•Brazilian dogs, and cats to a lesser extent, are an important reservoir of resistance determinants.•Saliva was proved to be a potential source of transmission of ESBL-producing ...Enterobacteriaceae.•ESBL/pAmpC were detected in 24.8% of stray cats/dogs and in 10.8% of diseased pets.•The typical CTX-M-2/8 were identified, but the CMY-2/IncI1/ST12 association was predominant.•Despite broad diversity, E. coli clones ST90, ST457, ST973, and ST2541 were dominant.
Extended-spectrum beta-lactamase (ESBL)- and plasmid-mediated AmpC (pAmpC)-carrying Enterobacteriaceae have widely disseminated in human, animal and environmental reservoirs. Pets have been recognized as a source of ESBL/pAmpC worldwide, and are possibly also a source of human contamination. The aim of this study was to document to what extent cats and dogs may act as a driving force in the spread of ESBLs and pAmpCs in Brazil. A total of 113 healthy stray cats and dogs and 74 sick pets were sampled, and extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESC-R) were detected in 28/113 (24.8%) and 8/74 (10.8%) tested animals, respectively. Different Enterobacteriaceae isolates (mostly E. coli), a large number of E. coli clones (with ST90, ST457, ST973 and ST2541 being predominant), and several ESBL/pAmpC genes and plasmids were characterized, highlighting the ability of stray and pet cats and dogs to further spread a wide range of ESC-resistance determinants. The ESBL phenotype was due to the blaCTX-M-2 and blaCTX-M-8 genes, as found in human epidemiology in Brazil, but blaCTX-M-9 and blaCTX-M-15 were also identified. The pAmpC phenotype was systematically due to the presence of the blaCMY-2 gene, mostly carried by IncI1 ST12 plasmids. Our results showed that pets can be considered a significant reservoir of multidrug-resistant bacteria in Brazil. This is especially true for healthy stray dogs that displayed the highest prevalence (24.8%) of ESBLs/pAmpC resistance determinants, which can then be further spread both to the environment and to other animals or humans by contact.
OBJECTIVES:Compare acute complication and mortality rates of geriatric patients with acetabular fractures (AFs) matched to hip fractures (HFs).
DESIGN:Retrospective cohort study.
SETTING:American ...College of Surgeons National Surgical Quality Improvement Project.
PATIENTS:Using Current Procedural Terminology codes, the American College of Surgeons National Surgical Quality Improvement Project registry was used to identify all patients ≥60 years from 2011 to 2016 treated for AFs undergoing open reduction internal fixation (ORIF) and HFs (undergoing ORIF, hemiarthroplasty, or cephalomedullary nail).
OUTCOME MEASUREMENTS:Patient characteristics, comorbidities, functional status, acute complications, and mortality rates were recorded. Patients were matched 1:5 (AF:HF). Chi-square, Fisher exact, and Mann–Whitney U tests were used to compare groups, and multivariable logistic regression was used to compare the risk of complications or death while adjusting for relevant covariates.
RESULTS:A total of 303 AF patients (age78.2 ± 9.2 years/59.7% females/27.1% wall, 28.4% one column and 45.2% 2 columns ORIF) were matched to 1511 HF patients (age78.3 ± 9.1 years/60.2% females/37.2% hemiarthroplasty, 16.3% ORIF and 47.4% cephalomedullary nail). Length of stay (8.4 ± 7.1 vs. 6.4 ± 5.9 days) and time to surgery (TS) 2.3 ± 1.8 versus 1.2 ± 1.4 days were longer in the AF group (P < 0.01). Unadjusted mortality rates were nonsignificantly higher for AFs versus HFs (6.6% vs. 4.6%, P = 0.14). After covariable adjustment, the risk of mortality was significantly higher for AFs versus HFs (odds ratio1.89, 95% confidence interval1.07–3.35).
CONCLUSION:Geriatric AFs pose a significantly higher adjusted mortality risk when compared with HF patients. Strategies to mitigate risk factors in this population are warranted.
LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
•The prefrontal cortex activity increased early after an external load was imposed on the inspiratory muscles.•However, it was not associated with dyspnea nor inspiratory muscle effort throughout the ...inspiratory loading protocol.•At task failure, no signs of central fatigue were present in the prefrontal cortex.
We aimed to investigate whether changes in prefrontal cortex (PFC) oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb) associates with inspiratory muscle effort during inspiratory threshold loading (ITL) in healthy participants.
Participants performed an incremental ITL. Breathing pattern, partial pressure of end-tidal CO2 (PETCO2), mouth pressure and O2Hb and HHb over the right dorsolateral PFC, sternocleidomastoid (SCM), and diaphragm/intercostals (Dia/IC) were monitored.
Fourteen healthy participants (8 men; 29 ± 5 years) completed testing. Dyspnea was higher post- than pre-ITL (5 ± 1 vs. 0 ± 1, respectively; P<0.05). PFC O2Hb increased (P < 0.001) and HHb decreased (P = 0.001) at low loads but remained stable with increasing ITL intensities. PFC total hemoglobin increased at task failure compared to rest. SCM HHb increased throughout increasing intensities. SCM and Dia/IC total hemoglobin increased in the at task failure compared to rest. PETCO2 did not change (P = 0.528).
PFC is activated early during the ITL but does not show central fatigue at task failure despite greater dyspnea and an imbalance of SCM oxygen demand and delivery.
Abstract Comprehensive access to health is a global issue. One-third of the population does not have regular access to essential medicines. People Deprived of Liberty (PDL) are one of those people in ...a situation of unequal access. Given the uniqueness of the penitentiary system, this research aimed to identify the determining factors in the access to medicines made available by the Brazilian Unified Health System (SUS) for the PDLs in Pará, Brazil. The applied, exploratory, qualitative research was conducted from August 2019 to February 2020 using the APOTECA framework. The APOTECA framework analysis revealed that technical, political, and administrative factors are the main hurdles to guaranteeing equal access to medicines made available by the SUS for the PDLs in Pará. The deprivation of liberty, social vulnerability, and other factors inherent to the prison reality hinder the implementation of PDLs’ right to health, and several challenges must be overcome to secure equal access to medicines.
Resumo O acesso integral à saúde é um problema global. Estima-se, que um terço da população não tenha acesso regular aos medicamentos essenciais. A Pessoa Privada de Liberdade (PPL) é uma das que apresenta situações de iniquidades de acesso. Diante da singularidade do sistema penitenciário, esta pesquisa objetivou identificar os fatores determinantes no acesso aos medicamentos disponibilizados pelo Sistema Único de Saúde (SUS) para a PPL paraense. Trata-se de uma pesquisa aplicada, exploratória, qualitativa, realizada no período de agosto de 2019 a fevereiro de 2020, utilizando-se, também do framework APOTECA. Evidenciou-se na análise do framework APOTECA que fatores técnicos, políticos e administrativos são identificados como principais barreiras na garantia ao acesso equânime aos medicamentos disponibilizados pelo SUS para a PPL paraense. A privação de liberdade, vulnerabilidade social e outros fatores inerentes a realidade carcerária dificultam a efetivação do direito à saúde das PPL, sendo que diversos desafios devem ser superados quanto a garantia ao acesso equânime aos medicamentos.
Paiche (Arapaima gigas) belongs to the Kingdom Animalia, Phylum Chordata, Class Actinopterygii, Order Osteoglossiformes, Family Arapaimidae, Genus Arapaima, and its origin may date to the Jurassic ...period. The species has natural habitat in the Amazonian rivers, found mainly in marginal lakes, being considered an important fishing resource, with high market value and high demand for meat and leather in both Brazilian and international trade. This study aims to report the morphology of the esophagus and stomach by light microscopy and scanning electronics microscopy. The esophagus was presented as muscular, short, tubular and fan-shaped in the cranial portion, also presenting deep longitudinal folds, and the entire mucosa is covered by mucus secretory cells with distinct morphological characteristics. Pirarurcu’s stomach has a J-shape divided into three regions: cardiac with a lighter aspect, fundus portion with few folds in the mucosa, and pyloric with deeper folds, also presenting gastroliths in fundus and pyloric portions. Both microscopy studies highlighted three glandular regions, composed by mucoid columnar epithelial cells, gastric crypts with different shapes and sizes depending on each portion, in which the different shapes of the mucosal folds in each region of the stomach were evident, and digitiform microsaliences were found in the cardiac region, and micro-orifices and desmosome in the fundus region. Also, fundus and pyloric portions produce more mucus than the cardiac. Then morphology found was consistent with the eating habits and management of distinct characteristics of the digestive tract.
Researchers see algae as a promising tool to discover both efficient and safe agents for pain therapy. We evaluated the antinociceptive and anti-inflammatory activities of lectin from the marine alga ...Pterocladiella capillacea lectin (PcL). PcL was purified and tested in classical models of nociception and inflammation. Male Swiss mice received PcL 30 min prior to receiving 0.8% acetic acid (10 μl/10 g, i.p.), 1% formalin (20 μl/intraplantar) or the hot plate test, and were compared to untreated animals or animals pretreated with indomethacin or morphine. PcL (0.9, 8.1 or 72.9 mg/kg, i.v.) significantly reduced the number of writhes (30%, 39%, and 52%, respectively). PcL (72.9 mg/kg, i.v.) also reduced (p<0.05) both the first and second phases of the formalin test by 58% and 87%, respectively. However, PcL (72.9 mg/kg) did not present significant antinociceptive effects in the hot plate test when compared to morphine, suggesting that its antinociceptive action occurs via peripheral rather than a central-acting mechanism. It was also observed that leukocyte migration was induced by carrageenan (500 μg/cavity) in male Wistar rats and that PcL (8.1 mg/kg, i.v.) significantly reduced neutrophil migration by 84%, as compared to untreated animals, suggesting inhibition of inflammatory mediators. The data indicated that PcL has peripheral actions with both anti-inflammatory and antinociceptive properties.
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