Genotypical characterization of thermotolerant coliforms isolated from food produced by a Solidarity Economic Venture of Bahia (Brazil)

Many Solidarity Economic Venture (SEV) are family farmers who seek to add value to production through artisanal processing, which can lead to food contamination. Thus, this study aimed to genotypically characterize thermotolerant coliforms (TtC) strains from food produced by local agribusinesses of SEV during January to April 2019. Samples from thirteen production units (PU) from the SEV were submitted to a microbiological analysis of thermotolerant coliforms (AFNOR 3M1/2 - 09/89), using a fast count method in Petrifilm™ dishes. The Polymerase Chain Reaction (PCR) technique was used to verify the following virulence genes (VGs) associated with Escherichia coli: stx, typical from enterohemorrhagic E. coli (EHEC); bfpA typical from entheropathogenic E. coli (EPEC) and elt and slt, typical from entherotoxigenic E. coli (ETEC). The results showed that two samples of queijadinha (typical Brazilian candy made with eggs and coconut) and one sample of cassava cake presented characteristic colonies TtC. This way, three strains were isolated in order to perform the PCR technique. However, the genes used in the reaction were not detected in the isolated strains. Therefore, it is suggested that the isolated strains are from E. coli pathotypes with different virulence genes than the ones analyzed belong other types of TtC, such as Enterobacter and Klebsiella. Although the virulence of genes has not been confirmed, the presence of TtC on food indicates hygiene flaws during production and, therefore, measurements to control and prevent contamination should be taken.

Validation of a Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire

Background

The aim of this study was to validate and determine at pretest level the reliability of the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire.

Material and Methods

This study employed 37 head and neck cancer patients. Each patient signed an informed consent and responded to the Portuguese version of the questionnaire in the form of an interview. This was repeated again after 2 weeks. A standard single question provided a validity check. Data were analyzed using Cronbach’s α to test its reliability and total and interitem correlation, and intraclass correlation to determine its internal consistency and test-retest reliability. Construct validity supported by objective measurements as salivary secretion was also investigated. Significance was set at .05.

Results

Cronbach’s α was 0.91 and 0.89 for the first and second test administrations, respectively, which indicates that the internal consistency was excellent. The intraclass correlation coefficient value for the test-retest reliability was 0.70. The correlation between the total score of the questionnaire and standard single dry mouth question was 0.72 for the first round, indicating a good correlation.

Conclusions

Demonstrating very good psychometric properties, the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire is a valid tool and can be considered a reliable instrument to measure xerostomia in head and neck cancer patients.

Key words:Xerostomia, quality of life, xerostomia questionnaire, transcultural validation, head and neck cancer, radiotherapy, saliva.

P6404Myocardial infarction with nonobstructive coronary arteries: does aspirin have a place in the treatment of this entity?

Background

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is still a clinical enigma that is being increasingly recognised, as the number of coronary angiographies we perform in our centres also increase. However, the treatment for this entity is still a matter of important debate, not only due to the different causative mechanisms of this disease but also because there are no major trials regarding MINOCA treatment.

Purpose

To determine the association between acetylsalicylic acid (ASA) use after discharge and mortality after discharge in MINOCA patients admitted to a coronary care unit (CCU).

Methods

We analyzed data from 370 (11.7% of the global sample) patients admitted with MINOCA in our CCU. Patients with other final diagnoses, missing mortality data, previous acute myocardial infarction, contra-indications to aspirin and known heart failure before admission were excluded. All patients underwent transthoracic echocardiography and coronary angiography at any point during hospitalisation. After adjusting data for relevant comorbidities we then compared mortality after hospital discharge between the ASA group and the no-ASA group.

Results

Of all MINOCA patients admitted in our CCU, 84 (22.7%) were diagnosed with ST-elevation myocardial infarction (STEMI) and 286 (77.3%) with non-ST elevation myocardial infarction (NSTEMI). 296 (80%) patients received ASA after discharge. Both groups were homogeneous as we did not find any significant differences between groups regarding age (p=0.106), left ventricle ejection fraction (p=0.100), GRACE score at hospitalisation (p=0.150), Killip-Kimball class at hospitalisation (p=0.604), incidence of acute kidney injury (p=0.450), maximum c-reactive protein during stay (p=0.804) and low-density lipoprotein levels at hospitalization (p=0.055). There was also no difference in the incidence of diabetes (p=0.350), exposure to daily stress (p=0.767), active smoking (p=0.569), dyslipidemia (p=0.229), hypertension (p=0.057) and type of myocardial infarction (STEMI vs NSTEMI – p=0.215). In this MINOCA cohort (5 years follow-up) a total of 47 patients died (12.7%). ASA vs. no-ASA 1-month (3.1% vs. 0.0%, p=0.214), 6-month (4.5% vs. 1.4%, p=0.317), 1-year (5.9% vs 5.6%, p=0.900), 3-year (10.5% vs. 8.3%, p=0.668) and 5-year (13.3% vs. 12.5%, p=0.860) all-cause mortality was not significantly different. The same non-significant trend towards higher mortality with ASA was obtained when survival curves were taken into account.

Conclusions

MINOCA remains a challenging entity. In our study, the systematic use of ASA in all patients following MINOCA was not associated with better survival after long-term follow-up.

P2655ST-elevation myocardial infarction in women: a more satisfactory outcome?

Background

Despite all the advances registered in the last decade regarding acute myocardial infarction with ST-segment elevation (STEMI) treatment, this entity remains prevalent and highly lethal. Women constitute a lower proportion of STEMI patients, however, they show important differences when compared to men. Thanks to the lower representation of women in STEMI trials, less is know about this patient subpopulation.

Purpose

To determine and understand gender differences in patients admitted with STEMI in a coronary care unit (CCU).

Methods

Observational retrospective study of patients admitted with STEMI in a CCU, between 2006 and 2017. Patients were split between groups according to gender and were assessed in terms of risk factors, diagnosis, treatment, complications and mortality.

Results

A total of 2516 patients were included in the study. 1833 were men (72.9%) and 682 were women (27.1%). Mean age was superior in women (73.3±13.2 vs. 64.1±12.8 years, p<0.001), and displayed a greater cardiovascular comorbidity burden such as hypertension (79.6% vs. 66.2%, p<0.001) and diabetes (55.8% vs. 45.3%, p<0.001). At admission time women registered a higher mean TIMI (2.79 vs. 2.62, p=0.009) and GRACE score (166.3 vs. 146.3, p<0.001) which did not reflect in a higher hospital stay (mean 4.75 vs. 5.29 days, p=0.043). Before admission women were less treated with aspirin (26.4% vs. 33.2%, p=0.014) and statins (36.8% vs. 46.5%, p=0.001). There were no differences regarding access to revascularization (98% vs. 96.5%, p=0.105) but women presented more normal coronary angiographies (10.2% vs. 3.6%, p<0.001). During hospital stay, women evolved more to Killip-Kimball (KK) class III (4.5% vs. 1.9%, p<0.001) and KK class IV (15.9% vs. 11.2%, p<0.001). Intra-hospital (13.9% vs. 8.2%, p<0.001), 1-month (18.4% vs. 13.2%, p<0.001), 6-month (22.2% vs. 16.1%, p<0.001) and 1-year mortality (25.7% vs. 17.8%, p<0.01) was superior in women. After multivariate analysis heart failure on admission (OR 9.2, CI 95% 6.7–12.8), intravenous amiodarone use (OR 3.5, CI 95% 2.5–4.8), diabetes (OR 2.3, CI 95% 1.8–2.8), female gender (OR 1.6, CI 95% 1.3–2.0) and peak serum creatinine during hospital stay (OR 1.7, CI 95% 1.6–1.9) were independent predictors of 1-year mortality. After adjustment for age, diabetes, hypertension, previous acute myocardial infarction and initial KK, female gender maintained its potency as a significant 1-year mortality predictor.

Conclusions

Women presenting with STEMI register poorer outcomes compared to men. In our study, female gender was considered a good independent predictor of short-term and long-term mortality.

Dynamics of clonal and plasmid backgrounds of Enterobacteriaceae producing acquired AmpC in Portuguese clinical settings over time

OBJECTIVES

The objective of this work was to provide detailed molecular data on clinically acquired AmpC (qAmpC)-producing Enterobacteriaceae from two different periods (2002-2008 and 2010-2013) in order to clarify the contribution of clonal and plasmid genetic platforms for the current epidemiological scenario concerning extended-spectrum beta-lactams resistance.

METHODS

We analysed 1246 Enterobacteriaceae non-susceptible to third-generation cephalosporins from two hospitals and one community laboratory between 2010 and 2013. Bacterial identification, antibiotic susceptibility, identification of qAmpC and plasmid-mediated quinolone resistance genes, clonal (pulsed-field gel electrophoresis (PFGE), Multilocus sequence typing (MLST)) and plasmid (S1-/I-CeuI-PFGE, replicon typing, hybridization) analysis were performed by standard methods. Whole-genome sequencing (WGS) was performed in two ST11-Klebsiella pneumoniae isolates harbouring DHA-1.

RESULTS

The occurrence of qAmpC was lower (2.6%) than that observed in a previous survey (7.4%), and varied slightly over time. Isolates produced DHA-1 (53%), CMY-2 (44%) or DHA-6 (3%), but significant epidemiological changes were observed in the two surveys. While DHA-1 persisted in different institutions by selection of a worldwide epidemic IncR plasmid in an ST11 harbouring KL105, CMY-2 rates increased over time linked to IncI1 plasmids (instead of IncK or IncA/C₂) in multiple Escherichia coli clones.

CONCLUSIONS

The higher frequency of DHA-1 qAmpC in these species contrasts with the scenario in most European countries. Furthermore, the different genetic backgrounds associated with either extended-spectrum β-lactamases (ESBLs) or acquired AmpC β-lactamases (qAmpC) in our country might have contributed to their differential expansion.

Accumulation of copper by the aquatic macrophyte Salvinia biloba Raddi (Salviniaceae)

Abstract Aquatic macrophytes have properties and mechanisms which are useful for the removal of substances in solution, commonly used in phytoremediation processes in aquatic environments. This study evaluated the performance of copper (Cu) accumulation by Salvinia biloba Raddi (Salviniaceae) in different metal concentrations (1, 3 and 5 µg mL-1), as well as the control treatment, measured at intervals of 0, 7 and 14 days under laboratory conditions, with control as to pH and luminosity. After the experiment, the S. biloba biomass was washed, kiln dried, crushed and subjected to the process of digestion, and subsequently the accumulated copper content was determined by atomic absorption spectroscopy. The results showed that S. biloba is apt at accumulating copper, varying significantly between different treatments and days of exposure to the contaminant, as well as its interaction (treatment × days). The highest accumulation values were observed in treatment with 5 µg mL-1, which at 14 days, with 11,861 µg g-1 of copper. We observed symptoms of toxicity and mortality in plants, probably indicating the effect of copper on the species when at high levels. Salvinia biloba is an efficient species in the removal of copper in solution, its recommendation as a remediating agent in aquatic ecosystems being possible.

Long-term dissemination of acquired AmpC β-lactamases among Klebsiella spp. and Escherichia coli in Portuguese clinical settings

We investigated the occurrence, diversity and molecular epidemiology of genes coding for acquired AmpC β-lactamases (qAmpC) among clinical isolates of Enterobacteriaceae lacking inducible chromosomal AmpCs in Portugal. A total of 675 isolates non-susceptible to broad-spectrum cephalosporins obtained from four hospitals and three community laboratories during a 7-year period (2002-2008) were analysed. The presence of genes coding for qAmpC was investigated by phenotypic criteria, polymerase chain reaction (PCR) and sequencing. Bacterial identification, antibiotic susceptibility testing, conjugation assays and clonal analysis were performed by standard procedures. The presence of bla(qAmpC) genes was detected in 50 % (50/100; 41 Klebsiella pneumoniae, 5 Escherichia coli, 4 Klebsiella oxytoca) of the presumptive qAmpC producers. DHA-1, detected in those species, was the most prevalent qAmpC (94 %, 47/50), being identified since 2003 and throughout the studied period in different institutions. Despite the high clonal diversity observed, three DHA-1-producing Klebsiella spp. clones were more frequently identified. CMY-2 (6 %, 3/50) was observed in B1-E. coli clones. Conjugative transfer was only observed in one (2 %) CMY-2-producing isolate. Most qAmpC producers (94 %, 47/50) co-expressed SHV-type and/or OXA-1 or CTX-M-32 extended-spectrum β-lactamases (ESBLs). To the authors' knowledge, this is the first description of the molecular epidemiology and the long-term dissemination of qAmpC-producing Enterobacteriaceae in Portuguese clinical settings, highlighting an evolution towards a more complex epidemiological situation regarding cephalosporin resistance in Portugal.

Two Distinct Introductions of the West Nile Virus in Portugal Disclosed by Phylogenetic Analysis of Genomic Sequences

In this report, we describe genomic sequencing and analysis of different West Nile virus strains isolated from mosquitoes in the south of Portugal (Alentejo and Algarve) at two different time points (1971 and 2004, respectively). Phylogenetic analysis indicated different origins for the two recorded introductions of WNV in our country, with strains segregating in different sub-clades within lineage 1a. PTRoxo (isolated in 1971) was found to be very similar to an Egyptian WNV strain isolated in 1951, while the viruses isolated in 2004 formed a statistically well-supported group with WNV strains isolated over the last decade in countries lining the Mediterranean (Morocco, Italy, and France). Analyses of the putative amino acid sequences showed all the main expected features described for viral mature proteins except for the absence of the N-glycosylation site in the envelope glycoprotein of PTRoxo, which may be reflected as attenuated neurovirulence and neuroinvasive phenotypes.

Luteal phase oestradiol administration in ovarian stimulation cycles with GnRH antagonist is comparable to the GnRH agonist (long) protocol

PURPOSE

The purpose of the study was to compare the effectiveness of GnRH antagonist with luteal phase estradiol administration to GnRH agonist cycles, long protocol.

METHODS

55 IVF-ICSI patients received oestradiol in the luteal phase of the cycle, before a cycle with GnRH antagonist. Fifty-five patients submitted to IVF-ICSI with the use of agonist were allocated, age matched, as a control group (historical control). The primary outcome was the number of retrieved oocytes.

RESULTS

Patients were similar in terms of clinical characteristics. No differences were found in the number of oocytes retrieved (study group, 8.1 +/- 4.7; control group, 7.4 +/- 4.5) or in oocyte quality.

CONCLUSIONS

We clearly demonstrated that the effectiveness of GnRH antagonist when combined with luteal phase estradiol is comparable to GnRH agonist cycles.

Control a 2-Axis Servomechanism by Gesture Recognition Using a Generic WebCam

This paper presents two approaches used to control a 2-axis servomechanism by gesture recognition. For both approaches, the adopted control philosophy was: In the system's learning phase, the control images are acquired by a generic webcam and associated to the desired orders. On the other hand, in the working phase, each control image is acquired, by the same webcam and, by comparison with the stored orders images, the desired order is recognized and processed by the servomechanism in quasi real time. In this paper, the used servomechanism and both implemented approaches are described, and are indicated some advantages and weakness of each one. Two examples of images control sets are also presented, and some conclusions and future works are addressed.

[Use of antipsychotic drugs. A multicentric study of inpatients with acute psychotic disorders]

With the objective of determining the pattern and decision making process in using antipsychotic drugs in patients admitted to hospital for acute psychotic disorder we have made a retrospective analysis in 244 in-patients in 7 hospitals for mental disorders. We have selected two groups, IM and PO, that in the first three days of internment have received either intravenous antipsychotic medication or oral medication; the demographical, clinical and therapeutical differences have been considered (with a review of the cases at 6 and 12 months after discharge from hospital). Homogeneity was considered regarding age, race, gender, age at the onset of the disease and diagnosis; in the IM group there were a larger number of compulsive admissions. The most prevalent psychotic disorders in both groups were schizophrenia and bipolar disorder; with no association being made between the initial diagnosis and drug administration. The hospitalization period was the same for both groups, although in the patients in the IM group the need for special precautions was more frequent. Medication with anxiolytics was higher in the PO group on day 1 and 2 of the hospitalization and the same for the two groups on day 3 and on discharge. The number of new admissions, as well as the percentage of patients taking antipsychotic, anxiolytic and anticholinergic medication was similar in both groups after a period of 6 and 12 months follow-up. In this study, agitation and aggressive/destructive behaviours in the initial phase of hospitalization in the IM group (including the first contact, most of the times on admission at the ER) were statistically significant factors for the use of intramuscular administration of antipsychotic drugs.

Nutrient removal in a sequencing batch reactor operated with short anaerobic/aerobic cycles

A single sequencing batch reactor operated with short intermittent aeration cycles was used to simultaneously remove carbon, nitrogen and phosphorus. The complete cycle, comprising feeding, anaerobiosis, aerobiosis, settling and decanting, was only 36 minutes long. The system has shown high and stable nutrient removal at 30 degrees C with acetate as carbon source and it has proved to be rather robust and dynamic, efficiently adapting to most of the changes in operating parameters tested: presence of nitrate in the feeding medium, different substrates (propionate and butyrate), temperature and nutrient shock loads. For the optimum conditions used, a removal efficiency of over 90% was obtained for each nutrient. Description of the population kinetics was obtained for each operating condition, by performing batch tests. Kinetic and stoichiometric parameters were used to infer the relative contribution of each group of microorganisms on SBR performance. Compared to the traditional SBR operated with cycles of 6 hours, the use of short intermittent aeration cycles of 36 minutes corresponds to a 40% reduction on aeration time.

Fluoroaluminate stimulates phosphorylation of p130 Cas and Fak and increases attachment and spreading of preosteoblastic MC3T3-E1 cells

Fluoroaluminate is a G-protein activator, it stimulates osteoblastic cells in culture, and is a bone-forming agent in vivo. To elucidate the mechanisms of G-protein-mediated action of fluoroaluminate in osteoblasts, we studied protein tyrosine phosphorylation in the preosteoblastic cell line MC3T3-E1. Fluoroaluminate, lysophosphatidic acid (LPA; an agonist for G-protein-coupled receptor), or adhesion to type I collagen all stimulated phosphorylation of a similar set of proteins, including p130, p120, p110 (previously identified as proline-rich tyrosine kinase 2, Pyk2), and p70. The phosphorylation of these proteins was sensitive to an Src inhibitor, but not to a Gi-protein inactivator, pertussis toxin. By purification/mass spectrometry and by immunodepletion, p130 protein was identified as p130 Cas (Crk-associated protein), a Src substrate and a protein involved in signaling by cell-adhesion receptors, integrins. Phosphorylation of immunoprecipitated p130 Cas increased upon stimulation with fluoroaluminate and with agonists of G-protein-coupled receptors, but not with growth factors. By immunodepletion, the p120 protein was identified as focal adhesion kinase, Fak. The addition of fluoroaluminate during cell attachment to type I collagen further stimulated phosphorylation of p130 Cas and of Fak. Simultaneously, fluoroaluminate increased the number of attached MC3T3-E1 cells and their spreading. These novel aspects of fluoroaluminate action in cell culture may be important for the bone-forming action of fluoroaluminate in vivo.

[Hysterosonosalpingography and hysterosalpingography in the diagnosis of tubal patency in infertility patients]

OBJECTIVES

To compare the hysterosonosalpingography(HSS) to the hysterosalpingography(HSG) in the evaluation of the tubal factor in infertility patients.

MATERIAL AND METHODS

A transversal study with 30 patients in infertility investigation, with age minor than 38 years was performed. The patients were submitted to HSS, HSG and laparoscopy (LPC) in the first cycle menstrual phase. The evaluation of tubal patency of HSS and HSG, with LPC like gold-standard was compared. It was calculated the negative predictive value (PV-) of the exams. The HSS used Ecovist like contrast agent, the HSG used water soluble contrast media and the LPC used tubal insufflation with methylene blue. It was considered significative a p< 0.05

RESULTS

The final sample was of 26 patients (4 leave the investigation). The mean age was of 30,6 years. The HSS showed tubal patency in at least one of the tubes in 24 patients (92,3%). The HSG showed tubal patency in one of the tubes in 25 patients (96,2%), and the LPC in 25 patients (96,2%). The PV- of the HSS was of 92% and the PV- of HSG was of 100%. The differences were not statistically significant (p=0.996, Yates test).

CONCLUSIONS

The HSS is an alternative method in the evaluation of tubal patency in infertility patients.

Electron Spectroscopic Imaging of Magnetotactic Bacteria: Magnetosome Morphology and Diversity

Magnetotactic bacteria from aquatic environments were analyzed with the electron spectroscopic imaging technique. Rod-shaped bacteria and cocci were present in most of the samples observed. Magnetotactic multicellular aggregates were also observed at some of the sampling sites. The use of electron spectroscopic imaging allowed the observation of magnetosomes inside magnetotactic microorganisms with exceptional clarity. The number, size, and morphology of magnetosomes, as well as their ultrastructural spatial disposition inside the bacterial cell, could be directly observed and associated with the disposition of flagella of the respective cells.This allowed us to examine the structural relationships between magnetosomes and flagella, which are important components in the mechanisms of magnetotaxis. In disrupted magnetotactic multicellular aggregates, connections between cells were also visualized. We believe this technique will be useful in studying not only magnetotactic bacteria but also other uncultured microorganisms from natural environments.

[Human leptospirosis. A short review concerning a caseload]

Leptospirosis, a zoonosis with worldwide distribution, may have a broad spectrum of clinical manifestations that can delay the diagnosis, especially in wet climates where other conditions may dissimulate the main aspects. The authors describe 42 cases of patients with leptospirosis admitted to the Infectious Diseases Unit of a general hospital since 1990. The goal was to analyse epidemiological features, clinical manifestations, laboratory findings, treatment and evolution. There were 23 males (54.7%) and 19 females (45.2%), with ages ranging from 17 to 82 years. Most cases occurred in occupational settings, especially in those in contact with animals or stagnant water. All the cases had serological confirmation (by MAT or ELISA methods). Anicteric forms represented 42.9% of the total, which implies that in many cases a diagnosis is not immediately evident. The main symptoms, other than fever (97.6%) and jaundice (57.1%), were myalgia (71.4%), headache (42.8%) and nausea (33.3%). Renal involvement was common (52%), but the most severe forms occurred in 3 patients who required hemodialysis; followed by D.I.C. in 9.5%; meningitis in 4.7% and pulmonary involvement in 2.3% of the cases. The serovars most commonly identified were L. icterohaemorraghiae (28.5%), L. australis (14.3%), L. grippothyphosa (11.9%) and L. canicola (9.5%). The patients were treated with penicillin G (83.3%) or doxycyclin (9.5%). Two of them deceased (4.7%) and the remainder had a good evolution. The diagnosis of leptospirosis may be delayed if physicians fail to include this infection in the initial differential diagnosis. In view of this, the authors emphasize that when nonspecific clinical manifestations occur, a good epidemiological history is useful in proposing this diagnosis.

Prenatal diagnosis of a benign facial tumor

We report a case of prenatal diagnosis of a benign fetal skin tumor on the chin made at 27 weeks of pregnancy by ultrasound scan. We report this case given the uncommon diagnosis and the unique fetal facial profile seen on ultrasound, resembling the image of an ancient Egyptian pharaoh which made us call it 'Ramses' sign' as a future mnemonic aid to sonographers.