Background: The carrier state of methicillin-resistant Staphylococcus aureus is pointed as an infection predictor and a factor for environmental and person-to-person dissemination, including health service workers. These, when colonized are commonly associated to outbreaks. Objective: Analyze the prevalence of Staphylococcus aureus in saliva of workers at a university hospital. Methodology: Epidemiologic longitudinal study carried out in Curitiba, Paraná, Brazil, with 486 workers between April 2006 and June 2008. Three saliva samples were collected and a data collection instrument was applied. Staphylococcus aureus were isolated from the clinical specimen and characterized by phenotypes. The data from the instrument and the laboratory results were organized and processed with EPI-Info software and analyzed via descriptive statistics. Results: Among the healthcare workers studied, 60.9% were colonized by Staphylococcus aureus in saliva; of those, 67.9% were transitory carriers and 32.1% were persistent carriers; the prevalence of meticillin-resistant Staphylococcus aureus (MRSA) among the isolated cases was 15.7%. The average prevalence of MRSA was 12.7% and higher among nurses’ aides (21.4%) and cleaning aides (20.6%) and lower among nurses (4.5%) and doctors (5.9%). Conclusions: Healthcare workers presented high prevalence of Staphylococcus aureus in saliva, indicating the mouth as an important body site to investigate colonization by MRSA and a potential source to its dissemination.

Introduction: The health status of caregivers is associated with satisfaction with life and so in the way of delivering care to the elderly with Alzheimer’s. Objective: To evaluate the health status and life satisfaction of family caregivers of elderly with Alzheimer’s, users of a Reference Center for Care in Alzheimer’s disease in Curitiba, Paraná, Brazil. Materials and methods: This is a cross-sectional quantitative study. The convenience sample consisted of 208 family caregivers and selected during the period December 2009 to February 2010, through the inclusion and exclusion criteria. The study was conducted in the Reference Center. Data were collected through semi-structured interviews and application of the scales: Zarit caregiver burden interview, Subjective Well-Being and Functional Staging. For statistical analysis, we applied the Chi-square, Mann-Whitney and Kruskal-Wallis test, using Epi-Info 6.04. Results were considered statistically significant if their level was less than 5% (p

Population-based cancer survival is an indicator of the effectiveness of cancer services that reflects the survival of all cancer patients in the population, regardless of socioeconomic status and disease characteristics. Provision of an up-to-date survival estimate of patients recorded within Cali Population Cancer Registry (RPCC) in 1998-2017. As a second objective, results will be compared with those reported by the CONCORD study for cancers prioritized by the current Ten-Year Cancer Control Plan of Colombia, 2012-2021. Adult cancer cases (aged 15 to 99 years) for nine cancer types diagnosed between 1998 and 2017, with follow-up to 2018, were obtained from the RPCC. The 5-year age-standardized net survival estimates (NS) were estimated using the Pohar-Perme. The results for the period 1995- 2014 were compared with those reported by the CONCORD study for the following locations: stomach (C16), breast (C50), cervix (C53), prostate (C61), and lung (C33-34). Five-year survival estimates for breast and prostate cancers improved ten percentage points through 2007 (70.8 to 81.1 for breast and 79.9 to 90.2 for prostate) and remained stable during 2008-2017. For cervical cancer, survival estimates has remained stable for the last two decades at 53%. For stomach cancer and lung cancer, five-year NS was lower than 25% over the study period. For colorectal cancer, survival estimates increased from 37.9% in 1998-2002 to 54.8% in 2013-2017. Compared to previous 5-year survival estimates of cases diagnosed in 2010-2014, the estimates in this study are significantly higher than those obtained by CONCORD. Survival estimates of patients diagnosed in 1995-2009 showed no difference to CONCORD study. Periodic update of vital status and date of last contact reduces bias in survival estimates in population-based cancer registries with passive follow-up.

El comportamiento de la pandemia de COVID-19 durante los tres picos registrados en Cali ha sido heterogéneo y la severidad de los contagios y decesos ha variado durante el tiempo. Cali con 2.2 millones de habitantes es la tercera ciudad mas poblada de Colombia, registra a la fecha (21-11-21) 285 mil casos confirmados y 7,474 muertes por la infección. El plan de vacunación contra el SARS-CoV2 iniciado en febrero de 2021, ha inmunizado en Cali 1.54 millones de personas. Al igual que en el resto del país, el desarrollo del plan de vacunación en Cali coincidió con el tercer pico de la pandemia, el más prolongado y de mayor mortalidad; así, como con múltiples movilizaciones sociales de cientos de manifestantes agolpados en las calles entre mayo y junio del 2021, en protesta a una reforma tributaria impopular promulgada por el gobierno nacional. En Cali el plan de vacunación también se afectó por falta de acceso a servicios de salud y puntos de vacunación por bloqueos registrados en diferentes territorios de la ciudad. Al final del tercer pico, el país afrontó dificultades para continuar con el plan de vacunación por barreras al acceso de biológicos en el mercado internacional.

Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.

Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

Introduction: Car painters are routinely exposed to organic solvents classified as carcinogenic and mutagenic substances. Objective: To characterize the population susceptibility and evaluate the genotoxic effects of exposure to organic solvents. Methods: A cross-sectional study comparing a group of car painters exposed to organic solvents with a non-exposed group. CYP2E1 polymorphisms and the presence of micronuclei in lymphocytes were determined. Results: One hundred twenty-two workers participated in the study: 62 who worked in car paint shops and were exposed to solvents, and 60 who were not exposed. There were statistically significant differences between the two groups regarding micronucleated cells and nucleoplasmic bridges frequencies (p= 0.042 and p= 0.046, respectively; exact likelihood ratio). Significant differences were found at the interaction between the CYP2E1 genotype c1c1 and occupational exposure to solvents, with higher frequencies of micronuclei (p= 0.013) and micronucleated cells (p= 0.015). However, when the frequencies of micronuclei, micronucleated cells and nucleoplasmic bridges in the exposure group were compared between the c1c1 and c2c2/c1c2 allele groups of the CYP2E1 polymorphism, statistically significant differences were found. Conclusions: This study confirms that when workers with CYP2E1 polymorphisms, specifically the c1c1 genotype, are exposed to organic solvents, they are more likely to have somatic cell mutations, a condition associated with increased susceptibility to diseases such as cancer

This letter focuses on recent and interesting work on breastfeeding, to emphasize two observations. The first observation refers to the fact that, in Mateus and Cabrera’s manuscript It was hardly discussed whether the referred knowledge and skills may be relevant to understanding the mothers’ behavior regarding their commitment to breastfeeding. The relevance of these cognitive aspects requires more attention due to their relationship with breastfeeding practices, and in general with the long-term mother-infant dyad. Because the knowledge and skills to maintain successful breastfeeding have implications for developing instructional content in interventions for mothers as well, great attention needs to be paid to the size of the effect of differences between reported frequencies in pregnancy and the immediate puerperium. In Table 3, these differences were examined by the McNemar statistical test, which allows obtaining the statistical significance of the rejection of the null hypothesis of no differences. But neither this test nor the size of its p-value inform about the degree or size of the differences. An estimate of the size or magnitude of the differences, represented as point values or confidence intervals (as reported in Tables 4 and 5), tend to better specify tests of statistical significance. Therefore, we estimate the practical significance of the difference between the percentages obtained in pregnancy and the immediate puerperium for each of the knowledge and basic skills reported in Table 3. With the only numerical data presented in this table, we calculated the McNemar odd ratio (McNemar OR , and standardized difference measures d: d Cox 8 and d probit . These show less bias with their population values in relation to other estimators5. Because they both assume different statistical assumptions e.g., logistic distribution for McNemar OR and d Cox , and normal distribution for d probit , calculating bothwill report the convergence or divergence of these estimates.

A historical follow-up on the medical diaries about the patient is made, from the Hippocratic texts to the appearance of the current canon of the clinical history formulated by Boerhaave in the seventeenth century, through the medieval consilia and the curationes and observationes of the Renaissance; and it is discussed how much the patient's story is present in those writings. It is postulated that the medical narrative that starts from adequately listening to the patient and his story, and adopts a literary workshop format, it is a pedagogical tool that contributes to comprehensive medical training, and offers the patient the opportunity to be treated in an empathic and humanized environment.

In the past four months SARS-CoV-2 has reached most countries in the world. Public health strategies based on widespread testing and proper isolation of positive cases have shown to be helpful to reduce local transmission of SARS-CoV-2. Confirmatory tests, that identify viral RNA, and screening serological tests that identify viral antigens or host antibodies against viral proteins are part of the tools that nations can use to fight infectious disease epidemics. Understanding how each test works can provide insights about their test characteristics and how they can be used for different clinical and public health goals. Testing is a key strategy to reduce viral transmission, not only for this epidemic, but also for others to come.