Análise comparativa dos resultados de exames colpocitológicos realizados em Governador Valadares-MG com aqueles realizados no país, região sudeste e Minas Gerais / Comparative analysis of the cervical cytopathological examination results carried out in Governador Valadares-MG with those conducted in the country, southeast region and Minas Gerais state

Objetivo: O objetivo desse estudo foi comparar resultados de exames colpocitológicos realizados em âmbito nacional, na região sudeste e em Minas Gerais com aqueles obtidos no município de Governador Valadares (GV). Métodos: As informações sobre exames colpocitológicos, realizados nas quatro esferas, de janeiro/2006 a dezembro/2014, foram obtidas na consulta ao Sistema de Informação do Câncer do Colo do Útero ­ Siscolo. Resultados: A taxa de exames alterados foi de 2,8%, 3,3%, 2,2% e 2,7% [Brasil, Sudeste, Minas Gerais (MG) e GV, respectivamente]. Essa taxa foi significativamente mais alta em GV quando comparada com MG e significativamente mais baixa que a da região sudeste e do Brasil. As principais alterações, em todas as esferas, foram: atipias em células escamosas de significado indeterminado possivelmente não neoplásicas, lesão intraepitelial escamosa de baixo grau e lesão intraepitelial escamosa de alto grau. As taxas de incidência de câncer do colo do útero foram: 27,03; 28,02; 16,99 e 23,16 casos por 100 mil habitantes no país, região sudeste, MG e GV, respectivamente. Governador Valadares apresentou uma taxa significativamente mais alta apenas quando comparada com dados de Minas Gerais. Conclusão: Concluindo, os exames realizados em GV mostram algumas diferenças significativas em relação às outras esferas. É necessário implementar uma política de monitoramento interno da qualidade para aumentar a sensibilidade do exame, além de maior investimento na educação continuada do profissional que faz a leitura das lâminas.

Objective: Cervical cancer is one of the leading causes of cancer death in women and can be prevented by the early detection of precursor lesions by cytological techniques. The objective of this study was to compare the results of colpocytological exams performed at national, regional and state level with those obtained at Governador Valadares (GV). Methods: Information was obtained on colpocytological exams performed in the four spheres, from January / 2006 to December / 2014, from the Cervical Cancer Information System ­ Siscolo. Results: The rate of altered exams was 2.8%, 3.3%, 2.2% and 2.7% [Brazil, Southeast, Minas Gerais (MG) and GV, respectively]. This rate was significantly higher in GV when compared to MG and significantly lower than that in the Southeast and Brazil. The main injuries in all spheres were: atypical squamous cells of undetermined significance, possibly non-neoplastic, low grade squamous intraepithelial lesion and high grade squamous intraepithelial lesion. The incidence rates of cervical cancer were: 27.03; 28.02; 16.99 and 23.16 cases per 100,000 inhabitants in the country, southeast region, MG and GV, respectively. GV showed a significantly higher rate only when compared with MG data. Conclusion: Concluding, the exams carried out in GV show some significant differences in relation to the other spheres. It is necessary to implement an internal quality monitoring policy to improve the quality of the exam, besides greater investment in the continuing education of the professional who does the scrutiny of the blades.

Antimicrobial modulator of inflammatory response in third molar surgery compared with conventional medication

Surgeries performed in retained third molars occur in the contaminated field, bringing post-operative problems such as pain, bleeding, discomfort, swelling, infection, trismus, and inactive days. This study evaluated the differences between conventional medication and topical doxycycline in third molar surgery. Twenty-eight patients were selected requiring removal of four third molar. Half of the mouth was randomly selected to undergo surgery with the use of conventional medication (analgesic, anti-inflammatory and antimicrobial) and after 25-30 days, the other half of the mouth was subjected to surgery using doxycycline delivered through gel nanotubes. The results showed that in both treatments there was no clinical infection. The other evaluations were significantly lower in relation to pain, bleeding, edema, inactive days, trismus, and discomfort when compared with conventional therapy.

Prior oropharyngeal colonization and ventilator-associated pneumonia

This study evaluated the relationship between previous colonization of the oropharynx and development of ventilator-associated pneumonia through the classification of genomic fingerprint pattern by pulsed-field gel electrophoresis of both oxacillin-resistant and oxacillin-susceptible Staphylococcus aureus isolates obtained from hospitalized patients in an intensive care unit.

Antimicrobial use, incidence, etiology and resistance patterns in bacteria causing ventilator-associated pneumonia in a clinical-surgical intensive care unit

INTRODUCTION: Antimicrobial resistance is an increasing threat in hospitalized patients, and inappropriate empirical antimicrobial therapy is known to adversely affect outcomes in ventilator-associated pneumonia (VAP). The aim of this study was to evaluate antimicrobial usage, incidence, etiology, and antimicrobial resistance trends for prominent nosocomial pathogens causing ventilator-associated pneumonia in a clinical-surgical intensive care unit (ICU). METHODS: Gram-negative bacilli and Staphylococcus aureus causing VAP, as well as their antimicrobial resistance patterns and data on consumption (defined daily dose [DDD] per 1,000 patient days) of glycopeptides, extended-spectrum cephalosporins, and carbapenems in the unit were evaluated in two different periods (A and B). RESULTS: Antimicrobial use was high, mainly of broad-spectrum cephalosporins, with a significant increase in the consumption of glycopeptides (p < 0.0001) and carbapenems (p < 0.007) in period B. For Acinetobacter baumannii and members of the Enterobacteriaceae family, 5.27- and 3.06-fold increases in VAPs, respectively, were noted, and a significant increase in resistance rates was found for imipenem-resistant A. baumannii (p = 0.003) and third-generation cephalosporins-resistant Enterobacteriaceae (p = 0.01) isolates in this same period. CONCLUSIONS: Our results suggest that there is a link between antibiotics usage at institutional levels and resistant bacteria. The use of carbapenems was related to the high rate of resistance in A. baumannii and therefore a high consumption of imipenem/meropenem could play a major role in selective pressure exerted by antibiotics in A. baumannii strains.

Relationship between antibiotic consumption, oropharyngeal colonization, and ventilator-associated pneumonia by Staphylococcus aureus in an intensive care unit of a Brazilian teaching hospital / Relação entre consumo de antibióticos, colonização de orofaringe e pneumonia associada à ventilação por Staphylococcus aureus em um hospital de ensino brasileiro

INTRODUCTION: his study evaluated the consumption of major classes of antibiotics, the colonization of the oropharynx of patients on mechanical ventilation, and the risk of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus in an intensive care unit for adults. METHODS: A case-control study was carried out using colonized patients (cases) by oxacillin-resistant S. aureus (ORSA) and (controls) oxacillin-sensitive S. aureus (OSSA) from May 2009 to August 2010. The occurrence of VAP by S. aureus was also evaluated in the same period. Antibiotic consumption was expressed as the number of defined daily doses (DDD)/1,000 patient-days for glycopeptides, carbapenems, and extended-spectrum cephalosporins. RESULTS: Three hundred forty-six (56.1 percent) patients underwent mechanical ventilation with a frequency of oropharyngeal colonization of 36.4 percent, corresponding to 63.5 percent for ORSA and 36.5 percent for OSSA. The risk of illness for this organism was significant (p<0.05), regardless of whether colonization/infection was by ORSA or OSSA. The consumption of antibiotics was high, mainly for broad-spectrum cephalosporins (551.26 DDDs/1,000 patient-days). The high density of use of glycopeptides (269.56 DDDs/1,000 patient-days) was related to colonization by ORSA (Pearson r=0.57/p=0.02). Additionally, age >60 years, previous antibiotic therapy, and previous use of carbapenems were statistically significant by multivariate analysis. CONCLUSIONS: There was a significant relationship between the colonization of the oropharyngeal mucosa and the risk of VAP by both phenotypes. The use of glycopeptides was related to colonization by ORSA.

INTRODUÇÃO: Este estudo avaliou o consumo das principais classes de antibióticos, a colonização de orofaringe de pacientes sob ventilação mecânica e o risco de pneumonia associada à ventilação (PAV) causada por Staphylococcus aureus em uma unidade de terapia intensiva (UTI) de adultos. MÉTODOS: Foi realizado um estudo caso-controle, sendo caso os pacientes colonizados pelo oxacillin-resistant Staphylococcus aureus (ORSA), e controle aqueles pelo oxacillin-sensitive Staphylococcus aureus (OSSA), no período de maio de 2009 a agosto de 2010. A ocorrência de PAVs por S. aureus também foi avaliada no mesmo período. O consumo de antibióticos foi expresso pelo número de doses diárias definidas (DDDs)/1.000 pacientes-dia para glicopeptídeos, carbapenêmicos e cefalosporinas de amplo espectro. RESULTADOS: Trezentos e quarenta e seis (56,1 por cento) dos pacientes foram submetidos à ventilação mecânica com uma frequência de colonização de orofaringe de 36,4 por cento, correspondendo a 63,5 por cento e 36,5 por cento de ORSA e OSSA, respectivamente. O risco de adoecimento por este microrganismo foi significativo (p<0,05), considerando se a colonização/infecção foi por ORSA ou OSSA. O consumo de antibióticos foi alto, principalmente para cefalosporinas de amplo espectro (551,26 DDDs/1.000 pacientes-dia). A elevada densidade de uso de glicopetídeos (269,56 DDDs/1.000) foi relacionada com a colonização pelo ORSA (Pearson r=0.57/p=0.02). Adicionalmente, idade > 60 anos, terapia antibiótica prévia e uso prévio de carbapenêmicos foram estatisticamente significantes por análise multivariada. CONCLUSÕES: Foi observada uma relação significativa entre a colonização da mucosa de orofaringe e o risco de PAV por ambos fenótipos. O uso de glicopeptídos foi relacionado com a colonização pelo ORSA.