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1.
Bol. latinoam. Caribe plantas med. aromát ; 19(1): 65-76, ene. 2020. tab, ilus
Article in English | LILACS (Americas) | ID: biblio-1102867

ABSTRACT

Due to the biological activities of Syzygium aromaticum essential oil, its incorporation in methacrylate polymeric (Eudragit E100) nanoparticles (NP), physical characterization, and antimicrobial essays were evaluated. The clove bears great potential for applications in dentistry. The oil was obtained by hydrodistillation and oil loaded NP using the nanoprecipitation method. Particle size and polydispersity index were determined by photon correlation spectroscopy, and physical morphology by electron microscopy. Loading capacity and in vitro eugenol release were evaluated by gas mass chromatography, and the antimicrobial activity of oil loaded-NP was calculated against Streptococcus mutans. Different chemical ingredients were characterized, and eugenol was the principal compound with 51.55%. Polymer content was directly related to NP homogenous size, which was around 150 nm with spherical morphology. A 73.2% loading capacity of eugenol was obtained. Oil loaded NP presented a fickian-type release mechanism of eugenol. Antimicrobial activity to 300 µg/mL was obtained after 24 h.


Debido a las actividades biológicas del aceite esencial de Syzygium aromaticum, se evaluó su incorporación en nanopartículas (NP) de metacrilato polimérico (Eudragit E100), su caracterización y ensayos antimicrobianos. El clavo tiene un gran potencial para aplicaciones en odontología. El aceite se obtuvo por hidrodestilación y las NP cargado de aceite utilizando el método de nanoprecipitación. El tamaño de partícula y el índice de polidispersidad se determinaron mediante espectroscopia de correlación fotónica y su morfología por microscopía electrónica. La capacidad de carga y la liberación de eugenol in vitro se evaluaron mediante cromatografía de gases en masa, y la actividad antimicrobiana se evaluó contra Streptococcus mutans. Se caracterizaron diferentes ingredientes químicos, siendo el eugenol el principal compuesto con 51.55%. El contenido de polímero se relacionó directamente con el tamaño homogéneo de NP, que fue de alrededor de 150 nm con morfología esférica. Se obtuvo un 73,2% de capacidad de carga de eugenol. El aceite cargado en NP presentó un mecanismo de liberación de eugenol de tipo fickiano. La actividad antimicrobiana a 300 µg/mL se obtuvo después de 24 h.


Subject(s)
Polymers/chemistry , Oils, Volatile/administration & dosage , Syzygium/chemistry , Nanoparticles/chemistry , Anti-Bacterial Agents/administration & dosage , Streptococcus mutans/drug effects , Eugenol/pharmacology , Oils, Volatile/pharmacology , Administration, Oral , Chromatography, Thin Layer , Drug Delivery Systems , Gas Chromatography-Mass Spectrometry , Anti-Bacterial Agents/pharmacology
2.
Rev. cuba. estomatol ; 56(3): e2012, jul.-set. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1093230

ABSTRACT

RESUMEN Introducción: Los dentífricos con ingredientes activos previenen la caries dental en niños. Objetivo: Determinar la actividad antibacteriana in vitro de tres dentífricos sin flúor y dos soluciones control frente a cepas estándares de Streptococccus mutans. Métodos: Se realizó un estudio transversal, prospectivo y experimental a doble ciego. Se utilizó agar tripticasa de soya con el método de difusión a 37 °C durante 24 h. Se observó el tamaño de los halos de crecimiento inhibitorio en cada grupo. El análisis de los datos se realizó con el software SPSS15, mediante pruebas estadísticas de corroboración de distribución gaussiana de Shapiro-Wilk, prueba de Kruskal-Wallis y de Mann-Whitney. Resultados: El diámetro de inhibición en gluconato de clorhexidina al 0,12 por ciento fue de 26,69 mm (± 1,85), en el agua destilada de 6 mm (± 0) y para las pastas dentífricas de 6 mm (± 0) y 22,93 mm (± 3,39). Al comparar los diámetros obtenidos por la acción del gluconato de clorhexidina 0,12 por ciento y del agua destilada con los dentífricos libre de flúor, sólo en uno de los casos se obtuvieron diferencias estadísticamente significativas (p< 0,05). Conclusiones: No todos los dentífricos para la higiene bucal del bebé estudiados presentan actividad antibacteriana frente a la cepa de Streptococcus mutans ATCC 25175(AU)


ABSTRACT Introduction: Toothpastes with active ingredients prevent dental caries in children. Objective: Determine the in vitro antibacterial activity of three fluoride-free toothpastes and two control solutions against standard Streptococccus mutans strains. Methods: A prospective cross-sectional experimental double-blind study was conducted. Trypticase soy agar was used applying the diffusion method at 37 °C for 24 h. The size of the growth inhibition haloes of each group was examined. Data analysis was based on SPSS15 software, using Shapiro-Wilk Gaussian distribution corroboration statistical tests, and the Kruskal-Wallis and Mann-Whitney tests. Results: Inhibition diameter was 26.69 mm (± 1.85) for 0.12 percent chlorhexidine gluconate, 6 mm (± 0) for distilled water, and 6 mm (± 0) and 22.93 mm (± 3.39) for the toothpastes. Comparison of the diameters obtained by the action of 0.12 percent chlorhexidine gluconate and distilled water with the fluoride-free toothpastes revealed statistically significant differences in only one of the cases (p< 0.05). Conclusions: Not all the baby toothpastes studied display antibacterial activity against the Streptococcus mutans strain ATCC 25175(AU)


Subject(s)
Humans , Infant , Streptococcus mutans/isolation & purification , Data Interpretation, Statistical , Dentifrices/adverse effects , Anti-Bacterial Agents/administration & dosage , Cross-Sectional Studies , Prospective Studies
3.
Rev. med. Rosario ; 85(2): 64-71, mayo-ago. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1053150

ABSTRACT

El aumento de la resistencia bacteriana a los antibióticos se ha vuelto un problema global de salud. Entre otros factores, incide la actitud del médico a la hora de indicar tratamiento antibacteriano y en qué medida se basa en la evidencia. Para conocer cómo efectúa sus indicaciones en la práctica diaria se analizaron las respuestas a un cuestionario anónimo formulado a 100 médicos. Se encontraron diferencias en el modo de prescripción entre los facultativos, inclusive tratar con antibióticos sin haber realizado estudio etiológico, así como distinta respuesta de clínicos y cirujanos. Esto pone en evidencia la necesidad de que cada institución de salud disponga de un protocolo para la administración de estos medicamentos (AU)


Recently there has been a dramatic global increase in bacterial resistance. Phisician´s attitude affects the indication of antibacterial treatment. In order to know how they make their indications in daily practice we analyzed the answers to an anonymous questionnaire to 100 MD. Differences were found in the way of prescribing among physicians. Some of them administered antibiotics without having carried out etiological studies. There was also different response from clinicians and surgeons. This highlights the need for each health institution to have a protocol for the administration of these drugs (AU)


Subject(s)
Humans , Male , Female , Drug Resistance, Bacterial , Anti-Bacterial Agents/administration & dosage , Drug Prescriptions/statistics & numerical data , Public Health/statistics & numerical data , Surveys and Questionnaires
4.
Pesqui. bras. odontopediatria clín. integr ; 19(1): 4430, 01 Fevereiro 2019. tab
Article in English | LILACS (Americas), BBO | ID: biblio-997963

ABSTRACT

Objective: To evaluate antibiotic prescribing practices of dentists working in a major teaching hospital in Sudan, and to assess the need for establishing education programmes to enhance dentists' awareness of antibiotic use. Material and Methods: A cross-sectional study was carried out by distributing an anonymous self-administered questionnaire to a convenience sample of dental practitioners at major teaching hospital in Khartoum/Sudan. The questionnaire investigated knowledge and attitudes of participants in relation to antibiotic prescribing in dental practice. Results: One hundred out of 135 dental practitioners working at the hospital participated in the survey with 48 males and 52 females. Most of the participants (N=44) did not specify their preferable drug reference, while 32 participants specified British National Formulary, and the practice was significantly associated with a higher professional rank (p<0.001). Metronidazole was the most frequently cited antibiotic for dentofacial infections (N=73) and Acute Necrotizing Ulcerative Gingivitis (N=56), while amoxicillin was the most frequently cited antibiotic for dento-alveolar infections and infective endocarditis prophylaxis (N=88 and N=47, respectively). Conclusion: Undergraduate, as well as postgraduate courses,, are required in Sudan to provide up-to-date orientation on antibiotic use, and to increase awareness of dentists about antibiotic prescribing.


Subject(s)
Humans , Male , Female , Drug Prescriptions , Sudan , Health Knowledge, Attitudes, Practice , Dentists , Focal Infection, Dental/diagnosis , Anti-Bacterial Agents/administration & dosage , Chi-Square Distribution , Health Education , Surveys and Questionnaires
5.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 126-129, Jan.-Mar. 2019. graf
Article in Portuguese | LILACS (Americas) | ID: biblio-985129

ABSTRACT

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.


ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.


Subject(s)
Humans , Male , Female , Streptococcus pneumoniae/isolation & purification , Pericardial Effusion/diagnostic imaging , Pericarditis/diagnosis , Pericarditis/physiopathology , Pericarditis/microbiology , Pericarditis/therapy , Pneumococcal Infections/diagnosis , Pneumococcal Infections/physiopathology , Pneumococcal Infections/therapy , Echocardiography/methods , Radiography, Thoracic/methods , Cerebrospinal Fluid/microbiology , Fatal Outcome , Blood Culture/methods , Meningitis/diagnosis , Meningitis/physiopathology , Meningitis/microbiology , Meningitis/therapy , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification , Neurologic Examination/methods
6.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 27-33, Jan.-Mar. 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-985138

ABSTRACT

RESUMO Objetivo: Verificar o perfil e a adequabilidade do uso de antibacterianos em crianças hospitalizadas. Métodos: Estudo transversal. Foi feita a análise de todas as crianças que utilizaram antibacterianos durante a internação de janeiro a dezembro de 2015, em um hospital filantrópico de direito privado de grande porte no sul do Brasil. As informações foram obtidas por revisão dos prontuários e incluíram dados demográficos (idade, sexo, raça e peso corporal) e clínicos (motivo da internação, uso deantibacterianos e desfecho clínico). Utilizou-se estatística descritiva. Resultados: Dos 318 pacientes incluídos, 61,3% eram do sexo masculino. A faixa etária variou de 2 a 11 anos (média: 5,8±2,9 anos de idade). A prevalência do uso de antibacterianos foi de 24,4% considerando o total de 1.346 crianças que foram hospitalizadas. O tempo de internação apresentou mediana de quatro dias. O principal motivo de internação foi clínico e o antibacteriano mais prescrito foi a cefazolina, sendo a via intravenosa predominante. Em relação ao uso de antibacterianos, 62,2% apresentaram prescrições de antibacterianos consideradas adequadas. A subdosagem e a superdosagem tiveram, respectivamente, os valores de 11,7 e 14,6% dos pacientes incluídos. Quanto aos intervalos de administração, 8% foram caracterizados com intervalos longos e 3,5%, curtos. Conclusões: Apesar de a prevalência encontrada do uso de antibacterianos nas crianças hospitalizadas não ser tão elevada, parte considerável da amostra apresentou inadequabilidade quanto ao uso desse tipo de medicamento, se considerados a dose e o intervalo de utilização. Esses dados são motivo de preocupação para o desenvolvimento de resistência bacteriana e ocorrência de reações adversas.


ABSTRACT Objective: To examine the profile and appropriate use of antibiotics among hospitalized children. Methods: A cross-sectional study was conducted with children who had taken antibiotics during hospitalization in a private philanthropic hospital in Southern Brazil, from January to December 2015. The data were obtained by reviewing medical records, encompassing demographic data (age, gender, ethnicity, and body weight) and clinical data (causes of hospitalization, use of antibiotics, and clinical outcome). Descriptive statistics was used to present the data. Results: Of the 318 participants included in the study, 61.3% were male patients. The age range varied between 2 and 11 years, with mean age of 5.8±2.9 years. The prevalence of antibiotics was 24.4% out of the 1,346 hospitalized children. Median hospital stay was four days. The main cause of hospitalization was clinical instability, and the most commonly prescribed antibiotics was Cefazolin, mostly administered intravenously. Regarding the administration of antibiotics, 62.2% were adequately prescribed, even though underdose was 11.7%, and overdose was 14.6% in the studied patients. Antibiotic administration intervals were characterized as long in 8% of cases, and short in 3.5% of cases. Conclusions: Although the prevalence of antibiotics among hospitalized children was not that high, a considerable part of the sample presented inadequacy regarding the dosage and range of use. These data raise concerns about bacterial resistance and adverse reactions.


Subject(s)
Humans , Male , Female , Child , Hospitalization/statistics & numerical data , Medical Records, Problem-Oriented/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Brazil/epidemiology , Child, Hospitalized/statistics & numerical data , Cross-Sectional Studies , Length of Stay/statistics & numerical data , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/adverse effects
7.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 152-156, 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1010241

ABSTRACT

Introduction: A common practice in the management of patients with chronic rhinosinusitis (CRS), the empirical use of antibiotics may contribute to treatment failure and to the development of antimicrobial resistance. Objective: To determine the antibiotic sensitivity pattern of aerobic and anaerobic bacteria associated with CRS. Methods: This was a prospective cross-sectional study in which endoscopically guided middlemeatal swabs (IBMSpss, version 16.0, Chicago, IL, USA) were aseptically taken from patients diagnosed with CRS after obtaining informed consent and ethical clearance. The samples were sent to the laboratory for qualitative and semiquantitative analysis via gram stain, aerobic, anaerobic cultures and antibacterial sensitivity tests. The collected data was analyzed using SPSS for Windows, version 16 (SPSS Inc, Chicago, IL, USA). Simple statistical parameters and paired sample t-test were used, as appropriate. Results: There were 74 (56.92%) bacterial growths, out of which 55 (74.32%) were aerobic and 19 (25.68%) were anaerobic isolates, from a total of 130 patients. About 13 (17.5%- 18%) of these bacterial growths yielded a mixed growth of aerobic and anaerobic isolates. Themost common bacterial isolates were 26 (35.14%) Staphylococcus aureus, Haemophilus influenzae 9 (12.16%), Streptococcus viridians 8 (10.81%), and Streptococcus pneumoniae 5 (6.76%). Augmentin, ciprofloxacin, and Peflacine were found to bemost effective, followed by levofloxacin, Rocephin, erythromycin and Zinat in that order (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bacteria, Anaerobic , Bacteria, Aerobic , Anti-Bacterial Agents/administration & dosage , Sinusitis/microbiology , Microbial Sensitivity Tests , Rhinitis/microbiology , Chronic Disease , Cross-Sectional Studies , Prospective Studies , Amoxicillin-Potassium Clavulanate Combination , Drug Resistance, Bacterial , Nigeria
8.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 36(4): 511-514, out.-dez. 2018. graf
Article in Portuguese | LILACS (Americas) | ID: biblio-977087

ABSTRACT

RESUMO Objetivo: Apresentar um caso de dermatite perioral granulomatosa (DPG) com acometimento extrafacial e resposta terapêutica satisfatória ao uso de macrolídeo oral por curto período. Descrição do caso: Escolar de nove anos, sexo feminino, com quadro exuberante de DPG com acometimento extrafacial. Durante o período de evolução, submeteu-se a múltiplas terapêuticas ineficazes, apresentando melhora significativa das lesões após o uso de azitromicina por cinco dias. Comentários: A DPG é uma afecção dermatológica inflamatória representada por erupções papuloeritematosas em região perioral, nasal e periorbitária, mais comum em crianças e adolescentes. Raramente estende-se à região genital, ao tronco e às extremidades, caracterizando o comprometimento extrafacial. De etiologia ainda desconhecida, parece apresentar correlação com uso de corticosteroides tópicos e outros agentes.


ABSTRACT Objective: To present a case of granulomatous perioral dermatitis (GPD) with extra-facial involvement and good response to short-term treatment with oral macrolide. Case description: A 9-year-old girl presented with exuberant GPD with extra-facial involvement. During follow-up, she received multiple ineffective therapies, but showed significant improvement of the lesions after the use of azithromycin for five days. Comments: GPD is an inflammatory dermatological condition represented by papulo-erythematous eruptions on perioral, nasal and periorbital regions, more prevalent in children and adolescents. It rarely extends to the genital region, trunk, and extremities, which characterizes its extra-facial manifestation. Its etiology is unknown, but it seems to have a correlation with the use of topical corticosteroids and other agents.


Subject(s)
Humans , Female , Child , Azithromycin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Remission Induction , Administration, Oral , Dermatitis, Perioral/complications , Dermatitis, Perioral/drug therapy , Granuloma/complications , Granuloma/drug therapy
9.
Arch. argent. pediatr ; 116(6): 769-772, dic. 2018. ilus, tab
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-973695

ABSTRACT

La sepsis es la principal causa de mortalidad neonatal. La forma precoz, habitualmente, está relacionada con la colonización recto-vaginal u otros factores de riesgo materno. En la forma tardía, es difícil establecer su origen; por lo general, es nosocomial o de la comunidad. El Streptococcus agalactiae (Streptococcus beta-hemolítico del grupo B) es el germen implicado con más frecuencia en la sepsis neonatal en países desarrollados. La forma tardía, generalmente, se presenta con septicemia y meningitis, y, en ocasiones, pueden detectarse infecciones osteoarticulares o de piel y tejidos blandos. El síndrome celulitis-adenitis en la región cervical, forma poco frecuente de presentación, es causado por Staphylococcus aureus y, ocasionalmente, por Streptococcus agalactiae. Se reportan 2 casos de sepsis neonatal tardía con clínica de celulitis-adenitis cervical causados por Streptococcus beta-hemolítico del grupo B, con una evolución satisfactoria con terapia antibiótica de amplio espectro.


Septicemia is the main cause of neonatal mortality. The early-onset neonatal sepsis is usually related to maternal factor risks including recto-vaginal colonization. In the late-onset neonatal septicemia it is more difficult to establish the etiology because the majority of the cases are nosocomial or community related. The Streptococcus agalactiae (beta-hemolytic Streptococcus) is the most frequent germ associated with neonatal sepsis in developed countries. The late-onset form usually occurs with septic symptoms and meningitis and, in a few cases, with osteoarticular, skin and soft tissue infection. Adenitis-cellulitis syndrome is rarely seen, and its main cause is Staphylococcus aureus, followed by Streptococcus agalactiae. We report two cases of group B Streptococcus late-onset neonatal septicemia, both of them with adenitis-cellulitis syndrome. Patients recovered uneventfully after an adequate antibiotic therapy.


Subject(s)
Humans , Male , Infant , Streptococcal Infections/diagnosis , Cellulitis/diagnosis , Neonatal Sepsis/diagnosis , Lymphadenitis/diagnosis , Streptococcal Infections/microbiology , Streptococcal Infections/drug therapy , Streptococcus agalactiae/isolation & purification , Syndrome , Cellulitis/microbiology , Cellulitis/drug therapy , Neonatal Sepsis/microbiology , Neonatal Sepsis/drug therapy , Lymphadenitis/microbiology , Lymphadenitis/drug therapy , Anti-Bacterial Agents/administration & dosage
10.
Arch. argent. pediatr ; 116(6): 785-788, dic. 2018. ilus
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-973699

ABSTRACT

La espondilodiscitis infecciosa es una infección poco frecuente en niños, con mayor incidencia en menores de 6 años. Se presenta el caso de una paciente de 8 años, que se internó por dolor lumbar de 2 meses de evolución, afebril. La radiografía, tomografía e imagen por resonancia magnética nuclear fueron compatibles con espondilodiscitis a nivel de L4-L5. Luego de 10 días de antibioticoterapia empírica con clindamicina, con regular respuesta, se realizó punción ósea y se aisló Kingella kingae. Existe un aumento en la incidencia de infecciones osteoarticulares por Kingella kingae en lactantes y niños pequeños. La reemergencia en los últimos años se justifica por la optimización en las técnicas de cultivo, el uso de sistemas automatizados y de técnicas moleculares de diagnóstico. Kingella kingae es un patógeno que ha adquirido importancia en los últimos años en las infecciones osteoarticulares.


Infectious Spondylodiscitis is a rare infection in children. It is more frequent in patients under 6 years of age. We report the case of an 8-year-old patient with lumbar pain for 2 months, without fever. Xrays, computed tomography and magnetic resonance imaging all three showed spondylodiscitis L4-L5. After a 10-day antibiotic treatment with clindamycin with regular response, a bone puncture was performed isolating Kingella kingae (Kk). Ostearticular infections caused by Kk have increased among infants and children. Due to improvement in culture techniques, the usage of automatic systems and assessment molecular techniques, these infections re-emerged in the past few years. Kk is a pathogen that has lately become significant in osteoarticular infections.


Subject(s)
Humans , Female , Child , Discitis/diagnosis , Neisseriaceae Infections/diagnosis , Kingella kingae/isolation & purification , Anti-Bacterial Agents/administration & dosage , Magnetic Resonance Imaging/methods , Clindamycin/administration & dosage , Discitis/microbiology , Discitis/drug therapy , Tomography, X-Ray Computed/methods , Neisseriaceae Infections/microbiology , Neisseriaceae Infections/drug therapy
11.
Rev. bras. ter. intensiva ; 30(4): 414-422, out.-dez. 2018. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-977983

ABSTRACT

RESUMO Objetivo: Descrever os efeitos de melhorias sucessivas nos sistemas de alerta precoce para identificação de pacientes com sepse, no que se refere ao tempo até o diagnóstico, à administração de antibióticos e à mortalidade. Métodos: Trata-se de um estudo observacional de coorte, que descreve as sucessivas melhorias implantadas em um período de 10 anos no sistema de alerta precoce para detecção de sepse, incluindo vigilância ativa manual sistemática, alertas eletrônicos via telefonista, e alertas enviados diretamente a dispositivos móveis da enfermagem. Para todos os períodos, após o desencadeamento do alerta, o tratamento foi realizado segundo as diretrizes institucionais para sepse. Resultados: Durante estes anos, detectaram-se 637 pacientes com sepse. O tempo mediano entre a triagem e o diagnóstico foi reduzido de 19:20 (9:10 - 38:15) horas para 12:40 (2:50 - 23:45) horas quando se utilizou o método manual de vigilância (p = 0,14), para 2:10 (1:25 - 2:20) horas quando o alerta foi enviado automaticamente ao serviço telefônico do hospital (p = 0,014) e para 1:00 (0:30 - 1:10) horas quando o alerta foi enviado diretamente ao telefone celular da enfermagem (p = 0,02), com manutenção de valores similares nos anos que se seguiram. Não houve diferença no tempo até o tratamento em relação aos pacientes sobreviventes e não sobreviventes. Conclusão: Sistemas eletrônicos auxiliam na redução do tempo entre a triagem e o diagnóstico e entre o diagnóstico e o início da antibioticoterapia em pacientes com sepse.


ABSTRACT Objective: To describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality. Methods: This was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines. Results: In total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors. Conclusion: Electronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.


Subject(s)
Humans , Male , Female , Aged , Telephone , Triage/methods , Sepsis/diagnosis , Anti-Bacterial Agents/administration & dosage , Time Factors , Cohort Studies , Practice Guidelines as Topic , Sepsis/mortality , Sepsis/drug therapy
12.
Int. j. cardiovasc. sci. (Impr.) ; 31(6): 578-584, nov.- dez. 2018. tab
Article in English | LILACS (Americas) | ID: biblio-979722

ABSTRACT

Background: Rheumatic carditis is a challenge for treatment and secondary prophylaxis, due to severe valve sequelae. Objective: To evaluate the cases of rheumatic carditis in patients under 18 years old treated with corticosteroids.Methods: An observational, longitudinal and retrospective study was carried out on the profile of patients, in the period of 2000-2015. We selected those who received corticosteroid therapy at immunosuppressive doses, for the treatment of carditis and were aged 5 to 18 years. Data were extracted from medical records. Calculations of: averages, standard deviations, medians and interquartile ranges, ratios and 95% confidence intervals were obtained. Chi-square and Wilcoxon tests were applied for comparisons. The level of significance was 5%. Results: Of the 93 cases, 93.53% developed moderate or severe carditis. Mitral regurgitation was detected in 100% of the sample. Pulse therapy was administered in 11.83%. Surgery was performed in 23.69% of patients: mitral, aortic and/or tricuspid valve repair or replacement. The evolution of the cases was favorable in 70.96%. There was a good response among those who received only clinical treatment and those who belonged to the surgical group. The comparison of the initial and posterior valve lesions to the corticoid use was statistically significant (p < 0.001). A difference between the ejection fraction medians was observed (p = 0.048). Hospitalization was required twice or more for 45.16% of the patients. The mortality rate was 5.38%.Conclusions: The patients showed significant clinical improvement. The treatment was effective, reducing trivalvular impairment


Subject(s)
Humans , Male , Female , Child , Adolescent , Rheumatic Fever/therapy , Adrenal Cortex Hormones/therapeutic use , Hospitals, Public , Myocarditis/complications , Myocarditis/physiopathology , Aortic Valve , Penicillins/therapeutic use , Prostheses and Implants , Tertiary Healthcare/methods , Prednisone/administration & dosage , Statistical Analysis , Treatment Outcome , Observational Study , Anti-Bacterial Agents/administration & dosage , Mitral Valve , Mitral Valve Insufficiency
13.
Braz. j. microbiol ; 49(3): 552-558, July-Sept. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-951796

ABSTRACT

Abstract Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.


Subject(s)
Humans , Postoperative Complications/microbiology , Bacteria/drug effects , Bacterial Infections/microbiology , Cross Infection/microbiology , Anti-Bacterial Agents/administration & dosage , Postoperative Complications/prevention & control , Bacteria/isolation & purification , Bacteria/growth & development , Bacterial Infections/prevention & control , Preoperative Care , Drug Resistance , Microbial Sensitivity Tests , China , Cross Infection/prevention & control , Antibiotic Prophylaxis
14.
An. bras. dermatol ; 93(4): 590-591, July-Aug. 2018. graf
Article in English | LILACS (Americas) | ID: biblio-949935

ABSTRACT

Abstract: Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Its association with other STIs, including HIV, demands early diagnosis and immediate treatment of patients. We herein report an unusual serpiginous form of secondary syphilis.


Subject(s)
Humans , Male , Adult , Syphilis/complications , Foot Dermatoses/etiology , Hand Dermatoses/etiology , Penicillin G Benzathine/administration & dosage , Syphilis/diagnosis , Syphilis/drug therapy , Foot Dermatoses/diagnosis , Foot Dermatoses/drug therapy , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Injections, Intramuscular , Anti-Bacterial Agents/administration & dosage
15.
Arch. argent. pediatr ; 116(3): 198-203, jun. 2018. tab
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-950010

ABSTRACT

Introducción. La infección es de las complicaciones más frecuentes de los sistemas de derivación ventricular de líquido cefalorraquídeo. El objetivo fue describir las características clínicas, microbiológicas y evolutivas de niños con infección asociada a sistemas de derivación ventricular de líquido cefalorraquídeo y analizar los factores de riesgo, relacionados con la mortalidad. Población y métodos. Estudio descriptivo, retrospectivo, llevado a cabo en el Hospital "Prof. Dr. Juan P. Garrahan" de la Ciudad de Buenos Aires. Se evaluaron todos los pacientes internados desde el 1/1/2012 y el 31/12/2015 compatibles con ventriculitis y cultivo de líquido cefalorraquídeo positivo. Resultados. Se incluyeron 49 pacientes con 57 infecciones. La mediana de edad fue de 62 meses (rango intercuartílico: 19-114). Predominó el sexo masculino: 34 (70%). El tumor del sistema nervioso central fue la enfermedad de base más frecuente: 20 (40%). Se aisló estafilococo coagulasa negativo en 26 (46%), Staphylococcus aureus en 13 (23%), bacilos Gramnegativos en 11 (19%) y otros en 7 (12%). En 55 (97%) de las infecciones, se realizó tratamiento quirúrgico con retiro del sistema de derivación ventricular más antibioticoterapia. La mortalidad fue del 9%. Los únicos factores asociados a la mortalidad estadísticamente significativos fueron hemocultivos positivos (p= 0,04), fiebre al ingreso (p= 0,04) y shock séptico (p= 0,0006). Conclusiones. El estafilococo coagulasa negativo fue el germen más frecuente. El retiro de la válvula, junto con la antibioticoterapia, fue el tratamiento más utilizado. La presencia de fiebre al ingreso, hemocultivos positivos y shock séptico fueron predictores de mortalidad.


Introduction. Infections are the most common complications of ventricular cerebrospinal fluid shunts. The objective of this study was to describe the clinical, microbiological, and evolutionary characteristics of children with ventricular cerebrospinal fluid shunt-associated infections and analyze the risk factors for mortality. Population and methods. Descriptive, retrospective study carried out at Hospital "Prof. Dr. Juan P. Garrahan" in the Autonomous City of Buenos Aires. All patients hospitalized between January 1st, 2012 and December 31st, 2015 who were compatible with ventriculitis and had a positive cerebrospinal fluid culture were assessed. Results. A total of 49 patients with 57 infections were included. Their median age was 62 months (interquartile range: 19-114). Males predominated: 34 (70%). A central nervous system tumor was the most common underlying disease: 20 (40%). Coagulase-negative Staphylococcus was isolated in 26 (46%); Staphylococcus aureus, in 13 (23%); Gram-negative bacilli, in 11 (19%); and other microorganism, in 7 (12%). Treatment consisted of removal of ventricular shunt plus antibiotic therapy for 55 (97%) infections. The mortality rate was 9%. The only statistically significant factors associated with mortality were positive blood cultures (p= 0.04), fever at the time of admission (p= 0.04), and septic shock (p= 0.0006). Conclusions. Coagulase-negative Staphylococcus was the most common microorganism. Valve removal plus antibiotic therapy was the most frequently instituted treatment. Fever at the time of admission, positive blood cultures, and septic shock were predictors of mortality.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Bacteria/isolation & purification , Bacterial Infections/epidemiology , Cerebrospinal Fluid Shunts/adverse effects , Anti-Bacterial Agents/administration & dosage , Argentina/epidemiology , Shock, Septic/mortality , Shock, Septic/epidemiology , Bacterial Infections/microbiology , Bacterial Infections/mortality , Epidemiology, Descriptive , Retrospective Studies , Risk Factors , Device Removal , Hospitalization
16.
J. pediatr. (Rio J.) ; 94(3): 258-267, May-June 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-954614

ABSTRACT

Abstract Objective Since the present group had already described the composition of the intestinal microbiota of Brazilian infants under low social economic level, the aim of the present study was to analyze the microbial community structure changes in this group of infants during their early life due to external factors. Methods Fecal samples were collected from 11 infants monthly during the first year of life. The infants were followed regarding clinical and diet information and characterized according to breastfeeding practices. DNA was extracted from fecal samples of each child and subjected to Polymerase Chain Reaction - Denaturing Gradient Gel Electrophoresis. Results The results revealed a pattern of similarity between the time points for those who were on exclusive breastfeeding or predominant breastfeeding. Although there were changes in intensity and fluctuation of some bands, the Denaturing Gradient Gel Electrophoresis patterns in the one-year microbial analysis were stable for breastfeeding children. There was uninterrupted ecological succession despite the influence of external factors, such as complementary feeding and antibiotic administration, suggesting microbiota resilience. This was not observed for those children who had mixed feeding and introduction of solid food before the 5th month of life. Conclusion These results suggested an intestinal microbiota pattern resilient to external forces, due to the probiotic and prebiotic effects of exclusive breastfeeding, reinforcing the importance of exclusive breastfeeding until the 6th month of life.


Resumo Objetivo Como nosso grupo já havia descrito a composição da microbiota intestinal de neonatos brasileiros em baixo nível socioeconômico, o objetivo deste estudo foi analisar alterações estruturais da comunidade microbiana desse grupo de neonatos no início de sua vida devido a fatores externos. Métodos Amostras fecais foram coletadas mensalmente de 11 neonatos durante o primeiro ano de vida. Os neonatos foram acompanhados com relação a informações clínicas e nutricionais e caracterizados de acordo com práticas de amamentação. O DNA foi extraído das amostras fecais de cada criança e submetido a análise através da técnica de Reação em Cadeia da Polimerase - Eletroforese em Gel de Gradiente Desnaturante. Resultados Os resultados revelaram um padrão de similaridade entre seus próprios pontos temporais em indivíduos em aleitamento materno exclusivo ou predominante. Apesar de variações na intensidade e flutuação de algumas bandas, o padrão Eletroforese em Gel de Gradiente Desnaturante na análise microbiana de um ano foi estável em crianças em aleitamento materno. Houve sucessão ecológica ininterrupta apesar da influência de fatores externos, como alimentação complementar e administração de antibióticos, sugeriu resiliência da microbiota. Isso não foi observado nas crianças com alimentação heterogênea e introdução de alimentos sólidos antes do quinto mês de vida. Conclusão Nossos resultados sugerem um padrão de microbiota intestinal resiliente a forças externas, devido a efeitos probióticos e prebióticos do aleitamento materno exclusivo, reforçam a importância do aleitamento materno exclusivo até o sexto mês de vida.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Bacteria/immunology , Breast Feeding , Feces/microbiology , Intestines/microbiology , Anti-Bacterial Agents/administration & dosage , Bacteria/drug effects , Bacteria/genetics , RNA, Bacterial/analysis , RNA, Ribosomal, 16S/analysis , Polymerase Chain Reaction , Electrophoresis, Agar Gel
17.
An. acad. bras. ciênc ; 90(1): 401-414, Mar. 2018. tab
Article in English | LILACS (Americas) | ID: biblio-886923

ABSTRACT

ABSTRACT Two experiments (E) were carried out to evaluate the effects of fumaric acid and an acidifier blend [composed by calcium formate, calcium lactate and medium-chain fatty acids (capric and caprylic)] in piglet diets containing colistin (40 ppm) or halquinol (120 ppm) on performance, diarrhea incidence (E1), organs relative weight, pH values, intestinal morphometry and microbiota (E2). In E1, 192 and E2, 24 piglets weaned at 21-day-old were randomly assigned to blocks with 2x2 factorial arrangement of treatments [absence or presence of fumaric acid x absence or presence of acidifier blend], six replicates of eight (E1) and one piglet per pen (E2). For E1, the treatments were control (CD): no acidifier product + 40 ppm of colistin, FA: fumaric acid in absence of acidifier blend, AB: acidifier blend in absence of fumaric acid and, AF+AB: presence of fumaric acid and acidifier blend. For E2, the pre-starter I diet were used and the same treatments as E1 evaluated. No treatment effects (P>0.05) were observed on performance, diarrhea incidence (E1), gut pH values and duodenum morphometry of piglets (E2). However, the addition of AB increased (P<0.05) large intestine relative weight and, FA addition decreased (P<0.05) pancreas relative weight, jejunum villi height and, total coliform and E. coli counts in cecum. The inclusion of FA and AB in diets containing colistin or halquinol did not improve performance, although FA exerted an inhibitory effect on cecum microbiota.


Subject(s)
Animals , Male , Swine/growth & development , Chloroquinolinols/administration & dosage , Colistin/administration & dosage , Dietary Supplements/analysis , Gastrointestinal Tract/physiology , Diarrhea/veterinary , Animal Feed/analysis , Swine/physiology , Chloroquinolinols/adverse effects , Colistin/adverse effects , Dietary Supplements/adverse effects , Diarrhea/chemically induced , Fumarates/administration & dosage , Intestinal Mucosa/drug effects , Animal Feed/adverse effects , Anti-Bacterial Agents/administration & dosage
18.
Pesqui. bras. odontopediatria clín. integr ; 18(1): 4003, 15/01/2018. tab
Article in English | LILACS (Americas), BBO | ID: biblio-967105

ABSTRACT

Objective: To evaluate errors in dental prescriptions of antibiotics for therapeutic purpose. Material and Methods: This was a descriptive study using a random and calculated sample of 366 prescriptions (July1 2011 to June 30 2012), from a total of 31 105 dental prescriptions, was surveyed in an important drugstore chain in a large Brazilian city. Data was validated by double entry in Epi-data (EpiData Assoc, Odense M, Denmark) and then analysed in SPSS (version 19.0, Chicago, IL, USA). Statistical analyses included the calculation of proportions with a 95% confidence interval (CI). Results: We identified 272 prescriptions for therapeutic purpose. Prescription errors involved spelling of the antibiotic name, dose, dosing intervals and duration of treatment. A total of 116 prescriptions (42.6%; 95% CI 36.9%-48.6%) were considered to be totally correct with regard to the generic name, dose, dosing interval and duration of the antibiotic therapy. Most of the antibiotics prescribed by dentists showed errors related to the name, dose, intervals and duration of treatment. Conclusion: These errors may compromise the effectiveness of drug therapy, contribute to microbial resistance and increase the risk of adverse events and costs of treatment.


Subject(s)
Drug Prescriptions , Brazil , Dentists , Inappropriate Prescribing/ethics , Anti-Bacterial Agents/administration & dosage , Epidemiology, Descriptive , Data Interpretation, Statistical
20.
Evid. actual. práct. ambul ; 21(4): 122-123, 2018. tab.
Article in Spanish | LILACS (Americas) | ID: biblio-1015639

ABSTRACT

Partiendo de una viñeta clínica la autora plantea el siguiente interrogante: ¿En pacientes mayores de 65 años con diag-nóstico probable de bronquitis aguda, el uso de antibióticos produce mejora en algún parámetro clínico?Luego de realizar una busqueda bibliográfica se resumen la evidencia publicada en una reciente revisión sistemática, la cual concluye que si bien existen beneficios estadísticamente significativos en algunos resultados de interés, estos no parecen tener impacto clínico teniendo en cuenta la naturaleza habitualmente autolimitada y benigna de esta enfermedad y la posibilidad de efectos colateales relacionados con el tratamiento. Es importante destacar sin embargo que la eviden-cia resultó limitada para abordar cabalmente a la población anciana afectada por este problema. (AU)


Moved by a clinical vignette, the author propose the following question: In patients over 65 with probable diagnosis of acute bronchitis, does the use of antibiotics produce improvement in any clinical outcome?After carrying out a bibliographic search, the evidence published in a recent systematic review is summarized, which concludes that although there are statistically significant benefits in some results of interest, these do not seem to have clinical impact, tak-ing into account the usually self-limited and benign nature of this disease and the possibility of collateral effects related to the treatment. It is important to highlight, however, that the evidence was limited to fully address the elderly population affected by this problem. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Bronchitis/drug therapy , Drug Resistance, Microbial/drug effects , Evidence-Based Practice/trends , Anti-Bacterial Agents/therapeutic use , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/drug therapy , Vomiting , Bronchitis/diagnosis , Bronchitis/prevention & control , Diarrhea , Tachypnea/therapy , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Nausea
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