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

Detection of Helicobacter genus from gastric biopsy fragments of dogs and cats

Sinais clínicos de dispepsia são frequentemente observados em pequenos animais, recomendando-se nesses pacientes a pesquisa de Helicobacter sp., pois esse agente pode estar associado com a ocorrência desses distúrbios. Há poucos relatos de isolamento dessa bactéria em animais no Brasil. Portanto, o objetivo do estudo foi investigar a presença de Helicobacter sp. em pacientes com indicação de endoscopia digestiva alta, atendidos no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul, empregando os métodos diagnósticos mais comumente adotados para sua detecção. Foram colhidos fragmentos de biópsia gástrica de um total de 30 cães e gatos submetidos à endoscopia, que não faziam uso de medicação antimicrobiana e inibidores de bomba de prótons no período mínimo de quatro semanas anteriores à coleta. Os fragmentos foram submetidos ao teste rápido da ureia (URT), colorações histológicas (H&E, Warthin Starry-WS), imunohistoquímica (IHQ), semi-nested PCR, tendo como alvo o gene 16SrRNA e cultura. Foram considerados positivos para Helicobacter sp. os pacientes que apresentaram resultado positivo em pelo menos dois métodos diagnósticos. Em apenas três animais foram detectadas lesões macroscópicas durante a endoscopia e 17 apresentaram lesões histopatológicas na mucosa do estômago. O URT foi positivo em 25 amostras e Helicobacter foi isolado de oito animais. Lâminas coradas por H&E e WS monstraram bactérias com morfologia compatível em 20 e 26 amostras, respectivamente. As técnicas de IHQ e semi-nested PCR resultaram positivas em 27 e 28 amostras, respectivamente. Ao todo, 28 pacientes foram considerados positivos, sendo que IHQ e semi-nested PCR detectaram 96,4% e 100% desses, respectivamente. Dessa forma, conclui-se que ambas as técnicas podem ser recomendadas para a detecção de Helicobacter em pequenos animais. A presença de Helicobacter sp. pode ter causado os sinais gastrintestinais apresentados por cães e gatos incluídos no estudo, porém em muitos pacientes sintomáticos houve presença da bactéria na ausência de lesões microscópicas detectáveis.Dyspepsia signs are frequently observed in small animals. In these patients, Helicobacter sp. investigation is recommended, since this pathogen may be associated with the occurrence of this kind of disorders. In Brazil there are few reports of Helicobacter sp. detection in small animals. Therefore, the aim of the study was to investigate the presence of Helicobacter sp. by the most common methods adopted for diagnosis in patients referred for upper endoscopy at the Veterinary Hospital of the Federal University of Rio Grande do Sul. Thirty patients, which had not been using any antimicrobial drugs and proton pump inhibitors for at least four weeks prior the endoscopy, were selected for this study. The biopsy fragments were submitted to rapid urea test (URT), histological staining (H&E, Warthin Starry- WS), immunohistochemistry (IHC), semi-nested PCR targeting the 16S rRNA gene and culture. Patients that tested positive in at least two diagnostic methods were considered positive for Helicobacter sp. Macroscopic lesions were detected in only three animals during endoscopy, and seventeen had histopathological lesions in the stomach mucous. The URT resulted in 25 positive samples, while Helicobacter sp. was isolated from only eight patients. Histological staining (H&E and WS) showed bacteria with typical morphology in 20 and 26 samples, respectively. The IHC and semi-nested PCR were positive in 27 and 28 samples, respectively. A total of 28 patients were considered positive; among them IHC and semi-nested PCR resulted positive in 96.4% and 100%, respectively. In conclusion, both techniques can be recommended for Helicobacter sp. detection in small animals. Helicobacter infection may have been the cause of gastrointestinal signs detected in patients; however many symptomatic animals without microscopic lesions were also diagnosed positive

Controle de Salmonella Enteritidis em aves, através do uso de bacterinas comerciais : revisão de literatura

A Salmonella Enteritidis é um dos principais agentes da toxinfecção alimentar em humanos, estando associado, principalmente, ao consumo de alimentos de origem avícola. No Brasil, desde 2003, está permitido o uso de bacterinas em matrizes comerciais. A imunização das aves com vacinas inativadas surgiu como uma ferramenta auxiliar para o controle e a prevenção da Salmonella Enteritidis. Segundo estudos, a vacinação confere proteção parcial contra a colonização intestinal, entretanto constatou-se uma significativa redução da excreção da bactéria para o ambiente e a diminuição da contaminação dos ovos, fator o qual é de extrema importância para a saúde pública, visto que os ovos são o principal veículo de transmissão de salmonelas para o homem. Portanto, recomenda-se o uso das bacterinas desde que seja complementado com a utilização dos demais métodos de controle e prevenção disponíveis.Salmonella Enteritidis is one of the main causes of human food poisoning. Salmonellosis has been highly associated to consumption of poultry-derived food. Since 2003, the use of bacterins in laying hens is allowed in Brazil. The poultry immunization with inactivated vaccines has become a useful tool for control Salmonella Enteritidis. According to studies, the vaccination result in a partial protection against intestinal colonization, however, a significant reduction of bacterium elimination to the environment and the reduction of egg contamination are possible. Reduction on egg contamination is extremely important to the consumers, since eggs are the main vehicle to human infection by Salmonella Enteritidis. Therefore, the use of bacterins is highly recommended in association with other available methods of control and prevention

Ocorrência e perfil de resistência de bactérias causadoras de otites externas em cães atendidos no Hospital de Clínicas Veterinárias da UFRGS

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Ocorrência e perfil de resistência de bactérias causadoras de otites externas em cães atendidos no Hospital de Clínicas Veterinárias da UFRGS

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30 years of fatal dengue cases in Brazil: a review

Abstract Background Over the last 30 years, extensive dengue epidemics have occurred in Brazil, characterized by emergences and re-emergences of different serotypes, a change in the epidemiological profile and an increase in the number of severe and fatal cases. Here, we present a review on the dengue fatal cases that occurred in Brazil in 30 years (1986–2015). Methods We performed an ecological study by using secondary data on dengue fatal cases obtained in the National System of Reported Diseases (Sistema de Informação de Agravos de Notificação -SINAN) and in the Mortality Information System (SIM), both maintained by the Brazilian Ministry of Health. Cases were analyzed by region, demographic variables, clinical classification and complications based on the data available. Results In 30 years (1986–2015), the Southeast region reported 43% (n = 2225) of all dengue deaths in the country. The Midwest region was responsible for 18% of the fatal cases. After 2000, deaths occurred in almost all states, with the exception of Santa Catarina and Rio Grande do Sul, South region. From 2006 to 2010, the number of deaths increased, with higher rates of mortality, especially in Goiás and Mato Grosso. From 2011 to 2015, Goiás became the state with the highest mortality rate in the country, and Rio Grande do Sul reported its first dengue deaths. In 30 years, a total of 2682 dengue deaths occurred in males and 2455 in females, and an equal distribution between the sexes was observed. From 1986 to 2006, dengue deaths occurred predominantly in individuals over 15 years old, but this scenario changed in 2007–2008. After 2009, fatal cases on individuals above 15 years old became more frequent, with peaks in the years of 2010, 2013 and 2015. Conclusions The Brazil is experiencing a hyperendemic scenario, which has resulted in the co-circulation of the four DENV serotypes and with the increasing occurrence of severe and fatal cases. The disease surveillance and studies characterizing what has been reported overtime, are still important tools to better understand the factors involved in the disease outcome