Hospital In Recife Research Articles

O videogame ativo como estratégia do profissional de educação física no auxílio do tratamento de câncer infanto-juvenil

Buscou-se conhecer e analisar a percepção de crianças e adolescentes acerca da utilização do videogame ativocomo uma estratégia do profissional de educação física para auxiliar no enfrentamento do período de hospitalização de crianças e adolescentes para tratamento de câncer. Trata-se de uma pesquisa-ação que envolveu 14 pacientes com média de idade de 11,21 anos, internados no Centro Hospitalar de Oncohematologia Pediátrica do Hospital Universitário Oswaldo Cruz em Recife, Pernambuco. Utilizou-se da entrevista semiestruturada, da observação participante e do diário de campo para coleta de dados. Foram utilizados o X-Box 360 com Kineckte jogos de esporte e dança. Os resultados apontaram a aceitação do grupo de pacientes em relação aos jogos do videogame ativo, configurando-o em uma possível estratégia do profissional de educação física para auxiliar no de enfrentamento do período de hospitalização para tratamento oncológico. 

Factors associated with spontaneous perineal lacerations in deliveries without episiotomy in a university maternity hospital in the city of Recife, Brazil: a cohort study

Objectives: The objective of this study is to determine factors associated with spontaneous perineal laceration in low-risk pregnant women who delivered vaginally without episiotomy in a university maternity hospital in Recife, Pernambuco, Brazil.Methods: A prospective cohort study was conducted with 222 low-risk, full-term pregnant women admitted in labor with a single fetus in cephalic presentation. Women with malformed fetuses were excluded from the study. The variables analyzed were: the frequency and severity of lacerations, the women’s biological, sociodemographic, clinical and obstetrical characteristics, neonatal characteristics, and data on their deliveries and procedures. For the data analysis, risk ratios and their 95% confidence intervals were calculated. A significance level of 5% was adopted and multiple regression analysis was performed.Results: Spontaneous first-degree perineal tears were registered in 47% of the women, second-degree tears in 31%, and third degree tears in only 1.8%. There were no cases of fourth-degree tears. Having experienced normal childbirth previously constituted a protective factor against vaginal tearing (OR = 0.46; 95%CI: 0.23–0.91; p = .027).Conclusion: The principal protective factor against spontaneous lacerations was having experienced normal childbirth previously. Intrapartum strategies aimed at protecting the perineum and pelvic floor muscle training during prenatal care should be encouraged in these women.

To improve the communication between companion and patient, companion and team

Introduction: Multidisciplinary intervention with a group of followers of the oncology ward of a school hospital in Recife. During the internment, the anxieties that emerge are broad and complex, permeated by intense feelings like fear, insecurity, anger, revolt and sadness. This symptomatology is natural from the moment of crisis, rupture, (re) adaptation, which exposes the human being in his greatest weaknesses, anxieties and anxieties. Objectives: To provide a space of collective care through the exchange of experience, expression and resignification; to improve the communication between companion and patient, companion and team; provide information and guidance that facilitates the organization of the care routine. Methodology: The meeting took place weekly from the invitation made by the team. The group started with the presentation of the facilitators and then the presentation of the companions who said their name, the patient who was accompanying and had some degree of kinship with the same. This group was open, heterogeneous, educational and therapeutic, depending on the demand brought by the companions during the individual visits during the week. Results: Emotional strengthening of the rights and duties of the companions, and choice of coping strategies more effective. Conclusion: Extended and interdisciplinary care based on the knowledge of the needs of the companions for better patient care.

Intracameral moxifloxacin after cataract surgery: a prospective study.

To study the safety parameters associated with intracameral moxifloxacin application five weeks after cataract surgery. The study was a prospective case series set in a private hospital in Recife, Pernambuco, Brazil. A consecutive sample of 1,016 cataract surgeries was evaluated. The inclusion criteria were patients with indications for cataract surgery, a minimum of 55 years of age, and no history of allergy to quinolones. Patients were prepared for surgery using a 5% povidone solution diluted as a topical antiseptic agent. The operative technique was phacoemulsification with intraocular lens implantation. A 0.3-mL syringe was partially filled with moxifloxacin and 150 µg/0.03 mL of moxifloxacin was administered through the surgical incision at the end of the surgery. Postoperatively, patients were prescribed: (1) 0.5% moxifloxacin eyedrops 5 times daily for 1 week, and (2) 1% prednisolone acetate eyedrops 5 times daily for 1 week, followed by 4 times daily for 1 week and, subsequently, 2 times daily for 3 weeks. The outcomes were incidence of acute endophthalmitis, mean changes from baseline to 5 postoperative weeks in corneal endothelial cell density, corrected distance visual acuity and intraocular pressure. The mean age was 67 ± 5 years, and 56.2% of the patients were female. There were no cases of endophthalmitis. The mean preoperative corrected distance visual acuity was 58 letters ± 10 (SD), and the mean postoperative corrected distance visual acuity was 80 letters ± 4 (SD). The mean change in corneal endothelial cell density was 249 cells/mm (-10.3%). There was almost no difference in intraocular pressure. No study-related adverse events were observed. The results suggest moxifloxacin is a safe option for intracameral use after cataract surgery.

Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study

A Zika virus epidemic emerged in northeast Brazil in 2015 and was followed by a striking increase in congenital microcephaly cases, triggering a declaration of an international public health emergency. This is the final report of the first case-control study evaluating the potential causes of microcephaly: congenital Zika virus infection, vaccines, and larvicides. The published preliminary report suggested a strong association between microcephaly and congenital Zika virus infection. We did a case-control study in eight public maternity hospitals in Recife, Brazil. Cases were neonates born with microcephaly, defined as a head circumference of 2 SD below the mean. Two controls without microcephaly were matched to each case by expected date of delivery and area of residence. We tested the serum of cases and controls and the CSF of cases for detection of Zika virus genomes with quantitative RT-PCR and for detection of IgM antibodies with capture-IgM ELISA. We also tested maternal serum with plaque reduction neutralisation assays for Zika and dengue viruses. We estimated matched crude and adjusted odds ratios with exact conditional logistic regression to determine the association between microcephaly and Zika virus infection. We screened neonates born between Jan 15 and Nov 30, 2016, and prospectively recruited 91 cases and 173 controls. In 32 (35%) cases, congenital Zika virus infection was confirmed by laboratory tests and no controls had confirmed Zika virus infections. 69 (83%) of 83 cases with known birthweight were small for gestational age, compared with eight (5%) of 173 controls. The overall matched odds ratio was 73·1 (95% CI 13·0-∞) for microcephaly and Zika virus infection after adjustments. Neither vaccination during pregnancy or use of the larvicide pyriproxyfen was associated with microcephaly. Results of laboratory tests for Zika virus and brain imaging results were available for 79 (87%) cases; within these cases, ten were positive for Zika virus and had cerebral abnormalities, 13 were positive for Zika infection but had no cerebral abnormalities, and 11 were negative for Zika virus but had cerebral abnormalities. The association between microcephaly and congenital Zika virus infection was confirmed. We provide evidence of the absence of an effect of other potential factors, such as exposure to pyriproxyfen or vaccines (tetanus, diphtheria, and acellular pertussis, measles and rubella, or measles, mumps, and rubella) during pregnancy, confirming the findings of an ecological study of pyriproxyfen in Pernambuco and previous studies on the safety of Tdap vaccine administration during pregnancy. Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Detection of multidrug-resistant Pseudomonas aeruginosa harboring bla GES-1 and bla GES-11 in Recife, Brazil.

Pseudomonas aeruginosa, an important pathogen globally, presents several resistance mechanisms. This study aimed to investigate the presence of bla GES in clinical isolates of Pseudomonas aeruginosa obtained from various clinical specimens from patients admitted to three different hospitals in Recife, Brazil. The Guiana extended spectrum beta-lactamase (GES) enzymes are responsible for conferring broad spectrum resistance to beta-lactam drugs, including the carbapenems. A total of 100 carbapenem-resistant P. aeruginosa isolates underwent polymerase chain reaction (PCR) testing to identify bla GES, bla KPC, bla SPM-1, bla IMP, and bla VIM. Additionally, PCR products positive for bla GES were sequenced. The clonal profiles of these same isolates were then determined by means of enterobacterial repetitive intergenic consensus (ERIC)-PCR analysis. PCR analysis revealed that four isolates harbored bla GES; DNA sequencing showed that two harbored bla GES-1 and two bla GES-11. Beta-lactamase genes bla SPM-1, bla IMP, bla VIM, and bla KPC were investigated; none of these genes was detected. Automated susceptibility testing methods (Vitek®2, bioMérieux) showed that the bla GES-1-positive isolates were only susceptible to polymyxin B. The patterns obtained with ERIC-PCR methods showed clonal relationship between the two isolates that harbored bla GES-11, whereas different clonal profiles were found in the isolates harboring bla GES-1. We detected the presence of bacterial isolates positive for two different variants of the enzyme GES in three different hospitals from Recife, Brazil. These enzymes have a great capacity for dissemination among Gram-negative bacteria and confer broad-spectrum resistance to beta-lactam antibiotics and to the carbapenems.

AVALIAÇÃO DO AUTOCUIDADO NOS PORTADORES DE INSUFICIÊNCIA CARDÍACA

O objetivo deste estudo foi caracterizar o perfil clínico e sociodemográfico dos portadores de Insuficiência Cardíaca e descrever o comportamento de autocuidado. Estudo transversal descritivo, com amostra não probabilística de 57 pacientes da enfermaria cardiológica de hospital público do Recife, Brasil, entre maio e setembro de 2016. O autocuidado foi avaliado pela Self-Care of Heart Failure Index versão 6.2, versão brasileira. A idade média dos participantes foi de 62,9 anos; 31 (54,4%) homens; 36 (63,2%) alfabetizados; 26 (45,6%) de etiologia hipertensiva e 30 (52,6%) em classe funcional III. As médias dos escores nas subescalas indicaram autocuidado inadequado (manutenção do autocuidado: 43,3; manejo do autocuidado: 37,5 e confiança do autocuidado: 54,3). Escores mais elevados foram associados com escolaridade, os alfabetizados obtiveram média de 61 pontos (p=0,002). São necessários investimentos para melhorar o autocuidado e a enfermagem pode ter papel relevante nessa melhora.

Selective episiotomy vs. implementation of a non-episiotomy protocol: a randomized clinical trial

BackgroundDespite all the evidence corroborating the selective use of episiotomy and although routine use of the procedure is contraindicated, there are no evidences corroborating if episiotomy is necessary in any circumstance. The present clinical randomized trial was performed to compare maternal and perinatal outcomes in women submitted to a non-episiotomy protocol versus one of selective episiotomy.MethodsAn open-labelled, randomized clinical trial was carried out in a tertiary teaching hospital in Recife, Northeastern Brazil. Women in labor with a full-term live foetus, dilatation of 6 to 8 cm and cephalic presentation (vertex position) were included. Exclusion criteria consisted of bleeding disorders and an indication for a caesarean section. After signing the consent form, 241 women were randomized to a non-episiotomy protocol (the experimental group) or to a selective episiotomy group (the control group). No episiotomies were to be performed in the experimental group except under exceptional circumstances. In the control group, selective episiotomies were to be performed in accordance with the healthcare professionals’ clinical judgement. Maternal and perinatal outcomes were evaluated. Ratio Risk (RR) and the 95% confidence interval (95% CI) were calculated for our outcomes.ResultsThe analysis include 115 women assigned to a non-episiotomy protocol and 122 to selective episiotomy. There was no difference between the two groups with respect to maternal or perinatal outcomes. The episiotomy rate was similar (two cases in each group, about 1.7%), as was the duration of the second stage of labor, the frequency of perineal tears, severe perineal trauma, need for perineal suturing and blood loss at delivery.ConclusionsA non-episiotomy protocol appears to be safe for mother and child, and highlights the need to investigate whether there is, in fact, any indication for this procedure.Trial registrationThis trial was registered at ClinicalTrials.gov under reference number (NCT02178111).

First isolation and RFLP genotyping of Toxoplasma gondii from crab-eating fox (Cerdocyon thous—Linnaeus, 1766)

Wild animals may play an important role in the transmission and maintenance of Toxoplasma gondii in the environment. The purpose of the present study was to isolate and genotype T. gondii from a free-ranging crab-eating fox (Cerdocyon thous—Linnaeus, 1766). A crab-eating fox in critical health condition was attended in a veterinary hospital in Recife, Pernambuco State, Brazil. The animal died despite emergency treatment. The brain was collected aseptically and destined for mouse bioassay. One isolate of T. gondii was obtained, and Polymerase Chain Reaction − Restriction Fragment Length Polymorphism (PCR-RFLP) was used to assess genetic variability at 11 markers (SAG1, SAG2, altSAG2, SAG3, BTUB, GRA6, c228, c292, L358, PK1 and APICO). A murine model was used to assess the virulence of the isolate. Using the PCR-RFLP, genotype ToxoDB #13 was identified, which is considered an atypical strain. The isolate was classified as avirulent in the murine model. This is the first study to report T. gondii infection in the crab-eating fox.

Clonal spread and accumulation of β-lactam resistance determinants in Enterobacter aerogenes and Enterobacter cloacae complex isolates from infection and colonization in patients at a public hospital in Recife, Pernambuco, Brazil.

Enterobacter aerogenes and Enterobacter cloacae complex are the two species of this genus most involved in healthcare-associated infections that are ESBL and carbapenemase producers. This study characterized, phenotypically and genotypically, 51 isolates of E. aerogenes and E. cloacae complex originating from infection or colonization in patients admitted to a public hospital in Recife, Pernambuco, Brazil, by antimicrobial susceptibility profile, analysis of β-lactamase genes (blaTEM, blaSHV, blaCTX-M, blaKPC, blaVIM, blaIMP and blaSPM), PCR and DNA sequencing, plasmid profile and ERIC-PCR. In both species, the genes blaTEM, blaCTX-M and blaKPC were detected. The DNA sequencing confirmed the variants blaTEM-1, blaCTX-M-15 and blaKPC-2 in isolates. More than one gene conferring resistance in the isolates, including the detection of the three previously cited genes in strains isolated from infection sites, was observed. The detection of blaCTX-M was more frequent in isolates from infection sites than from colonization. The gene blaKPC predominated in E. cloacae complex isolates obtained from infections; however, in E. aerogenes isolates, it predominated in samples obtained from colonization. A clonal relationship among all of E. aerogenes isolates was detected by ERIC-PCR. The majority of E. cloacae complex isolates presented the same ERIC-PCR pattern. Despite the clonal relation presented by the isolates using ERIC-PCR, different plasmid and resistance profiles and several resistance genes were observed. The clonal dissemination and the accumulation of β-lactam resistance determinants presented by the isolates demonstrated the ability of E. aerogenes and E. cloacae complex, obtained from colonization and infection, to acquire and maintain different resistance genes.

Humanization in obstetric care: Psychodrama as an instrument in the learning processes

This article presents reports of a role-playing and sociodrama experience used in the development of teams in obstetric care, carried out between 2000 and 2002, as an integral part of the Ministry of Health program in Humanized Assistance to Women. The objective was to qualify, with the principles of Humanization, the mid- and senior-level professionals who worked in prenatal, childbirth and puerperium services in Brazilian public maternity hospitals in Recife, Joao Pessoa and Macapa.

Delivery care and the inadequacy of the obstetric care network in Pernambuco

Abstract Objectives: this study aims to evaluate parturition distribution of live-born children within the First Health Regional Administration (GERES I) in the state of Pernambuco, Brazil in 2012. Methods: live Birth Certificates were used to evaluate displacements between pregnant women's residential municipalities and birth localities. Flux maps were constructed to represent pregnant women transferred to Recife, and the estimated number of live-borns with high-risk and regular births was calculated for each municipality. Results: in 2012, only 50% of the births of live babies in the GERES I took place at the original residential municipality of the mother. In Recife, the number of childbirths was 1.5 times greater than expected for this year, with 56% representing non-residents. Eleven municipalities of the GERES I have maternity hospitals, however, none of these responded to the expected number of regular risk births. Conclusions: this disruption of the obstetric network leads to the disrespecting of women's right to know beforehand the place of childbirth and to create bonds with it. Municipalities perform fewer childbirths than expected, resulting in unnecessary transfers and the overloading of maternity hospitals in Recife.

Ultrastructural changes caused by polymyxin B and meropenem in multiresistant Klebsiella pneumoniae carrying blaKPC-2 gene.

The ultrastructural alterations caused by polymyxin B and meropenem and by the association between polymyxin B and meropenem were investigated in two multiresistant isolates of Klebsiella pneumoniae (K3-A2 and K12-A2) carriers of blaKPC-2, coming from infection and colonization in patients in a public hospital in Recife, Brazil. The ultrastructural changes were detected by transmission electron microscopy and scanning. The susceptibility of the isolates to antimicrobials was tested by the disc diffusion method and microdilution in broth. The analysis by electron microscopy showed that the isolates presented morphological and ultrastructural cellular changes when subjected to a clinically relevant concentration of antimicrobials alone or in combination. When subjected to meropenem, they presented retraction of the cytoplasmic material, rupture of the cell wall and extravasation of the cytoplasmic content. When submitted to polymyxin B, the isolates showed condensation of the ribosomes, DNA clotting, cell wall thickening and the presence of membrane compartment. When subjected to polymyxin B and meropenem in combination, the isolates showed a higher intensity of the ultrastructural changes visualized. This is the first report of the ultrastructural changes caused by polymyxin B and meropenem in multiresistant isolates of K. pneumoniae carriers of the blaKPC-2 gene. It should be noted that even when the K. pneumoniae isolates were multiresistant carriers of the blaKPC-2 gene, they underwent important structural change owing to the action of polymyxin B and meropenem.

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study

The microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy. We did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities. Between Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6-∞); OR 113·3 (95% CI 14·5-∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9-∞) for four cases without brain abnormalities. Our data suggest that the microcephaly epidemic is a result of congenital Zika virus infection. We await further data from this ongoing study to assess other potential risk factors and to confirm the strength of association in a larger sample size. Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Detection of blaSPM-1, blaKPC, blaTEM and blaCTX-M genes in isolates of Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. from cancer patients with healthcare-associated infections.

Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. are three of the pathogens most frequently involved in infections of cancer patients, and the production of β -lactamases is a major mechanism of resistance due to its wide diversity of existing enzymes. Therefore, the aim of the present study was to investigate the microbiological profile and data related to patients and infections, and to search for β -lactamase genes in bacterial isolates from hospitalized cancer patients in a hospital in Recife, Pernambuco, Brazil. A total of 169 isolates were recovered between 2012 and 2014, of which 58 were P. aeruginosa, 36 were Acinetobacter spp. and 75 were Klebsiella spp. A high percentage of carbapenem resistance was observed in P. aeruginosa and Acinetobacter spp. Among the carbapenem-resistant bacteria, the blaSPM-1 gene was detected in P. aeruginosa (35.5 %) and Acinetobacter spp. (3.8 %), while blaKPC was detected in P. aeruginosa (25.8 %) only. Among the third- and fourth-generation cephalosporin-resistant strains, in Klebsiella spp. we detected the genes blaTEM (30.6 %), blaCTX-M (58.3 %) and blaKPC (5.6 %), and in Acinetobacter spp. only blaTEM (25.9 %). This the first report of an Acinetobacter baumannii blaSPM-1 gene carrier that has been isolated in Brazil. The most frequent cancer types were bowel tumour [14.8 %; 95 % confidence interval (CI95 %) 9.8-21.1 %], breast cancer (13.6 %; CI95 % 8.8-19.7 %) and prostate cancer (11.2%; CI95 % 6.9-17.0 %). These results therefore provide knowledge of susceptibility profile and resistance mechanisms and thus can contribute to the strategic formulation of hospital infection control plans and the rational use of antimicrobials, reducing mortality from infection levels in cancer patients.

Transorbital Ultrasonographic Measurement of the Optic Nerve Sheath Diameter in Preeclampsia [24J

INTRODUCTION: Preeclampsia is ranked as the second leading cause of maternal mortality worldwide, mostly due to acute cerebral complications. The objective of this study is to estimate the frequency of increased intracranial pressure (ICP) using transorbital ultrasound among pregnant women with and without preeclampsia. METHODS: Between September and October 2014, a cross-sectional study was conducted in a tertiary care hospital in Recife, Brazil. Ultrasonographic measurements of the optic nerve sheath diameter (ONSD), using a 10–12 MHz ultrasound linear probe, were performed in two groups: preeclamptic patients and non-preeclamptic pregnant women. Fisher's exact test was used to compare categorical data established to detect increased intracranial pressure between groups. RESULTS: A total of 33 cases were included in the study: 18 women with and 15 without preeclampsia with a mean (SD) age of 27.7 (7.4) and 23.3 (7.2) years respectively. The most frequent severe features in the patients with preeclampsia were: BP ≥160/110 mm Hg (100%), headache (22.2%) and focal neurologic signs (22.2%). Signs of elevated ICP were found in 27.7% of preeclamptic women, whereas none of the healthy ones had the ONSD measurement above 5 mm (value associated to detect ICP >20 cm H2O with a sensitivity of 88% and specificity of 93%). There was a statistically significant relation between increased ICP and preeclampsia (P<.05). CONCLUSION: Ultrasonographic measurement of the ONSD is a promising tool for the assessment of increased ICP and risk stratification in patients with preeclampsia. Further studies are necessary to substantiate the value of this non-invasive technique considering the possible neurologic complications in preeclampsia.

Phenotypic and molecular characterization of resistance to macrolides, lincosamides and type B streptogramin of clinical isolates of Staphylococcus spp. of a university hospital in Recife, Pernambuco, Brazil

IntroductionThere is a mechanism of macrolide resistance in Staphylococcus spp. which also affects the lincosamides and type B streptogramins characterizing the so-called MLSB resistance, whose expression can be constitutive (cMLSB) or inducible (iMLSB) and is encoded mainly by ermA and ermC genes. The cMLSB resistance is easily detected by susceptibility testing used in the laboratory routine, but iMLSB resistance is not. Therapy with clindamycin in cases of infection with isolated iMLSB resistance may fail. ObjectiveTo characterize the phenotypic (occurrence of cMLSB and iMLSB phenotypes) and molecular (occurrence of ermA and ermC genes) profiles of MLSB resistance of clinical isolates of susceptible and methicillin-resistant Staphylococcus aureus and CNS (coagulase-negative Staphylococcus) from patients of a university hospital, in Pernambuco. MethodsThe antimicrobial susceptibility of 103 isolates was determined by the disk diffusion technique in Mueller–Hinton agar followed by oxacillin screening. The iMLSB phenotype was detected by D test. Isolates with cMLSB and iMLSB phenotypes were subjected to polymerase chain reaction (PCR) for the detection of ermA and ermC genes. ResultsThe cMLSB and iMLSB phenotypes were respectively identified in 39 (37.9%) and five (4.9%) isolates. The iMLSB phenotype was found only in four (10.8%) methicillin-susceptible S. aureus and one (4.5%) methicillin-resistant S. aureus. In the 44 isolates subjected to PCR, four (9.1%) only ermA gene was detected, a lower frequency when compared to only ermC 17 (38.6%) gene and to one (2.3%) isolate presenting both genes. ConclusionIn the Staphylococcus spp. analyzed, the ermC gene was found more often than the ermA, although the iMLSB phenotype had been less frequent than the cMLSB. It was important to perform the D test for its detection to guide therapeutic approaches.

Prostatic artery embolization: radiation exposure to patients and staff

The aim of this study was to evaluate the radiation doses to patients and staff received from the first cases of prostatic artery embolization (PAE) conducted in a public hospital in Recife, Brazil. Five PAE procedures for 5 men diagnosed with benign prostatic hyperplasia were investigated. In order to characterize patient exposure, dosimetric quantities, such as the air kerma-area product (PKA), the cumulative air kerma at the interventional reference point (Ka,r), the number of images, etc, were registered. To evaluate the possibility for deterministic effects, the peak skin dose (PSD) was measured using radiochromic films. For evaluation of personal dose equivalent and effective dose to the medical staff, thermoluminescent dosemeters (TLD-100) were used. The effective dose was estimated using the double dosimetry alghoritm of von Boetticher. The results showed that the mean patient’s PSD per procedure was 2674.2 mGy. With regard to the medical staff, the mean, minimum and maximum effective doses estimated per procedure were: 18 μSv, 12 μSv and 21 μSv respectively. High personal equivalent doses were found for the feet, hands and lens of the eye, due to the use of multiple left anterior oblique projections and the improper use of the suspended lead screen and the lead curtain during procedures.

Visceral Adiposity in the First Half of Pregnancy in Association with Glucose, Lipid and Insulin Profiles in Later Pregnancy: A Cohort Study.

Background Obesity is the most common risk factor in pregnancy but few studies have assessed the association of between visceral adiposity (VAT) depth in early to mild pregnancy and insulin resistance (IR), dysglycemia and dyslipidemia in later pregnancy. Objective To assess the association between VAT depth in early to mid pregnancy and IR [homeostatic model assessment of IR (HOMA-IR)], dysglycemia and dyslipidemia in later pregnancy. Methods We completed a prospective cohort study of 344 pregnant women at a single large hospital in Recife, Brazil. VAT depth was measured by ultrasound at 15-20weeks gestation. Serum glucose, insulin and lipids were evaluated at 32-37weeks gestation. Results In contrast to pre-pregnancy body mass index (BMI), VAT depth at 15-20weeks was generally inferior in explaining the variation in the biochemical measures at 32-37weeks gestation. This was the case for fasting HOMA-IR (adjusted r(2): 0.21 vs. 0.11, respectively), fasting insulin (adjusted r(2): 0.27 vs. 0.09, respectively), and lipids. Only for fasting glucose was the opposite true, but marginally (adjusted r(2) 0.03 vs. 0.06, respectively). Conclusion VAT depth measured in the first half of pregnancy is not better than pre-pregnancy BMI in predicting IR and related biochemical measures in later pregnancy.

APOA5 polymorphisms associated with lipid metabolism in Brazilian children and adolescents.

Single nucleotide polymorphisms in the APOA5 gene have been studied for their association with metabolic syndrome. Thus, elucidating the effect of the mechanism involved in APOA5 gene polymorphisms on lipid metabolism is of great importance. In this study we aimed to determine the allelic and genotypic frequencies of -1131T>C, Ser19Trp, and intergenic APOA4/A5 and to evaluate the association between these variants with plasma lipid levels in children and adolescents from Brazil. This study included 524 healthy children and adolescents from Mother and Child Hospital in Recife, Pernambuco, Brazil. Data were obtained on medical history, drug intake, lifestyle variables, and demography. DNA from collected samples was extracted and genotyped for the three polymorphisms. In this studied population, triglycerides and very low-density protein levels were significantly high in subjects carrying the 19WW genotype (P < 0.001), demonstrating the presence of this genetic risk factor in children and adolescents.