Indicators of Eating Disorders in Sexually Abused Brazilian Adolescents: Family and School Contexts.

Eating disorders, characterized by abnormal eating behaviors, are among a wide variety of psychiatric conditions that mainly affect children and adolescents. These disorders have a multifactorial origin and can be associated with restrictive diets, negative feelings, harmful family relationships, and post-traumatic stress. Thus, this study's objective was to evaluate the association between indicators of eating disorders and family and school contexts in Brazilian adolescents who previously experienced sexual abuse and examine the findings based on sex. National School Health Survey data were utilized. Among 102,301 students between 11 and 19 years of age, 4124 reported having experienced sexual abuse and were included in this study. Self-report questionnaires were used to assess participants' health status and the presence of risk behaviors, which were examined through multivariate analysis using a Poisson regression model. The results indicated positive relationships between self-induced vomiting, laxative misuse, and other purgative methods and infrequent meals with family, hunger, and the presence of violence in students' daily lives, regardless of sex (p < 0.05). In addition, body dissatisfaction and negative feelings about one's body were associated with having been bullied or teased by schoolmates for both sexes (p < 0.05). Distant relationships with parents were associated with purgative methods and body dissatisfaction among female students (p < 0.05). In conclusion, body dissatisfaction, negative feelings about one's body, laxative misuse, self-induced vomiting, and purgative methods were found to be associated with factors in family and school contexts such as hunger, infrequent meals with family, family violence, distant relationships with parents, and bullying at school in adolescents who have previously experienced sexual abuse.

Estratégias para controle de infeccção hospitalar causada por Enterococcus Vancomicina-resistentes: uma revisão integrativa / Strategies for the control of hospital infections caused by Vancomycin-resistant Enterococcus: an integrative review / Estrategias para controlar la infección del hospital causada por Enterococcus resistente a la Vancomicina: una revisión integrativa

Objetivo: avaliar a importância dos Enterococcus resistentes à Vancomicina (VRE) como agentes de infecções relacionadas à assistência à saúde (IRAS) e identificar as estratégias nacionais e internacionais usadas no controle de IRAS por VREs. Método: revisão integrativa da literatura. Seleção de 18 artigos que tratavam da importância de IRAS por VREs e das estratégias de controle. Resultados: observou-se concordância entre os artigos em relação às maneiras de minimizar os índices de IRAS por VREs. A ocorrência de IRAS é permissiva quando medidas para higiene são inadequadas. Ademais, treinamentos acerca do uso de antimicrobianos, culturas de vigilância e estruturação de uma comissão especializada são estratégias para redução de casos e que devem ser seguidas para contingência de VREs como agentes de IRAS. Conclusão: ações preventivas são a maneira mais eficiente de reduzir os casos de IRAS por VREs. É imprescindível padronizar e controlar o uso de antimicrobianos visando à prevenção da seleção de linhagens resistentes. Ainda, faz-se necessário manter ativas estratégias administrativas para controle de IRAS e atualização dos profissionais técnicos e da limpeza que atuam nos serviços de saúde, possibilitando educação continuada acerca de todos os tópicos que envolvam o controle dos casos.(AU)

Objective: to evaluate the importance of Vancomycin-resistant Enterococcus (VREs) as agents of Health care-associated infections (HAIs) and to identify national and international strategies used in the control of HAIs by VREs. Method: this is an integrative literature review. We selected 18 articles that dealt with the importance of HAIs by VREs and the control strategies. Results: we noted an agreement among the articles regarding ways to minimize the rates of HAIs by VREs. The occurrence of HAIs is permissive when hygiene measures are inadequate. Furthermore, training on the use of antimicrobials, surveillance cultures, and the structuring of a specialized committee are strategies to reduce cases and should be followed for the contingency of VREs as agents of HAIs. Conclusion: preventive actions are the most efficient way to reduce cases of HAIs by VREs. It is essential to standardize and control the use of antimicrobials, in order to prevent the selection of resistant strains. Furthermore, it is necessary to keep active administrative strategies for the control of HAIs and to update the technical and cleaning professionals who work in health services, enabling continuing education on all topics involving case control.(AU)

Objetivo: evaluar la importancia de los Enterococcus resistentes a la Vancomicina (VREs) como agentes de infecciones asociadas a la atención sanitaria (IAAS) e identificar las estrategias nacionales e internacionales utilizadas para controlar las IAAS causadas por los VREs. Método: revisión integradora de la literatura. Se seleccionaron 18 artículos que trataban sobre la importancia de las IAAS por los VREs y las estrategias de control. Resultados: se observó una concordancia entre los artículos sobre las formas de minimizar las tasas de IAAS por VREs. La aparición de IAAS es permisible cuando las medidas de higiene son inadecuadas. Además, los tratamientos sobre el uso de antimicrobianos, las culturas de vigilancia y la estructuración de una comisión especializada son estrategias para reducir los casos y que deben seguirse para la contingencia de los VREs como agentes de IAAS. Conclusión: las acciones preventivas son la forma más eficiente de reducir los casos de IAAS por VREs. Es imprescindible programar y controlar el uso de antimicrobianos para prevenir la aparición de líneas resistentes. Asimismo, es necesario mantener activas las estrategias administrativas para el control de las IAAS y la actualización de los profesionales técnicos y de limpieza que trabajan en los servicios sanitarios, permitiendo la formación continua en todos los temas que involucran el control de casos.(AU)

The dissemination of COVID-19: an expectant and preventive role in global health

Backgroung: Coronaviruses (CoV) make up a large family of viruses, known since the mid-1960s, which received this name due to the spikes on its surface, which resemble a crown (from the Latin corona). CoV infections can cause everything from a common cold to severe respiratory syndromes, such as severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV).COVID-19 (SARS-CoV2) is a new variant of the coronavirus, and its isolation occurred in China on January 7th, 2020. COVID-19 has stood out with a high impact on public health due to the high number of cases with infection in a short period of time. However, it is possible to observe that 17% of patients confirmed with COVID-19 have severe infections and about 2.5% of these patients die. Current studies have shown that the number of mild and asymptomatic cases may be even greater. Thus, the challenges for controlling unreported cases of patients with mild symptoms that are spreading the virus and interfering with the magnitude and real data of the cases stand out. The transmission of the coronavirus occurs between humans, and it can occur from person to person through the air, through coughing or sneezing, by touching or shaking hands or by contact with contaminated objects or surfaces, followed by contact with the mouth, nose or eyes. Given the fluctuation in the incidence and the lethality rate, it is essential to stand out the precepts of health promotion in search of reorienting hygiene practices, considering that there is validity in health care models, still with a curative approach and the current situation experienced by the world population requires a preventive stance.(AU)

Os coronavírus (CoV) compõem uma grande família de vírus, conhecidos desde meados da década de 1960, que receberam esse nome devido às espículas na sua superfície, que lembram uma coroa (do latim corona). As infecções pelo CoV podem causar desde um resfriado comum até síndromes respiratórias graves, como a síndrome respiratória aguda grave (SARS-CoV) e a síndrome respiratória do Oriente Médio (MERS-CoV). O COVID-19 (SARS-CoV2) é nova variante do coronavírus, sendo que o seu isolamento ocorreu na China em 07/01/2020. O COVID-19 tem se destacado com alto impacto na saúde pública devido ao elevado número de casos com a infecção em um curto período de tempo. Entretanto, é possível observar que apenas 17% dos pacientes confirmados com COVID-19 apresentam infecções graves e cerca de 2,5% destes pacientes morrerem. No entanto, os estudos atuais tem evidenciado que o número de casos leves e assintomáticos podem ser ainda maiores. Dessa forma, destacam-se os desafios para o controle dos casos não notificados de pacientes com sintomas leves que estão espalhando o vírus e interferindo na magnitude e nos dados reais dos casos. A transmissão do coronavírus acontece entre humanos, podendo ocorrer de pessoa a pessoa pelo ar, por meio de tosse ou espirro, pelo toque ou aperto de mão ou pelo contato com objetos ou superfícies contaminadas, seguido pelo contato com a boca, nariz ou olhos. Dada a oscilação da incidência e da taxa de letalidade reforça-se a importância dos preceitos da promoção da saúde em busca da reorientação de práticas de higiene, considerando que há vigência nos modelos assistenciais em saúde, sendo hegemônico o curativismo e a atual situação vivenciada pela população mundial exige postura preventiva.

Increased serum gastrin in patients with different clinical forms of Chagas disease coinfected with Helicobacter pylori.

Trypanosoma cruzi and Helicobacter pylori (HP) are pathogens that cause chronic diseases and have been associated with hypergastrinemia. The aim of this study was to evaluate the fasting gastrin levels in patients with different clinical forms of Chagas disease (CD), coinfected or not by HP. The enrolled individuals were outpatients attending at the university hospital. HP infection was assessed by serology and 13 C-urea breath test. Fasting serum gastrin concentration was measured by chemiluminescence assay. Gastric endoscopic and histological features were also evaluated. Associations between CD and serum gastrin level were evaluated in a logistical model, adjusting for age, gender and HP status. A total of 113 patients were evaluated (45 with Chagas disease and 68 controls). In the multivariate analysis, increasing serum gastrin levels (OR= 1.02; 95% CI= 1.01-1.12), increasing age (OR= 1.05; 95% CI= 1.02 - 1.09) and HP-positive status (OR = 2.88; 95% CI = 1.10 - 7.51) remained independently associated with CD. The serum gastrin levels were significantly higher in the group of patients with the cardiodigestive form ( P = 0.03) as well as with digestive form ( P = <0.001) of Chagas disease than in the controls. In conclusion, patients with cardiodigestive and digestive clinical forms of CD have increased basal serum gastrin levels in comparison with controls. Moreover, we also demonstrated that H. pylori coinfection contributes to the hypergastrinemia shown in CD.

Estratégias para o controle da Sífilis Congênita no município de Diadema-SP / Strategies for the control of congenital syphilis in Diadema-SP

Este trabalho aborda as distintas estratégias construídas em rede por meio de cooperação horizontal adotadas pelo município de Diadema, para subsidiar as equipes mediante a complexidade que é ofertar a longitudinalidade do cuidado aos pacientes com suspeita /diagnóstico de sífilis. Dessa forma, o principal objetivo é apoiar, aperfeiçoar e padronizar a assistência ofertada pelas equipes da Atenção Básica com arranjos de baixo custo nas ações de prevenção, detecção, tratamento, monitoramento e combate à sífilis adquirida, em gestante e congênita, de acordo com as diretrizes do Ministério da Saúde. O progresso das estratégias utilizadas demonstrou impactos positivos a respeito do rastreamento e tratamento da sífilis no município, em médio prazo e custo relativamente baixo.

Modulation of Galectin-3 and Galectin 9 in gastric mucosa of patients with chronic gastritis and positive Helicobacter pylori infection.

OBJECTIVES: Galectins are mediators that play an important role in the inflammatory response and in this study we analyzed the expression of Galectins (Gal) -1, -3 and -9 in biopsies of the gastric antrum of patients with upper gastrointestinal symptoms. METHODOLOGY: 44 patients with upper digestive tract symptoms were evaluated, and underwent Upper Digestive Endoscopy examination. Sections of the gastric antrum were fixed in buffered formaldehyde at 4% in order to perform the anatomopathological examination and immunohistochemical analysis for Galectins-1, -3 and -9 expression. Fresh sections of gastric antrum were used for DNA extraction and evaluation of Helicobacter pylori (H. pylori). P values<0.05 were considered statistically significant. RESULTS: Gal-1 was significantly more expressed on stroma than epithelium (p<0.0001), whereas Gal-3 and Gal-9 were more expressed on epithelium (p<0.0001). Gal-3 was found to be significantly higher in the stroma of patients with H. pylori infection, mainly on Cag-A positive H. pylori (p<0.0001). Gal-9 was down modulated in stroma of patients with chronic gastritis. CONCLUSION: Up modulation of Gal-3 expression was associated with H. pylori infection and down modulation of Gal-9 with the inflammatory process of chronic gastritis.

Diversity of group A rotavirus genes detected in the Triângulo Mineiro region, Minas Gerais, Brazil

ABSTRACT Group A rotaviruses are the main causative agent of infantile gastroenteritis. The segmented nature of the viral genome allows reassortment of genome segments, which can generate genetic variants. In this study, we characterized the diversity of the VP7, VP4 (VP8*), VP6, NSP4, and NSP5 genes of the rotaviruses that circulated from 2005 to 2011 in the Triângulo Mineiro (TM) region of Brazil. Samples with genotypes G2 (sublineages IVa-1 and IVa-3), G1 (sublineage I-A), G9 (lineage III), G12 (lineages II and III), G8 (lineage II), G3 (lineage III), P[4] (sublineages IVa and IVb), P[8] (sublineages P[8]-3.6, P[8]-3.3, and P[8]-3.1), I2 (lineage VII), E2 (lineages VI, XII, and X), and H2 (lineage III) were identified. The associations found in the samples were G1, G9, or G12 with P[8]-I1-E1-H1; G2 or G8 with P[4]-I2-E2-H2; G12 with I3-E3-H6; and G3 with P[4]-I2-E3-H3 (previously unreported combination). Reassortment events in G2P[4] strains and an apparent pattern of temporal segregation within the lineages were observed. Five TM samples contained genes that exhibited high nucleotide and amino acid identities with strains of animal origin. The present study includes a period of pre- and post-introduction of rotavirus vaccination in all Brazilian territories, thereby serving as a basis for monitoring changes in the genetic constitution of rotaviruses. The results also contribute to the understanding of the diversity and evolution of rotaviruses in a global context.

Diversity of group A rotavirus genes detected in the Triângulo Mineiro region, Minas Gerais, Brazil.

Group A rotaviruses are the main causative agent of infantile gastroenteritis. The segmented nature of the viral genome allows reassortment of genome segments, which can generate genetic variants. In this study, we characterized the diversity of the VP7, VP4 (VP8*), VP6, NSP4, and NSP5 genes of the rotaviruses that circulated from 2005 to 2011 in the Triângulo Mineiro (TM) region of Brazil. Samples with genotypes G2 (sublineages IVa-1 and IVa-3), G1 (sublineage I-A), G9 (lineage III), G12 (lineages II and III), G8 (lineage II), G3 (lineage III), P[4] (sublineages IVa and IVb), P[8] (sublineages P[8]-3.6, P[8]-3.3, and P[8]-3.1), I2 (lineage VII), E2 (lineages VI, XII, and X), and H2 (lineage III) were identified. The associations found in the samples were G1, G9, or G12 with P[8]-I1-E1-H1; G2 or G8 with P[4]-I2-E2-H2; G12 with I3-E3-H6; and G3 with P[4]-I2-E3-H3 (previously unreported combination). Reassortment events in G2P[4] strains and an apparent pattern of temporal segregation within the lineages were observed. Five TM samples contained genes that exhibited high nucleotide and amino acid identities with strains of animal origin. The present study includes a period of pre- and post-introduction of rotavirus vaccination in all Brazilian territories, thereby serving as a basis for monitoring changes in the genetic constitution of rotaviruses. The results also contribute to the understanding of the diversity and evolution of rotaviruses in a global context.

Função motora e qualidade de vida de indivíduos com paralisia cerebral / Motor function and life quality of individuals with cerebral palsy

OBJETIVO: Avaliar e correlacionar a função motora grossa e a qualidade de vida de crianças com PC. MÉTODOS: Foi verificado em 20 crianças o tipo clínico e anatômico, a função motora grossa pela GMFM (Gross Motor Function Measure) e a qualidade de vida pelo Questionário de Qualidade de Vida Pediátrico (PedsQL). Foi utilizado o teste de Shapiro-Wilk e o de Kruskal-Wallis. Para correlacionar utilizou-se da Análise de Correlação Canônica, o teste da Razão de Verossimilhança e a Estatística Multivariada de Wilks Lambda, com nível de significância de 5%. RESULTADOS: Apresentaram idade média de 8,4±4,03 anos. Os indivíduos com hemiparesia espástica apresentaram função motora significativamente maior que os com tetraparesia atetóide e espástica. Verificou-se a existência de alta correlação canônica significativa entre as variáveis da GMFM e PedsQL. CONCLUSÃO: Os achados demonstram que quanto maior for o comprometimento da função motora grossa menor será a sua qualidade de vida.

OBJECTIVE: The objective of this study was to evaluate and correlate the gross motor function and the quality of life of children with cerebral palsy. METHODS: Clinical and anatomical type, the gross motor function through the Gross Motor Function Measure and the quality of life were verified in 20 subjects through questionnaire for quality of Pediatric Life. The Shapiro-Wilk's test and the Kruskal-Wallis were used for the analyses. To correlate, we used the Canonical Correlation Analysis, the Likelihood Ratio test and Wilk's Lambda Multivariate Statistics, with significance level of 5%. RESULTS: The average age of the subjects was 8.4±4.03 years. Individuals with spastichemiparesis showed significantly greater motor function than those classified as athetoid quadriplegia and spastic. The existence of highly significant canonical correlation was found between the variables relating to the Gross Motor Function Measure and quality of Pediatric Life. CONCLUSION: The findings show that the greater the impairment of gross motor function the lower the qualify of life.

Caracterização dos pacientes com transtorno obsessivo compulsivo: um estudo epidemiológico / Characterization of patients with obsessive-compulsive disorder: an epidemiological study / Caracterización de los pacientes con trastorno obsesivo compulsivo: un estudio epidemiológico

Trata-se de estudo retrospectivo e exploratório, realizado em instituição psiquiátrica com o objetivo de caracterizar os pacientes acometidos por Transtorno Obsessivo Compulsivo quanto ao sexo, idade, proveniência, tempo de internação, tipo de alta, tipo de internação e fonte financiadora da internação. A amostra foi constituída por 61 pacientes sendo predominante o sexo feminino (47-77%), a faixa etária acima de 41 anos (41-67%), provenientes da própria família (31-50,8%) e o tempo de internação de 30 dias (33-54,1%). A alta médica foi a mais frequente (51-83,6%), houve prevalências similares entre as primeiras internações (30-49,2%) e reinternações (31-50,8%); o principal financiador das internações hospitalares foi o Sistema Único de Saúde (54-88,5%). Ações que visem diagnosticar precocemente o transtorno devem ser desenvolvidas para que o tratamento seja prontamente iniciado a fim de evitar o agravamento de obsessões e compulsões.

This is a retrospective, exploratory study, undertaken in a psychiatric institution with the aim of characterizing the patients affected by Obsessive-Compulsive Disorder by sex, age, provenance, duration of hospitalization, type of discharge, type of hospitalization, and source of financing of hospitalization. The sample comprised 61 patients, the majority of whom were female (47-77%), age range over 41 years old (41-67%), who came to hospital from the family home (31-50.8%) and length of hospitalization of 30 days (33-54.1%). The most frequent type of discharge was medical (51-83.6%), and there were similar prevalences for first hospitalizations (30-49.2%) and re-hospitalizations (31-50.8%); the main financer for hospitalization was the Unified Health System (54-88.5%). Actions for the early diagnosis of this disorder must be developed so that the treatment may be initiated promptly, so as to avoid the worsening of obsessions and compulsions.

Este es un estudio retrospectivo y exploratorio, realizado en institución psiquiátrica con el objetivo de caracterizar los pacientes víctimas del Trastorno Obsesivo Compulsivo cuanto al sexo, edad, proveniencia, tiempo de internación, tipo de alta, tipo de internación y fuente financiadora de la internación. La muestra fue constituida de 61 pacientes, siendo predominante el sexo femenino (47-77%), la franja etaria de mayores de 41 años (41-67%), provenientes de la propia familia (31-50,8%) y el tiempo de internación de 30 días (33-54,1%). La alta médica fue la más frecuente (51-83,6%), huvo prevalencias similares entre las primeras internaciones (30-49,2%) y reinternaciones (31-50,8%); el principal financiador de las internaciones hospitalares fue el Sistema Único de Salud (54-88,5%). Es necesario desarrolar acciones cuya finalidad sea diagnosticar de modo precoz el trastorno para que el tratamiento sea luego iniciado a fin de evitar que enpeoren las obsesiones y compulsiones.

Seroprevalence of Helicobacter pylori infection in chagasic and nonchagasic patients from the same geographical region of Brazil.

INTRODUCTION: In this study, we evaluated the seroprevalence of Helicobacter pylori infection among chagasic and non-chagasic subjects as well as among the subgroups of chagasic patients with the indeterminate, cardiac, digestive, and cardiodigestive clinical forms. METHODS: The evaluated subjects were from the Triângulo Mineiro region, Minas Gerais, Brazil. Chagasic patients showed positive reactions to the conventional serological tests used and were classified according to the clinical form of their disease. Immunoglobulin G antibodies specific to H. pylori were measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS: The overall H. pylori prevalence was 77.1% (239/310) in chagasic and 69.1% (168/243) in non-chagasic patients. This difference was statistically significant even after adjustment for age and sex (odds ratio = 1.57; 95% confidence interval, 1.02-2.42; p = 0.04) in multivariate analysis. The prevalence of infection increased with age in the non-chagasic group (p = 0.007, χ² for trend), but not in the chagasic group (p = 0.15, χ² for trend). H. pylori infection was not associated with digestive or other clinical forms of Chagas disease (p = 0.27). CONCLUSIONS: Our findings demonstrate that chagasic patients have a higher prevalence of H. pylori compared to non-chagasic subjects; a similar prevalence was found among the diverse clinical forms of the disease. The factors contributing to the frequent co-infection with H. pylori and Trypanosoma cruzi as well as its effects on the clinical outcome deserve further study.

Seroprevalence of Helicobacter pylori infection in chagasic and nonchagasic patients from the same geographical region of Brazil / Soroprevalência da infecção por Helicobacter pylori em indivíduos chagásicos e não-chagásicos da mesma região geográfica do Brasil

INTRODUCTION: In this study, we evaluated the seroprevalence of Helicobacter pylori infection among chagasic and non-chagasic subjects as well as among the subgroups of chagasic patients with the indeterminate, cardiac, digestive, and cardiodigestive clinical forms. METHODS: The evaluated subjects were from the Triângulo Mineiro region, Minas Gerais, Brazil. Chagasic patients showed positive reactions to the conventional serological tests used and were classified according to the clinical form of their disease. Immunoglobulin G antibodies specific to H. pylori were measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS: The overall H. pylori prevalence was 77.1% (239/310) in chagasic and 69.1% (168/243) in non-chagasic patients. This difference was statistically significant even after adjustment for age and sex (odds ratio = 1.57; 95% confidence interval, 1.02-2.42; p = 0.04) in multivariate analysis. The prevalence of infection increased with age in the non-chagasic group (p = 0.007, χ2 for trend), but not in the chagasic group (p = 0.15, χ2 for trend). H. pylori infection was not associated with digestive or other clinical forms of Chagas disease (p = 0.27). CONCLUSIONS: Our findings demonstrate that chagasic patients have a higher prevalence of H. pylori compared to non-chagasic subjects; a similar prevalence was found among the diverse clinical forms of the disease. The factors contributing to the frequent co-infection with H. pylori and Trypanosoma cruzi as well as its effects on the clinical outcome deserve further study.

INTRODUÇÃO: No presente estudo, foi comparada a soroprevalência da infecção por Helicobacter pylori entre os indivíduos chagásicos e não-chagásicos, bem como entre subgrupos de chagásicos com as formas clínicas indeterminada, cardíaca, digestiva e cardiodigestiva. MÉTODOS: Os indivíduos avaliados eram provenientes da região do Triângulo Mineiro, Minas Gerais, Brasil. Foram realizados testes sorológicos convencionais para diagnóstico da infecção pelo T. cruzi e os chagásicos foram classificados de acordo com a forma clínica. O diagnóstico de infecção por H. pylori foi estabelecido pela detecção de anticorpos IgG específicos utilizando-se um kit comercial de ELISA. RESULTADOS: A prevalência da infecção por H. pylorifoi 77,1% (239/310) no grupo de pacientes chagásicos e 69,1% (168/243) no grupo de não-chagásicos. Esta diferença foi estatisticamente significativa mesmo após ajuste para idade e sexo (OR = 1,57; 95% CI, 1,02-2,42; p = 0,04) na análise multivariada. A prevalência da infecção aumentou de acordo com a idade no grupo não-chagásicos (p = 0,007, χ2 for trend) mas este aumento não foi observado no grupo dos chagásicos (p = 0,15, χ2 for trend). Não houve associação da infecção por H. pylori com a forma digestiva ou com qualquer outra forma clínica da doença de Chagas (p = 0,27). CONCLUSÕES: Foi demonstrado que pacientes chagásicos apresentam maior prevalência da infecção por H. pylori quando comparados com não-chagásicos, independente da forma clínica da doença. Os fatores que contribuem para a frequente co-infecção Helicobacter pylori e Trypanosoma cruzi, bem como seus efeitos na evolução clínica das doenças associadas devem ser melhor estudados.

Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients.

Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found to be colonised with vanC VRE and only one patient (0.3%) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1%) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.

Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients

Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1 percent) were found to be colonised with vanC VRE and only one patient (0.3 percent) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1 percent) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.

Transmission of anogenital warts in children and association with sexual abuse / Transmissão de verrugas anogenitais em crianças e associação com abuso sexual

INTRODUCTION: the incidence of anogenital condyloma acuminata in children shows remarkable increase in the last two decades, as well as by its association with sexual abuse. However, this relationship presents controversies regarding the etiology of infection, which makes answering challenging, particularly in legal-ethical aspects. OBJECTIVE: review of the literature about HPV transmission in children and relationship with sexual abuse. METHODS: synthesis of data from the query to Journal Citation Reports (JCR-ISI), Medical Literature Analysis and Retrieval System Online (Medline), Scientific Electronic Library Online (Scielo) and the Latin American and Caribbean Health Sciences (Lilacs). MeSH descriptors were used Terms with syntax (HPV [All Fields]) AND ("Child Sexual Abuse," [MeSH Terms]). Relevant articles between 1989 and 2009 were selected. Legal-ethical aspects were consulted in the criminal law and Brazilian Child and Adolescent Statute. RESULTS: different forms of non-sexual transmission of HPV in children are documented, including the vertical transmission, self and hetero inoculation of cutaneous warts, and acquisition by instruments. Studies are conflicting as to the applicability of HPV-DNA to differentiate the sexual transmission and not sexual anogenital warts. CONCLUSION: evidence indicates that in children under two years non-sexual transmission of HPV should be strongly considered in the absence of genital lesions, another STD, or consistent history of abuse. The likelihood of association between HPV and sexual abuse increases directly with age, especially after five years.(AU)

INTRODUÇÃO: A incidência do condiloma acuminado anogenital em crianças mostra notável aumento nas últimas duas décadas, bem como o interesse por sua associação com o abuso sexual. No entanto, essa relação apresenta controvérsias quanto à etiologia da infecção, o que torna o atendimento desafiador, particularmente nos aspectos ético-legais. OBJETIVO: Revisão da literatura sobre transmissão do HPV em crianças e relação com abuso sexual. MÉTODO: Síntese de dados da consulta ao Journal Citation Reports (JCR-ISI), Medical Literature Analysis and Retrieval System Online (Medline), Scientific Eletronic Library Online (Scielo) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Foram utilizados descritores MeSH Terms com sintaxes (HPV [All Fields]) AND ("Child Abuse, Sexual" [MeSH Terms]). Artigos relevantes entre 1989 e 2009 foram selecionados. Aspectos ético-legais foram consultados na legislação penal e Estatuto da Criança e do Adolescente. RESULTADOS: Diferentes formas de transmissão não sexual do HPV em crianças estão documentadas, destacando-se a transmissão vertical, auto e heteroinoculação de verrugas cutâneas, e aquisição por instrumentos. Estudos são discordantes quanto à aplicabilidade do DNA-HPV para diferenciar a transmissão sexual e não sexual das verrugas anogenitais. CONCLUSÃO: Evidências indicam que em crianças com menos de dois anos de idade a transmissão não sexual do HPV deve ser fortemente considerada na ausência de lesões genitais, de outra DST, ou de história consistente de abuso. A probabilidade de associação entre HPV e abuso sexual aumenta diretamente com a idade, principalmente após os cinco anos.(AU)

Transmission of anogenital warts in children and association with sexual abuse

INTRODUÇÃO: A incidência do condiloma acuminado anogenital em crianças mostra notável aumento nas últimas duas décadas, bem como o interesse por sua associação com o abuso sexual. No entanto, essa relação apresenta controvérsias quanto à etiologia da infecção, o que torna o atendimento desafiador, particularmente nos aspectos ético-legais. OBJETIVO: Revisão da literatura sobre transmissão do HPV em crianças e relação com abuso sexual. MÉTODO: Síntese de dados da consulta ao Journal Citation Reports (JCR-ISI), Medical Literature Analysis and Retrieval System Online (Medline), Scientific Eletronic Library Online (Scielo) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Foram utilizados descritores MeSH Terms com sintaxes (HPV [All Fields]) AND ("Child Abuse, Sexual" [MeSH Terms]). Artigos relevantes entre 1989 e 2009 foram selecionados. Aspectos ético-legais foram consultados na legislação penal e Estatuto da Criança e do Adolescente. RESULTADOS: Diferentes formas de transmissão não sexual do HPV em crianças estão documentadas, destacando-se a transmissão vertical, auto e heteroinoculação de verrugas cutâneas, e aquisição por instrumentos. Estudos são discordantes quanto à aplicabilidade do DNA-HPV para diferenciar a transmissão sexual e não sexual das verrugas anogenitais. CONCLUSÃO: Evidências indicam que em crianças com menos de dois anos de idade a transmissão não sexual do HPV deve ser fortemente considerada na ausência de lesões genitais, de outra DST, ou de história consistente de abuso. A probabilidade de associação entre HPV e abuso sexual aumenta diretamente com a idade, principalmente após os cinco anos.

Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study.

INTRODUCTION: In the past two decades members of the genus Enterococcus have emerged as important nosocomial pathogens worldwide. This study prospectively analyzed the distribution of species and trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital from 2006-2009. METHODS: Enterococcal species were identified by conventional biochemical tests. The antimicrobial susceptibility profile was performed by disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI). A screening test for vancomycin was also performed. Minimal inhibitory concentration (MIC) for vancomycin was determined using the broth dilution method. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). RESULTS: A total of 324 non-repetitive enterococcal isolates were recovered, of which 87% were E. faecalis and 10.8% E. faecium. The incidence of E. faecium per 1,000 admissions increased significantly (p < 0.001) from 0.3 in 2006 to 2.3 in 2009. The VRE rate also increased over time from 2.5% to 15.5% (p < 0.001). All VRE expressed high-level resistance to vancomycin (MIC >256 µg/ mL) and harbored vanA genes. The majority (89.5%) of VRE belonged to E. faecium species, which were characteristically resistant to ampicillin and quinolones. Overall, ampicillin resistance rate increased significantly from 2.5% to 21.4% from 2006-2009. Resistance rates for gentamicin, chloramphenicol, tetracycline, and erythromycin significantly decreased over time, although they remained high. Quinolones resistance rates were high and did not change significantly over time. CONCLUSIONS: The data obtained show a significant increasing trend in the incidence of E. faecium resistant to ampicillin and vancomycin.

Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study / Evolução da resistência aos antimicrobianos entre isolados clínicos de enterococos em um hospital terciário brasileiro: um estudo de 4 anos

INTRODUCTION: In the past two decades members of the genus Enterococcus have emerged as important nosocomial pathogens worldwide. This study prospectively analyzed the distribution of species and trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital from 2006-2009. METHODS: Enterococcal species were identified by conventional biochemical tests. The antimicrobial susceptibility profile was performed by disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI). A screening test for vancomycin was also performed. Minimal inhibitory concentration (MIC) for vancomycin was determined using the broth dilution method. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). RESULTS: A total of 324 non-repetitive enterococcal isolates were recovered, of which 87 percent were E. faecalis and 10.8 percent E. faecium. The incidence of E. faecium per 1,000 admissions increased significantly (p < 0.001) from 0.3 in 2006 to 2.3 in 2009. The VRE rate also increased over time from 2.5 percent to 15.5 percent (p < 0.001). All VRE expressed high-level resistance to vancomycin (MIC >256µg/ mL) and harbored vanA genes. The majority (89.5 percent) of VRE belonged to E. faecium species, which were characteristically resistant to ampicillin and quinolones. Overall, ampicillin resistance rate increased significantly from 2.5 percent to 21.4 percent from 2006-2009. Resistance rates for gentamicin, chloramphenicol, tetracycline, and erythromycin significantly decreased over time, although they remained high. Quinolones resistance rates were high and did not change significantly over time. CONCLUSIONS: The data obtained show a significant increasing trend in the incidence of E. faecium resistant to ampicillin and vancomycin.

INTRODUÇÃO: Nas últimas duas décadas, os enterococos emergiram como importantes patógenos nosocomiais no mundo inteiro. Neste estudo, foi analisada a distribuição das espécies e a evolução da resistência aos antimicrobianos entre isolados clínicos de enterococos obtidos em um hospital terciário, no período de 2006 a 2009. MÉTODOS: As espécies foram identificadas por testes bioquímicos convencionais e o perfil de sensibilidade foi determinado pelo método de disco difusão. A sensibilidade à vancomicina foi também determinada pela triagem em agar e pela concentração inibitória mínima (CIM). Testes moleculares foram utilizados para confirmar as espécies e determinar os genótipos dos enterococos resistentes à vancomicina (VRE). RESULTADOS: Foram analisadas 324 amostras de enterococos, sendo 87 por cento E. faecalis e 10,8 por cento E. faecium. A incidência de E. faecium por 1.000 pacientes internados aumentou significativamente (p < 0,001) de 0,3 em 2006 para 2,3 em 2009. A taxa de VRE também aumentou significativamente de 2,5 por cento para 15,5 por cento (p < 0,001). Todos os VRE apresentaram genótipo VanA e CIM >256µg/mL para vancomicina. A maioria (89,5 por cento) dos VRE pertencia à espécie E. faecium e foram resistentes à ampicilina e quinolonas. Foi observado um aumento significativo na taxa de resistência à ampicilina, de 2,5 por cento (2006) para 21,4 por cento (2009). As taxas de resistência para gentamicina, cloranfenicol, tetraciclina e eritromicina diminuíram significativamente no período do estudo. Para as quinolonas, as taxas de resistência foram elevadas não alteraram significativamente, no período do estudo. CONCLUSÕES: Os resultados do presente estudo mostram um aumento significativo na incidência de E. faecium resistentes à ampicilina e vancomicina.

First report of vancomycin-resistant Enterococcus faecalis in Uberaba, Minas Gerais state

In this study we report the first isolation of VanA-type vancomycin-resistant Enterococcus faecalis strains from two different patients hospitalized in the same intensive care unit at the hospital of Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.

Gasto energético no recém-nascido e lactente com sepse / Energetic spent in the newborn and infant with sepsis

INTRODUÇÃO: as necessidades nutricionais e particularmente o metabolismo energético de crianças são temas controversos na literatura. OBJETIVO: caracterizar o gasto energético em repouso em recém-nascidos e lactentes com sepse. MÉTODO: foram consultadas as bases de dados do Medline, SciELO, BVS Pepsic e Lilacs. Utilizou-se como estratégia de busca no MEDLINE newborn and energy spent or sepsis em todos os campos. RESULTADOS: recém-nascidos e lactentes em casos de sepse grave apresentam imaturidade dos sistemas enzimáticos, limitando a produção de alguns aminoácidos como a cisteína (deficiência da enzima cistationase em pré-termo), taurina, glutamina e nucleotídeos como colina e inositol. Este fato torna estes nutrientes condicionalmente essenciais para estas população. CONCLUSÃO: vários conceitos estabelecidos para adultos são transpostos para a faixa pediátrica, o que é inadequado, podendo ocasionar graves conseqüências à saúde dos recém-nascidos e lactentes.