Carnobacterium maltaromaticum as bioprotective culture against spoilage bacteria in ground meat and cooked ham.

This study assessed the bioprotective effect of Carnobacterium maltaromaticum (CM) against Pseudomonas fluorescens (PF) and Brochothrix thermosphacta (BT) in ground beef and sliced cooked ham stored in high- and low-oxygen-modified atmospheres (66/4/30% O2/N2/CO2 and 70/30% N2/CO2, respectively). Both meat products were inoculated with CM, PF, and BT individually or in combination and stored for 7 days (3 days at 4 °C + 4 days at 8 °C) for ground beef and 28 days (10 days at 4 °C + 18 days at 8 °C) for sliced cooked ham. Each food matrix was assigned to 6 treatments: NC (no bacterial inoculation, representing the indigenous bacteria of meat), CM, BT, PF, CM + BT, and CM + PF. Bacterial growth, pH, instrumental color, and headspace gas composition were assessed during storage. CM counts remained stable from inoculation and throughout the shelf-life. CM reduced the population of inoculated and indigenous spoilage bacteria, including BT, PF, and enterobacteria, and showed a negligible impact on the physicochemical quality parameters of the products. Furthermore, upon simulating the shelf-life of ground beef and cooked ham, a remarkable extension could be observed with CM. Therefore, CM could be exploited as a biopreservative in meat products to enhance quality and shelf-life.

Novel immobilization method of Lactiplantibacillus plantarum in grains for dry food products.

This study aimed to assess the potential use of grains (amaranth, millet, and quinoa) as immobilizing matrices on the metabolic activity of Lactiplantibacillus plantarum and evaluate the viability of the probiotic immobilized in millet during simulated oro-gastrointestinal digestion (OGI) and storage. Firstly, different grains, sterilization and immobilization times were assessed. Secondly, Lp. plantarum was immobilized in millet and its viability and metabolic activity were assessed during non-refrigerated long-term storage and OGI. Metabolic activity was higher with 15 min. of grain sterilization and 72 h of immobilization. Lp. plantarum in millet showed the highest count. Millet grains were able to maintain the high population (>7 log CFU/g) and the metabolic activity of Lp. plantarum during up to 150 d of storage and conferred a protective effect on entrapped probiotic cells during OGI. Millet is a promising immobilizing matrix for the addition of probiotics in dry food products.

The influence of eugenol, benzocaine and ice water on the welfare of adult grass carp (Ctenopharyngodon idella).

The aim of this study was to evaluate the effects of eugenol, benzocaine, and ice water during the sedative, anesthetic or euthanasia processes on the welfare of adult grass carp (Ctenopharyngodon idella). The experimental design was randomized and the animals were divided into eight groups. Sixty-two animals underwent an acclimation period. The neutral group used to obtain basal data of grass carp were not subjected to treatments, but anesthetized to collect blood samples and euthanized by medullary section. The others seven groups were submitted to seven treatments with eight repetitions (control group; ethanol; eugenol 50 mgL-1, eugenol 250 mgL-1, benzocaine 100 mgL-1, benzocaine 300 mgL-1, and ice water 2:1), their behavior was observed. Blood samples was collected and then euthanized by medullary sectioning. Biometric data were measured and a part of the liver was collected for hepatic glycogen analysis. There was a statistically significant difference in the time required to reach the anesthetic stage between the groups (p < 0.01). Benzocaine and eugenol at the higher concentration provided the fastest responses to sedatives and anesthetics, respectively. The animals subjected to higher anesthetic concentrations reached stage five and did not return from anesthesia, therefore, benzocaine and eugenol were effective euthanizing agents. Benzocaine at the lowest concentration showed the highest concentrations of glucose and cortisol (p < 0.05). Although benzocaine at 100 mgL-1 concentrations is widely used as an anesthetic in fish, this study demonstrated its use as a stressor agent. Basal data of grass carp for stress parameters are presented for the first time.

Carnobacterium as a bioprotective and potential probiotic culture to improve food quality, food safety, and human health - a scoping review.

It is well-known that some bacteria can promote human and animal health. Bacteria of the genus Carnobacterium, while underexplored, have demonstrated significant probiotic and bioprotective potential. In this review, the recent scientific advances in this area are discussed. There are several requirements for a strain to be considered a probiotic or bioprotective agent, including the absence of antimicrobial resistance and the ability to colonize the gastrointestinal tract. Several researchers have reported such features in Carnobacterium bacteria, especially with regard to the production of antimicrobial substances. Research into animal production has advanced, especially in the aquaculture field, wherein inhibitory activity has been demonstrated against several important pathogens (for example Vibrio), and improvement in zootechnical indexes is evident. With respect to human health-related applications, research is still in the early stages. However, excellent in vitro results against pathogens, such as Candida albicans and Pseudomonas aeruginosa, have been reported. Carnobacterium bacteria have been assessed for a variety of applications in food, including direct application to the matrix and application to smart packaging, with proven effectiveness against Listeria monocytogenes. However, there is a lack of in vivo studies on Carnobacterium applications, which hinders its applications in various industries despite its high potential.

Escherichia coli ST224 and IncF/blaCTX-M-55 plasmids drive resistance to extended-spectrum cephalosporins in poultry flocks in Parana, Brazil.

Resistant Enterobacterales of avian intestinal origin can contaminate carcasses during broiler processing and thereby spread through the human food chain. This study aimed at assessing the prevalence, diversity and genomic characteristics of ESBL/AmpC Enterobacterales in poultry flocks from different farms and cities in the state of Paraná, Brazil. Enterobacterales isolated from cloacal samples were subjected to antimicrobial susceptibility testing (AST). ESBL/AmpC isolates were whole-genome sequenced and subjected to S1-nuclease pulsed-field gel electrophoresis (S1-PFGE) followed by Southern blotting to determine the location of resistant genes on plasmids. A surprisingly high proportion of E. coli (40.6 %) collected on non-selective plates presented an ESBL/AmpC phenotype. Multidrug resistance was statistically not higher in ESBL/AmpC E. coli having the potential to be Avian Pathogenic (APEC-like) compared to non-APEC-like ESBL/AmpC E. coli isolates. Resistance to antibiotics not authorized for use in poultry in the State of Paraná was observed, suggesting that antimicrobial resistance (AMR) is co-selected by the use of veterinary-licensed antibiotics. Phylogenetic analyzes revealed the presence of identical or highly similar ESBL/AmpC E. coli clones on farms distant up to 100 km of each other; this strongly suggests that the centralization and verticalization of the poultry industry can facilitate the spread of resistant bacteria among different farms, companies, and cities. The molecular characterization of clones and plasmids proved the dominance of the ST224 E. coli lineage and the IncF/blaCTX-M-55 plasmid, possibly indicating the emergence of successful clones and plasmids adapted to the chicken host. Our data contribute to the epidemiological tracking of resistance mechanisms in Enterobacterales from poultry and to knowledge for further One Health studies to control the spread of resistant bacteria from food animals to humans.

Intake and performance of growing lambs supplemented with quebracho tannins.

Tannins can modulate rumen fermentation and increase the bypass protein; however, the use of different doses and sources of condensed tannins (CT) in animal diets has divergent results. The aim of this study was to evaluate the effect of different levels of dietary quebracho extract inclusion, as a CT source, in the performance and carcass characteristics of growing lambs. Forty-eight weaned lambs (Texel, Suffolk, and Hampshire Down crossbred) were homogenously blocked into four groups and supplemented at 0, 10, 30, and 60 g tannins/kg dry matter intake (DMI) (CONT, T1%, T3%, and T6%, respectively). The DMI, the roughage to concentrate ratio, the feed conversion rate (FCR), the average daily gain (ADG), and the body condition score (BCS) were evaluated. After the trial, animals were slaughtered, and the cold carcass weight, carcass yield, and subcutaneous fat thickness (SFT) were determined. Higher levels of CT in T3% and T6% reduced (P < 0.001) the total DMI and intake of concentrate without impacting (P = 0.071) the roughage intake (% body weight). ADG was the lowest for T6%, although the total weight gain and BCS were the lowest also for T3% (P < 0.001). FCR was worst for T6% (P < 0.001). Regarding carcass characteristics, T6% had the lowest weight of carcass (P = 0.003) and SFT (P = 0.021) compared to CONT. Carcass yields were similar among all the groups (P = 0.247). T1% did not differ from CONT to any parameter (P > 0.05). Supplementing quebracho CT at a low dose did not show beneficial effects; moreover, higher doses of CT led to detrimental effects in intake and animal performance.

Non-conventional cultures and metabolism-derived compounds for bioprotection of meat and meat products: a review.

Meat and meat products are important nutritional sources for humans; however, they are highly susceptible to pathogenic or spoilage bacteria, which leads to economic losses for the industry and has become a public health threat. Several biological methods have been developed to promote meat safety and to increase shelf life, mostly focusing on lactic acid bacteria from the genera Lactobacillus and Pediococcus. However, little attention has been paid to other groups of microorganisms with potential use as bioprotective cultures. This review aims to discuss the potential use of non-conventional microorganisms and biometabolites for bioprotection in meat and meat products. This review covers recent research involving the use of non-conventional microorganisms to improve the quality and safety of meat products. Bacteria that are often overlooked also have the potential for use in the food industry, either by direct application or by using their metabolites in the product itself or the development of intelligent packaging systems. Hopefully, this review will instigate new studies on emerging biological methods to ensure the safety of food and protect the health of consumers.

Simultaneous feeding of calcium butyrate and tannin extract decreased the incidence of diarrhea and proinflammatory markers in weaned piglets.

OBJECTIVE: This study was conducted to investigate the effect of associating calcium butyrate with tannin extract, compared to an antimicrobial on the growth performance, incidence of diarrhea, intestinal histology, immune-expression of cyclooxygenase-2 (COX-2) and tumor necrosis factor α (TNF-α) in piglets. METHODS: Seventy-two piglets (36 barrows and 36 gilts) weaned at 28±2 d and initial body weight of 7.17±1.07 kg were allocated to 3 treatments in a randomized complete block design with 8 replicates per treatment and 3 animals per experimental unit. Treatments were composed of NC, negative control: basal diet without additives; PC, positive control: basal diet + 40 mg/kg of colistin sulfate; or BT, basal diet + calcium butyrate + tannin extract. The butyrate and tannin inclusion levels were 0.15% in the pre-starter phase and 0.075% in the starter phase. Incidence of diarrhea was monitored daily, and on d 14 and 35 of experiment, 1 animal from each experimental unit was slaughtered to collect intestinal samples. RESULTS: No significant differences were observed for growth performance. The butyrate-and tannin-based additive resulted in reduced (p<0.05) incidence of diarrhea in piglets during d 1 to 14 and d 1 to 35 in comparison with the other treatments. Piglets that consumed the diet containing the calcium-butyrate and tannin showed a lower (p<0.05) crypt depth in the duodenum than those receiving the NC treatment at 14 d of experimentation. The BT treatment provided a lower (p<0.05) immune-expression of COX-2 at 14 d and TNF-α at 35 d in the duodenum. CONCLUSION: Association between calcium butyrate and tannin extract resulted in a significant decrease in the incidence of diarrhea and inflammatory process in the duodenum of piglets. Therefore, calcium-butyrate combined with tannin could be a part of an alternative program to reduce the use of antimicrobials in the diet of weaned piglets.

Bacteriophages as tools for biofilm biocontrol in different fields.

Microbial biofilms are difficult to control due to the limited accessibility that antimicrobial drugs and chemicals have to the entrapped inner cells. The extracellular matrix, binds water, contributes to altered cell physiology within biofilms and act as a barrier for most antiproliferative molecules. Thus, new strategies need to be developed to overcome biofilm vitality. In this review, based on 223 documents, the advantages, recommendations, and limitations of using bacteriophages as 'biofilm predators' are presented. The plausibility of using phages (bacteriophages and mycoviruses) to control biofilms grown in different environments is also discussed. The topics covered here include recent historical experiences in biofilm control/eradication using phages in medicine, dentistry, veterinary, and food industries, the pros and cons of their use, and the development of microbial resistance/immunity to such viruses.

Recommendations for Managing Endodontic Emergencies during Coronavirus Disease 2019 Outbreak.

INTRODUCTION: The management of endodontic emergencies has been particularly challenging during the coronavirus disease 2019 (COVID-19) outbreak because of the possible generation of airborne particles and aerosols. The aim of this report was to contribute to the practice of endodontics by proposing a general protocol for the management of emergencies showing the rationale for remote diagnosis, clinical procedures, and the use of personal protective equipment and barriers at the dental office during the COVID-19 outbreak. METHODS: A review of the literature was conducted up to May 2020 on relevant institutional sites, aiming to retrieve the best updated evidence. The reporting considered the Reporting Tool for Practice Guidelines in Health Care statement. RESULTS: Recommendations from Cochrane Oral Health, the American Dental Association, and the Centers for Disease Control and Prevention were included along with the American Association of Endodontists resources and scientific articles that addressed the issue. CONCLUSIONS: The proposed protocol could contribute to the management of endodontic emergencies at the dental office during the COVID-19 outbreak.

Nisin and ε-poly-L-lysine as natural antimicrobials towards spoilage-associated Lactobacillus plantarum / Combinação de nisina e ε-poly-L-lysina como antimicrobianos naturais contra Lactobacillus plantarum associado à deterioração

ABSTRACT: Sausages are highly susceptible to microbial spoilage. Lactic acid bacteria (LAB) is the main group of spoilage bacteria in vacuum packed cooked sausages. To control microbial growth natural antimicrobials have been used as food preservatives. The aim of this study was to identify strains of lactic acid bacteria isolated from spoiled commercial Calabresa sausages and use them in an in vitro challenge with the natural antimicrobials, nisin (NI) and ε-poly-L-lysine (ε-PL). Mass spectrometry identification of LAB isolated from sausages using MALDI-TOF revealed a predominance of L. plantarum in the LAB population. RAPD-PCR of L. plantarum strains showed four different genetic profiles. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of NI and ε-PL, alone and in combination, against a pool of different profiles L. plantarum were determined. MIC of NI and ε-PL were 0.468 mg/ L and 75 mg/ L; respectively, whereas MBC of NI and ε-PL were 12.48 mg/L and 150 mg/L, respectively. The combined effect of NI and ε-PL was determined using concentrations at 1/4 and 1/8 of individual MICs. Synergistic effect was confirmed at both concentrations showing a fractional inhibitory concentration index of 0.5 and 0.2, respectively. The combination of NI and ε-PL at a small concentration of 0.05 mg/L and 9.375 mg/L, respectively, showed inhibitory effect towards spoilage L. plantarum Results show the potential of the combined use of NI and ε-PL to control sausage spoilage-associated with lactobacilli.

RESUMO: Linguiças são altamente susceptíveis à deterioração microbiana. As bactérias ácido lácticas (BAL) são o principal grupo de bactérias deteriorantes em linguiças cozidas embaladas a vácuo. Para controlar o crescimento microbiano, antimicrobianos naturais têm sido utilizados como conservantes de alimentos. O objetivo deste estudo foi identificar cepas de bactérias ácido lácticas isoladas de linguiças Calabresa em deterioração e utilizá-las como modelo in vitro com os antimicrobianos naturais nisina (NI) e ε-poly-L-lysina (ε-PL). A identificação por espectrometria de massa das BAL isoladas das linguiças usando a técnica de MALDI-TOF revelou predominância de L. plantarum. A PCR-RAPD revelou quatro perfis genéticos diferentes. A concentração inibitória mínima (CIM) e a concentração bactericida mínima (CBM) de NI e ε-PL, individualmente e em combinação, contra o pool de L. plantarum foram determinadas. O valor de CIM de NI e ε-PL foi 0,468 mg/L e 75 mg/L, respectivamente, e de CBM de NI e ε-PL foi 12,48 mg/L e 150 mg/L, respectivamente. O efeito da combinação de NI e ε-PL foi determinada usando concentrações de 1/4 e 1/8 dos CIMs individuais. O efeito sinérgico foi confirmado em ambas concentrações mostrando um índice de concentração inibitório fracionado de 0,5 e 0,2, respectivamente. A combinação de NI e ε-PL em baixa concentração, 0,05 mg/L e 9,375 mg/L, respectivamente, mostrou efeito inibitório contra L. plantarum. Os resultados demonstram o potencial do uso combinado de NI e ε-PL para o controle de lactobacilos associados à deterioração em linguiça.

Repair of the middle and posterior compartments of the pelvic floor via perineal and vaginal routes without the use of mesh - technique description and case series / Correção dos compartimentos médio e posterior do assoalho pélvico por vias perineal e vaginal sem uso de tela - descrição de técnica e série de casos

ABSTRACT Introduction: Currently, problems such as constipation due to outlet obstruction, rectal/vaginal prolapse and fecal and urinary incontinence have become increasingly more frequent because of the population aging process, with great impact on the quality of life. Objective: To describe a technique for surgical repair of middle/posterior pelvic floor compartments and extra-mucosal rectal wall treatment by transperineal and vaginal approach, using native tissues and present the results in twenty patients submitted to this surgical technique. Method: Patients with symptoms secondary to middle/posterior pelvic floor descent and anatomical changes confirmed by proctological exam and pelvic MRI defecography. Results were evaluated through the Agachan constipation score, using pre- and post-operative questionnaires. Results: Immediate repair of rectocele and musculature, with prompt improvement of constipation, sustained by 42 months. There were no severe complications in the postoperative period. Conclusion: This is an effective technique, with adequate anatomic repair, improvement of constipation scores and with low risk.

RESUMO Introdução: Problemas como constipação intestinal por obstrução de saída, prolapsos retal/vaginal e incontinências fecal e urinária são cada vez mais frequentes pelo envelhecimento populacional, com grande impacto na qualidade de vida. Objetivo: Descrever técnica para correção do compartimento médio/posterior do assoalho pélvico e tratamento extramucoso da parede retal, por vias perineal e vaginal, utilizando tecidos nativos. Apresentar os resultados da cirurgia em 20 pacientes submetidas à técnica. Método: Pacientes com sintomas secundários ao descenso de assoalho pélvico médio/posterior, submetidas à propedêutica - exame proctológico e defecografia por RNM de pelve que confirmaram as alterações anatômicas. A avaliação dos resultados foi feita com questionários no pré e pós-operatório, com a utilização do escore de Agachan para constipação intestinal. Resultado: Correção imediata da retocele e da musculatura, com melhora imediata da constipação intestinal, sustentada ao longo de 42 meses. Sem complicações graves no pós-operatório. Conclusão: Técnica eficaz, com correção anatômica adequada, associada a melhora significativa dos escores de constipação e de baixo risco.

Resistant starch supplementation attenuates inflammation in hemodialysis patients: a pilot study.

PURPOSE: In chronic kidney disease (CKD) patients, dysbiosis is associated with inflammation and cardiovascular risk, so many nutritional strategies are being studied to reduce these complications. Resistant starch (RS) can be considered a prebiotic that promotes many benefits, including modulation of gut microbiota which is linked to immune-modulatory effects. The aim of this study was to evaluate the effects of RS supplementation on proinflammatory cytokines in CKD patients on hemodialysis (HD). METHODS: A double-blind, placebo-controlled, randomized trial was conducted with sixteen HD patients (55.3 ± 10.05 years, body mass index (BMI) 25.9 ± 5.42 kg/m2, 56% men, time on dialysis 38.9 ± 29.23 months). They were allocated to the RS group (16 g RS/day) or placebo group (manioc flour). The serum concentration of ten cytokines and growth factors was detected through a multiparametric immunoassay based on XMap-labeled magnetic microbeads (Luminex Corp, USA) before and after 4 weeks with RS supplementation. RESULTS: After RS supplementation, there was a reduction of Regulated upon Activation, Normal T-Cell Expressed and Secreted (p < 0.001), platelet-derived growth factor (two B subunits) (p = 0.014) and interferon-inducible protein 10 (IP-10) (p = 0.027). The other parameters did not change significantly. CONCLUSION: This preliminary result indicates that RS may contribute to a desirable profile of inflammatory markers in CKD patients.

Carnobacterium maltaromaticum as bioprotective culture in vitro and in cooked ham.

The bioprotective effects of Carnobacterium maltaromaticum (CM) strains were assessed in vitro and in sliced cooked ham. CM strains were tested in vitro against Listeria monocytogenes (LM), Escherichia coli O157:H7 (EC) and Salmonella Typhimurium (ST). In vitro effect was evaluated using co-culture (with and without EDTA) and cell-free supernatant (CFS). CFS was tested by agar well diffusion and minimum inhibitory concentration. In cooked ham, the inhibitory effect of CM on L. innocua (LI) and on the physicochemical parameters were evaluated for 7 days at 4 °C. In co-cultures at -1 °C and 4 °C, all CM isolates inhibited LM. A slight inhibition was observed against the Gram-negative bacteria with the addition of EDTA. CFS did not show inhibitory effect under the studied conditions. In cooked ham, CM inhibited LI growth and did not affect the physicochemical parameters of the product during storage. CM strains show potential to be used as bioprotective cultures in cold-stored cooked ham and improve its safety.

Organizational structure analysis of the Patient Safety Center in hospitals of the Sentinel Network. / Análise da estrutura organizacional do Núcleo de Segurança do Paciente dos hospitais da Rede Sentinela.

OBJECTIVE: To analyze the organizational structure of the Patient Safety Centers. METHOD: This is an exploratory and descriptive study with 12 coordinators of the Patient Safety Center. Data were collected using a structured and validated questionnaire with two evaluation domains based on Donabedian's triad of structure and process. RESULTS: The Patient Safety Center was implemented in the services with the participation and support of senior management. Human resources and materials are shared with other sectors. Points for improvement were identified regarding the center's activities, sentinel event prevention, risk management strategies, and professional training. CONCLUSION: Strategies are needed to ensure a non-punitive culture, event notification, sentinel event prevention, core activities, risk management, and professional training.

Validation of self-assessment instrument for the Patient Safety Center.

OBJECTIVE: To develop and validate an instrument for the self-assessment of the Patient Safety Centers in health care institutions. METHOD: Non-experimental methodological study. Divided in the following stages: literature review and construction of the preliminary instrument; content validation by nine professionals with experience in Quality Management and patient safety, who contributed to the adequacy of the items in terms of clarity and relevance; finally, 12 PSC coordinators, which conducted the reliability validation of the final instrument, using Cronbach's Alpha. RESULTS: The instrument presented content validity regarding clarity and relevance, evidenced by an agreement level greater than 70%. The internal consistency presented high reliability, with a Cronbach's alpha of 0.857 for the general instrument, 0.825 for the domain Structure, and 0.809 for the domain Process. CONCLUSION: The instrument presented evidence of content validity and reliability for self-assessment, implementation and evaluation of the PSC in health institutions.

Natural antimicrobials for control of Salmonella Enteritidis in feed and in vitro model of the chicken digestive process.

This study evaluated the antimicrobial effect of essential oils (EO) and organic acids (OA) against Salmonella Enteritidis in chicken feed and during an in vitro model that mimics the chicken digestive process. The minimal inhibitory concentration (MIC) of allyl isothiocyanate (AITC), carvacrol (CV), propionic acid (PROP) and caproic acid (CAP) were individually determined. Then, based on the MICs of each compound, combinations of EOs and/or OAs were tested to evaluate their synergic antimicrobial effect. The synergic effect of AITC and CAP was the most efficient against the bacterial strain tested. Commercial feed was inoculated with a 5-strain cocktail of S. Enteritidis and treated with different doses of AITC + CAP to evaluate their effect on the growth/survival of the pathogen. In addition, the simulated digestion model was used to access the antimicrobial effect of AITC + CAP added to the feed towards S. Enteritidis and Lactobacillus plantarum. Synergistic effect was found between AITC (0.065 mM) and CAP (17.5 mM) against S. Enteritidis in chicken feed, where S. Enteritidis was reduced to undetectable levels (<1.00 log CFU/g). AITC (1.95 mM) + CAP (45 mM) also decreased (p < 0.05) the population of S. Enteritidis in the simulated digestion, while the growth of L. plantarum was not affected. Therefore, the addition of AITC + CAP in feed might be a potential natural antimicrobial able to prevent economic losses caused for Salmonella in chicken.

A possible link between polyunsaturated fatty acids and uremic toxins from the gut microbiota in hemodialysis patients: A hypothesis.

INTRODUCTION: Indoxyl sulfate (IS) and p-cresyl sulfate (p-CS) are albumin-bound uremic toxins that are difficult to remove by hemodialysis (HD). Human serum albumin (HSA) carries several compounds, including fatty acids that can bind to site II of HSA and represent competing ligands for uremic toxins. The aim of this study was to investigate the association between fatty acids and uremic toxin plasma levels in patients undergoing HD. METHODS: Thirty-three HD patients (51.5% male, 54.9 ± 10.2 years old, 44.63 ± 28.4 months on HD, albumin level of 3.8 ± 0.3 g/dL) were evaluated. The erythrocyte fatty acid content (saturated fatty acid [SFA], monounsaturated fatty acid [MUFA], and polyunsaturated fatty acid [PUFA]) was measured by gas chromatography, and total IS and p-CS plasma levels were measured by reversed-phase high-performance liquid chromatography. FINDINGS: The mean percentages of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) + DHA and gamma-linolenic (GLA) acid in the erythrocyte membrane were 1.35% ± 0.74%, 1.85% ± 0.79%, and 0.33% ± 0.26%, respectively. The mean levels of IS and p-CS were 19.4 ± 11.9 mg/dL and 101.5 ± 57.2 mg/dL, respectively. There was no significant association between SFA and MUFA and IS and p-CS; however, a negative correlation was found between p-CS and specific PUFAs, and the association between GLA and p-CS levels was retained after adjusting for potential confounding variables (ß = -0.49, P = 0.007). DISCUSSION: Polyunsaturated fatty acids may contribute to the decrease in p-CS uremic toxin plasma levels in patients with chronic kidney disease undergoing HD.

Validation of self-assessment instrument for the Patient Safety Center / Validez del instrumento de autoevaluación de los Núcleos de Seguridad del Paciente / Validação de instrumento de autoavaliação dos Núcleos de Segurança do Paciente

ABSTRACT Objective: To develop and validate an instrument for the self-assessment of the Patient Safety Centers in health care institutions. Method: Non-experimental methodological study. Divided in the following stages: literature review and construction of the preliminary instrument; content validation by nine professionals with experience in Quality Management and patient safety, who contributed to the adequacy of the items in terms of clarity and relevance; finally, 12 PSC coordinators, which conducted the reliability validation of the final instrument, using Cronbach's Alpha. Results: The instrument presented content validity regarding clarity and relevance, evidenced by an agreement level greater than 70%. The internal consistency presented high reliability, with a Cronbach's alpha of 0.857 for the general instrument, 0.825 for the domain Structure, and 0.809 for the domain Process. Conclusion: The instrument presented evidence of content validity and reliability for self-assessment, implementation and evaluation of the PSC in health institutions.

RESUMEN Objetivo: Desarrollar y validar un instrumento para autoevaluación de los Núcleos de Seguridad del Paciente en las instituciones de salud. Método: Estudio metodológico no experimental, dividido en las siguientes etapas: revisión bibliográfica y construcción del instrumento preliminar; validez del contenido por nueve profesionales con experiencia en Gestión de Calidad y seguridad del paciente, que contribuyeron para la adecuación de los ítems respecto a la claridad y a la pertinencia; para finalizar, 12 coordinadores del NSP procedieron a la validez de la confiabilidad del instrumento final, realizado mediante el Alfa de Cronbach. Resultados: El instrumento demostró validez de contenido con relación a la claridad y a la pertinencia comprobados por un consenso superior al 70%. La consistencia interna logró confiabilidad alta, presentando alfa de Cronbach 0,857 en el instrumento general, 0,825 en el Dominio Estructura y 0,809 en el Dominio Proceso. Conclusión: El instrumento alcanzó evidencias de validez de contenido y confiabilidad para autoevaluación , implantación y diagnóstico del NSP en las instituciones de salud.

RESUMO Objetivo: Desenvolver e validar um instrumento para autoavaliação dos Núcleos de Segurança do Paciente nas instituições de saúde. Método: Estudo metodológico não-experimental, dividido nas seguintes etapas: revisão bibliográfica e construção do instrumento preliminar; validação do conteúdo por nove profissionais com experiência em Gestão da Qualidade e segurança do paciente que contribuíram para adequação dos itens quanto à clareza e pertinência; por fim, 12 coordenadores de NSP procederam a validação da confiabilidade do instrumento final, realizada por meio do Alfa de Cronbach. Resultados: O instrumento apresentou validade de conteúdo quanto à clareza e pertinência evidenciada pelo consenso acima de 70%. A consistência interna alcançou confiabilidade alta, apresentando alfa de Cronbach 0,857 para o instrumento geral, 0,825 para o Domínio Estrutura e 0,809 para o Domínio Processo. Conclusão: O instrumento atingiu evidências de validade de conteúdo e confiabilidade para autoavaliação, implantação e diagnóstico do NSP nas instituições de saúde.