Jane Dagmar Pollo Renner

Antibiotic resistance and detection of the sul2 gene in urinary isolates of Escherichia coli in patients from Brazil

INTRODUCTION The present study aimed to assess the antibiotic resistance profiles and detect the presence of the sul2 gene in sulfamethoxazole-susceptible and resistant isolates of Escherichia coli obtained from outpatients and inpatients with urinary tract infections. METHODOLOGY The resistance profiles of 739 strains were assessed and the presence of the sul2 gene in 100 isolates was tested. RESULTS The antibiotics with the highest resistance rates were ampicillin (57.4%) and trimethoprim-sulfamethoxazole (44.7%). The presence of the gene sul2 was detected in 66.7% of outpatient samples and 67.9% of inpatient samples. CONCLUSIONS Our results demonstrate that E. coli isolates exhibit high resistance to various classes of antibiotics, highlighting the need for developing strategies to help in prescribing antibiotics.

Dyslipidemia is Associated with Unfit and Overweight-Obese Children and Adolescents.

Background Both poor aerobic fitness and obesity, separately, are associated with abnormal lipid profiles. Objective To identify possible relationships of dyslipidemia with cardiorespiratory fitness and obesity, evaluated together, in children and adolescents. Methods This cross-sectional study included 1,243 children and adolescents (563 males and 680 females) between 7 and 17 years of age from 19 schools. Obesity was assessed using body mass index (BMI) measurements, and cardiorespiratory fitness was determined via a 9-minute run/walk test. To analyze the lipid profile of each subject, the following markers were used: total cholesterol, cholesterol fractions (high-density lipoprotein and low-density lipoprotein) and triglycerides. Data were analyzed using SPSS v. 20.0, via prevalence ratio (PR), using the Poisson regression. Results Dyslipidemia is more prevalent among unfit/overweight-obese children and adolescents compared with fit/underweight-normal weight boys (PR: 1.25; p = 0.007) and girls (PR: 1.30, p = 0.001). Conclusions The prevalence of dyslipidemia is directly related to both obesity and lower levels of cardiorespiratory fitness.

CYP2B6 516 G>T polymorphism and side effects of the central nervous system in HIV-positive individuals under Efavirenz treatment: Study of a sample from southern Brazil

This study aimed to identify the 516 G>T polymorphism of the CYP2B6 gene and evaluate its influence on central nervous system (CNS) side effect development in HIV-positive individuals undergoing Efavirenz (EFV) treatment in a population from southern Brazil. Additionally, we performed a survey on the clinical and epidemiological characteristics of our sample. In addition to medical records evaluation, whole blood of 89 individuals was analyzed for viral load, T lymphocyte count (CD4+ and CD8+), and the polymorphism. Considering the side effects of the CNS reported by individuals but without considering the genetic variables, no statistically significant association was noted between the adverse effects and the antiretroviral treatment (including or not EFV). In addition, no statistically significant difference was noted for the influence of genotype on the viral load or the number of T lymphocytes (CD4+ and CD8+) among individuals undergoing EFV treatment. This is the first study that investigated the impact of the 516 G>T polymorphism of the CYP2B6 gene among HIV-positive individuals from southern Brazil. Its clinical significance indicates the need for prospective studies in this population.

Association between overweight and obesity in schoolchildren with rs9939609 polymorphism (FTO) and family history for obesity

OBJECTIVE To determine the association between overweight/obesity in schoolchildren with FTO rs9939609 polymorphism (fatmass and obesity associated) and family history of obesity. METHODS Cross-sectional study comprising a sample of 406 children aged 7-17 years in a city in southern Brazil. Overweight/obesity in schoolchildren was assessed by body mass index (BMI), and family history of obesity was self-reported by parents. Polymorphism genotyping was performed by real time PCR (polymerase chain reaction). The association between the nutritional status of schoolchildren with the presence of family obesity, stratified by polymorphism genotypes (AA [at-risk for obesity], AT, and TT), was assessed by prevalence ratio values (PR) through Poisson regression. RESULTS Among schoolchildren with the AA genotype, 57.4% had overweight/obesity; the percentage was lower for the AT and TT genotypes (33.1% and 28.9%, respectively). Overweight/obesity in schoolchildren was associated with a family history of obesity, especially among children with the AA genotype. The prevalence was higher among those with an obese mother (PR: 1.28; p<0.001), obese maternal or paternal grandmother (PR: 1.22; p=0.047), and obese paternal grandfather (PR: 1.32; p<0.001). CONCLUSIONS There is an association between the AA genotype of rs9939609 polymorphism and BMI among schoolchildren. The association between overweight/obesity in schoolchildren with a family history of obesity was found mainly among students with the AA genotype.

Hyperuricemia is associated with low cardiorespiratory fitness levels and excess weight in schoolchildren

OBJECTIVE To evaluate the possible association between hyperuricemia and cardiorespiratory fitness levels/nutritional profile, grouped into a single variable, in schoolchildren. METHOD Cross-sectional study of 2335 students from Elementary schools, aged 7-17 years of both genders, stratified by conglomerates of a municipality in Southern Brazil. Body mass index (BMI) was calculated and cardiorespiratory fitness (CRF) was assessed by the 6-minute run/walk test. The BMI and CRF were grouped into a single variable, considering: (1) low and normal weight/fit; (2) low and normal weight/unfit; (3) overweight-obesity/fit; (4) overweight-obesity/unfit. The Poisson regression (prevalence ratio, PR) was used for the association between hyperuricemia and BMI/CRF ratio with 95% confidence intervals and differences were considered significant when p<0.05. RESULTS There is an association, although subtle, between the presence of hyperuricemia with low levels of CRF and the presence of excess weight, when grouped into a single variable. Boys and girls with this condition have higher prevalence of hyperuricemia (PR: 1.07; p=0.007 for boys; PR: 1.10; p<0.001 for girls). CONCLUSION Together, excess weight and low levels of cardiorespiratory fitness are associated with the presence of hyperuricemia in schoolchildren.

Obesity parameters as predictors of early development of cardiometabolic risk factors

The scope of this study was to verify the association between different overweight and obesity parameters and the metabolic risk profile among school-age students. The randomized cross-sectional study included 1254 children and adolescents, aged 7 to 17, from a city in southern Brazil. Body mass index (BMI), waist circumference (WC) and percentage of fat (PF), measured at the triceps and based on subscapular skinfold thickness, were used as the parameters to evaluate overweight/obesity status. Systolic blood pressure (SBP), total cholesterol, high-density lipoprotein cholesterol (HDL), low-density protein cholesterol (LDL) and triglycerides were also measured. The metabolic risk profile was calculated based on the sum of the z score of the metabolic variables adjusted by age. A three-model Poisson analysis was used to verify the association between BMI, WC and PF with metabolic risk profile. BMI showed the highest probability for developing metabolic risk compared with WC (overweight - PR: 1.63 and obesity - PR: 3.87) and PF (overweight - PR: 1.62 and obesity - PR: 2.92). In conclusion, BMI seems to be a better parameter of overweight/obesity than WC and PF in the assessment of metabolic risk among youths.

What are the risk factors and agents responsible for bacterial infections in ICUs

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult and neonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted in adult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU, 58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulase negative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantly presented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) and Enterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but with infections caused by Gram positive cocci, mainly CNS. Palavras-chave: Hospital Infections. Risk factors. Bacterial infections. Intensive care units. *Department of Biology and Pharmacy, UNISC. Santa Cruz do Sul, RS, Brazil. E-mail: janerenner@unisc.br DOI: 10.15343/0104-7809.201842016176 INTRODUCTION Healthcare-associated infections (HAI) are public health problems, with impact on length of hospital stay, morbidity and mortality, and spending on therapeutic and diagnostic procedures. The repercussions for the patients, their families and the community in general, go from being absent from their jobs and social lives, to the consequent psychological, economic and social commitment1. In addition, infections with antimicrobial-resistant microorganisms has been increasing the attention of hospital infection control services. The impact of this infectious complication is translated as prolonged hospitalization, new admissions, increased costs, sequelae and death. There is no accurate estimate of the worldwide impact of these infections2. Critically ill patients hospitalized in Intensive Care Units (ICUs) are more vulnerable to nosocomial infection compared to other units, because of their high complexity in care and their high risk of infection. These patients are frequently exposed to risk factors such as immunosuppressive drugs, complex surgeries, broad spectrum antimicrobials, interaction with the health team, among others3. This means that although the number of patients in ICUs is smaller in comparison to the number of patients in other sectors, the infection rate is significantly higher4. Invasive therapies or diagnostic interventions, such as mechanical ventilation, invasive pressure monitoring, urinary catheterization and central venous catheterization, as well as a more debilitated state of health and prolonged hospitalization time contribute to this profile5. In a multidisciplinary context in the ICU environment, the approach of hospitalized patients colonized or infected with multiresistant bacteria has received special attention from Hospital Infection Control Committees (HICCs) in recent years6. Given the importance of the role of the HICC in a hospital, through this study we sought to outline a bacterial profile responsible for HAIs in the ICU of this university hospital. Moreover, we sought to W ha t a re th e ri sk fa ct or s an d ag en ts re sp on si bl e fo r b ac te ri al in fe ct io ns in IC U s? O M un do d a Sa úd e, S ão P au lo 20 18 ;4 2( 1) :6 176 62 verify if the function of the HICC, together with the clinical staff and assisting laboratory, is having an effect on the control of the number of HAIs. Evaluation studies of HAI are indispensable in that they share important information in the fight against this health problem. This study aimed to analyze the main predisposing factors and the prevalence of microorganisms in bacterial infections of patients hospitalized in the Adult and Neonatal ICUs of a university hospital in Vale do Rio Pardo RS.

High urate concentration is associated with elevated blood pressure in schoolchildren

Abstract Background Studies in adults have shown a relationship between high blood pressure and hyperuricemia, but few studies have investigated this association in children and adolescents. The aim of the present study was to associate urate concentration with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in schoolchildren. Methods This cross-sectional study used a sample of 2335 schoolchildren in basic education between 7 and 17 years old. Blood pressure was classified by percentile according to Brazilian parameters for sex and age, reclassified into two categories: normal and borderline/hypertension. Blood collection to obtain serum for urate concentration analysis was performed after a 12-h fast. Values above 5.5 mg/dL were considered hyperuricemia. Descriptive data were presented in frequency and percentage. Linear regression and Poisson regression (prevalence ratio [PR]) was used to test the association between urate concentration and blood pressure. Results Urate concentration was weakly associated with SBP (β: 0.05; 95% CI: 0.02–0.08) and DBP (β: 0.03; 95% CI: 0.01–0.05) z-scores. Schoolchildren with hyperuricemia had a higher prevalence of high SBP (PR: 1.12; p<0.001) and DBP (PR: 1.08; p<0.001). Conclusions Elevated urate concentration is associated with altered blood pressure in schoolchildren.

Hepatitis C: evaluation of outcomes and georeferencing of cases in Santa Cruz do Sul, Brazil, between 2002 and 2015. A cross-sectional study

BACKGROUND Hepatitis C virus infection is one of the main causes of chronic liver disease, with high death rates. The aim here was to analyze case outcomes, sociodemographic and clinical characteristics and spatial distribution among patients diagnosed with hepatitis C in the city of Santa Cruz do Sul (RS), Brazil. DESIGN AND SETTING Cross-sectional study on 200 cases of hepatitis C in Santa Cruz do Sul that were notified between 2002 and 2015. METHODS Secondary data including sociodemographic and clinical variables and type of outcome (death, follow-up, abandonment or clinical cure) were gathered. The spatial distribution analysis on hepatitis C virus cases according to outcome was based on information regarding residential address. RESULTS 58.5% of the patients were 41 years of age and over, 67% were males and 92.5% had the chronic form of the disease. The most frequent transmission route was illicit drug injection (29%); 15.1% of the patients presented coinfection with the human immunodeficiency virus (HIV). Regarding outcomes, 31% achieved clinical cure, 10% died and 20% abandoned follow-up. The cases studied were mainly located in regions of the city characterized by lower socioeconomic status, with high frequency of places used for drug trafficking. CONCLUSION The population consisted of adults aged 41 years and over, mostly with chronic hepatitis C. The most common transmission routes were illicit drug injection and blood transfusions. There were high rates of HIV coinfection and abandonment of disease monitoring and predominance of cases in neighborhoods with low socioeconomic status.

Neuropsychomotor development and genomic stability associated to folate and blood iron levels in preschool children

Objectives: to evaluate the neuropsychomotor development and the genomic stability associated to folate and blood iron levels in preschool children. Methods: a cross-sectional study in which evaluated the biochemical exams (complete hemogram, serum ferritin, iron and folate), neuropsychomotor development (Denver II Test) and genotoxicity (micronuclei cytome in buccal mucosa cells) of 55 children aging 36-59 months old. Student ́s T test, Kruskal-Wallis and Pearson’s or Spearman’s correlation tests were applied with a significance level of p<0.05 for data analysis. Results: the prevalence of anemia was 1.8%. The Denver II test classified 32.7% of the children as normal and 67.3% were suspected of having a delay. The children suspected of having a delay presented a slight reduction on hemoglobin and hematocrit (p=0.05 and p=0.14), intermediate reduction on iron and folate (p=0.29 and p=0.23) and a notable reduction on ferritin (p=0.03). Folate and iron were significantly associated to the frequency of cells with DNA damages (p<0.05). The frequency of binucleated cells was positively associated to the Red Cell Distribution Width (RDW) (r=0.56; p=0.02) in children without a delay and negatively with folate (r=-0.334; p=0.047) in children with a delay. Conclusions: this study showed a low prevalence of anemia, but a high rate of children suspected of having a neuropsychomotor, possibly associated to low ferritin levels. Additionally, iron and folate were associated to DNA damage which may have contributed to the psychomotor development delay.