Evaluation of sampling locations in pregnant women and newborns for the detection of colonisation with antibiotic-resistant bacteria.

Up to now, little has been known about the prevalence and clinical relevance of colonisation of asymptomatic pregnant women with methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli. In this two-centre cross-sectional study, we evaluated the performance and importance of screening at different times and different locations for colonisation in pregnant women and newborns. Between October 2013 and December 2015, four samples were collected from pregnant women, two from newborns at birth and three from 3-day-old newborns. Samples were screened on culturing media and were confirmed with molecular methods. MSSA was used as a surrogate for MRSA, as the two share most microbiologic characteristics and colonisation patterns. Of 763 pregnant women, 14.5% (111) were colonised with MSSA, 0.4% (3) with MRSA and 2.6% (20) with ESBL-producing E. coli. Of 658 newborns, 0.9% (10) were colonised with MSSA at birth and 13.1% (70) at 3 days old, 0.5% (3) were colonised with MRSA and 2.6% (17) with ESBL-producing E. coli. Nasal sampling identified 91.0% of MSSA-colonised pregnant women and 60.0% of newborns. In newborns, nasal and umbilical sampling at 3 days after birth discovered 84.0% of colonised cases. For ESBL-producing E. coli, the perianal region was positive in all colonised pregnant women and in 88.2% of colonised newborns. Combining nasal and perianal swabs is optimal when screening for antibiotic-resistant bacteria in pregnant women. Nasal, perianal and umbilical sample collection from 3-day-old newborns significantly increased the sensitivity compared to screening immediately after birth.

Efeito da expansão rápida da maxila na cavidade nasal avaliado por meio da rinometria acústica / Effects of rapid maxillary expansion of the nasal cavity, evaluated by acoustic rhinometric

Foi realizado um estudo para investigar os efeitos da expansão rápida da maxila na área mínima de secção tranversa nasal, em uma amostra composta por 27 indivíduos, leucodermas, sendo 11 do sexo masculino e 16 do sexo feminino, em fase de dentadura mista, com idade variando entre 6,75 e 11,67 anos. Todos eram portadores de mordida cruzada posterior, uni ou bilateral, envolvendo caninos e molares decíduos e primeiros molares permanentes, com indicção de expansão rápida da maxila. Com a metodologia estabelecida, os pacientes foram submetidos à expansão rápida da maxila com o aparelho tipo "Haas Modificado", sendo o aparelho ativado 4/4 de volta logo após sua fixação e 2/4 de volta nos dias subsequentes, até atingir-se o limite máximo desejado. Para a obtenção dos valores da área mínima da secção tranversa nasal, antes e após o uso do descongestionante nasal tópico, os pacientes foram submetidos a exames de rinometria acústica, através do rinômetro "Eccovision Acoustic Rhinometer - Model Ar - 1003, Hood Laboratories Pembroke MA". Os exames foram realizados em três tempos: antes da expansão (T1), imediatamente após a expansão (T2) e 90 dias após a expansão (T3), sendo os valores da área obtidos nos três momentos e analisados estatisticamente. Após a avaliaçao, constatou-se um aumento da área mínima de secção transversal nasal, de T1 para T2 em 24 indivíduos (88,89%) e de T1 para T3 em 21 indivíduos da amostra (77,78%). Estas variações corresponderam a 17,5% e 16,25% de aumento de área, respectivamente, não sendo encontradas diferenças estatisticamente significantes entre T2 e T3. Pode-se concluir através dos resultados obtidos que a ERM produz aumento da área mínima de secção transversa nasal, sendo os efeitos produzidos substanciais e estáveis nos tempos estudados

A study was carried out to investigate the effects of rapid maxillary expansion in the nasal minimum cross-sectional area, with a sample composed of 27 caucasian people, being 11 males and 16 females, all of them in the phase of mixed dentition, with an age range of 6,75 to 11,67 years old. All of them presented posterior crossbite, unilateral or bilateral, affecting cuspids and deciduous molars and first permanent molars, indicating rapid maxillary expansion. With the established methodology, the patients were submitted to a rapid maxillary expansion with the modifical Haas appliance. This appliance was actived 4/4 of a turn right after its fixation and 2/4 of a turn in the subsequent days until it achieved the maximum desired limit. In order to obtain the values of the nasal minimum cross-sectional area, wich was taken before and after the use of a topical nasal decongestant, the patients were submitted to acoustic rhinometer exams, through the rhinometer "Eccovision Acoustic Rhinometer - Model Ar - 1003, Hood Laboratories Pembroke MA". The exams took place in three different times: before expansion (T1), immediate after the expansion (T2) and ninety days after the expansion (T3), the area values were obtained in these three moments and analysed statistically. After the evaluation, an increase of the nasal minimum cross-sectional area was noticed. From T1 to T2 was noticed in 24 people (88,89%) and from T1 to T3 it was noticed in 21 people from the sample (77,78%). These variations corresponded to 17,5% and 16,25% increase of the area, respectively, not being found any statistically relevant difference between T2 and T3. It can be concluded from the obtained results that the RME (Rapid Maxillary Expansion) produces an increase of the nasal minimum cross-secional area, being the effects substancial and stabel during the time studied