The epidemiology of Clostridioides difficile infection in Brazil: A systematic review covering thirty years.

Clostridioides difficile is considered one of the main etiological agents of bacterial diarrhea associated with the use of antibiotics. It is an important nosocomial pathogen and the main cause of morbidity and mortality. In recent years, infections associated with C. difficile have led to numerous investigations. It is well known that C. difficile associated diarrhea (CDAD) is favored by the suppression or imbalance of the intestinal microbiome during or after antibiotic therapy. Other risk factors are, for instance, advanced age, long periods of hospitalization, chemotherapy, and other gastrointestinal infections. In the 2000's, the number of CDAD cases largely increased due to the emergence of the epidemic clone named BI/NAP1 ribotype 027, responsible for causing several outbreaks in developed countries, such as Canada, the United States, and the United Kingdom. The presence of the epidemic clone has been reported in Asia, Latin America and Australia, however, infections associated with C. difficile (CDI) in these geographic regions are usually caused by other ribotypes. In Brazil, for instance, epidemiological data on the incidence of CDI are still limited, especially regarding the spread of C. difficile within hospital units, the spectrum of toxigenic genes and the antimicrobial resistance profile. Some studies have demonstrated the importance of notifying cases related to CDI and taking special care measures in order to minimize the spread of epidemic strains in Brazil. Finally, epidemiological analysis of the prevalent and/or exclusive ribotypes circulating in Brazil can contribute to understand and to correlate characteristics associated with the biology of this pathogen with other globally circulating ribotypes. This review aimed to summarize all published work related to the isolation of C. difficile from human patients in Brazil, being the main focus, the methodologies used for identification of prevalent ribotypes, the antimicrobial susceptibility profile, and the diseases associated with the acquisition of CDI.

Characterization of Clostridioides difficile ribotypes in domestic dogs in Rio de Janeiro, Brazil.

Clostridioides difficile is the major etiologic agent of nosocomial bacterial diarrhoea and pseudomembranous colitis. The pathogenesis of C. difficile infection (CDI)involves two cytotoxic enzymes (TcdA, TcdB) that cause colonic epithelial damage, fluid accumulation and enteritis. CDI has been demonstrated in a variety of animal species and some reports have recently raised the importance of wild animals as a reservoir of this pathogen and possible transmission to humans and domestic animals. The aim of this study was to characterize C. difficile isolates obtained from pet dogs in Rio de Janeiro, Brazil. A total of 50 faecal samples were obtained from healthy and diarrheic dogs. Five of fifty samples (10%) grew C. difficile. Of those, three belonged to the PCR ribotype 106 (ST 42) and were toxigenic (A+B+). The other two strains belonged to the PCR ribotype 010 (ST 15) and were not toxin producers (A-B-). None of the isolates tested positive for the binary toxin genes. Considering the antimicrobial resistance patterns of all isolates using EUCAST breakpoints, all strains were sensitive to metronidazole and vancomycin. However, two strains (ribotype 106 and ribotype 010), were resistant to clindamycin (≤256 µg/mL). All strains were strong biofilm producers. Our study provides evidence that dogs can act as reservoirs for C. difficile epidemic ribotypes.

Peanut skin extract reduces lipid oxidation in cooked chicken patties.

The objectives of this study were to evaluate the antioxidant capacity of peanut skin extract and its effect on the color and lipid oxidation of cooked chicken patties over 15 d of refrigerated storage. The extract was obtained using 80% ethanol and evaluated in terms of total phenolic content, reducing power based on the ferric reducing ability of plasma (FRAP) reagent, and 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity. The patties were made with ground thigh fillets, chicken skin, and 2% salt. They were homogenized and divided into the following two groups: a control treatment without antioxidants and a peanut skin treatment with 70 mg gallic acid equivalent (GAE)/kg per patty. Analyses of the fatty acid profiles, instrumental colors (L*, a*, and b*) and thiobarbituric acid reactive substances (TBARS) were performed on d 1, 8, and 15 of storage at 1±1ºC. The peanut skin extract resulted in a phenolic content of 32.6±0.7 mg GAE/g dry skin, an antioxidant activity (FRAP) of 26.5±0.8 6 µmol Trolox equivalent/g dry skin, and an efficient concentration (EC50) of 46.5 µg/mL. The total unsaturated fatty acid was approximately 73%, and 39% of this fatty acid content was monounsaturated. The peanut skin extract slowed the decrease in the a* values (P<0.05) but reduced the L* and b* values compared to the control samples during storage (P<0.05). Lipid oxidation was minimized by the peanut skin extract (P<0.05), which resulted in a maximum value of 0.97 malondialdehyde (MDA)/kg compared to values that were close 19 mg MDA/kg patties in the control sample at the end of storage period. Thus, it can be concluded that although peanut skin extract causes little color change, it can be applied as a natural antioxidant to cooked chicken patties because it efficiently inhibits lipid oxidation in this product during refrigerated storage.

Effect of spray drying on the sensory and physical properties of hydrolysed casein using gum arabic as the carrier.

This study was aimed at spray drying hydrolysed casein using gum Arabic as the carrier agent, in order to decrease the bitter taste. Three formulations with differing proportions of hydrolysed casein: gum Arabic (10:90, 20:80 and 30:70) were prepared and characterized. They were evaluated for their moisture content, water activity, hygroscopicity, dispersibility in water and in oil, particle size and distribution, particle morphology, thermal behaviour (DSC) and bitter taste by a trained sensory panel using a paired-comparison test (free samples vs. spray dried samples). The proportion of hydrolysed casein did not affect the morphology of the microspheres. The spray drying process increased product stability and modified the dissolution time, but had no effect on the ability of the material to dissolve in either water or oil. The sensory tests showed that the spray drying process using gum Arabic as the carrier was efficient in attenuating or masking the bitter taste of the hydrolysed casein.

Sacroiliac joint dysfunction and lumbar pain. Evaluation in a Brazilian population.

The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

El estudio pretende evaluar la incidencia y evolución de la disfunción de la articulación sacroilíaca (DASI). Para llegar a 50 pacientes con diagnóstico de DASI, se examinaron consecutivamente 192 pacientes con dolor lumbar y fracaso en el abordaje conservador (26% de incidencia). Inicialmente, los pacientes se sometieron a un bloqueo de la articulación sacroilíaca (ASI) con corticosteroides intraarticulares (IA) seguido, si era necesario, de radiofrecuencia ASI enfriada o remitidos a una intervención quirúrgica, en orden de complejidad. De los 50 pacientes sometidos al bloqueo IA SI, 41 (82%) refirieron mejoría del dolor y de la calidad de vida y menor consumo de analgésicos de rescate durante 25 semanas. El bloqueo indujo un rápido inicio del alivio del dolor y hubo una caída en la puntuación media del dolor de 8 a 2 cm (p < 0.001) mantenida hasta 25 semanas. El consumo de analgésicos de rescate también disminuyó significativamente (p < 0.05). Sin embargo, nueve pacientes (18%) no refirieron una mejoría duradera en la evaluación de la tercera semana y se sometieron a radiofrecuencia fría. De esta población de nueve, siete tuvieron éxito (78%), mientras que a dos se les recomendó cirugía. De los 50 pacientes, 82% se sintió cómodo después del bloqueo IA, 18% fue sometido a radiofrecuencia, con una tasa de éxito de 78%. La incidencia final de sugerencia de cirugía fue de 4%.

Oxidative stress biomarkers response to high intensity interval training and relation to performance in competitive swimmers.

AIM: Aim of the study is to investigate the modulations of oxidative stress biomarkers and some antioxidants induced by high intensity interval training bout and its relation to swimming performance. METHODS: Ten swimmers performed a set of 8 maximal swims along 100 m by style of their specialty, with 10 minute for a rest. The concentration of blood lactate ([Lac]) was determined after each swim. The lactate tolerance index (LTI) was determined by the ratio between [Lac] and the respective times of execution of the 8 swims. The time to complete first 100 m swim at maximum effort (P100) and the international point score (IPS) reached in a specific competition were considered performance parameters. Venous blood was collected before and after the anaerobic training effort. RESULTS: Mean blood lactate concentration in the eight swims was 10.9 ± 1.2 mM. Significant increases were observed for TBARS (pre: 4.1±0.7 ?mol/L; post: 4.9±1.1. ?mol/L), CK (pre: 206.4±170.7 U/L; post: 244.4±176.9. U/L), GSH (pre: 0.52±0.06; post: 0.62±0.05. mM), and ascorbic acid (pre: 0.06±0.02; post: 0.11±0.03. mg/dL) after the anaerobic training bout compared to the values obtained before it. In addition, significant correlations (P < 0.05) were detected between LTI and P100 (r = -0.87) and IPS (r = 0.64) and between variation of ascorbic acid and P100 (r = -0.60). CONCLUSION: Anaerobic training bout proposed induces oxidative stress and cell muscle damage markers as well as modulates some antioxidants of competitive swimmers. The modulation of ascorbic acid seems to play an important role in the performance of these athletes.

Can established cultured papilloma cells harbor bovine papillomavirus?

Papillomaviruses have been reported to be very difficult to grow in cell culture. Also, there are no descriptions of cell cultures from lesions of bovine cutaneous papillomatosis, with identification of different bovine papilloma virus (BPV) DNA sequences. In the present report, we describe primary cell cultures from samples of cutaneous lesions (warts). We investigated the simultaneous presence of different BPV DNA sequences, comparing the original lesion to different passages of the cell cultures and to peripheral blood. BPV 1, 2 and 4 DNA sequences were found in lesion samples, and respective cell cultures and peripheral blood, supporting our previous hypothesis of the possible activity of these sequences in different samples and now also showing how they can be maintained in different passages of cell cultures.

The effect of buserelin acetate on the uterus of adult rats: morphological aspects.

PURPOSE OF INVESTIGATION: To evaluate the effect of buserelin acetate on the morphology of the endometrium of adult, non-castrated, female Wistar rats. METHODS: Female Wistar rats at estrus or diestrus (assessed by vaginal cytology) received daily subcutaneous injections of 20 mg buserelin acetate for four, eight or 12 days. Rats were sacrificed 24 hours or five days following final dosage. A control group received diluent for 12 days. RESULTS: Progressive tissue hypotrophy occurred during treatment and was followed by estrogenic hyperactivity five days after the end of treatment. Vaginal cytology and endometrial histology revealed intense, vacuolized lining and glandular epithelia, brush borders and endometrial stroma densely infiltrated with eosinophils. CONCLUSIONS: Buserelin acetate appears to cause a progressive blockade of gonadotrophin secretion when administered to female rats for four, eight or 12 days, and an important rebound effect, with accentuated estrogen release already apparent in the first estrous cycle following treatment.

Assessment of a novel pinhole supplementary implant for sulcus fixation in pseudophakic cadaver eyes.

PurposeTo evaluate a novel small-aperture supplementary implant that applies the principle of pinholes for management of irregular astigmatism, in postmortem human eyes.MethodsPseudophakic human cadaver eyes were imaged by anterior segment optical coherence tomography (AS-OCT) to assess position of the in-the-bag intraocular lens (IOL). Eyes were prepared as per the Miyake-Apple technique. Two versions of the supplementary implant (open-loop and tripod designs) were then inserted into the sulcus of each eye. Evaluations under AS-OCT and from anterior and posterior views of the anterior segment were used to assess IOL fixation, centration, tilt, and interlenticular distance (ILD). This experimental study has been conducted in John A. Moran Eye Center, University of Utah.ResultsNine eyes were selected, with various sizes, primary IOL materials/designs, and Soemmering's ring formation. The open-loop model exhibited a mild degree of decentration and tilt in 2 eyes with zonular dehiscence. Mild decentration and tilt of the tripod were observed in 4 eyes; in 1 additional eye it was centered but mildly tilted. Three eyes with zonular dehiscence had one of the closed loops of the tripod located posteriorly to the ciliary processes. In all cases, an ILD was observed between the lenses (open loop: 0.65±0.13 mm; tripod: 0.41±0.12 mm).ConclusionsIt is important to take into account anatomical aspects related to ciliary sulcus fixation of supplementary IOLs. Both designs evaluated, exhibited appropriate centration and ILD. The open-loop design had less risk of tilt in association with haptics protruding posteriorly through areas of zonular weakness.

Characterization of two cell lines with distinct phenotypes and genotypes established from a patient with renal cell carcinoma.

Two human renal carcinoma cell lines have been established from the same patient. One cell line (CCF-RC1) was obtained from the primary tumor and the second (CCF-RC2) was established from cells of the renal vein effluent of the perfused tumorous kidney. Although they were established from the same patient, the cell lines differed in certain biological properties. They have been passaged up to 50 times in vitro for about two years. Each has an epithelial morphology and exhibits mutilayering. Cell cycle time of CCF-RC1 and CCF-RC2 was 34 and 36 h, respectively. They exhibited anchorage independent growth, and the plating efficiency of CCF-RC2 in soft agar was higher than that of CCF-RC1. Both lines induced tumors in nude mice at the site of s.c. injection closely resembling the original tumor in histological examination. Electron microscopic features of both tumors in nude mice were consistent with epithelial origin. Doubling time of CCF-RC1 and CCF-RC2 in nude mice was 11 and 12 days, respectively. CCF-RC1 and CCF-RC2 have hypotetraploid karyotype and modal numbers of 83 and 73, presenting two and three marker chromosomes, respectively. Immunocytology with commercial monoclonal antibodies against renal carcinoma (URO-3) and cytokeratin (Mac 6) showed positive reactions with both lines, suggesting that these cell lines derived from renal epithelium. A murine monoclonal antibody (2E11) was generated against CCF-RC2 by the hybridoma technique; 2E11 reacted with CCF-RC2, but not with CCF-RC1. These cell lines may provide a useful model for the study of tumor heterogeneity and its relationship to metastasis.

Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroacetabular impingement: Outcomes following hip arthroscopy for treatment of chondrolabral damage.

The purpose of this study was to determine patient-reported outcomes of patients with mild to moderate developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) undergoing arthroscopy of the hip in the treatment of chondrolabral pathology. A total of 28 patients with a centre-edge angle between 15° and 19° were identified from an institutional database. Their mean age was 34 years (18 to 53), with 12 female and 16 male patients. All underwent labral treatment and concomitant correction of FAI. There were nine reoperations, with two patients requiring revision arthroscopy, two requiring periacetabular osteotomy and five needing total hip arthroplasty. Patients who required further major surgery were more likely to be older, male, and to have more severe DDH with a larger alpha angle and decreased joint space. At a mean follow-up of 42 months (24 to 89), the mean modified Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p < 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to 43; p < 0.001). Median patient satisfaction was 9.0/10 (1 to 10). Patients reported excellent improvement in function following arthroscopy of the hip. This study shows that with proper patient selection, arthroscopy of the hip can be successful in the young patient with mild to moderate DDH and FAI.

Antibiotic-acrylic bone cement composites. Studies of gentamicin and Palacos.

Palacos bone cement with and without contained gentamicin was tested for antibacterial efficacy using a rabbit model of a knee hemiarthroplasty and a challenge with intra-articular Escherichia coli. The gentamicin-containing cement prevented infection from challenge with Escherichia coli and protected against inadvertent operative infection as well. Antibiotic concentrations in synovial fluid and urine remained in the therapeutic range for three days, whereas levels in serum were always quite low. Eight per cent of the gentamicin had leached out of the bone cement by eight days, most of it during the first day. Thereafter, extremely small amounts of gentamicin left the cement on a daily basis. The amount of antibiotic leaching out in vitro was proportional to the surface area of the cement. More eluted into serum than into saline.

[Hypersensitivity to allopurinol. Efficacy of a desensitizing protocol in 3 cases]. / Hipersensibilidad al alopurinol. Eficacia de un protocolo de desensibilización en tres casos.

Allopurinol is often prescribed for the treatment of hyperuricemia. It inhibits the uric acid production binding tightly to xanthine oxidase. Although it is generally well tolerated, an almost 10% prevalence of adverse reactions has been reported, particularly gastrointestinal and neurological effects. Some hypersensitivity syndromes have also been described (rash, vasculitis or exfoliative dermatitis). In these cases, if a substitute treatment is not available, a desensitization procedure to the drug must be considered. We present three patients with cutaneous hypersensitivity to allopurinol, two who developed urticaria and other one who had a fixed drug eruption. Skin test were all negatives with positive oral challenge test. An out- patient desensitization procedure to allopurinol was initiated, repeating the last tolerated doses for 4 or 5 days, and reaching maintenance therapeutic drug doses without any significant adverse effect (only one case of cutaneous pruritus). These experiences and the previously reported in the literature, show that the desensitization to allopurinol is a good therapeutic alternative in hypersensitivity reactions to the drug.

Development and sensory evaluation of soy milk based yoghurt.

Yoghurts were prepared by fermentation of soy milk using a mixed starter culture containing Lactobacillus bulgaricus and Streptococcus thermophilus. Soy milk at 9 degrees Brix was homogenised under pressure (17 MPa) and fermented with and without addition of sucrose (2.0 and 2.5 g per 100 g) for 4, 5, 6 and 7 hours. The yoghurts were evaluated in terms of sensory quality, pH, titrable acidity, phytic acid and oligosaccharides: A yoghurt with the best sensory quality was obtained using the homogenised soy milk with 2% sucrose addition and fermented for 6 h. Lactobacillus bulgaricus and Streptococcus thermophilus did not produce phytases and alpha-galactosidases at the experimental conditions, consequently, phytic acid and galactosides were not affected by the process.

[Intrauterine malnutrition in rats. II. Study of weight and mortality of the offspring]. / Desnutrição intrauterina em ratos. II Estudo do peso e mortalidade do produto da concepção.

Rats were submitted to protein-calorie deprivation during different periods of gestation and the body weight and mortality of offspring were evaluated at 0, 28 and 90 days of age. The body weight was considered adequate (n) when the values were up to 2 SD below the mean values of control animals, or inadequate (d) when the values were below 2 SD. Rats of the control group (C) were fed ad libitum (protein 21%), and the rats of the experimental groups were fed during all gestational period (D), during the first half (D1) or second half of pregnancy (D2), with a diet containing 1% of protein, and the intake reduced to 50%. Significant differences were observed in the ponderal evolution for all experimental groups. Group D was the most damaged, with the greatest ponderal deficiency and the greatest mortality rates. Similar behavior was observed for D2. Group D1 was similar to C with the best results and the lowest mortality rate.

[Intrauterine malnutrition in rats. I. Impact on weight gain, length of pregnancy and number of offspring]. / Desnutricão intrauterina em ratos. I. Repercussões no ganho de peso, tempo de gestação e no número de recém--nascidos.

Rats were submitted to protein-caloric deprivation during different periods of gestation. Maternal body weight gain, duration of pregnancy and number of offspring were evaluated. Rats of the control group (C) were fed ad libitum (protein 21%), and rats of the experimental groups were fed during all gestational period (D), during the first half (D1) or second half of pregnancy (D2) with a diet containing 1% of protein, and the intake was reduced to 50%. We concluded that malnutrition during pregnancy induced lower maternal weight (C greater than D1 greater than D2 greater than D) and lower number of offspring ( [C = D1] greater than D2 greater than D). No differences were observed in the duration of pregnancy in all groups studied.

Lupus erythematosus: considerations about clinical, cutaneous and therapeutic aspects.

Systemic Lupus Erythematosus is a chronic inflammatory disease with multifactorial etiology. Although clinical manifestations are varied, the skin is an important target-organ, which contributes to the inclusion of skin lesions in 4 out of the 17 new criteria for the diagnosis of the disease, according to the Systemic Lupus International Collaborating Clinics. The cutaneous manifestations of lupus are pleomorphic. Depending on their clinical characteristics, they can be classified into Acute Cutaneous Lupus Erythematosus, Subacute Cutaneous Lupus Erythematosus, Chronic Cutaneous Lupus Erythematosus and Intermittent Cutaneous Lupus Erythematosus. Treatment is based on preventive measures, reversal of inflammation, prevention of damage to target organs and relief of adverse events due to pharmacological therapy. The most commonly used treatment options are topical, systemic and surgical treatment, as well as phototherapy. The correct handling of the cases depends on a careful evaluation of the morphology of the lesions and the patient's general status, always taking into consideration not only the benefits but also the side effects of each therapeutic proposal.

Microencapsulation of Bifidobacterium animalis subsp. lactis and Lactobacillus acidophilus in cocoa butter using spray chilling technology.

In the present study, the cells of Bifidobacterium animalis subsp. lactis (BI-01) and Lactobacillus acidophilus (LAC-04) were encapsulated in cocoa butter using spray-chilling technology. Survival assays were conducted to evaluate the resistance of the probiotics to the spray-chilling process, their resistance to the simulated gastric and intestinal fluids (SGF and SIF), and their stability during 90 days of storage. The viability of the cells was not affected by microencapsulation. The free and encapsulated cells of B. animalis subsp. lactis were resistant to both SGF and SIF. The micro-encapsulated cells of L. acidophilus were more resistant to SGF and SIF than the free cells; the viability of the encapsulated cells was enhanced by 67%, while the free cells reached the detection limit of the method (10(3) CFU/g). The encapsulated probiotics were unstable when they were stored at 20 °C. The population of encapsulated L. acidophilus decreased drastically when they were stored at 7 °C; only 20% of cells were viable after 90 days of storage. The percentage of viable cells of the encapsulated B. animalis subsp.lactis, however, was 72% after the same period of storage. Promising results were obtained when the microparticles were stored at -18 °C; the freeze granted 90 days of shelf life to the encapsulated cells. These results suggest that the spray-chilling process using cocoa butter as carrier protects L. acidophilus from gastrointestinal fluids. However, the viability of the cells during storage must be improved.