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ABSTRACT Background: Cases of coronavirus disease 2019 (COVID-19) requiring hospitalization continue to appear in vulnerable populations, highlighting the importance of novel treatments. The hyperinflammatory response underlies the severity of the disease, and targeting this pathway may be useful. Herein, we tested whether immunomodulation focusing on interleukin (IL)-6, IL-17, and IL-2, could improve the clinical outcomes of patients admitted with COVID-19. Methods: This multicenter, open-label, prospective, randomized controlled trial was conducted in Brazil. Sixty hospitalized patients with moderate-to-critical COVID-19 received in addition to standard of care (SOC): IL-17 inhibitor (ixekizumab 80 mg SC/week) 1 dose every 4 weeks; low-dose IL-2 (1.5 million IU per day) for 7 days or until discharge; or indirect IL-6 inhibitor (colchicine) orally (0.5 mg) every 8 hours for 3 days, followed by 4 weeks at 0.5 mg 2x/day; or SOC alone. The primary outcome was accessed in the “per protocol” population as the proportion of patients with clinical improvement, defined as a decrease greater or equal to two points on the World Health Organization’s (WHO) seven-category ordinal scale by day 28. Results: All treatments were safe, and the efficacy outcomes did not differ significantly from those of SOC. Interestingly, in the colchicine group, all participants had an improvement of greater or equal to two points on the WHO seven-category ordinal scale and no deaths or patient deterioration were observed. Conclusions: Ixekizumab, colchicine, and IL-2 were demonstrated to be safe but ineffective for COVID-19 treatment. These results must be interpreted cautiously because of the limited sample size.

https://doi.org/10.1590/0037-8682-0565-2022

[SciELO Preprints] - COVID-19 in Long Term Care Institutions for the Older People: an epidemiological survey: COVID-19 in Institutions for the Older People
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Lima, Nereida Viana, Jaciara Bellissimo-Rodrigues, Fernando Moriguti, Julio Ferriolli, Eduardo Santos, Jair

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Publication date: 2021-04-05

Abstract: En Es Pt

Objective: To map the occurrence of SARS-CoV-2 infection in Long-Term Care Institutions for the Elderly (LTCI) in the city of Ribeirão Preto, SP, including the elderly and employees, identifying associated factors, aiming at the timely adoption of preventive measures. Methodology: Epidemiological survey carried out in a medium-sized city to identify SARS-CoV-2 infection in residents and employees, identifying associated factors. There was stratified sampling, with demographic and health data, current or recent symptoms common to the infection being collected, in addition to assessing basic activities of daily living (BADL) and the cognition with application of the Mini Mental State Examination (MMSE). A serological test was carried out on all those selected. Results: The elderly in the sample were 80.2 ± 9.7 years old and employees 37.4 ± 12.2 years old. The serological test positivity was 13.3% among the elderly and 25.9% among employees. Elderly people presented 2.9 ± 1.5 chronic diseases, with the use of 5.7 ± 2.8 medications, only 11.1% with negative dementia screening and 20% independent. Staff had SARS-CoV-2 detected previously in only 6.9%, with 30% without influenza vaccination and without systematic symptom checking. Conclusions: Strict rules of behavior should be instituted, as every employee is potentially a transmitter of the disease and, therefore, must be screened for symptoms before each workday. There was a high prevalence of cognitive changes that can make it difficult to comply with individual protection measures within the LTCIs.

Objetivo: Mapear la ocurrencia de la infección por SARS-CoV-2 en Instituciones de Atención de Larga Duración para Ancianos (IALD) de la ciudad de Ribeirão Preto, SP, incluyendo ancianos y empleados, identificando factores asociados, con miras a la adopción oportuna de medidas preventivas. Metodología: Encuesta epidemiológica realizada en una ciudad de tamaño mediano para identificar la infección por SARS-CoV-2 en residentes y empleados, identificando factores asociados. Se realizó un muestreo estratificado, recogiéndose datos demográficos y de salud, síntomas actuales o recientes comunes a la infección, además de evaluar las actividades básicas de la vida diaria (ABVD) y cognición con la aplicación del Mini Examen del Estado Mental (MEEM). Fue realizado prueba serológica en todos los seleccionados. Resultados: Los ancianos de la muestra tenían 80,2 ± 9,7 años y los empleados 37,4 ± 12,2 años. La positividad de la prueba serológica fue del 13,3% entre los ancianos y del 25,9% entre los empleados. Los ancianos presentaron 2,9 ± 1,5 enfermedades crónicas, con el uso de 5,7 ± 2,8 medicamentos, solo el 11,1% con cribado de demencia negativo y 20% independiente. El personal había detectado el SARS-CoV-2 anteriormente sólo el 6,9%, con un 30% sin vacunación contra la influenza y sin un control sistemático de los síntomas. Conclusiones: Deben instituirse reglas estrictas de comportamiento, ya que cada empleado es potencialmente un transmisor de la enfermedad y, por lo tanto, debe ser examinado para detectar síntomas antes de cada jornada laboral. Hubo una alta prevalencia de cambios cognitivos que pueden dificultar el cumplimiento de las medidas de protección individual dentro de las IALD.

Objetivo: Mapear a ocorrência da infecção por SARS-CoV-2 nas Instituições de Longa Permanência para Idosos (ILPIs) da cidade de Ribeirão Preto, SP, incluindo idosos e funcionários, identificando fatores associados, visando adoção oportuna de medidas preventivas.Metodologia: Inquérito epidemiológico realizado em cidade de médio porte para identificar a infecção por SARS-CoV-2 em residentes e funcionários, identificando fatores associados. Houve amostragem estratificada, sendo coletados dados demográficos, de saúde, sintomas atuais ou recentes comuns à infecção, além de avaliadas as atividades básicas de vida diárias (ABVD) e a cognição com aplicação do Mini Exame do Estado Mental (MEEM). Foi realizado teste sorológico em todos os sorteados.Resultados: Os idosos da amostragem tinham 80,2±9,7 anos e funcionários 37,4 ±12,2 anos. A positividade no teste sorológico foi de 13,3% entre idosos e 25,9% em funcionários. Idosos apresentavam 2,9±1,5 doenças crônicas, com uso de 5,7±2,8 medicamentos, somente 11,1% com rastreio para demência negativo e 20% independentes. Os funcionários tinham SARS-CoV-2 detectada previamente em apenas 6,9%, com 30% sem vacinação contra influenza e sem checagem sistemática de sintomas.Conclusões: Regras rígidas de comportamento devem ser instituídas, pois todo funcionário é potencialmente um transmissor da doença e, por isso, devem ser rastreados quanto a sintomas antes de cada dia de trabalho. Houve elevada prevalência de alterações cognitivas que podem dificultar o cumprimento das medidas de proteção individual dentro das ILPIs.

https://doi.org/10.1590/SciELOPreprints.2065

Feasibility of very short-term forecast models for COVID-19 hospital-based surveillance
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Martinez, Edson Zangiacomi

; Passos, Afonso Dinis Costa

; Cinto, Antônio Fernando

; Escarso, Andreia Cássia

; Monteiro, Rosane Aparecida

; Silva, Jorgete Maria e

; Bellissimo-Rodrigues, Fernando

; Aragon, Davi Casale

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e07622020

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: We evaluated the performance of Bayesian vector autoregressive (BVAR) and Holt’s models to forecast the weekly COVID-19 reported cases in six units of a large hospital. METHODS: Cases reported from epidemiologic weeks (EW) 12-37 were selected as the training period, and from EW 38-41 as the test period. RESULTS: The models performed well in forecasting cases within one or two weeks following the end of the time-series, but forecasts for a more distant period were inaccurate. CONCLUSIONS: Both models offered reasonable performance in very short-term forecasts for confirmed cases of COVID-19.

https://doi.org/10.1590/0037-8682-0762-2020 334 downloads

Prevalence of virological and serological markers of SARS-CoV-2 infection in the population of Ribeirão Preto, Southeast Brazil: an epidemiological survey
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Martinez, Edson Zangiacomi

; Passos, Afonso Dinis Costa

; Fabbro, Amaury Lelis Dal

; Silva, Anderson Soares da

; Escarso, Andreia Cássia

; Pazin-Filho, Antônio

; Fonseca, Benedito Antônio Lopes da

; Maciel, Benedito Carlos

; Araújo, Daniel Cardoso de Almeida e

; Clé, Diego Villa

; Gaspar, Gilberto Gambero

; Santos, Jair Lício Ferreira dos

; Ferreira, Janise Braga Barros

; Souza, João Paulo

; Mello, Luane Marques de

; Santos, Luciane Loures dos

; Passos, Luzia Márcia Romanholi

; Siconelli, Márcio Junio Lima

; Cavalli, Ricardo de Carvalho

; Santana, Rodrigo de Carvalho

; Calado, Rodrigo do Tocantins

; Scarpelini, Sandro

; Bollela, Valdes Roberto

; Floriano, Vitor Gonçalves

; Bellissimo-Rodrigues, Fernando

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0210-2021

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.

https://doi.org/10.1590/0037-8682-0210-2021 117 downloads

Maternal Mortality: An Eco-Social Phenomenon that Calls for Systemic Action
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Souza, João Paulo

; Bellissimo-Rodrigues, Fernando

; Santos, Luciane Loures dos

Revista Brasileira de Ginecologia e Obstetrícia

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apr 2020, Volume 42 N. 4 Pages 169 - 173

Abstract: En | Text: En | PDF: En

https://doi.org/10.1055/s-0040-1710041 523 downloads

Surgical antibiotic prophylaxis: is the clinical practice based on evidence?
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Pereira, Lucas Borges

; Feliciano, Cinara Silva

; Siqueira, Diego Silva

; Bellissimo-Rodrigues, Fernando

; Pereira, Leonardo Régis Leira

einstein (São Paulo)

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2020, Volume 18 elocation eAO5427

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar a utilização de antibioticoprofilaxia cirúrgica. Métodos: Foi realizado um estudo descritivo em um hospital universitário de cuidado terciário por meio de coleta de dados de prescrição, sociodemográficos e de hospitalização sobre todos os pacientes internados em 2014 que utilizaram pelo menos um medicamento antimicrobiano. Esses dados foram coletados da base de dados eletrônica do hospital. O consumo de antimicrobianos foi analisado de acordo com a classificação anatômica terapêutica e química/dose diária definida por mil pacientes-dia. Realizou-se uma análise exploratória por meio da análise de componentes principais. Resultados: Um total de 5.182 pacientes internados receberam prescrição de antibioticoprofilaxia cirúrgica, que corresponde a 11,7% do total de antibióticos utilizados no hospital. As unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular e terapia intensiva pós-operatória foram responsáveis pela utilização de mais da metade (56,3%) da antibioticoprofilaxia cirúrgica. A duração de uso desses antimicrobianos nessas unidades foi 2,2, 2,0 e 2,4 dias, respectivamente. Cefalosporinas de terceira geração e fluoroquinolonas foram as classes de antimicrobianos com tempo de utilização mais longo. Conclusão: A utilização de antibioticoprofilaxia cirúrgica foi inadequada nas unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular, terapia intensiva pós-operatória, ginecologia e obstetrícia e otorrinolarigonlogia. Portanto, são importantes o desenvolvimento e a implantação de estratégias que promovam o uso racional de antibioticoprofilaxia cirúrgica nos hospitais.

ABSTRACT Objective: To assess the surgical antibiotic prophylaxis. Methods: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis. Results: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes. Conclusion: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.

https://doi.org/10.31744/einstein_journal/2020ao5427 759 downloads

Are SARS-CoV-2 reinfection and Covid-19 recurrence possible? a case report from Brazil
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Bonifácio, Lívia Pimenta

; Pereira, Ana Paula Sulino

; Araújo, Daniel Cardoso de Almeida e

; Balbão, Viviane da Mata Pasti

; Fonseca, Benedito Antônio Lopes da

; Passos, Afonso Dinis Costa

; Bellissimo-Rodrigues, Fernando

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20200619

Abstract: En | Text: En | PDF: En

Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19.

https://doi.org/10.1590/0037-8682-0619-2020 5960 downloads

Secondary syphilis: a woman with flat condyloma
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Moscovici, Leonardo

; Lorenzato, Renata Zago

; Bellissimo-Rodrigues, Wanessa Teixeira

; Bellissimo-Rodrigues, Fernando

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volume 52 elocation e20180295

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0037-8682-0295-2018 2722 downloads

Prevalence and risk factors of toxoplasmosis among adults in a small Brazilian city
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Passos, Afonso Dinis Costa

; Bollela, Valdes Roberto

; Furtado, João Marcelo Fortes

; Lucena, Moisés Moura de

; Bellissimo-Rodrigues, Fernando

; Paula, Jayter Silva

; Melo, Laura Valdiane Luz

; Rodrigues, Maria de Lourdes Veronese

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2018, Volume 51 N. 6 Pages 781 - 787

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: The prevalence of Toxoplasma gondii infection varies markedly among different populations, especially depending on factors related to socioeconomic development and eating habits. Cássia dos Coqueiros is a small city in Brazil with rural characteristics and increased risk factors traditionally associated with T. gondii infection. METHODS: We carried out a cross-sectional study involving 970 inhabitants aged 18 years or more, selected from patients of the local health unit and home visits in urban and rural areas. Each participant completed a survey with questions regarding demographic, socioeconomic, and risk factors for toxoplasmosis. Blood samples from participants were tested for presence of IgG and IgM antibodies against T. gondii using a chemiluminescent microparticle immunoassay. RESULTS: The prevalence of IgG and IgM antibodies was 62.3% and 2.5%, respectively. Variables that proved to be independent predictors of infection were age, low levels of education, and previous diagnosis of toxoplasmosis. CONCLUSIONS: The high prevalence of toxoplasmosis serological markers in this adult population highlights the need to promote preventive practices, especially those directed toward women of childbearing age, in this part of Brazil.

https://doi.org/10.1590/0037-8682-0214-2017 1956 downloads

10.

Is community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) an emerging pathogen among children in Brazil?
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Paternina-de la Ossa, Rolando

; Prado, Seila Israel do

; Cervi, Maria Célia

; Lima, Denissani Aparecida Ferrari dos Santos

; Martinez, Roberto

; Bellissimo-Rodrigues, Fernando

Brazilian Journal of Infectious Diseases

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oct 2018, Volume 22 N. 5 Pages 371 - 376

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective: To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods: This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients’ medical records. Results: We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54–5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16–22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions: CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.

https://doi.org/10.1016/j.bjid.2018.10.276 1076 downloads

11.

CARGA DE TRABALHO DE ENFERMAGEM E A MORTALIDADE DOS PACIENTES EM UNIDADE DE TERAPIA INTENSIVA
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Nassiff, Aline

; Araújo, Thamiris Ricci de

; Menegueti, Mayra Gonçalves

; Bellissimo-Rodrigues, Fernando

; Basile-Filho, Anibal

; Laus, Ana Maria

Texto & Contexto - Enfermagem

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2018, Volume 27 N. 4 elocation e0390017

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

ABSTRACT Objective: to verify if the nursing workload is a predictor of mortality at an Intensive Care Unit. Method: cross-sectional and retrospective documentary study, developed at the Intensive Care Unit of a tertiary university hospital. The Receiver Operator Characteristic Curve was used, consisting of the Nursing Activities Score and the APACHE severity score, using logistic regression to analyze the prediction of mortality. Results: the sample included 324 patients, 214 (66%) of whom survived. The mean Nursing Activities Score during the first 24 hours of hospitalization was 79.3 points, ranging from 34.8 to 134.2 points, and the median APACHE II was 24.5 (2-42). In the analysis of the Receiver Operator Characteristic Curve, the Nursing Activities Score evidenced an area under the curve corresponding to 0.626; CI between 0.570 and 0.678 and an APACHE II score of 0.721, with a 95% confidence interval from 0.669 to 0.769. Conclusion: the nursing workload did not serve as a mortality predictor at the Intensive Care Unit, as the patients who demand the main nursing workload are not necessarily the patients who evolve to death.

RESUMEN Objetivo: verificar si la carga de trabajo de enfermería aferida por el Nursing Activity Score como predictor de mortalidad en Unidad de Terapia Intensiva. Método: estudio documental, retrospectivo, corte transversal, desarrollado en la Unidad de Terapia Intensiva de un hospital universitario terciario. Se utilizó la curva Receiver Operator Characteristic Curve compuesta por el Nursing Activity Score y índice de gravedad APACHE y regresión logística para análisis de la predicción de mortalidad. Resultados: compusieron la muestra 324 pacientes, siendo 214 (66%) sobrevivientes. El promedio Nursing Activities Score de las primeras 24 horas de internación fue de 79,3 puntos, variando de 34,8 a 134,2 puntos y el APACHE II mediano fue de 24,5 (2-42). En el análisis de la curva Receiver Operator Characteristic Curve o Nursing Activities Score evidenció un área sobre la curva de 0,626; IC 0,570 a 0,678 y el APACHE II de 0,721 con intervalo de confianza IC 95% de 0,669 a 0,769. Conclusión: la carga de trabajo de enfermería no fue un predictor de mortalidad en Unidad de Terapia Intensiva, pues los pacientes que demandan la mayor carga de trabajo de enfermería no necesariamente son aquellos que evolucionan a muerte

RESUMO Objetivo: verificar se a carga de trabalho de enfermagem é em preditor de mortalidade em Unidade de Terapia Intensiva. Método: estudo documental, retrospectivo, corte transversal, desenvolvido na Unidade de Terapia Intensiva de um hospital universitário terciário. Utilizou-se a curva Receiver Operator Characteristic Curve composta pelo Nursing Activities Score e índice de gravidade APACHE e regressão logística para análise da predição de mortalidade. Resultados: compuseram a amostra 324 pacientes, sendo 214 (66%) sobreviventes. A média Nursing Activities Score das primeiras 24 horas de internação foi de 79,3 pontos, variando de 34,8 a 134,2 pontos e o APACHE II mediano foi 24,5 (2-42). Na análise da curva Receiver Operator Characteristic Curve o Nursing Activities Score evidenciou uma área sobre a curva de 0,626; IC 0,570 a 0,678 e o APACHE II de 0,721 com intervalo de confiança IC 95% de 0,669 a 0,769. Conclusão: a carga de trabalho de enfermagem não foi um preditor de mortalidade em Unidade de Terapia Intensiva, pois os pacientes que demandam a maior carga de trabalho de enfermagem não necessariamente são aqueles que evoluem para óbito.

https://doi.org/10.1590/0104-07072018000390017 6 downloads

12.

CARGA DE TRABALHO DE ENFERMAGEM E A MORTALIDADE DOS PACIENTES EM UNIDADE DE TERAPIA INTENSIVA
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Nassiff, Aline

; Araújo, Thamiris Ricci de

; Menegueti, Mayra Gonçalves

; Bellissimo-Rodrigues, Fernando

; Basile-Filho, Anibal

; Laus, Ana Maria

Texto & Contexto - Enfermagem

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2018, Volume 27 N. 4 elocation e0390017

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0104-07072018000390017 3314 downloads

13.

Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects
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Menegueti, Mayra Gonçalves

; Betoni, Natália Cristina

; Bellissimo-Rodrigues, Fernando

; Romão, Elen Almeida

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2017, Volume 50 N. 6 Pages 783 - 787

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Bloodstream infections are the second most common cause of death among patients on hemodialysis. This study aimed to evaluate the incidence of and risk factors associated with central venous catheter-related infections in patients undergoing hemodialysis, and to identify and characterize the type and antimicrobial susceptibility profiles of the primary microorganisms isolated during one year of follow-up. METHODS: A prospective cohort study was conducted in 2014 in a hemodialysis referral center. We included 200 outpatients with acute kidney injury who had no permanent venous access. A nurse assessed the patients for signs of infection three times per week during dressing changes. The clinicopathologic characteristics of patients with and without local or systemic infection were compared. RESULTS: Fifty-five episodes of catheter-related infections occurred in 43 (22%) patients; 38 (69%) were bloodstream infections and 17 (31%) were local infections. Thirty-two (75%) patients with infection had femoral vein catheter placement. In total, 6,240 hemodialysis sessions were performed; the rates of primary bloodstream and local infection were 6.1 and 2.7 episodes per 1,000 patients on daily dialysis, respectively. In the univariate analysis, diabetes was significantly associated with the development of infection, while level of education, ethnicity, age, and sex were not. Gram-negative bacteria were primarily isolated from blood culture specimens (55% of samples). Of the Gram-negative isolates, 56% were resistant to the carbapenems. CONCLUSIONS: We identified a high incidence of catheter-related infections caused by resistant microorganisms in patients undergoing hemodialysis via central venous catheters.

https://doi.org/10.1590/0037-8682-0438-2017 2690 downloads

14.

Uma agenda de pesquisa para a Atenção Primária à Saúde no estado de São Paulo, Brasil: o estudo ELECT
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Orlandin, Eduardo Antônio de Sousa

; Moscovici, Leonardo

; Franzon, Ana Carolina Arruda

; Passos, Afonso Dinis Costa

; Fabbro, Amaury Lelis Dal

; Vieira, Elisabeth Meloni

; Bellissimo-Rodrigues, Fernando

; Gusso, Gustavo Diniz Ferreira

; Ferreira, Janise Braga Barros

; Marques, João Mazzoncini de Azevedo

; Ribeiro, Luciana Cisoto

; Santos, Luciane Loures dos

; Demarzo, Marcelo Marcos Piva

; Fontão, Paulo Celso Nogueira

; Souza, João Paulo

Interface - Comunicação, Saúde, Educação

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- SciELO Analytics

jun 2017, Volume 21 N. 61 Pages 349 - 361

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

A consolidação da Atenção Primária à Saúde (APS) requer políticas públicas embasadas por evidências científicas. Este artigo apresenta o estudo ELECT, cujo objetivo foi identificar temas prioritários de pesquisa para a fortalecimento da APS no estado de São Paulo, Brasil. Com a participação de especialistas e de um grupo focal com usuários, foi obtida uma lista com os vinte principais obstáculos, bem como dez temas de pesquisa prioritários, na APS. Os resultados apontam para problemas e temas de pesquisas relacionados à: organização da gestão, capacitação de profissionais e gestores, valorização profissional, criação de mecanismos de colaboração entre equipes de saúde e informatização dos recursos. Espera-se, assim, estimular o debate no contexto da APS sobre o papel da priorização de pesquisas, seus obstáculos e proposições de pesquisa. Almeja-se, também, estimular a adoção de modelos mais participativos de seleção de temas de pesquisa.

The consolidation of Primary Health Care (PHC) requires public policies based on scientific evidence. This paper presents the ELECT study, aimed to identify priority research themes for strengthening PHC in the state of Sao Paulo, Brazil. A list of the twenty main obstacles and ten priority research themes in PHC were obtained with participation of specialists and a focus group with users. The results point to problems and research issues related to organizational management, training of professionals and managers, professional development, creation of cooperation mechanisms between health teams and computerization of resources. It is expected to stimulate debate in the context of the PHC on the role of research prioritization, its obstacles and research propositions. It also aims to encourage the adoption of more participatory models of selection of research topics.

La solidificación de la Atención Primaria de Salud (APS) requiere políticas públicas con base en evidencias científicas. Este artículo presenta el estudio ELECT, cuyo objetivo fue identificar temas prioritarios de investigación para el fortalecimiento de la APS en el estado de São Paulo. Con la participación de especialistas y de un grupo de opinión formado por usuarios, se obtuvo una lista con los veinte principales obstáculos, así como diez temas de investigación prioritarios en la APS. Los resultados señalan problemas y temas de investigación relacionados a la organización de la gestión, la capacitación de profesionales y gestores, la valorización profesional, la creación de mecanismos de colaboración entre equipos de salud e informatización de los recursos. Se espera por lo tanto incentivar el debate en el contexto de la APS sobre el papel de la priorización de investigaciones, sus obstáculos y propuestas de investigación. Se anhela también incentivar la adopción de modelos más participativos de selección de temas de investigación.

https://doi.org/10.1590/1807-57622016.0103 434 downloads

15.

Uma agenda de pesquisa para a Atenção Primária à Saúde no estado de São Paulo, Brasil: o estudo ELECT
Facebook Twitter

Other social networks
Google+
LinkedIn
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- Dimensions
- PlumX
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Orlandin, Eduardo Antônio de Sousa

; Moscovici, Leonardo

; Franzon, Ana Carolina Arruda

; Passos, Afonso Dinis Costa

; Fabbro, Amaury Lelis Dal

; Vieira, Elisabeth Meloni

; Bellissimo-Rodrigues, Fernando

; Gusso, Gustavo Diniz Ferreira

; Ferreira, Janise Braga Barros

; Marques, João Mazzoncini de Azevedo

; Ribeiro, Luciana Cisoto

; Santos, Luciane Loures dos

; Demarzo, Marcelo Marcos Piva

; Fontão, Paulo Celso Nogueira

; Souza, João Paulo

Interface - Comunicação, Saúde, Educação

Journal Metrics
- Sobre o periódico
- SciELO Analytics

jun 2017, Volume 21 N. 61 Pages 349 - 361

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/1807-57622016.0103 2901 downloads

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