Eveline Franco da Silva

Genomic characterization of Arcanobacterium pyogenes isolates recovered from the uterus of dairy cows with normal puerperium or clinical metritis

Arcanobacterium pyogenes is considered to be the most relevant bacterium involved in the establishment of puerperal uterine infection in cattle due to its persistence in utero, resistance to treatment and synergic action with Gram negative anaerobes. Once the infection is established, A. pyogenes is responsible for the persistence of the infection. The objective of this study was to characterize A. pyogenes field isolates recovered from the uterus of cows with either normal puerperium or clinical metritis, in an attempt to identify factors that might be associated with the establishment and persistence of the disease. This characterization was based on BOX-PCR typing and on screening of eight virulence factor genes (plo, nanP, nanH, cbpA, fimA, fimC, fimE, fimG) by conventional PCR. Finally, a relationship between clonal types, virulence factors and presence of disease was investigated. A. pyogenes clonal types identified from isolates recovered from the uterus of postpartum dairy cows differed among herds. Although some clonal types were strictly associated with the development of clinical metritis, others were identified from isolates recovered from normal puerperium and clinical metritis cows. Moreover, the presence of the eight virulence factor genes was not related with the ability to induce clinical metritis, suggesting that the type of A. pyogenes may not be a determinant factor in the development of the disease. We suggest that host intrinsic factors, the synergism between A. pyogenes and other bacteria and the differential gene expression of virulence factor genes may play a more relevant role in the establishment of puerperal uterine infections.

Gene transcription of TLR2, TLR4, LPS ligands and prostaglandin synthesis enzymes are up-regulated in canine uteri with cystic endometrial hyperplasia–pyometra complex

Escherichia coli (E. coli) is the most frequent bacterium isolated in cases of cystic endometrial hyperplasia-pyometra complex, the most frequent endometrial disorder in the bitch. Toll-like receptors (TLRs) play an essential role in the innate immune system. The aim of this study was to compare transcription of genes encoding TLR2, TLR4 and LPS ligands (CD14, MD-2, LBP), prostaglandin synthesis enzymes (COX1, COX2, PGES1 and PGFS), and to compare COX1 and COX2 protein expression and PGE(2) and PGF(2alpha) endometrial content in the endometrium of canine diestrous uteri with (n=7) or without (n=7) pyometra. All cases of pyometra were hyperplastic and E. coli was the only isolated bacteria, while diestrous normal uteri did not present signs of cystic endometrial hyperplasia and were negative for bacteriology. Except for COX1, transcription of all genes was significantly higher in pyometra than in normal endometria. COX1 protein was observed in both normal and pyometra uteri, but COX2 protein was only present in pyometra cases. Endometrial PGE(2) and PGF(2alpha) content were significantly higher in pyometra than in normal diestrous endometria. In conclusion, data obtained in this study provides evidence that pyometra-isolated E. coli induces the up-regulation of TLR2 and TLR4 genes in the canine diestrous endometrium. This up-regulation, which is probably the result of the stimulation by LPS and lipoprotein E. coli constituents, leads to the endometrial up-regulation of PG synthesis genes. This, in turn, results in a higher endometrial concentration of PGE(2) and PGF(2alpha), which may further regulate the local inflammatory response.

Genomic and phenotypic characterization of Escherichia coli isolates recovered from the uterus of puerperal dairy cows

The role of Escherichia coli in the pathogenesis of the puerperal uterine infection of the cow is largely unknown. It is proposed that E. coli favors the persistence of Arcanobacterium pyogenes and gram-negative bacteria that are pivotal to the establishment of the infection. Here, we report the genomic and phenotypic characteristics of 72 E. coli isolates recovered from the uterus of dairy cows with normal puerperium (n = 12; 35 isolates) or clinical metritis (n = 18; 37 isolates), in an attempt to identify characteristics that are related to the establishment of uterine infection. We evaluated DNA fingerprints generated by repetitive element sequence-based PCR, phylogenetic grouping, the presence of 15 virulence factor genes, in vitro biofilm formation and its relationship to curli fimbriae expression, and cellulose production. We found a wide genetic diversity (40 clonal types), including types common to normal puerperium and clinical metritis cows (n = 6), as well as types specific to normal puerperium (n = 14) or clinical metritis (n = 20) cows. Isolates were assigned to phylogenetic groups B1 (58%), A (31%), and D (11%). Only 4 virulence factor genes were detected (hlyE, hlyA, iuc, and eaeA). In vitro biofilm formation was significantly affected by culture medium and incubation temperature. Curli fimbriae expression and cellulose production, although related to biofilm formation, were not required for it. None of the evaluated E. coli characteristics were significantly related to the establishment of the uterine infection. In conclusion, data presented in this paper indicate that E. coli isolates recovered from the uterus of puerperal cows present a wide genetic diversity, do not belong to a known pathogenic group, and have a low potential of virulence and persistence. This corroborates the putative role of the bacterium in the pathogenesis of the puerperal uterine infection of the cow.

Prostaglandin synthesis genes are differentially transcripted in normal and pyometra endometria of bitches.

Pro-inflammatory stimuli, such as endotoxins released by Gram-negative bacteria, are potent stimulators of prostaglandin (PG) synthesis. The aim of this study was to evaluate the gene transcription pattern of PG synthesis enzymes in normal (anestrous, n = 6 and diestrous, n = 8) and pyometra (n = 7) endometria of bitches. Uteri were collected during routine ovariohysterectomy, processed for histopathological evaluation and uterine contents cultured. Gene transcription of COX-1, COX-2, mPGES-1 and PGF-synthase (PGFS) were evaluated by relative real-time PCR and normalized with the ribosomal protein L27 (RPL27) housekeeping gene. Normal uteri had no histological abnormalities and were negative for bacteriology. All pyometra uteri were hyperplasic and Escherichia coli was the only isolated bacterium. Except for COX-1, gene transcription was significantly higher in pyometra than in normal endometria. No significant differences in gene transcription were observed between normal diestrous and anestrous endometria. COX-2 gene transcription was 19 and 69 times higher in pyometra than in diestrous and anestrous endometria (p < 0.001), while PGFS gene transcription had a 3- and 600-fold increase in pyometra endometria compared to normal diestrous and anestrous endometria (p < 0.001). Gene transcription of mPGES-1 was 9 times higher in pyometra than in normal uteri (p < 0.01). Based on these results, we suggest that pyometra-associated E. coli endotoxin release stimulates the up-regulation of COX-2 PGFS and mPGES-1 gene transcription in the endometrium.

Percepção da equipe de enfermagem sobre humanização em unidade de tratamento intensivo neonatal e pediátrica

The humanization of healthcare is one of the key priorities of healthcare policies in Brazil, and directly reflects on the attitudes of user, employees and managers of health services. The aim of this study was to identify perception of the nursing team in terms of humanization of assistance in a neonatal and paediatric intensive care unit based on exploratory-descriptive research and a qualitative approach. A total of 11 members of a nursing team at the neonatal and paediatric intensive care unit of a hospital in southern Brazil participated in this study. Data was collected by means of semi structured interviews that were subsequently processed according to reference standards of thematic content analysis. This analysis resulted in three thematic categories: to humanize is to perceive the other as all-providing and all-supportive; bonding and communication as humanizing practices; and lack of ambience as a dehumanizing practice. Results showed that perception of the nursing team in relation to humanization is determined by the actual science and awareness of nursing care rather than specific acknowledgement of the National Humanization Policy.A humanizacao em saude e uma das prioridades nas politicas de saude no Brasil, implicando as atitudes dos usuarios, trabalhadores e gestores dos servicos. Este estudo objetivou identificar a percepcao da equipe de enfermagem sobre a humanizacao no cuidado em uma unidade de terapia intensiva neonatal e pediatrica. Trata-se de uma pesquisa exploratoria, descritiva, com abordagem qualitativa. Participaram, do estudo, 11 integrantes da equipe de enfermagem da unidade de terapia intensiva neonatal e pediatrica de um hospital do sul do Brasil. A coleta de dados ocorreu por meio de entrevistas semiestruturadas, analisadas conforme referencial da analise de conteudo tematica. Emergiram tres categorias tematicas: humanizar e ver o outro como um todo-acolher; o vinculo e a comunicacao como praticas humanizadoras; e falta de ambiencia como pratica desumanizadora. Identificou-se que a compreensao da equipe de enfermagem sobre humanizacao pauta-se na propria ciencia do cuidado de enfermagem, e nao especificamente na Politica Nacional de Humanizacao.

Conhecimento de puérperas sobre amamentação exclusiva

This is a descriptive study, with a qualitative approach, aimed to identify the knowledge of puerperal women on exclusive breastfeeding. Data were collected between September-October 2011, through semi-structured interview. Thirteen puerperal women, interned in a rooming unit of a public institution in the city of Caxias do Sul-RS, participated in the study. Data analysis was performed using thematic analysis. From the interpretation of information three categories emerged: the knowledge about exclusive breastfeeding, the breastfeeding process and the influences of received information. Even getting information from health professionals in the prenatal period, it is possible to understand that there is a need to improve communication and monitoring of mothers, as a continuity of professional care in the postpartum period, and also later, in the remote.This is a descriptive study, with a qualitative approach, aimed to identify the knowledge of puerperal women on exclusive breastfeeding. Data were collected between September-October 2011, through semi-structured interview. Thirteen puerperal women, interned in a rooming unit of a public institution in the city of Caxias do Sul-RS, participated in the study. Data analysis was performed using thematic analysis. From the interpretation of information three categories emerged: the knowledge about exclusive breastfeeding, the breastfeeding process and the influences of received information. Even getting information from health professionals in the prenatal period, it is possible to understand that there is a need to improve communication and monitoring of mothers, as a continuity of professional care in the postpartum period, and also later, in the remote.

Mulheres soropositivas para o HIV e seus companheiros frente à decisão pela gestação

The purpose of this qualitative, descriptive exploratory study is to investigate the reasons why HIV seropositive women and their partners make the decision of becoming pregnant despite the risk of vertical transmission, contamination or reinfection of the partner. The subjects of this study were six pregnant women. Data collection was done through a semi-structured questionnaire which was organized in the NVIVO 2.0 software and interpreted through theme-based content analysis. Through this analysis three themes emerged: Pregnancy planning; Knowledge of HIV/AIDS transmission and treatment; Living in the context of HIV/ AIDS. The relevance of this study resides on the fact that the desire of the couple in becoming parents remains, despite of the awareness regarding the risks of vertical transmission and contamination.Estudo exploratorio descritivo, com abordagem qualitativa, que objetivou investigar os motivos que levam mulheres soropositivas para o HIV e seus companheiros a decidirem engravidar, tendo em vista o risco da transmissao vertical e da contaminacao ou reinfeccao do parceiro. Participaram do estudo seis gestantes. A coleta de dados foi realizada por questionario semiestruturado, sendo os dados organizados no software NVivo 2.0 e interpretados por meio da analise de conteudo do tipo tematica. Da analise emergiram tres temas: Planejamento da Gravidez; Conhecimento sobre Transmissao e Tratamento do HIV/AIDS; Vivendo no Contexto HIV/AIDS. A importância do estudo reside no fato de que, apesar do risco da transmissao vertical e da contaminacao do parceiro ser conhecido pelo casal, isto nao interfere no desejo de serem pais.The purpose of this qualitative, descriptive exploratory study is to investigate the reasons why HIV seropositive women and their partners make the decision of becoming pregnant despite the risk of vertical transmission, contamination or reinfection of the partner. The subjects of this study were six pregnant women. Data collection was done through a semi-structured questionnaire which was organized in the NVIVO 2.0 software and interpreted through theme-based content analysis. Through this analysis three themes emerged: Pregnancy planning; Knowledge of HIV/AIDS transmission and treatment; Living in the context of HIV/AIDS. The relevance of this study resides on the fact that the desire of the couple in becoming parents remains, despite of the awareness regarding the risks of vertical transmission and contamination.

Percepções de um grupo de mulheres sobre a doença hipertensiva específica da gestação

The objective of this study was to identify the knowledge women in childbirth have regarding gestational hypertension disease (DHEG); to learn their perceptions of its risk and gravity; and to understand the repercussions of DHEG for these women and their families. This is a qualitative research aiming at an exploratory study. Data collection took place through individual semi-structured interviews with ten women in childbirth who were diagnosed with DHEG and data analysis was performed using the Analysis of Content. So, thematic categories emerged addressing the women´s knowledge of DHEG; their perceptions about the diagnosis and the professional care offered; and the repercussions DHEG had for them and their families. The study highlights the necessity to rethink and to reorganize the model of perinatal care, not only at the tertiary level but also at the basic health centers.Objetivou-se identificar o conhecimento das puerperas em relacao a doenca hipertensiva especifica da gestacao (DHEG), conhecer suas percepcoes quanto ao risco e gravidade da doenca e conhecer as repercussoes da DHEG para estas mulheres e suas familias. Trata-se de uma pesquisa qualitativa na perspectiva de um estudo exploratorio descritivo. A coleta de informacoes ocorreu com dez puerperas com diagnostico de DHEG por meio de entrevistas individuais semi-estruturadas, analisadas conforme referencial da Analise de Conteudo. Assim, emergiram categorias tematicas abordando o conhecimento sobre DHEG, percepcoes sobre o diagnostico e o cuidado profissional, e repercussoes da DHEG para as mulheres e suas familias. O estudo aponta a necessidade de se repensar e reorganizar o modelo de assistencia perinatal, nao apenas a nivel terciario, mas nas unidades basicas de saude.This study aims to identify the knowledge women in childbirth (puerperas) have regarding gestational hypertension disease (GHD), to learn how they perceive its risk and gravity, and to understand the repercussions of GHD for these women and their families. This is a descriptive exploratory study using qualitative research methods. Data collection took place through individual semi-structured interviews with ten women in childbirth (puerperas) who were diagnosed with GHD. The analysis of the data was performed using Content Analysis. Thematic categories emerged addressing the womens knowledge of GHD; how they perceive diagnosis and the professional care offered; and the repercussions GHD had for them and their families. The study highlights the necessity to rethink and to reorganize the model of perinatal care, not only at the tertiary level but also at primary healthcare centers.

Métodos não farmacológicos de alívio da dor durante trabalho de parto e parto

This study aimed to analyze the scientific production related to nonpharmacological methods of pain relief during labor and delivery, through an integrative literature review conducted by means of databases Latin American Health Sciences (LILACS) and Scientific Electronic Library Online (SciELO). It is included 21 articles derived from studies conducted inBrazil, published between 2003 and 2009. The studies approached: mobility, hydrotherapy, cryotherapy, transcutaneous electrical stimulation, breathing techniques and relaxation. The southeast had a higher number of publications, with a higher incidence between the years 2005 to 2007. As for the author, shows a higher development of nurses on the other professionals. The evidence of the reduction of fear and use of analgesics and anesthetics makes it possible to use these therapies. The study allowed the visibility of the scientific production on this theme, pointing to the importance of carrying out exploratory studies

Infection prevention and control in neonatal intensive care unit

Objetivou-se identificar o conhecimento da equipe de enfermagem de uma Unidade de Terapia Intensiva Neonatal (UTIN) sobre o controle de infeccao, identificando os fatores que facilitam ou dificultam o controle e prevencao das Infeccoes Relacionadas a Assistencia a Saude (IRAS). Estudo descritivo com abordagem qualitativa, realizado com tres enfermeiras e 15 tecnicas de enfermagem, que atuam em uma UTIN de uma instituicao filantropica, na regiao sul do Brasil. Evidenciou-se que a equipe de enfermagem possui grande conhecimento sobre os fatores que facilitam a prevencao e controle das IRAS em UTIN, sendo o principal, a higienizacao das maos. Entre os fatores que dificultam o controle e prevencao, estao a superlotacao e a excessiva carga de trabalho. A atuacao eficiente e qualificada da equipe de enfermagem constitui-se em estrategia de prevencao e controle das IRAS.This study was aimed to identify the knowledge of the nursing team of a Neonatal Intensive Care Unit (NICU) on infection control, identijfying the factors that facilitate or hinder the prevention and control of Healthcare Associated Infections (HICAI). A descriptive study using a qualitative research method conducted with three nurses and 15 nurse technicians, who work in a NICU of a charitable organization, in southern Brazil. It became evident that the nursing staff had great knowledge about the factors that facilitate the prevention and control of HCAI in NICU, the most important factor being proper hand hygiene. Among the factors that hinder infection prevention and control are to overcrowding and excessive workload. The efficient performance of the nursing staff is an important part of the strategy for prevention and control of HCAI.