Outbreak of Pseudomonas aeruginosa High-Risk Clone ST309 Serotype O11 Featuring blaPER-1 and qnrVC6.

Pseudomonas aeruginosa is a leading cause of hospital-acquired infections worldwide. Biofilm production, antibiotic resistance, and a wide range of virulence factors contribute to their persistence in nosocomial environments. We describe an outbreak caused by a multidrug-resistant P. aeruginosa strain in an ICU. Antibiotic susceptibility was determined and blaPER-1 and qnrVC were amplified via PCR. Clonality was determined using PFGE and biofilm formation was studied with a static model. A combination of antibiotics was assessed on both planktonic cells and biofilms. WGS was performed on five isolates. All isolates were clonally related, resistant to ceftazidime, cefepime, amikacin, and ceftolozane-tazobactam, and harbored blaPER-1; 11/19 possessed qnrVC. Meropenem and ciprofloxacin reduced the biofilm biomass; however, the response to antibiotic combinations with rifampicin was different between planktonic cells and biofilms. WGS revealed that the isolates belonged to ST309 and serotype O11. blaPER-1 and qnrVC6 were associated with a tandem of ISCR1 as part of a complex class one integron, with aac(6')-Il and ltrA as gene cassettes. The structure was associated upstream and downstream with Tn4662 and flanked by direct repeats, suggesting its horizontal mobilization capability as a composite transposon. ST309 is considered an emerging high-risk clone that should be monitored in the Americas.

Great Plasticity in a Great Pathogen: Capsular Types, Virulence Factors and Biofilm Formation in ESBL-Producing Klebsiella pneumoniae from Pediatric Infections in Uruguay.

Klebsiella pneumoniae is widely recognized as an opportunistic hospital and community pathogen. It is one of the priority microorganisms included in the ESKAPE group, and its antibiotic resistance related to extended-spectrum ß-lactamases (ESBL) is a global public health concern. The multi-drug resistance (MDR) phenotype, in combination with pathogenicity factors, could enhance the ability of this pathogen to cause clinical infections. The aim of this study was to characterize pathogenicity factors and biofilm formation in ESBL-producing K. pneumoniae from pediatric clinical infections. Capsular types, virulence factors, and sequence types were characterized by PCR. Biofilm formation was determined by a semiquantitative microtiter technique. MDR phenotype and statistical analysis were performed. The K24 capsular type (27%), virulence factors related to iron uptake fyuA (35%) and kfuBC (27%), and sequence types ST14 (18%) and ST45 (18%) were the most frequently detected. Most of the strains were biofilm producers: weak (22%), moderate (22%), or strong (12%). In 62% of the strains, an MDR phenotype was detected. Strains with K24 capsular type showed an association with ST45 and the presence of fyuA; strains with kfuBC showed an association with moderate or strong biofilm production and belonging to ST14. Weak or no biofilm producers were associated with the absence of kfuBC. The MDR phenotype was associated with the main ESBL gene, blaCTX-M-15. The high plasticity of K. pneumoniae to acquire an MDR phenotype, in combination with the factors exposed in this report, could make it even more difficult to achieve a good clinical outcome with the available therapeutics.

Novel Resistance Regions Carrying TnaphA6, blaVIM-2, and blaPER-1, Embedded in an ISPa40-Derived Transposon from Two Multi-Resistant Pseudomonas aeruginosa Clinical Isolates.

Antibiotic resistance is an alarming problem throughout the world and carbapenem-resistant Pseudomonas aeruginosa has been cataloged as critical in the World Health Organization list of microorganisms in urgent need for the development of new antimicrobials. In this work, we describe two novel resistance regions responsible for conferring a multidrug resistance phenotype to two clinical isolates of P. aeruginosa (Pa873 and Pa6415) obtained from patients hospitalized in the ICU of University Hospital of Uruguay. Bacterial identification and antibiotic susceptibility tests were performed using MALDI-TOF and the Vitek 2 system, respectively. WGS was performed for both isolates using Oxford Nanopore Technologies and Illumina and processed by means of hybrid assembly. Both isolates were resistant to ceftazidime, cefepime, piperacillin-tazobactam, aztreonam, and imipenem. Strain Pa6415 also showed resistance to ciprofloxacin. Both strains displayed MICs below the susceptibility breakpoint for CAZ-AVI plus 4 mg/L of aztreonam as well as cefiderocol. Both resistance regions are flanked by the left and right inverted repeats of ISPa40 in two small regions spanning 39.3 and 35.6 kb, for Pa6415 and Pa873, respectively. The resistance region of Pa6415 includes TnaphA6, and the new Tn7516 consists of IRi, In899, qacEΔ1-sul1-ISCR1, qnrVC6-ISCR1-blaPER-1-qacEΔ1-sul1, araJ-like, IS481-like tnpA, ISPa17, and IRR. On the other hand, the resistance region of Pa873 includes Tnaph6 and the new Tn7517 (IRi, In899, qacEΔ1-sul1, ISCR1-blaPER-1-qacEΔ1-sul1, araJ-like, IS481-like tnpA, ISPa17, and IRR). It is necessary to monitor the emergence of genetic structures that threaten to invalidate the available therapeutic resources.

Combined photocatalytic and biological process for textile wastewater treatments.

Azo dyes, common in textile wastewater, have high photolytic and chemical stabilities, which make them difficult to be removed using conventional treatments. This study aims to evaluate a combined process using heterogeneous photocatalysis, with ZnO/UV or TiO2 /UV (0.6 g catalyst L-1 solution/2-hr UV radiation), and a biological process for textile wastewater treatment. After the proposed treatments, the color and organic matter removals from synthetic wastewater (SW) and industrial wastewater (IW) were evaluated. For SW, the coupled photocatalytic (ZnO/UV or TiO2 /UV)-biological system promoted a high extent of color removal (98%) and total organic carbon (TOC) reduction (>80%). Promising results were obtained with IW using combined photocatalytic (TiO2 /UV)-biological treatments, reaching 97% and 63% of color and TOC removal, respectively. This process, coupling heterogeneous photocatalysis and a bioprocess, has proved to be a good alternative for the treatment of textile wastewater, not only for color removal but also for dye mineralization purposes. PRACTITIONER POINTS: A combined process using heterogeneous photocatalysis (ZnO/UV or TiO2 /UV) and biological process was evaluated for synthetic (SW) and industrial (IW) textile wastewaters treatment. For SW, coupled process promoted high extent of colour and organic matter removals. For IW, promising results were obtained with TiO2 /UV-biological treatment (97% of colour and 63% of organic matter removals).

Morbidity of schistosomiasis mansoni in a low endemic setting in Ouro Preto, Minas Gerais, Brazil

Abstract INTRODUCTION: Despite the advances of disease control programs, severe forms of schistosomiasis are prevalent. The prevalence of the disease in areas frequented by tourists urges for permanent prevention and control. The aim of this study was to describe the morbidity of schistosomiasis in the district of Antônio Pereira, Ouro Preto, Minas Gerais, Brazil. METHODS: The proportion of positives was defined by Kato-Katz coproscopy and urinary POC-CCA rapid test. Hepatosplenic form was diagnosed using abdominal ultrasound. RESULTS: Out of 180 participants,97 were examined by Kato-Katz, with 4 (4.1%) being positive. Thirty-four (22.1%) out of 154 were positive by POC-CCA. Five (2.8%) of 177 examined by ultrasound had hepatosplenic form. One of them had undergone splenectomy. One (0.6%)participant had myeloradiculopathy. CONCLUSIONS: Severe forms of schistosomiasis are still prevalent in low endemic areas and should be thoroughly investigated.

The cascade of care to prevent mother-to-child transmission in Rio de Janeiro, Brazil, 1996-2013: improving but still some way to go.

OBJECTIVE: To describe the cascade of care to HIV mother-to-child transmission (PMTCT) in a Rio de Janeiro reference paediatric clinic and evaluate the main factors possibly associated with HIV transmission. METHODS: Data on antenatal care (ANC), perinatal and neonatal assistance to HIV-infected and HIV-exposed but uninfected children assisted in the clinic from 1996 to 2013 were collected. The cascade of care was graphically demonstrated, and possible factors associated with HIV infection were described using regression models for bivariate and multivariate analysis. We imputed missing values of explanatory variables for the final model. RESULTS: A total of 989 children were included in the analysis: 211 were HIV and 778 HEU. Graphically, the HIV PMTCT cascade of care improved from 1996/2000 to the later periods, but not from 2001/2006 to 2007/2013. The main factor independently associated with the HIV infection over time was breastfeeding. In the period 1996/2000, the lack of antiretroviral use during labour was associated HIV transmission. While in 2001/2007, other modes of delivery but elective Caesarean section, and lack of maternal antiretroviral use during ANC were associated with HIV transmission. In the last period, the main factor associated with transmission was the lack of maternal ANC. CONCLUSIONS: The HIV PMTCT cascade improved over time, but HIV vertical transmission remains a problem, and better access to ANC is needed.

Morbidity of schistosomiasis mansoni in a low endemic setting in Ouro Preto, Minas Gerais, Brazil.

INTRODUCTION: Despite the advances of disease control programs, severe forms of schistosomiasis are prevalent. The prevalence of the disease in areas frequented by tourists urges for permanent prevention and control. The aim of this study was to describe the morbidity of schistosomiasis in the district of Antônio Pereira, Ouro Preto, Minas Gerais, Brazil. METHODS: The proportion of positives was defined by Kato-Katz coproscopy and urinary POC-CCA rapid test. Hepatosplenic form was diagnosed using abdominal ultrasound. RESULTS: Out of 180 participants,97 were examined by Kato-Katz, with 4 (4.1%) being positive. Thirty-four (22.1%) out of 154 were positive by POC-CCA. Five (2.8%) of 177 examined by ultrasound had hepatosplenic form. One of them had undergone splenectomy. One (0.6%)participant had myeloradiculopathy. CONCLUSIONS: Severe forms of schistosomiasis are still prevalent in low endemic areas and should be thoroughly investigated.

La Hipertensión Arterial es factor de riesgo para el desarrollo y progresión de la Enfermedad Renal Crónica / Arterial Hypertension is a risk factor for the development and progression of Chronic Kidney Disease

RESUMEN El vínculo entre Hipertensión Arterial (HTA) y Enfermedad Renal Crónica (ERC) es recíproco y complejo. La HTA es un factor de riesgo reconocido para el desarrollo de ERC, y la incidencia de enfermedad renal se incrementa conforme aumenta la severidad de la HTA. Adicionalmente la presencia de HTA se vincula a progresión de la ERC desde etapas tempranas hasta el desarrollo de ERC-extrema. La presencia de HTA enmascarada, HTA de túnica blanca y la pérdida del patrón dipping nocturno se vinculan a desarrollo y progresión de enfermedad renal. El tamizaje de ERC es recomendado para pacientes con HTA en riesgo de desarrollar la enfermedad. Es más discutido si debe realizarse tamizaje en individuos con bajo riesgo de desarrollar ERC. Las cifras objetivo de presión arterial en este grupo de pacientes son sugeridas por las guías KDIGO. Múltiples estudios han buscado identificar si el control intensivo de presión arterial disminuye la incidencia de ERC y su progresión pero los resultados no son concluyentes. El presente trabajo revisa el vínculo entre HTA y desarrollo y progresión de la ERC. Se puntualiza sobre la población con HTA que se beneficia del tamizaje de ERC y los valores objetivo de presión arterial en este grupo.

ABSTRACT The link between Arterial Hypertension (AHT) and Chronic Renal Disease (CKD) is reciprocal and complex. HBP is a recognized risk factor for the development of CKD, and the incidence of renal disease increases as the severity of hypertension increases. Additionally, the presence of hypertension is linked to progression of CKD from early stages to the development of extreme-ERC. The presence of masked HTA, white tunica HTA and loss of nocturnal dipping pattern are associated with development and progression of renal disease. Screening for CKD is recommended for patients with hypertension at risk of developing the disease. It is more controversial whether screening should be done in individuals at low risk of developing CKD. The target blood pressure figures in this group of patients are suggested by the KDIGO guidelines. Multiple studies have sought to identify whether intensive blood pressure control decreases the incidence of CKD and its progression but the results are inconclusive. This paper reviews the link between hypertension and development and progression of CKD. It is pointed out the population with hypertension that benefits from CKD screening and target blood pressure values ​​in this group.

Extended-spectrum ß-lactamases, transferable quinolone resistance, and virulotyping in extra-intestinal E. coli in Uruguay.

INTRODUCTION: To characterize extended-spectrum ß-lactamases (ESBLs) and plasmid-mediated quinolone resistance (PMQR) genes in Escherichia coli isolates obtained from extra-intestinal samples in three Uruguayan hospitals. METHODOLOGY: Fifty-five ESBL-producing E. coli isolates were studied. Virulence genes, ESBLs, and PMQR genes were detected by polymerase chain reaction. ESBL-producing isolates were compared by pulsed-field gel electrophoresis. Multi-locus sequence typing was also performed on 13 selected isolates. RESULTS: Thirty-seven isolates harbored blaCTX-M-15 (67.3%), eight blaCTX-M-2 (14.6%), five blaCTX-M-14 (9.1%), three carried both blaCTX-M-2 and blaCTX-M-14, one blaCTX-M-9, and one blaCTX-M-8. Among the CTX-M-15 producers, 92% belonged to sequence types ST131 and ST405, and carried aac(6')Ib-cr as well. Isolates harboring blaCTX-M-2, blaCTX-M-14, blaCTX-M-9, or blaCTX-M-8 were found to be genetically unrelated. CONCLUSIONS: The successful dissemination of CTX-M-15-producing E.coli isolates seems to be linked to the spreading of high-risk clones and horizontal gene transfer. A trade-off between carrying more antibiotic resistance and less virulence-related genes could partially account for the evolutionary advantages featured by successful clones.

In Utero Exposure to Antiretroviral Drugs: Effect on Birth Weight and Growth Among HIV-exposed Uninfected Children in Brazil.

BACKGROUND: There are concerns about the effects of in utero exposure to antiretroviral drugs (ARVs) on the development of HIV-exposed but uninfected (HEU) children. The aim of this study was to evaluate whether in utero exposure to ARVs is associated with lower birth weight/height and reduced growth during the first 2 years of life. METHODS: This cohort study was conducted among HEU infants born between 1996 and 2010 in Tertiary children's hospital in Rio de Janeiro, Brazil. Weight was measured by mechanical scale, and height was measured by measuring board. Z-scores for weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length were calculated. We modeled trajectories by mixed-effects models and adjusted for mother's age, CD4 cell count, viral load, year of birth and family income. RESULTS: A total of 588 HEU infants were included of whom 155 (26%) were not exposed to ARVs, 114 (19%) were exposed early (first trimester) and 319 (54%) later. WAZ were lower among infants exposed early compared with infants exposed later: adjusted differences were -0.52 (95% confidence interval [CI]: -0.99 to -0.04, P = 0.02) at birth and -0.22 (95% CI: -0.47 to 0.04, P = 0.10) during follow-up. LAZ were lower during follow-up: -0.35 (95% CI: -0.63 to -0.08, P = 0.01). There were no differences in weight-for-length scores. Z-scores of infants exposed late during pregnancy were similar to unexposed infants. CONCLUSIONS: In HEU children, early exposure to ARVs was associated with lower WAZ at birth and lower LAZ up to 2 years of life. Growth of HEU children needs to be monitored closely.

Atuação fonoaudiológica na hidrocefalia congênita com derivação ventrículo peritoneal: relato de caso / Practice of speech therapy in congenital hydrocephalus with ventriculoperitoneal shunt: a case report

Resumo:A Hidrocefalia é definida como um transtorno na hidrodinâmica liquórica, com aumento do seu volume no compartimento intracraniano, da dilatação ventricular e da pressão intracraniana. O tratamento da hidrocefalia é feito com uso de válvulas de derivação periventricular (shunt). Se não for tratada, a criança com hidrocefalia poderá apresentar macrocefalia, retardo do desenvolvimento neuropsicomotor, infecções, meningites, dificuldades para aprender e alimentar-se (disfagia). Este estudo busca relatar as principais alterações fonoaudiológicas encontradas em um indivíduo diagnosticado com hidrocefalia congênita, tratada tardiamente com derivação ventrículo peritoneal. Trata-se de um estudo retrospectivo, descritivo dos dados contidos no prontuário. O paciente apresentou alterações de órgãos fonoarticulatórios, sialorréia, apertamento mandibular e Disfagia Orofaríngea Neurogênica de grau Moderado/Severo. Foram realizados exercícios de estimulação profunda, crioterapia, pontos motores da face, manobras facilitadoras da deglutição e correção postural durante a oferta de via oral. A literatura para atuação fonoaudiológica na hidrocefalia é escassa, porém, com este relato de caso, foi possível relatar as principais alterações fonoaudiológicas e intervenções terapêuticas encontradas na Hidrocefalia Congênita.

Resumo:A Hidrocefalia é definida como um transtorno na hidrodinâmica liquórica, com aumento do seu volume no compartimento intracraniano, da dilatação ventricular e da pressão intracraniana. O tratamento da hidrocefalia é feito com uso de válvulas de derivação periventricular (shunt). Se não for tratada, a criança com hidrocefalia poderá apresentar macrocefalia, retardo do desenvolvimento neuropsicomotor, infecções, meningites, dificuldades para aprender e alimentar-se (disfagia). Este estudo busca relatar as principais alterações fonoaudiológicas encontradas em um indivíduo diagnosticado com hidrocefalia congênita, tratada tardiamente com derivação ventrículo peritoneal. Trata-se de um estudo retrospectivo, descritivo dos dados contidos no prontuário. O paciente apresentou alterações de órgãos fonoarticulatórios, sialorréia, apertamento mandibular e Disfagia Orofaríngea Neurogênica de grau Moderado/Severo. Foram realizados exercícios de estimulação profunda, crioterapia, pontos motores da face, manobras facilitadoras da deglutição e correção postural durante a oferta de via oral. A literatura para atuação fonoaudiológica na hidrocefalia é escassa, porém, com este relato de caso, foi possível relatar as principais alterações fonoaudiológicas e intervenções terapêuticas encontradas na Hidrocefalia Congênita.

Urinary tract infection in Uruguayan children: Aetiology, antimicrobial resistance and uropathogenic Escherichia coli virulotyping.

Uropathogenic Escherichia coli (UPEC) is the most frequent cause of urinary tract infection (UTI). Virulence factors (VFs) of UPEC in children are not well known. Circulating antibiotic resistance mechanisms in the community are increasing. In this study, the aetiological agents of UTI and antibiotic resistance mechanisms of 124 strains isolated from urine cultures from children with community-acquired UTI were determined. Virulotyping of isolated E. coli strains was also described. ß-Lactam, fluoroquinolone and sulfonamide resistance genes as well as integrons were detected by PCR. E. coli phylogenetic groups and 25 VFs were sought by multiplex PCR. E. coli was the most frequent aetiological agent (88.7%), of which 48.2% belonged to phylogenetic group D and 35.5% to group B2. Moreover, 81.8% were considered UPEC and >93% had virulence structures, with kpsMTII, fimH and iutA being the most frequent. Most of the E. coli isolates were susceptible to amoxicillin/clavulanic acid (AMC) (87.3%), nitrofurantoin (97.3%), cefuroxime and third-generation cephalosporins (100%). Resistance levels to oxyimino-cephalosporins were higher in non-E. coli isolates, with circulation of integrons, blaCTX-M-2 and blaCMY-2 detected in the community. Moreover, 8.1% of isolates were resistant to fluoroquinolones, with qnrB found in two isolates. Resistance to trimethoprim/sulfamethoxazole was found in 37.9% of isolates, with 85.5% harbouring sul genes. E. coli isolated from children with UTI presented high rates of VFs. Nitrofurantoin, AMC and cefuroxime would be suitable antibiotics to treat UTI in children. However, the presence of integrons (fundamentally class 1) and circulation of broad-spectrum ß-lactamases in the community makes continuous surveillance necessary.

Perfil do paciente atendido pela fonoaudiologia na unidade de urgência e emergência de um hospital universitário / The profile of a patient receiving speech-language therapy assistance at a school hospital emergency unit

OBJETIVO: Caracterizar a população atendida pelos residentes de Fonoaudiologia no pronto-socorro de um hospital universitário. MÉTODOS: A amostra foi composta por 150 sujeitos de ambos os gêneros, na faixa etária de 20 anos a 59 anos e acima de 60 anos, internados no período de março de 2010 a março de 2012. RESULTADOS: Houve predominância de pacientes do gênero masculino, idosos, com ensino fundamental incompleto e com baixa renda, procedentes, em sua maioria, da capital, Goiânia, e região metropolitana. No diagnóstico médico, predominaram as doenças do aparelho circulatório, doenças do aparelho digestivo e doenças do sistema nervoso. Os diagnósticos fonoaudiológicos encontrados foram: deglutição normal/funcional, disfagia orofaríngea neurogênica e disfagia esofágica. CONCLUSÃO: Faixa etária associada a doenças de base prevalentes pode levar a distúrbios da deglutição, podendo agravar o quadro e prolongar o período de permanência do sujeito na instituição, sendo de extrema importância a presença do fonoaudiólogo nos serviços de urgência e emergência, para avaliar, diagnosticar e tratar os distúrbios deglutitórios.

PURPOSE: This paper sought to evaluate patients receiving assistance from resident speech-language therapists at a school hospital emergency room. METHODS: Both adult and elderly patients were included in this study. In total, 150 individuals of both genders, including adults between the ages of 20-59 years and elderly individuals over 60 years of age, who were hospitalized from March 2010 to March 2012 were studied. RESULTS: The patients were predominantly male and elderly, with incomplete elementary school education and a low income, and originated from the capital city and metropolitan region. The medical diagnoses predominantly revealed circulatory diseases, digestive disorders, and nervous system disorders. The speech-language therapy diagnoses showed normal swallowing function, neurogenic oropharyngeal dysphagia, and esophageal dysphagia. CONCLUSION: The prevalence of age-related systemic disorders may lead to swallowing disorders, which could trigger complications such as longer hospital stays. Therefore, the presence of a speech-language therapist in an emergency room is important to assess, diagnose, and treat swallowing disorders.

Detection of intracellular bacterial communities in a child with Escherichia coli recurrent urinary tract infections.

The formation of intracellular bacterial communities (IBC) has been proposed as a new pathogenic model for urinary tract infections. Scarce reports describe this phenomenon in humans. We describe the presence of IBC in uroepithelial cells of a child with recurrent urinary infections. Urine specimen was collected from a child with Escherichia coli UTI and analyzed by light and confocal laser scanning microscopy (CLSM). The capability of this strain to produce intracellular infection in bladder tissue was confirmed in mice models. Escherichia coli phylogenetic group, presence of virulence factors genes, and its multiple locus sequence type were determined. CLSM showed large collections of morphologically coccoid and rod bacteria in eukaryotic cells cytoplasm, even seemingly protruding from the cells. Escherichia coli EC7U, ST3626, harbored type 1, P, and S/F1C fimbriae and K1 capsule genes. In this report, we confirm the presence of IBC in children with UTI, as it has been described before in women.

Decolorization and mineralization of reactive dyes by a photocatalytic process using ZnO and UV radiation.

Reactive dyes are one of the major pollutants in textile wastewater and a concern because they are not easily degraded by conventional wastewater treatments. Heterogeneous photocatalysis has been considered an effective option for treating wastewater containing those dyes. This research work assesses the photocatalytic degradation of reactive dyes using UV irradiation and pure or impregnated ZnO. In addition to photocatalysis, separate photolysis and adsorption experiments were conducted but showed low efficiency. The dye degradation was monitored by UV-Vis spectroscopy and mineralization was determined by total organic carbon (TOC) analyses. Total color removal was achieved after 30 min of irradiation using pure ZnO. The Black 5 dye photocatalytic decolorization reaction followed first-order kinetics, while Yellow 145, Red 4 and Blue 21 dyes followed zero-order kinetics. TOC removals in the range of 70-80% were achieved after 240 min of individual photocatalytic treatment with ZnO. The performance of each photocatalyst was also compared when the four dyes were mixed together and the order of efficiency in the mineralization process was as follows: Fe/ZnO > ZnO > Co/ZnO. This result was explained by the crystal field theory.

Efeitos do Tai Chi Pai Lin no uso de medicamentos na Prefeitura de São Paulo / Effects of Tai Chi Pai Lin on medication use in São Paulo City Hall

Introdução: Tai Chi Pai Lin é um conjunto de práticas corporais e meditativas da Medicina Tradicional Chinesa integrado por treinamentos de automassagem, meditação taoísta e sequências de movimentos suaves, circulares e lentos que promovem a flexibilidade, o relaxamento e o equilíbrio emocional.Dentre os benefícios do Tai Chi descritos na literatura pode-se ressaltar a redução de risco cardiovascular através da diminuição da pressão arterial e desempenho aeróbico (Taylor-Pilliae, 2006), justificando sua adoção entre as estratégias para prevenção e controle das Doenças e Agravos Não Transmissíveis (DANT). Doenças isquêmicas do coração, associadas à obesidade, depressão e estresse, são a primeira causa de morte na Coordenadoria Regional de Saúde Centro-Oeste (CRS CO), de acordo com dados da Coordenação de Epidemiologia e Informação (CEINFO, 2006). Nesta pesquisa investigamosrelações entre a prática de Tai Chi Pai Line o uso de medicamentos. Objetivos: Avaliar os efeitos da prática do Tai Chi Pai Lin em relação ao uso de medicamentos pelos usuários das unidades de saúde da CRS CO. Método: Foram selecionados randomicamente 75 usuários de prática de Tai Chi Pai Lin dos diversos serviços de saúde pública da CRS CO da cidade de São Paulo. Eles responderam questionários sobre o uso de medicamentos e indicaram alterações atribuídas à esta prática. A análise estatística foi realizada através dos programas Epi-Info e SPSS. Resultados: A percepção referida desta população em relação ao uso de medicamentos após a prática do Tai Chi Pai Lin mostrou: dos 12,70% que referiram utilizar antiinflamatório, 66,70% referiram diminuição do uso deste medicamento; dos 16,40% que referiram utilizar calmante, 60% referiram diminuição do uso deste medicamento; dos 14,50% que referiram utilizar antidepressivo, 55,60% referiram diminuição do uso deste medicamento edos 34,50% que referiram utilizar antihipertensivo, 25% referiram diminuição do uso deste medicamento. Conclusão: As práticas do Tai Chi Pai Lin podem oferecer uma contribuição para redução da necessidade do uso de alguns medicamentos mais utilizados pelos usuários dos serviços de saúde pública da cidade de São Paulo.

Epidemiologia do dengue no Estado do Rio Grande do Norte, Brasil, 2000 a 2009 / Epidemiology of dengue fever in the State of Rio Grande do Norte, Brazil, 2000 to 2009

Objetivo: descrever as características epidemiológicas do dengue no Estado do Rio Grande do Norte, Brasil, no período 2000-2009. Métodos: foram analisados dados secundários do Sistema de Informação de Agravos de Notificação (Sinan) e de planilhas paralelas do dengue. Resultados: foram registrados 186.469 casos no período; as médias e medianas anuais foram de 18.647 e17.059 casos, respectivamente; as maiores incidências ocorreram nos meses de fevereiro a junho, e os sorotipos virais circulantes detectados no período foram DENV-1, DENV-2 e DENV-3; picos de incidência foram registrados nos anos de 2008 (41.987 casos) e 2001 (39.968 casos); o sexo feminino e indivíduos na faixa etária de 15 a 34 anos foram os mais acometidos; observou-se alto percentual de casos com critério de encerramento ignorado ou em branco, e a letalidade variou de 2,0 por cento a 20,0 por cento. Conclusão: o Estado do Rio Grande do Norte, o dengue revela perfil endêmico com picos epidêmicos, principalmente durante a (re) introdução de novos sorotipos virais.

Objective: to describe dengue fever epidemiology in the State of Rio Grande do Norte, Brazil, in the period 2000-2009. Methods: were used secondary data from Notifiable Diseases Information System (Sinan) and parallel sheets. Results: there were 186,469 registered cases in the period; the annual averages and medians were 18,647 and 17,059 cases, respectively; the highest incidences occurred in the months from February to June, and the circulating virus serotypes detected were DENV-1,DENV-2 and DENV-3; incidence peaks were recorded in the years 2008 (41.987cases) and 2001 (39,968 cases); female gender and individuals aged 15-34 years were the most affected; there was a high percentage of cases with foreclosure criteria ignoredor blank; and the lethality rate ranged from 2.0 per cent to 20.0 per cent. Conclusion: in the state of Rio Grande do Norte, the disease reveals endemic profile with epidemic peaks, specially during the (re)introduction of new serotypes.

A Terapia Anti-TNF-α na Artrite Reumatóide / The Anti-TNF-α therapy in the rheumatoid arthritis

A Artrite Reumatóide é uma doença crônica, sistêmica, autoimune, de etiologia desconhecida, que envolve predominantemente as articulações sinoviais, o que pode acarretar deformidade e destruição das mesmas. Com a progressão da doença, os pacientes com Artrite Reumatóide desenvolvem incapacidade para realização de suas atividades tanto de vida diária como profissional, gerando um impacto econômico significativo para o paciente e para a sociedade. Embora a causa exata da Artrite Reumatóide permaneça desconhecida, estudos realizados ao longo das duas últimas décadas possibilitaram maior compreensão da patogenia desta doença. Este conhecimento vem permitindo o desenvolvimento de novas terapias usadas para tratar as formas mais graves da doença. O principal objetivo do tratamento é atingir a remissão, no entanto, quando este não for possível, espera-se a prevenção do dano articular e da perda da função e ainda redução da dor. As mais recentes estratégias para o tratamento da Artrite Reumatóide envolvem o diagnóstico precoce e o controle agressivo do processo inflamatório. O reconhecimento de citocinas pró-inflamatórias mais expressas como o fator de necrose tumoral α (TNF-α) e interleucina (IL) 1 e IL6 possibilitou o surgimento de novas terapias dirigidas contra essas citocinas alvos. O TNF-α é uma citocina pró-inflamatória que desempenha papel chave na resposta imune, na defesa contra microrganismos e no processo inflamatório. Agentes biológicos que inibem o TNF-α são considerados eficazes na redução da atividade e no retardamento do dano estrutural articular na Artrite Reumatóide, em especial nas formas refratárias aos tratamentos convencionais. Atualmente, estão disponíveis no mercado brasileiro, três agentes anti-TNF-α: infliximabe, etanercepte e adalimumabe. Estes agentes são relativamente seguros para Artrite Reumatóide, mas podem, no entanto, apresentar complicações infecciosas graves, como a reativação da tuberculose latente. O alto custo dessas ... .

Rheumatoid arthritis is a chronic, systemic autoimmune disease of unknown etiology that involves predominantly synovial articulations, which can lead to deformity and destruction. With the progression of the disease, patients with Rheumatoid Arthritis develop inability to perform activities of daily living both as a professional, generating a significant economic impact for the patient and to society. Although the exact cause of rheumatoid arthritis remains unknown, studies conducted over the past two decades has enabled greater understanding of the pathogenesis of this disease. This knowledge has allowed the development of new therapies used to treat severe forms of the disease. The main goal of treatment is to achieve remission, however, when this can not be expected to prevent joint damage and loss of function and even reduce pain. The latest strategies for the treatment of Rheumatoid Arthritis involve the early diagnosis and aggressive control of inflammation. The recognition of pro-inflammatory cytokines expressed more as tumor necrosis factor α (TNF-α) and interleukin (IL) 1 and IL6 enabled developing new therapies directed against these cytokines targets. TNF-α is a proinflammatory cytokine that plays a key role in immune response, defense against microorganisms and the inflammatory process. Biological agents that inhibit TNF-α are considered effective in reducing activity and in the retardation of structural joint damage in rheumatoid arthritis, especially in forms refractory to conventional treatments. Currently, they are available in Brazil, three anti-TNF-α: infliximab, etanercept and adalimumab. These drugs are relatively safe for Rheumatoid Arthritis, but may, however, present serious infectious complications such as reactivation of latent tuberculosis.The high cost of these drugs, their use in hospital and the risk to opportunistic infections remain the limiting factors for its widespread use in the treatment of Rheumatoid Arthritis ....