Human exposure to elements through consumption of raw and cooked fish in an urban region of the central Brazilian Amazon biome: Health risks.

Fish is an important source of animal protein for local communities in the Amazon basin, whose food safety must be assured. However, certain potential toxicants elements, can bioaccumulate in fish species, which inhabit anthropogenically polluted waters, ultimately posing a risk to human health. In the present study, the concentrations of nine elements (Al, As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) were determined in raw and cooked samples of eight fish species consumed in Santarém (northern Brazil, Amazon biome). The potential for non- carcinogenic human health risks linked to the consumption of cooked fish were evaluated for adults and children in two different scenarios. Four carnivores, three omnivores and one detritivore, all of them regularly marketed and consumed by the Santarém population, were the target species. The safety reference values set by national and international guidelines for humans, in both raw and cooked preparations, were used. In most cases, the cooking process showed a trend to increase elements concentrations compared to raw samples, however the differences were not significant. Moreover, the risk assessment showed danger for children in relation to Hg from the consumption of fish, in both scenarios evaluated. For adults, in one of the scenarios, there was a health risk associated to Hg as a result of carnivorous fish consumption. In a context of combined exposure to all elements, children were at risk when consuming fish, especially carnivorous and omnivorous species. For adults, the mixture of elements posed a risk to health human only for carnivorous fish consumption. The results reveal an environmental scenario of Hg contamination, which requires monitoring actions to preserve the aquatic biodiversity and human health in the Brazilian Amazon biome.

A set of antibiotic-resistance mechanisms and virulence factors in GES-16-producing Klebsiella quasipneumoniae subsp. similipneumoniae from hospital wastewater revealed by whole-genome sequencing.

Klebsiella quasipneumoniae subsp. similipneumoniae has emerged as a human pathogen and sporadic isolates from non-clinical sources were reported. Here, we described the phenotypic- and genomic-characteristics of a multidrug-resistant (MDR) and potentially hypervirulent (MDR-hv) Klebsiella quasipneumoniae subsp. similipneumoniae (KqA1) isolated from hospital wastewater. The antibiotic susceptibility profile of KqA1 was investigated using disk-diffusion method, broth microdilution method, and agar dilution method, and the genetic characteristics of antimicrobial resistance, mobile genetics elements, and virulence were evaluated by genomic DNA sequencing on the Illumina® NovaSeq6000 platform as well as by bioinformatic analysis. Resistome analyses revealed the presence of genes related to resistance to ß-lactams, aminoglycosides, quinolones, tetracyclines, sulfonamides, trimethoprim, chloramphenicol, macrolides, and fosfomycin. New genetic contexts to blaGES-16 (carbapenemase gene) and to fosA (fosfomycin resistance gene) were described. A set of mechanisms that can contribute to antibiotic resistance, commonly detected in Klebsiella spp., was also found including chromosomal mutations, efflux systems, proteins, and regulators. Moreover, KqA1 presented genes related to tolerance to metals (arsenic, copper, nickel, cobalt, magnesium, cadmium, zinc, tellurium, selenium) and to biocides (quaternary-ammonium compounds). The isolate was classified as potentially hypervirulent due to a wide range of virulence factors found associated to regulation, motility, biofilm, effector delivery systems, immune modulation, nutritional/metabolic factors, adherence, invasion, and competitive advantage. The occurrence of MDR-hv KqA1 in hospital wastewater points out how this environment matrix plays a crucial role in the maintenance and selection of critical bacterial pathogens. Regarding One Health perspective, it is evident the need for multidisciplinary implementation of control measures for antibiotic-resistant bacteria, not only in hospital settings but also in a general environmental context to mitigate the dissemination of MDR and hv bacteria.

Conhecimento e atitude sobre diabetes mellitus em pacientes hospitalizados / Knowledge and attitude about diabetes mellitus in hospitalized patients

Introdução: a educação em diabetes mellitus tem como objetivo orientar as pessoas e ajudar a enfrentar e atuar ativamente na prevenção de complicações que podem surgir com a doença. Objetivo: caracterizar os pacientes com diagnóstico de diabetes mellitus (DM) internados em um hospital terciário do Sul do Brasil por meio da análise dos seus escores de conhecimento e atitudes em relação à doença. Métodos: realizou-se um estudo transversal com 69 pacientes entre os meses de setembro de 2019 e janeiro de 2020. Para coleta de dados, foram utilizados três questionários: um sobre conhecimento do DM (DKN-A), outro acerca das atitudes psicológicas sobre a doença (ATT-19) e um último constituído por perguntas objetivas aplicadas por meio de entrevista, o qual avalia as características clínicas e sociodemográficas de cada paciente. Para a análise estatística, foram utilizados os testes qui-quadrado ou Exato de Fisher. Resultados: em relação ao questionário DKN-A, 49 pacientes avaliados (71%) obtiveram boa pontuação (escore superior a 8 pontos), a qual está associada a um bom conhecimento do DM. Verificou-se que esses pacientes realizavam acompanhamento médico do DM de forma mais regular, consultando, no mínimo, três vezes ao ano (p=0,036). 66 participantes (95,7%) apresentaram baixa pontuação no questionário ATT-19. Discussão: grande parte dos pacientes avaliados têm bom conhecimento sobre o DM, entretanto, a baixa pontuação no questionário ATT-19 apresentada pela maioria dos pacientes indica dificuldade de enfrentamento da doença. O acompanhamento médico mais regular do diabetes mellitus pode estar associado a maior envolvimento do paciente no tratamento da doença, assim como maior e mais frequente fluxo de informações entre médico e paciente.

Introduction: diabetes education aims to guide people and help to face and act actively in preventing complications that may arise with the disease. Aims: to characterize patients diagnosed with Diabetes Mellitus (DM) admitted to a tertiary hospital in southern Brazil through the analysis of their knowledge and attitudes towards the disease. Methods: a cross-sectional study with 69 patients was carried out between September 2019 and January 2020. For data collection, three questionnaires were used: one on knowledge of DM (DKN-A), another on psychological attitudes about the disease (ATT-19) and a last one consisting of objective questions applied through an interview, which assesses the clinical and sociodemographic characteristics of each patient. For statistical analysis, Chi-square or Fisher's exact tests were used. Results: regarding the DKN-A questionnaire, 49 patients evaluated (71%) obtained a good score (score greater than 8 points), which is associated with a good knowledge of DM. It was found that these patients underwent medical monitoring of Diabetes on a more regular basis, consulting at least three times a year (p = 0.036). Sixty-six participants (95.7%) had low scores on the ATT-19 questionnaire. Discussion: most of the patients evaluated have good knowledge about DM, however, the low score on the ATT-19 questionnaire presented by most patients indicates difficulty in coping with the disease. More regular medical monitoring of Diabetes may be associated with greater patient involvement in the treatment of the disease, as well as a greater and more frequent flow of information between doctor and patient.

Gram-negative bacteria carrying ß-lactamase encoding genes in hospital and urban wastewater in Brazil.

Multidrug resistance mediated by ß-lactamase in Gram-negative bacilli is a serious public health problem. Sewers are considered reservoirs of multiresistant bacteria due to presence of antibiotics that select them and favor their dissemination. The present study evaluated the antibiotic resistance profile and ß-lactamases production in Gram-negative bacilli isolates from hospital sewage and urban wastewater treatment plants (UWWTP) in Brazil. Bacteria were isolated and identified with biochemical tests. Antibiotic susceptibility testing was performed by the disk-diffusion method and detection of extended-spectrum ß-lactamase and carbapenemases by enzymatic inhibitor and conventional PCR. Differences in resistance to amoxicillin clavulanic, aztreonam, cefepime, and cefotaxime were observed in hospital sewage compared with urban sewage (p < 0.05). The multidrug-resistant phenotype was observed in 33.3% of hospital sewage isolates (p = 0.0025). ß-lactamases genes were found in 35.6% of isolates, with the most frequent being blaKPC and blaTEM (17.8%), and blaSHV and blaCTX-M (13.3% and 8.9%, respectively). The data obtained are relevant, since the bacteria detected are on the priority pathogens list from the World Health Organization and hospital sewage could be released untreated into the municipal collection system, which may favor the spread of resistance. Changes in hospital sewage discharge practices, as well as additional technologies regarding effluent disinfection in the UWWTP, can prevent the spread of these bacteria into the environment and negative impact on water resources.

Enteroparasitos em crianças de instituição de ensino filantrópica: ênfase para Cryptosporidium spp. e Giardia spp. / Enteroparasites in children of a philanthropic school institution: emphasis for Cryptosporidium spp. and Giardia spp.

Introdução: A inserção das crianças em creches e pré-escolas tem constituído um importante dispositivo na atual configuração social. No entanto, o convívio permanente na creche/escola propicia o adoecimento das crianças com maior frequência quando comparadas com outras que permanecem em espaços familiares mais restritos, especialmente por enteroparasitos. Objetivos: O presente estudo teve como objetivo avaliar a prevalência de Cryptosporidium spp. e Giardia spp., considerados enteroparasitos oportunistas emergentes e reemergentes, e outros enteroparasitos em amostras de fezes de crianças de 2 a 6 anos de uma escola de educação infantil filantrópica. Casuística e Métodos: Participaram do estudo 32 crianças e a detecção de enteroparasitos foi feita pelo Método de Hoffmann, Pons e Janer. A identificação de Cryptosporidiumspp. foi realizada pela centrífugo-sedimentação formalina-éter seguido da coloração de Ziehl-Neelsen modificada. Para confirmação de Cryptosporidium spp. e Giardia spp. foi utilizado o teste de ELISA (RIDASCREEN®). Resultados: A prevalência de enteroparasitos foi de 62,5%, com elevada frequência de Cryptosporidiumspp. (31%) e Giardia spp. (25%). A idade mais acometida por esses microrganismos emergentes e reemergentes foi de 3 e 4 anos. Conclusão: A partir do exposto, é de suma importância realizar processos de educação em saúde para famílias e funcionários das instituições escolares a respeito das principais formas de transmissão e medidas de prevenção de enteroparasitoses, a fim de evitar a disseminação de microrganismos patogênicos no ambiente escolar.

Introduction:The insertion of children in daycare center and pre-schools has been an important device in the current social configuration. However, t he p ermanent living in the daycare center makes the children sickness more frequently when compared to others who remain in more restricted family spaces, especially for enteroparasites. Objectives: The present study aimed to evaluate the prevalence of Cryptosporidiumspp. and Giardia spp., emerging and re-emerging opportunistic enteroparasites, and other enteroparasites in faeces samples from children aged 2 to 6 years old of a philanthropic daycare center. Patients andMethods:Thirty-two children participated in the study and the detection of enteroparasites was carried out by the method of Hoffmann, Pons and Janer. Identification of Cryptosporidium spp. was c arried out by centrifugal-sedimentation formalin-ether followed by modified Ziehl-Neelsen staining. For confirmation of Cryptosporidiumspp. and Giardia spp. the ELISA test (RIDASCREEN®) was used. Results:The prevalence of enteroparasites was 62.5%, with a high frequency of Cryptosporidium spp. (31%) and Giardiaspp. (25%). The age most affected by these emerging and re-emerging microorganisms was 3 and 4 years old. Conclusion:From the above, health education processes for families and staff of scholar institutions on the main forms of transmission and prevention of enteroparasitoses are of paramount importance in order to avoid the spread of pathogenic microorganisms in the school environment.

Adaptação do Ecomapa proposto no Modelo Calgary para avaliação socioambiental de parasitoses intestinais em crianças de creches filantrópicas / Adapting the Ecomap proposed in the Calgary Model for the socio-environmental evaluation of intestinal parasites in children at philanthropic day care centers

Os objetivos do estudo foram avaliar a frequência de enteroparasitos em crianças de creches filantrópicas e adaptar um diagrama de Ecomapa para avaliar as condições socioambientais envolvidas. Um total de 151 amostras de fezes, coletadas de 66 crianças de dois a seis anos de idade foram analisadas por meio de técnicas de Hoffman, Pons e Janer (HPJ), e de Faust e colaboradores. Um questionário estruturado foi aplicado aos responsáveis pelas crianças, e um Ecomapa foi adaptado para avaliar as interações entre as crianças parasitadas e os condicionantes socioambientais. Enteroparasitos patogênicos (Ascaris lumbricoides, Balantidium coli, Giardia lamblia e Strongyloides stercoralis) e não patogênicos (Chilomastix mesnili, Endolimax nana, Entamoeba coli e Iodamoeba butschilii) foram identificados, acometendo 37,9 % das crianças. Com o Ecomapa observaram-se fortes correlações dos parâmetros avaliados (renda familiar, higiene alimentar e pessoal, escolaridade dos responsáveis, contato com animais domésticos e interpessoal) com as crianças parasitadas. O parasito Giardia lamblia foi o de maior frequência e a adaptação do Ecomapa permitiu efetuar a avaliação dos principais condicionantes envolvidos. Diante do exposto é necessário implementar o programa de educação em saúde no ambiente escolar que estimulem os hábitos de higiene alimentar e pessoal, como atividades de prevenção e controle de parasitos.

This study evaluated the enteroparasites frequency in children at philanthropic daycare centers, andthe adaptation of an Ecomap diagram to evaluate the socio-environmental conditions. The 151 faecessamples collected from 66 children aged two to six years old were analyzed, by using the techniquesof Hoffman, Pons and Janer (HPJ) and Faust et col. A structured questionnaire was applied tothose responsible for children, and an Ecomap was adapted for evaluating the interactions betweenparasitized children and socio-environmental conditions. Pathogenic enteroparasites (Ascarislumbricoides, Balantidium coli, Giardia lamblia e Strongyloides stercoralis) and non-pathogenicones (Chilomastix mesnili, Endolimax nana, Entamoeba coli e Iodamoeba butschilii) were identified,and affecting 37.9 % of children. The Ecomap indicated the strong relationships of the evaluated parameters (family income, personal and food hygiene, schooling of the responsible, contactwith domestic animals and interpersonal) with the parasitized children. Giardia lamblia was the parasite showing the highest frequency, and the adaptation of the Ecomap allowed to evaluate the main conditioning factors involved. In view of these findings, it is needed to implement the health education program in the school environment for stimulating the food and personal hygiene habits, as the activities for parasites prevention and control.