Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: A multicentric retrospective study in a large Brazilian metropolitan area.

PURPOSE: The goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates. MATERIALS AND METHODS: We conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality. RESULTS: In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression. CONCLUSIONS: Patients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies.

Central nervous system infection in the intensive care unit: Development and validation of a multi-parameter diagnostic prediction tool to identify suspected patients.

BACKGROUND: Central nervous system infections (CNSI) are diseases with high morbidity and mortality, and their diagnosis in the intensive care environment can be challenging. Objective: To develop and validate a diagnostic model to quickly screen intensive care patients with suspected CNSI using readily available clinical data. METHODS: Derivation cohort: 783 patients admitted to an infectious diseases intensive care unit (ICU) in Oswaldo Cruz Foundation, Rio de Janeiro RJ, Brazil, for any reason, between 01/01/2012 and 06/30/2019, with a prevalence of 97 (12.4%) CNSI cases. Validation cohort 1: 163 patients prospectively collected, between 07/01/2019 and 07/01/2020, from the same ICU, with 15 (9.2%) CNSI cases. Validation cohort 2: 7,270 patients with 88 CNSI (1.21%) admitted to a neuro ICU in Chicago, IL, USA between 01/01/2014 and 06/30/2019. Prediction model: Multivariate logistic regression analysis was performed to construct the model, and Receiver Operating Characteristic (ROC) curve analysis was used for model validation. Eight predictors-age <56 years old, cerebrospinal fluid white blood cell count >2 cells/mm3, fever (≥38°C/100.4°F), focal neurologic deficit, Glasgow Coma Scale <14 points, AIDS/HIV, and seizure-were included in the development diagnostic model (P<0.05). RESULTS: The pool data's model had an Area Under the Receiver Operating Characteristics (AUC) curve of 0.892 (95% confidence interval 0.864-0.921, P<0.0001). CONCLUSIONS: A promising and straightforward screening tool for central nervous system infections, with few and readily available clinical variables, was developed and had good accuracy, with internal and external validity.

Autoclassificação da saúde e autovaliação da assistência para seu cuidado segundo moradores de assentamentos rurais / Self-classification of the health of residents belonging to rural settlements and their evaluation of the healthcare received

Moradores de assentamentos rurais enfrentam dificuldades de acesso aos serviços de saúde. Isso é determinado pelas condições socioeconômicas destas populações. É possível que essas pessoas classifiquem insatisfatoriamente a própria saúde e a qualidade dos serviços públicos que têm acesso. Este estudo objetivou analisar a autoclassificação da saúde entre moradores de assentamentos rurais e sua avaliação aos serviços de saúde que utilizam. Pesquisa transversal, que entrevistou, através de um instrumento semiestruturado, moradores de dois assentamentos rurais localizados em Uberlândia, Minas Gerais, Brasil. O instrumento buscou analisar o perfil epidemiológico, a autoclassificação da saúde desses moradores, utilizando uma escala avaliativa. Foi também analisado como eles avaliam a qualidade dos serviços de saúde que acessam. Foram entrevistados 24 moradores de dois assentamentos. 54.2% deles (n=13) possuíam doenças crônicas. As mais relatadas foram Hipertensão Arterial Sistêmica e Diabetes Mellitus. Entre os moradores, 45.8% (n=11) auto classificaram a própria saúde como fraca ou razoável e 45.8% como boa. A análise dos discursos indicou insatisfação com a qualidade do serviço de saúde utilizado. Os índices de doenças crônicas encontradas entre os moradores dos assentamentos rurais podem ser decorrentes da baixa cobertura de Atenção Primária à Saúde próximos de suas residências. A melhoria da qualidade do serviço prestado pelas Unidades Básicas de Saúde da Família próximas aos assentamentos rurais pode reduzir os índices de doenças cardiovasculares futuras entre essa população.

Residents of rural settlements face difficulties in accessing health services. This is determined by the socioeconomic conditions of these populations. It is possible that these people rate their own health and the quality of public services they have access to as unsatisfactory. This study aimed to analyze the self-evaluation of health among residents of rural settlements and their assessment of the health services they use. This was a cross-sectional study, which interviewed, through a semi-structured instrument, residents of two rural settlements located in Uberlândia, Minas Gerais, Brazil. The instrument sought to analyze the epidemiological profile, the self-evaluation of the health of these residents, using an evaluative scale. Moreover, their assessment of the quality of the health services they access was evaluated. Twenty-four residents of two settlements were interviewed. 54.2% of them (n=13) had chronic diseases. The most reported were Systemic Arterial Hypertension and Diabetes Mellitus. Among residents, 45.8% (n=11) evaluated their own health as poor or fair and 45.8% as good. The analysis of the speeches indicated dissatisfaction with the quality of the health services used. The chronic disease rates found among residents of rural settlements may be due to the low coverage of Primary Health Care close to their homes. Improving the quality of the service provided by the Basic Family Health Units closest to rural settlements can reduce future cardiovascular disease rates among this population.