Bacterial Co-Infection in Patients with COVID-19 Hospitalized (ICU and Not ICU): Review and Meta-Analysis.

The prevalence of patients hospitalized in ICUs with COVID-19 and co-infected by pathogenic bacteria is relevant in this study, considering the integrality of treatment. This systematic review assesses the prevalence of co-infection in patients admitted to ICUs with SARS-CoV-2 infection, using the PRISMA guidelines. We examined the results of the PubMed, Embase, and SciELO databases, searching for published English literature from December 2019 to December 2021. A total of 542 rec ords were identified, but only 38 were eligible and, and of these only 10 were included. The tabulated studies represented a sample group of 1394 co-infected patients. In total, 35%/138 of the patients were co-infected with Enterobacter spp., 27% (17/63) were co-infected with methicillin-sensitive Staphylococ cus aureus, 21% (84/404) were co-infected with Klebsiella spp., 16% (47/678) of patients were co-infected with coagulase-negative Staphylococcus, 13% (10/80) co-infected with Escherichia coli (ESBL), and 3% (30/1030) of patients were co-infected with Pseudomonas aeruginosa. The most common co-infections were related to blood flow; although in the urinary and respiratory tracts of patients Streptococcus pneumoniae was found in 57% (12/21) of patients, coagulase negative Staphylococcus in 44% (7/16) of patients, and Escherichia coli was found in 37% (11/29) of patients. The present research demonstrated that co-infections caused by bacteria in patients with COVID-19 are a concern.

Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes

Abstract Objective: The clinical cases of patients with multisystem inflammatory syndrome (MIS-C) were analyzed via a systematic review and meta-analysis of the clinical findings, treatments, and possible outcomes of articles retrieved via database searches. Sources: The authors searched the PubMed, Scielo, Web of Science, Science Direct, EMBASA, EBSCO, and Scopus databases for articles containing the keywords "multisystem inflammatory syndrome in children" or "MIS-C" or "PIMS-TS" or "SIMP" and "COVID-19" or "SARS-CoV-2" published between December 1st, 2019 and July 10th, 2021. Patient characteristics, tissue and organ comorbidities, the incidence of symptoms after COVID-19 infection, treatment, and patient evolution in the articles found were evaluated. The data were abstracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Newcastle-Ottawa Scale (NOS). Findings: In total, 98 articles (2275 patients) were selected for demographics, clinical treatment, and outcomes of patients diagnosed with MIS-C. The average age of children with MIS-C, 56.8% of whom were male, was of nine years. Fever (100%), gastrointestinal (GI) (82%), and abdominal pain (68%) were the decisive symptoms for the diagnosis of MIS-C. Shock and/or hypotension were common in patients with MIS-C. Cardiac symptoms (66%) predominated over respiratory (39%) and neurological (28%) symptoms. MIS-C treatment followed the common guidelines for treating children with septic shock and Kawasaki disease (KD) and proved to be effective. Conclusions: This meta-analysis highlights the main clinical symptoms used for the diagnosis of MIS-C, the differences between MIS-C and KD, and the severity of the inflammatory process and urgency for hospital care.

Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes.

OBJECTIVE: The clinical cases of patients with multisystem inflammatory syndrome (MIS-C) were analyzed via a systematic review and meta-analysis of the clinical findings, treatments, and possible outcomes of articles retrieved via database searches. SOURCES: The authors searched the PubMed, Scielo, Web of Science, Science Direct, EMBASA, EBSCO, and Scopus databases for articles containing the keywords "multisystem inflammatory syndrome in children" or "MIS-C" or "PIMS-TS" or "SIMP" and "COVID-19" or "SARS-CoV-2" published between December 1st, 2019 and July 10th, 2021. Patient characteristics, tissue and organ comorbidities, the incidence of symptoms after COVID-19 infection, treatment, and patient evolution in the articles found were evaluated. The data were abstracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Newcastle-Ottawa Scale (NOS). FINDINGS: In total, 98 articles (2275 patients) were selected for demographics, clinical treatment, and outcomes of patients diagnosed with MIS-C. The average age of children with MIS-C, 56.8% of whom were male, was of nine years. Fever (100%), gastrointestinal (GI) (82%), and abdominal pain (68%) were the decisive symptoms for the diagnosis of MIS-C. Shock and/or hypotension were common in patients with MIS-C. Cardiac symptoms (66%) predominated over respiratory (39%) and neurological (28%) symptoms. MIS-C treatment followed the common guidelines for treating children with septic shock and Kawasaki disease (KD) and proved to be effective. CONCLUSIONS: This meta-analysis highlights the main clinical symptoms used for the diagnosis of MIS-C, the differences between MIS-C and KD, and the severity of the inflammatory process and urgency for hospital care.

Genomics and epidemiology for gastric adenocarcinomas (GE4GAC): a Brazilian initiative to study gastric cancer

Gastric cancer (GC) is the fifth most common type of cancer worldwide with high incidences in Asia, Central, and South American countries. This patchy distribution means that GC studies are neglected by large research centers from developed countries. The need for further understanding of this complex disease, including the local importance of epidemiological factors and the rich ancestral admixture found in Brazil, stimulated the implementation of the GE4GAC project. GE4GAC aims to embrace epidemiological, clinical, molecular and microbiological data from Brazilian controls and patients with malignant and pre-malignant gastric disease. In this letter, we summarize the main goals of the project, including subject and sample accrual and current findings

The burden of serious human fungal infections in Brazil.

In Brazil, human fungal infections are prevalent, however, these conditions are not officially reportable diseases. To estimate the burden of serious fungal diseases in 1 year in Brazil, based on available data and published literature. Historical official data from fungal diseases were collected from Brazilian Unified Health System Informatics Department (DATASUS). For fungal diseases for which no official data were available, assumptions of frequencies were made by estimating based on published literature. The incidence (/1000) of hospital admissions for coccidioidomycosis was 7.12; for histoplasmosis, 2.19; and for paracoccidioidomycosis, 7.99. The estimated number of cryptococcal meningoencephalitis cases was 6832. Also, there were 4115 cases of Pneumocystis pneumonia in AIDS patients per year, 1 010 465 aspergillosis and 2 981 416 cases of serious Candida infections, including invasive and non-invasive diseases. In this study, we demonstrate that more than 3.8 million individuals in Brazil may be suffering from serious fungal infections, mostly patients with malignant cancers, transplant recipients, asthma, previous tuberculosis, HIV infection and those living in endemic areas for truly pathogenic fungi. The scientific community and the governmental agencies should work in close collaboration in order to reduce the burden of such complex, difficult-to-diagnose and hard to treat diseases.

Characterization of a Cryptic and Intriguing Low Molecular Weight Plasmid.

The complete nucleotide sequence of cryptic plasmid pVCM04 isolated from Salmonella enterica serovar Enteritidis was determined and analyzed. pVCM04 contains 3853 bp with 53.6 % GC content and has twelve ORFs with more than 50 amino acids. Five of these sequences showed homology with replication and mobilization proteins. ORF1 and ORF2 showed homology with replication proteins, while ORFs 3-5 showed homology with mobilization proteins. The pVCM04 possesses a region associated with the theta-type replication mechanism. BLASTn search analysis revealed unexpectedly no similarity with sequences deposited in GenBank. The nucleotide sequence of pVCM04 can be divided into two arms: the region between nucleotides 552-1774 (encoding RepA and RepB) and the region between nucleotides 1775-3853 (encoding MobA, MobB and MobC). Codon bias pattern is distinct between mobA and repA, so the program Modeltest was used to select the best evolutionary model to study these genes. The result of ModelTest (model GTR+G for mobA and model HKY+G for repA) suggests that these genes would be subject to different selective pressures. Considering the differences in the codon usage, the selection of two different evolutionary models, and the absence of plasmids with homology to pVCM04 in GenBank, we believe that pVCM04 is a chimeric molecule and represents a new plasmid lineage.

Clostridium difficile infection in Brazil: a neglected problem?

The epidemiology of Clostridium difficile infection is virtually unknown in Brazil. In this prospective study, 8.3% of patients with nosocomial diarrhea were found to have toxigenic strains of C difficile in their feces. The relevant risk factors for Clostridium difficile infection were receipt of solid organ transplantation and septic shock.

Discrepancies among three laboratory methods for Clostridium difficile detection and a proposal for their optimal use.

Clostridium difficile is the major cause of nosocomial diarrhoea. Several detection methods are available for the laboratory diagnosis of C. difficile, but these vary in terms of sensitivity and specificity. In this study, we compared the performance of three following laboratory tests to detect C. difficile: in-house real-time PCR aiming for toxin B gene (tcdB), EIA for detection of toxins A and B (Premier Toxins A & B) and C. difficile culture in selective medium (bioMerieux). Our results were grouped into three categories as follows: (1) C. difficile-associated diarrhoea (CDAD); (2) asymptomatic carriers; and (3) negative results. Among the 113 patients included in the study, 9 (8.0%) were classified as CDAD, 19 (16.8%) were asymptomatic carriers, 76 (67.2%) had negative results and 9 (8.0%) could not be categorized (positive test for C. difficile toxins only). PCR was found to be the most sensitive diagnostic test in our study, with the potential to be used as a screening method for C. difficile colonization/CDAD. Diagnosis of CDAD would be better performed by a combination of PCR and EIA tests.

[Ants in a hospital environment and its importance as vector of bacteria]. / Formigas em ambiente hospitalar e seu potencial como transmissoras de bactérias.

The external ant community of Hospital Municipal de Morrinhos, in Morrinhos, Goiás State, was characterized by the low rates of richness, diversity, dominance and equity of species abundance. Pheidole sp.1, a polygynic species was numerically dominant in this environment, although it coexists with potentially competitive species. This ant species prevailed within all hospital departments and its space-time distribution was a little aggregated (variance/mean ratio = 1.102, chi2 = 29.38, P < 0.01). Escherichia, Salmonella, Aeromonas, Enterococcus, Staphylococcus and Klebsiella were the bacteria associated to this ant species in nearly all hospital annexes. The unicolonialism of Pheidole sp.1 tends to increase the contamination and dissemination process of infecto-contagious agents. The control and management of this ant species must be followed by practices that reduce the colonization process by other queens and the quantity of site nidification within the hospital.

Formigas em ambiente hospitalar e seu potencial como transmissoras de bactérias / Ants in a hospital environment and its importance as vector of bacteria

A comunidade de formigas da área externa ao hospital do Hospital Municipal de Morrinhos, GO, caracterizou-se pelos baixos índices de riqueza, diversidade, dominância e eqüidade de abundância das espécies. Pheidole sp.1, uma espécie poligínica, dominou esse ambiente apesar da coexistência com espécies potencialmente competitivas. A mesma espécie de formiga predominou no interior de praticamente todas as repartições do hospital e sua distribuição espaço-temporal aproximou-se da agregada (variância/média = 1.102, χ2 = 29.38, P < 0.01). Escherichia, Salmonella, Aeromonas, Enterococcus, Staphylococcus e Klebsiella foram os gêneros de bactérias associados a essa espécie de formiga em praticamente todas as repartições do hospital. O unicolonialismo de Pheidole sp.1 tende a potencializar o processo de contaminação e disseminação de agentes infecto-contagiosos. O manejo e controle da espécie devem ser acompanhados de técnicas que reduzam o processo de colonização por novas rainhas e a quantidade de locais de nidificação no interior do hospital.

The external ant community of Hospital Municipal de Morrinhos, in Morrinhos, Goiás State, was characterized by the low rates of richness, diversity, dominance and equity of species abundance. Pheidole sp.1, a polygynic species was numerically dominant in this environment, although it coexists with potentially competitive species. This ant species prevailed within all hospital departments and its space-time distribution was a little aggregated (variance/mean ratio = 1.102, χ2 = 29.38, P < 0.01). Escherichia, Salmonella, Aeromonas, Enterococcus, Staphylococcus and Klebsiella were the bacteria associated to this ant species in nearly all hospital annexes. The unicolonialism of Pheidole sp.1 tends to increase the contamination and dissemination process of infecto-contagious agents. The control and management of this ant species must be followed by practices that reduce the colonization process by other queens and the quantity of site nidification within the hospital.

Avaliação do leite in natura comercializado clandestinamente no município de Morrinhos, Go / Avaliation of in natura milk commercialized without due authorization in Morrinhos city, GO

Em Morrinhos, GO, é uma prática comum os produtores rurais distribuírem o leite diretamente aos consumidores. Dessa forma, o objetivo deste trabalho foi avaliar a qualidade microbiológica e físico-químicado leite in natura produzido no município e distribuído diretamente aos consumidores. Foram realizadas análises microbiológicas e físico-químicas do leite cru comercializado clandestinamente no município de Morrinhos - GO. No período de agosto a dezembro de 2005. Foram coletadas e analisadas 21 amostras de leite. Os resultados mostraram 15 (71,4%) amostras com contagens de bactérias mesófilas superiores a 105UFC/mL, para Staphylococcus aureus os níveis foram superiores a 104 UFC/mL em 6 amostras (28,5 %), os índices para bactérias psicrotróficas e coliformes totais ultrapassam 104 UFC/mL; em doze e sete amostras analisadas (58% e 35%), respectivamente. Cinco amostras (24%) estavam contaminadas com coliformes fecais. As análises físico-químicas realizadas foram: densidade, crioscopia, acidez, gordura, extrato seco total, extrato seco desengordurado, alizarol, cloreto, amido, peróxido de hidrogênio, formol, hipoclorito einibidor (antibiótico). Destas, apenas duas (10%) das análises de crioscopia e quatro (19%) das análises de gordura, encontravam-se fora dos padrões. Para o teste com alizarol sete (33%) do total analisado, apresentaram instabilidade e em duas (10%) das amostras, o cloreto estava presente. Considerando as análises microbiológicas e físico-químicas, há a necessidade de se fazer um trabalho de conscientização junto aos produtores, visando melhorar as características higiênico-sanitárias.