Pesquisa | SciELO

ABSTRACT Objective: To evaluate the risk factors for healthcare-related infections during the COVID-19 pandemic in intensive care units, to investigate the impact of COVID-19 on Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and ventilator-associated pneumonia, and to describe healthcare-associated infections in the waves of the COVID-19 pandemic. Methods: This nested case-control study was conducted in a 137-bed adult medical/surgical intensive care unit at a private hospital in São Paulo, Brazil, between January 11, 2019, and May 21, 2022. Case patients were identified using the Nosocomial Infection Control Committee database and control patients were identified using the intensive care unit's EPIMED system. For the analysis of risk factors, the chi-square test, multiple logistic regression model, and Kaplan-Meier method were used to identify independent risk factors, considering p<0.05. Results: The Case Group consisted of 189 healthcare-associated infections, including ventilator-associated pneumonia (61.4%), Central Line-Associated Bloodstream Infection (30.1%), Catheter-Associated Urinary Tract Infection (8.5%), and the Control Group consisted of 6,834 patients. The independent risk factors were COVID-19 infection (OR=2.84, 95%CI=1.92–4.23, p<0.01), length of stay in intensive care greater than 14 days (OR=3.15, 95%CI=1.95–5.14, p<0.01), length of hospital stay greater than 30 days (OR=3.64, 95%CI=2.44–5.51, p<0.01), and patients who were in the third wave (OR=1.72, 95%CI=1.05–2.91, p=0.04). Ventilator-associated pneumonia was the only healthcare-related infection for which COVID-19 infection was an independent risk factor (OR=3.32, 95%CI=1.92–5.94, p<0.01). Conclusion: COVID-19 and length of hospital stay were independent risk factors for healthcare-associated infections, and only ventilator-associated pneumonia was affected by the COVID-19 pandemic. Objective healthcarerelated healthcare related COVID19 COVID 19 COVID-1 units LineAssociated Line Associated CatheterAssociated Catheter ventilatorassociated ventilator associated healthcareassociated Methods casecontrol case 137bed bed 137 medicalsurgical medical surgical Paulo Brazil 11 2019 21 2022 s system chisquare chi square test model KaplanMeier Kaplan Meier p005 p 0 05 p<0.05 Results 18 61.4%, 614 61.4% , 61 4 (61.4%) 30.1%, 301 30.1% 1 (30.1%) 8.5%, 85 8.5% 8 5 (8.5%) 6834 6 834 6,83 OR=2.84, OR284 OR 2 84 (OR=2.84 95CI192423 CI 95 92 23 95%CI=1.92–4.23 p<0.01, p001 p<0.01 01 p<0.01) OR=3.15, OR315 3 15 (OR=3.15 95CI195514 95%CI=1.95–5.14 OR=3.64, OR364 64 (OR=3.64 95CI244551 44 51 95%CI=2.44–5.51 OR=1.72, OR172 72 (OR=1.72 95CI105291 91 95%CI=1.05–2.91 p=0.04. p004 p=0.04 . 04 p=0.04) Ventilatorassociated Ventilator OR=3.32, OR332 32 (OR=3.32 95CI192594 94 95%CI=1.92–5.94 p<0.01. Conclusion COVID1 COVID- 13 201 202 p00 p<0.0 61.4 (61.4% 30.1 (30.1% 8.5 (8.5% 683 83 6,8 OR=2.84 OR28 (OR=2.8 95CI19242 9 95%CI=1.92–4.2 OR=3.15 OR31 (OR=3.1 95CI19551 95%CI=1.95–5.1 OR=3.64 OR36 (OR=3.6 95CI24455 95%CI=2.44–5.5 OR=1.72 OR17 7 (OR=1.7 95CI10529 95%CI=1.05–2.9 p=0.0 OR=3.32 OR33 (OR=3.3 95CI19259 95%CI=1.92–5.9 20 p0 p<0. 61. (61.4 30. (30.1 8. (8.5 68 6, OR=2.8 OR2 (OR=2. 95CI1924 95%CI=1.92–4. OR=3.1 OR3 (OR=3. 95CI1955 95%CI=1.95–5. OR=3.6 95CI2445 95%CI=2.44–5. OR=1.7 OR1 (OR=1. 95CI1052 95%CI=1.05–2. p=0. OR=3.3 95CI1925 95%CI=1.92–5. p<0 (61. (30. (8. OR=2. (OR=2 95CI192 95%CI=1.92–4 OR=3. (OR=3 95CI195 95%CI=1.95–5 95CI244 95%CI=2.44–5 OR=1. (OR=1 95CI105 95%CI=1.05–2 p=0 95%CI=1.92–5 p< (61 (30 (8 OR=2 (OR= 95CI19 95%CI=1.92– OR=3 95%CI=1.95– 95CI24 95%CI=2.44– OR=1 95CI10 95%CI=1.05– p= (6 (3 ( OR= (OR 95CI1 95%CI=1.92 95%CI=1.95 95CI2 95%CI=2.44 95%CI=1.05 95CI 95%CI=1.9 95%CI=2.4 95%CI=1.0 95%CI=1. 95%CI=2. 95%CI=1 95%CI=2 95%CI= 95%CI

https://doi.org/10.31744/einstein_journal/2024ao0939

Method for Defining the Automation Level of an eVTOL
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Borges, Sarah Francisca de Souza

; Cardoso Junior, Moacyr Machado

; Castilho, Diogo Silva

Journal of Aerospace Technology and Management

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2024, Volume 16 elocation e2224

Resumo: En | Texto: En | PDF: En

ABSTRACT Optimizing pilot-automation collaboration necessitates early safety assessment of the aircraft, which involves a rigorous examination of potential scenarios. This article seeks to establish a comprehensive framework for safety analysis, exploring various levels of automation (LoA) within high-technology projects such as electric vertical takeoff and landing (eVTOL) aircraft. The method is divided into three phases: the first involves defining the operations concept; the second involves applying the systems theoretic process analysis (STPA) method; and the third encompasses determining the safest LoA. Furthermore, this article scrutinizes the landing operations of eVTOL aircraft in urban centers. The identified control actions (CAs) include flight monitoring, landing verification, speed selection, and maneuvering. Ultimately, a LoA categorized as automated decision making emerged as the safest. This entails the concurrent monitoring and generation of alternatives by both the pilot and the autopilot, with the final selection of the optimal alternative and its subsequent implementation exclusively entrusted to the autopilot. This work contributes by presenting evidence that safety analysis should commence at the level of individual CAs, rather than at a higher level encompassing complete operations or the entire aircraft. This approach aims to generate comprehensive, practical, and effective safety requirements. pilotautomation scenarios (LoA hightechnology high technology (eVTOL phases concept STPA (STPA Furthermore centers CAs (CAs verification maneuvering Ultimately autopilot practical requirements

https://doi.org/10.1590/jatm.v16.1342

Clinical characteristics and outcomes of patients with COVID-19 admitted to the intensive care unit during the first and second waves of the pandemic in Brazil: a single-center retrospective cohort study COVID19 COVID 19 COVID-1 Brazil singlecenter single center COVID1 1 COVID-
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Corrêa, Thiago Domingos

; Midega, Thais Dias

; Cordioli, Ricardo Luiz

; Barbas, Carmen Silvia Valente

; Rabello Filho, Roberto

; Silva, Bruno Caldin da

; Silva Júnior, Moacyr

; Nawa, Ricardo Kenji

; Carvalho, Fabrício Rodrigues Torres de

; Matos, Gustavo Faissol Janot de

; Lucinio, Neide Marcela

; Rodrigues, Rodrigo Dias

; Eid, Raquel Afonso Caserta

; Bravim, Bruno de Arruda

; Pereira, Adriano José

; Santos, Bento Fortunato Cardoso dos

; Pinho, João Renato Rebello

; Pardini, Andreia

; Teich, Vanessa Damazio

; Laselva, Claudia Regina

; Cendoroglo Neto, Miguel

; Klajner, Sidney

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2023, Volume 21 elocation eAO0233

Resumo: En | Texto: En | PDF: En

ABSTRACT Objective To describe and compare the clinical characteristics and outcomes of patients admitted to intensive care units during the first and second waves of the COVID-19 pandemic. Methods In this retrospective single-center cohort study, data were retrieved from the Epimed Monitor System; all adult patients admitted to the intensive care unit between March 4, 2020, and October 1, 2021, were included in the study. We compared the clinical characteristics and outcomes of patients admitted to the intensive care unit of a quaternary private hospital in São Paulo, Brazil, during the first (May 1, 2020, to August 31, 2020) and second (March 1, 2021, to June 30, 2021) waves of the COVID-19 pandemic. Results In total, 1,427 patients with COVID-19 were admitted to the intensive care unit during the first (421 patients) and second (1,006 patients) waves. Compared with the first wave group [median (IQR)], the second wave group was younger [57 (46-70) versus 67 (52-80) years; p<0.001], had a lower SAPS 3 Score [45 (42-52) versus 49 (43-57); p<0.001], lower SOFA Score on intensive care unit admission [3 (1-6) versus 4 (2-6); p=0.018], lower Charlson Comorbidity Index [0 (0-1) versus 1 (0-2); p<0.001], and were less frequently frail (10.4% versus 18.1%; p<0.001). The second wave group used more noninvasive ventilation (81.3% versus 53.4%; p<0.001) and high-flow nasal cannula (63.2% versus 23.0%; p<0.001) during their intensive care unit stay. The intensive care unit (11.3% versus 10.5%; p=0.696) and in-hospital mortality (12.3% versus 12.1%; p=0.998) rates did not differ between both waves. Conclusion In the first and second waves, patients with severe COVID-19 exhibited similar mortality rates and need for invasive organ support, despite the second wave group being younger and less severely ill at the time of intensive care unit admission. COVID19 COVID 19 COVID-1 pandemic singlecenter single center study System 2020 2021 Paulo Brazil May 31 30 total 1427 427 1,42 421 (42 1,006 1006 006 (1,00 median IQR, IQR , (IQR)] 57 [5 4670 46 70 (46-70 6 5280 52 80 (52-80 years p<0.001, p0001 p p<0.001 0 001 p<0.001] 45 [4 4252 42 (42-52 4357 43 (43-57) [ 16 (1-6 26 2 (2-6) p=0.018, p0018 p=0.018 018 p=0.018] 01 (0-1 02 (0-2) 10.4% 104 10 (10.4 18.1% 181 18 p<0.001. . 81.3% 813 81 (81.3 53.4% 534 53 highflow high flow 63.2% 632 63 (63.2 23.0% 230 23 stay 11.3% 113 11 (11.3 10.5% 105 5 p=0.696 p0696 696 inhospital 12.3% 123 12 (12.3 12.1% 121 p=0.998 p0998 998 support COVID1 COVID- 202 142 1,4 (4 1,00 100 00 (1,0 (IQR) 467 7 (46-7 528 8 (52-8 p000 p<0.00 425 (42-5 435 (43-57 (1- (2-6 p001 p=0.01 (0- (0-2 10.4 (10. 18.1 81.3 (81. 53.4 63.2 (63. 23.0 11.3 (11. 10.5 p=0.69 p069 69 12.3 (12. 12.1 p=0.99 p099 99 20 14 ( 1,0 (1, (IQR (46- (52- p00 p<0.0 (42- (43-5 (1 (2- p=0.0 (0 10. (10 18. 81. (81 53. 63. (63 23. 11. (11 p=0.6 p06 12. (12 p=0.9 p09 9 (46 (52 p0 p<0. (43- (2 p=0. (8 (6 (5 p<0 (43 p=0 p< p=

https://doi.org/10.31744/einstein_journal/2023ao0233

Factors associated with multidrug-resistant bacteria in healthcare-associated infections: a pediatric intensive care unit case-control study
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Silva, Barbara Barduchi Oliveira da

; Silva Júnior, Moacyr

; Menezes, Fernando Gatti de

; Troster, Eduardo Juan

einstein (São Paulo)

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2022, Volume 20 elocation eAO6704

Resumo: En | Texto: En | PDF: En

ABSTRACT Objective To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit. Methods A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a high-complexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections. Results There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p<0.001), in whom the likelihood of multidrug-resistant bacteria infection was estimated to be nine-fold higher than among non-immunosuppressed patients (OR 8.97; 95%CI 2.69-29.94). In the analysis of multiple logistic regression model, we observed that immunosuppressed patients had an 8.5-fold higher chance of multidrug-resistant bacteria infection when compared to non-immunosuppressed patients (OR 8.48; 95%CI 2.54-28.35; p=0.001). There is evidence of association between the Case Group and presence of Gram-positive (p=0.007), coagulase-negative Staphylococcus (p<0.001), and Gram-negative (p=0.041) microorganisms. Conclusion The immunocompromised-state variable is a factor related to healthcare-associated infections caused by multidrug-resistant bacteria, and the Case Group presented higher proportions of Gram-positive microorganisms and coagulase-negative Staphylococcus.

https://doi.org/10.31744/einstein_journal/2022ao6704

COMVC-19: A Program to protect healthcare workers’ mental health during the COVID-19 Pandemic. What we have learned
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Fukuti, Pedro

; Uchôa, Caroline Louise Mesquita

; Mazzoco, Marina Flaborea

; Cruz, Isabella D'Andrea Garcia da

; Echegaray, Mariana V.F.

; Humes, Eduardo de Castro

; Silveira, Júlia Belizário

; Santi, Talita Di

; Miguel, Euripedes Constantino

; Corchs, Felipe

; Fatori, Daniel

; Campello, Guilherme

; Oliveira, Gabriel M. de

; Argolo, Felipe C.

; Ferreira, Felipe de M.

; Machado, Gustavo

; Argeu, Adriana

; Oliveira, Graça Maria Ramos de

; Serafim, Antônio de Pádua

; Siqueira, Luciana de Lima

; Rossi, Luciane de

; Rios, Izabel Cristina

; Oliveira, Talita Rodrigues de

; Antoniazzi, Leilane C. K.

; Gagliotti, Daniel Augusto Mori

; Abelama Neto, Emílio

; Oliveira Junior, Paulo Novais de

; Correia, Aline Villalobo

; Gonçalves, Luca Schilling

; Tortato, Liana Silva

; Busato, Wagner Machado Moraes

; Guimarães-Fernandes, Flávio

; Alves, Marcos

; Leite Netto, Oswaldo Ferreira

; Schoueri, Patrícia de Campos Lindenberg

; Roque, Márcio de Assis

; Merlin, Silvia Stahl

; Boer, Giovana Cardoso Machado

; Sallet, Paulo Clemente

; Malbergier, André

; Spedo, Mariana Abrahão

; Kamitsuji, Carla Satie

; Faria, Elizabeth de

; Moreira, Moacyr Vergara de Godoy

; Kaufman, Arthur

; Abdo, Carmita

; Scanavino, Marco de Tubino

; Lancman, Selma

; Tavares, Hermano

; Polanczyk, Guilherme

; Brunoni, André R.

; Forlenza, Orestes V.

; Barros-Filho, Tarcísio Eloy Pessoa de

Clinics

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2021, Volume 76 elocation e2631

Resumo: En | Texto: En | PDF: En

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

https://doi.org/10.6061/clinics/2021/e2631

Clinical characteristics and outcomes of COVID-19 patients admitted to the intensive care unit during the first year of the pandemic in Brazil: a single center retrospective cohort study
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Corrêa, Thiago Domingos

; Midega, Thais Dias

; Timenetsky, Karina Tavares

; Cordioli, Ricardo Luiz

; Barbas, Carmen Silvia Valente

; Silva Júnior, Moacyr

; Bravim, Bruno de Arruda

; Silva, Bruno Caldin

; Matos, Gustavo Faissol Janot de

; Nawa, Ricardo Kenji

; Carvalho, Fabrício Rodrigues Torres de

; Queiroz, Verônica Neves Fialho

; Rabello Filho, Roberto

; Piza, Felipe Maia de Toledo

; Pereira, Adriano José

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Santos, Bento Fortunato Cardoso dos

; Pardini, Andreia

; Teich, Vanessa Damázio

; Laselva, Claudia Regina

; Cendoroglo Neto, Miguel

; Klajner, Sidney

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2021, Volume 19 elocation eAO6739

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Descrever características clínicas, uso de recursos e desfechos e identificar preditores de mortalidade intra-hospitalar de pacientes com COVID-19 admitidos na unidade de terapia intensiva. Métodos: Estudo de coorte retrospectivo, em centro único, realizado em um hospital privado localizado em São Paulo (SP). Pacientes adultos (≥18 anos) admitidos consecutivamente na unidade de terapia intensiva, entre 4 de março de 2020 a 28 de fevereiro de 2021, foram incluídos neste estudo. Os pacientes foram classificados como sobreviventes e não sobreviventes, de acordo com a alta hospitalar. Resultados: Durante o período do estudo, 1.296 pacientes [mediana (intervalo interquartil) de idade: 66 (53-77) anos] com COVID-19 foram admitidos na unidade de terapia intensiva. Destes, 170 (13,6%) pacientes morreram no hospital (não sobreviventes), e 1.078 (86,4%) receberam alta hospitalar (sobreviventes). Comparados aos sobreviventes, os não sobreviventes eram mais idosos [80 (70-88) versus 63 (50-74) anos; p<0,001], apresentavam pontuação mais alta no sistema prognóstico Simpliﬁed Acute Physiology Score 3 [59 (54-66) versus 47 (42-53); pontos p<0,001] e tinham mais comorbidades. Durante a internação na unidade de terapia intensiva, 56,6% dos pacientes usaram ventilação não invasiva, 32,9% usaram ventilação mecânica invasiva, 31,3% usaram cateter nasal de alto fluxo, 11,7% foram submetidos à terapia renal substitutiva, e 1,5% usou oxigenação por membrana extracorpórea. Os preditores independentes de mortalidade intra-hospitalar foram idade, Sequential Organ Failure Assessment, Índice de Comorbidade de Charlson, necessidade de ventilação mecânica, uso de cateter nasal de alto fluxo, uso de terapia renal substitutiva e suporte por oxigenação por membrana extracorpórea. Conclusão: Pacientes com quadros graves da COVID-19 admitidos na unidade de terapia intensiva apresentaram considerável mortalidade e morbidade, com alta demanda de terapia de suporte e internação prolongada em unidade de terapia intensiva e hospitalar.

ABSTRACT Objective: To describe clinical characteristics, resource use, outcomes, and to identify predictors of in-hospital mortality of patients with COVID-19 admitted to the intensive care unit. Methods: Retrospective single-center cohort study conducted at a private hospital in São Paulo (SP), Brazil. All consecutive adult (≥18 years) patients admitted to the intensive care unit, between March 4, 2020 and February 28, 2021 were included in this study. Patients were categorized between survivors and non-survivors according to hospital discharge. Results: During the study period, 1,296 patients [median (interquartile range) age: 66 (53-77) years] with COVID-19 were admitted to the intensive care unit. Out of those, 170 (13.6%) died at hospital (non-survivors) and 1,078 (86.4%) were discharged (survivors). Compared to survivors, non-survivors were older [80 (70-88) versus 63 (50-74) years; p<0.001], had a higher Simpliﬁed Acute Physiology Score 3 [59 (54-66) versus 47 (42-53) points; p<0.001], and presented comorbidities more frequently. During the intensive care unit stay, 56.6% of patients received noninvasive ventilation, 32.9% received mechanical ventilation, 31.3% used high flow nasal cannula, 11.7% received renal replacement therapy, and 1.5% used extracorporeal membrane oxygenation. Independent predictors of in-hospital mortality included age, Sequential Organ Failure Assessment score, Charlson Comorbidity Index, need for mechanical ventilation, high flow nasal cannula, renal replacement therapy, and extracorporeal membrane oxygenation support. Conclusion: Patients with severe COVID-19 admitted to the intensive care unit exhibited a considerable morbidity and mortality, demanding substantial organ support, and prolonged intensive care unit and hospital stay.

https://doi.org/10.31744/einstein_journal/2021ao6739

Seismic analysis of reinforced concrete buildings with participating masonry infills
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Alva, Gerson Moacyr Sisniegas

; Rigão, Alessandro Onofre

; Kaminski Junior, João

; Pinheiro, Marco Antônio Silva

Revista IBRACON de Estruturas e Materiais

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2021, Volume 14 Nº 3 elocation e14315

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Neste trabalho são realizadas análises sísmicas em edifício de concreto armado com sistema estrutural de pórticos preenchidos com alvenarias participantes. Para a determinação das forças sísmicas, utiliza-se o método espectral da ABNT NBR 15421:2006. Para a simulação da rigidez axial das alvenarias nos pórticos emprega-se o modelo de diagonal equivalente, segundo diversas expressões encontradas na literatura. O principal objetivo é avaliar as diferenças entre essas expressões da literatura para a diagonal equivalente na resposta sísmica. Outro objetivo é de comparar resultados ao se desconsiderar a rigidez das alvenarias sob a ação sísmica. Os resultados são comentados e fornecem contribuições a engenheiros estruturais para o projeto de estruturas aporticadas de edifícios com alvenarias participantes submetidos a ações sísmicas.

ABSTRACT In this paper, seismic analyses are performed of a reinforced concrete frame building with participating masonry walls are carried out. The spectral method of the Brazilian code – ABNT 15421:2006 – was used to obtain the lateral seismic loads. The equivalent diagonal-strut model was employed to simulate the axial stiffness of the masonry walls in the frames, according to different formulations founded in literature. The main purpose is to evaluate the differences implemented by the different formulations for the equivalent strut on the seismic response. This paper also aims at comparing results obtained when the masonry stiffness is not considered under seismic loads. The results obtained are analyzed with the purpose of providing contributions for structural engineers in the design of framed structure buildings with participating masonry walls subjected to seismic loads.

https://doi.org/10.1590/s1983-41952021000300015 333 downloads

Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection
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Corrêa, Thiago Domingos

; Matos, Gustavo Faissol Janot de

; Bravim, Bruno de Arruda

; Cordioli, Ricardo Luiz

; Garrido, Alejandra del Pilar Gallardo

; Assuncao, Murillo Santucci Cesar de

; Barbas, Carmen Silvia Valente

; Timenetsky, Karina Tavares

; Rodrigues, Roseny dos Reis

; Guimarães, Hélio Penna

; Rabello Filho, Roberto

; Lomar, Frederico Polito

; Scarin, Farah Christina de La Cruz

; Batista, Carla Luciana

; Pereira, Adriano José

; Guerra, João Carlos de Campos

; Carneiro, Bárbara Vieira

; Nawa, Ricardo Kenji

; Brandão, Rodrigo Martins

; Pesaro, Antônio Eduardo Pereira

; Silva Júnior, Moacyr

; Carvalho, Fabricio Rodrigues Torres de

; Silva, Cilene Saghabi de Medeiros

; Almeida, Ana Claudia Ferraz de

; Franken, Marcelo

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2020, Volume 18 elocation eAE5793

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Em dezembro de 2019, uma série de pacientes com pneumonia grave foi identificada em Wuhan, província de Hubei, na China. Esses pacientes evoluíram para síndrome respiratória aguda grave e síndrome do desconforto respiratório agudo. Posteriormente, a COVID-19 foi atribuída a um novo betacoronavírus, o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2). Cerca de 20% dos pacientes com diagnóstico de COVID-19 desenvolvem formas graves da doença, incluindo insuficiência respiratória aguda hipoxêmica, síndrome respiratória aguda grave, síndrome do desconforto respiratório agudo e insuficiência renal aguda e requerem admissão em unidade de terapia intensiva. Não há nenhum ensaio clínico randomizado controlado que avalie potenciais tratamentos para pacientes com infecção confirmada pela COVID-19 no momento da publicação destas recomendações de tratamento. Dessa forma, essas recomendações são baseadas predominantemente na opinião de especialistas (grau de recomendação de nível C).

ABSTRACT In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).

https://doi.org/10.31744/einstein_journal/2020ae5793 23244 downloads

Comment to: Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection
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Corrêa, Thiago Domingos

; Matos, Gustavo Faissol Janot de

; Bravim, Bruno de Arruda

; Cordioli, Ricardo Luiz

; Garrido, Alejandra del Pilar Gallardo

; Assuncao, Murillo Santucci Cesar de

; Barbas, Carmen Silvia Valente

; Timenetsky, Karina Tavares

; Rodrigues, Roseny dos Reis

; Guimarães, Hélio Penna

; Rabello Filho, Roberto

; Lomar, Frederico Polito

; Scarin, Farah Christina de La Cruz

; Batista, Carla Luciana

; Pereira, Adriano José

; Guerra, João Carlos de Campos

; Carneiro, Bárbara Vieira

; Nawa, Ricardo Kenji

; Brandão, Rodrigo Martins

; Pesaro, Antônio Eduardo Pereira

; Silva Júnior, Moacyr

; Carvalho, Fabricio Rodrigues Torres de

; Silva, Cilene Saghabi de Medeiros

; Almeida, Ana Claudia Ferraz de

; Franken, Marcelo

; Pesavento, Marcele Liliane

; Eid, Raquel Afonso Caserta

; Ferraz, Leonardo José Rolim

einstein (São Paulo)

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2020, Volume 18 elocation eCE5931

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.31744/einstein_journal/2020ce5931 214 downloads

10.

Synthesis and biological evaluation of novel imidazolidine derivatives as candidates to schistosomicidal agents
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Matos-Rocha, Thiago José

; Lima, Maria do Carmo Alves de

; Silva, Anekécia Lauro da

; Oliveira, Jamerson Ferreira de

; Gouveia, Allana Lemos Andrade

; Silva, Vinícius Barros Ribeiro da

; Almeida Júnior, Antônio Sérgio Alves de

; Brayner, Fábio André

; Cardoso, Pablo Ramon Gualberto

; Pitta-Galdino, Marina da Rocha

; Pitta, Ivan da Rocha

; Rêgo, Moacyr Jesus Barreto de Melo

; Alves, Luiz Carlos

; Pitta, Maira Galdino da Rocha

Revista do Instituto de Medicina Tropical de São Paulo

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2017, Volume 59 elocation e8

Resumo: En | Texto: En | PDF: En

ABSTRACT Introduction: Schistosomiasis is an infectious parasitic disease caused by trematodes of the genus Schistosoma, which threatens at least 258 million people worldwide and its control is dependent on a single drug, praziquantel. The aim of this study was to evaluate the anti-Schistosoma mansoni activity in vitro of novel imidazolidine derivatives. Material and methods: We synthesized two novel imidazolidine derivatives: (LPSF/PTS10) (Z)-1-(2-chloro-6-fluorobenzyl)-4-(4-dimethylaminobenzylidene)-5-thioxoimidazolidin-2-one and (LPSF/PTS23) (Z)-1-(2-chloro-6-fluoro-benzyl)-5-thioxo-4-(2,4,6-trimethoxy-benzylidene)-imidazolidin-2-one. The structures of two compounds were determined by spectroscopic methods. During the biological assays, parameters such as motility, oviposition, mortality and analysis by Scanning Electron Microscopy were performed. Results: LPSF/PTS10 and LPSF/PTS23 were considered to be active in the separation of coupled pairs, mortality and to decrease the motor activity. In addition, LPSF/PTS23 induced ultrastructural alterations in worms, after 24 h of contact, causing extensive erosion over the entire body of the worms. Conclusion: The imidazolidine derivatives containing the trimetoxy and benzylidene halogens showed promising in vitro schistosomicidal activity.

https://doi.org/10.1590/s1678-9946201759008 2241 downloads

11.

Strategies for appropriate antibiotic use in intensive care unit
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Silva, Camila Delfino Ribeiro da

; Silva Júnior, Moacyr

einstein (São Paulo)

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Set 2015, Volume 13 Nº 3 Páginas 448 - 453

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O consumo de antibióticos é elevado, principalmente nas unidades de terapia intensiva. Infelizmente, a maior parte desse uso é inadequado e favorece o aumento de bactérias multirresistentes. Sabe-se que a terapia empírica inicial de amplo espectro diminui a mortalidade, porém o uso prolongado e irracional dos antimicrobianos, além da multirresistência, pode elevar o risco de toxicidade, de interações medicamentosas e de diarreia por Clostridium difficile. Algumas estratégias para o uso racional de antimicrobianos incluem evitar tratamento de colonização, descalonamento, monitorização do nível sérico dos antimicrobianos, duração adequada de tratamento e uso de marcadores biológicos. Esta revisão discute a efetividade dessas estratégias, bem como a importância de conhecimentos em microbiologia, devido a alguns agentes resistentes como Staphylococcus aureuse Klebsiella pneumoniae, para redução tanto do consumo de antimicrobianos como da resistência bacteriana, sem impacto em mortalidade.

The comsumption of antibiotics is high, mainly in intensive care units. Unfortunately, most are inappropriately used leading to increased multi-resistant bacteria. It is well known that initial empirical therapy with broad-spectrum antibiotics reduce mortality rates. However the prolonged and irrational use of antimicrobials may also increase the risk of toxicity, drug interactions and diarrhea due to Clostridium difficile. Some strategies to rational use of antimicrobial agents include avoiding colonization treatment, de-escalation, monitoring serum levels of the agents, appropriate duration of therapy and use of biological markers. This review discusses the effectiveness of these strategies, the importance of microbiology knowledge, considering there are agents resistant to Staphylococcus aureus andKlebsiella pneumoniae, and reducing antibiotic use and bacterial resistance, with no impact on mortality.

https://doi.org/10.1590/S1679-45082015RW3145 16730 downloads

12.

Tuberculosis patients co-infected with Mycobacterium bovis and Mycobacterium tuberculosis in an urban area of Brazil
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Silva, Marcio Roberto

; Rocha, Adalgiza da Silva

; Costa, Ronaldo Rodrigues da

; Alencar, Andrea Padilha de

; Oliveira, Vania Maria de

; Fonseca Junior, Antonio Augusto

; Sales, Mariana Lazaro

; Issa, Marina de Azevedo

; Soares Filho, Paulo Martins

; Pereira, Omara Tereza Vianello

; Santos, Eduardo Calazans dos

; Mendes, Rejane Silva

; Ferreira, Angela Maria de Jesus

; Mota, Pedro Moacyr Pinto Coelho

; Suffys, Philip Noel

; Guimaraes, Mark Drew Crosland

Memórias do Instituto Oswaldo Cruz

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Mai 2013, Volume 108 Nº 3 Páginas 321 - 327

Resumo: En | Texto: En | PDF: En

In this cross-sectional study, mycobacteria specimens from 189 tuberculosis (TB) patients living in an urban area in Brazil were characterised from 2008-2010 using phenotypic and molecular speciation methods (pncA gene and oxyR pseudogene analysis). Of these samples, 174 isolates simultaneously grew on Löwenstein-Jensen (LJ) and Stonebrink (SB)-containing media and presented phenotypic and molecular profiles of Mycobacterium tuberculosis, whereas 12 had molecular profiles of M. tuberculosis based on the DNA analysis of formalin-fixed paraffin wax-embedded tissue samples (paraffin blocks). One patient produced two sputum isolates, the first of which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, and the second of which only grew on SB media and presented phenotypic profiles of Mycobacterium bovis. One patient provided a bronchial lavage isolate, which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, but had molecular profiles of M. bovis from paraffin block DNA analysis, and one sample had molecular profiles of M. tuberculosis and M. bovis identified from two distinct paraffin blocks. Moreover, we found a low prevalence (1.6%) of M. bovis among these isolates, which suggests that local health service procedures likely underestimate its real frequency and that it deserves more attention from public health officials.

https://doi.org/10.1590/S0074-02762013000300010 3619 downloads

13.

Recent changes in Clostridium difficile infection
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Silva Júnior, Moacyr

einstein (São Paulo)

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Mar 2012, Volume 10 Nº 1 Páginas 105 - 109

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Clostridium difficile é a principal causa de diarreia hospitalar. A diarreia por C. difficile aumentou sua incidência e sua morbiletalidade nos últimos anos. Os principais fatores de risco relacionados são uso de antibióticos, idosos e permanência hospitalar prolongada. Muitos pacientes recebem combinação de antibióticos ou múltiplos antibióticos, constituindo-se, assim, o principal fator de risco para o desenvolvimento de infecção ou de recorrência de diarreia associada ao C. difficile. Por isso, intervenções que otimizem a prescrição de antibióticos associado à aderência de medidas de controle de infecção podem reduzir aquisição dessa infecção. Assim, esta revisão aborda a mudança da epidemiologia da infecção por C. difficile e seu tratamento.

Clostridium difficile is the main cause of nosocomial diarrhea. Diarrhea associated with C. difficile has increased incidence, morbidity, and mortality in the last few years. The major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. Many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to C. difficile or its recurrence. Therefore, interventions to improve antibiotic prescribing, as well as compliance with infection control measures can reduce hospital-acquired C. difficile infections. This review addresses the epidemiological changes in C. difficile disease and its treatment.

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14.

Efeitos da sucção à mamadeira e ao seio materno em bebês prematuros
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Silva, Maria Helena Abud da

; Fujinaga, Cristina Ide

; Leite, Adriana Moraes

; Silva, Andreara de Almeida e

; Costa Junior, Moacyr Lobo da

; Scochi, Carmen Gracinda Silvan

Rev Rene

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Mar 2011, Volume 12 Nº 1 Páginas 81 - 87

Resumo: En Es Pt | Texto: En Es Pt | PDF: En | PDF: Es | PDF: Pt

Feeding a premature infant is a concern when it comes to neonatal care and breastfeeding has been recommended. However, not all services advocates breastfeeding to their patients. The aim of this study was to compare the effects of sucking on the feeding bottle and on the breast regarding the oxygen saturation, skin temperature, heart as well as respiratory rates. Each of the premature infants was its own control, being submitted to bottle suction sections as well as breastfeeding sections. In total, 76 sections of suction were carried out, in which the variables skin temperature, heart and respiratory rates as well as oxygen saturation were monitored. Skin temperature and heart and respiratory rates did not present statistically significant differences. There were important alterations in oxygen saturation, with greater occurrence for feeding bottle. Breast suction was shown to be less stressful than the feeding bottle suction, concerning oxygen saturation.

La alimentación del prematuro es una preocupación en la asistencia neonatal y la lactancia materna ha sido recomendada. Sin embargo, ni todos los servicios preconizan alimentación al seno materno a esa clientela. Este estudio tuvo como objetivo comparar los efectos de la succión al biberón y al seno materno sobre la saturación de oxígeno, temperatura cutánea, frecuencias cardíaca y respiratoria. Se trata de estudio de caso, en el cual cada prematuro fue control de si mismo, siendo sometido a sesiones de succión al biberón y al seno materno. Se realizaron 76 sesiones de succión, en las cuales fueron monitoreadas las variables temperatura cutánea, frecuencia cardíaca y respiratoria y saturación de oxígeno. La temperatura cutánea, frecuencias cardíaca y respiratoria no presentaron diferencias estadísticamente significantes. Hubo alteraciones importantes en la saturación de oxígeno, con mayor incidencia para succión al biberón. Se concluyó que la succión al seno materno se reveló menos estresante que la succión al biberón cuanto a la saturación de oxígeno.

A alimentação do prematuro é uma preocupação na assistência neonatal e o aleitamento materno tem sido recomendado. Entretanto, nem todos os serviços preconizam alimentação ao seio materno a essa clientela. O objetivo do estudo foi comparar os efeitos da sucção à mamadeira e ao seio materno sobre a saturação de oxigênio, temperatura cutânea, freqüências cardíaca e respiratória. Trata-se de estudo de caso, no qual cada prematuro foi controle dele próprio, sendo submetido a sessões de sucção à mamadeira e ao seio materno. Realizaram-se 76 sessões de sucção, nas quais se monitorou as variáveis temperatura cutânea, freqüência cardíaca e respiratória e saturação de oxigênio. A temperatura cutânea, freqüências cardíaca e respiratória não apresentaram diferenças estatisticamente significantes. Houve alterações importantes na saturação de oxigênio, com maior ocorrência para sucção à mamadeira. Concluiu-se que a sucção ao seio materno mostrou-se menos estressante do que a sucção à mamadeira quanto à saturação de oxigênio.

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15.

Transtornos mentais e comportamentais no sistema de informações hospitalares do SUS: perspectivas para a enfermagem
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Silva, Edilaine Cristina da

; Costa Junior, Moacyr Lobo da

Revista da Escola de Enfermagem da USP

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Jun 2006, Volume 40 Nº 2 Páginas 196 - 202

Resumo: Pt En Es | Texto: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Este estudo objetivou explorar algumas das possibilidades de informações sobre os transtornos mentais e comportamentais usando a Internet, especificamente dentro do site do Ministério da Saúde, DATASUS. Apresentou elementos que ilustram recursos dos Sistemas de Informação em Saúde, os quais podem ser utilizados pelos enfermeiros como um meio seguro e simplificado para obtenção de dados. O estudo focalizou internações psiquiátricas pelo SIH-SUS no município de Ribeirão Preto, SP. Ante a necessidade do enfermeiro de utilizar os recursos que possam contribuir para a organização dos serviços e para a análise da situação dos transtornos mentais e comportamentais, os dados do SIH-SUS apresentam-se como instrumento possível para desencadear o processo de análise, cujos resultados podem possibilitar mudanças importantes para o gerencimento dos serviços, na busca de qualidade na assistência em saúde mental e psiquiatria.

The purpose of this study was to explore some of the possibilities of getting information about mental and behavior disorders using the Internet, specifically at the Ministry of Health's DATASUS website. The site presented elements that illustrate the Health Information Systems' resources, which may be used by nurses as a safe and simplified way of obtaining data. The study focused on psychiatric hospitalization through the SIH-SUS in the city of Ribeirão Preto, State of São Paulo. Given the nurses' needs to use technological resources that can contribute for the organization of the service and the analysis of the situation of the mental and behavior disorders, SIH-SUS data are a possible instrument to start the analysis whose results may make possible important and effective changes for the management of the services, in search for quality in mental and psychiatric health assistance.

En este estudio se tuvo como objetivo explorar algunas posibilidades de informaciones sobre los trastornos mentales y de comportamiento usando Internet, específicamente dentro de la página Web del Ministerio de Salud, DATASUS. Se presentó elementos que ilustran recursos de los Sistemas de Información en Salud, que pueden ser utilizados por los enfermeros como un medio seguro y simplificado para la obtención de datos. El estudio enfocó hospitalizaciones psiquiátricas realizadas por el SIH-SUS en el municipio de Ribeirão Preto, estado de São Paulo. Ante la necesidad que tiene el enfermero de utilizar los recursos que puedan contribuir a la organización de los servicios y análisis de la situación de los trastornos mentales y de comportamiento, los datos del SIH-SUS se presentan como instrumento posible para desencadenar el proceso de análisis, cuyos resultados pueden posibilitar cambios importantes para la gerencia de los servicios, en búsqueda de calidad en la asistencia en salud mental y psiquiátrica.

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