Evaluation of in-vitro susceptibility of ß-lactam-resistant Gram-negative bacilli to ceftazidime-avibactam and ceftolozane-tazobactam from clinical samples of a general hospital in southern Brazil

ABSTRACT Background: The spread of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing gram-negative bacilli (GNB) represent a global public health threat that limits therapeutic options for hospitalized patients. This study aimed to evaluate the in-vitro susceptibility of β-lactam-resistant GNB to ceftazidime-avibactam (C/A) and ceftolozane-tazobactam (C/T), and investigate the molecular determinants of resistance. Methods: Overall, 101 clinical isolates of Enterobacterales and Pseudomonas aeruginosa collected from a general hospital in Brazil were analyzed. Susceptibility to the antimicrobial agents was evaluated using an automated method, and the minimum inhibitory concentrations (MIC50/90) of C/A and C/T were determined using Etest®. The β-lactamase-encoding genes were investigated using polymerase chain reaction. Results: High susceptibility to C/A and C/T was observed among ESBL-producing Enterobacterales (100% and 97.3% for CLSI and 83.8% for BRCAST, respectively) and carbapenem-resistant P. aeruginosa (92.3% and 87.2%, respectively). Carbapenemase-producing Klebsiella pneumoniae exhibited high resistance to C/T (80%- CLSI or 100%- BRCAST) but high susceptibility to C/A (93.4%). All carbapenem-resistant K. pneumoniae isolates were susceptible to C/A, whereas only one isolate was susceptible to C/T. Both antimicrobials were inactive against metallo-β-lactamase-producing K. pneumoniae isolates. Resistance genes were concomitantly identified in 44 (44.9%) isolates, with bla CTX-M and bla SHV being the most common. Conclusions: C/A and C/T were active against microorganisms with β-lactam-resistant phenotypes, except when resistance was mediated by metallo-β-lactamases. Most C/A- and C/T-resistant isolates concomitantly carried two or more β-lactamase-encoding genes (62.5% and 77.4%, respectively).

Personalidade e Padrões Comportamentais do Sono: Diferenças entre Homens e Mulheres / Rasgos de Personalidad y lós Patrones de Sueño de Comportamiento: Diferencias entre Hombres y Mujeres / Personality Traits and Behavioral Sleep Patterns: Differences between Men and Women

Resumo O presente estudo teve o objetivo de verificar os efeitos comportamentais do sono nos traços de personalidade de adultos jovens. Participaram desta pesquisa 114 voluntários entre 18 e 40 anos de idade. Os sujeitos foram divididos em três grupos: Moderadamente Matutino (n = 23); Intermediário (n = 52) e Moderadamente Vespertino (n = 39). Entre os instrumentos de pesquisa utilizou-se o Questionário de Matutinidade e Vespertinidade de Horne e Östberg e Inventário dos Cinco Grandes Fatores de Personalidade. A MANOVA mostrou diferença significativa entre os cronotipos e os traços de personalidade [λ = 0,78; F(10,198) = 2,52; p < 0,05; η2 = 0,11]. Observou-se diferença significativa apenas para os traços de extroversão [F(2,103) = 3,65; p < 0,05; η2 = 0,06] e amabilidade [F(2,103) = 8,03; p < 0,05; η2 = 0,14]. Este estudo sugere que pessoas com diferentes traços de personalidades possuem horas específicas para realizar suas atividades e que existe uma relação com o padrão do cronotipo. Em geral, os dados indicam que homens e mulheres apresentam traços de personalidade diferentes em relação aos efeitos comportamentais do sono.

Resumen Este estúdio tuvo como objetivo verificar los efectos del comportamento del sueño em los rasgos de personalidad de los adultos jóvenes. El estúdio recogió 114 voluntarios de entre 18 y 40 años de edad. Los sujetos fueron divididos entres grupos: Moderadamente mañana (n = 23); Intermedio (n = 52) y moderadamente Vespertino (n = 39). Entre el instrumento de estudio utilizado el Cuestionario matutinidad y vespertinidad Horne y Östberg y el Inventario de los cinco grandes factores. MANOVA mostró una diferencia significativa entre el cronotipo y rasgos de personalidad [λ = 0.78; F(10.198) = 2.52; p <.05; η2 = 0.11]. Los resultados mostraron una diferencia significativa en la extraversión [F(2.103) = 3.65; p < .05; η2 = 0.06] y rasgos de bondad [F(2.103) = 8.03; p < .05; η2 = 0.14]. La investigación sugiere que entre estos sujetos, diferentes rasgos de personalidad pueden influir en la preferencia por ciertos períodos del día para llevar a cabo las actividades diarias y que existe una relación con el cronotipo estándar. Además, los resultados indican que hombres y mujeres tienen diferentes rasgos de personalidad cuando se comprueban los efectos del comportamiento del sueño.

Abstract This study aimed to investigate the behavioral effects of sleep on the personality traits of young adults. The sample consisted of 114 volunteers with ages between 18 and 40. The subjects were characterized into three groups according to Horne and Östberg (1975): Moderately Morning (n = 23); intermediary (n = 52) and Moderately Evening (n = 39). The Horne and Östberg Morningness and Eveningness questionnaire and the Big five Personality Inventory were used for data collection. MANOVA showed a significant difference between the chronotype and personality traits [λ = 0.78; F(10.198) = 2.52; p < .05; η2 = 0.11]. The results showed a significant difference on extraversion [F(2.103) = 3.65; p < .05; η2 = 0.06] and kindness traits [F(2.103) = 8.03; p < .05; η2 = 0.14]. The investigation suggests that among these subjects, different personality traits may influence preference for certain periods of the day to carry out daily activities and that there is a relationship with the standard chronotype. Also, the results indicate that men and women have different personality traits when the effects of the sleep behavior are checked.

Influence of the ventilatory mode on acute adverse effects and facial thermography after noninvasive ventilation / Influência do modo ventilatório nos efeitos adversos agudos e na termografia da face após ventilação não invasiva

ABSTRACT Objective: To compare the incidence and intensity of acute adverse effects and the variation in the temperature of facial skin by thermography after the use of noninvasive ventilation (NIV). Methods: We included 20 healthy volunteers receiving NIV via oronasal mask for 1 h. The volunteers were randomly divided into two groups according to the ventilatory mode: bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP). Facial thermography was performed in order to determine the temperature of the face where it was in contact with the mask and of the nasal dorsum at various time points. After removal of the mask, the volunteers completed a questionnaire about adverse effects of NIV. Results: The incidence and intensity of acute adverse effects were higher in the individuals receiving BiPAP than in those receiving CPAP (16.1% vs. 5.6%). Thermographic analysis showed a significant cooling of the facial skin in the two regions of interest immediately after removal of the mask. The more intense acute adverse effects occurred predominantly among the participants in whom the decrease in the mean temperature of the nasal dorsum was lower (14.4% vs. 7.2%). The thermographic visual analysis of the zones of cooling and heating on the face identified areas of hypoperfusion or reactive hyperemia. Conclusions: The use of BiPAP mode was associated with a higher incidence and intensity of NIV-related acute adverse effects. There was an association between acute adverse effects and less cooling of the nasal dorsum immediately after removal of the mask. Cutaneous thermography can be an additional tool to detect adverse effects that the use of NIV has on facial skin.

RESUMO Objetivo: Comparar a incidência e a intensidade de efeitos adversos agudos e a variação da temperatura da pele da face através da termografia após a aplicação de ventilação não invasiva (VNI). Métodos: Foram incluídos 20 voluntários sadios, de ambos os gêneros, submetidos à VNI com máscara oronasal por 1 h e divididos aleatoriamente em dois grupos de acordo com o modo ventilatório: bilevel positive airway pressure (BiPAP) ou continuous positive airway pressure (CPAP). A termografia da face foi realizada para determinar a temperatura na região de contato da máscara e no dorso do nariz em momentos diferentes. Os voluntários preencheram um questionário de efeitos adversos após a retirada da VNI. Resultados: A incidência e a intensidade dos efeitos adversos agudos foram maiores naqueles submetidos a BiPAP em relação aos submetidos a CPAP (16,1% vs. 5,6%). A análise termográfica evidenciou um esfriamento significativo da pele facial nas duas regiões de estudo imediatamente após a retirada da máscara. Os efeitos adversos agudos em maior intensidade ocorreram predominantemente no grupo de participantes cuja redução da temperatura média no dorso do nariz foi menor (14,4% vs. 7,2%). A análise visual termográfica de zonas de esfriamento e aquecimento na face identificou regiões de hipoperfusão ou hiperemia reativa. Conclusões: O uso do modo BiPAP associou-se a maior incidência e intensidade de efeitos adversos agudos associados à VNI. Houve associação entre efeitos adversos agudos e menor esfriamento da pele do dorso do nariz imediatamente após a retirada da máscara. A termografia cutânea pode ser uma ferramenta adicional na detecção de efeitos adversos na pele da face associados ao uso da VNI.

Manifestações dermatológicas em pacientes infectados pelo HIV: um estudo de prevalência / Dermatological manifestations in HIV-infected patients: a prevalence study

Na infecção pelo HIV, a pele pode ser tanto um indicador precoce de doença quanto de gravidade. Este estudo analisou a frequência e a apresentação clínica de manifestações dermatológicas em pacientes portadores de HIV, destacando as lesões mais encontradas, e correlacionou suas características com o estado imunológico. Foram encontradas 129 lesões mucocutâneas dentre os 57 pacientes portadores de HIV examinados, havendo em média 2,25 lesões por paciente. As dermatoses mais comuns, em ordem decrescente de frequência, foram candidíase oral, onicomicose e dermatite seborreica. As lesões oportunistas mostraram relação significativa com deficiência imunológica, e as afecções de pele mais encontradas mostraram-se bons indicadores do estado imunológico do paciente e da progressão da doença.

In the HIV infection the skin can be either an early indicator of disease and severity. This study examined the frequency and clinical presentation of skin manifestations in patients with HIV, highlighting the most frequent injuries, and correlated their characteristics with the immune status. We found 129 mucocutaneous lesions among 57 patients with HIV, with an average of 2.25 lesions per patient. The most common skin diseases in descending order of frequency were oral candidiasis, onychomycosis and seborrheic dermatitis. Opportunistic lesions showed significant relationship with immune deficiency and the most frequent skin diseases proved to be good indicators of the immune status of the patient and disease progression.

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: parte II. Ventilação mecânica, controle endócrino metabólico e aspectos hematológicos e infecciosos / Guidelines for potential multiple organ donors (adult): part II. Mechanical ventilation, endocrine metabolic management, hematological and infectious aspects

A atuação do intensivista durante a manutenção do potencial doador falecido na busca da redução de perdas de doadores e do aumento da efetivação de transplantes não se restringe aos aspectos hemodinâmicos. O adequado controle endócrino-metabólico é essencial para a manutenção do aporte energético aos tecidos e do controle hidro-eletrolítico, favorecendo inclusive a estabilidade hemodinâmica. A abordagem das alterações hematológicas é igualmente importante considerando as implicações da prática transfusional inapropriada. Ressalta-se ainda o papel da ventilação protetora na modulação inflamatória e conseqüente aumento do aproveitamento de pulmões para transplante. Por fim, assinala-se a relevância da avaliação criteriosa das evidências de atividade infecciosa e da antibioticoterapia na busca do maior utilização de órgãos de potenciais doadores falecidos.

The role of intensive care specialists in the maintenance of deceased potential donors is not restricted to hemodynamics. Appropriate endocrine-metabolic management is fundamental to maintaining energy support and hydroelectrolytic control, which cooperate for hemodynamic stability. Hematological changes are also important, especially considering the issues caused by inappropriate transfusions. In addition, this article discusses the role of appropriate protective ventilation to prevent inflammatory responses and to provide more transplantable lungs. Finally, judicious assessment of infections and antibiotic therapy is discussed.

Use of antibiotics without medical prescription

The inappropriate use of antibiotics for the treatment of infections is a worldwide problem that has implications for the cost of treatment and the development of resistant strains of bacteria. The use of antibiotics should follow specific criteria; they are on top of the list of self-medication drugs in countries that do not control their commercialization. OBJECTIVES: To determine the percentage of pharmacies that attend the public and sell antibiotics without medical prescription in a medium-sized city in Brazil, and analyze the variables involved in this procedure. MATERIALS AND METHODS: 107 of the 136 pharmacies registered in our city were evaluated. These pharmacies were visited by actresses who simulated having a sister with symptoms of a non-complicated rhino-sinusitis, so that they could obtain antibiotics without a medical prescription. Each pharmacy was visited only once; the only variable in the simulated clinical setting was the report of fever temperature, which was randomly assigned between 38.5 and 40 degrees Celsius. RESULTS: Antibiotics were offered in 58 percent of the pharmacies, and this offer was increased to 74 percent after the actresses insisted on having them. In 65.4 percent of the pharmacies, the actresses were attended by a pharmacist, and 84.2 percent of them said they would sell antibiotics. When the request for antibiotics was denied (26 percent), only 7.5 percent was due to absence of prescription. The most frequent reason for refusal to sell antibiotics, was because the attendant deemed it unnecessary (46.6 percent) CONCLUSION: Antibiotics can be easily bought in the great majority of the pharmacies in our town without a medical prescription and a clear indication. Fever temperature did not modify the attendant's indication of the drug.

Corpo estranho na arteria pulmonar direita / Foreign body in the right pulmonary artery

Os autores relatam caso de corpo estranho intra-arterial de natureza metálica em que houve dificuldade no diagnóstico topográfico, com a conseqüente dificuldade terapêutica. Trata-se de caso curioso e raro, verificado no Hospital Nossa Senhora das Graças, em Curitiba (PR)