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au:Costa, Silvia Figueiredo

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Measles, mumps and rubella vaccine 12 months after hematopoietic stem cell transplantation
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Randi, Bruno Azevedo

; Fernandes, Eder Gatti

; Higashino, Hermes Ryoiti

; Lopes, Marta Heloisa

; Rocha, Vanderson Geraldo

; Costa, Silvia Figueiredo

; Sartori, Ana Marli Christovam

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e21

Abstract: En | Text: En | PDF: En

ABSTRACT The measles, mumps and rubella (MMR) vaccine is usually recommended from 24 months after a hematopoietic stem cell transplant (HSCT). Some authors have demonstrated that the MMR vaccination can be safe from 12 months post-HSCT in non-immunosuppressed patients, as recommended by the Brazilian National Immunization Program/Ministry of Health, since 2006. The objectives of this study were to evaluate when patients received MMR vaccine after an HSCT in our care service and if there were reports of any side effects. We retrospectively reviewed the records of HSCT recipients who received at least one MMR dose in our care service, a quaternary teaching hospital in Sao Paulo city, Brazil, from 2017 to 2021. We identified 82 patients: 75.6% (90.1% in the autologous group and 45.1% in the allogeneic group) were vaccinated before 23 months post-transplantation. None reported side effects following the vaccination. Our data support that the MMR vaccination is safe from 12 to 23 months after HSCT.

https://doi.org/10.1590/s1678-9946202365021

Streptococcus constellatus causing concomitant extra and intracranial abscesses complicated with sagittal sinus thrombosis
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Farias, Luís Arthur Brasil Gadelha

; Firmino, Natália Nogueira

; Sousa, Marcos Maciel

; Lira, Mateus Lavor

; Meireles, Leonardo Nogueira

; Stolp, Ângela Maria Veras

; Maia, Kelma Maria

; Costa, Silvia Figueiredo

; Perdigão Neto, Lauro Vieira

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e10

Abstract: En | Text: En | PDF: En

ABSTRACT Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more commonly in the gastrointestinal tract, lungs, and heart. Brain abscesses are severe neurological infections with high mortality rates. Streptococcus species other than S. pneumoniae are rare causes of brain abscesses. This case report highlights a severe case of extra and intracranial abscesses due to S. constellatus in an immunocompetent host

https://doi.org/10.1590/s1678-9946202365010

Multidisciplinary Scientific Cruises for Environmental Characterization in the Santos Basin – Methods and Sampling Design
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Moreira, Daniel L.

; Dalto, Adriana G.

; Figueiredo JR, Alberto G.

; Valerio, Aline M.

; Detoni, Amalia M. S.

; Bonecker, Ana C. T.

; Signori, Camila N.

; Namiki, Cláudia

; Sasaki, Dalton K.

; Pupo, Daniel V.

; Silva, Danilo A.

; Kutner, Deborah S.

; Duque-Castaño, Diana C.

; Marcon, Eduardo H.

; Gallotta, Fabiana D. C.

; Paula, Fabiana S.

; Gallucci, Fabiane

; Roque, Gabriela C. F.

; Campos, Giulia S.

; Fonseca, Gustavo

; Mattos, Gustavo

; Lavrado, Helena P.

; Silveira, Ilson C. A. da

; Costa, Jessica O.

; Santos Filho, João R. dos

; Carneiro, Juliane C.

; Moreira, Julio C.F.

; Rozo, Laura

; Araujo, Leandro F.M.

; Lazzari, Letícia

; Silva, Letícia O. da

; Michelazzo, Luan S.

; Fernandes, Luciano F.

; Dottori, Marcelo

; Araújo Jr., Marcus A. G. de

; Chuqui, Mateus G.

; Ceccopieri, Milena

; Borges-Silva, Milton

; Kampel, Milton

; Bergo, Natascha M.

; Silva, Paulo V. M.

; Tura, Pedro M.

; Moura, Rafael B. de

; Romano, Renato G.

; Martins, Renato P.

; Carreira, Renato S.

; Toledo, Rodrigo G.A.

; Bonecker, Sérgio L.C.

; Disaró, Sibelle T.

; Rodrigues, Silvana V.

; Corbisier, Thais N.

; Vicente, Thaisa M.

; Paiva, Vitor G. de

; Pellizari, Vivian H.

; Belo, Wellington C.

; Brandini, Frederico P.

; Sousa, Silvia H.M

Ocean and Coastal Research

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2023, Volume 71 Suppl. 3 elocation e23022

Abstract: En | Text: En | PDF: En

Abstract The Santos Basin (SB) is the main petroliferous basin in the Brazilian continental margin and one of the most studied marine areas in Brazil. However, historical data suggest that new efforts should be carried out to acquire quantitative biological data, especially in the deep sea, to establish the baseline of essential ocean variables in different ecosystems for future monitoring programs. The Brazilian energy company Petrobras planned and executed 24 oceanographic cruises over a period of 2 years to assess the benthic (SANSED cruise) and pelagic (SANAGU cruise) systems of the SB (356 days at sea in 2019 and 2021/2022). These efforts were part of the Santos Project, which comprised a comprehensive environmental study aimed at investigating benthic and pelagic variables to characterize ecology, biogeochemistry, thermohaline properties of water masses, and ocean circulation patterns, geomorphology, and sedimentology, as well as organic and inorganic chemistry. Here we present the detailed sampling designs and the field methods employed on board, during the SB scientific cruises. All sampling protocols were based on standardized approaches. For the benthos analyses, triplicate sediment samples were performed using a GOMEX-type box corer (0.25 m²) or a large modified Van Veen grab (0.75 m²) at 100 stations ranging from 25 to 2400 m depth. At each station, 25 geochemical and physico-chemical parameters were analyzed in addition to micro-, meio-, and macrofauna and living foraminifera samples. For the pelagic system, 60 stations were selected to investigate the plankton community, ranging in size from pico- to macroplankton, through vertical, horizontal, and oblique net hauls (20, 200, and 500 μm mesh size), as well as 25 biogeochemical parameters collected with an aid of a CTD-rosette sampler. Part of this scientific information also serves the Regional Environmental Characterization Project (PCR-BS) in support of Petrobras’ Santos Basin drilling licensing process led by the Brazilian Environmental Agency – IBAMA. This project contributes to the sustainable development of the SB, in line with the guidelines of the United Nations Decade of Ocean Science for Sustainable Development.

https://doi.org/10.1590/2675-2824071.22072dlm

Fatores individuais e contextuais associados ao tabagismo em adultos jovens brasileiros
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Morais, Évelin Angélica Herculano de

; Oliveira, Bárbara Emiliano de

; Roesberg, Joana Motta Araújo

; Souza, Priscila Silvia Nunes

; Souza, Raissa Naytiara Barbosa de

; Costa, Saraid Figueiredo

; Marques, Vitória da Silva

; Abreu, Mery Natali Silva

Ciência & Saúde Coletiva

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jun 2022, Volume 27 N. 6 Pages 2349 - 2362

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

Resumo Aos jovens é atribuída especial atenção no que tange ao tabagismo por se tratar de um período da vida em que o uso dessa e outras substâncias geralmente inicia e se consolida. Não há estudos sobre fatores de risco associados aos adultos jovens, com amostra representativa do Brasil e que consideram aspectos individuais e contextuais. O objetivo foi identificar fatores associados ao tabagismo em adultos jovens brasileiros de 18 a 24 anos, considerando a influência conjunta de fatores individuais e contextual avaliado por meio do Índice de Desenvolvimento Humano Municipal (IDHM). Estudo transversal, de base populacional, que utilizou dados da Pesquisa Nacional de Saúde de 2019. Por meio do modelo multinível de Poisson com variâncias robustas para estimação da Razão de Prevalência, foram analisadas variáveis individuais, e como variável contextual, o IDHM em cada Unidade Federativa. Além de fatores individuais, o IDHM também se mostrou associado ao tabagismo dos jovens, com aumento da prevalência de consumo de tabaco entre os jovens à medida que se aumenta o IDHM do estado (p<0,001), indicando que residir em UF com melhores condições socioeconômicas segundo o IDHM está associado a maior probabilidade de o jovem fumar se comparados com aqueles que residem nos demais estados.

Abstract Young people receive special attention regarding smoking as it is a period of life in which the use of this and other substances generally starts and is consolidated. There are no studies on risk factors associated with young adults with a representative sample from Brazil that take into consideration individual and contextual aspects. The objective was to identify factors associated with smoking among young Brazilian adults aged 18 to 24 years, considering the combined influence of individual and contextual factors assessed through the Municipal Human Development Index (MHDI). It involved a cross-sectional, population-based study that used data from the 2019 National Health Survey. Using the Poisson multilevel model with robust variance for estimating the Prevalence Ratio, individual variables were analyzed, and the MHDI as a contextual variable in each Federative Unit. In addition to individual factors, the MHDI was also associated with smoking among young people, with an increase in the prevalence of tobacco consumption among young people as the state’s MHDI increases (p<0.001), indicating that living in a state with better conditions according to the MHDI, socioeconomic status is associated with a higher probability of young people smoking when compared to those residing in other states.

https://doi.org/10.1590/1413-81232022276.20622021

Fatores individuais e contextuais associados ao tabagismo em adultos jovens brasileiros
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Morais, Évelin Angélica Herculano de

; Oliveira, Bárbara Emiliano de

; Roesberg, Joana Motta Araújo

; Souza, Priscila Silvia Nunes

; Souza, Raissa Naytiara Barbosa de

; Costa, Saraid Figueiredo

; Marques, Vitória da Silva

; Abreu, Mery Natali Silva

Ciência & Saúde Coletiva

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jun 2022, Volume 27 N. 6 Pages 2349 - 2362

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

https://doi.org/10.1590/1413-81232022276.20622021

Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites
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Farias, Luís Arthur Brasil Gadelha

; Stolp, Ângela Maria Veras

; Bandeira, Silviane Praciano

; Mesquita, Rafael Ferreira

; Bessa, Pedro Pinheiro de Negreiros

; Holanda, Pablo Eliack Linhares de

; Costa, Silvia Figueiredo

; Takeda, Christianne Fernandes Valente

; Perdigão Neto, Lauro Vieira

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e33

Abstract: En | Text: En | PDF: En

ABSTRACT Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs’ and cats’ mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski’s sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.

https://doi.org/10.1590/s1678-9946202264033

Cryptosporidium diagnosis in different groups of children and characterization of parasite species
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Pacheco, Flávia Thamiris Figueiredo

; Freitas, Humberto Fonseca de

; Silva, Renata Kelly Novais Rodrigues

; Carvalho, Silvia Souza de

; Martins, Adson Santos

; Menezes, Joelma Figueiredo

; Ribeiro, Tereza Cristina Medrado

; Mattos, Ângela Peixoto de

; Costa-Ribeiro Júnior, Hugo da

; Pedreira, Joice Neves Reis

; Soares, Neci Matos

; Teixeira, Márcia Cristina Aquino

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0041-2022

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. Methods: Children’s feces were analyzed by modiﬁed Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. Results: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). Conclusions: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

https://doi.org/10.1590/0037-8682-0041-2022

COVID-19 and isolation: Risks and implications in the scenario of new variants
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Dias, Viviane Maria de Carvalho Hessel

; Oliveira, Alexandre Ferreira

; Marinho, Ana Karolina Barreto Berselli

; Santos Ferreira, Carlos Eduardo dos

; Domingues, Carlos Eduardo Ferreira

; Fortaleza, Carlos Magno Castelo Branco

; Vidal, Claudia Fernanda de Lacerda

; Carrilho, Claudia Maria Dantas de Maio

; Pinheiro, Debora Otero Britto Passos

; de Assis, Denise Brandão

; Medeiros, Eduardo Alexandrino

; Morejón, Karen Mirna Loro

; Weissmann, Leonardo

; Michelin, Lessandra

; Carneiro, Marcelo

; Nogueira, Maria Dolores Santos da Purificação

; de Oliveira, Priscila Rosalba Domingos

; Buralli, Rafael Junqueira

; Stucchi, Raquel Silveira Bello

; Lins, Rodrigo Schrage

; Costa, Silvia Figueiredo

; Chebabo, Alberto

Brazilian Journal of Infectious Diseases

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2022, Volume 26 N. 5 elocation 102703

Abstract: En | Text: En | PDF: En

Abstract With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.

https://doi.org/10.1016/j.bjid.2022.102703

Diretriz de Miocardites da Sociedade Brasileira de Cardiologia – 2022
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Montera, Marcelo Westerlund

; Marcondes-Braga, Fabiana G.

; Simões, Marcus Vinícius

; Moura, Lídia Ana Zytynski

; Fernandes, Fabio

; Mangine, Sandrigo

; Oliveira Júnior, Amarino Carvalho de

; Souza, Aurea Lucia Alves de Azevedo Grippa de

; Ianni, Bárbara Maria

; Rochitte, Carlos Eduardo

; Mesquita, Claudio Tinoco

; de Azevedo Filho, Clerio F.

; Freitas, Dhayn Cassi de Almeida

; Melo, Dirceu Thiago Pessoa de

; Bocchi, Edimar Alcides

; Horowitz, Estela Suzana Kleiman

; Mesquita, Evandro Tinoco

; Oliveira, Guilherme H.

; Villacorta, Humberto

; Rossi Neto, João Manoel

; Barbosa, João Marcos Bemfica

; Figueiredo Neto, José Albuquerque de

; Luiz, Louise Freire

; Hajjar, Ludhmila Abrahão

; Beck-da-Silva, Luis

; Campos, Luiz Antonio de Almeida

; Danzmann, Luiz Cláudio

; Bittencourt, Marcelo Imbroinise

; Garcia, Marcelo Iorio

; Avila, Monica Samuel

; Clausell, Nadine Oliveira

; Oliveira Jr, Nilson Araujo de

; Silvestre, Odilson Marcos

; Souza, Olga Ferreira de

; Mourilhe-Rocha, Ricardo

; Kalil Filho, Roberto

; Al-Kindi, Sadeer G.

; Rassi, Salvador

; Alves, Silvia Marinho Martins

; Ferreira, Silvia Moreira Ayub

; Rizk, Stéphanie Itala

; Mattos, Tiago Azevedo Costa

; Barzilai, Vitor

; Martins, Wolney de Andrade

; Schultheiss, Heinz-Peter

Arquivos Brasileiros de Cardiologia

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2022, Volume 119 N. 1 Pages 143 - 211

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

https://doi.org/10.36660/abc.20220412

10.

Evaluation of eleven immunochromatographic assays for SARS-CoV-2 detection: investigating the dengue cross-reaction
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Oliveira, Beatriz Araujo

; Oliveira, Lea Campos de

; Oliveira, Franciane Mendes de

; Pereira, Geovana Maria

; Souza, Regina Maia de

; Manuli, Erika Regina

; Marchini, Fabricio Klerynton

; Espinoza, Evelyn Patrícia Sanchez

; Park, Marcelo

; Taniguchi, Leandro

; Mendes, Pedro Vitale

; Franco, Lucas Augusto Moyses

; Nastri, Ana Catharina

; Oliveira, Maura Salaroli de

; Vieira Junior, José Mauro

; Kallas, Esper Georges

; Levin, Anna Sara

; Sabino, Ester Cerdeira

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e63

Abstract: En | Text: En | PDF: En

ABSTRACT COVID-19 disease is spread worldwide and diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and a low-cost alternative especially in low and middle-income countries, which lack structure to perform certain diagnostic techniques. Here we evaluate the sensitivity and specificity of eleven different IC tests in 145 serum samples from confirmed cases of COVID-19 using RT-PCR and 100 negative serum samples from blood donors collected in February 2019. We also evaluated the cross-reactivity with dengue using 20 serum samples from patients with confirmed diagnosis for dengue collected in early 2019 through four different tests. We found high sensitivity (92%), specificity (100%) and an almost perfect agreement (Kappa 0.92) of IC assay, especially when we evaluated IgG and IgM combined after 10 days from the onset of symptoms with RT-PCR. However, we detected cross-reactivity between dengue and COVID-19 mainly with IgM antibodies (5 to 20% of cross-reaction) and demonstrated the need for better studies about diagnostic techniques for these diseases.

https://doi.org/10.1590/s1678-9946202264063

11.

MRSA outbreak in a Neonatal Intensive Care Unit in a developed country: importance of rapid detection of reservoirs and implementation of intervention measures
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Moura, Maria Luísa

; Rizek, Camila Fonseca

; Aguiar, Elisa

; Barros, Ana Natiele da Silva

; Costa, Sibeli

; Santos, Sania Alves dos

; Marchi, Ana Paula

; Gibelli, Maria Augusta Bento Cicaroni

; Tragante, Carla Regina

; Araújo, Maria Rita Elmor de

; Rossi, Flavia

; Guimaraes, Thais

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e58

Abstract: En | Text: En | PDF: En

ABSTRACT We described a MRSA bloodstream infection outbreak that was rapidly identified and controlled in a Neonatal Intensive Care Unit after implementation of a bundle of measures, including PCR-screening and HCW decolonization. We found 35% of healthcare workers(HCW) colonized with S. aureus by PCR, one of them that presented skin lesion positive for MSSA (same clone and spa type than two patients). Our findings raise the hypothesis that the outbreak could be related to HCW colonization.

https://doi.org/10.1590/s1678-9946202264058

12.

Avaliação de dor do recém-nascido durante punção arterial: estudo observacional analítico
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Alberice, Rayanne Marques Costa

; Silva, Silvia Cristina Oliveira da

; Leite, Anna Caroline Costa

; Manzo, Bruna Figueiredo

; Simão, Delma Aurélia da Silva

; Marcatto, Juliana de Oliveira

Revista Brasileira de Terapia Intensiva

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sep 2021, Volume 33 N. 3 Pages 434 - 439

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

RESUMO Objetivo: Avaliar a intensidade de dor durante a punção arterial realizada em recém-nascidos internados em uma unidade de cuidados progressivos neonatais e avaliar a percepção do profissional em relação à dor neonatal. Métodos: Estudo observacional analítico, em que foram observadas 62 punções arteriais realizadas em 35 neonatos. Avaliou-se a dor durante a coleta pela escala Premature Infant Pain Profile. Os profissionais responsáveis pela coleta avaliaram a dor pela escala numérica verbal de zero a dez. Os dados foram submetidos à análise estatística descritiva por meio do programa Statistical Package for the Social Science. Resultados: Entre os recém-nascidos, 30,6% (n = 19) não tiveram dor ou tiveram dor leve (0 - 6), 24,2% (n = 15) apresentaram dor leve a moderada (7 - 11) e 45,2% (28) dor intensa (12 - 21). Constatou-se que os profissionais identificam a dor durante o procedimento. Conclusão: A punção arterial é considerada um procedimento doloroso e pode resultar em dor leve a intensa, sendo necessária a adoção de estratégias sistematizadas de avaliação, possibilitando a intervenção terapêutica adequada.

ABSTRACT Objective: To evaluate pain intensity during arterial puncture performed in newborns admitted to a neonatal progressive care unit and to evaluate the perception of health professionals regarding neonatal pain. Methods: This was an observational analytical study in which 62 arterial punctures were performed in 35 neonates. Pain was assessed during collection using the Premature Infant Pain Profile scale. The health professionals responsible for collection evaluated pain using a verbal numerical scale ranging from zero to ten. The data were subjected to descriptive statistical analysis using the Statistical Package for the Social Science software. Results: Among the newborns, 30.6% (n = 19) had no pain or mild pain (0 - 6), 24.2% (n = 15) had mild to moderate pain (7 - 11) and 45.2% (28) had severe pain (12 - 21). It was found that health professionals identified pain during the procedure. Conclusion: Arterial puncture is considered a painful procedure that can result in mild to severe pain. The adoption of systematic evaluation strategies is necessary to enable appropriate therapeutic intervention.

https://doi.org/10.5935/0103-507x.20210058 80 downloads

13.

Effectiveness of surveillance cultures for high priority multidrug-resistant bacteria in hematopoietic stem cell transplant units
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Mendes, Elisa Teixeira

; Salomão, Matias Chiarastelli

; Tomichi, Lísia Moura

; Oliveira, Maura Salaroli

; Graça, Mariana

; Rossi, Flavia

; Sapadao, Fernanda

; Guimarães, Thais

; Rocha, Vanderson

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e77

Abstract: En | Text: En | PDF: En

ABSTRACT Surveillance strategies to detect colonization are an important tool to prevent and control the spread of microorganisms in hematopoietic stem cell transplant (HSCT) units. The aim of this study was to evaluate routine surveillance cultures for screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa), and vancomycin-resistant enterococci (VRE). Surveillance cultures were collected (1,323 samples) from 200 patients admitted to an HSCT unit over one year; swabs were taken on admission and then weekly. We compared the positivity of cultures for each site, agent, clinical and epidemiological data according to the colonization status. Infection due to multidrug-resistant organisms (MDROs) occurred in 52 (21.5%) patients, 45 (86.5%) due to blood stream infection; 12 (23%) patients had a positive surveillance culture before the infection. Cultures of 554 (41.8%) samples were performed for CRPa, 413 (31.2%) for VRE and 356 (27%) for CRE. Of these, 179 (13.5%) were positive. Colonization by any MDRO, CRE or CRPa was associated with increased risk of infection (P < 0.05), but not with death. Previous colonization by an MDRO was a significant risk for infection by these pathogens, specially by CRE. Overall, rectal swabs had the highest positivity rate compared with other sites, oropharynx swabs were an option for CRPa, and fecal cultures showed low positivity. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, routine VRE surveillance should be questioned with regard to patients undergoing auto-HSCT due to the additional cost and little impact on survival rates.

https://doi.org/10.1590/s1678-9946202163077 50 downloads

14.

Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
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Bocchi, Edimar Alcides

; Moreira, Henrique Turin

; Nakamuta, Juliana Sanajotti

; Simões, Marcus Vinicius

; Casas, Alberto de Almeida Las

; Costa, Altamiro Reis da

; Assis, Amberson Vieira de

; Durães, André Rodrigues

; Pereira-Barretto, Antonio Carlos

; Ravessa, Antonio Delduque de Araujo

; Macedo, Ariane Vieira Scarlatelli

; Biselli, Bruno

; Pinto, Carolina Maria Nogueira

; Filho, Conrado Roberto Hoffmann

; Costantini, Costantino Roberto

; Almeida, Dirceu Rodrigues

; Santos Jr, Edval Gomes dos

; Soliva Junior, Erwin

; Figueiredo, Estevão Lanna

; Albuquerque, Felipe Neves de

; Paulitsch, Felipe

; Neuenschwander, Fernando Carvalho

; Figueiredo Neto, José Albuquerque de

; Brito, Flavio de Souza

; Lopes, Heno Ferreira

; Villacorta, Humberto

; Souza Neto, João David de

; Sepulveda, João Mariano

; Ayoub, José Carlos Aidar

; Vilela-Martin, José F.

; Cardoso, Juliano Novaes

; Uemura, Laercio

; Moura, Lidia Zytynski

; Maia, Lilia Nigro

; Oliveira, Lucia Brandão de

; Maia, Lucimir

; Silva, Luís Beck da

; Gowdak, Luís Henrique Wolff

; Danzmann, Luiz Claudio

; Andrade, Marcus

; Braile-Sternieri, Maria Christiane Valeria Braga

; Moreira, Maria da Consolação Vieira

; França Neto, Olimpio R

; Filho, Otavio Rizzi Coelho

; Esteves, Paulo Frederico

; Raupp-da-Rosa, Priscila

; Silva, Ricardo Jorge de Queiroz e

; Mourilhe-Rocha, Ricardo

; Viégas, Ruy Felipe Melo

; Rassi, Salvador

; Mangili, Sandrigo

; Kaiser, Sergio Emanuel

; Martins, Silvia Marinho

; Kawabata, Vitor Sergio

Clinics

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2021, Volume 76 elocation e1991

Abstract: En | Text: En | PDF: En

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

https://doi.org/10.6061/clinics/2021/e1991 870 downloads

15.

Colistin-resistant Escherichia coli belonging to different sequence types: genetic characterization of isolates responsible for colonization, community- and healthcare-acquired infections
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Paiva, Yrving

; Nagano, Debora Satie

; Cotia, Andre Luis Franco

; Guimarães, Thais

; Martins, Roberta Cristina Ruedas

; Perdigão Neto, Lauro Vieira

; Côrtes, Marina Farrel

; Marchi, Ana Paula

; Corscadden, Louise

; Machado, Anna Silva

; Paula, Alexandre Inácio de

; Franco, Lucas Augusto Moyses

; Neves, Patricia Regina

; Levin, Anna Sara

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e38

Abstract: En | Text: En | PDF: En

ABSTRACT The plasmid-mediated colistin-resistance gene named mcr-1 has been recently described in different countries and it became a public health challenge. Of note, few studies have addressed the spread of Escherichia coli harboring the mcr-1 gene in both, community and hospital settings. A total of seven colistin-resistant E. coli carrying mcr-1, collected from 2016 to 2018, from community (n=4), healthcare-acquired infections (n=2) and colonization (n=1) were identified in three high complexity hospitals in Sao Paulo, Brazil. These colistin-resistant isolates were screened for mcr genes by PCR and all strains were submitted to Whole Genome Sequencing and the conjugation experiment. The seven strains belonged to seven distinct sequence types (ST744, ST131, ST69, ST48, ST354, ST57, ST10), and they differ regarding the resistance profiles. Transference of mcr-1 by conjugation to E. coli strain C600 was possible in five of the seven isolates. The mcr-1 gene was found in plasmid types IncX4 or IncI2. Three of the isolates have ESBL-encoding genes (blaCTX-M-2, n=2; blaCTX-M-8, n=1). We hereby report genetically distinct E. coli isolates, belonging to seven STs, harboring the mcr-1 gene, associated to community and healthcare-acquired infections, and colonization in patients from three hospitals in Sao Paulo. These findings point out for the potential spread of plasmid-mediated colistin-resistance mechanism in E. coli strains in Brazil.

https://doi.org/10.1590/s1678-9946202163038 332 downloads

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