Perfil clínico de pacientes com sepse internados em unidade de terapia intensiva: um estudo transversal / Clinical profile of patients with sepsis admitted to an intensive care unit: a cross-cutting study / Perfil clínico de pacientes con sepsis ingresados en unidad de cuidados intensivos: estudio transversal

Objetivo: identificar o perfil clínico de pacientes com sepse internados em Unidade de Terapia Intensiva. Método: pesquisa documental. A amostra contou com 50 prontuários de pacientes com quadro de sepse. A análise foi realizada através de estatística descritiva e teste de Qui-Quadrado de Pearson. O estudo foi aprovado pelo Comitê de Ética em Pesquisa sob número de protocolo 3.779.654. Resultados: idade média foi de 66,4 anos, prevaleceram os indivíduos do sexo masculino, que eram procedentes da emergência, com acesso venoso central e sondagem vesical de demora, sepse pulmonar, presença de distúrbios cardiovasculares e óbito como desfecho. Observou-se associação significativa entre distúrbios gastrointestinais e envelhecimento com sepse abdominal. Conclusão: é necessário o fortalecimento de políticas públicas de saúde voltadas para a qualificação dos profissionais com intuito de prevenir e reconhecer precocemente a sepse

Objective: to identify the clinical profile of patients with sepsis admitted to the Intensive Care Unit. Method: documentary research. The sample included 50 medical records of patients with sepsis. The analysis was performed using descriptive statistics and Pearson's Chi-Square test. The study was approved by the Research Ethics Committee under protocol number 3,779,654. Results: mean age was 66.4 years, males who came from the emergency room prevailed, with central venous access and indwelling urinary catheter, pulmonary sepsis, presence of cardiovascular disorders and death as an outcome. There was a significant association between gastrointestinal disorders and aging with abdominal sepsis. Conclusion: it is necessary to strengthen public health policies aimed at training professionals in order to prevent and early recognize sepsis

Objetivo: identificar el perfil clínico de los pacientes con sepsis ingresados en la Unidad de Cuidados Intensivos. Método: investigación documental. La muestra incluyó 50 historias clínicas de pacientes con sepsis. El análisis se realizó mediante estadística descriptiva y la prueba de chi-cuadrado de Pearson. El estudio fue aprobado por el Comité de Ética en Investigación con el número de protocolo 3.779.654. Resultados: la edad promedio fue de 66,4 años, predominaron los varones que acudieron a urgencias, con acceso venoso central y sonda vesical permanente, sepsis pulmonar, presencia de trastornos cardiovasculares y muerte como desenlace. Hubo una asociación significativa entre los trastornos gastrointestinales y el envejecimiento con sepsis abdominal. Conclusión: es necesario fortalecer las políticas de salud pública orientadas a la formación de profesionales para prevenir y reconocer precozmente la sepsis

Efficacy of probiotics in preventing late-onset sepsis in very low birth weight infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVE@#To study the efficacy of probiotics in preventing late-onset sepsis (LOS) in very low birth weight (VLBW) infants.@*METHODS@#Databases including PubMed, Web of Science, Cochrane Library, Wanfang Data, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database were searched for randomized controlled trials (RCTs) of probiotics in preventing LOS in VLBW infants. LOS was classified as clinical LOS and confirmed LOS. RevMan 5.4 was used to perform the Meta analysis.@*RESULTS@#A total of 31 RCTs were included, with 3 490 VLBW infants in the probiotics group and 3 376 VLBW infants in the control group. The Meta analysis showed that compared with the control group, the probiotics group had significantly lower risks of clinical LOS (@*CONCLUSIONS@#Current evidence indicates that probiotics may reduce the risk of clinical LOS and clinical/confirmed LOS in VLBW infants, and the risk of confirmed LOS in VLBW infants who are exclusively breastfed.

Calcifilaxis / Calciphylaxis

Resumen La calcifilaxis es una enfermedad poco frecuente, aunque presenta una elevada tasa de mortalidad debido sobre todo a complicaciones como sepsis o gangrena. Generalmente se asocia a insuficiencia renal severa. Se define como la calcificación de la capa media de vasos de pequeño y mediano tamaño de la dermis y tejido celular subcutáneo. Clínicamente se manifiesta como un síndrome de livedoracemosa que progresa a púrpura retiforme y necrosis cutánea. La primera línea de tratamiento es el tiosulfato sódico.

Abstract Calciphylaxis is a rare disease, although it has a high mortality rate due mainly to complications such as sepsis or gangrene. It is usually associated with severe renal failure. It is defined as the calcification of the middle layer of small and medium-sized vessels of the dermis and subcutaneous cellular tissue. Clinically it manifests as a livedoracemosa syndrome that progresses to retinal purpura and cutaneous necrosis. The first line of treatment is sodium thiosulfate.

Aplicação de tecnologia educativa na sensibilização do protocolo de sepse em unidade de tocoginecologia / Application of educational technology in the sensitization of the sepse protocol in a tocogyncology unit / Aplicación de tecnología educativa en la sensibilización del protocolo de sepse en unidad de tocoginecología

Objetivo: avaliar o impacto da sensibilização no setor e adesão ao protocolo de sepse em unidade de tocoginecologia. Método: Trata-se de uma pesquisa-ação no período de janeiro a março/2016, com 63 profissionais que trabalham em unidade de tocoginecologia de um hospital de alta complexidade. Resultados: 51% dos profissionais receberam o treinamento sobre o protocolo de sepse e após, 50% dos pacientes que tinham critérios de SIRS foram incluídos no protocolo de sepse, sendo que o desfecho de 03 destas, foi alta hospitalar e 02 foram transferidas para UTI devido sepse grave. O tempo médio de administração do antibiótico foi 50 minutos, da solicitação do hemograma foi 46,25 minutos e do resultado do lactato foi acima de 30 minutos. Conclusão: Ainda há necessidade de melhoria em relação à adesão pela equipe de Enfermagem para implantação de medidas de combate à sepse

Objective: to evaluate the impact of the sensitization in the sector and adherence to the protocol of sepsis in a unit of tocoginecology. Method: This is an action research from January to March/2016, with 63 professionals working in a tocoginecology unit of a highly complex hospital. Results: 51% of the professionals received training on the sepsis protocol and after that, 50% of the patients who had SIRS criteria were included in the sepsis protocol, and the outcome of 03 of these was hospital discharge and 02 were transferred to the ICU Due to severe sepsis. The mean time of administration of the antibiotic was 50 minutes, the request of the blood count was 46.25 minutes and the result of the lactate was over 30 minutes. Conclusion: There is still a need for improvement regarding adherence by the Nursing team to implement measures to combat sepsis

Objetivo: evaluar el impacto de la sensibilización en el sector y la adhesión al protocolo de sepsis en unidad de tocoginecología. Método: Se trata de una investigación-acción en el período de enero a marzo/2016, con 63 profesionales que trabajan en unidad de tocoginecología de un hospital de alta complejidad. Resultados: 51% de los profesionales recibieron el entrenamiento sobre el protocolo de sepsis y después, 50% de los pacientes que tenían criterios de SIRS fueron incluidos en el protocolo de sepsis, siendo el desenlace de 03 de ellas, fue alta hospitalaria y 02 fueron transferidas a UTI Debido a la sepse grave. El tiempo promedio de administración del antibiótico fue de 50 minutos, de la solicitud del hemograma fue 46,25 minutos y el resultado del lactato fue de más de 30 minutos. Conclusión: Aún hay necesidad de mejora en relación a la adhesión por el equipo de Enfermería para implantación de medidas de combate a la sepsis

O enfermeiro na detecção dos sinais e sintomas que antecedem sepse em pacientes na enfermaria / The nurse approach towards the detection of antecedent signs and symptoms of sepsis in patients at a nursing ward / El enfermero en la detección de los señales y síntomas que antecede a sepse en pacientes en la enfermería

Objective: The study's goal has been to describe the antecedent signs and symptoms of sepsis in patients hospitalized in the Medical Clinic of a Federal Hospital in Rio de Janeiro city, which are identified by a Registered Nurse; to analyze how the Nurse correlates the signs and symptoms with Sepsis-1, Sepsis-2 and Sepsis-3. Methods: It is a descriptive study with a quantitative approach; the population were 10 Registered Nurses who worked daytime shifts in the nursing ward. Data collection was performed through a structured questionnaire, addressing the identification of signs and symptoms that precede sepsis, including the characteristics and peculiarities of sepsis. Results: The Nurses have adequate understanding regarding the concept of sepsis, although they have showed difficulties in correlating some of the signs and symptoms. Conclusion: The Nurses are aware that sepsis is a health problem and that they provide direct care to the patient, therefore, it is important to identify the signs and symptoms that precede it in order to offer quality assistance and to help reducing new cases

Objetivo: Descrever os sinais e sintomas que antecedem a sepse em pacientes internados na Clínica Médica de um Hospital Federal no Rio de Janeiro identificados pelo Enfermeiro; analisar como o Enfermeiro correlaciona os sinais e sintomas com a Sepsis-1, Sepsis-2 e Sepsis-3. Métodos: Estudo descritivo com abordagem quantitativa, a população foram 10 Enfermeiros em plantões diurnos na enfermaria da Clínica. A coleta de dados foi um questionário estruturado, abordando identificação dos sinais e sintomas que antecedem a sepse, englobando as características e particularidades da sepse. Resultados: Evidenciou-se que possuem entendimento sobre o conceito de sepse, entretanto apresentaram dificuldades em correlacionar alguns dos sinais e sintomas dos tipos de sepse. Conclusão: Ciente que a sepse é um problema de saúde e o Enfermeiro presta cuidado direto ao paciente, percebe-se a importância na identificação dos sinais e sintomas que a antecedem para oferecer assistência de qualidade e auxiliar na redução dos casos

Objetivo: Describe los síntomas y antecedentes de la sepsis en pacientes internados en la Clínica Médica de un Hospital Federal en Río de Janeiro por el enfermero; analizar cómo el enfermero correlaciona los signos y síntomas con Sepsis-1, Sepsis-2 y Sepsis-3. Métodos: Estudio descriptivo con abordaje cuantitativo, la población fue 10 enfermeros en turnos diurnos en la enfermería de la Clínica. La recolección de datos fue un cuestionario estructurado, abordando identificación de los signos y síntomas que anteceden a la sepsis, englobando las características y particularidades de la sepsis. Resultados: Tienen un entendimiento adecuado sobre el concepto de sepsis, sin embargo, presentan dificultades en correlacionar algunos de los signos y síntomas. Conclusión: Es consciente de que la sepsis es un problema de salud y el enfermero presta atención directa al paciente, se percibe la importancia en la identificación de los signos y síntomas que la anteceden para ofrecer asistencia de calidad y auxiliar en la reducción de los casos

Perfil epidemiológico e análise da efetividade para prevenção de óbitos de pacientes inseridos em protocolo de sepse / Epidemiological profile and effectiveness analysis for the prevention of deaths of patients enrolled in a sepsis protocol

Objetivo: Avaliar casos de sepse e choque séptico verificando perfil epidemiológico, tratamento, adesão às recomendações internacionais e grau de efetividade das intervenções, para analisar sua efetividade na redução da mortalidade. Métodos: Trata-se de estudo observacional transversal com revisão dos atendimentos de sepse e choque séptico entre abril de 2013 e dezembro de 2015. Quanto à efetividade na prevenção de óbitos, o período foi de 2014 a 2015. Resultados: Foram incluídos 412 pacientes (55,3 anos), sendo 58% do sexo masculino. Dentre os pacientes, 80,1% foram inseridos no protocolo no tempo preconizado, 79,9% tiveram coleta de lactato e 91,7% de hemocultura no prazo (p<0,05). Iniciaram antibioticoterapia no prazo 87,4% da amostra. Ocorreram 68 óbitos no pronto-socorro, sendo 80,9% relacionados à sepse. Para a efetividade de prevenção de óbitos, foram incluídos 351 pacientes. O total de prevenção de óbitos foi de 325 pacientes, sendo 52,9% em 2014. O índice de prevenção de óbitos foi crescente (92,6%), indicando alta efetividade. Conclusão: Evidenciou- se alta letalidade nos quadros sépticos. A análise de dados epidemiológicos aponta possíveis melhorias para uniformizar e garantir o melhor atendimento dos pacientes. A adesão e a efetividade do protocolo têm sido crescentes, alcançando índice de prevenção de óbitos muito próximo do ideal. (AU)

Objective: To evaluate cases of sepsis and septic shock checking epidemiological profile, treatment, adherence to the international recommendations, and effectiveness degree of interventions, to analyze the effectiveness in mortality reduction. Methods: This is a cross-sectional observational study with review of sepsis and septic shock between april of 2013 and December of 2015. Regarding effectiveness in preventing deaths, the period was from 2014 to 2015. Results: A total of 412 patients (55.3 years) were included, with 58% male individuals. Of these patients, 80.1% were inserted in the protocol at the recommended time, 79.9% underwent lactate collection, and 91.7% underwent blood culture within the term (p<0.05). Antibiotic therapy was initiated in 87.4% within the term. There were 68 deaths in the emergency room, 80.9% of which were related to sepsis. For the effectiveness of death prevention, 351 patients were included. The total number of prevented deaths was 325 patients, 52.9% in 2014. The death prevention index was increasing (92.6%), indicating high effectiveness. Conclusion: High lethality was observed in septic patients. Epidemiological data analysis points to possible improvement to standardize and guarantee the best care for patients. Protocol compliance and effectiveness have been increasing, reaching an index of deaths prevention very close to the optimal one. (AU)

The declaration of São Paulo: sepsis as the main cause of preventable death and disability in Latin America. A call to action in order to reduce the burden of sepsis / Declaración de São Paulo: Sepsis como la principal causa de muerte y discapacidad prevenibles en América Latina. Un llamado a la acción para reducir el impacto de la sepsis

Sepsis is a major cause of preventable deaths in Latin American (LATAM) countries, and is the most frequent cause of death from infection. During the Latin American Sepsis Institute meeting in São Paulo, Brazil, on May 30, 2018, delegates representing 16 LATAM countries called for urgent action by governments, healthcare workers, and the community, to support the national and international commitments to improve the prevention, diagnosis, and treatment of sepsis and to dedicate human and financial resources to accomplish these goals. The delegates supported the following declaration:Noting that sepsis is recognized as a global health priority by World Health Organization (WHO) Resolution WHA A70/13 and that member nations are urged to adopt national policies to improve the prevention, recognition, and treatment of sepsis.

La sepsis es una de las principales causas de muerte prevenible en los países de América Latina (LATAM) y es la causa más frecuente de muerte por infección. Durante la reunión del Instituto Latinoamericano de Sepsis en São Paulo, Brasil, el 30 de mayo de 2018, los delegados en representación de 16 países de LATAM pidieron acciones urgentes por parte de los gobiernos, los trabajadores de la salud y la comunidad, para apoyar los compromisos nacionales e internacionales para mejorar la prevención, diagnóstico y tratamiento de la sepsis y dedicar recursos humanos y financieros para lograr estos objetivos. Los delegados apoyaron la siguiente declaración: Señalando que la sepsis es reconocida como una prioridad de salud global por la Resolución WHA A70 / 13 de la Organización Mundial de la Salud (OMS) y que se insta a los países miembros a adoptar políticas nacionales para mejorar la prevención, el reconocimiento y el tratamiento de la sepsis. .

Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound - guided prostate biopsy

ABSTRACT Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations. Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound - guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics. Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 - 0.78; P = 0.021). Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.

Incidencia de sepsis precoz por Streptococcus agalactiae en recién nacidos del Centro Hospitalario Pereira Rossell en el período 2007-2015 / Incidence of group B streptococcal early-onset sepsis in infants born at Centro Hospitalario Pereira Rossell between 2007-2015

Resumen Introducción La infección por Streptococcus agalactiae (β-hemolítico del grupo B (SGB) continúa siendo una de las principales causas de sepsis precoz en países desarrollados a pesar de la implementación de profilaxis efectiva. Objetivos Describir la incidencia, características clínicas y mortalidad de sepsis precoz por SGB en recién nacidos del Centro Hospitalario Pereira Rossell (CHPR), y analizar las fallas de adherencia a las estrategias de prevención. Métodos Estudio retrospectivo de descripción de casos entre los años 2007 a 2015 identificados a partir de la base de datos del laboratorio de bacteriología. Resultados Se identificaron 15 casos de sepsis neonatal precoz a SGB con una incidencia en el período de estudio de 0,23‰. La quimioprofilaxis intraparto no fue realizada en caso alguno. Todos los recién nacidos se presentaron sintomáticos en las primeras 15 h de vida. La dificultad respiratoria fue el signo más frecuente (80%). En un caso se aisló SGB de líquido cefalorraquídeo. La mortalidad fue de 20%. Todas las muertes ocurrieron en las primeras 24 h de vida, siendo dos tercios prematuros. Conclusión La incidencia de sepsis precoz por SGB en el CHPR fue similar a la incidencia en centros donde se realiza quimioprofilaxis. Una mejor adherencia a las estrategias de prevención podría disminuir la incidencia.

Background: Group B Streptococcus (GBS) disease remains the leading cause of early-onset sepsis (EOS) in developed countries despite effective prophylaxis strategies. Aims: To describe the incidence, clinical features and mortality of GBS EOS in infants born at Centro Hospitalario Pereira Rossell (CHPR) and analyse failure of adherence to prevention strategies. Methods: Retrospective review of EOS cases between 2007 and 2015 collected from the bacteriology laboratory database. Results: Fifteen cases of GBS EOS were identified, with an incidence of 0.23% during the study period. Intrapartum antibiotic prophylaxis (IAP) was not administered in any of the cases. All infants were symptomatic within the first 15 hours of life, mainly due to respiratory signs (80%). In one case, GBS was isolated from spinal fluid. Mortality rate was 20%. All deaths occurred in the first 24 hours of life, corresponding two thirds to preterm infants. Conclusion: The incidence of GBS EOS at CHPR was similar to other centers where IAP is implemented. Better adherence to prophylaxis strategies could reduce the incidence.

Avaliação do tratamento da sepse com glutamina via enteral em ratos / Evaluation of sepsis treatment with enteral glutamine in rats

RESUMO Objetivo: analisar a influência da glutamina nas alterações morfo-histológicas observadas em íleo, pulmão, rim e fígado de ratos Wistar submetidos à sepse. Métodos: a sepse foi induzida por meio de ligadura e punção do ceco. Os animais foram divididos em dois grupos: grupo A, controle, com cinco animais, e grupo B, experimento, com dez animais que utilizaram previamente glutamina por dois dias por via enteral. Na análise histológica, classificou-se as lesões de acordo com um escore cujo valor atribuído dependia da gravidade da lesão e do órgão acometido. A somatória dos valores atribuídos a cada animal resultou em sua nota final. No íleo, avaliaram-se as vilosidades; no fígado, esteatose microgoticular; no pulmão, pneumonite intersticial; e no rim, vacuolização dos túbulos contorcidos proximais. Resultados: a lise celular e a destruição das vilosidades no íleo do grupo controle foram mais intensas em relação aos animais que receberam glutamina. No rim, verificou-se vacuolização mais acentuada dos túbulos contorcidos proximais no grupo controle em relação aos animais que receberam glutamina. Tanto a esteatose microgoticular como a pneumonite intersticial mostraram-se semelhantes em ambos os grupos. Conclusão: o uso de glutamina via enteral previamente à sepse na dose de 0,5 g/kg/dia preservou de maneira significativa a estrutura histológica do intestino delgado e os rins em ratos.

ABSTRACT Objective: to analyze the influence of glutamine on morphological and histological changes observed in the ileum, lung, kidney and liver of Wistar rats subjected to sepsis. Methods: we induced sepsis by cecal ligature and puncture. We divided the animals in two groups: group A, control, with five animals, and group B, experience, with ten animals that received enteral glutamine two days before sepsis induction. We used histological analysis to rank the injury according to a score dependent on the injury severity and the affected organ. The sum of values assigned to each animal resulted in a final grade. We assessed the villi in the ileum, microgoticular steatosis in the liver, interstitial pneumonitis in the lungs, and vacuolation of the proximal convoluted tubules in the kidneys. Results: cell lysis and destruction of the villi of the ileum were more intense in the control group when compared with animals receiving glutamine. In the kidney, we found more pronounced vacuolization in the proximal convoluted tubules in the control group compared with animals receiving glutamine. Both microgoticular steatosis and interstitial pneumonitis were similar between groups. Conclusion: administration of enteral glutamine prior to sepsis preserved the histological structure.

Effects of statins on the development of sepsis and organ dysfunction in hospitalized older patients in China

ABSTRACT This study aimed to evaluate the protective role of statins on the development of sepsis and infection-related organ dysfunction and mortality in a hospitalized older Chinese population with bacterial infections. In this retrospective cohort study, 257 older patients with bacterial infection were divided into two groups: a statin group, those who had received statin therapy for ≥1 month before admission and continued receiving statin during hospitalization; and a non-statin group, those who had never received statin or used statin for <1 month prior to admission. A multivariate logistic regression analysis was performed to identify risk and protective factors for severe sepsis. A significantly lower incidence of organ dysfunction was found in the statin group, as compared with the non-statin group (13.3% vs 31.1%, respectively; p = 0.002), corresponding to adjusted rates ratio of 0.32 (95% confidence interval [CI], 0.13-0.75; p = 0.009). No significant difference was found between statin and non-statin groups in 30-day sepsis-related mortality (4.4% vs 10.2%, respectively; p = 0.109), incidence of intensive care unit admission (13.3% vs 16.8%, respectively; p = 0.469), or length of hospital stay (20.5 vs 25.9 days, respectively; p = 0.61). Statins significantly reduced the development of sepsis and infection-related organ dysfunction in hospitalized older Chinese patients but did not reduce 30-day mortality, ICU admission incidence, or length of hospital stay.

The effect of tadalafil therapy on kidney damage caused by sepsis in a polymicrobial septic model induced in rats: a biochemical and histopathological study

ABSTRACT Introduction Sepsis is an inflammatory reaction to bacteria involving the whole body and is a significant cause of mortality and economic costs. The purpose of this research was to determine whether tadalafil exhibits a preventive effect on sepsis in a septic model induced in rats with cecal ligation and puncture (CLP). Materials and Methods Rats were randomly separated into groups, 10 rats in each: (i) a sham (control) group, (ii) an untreated sepsis group, (iii) a sepsis group treated with 5mg/kg tadalafil and (iv) a sepsis group treated with 10mg/kg tadalafil. A polymicrobial sepsis model was induced in rats using CLP. Rats were sacrificed after 16h, and blood and kidney tissues were collected for biochemical and histopathological study. Results Levels of the inflammatory parameter IL-6 decreased significantly in the sepsis groups receiving tadalafil in comparison with the untreated sepsis group (p<0.05). In terms of histopathology, inflammation scores investigated in kidney tissues decreased significantly in the sepsis groups receiving tadalafil compared to the untreated sepsis group (p<0.05). In addition, levels of creatinine and cystatin C measured in septic rats receiving tadalafil were lower by a clear degree than in septic rats (p<0.05). Conclusion In this study, tadalafil exhibited a preventive effect for sepsis-related damage by suppressing inflammation in serum and kidney tissue of septic rats in a polymicrobial sepsis model induced with CLP.

Actualización en técnica aséptica y uso de antibióticos profilácticos en procedimientos quirúrgicos ambulatorios que comprometan piel y mucosas / Aseptic techniques for minor surgical procedures: an update

Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

A double-blinded randomized trial on growth and feeding tolerance with Saccharomyces boulardii CNCM I-745 in formula-fed preterm infants / Ensaio duplo-cego randomizado sobre crescimento e tolerância de alimentação com a Saccharomyces boulardii CNCM I-745 em neonatos prematuros alimentados com fórmula

Abstract Objective: The use of probiotics is increasingly popular in preterm neonates, as they may prevent necrotizing enterocolitis sepsis and improve growth and feeding tolerance. There is only limited literature on Saccharomyces boulardii CNCM I-745 (S. boulardii) in preterm infants. Method: A prospective, randomized, case-controlled trial with the probiotic S. boulardii (50 mg/kg twice daily) was conducted in newborns with a gestational age of 30-37 weeks and a birth weight between 1500 and 2500 g. Results: 125 neonates were enrolled; 63 in the treatment and 62 in the control group. Weight gain (16.14 ± 1.96 vs. 10.73 ± 1.77 g/kg/day, p < 0.05) and formula intake at maximal enteral feeding (128.4 ± 6.7 vs. 112.3 ± 7.2 mL/kg/day, p < 0.05) were significantly higher in the intervention group. Once enteral feeding was started, the time needed to reach full enteral feeding was significantly shorter in the probiotic group (0.4 ± 0.1 vs. 1.7 ± 0.5 days, p < 0.05). There was no significant difference in sepsis. Necrotizing enterocolitis did not occur. No adverse effects related to S. boulardii were observed. Conclusion: Prophylactic supplementation of S. boulardii at a dose of 50 mg/kg twice a day improved weight gain, improved feeding tolerance, and had no adverse effects in preterm infants >30 weeks old.

Resumo Objetivo: O uso de probióticos está cada vez mais popular em neonatos prematuros, já que podem prevenir a enterocolite necrosante (ECN) e a sepse e aumentar o crescimento e a tolerância de alimentação. Há apenas uma literatura limitada sobre a Saccharomyces boulardii CNCM I-745 (S. boulardii) em neonatos prematuros. Método: Um ensaio de caso-controle prospectivo randomizado com o probiótico S. boulardii (50 mg/kg duas vezes por dia) foi feito com recém-nascidos com idade gestacional de 30 a 37 semanas e peso ao nascer entre 1.500 e 2.500 g. Resultados: Foram incluídos 125 neonatos, 63 no grupo de tratamento e 62 no de controle. O ganho de peso (16,14 ± 1,96 em comparação com 10,73 ± 1,77 g/kg/dia, p < 0,05) e a ingestão de fórmula com nutrição enteral máxima (128,4 ± 6,7 em comparação com 112,3 ± 7,2 mL/kg/dia, p < 0,05) foram significativamente maiores no grupo de intervenção. Assim que a nutrição enteral foi iniciada, o tempo necessário para atingir a nutrição enteral completa foi significativamente menor no grupo probiótico (0,4 ± 0,1 em comparação com 1,7 ± 0,5 dia, p < 0,05). Não houve diferença significativa em sepse. Não ocorreu ECN. Não foi observado efeito colateral relacionado à S. boulardii. Conclusão: A suplementação profilática de S. boulardii em uma dose de 50 mg/kg duas vezes por dia melhorou o ganho de peso, aumentou a tolerância de alimentação e não teve efeito colateral em neonatos prematuros > 30 semanas de idade.

Copaiba oil effect on induced fecal peritonitis in rats

PURPOSE: To evaluate the effects of copaiba oil as a prophylactic and/or therapeutic substance on survival of rats subjected to cecal ligation and puncture, describing histopathological and oxidative stress findings.METHODS:Forty rats (Ratus norvegicus) were distributed into five study groups (N=8): Sham group (ShG): normal standard animals; Sepse group (SepG): submitted a cecal ligation and puncture (CLP); Pre group (PreG): administered copaiba oil once daily by subcutaneous injection for five days before carrying out CLP; Post CLP group (PostG): administered copaiba oil once daily by subcutaneous injection from the first day of CLP until death by sepsis; and Pre/Post group (Pre/PostG): administered copaiba oil once daily by subcutaneous injection for five days before carrying out CLP and from the first day of CLP until de death by sepsis. After the death of the animals, blood was collected for assessment of oxidative stress and histological analysis were performed. The Kaplan-Meier curves of surviving time were realized.RESULTS: Survival analysis demonstrated that animals treated with copaiba oil prior to the execution of the CLP (PreG and Pre/Post groups) had longer survival compared to the sepsis group (p<0.0001) whereas animals receiving copaiba only after the completion of CLP (PostG) showed no statistically significant difference compared to the sepsis group. However, when comparing the two groups in which was administered copaiba previously (PreG and Pre/PostG groups), there was no statistical significance between the groups (p=0.4672). There was no statistical difference between histopathological findings or the levels of oxidative stress.CONCLUSION: Prophylactic subcutaneous administration of copaiba increases survival of rats subjected to severe sepsis by cecal ligation and puncture.

Sepsis neonatal grave en una unidad de cuidados intensivos / Severe neonatal sepsis in an intensive care unit

INTRODUCCIÓN: la sepsis neonatal grave se produce en 0,5 a 8,0 de cada 1 000 nacidos vivos, y es la causa más común de muerte neonatal. OBJETIVO: caracterizar la sepsis neonatal grave en los pacientes ingresados en el servicio de Neonatología del Hospital Universitario Ginecoobstétrico "Mariana Grajales", de Santa Clara, durante los años 2011-2012. MÉTODOS: se realizó un estudio observacional, descriptivo, de tipo transversal, con elementos de enfoque cualitativo y cuantitativo. El universo de estudio quedó conformado por el total de recién nacidos con sepsis neonatal grave (105 neonatos), lo que coincidió con la muestra. Las variables perinatales seleccionadas fueron: total de nacidos vivos, ingresos en terapia neonatal (con sepsis y con sepsis graves), edad gestacional, clasificación de la sepsis, microorganismos aislados, estudios microbiológicos y tasa por 1 000 nacidos vivos por infección. RESULTADOS: de los 145 neonatos con diagnóstico de sepsis, 105 de ellos evolucionaron con sepsis grave (72,4 %). Se comprobó que 70 pacientes del total nacieron pretérminos, que representó el 66,6 %; y 74 niños presentaron sepsis generalizada adquirida confirmada. Fue más frecuente el aislamiento del Staphylococcus coagulasa negativo. CONCLUSIONES: más de la mitad de los neonatos con sepsis se comportaron como una sepsis grave. La prematuridad se relacionó estrechamente con esta entidad en la etapa neonatal. La sepsis generalizada adquirida fue la más frecuente. Más de la mitad de los hemocultivos fueron positivos, y los microorganismos más frecuentes fueron el Staphylococcus coagulasa negativo y la Candida.

INTRODUCTION: severe neonatal sepsis occurs in 0.5 to 8 per 1 000 livebirths and is the common cause of neonatal death. OBJECTIVE: to characterize the severe neonatal sepsis in patients admitted to the neonatology service of "Mariana Grajales" university gynecological and obstetric hospital located in Santa Clara during 2011 and 2012. METHODS: observational, descriptive and cross-sectional study was conducted, using quantitative and qualitative-focused elements. The universe of study was the total number of newborns with severe neonatal sepsis (105 neonates), which agreed with the sample. The selected perinatal variables included total number of livebirths, admissions to neonatal therapy service (with sepsis and severe sepsis), gestational age, classification of sepsis, isolated microorganisms, microbiological studies and infection rate per 1 000 livebirths. RESULTS: of 145 neonates with sepsis diagnosis, 105 progressed into severe sepsis (72.4 %). It was confirmed that 70 patients were preterm born, accounting for 66.6 % and 74 children presented with confirmed acquired generalized sepsis. The most isolated agent was negative Staphylococcus coagulase. CONCLUSIONS: half of neonates with sepsis behaved as if they had severe sepsis. Prematurity was closely related to this entity at the neonatal phase. Acquired generalized sepsis was the most common. More than 50 % of the hemocultures were positive and the most frequent ones were negative Staphylococcus coagulase and Candida.

Sepse: um problema de saúde pública / Sepsis: a public health problem

A medicina aeroespacial é uma área da medicina com escopo próprio e vigorosa existência. Existe desde quando o homem conseguiu alçar voo em objeto mais pesado que o ar. Sua trajetória se aproveita de vitoriosa história de descobertas e criação de meios para adaptar o corpo e a mente humana ao ambiente hostil da condição hipobárica e, nas viagens siderais, ao microgravitacional. A evolução dos meios de transporte de massa, com aeronaves cada vez maiores e a possibilidade de acesso de mais passageiros, aumentou o número de intercorrências a bordo, inclusive algumas com desfecho fatal. Esse contexto tem exigido de médicos em viagem, a lazer ou a trabalho, intervenções pontuais em socorro a tais acontecimentos. A Câmara Técnica de Medicina Aeroespacial trabalha há três anos para produzir um documento que oriente os médicos sobre a abordagem dessas intercorrências de modo adequado. Tal preocupação decorre do fato de que, durante a formação dos médicos, não lhes é propiciado o aprendizado sobre a repercussão dos ambientes hostis hipo e hiperbáricos, ambos com profundas repercussões fisiológicas e fisiopatológicas sobre o organismo do homem.