Os desafios do atendimento de pacientes com sequelas cardiovasculares decorrentes de trauma do tórax / Challenges in the care of patients with cardiovascular sequels resulting from chest trauma

Introdução: O tórax apresenta estruturas de diversos sistemas de sustentação da vida, dentre eles o respiratório e o cardiovascular. Por conter, estruturas nobres para a manutenção da vida, os potenciais para ocorrer lesões graves em decorrência de traumas são muito grandes, como dados mostram, 25% das mortes são secundárias a trauma torácico. Dentro deste contexto, questiona-se quais os desafios no atendimento de pacientes com sequelas cardiovasculares decorrentes de traumas torácicos? Portanto, esse estudo tem como objetivo identificar as dificuldades enfrentadas na assistência de saúde de pacientes com repercussões cardiovasculares devido a trauma de tórax, através da elaboração de um formulário baseado em revisão bibliográfica de dados da literatura científica publicados sobre esse tema. Metodologia: O trabalho baseia-se numa revisão integrativa de literatura, na qual foram analisados artigos publicados em revistas científicas, utilizando-se das bases de dados da BVS (Biblioteca Virtual da Saúde), como: Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Scielo (Scientific Electronic Library Online). Resultados: Após as análises e seleção, restaram-se sete artigos para integrar a discussão. Os artigos selecionados, estão descritos na tabela, com autores, título, metodologia, resultados e conclusão. Em seguida, foi realizada uma discussão acerca destes artigos. Conclusão: Cada um dos casos revisados neste estudo demonstra a necessidade e a importância de acompanhamento cuidadoso de todos os pacientes que sofreram trauma torácico fechado, mesmo que a avaliação cardíaca inicial possa ser negativa.

Evolução clínica de um grupo de pacientes com TB multirresistente atendidos em um centro de referência na cidade do Rio de Janeiro

OBJETIVO: Analisar as características clínicas e a evolução de um grupo de pacientes com culturas de escarro positivas para Mycobacterium tuberculosis multirresistente (MR) e tratados em um centro de referência no município do Rio de Janeiro. MÉTODOS: A partir dos resultados de M. tuberculosis MR em culturas de escarro, foram selecionados 50 pacientes cujos dados clínicos foram obtidos através do Banco de Dados TBMR do Ministério da Saúde. Foram considerados a frequência de abandono, as recidivas, as falências e os tratamentos prévios para TB até o diagnóstico de TBMR. O padrão radiológico foi classificado em uni- ou bilateral, e cavitário ou não. Dois anos após o término do tratamento padronizado para TBMR, o desfecho (cura, falência, abandono ou óbito) de cada paciente foi avaliado e repetido a cada dois anos. O período de seguimento foi de oito anos após o tratamento. RESULTADOS: A média do número de tratamentos prévios foi de 2,3 ± 0,9. O tempo médio entre o diagnóstico inicial e o desenvolvimento de TBMR foi de 2 ± 1,7 anos. Após dois anos do tratamento inicial para TBMR houve 2 abandonos, 8 óbitos, 18 curas e 22 falências. A análise bivariada mostrou que o comprometimento pulmonar bilateral e o padrão cavitário reduziram acentuadamente a chance de cura, com risco relativo de 1-0,6 (40%) e 1-0,7 (30%), respectivamente. Ao final do seguimento, houve 2 abandonos, 9 falências, 17 curas e 22 óbitos. CONCLUSÕES: O comprometimento pulmonar bilateral e lesões cavitárias reduziram a possibilidade de cura dos pacientes com TBMR. A maioria dos pacientes com falha de tratamento evoluiu para óbito no período de 8 anos

Resistência do Mycobacterium tuberculosis à isoniazida por mutações em duas regiões diferentes do gene katG

OBJETIVO: Analisar e comparar as mutações em duas regiões diferentes do gene katG, responsáveis pela resistência à isoniazida (INH). MÉTODOS: As análises foram feitas em 97 cepas de Mycobacterium tuberculosis multirresistentes isoladas de culturas de escarro provenientes do Centro de Referência Professor Hélio Fraga. Outras 6 cepas, sensíveis à INH, não apresentaram mutações e foram incluídas como controle. Duas regiões do gene katG (GenBank nº de acesso U06258) - região 1, do códon 1 até o códon 119, e região 2, do códon 267 até o códon 504 - foram amplificadas por PCR e sequenciadas para a identificação das mutações. RESULTADOS: Sete cepas eram resistentes à INH e não mostraram mutação nas duas regiões. Trinta cepas apresentaram mutações na região 1, que se caracterizou por um grande número de deleções, especialmente no códon 4 (24 cepas). A região 2 mostrou 83 mutações pontuais, principalmente no códon 315, com 73 casos de troca de serina (AGC) para treonina (ACC). A análise da região 2 permitiu o diagnóstico de resistência à INH em 81,4% das cepas. Nove cepas tiveram mutações somente na região 1, e isso permitiu o aumento de identificação de cepas resistentes à INH para 90,6%. CONCLUSÕES: O número de mutações do códon 315 foi elevado, compatível com os casos descritos no Brasil e em outros países, e a análise da região 1 aumentou a detecção de mutações em mais 9,2%

Monitoring clinical and microbiological evolution of a cystic fibrosis patient over 26 years: experience of a Brazilian CF Centre

Abstract Background Burkholderia cepacia complex is a group of opportunistic pathogens in cystic fibrosis (CF) patients believed to be associated with poor prognosis and patient-to-patient transmissibility. Little is known about clinical outcomes after B. vietnamiensis chronic colonization/infection. Case presentation A 33 yo male patient had diagnosis of CF by 7 yo, after recurrent pneumonia during infancy and lobectomy (left upper lobe) at 6 yo. Burkholderia cepacia complex (Bcc) was first isolated by 13 yo, and the patient fulfilled the criteria for chronic colonization by 15 yo. In the following 16 years (1997–2013), there was intermittent isolation of P. aeruginosa and continuous isolation of Bcc, identified as B. vietnamiensis. There was clinical and laboratorial stability for 16 years with annual rate of decline in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) of 1.61 and 1.35%, respectively. From 2013 to 2015, there was significant clinical and lung function deterioration: annual rate of decline in FEV1 and FVC was 3 and 4.1%, respectively while body mass index decreased from 18.1 to 17.1. Episodes of hemoptysis and respiratory exacerbations (with hospital admissions) became more frequent. CF related diabetes was diagnosed (fasting glycemia: 116 mg/dL, oral glucose tolerance test: 305 mg/dL). Because of the severity of the disease in the last years, in addition to traditional microbiological surveillance, microbiome analysis by next generation sequencing (NGS) was performed on respiratory secretions. The NGS showed that 97% of the sequencing data were attributed to genus Burkholderia. Conclusions We report the case of a 33-year-old male CF patient known to have chronic infection with B. vietnamiensis who remained clinically stable for 16 years and presented recent clinical and laboratorial deterioration. Microbiome analysis of respiratory secretions was performed in 3 samples collected in 2014–2015. Clinical deterioration overlapped with cystic fibrosis-related diabetes and microbiome composition revealed no significant differences when compared microbiome results to culture dependent methods

Archaeal and bacterial communities of heavy metal contaminated acidic waters from zinc mine residues in sepetiba bay

9 p. : il., tab.Mining of metallic sulfide ore produces acidic water with high metal concentrations that have harmful consequences for aquatic life. To understand the composition and structure of microbial communities in acid mine drainage (AMD) waters associated with Zn mine tailings, molecular diversity of 16S genes was examined using a PCR, cloning, and sequencing approach. A total of 78 operational taxonomic units (OTUs) were obtained from samples collected at five different sites in and around mining residues in Sepetiba Bay, Brazil. We analyzed metal concentration, physical, chemical, and microbiological parameters related to prokaryotic diversity in low metal impacted compared to highly polluted environments with Zn at level of gram per liter and Cd–Pb at level of microgram per liter. Application of molecular methods for community structure analyses showed that Archaea and Bacteria groups present a phylogenetic relationship with uncultured environmental organisms. Phylogenetic analysis revealed that bacteria present at the five sites fell into seven known divisions, a-Proteobacteria (13.4%), b-Proteobacteria (16.3%), c-Proteobacteria (4.3%), Sphingobacteriales (4.3%), Actinobacteria (3.2%) Acidobacteria (2.1%), Cyanobacteria (11.9%), and unclassified bacteria (44.5%). Almost all archaeal clones were related to uncultivated Crenarchaeota species, which were shared between high impacted and low impacted waters. Rarefaction curves showed that bacterial groups are more diverse than archaeal groups while the overall prokaryotic biodiversity is lower in high metal impacted environments than in less polluted habitats. Knowledge of this microbial community structure will help in understanding prokaryotic diversity, biogeography, and the role of microorganisms in zinc smelting AMD generation and perhaps it may be exploited for environmental remediation procedures in this area

Bacterial communities of the marine sponges Hymeniacidon heliophila and Polymastia janeirensis and their environment in Rio de Janeiro, Brazil

12 p. : il.In this study we performed a survey of the bacterial communities associated with the Western Atlantic demosponges Hymeniacidon heliophila and Polymastia janeirensis, based on 16S rRNA sequencing and transmission electron microscopy (TEM). We compared diversity and composition of the sponge-associated bacteria to those of environmental bacteria, represented by free-living bacterioplankton and by bacteria attached to organic particulate matter in superWcial sediments. Partial bacterial 16S rRNA sequences from seawater, sediment, and sponges were retrieved by PCR, cloning, and sequencing. Sequences were subjected to rarefaction analyses, phylogenetic tree construction, and LIBSHUFF quantitative statistics to verify coverage and similarity between libraries. Community structure of the free-living bacterioplankton was phylogenetically different from that of the sponge-associated bacterial assemblages. On the other hand, some sediment-attached bacteria were also found in the sponge bacterial community, indicating that sponges may incorporate bacteria together with sediment particles. Rare and few prokaryotic morphotypes were found in TEM analyses of sponge mesohyl matrix of both species. Molecular data indicate that bacterial richness and diversity decreases from bacterioplankton, to particulate organic sediment, and to H. heliophila and P. janeirensis. Sponges from Rio de Janeiro harbor a pool of novel and exclusive sponge-associated bacterial taxa. Sponge-associated bacterial communities are composed of both taxons shared by many sponge groups and by species-speciWc bacteria

Complete genome sequence of the sugarcane nitrogen-fixing endophyte gluconacetobacter diazotrophicus PAL5

17 p. : il.Background: Gluconacetobacter diazotrophicus Pal5 is an endophytic diazotrophic bacterium that lives in association with sugarcane plants. It has important biotechnological features such as nitrogen fixation, plant growth promotion, sugar metabolism pathways, secretion of organic acids, synthesis of auxin and the occurrence of bacteriocins. Results: Gluconacetobacter diazotrophicus Pal5 is the third diazotrophic endophytic bacterium to be completely sequenced. Its genome is composed of a 3.9 Mb chromosome and 2 plasmids of 16.6 and 38.8 kb, respectively. We annotated 3,938 coding sequences which reveal several characteristics related to the endophytic lifestyle such as nitrogen fixation, plant growth promotion, sugar metabolism, transport systems, synthesis of auxin and the occurrence of bacteriocins. Genomic analysis identified a core component of 894 genes shared with phylogenetically related bacteria. Gene clusters for gum-like polysaccharide biosynthesis, tad pilus, quorum sensing, for modulation of plant growth by indole acetic acid and mechanisms involved in tolerance to acidic conditions were identified and may be related to the sugarcane endophytic and plant-growth promoting traits of G. diazotrophicus. An accessory component of at least 851 genes distributed in genome islands was identified, and was most likely acquired by horizontal gene transfer. This portion of the genome has likely contributed to adaptation to the plant habitat. Conclusion: The genome data offer an important resource of information that can be used to manipulate plant/bacterium interactions with the aim of improving sugarcane crop production and other biotechnological applications