Avaliação da prescrição de antimicrobianos para infecção relacionada à assistência à saúde em um hospital escola de Recife – PE.

Justification and Objective: in Intensive Care Units (ICU) are the highest rates of Healthcare-associated infections (HAI). Antimicrobial therapy for these infections has become increasingly challenging due to high rates of antimicrobial resistance. Thus arises the need for appropriate antibiotic therapy. Thus arises the need to assess the antimicrobial therapy for patients with IRAS The study aims to evaluate antimicrobials prescriptions for patients diagnosed with HAI in the Adult ICU of a teaching hospital in Recife-PE in 2010. Methods: cross-sectional, descriptive, and retrospective study using the HAI reporting forms, prescriptions and medical records of patients aged from 18 years, in Adult ICU of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). The variables analyzed in the study were gender, age, admission diagnosis, etiologic agent, Infection Related to Health Care, antibiotics, high and óbto. Data were collected from the analysis of HAI reporting forms, data collection form of HAI reporting forms and records and / or prescriptions. Results: The study population consisted of 31 notifications. The respiratory tract infections were the most frequent (80.6%). The microbiological confirmation was 83.9%, totaling 11 species of microorganisms, one of which being multiresistant. The use of 14 different antimicrobials was observed with monotherapy in a minority of cases. Only two patients underwent five schemes. Mistake regarding prescription was not observed, but misconceptions about some doses, intervals and as an association were highlighted. Conclusion: the indicators analyzed showed no significant discrepancies when compared with other national or international studies. One perceives the need for further studies on the use of antimicrobials. Keywords: Anti-Bacterial Agents. Infection. Prescriptions. Drug Resistance, Microbial. Intensive Care Units.Justificativa e Objetivos: Nas Unidades de Terapia Intensiva (UTI) encontram-se as maiores taxas de Infecção Relacionada à Assistência à Saúde (IRAS). A terapia antimicrobiana para essas infecções está cada vez mais desafiadora devido às altas taxas de resistência microbiana. Assim, surge a necessidade de avaliar a terapia antimicrobiana para pacientes com IRAS. O objetivo deste estudo foi avaliar as prescrições de antimicrobianos para pacientes com IRAS na UTI Adulto de um Hospital Escola de Recife-PE no ano 2010. Métodos: estudo transversal, descritivo, retrospectivo, utilizando as fichas de notificação de IRAS, prescrições e prontuários de pacientes com dezoito anos ou mais, internados na UTI Adulto do Instituto de Medicina Integral Profº Fernando Figueira (IMIP). As variáveis analisadas no estudo foram sexo, idade, diagnóstico de admissão, agente etiológico, Infecção Relacionada a Assistência à Saúde, antibioticoterapia, alta e óbito. Os dados foram coletados a partir da análise das fichas de notificação de IRAS, Formulário de coleta de dados das fichas de notificação de IRAS e prontuários e/ou das prescrições. Resultados: A população do estudo foi composta por 31 notificações. As Infecções do Trato Respiratório foram as mais frequentes (80,6%). A confirmação microbiológica foi de 83,9%, totalizando 11 espécies de microrganismos, um deles multirresistente. Observou-se a utilização de 14 antimicrobianos diferentes com a monoterapia na minoria das situações. Dois pacientes chegaram a realizar até cinco esquemas. Não se observou erro quanto à indicação, porém evidenciaram-se equívocos quanto a doses, intervalos e quanto à associação de medicamentos. Conclusão: os indicadores analisados não apresentaram discrepâncias significativas quando comparados com estudos nacionais ou internacionais. Percebe-se a necessidade de mais estudos de utilização de antimicrobianos. DESCRITORES: Antibióticos. Infecções. Prescrições. Resistência Microbiana a Antibióticos. Unidades de Terapia Intensiva

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author

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