DIRECT COST OF CENTRAL VENOUS CATHETER INSERTION FOR CONVENTIONAL HEMODIALYSIS

Objetivo: identificar o custo direto médio da inserção de cateter venoso central de longa permanência em pacientes submetidos à hemodiálise convencional em um hospital público de ensino e pesquisa.Método: pesquisa quantitativa, exploratório-descritiva, realizada em um Centro de Diálise, em São Paulo, Brasil entre novembro e dezembro/2019. Calculou-se o custo direto médio multiplicandose o tempo despendido por profissionais de saúde pelo custo unitário da mão de obra direta, somando-se aos custos de insumos.Resultados: o custo direto médio total correspondeu a US$134,56 (DP±3,65), sendo US$107,01 (DP±0,23) relativos ao custo com material, US$22,10 (DP±3,63) com a mão de obra direta da equipe de inserção do cateter, US$4,65 (DP±0,00) com custo de medicamentos e US$0,80 (DP±0,15) com custo de soluções.Conclusão: constatou-se o impacto dos custos com recursos materiais e a imprescindibilidade da sua alocação racional, especialmente nos hospitais públicos de ensino e pesquisa, que possuem recursos financeiros limitados.Objective: to identify the average direct cost of long-term central venous catheter insertion in patients undergoing conventional hemodialysis in a public teaching and research hospital.Method: quantitative, exploratory-descriptive research, conducted in a Dialysis Center in São Paulo, Brazil between November and December/2019. The average direct cost was calculated by multiplying the time spent by health professionals by the unit cost of direct labor, adding to the costs of inputs.Results: The average total direct cost was US$134.56 (SD±3.65), of which US$107.01 (SD±0.23) for material costs, US$22.10 (SD±3.63) for direct labor of the catheter insertion team, US$4.65 (SD±0.00) for medication costs, and US$0.80 (SD±0.15) for solution costs.Conclusion: the impact of costs with material resources and the indispensability of their rational allocation was verified, especially in public teaching and research hospitals, which have limited financial resources.Objetivo: identificar el costo directo de la inserción de catéteres venosos centrales de larga duración en pacientes sometidos a hemodiálisis convencional en un hospital público de enseñanza e investigación. Método: investigación cuantitativa exploratoria-descriptiva realizada en un Centro de Diálisis de São Paulo, Brasil, entre noviembre ydiciembre/2019. El costo directo medio se calculó multiplicando el tiempo empleado por los profesionales de la salud por el costo unitario de la mano de obra directa, sumando los costos de los insumos. Resultados: el costo directo medio total fue de 134,56 dólares (SD±3,65), de los cuales 107,01 dólares (SD±0,23) fueron costos de material, 22,10 dólares (SD±3,63) fueron costos de mano de obra directa del equipo de inserción de catéteres, 4,65 dólares (SD±0,00) fueron costos de medicación y 0,80 dólares (SD±0,15) fueron costos de solución. Conclusión: se ha constatado el impactode los costos de los recursos materiales y la importancia de su asociación racional, especialmente en los hospitales públicos de enseñanza e investigación, que cuentan con recursos financieros limitados

Indie existence aesthetics: articulations around the mainstream conception

Indie emerged as sound and creative experimentations that sought to move away from the mainstream music. This conception, applied to a musical genre, can be understood as an aesthetic conception. Foucault points out that the search for an aesthetic that legitimizes our existence is an ethical subject's constitution practice. In turn, music fans interact to discuss, validating or rejecting content directed to them by the music industry and the artists they enjoy. The interactivity between fans about media products characterizes them as prosumers, i.e., consumers who act productively on what they consume. Thus, present research aims to analyze how prosumerist interactions of indie music fans define the genre through an aesthetic of existence. To this purpose, the research was conducted through netnography in one of the main virtual fan communities of the genre. The results indicate the exercise of two aesthetics: one presents the indie as an alternative to the mainstream, forged in the conceptions of freedom and resistance; another testifies to the indie as adherent to the mainstream, thanks to the capacity to expand access to the genre. Although they sound irreconcilable, both are based on the understanding that the indie is beautiful and that it needs to be preserved from its relationship with the mainstream conception

Statewide evaluation of infection control measures for preventing coronavirus disease 2019 in hemodialysis facilities

OBJECTIVE: This study aimed to evaluate the occurrence of coronavirus disease 2019 (COVID-19) in hemodialysis facilities and the occurrence of and risk factors for clustering of COVID-19 cases. METHODS: We conducted a cross-sectional online survey between March and July 2020, in all dialysis facilities in São Paulo state, using Google Forms. The online questionnaire contained questions addressing specific components of infection prevention and control practices and the number of cases during the COVID-19 pandemic. RESULTS: A total of 1,093 (5%) COVID-19 cases were reported among 20,984 patients; approximately 56% of the facilities had ≥1 cluster. Most facilities implemented various measures (such as allocation of dedicated COVID-19 areas/shifts, symptom screening, environmental disinfection, and maintenance of adequate ventilation) to prevent the transmission of severe acute respiratory syndrome coronavirus 2. Clustering of COVID-19 cases was suspected in only 7% of dialysis facilities. The only variable associated with this event was the performance of aerosol-generating procedures (odds ratio: 4.74; 95% confidence interval: 1.75-12.86). CONCLUSION: Attention should be paid to avoiding the performance of aerosol-generating procedures in dialysis facilities and monitoring the clustering of cases

Maternal hemodynamic responses to two different types of moderate physical exercise during pregnancy: a randomized clinical trial

Background/Aim:  Maternal hemodynamic responses (heart rate, systolic and diastolic blood pressure) were compared during two types of moderate-intensity physical exercise. Methods:  A randomized clinical trial compared 120 pregnant women performing physical exercise on a treadmill (n=64) or stationary bicycle (n=56).  In 44 of these women (n=23 treadmill; n=21 bicycle), blood pressure was monitored for 24 hours following exercise.  Repeated-measures analysis compared maternal heart rate, systolic and diastolic blood pressure before, during and in the 24 hours following exercise in both groups.  Results:  Maternal heart rate increased significantly (p<0.001) with both types of exercise (from 84 at rest to 112 bpm on the treadmill and from 87 at rest to 107 bpm on the bicycle), without exceeding the limit of 140 bpm.  Systolic pressure increased from 110 at rest to 118 mmHg on the bicycle (p=0.06) and from 112 at rest to 120 mmHg on the treadmill (p=0.02).  Systolic pressure dropped steadily following exercise, reaching its lowest level (104 mmHg) after 14 hours, increasing thereafter and returning to pre-exercise levels by the 19th hour.  Diastolic pressure increased during exercise irrespective of the type of exercise (p=0.27), from 70 at rest to 75 mmHg on the bicycle (p=0.39) and from 70 at rest to 76 mmHg on the treadmill (p=0.18), with the lowest level (59 mmHg) being at the 13th hour. Conclusions:  A slight increase in blood pressure levels was found during exercise; however, this was not clinically significant and was followed by a substantial hypotensive effect that lasted around 19 hours. Register: Clinical Trials NCT01383889

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance

Background: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions: HAI increased during COVID-19. The microorganisms’ susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use

Influence of sweeteners in the biodistribution of radiopharmaceutical and laboratory tests in rats

This study aimed to evaluate the effect of supplementation of sucralose and fructose on the metabolism of adolescent rats. Eighteen male Wistar rats were divided into 3 groups: control group (GC), fructose group (GF) treated with 50 mg/kg of fructose, and sucralose group (GS) receiving 50 mg/kg of sucralose for 24 days. The weight and feed intake were measured weekly. At the end of the experiment, some biochemical parameters, histopathology of the liver and biodistribution of the radiotracer 99mTc-sodium phytate in liver and blood were analyzed. The GF showed higher body weight only in the first week compared with GS and GC (p<0.05). Histopathology and % ATI/g radiotracer 99mTc-sodium phytate in liver and blood were not different between the groups. The GF showed higher values of aspartate aminotransferase activity, bilirubin, alkaline phosphatase activity and gamma glutamyl transferase activity, compared with the other groups (GC and GS) (p<0.05). Activity of alanine aminotransferase and albumin level of GF were higher than GS (p<0.05). For other parameters, no statistical difference was observed. It was concluded that the use of fructose during the experiment was able to alter hepatic enzymes, but on the other hands, the use of sucralose caused no change.Keywords: Sucralose, fructose, adolescent rats, radiopharmaceutica

Frequency and factors associated with hospital readmission after COVID-19 hospitalization: the importance of post-COVID diarrhea

Purpose: The aim of this study was to describe the incidence and risk factors for hospital readmission and infection during the months after COVID-19 hospital admission. Methods: This prospective study included adult patients who were hospitalized due to COVID-19 and had been discharged from April 2020 to August 2020. All patients had a medical evaluation with a structured questionnaire 6 to 11 months after hospital admission. The authors included only patients with confirmed COVID-19 by RT-PCR. Patients with pregnant/postpartum women, with a proven COVID-19 reinfection or incapable of answering the questionnaire were excluded. Results: A total of 822 patients completed the follow-up assessment, and 68% reported at least one recurrent symptom related to COVID-19. The most frequent symptom was myalgia (42%). Thirty-two percent of patients visited an emergency room after COVID-19 hospitalization, and 80 (10%) patients required re-hospitalization. Risk factors for hospital readmission were orotracheal intubation during COVID-19 hospitalization (p = 0.003, OR = 2.14), Charlson score (p = 0.002, OR = 1.21), congestive heart failure (p = 0.005, OR = 2.34), peripheral artery disease (p = 0.06, OR = 2.06) and persistent diarrhea after COVID-19 hospitalization discharge (p = 0.02, OR = 1.91). The main cause of hospital readmission was an infection, 43 (54%). Pneumonia was the most frequent infection (29%). Conclusions: The presence of symptoms after six months of COVID-19 diagnosis was frequent, and hospital readmission was relatively high

Liver abscess in a patient with fever of undetermined origin- case report

Abscesso hepático é o tipo mais comum de abscesso visceral. Sua prevalência é estimada em 2,3 casos por 100.000 pessoas anualmente e é maior entre homens do que mulheres. O abscesso hepático pode vir acompanhado por sinais e sintomas comuns a outras doenças como febre, emagrecimento e dor no hipocôndrio direito. Dessa forma, o diagnóstico essencialmente clínico é difícil de ser estabelecido. O artigo objetiva discutir o abscesso hepático em paciente com febre de origem indeterminada (FOI), através do relato de caso de um paciente de 43 anos que, dentre outros sintomas, apresentava tosse. O quadro clínico associado a aspectos epidemiológicos, levantaram a suspeita inicial de afecções respiratórias, o que postergou o diagnóstico de abscesso hepático.Liver abscess is the most common type of visceral abscess. The prevalence is estimated at 2.3 cases per 100,000 people annually and is higher among men than women. Liver abscess may be accompanied by signs and symptoms common to other diseases such as fever, weight loss and pain in the right hypochondrium. Thus, the essentially clinical diagnosis is difficult to establish. The article aims to discuss liver abscess in a patient with fever of unknown cause, through the case report of a 43-year-old patient who, among other symptoms, had cough. The clinical condition associated with epidemiological aspects raised the initial suspicion of respiratory disorders, which delayed the diagnosis of liver abscess