Infecção meningocócica em crianças no Brasil: análise do período de 2013 a 2017 / Meningococcal infection in children in Brazil: analysis of the period 2013 to 2017

INTRODUÇÃO: A infecção meningocócica (IM) é causada pela bactéria Neisseria meningitidis (N. meningitidis), um diplococo aeróbico, GRAM - negativo que possui 12 sorogrupos caracterizados por uma cápsula polissacarídica. Entretanto, os grupos A, B, C, X, Y e W são responsáveis por maiores repercussões clínicas. METODOLOGIA: Trata – se de uma pesquisa quantitativa, retrospectiva e descritiva, realizada a partir de coletas de dados disponibilizados no Sistema de Internações Hospitalares do Sistema Único de Saúde (SIH/SUS), abarcando uma série temporal de 2013 até 2017. Nesta pesquisa foi realizado o levantamento de dados referentes às internações hospitalares por infecção meningocócica no Brasil. RESULTADOS: Durante o período analisado, o Brasil registrou 4.101 internações por Infecção Meningocócica em crianças, sendo as regiões Sudeste (47,9%) e Nordeste (18,8%) as mais prevalentes. Nesse período, observou-se diminuição no número de internações pela doença, porém, é válido ressaltar que o ano de 2013 (34,2%) concentrou o maior número de hospitalizações, seguido por 2014 (23%) e 2015 (17%). Enquanto que os anos de 2016 e 2017 obtiveram o menor número de internações, com 13,3% e 12,4%; respectivamente. Ademais, taxa de mortalidade das regiões Norte e Nordeste (8,80 e 7,76, respectivamente) apresentou os piores registros, ficando ambas acima da média nacional (6,93). CONCLUSÃO: O estudo evidenciou que a IM em crianças é uma patologia que requer atenção especial, principalmente, em regiões onde há expressividade de notificações e óbitos pela doença (Sudeste e Nordeste). Além disso, deve – se atentar para a elevada taxa de mortalidade no Norte do país, o que pode estar correlacionado aos diferentes aspectos socioeconômicos dessa região

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status