Prediction of Bloodstream Infection Events and Infections of the Lower Respiratory Tract in ICU Patients: Expected and Unexpected Infections

Background. Bloodstream infection (BSI) - Central and Non-Central Line Associated - and infections of the lower respiratory tract (RESP) - pneumonia and non pneumonia lower respiratory infections - are some of the main causes of unexpected death in Intensive Care Units (ICUs). Although the leading causes of these infections are already known, risk prediction models can be used to identify unexpected cases. This study aims to investigate whether or not it is possible to build multivariate models to predict BSI and RESP events. Methods. Univariate and multivariate analysis using multiple logistic regression models were built to predict BSI and RESP events. ROC curve analysis was used to validate each model. Independent variables: 29 quantitative parameters and 131 categorical variables. BSI and RESP were identified using Brazilian Health Regulatory Agency protocols with data collected between January and November 2020 from a medical-surgical ICU in a Brazilian Hospital. Definitions: if an infection is 5% or less likely to occur according to the model used and it eventually occurs, it will be classified as "unexpected", or else, if an infection is 10% or less likely to occur, it will be classified as "probably unexpected". Otherwise, infections will be classified as "expected". Patients with a 30% or more risk for BSI or RESP will be classified as "high risk". Results. A total of 1,171 patients were accessed: 70 patients with BSI (95% confidence interval [CI], 3.1%-5%), 66 patients with RESP (95% CI, 2.9%-4.7%), 235 deaths (95% CI, 11.8%-14.9%). Of the 160 potential risk factors evaluated, logistic models for BSI and RESP identified respectively five and seven predictors (Tables 1 and 2, and Figure 1). Patients admitted to the ICU with Covid-19 had a three fold BSI risk and five times more RESP risk than patients without this diagnosis. Conclusion. The built models make possible the identification of the expected infections and the unexpected ones. Three main course of actions can be taken using these models and associated data: (1) Before the occurrence of BSI and RESP: to place high risk patients under more rigorous infection surveillance. (2) After the occurrence of BSI or RESP: to investigate "unexpected" infections. (3) At discharge: to identify high risk patients with no infections for further studies.

LEPTOSPIROSE EM PACIENTE COM ARTRITE REUMATOIDE: UM DESAFIO DIAGNÓSTICO - RELATO DE CASO

O objetivo desse relato de caso foi demonstrar as particularidades no diagnóstico e possíveis diagnósticos diferenciais em pacientes imunossuprimidos com síndrome febril aguda. Paciente feminina, 37 A, auxiliar administrativo, portadora de artrite reumatoide, imunossuprimida em uso de Simponi associado a Metotrexato 10 mg/semana, com diagnóstico anterior de tumor desmóide em 2016. Após a 2ª dose de Simponi, cursa com quadro agudo de cefaleia de característica persistente, refratária a uso de sintomáticos, acompanhado de náuseas, com queda relativa do estado geral, sudorese de característica noturna, mialgia difusa e episódios recorrentes de febre. Durante esse período foi imunizada com a 2ª dose da vacina para o covid-19. Após a vacinação surgiu nova sintomatologia, disúria isolada. Diante disso, conduzimos com a internação hospitalar para rastreio infeccioso e vigilância clínica. Foi interrogado descompensação infecciosa viral, ITU, reação medicamentosa de suspeição pouco provável e doença hematológica. Foi solicitado laboratório completo, incluindo sorologias virais para citomegalovírus, EBV, parvo vírus, toxoplasmose, leptospirose, hemocultura de 2 amostras de sítios diferentes, EAS e urocultura, ferritina e triglicerídeos devido a febre com alterações de transaminase, aventando um possível quadro viral desencadeado por síndrome hematofágica. Complementando com exames de imagem, como USG de abdome total para avaliar a possibilidade de hepatoesplenomegalia e USG de cervical para avaliar linfonodos. Paciente evolui com piora clínica em vigência de dor abdominal. Solicitada tomografia de abdome, apresentando imagem com vesícula parcialmente distendida, associado à presença de líquido perivesicular, A clínica cirúrgica opta por abordagem invasiva, sendo realizado colecistectomia videolaparoscopia. No pós-operatório, ficando aos cuidados intensivos pela UTI e escalonado para tazocin (D10). Após resultado da sorologia para leptospirose com IgM reagente interrompeu uma longa série de exames negativos e febre prolongada, sem diagnóstico. Apresentou evolução clínica satisfatória, resultando em alta hospitalar. A artrite reumatoide é acompanhada de sintomas constitucionais inespecíficos, principalmente a febre baixa em pacientes imunossuprimidos. O diagnóstico de leptospirose foi concluído mais tardiamente, quando os exames da admissão foram disponibilizados. Um caso de uma enfermidade de alto impacto, contudo negligenciada como problema de saúde pública.

The challenges of teaching Chemistry in the COVID-19 pandemic: The flipped classroom methodology adapted for virtual mode in Brazil

The arrival of the COVID-19 pandemic imposed a series of restrictions on a global scale. A new social dynamic had to be adopted around the world, in an attempt to contain its effects. Teaching activities, as it could not be otherwise, also had to be adapted to totally virtual reality, as a result of the need for social distance. One of the main challenges was to implement virtual teaching in a way that reached the entire academic community. Since then, different methodologies have been adopted to meet the demands of the most varied contexts. In this manuscript we report the use of the flipped classroom methodology in two General Chemistry classes, adapted to the virtual modality, in the context of a Brazilian federal university. The students’ perception of the methodology and the tutorial work developed in one of the classes was evaluated. The results show that the flipped classroom can be adapted to fully virtual reality, being favored in various ways by tutoring work. © 2021 Facultad de Quimica, UNAM. All rights reserved.

Patients with head & neck cancer with COVID-19 in Brazil

Introduction: With the emergence of SARS-CoV-2 infection, concern for the most vulnerable populations has become an urgency. Several studies warn of the weakness of patients with head & neck cancer (HNC). The objective is to describe the sociodemographic and clinical profile of patients with HNC with a positive diagnosis for COVID-19 who required hospitalization. Method: In this prospective observational study, carried out from March to May 2020, we included individuals of both sexes, enrolled in the Head and Neck Surgery Department of the Brazilian National Cancer Institute and diagnosed with COVID-19 who needed hospitalization. Results: A total of 1153 patients were attended in this period;30 patients required hospitalization and tested positive for COVID-19. The group had a mean age of 62.4 years, with a prevalence of male patients (n = 20;66.67%). There was a predominance of elderly (63.33%), self-declared White (73.32), married (53.32), with low education (56.58%), and smokers (56.67%). Most patients had advanced clinical oncological staging (III-IV;53.33%), approximately. The larynx was the site with the highest prevalence of individuals (n = 7), followed by the thyroid (n = 5) and the oral cavity (n = 5). Systemic arterial hypertension and diabetes mellitus were the most prevalent comorbidities. It was observed that 60% of patients delayed the start of cancer treatment due to a positive diagnosis for COVID-19. Ten deaths had been confirmed, for a mortality rate of 33.3% in the sample. Conclusion: The present study describes a group of patients with HNC at increased risk for hospitalization infected by COVID-19: elderly individuals, with advanced tumors, economically disadvantaged, and undergoing cancer diagnosis and treatment who were not in social isolation.

Coronavirus versus 70% Alcohol: Comments and Some Fundamental Definitions

The new coronavirus pandemic (COVID-19) is a global problem that is having severe impacts on health systems worldwide. One particular characteristic of this virus is its high transmission rate, which has led to a high demand for personal care materials such as masks, gloves, and alcohol for asepsis. Seventy percent is the ideal concentration for the ethanol used in hand sanitizers;however, this concentration can be expressed in different ways, and, consequently, the different solutions will have different antiseptic activity. In this manuscript we comment on some characteristics of alcohol-based preparations and the different ways of expressing the concentrations. Copyright © 2022, Faculdade de Ciencias Farmaceuticas (Biblioteca). All rights reserved.