Características epidemiológicas de pacientes com sepse em unidade de terapia intensiva

Background and Objectives: Despite the novelties related to the early diagnosis and microbial screening of sepsis cases, it is necessary to understand the clinical-epidemiological aspects of the health services in order to define the specificities of the patients affected by Intensive Care Units (ICUs). In this context, the objective is to describe the epidemiological characteristics of patients with sepsis in the ICU. Methods: This is an exploratory-descriptive, retrospective, documental study, with a quantitative approach, carried out between May and July 2018, in a teaching hospital in the Northern Zone of the State of Ceará. The records of patients who presented sepsis at the ICU of the referred hospital were used as data source, reaching a sample of 62 charts for analysis. The collected data were stored in MicrosoftExcel and OriginLab 8 programs for later construction of graphs and tables for information analysis. Results: The cases were predominantly male, resident in surrounding municipalities and young adults aged 19 to 39 years. Cranioencephalic trauma and polytraumatism were the initial diagnoses that prevailed. Gram-positive bacteria had a higher prevalence, beating gram-negative bacilli and fungi. The most commonly used antimicrobials were Cefepime and Vancomycin. The evolution of infections was associated with factors such as: patients' health status; use of invasive devices and long period of hospitalization. Conclusion: The information obtained in this research indicates that epidemiological data play a crucial role in the application of new resources, technologies and treatments. Such knowledge will allow the development of strategies and behaviors directed at quality in intensive care.Justificación y Objetivos: A pesar de las novedades relacionadas al diagnóstico precoz y al rastreo microbiano de los casos de sepsis, se hace necesario comprender los aspectos clínicoepidemiológicos de los servicios de salud para definir las especificidades de los pacientes acometidos en Unidades de Terapia Intensiva (UTI). En este contexto, se objetiva describir las características epidemiológicas de pacientes con sepsis en UTI. Métodos: Se trata de una investigación exploratoria-descriptiva, retrospectiva, documental, con abordaje cuantitativo, realizado entre mayo y julio de 2018, en hospital de enseñanza de la Zona Norte del Estado de Ceará. Se utilizó como fuente de datos los prontuarios de pacientes que presentaron sepsis en las UTI del referido hospital, alcanzando una muestra de 62 prontuarios para análisis. Los datos recopilados se almacenaron en los programas MicrosoftExcel y OriginLab 8 para la construcción posterior de gráficos y tablas para el análisis de la información. Resultados: Los casos tuvieron predominancia en individuos del sexo masculino, residentes en municipios interiores circundantes y adultos jóvenes con edad entre 19 y 39 años. El traumatismo craneoencefálico y el politraumatismo fueron los diagnósticos iniciales que prevalecieron. Las bacterias gram-positivas tuvieron mayor prevalencia, superando los bacilos gram-negativos y los hongos. Los antimicrobianos más utilizados fueron Cefepima y Vancomicina. Las evoluciones de las infecciones estuvieron asociadas a factores como: estado de salud de los pacientes; el uso de dispositivos invasivos y el largo período de internación. Conclusión: Las informaciones obtenidas en esta investigación indican que los datos epidemiológicos desempeñan un papel crucial en la aplicación de nuevos recursos, tecnologías y tratamientos. Tales conocimientos permitirán desarrollar estrategias y conductas dirigidas a la calidad en la asistencia intensiva.Justificativa e Objetivos: Apesar das novidades relacionadas ao diagnóstico precoce e ao rastreamento microbiano dos casos de sepse, faz-se necessário compreender os aspectos clínico-epidemiológicos dos serviços de saúde visando definir as especificidades dos pacientes acometidos em Unidades de Terapia Intensiva (UTI). Nesse contexto, objetiva-se descrever as características epidemiológicas de pacientes com sepse em UTI. Métodos: Trata-se de uma pesquisa exploratória-descritiva, retrospectiva, documental, com abordagem quantitativa, realizada entre maio e julho de 2018, em hospital de ensino da Zona Norte do Estado do Ceará. Utilizou-se como fonte de dados os prontuários de pacientes que apresentaram sepse nas UTI do referido hospital, alcançando-se uma amostra de 62 prontuários para análise. Os dados coletados foram armazenados nos programas Microsoft Excel e Origin Lab 8 para posterior construção de gráficos e tabelas para análise das informações. Resultados: Os casos tiveram predominância em indivíduos do sexo masculino, residentes em municípios interioranos circunvizinhos e adultos jovens com idade entre 19 e 39 anos. O traumatismo cranioencefálico e o politraumatismo foram os diagnósticos iniciais que prevaleceram. As bactérias grampositivas tiveram maior prevalência, superando os bacilos gram-negativos e os fungos. Os antimicrobianos mais utilizados foram Cefepime e Vancomicina. As evoluções das infecções estiveram associadas a fatores como: estado de saúde dos pacientes; utilização de dispositivos invasivos e longo período de internação. Conclusão: As informações obtidas nesta pesquisa indicam que os dados epidemiológicos desempenham papel crucial no que diz respeito à aplicação de novos recursos, tecnologias e tratamentos. Tais conhecimentos permitirão desenvolver estratégias e condutas direcionadas à qualidade na assistência intensiva

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system

The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1st, 2004, to December 1st, 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB

O impacto da pandemia no desempenho de monitores de anatomia em processos de seleção de bolsas de uma instituição pública / The impact of the pandemic on the performance of anatomy monitors in scholarship selection processes at a public institution

Os processos seletivos de monitores da instituição pública federal são realizados no início de cada semestre letivo com avaliação prática e teórica do desempenho dos estudantes aptos a serem monitores de anatomia e neuroanatomia humana. Com isso, o objetivo do presente estudo foi avaliar o desempenho cognitivo dos estudantes candidatos ao processo seletivo de monitoria de anatomia e neuroanatomia humana entre os anos de 2018 e 2022. Nesse viés, o estudo em questão identificou o impacto negativo do ensino remoto durante a pandemia do Coronavírus nos anos de 2020 e 2021. Desse modo, a análise verificou que apesar dos esforços dispendidos com o uso de tecnologias, metodologias ativas de ensino aprendizagem, estudo híbrido com aulas síncronas e assíncronas, os estudantes que participaram do processo seletivo presencial no ano de 2022 demonstraram desempenhos piores em comparação com os estudantes que participaram dos processos seletivos presenciais entre os anos de 2018 a 2019. Depreende-se, então, que o ensino presencial de anatomia humana é essencial para o bom aprendizado dos conteúdos abordados na unidade curricular do curso de medicina da instituição pública avaliada

Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit

ObjectivesTo assess the ABC2-SPH score in predicting COVID-19 in-hospital mortality, during intensive care unit (ICU) admission, and to compare its performance with other scores (SOFA, SAPS-3, NEWS2, 4C Mortality Score, SOARS, CURB-65, modified CHA2DS2-VASc, and a novel severity score).Materials and methodsConsecutive patients (≥ 18 years) with laboratory-confirmed COVID-19 admitted to ICUs of 25 hospitals, located in 17 Brazilian cities, from October 2020 to March 2022, were included. Overall performance of the scores was evaluated using the Brier score. ABC2-SPH was used as the reference score, and comparisons between ABC2-SPH and the other scores were performed by using the Bonferroni method of correction. The primary outcome was in-hospital mortality.ResultsABC2-SPH had an area under the curve of 0.716 (95% CI 0.693–0.738), significantly higher than CURB-65, SOFA, NEWS2, SOARS, and modified CHA2DS2-VASc scores. There was no statistically significant difference between ABC2-SPH and SAPS-3, 4C Mortality Score, and the novel severity score.ConclusionABC2-SPH was superior to other risk scores, but it still did not demonstrate an excellent predictive ability for mortality in critically ill COVID-19 patients. Our results indicate the need to develop a new score, for this subset of patients

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Educomunicação, Transformação Social e Desenvolvimento Sustentável

Esta publicação apresenta os principais trabalhos dos GTs do II Congresso Internacional de Comunicação e Educação nos temas Transformação social, com os artigos que abordam principalmente Educomunicação e/ou Mídia-Educação, no contexto de políticas de diversidade, inclusão e equidade; e, em Desenvolvimento Sustentável os artigos que abordam os avanços da relação comunicação/educação no contexto da educação ambiental e desenvolvimento sustentável

Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).</jats:sec

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications