Results of a national system-wide quality improvement initiative for the implementation of evidence-based infection prevention practices in Brazilian hospitals.

BACKGROUND: Quality improvement (QI) methods are recommended to address healthcare-associated infections (HCAIs) in hospitals, but whereas internal initiatives have been widely studied, there is little evidence on the application and effect of a QI approach from an external system-wide perspective. AIM: To analyse the effect of a national system-wide QI initiative aimed at promoting HCAI prevention via regulatory interventions in Brazil. METHODS: A QI cycle approach designed and assessed with a before-and-after quasi-experimental design was implemented by the Brazilian Health Regulatory Agency (ANVISA), targeting 1869 hospitals. Eleven evidence-based quality indicators related to HCAI prevention and a composite measure were assembled, shared, and assessed; the intervention to improve was then based on participatory multifaceted regulatory actions. Absolute and relative improvements were estimated after the intervention. FINDINGS: In all, 563 hospitals (30.1% response) totalling 86,837 beds participated in the baseline assessment, and 681 hospitals (36.4% response) totalling 101,231 beds in the second. Ten of the 11 criteria improved (P < 0.05), as well as the composite indicator (P = 0.001) in all the regions of the country, particularly in the group of hospitals participating at baseline. 'Hand hygiene (HH) infrastructure' reached 100% (baseline: 97.9; P = 0.001), 'HH protocol' 96.9% (baseline: 92.9; P = 0.001), 'HH monitoring' 70% (baseline: 60.7; P < 0.001) and 'existence of antimicrobial prescription protocol' 80.7% (baseline: 73.2; P < 0.001), among others. The HCAI rates of the participating hospitals decreased after the intervention (P < 0.05). CONCLUSION: The QI cycle approach was useful in guiding system-wide interventions for patient safety. External regulation was feasible and effective in promoting internal HCAI prevention nationwide.

Comparison between the additive effects of diluted (rFSH) and diluted/dynamized (FSH 6 cH) recombinant follicle-stimulating hormone on the in vitro culture of ovine preantral follicles enclosed in ovarian tissue.

OBJECTIVE: This study compared 2 types of recombinant follicle stimulating hormone (rFSH): diluted and diluted/dynamized, on in vitro development of ovine follicles. METHODS: In experiment 1, ovarian fragments were cultured for 1 or 7 days in α-MEM(+) in the absence or presence of different concentrations of diluted rFSH to determine the best concentration. In experiment 2, the effect of diluted and diluted/dynamized rFSH (rFSH 6 cH--ultradiluted and succussioned), alone or in combination, was studied. RESULTS: In experiment 1, compared to control, 50ng/mL of diluted rFSH induced higher rates of follicular survival after 7 days of culture and higher percentages of growing follicles at day 1 of culture (P<0.05). In experiment 2, compared to control, diluted/dynamized rFSH induced higher follicular diameter and survival rate after 7 days and early follicle activation at day 1 of culture (P<0.05). Compared to diluted rFSH, diluted/dynamized rFSH induced higher rates of follicle activation at day 1 of culture (P<0.05). CONCLUSION: In conclusion, compared to the control medium, diluted/dynamized rFSH promoted survival and early activation of follicles, while diluted rFSH promoted higher activation later in the culture. Thus, diluted/dynamized rFSH may be used as an alternative to diluted rFSH for the in vitro culture of ovine preantral follicles.

MDGC-MS analysis of essential oils from Protium heptaphyllum (Aubl. ) and their antifungal activity against Candida specie / Análise MDGC-MS de óleos essenciais de Protium heptaphyllum (Aubl. ) e sua atividade antifúngica contra espécies de Candida

ABSTRACT Protium heptaphyllum is found in the Amazon region, and in various Brazilian states and South American countries. Also Known as almecega, it produces an oil resin used in traditional medicine as analgesic, anti-inflammatory, cicatrizant and expectorant, it is rich in pentacyclic triterpenes and essential oil. The main objective of this study was to analyze the chemical composition of P. heptaphyllumresin (OEPh) over different extraction times and to evaluate their antifungal activity against Candida species, obtained from gardeners with onychomycosis, using the disk diffusion method. The OEPh was obtained by hydrodistillation and analyzed by Multidimensional Gas Chromatography coupled with Mass Spectrometry (MDGC / MS). Candida species were obtained from lesions on the nails of horticulturist from a community garden in the city of Teresina, Piauí, Brazil. The antifungal activity in concentrations of 1000 µg/L, 500 µg/L and 250 µg/L, PROTOCOL M44-A2 (CLSI 2009) OEPh was tested. The main constituents identified were: l-limonene, α-terpineol, p-cineol, o-cymene and α-phellandrene, however, its composition varies significantly with extraction time. All species, except C. rugosa, were inhibited with halo (≥ 14 mm) at 1000 μg / L. C. krusei is naturally resistant to the drug fluconazole, but when tested with OEPh the clinical species (case 9) demonstrated sensitivity in three dilutions (halo ≤ 10 ≥ 14) and the standard strain was inhibited at concentration of 1000 μg/Lg / L (halo 14mm). A similar situation also occurred with the standard strain of C. parapsilosis (halo ≥ 11mm). OEPh has considerable antifungal activity, which merits further investigation for alternative clinical applications, since this species is widely distributed in our community, and it presents good yields, and also has important therapeutic applications.

RESUMO Protium heptaphyllum é encontrada na região amazônica, em vários estados do Brasil e países da América do Sul. Conhecida como almecega produz uma resina oleosa usada na medicina popular como analgésica, antiinflamatória, cicatrizante e expectorante, é rica em triterpenos pentaciclicos e óleo essencial. O objetivo principal do presente trabalho foi analisar a composição química do óleo essencial da resina P. heptaphyllum (OEPh) em diferentes tempo de extração e avaliarsuaatividade antifúngica contra espécies de Candida, isoladas de horticultores com onicomicoses, por método de disco-difusão. O OEPh foi obtido por hidrodestilação, analisado por Cromatografia Gasosa Multidimensinal Acoplada a Espectrometria de Massas (MDGC/MS). As espécies de Candida foram obtidas de lesões nas unhas de horticultores de uma horta comunitária na cidade de Teresina, Piauí, Brasil. Testou-se a atividade antifúngica do OEPhnas concentrações de 1000 μg/L, 500 μg/L e 250 μg/L, protocolo M44-A2 (CLSI 2009). Os principais constituintes identificados foram l- limoneno, α-terpineol, p-cineol, o-cimeno e α-felandreno, entretanto, sua composição varia significativamente em decorrência do tempo de extração. Todas as espécies, exceto a C. rugosa, foram inibidas com halo ( Χ ≥ 14 mm) na concentração de 1000 μg/L. C. krusei é naturalmente resistente ao fármaco fluconazol, mas quando testado com OEPh,a espécie clínico (caso 9) demonstrou sensibilidade nas três diluições (halo Χ ≤ 10 ≥ 14) e a cepa padrão foi inibida na concentração de 1000 μg/L (halo Χ 14mm). Fato semelhante também ocorreu com a cepa padrão de C. parapsilosis (halo Χ ≥ 11mm). O OEPh possui atividade antifúngica considerável, merecendo uma investigação mais aprofundada para aplicações clínicas alternativas, uma vez que esta espécie é amplamente distribuída em nossa comunidade, apresenta bom rendimento e, ainda, aplicações terapêuticas importantes.

Plantas medicinais utilizadas pela população do município de Lagarto- SE, Brasil ­ ênfase em pacientes oncológicos / Medicinal Plants Used by the Population of Lagarto, SE, Brazil ­ Emphasis in Cancer Patients

RESUMO A utilização de plantas com fins medicinais é uma das mais antigas formas de prática medicinal da humanidade. Entretanto, o conceito de "natural"; contribui para o pensamento popular e errôneo de que Plantas Medicinais (PM) são sinônimos de produtos seguros, o qual pode ocasionar no desenvolvimento de efeitos adversos ou interações medicamentosas. Neste contexto, foi realizado levantamento etnofarmacológico das Plantas Medicinais (PM) utilizadas no município de Lagarto, SE, Brasil, com ênfase de seu uso por pacientes oncológicos. Um total de 706 moradores foram entrevistados. Foram citadas 80 plantas, das quais 57 foram identificadas em nosso laboratório. O uso de plantas medicinais (MP) para fins terapêuticos foi relatada por 336 (47,65%) entrevistados. As MPs mais utilizados foram: Erva-Cidreira (Lippiaalba (Mill) N. E. Brown - 103, 30,8%), Boldo (Plectranthus barbatus Andr. - 53, 15,7%), e Capim-Santo (Cymbopogon citratus (D.C.) Stapf - 49, 14,6%). Dos entrevistados que relataram o uso de MPs, metade (360, 50,95%) comunicaram ao médico, mas não receberam orientações específicas. As doenças crônicas mais comuns identificadas foram: hipertensão arterial (144, 20,34%), câncer (55, 7,81%) e diabetes (41, 5,89%). Dos pacientes com câncer, cerca de 40% (22) relataram utilizar PMs concomitante com quimioterapia, dado alarmante, visto a possibilidade de interações medicamentosas entre PMs e antineoplásicos. Diante desses dados, foi observado o uso de PM pela população de Lagarto, SE, e por pacientes oncológicos dessa região, porém, sem os mesmos receberem orientações de um profissional qualificado.

Medicinal Plants Used by the Population of Lagarto, SE, Brazil ­ Emphasis in Cancer Patients. The use of plants for medicinal purposes is one of the oldest forms of medical practice. However, the concept of "natural" contributes to the popular and erroneous thinking that Medicinal Plants (PM) are synonymous of safe products, which may result in the development of adverse effects or drug interactions, particularly in cancer patients. In this context, it was conducted an ethnopharmacological survey of MP used in Lagarto, SE, Brazil, with emphasis in cancer patients. A total of 706 residents were interviewed, and they mentioned 80 plants, from which 57 were identified. The use of medicinal plants (MP) for therapeutic purpose was reported by 336 (47.65%) of the participants. The most used MPs were as follows: Bushy Lippia (Lippia alba (Mill) N. E. Brown­ 103, 30.8%), Boldo (Plectranthus barbatus Andr. ­ 53, 15.7%), and Lemon Grass (Cymbopogon citratus (D.C.) Stapf. ­ 49, 14.6%). From the participants who reported the use of MPs, half of them (360, 50.95%) spoke with a doctor but did not receive specific guidelines. The most common chronic diseases identified were: arterial hypertension (144, 20.34%), cancer (55, 7.81%) and diabetes (41, 5.89%). From these cancer patients, approximately 40% of them (22) used MP concomitantly with chemotherapy, an alarming discovery, as drug interactions are possible between MPs and antineoplastics. Given these data, we observed the use of the PM by the population of Lagarto, SE, and by cancer patients of this region, but they did not receive guidance from a qualified professional

Efeito da fração não-oleosa doRicinus communisna biodistribuição comTecnécio-99m em camundongos / Effect of non-oily fraction ofRicinus communis on the bio distribution with Technetium-99m in mice

RESUMO Ricinus communisé uma planta pertence à família Euforbiaceae. A partir de seus frutos é extraído o óleo de rícino e outra fração altamente tóxica (fração não-oleosa). Neste estudo, foi avaliado o efeito da fração não oleosa de R. communis(FNORC) na biodistribuição do Tc-99m em camundongos sadios e em animais transplantados com Sarcoma-180 (S180). Para avaliação da biodistribuição do Tc-99m, o percentual de atividade radioativa total injetada (ATI%) foi mensurada utilizando um contador gama. Os resultados mostraram que, em animais sadios, houve aumento da captação do Tc-99m após o tratamento com FNORC pelos rins, cérebro e estômago. Apenas houve diminuição da absorção deste radioisótopo nos músculos. Em animais com tumor, houve redução significativa da captação do Tc-99m no coração, pulmões e tumor, e foi observado o aumento da captação apenas nos rins. Foi observada também a diminuição da concentração das proteínas plasmáticas totais em animais com tumor após tratamento com FNORC e atividade antitumoral significativa. Diante desses dados, conclui-se que fração não oleosa de R. communis possui atividade antitumoral significativa, porém altera a biodistribuição do Tc-99m, fato este que pode resultar em falhas nos processos de diagnóstico por imagem que utilizem este radioisótopo como marcador.

ABSTRACT Ricinus communis is a plant belonging to the Euforbiaceae family. From its fruits, it is extracted the castor oil and another highly toxic fraction (non-oily fraction). In this study, we evaluated the effect of the non-oily fraction of R. communis (NOFRC) on the bio distribution of Tc-99m in healthy mice and in animals transplanted with Sarcoma-180 (S180). To evaluate the bio distribution of theTc-99m, the percentage of the total injected radioactivity (% TIR) was measured through a gamma counter. There was an increase in the capitation of Tc-99m after the treatment with NOFRC in the kidneys, brain, and stomach of healthy animals. A decrease in the reception of this radionuclide was only found in the muscles. In animals with tumour, there was a significant reduction in the uptake of Tc-99m in the heart, lungs and tumour. An increase in the capitation was only observed in the kidneys. It was also observed a reduction in the total plasma protein concentration in animals with tumours after the treatment with NOFRC, besides significant antitumor activity. We concluded that there is antitumor activity in the NOFRC, but that it alters the biodistribution of Tc-99m, a fact which may result in failures in the diagnostic imaging process using this radioisotope as a marker.

Femoral biomechanic and microtomography from male ratssubmitted to dietary restriction supplemented with sucrose

Food restriction reduces body weight and influence bone mass and also is correlated with bone mineraldensity (BMD). Mechanisms have been proposed for the loss of BMD after body weight reduction, includingreduced energy intake. Growing 8 wk-old Wistar male rats were randomly divided into Control and Calorierestriction associated with sucrose 30% (CRS). These animals were subjected to intermittent food restrictionduring 8 weeks and had free access to tap water and sucrose30% in distilled water. The rats were euthanizedat the end of week 8, blood collected from abdominal aorta artery, femurs cleaned of adherent soft tissues,scanned using dual energy X-ray absorptiometry, structural and material properties determined by three-pointbending testing in the mid-diaphyseal region, bone surface tested in a microhardness tester and microstructurewas assessed in a microcomputer tomography. In CRS animals body weight decreased significantly relative tothe Control animals. There was a clear option for high-sucrose beverage in CRS animals. No difference wasobserved in biochemical, densitometric and biomechanical analyzes. Results from micro CT showed onlysignificant difference in connectivity of trabecular bone. It has been suggested that rats submitted to foodrestriction consumed sugar not because of its inherent palatability, but in order to alter their macronutrientbalance and animals need to meet energy demands in high-sucrose.

Adding ascorbic acid to vitrification and IVC medium influences preantral follicle morphology, but not viability.

In this study, we analysed the effect on morphology and viability of ovine primordial follicles, when ascorbic acid (AA) was added to vitrification and in vitro culture (IVC) media. For morphological analysis, ovarian tissue was vitrified using DMSO or ethylene glycol (EG), to which AA was added or omitted. After warming, the tissue was fixed for histology or 1-day cultured in the presence or absence of AA. Isolated primordial follicles from ovine ovarian tissue vitrified with DMSO or EG, both supplemented with AA were stained with trypan blue for viability analysis, or 5-day cultured with or without AA followed by a viability analysis. In this study, we report on the successful vitrification protocol developed for ovine ovarian tissue using EG. Vitrification using DMSO reduced the percentage of morphological normal primordial follicles, whereas addition of AA to the vitrification and culture media did enhance these results (p < 0.05). However, vitrification in a DMSO + AA medium followed by 5-day IVC resulted in a significant decrease in the follicular viability, independently of the presence of AA in the IVC medium.

The effect of carbon and nitrogen sources on bovicin HC5 production by Streptococcus bovis HC5.

AIMS: To investigate the effect of media composition and agroindustrial residues on bovicin HC5 production by Streptococcus bovis HC5. METHODS AND RESULTS: Batch cultures of S. bovis HC5 were grown in basal medium containing different carbon and nitrogen sources. The activity of cell-free and cell-associated bovicin HC5 was determined in culture supernatants and acidic extracts obtained from cell pellets, respectively. Streptococcus bovis HC5 produced bovicin using a variety of carbon and nitrogen sources. The highest specific activity was obtained in media containing 16 g l(-1) of glucose, after 16 h of incubation. The peak in cell-free and cell-associated bovicin HC5 activity was detected when S. bovis HC5 cultures reached stationary phase. The bovicin HC5 specific activity and bacterial cell mass increased approximately 3-fold when yeast extract and trypticase (0.5 and 1.0 g l(-1), respectively) were added together to the basal medium. Streptococcus bovis HC5 cultures produced bovicin HC5 in cheese whey and sugar cane juice and maximal volumetric productivity was obtained after 12 h of incubation. CONCLUSIONS: Streptococcus bovis HC5 is a versatile lactic acid bacterium that can utilize several carbon and nitrogen sources for bovicin HC5 production. This bacterium could be a useful model to study bacteriocin production in the rumen ecosystem. SIGNIFICANCE AND IMPACT OF THE STUDY: The use of agroindustrial residues as carbon sources could have an economical impact on bovicin HC5 production. To our knowledge, this is the first report to show the use of sugar cane juice for bacteriocin production by lactic acid bacteria.

Bovicin HC5 reduces thermal resistance of Alicyclobacillus acidoterrestris in acidic mango pulp.

AIMS: To test the effect of bovicin HC5 against vegetative cells and endospores of Alicyclobacillus acidoterrestris DSMZ 2498 in synthetic media and in acidic mango pulp. METHODS AND RESULTS: Alicyclobacillus acidoterrestris was grown in synthetic medium at 40 degrees C and pH 4.0. The effect on vegetative cells was assayed by adding bovicin HC5 to synthetic medium (40-160 AU ml(-1)) or to mango pulp (100 AU ml(-1)) at various pH values and determining the effect on growth (OD(600 nm)) and viable cell number, respectively. The effect of bovicin HC5 on spore germination and thermal sensitivity of A. acidoterrestris was tested in mango pulp (pH 4.0) containing 80 AU ml(-1) of bovicin HC5. Bovicin HC5 was bactericidal against vegetative cells of A. acidoterrestris at different pH values and showed sporicidal activity against endospores of this bacterium. When spores of A. acidoterrestris were heat treated in the presence of bovicin HC5, D-values decreased 77% to 95% compared to untreated controls at temperatures ranging from 80 to 95 degrees C. CONCLUSION: Bovicin HC5 was bactericidal and sporicidal against A. acidoterrestrsi DSMZ 2498. SIGNIFICANCE AND IMPACT OF THE STUDY: These results indicated that bovicin HC5 has potential to prevent spoilage of acidic fruit juices by thermocidophilic spore-forming bacteria.

Cardiovascular effects of Hyptis fruticosa essential oil in rats.

In non-anesthetized normotensive rats, Hyptis fruticosa essential oil (HFEO, 5, 10, 20 and 40 mg/kg; i.v.) induced hypotension associated with tachycardia. In intact and isolated rings of rat superior mesenteric artery (control), HFEO (1-1000 microg/ml, n=6, cumulatively) induced concentration-dependent relaxations of tonus induced by 10 microM phenylephrine (Phe) (pD(2)=2.6+/-0.27; E(max)=64+/-8.3%). In denuded endothelium pre-contracted rings with Phe or K(+)-depolarizing solution (80 mM), the concentration-response curves to HFEO were not shifted (pD(2)=2.3+/-0.25 and 2.3+/-0.28, respectively), but their maximal responses were significantly (P<0.05 vs control) increased (E(max)=122.3+/-18.2% and 92+/-3.6%, respectively). HFEO was also capable of antagonizing the concentration-response curves to CaCl(2) (3 microM-30 mM) in a dose-dependent manner.

[Congenital myotonia. Report of 7 patients]. / Miotonia congênita. Relato de sete pacientes.

Myotonia is the phenomenon of decrease of muscular relaxation rate, after either a contraction or a mechanical or electrical stimulus. Congenital myotonias are hereditary affections and do not present muscular dystrophy. The current trend is to group them as ionic channels diseases, together with the periodic paralysis. The authors accompanied the cases of seven patients, six males and one female, with ages ranging from 16 to 48 years (average 27 years) and onset of symptoms between 1 and 10 years (average 5 years). These patients presented a myotonic phenomenon unleashed by intensive contraction and global muscular hypertrophy. Three patients were diagnosed as cases of Becker type generalized myotonia because they presented a recessive autosomic heredity and/or transient episodes of muscular weakness. Two patients fitted the description of Thomsen congenital myotonia, with a pattern of dominating autosomic heredity and/or absence of weakness episodes or worsening factors for their condition. Two patients presented fluctuating myotonia, which because worse in cold weather or at potassium intake. The clinical diagnosis was confirmed through complementary tests (electroneuromyography, muscle biopsy and DNA study). Each of the patients made use of different drugs, in the search of optimal lessening of their myotonia. There were five reports of amelioration with the use of diphenilhydantoine; one report with the use of carbamazepine; three reports with the use of acetazolamide; one report with the use of a calcium channel blocker; one report with the use of a beta-adrenergic; one report with the use of thiazide; and none with the use of quinidine/procainamide.