Impact Of Hospital Infections On Patients Outcomes Undergoing Cardiac Surgery At Santa Casa De Misericórdia De Marília [impacto Das Infecções Hospitalares Na Evolução De Pacientes Submetidos à Cirurgia Cardíaca Na Santa Casa De Misericórdia De Marília]

Objective: this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods: Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília. Results: 351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age ≥ 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay ≥ 2 days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation ≥ 2 days (OR11, 93, 95% CI 6.1 to 23.08), use of urinary catheter ≥ 3 days (OR 4.85 95% CI 2.95-7.99). Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24). Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0), insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2). Conclusion: Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.292167176(2011), World Health Organization. Report on the burden of endemic health care-associated infection worldwide. Geneva: WHO Document Production ServicesUmscheid, C.A., Mitchell, M.D., Doshi, J.A., Agarwal, R., Williams, K., Brennan, P.J., Estimating the proportion of healthcare associated infections that are reasonably preventable and the related mortality and costs (2011) Infect Control Hosp Epidemiol, 32 (2), pp. 101-114Kollef, M.H., Sharpless, L., Vlasnik, J., Pasque, C., Murphy, D., Fraser, V.J., The impact of nosocomial infections on patient outcomes following cardiac surgery (1997) Chest, 112 (3), pp. 666-675Hortal, J., Muñoz, P., Cuerpo, G., Litvan, H., Rosseel, P., Bouza, E., Ventilator-associated pneumonia in patients undergoing major heart surgery: An incidence study in European (2009) Crit Care, 13 (3), p. 80. , European Study Group on Nosocomial InfectionEuropean Workgroup of Cardiothorac IntensivistsBouza, E., Hortal, J., Muñoz, P., Pascau, J., Pérez, M.J., Hiesmayr, M., Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: A one-day European prevalence study (ESGNI-008) (2006) J Hosp Infect, 64 (3), pp. 224-230. , European Study Group on Nosocomial InfectionsEuropean Workgroup of Cardiothoracic IntensivistsLe Guillou, V., Tavolacci, M.P., Baste, J.M., Hubscher, C., Bedoit, E., Bessou, J.P., Surgical site infection after central venous catheter-related infection in cardiac surgery (2011) Analysis of a Cohort of 7557 Patients. J Hosp Infect, 79 (3), pp. 236-241Horan, T.C., Andrus, M., Dudeck, M.A., CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting (2008) Am J Infect Control, 36 (5), pp. 309-332Fowler Jr., V.G., O'Brien, S.M., Muhlbaier, L.H., Corey, G.R., Ferguson, T.B., Peterson, E.D., (2005) Clinical Predictors of Major Infections After Cardiac Surgery. Circulation, 30 (9 SUPPL.), pp. 358-365. , 112de Santo, L.S., Bancone, C., Santarpino, G., Romano, G., de Feo, M., Scardone, M., Microbi-ologically documented nosocomial infections after cardiac surgery: An 18-month prospective tertiary care center report (2008) Eur J Cardiothorac Surg, 33 (4), pp. 666-672Manniën, J., Wille, J.C., Kloek, J.J., van Benthem, B.H., Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands (2011) J Thorac Cardio-vasc Surg, 141 (4), pp. 899-904. , 2002-2007Berg, T.C., Kjørstad, K.E., Akselsen, P.E., Seim, B.E., Løwer, H.L., Stenvik, M.N., National sur-veillance of surgical site infections after coronary artery bypass grafting in Norway: Inci-dence and risk factors (2011) Eur J Cardiothorac Surg, 40 (6), pp. 1291-1297Vosylius, S., Sipylaite, J., Ivaskevicius, J., Determinants of outcome in elderly patients admitted to the intensive care unit (2005) Age Ageing, 34 (2), pp. 157-162Sá, M.P., Soares, E.F., Santos, C.A., Figueiredo, O.J., Lima, R.O., Escobar, R.R., Risk factors for mediastinitis after coronary artery bypass grafting surgery (2011) Rev Bras Cir Cardio-vasc, 26 (1), pp. 27-35Tiveron, M.G., Fiorelli, A.I., Mota, E.M., Mejia, O.A.V., Brandão, C.M.A., Dallan, L.A.O., Fatores de risco pré-operatórios para mediastinite após cirurgia cardíaca: Análise de 2768 pacientes (2012) Rev Bras Cir Cardiovasc, 27 (2), pp. 203-210Magedanz, E.H., Bodanese, L.C., Guaragna, J.C.V.C., Albuquerque, L.C., Martins, V., Minossi, S.D., Elaboração de escore de risco para mediastinite pós-cirurgia de revascularização do miocárdio (2010) Rev Bras Cir Cardiovasc, 25 (2), pp. 154-159Steingrimsson, S., Gottfredsson, M., Kristinsson, K.G., Gudbjartsson, T., Deep sternal wound in-fections following open heart surgery in Iceland: A population-based study (2008) Scand Cardio-vasc J, 42 (3), pp. 208-213Risnes, I., Abdelnoor, M., Almdah, S.M., Svennevig, J.L., Mediastinitis after coronary artery by-pass grafting risk factors and long-term survival (2010) Ann Thorac Surg, 89 (5), pp. 1502-1509Filsoufi, F., Castillo, J.G., Rahmanian, P.B., Broumand, S.R., Silvay, G., Carpentier, A., Epide-miology of deep sternal wound infection in cardiac surgery (2009) J Cardiothorac Vasc Anesth, 23 (4), pp. 488-494Knapik, P., Nadziakiewicz, P., Urbanska, E., Saucha, W., Herdynska, M., Zembala, M., Cardiopul-monary bypass increases postoperative glycemia and insulin consumption after coronary surgery (2009) Ann Thorac Surg, 87 (6), pp. 1859-1865Riera, M., Ibáñez, J., Herrero, J., De Ibarra, J.I.S., Enríquez, F., Campillo, C., Respiratory tract in-fections after cardiac surgery: Impact on hospital morbidity and mortality (2010) J Cardiovasc Surg (Torino), 51 (6), pp. 907-914Garey, K.W., Kumar, N., Dao, T., Tam, V.H., Gentry, L.O., Risk factors for postoperative chest wound infections due to gram-negative bactéria in cardiac surgery patients (2006) J Chemother, 18 (4), pp. 402-408Inkster, T., Antibiotic prophylaxis for cardiac surgery: A shift away from traditional cephalosporins? (2009) J Cardiothorac Vasc Anesth, 23 (6), pp. 933-935Rahmanian, P.B., Adams, D.H., Castillo, J.G., Carpentier, A., Filsoufi, F., Predicting hospital mor-tality and analysis of long-term survival after major noncardiac complications in cardiac surgery patients (2010) Ann Thorac Surg, 90 (4), pp. 1221-1229Cove, M.E., Spelman, D.W., Maclaren, G., Infectious complications of cardiac surgery: A clinical review (2012) J Cardiothorac Vasc Anesth, 26 (6), pp. 1094-1100Flodgren, G., Conterno, L.O., Mayhew, A., Omar, O., Pereira, C.R., Shepperd, S., Interventions to improve professional adherence to guidelines for prevention of device-related infections (2013) Cochrane Database Syst Rev, 3. , CD00655

Tick-borne pathogens infecting dogs from a highland swamp area

RESUMO Objetivou-se neste estudo relatar a frequência e a identidade de patógenos transmitidos por carrapatos em cães residentes de uma área caracterizada por brejo de alta altitude. Amostras sanguíneas (n=203) foram coletadas e molecularmente analisadas via PCR (Babesia spp., Hepatozoon spp., Anaplasma spp. e Ehrlichia spp.) e sequenciamento de DNA. De todas as amostras analisadas, 8,87% (18/203) foram positivas a algum patógeno transmitido por carrapato. Especificamente, 5,42% (11/203) e 3,45% (7/203) foram positivos a Anaplasma platys e Ehrlichia canis, respectivamente. Este estudo fornece, pela primeira vez, evidência científica de infecção de cães por esses patógenos nessa área de alta altitude e reforça o provável papel de R. sanguineus s.l. como vetor de A. platys, principalmente considerando.se que muitos animais positivos eram infestados por essa espécie de carrapato

Dilatonic global strings

We examine the field equations of a self-gravitating global string in low energy superstring gravity, allowing for an arbitrary coupling of the global string to the dilaton. Massive and massless dilatons are considered. For the massive dilaton the spacetime is similar to the recently discovered non-singular time-dependent Einstein self-gravitating global string, but the massless dilaton generically gives a singular spacetime, even allowing for time-dependence. We also demonstrate a time-dependent non-singular string/anti-string configuration, in which the string pair causes a compactification of two of the spatial dimensions, albeit on a very large scale.Comment: 18 pages RevTeX, 3 figures, references amende

Gravitational field around a time-like current-carrying screwed cosmic string in scalar-tensor theories

In this paper we obtain the space-time generated by a time-like current-carrying superconducting screwed cosmic string(TCSCS). This gravitational field is obtained in a modified scalar-tensor theory in the sense that torsion is taken into account. We show that this solution is comptible with a torsion field generated by the scalar field $\phi$. The analysis of gravitational effects of a TCSCS shows up that the torsion effects that appear in the physical frame of Jordan-Fierz can be described in a geometric form given by contorsion term plus a symmetric part which contains the scalar gradient. As an important application of this solution, we consider the linear perturbation method developed by Zel'dovich, investigate the accretion of cold dark matter due to the formation of wakes when a TCSCS moves with speed $v$ and discuss the role played by torsion. Our results are compared with those obtained for cosmic strings in the framework of scalar-tensor theories without taking torsion into account.Comment: 21 pages, no figures, Revised Version, presented at the "XXIV- Encontro Nacional de Fisica de Particulas e Campos ", Caxambu, MG, Brazil, to appear in Phys. Rev.

Fatores associados à insuficiência renal aguda pós-transplante hepático

OBJECTIVE: To evaluate the prevalence and the risk factors associated to the development of acute renal failure in patients submitted to liver transplant, at Hospitalde Clínicas de Porto Alegre from September 1996 to September 1998.PATIENTS AND METHODS: 36 patients that developed acute renal failure after liver transplant (group 1) were compared to those who did not develop acute renalfailure after liver transplant (group 2). The following factors were analyzed prior to surgery: etiology of the renal failure, classification of Child-Pugh, diabetes mellitus,and creatinine levels; during surgery: duration of warm ischemia, duration of surgery, duration of anesthesia; CHAD type of portocaval anastomosis; and after surgery: creatinine levels, infections, need for dialysis, duration of stay at the intensive care unit, cyclosporine levels, need for another intervention, and mortality. All data were evaluated during the first 7 days after surgery, with the exception of chronic renal failure and mortality, which were evaluated during a 3-month period.RESULTS: The prevalence of acute renal failure was high (approximately 49%). The presence of previous diabetes mellitus (P=0.03), the CHAD units used duringsurgery (P=0.046), the duration of stay at the intensive care unit (P=0.01), the surgical technique (P=0,04), and the need for another intervention (P=0.02), were allsignificantly associated to the development of acute renal failure after liver transplant in our sample. There was a significant level of mortality among patients that developed acute renal failure (P=0.02).CONCLUSIONS: We concluded that acute renal failure is a significant cause of mortality among patients submitted to hepatic transplant when associated to multiplerisk factors. OBJETIVO: A prevalência e os fatores de risco associados ao desenvolvimento de IRA nos pacientes submetidos a transplante no Hospital de Clínicas de Porto Älegre (HCPA) no período de setembro/96 a setembro/98.PACIENTES E MÉTODOS: Foram comparados os pacientes que desenvolveram IRA (grupo 1) com os que não desenvolveram (grupo 2). Foram analisados no préoperatório: etiologia da isuficiência hepática, classificação de Child-Pugh, diabete melito (DM) e nível de creatinina; no trans-operatório: tempo de isquemia quente, tempo cirúrgico, tempo de anestesia, unidades de concentrado de hemácias (CHAD), tipo de anastomose porto-cava; e no pós-operatório: níveis de creatinina, infecções, necessidades de diálise, permanência na unidade de tratamento intensivo (UTI), níveis de ciclosporina, reintervenções e mortalidade. Todos os dados foram avaliados nos primeiros 7 dias de pós-operatório, com exceção de insuficiência renal crônica e mortalidade avaliados por 3 meses.RESULTADOS: A prevalência de IRA foi elevada, sendo de aproximadamente 49%. Verificamos que a presença de DM prévia (P = 0,03), unidades de CHAD utilizados no trans-operatório (p = 0,046), o tempo de internação na UTI (P = 0,001), técnica cirúrgica (P = 0,04) e necessidade de reintervenção cirúrgica (P = 0,02) estiveram associados significativamente com o desenvolvimento de IRA no pós-operatório de TxH em nossa amostra. Os pacientes que desenvolveram IRA apresentaram uma significativa mortalidade (P = 0,02). Concluímos que a IRA é uma causa significativa de mortalidade nos pacientes submetidos à transplante hepático estando associada a múltiplos fatores de risco

Technical summary

Human interference with the climate system is occurring. Climate change poses risks for human and natural systems. The assessment of impacts, adaptation, and vulnerability in the Working Group II contribution to the IPCC's Fifth Assessment Report (WGII AR5) evaluates how patterns of risks and potential benefits are shifting due to climate change and how risks can be reduced through mitigation and adaptation. It recognizes that risks of climate change will vary across regions and populations, through space and time, dependent on myriad factors including the extent of mitigation and adaptation

Effect of light, food additives and heat on the stability of sorghum 3-deoxyanthocyanins in model beverages.

This work aimed to evaluate the stability of sorghum 3-deoxyanthocyanins (DXA) in model beverages (pH 3.5) elaborated with crude sorghum phenolic extract, containing ascorbic acid and sulphite, under fluorescent light exposure and subjected to heat treatment. There was no significant difference in the DXA degradation during storage under light exposure (24.16%) and absence of light (20.72%). DXA degradation did not differ in the presence of ascorbic acid during storage under light exposure (23.99-25.38%) and absence of light (19.87-21.74%). The addition of sulphite caused an initial bleaching reaction, but as a reversible reaction, the anthocyanin content was higher on the last day of storage compared to the first day. There were no significant differences in total anthocyanin content of all treatments subjected to the heat treatment (80 °C for 5 and 25 min). Thus, crude DXA are very stable under light, additives and heat, and may be useful as natural food colourants