Non-clonal occurrence of pmrB mutations associated with polymyxin resistance in carbapenem-resistant Klebsiella pneumoniae in Brazil.

BACKGROUND: Polymyxins are currently used as a "last-line" treatment for multidrug-resistant Gram-negative infections. OBJECTIVES: To identify the major mechanisms of resistance to polymyxin and compare the genetic similarity between multi-drug resistant Klebsiella pneumoniae strains recovered from inpatients of public hospitals in the Mid-West of Brazil. METHODS: 97 carbapenems non-susceptible K. pneumoniae were studied. ß-lactamases (bla OXA-48, bla KPC, bla NDM, bla CTX-M, bla SHV, bla TEM, bla IMP, bla VIM) and mcr-1 to mcr-5 genes were investigated by polymerase chain reaction (PCR). Mutations in chromosomal genes (pmrA, pmrB, phoP, phoQ, and mgrB) were screened by PCR and DNA sequencing. Clonal relatedness was established by using pulsed-field gel electrophoresis and multilocus sequence typing. FINDINGS: K. pneumoniae isolates harbored bla KPC (93.3%), bla SHV (86.6%), bla TEM (80.0%), bla CTX-M (60%) genes. Of 15 K. pneumoniae resistant to polymyxin B the authors identified deleterious mutations in pmrB gene, mainly in T157P. None K. pneumoniae presented mcr gene variants. Genetic polymorphism analyses revealed 12 different pulsotypes. MAIN CONCLUSIONS: Deleterious mutations in pmrB gene is the main chromosomal target for induction of polymyxin resistance in carbapenem-resistant K. pneumoniae in public hospitals in the Mid-West of Brazil.

Impact of pelvic radiotherapy on female sexuality.

PURPOSE: To assess physical and psychological morbidity, sexual functioning and social and relationship satisfaction among women treated with pelvic radiotherapy. METHODS: Observational (case-control) study of 199 women: 98 submitted to pelvic radiotherapy for the treatment of uterine, rectal or anal cancers and 101 without a personal history of cancer and similar socio-demographic variables. These completed a socio-demographic and clinical questionnaire, and validated measures of psychological health (DASS: Lovibond and Lovibond in Behav Res Ther 33:353-343, 1995), sexual function (FSFI: Rosen et al. in J Sex Marital Ther 26:191-208, 2007), social support (ESSS: Ribeiro in Analise Psicologica 3:547-558, 1999) and relationship satisfaction (IMS: Hudson in The WALMYR assessment scales scoring manual 1992). RESULTS: Women submitted to pelvic irradiation reported a higher rate of adverse physical symptoms in the last month: fatigue 59 versus 25% (p < 0.001), lack of strength 42 versus 20% (p = 0.001), diarrhoea 24 versus 12% (p = 0.032), vaginal discharge 17 versus 7% (p = 0.024), skin erythema 9 versus 2% (p = 0.026). Levels of depression, anxiety and stress were higher among radiotherapy patients, but only reach statistical significance for the stress parameter (6.1 vs. 4.0, p = 0.012). Also these women reported lower scores of satisfaction with social support (57.2 vs. 62.2, p = 0.005) and sexual function (8.5 vs. 13.5, p = 0.049). No statistically significant differences occurred between the two groups regarding scores of relationship satisfaction (20.8 vs. 19.9, p = n.s.). CONCLUSIONS: Our results suggested that pelvic radiotherapy had a negative impact on female sexuality. Thus, interventions that would help to reduce this impact need to be designed and integrated into routine clinical practice.

Molecular Epidemiology of blaKPC-Encoding Klebsiella pneumoniae Isolated from Public Hospitals in Midwest of Brazil.

This study was conducted to determine the molecular epidemiology of blaKPC-encoding Klebsiella pneumoniae recovered from three public hospitals in Brazil. Molecular investigation of blaOXA-48, blaKPC, blaNDM, blaCTX-M, blaSHV, blaTEM, blaIMP, and blaVIM resistance genes was performed in 99 K. pneumoniae isolates from inpatients of intensive care units. Antimicrobial susceptibility was determined with a Vitek-2 System, except for polymyxin B, which was evaluated by the microbroth dilution test. Clonal relatedness was established by pulsed-field gel electrophoresis and multilocus sequence typing. Screening resistance genes showed that K. pneumoniae isolates carried the blaKPC (88.9%), blaSHV (73.5%), blaTEM (72.2%), and blaCTX-M (43.9%) genes. The most frequent sequence types (STs) were ST273, ST11, ST 1298, ST13, ST2687, and ST37. We report new STs in K. pneumoniae that have not been detected previously in Brazil. K. pneumoniae belonging to the same clone is present in different hospitals in the same region, showing the spread of multidrug-resistant K. pneumoniae.

Transcriptome analysis of the phytobacterium Xylella fastidiosa growing under xylem-based chemical conditions.

Xylella fastidiosa is a xylem-limited bacterium responsible for important plant diseases, like citrus-variegated chlorosis (CVC) and grapevine Pierce's disease (PD). Interestingly, in vitro growth of X. fastidiosa in chemically defined media that resemble xylem fluid has been achieved, allowing studies of metabolic processes used by xylem-dwelling bacteria to thrive in such nutrient-poor conditions. Thus, we performed microarray hybridizations to compare transcriptomes of X. fastidiosa cells grown in 3G10-R, a medium that resembles grape sap, and in Periwinkle Wilt (PW), the complex medium traditionally used to cultivate X. fastidiosa. We identified 299 transcripts modulated in response to growth in these media. Some 3G10R-overexpressed genes have been shown to be upregulated in cells directly isolated from infected plants and may be involved in plant colonization, virulence and environmental competition. In contrast, cells cultivated in PW show a metabolic switch associated with increased aerobic respiration and enhanced bacterial growth rates.

Post-neurosurgical meningitis caused by KPC-producing Klebsiella pneumoniae: report of two cases.

Nosocomial bacterial infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is associated with high mortality in neurosurgical patients. There are few reports in the literature on meningitis caused by CRKP. We report two cases of CRKP meningitis after neurosurgery. The K. pneumoniae identification and antimicrobial susceptibility testing were performed using the Vitek Compact System. Minimum inhibitory concentrations of polymyxin B were determined using the broth microdilution method. Molecular typing of K. pneumoniae isolates was investigated using multilocus sequence typing. Antimicrobial susceptibility testing showed that the K. pneumoniae isolates were multidrug resistant and co-produced extended-spectrum ß-lactamases and KPC enzymes. The patients were treated with intrathecal polymyxin. Genetic polymorphism analyses revealed two different K. pneumoniae clones (ST1298 and ST2687), which were observed for the first time in CRKP infections. We recommend intravenous administration of intrathecal polymyxin for treating meningitis caused by multidrug-resistant K. pneumoniae .

Melioidosis, an emerging infectious disease in the Midwest Brazil: A case report.

RATIONALE: Melioidosis is an emerging infectious disease in Brazil and caused by Burkholderia pseudomallei, with high morbidity and mortality rates. A total of 28 melioidosis cases were reported in Brazil until 2015. The majority of melioidosis cases were reported in the Northwest region of Brazil and such cases were not previously detected in the Midwest region of Brazil. PATIENT CONCERNS: A 42-year-old man was admitted with a non-productive cough, dyspnea, myalgia, diffuse abdominal pain. Pulmonary auscultation revealed a vesicular murmur, snoring sounds, and the presence of basal crackling rales in the left hemithorax. The patient evolved with several respiratory failures and he was diagnosed as the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil. DIAGNOSIS: The cell isolates were subjected to 16S rRNA gene sequencing to confirm the bacterial species. INTERVENTIONS: Administration of trimethoprim/sulfamethoxazole and meropenem stabilized the clinical condition of the patient. Subsequently upon discharge, the patient was also treated with trimethoprim/sulfametothoxazole for a year. OUTCOME: We reported the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil and the patient survived. LESSONS: The emergence of melioidosis in the Midwest region is being neglected and underestimated and melioidosis must be considered of the differential diagnosis in community infections.

Ensino de tecnologia assistiva nos cursos de graduação em terapia ocupacional do Estado de São Paulo / Teaching assistive technology in undergraduate courses in occupational therapy in the State of São Paulo

Resumo Introdução O conhecimento sobre tecnologia assistiva relaciona-se aos aspectos do domínio da terapia ocupacional, assim, interroga-se se tal conhecimento tem sido abordado nos cursos de graduação. Objetivos Identificar os cursos de graduação em terapia ocupacional no estado de São Paulo que ofertam discipinas referentes à tecnologia assistiva, identificar as disciplinas, suas respectivas cargas horárias e o conteúdo presente em cada uma delas. Método A amostra foi composta por oito universidades, cinco públicas e três privadas. A busca foi feita nas matrizes curriculares, planos de ensino de disciplinas específicas e não específicas, objetivos e conteúdos disponibilizados on-line ou solicitados ao coordenador de curso. Realizou-se análise descritiva dos dados. Resultados Constatou-se a oferta do conteúdo de tecnologia assistiva nas universidades investigadas, com diferença entre a carga horária e o conteúdo ofertado. A análise por área de aplicação da tecnologia assistiva evidenciou que o conteúdo sobre órteses é oferecido em 100% dos cursos analisados, seguido de produtos assistivos para o desempenho de atividades cotidianas e de prótese, ambos conteúdos encontrados em 75% dos cursos; equipamentos para mobilidade; acessibilidade e desenho universal em 62,5%; comunicação alternativa em 50% dos cursos. Conclusão Os resultados apontam a relevância de uma maior homogeneidade de conteúdo entre as universidades investigadas e sugerem que este estudo tem potencial para fomentar discussões sobre a formação do terapauta ocupacional na área da tecnologia assistiva, uma vez que os resultados advêm da análise dos cursos de graduação localizados no estado que possui o maior número de cursos de terapia ocupacional no Brasil.

Abstract Introduction Knowledge about assistive technology is related to aspects of the field of occupational therapy, thus, it is questioned whether such knowledge has been addressed in undergraduate courses. Objectives To identify the undergraduate courses in occupational therapy in the state of São Paulo that offer disciplines related to assistive technology, identify the disciplines, their respective workloads and the content present in each of them. Method The sample consisted of eight universities, five public and three private. The search was made in the curricular matrices, teaching plans of specific and non-specific disciplines, objectives and contents available online or requested from the course coordinator. Descriptive data analysis was performed. Results It was found that assistive technology content was offered in the investigated universities, with a difference between the workload and the content offered. The analysis by assistive technology application area showed that the content on orthoses is offered in 100% of the analyzed courses, followed by assistive products for the performance of daily activities and prostheses, both contents found in 75% of the courses; mobility equipment; accessibility and universal design in 62.5%; alternative communication in 50% of the courses. Conclusion The results point to the relevance of greater homogeneity of content between the investigated universities and suggest that this study has the potential to foster discussions about the formation of occupational therapists in the assistive technology area, since the results come from the analysis of undergraduate courses located in the state which has the largest number of occupational therapy courses in Brazil.

Strategies for Developing Students' Empathy and Awareness for the Needs of People with Disabilities: Contributions to Design Education.

The design of products for people with disabilities requires the understanding of a wide range of factors related to users' health, functional abilities, needs, expectations and preferences. Such multifactorial perspective is often perceived as beyond the reach by the students of both graphic and product design, as it comprises knowledge from different areas such are not usually part of design curriculum as health, rehabilitation, computer science and biomedical engineering. Here, we report on strategies for developing design students' empathy and awareness for the needs and expectations of people with disabilities. By means of a combination of theoretical and practical approaches, a course on Inclusive Design was developed as part of the regular curriculum of the Bachelor Programme in Design at Sao Paulo State University (UNESP, Bauru campus, Brazil), with the collaborative participation of members of SORRI BAURU Rehabilitation Center. The final projects developed by the students were based on the demands presented by SORRI BAURU's rehabilitation team, and results reveal that the theoretical-practical approach based on interdisciplinarity was shown to provide the design students a learning experience that, ultimately, supports the quality decision-making in the design process. This paper describes the pedagogical approach, theoretical contents and practical activities developed during the Inclusive Design course. The challenges, benefits, results, and contributions of this experience from the perspective of the design education are also discussed.

Evaluation of environmental effects on reproductive characteristics of Mangalarga Marchador mares in a commercial embryo transfer program.

The objective of this study was to evaluate the environmental effects on embryo recovery rate and pregnancy rate of Mangalarga Marchador mares. The reproductive characteristics of donor and recipient mares were evaluated during five years in Brazilian tropical environment. The mares were used throughout the year and seasons were classified as: October to April (breeding season - BS); May (autumn transition out of the breeding season - ATBS); June to August (non-breeding season - nBS); and September (vernal transition into the breeding season - VTBS). Daily temperature rainfall and hours of daylight (photoperiod) were measured during all months and years of evaluation. The embryo recovery rate (ERR) and the pregnancy rate (PR) were observed and frequencies were calculated. The effect of environmental variables, day of flushing, and hormonal treatments (estradiol benzoate and progesterone) were determined for the reproductive measures using the Chi-square and Kruskal-Wallis tests. Significant effects were noted of the year, season and temperature on ERR (P < 0.05), but no significant effects were observed of the environmental parameters (year, season, hormone treatment, rainfall and photoperiod) on PR (P > 0.05). The day of uterine flush affected ERR (P < 0.05) but did not affect PR (P > 0.05). In addition, hormone treatment also supported favorable results of PR in recipient mares during nBS. The conclusion is that mares of this breed can be used in reproduction all year long, with good pregnancy rates, in Brazil's tropical environment. The hormone treatment also supported favorable pregnancy rates in recipient mares during the non-breeding season. It seems that mares can have good pregnancy rates throughout the year in Brazil´s tropical environment.

Photoacclimation strategies in northeastern Atlantic seagrasses: Integrating responses across plant organizational levels.

Seagrasses live in highly variable light environments and adjust to these variations by expressing acclimatory responses at different plant organizational levels (meadow, shoot, leaf and chloroplast level). Yet, comparative studies, to identify species' strategies, and integration of the relative importance of photoacclimatory adjustments at different levels are still missing. The variation in photoacclimatory responses at the chloroplast and leaf level were studied along individual leaves of Cymodocea nodosa, Zostera marina and Z. noltei, including measurements of variable chlorophyll fluorescence, photosynthesis, photoprotective capacities, non-photochemical quenching and D1-protein repair, and assessments of variation in leaf anatomy and chloroplast distribution. Our results show that the slower-growing C. nodosa expressed rather limited physiological and biochemical adjustments in response to light availability, while both species of faster-growing Zostera showed high variability along the leaves. In contrast, the inverse pattern was found for leaf anatomical adjustments in response to light availability, which were more pronounced in C. nodosa. This integrative plant organizational level approach shows that seagrasses differ in their photoacclimatory strategies and that these are linked to the species' life history strategies, information that will be critical for predicting the responses of seagrasses to disturbances and to accordingly develop adequate management strategies.

Structural and physiological responses of Halodule wrightii to ocean acidification.

Coastal areas face high variability of seawater pH. Ocean acidification (OA) and local stressors are enhancing this variability, which poses a threat to marine life. However, these organisms present potential phenotypic plasticity that can offer physiological and structural tools to survive in these extreme conditions. In this study, we evaluated the effects of elevated CO2 levels and consequent pH reduction on the physiology, anatomy and ultrastructure of the seagrass Halodule wrightii. A mesocosm study was conducted in an open system during a 30-day experiment, where different concentrations of CO2 were simulated following the natural variability observed in coastal reef systems. This resulted in four experimental conditions simulating the (i) environmental pH (control condition, without CO2 addition) and (ii) reduced pH by - 0.3 units, (iii) - 0.6 units and (iv) - 0.9 units, in relation to the field condition. The evaluated population only suffered reduced optimum quantum yield (Y(II)), leaf width and cross-section area under the lowest CO2 addition (- 0.3 pH units) after 30 days of experiment. This fitness commitment should be related to carbon concentration mechanisms present in the evaluated species. For the highest CO2 level, H. wrightii demonstrated a capacity to compensate any negative effect of the lowest pH. Our results suggest that the physiological behaviour of this primary producer is driven by the interactions among OA and environmental factors, like irradiance and nutrient availability. The observed behaviour highlights that high-frequency pH variability and multifactorial approaches should be applied, and when investigating the impact of OA, factors like irradiance, nutrient availability and temperature must be considered as well.

First record of in vitro formation of ectomycorrhizae in Psidium cattleianum Sabine, a native Myrtaceae of the Brazilian Atlantic Forest.

Like many other species of trees native to the Brazilian Mata Atlântica (Atlantic Forest), the Myrtaceae, such as the Red Araza (Psidium cattleianum Sabine), are widely cited as arbuscular mycorrhizal formers. Nevertheless, recent studies show evidence that Myrtaceae from different tropical, subtropical and neotropical ecosystems can also prompt the formation of ectomycorrhizae, indicating that this species' ectomycorrhizal status should be further explored. Because of this, this research effort studied the in vitro interaction between the Red Araza and two ectomycorrhizal fungi isolates, belonging to the Pisolithus microcarpus (D17) and Scleroderma citrinum (UFSC-Sc133) species. An analysis was performed to determine the formation of ectomycorrhizal structures, or lack thereof, and the developmental differences between the in vitro mycorrhized and non-mycorrhized plants. The analysis proved that indeed an ectomycorrhizal association was developed between the Red Araza, and the D17 and UFSC-Sc133 isolates, a fact never before registered in the existing literature. After an in vitro period of 110 days, it was confirmed that the D17 and UFSC-Sc133 isolates formed mycorrhizal colonization of 91.6% and 15.7%, respectively. Furthermore, both isolates also promoted root thickening, and the formation of a fungal mantle and a Hartig net. However, when compared to the Control plants, the fungal isolates did not contribute to an increase in the development of the subject plants, possibly due to the specific experimental conditions used, such as a high humidity environment and high availability of nutrients in the symbiotic substrate.

KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil.

The emergence of ß-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the bla KPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.

Development of the SORRI-BAURU Posterior Walker.

This study aimed to report on the design and development of a low cost Reverse Walker through a participative development cycle with people undergoing rehabilitation. The creation and fundamentals of the concept are described, as well as the development of prototypes and their provision to subjects with mobility problems. The Reverse Walker benefits the user by promoting a more upright posture and favoring the development of postural balance. Enhancing the mobility of people with disabilities may benefit their independence, social participation and quality of life.

Non-clonal occurrence of pmrB mutations associated with polymyxin resistance in carbapenem-resistant Klebsiella pneumoniae in Brazil

BACKGROUND Polymyxins are currently used as a "last-line" treatment for multidrug-resistant Gram-negative infections. OBJECTIVES To identify the major mechanisms of resistance to polymyxin and compare the genetic similarity between multi-drug resistant Klebsiella pneumoniae strains recovered from inpatients of public hospitals in the Mid-West of Brazil. METHODS 97 carbapenems non-susceptible K. pneumoniae were studied. β-lactamases (bla OXA-48, bla KPC, bla NDM, bla CTX-M, bla SHV, bla TEM, bla IMP, bla VIM) and mcr-1 to mcr-5 genes were investigated by polymerase chain reaction (PCR). Mutations in chromosomal genes (pmrA, pmrB, phoP, phoQ, and mgrB) were screened by PCR and DNA sequencing. Clonal relatedness was established by using pulsed-field gel electrophoresis and multilocus sequence typing. FINDINGS K. pneumoniae isolates harbored bla KPC (93.3%), bla SHV (86.6%), bla TEM (80.0%), bla CTX-M (60%) genes. Of 15 K. pneumoniae resistant to polymyxin B the authors identified deleterious mutations in pmrB gene, mainly in T157P. None K. pneumoniae presented mcr gene variants. Genetic polymorphism analyses revealed 12 different pulsotypes. MAIN CONCLUSIONS Deleterious mutations in pmrB gene is the main chromosomal target for induction of polymyxin resistance in carbapenem-resistant K. pneumoniae in public hospitals in the Mid-West of Brazil.

[Dysmenorrhea in adolescents and young adults: prevalence, related factors and limitations in daily living]. / Dismenorreia em adolescentes e jovens adultas: prevalência, factores associados e limitações na vida diária.

OBJECTIVE: To determine the prevalence of dysmenorrhea, limitations in daily living and health care use due to menstrual pain. MATERIAL AND METHODS: Observational transversal study of 274 adolescents and young adults (age ≤ 26) who had menstruated in the six months prior to the study, assisted at a Primary Health Care Center. Data were obtained by a 24-item anonymous questionnaire, which included questions about socio-demographic variables, menstrual cycle, presence, duration, severity, treatment and limitations of dysmenorrhea. RESULTS: One hundred and seventy-two (62.8%) subjects experienced menstrual pain. Of these, 65.7% reported having limitations in their daily activities due to dysmenorrhea. The prevalence of limitations in daily living was influenced by the presence of additional symptoms (r=0.331; p <0.001), pain intensity (r=0.281; p <0.001) and pain duration (r=0.172; p=0.027). The most commonly mentioned limitation was anxiety/depression (42.5%). Fourteen of the subjects reported missing school or work due to dysmenorrhea. A total of 48 respondents sought medical help and 135 reported using therapeutic measures to ease their pain. The most common treatments reported for pain treatment included NSAID's (38.5%) and oral pills (37.0%). The existence of additional symptoms (r=0.247; p=0.001) and the intensity of pain (r=0.160; p=0.039) led to the search for health care. CONCLUSIONS: Dysmenorrhea is highly prevalent among this sample of adolescents and young adults and is related to absenteeism. Thus, health care providers should regularly screen for dysmenorrhea and offer appropriate treatment.

Metallo-ß-lactamase and genetic diversity of Pseudomonas aeruginosa in intensive care units in Campo Grande, MS, Brazil.

Infection by Pseudomonas aeruginosa has spread worldwide, with limited options for treatment. The purpose of this study was to investigate metallo-ß-lactamase-producing P. aeruginosa strains and compare their genetic profile using samples collected from patients in intensive care units. Forty P. aeruginosa strains were isolated from two public hospitals in Campo Grande, Mato Grosso do Sul State, from January 1st, 2007 to June 31st, 2008. Profiles of antimicrobial susceptibility were determined using the agar diffusion method. Metallo-ß-lactamase was investigated using the double-disk diffusion test and PCR. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Respiratory and urinary tracts were the most common isolation sites. Of the 40 samples tested, 72.5% (29/40) were resistant to ceftazidime and 92.5% (37/40) to imipenem, whereas 65% (26/40) were resistant to both antimicrobials. Fifteen pan-resistant samples were found. Five percent (2/40) of samples were positive for metallo-ß-lactamase on the phenotype test. No metallo-ß-lactamase subtype was detected by PCR. Macrorestriction analysis revealed 14 distinct genetic patterns. Based on the superior accuracy of PCR, it can be inferred that P. aeruginosa isolates from the investigated hospitals have alternative mechanisms of carbapenem resistance. The results also suggest clonal spread of P. aeruginosa between the studied hospitals.

KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil

The emergence of β-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the blaKPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.

Atenção ao aborto no Sistema Único de Saúde no Nordeste Brasileiro: a estrutura dos serviços / Abortion care in the Brazilian National Health Service in the Northeast of Brazil: the structure of services

Avaliar a estrutura de maternidades que prestam atenção a mulheres em situação de abortamento no Sistema Único de Saúde, em Salvador, Recife e São Luís. Métodos: foram selecionadas três maternidades em cada capital. Os dados foram obtidos por entrevista com gerente do serviço ou equipe de direção e observação direta. Utilizou-se instrumento com 120 questões pontuadas abrangendo seis componentes - planta física, recursos materiais, recursos humanos, materiais de consumo, educação em saúde e ferramentas de gestão que incorporam quatro dimensões de avaliação - insumo/ambiente físico; qualidade técnica e gerencial do cuidado; acolhimento/orientação e continuidade da atenção. Os resultados foram categorizados pelo percentual obtido em relação ao máximo esperado: suficiente (B a 80 por cento); intermediário (de 50 por cento a 79 por cento); insuficiente (< 50 por cento). Resultados: os componentes melhor pontuados foram planta física, recursos materiais e material de consumo. Educação em saúde e ferramentas de gestão tiveram pior pontuação. Nenhuma unidade atingiu nível considerado suficiente. Sete foram classificadas no nível intermediário e duas insuficiente. Conclusões: as unidades estudadas não apresentam estrutura adequada para o modelo de atenção ao abortamento preconizado. Há necessidade de intervenções para qualificar a estrutura dos serviços para a atenção ao aborto e promover a huma-nização do cuidado...

To assess the structure of maternity hospitals that provide care for woman undergoing abortions in the Brazilian National Health Service in the cities of Salvador, Recife and São Luís. Methods: three maternity hospitals were selected in each State capital. The data were obtained by way of interviews with the service manager or team of directors and direct observation. The interviews involved 120 questions divided into six sections - physical infrastructure, material resources, human resources, consumable materials, health education and management tools, covering four areas of evaluation - materials/physical environment; technical quality and care management; reception/guidance and continuity of care. The results were presented as a percentage of the maximum possible score: adequate (B80 percent); average (50 percent - 79 percent); inadequate (< 50 percent). Results: the highest scoring sections were physical infrastructure, material resources and consumable materials. Health education and management tools received the worst scores. No unit was deemed to have attained an adequate level of care. Seven were classified as average and two as inadequate. Conclusions: the units studied did not have an adequate structure for the intended abortion care model. There is a need for intervention to improve the structure of abortion care services and to promote the humanization of care...