In Brazil, since 2009, there has been an ever increasing widespread of the bla(KPC-2) gene, mainly in Klebsiella pneumoniae. This study aims to assess the molecular epidemiology and genetic background of this gene in Enterobacteriaceae (non-K. pneumoniae) species from 9 Brazilian states between 2009 and 2011. Three hundred eighty-seven isolates were analyzed exhibiting nonsusceptibility to carbapenems, in which the bla(KPC-2) gene was detected in 21.4%. By disk diffusion and E-test, these isolates exhibited high rates of resistance to most of the antimicrobials tested, including tigecycline (45.6% nonsusceptible) and polymyxin B (16.5%), the most resistant species being Enterobacter aerogenes and Enterobacter cloacae. We found great clonal diversity and a variety of bla(KPC-2)-carrying plasmids, all of them exhibiting a partial Tn4401 structure. Therefore, this study demonstrates the dissemination of KPC-2 in 9 Enterobacteriaceae species, including species that were not previously described such as Pantoea agglomerans and Providencia stuartii.

A fter the first description of NDM-1 carbapenemase in a Providencia rettgeri isolate in Brazil in February 2013 (1), the public hospital where this isolate was recovered began an active surveillance in search of asymptomatic carriers and in the hospital environment. Furthermore, a retrospective study of carbapenem-resistant isolates stored at that hospital since 2012 was performed. Six NDM-1-producing Enterobacter hormaechei subsp. oharae isolates, identified by the Vitek2 system and hsp60 genotyping, were recovered and characterized by phenotypic assays and molecular techniques, such as PCR and DNA sequencing (2, 3). One isolate (CCBH10892) was recovered from a rectal swab of a patient at the intensive care unit (ICU) in September 2012 (a time period prior to the isolation of NDM-positive P. rettgeri). The others were isolated from March to May 2013 from rectal swabs of patients (n ϭ 4) and a sink (n ϭ 1) located in the same ICU.Pulsed-field gel electrophoresis (PFGE) of XbaI-digested DNA (4) showed that all isolates belonged to the same clone; the isolates were considered to be multidrug resistant, as they were susceptible only to amikacin (MIC range of 8 to 16 mg/liter) and polymyxin B (MIC Յ 1 mg/liter) by the Etest method (Fig. 1). Besides bla NDM-1 , all these isolates carried bla CTX-M-15 , qnrB4, and aac(6)-Ib genes, detected by PCR and sequencing. Plasmid analysis by restriction digests with S1 nuclease and Southern blotting (5) showed that the bla NDM-1 and qnrB4 genes were located on the same plasmids, ranging in size from 420 to 490 kb (Fig. 1).To obtain a comprehensive in-depth view of the genetic structure surrounding the bla NDM-1 , bla CTX-M-15 , and qnrB4 genes, the genomic sequence of the CCBH10892 isolate was determined on an Illumina MiSeq system. A total of 1,149,470 reads (5,373,710 bp) were assembled with Geneious assembler (Biomatters) to generate 56 contigs. We found bla NDM-1 in a 94,795-bp contig flanked by a truncated ISAba125 sequence at the right boundary and by a bleomycin resistance gene (ble MBL ) at the left (GenBank accession number KF727591). This region shared 99% identity with the NDM region present in a plasmid carried by a Klebsiella pneumoniae isolate from Taiwan (6). In this contig, some conjugation and plasmid transfer genes and a replication protein gene belonging to the IncF group were also observed. However, this replicon could not be detected by the PCR-based replicon typing (PBRT) scheme (7).The qnrB4 gene was found in a 16,569-bp contig in which ISCR1 and genes encoding permeases (sapA, sapB, and sapC) and phage shock proteins (pspA, pspB, pspC, and pspD) and AmpC bla DHA-1 (GenBank accession number KF646592) were also observed. This same region has been reported in different plasmids of other bacterial species (8).bla was integrated into the chromosome associated with an upstream ISEcp1 element in a 277,989-bp contig (part of it is in the sequence available at GenBank accession number KF727590). This transposition unit was inserted into the flhC gene, which enc...

Introdução: Recentemente, houve crescimento da incidência do câncer de pele. Radiação solar, história familiar, imunossupressão, pele clara e idade constituem fatores de risco da doença. Objetivo: Correlacionar a mortalidade do câncer de pele com variáveis socioeconômicas. Método: Estudo ecológico, utilizando a planilha de dados da incidência de radiação solar do projeto aquecedor solar de baixo custo (ASBC), e indicadores de condições de vida do Censo de 2010. Os dados foram exportados para o SPSS 14.0, para analisar a correlação (coeficiente de correlação de Spearman), e as variáveis foram comparadas. Resultados: Associações estatisticamente significantes ocorreram entre o coeficiente de mortalidade por câncer maligno de pele com a renda familiar média (r=-0,316, p<0,006) indicando que, quanto maior a renda, menor a mortalidade por neoplasia maligna, ocorrendo o mesmo com a proporção de óbitos evitáveis em menores de 4 anos (r=-0,292, p<0,01) e a proporção de mortes evitáveis entre 5 e 74 anos (r=-0,372, p<0,001). A proporção da população ganhando menos de 1/2 salário-mínimo (r=0,232, p<0,05) indica que, quanto maior a proporção populacional com renda inferior a 1/2 salário-mínimo, maior será a mortalidade por neoplasia maligna, similar à proporção da população ganhando menos de 1/4 de salário-mínimo (r=0,229, p<0,05). Conclusão: Sendo um assunto de saúde pública intimamente relacionado à renda, o câncer de pele ainda carece de ações de prevenção primária e secundária.

Introduction: Medical students, susceptible to sleep disorders, have irregular sleep-awake cycle, with repercussions on the quality of life and reduced academic performance, often with greater incidence of psychiatric disorders, estimated at 15% to 25% during your academic training. Objective: To evaluate the sleep habits in students of medical school in a private college of Rio de Janeiro, Brazil. Method: This subset study is a part of an observational study with cross-sectional delineation, with data collected through the application of an anonymous questionnaire, where they were asked about the number (and modification) of hours they sleep daily, in addition to reports of “stress and anxiety”. These data collected formed the basis of an instrument for assessing the quality of life on the medical students of this College. Results: We analyzed data from 481 students: 82 (17%) at the first year, 118 (24.5%) at the second year, 99 (20.6%) at the third, 64 (13.3%) and 118 (24.5%) within the fifth and sixth years. The average age was 21.7 years (16-42) and 306 (63.6%) of female gender. As for the hours of sleep, 445 students (92.5%) report 5 to 8 hours of sleep, and 216 (44.9%) a minimum of 6 hours. In the sleep of the weekends, 394 (81.9%) reported change in the number of hours and, 313 (65.1%) referred to a reduction after the entrance into college. It was reported "some level of stress and anxiety,“ not related to the least number of hours sleepping (0.07). Comparing the data obtained among the 199 students of the first and second years (62.8% female-group A) to 117 at fifth and sixth years (70.9% female-group B), we observed similarity in relation to (1) number of 5 to 8 hours sleepping (A 92.9% x 90.5% B), (2) change the hours of sleepping on the weekends (A 81.9% x 79.5% B), and (3) reduction of sleepping hours after the entrance into College (A 81.9% x 78.6% B). With regard to the report of "stress and anxiety”, we observed statistically significant difference between the groups (A 100% x 88% B, p < 0.03). Conclusion: The change in lifestyle imposed on joining a new school learning model, generates anxiety and loss of sleep hours among students. The development of resilience and adaptation to change, both individual and institutional, may have been responsible to varying degrees of stress.

Introduction: According to the World Health Organization , performing physical activity (PA) results in less chance of coronary heart disease development, hypertension, diabetes, obesity, heart attack, colon and breast cancer and depression, in addition to promote quality of life (QOL) improvement. Some studies show that students’ perceptions about QOL during your college experience are essentially related to the levels of academic support. Thus, it is considered that the level of subject PA is crucial in promoting health and QOL in medical students and have important role to disseminate information in society, that could modify the community culture and habits where they are inserted. Objective: To identify the profile of PA on medical students of a private College in Rio de Janeiro, Brazil. Method: This subset study is part of an observational study with cross-sectional delineation, with data collected through the application of an anonymous questionnaire. The collection of these data was the basis of an instrument for assessing the QOL of the medical students of this College. For descriptive purposes, we analyze gender, age, BMI (body mass index), year, place and frequency of PA, type of exercise performed and time spent per week with PA. Results: Of the 490 students with an average age 21.7 years (16-42 years), 64.1% female, 75.1% practiced PA prior to entered the medical college, but 38.4% decreased the frequency after initiated the college, 22.2% perform regular PA three times a week, 44.5% practice anaerobic and aerobic PA and 28.6% are sedentary. Among the male participants, 83% x 70.7% female, practiced PA before starting the course of Medicine (p 0.003), both with reduced frequency after admission in college (38.1% x 38.5%, respectively, p NS). The combined aerobic and anaerobic activities predominates in both genders. Comparing the data obtained between the first and second years (Group A), with the fifth and sixth years students (Group B), statistically significant relative (1) sedentary (A 34.5% x 23.3% B) and reduction PA after admission in college (A 33% x 56.7% B). Conclusion: Studies confirm that the teaching model with full-time activities imposed in medicine schools, reduces the time required to adapt personal habits and maintain a good QOL.