Mortalidade por gastrosquise no estado do Rio de Janeiro: uma série de 10 anos

OBJETIVO: Analisar a mortalidade e fatores associados em uma série de nascimentos com gastrosquise no estado do Rio de Janeiro em 10 anos (2005 a 2014). MÉTODO: Estudo de coorte retrospectiva, no qual foram relacionadas as bases de dados do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade por linkage probabilístico. A base de dados final foi construída em duas etapas, que consistiram em: preparo das duas bases de dados iniciais e estabelecimento de relações entre elas. RESULTADOS: Os recém-nascidos pré-termo e os com baixo peso ao nascer tiveram maior chance de óbito, com significância estatística (p = 0,03 e p = 0,006, respectivamente). Em relação ao local de nascimento, embora a frequência de óbito tenha sido maior nas maternidades do que em hospitais gerais (p = 0,04; OR = 0,5; IC95% 0,3–1,0), foi observado que uma unidade caracterizada como hospital geral apresentou uma frequência alta de nascimentos (61,2%) e, na análise comparativa da chance de óbito dessa unidade com as demais, encontrou-se uma chance de morrer 7,5 maior em hospitais gerais e 3,2 maior em maternidades, com significância estatística (p < 0,001). Além disso, nascer em unidades de terapia intensiva tipo II aumentou a chance de óbito em 3,9 vezes em comparação com as do tipo III (p < 0,001). CONCLUSÃO: Este estudo dá subsídios para a discussão de duas possíveis estratégias no tratamento de recém-nascidos com gastrosquise. A primeira seria a centralização do cuidado em unidades terciárias, possibilitando que o cuidado à malformação seja analisado de forma mais minuciosa e padronizada. A segunda, e talvez mais factível, seria a elaboração de diretrizes clínicas que padronizem o cuidado imediato aos bebês com gastrosquise nascidos fora de centros terciários, bem como a padronização do transporte deles até a chegada ao centro terciário.OBJECTIVE: To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD: A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS: Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3–1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION: This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center

Epidemiological profile of primary bloodstream infections in neonatal intensive care unit

Objectives: Describe the epidemiological profile of the primary bloodstream infections associated to central venous catheter in a Neonatal Intensive Care Unit of a hospital in Rio de Janeiro, year 2010. Method: Descriptive and retrospective study. A database was created on Epi_info program to index data and further analysis. Results: 16 newborns (NB) evolved to BSI associated to CVC; 66,7% were pre terms and 92,3% received parenteral nutrition. The peripheral inserted catheter was the most used (55,6%), followed by umbilical venous catheter with 22,2%. Among the isolated microorganisms, 42,8% were Negative Staphylococcus Coagulase, 28,5% were Staphylococcus Aureus and 14,2% were Candida Albicans. Conclusion: Became clear that the conditions related to the NB, to the pregnancy and to the CVC are factors that predispose these customers, and reinforce the need of specific programs to prevent and control the BSI

Registros de cardiopatia congênita em crianças menores de um ano nos sistemas de informações sobre nascimento, internação e óbito do estado do Rio de Janeiro, 2006-2010

Resumo OBJETIVO: descrever a ocorrência de casos de cardiopatia congênita em menores de um ano de vida registrados nos sistemas de informações em saúde do estado do Rio de Janeiro no período de 2006 a 2010. MÉTODOS: estudo descritivo, com dados do Sistema de Informações sobre Nascidos Vivos (Sinasc), Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) e Sistema de Informações sobre Mortalidade (SIM). RESULTADOS: foram encontrados 345 registros no Sinasc, 1.089 crianças internadas (SIH/SUS) e 1.121 óbitos de menores de um ano tendo como causa básica cardiopatia congênita (SIM); a prevalência de cardiopatias congênitas foi de 3,18/10 mil nascidos vivos; as cardiopatias foram as principais causas de óbito no grupo das malformações congênitas, com coeficiente de mortalidade de 1,03/1.000 nascidos vivos. CONCLUSÃO: houve sub-registro de casos de cardiopatia congênita no Sinasc, demonstrando a dificuldade do diagnóstico precoce

Perfil epidemiológico de las infecciones primarias del torrente sanguíneo en una unidad de cuidados intensivos neonatal

Submitted by Luis Guilherme Macena ([email protected]) on 2013-08-13T19:28:26Z No. of bitstreams: 1 PERFIL EPIDEMIOLÓGICO DE LAS INFECCIONES PRIMARIAS DEL TORRENTE SANGUÍNEO EN UNA UNIDAD DE CUIDADOS.pdf: 308273 bytes, checksum: 19e701d6733fe6d78a838442ae40a9b2 (MD5)Made available in DSpace on 2013-08-13T19:28:26Z (GMT). No. of bitstreams: 1 PERFIL EPIDEMIOLÓGICO DE LAS INFECCIONES PRIMARIAS DEL TORRENTE SANGUÍNEO EN UNA UNIDAD DE CUIDADOS.pdf: 308273 bytes, checksum: 19e701d6733fe6d78a838442ae40a9b2 (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Fernandes Figueira. Núcleo de Vigilância Epidemiológica. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Comissão de Controle de Infecção Hospitalar. Rio de Janeiro, RJ, BrasilUniversidade Federal do Estado do Rio de Janeiro. Programa de Pós-Graduação em Enfermagem. Rio de Janeiro, RJ, BrasilObjetivos: Descrever o perfil epidemiológico das infecções primárias de corrente sanguínea associadas ao cateter venoso central na Unidade de Terapia Intensiva Neonatal de um hospital no Rio de Janeiro no ano de 2010. Método: estudo descritivo e retrospectivo. Foi elaborado um banco de dados no programa Epi_info para indexação dos dados e posterior análise. Resultados: 16 recém-nascidos (RN) evoluíram para IPCS associadas ao CVC; 66,7% eram pré-termos e 92,3% receberam nutrição parenteral. O cateter de inserção periférica foi o mais utilizado (55,6%), seguido do cateter umbilical venoso com 22,2%. Dos microrganismos isolados 42,8% eram Staphylococcus Coagulase Negativo, 28,5% eram Staphylococcus aureus e 14,2% eram Candida Albicans. Conclusão: Percebeu-se que condições relacionadas ao RN, à gestação e ao CVC são fatores que predispõem esta clientela, o que reforça a necessidade de programas específicos de prevenção e controle de IPCS.Objectives: Describe the epidemiological profile of the primary bloodstream infections associated to central venous catheter in a Neonatal Intensive Care Unit of a hospital in Rio de Janeiro, year 2010. Method: Descriptive and retrospective study. A database was created on Epi_info program to index data and further analysis. Results: 16 newborns (NB) evolved to BSI associated to CVC; 66,7% were pre terms and 92,3% received parenteral nutrition. The peripheral inserted catheter was the most used (55,6%), followed by umbilical venous catheter with 22,2%. Among the isolated microorganisms, 42,8% were Negative Staphylococcus Coagulase, 28,5% were Staphylococcus Aureus and 14,2% were Candida Albicans. Conclusion: Became clear that the conditions related to the NB, to the pregnancy and to the CVC are factors that predispose these customers, and reinforce the need of specific programs to prevent and control the BSI.Objetivos: describir el perfil epidemiológico de las infecciones primarias del torrente sanguíneo asociadas al catéter venoso central en la Unidad de Cuidados Intensivos Neonatal de un hospital en Río de Janeiro en el año 2010. Método: estudio descriptivo y retrospectivo. Se ha elaborado una base de datos en el programa Epi_info para indización de los datos y análisis posterior. Resultados: 16 recién nacidos (RN) han progresado a ITS asociadas al CVC. 66,7% eran prematuros. 92,3% recibieron nutrición parenteral. El catéter de inserción periférica fue lo más utilizado (55,6%), seguido del catéter umbilical venoso con 22,2%. De los microorganismos aislados 42,8% eran Staphylococcus Coagulase Negativo, 28,5% eran Staphylococcus aureus y 14,2% eran Candida Albicans. Conclusión: Se observó que condiciones relacionadas al RN, a la gestación y al CVC son factores que predisponen a estos pacientes. Lo que refuerza la necesidad de programas específicos de prevención y controle de ITS

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research