Febre tifóide e paratifóide

Universidade do Estado do Pará. Belém, PA, Brasil.Ministério da Saúde. Fundação Nacional de Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Ministério da Saúde. Fundação Nacional de Saúde. Instituto Evandro Chagas. Belém, PA, Brasil

Derrame pleural parapneumônico: realidade e estratégias em um hospital universitário na Amazônia

Objective: to define the profile and analyze the postoperative evolution of children with parapneumonic pleural effusion (PPE), and to evaluate strategies used in the presence of diagnostic and therapeutic limitations, emphasizing the open thoracic drainage (OTD). Methods: we conducted a cross-sectional, prospective, analytical study in which we followed children admitted in an Amazon university hospital with surgically addressed PPE, from October 2010 to October 2011. Results: we studied 46 patients, most children under three years of age (74%), with no gender predominance. A significant portion of the sample (28%) had inappropriate body mass index. We found short stature in five patients (11%), which tended, in general, to a worst postoperative outcome when compared with children of normal height (p=0.039). The average duration of symptoms till admission was 16.9 days. Empyema was a common diagnosis in the first surgery (47.8%), and its bearers had longer duration of chest tube drainage (p=0.015). Most children (80.4%) were operated only once. The mean length of hospital stay was 25.9 days. Thoracic drainage (water-sealed) was the most common procedure (85%), with conversion to OTD in 24% of the sample, thoracotomy being rare (4%). There were no deaths. Conclusion: the studied individuals often had advanced disease and nutritional disorders, affecting outcome. OTD remains a valid option for specific situations, and further studies are needed for confirmation.Objetivo: definir o perfil e analisar a evolução pós-operatória de crianças com derrame pleural parapneumônico (DPP), bem como, avaliar estratégias utilizadas na vigência de limitações diagnóstico-terapêuticas, enfatizando a drenagem torácica aberta (DTA). Métodos: estudo transversal, prospectivo, analítico, no qual foram acompanhadas as crianças admitidas em um hospital universitário da Amazônia com o diagnóstico de DPP abordado cirurgicamente, no período entre outubro de 2010 a outubro de 2011. Resultados: foram estudados 46 pacientes, a maioria menor de três anos de idade (74%), sem predominância de sexo. Significativa parcela da amostra (28%) possuía índice de massa corpórea inadequado. Baixa estatura foi encontrada em cinco pacientes (11%), que tenderam, em geral, à pior evolução pós-operatória, quando comparados com as crianças de estatura normal (p=0,039). A duração média dos sintomas à admissão foi 16,9 dias. O empiema foi diagnóstico comum na primeira intervenção cirúrgica (47,8%), e seus portadores apresentaram maior duração da drenagem torácica (p=0,015). A maioria das crianças (80,4%) foi operada apenas uma vez. A média de dias de internação hospitalar foi 25,9 dias. A drenagem torácica fechada em selo d’água foi a cirurgia mais realizada (85%), precisando ser convertida em DTA em 24% da amostra e toracotomias foram raras (4%). Não houve óbitos. Conclusão: os indivíduos estudados possuíam frequentemente doença avançada e distúrbios nutricionais, repercutindo na evolução clínica. A DTA permanece como uma opção válida para situações específicas, e novos estudos ainda são necessários para confirmação

Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital

ABSTRACT Objective: to define the profile and analyze the postoperative evolution of children with parapneumonic pleural effusion (PPE), and to evaluate strategies used in the presence of diagnostic and therapeutic limitations, emphasizing the open thoracic drainage (OTD) . Methods: we conducted a cross-sectional, prospective, analytical study in which we followed children admitted in an Amazon university hospital with surgically addressed PPE, from October 2010 to October 2011. Results: we studied 46 patients, most children under three years of age (74%), with no gender predominance. A significant portion of the sample (28%) had inappropriate body mass index. We found short stature in five patients (11%), which tended, in general, to a worst postoperative outcome when compared with children of normal height (p=0.039). The average duration of symptoms till admission was 16.9 days. Empyema was a common diagnosis in the first surgery (47.8%), and its bearers had longer duration of chest tube drainage (p=0.015). Most children (80.4%) were operated only once. The mean length of hospital stay was 25.9 days. Thoracic drainage (water-sealed) was the most common procedure (85%), with conversion to OTD in 24% of the sample, thoracotomy being rare (4%). There were no deaths. Conclusion: the studied individuals often had advanced disease and nutritional disorders, affecting outcome. OTD remains a valid option for specific situations, and further studies are needed for confirmation

Infecciones asociadas a los cuidados de salud en pacientes VIH-positivos y VIH/SIDA-negativos: una casuística de la Región Amazónica

Additional financial support for this study was provided by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and Pró-Reitoria de Pesquisa e PósGraduação da UFPA (PROPESP) of Universidade Federal do Pará (UFPA).Universidade Federal do Pará. Faculdade de Enfermagem. Belém, PA, Brasil / Universidade Federal do Pará. Hospital Universitário João de Barros Barreto. Enfermaria de Doenças Infecciosas. Belém, PA, Brasil.Universidade Estadual do Pará. Departamento de Doenças Infecciosas. Belém, PA, Brasil / Universidade Federal do Pará. Departamento de Doenças Infecciosas. Belém, PA, Brasil.Universidade Estadual do Pará. Departamento de Doenças Infecciosas. Belém, PA, Brasil / Centro Universitário do Pará. Belém, PA, Brasil.Universidade Federal do Pará. Hospital Universitário João de Barros Barreto. Comitê de Controle de Infecção Hospitalar. Belém, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade Federal do Pará. Departamento de Doenças Infecciosas. Belém, PA, Brasil.OBJECTIVE: To investigate and compare the incidence of healthcare-associated infections (HAIs) involving HIV and non-HIV/AIDS patients. METHODS: Analytical, observational and prospective study. Setting: The Infectious Disease Nursery at the Hospital Universitário João de Barros Barreto in Belém, Pará State, Brazil. Patients: HIV and non-HIV/AIDS inpatients from February to December 2007. The patients were monitored daily from admission to the day of discharge. RESULTS: During the study period, there were 20,276 reported patient-days. Out of the 1,130 discharged patients, 40 patients acquired HAIs, and HAIs occurred more frequently in the HIV-positive patients (57.5%), with 29 (60.4%) HAI episodes (p ≤ 0.05). A total of 11 (55%) HIV-positive patients showed a TCD4 cell count < 100 cell/mm3, and 15 (65.22%) HIV-positive patients died from complications associated with the HAIs (p = 0.009). The most frequent infections were urinary tract infections related to urinary catheter use per 1,000 catheter-days in non-HIV patients, with 12.11 episodes (p = 0.13). However, HIV-positive patients were more often infected with pneumonia, with 1.6 episodes per 1,000 patient-days (p = 0.04). CONCLUSION: HAI are more likely to occur in HIV-positive patients, most likely as a consequence of their immune condition, and this risk, which is associated with invasive procedures, justifies the need for preventive measures.OBJETIVO: Investigar e comparar a incidência de infecções relacionadas à assistência à saúde (IRAS), envolvendo pacientes HIV e não HIV/aids. MÉTODO: Estudo analítico, observacional e prospectivo ocorrido na Enfermaria de Doenças Infecciosas do Hospital Universitário João de Barros Barreto em Belém, Estado do Pará, Brasil. Pacientes: Internos, portadores de HIV e não HIV/aids, de fevereiro a dezembro de 2007, com monitoramento diário da admissão até a alta hospitalar. RESULTADOS: Durante o período de estudo, foram relatados 20.276 pacientes/dia. De 1.130 pacientes com alta, 40 contraíram IRAS, e as IRAS ocorreram mais frequentemente nos HIV-positivos (57,5%), com 29 (60,4%) episódios de IRAS (p ≤ 0,05). Um total de 11 (55%) HIV-positivos apresentou contagem de células TCD4 < 100 células/mm3, e 15 (65,22%) HIV-positivos morreram de complicações associadas com as IRAS (p = 0,009). A infecção mais frequente foi a do trato urinário, associada ao uso de cateter urinário, 1.000 cateteres-dia em pacientes não HIV, com 12,11 episódios (p = 0,13). Entretanto, os HIV-positivos apresentaram pneumonia mais frequentemente, com 1,6 episódios em 1.000 pacientes-dia (p = 0,04). CONCLUSÃO: As IRAS apresentam maior probabilidade de ocorrência em HIV-positivos, provavelmente devido as suas condições de imunidade, e esse risco, que está associado com procedimentos invasivos, justifica a necessidade de medidas preventivas

Aspectos epidemiológicos, clínicos e evolutivos da tuberculose em idosos de um hospital universitário em Belém, Pará

Objective: To evaluate the epidemiological, clinical and evolutionary aspects of tuberculosis in elderly patients of a university hospital in Belém, Pará. Method: A cross-sectional study was conducted in a university hospital, where 82 records of cases of tuberculosis in elderly patients were analyzed. The data was analyzed by applying the G-test, assuming a level of α=0.05 (5%) and a value of p=0.05. Results: Most of the elderly patients were male (64.6%), aged 60-69 years, especially among men (64.2%). Most were new cases of tuberculosis (95.1%), with a pulmonary clinical form (75.6%), associated diseases (69.5%) and a length of stay exceeding 21 days. Fever (67.1%), dyspnea (64.6%), weight loss (61.0%), productive cough (59.8%), chest pain (51.2%) were the main signs and symptoms. Regarding treatment, there was a high percentage of adverse reactions (50%), predominantly gastrointestinal events (70.7%). Most patients were cured (59.8%), but mortality from tuberculosis was considered high (15.9%). In terms of the exposure variables and outcome, there was a statistically significant difference for the age group (p=0.017), length of stay (p=0.000) and adverse reactions (p=0.018) only. Conclusion: The clinical presentation and therapeutic management of tuberculosis among the elderly has characteristics peculiar to this group, making it important to strengthen strategies that facilitate early identification of suspected cases of TB among elderly persons in the community, which should take place mainly through the primary care system.Objetivo: Avaliar os aspectos epidemiológicos, clínicos e evolutivos da tuberculose em idosos em um Hospital Universitário na cidade de Belém, Pará. Método: Trata-se de um estudo do tipo transversal, realizado em um hospital universitário, onde foram analisados 82 prontuários de casos de tuberculose em idosos. Os dados foram analisados através da aplicação do Teste G, admitindo-se nível α=0,05 (5%) e valor de p≤0,05. Resultados: A maioria dos idosos era do sexo masculino (64,6%), com faixa etária de 60 a 69 anos, mais destacadamente entre os homens (64,2%), casos novos de tuberculose (95,1%), apresentando forma clínica pulmonar (75,6%), agravos associados (69,5%) e tempo de internação superior a 21 dias. Febre (67,1%), dispneia (64,6%), emagrecimento (61,0%), tosse produtiva (59,8%) e dor torácica (51,2%) foram os principais sinais e sintomas. Em relação ao tratamento, houve elevado percentual de reações adversas (50%), predominando as manifestações gastrointestinais (70,7%). A maioria dos pacientes curou (59,8%), contudo, o óbito por tuberculose foi considerado alto (15,9%). Quanto às variáveis de exposição e o desfecho, houve diferença estatisticamente significativa apenas para a faixa de idade (p=0,017), tempo de internação (p=0,000) e reação adversa (p=0,018). Conclusão: a apresentação clínica e manejo terapêutico da tuberculose no idoso é diferenciado, fazendo-se necessário o fortalecimento de estratégias que propiciem a identificação precoce dos idosos suspeitos de tuberculose na comunidade, o que deve ocorrer principalmente através da Atenção Básica

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units

Abstract: INTRODUCTION: The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. Given the lack of information regarding the dynamics of multidrug resistance in northern Brazil, we analyzed the clinical and microbiological features of nosocomial infections caused by P. aeruginosa. METHODS Between January 2010 and March 2012, we conducted a retrospective cohort study of P. aeruginosa isolates from 54 patients who were hospitalized in intensive care units. The clinical and epidemiologic variables were analyzed, including the patients' demographic data and comorbidities, and the lengths of the intensive care unit stays, the classification of the infections as nosocomial, the use of invasive procedures, antimicrobial therapy, and the patients' outcomes. We undertook susceptibility tests, molecular detection of the metallo-&#946;-lactamase genes, and genotypic analyses of the isolates using the repetitive element-polymerase chain reaction. RESULTS: Multidrug resistance occurred most frequently among isolates from adults who had been hospitalized for an average of 87.1 days. The use of mechanical ventilation and urinary catheters were risk factors for infection. The four isolates that harbored the blaSPM-1-like gene showed >95% genetic similarity. CONCLUSIONS This study's findings show that P. aeruginosa has a high death rate, and that inadequate treatment and invasive procedures are risk factors for infection. This is the first report describing the detection of the blaSPM-1-like gene in northern Brazil. These results highlight the need for better monitoring and a greater understanding of nosocomial infections and their public health impacts

Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: a meta-analysis

Universidade do Estado do Pará. Departamento de Patologia. Belém, PA, Brasil.Universidade do Estado do Pará. Programa de Pós-Graduação em Biologia Parasitária na Amazônia. Belém, PA, Brasil.Universidade do Estado do Pará. Programa de Pós-Graduação em Biologia Parasitária na Amazônia. Belém, PA, Brasil.Universidade do Estado do Pará. Programa de Pós-Graduação em Biologia Parasitária na Amazônia. Belém, PA, Brasil.Universidade do Estado do Pará. Departamento de Patologia. Belém, PA, Brasil.Universidade do Estado do Pará. Programa de Pós-Graduação em Biologia Parasitária na Amazônia. Belém, PA, Brasil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Pseudomonas aeruginosa is the leading cause of nosocomial infections with high mortality rates owing to the limited therapeutic options for multidrug-resistant Pseudomonas aeruginosa (MDRPA) and metallo-beta-lactamase (MBL)-producing strains. Herein, we present a meta-analysis exploring the association between MDRPA and São Paulo MBL-1 (SPM-1)-producing strains vs. mortality. Online databases were screened to identify studies published between 2006 and 2016. A total of 15 studies, comprising 3,201 cases of P. aeruginosa infection, were included. Our results demonstrated a higher mortality rate among patients infected with MDRPA (44.6%, 363/813) than those with non-MDRPA infection (24.8%, 593/2,388) [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.70-3.36, p <0.00001]. The risk of mortality in patients with non-SPM-1 strains was four times higher than that observed in the patients of the SPM-1 group; however, no statistically significant difference was observed (p = 0.43). In conclusion, the results of our study demonstrated that patients infected with MDRPA had a significantly higher mortality rate than that of patients infected with non-MDRPA strains, especially patients with bloodstream infection (BSI), immunosuppression, and inadequate antimicrobial therapy. The absence of studies on the molecular aspects of blaSPM-1 and its association with mortality limited the analysis; therefore, our results should be interpreted with caution. Our findings also highlight the need for more studies on the molecular aspects of resistance and the peculiarities of different nosocomial settings

Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: a meta-analysis

Abstract Pseudomonas aeruginosa is the leading cause of nosocomial infections with high mortality rates owing to the limited therapeutic options for multidrug-resistant Pseudomonas aeruginosa (MDRPA) and metallo-beta-lactamase (MBL)-producing strains. Herein, we present a meta-analysis exploring the association between MDRPA and São Paulo MBL-1 (SPM-1)-producing strains vs. mortality. Online databases were screened to identify studies published between 2006 and 2016. A total of 15 studies, comprising 3,201 cases of P. aeruginosa infection, were included. Our results demonstrated a higher mortality rate among patients infected with MDRPA (44.6%, 363/813) than those with non-MDRPA infection (24.8%, 593/2,388) [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.70-3.36, p <0.00001]. The risk of mortality in patients with non-SPM-1 strains was four times higher than that observed in the patients of the SPM-1 group; however, no statistically significant difference was observed (p = 0.43). In conclusion, the results of our study demonstrated that patients infected with MDRPA had a significantly higher mortality rate than that of patients infected with non-MDRPA strains, especially patients with bloodstream infection (BSI), immunosuppression, and inadequate antimicrobial therapy. The absence of studies on the molecular aspects of blaSPM-1 and its association with mortality limited the analysis; therefore, our results should be interpreted with caution. Our findings also highlight the need for more studies on the molecular aspects of resistance and the peculiarities of different nosocomial settings