Perfil da microbiota e padrões de resistência aos antimicrobianos em uroculturas de pacientes transplantados renais

Objective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.El trasplante renal consiste en uno de los medios para mantener la vida en pacientes con enfermedad renal terminal y se trata del manejo con mayor coste-beneficio, sin embargo es un procedimiento quirúrgico complejo. Los factores asociados al desarrollo de la UTI post-transplante son multifactoriales y se definen según la relación entre los agentes etiológicos y las causas del anfitrión. La presencia de microorganismos están relacionados con mal pronóstico a corto y largo plazo en las unidades de trasplante renal. Ante esto, el objetivo del estudio fue analizar el perfil de microorganismos presentes y sensibilidad de éstos a los antimicrobianos en uroculturas de pacientes trasplantados renales en el período 2021-2022. Se trata de un estudio retrospectivo con análisis cuantitativo de los datos de uroculturas positivas de pacientes trasplantados renales acompañados en el Hospital General de Fortaleza entre enero de 2021 y diciembre de 2022. Se empleó un instrumento de investigación elaborado que contenía variables clasificatorias y los datos se obtuvieron a través de registros de las uroculturas existentes en el sistema de prontuario electrónico utilizado por el hospital. De las 534 uroculturas solicitadas, el 36,7% presentó resultado positivo, siendo el 60,4% mujeres de entre 20 y 59 años. La mayoría de los casos se desarrolló en pacientes que recibieron seguimiento ambulatorio (56,2%). Los microorganismos aislados fueron predominantemente enterobacterias (81,34%), con prevalencia de E. coli (69,30%). Los perfiles de sensibilidad antimicrobiana variaron, con la resistencia de E. coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino y ciprofloxacin. Estos hallazgos proporcionan información importante sobre métodos clínicos específicos, métodos preventivos y mejoras en la calidad de vida de los trasplantes renales.  Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais

Clinical characteristics and outcomes of patients hospitalized with COVID-19 in Brazil: Results from the Brazilian COVID-19 registry

Objectives: To describe the clinical characteristics, laboratory results, imaging findings, and in-hospital outcomes of COVID-19 patients admitted to Brazilian hospitals.Methods: A cohort study of laboratory-confirmed COVID-19 patients who were hospitalized from March 2020 to September 2020 in 25 hospitals. Data were collected from medical records using Research Electronic Data Capture (REDCap) tools. A multivariate Poisson regression model was used to assess the risk factors for in-hospital mortality. Results: For a total of 2,054 patients (52.6% male; median age of 58 years), the in-hospital mortality was 22.0%; this rose to 47.6% for those treated in the intensive care unit (ICU). Hypertension (52.9%), diabetes(29.2%), and obesity (17.2%) were the most prevalent comorbidities. Overall, 32.5% required invasive mechanical ventilation, and 12.1% required kidney replacement therapy. Septic shock was observed in 15.0%, nosocomial infection in 13.1%, thromboembolism in 4.1%, and acute heart failure in 3.6%. Age >= 65 years, chronic kidney disease, hypertension, C-reactive protein 100 mg/dL, platelet count < 100 =109/L, oxygen saturation < 90%, the need for supplemental oxygen, and invasive mechanical ventilation at admission were independently associated with a higher risk of in-hospital mortality. The overall use of antimicrobials was 87.9%. Conclusions: This study reveals the characteristics and in-hospital outcomes of hospitalized patients with confirmed COVID-19 in Brazil. Certain easily assessed parameters at hospital admission were independently associated with a higher risk of death

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Equipamentos e insumos odontológicos e sua relação com as unidades da atenção primária à saúde

Objetivo: Analisar a relação entre equipamentos/insumos odontológicos e as unidades de atenção primária à saúde. Métodos: Estudo transversal do tipo quantitativo realizado em postos de saúde (n=243) e unidades básicas de saúde (USB) (n=1101), nas 16 regionais de saúde do Estado da Paraíba, no ano de 2012 e primeiro semestre de 2013. Coletaram-se dados secundários sobre equipamentos e insumos odontológicos nas unidades de saúde. Esses dados emergiram das questões de saúde bucal do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ). Aplicaram-se os testes t de Student e Qui-quadrado (p=0,05). Resultados: Encontrou-se um número reduzido de equipamentos e insumos odontológicos, como autoclaves em condições de uso em apenas 27,2% (n=66) dos postos de saúde e em 29,0% (n=319) das UBS, e selantes em quantidade suficiente apenas em 31,7% (n=77) dos postos de saúde e em 30,7% (n=338) das UBS. Há diferença entre os tipos de unidades e a disponibilidade de equipamentos e materiais, como refletores (p<0,05), constatando-se associações com as regionais de saúde. Conclusão: Na atenção básica, as unidades de saúde do Estado da Paraíba apresentam alguns equipamentos e insumos em número reduzido, com diferença significativa entre o tipo de unidade e as regionais de saúde do estado