Um estudo retrospectivo dos achados histopatológicos em 894 casos de megacólon: qual é a relação entre megacólon e o câncer de cólon?

Patients with megaesophagus (ME) have increased prevalence of cancer of the esophagus. In contrast, a higher incidence of colorectal cancer is not observed in patients with megacolon (MC). MC is very common in some regions of Brazil, where it is mainly associated with Chagas disease. We reviewed the pathology records of surgical specimens of all patients submitted for surgical resection of MC in the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto (HC-FMRP), from the University of São Paulo. We found that 894 patients were operated from 1952 until 2001 for MC resection. Mucosal ulcers, hyperplasia and chronic inflammation were frequently found, while polyps were uncommon. No patients with MC presented any type of colonic neoplasm. This observation reinforces the hypothesis that MC has a negative association with cancer of the colon. This seems to contradict the traditional concept of carcinogenesis in the colon, since patients with MC presents important chronic constipation that is thought to cause an increase in risk for colon cancer. MC is also associated with other risk factors for cancer of colon, such as hyperplasia, mucosal ulcers and chronic inflammation. In ME these factors lead to a remarkable increase in cancer risk. The study of mucosal cell proliferation in MC may provide new insights and useful information about the role of constipation in colonic carcinogenesis.Pacientes com megaesôfago (ME) possuem incidência aumentada de câncer de esôfago. Em contraste, há poucos relatos na literatura de associação entre megacólon (MC) e câncer de cólon. O MC é muito comum em algumas regiões do Brasil, e na maioria das vezes, está associado à Doença de Chagas. Nós reavaliamos os arquivos de patologia de peças cirúrgicas de todos os pacientes submetidos à ressecção de MC no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HC-FMRP), da Universidade de São Paulo. Encontramos o número de 894 pacientes que foram operados de 1952 até 2001 para a ressecção do MC. Úlceras da mucosa, hiperplasia e inflamação crônica foram frequentemente encontrados, enquanto pólipos foram incomuns. Nenhum paciente com MC apresentou qualquer tipo de neoplasia do cólon. Essa observação reforça a hipótese de que o MC tem uma associação negativa com câncer de cólon. Isso parece contradizer o conceito tradicional de carcinogênese do cólon, uma vez que pacientes com MC apresentam constipação crônica importante, a qual é tida como uma causa que aumenta o risco de câncer de cólon. MC também está associado a outros fatores de risco para o câncer de cólon, como hiperplasia, úlceras da mucosa e inflamação crônica. No megaesôfago (ME), tais fatores aumentam o risco de câncer esofágico. O estudo da proliferação celular da mucosa no MC pode fornecer informações úteis sobre o papel da constipação na carcinogênese colônica

Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features

Background: Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients.Methods: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (<= 16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project).Results: in our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (<= 16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. the most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). the crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). the most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem.Conclusions: in our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.Pfizer, Inc.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Inst Oncol Pediat IOP GRAAC, São Paulo, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, São Paulo, BrazilHosp 9 Julho, São Paulo, BrazilSanta Casa Porto Alegre, Porto Alegre, RS, BrazilHosp Conceicao, Porto Alegre, RS, BrazilHosp Base, Brasilia, DF, BrazilHosp Walter Cantidio, Fortaleza, Ceara, BrazilHosp Diadema, São Paulo, BrazilHosp Espanhol, Salvador, BA, BrazilHosp Coracao, Natal, RN, BrazilHosp UNIMED, Natal, RN, BrazilHosp Clin Goiania, Goiania, Go, BrazilHosp Rim & Hipertensao, São Paulo, BrazilUniv Fed Triangulo Mineiro, Uberaba, MG, BrazilVirginia Commonwealth Univ, Richmond, VA USAUniversidade Federal de São Paulo UNIFESP, São Paulo, BrazilFAPESP: 2006/57700-0Web of Scienc

II Diretriz Brasileira de Transplante Cardíaco

Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasIIHospital de Messejana Dr. Carlos Alberto Studart GomesUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaInstituto Dante Pazzanese de CardiologiaUniversidade Federal de Minas Gerais Hospital das ClínicasFaculdade de Medicina de São José do Rio PretoPontifícia Universidade Católica do ParanáIHospital Israelita Albert EinsteinInstituto Nacional de Cardiologia, Fundação Universitária do Rio Grande do Sul Instituto de CardiologiaReal e Benemérita Sociedade de Beneficência Portuguesa, São PauloHospital Pró-Cardíaco do Rio de JaneiroSanta Casa do Rio de JaneiroUNIFESP, EPMSciEL

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure (vol 9, e114548, 2014)

Hosp Univ Austral, Div Infect Dis Prevent & Infect Control Serv, Buenos Aires, DF, ArgentinaHosp Univ Austral, Microbiol Lab, Buenos Aires, DF, ArgentinaMonash Hlth, Monash Infect Dis, Clayton, Vic, AustraliaWollongong Hosp, Wollongong, NSW, AustraliaUniversidade Federal de São Paulo, Div Infect Dis, Lab Especial Microbiol Clin, São Paulo, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilVirginia Commonwealth Univ, Med Ctr, Richmond, VA USAHosp Rim & Hipertensao, São Paulo, BrazilHosp Santa Casa Porto Alegre, Porto Alegre, RS, BrazilHosp Conceicao, Porto Alegre, RS, BrazilHosp Walter Cantidio, Fortaleza, Ceara, BrazilHosp Diadema, São Paulo, BrazilHosp Espanhol, Salvador, BA, BrazilHosp Clin Goiania, Goiania, Go, BrazilMt Sinai Hosp, Toronto, ON M5G 1X5, CanadaUniv Alberta, Div Infect Dis, Edmonton, AB, CanadaCairo Univ Kasr Ainy, Dar Al Fouad Hosp, Fac Med, Dept Clin Pathol, Cairo, EgyptHygeia Gen Hosp, Athens, GreeceUniv Tubingen Hosp, Internal Med, Div Infect Dis, Tubingen, GermanyTokyo Metropolitan Tama Med Ctr, Dept Infect Prevent, Tokyo, JapanAmphia Hosp Breda, Lab Microbiol & Infect Control, Breda, NetherlandsThammasat Univ Hosp, Div Infect Dis, Pathum Thani, ThailandSt John Hosp & Med Ctr, Infect Prevent & Control Dept, Grosse Pointe Woods, MI USAUniv Hosp Bern, Dept Infect Dis, CH-3010 Bern, SwitzerlandUniv Bern, Bern, SwitzerlandBarnes Jewish Hosp, St Louis, MO 63110 USAUniversidade Federal de São Paulo, Div Infect Dis, Lab Especial Microbiol Clin, São Paulo, BrazilWeb of Scienc

Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program

Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed across five regions of Brazil to assess the incidence, species distribution, antifungal susceptibility, and risk factors for bloodstream infections due to Candida species. From June 2007 to March 2010, we studied a total of 2,563 nosocomial bloodstream infection (nBSI) episodes. Candida spp. was the 7th most prevalent agent. Most of the patients were male, with a median age of 56 years. A total of 64 patients (46.7%) were in the ICU when candidemia occurred. Malignancies were the most common underlying condition (32%). The crude mortality rate of candidemia during the hospital admission was 72.2%. Non-albicans species of Candida accounted for 65.7% of the 137 yeast isolates. C. albicans (34.3%), Candida parapsilosis (24.1%), Candida tropicalis (15.3%) and Candida glabrata (10.2%) were the most prevalent species. Only 47 out of 137 Candida isolates were sent to the reference laboratory for antifungal susceptibility testing. All C. albicans, C. tropicalis and C. parapsilosis isolates were susceptible to the 5 antifungal drugs tested. Among 11 C. glabrata isolates, 36% were resistant to fluconazole, and 64% SDD. All of them were susceptible to anidulafungin and amphotericin B. We observed that C. glabrata is emerging as a major player among non-albicans Candida spp. and fluconazole resistance was primarily confined to C. glabrata and C. krusei strains. Candida resistance to echinocandins and amphotericin B remains rare in Brazil. Mortality rates remain increasingly higher than that observed in the Northern Hemisphere countries, emphasizing the need for improving local practices of clinical management of candidemia, including early diagnosis, source control and precise antifungal therapy.Pfizer, Inc.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Univ Fed Sao Paulo, Dept Med, Div Infect Dis, Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Div Med Practice, Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Inst Israelita Ensino & Pesquisa Albert Einstein, Sao Paulo, SP, BrazilUniv Iowa, Carver Coll Med, Dept Internal Med, Iowa City, IA USAHosp Sao Paulo, Lab Cent, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Med, Div Infect Dis, Sao Paulo, SP, BrazilFAPESP: 2010/13533-9Web of Scienc

Low compliance with alcohol gel compared with chlorhexidine for hand hygiene in ICU patients: results of an alcohol gel implementation program

Although the introduction of alcohol based products have increased compliance with hand hygiene in intensive care units (ICU), no comparative studies with other products in the same unit and in the same period have been conducted. We performed a two-month-observational prospective study comparing three units in an adult ICU, according to hand hygiene practices (chlorhexidine alone-unit A, both chlorhexidine and alcohol gel-unit B, and alcohol gel alone-unit C, respectively). Opportunities for hand hygiene were considered according to an institutional guideline. Patients were randomly allocated in the 3 units and data on hand hygiene compliance was collected without the knowledge of the health care staff. TISS score (used for measuring patient complexity) was similar between the three different units. Overall compliance with hand hygiene was 46.7% (659/1410). Compliance was significantly higher after patient care in unit A when compared to units B and C. On the other hand, compliance was significantly higher only between units A (32.1%) and C (23.1%) before patient care (p=0.02). Higher compliance rates were observed for general opportunities for hand hygiene (patient bathing, vital sign controls, etc), while very low compliance rates were observed for opportunities related to skin and gastroenteral care. One of the reasons for not using alcohol gel according to health care workers was the necessity for water contact (35.3%, 12/20). Although the use of alcohol based products is now the standard practice for hand hygiene the abrupt abolition of hand hygiene with traditional products may not be recommended for specific services

Robot-assisted radical prostatectomy in Brazil: preliminary results

Purpose: To report the initial experience on robot-assisted radical prostatectomy in Brazil. Methods: From March 2008 to March 2009, a hundred patients were treated with robot-assisted radical prostatectomy. Patient’s demographic data, as well as perioperative results of the procedures, are described in this study. Rresults: Patients’ mean age and mean PSA were 58 years and 7.58 ng/ml, respectively. All procedures were performed through transperitoneal approach, with a mean bleeding of 480 mL and surgical time of 298 minutes. A surgical margin affected by cancer was present in 16% of the cases. There were four complications: bleeding requiring transfusion (two cases), rectal perforation corrected on the spot and inadequate functioning of the robot. There was no conversion to another access or obit occurrences in this caseload. Cconclusions: Robot-assisted prostatectomy is a reality in Brazil and the results herein presented demonstrate that this procedure can be safely performed. Long-term follow-up is still necessary to assess the oncological and functional outcomes