Post-discharge mortality in adult patients hospitalized for tuberculosis : a prospective cohort study

Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index

Randomized in vivo evaluation of photodynamic antimicrobial chemotherapy on deciduous carious dentin

The aim of this randomized in vivo study was to compare antimicrobial chemotherapies in primary carious dentin. Thirty-two participants ages 5 to 7 years underwent partial caries removal from deep carious dentin lesions in primary molars and were subsequently divided into three groups: control [chlorhexidine and resin-modified glass ionomer cement (RMGIC)], LEDTB [photodynamic antimicrobial chemotherapy (PACT) with light-emitting diode associated with toluidine blue solution and RMGIC], and LMB [PACT with laser associated with methylene blue solution and RMGIC]. The participants were submitted to initial clinical and radiographic examinations. Demographic features and biofilm, gingival, and DMFT/DMFS indexes were evaluated, in addition to clinical and radiographic followups at 6 and 12 months after treatments. Carious dentin was collected before and after each treatment, and the number of Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Fusobacterium nucleatum, Atopobium rimae, and total bacteria was established by quantitative polymerase chain reaction. No signs of pain or restoration failure were observed. All therapies were effective in reducing the number of microorganisms, except for S. sobrinus. No statistical differences were observed among the protocols used. All therapies may be considered as effective modern approaches to minimal intervention for the management of deep primary caries treatment2010FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP#2010/07212-5; #2011/08392-

Software engineering for self-adaptive systems:research challenges in the provision of assurances

The important concern for modern software systems is to become more cost-effective, while being versatile, flexible, resilient, dependable, energy-efficient, customisable, configurable and self-optimising when reacting to run-time changes that may occur within the system itself, its environment or requirements. One of the most promising approaches to achieving such properties is to equip software systems with self-managing capabilities using self-adaptation mechanisms. Despite recent advances in this area, one key aspect of self-adaptive systems that remains to be tackled in depth is the provision of assurances, i.e., the collection, analysis and synthesis of evidence that the system satisfies its stated functional and non-functional requirements during its operation in the presence of self-adaptation. The provision of assurances for self-adaptive systems is challenging since run-time changes introduce a high degree of uncertainty. This paper on research challenges complements previous roadmap papers on software engineering for self-adaptive systems covering a different set of topics, which are related to assurances, namely, perpetual assurances, composition and decomposition of assurances, and assurances obtained from control theory. This research challenges paper is one of the many results of the Dagstuhl Seminar 13511 on Software Engineering for Self-Adaptive Systems: Assurances which took place in December 2013

Effectiveness and Waning of Protection With Different SARS-CoV-2 Primary and Booster Vaccines During the Delta Pandemic Wave in 2021 in Hungary (HUN-VE 3 Study)

BackgroundIn late 2021, the pandemic wave was dominated by the Delta SARS-CoV-2 variant in Hungary. Booster vaccines were offered for the vulnerable population starting from August 2021.MethodsThe nationwide HUN-VE 3 study examined the effectiveness and durability of primary immunization and single booster vaccinations in the prevention of SARS-CoV-2 infection, Covid-19 related hospitalization and mortality during the Delta wave, compared to an unvaccinated control population without prior SARS-CoV-2 infection.ResultsThe study population included 8,087,988 individuals who were 18–100 years old at the beginning of the pandemic. During the Delta wave, after adjusting for age, sex, calendar day, and chronic diseases, vaccine effectiveness (VE) of primary vaccination against registered SARS-CoV-2 infection was between 11% to 77% and 18% to 79% 14–120 days after primary immunization in the 16–64 and 65–100 years age cohort respectively, while it decreased to close to zero in the younger age group and around 40% or somewhat less in the elderly after 6 months for almost all vaccine types. In the population aged 65–100 years, we found high, 88.1%–92.5% adjusted effectiveness against Covid-19 infection after the Pfizer-BioNTech, and 92.2%–95.6% after the Moderna booster dose, while Sinopharm and Janssen booster doses provided 26.5%–75.3% and 72.9%–100.0% adjusted VE, respectively. Adjusted VE against Covid-19 related hospitalization was high within 14–120 days for Pfizer-BioNTech: 76.6%, Moderna: 83.8%, Sputnik-V: 78.3%, AstraZeneca: 73.8%, while modest for Sinopharm: 45.7% and Janssen: 26.4%. The waning of protection against Covid-19 related hospitalization was modest and booster vaccination with mRNA vaccines or the Janssen vaccine increased adjusted VE up to almost 100%, while the Sinopharm booster dose proved to be less effective. VE against Covid-19 related death after primary immunization was high or moderate: for Pfizer-BioNTech: 81.5%, Moderna: 93.2%, Sputnik-V: 100.0%, AstraZeneca: 84.8%, Sinopharm: 58.6%, Janssen: 53.3%). VE against this outcome also showed a moderate decline over time, while booster vaccine types restored effectiveness up to almost 100%, except for the Sinopharm booster.ConclusionsThe HUN-VE 3 study demonstrated waning VE with all vaccine types for all examined outcomes during the Delta wave and confirmed the outstanding benefit of booster vaccination with the mRNA or Janssen vaccines, and this is the first study to provide clear and comparable effectiveness results for six different vaccine types after primary immunization against severe during the Delta pandemic wave

The prevalence and adequacy of antibiotic prescriptions in Hospital de Clínicas de Porto Alegre

Durante o dia 30 de julho de 1987, foram estudados alguns aspectos envolvendo o uso de antibióticos no Hospital de Clínicas de Porto Alegre. De 432 pacientes internados, 182 (42%) estavam utilizando antibióticos,e destes, 42% recebiam a medicação de forma inadequada. Dos antibióticos usados terapeuticarhente, os mais prescritos foram ampicilina, penicilina, cefalosporinas e amicacina. Entre os usados profilaticamente, destacaram-se cefa/osporinas, gentamicina e ampicilina. O trabalho sugere que o controle do uso de antibióticos pode reduzir a adoção inapropriada destes agentes.On July 30th 1987 there was made a survey to evaluate the antibiotic use in the Hospital de Clínicas de Porto Alegre. 432 patients were investigated and 182 (42%) were under antimicrobial therapy. This group showed 42% o f patients receiving antimicrobians inappropriately. The antibiotics most used therapeuticaly were ampicillin, penicillin, cefalosporin and amikacin. For prophylaxis the most used were cefalosporin, gentamicin and ampicillin. This paper suggests that contra/ procedures can reduce the inappropriate use of antimicrobial agents in our hospital

Movimentos surdos e os fundamentos e metas da escola bilíngue de surdos: contribuições ao debate institucional

Nesse artigo, a trajetória percorrida pela comunidade surda de Brasília para a implantação da Primeira Escola Pública Integral Bilíngue Libras e Português-Escrito do Distrito Federal agrega-se à apresentação de uma abordagem geral e histórica do conceito buscado pelo Movimento Nacional em favor da Cultura e Educação de Surdos para as Escolas Bilíngues. Esse artigo apresenta também metas, princípios e diretrizes dessas Escolas Bilíngues, fundamentados nos estudos acadêmicos em crescente expansão nos programas de pós-graduação das universidades brasileiras, nas experiências dos alunos surdos matriculados em um sistema educacional fadado ao fracasso escolar, nas experiências dos profissionais da educação envolvidos em pesquisas que levam à melhoria da qualidade do ensino oferecido e na legislação que, timidamente, começa a absorver o paradigma educacional eleito pela comunidade surda para a construção das Escolas Bilíngues de Surdos em todo o território nacional. A partir das perspectivas lançadas nesse contexto, as primeiras instituições criadas como Escolas Bilíngues de Surdos podem ser modelos para a criação, melhoria e ampliação de Escolas Bilíngues de Surdos, das já existentes e das iminentes nos diferentes estados brasileiros