Impact of a surgical safety checklist on surgical site infections, antimicrobial resistance, antimicrobial consumption, costs and mortality.

BACKGROUND: In 2010, following the recommendations of the World Health Organization (WHO), our hospital implemented a surgical safety programme centred around a surgical safety checklist. AIM: The aim of this study was to compare indicators of surgical site infection, antimicrobial consumption, antimicrobial resistance, costs and in-hospital mortality before (January 2006 to July 2010) and after (August 2010 to December 2014) implementation of the programme. METHODS: A case-control study was carried out matching patients with surgical site infection (SSI) to surgical patients without infection to examine the impact of the intervention. FINDINGS: Use of the surgical checklist was associated with a significant reduction in SSI. When comparing the two time periods, we also identified a reduction in infections due to micro-organisms in the ESKAPE group (from 90.7% to 73.9%, P<0.001), a reduction of SSI in patients with contaminated, infected and potentially contaminated wounds, and for those in whom perioperative antimicrobial prophylaxis was discontinued in less than 48 hours. Overall, there was a reduction in antimicrobial resistance, though there was increased resistance to carbapenems for, to glycopeptides for Enterococcus faecium, and to clindamycin for Staphylococcus aureus. We also detected increased antimicrobial consumption of second- and third-generation cephalosporins and clindamycin. We observed a reduction in hospital deaths from 6.4% to 3.2% (P=0.001), but we did not observe any reduction in costs. CONCLUSIONS: Implementation of a surgical checklist was an independent predictor of SSI reduction, and was also associated with a decrease in antimicrobial resistance and reduced in-hospital mortality.

Acerola (Malpighia glabra L.) and guava (Psidium guayaba L.) industrial processing by-products stimulate probiotic Lactobacillus and Bifidobacterium growth and induce beneficial changes in colonic microbiota.

AIMS: This study evaluated whether by-products from industrial processing of acerola (Malpighia glabra L.; AB) and guava (Psidium guajava L.; GB) fruit may stimulate the growth and metabolism of probiotic Lactobacillus and Bifidobacterium and induce changes in human colonic microbiota. METHODS AND RESULTS: The ability of non-digested and digested AB or GB to stimulate the growth ad metabolism of Lactobacillus acidophilus LA-05, Lactobacillus casei L-26 and Bifidobacterium animalis subsp. lactis BB-12 was evaluated. Changes in populations of distinct bacterial groups of human colonic microbiota induced by digested AB and GB were evaluated using an in vitro colonic fermentation system. Non-digested and digested AB and GB favoured probiotic growth. No difference among counts of probiotics in media with glucose, fructooligosaccharides and non-digested and digested AB and GB was found during a 48-h cultivation. Cultivation of probiotics in media with non-digested and digested AB and GB resulted in decreased pH, increased organic acid production and sugar consumption over time. Digested AB and GB caused overall beneficial changes in abundance of Bifidobacterium spp., Lactobacillus-Enterococcus, Eubacterium rectall-Clostridium coccoides and Bacteroides-Provotella populations, besides to decrease the pH and increase the short-chain fatty acid production during a 24-h in vitro colonic fermentation. CONCLUSION: AB and GB could be novel prebiotic ingredients because they can stimulate the growth and metabolism of probiotics and induce overall beneficial changes in human colonic microbiota. SIGNIFICANCE AND IMPACT OF THE STUDY: AB and GB stimulated the growth and metabolism of probiotics, in addition to induce beneficial alterations in human colonic microbiota composition and increase short-chain fatty acid production. These results characterize AB and GB as potential prebiotic ingredients and fruit processing by-products as sources of added-value compounds.

Genetic associations between visual scores, body weight and age at first calving in nellore breed cattle / Associações genéticas entre escores visuais, peso corporal e idade ao primeiro parto de bovinos da raça Nelore

Body weight records of 231,416 Nellore females obtained from the Brazilian Association of Zebu Breeders were used to determine a linear combination between visual appraisal scores (body structure, precocity and muscling) using principal components analysis (PC), and to verify their genetic association with body weight at 12 months (BW) and age at first calving (AFC). The mixed linear model included the fixed effect of the contemporary group and the linear and quadratic effects of age at calving, random effects of genetic additive, maternal environment and temporary environment. Heritability estimates for BW, PC and AFC were 0.51, 0.30 and 0.17, respectively. Genetic additive correlations between BW and PC; BW and AFC, and PC and AFC were 0.48; -0.31 and -0.55; respectively. Spearman's correlations for the best-ranked bulls based on PC prediction were positive between BW and PC and negative among the other combinations. Heritability estimates and correlations indicate potential genetic gains for BW and CP with reduced AFC in cows. The use of PC allows positive responses on precocity and body weight development.(AU)

Utilizaram-se registros de pesos corporais de 231.416 fêmeas bovinas da raça Nelore, oriundos dos registros da Associação Brasileira de Criadores de Zebu-ABCZ, com o objetivo de estabelecer, por componentes principais, uma combinação linear (CP) das características de escores visuais de estrutura (E), precocidade (P) e musculosidade (M), bem como verificar sua associação genética com o peso corporal aos 12 meses (PC) e à idade ao primeiro parto (IPP). O modelo linear misto utilizado incluiu os efeitos fixos de grupo de contemporâneos e os efeitos linear e quadrático da idade da vaca ao parto, os efeitos aleatórios genético aditivo, ambiente materno e ambiente temporário. Estimativas de herdabilidade para PC, CP e IPP foram iguais a 0,51; 0,30 e 0,17, respectivamente. Correlações genéticas aditivas entre PC e CP; PC e IPP; e, ainda, CP e IPP foram iguais a 0,48; -0,31 e -0,55, respectivamente. As correlações de Spearman para os melhores reprodutores classificados em relação à predição de CP foram positivas entre PC e CP e negativas entre as demais combinações. Estimativas de herdabilidade e de correlações indicam possibilidade de ganhos genéticos expressivos para PC e CP com redução para IPP nas fêmeas. A utilização de CP possibilita respostas favoráveis para precocidade sexual e desenvolvimento ponderal.(AU)

Descrição anatômica da artéria carótida externa e seus ramos na preguiça-comum / Anatomical description of external carotid artery and its branches in sloth

Bradypus variegatus, espécie pertencente à família Bradypodidae e à superordem Xenarthra, pode ser considerada modelo biológico de caráter multidisciplinar. Assim, realizou-se um trabalho de descrição anatômica da artéria carótida externa (ACE) e dos seus ramos no bicho-preguiça B. variegatus. Utilizaram-se 10 animais adultos, sendo todos fêmeas, que foram submetidos à dissecação, constatando-se que a artéria (a.) carótida comum se bifurca, em externa e interna, no nível do primeiro anel traqueal. A ACE, então, segue estendendo-se até a maxila, onde emite ramos para a região temporal e para o polo posterior do olho. Em todos os animais estudados, foram observados sete ramos principais da ACE, que, segundo a sua origem e localização, foram denominados como a. auricular, a. lingual, a. facial, a. alveolar, a. inferior, a. temporal, a. maxilar e a. oftálmica. Os ramos maxilar e oftálmico correspondem aos terminais e os demais são ramos colaterais. Em 50% dos animais analisados, foi verificada a presença de anastomoses arteriais e 40% deles apresentaram o acréscimo de um ramo aos principais. Desses, 30% demonstraram a presença de um ramo traqueal e 10% de um ramo sublingual, sendo esses ramos colaterais.(AU)

Bradypus variegatus is a species belonging to the family Bradypodidae and superorder Xenarthra, which should be considered as a multidisciplinary biological model. Thus, an anatomical description of the external carotid artery (ACE) and its branches in sloth B. variegatus was studied. Ten adult animals, all of them female, were submitted to dissection, and it was observed that the common carotid artery (a.) bifurcates in external and internal at the level of the first tracheal ring. Then, ACE extends through the maxilla where it launches branches to the temporal region and posterior eye side. For all sampled animals, seven principal branches of ACE were observed, and according to their origin and location were denominated as auricular, lingual, facial, bottom alveolar, temporal, maxillary and ophthalmic arteries. The maxillary and ophthalmic branches correspond to the terminals and the other branches are collateral. Presence of arterial anastomoses was observed in 50% of the sampled animals and 40% of them had increase of a branch on the principal. In these, 30% had presence of one tracheal branch and 10% of a sublingual branch, considering these branches as collateral.(AU)

Asthma app use and interest among patients with asthma: a multicenter study

No disponible

P2X7R and PANX-1 channel relevance in a zebrafish larvae copper-induced inflammation model.

Copper is a metal that participates in several essential reactions in living organisms, and it has been used as an inflammatory inducing agent in zebrafish larvae. In this study, we evaluated the effect P2X7 receptor and/or pannexin channel 1 (PANX-1) blockage in this inflammation model. To perform the experiments, 7 dpf larvae were exposed to 10 µM of copper and treated with 100 µM probenecid, PANX-1 inhibitor, and/or 300 nM A740003, a P2X7R selective antagonist. Larvae survival was assessed up to 24 h after treatments. The evaluation of larvae behavior was evaluated after acute (4 h) and chronic (24 h) exposure. The parameters of locomotor activity measured were: mobile time, average speed, distance and turn angle. We analyzed the gene expression of the P2X7 receptor, PANX1a and PANX1b channels and interleukins IL-10 and IL-1b after 24 h of treatment. Treatments did not decrease larval survival in the time interval studied. Changes in larvae locomotion were observed after the longest time of exposure to copper and the treatment with probenecid was able to reverse part of the effects caused by copper. No significant difference was observed in the oxidative stress assays and probenecid and copper treatment decrease partially PANX1a gene expression groups. The data presented herein shows the relevance of the blockage of P2X7-PANX-1 in copper-induced inflammation.

Clinical and molecular markers in COPD.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, and there is a clinical need for validated markers and biomarkers that can contribute to the assessment of patients, risk prediction, treatment guidance, and assessment of response. Although according to the 2018 GOLD guidelines clinically useful biomarkers for COPD patients in stable condition have yet to be identified, several clinical markers and biomarkers have been proposed for COPD. These include isolated clinical markers, such as symptoms and Health Status assessment, exercise tests, function tests and imaging, and also composite scores and molecular markers. However, and despite strong efforts to identify useful markers in an attempt to improve prognostic and therapeutic approaches, results have not been consistent and expectations of relying on these markers in near future are faint. Current approaches to COPD have shifted from treating the disease to treating the individual patient. There is a clear need to identify treatable traits, focusing more on the patient and not on the disease, in order to implement an increasingly personalized treatment of COPD in the clinic, leading to true precision medicine. There is a need to identify combinations of clinical markers and biomarkers, genetic markers, and phenotypes that can guide the personalized therapy of COPD patients. This critical review will therefore focus not only on currently established markers and biomarkers in COPD but also on possible future approaches toward precision medicine.

Produção científica acerca do descolamento prematuro da placenta / Scientific production on abruptio placentae

Objetivo: analisar as produções científicas disponíveis na literatura, sobre descolamento prematuro da placenta (DPP). Métodos: trata-se de uma revisão integrativa de literatura. A busca foi realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e MEDLINE pela Pubmed, a partir da questão norteadora “Quais as evidências científicas sobre descolamento prematuro da placenta?”. Resultados: predominaram estudos que não apresentam fortes evidências para aplicação clínica e a totalidade é de autoria médica. Os estudos analisados têm como foco a associação de DPP com patologias, alterações genéticas e comportamentais na gestação. Considerações finais: percebe-se a escassez com níveis de evidência altos, bem como, ausência de produções na área de enfermagem.

Objetive: this study aimed to analyze the scientific publications available in the literature onabruptio placentae. Methods: this is an integrative literature review. The search was conducted inthe databases Latin American and Caribbean Health Sciences (LILACS) and MEDLINE by PubMed, fromthe guiding question "What are the scientific evidence of abruptio placentae?”. Results: studies thatdo not show strong evidence for clinical application predominated, most medical authorship. Thestudies analysis were focused on the DPP association with diseases, genetic and behavioral changesduring pregnancy. Final Considerations: there is a shortage with high levels of evidence, as well asthe absence of productions in nursing.

Spitz Tumors of the Skin.

Spitz tumors are melanocytic neoplasms hallmarked by large cell size, lack of high-grade atypia, and a regular architecture. Most are nonpigmented or poorly pigmented. Malignant potential ranges from absent (Spitz nevus), to fully present (spitzoid melanoma), with a further, ill-defined group of Spitz tumors with limited metastatic potential. Microscopic evaluation may prove inconclusive in some instances, resulting in a verdict of Spitz tumor of uncertain malignant potential (STUMP). STUMP is, therefore, not an entity, and should not be equated with Spitz tumors with limited metastatic potential. Novel diagnostic techniques are yielding promising results, and further evaluation is ongoing.

Active surveillance and safety organizational goals to reduce central line-associated bloodstream infections outside the intensive care unit: 9 years of experience.

We performed a quasi-experimental, cohort study in the medical-surgical inpatient wards comparing central line-associated bloodstream infection (CLABSI) rates and microbiologic characteristics in 3 phases. The CLABSI rates decreased 60% from phase 1 to 2 and 61.5% from phase 2 to 3. Gram-positive organisms were most frequently isolated in phases 1 and 3, and gram-negative bacilli were most frequently isolated in phase 2. The CLABSI surveillance and prevention program focusing on patient safety had a significant impact on CLABSI rates.

CYP2D6*4 polymorphism: A new marker of response to hormonotherapy in male breast cancer?

BACKGROUND: Tamoxifen remains the standard hormonotherapy for Male breast cancer patients (MBC). Previous studies, in women, tried to evaluate the impact of CYP2D6 polymorphisms in tamoxifen efficacy with conflicting results. Herein we analyze the relation between CYP2D6*4 polymorphism and survival in MBC patients. PATIENTS AND METHODS: Fifty-three patients, proposed to tamoxifen in adjuvant setting, were enrolled. Clinical information was collected from records and histological revision with additional immunochemistry analysis was done to better characterize the tumors. Comprehensive CYP2D6*4 genotyping from blood or tumor tissue was performed and translated into two predicted metabolic activity groups. RESULTS: Patients included in the two CYP2D6*4 groups did not differ concerning to age, histological characteristics, and primary treatments performed. Median age at diagnosis was 63 years-old and patients were submitted at least to mastectomy and adjuvant hormonotherapy. Recurrence was observed in 7 patients (13.2%) and 13 patients (25.5%) died with a 5-year disease-free survival of 86.2%. The poorer metabolizer group had a high risk for recurrence (p = 0.034) and this outcome effect remains in different subgroups: in tumors larger than 2 cm (p < 0.001), nodal status, N0 vs N+ (p = 0.04) and in advanced stage, stage III (p < 0.001). Poorer metabolizer patients had also a worse overall survival when tumors were larger than 2 cm (p = 0.03). CONCLUSIONS: In our series, there was an association between CYP2D6*4 polymorphism and a probability of recurrence, with a consistent effect in risk groups defined by classic prognostic factors. Multicentric studies with larger samples are needed to validate these results.

Arterial tissue and plasma concentration of enzymatic-driven oxysterols are associated with severe peripheral atherosclerotic disease and systemic inflammatory activity.

INTRODUCTION: Cholesterol undergoes oxidation via both enzymatic stress- and free radical-mediated mechanisms, generating a wide range of oxysterols. In contrast to oxidative stress-driven metabolites, enzymatic stress-derived oxysterols are scarcely studied in their association with atherosclerotic disease in humans. METHODS: 24S-hydroxycholesterol (24S-HC), 25-hydroxycholesterol (25-HC), and 27-hydroxycholesterol (27-HC) were assessed in plasma and arteries with atherosclerotic plaques from 10 patients (54-84 years) with severe peripheral artery disease (PAD) as well as arteries free of atherosclerotic plaques from 13 individuals (45-78 years, controls). RESULTS: Plasma 25-HC was higher in PAD individuals than in controls (6.3[2] vs. 3.9[1.9] ng/mgCol; p = 0.004). 24S-HC and 27-HC levels were, respectively, five- and 20-fold higher in the arterial tissue of PAD individuals than in those of the controls (p = 0.016 and p = 0.001). Plasma C-reactive protein correlated with plasma 24-HC (r = 0.51; p = 0.010), 25-HC (r = 0.75; p < 0.001), 27-HC (r = 0.48; p = 0.015), and with tissue 24S-HC (r = 0.4; p = 0.041) and 27-HC (r = 0.46; p = 0.023). CONCLUSION: Arterial intima accumulation of 27-HC and 24S-HC is associated with advanced atherosclerotic disease and systemic inflammatory activity in individuals with severe PAD.

Frecuencia de la depresión puerperal en la maternidad de un hospital universitario de la Región del Sur / No disponible

Este estudio tuvo como objetivo identificar la frecuencia de riesgo para desencadenar la depresión posparto, en puérperas internadas en la maternidad de un Hospital Universitario, a través de la aplicación de la escala Edinburgh Post-Natal Depression Scale (EPDS). Se trata de un estudio cuantitativo, exploratorio descriptivo. Participaran del estudio 53 puérperas en posparto inmediato en el período de abril a mayo de 2009. Fue aplicado un cuestionario elaborado con base en la escala EPDS. Los datos obtenidos a través de la aplicación de la escala fueran analizados e interpretados, a través de la estadística descriptiva. Se respetaron todas las determinaciones de la Resolución 196/96 de estudio con seres humanos. Los resultados señalaron que el riesgo de depresión posparto fue encontrado en seis puérperas (11%), lo que demuestra la importancia de los profesionales de la salud en realizar la detección precoz de la depresión posparto, teniendo como ayuda la escala EPDS, por la eficacia y practicidad de su aplicación (AU)

This study aimed to identify the frequency of risk to trigger postpartum depression in women interned in a Maternity Hospital, through the application of the scale Edinburgh Post-Natal Depression Scale (EPDS). It is a quantitative, exploratory and descriptive study. It included 53 postpartum women in the immediate postpartum period from April to May 2009. A questionnaire was developed based on the scale Edinburgh Post-Natal Depression Scale (EPDS). The obtained data through the application of the scale were analyzed and interpreted using descriptive statistics and taking into account all the provisions from the Resolution196/96 of the research with humans. The results showed that the risk of postpartum depression was found in six women (11%), which demonstrate the importance of health professionals to perform the early detection of postpartum depression, with the EPDS scale aid, the effectiveness’ and practicality of its implementation (AU)

New methodology for obtaining CdTe quantum dots by using ultrasound.

Luminescent CdTe quantum dots (Qdots) have been produced at few minutes by using a new, simple and fast methodology in an aqueous medium by using ultrasound irradiation to accelerate the process of tellurium reduction. The structural and optical properties were characterized by TEM, XRD, absorption and fluorescence spectrocopy. The produced Qdots are in a strong quantum confinement regime and have only one fluorescence band. Moreover, the nanoparticles seem to be monodispersed, which is in accordance with the fluorescence results. We have developed a simple route for preparing monodispersed CdTe Qdots in an aqueous media. The use of ultrasound allows the morphology to be better controlled and the surfaces defects of Qdots to be reduced.

What is the impact of surgical site infection on graft function in kidney transplant recipients?

The impact of surgical site infections (SSIs) on graft function in kidney transplant recipients is controversial. We conducted a matched case-control study (1:1 ratio) between April 2001 and December 2004 in a Brazilian cohort of kidney transplant recipients. The epidemiological and clinical characteristics of SSIs were described based on chart review. The impact on graft function was assessed by comparing serum creatinine measurements and creatinine clearance up to 18 months after transplantation with analysis of variance model. Among 1939 kidney transplants, 120 patients with 145 SSIs were enrolled. Most wound infections were superficial (73.1%). The mortality rate was 0.8%. No impact on graft function was detected. In conclusion, accurate identification of SSIs may have resulted in shorter hospitalization periods, but they had no impact on graft function up to 18 months post transplantation.

In vitro and in vivo determination of antioxidant activity and mode of action of isoquercitrin and Hyptis fasciculata.

Reactive oxygen species (ROS) are thought to underline the process of ageing and the pathogenicity of various diseases, such as neurodegenerative disorders and cancer. The use of traditional medicine is widespread and plants still present a large source of natural antioxidants that might serve as leads for the development of novel drugs. In this paper, the alcoholic extract from leaves of Hyptis fasciculata, a Brazilian medicinal plant, and isoquercitrin, a flavonoid identified in this species, showed to be active as 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavengers. The extract of Hyptis fasciculata and isoquercitrin were also able to increase tolerance of the eukaryotic microorganism Saccharomyces cerevisiae to both hydrogen peroxide and menadione, a source of superoxide. Cellular protection was correlated with a decrease in oxidative stress markers, such as levels of ROS, protein carbonylation and lipid peroxidation, confirming the antioxidant potential of Hyptis fasciculata and isoquercitrin.