Brain stimulation for treatment-resistant depression.

Depression is one of the main public health problems in the world, having a high prevalence and being considered the main cause of disability. An important portion of patients does not respond to treatment with the initial trial of conventional antidepressants in the current depressive episode of moderate to severe intensity, which characterizes treatment-resistant depression. In this context, non-invasive neuromodulation procedures use an electric current or magnetic field to modulate the central nervous system, and they represent a new option for patients with treatment-resistant depression.

Presence and Resistance Profile of Staphylococcus spp. Isolated from Slaughtered Pigs.

Background: The objective of this study was to isolate Staphylococcus spp. and to characterize the resistance profile in nasal samples from pigs slaughtered for consumption. Material and Methods: Intranasal swabs were collected from 100 pigs immediately after bleeding in a slaughterhouse located in the largest pork production region in Brazil, these samples were cultured and isolated to identify Staphylococcus spp. in coagulase positive (CoPS) and coagulase negative (CoNS) and molecular identification of Staphylococcus aureus and then subjected to the disk-diffusion test to identify the bacterial resistance profile and search for the mecA gene. Results: Of the 100 samples collected, it was possible to isolate 79 Staphylococcus spp., of these, 72.15% were classified as CoNS and 27.85% of the isolates classified as CoPS. Among the CoPS isolates, 77.27% were identified as S. aureus. Through the disk-diffusion test, it was possible to verify isolates resistant to clindamycin and erythromycin (98.73%), chloramphenicol (93.67%), and doxycycline (89.87%). There was amplification of the mecA gene in 30.38% of Staphylococcus spp. Conclusion: The results of this study highlight the need for the careful use of antibiotics in swine production, in addition to aiming at continuous surveillance in relation to the rate of multiresistant microorganisms within these environments, focused on large industrial centers; such results also indicate the importance of understanding, through future studies, possible pathways to transmission of these microorganisms directly, or indirectly, through meat products derived from these pigs, which can be considered neglected diffusers of variants of Staphylococcus spp. resistant to antibiotics or carriers of important resistance genes related to One Health.

Presence of Staphylococcus spp. carriers of the mecA gene in the nasal cavity of piglets in the nursery phase.

The presence of Staphylococcus spp. resistant to methicillin in the nasal cavity of swine has been previously reported. Considering the possible occurrence of bacterial resistance and presence of resistance genes in intensive swine breeding and the known transmissibility and dispersion potential of such genes, this study aimed to investigate the prevalence of resistance to different antibiotics and the presence of the mecA resistance gene in Staphylococcus spp. from piglets recently housed in a nursery. For this, 60 nasal swabs were collected from piglets at the time of their housing in the nursery, and then Staphylococcus spp. were isolated and identified in coagulase-positive (CoPS) and coagulase-negative (CoNS) isolates. These isolates were subjected to the disk-diffusion test to evaluate the bacterial resistance profile and then subjected to molecular identification of Staphylococcus aureus and analyses of the mecA gene through polymerase chain reaction. Of the 60 samples collected, 60 Staphylococcus spp. were isolated, of which 38 (63.33%) were classified as CoNS and 22 (36.67%) as CoPS. Of these, ten (45.45%) were identified as Staphylococcus aureus. The resistance profile of these isolates showed high resistance to different antibiotics, with 100% of the isolates resistant to chloramphenicol, clindamycin, and erythromycin, 98.33% resistant to doxycycline, 95% resistant to oxacillin, and 85% resistant to cefoxitin. Regarding the mecA gene, 27 (45%) samples were positive for the presence of this gene, and three (11.11%) were phenotypically sensitive to oxacillin and cefoxitin. This finding highlights the importance of researching the phenotypic profile of resistance to different antimicrobials and resistance genes in the different phases of pig rearing to identify the real risk of these isolates from a One Health perspective. The present study revealed the presence of samples resistant to different antibiotics in recently weaned production animal that had not been markedly exposed to antimicrobials as growth promoters or even as prophylactics. This information highlights the need for more research on the possible sharing of bacteria between sows and piglets, the environmental pressure within production environments, and the exposure of handlers during their transport, especially considering the community, hospital, and political importance of the presence of circulating resistant strains.

Pet dogs as reservoir of oxacillin and vancomycin-resistant Staphylococcus spp.

The aim of this study was to verify the bacterial resistance profile and detect the presence of mecA gene in Staphylococcus spp. isolated from the nasal microbiota of domiciled dogs. For this purpose 100 nasal swabs from 100 domiciled dogs were collected from the central area of the city of Umuarama (PR), along with a questionnaire answered by their owners. After the isolation all Staphylococcus spp. isolates were submitted to the diffusion disc test by the Kirby-Bauer method, and only oxacillin-resistant samples were submitted to the PCR technique to search for the mecA gene and the results were then submitted to statistical analysis to verify possible risk variables. The 100 Staphylococcus spp. and coagulase negative, among which 41 isolates were resistant to oxacillin, no samples were positive for the mecA gene presence, however, 12 resistant to vancomycin were found. It can be concluded that the domiciled dogs are carriers of Staphylococcus spp. multiresistant, being these a possible source of human contamination.

Safety in the practice of decontaminating filtering facepiece respirators: A systematic review.

BACKGROUND: Considering the new SARS-CoV-2 pandemic and the potential scarcity of material resources, the reuse of personal protective equipment such as filtering facepiece respirators (FFRs) for N95 filtering or higher is being discussed, mainly regarding the effectiveness and safety of cleaning, disinfection and sterilization processes. AIM: To analyze the available evidence in the literature on the safety in processing FFRs. METHODS: A systematic review conducted by searching for studies in the following databases: PubMed, CINAHL, LILACS, CENTRAL, EMBASE, Web of Science, and Scopus. RESULTS: Forty studies were included in this review. The disinfectant/sterilizing agents most frequently tested at different concentrations and exposure periods were ultraviolet irradiation, vaporized hydrogen peroxide and steam sterilization. Microbial reduction was assessed in 21 (52.5%) studies. The only disinfectants/sterilizers that did not caused degradation of the material-integrity were alcohol, electric cooker, ethylene oxide, and peracetic acid fogging. Exposure to ultraviolet irradiation or microwave generated-steam resulted in a nonsignificant reduction in filter performance. CONCLUSION: There is a complex relationship between the FFR raw materials and the cycle conditions of the decontamination methods, evidencing the need for validating FFRs by models and manufacturers, as well as the process. Some methods may require additional tests to demonstrate the safety of FFRs for use due to toxicity.

Staphylococcus spp. Isolated from Bovine Subclinical Mastitis in Different Regions of Brazil: Molecular Typing and Biofilm Gene Expression Analysis by RT-qPCR.

Bovine mastitis is mainly caused by bacteria of the genus Staphylococcus spp., which possess different virulence factors, including the capacity for biofilm formation that provides enhanced protection against the action of immune system components and serves as a barrier against the penetration of antimicrobial agents. This study aimed to characterize 181 Staphylococcus spp. Strains-including Staphylococcusaureus and coagulase-negative staphylococci (CoNS) isolated from bovine subclinical mastitis in six Brazilian states-by molecular methods. RT-qPCR was used to verify the expression of genes of the ica operon-mainly responsible for biofilm formation-as well as bap and bhp. Chromosome similarity among the isolates was investigated by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The icaA gene was detected in 79 (43.6%) isolates, icaB in 24 (13.2%), icaC in 57 (31.4%), and icaD in 127 (70.1%). The bap gene was identified in 66 (36.4%) isolates, while the bhp gene was found in nine (4.9%). RT-qPCR confirmed the expression of the icaA gene in 60 (75.9%) isolates, of icaB in six (25%), of icaC in 26 (45.6%), and of icaD in 80 (63%). Clonal typing of the isolates by PFGE permitted the identification of eight Staphylococcusaureus clusters that simultaneously included ≥3 strains, with a similarity of ≥80%. Regarding the other species studied, three clusters were observed for Staphylococcuschromogenes and four clusters for Staphylococcusepidermidis. Only one cluster each was identified for Staphylococcussaprophyticus and Staphylococcussimulans, while the other species did not form any cluster. With respect to MLST, ST126 and ST1 were the prevalent sequence types in S. aureus, while in S.epidermidis all sequence types were different. These results reveal strains with the same evolutionary origin as other isolates, which might cause infections in humans and animals, suggesting their ability to spread between these species.

Quantification of the neurons of myenteric plexus of the bat molossus rufus / Quantificação dos neurônios do plexo mientérico de morcegos da espécie Molossus rufus

There are no studies that characterize the enteric nervous system (ENS) bats. The organization and density of myenteric neurons may vary according to the animal species, as well as the segment of the digestive tube considered. The nitric oxide is one of the key neurotransmitters present in the myenteric neurons, acting as a mediator in the smooth muscle relaxation. These neurons are evidenced by immunohistochemistry of nitric oxide synthase (NOS) or by NADPH-diaphorase histochemistry. In this sense, this study aimed to characterize the total neuronal population and subpopulation NADPH-d+ of the myenteric plexus present in the jejunum of the insectivore species Molossus rufus quantitatively. Five specimens were collected of M. rufus in a buffer area of the "Reserva Biológica das Perobas" in the microregion of Cianorte/PR. After the euthanasia, in a chamber saturated with isoflurane, segments were collected from the small intestine corresponding to the jejunum intended for two techniques for neuronal marking, Giemsa and NADPH-diaphorase, and a fragment to the histological technique of hematoxylin-eosin and Masson's trichrome. All the procedures were approved by the "Comitê de Ética no Uso de Animais Unipar" (CEUA - protocol No. 34347/2017) and the "Instituto Chico Mendes de Conservação da Biodiversidade" (ICMBio - protocol No. 60061-1) The histological sections allowed to highlight the location of the myenteric plexus between the longitudinal and circular layers of the muscular tunic. The myenteric plexus had an average of total neuronal population (neurons Giemsa+) of 279.23 neurons/mm2, being the nitrergic neurons (neurons NADPH-d+) represented 20.4% of this total population, with an average of 58.14 neuron/mm2. Therefore, the collected data are consistent with previous studies in other mammalian species concerning the location of the myenteric plexus, as well as the neural myenteric proportion NADPH-d+ compared with the population of neurons Giemsa+. The gaps in the knowledge of ENS of bats limits comparative intraspecific and interspecific studies.(AU)

Não há estudos que caracterizem o sistema nervoso entérico (SNE) destes animais, configurando uma lacuna no conhecimento quanto à biologia destes indivíduos. A organização e densidade dos neurônios mientéricos podem variar de acordo com a espécie animal bem como o segmento do tubo digestório considerado. O óxido nítrico é um dos principais neurotransmissores presentes nos neurônios mientéricos, atuando como mediador no relaxamento do músculo liso gastrointestinal, de modo que estes neurônios são evidenciados igualmente pela imunohistoquímica da óxido nítrico-sintase (NOS) ou pela histoquímica da NADPH-diaforase. Neste sentido, objetivou-se caracterizar quantitativamente a população neuronal total e subpopulação NADPH-d+ do plexo mientérico presente no jejuno da espécie Molossus rufus de hábito alimentar insetívoro. Foram coletados cinco espécimes de M. rufus em área de amortecimento da Reserva Biológica das Perobas na microrregião de Cianorte/PR. Após a eutanásia, em câmara saturada com isoflurano, foram coletados segmentos do intestino delgado correspondentes ao jejuno destinados a duas técnicas para marcação neuronal, Giemsa e NADPH-diaforase e, um fragmento para a técnica histológica de hematoxilina-eosina e tricômio de Masson. Todos os procedimentos realizados foram aprovados pelo Comitê de Ética no Uso de Animais da Unipar (CEUA - protocolo nº 34347/2017) e pelo Instituto Chico Mendes de Conservação da Biodiversidade (ICMBio - protocolo nº 60061-1) Os cortes histológicos possibilitaram evidenciar a localização do plexo mientérico entre os estratos longitudinal e circular da túnica muscular. Neurônios Giemsa+ apresentaram uma média de 279,23 neurônios/mm2, já os neurônios nitrérgicos apresentaram em média 20,4% da população neuronal mientérica total, sendo evidenciados 58,14 neurônios NADPH-d+/mm2. Portanto, os dados coletados mostram-se condizentes com estudos anteriores em outras espécies de mamíferos quanto à localização do plexo mientérico, bem como, a proporção neuronal mientérica NADPH-d+ comparada com a população de neurônios Giemsa+. As lacunas existentes quanto ao conhecimento do SNE de morcegos limita possíveis inferências em comparativo intraespecífico e interespecífico.(AU)

Antimicrobial Resistance and Extended-Spectrum Beta-Lactamase Production in Enterobacteria Isolated from Free-Living Primates.

The aim of this study was to evaluate the profile of antimicrobial resistance in members of the family Enterobacteriaceae and to detect strains of extended-spectrum beta-lactamases (ESBL) in free-living Sapajus nigritus. Oral and rectal swabs were collected from 15 primates to isolate and identify bacteria, conduct phenotypic tests to detect antimicrobial sensitivity and ESBL-producing strains, and calculate the multiple antimicrobial resistance index. The least effective antimicrobial was amoxicillin (72.72%) and ampicillin (57.57%), and the samples were considered as high risk for public health. No sample was positive for ESBL production. The results show that this study is relevant to One Health initiatives, considering the possibility of transmission of bacterial resistance and resistant genes originating from direct or indirect interaction of S. nigritus with parkgoers. However, these animals cannot be considered as the only reservoirs and transmitters of resistant bacteria as they can be contaminated by human-origin bacteria that can be extremely harmful and often prove lethal to them that play an important role in relationship to the ecology, spreading seeds and controlling insects.

High frequency equipment promotes antibacterial effects dependent on intensity and exposure time.

BACKGROUND: The indiscriminate use of antibiotics has caused bacteria to develop mechanisms of resistance to antibacterial agents, limiting treatment options. Therefore, there is a great need for alternative methods to control infections, especially those related to skin. One of the alternative methods is the high frequency equipment (HFE), which is used on skin conditions as an analgesic, an anti-inflammatory, and mainly to accelerate cicatricial processes and have a bactericidal effect through the formation of ozone. This research investigated the antibacterial effect of HFE on standard cultures of bacteria. MATERIALS AND METHODS: Dilutions (104 colony forming unit mL-1) were performed for Enterobacter aerogenes and Staphylococcus aureus with 24-hour growth bacteria. Then, 1 µL of each dilution was pipetted into suitable medium and the HFE flashing technique was used at intensities of 6, 8 and 10 mA for 30, 60, 90, 120 and 180 seconds. The control group received no treatment. Plates were incubated at 37°C for 24 hours and then read. RESULTS: The spark at intensity of 6 mA had no bactericidal effect on the E. aerogenes; however, a significant bacterial growth reduction occurred at intensity of 8 mA after 120 and 180 seconds, and at 10 mA, reduction in bacterial growth could already be verified at 30 seconds and total bacterial growth inhibition occurred in 180 seconds. For S. aureus, there was a strong bacterial growth inhibition at all intensities used; however, at 6 mA, absence of bacterium growth after 120 and 180 seconds was observed. By increasing the flashing intensity to 8 and 10 mA, it was observed that the bacterium growth was inhibited after only 30 seconds of irradiation. CONCLUSION: The HFE has time-dependent antibacterial effects against E. aerogenes and S. aureus bacteria that have several resistance mechanisms.

Use of a clinical-laboratory score to guide treatment of gestational diabetes.

OBJECTIVE: To assess the outcomes of implementing a clinical-laboratory score in the treatment of pregnant women with gestational diabetes. METHODS: A retrospective before-and-after implementation analysis was undertaken using data and neonatal outcomes for pregnant women with gestational diabetes treated before (January 2011-December 2012; control group) and after (January 2013-December 2014; score group) introduction of a newly developed score. To evaluate the effects of score adoption, odds ratios with 95% confidence intervals were calculated after adjustment for confounding factors. RESULTS: The control group included a greater proportion of women treated with diet alone (170/312 [54.5%]) than the study group did (122/391 [31.2%]; P<0.001). By contrast, more women in the study group received metformin (172 [44.0%] vs 77 [24.7%]; P<0.001). The neonatal outcomes, including low Apgar scores at 1 minute and at 5 minutes and neonatal intensive care unit admission, were similar in both groups. Multivariate logistic regression analysis showed that the adoption of the score did not significantly affect the choice of treatment or the birth weight rating. CONCLUSION: The score served well as an orientation tool in therapeutic decision making and had no negative effect on the treatment choice and perinatal outcomes.

Análises dos recursos hídricos do parque municipal dos xetás, umuarama-PR / Analysis of water resources of the municipal park xetás, umuarama-PR

O objetivo deste trabalho foi avaliar os padrões qualitativos dos recursos hídricos localizadas no Parque Municipal dos Xetás na cidade de Umuarama (PR), o local é considerado Área de Proteção Ambiental, onde possui algumas fontes de poluição gerando conhecimento das condições físico-químicas e bacteriológicas para os habitantes da cidade ou para outros indivíduos. Foram analisados os parâmetros como demanda química de oxigênio (DQO), cor aparente, óleos e graxas, nitrato, surfactantes, turbidez, pH, chumbo e mercúrio em amostras coletadas de pontos específicos. As análises foram realizadas segundo as especificações do Standard Methods for Examination of Water and Wastewather e obtiveram-se teor mínimo e máximo que variou no resultado do DBO de 2,40 e 25,50 mg de O2/L, cor aparente variou entre 36,00 e 146 mg Pt-Co/L e óleos e graxas variou entre 8 e 28,5 mg/L de acordo com especificações vigentes todas as análises deveriam estar ausentes. Não foram detectados DQO, nitrato, surfactantes, turbidez, pH e mercúrio nas amostras analisadas. No microbiológico os coliformes totais foram de 3,0 x104 e 6,0 x105 e coliformes termotolerantes entre 1,0 x104 e 1,6 x107 nas amostras analisadas. A análise de mercúrio foi realizada pelo laboratório de análises toxicológicas e ambientais (LATAM) de Curitiba-PR, as análises microbiológicas de coliformes termotolerantes e coliformes totais analisadas pelo laboratório da SANEPAR conveniada com a UNIPAR e as demais análises foram realizadas no laboratório da Universidade Paranaense ­ UNIPAR. Concluiu-se que os efeitos causados pelas emissões de esgotos clandestinos de alguns pontos da cidade sendo estes, despejados nas nascentes do Parque Municipal dos Xetás, foram significativos de acordo com os parâmetros da portaria 518 do ministério da saúde e pela resolução 357 do CONAMA.

The purpose of this study was to evaluate the quality standards of water resources located in the Xetás municipal park in the city of Umuarama (PR). The site is considered an Environmental Protection Area. The study area has some pollution sources generating knowledge of the physical-chemical and bacteriological conditions for the inhabitants of the city or to other individuals. Parameters such as chemical oxygen demand (COD), apparent color, oils and grease, nitrate, surfactants, turbidity, pH, lead and mercury were analyzed in samples collected at specific points. Analyses were carried out according to the specifications set forth in the Standard Methods for Examination of Water and Wastewater, presenting minimum and maximum content BOD results that varied from 2.40 and 25.50 mg O2/L, apparent color ranged from 36.00 and 146 mg Pt-Co/L, and oils and grease ranged between 8 and 28.5 mg/L. According to existing specifications, all analyzes should be absent. No results for COD, nitrate, surfactants, turbidity, pH and mercury were found in the samples analyzed. In microbiological examinations, total coliforms were 3.0 x104 and 6.0 x105 and thermotolerant coliforms ranged between 1.0 x104 and 1.6 x107 in the analyzed samples. The analyses were carried out in the laboratory of the Universidade Paranaense ­ UNIPAR; mercury analyzes were carried out by the laboratory toxicological and environmental (LATAM) of Curitiba-PR, and the microbiological analysis of thermotolerant coliforms and total coliforms were analyzed by SANEPAR laboratory outsourced by UNIPAR, and the remaining analyzes were performed in the laboratory of the Universidade Paranaense - UNIPAR. It can be concluded that the effects caused by the emissions of clandestine sewage from some points of the city being dumped at the water sources of the Xetás Municipal Park were significant according to the parameters set forth in Ordinance 518 of the Ministry of Health and Resolution 357 by CONAMA.

Short communication: ß-Lactam resistance and vancomycin heteroresistance in Staphylococcus spp. isolated from bovine subclinical mastitis.

The use of antimicrobial agents has led to the emergence of resistant bacterial strains over a relatively short period. Furthermore, Staphylococcus spp. can produce ß-lactamase, which explains the survival of these strains in a focus of infection despite the use of a ß-lactam antibiotic. The aim of this study was to evaluate the resistance of Staphylococcus spp. isolated from bovine subclinical mastitis to oxacillin and vancomycin (by minimum inhibitory concentration) and to detect vancomycin heteroresistance by a screening method. We also evaluated ß-lactamase production and resistance due to hyperproduction of this enzyme and investigated the mecA and mecC genes and performed staphylococcal cassette chromosome mec typing. For this purpose, 181 Staphylococcus spp. isolated from mastitis subclinical bovine were analyzed. Using the phenotypic method, 33 (18.2%) of Staphylococcus spp. were resistant to oxacillin. In contrast, all isolates were susceptible to vancomycin, and heteroresistance was detected by the screening method in 13 isolates. Production of ß-lactamase was observed in 174 (96%) of the Staphylococcus spp. isolates. The mecA gene was detected in 8 isolates, all of them belonging to the species Staphylococcus epidermidis, and staphylococcal cassette chromosome mec typing revealed the presence of type I and type IV isolates.

Neonatal outcomes according to different therapies for gestational diabetes mellitus / Desfechos neonatais de acordo com diferentes terapêuticas do diabetes mellitus gestacional

Abstract: Objectives: To compare different neonatal outcomes according to the different types of treatments used in the management of gestational diabetes mellitus. Methods: This was a retrospective cohort study. The study population comprised pregnant women with gestational diabetes treated at a public maternity hospital from July 2010 to August 2014. The study included women aged at least 18 years, with a singleton pregnancy, who met the criteria for gestational diabetes mellitus. Blood glucose levels, fetal abdominal circumference, body mass index and gestational age were considered for treatment decision-making. The evaluated neonatal outcomes were: type of delivery, prematurity, weight in relation to gestational age, Apgar at 1 and 5 min, and need for intensive care unit admission. Results: The sample consisted of 705 pregnant women. The neonatal outcomes were analyzed based on the treatment received. Women treated with metformin were less likely to have children who were small for gestational age (95% CI: 0.09-0.66) and more likely to have a newborn adequate for gestational age (95% CI: 1.12-3.94). Those women treated with insulin had a lower chance of having a preterm child (95% CI: 0.02-0.78). The combined treatment with insulin and metformin resulted in higher chance for a neonate to be born large for gestational age (95% CI: 1.14-11.15) and lower chance to be born preterm (95% CI: 0.01-0.71). The type of treatment did not affect the mode of delivery, Apgar score, and intensive care unit admission. Conclusions: The pediatrician in the delivery room can expect different outcomes for diabetic mothers based on the treatment received.

Resumo: Objetivos: Comparar diferentes desfechos neonatais de acordo com as diferentes modalidades de tratamento do diabetes mellitus gestacional. Métodos: Trata-se de uma coorte retrospectiva. A população do estudo foi composta por gestantes com diabetes gestacional atendidas em uma maternidade pública de julho de 2010 a agosto de 2014. Foram incluídas mulheres com idade mínima de 18 anos, gestação única e com critérios para diabetes mellitus gestacional. Para decisão terapêutica foram considerados glicemias, circunferência abdominal fetal, índice de massa corporal e idade gestacional. Os desfechos neonatais avaliados foram: via de parto, prematuridade, relação do peso com idade gestacional, Apgar no 1º e 5º minuto e necessidade de internação em unidade de terapia intensiva. Resultados: A amostra foi composta por 705 gestantes. Os desfechos neonatais foram analisados com base na terapêutica recebida. Mulheres tratadas com metformina tiveram menor chance de ter filhos pequenos para a idade gestacional (IC 95%: 0,09-0,66) e maior chance de ter um filho adequado para a idade gestacional (IC 95%: 1,12-3,94). A gestante tratada com insulina teve menor chance de ter um filho prematuro (IC 95%: 0,02-0,78). O tratamento feito com a associação de insulina e metformina resultou em maior chance de um recém-nascido grande para a idade gestacional (IC 95%: 1,14-11,15) e menor chance de prematuridade (IC 95%: 0,01-0,71). A modalidade de tratamento não interferiu na via de parto, Apgar e internação em terapia intensiva. Conclusões: O pediatra na sala de parto pode esperar diferentes desfechos para o filho de mãe diabética, com base no tratamento recebido.

Neonatal outcomes according to different therapies for gestational diabetes mellitus.

OBJECTIVES: To compare different neonatal outcomes according to the different types of treatments used in the management of gestational diabetes mellitus. METHODS: This was a retrospective cohort study. The study population comprised pregnant women with gestational diabetes treated at a public maternity hospital from July 2010 to August 2014. The study included women aged at least 18 years, with a singleton pregnancy, who met the criteria for gestational diabetes mellitus. Blood glucose levels, fetal abdominal circumference, body mass index and gestational age were considered for treatment decision-making. The evaluated neonatal outcomes were: type of delivery, prematurity, weight in relation to gestational age, Apgar at 1 and 5min, and need for intensive care unit admission. RESULTS: The sample consisted of 705 pregnant women. The neonatal outcomes were analyzed based on the treatment received. Women treated with metformin were less likely to have children who were small for gestational age (95% CI: 0.09-0.66) and more likely to have a newborn adequate for gestational age (95% CI: 1.12-3.94). Those women treated with insulin had a lower chance of having a preterm child (95% CI: 0.02-0.78). The combined treatment with insulin and metformin resulted in higher chance for a neonate to be born large for gestational age (95% CI: 1.14-11.15) and lower chance to be born preterm (95% CI: 0.01-0.71). The type of treatment did not affect the mode of delivery, Apgar score, and intensive care unit admission. CONCLUSIONS: The pediatrician in the delivery room can expect different outcomes for diabetic mothers based on the treatment received.

Salame com reduzido teor de sódio e iogurte comercial como cultura starter / Salami with reduced sodium content and commercial yogurt as starter culture / Salame reducido en sodio y yogurt comercial como cultura starter

A hipertensão arterial tornou-se na atualidade um dos grandes problemas da saúde pública em vários países, incluindo o Brasil, mudanças no estilo de vida, incluindo os hábitos alimentares são importantes para a prevenção, especificamente a redução do consumo de sódio. Este trabalho objetivou desenvolver e analisar salames desenvolvidos com redução do teor de sódio e emprego de iogurte natural comercial como cultura starter. Foram produzidos salames com adição de 1,5% de cloreto de sódio e com a mesma porcentagem de uma mistura contendo 80% de cloreto de sódio e 20% de cloreto de potássio que foram mantidos por 21 dias em temperatura de 20ºC seguido por mais 23 dias em temperatura de refrigeração. Foram avaliados a composição da massa base dos salames, a variação nos valores de pH e contagem em NMP/g de coliformes termotolerantes. O salame com redução de sódio e cultura starter de iogurte foi vantajosa, pois o produto final manteve as características físico-químicas e microbiológicas preconizadas pela legislação.(AU)

High blood pressure has become one of the major public health concerns in several countries, including Brazil. Thus, some changes in habits are necessary, including eating habits, for prevention, especially by reducing sodium intake. This work aimed at developing and analyzing salamis with reduced sodium content and the use of commercial yoghurt as starter culture. Salamis were produced with the addition of 1.5% sodium chloride, with the same percentage from a mixture containing 80% sodium chloride and 20% potassium chloride. They were stored for 7 days at 20 °C followed by further 23 days under refrigeration. The composition of the salami base mass and the variation of the pH values and the MPN/g count of thermo-tolerant coliforms were analyzed. The results showed that the substitution of 20% sodium chloride by potassium chloride did not present any changes to fermentation characteristics of the salamis, which reached pH values close to the expectations and found in the literature. The microbiological analysis showed that the salamis produced were good for consumption since values were below the maximum threshold allowed by the Brazilian legislation.(AU)

La hipertensión arterial se volvió en la actualidad uno de los grandes problemas de la salud pública en varios países, incluyendo Brasil, y cambios en el estilo de vida, así como los hábitos alimentares son importantes para la prevención, específicamente la reducción de sodio y empleo de yogurt natural comercial como cultura Starter. Se han producido salames con adicción de 1,5% de cloruro de sodio y con el mismo porcentaje de una mezcla conteniendo 80% de cloruro de sodio y 20% de cloruro de potasio que fueron mantenidos por 21 días en temperatura de 20ºC seguido por más 23 días en temperatura de refrigeración. Se evaluó la composición de la masa base de los salames, la variación en los valores del pH y conteo en NMP/g de coliformes termotolerantes. El salame con reducción de sodio y cultura starter de yogurt se hizo ventajoso, pues el producto final mantuvo las características físico químicas y microbiológicas preconizadas por la legislación.(AU)

Detection of Enterotoxigenic Potential and Determination of Clonal Profile in Staphylococcus aureus and Coagulase-Negative Staphylococci Isolated from Bovine Subclinical Mastitis in Different Brazilian States.

Epidemiological studies have identified Staphylococcus aureus as the most common agent involved in food poisoning. However, current research highlights the importance of toxigenic coagulase-negative staphylococci (CoNS) isolated from food. The aim of this study was to characterize Staphylococcus spp. isolated from cows with bovine subclinical mastitis regarding the presence of genes responsible for the production of staphylococcal enterotoxins and of the tst-1 gene encoding toxic shock syndrome toxin 1, and to determine the clonal profile of the isolates carrying any of the genes studied. A total of 181 strains isolated in different Brazilian states, including the South, Southeast, and Northeast regions, were analyzed. The sea gene was the most frequent, which was detected in 18.2% of the isolates, followed by seb in 7.7%, sec in 14.9%, sed in 0.5%, see in 8.2%, seg in 1.6%, seh in 25.4%, sei in 6.6%, and ser in 1.6%. The sej, ses, set, and tst-1 genes were not detected in any of the isolates. The typing of the isolates by pulsed-field gel electrophoresis revealed important S. aureus and S. epidermidis clusters in different areas and the presence of enterotoxin genes in lineages isolated from animals that belong to herds located geographically close to each other.

Efeitos da papaína intramamária em vacas com mastite subclínica sobre a contagem de células somáticas e sólidos totais / Effects of intramammary papain in cows with subclinical mastitis on somatic cell count and total solids / Efectos de la papaína intramamaria en vacas con mastitis subclínica en recuento de células somáticas y sólidos totales

A mastite é a principal enfermidade que acomete o gado leiteiro. De todas as formas, a mastite subclínica é a que causa maiores perdas, na redução da produção, na diminuição da qualidade do leite e pelos altos custos de tratamento e descarte precoce de vacas. Altas contagens de células somáticas e baixo teor de sólidos totais no leite geralmente estão associados à mastite. Dessa forma, o objetivo deste estudo foi avaliar os efeitos de um creme de papaína a 2%, associado ou não ao cloridrato de ceftiofur (125mg) por via intramamária sobre a contagem de células somáticas e sólidos totais. O estudo foi realizado em 23 quartos mamários com mastite subclínica, detectadas pelo exame do CMT (California Mastitis Test) e da CCS (contagem de células somáticas), divididas em 4 grupos (1 ­ cloridrato de ceftiofur 125 mg; 2- cloridrato de ceftiofur 125mg + papaína 2%; 3- papaína 2%; 4- controle). As análises foram feitas com base no CMT, na CCS e de sólidos totais (ST) antes e após o tratamento. Os quartos mamários que foram tratados com papaína 2% tiveram alterações no leite, com catarro, grumos e coágulo com intensificação do quadro inflamatório. Não houve diferença significativa ao teste T entre as amostras antes e após o tratamento em nenhum dos grupos para as variáveis estudadas.(AU)

Mastitis is the main disease affecting dairy cattle. From all forms, subclinical mastitis is the one that causes the greater losses, with reduced production, decreased milk quality and by high treatment costs and early disposal of cows. High somatic cell counts and low total solids in milk are usually associated with mastitis. Thus, the aim of this study was to assess the effects of a intrammamarily 2% papain cream associated or not with ceftiofur hydrochloride (125mg) on somatic cell count and total solids. The study was performed on 23 breasts with subclinical mastitis, detected through CMT (California Mastitis Test) and SCC (somatic cell count), divided into 4 groups (1 - 125 mg ceftiofur hydrochloride, 2 - ceftiofur hydrochloride 125mg + 2% papain, 3 - 2% papain, 4 - control). The analyzes were based on CMT, SCC and total solids (TS) before and after treatment. The breasts that were treated with 2% papain presented changes in milk, with phlegm, lumps and clot with intensification of the inflammation. There were no significant differences between the T-test samples before and after treatment in either group for the studied variables.(AU)

La mastitis es la principal enfermedad que afecta el ganado lechero. La mastitis subclínica es la que causa grandes pérdidas en la reducción de la producción, disminución de la calidad de la leche, los altos costos de tratamiento y desecho precoz de vacas. Los altos recuentos de células somáticas y bajo contenido de sólidos totales en la leche están generalmente asociados con mastitis. Por lo tanto, el objetivo de este estudio fue evaluar los efectos de un 2% de papaína crema, con o sin el clorhidrato de ceftiofur (125 mg) por vía intramamaria en el recuento de células somáticas y sólidos totales. El estudio se realizó en 23 cuartos mamarios con mastitis subclínica, detectadas mediante el examen de la CMT (Prueba de Mastitis de California) y CCS (recuento de células somáticas), dividido en 4 grupos (1 - ceftiofur clorhidrato 125 mg; 2- clorhidrato de ceftiofur 125 mg + papaína 2%; 3- papaína 2%; 4 - control). Los análisis se basaron en CMT, en CCS y sólidos totales (ST), antes y después del tratamiento. Las glándulas mamarias que fueron tratadas con papaína 2% tuvieron cambios en la leche, con flema, grañones y coágulos con intensificación de inflamación. No hubo diferencia significativa por la prueba T, entre las muestras antes y después del tratamiento, en ninguno de los grupos para las variables estudiadas.(AU)

O Entendimento do Paciente sobre Hipertensão Arterial: uma Análise com Base no Risco Cardiovascular / The Patient’s Knowledge about Hypertension: an Analysis Based on Cardiovascular Risk

Fundamentos: O autoconhecimento da hipertensão arterial pode contribuir para seu melhor controle; no entanto,desconhece-se o quanto esse conhecimento é influenciado pela gravidade da própria doença.Objetivo: Avaliar o conhecimento de sujeitos com hipertensão arterial sistêmica sobre a própria doença com base no risco cardiovascular.Métodos: Estudo transversal, qualiquantitativo, com utilização de entrevista semiestruturada aplicada em113 sujeitos com hipertensão, acompanhados em uma Unidade Básica de Saúde de Joinville, SC, Brasil. Dadossocioeconômicos, antropométricos, laboratoriais e valores de pressão arterial foram considerados em cada grupo de risco cardiovascular, estratificados com base nas VI Diretrizes Brasileiras de Hipertensão Arterial.Resultados: A média de idade foi 57,8±10,0 anos, 64,0% de mulheres. A idade mais avançada, maior valor dapressão arterial sistólica e tempo de hipertensão, bem como a maior presença de diabetes, dislipidemia e tabagismo foram mais prevalentes no grupo de maior risco cardiovascular. O conhecimento envolvendo os fatores de risco e modificação do estilo de vida não foi diferente entre os grupos de risco cardiovascular. Apenas o conhecimentosobre as complicações associadas à hipertensão arterial foi menor no grupo de muito alto risco cardiovascular(p<0,001). Conclusão: O grupo de maior risco cardiovascular é aquele que evidencia maior desconhecimento sobre as complicações associadas à hipertensão arterial sistêmica.

Background: The patient’s knowledge about hypertension can contribute to the best control of it; however, the influence on such knowledge by the seriousness of the disease is unknown. Objective: Assessing the knowledge of individuals with arterial hypertension about their own disease based on the cardiovascular risk. Methods: Cross-sectional, quali-quantitative study, using semi-structured interview made with 113 individuals with hypertension,followed-up in a Basic Health Unit of Joinville, SC, Brazil. Social and economic, anthropometric, laboratorial data and blood pressure values were considered in each cardiovascular risk group, stratified based on the VI Brazilian Guidelines on Hypertension. Results: The mean age was of 57.8+10.0 years, 64.0% being women. The most advanced age, highest systolic blood pressure and hypertension time, as well as the higher rate of presence of diabetes, dyslipidemia and smoking were more predominant in the groupwith the highest cardiovascular risk. The knowledge about the risk factors and change in lifestyle was not different between the cardiovascular risk groups. Only the knowledge about the complications related to arterial hypertension was not as extensive in thegroup with very high cardiovascular risk (p<0.001). Conclusion: The group with the highest cardiovascular risk is the one showing the poorest knowledge about the complications related to hypertension.

Parâmetros a serem considerados no tratamento e controle do Diabetes Gestacional / Parameters to be considered in the treatment and control of Gestational Diabetes

O diabetes gestacional é uma doença metabólica crônica, cuja principal característica é a resistência insulínica, que repercute na morbidade materna e nos desfechos perinatais. Sua prevalência no Brasil está em torno de 7 a 10%. Quando utilizados valores glicêmicos mais baixos do que aqueles anteriormente propostos, um grupo maior de gestantes é enquadrado no diagnóstico desta doença, contribuindo para aumento de sua incidência. Diante deste fato e dos diversos efeitos adversos do diabetes, como hiperinsulinemia fetal e macrossomia, é necessário instituir uma terapêutica rápida e eficaz. A decisão em iniciar esta terapêutica baseia-se em conceitos sabidamente conhecidos, tais como valores glicêmicos de controle, estudo ecográfico fetal (medida da circunferência abdominal), idade gestacional e obesidade materna. Neste trabalho, esses conceitos foram discutidos após uma revisão dos artigos atuais e de maior relevância cientifica.(AU)

The gestational diabetes is a metabolic chronic disorder which main feature is the insulin resistance and its consequences as maternal morbidity and perinatal outcomes. The prevalence in Brazil is from 7 to 10%. When we use lower targets of glycemic control than those previously used, a greater group of pregnants fits into the diagnosis of diabetes, and thereby increasing the incidence of the disease. Towards this and the several adverse outcomes, as fetal hyperinsulinemia and macrossomia, an early and effective treatment has to be established. The decision in begin the therapy is based on elements already known, as the glycemic targets, fetal ultrasound (abdominal circumference measure), gestational age and maternal obesity. These elements are discussed in this paper after a literature review of the latest and more scientific important articles.(AU)

Toxoplasmosis, leptospirosis and brucellosis in stray dogs housed at the shelter in Umuarama municipality, Paraná, Brazil.

BACKGROUND: Leptospirosis, toxoplasmosis and brucellosis are diseases with worldwide distribution. Among stray dogs, these zoonoses are facilitated by direct contact with other animal species, by the habit of scavenging garbage and hunting in search of food, drinking standing water, smelling other animals' urine, licking female genitalia and the sexual act itself. The objective of this study was to detect antibodies anti-Toxoplasma gondii, anti-Leptospira spp., anti-Brucella canis and anti-Brucella abortus in stray dogs housed in shelters at Umuarama city, Paraná, Brazil. In order to detect toxoplasmosis, indirect immunofluorescence assay (IFA) was performed, agglutination microscopic (MAT) test for leptospirosis and agar gel immunodiffusion (AGID) and buffered acidified antigen (BAA) tests for brucellosis. RESULTS: Of the 175 serum samples analyzed, 70.85% were considered positive for toxoplasmosis by IFA, 20% by MAT for leptospirosis and 2.85% by AGID for Brucella canis. CONCLUSIONS: The serological results of this study showed that stray dogs housed at the private shelter are potential carriers of these three different zoonoses and contribute to the spread and maintenance of these etiologic agents in the urban area of Umuarama (PR), Brazil.