Descrição de casos de Enterobactérias Produtoras de Carbapenemases subtipos Oxa-48 e NDM em hospital público de Porto Alegre

ABSTRACT Background and objective: The bacterial multidrug resistance restless managers and health professionals in global. In this context, carbapenem resistance in Enterobacteriaceae is particularly worrying because of its high mortality (from 40 to 50% in 30 days) and by reduced treatment options. Between the carbapenemases, subtypes KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi Metallobetalactamase) and OXA (Oxa-carbapenemase) we found in Rio Grande do Sul. This study aim describing the cases of carbapenemase-producing Enterobacteriaceae (CPE) subtypes OXA and NDM in a public hospital in Porto Alegre, Brazil. Method: descriptive research, using the database of hospital infection control committee at the hospital. Data collection occurred after approval by the Research Ethics Committee in April 2015. The sample comprised the confirmed cases of CPE subtypes OXA and NDM from January to December 2013. Results: We identified 34 cases of CPE, those 22 confirmed cases of subtype OXA-48 and 12 cases of subtype NDM. Among patients with subtype OXA-48, men totaled 77.3% and surpassed the colonization 81.2% infection; mortality reached 54.5% of cases, and the most prevalent organism was Klebsiella pneumoniae (45.5%). Men accounted for 58.4% of NDM, with predominance of colonization 83.3% in isolates of Enterobacter cloacae, whose mortality accounted for 58.3%. Conclusion: the high mortality and prevalence of colonization were relevant in this research. Therefore, early detection of these resistance mechanisms can help to contain its spread. KEYWORDS: Drug resistance, Microbial. Infection control. EnterobacteriaceaeRESUMEN Justificación y objetivos: La multirresistencia bacteriana hojas gestores inquietos y profesionales de la salud en el ámbito mundial. En este contexto, la resistencia carbapenem en enterobacterias es de particular interés debido a su alta tasa de mortalidad (40 a 50% en 30 días) y las opciones de tratamiento reducidos. Entre los carbapenemasas, los subtipos KPC (Klebsiella pneumoniae carbapenemase), NDM (Nueva Delhi Metallobetalactamase) y OXA (Oxa-carbapenemase) se encuentran en Rio Grande do Sul. El objetivo de este estudio es describir los casos de Enterobatérias Productoras de Carbapenemasas (EPC) de los subtipos OXA y NDM en hospital público de Porto Alegre. Métodos: Se trata de un estudio descriptivo mediante el comité de infecciones intrahospitalarias, un estudio de base de datos. La recolección de datos se llevó a cabo después de la aprobación del Comité de Ética de Investigación en abril de 2015. La muestra compuesta casos confirmados de EPC subtipos OXA y NDM de enero a diciembre 2013. Resultados: Se identificaron 34 casos de EPC, 22 casos confirmados de subtipo OXA-48 y 12 casos de subtipo NDM. En OXA-48 subtipo, los hombres han ascendido a 77,3% y la colonización han superado con creces la infección por el 81,2%; mortalidad alcanzó 54,5% de los casos, el organismo más prevalente Klebsiella pneumoniae (45,5%). Los hombres han ascendido a 58,4% de los casos de NDM, especialmente la colonización del 83,3% en aislamientos de Enterobacter cloacae, que representaron el 58,3% de mortalidad. Conclusiones: La alta mortalidad y la prevalencia de colonización eran relevantes en esta investigación. Por lo tanto, la detección temprana de estos mecanismos de resistencia puede contribuir a su propagación. PALABRAS CLAVE: Farmacorresistencia Microbiana. Control de Infecciones. EnterobacteriaceaeJustificativa: A multirresistência bacteriana vem preocupando gestores e profissionais de saúde em esfera global. Neste contexto, a resistência aos carbapenêmicos em enterobactérias é particularmente preocupante em função de sua alta mortalidade (de 40 a 50% em 30 dias) e pelas reduzidas opções de tratamento. Entre as carbapenemases, os subtipos KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi Metallobetalactamase) e OXA (Oxa-carbapenemase) são encontrados no estado. Objetivo: descrever os casos de enterobatérias produtoras de carbapenemase (EPC) subtipos OXA e NDM em um hospital público de Porto Alegre. Método: Trata-se de pesquisa transversal, utilizando o banco de dados da Comissão de Controle de Infecção Hospitalar do hospital em estudo. A coleta de dados ocorreu após aprovação do Comitê de Ética em Pesquisa no mês de abril de 2015. A amostra englobou os casos confirmados de EPC subtipos OXA e NDM de janeiro a dezembro de 2013. Resultados: Foram identificados 34 casos de EPC, sendo 22 casos confirmados do subtipo OXA-48 e 12 casos do subtipo NDM. Entre os pacientes portadores do subtipo OXA-48, os homens totalizaram 77,3% e a colonização superou em muito a infecção 81,2%; a mortalidade atingiu 54,5% dos casos, sendo que o microrganismo mais prevalente foi a Klebsiella pneumoniae (45,5%). Os homens somaram 58,4% dos casos de NDM, com predominância de colonizações 83,3% em isolados de Enterobacter cloacae, cuja mortalidade contabilizou 58,3%. Conclusões: A elevada mortalidade e a prevalência de colonizações foram relevantes nesta pesquisa. Portanto, a detecção precoce destes mecanismos de resistência pode contribuir para conter sua disseminação

MINUTO CORONA: A EXTENSÃO UNIVERSITÁRIA NO ENFRENTAMENTO DA PANDEMIA DE COVID-19

Em março de 2020, a Coronavírus Disease (COVID-19), até então desconhecida e sem tratamento específico, preocupou o mundo, principalmente pela transmissibilidade. A população, em sua grande parte mais leiga, assistia a tudo isso sem saber muito bem o que fazer ou como reagir, e surgiam, a todo momento, orientações que se fizeram necessárias para (con)vivermos como sociedade diante de inúmeros questionamentos. Entendemos que se fazia necessário construir um diálogo com a população em geral, visando a dispor de uma comunicação efetiva sobre o cenário da pandemia. Percebemos que a carência de informação qualificada, as dúvidas e as fake news seriam um obstáculo para as pessoas entenderem a gravidade da situação desencadeada pelo coronavírus. Desta forma, como voluntários, nos unimos em uma Ação de Extensão denominada MINUTO CORONA, que tem como pilar a construção do conhecimento além dos muros da universidade, com o foco na comunicação rápida e eficaz. Nosso objetivo é responder as perguntas e publicar conteúdos científicos. Estes são divididos em categorias, como: máscaras, testes e diagnósticos, sinais e sintomas, contágio, desinfecção e limpeza, medicações, vacinas, fake news, orientações e relatos. Nosso diferencial: responder e interagir com as pessoas. As evidências científicas foram a mola propulsora da equipe, a partir das quais traduzimos o conhecimento para linguagem acessível, disponibilizado nas redes sociais. Nosso alcance ultrapassou as expectativas e contabilizou mais de 123.482 interações com a população. A ação aproximou realidades e promoveu saúde, conectando a universidade à comunidade por meio da tecnologia

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Factors related to surgical site infections after obstetric procedures

AIMS: Surgical site infection is the second main cause of nosocomial infections and a major complication during postpartum period. This study aimed to describe characteristics and risk factors found in puerperal women who had surgical site infection. METHODS: A retrospective cross-sectional study was conducted at Hospital Femina, Porto Alegre, Rio Grande do Sul, Brazil, including deliveries from January 2009 to December 2010. From a total of 9528 deliveries, 110 records of patients diagnosed with surgical site infection after vaginal delivery or cesarean section were detected and analyzed. RESULTS: We found a rate of surgical site infection of 1.53% for cesarean deliveries and of 1.01% for vaginal deliveries (RR 1.5, 95%CI 1.3-1.7). Among the patients with surgical site infection many had low socioeconomic status, were obese and had incorrect administration of antibiotic prophylaxis in pre-partum. CONCLUSIONS: The risk of infection was one and a half times greater after a caesarean section than after a vaginal delivery. The rates of postpartum surgical site infection found in this study, as well as some characteristics of the patients who developed infections, stress the importance of identifying potential risk factors and to seek prevention in obstetric patients through standards of practice that include proper use of prophylactic antibiotics

ADOECIMENTO MENTAL: INTERFACES COM O AMBIENTE DE TRABALHO DURANTE A PANDEMIA DE COVID-19, SOB A ÓTICA DOS PROFISSIONAIS DE ENFERMAGEM

O crescimento de patologias invisíveis decorrentes do desgaste psíquico dos profissionais de enfermagem acende um alerta: faltam políticas trabalhistas das instituições com foco na prevenção. Este estudo tem como objetivo avaliar qual a percepção dos profissionais de enfermagem sobre o adoecimento mental em seu ambiente de trabalho, potencializado com o atual momento pandêmico. Também visa a identificar quais são as ações que as instituições de saúde contratantes adotam como medidas de prevenção. Trata-se de estudo transversal e descritivo, no qual utilizou-se à técnica de snowball, através da ferramenta Google Forms®. A pesquisa respeitou os preceitos éticos da Resolução CNS 466/2012 e foi realizada nos meses de julho e agosto de 2020. Responderam aos questionamentos 45 enfermeiros e 56 técnicos em enfermagem, com prevalência de 85,14% sendo mulheres. A elevada carga horária e a pressão na rotina de trabalho, a baixa remuneração e as condições precárias para o exercício da atividade foram os fatores listados que mais somaram para o adoecimento mental. Embora 73 dos respondentes nunca houvessem se afastado do trabalho por períodos prolongados, 30 destes foram afastados por adoecimento mental. Salienta-se que 61 profissionais de enfermagem, os quais responderam, não têm conhecimento de iniciativas preventivas para adoecimento mental em suas empresas. Este estudo revela que o ambiente laboral, as condições precárias para o exercício das atividades, a sobrecarga de trabalho associado ao medo do desconhecido, como a nova a doença causada pelo coronavírus, a Covid-19, são os principais fatores que contribuem para o desenvolvimento de patologias mentais dos profissionais de enfermagem. Deste modo, torna-se essencial que medidas protetivas para o autocuidado em saúde mental sejam oferecidas pelas instituições de saúde

Chasing Gravitational Waves with the Chereknov Telescope Array

Presented at the 38th International Cosmic Ray Conference (ICRC 2023), 2023 (arXiv:2309.08219)2310.07413International audienceThe detection of gravitational waves from a binary neutron star merger by Advanced LIGO and Advanced Virgo (GW170817), along with the discovery of the electromagnetic counterparts of this gravitational wave event, ushered in a new era of multimessenger astronomy, providing the first direct evidence that BNS mergers are progenitors of short gamma-ray bursts (GRBs). Such events may also produce very-high-energy (VHE, > 100GeV) photons which have yet to be detected in coincidence with a gravitational wave signal. The Cherenkov Telescope Array (CTA) is a next-generation VHE observatory which aims to be indispensable in this search, with an unparalleled sensitivity and ability to slew anywhere on the sky within a few tens of seconds. New observing modes and follow-up strategies are being developed for CTA to rapidly cover localization areas of gravitational wave events that are typically larger than the CTA field of view. This work will evaluate and provide estimations on the expected number of of gravitational wave events that will be observable with CTA, considering both on- and off-axis emission. In addition, we will present and discuss the prospects of potential follow-up strategies with CTA

Performance of a proposed event-type based analysis for the Cherenkov Telescope Array

The Cherenkov Telescope Array (CTA) will be the next-generation observatory in the field of very-high-energy (20 GeV to 300 TeV) gamma-ray astroparticle physics. Classically, data analysis in the field maximizes sensitivity by applying quality cuts on the data acquired. These cuts, optimized using Monte Carlo simulations, select higher quality events from the initial dataset. Subsequent steps of the analysis typically use the surviving events to calculate one set of instrument response functions (IRFs). An alternative approach is the use of event types, as implemented in experiments such as the Fermi-LAT. In this approach, events are divided into sub-samples based on their reconstruction quality, and a set of IRFs is calculated for each sub-sample. The sub-samples are then combined in a joint analysis, treating them as independent observations. This leads to an improvement in performance parameters such as sensitivity, angular and energy resolution. Data loss is reduced since lower quality events are included in the analysis as well, rather than discarded. In this study, machine learning methods will be used to classify events according to their expected angular reconstruction quality. We will report the impact on CTA high-level performance when applying such an event-type classification, compared to the classical procedure

Chasing Gravitational Waves with the Chereknov Telescope Array

Presented at the 38th International Cosmic Ray Conference (ICRC 2023), 2023 (arXiv:2309.08219)2310.07413International audienceThe detection of gravitational waves from a binary neutron star merger by Advanced LIGO and Advanced Virgo (GW170817), along with the discovery of the electromagnetic counterparts of this gravitational wave event, ushered in a new era of multimessenger astronomy, providing the first direct evidence that BNS mergers are progenitors of short gamma-ray bursts (GRBs). Such events may also produce very-high-energy (VHE, > 100GeV) photons which have yet to be detected in coincidence with a gravitational wave signal. The Cherenkov Telescope Array (CTA) is a next-generation VHE observatory which aims to be indispensable in this search, with an unparalleled sensitivity and ability to slew anywhere on the sky within a few tens of seconds. New observing modes and follow-up strategies are being developed for CTA to rapidly cover localization areas of gravitational wave events that are typically larger than the CTA field of view. This work will evaluate and provide estimations on the expected number of of gravitational wave events that will be observable with CTA, considering both on- and off-axis emission. In addition, we will present and discuss the prospects of potential follow-up strategies with CTA

Chasing Gravitational Waves with the Chereknov Telescope Array

Presented at the 38th International Cosmic Ray Conference (ICRC 2023), 2023 (arXiv:2309.08219)2310.07413International audienceThe detection of gravitational waves from a binary neutron star merger by Advanced LIGO and Advanced Virgo (GW170817), along with the discovery of the electromagnetic counterparts of this gravitational wave event, ushered in a new era of multimessenger astronomy, providing the first direct evidence that BNS mergers are progenitors of short gamma-ray bursts (GRBs). Such events may also produce very-high-energy (VHE, > 100GeV) photons which have yet to be detected in coincidence with a gravitational wave signal. The Cherenkov Telescope Array (CTA) is a next-generation VHE observatory which aims to be indispensable in this search, with an unparalleled sensitivity and ability to slew anywhere on the sky within a few tens of seconds. New observing modes and follow-up strategies are being developed for CTA to rapidly cover localization areas of gravitational wave events that are typically larger than the CTA field of view. This work will evaluate and provide estimations on the expected number of of gravitational wave events that will be observable with CTA, considering both on- and off-axis emission. In addition, we will present and discuss the prospects of potential follow-up strategies with CTA