Caracterização de cepas de Enterobacteriaceae resistentes a carbapenens isoladas no Distrito Federal

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Biologia Microbiana, 2014.A emergência global de cepas de entero bactérias resistentes aos carbapenens (ERC)tornou-se um problema de saúde pública em virtude do limitado arsenal terapêutico disponível para o tratamento de infecções causadas por estes organismos multirresistentes. Em Brasília, hospitais públicos e privados relatam a presença decepas produtoras da carbapenemase de Klebsiella pneumoniae - KPC - desde 2010.Além de KPC, as carbapenemases NDM, IMP, VIM e OXA-48 vêm ganhando destaque no contexto mundial. Este trabalho avaliou o perfil de susceptibilidade, bem como a produção de carbapenemase, em 524 cepas de ERC isoladas em hospitais de Brasília entre os anos de 2011 e 2013. As cepas de ERC foram caracterizadas quanto à presença dos genes blaKPC, blaVIM, blaIMP, blaOXA e blaNDM. Klebsiella pneumoniae respondeu por 74% das cepas de ERC isoladas, seguida por Enterobacter aerogenescom 9,4% dos isolamentos. As cepas apresentaram alta frequência de resistência aosβ-lactâmicos testados. Com relação aos carbapenens, a frequência de resistência aoimpenem foi a menor detectada, com 87% das cepas resistentes. Diante dosaminoglicosídeos, a frequência de resistência a tobramicina, gentamicina e amicacinafoi de 60%, 42% e 8%, respectivamente. Para algumas classes de antibióticos foi detectada uma baixa frequência de resistência em função da espécie analisada.Apenas 8% das cepas de ERC da espécie Proteus mirabilis apresentaram resistência ao sulfametoxazol, e na espécie E. aerogenes apenas 2% dos isolados foram resistentes à tetraciclina. O gene blaKPC foi predominantemente detectado nas cepasde ERC analisadas com positividade de 77%, seguido de blaNDM (1,9%) e blaIMP(0,4%). Em 2013, o gene blaNDM foi, pela primeira vez, detectado nos hospitais deBrasília em isolados das espécies Providencia rettigeri (n = 1), K. pneumoniae (n = 2)e P. mirabilis (n = 1). Em 2014, cepas adicionais de K. pneumoniae positivas parablaNDM foram detectadas em diferentes hospitais. Ensaios de RAPD confirmaram adispersão clonal de cepas de K. pneumoniae produtoras de NDM entre hospitais de Brasília. Este estudo alerta para a dispersão do gene blaNDM, detectado em diferentes espécies, e para a emergência de um clone de K. pneumoniae produtor de NDM entre hospitais de Brasília. _________________________________________________________________________________ ABSTRACTThe global emergence of carbapenem-resistant Enterobacteriaceae (CRE) strains has become a public health problem due to the limited therapeutic options available to treat infections caused by these multidrug-resistant organisms. In Brasilia, public and private hospitals have reported the presence of Klebsiella pneumoniae carbapenemase (KPC)-producing strains since 2010. In addition to KPC, the NDM, IMP, VIM and OXA- 48 carbapenemases have attracted the global attention. This study evaluated the susceptibility profile as well as the production of carbapenemase in 524 CRE strains isolated in hospitals in Brasília between the years of 2011 and 2013. CRE strains were characterized for the presence of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA genes. Klebsiella pneumoniae accounted for 74% of the isolated CRE strains, followed by Enterobacter aerogenes with 9.4% of the isolates. Strains showed a high frequency of resistance to the tested β-lactams. With regard to carbapenems, the frequency of resistance to imipenem was the lowest detected, with 87% of the strains displaying resistance. Regarding aminoglycosides, the frequency of resistance to tobramycin, amikacin and gentamicin was of 60%, 42% and 8%, respectively. For some antibiotics, a low frequency of resistance was detected depending on the species examined. Only 8% of the CRE strains belonging to the Proteus mirabilis species were resistant to sulfamethoxazole, and in the species of E. aerogenes only 2% of the isolates were resistant to tetracycline. The gene blaKPC was predominant in the studied CRE strains, with positivity of 77%, followed by blaNDM (1.9%) and blaIMP (0.4%). In 2013, the gene blaNDM started to be detected in isolates of Providencia rettigeri (n = 1), K. pneunoniae (n = 2), and P. mirabilis (n = 1) recovered in Brasília hospitals. Early in 2014, additional strains of K. pneumoniae positive for blaNDM were detected in different hospitals. RAPD assays confirmed the spread of a K. pneumoniae clone producing NDM among hospitals in Brasilia. This study warns about the spread of the gene blaNDM, detected in different species, and about the emergence of a single clone of NDM-producing K. pneumoniae among hospitals in Brasília

An update on the status of breast cancer screening in Brazil after the covid-19 pandemic

We have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50–69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years

Análise locacional e impactos econômicos do segmento sucroalcooleiro em Mato Grosso

<div align="justify">O cultivo da cana-de-açúcar tem se intensificado na região central do Brasil e oestado de Mato Grosso tornou-se um dos principais produtores de etanol e açúcardo país. Entender o comportamento desta cadeia, considerando a caracterizaçãoeconômica espacial do cultivo e os efeitos multiplicadores sobre a economia éimportante para sabermos a magnitude de cada atividade e sua importância para odesenvolvimento local. Para mensurar os efeitos multiplicadores foi utilizada a MatrizInsumo-Produto (MIP) de Mato Grosso, atualizada para o ano de 2007, que permitiua construção dos índices de ligações Rasmussen-Hirschman e dos efeitosmultiplicadores. A identificação da concentração territorial do cultivo da cana-deaçúcarfoi possível por meio do Índice de Concentração Normalizado (ICN), queutiliza dados do PIB e do valor da produção para mapear os espaços cuja referidaatividade é tida como economicamente diferenciada. O resultado auferido reflete queo elo industrial da cadeia possui forte poder de dispersão de investimento e que em2007 se localizava em apenas 11 municípios no estado. O elo agrícola da cadeiaapresentou forte sensibilidade de dispersão e também se localiza em 11 municípiostidos como diferenciados e que por isto concentram a produção da cana em seusterritórios.<br><br>Abstract The cultivation of sugar cane has intensified in the central region of Brazil andthe state of Mato Grosso has become a leading producer of ethanol and sugar in thecountry. Understanding the behavior of this chain, considering the characterization ofgrowing economic space and the multiplier effects on the economy is important toknow the magnitude of each activity and its importance for local development. Tomeasure the multiplier effects we used the input-output matrix (IPM) of Mato Grosso,updated to the year 2007, which allowed the construction of indexes linksRasmussen-Hirschman and multiplier effects. The identification of territorialconcentration of the cultivation of cane sugar was possible by means of NormalizedConcentration Index (NCI), which uses data of GDP and production value to map theareas where such activity is seen as economically differentiated. The result earnedreflects the industrial chain link has a strong scattering power of investment and in2007 was located in only 11 municipalities in the state. The link in the chain had astrong agricultural sensitivity of dispersion and is also located in 11 cities seen asdifferent and so concentrate the production of sugarcane in their territories.</div

ESCOLA GUATEMALA: MODIFICAÇÕES CONCEITUAIS NA EDUCAÇÃO FÍSICA

O objetivo deste trabalho é apresentar as modificações conceituaispelas quais passou a Educação Física entre os anos 1960 e 1969,na ótica do professor Alfredo Faria Junior. Aplicaram-se doisinstrumentos: a revisão da literatura e a observação participante

COMPETITIVENESS ASSESSMENT WITH THE IMPLEMENTATION OF AN ENERGY CAPACITY MARKET IN BRAZIL

Purpose: This article investigates issues related to the need to implement a capacity market in the Brazilian electricity sector to add security to the system and increase market competitiveness to benefit its energy consumers, as well as attract investments to the supply segments of this industry.   Theoretical Framework:  This research focuses on the Market Design Theory and the transition to the capacity market, detailing its principles and relevance in the current context. Through it, we seek to understand the mechanisms that shape the contemporary market.   Design/Methodology/Approach: This research adopts an applied research approach. It is structured as a case study, where Brazil is analyzed in the context of implementing a capacity market. Techniques such as interviews, and documentary research were used to collect data.   Findings: The study delves into the intricacies of establishing a capacity market in a competitive environment. The central findings encompass distinctions between the separation of backing and energy versus the capacity market; the blueprint of the auction and regulation of contracting; shaping the long-term market perspective; and the methodology for deducing the capacity market demand.   Research, Practical &amp; Social Implications:   This article contributes to the literature by surveying cases on capacity market development in developed countries. Furthermore, as a practical contribution, it details the benefit of implementing a capacity market in the Brazilian case.   Originality/Value: This research provides innovative solutions for Brazil, drawing from global benchmarks and tailoring them to Brazil's unique challenges and recent legal changes