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BACKGROUND: The fragmented QRS complex (FQRS) was found to be associated to malignant ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy and other entities. There is scant data available correlating the presence of FQRS with QT interval prolongation in patients with ischemic heart disease (IHD). METHODS: A descriptive, retrospective, cross-sectional study was performed in 123 patients with IHD to analyze and correlate the presence of FQRS with QT interval prolongation in the conventional 12-leads electrocardiogram in patients with documented chronic IHD. RESULTS: There were 62% male patients. The mean age was 63.8±12.6 years. Thirty six (44%) patients had fragmented QRS (64% men and 36% women). The duration of QT and QTc, the mean values were 413±59ms, and 463±67ms, respectively. Of the 36 patients with FQRS, 23 patients have prolongation of the QTc interval, and 13 patients did not present it. Of the 45 patients without FQRS, 21 of them have prolongation of the QTc interval, and 24 patients did not have it. These data resulted in a sensitivity of 52% with a moderate SnNout, a specificity of 65% with moderate SpPin, a positive predictive accuracy of 64%, a negative predictive accuracy of 53%. These data resulted in a prevalence of 54%. CONCLUSION: the presence of FQRS in the ECG has a moderate sensitivity and specificity, as well as, moderate negative and positive predictive value of the existence of QT interval prolongation in patients with ischemic heart disease.

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BACKGROUND: Contaminated surfaces play an important role in the transmission of certain pathogens that are responsible for healthcare-associated infections. Although previous studies have shown that meticillin-resistant Staphylococcus aureus (MRSA) can survive on dry surfaces at room temperature, no published data regarding vancomycin-intermediate S. aureus (VISA) are available to date. AIM: To compare the survival time on different types of surfaces, cell-surface hydrophobicity, adherence to abiotic surfaces and biofilm formation of meticillin-susceptible S. aureus (MSSA), MRSA and VISA. METHODS: Survival of the S. aureus strains was tested on latex, cotton fabric, vinyl flooring and formica. Cell-surface hydrophobicity was determined using the hydrocarbon interaction affinity method. Adhesion to abiotic surfaces was tested on granite, latex (gloves), glass, vinyl flooring and formica. Biofilm formation was evaluated at 6, 12, 24 and 48 h. FINDINGS: All of the samples survived on the vinyl flooring and formica for at least 40 days. VISA survived on both surfaces for more than 45 days. All of the strains were highly hydrophobic. VISA adhered to latex, vinyl flooring and formica. Biofilm formation increased for all of the tested strains within 6-24 h. CONCLUSION: VISA present high survival, adherence and cell-surface hydrophobicity. Therefore, as the treatment of patients with VISA is a significant challenge for clinicians, greater care with cleaning and disinfection of different types of surfaces in healthcare facilities is recommended because these may become important reservoirs of multi-resistant pathogens.

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AIMS: The objective of this study was to assess the antimicrobial efficacy of alcohol-based hand gels according to European Norm 1500 (EN 1500). METHODS AND RESULTS: We assessed the antimicrobial efficacy of 12 alcohol-based hand gels produced in Brazil, containing 70% w/w or v/v ethyl alcohol as the active ingredient, according to EN 1500, with a 30-s application. In addition, 70% w/w ethyl alcohol and three alcohol-based hand rubs commonly used in Europe and effective according to EN 1500 were also tested. Eight of 12 (67%) alcohol-based hand gels produced in Brazil failed by EN 1500. In contrast, 70% w/w ethyl alcohol and European alcohol-based hand rubs were approved by EN 1500. CONCLUSIONS: In this study, the majority of Brazilian alcohol-based hand gels showed limited efficacy on hand hygiene within 30 s. SIGNIFICANCE AND IMPACT OF THE STUDY: The findings of this study may be used as an important argument to motivate Brazilian manufacturers to improve the antimicrobial efficacy of alcohol-based hand gels, because it is prudent to suppose that alcohol-based hand gels can be recommended for use in healthcare settings only if they show antimicrobial activity at least similar to that of alcohol-based liquid preparations, including the traditional 70% w/w ethyl alcohol.

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AIMS: To investigate the susceptibility pattern and the molecular epidemiology of Acinetobacter baumannii isolates in two periods (1994-1996 and 2004-2007) in Londrina University Hospital. METHODS AND RESULTS: Antimicrobial susceptibility of 150 A. baumannii isolates was assessed by disc diffusion and agar dilution methods. Genetic similarity amongst the isolates was evaluated by ERIC-PCR. Resistance of A. baumannii to carbapenems increased from 2% (1994-1996) to 73% (2004-2007). Thirty-eight clones were detected. CONCLUSIONS: The results of the study suggest that the high prevalence of carbapenem resistance amongst Acinetobacter baumannii organisms in this institution is not caused by the spread of a predominant clone. SIGNIFICANCE AND IMPACT OF THE STUDY: This work reinforces the importance monitoring antimicrobial susceptibility rates.

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The antimicrobial activity of meropenem combined with either polymyxin B or gatifloxacin was evaluated by the checkerboard method against Pseudomonas aeruginosa (10 strains) and Acinetobacter baumannii (10 strains). In addition, the triple combination of polymyxin B, gatifloxacin, and meropenem was also studied as well as the polymyxin B and gatifloxacin combination. A partial synergism interaction between meropenem and polymyxin B was observed for 80% of the A. baumannii strains. In contrast, this combination showed an indifferent effect for 80% of the P. aeruginosa strains tested. The combination of meropenem and gatifloxacin showed synergism only for two strains of A. baumannii, and partial synergism and additive effect for seven strains and indifference for four strains of both species. For the strains of P. aeruginosa, the double combination of polymyxin B and gatifloxacin and the triple combination of meropenem, polymyxin B and gatifloxacin were indifferent for the majority of the strains tested, that is, 90 and 80% respectively.

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O cancer de mama constitui a primeira causa de morte entre as mulheres. Apos tratamento cirurgico(mastectomia) podem ocorrer algumas complicacoes, dentre elas o linfedema no membro homolateral a cirurgia. Objetivo: analiasar os efeitos da corrente de alta voltagem (CAV) no linfedema de membro superior em mulheres submetidas a mastectomia. Metodo: foram selecionadas 15 voluntarias com idade entre 40 e 65 anos (51,13+-9,08) com mastectomia unilateral e apresentando como principal sequela pos-cirurgica o linfedema secundario. O protocolo de tratamento constitui da aplicacao de CAv por 20 minutos, no membro afetado, durante 7 semanas, totalizando 14 sessoes. A evolucao do tratamento foi analisada pela perimetria (em seis pontos distintos: A,B,C,D,E,F) pela volumetria pre e pos-tratamento, alem da analise de severidade do linfedema. Resultados: os resultados da perimetria do membro afetado ponto A(20,33cm+-1,59 e 18,90 cm+-1,48), ponto B(23,80cm+-1,64 e 22,30 +-1,69), ponto C(26,13 cm+-3,79 e 26,50+-3,45), ponto D(29,63cm+-3,76 e 27,93+-3,35), ponto E(32,90cm+-5,11 e 30,90cm+-4,54), ponto F(34,27cm+-5,28 e 3 2,17cm+-4,96) e da volumetria (2,18L+-0,96 e 1,99L+-0,88) foram significativos (p<0,05) quando compardos aos membros-controle. A reducao em 4,35 por cento da severidade do linfedema tambem foi significativa (p<0,05). Conclusoes: os resultados do estudo demonstram efetividade na reducao do linfedema com o protocolo aplicado

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The post-antibiotic effect (PAE) of penicillin was measured in vitro against a group A streptococcal strain by the kinetic growth method. The duration of the effect was 2.8 h. The bacterial morphology and some streptococcal products were analyzed during and after the PAE, after being exposed to penicillin in a concentration of 1xMIC for 2 h. Bacteria not previously exposed to penicillin were used as a control culture. Morphological changes and increases in the size of treated streptococci were observed by electronic microscope during the post-antibiotic phase. The post-penicillin effect on the production of cell-bound hemolysin and free hemolysin was examined using sheep red blood cells. Production of cell-bound hemolysin rose sharply, but was inhibited by the antimicrobial agent. The free lysin diminished significantly, and concomitantly with a higher production of free toxin by the treated cells. No effect was observed on the specific carbohydrate group when the antigen was tested with streptococcal group A antiserum.

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OBJECTIVE: The effectiveness of hand-cleansing agents in removing a hospital strain of methicillin-resistant Staphylococcus aureus from artificially contaminated hands of five volunteers was studied. DESIGN: The products used were plain liquid soap, ethyl alcohol 70% (by weight), 10% povidone-iodine liquid soap (PVP-I), and chlorhexidine gluconate (4%) detergent. The experiments were performed using a Latin square statistical design, with two 5x4 randomized blocks. The removal rates of S aureus cells from contaminated fingertips were estimated by analysis of variance, the response variable being the log10 reduction factor (RF), ie, log10 of the initial counts minus log10 of the final counts. In the first and second blocks, the fingertips of the volunteers were contaminated in mean with 3.76 log10 colony-forming units ([CFU] light-contamination hand) and 6.82 log10 CFU (heavy-contamination hand), respectively. RESULTS: In the first block, there were significant differences between treatments (P<.05). The 10% PVP-I (RF, 3.76) and 70% ethyl alcohol (RF, 3.51) had significantly higher removal rates than plain liquid soap (RF, 1.96) and 4% chlorhexidine (RF, 1.91). In the second block, 10% PVP-I (RF, 4.39) and 70% ethyl alcohol (RF, 3.27) also were significantly more effective than plain liquid soap (RF, 1.77) and 4% chlorhexidine (RF, 1.37; P<.05). Plain liquid soap was significantly more effective than chlorhexidine (4%) detergent. CONCLUSIONS: The results suggest that 10% PVP-I and 70% ethyl alcohol may be the most effective hand-cleansing agents for removing methicillin-resistant S aureus strain from either lightly or heavily contaminated hands.

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Microbial growth in a Todd-Hewitt broth has been followed to determine the in-vitro post-antibiotic effects of penicillin in a Lancefield group A streptococcal strain. Bacteria were exposed for 2 h at 37 degrees C to 1 x MIC of penicillin. Following antibiotic removal, inactivation with penicillinase and regrowth in a drug-free broth, the duration of the effect was found to be 2.8 h. By studying the affinity of streptococci for xylene in the post-antibiotic phase we observed that the penicillin treatment had no effect on the cell surface hydrophobicity. The ability of the same streptococci to adhere to human buccal epithelial cells was greatly reduced. Streptococci exposed to penicillin produced much more deoxyribonuclease and hyaluronidase than control bacteria.

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