[Patient safety: Patients perception at primary care level at an urban healthcare district]. / Seguridad del paciente: percepción de los pacientes en atención primaria de un distrito sanitario urbano.

OBJECTIVES: Patient safety is a quality objective and a priority in healthcare. Most of the research has focused on the hospital setting and from the professional perspective. The objective of our study is to know the opinion of the patient who attends primary care regarding its safety in this area. MATERIAL AND METHODS: Cross-sectional observational study. A survey carried out with patients chosen through four health centres representing different socioeconomic levels of the same Basic Health Zone. Fifty patients per centre were surveyed. RESULTS: Two hundred patients surveyed of whom more than 90% reported no negative experiences in terms of errors in medication, identification, diagnosis or clinical management, highlighting the good care received and the good resolution of their problem. However, only around half claimed to understand the explanations of the healthcare professionals or to have had the opportunity to give an opinion or have shared decision-making on their management. These factors were closely related to the perceived lack of time in consultation and constant change of physician. CONCLUSIONS: The vast majority of our patients report no adverse effects or safety issues during their primary care attendance. However, there is evidence of the need to strengthen aspects related to consultation time and increase the number and stability of human resources in health centres to improve patient satisfaction with the health system.

[Discussion groups as an approach to assess knowledge, attitudes and practices of hand hygiene among the adult intensive care unit professionals from a referral hospital]. / Grupos de discusión como abordaje para valorar conocimiento, actitudes y prácticas de higiene de manos en profesionales de la unidad de cuidados intensivos de adultos de un hospital de referencia.

OBJECTIVES: The adherence to hand hygiene practices among the adult Intensive Care Unit (ICU) professionals in this hospital has not improved substantially in the last years, regardless of the theoretical training sessions conducted. A study was made of the knowledge, attitudes, and practices of the ICU personnel in this field. METHODS: Several small discussion groups with ICU staff organised by preventive medicine professionals were scheduled in March 2018. Semi-structured questions on hand hygiene and use of gloves were included. The points discussed were listed into strengths and weaknesses. Knowledge was then assessed using an anonymous questionnaire, after the sessions. RESULTS: Thirteen 60-minute sessions were carried out with 157 participants from all professional categories (82% from ICU, median=11 participants / session). The majority perceived hand hygiene as a priority issue of personal responsibility for patient safety. They identified factors that limit their ability to improve their adherence. Certain habits have more to do with personal preferences than with theoretical knowledge or technical indications. CONCLUSIONS: The discussion groups have helped to make a diagnosis of the situation that will be useful to strengthen those areas of improvement that have been identified. If we aim for a cultural change, and eliminate incorrect habits, it seems more useful to carry out adequate continuing education as part of the daily routine of professionals.

[Testicular epidermoid cyst]. / Quiste epidermoide testicular.

INTRODUCTION: Testicular tumors are usually managed by radical orchiectomy because of the high incidence of malignant lesions. Epidermoid cyst of the testis is a rare benign tumor, and its differential diagnosis from malignant testicular tumors is difficult. MATERIALS AND METHODS: The clinical records of seven patients who attended our hospital with testicular epidermoid cysts were reviewed. Preoperative evaluation consisted of testicular ultrasonography in 6 patients, and magnetic resonance imaging in 4 patients. A peroperative biopsy was performed in four patients. RESULTS: Ultrasonographic appearance was specific for diagnosis of epidermoid cyst in 80% of patients. Pathological diagnosis was made in all biopsies taken during surgery. Conservative management was (tumorectomy or partial orquidectomy) performed in 6 patients (85%). CONCLUSIONS: Preoperative imaging findings, gross characteristics of the lesion, and peroperative biopsy results provide adequate information to attempt testis-sparing surgery instead of radical orchiectomy.

[Risk factors for Alzheimer's disease]. / Factores de riesgo de la enfermedad de Alzheimer.

AIM: In this review we present and discuss the main risk factors for Alzheimer's disease (AD) reported by epidemiological, genetic and biochemical studies. DEVELOPMENT: The most frequently mentioned factors are: 1. Age. It is the principal marker for the disease risk; 2. Sex. It is estimated that the prevalence of AD is higher in women than in men; 3. Genetics. Although the genetic role has been demonstrated, there is an important genetic heterogeneity; 4. Tobacco. Various studies have found a protective effect, however this effect could be attributed to survival bias; 5. Alcohol. The regular consumption of alcohol was associated with reduced incidence of AD, especially with wine consumption; 6. Family history of dementia. Nearly 40% of persons with AD have family history of dementia; 7. Non steroidal antiinflammatories (NSAIDs). The use of NSAIDS could help in reducing the symptoms of the disease or even avoid them; 8. Craneoencephalic trauma. The role of the craneoencephalic trauma is controversial; 9. Education. The increase of AD in low education persons was published; 10. Diet. The consumption of antioxidants in diet o in supplementary forms appears to be neuroprotector. CONCLUSIONS: The grand variety of published epidemiological studies with different methodology makes it difficult to find homogeneous results. This leaves us controversial impressions about how to prevent the disease.

Avaliaçäo da eficiência de um probiótico no controle de diarréia e no ganho de peso de bezerros / Evaluation of the efficiency of a probiotic in the control of diarrhea and weight gain in calves

Foram utilizadas 99 vacas prenhes distribuídas em oito grupos que receberam os seguintes tratamentos: grupo I, com 29 vacas näo vacinadas e seus bezerros que näo receberam probiótico, ficando como controle; grupo II, com 10 vacas vacinadas e seus bezerros que näo receberam probiótico; grupos III,IV e V, com 10 animais cada, vacas vacinadas e seus bezerros que receberam probiótico durante 5, 15 e 30 dias, respectivamente; os grupos VI, VII e VIII, com 10 animais cada, vacas näo vacinadas e seus bezerros que receberam probiótico durante 5, 15 e 30 dias, respectivamente. Cada animal dos grupos vacinados recebeu duas doses vacinais contendo os pili K99 e A14 de Escherichia coli na dose de 5,0ml por via subcutânea. O probiótico contendo Ruminobacter amylophilum, Ruminobacter succinogenes, Succinovibrio dextrinosolvens, Bacillus cereus, Lactobacillus acidophilus e Streptococcus faecium, na dose de 3,0X10 elevado a oitava potência células vivas (UFC) de cada amostra em 250ml de leite, era administrado por via oral. Os animais foram observados diariamente e foram determinados os títulos de anticorpos anti-K99 e anti-A14 no soro e no colostro. Anotaram-se os pesos dos bezerros ao nascimento e aos 30 dias. Os resultados mostraram que a associaçäo de vacina com probiótico administrado por 15 e 30 dias foram os tratamentos mais eficientes no controle da diarréia e ganho de peso

Utilizaçäo de vacina e probiótico no controle de diarréia enterotoxigênica em suínos causada por Escherichia coli / Use of vaccine and probiotic in the control of swine diarrhea caused by enterotoxigenic Escherichia coli

Quarenta e duas porcas prenhes foram divididas em oito grupos e submetidas aos seguintes tratamentos: grupo I-com sete porcas näo vacinadas, cujos leitöes näo receberam probiótico, as quais permaneceram como controle, grupo II-com cinco porcas vacinadas e seus leitöes que näo receberam probiótico, grupos III, IV e V-com cinco porcas cada, vacinadas, e seus leitöes que receberam probiótico durante 5, 15 e 28 dias, respectivamente, e grupos VI, VII e VIII-com cinco porcas cada, näo vacinadas, e seus leitöes que receberam probiótico durante 5, 15 e 28 dias, respectivamente. Cada animal dos grupos vacinados recebeu duas doses de 5,0ml de vacina contendo os pili K88, K99, 987P e F42 de Escherichia coli por via subcutânea. O probiótico continha Lactobacillus acidophylus na dose de 2,0x10 elevado a oitava potência células vivas em 20ml de leite e administrado por via oral. Em todos os animais observados clinica e bacteriologicamente, foram determinados os títulos de anticorpos anti-K88, anti-K99, anti-987P e anti-F42 no soro e no colostro. Os resultados mostraram que a combinaçäo de vacina com o probiótico por 28 dias foi o mais eficiente tratamento para o controle de diarréia causada por Escherichia coli enterotoxigênica

A comparative study of the efficiency of a pro-biotic and the anti-K99 and anti-A14 vaccines in the control of diarrhea in calves in Brazil.

A total of 99 pregnant cows were divided into eight groups submitted to the following treatments: group I (n = 29) consisted of unvaccinated cows whose calves did not receive a probiotic and was used as control. Group II (n = 10) consisted of vaccinated cows whose calves did not receive a probiotic. Groups III, IV and V (n = 10 neach) consisted of vaccinated cows whose calves received a probiotic for 5, 15 and 30 days, respectively. Groups VI, VII and VIII (n = 10 each) consisted of unvaccinated cows whose calves received a probiotic for 5, 15 and 30 days, respectively. Each animal in the vaccinated groups received two 5.0 ml vaccine doses containing pili K99 and A14 of Escherichia coli by the subcutaneous route. The probiotic containing Lactobacillus acidophilus at the dose of 2.0 x 10(8) live cells in 250 ml milk, was administered orally. All animals were observed clinically and bacteriologically and anti-K99 and anti-A14 antibody titers were determined in serum and colostrum. Mean calf weight was measured at birth and at 30 days of age. The results showed that a combination of the vaccine with the probiotic administered for 15 and 30 days was the most efficient treatment for the control of diarrhea.

Salmonella em raçäo para aves no Brasil / Salmonella in poultry feeds in Brazil

This experiment was undertaken to determine the possible presence of Salmonella in poultry diets.A total of two hundred samples of ration fr4om 4 commercial poultry feed industries were examined.The results revealed the presence of salmonellae in 10 cents of the samples studied and 14 serotypes were identified.The produce for Salmonella isolation included the pre-enrichment step and the strains were submited to antimicrobial tests.The 29 strains were resistant to the followings antimicrobial agents(porcents

Virulence factors in Escherichia coli strains isolated from pigs in the Ribeirao Preto region, State of Sao Paulo, Brazil.

Three-hundred faecal swabs were obtained from pigs with diarrhoea in farms located in different areas of the Ribeirao Preto region in the State of Sao Paulo. One-hundred Escherichia coli strains were isolated and tested for production of thermolabile (TL) and thermostable (STRa and STb) enterotoxins, and for the presence of colonization factors F4, F5 and F6. The strains were also tested for sensitivity to 14 antibiotics and chemotherapeutic agents. Twenty-four Escherichia coli strains produced enterotoxin STb, 5 produced LT and 3 produced STa. In the mannose-resistant haemagglutination reaction, one strain reacted positively with sheep, chicken, horse and human red blood cells and another reacted positively with guinea pig, sheep, chicken, horse and human red cells. However, both strains were negative for colonization factors F4, F5 and F6 when submitted to the slide agglutination test. All Escherichia coli strains were resistant to at least one antibiotic, the highest percentages being obtained for resistance to penicillin, tetracycline and cephalotin. In addition to the importance of the virulence factors normally encountered in enterotoxigenic Escherichia coli strains from pigs, the present results show the possible existence of new colonization factors other than F4, F5 and F6 participating in E. coli-induced pigs colibacillosis in the Ribeirao Preto region.