Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units.

BACKGROUND: Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM: To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS: A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS: The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION: Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.

Chest computed tomography findings of patients infected with Covid-19 and their association with disease evolution stages.

INTRODUCTION: To describe CT findings in patients with confirmed Covid-19 infection and correlate them with the disease evolution stages. METHODS: This is a historical cohort observational analytical study carried out with outpatients, inpatients, and emergency patients from a private hospital in Maceió/AL, Brazil. The final sample consisted of 390 patients with positive RT-PCR for Covid-19 with available laboratory tests and chest CT results. RESULTS: The most frequent initial symptoms were cough, fever, dyspnea and headache. The most commonly found comorbidities were hypertension, diabetes mellitus and obesity. A total of 22% of the CT scans showed no alterations; ground-glass opacity was the most frequently found one. There was a significant association between age, comorbidities, pulmonary involvement, ground-glass opacity, mosaic attenuation and percentage of pulmonary involvement with death. The analysis of the disease stages showed a significant association with laboratory data (CRP and platelet levels), ground-glass opacity and mosaic attenuation with the disease evolution stages in relation to the days since symptom onset. CONCLUSION: The disease evolution of Covid-19 occurs in stages, and this study describes tomographic findings in patients with confirmed Covid-19 infection and shows they vary depending on the disease evolution stages. IMPLICATIONS FOR PRACTICE: This paper provides important addition to the various records that have been accumulated through the Covid-19 pandemic.

Sensitivity of seed germination to water stress in high-altitude populations of a threatened palm species.

Divergence in seed germination patterns among populations of the same species is important for understanding plant responses to environmental gradients and potential plant sensitivity to climate change. In order to test responses to flooding and decreasing water potentials, over 3 years we germinated and grew seeds from three habitats of Euterpe edulis Mart. occurring along an altitudinal gradient. Seed germination and root growth were evaluated under different water availability treatments: control, flood, -0.4 MPa, -0.8 MPa, in the years 2012, 2013 and 2014, and in the final year of the experiment (2014) at -1.0 MPa and -1.5 MPa. Seeds from the montane habitat did not germinate in the flooding treatment. Seed germination of all three habitats decreased in the -1.5 MPa treatment and the montane habitat had lowest germination in this treatment. Time required for half of the seeds to germinate increased up to -0.8 MPa. Seeds from montane habitats germinated more slowly in all treatments. The only difference in seed germination synchrony was an increase in the submontane population under the flooding treatment. However, synchrony decreased at the lowest water potentials. Roots of the montane population were more vigorous in most treatments, except at -0.8 MPa. The unusual ability of these seeds to germinate at low water potentials might be related to early seed germination at the onset of the rainy season, which potentially decreases seed predation pressure. Seeds of the montane population were more sensitive to both types of water stress. A predicted increase in the frequency and intensity of extreme high rainfall or drought events may predispose early stages of this population to adverse factors that might negatively affect population viability with elevational in future climate change scenarios.

Molossinema wimsatti infection in the brain of Pallas's mastiff bats (Molossus molossus).

The present report describes two cases of infection by Molossinema wimsatti in the brain of Pallas's mastiff bats (Molossus molossus). The first bat was captured and killed by a domestic cat in a suburban area of the municipality of Patos, Paraiba, northeastern Brazil. The second bat was found crawling on the ground in the same area before dying. No gross lesions were found at necropsy. Histology of the central nervous system revealed filarioid nematodes in the brain ventricles and cerebellum. There were adults, subadults and eggs, the latter sometimes containing microfilariae. No inflammatory response was observed in bat 1, while bat 2 presented a mild lymphoplasmacytic meningoencephalitis. Three nematodes were recovered and submitted for parasitological examination. The diagnosis of M. wimsatti infection was based on the histomorphological and parasitological characteristics of the agent and its location in the brain ventricular system of insectivorous bats. The infection likely occurs in other insectivorous bats from South American and Caribbean countries but may be overlooked.

Low efficacy of atopy patch test in predicting tolerance development in non-IgE-mediated cow's milk allergy.

BACKGROUND: The food atopy patch (APT) test has been used in previous studies to help the diagnosis of non-IgE mediated food allergies (FA). The aim of this study was to evaluate the efficacy of different cow's milk APT preparations to predict oral tolerance in children with previous non-IgE-mediated cow's milk allergy (CMA) diagnosis. METHODS: Thirty-two patients non-IgE-mediated CMA diagnosed by oral food challenge (OFC) were enrolled to perform APT with three different cow's milk preparations (fresh, 2% in saline solution, 2% in petrolatum) and comparing with a new OFC after at least three months of diet exclusion. RESULTS: Only six (18.7%) subjects presented positive OFC to cow's milk. No differences in gender, onset symptoms age, OFC age, Z-score, and exclusion period were found between positive and negative OFC patients. Preparations using fresh milk and powdered milk in petrolatum presented sensitivity equal to zero and specificity 92.3% and 96.1%. The preparation using powdered milk in saline solution showed sensitivity and specificity of 33.3% and 96.1%. Two patients presented typical IgE symptoms after OFC. CONCLUSION: Cow's milk APT presented a low efficacy to predict tolerance in patients with previous non-IgE-mediated CMA and should not be used in clinical routine. The presence of typical IgE reactions after OFC hallmark the necessity of previous IgE-mediated investigation for this patient group.

Neurotoxicosis in horses associated with consumption of Trema micrantha.

BACKGROUND: Trema micrantha is a tree widely distributed throughout the Americas. The tree produces highly palatable leaves that have been associated with natural poisoning in goats, sheep and horses, in which hepatic necrosis and hepatic encephalopathy have been observed. OBJECTIVES: This study describes malacia and haemorrhage in the central nervous system (CNS) due to T. micrantha consumption, with minimal to absent hepatic lesions. STUDY DESIGN: Retrospective case series. METHODS: A total of 14 horses with a history of neurological signs and spontaneous consumption of T. micrantha leaves were submitted to necropsy and multiple samples were collected for histopathology. Details of clinical history and signs of the horses were obtained through inquiries to the owners and attending veterinarians. RESULTS: All the 14 horses had neurological signs of ataxia, severe sialorrhoea, involuntary running movements, sternal and lateral recumbency, and death after a clinical course that lasted from 24 h to 9 days. For a few days prior to onset of clinical signs, all horses had spontaneously consumed, potentially toxic doses of T. micrantha leaves. All 14 brains had diffuse yellowish discoloration affecting the rhombencephalon, mesencephalon, diencephalon, telencephalon and corpus striatum. In all cases, the most severe lesions were observed in the pons. Spinal cord lesions were observed affecting the lumbar intumescence, which was swollen with darken and depressed areas at the dorsal and ventral horns, and at the sacral level, which on cut surface displayed a friable and yellowish grey matter. The lesions observed grossly in brain and spinal cord consisted microscopically of severe vasculitis and liquefactive necrosis of white and grey matter of the brainstem, cerebellum and spinal cord. MAIN LIMITATIONS: This is a small retrospective series relying on clinical observations reported by owners and attending veterinarians. The mechanism of action of the plant toxin in the CNS is still unidentified. CONCLUSION: T. micrantha poisoning in horses causes predominantly a neurological disease, with minimal to absent hepatic lesions.

Maximal lactate steady state is altered in the heat.

The aim of this study was to compare the maximal lactate steady state (MLSS) and ventilatory threshold (VT) under different environments (TEMP: 22°C; and HOT: 40°C; 50% RH). 8 male subjects (age 23.9±2.4 years, body mass 75.9±7.3 kg and VO2(max) 47.8±4.9 mL·kg(-1)·min(-1)) performed a series of tests to determine the peak workload (W(peak)), VT and MLSS on a cycle ergometer. W(peak) was higher in the TEMP as compared to the HOT condition (225±9 W vs. 195±8 W, respectively; p<0.05). The workload at MLSS was higher at 22°C (180±11 W) than 40°C (148±11 W; p<0.05), as well as VT at 22°C (156±9 W) was higher than 40°C (128±6 W). Likewise, the blood lactate concentration at MLSS was higher at 22°C (5.60±0.26 mM) than 40°C (4.22±0.48 mM; p<0.05). The mean of heart rate (HR) was not statistically different between TEMP (168±3 bpm) and HOT (173±3 bpm) at MLSS, despite being different at trials between the 25(th) and the 30(th) min of exercise. The HR at VT was significantly higher in HOT (153±4 bpm) as compared to the TEMP (145±2 bpm). Our results suggest that environmental conditions may influence the determination of MLSS and VT. Moreover, VT was appropriate for estimation of the workload at MLSS in the HOT.

Pilot study of the relationship between the hardness and abrasion resistance of two base metal alloys used for metal-ceramic restorations.

STATEMENT OF PROBLEM: Base metal alloys present high values of strength and hardness, which have been associated with the greater abrasion resistance and polishing of metal-ceramic restorations. However, surface hardness has been shown to be a poor indicator of abrasion resistance. PURPOSE: The study aimed to compare the hardness and abrasion resistance of Ni-Cr alloys and determine whether there is a correlation between these 2 properties. MATERIAL AND METHODS: Two Ni-Cr alloys for metal-ceramic restorations with different hardness values were subjected to the following procedures: (1) initial measurement of Vickers hardness, (2) a series of abrasion cycles, (3) measurement of mass loss after each cycle, and (4) Vickers hardness measurements after each cycle. RESULTS: For each alloy, linear regression revealed a negative correlation between hardness and reduction in mass. The higher hardness of alloy A was associated with higher mass loss during abrasion when compared with alloy B. CONCLUSION: There was no significant correlation between hardness and mass loss for either alloy.

Field observations of Ateleia glazioviana poisoning in cattle in Southern Brazil.

Ateleia glazioviana is an important poisonous plant from southern Brazil. Heavy losses in cattle from this region occur each year due to ingestion of the plant. The epidemiological, clinical, gross and histopathological features of A. glazioviana poisoning in cattle are described here from a 5-year field survey in southern Brazil. A. glazioviana poisoning in cattle induces 3 clinical presentations: abortions, disease characterized by lethargy, and cardiac failure. The latter is associated with marked necrosis and fibrosis of the myocardium and can cause sudden death or congestive heart failure.

Monensin poisoning in Brazilian horses.

Three outbreaks of monensin poisoning caused 12 deaths in 16 horses. The illnesses were associated with the ingestion of the same batch of a commercial ration labeled for feeder calves which contained 180 +/- 20 ppm sodium monensin. The morbidity rate was 100% and lethality was 60%, 75%, and 100%. Clinical signs were tachycardia and cardiac arrythmia, groaning, incoordination, sudoresis, recumbency, and paddling movements with the limbs before death. Two horses had dark discolored urine (myoglobinuria). Serum levels of creatine phosphokinase activity were increased. Main necropsy findings were in the skeletal muscles and myocardium.

Polarization-induced pulse spreading in birefringent optical fibers with zero differential group delay.

The polarization properties of concatenations of trunks of birefringent fibers and elements with polarization-dependent losses are analyzed. We show both theoretically and experimentally that the concatenation can have zero differential group delay over a whole range of wavelengths but that a pulse propagating down the concatenation can still experience significant pulse spreading. In this example the two main methods used for characterizing polarization mode dispersion in optical fiber systems, i.e., Jones matrix eigenanalysis and the interferometric method, give different results. This counterintuitive example underlines the need for a careful assessment of the basic concepts related to polarization effects in the presence of polarization-dependent losses.

Self-report of symptom frequency and symptom distress in kidney transplant recipients.

OBJECTIVE: The aim of this study was to assess symptom frequency and symptom distress associated with adverse effects of immunosuppressive therapy in kidney transplant recipients and to correlate it with compliance and socio-demographic characteristics. METHODS: Symptom frequency and symptom distress were evaluated by the 'Adapted Transplant Symptom Frequency and Symptom Distress Scale'. Data were collected from 85 patients who had undergone a kidney transplant between 1995 and 1997. RESULTS: Women reported a significantly higher level of symptom frequency and symptom distress when compared with men. The most frequent symptoms reported by women were changed appearance and increased hair growth, whereas for men were increased appetite and 'moon face'. Nevertheless the most distressing symptoms for women were painful menstruation and insomnia and for men were impotence and decreased interest in sex. Concerning compliance the non-compliant group reported a higher level of symptom frequency and symptom distress when compared with the compliant group. These results suggest that complications caused by symptoms associated with the adverse effects of immunosuppressive therapy are perceived differently by men and women and may induce non-compliance.

Redroot pigweed (Amaranthus retroflexus) poisoning of cattle in southern Brazil.

Two outbreaks of Amaranthus retroflexus (redroot pigweed) poisoning occurring in cattle in southern Brazil in late summer and early autumn are described. In both instances too many cattle were held in small paddocks heavily invaded by A retroflexus in its seeding stage. In 1 herd 8/28 heifers and in the other 15/45 adult cows died. Clinical courses ranged from 3 to 7 d. Clinical signs included depression, loss of weight, mild serous nasal discharge, foul smelling liquid feces tinged with blood, subcutaneous dependent edema, and laborious and incoordinated walking. Main necropsy findings were subcutaneous, cavitary and perirenal edemas, renal subcapsular hematomas, and ulcerative lesions in the alimentary tract. The kidneys were swollen and pale. Histopathological findings were in the kidneys and consisted of tubular degeneration, necrosis and regeneration with interstitial fibrosis and tubular proteinosis.

Coffee Senna (Senna occidentalis) poisoning in cattle in Brazil.

Four 4-5-y-old cows out of a group of 20 developed a toxic myopathy approximately 10 d after being started on a ration contaminated with 21.5% Senna occidentalis beans. Clinical signs included progressive muscle weakness, incoordination of hindlimbs, reluctance to move, dragging of the tip of the hooves of the hindlimbs, and sternal and lateral recumbency. Gross lesions included white to whitish-yellow discolored areas of several groups of skeletal muscle in various regions of the body, but more markedly in the hindlimbs. Significant histopathological changes were restricted to skeletal muscles with variable degrees of segmental degenerative myopathy associated with reparative events. The earliest change seen at electron microscopy of affected skeletal muscles was mitochondrial swelling. More advanced changes ranged from disruption of sarcoplasm and myofibrils to complete lysis of a myofiber segment and early regeneration. Myocardial fibers had swollen mitochondria, disruption of cristae and dense matrical globules. The epidemiology, clinical data and gross, histopathological, and ultrastructural features of S occidentalis poisoning in cattle are presented.

Ionophore antibiotic (narasin) poisoning in rabbits.

Outbreaks of narasin poisoning in rabbits from several commercial rabbit-raising farms in the state of Parana, Brazil, are reported. Approximately 5,000/35,000 rabbits died after having consumed a pelleted ration to which poultry ration premix had been added. Clinical signs included apathy, anorexia, muscle weakness, impaired walking, diarrhea, respiratory distress, and opistothonus. Gross findings were not remarkable, but varying degrees of degeneration, necrosis and regeneration of skeletal muscles were consistent histopathological features in affected rabbits. Myocardial changes were mild or absent. Thirty ppm of narasin were detected in the ration fed the rabbits. The disease was experimentally reproduced by feeding the suspected ration and by administering narasin po to rabbits.

Senecio spp poisoning in cattle in southern Brazil.

Epidemiological, clinical, necropsy and histopathological data were accumulated during the study of 15 outbreaks of Senecio spp poisoning in cattle occurring during the last 3 y in the State of Rio Grande do Sul, Brazil. Morbidity averaged 17% and mortality was virtually 100%. The peak mortality occurred during spring and early summer. The most constant clinical signs included anorexia, depression, tenesmus often followed by rectal prolapse, and rough hair coat. Affected animals remained apart from the rest of the herd, lost weight, presented ascites, and had signs of digestive and neurological disturbances. Icterus, photodermatitis, polydipsia, and dependent subcutaneous edema were occasionally noticed. Two main clinical courses could be distinguished. In the protracted form, progressive weight loss terminated with death within many weeks or months. Alternatively, an acute or subacute course led to death in a few days. In both forms, necropsy and histopathological findings included diffuse fibrosis of the liver, hepatomegalocytosis, and biliary hyperplasia. Extrahepatic lesions included gastrointestinal and mesenteric edema, distension, edema and adenomatoid hyperplasia of the gallbladder, and spongy degeneration of the cerebral white matter. S brasiliensis and S oxyphyllus were the species involved in the field outbreaks.