Gas chromatographic techniques and spectroscopic approaches for a deep characterization of Piper gaudichaudianum Kunth essential oil from Brazil.

Piper gaudichaudianum Kunth essential oil (EO) is a natural source of bioactive components, having multiple therapeutic applications. Its chemical composition is highly variable, and strictly depends on abiotic factors, resulting in various biological activities. The present study details the utilization of multiple gas chromatographic techniques alongside nuclear magnetic resonance (NMR) spectroscopy to characterize the essential oil of Piper gaudichaudianum Kunth from Brazil. Seventy-six components were identified using GC-MS analysis, while enantio­selective multidimensional gas chromatography elucidated the enantiomeric distribution of eight chiral components, for the first time in the literature. Following GC-MS analysis, an unidentified component, constituting approximately 27 % of the total oil, prompted an isolation step through preparative gas chromatography. Through the combined use of nuclear magnetic resonance, GC-Fourier transform infrared spectroscopy (FTIR), and mass spectrometry (MS), the unknown molecule was structurally identified as 4-[(3E)­dec-3-en-1-yl]phenol. Remarkably, it was identified as a known molecule, gibbilimbol B, and not previously listed in any MS database. Subsequently, the spectrum was included in a commercial library, specifically the FFNSC 4.0 MS database, for the first time.

Situacion de la sifilis congénita en Paraguay utilizando datos del sistema de informacion perinatal (sip plus)

Introducción : Se promueven iniciativas para mejorar la salud de las mujeres y niños siendo el denominador común disponer de un sistema de información con repercusión en la salud de esta población. En Paraguay el SIP PLUS es utilizado con diferente grado de cobertura en los servicios maternoinfantiles. Objetivo: analizar la calidad de los datos generados para la construcción de los indicadores de Eliminación de la Sífilis Congénita (SC). Metodología: Estudio nacionalmente representativo utilizando datos generados por el SIP PLUS. Resultados: 32.479 historias perinatales cargadas desde el 2018 a julio del 2021. La representación de la muestra 1,5% en 2018 al 23% en 2021. Mayores pérdidas de información en el 2020. Para las variables de contexto con menos pérdidas de información en comparación a las de prevención primaria, secundaria y salud reproductiva. La pérdida de datos para: porcentaje de mujeres embarazadas con cuidado prenatal (4 o más) en un promedio de 64,4%; porcentaje de mujeres embarazadas tamizadas 43,1 % en el 2020 y 33,4% en 2019; positividad de la prueba de sífilis 49% en el 2020. Lo que también se observa en el indicador de tratamiento. Se registraron 506 casos de SC. Tasa de SCx1000 nacidos vivos ( 10 x1000 nacidos vivos en los 4 años analizados. Edad adolescente (p: 0,040) como factor de riesgo para SC. Conclusiones: Pérdida de registros en lo referente a ETMI, por falta de carga de datos. Alta incidencia de SC en los años analizados. Adolescentes como factor de riesgo para SC.

Introduction: Initiatives are promoted to improve the health of women and children, the common denominator being having an information system with an impact on the health of this population. In Paraguay, the SIP PLUS is used with different degrees of coverage in maternal and child services. Objective: analyze the quality of the data generated for the construction of the indicators for the Elimination of Congenital Syphilis (CS). Methodology: Nationally representative study using data generated by the SIP PLUS. Results: 32,479 perinatal histories uploaded from 2018 to July 2021. The representation of the sample went from 1.5% in 2018 to 23% in 2021. Greater information losses in 2020. For the context variables with fewer information losses in comparison to those of primary, secondary prevention and reproductive health. Loss of data for: percentage of pregnant women with prenatal care (4 or more) averaged 64.4%; percentage of pregnant women screened 43.1% in 2020 and 33.4% in 2019; syphilis test positivity 49% in 2020. This is also observed in the treatment indicator. 506 cases of CS were recorded. Rate of SCx1000 live births  10 x1000 live births in the 4 years analyzed. Adolescent age (p: 0.040) as a risk factor for CS. Conclusions: Loss of records regarding ETMI, due to lack of data loading. High incidence of CS in the years analyzed. Adolescents as a risk factor for CS.

Producción científica de la Universidad Nacional de Asunción en bases de datos internacionales

Introducción: La difusión y visibilidad de la producción científica son cruciales para lograr un impacto significativo. En este sentido, las bases de datos con cobertura internacional juegan un papel fundamental. Objetivo: Este estudio buscó caracterizar la producción científica de la Universidad Nacional de Asunción en 2022 mediante el análisis de tres bases de datos con cobertura internacional: Web of Science, Scopus y PubMed. Metodología: El estudio empleó un enfoque bibliométrico. Los registros bibliográficos fueron recolectados entre mayo y junio de 2023 utilizando la opción de búsqueda por afiliación "Universidad Nacional de Asunción" en las tres bases de datos. Los resultados de la búsqueda fueron filtrados en base a los criterios especificados por las bases de datos, limitando la búsqueda a artículos publicados en revistas científicas en el año 2022. Resultados: Se recogieron un total de 263 artículos, la mayoría de ellos publicados en revistas de alto impacto por editoriales reconocidas internacionalmente. El autor más prolífico tenía 30 artículos publicados, y la mayoría de los trabajos reflejaban la colaboración entre autores de la UNA como coautores. En cuanto al número de artículos por título de revista, el mayor número fue de 8, 7 y 4 artículos en Web of Science, Scopus y PubMed, respectivamente. Los editores más importantes de los artículos fueron Elsevier, Springer y Wiley, entre otros. Discusión: El análisis de los 263 artículos publicados indica la fuerte presencia de la Universidad Nacional de Asunción en revistas de alto impacto y editoriales de renombre internacional, particularmente en el campo de la Psiquiatría debido a la relevancia de la pandemia en la salud mental. Destaca la colaboración internacional de los autores de la UNA, pero hay margen de mejora, como la presentación uniforme de la afiliación universitaria. La indexación de los artículos en bases de datos internacionales es crucial para la visibilidad.

Introduction: The dissemination and visibility of scientific production are crucial for achieving significant impact. In this regard, databases with international coverage play a vital role. Objective: This study aimed to characterize the scientific production of the Universidad Nacional de Asunción in 2022 by analyzing three databases with international coverage: Web of Science, Scopus, and PubMed. Methodology: The study employed a bibliometric approach. The bibliographic records were collected between May and June 2023 using the search option by affiliation "Universidad Nacional de Asunción" in the three databases. The search results were filtered based on the criteria specified by the databases, limiting the search to articles published in scientific journals in 2022. Results: A total of 263 articles were collected, with most of them published in high-impact journals by internationally recognized publishers. The most prolific author had 30 published articles, and most papers reflected collaboration between UNA authors as co-authors. Regarding the number of articles per journal title, the highest number was 8, 7, and 4 articles in Web of Science, Scopus, and PubMed, respectively. The most important publishers of the articles were Elsevier, Springer, and Wiley, among others. Discussion: The analysis of the 263 published articles indicates the strong presence of the Universidad Nacional de Asunción in high-impact journals and internationally renowned publishers, particularly in the field of Psychiatry due to the relevance of the pandemic on mental health. The international collaboration of UNA authors stands out, but there is room for improvement, such as the uniform presentation of university affiliation. The indexing of the articles in international databases is crucial for visibility.

Profilaxis quirúrgica en Apendicectomía en niños ≤ 15 años internados en un Hospital de Referencia desde enero a diciembre del año 2022

Introducción: Las infecciones de sitio quirúrgico (ISQ), se encuentran entre las infecciones asociadas al cuidado de la salud (IACS) más frecuentes, la profilaxis antibiótica administrada en el período preoperatorio contribuye a prevenir las ISQ. Objetivo: determinar si los esquemas antimicrobianos utilizados para profilaxis en cirugía corresponden a recomendados por Guías Internacionales de Tratamiento de Enfermedades Infecciosas; así como conocer los esquemas antimicrobianos utilizados, estimar el costo de la quimioprofilaxis y comparar con los resultados obtenidos en un estudio similar realizado en el mismo servicio en el año 2005. Materiales y métodos: Estudio descriptivo, observacional, retrospectivo donde se seleccionaron todas las historias clínicas de pacientes de ≤15 años de edad sometidos a apendicectomía, con diagnóstico posquirúrgico de apendicitis congestiva o flegmonosa, desde enero a diciembre del 2022. Se elaboró una planilla electrónica donde se cargaron los siguientes datos: antibiótico utilizado, dosis, número de dosis y momento de la administración. Resultados: 53 pacientes ≤ de 15 años fueron sometidos a apendicectomía, de los cuales 21 llenaban los criterios de inclusión. Fue utilizado Amoxicilina/Sulbactam en 19/21. El número total de dosis administradas fue de 68 dosis y la media de 3,3±1,9 dosis; solo en 8 de los pacientes se administró el antimicrobiano profiláctico en el tiempo correcto; solo 1 paciente recibió el esquema correcto, 1 sola dosis, 1 hora antes del inicio de la cirugía. El costo de la profilaxis antimicrobiana por paciente fue de 15,7 USD. Conclusión: Este trabajo nos permitió verificar la falta de aplicación de guías en el uso de antimicrobianos en la profilaxis quirúrgica, lo cual demuestra: i) la necesidad de revisar y estandarizar la conducta de prescripción relacionada en profilaxis quirúrgica, ii) la importancia de elaborar y socializar una guía de manejo de antimicrobianos y iii) el monitoreo de su implementación.

Introduction: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCIs). Antibiotic prophylaxis administered during the preoperative period contributes to preventing SSIs. Objective: to determine if the antimicrobial regimens used for prophylaxis in surgery correspond to those recommended by International Guidelines for the Treatment of Infectious Diseases; as well as knowing the antimicrobial regimens used, estimating the cost of chemoprophylaxis and comparing the current results with those obtained in a similar study carried out in the same service in 2005. Materials and methods: This was a descriptive, observational and retrospective study where we reviewed all medical records of patients ≤15 years of age undergoing appendectomy, with a post-surgical diagnosis of congestive or phlegmonous appendicitis, from January to December 2022. An electronic spreadsheet was prepared where the following data were uploaded: antibiotic used, dose, number of doses and time of administration. Results: 53 patients ≤ 15 years of age underwent appendectomy, of which 21 met the inclusion criteria. Amoxicillin/Sulbactam was used in 19/21. The total number of doses administered was 68 doses and the average was 3.3±1.9 doses; only in 8 of the patients was the prophylactic antimicrobial administered at the correct time; only 1 patient received the correct regimen, 1 single dose, 1 hour before the start of surgery. The cost of antimicrobial prophylaxis per patient was 15.7 USD. Conclusions: This study allowed us to verify the lack of application of existing guidelines in the use of antimicrobials in surgical prophylaxis, which demonstrates: i) the need to review and standardize prescription behavior related to surgical prophylaxis, ii) the importance of developing and disseminating an antimicrobial management guide and iii) the need to monitor its implementation.

Could the Urease of the Gut Bacterium Proteus mirabilis Play a Role in the Altered Gut-Brain Talk Associated with Parkinson's Disease?

Intestinal dysbiosis seems to play a role in neurodegenerative pathologies. Parkinson's disease (PD) patients have an altered gut microbiota. Moreover, mice treated orally with the gut microbe Proteus mirabilis developed Parkinson's-like symptoms. Here, the possible involvement of P. mirabilis urease (PMU) and its B subunit (PmUreß) in the pathogenesis of PD was assessed. Purified proteins were given to mice intraperitoneally (20 µg/animal/day) for one week. Behavioral tests were conducted, and brain homogenates of the treated animals were subjected to immunoassays. After treatment with PMU, the levels of TNF-α and IL-1ß were measured in Caco2 cells and cellular permeability was assayed in Hek 293. The proteins were incubated in vitro with α-synuclein and examined via transmission electron microscopy. Our results showed that PMU treatment induced depressive-like behavior in mice. No motor deficits were observed. The brain homogenates had an increased content of caspase-9, while the levels of α-synuclein and tyrosine hydroxylase decreased. PMU increased the pro-inflammatory cytokines and altered the cellular permeability in cultured cells. The urease, but not the PmUreß, altered the morphology of α-synuclein aggregates in vitro, forming fragmented aggregates. We concluded that PMU promotes pro-inflammatory effects in cultured cells. In vivo, PMU induces neuroinflammation and a depressive-like phenotype compatible with the first stages of PD development.

Chemical Composition and In Vitro Antioxidant Activity of Salvia aratocensis (Lamiaceae) Essential Oils and Extracts.

Salvia aratocensis (Lamiaceae) is an endemic shrub from the Chicamocha River Canyon in Santander (Colombia). Its essential oil (EO) was distilled from the aerial parts of the plant via steam distillation and microwave-assisted hydrodistillation and analyzed using GC/MS and GC/FID. Hydroethanolic extracts were isolated from dry plants before distillation and from the residual plant material after distillation. The extracts were characterized via UHPLC-ESI(+/-)-Orbitrap-HRMS. The S. aratocensis essential oil was rich in oxygenated sesquiterpenes (60-69%) and presented τ-cadinol (44-48%) and 1,10-di-epi-cubenol (21-24%) as its major components. The in vitro antioxidant activity of the EOs, measured via an ABTS+• assay, was 32-49 µmol Trolox® g-1 and that measured using the ORAC assay was 1520-1610 µmol Trolox® g-1. Ursolic acid (28.9-39.8 mg g-1) and luteolin-7-O-glucuronide (1.16-25.3 mg g-1) were the major S. aratocensis extract constituents. The antioxidant activity of the S. aratocensis extract, obtained from undistilled plant material, was higher (82 ± 4 µmol Trolox® g-1, ABTS+•; 1300 ± 14 µmol Trolox® g-1, ORAC) than that of the extracts obtained from the residual plant material (51-73 µmol Trolox® g-1, ABTS+•; 752-1205 µmol Trolox® g-1, ORAC). S. aratocensis EO and extract had higher ORAC antioxidant capacity than the reference substances butyl hydroxy toluene (98 µmol Trolox® g-1) and α-tocopherol (450 µmol Trolox® g-1). S. aratocensis EOs and extracts have the potential to be used as natural antioxidants for cosmetics and pharmaceutical products.

Use of near-infrared reflectance spectroscopy on feces to estimate digestibility and dry matter intake of dietary nutritional characteristics under grazing conditions in Colombian creole steers.

Digestibility and intake are parameters difficult and expensive to estimate under grazing conditions; therefore, the aim of this study was to develop near-infrared reflectance spectroscopy (NIRS) calibrations applied to feces (F-NIRS) and evaluate their accuracy to predict dry matter digestibility (DMD) and dry matter intake (DMI) of Colombian creole cattle. Five digestibility trials using creole steers were conducted; indigestible neutral detergent fiber (iNDF) was used as internal marker and Cr2O3 and TiO2 as external markers. A total of 249 forage and 396 fecal samples from individual animals were collected, dried, and grinded for conventional chemical analysis. For spectral analysis, fecal samples were pooled across collection periods (77 samples). Chemometric analysis was performed using WinISI V4.10 software applying the modified partial least squares method. Cross-validation was performed to avoid overfitting the models. The goodness-of-fit statistics considered were the coefficient of determination in cross-validation and prediction sets (R2cv and r2, respectively) and the ratio performance deviation (RPD). Fecal NIRS calibrations developed for forage and supplement DMD showed a satisfactory fit (R2cv =0.87 and RPD=2.77 and R2cv=0.92 and RPD=3.50, respectively). The accuracy of fecal output equations using chromium (Cr) and titanium (Ti) was similar in terms of R2cv (0.92) and RPD (3.63 vs. 3.57). Total DMI equations using Ti performed better compared to Cr (R2cv = 0.82 vs. 0.78; RPD=2.41 vs. 2.17, respectively). The F-NIRS models were validated using a completely independent set of fecal samples showing a moderate fit (r2>0.8 and RPD>2.0). This study showed that F-NIRS is a feasible tool to predict DMD and DMI of creole steers under grazing conditions. However, previous to socialization, this requires an improvement in accuracy of the calibrated equations related to grazing animals in different production contexts.

Avaliação psicológica no estado do Maranhão: cenário atual e direções futuras / Psychological assessment in the state of Maranhão: current scenario and future directions / Evaluación psicológica en el estado de Maranhão: escenario actual y direcciones futuras

As últimas duas décadas trouxeram mudanças para o campo da Avaliação Psicológica (AP) no Brasil. Considerando que historicamente o desenvolvimento da Psicologia foi desigual entre as regiões do país, este estudo teve como objetivo investigar as práticas, a formação e o conhecimento de psicólogos maranhenses sobre avaliação psicológica. Participaram 124 psicólogos com registro ativo no Conselho Regional de Psicologia do Maranhão, que responderam a um roteiro estruturado de entrevista elaborado para este estudo. Os resultados mostraram que a maioria afirma realizar AP na sua prática profissional, que entrevista é a técnica mais usada e considerada mais importante para o processo, que há indícios de avanço na formação em AP no estado do Maranhão, mas que permanecem dificuldades em relação à compreensão de conceitos psicométricos e na inserção das práticas de AP no dia a dia do trabalho dos psicólogos. (AU)

The field of Psychological Assessment (PA) in Brazil faced changes in the last two decades. Since the development of Psychology has been historically uneven between the regions of the country, this study aimed to assess the practices, academic training, and knowledge of psychologists from the state of Maranhão on psychological assessment. 124 psychologists with active registration in the Regional Council of Psychology of Maranhão participated responding to a structured interview script prepared for this study. The results show that most claim to perform PA in their professional practice; that interview is the most used technique and it is considered the most important for the process; that there are indications of progress in PA training in the state of Maranhão, but some difficulties remain regarding the comprehension of psychometric concepts and the insertion of PA practices in the daily work of psychologists. (AU)

Las ultimas dos décadas trajeron cambios para el campo de la Evaluación Psicológica (EP) en Brasil. Considerando que históricamente el desarrollo de la Psicología fue desigual entre las regiones del país, este estudio tuvo como objetivo investigar las prácticas, la formación y el conocimiento de psicólogos del estado de Maranhão sobre evaluación psicológica. Participaron 124 psicólogos con matrícula activa en el Consejo Regional de Psicología de Maranhão, que respondieron a un guión estructurado de entrevista elaborado para este estudio. Los resultados mostraron que: la mayoría afirma realizar EP en su práctica professional; la entrevista es la técnica mas usada y considerada mas importante para el processo; hay indicios de avances en la formación en EP en el estado de Maranhão, pero permanecen dificultades en relación a la comprensión de conceptos psicométricos y en la inserción de las prácticas de EP en el día a día del trabajo de los psicólogos. (AU)

Bartolomé Coronel: Rescate del olvido con la memoria - Uno de los primeros médicos de niños de la Medicina Paraguaya / Bartolomé Coronel: Rescue from oblivion with memory - One of the first children's doctors of Paraguayan Medicine

La sistematización de una historia de vida requiere una rigurosa selección de la información proveniente de diversas fuentes. Este breve estudio cualitativo utiliza el método biográfico y su objetivo es describir la figura de Bartolomé Coronel, considerado uno de los primeros médicos de niños y su aporte a la sociedad asuncena de principios del siglo XX, fallecido en plena pandemia de la peste Bubónica, en 1911. Se toman diversas fuentes desde la semblanza realizada por la insigne educadora Celsa Speratti de Garcete, cartas familiares, datos de su biografía aportados por un familiar cercano, discursos alusivos al sujeto de estudio y otros textos que permiten elaborar una mirada colectiva hacia el mismo. En conclusión, el contexto actual de Covid19 y el de la peste Bubónica presenta el mismo riesgo y escasas medidas de bioseguridad a pesar del avance de la ciencia y la medicina en nuestros días. La figura del Dr. Bartolomé Coronel presenta una riqueza de matices y merece ser rescatado con la memoria del olvido.

Life story systematization requires a rigorous selection of information from various sources. This brief qualitative study uses the biographical method and its objective is to describe the figure of Bartolomé Coronel. Considered one of the first children doctors and his contribution to Asuncion society at the beginning of the 20th century, who died in the Bubonic plague pandemic, in 1911. Various sources are taken: from the profile made by the distinguished educator Celsa Speratti de Garcete, family letters, details of her biography provided by a familiar, speeches allusive to the subject of study and other texts that allow a collective view of him. In conclusion, the current context of Covid19 and the Bubonic plague in the past present the same risk and scarce biosecurity measures taked despite the advancement of science and medicine in our days. The figure of Dr. Bartolomé Coronel presents a wealth of nuances and deserves to be rescued with the memory of oblivion.

Effects of explosive and impact exercises on gait parameters in elderly women / Efectos de los ejercicios explosivos y de impacto sobre los parámetros de la marcha en adultas mayores

Abstract Introduction: Several systematic reviews and meta-analyses have suggested that physical activity programs combining low impact exercises and resistance exercises help maintaining functional capacity in older adults. Objective: To analyze the effects of an aquatic training program involving both impact and explosive exercises on gait parameters of women aged 60 and above. Materials and methods: 60 physically active women (64.08±3.98 years) were divided into 2 groups: those training in a pool by performing series ofjumps, i.e., the experimental group (EG= 35), and the control group (CG=35). EG participants trained 3 times per week during 32 weeks in an hour per session basis. Body composition measurements, explosive strength, and gait parameters (in a 6 meters long track) were assessed using the center of pressure (COP) indicator before and after participating in the training program. Results: When comparing both groups, differences in explosive strength and power (EG vs. CG; p values=from 0.05 to 001) were observed, as well as changes in gait parameters related to the COP (EG vs. CG: p = 0.05-001), in particular EG participants had significant and positive changes. Conclusion: The aquatic training program described here produced an increase in muscle strength and muscle power, thus gait parameters were improved. Bearing this in mind, an improved availability of similar programs for older adults should be considered, since their participation in these programs could help them improve their functional capacity, and, thus, their quality of life.

Resumen Introducción. Varias revisiones sistemáticas y meta-análisis han sugerido que los programas de actividad física que combinan ejercicios de bajo impacto y de fuerza mantienen la capacidad funcional en adultos mayores. Objetivo. Analizar el efecto de un programa de entrenamiento acuático basado en movimientos explosivos y de impacto en los parámetros de la marcha en adultas mayores. Materiales y métodos. 60 mujeres físicamente activas (64.08±3.98 años) fueron divididas en dos grupos, uno control (CG=35) y otro de intervención (entrenamiento en piscina usando multisaltos) (IG=35). El IG entrenó por 32 semanas, 3 días a la semana, 1 hora por sesión. Se evaluó la composición corporal, la fuerza explosiva y los parámetros de la marcha sobre 6m de recorrido usando el centro de presión (COP) antes y después de participar en el programa. Resultados. Se presentaron diferencias en la fuerza explosiva y la potencia (EG vs. CG; p=0.05-001), así como cambios en los parámetros de la marcha relacionados al COP (EG vs. CG: p=0.05-001), con cambios significativos y positivos para EG. Conclusión. El programa de entrenamiento en agua con movimientos de impacto y explosivos induce ganancias en fuerza muscular y potencia, lo que mejora la capacidad de caminar. Teniendo en cuenta lo anterior, se debe considerar ofrecer una mejor disponibilidad de programas similares a esta población, ya que su participación en estos programas podría ayudarles a mejorar su capacidad funcional y, por tanto, su calidad de vida.

Factors associated with vancomycin-resistant enterococci colonization in a pediatric intensive care unit of Paraguay: A cross-sectional study on hospital charts. / Factores asociados a colonización por enterococo sp resistente a vancomicina en una unidad de cuidados intensivos pediátricos del Paraguay: estudio transversal sobre historias clínicas.

INTRODUCTION: Vancomycin-resistant enterococci (VRE) infections have become widespread and a challenge in hospitalized patients. The threat of infection by intractable enterococci and the possibility that vancomycin resistance could involve pneumococci or staphylococci advocate for careful surveillance of resistant strains. OBJECTIVE: To determine the risk factors associated with VRE colonization in pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) in the period between January 2012 and June 2013. METHODS: We conducted a cross-sectional study analyzing the clinical histories of 140 patients admitted to the PICU (children from 1 month to 18 years) who underwent rectal swab cultures within 48 hours of admission. We calculated the odds ratios and confidence intervals of the risk factors for VRE colonization in the PICU, and then we used multiple logistic regression for the statistically significant variables. RESULTS: VRE colonization was present in 18.6% of patients. The following variables were identified as risk factors associated with VRE colonization: prior hospitalization in the past year (odds ratio: 10.8; 95% confidence interval: 2.43 to 47.8; p = 0.001); prior use of one broad-spectrum antibiotic (odds ratio: 5.05; 95% confidence interval: 2.04 to 12.5; p = 0.000); use of two or more broad-spectrum antibiotics in past year (odds ratio: 5.4; 95% confidence interval: 1.5 to 18.4; p = 0.009); prior hospitalization in a high-risk area (odds ratio: 4.91; 95% confidence interval: 1.83 to 13.2; p = 0.000); hospitalization for more than five days in a high-risk area (odds ratio: 5.64; 95% confidence interval: 2.18 to 14.6; p = 0.000); and use of immunosuppressant drugs (odds ratio: 4.84; 95% confidence interval: 1.92 to 11.9; p = 0.001). In a logistic multiple regression the use of two or more broad-spectrum antibiotics (odds ratio: 4.81; 95% confidence interval: 1.01 to 22.8; p = 0.047) and prior hospitalization in past year (odds ratio: 7.84; 95% confidence interval: 1.24 to 49.32; p = 0.028) were identified as independent factors statistically associated with VRE colonization. CONCLUSION: Pediatric patients admitted for intensive care with a history of prior hospitalization in the past year and exposure to two or more broad-spectrum antibiotics have a greater risk of colonization by vancomycin-resistant enterococci.

INTRODUCCIÓN: Las infecciones por Enterococcus sp resistente a la vancomicina se han diseminado y generan un desafío clínico-terapéutico en los pacientes hospitalizados. La amenaza de que la infección por enterococos intratables y la posibilidad que la resistencia a la vancomicina pueda propagarse a neumococos o estafilococos, abogan por la vigilancia atenta de las cepas resistentes. OBJETIVO: Determinar los factores de riesgos asociados a la portación de Enterococcus sp resistente a la vancomicina en pacientes pediátricos ingresados en una unidad de cuidados intensivos pediátricos del Paraguay en el periodo entre enero de 2012 y junio de 2013. MÉTODOS: Estudio transversal. Se analizaron las historias clínicas previas de 140 pacientes ingresados a terapia intensiva (niños de un mes a 18 años), a quienes se realizaron cultivos de hisopado rectal dentro de las 48 horas del ingreso, para determinar los factores asociados a la portación de Enterococcus sp resistente a la vancomicina en unidad de cuidados intensivos pediátricos. Se calculó el Odd ratio con sus intervalos de confianza y p < 0,05 para las variables de estudio. Posteriormente, se realizó regresión logística múltiple para las variables estadísticamente significativas. RESULTADOS: La portación de Enterococcus sp resistente a la vancomicina se observó en 18,6% de los pacientes. Se identificaron como factores asociados: la hospitalización previa durante el último año (Odds ratio: 10,8; intervalo de confianza 95%: 2,43 a 47,8; p = 0,001), uso previo de antibióticos de amplio espectro (Odds ratio: 5,05; intervalo de confianza 95%: 2,04 a 12,5; p = 0,000), uso de dos o más antibióticos de amplio espectro en el último año (Odds ratio: 5,4; intervalo de confianza 95%: 1,5 a 18,4; p = 0,009), internación previa en área de alto riesgo (Odds ratio: 4,91; intervalo de confianza 95%: 1,83 a 13,2; p = 0,000), internación por igual o mayor a seis días en área de alto riesgo (Odds ratio: 5,64; intervalo de confianza 95%: 2,18 a 14,6; p = 0,000) y uso de inmunosupresores (Odds ratio: 4,84; intervalo de confianza 95%: 1,92 a 11,9; p = 0,001). La regresión múltiple señala a la utilización de dos o más antibióticos de amplio espectro (Odds ratio: 4,81; intervalo de confianza 95%: 1,01 a 22,8; p = 0,047) y a la historia de hospitalización previa dentro del año (Odds ratio: 7,84; intervalo de confianza 95%: 1,24 a 49,32; p = 0,028) como factores independientes asociados estadísticamente con la portación de Enterococcus sp resistente a la vancomicina. CONCLUSIÓN: Los pacientes pediátricos ingresados en la unidad de cuidados intensivos con historia de internación previa dentro del año y la exposición a dos o más antibióticos de amplio espectro, tienen mayor riesgo de colonización por el enterococo resistente a vancomicina.

Feline primary hyperaldosteronism: an emerging endocrine disease / Hiperaldosteronismo primário felino: uma enfermidade endócrina emergente

ABSTRACT: The primary hyperaldosteronism, an endocrine disease increasingly identified in cats, is characterized by adrenal gland dysfunction that interferes with the renin-angiotensin-aldosterone system, triggering the hypersecretion of aldosterone. Pathophysiological consequences of excessive aldosterone secretion are related to increased sodium and water retention, and increased excretion of potassium, which induce hypertension and severe hypokalemia, respectively. The most common clinical findings in cats include: polydipsia, nocturia, polyuria, generalized weakness, neck ventroflexion, syncope, anorexia, weight loss, pendulous abdomen and blindness. Diagnosis is based on the evidence of hormonal hypersecretion with suppression of renin release, imaging and histopathological evaluation of adrenal glands. Treatment may be curative with adrenalectomy, in cases of unilateral disease, or conservative, through administration of aldosterone antagonists, potassium supplementation and antihypertensives. Prognosis varies from fair to good with the appropriate therapy. This article reviews the main aspects of primary aldosteronism in cats, providing the clinician with important information for the diagnosis of this disease.

RESUMO: O hiperaldosteronismo primário, doença endrócrina cada vez mais identificada em felinos, caracteriza-se pela disfunção da glândula adrenal com interferência no sistema renina-angiotensina-aldosterona, desencadeando a hipersecreção de aldosterona. As consequências da secreção excessiva de aldosterona estão relacionadas com o aumento da retenção de sódio e água e aumento da excreção de potássio, que ocasionarão, respectivamente, hipertensão arterial sistêmica e hipocalemia grave. O diagnóstico é realizado com base na comprovação da hipersecreção hormonal com supressão da liberação de renina, além de exames de imagem e avaliação histopatológica da adrenal. O tratamento pode ser curativo, com a adrenalectomia, em enfermidades unilaterais, ou conservativo, por meio de antagonistas da aldosterona, suplementação de potássio e anti-hipertensivos. O prognóstico é bom e reservado com a terapia apropriada.

Feline primary hyperaldosteronism: an emerging endocrine disease / Hiperaldosteronismo primário felino: uma enfermidade endócrina emergente

The primary hyperaldosteronism, an endocrine disease increasingly identified in cats, is characterized by adrenal gland dysfunction that interferes with the renin-angiotensin-aldosterone system, triggering the hypersecretion of aldosterone. Pathophysiological consequences of excessive aldosterone secretion are related to increased sodium and water retention, and increased excretion of potassium, which induce hypertension and severe hypokalemia, respectively. The most common clinical findings in cats include: polydipsia, nocturia, polyuria, generalized weakness, neck ventroflexion, syncope, anorexia, weight loss, pendulous abdomen and blindness. Diagnosis is based on the evidence of hormonal hypersecretion with suppression of renin release, imaging and histopathological evaluation of adrenal glands. Treatment may be curative with adrenalectomy, in cases of unilateral disease, or conservative, through administration of aldosterone antagonists, potassium supplementation and antihypertensives. Prognosis varies from fair to good with the appropriate therapy. This article reviews the main aspects of primary aldosteronism in cats, providing the clinician with important information for the diagnosis of this disease.(AU)

O hiperaldosteronismo primário, doença endrócrina cada vez mais identificada em felinos, caracteriza-se pela disfunção da glândula adrenal com interferência no sistema renina-angiotensina-aldosterona, desencadeando a hipersecreção de aldosterona. As consequências da secreção excessiva de aldosterona estão relacionadas com o aumento da retenção de sódio e água e aumento da excreção de potássio, que ocasionarão, respectivamente, hipertensão arterial sistêmica e hipocalemia grave. O diagnóstico é realizado com base na comprovação da hipersecreção hormonal com supressão da liberação de renina, além de exames de imagem e avaliação histopatológica da adrenal. O tratamento pode ser curativo, com a adrenalectomia, em enfermidades unilaterais, ou conservativo, por meio de antagonistas da aldosterona, suplementação de potássio e anti-hipertensivos. O prognóstico é bom e reservado com a terapia apropriada.(AU)

Posición más frecuente de inclusión de terceros molares mandibulares y su relación anatómica con el conducto dentario inferior en pacientes del Hospital Nacional de Itauguá hasta el año 2012 / Most common position of including mandibular third molar and its anatomical relationship with the inferior dentary canal in patients of National Hospital of Itauguá until 2012

RESUMEN Introducción: Los terceros molares mandibulares incluidosson de importante estudio por su variedad de presentación, por la patología y accidentes que frecuentemente desencadenan.El tercer molar mandibular es la última pieza dentaria en hacer erupción en la cavidad oral, presenta mayor frecuencia y variedad de anomalías en su proceso eruptivo, así como patologías y accidentes que puedendesencadenar. Objetivo: determinar la posición radiográfica más frecuente de inclusión de terceros molares mandibulares y su relación anatómica con el conducto dentario inferior. Materiales y métodos: estudio observacional descriptivo temporalmenteretrospectivo con componente analítico. Fueron analizadas radiografías panorámicas de pacientes que acudieron al Hospital en un periodo de tiempo, teniendo en cuenta la edad y el género. Resultados: Ingresaron al estudio 138 casos en donde, según la clasificación de Winter, tanto el lado derecho como el izquierdo mandibular presentaron mayor predominancia por la posición mesioangular (56,5%) (58%) respectivamente. Según la clasificación de Pell-Gregory, se constató que tanto para el tercer molar inferior derecho (50,7%) como para el tercer molar inferior izquierdo (58,7%) predominó la clase II. El tipo más frecuente para el lado izquierdo fue el Tipo A con un 50,7% y para el lado derecho el Tipo B con un 50,7%. En cuanto a la relación anatómica con el conducto dentario inferior, se observó que las las posiciones vertical y mesioangular ambas con 8% guardan mayor relación. Así mismo seconstató que el 39,1% de los terceros molares inferiores, cualquiera sea el lado,se encontraban en posición cercana. El lado derecho con 17,4% presentó mayor relacionamiento con el conducto. Conclusión: La franja etárea comprendida entre 18 y 25 años acumuló mayor porcentaje de inclusión,siendo también el sexo femenino el porcentaje mayor. En ambos géneros predominó la posición mesioangular, siendo en mayor proporción para el lado izquierdo. La posición vertical y mesioangular fueron observadas con mayor frecuencia en relación con el conducto dentario inferior.

ABSTRACT Introduction: Mandibular third molars are important study for its variety of presentation, pathology and accidents often trigger.The mandibular third molar is the last tooth to erupt into the oral cavity, has greater variety and frequency anomalies in the eruptive process, as well as diseases and accidents that can trigger. Objective: To determine the most frequent radiographic position including mandibular third molar and its anatomical relation to the mandibular canal. Materials and Methods: Retrospective descriptive study with an analytical component. Panoramic radiographs were analyzed from patients attending the Hospital over a period of time, taking into account age and gender. Results: 138 cases were admitted to the study where, as rated by Winter, both right and left mandibular showed more predominance by mesioangular position (56.5%) (58 %) respectively. According to the classification of Pell-Gregory, it was found that for both the third lower right molar (50.7 %) to the lower left third molar (58.7 %) predominated class II. The most common type for the left side was the Type A with 50.7% for the right side and the Type Bwith 50.7 %. Regarding the anatomical relationship with the mandibular canal, it was observed that the vertical positions and mesioangular both with 8% relate more. So, it was verified that 39.1 % of the third molars inferior, whichever side was found in close position. The right side with 17.4% had a higher relationship with the canal. Conclusion: The age group between 18 and 25 years old accumulated higher percentage of inclusion, being also the highest percentage female. Sex both genders predominated the mesioangular position, being in greater proportion to the left. The vertical position and mesioangular were observed more frequently in relation with the inferior mandibular canal.

Estado de conservação de respiradores PFF-2 após uso na rotina hospitalar / Maintenance status of N95 respirator masks after use in a health care setting / Estado de conservación de respiradores PFF-2 después de su uso en la rutina hospitalaria

Visando quantificar os danos impostos a respiradores PFF-2 ao longo do tempo de uso e estimar seu período de validade na prática clínica, este estudo baseou-se na análise descritiva de máscaras cônicas do tipo PFF-2, coletadas por auxiliares de enfermagem após um, cinco, 15 e 30 dias consecutivos de uso, num hospital de referência para doenças infecciosas. Marcas de identificação pessoal foram encontradas em todos os respiradores já no primeiro dia de uso. A partir do quinto dia, todas as máscaras apresentavam sujeiras, enquanto dobraduras foram observadas em mais de 80 por cento dos equipamentos. Manchas internas e dobras foram mais freqüentes após turnos de 12 horas do que plantões de 6 horas (p < 0.05). 16,17 por cento das máscaras estavam extraviadas no quinto dia e 38.93 por cento após o 30º dia de uso. O prazo de validade do respirador PFF-2, embora não seja conveniente reutilizá-lo, deve se limitar a cinco dias.

With the purpose of assessing the damages to N95 respirator masks over time and to estimate their expiration after use in clinical practice, this study was based on the descriptive analysis of N95 cone-shaped masks collected by nursing assistants after one, five, 15, and 30 consecutive days of use. Personal identification marks were founds in every respirator already on the first day of use. From the fifth day onward, all masks presented some type of dirt while folds were observed in more than 80 percent of the devices. Internal stains and folds were more frequent among workers of the 12-hour shift in comparison to the 6-hour shift (p < 0.05). The percentage of misplaced respirators was 16.17 percent by day five and reached 38.93 percent by day thirty. Though there is no convenience in reusing N95 respirators, their expiration should not exceed 5 days of use.

En la intención de cuantificar los daños impuestos a respiradores PFF-2 a lo largo del tiempo de uso y estimar su vida útil en la práctica clínica, este estudio se basó en el análisis descriptivo de máscaras cónicas del tipo PFF-2 revisadas después de uno, cinco, quince y treinta días consecutivos de uso por auxiliares de enfermería en un hospital de referencia para enfermedades infecciosas. Ya en el primer día de uso fueron encontradas marcas de identificación personal en todos los respiradores. A partir del quinto día, todas las máscaras presentaban suciedad, mientras que fueron observados pliegues en más del 80 por ciento de los equipos. Las manchas internas y pliegues fueron más frecuentes luego de turnos de 12 horas que de guardias de 6 horas (p<0,05). 16,17 por ciento de las máscaras habían sido extraviadas hacia el quinto día, y 38,93 por ciento luego del trigésimo día de uso. El tiempo de validez del respirador PFF-2, aunque no sea conveniente reutilizarlo, debe limitarse a cinco días.

[Maintenance status of N95 respirator masks after use in a health care setting]. / Estado de conservação de respiradores PFF-2 após uso na rotina hospitalar.

With the purpose of assessing the damages to N95 respirator masks over time and to estimate their expiration after use in clinical practice, this study was based on the descriptive analysis of N95 cone-shaped masks collected by nursing assistants after one, five, 15, and 30 consecutive days of use. Personal identification marks were founds in every respirator already on the first day of use. From the fifth day onward, all masks presented some type of dirt while folds were observed in more than 80% of the devices. Internal stains and folds were more frequent among workers of the 12-hour shift in comparison to the 6-hour shift (p < 0.05). The percentage of misplaced respirators was 16.17% by day five and reached 38.93% by day thirty. Though there is no convenience in reusing N95 respirators, their expiration should not exceed 5 days of use.

Conservação do equipamento de proteção individual (máscara PFF - 2) após uso por auxiliares de enfermagem

Os profissionais de enfermagem são indivíduos de alto risco ocupacional para aquisição de tuberculose e o equipamento de proteção individual – máscara PFF-2 não apresenta prazo de validade bem definido após uso. Foram objetivos deste estudo: verificar o grau de esclarecimento dos profissionais quanto à máscara PFF-2 e suas indicações, identificar a confiança depositada pelo usuário no equipamento e listar os maiores fatores de desestímulo ao seu uso, qualificar e quantificar os danos impelidos à estrutura da máscara ao longo do tempo e estimando assim, o período de validade da máscara após uso na rotina clínica. O estudo foi realizado no Instituto de Infectologia Emílio Ribas IIER, dividindo-se em duas etapas, a saber: Etapa I – aplicação de um breve questionário a auxiliares de enfermagem atuantes na assistência direta aos pacientes internados; e Etapa II – distribuição e análise descritiva das máscaras PFF-2 recolhidas após um, cinco, quinze e trinta dias consecutivos de uso. Do total de 167 funcionários incluídos no estudo, 115 (68,87%) trabalhavam no período diurno e 52 (31,13%) no noturno. Houve um predomínio do sexo feminino (86,22%), com idade variando entre 20 e 67 anos. Apenas 73,05% dos profissionais expressaram confiança na efetividade da máscara. Quanto às indicações para seu uso, a resposta correta “toda e qualquer suspeita de tuberculose” foi assinalada por 50,00% dos entrevistados. As causas de maior interferência para o uso da máscara foram o desconforto para respirar (35,69%) e as dificuldades no acondicionamento das máscaras (20% das citações). Na etapa II, observaram-se danos na estrutura física do equipamento principalmente às custas de marcas de identificação individual e dobras provocadas ao se guardar a máscara quando fora do uso, estas últimas presentes em absolutamente todas as máscaras após o 15° dia. Também foi grande o percentual de máscaras extraviadas ao longo do estudo, sendo superior a 15,00% após 5 dias e ...