calculated using the disk diffusion agar technique. RESULTS: In total, 181 isolates were obtained, 93 from (surfaces), 18 from the air, and 70 clinical samples. S. epidermidis was the most frequent species (66.8%), and the failure rate in air cleaning was 100%. More than 60% of the isolates were MDR, and the majority of clinical isolates (60.4%) had a resistance profile identical to that of the environmental isolates. CONCLUSION: Staphylococcus spp. were found in most of the analyzed samples, with a high frequency of MDR isolates, demonstrating the importance of the hospital environment as a reservoir, and the need for infection control measures, and rational use of antimicrobials.

Cooked Black Turtle Beans Ameliorate Insulin Resistance and Restore Gut Microbiota in C57BL/6J Mice on High-Fat Diets.

Colored common beans are associated with health promoting and chronic disease prevention effects. Male C57BL/6J mice were fed high-fat (HF) diets supplemented with cooked black turtle beans (HFB) to prevent obesity related insulin resistance. Mice on both HF and HFB were obese compared to mice fed a low-fat (LF) diet. Plasma low density lipoprotein (LDL) and triglyceride concentrations of mice fed HFB diet were 28% and 36.6% lower than those on HF diet. Homeostatic model assessment of insulin resistance (HOMA-IR) index of mice fed HFB diet was 87% lower than that of mice fed HF diet. Diabetes related biomarkers, gastric inhibitory polypeptide (GIP), leptin, glucagon, and inflammatory cytokines interleukin 4 (IL-4) and IL-5, 10 and 12, IFN-g and TNF-α were significantly affected by HFB diet. Pparα, Cyp7a1 and Fasn were down-regulated by HFB diet while LDL-R, Srebp-2, Adipoq and Slc2a4 were up-regulated by HFB diet. The ratio of Firmicutes/Bacteroidetes (F/B) was also decreased 64.1% by HFB diet compared to HF diet. The results indicated that cooked black turtle bean consumption could ameliorate insulin resistance and lower plasma LDL in mice fed HF diet through glucose signaling pathway and JNK/c-Jun pathway. Meanwhile, cooked black turtle bean consumption restored the gut microbiome.

Quercetin Ameliorates Insulin Resistance and Restores Gut Microbiome in Mice on High-Fat Diets.

Quercetin is a flavonoid that has been shown to have health-promoting capacities due to its potent antioxidant activity. However, the effect of chronic intake of quercetin on the gut microbiome and diabetes-related biomarkers remains unclear. Male C57BL/6J mice were fed HF or HF supplemented with 0.05% quercetin (HFQ) for 6 weeks. Diabetes-related biomarkers in blood were determined in mice fed high-fat (HF) diets supplemented with quercetin. Mice fed the HFQ diet gained less body, liver, and adipose weight, while liver lipid and blood glucose levels were also lowered. Diabetes-related plasma biomarkers insulin, leptin, resistin, and glucagon were significantly reduced by quercetin supplementation. In feces, quercetin supplementation significantly increased the relative abundance of Akkermansia and decreased the Firmicutes/Bacteroidetes ratio. The expression of genes Srebf1, Ppara, Cyp51, Scd1, and Fasn was downregulated by quercetin supplementation. These results indicated that diabetes biomarkers are associated with early metabolic changes accompanying obesity, and quercetin may ameliorate insulin resistance.

Surgical results and quality of life of patients submitted to restorative proctocolectomy and ileal pouch-anal anastomosis.

PURPOSE: restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in some cases of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). IPAA allows complete removal of the diseased colon and rectum, however, it is associated with substantial morbidity and potential consequences to patients' quality of life (QoL). AIMS: to evaluate the surgical results, functional outcomes and QoL after IPAA; and to examine the impact of surgical complications upon QoL. METHODS: we reviewed the records of 55 patients after IPAA, with emphasis on surgical outcomes. Forty patients answered the questionnaires. The Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ), and Short Form 36 Health Survey Questionnaire (SF36). RESULTS: the average age was 42.1±14.1 years. 63.6% of the patients were male, and 69.1% had FAP. Operative mortality was 1.8% and overall morbidity was 76.4%. Anastomotic leakage was the most frequent early complication (34.5%). Pouchitis (10.8%) and small bowel obstruction (9.1%) were the most common late complications. Patients with UC had the most severe complications (p=0.014). Pelvic complications did not have a negative effect on functional outcomes or QoL scores. Female patients had decreased pouch evacuation frequency, fewer nocturnal bowel movements, decreased bowel symptom impact on QoL (p=0.012), and better CGQL (p=0.04). Patients with better education had better QoL scores, and patients who had their pouches for more than five years scored lower. CONCLUSION: the high morbidity has no impact on function or QoL. Bowel function is generally acceptable. QoL is good and affected by sex, education and time interval since IPAA.

Quantification of biofilm produced by clinical, environment and hands' isolates Klebsiella species using colorimetric and classical methods.

Some species of Klebsiella, such as Klebsiella pneumoniae and Klebsiella oxytoca, are important nosocomial pathogens frequently involved in outbreaks in Neonatal Intensive Care Units (NICU) and have the ability to form a biofilm. This study aims to evaluate the biofilm production of K. pneumoniae and K. oxytoca isolates collected from the hands of health professionals, neonates' blood and the environment of a Brazilian NICU, using three colorimetric methods and a classical method of counting the colony-forming units and compare the analysis among these techniques. The biofilm formation was carried out by the microplate technique, using three colorimetric assays: crystal violet, safranin and 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl) -5 [(phenylamino) arbonyl] - 2H-tetrazolium hydroxide (XTT). Also, colony-forming units were determined. Twenty-eight isolates of K. pneumoniae were collected from the blood, hands and environment and five of K. oxytoca from the hands and environment. All of them were strong biofilm producers, but K. pneumoniae isolates produced more biofilm than K. oxytoca when compared to the American Type Culture Collection (ATCC) strains used as positive controls. The number of viable cells in the biofilm produced by K. pneumoniae isolated from blood was significantly higher than in the control sample. Regarding the three colorimetric tests used in the study, the violet crystal obtained a higher absorbance average. The use of crystal-violet and XTT in the evaluation of biofilm in vitro make possible a complete analysis, since that it can quantify the total biomass (including the extracellular matrix) and evaluate the metabolic activity. In conclusion, this study identified isolates of K. pneumoniae and K. oxytoca that produce biofilms in the NICU and the bloodstream of neonates. This fact deserves attention since these patients are immunocompromised. The best methods will be chosen to answer research questions by always adopting more than one method so that more than one parameter or component of the biofilm is analyzed.

Cryptococcus liquefaciens isolated from the hand of a healthcare professional in a neonatal intensive care unit.

Fungal infections are responsible for high morbidity and mortality in neonatal patients, especially in premature newborns. Infections in neonates caused by Cryptococcus spp. are rare, but it has occurred in an immunocompromised population. This study aims to describe the isolation of Cryptococcus liquefaciens from the hands of a health professional in a neonatal intensive care unit, and to evaluate the production of biofilm and virulence factors and susceptibility to antifungals. Antifungal susceptibility tests were performed according to Clinical and Laboratory Standard Institute document M27-A3. Thermotolerance virulence factors and DNase, phospholipase, proteinase, and hemolytic activities were verified through phenotypic tests; biofilm was evaluated by determining the metabolic activity and biomass. The isolate did not produce any of the tested enzymes and was susceptible to all antifungals (amphotericin B, fluconazole, and micafungin). The growth at 37 °C was very weak; however, the isolate showed a strong biomass production and low metabolic activity. This is the first report of C. liquefaciens isolated from the hands of a health professional. The isolate did not express any of the studied virulence factors in vitro, except for the low growth at 37 °C in the first 48 h, and the strong production of biofilm biomass. Cryptococcus liquefaciens can remain in the environment for a long time and is a human pathogen because it tolerates temperature variations. This report draws attention to the circulation of rare species in critical locations, information that may help in a fast and correct diagnosis and, consequently, implementation of an appropriate treatment.

Healthcare-associated infections in high-risk neonates: Temporal trends in a national surveillance system.

BACKGROUND: Increased survival of preterm neonates who require hospitalization at the Neonatal Intensive Care Unit has led to an increase in infections. This study aims to describe the temporal trend, risk factors, and outcome of healthcare-associated infections in a NICU of a high complexity hospital, with emphasis on the differences of incidence between bacterial and fungal infections. METHODS: The study was carried out from January 2013 to December 2016, with daily follow-up of the newborns by the National Healthcare Safety Network. RESULTS: The study included 881 newborns, of whom 214 had a bacterial infection, 19 had fungi infection, and 12 bacterial and fungal infections associated. The hospital infection rate was 12/1000 patient-days. SNAPPE>24, days of hospitalization and PICC days were independent risk factors for the development of fungal and bacterial infection, respectively, with statistical significance for bacterial and fungal infections. The mortality rate was 2.6 times higher in those who had fungal infection than in those who had a bacterial infection. The occurrence of invasive infections was higher in the years 2015 and 2016 and Gram-negative bacteria and yeasts were more frequent, impacting morbidity and mortality. CONCLUSIONS: The use of invasive devices is a risk factor for the occurrence of HAI caused by bacteria and fungi. The frequency of deaths was higher in the group of neonates with fungal infection. These results point to the importance of constant epidemiological surveillance and measures of effective control of infections in NICU.

Tiger Nut (Cyperus esculentus) as a Functional Ingredient in Gluten-Free Extruded Snacks.

Tiger nut (TN) is a nutritious source of gluten-free flour, used generally in healthy beverages, but its incorporation in gluten-free extruded snacks has not been explored. TN flour was blended at different concentrations (up to 70%) with rice flour and soluble fiber, for the development of gluten-free snacks on a twin-screw extruder. The effect of TN inclusion in the formulations was evaluated on relevant physiochemical characteristics of the snacks. Viscoamylograph of the raw formulations showed that TN addition increased (p < 0.01) onset temperature and delayed peak viscosity. In the extruded flours, TN contributed to limit the starch degradation during extrusion. Diameter, expansion ratio, true density, and total pore volume of the extrudates were reduced (pf < 0.01) by the increased TN content in the formulations, while bulk density rose. The surfaces of the extruded snacks were modified by the increasing inclusion of TN in substitution of rice in the formulations. Extrudates containing 10% TN showed the best overall texture profile. Moreover, TN addition enhanced the ash and protein content of the snacks and increased their total antioxidant activity. This study demonstrated that incorporation of 10% TN flour into rice-based formulation was suitable for making gluten-free snacks with acceptable physical properties.

Candidemia by Candida parapsilosis in a neonatal intensive care unit: human and environmental reservoirs, virulence factors, and antifungal susceptibility.

The Candida parapsilosis complex has emerged as one of the main causes of candidemia worldwide. This study aims to evaluate possible C. parapsilosis sensu stricto reservoirs in a NICU, the expression of virulence factors, and antifungal susceptibility, and to analyze their genetic and phenotypic similarity. The study included 17 isolates of C. parapsilosis: seven environmental, one from a newborn's mother, and nine samples from six newborns. We used molecular and phenotypic tests to characterize the isolates and to trace possible routes of infection. The genetic similarity was determined by random amplified polymorphic DNA. The hemolytic and DNAse activity was determined using sheep's blood and DNAse agar, biofilm production by XTT method, and the susceptibility to antifungals through microdilution methodology. Two environmental strains isolated in the same month had high similarity. The 17 isolates expressed at least one of the three virulence factors studied, and one environmental isolate was resistant to fluconazole. This study shows that environmental contamination can be an important reservoir of potentially pathogenic microorganisms, since isolates of C. parapsilosis sensu stricto collected from the hospital environment were able to express virulence factors. Therefore, we emphasized the importance of determining the transmission routes in NICU in order to detect pathogen sources and reservoirs, as well as to establish prevention measures, such as adequate disinfection of the environment.

Risk factors associated with mortality among patients who had candidemia in a university hospital.

INTRODUCTION: Bloodstream infection due to Candida spp. is a primary cause of morbidity and mortality in tertiary hospitals. METHODS: In this retrospective study, we included patients with a positive blood culture for Candida spp. after 48 h of hospitalization. RESULTS: A total of 335 patients who had candidemia were included in this study. Risk factors associated with mortality were hospitalization in internal medicine units and surgical clinics, age >60 years, mechanical ventilation, orotracheal intubation, hemodialysis, corticosteroids use, and C. parapsilosis infection. CONCLUSIONS: This study highlights the importance of health care related to invasive procedures and actions to improve patient immunity.