PERFIL CLÍNICO-EPIDEMIOLÓGICO DA APENDICITE AGUDA EM UM HOSPITAL DO TOCANTINS, BRASIL

OBJETIVO: O estudo teve como objetivo descrever o perfil clínico e epidemiológico de casos de apendicite aguda (AA) submetidos a apendicectomia em um hospital do interior do Tocantins durante 2017 e 2018. METODOLOGIA: Foram analisados prontuários de pacientes submetidos a apendicectomia entre 2017 e 2018. Variáveis como idade, sexo, raça/etnia, estado civil, ocupação, procedência, fase evolutiva da AA, início da sintomatologia até a cirurgia, tempo de cirurgia, tempo de internação, uso de dreno, antibioticoterapia, complicações e evolução foram incluídas. Os dados foram tabulados em planilha Excel e analisados pelo software SPSS versão 25. RESULTADOS: Foram identificados 131 casos de pacientes submetidos à apendicectomia, sendo 58 (44,3%) em 2017 e 73 (55,7%) em 2018. Apenas 62 prontuários foram encontrados e incluídos no estudo. O perfil foi homens, pardos, jovens (média de 28,97 anos), solteiros, estudantes, procedente de Porto Nacional. A classificação da fase evolutiva da AA, mostrou 50% não complicada (grau 1 e 2) e 30,7% complicada (3 e 4). Houve maior incidência no mês de agosto. Fora identificada complicações em 4,8% dos casos e todos evoluíram para alta. CONCLUSÃO: Os resultados do estudo remetem ao perfil de paciente com AA atendido na região e reforça a importância do diagnóstico rápido

PROFILE OF CONFIRMED PREGNANT WOMEN FOR ZIKA VIRUS AND PRENATAL CARE IN THE PRIMARY HEALTH CARE OF PALMAS, TOCANTINS, 2016

RESUMO Objetivo: descrever a assistência pré-natal e perfil das gestantes confirmadas para zika vírus na atenção primária à saúde de Palmas, Tocantins no ano de 2016. Métodos: Trata-se de um estudo descritivo, com dados obtidos do SINAN, SISPRENATAL e SINASC. Foram confirmadas 63 gestantes com a infecção por Zika vírus por exame laboratorial. Resultados: A média de idade das gestantes foi de 26 anos. Os casos confirmados foram notificados predominantemente nas unidades de pronto atendimento (41,27%) e no hospital materno de referência (47,62%). Houve predomínio de gestantes pardas (61,90%), sem ensino médio completo (73,02%), em união estável (47,62%) e jovens (58,73%), que foram atendidas em quase totalidade nos serviços públicos de atenção secundária e terciária. Conclusão: Os resultados deste estudo mostraram a necessidade de melhoria para a assistência pré-natal às gestantes positivas na atenção primária e trouxe evidências do caráter da vulnerabilidade social da infecção pelo Zika vírus na capital do Tocantins.   Palavras-chave: Cuidado Pré-Natal; Epidemiologia; Zika vírus; Atenção Primária à Saúde. ABSTRACT Objective: describe the prenatal care and profile of confirmed pregnant women for zika virus in the primary health care of Palmas city, Tocantins, in the year 2016. Methods: This is a descriptive study, with data obtained from SINAN, SISPRENATAL and SINASC. Sixty-three pregnant women with Zika virus infection were confirmed by laboratory examination. Results: The mean age of pregnant women was 26 years. The confirmed cases were predominantly reported in the emergency care units (41.27%) and in the maternal reference hospital (47.62%). There was a predominance of brown pregnant women (61.90%), without complete secondary education (73.02%), in a stable union (47.62%) and young women (58.73%), who were attended almost entirely in public services of secondary and tertiary care. Conclusion: The results of this study showed the need for improvement for prenatal care to positive pregnant women in primary care and brought evidence of the social vulnerability of the Zika virus infection in the capital of Tocantins. Keywords: Prenatal care; Epidemiology; Zika virus; Primary Health Care.Objective: describe the prenatal care and profile of confirmed pregnant women for zika virus in the primary health care of Palmas city, Tocantins, in the year 2016. Methods: This is a descriptive study, with data obtained from SINAN, SISPRENATAL and SINASC. Sixty-three pregnant women with Zika virus infection were confirmed by laboratory examination. Results: The mean age of pregnant women was 26 years. The confirmed cases were predominantly reported in the emergency care units (41.27%) and in the maternal reference hospital (47.62%). There was a predominance of brown pregnant women (61.90%), without complete secondary education (73.02%), in a stable union (47.62%) and young women (58.73%), who were attended almost entirely in public services of secondary and tertiary care. Conclusion: The results of this study showed the need for improvement for prenatal care to positive pregnant women in primary care and brought evidence of the social vulnerability of the Zika virus infection in the capital of Tocantins

Epidemiologia molecular e estudo dos fatores de virulência de Staphylococcus aureus resistentes à oxacilina isolados de feridas em pacientes atendidos em unidades básicas de saúde da cidade de Botucatu

Diante da importância de S. aureus resistente à meticilina (Methicillin-resistant Staphylococcus aureus - MRSA) em feridas, este estudo objetivou estudar a prevalência, fatores de risco e epidemiologia molecular de S. aureus coletados de feridas e narinas de pacientes atendidos nas 17 Unidades Básicas de Saúde do município de Botucatu-SP, Brasil. Após a identificação dos isolados de S. aureus, foram realizados: teste de susceptibilidade à 13 drogas antimicrobianas, identificação do gene de resistência (mecA) e dos genes codificadores da Leucocidina PantonValentine- PVL (pvl), enterotoxinas A-E (sea, seb, sec, sed, e see), hemolisinas α, β e δ (hla, hlb e hld), esfoliatinas A, B e D (eta, etb e etd), biofilme (icaAD) e Toxina-1 da Sindrome do choque tóxico – TSST-1 (tst); tipagem molecular por Pulsed-Field Gel Eletroforese (PFGE), Multilocus sequence typing (MLST) e spa typing. Foram incluídos 171 pacientes, dos quais foram isolados 119 S. aureus. Amostras nasais foram coletadas apenas em 74 pacientes do total estudado. A prevalência de S. aureus e MRSA foi de 51,5% e 8,7%, respectivamente. No geral foram isolados 101 MSSA de 73 pacientes, destes 98 foram isolados de feridas e 21 de narinas; e 18 MRSA de 15 pacientes, sendo 4 isolados de narinas e 14 de feridas, com 6 MRSA com SCCmec tipo II e 12 com SCCmec tipo IV. Os isolados mostraram alto nível de resistencia a penicilina (85%), seguido pela eritromicina (27%), gentamicina (12%), clindamicina (11%), e levofloxacina (6%). Não houve resistência ao sulfametoxazol/trimetoprim, ácido fusídico, tigeciclina, quinupristina/dalfopristina e linezolida. A pesquisa por genes de virulência nos 119 isolados de S. aureus sensíveis e resistentes demonstrou que 42% possuem genes para enterotoxina A, 11% para enterotoxina B, 26% para enterotoxina C e 0,8% para enterotoxina D, 100% para o gene icaA, 95,8% para o gene icaD, 97,5% para o gene da hemolisina alfa, 65% para hemolisina beta, 95% para hemolisina delta, 4,2% para TSST-1 e 2,5% para o gene da PVL. Houve associação entre a presença de S. aureus nas narinas a nas feridas (p<0,01), o mesmo ocorreu para MRSA (p<0,01). A análise multivariada para S. aureus, demonstrou associação negativa com idade (OR: 0,94, IC95%: 0,90-0,98, p<0,01), uso de amoxicilina (OR: 0,16, IC95%: 0,04-0,60, p<0,01) e de ciprofloxacina (OR: 0,28, IC95%: 0,08-0,98, p=0,04). Por outro lado, observou-se associação positiva com uso de benzilpenicilina (OR:3,81, IC95%:1,23-11,82, p=0,02). Houve a formação de oito clusters, com predominância de MSSA que apresentaram as STs: 5, 30, 188, 1635 e spa t002. Os 18 MRSA foram caracterizados pelos STs: 5, 8 e 1176 e pelos spas t002, t008 e t062. Foram isoladas linhagens semelhantes aos clones internacionais USA300, USA500 e USA800. Nossos resultados demonstram a presença de clones importantes de MRSA resistentes e virulentos em pacientes atendidos nas diferentes UBSs estudadas.Given the importance of methicillin resistant S. aureus (Methicillin-resistant Staphylococcus aureus - MRSA) and wounds, this study aimed to study the prevalence, risk factors and molecular epidemiology related to the presence of S. aureus sensitive and resistant to methicillin in wounds of patients who attended BHUs in a city in Sao Paulo state, Brazil. After the identification of S. aureus isolates was performed: susceptibility testing to 13 antimicrobial drugs, identification of the resistance gene (mecA) and the genes encoding Panton-Valentine Leukocidin - PVL (pvl), enterotoxins AE (sea , seb, sec, sed and see) hemolysins α, β and δ (hla, hlb and hld), esfoliatinas A, B and D (eta, etb and etd), biofilm (icaAD) and Toxin-1 syndrome of toxic shock - TSST-1 (tst); Molecular typing by Pulsed-Field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and spa typing. 171 patients were included and 119 S. aureus isolates. Nasal samples were collected only in 74 patients of the total sample. The prevalence of S. aureus and MRSA was 51.5% and 8.7%, respectively. Overall 101 MSSA were isolated from 73 patients, 98 of these were isolated from wounds and 21 nostrils; MRSA and 18 of 15 patients, 4 isolates from nostrils and 14 wounds, with six MRSA with SCCmec type II and 12 SCCmec type IV. The strains showed high-level resistance to penicillin (85%) followed by erythromycin (27%), gentamicin (12%), clindamycin (11%) and levofloxacin (6%). There was no resistance to sulfamethoxazole / trimethoprim, fusidic acid, tigecycline, quinupristin / dalfopristin and linezolid. The search for virulence genes in the 119 isolates of S. aureus sensitive and resistant, 42% demonstrated presence of genes sea, 11% to seb, 26% to sec , 0.8% to sed, 100% to icaA, 95.8% icaD, 97.5% to hla, 65% to hlb, 95% to hld, 4.2% to tst and 2.5% to pvl. There was an association between the presence of S. aureus in the nostrils to the wounds (p<0.01), the same was true for MRSA (p<0.01). Multivariate analysis for S. aureus, showed a negative association with age (OR: 0.94, 95% CI: 0.90-0.98, p<0.01), use of amoxicillin (OR: 0.16, 95% CI: 0.04-0.60, p<0.01) and ciprofloxacin (OR: 0.28, 95% CI: 0.08-0.98, p=0.04). On the other hand, there was a positive association with use of penicillin G (OR: 3.81, 95% CI: 1.23-11.82, p=0.02). There was the formation of eight clusters, with a predominance of MSSA presenting the STs: 5, 30, 188, 1635 and spa t002. The 18 MRSA were characterized by STs 5, 8 and spas 1176 and the t002, t008 and t062. Strains were isolated similar to international clones USA300, USA500 and USA800. Our results demonstrate the presence of important clones resistant and virulent MRSA patients studied in different UBS.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Detection of enterotoxin A in coagulase-negative staphylococci isolated from nutrition students

Background: Staphylococcus is a clinically important genus because of its capacity to produce enterotoxins and to cause food poisoning. Staphylococci are the most frequent microorganisms of the skin and mucosal microbiota, with an estimated 20 to 40% of individuals carrying these bacteria on their hands or nose. Since nutrition professionals are involved in the handling and preparation of foods and are possible carriers of these bacteria, the objective of this study was to investigate the presence of Staphylococcus on the hands and in the nasal fossae of undergraduate nutrition students and to determine the enterotoxigenic capacity of these microorganisms. Methods and Findings: A total of 201 strains were isolated from the hands and nose of 61 nutrition students. Of these, 180 (89.5%) were identified as coagulasenegative staphylococci and 21 (10.5%) as S. aureus. Thirty-seven (18.4%) Staphylococcus isolates were producers of enterotoxin A. Toxin production was detected in 5 (19%) of the S. aureus isolates and in 31 (17.2%) of the coagulase-negative staphylococci. Conclusions: This study demonstrated a large number of enterotoxin-producing staphylococci on the hands and nose of nutrition students and professionals involved in the handling and preparations of foods. These findings indicate the need for adequate hygiene measures to prevent food poisoning. © iMedPub

Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil

Abstract INTRODUCTION: Wounds can be colonized by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We evaluated the prevalence of S. aureus and MRSA in the wounds of patients treated at Basic Health Units in Brazil and identified risk factors associated with their presence. RESULTS: The prevalence rates of S. aureus and MRSA were 51.5% and 8.7%, respectively. There was a correlation between the presence of S. aureus in wounds and nostrils (p<0.01). A positive association was detected between S. aureus infection and previous benzylpenicillin use (p=0.02). No associations were observed for MRSA. CONCLUSIONS: Multidrug-resistant pathogens are present in primary healthcare settings in Brazil

Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil

<div><p>Abstract INTRODUCTION: Wounds can be colonized by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We evaluated the prevalence of S. aureus and MRSA in the wounds of patients treated at Basic Health Units in Brazil and identified risk factors associated with their presence. RESULTS: The prevalence rates of S. aureus and MRSA were 51.5% and 8.7%, respectively. There was a correlation between the presence of S. aureus in wounds and nostrils (p<0.01). A positive association was detected between S. aureus infection and previous benzylpenicillin use (p=0.02). No associations were observed for MRSA. CONCLUSIONS: Multidrug-resistant pathogens are present in primary healthcare settings in Brazil.</p></div