RANKL signaling drives skeletal muscle into the oxidative profile.

The bone-muscle unit refers to the reciprocal regulation between bone and muscle by mechanical interaction and tissue communication via soluble factors. The receptor activator of NF-κB ligand (RANKL) stimulation induces mitochondrial biogenesis and increases the oxidative capacity in osteoclasts and adipocytes. RANKL may bind to the membrane bound receptor activator of NF-κB (RANK) or to osteoprotegerin (OPG), a decoy receptor that inhibits RANK-RANKL activation. RANK is highly expressed in skeletal muscle, but the contribution of RANKL to healthy skeletal muscle fiber remains elusive. Here we show that RANKL stimulation in C2C12-derived myotubes induced activation of mitochondrial biogenesis pathways as detected by RNA-seq and western blot. RANKL expanded the mitochondrial reticulum, as shown by mitochondrial DNA quantification and MitoTracker staining, and boosted the spare respiratory capacity. Using MEK and MAPK inhibitors, we found that RANKL signals via ERK and p38 to induce mitochondrial biogenesis. The soleus from OPG-/- and OPG+/- mice showed higher respiratory rates compared to C57BL6/J wild-type (WT) mice, which correlates with high serum RANKL levels. RANKL infusion using a mini-osmotic pump in WT mice increased the number of mitochondria, boosted the respiratory rate, increased succinate dehydrogenase (SDH) activity in skeletal muscle, and improved the fatigue resistance of gastrocnemius. Therefore, our findings reveal a new role of RANKL as an osteokine-like protein that impacts muscle fiber metabolism.

Bone modeling and remodeling are processes intricately related to bone health regulated by the RANKL system. The RANKL (receptor activator of NF-κB ligand) is a protein essential for bone resorption. RANKL activates RANK (receptor activator of NFκB) in the cell membrane of osteoclasts and can also bind to OPG (osteoprotegerin), which acts as a soluble decoy receptor. Therefore, the levels of RANKL and OPG determine the degree of osteoclast activation and bone resorption. Bone and muscle mechanically interact for movement as bone is a lever for skeletal muscle to exert force. They also communicate via soluble factors that reciprocally regulate their function. Skeletal muscle fibers express RANK, but the role of RANKL signaling in healthy myotubes was still unknown. Here, we propose that RANKL regulates muscle metabolism by inducing mitochondrial biogenesis. We show that RANKL increases mitochondrial area in myotubes and the expression of mitochondrial markers, boosting the spare respiratory capacity. In mice knockout for OPG, which shows high levels of RANKL and unopposed RANK-RANKL stimulation, we found higher respiratory rates than in the wild-type mice. We also infused a low dose of RANKL in wild-type mice, which is around ten times lower than the dose to induce osteoporosis, and found increased mitochondrial number and higher respiratory rates in soleus. In the gastrocnemius, we also observed increased phosphorylative respiration and improved resistance to fatigue compared to mice treated with the vehicle solution. Our findings indicate that RANKL regulates both bone and muscle under physiological conditions by inducing mitochondrial biogenesis and oxidative metabolism in skeletal muscle fibers.

Proteome profiling of enriched membrane-associated proteins unraveled a novel sophorose and cello-oligosaccharide transporter in Trichoderma reesei.

BACKGROUND: Trichoderma reesei is an organism extensively used in the bioethanol industry, owing to its capability to produce enzymes capable of breaking down holocellulose into simple sugars. The uptake of carbohydrates generated from cellulose breakdown is crucial to induce the signaling cascade that triggers cellulase production. However, the sugar transporters involved in this process in T. reesei remain poorly identified and characterized. RESULTS: To address this gap, this study used temporal membrane proteomics analysis to identify five known and nine putative sugar transporters that may be involved in cellulose degradation by T. reesei. Docking analysis pointed out potential ligands for the putative sugar transporter Tr44175. Further functional validation of this transporter was carried out in Saccharomyces cerevisiae. The results showed that Tr44175 transports a variety of sugar molecules, including cellobiose, cellotriose, cellotetraose, and sophorose. CONCLUSION: This study has unveiled a transporter Tr44175 capable of transporting cellobiose, cellotriose, cellotetraose, and sophorose. Our study represents the first inventory of T. reesei sugar transportome once exposed to cellulose, offering promising potential targets for strain engineering in the context of bioethanol production.

Growth-dependent Gene Expression Variation Influences the Strength of Codon Usage Biases.

The most highly expressed genes in microbial genomes tend to use a limited set of synonymous codons, often referred to as "preferred codons." The existence of preferred codons is commonly attributed to selection pressures on various aspects of protein translation including accuracy and/or speed. However, gene expression is condition-dependent and even within single-celled organisms transcript and protein abundances can vary depending on a variety of environmental and other factors. Here, we show that growth rate-dependent expression variation is an important constraint that significantly influences the evolution of gene sequences. Using large-scale transcriptomic and proteomic data sets in Escherichia coli and Saccharomyces cerevisiae, we confirm that codon usage biases are strongly associated with gene expression but highlight that this relationship is most pronounced when gene expression measurements are taken during rapid growth conditions. Specifically, genes whose relative expression increases during periods of rapid growth have stronger codon usage biases than comparably expressed genes whose expression decreases during rapid growth conditions. These findings highlight that gene expression measured in any particular condition tells only part of the story regarding the forces shaping the evolution of microbial gene sequences. More generally, our results imply that microbial physiology during rapid growth is critical for explaining long-term translational constraints.

Integrating morphological, biochemical, behavioural, and molecular approaches to investigate developmental toxicity triggered by tebuthiuron in zebrafish (Danio rerio).

Tebuthiuron (TBU), a phenylurea herbicide, is widely applied in agricultural and non-agricultural soils. Because TBU resists degradation, it can contaminate water and reach the biota once it is released into the environment. However, the potential toxic effects of TBU on aquatic developing organisms have been poorly studied. By taking advantage of the early-life stages of zebrafish (Danio rerio), we have combined morphological, biochemical, behavioural, and molecular approaches to investigate the developmental toxicity triggered by environmentally relevant concentrations (from 0.1 to 1000 µg/L) of TBU. Exposure to TBU did not elicit morphological abnormalities but it significantly delayed hatching. In addition, TBU altered the frequency of tail coils in one-day post-fertilization (dpf) old embryos. Moreover, TBU exposure during four days significantly inhibited the whole body AChE activity of larvae. At the molecular level, TBU did not significantly affect the mRNA levels of four genes (elavl3, gfap, gap43, and shha) that play key roles during the neurodevelopment of zebrafish. By assessing the motor responses to repeated light-dark stimuli, 6 dpf larvae exposed to TBU displayed hyperactivity, showing greater travelling distance during the dark periods. Our categorization of swimming speed revealed an interesting finding - after the light was turned off, the exposed larvae abandoned the freezing mode (<2 mm/s) and travelled mainly at cruising speed (2-20 mm/s), showing that the larval hyperactivity did not translate into higher swimming velocity. Overall, our results offer new insights into the TBU toxicity to developing organisms, namely effects in AChE activity and hyperactivity, providing support data for future studies considering environmental risk assessment of this herbicide.

Growth-dependent gene expression variation influences the strength of codon usage biases.

The most highly expressed genes in microbial genomes tend to use a limited set of synonymous codons, often referred to as "preferred codons." The existence of preferred codons is commonly attributed to selection pressures on various aspects of protein translation including accuracy and/or speed. However, gene expression is condition-dependent and even within single-celled organisms transcript and protein abundances can vary depending on a variety of environmental and other factors. Here, we show that growth rate-dependent expression variation is an important constraint that significantly influences the evolution of gene sequences. Using large-scale transcriptomic and proteomic data sets in Escherichia coli and Saccharomyces cerevisiae, we confirm that codon usage biases are strongly associated with gene expression but highlight that this relationship is most pronounced when gene expression measurements are taken during rapid growth conditions. Specifically, genes whose relative expression increases during periods of rapid growth have stronger codon usage biases than comparably expressed genes whose expression decreases during rapid growth conditions. These findings highlight that gene expression measured in any particular condition tells only part of the story regarding the forces shaping the evolution of microbial gene sequences. More generally, our results imply that microbial physiology during rapid growth is critical for explaining long-term translational constraints.

Novel Parvoviruses from Wild and Domestic Animals in Brazil Provide New Insights into Parvovirus Distribution and Diversity.

Parvoviruses (family Parvoviridae) are small, single-stranded DNA viruses. Many parvoviral pathogens of medical, veterinary and ecological importance have been identified. In this study, we used high-throughput sequencing (HTS) to investigate the diversity of parvoviruses infecting wild and domestic animals in Brazil. We identified 21 parvovirus sequences (including twelve nearly complete genomes and nine partial genomes) in samples derived from rodents, bats, opossums, birds and cattle in Pernambuco, São Paulo, Paraná and Rio Grande do Sul states. These sequences were investigated using phylogenetic and distance-based approaches and were thereby classified into eight parvovirus species (six of which have not been described previously), representing six distinct genera in the subfamily Parvovirinae. Our findings extend the known biogeographic range of previously characterized parvovirus species and the known host range of three parvovirus genera (Dependovirus, Aveparvovirus and Tetraparvovirus). Moreover, our investigation provides a window into the ecological dynamics of parvovirus infections in vertebrates, revealing that many parvovirus genera contain well-defined sub-lineages that circulate widely throughout the world within particular taxonomic groups of hosts.

An Empirical Component-Based Model for High-Strength Bolts at Elevated Temperatures.

High-strength structural bolts are used in nearly every steel beam-to-column connection in typical steel building construction practice. Thus, accurately modeling the behavior of high-strength bolts at elevated temperatures is crucial for properly evaluating the connection capacity, and is also important in evaluating the strength and stability of steel buildings subjected to fires. This paper uses a component-based modeling approach to empirically derive the ultimate tensile strength and modulus of elasticity for grade A325 and A490 bolt materials based on data from double-shear testing of high-strength 25 mm (1 in) diameter bolts at elevated temperatures. Using these derived mechanical properties, the component-based model is then shown to accurately account for the temperature-dependent degradation of shear strength and stiffness for bolts of other diameters, while also providing the capability to model load reversal.

Characterization of the Bujaru, frijoles and Tapara antigenic complexes into the sandfly fever group and two unclassified phleboviruses from Brazil.

The genus Phlebovirus includes the sandfly fever viruses and tick-transmitted uukuviruses. Sandfly fever group viruses have been isolated from various vertebrate species and from phlebotomines and occasionally alternative arthropods, e.g. mosquitoes, or ceratopogonids of the genus Culicoides. Uukuniemi serogroup viruses have been isolated from various vertebrate species and from ticks. Despite the public health importance of some viruses of the genus, the genomic diversity of phleboviruses that could be incriminated as causative of human or veterinary diseases remains underestimated. Here we describe the nearly complete sequences and genomic characterization of two phleboviruses belonging to the Bujaru antigenic complex: the prototype species and the Munguba virus. Furthermore, six previously unclassified phleboviruses isolated in Brazil were also sequenced and characterized: Ambe, Anhanga, Joa, Uriurana, Urucuri and Tapara viruses. The results of the phylogenetic analysis indicated that these viruses group with viruses of three antigenic complexes (Bujaru, Tapara and frijoles clades), with two unclassified phleboviruses. We also performed genomic reassortment analysis and confirmed that there were no events for the viruses described in this study, but we found a new potential reassortment in Medjerda Valley virus, which contains S and L segments of Arbia virus, and probably a unique M segment, both viruses circulate in the same geographic region, indicating these two isolates represent two distinct viruses. This study provides insights into the genetic diversity, classification and evolution of phleboviruses.

A real-time RT-PCR for rapid detection and quantification of mosquito-borne alphaviruses.

Mosquito-borne alphaviruses are widely distributed throughout the world, causing important human illnesses. Therefore, the development of methods to enable early diagnosis of infections by alphavirus is essential. We show here the development and evaluation of a quantitative real-time RT-PCR using genus-specific primers to the nsP1 viral gene of all mosquito-borne alphaviruses. The specificity and sensitivity of the assay were tested using seven alphaviruses and RNA transcribed from Venezuelan equine encephalitis virus. The detection limits of real-time RT-PCR ranged from 10 to 76 copies per ml. The melting temperature (TM) values for amplification of the alphavirus genomes were 83.05 °C and 85.28 °C. Interestingly, the assay suggested the possibility the arthritogenic alphaviruses with TM peaks of 84.83 to 85.28 °C and encephalitic alphaviruses of 83.34 °C to 84.68 °C could be discriminated both diseases. Real-time RT-PCR may prove very useful for the screening and preliminary diagnosis in outbreaks and surveillance studies as well as for measuring the viral load in pathogenesis studies.

Evaluation and optimization of SYBR Green real-time reverse transcription polymerase chain reaction as a tool for diagnosis of the Flavivirus genus in Brazil.

INTRODUCTION: The genus Flavivirus includes several pathogenic species that cause severe illness in humans. Therefore, a rapid and accurate molecular method for diagnosis and surveillance of these viruses would be of great importance. Here, we evaluate and optimize a quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) method for the diagnosis of the Flavivirus genus. METHODS: We evaluated different commercial kits that use the SYBR Green system for real-time RT-PCR with a primer set that amplifies a fragment of the NS5 flavivirus gene. The specificity and sensitivity of the assay were tested using twelve flaviviruses and ribonucleic acid (RNA) transcribed from the yellow fever virus. Additionally, this assay was evaluated using the sera of 410 patients from different regions of Brazil with acute febrile illness and a negative diagnosis for the dengue virus. RESULTS: The real-time RT-PCR amplified all flaviviruses tested at a melting temperature of 79.92 to 83.49°C. A detection limit of 100 copies per ml was determined for this assay. Surprisingly, we detected dengue virus in 4.1% (17/410) of samples from patients with febrile illness and a supposedly negative dengue infection diagnosis. The viral load in patients ranged from 2.1×107to 3.4×103copies per ml. CONCLUSIONS: The real-time RT-PCR method may be very useful for preliminary diagnoses in screenings, outbreaks, and other surveillance studies. Moreover, this assay can be easily applied to monitor viral activity and to measure viral load in pathogenesis studies.

A real-time reverse transcriptase polymerase chain reaction for detection and quantification of Vesiculovirus.

Vesiculoviruses (VSV) are zoonotic viruses that cause vesicular stomatitis disease in cattle, horses and pigs, as well as sporadic human cases of acute febrile illness. Therefore, diagnosis of VSV infections by reliable laboratory techniques is important to allow a proper case management and implementation of strategies for the containment of virus spread. We show here a sensitive and reproducible real-time reverse transcriptase polymerase chain reaction (RT-PCR) for detection and quantification of VSV. The assay was evaluated with arthropods and serum samples obtained from horses, cattle and patients with acute febrile disease. The real-time RT-PCR amplified the Piry, Carajas, Alagoas and Indiana Vesiculovirus at a melting temperature 81.02 ± 0.8ºC, and the sensitivity of assay was estimated in 10 RNA copies/mL to the Piry Vesiculovirus. The viral genome has been detected in samples of horses and cattle, but not detected in human sera or arthropods. Thus, this assay allows a preliminary differential diagnosis of VSV infections.

A real-time reverse transcriptase polymerase chain reaction for detection and quantification of Vesiculovirus

Vesiculoviruses (VSV) are zoonotic viruses that cause vesicular stomatitis disease in cattle, horses and pigs, as well as sporadic human cases of acute febrile illness. Therefore, diagnosis of VSV infections by reliable laboratory techniques is important to allow a proper case management and implementation of strategies for the containment of virus spread. We show here a sensitive and reproducible real-time reverse transcriptase polymerase chain reaction (RT-PCR) for detection and quantification of VSV. The assay was evaluated with arthropods and serum samples obtained from horses, cattle and patients with acute febrile disease. The real-time RT-PCR amplified the Piry, Carajas, Alagoas and Indiana Vesiculovirus at a melting temperature 81.02 ± 0.8ºC, and the sensitivity of assay was estimated in 10 RNA copies/mL to the Piry Vesiculovirus. The viral genome has been detected in samples of horses and cattle, but not detected in human sera or arthropods. Thus, this assay allows a preliminary differential diagnosis of VSV infections.

Evaluation and optimization of SYBR Green real-time reverse transcription polymerase chain reaction as a tool for diagnosis of the Flavivirus genus in Brazil

Abstract: INTRODUCTION: The genus Flavivirus includes several pathogenic species that cause severe illness in humans. Therefore, a rapid and accurate molecular method for diagnosis and surveillance of these viruses would be of great importance. Here, we evaluate and optimize a quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) method for the diagnosis of the Flavivirus genus. METHODS: We evaluated different commercial kits that use the SYBR Green system for real-time RT-PCR with a primer set that amplifies a fragment of the NS5 flavivirus gene. The specificity and sensitivity of the assay were tested using twelve flaviviruses and ribonucleic acid (RNA) transcribed from the yellow fever virus. Additionally, this assay was evaluated using the sera of 410 patients from different regions of Brazil with acute febrile illness and a negative diagnosis for the dengue virus. RESULTS: The real-time RT-PCR amplified all flaviviruses tested at a melting temperature of 79.92 to 83.49°C. A detection limit of 100 copies per ml was determined for this assay. Surprisingly, we detected dengue virus in 4.1% (17/410) of samples from patients with febrile illness and a supposedly negative dengue infection diagnosis. The viral load in patients ranged from 2.1×107to 3.4×103copies per ml. CONCLUSIONS: The real-time RT-PCR method may be very useful for preliminary diagnoses in screenings, outbreaks, and other surveillance studies. Moreover, this assay can be easily applied to monitor viral activity and to measure viral load in pathogenesis studies.

Alpha-Lipoic Acid Attenuates Oxidative Damage in Organs After Sepsis.

Sepsis progression is linked with the imbalance between reactive oxygen species and antioxidant enzymes. Thus, the aim of this study was to evaluate the effect of alpha-lipoic acid (ALA), a powerful antioxidant, in organs of rats submitted to sepsis. Male Wistar rats were subjected to sepsis by cecal ligation puncture (CLP) and treated with ALA or vehicle. After CLP (12 and 24 h), the myeloperoxidase (MPO) activity, protein and lipid oxidative damage, and antioxidant enzymes in the liver, kidney, heart, and lung were evaluated. ALA was effective in reducing MPO activity, lipid peroxidation in the liver, and protein carbonylation only in the kidney in 12 h after CLP. In 12 h, SOD activity increased in the kidney and CAT activity in the liver and kidney with ALA treatment. Thus, ALA was able to reduce the inflammation and oxidative stress in the liver and kidney after sepsis in rats.

Dificuldades e necessidades da equipe de enfermagem em serviços de hemodinâmica e angiografia / Nursing team dificulties and needs at Angiography and Hemodinamics Services

Introdução: Os serviços de hemodinâmica e Angiografia estão surgindo em várias instituições no país. Enfermeiros capacitados nesses serviços são requisitados, e a deficiência para encontrar profissional capacitado é evidente. Objetivo: O objetivo deste estudo foi identificar dificuldades e necessidades da equipe de enfermagem em serviços de hemodinâmica e angiografia no país. Metodologia: Os dados foram coletados por meio de questionário com as seguintes variáveis: sexo, idade, exames realizados mensalmente, número de funcionários, supervisão direta e indireta, compra de produtos usados na hemodinâmica, processo de re-esterilização, dificuldades cotidianas, atividade executada em outro setor, tempo de compressão depois da retirada de introdutor; além das atividades executadas por profissionais enfermeiros, técnicos e auxiliares de enfermagem, técnicos de radiologia e médicos. O questionário foi aplicado a 56 enfermeiros hemodinamicistas, que atuam em 30 cidades de 17 estados do Brasil. Resultados: Os questionários continham perguntas abertas e fechadas, cujas respostas foram expressas em forma de Tabela, em anexo. Após a avaliação percebe-se que há dificuldade em gerenciar e liderar o setor de hemodinâmica, assim como em executar diversas atividades, quer sejam simples ou complexas. A responsabilidade de supervisão do enfermeiro de hemodinâmica é ampla, como gerenciar materiais de alto custo, liderança da equipe. A literatura sobre o assunto é deficiente. Conclusões: Os enfermeiros que atuam em serviços de hemodinâmica e angiografia estão vivenciando a evolução do setor, suas dificuldades, assim como suas necessidades.

Introduction: Hemodynamic and angiography services are emerging in several institutions nationwide. Skilled registered nurses are often requested to work at these services, and it is becoming increasingly difficult to find a skilled professional. Objective: The aim of this study was to identify the nursing team needs and difficulties at the hemodynamic and angiography services nationwide. Methodology: Data were collected through a questionnaire composed of the following variables: gender, age, examinations performed monthly, number of employees, direct and indirect supervision, hemodynamic product purchasing, reesterilization process, difficulties in daily practice, activity performed in another sector, compression time after introducer with drawal, and activities performed by nurse professionals, licensed practical nurses and practical nurses (nurses’ aides), radiology technician, and physician. The questionnaire was applied to 56 hemodynamic nurses who work in 30 cities in 17 Brazilian States. Results: Questionnaires consisted of open and closed questions. The answers are summarized in Table. After the evaluation, the difficulty to manage and lead this sector as well as to perform several activities either simple or complex was highlighted. The nurse’s supervision responsibility is wide and involves the management of high-cost materials and team leadership. The literature regarding this issue is scarce and poor. Conclusions: Nurses who work at hemodynamic and angiography services are experiencing the evolution and progress of the sector, as well as its needs and difficulties.

Sputum examination in the clinical management of community-acquired pneumonia.

OBJECTIVE: To evaluate the frequency of the use of sputum examination in the clinical management of community-acquired pneumonia (CAP) in a general hospital and to determine whether its use has an impact on mortality. METHODS: The medical records of CAP patients treated as inpatients between May and November of 2004 at the Nossa Senhora da Conceição Hospital, located in Porto Alegre, Brazil, were reviewed regarding the following aspects: age; gender; severity of pneumonia (Fine score); presence of sputum; sputum bacteriology; treatment history; change in treatment; and mortality. RESULTS: A total of 274 CAP patients (134 males and 140 females) were evaluated. Using the Fine score to quantify severity, we classified 79 (28.8%) of those 274 patients as class II, 45 (16.4%) as class III, 97 (35.4%) as class IV, and 53 (19.3%) as class V. Sputum examination was carried out in 92 patients (33.6%). A valid sample was obtained in 37 cases (13.5%), and an etiological diagnosis was obtained in 26 (9.5%), resulting in a change of treatment in only 9 cases (3.3%). Overall mortality was 18.6%. Advanced age (above 65), CAP severity, and dry cough were associated with an increase in the mortality rate. Sputum examination did not alter any clinical outcome or have any influence on mortality. CONCLUSION: Sputum examination was used in a minority of patients and was not associated with any noticeable benefit in the clinical management of patients with CAP treated in a hospital setting.

Exame do escarro no manejo clínico dos pacientes com pneumonia adquirida na comunidade / Sputum examination in the clinical management of community-acquired pneumonia

OBJETIVO: Este estudo retrospectivo avaliou a freqüência do uso da bacteriologia do escarro no manejo clínico de pacientes com pneumonia adquirida na comunidade (PAC) em um hospital geral, e se a utilização deste método modificou a mortalidade. MÉTODOS: Os prontuários de pacientes internados no Hospital Nossa Senhora da Conceição, em Porto Alegre (RS) Brasil, para tratamento de PAC entre maio e novembro de 2004 foram revisados quanto aos seguintes aspectos: idade; sexo; gravidade da pneumonia (escore de Fine); presença de expectoração; bacteriologia do escarro; história de tratamento; resposta clínica; troca de tratamento; e mortalidade. RESULTADOS: Foram avaliados 274 pacientes com PAC, sendo 134 do sexo masculino. Dentre os 274 pacientes, 79 (28,8 por cento) apresentavam, de acordo com o escore de Fine, classe II; 45 (16,4 por cento), classe III; 97 (35,4 por cento), classe IV; e 53 (19,3 por cento), classe V. Em 92 pacientes (33,6 por cento), uma amostra de escarro foi colhida para exame bacteriológico. Obtivemos amostra válida em 37 casos (13,5 por cento) e diagnóstico etiológico em 26 (9,5 por cento), o que resultou em modificação do tratamento em apenas 9 casos (3,3 por cento). A mortalidade geral foi 18,6 por cento. Idade acima de 65 anos, a gravidade da PAC e a ausência de escarro associaram-se à maior mortalidade. A bacteriologia do escarro não influenciou o desfecho clínico, nem a taxa de mortalidade. CONCLUSÃO: O exame do escarro foi uma ferramenta diagnóstica utilizada na minoria dos pacientes, e não trouxe benefício detectável no manejo clínico dos pacientes com PAC tratados em ambiente hospitalar.

OBJECTIVE: To evaluate the frequency of the use of sputum examination in the clinical management of community-acquired pneumonia (CAP) in a general hospital and to determine whether its use has an impact on mortality. METHODS: The medical records of CAP patients treated as inpatients between May and November of 2004 at the Nossa Senhora da Conceição Hospital, located in Porto Alegre, Brazil, were reviewed regarding the following aspects: age; gender; severity of pneumonia (Fine score); presence of sputum; sputum bacteriology; treatment history; change in treatment; and mortality. RESULTS: A total of 274 CAP patients (134 males and 140 females) were evaluated. Using the Fine score to quantify severity, we classified 79 (28.8 percent) of those 274 patients as class II, 45 (16.4 percent) as class III, 97 (35.4 percent) as class IV, and 53 (19.3 percent) as class V. Sputum examination was carried out in 92 patients (33.6 percent). A valid sample was obtained in 37 cases (13.5 percent), and an etiological diagnosis was obtained in 26 (9.5 percent), resulting in a change of treatment in only 9 cases (3.3 percent). Overall mortality was 18.6 percent. Advanced age (above 65), CAP severity, and dry cough were associated with an increase in the mortality rate. Sputum examination did not alter any clinical outcome or have any influence on mortality. CONCLUSION: Sputum examination was used in a minority of patients and was not associated with any noticeable benefit in the clinical management of patients with CAP treated in a hospital setting.

Terapia tópica de feridas: utilização de papaína / Terapia tópica de heridas: la utilización de la papaína / Topical therapy of wounds: the use of papain

A papaína é utilizada no tratamento de feridas geralmente associada a outros produtos como a uréia, pois ao proporcionar um meiomais úmido no leito da ferida, tal associação permite debridamento químico, acelerando o processo de cicatrização do tecido. Estudoexploratório, descritivo, baseado em revisão de literatura compreendendo o período de 1986 a 2005. Teve como objetivo geralidentificar as publicações nacionais quanto ao uso da papaína no tratamento de feridas, por meio de um levantamento bibliográficorealizado nos bancos de dados LILACS, BEDENF e DEDALUS e Serviço de Comutação Bibliográfica. Os descritores utilizados foram:ferida x papaína, papaína x uso terapêutico, ferimentos e lesões x papaína x cicatrização, úlcera de decúbito x úlcera diabética dopé x úlcera por estase. Foram localizados 179 artigos e seis dissertações; destes, foram selecionados 10 periódicos e uma dissertaçãosegundo critérios de inclusão pré-estabelecidos. Apesar da papaína ser um produto de baixo custo, de fácil aplicação e com bonsresultados cicatriciais em feridas descritos pela literatura, sua aplicação ainda é pouco utilizada nos serviços de saúde do Brasil.Recomenda-se o desenvolvimento de novos estudos e aprofundamento científico sobre as propriedades da papaína, especialmentepelos enfermeiros, pois além de responsáveis pela realização dos curativos, também devem avaliar os resultados e/ou sugerir a suaaplicação.

Papain is used in wounds treatment usually associated to other products such as urea, because upon providing a more humidenvironment to the wound bed, such association allows chemical debridement, accelerating the cicatrisation process of the tissue.Exploratory and descriptive study, based on bibliography review involving period from 1986 to 2005. This study had as generalobjective identify the national publications about the use of papain in wound treatment, through a bibliographical finding accomplishedat the data bench Lilacs, Bedenf and Dedalus and Bibliographical Commutation Service. The descriptors used were: wound x papain,papain x therapeutic use, wounds and injuries x papain x cicatrisation, bedsore x diabetic foot ulcer x stasis ulcer. 179 articles werefound and six dissertations; among them 10 periodic articles and 1 dissertation have been selected according to pre-establishedinclusion criteria. Although papain is a low cost product, and easily applicable, presenting good results in wound cicatrisation,described by the bibliography, its application is still little used in Health Services in Brazil. It is recommended the development of newstudies and a deep scientific research about the papain properties, especially by nurses, because besides they are the responsiblefor executing the curative procedures, they also must evaluate the results and/or suggest their application.

La papaína es utilizada en el tratamiento de heridas generalmente asociada a otros productos como la urea, pues al proporcionar unmedio más húmedo en el lecho de la herida, tal asociación permite debridamiento químico, acelerando el proceso de cicatrización deltejido. Estudio exploratorio, descriptivo, basado en revisión de literatura comprendiendo el período de 1986 a 2005. Ha tenido comoobjetivo general identificar las publicaciones nacionales en cuanto al uso de la papaína en el tratamiento de heridas, por medio de unlevantamiento bibliográfico realizado en los bancos de datos Lilacs, Bedenf y Dedalus y Servicio de Comutación Bibliográfica. Losdescriptores utilizados han sido: herida x papaína, papaína x uso terapéutico, heridas y lesiones x papaína x cicatrización, úlcera dedecúbito x úlcera diabética del pie x úlcera por estasis. Se han localizado 179 artículos y seis disertaciones; de estos se hanseleccionado 10 periódicos y una disertación según criterios de inclusión preestablecidos. A pesar de la papaína ser un producto debajo coste, de fácil aplicación y con buenos resultados de cicatrización en heridas, descritos por la literatura, su aplicación todavía espoco utilizada en los servicios de salud de Brasil. Recomiéndase el desarrollo de nuevos estudios y profundización científica sobre laspropiedades de la papaína, especialmente por los enfermeros, pues además de responsables por la realización de los apósitostambién deben evaluar los resultados y/o sugerir su aplicación.

Revisão de estudos clínicos de enfermagem: utilização de papaína para o tratamento de feridas / Literature review of nursing clinical studies: the use of papain for the treatment of wounds

A papaína tem sido utilizada pelo enfermeiro para o tratamento de diversas feridas. No entanto, necessita-se de evidências que demonstrem seu efeito no desbridamento e aceleração da cicatrização. Esta investigação, por meio de revisão de literatura, teve como objetivo compilar estudos realizados por enfermeiros brasileiros ou graduandos de enfermagem na literatura nacional e indexados nos Bancos de Dados de Enfermagem, Bibliográficos da Universidade de São Paulo e Literatura Latino-Americana em Ciências da Saúde, para averiguar as evidências disponíveis sobre a utilização da papaína. Foram analisados sete artigos de 1987 a 2000. Constatou-se reduzida produção científica de enfermagem e ausência de estudos com forte evidência do efeito terapêutico da papaína em feridas, sendo necessárias mais pesquisas com desenhos experimentais para a efetiva comprovação de sua eificácia.