Impacto do maldi-tof na sepse: uma revisão integrativa

A sepse é um quadro dinâmico que rapidamente pode evoluir para estágios graves e cuja a intervenção precoce tem um importante impacto no prognóstico do paciente. Tendo em vista que um tratamento eficaz depende da rápida identificação do patógeno causador do quadro, métodos diagnósticos rápidos ganham importante papel dentro do protocolo. Dentre as várias formas de identificar o agente causador da sepse, o Matrix Associated Laser Desorption-Ionization – Time of Flight (MALDI-TOF) tem grande potencial por sua velocidade nos resultados e confiabilidade. O MALDI-TOF é um método diagnóstico que consiste em colocar o material biológico em placa de matriz polimérica, sendo o material vaporizado por um lazer e coletado por um tubo que possui um detector no final, que avalia o tempo de chegada das moléculas evaporadas da substância. Esses dados são, então, colocados em um gráfico, com picos para cada fungo e bactéria, e então interpretados com um banco de dados já conhecido, concedendo o resultado diagnóstico . Esse trabalho teve como objetivo verificar a utilidade do Maldi-TOF como ferramenta diagnóstica nos protocolos de sepse em comparação com a cultura. Como objetivos específicos, esse trabalho se propôs a verificar se houve uma redução no tempo de diagnóstico microbiológico, internamento, tratamento e uma melhora na evolução do paciente, assim como avaliar se houve concordância entre os resultados apresentados pelo MALDI-TOF e o método convencional. Como metodologia, foi realizado uma revisão integrativa nas bases de dados: SciELO, BVS Salus, Scopus, Web of Science, PUBMED e google academico. A seleção de artigos foi feita por dois pesquisadores, individualmente, resultando em 16 artigos finais, dos quais foram extraídos seus dados e realizada a discussão. Foi obtido como resultados que o uso do Maldi-TOF no protocolo de sepse reduz o tempo até identificação do patógeno permitindo, consequentemente, uma redução no tempo até terapia efetiva, tempo até terapia optima, tempo de estadia hospitalar e na mortalidade. Observou-se que a redução no tempo de estadia, assim como, na melhora no tratamento, tem importante impacto econômico no hospital, causando redução de diversos custos quando comparado ao método convencional. No entanto, o MALDI-TOF tem importantes limitações como a dificuldade na identificação de amostras polimicrobianas, sua dependência dos agentes registrados nos bancos de dados, sua ausência de um protocolo único estabelecido para processamento de amostras diretamente de hemocultura positiva e sua limitação na identificação de bactérias gram positivas. Conclui-se que a inclusão do MALDI-TOF no protocolo de sepse traz importantes benefícios tanto em relação ao tempo ate identificação do agente, quanto em relação à melhora no prognóstico do paciente. No entanto, ainda são necessárias algumas melhorias de forma a contornar as limitações atualmente presentes

Relação da profilaxia pré-exposição (PrEP) com o uso de preservativo no Brasil

Introdução: A síndrome da imunodeficiência humana adquirida (SIDA) ganhou repercussão mundial em 1981 quando tornou-se uma epidemia. Desde então, 74,9 milhões de pessoas foram infectadas e 32 milhões morreram de doenças relacionadas à aids. Assim, esforços fizeram-se necessários para prevenir a infecção do HIV. Recentemente, a profilaxia préexposição (PrEP), composta por tenofovir e entricitabina, tornou-se uma alternativa para a população alvo, mais suscetível a adquirir a infecção. Entretanto, a possibilidade de relações sexuais sem o uso de preservativo pode diminuir a adesão a esse método e aumentar as outras infecções sexualmente transmissíveis (ISTs). Objetivo: Analisar o efeito da profilaxia pré-exposição na adesão ao uso de preservativo no Brasil. Método e materiais: Trata-se de um estudo ecológico conduzido com base em dados quantitativos do ministério da saúde de uso e consequências da PrEP entre os anos de 2018 a 2021. Resultados: Em relação ao uso de preservativo houve uma queda significativa na adesão, pois no 1⁰ atendimento: 33% dos pacientes afirmaram usar todas as vezes, 36% mais da metade das vezes, 11% metade das vezes, 12% menos da metade das vezes, 10% nenhuma vez. Já no último atendimento 23% afirmaram usar todas as vezes, 25% mais da metade das vezes, 13% metade das vezes, 16% menos da metade das vezes, 23% nenhuma vez. Conclusão: Faz-se necessário o esforço de maior conscientização para os usuários de PrEP, que tendem a abandonar os preservativos, permaneçam a se prevenir contra as outras ISTs, haja vista que a PrEP previne apenas contra o HIV

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Challenges and approaches for the development of safer immunomodulatory biologics

Immunomodulatory biologics are a class of agents that render their therapeutic effect via modulating or harnessing immune responses. Despite their therapeutic efficacy in complex conditions including cancer and autoimmune diseases, there is a growing concern about their unwanted adverse events including infections, malignancy, cytokine release syndromes, anaphylaxis, hypersensitivity and immunogenicity. In this article, we assess the safety issues associated with immunomodulatory biologics and discuss the key approaches to understand, predict and mitigate adverse events associated with their use

Are rare species useful species? Obstacles to the conservation of tree diversity in the dry forest zone agro-ecosystems of Mesoamerica

Aim To test the potential to conserve rare dry forest tree and shrub species circa situm.Location Oaxaca, Mexico and Southern Honduras.Methods Local uses (timber, posts and firewood) of species were determined principally through semistructured interviews with 20 rural householders in each of four communities in Honduras and four in Oaxaca. Tree and shrub diversity inventories were carried out in a total of 227 forest patches and parcels of farmland in those eight communities. Species’ conservation priorities were determined using the star system of Hawthorne (1996) and IUCN listings.Results Despite a large number of useful species, remarkably few were also conservation priorities. Useful species were found to be substitutable as is illustrated by Bombacopsis quinata, Cordia alliodora, Guaiacum sanctum and G. coulteri.Conclusions In these areas, circa situm conservation is inhibited by the lack of species that are both rare and useful. Usefulness must be interpreted as a function of substitutability. Natural regeneration provides an abundance of diversity, farmers are unlikely to invest in the management of a species when suitable substitutes are freely available. The key to conserving rare species may be in maintaining or enhancing the value of the landscape elements in which they are found

BioTIME:a database of biodiversity time series for the Anthropocene

Abstract Motivation: The BioTIME database contains raw data on species identities and abundances in ecological assemblages through time. These data enable users to calculate temporal trends in biodiversity within and amongst assemblages using a broad range of metrics. BioTIME is being developed as a community‐led open‐source database of biodiversity time series. Our goal is to accelerate and facilitate quantitative analysis of temporal patterns of biodiversity in the Anthropocene. Main types of variables included: The database contains 8,777,413 species abundance records, from assemblages consistently sampled for a minimum of 2 years, which need not necessarily be consecutive. In addition, the database contains metadata relating to sampling methodology and contextual information about each record. Spatial location and grain: BioTIME is a global database of 547,161 unique sampling locations spanning the marine, freshwater and terrestrial realms. Grain size varies across datasets from 0.0000000158 km² (158 cm²) to 100 km² (1,000,000,000,000 cm²). Time period and grain: BioTIME records span from 1874 to 2016. The minimal temporal grain across all datasets in BioTIME is a year. Major taxa and level of measurement: BioTIME includes data from 44,440 species across the plant and animal kingdoms, ranging from plants, plankton and terrestrial invertebrates to small and large vertebrates. Software format: .csv and .SQL