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1.
Measles, mumps and rubella vaccine 12 months after hematopoietic stem cell transplantation
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Randi, Bruno Azevedo
; Fernandes, Eder Gatti
; Higashino, Hermes Ryoiti
; Lopes, Marta Heloisa
; Rocha, Vanderson Geraldo
; Costa, Silvia Figueiredo
; Sartori, Ana Marli Christovam
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
ABSTRACT The measles, mumps and rubella (MMR) vaccine is usually recommended from 24 months after a hematopoietic stem cell transplant (HSCT). Some authors have demonstrated that the MMR vaccination can be safe from 12 months post-HSCT in non-immunosuppressed patients, as recommended by the Brazilian National Immunization Program/Ministry of Health, since 2006. The objectives of this study were to evaluate when patients received MMR vaccine after an HSCT in our care service and if there were reports of any side effects. We retrospectively reviewed the records of HSCT recipients who received at least one MMR dose in our care service, a quaternary teaching hospital in Sao Paulo city, Brazil, from 2017 to 2021. We identified 82 patients: 75.6% (90.1% in the autologous group and 45.1% in the allogeneic group) were vaccinated before 23 months post-transplantation. None reported side effects following the vaccination. Our data support that the MMR vaccination is safe from 12 to 23 months after HSCT.
2.
Streptococcus constellatus causing concomitant extra and intracranial abscesses complicated with sagittal sinus thrombosis
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Farias, Luís Arthur Brasil Gadelha
; Firmino, Natália Nogueira
; Sousa, Marcos Maciel
; Lira, Mateus Lavor
; Meireles, Leonardo Nogueira
; Stolp, Ângela Maria Veras
; Maia, Kelma Maria
; Costa, Silvia Figueiredo
; Perdigão Neto, Lauro Vieira
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
ABSTRACT Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more commonly in the gastrointestinal tract, lungs, and heart. Brain abscesses are severe neurological infections with high mortality rates. Streptococcus species other than S. pneumoniae are rare causes of brain abscesses. This case report highlights a severe case of extra and intracranial abscesses due to S. constellatus in an immunocompetent host
3.
Multidisciplinary Scientific Cruises for Environmental Characterization in the Santos Basin – Methods and Sampling Design
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Moreira, Daniel L.
; Dalto, Adriana G.
; Figueiredo JR, Alberto G.
; Valerio, Aline M.
; Detoni, Amalia M. S.
; Bonecker, Ana C. T.
; Signori, Camila N.
; Namiki, Cláudia
; Sasaki, Dalton K.
; Pupo, Daniel V.
; Silva, Danilo A.
; Kutner, Deborah S.
; Duque-Castaño, Diana C.
; Marcon, Eduardo H.
; Gallotta, Fabiana D. C.
; Paula, Fabiana S.
; Gallucci, Fabiane
; Roque, Gabriela C. F.
; Campos, Giulia S.
; Fonseca, Gustavo
; Mattos, Gustavo
; Lavrado, Helena P.
; Silveira, Ilson C. A. da
; Costa, Jessica O.
; Santos Filho, João R. dos
; Carneiro, Juliane C.
; Moreira, Julio C.F.
; Rozo, Laura
; Araujo, Leandro F.M.
; Lazzari, Letícia
; Silva, Letícia O. da
; Michelazzo, Luan S.
; Fernandes, Luciano F.
; Dottori, Marcelo
; Araújo Jr., Marcus A. G. de
; Chuqui, Mateus G.
; Ceccopieri, Milena
; Borges-Silva, Milton
; Kampel, Milton
; Bergo, Natascha M.
; Silva, Paulo V. M.
; Tura, Pedro M.
; Moura, Rafael B. de
; Romano, Renato G.
; Martins, Renato P.
; Carreira, Renato S.
; Toledo, Rodrigo G.A.
; Bonecker, Sérgio L.C.
; Disaró, Sibelle T.
; Rodrigues, Silvana V.
; Corbisier, Thais N.
; Vicente, Thaisa M.
; Paiva, Vitor G. de
; Pellizari, Vivian H.
; Belo, Wellington C.
; Brandini, Frederico P.
; Sousa, Silvia H.M
.
Abstract The Santos Basin (SB) is the main petroliferous basin in the Brazilian continental margin and one of the most studied marine areas in Brazil. However, historical data suggest that new efforts should be carried out to acquire quantitative biological data, especially in the deep sea, to establish the baseline of essential ocean variables in different ecosystems for future monitoring programs. The Brazilian energy company Petrobras planned and executed 24 oceanographic cruises over a period of 2 years to assess the benthic (SANSED cruise) and pelagic (SANAGU cruise) systems of the SB (356 days at sea in 2019 and 2021/2022). These efforts were part of the Santos Project, which comprised a comprehensive environmental study aimed at investigating benthic and pelagic variables to characterize ecology, biogeochemistry, thermohaline properties of water masses, and ocean circulation patterns, geomorphology, and sedimentology, as well as organic and inorganic chemistry. Here we present the detailed sampling designs and the field methods employed on board, during the SB scientific cruises. All sampling protocols were based on standardized approaches. For the benthos analyses, triplicate sediment samples were performed using a GOMEX-type box corer (0.25 m²) or a large modified Van Veen grab (0.75 m²) at 100 stations ranging from 25 to 2400 m depth. At each station, 25 geochemical and physico-chemical parameters were analyzed in addition to micro-, meio-, and macrofauna and living foraminifera samples. For the pelagic system, 60 stations were selected to investigate the plankton community, ranging in size from pico- to macroplankton, through vertical, horizontal, and oblique net hauls (20, 200, and 500 μm mesh size), as well as 25 biogeochemical parameters collected with an aid of a CTD-rosette sampler. Part of this scientific information also serves the Regional Environmental Characterization Project (PCR-BS) in support of Petrobras’ Santos Basin drilling licensing process led by the Brazilian Environmental Agency – IBAMA. This project contributes to the sustainable development of the SB, in line with the guidelines of the United Nations Decade of Ocean Science for Sustainable Development.
4.
Fatores individuais e contextuais associados ao tabagismo em adultos jovens brasileiros
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Morais, Évelin Angélica Herculano de
; Oliveira, Bárbara Emiliano de
; Roesberg, Joana Motta Araújo
; Souza, Priscila Silvia Nunes
; Souza, Raissa Naytiara Barbosa de
; Costa, Saraid Figueiredo
; Marques, Vitória da Silva
; Abreu, Mery Natali Silva
.
Resumo Aos jovens é atribuída especial atenção no que tange ao tabagismo por se tratar de um período da vida em que o uso dessa e outras substâncias geralmente inicia e se consolida. Não há estudos sobre fatores de risco associados aos adultos jovens, com amostra representativa do Brasil e que consideram aspectos individuais e contextuais. O objetivo foi identificar fatores associados ao tabagismo em adultos jovens brasileiros de 18 a 24 anos, considerando a influência conjunta de fatores individuais e contextual avaliado por meio do Índice de Desenvolvimento Humano Municipal (IDHM). Estudo transversal, de base populacional, que utilizou dados da Pesquisa Nacional de Saúde de 2019. Por meio do modelo multinível de Poisson com variâncias robustas para estimação da Razão de Prevalência, foram analisadas variáveis individuais, e como variável contextual, o IDHM em cada Unidade Federativa. Além de fatores individuais, o IDHM também se mostrou associado ao tabagismo dos jovens, com aumento da prevalência de consumo de tabaco entre os jovens à medida que se aumenta o IDHM do estado (p<0,001), indicando que residir em UF com melhores condições socioeconômicas segundo o IDHM está associado a maior probabilidade de o jovem fumar se comparados com aqueles que residem nos demais estados.
Abstract Young people receive special attention regarding smoking as it is a period of life in which the use of this and other substances generally starts and is consolidated. There are no studies on risk factors associated with young adults with a representative sample from Brazil that take into consideration individual and contextual aspects. The objective was to identify factors associated with smoking among young Brazilian adults aged 18 to 24 years, considering the combined influence of individual and contextual factors assessed through the Municipal Human Development Index (MHDI). It involved a cross-sectional, population-based study that used data from the 2019 National Health Survey. Using the Poisson multilevel model with robust variance for estimating the Prevalence Ratio, individual variables were analyzed, and the MHDI as a contextual variable in each Federative Unit. In addition to individual factors, the MHDI was also associated with smoking among young people, with an increase in the prevalence of tobacco consumption among young people as the state’s MHDI increases (p<0.001), indicating that living in a state with better conditions according to the MHDI, socioeconomic status is associated with a higher probability of young people smoking when compared to those residing in other states.
5.
Fatores individuais e contextuais associados ao tabagismo em adultos jovens brasileiros
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Morais, Évelin Angélica Herculano de
; Oliveira, Bárbara Emiliano de
; Roesberg, Joana Motta Araújo
; Souza, Priscila Silvia Nunes
; Souza, Raissa Naytiara Barbosa de
; Costa, Saraid Figueiredo
; Marques, Vitória da Silva
; Abreu, Mery Natali Silva
.
Resumo Aos jovens é atribuída especial atenção no que tange ao tabagismo por se tratar de um período da vida em que o uso dessa e outras substâncias geralmente inicia e se consolida. Não há estudos sobre fatores de risco associados aos adultos jovens, com amostra representativa do Brasil e que consideram aspectos individuais e contextuais. O objetivo foi identificar fatores associados ao tabagismo em adultos jovens brasileiros de 18 a 24 anos, considerando a influência conjunta de fatores individuais e contextual avaliado por meio do Índice de Desenvolvimento Humano Municipal (IDHM). Estudo transversal, de base populacional, que utilizou dados da Pesquisa Nacional de Saúde de 2019. Por meio do modelo multinível de Poisson com variâncias robustas para estimação da Razão de Prevalência, foram analisadas variáveis individuais, e como variável contextual, o IDHM em cada Unidade Federativa. Além de fatores individuais, o IDHM também se mostrou associado ao tabagismo dos jovens, com aumento da prevalência de consumo de tabaco entre os jovens à medida que se aumenta o IDHM do estado (p<0,001), indicando que residir em UF com melhores condições socioeconômicas segundo o IDHM está associado a maior probabilidade de o jovem fumar se comparados com aqueles que residem nos demais estados.
Abstract Young people receive special attention regarding smoking as it is a period of life in which the use of this and other substances generally starts and is consolidated. There are no studies on risk factors associated with young adults with a representative sample from Brazil that take into consideration individual and contextual aspects. The objective was to identify factors associated with smoking among young Brazilian adults aged 18 to 24 years, considering the combined influence of individual and contextual factors assessed through the Municipal Human Development Index (MHDI). It involved a cross-sectional, population-based study that used data from the 2019 National Health Survey. Using the Poisson multilevel model with robust variance for estimating the Prevalence Ratio, individual variables were analyzed, and the MHDI as a contextual variable in each Federative Unit. In addition to individual factors, the MHDI was also associated with smoking among young people, with an increase in the prevalence of tobacco consumption among young people as the state’s MHDI increases (p<0.001), indicating that living in a state with better conditions according to the MHDI, socioeconomic status is associated with a higher probability of young people smoking when compared to those residing in other states.
6.
Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites
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Farias, Luís Arthur Brasil Gadelha
; Stolp, Ângela Maria Veras
; Bandeira, Silviane Praciano
; Mesquita, Rafael Ferreira
; Bessa, Pedro Pinheiro de Negreiros
; Holanda, Pablo Eliack Linhares de
; Costa, Silvia Figueiredo
; Takeda, Christianne Fernandes Valente
; Perdigão Neto, Lauro Vieira
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
ABSTRACT Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs’ and cats’ mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski’s sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.
7.
COVID-19 and isolation: Risks and implications in the scenario of new variants
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Dias, Viviane Maria de Carvalho Hessel
; Oliveira, Alexandre Ferreira
; Marinho, Ana Karolina Barreto Berselli
; Santos Ferreira, Carlos Eduardo dos
; Domingues, Carlos Eduardo Ferreira
; Fortaleza, Carlos Magno Castelo Branco
; Vidal, Claudia Fernanda de Lacerda
; Carrilho, Claudia Maria Dantas de Maio
; Pinheiro, Debora Otero Britto Passos
; de Assis, Denise Brandão
; Medeiros, Eduardo Alexandrino
; Morejón, Karen Mirna Loro
; Weissmann, Leonardo
; Michelin, Lessandra
; Carneiro, Marcelo
; Nogueira, Maria Dolores Santos da Purificação
; de Oliveira, Priscila Rosalba Domingos
; Buralli, Rafael Junqueira
; Stucchi, Raquel Silveira Bello
; Lins, Rodrigo Schrage
; Costa, Silvia Figueiredo
; Chebabo, Alberto
.
Abstract With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.
8.
Evaluation of eleven immunochromatographic assays for SARS-CoV-2 detection: investigating the dengue cross-reaction
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Oliveira, Beatriz Araujo
; Oliveira, Lea Campos de
; Oliveira, Franciane Mendes de
; Pereira, Geovana Maria
; Souza, Regina Maia de
; Manuli, Erika Regina
; Marchini, Fabricio Klerynton
; Espinoza, Evelyn Patrícia Sanchez
; Park, Marcelo
; Taniguchi, Leandro
; Mendes, Pedro Vitale
; Franco, Lucas Augusto Moyses
; Nastri, Ana Catharina
; Oliveira, Maura Salaroli de
; Vieira Junior, José Mauro
; Kallas, Esper Georges
; Levin, Anna Sara
; Sabino, Ester Cerdeira
; Costa, Silvia Figueiredo
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
ABSTRACT COVID-19 disease is spread worldwide and diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and a low-cost alternative especially in low and middle-income countries, which lack structure to perform certain diagnostic techniques. Here we evaluate the sensitivity and specificity of eleven different IC tests in 145 serum samples from confirmed cases of COVID-19 using RT-PCR and 100 negative serum samples from blood donors collected in February 2019. We also evaluated the cross-reactivity with dengue using 20 serum samples from patients with confirmed diagnosis for dengue collected in early 2019 through four different tests. We found high sensitivity (92%), specificity (100%) and an almost perfect agreement (Kappa 0.92) of IC assay, especially when we evaluated IgG and IgM combined after 10 days from the onset of symptoms with RT-PCR. However, we detected cross-reactivity between dengue and COVID-19 mainly with IgM antibodies (5 to 20% of cross-reaction) and demonstrated the need for better studies about diagnostic techniques for these diseases.
9.
MRSA outbreak in a Neonatal Intensive Care Unit in a developed country: importance of rapid detection of reservoirs and implementation of intervention measures
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Moura, Maria Luísa
; Rizek, Camila Fonseca
; Aguiar, Elisa
; Barros, Ana Natiele da Silva
; Costa, Sibeli
; Santos, Sania Alves dos
; Marchi, Ana Paula
; Gibelli, Maria Augusta Bento Cicaroni
; Tragante, Carla Regina
; Araújo, Maria Rita Elmor de
; Rossi, Flavia
; Guimaraes, Thais
; Costa, Silvia Figueiredo
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
ABSTRACT We described a MRSA bloodstream infection outbreak that was rapidly identified and controlled in a Neonatal Intensive Care Unit after implementation of a bundle of measures, including PCR-screening and HCW decolonization. We found 35% of healthcare workers(HCW) colonized with S. aureus by PCR, one of them that presented skin lesion positive for MSSA (same clone and spa type than two patients). Our findings raise the hypothesis that the outbreak could be related to HCW colonization.
10.
Conforto Térmico em trabalhadores de aviários
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Ferreira, Ana
; Simões, Hélder
; Figueiredo, João Paulo
; Paixão, Susana
; Costa, Lúcia Simões
; Seco, Sílvia
; Loureiro, António
.
Resumen Marco contextual: como puede haber vulnerabilidad de los trabajadores avícolas a las temperaturas dentro de los aviarios en comparación con las del exterior, es importante analizar su exposición ocupacional en relación al confort térmico. Objetivos: evaluar el confort térmico en trabajadores del sector avícola en ambientes interiores y exteriores y analizar su posible relación con la etapa de desarrollo del pollo. Metodología: el estudio realizado fue observacional, transversal, con una muestra de conveniencia de 6 trabajadores de 8 aviarios. La recogida de datos se realizó mediante un cuestionario dirigido a todos los trabajadores seguido de la medición de los valores de Predicted Mean Vote (PMV) y Predicted Percentage of Dissatisfied (PPD). Resultados: en aviarios de pollos de 8 días hubo una concordancia total entre los valores de PMV y PPD, en 35 días una concordancia significativa y en 85 días una concordancia considerable. Conclusión: existe malestar térmico en los trabajadores evaluados, especialmente aquellos que laboran en aviarios para pollos con 8 y 35 días de edad. El malestar térmico fue peor en los aviarios de pollos de 8 días, revelando así la relación entre el índice de confort térmico y la etapa de desarrollo del pollo.
Resumo Enquadramento: podendo existir vulnerabilidade dos trabalhadores avícolas face às temperaturas do interior dos aviários em comparação com as do exterior é importante analisar a sua exposição ocupacional em termos de conforto térmico. Objetivos: avaliar o conforto térmico em trabalhadores do setor avícola no ambiente interior e exterior dos aviários e analisar a sua possível relação com a fase de desenvolvimento do frango. Metodologia: o estudo efetuado foi observacional, transversal, com uma amostra por conveniência de 6 trabalhadores de 8 aviários. A recolha de dados foi realizada através de um questionário dirigido a todos os trabalhadores seguida da medição dos valores de Predicted Mean Vote (PMV) e Predicted Percentage of Dissatisfied (PPD). Resultados: em aviários de frangos com 8 dias de idade verificou-se uma total concordância entre os valores de PMV e PPD, nos de 35 dias uma concordância significativa e nos de 85 dias uma considerável concordância. Conclusão: existe desconforto térmico nos trabalhadores avaliados, especialmente nos que trabalham em aviários para frangos com 8 e 35 dias de idade. O desconforto térmico foi pior nos aviários de frangos com 8 dias, revelando assim a relação entre o índice de conforto térmico e a fase de desenvolvimento do frango.
Abstract Background: as there may be vulnerability of poultry workers to the temperatures inside the aviaries compared to those outside, it is important to analyze their occupational exposure in terms of thermal comfort. Objectives: evaluate the thermal comfort in poultry sector workers in indoor and outdoor environments and analyze its possible relationship with the chicken developmental stage. Methodology: the study carried out was observational, cross-sectional, with a convenience sample of 6 workers from 8 aviaries. Data collection was carried out through a questionnaire addressed to all workers followed by the measurement of Predicted Mean Vote (PMV) and Predicted Percentage of Dissatisfied (PPD). Results: in 8-day-old chicken aviaries there was a complete agreement between the values of PMV and PPD, in the 35-day-old aviaries a significant agreement and in the 85-day-old a considerable agreement. Conclusion: there is thermal discomfort in the assessed workers, especially in those who work in aviaries for chickens with 8 and 35 days of age. Thermal discomfort was worse in 8-day-old chicken aviaries, thus revealing the relationship between the thermal comfort index and the chicken development stage.
https://doi.org/10.37914/riis.v4i1.145
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11.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
12.
Effectiveness of surveillance cultures for high priority multidrug-resistant bacteria in hematopoietic stem cell transplant units
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Mendes, Elisa Teixeira
; Salomão, Matias Chiarastelli
; Tomichi, Lísia Moura
; Oliveira, Maura Salaroli
; Graça, Mariana
; Rossi, Flavia
; Sapadao, Fernanda
; Guimarães, Thais
; Rocha, Vanderson
; Costa, Silvia Figueiredo
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
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.
https://doi.org/10.1590/s1678-9946202163077
50 downloads
13.
Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
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Bocchi, Edimar Alcides
; Moreira, Henrique Turin
; Nakamuta, Juliana Sanajotti
; Simões, Marcus Vinicius
; Casas, Alberto de Almeida Las
; Costa, Altamiro Reis da
; Assis, Amberson Vieira de
; Durães, André Rodrigues
; Pereira-Barretto, Antonio Carlos
; Ravessa, Antonio Delduque de Araujo
; Macedo, Ariane Vieira Scarlatelli
; Biselli, Bruno
; Pinto, Carolina Maria Nogueira
; Filho, Conrado Roberto Hoffmann
; Costantini, Costantino Roberto
; Almeida, Dirceu Rodrigues
; Santos Jr, Edval Gomes dos
; Soliva Junior, Erwin
; Figueiredo, Estevão Lanna
; Albuquerque, Felipe Neves de
; Paulitsch, Felipe
; Neuenschwander, Fernando Carvalho
; Figueiredo Neto, José Albuquerque de
; Brito, Flavio de Souza
; Lopes, Heno Ferreira
; Villacorta, Humberto
; Souza Neto, João David de
; Sepulveda, João Mariano
; Ayoub, José Carlos Aidar
; Vilela-Martin, José F.
; Cardoso, Juliano Novaes
; Uemura, Laercio
; Moura, Lidia Zytynski
; Maia, Lilia Nigro
; Oliveira, Lucia Brandão de
; Maia, Lucimir
; Silva, Luís Beck da
; Gowdak, Luís Henrique Wolff
; Danzmann, Luiz Claudio
; Andrade, Marcus
; Braile-Sternieri, Maria Christiane Valeria Braga
; Moreira, Maria da Consolação Vieira
; França Neto, Olimpio R
; Filho, Otavio Rizzi Coelho
; Esteves, Paulo Frederico
; Raupp-da-Rosa, Priscila
; Silva, Ricardo Jorge de Queiroz e
; Mourilhe-Rocha, Ricardo
; Viégas, Ruy Felipe Melo
; Rassi, Salvador
; Mangili, Sandrigo
; Kaiser, Sergio Emanuel
; Martins, Silvia Marinho
; Kawabata, Vitor Sergio
.
OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.
https://doi.org/10.6061/clinics/2021/e1991
870 downloads
14.
Colistin-resistant Escherichia coli belonging to different sequence types: genetic characterization of isolates responsible for colonization, community- and healthcare-acquired infections
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Paiva, Yrving
; Nagano, Debora Satie
; Cotia, Andre Luis Franco
; Guimarães, Thais
; Martins, Roberta Cristina Ruedas
; Perdigão Neto, Lauro Vieira
; Côrtes, Marina Farrel
; Marchi, Ana Paula
; Corscadden, Louise
; Machado, Anna Silva
; Paula, Alexandre Inácio de
; Franco, Lucas Augusto Moyses
; Neves, Patricia Regina
; Levin, Anna Sara
; Costa, Silvia Figueiredo
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
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.
https://doi.org/10.1590/s1678-9946202163038
332 downloads
15.
Are mobile phones part of the chain of transmission of SARS-CoV-2 in hospital settings?
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Espinoza, Evelyn Patricia Sánchez
; Cortes, Marina Farrel
; Noguera, Saidy Vasconez
; Paula, Anderson Vicente de
; Guimarães, Thais
; Boas, Lucy Santos Villas
; Park, Marcelo
; Silva, Cristina Carvalho da
; Morales, Ingra
; Perdigão Neto, Lauro Vieira
; Tozetto-Mendoza, Tania Regina
; Boszczowski, Icaro
; Sabino, Ester Cerdeira
; Mendes-Correa, Maria Cássia
; Levin, Anna Sara
; Costa, Silvia Figueiredo
.
Revista do Instituto de Medicina Tropical de São Paulo
- Journal Metrics
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.
https://doi.org/10.1590/s1678-9946202163074
177 downloads
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