SUMMARY OBJECTIVE: The polycystic ovary syndrome is the most common endocrine disorder, characterized by the dysregulation of ovarian angiogenesis. This alteration can be related to changes in the activities of the vascular endothelial growth factor (VEGF) gene. Single-nucleotide polymorphisms have been observed in the promoter, intronic, and untranslated regions of the VEGF gene, and several studies have suggested that these polymorphisms may be associated with the risk of polycystic ovary syndrome. This study aimed to investigate the association between rs2010963 and rs833061 polymorphisms and haplotypes of VEGF in the etiology of polycystic ovary syndrome. METHODS: A total of 210 women, 102 diagnosed with polycystic ovary syndrome and 108 controls, participated in this study. The genotyping of the samples was performed by PCR-RFLP and real-time PCR for rs2010963 and rs833061 polymorphisms, respectively. The statistical analyses were performed by the chi-square test and logistic regression model. RESULTS: The clinical characteristics of the patients showed that 75.8% of the patients did not become pregnant, 36.3% had a family history of polycystic ovary syndrome, 58.6% were obese, and about 60% had clinical characteristics of hyperandrogenism. There were no associations between the distribution of rs2010963 (OR 1.24; 95%CI 0.60–2.57; p=0.56) and rs833061 (OR 0.78; 95%CI 0.32–1.92; p=0.59) in patients and controls. CONCLUSIONS: The patients with polycystic ovary syndrome have similar rates of VEGF polymorphisms rs2010963 and rs833061 on the general population.

ABSTRACT Salmonellosis ranks among the most frequently reported zoonosis worldwide and is often associated with foodborne outbreaks. Since the 1950s, the distribution of Salmonella serotypes in Sao Paulo State, Brazil, has been documented and periodically reported. In this study, we updated the data on the distribution of Salmonella serotypes received in our reference laboratory, isolated from human infections and nonhuman sources, from 2004 to 2020. In that period, a total of 9,014 Salmonella isolates were analyzed, of which 3,553 (39.4%) were recovered from human samples, mainly of stool (65%) and blood (25.6%), and 5,461 (60.6%) were isolated from nonhuman origins, such as animals (47.2%), food (27.7%) and animal environments (18.6%). In human isolates, a total of 104 serotypes were identified and the most frequent ones were Enteritidis, Typhimurium, S . I. 4,[5],12:i:-, Dublin and Typhi. A consistent reduction of the Enteritidis proportion was observed over the years. Among the 156 serotypes identified in isolates with nonhuman origins, Enteritidis, Mbandaka, Typhimurium, Agona and Anatum were ranked as the top five Salmonella serotypes; in more recent years, S . Heidelberg has increased in frequency. Although with different proportions, the top 10 prevalent serotypes were identified in both human and nonhuman origins, underscoring the role of animals, food products and environment as reservoirs of Salmonella with potential to cause human salmonellosis.

ABSTRACT The objective was to reveal the perception of Nurses regarding occupational physical violence in urgency and emergency services. A qualitative study developed through 16 individual interviews with data collected between March and May 2015 in two hospitals of medium complexity, located in the north of Paraná. To interpret the speeches, content analysis and Symbolic Interactionism were adopted as methodological and theoretical references, respectively. It was identified that the aggressive acts were perpetrated, mostly, by patients and professionals from other health areas, and their motivations were closely related to the communication among the people involved. Another aspect revealed was the reactions of the workers according to their personal characteristics and the way they developed the self (self-awareness). Understanding occupational physical violence from the perspective of different actors made it possible to understand its complexity and the importance of actions to be developed not only by the nursing professionals, but also by the multi professional and intersectoral teams to prevent and confront occupational violence.

RESUMEN Se buscó descubrir la percepción de los trabajadores de enfermería sobre la violencia física laboral en los servicios de urgencias y emergencias de un hospital. Estudio cualitativo desarrollado a través de 16 entrevistas individuales. Los datos se recogieron entre marzo y mayo de 2015 en dos hospitales de mediana complejidad ubicados en el norte del estado de Paraná. Los discursos se interpretaron según el análisis de contenido y el interaccionismo simbólico como referentes metodológico y teórico, respectivamente. Se identificó que los actos agresivos fueron cometidos, sobre todo, por pacientes y profesionales de otras áreas de la salud, y sus motivaciones estaban estrechamente vinculadas con la manera cómo se comunicaban las personas involucradas en el hecho. Otro aspecto dado a conocer fueron las reacciones de los trabajadores en función de sus características personales y de la manera cómo habían desarrollado su propia conciencia. La comprensión de la violencia física laboral desde la perspectiva de los distintos personajes reveló la complejidad y la importancia de implementar acciones no sólo por parte del personal de enfermería, sino también por los equipos multidisciplinarios e intersectoriales, con miras a prevenir y combatir la violencia laboral.

RESUMO Objetivou-se desvelar as percepções de trabalhadores de enfermagem em relação à violência física ocupacional em serviços de urgência e emergência hospitalares. Estudo qualitativo desenvolvido por meio de 16 entrevistas individuais, cujos dados foram coletados entre março e maio de 2015 em dois hospitais de média complexidade, localizados no norte do Paraná. Para interpretação dos discursos adotaram-se análise de conteúdo e interacionismo simbólico como referenciais metodológico e teórico, respectivamente. Identificou-se que os atos agressivos foram perpetrados, em sua maioria, por pacientes e por profissionais de outras áreas da saúde, e suas motivações estavam intimamente relacionadas à maneira com que os envolvidos se comunicaram. Outro aspecto desvelado foram as reações dos trabalhadores de acordo com suas características pessoais e a maneira como desenvolveram o self (consciência de si mesmo). A compreensão da violência física ocupacional sob a perspectiva dos diferentes atores revelou sua complexidade e a importância do desenvolvimento de ações, não apenas por parte dos profissionais de enfermagem, mas pelas equipes multiprofissionais e intersetoriais, visando à prevenção e ao enfrentamento da violência ocupacional.

Objectives: The aim of this study is to report the occurrence of the first outbreak of food poisoning caused by SalmonellaAlachua in Brazil, as well as the antimicrobial susceptibility and the genetic relatedness of SalmonellaAlachua strains isolated from clinical and food samples.Material and methods: To elucidate the outbreak, an epidemiological investigation was carried out, and two samples of common food were tested - mayonnaise salad and galinhada(a traditional Brazilian dish of chicken and rice) - according to the Compendium of methods for the microbiological examination of foods. Five stool samples were tested employing classic methods for the isolation and identification of enterobacteria. Strains of Salmonella were characterized for antibiotic susceptibility according to the Clinical and Laboratory Stan- dards Institute guidelines (2013), and submitted to pulsed-field gel electrophoresis analysis, performed according to the Centers for Disease Control and Prevention PulseNet protocol.Results: A total of 94 people were interviewed after ingesting the food, 66 of whom had become ill. A 60-year old female patient who was hospitalized in a serious condition, developed septic shock and died two days after consuming the food. The presence of SalmonellaAlachua was confirmed in all the analyzed stool samples, and in the two types of food. The five strains showed higher than minimum inhibitory concentration values of nalidixic acid (≥256 µg/mL) and reduced ciprofloxacin susceptibility (minimum inhibitory concentration = 0.5 µg/mL). The pulsed-field gel electrophoresis analysis revealed indistinguishable patterns in SalmonellaAlachua strains isolated from clinical and food samples.Conclusion: The data presented herein confirm the foodborne disease outbreak. They also allowed for the identification of the source of infection, and suggest that products from poultry are potential reservoirs for this serotype, reinforcing the importance of warning consumers about the danger of possible contamination.

OBJETIVO: Determinar os efeitos da própolis verde solúvel em água na angiogênese de câncer de bexiga em ratos que receberam n-butil-(-4-hidroxibutil) nitrosamina (BBN). METODOS: Nove grupos foram estabelecidos, onde em seis destes (grupos de 1 a 6) os animais receberam BBN a 0,05% em água de beber por 14 semanas. Na 32ª semana das 40 semanas, os grupos 1, 2, 3 e 4 foram tratados respectivamente com água, L lisina (300 mg/kg/dia), celecoxibe (30 mg/kg/dia) e própolis (300 mg/kg/dia). Os grupos 5 e 6 receberam própolis e L lisina da 1ª a 40ª semana (150 mg/ kg/dia). A densidade microvascular foi determinada por cortes histológicos corados pelo CD-31 e analisados por programa de computador específico. RESULTADOS: A densidade microvascular em carcinomas de bexiga foi menor com p<0,01 nos ratos que receberam própolis do que nos carcinomas do grupo controle que recebeu apenas carcinógeno. Por outro lado, a densidade microvascular de tumores de ratos que receberam carcinógeno e L-Lisina por 40 semanas desde o início do carcinógeno foi significantemente maior com p<0,01 que a densidade microvascular dos tumores de seu respectivo grupo controle. CONCLUSÃO: A própolis verde solúvel em água inibiu a angiogênese em câncer de bexiga induzido pelo BBN, enquanto a L- lisina estimulou a angiogênese quando iniciada juntamente com o BBN.

PURPOSE: To determine the effects of water-soluble derivative of green propolis in bladder cancer angiogenesis in rats given N-butyl-(-4-hydroxybutyl) nitrosamine (BBN). METHODS: Nine groups were established, where six of them (Groups 1 to 6), the animals received 0.05% BBN in their drinking water for 14 weeks. From the 32nd to the 40th week, Groups 1, 2, 3 and 4 were treated respectively with water, L-lysine (300 mg/kg/day), celecoxib (30 mg/kg/day) and propolis (300 mg/kg/day). Groups 5 and 6 were given propolis and L-lysine from the 1st to the 40th week (150 mg/kg/day). Microvascular density was determined by histological sections stained for the marker CD-31 and analyzed with specific software. RESULTS: The microvascular density in bladder carcinomas was lower (p<0.01) in rats receiving propolis than in controls given carcinogen only. On the other hand, the microvascular density of tumors in rats receiving carcinogen and L-lysine for 40 weeks from the beginning of carcinogen treatment was significantly higher (p<0.01) than in the corresponding controls. CONCLUSION: Water-soluble derivative of propolis inhibits angiogenesis in BBN-induced rat bladder cancer, while L-lysine treatment stimulates angiogenesis if initiated concurrently with BBN.

OBJETIVO: Determinar os efeitos da própolis verde extraída em L - Lisina (WSDP) e da L-Lisina por 40 semanas em ratos induzidos a carcinogênese de bexiga. MÉTODOS: Os animais (grupos I, II, III, IV, V e VI) receberam BBN por 14 semanas. O grupo I foi tratado com própolis 30 dias antes de receber BBN e em seguida estes animais foram tratados diariamente com própolis; Os grupos II e III foram tratados com própolis subcutânea e oral (respectivamente) e concorretemente com BBN. Os animais do grupo IV foram tratados com L- Lisina; o grupo V recebeu água subcutânea; o grupo VI recebeu apenas BBN. Entre os animais não submetidos a indução de carcinogênese, Grupo VII, receberam própolis, Grupo VIII, receberam L-Lisina e Grupo IX receberam água. RESULTADOS: A incidência de carcinoma no grupo I foi menor que no grupo controle (grupo IV) A multiplicidade de carcinoma no grupo IV foi maior que no grupo VI. Todos os animais tratados com L - Lisina desenvolveram carcinomas e estes foram mais invasivos no grupo IV que no grupo controle. Por outro lado o grupo VIII não apresentou lesões. CONCLUSÃO: WSDP é quimiopreventiva contra a carcinogese de bexiga se administrada 30 dias antes do início do BBN, e a L - Lisina causa promoção da carcinogênese de bexiga.

PURPOSE: To determine the effects of green propolis extracted in L-lysine (WSDP) and of L- lysine for 40 weeks on induced rat bladder carcinogenesis. METHODS: The animals (groups I, II, III, IV, V and VI) received BBN during 14 weeks. Group I was treated with propolis 30 days prior received BBN, and then these animals were treated daily with propolis; Groups II and III was treated with subcutaneous and oral propolis (respectively) concurrently with BBN. The animals of Group IV were treated L-lysine; Group V received water subcutaneous; and Group VI received only to BBN. Among the animals not submitted to carcinogenesis induction, Group VII received propolis, Group VIII received L-lysine and Group IX received water. RESULTS: The carcinoma incidence in Group I was lower than that of control (Group VI). The carcinoma multiplicity in Group IV was greater than in Group VI. All animals treated with L-lysine developed carcinomas, and they were also more invasive in Group IV than in controls. On the other hand, Group VIII showed no bladder lesions. CONCLUSION: The WSDP is chemopreventive against rat bladder carcinogenesis, if administered 30 days prior to BBN , and that L-lysine causes promotion of bladder carcinogenesis.

This study aims to verify the causes of students’ dropouts in the Certified Nurse Assistant (CNA) and License Practical Nurse (LPN) courses associated to the Nursing Workers Credentialing Project (Profae) in Paraná State. Data was collected through telephone interviews and processed by the Epi Info software. From the 355 students identified as “dropouts” 66.5% of them were interviewed. Most of the dropouts students from the Certified Nurse Assistant course did not work in that area whilst the opposite occurred with the License Practical Nurse course evaded students. The reasons for the dropouts were: working hours’ incompatibility (19.1%), disliking the area (12.7%), family health problems (11.0%), personal health problems (10.2%) and pregnancy (8.5%). The supply of training professional programs directed to CNAs and LPNs does not guarantee the students’ attendance to the course even though they work in the nursing area.

El trabajo tuvo como objetivo analizar la evasión de alumnos de los cursos de auxiliar y técnico de enfermería vinculados al Proyecto de Profesionalización de los Trabajadores de Enfermería (Profae), en Paraná. El estudio es de carácter descriptivo y cualitativo. Los datos han sido recolectados en 2002 por medio de entrevistas por teléfono, y procesados a través del programa Epi Info. De los 355 alumnos identificados en la situación de “evadido”, un 66,5% han sido entrevistados. Se observó que la mayoría de los evadidos del curso auxiliar no actuaba en el área, mientras que el contrario ha sido observado con relación a los evadidos del curso técnico de enfermería. Los motivos de evasión más mencionados han sido: incompatibilidad con el horario de trabajo (19,1%), no “haberle gustado” el área (12,7%), problema de salud en la familia (11,0%), problema de salud personal (10,2%) y embarazo (8,5%). La oferta de profesionalización a los auxiliares y técnicos de enfermería no garantiza la permanencia de los alumnos en el curso, aun siendo ellos trabajadores y actuando en el área de enfermería.

Analisa-se no presente trabalho a evasão de alunos dos cursos de auxiliar e técnico de enfermagem vinculados ao Projeto de Profissionalização dos Trabalhadores de Enfermagem (Profae), no Paraná. O estudo é de caráter descritivo e quantitativo. Os dados foram coletados em 2002 por meio de entrevistas por telefone e processados através do programa Epi Info. Dos 355 alunos identificados na situação de “evadido”, 66,5% foram entrevistados. Observou-se que a maioria dos evadidos do curso auxiliar não atuava na área, enquanto o contrário foi observado quanto aos evadidos do curso técnico de enfermagem. Os motivos de evasão mais citados foram: incompatibilidade com o horário do trabalho (19,1%), não ter “gostado” da área (12,7%), problemas de saúde na família (11,0%), problemas de saúde pessoal (10,2%) e gravidez (8,5%). A oferta de profissionalização aos auxiliares e técnicos de enfermagem não garante a permanência dos alunos no curso, mesmo sendo eles trabalhadores e atuando na área de enfermagem.

INTRODUÇÃO: A tuberculose permanece um problema de saúde pública mundial. OBJETIVO: Avaliar um sistema de diagnóstico automatizado de tuberculose, comparando-o com baciloscopia e cultura em meio de Lowenstein-Jensen. MÉTODO: Estudo comparativo entre os resultados obtidos no sistema automatizado, baciloscopia do escarro e em meio de Lowenstein-Jensen, em 844 amostras de escarro de setembro a dezembro de 1999, em centro de referência para tuberculose em São Paulo (SP). RESULTADOS: Das 844 amostras, 27,1% mostraram-se positivas para bacilo álcool-acidorresistente e 72,9% negativas. Nos cultivos em Lowenstein-Jensen, 34,7% foram positivas e 63% negativas; no sistema automatizado, 37,1% foram positivas e 56,9% negativas. Observou-se sensibilidade de 98,1% e 91.9% no sistema automatizado e no Lowenstein-Jensen, respectivamente. A especificidade e o valor preditivo positivo foram de 100% nos dois métodos. O valor preditivo negativo foi de 98,9% no sistema automatizado e de 95,5% no Lowenstein-Jensen. A acurácia foi de 99,3% no sistema automatizado e 97% no Lowenstein-Jensen e o Kappa de 0,99 no sistema automatizado e 0,94 no Lowenstein-Jensen. O tempo médio de detecção das micobactérias no sistema automatizado (10,5 dias) apresentou diferença estatística significativa quando comparado com o método de Lowenstein-Jensen (34,7 dias). CONCLUSÃO: O rendimento da cultura com o sistema automatizado apresentou diferença estatística significativa quando comparado com o meio de Lowenstein-Jensen. O tempo médio de detecção das micobactérias foi significativamente reduzido no sistema automatizado. O rendimento do sistema automatizado justifica sua utilização em unidade de referência ambulatorial para a tuberculose em São Paulo.

BACKGROUND: Tuberculosis continues to be a global health problem. OBJECTIVE: To evaluate an automated system designed to diagnose tuberculosis, comparing it to sputum microscopy and culture in Löwenstein-Jensen medium. METHOD: A comparative study using 844 sputum samples, collected between September and December of 1999 at a reference center for tuberculosis in São Paulo, Brazil, to draw distinctions between the results obtained through the use of the automated system and those obtained through sputum microscopy and culture in Löwenstein-Jensen medium. RESULTS: Of the 844 samples evaluated, 27.1% tested positive for acid-fast bacilli, and 72.9% tested negative. In Löwenstein-Jensen culture, 34.7% were positive and 63% were negative, compared with 37.1% positivity and 56.9% negativity using the automated system. Sensitivity was 98.1% for the automated system and 91.9% for Löwenstein-Jensen culture. Specificity and positive predictive value were 100% for both methods. Negative predictive value was 98.9% for the automated system and 95.5% for Löwenstein-Jensen culture. The degree of accuracy was 99.3% for the automated system and 97% for Löwenstein-Jensen culture, and the Kappa was 0.99 for the automated system and 0.94 for Löwenstein-Jensen culture. The difference between the mean time to detection of mycobacteria using the automated system (10.5 days) and that found using Löwenstein-Jensen culture (34.7 days) was statistically significant. CONCLUSION: The difference between the culture yield obtained using the automated system and that achieved with Löwenstein-Jensen culture was statistically significant. Mean time to detection of mycobacteria was significantly shorter with the automated system. The higher yield provided by this new system justifies its use in a reference center for tuberculosis in São Paulo

O objetivo deste estudo foi analisar o efeito da sialoadenectomia sobre o desenvolvimento da candidose oral após uma ou quatro inoculações de Candida albicans. Inicialmente, uma suspensão contendo 10(8) células/ml de C. albicans ATCC 36801 foi preparada. Setenta e oito camundongos sialoadenectomizados e mesma quantidade de camundongos com fluxo salivar normal receberam uma única inoculação de suspensão de C. albicans. Outro grupo, com o mesmo número de camundongos, recebeu 4 inoculações. O grupo controle consistiu de 6 camundongos sialoadenectomizados e 6 com fluxo salivar normal que não foram inoculados com C. albicans. O desenvolvimento de candidose foi estudado histologicamente na língua dos animais em períodos de 1, 2, 3, 5 e 8 dias após a inoculação e em intervalos de 15 dias até 165 dias. De acordo com os resultados obtidos, conclui-se que a sialoadenectomia e uma maior freqüência de inoculação influenciaram na presença e extensão das lesões de candidose.

The aim of this study was to analyze the effect of sialoadenectomy on the development of oral candidosis after one or four inoculations of Candida albicans. Initially, a suspension containing 10(8) cells/ml of C. albicans ATCC 36801 was prepared. Seventy-eight sialoadenectomized mice and a similar amount of mice with normal salivary flow received a single inoculation of C. albicans suspension. Another group with a similar number of mice received 4 inoculations. The control group consisted of 6 sialoadenectomized mice and 6 mice with normal salivary flow that were not inoculated with C. albicans. Candidosis development was studied histologically in the tongue of the animals 1, 2, 3, 5, and 8 days after inoculation and at 15-day intervals up to 165 days. According to the results obtained, it could be concluded that sialoadenectomy and a higher frequency of yeast inoculation influenced the presence and extension of candidosis lesions.

Com o objetivo de estudar algumas características epidemiológicas dos portadores de tuberculose pulmonar multirresistente e suas influências sobre o controle e o tratamento, foi avaliada uma coorte de 4 anos de pacientes selecionados pela recuperação do Mycobacterium tuberculosis no escarro, resistência à rifampicina, isoniazida e mais uma terceira droga usual ou falência do esquema de reserva, matriculados em uma referência na cidade de São Paulo. As variáveis estudadas foram: sexo e idade, tipo de multirresistência, contágio, condições associadas, perfil de resistência às drogas usuais e distribuição das lesões na radiologia convencional. Revistos 182 pacientes, 112 (61,5%) masculinos, com idade variando entre 16 e 64 anos (35,7±6,8). Com base na história terapêutica foram discriminados os seguintes tipos: MR-primária (com teste de sensibilidade inicial), 11 (6%), MR-pós-primária (irregularidade no tratamento anterior), 134 (74%) e MR-indeterminada (falência após uso regular informado dos esquemas usuais), 37 (20%). Contágio presente em 41 de 170 pacientes, predominando o intradomiciliar sobre o institucional. Identificados 4 surtos familiares e nenhum institucional. O abandono (45%) foi a mais freqüente condição associada, seguido do etilismo (27%), falência seqüencial aos esquemas de retratamento (23%), contágio com multirresistência (15%), reações adversas às drogas (6%), HIV-positivo (4%) e diabetes (3%). Resistência à rifampiina+isoniazida em 100%, 83% à estreptomicina e 47% ao etambutol. Todos com cavidades no Rx de tórax convencional, unilaterais em 35 (19%). Discutem-se os achados e apresentam-se sugestões.

In order to study certain epidemiological features of multidrug-resistant tuberculosis (MDR-TB) carriers and their influence on the control and treatment, a group of patients was evaluated over a four-year period, selected by: Mycobacterium tuberculosis isolation from sputum; resistance to Rifampin, Isoniazid and one more drug, or, failure of reserve regimen, all cases were from a tuberculosis reference unit in the City of São Paulo. A total of 182 patients were reviewed, with a mean age of 35.7±6.8 years and 112 (61.5%) were male. These patients was classified according to therapeutic history, as: primary MDR-TB (with initial sensitivity test) 11 (6%); post primary MDR-TB (after irregular use previous treatment) 134 (74%), and indeterminate MDR-TB (failure after regular use of initial and reserve regimens) 37 (20%). Contagion was identified in 41/170 patients, acquired through domiciliary rather than institutional transmission. There were four familial outbreaks and none were institutional. The most frequent condition associated with these cases was abandonment of therapy (45%) followed by alcoholism (27%), sequential failure in the treatment regimens (23%), MDR contagion (15%), drug reaction (6%), HIV positive (4%) and diabetes (3%). There was resistance to Rifampin+Isoniazid in 100%, Streptomycin in 83% and Ethambutol in 47%. Conventional X-ray revealed cavities in all, though only 35 (19%) were unilateral. These cases are discussed and some suggestions presented.