RESUMO

Objetivo: describir las características clínicas, epidemiológicas y sobre el diagnóstico en casos de sífilis gestacional (SG) y congénita altamente probable. Métodos: estudio observacional descriptivo que incluyó a todos los recién nacidos (RN) y sus madres con diagnóstico de sífilis congénita (SC) y SG atendidos en la Clínica Universitaria Bolivariana de Medellín, Colombia, del 1/01/2017 al 31/12/2021. Resultados: en 71 RN y sus madres con diagnóstico de sífilis, se identificaron 22 casos de SC altamente probable. En 22 gestantes, 58.1 % fueron menores de 26 años y 18.1 % ≤18 años. El 100 % contaba con afiliación al sistema de salud, pero 40.1 % no realizó controles prenatales. En el 59 % de la muestra, el diagnóstico se estableció en el tercer trimestre, siendo la sífilis latente indeterminada (45.4 %), latente temprana (27.2 %) y secundaria (13.6 %) las presentaciones clínicas más frecuentes. La ecografía obstétrica se realizó en 63.6 % (14/22) de las gestantes, reportando hallazgos sugestivos de sífilis fetal en 35.7 %. El 54.5 % de las pacientes que fueron tratadas para sífilis recibieron penicilina, 16.6 % <30 días antes del parto y 16.6 % presentó falla terapéutica. En 77.2 % de los casos la pareja no fue tratada o no se registró la información. En 22 RN 50 % fueron prematuros, 63.6 % tuvieron un peso <2500g, 72.7 % presentó manifestaciones clínicas y 7 (31.8 %) fueron hijos de madres adecuadamente tratadas. Conclusión: en el grupo de gestantes predominaron las mujeres jóvenes y adolescentes, alta inasistencia al control prenatal, diagnóstico tardío y subregistro del tratamiento recibido en sus parejas. En los RN predominó la prematuridad y el bajo peso y 7 neonatos fueron hijos de madres adecuadamente tratadas, lo que sugiere falla terapéutica que pudiera estar relacionada con un tratamiento tardío o estadios clínicos de la sífilis.

Objective: to describe the clinical, epidemiological and laboratory characteristics in mothers with gestational syphilis (GS) and their newborns with highly probable congenital syphilis (CS). Methods: descriptive observational study which includes all newborns (NB) and their mothers with diagnosis of GS and GS treated at the Bolivarian University Clinic from Medellin, Colombia, from 1/01/2017 to 31/12/2021. Results: 71 NB and their mothers were diagnosed with syphilis and 22 cases of highly probable CS were identified. Of 22 pregnant women, 58.1 % were under 26 years of age and 18.1 % ≤18 years of age. All mothers were affiliated to healthcare system, however 40.1 % did not have prenatal visits. Syphilis was most commonly diagnosed in the third trimester (59 %) and the most frequent clinical presentations during pregnancy were unknown duration (45.4 %), early latent (27.2 %), and secondary (13.6 %). Obstetric ultrasound was performed in 63.6 % (14/22), of those, 37.5% reported findings suggestive of fetal syphilis. 54.5 % of the mothers received treatment with penicillin, in 16.6 % it was given up to 30 days before delivery, 16.6 % presented therapeutic failure. Treatment for the partner was not given or not recorded in 77.2 %. Of 22 NB with CS, 50% were premature, 63.6 % weighed <2500g, 72.7 % presented clinical manifestations and 7 (31.8 %) were children of adequately treated mothers. Conclusion: in this group of pregnant women, young women and adolescents predominated, there was a high misattendance to prenatal visit, late diagnosis and underreporting of treatment to their partners. Prematurity and low birth weight predominated in newborns and 7 neonates were children of mothers with adequate treatment, which suggests therapeutic failure that could be related to late treatment or stages of syphilis.

Objetivo: descrever as características clínicas, epidemiológicas e diagnósticas dos casos de sífilis gestacional (SG) e congênita de alta probabilidade. Métodos: estudo observacional descritivo que incluiu todos os recém-nascidos (RN) e suas mães com diagnóstico de sífilis congênita (SC) e SG atendidos na Clínica Universitária Bolivariana de Medellín, Colômbia, de 01/01/2017 a 31/12/2021. Resultados:em 71 RN e suas mães com diagnóstico de sífilis foram identificados 22 casos de SC altamente provável. Em 22 gestantes, 58.1% tinham menos de 26 anos e 18.1% tinham ≤18 anos. 100% eram vinculadas ao sistema de saúde, mas 40.1% não realizaram pré-natal. Em 59% da amostra o diagnóstico foi estabelecido no terceiro trimestre, sendo a sífilis latente indeterminada (45.4%), latente precoce (27.2%) e secun-dária (13.6%) as apresentações clínicas mais frequentes. A ultrassonografia obstétrica foi realizada em 63.6% (14/22) das gestantes, relatando achados sugestivos de sífilis fetal em 35.7%. 54.5% das pacientes que foram tratadas para sífilis receberam penicilina, 16.6% <30 dias antes do parto e 16.6% apresentaram falha terapêutica. Em 77.2% dos casos o casal não foi atendido ou a informação não foi registrada. Dos 22 RNs, 50% eram prematuros, 63.6% tinham peso <2500g, 72.7% apresentavam manifestações clínicas e 7 (31.8%) eram filhos de mães adequadamente tratadas. Conclusão: no grupo de gestantes predominaram mulheres jovens e adolescentes, ele-vado não comparecimento ao pré-natal, diagnóstico tardio e subregistro do tratamento recebido pelos parceiros. A prematuridade e o baixo peso predominaram nos RN e 7 neonatos eram filhos de mães tratadas adequadamente, o que sugere falha terapêutica que pode estar relacionada ao tratamento tardio ou aos estágios clínicos da sífilis

RESUMO

Approximately 10% of the population reports being allergic to penicillin, although usually less than 1% really are. In addition, people with proven allergies over the years may no longer be allergic. Unconfirmed penicillin allergy and use of alternative antimicrobials result in more treatment failures; more severe adverse effects. Higher cost; longer hospitalizations; increase in the emergence of multi-resistant germs associated with health care. The risk of cross-allergy between ß-lactam groups is usually <2%, depending on the similarity of the side chains, so prescribing antibiotics from another ß-lactam group is safe as long as we take into account the structural similarity. Incorporating the reassessment of allergies and improving the prescription of antibiotics in this group of patients reduces the generation and spread of multi-resistant germs, and the associated costs. There are simple methods and specific scores that simplify allergy reassessment. The objective of this review is to expose how, through these methods, the delabeling of patients erroneously labeled as allergic and the safe prescription of ß-lactam antibiotics can be achieved.

Aproximadamente el 10% de la población refiere ser alérgico a la penicilina, aunque habitualmente menos del 1% lo es; además las personas con alergia demostrada con el paso de los años pueden dejar de ser alérgicos. La alergia a la penicilina sin confirmación y el uso de antimicrobianos alternativos tienen como efecto más fallas en el tratamiento; más efectos adversos graves; mayor costo; internaciones más prolongadas; incremento en la emergencia de gérmenes multirresistentes asociados a los cuidados de la salud. El riesgo de alergia cruzada entre grupos de ß-lactámicos suele ser <2%, dependiendo de la similitud de las cadenas laterales, por lo que prescribir antibióticos de otro grupo de ß-lactámicos es seguro siempre que tengamos en cuenta la similitud estructural. Incorporar la reevaluación de alergias y mejorar la prescripción de antibióticos en este grupo de pacientes, disminuye la generación y propagación de gérmenes multirresistentes, y los costos asociados. Existen métodos sencillos y escalas específicas que permiten simplificar la reevaluación de la alergia. El objetivo de esta revisión es exponer cómo a través de estos métodos, puede lograrse el desrotulado de pacientes erróneamente etiquetados como alérgicos y la prescripción segura de antibióticos ß-lactámicos.

RESUMO

En esta guía práctica se describen diez intervenciones, seis de las cuales tienen lugar en el momento de la prescripción o antes de ella y cuatro que tienen lugar después. La lista completa se incluye en una hoja de resumen para cada intervención. Aunque esta lista no es exhaustiva, las intervenciones seleccionadas son las que se implementan con frecuencia y disponen de una evaluación de su impacto en la bibliografía médica.

RESUMO

En esta guía práctica se describen diez intervenciones, seis de las cuales tienen lugar en el momento de la prescripción o antes de ella y cuatro que tienen lugar después. La lista completa se incluye en una hoja de resumen para cada intervención. Aunque esta lista no es exhaustiva, las intervenciones seleccionadas son las que se implementan con frecuencia y disponen de una evaluación de su impacto en la bibliografía médica.

RESUMO

Although diphtheria is a vaccine-preventable disease, numerous cases are still reported around the world, as well as outbreaks in countries, including European ones. Species of the Corynebacterium diphtheriae complex are potentially toxigenic and, therefore, must be considered given the possible consequences, such as the circulation of clones and transmission of antimicrobial resistance and virulence genes. Recently, Corynebacterium rouxii was characterized and included among the valid species of the complex. Therefore, two cases of C. rouxii infection arising from infections in domestic animals are presented here. We provide molecular characterization, phylogenetic analyses, genome sequencing, and CRISPR-Cas analyses to contribute to a better understanding of the molecular bases, pathogenesis, and epidemiological monitoring of this species, which is still little studied. We confirmed its taxonomic position with genome sequencing and in silico analysis and identified the ST-918 for both strains. The clinical isolates were sensitive resistance to benzylpenicillin and rifampin. Antimicrobial resistance genes, including tetB, rpoB2, and rbpA genes, were predicted. The bla and ampC genes were not found. Several virulence factors were also detected, including adhesion, iron uptake systems, gene regulation (dtxR), and post-translational modification (MdbA). Finally, one prophage and the Type I-E CRISPR-Cas system were identified.

RESUMO

Neisseria gonorrhoeae is a global threat to public health due to the accumulation of antimicrobial resistance mechanisms. ST-1901 is an internationally important sequence type (ST) because of its high incidence and the usual occurrence of chromosomally determined resistance. In this study, we describe the evolution of the ST-1901 and its single locus variants in Rio de Janeiro from 2006 to 2022. We analyzed 82 N. gonorrhoeae isolates according to antimicrobial susceptibility profile, resistance mechanisms, molecular typing, and phylogenetics. Six different single locus variants were detected. Phylogenetic analysis identified five clades, which share similar characteristics. Resistance rates for penicillin and tetracycline decreased due to the lower occurrence of resistance plasmids, but intermediary resistance to penicillin rose. Resistance to ciprofloxacin remained high throughout all clades and the years of the study. Regarding resistance to azithromycin, alterations in mtrR promoter and gene, and 23S rRNA encoding gene rrl were detected, with a notable rise in the incidence of C2611T mutations in more recent years occurring in four of five clades. In contrast, ß-lactam resistance associated penA 34 mosaic was found only in one persisting clade (Clade D), and unique G45D and A39T mutations in mtrR gene and its promoter (Nm-Like) were found only in Clade B. Taken together, these data suggest that ST-1901, a persistently circulating lineage of N. gonorrhoeae in Rio de Janeiro, has undergone changes over the years and may evolve to develop resistance to the current recommended dual therapy adopted in Brazil, namely, ceftriaxone and azithromycin.

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La actinomicosis pélvica es una infección poco común del tracto genital inferior y la pelvis. La especie causal más frecuente es la bacteria Actinomyces israelii, y se debe sospechar en toda paciente que presente dolor crónico pélvico y hemorragia uterina. Aunque se manifiesta excepcionalmente en mujeres sin antecedentes de portar dispositivos intrauterinos, es importante considerarla como diagnóstico. Se presenta el caso clínico de una paciente de 12 años con hemorragia uterina anormal resistente al tratamiento, que requirió intervención quirúrgica, incluyendo biopsia endometrial. El diagnóstico resultante fue actinomicosis endometrial. Este caso aporta la actualización del conocimiento sobre esta rara enfermedad y su presentación poco frecuente en adolescentes(AU)

Pelvic actinomycosis is a rare infection of the lower genital tract and pelvis. The most common causative species is the bacterium Actinomyces israelii, and it should be suspected in any patient who presents with chronic pelvic pain and uterine bleeding. Although it occurs exceptionally in women without a history of carrying intrauterine devices, it is important to consider it as a diagnosis. It is presented the clinical case of a 12-year-old patient with abnormal uterine bleeding resistant to treatment, which required surgical intervention, including endometrial biopsy. The resulting diagnosis was endometrial actinomycosis. This case contributes to updating knowledge about this rare disease and its uncommon presentation in adolescents(AU)

RESUMO

This article examines discoveries, inventions, and innovations related to penicillin by sampling activities to solve technological problems which can be traced by the distribution of scientific articles, government reports, innovations, and patents between 1929 and 1945, and proposes reflection on the importance of scientific progress for national security. The analysis highlights the technological trajectory and outcomes in the area of intellectual property, considering US policy implemented to catalyze innovation and provide institutional conditions to meet national defense needs as an important factor, although this did not necessarily imply a unique solution in other contexts.

A partir de pesquisa sobre a descoberta, a invenção e a inovação relacionadas à penicilina, por amostra de atividades de resolução de problemas tecnológicos rastreada pela distribuição, no período de 1929 a 1945, de trabalhos científicos, relatórios de governo, inovações e patentes, o artigo propõe uma reflexão sobre a importância do progresso científico para a segurança nacional. A análise destaca a trajetória tecnológica e os resultados na área de propriedade intelectual, considerando um fator importante a política implementada nos EUA para catalisar processos de inovação e oferecer condições institucionais para atender às demandas de defesa nacional, o que não significa necessariamente unicidade de solução em outros contextos.

RESUMO

OBJECTIVE: In this study, the effects of leptin, cannabinoid-1 (CB1) receptor agonist ACEA and antagonist AM251, and the interactions between leptin and CB1 receptor agonist/antagonist on oxidant and antioxidant enzymes in the cerebrum, cerebellum, and pedunculus cerebri tissue samples were investigated in the penicillin-induced epileptic model. METHODS: Male Wistar albino rats (n=56) were included in this study. In anesthetized animals, 500 IU penicillin-G potassium was injected into the cortex to induce epileptiform activity. Leptin (1 µg), ACEA (7.5 µg), AM251 (0.25 µg), and the combinations of the leptin+ACEA and leptin+AM251 were administered intracerebroventricularly (i.c.v.) after penicillin injections. Malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels were measured in the cerebral tissue samples and plasma with the ELISA method. RESULTS: MDA levels increased, while SOD and GPx levels decreased after penicillin injection in the cerebrum and cerebellum. The efficacy of penicillin on SOD, MDA and GPx levels was further enhanced after leptin or AM251 injections. Whereas, ACEA decreased the MDA levels and increased GPx levels compared with the penicillin group. Administration of AM251+leptin did not change any oxidation parameter compared with the AM251. Furthermore, co-administration of ACEA and leptin significantly increased oxidative stress compared with the ACEA-treated group by increasing MDA and decreasing GPx levels. CONCLUSION: It was concluded that leptin reversed the effect of ACEA on oxidative stress. Co-administration of AM251 and leptin did not change oxidative stress compared with the AM251-treated group suggesting AM251 and leptin affect oxidative stress using the same pathways.

RESUMO

ABSTRACT: We conducted a systematic literature review and meta-analysis to assess the efficacy of alternative treatments for neurosyphilis. We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science from database inception to September 2023, for studies in neurosyphilis that compared penicillin monotherapy with other treatments. We focused on the impact of these therapies on treatment response, but also assessed data regarding reinfection and adverse drug events. Random-effect models were used to obtain pooled mean differences. Of 3415 screened studies, 6 met the inclusion criteria for the systematic literature review. Three studies provided quantitative data that allowed for inclusion in the meta-analysis. Our analysis revealed that the efficacy of intravenous (IV) ceftriaxone 2 g daily for 10 days (51 patients) did not appear statistically different compared with IV penicillin G 18 to 24 million units daily for 10 days (185 patients) for neurosyphilis (pooled odds ratio, 2.85; 95% confidence interval, 0.41-19.56; I 2 = 49%). No statistical difference between ceftriaxone and penicillin was identified in people living with human immunodeficiency virus (HIV) (pooled odds ratio, 4.51; 95% confidence interval, 0.50-40.49; I 2 = 34%). We concluded that alternative therapy with IV ceftriaxone appears similar to penicillin, potentially expanding treatment options for neurosyphilis. Other treatment options including doxycycline warrant further study.

RESUMO

Antimicrobial resistance (AMR) in food animals is a growing threat to animal health and potentially to human health. In resource-limited settings, allocating resources to address AMR can be guided with maps. Here, we mapped AMR prevalence in 7 antimicrobials in Escherichia coli and nontyphoidal Salmonella species across low- and middle-income countries (LIMCs), using 1088 point-prevalence surveys in combination with a geospatial model. Hotspots of AMR were predicted in China, India, Brazil, Chile, and part of central Asia and southeastern Africa. The highest resistance prevalence was for tetracycline (59% for E. coli and 54% for nontyphoidal Salmonella, average across LMICs) and lowest for cefotaxime (33% and 19%). We also identified the antimicrobial with the highest probability of resistance exceeding critical levels (50%) in the future (1.7-12.4 years) for each 10 × 10 km pixel on the map. In Africa and South America, 78% locations were associated with penicillins or tetracyclines crossing 50% resistance in the future. In contrast, in Asia, 77% locations were associated with penicillins or sulphonamides. Our maps highlight diverging geographic trends of AMR prevalence across antimicrobial classes, and can be used to target AMR surveillance in AMR hotspots for priority antimicrobial classes.

RESUMO

Detecting antibiotic residues is vital to minimize their impact. Yet, existing methods are complex and costly. Biosensors offer an alternative. While many biosensors detect various antibiotics, specific ones for beta-lactams are lacking. To address this gap, a biosensor based on the AmpC beta-lactamase regulation system (ampR-ampC) from Pseudomonas sp. IB20, an Antarctic isolate, was developed in this study. The AmpR-AmpC system is well-conserved in the genus Pseudomonas and has been extensively studied for its involvement in peptidoglycan recycling and beta-lactam resistance. To create the biosensor, the ampC coding sequence was replaced with the mCherry fluorescent protein as a reporter, resulting in a transcriptional fusion. This construct was then inserted into Escherichia coli SN0301, a beta-lactam hypersensitive strain, generating a whole-cell biosensor. The biosensor demonstrated dose-dependent detection of penicillins, cephalosporins and carbapenems. However, the most interesting aspect of this work is the high sensitivity presented by the biosensor in the detection of carbapenems, as it was able to detect 8 pg/mL of meropenem and 40 pg/mL of imipenem and reach levels of 1-10 ng/mL for penicillins and cephalosporins. This makes the biosensor a powerful tool for the detection of beta-lactam antibiotics, specifically carbapenems, in different matrices.

RESUMO

OBJECTIVE: To develop a treatment algorithm for patients with penicillin allergy. METHODS: Retrospective study, carried out in adult patients with penicillin allergy, who were in group 3 or 4 of the established classification, and attended the outpatient clinic of the Department of Pulmonology and Allergy of the Central Hospital of the Social Security Institute, between January 2021 and December 2022. Each patient underwent an amoxicillin provocation test, after obtaining informed consent. RESULTS: 60 patients were registered, who were able to remove the penicillin allergy label and whose medical history was corrected, with financial benefits for the patient and the health service of Paraguay. CONCLUSIONS: Penicillin allergy labels can lead to irrational prescription of antibiotics, prolonged hospital stays, and increased need for consultation. Risk stratification, based on historical characteristics alone, is capable of safely identifying ideal patients for direct challenge testing. This study demonstrates the feasibility of the first penicillin delabeling program applicable in an outpatient setting, which can be performed even outside of hospital allergy services.

OBJETIVO: Elaborar un algoritmo de tratamiento en pacientes con alergia a la penicilina. MÉTODOS: Estudio retrospectivo, efectuado en pacientes adultos con alergia a la penicilina, que permanecieran en el grupo 3 o 4 de la clasificación establecida, y asistieron a consulta ambulatoria en el Departamento de Neumología y Alergia del Hospital Central del Instituto de Previsión Social, entre enero de 2021 y diciembre de 2022. A cada paciente se realizó una prueba de provocación con amoxicilina, previo consentimiento informado. RESULTADOS: Se registraron 60 pacientes, a quienes se logró eliminar el rotulo de alergia a la penicilina y a quienes se corrigió su historia clínica, con beneficios financieros para el paciente y el servicio de salud de Paraguay. CONCLUSIÓN: Las etiquetas de alergia a la penicilina pueden suponer una prescripción irracional de antibióticos, estancia hospitalaria prolongada y mayor necesidad de consulta. La estratificación del riesgo, solo por características históricas, es capaz de identificar de manera segura a los pacientes ideales para las pruebas de desafío directo. Este estudio demuestra la viabilidad del primer programa de desetiquetado de penicilina aplicable en un entorno ambulatorio, que puede realizarse incluso fuera de los servicios de alergia de los hospitales.

RESUMO

Objectives: To describe the application of Positive Deviance (PD) and its outcomes in the diagnosis and treatment of gestational syphilis (GS) and the prevention of congenital syphilis (CS). Material and methods: A descriptive cohort study was conducted. Women treated at the Subred Sur (SRS) of Bogotá, diagnosed with GS in 2017-2018, were included. The 2018 cohort was exposed to Positive Deviance (PD) to identify useful practices for CS prevention, implement them, and overcome existing barriers. Adherence to the Colombian Guideline for GS management and CS incidence were described. Results: A total of 284 GS cases were confirmed. Timely treatment initiation increased from 81.8 % to 90.2 %, penicillin sensitivity testing decreased from 38 % to 12.9 %, and complete treatment improved from 43.8 % to 82.6 %. In 2018, 97.5 % received at least one dose of penicillin. The incidence rate of CS decreased from 41.9 % to 29.6 %. Of the patients, 45% were diagnosed with GS in the third trimester, among whom the CS incidence rate was 59 %. Conclusions: This study describes the effects of applying PD as an innovative approach to improve adherence to timely and appropriate GS treatment and prevent CS. Prospective studies with a control group are needed to more robustly evaluate the benefits of this methodology in process and outcome indicators, as well as its impact on reducing mother to child transmission of syphilis.

Objetivos: describir la aplicación de desviación positiva (DP) y sus resultados en el diagnóstico y tratamiento de la sífilis gestacional (SG), y prevención de la sífilis congénita (SC). Materiales y métodos: estudio de cohortes descriptivas. Se incluyeron mujeres atendidas en la Subred Sur (SRS) de Bogotá, con diagnóstico de SG en 2017-2018. La cohorte de 2018 fue expuesta a desviación positiva (DP), buscando identificar mejores prácticas para prevenir la SC, cómo aplicarlas y superar las barreras existentes. Se describe la adherencia a los indicadores de implementación de la Guía Colombiana para el manejo de SG y la incidencia de SC. Resultados: se confirmaron 284 casos de SG. El inicio oportuno de tratamiento pasó de 81,8 a 90,2 %, la solicitud de prueba de sensibilidad a penicilina disminuyó de 38 a 12,9 %, el tratamiento completo se incrementó de 43,8 a 82,6 %. El 97,5 % recibió al menos una dosis de penicilina en 2018. La proporción de incidencia de SC disminuyó de 41,9 a 29,6 %. El 45 % de las pacientes fueron diagnosticadas con SG en el tercer trimestre, en ellas la proporción de incidencia de SC fue 59 %. Conclusiones: este estudio describe los efectos de la aplicación de DP, como un enfoque innovador para mejorar la adherencia al tratamiento oportuno y adecuado de la SG y prevenir la SC. Se requieren estudios prospectivos con grupo control para evaluar de manera más sólida los beneficios de esta metodología en los indicadores de proceso y resultado, así como su impacto en la reducción de la transmisión materno-infantil de la sífilis.

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Resumo A partir de pesquisa sobre a descoberta, a invenção e a inovação relacionadas à penicilina, por amostra de atividades de resolução de problemas tecnológicos rastreada pela distribuição, no período de 1929 a 1945, de trabalhos científicos, relatórios de governo, inovações e patentes, o artigo propõe uma reflexão sobre a importância do progresso científico para a segurança nacional. A análise destaca a trajetória tecnológica e os resultados na área de propriedade intelectual, considerando um fator importante a política implementada nos EUA para catalisar processos de inovação e oferecer condições institucionais para atender às demandas de defesa nacional, o que não significa necessariamente unicidade de solução em outros contextos.

Abstract This article examines discoveries, inventions, and innovations related to penicillin by sampling activities to solve technological problems which can be traced by the distribution of scientific articles, government reports, innovations, and patents between 1929 and 1945, and proposes reflection on the importance of scientific progress for national security. The analysis highlights the technological trajectory and outcomes in the area of intellectual property, considering US policy implemented to catalyze innovation and provide institutional conditions to meet national defense needs as an important factor, although this did not necessarily imply a unique solution in other contexts.

RESUMO

Introdução: A sífilis é uma infecção sexualmente transmissível (IST) causada pela bactéria Treponema pallidum podendo ter complicações graves. A forma sexual corresponde à sífilis adquirida e/ou gestacional (SG) e a forma vertical à sífilis congênita (SC). Como não há vacina, o diagnóstico e o tratamento são essenciais para o controle da doença na população. Objetivo: Analisar, por meio de uma revisão sistemática, as principais falhas inerentes ao tratamento da SG no Brasil. Métodos: Trata-se de uma revisão sistemática com amostra final de 26 artigos levantados junto a National Library of Medicine from United States of America e a Biblioteca Virtual em Saúde, selecionados segundo os critérios do Preferred Reporting items for Systematic Reviews and Meta-Analyses. Foram eleitos artigos do ano de 2018 a 2022 publicados em revistas e cadernos de saúde com análise epidemiológica e temporal. Resultados: Foi evidenciado falhas relacionadas ao tratamento da SG, dentre elas a insegurança dos profissionais de saúde em administrar os medicamentos, tratamento inadequado da parceria sexual, atraso no diagnóstico, erro de notificação, desabastecimento de penicilina, desconhecimento da doença pela população, repasse incorreto de informações pelos profissionais, difícil acesso a rede de saúde, baixa escolaridade e educação sexual precária. Conclusão: O estudo apresentou várias falhas no tratamento da SG no Brasil, enfatizando prioritariamente o quanto ainda é notório o impacto que o baixo nível educacional tem na sociedade brasileira.

Introduction: Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum and can cause serious complications. The sexual form corresponds to acquired and/or gestational syphilis (SG) and the vertical form to congenital syphilis (CS). Because there is no vaccine, diagnosis and treatment are essential to control the disease in the population. Objective: To analyze, through a systematic review, the main flaws for treating GS in Brazil. Methods: This is a systematic review with a final sample of twenty-six articles collected from the National Library of Medicine of the United States of America and the Virtual Health Library (Latin America), selected according to the criteria of the Preferred Reporting items for Systematic Reviews and Meta-Analyses. Articles published from 2018 to 2022 in scientific journals with epidemiological and temporal analysis were elected. Results: Failures related to the treatment of GS were evidenced, among them the insecurity of health professionals in the administration of medications, inadequate treatment of the sexual partner, delay in diagnosis, error in notification, shortage of penicillin, lack of knowledge of the disease by the population, incorrect transfer of information by professionals, difficult access to the health network, low schooling level, and precarious sex education. Conclusion: The study showed several flaws for treating GS in Brazil, emphasizing primarily how much the impact of low educational level has on Brazilian society is still notorious.

RESUMO

Bacterial cell wall formation is essential for cellular survival and morphogenesis. The peptidoglycan (PG), a heteropolymer that surrounds the bacterial membrane, is a key component of the cell wall, and its multistep biosynthetic process is an attractive antibacterial development target. Penicillin-binding proteins (PBPs) are responsible for cross-linking PG stem peptides, and their central role in bacterial cell wall synthesis has made them the target of successful antibiotics, including ß-lactams, that have been used worldwide for decades. Following the discovery of penicillin, several other compounds with antibiotic activity have been discovered and, since then, have saved millions of lives. However, since pathogens inevitably become resistant to antibiotics, the search for new active compounds is continuous. The present review highlights the ongoing development of inhibitors acting mainly in the transpeptidase domain of PBPs with potential therapeutic applications for the development of new antibiotic agents. Both the critical aspects of the strategy, design, and structure-activity relationships (SAR) are discussed, covering the main published articles over the last 10 years. Some of the molecules described display activities against main bacterial pathogens and could open avenues toward the development of new, efficient antibacterial drugs.

RESUMO

The tambaqui (Colossoma macropomum) is a species of great economic importance for fish farming in the Brazilian Amazon, and acanthocephaliasis caused by Neoechinorhynchus buttnerae (Golvan 1956) represents an obstacle to its production due to it causing severe morphological damage to the intestinal mucosa, thus impairing the absorption of nutrients and causing weight loss in the fish. Therefore, the establishment of in vitro protocols for evaluation of anthelmintic drugs is the first step to development of effective measures for in vivo control of this endoparasite. The present study evaluated the in vitro survival of N. buttnerae maintained in Eagle's minimum essential medium under different culture conditions. Three assays were carried out to evaluate whether temperature, supplementation with the antibiotics penicillin and streptomycin, and culture medium replacement or no replacement would influence the motility and morphology of the acanthocephalans. The results of the Kaplan-Meier analysis indicated that the use of culture in minimum essential medium together with penicillin and streptomycin prolonged the parasite's survival when kept at temperatures of 24 °C or 28 °C. We describe herein for first time an alternative protocol that is ideal for the in vitro culture of N. buttnerae. As such, this protocol ensures greater reliability in further in vitro studies with N. buttnerae.

RESUMO

Background: The most commonly reported antibiotic allergy is penicillin. The false label of "allergy" to penicillin negatively affects the patient's quality of life and medical care. Objective: To determine the frequency of allergy to penicillin and amoxicillin by in vivo exposure tests in patients with a history of immediate reaction to this class of medicinal products. Methods: Observational, cross-sectional, descriptive and prolective study in patients between 12 and 60 years of age with a history of immediate reaction to penicillin and/or amoxicillin. Prick and intradermal skin tests were performed with benzylpenicilloyl polylysine (Pre-Pen), penicillin G and oral challenge test with amoxicillin. The frequency of positivity and negativity in these tests was calculated with a 95% CI. Results were analyzed in Epi info 7.2.5.0. Results: In total 13 patients (10 women) were included, with a mean age of 39 years (SD 12.14). In 84.6% the last adverse drug reaction occurred 10 years ago and in all manifested with urticaria. The 38.4% confirmed penicillin allergy and the most frequent adverse reaction after in vivo tests was pruritus. Conclusions: The clinical history alone is not sufficient, all patients with suspected penicillin allergy should be evaluated by in vivo exposure tests with major and minor determinants to corroborate or rule out allergy to this pharmacological class.

Antecedentes: La alergia a antibióticos notificada con más frecuencia es la penicilina. La falsa etiqueta de "alergia" a la penicilina afecta negativamente la calidad de vida del paciente y la atención médica. Objetivo: Determinar la frecuencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes con antecedente de reacción inmediata a esta clase de medicamentos. Métodos: Estudio observacional, transversal, descriptivo y prolectivo en pacientes entre 12 y 60 años con antecedente de reacción inmediata a penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, y prueba de reto oral con amoxicilina. La frecuencia de positividad y negatividad en estas pruebas fue calculado con un IC del 95%. Los resultados se analizaron en Epi info 7.2.5.0. Resultados: Se incluyeron 13 pacientes (10 mujeres), con una media de edad de 39 años (DE 12.14) y diagnóstico predominante de rinitis alérgica (61,5%). En 84,6% de casos la última reacción adversa a medicamentos ocurrió 10 años atrás y en todos se manifestó con urticaria. Sólo en cinco pacientes (38,4%) se corroboró alergia a penicilina y la reacción adversa más frecuente tras las pruebas in vivo fue prurito (23 %). Conclusiones: La historia clínica por sí sola no es suficiente, todos los pacientes con sospecha de alergia a penicilina deben ser evaluados mediante pruebas de exposición in vivo con los determinantes mayores y menores para corroborar o descartar alergia a esta clase farmacológica.

RESUMO

Objectives: To confirm the presence of allergy to penicillin and amoxicillin by in vivo exposure tests in patients with a history of immediate reaction to these drugs. Methods: Observational, cross-sectional, descriptive and prolective study. Patients between 12 and 60 years old with a history of immediate reaction after administration of penicillin and/or amoxicillin were included. Skin prick and intradermal tests were performed with benzylpenicilloyl polylysine and penicillin G, as well as oral challenge with amoxicillin. Results: Ten female and 3 male patients were included. The mean age was 39 years. In 84.6% of the cases the last adverse drug reaction occurred 10 years ago and in all cases it manifested with urticaria. Allergy to penicillin was corroborated in only 38.4% of cases. The most frequent adverse reaction after in vivo exposure tests was pruritus in 23%. Conclusions: Patients with suspected penicillin allergy should be evaluated by in vivo exposure testing with major and minor determinants to corroborate or rule out allergic reactions and improve treatment conditions.

Objetivos: Confirmar la presencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes que refieren antecedente de reacción inmediata con estos medicamentos. Métodos: Estudio observacional, transversal, descriptivo y prolectivo. Se incluyeron pacientes entre 12 y 60 años con antecedente de reacción inmediata tras administración de penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, así como desafío oral con amoxicilina. Resultados: Se incluyeron 10 pacientes femeninos y 3 masculinos. La edad promedio fue 39 años. En 84,6% de los casos la última reacción adversa a medica- mentos ocurrió 10 años atrás y en todos los casos se manifestó con urticaria. Sólo en el 38,4% se corroboró alergia a penicilina. La reacción adversa más frecuen- te, tras las pruebas de exposición in vivo fue prurito en el 23%. Conclusiones: Los pacientes con sospecha de alergia a penicilina se deben evaluar mediante pruebas de exposición in vivo con los determinantes mayores y menores, para corroborar o descartar reacciones alérgicas y mejorar las condiciones de tratamiento.