Assuntos
Infecções por HIV/complicações , Hospedeiro Imunocomprometido , Infecções Oportunistas , Infecções Respiratórias/etiologia , Infecções Respiratórias/imunologia , Adulto , Infecções Bacterianas/complicações , Infecções por HIV/virologia , Humanos , Pacientes Internados , Masculino , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Estudos Prospectivos , Viroses/complicaçõesRESUMO
OBJECTIVE: We analyzed baseline and follow-up characteristics related to poorer renal outcomes in a Brazilian cohort of admixture race patients with lupus nephritis. METHODS: Overall, 280 outpatients with a diagnosis of systemic lupus erythematosus and previous kidney biopsy of lupus nephritis were recruited from August 2015 to December 2018 and had baseline laboratory and histologic data retrospectively analyzed; patients were then followed-up and data were recorded. The main outcome measure was the estimated glomerular filtration rate at last follow-up. Secondary analyses assessed the impact of initial kidney histology and treatment in long-term kidney survival. RESULTS: Median duration of lupus nephritis was 60 months (interquartile range: 27-120); 40 (14.3%) patients presented progressive chronic kidney disease (estimated glomerular filtration rate <30 and ≥10 ml/min/1.73 m2) or end-stage kidney disease at last visit. Adjusted logistic regression analysis showed that class IV lupus nephritis (odds ratio 14.91; 95% confidence interval 1.77-125.99; p = 0.01) and interstitial fibrosis ≥25% at initial biopsy (odds ratio 5.87; 95% confidence interval 1.32-26.16; p = 0.02), lack of complete or partial response at 12 months (odds ratio 16.3; 95% confidence interval 3.74-71.43; p < 0.001), and a second renal flare (odds ratio 4.49; 95% confidence interval 1.10-18.44; p = 0.04) were predictors of progressive chronic kidney disease. In a Kaplan-Meier survival curve we found that class IV lupus nephritis and interstitial fibrosis ≥25% were significantly associated with end-stage kidney disease throughout follow-up (hazard ratio 2.96; 95% confidence interval 1.3-7.0; p = 0.036 and hazard ratio 4.96; 95% confidence interval 1.9-12.9; p < 0.0001, respectively). CONCLUSION: In this large cohort of admixture race patients, class IV lupus nephritis and chronic interstitial damage at initial renal biopsy together with non-response after 1 year of therapy and relapse were associated with worse long-term renal outcomes.
Assuntos
Progressão da Doença , Falência Renal Crônica/etiologia , Nefrite Lúpica/fisiopatologia , Adulto , Brasil , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Humanos , Nefrite Lúpica/classificação , Nefrite Lúpica/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
The aim of this study was to determine the epidemiology (location, microbial load, microbiome, presence/absence of biofilm and pathogens, including ESKAPE-Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species, and antimicrobial susceptibility profiles) of the bacterial contamination on intensive care units (ICUs) surfaces. Fifty-seven high-touched surfaces were collected from adult, paediatric and neonatal ICUs from two large public Brazilian hospitals from central and north regions. Samples (c. 4 cm2 ) were subjected to culture (qualitative), qPCR targeting 16s rRNA gene (microbial load-bacteria per cm2 ), 16s rRNA amplicon sequencing (microbiome analysis) and scanning electron (SEM) or confocal laser scanning microscopy (CLSM) (biofilm presence). Multidrug resistant organisms (MROs) were detected using specific chromogenic agar. The average bacterial load was 1·32 × 104 bacteria per cm2 , container for newborn feeding bottles, stretcher mattress, humidicrib mattress filling and computer keyboards presented the higher bioburden. However, only 45·6% (26/57) were culture-positive, including 4/26 with MROs. ESKAPE organisms were detected in 51·8% of the samples subjected to next-generation sequencing. Viability staining and CLSM demonstrated live bacteria on 76·7% of culture-negative samples. Biofilm was present on all surfaces subjected to microscopy (n = 56), demonstrating that current cleaning practices are suboptimal and reinforcing that MROs are incorporated into hospital surfaces biofilm. SIGNIFICANCE AND IMPACT OF THE STUDY: Contamination of healthcare facilities surfaces has been shown to play a major role in transmission of pathogens. The findings of this study show that dry surface biofilms are widespread and can incorporate pathogens and multidrug-resistant organisms (MROs). Biofilms on highly touched surfaces pose a risk to patients, as dry surface biofilms persist for long period and micro-organisms within biofilm have been shown to be transmitted. This study also provides a better understanding of microbial populations in hospital environments, reinforcing that pathogens and MROs are found incorporated into biofilm, which impacts the difficulty in cleaning/disinfection.
Assuntos
Biofilmes/crescimento & desenvolvimento , Desinfecção/métodos , Contaminação de Equipamentos/estatística & dados numéricos , Unidades de Terapia Intensiva , Acinetobacter baumannii/crescimento & desenvolvimento , Acinetobacter baumannii/isolamento & purificação , Brasil , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla , Enterococcus faecium/crescimento & desenvolvimento , Enterococcus faecium/isolamento & purificação , Contaminação de Equipamentos/prevenção & controle , Humanos , Recém-Nascido , Klebsiella pneumoniae/crescimento & desenvolvimento , Klebsiella pneumoniae/isolamento & purificação , Microbiota , Microscopia Confocal , Microscopia Eletrônica de Varredura , Pseudomonas aeruginosa/crescimento & desenvolvimento , Pseudomonas aeruginosa/isolamento & purificação , RNA Ribossômico 16S , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus aureus/isolamento & purificaçãoRESUMO
O objetivo deste estudo foi avaliar os efeitos do tacrolimo e da ciclosporina na produção lacrimal de cães com ceratoconjuntivite seca (CCS) durante 90 dias. Para tanto, foram utilizados colírios de tacrolimo 0,02% (TcL) e ciclosporina 0,1% (CsA) em 14 cães com CCS. Os animais foram distribuídos em dois grupos e avaliados antes do início do tratamento (T0) e aos 15 (T1), 30 (T2), 45 (T3), 60 (T4), 75 (T5) e 90 (T6) dias após o início do tratamento. Na avaliação clínica, observou-se maior redução da secreção ocular, da opacidade e do edema corneano e da vascularização conjuntival. no grupo tacrolimo. No teste de Schirmer, verificou-se produção basal de 6(4,07 e 5,86(2,85mm/min no TcL e CsA, respectivamente, com aumento significativo da produção lacrimal em ambos os grupos, contudo houve aumento significativo da produção lacrimal a partir dos 15 dias de tratamento no grupo TcL (17,88(5,51mm/min), mas apenas a partir dos 45 dias no grupo CsA (11,86(4,74mm/min). Conclui-se que o uso do colírio tacrolimo aumentou em 68,83% a produção lacrimal em 90 dias de tratamento, comparado com a ciclosporina (56,82%), além de diminuir as manifestações clínicas inerentes à CCS, quando comparado à terapia com ciclosporina.(AU)
The objective of this study was to evaluate the effects of tacrolimus and cyclosporine on the lacrimal production of dogs with ketaroconjunctivitis sicca (KCS) for 90 days. Tacrolimus 0.02% (TcL) and 0.1% cyclosporine (CsA) eye drops were used in 14 dogs with KCS. The animals were randomly assigned to two groups and evaluated before treatment (T0) and at 15 (T1), 30 (T2), 45 (T3), 60 (T4), 75 (T5) and 90 (T6) days after initiation of treatment. Clinical evaluation showed significant reduction of ocular secretion, corneal opacity and edema and conjunctival vascularization in the tacrolimus group. Schirmer test showed basal lacrimal production of 6(4.07 and 5.86(2.85mm/min for TcL and CsA, respectively, with significant increase in lacrimal production in both groups. There was a significant increase in lacrimal production after 15 days of treatment in the TcL group (17.88(5.51mm/min), but only after 45 days in the CsA group (11.86(4.74mm/min). Tacrolimus drops increased lacrimal production in 68.83% after 90 days of treatment, compared to cyclosporine (56.82%), and also reduced clinical manifestations related to KCS when compared to cyclosporine.(AU)
Assuntos
Animais , Cães , Ceratoconjuntivite Seca/tratamento farmacológico , Ceratoconjuntivite Seca/veterinária , Soluções Oftálmicas/análise , Ciclosporina , TacrolimoRESUMO
O objetivo deste estudo foi avaliar os efeitos do tacrolimo e da ciclosporina na produção lacrimal de cães com ceratoconjuntivite seca (CCS) durante 90 dias. Para tanto, foram utilizados colírios de tacrolimo 0,02% (TcL) e ciclosporina 0,1% (CsA) em 14 cães com CCS. Os animais foram distribuídos em dois grupos e avaliados antes do início do tratamento (T0) e aos 15 (T1), 30 (T2), 45 (T3), 60 (T4), 75 (T5) e 90 (T6) dias após o início do tratamento. Na avaliação clínica, observou-se maior redução da secreção ocular, da opacidade e do edema corneano e da vascularização conjuntival. no grupo tacrolimo. No teste de Schirmer, verificou-se produção basal de 6(4,07 e 5,86(2,85mm/min no TcL e CsA, respectivamente, com aumento significativo da produção lacrimal em ambos os grupos, contudo houve aumento significativo da produção lacrimal a partir dos 15 dias de tratamento no grupo TcL (17,88(5,51mm/min), mas apenas a partir dos 45 dias no grupo CsA (11,86(4,74mm/min). Conclui-se que o uso do colírio tacrolimo aumentou em 68,83% a produção lacrimal em 90 dias de tratamento, comparado com a ciclosporina (56,82%), além de diminuir as manifestações clínicas inerentes à CCS, quando comparado à terapia com ciclosporina.(AU)
The objective of this study was to evaluate the effects of tacrolimus and cyclosporine on the lacrimal production of dogs with ketaroconjunctivitis sicca (KCS) for 90 days. Tacrolimus 0.02% (TcL) and 0.1% cyclosporine (CsA) eye drops were used in 14 dogs with KCS. The animals were randomly assigned to two groups and evaluated before treatment (T0) and at 15 (T1), 30 (T2), 45 (T3), 60 (T4), 75 (T5) and 90 (T6) days after initiation of treatment. Clinical evaluation showed significant reduction of ocular secretion, corneal opacity and edema and conjunctival vascularization in the tacrolimus group. Schirmer test showed basal lacrimal production of 6(4.07 and 5.86(2.85mm/min for TcL and CsA, respectively, with significant increase in lacrimal production in both groups. There was a significant increase in lacrimal production after 15 days of treatment in the TcL group (17.88(5.51mm/min), but only after 45 days in the CsA group (11.86(4.74mm/min). Tacrolimus drops increased lacrimal production in 68.83% after 90 days of treatment, compared to cyclosporine (56.82%), and also reduced clinical manifestations related to KCS when compared to cyclosporine.(AU)
Assuntos
Animais , Cães , Ceratoconjuntivite Seca/tratamento farmacológico , Ceratoconjuntivite Seca/veterinária , Soluções Oftálmicas/análise , Ciclosporina , TacrolimoRESUMO
BACKGROUND: During functionality testing and packaging of reusable surgical instruments (RSI) for sterilization, instruments are frequently touched. There is a lack of standards relating to hand hygiene frequency and use of gloves in the sterilizing service unit packing area. AIM: To determine the effect of hand hygiene and glove use on maintenance of RSI cleanliness. METHODS: Following manual and automated cleaning, Halsted-mosquito forceps were assessed for adenosine triphosphate (ATP), protein and microbial contamination after handling with gloved and ungloved but washed hands using an ATP surface swab test, bicinchoninic acid assay, and standard culture plate/broth, respectively. Gram's stain was used to classify the isolates. RSI contamination was assessed immediately following and 1, 2, and 4 h after washing hands. FINDINGS: Packing instruments with hands that had been unwashed for 2 or 4 h resulted in a significant increase in contaminating ATP when compared with all other treatment groups (P < 0.05). There was a significant correlation between the time since washing hands, the amount of ATP (r = 0.93; P ≤ 0.001), and the microbial load (r = 0.83; P ≤ 0.001) contaminating the forceps, where the longer the time the hands remained unwashed the higher the contamination. Significantly more contaminating protein was found on forceps handled with ungloved hands that had not been washed for 2 or 4 h (P < 0.001). CONCLUSION: Critical RSI inspection, assembling, lubricating and packing should be performed using either gloves or within 1 h of washing hands.
Assuntos
Contaminação de Equipamentos/prevenção & controle , Luvas Cirúrgicas/estatística & dados numéricos , Higiene das Mãos/métodos , Controle de Infecções/métodos , Instrumentos Cirúrgicos/microbiologia , Trifosfato de Adenosina/análise , Humanos , Técnicas Microbiológicas , Proteínas/análiseRESUMO
This study evaluated the differences in composition, abundance and morphology of testate amoebae among different habitats of the same aquatic environment (plankton, aquatic macrophyte and sediment) in the Upper Paraná River floodplain. Triplicate samplings were undertaken monthly at each habitat from April 2007 to March 2008. The structure of the community of testate amoebae was different among the habitats. The species typical for each habitat, according to Indval, were classified by their shell morphology. Arcella species together with Difflugia gramen and Difflugia pseudogramem were more abundant for plankton. Trinema and Phryganella stood out by their abundance and frequency in aquatic macrophytes. Centropyxis was an indicator of sediment. The results indicated a higher frequency of hemispherical and spherical shells in plankton and spherical and elongated shells in aquatic macrophytes. In the sediment, there was a high frequency of elongated species. Our results support the hypothesis that the community of testate amoebae has different structures among the habitats, refuting the idea that the organization of this community in plankton is guided by random events like the resuspension of organisms from the sediment and their displacement from marginal vegetation.
Assuntos
Amoeba/classificação , Ecossistema , Rios/parasitologia , Biodiversidade , Brasil , Áreas AlagadasRESUMO
The effect of tannins on endoparasite control in hair sheep was investigated using 20 entire lambs of the Santa Inês breed. At the beginning of the experiment these animals were 6-months old and weighed 22.5kg+/-4.7. The treatments used were (10 animals each): GT (animals receiving 18g of Acácia negra containing 18% of condensed tannin/animal/week) and GC (animals not receiving tannin). The experiment lasted 84 days, with animals kept on an Andropogon gayanus pasture. Faeces were collected weekly, with weighing and blood collection carried out fortnightly. At slaughter, the adult worms were harvested for identification and counting. Although the GT animals weighed more than the GC lambs at slaughter, these differences were not significant (P>0.05). In general, the values for haemoglobin, hematocrit, total protein, urea, phosphorus and calcium in the serum were within normal levels and no significant differences between groups were observed. For faecal egg count (FEC), lower values were observed throughout the experiment in the group receiving tannin, but these differences were only significant in the eighth week. There was a lower output of eggs by regression for GT compared with GC (P<0.05). The species identified, in decreasing order of worm count, were: Trichostrongylus colubriformis, Haemonchus contortus, Oesophagostomum columbianum, Cooperia sp., Strongyloides papillosus, Trichuris globulosa and Moniezia expansa. The total worm count and number of each species of worm were lower for GT compared with GC for T. colubriformis and Cooperia sp. (P<0.05). Condensed tannin (CT) from A. negra had an antiparasitic effect, thereby representing an alternative for worm control in sheep.
Assuntos
Acacia/química , Anti-Helmínticos/uso terapêutico , Helmintíase Animal/tratamento farmacológico , Fitoterapia/veterinária , Doenças dos Ovinos/tratamento farmacológico , Taninos/uso terapêutico , Animais , Animais Recém-Nascidos , Masculino , Contagem de Ovos de Parasitas/veterinária , Controle Biológico de Vetores , Fitoterapia/métodos , Distribuição Aleatória , Ovinos/crescimento & desenvolvimento , Especificidade da Espécie , Resultado do Tratamento , Aumento de PesoRESUMO
OBJECTIVE: To highlight the importance of venomous animal accidents in childhood. The conducts are based on the proposals of the Ministério da Saúde do Brasil [Ministry of Health of Brazil] to standardize medical care in this kind of accident. This article shows the importance of early clinical diagnosis and assistance.METHODS: Review of international and national literature that includes original articles, official standards and books.RESULTS: Pediatricians may always feel insecure when they have to attend children who had venomous animal accidents because this kind of pathology is not very common. This article tries to offer easy guidelines and describes the main steps to be followed. Besides, peculiar or unusual aspects of these accidents are to be found in the literature referred to in the end of this article. Venomous animal accidents are always more severe in children, therefore resulting in higher mortality and sequelae. We assert that the early antivenom sera is extremely helpful.CONCLUSIONS: The systematization of the assistance may guarantee that the essential steps are followed thus making the assistance itself more effective. This is the purpose of the guidelines presented in this article.
RESUMO
OBJECTIVE: To investigate the frequency of different kinds of burns, associated factors, major complications and their relations to other variables. METHODS: Descriptive study performed at Hospital João XXIII from January to December of 1992 with five hundred and thirtyseven children and adolescents. RESULTS: The age distribution was as follows: 408 patients were children (76%) and 129 were teenagers (24%). Most of the accidents, 398 cases (74%) happened at home, 235 of which (59%) in the kitchen. 80 patients were interned. They had the highest relative frequency of accidents outside home (p<0.05). Of these interned patients, 7 (9.0%) developed septicemia. The flame was the predominant agent within the group of inpatients (p<0.01) and was responsible for the highest extension of burning (p<0.05). Teenagers had the largest body burned surface compared to children (p<0.01). Local treatment with pomade or home made medicine was observed in 290 cases (54%); local wash with water only in 32 (6.0%). Dehydration was the most frequent complication and occurred in 28 (5,0%) patients. The average amount of internment was 30-/+33 days. CONCLUSIONS: Most of burning were consequence of domestic accidents, especially in youngers than 7 years old; hot liquids are the most frequent agents and kitchen the most frequent place. Flame, which determined the largest and deepest lesions, was the first cause of burns in teenagers and the second in children. Dehydration is the most frequent complication in the earlier phases and septicemia in the others.
RESUMO
A child, who had undergone ventriculoperitoneal shunting, presented with repeated episodes of pneumonia and expectoration of CSF. Chest x-ray demonstrated the presence of the shunt catheter in the base of the left lung. In the present case the distal end of the catheter perforated the diaphragm, entering the thoracic cavity through the pleura and penetrating the pulmonary parenchyma. CSF then flowed freely into the alveoli and bronchi and became expectorated during repeated bouts of coughing associated with pneumonia. This respiratory complication disappeared after the removal of the catheter. We theorize that the penetration of the catheter into the thoracic cavity was secondary to its displacement from the iliac fossa to the left infradiaphragmatic space between the spleen and the diaphragm where the intra-abdominal pressure is lowest. The respiratory movements and the hypertension inside the abdomen created a constant friction of the catheter against the diaphragm which was finally perforated, permitting the passage of the peritoneal end of the shunting device into the thoracic cavity and secondary penetration of the lung.