No abstract

RESUMO Este artigo descreve as condições atuais da rede de monitoramento de qualidade do ar no Brasil. Os resultados revelam que apenas dez estados e o DF realizam o monitoramento através de 371 estações ativas - 80% delas na Região Sudeste. Outras informações relevantes são: (i) 41,2% das estações nacionais são privadas; no estado do Rio de Janeiro elas representam 60% do total de suas estações, enquanto no estado de São Paulo, 100% das estações são públicas; (ii) o MP10 é o poluente mais monitorado em 62,8% das estações e o MP2,5 em apenas 25,9% delas; e, (iii) a comunicação dos dados de monitoramento em tempo real à população ocorre em cinco estados. Após trinta anos de sua criação, a Rede Nacional de Qualidade do Ar encontra-se incompleta, e insuficientemente implantada, inviabilizando uma adequada gestão da qualidade do ar pelos órgãos ambientais.

Nosocomial dissemination of glycopeptide-resistant enterococci represents a major problem in hospitals worldwide. In Brazil, the dissemination among hospitals in the city of São Paulo of polyclonal DNA profiles was previously described for vancomycin-resistant Enterococcus faecium. We describe here the dissemination of VanA phenotype E. faecalis between two hospitals located in different cities in the State of São Paulo. The index outbreak occurred in a tertiary care university hospital (HCUSP) in the city of São Paulo and three years later a cluster caused by the same strain was recognized in two patients hospitalized in a private tertiary care hospital (CMC) located 100 km away in the interior of the state. From May to July 1999, 10 strains of vancomycin-resistant E. faecalis were isolated from 10 patients hospitalized in the HCUSP. The DNA genotyping using pulsed-field gel electrophoresis (PFGE) showed that all isolates were originated from the same clone, suggesting nosocomial dissemination. From May to July 2002, three strains of vancomycin-resistant E. faecalis were isolated from two patients hospitalized in CMC and both patients were colonized by the vancomycin-resistant Enterococcus in skin lesions. All isolates from CMC and HCUSP were highly resistant to vancomycin and teicoplanin. The three strains from CMC had minimum inhibitory concentration >256 µg/ml for vancomycin, and 64 (CMC 1 and CMC 2) and 96 µg/ml (CMC 3) for teicoplanin, characterizing a profile of VanA resistance to glycopeptides. All strains had the presence of the transposon Tn1546 detected by PCR and were closely related when typed by PFGE. The dissemination of the E. faecalis VanA phenotype among hospitals located in different cities is of great concern because E. faecalis commonly colonizes the gastrointestinal tract of patients and healthy persons for periods varying from weeks to years, which, together with the persistence of vancomycin-resistant Enterococcus in hospital rooms after standard cleaning procedures, increases the risk of the dissemination and reservoir of the bacteria.

Resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. The reasons for this are not clear. It is possible that the severity of the underlying disease and the patient's condition have a larger role than the K. pneumoniae infection in determining the outcome, and initially inadequate treatment may not have an impact sufficient to cause irreversible damage, allowing treatment to be changed to an effective drug.

Myocardial infarction after major surgery occurred 25 times in 214 patients who had previously sustained infarcts. Analysis of data obtained before, during and after 335 operations in these patients revealed the following pathogenetic factors in the infarction: (1) The patient with the highest coronary risk had arterial hypertension of at least 160/95 mmHg and advanced arteriosclerosis combined with coronary arterial, peripheral arterial, cerebrovascular, and renovascular disease. (2) Myocardial necrosis occurred when oxygen supply was reduced, as evidenced from a fall in systolic blood pressure to 70 mmHg or less during operation or anaemia (RBC smaller than or equal to 3,5 times 10-6/mul) early after operation. (3) Risk of infarction was highest during the early postoperative stress period with elevated plasma catecholamine levels and thus an increased myocardial oxygen demand.