Evaluation of the experimental inoculation of Cryptococcus albidus and Cryptococcus laurentii in normal mice: virulence factors and molecular profile before and after animal passage.

The genus Cryptococcus includes free-developing species, a few of which are of medical importance. Some, such as C. neoformans and C. gattii, cause infections in man frequently and C. albidus and C. laurentii cause less so. The aims of this study were to evaluate organ colonization after inoculation of C. albidus and C. laurentii isolates in normal BALB/c mice, the virulence factors (growth at 37 degrees C, capsule, melanin, proteinase, and phospholipase production) and the molecular profile (PCR-fingerprinting) of the yeasts before and after infection. The importance of different profiles (virulence and molecular) was considered in relation to the distribution in different organs and to the time intervals of isolation from organs. C. albidus was isolated from animal organs 2 to 10 days after inoculation and C. laurentii from 2 to 120 days. Most isolates of the two species kept the virulence factors showed before inoculation. The high homogeneity of the molecular profile of C. albidus and the high heterogeneity of C. laurentii were kept through the passages in animals. It is concluded that most isolates of both species were recovered from the animal organs after 5 or more days, and phenotypes were not altered by inoculation. No molecular alteration was detected and the virulence factors were not related to the time intervals before isolation from organs.

Group B Streptococcus carriers among HIV-1 infected pregnant women: prevalence and risk factors.

OBJECTIVE: The objective was to determine the frequency and risk factors of anogenital colonization by Streptococcus agalactiae (GBS) in pregnant women infected with human immunodeficiency virus type 1 (HIV-1). STUDY DESIGN: A prospective study was conducted on 207 pregnant women divided into two groups: HIV group (n=101) and a control group consisting of HIV-uninfected pregnant women (n=106) to assess regional colonization by GBS. Anal and vaginal swabs were collected and cultured in Todd-Hewitt broth, followed by a confirmatory test. For a control group with an anticipated proportion based on literature research of 10-30% and alpha=0.05, a sample size of 100 would have a power of 80% to detect a difference of 15% or greater with a study group. The mothers were studied in terms of frequency of anogenital colonization by GBS, maternal epidemiological data, and TCD4 lymphocyte counts. The results were analyzed using the chi(2)-test, Fisher's exact test and the Student's t-test, with the level of significance set at p<0.05. RESULTS: Twenty (19.8%) HIV-1-infected pregnant women were found to be colonized by GBS at between 35 and 37 weeks' gestation. In the control group, the prevalence of GBS was 14.1%. CONCLUSION: No significant increase in GBS colonization was observed in HIV-1-infected pregnant women. Maternal colonization of GBS in HIV-infected pregnant women was not found to be associated with their immunological status. Sexual contact does not seem to be the principal way of transmitting GBS.

[Occurrence of dermatophyte, in nails, feet and hands of university students]. / Ocorrência de dermatófitos em amostras de unhas, pés e mãos coletadas de estudantes universitários.

The objective of this paper was to evaluate the occurrence of dermatophytes, specifically in the nails, feet and hands of university students with and without lesions. Two hundred and eighty samples were collected; 31 (11.1%) were positive by direct examination, while only 20 (7.1%) showed dermatophyte growth in culture, as well as direct positive examination. Trichophyton rubrum was the most frequently isolated (80%) dermatophyte followed by T. mentagrophytes (20%). Considering the sites analyzed, dermatophyte occurrence was: 10.4% in toenails, 5% in foot skin, 2.5% in fingernails and 0.4% in hand skin.

ANTIFUNGAL SUSCEPTIBILITY TESTING AND GENOTYPING CHARACTERIZATION OF Cryptococcus neoformans AND gattii ISOLATES FROM HIV-INFECTED PATIENTS OF RIBEIRÃO PRETO, SÃO PAULO, BRAZIL.

Cryptococcosis is a leading invasive fungal infection in immunocompromised patients. Considering the high prevalence and severity of these infections in immunocompromised patients attended at HC-FMRP-USP, the present research aimed to characterize the clinical isolates of Cryptococcus strains by biochemical and molecular methods and evaluate antifungal susceptibility of clinical isolates. Fifty isolates from 32 HIV-positive patients were obtained at HC-FMRP-USP. Most of the isolates (78.1%) were identified as C. neoformans, and 100% of C. neoformans and C. gattii strains were susceptible to amphotericin B, ketoconazole and fluconazole. All isolates were classified as serotype A (grubbii variety) by PCR and most of them were characterized in mating type MATa. PCR analysis of specific M13 microsatellite sequence revealed that VNI type was predominant among C. neoformans, while VGII was predominant among C. gattii. The strains did not show a significant resistance to the antifungals tested, and Canavanine-Glycine-Bromthymol Blue Agar (CGB) proved to be a reliable test presenting a good correlation with the molecular characterization. C. neoformans isolated from disseminated infections in the same patient showed molecular identity when different anatomical sites were compared; besides, the studied strains did not present a significant increase in resistance to antifungal agents. In addition, the homogeneity of the molecular types and detection of the mating types suggested a low possibility of crossing among the strains.

Colonization by Streptococcus agalactiae during pregnancy: maternal and perinatal prognosis.

We reviewed colonization by group B Streptococcus beta-haemolyticus of Lancefield (SGB), or Streptococcus agalactiae, in pregnant women, and the consequences of infection for the mother and newborn infant, including factors that influence the risk for anogenital colonization by SGB. We also examined the methods for diagnosis and prophylaxis of SGB to prevent early-onset invasive neonatal bacterial disease. At present, it is justifiable to adopt anal and vaginal SGB culture as part of differentiated obstetrical care in order to reduce early neonatal infection. The rates, risk factors of maternal and neonatal SGB colonization, as well as the incidence of neonatal disease, may vary in different communities and need to be thoroughly evaluated in each country to allow the most appropriate preventive strategy to be selected.

Teste de Progresso em Consórcios para Todas as Escolas Médicas do Brasil / Consortia of Cross-Institutional Progress Testing for All Medical Schools in Brazil

RESUMO O Teste de Progresso é uma ferramenta de avaliação longitudinal do ganho de conhecimento de estudantes que tem sido aplicada no Brasil há mais de dez anos. O teste situa o estudante em seu processo evolutivo de ensino-aprendizagem e permite à instituição realizar o diagnóstico de suas deficiências ao longo da estrutura curricular. Ele pode ser utilizado pelos colegiados competentes para avaliação de alterações curriculares e avaliações específicas de disciplinas ou módulos de ensino. Com base na experiência de um consórcio de escolas, a Associação Brasileira de Educação Médica (Abem) propôs um projeto que tinha como um de seus objetivos incentivar escolas de todo o País a adotarem o Teste de Progresso como uma de suas ferramentas de avaliação. Reportamos a estratégia adotada para constituir núcleos interinstitucionais de avaliação com Teste de Progresso, bem como os resultados da primeira prova nacional do Teste de Progresso, que contou com a participação de 58 escolas e 23.065 estudantes. A implantação de núcleos interinstitucionais de Teste do Progresso com processos colaborativos de realização da prova representou um avanço para as escolas envolvidas. As escolas iniciaram um processo de colaboração não apenas para o Teste de Progresso, mas também para o intercâmbio de informações e experiências que trocam com base no conhecimento de cada uma. O projeto funcionou como o início de um movimento para que escolas médicas de todas as regiões do País adotem o Teste de Progresso como uma ferramenta de avaliação com potencial para reorientar a formação médica, ao fornecer um diagnóstico de formação em nível individual e institucional.

ABSTRACT Progress Testing has been applied in Brazil for more than ten years. It is a tool for longitudinal evaluation of students' knowledge across levels of training. The test situates the student in his evolutionary teaching-learning process and allows the institution to diagnose its deficiencies throughout the curricular structure. It can be used to evaluate curricular changes and specific assessments of disciplines or teaching modules. From the experience of a consortium of schools, the Brazilian Association of Medical Education (ABEM) proposed a project that aimed to encourage schools throughout the country to adopt Progress Testing as one of its evaluation tools. We report on the strategy adopted to establish interinstitutional evaluation nuclei with Progress Testing, as well as the results of the first national exam, administered by 58 schools to 23,065 students. The implantation of cross-institutional Progress Testing triggered collaborative processes among the schools involved. Schools have begun a collaborative process not only for the Progress Testing, but also for the exchange of information. The project served as the beginning of a movement for medical schools in all regions of the country to adopt Progress Testing as an assessment tool with the potential to reorient medical training by providing information regarding institutional and individual performances.

Aprendizado eletrônico na formação multiprofissional em saúde: avaliação inicial / E-learning in multi-professional health training: an initial evaluation

O objetivo deste relato é apresentar, dentro da proposta do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde), uma parte do projeto da Faculdade de Medicina de Ribeirão Preto (USP). Trata-se da estratégia de inserção das Tecnologias de Informação e Comunicação (TIC) no ensino de graduação extramuros da FMRP, que visa definir e implantar recursos tecnológicos de Aprendizado Eletrônico para apoiar atividades discentes e docentes, gestão da informação, educação continuada e segunda opinião formativa. A trajetória metodológica delineou tanto o processo de atendimento de parte das ações do eixo Cenário de Prática em Atenção Básica de saúde relativa ao processo de ampliação da rede de malha ótica, essencial para suporte às atividades de desenvolvimento do uso das TIC, quanto a abordagem qualitativa de um estudo exploratório sobre a utilização do Teleduc no primeiro ano do eixo de Atenção à Saúde da Comunidade (ASC) do curso de Medicina. Nesta investigação foram realizados dois grupos focais com aplicação de questionário estruturado a discentes e docentes.

As part of the proposal of the National Program for Reorientation of Professional Training in Health (Pró-Saúde), this report discusses the project at the Ribeirão Preto School of Medicine, University of São Paulo (FMRP/USP). The focus is a strategy for the inclusion of information and communication technologies in extramural undergraduate training at FMRP, aimed at defining and deploying e-learning technological resources to support student and faculty activities, information management, continuing education, and formative second opinion. The methodological approach designed both the process of covering part of the actions from the Setting for Practice in Primary Healthcare pertaining to expansion of the fiber optic network, essential for supporting and developing ICT use, and the qualitative approach of an exploratory study on the use of e-learning in the first year of the Community Healthcare course in the undergraduate medical program. The study used two focus groups and a structured questionnaire for students and faculty.

Influência do tempo e do meio de transporte no isolamento de fungos patogênicos de biópsias de pele / Effects of time delay and transportation on isolation of pathogenic fungi from skin biopsies

FUNDAMENTOS: Não está definido como o meio de transporte e o intervalo de tempo até o processamento final interferem no isolamento de fungos patogênicos em material obtido de biópsias de pele. OBJETIVOS: Determinar o efeito da inoculação tardia de biópsias de pele, transportadas em diferentes meios líquidos, na taxa de isolamento de fungos patogênicos. MÉTODOS: De 47 pacientes com lesões cutâneas suspeitas de micoses invasivas obtiveram-se 278 biópsias das lesões. Cada biópsia foi transportada em frascos com caldo Sabouraud com cloranfenicol ou solução salina de cloreto de sódio e inoculada em ágar Sabouraud após 48-72 horas (precoce) ou após 72 horas até sete dias (tardio), constituindo-se quatro grupos de estudo. RESULTADOS: As medianas das taxas de isolamento dos quatro grupos de esporotricose foram 100 por cento e de paracoccidioidomicose foram 84 por cento e 50 por cento nos grupos precoces/solução salina ou caldo Sabouraud e 64 por cento e 84 por cento nos grupos tardios/solução salina ou caldo Sabouraud, respectivamente (p=0,88). Baixas taxas de contaminação resultaram em especificidade diagnóstica de 82 por cento para doenças não fúngicas. CONCLUSÕES: Biópsias de pele podem ser transportadas em caldo Sabouraud ou solução salina por períodos de até sete dias, à temperatura ambiente, sem afetar a viabilidade dos fungos.

BACKGROUND: It is not clear how culture media used during transport and the interval between the biopsy procedure and final processing can affect the successful isolation of fungi. OBJECTIVE: The aim of this study was to investigate the effects of late inoculation of skin biopsies, transported in different sterile fluids, on the isolation rate of pathogenic fungi. METHODS: A total of 278 punch biopsy specimens were collected from 47 patients with suspected lesions of invasive mycoses. Each biopsy was transported in vials with Sabouraud medium with chloramphenicol or saline solution and finally inoculated on Sabouraud agar and 2 percent chloramphenicol after a 48-72-hour (early) or after 72-hour-7-day (late) interval, comprising four groups of study. RESULTS: The medians of isolation rate of the four sporotrichosis groups were 100 percent. For paracoccidioidomycosis, the medians ranged from 50 percent to 84 percent, with no statistically significant difference among the groups (p=0.88). CONCLUSION: It was concluded that skin biopsies can be transported in Sabouraud medium or saline solution within a 7-day interval from specimen collection up to final inoculation, at room temperature, maintaining viability and growth rate of fungus in culture.

A incorporação de recursos de simulação no curso de graduação em medicina da Faculdade de Medicina de Ribeirão Preto - USP / Implementing simulation-based education in the medical undergraduate program

A Faculdade de Medicina de Ribeirão Preto (FMRP), desde o início do seu funcionamento em 1952, caracteriza-se pela inovação e pela busca da excelência no desempenho das suas atividades de ensino, pesquisa científica e de assistência à saúde da população. No curso de graduação em Medicina, esta busca tem se refletido em sucessivas mudanças da estrutura curricular e em esforços repetidos para a modernização dos métodos de ensino. Neste sentido, há várias décadas vem sendo introduzidas técnicas de simulação, envolvendo modelos, manequins e simuladores e, em menor escala, o uso de pacientes padronizados. No momento atual, aprovou-se revisão do projeto pedagógico do curso, com redefinição das competências gerais eespecíficas a serem adquiridas pelos formandos e o estabelecimento de metas a serem atingidas para a renovação dos métodos de ensino, de modo a que sejam oferecidas ao estudante oportunidades de aprendizado mais ativo. Dentre estas metas, prevê-se o investimento em laboratório de habilidades e na difusão das práticas de simulação aplicadas ao ensino e treinamentodo estudante.

The Ribeirão Preto Faculty of Medicine (FMRP), since the early days of its medical undergraduate program in 1952, may be characterized as an innovative institution in the search of excellence in teaching, scientific research and health assistance. The FMRP medical undergraduate program underwent successive changes in its curriculum structure, and has hosted repeated efforts for modernization and improvement in teaching and learning methods. In this context, a number of simulation techniques have been introduced throughout the last decades, which included the utilization of plastic models, mannequins and simulators and, at lesser extent, of simulated, standardized patients for teaching and assessment. A revision of the educational plan for the medical undergraduate program has been recently approved, with a redefinition of the general and specific skills and competences to be achieved by medical graduates. This new planin cludes a set of objectives to be pursued in the near future, which includes the continuous improvement in teaching and learning methods aiming at providing conditions for a more active learning. This set of objectives includes the investment for the implementation of a skills laboratory, and for the diffusion of simulation techniques.

Ocorrência de dermatófitos em amostras de unhas, pés e mãos coletadas de estudantes universitários / Occurrence of dermatophyte, in nails, feet and hands of universitary students

Este trabalho teve como objetivo, avaliar a presença de dermatófitos, especificamente em unhas, pés e mãos de estudantes universitários com e sem lesões sugestivas de dermatofitose. Foram coletadas 280 amostras dessas regiões, das quais 31 (11,1 por cento) apresentaram positividade apenas pelo exame direto, e 20 (7,1 por cento) tiveram, além do exame direto positivo, crescimento de dermatófito, mediante cultivo da amostra biológica. T. rubrum foi o dermatófito isolado com maior freqüência (80 por cento), seguido por T. mentagrophytes (20 por cento). Considerando os sítios analisados neste trabalho, a ocorrência de dermatófitos foi observada em 10,4 por cento nas unhas dos pés, 5 por cento nas escamas de pés, 2,5 por cento nas unhas das mãos e apenas 0,4 por cento nas escamas das mãos.

Colonization by Streptococcus agalactiae during pregnancy: maternal and perinatal prognosis

We reviewed colonization by group B Streptococcus beta-haemolyticus of Lancefield (SGB), or Streptococcus agalactiae, in pregnant women, and the consequences of infection for the mother and newborn infant, including factors that influence the risk for anogenital colonization by SGB. We also examined the methods for diagnosis and prophylaxis of SGB to prevent early-onset invasive neonatal bacterial disease. At present, it is justifiable to adopt anal and vaginal SGB culture as part of differentiated obstetrical care in order to reduce early neonatal infection. The rates, risk factors of maternal and neonatal SGB colonization, as well as the incidence of neonatal disease, may vary in different communities and need to be thoroughly evaluated in each country to allow the most appropriate preventive strategy to be selected.

Infecçäo primária do trato urinário por Torulopsis glabrata / Primary infection of urinary tract by Torulopsis glabrata

Apresenta-se um caso de infecçöo das vias urinárias e fungemia por Torulopsis glabrata em uma paciente diabética necessitando cateterizaçäo uretal freqüente. Além da identificaçäo micológica, existiam níveis significantes de anticorpos contra Torulopsis no soro da paciente. Os fatores predisponentes, diagnóstico e tratamento das infecçöes fúngicas do trato urinário säo discutidos