Aspects related to biofilm production and antifungal susceptibility of clinically relevant yeasts of the genus Trichosporon.

Trichosporonosis corresponds to a systemic fungal disease that leads to high mortality rates and is frequently associated with medical devices. It affects immunosuppressed patients in particular and is strongly linked to acquired human immunodeficiency, organ and tissue transplants, and malignant hematologic diseases such as leukemia and lymphomas. Trichosporon infections have been increasingly reported worldwide; however, little information is available either about their characteristics or the causative microorganism. Thus, the aims of the present study were: to investigate 59 yeasts of the genus Trichosporon by verifying the biofilm formation capacity of isolates; to analyze the susceptibility patterns of planktonic cells against the antifungals fluconazole, itraconazole, amphotericin-B, voriconazole, and caspofungin by comparing European Committee for Antimicrobial Susceptibility Testing (EUCAST) broth microdilution technique with the commercial method Etest; and to assess the susceptibility patterns of biofilm cells (sessile) against the same antifungals through broth microdilution. The ability to form biofilm on the surface of polystyrene plates was noted for all isolates, and 54.3% of samples were considered strong producers. Comparison between the antifungal susceptibility techniques evidenced that Etest showed higher and discordant minimum inhibitory concentrations (MICs) from those obtained by the microdilution method, especially for fluconazole, itraconazole, and caspofungin. Considering the susceptibility of biofilms, most species had high MIC50 and MIC90 against the tested antifungals, showing 4-to-66-fold higher concentrations for amphotericin B and 2-to-33-fold greater concentrations for caspofungin. These results highlight the importance of further studies with Trichosporon spp. for comparison between laboratory findings and in vivo response, considering both the susceptibility tests and the behavior of biofilm cells against drugs.

This study investigated 59 isolates of the medically important yeast Trichosporon in relation to their ability to form biofilms and the susceptibility of biofilms to antifungal agents. All isolates were able to produce biofilms and biofilms showed lower antifungal susceptibility.

Early clinical and microbiological predictors of outcome in hospitalized patients with cryptococcal meningitis.

BACKGROUND: Cryptococcal meningitis causes high mortality in immunocompromised and immunocompetent patients. The objective of this study was to identify early predictors of clinical outcome, available at the first days of hospitalization, in patients with cryptococcal meningitis in a tertiary center in Brazil. METHODS: Ninety-six cases of cryptococcal meningitis with clinical, epidemiological and laboratory data, and identification and antifungal susceptibility of the strains were analyzed. Quantitative CSF yeast counts were performed by direct microscopic exam with a Fuchs-Rosenthal cell counting chamber using an institutional protocol. Univariable and multiple analyses using logistic regression were performed to identify predictors, available at the beginning of hospitalization, of in-hospital mortality. Moreover, we performed a secondary analysis for a composite outcome defined by hospital mortality and intensive care unit transfer. RESULTS: The species and the antifungal susceptibility were not associated with the outcomes evaluated. The variables significantly associated with the mortality were age (OR = 1.08, 95% CI 1.02-1.15), the cerebrospinal fluid (CSF) yeasts count (OR = 1.65, 95% CI 1.20-2.27), systemic arterial hypertension (OR = 22.63, 95% CI 1.64-312.91) and neurological impairment identified by computed tomography (OR = 41.73, 95% CI 3.10-561.65). At the secondary analysis, CSF yeast count was also associated with the composite outcome, in addition to the culture of Cryptococcus spp. from bloodstream and cerebral toxoplasmosis. The associations were consistent with survival models evaluated. CONCLUSIONS: Age and CSF yeast count were independently associated with in-hospital mortality of patients with cryptococcal meningitis but Cryptococcus species identification and antifungal susceptibility were not associated with the outcomes. Quantitative CSF yeast counts used in this study can be evaluated and implemented in other low and middle-income settings.

Caryocar brasiliense oil improves cardiac function by increasing Serca2a/PLB ratio despite no significant changes in cardiovascular risk factors in rats.

BACKGROUND: Caryocar brasiliense (pequi) oil is high in monounsaturated fat acids (MUFA), especially oleic, and in carotenoids, which have been associated with protection against cardiovascular disease. However, this food is poorly studied in this context, especially in the cardiac function. Therefore, we investigated the effects of a long-term intake of pequi oil in systemic cardiovascular risk factors and in the ex vivo cardiac function of rats. METHODS: Previously, we determined fatty acids and carotenoids in pequi oil. Next, male rats were divided in C - control group feed a standard diet, and PO - pequi oil group fed the same diet added pequi oil (+2.25 g.100 g-1). After 15 weeks, plasma lipids, glucose, insulin, blood pressure, heart rate, hepatic lipids were accessed and visceral fat pads were harvested. Hearts were used for the ex vivo cardiac function, histologic assays, SERCA2a and phospholanban (PLB) determinations. RESULTS: In agreement with scientific data, pequi oil had expressive amounts MUFA, especially oleic acid, and carotenoids. Hepatic triglycerides (TG) were reduced by pequi oil intake (p < 0.05). All others cardiovascular risk factors were not changed. The intrinsic heart rate was lower in PO group (p < 0.05). SERCA2a content was higher in this group (p < 0.05), without affecting PLB. Also, SERCA2a/PLB ratio increased in PO group (p < 0.05). CONCLUSION: Pequi oil intake improved cardiac function ex vivo, despite no significant changes in systemic cardiovascular risk factors. The higher lipid offer in pequi oil diet, its composition in oleic acid and carotenoids could be related to those effects.

Antifungal Resistance in Cryptococcal Infections.

Antifungal therapy, especially with the azoles, could promote the incidence of less susceptible isolates of Cryptococcus neoformans and C. gattii species complexes (SC), mostly in developing countries. Given that these species affect mostly the immunocompromised host, the infections are severe and difficult to treat. This review encompasses the following topics: 1. infecting species and their virulence, 2. treatment, 3. antifungal susceptibility methods and available categorical endpoints, 4. genetic mechanisms of resistance, 5. clinical resistance, 6. fluconazole minimal inhibitory concentrations (MICs), clinical outcome, 7. environmental influences, and 8. the relevance of host factors, including pharmacokinetic/pharmacodynamic (PK/PD) parameters, in predicting the clinical outcome to therapy. As of now, epidemiologic cutoff endpoints (ECVs/ECOFFs) are the most reliable antifungal resistance detectors for these species, as only one clinical breakpoint (amphotericin B and C. neoformans VNI) is available.

Fragmented adipose tissue transplanted to craniofacial deformities induces bone repair associated with immunoexpression of adiponectin and parathyroid hormone 1-receptor.

Objective : This study analyzed the influence of autogenous white adipose tissue on bone matrix development in critical-size defects created in rabbit calvaria. Materials and methods : A 15-mm-diameter defect was created in the calvaria of 42 rabbits. Twenty-one rabbits were treated with 86 mm(3) of immediate transplant of fragmented white subcutaneous adipose tissue (WSAT); the others constituted the control group (sham). The animals were euthanized at 7, 15, and 40 days postsurgery (n = 7), and the histological data were analyzed by histomorphometry and immunohistochemistry using the anti-adiponectin and parathyroid hormone 1-receptor (PTH1R) antibodies. Results : The calvariae treated with fragmented WSAT demonstrated significant bone formation. These results coincided with the significant presence of immunopositivity to adiponectin and PTH1R in loci, which in turn coincided with the increase in bonelike matrix deposited both in fat tissue stroma and adipocytes' cytoplasm. In contrast, the control group revealed a small amount of bone-matrix deposition and presented scarce PTH1R expression and a lack of immunostain for adiponectin. Conclusion : These results indicate that transplant of fragmented white subcutaneous adipose tissue may be an alternative to treatment of craniofacial bone deformities because adipose tissue suffers from osseous metaplasia and exhibits immunoexpression of the adiponectin and PTH1R, which are proteins associated with bone metabolism.

Fragmented adipose tissue graft for bone healing: histological and histometric study in rabbits' calvaria.

OBJECTIVE: The adipose tissue represents an important reservoir of stem cells. There are few studies in the literature with which to histologically evaluate whether or not the adipose tissue graft is really a safe option to achieve bone repair. This study histologically analyzed the effect of fragmented autogenous adipose tissue grafts on bone healing in surgically created, critical-size defects (CSD) in a rabbit's calvaria. STUDY DESIGN: Forty-two New Zealand rabbits were used in this study. CSD that were 15 mm in diameter were created in the calvarium of each animal. The defects were randomly divided into two groups: in Group C (control), the defect was filled only by a blood clot and, in Group FAT (i.e., fragmented adipose tissue), the defect was filled with fragmented autogenous adipose tissue grafts. The groups were divided into subgroups (n = 7) for euthanasia at 7, 15, and 40 days after the procedure had been conducted. Histologic and histometric analyses were performed. Data were statistically analysed with ANOVA and Tukey's tests (p < 0.05). RESULTS: The amount of bone formation did not show statistically significant differences seven days after the operation, which indicates that the groups had similar amounts of mineral deposition in the earlier period of the repair. Conversely, a significant of amount of bone matrix deposition was identified in the FAT group at 15 and 40 days following the operation, both on the border and in the body of the defect. Such an outcome was not found in the control group. CONCLUSION: In this study, an autologous adipose tissue graft may be considered as likely biomaterial for bone regeneration, since it positively affected the amount of bone formation in surgically created CSD in the rabbits' calvaria 40 days after the procedure had been performed. Further investigations with a longer time evaluation are warranted to determine the effectiveness of autologous adipose tissue graft in the bone healing.

Development and validation of a simple and rapid liquid chromatography method for the determination of genistein in skin permeation studies.

Genistein (GEN) has potential advantages for topical skin delivery, but no literature data are available for its quantitation in different skin layers, such as the stratum corneum (SC). Therefore, a simple, rapid, selective and sensitive bioanalytical method was developed and validated for GEN quantitation in porcine skin samples following in vitro permeation studies. GEN was assayed by HPLC with UV-Vis detection (270 nm) using 0.5% acetic acid in water-n-propanol-acetonitrile (50 : 2 : 48, v/v/v) as mobile phase (flow-rate of 1.0 mL/min). Specificity was demonstrated since endogenous skin components did not interfere with GEN peak. Standard analytical curve was linear over the concentration range (0.1-60 µg/mL) and the lower limit of quantitation was determined for different skin layers (100 ng/mL). GEN recovery from skin layers ranged from 95.57 to 97.57%. Permeation studies were carried out using an automated vertical diffusion cell apparatus. No fluctuation on the amount of GEN retained in the SC was observed over time, but increasing amounts of the drug were found in deeper layers of the skin. The method was reliable and reproducible for the quantitation GEN in skin samples enabling the determination of the cutaneous penetration profile of this drug in permeation experiments.

Bone healing in critical-size defects treated with immediate transplant of fragmented autogenous white adipose tissue.

This study analyzed the influence of fragmented autogenous white subcutaneous adipose tissue (WSAT) on bone healing in critical-size defects created in rabbit calvaria. A 15-mm diameter defect was created in the calvaria of 42 rabbits, which were treated with 86 mm3 WSAT grafts or filled only with blood clots (control). Animals were euthanized at 7, 15, and 40 days postsurgery (n = 7), and the data were analyzed using histomorphometry and immunohistochemistry using the anti-CD34 and bone morphogenetic protein-2 (BMP2) antibodies. The calvaria treated with only blood clots demonstrated positivity to CD34 concentrated in endothelial cells, whereas the BMP2 were restricted to the borders of the defects. In contrast, the group treated with WSAT revealed fatty cells exhibiting positivity to BMP2 both in membrane and cytoplasm and intense quantities of stromal spindle cells that exhibited positivity to CD34 simultaneously to BMP2; these results together coincided with a larger bone matrix deposited in all postsurgery periods analyzed. These results revealed that the WSAT may be an alternative to craniofacial bone reconstruction because the adipose tissue exhibited prominent immunoexpression of BMP2, which was coexpressed with stromal CD34+ cells, indicating the plasticity of CD34+ stem cells into osteoblasts, and in the adipocytes, facts that suggest bone tissue development through cellular transdifferentiation from adipocytes.

Evaluation of the Sensititre YeastOne and Etest in Comparison with CLSI M38-A2 for Antifungal Susceptibility Testing of Three Azoles, Amphotericin B, Caspofungin, and Anidulafungin, against Aspergillusfumigatus and Other Species, Using New Clinical Breakpoints and Epidemiological Cutoff Values.

Aspergillosis is an invasive fungal disease associated with high mortality. Antifungal susceptibility testing (AFST) is receiving increasing consideration for managing patients, as well as for surveilling emerging drug resistance, despite having time-consuming and technically complex reference methodologies. The Sensititre YeastOne (SYO) and Etest methods are widely utilized for yeasts but have not been extensively evaluated for Aspergillus isolates. We obtained Posaconazole (POS), Voriconazole (VCZ), Itraconazole (ITC), Amphotericin B (AMB), Caspofungin (CAS), and Anidulafungin (AND) minimum inhibitory concentrations (MICs) for both the Etest (n = 330) and SYO (n = 339) methods for 106 sequenced clinical strains. For 84 A. fumigatus, we analyzed the performance of both commercial methods in comparison with the CLSI-AFST, using available cutoff values. An excellent correlation could be demonstrated for Etest-AMB and Etest-VCZ (p < 0.01). SYO-MICs of AMB, VCZ, and POS resulted in excellent essential agreement (>93%), and >80% for AMB, VCZ, and ITC Etest-MICs. High categoric agreement was found for AMB, ITC, and CAS Etest-MICs (>85%) and AMB SYO-MICs (>90%). The considerable number of major/very major errors found using Etest and SYO, possibly related to the proposed cutoffs and associated with the less time-consuming processes, support the need for the improvement of commercial methods for Aspergillus strains.

Coumaric acid analogues inhibit growth and melanin biosynthesis in Cryptococcus neoformans and potentialize amphotericin B antifungal activity.

Fungal infections are on the rise, since the imunocompromised population is increasing due to AIDS/HIV, organ transplant and chemotherapy. Many environmental and pathogenic fungi are able to accomplish melanin biosynthesis as a virulence factor to promote host invasion. Melanized cells are more resistant to radiation, oxidative and osmotic stresses; also melanin confers an advantage in vivo, since melanized cells are more resistant to phagocytic engulfment and oxidative stress caused by the host defense cells and by some antifungal drugs, such as fluconazole (FCZ) and amphotericin B (AmB). Brown, red or black melanin pigments can be produced by the polyketide pathway (DHN-melanin) or from dihydroxyphenols, such as L-DOPA (L-3,4-dihydroxyphenylalanine) and L-tyrosine by polyphenoloxidases. Among several pathogenic fungi, Cryptococcus neoformans is a melanized yeast that causes pneumonia and meningoencephalitis in immunocompromised patients. The knockout of the laccase genes or other interruptions on melanin biosynthetic pathway generates cryptococcal strains with attenuated virulence in an animal model. In this study 16 analogues of coumaric and cinnamic acid were evaluated as possible tyrosinase inhibitors. We have identified some valuable inhibitors of C. neoformans growth and melanin biosynthesis disruption agents. The results showed that coumaric acid derivatives (1a-c), the ketones (3a-b) and 2-allylphenol (7c) are significant inhibitors of tyrosinase and melanization of the fungus. Two analogues (1b and 3b) were selected as promising antimelanogenic agents to be combined with AmB, showing to promote 16-fold reduction in the AmB fungicidal concentration with no appreciable cytotoxicity to mammalian cells. The data suggest that inhibition of the melanin biosynthesis by these compounds may increase the susceptibility of the cells to the oxidative stress generated by AmB. In summary, our data show that C. neoformans can be a suitable model system to test novel inhibitors that target melanin biosynthesis, and novel compounds for adjunct therapy against C. neoformans were identified.

Effects of probiotic fermented milk on biofilms, oral microbiota, and enamel.

The aim of this study was to evaluate in vitro and in vivo the effects of 2 brands of probiotic fermented milk on biofilms, oral microbiota, and enamel. For the in situ experiment, ten volunteers wore palatine devices containing four blocks of bovine dental enamel over 3 phases, during which 20% sucrose solution, Yakult® (Treatment A), and Batavito® (Treatment B) were dropped on the enamel blocks. Salivary microbial counts were obtained and biofilm samples were analyzed after each phase. For the in vivo experiment, the same ten volunteers drunk Yakult® (Treatment C) and Batavito® (Treatment D) in two phases. Saliva samples were collected for microbial analysis after each phase. The in situ study showed that in comparison with Treatment A, Treatment B resulted in fewer total cultivable anaerobes and facultative microorganisms in biofilms, higher final microhardness, lower percentage change in surface hardness, and smaller integrated subsurface enamel hardness. In the in vivo study, Treatment D resulted in a reduction in the counts of all microorganisms. The results suggested that the probiotic fermented milk Batavito®, but not Yakult®, reduced the amount of oral microorganisms and mineral loss in bovine enamel.

Report of filamentous forms in a mating type VNI clinical sequential isolates of Cryptococcus neoformans from an HIV virus-infected patient.

We reported a cryptococcal meningitis Aids-patient infected with a mating type VNI isolate showing filamentous cells in direct examination of cerebrospinal fluid. Clinical data, outcome, treatment features and microbiological findings were discussed.

A new culture medium for recovering the agents of Cryptococcosis from environmental sources.

The isolation of Cryptococcosis agents from environmental samples may be difficult due to the presence of groups of fast-growing fungi. We propose a new culture medium based on a modification of Dichloran Rose-Bengal Chloramphenicol Medium (DRBCm) to detect colonies of Cryptococcus neoformans. Our results indicate that DRBCm is superior to the classical Bird Seed Agar in its ability to detect colonies of C. neoformans.

Autofix: uma tecnologia para fixação segura de tubo orotraqueal / Pre-hospital nursing interventions: narrative review

Objetivo: construir e validar de uma tecnologia diferenciada para fixação de tubo orotraqual em pacientes críticos. Metodologia: trata-se de um estudo de desenvolvimento metodológico, para construção e validação de um protótipo para fixação segura denominado "autofix". Participaram da pesquisa 15 juízes especialistas profissionais da saúde, equipe multiprofissional, médicos intensivistas, enfermeiros especialistas e fisioterapeutas intensivistas. A validação de conteúdo evidenciou todos os itens como excelentes IVC (≥ 0,78), teve excelente IVC global de 0,97, evidenciando que o instrumento poderá favorecer o paciente e equipe para uma assistência humanizada e qualificada. A tecnologia construída e validada foi desenvolvida para atuar como estratégia de segurança e humanização do paciente crítico em uso da ventilação mecânica. (AU)

Objective: To construct pre-hospital nursing intervention algorithms for trauma victims. Methodology: Literature Narrative Review, between 2008 and 2019, in the main databases. Two independent reviewers carried out the critical evaluation, extraction and synthesis of data. The construction of the algorithms resulted from the interpretive process of the narrative review by three experts. The theoretical model of Virginia Henderson was used. Results: Seventeen documents were obtained, six were included in the development of the metaparadigm Health, Person and Environment and 16 were included in the development and construction of assessment, diagnosis and nursing interventions algorithms for trauma victims. Conclusions: The review enabled the operationalization of Henderson's theoretical model for pre-hospital care, allowing the creation of algorithms to guide nursing practice. (AU)

Objetivo: Construir algoritmos de intervención de enfermería prehospitalaria para víctimas de traumatismos. Metodología: Revisión narrativa de literatura, entre 2008 y 2019, en las principales bases de datos. Dos revisores independientes realizaron la evaluación crítica, extracción y síntesis de los datos. La construcción de los algoritmos fue el resultado del proceso interpretativo de la revisión por parte de tres expertos. Se utilizó el modelo de Virginia Henderson. Resultados: Se obtuvieron diecisiete documentos, seis se incluyeron en el desarrollo de los metaparadigmas y 16 se incluyeron en el desarrollo y construcción de algoritmos de evaluación, diagnóstico e intervenciones de enfermería. Conclusiones: La revisión permitió la operacionalización del modelo de Henderson para la atención prehospitalaria, permitiendo la creación de algoritmos. (AU)

Prevalence, distribution and antifungal susceptibility profiles of Candida parapsilosis, Candida orthopsilosis and Candida metapsilosis bloodstream isolates.

The Candida parapsilosis group encompasses three species: C. parapsilosis, Candida orthopsilosis and Candida metapsilosis. These species are phenotypically indistinguishable, and molecular methods are needed for their detection. We analysed 152 unique blood culture isolates of the C. parapsilosis group obtained during 1997-2011. The isolates were screened by PCR amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Isolates with RFLP patterns distinct from those of the C. parapsilosis group were characterized as C. parapsilosis sensu stricto (90.8 %), C. orthopsilosis (8.6 %) and C. metapsilosis (0.6 %). Antifungal susceptibility tests indicated that all isolates were susceptible to itraconazole, amphotericin B and caspofungin. Although C. orthopsilosis and C. metapsilosis isolates were susceptible to fluconazole, higher MICs (≥2 mg l(-1)) were observed for C. orthopsilosis. Three isolates (2.0 %) of C. parapsilosis sensu stricto were resistant to voriconazole. Five C. parapsilosis isolates (3.3 %) were intermediate, and a single isolate (0.7 %) was resistant (MIC 16 mg l(-1)) to fluconazole. These data were confirmed using reference strains. It was observed that C. parapsilosis isolates were less susceptible to all triazoles, and this finding deserves further attention to assess the appearance of cross-resistance phenomena. In conclusion, C. metapsilosis and C. orthopsilosis are involved in a small but significant number of invasive infections in Brazil.

[Critical trajectories of female victims of gender violence: discourse analysis of women and staff professionals in Porto Alegre, Rio Grande do Sul State, Brazil]. / Rotas críticas de mulheres em situação de violência: depoimentos de mulheres e operadores em Porto Alegre, Rio Grande do Sul, Brasil.

This qualitative study aims to describe the trajectories of female victims of gender violence in Porto Alegre, Rio Grande do Sul State, Brazil. The methodology included in-depth interviews with women and staff, attempting to map the critical paths of women when they made the decision to seek professional help. We interviewed 21 women victims of gender violence and 25 professionals, including law enforcement officials, health and social workers, and nongovernmental organizations. The women's trajectories in the services were mapped, identifying facilitating factors and obstacles in the process of breaking with gender violence. The victims reported: pressure by professional staff to return to their marriages and police inefficiency in providing protection. The discourse of law enforcement officials and health and social workers showed a range of different concepts regarding violence, medicalization of violence, and network fragmentation.

Pain in onco-hematologic patients and its association with analgesia / Caracterização da dor em pacientes onco-hematológicos e sua associação com a analgesia

ABSTRACT BACKGROUND AND OBJECTIVES: It is understood that in light of the increasing number of cancer diagnoses, one should intensify the quality of assistance offered to those patients, aiming at improving quality of life and minimizing suffering of patients and their relatives. Nursing assistance should be enhanced and focused on cancer patients' pain evaluation, to help pain characterization and, as a consequence, to improve multiprofessional assistance. This study aimed at characterizing onco-hematologic patients' pain and at associating it to offered analgesia. METHODS: This is a descriptive, prospective and longitudinal study developed with 20 patients with onco-hematologic disease admitted to the hematology unit, Hospital Universitário Walter Cantídeo. Visual analog scale and pain numerical scale were applied, in addition to multidimensional pain evaluation scale and McGil questionnaire. RESULTS: Primary cause of pain was intestinal infection. Acute pain lasting the whole day has prevailed. According to multidimensional pain evaluation scale, most commonly reported acute descriptor was deep, and of chronic persistent. Most commonly mentioned word of McGill questionnaire was unbearable, being the evaluative category the most commonly used. When evaluating analgesia, it was noted that 12 out of 20 medical prescriptions were incompatible with World Health Organization recommendations. CONCLUSION: Scales are extremely important to measure and characterize pain. The nursing team should be at the front for its implementation and use in hospital units, especially in cancer units due to the high incidence of this symptom.

RESUMO JUSTIFICATIVA E OBJETIVOS: Entende-se que diante da crescente incidência no diagnóstico de câncer, deve-se intensificar a qualidade da assistência oferecida a esses pacientes, com o intuito de melhorar a qualidade de vida e amenizar o sofrimento dos pacientes e dos familiares. A assistência de enfermagem deve ser aprimorada e focada na avaliação da dor do paciente oncológico, para facilitar a caracterização da dor e, consequentemente, melhorar o tratamento multiprofissional. O objetivo deste estudo foi caracterizar a dor dos pacientes onco-hematológicos e associar com a analgesia ofertada. MÉTODOS: Estudo descritivo, prospectivo, longitudinal, desenvolvido com 20 pacientes que apresentaram diagnóstico de doença onco-hematológica e que estivesse internado na unidade de hematologia do Hospital Universitário Walter Cantídeo. Foram aplicadas as escalas analógicas visual e numérica da dor, multidimensional de avaliação de dor e o questionário de McGill. RESULTADOS: A principal causa de dor foi por infecção intestinal. Prevaleceu a dor aguda e que durava o dia todo. Pela escala multidimensional de avaliação de dor o descritor agudo mais relatado foi profundo e do crônico persistente. A palavra mais citada no McGill foi insuportável, com a categoria avaliativa sendo a mais utilizada. Na avaliação da analgesia, percebeu-se que 13 das 20 prescrições médicas estavam incompatíveis com as recomendações da Organização Mundial da Saúde. CONCLUSÃO: As escalas são de extrema importância na mensuração e caracterização da dor. A enfermagem deve estar à frente na sua implantação e utilização nas unidades hospitalares, de maneira especial nas oncológicas pela alta incidência desse sintoma.

Effects of probiotic fermented milk on biofilms, oral microbiota, and enamel

The aim of this study was to evaluate in vitro and in vivo the effects of 2 brands of probiotic fermented milk on biofilms, oral microbiota, and enamel. For the in situ experiment, ten volunteers wore palatine devices containing four blocks of bovine dental enamel over 3 phases, during which 20% sucrose solution, Yakult® (Treatment A), and Batavito® (Treatment B) were dropped on the enamel blocks. Salivary microbial counts were obtained and biofilm samples were analyzed after each phase. For the in vivo experiment, the same ten volunteers drunk Yakult® (Treatment C) and Batavito® (Treatment D) in two phases. Saliva samples were collected for microbial analysis after each phase. The in situ study showed that in comparison with Treatment A, Treatment B resulted in fewer total cultivable anaerobes and facultative microorganisms in biofilms, higher final microhardness, lower percentage change in surface hardness, and smaller integrated subsurface enamel hardness. In the in vivo study, Treatment D resulted in a reduction in the counts of all microorganisms. The results suggested that the probiotic fermented milk Batavito®, but not Yakult®, reduced the amount of oral microorganisms and mineral loss in bovine enamel.

Report of filamentous forms in a mating type VNI clinical sequential isolates of Cryptococcus neoformans from an HIV virus-infected patient

We reported a cryptococcal meningitis Aids-patient infected with a mating type VNI isolate showing filamentous cells in direct examination of cerebrospinal fluid. Clinical data, outcome, treatment features and microbiological findings were discussed

A new culture medium for recovering the agents of Cryptococcosis from environmental sources

The isolation of Cryptococcosis agents from environmental samples may be difficult due to the presence of groups of fast-growing fungi. We propose a new culture medium based on a modification of Dichloran Rose-Bengal Chloramphenicol Medium (DRBCm) to detect colonies of Cryptococcus neoformans. Our results indicate that DRBCm is superior to the classical Bird Seed Agar in its ability to detect colonies of C. neoformans.