Fisiología respiratoria: circulación pulmonar / Respiratory physiology: pulmonary circulation

El pulmón recibe sangre desde la circulación bronquial y pulmonar. La circulación pulmonar presenta importantes diferencias con la sistémica, sus vasos sanguíneos poseen características únicas que le permiten cumplir sus diferentes funciones, siendo la más importante el intercambio gaseoso. Existen múltiples factores, activos y pasivos, que están involucrados en la regulación de la resistencia vascular y flujo sanguíneo pulmonar.

The lung receives blood from the bronchial and the pulmonary circulation. The pulmonary circulation presents important differences with the systemic circulation, its blood vessels have unique characteristics that allow them to fulfill their different functions, the most important being gas exchange. There are multiple factors, active and passive, that are involved in the regulation of vascular resistance and pulmonary blood flow.

Variantes genéticas del SARS-CoV-2 y sus implicaciones clínicas / Genetic variants of SARS-CoV-2 and its clinical implications

El SARS-CoV-2, agente causal de la actual pandemia de la COVID-19, va sufriendo mutaciones como consecuencia de su ciclo evolutivo, lo que ha originado diferentes variantes genéticas, que han sido agrupadas en dos categorías: preocupante (alfa o británica, beta o sudafricana, gamma o brasileña y delta o india) y de interés (lamdba, mu, épsilon, eta, iota, kappa, zeta, theta); estas conllevan implicaciones clínicas en la transmisibilidad, virulencia y resistencia del SARS-CoV-2 a la inmunidad natural y adquirida, lo que representa un serio desafío para los servicios de salud en todo el mundo. En este artículo se describen dichas variantes genéticas, con énfasis en su probable impacto clínico, y además se plantea la posibilidad de que aparezcan otras, como fenómeno natural en la evolución de los virus.

The SARS-CoV-2, causal agent of the COVID-19 current pandemic, is suffering mutations as a consequence of its evolutive cycle, what has originated different genetic variants that have been grouped in two categories: worrying (alpha or British, beta or South African, gamma or Brazilian and delta or Indian) and of interest (lamdba, mu, epsilon, eta, iota, kappa, zed, theta); these categories bear clinical implications in the transmissibility, virulence and resistance from SARS-CoV-2 to the natural and acquired immunity, what represents a serious challenge in health services worldwide. These genetic variants are described in this work, with emphasis in its probable clinical impact, and the possibility that other variants could appear is also explained, as natural phenomenon in the evolution of viruses.

Prevalencia y patrones de resistencia adquirida a antirretrovirales en menores de 18 años en el Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" / Prevalence and patterns of acquired resistance to antiretrovirals in children under 18 years of age

Introducción: La resistencia a antirretrovirales compromete la efectividad del tratamiento de pacientes con infección por VIH, llevando a falla virológica e inmunológica, deterioro clínico y comprometiendo tratamientos futuros. Los niños y adolescentes tienen mayor riesgo de desarrollo de resistencia asociados a terapias prolongadas, mala adherencia y limitadas opciones terapéuticas. Se desconoce la prevalencia y patrones de resistencia adquirida en población pediátrica panameña. Objetivos: Conocer la prevalencia y describir los patrones de resistencia adquirida en población pediátrica infectada con falla virológica en el período 2009-2019 Material y Método: Estudio descriptivo. Se incluyeron sujetos menores de 18 años de edad, con al menos un año de tratamiento, en falla virológica y que contaban con una prueba de genotipaje. Se realizó revisión de los expedientes clínicos para la obtención de los datos. Se describen las características demográficas, historial de tratamiento, resistencia a familias de antirretrovirales y mutaciones específicas Resultados y conclusiones: 13 pacientes fueron incluidos en el estudio de un total de 72 pacientes con infección de VIH atendidos en el período de estudio, para una prevalencia de resistencia del 18% de sujetos en terapia con resistencia. Se encontró 92% de resistencia a Inhibidores de la transcriptasa reversa análogo de nucleósidos, 61.5% a inhibidores de la transcriptasa reversa no análogos de nucleósidos y 23% de resistencia a Inhibidores de proteasa, las mutaciones M184V y K103N fueron las más frecuentes. Se requiere mantener la vigilancia de resistencia en niños con el fin de ajustar las recomendaciones de tratamiento.

Introduction: Antiretroviral resistance compromises the effectiveness of the treatment of patients with HIV infection, leading to virological and immunological failure, clinical deterioration and compromising future treatments. Children and adolescents are at increased risk of developing resistance associated with prolonged therapies, poor adherence, and limited therapeutic options. The prevalence and patterns of acquired resistance in the Panamanian pediatric population are unknown. Metodology Descriptive study. Subjects under 18 years of age, with at least one year of treatment, in virological failure and who had a genotyping test were included. A review of the clinical records was carried out to obtain the data. Demographic characteristics, treatment history, and at the time of genotyping, resistance to antiretroviral families and specific mutations are described. Conclusions: 13 patients were included in the study of a total of 72 patients with HIV infection attended in the study period, for a prevalence of 18% of subjects on antirretroviral therapy. It was found 92% resistance to nucleoside reverse transcriptase inhibitor, 61.5% to non- nucleoside reverse transcriptase inhibitor and 23% resistance to protease inhibitor. The M184V and K103N mutation were the most frequent. Surveillance of ARV resistance in children is required to adjust treatment recommendations.

Perfil de resistencia genotípica y fenotípica presente en bacterias aisladas a partir de fómites en Armenia, Quindío-Colombia período junio-julio 2019 / Genotypic and phenotypic resistance profile present in bacteria isolated from fomites in Armenia, Quindío-Colombia period June-July 2019

Resumen Introducción: La antibiótico-resistencia es un fenómeno por el cual las bacterias logran sobrevivir al tratamiento con antimicrobianos; con incidencia en ambientes intra y extrahospitalarios como: fuentes hídricas, sector agrario/ganadero y fómites. Objetivo: Describir bacterias presentes en fómites de alta circulación en una región centro-occidental de Colombia junto a su perfil de sensibilidad fenotípica y presencia de genes para betalactamasas tipo TEM-full, OXA-3 y SHV-full. Metodología: Se aislaron cepas bacterianas de billetes, pasamanos de escaleras eléctricas y botones de cajeros automáticos; se evaluó su perfil de sensibilidad fenotípica por medio de concentración mínima inhibitoria-técnica automatizada/Vitek2® y genes para betalactamasas tipo TEM-full, OXA-3 y SHV-full mediante PCR convencional. Resultados: Se obtuvo 30 aislados; Acinetobacter baumannii complex, fue la más común; el fómite con mayor aislados y resistencia fueron los billetes; el 53% portó al menos uno de los genes estudiados. Se identificaron bacterias gramnegativas con resistencia frente a: Imipinem, Piperacilina/Tazobactam, Colistina, Ceftazidima, Tigeciclina y Ceftriaxona; bacterias grampositivas con resistencia frente a: Quinupristina/Dalfopristina, Minociclina, Tetraciclina, Teicoplanina, Nitrofuratoina, Oxacilina, Clindamicina, Trimetropina-sulfametoxazol, y Minociclina. Conclusión: Teniendo en cuenta la circulación de cepas con estas resistencias, es importante la educación en la comunidad para evitar la adquisición o propagación de infecciones por manipulación inadecuada de fómites.

Abstract Introduction: Antibiotic-resistance is a phenomenon by which bacteria manage to survive antimicrobial treatment; with incidence in intra and extra hospital environments such as: water sources, agricultural / livestock sector and fomites. Aim: To describe bacteria present in high circulation fomites in a central-western region of Colombia, with their phenotypic sensitivity profile and presence of genes beta-lactamases (TEM, OXA3 and SHV). Methodology: We isolate bacterial strains from banknotes, escalator handrails and ATM buttons. We evaluated its phenotypic sensitivity profile by minimal inhibitory concentration automated technique using Vitek 2® and presence of genes for beta-lactamases type TEM-full, OXA-3 and SHV-full by conventional PCR. Results: A total of 30 isolates were obtained; Acinetobacter baumannii complex, was the most common; banknotes were the form with the highest number of isolates and resistance. Of the total isolates, 53% carried at least one of the genes studied. Phenotypically, gram-negative bacteria were identified with resistance against: Imipinem, Piperacillin / Tazobactam, Colistin, Ceftazidime, Tigecycline and Ceftriaxone; Gram-positive bacteria with resistance to: Quinupristin / Dalfopristin, Minocycline, Tetracycline, Teicoplanin, Nitrofuratoin, Oxacillin, Clindamycin, Trimethropine-sulfamethoxazole, and Minocycline. Conclusion: Taking into account the circulation of strains with these resistances, it is important to educate the community to avoid the acquisition or spread of infections due to the inappropriate handling of this type of inanimate elements.

Parâmetros ósseos de codornas de corte suplementadas com diferentes níveis de vitamina A, de 15 a 35 dias de idade / [Parameters of bone of meat-type quail supplemented with different levels of vitamin A from 15 to 35 days of age]

Avaliou-se o efeito da utilização de níveis crescentes de vitamina A sobre os parâmetros ósseos de codornas de corte de 15 a 35 dias de idade. Foram utilizadas 1520 codornas, não sexadas, com peso médio inicial de 85±4,25g, distribuídas em um delineamento inteiramente ao acaso, totalizando oito tratamentos com cinco repetições e 38 codornas por unidade experimental. Os tratamentos consistiram de oito níveis de suplementação de vitamina A (0; 4.500; 6.000; 7.500; 9.000; 10.500; 12.000 e 13.500UI/kg da dieta). O período experimental foi de 15 a 35 dias de idade. Os ossos analisados apresentaram uma redução linear para o índice de Seedor, resistência óssea e teor de cinzas do fêmur e da tíbia de acordo com os níveis de suplementação de vitamina A. A suplementação de vitamina A para codornas de corte de 15 a 35 dias de idade mostrou resultados negativos para a qualidade óssea, com a necessidade de mais estudos sobre seu antagonismo com a vitamina D.(AU)

This study evaluated the effect of using increasing levels of vitamin A on bone parameters in meat-type quails from 15 to 35 days old. A total of 1520 unsexed quail with an average initial weight of 85g distributed in a completely randomized design, totaling eight treatments with five replicates and 38 quails per experimental unit were used. The treatments consisted of eight vitamin supplementation levels A (0; 4,500; 6,000; 7,500; 9,000; 10,500; 12,000 and 13,500IU / kg diet). The experimental period was 15 to 35 days of age. The bones analyzed showed a linear reduction to the Seedor index, bone strength and ash content of the femur and tibia according to vitamin supplementation levels Vitamin A supplementation for cutting quails from 15 to 35 days of age showed negative results for bone quality, with the need for more studies on its antagonism to vitamin D.(AU)

Effects of clopidogrel resistence and CYP2C19 genotype on the clinical prognosis of patients with acute coronary syndrome undergoing percutaneous coronary intervention / 中华心血管病杂志

Objective: To investigate the effects of clopidogrel resistence and CYP2C19 genotype on the clinical prognosis of acute coronary syndrome(ACS) patients undergoing percutaneous coronary intervention(PCI). Methods: This study was a retrospective cohort study. ACS patients who underwent PCI in Beijing Anzhen Hospital from October 2015 to January 2017 were recruited. The inhibition rate of adenosine diphosphate(ADP) was monitored by thromboelastography. All of these patients were divided into clopidogrel resistance and non-resistance group according to the monitoring results. CYP2C19 genotype was detected by TaqMan probe-based real-time quantitative PCR. Patients were divided into slow, medium and fast metabolic group, according to the CYP2C19 genotype. After 12 months of follow-up, the end points included all-cause death, cardiac death, angina, myocardial infarction, stent thrombosis, ischemic stroke and hemorrhage were collected. Combined thrombotic events were defined as a composite of angina, myocardial infarction, stent thrombosis and ischemic stroke. The differences of the incidence of clinical events between groups were compared. Cox regression was used to analyze the effects of clopidogrel resistance and CYP2C19 genotype on the combined thrombotic events, cardiac death and hemorrhage. Results: A total of 1 696 patients were included, and the age was (59.4±9.6) years, with 1 280(75.5%) males. There were 471 cases(27.8%) in clopidogrel resistance group, and 1 225 cases(72.2%) in clopidogrel non-resistance group. There were 218 patients(12.9%) were in slow metabolic group, 668(39.4%) in medium metabolic group, and 810 (47.8%) in fast metabolic group. The median follow-up time was 13.3 months, and 131 cases were lost to follow-up, with a loss follow-up rate of 7.7%. Compared with the clopidogrel non-resistance group, the clopidogrel resistance group had a higher incidence of myocardial infarction(7.6%(36/471) vs. 5.1%(62/1 225), P=0.041), a lower incidence of hemorrhage (13.2%(62/471) vs. 17.9%(219/1 225), P=0.020) and minor hemorrhage(11.5%(54/471) vs. 15.8% (194/1 225), P=0.022). There were no statistically significant difference in all-cause death, cardiac death, angina, stent thrombosis, ischemic stroke and severe bleeding between clopidogrel resistance and non-resistance group(all P>0.05). There was no statistically significant difference in the incidence of endpoint events among different CYP2C19 genotypes (all P>0.05). Cox regression analysis showed that clopidogrel resistance was an independent factor of combined thrombotic events (OR=2.334, 95%CI 1.215-4.443, P=0.016) and bleeding events (OR=0.481, 95%CI 0.174-0.901, P=0.023). While CYP2C19 genotype was not independent factor for combined thrombotic events, cardiac death and hemorrhage (all P>0.05). Conclusion: For ACS patients after PCI, clopidogrel resistance can increase the risk of combined thrombotic events, but also reduce the risk of bleeding; while CYP2C19 genotype is not an independent factor for clinical prognosis.

A educação ocupada: um ensaio psicopolítico sobre as ocupações secundaristas de São Paulo / The occupied education: a psychopolitical essay on the occupations of secondary schools in São Paulo / La educación ocupada: un ensayo psicopolítico acerca de las ocupaciones de secundaria en el estado de São Paulo / L'éducation occupée: un essai psychopolitique sur les occupations des lycées à São Paulo

O presente ensaio busca oferecer uma reflexão a respeito do movimento secundarista de ocupações das escolas estaduais de São Paulo, a partir da perspectiva da Psicologia Política. Considerando a característica fortemente interdisciplinar desse campo do conhecimento, serão trazidos para a discussão autores provindos de diversas áreas que possam contribuir para uma análise psicopolítica do movimento em questão, lançando luz sobre os temas que dali emergiram, tais como: as relações entre democracia e educação, entre poder e resistência e entre movimentos sociais e políticas públicas. A análise aponta, a nosso ver, para a importância da participação política e para a necessidade de um ambiente escolar aberto a processos democráticos, com o fomento da consciência política e do exercício da cidadania, com vistas à formação crítico-reflexiva dos estudantes quanto à sociedade em que vivem, tal como visto nas ocupações.

This essay seeks to offer a reflection on the secondary school movement of occupations of state schools in São Paulo, from the perspective of Political Psychology. Considering the strongly interdisciplinary feature of this field of knowledge, we will bring to discussion authors of several areas that can contribute to a psycho-political analysis of the movement in question, shedding light on the issues that there have emerged, such as the relationship between democracy and education, between power and resistance and between social movements andpublic policies. The analysis points out, in our view, to the importance of reflection on the relationship between individual and state, political participation and the need for a school environment open to democratic processes, with the development of political consciousness and citizenship, with the aim of critical-reflexive education of students about the society in which they live in, as seen in occupations.

Este ensayo pretende ofrecer una reflexión sobre el movimiento secundarista de ocupación de las escuelas del estado de Sao Paulo, desde la perspectiva de la Psicologia Política. Teniendo en cuenta la característica fuertemente interdisciplinar de este campo del conocimiento, recurriremos a autores de diversos campos, que pueden contribuir a un análisis psico-político del movimiento en cuestión, arrojando luz acerca de los problemas que han surgido, como la relación entre la democracia y la educación, entre el poder y la resistencia y entre los movimientos sociales y las políticas públicas. El análisis senala la importancia de la participación política y la necesidad de un entorno escolar abierto a los procesos democráticos, fomentando la conciencia política y la ciudadanía, con vistas a la formación crítico-reflexiva de los estudiantes a respecto de la sociedad en la que viven y sobre como se ven en las ocupaciones.

Le présent essai a pourbut de proposer une réflexion sur le mouvement d'occupations des lycées publics de l 'état de São Paulo par les lycéens de cet état, à partir de la perspective de la psychologie politique. Compte tenu de la nature fortement interdisciplinaire de cette sphère de la connaissance, nous évoquer ons dans cette discussion de sauteur sissus de différents domaines pouvant apporter leur contribution à une analyse psychopolitique du mouvement en question, enfaisant la lumière sur les thèmes qui en ont émergé, tels que: la relation entre démocratie et éducation, entre pouvoir et résistance, et entre mouvement ssociaux et politiques publiques. Cette analyse signale, à notre avis, l'importance de la participation politique et la nécessité d'un environnement scolaire ouvert aux processus démocratiques, visant à la promotion de la conscience politique et l'exercice de la citoyenneté, en vue de la formation critique et réflexive de sélèves vis-à-vis de la société dans laquelle ils vivent, tel que nous avons pu voir lors des occupations.

Evaluation of resistance to natural poisoning by Amorimia septentrionalis in goats which had received sodium monofluoroacetate degrading bacteria / Avaliação da resistência à intoxicação natural por Amorimia septentrionalis em caprinos que receberam bactérias degradadoras de monofluoroacetato de sódio

Amorimia septentrionalis is an important sodium monofluoroacetate (MFA) containing plant that causes sudden death in ruminants in northeastern Brazil. MFA degrading bacteria are being used in the prevention against poisoning by this plant. The aim of this study was to evaluate if goats which had per os received MFA degrading bacteria remained resistant when exposed to natural poisoning by A. septentrionalis. Eighteen goats were randomly distributed into three groups: the goats of Group 1 previously received, during 40 days, a solution containing the bacteria Ralstonia sp. and Burkholderia sp., those goats in the Group 2 received the bacteria Paenibacillus sp. and Cupriavidus sp. and goats from Group 3 did not receive any bacteria. After the administration period, during 60 days, the animals of all groups were released to graze on a one hectare paddock, with significant amount of A. septentrionalis. They were observed daily for the spontaneous consumption of A. septentrionalis leaves and the occurrence of clinical signs of poisoning or sudden death. Goats from all groups consumed significant amounts of A. septentrionalis during the experimental period. Goats that did not receive MFA-degrading bacteria (Group 3) became sick and died from the 25th to the 27th day of the experiment, whereas the goats of the groups that received MFA-degrading bacteria showed only clinical sings when A. septentrionalis regrowth after the 55th day of the experiment. The days elapsed from field observation to death of Group 3 goats (25.5±0.9 days) were significantly lower (p<0.05) than Group 1 (58.6±1.3 days) and Group 2 (57.8±1.5 days). Thus, it can be concluded that administration of MFA degrading bacteria increases the resistance to natural poisoning by A. septentrionalis.(AU)

Amorimia septentrionalis que contém monofluoroacetato de sódio (MFA) é responsável pela ocorrência de mortes súbitas em ruminantes no nordeste do Brasil. Bactérias degradadoras desse composto estão sendo utilizadas na prevenção contra a intoxicação por essa planta. O objetivo deste estudo foi avaliar se caprinos que receberam, via oral, bactérias degradadoras de MFA permaneciam resistentes quando expostos a intoxicação natural por A. septentrionalis. Dezoito caprinos foram divididos em três grupos, os caprinos do Grupo 1 receberam anteriormente, durante 40 dias, uma solução contendo as bactérias Ralstonia sp. e Burkholderia sp., os do Grupo 2 receberam, também por 40 dias as bactérias Paenibacillus sp. e Cupriavidus sp. e os do Grupo 3 não receberam nenhuma bactéria. Após o período de administração, durante 60 dias, os animais de todos os grupos foram soltos para pastar em um piquete de um hectare, que apresentava uma quantidade significativa da planta. Diariamente eles foram observados quanto ao consumo espontâneo das folhas de A. septentrionalis e quanto à presença de sinais clínicos de intoxicação ou morte. Os caprinos de todos os grupos consumiram quantidades significantes da planta durante o período experimental. Os caprinos que não receberam as bactérias degradantes de MFA (Grupo 3) adoeceram e morreram entre o 25º e o 27º dia de experimento, enquanto que os que receberam as bactérias degradantes de MFA (Grupo 1 e 2) só apresentaram sinais clínicos no 55º dia de experimento, o que coincidiu com a rebrota da planta. Os dias transcorridos desde a observação a campo até a morte dos caprinos do Grupo 3 (25,5±0,9 dias) foram significativamente menores (p<0,05) que os do Grupo 1 (58,6±1,3 dias) e do Grupo 2 (57,8±1,5 dias). Com isso pode-se concluir que a administração de bactérias degradadoras de MFA aumenta à resistência a intoxicação natural por A. septentrionalis.(AU)

Corpo e identidade: um olhar sobre mulheres praticantes de bodybuilding / Body and identity: on female bodybuilders / Cuerpo e identidad: una mirada sobre mujeres practicantes de fisiculturismo

O estudo tratou de investigar a relação entre a modificação corporal e o processo de construção identitária em mulheres praticantes de bodybuilding na cidade de Brasília/DF. Para isso, foram entrevistadas sete mulheres que aderem ao treinamento intenso de musculação e dieta alimentar restrita, sendo seis delas atletas e apenas uma não atleta. Os resultados, apresentados e discutidos sob a forma de eixos de análise, revelam: 1) modos ascéticos particulares como as entrevistadas operam com restrições (alimentares e de treinamentos musculares) a que estão submetidas em busca do corpo almejado; 2) que a forma de operar e dar sentido ao corpo tanto para as atletas quanto para a veterana indica construção de identidades distintas

This study looked into the relationship between body modification and the process of identity construction in female bodybuilders in Brasilia, DF. Seven women ­ six athletes and one non-athlete ­ who practice intense bodybuilding and restricted diet were interviewed. The results are presented and discussed as interconnected categories and reveal that 1) they have particular ascetic ways to deal with (dietary and muscle training)restrictions to reach the desired body and 2) the ways of operating and ascribing meaning to their own bodies are very important to build the identities of both the athletes and the non-athlete

El estudio buscó investigar la relación entre la modificación del cuerpo y el proceso de construcción identitaria en mujeres practicantes de fisiculturismo en Brasilia/ DF. Para ello, fueron entrevistadas siete mujeres que adhieren al entrenamiento intenso de la musculatura y a una dieta alimentaria restringida, seis de ellas atletas y solo una no atleta. Los resultados, presentados y discutidos bajo la forma de ejes de análisis, revelan: 1) formas ascéticas particulares en que las entrevistadas operan con restricciones (alimentarias y de entrenamiento muscular) a que están sometidas para obtener el cuerpo deseado, 2) que la forma de operar y dar sentido al cuerpo, tanto para las atletas como para la veterana no atleta, indica la construcción de identidades distintas

Incidência de infecções primárias na corrente sanguínea em uma UTI neonatal / Incidence of primary bloodstream infections in a neonatal intensive care UNIT

As infecções primárias da corrente sanguínea são umas das principais causas de morbimortalidade intra-hospitalar. Além da grande responsabilidade sobre as mortes perinatais, estas são as principais infecções em Unidade de Terapia Intensiva Neonatal (UTI neonatal) e estão associadas a altos custos hospitalares, representando assim um grave problema de saúde pública. O objetivo é identificar a incidência de Infecções Primárias da Corrente Sanguínea (IPCS) em uma UTI neonatal de uma unidade hospitalar do Estado de Santa Catarina, Trata-se de um estudo descritivo retrospectivo, de abordagem quantitativa, tendo por base os dados coletados pela Comissão de Controle de Infeções relacionadas à assistência à saúde (CCIH) . Esta caracteriza as infecções com base nos Critérios Diagnósticos de Infecções Relacionadas à Assistência à Saúde da Agência Nacional de Vigilância Sanitária (ANVISA) as IPCS ocorridas na UTI neonatal nos anos de 2014 a 2015. Ocorreram neste período um total de 30 casos, sendo que em ambos os anos a maioria dos casos de IPCS ocorreram em pacientes do sexo feminino e com mais de 1.500g de peso ao nascer. A caraterização das IPCS laboratorial foi positiva em 88,5% e dentre as bactérias isoladas, apenas 4 (44,44%) no ano de 2014 foram classificadas como multirresistentes e não foram encontradas estas no ano de 2015. As bactérias mais comumente isoladas foram Staphylococcus aureus (41,6%) e Staphylococcus coagulase negativa (37,5%). Sendo que o desfecho dos casos foi predominantemente alta hospitalar.

The primary bloodstream infections are a major cause of in-hospital mortality. Besides the great responsibility on perinatal deaths, these are the main infections in neonatal ICUs and are associated with high hospital costs, thus representing a serious public health problem. The aim of this article is to analyze the incidence of Primary Blood Stream Infections in the Intensive Care Unit of a hospital in the state of Santa Catarina, as well as identify the most prevalent bacteria in IPCS and its sensitivity to antibiotics. This is a retrospective descriptive study with a quantitative approach, based on data collected by the Commission of Hospital Infection Control (CCIH) of Tereza Ramos Hospital (HTR), which characterized the IPCS occurred in the Neonatal Intensive Care Unit of the same hospital in the years 2014 and 2015. Occurred in this period a total of 30 cases, and in both years the majority of cases of IPCS occurred in female patients and over 1.500g and the predominant outcome was discharged. Blood cultures were positive in 88.5% and among the bacteria isolated, only 4 (44.44%) in 2014 were classified as multirresistentes. As most commonly isolated bacteria were Staphylococcus aureus (41.6%) and staphylococcus coagulase negative (37.5%). It is understood finally that the characteristics of the patients in our ICU IPCS follows specific pattern and increasing values, showing that are required targeted and effective measures to reduce the number of infections at our institution.

Perfil de prescrição de antimicrobianos nas unidades básicas de saúde conveniadas com a universidade de Itaúna/MG / Antimicrobial prescription profile in the basic health units agreed with the university of Itaúna/MG

INTRODUÇÃO: O uso abusivo de antibacterianos está intimamente relacionado ao desenvolvimento de resistência bacteriana, considerada, atualmente, um problema de saúde pública mundial. Segundo a Organização Mundial de Saúde, em 2001, mais da metade das prescrições de antimicrobianos foram inapropriadas e dois terços de sua utilização foram feitas sem prescrição médica. Assim, o uso racional desse medicamento requer uma seleção criteriosa e bom senso clínico do prescritor. OBJETIVOS: Analisar o perfil de prescrição de antimicrobianos nas Unidades Básicas de Saúde da Família (UBSF) do município de Itaúna-MG, conveniados com a Universidade de Itaúna (UIT) e contribuir para que futuras intervenções possam ser conduzidas promovendo do uso racional dos antimicrobianos na atenção primária. MÉTODOS: Estudo transversal de prontuários médicos de pacientes atendidos nas UBSF de Itaúna/MG conveniadas com a UIT, realizado entre março de 2013 e março de 2014, para os quais foram prescritos antibióticos. RESULTADOS: A classe de antimicrobianos mais prescrita foi a das penicilinas seguido pelas quinolonas e macrolídeos. Quanto à duração do tratamento, o período de cinco a dez dias foi observado na maioria das prescrições. As principais indicações clínicas foram infecção das vias aéreas superiores não especificadas, amigdalite, otite, sinusite, infecção do trato urinário entre outros. A solicitação de culturas foi realizada em apenas 5,5% dos casos. CONCLUSÃO: A análise do perfil das prescrições revelou a necessidade de reciclagem da equipe e adoção de protocolos clínicos. Tais medidas permitirão a uniformização das condutas, otimizando as prescrições e reduzindo o risco do uso inapropriado de antimicrobianos. (AU)

Introduction: The overuse of antibacterials is closely related to the development of bacterial resistance, currently considered a problem of public health worldwide. According to the World Health Organization, in 2001 over half of the antimicrobial prescriptions were inappropriate and two thirds of its use were made without prescription. Thus, the rational use of this drug requires careful selection and clinical judgment of the prescriber. Objectives: To analyze the antimicrobial prescription profile in the Basic Health Units of family of Itaúna-MG, that have agreements with the University of Itaúna (UIT) and contribute to future interventions that can be conducted to promote the rational use of antimicrobials in primary care. Methods: Cross-sectional study of medical records of patients treated in Basic Health Units of family Itaúna / MG with agreement with the UIT, held between March 2013 and March 2014, for which antibiotics were prescribed. Results: The most prescribed class of antimicrobials was the penicillins followed by quinolones and macrolides. About the duration of treatment, five to ten days was observed in the majority of prescriptions. The main clinical indications were infection of the upper airways unspecified, tonsillitis, otitis, sinusitis, urinary tract infection, among others. The request of cultures was performed in only 5.5% of cases. Conclusion: The analysis of the profile of prescriptions revealed the need for retraining of staff and adoption of clinical protocols. These measures will enable to uniform the procedures, optimizing the regulations and reducing the risk of inappropriate use of antimicrobials. (AU)

Non-fastidous antibiotic-resistance bacteria pollution in tap water / 军事医学

Objective To study the non-fastidous antibiotic-resistance bacteria pollution in tap water from a neighborhood in Tianjin.Methods Tap water samples were collected and bacteria were isolated by R2A agar,and 16S rRNA gene sequence for the identification of bacteria isolates was used.Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method.Results Among the 39 non-fastidous bacteria isolates,the resistance rate of antibioticresistance bacteria was 79.49％,including Enterococcus,Staphylococcus,Acinetobacter and Pseudomonas.Some bacteria (28.21％) showed resistance against only one antibiotic.The others (51.28％) were multiple resistant bacteria.Trimethoprim/sulfamethoxazole resistance was most prevalent (53.85％),and sulfamethoxazole resistance was also widely distributed (28.21％).Conclusion Tap water from this neighborhood is heavily polluted by non-fastidous antibioticresistantance bacteria,which deserves more attention.

Tratamiento de la infección del torrente sanguíneo por pseudomona aeruginosa con resistencia a carbapenemicos / Bloodstream infección treatment by carbapenem-resistant pseudomonas aeruginosa

La Pseudomona aeruginosa es una bacteria gramnegativa con gran capacidad de adaptación a ambientes hostiles, uno de ellos, el medio hospitalario, donde ha surgido como germen a temer por el papel preponderante que ha tenido en los pacientes que cursan con infecciones del torrente sanguíneo, dado por el desarrollo de mecanismo de resistencia a diferentes antimicrobianos que hace complejo el manejo terapéutico, incrementando de esta manera la morbimortalidad, la estancia hospitalaria y los gastos en atención sanitaria de estos paciente. Se realizó una revisión sistemática de la literatura disponible para establecer el estado actual del manejo antimicrobiano de la infección del torrente sanguíneo por Pseudomona aeruginosa

Pseudomonas aeruginosa is a gram-negative bacteria, possesses a great adaptability to hostile environ-ments, one of them is the clinical environment, where it has emerged as a fearful germ which performs a leading role in patients who present bloodstream infections, due to its development resistance mechanisms to different antimicrobial it makes therapeutic management complex, increases mortality and morbidity, hospital stay and health care expenses for these patients are high. A systematic review of available literature was performed to establish the current status of antimicrobial management of bloodstream infection by Pseudomonas aeruginosa

A elaboração e seus modelos: Leitura principal, Congresso da IPA em Berlim, Julho de 2007 / The development and its models: main reading, IPA Congress in Berlin, July 2007 / La perlaboration et ses modèles: lecture principale, Congrès de la IPA à Berlin, juillet 2007 / La elaboración y sus modelos: lectura principal, Congreso de IPA, Berlín, julio de 2007

Resumo: A elaboração é inerente ao trabalho psicanalítico, é sua própria forma, portanto está sempre presente, mas muda de aspecto, de implicação e de economia de acordo com as exigências deste. Explorarei três modelos de seu funcionamento em função do que está em primeiro plano no trabalho psicanalítico. No primeiro modelo, o que está em questão no trabalho é ajudar a tomada de consciência de um complexo representacional reprimido; o segundo relaciona-se com o trabalho psíquico referente a tornar consciente moções pulsionais ou experiências psíquicas que não puderam ser representadas, de modo que o tempo da análise torna-se o primeiro tempo a posteriori (après-coup); o terceiro é o modelo no qual a representação e a simbolização de uma experiência subjetiva, assim como suas implicações pulsionais, foram realizadas, fazendo o analisando se apropriar subjetivamente destas para poder integrá-las.

Abstract: Working through is an integral part of the psychoanalytic process, one could even say its epitome. It is therefore always present in the work of an analysis, but depending on the various phases and constraints that arise in that process, changes are brought to its form, to the issues involved in it and to its economic dimension. I will explore three forms (or models) of how working through functions in relation to the dominant feature of any given analytical process. In the first of these, the issue that has to be worked over involves insight into repressed representational complex; in the second form, work has to be done on bringing into consciousness drive-related impulses or mental experiences that have not been able to be represented until then, so the analysis itself would be the first occasion on which retroactive [après-coup] processing could be initiated; and in the third form, when representation and some kind of symbolization of the subjective experience and the drive-related issues that are part of it have been accomplished, the analysand has to appropriate these issues subjectively and integrate them.

Résumé: La perlaboration est inhérente au travail psychanalytique, elle en est la forme même, et est donc toujours présente dans celui-ci, mais change de forme, d'enjeux et d'économie selon leur moments et exigences. J'explorerais trois formes, trois modèles de son fonctionnement en fonction de ce qui est au premier plan du travail psychanalytique. Une première forme où l'enjeu du travail est celui d'aider à la prise de conscience d'un complexe représentationnel refoilé ; une seconde forme où le travail psychique concerne le " devenir conscient " de motions pulsionnelles ou d'expériences psychiques qui n'ont pu être antérieurement représentées et dont le temps de l'analyse est le premier temps d'après-coup ; et enfin une troisième forme où ont été effectuées la repésentation et une certaine forme de symboliser l'exprérience subjective et ses enjeux pulsionnels, en faisent l'analysant l'approprier subjectivement et l'intégrer.

Resumen: La elaboración es inherente al trabajo psicoanalítico, es su propia forma y está siempre presente, sin embargo, cambia de forma, de implicación y de economía según las exigencias de dicho trabajo. Voy a examinar tres modelos de su funcionamiento en función de lo que está en primer plan para el trabajo psicoanalítico. En el primer modelo, está en cuestión la toma de conciencia de un complejo representacional reprimido; en el segundo, cuando el trabajo psíquico consiste en "hacer consciente" las pulsiones o experiencias mentales que hasta aquel momento no han sido posibles de ser representadas, de manera que el tiempo de análisis es la primera ocasión a posteriori (après-coup); y en el tercer modelo, cuando se han alcanzado la representación y simbolización de una experiencia subjetiva y de las cuestiones relacionadas con la pulsión, entonces el analizando tiene que apropiarse subjetivamente de éstos e integrarlos.

Do estado à micropolítica: laço social e modalidades de (r)existência / Del estado hasta la micropolitica: lazo social y modos de (r) existencia / From state to micropolitics: social bond and modalities of (r)existence

O presente artigo tem por objetivo discutir acerca do Laço Social, partindo de sua formalização institucional pelo Estado e articulando - em relativa contraposição - com a noção de micropolítica, enquanto possibilidade alternativa de existência social e resistência em relação ao desamparo e ao status quo. À luz da psicanálise, em especial às obras sociais de Sigmund Freud e às leituras de Eugène Enriquez a respeito das formações sociais, procuramos compreender a relação entre a gênese da sociabilidade na horda primeva e o atual Estado moderno, levando em consideração as implicações de sua instrumentalização para perpetrar modos de opressão, exclusão e violência. Pela ótica da Esquizoanálise, abordamos a questão da micropolítica como propiciadora de linhas de fuga - em relação ao domínio estatal mantenedor da ordem imposta, absorvida e reproduzida - para fomentar novas e produtivas formas de estabelecer laços sociais.

Este artículo tiene como objetivo discutir sobre el lazo social, a partir de su formalización institucional por parte del Estado y en articulación - en parcial contraste - con la noción de micropolitica, como una posibilidad alternativa de la existencia social y la resistencia contra lo desamparo y el status quo. A la luz del psicoanálisis, especialmente las obras sociales de Sigmund Freud y lecturas de Eugène Enriquez sobre las formaciones sociales, tratando de entender la relación entre la génesis de la sociabilidad en el horda primitiva y el Estado moderno actual, teniendo en cuenta las implicaciones de su instrumentalización para perpetrar los modos de opresión, la exclusión y la violencia. Desde la perspectiva de esquizoanálisis, abordamos el tema de la micropolítica como prenda de líneas de fuga - en relación con el dominio mantenedor del estado de orden impuesto, absorto y reproducido - promover nuevas y productivas formas de establecer lazos sociales.

This article aims to discuss the Social Bond, from its institutional formalization by the State and articulating - in relative contrast - with the notion of micropolitics, as an alternative possibility for social existence and resistance to the helplessness and the status quo. In light of psychoanalysis, particularly the social works of Sigmund Freud and readings from Eugène Enriquez about the social formations, we tried to understand the relationship between the genesis of sociality in the primal horde and the current modern State, taking into account the implications of its instrumentation to perpetrate modes of oppression, exclusion and violence. From the standpoint of Schizoanalysis, we address the issue of micropolitics as a pledge of lines of flight - in relation to the State domain, maintainer of the imposed, absorbed and reproduced order - to foster new and productive ways to establish social bonds.

Aspectos biológicos de Dichelops melacanthus em três temperaturas, alimentados com grãos imaturos de milho 2B688Hx e 2B688 / Biological aspects of Dichelops melacanthus at three temperature, reared on immature 2B688Hx and 2B688 corn grains

RESUMO: Este estudo investigou os aspectos biológicos de Dichelops melacanthus (Hemiptera: Pentatomidae) em três temperaturas (19±1°C, 25±1°C e 31±1°C), alimentados com grãos imaturos de milho 2B688Hx (expressa a proteína inseticida Cry1F, para o controle de lepidópteros-alvo) e 2B688. Foi observado que a temperatura de 19±1°C prejudicou o desenvolvimento de D. melacanthus, pois, nessa condição, foi registrada a maior taxa de mortalidade das ninfas, menor peso de adultos e as fêmeas não ovipositaram. Por outro lado, a duração da fase jovem, mortalidade, peso de adultos, fecundidade e viabilidade de ovos não diferiu entre as temperaturas 25±1°C e 31±1°C. Também foi demonstrado que os aspectos biológicos dos percevejos alimentados com grãos imaturos de milho 2B688Hx não diferiram dos que se desenvolveram com a isolinha 2B688. Este estudo comprova que D. melacanthus desenvolve-se melhor em condições de temperaturas mais elevadas (até 31±1°C), e o fato de se alimentar com grãos imaturos de milho 2B688Hx não afeta o seu desenvolvimento.

ABSTRACT: This study investigated the development of Dichelops melacanthus (Hemiptera: Pentatomidae) at different temperatures (19±1°C, 25±1°C and 31±1°C) reared on 2B688Hx (expressing Cry1F insectice protein to control lepidopterans target) immature corn grains. The temperature of 19±1°C impaired the development of D. melacanthus and recorded the highest mortality of nymphs, lower weight and adult females laid no eggs. Moreover, the length of the nymphal biology, adult weight, fecundity and viability of eggs did not differ between temperatures 25±1°C and 31±1°C. It was also shown that the biological aspects of green belly stink bugs fed with 2B688Hx immature grains of corn do not differ from that develop with 2B688 isoline. This study showed that the biological cycle of D. melacanthus is favored at warmer temperature (until 31±1°C), and the consume of immature corn grain 2B688Hx does not affect its development.

Distribution and drug resistance of pathogens for bacterial infection after lung transplantation / 中华器官移植杂志

Objective To analyze the distribution and drug resistance of pathogens for bacterial infection after lung transplantation,so as to provide evidence for clinical prophylactic strategies postoperation and reasonable use of antibiotics.Method The bacterial distribution and drug resistance of 81 recipients after lung transplantation in our hospital were retrospectively analyzed from May 2009 to October 2012.The VITEK-32 full-automatic microbial identification system (Biomerieux,France)and its supplementary reagent were used for bacterial identification and drug sensitive test.The data were statistically analyzed by using the software SPSS 13.0.Result There were 67 cases of bacterial infection in the 81 recipients after lung transplantation and the infection rate was 82.72％ (67/81).The infection was caused by one kind of bacteria in 20 patients,two kinds of bacteria in 23 patients and multiple bacteria in 24 patients.157 strains pathogenic bacteria were produced,and the grampositive bacilli and the gram-negative bacilli accounted for 12.74％ and 87.26％ respectively.The most common pathogens for the bacterial infection were Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,Stenotrophomonasmaltophilia,Escherichia coli and Staphylococcus aureus.Most of the bacterial infections occurred in the early period (≤1 month) after lung transplantation and most non-fermentative bacterial pathogens were resistant to multi-antibiotics.Conclusion The bacterial infection rate is high after lung transplantation.The rational use of antibiotics in clinical practice should be adjusted according to the bacterial distribution and drug resistance.

Expound the Human Papilloma Virus Infection from the Theory of Fuxie / 浙江中医药大学学报

Objective] Through the system arrangement of Fuxie theory on academic context and diagnosis and treatment,preliminarily discuss the relationship between the human papilloma virus infection and Fuxie,in order to more thoroughly understand the HPV infection,broaden the clinical diagnosis and treatment,improve the clinical curative effect.[Method] To analyze,arrange,summarize and conclude Fuxie theory from the concept,causes, pathways and treatment,that of famous ancient physicians. [Result] Fuxie theory originates from internal classic,then develop up to now.Although controversy persists in the process of development,Fuxie theory still has its important practical significance.Dictionary of Chinese Traditional Medicine defines Fuxie as disease hidden in the body without immediate onset.Not merely six exogenous factors and internal injuries,complex pathogens all can lead to evil lurking.For its pathological basis,outbound pathways should be based on syndrome,and identified according to the etiology.Strengthening the body resistance to eliminate pathogenic factors is the generally treatment of Fuxie, and treatment should be dialectical according to its pathogenesis. [Conclusion] By carding Fuxie theory and analyzing the relationship between HPV infection and Fuxie,fully confirm that“the human papilloma virus infection is Fuxie”. Fuxie perspective provides the basis for HPV infection treatment,and a new way of thinking for clinical prevention and control of HPV infection.

Analysis in drug resistance and distribution of Streptococcus pneumonia infection in one area / 国际检验医学杂志

Objective To investigate the dynamic changes of infection distribution ,current resistance situation of Streptococcus pneumoniae(SP) in Sichuan area for the guidance of clinical therapy of SP .Methods The clinical result of SP from January 2013 to June 2016 were collected in our hospital .The age ,distribution department ,sample type ,the season and drug susceptibility results were analyzed .Results Infections caused by SP was prevalent in spring and winter ,and which mainly occurred in the infant and the elderly .The number of SP was maximum in the pediatrics ,and the detection rate was above 59% .Clinical isolates of SP mainly were detected from sputum ,followed by the blood .Penicillin G‐resistant SP strains were isolated more and more from 2013 to 2016 in Si‐chuan area .Erythromycin(E) ,Tetracycline(TC) and Trimethoprim/Sulfamethoxazole(SXT) had the higher resistance .No drug‐re‐sistant strains of Vancomycin(VA) and Linezolid(LZD) were detected .Levofloxacin(LEV) and Moxifloxacin(MXF) were more sensitive ,being more 95% ,and the sensitive rate of Chlormycetin(CL) also was over 87% .Conclusion There is an upward trend to detect the penicillin G‐resistant SP strains .Using of E ,TC and SXT should be managed ,because of its higher resisitance rate .How‐ever ,LEV ,MXF ,VA and LZD could still be used by clinical doctors for its higher sensitive rate .

Polimorfismo GLY972ARG del Gen sustrato de receptor de insulina 1 en pre-púberes con riesgo cardiometabólico / GLY972ARG plymorphism in the insulin receptor substrate 1 Gene in prepubertal children with cardiometabolic risk

Introducción: El sustrato del receptor de insulina 1 (IRS1) es un componente importante de la cascada de transducción de señales de la insulina y podría estar relacionado con los trastornos metabólicos asociados al síndrome metabólico. Objetivo: Evaluar el papel del polimorfismo Gly972Arg del gen IRS1 con factores de riesgo cardiometabólicos en niños pre-púberes. Metodología: Se estudiaron 279 niños con edades comprendidas entre 2-12 años, clasificados según los parámetros antropométricos y bioquímicos en: a) niños obesos sin RI (n=135), b) niños obesos con RI (n=80) y c) niños controles sanos (n=64). A cada niño se le realizó una extracción de sangre en ayunas y una postprandial, para determinar glicemia e insulina basal y postprandial, triglicéridos, colesterol total y fraccionado y la frecuencia genotípica del SNP Gly972Arg. Resultados: Se observó que 37,5% de los niños presentó RI; 9,6% hiperglicemia en ayunas; 27,3% hipertrigliceridemia y 50,46% bajos niveles de HDL-c. La frecuencia genotípica fue 89% genotipo Gly/Gly y 11% genotipo Gly/Arg. Se encontró diferencia significativa en la distribución de los diferentes genotipos del gen de IRS1 en los niños con sobrepeso/obesidad sin RI y niños con sobrepeso/obesidad con RI con respecto al grupo control (OR= 4,47; IC 95%=0,96-16,92; p < 0,05) y (OR= 4,43; IC 95%=0,93-21,00; p < 0,05) respectivamente. Conclusión: Se observó una asociación entre la presencia del genotipo Gly/Arg del gen IRS1 con sobrepeso/obesidad (factor de riesgo cardiometabólico) en los niños del estudio, presentando estos niños 4 veces más riesgos a presentar sobrepeso/obesidad que los niños con el genotipo Gly/Gly.

Introduction: Insulin receptor substrate 1 (IRS-1) is an important component of the insulin signal transduction cascade and could be related with metabolic disorders associated with metabolic syndrome (MS). Aim: Evaluate the role of the Gly972Arg polymorphism in the IRS1 gene in prepubertal children with cardiometabolic risk factors. Methods: We studied 279 children between 2-12 years of age, divided in groups 3 groups: a) obese children without insulin resistance (IR) (n=135), b) obese children with IR (n=80) and c) healthy children as controls (n=64). Basal and postprandial glucose, insulin, triglycerides, total and fractionated cholesterol and genotype frequency of the Gly972Arg SNP were determined in fasting and postprandial samples in each child. Results: 37.5% of the children had IR; in the fasting state, 9.6% had hyperglycemia, 27.3% hypertriglyceridemia and 50.46 % low HDL-C. The genotypic frequency was 89% for the Gly / Gly genotype and 11% Gly / Arg genotype. Significant difference was found in the distribution of the different genotypes of the IRS1 gene in children with overweight/obesity without IR and children with overweight/obesity with IR compared to the control group (OR = 4.47;CI 95% = 0.96-16.92; p <0.05) and (OR = 4.43; CI 95%= 0.93 - 21.00, p <0.05) respectively. Conclusion: Association between the presence of Gly/Arg genotype of the IRS1 gene with overweight/obesity (cardiometabolic risk factor) was observed in the studied children. These children were four times more likely to be overweight/obese than children with Gly / Gly genotype.