Notificação de infecções em unidade neonatal com critérios nacionais.

Backgound and Objectives: Healthcare Associated Infections in neonates represent a challenge and an active surveillance system is essential to develop preventive measures. This study aims to describe the main sites and data of Healthcare Associated Infections according to the criteria defi ned by National Agency for Sanitary Surveillance at a reference Neonatal Unit. Methods:This is a prospective observational study conducted from 2009 to 2010. We included all patients at risk and notifi cation of infections followed criteria defi ned by Agência Nacional de Vigilância Sanitária. For Statistical analysis, we calculated the incidence density of Healthcare Associated Infections, frequency and percentage of microorganisms, mortality, and incidence density of deviceassociated infections. Results: This study followed 609 newborns, with 13,215 patient-days. Incidence density of infection was 26.3 per 1000 patient-days, predominantly bloodstream infection (58.8%). microorganisms were isolated, in 116 (33.4%) cases, predominantly coagulase negative Staphylococcus. Conclusion: The main sites and data of IRAS were similar to other previous studies. The defi nition of parameters for national surveillance of Healthcare Associated Infections is critical for planning actions in order to prevent these diseases in susceptible populations as neonates.Justificativa e Objetivos: : O controle de infecções relacionadas à assistência a saúde em neonatos representa um desafio e um sistema de vigilância ativa é essencial definir medidas preventivas. Este estudo tem como objetivo descrever as principais topografias e indicadores de infecções relacionadas à assistência a saúde em Unidade Neonatal conforme os critérios de vigilância epidemiológica estabelecidos pela Agência Nacional de Vigilância Sanitária. Métodos: Trata-se estudo transversal, observacional, prospectivo, realizado de 2009 a 2010. Foram incluídos todos os pacientes sob risco e a notificação de infecções seguiu os critérios recomendados pela Agência Nacional de Vigilância Sanitária. Análise estatística, com cálculo da densidade de incidência de infecções, frequência e percentual de microrganismos, mortalidade, letalidade e densidade de incidência de infecções associadas a procedimentos invasivos. Resultados: Foram acompanhados 609 neonatos sob risco, totalizando 13.215 pacientes-dia no período. A densidade incidência de infecção foi de 26,3 por 1000 pacientes-dia, predominando infecção de corrente sanguínea (58,8%). Em 116 (33,4%) casos de infecções notificadas, houve isolamento de microrganismo, predominando Staphylococcus coagulase negativo. Conclusão: Os principais indicadores de infecções e topografias foram semelhantes a outros estudos conduzidos previamente. A definição de parâmetros de vigilância epidemiológica de infecções relacionadas à assistência a saúde em nível nacional é fundamental para o planejamento de ações com o objetivo de prevenir estes agravos em populações suscetíveis como neonatos. Descritores: Vigilância Epidemiológica, Infecção Hospitalar, Neonatologia

Notification of Infections in a Neonatal Unity Based on National Criteria

Backgound and Objectives: Healthcare Associated Infections in neonates represent a challenge and an active surveillance system is essential to develop preventive measures. This study aims to describe the main sites and data of Healthcare Associated Infections according to the criteria defi ned by National Agency for Sanitary Surveillance at a reference Neonatal Unit. Methods:This is a prospective observational study conducted from 2009 to 2010. We included all patients at risk and notifi cation of infections followed criteria defi ned by Agência Nacional de Vigilância Sanitária. For Statistical analysis, we calculated the incidence density of Healthcare Associated Infections, frequency and percentage of microorganisms, mortality, and incidence density of deviceassociated infections. Results: This study followed 609 newborns, with 13,215 patient-days. Incidence density of infection was 26.3 per 1000 patient-days, predominantly bloodstream infection (58.8%). microorganisms were isolated, in 116 (33.4%) cases, predominantly coagulase negative Staphylococcus. Conclusion: The main sites and data of IRAS were similar to other previous studies. The defi nition of parameters for national surveillance of Healthcare Associated Infections is critical for planning actions in order to prevent these diseases in susceptible populations as neonates

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Color-Tunable Fluorescence and White Light Emission from Mesoporous Organosilicas Based on Energy Transfer from 1,8-Naphthalimide Hosts to Perylenediimide Guests

The present work reports Förster resonance energy transfer (FRET) from 1,8-naphthalimide (NI) donors bound to the pore walls of mesoporous silicas to perylenediimide (PDI) acceptors doped into the mesochannels. Mesoporous organosilicas containing covalently bound NI were synthesized by co-condensation of tetraethylorthosilicate (TEOS) with N-(3-(triethoxysilyl)­propyl)-1,8-naphthalimide (TEPNI) in the presence of a block copolymer surfactant as a template. The resulting materials were highly ordered, presenting a 2D hexagonal structure, and displayed easily tunable optical properties, which could be controlled by the amount of NI in the sample. A sample prepared from a diluted TEPNI solution (SBANId) presented a blue, monomerlike emission. In contrast, when a concentrated TEPNI solution was used, the resulting material (SBANIc) displayed a green, excimerlike emission. For the FRET studies, N,N′-bis­(2,6-dimethylphenyl)-3,4,9,10-perylenediimide was doped into the pores of the SBANI samples from chloroform solutions. When excited at the NI absorption maximum (350 nm), PDI-doped SBANIc showed intense quenching of the NI emission band, even at very low PDI doping, with quenching efficiencies reaching nearly 80% with only 0.6 mol % PDI (PDI/NI ≈ 1:170). The emission of PDI was observed at higher doping ratios, even though the PDI hardly absorbs at 350 nm, thus evidencing FRET from the host NI to the guest PDI. SBANI materials with a suitable amount of the PDI dopant displayed a white emission, spanning the whole visible spectrum

Synthesis of Novel Periodic Mesoporous Organosilicas Containing 1,4,5,8-Naphthalenediimides within the Pore Walls and Their Reduction To Generate Wall-Embedded Free Radicals

Novel periodic mesoporous organosilicas (PMOs) containing 1,4,5,8-Naphthalenediimide (NDI) chromophores as an integral part of the pore walls were synthesized in acidic conditions, in the presence of inorganic tetraethyl orthosilicate, using triblock copolymer surfactant Pluronic P-123 as a template. The NDI precursor, the bridged silsesquioxane <i>N</i>,<i>N</i>′-bis­(3-triethoxysilylpropyl)-1,4,5,8-naphthalenediimide, was synthesized by reaction of 1,4,5,8-naphthalenetetracarboxylic dianhydride with excess 3-aminopropyltriethoxysilane. A series of samples containing up to 19% (weight %) of NDI were prepared (the materials were labeled PMONDIs). ¹³C and ²⁹Si solid-state nuclear magnetic resonance revealed that the NDI moiety was intact in the PMONDIs and efficiently grafted to the silica network. Samples with up to 16% NDI load presented an ordered two-dimensional-hexagonal mesoscopic structure, according to small-angle X-ray scattering, transmission electron microscopy, and nitrogen adsorption isotherms. Fluorescence spectra of the PMONDIs showed excimer formation upon excitation, suggesting high flexibility of the organic moieties. Reduction of PMONDIs with aqueous sodium dithionite led to the formation of wall-embedded NDI anion radicals, as observed by the appearance of new visible/near-infrared absorption bands. The PMONDIs were also shown to be efficient photocatalysts in the degradation of sulfadiazine, an antibiotic selected here as a model pollutant, which is usually present in water bodies and wastewater

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt