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RESUMOObjetivou-se verificar a possível associação entre a severidade clínica e a ocorrência de infecções relacionadas à assistência em saúde. Conduziu-se uma coorte prospectiva em uma unidade de terapia intensiva de um hospital universitário, de agosto de 2009 a fevereiro de 2010. Utilizou-se o Average Severity Index Score para avaliar a severidade clínica. Os dados foram coletados por vigilância ativa e processados no SPSS. Realizou-se análise univariada e considerou-se significância estatística de p<0,05, com intervalo de confiança de 95%. O índice de severidade esteve relacionado à ocorrência de infecções, assim como tempo de permanência na unidade de terapia intensiva, tipo de paciente, uso de procedimento invasivo, antimicrobiano, colonização e desfecho do paciente (p<0,05). A presença de infecções foi um fator preditivo para a ocorrência de óbitos (p=0,000). Tais achados reforçam a ideia de que a ocorrência de infecção constitui uma complexa cadeia, multifatorial, com destaque para a severidade clínica do paciente.Descritores: Índice de gravidade de doença. Infecção hospitalar. Unidades de terapia intensiva. Oliveira AC, Paula AO, Iquiapaza RA, Lacerda ACS. Infecções relacionadas à assistência em saúde e gravidade clínica em uma unidade de terapia intensiva. Rev Gaúcha Enferm. 2012;33(3):89-96. RESUMEN Este estudio evaluó la posible asociación entre la severidad clínica y la incidencia de infecciones relacionadas a asistencia en salud. Se realizó un estudio prospectivo en una unidad de cuidados intensivos de un hospital universitario

IntroductionHuman adipose tissue-derived stem cells (hASCs) are attractive cells for therapeutic applications and are currently being evaluated in multiple clinical trials. Prior to their clinical application, hASCs must be expanded ex vivo to obtain the required number of cells for transplantation. Fetal bovine serum is the supplement most widely used for cell culture, but it has disadvantages and it is not safe for cell therapy due to the risks of pathogen transmission and immune reaction. Furthermore, the cell expansion poses a risk of accumulating genetic abnormalities that could lead to malignant cell transformation. In this study, our aim was to evaluate the proliferation pattern as well as the resistance to spontaneous transformation of hASCs during expansion in a xeno-free culture condition.MethodshASCs were expanded in Dulbecco’s modified Eagle’s medium supplemented with pooled allogeneic human serum or fetal bovine serum to enable a side-by-side comparison. Cell viability and differentiation capacity toward the mesenchymal lineages were assessed, along with immunophenotype. Ki-67 expression and the proliferation kinetics were investigated. The expression of the transcription factors c-FOS and c-MYC was examined with Western blot, and MYC, CDKN2A, ERBB2 and TERT gene expression was assessed with quantitative PCR. Senescence was evaluated by β-gal staining. Karyotype analysis was performed and tumorigenesis assay in vivo was also evaluated.ResultsThe hASCs expanded in medium with pooled allogeneic human serum did not show remarkable differences in morphology, viability, differentiation capacity or immunophenotype. The main difference observed was a significantly higher proliferative effect on hASCs cultured in pooled allogeneic human serum. There was no significant difference in C-FOS expression; however, C-MYC protein expression was enhanced in pooled allogeneic human serum cultures compared to fetal bovine serum cultures. No difference was observed in MYC and TERT mRNA levels. Moreover, the hASCs presented normal karyotype undergoing senescence, and did not form in vivo tumors, eliminating the possibility that spontaneous immortalization of hASCs had occurred with pooled allogeneic human serum.ConclusionsThis complete characterization of hASCs cultivated in pooled allogeneic human serum, a suitable xeno-free approach, shows that pooled allogeneic human serum provides a high proliferation rate, which can be attributed for the first time to C-MYC protein expression, and showed cell stability for safe clinical applications in compliance with good manufacturing practice.

Human adipose-derived stem cells (hASCs) are currently a point of focus for bone tissue engineering applications. However, the ex vivo expansion of stem cells before clinical application remains a challenge. Fetal bovine serum (FBS) is largely used as a medium supplement and exposes the recipient to infections and immunological reactions. In this study, we evaluated the osteogenic differentiation process of hASCs in poly-3-hydroxybutyrate-co-3-hydroxyvalerate (PHB-HV) scaffolds with the osteogenic medium supplemented with pooled allogeneic human serum (aHS). The hASCs grown in the presence of FBS or aHS did not show remarkable differences in morphology or immunophenotype. The PHB-HV scaffolds, which were developed by the freeze-drying technique, showed an adequate porous structure and mechanical performance as observed by micro-computed tomography, scanning electron microscopy (SEM), and compression test. The three-dimensional structure was suitable for allowing cell colonization, which was revealed by SEM micrographs. Moreover, these scaffolds were not toxic to cells as shown by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The differentiation capacity of hASCs seeded on scaffolds was confirmed by the reduction of the proliferation, the alkaline phosphatase (AP) activity, expression of osteogenic gene markers (AP, collagen type I, Runx2, and osteocalcin), and the expression of bone markers, such as osteopontin, osteocalcin, and collagen type I. The osteogenic capacity of hASCs seeded on PHB-HV scaffolds indicates that this scaffold is adequate for cell growth and differentiation and that aHS is a promising supplement for the in vitro expansion of hASCs. In conclusion, this strategy seems to be useful and safe for application in bone tissue engineering.

Mineralized poly(ε-caprolactone)/gelatin core-shell nanofibers were prepared via co-axial electrospinning and subsequent incubation in biomimetic simulated body fluid containing ten times the calcium and phosphate ion concentrations found in human blood plasma. The deposition of calcium phosphate on the nanofiber surfaces was investigated through scanning electronic microscopy and X-ray diffraction. Energy dispersive spectroscopy results indicated that calcium-deficient hydroxyapatite had grown on the fibers. Fourier transform infrared spectroscopy analysis suggested the presence of hydroxyl-carbonate-apatite. The results of a viability assay (MTT) and alkaline phosphatase activity analysis suggested that these mineralized matrices promote osteogenic differentiation of human adipose-derived stem cells (hASCs) when cultured in an osteogenic medium and have the potential to be used as a scaffold in bone tissue engineering. hASCs cultured in the presence of nanofibers in endothelial differentiation medium showed lower rates of proliferation than cells cultured without the nanofibers. However, endothelial cell markers were detected in cells cultured in the presence of nanofibers in endothelial differentiation medium.

RESUMOPesquisas realizadas demonstram falta de padronização dos métodos de avaliação da aderência dos profissionais de saúde à prática da higienização das mãos. Assim, este estudo de revisão objetivou identificar os diferentes métodos utilizados para avaliação da aderência a essa prática, referendados na literatura por meio de consulta às seguintes bases de dados -Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Analysis Retrieval System Online e Scientific Eletronic Library Online nas quais foram identificados 210 estudos, dentre os quais foram selecionados 34 artigos divulgados entre os anos de 2001 a 2010. O estudo apresenta os diferentes métodos adotados para realizar a avaliação da aderência aos procedimentos de higienização das mãos e aponta seus pontos fortes e fragilidades, a fim de subsidiar uma análise crítica por parte dos profissionais de saúde, com o intuito de favorecer a escolha do método mais adequado a cada instituição e realidade. Descritores: Lavagem de mãos; Monitoramento; Precauções universais; Fidelidade a diretrizes ABSTRACTSurveys conducted show a lack of standardized methods for assessing the adherence of health professionals to the practice of hand hygiene. Therefore, this review aimed to identify the different methods used to assess adherence to this practice found within the literature, referenced by the following query databases -Latin American and Caribbean Health Sciences, Medical Analysis Retrieval System Online Scientific Electronic Library Online. A total of 210 studies were identified, among which 34 were selected articles published between the years 2001 to 2010. The study presents the different methods used to conduct the evaluation of adherence to hand hygiene procedures and highlights their strengths and weaknesses, in order to subsidize the critical analysis on the part of health professionals, to facilitate the choice of the most appropriate method for each institution and reality. Keywords: Handwashing; Monitoring; Universal precautions; Guideline adherence RESUMENInvestigaciones realizadas demuestran falta de patronización de los métodos de evaluación de la adherencia de los profesionales de salud a la práctica de la higiene de las manos. Así, este estudio de revisión tuvo como objetivo identificar los diferentes métodos utilizados para la evaluación de la adherencia a esa práctica, refrendados en la literatura por medio de consulta a las siguientes bases de datos -Literatura Latino-Americana y del Caribe en Ciencias de la Salud, Medical Analysis Retrieval System Online e Scientific Eletronic Library Online en las cuales fueron identificados 210 estudios, de los cuales fueron seleccionados 34 artículos difundidos entre los años de 2001 a 2010. El estudio presenta los diferentes métodos adoptados para realizar la evaluación de la adherencia a los procedimientos de higiene de las manos y señala sus puntos fuertes y fragilidades, a fin de subsidiar un análisis crítico por parte de los profesionales de salud, con la intención de favorecer la elección de...

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