Extracellular vesicles from the mycoparasitic fungus Trichoderma harzianum.

Trichoderma harzianum is a filamentous fungus that can act as a mycoparasite, saprophyte, or a plant symbiotic. It is widely used as a biological control agent against phytopathogenic fungi and can also be used for plant growth promotion and biofortification. Interaction between T. harzianum and phytopathogenic fungi involves mycoparasitism, competition, and antibiosis. Extracellular vesicles (EVs) have been described as presenting a central role in mechanisms of communication and interaction among fungus and their hosts. In this study, we characterized extracellular vesicles of T. harzianum produced during growth in the presence of glucose or S. sclerotiorum mycelia. A set of vesicular proteins was identified using proteomic approach, mainly presenting predicted signal peptides.

High Frequency of OXA-253-Producing Acinetobacter baumannii in Different Hospitals in Recife, Brazil.

Here, we report the isolation of 31 Acinetobacter baumannii strains producing OXA-253 in a single large Brazilian city. These strains belonged to five different sequence types (STs), including 4 STs not previously associated with blaOXA-253 In all strains, the blaOXA-253 gene was located in a plasmid within a genetic environment similar to what was found previously in Brazil and Italy. The reported data emphasize the successful transmission of the blaOXA-253 gene through a large area and the tendency for this resistance determinant to remain in the A. baumannii population.

Mutational and acquired carbapenem resistance mechanisms in multidrug resistant Pseudomonas aeruginosa clinical isolates from Recife, Brazil.

An investigation was carried out into the genetic mechanisms responsible for multidrug resistance in nine carbapenem-resistant Pseudomonas aeruginosa isolates from different hospitals in Recife, Brazil. Susceptibility to antimicrobial agents was determined by broth microdilution. Polymerase chain reaction (PCR) was employed to detect the presence of genes encoding ß-lactamases, aminoglycoside-modifying enzymes (AMEs), 16S rRNA methylases, integron-related genes and OprD. Expression of genes coding for efflux pumps and AmpC cephalosporinase were assessed by quantitative PCR. The outer membrane proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The blaSPM-1, blaKPC-2 and blaGES-1 genes were detected in P. aeruginosa isolates in addition to different AME genes. The loss of OprD in nine isolates was mainly due to frameshift mutations, premature stop codons and point mutations. An association of loss of OprD with the overexpression of MexAB-OprM and MexXY-OprM was observed in most isolates. Hyper-production of AmpC was also observed in three isolates. Clonal relationship of the isolates was determined by repetitive element palindromic-PCR and multilocus sequence typing. Our results show that the loss of OprD along with overexpression of efflux pumps and ß-lactamase production were responsible for the multidrug resistance in the isolates analysed.

Fatal cardiac tamponade associated with central venous catheter: a report of 2 cases diagnosed in autopsy.

The authors present 2 cases of fatal cardiac tamponade associated with the insertion of a central venous catheter. The first case occurred soon after the insertion of the catheter (early complication), and the second case, 4 days after (late complication). In both cases, the post-catheter insertion check chest x-ray film showed the tip of the catheter located within the heart silhouette. The diagnosis of cardiac tamponade was made only during the cadaverous examination. In the first case, the catheter was found to be in the right internal jugular vein at autopsy. The postmortem examination showed a clear liquid inside the pericardial cavity and the inferior vena cava injury. In the second case, the catheter had been inserted via the right subclavian vein puncture and there was a perforation of the right atrium at autopsy. The child was using total parenteral nutrition, and the intrapericardial liquid was milky. The incorrect placement of the catheter tip and unrecognized complications led the 2 children to death.

Anti-inflammatory and antiophidic effects of extract of Hymenaea eriogyne Benth and structure-activity relationship prediction of the major markers in silico.

ETHNOPHARMACOLOGICAL RELEVANCE: Hymenaea eriogyne Benth (Fabaceae) is popularly known as "Jatobá". Despite its use in folk medicine to treat inflammatory disorders, there are no descriptions that show its anti-inflammatory potential. AIM OF THE STUDY: In this sense, this study aimed to evaluate the anti-inflammatory and antivenom action of bark and leaves extract of H. eriogyne. MATERIALS AND METHODS: The in vivo anti-inflammatory activity was conducted by carrageenan-induced paw edema and zymosan-induced air pouch models, evaluating the edematogenic effect, leukocyte migration, protein concentration, levels of pro-inflammatory cytokines, malondialdehyde (MDA) and MPO activity. The antivenom potential was investigated in vitro on the enzymatic action (proteolytic, phospholipase and hyaluronidase) of Bothrops brazili and B. leucurus venom, as well as in vivo on the paw edema model induced by B. leucurus. Furthermore, the influence of its markers (astilbin and rutin) on myeloperoxidase (MPO) activity was investigated in silico. For molecular docking, AutodockVina, Biovia Discovery Studio, and Chimera 1.16 software were used. RESULTS: The extracts and bark and leaves of H. eriogyne revealed a high anti-inflammatory effect, with a reduction in all inflammatory parameters evaluated. The bark extract showed superior results when compared to the leaf extract, suggesting the influence of the astilbin concentration, higher in the bark, on the anti-inflammatory action. In addition, only the H. eriogyne bark extract was able to reduce MDA, indicating an associated antioxidant effect. Regarding the in vitro antivenom action, the extracts (bark and leaves) revealed the ability to inhibit the proteolytic, phospholipase and hyaluronidase action of both bothropic venom, with a greater effect against B. leucurus venom. In vivo, extracts from the bark and leaves of H. eriogyne (50 - 200 mg/kg) showed antiedematogenic activity, reducing the release of MPO and pro-inflammatory cytokines, indicating the presence of bioactive components useful in controlling the inflammatory process induced by the venom. In the in silico assays, astilbin and rutin showed reversible interactions of 9 possible positions and orientations towards MPO, with affinities of -9.5 and -10.4 kcal/mol and interactions with Phe407, Gln91, His95 and Arg239, important active pockets of MPO. Rutin demonstrated more effective types of interactions with MPO. CONCLUSION: This approach reveals for the first time the anti-inflammatory action of H. eriogyne bark and leaf extracts in vivo, as well as its antiophidic potential. Moreover, the distinct effect of pharmacogens as antioxidant agents and distinct effect of astilbin and rutin under MPO sheds light on the different anti-inflammatory mechanisms of bioactive compounds present in H. eriogyne extracts, with high potential for the prospection of new pharmacological agents.

First description of KPC-2-producing Klebsiella oxytoca in Brazil.

The present work reports the detection of the first case of nosocomial Klebsiella oxytoca producing class A carbapenemase KPC-2 in Brazil. The isolate KPN106 carried a 65-kb IncW-type plasmid that harbors the blaKPC gene and Tn4401b. Moreover, we detected the presence of a class 1 integron containing a new allele, arr-8, followed by a 5'-truncated dhfrIIIc gene. In view of the recent results, we emphasize the high variability of the bacterial and genetic hosts of this resistance determinant.

First description of KPC-2-producing Pseudomonas putida in Brazil.

This work reports the identification of the first case of a KΡC-2-producing Pseudomonas putida isolate (PP36) in Brazil. The PP36 isolate was resistant to all the antimicrobials tested except polymyxin B. In addition to the discovered bla(KPC-2) gene, genetic analysis showed the presence of a class 1 integron containing the dhfrXVb gene and the new allele arr-6, which codes for resistance to rifampin. These elements were found in an IncFI 65-kb plasmid.

Changing the epidemiology of carbapenem-resistant Pseudomonas aeruginosa in a Brazilian teaching hospital: the replacement of São Paulo metallo-ß-lactamase-producing isolates.

In Brazil, carbapenem-resistant Pseudomonas aeruginosa isolates are closely related to the São Paulo metallo-ß-lactamase (SPM) Brazilian clone. In this study, imipenem-resistant isolates were divided in two sets, 2002/2003 and 2008/2009, analysed by pulsed field gel electrophoresis and tested for the Ambler class B metallo-ß-lactamase (MBL) genes blaSPM-1, blaIMP and blaVIM. The results show a prevalence of one clone related to the SPM Brazilian clone in 2002/2003. In 2008/2009, P. aeruginosa isolates were mostly MBL negative, genetically diverse and unrelated to those that had been detected earlier. These findings suggest that the resistance to carbapenems by these recent P. aeruginosa isolates was not due to the spread of MBL-positive SPM-related clones, as often observed in Brazilian hospitals.

Phytochemical analysis and preclinical toxicological, antioxidant, and anti-inflammatory evaluation of hydroethanol extract from the roots of Harpalyce brasiliana Benth (Leguminosae).

ETHNOPHARMACOLOGICAL RELEVANCE: Harpalyce brasiliana Benth (Leguminosae) is a shrub endemic to Brazil, popularly known as "snake's root." This species is used in folk medicine for the treatment of inflammation and snakebites. However, up to now there is no scientific research to justify its popular use. The study aimed to characterize the phytochemical profile of the hydroethanol extract from the roots of H. brasiliana (Hb), to evaluate its antioxidant and anti-inflammatory potential, as well as to investigate its cytotoxicity and acute toxicity. MATERIALS AND METHODS: The extract was obtained by maceration method using a solution of ethanol:water (70: 30, v/v). The phytochemical profile was obtained by liquid chromatography coupled to mass spectrometry. The cytotoxicity of extract (31-2000 µg/mL) was evaluated in vitro, by the 3-methyl-[4-5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) method using murine macrophage and fibroblast cell lines (RAW 247.6 and 3T3, respectively) and by the hemolytic assay. For the in vivo acute toxicity, the extract (2000 mg/kg) was administered and after 14 days the weight (body and organs) and hematological and biochemical parameters were analyzed. Chemical free radical scavenging effect of the extract (125-2000 µg/mL) was investigated through diphenylpicryl hydrazine reduction, total antioxidant capacity, reducing power, hydroxyl radical scavenging, and iron and copper chelating assays. In vitro anti-inflammatory effect of the extract (125, 500, and 2000 µg/mL) was demonstrated through of nitric oxide (NO) analyzed in lipopolysaccharides stimulated RAW 264.7 cells. In vivo anti-inflammatory activities were evaluated in carrageenan-induced paw edema and zymosan-air-pouch models, with gavage administration (post-treatment) of extract at 100, 200, and 400 mg/kg. For the first animal model, the anti-edematogenic activity and myeloperoxidase (MPO) levels were investigated, while in the zymosan-air-pouch model the leukocyte number, MPO, total protein and pro-inflammatory cytokine (IL-1ß, IL-6, and TNF-α) levels were quantified. In addition, the oxidative parameters such as malondialdehyde (MDA) and reduced glutathione (GSH) were determined. RESULTS: The phytochemical profile revealed the presence of 20 compounds, mainly prenylated and geranylated pterocarpans. The extract demonstrated no cytotoxicity in erythrocytes, macrophages and fibroblasts cells at the tested concentrations, as well as no sign of toxicity and mortality or significant alterations on the hematological and biochemical parameters in the acute toxicity model. The extract was also able to neutralize chemical free radicals, with copper and iron chelating effect. For the NO dosage, the extract evidenced the reduction of expression of NO after the administration of the extract (500 and 2000 µg/mL). The edematogenic model revealed a decrease in paw edema and MPO level, while the zymosan-air-pouch model evidenced a reduction of leukocyte number (especially of polymorphornuclears), MPO production, and total protein and cytokine levels, and demonstrated the antioxidant effect through a decrease in MDA and increase in GSH parameters. CONCLUSION: This approach demonstrates for the first time that Hb is not cytotoxic, has low acute toxicity, and possesses antioxidant and anti-inflammatory properties in preclinical analyses, corroborating its popular use.

Ricotta cream: classification based on moisture and fat content considering general standards for cheeses and cream cheeses.

Ricotta cream though an emerging product sold in Brazil, by 2021 it has no fixed quality standards, a condition that can result in products with variable composition and properties. Additionally, there are no methods of sampling or analysis for its official control. In this context, this study investigated the physicochemical quality of five Brazilian ricotta cream brands to verify the extent of differences in the composition of this product, emphasizing the characterization and classification according to the Brazilian legislation and the Codex Alimentarius standards. Significant differences between brands concerning pH, titratable acidity, moisture, ash, fat, and fat in dry matter (FDM) were observed (P < 0.05), which were probably a result of their heterogeneous ingredient composition. According to Brazilian regulatory standards, all samples fit the "very high moisture" definition, and the brands A, B, D and E achieved the classification of "high-fat cheeses" since they contained at least 60.0% of FDM. Brand C was the only product that could be classified as a "medium fat cheese" due to having FDM values between 25.0% and 44.9%. All samples fit the Brazilian and Codex Alimentarius classification for "cream cheeses" based on their moisture, dry matter content, moisture on a fat-free basis and FDM. The results reinforce the need for regulatory standards regarding the physicochemical quality and composition of this cheese variety, to guarantee more transparency for the consumers and that they have access to more homogeneous products.

Dehydrodieugenol B and hexane extract from Endlicheria paniculata regulate inflammation, angiogenesis, and collagen deposition induced by a murine sponge model.

The present study reports the evaluation of hexane extract from Endlicheria paniculata and its main metabolite dehydrodieugenol B in the inflammatory response induced by a murine implant sponge model. As a result, a reduction in the inflammatory markers (myeloperoxidase and N-acetyl-ß-D-glucosaminidase) and number of mast cells were observed in comparison to the control group. All doses were also able to reduce angiogenic parameters evaluated in fibrovascular tissue. In implants treated with dehydrodieugenol B a reduction in total collagen deposition and types I and III collagen fibers were observed, while an increased in total collagen deposition and types I and III collagen fibers were observed in the treatment with hexane extract. Docking studies into cyclooxygenase-2 active site revealed that the dehydrodieugenol B had binding modes and energies comparable with celecoxib, diclofenac and ibuprofen. Therefore, dehydrodieugenol B was able to alter key components of chronic inflammation, resulting in a reduced inflammatory response and also presenting antifibrogenic and antiangiogenic effects. However, treatment with hexane extract resulted in a reduced inflammatory response with antiangiogenic effects, but caused fibrogenic effects.

Comparative Genomics of Acinetobacter baumannii Clinical Strains From Brazil Reveals Polyclonal Dissemination and Selective Exchange of Mobile Genetic Elements Associated With Resistance Genes.

Acinetobacter baumannii is an opportunistic bacterial pathogen infecting immunocompromised patients and has gained attention worldwide due to its increased antimicrobial resistance. Here, we report a comparative whole-genome sequencing and analysis coupled with an assessment of antibiotic resistance of 46 Acinetobacter strains (45 A. baumannii plus one Acinetobacter nosocomialis) originated from five hospitals from the city of Recife, Brazil, between 2010 and 2014. An average of 3,809 genes were identified per genome, although only 2,006 genes were single copy orthologs or core genes conserved across all sequenced strains, with an average of 42 new genes found per strain. We evaluated genetic distance through a phylogenetic analysis and MLST as well as the presence of antibiotic resistance genes, virulence markers and mobile genetic elements (MGE). The phylogenetic analysis recovered distinct monophyletic A. baumannii groups corresponding to five known (ST1, ST15, ST25, ST79, and ST113) and one novel ST (ST881, related to ST1). A large number of ST specific genes were found, with the ST79 strains having the largest number of genes in common that were missing from the other STs. Multiple genes associated with resistance to ß-lactams, aminoglycosides and other antibiotics were found. Some of those were clearly mapped to defined MGEs and an analysis of those revealed known elements as well as a novel Tn7-Tn3 transposon with a clear ST specific distribution. An association of selected resistance/virulence markers with specific STs was indeed observed, as well as the recent spread of the OXA-253 carbapenemase encoding gene. Virulence genes associated with the synthesis of the capsular antigens were noticeably more variable in the ST113 and ST79 strains. Indeed, several resistance and virulence genes were common to the ST79 and ST113 strains only, despite a greater genetic distance between them, suggesting common means of genetic exchange. Our comparative analysis reveals the spread of multiple STs and the genomic plasticity of A. baumannii from different hospitals in a single metropolitan area. It also highlights differences in the spread of resistance markers and other MGEs between the investigated STs, impacting on the monitoring and treatment of Acinetobacter in the ongoing and future outbreaks.

Potencialities of ciberspaSUS: social networks as devices of public health policies in Brazil. / Potências do CiberespaSUS: redes sociais como dispositivos de políticas públicas de saúde no Brasil.

OBJECTIVE: This paper examines two experiences of social networks developed as a space for strengthening public health policies in the Brazilian context. To describe and analyze some possibilities of using social networks as devices linked to public health policies based on the experience of two comparative cases currently underway in Brazil: The HumanizaSUS Network and the Community of Primary Care Practices. METHODS: This is qualitative research with a comparative case study approach, with emphasis on the exploitation of data available in the public platform of both networks and publications around these two experiences. RESULTS: Webometric data of the cases studied will be shown, pointing out aspects of differentiation and similarity between them from three axes of analysis: (1) theoretical-conceptual framework; (2) the design of the platform, its functionalities and its daily support process; (3) the singularities of the related policies. The discussion of these points indicates that social networks can function as devices for education, production of a collection of experiences, clinical collaboration and especially a collaborative creation of spaces for sharing experiences and collective reflection on the daily construction of public policy.

Este artigo examina duas experiências de redes sociais desenvolvidas como espaço de fortalecimento das políticas públicas de saúde no contexto brasileiro. O objetivo é descrever e analisar algumas possibilidades de uso das redes sociais como dispositivos vinculados às políticas públicas de saúde, a partir da experiência de dois casos comparados em curso no Brasil: a Rede Humaniza SUS e a Comunidade de Práticas da Atenção Básica. Trata-se de uma pesquisa qualitativa que parte da abordagem de estudo de caso comparados, com ênfase na exploração de dados disponíveis na plataforma pública de ambas as redes e em publicações em torno destas duas experiências. Serão apresentados dados webométricos dos casos estudados, apontando aspectos de diferenciação e semelhança entre eles, a partir de três eixos de análise: (1) marco teórico-conceitual; (2) o design da plataforma, suas funcionalidades e seu processo de sustentação cotidiana; (3) as singularidades das políticas vinculadas. A discussão desses pontos indica que as redes sociais podem funcionar como dispositivos para a formação, para a produção de acervo de experiências, para a colaboração clínica e, especialmente, para a criação colaborativa de espaços de compartilhamento de experiências e reflexão coletiva sobre a construção cotidiana de uma política pública.

Educação continuada ou permanente em saúde? análise da produção pan-americana da saúde / Continued or permanent education in health? analysis of the production of the pan american health organization / ¿ educación continua o permanente en salud? análisis de la producción de la organización panamericana de la salud

Resumo A fim de resgatar e sistematizar os diferentes posicionamentos que conformaram a trajetória de construção da noção de educação permanente em saúde, o artigo tem como objetivo revisar as discussões realizadas pela Organização Pan-Americana da Saúde, no período entre 1974 e 2002, em relação às práticas de educação na saúde, com o intuito de compreender as linhas de força, intencionalidades e jogos de poder involucrados nesse debate. Realizou-se pesquisa documental e bibliográfica, utilizando como referencial analítico a noção de matriz conceitual. Os resultados apresentam os elementos componentes destas matrizes e seus respectivos contextos de emergência, os quais corroboram a existência de duas matrizes conceituais na produção da Organização Pan-Americana da Saúde, a saber, a educação continuada em saúde e a educação permanente em saúde referentes, respectivamente, aos períodos de 1974 a 1984 e 1985 a 2002. Discute-se que a ampliação e a reconfiguração do plano conceitual ensejadas pela segunda matriz, em grande medida centradas no método pedagógico, esbarra em limites que podemos correlacionar não apenas ao redirecionamento da agenda da instituição, mas também à experiência de implementação da Política Nacional de Educação Permanente em Saúde e às contradições que marcaram a trajetória da gestão do trabalho do Sistema Único de Saúde.

Abstract To rescue and systematize the different positions that shaped the path of the construction of the permanent education in health concept, the article aims to review the discussions carried out by the Pan American Health Organization in the period ranging from 1974 to 2002 with regard to health education practices to understand the lines of force, intentionalities, and power games involved in this debate. Documental and bibliographical research was carried out using the conceptual matrix notion as an analytical reference. The results present the elements that comprise these matrices and their respective emergency contexts, which corroborate the existence of two conceptual matrices in the production of the Pan American Health Organization, namely continuing education in health and permanent health education, respectively, from 1974 to 1984 and from 1985 to 2002. It is argued that the expansion and reconfiguration of the conceptual plan provided by the second matrix, largely centered on the pedagogical method, faces limitations that we can correlate not only with the redirection of the institution's agenda, but also with the experience of implementing the National Policy for Permanent Education in Health and the contradictions that marked the path followed by the management of the work of the Unified Health System.

Resumen Con la finalidad de recobrar y sistematizar los diferentes posicionamientos que han conformado la trayectoria de construcción de la noción de educación permanente en salud, el artículo tiene como objetivo revisar las discusiones realizadas por la Organización Panamericana de la Salud, en el período de 1974 a 2001, con relación a las prácticas de educación en la salud, con el objetivo de comprender las líneas de fuerza, intencionalidades y juegos de poder involucrados en este debate. Se realizó una investigación documental y bibliográfica, utilizando como referencia analítica la noción de matriz conceptual. Los resultados presentan los elementos componentes de estas matrices y sus respectivos contextos de emergencia, los cuales corroboran la existencia de dos matrices conceptuales en la producción de la organización Panamericana de la salud, a saber, la educación continua en salud y la educación permanente en salud referentes, respectivamente, a los períodos de 1974 a 1984 y 1985 a 2002. Se discute que la ampliación y la reconfiguración del plano conceptual posibilitadas por la segunda matriz, en gran medida centradas en el método pedagógico, tropiezan con límites que podemos correlacionar no solo con la reorientación de la agenda de la institución, sino también con la experiencia de implementación de la Política Nacional de Educación Permanente en Salud y con las contradicciones que han marcado la trayectoria de la gestión del trabajo del Sistema Único de Salud.

Potências do CiberespaSUS: redes sociais como dispositivos de políticas públicas de saúde no Brasil / Potencialities of ciberspaSUS: social networks as devices of public health policies in Brazil

Resumo Este artigo examina duas experiências de redes sociais desenvolvidas como espaço de fortalecimento das políticas públicas de saúde no contexto brasileiro. O objetivo é descrever e analisar algumas possibilidades de uso das redes sociais como dispositivos vinculados às políticas públicas de saúde, a partir da experiência de dois casos comparados em curso no Brasil: a Rede Humaniza SUS e a Comunidade de Práticas da Atenção Básica. Trata-se de uma pesquisa qualitativa que parte da abordagem de estudo de caso comparados, com ênfase na exploração de dados disponíveis na plataforma pública de ambas as redes e em publicações em torno destas duas experiências. Serão apresentados dados webométricos dos casos estudados, apontando aspectos de diferenciação e semelhança entre eles, a partir de três eixos de análise: (1) marco teórico-conceitual; (2) o design da plataforma, suas funcionalidades e seu processo de sustentação cotidiana; (3) as singularidades das políticas vinculadas. A discussão desses pontos indica que as redes sociais podem funcionar como dispositivos para a formação, para a produção de acervo de experiências, para a colaboração clínica e, especialmente, para a criação colaborativa de espaços de compartilhamento de experiências e reflexão coletiva sobre a construção cotidiana de uma política pública.

Abstract This paper examines two experiences of social networks developed as a space for strengthening public health policies in the Brazilian context. Objective To describe and analyze some possibilities of using social networks as devices linked to public health policies based on the experience of two comparative cases currently underway in Brazil: The HumanizaSUS Network and the Community of Primary Care Practices. Methods This is qualitative research with a comparative case study approach, with emphasis on the exploitation of data available in the public platform of both networks and publications around these two experiences. Results Webometric data of the cases studied will be shown, pointing out aspects of differentiation and similarity between them from three axes of analysis: (1) theoretical-conceptual framework; (2) the design of the platform, its functionalities and its daily support process; (3) the singularities of the related policies. The discussion of these points indicates that social networks can function as devices for education, production of a collection of experiences, clinical collaboration and especially a collaborative creation of spaces for sharing experiences and collective reflection on the daily construction of public policy.

[Education and competences for the Brazilian Unified Health System (SUS): is it possible to find alternatives to the logic of late capitalism?]. / Educação e competências para o SUS: é possível pensar alternativas à(s) lógica(s) do capitalismo tardio?

The transformations that have revolutionized the labor market in contemporary society make it necessary to think of new alternatives for training health care professionals, thereby establishing a new approach to the health problems of individuals and collectives. Based on these considerations, this paper sets out to discuss training in health--based on the concept of competence--with a focus on education for the Brazilian Unified Health System (SUS), using attempts to analyze and propose an alternative to the system entrenched in the logic of late capitalism as a theoretical benchmark. It is thus a reflection on the subject, correlating theory and praxis, in constant and relentless movement of construction, deconstruction and (re)construction of propositions.

Emergence of extensively drug-resistant OXA-72-producing Acinetobacter baumannii in Recife, Brazil: risk of clonal dissemination?

Two new examples of OXA-72-producing Acinetobacter baumannii isolate resistant to a broad spectrum of antimicrobials, but not polymyxin B, have been identified in Recife, Brazil. Molecular typing indicated a close genetic link with the OXA-72-producing A. baumannii previously isolated in São Paulo, suggesting the possibility of clonal dissemination within the country.

Mutational and acquired carbapenem resistance mechanisms in multidrug resistant Pseudomonas aeruginosa clinical isolates from Recife, Brazil

An investigation was carried out into the genetic mechanisms responsible for multidrug resistance in nine carbapenem-resistant Pseudomonas aeruginosaisolates from different hospitals in Recife, Brazil. Susceptibility to antimicrobial agents was determined by broth microdilution. Polymerase chain reaction (PCR) was employed to detect the presence of genes encoding β-lactamases, aminoglycoside-modifying enzymes (AMEs), 16S rRNA methylases, integron-related genes and OprD. Expression of genes coding for efflux pumps and AmpC cephalosporinase were assessed by quantitative PCR. The outer membrane proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The blaSPM-1, blaKPC-2 and blaGES-1 genes were detected in P. aeruginosaisolates in addition to different AME genes. The loss of OprD in nine isolates was mainly due to frameshift mutations, premature stop codons and point mutations. An association of loss of OprD with the overexpression of MexAB-OprM and MexXY-OprM was observed in most isolates. Hyper-production of AmpC was also observed in three isolates. Clonal relationship of the isolates was determined by repetitive element palindromic-PCR and multilocus sequence typing. Our results show that the loss of OprD along with overexpression of efflux pumps and β-lactamase production were responsible for the multidrug resistance in the isolates analysed.

Educação e competências para o SUS: é possível pensar alternativas à(s) lógica(s) do capitalismo tardio? / Education and competences for the Brazilian Unified Health System (SUS): is it possible to find alternatives to the logic of late capitalism?

As transformações vividas no mundo do trabalho na sociedade contemporânea levam à necessidade de se repensar alternativas para a formação dos profissionais de saúde, permitindo, assim, a abordagem dos problemas de saúde dos sujeitos e das coletividades. Com base nessas considerações, o presente trabalho pretende discutir a formação em saúde - em torno do conceito de competência -, tendo como foco a educação para o SUS, tomando como marco teórico a tentativa de analisar e propor uma alternativa àquelas entrincheiradas na lógica do capitalismo tardio. Trata-se, pois, de uma reflexão sobre o assunto, correlacionando a teoria e a práxis, num movimento constante e incessante de construção, desconstrução e (re)construção de proposições.

The transformations that have revolutionized the labor market in contemporary society make it necessary to think of new alternatives for training health care professionals, thereby establishing a new approach to the health problems of individuals and collectives. Based on these considerations, this paper sets out to discuss training in health - based on the concept of competence - with a focus on education for the Brazilian Unified Health System (SUS), using attempts to analyze and propose an alternative to the system entrenched in the logic of late capitalism as a theoretical benchmark. It is thus a reflection on the subject, correlating theory and praxis, in constant and relentless movement of construction, deconstruction and (re)construction of propositions.

Changing the epidemiology of carbapenem-resistant Pseudomonas aeruginosa in a Brazilian teaching hospital: the replacement of São Paulo metallo-β-lactamase-producing isolates

In Brazil, carbapenem-resistant Pseudomonas aeruginosa isolates are closely related to the São Paulo metallo-β-lactamase (SPM) Brazilian clone. In this study, imipenem-resistant isolates were divided in two sets, 2002/2003 and 2008/2009, analysed by pulsed field gel electrophoresis and tested for the Ambler class B metallo-β-lactamase (MBL) genes blaSPM-1, blaIMP and blaVIM. The results show a prevalence of one clone related to the SPM Brazilian clone in 2002/2003. In 2008/2009, P. aeruginosa isolates were mostly MBL negative, genetically diverse and unrelated to those that had been detected earlier. These findings suggest that the resistance to carbapenems by these recent P. aeruginosa isolates was not due to the spread of MBL-positive SPM-related clones, as often observed in Brazilian hospitals.