Abstract Infections caused by hepatitis B virus (HBV) and hepatitis C virus (HCV), are global health issues and a serious risk associated to transfusional medicine; especially being one of the most important causes of liver damage in Mexico. Objective: To determine the prevalence of HBV and HCV in blood donors in Hospital Angeles Pedregal in a time lapse of 19 months. Material and methods: Retrospective and descriptive study carried out between the 1st of January 2018 and the 31st of July 2019, which included 5,705 donors. Results: Of 4,030 selected cases, 30.72% were female and 69.28% were male. We identified 22 altruistic donors and 4,008 for replacement of blood products. Global seroprevalence observed in our population was 0.27% for HCV and 0.04% for HBV. HVC infection was more frequent in females between 45 to 65 years, with three cases. Conclusions: A low prevalence of HBV and HVC infection was found, being 0.27% and 0.04%, respectively, HCV prevalence was found to be 5.5 times greater than HBV. These findings are probably explained because blood donors generally are healthy.

Resumen La infección por virus de hepatitis B (VHB) y C (VHC) es un problema de salud pública mundial y un riesgo grave para la medicina transfusional, pues es una causa importante de daño hepático en México. Objetivo: Determinar la prevalencia de VHB y VHC en donadores de sangre que acudieron al Hospital Ángeles Pedregal en un lapso de 19 meses. Material y métodos: Estudio descriptivo y retrospectivo, realizado del 1 de enero de 2018 al 31 de julio de 2019 en el que se incluyeron a 5,705 donadores. Resultados: De los 4,030 casos seleccionados, 30.72% correspondió a mujeres y 69.28% a hombres; se identificaron 22 donaciones altruistas y 4,008 para reposición de hemoderivados. La seroprevalencia global observada en nuestra población fue de 0.27% para VHC y 0.04% para VHB. La infección por VHC tuvo mayor frecuencia en el sexo femenino entre los 45 a 65 años con tres casos. Conclusiones: Se encontró una baja prevalencia de infección por VHB y VHC, la cual fue de 0.27 y 0.04% respectivamente, y en nuestra población hubo 5.5 veces más prevalencia de la infección por VHC que por VHB. Probablemente se debió a que la población que acude a donar sangre se encuentra generalmente sana.

RESUMO OBJETIVO Descrever práticas de distanciamento social em nove municípios do Rio Grande do Sul por sexo, idade, escolaridade e cidade. MÉTODOS Foram realizados dois estudos transversais sequenciais representativos da população urbana nos municípios de Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana com o intuito de estimar a prevalência populacional de Covid-19. Foi aplicado questionário contendo três perguntas sobre distanciamento social, cujas práticas foram submetidas a análises descritivas por subgrupos. Os dados foram comparados por testes qui-quadrado. RESULTADOS Em termos de grau de distanciamento social, 25,8% dos entrevistados relataram estar praticamente isolados e 41,1% indicam praticar bastante distanciamento. Relataram ficar em casa o tempo todo 20,1% dos entrevistados, e 44,5% informam que saem apenas para atividades essenciais. Mais da metade dos domicílios não recebe visitas de não moradores. O grupo que relatou menos distanciamento social foi o de adultos entre 20 e 59 anos, enquanto mais de 80% dos entrevistados com 60 anos ou mais relataram estar praticamente isolados ou fazendo bastante distanciamento. As mulheres relataram fazer mais distanciamento que os homens, e os grupos de maior escolaridade foram os que relataram sair diariamente para atividades regulares com mais frequência. CONCLUSÕES Os grupos mais jovens e mais idosos estão mais protegidos pelo distanciamento social, mas há grupos bastante expostos, o que pode ser um limitador importante no controle da progressão da epidemia de Covid-19.

ABSTRACT OBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

RESUMO OBJETIVO Descrever práticas de distanciamento social em nove municípios do Rio Grande do Sul por sexo, idade, escolaridade e cidade. MÉTODOS Foram realizados dois estudos transversais sequenciais representativos da população urbana nos municípios de Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana com o intuito de estimar a prevalência populacional de Covid-19. Foi aplicado questionário contendo três perguntas sobre distanciamento social, cujas práticas foram submetidas a análises descritivas por subgrupos. Os dados foram comparados por testes qui-quadrado. RESULTADOS Em termos de grau de distanciamento social, 25,8% dos entrevistados relataram estar praticamente isolados e 41,1% indicam praticar bastante distanciamento. Relataram ficar em casa o tempo todo 20,1% dos entrevistados, e 44,5% informam que saem apenas para atividades essenciais. Mais da metade dos domicílios não recebe visitas de não moradores. O grupo que relatou menos distanciamento social foi o de adultos entre 20 e 59 anos, enquanto mais de 80% dos entrevistados com 60 anos ou mais relataram estar praticamente isolados ou fazendo bastante distanciamento. As mulheres relataram fazer mais distanciamento que os homens, e os grupos de maior escolaridade foram os que relataram sair diariamente para atividades regulares com mais frequência. CONCLUSÕES Os grupos mais jovens e mais idosos estão mais protegidos pelo distanciamento social, mas há grupos bastante expostos, o que pode ser um limitador importante no controle da progressão da epidemia de Covid-19.

ABSTRACT OBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

RESUMO OBJETIVO: Foram estudados os usuários do programa de distribuição de medicamentos especializados da rede pública de saúde de Guarapuava, Paraná, Brasil. MÉTODOS: Uma coorte prospectiva, em que os idosos foram examinados em dois momentos, com um intervalo de três anos, com 30 pacientes na fase I e 16 na fase II. A metodologia foi composta por visitas domiciliares, avaliação antropométrica; avaliação nutricional e hematológica. Para a progressão da DA, utilizou-se a escala Clinical Demential Rating (CDR). Os testes de Shapiro-Wilk, teste de Wilcoxon e correlações com associações (Δ%), p < 0,05 para as análises estatísticas. RESULTADOS: A progressão da doença, segundo o CDR, evoluiu, pois, em 2014, a maioria dos pacientes encontrava-se em CDR 3. Na análise dos micronutrientes, somente as vitaminas do complexo B (B1, B2, B3, B5, B6) apresentaram redução significativa em 2014. O consumo de carboidratos e lipídeos aumentou na avaliação de 2014, e o consumo de proteínas diminuiu. Quanto ao peso médio dos idosos, houve um aumento em 2014, 65,9 (± 15,6) kg, com IMC 26,75 (± 4, 5); em 2011, o peso médio foi 62,44 kg (± 14,36), IMC 24,64 (± 4,97). CONCLUSÃO: Não foram encontrados pacientes anêmicos ou desnutridos na amostra. A hipótese de que os pacientes provavelmente já apresentavam sobrepeso ou obesidade antes do desenvolvimento da DA, e que isso pode estar associado com um aumento de risco de demência, pode ser sugerida.

SUMMARY OBJECTIVE: We studied the users of the Specialized Drug Distribution Program of the public health network. METHODS: A prospective cohort examined the elderly at two intervals of three years and included 30 patients in phase I and 16 in phase II. The methodology was composed of home visits, anthropometric, nutritional and hematological evaluation. For the progression of AD, the Clinical Dementia Rating (CDR) scale was used. RESULTS: According to the CDR, the disease evolved, since in 2014 most of the patients were in CDR 3. In the analysis of the micronutrients, only the B vitamins (B1, B2, B3, B5, B6) presented a significant reduction in 2014. The consumption of carbohydrates and lipids increased in the 2014 evaluation, and protein consumption decreased. As for the average weight of the elderly, there was an increase in 2014, 65.9 (± 15.6) Kg, with a BMI of 26.75 (± 4, 5), in 2011 the average weight was 62.44 kg (± 14, 36), BMI 24.64 (± 4.97). CONCLUSION: The hypothesis that patients are likely to be overweight or obese before the development of AD and that this may be associated with an increased risk of dementia is suggested.

ABSTRACT Antimicrobial resistance is a serious public health problem and Salmonella spp. is highly resistant to antimicrobial agents. Biofilms are important in the food industry due to their formation on products, utensils, and surfaces and the difficulty in their removal. The objective of this study was to assess extended spectrum beta-lactamase (ESBL) production, antimicrobial resistance, and biofilm production of Salmonella isolated from poultry slaughterhouses. Antimicrobial susceptibility was assessed by the disk diffusion assay and ESBL by double diffusion disk assay using the beta-lactamase inhibitor (amoxicillin+clavulanate). The antimicrobials tested were: ampicillin, amoxicillin+clavulanate, aztreonam, ceftazidime, cefotaxime, chloramphenicol, gentamicin, enrofloxacin, sulfonamide, and tetracycline. Serovars Infantis, Panamá, and Tennessee were found to produce ESBL. All serovars were sensitive to tetracycline, and S. Brandenburg was sensitive to all drugs tested. Serovars Panamá, Anatum, Infantis, and Schwarzengrund were moderate biofilm producers at 3 ºC and 9 ºC±1 ºC, respectively, showing possible adaptation of these serovars to these temperatures. Antimicrobials should be used with caution because of the levels of resistance observed and because of ESBL production, and hygiene and sanitary measures should be enhanced to minimize the adhesion of biofilm-forming Salmonella serovars at refrigeration temperatures.

Abstract BACKGROUND Nowadays, the American Diabetes Association (ADA) recognizes the use of three tests for the diagnosis of diabetes mellitus, including the determination of glycated hemoglobin (HbA1c). OBJECTIVE To evaluate if the established value of 6.5% of glycated hemoglobin for the diagnosis of diabetes mellitus is applicable to the Mexican population. MATERIAL AND METHOD A descriptive, transversal and analytic study was done in October 2016 in persons that were subjected to a capillary test for HbA1c and serum glucose. RESULTS There were included 388 subjects in whom it was determined that the age and the sex did not influence on the obtaining of a determinate level of HbA1c. Capillary HbA1c test tended to diagnose a greater number of cases of prediabetes (170 vs 63) and diabetes (27 vs 13) compared with serum glucose test, with a difference in the number of healthy persons between the two groups of 121 (191 healthy persons with HbA1C and 312 healthy persons with serum glucose); however, both variables shared a 90.2% of similarity (p < 0.001). It was obtained a new threshold of HbA1C for the diagnosis of diabetes of 6.65% (with sensitivity and specificity of 76% and 97%, respectively). CONCLUSION With the new cutoff value the incidence of cases of diabetes decreased in the HbA1c group, with a reduction of 7% to 4.9% (27 to 19 cases).

Resumen ANTECEDENTES En la actualidad la Asociación Americana de Diabetes (ADA) acepta el uso de tres pruebas para el diagnóstico de diabetes mellitus, que incluyen la determinación de hemoglobina glucosilada (HbA1c). OBJETIVO Evaluar si la cifra establecida de HbA1c de 6.5% para el diagnóstico de diabetes mellitus es válida para la población mexicana. MATERIAL Y MÉTODO Estudio descriptivo, transversal y analítico en el que en octubre de 2016 se incluyeron personas en quienes se determinó HbA1c en sangre capilar y glucemia en sangre venosa. RESULTADOS Se incluyeron 388 pacientes. Se determinó que ni la edad ni el sexo predisponen a la obtención de una cifra determinada de HbA1c. La prueba de HbA1c capilar tendió a diagnosticar mayor número de casos de prediabetes (170 vs 63) y diabetes (27 vs 13) en comparación con la prueba de glucosa sérica, con diferencia en el número de personas sanas entre ambos grupos de 121 (191 personas sanas con HbA1c y 312 personas sanas con glucosa sérica); sin embargo, ambas variables compartieron 90.2% de similitud (p < 0.001). Se obtuvo un nuevo nivel de corte de HbA1c para el diagnóstico de diabetes de 6.65% (con sensibilidad y especificidad de 76 y 97%, respectivamente). CONCLUSIÓN Con el nuevo punto de corte disminuyó la incidencia de casos de diabetes en el grupo de HbA1c, con reducción de 7 a 4.9% (27 a 19 casos).

Resumo O objetivo deste estudo é compreender como se articulam percepções sobre HIV e aids em narrativas de usuários e usuárias do Sistema de Saúde, trazendo elementos qualitativos que demonstram a importância do aconselhamento em saúde sexual. Foram entrevistados nove usuárias e usuários de um serviço de saúde especializado (CTA) em Porto Alegre, no momento da procura pelo Teste Rápido para HIV, sífilis e hepatites B e C. As narrativas geraram dois eixos de compreensão: Risco/Promiscuidade e Culpa/Responsabilização. Estes eixos sintetizaram algumas das inúmeras possibilidades de significação frente à necessidade de realização do teste de HIV. Os elementos promiscuidade, risco, culpa e responsabilização se compunham a partir de diferentes marcadores sociais, envolvendo experiências sociais que se articulavam com o discurso biomédico epidemiológico. Neste contexto, o aconselhamento se apresenta como um espaço potente para desconstruir significações essencialistas e noções estereotipadas de risco. Este estudo mostra que as narrativas reiteram entendimentos de sexualidade como dimensão individualizada, indicando a necessidade de propostas de trabalho em saúde pela via da singularidade. Considera-se que análises qualitativas centradas na experiência de usuários(as) são estratégicas num projeto de promoção de saúde sexual como processo coletivo.

Abstract The objective of this study is to understand how perceptions about HIV and AIDS are articulated in narratives of male and female patients of the Public Health System, with qualitative elements that demonstrate the importance of sexual health counseling. Nine male and female patients of a specialized health service (CTA) were interviewed in Porto Alegre when they visited the CTA for the HIV, Syphilis and Hepatitis B and C Rapid Test. The narratives generated two understanding axes: Risk/Promiscuity and Guilt/Accountability. These axes synthesized some of the innumerable possibilities of meaning in relation to the need to perform the HIV test. The elements promiscuity, risk, guilt and accountability were composed of different social markers, involving social experiences that were articulated with the epidemiological biomedical discourse. In this context, counseling represents a powerful space to deconstruct essentialist meanings and stereotyped notions of risk. This study shows that the narratives reaffirm the understanding of sexuality as an individualized dimension, which indicates the need for health work proposals on singularity. Qualitative analyses focused on the patients’ experience are strategic measures in a project to promote sexual health as a collective process.

Resumo O objetivo deste estudo é compreender como se articulam percepções sobre HIV e aids em narrativas de usuários e usuárias do Sistema de Saúde, trazendo elementos qualitativos que demonstram a importância do aconselhamento em saúde sexual. Foram entrevistados nove usuárias e usuários de um serviço de saúde especializado (CTA) em Porto Alegre, no momento da procura pelo Teste Rápido para HIV, sífilis e hepatites B e C. As narrativas geraram dois eixos de compreensão: Risco/Promiscuidade e Culpa/Responsabilização. Estes eixos sintetizaram algumas das inúmeras possibilidades de significação frente à necessidade de realização do teste de HIV. Os elementos promiscuidade, risco, culpa e responsabilização se compunham a partir de diferentes marcadores sociais, envolvendo experiências sociais que se articulavam com o discurso biomédico epidemiológico. Neste contexto, o aconselhamento se apresenta como um espaço potente para desconstruir significações essencialistas e noções estereotipadas de risco. Este estudo mostra que as narrativas reiteram entendimentos de sexualidade como dimensão individualizada, indicando a necessidade de propostas de trabalho em saúde pela via da singularidade. Considera-se que análises qualitativas centradas na experiência de usuários(as) são estratégicas num projeto de promoção de saúde sexual como processo coletivo.

Abstract The objective of this study is to understand how perceptions about HIV and AIDS are articulated in narratives of male and female patients of the Public Health System, with qualitative elements that demonstrate the importance of sexual health counseling. Nine male and female patients of a specialized health service (CTA) were interviewed in Porto Alegre when they visited the CTA for the HIV, Syphilis and Hepatitis B and C Rapid Test. The narratives generated two understanding axes: Risk/Promiscuity and Guilt/Accountability. These axes synthesized some of the innumerable possibilities of meaning in relation to the need to perform the HIV test. The elements promiscuity, risk, guilt and accountability were composed of different social markers, involving social experiences that were articulated with the epidemiological biomedical discourse. In this context, counseling represents a powerful space to deconstruct essentialist meanings and stereotyped notions of risk. This study shows that the narratives reaffirm the understanding of sexuality as an individualized dimension, which indicates the need for health work proposals on singularity. Qualitative analyses focused on the patients’ experience are strategic measures in a project to promote sexual health as a collective process.

RESUMO Objetivo: Avaliar a percepção subjetiva de qualidade de sono em estudantes de medicina, comparando as diferentes fases do curso. Métodos: Estudo transversal envolvendo todos os estudantes entre o 1º e o 6º ano da graduação em medicina em uma universidade na cidade de Botucatu (SP), que foram convidados a responder o Índice de Qualidade do Sono de Pittsburgh, validado para uso no Brasil. Os resultados dos componentes do índice foram avaliados na amostra global e em três grupos de acordo com o ciclo do curso: básico (1º e 2º anos), de fisiopatologia (3º e 4º anos) e de internato clínico (5º e 6º anos). Resultados: Dos 540 estudantes convidados, 372 responderam o instrumento adequadamente. Desses, 147 (39,5%) relataram ter uma qualidade de sono ruim ou muito ruim, 110 (29,5%) demoram mais de 30 min para conseguir dormir, 253 (68,0%) dormem de 6-7 h por noite, 327 (87,9%) relataram ter eficiência do sono adequada, 315 (84,6%) não indicavam ter distúrbios do sono, 32 (8,6%) relataram fazer uso de medicamentos para dormir, e 137 (36,9%) apresentavam dificuldades em se manter acordados durante o dia ao menos uma vez por semana. Na comparação entre os grupos, os alunos do ciclo básico apresentaram uma pior percepção da qualidade subjetiva do sono e de disfunção diurna que os outros alunos. Conclusões: Estudantes de medicina parecem estar mais expostos a distúrbios de sono, sendo aqueles nos anos iniciais mais afetados por apresentar uma percepção pior de sono. Intervenções ativas devem ser implantadas para melhorar a higiene do sono desses alunos.

ABSTRACT Objective: To evaluate and compare subjective sleep quality in medical students across the various phases of the medical course. Methods: This was a cross-sectional study involving medical undergraduates at one medical school in the city of Botucatu, Brazil. All first- to sixth-year students were invited to complete the Pittsburgh Sleep Quality Index, which has been validated for use in Brazil. Participants were divided into three groups according to the phase of the medical course: group A (first- and second-years); group B (third- and fourth-years); and group C (fifth- and sixth-years). The results obtained for the instrument components were analyzed for the total sample and for the groups. Results: Of the 540 students invited to participate, 372 completed the instrument fully. Of those, 147 (39.5%) reported their sleep quality to be either very or fairly bad; 110 (29.5%) reported taking more than 30 min to fall asleep; 253 (68.0%) reported sleeping 6-7 h per night; 327 (87.9%) reported adequate sleep efficiency; 315 (84.6%) reported no sleep disturbances; 32 (8.6%) reported using sleeping medication; and 137 (36.9%) reported difficulty staying awake during the day at least once a week. Group comparison revealed that students in group A had worse subjective sleep quality and greater daytime dysfunction than did those in groups B and C. Conclusions: Medical students seem to be more exposed to sleep disturbance than other university students, and first- and second-years are more affected than those in other class years because they have worse subjective sleep quality. Active interventions should be implemented to improve sleep hygiene in medical students.

ABSTRACT Background: Immune thrombocytopenia is an immune disease characterized by thrombocytopenia and bleeding due to platelet antibodies against platelet membrane glycoproteins. Human platelet antigens are derived from polymorphisms of these glycoproteins. The aim of this study was to investigate human platelet antigen frequencies in immune thrombocytopenia patients from the state of Amazonas, Brazil and investigate the potential association between specific antigens and risk for immune thrombocytopenia. Method: Human platelet antigen typing was performed by BeadChip technology to determine allelic variants of 11 systems (HPA-1 to HPA-9, HPA-11 and HPA-15). Thirty-six patients (8 male and 28 female) with a median age of 34 years (range: 9-69 years) were evaluated and compared with data from Amazonas blood donors. Results: Platelet counts varied from 3 to 98 × 109/L. The allele frequencies were 0.944 for HPA-1a, 0.056 for HPA-1b, 0.847 for HPA-2a, 0.153 for HPA-2b, 0.555 for HPA-3a, 0.444 for HPA-3b, 0.805 for HPA-5a, 0.222 for HPA-5b, 0.9975 for HPA-9a, 0.025 for HPA-9b, 0.486 for HPA-15a and 0.513 for HPA-15b. Among immune thrombocytopenia individuals, no b allele of the HPA-4, -6, -7, -8 and -11 were found. Conclusions: The results suggest HPA-1a, HPA-3b and HPA-5b are immune thrombocytopenia-specific autoepitopes.

Abstract Globally, the prevalence of sepsis is more than 19 million cases per year with an estimated mortality of 30%. The most frequently identified risk factors are chronic diseases (HIV-AIDS, COPD and neoplasms) and the use of immunosuppressive agents. The most susceptible popula tion to develop these complications are the ones in babyhood or the elderly. Among the multiple pathogens, bacteria are considered the microorganisms primarily involved in the development of severe sepsis. Within the foci of infection, pneumonia is considered to be the most common, followed by intra-abdominal infections, urinary tract and primary bloodstream infections. It has been demonstrated that early treatment significantly improves survival. Interventions to be performed include antimicrobial therapy, fluid resuscitation, ventilatory support and supportive measures (antithrombotic prophylaxis, glycemic control and prophylaxis to prevent stress gastric ulcers and nutrition).

Resumen En el mundo, la prevalência de sepsis es de más de 19 millones de casos por año, con mortalidad estimada de 30%. Los factores de riesgo identificados más frecuentemente son las enfermedades crónicas (VIH-SIDA, EPOC y neoplasias), así como la administración de agentes inmunosupresores. La población más susceptible de padecer estas complicaciones es la que se encuentra en los extremos de la vida. De los múltiples agentes patógenos, las bacterias son los microorganismos principalmente implicados en la aparición de la sepsis grave. Entre los focos infecciosos, en primer lugar está la neumonía, seguida de infecciones intraabdominales, de las vías urinarias e infecciones primarias del torrente sanguíneo. Se ha demostrado que el tratamiento temprano aumenta la supervivencia de manera significativa. Las intervenciones que deben realizarse incluyen: tratamiento antimicrobiano, resucitación hídrica, apoyo ventilatorio y tratamiento de soporte (profilaxis antitrombótica, control de la glucemia y profilaxis para evitar úlceras gástricas por estrés y nutrición, entre otras medidas).

RESUMO Quatro bovinos, com fistulas ruminais, foram alimentados em Quadrado Latino com os tratamentos compreendendo a adição diária no rúmen de: levedura (5g), monensina(200mg), Fator P (3g) e controle. Foram determinadas a Degradabilidade in situ de três capins tropicais (Tifton-85, Brachiaria e Mombaça e silagem de Mombaça), o pH ruminal, produção de ácidos graxos voláteis, N-amoniacal e população de protozoários. Não foi observada interação significativa entre tratamentos e capins e diferenças significativas entre os tratamentos, exceto na fração b da Brachiaria e silagem de Mombaça. O Mombaça apresentou alta solubilidade da MS e da FDN em relação aos demais capins e a Brachiaria maior solubilidade da PB. O processamento do Mombaça na forma de silagem promoveu redução fração solúvel e degradabilidades potencial (DE) e efetiva (DE) da MS e FDN e aumento da fração solúvel e DE da PB. A monensina promoveu menor produção de ácido acético, maior de propiônico e menor acético:propiônico em relação a controle. A levedura e Fator P apresentaram maior concentração total de AGCC que a monensina e controle. A monensina promoveu aumento de protozoários Diplodiniinae em relação à dieta controle, mas não houve diferença na contagem de Entodinium e de total de ciliados entre os tratamentos. Capins tropicais na forma de feno e de silagem apresentam diferentes degradabilidade ruminal não sendo influenciados por aditivos na dieta, com exceção da monensina no capim Brachiaria e silagem de Mombaça, mas estes afetam a fermentação e a população de protozoários no rúmen.

SUMMARY Four cattle rumen fistulae were fed on Latin Square with four treatments including the daily addition into rumen of: yeast (5g), monensin (200mg), Fator P (3g) and control. In situ degradability was determined with three tropical grasses: Tifton-85, Brachiaria, Mombasa and Mombasa silage, as well as ruminal pH, production of volatile fatty acids, ammonia-N and protozoa population. There was no significant interaction between treatment and grasses and significant differences between treatments, except in fraction b of Brachiaria and Mombasa silage. The Mombasa showed high solubility of DM and NDF compared to other grasses and Brachiaria higher solubility of CP. Processing of Mombasa as silage promoted reduction of soluble fraction and potential (PD) and effective degradabilities (ED) of DM and NDF and increased soluble fraction and ED of CP. Monensin produced lower production of acetic acid, higher of propionic and lower acetic: propionic acid. Yeast and Fator P showed higher total acids concentration than monensin and control. Diplodiniinae protozoa was increased with monensin compared to the control diet, but there was no difference in Entodinium and total ciliates between treatments. Tropical grasses in the form of hay and silage have different ruminal degradability not being influenced by additives in the diet, but these affect fermentation and protozoa population in the rumen.

Abstract BACKGROUND: Acute kidney injury (AKI) is a multifactorial acute dysfunction. In the postoperative period is associated with more morbidity and mortality and we have little information on AKI in noncardiac surgeries. Urine output (UO) is a functional index and a biomarker of tubular injury. OBJECTIVE: To determine the incidence of AKI in patients post-appendectomy, the presence of postoperative oliguria and risk factors. MATERIAL AND METHOD: An observational, transversal, retrospective study was done. We reviewed records of patients undergoing appendectomy from February 2015 to January 2016 in the Hospital Ángeles Pedregal, Mexico City. We included patients aged 18 years and excluded patients without control of liquids. AKI was defined and classified by KDIGO guidelines. Demographics were expressed in medians. We used χ2 Pearson as parametric measure and present data in OR with confidence interval (CI) 95%. RESULTS: In 12 months, 196 cases were reviewed. 114 patients did not meet fluid control and were excluded, left 82 patients for analysis. We found an AKI incidence of 26%, AKI I, 48% and AKI II, 52%. The median age in the AKI group was 38 years (18-77). From no-AKI group, 54% showed transient oliguria recovering transient oliguria and 21% at 4 hours. In the AKI group, 76% had oliguria in recovery (p=0.097, OR 2.54 95% CI 0.826-7.820); 81% had oliguria at 4 hours after surgery (p≤0.05, OR 95% CI 3.94-47.6 13.66), sensitivity and specificity of 80% and 79%, PPV 56% and NPV 92%. CONCLUSION: We found a similar incidence reported in previous studies; however, we have more AKI II cases. We found a statistically significant association between UO 4 hours and AKI. AKI in the postoperative period has been associated with poor prognosis, so that timely detection for the proper handling is important. The presence of AKI in our population is considerable and strict control of fluids is essential for early detection, UO 4 hours after surgery can alert that patients may have AKI at 6 and 12 hours, starting an intervention.

Resumen ANTECEDENTES: la lesión renal aguda es una disfunción aguda multifactorial. En el periodo posquirúrgico aumenta la mortalidad y morbilidad y existe poca información acerca de lesión renal aguda en cirugías no cardiacas. El gasto urinario es un índice funcional y biomarcador de lesión tubular, aparte de los criterios diagnósticos. OBJETIVO: determinar la incidencia de lesión renal aguda en pacientes posapendicectomía, la existencia de oliguria posquirúrgica y los factores de riesgo de lesión renal aguda. MATERIAL Y MÉTODO: estudio observacional, transversal, retrospectivo, en el que revisamos los expedientes de pacientes sometidos a apendicectomía de febrero de 2015 a enero de 2016 en el Hospital Ángeles Pedregal. Incluimos pacientes mayores de 18 años y excluimos a los pacientes sin control de líquidos. Se definió y clasificó la lesión renal aguda con las guías KDIGO. Los datos demográficos se expresan en medianas. Utilizamos χ2 de Pearson como medida no paramétrica y presentamos datos en razón de momios (OR) con intervalo de confianza (IC) de 95%. RESULTADOS: en 12 meses se revisaron 196 expedientes; 114 pacientes no cumplieron con control de líquidos y se excluyeron, quedaron 82 pacientes para análisis. Encontramos incidencia de 26% de lesión renal aguda, 48% en estadio 1 y 52% en estadio 2. El 62% eran mujeres. La mediana de edad en el grupo de lesión renal aguda fue de 38 años (límites: 18-77). Del grupo sin lesión renal aguda, 54% tuvo oliguria transitoria en recuperación y 21% oliguria transitoria a las cuatro horas. En el grupo de lesión renal aguda, 76% tenía oliguria en recuperación (p=0.097, OR 2.54 IC 95% 0.826-7.820). El 81% tenía oliguria cuatro horas después de la cirugía (p≤0.05, OR 13.66 IC 95% 3.94-47.6), la sensibilidad y especificidad fueron de 80 y 79%, respectivamente; el valor predictivo positivo fue de 56% y el valor predictivo negativo de 92%. CONCLUSIONES: encontramos incidencia similar a la reportada en estudios previos; sin embargo, tuvimos más casos de estadio 2. Encontramos una asociación estadísticamente significativa entre diuresis media horaria a las cuatro horas y lesión renal aguda. La lesión renal aguda en el periodo posquirúrgico se ha relacionado con mal pronós tico, por lo que su detección oportuna para el manejo adecuado es importante. La existencia de lesión renal aguda en nuestra población es considerable y el control estricto de líquidos es indispensable para la detección oportuna, la medición de la diuresis media horaria cuatro horas después de la cirugía puede alertar sobre qué pacientes pueden padecer lesión renal aguda a las 6 y 12 horas, para iniciar la intervención y abordaje oportunos.

Resumo Este estudo teve o objetivo de avaliar a contaminação de carcaças suínas por Salmonella sp. em oito pontos específicos, no processo de abate de suínos, identificando a ocorrência e o motivo dessas contaminações. A pesquisa foi realizada em um frigorífico do Estado do Rio Grande do Sul, no período de abril a agosto de 2014. As amostras foram coletadas a partir de esfregaços, utilizando a técnica da esponja abrasiva em quatro regiões anatômicas na superfície da carcaça. A análise estatística foi realizada através do teste Qui-Quadrado. Trinta e três carcaças foram submetidas à coleta amostral, totalizando 258 amostras coletadas em todos os pontos. A partir da análise microbiológica, obteve-se uma frequência total de isolamento de Salmonella sp. igual a 7,75% do total de amostras. De acordo com os resultados das análises estatísticas, não há diferença significativa entre os pontos amostrados, uma vez que as diferenças dos valores encontrados para o número de carcaças contaminadas por Salmonella sp. são baixas, mesmo comparando os pontos de maior contaminação com os de menor contaminação. O maior percentual de isolamento microbiano foi encontrado após a escaldagem e a depilação (ponto A), com 17,85%. Os pontos B (após o toalete externo), C (seguido da abertura do abdômen) e E (imediatamente após a serragem das carcaças) apresentaram 10% de contaminantes cada. Os pontos F (antes da lavagem final das carcaças) e H (após 24 horas de resfriamento) tiveram valores de 6,89%, seguidos pelo ponto G (imediatamente após a lavagem final das carcaças, antes do resfriamento), com 3,33%. O menor valor de contaminação foi encontrado no ponto D (após a liberação do rabo), com 3,1%. Assim, de acordo com os pontos amostrados, o frigorífico avaliado possui condições higienicossanitárias satisfatórias, de acordo com padrões estabelecidos internacionalmente e programas de controle, que favorecem as boas práticas de fabricação e avaliação dos pontos críticos de controle.

Summary This study aimed to evaluate the contamination of swine carcasses by Salmonella sp. at eight specific points in the swine slaughtering process, identifying the occurrence and the reasons for these contaminations. The survey was carried out in a swine processing plant in the state of Rio Grande do Sul, Brazil, in the period from April to August 2014. Samples were collected with swabs using the abrasive pad technique from four anatomical regions of the carcass surface. The statistical analysis was carried out using the chi-square test. Thirty-three carcasses were selected and subjected to sampling, giving a total of 258 samples collected at all points. The microbiological analyses showed a total frequency of Salmonella sp isolation equal to 7.75% of the total number of samples. According to the results of the statistical analyses, there were no significant differences between the points sampled, since the values found for the number of carcasses contaminated with Salmonella sp. were low, even when comparing the more contaminated points with the less contaminated points. The highest percentage of microbial isolation was found after scalding and hair removal (point A) with 17.85%. Points B (after external washing), C (after opening of the abdomen) and E (immediately after sawing the carcass) each showed 10% of contaminants. Points F (before the final washing of the carcasses) and H (after 24 hours of cooling) showed values of 6.89%, followed by point G (immediately after the final washing of the carcasses and before cooling) which showed 3.33%. The lowest contamination was found at point D (after release of the tail) with 3.1%. Thus, according to the points sampled, the slaughterhouse examined had satisfactory hygienic and sanitary conditions in accordance with internationally established standards and control programs that support good manufacturing practices and the evaluation of critical control points.

Abstract The aim of this study was to evaluate the thickness of resin cements in the root thirds when using conventional fiberglass posts (CP) and relined fiberglass posts (RP) in weakened roots and to evaluate the morphological characteristics of the dentin-resin interface. Forty human maxillary anterior teeth had the crown sectioned below the cemento-enamel junction. The canals were endodontically treated and weakened with diamond burs. Teeth were divided into four groups (n = 10): Group 1 – CP + RelyX ARC; Group 2 – CP + RelyX U200; Group 3 – RP + RelyX ARC; and Group 4 – RP + RelyX U200. Prior to luting, 0.1% Fluorescein and 0.1% Rhodamine B dyes were added to an adhesive and resin cement, respectively. Slices were obtained from the apical, middle, and cervical thirds of the root. Confocal laser scanning microscopy images were recorded in four areas (buccal, lingual, mesial, distal) of each third. In each area, four equidistant measures of the resin cement were made and the mean value was calculated. The interface morphology was observed. The data were submitted to three-way ANOVA and Tukey’s test (α = 0.05). The interaction between fiberglass posts, resin cement, and root thirds was significant (p < 0.0001). The resin cement thicknesses were significantly lower for RP in comparison with CP, except in the apical third. There was no significant difference between the resin cements for RP. There was formation of resin cement tags and adhesive tags along the root for RP. RP favored the formation of thin and uniform resin cement films and resin tags in weakened roots.