Role of antimicrobial stewardship programmes in children: a systematic review.

The United Nations and the World Health Organization have designated antimicrobial resistance (AMR) as a major health priority and developed action plans to reduce AMR in all healthcare settings. Establishment of institutional antimicrobial stewardship programmes (ASPs) is advocated as a key intervention to reduce antibiotic consumption in hospitals and address high rates of multi-drug-resistant (MDR) bacteria. PUBMED and the Cochrane Database of Systematic Reviews (January 2007-March 2017) were searched to identify studies reporting the effectiveness of ASPs in general paediatric wards and paediatric intensive care units (PICUs) for reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, and antibiotic resistance and healthcare-associated infections (HAIs). Neonatal units and antifungal agents were excluded. Of 2509 titles and abstracts, nine articles were eligible for inclusion in the final analysis. All studies reported a reduction in the use of broad-spectrum/restricted antibiotics or antibiotic consumption. One study reported a reduction in HAIs in a PICU, and another study evaluated bacterial resistance, showing no effect following ASP implementation. Prospective audit on antibiotic use was the most common ASP core component (eight of nine studies). Antibiotic pre-authorization was described in two studies. Other described interventions were the provision of guidelines or written information (five of nine studies), and training of healthcare professionals (one study). There is limited evidence for a reduction in antibiotic consumption and use of broad-spectrum/restricted agents following ASP implementation specifically in PICUs. Data evaluating the impact of ASPs on HAIs and AMR in PICUs are lacking. In addition, there is limited information on effective components of a successful ASP in PICUs.

Vitamin C supplementation has no effect on American bullfrog's immune response.

American bullfrog (Lithobates catesbeianus) is the only species raised in Brazilian commercial frog farms, and the intensive culture of these animals has gained great popularity in Brazil over the past several years. Stress is one of the major obstacles in frog culture. To minimise this problem, the aim of the present study was to investigate the role of added vitamin C in the diet of American bullfrogs as an antistress factor through the assessment of plasma corticosterone, leucocyte levels and macrophage activation in animals raised in confinement. The experimental design was entirely randomised, with six treatments (supplementation of 0, 250, 500, 750, 1000 and 2000 mg of vitamin C/kg of feed) and four replications. The plasma corticosterone level, leucocyte level and macrophage activation were evaluated. It was concluded that vitamin C had no influence on the evaluated parameters due to the possible adaptation of the animals to life in captivity (domestication). The results of this research indicate that farmers should not increase the levels of vitamin C in commercial feeds because this would only enhance production costs.

Radon as a natural tracer for gas transport within uranium waste rock piles.

Acid mine drainage (AMD) has been identified as the main cause for outflow of acid water and radioactive/non-radioactive contaminants. AMD encompasses pyrites oxidation when water and oxygen are available. AMD was identified in uranium waste rock piles (WRPs) of Indústrias Nucleares do Brasil-Caldas facility (Brazilian uranium mine), resulting in high costs for water treatment. AMD reduction is the main challenge, and scientific investigation has been conducted to understand oxygen and water transportation within WRPs, where 222Rn is used as natural tracer for oxygen transportation. The study consists of soil radon gas mapping in the top layer of WRP4 using active soil gas pumping, radon adsorption in active charcoal and 222Rn determination using high-resolution gamma-ray spectrometry. A sampling network of 71 points was built where samples were collected at a depth of 40 cm. Soil radon gas concentration ranged from 33.7 to 1484.2 kBq m(-3) with mean concentration of 320.7±263.3 kBq m(-3).

Antiquity, botany, origin and domestication of Jatropha curcas (Euphorbiaceae), a plant species with potential for biodiesel production.

Jatropha curcas is a multi-purpose plant species, with many advantages for biodiesel production. Its potential oil productivity is 1.9 t/ha, beginning the fourth year after planting. Nevertheless, limitations such as high harvest cost, lack of scientific konowledge and low profitability have prevented it from being utilized commercially. In order to provide information that could be useful to improve the status of this species as a bioenergy plant, we elucidated the center of origin and the center of domestication of J. curcas (Mexico). Evidence of the antiquity of knowledge of J. curcas by Olmeca people, who lived 3500-5000 years ago, reinforces its Mexican origin. The existence of non-toxic types, which only exist in that country, along with DNA studies, also strongly suggest that Mexico is the domestication center of this species. In Brazil, the Northern region of Minas Gerais State presents types with the highest oil content. Here we propose this region as a secondary center of diversity of J. curcas.

Selenite and selenate effects on mercury (Hg(2+)) uptake and distribution in tilapia, Oreochromis niloticus L., assessed by chronic bioassay.

Aquatic organisms are considered excellent biomarkers of mercury (Hg) occurrence in the environment. Selenium (Se) acts in antagonism to this metal, stimulating its elimination, and reducing its toxicity. In this paper, tilapia (Oreochromis niloticus) were chronically acclimated in sub-lethal Hg(2+), Hg(2+) + Se(4+) and Hg(2+) + Se(6+) concentrations. Distribution and bioaccumulation of both elements were evaluated in fish tissues. The kidney was the main target of the Hg and Se uptake, and the presence of Hg induced the Se hepatic elimination. The Hg bioaccumulation in the gill, spleen and heart were higher in the presence of Se(6+) than in the presence of Se(4+).

Definition of minimal domains of interaction within the recombination-activating genes 1 and 2 recombinase complex.

During V(D)J recombination, recognition and cleavage of the recombination signal sequences (RSSs) requires the coordinated action of the recombination-activating genes 1 and 2 (RAG1/RAG2) recombinase complex. In this report, we use deletion mapping and site-directed mutagenesis to determine the minimal domains critical for interaction between RAG1 and RAG2. We define the active core of RAG2 required for RSS cleavage as aa 1-371 and demonstrate that the C-terminal 57 aa of this core provide a dominant surface for RAG1 interaction. This region corresponds to the last of six predicted kelch repeat motifs that have been proposed by sequence analysis to fold RAG2 into a six-bladed beta-propeller structure. Residue W317 within this sixth repeat is shown to be critical for mediating contact with RAG1 and concurrently for stabilizing binding and directing cleavage of the RSS. We also show that zinc finger B (aa 727-750) of RAG1 provides a dominant interaction domain for recruiting RAG2. In all, the data support a model of RAG2 as a multimodular protein that utilizes one of its six faces for establishing productive contacts with RAG1.

Extensive intra-hospital spread of a methicillin-resistant staphylococcal clone.

OBJECTIVE: Infection by antibiotic-resistant bacteria can pose serious complications to the therapy of cancer patients. The authors introduced DNA fingerprinting techniques for tracking methicillin-resistant Staphylococcus aureus (MRSA) clones recovered at a central cancer hospital of Lisbon (Instituto Português de Oncologia) with the purpose of making an inventory of the MRSA clones endemic during 1995, and compared them with the outbreak-related clones of 1993. DESIGN: A small group (6 strains) of epidemiologically related MRSA isolated during a suspected outbreak in 1993 and all consecutive single-patient isolates of MRSA (34 strains) recovered between January and November of 1995 from infected patients and health care personnel were characterized using DNA probes and pulsed-field gel electrophoresis. RESULTS: The six 1993 strains and more than half of all 1995 isolates, including those recovered from the health care personnel, showed DNA fingerprints characteristic of the "Iberian MRSA," a multiresistant clone widespread in Portuguese and Spanish hospitals. Four patients were infected by another MRSA clone previously seen only in hospitals in Brazil. CONCLUSION: The epidemic Iberian clone was among the index cases involved with the MRSA outbreak in 1993, and this was found to be endemic in a follow-up survey conducted in 1995, colonizing health care personnel and spreading to most hospital wards. A few isolates of another epidemic clone, the Brazilian MRSA, also were detected among 1995 isolates. A better understanding of the mechanism(s) of epidemicity of these rapidly spreading clones is urgently needed.

[Instrument for the evaluation of the adult patients' ability for self-care--CADEM]. / Instrumento para avaliação da capacidade de autocuidado de pacientes adultos--CADEM.

This study develops a tool to facilitate the determination of adult patients selfcare ability aiming at promoting clear and objective communication. The tool developed, called CADEM, establishes levels to determine patient's categorization according to their need of nursing care. It has been-considered that CADEM is a valid tool and can help in planning nursing care, and also to register the patients' evolution through its continued and systematic use, therefore helping to justify necessary changes in Nursing care planning.