Emerging threat: Antimicrobial resistance proliferation during epidemics - A case study of the SARS-CoV-2 pandemic in South Brazil.

The escalating global concern of antimicrobial resistance poses a significant challenge to public health. This study delved into the occurrence of resistant bacteria and antimicrobial resistance genes in the waters and sediments of urban rivers and correlated this emergence and the heightened use of antimicrobials during the COVID-19 pandemic. Isolating 45 antimicrobial-resistant bacteria across 11 different species, the study identifies prevalent resistance patterns, with ceftriaxone resistance observed in 18 isolates and ciprofloxacin resistance observed in 13 isolates. The detection of extended-spectrum ß-lactamases, carbapenemases, and acquired quinolone resistance genes in all samples underscores the gravity of the situation. Comparison with a pre-pandemic study conducted in the same rivers in 2019 reveals the emergence of previously undetected new resistant species, and the noteworthy presence of new resistant species and alterations in resistance profiles among existing species. Notably, antimicrobial concentrations in rivers increased during the pandemic, contributing significantly to the scenario of antimicrobial resistance observed in these rivers. We underscore the substantial impact of heightened antimicrobial usage during epidemics, such as COVID-19, on resistance in urban rivers. It provides valuable insights into the complex dynamics of antimicrobial resistance in environmental settings and calls for comprehensive approaches to combat this pressing global health issue, safeguarding both public and environmental health.

Clinical and microbiological profile of health care-associated infections in a tertiary hospital: Comparison between a cohort of hospitalized patients during prepandemic and COVID-19 pandemic periods.

BACKGROUND: During the COVID-19 pandemic, health service practices underwent significant changes, impacting the occurrence of health care-associated infections (HAIs). This study presents the epidemiology of bacterial infections and compares clinical data on nosocomial infections in hospitalized patients before and during the pandemic. METHODS: A unicentric, observational, retrospective cohort study was conducted with descriptive analyses on the microorganism identification and resistance profile. Patient's clinical data who had hospital-acquired infection (HAI), during their hospitalization in a tertiary hospital before and during the COVID-19 pandemic was compared by descriptive and inferential analyses. RESULTS: A total of 1,581 bacteria were isolated from 1,183 hospitalized patients. Among patients coinfected with COVID-19, there was a statistically significant increase in HAI-related deaths (P < .001) and HAI caused by multidrug-resistant organisms (P < .001), mainly by Acinetobacter baumannii and Staphylococcus aureus. A higher odds ratio of HAI-related deaths compared to the prepandemic period was observed (odds ratio 6.98 [95% confidence interval 3.97-12.64]). CONCLUSIONS: The higher incidence of multidrug-resistant bacteria and increased deaths due to HAI, especially in patients with COVID-19 coinfection, might be related to various factors such as increased workload, broad-spectrum antibiotic use, and limited resources. The pandemic has changed the profile of circulating bacteria and antimicrobial resistance. Prevention strategies should be considered to reduce the impact of these infections.

Single puncture approach guided by transesophageal echocardiography for atrial fibrillation ablation in a patient with prior percutaneous septal closure: case report.

Background: Atrial septal defect (ASD) is associated with a risk of developing atrial fibrillation (AF) higher than in the general population, even after percutaneous or surgical septal closure. Catheter ablation is an effective treatment strategy for preventing recurrences and reducing the AF burden. However, electrophysiologists are faced with technical difficulties and the risk of complications with the left atrium access in patients with prior ASD percutaneous closure. Case summary: We report a case of a patient with highly symptomatic paroxysmal AF, with an ASD, closed percutaneously many years before, who underwent a successful catheter AF ablation, using a single transeptal (TSP) approach guided by transesophageal echocardiography (TEE). Discussion: In patients with ASD and an occluder device implanted, there is a potential risk for septal tear during the TSP passage, device dislodgement, or thrombus formation on the device. Atrial fibrillation ablation in this subset of patients has often been protracted and scarcely reported. TEE and intra-cardiac echocardiography have been increasingly used for interventional procedure guidance during AF ablation. As described here, AF ablation using a simplified single TSP guided by TEE is feasible, safe, and effective after device ASD closure.

Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry. / Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19.

BACKGROUND: Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. OBJECTIVES: To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. METHODS: This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. RESULTS: Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. CONCLUSION: Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

FUNDAMENTO: As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. OBJETIVOS: Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. MÉTODOS: Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. RESULTADOS: Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. CONCLUSÃO: Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians.

OBJECTIVES: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. METHODS: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. RESULTS: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. CONCLUSION: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease.

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19 / Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry.

The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (ß = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (ß = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (ß = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (ß = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.

Autonomia reprodutiva entre mulheres: uma revisão integrativa da literatura / Reproductive autonomy among women: an integrative literature review / Autonomía reproductiva entre las mujeres: una revisión integrativa de la literatura

Objetivo: analisar as evidências científicas acercada capacidade da mulher de decidir livremente sobre questões reprodutivas através das subescalas daEscala de Autonomia Reprodutiva e sua associação com as características sociodemográficas. Método:revisão de literatura integrativa em torno da análise daautonomia reprodutiva entre mulheres. Para a seleção dos artigos foi efetuada uma consulta aos Descritores em Ciência da Saúde (DeCS) e Medical Subject Headings (MeSH), sendo identificados e utilizados os descritores: Reproductive Autonomy Scale, Decision-Making, Women, Tomada de decisões, Mulheres, e combinados através do operador booleano AND. Resultados: a busca bibliográfica ocorreu em dezembro/2021nas bases Pubmed, SCOPUS, Scielo, Lilacse portal BVS, inicialmente encontrou 238títuloscom exclusão de 93 duplicatas, e após a triagem, seteartigos foram incluídos.Após realização das análises desses estudos foram apontadas as categorias "Autonomia reprodutiva: gênero e poder" e "Característicassociodemográficasdas mulheres e autonomia reprodutiva".Considerações finais:é importante conhecer o contexto sociodemográfico e a dinâmica de autonomia reprodutiva no qual as mulheres estão inseridas. Assim, diante de um cenário real de fragilidades sociais que a mulher vivencia, inclusive as que estão em condições desfavoráveis, a exemplo das questões raciais, faz-se necessário ações que fortaleçam a promoção dos direitos reprodutivos na atenção primária de saúde.

Objective: to analyze the scientific evidence about the woman's ability to decide freely on reproductive issues through the subscales of the Reproductive Autonomy Scale and their association with sociodemographic characteristics. Method:integrative literature review onthe analysis of reproductive autonomy among women. For the selection of articles, the Health Science Descriptors (DeCS) and Medical Subject Headings (MeSH) were consulted, and the following descriptors were identified and used: Reproductive Autonomy Scale, Decision-Making, Women, Decision-making, Women, and combined using the Boolean AND operator. Results:the bibliographic search took place in December/2021 in Pubmed, SCOPUS, Scielo, Lilacs and BVS portal, initially found 238 titles with the exclusion of 93 duplicates, and after screening, seven articles were included. After performing the analyses of these studies, the categories "Reproductive autonomy: gender and power" and "Sociodemographic characteristics of women and reproductive autonomy" were pointed out. Final considerations:it is important to know the sociodemographic context and the dynamics of reproductive autonomy in which women are inserted. Thus, faced with a real scenario of social weaknesses that women experience, including those in unfavorable conditions, such as racial issues, actions that strengthen the promotion of reproductive rights in primary health care are necessary.

Objetivo: analizar las evidencias científicas sobre la capacidad de las mujeres para decidir libremente sobre cuestiones reproductivas a través de las subescalas de la Escala de Autonomía Reproductiva y su asociación con características sociodemográficas. Método:revisión integrativa de la literatura sobre el análisis de la autonomía reproductiva de las mujeres. Para seleccionar los artículos se realizó una consulta a los Descriptores de Ciencias de la Salud (DeCS) y a los Encabezamientos de Temas Médicos (MeSH), y se identificaron y utilizaron los siguientes descriptores: Escala de Autonomía Reproductiva, Toma de Decisiones, Mujeres, Toma de Decisiones, Mujeres, y combinados usando el operador booleano AND. Resultados:la búsqueda bibliográfica se realizó en diciembre/2021 en Pubmed, SCOPUS, Scielo,Lilacs y el portal de la BVS, encontró inicialmente 238 títulos con la exclusión de 93 duplicados, y después de la selección, se incluyeron siete artículos. Luego de realizar el análisis de estos estudios, se identificaron las categorías "Autonomía reproductiva: género y poder" y "Características sociodemográficas de las mujeres y autonomía reproductiva". Consideraciones finales:es importante conocer el contexto sociodemográfico y la dinámica de autonomía reproductiva en la que se insertan las mujeres. Así, ante un escenario real de fragilidades sociales que viven las mujeres, incluidas aquellas en condiciones desfavorables, como las cuestiones raciales, son necesarias acciones que fortalezcan la promoción de los derechos reproductivos en la atención primaria de salud.

INCIDÊNCIA DE ANEMIA FERROPRIVA EM GESTANTES EM UM MUNICÍPIO DE PEQUENO PORTE / INCIDENCE OF FERROPRIVATE ANEMIA IN PREGNANT WOMEN IN A SMALL MUNICIPALITY

Introdução: Anemia ferropriva é caracterizada como a diminuição na concentração de hemoglobina, ocorrendo como consequência uma redução da reserva de ferro no organismo. Esta anemia por deficiência de ferro é a mais comum das deficiências nutricionais do mundo. Objetivo: Analisar a incidência de Anemia Ferropriva em gestantes atendidas nas Unidades de Saúde do município de Solonópole-Ceará em 2020. Matérias e Métodos: O tipo de estudo empregado nesta pesquisa foi o de corte transversal, retrospectivo e documental. A investigação foi realizada nas Unidades de Saúde do serviço público da cidade de Solonópole-Ce. Foram selecionadas as Unidades que prestam serviço de pré-natal no referido município. Resultados e Discussão: Foram avaliadas um total de 278 gestantes e a percentagem de anêmicas e não anêmicas. No nosso estudo a percentagem foi de 75 (26,98%) de gestantes anêmicas contra 203(73,02%) de gestantes não anêmicas. Conclusão: A modificação do hábito alimentar com a introdução de dietas ricas em ferro, o monitoramento da anemia por meio de exames laboratoriais e uma suplementação medicamentosa de ferro, são importância para evitar possíveis efeitos colaterais na gestação.

Introduction: Iron deficiency anemia is characterized as a decrease in hemoglobin concentration, resulting in a reduction in the body's iron reserve. This iron deficiency anemia is the most common nutritional deficiency in the world. Objective: To analyze the incidence of Iron Deficiency Anemia in pregnant women attended at Health Units in the city of Solonópole-Ceará in 2020. Materials and Methods: The type of study used in this research was cross-sectional, retrospective and documentary. The investigation was carried out in the Health Units of the public service in the city of Solonópole-Ce. Units that provide prenatal care in that city were selected. Results and Discussion: A total of 278 pregnant women and the percentage of anemic and non-anemic were evaluated. In our study, the percentage was 75 (26.98%) of anemic pregnant women against 203 (73.02%) of non-anemic pregnant women. Conclusion: Changing eating habits with the introduction of iron-rich diets, monitoring anemia through laboratory tests and drug supplementation with iron are important to avoid possible side effects during pregnancy.

The Economic Impact of COVID-19 Treatment at a Hospital-level: Investment and Financial Registers of Brazilian Hospitals.

Background: The economic impact associated with the treatment strategies of coronavirus disease-2019 (COVID-19) patients by hospitals and health-care systems in Brazil is unknown and difficult to estimate. This research describes the investments made to absorb the demand for treatment and the changes in occupation rates and billing in Brazilian hospitals. Methods: This research covers the initial findings of "COVID-19 hospital costs and the proposition of a bundled reimbursement strategy for the health-care system," which includes 10 hospitals. The chief financial officer, the chief medical officer, and hospital executives of each participating hospital provided information regarding investments attributed to COVID-19 patient treatment. The analysis included variations in occupation rates and billing from 2019 to 2020 observed in each institution, and the investments for medical equipment, individual protection materials and building construction per patient treated. Results: The majority of hospitals registered a decrease in hospitalization rates and revenue from 2019 to 2020. For intensive care units (ICUs), the mean occupancy rate ranged from 88% to 83%, and for wards, it ranged from 85% to 73%. Monthly average revenue decreased by 10%. The mean hospital investment per COVID-19 inpatient was I$6800 (standard deviation 7664), with the purchase of ventilators as the most common investment. For this item, the mean, highest and lowest acquisition cost per ventilator were, respectively, I$31 468, I$48 881 and I$17 777. Conclusion: There was significant variability in acquisition costs and investments by institution for responding to the COVID-19 pandemic. These findings highlight the importance of continuing microeconomic studies for a comprehensive assessment of hospital costs. Only with more detailed analyses, will it be possible to define and drive sustainable strategies to manage and reimburse COVID-19 treatment in health-care systems.

Predictive factors, outcomes, and molecular epidemiology of Clostridioides difficile diarrhea in Brazilian hospitals.

Little is known about the role of lineage of strains of Clostridioides difficile (CD) on the clinical presentation of CD infection (CDI) in Latin America, especially regarding the treatment response. We conducted a multicenter, prospective study to investigate the predictive factors and treatment outcomes of CDI in hospitalized patients and to performed phenotypical and molecular characterization of CD strains. A total of 361 diarrheic patients at 5 hospitals from different regions of the country were enrolled. All stool samples were tested for glutamate dehydrogenase (GDH), toxins A and B, and toxin genes using a nucleic acid amplification test (NAAT). Specimens were cultured and susceptibility profile and whole-genome sequencing (WGS) were performed. CDI positivity was 15% (56/377). Predictive factors for CDI were prior use of meropenem (OR 4.09, 95% CI 2.097-7.095; p<0.001), mucus in stools (OR 3.29; 95% CI 1.406-7.722; p=0.006) and neutrophil left-shift with >20% of bands (OR 3.77; 95% IC 1.280-11.120; p=0.016). Overall mortality was 19%, with no deaths attributed to CDI. Oral metronidazole was used in 74% of cases, with 85% of cure and 14% of recurrence. A total of 35 CD isolates were recovered, all of them susceptible to metronidazole and vancomycin. The WGS revealed 17 different STs, six of which were novel. ST42 was the most common ST and hypervirulent strains were not found. Severe CDI were caused by ST42, ST5, ST8, ST48, ST33 and a novel ST667. The ermB gene was more frequently found in isolates of ST42 (p=0.004).

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts.

Xpert® MTB/RIF has been widely used for tuberculosis (TB) diagnosis in Brazil, since 2014. This prospective observational study aimed to evaluate the performance of Xpert in different contexts during a two-year period: (i) laboratory and clinical/epidemiological diagnosis; (ii) HIV-positive and -negative populations; (iii) type of specimens: pulmonary and extrapulmonary. Overall, 924 specimens from 743 patients were evaluated. The performance of the assays was evaluated considering culture (Lowenstein Jensen or LJ medium) results and composite reference standard (CRS) classification as gold standard. According to CRS evaluation, 219 cases (29.5%) were classified as positive cases, 157 (21.1%) as 'possible TB', and 367 (49.3%) as 'not TB'. Based on culture, Xpert and AFB smear achieved a sensitivity of 96% and 62%, respectively, while based on CRS, the sensitivities of Xpert, AFB smear, and culture were 40.7%, 20%, and 25%, respectively. The pooled sensitivity and specificity of Xpert were 96% and 94%, respectively. Metric evaluations were similar between pulmonary and extrapulmonary samples against culture, whereas compared to CRS, the sensitivities were 44.6% and 29.3% for the pulmonary and extrapulmonary cases, respectively. The Xpert detected 42/69 (60.9%) patients with confirmed TB and negative culture on LJ medium, and 52/69 (75.4%) patients with negative AFB smear results. There was no significant difference in the diagnostic accuracy based on the types of specimens and population (positive- and negative-HIV). Molecular testing detected 13 cases of TB in culture-negative patients with severe immunosuppression. Resistance to rifampicin was detected in seven samples. Herein, Xpert showed improved detection of pulmonary and extrapulmonary TB cases, both among HIV-positive and -negative patients, even in cases with advanced immunosuppression, thereby performing better than multiple other diagnostic parameters.

Prevalence of Clostridioides difficile associated diarrhea in hospitalized patients in five Brazilian centers: A multicenter, prospective study.

Epidemiological data on CD infection (CDI) in Latin American are scarce. CDI prevalence and strains characterization were prospectively evaluated in 5 Brazilian hospitals from different regions. Prevalence rates of CDI were 15%, ranging from 0 to 37%. ST42 was the most common Sequence Type and hypervirulent strains were not identified.

Brucella Laboratory Exposures in Brazil: Rare or Unnoticed?

Laboratory exposures to Brucella spp. are preventable. After an outbreak in Brazil, human brucellosis was made statutorily reportable as well as laboratory accidents. After the implementation of this law, three laboratorial accidents with Brucella abortus were reported in a Brazilian city, and 58 workers were exposed from January 2019 to April 2020. We describe the exposure level, prophylaxis, and serosurvey after 6 months, and we highlight the importance of disease report.

Burnout is associated with a depressive interpretation style.

The aim of this 188-participant study (65% female; mean age = 40.31) was to examine whether burnout and depression are associated with similar interpretation biases in the processing of emotional information. Burnout symptoms were assessed with the Maslach Burnout Inventory-General Survey and depressive symptoms with the 9-item depression module of the Patient Health Questionnaire. Interpretation bias toward emotional information was examined using an amended version of the Word-Sentence Association Paradigm (WSAP). In the WSAP, participants are asked to decide whether emotionally-valenced words are related to ambiguous sentences. Burnout and depression were each associated with a higher endorsement of negative interpretations and a higher ratio of negative interpretations to positive interpretations. Negative word endorsement and positive word endorsement interacted in such a way that negative word endorsement was predictive of burnout and depression only when positive word endorsement levels were relatively low. Our findings suggest that burnout and depression are associated with similar alterations in the interpretation of ambiguous information. This study supports the view that burned out individuals perceive the world with "depressive glasses." Cognitive bias modification techniques employed in the treatment of depressive conditions may constitute relevant therapeutic options for "burned out" individuals.

Docosahexaenoic acid promotes cell cycle arrest and decreases proliferation through WNT/ß-catenin modulation in colorectal cancer cells exposed to γ-radiation.

The effects of radiation are known to be potentiated by N-3 polyunsaturated fatty acids, which modulate several signaling pathways, but the molecular mechanisms through which these fatty acids enhance the anticancer effects of irradiation in colorectal cancer (CRC) treatment remain poorly elucidated. Here, we aimed to ascertain whether the fatty acid docosahexaenoic acid (DHA) exerts a modulating effect on the response elicited by radiation treatment (RT). Two CRC cell lines, Caco-2 and HT-29, were exposed to RT, DHA, or both (DHA + RT) for various times, and then cell viability, proliferation, and clonogenicity were assessed. Moreover, cell cycle, apoptosis, and necrosis were analyzed using flow cytometry, and the involvement of WNT/ß-catenin signaling was investigated by immunofluorescence to determine nuclear ß-catenin, GSK3ß phosphorylation status, and TCF/LEF-activity reporter. DHA and RT applied separately diminished the viability of both HT-29 and Caco-2 cells, and DHA + RT caused a further reduction in proliferation mainly in HT-29 cells, particularly in terms of colony formation. Concomitantly, our results verified cell cycle arrest in G0/G1 phase, a reduction of cyclin D1 expression, and a decrease in GSK3ß phosphorylation after the combined treatment. Furthermore, immunofluorescence quantification revealed that nuclear ß-catenin was increased in RT-exposed cells, but this effect was abrogated in cells exposed to DHA + RT, and the results of TCF/LEF-activity assays confirmed that DHA attenuated the increase in nuclear ß-catenin activity induced by irradiation. Our finding shows that DHA applied in combination with RT enhanced the antitumor effects of irradiation on CRC cells, and that the underlying mechanism involved the WNT/ß-catenin pathway. © 2018 BioFactors, 45(1):24-34, 2019.

Interfaces entre profissionais de saúde e a humanização da assistência ao parto / Interfaces between healt professionals and humanization of labor assistance

Objetivo: descrever a percepção dos profissionais de saúde acerca dos aspectos relacionados à humanização ao parto e nascimento Metodologia: Estudo descritivo com abordagem qualitativa, realizado com 26 profissionais de saúde especialistas em obstetrícia (10 enfermeiros e 16 médicos) de três maternidades públicas de risco habitual em Recife-PE. Utilizou-se como referencial teórico a Análise crítica do discurso. Resultados: Dificuldades enfrentadas no desenvolvimento da assistência ao parto e nascimento; Discurso divergente em relação à humanização da assistência ao parto e nascimento; Divergência entre modelos assistenciais obstétricos seguidos. Conclusões: percebe-se a necessidade de ampliar a compreensão de humanização do parto e nascimento pelos profissionais, tendo como objetivo prestar uma atenção voltada às necessidades da parturiente e família.

Objective: to describe the perception of health professionals about the aspects related to humanization at birth and birth. Methodology: A descriptive study with a qualitative approach, carried out with 26 health professionals specialized in obstetrics (10 nurses and 16 physicians) from three public maternity hospitals at usual risk In Recife-PE. Critical analysis of discourse was used as theoretical reference. Results: Difficulties faced in the development of delivery and birth care; Divergent discourse regarding the humanization of delivery and birth care; Divergence between assisted obstetric care models. Conclusions: the need to extend the understanding of humanization of birth and birth by professionals is perceived, with the objective of paying attention to the needs of the parturient and the family.

Objetivo: describir la percepción de los profesionales de salud acerca de los aspectos relacionados con la humanización al parto y el nacimiento. Métodos: Estudio descriptivo con abordaje cualitativo, realizado con 26 profesionales de salud especialistas en obstetricia (10 enfermeros y 16 médicos) de tres maternidades públicas de riesgo habitual En Recife-PE. Se utilizó como referencial teórico el análisis crítico del discurso. Resultados: Dificultades enfrentadas en el desarrollo de la asistencia al parto y el nacimiento; Discurso divergente en relación con la humanización de la asistencia al parto y el nacimiento; Divergencia entre modelos asistenciales obstétricos seguidos. Conclusiones: se percibe la necesidad de ampliar la comprensión de humanización del parto y nacimiento por los profesionales, teniendo como objetivo prestar una atención volcada a las necesidades de la parturienta y familia.

Antimicrobial activity of plazomicin against Enterobacteriaceae-producing carbapenemases from 50 Brazilian medical centers.

Plazomicin is a next-generation aminoglycoside with activity against Enterobacteriaceae, including carbapenemase-producing Enterobacteriaceae (CPE). The aim of this study was to evaluate the activity of plazomicin against CPE (Klebsiella spp., Escherichia coli, Serratia spp., Enterobacter spp., Citrobacter spp., Morganella spp., Proteus spp., Providencia spp.) from different Brazilian hospitals. A total of 4000 carbapenem-resistant Enterobacteriaceae isolates were collected from clinical samples in 50 Brazilian hospitals during 2013-2015. Of these, 499 carbapenem-resistant isolates (CLSI criteria) were selected for further evaluation via broth microdilution to assess for the activity of plazomicin, colistin, tigecycline, meropenem, amikacin, and gentamicin. Additionally, the isolates were assessed for the presence of carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like, blaIMP, blaBKC, blaGES, and blaVIM) by polymerase chain reaction (PCR). When PCR was positive to blaOXA-48-like, blaIMP, blaGES, and blaVIM, the carbapenemase genes were sequenced. blaKPC was the most prevalent carbapenemase gene found (n=397), followed by blaNDM (n=81), blaOXA-48 (n=12), and blaIMP-1 (n=3). Other genes were identified in only 1 isolate each: blaBKC-1, blaGES-16, blaGES-1, blaOXA-370, and blaVIM-1. One isolate had 2 carbapenemase genes (blaKPC and blaNDM). Thirty-three percent of the isolates were nonsusceptible to colistin, 24% to tigecycline, 97% to meropenem, 51% to amikacin, and 81% to gentamicin (via EUCAST criteria). The plazomicin MIC50/90 was 0.5/64mg/L, with 85% of MICs ≤2mg/L and 87% of MICs ≤4mg/L. Elevated MICs to plazomicin were not associated with a specific carbapenemase or bacterial species. The MICs of plazomicin against CPE were lower than those of other aminoglycosides. Plazomicin is a promising drug for the treatment of CPE infections.

Traumatismo dental en bebés / Traumatismo dental em bebês / Dental trauma in infants

Las ocurrencias traumáticas pueden traer consecuencias desagradables tanto en lo físico como en lo estético, como en el aspecto psicológico. Los traumas sufridos por bebés traen situaciones casi irreparables en el momento, tales como las limitaciones inherentes a la edad del paciente cuando aún es bebé. Las soluciones protésicas, por ejemplo, son casi siempre descartadas porque la edad del paciente es incompatible con el uso de una prótesis. Así, como ésta, también ocurren muchas otras situaciones, limitando un tratamiento inmediato y representando para el paciente un problema a ser resuelto. Por lo tanto, en el trabajo se hace una revisión de la bibliografía que aborda el traumatismo dental en bebés y comentarios sobre los exámenes a realizar, siempre considerando la edad, crecimiento y desarrollo, además de relatar las consecuencias de esos traumatismos en esta franja etaria inicial de vida como resultado. Finalmente, trata de alertar a los responsables de los niños de los cuidados de emergencia que se deben tener en algunas ocurrencias de traumatismos dentales en bebés.

As ocorrências traumáticas podem trazer consequências desagradáveis seja na questão física como na estética, ou no aspecto psicológico. Os traumas acometidos em bebês, trazem, situações quase que irreparáveis no momento, tais como as limitações inerentes à idade do paciente quando ainda bebê. As resoluções protéticas, por exemplo, são quase sempre descartadas, uma vez que a idade do paciente é incompatível com o uso de uma prótese. Assim, como esta, muitas outras situações também ocorrem, limitando um tratamento imediato, representando um problema a ser resolvido para o paciente. Assim sendo, no trabalho é feito uma revisão de literatura que aborda o traumatismo dentário em bebês e comentários sobre os exames a serem feitos, sempre considerando a idade, crescimento e desenvolvimento, além de relatar as consequências desses traumatismos nesta faixa etária inicial de vida como resultado. Por fim, trata de alertar os responsáveis pelas crianças, dos cuidados emergenciais que se deve ter em algumas ocorrências de traumatismos dentais em bebês.

Traumatic events can result in unpleasant outcomes, both physically and aesthetically, including psychological aspects. Dental trauma in infants results in almost irreparable damages at the time, such as limitations inherent to the patient's age. For instance, prosthetic interventions for infants are almost always disregarded as the patient's age is not compatible with the use of prosthesis. Therefore, many other similar situations involving infants may also occur, which temlimits any immediate treatment and represents a problem to be solved. The present work aims to review the literature on dental trauma in infants and discuss on the exams to be performed, always considering age, growth and development of the patient, in addition to reporting traumatic outcomes in this early age group. Finally, the present work also attempts to advise the caregivers about the emergency care they should follow in some occurrences of dental trauma in infants.