Base molecular dos fatores de virulência de Streptococcus equi

Streptococcus equi subespécie equi (S. equi) é responsável pela adenite equina, doença infecto-contagiosa que ocorre com elevadas prevalências em todo o mundo. Desde a primeira descrição desta enfermidade não tem sido possível realizar o controle da mesma, o que pode ser explicado pela variabilidade nos genes de virulência. Ao longo dos anos alguns estudos foram realizados para identificar os fatores de virulência envolvidos na patogenia da enfermidade, no entanto, ainda existem algumas lacunas sobre a ocorrência e mecanismos desses genes na patogenia da doença. Desta forma, objetiva-se com esta revisão discorrer sobre os principais fatores de virulência de S. equi subespécie equi, os genes que participam na expressão dos mesmos e avanços no desenvolvimento de vacinas

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Anti-Chlamydia abortus and Anti-Mycobacterium avium subsp. paratuberculosis Antibodies in Buffaloes in the State of Pernambuco, Brazil

Background: The occurrence of economic losses in buffaloes may be related to reproductive problems such as chlamydiosis caused by the bacteria Chlamydia abortus considered as a zoonotic agent; and digestive problems highlighting the infection by Mycobacterium avium subsp. paratuberculosis (Map), responsible for paratuberculosis. There is a little information about these diseases in buffaloes, therefore the aim of this study was to determine the occurrence of anti-Chlamydia abortus and anti- Mycobacterium avium subsp. paratuberculosis (Map) antibodies in water buffaloes in the state of Pernambuco, Brazil.Materials, Methods & Results: The 262 bubaline sera belonging to the serum bank of the Infectious Diseases Laboratory (LIDIC) of the Federal Rural University of Pernambuco (UFRPE) were analyzed. The samples were from nine properties distributed in the municipalities of Agreste and Zona da Mata of the state of Pernambuco. For the detection of anti-Chlamydia abortus and anti-Map antibodies was used a technique of Enzyme immunoabsorption Assay (ELISA) of the IDEXX® by following the manufacturer's instructions. Regarding the detection of anti-Chlamydia abortus antibodies, it was observed that 47.70% (125/262) of the samples were positive. All properties showed at least one positive animal for the investigation of anti-Chlamydia abortus antibodies. It was also verified the occurrence of 7.25% of suspected animals for the investigation of anti-C. abortus antibodies. No positives animals were observed for Map in the bubaline analyzed.Discussion: The occurrence of anti-C. abortus antibodies in buffaloes in the region can be explained by the fact that properties with buffalo breeding has sanitary management that allows the contact between animals, thus increasing the risk of transmission of the agent. In addition, the variation found from 35% to 68.75% may be associated with divergences to the type of management and breeding system used in each property. The percentage of suspected animals may suggest that the number of positive animals is higher or that there were non-specific reactions with other species of Chlamydia, but it is not possible to determine the seroconversion without the accomplishment of paired serology. Because it is a zoonosis, C. abortus may be a risk to the health of the population involved, since the transmission of the bacteria to humans can occur by contact with secretions and excretions of these animals. No positive animals were found for the occurrence of anti-Map antibodies, however, there are reports of the infection identifying animals with clinical signs or properties with a history of the disease, and this may be related to the differences in each property in relation to the history and sanitary management. Moreover, the ELISA test may not be sensitive to the agent depending on the phase of the infection, because if the response is predominantly cellular, the number of antibodies is diminished, making the serological diagnosis difficult. The use of more sensitive tests for the bubaline species can also favor the diagnosis of the infection. Although the occurrence of anti-Map antibodies in the analyzed samples was not detected, it is important to carry out routine epidemiological studies, since the disease has already been registered in water buffaloes in the state of Pernambuco. Considering the occurrence of anti-Chlamydia abortus antibodies it is suggested to conduct studies in order to isolate the agent and verify its real importance in the reproductive disorders of the bubaline species, since this agent causes reproductive losses and has a zoonotic character

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field