Immediate load implants: systematic review of the major technical and patient comfort approaches

Introduction: The first implant follow-up studies constituted the scientific foundation of modern implantology. Early loading was identified as a critical factor and, therefore, several waiting times were tried until the establishment of a period of at least three months for the mandible and five to six months for the maxilla. Therefore, implant with immediate load (ILI) was defined as “installation of a prosthetic element over an implant, without OI having occurred”. Objective: To demonstrate, through a systematic review, the clinical success rates of the immediate loading technique, present the indication criteria, and the follow-up of the procedures. Methods: This study followed the PRISMA model. Clinical studies were selected, involving retrospective, prospective and randomized studies. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. The bibliographic search was performed using online databases PubMed, Scopus, Web of Science, and Google Scholar. Results and Conclusion: A total of 135 articles were found involving immediate loading implants. A total of 78 articles were evaluated in full and 35 were included and evaluated in the present study. The analysis of the literature obtained showed that the success rates with the ILI technique are compatible with those of the late loading, as long as certain guidelines are followed, which were divided into factors related to the patient, surgical technique, implant, prosthesis, and to aesthetics. The high success rate is a consequence of correct surgical and prosthetic planning, harmony between the implant system, patient, and dentist

Molecular epidemiology and virulence markers of Salmonella Infantis isolated over 25years in São Paulo State, Brazil

AbstractInfection of humans and animals caused by Salmonella is a major public health problem worldwide. Among the more than 2500 serovars, S. Infantis has been one of the 15 most isolated serovars in the world. Despite its clinical importance, little is known about the molecular characteristics of S. Infantis strains from Brazil. The aims of this study were to type S. Infantis isolates of this country and to assess their pathogenic potential. The molecular epidemiology of 35 S. Infantis strains, isolated from human sources (25) and food items (10) between 1984 and 2009 in São Paulo State, Brazil, were investigated using ERIC-PCR, PFGE and MLST. Furthermore, the presence of some virulence markers from Salmonella pathogenicity islands (SPIs) SPI-1 and SPI-2 and from the virulence plasmid was assessed by PCR. Using ERIC-PCR, 34 S. Infantis strains exhibited a high genetic similarity (⩾93.7%) and using PFGE, 32 strains exhibited a similarity ⩾80.6%. Additionally, MLST showed a high clonal similarity among strains that all presented the same ST32. Thirty-two isolates under investigation contained the virulence markers invA, sopB, sopD, sipA, sipD, ssaR, sifA, flgK, fljB and flgL. In conclusion, the S. Infantis strains studied were genetically similar, suggesting that a prevalent subtype has been causing disease and food contamination during a 25year period in São Paulo State, an important metropolitan region in Brazil. Furthermore, the contamination between strains from food items and sick humans indicates that better control measures for S. Infantis may be needed in this country

Antimicrobial activity of products based on potassium monopersulfate on bacteria associated with avian infections

O objetivo deste trabalho foi avaliar a atividade antimicrobiana de quatro novos produtos à base de monopersulfato de potássio em biofilmes bacterianos associados a infecções aviárias, para a desinfecção de bebedouros em granjas avícolas. Inicialmente, realizaram-se testes em células bacterianas planctônicas, para verificar a atividade antimicrobiana e a concentração inibitória mínima dos produtos, denominados PA, PB, PC e PD. Esses produtos foram testados em biofilmes maduros dos patógenos aviários Escherichia coli, Salmonella enterica subsp. enterica serovar Enteritidis e Listeria monocytogenes, cultivados em espécimes preservados em blocos de acrílico, por meio da contagem de unidades formadoras de colônias, por microscopia eletrônica de varredura e por microscopia de fluorescência confocal. Todos os produtos foram eficazes contra as espécies bacterianas avaliadas. Os produtos PA e PB inibiram o crescimento bacteriano em concentrações ≤ 0,13%, e PC e PD apresentaram o mesmo efeito em concentrações ≤ 0,25%. Além disso, o produto PA foi capaz de eliminar os biofilmes maduros de S. enterica subsp. enterica serovar Enteritidis e L. monocytogenes. Os produtos à base de monopersulfato de potássio avaliados, notadamente o PA, são eficazes contra biofilmes bacterianos associados a infecções aviárias e apresentam potencial como sanitizantes e desinfetantes em bebedouros de granjas avícolas.The objective of this work was to evaluate the antimicrobial activity of four new potassium monopersulfate-based products on bacterial biofilms associated with avian infections, in order to disinfect drinking fountains in poultry farms. Initially, tests were performed in planktonic bacterial cells, to verify the antimicrobial activity and the minimum inhibitory concentration of the products, named PA, PB, PC, and PD. These products were tested on mature biofilms of the avian pathogens Escherichia coli, Salmonella enterica subsp. enterica serovar Enteritidis, and Listeria monocytogenes, grown on specimens preserved in acrylic blocks, by counting colony-forming units, scanning electron microscopy, and confocal fluorescence microscopy. All products were effective against the evaluated bacterial species. The PA and PB products inhibited the bacterial growth at ≤ 0.13% concentrations, and PC and PD showed the same effect at ≤ 0.25% concentrations. Furthermore, the PA product was able to eliminate mature biofilms of S. enterica subsp. enterica serovar Enteritidis and L. monocytogenes. The evaluated monopersulfate-based products, notably PA, are effective against bacterial biofilms associated with avian infections and show potential as sanitizers and disinfectants for drinking fountains in poultry farms

High Prevalence of Multidrug-Resistant Klebsiella pneumoniae Harboring Several Virulence and β-Lactamase Encoding Genes in a Brazilian Intensive Care Unit

Klebsiella pneumoniae is an important opportunistic pathogen that commonly causes nosocomial infections and contributes to substantial morbidity and mortality. We sought to investigate the antibiotic resistance profile, pathogenic potential and the clonal relationships between K. pneumoniae (n = 25) isolated from patients and sources at a tertiary care hospital’s intensive care units (ICUs) in the northern region of Brazil. Most of K. pneumoniae isolates (n = 21, 84%) were classified as multidrug resistant (MDR) with high-level resistance to β-lactams, aminoglycosides, quinolones, tigecycline, and colistin. All the 25 isolates presented extended-spectrum beta-lactamase-producing (ESBL), including carbapenemase producers, and carried the blaKPC (100%), blaTEM (100%), blaSHV variants (n = 24, 96%), blaOXA-1 group (n = 21, 84%) and blaCTX-M-1 group (n = 18, 72%) genes. The K2 serotype was found in 4% (n = 1) of the isolates, and the K1 was not detected. The virulence-associated genes found among the 25 isolates were mrkD (n = 24, 96%), fimH-1 (n = 22, 88%), entB (100%), iutA (n = 10, 40%), ybtS (n = 15, 60%). The genes related with efflux pumps and outer membrane porins found were AcrAB (100%), tolC (n = 24, 96%), mdtK (n = 22, 88%), OmpK35 (n = 15, 60%), and OmpK36 (n = 7, 28%). ERIC-PCR was employed to determine the clonal relationship between the different isolated strains. The obtained ERIC-PCR patterns revealed that the similarity between isolates was above 70%. To determine the sequence types (STs) a multilocus sequence typing (MLST) assay was used. The results indicated the presence of high-risk international clones among the isolates. In our study, the wide variety of MDR K. pneumoniae harboring β-lactams and virulence genes strongly suggest a necessity for the implementation of effective strategies to prevent and control the spread of antibiotic resistant infections

Whole genome sequencing of the multidrug-resistant Chryseobacterium indologenes isolated from a patient in Brazil

Chryseobacterium indologenes is a non-glucose-fermenting Gram-negative bacillus. This emerging multidrug resistant opportunistic nosocomial pathogen can cause severe infections in neonates and immunocompromised patients. This study aimed to present the first detailed draft genome sequence of a multidrug-resistant C. indologenes strain isolated from the cerebrospinal fluid of an infant hospitalized at the Neonatal Intensive Care Unit of Brazilian Tertiary Hospital. We first analyzed the susceptibility of C. indologenes strain to different antibiotics using the VITEK 2 system. The strain demonstrated an outstanding resistance to all the antibiotic classes tested, including β-lactams, aminoglycosides, glycylcycline, and polymyxin. Next, C. indologenes was whole-genome-sequenced, annotated using Prokka and Rapid Annotation using Subsystems Technology (RAST), and screened for orthologous groups (EggNOG), gene ontology (GO), resistance genes, virulence genes, and mobile genetic elements using different software tools. The draft genome contained one circular chromosome of 4,836,765 bp with 37.32% GC content. The genomic features of the chromosome present numerous genes related to cellular processes that are essential to bacteria. The MDR C. indologenes revealed the presence of genes that corresponded to the resistance phenotypes, including genes to β-lactamases (blaIND–13, blaCIA–3, blaTEM–116, blaOXA–209, blaVEB–15), quinolone (mcbG), tigecycline (tet(X6)), and genes encoding efflux pumps which confer resistance to aminoglycosides (RanA/RanB), and colistin (HlyD/TolC). Amino acid substitutions related to quinolone resistance were observed in GyrA (S83Y) and GyrB (L425I and K473R). A mutation that may play a role in the development of colistin resistance was detected in lpxA (G68D). Chryseobacterium indologenes isolate harbored 19 virulence factors, most of which were involved in infection pathways. We identified 13 Genomic Islands (GIs) and some elements associated with one integrative and conjugative element (ICEs). Other elements linked to mobile genetic elements (MGEs), such as insertion sequence (ISEIsp1), transposon (Tn5393), and integron (In31), were also present in the C. indologenes genome. Although plasmids were not detected, a ColRNAI replicon type and the most resistance genes detected in singletons were identified in unaligned scaffolds. We provided a wide range of information toward the understanding of the genomic diversity of C. indologenes, which can contribute to controlling the evolution and dissemination of this pathogen in healthcare settings

A Profilaxia pré-exposição ao HIV em um serviço no oeste do Paraná : HIV pre-exposure Prophylaxis in a service in west Paraná

Introdução: A Profilaxia Pré-Exposição (PrEP) é um método de prevenção ao HIV, teve sua eficácia comprovada e também está disponível, gratuitamente, pelo SUS, para alguns grupos em serviços de referência. Objetivo: Apresentar o fluxo de atendimento e os resultados em relação a PrEP em um serviço especializado localizado na região Oeste do Estado do Paraná. Métodos: Trata-se de um estudo retrospectivo que utilizou como fonte de informações as bases de dados do Ministério da Saúde e também relatórios públicos do serviço em questão. Resultados: O serviço, buscando facilitar o acesso e garantir melhor decisão do paciente em relação ao uso da medicação, estabeleceu um fluxo em que os pacientes que procuram para testagem e aconselhamento são abordados pela equipe em relação ao início da profilaxia, são solicitados os exames iniciais e agendado para consulta médica. Verificou-se que nesse serviço no período de agosto 2020 a abril de 2021 atendeu 123 pacientes em uso de profilaxia, 104 ativos e 19 descontinuidades, percentual de 15%, abaixo dos 44% do Paraná e 41% do Brasil. Gays e HSH representam 65% dos usuários. A faixa etária com maior procura está entre 25 a 39 anos (60%) e 78% possui mais de 8 anos de estudo. Apenas 29% relatou efeitos adversos nos primeiros 30 dias e 70% referiu fazer uso de todos os comprimidos. Conclusão: O serviço apresentado tem conseguido resultados semelhantes aos nacionais na maioria dos dados analisados, porém um índice menor de abandono o que poderia estar relacionado à organização interna em relação a indicação e ao acompanhamento. A disseminação da profilaxia em indivíduos com menor escolaridade também foi maior neste serviço. Ainda é necessário ampliar a divulgação da profilaxia para a população em geral pois há muito mais pacientes dentro do público alvo e ainda existe uma concentração da procura por brancos e de alta escolaridade

A Fatal Bacteremia Caused by Hypermucousviscous KPC-2 Producing Extensively Drug-Resistant K64-ST11 Klebsiella pneumoniae in Brazil

We report a fatal bacteremia caused by Klebsiella pneumoniae in a 60–70-year-old patient from Brazil. The genomic analysis of three isolates (from blood culture, nasal and anal swabs) showed that the bacteremia was caused by a KPC-2 producing extensively drug-resistant K64-ST11 hypermucousviscous K. pneumoniae (hmKP) harboring several virulence and antimicrobial resistance genes. Although the isolates did not present virulence markers associated with hypervirulent K. pneumoniae (hvKP), they showed invasion and toxicity to epithelial Hep-2 cells; resistance to cell microbicidal mechanisms; and blood and human serum survival, evidencing their pathogenic potential. This study highlights the risk of infection caused by hmKp strains not characterized as hvKP as well as the clinical implications and difficulty of treatment, especially in elderly or immunocompromised patients