Mortality related to candidemia and risk factors associated with non-candida albicans

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In-hospital outcomes of Infective Endocarditis from 1978 to 2015: analysis through machine-learning techniques

© 2021 The Authors. Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. This is an open access article under the CC BY-NC- ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Background: Early identification of patients with infective endocarditis (IE) at higher risk for in-hospital mortality is essential to guide management and improve prognosis. Methods: A retrospective analysis was conducted of a cohort of patients followed up from 1978 to 2015, classified according to the modified Duke criteria. Clinical parameters, echocardiographic data, and blood cultures were assessed. Techniques of machine learning, such as the classification tree, were used to explain the association between clinical characteristics and in-hospital mortality. Additionally, the log-linear model and graphical random forests (GRaFo) representation were used to assess the degree of dependence among in-hospital outcomes of IE. Results: This study analyzed 653 patients: 449 (69.0%) with definite IE; 204 (31.0%) with possible IE; mean age, 41.3 ± 19.2 years; 420 (64%) men. Mode of IE acquisition: community-acquired (67.6%), nosocomial (17.0%), undetermined (15.4%). Complications occurred in 547 patients (83.7%), the most frequent being heart failure (47.0%), neurologic complications (30.7%), and dialysis-dependent renal failure (6.5%). In-hospital mortality was 36.0%. The classification tree analysis identified subgroups with higher in-hospital mortality: patients with community-acquired IE and peripheral stigmata on admission; and patients with nosocomial IE. The log-linear model showed that surgical treatment was related to higher in-hospital mortality in patients with neurologic complications. Conclusions: The use of a machine-learning model allowed identification of subgroups of patients at higher risk for in-hospital mortality. Peripheral stigmata, nosocomial IE, absence of vegetation, and surgery in the presence of neurologic complications are predictors of fatal outcomes in machine learning-based analysis.info:eu-repo/semantics/publishedVersio

Revisão de literatura: a importância do exercício físico no tratamento do diabetes mellitus tipo 2 / Literature review: the importance of exercise in the treatment of type 2 diabetes mellitus

O diabetes mellitus tipo 2 é uma doença de caráter metabólico e multifatorial. Ela está presente entre os diagnósticos mais prevalentes da atenção básica. Uma das formas de prevenir essa patologia e atenuar seus desfechos negativos é por meio de atividades físicas regulares. Dessa forma, o presente estudo objetiva mostrar a importância da prática de exercicios no manejo da doença. Foram selecionados artigos das plataformas PubMed e Scielo, utilizando os descritores exercises, therapy, glycemic control, diabetes mellitus type 2, diabetes tipo 2, exercícios e tratamento. Foram elegidos estudos publicados entre os anos de 2002 e 2020, nas línguas portuguesa, inglesa e espanhola. Os estudos analisados mostraram o papel coadjuvante do exercício físico no controle de parâmetros metabólicos, como a glicemia e a resistência insulínica, além da melhora no sistema cardiovascular. O estímulo e a orientação da pratica de exercícios físicos devem fazer parte da rotina de cuidados com os pacientes diabéticos

Consenso em criptococose - 2008

Univ Sao Paulo, Fac Med, Div Clin Mol Infecciosas, Hosp Clin, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Med, Sao Paulo, BrazilUniv Estadual Campinas, Hosp Clin, Inst Infectol Emilio Ribas, Campinas, SP, BrazilFundacao Oswaldo Cruz, Dept Microbiol Immunol & Parasitol, Inst Pesquisa Clin Evandro Chagas, Rio De Janeiro, BrazilUniv Fed Parana, Fac Med, Dept Saude Comunitaria, BR-80060000 Curitiba, Parana, BrazilUniv Fed Rio Grande do Sul, Fac Med, Dept Clin Med, Porto Alegre, RS, BrazilUniv Estadual Campinas, Fac Ciencias Med, Dept Clin Med, Sao Paulo, BrazilInst Doencas Trop Natan Portela, Teresina, PI, BrazilUniv Sao Paulo, Fac Med, Dept Mol Infecciosas & Parasitarias, Sao Paulo, BrazilUniv Estadual Campinas, Fac Ciencias Med, Dept Clin Med, Campinas, SP, BrazilUniv Fed Uberlandia, Fac Med, BR-38400 Uberlandia, MG, BrazilFac Med Triangulo Mineiro, Dept Clin Med, Uberaba, MG, BrazilInst Infectol Emilio Ribas, Sao Paulo, BrazilUniv Estadual Sao Paulo, Fac Med Botucatu, Dept Doencas Trop & Diagnost Imagem, Sao Paulo, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Clin Med, Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Med, Sao Paulo, BrazilWeb of Scienc

Isolation and drug susceptibility of Candida parapsilosis sensu lato and other species of C. parapsilosis complex from patients with blood stream infections and proposal of a novel LAMP identification method for the species

Candida parapsilosis complex (CPC) is the third Candida species isolated in blood cultures of patients from our Hospital, following C. albicans and C. tropicalis. From 2006 to 2010, the median annual distribution of CPC was 8 cases/year. Records of 36 patients were reviewed. CPC were 31 (86.1 %) C. parapsilosis; 4 (11.1 %) C. orthopsilosis; and 1 (2.8 %) C. metapsilosis. Clinical characteristics were central venous catheter, 34 (94.4 %); parental nutrition, 25 (70 %); surgery, 27 (57.9 %); prior bacteremia, 20 (51.3 %); malignancy, 18 (50 %). General mortality was 47.2 %. Death was higher in immunosuppressed patients (17 vs. 11; p = 0.003). Three out four (75 %) patients with C. orthopsilosis and 14 out 31 (45.2 %) with C. parapsilosis died (p = 0.558). Thirty-nine individual isolates were tested for susceptibility to seven antifungal drugs, with MICs values showing susceptibility to all of them. Two isolates, one C. orthopsilosis and one C. parapsilosis, had fluconazole MIC = 4 mu g/mL. Differentiation among CPC has implication in caring for patients with invasive candidiasis since there are differences in virulence, pathogenicity and drug susceptibility. A method targeting the topoisomerase II gene based on loop-mediated isothermal amplification (LAMP) was developed. LAMP emerges as a promising tool for the identification of fungal species due to the high sensitivity and specificity. LAMP can be performed at the point-of-care, being no necessary the use of expensive equipment. In our study, the method was successful comparing to the DNA sequencing and proved to be a reliable and fast assay to distinguish the three species of CPC1791-25362sem informaçã

Serum markers as an aid in the diagnosis of pulmonary fungal infections in AIDS patients

Introduction: The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy. Materials and methods: A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients’ serums were tested for (1–3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis. Results: 60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p = 0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241 pg/mL) and lactate dehydrogenase (mean: 762 U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients. Conclusion: In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population. Keywords: Pulmonary infection, HIV/AIDS, (1-3)-β-D-Glugan, LDH, LAMP, Pneumocystosis, Fungal infectio

O acolhimento na relação entre usuários da atenção primária e serviços de saúde/ Accommodation in the relationship between primary care users and health services

Acessibilidade a serviços de saúde refere-se às características destes que permitem que sejam facilmente utilizados pelos usuários potenciais. Essa é uma temática importante da avaliação em saúde, por tratar da disponibilidade e distribuição social destes recursos. Entre as dimensões de acessibilidade, destaca-se uma, nesse caso: a sócio organizacional, que equivale às características da oferta de serviços e que intervêm na relação entre características dos indivíduos e o uso de serviços, facilitando ou dificultando o acesso. Esta pesquisa objetivou avaliar o processo de trabalho das equipes enfocando, especialmente, a acessibilidade sócio organizacional utilizando-se o acolhimento avançado, uma nova estratégia que surge na atenção básica. Trata-se de uma pesquisa de campo descritiva, caráter exploratório, com abordagem qualitativa e quantitativa desenvolvida na Unidade André Luiz II, no município de Patos de Minas, no ano de 2018. Foram aplicados dois questionários, um antes da implantação do acolhimento avançado e aumento do número de consultas compartilhadas, e outro posterior à implantação do novo sistema, que indagavam sobre a satisfação tanto da população quanto da ESF em relação aos serviços oferecidos. A amostra questionada foi no total de 77 pessoas, sendo 63 pertencentes à população e 14 à ESF. Em uma analise comparativa dos resultados de antes e depois do projeto percebe-se que houve uma melhora em geral nos serviços prestados pela UBS tanto na opinião dos usuários quanto da ESF. Assim, nota-se a eficácia dessa nova forma de abordagem na atenção básica e os benefícios que essa trouxe para a UBS em questão

Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the brazilian national health system

Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS). Methods: Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time. Results: Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model. Conclusion: Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS193341352FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2014/50045-