Evaluation of antimicrobial consumption in the neonatal population undergoing antimicrobial stewardship programmes: a systematic review.

BACKGROUND: Indiscriminate use of antimicrobials in neonatal sepsis treatment contributes to consumption misuse, and the optimization of prescription programmes is encouraged as a way of reducing this inappropriate use. AIM: To evaluate the impact of intervention programmes for adequate antimicrobial use (antimicrobial stewardship programmes) in consumption measurements of such drugs in neonatology. METHODS: The search for articles was performed in electronic databases and by manual search for citations in publications initially identified. Electronic databases searched were BVS (Virtual Health Library), Cochrane Library, Embase, MEDLINE/PubMed, SciELO, Scopus, and Web of Science. There was no date or period limit for inclusion of articles. The PICO question was defined as populations of neonates admitted to neonatal intensive care units undergoing an intervention programme to optimize antimicrobial therapy in relation to neonates not exposed to the programme and the outcome obtained in antimicrobials consumption. FINDINGS: The initial search in databases resulted in 1223 articles. Articles were screened and 16 original studies related to subject were selected, which conducted a quantitative approach to antimicrobials consumption for the population of interest. Most articles used days of therapy (DOT) as the main measure of antimicrobial consumption and have had a high-quality rating by Newcastle-Ottawa Scale. All studies were carried out in local hospitals at a single centre and most were in high-income countries. CONCLUSION: Of all studies identified by the search, few evaluated antimicrobial consumption in neonatology. New studies are needed, and DOT was shown to be the most adequate metric to measure consumption.

Presence of intestinal helminths decreases T helper type 1 responses in tuberculoid leprosy patients and may increase the risk for multi-bacillary leprosy.

Resistance to intracellular pathogens such as Mycobacterium leprae is dependent upon an effective T helper type 1 (Th1)-type immune response. On the other hand, intestinal helminths are known to subvert the host's immune response towards to either a Th2-type immune response or a regulatory T cell up-regulation, which may affect the host's ability to mount an effective response to mycobacteria. Here, we report a significant association between intestinal helminth infections and lepromatous leprosy [odds ratio (OR), 10.88; confidence interval (CI) 95%: 4.02-29.4; P<0.001]. We also observed that the frequency of intestinal helminths correlated strongly with the mycobacterial index (r=0.982, P<0.01). Corroborating with our hypothesis, intracellular levels of interferon-gamma were decreased significantly in leprosy patients co-infected with intestinal helminths when compared to leprosy patients without worms. Conversely, lepromatous leprosy patients with intestinal worms produced higher levels of both interleukin (IL)-4 and IL-10. Our results suggest that a pre-existing infection by intestinal helminths may facilitate the establishment of M. leprae infection or its progression to more severe forms of leprosy.

Short report: do intestinal nematodes increase the risk for multibacillary leprosy?

Intestinal helminths are known to subvert the host's immune response towards a Th2 response, which in turn may lead to both eosinophilia and high immunoglobulin E titers often associated with these parasites. Mycobacterium leprae infection may lead to different clinical and pathological forms. Multibacillary forms are associated with Th2 cytokines, whereas paucibacillary forms are associated with Th1 cytokines. We report a significantly higher frequency of intestinal helminthic infections in patients with the lepromatous form, a multibacillary form of leprosy (odds ratio, 2.99; 95% confidence interval, 1.82-4.95; P = 0.006) when compared with patients with paucibacillary leprosy or to a control group without leprosy. A direct correlation was also found between mycobacterial index and the frequency of intestinal helminths. Our results suggest that the presence of intestinal helminths may facilitate the establishment of M. leprae infection or the progression to more severe forms of leprosy.

Açäo dos raios X corpo total sobre os neutrófilos do sangue periférico em primata Cebus apella (macaco prego) / Effects of whole-body X-radiation on the neutrophils of the peripheral blood of the primate Cebus apella (weeping capuchin)

Amostras de sangue periférico foram obtidas de cinco primatas Cebus apella (macaco prego), antes e após exposiçäo aos raios X corpo inteiro, na dose única de 25,8 mC/kg (100R). Parte das amostras foi utilizada para a contagem global de cariosquizes e o restante para a realizaçäo de extensöes sanguíneas e submetidas à coloraçäo de Wright e aos seguintes métodos citoquímicos: ácido periódico Schiff (PAS) para a identificaçäo de glicogênio, Sudan black B para a detecçäo de fosfolipídios e o-toluidina-água oxigenada para a demonstraçäo da mieloperoxidase. Com o método de Wright foram observadas aos 1, 3 e 6 dias após exposiçäo à radiaçäo, alteraçöes nucleares e citoplasmáticas. Após aplicaçäo dos métodos citoquímicos acima referidos, foram observados, de modo geral, nos mesmos períodos de tempo após irradiaçäo: alteraçäo no padräo de distribuiçäo dos grânulos de glicogênio, grânulos mieloperoxidase positivos e sudanófilos de neutrófilos. No que diz respeito a cariosquizes, constatou-se um aumento dos mesmos após 1 dia, persistindo até o 3§ dia após irradiaçäo. Noventa dias após, näo foi observada nenhuma alteraçäo acima referida