Consumo de benzilpenicilina como indicador de controle de sífilis

A sífilis é uma doença de notificação compulsória e obrigatória ao Sistema de Informação de Agravos de Notificação (SINAN), em todas as suas formas de apresentação, sendo a benzilpenicilina benzatina o tratamento de escolha. O objetivo do estudo foi comparar o consumo do medicamento benzilpenicilina benzatina entre as regiões de saúde de uma capital da região sul do país de acordo com o georreferenciamento dos casos notificados de sífilis. Trata-se de um estudo descritivo com desenho transversal do consumo retrospectivo do medicamento benzilpenicilina benzatina e de casos notificados de sífilis. Os dados dos casos de sífilis foram obtidos das notificações realizadas no SINAN através do sistema Business Intelligence (BI) e os dados de consumo do medicamento foram obtidos a partir do sistema informatizado de Dispensação de Medicamentos (DIS) da Secretaria Municipal, no ano de 2019. As notificações e o consumo do medicamento foram georreferenciadas de acordo com as 8 regiões de saúde. A partir da compilação dos dados foram calculadas as taxas de casos e de consumo em relação a população de cada região. Foram analisadas 3188 notificações no SINAN e um total de 35191 frascos do medicamento benzilpenicilina benzatina. Ao compararmos o número de casos e o consumo de frascos de todo município verificase uma variabilidade de consumo que não é acompanhada número de casos. Quando analisadas os gráficos de consumo e de casos separadamente por regiões verifica-se uma variabilidade em todas as regiões. A relação frascos por casos mostrou que cada paciente retirou 11 frascos do medicamento, sendo um valor consumido alto, quando consideramos que o tratamento completo seria de 2 a 6 frascos por caso. Com a visualização do georreferenciamento de casos a partir da retirada do medicamento conseguimos estabelecer hipóteses de gestão em saúde a partir do monitoramento e acompanhamento dos dados sobre as notificações de sífilis e da retirada de medicamentos.Syphilis is a disease with compulsory and mandatory notification to the Notifiable Diseases Information System (SINAN), in all its forms of presentation, with benzathine benzylpenicillin being the treatment of choice. The aim of the study was to compare the consumption of the drug benzylpenicillin benzathine between the health regions of a capital in the southern region of the country, according to the georeferencing of notified cases of syphilis. This is a retrospective analysis of secondary data on the consumption of the drug benzylpenicillin benzathine and on reported cases of syphilis. Data on syphilis cases were obtained from notifications made in SINAN through the Business Intelligence (BI) system and drug consumption data were obtained from the computerized system of Drug Dispensing (DIS) of the Municipal Secretariat, in the year 2019 Notifications and drug consumption were georeferenced according to the 8 health regions. From the compilation of data, the rates of cases and consumption in relation to the population of each region were calculated. A total of 3188 notifications in SINAN and a total of 35191 vials of the benzathine benzylpenicillin were analyzed. When comparing the number of cases and the consumption of bottles in the entire municipality, there is a variability in consumption that is not accompanied by the number of cases. When the consumption and case curves are analyzed separately by region, there is variability in all regions. The relation bottles by cases showed that each patient removed 11 bottles of the drug, with a high consumed value, when considering that the complete treatment would be 2 to 6 bottles per case. With the visualization of the georeferencing of cases from the withdrawal of the drug, we were able to establish health management hypotheses based on the monitoring and follow-up of data on the notifications of syphilis and the withdrawal of drugs

Consumption of benzylpenicillin as a syphilis control indicator

Syphilis is a disease with compulsory and mandatory notification to the Notifiable Diseases Information System (SINAN), with benzathine benzylpenicillin being the treatment of choice. The aim of the study was to compare the consumption of benzylpenicillin benzathine, from the dispensation, between the health regions of a capital in the southern region of the country, according to the georeferencing of notified cases of syphilis. This is a descriptive, cross-sectional, retrospective study of the use of benzylpenicillin benzathine and of reported cases of syphilis. Data on syphilis cases were obtained from notifications made in SINAN, and drug consumption data were obtained from the Municipal Health Department computerized system for Drug Dispensing from January 1st, 2019 to December 31st, 2019. Notifications and drug consumption were georeferenced according to 8 health regions. From the compilation of data, the rates of cases and consumption in relation to the population of each region were calculated. A total of 3188 notifications and a total of 35191 vials of benzathine benzylpenicillin were analyzed. The ratio of vials by SINAN notifications showed that each patient took 11 vials of the drug, which is a higher value if we consider that the complete treatment is 2 to 6 vials per case

Análise de erros de prescrição de morfina e tramadol em idosos: uma proposta de melhorias

Este trabalho tem como objetivo identificar a prevalência de erros de prescrição de morfina solução injetável e tramadol solução injetável de pacientes com idade igual ou superior a 60 anos, hospitalizados na Unidade de Internação Adulto do Hospital Universitário (HU) Canoas. Trata-se de um estudo observacional descritivo retrospectivo, de caráter quantitativo. Foram utilizadas 496 prescrições contendo os medicamentos morfina solução injetável e tramadol solução injetável. A coleta de dados foi realizada no período de abril e maio de 2018. Os dados foram repassados para uma planilha do software Microsoft Excel, para análise de frequência. Das 496 prescrições avaliadas, foram encontrados 130 (26,21%) erros de prescrição demedicamentos,sendo 49 erros envolvendo morfina e 81 envolvendotramadol. Se tratando de pacientes idosos em uso de analgésicos opioides, a inclusão do farmacêutico na equipe multiprofissional para a avaliação das prescrições,aumentaria agarantiado sucesso terapêutico e da segurança do paciente

Spatial analysis of probable cases of dengue fever, chikungunya fever and zika virus infections in Maranhao State, Brazil

Dengue fever, chikungunya fever, and zika virus infections are increasing public health problems in the world, the last two diseases having recently emerged in Brazil. This ecological study employed spatial analysis of probable cases of dengue fever, chikungunya fever, and zika virus infections reported to the National Mandatory Reporting System (SINAN) in Maranhao State from 2015 to 2016. The software GeoDa version 1.10 was used for calculating global and local Moran indices. The global Moran index identified a significant autocorrelation of incidence rates of dengue (I=0.10; p=0.009) and zika (I=0.07; p=0.03). The study found a positive spatial correlation between dengue and the population density (I=0.31; p<0.001) and a negative correlation with the Performance Index of Unified Health System (PIUHS) by basic care coverage (I=-0.08; p=0.01). Regarding chikungunya fever, there were positive spatial correlations with the population density (I=0.06; p=0.03) and the Municipal Human Development Index (MHDI) (I=0.10; p=0.002), and a negative correlation with the Gini index (I=-0.01; p<0.001) and the PIUHS by basic care coverage (I=-0.18; p<0.001). Lastly, we found positive spatial correlations between Zika virus infections and the population density (I=0.13; p=0.005) and the MHDI (I=0.12; p<0.001), as well as a negative correlation with the Gini index (I=-0.11; p<0.001) and the PIUHS by basic care coverage (I=-0.05; p=0.03). Our results suggest that several socio-demographic factors influenced the occurrence of dengue fever, chikungunya fever, and zika virus infections in Maranhao State

Genomic epidemiology unveils the dynamics and spatial corridor behind the Yellow Fever virus outbreak in Southern Brazil

Despite the considerable morbidity and mortality of yellow fever virus (YFV) infections in Brazil, our understanding of disease outbreaks is hampered by limited viral genomic data. Here, through a combination of phylogenetic and epidemiological models, we reconstructed the recent transmission history of YFV within different epidemic seasons in Brazil. A suitability index based on the highly domesticated Aedes aegypti was able to capture the seasonality of reported human infections. Spatial modeling revealed spatial hotspots with both past reporting and low vaccination coverage, which coincided with many of the largest urban centers in the Southeast. Phylodynamic analysis unraveled the circulation of three distinct lineages and provided proof of the directionality of a known spatial corridor that connects the endemic North with the extra-Amazonian basin. This study illustrates that genomics linked with eco-epidemiology can provide new insights into the landscape of YFV transmission, augmenting traditional approaches to infectious disease surveillance and control

Measurement of the p-pbar -> Wgamma + X cross section at sqrt(s) = 1.96 TeV and WWgamma anomalous coupling limits

The WWgamma triple gauge boson coupling parameters are studied using p-pbar -> l nu gamma + X (l = e,mu) events at sqrt(s) = 1.96 TeV. The data were collected with the DO detector from an integrated luminosity of 162 pb^{-1} delivered by the Fermilab Tevatron Collider. The cross section times branching fraction for p-pbar -> W(gamma) + X -> l nu gamma + X with E_T^{gamma} > 8 GeV and Delta R_{l gamma} > 0.7 is 14.8 +/- 1.6 (stat) +/- 1.0 (syst) +/- 1.0 (lum) pb. The one-dimensional 95% confidence level limits on anomalous couplings are -0.88 < Delta kappa_{gamma} < 0.96 and -0.20 < lambda_{gamma} < 0.20.Comment: Submitted to Phys. Rev. D Rapid Communication

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Search for the Standard Model Higgs Boson in the ZH --> neutrino-neutrino-b-b channel

We report a search for the standard model (SM) Higgs boson based on data collected by the D0 experiment at the Fermilab Tevatron Collider, corresponding to an integrated luminosity of 260 pb^-1. We study events with missing transverse energy and two acoplanar b-jets, which provide sensitivity to the ZH production cross section in the neutrino-neutrino-b-b channel and to WH production, when the lepton from the W -> lepton+neutrino decay is undetected. The data are consistent with the SM background expectation, and we set 95% C.L. upper limits on sigma(p p-bar -> ZH/WH) x B(H -> b b-bar) from 3.4/8.3 to 2.5/6.3 pb, for Higgs masses between 105 and 135 GeV.Comment: submitted to Phys. Rev. Letter

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Rarity of monodominance in hyperdiverse Amazonian forests.

Tropical forests are known for their high diversity. Yet, forest patches do occur in the tropics where a single tree species is dominant. Such "monodominant" forests are known from all of the main tropical regions. For Amazonia, we sampled the occurrence of monodominance in a massive, basin-wide database of forest-inventory plots from the Amazon Tree Diversity Network (ATDN). Utilizing a simple defining metric of at least half of the trees ≥ 10 cm diameter belonging to one species, we found only a few occurrences of monodominance in Amazonia, and the phenomenon was not significantly linked to previously hypothesized life history traits such wood density, seed mass, ectomycorrhizal associations, or Rhizobium nodulation. In our analysis, coppicing (the formation of sprouts at the base of the tree or on roots) was the only trait significantly linked to monodominance. While at specific locales coppicing or ectomycorrhizal associations may confer a considerable advantage to a tree species and lead to its monodominance, very few species have these traits. Mining of the ATDN dataset suggests that monodominance is quite rare in Amazonia, and may be linked primarily to edaphic factors