RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico. Objetivo neonatos International CRD42021274210 CRD PubMed LatinoAmericano Latino Americano BVS/BIREME, BVSBIREME BVS/BIREME , BVS BIREME (BVS/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyises Meta Analyises PRISMA. PRISMA . (PRISMA) 1 duplicatas 2 resumos 3 relevantes 4 independentes longitudinais transversais pares humanos inglês espanhol português recémnascidos recém nascidos toxoplasmose rubéola citomegalovírus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV 2, SARS-CoV-2 PCR. (PCR) informações autor publicação nacionalidade sujeitos estudo conclusão Simples inespecíficos etiológica Conclusões neurológico CRD4202127421 (BVS/BIREME (EMBASE 20 (PRISMA (TORCH B1 B-1 SARS-CoV- (PCR CRD420212742 B- SARS-CoV CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis. Objective neonates source PROSPERO, PROSPERO , (PROSPERO) CRD42021274210 CRD databases PubMed Library VHL/BIREME, VHLBIREME VHL/BIREME VHL BIREME (VHL/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyses Meta Analyses PRISMA (PRISMA guidelines 1 removal 2 abstracts 3 Fulltext Full reports 4 authors nonrandomized non trials longitudinal crosssectional, crosssectional cross sectional, sectional cross-sectional peerreviewed peer reviewed humans English Spanish Italian Portuguese toxoplasmosis rubella cytomegalovirus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV2, CoV2 CoV SARS-CoV2 PCR. . (PCR) information author publication nationality subjects type results conclusion synthesis symptoms investigation Conclusions prognosis (PROSPERO CRD4202127421 (VHL/BIREME (EMBASE 20 (TORCH B1 B-1 SARS-CoV (PCR CRD420212742 B- CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Purpose: To characterize the extracellular vesicle protein cargo in the aqueous humor and plasma of patients with ocular toxoplasmosis. Methods: Aqueous humor and plasma were collected from six patients with active ocular toxoplasmosis and six patients with cataract. Extracellular vesicles were isolated, and western blotting and mass spectrometry were performed for protein analysis. Results: All plasma samples from patients with ocular toxoplasmosis and cataract were positive for the tetraspanins CD63 and TSG101. However, the aqueous humor from patients with ocular toxoplasmosis was positive only for CD63. Sixty-seven new unreported proteins were identified in the aqueous humor and plasma of patients with the ocular toxoplasmosis and cataract. Of the 67 proteins, 10 and 7 were found only in the cataract and ocular toxoplasmosis groups, respectively. In general, these proteins were involved in immune system activation and retina homeostasis and were related to infections and retina-associated diseases. Conclusion: The distinct protein signatures between ocular toxoplasmosis and cataract may be helpful in the differential diagnosis of ocular toxoplasmosis. However, more studies are needed to better understand the role of these proteins in the pathogenesis of ocular toxoplasmosis. Purpose Methods isolated analysis Results CD CD6 TSG101 TSG However Sixtyseven Sixty seven 6 1 groups respectively general retinaassociated associated diseases Conclusion TSG10 TSG1

ABSTRACT: Bovine mastitis is the most impacting disease of dairy industry, and it is characterized by a complexity of causal agents, which have revealed a geographical variation among regions and countries. The mastitis-related pathogens have been traditionally classified as contagious or environmental, based on habits of the microorganisms and transmission routes. Besides, the severity of mammary infections has been associated with the virulence of the pathogens, and immune and nutritional status of the hosts. Considering this scenario, we investigated the etiological pattern, clinical severity scores, and days in milk (DIM) data in 4,273 clinical cases of bovine mastitis among ten large-dairy farms located in Brazil. Streptococcus dysgalactiae (283/4,273 = 6.6%), Escherichia coli (190/4,273 = 4.4%), Prototheca spp. (112/4,273 = 2.6%), and Streptococcus uberis (95/4,273 = 2.2%) were the predominant pathogens isolated. Among 4,273 clinical cases, clinical severity score was available in 43.8% (1,871/4,273) animals. From these, 69.8% (1,306/1,871), 27.3% (510/1,871), and 2.9% (55/1,871) were scored as mild, moderate, and severe, respectively. Pathogens were observed mainly in samples obtained during the first 100 days in milk, and clinical severity scored mainly as mild. Our results contributed to the etiological identification, clinical severity scoring, and milking aspects of mastitic cows in dairy farms with a history of clinical mammary infections. ABSTRACT industry agents countries mastitisrelated related environmental routes Besides hosts scenario pattern scores DIM (DIM 4273 4 273 4,27 largedairy large Brazil 283/4,273 2834273 283 (283/4,27 6.6%, 66 6.6% , 6 6.6%) 190/4,273 1904273 190 (190/4,27 4.4%, 44 4.4% 4.4%) spp 112/4,273 1124273 112 (112/4,27 2.6%, 26 2.6% 2 2.6%) 95/4,273 954273 95 (95/4,27 2.2% 22 isolated 438 43 8 43.8 1,871/4,273 18714273 1 871 (1,871/4,273 animals these 698 69 69.8 1,306/1,871, 13061871 1,306/1,871 306 (1,306/1,871) 27 3 27.3 510/1,871, 5101871 510/1,871 510 (510/1,871) 29 9 2.9 55/1,871 551871 55 (55/1,871 mild moderate severe respectively 10 identification scoring 427 4,2 283/4,27 283427 28 (283/4,2 6.6 190/4,27 190427 19 (190/4,2 4.4 112/4,27 112427 11 (112/4,2 2.6 95/4,27 95427 (95/4,2 2.2 43. 1,871/4,27 1871427 87 (1,871/4,27 69. 1306187 1,306/1,87 30 (1,306/1,871 27. 510187 510/1,87 51 (510/1,871 2. 55/1,87 55187 5 (55/1,87 42 4, 283/4,2 28342 (283/4, 6. 190/4,2 19042 (190/4, 4. 112/4,2 11242 (112/4, 95/4,2 9542 (95/4, 1,871/4,2 187142 (1,871/4,2 130618 1,306/1,8 (1,306/1,87 51018 510/1,8 (510/1,87 55/1,8 5518 (55/1,8 283/4, 2834 (283/4 190/4, 1904 (190/4 112/4, 1124 (112/4 95/4, 954 (95/4 1,871/4, 18714 (1,871/4, 13061 1,306/1, (1,306/1,8 5101 510/1, (510/1,8 55/1, 551 (55/1, 283/4 (283/ 190/4 (190/ 112/4 (112/ 95/4 (95/ 1,871/4 1871 (1,871/4 1306 1,306/1 (1,306/1, 510/1 (510/1, 55/1 (55/1 283/ (283 190/ (190 112/ (112 95/ (95 1,871/ 187 (1,871/ 130 1,306/ (1,306/1 510/ (510/1 55/ (55/ (28 (19 (11 (9 1,871 18 (1,871 13 1,306 (1,306/ (510/ (55 (2 (1 ( 1,87 (1,87 1,30 (1,306 (510 (5 1,8 (1,8 1,3 (1,30 (51 1, (1, (1,3

RESUMO: A mastite bovina é a doença mais impactante na indústria de laticínios e é caracterizada por uma complexidade de agentes causais, os quais têm revelado uma variação geográfica entre regiões e países. Os patógenos relacionados à mastite têm sido tradicionalmente classificados como contagiosos ou ambientais, com base na fonte de infecção ou origem e nas vias de transmissão. Além disso, a gravidade das infecções mamárias tem sido associada à virulência dos patógenos, e ao estado imunológico e nutricional dos animais. Considerando esse cenário, investigamos os agentes etiológicos, os escores de gravidade clínica e os dados de dias em lactação (DEL) em 4.273 casos clínicos de mastite bovina em dez fazendas de grande porte, quatro localizadas no sudoeste do estado de São Paulo e seis no sul do Estado de Minas Gerais, Brasil. Streptococcus dysgalactiae (283/4.273 = 6,6%), Escherichia coli (190/4.273 = 4,4%), Prototheca spp. (112/4.273 = 2,6%) e Streptococcus uberis (95/4.273 = 2,2%) foram os patógenos predominantes isolados. Entre os 4.273 casos clínicos, a pontuação de gravidade clínica estava disponível em 43,8% (1.871/4.273) dos animais. Desses, 69,8% (1.306/1.871), 27,3% (510/1.871) e 2,9% (55/1.871) foram classificados como leves, moderados e graves, respectivamente. Os patógenos foram observados principalmente em amostras obtidas durante os primeiros 100 dias em lactação, e a gravidade clínica foi principalmente classificada como leve. Nossos resultados contribuem para a identificação etiológica, a pontuação de gravidade clínica e os aspectos de ordenha de vacas com mastite em fazendas leiteiras com histórico de infecções mamárias clínicas. RESUMO causais países ambientais transmissão disso animais cenário etiológicos DEL (DEL 4273 4 273 4.27 porte Gerais Brasil 283/4.273 2834273 283 (283/4.27 6,6%, 66 6,6% , 6 6,6%) 190/4.273 1904273 190 (190/4.27 4,4%, 44 4,4% 4,4%) spp 112/4.273 1124273 112 (112/4.27 2,6% 26 2 95/4.273 954273 95 (95/4.27 2,2% 22 isolados 438 43 8 43,8 1.871/4.273 18714273 1 871 (1.871/4.273 Desses 698 69 69,8 1.306/1.871, 13061871 1.306/1.871 306 (1.306/1.871) 27 3 27,3 510/1.871 5101871 510 (510/1.871 29 9 2,9 55/1.871 551871 55 (55/1.871 leves graves respectivamente 10 leve etiológica clínicas 427 4.2 283/4.27 283427 28 (283/4.2 6,6 190/4.27 190427 19 (190/4.2 4,4 112/4.27 112427 11 (112/4.2 2,6 95/4.27 95427 (95/4.2 2,2 43, 1.871/4.27 1871427 87 (1.871/4.27 69, 1306187 1.306/1.87 30 (1.306/1.871 27, 510/1.87 510187 51 (510/1.87 2, 55/1.87 55187 5 (55/1.87 42 4. 283/4.2 28342 (283/4. 6, 190/4.2 19042 (190/4. 4, 112/4.2 11242 (112/4. 95/4.2 9542 (95/4. 1.871/4.2 187142 (1.871/4.2 130618 1.306/1.8 (1.306/1.87 510/1.8 51018 (510/1.8 55/1.8 5518 (55/1.8 283/4. 2834 (283/4 190/4. 1904 (190/4 112/4. 1124 (112/4 95/4. 954 (95/4 1.871/4. 18714 (1.871/4. 13061 1.306/1. (1.306/1.8 510/1. 5101 (510/1. 55/1. 551 (55/1. 283/4 (283/ 190/4 (190/ 112/4 (112/ 95/4 (95/ 1.871/4 1871 (1.871/4 1306 1.306/1 (1.306/1. 510/1 (510/1 55/1 (55/1 283/ (283 190/ (190 112/ (112 95/ (95 1.871/ 187 (1.871/ 130 1.306/ (1.306/1 510/ (510/ 55/ (55/ (28 (19 (11 (9 1.871 18 (1.871 13 1.306 (1.306/ (510 (55 (2 (1 ( 1.87 (1.87 1.30 (1.306 (51 (5 1.8 (1.8 1.3 (1.30 1. (1. (1.3

ABSTRACT Introduction: toxoplasmosis is a parasitosis that causes serious infections in immunocompromised patients and newborns. The serological status of the mother influences the possibility of transmission to the fetus if the infection is contracted during pregnancy. It is necessary to know the prevalence of this condition in pregnant women as a first step to carry out actions aimed at knowing the real burden of the disease and reducing this pathology. Objective: determine the IgG and IgM seroprevalence of toxoplasmosis in pregnant women and newborns from January 2017 to January 2021. Methodology: pregnant women in their immediate peripartum period and newborns up to one week of extrauterine life were included. IgG and IgM were measured in peripheral blood by the ECLIA method. The calculated sample size was 800 per group, for the study period. Results: 2524 newborns and 2029 pregnant women were included. The prevalence of IgG was 97.5 % and 97 % for pregnant women and newborns, respectively, and IgM: 4.7 % and 1.9% for women and newborns, respectively. The seroprevalence trends remained constant for IgG for both groups, while IgM showed a slight increasing trend. Conclusions: IgG seroprevalence was close to 100% in both populations, probably due to the transplacental transfer of IgG, however, a small percentage of IgM was noted, a probable marker of acute infection.

RESUMEN Introducción: la toxoplasmosis es una parasitosis que causa infecciones graves en inmunocomprometidos y recién nacidos. El estado serológico de la madre influye en la posibilidad de transmisión al feto si la infección es contraída durante el embarazo. Es necesario conocer la prevalencia de esta afección en gestantes como primer paso para realizar acciones tendientes a conocer la carga real de la enfermedad y disminuir esta patología. Objetivo: determinar la seroprevalencia IgG e IgM de toxoplasmosis de gestantes y recién nacidos periodo de enero 2017 a enero 2021. Metodología: se incluyeron las gestantes en su periodo periparto inmediato y recién nacidos hasta la semana de vida extrauterina. Se midió IgG e IgM en sangre periférica por método ECLIA. El tamaño muestral calculado fue de 800 por grupo, para el periodo de estudio. Muestreo no probabilístico de casos consecutivos. Resultados: fueron incluidos 2524 recién nacidos y 2029 gestantes. Las prevalencias de IgG fueron de 97,5 % y 97 % para gestantes y recién nacidos respectivamente, y la IgM: 4,7% y 1,9 % para mujeres y recién nacidos respectivamente. Las tendencias de las seroprevalencias se mantuvieron constantes para IgG para ambos grupos, mientras que la IgM presentó una leve tendencia al aumento. Conclusiones: la seroprevalencia de IgG fue cercana al 100 % en ambas poblaciones, probablemente debido a la transferencia transplacentaria de IgG, sin embargo, se nota un porcentaje pequeño de IgM, probable marcador de infección aguda.

ABSTRACT Introduction: the COVID-19 pandemic presented challenges worldwide. The acceptance of vaccines in the population is essential as a preventive measure. It is undeniable that there are factors that increase rejection or questioning in this regard, which may be related to culture, politics, trust, convenience, experience in health services, and also the opinion of the environment. Objective: to determine the percentage of students and teachers vaccinated, and the number of doses applied against COVID-19 in Facultad de Odontología at the Universidad Nacional de Asunción, in the year 2022. Methodology: cross-sectional descriptive observational study, applying a digital survey with 23 questions about knowledge, application and self-perception of the vaccine; in addition to demographic data. Results: 168 respondents were included, 128 students and 40 teachers. 80.0 % were women. 97.6 % have been vaccinated against COVID-19, the majority (85.4 %) received three doses of the vaccine. 34.1 % received the Covaxin vaccine, 32.9 % Sputnik V, 15.9 % AstraZeneca and 17.1 % others (Pfizer, Sinopharm and Moderna). 35.1 % had doubts about the effectiveness but most of them were applied anyway. 94.1 % considered the vaccine necessary and 88.7 % safe. 78.5 % responded that coverage is high to prevent the symptoms of the disease. 35.1% mentioned feeling fully protected with the vaccine. 78.6% know that some adverse reaction may occur after application. Conclusion: almost all of the respondents were vaccinated and had received all three doses of the COVID-19 vaccine at the time of the survey.

RESUMEN Introducción: la pandemia por COVID-19 presentó desafíos a nivel mundial. La aceptación de las vacunas en la población es indispensable como medida preventiva. Es innegable que existen factores que elevan el rechazo o cuestionamiento al respecto, que pueden estar relacionados con la cultura, política, confianza, conveniencia, experiencia en servicios sanitarios, también la opinión del entorno. Objetivo: determinar el porcentaje de estudiantes y docentes vacunados, y el número de dosis aplicadas contra el COVID-19 de la Facultad de Odontología de la Universidad Nacional de Asunción, en el año 2022. Metodología: estudio observacional descriptivo de corte transversal, aplicando una encuesta en digital con 23 preguntas acerca del conocimiento, aplicación y autopercepción de la vacuna; además de datos demográficos. Resultados: fueron incluidos 168 encuestados, 128 estudiantes y 40 docentes. 80,0 % fueron mujeres. 97,6 % se ha vacunado contra COVID-19, la mayoría (85,4 %) se aplicó tres dosis de la vacuna. 34,1 % se aplicó la vacuna Covaxin, 32,9 % Sputnik V, 15,9 % AstraZeneca y 17,1 % otras (Pfizer, Sinopharm y Moderna). El 35,1 % tuvo dudas acerca de la eficacia pero que en su mayoría se aplicaron igualmente. El 94,1 % consideró necesaria y el 88,7 % segura la vacuna. El 78,5 % respondió que la cobertura es elevada para prevenir los síntomas de la enfermedad. El 35,1 % mencionó sentirse protegido en su totalidad con la vacuna. El 78,6 % sabe que puede presentarse luego de la aplicación alguna reacción adversa. Conclusión: casi la totalidad de los encuestados se encontraban vacunados y se aplicaron las tres dosis de la vacuna COVID-19 al momento de la encuesta.

Resumen: Introducción: El cateterismo urinario es un procedimiento frecuente y en ocasiones es utilizado por fuera de las indicaciones aceptadas para el mismo. Esto aumenta el riesgo de complicaciones vinculadas a su uso, por lo que pueden ser prevenibles. El objetivo del estudio es conocer las características del uso de cateterismo urinario en pacientes ingresados en salas de cuidados moderados de un hospital universitario del tercer nivel de atención, determinar la frecuencia, duración e indicaciones más frecuentes, así como evaluar la presencia de complicaciones asociadas al mismo Metodología: Estudio de corte transversal, realizado en salas de cuidados moderados de un hospital terciario y universitario de Montevideo, Uruguay, el 21 de diciembre de 2022. Se incluyeron pacientes hospitalizados que presentaban o presentaron catéter vesical en la presente internación y se completó la recolección de variables mediante la revisión de la historia clínica. Resultados: De 155 pacientes ingresados en salas de cuidados moderados, a 26 (16,7%) les fue colocado un catéter urinario. La mediana de edad fue 61 años, 80% eran de sexo masculino. La mediana de internación fue de 22 días. En todos los pacientes se utilizó sonda vesical y el 54% fue colocado en el Departamento de Emergencia. En el 46% de los pacientes no se encontró indicación escrita de colocación en la historia clínica. En 50% de los casos no está especificado el motivo de indicación de sonda vesical, mientras que las indicaciones identificadas más frecuentes fueron el control de diuresis (27%) y la desobstrucción de vía urinaria baja (23%). La duración de cateterismo fue de una mediana de 13,5 días, mientras que el 27% de los pacientes la usaron más de 30 días. 35% de los pacientes presentaron complicaciones vinculadas a la sonda vesical, en su mayoría no infecciosas (27%) y 15% presentaron infección urinaria. Estos pacientes tuvieron una duración de cateterismo mayor a los que no presentaron complicaciones (23 vs 10 días, p=0,411). Conclusiones: El catéter vesical fue utilizado en un porcentaje no despreciable de pacientes ingresados en salas de cuidados moderados, de forma prolongada y frecuentemente sin indicación precisa, lo cual expone a un riesgo aumentado de complicaciones vinculadas.

Abstract: Introduction: Urinary catheterization is a frequent procedure and is sometimes used outside of its accepted indications. This increases the risk of complications related to its use, so they may be preventable. The objective of this study is to know the characteristics of the use of urinary catheterization in patients admitted to moderate care wards of a tertiary care university hospital, to determine the frequency, duration and most frequent indications, as well as to evaluate the presence of associated complications. Methodology: Cross-sectional study, carried out in moderate care wards of a tertiary care and university hospital in Montevideo, Uruguay, on December 21, 2022. Hospitalized patients who present or presented a bladder catheter during the present hospitalization were included, and the collection of variables was completed by reviewing the medical history. Results: Of 155 patients admitted to moderate care wards, 26 (16.7%) had a urinary catheter placed. The median age was 61 years, 80% were male. The median hospitalization was 22 days. In all patients a bladder catheter was used and 54% were placed in the Emergency Department. In 46% of the patients, no written indication for placement was found in the clinical history. In 50% of cases, the reason for indicating the bladder catheter is not specified, while the most frequent indications identified were diuresis control (27%) and lower urinary tract obstruction (23%). The duration of catheterization was a median of 13.5 days, while 27% of the patients used it for more than 30 days. 35% of the patients presented complications related to the bladder catheter, mostly non-infectious (27%) and 15% presented urinary tract infection. These patients had a longer duration of catheterization than those without complications (23 vs 10 days, p=0,411). Conclusions: The bladder catheter was used in a non-negligible percentage of patients admitted to moderate care wards, for a long time and often without a precise indication, which exposes them to an increased risk of related complications.

Resumo: Introdução: O cateterismo urinário é um procedimento frequente e às vezes é usado fora de suas indicações aceitas. Isso aumenta o risco de complicações relacionadas ao seu uso, portanto, podem ser evitáveis. O objetivo deste estudo é conhecer as características do uso do cateterismo urinário em pacientes internados em enfermarias de cuidados moderados de um hospital universitário terciário, determinar a frequência, duração e indicações mais frequentes, bem como avaliar a presença de complicações associadas ao mesmo. Metodologia: Estudo transversal, realizado em quartos de cuidados moderados de um hospital terciário e universitário em Montevidéu, Uruguai, em 21 de dezembro de 2022. Foram incluídos pacientes que apresentaram ou apresentaram sonda vesical durante a internação atual e a coleta de variáveis foi concluída .revisando o histórico médico. Resultados: Dos 155 pacientes admitidos em enfermarias de cuidados moderados, 26 (16,7%) tiveram um cateter urinário colocado. A idade média foi de 61 anos, 80% eram do sexo masculino. A mediana de internação foi de 22 dias. Em todos os doentes foi utilizada sonda vesical e 54% foram internados no Serviço de Urgência. Em 46% dos pacientes, nenhuma indicação escrita para colocação foi encontrada na história clínica. Em 50% dos casos não é especificado o motivo da indicação da sonda vesical, enquanto as indicações mais frequentes identificadas foram controle da diurese (27%) e desobstrução do trato urinário inferior (23%). A duração do cateterismo foi em média de 13,5 dias, enquanto 27% dos pacientes o utilizaram por mais de 30 dias. 35% dos pacientes apresentaram complicações relacionadas ao cateter vesical, em sua maioria não infecciosas (27%) e 15% apresentaram infecção urinária. Esses pacientes tiveram uma duração mais longa de cateterismo do que aqueles sem complicações (23 vs 10 dias, p=0,411). Conclusões: A sonda vesical foi utilizada em percentual não desprezível de pacientes internados em quartos de cuidados moderados, por tempo prolongado e muitas vezes sem indicação precisa, o que os expõe a um risco aumentado de complicações associadas.

Abstract Introduction: Nursing staffing in adult intensive care has been at a ratio of two patients per nurse or one patient for one nurse. Currently, patients require complex and specialized care that provides safety and reduces Healthcare-Associated Infections. Objective: Evidencing the importance of equipping nursing personnel according to the severity of the patient compared to the nurse-patient ratio in order to reduce Healthcare-Associated Infections in patients in the adult intensive care unit. Methodology: This is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted from September 2021 to March 2022. The databases PubMed, ScienceDirect, Epistemonikos and CUIDEN were used, and the following terms were utilized, i.e., nursing personnel, patient severity, nurse-patient ratio, healthcare-associated infections, and the Boolean operators AND, OR, and WITH. The sample consisted of 8 studies that were assessed using the Critical Reading Cards (FLC 3.0) and graded according to the National Institute for Health and Care Excellence. Results: Staffing according to patient severity compared to the nurse-patient indicator reduced healthcare-associated infections, mortality, sepsis occurrence, and medication errors. The impact on patients and nursing personnel showed improved quality of care and reduced burnout and work stress, which benefited the patient. Conclusion: It is important to provide nursing personnel according to the severity of the patient and with personnel having an academic level of at least a bachelor's degree in order to improve the quality of care and reduce healthcare-associated infections.

Abstrato Introdução: A equipe de enfermagem na terapia intensiva de adultos tem estado em uma proporção de dois pacientes para um enfermeiro ou um paciente para um enfermeiro. Atualmente, os pacientes que chegam exigem cuidados complexos e especializados que ofereçam segurança e reduzam as infecções associadas à assistência à saúde. Objetivo: Demonstrar a importância do dimensionamento do pessoal de enfermagem de acordo com a gravidade do paciente em comparação com o indicador enfermeiro-paciente, para reduzir as infecções associadas à assistência à saúde em pacientes adultos internados em unidades de terapia intensiva. Metodologia: Revisão sistemática com base nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses, realizada entre setembro de 2021 e março de 2022, mediante os bancos de dados PubMed, ScienceDirect, Epistemonikos e CUIDEN, e usando os seguintes termos: pessoal de enfermagem, gravidade do paciente, relação enfermeiro-paciente, infecções associadas à assistência à saúde, operadores AND, OR, WITH. A amostra consistiu em 8 estudos, avaliados usando os programas Critical Reading Card e classificados de acordo com o Instituto Nacional de Excelência em Saúde e Cuidados. Resultados: O dimensionamento de profissionais de acordo com a gravidade do paciente, em comparação com o indicador enfermeiro-paciente, reduziu as infecções associadas à assistência à saúde, mortalidade, ocorrência de sepse e erros de medicação. O impacto sobre os pacientes e o pessoal de enfermagem mostrou uma melhor qualidade de atendimento, redução do esgotamento e do estresse no trabalho, o que beneficiou o paciente. Conclusão: É importante fornecer pessoal de enfermagem de acordo com a gravidade do paciente e com pessoal com nível acadêmico de, no mínimo, bacharelado, a fim de melhorar a qualidade do atendimento e reduzir as infecções associadas à assistência à saúde.

Resumen Introducción: Dotar al personal de enfermería en la terapia intensiva adultos ha sido en proporción dos pacientes por enfermera o 1:1. Actualmente, los pacientes que ingresan requieren cuidados complejos y especializados que proporcionen seguridad y disminución de infecciones asociadas a la atención en salud. Objetivo: Evidenciar la importancia de dotar al personal de enfermería según gravedad del paciente comparado con indicador enfermera-paciente para disminuir infecciones asociadas a la atención en salud en pacientes de la unidad de terapia intensiva adultos. Metodología: Revisión sistemática, basada en la declaración Preferred Reporting Items for Sistematyc Reviews and Meta-analyses, realizada en septiembre 2021 a marzo 2022, se utilizaron las bases de datos PubMed, ScienceDirect, Epistemonikos y CUIDEN, empleando términos: personal de enfermería, gravedad del paciente, relación enfermero-paciente, infecciones asociadas a la atención a la salud, operadores boléanos AND, OR, WITH. La muestra fue de 8 estudios, evaluados mediante los programas de Fichas de Lectura Crítica y gradados según el National Institute for Health and Care Excellence. Resultados: Dotar de personal según gravedad del paciente comparado con indicador enfermera-paciente disminuyó infecciones asociadas a la atención en salud, mortalidad, aparición de sepsis y errores en la medicación. Las repercusiones en pacientes y personal de enfermería mostraron mejor calidad de la atención, disminución de agotamiento y estrés laboral lo que benefició al paciente. Conclusión: Es importante dotar al personal de enfermería según gravedad del paciente, con personal de nivel académico licenciatura para mejorar la calidad de atención y disminuir las infecciones asociadas a la atención en salud.

Abstract Background: Urinary tract infections (UTIs) are the second most common cause of graft dysfunction, accounting for significant morbidity, and are associated with poor graft and patient survival. This study aimed to assess the association between post-renal transplant UTI and graft outcomes. Methods: We examined the effect of UTIs on graft outcomes in patients who underwent renal transplantation surgery between January 2010 and December 2022. The study population included 349 renal transplantations, of which 74 experienced 140 UTI events. Based on the number of UTI episodes, patients were categorized into three groups. Results: Of the 349 recipients, 275 (74.4%) had no UTI, 47 (18.8%) had non-recurrent UTIs (NR-UTIs), and 27 (6.8%) had recurrent UTIs (R-UTIs). Kaplan-Meier survival analysis showed that post-KT UTI status was a significant factor in graft survival, death-censored graft survival, and patient survival after a follow up of 5 years (log rank, P < 0.001). R-UTIs were associated with very poor graft survival and patient survival when compared with no UTI after a follow up of 5 years (hazard ratio [HR], 1.506; 95% confidence interval [CI], 1.233–1.840; P < 0.001 & HR, 1.529; 95% CI, 1.227–1.905; P = 0.001). R-UTIs were more likely to be associated with multi-drug resistant Gram-negative organisms (Klebsiella pneumonia or Escherichia coli) with resistance to nitrofurantoin (RR, 2.753; 95% CI, 1.257–6.032; P = 0.01) and carbapenem (RR, 2.064; 95% CI, 0.988–4.314; P = 0.05). Conclusion: Compared to no UTI, R-UTIs were associated to worse graft and patient outcomes after a follow-up of 5 years, whereas NR-UTIs were associated with poor graft and patient outcomes in the long term. Background (UTIs dysfunction morbidity postrenal post Methods 201 2022 34 transplantations 7 14 events episodes groups Results recipients 74.4% 744 4 (74.4% 18.8% 188 18 8 (18.8% nonrecurrent non NRUTIs, NRUTIs NR , (NR-UTIs) 2 6.8% 68 6 (6.8% RUTIs. RUTIs R . (R-UTIs) KaplanMeier Kaplan Meier postKT KT deathcensored death censored log rank 0.001. 0001 0 001 0.001) hazard HR [HR] 1.506 1506 1 506 95 CI [CI] 1.233–1.840 12331840 233 840 0.00 1.529 1529 529 1.227–1.905 12271905 227 905 multidrug multi drug Gramnegative Gram negative Klebsiella coli RR, RR (RR 2.753 2753 753 1.257–6.032 12576032 257 032 0.01 01 2.064 2064 064 0.988–4.314 09884314 988 314 0.05. 005 0.05 05 0.05) Conclusion followup term 20 202 3 74.4 (74.4 18.8 (18.8 (NR-UTIs 6.8 (6.8 (R-UTIs 000 00 [HR 1.50 150 50 9 [CI 1.233–1.84 1233184 23 84 0.0 1.52 152 52 1.227–1.90 1227190 22 90 2.75 75 1.257–6.03 1257603 25 03 2.06 206 06 0.988–4.31 0988431 98 31 74. (74. 18. (18. 6. (6. 1.5 15 1.233–1.8 123318 0. 1.227–1.9 122719 2.7 1.257–6.0 125760 2.0 0.988–4.3 098843 (74 (18 (6 1. 1.233–1. 12331 1.227–1. 12271 2. 1.257–6. 12576 0.988–4. 09884 (7 (1 ( 1.233–1 1233 1.227–1 1227 1.257–6 1257 0.988–4 0988 1.233– 123 1.227– 122 1.257– 125 0.988– 098 1.233 12 1.227 1.257 0.988 09 1.23 1.22 1.25 0.98 1.2 0.9

Resumo Histórico: Infecções do trato urinário (ITU) são a segunda causa mais comum de disfunção do enxerto, responsáveis por morbidade significativa, sendo associadas à baixa sobrevida do enxerto e paciente. O objetivo deste estudo foi avaliar associação entre ITU pós-transplante renal e desfechos do enxerto. Métodos: Examinamos o efeito das ITU nos desfechos do enxerto em pacientes submetidos ao transplante renal entre janeiro/2010 e dezembro/2022. A população do estudo incluiu 349 transplantes renais, dos quais 74 apresentaram 140 eventos de ITU. Baseado no número de episódios de ITU, categorizamos os pacientes em três grupos. Resultados: Dos 349 receptores, 275 (74,4%) não apresentaram ITU, 47 (18,8%) apresentaram ITU não recorrentes (ITU-NR) e 27 (6,8%) apresentaram ITU recorrentes (ITU-R). O método de Kaplan-Meier mostrou que o status da ITU pós-TR foi um fator significativo na sobrevida do enxerto, sobrevida do enxerto censurada para óbito e sobrevida do paciente após acompanhamento de 5 anos (log rank, P < 0,001). ITU-R foram associadas à sobrevida muito baixa do enxerto e sobrevida do paciente comparadas com nenhuma ITU após acompanhamento de 5 anos (razão de risco [RR], 1,506; IC 95%, 1,233–1,840; P < 0,001 & RR, 1,529; IC 95%, 1,227–1,905; P = 0,001). ITU-R apresentaram maior probabilidade de serem associadas a organismos Gram-negativos multirresistentes (Klebsiella pneumonia ou Escherichia coli) resistentes à nitrofurantoína (RR, 2,753; IC 95%, 1,257–6,032; P = 0,01) e carbapenem (RR, 2,064; IC 95%, 0,988–4,314; P = 0,05). Conclusão: Em comparação com ausência de ITU, ITU-R foram associadas a piores desfechos do enxerto e paciente após acompanhamento de 5 anos, enquanto ITU-NR foram associadas a piores desfechos do enxerto e paciente em longo prazo. Histórico (ITU significativa póstransplante pós Métodos janeiro2010 janeiro 2010 janeiro/201 dezembro2022 dezembro 2022 dezembro/2022 34 renais 7 14 grupos Resultados receptores 74,4% 744 4 (74,4% 18,8% 188 18 8 (18,8% ITUNR NR (ITU-NR 2 6,8% 68 6 (6,8% ITUR. ITUR R . (ITU-R) KaplanMeier Kaplan Meier pósTR TR log rank 0,001. 0001 0 001 0,001) razão RR , [RR] 1,506 1506 1 506 95 95% 1,233–1,840 12331840 233 840 0,00 1,529 1529 529 1,227–1,905 12271905 227 905 Gramnegativos Gram negativos Klebsiella coli (RR 2,753 2753 753 1,257–6,032 12576032 257 032 0,01 01 2,064 2064 064 0,988–4,314 09884314 988 314 0,05. 005 0,05 05 0,05) Conclusão prazo janeiro201 201 janeiro/20 dezembro202 202 dezembro/202 3 74,4 (74,4 18,8 (18,8 6,8 (6,8 (ITU-R 000 00 [RR 1,50 150 50 9 1,233–1,84 1233184 23 84 0,0 1,52 152 52 1,227–1,90 1227190 22 90 2,75 75 1,257–6,03 1257603 25 03 2,06 206 06 0,988–4,31 0988431 98 31 janeiro20 20 janeiro/2 dezembro20 dezembro/20 74, (74, 18, (18, 6, (6, 1,5 15 1,233–1,8 123318 0, 1,227–1,9 122719 2,7 1,257–6,0 125760 2,0 0,988–4,3 098843 janeiro2 janeiro/ dezembro2 dezembro/2 (74 (18 (6 1, 1,233–1, 12331 1,227–1, 12271 2, 1,257–6, 12576 0,988–4, 09884 dezembro/ (7 (1 ( 1,233–1 1233 1,227–1 1227 1,257–6 1257 0,988–4 0988 1,233– 123 1,227– 122 1,257– 125 0,988– 098 1,233 12 1,227 1,257 0,988 09 1,23 1,22 1,25 0,98 1,2 0,9

Abstract Background: In institutionalized elderly people, urinary tract infections are the most common, involving 12% to 30% of this population, with at least one episode per year, where several risk factors influence their occurrence. Objective: To determine the prevalence of urinary tract infections in older people institutionalized in a private institution of social solidarity and to identify the risk factors. Methodology: This is a cross-sectional, observational, and epidemiological study conducted on a convenience sample of people who are institutionalized in a private institution of social solidarity and belong to three different services. Data was collected over 8 months, and the number of patients in the different services was recorded (n = 171). Results: The institution had a urinary tract infection prevalence of 18.1%. Although more cases occurred in women (p = 0.641) and people older than 75 years (p = 0.269), there were no significant differences. Location of hospitalization was identified as a risk factor for developing a urinary tract infection (p = 0.024). Conclusion: Out of the 171 people who were institutionalized, 31 developed a urinary tract infection. It is important to adopt educational and preventive measures.

Resumo Enquadramento: Nas pessoas idosas institucionalizadas, a infeção urinária é a mais comum, envolvendo 12% a 30% desta população, com pelo menos um episódio por ano, onde diversos fatores de risco influenciam a sua ocorrência. Objetivo: Determinar a prevalência das infeções urinárias em pessoas institucionalizadas numa instituição particular de solidariedade social e identificar os fatores de risco. Metodologia: Estudo epidemiológico observacional transversal. Os participantes são pessoas institucionalizadas numa instituição particular de solidariedade social e que pertencem a três valências diferentes. Amostra por conveniência. A colheita de dados realizou-se durante 8 meses, com registo do número total de utentes das várias valências (n = 171). Resultados: A prevalência de infeção urinária na instituição foi de 18,1%. Ocorreram mais casos em mulheres (p = 0,641) e em pessoas com idade superior a 75 anos (p = 0,269), mas sem diferenças significativas. O local de internamento demonstrou ter influência no risco de desenvolvimento de infeção urinária (p = 0,024). Conclusão: Das 171 pessoas internadas, 31 desenvolveram infeção urinária. São necessárias atitudes educativas e preventivas.

Resumen Marco contextual: En los ancianos institucionalizados, las infecciones del tracto urinario son las más comunes, afectando del 12% al 30% de esta población, con al menos un episodio por año, donde varios factores de riesgo influyen en su aparición. Objetivo: Determinar la prevalencia de infecciones urinarias en personas institucionalizadas en una institución privada de solidaridad social e identificar los factores de riesgo. Metodología: Estudio epidemiológico observacional transversal. Los participantes fueron personas institucionalizadas en una institución privada de solidaridad social y pertenecientes a tres servicios diferentes. Muestra de conveniencia. Los datos se recogieron durante un período de 8 meses y se registró el número total de usuarios de los distintos centros (n = 171). Resultados: La prevalencia de infección urinaria en la institución fue del 18,1%. Hubo más casos en mujeres (p = 0,641) y en mayores de 75 años (p = 0,269), pero sin diferencias significativas. Se demostró que el lugar de hospitalización influía en el riesgo de desarrollar infección urinaria (p = 0,024). Conclusión: De las 171 personas hospitalizadas, 31 desarrollaron infección urinaria. Se necesitan actitudes educativas y preventivas.

Abstract Background: Healthcare-associated infections are a prevalent issue in health systems that affect everyone. The incidence and prevalence of healthcare-associated infections depend on the context in which they occur. An example of this is ventilator-associated pneumonia in intensive care units. Objective: To analyze the determinants of ventilator-associated pneumonia in an intensive care unit of a central hospital in northern Portugal. Methodology: A retrospective, descriptive-correlational quantitative study was conducted with 705 patients admitted to the ICU of the hospital under investigation. Results: The results show that male gender, previous antibiotic use, endotracheal reintubation, level of consciousness, cuff pressure, ventilation time, injury, poisoning, and certain other consequences of external causes as admitting diagnosis are among the determinants of ventilator-associated pneumonia. Moreover, the incidence of ventilator-associated pneumonia was of 4.5%. Conclusion: The study recommends the judicious use of antibiotics, limiting the duration of invasive ventilation, implementing ventilator weaning protocols, and auditing compliance with the care bundle for ventilator-associated pneumonia. This study sheds light on the prevention of ventilator-associated pneumonia and its recommendations contribute to better care and more effective and safer nursing interventions.

Resumo Enquadramento: As infeções associadas aos cuidados de saúde (IACS) são uma problemática atual dos sistemas de saúde variando a sua incidência, prevalência do contexto de cuidados. A pneumonia associada à ventilação (PAV) é disso um exemplo ocorrendo em unidades de cuidados intensivos (UCI). Objetivo: Analisar determinantes da PAV, em doentes internados numa UCI de um hospital central do norte de Portugal. Metodologia: Estudo descritivo-correlacional e retrospetivo, com base nos registos de 705 doentes internados na UCI. Resultados: Constituíram-se determinantes da PAV o sexo masculino, tratamento prévio com antibiótico, reintubação endotraqueal, nível de consciência, pressão de cuff, tempo de ventilação, diagnóstico de entrada lesões, envenenamento e algumas outras consequências de causas externas. A incidência de PAV foi de 4,5%. Conclusão: O uso criterioso de antibióticos, o menor tempo possível de ventilação invasiva, a implementação de protocolos de desmame ventilatório e auditorias ao cumprimento da bundle da PAV podem contribuir para melhores cuidados e intervenções de enfermagem mais eficazes e seguras.

Resumen Marco contextual: Las infecciones asociadas a los cuidados sanitarios (IACS) son un problema actual en los sistemas sanitarios, y su incidencia y prevalencia varían en función del entorno asistencial. Un ejemplo de ello es la neumonía asociada a la ventilación mecánica (PAV), que se da en las unidades de cuidados intensivos (UCI). Objetivo: Analizar los determinantes de la PAV en pacientes ingresados en la UCI de un hospital central del norte de Portugal. Metodología: Estudio descriptivo-correlacional y retrospectivo, basado en los registros de 705 pacientes ingresados en la UCI. Resultados: Los factores determinantes de la PAV fueron el sexo masculino, el tratamiento antibiótico previo, la reintubación endotraqueal, el nivel de consciencia, la presión del manguito, el tiempo de ventilación, el diagnóstico de entrada de lesiones, la intoxicación y algunas otras consecuencias de causas externas. La incidencia de PAV fue del 4,5%. Conclusión: El uso prudente de antibióticos, el menor tiempo posible de ventilación invasiva, la aplicación de protocolos de destete del ventilador y las auditorías de cumplimiento del paquete de PAV pueden contribuir a mejorar los cuidados y a que las intervenciones de enfermería sean más eficaces y seguras.

Abstract Shrimp aquaculture has rapidly expanded in the last decades, representing an important economic activity worldwide; however, infections (bacterial and viral) are one of the biggest challenges in aquaculture activity. Acute Hepatopancreatic Necrosis Disease (AHPND) is a bacterial disease that affects shrimp farm ponds and occurs during the first 30 days after stocking in shrimp ponds, causing mortalities of up to 70 - 100 %. Microbiota has an important role in shrimp aquaculture and disease control. In the present study, pirA and pirB genes were amplified by PCR to confirm AHPND and non-AHPND in shrimp hepatopancreas; samples were sequenced using the MiSeq platform targeting the V3-V4 16S ribosomal (rRNA) hypervariable regions. Results demonstrated a diverse microbiota in the non-AHPND group, mainly composed of phyla Proteobacteria, Firmicutes, and Actinobacteria. Furthermore, Proteobacteria was the dominant phyla in the hepatopancreas infected with AHPND, while Firmicutes tended to decrease. Vibrio was the most abundant at the genus level, prevailing in some genera like Corynebacterium, Weissella, Lactobacillus, Photobacterium, and Geobacillus. Results suggest that AHPND causes dysbiosis in the hepatopancreatic microbiota, and the Firmicutes phylum could require to be restored under such scenario.

Resumen La producción acuícola de camarón se ha expandido rápidamente en las últimas décadas, convirtiéndose en una importante actividad económica a nivel mundial. Sin embargo, algunas infecciones bacterianas y virales son un gran desafío para esta actividad. La Necrosis Hepatopancreática Aguda (AHPND) es una enfermedad bacteriana que afecta a los estanques de granjas camaroneras y se presenta durante los primeros 30 días después de la siembra en estanques de camarones, causando una mortalidad del 70 - 100 %. La microbiota tiene un papel importante en la producción del camarón y el control de enfermedades. En el presente estudio, los genes pirA y pirB fueron amplificados por PCR para confirmar tanto organismos positivos como negativos a AHPND en hepatopáncreas de camarones. Posteriormente se secuenciaron las regiones hipervariables ribosómicas (ARNr) V3-V4 del gen 16S utilizando la plataforma MiSeq. Los resultados demostraron una microbiota diversa en el grupo negativo a AHPND, compuesto principalmente por filos Proteobacteria, Firmicutes y Actinobacteria. Además, Proteobacteria fue el filo dominante en el hepatopáncreas infectado con AHPND, mientras que Firmicutes tendió a disminuir. Vibrio fue el género más abundante, prevaleciendo sobre algunos géneros como Corynebacterium, Weissella, Lactobacillus, Photobacterium y Geobacillus. Los resultados sugieren que la enfermedad de AHPND causa disbiosis en la microbiota hepatopancreática, y el filo Firmicutes podría requerir ser restaurado en dicho escenario.

BACKGROUND. While a large number of cases in an HIV setting may be attributed to infections, there has also been a rise in HIV-associated malignancies such as Kaposi sarcoma and aggressive B-cell lymphoma. Good clinical outcomes have been attributed to timely clinicopathological diagnosis of these malignancies. OBJECTIVE. To describe the clinicopathological features of cases with acute abdomen secondary to AIDS-defining malignancy in the gatrointestinal tract. METHOD. This is a retrospective analysis of all cases presenting with acute abdomen and histologically diagnosed AIDS-defining malignancies of the gastrointestinal tract over a period of 8 years in our centre. Clinicopathological characteristics were retrieved from the laboratory information system. Archived haematoxylin and eosin-stained sections and immunohistochemical stains were reappraised. RESULTS. A total of 13 cases, which consisted of 5 males and 8 females, with an average age of 35 years formed the study sample. All the patients were HIV-positive on antiretroviral therapy, and presented with acute abdomen. Intraoperatively, there were five intussusceptions, three strictures, three perforated tumours and two luminal occlusions. Histopathology confirmed five cases of Kaposi sarcoma and eight cases of high-grade B-cell lymphomas. Two patients with high-grade B-cell lymphomas died after surgical intervention. CONCLUSION. Expedited histopathological assessment of bowel resection in HIV-infected patients could improve clinical outcomes with early treatment.

Respiratory syncytial virus (RSV) is the commonest cause of lower respiratory tract infection (LRTI) in children, particularly those aged <1 year. In South Africa (SA), increased hospitalisation rates during the RSV season, including access to intensive care facilities, place a huge burden on the healthcare system. Furthermore, RSV-LRTI during early childhood may lead to long-term respiratory sequelae, including recurrent wheezing, asthma, and impairment of lung function. Recently, two new RSV prevention strategies have emerged: nirsevimab, a long-acting monoclonal antibody, and a maternal RSV vaccine. Both strategies have shown high efficacy in reducing RSV-LRTI hospitalisation in infants and are being considered for licensure in SA. Implementation of these prevention strategies, combined with public engagement and collaboration between stakeholders, could significantly reduce RSV-related morbidity and mortality in SA.

Antibiotic resistance is a global threat, with a disproportionate burden of mortality in low- and middle-income countries. It is increasing in both the public and private healthcare sectors within South Africa, especially in Gram-negative organisms, and is associated with increased use of World Health Organization watch and reserve antibiotics. There is a need for improved access to new antibiotics to treat infections caused by drug-resistant organisms in order to limit side-effects and improve patient outcomes of currently available antibiotics. We propose the responsible introduction of these new antibiotics with both administrative and clinical oversight in order to preserve the longevity of these precious antibiotics.

Abstract Hailey-Hailey disease is a rare genodermatosis described in 1939, with an autosomal dominant inheritance pattern, characterized by compromised adhesion between epidermal keratinocytes. It has an estimated prevalence of 1/50,000, with no gender or race predilection. It results from a heterozygous mutation in the ATP2C1 gene, which encodes the transmembrane protein hSPA1C, present in all tissues, with preferential expression in keratinocytes. Mutations in the ATP2C1 gene cause changes in the synthesis of junctional proteins, leading to acantholysis. It usually begins in adulthood, with isolated cases at the extremes of life. It manifests as vesico-bullous lesions mainly in the flexural areas, which develop into erosions and crusts. Chronic lesions may form vegetative or verrucous plaques. Pruritus, a burning feeling and pain are common. It evolves with periods of remission and exacerbation, generally triggered by humidity, friction, heat, trauma and secondary infections. The diagnosis is based on clinical and histopathological criteria: marked suprabasal acantholysis, loosely joined keratinocytes, giving the appearance of a “dilapidated brick wall”, with a few dyskeratotic cells. The acantholysis affects the epidermis and spares the adnexal epithelia, which helps in the differential diagnosis with pemphigus vulgaris. Direct immunofluorescence is negative. The main differential diagnoses are Darier disease, pemphigus vegetans, intertrigo, contact dermatitis, and inverse psoriasis. There is no cure and the treatment is challenging, including measures to control heat, sweat and friction, topical medications (corticosteroids, calcineurin inhibitors, antibiotics), systemic medications (antibiotics, corticosteroids, immunosuppressants, retinoids and immunobiologicals) and procedures such as botulinum toxin, laser and surgery. There is a lack of controlled clinical trials to support the choice of the best treatment. HaileyHailey Hailey 1939 pattern keratinocytes 150000 1 50 000 1/50,000 predilection ATPC ATP C ATP2C hSPA1C hSPAC hSPA tissues proteins adulthood life vesicobullous vesico bullous areas crusts plaques Pruritus common exacerbation humidity friction heat infections criteria dilapidated wall, wall , wall” cells epithelia vulgaris negative vegetans intertrigo dermatitis psoriasis challenging corticosteroids (corticosteroids inhibitors antibiotics, antibiotics antibiotics) (antibiotics immunosuppressants immunobiologicals toxin surgery 193 15000 5 00 1/50,00 19 1500 0 1/50,0 150 1/50, 15 1/50 1/5 1/