Memoria para optar al Título Profesional de Médico Veterinario / Las malformaciones congénitas, ocurren como consecuencia de defectos que alteran los mecanismos biológicos del desarrollo embrionario. Su etiología es variada, asociada a factores ambientales, genéticos y de orden multifactorial. En perros, las cirugías del sistema urogenital son las más frecuentes, por ello, se debe tener en consideración la existencia de patologías congénitas que lo afectan y cuya corrección es quirúrgica. Esta monografía reúne los conocimientos publicados sobre patogenia, presentación clínica, diagnóstico y técnicas quirúrgicas de las patologías congénitas de resolución quirúrgica que con más frecuencia se presentan en el sistema urogenital en perros. En base a una revisión sistemática de literatura, que considera estudio de casos, revisiones y ensayos clínicos incluidos en las bases de datos electrónicas; Pubmed, Europe Pubmed, Wiley Online Library, Scielo y ScienceDirect, se obtuvo un total de 72 publicaciones científicas, 2 memorias y 7 libros. Se presentan en Tablas Resumen las técnicas quirúrgicas descritas según malformación congénita, las causas publicadas de las patologías y el Análisis de técnicas quirúrgicas utilizadas en los tratamientos. De los temas recopilados se obtuvo una mayor cantidad de antecedentes de criptorquidia e hipospadia, y una falta de información sobre la etiología de la mayoría de las malformaciones descritas. Finalmente, se puede concluir que son enfermedades de publicación poco frecuente, algunas son subclínicas, otras pueden afectar la calidad de vida del paciente, y posiblemente son hereditarias. Los desafíos en investigación están orientados a determinar su etiología y suplir los déficit de las técnicas tradicionales y evaluar las nuevas técnicas descritas, analizando los beneficios de la incorporación de nuevas tecnologías en relación a los costos

Dynamic transperineal ultrasound (TPUS) video allows for kinematic analysis of urogenital morphology and mobility, however, measures are often limited to peak displacements of anatomical landmarks and are vulnerable to error incurred by probe rotation during imaging. This thesis aimed to (1) develop an algorithm to calculate kinematic curves of urogenital landmark motion from TPUS video and to (2) investigate the error incurred in these kinematic measures due to in-plane ultrasound probe rotation. UROKIN, a semi-automated software, was developed and, as a proof of concept, was used to identify differences in urogenital kinematics during pelvic floor muscle maximum voluntary contractions between women with and without stress urinary incontinence. A mathematical model revealed that the error incurred by TPUS probe rotation in the x- (anterior-posterior) and y- (cranial-caudal) directions, was a factor of: r, the radius of rotation; Ɵ, the in-plane angular probe rotation; and α, the angular deviation between the anatomical planes and the coordinate system in which error was calculated. As an absolute measure, the error incurred by in-plane probe rotation is reduced to a factor of only r and Ɵ. Moving forward, UROKIN must be adapted to include findings from (1), and must be tested for validity and reliability.

As a result of alcohol consumption being highly prevalent in today’s society, research has been done to investigate the effects of alcohol on the body’s physiological systems. Research has indicated that heavy alcohol consumption is detrimental to the normal structure and function of some organs, especially the liver. However, little research has focused on the effects of chronic alcohol consumption on the female reproductive system. To investigate these effects, the uterine tissues of mice fed an ethanol diet (the NIAAA model also known as the Lieber-DeCarli diet) and mice fed a control diet were compared. The NIAAA model was chosen for this research because it simulates the drinking pattern that is known to cause liver disease in alcoholic hepatitis patients. This is achieved by incorporating both chronic and binge drinking patterns of alcohol consumption. In this study, the mucin layer that lines the endometrial surface of the uterus was analyzed in mice separated into ethanol and control fed groups. The ethanol fed mice were put on the Lieber-DeCarli 5% (v/v) ethanol diet ad libitum for 10-days followed by a single high dose of ethanol (5g/kg) on the 11th day. The control fed mice were placed on an ethanol free isocaloric diet (supplemented with maltose dextrin to match the calories of ethanol). After the 11th day, the mice were sacrificed, and uterine tissues were harvested. The tissues were then embedded in paraffin, sectioned, stained via the Hematoxylin and Eosin (H&E) technique, and examined under a microscope. The thickness of the uterine mucin layer was then measured for each animal and the average thicknesses were calculated. A one-way ANOVA test was employed to compare the mucin thickness between the two groups of animals. The test revealed no statistically significant difference between the thicknesses of the uterine mucin layer in the control and ethanol fed animals (P-value: 0.774).

Prostate and breast cancer are the leading causes of cancer-related death in men and women, respectively, and metastasis is the primary factor underlying the high mortality rates.1 Snail transcription factor is an important molecule that drives prostate and breast cancer metastasis through the process of epithelial mesenchymal transition (EMT). Proteolytic enzymes that promote invasion and metastasis such as the lysosomal cysteine protease cathepsin L (Cat L) have been shown to degrade E-cadherin, promoting the epithelial mesenchymal transition (EMT).2 It has also been shown that silencing Cat L can inhibit transforming growth factor-beta (TGF-β)-mediated EMT by suppressing Snail transcription factor.3 Several recent studies have highlighted an additional unexpected localization and site of action for Cat L within the nucleus in breast, colon and prostate cancer.4 Natural products have been shown to be efficacious in prevention and possible treatment of cancer.5 Specifically, we have been studying Muscadine Grape Skin Extract (MSKE) as a possible candidate to inhibit Snail signaling. MSKE has previously been shown to promote prostate cancer apoptosis.6 We hypothesized that Snail promotes nuclear localization of Cat L, which promotes EMT associated with increased migration and invasion, and that antagonizing Snail-Cat L signaling would lead to mesenchymal epithelial transition (MET). We showed for the first time that MSKE promotes apoptosis through induction of endoplasmic reticulum stress response and autophagy. Additionally, MSKE could inhibit Snail-mediated EMT via scavenging reactive oxygen species. Moreover, Snail could promote nuclear localization of Cat L, which then promoted cleavage of CDP/Cux, increased Snail transcription and decreased E-cadherin transcription by direct promoter binding of cleaved CDP/Cux, leading to EMT associated with increased migration and invasion. Interestingly, Z-FY-CHO, a small molecule specific inhibitor of Cat L, as well as MSKE could antagonize this signaling by promoting nuclear to cytoplasmic re-localization of Cat L. Therefore, we have dissected novel mechanisms of action of Snail and how it can be antagonized by MSKE natural product.

O objetivo deste trabalho foi verificar o possível efeito protetor da L-glutamina e da L-arginina sobre a próstata ventral de ratos quando administradas por gavagem. Procurou-se simular as condições clinicas de pacientes submetidos à radioterapia pélvica tendo como órgão alvo outro órgão pélvico que não a próstata. Foram analisados os efeitos desta irradiação sobre a próstata considerando este órgão como normal. Foram utilizados ratos Wistar divididos em quatro grupos: Controle, animais não submetidos à irradiação (n= 10); Irradiado, submetidos à irradiação abdominal e sem suplementação adicional de aminoácido por 21 dias (n= 10); Irradiado + Lglutamina, submetidos à irradiação abdominal e com suplementação adicional de L- glutamina por 21 dias (n= 10); e Irradiado + L-arginina, submetidos à irradiação abdominal e com suplementação adicional de L- arginina por 21 dias (n= 9). Os grupos foram mantidos em condições padrão de laboratório durante todas as etapas do experimento. Os animais submetidos à irradiação abdominal receberam uma dose única de 1000 cGy no dia 8 da experimentação. A Lglutamina e a L-arginina foram dissolvidas em água destilada e administrada por gavagem através da agulha IC-810. As próstatas foram removidas e processadas para inclusão em parafina. Foram estudados os seguintes parâmetros: estrutura acinar (área dos ácinos e altura do epitélio) e colágeno analisados por métodos morfométricos e peso corporal. O ganho de peso nos grupos suplementados foi significativamente maior se comparado ao grupo irradiado. Houve redução da altura do epitélio no grupo irradiado quando comparado ao controle. A altura do epitélio no grupo suplementado com L-arginina foi significativamente maior do que nos grupos irradiado e suplementado com L-glutamina. Houve diminuição, de aproximadamente 18%, da área dos ácinos no grupo suplementado com L-glutamina. Já no grupo suplementado com Larginina o valor foi similar ao do controle. O efeito da L-glutamina sobre o parênquima prostático foi o de manter proporcionalmente o colágeno, preservando a integridade da matriz extracelular. No grupo suplementado com L-arginina, apesar da discreta redução na distribuição proporcional de colágeno este também manteve índices semelhantes ao do controle. A radiação abdominal promoveu algumas modificações estruturais na próstata ventral de ratos. Essas modificações podem ser parcialmente prevenidas pela suplementação oral com L-glutamina e de L-arginina. / The aim of this study was to investigate the possible protective effect of L-glutamine and Larginine on the rat ventral prostate when administered by gavage. We tried to simulate the clinical conditions of patients undergoing pelvic radiotherapy as with other pelvic organ target organ than the prostate. We analyzed the effects of irradiation on prostate considering this organ as normal. Wistar rats were divided into four groups: Control, animals not exposed to irradiation (n= 10); Irradiated, submitted to abdominal irradiation and without additional amino acid supplementation (n= 10); Irradiated + L-glutamine, submitted abdominal irradiation and additional supplementation with L-glutamine for 21 days (n= 10), and Irradiated + L-arginine, underwent abdominal irradiation and additional supplementation with L-arginine for 21 days (n=9). The groups were kept under standard laboratory conditions during all stages of the experiment. The animals underwent abdominal irradiation received a single dose of 1000 cGy in eight days of trial. L-glutamine and L-arginine were dissolved in distilled water and administered by gavage needle through the IC-810 . The prostates were removed and processed for paraffin embedding. We studied the following parameters: acinar structure (area of acini and epithelial height) and collagen analyzed by morphometric methods and body weight. Weight gain in the supplemented groups was significantly higher compared to the irradiated group. There was a reduction in epithelial height in the irradiated group compared to control. The height of the epithelium in the group supplemented with L-arginine was significantly higher than in irradiated and supplemented with L-glutamine. There was a decrease of approximately 18% of the area of the lobes in the group supplemented with L-glutamine. In the group supplemented with Larginine was similar to the value of control. The effect of L-glutamine on the prostatic parenchyma was to keep the collagen in proportion, preserving the integrity of the extracellular matrix. In the group supplemented with L-arginine, despite a slight reduction in the proportional distribution of this collagen also maintained similar levels to the control. The abdominal radiation caused some structural changes in rat ventral prostate. These modifications can be partially prevented by oral supplementation with L-glutamine and L-arginine.

O objetivo deste trabalho foi verificar o possível efeito protetor da L-glutamina e da L-arginina sobre a próstata ventral de ratos quando administradas por gavagem. Procurou-se simular as condições clinicas de pacientes submetidos à radioterapia pélvica tendo como órgão alvo outro órgão pélvico que não a próstata. Foram analisados os efeitos desta irradiação sobre a próstata considerando este órgão como normal. Foram utilizados ratos Wistar divididos em quatro grupos: Controle, animais não submetidos à irradiação (n= 10); Irradiado, submetidos à irradiação abdominal e sem suplementação adicional de aminoácido por 21 dias (n= 10); Irradiado + Lglutamina, submetidos à irradiação abdominal e com suplementação adicional de L- glutamina por 21 dias (n= 10); e Irradiado + L-arginina, submetidos à irradiação abdominal e com suplementação adicional de L- arginina por 21 dias (n= 9). Os grupos foram mantidos em condições padrão de laboratório durante todas as etapas do experimento. Os animais submetidos à irradiação abdominal receberam uma dose única de 1000 cGy no dia 8 da experimentação. A Lglutamina e a L-arginina foram dissolvidas em água destilada e administrada por gavagem através da agulha IC-810. As próstatas foram removidas e processadas para inclusão em parafina. Foram estudados os seguintes parâmetros: estrutura acinar (área dos ácinos e altura do epitélio) e colágeno analisados por métodos morfométricos e peso corporal. O ganho de peso nos grupos suplementados foi significativamente maior se comparado ao grupo irradiado. Houve redução da altura do epitélio no grupo irradiado quando comparado ao controle. A altura do epitélio no grupo suplementado com L-arginina foi significativamente maior do que nos grupos irradiado e suplementado com L-glutamina. Houve diminuição, de aproximadamente 18%, da área dos ácinos no grupo suplementado com L-glutamina. Já no grupo suplementado com Larginina o valor foi similar ao do controle. O efeito da L-glutamina sobre o parênquima prostático foi o de manter proporcionalmente o colágeno, preservando a integridade da matriz extracelular. No grupo suplementado com L-arginina, apesar da discreta redução na distribuição proporcional de colágeno este também manteve índices semelhantes ao do controle. A radiação abdominal promoveu algumas modificações estruturais na próstata ventral de ratos. Essas modificações podem ser parcialmente prevenidas pela suplementação oral com L-glutamina e de L-arginina. / The aim of this study was to investigate the possible protective effect of L-glutamine and Larginine on the rat ventral prostate when administered by gavage. We tried to simulate the clinical conditions of patients undergoing pelvic radiotherapy as with other pelvic organ target organ than the prostate. We analyzed the effects of irradiation on prostate considering this organ as normal. Wistar rats were divided into four groups: Control, animals not exposed to irradiation (n= 10); Irradiated, submitted to abdominal irradiation and without additional amino acid supplementation (n= 10); Irradiated + L-glutamine, submitted abdominal irradiation and additional supplementation with L-glutamine for 21 days (n= 10), and Irradiated + L-arginine, underwent abdominal irradiation and additional supplementation with L-arginine for 21 days (n=9). The groups were kept under standard laboratory conditions during all stages of the experiment. The animals underwent abdominal irradiation received a single dose of 1000 cGy in eight days of trial. L-glutamine and L-arginine were dissolved in distilled water and administered by gavage needle through the IC-810 . The prostates were removed and processed for paraffin embedding. We studied the following parameters: acinar structure (area of acini and epithelial height) and collagen analyzed by morphometric methods and body weight. Weight gain in the supplemented groups was significantly higher compared to the irradiated group. There was a reduction in epithelial height in the irradiated group compared to control. The height of the epithelium in the group supplemented with L-arginine was significantly higher than in irradiated and supplemented with L-glutamine. There was a decrease of approximately 18% of the area of the lobes in the group supplemented with L-glutamine. In the group supplemented with Larginine was similar to the value of control. The effect of L-glutamine on the prostatic parenchyma was to keep the collagen in proportion, preserving the integrity of the extracellular matrix. In the group supplemented with L-arginine, despite a slight reduction in the proportional distribution of this collagen also maintained similar levels to the control. The abdominal radiation caused some structural changes in rat ventral prostate. These modifications can be partially prevented by oral supplementation with L-glutamine and L-arginine.

Escherichia coli pode causar infecção intestinal e extra-intestinal, de origem comunitária ou hospitalar, prevalecendo como agente de infecção do trato urinário (ITU). O objetivo do presente estudo foi caracterizar a produção de <font face=\"Symbol\">b-lactamases de espectro estendido (ESBL), grupos filogenéticos, e a relação clonal em isolados clínicos de E. coli recuperados de pacientes ambulatoriais e internados atendidos em um Hospital Universitário de São Paulo, no período de 2005 a 2007. Seis por cento (34/562) dos isolados de E. coli estudados foram caracterizados como produtores de ESBL, sendo associados exclusivamente a infecções extra-intestinais, tanto nos pacientes ambulatoriais (10/28, 36%) como nos internados (18/28, 64%), dos quais 56% (19/34) foram recuperados de uroculturas. Os isolados produtores de ESBL exibiram um fenótipo multirresistente apresentando um perfil de resistência a ampicilina (100%), cefalotina (100%), cefotaxima (100%), ceftazidima (79%), sulfametoxazol-trimetoprim (62%), gentamicina (56%), ciprofloxacina (50%) e amicacina (6%) e permanecendo suscetíveis ao imipinem. A produção de ESBL esteve associada com a presença de genes do tipo blaCTX-M-2 (94%, 32/34), blaCTX-M-15 (3%, 01/34) e blaCTX-M-1 (3%, 01/34). Entre os isolados produtores de ESBL, os grupos filogenéticos B1 (53%, 18/34) e A (18%, 6/34), de baixa virulência, foram predominantes sobre os grupos filogenéticos, de alta virulência, B2 (12%, 4/34) e D (18%, 6/34). De fato, os genes de virulência pap, cnf1, sfa, hly, e iuc, associados com adesão, invasão e disseminação, não foram identificados. A tipagem genotípica por PFGE (utilizando a enzima Xbal) com posterior análise em dendrograma, identificou a presença de 31 clusters entre os 34 isolados produtores de ESBL. Em resumo, a alta incidência de isolados clonalmente não relacionados, pertencentes aos grupos filogenéticos A e B1, de baixa virulência, sugere que cepas comensais de E. coli podem adquirir genes de resistência do tipo blaCTX-M por transferência horizontal contribuindo no estabelecimento e no prognóstico de infecções extra-intestinais, principalmente do trato urinário. / Escherichia coli can produce both intestinal and extraintestinal community- or nosocomial-acquired infection, being the main agent of urinary tract infection (UTI). The aim of this study was to characterize the extended-spectrum beta-lactamase (ESBL) production, phylogenetic groups, and clonal relationship among E. coli clinical isolates recovered from inpatients and outpatients admmited at a university hospital in São Paulo. During 2005 to 2007, six percents (34/562) E. coli isolates were characterized as ESBL producers, being associated exclusively to extraintestinal infections in both inpatients (10/28, 36%) and outpatients (18/28, 64%), of which 56% (19/34) were recovered from urine cultures. ESBL-producing E. coli exhibited a multidrug-resistant phenotype with a resistance profile to ampicillin (100%), cephalotin (100%), cefotaxime (100%), ceftazidime (79%), sulphamethoxazole-trimethoprim (62%), gentamicin (56%), ciprofloxacin (50%), and amikacin (6%), and remaining susceptible to imipenem. In this regard, ESBL production was associated with the presence of blaCTX-M-2 (94%, 32/34), blaCTX-M-15 (3%,1/34) and blaCTX-M-1 (94%, 32/34) genes. On the other hand, low-virulence phylogenetic groups B1 (53%, 18/34) and A (18%, 6/34) were predominant over high-virulence phylogenetic groups B2 (12%, 4/34) and D (18%, 6/34), among ESBL-producing E. coli isolates studied. In fact, pap, cnf1, sfa, hly, and iuc virulence genes associated with adhesion, invasion and dissemination were not identified. Finally, genotyping by PFGE (using XbaI restriction) with subsequent cluster analysis (dendrogram) revealed the presence of 31 cluster among 34 ESBL-producing E. coli. In summary, the high prevalence of clonally unrelated ESBL-producing E. coli belonging to low-virulence phylogenetic groups A and B1 suggest that comensal E. coli can acquire blaCTX-M-like resistance genes through horizontal gene tranfer, contributing to the establishment and outcome of extraintestinal infections, mainly in the urinary tract.

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2016-07-13T19:34:20Z No. of bitstreams: 2 Dissertação - Liana da Silva Gomes - 2016.pdf: 2370951 bytes, checksum: 095accbdb536c0767a23abc7d237e045 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-07-14T13:35:50Z (GMT) No. of bitstreams: 2 Dissertação - Liana da Silva Gomes - 2016.pdf: 2370951 bytes, checksum: 095accbdb536c0767a23abc7d237e045 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-07-14T13:35:50Z (GMT). No. of bitstreams: 2 Dissertação - Liana da Silva Gomes - 2016.pdf: 2370951 bytes, checksum: 095accbdb536c0767a23abc7d237e045 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Normal prostate development is highly dependent of an equilibrated hormonal regulation, so that sensible interferences during this period may predispose the gland to lesions during ageing. Industrial activities have increased the exposure of this gland to active elements found in environment. Within these elements, we find aluminum, the first metal being and the third chemical element more abundant in earth crust. Independently from the complex form in which it can be found, it presents toxic effect for living beings having the potential to disrupt the development and growth of several organs and systems, when ingested in high doses. However, little scientific evidence shows the effects of exposure in the reproductive system. Therefore, the aim of this study was to evaluate whether the intrauterine exposure to aluminum chloride (AlCl3) may alter the male and female ventral prostate of neonatal and adult gerbil. Two groups where formed: control and AlCl3. The pregnant females received daily doses of AlCl3 (100 mg/Kg/day) or from the dilution vehicle, from 17th to 24th gestational day. Following the birth, males and females were separated and euthanized with 1 (PN1) and 90-days-old (PN90). The ventral prostates of male and females of the experimental groups were removed and collected, and later, structural, cytochemical and immunohistochemical analysis were conducted. Furthermore, the branching pattern of the prostate in one day-old animals was described by three dimensional reconstruction. Here, we demonstrate that the Al decreases the body weight of PN1 males and females, and also reduce the anogenital distance (AGD) of PN1 females. Moreover, Al changed the prostate developmental patterns of PN1 animals, causing an increase in proliferative status and decreasing androgen receptor (AR) immunomarking. These data suggests that the aluminum-promoted changes were permanent, since these differences in AR immunomarking were also observed either in adult females or males. Therefore, we reveal that the Al acts as an endocrine-disrupting chemical, changing the antiandrogenic activity of prostate epithelial and stromal cells. / desenvolvimento prostático, desde a etapa pré-natal até a puberdade, é controlado por ações hormonais de forma que sensíveis intervenções ambientais durante estes períodos podem predispor a glândula a desenvolver lesões durante a vida senil. Com o avanço da industrialização, tem sido cada vez maior a exposição aos elementos ativos no meio ambiente. Entre esses elementos, temos o alumínio (Al), sendo o primeiro metal e o terceiro elemento químico em massa mais abundante na crosta terrestre. Independente da forma complexada que pode vir a ser encontrado, ele apresenta um efeito tóxico significativo no ser humano que podendo causar alterações no crescimento e no desenvolvimento de sistemas distintos, quando ingerido em altas doses. Porém, poucas evidências científicas demonstram os efeitos da exposição no sistema reprodutor. Assim, o objetivo desta pesquisa foi avaliar se a exposição intrauterina ao cloreto de alumínio (AlCl3) pode alterar a próstata ventral masculina e feminina de gerbilos neonatos e adultos. Foram formados dois grupos: controle e AlCl3. As fêmeas grávidas receberam doses diárias de AlCl3 (100 mg/Kg/dia) ou do veículo de diluição (solução salina 0,9%), do dia 17 a 24 de gestação. Após nascimento, os machos e fêmeas foram separados e eutanaziados com um dia (PN1) e noventa dias (PN90) de idade. As próstatas ventrais dos machos e fêmeas dos grupos experimentais foram removidas e coletadas, e posteriormente, foram realizadas análises estruturais, citoquímicas e imunohistoquímicas. Além disso, o padrão de ramificação da próstata nos animais de um dia de idade foi descrito mediante reconstrução tridimensional (3D). Os resultados demonstraram que a exposição ao Al diminuiu o peso corpóreo das fêmeas e machos PN1, e reduziu a distância anogenital das fêmeas PN1. Além disso, o Al alterou o padrão de desenvolvimento prostático de machos e fêmeas PN1, tornando estas glândulas mais proliferativas e com reduzida imunomarcação para AR. As alterações promovidas pela exposição ao Al parecem ser permanentes, visto que modificações na expressão de receptores hormonais e altos índices de proliferação celular também são observados nas fêmeas e machos adultos. Estes dados indicam que o Al agiu como um desregulador endócrino sobre a próstata, exercendo atividade antiandrogênica sobre as células epiteliais e estromais prostáticas.

Escherichia coli pode causar infecção intestinal e extra-intestinal, de origem comunitária ou hospitalar, prevalecendo como agente de infecção do trato urinário (ITU). O objetivo do presente estudo foi caracterizar a produção de <font face=\"Symbol\">b-lactamases de espectro estendido (ESBL), grupos filogenéticos, e a relação clonal em isolados clínicos de E. coli recuperados de pacientes ambulatoriais e internados atendidos em um Hospital Universitário de São Paulo, no período de 2005 a 2007. Seis por cento (34/562) dos isolados de E. coli estudados foram caracterizados como produtores de ESBL, sendo associados exclusivamente a infecções extra-intestinais, tanto nos pacientes ambulatoriais (10/28, 36%) como nos internados (18/28, 64%), dos quais 56% (19/34) foram recuperados de uroculturas. Os isolados produtores de ESBL exibiram um fenótipo multirresistente apresentando um perfil de resistência a ampicilina (100%), cefalotina (100%), cefotaxima (100%), ceftazidima (79%), sulfametoxazol-trimetoprim (62%), gentamicina (56%), ciprofloxacina (50%) e amicacina (6%) e permanecendo suscetíveis ao imipinem. A produção de ESBL esteve associada com a presença de genes do tipo blaCTX-M-2 (94%, 32/34), blaCTX-M-15 (3%, 01/34) e blaCTX-M-1 (3%, 01/34). Entre os isolados produtores de ESBL, os grupos filogenéticos B1 (53%, 18/34) e A (18%, 6/34), de baixa virulência, foram predominantes sobre os grupos filogenéticos, de alta virulência, B2 (12%, 4/34) e D (18%, 6/34). De fato, os genes de virulência pap, cnf1, sfa, hly, e iuc, associados com adesão, invasão e disseminação, não foram identificados. A tipagem genotípica por PFGE (utilizando a enzima Xbal) com posterior análise em dendrograma, identificou a presença de 31 clusters entre os 34 isolados produtores de ESBL. Em resumo, a alta incidência de isolados clonalmente não relacionados, pertencentes aos grupos filogenéticos A e B1, de baixa virulência, sugere que cepas comensais de E. coli podem adquirir genes de resistência do tipo blaCTX-M por transferência horizontal contribuindo no estabelecimento e no prognóstico de infecções extra-intestinais, principalmente do trato urinário. / Escherichia coli can produce both intestinal and extraintestinal community- or nosocomial-acquired infection, being the main agent of urinary tract infection (UTI). The aim of this study was to characterize the extended-spectrum beta-lactamase (ESBL) production, phylogenetic groups, and clonal relationship among E. coli clinical isolates recovered from inpatients and outpatients admmited at a university hospital in São Paulo. During 2005 to 2007, six percents (34/562) E. coli isolates were characterized as ESBL producers, being associated exclusively to extraintestinal infections in both inpatients (10/28, 36%) and outpatients (18/28, 64%), of which 56% (19/34) were recovered from urine cultures. ESBL-producing E. coli exhibited a multidrug-resistant phenotype with a resistance profile to ampicillin (100%), cephalotin (100%), cefotaxime (100%), ceftazidime (79%), sulphamethoxazole-trimethoprim (62%), gentamicin (56%), ciprofloxacin (50%), and amikacin (6%), and remaining susceptible to imipenem. In this regard, ESBL production was associated with the presence of blaCTX-M-2 (94%, 32/34), blaCTX-M-15 (3%,1/34) and blaCTX-M-1 (94%, 32/34) genes. On the other hand, low-virulence phylogenetic groups B1 (53%, 18/34) and A (18%, 6/34) were predominant over high-virulence phylogenetic groups B2 (12%, 4/34) and D (18%, 6/34), among ESBL-producing E. coli isolates studied. In fact, pap, cnf1, sfa, hly, and iuc virulence genes associated with adhesion, invasion and dissemination were not identified. Finally, genotyping by PFGE (using XbaI restriction) with subsequent cluster analysis (dendrogram) revealed the presence of 31 cluster among 34 ESBL-producing E. coli. In summary, the high prevalence of clonally unrelated ESBL-producing E. coli belonging to low-virulence phylogenetic groups A and B1 suggest that comensal E. coli can acquire blaCTX-M-like resistance genes through horizontal gene tranfer, contributing to the establishment and outcome of extraintestinal infections, mainly in the urinary tract.

Background Female stress urinary incontinence (SUI) greatly affects quality of life. The midurethal sling (MUS) procedure has been widely accepted as the standard of care treatment for SUI, although there is little information regarding patients' subjective reports of symptom improvement. Objectives The objective of this study was to identify clinical and demographic characteristics that predict subjective symptom improvement following MUS procedures in women with SUI. Materials and Methods The study design was retrospective cohort. Subjects included women who underwent MUS between 2006 and 2008, returned mailed surveys and met our predefined inclusion criteria. Pre-operative data included demographics, prior surgery, co-morbid diseases, urodynamics and concomitant reconstructive surgery. Subjective improvement was measured by score improvement on the UIQ-7, UDI-6, the UDI stress subscale and Question 3 of the UDI, "Do you experience urine leakage related to physical activity, coughing, or sneezing?" Results The mean age of the study sample was 57 years, parity was 2.5 and BMI was 28. Subjects with lower MUCP demonstrated more improvement on the UIQ-7. ΔUDI-6 stress subscale scores were more sensitive to symptom change than either the ΔUDI-6 or ΔUIQ-7. Older, menopausal subjects with urethral hypermobility and concomitant vaginal suspension showed less improvement than subjects without these characteristics. After controlling for urethral straining angle, PVR, menopause and time out from surgery, older age and concomitant vaginal suspension were associated with persistent post-op symptoms on the UDI-6 Question 3 and age remained the only variable associated with persistent symptoms on the UDI-6 stress subscale. Conclusion Concurrent vaginal suspension and advancing age were risk factors for persistent symptoms following MUS procedures in patients with SUI. Symptoms may recur after 24 post-operative months. Clinicians are encouraged to provide additional preoperative counseling to those women who are at greatest risk for persistent symptoms.