Naltrexone (NTX) and bupropion (BUP) are used in combination in clinical practice for obesity; however, the existing analytical methods for this drug combination are not sustainable. This work aims to develop an analytical method that is faster, easier and less expensive compared with high performance liquid chromatography (HPLC) and involves green technology without solvents to quantify BUP and NTX in combination. The objective was to validate a method using mid-infrared (MIR) spectroscopy associated with multivariate calibration and chemometrics to simultaneously measure NTX and BUP in a pharmaceutical capsule form. The models were developed using MIR spectroscopy with diffuse reflectance, with interval partial least squares (iPLS) variable selection. The working range selected to optimize the model was from 1885.8 to 1585.4 cm-1. The chosen model was obtained with partial least squares (PLS2) and with data pre-processed by first derivative Savitzky-Golay smoothing followed by mean centering, using four latent variables, providing a root mean square error of prediction of 1.8 mg g-1 for NTX and 6.42 mg g-1 for BUP. The method was validated according to current international standards. In conclusion, the methods developed in the MIR region provided statistically similar results to the validated chromatographic method for commercial pharmaceutical formulations.

Abstract Introduction Women with Polycystic Ovary Syndrome (PCOS) have a higher prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) than the general population. PCOS and NAFLD have common metabolic risk factors, however, the role of diet in NAFLD development is still uncertain in PCOS women. Objective To evaluate and compare the dietary patterns and nutritional intake in patients with PCOS with and without NAFLD. Method Cross-sectional study that included patients with PCOS diagnosed according to Rotterdam criteria. All participants were submitted to abdominal ultrasound to investigate liver steatosis. Dietary profile was assessed by 24-hour food recall (24hR), and Food Frequency Questionnaire (FFQ). Diet quality was assessed by the Healthy Eating Index (HEI) adapted for the Brazilian population. Physical activity practice was also assessed. Results 87 participants were included (average age 35.2 ± 5.7 years), among whom, 67 (77%) had NAFLD. The group with PCOS and NAFLD presented higher body mass index (BMI) (34.9 ± 4.5 vs. 30.4 ± 4.9 kg/m2; p = 0.001), Waist Circumference (WC) (103 [97‒113] vs. 95 [87.5‒100] cm; p < 0.001) and were considered physically active less frequently than those without NAFLD (34.3% vs. 60%; p = 0.04). Food intake and dietary patterns assessed by 24hR, FFQ and HEI presented no difference between the groups. Conclusions PCOS women with coexistent NAFLD had higher BMI, WC and were less physically active than those without NAFLD. Dietary evaluation showed that PCOS women with NAFLD had no significant difference in macro and micronutrients or food group intake and diet quality in comparison to those without NAFLD.

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

ABSTRACT Surveillance strategies to detect colonization are an important tool to prevent and control the spread of microorganisms in hematopoietic stem cell transplant (HSCT) units. The aim of this study was to evaluate routine surveillance cultures for screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa), and vancomycin-resistant enterococci (VRE). Surveillance cultures were collected (1,323 samples) from 200 patients admitted to an HSCT unit over one year; swabs were taken on admission and then weekly. We compared the positivity of cultures for each site, agent, clinical and epidemiological data according to the colonization status. Infection due to multidrug-resistant organisms (MDROs) occurred in 52 (21.5%) patients, 45 (86.5%) due to blood stream infection; 12 (23%) patients had a positive surveillance culture before the infection. Cultures of 554 (41.8%) samples were performed for CRPa, 413 (31.2%) for VRE and 356 (27%) for CRE. Of these, 179 (13.5%) were positive. Colonization by any MDRO, CRE or CRPa was associated with increased risk of infection (P < 0.05), but not with death. Previous colonization by an MDRO was a significant risk for infection by these pathogens, specially by CRE. Overall, rectal swabs had the highest positivity rate compared with other sites, oropharynx swabs were an option for CRPa, and fecal cultures showed low positivity. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, routine VRE surveillance should be questioned with regard to patients undergoing auto-HSCT due to the additional cost and little impact on survival rates.

Resumo O presente estudo investigou os efeitos de um análogo de reforçamento negativo sobre a seleção de culturantes e, diferentemente de estudos anteriores, buscou eliminar a interferência da punição negativa de outros culturantes. Três microculturas de laboratório, com três participantes cada, foram expostas a um delineamento ABAB. Os participantes escolhiam entre linhas coloridas e numeradas de 1 a 10. Na condição de Reforçamento Positivo (A), os culturantes-alvo produziam consequências culturais. Na condição de Reforçamento Negativo (B), as consequências culturais eram subtraídas a cada 30s, mas os culturantes-alvo podiam adiar a perda dessas consequências. O análogo de reforçamento negativo, assim como o de reforçamento positivo, selecionou os culturantes-alvo sem a interferência de contingências punitivas acidentais.

Abstract The present research investigated the effect of a negative reinforcement analog on the selection of culturants and, unlike previous studies, sought to eliminate the interference of the negative punishment of other culturants. Three laboratory microcultures, with three participants in each of them, were exposed to an ABAB design. The participants chose between colored lines, numbered from 1 to 10. In the Positive Reinforcement condition (A), target culturants produced cultural consequences. In the Negative Reinforcement condition (B), cultural consequences were subtracted every 30 seconds, but target culturants could delay the loss of those consequences. The analog of negative reinforcement, as well as that of positive reinforcement, selected target culturants without the interference of accidental punitive contingencies.

ABSTRACT The plasmid-mediated colistin-resistance gene named mcr-1 has been recently described in different countries and it became a public health challenge. Of note, few studies have addressed the spread of Escherichia coli harboring the mcr-1 gene in both, community and hospital settings. A total of seven colistin-resistant E. coli carrying mcr-1, collected from 2016 to 2018, from community (n=4), healthcare-acquired infections (n=2) and colonization (n=1) were identified in three high complexity hospitals in Sao Paulo, Brazil. These colistin-resistant isolates were screened for mcr genes by PCR and all strains were submitted to Whole Genome Sequencing and the conjugation experiment. The seven strains belonged to seven distinct sequence types (ST744, ST131, ST69, ST48, ST354, ST57, ST10), and they differ regarding the resistance profiles. Transference of mcr-1 by conjugation to E. coli strain C600 was possible in five of the seven isolates. The mcr-1 gene was found in plasmid types IncX4 or IncI2. Three of the isolates have ESBL-encoding genes (blaCTX-M-2, n=2; blaCTX-M-8, n=1). We hereby report genetically distinct E. coli isolates, belonging to seven STs, harboring the mcr-1 gene, associated to community and healthcare-acquired infections, and colonization in patients from three hospitals in Sao Paulo. These findings point out for the potential spread of plasmid-mediated colistin-resistance mechanism in E. coli strains in Brazil.

ABSTRACT Mobile phones (MPs) have become an important work tool around the world including in hospitals. We evaluated whether SARS-CoV-2 can remain on the surface of MPs of first-line healthcare workers (HCW) and also the knowledge of HCWs about SARS-CoV-2 cross-transmission and conceptions on the virus survival on the MPs of HCWs. A cross-sectional study was conducted in the COVID-19 Intensive Care Unit of a teaching hospital. An educational campaign was carried out on cross-transmission of SARS-CoV-2, and its permanence in fomites, in addition to the proper use and disinfection of MPs. Herewith an electronic questionnaire was applied including queried conceptions about hand hygiene and care with MP before and after the pandemic. The MPs were swabbed with a nylon FLOQ Swab™, in an attempt to increase the recovery of SARS-CoV-2. All MP swab samples were subjected to SARS-CoV-2 RT-PCR; RT-PCR positive samples were subjected to viral culture in Vero cells (ATCC® CCL-81™). Fifty-one MPs were swabbed and a questionnaire on hand hygiene and the use and disinfection of MP was applied after an educational campaign. Most HCWs increased adherence to hand hygiene and MP disinfection during the pandemic. Fifty-one MP swabs were collected and two were positive by RT-PCR (4%), with Cycle threshold (Ct ) values of 34-36, however, the cultures of these samples were negative. Although most HCWs believed in the importance of cross-transmission and increased adherence to hand hygiene and disinfection of MP during the pandemic, SARS-CoV-2 RNA was detected in MPs. Our results suggest the need for a universal policy in infection control guidelines on how to care for electronic devices in hospital settings.

Resumo O objetivo deste trabalho foi avaliar o efeito da manipulação das magnitudes das consequências individuais e culturais sobre o padrão de escolhas em situações de autocontrole ético e metacontingências. Seis estudantes universitários foram divididos em duas microculturas, uma com delineamento ABCAC’B’A e outra com um delineamento AC’B’ABCA. Nas condições B e B’, a magnitude da consequência individual para respostas impulsivas aumentava enquanto a consequência cultural diminuía. Nas condições C e C’, aumentava a magnitude da consequência cultural e diminuía a consequência individual. Os resultados indicaram a seleção de um padrão de escolhas em ambas as microculturas pela consequência cultural, com pouca ou nenhuma influência da manipulação da magnitude das consequências.

Abstract The objective of this study was to evaluate the effect of the magnitudes of the individual and cultural consequences on the pattern of choices in situations of ethical self-control and metacontingencies. Six college students were divided into two microcultures, one with ABCAC'B'A design and another with an AC'B'ABCA design. In conditions B and B’ the magnitude of the individual consequence for impulsive responses increased while the cultural consequence diminished. In conditions C and C’ the magnitude of the cultural consequence increased and the individual consequence diminished. The results indicated the selection of a pattern of choices by the groups of both microcultures, according to the cultural consequence, with little or no influence of the manipulation of the magnitude of the consequences.

Resumo Introdução: O tratamento da apneia obstrutiva do sono com pressão positiva nas vias aéreas em crianças é restrito devido a preocupações de que possa afetar o crescimento da maxila em longo prazo. Objetivo: Realizar uma revisão sistemática da literatura sobre o impacto em longo prazo do uso de uma máscara de pressão positiva nas vias aéreas na face média em indivíduos em crescimento. Método: A pesquisa bibliográfica foi realizada em setembro de 2019 utilizando as palavras-chave (long-term OR side effects OR longitudinal) AND (children OR child OR preschool OR adolescents OR adolescent OR infant OR infants) AND (craniofacial OR mid-face OR midface OR midfacial OR facial OR maxillary) AND (airway pressure OR ventilation) nas bases de dados PubMed, Web of Science e Lilacs. A pesquisa incluiu artigos publicados em inglês, até setembro de 2019, sobre os efeitos da pressão positiva nas vias aéreas no crescimento médio-facial. Resultados: A estratégia de busca identificou cinco estudos: dois relatos de casos, dois estudos transversais e um estudo de coorte retrospectivo. Todos os estudos avaliaram os efeitos em longo prazo do uso de máscara nasal na face média em crianças e adolescentes; quatro apresentaram hipoplasia da face média e um paciente não mostrou diferença após o tratamento em comparação com um controle. Conclusão: A maioria dos estudos demonstrou que o uso prolongado da pressão positiva nas vias aéreas nasal na infância/adolescência está associado à hipoplasia da face média.

Abstract Introduction: The treatment of obstructive sleep apnea with positive airway pressure in children is restricted due to concerns that it could affect maxilla growth over time. Objective: To undertake a systematic review of the literature about the long-term impact of using a positive airway pressure mask on the midface in growing individuals. Methods: The literature search was conducted in September 2019 using the keywords (“long-term” OR “long term” OR “side effects” OR longitudinal) AND (children OR child OR preschool OR adolescents OR adolescent OR infant OR infants) AND (craniofacial OR “mid-face” OR midface OR midfacial OR facial OR maxillary) AND (“airway pressure” OR ventilation) in the databases PubMed, Web of Science and Lilacs. The search included papers published in English, until September 2019, on the effects of positive airway pressure on midfacial growth. Results: The search strategy identified five studies: two case reports, two cross-sectional studies and one retrospective cohort study. All studies evaluated the long-term effects of a using a nasal mask on the midface in children and adolescents; four showed midface hypoplasia and one no showed difference post- treatment compared to a control. Conclusion: Most of the studies demonstrated that long-term use of nasal positive airway pressure in childhood/adolescence is associated with midface hypoplasia.

ABSTRACT Objective Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Subjects and methods Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. Results A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m 2 ). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Conclusion Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS. Arch Endocrinol Metab. 2020;64(3):235-42

Resumo Introdução: A titulação manual é o padrão-ouro para determinar a pressão ideal para o tratamento com a pressão positiva contínua nas vias aéreas; e a predição da pressão ideal é importante para evitar retardos na sua prescrição. Objetivo: Verificar se as avaliações clínicas antropométricas, polissonográficas, cefalométricas e das vias aéreas superiores podem predizer a configuração ideal da pressão do aparelho de pressão positiva contínua nas vias aéreas para pacientes com apneia obstrutiva do sono. Método: Foram selecionados 50 homens entre 25 e 65 anos, com índice de massa corporal menor ou igual a 35 kg/m2. Todos os pacientes fizeram polissonografia basal, seguida de avaliações clínicas cefalométricas e otorrinolaringológicas. Na segunda noite, foi feita polissonografia de titulação para estabelecer a pressão ideal. Resultados: A média de idade dos pacientes foi de 43 ± 12,3 anos, com índice de massa corporal médio de 27,1 ± 3,4 kg/m2 e índice de apneia-hipopneia de 17,8 ± 10,5 eventos por hora. Menor comprimento mandibular (p = 0,03), menor distância atlas-maxila (p = 0,03) e a presença de Mallampati III e IV (p = 0,02) foram preditores de pressão mais elevada. A fórmula para a pressão positiva contínua nas vias aéreas foi: 17,24 - (0,133 × comprimento da mandíbula) + (0,969 × classificação de Mallampati III e IV) - (0,926 × distância atlas-mandíbula). Conclusão: Em uma amostra de homens com apneia obstrutiva do sono leve a moderada, a pressão positiva contínua nas vias aéreas foi predita com o comprimento mandibular, a distância atlas-mandíbula e a classificação de Mallampati.

Abstract Introduction: Manual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment. Objective: To verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients. Methods: Fifty men between 25 and 65 years, with body mass indexes of less than or equal to 35 kg/m2 were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure. Results: The average age of the patients was 43 ± 12.3 years, with a mean body mass index of 27.1 ± 3.4 kg/m2 and an apnea-hypopnea index of 17.8 ± 10.5 events per hour. Smaller mandibular length (p = 0.03), smaller atlas-jaw distance (p = 0.03), and the presence of a Mallampati III and IV (p = 0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244 − (0.133 × jaw length) + (0.969 × Mallampati III and IV classification) − (0.926 × atlas-jaw distance). Conclusion: In a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas-jaw distance and Mallampati classification.

RESUMO Objetivo: Analisar o efeito da entrevista motivacional no autocuidado de pessoas com insuficiência cardíaca crônica. Método: Ensaio clínico randomizado, multicêntrico, dividindo as pessoas em grupo intervenção (n=59) e grupo controle (n=59), acompanhadas por 60 dias nos centros do Brasil e Uruguai. O grupo intervenção recebeu três consultas por entrevista motivacional, com intervalo de 30 dias, e o grupo controle manteve o acompanhamento convencional nas clínicas especializadas. Os dados foram avaliados através do Self-Care of Heart Failure Index 6.2, antes e após a intervenção, em cada um dos centros e analisados através de média, mediana, teste-t, análise de correlação pelo coeficiente de Spearman e efeito da intervenção pelo d de Cohen. Resultados: 118 pessoas concluíram o estudo. Diante da avaliação do efeito da entrevista motivacional no autocuidado, comparando-se ao acompanhamento convencional, foi identificado efeito médio na manutenção e manejo (Cohen-d=0,6723; 0,5086) e alto na confiança do autocuidado (Cohen-d=0,9877). Conclusão: A entrevista motivacional foi efetiva na melhora do autocuidado dos pacientes com insuficiência cardíaca, sendo uma estratégia factível a ser implementada em clínicas especializadas. Registro Brasileiro de Ensaios Clínicos: RBR-6fp5qt.

ABSTRACT Objective: To analyze the effect of motivational interviewing on self-care for people with chronic heart failure. Method: A multicenter randomized clinical trial, which divided people into an intervention group (n=59) and a control group (n=59), followed for 60 days in centers of Brazil and Uruguay. The intervention group received three consultations per motivational interviewing, with an interval of 30 days, and the control group maintained conventional follow-up in specialized clinics. The data were assessed using the Self-Care of Heart Failure Index 6.2, before and after intervention in each of the centers. They were analyzed using the mean, median, t-test, correlation analysis using the Spearman coefficient and effect of the intervention by Cohen’s d. Results: One hundred and eighteen people completed the study. In view of the assessment of the effect of the motivational interviewing on self-care, compared to conventional follow-up, a medium effect on maintenance and management (Cohen’s d=0.6723; 0.5086) and high on self-care confidence (Cohen’s d=0.9877). Conclusion: Motivational interviewing was effective in improving self-care in patients with heart failure, being a feasible strategy to be implemented in specialized clinics. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-6fp5qt.

RESUMEN Objetivo: Analizar el efecto de las entrevistas motivacionales en el autocuidado de personas con insuficiencia cardíaca crónica. Método: Ensayo clínico aleatorizado, multicéntrico, que divide a las personas en un grupo de intervención (n=59) y un grupo de control (n=59), seguidos durante 60 días en centros de Brasil y Uruguay. El grupo de intervención recibió tres consultas por entrevista motivacional, con un intervalo de 30 días, y el grupo de control mantuvo el monitoreo convencional en clínicas especializadas. Los datos se evaluaron utilizando el Self-Care of Heart Failure Index 6.2, antes y después de la intervención, en cada uno de los centros y se analizaron utilizando la media, la mediana, la prueba t, el análisis de correlación utilizando el coeficiente de Spearman y el efecto de la intervención por el d de Cohen. Resultados: 118 personas completaron el estudio. En vista de la evaluación del efecto de la entrevista motivacional sobre el autocuidado, en comparación con el seguimiento convencional, un efecto medio en el mantenimiento y el manejo (Cohen-d=0.6723; 0.5086) y alto en la confianza en el autocuidado (Cohen-d=0,9877). Conclusión: La entrevista motivacional fue efectiva para mejorar el autocuidado de pacientes con insuficiencia cardíaca, siendo una estrategia factible para ser implementada en clínicas especializadas. Registro brasileño de ensayos clínicos: RBR-6fp5qt.

ABSTRACT Objective: To analyze the effect of motivational interviewing on self-care for people with chronic heart failure. Method: A multicenter randomized clinical trial, which divided people into an intervention group (n=59) and a control group (n=59), followed for 60 days in centers of Brazil and Uruguay. The intervention group received three consultations per motivational interviewing, with an interval of 30 days, and the control group maintained conventional follow-up in specialized clinics. The data were assessed using the Self-Care of Heart Failure Index 6.2, before and after intervention in each of the centers. They were analyzed using the mean, median, t-test, correlation analysis using the Spearman coefficient and effect of the intervention by Cohen’s d. Results: One hundred and eighteen people completed the study. In view of the assessment of the effect of the motivational interviewing on self-care, compared to conventional follow-up, a medium effect on maintenance and management (Cohen’s d=0.6723; 0.5086) and high on self-care confidence (Cohen’s d=0.9877). Conclusion: Motivational interviewing was effective in improving self-care in patients with heart failure, being a feasible strategy to be implemented in specialized clinics. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-6fp5qt.

RESUMEN Objetivo: Analizar el efecto de las entrevistas motivacionales en el autocuidado de personas con insuficiencia cardíaca crónica. Método: Ensayo clínico aleatorizado, multicéntrico, que divide a las personas en un grupo de intervención (n=59) y un grupo de control (n=59), seguidos durante 60 días en centros de Brasil y Uruguay. El grupo de intervención recibió tres consultas por entrevista motivacional, con un intervalo de 30 días, y el grupo de control mantuvo el monitoreo convencional en clínicas especializadas. Los datos se evaluaron utilizando el Self-Care of Heart Failure Index 6.2, antes y después de la intervención, en cada uno de los centros y se analizaron utilizando la media, la mediana, la prueba t, el análisis de correlación utilizando el coeficiente de Spearman y el efecto de la intervención por el d de Cohen. Resultados: 118 personas completaron el estudio. En vista de la evaluación del efecto de la entrevista motivacional sobre el autocuidado, en comparación con el seguimiento convencional, un efecto medio en el mantenimiento y el manejo (Cohen-d=0.6723; 0.5086) y alto en la confianza en el autocuidado (Cohen-d=0,9877). Conclusión: La entrevista motivacional fue efectiva para mejorar el autocuidado de pacientes con insuficiencia cardíaca, siendo una estrategia factible para ser implementada en clínicas especializadas. Registro brasileño de ensayos clínicos: RBR-6fp5qt.

RESUMO Objetivo: Analisar o efeito da entrevista motivacional no autocuidado de pessoas com insuficiência cardíaca crônica. Método: Ensaio clínico randomizado, multicêntrico, dividindo as pessoas em grupo intervenção (n=59) e grupo controle (n=59), acompanhadas por 60 dias nos centros do Brasil e Uruguai. O grupo intervenção recebeu três consultas por entrevista motivacional, com intervalo de 30 dias, e o grupo controle manteve o acompanhamento convencional nas clínicas especializadas. Os dados foram avaliados através do Self-Care of Heart Failure Index 6.2, antes e após a intervenção, em cada um dos centros e analisados através de média, mediana, teste-t, análise de correlação pelo coeficiente de Spearman e efeito da intervenção pelo d de Cohen. Resultados: 118 pessoas concluíram o estudo. Diante da avaliação do efeito da entrevista motivacional no autocuidado, comparando-se ao acompanhamento convencional, foi identificado efeito médio na manutenção e manejo (Cohen-d=0,6723; 0,5086) e alto na confiança do autocuidado (Cohen-d=0,9877). Conclusão: A entrevista motivacional foi efetiva na melhora do autocuidado dos pacientes com insuficiência cardíaca, sendo uma estratégia factível a ser implementada em clínicas especializadas. Registro Brasileiro de Ensaios Clínicos: RBR-6fp5qt.

ABSTRACT Increased resistance to polymyxin in Klebsiella pneumoniae (ColRKP) has been observed. Molecular epidemiology, as well as the clinical impact of these difficult to treat pathogens need to be better characterized. We present the clinical outcomes of 28 patients infected by ColRKP in a tertiary hospital. Isolates with MIC >2 by Vitek 2 were confirmed by the microdilution broth test. Polymerase chain reaction (PCR) was performed for blaKPC, blaNDM, blaOXA-48 and blamcr-1 genes in the isolates, and Whole Genome Sequencing (WGS) was performed in six isolates. Seventeen (61%) patients were female and the mean age was 50 years old. In-hospital and 30-day mortality were 64% (18/28) and 53% (15/28), respectively. Central line-associated bloodstream infection in addition to bacteremia episodes due to other sources were the most frequent (61%). Mean APACHE and Charlson comorbidity index were 16 and 5, respectively. Twenty patients (71%) received at least one active drug and ten (35%) received two drugs: tigecycline 46% (13/28); amikacin 21% (6/28) and fosfomycin 3% (1 case). Twenty-six out of 28 tested cases were positive for blaKPC. Eight different clusters were identified. Four STs were detected (ST11, ST23, ST340, and ST437). Mutations on pmrA, arnB, udg, and yciM genes were present in all six isolates submitted to WGS; lpxMand mgrB mutations were also detected in all but one isolate. In conclusion, we observed resistance to polymyxin in severely ill patients mostly from intensive care units and/or immunosuppressed patients with high mortality rates in whom a diversity of ColRKP clusters was identified and might indicate selective pressure.

Abstract The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States – POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.