Virulence factors, antifungal susceptibility and molecular profile in candida species isolated from the hands of health professionals before and after cleaning with 70% ethyl alcohol-based gel.

Fungal infections in neonatal intensive care units (NICU) are mainly related to Candida species, with high mortality rates. They are predominantly of endogenous origin, however, cross-infection transmitted by healthcare professionals' hands has occurred. The aim of this study was to identify Candida species isolated from the hands of healthcare professionals in a NICU before and after hygiene with 70% ethanol-based gel and evaluate virulence factors DNase, phospholipase, proteinase, hemolysin, biofilm biomass production, and metabolic activity. In vitro antifungal susceptibility testing and similarity by random amplified polymorphic DNA (RAPD) were also performed. C. parapsilosis complex was the most frequent species (57.1%); all isolates presented at least one virulence factor; three isolates (Candida parapsilosis complex) were resistant to amphotericin B, two (Candida famata [currently Debaryomyces hansenii] and Candida guilliermondii [currently Meyerozyma guilliermondii]) was resistant to micafungin, and six (Candida parapsilosis complex, Candida guilliermondii [=Meyerozyma guilliermondii], Candida viswanathi, Candida catenulata [currently Diutina catenulata] and Candida lusitaniae [currently Clavispora lusitaniae]) were resistant to fluconazole. Molecular analysis by RAPD revealed two clusters of identical strains that were in the hands of distinct professionals. Candida spp. were isolated even after hygiene with 70% ethanol-based gel, highlighting the importance of stricter basic measures for hospital infection control to prevent nosocomial transmission.

Periprosthetic joint infections in patients with rheumatoid arthritis are associated with higher complication and mortality rates.

INTRODUCTION: Periprosthetic joint infection (PJI) remains the most devasting complication after total joint arthroplasty (TJA). There has been a significant focus on this topic in recently-published medical literature. However, relatively little has been published about PJI in patients with rheumatoid arthritis (RA), which are often physiologically frail and immunocompromised. A better understanding of PJI in this patient population is therefore crucial. The main aims of this paper are to (1) report complication and mortality rates in a cohort of PJI-RA patients; and (2) clinically characterize them. METHODS: Medical and surgical records of all RA PJI patients treated surgically from 2003 to 2020 were retrospectively reviewed. Medical history, physical examination, reactive protein (CRP) level, procalcitonin, white blood cell (WBC) count, joint aspiration results, and cultures were used to determine PJI. RESULTS: 54PJIs, 49 of them chronic, were treated in 53RA patients. Mean patient age was 65 yrs. (range = 32-88); 33females and 20 males (one bilateral hip). The overall mortality rate was 18.9%(n = 10), with five deaths directly attributed to PJI. Staphylococci accounted for 34 infections (63%), while 11(20.4%) had multiorganism infections and six culture-negative PJI. At the end of treatment 79.6%(n = 43) still had an implanted TJR, 7.4% (n = 4) had spacers, 5.6%(n = 3) had undergone resection arthroplasty, 3.7%(n = 2) arthrodesis, and one each amputation and exarticulation. CONCLUSIONS: Mortality and specially complication rates were (are) high in this RA patients group presenting PJI. Delays to diagnosis and treatment may explain some of these poor outcomes. LEVEL OF EVIDENCE: A cohort level III retrospective study.

Unraveling the epidemiology of urinary tract infections in neonates: Perspective from a Brazilian NICU.

BACKGROUND: Urinary tract infections (UTIs) can lead to neonatal complications like sepsis, worsened by empirical treatment, contributing to antimicrobial resistance (AMR). This study examined the incidence, etiology, risk factors, and antimicrobial susceptibility of uropathogens in a Neonatal Intensive Care Unit (NICU) in Brazil. METHODS: Medical records of neonates hospitalized in the NICU from January 2015 to June 2022 were retrospectively analyzed through the National Healthcare Safety Network system. RESULTS: Among 1,474 neonates, 3.9% developed UTI, with an alarming 24-fold increase in incidence from 2015 to 2021. Genitourinary complications (odds ratio = 4.8) were a major risk factor. Of the 71 uropathogens, 74.6% were Gram-negative bacteria (GNB), 21.2% Gram-positive bacteria (GPB), and 4.2% Candida albicans. AMR was notable, with 13.3% of GPB and 20.7% of GNB exhibiting multidrug-resistant (MDR), while 6.6% of GPB and 1.9% of GNB showed extensive drug-resistant (XDR). UTI was associated with prolonged hospitalization (16-59 days). In 57 neonates with UTI, 40.3% had bloodstream infections, elevating the risk of death (odds ratio = 1.8). CONCLUSIONS: The study underscores the urgency of implementing infection prevention and control measures in the NICU to curb rising UTI incidences, combat AMR, and mitigate severe complications in critically ill neonates.

Evaluation of dietary lignin on broiler performance, nutrient digestibility, cholesterol and triglycerides concentrations, gut morphometry, and lipid oxidation.

Two trials were performed in order to evaluate the effects of dietary Kraft lignin inclusion on broiler performance, ileal nutrient digestibility, blood lipid profile, intestinal morphometry, and lipid oxidation of meat. Trial 1 was conducted in order to evaluate performance and ileal digestibility for the period of 1 to 21 d of age, randomly distributing 490 day-old broiler chicks across 5 dietary treatments with 14 replicates containing 7 birds each in metabolic cages, while trial 2 was executed in order to evaluate performance, blood parameters, intestinal morphometry, carcass yield and abdominal fat, and lipid oxidation for the period of 1 to 42 d of age, randomly distributing 900 day-old broiler chicks across 5 dietary treatments with 15 replicates of 12 birds each in floor pens, being each bird in trial 2 challenged with coccidiosis vaccine at 10 d of age. The treatments used in both trials were: positive control (PC): basal diet + antimicrobial; negative control (NC): Basal diet; NC1: NC + 1% lignin; NC2: NC + 2% lignin; NC3: NC + 3% lignin. For trial 1, it was observed that birds fed diets containing 1% lignin had a significant positive effect for BW, feed intake (FI), average daily weight gain (BWG) and feed conversion rate (FCR), similar to the PC, but also showing better EE, CP and AAs ileal digestibility percentages when compared to other treatments. For trial 2, it was observed that during the period of 21 to 35 d, the inclusion of lignin in the diet provided better results in animal performance, similar to the PC group, but at 42 d, animals fed with dietary lignin showed results lower than animals fed the PC diet (P < 0.05). Animals fed with increasing lignin concentrations showed decreasing levels of HDL (P < 0.05). As of intestinal morphometry, animals fed with 1% and 3% lignin showed longer intestinal length (P < 0.05). At 14 d of age, it was observed that animals fed with lignin showed oxidation levels similar to the control treatments. The inclusion of up to 1% lignin in the diet provides beneficial effects on productive performance and nutrient digestibility, while the inclusion of 2% lignin provided lower cholesterol levels, lower villus/crypt ratio, and better internal organ development, therefore, it can be considered an alternative to performance-enhancing antimicrobials in broiler chicken diets.

Epidemiological indicators and predictors of lethality associated with fungal infections in a NICU: a historical series.

OBJECTIVES: Fungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. METHODS: This study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. RESULTS: Thirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). CONCLUSION: These findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU.

Impact of intestinal colonization by Gram-negative bacteria on the incidence of bloodstream infections and lethality in critically ill neonates.

BACKGROUND: Early detection of antimicrobial-resistant microorganisms is crucial to prevent subsequent invasive infections and contain their spread in the Neonatal Intensive Care Unit (NICU). This study aims to investigate the association between intestinal colonization (IC) by Gram-negative bacteria and the risk of bloodstream infection (BSI) in critically ill neonates. METHODS: Data from the electronic medical records of 678 newborns admitted to a NICU Brazilian between 2018 and 2022 were retrospectively analyzed. Participants were monitored by the National Health Security Network. RESULTS: Among neonates, 6.9 % had IC (56.9 % attributed to Acinetobacter baumannii); of these, 19.1 % developed BSI (66.7 % by Staphylococcus spp.). Within the A. baumannii colonization, 34.5 % occurred during an outbreak in September 2021. Colonized individuals had a longer mean length of stay (49.3 ± 26.4 days) and higher mortality rate (12.8 %) compared to non-colonized individuals (22.2 ± 16.9 days; 6.7 %, respectively). Previous use of antimicrobials and invasive devices significantly increased the risk of colonization. Colonization by drug-resistant microorganisms, along with the occurrence of BSI, was associated with increased mortality and reduced survival time. CONCLUSIONS: IC contributed to the incidence of BSI, leading to more extended hospital stays and higher mortality rates. Its early detection proved to be essential to identify an outbreak and control the spread of resistant microorganisms within the NICU.

Effects of feeding spray-dried plasma to broiler breeders and their progeny on broiler performance under stressful rearing conditions of coccidial challenge and heat stress.

A total of 216 Cobb 500 broiler breeder hens were randomly distributed across 2 dietary treatments with 0 or 1% spray-dried plasma (SDP) resulting in 27 replications/treatment and 4 birds/replication. In addition, 36 roosters were divided between the same treatments and housed, in individual pens, being each bird considered a replicate. Experimental diets were fed from 26 wk until 65 wk of age. At 29, 45, and 63 wk of age, broiler breeder hens were inseminated, and eggs were incubated. Three progeny studies were performed and hatched birds were allocated in a randomized 2 × 2 factorial design (maternal diet: with or without inclusion of 1% SDP × progeny diet: with or without the inclusion of 2% SDP from 1 to 7 d of age). After 7 d of age, all birds received the same diet until 42 d. In all trials, birds were challenged with coccidiosis vaccine at 7 d of age. Furthermore, in the second experiment, heat stress was also included for 6 h a day during the whole trial. At 42-days posthatch in the first experiment, greater FI, BW, and BWG in chicks hatched from breeders fed 1% dietary SDP was observed. This effect did not extend to the other hatches. In the second trial, a decreased FCR in broilers fed the control diet from breeder hens fed 1 % of SDP was observed, as well as an interaction between the SDP groups, since broilers supplemented with SDP and originated from breeders fed SDP showed higher BW and BWG in comparison to other groups at 42 d. In the third trial, contrary to what was observed in the first study, SDP supplementation did not affect any of the performance indexes. In the 3 studies, no differences were found in carcass characteristics. SDP did not affect hen BW, egg production, fertility, or hatch of fertile. These results suggest that providing dietary SDP to broilers has some beneficial effects on broiler chickens.

High-resolution ultrasonography for early diagnosis of neural impairment in seropositive leprosy household contacts.

Leprosy household contacts (HC) represent a high-risk group for the development of the disease. Anti-PGL-I IgM seropositivity also increases the risk of illness. Despite significant advances in leprosy control, it remains a public health problem; and early diagnosis of this peripheral neuropathy represents one of the main goals of leprosy programs. The present study was performed to identify neural impairment in leprosy HC by analyzing differences in high-resolution ultrasonographic (US) measurements of peripheral nerves between leprosy HC and healthy volunteers (HV). Seventy-nine seropositive household contacts (SPHC) and 30 seronegative household contacts (SNHC) underwent dermato-neurological examination and molecular analysis, followed by high-resolution US evaluation of cross-sectional areas (CSAs) of the median, ulnar, common fibular and tibial nerves. In addition, 53 HV underwent similar US measurements. The US evaluation detected neural thickening in 26.5% (13/49) of the SPHC and only in 3.3% (1/30) among the SNHC (p = 0.0038). The CSA values of the common fibular and tibial nerves were significantly higher in SPHC. This group also had significantly greater asymmetry in the common fibular and tibial nerves (proximal to the tunnel). SPHC presented a 10.5-fold higher chance of neural impairment (p = 0.0311). On the contrary, the presence of at least one scar from the BCG vaccine conferred 5.2-fold greater protection against neural involvement detected by US (p = 0.0184). Our findings demonstrated a higher prevalence of neural thickening in SPHC and support the role of high-resolution US in the early diagnosis of leprosy neuropathy. The combination of positive anti-PGL-I serology and absence of a BCG scar can identify individuals with greater chances of developing leprosy neuropathy, who should be referred for US examination, reinforcing the importance of including serological and imaging methods in the epidemiological surveillance of leprosy HC.

Influence of Dietary Phytase Inclusion Rates on Yolk Inositol Concentration, Hatchability, Chick Quality, and Early Growth Performance.

The aim of this study was to determine the influence of dietary phytase in breeder hens on yolk nutrients, hatchability, chick quality, and growth rate of their progeny, and their subsequent performance to 42 d post-hatch when fed diets with the same phytase concentrations. Breeder hens (n = 216) were divided into 3 groups receiving nutrient-adequate diets with reduced calcium (Ca) and phosphorus (P) (by 0.16% and 0.15%, respectively), supplemented with either 500, 1500, or 4500 FTU/kg phytase from 27 to 50 weeks of age. Eggs were collected at 38 weeks of age and incubated. On the day of hatch, the chick quality and hatchability were determined, and 18 chicks/group were euthanized for yolk sac collection and the determination of inositol and glycerol concentrations. The remaining chicks were divided into three groups, receiving different diets with reduced Ca and P (by 0.16% and 0.15%, respectively), supplemented with 0, 500, or 1500 FTU/kg phytase to 42 d post-hatch. Increasing the phytase concentration in the breeder hen diet linearly (p < 0.05) increased the number of early embryo deaths and decreased the number of late deaths and pips. The inositol concentration in the yolk sac at day of hatch increased (quadratic; p < 0.05) as the phytase dose increased in the breeder hen diet. The breeder hen diet (p < 0.05) influenced the body weight (BW), feed intake (FI), and feed conversion ratio (FCR) up to 21 days of age. The supplementation of breeder hen diets with 1500 FTU/kg phytase increased the concentration of sodium (Na), magnesium (Mg), potassium (K), manganese (Mn), and zinc (Zn) in the yolk sac. The inclusion of phytase doses up to 4500 FTU/kg appeared to influence embryo mortality, chick feed intake, and BW gain to 21 days and the FCR throughout the entire production phase.

Β-glucans and MOS, essential oil, and probiotics in diets of broilers challenged with Eimeria spp. and Clostridium perfringens.

The aim of this study was to evaluate the effectiveness of ß-glucans and MOS, essential oil (mixture of carvacrol and thymol), and the probiotic based on Saccharomyces boulardi, as an alternative to anticoccidial agents. In this experiment, six hundred seventy-two 1-day-old male broiler chicks were housed in batteries for 28 d. The experimental design of 4 randomized blocks with 24 cages each, and 7 birds per cage, consisted of an initial phase from 1 to 14 d of age, and a growth phase, from 15 to 28 d of age. The rations were formulated based on corn and soybean meal as energy and protein ingredients, respectively. All birds were inoculated with Eimeria spp and C. Perfringes at 14 d of age, and with C. Perfringes only at 21 d of age. The results showed the best weight gain in the initial phase when the anticoccidial agent was applied, whereas the use of additives in growth and entire experimental phases showed superior results in all treatments for this parameter. The birds that did not receive additives in the rations had the worst feed conversion in both phases and along raising. The results showed no significant differences between the treatments for the scores of lesions in the digestive tract and counts in the cecum, however, the red lesions increased numerically in the duodenum and jejunum of birds fed diets without the inclusion of additives. The use of additives indicated effectiveness for the parameters of performance in broilers challenged with C. Perfringes and Eimeria spp. at 14 d of age, and with C. Perfringes at 21 d of age.

High early failure rate for a new unicondylar knee system.

Background: This single-center retrospective study evaluated early failure rates for an unicompartmental knee arthroplasty (UKA) system with an anti-allergic surface. Methods: We studied 87 consecutive joints received an UKA at a single center between 2017 and 2020. All patients received a fully cemented anti-allergic Univation-Aesculap partial knee replacement implant with a corundum blasting surface. All joints had precise indication of unicompartmental arthroplasty according to the current criteria of this procedure. The current series was restricted to patients undergoing medial cemented UKA. Medial compartment osteoarthritis was the main indication. Results: We found early failure (aseptic loosening) was documented in 20 of the 87 joints (23%). The time to failure ranged from 7 weeks to 3 years, for an estimated 33% (15-46%) cumulative hazard rate for implant loosening over three years. No cases of periprosthetic joint infection were found. On average, the patients began complaining about first symptoms during the third month after surgery. In most cases (66.66%), the cement remained fixed to the bone. Conclusions: Based on these early results, the manufacturer of this implant stopped all further distribution. Continued efforts should be made to understand the clinical and radiographic outcomes of alternative and anti-allergic surface coatings in knee arthroplasty.

Maternal supplementation of different trace mineral sources on broiler breeder production and progeny growth and gut health.

Trace mineral minerals Zn, Cu, and Mn play important roles in breeder production and progeny performance. The objective of this study was to determine maternal supplementation of trace mineral minerals on breeder production and progeny growth and development. A total of 540 broiler breeders, Cobb 500 (Slow feathering; 0-66 weeks old) were assigned to one of three treatment groups with the same basal diet and three different supplemental trace minerals: ITM-inorganic trace minerals in sulfates: 100, 16, and 100 ppm of Zn, Cu, and Mn respectively; MMHAC -mineral methionine hydroxy analog chelate: 50, 8, and 50 ppm of bis-chelated MINTREX®Zn, Cu and Mn (Novus International, Inc.), and TMAAC - trace minerals amino acid complex: 50, 8, and 50 ppm of Zn, Cu, and Mn. At 28 weeks of age, eggs from breeder treatments were hatched for progeny trial, 10 pens with 6 males and 6 female birds per pen were fed a common diet with ITM for 45 days. Breeder production, egg quality, progeny growth performance, mRNA expression of gut health associated genes in breeder and progeny chicks were measured. Data were analyzed by one-way ANOVA; means were separated by Fisher's protected LSD test. A p-Value ≤ 0.05 was considered statistically different and 0.1 was considered numerical trend. Breeders on ITM treatment had higher (p < 0.05) body weight (BW), weight gain and lower (p < 0.05) feed conversion ratio (FCR) from 0 to 10 weeks, when compared to birds fed MMHAC. MMHAC significantly improved egg mass by 3 g (p < 0.05) and FCR by 34 points (0.05 < p < 0.1) throughout the reproductive period (26-66 weeks) in comparison to ITM. MMHAC improved (p < 0.01) egg yolk color versus (vs.) ITM and TMAAC in all periods, except 28 weeks, increased (p < 0.01) eggshell thickness and resistance vs. TMAAC at 58 weeks, and reduced (p < 0.05) jejunal NF-κB gene expression vs. TMAAC at 24 weeks. There was a significant reduction in tibial dry matter weight, Seedor index and resistance for the breeders that received MMHAC and/or TMAAC when compared to ITM at 18 weeks. Lower seedor index but numerically wider tibial circumference was seen in hens fed MMHAC at 24 weeks, and wider tibial circumference but lower tibial resistance in hens fed TMAAC at 66 weeks. Maternal supplementation of MMHAC in breeder hens increased (p < 0.0001) BW vs. ITM and TMAAC at hatching, reduced (p < 0.05) feed intake vs. ITM at d14 and d28, and improved (p < 0.01) FCR and performance index vs. TMAAC at d28, reduced (p < 0.01) NF-κB gene expression and increased (p < 0.05) A20 gene expression vs. TMAAC on d0 and vs. ITM on d14, reduced (p < 0.05) TLR2 gene expression vs. ITM on d0 and vs. TMAAC on d14, increased (p < 0.05) MUC2 gene expression vs. both ITM and TMAAC on d45 in progeny jejunum. Overall, these results suggest that supplementation with lower levels of MHA-chelated trace minerals improved breeder production and egg quality and reduced breeder jejunal inflammation while maintaining tibial development in comparison to those receiving higher inorganic mineral supplementation, and it also carried over the benefits to progeny with better growth performance, less jejunal inflammation and better innate immune response and gut barrier function in comparison to ITM and/or TMAAC.

Evaluation of a Phytogenic Compound with Minerals as a Possible Alternative to Ractopamine for Finishing Pigs.

The objective of this work was to evaluate the effect of a phytogenic compound for pigs in the growing and finishing phases as a possible substitute for ractopamine. A total of 140 pigs with an average initial weight of 48.8 kg ± 5.9 kg were used, distributed in a randomized block design, in a 3 × 2 factorial scheme (control diet (CONT), diet with inclusion of 2.5 kg per ton of a phytogenic compound (PC), and diet with 10 ppm of ractopamine (RAC), and two sexes: gilts and barrows), distributed in eight pens per treatment. The performance parameters were measured, and, at the end of the experimental period, the animals were slaughtered for carcass characteristics and pork quality analysis. The animals consuming RAC showed a better feed conversion, 4% improvement in relation to the group with the PC (p < 0.05). For daily weight gain, the animals supplemented with the PC showed 4.46% lower gain compared to RAC, and 3% greater gain compared to the CONT (p < 0.05). The animals that consumed the PC showed 5.6% lower shear force of the pork (p < 0.05) in relation to the CONT group and 29% lower in relation to the RAC group. The TBARS value presented a significant difference (p < 0.05), the CONTT group was 29% higher than the RAC, and the PC was 15.5% higher than the RAC. For chroma, the pork of the RAC group was 14% lower than the CONTT group and 10.3% less than the PC. There was no significant difference for the carcass parameters. It was concluded that the pigs in the ractopamine group presented the best performance; however, the phytogenic compound can be used against ractopamine's restriction because it improves daily weight gain and promotes a softer and less pale meat when compared with ractopamine.

Impact of sickle cell disease on work activity.

Introduction: Sickle cell disease is a group of conditions caused by anomalous hemoglobin that predisposes people to some clinical syndromes. Because of these recurrent syndromes, patients have difficulty finding and, often, keeping a job. Objectives: To evaluate the impact of sickle cell disease on the job situation of people with the condition. Methods: Thirty-two working-age people with sickle cell disease were recruited using the snowball sampling method and underwent semistructured interviews for demographic, socioeconomic, and clinical data collection. Results: Only 28.1% of the interviewees engaged in paid work, 46.9% had already worked but were not working at the time of the interview, and 25% had never worked. About 6% of participants lived in extreme poverty, and 28.4% lived on the poverty line. Monthly per capita income was less than one minimum salary in 56.2% of cases and less than 1.5 minimum salaries in 9.4%. Conclusions: Sickle cell disease has an important negative impact on employment situation, as about 70% of working-age people were inactive. This results in a high social cost represented by a very low monthly per capita income (≤ 1 minimum salary) in 93.7% of the participants.

Cardiovascular and metabolic changes in Brazilian truck drivers.

OBJECTIVE: To identify the relationship between the Ankle Brachial Index (ABI) and the presence of cardio-metabolic diseases, alcohol, and tobacco abuse among truck drivers. METHODS: This is a cross-sectional study with a quantitative approach carried out with 235 truck drivers. Demographic, professional, clinical, alcohol, and tobacco abuse data were collected through interviews. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) instrument was used for this study. An odds ratio (OR) and 95% confidence interval (95% CI) adjusted for logistic regression were used for the association between variables. The Spearman's test was used to correlate quantitative variables. The significance level used was α = 0.05. RESULTS: The sample consisted of 235 truck drivers, all males, with an average age of 42.4 years, married (69.8%), self-reported white skin color (43.4%). ABI values equal to or less than 0.89 were identified in 38.7% of truck drivers. Tobacco abuse appeared in 18.5% of participants, and alcohol abuse was present in 8.9% of truck drivers according to the ASSIST rating. The most commonly found self-reported cardiometabolic diseases were obesity (29%), systemic arterial hypertension (SAH) (21.7%), and diabetes mellitus (DM) (10.6%). Those with altered ABI had 5.65 times the odds to have self-reported diabetes mellitus (95% CI 2.20-14.52; p = 0.0003), 2.86 times the odds to present alcohol abuse (95% CI 1.03-7.97; p = 0.0400), 3.03 times the odds to have edema (95% CI 1.25-7.36; p = 0.0144) and 5.10 times the odds to have varicose veins in the lower limbs (95% CI 2.22-11.73; p = 0.0001) compared to those with normal ABI values. CONCLUSION: Truck drivers have changes in the ABI which are associated with long working hours, alcohol abuse and the presence of diabetes mellitus.

Inanimate Surfaces and Air Contamination with Multidrug Resistant Species of Staphylococcus in the Neonatal Intensive Care Unit Environment.

BACKGROUND: Contamination of the hospital environment with multi-resistant (MDR) Staphylococcus increases the risk of infection. The aim of this study is to identify the MDR species of Staphylococcus on inanimate surfaces, in air, and in clinical samples, and analyze the risk factors that correlate with the occurrence of infections in a Neonatal Intensive Care Unit. METHODS: Samples of inanimate surfaces and air were taken using a premoistened swab (0.9% sodium chloride) and spontaneous air sedimentation, respectively. The clinical isolates were recovered from infected neonates. The isolates (environmental and clinical) were identified by matrix-assisted laser desorption ionization-time of flight and the resistance profile was calculated using the disk diffusion agar technique. RESULTS: In total, 181 isolates were obtained, 93 from (surfaces), 18 from the air, and 70 clinical samples. S. epidermidis was the most frequent species (66.8%), and the failure rate in air cleaning was 100%. More than 60% of the isolates were MDR, and the majority of clinical isolates (60.4%) had a resistance profile identical to that of the environmental isolates. CONCLUSION: Staphylococcus spp. were found in most of the analyzed samples, with a high frequency of MDR isolates, demonstrating the importance of the hospital environment as a reservoir, and the need for infection control measures, and rational use of antimicrobials.

Hand-foot syndrome and nail disorders secondary to treatment with paclitaxel: Is there a relationship with the presence of fungi?

INTRODUCTION: This study aimed to evaluate the frequency of nail disorders and the presence of fungi on the nails of the hands and feet of patients with hand-foot syndrome secondary to treatment with paclitaxel. METHODS: Prospective study, carried out from October 2018 to December 2019, which included 81 patients undergoing treatment for breast cancer using paclitaxel and had signs and or symptoms of hand-foot syndrome with or without nail disorders. The data were collected through interviews guided by a structured questionnaire, information from medical records and reports of mycological exams. RESULTS: The average age of women was 54.7 ± 7.4 years. Nail disorders occurred in 69 patients (85.2%), and of these, 43 (62.3%) were positive for fungi. The fungi were yeasts (n = 38; 69%), dermatophytes (n = 15; 27.2%) and non-dermatophyte filamentous fungi (n = 8; 14.5%). CONCLUSIONS: Nail disorders were the most frequent manifestations in patients with hand-foot syndrome treated with paclitaxel and occurred in 85.2% of them. It was evidenced that fungi are present on the nails of these patients and can occur in up to 65.28%. The most prevalent fungi were Candida and Trichophyton. The nail lesion was associated with the type of treatment protocol used by the patient. The results of the study point to the need to select safe management alternatives for patients, so they can prevent nail lesions and prevent the proliferation of fungi, consequently reducing negative life impact during treatment.

Associação entre doenças cardiometabólicas autorreferidas, violência e uso de drogas em caminhoneiros / Association between self-reported cardiometabolic diseases, violence and drug use in truck drivers / Asociación entre enfermedades cardiometabólicas autoinformadas, violencia y consumo de drogas en conductores de camiones

Objetivo: analisar a associação entre doenças cardiometabólicas, violência sofrida e uso de drogas em caminhoneiros. Método: estudo transversal que envolveu 235 motoristas que estiveram em um posto de combustível no município de Uberlândia (MG), Brasil. Os dados foram coletados por meio de entrevistas autorrelatadas e aplicados os Testes de Qui Quadrado e Regressão Logística, adotando-se um nível de significância de 0,05 para todas as variáveis. Resultados: observou-se uma relação entre os eventos violentos no trânsito e algumas doenças cardiometabólicas, especialmente a doença vascular periférica (OR=6,00 (IC 95% 2,47-14,56) e a obesidade (OR=2,56 (IC 95% 1,42-4,62); sendo que também o abuso de álcool (OR=4,16 (IC 95% 1,53-11,29) e tabaco (OR=2,68 (IC 95% 1,10-6,51) se relacionaram com essas patologias. Conclusão: exposição a assaltos e acidentes de trânsito, e uso de álcool e tabaco foram associados a uma maior chance de prevalência das doenças cardiometabólicas entre caminhoneiros.

Objective: to analyze the association between cadiometabolic diseases, violence and drug use in truck drivers. Method: cross-sectional study, that involved 235 truck drives that were in a gas station in the city of Uberlândia (MG), Brazil. Data were collected through self-reported interviews and the Chi-Square and Logistic Regression tests were applied, adopting a significance level of 0.05 for all variables. Results: there was a relationship between violent traffic events and some cardiometabolic diseases, especially peripheral vascular disease (OR=6.00 (95% CI 2.47-14.56) and obesity (OR=2.56 (CI 95% 1.42-4.62); and also, alcohol abuse (OR=4.16 (95% CI 1.53-11.29) and tobacco (OR=2.68 (95% CI 1, 10-6.51) were related to these pathologies. Conclusion: exposure to robberies and traffic accidents, and the use of alcohol and tobacco were associated with a greater chance of prevalence of cardiometabolic diseases among truck drivers.

Objetivo: analizar la asociación entre enfermedades cardiometabólicas, violencia y consumo de drogas en camioneros. Método: estudio transversal, que involucró 235 camionetas que se encontraban en una gasolinera de la ciudad de Uberlândia (MG), Brasil. Los datos se recolectaron a través de entrevistas autoinformadas y se aplicaron las pruebas de Chi-Cuadrado y Regresión Logística, adoptando un nivel de significancia de 0.05 para todas las variables. Resultados: hubo relación entre eventos de tráfico violento y algunas enfermedades cardiometabólicas, especialmente enfermedad vascular periférica (OR = 6,00 (IC 95% 2,47-14,56) y obesidad (OR = 2,56 (IC 95% 1,42-4,62); y también, alcohol el abuso (OR = 4,16 (IC 95% 1,53-11,29) y el tabaco (OR = 2,68 (IC 95% 1, 10-6,51) se relacionaron con estas patologías. Conclusión: exposición a robos y accidentes de tráfico, y consumo de alcohol y el tabaco se asoció con una mayor probabilidad de prevalencia de enfermedades cardiometabólicas entre los conductores de camiones.

Copper and zinc hydroxychloride cosupplementation improve growth performance and carcass and reduce diarrhea frequency in grower-finisher pigs.

This study investigated copper (Cu) and zinc (Zn) hydroxychloride cosupplementation on the growth performance, diarrhea frequency, carcass, meat quality, and antioxidant activity in grower-finisher pigs. A total of 256 pigs were used from 70 to 154 days (d) of age, distributed in four treatments, with eight pigs in each pen and eight replications per treatment. Diets were provided to grower pigs from 70 to 112 days old and in the finisher, 112 to 154 days old. Copper was considered the low level at 100 mg Cu/kg and 90 mg Cu/kg, respectively, and 150 mg Cu/kg in both periods as high in the grower and finisher periods. In the grower and finisher period, zinc was cosupplemented in the diet at 80 mg Zn/kg and 70 mg Zn/kg, respectively. In the diets, T1 and T2 groups are the traditional inorganic sources for minerals (copper sulfate, CuSO4; zinc oxide, ZnO) and T3 and T4 hydroxychloride sources (copper hydroxychloride, CHC, and zinc hydroxychloride, ZHC). The flavomycin was associated with treatments with low Cu content in the inclusion of 50 g/ton. The experimental design was in randomized blocks, the data were submitted to analysis of PROC MIXED in SAS, the PDIFF test analyzed the treatment effect. At the finisher period, pigs fed both minerals from hydroxychloride source had a higher BW 154 d, average daily gain (ADG) 70 to 154 d, the hot and cold carcass weight and frequency of normal feces than those fed 150 mg Cu/kg and Zn from a traditional inorganic source (P < 0.05). The animals fed low Cu levels of the sulfate source had a higher ADG 70 to 154 d than those fed high Cu levels of the same source (P < 0.05). Pigs fed 150 mg Cu/kg cosupplemented with Zn from a hydroxychloride source had the highest carcass length (P < 0.05). There was no difference among the treatments for meat quality (P > 0.05). Pigs fed 150 mg Cu/kg and Zn from a traditional inorganic source had a higher superoxide dismutase (SOD) activity than the other treatments (P < 0.05). Animals fed low Cu levels from hydroxychloride had a higher malondialdehyde (MDA) formation than those fed sulfate source, regardless of the Cu levels and those fed high Cu levels of hydroxychloride (P < 0.05). In conclusion, 150 mg Cu/kg as copper sulfate cosupplemented to zinc oxide in the diet of growing and finishing pigs impairs the growth performance, carcass and increases diarrhea frequency, and copper and zinc hydroxychloride cosupplementation improves these characteristics.

Healthcare-associated infections in high-risk neonates: Temporal trends in a national surveillance system.

BACKGROUND: Increased survival of preterm neonates who require hospitalization at the Neonatal Intensive Care Unit has led to an increase in infections. This study aims to describe the temporal trend, risk factors, and outcome of healthcare-associated infections in a NICU of a high complexity hospital, with emphasis on the differences of incidence between bacterial and fungal infections. METHODS: The study was carried out from January 2013 to December 2016, with daily follow-up of the newborns by the National Healthcare Safety Network. RESULTS: The study included 881 newborns, of whom 214 had a bacterial infection, 19 had fungi infection, and 12 bacterial and fungal infections associated. The hospital infection rate was 12/1000 patient-days. SNAPPE>24, days of hospitalization and PICC days were independent risk factors for the development of fungal and bacterial infection, respectively, with statistical significance for bacterial and fungal infections. The mortality rate was 2.6 times higher in those who had fungal infection than in those who had a bacterial infection. The occurrence of invasive infections was higher in the years 2015 and 2016 and Gram-negative bacteria and yeasts were more frequent, impacting morbidity and mortality. CONCLUSIONS: The use of invasive devices is a risk factor for the occurrence of HAI caused by bacteria and fungi. The frequency of deaths was higher in the group of neonates with fungal infection. These results point to the importance of constant epidemiological surveillance and measures of effective control of infections in NICU.