Reducción del tiempo de tratamiento antimicrobiano en unidades de cuidados intensivos en Fortaleza, Brasil

Objective: To evaluate the application of the Antimicrobial (ATM) treatment time reduction strategy in Intensive Care Units (ICU) in an Antimicrobial Stewardship Program (ASP). Method: This is a descriptive and cross-sectional study, carried out in two ICU of a university hospital in Fortaleza, Brazil, from January/2017 to January/2019. Adult patients were included, accompanied by a pharmacist, and using ATM, in which the treatment time reduction strategy was applied. The evaluation of the strategy was made through the difference between the predicted time established at the beginning of the treatment and the effective days of use of each ATM. Results: Of the 100 patients included, 51.0 % were male and 64.0 % were elderly. The respiratory system was the most frequently affected by the infections (37.4 %) and the most prevalent classes of ATM were carbapenems (23.0 %) and glycopeptides (20.1 %). There was a decrease from 831 unnecessary days of antimicrobial therapy and from an average of 13.7 to 8.9 days of treatment. The greatest reductions in days were observed for meropenem, with 202 days reduced. The study also allowed the identification of associations between the reduction > 8 days of treatment and the variables length of stay > 22 days and patients in exclusive palliative care, and associations between hospital discharge and reductions of up to 7 days of therapy. Conclusions: The data obtained suggest that the presence of an ASP influences the practices of ATM use and its treatment time and emphasize the role of pharmaceutical professionals in these programs.Objetivo: Evaluar la aplicación de la estrategia reducción del tiempo de tratamiento Antimicrobiano (ATM) en Unidades de Cuidados Intensivos (UCI) en un Programa Stewardship de Antimicrobiano (ASP). Método: Este es un estudio descriptivo y transversal, realizado en dos UCI de un hospital universitario de Fortaleza, Brasil, de enero/2017 a enero/2019. Se incluyeron pacientes adultos, acompañados por un farmacéutico y utilizando ATM, en los que se aplicó la estrategia de reducción del tiempo de tratamiento. La evaluación de la estrategia se realizó a través de la diferencia entre el tiempo previsto establecido al inicio del tratamiento y los días efectivos de uso de cada ATM. Resultados: De los 100 pacientes incluidos, 51,0 % eran del sexo masculino y 64,0 % ancianos. El sistema respiratorio fue el más frecuentemente afectado (37,4 %) y las clases de ATM más prevalentes fueron los carbapenémicos (23,0 %) y los glicopéptidos (20,1 %). Hubo una disminución de 831 días innecesarios de terapia antimicrobiana y de un promedio de 13,7 a 8,9 días de tratamiento. Las mayores reducciones en días se observaron para meropenem, con 202 días reducidos. El estudio también permitió identificar asociaciones entre la reducción > 8 días de tratamiento y las variables estancia > 22 días y pacientes en cuidados paliativos exclusivos; y asociaciones entre alta hospitalaria y reducciones de hasta 7 días de terapia. Conclusiones: Los datos obtenidos sugieren que la presencia de un ASP influye en las prácticas de uso de ATM y su tiempo de tratamiento y enfatizan el papel de los profesionales farmacéuticos en estos programas

Reducción del tiempo de tratamiento antimicrobiano en unidades de cuidados intensivos en Fortaleza, Brasil

The authors are grateful for the contribution of the physicians, pharmacists and patients of the Walter Cantídio University Hospital who collaborated in the conduction of this study.Objective: To evaluate the application of the Antimicrobial (ATM) treatment time reduction strategy in Intensive Care Units (ICU) in an Antimicrobial Stewardship Program (ASP). Method: This is a descriptive and cross-sectional study, carried out in two ICU of a university hospital in Fortaleza, Brazil, from January/2017 to January/2019. Adult patients were included, accompanied by a pharmacist, and using ATM, in which the treatment time reduction strategy was applied. The evaluation of the strategy was made through the difference between the predicted time established at the beginning of the treatment and the effective days of use of each ATM. Results: Of the 100 patients included, 51.0 % were male and 64.0 % were elderly. The respiratory system was the most frequently affected by the infections (37.4 %) and the most prevalent classes of ATM were carbapenems (23.0 %) and glycopeptides (20.1 %). There was a decrease from 831 unnecessary days of antimicrobial therapy and from an average of 13.7 to 8.9 days of treatment. The greatest reductions in days were observed for meropenem, with 202 days reduced. The study also allowed the identification of associations between the reduction > 8 days of treatment and the variables length of stay > 22 days and patients in exclusive palliative care, and associations between hospi tal discharge and reductions of up to 7 days of therapy. Conclusions: The data obtained suggest that the presence of an ASP influences the practices of ATM use and its treatment time and emphasize the role of pharmaceutical professionals in these programs.Objetivo: Evaluar la aplicación de la estrategia reducción del tiempo de tratamiento Antimicrobiano (ATM) en Uni dades de Cuidados Intensivos (UCI) en un Programa Stewardship de Antimicrobiano (ASP). Método: Este es un estudio descriptivo y transversal, realizado en dos UCI de un hospital universitario de Fortaleza, Brasil, de enero/2017 a enero/2019. Se incluyeron pacientes adultos, acompañados por un farmacéutico y utilizan do ATM, en los que se aplicó la estrategia de reducción del tiempo de tratamiento. La evaluación de la estrategia se realizó a través de la diferencia entre el tiempo previsto establecido al inicio del tratamiento y los días efectivos de uso de cada ATM. Resultados: De los 100 pacientes incluidos, 51,0 % eran del sexo masculino y 64,0 % ancianos. El sistema respira torio fue el más frecuentemente afectado (37,4 %) y las clases de ATM más prevalentes fueron los carbapenémicos (23,0 %) y los glicopéptidos (20,1 %). Hubo una disminución de 831 días innecesarios de terapia antimicrobiana y de un promedio de 13,7 a 8,9 días de tratamiento. Las mayores reducciones en días se observaron para meropenem, con 202 días reducidos. El estudio también permitió identificar asociaciones entre la reducción > 8 días de trata miento y las variables estancia > 22 días y pacientes en cuidados paliativos exclusivos; y asociaciones entre alta hospitalaria y reducciones de hasta 7 días de terapia. Conclusiones: Los datos obtenidos sugieren que la presencia de un ASP influye en las prácticas de uso de ATM y su tiempo de tratamiento y enfatizan el papel de los profesionales farmacéuticos en estos programa

Nutrição e câncer de mama: um artigo de revisão

O câncer de mama é a segunda neoplasia mais comum entre as mulheres, sendo mais prevalente em mulheres entre 40 e 60 anos. Essa neoplasia, que representa a principal causa de morte por câncer entre as mulheres brasileiras, pode ser diagnosticada a partir de exames de mamografia e de ultrassom, sobretudo em mulheres mais jovens. Estudos recentes mostram que o aparecimento e a progressão do câncer de mama pode ser influenciada pelos hábitos alimentares da mulher.  Determinar a influência da alimentação no aparecimento, na progressão e no tratamento do câncer de mama. Para esta revisão integrativa, foram analisados artigos, publicados em português e em inglês, entre os anos de 2017 e 2022, nas bases de dado Medline, Pubmed, e Scielo, usando os descritores “câncer de mama”, “nutrição”, “dieta” e “nutriente" O estudo realizado por CACAU et al mostrou que os níveis de vitaminas A, D e E, em pacientes que consultaram no serviço de mastologia estavam abaixo do recomendado, o que se torna preocupante visto que essas vitaminas são importantes na prevenção do câncer.  SOUZA et al, observou em seus estudos transversais, que a obesidade e o sobrepeso estavam intimamente relacionados com o aparecimento do câncer de mama, devido à hiperestimulação estrogênica. CICCO et al mostra que o aconselhamento de mulheres a respeito do consumo de EPA e DHA é fundamental para reduzir os efeitos da quimioterapia. JIA et al, em seus estudos detalhou o efeito de cada um dos macronutrientes no surgimento e no desenvolvimento do câncer, apontando para aqueles que têm seu consumo estimulado e aqueles que devem ter seu consumo evitado. LIMA et al mostra em sua revisão de literatura a importância de um acompanhamento farmacoterápico durante a quimioterapia. O câncer de mama sofre grande influência de hábitos alimentares, devendo, alguns alimentos, como carnes vermelhas e bebidas alcoólicas serem evitados. No entanto, ainda é necessária a realização de mais estudos a fim de verificar o impacto da alimentação em grupos com fatores de risco específicos

Respirometry and Ruminant Nutrition

The gaseous exchange between an organism and the environment is measured by respirometry or indirect calorimetry. Once the oxygen consumption (O2) and the production of carbon dioxide (CO2) and methane (CH4) are known, the energy losses by gas and heat can be calculated. Energy metabolism and methane production have been studied in the Calorimetry and Metabolism Laboratory of the Federal University of Minas Gerais, located in Belo Horizonte, Minas Gerais, Brazil. Animals used are mainly Zebu cattle and their crossbreeds that represent most beef and dairy cattle breed grazed on tropical pastures. System calibration and routine work are addressed in this text. The results obtained on respirometric chambers are expressed in net energy (NE), which can be net energy for maintenance (NEm), lactation (NEL), weight gain (NEg), and pregnancy (NEp). NE is, in fact, what is used by the animal for maintenance and each productive function. The values of k (conversion efficiency of ME into NE) for maintenance (km), milk (kL), weight gain or growth (kg), and pregnancy (kp) are determined. Thanks to the peculiarity of the respirometric technique, the same animal can be evaluated several times, in different physiological states and planes of nutrition

Early reduction in PD-L1 expression predicts faster treatment response in human cutaneous leishmaniasis

Cutaneous leishmaniasis (CL) is caused by Leishmania donovani in Sri Lanka. Pentavalent antimonials (e.g. sodium stibogluconate; SSG) remain first line drugs for CL with no new effective treatments emerging. We studied whole blood and lesion transcriptomes from Sri Lankan CL patients at presentation and during SSG treatment. From lesions but not whole blood, we identified differential expression of immune-related genes, including immune checkpoint molecules, after onset of treatment. Using spatial profiling and RNA-FISH, we confirmed reduced expression of PD-L1 and IDO1 proteins on treatment in lesions of a second validation cohort and further demonstrated significantly higher expression of these checkpoint molecules on parasite-infected compared to non-infected lesional CD68+ monocytes / macrophages. Crucially, early reduction in PD-L1 but not IDO1 expression was predictive of rate of clinical cure (HR = 4.88) and occurred in parallel with reduction in parasite load. Our data support a model whereby the initial anti-leishmanial activity of antimonial drugs alleviates checkpoint inhibition on T cells, facilitating immune-drug synergism and clinical cure. Our findings demonstrate that PD-L1 expression can be used as predictor of rapidity of clinical response to SSG treatment in Sri Lanka and support further evaluation of PD-L1 as a host directed therapy target in leishmaniasis

Condutas iniciais na Síndrome Coronariana aguda e seu desfecho sobre os quadros de Taquiarritmias: uma revisão sistemática com metanálise: Initial conducts in acute Coronary Syndrome and its outcome on Tachyarrhythmia frames: a systematic review with meta-analysis

Este artigo tem por objetivo realizar uma revisão sistemática de literatura sobre condutas iniciais diante de um quadro síndrome coronariana aguda e seu impacto sobre quadros de taquiarritmias. Trata-se de uma revisão sistemática de literatura baseada em buscas nas bases de dados Biblioteca Virtual em Saúde – BVS, Google Acadêmico, Lilacs, Pubmed e Scientific Electronic Library Online – SciELO. A pesquisa utilizou-se dos seguintes descritores, segundo o DeCS, com seus correspondentes no idioma inglês e espanhol: Arritmias Cardíacas; Taquicardia; Síndrome Coronariana Aguda. Os principais resultados obtidos apontam que a síndrome coronariana aguda, um evento isquêmico do miocárdio, decorrente da hipoperfusão cardíaca, pode resultar em taquiarritmias supraventriculares (TSV) e ventriculares (TV), tendo seu desfecho clínico e prognóstico dependente do intervalo de tempo desde o início do evento e do tipo de taquiarritmia desencadeada. A partir disto, surge a questão sobre quais condutas iniciais tomadas diante de SCA minimizaria desfechos clínicos de taquiarritmias, a fim de garantir um manejo adequado e minimização da morbimortalidade

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

Repercussões do Sars-Cov-2 no âmbito da cirurgia geral e medicina de emergência: uma revisão

Na China, em dezembro de 2019, foram relatados os primeiros casos da patologia respiratória  COVID-19, doença causado pelo SARS-CoV-2, um RNA vírus. A propagação foi veloz e global, de maneira que a Organização Mundial de Saúde definiu como pandemia em março de 2020. A doença tem manifestação clínica variada, com enfermos assintomáticos ou manifestando quadro crítico, apresentando alta transmissibilidade e letalidade considerável. Simultaneamente, indivíduos com indicação cirúrgica, de origem traumática ou não, tiveram seus atendimentos eletivos paralisados e houve queda nos índices de intervenções de cunho emergencista, tanto devido o medo do indivíduo procurar um serviço de saúde e ser contaminado pelo coronavírus, quanto por outros fatores. Essa revisão teve como objetivo averiguar como a pandemia acometeu serviços de cirurgia geral de emergência, bem como elucidar os preditores e fatores que ocasionaram mudanças no manejo e intervenções cirúrgicas durante o surto de SARS-CoV-2