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BACKGROUND: While the role of Extended Focused Assessment with Sonography in Trauma (eFAST) is well defined in the management of severe blunt trauma, its performance in injuries caused by stab wounds has been poorly assessed. METHODS: Prospective single centre study which included all patients with stab wounds to the thorax or abdomen between December 2016 and December 2018. All patients underwent initial investigation with both eFAST and CT scan, except in cases of haemodynamic or respiratory instability, and in cases with a positive diagnosis by eFAST in which case surgery without CT scan was performed. RESULTS: Of the 200 consecutive patients included, 14 unstable patients underwent surgery immediately after eFAST. In these 14 patients, 9 had cardiac tamponade identified by eFAST and all were confirmed by surgery. In the remaining 186 patients, the median time between eFAST and CT scan was 30 min (IQR 20-49 min). Test characteristics (including 95% CI) for eFAST compared with reference standard of CT scan for detecting pneumothorax were as follows: sensitivity 77% (54%-92%), specificity 93% (90%-97%), positive predictive value (PPV) 60% (49%-83%), negative predictive value (NPV) 97% (93%-99%). Test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemothorax were as follows: sensitivity 97% (74%-99%), specificity 96% (92%-98%), PPV 83% (63%-93%) and NPV 99% (96%-100%). Finally, test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemoperitoneum were as follows: sensitivity 75% (35%-97%), specificity 97% (93%-99%), PPV 55% (23%-83%) and NPV 99% (96%-99%). CONCLUSIONS: In patients admitted with stab wounds to the torso, eFAST was not sensitive enough to diagnose pneumothorax and haemoperitoneum, but performed better in the detection of cardiac tamponade and haemothorax than the other injuries. More robust multicentre studies are needed to better define the role of eFAST in this specific population.
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Traumatismos Abdominais , Tamponamento Cardíaco , Pneumotórax , Traumatismos Torácicos , Ferimentos não Penetrantes , Ferimentos Perfurantes , Humanos , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Estudos Prospectivos , Hemotórax/etiologia , Hemotórax/complicações , Tamponamento Cardíaco/complicações , Hemoperitônio/etiologia , Hemoperitônio/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/complicações , Sensibilidade e Especificidade , Ultrassonografia , Traumatismos Abdominais/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/complicações , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagemRESUMO
Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.
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Antibacterianos/uso terapêutico , Infecções dos Tecidos Moles/tratamento farmacológico , Idoso , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Feminino , França , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/mortalidade , Resultado do TratamentoRESUMO
Objective: To evaluate the enamel bonding ability and orthodontic adhesive resin degree of conversion using the experimental bracket design. Material and Methods. Thirteen bovine teeth were used in the study. The experimental bracket was modified with a translucent region in the center of its body. After enamel etching, Orthocem orthodontic adhesive (FGM, Joinville, Brazil) was applied on the bracket base for bonding. The groups were divided as follows (n = 10 per group): (1) control (CB) with standard brackets and (2) spot bracket (SB) with experimental brackets featuring a 0.8 mm translucent region at the center using carbide bur. Shear bond strength (SBS) was evaluated after 24 hours in a universal testing machine and adhesive remnant index (ARI). The degree of conversion (DC) was analyzed using Raman spectroscopy (n = 3 per group). Data were then analyzed using Student's t-test and Mann-Whitney statistical methods. Results: The SB group exhibited a higher mean SBS (10.33 MPa) compared to the CB Group (8.77 MPa). However, there was no statistical difference between the groups (p = 0.376). Both SB and CB groups had a mean ARI score of 1. Raman analysis revealed a higher degree of conversion in the SB group (49.3%) compared to the CB group (25.9%). Conclusions: The experimental support showed a higher degree of adhesive conversion, although there was no significant increase in bond strength.
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Resinas Compostas , Colagem Dentária , Esmalte Dentário , Braquetes Ortodônticos , Polimerização , Resistência ao Cisalhamento , Animais , Bovinos , Colagem Dentária/métodos , Esmalte Dentário/química , Resinas Compostas/química , Teste de Materiais , Cimentos Dentários/química , Cimentos de Resina/químicaRESUMO
This study assessed the occurrence of five antibiotics, three hormones, caffeine, and long and short-chain perfluoroalkyl and polyfluoroalkyl substances (PFASs) in surface water and feedstuff samples obtained from aquaculture cages in Três Marias reservoir in Brazil. This is the first work to evaluate the presence of PFAS in surface water used for aquaculture in Brazil. Solid-phase extraction and low temperature partitioning extraction followed by liquid chromatography coupled to mass spectrometry (LC-MS) were performed to process and analyze surface water samples and feedstuff, respectively. The ecotoxicological risk quotient was calculated for target compounds detected in water. Ciprofloxacin and caffeine were detected in all surface water samples. Pharmaceutical drugs ranged from 0.7 ng L-1 (trimethoprim) to 389.2 ng L -1 (ß-estradiol). Estrone (10.24 ng g-1) and ß-estradiol (66.20 ng g-1) were also found in feedstuff. Four PFASs (PFOA, PFDoA, PFTeDA, and PFBS) were detected (9.40-15.2 µg L-1) at levels higher than reported in studies conducted worldwide. Ecotoxicological risk assessment indicated high risks for caffeine and PFOA, PFDoA, and PFTeDA with RQ values from 10 to 103. These findings reveal risks to biodiversity, ecosystem integrity and human health considering possible intake of these contaminants by fish consumption due to potential bioaccumulation of these substances. Hence, it is critical to conduct more studies in this direction in Brazil and other low and middle-low-income countries.
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Ácidos Alcanossulfônicos , Ciclídeos , Fluorocarbonos , Poluentes Químicos da Água , Humanos , Animais , Água/análise , Brasil , Monitoramento Ambiental , Antibacterianos/análise , Ácidos Alcanossulfônicos/análise , Cafeína/análise , Ecossistema , Estradiol/análise , Poluentes Químicos da Água/análise , Fluorocarbonos/análiseRESUMO
Persistent molecules, such as pesticides, herbicides, and pharmaceuticals, pose significant threats to both the environment and human health. Advancements in developing efficient photocatalysts for degrading these substances can play a fundamental role in remediating contaminated environments, thereby enhancing safety for all forms of life. This study investigates the enhancement of photocatalytic efficiency achieved by incorporating La3+ into Ag3PO4, using the co-precipitation method in an aqueous medium. These materials were utilized in the photocatalytic degradation of Rhodamine B (RhB) and Ciprofloxacin (CIP) under visible light irradiation, with monitoring conducted through high-performance liquid chromatography (HPLC). The synthesized materials exhibited improved stability and photodegradation levels for RhB. Particularly noteworthy was the 2% La3+-incorporated sample (APL2), which achieved a 32.6% mineralization of CIP, nearly three times higher than pure Ag3PO4. Toxicological analysis of the residue from CIP photodegradation using the microalga Raphidocelis subcapitata revealed high toxicity due to the leaching of Ag + ions from the catalyst. This underscores the necessity for cautious wastewater disposal after using the photocatalyst. The toxicity of the APL2 photocatalysts was thoroughly assessed through comprehensive toxicological tests involving embryo development in Danio rerio, revealing its potential to induce death and malformations in zebrafish embryos, even at low concentrations. This emphasizes the importance of meticulous management. Essentially, this study adeptly delineated a thorough toxicological profile intricately intertwined with the photocatalytic efficacy of newly developed catalysts and the resultant waste produced, prompting deliberations on the disposal of degraded materials post-exposure to photocatalysts.
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Lantânio , Fosfatos , Fotólise , Rodaminas , Compostos de Prata , Poluentes Químicos da Água , Peixe-Zebra , Compostos de Prata/química , Catálise , Rodaminas/química , Poluentes Químicos da Água/química , Poluentes Químicos da Água/toxicidade , Fosfatos/química , Fosfatos/toxicidade , Lantânio/química , Lantânio/toxicidade , Animais , Ciprofloxacina/química , Ciprofloxacina/toxicidade , LuzRESUMO
Ag2CrO4 is a representative member of a family of Ag-containing semiconductors with highly efficient visible-light-driven responsive photocatalysts. The doping process with Eu3+ is known to effectively tune their properties, thus opening opportunities for investigations and application. Here, we report the enhancement of the photocatalytic activity and stability of Ag2CrO4 by introducing Eu3+cations. The structural, electronic, and photocatalytic properties of Ag2CrO4:xEu3+ (x = 0, 0.25, 0.5, 1%) synthesized using the coprecipitation method were systematically discussed, and their photodegradation activity against rhodamine B (RhB), ciprofloxacin hydrochloride monohydrate (CIP), and 4-nitrophenol (4-NP) was evaluated. Structural analyses reveal a short-range symmetry breaking in the Ag2CrO4 lattice after Eu3+ doping, influencing the material morphology, size, and electronic properties. XPS analysis confirmed the incorporation of Eu3+ and alteration of the surface oxygen species. Furthermore, photoluminescence measurements indicated that the doping process was responsible for reducing recombination processes. The sample doped with 0.25% Eu3+ exhibited superior photocatalytic performance compared to pure Ag2CrO4. Scavenger experiments revealed an increase in the degradation via â¢OH reactive species for the sample doped with 0.25% Eu3+. DFT calculations provided atomic-scale insights into the structural and electronic changes induced by the Eu3+ doping process in the Ag2CrO4 host lattice. This study confirms that Eu3+ doping alters the band structure, enabling different degradation paths and boosting the separation/transfer of photogenerated charges, thereby improving the overall photocatalytic performance.
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Microbial colonization and development of infections in wounds is a sign of chronicity. The prevailing approach to manage and treat these wounds involves dressings. However, these often fail in effectively addressing infections, as they struggle to both absorb exudates and maintain optimal local moisture. The system here presented was conceptualized with a three-layer design: the outer layer made of a fibrous polycaprolactone (PCL) film, to act as a barrier for preventing microorganisms and impurities from reaching the wound; the intermediate layer formed of a sodium alginate (SA) hydrogel loaded with ampicillin (Amp) for fighting infections; and the inner layer comprised of a fibrous film of PCL and polyethylene glycol (PEG) for facilitating cell recognition and preventing wound adhesion. Thermal evaluations, degradation, wettability and release behavior testing confirmed the system resistance overtime. The sandwich demonstrated the capability for absorbing exudates (≈70 %) and exhibited a controlled release of Amp for up to 24 h. Antimicrobial testing was performed against Staphylococcus aureus and Escherichia coli, as representatives of Gram-positive and Gram-negative bacteria: >99 % elimination of bacteria. Cell cytotoxicity assessments showed high cytocompatibility levels, confirming the safety of the proposed sandwich system. Adhesion assays confirmed the system ease of detaching without mechanical effort (0.37 N). Data established the efficiency of the sandwich-like system, suggesting promising applications in infected wound care.
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Alginatos , Antibacterianos , Escherichia coli , Poliésteres , Staphylococcus aureus , Infecção dos Ferimentos , Alginatos/química , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antibacterianos/química , Antibacterianos/administração & dosagem , Poliésteres/química , Ampicilina/farmacologia , Ampicilina/uso terapêutico , Ampicilina/química , Humanos , Hidrogéis/química , Polietilenoglicóis/química , Animais , Bandagens , Testes de Sensibilidade Microbiana , Camundongos , Cicatrização/efeitos dos fármacosRESUMO
Here, we present the synthesis of a highly efficient V-doped α-Ag2WO4 catalyst for the oxidation of sulfides to sulfones, exhibiting a high degree of tolerance towards various sensitive functional groups. Remarkably, the catalysts with 0.01% V-doping content exhibited outstanding selectivity towards the oxidation process. Scavenger experiments indicated the direct involvement of electron-hole (e-/h+) pairs, hydroxyl radical (ËOH), and singlet oxygen (1O2) in the catalytic mechanism. Based on the experimental and theoretical results, the higher activity of the V-doped α-Ag2WO4 samples was associated with the preferential formation of the (100) surface in the catalyst morphology.
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Several diseases have been reported as affecting endangered wild sea turtle population worldwide, including spirorchiidiasis. This parasitic infection results in serious circulatory disorders in sea turtles, as well as tissue damage due to the presence of spirorchiids eggs. However, few reports of organs severely affected by tissue replacement caused by granulomatous inflammatory processes due to spirorchiidiasis in sea turtles are available. In this regard, this study describes massive lesions in 16 juvenile green turtles from southeastern Brazil presenting no other detectable diseases or injuries, associated to parasitic compression of air spaces, parasitic thyroid atrophy, parasitic encephalic compression and parasitic splenic lymphoid depletion. These rare injuries were categorized as extremely severe, affecting most spirorchiidiasis-infected organs. Spirorchiidiasis was, thus, noted herein as capable of causing a variety of lethal injuries to vital or extremely important organs in sea turtles. Spirorchiidiasis should, therefore, also be considered a potential cause of death in stranded green sea turtle monitoring efforts.
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OBJECTIVE: This study addressed dance practice intertwining communication, functional independence and social behavior in autistic children and adolescents with all levels of need support. DESIGN: A pilot randomized clinical trial with seventy-two participants between 8 and 15 years old were assessed for eligibility. SETTING: Theater rehearsal room and mental health clinic. INTERVENTIONS: Dance group (n = 17) or control group (n = 19), 24 sessions, once a week, lasting 40 min. MAIN OUTCOME MEASURES: The Autism Behavior Checklist (ABC), Autistic Screening Questionnaire (ASQ), Childhood Autism Rate Scale (CARS), Functional Independence Measure (FIM), and World Health Organization Disability Assessment Schedule (WHODAS, version 2.0, to assess mothers' functioning) were applied at two time points: baseline and end-point. RESULTS: Differences between dance and control groups were significant at post-intervention for communication (mean difference: 1.31; 99.8%CI: 0.29, 2.32, p < 0.001, d = 0.93); social cognition (mean difference: 1.01; 99.8%CI: 0.13, 1.89, p < 0.001, d = 0.82); autistic behavior (mean difference: 11.82; 99.8%CI: 17.33, -6.31, p < 0.001, d = 1.45). CONCLUSIONS: In this preliminary study, the findings provide ways of communication and social interaction through dance practice by autistic children and adolescents with all levels of support needs. Research on neurodiversity is needed to understand its feasibility and the lifestyle appropriation.
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Transtorno do Espectro Autista , Transtorno Autístico , Dança , Criança , Adolescente , Humanos , Transtorno Autístico/terapia , Projetos Piloto , ComunicaçãoRESUMO
Size and morphology control during the synthesis of materials requires a molecular-level understanding of how the addition of surface ligands regulates nucleation and growth. In this work, this control is achieved by using three carboxylic acids (tartaric, benzoic, and citric) during sonochemical syntheses. The presence of carboxylic acids affects the kinetics of the nucleation process, alters the growth rate, and governs the size and morphology. Samples synthesized with citric acid revealed excellent photocatalytic activity for the degradation process of Rhodamine B, and recyclability experiments demonstrate that it retains 91% of its photocatalytic activity after four recycles. Scavenger experiments indicate that both the hydroxyl radical and the hole are key species for the success of the transformation. A reaction pathway is proposed that involves a series of dissolution-hydration-dehydration and precipitation processes, mediated by the complexation of Ag+. We believe these studies contribute to a fundamental understanding of the crystallization process and provide guidance as to how carboxylic acids can influence the synthesis of materials with controlled size and morphology, which is promising for multiple other scientific fields, such as sensor and catalysis fields.
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The worldwide outbreak of the coronavirus pandemic (COVID-19) and other emerging infections are difficult and sometimes impossible to treat, making them one of the major public health problems of our time. It is noteworthy that Ag-based semiconductors can help orchestrate several strategies to fight this serious societal issue. In this work, we present the synthesis of α-Ag2WO4, ß-Ag2MoO4, and Ag2CrO4 and their immobilization in polypropylene in the amounts of 0.5, 1.0, and 3.0 wt %, respectively. The antimicrobial activity of the composites was investigated against the Gram-negative bacterium Escherichia coli, the Gram-positive bacterium Staphylococcus aureus, and the fungus Candida albicans. The best antimicrobial efficiency was achieved by the composite with α-Ag2WO4, which completely eliminated the microorganisms in up to 4 h of exposure. The composites were also tested for the inhibition of SARS-CoV-2 virus, showing antiviral efficiency higher than 98% in just 10 min. Additionally, we evaluated the stability of the antimicrobial activity, resulting in constant inhibition, even after material aging. The antimicrobial activity of the compounds was attributed to the production of reactive oxygen species by the semiconductors, which can induce high local oxidative stress, causing the death of these microorganisms.
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Although Ag-based materials are efficient against antibiotic-resistant bacteria, their high toxicity to living organisms represents a major challenge for obtaining useful products. In this work, we report the bactericidal activity of Ag4V2O7/ß-AgVO3 heterostructures, which proved to be effective against Klebsiella pneumoniae (ATCC 1706, a standard strain; A54970, a multidrug-resistant carbapenemase (KPC)-producing strain; A34057, a multidrug-resistant strain capable of producing extended spectrum beta-lactamases (ESBL); and a community-isolated strain, A58240) at minimum inhibitory concentrations (MIC) as low as 62.5 µg/mL. This activity is higher than that reported for the individual silver vanadates (Ag4V2O7 or ß-AgVO3) owing to the synergistic interactions between both semiconductors. However, the most efficient heterostructure was found to be toxic to mouse 3 T3 fibroblasts and to L. sativa and C. sativus seeds, as indicated by MTT ((4,5 - dimethylthiazol -2yl) 2,5 -diphenylbromide), neutral red assays and germination index measurements. The antimicrobial, phytotoxic and cytotoxic activities were all associated with an efficient generation of reactive oxygen species (ROS) in the heterostructure, especially OH and O2- radicals. The ROS production by Ag4V2O7/ß-AgVO3 heterostructures was measured through photodegradation studies with Rhodamine B. While the bactericidal activity of the heterostructures is promising, especially when compared to Ag-based materials, their use in practical applications will require encapsulation either to avoid leaching or to mitigate their toxicity to humans, animals and plants.
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Antibacterianos , Klebsiella pneumoniae , Animais , Antibacterianos/farmacologia , Humanos , Camundongos , Espécies Reativas de Oxigênio/farmacologia , Prata/farmacologia , Vanadatos/farmacologia , beta-Lactamases/metabolismoRESUMO
In this work, antibiotic pyrazinamide (PZA) photodegradation on palygorskite (Pal), NiWO4 crystals, and NiWO4-Pal (2, 6, and 10%) nanocomposites was evaluated under polychromatic irradiation. In the characterization of the samples, XRD patterns displayed good crystallinity for NiWO4 crystals and nanocomposites. In addition, the diffractograms were used in the Rietveld refinement for phase indexing, revealing a wolframite-type monoclinic structure with the space group P2/c. The active vibrational modes related to the characteristic groups of the samples were identified using Raman and FTIR spectroscopy. Photoluminescence (PL) spectra revealed that NiWO4 and NiWO4-Pal (2%) nanocomposite have the highest electron-hole pair recombination rate, and the contribution of the green component in the NiWO4-Pal (2%) nanocomposite indicates a greater contribution of deep energy levels to the PL profile. DRS in the UV-visible region indicated that NiWO4 crystals have indirect band-gap energy (Egap) 2.64 eV; NiWO4-Pal (2, 6, and 10%) nanocomposites have 2.62, 2.58, and 2.59 eV, respectively; and Pal has 2.83 eV. The catalytic tests showed that the NiWO4-Pal (2%) nanocomposite samples, under polychromatic radiation, exhibit greater efficiency in photodegradation at 110 min, with yield of 98.5%. The ROS tests indicated that the studied reactive species play a similar role in PZA photodegradation.
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Nanocompostos , Pirazinamida , Fotólise , Espécies Reativas de Oxigênio , Nanocompostos/química , Antibacterianos/químicaRESUMO
COVID-19, as the cause of a global pandemic, has resulted in lockdowns all over the world since early 2020. Both theoretical and experimental efforts are being made to find an effective treatment to suppress the virus, constituting the forefront of current global safety concerns and a significant burden on global economies. The development of innovative materials able to prevent the transmission, spread, and entry of COVID-19 pathogens into the human body is currently in the spotlight. The synthesis of these materials is, therefore, gaining momentum, as methods providing nontoxic and environmentally friendly procedures are in high demand. Here, a highly virucidal material constructed from SiO2-Ag composite immobilized in a polymeric matrix (ethyl vinyl acetate) is presented. The experimental results indicated that the as-fabricated samples exhibited high antibacterial activity towards Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) as well as towards SARS-CoV-2. Based on the present results and radical scavenger experiments, we propose a possible mechanism to explain the enhancement of the biocidal activity. In the presence of O2 and H2O, the plasmon-assisted surface mechanism is the major reaction channel generating reactive oxygen species (ROS). We believe that the present strategy based on the plasmonic effect would be a significant contribution to the design and preparation of efficient biocidal materials. This fundamental research is a precedent for the design and application of adequate technology to the next-generation of antiviral surfaces to combat SARS-CoV-2.
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The current unprecedented coronavirus pandemic (COVID-19) is increasingly demanding advanced materials and new technologies to protect us and inactivate SARS-CoV-2. In this research work, we report the manufacture of Ag3PO4 (AP)/polypropylene (PP) composites using a simple method and also reveal their long-term anti-SARS-CoV-2 activity. This composite shows superior antibacterial (against Staphylococcus aureus and Escherichia coli) and antifungal activity (against Candida albicans), thus having potential for a variety of technological applications. The as-manufactured materials were characterized by XRD, Raman spectroscopy, FTIR spectroscopy, AFM, UV-vis spectroscopy, rheology, SEM, and contact angle to confirm their structural integrity. Based on the results of first-principles calculations at the density functional level, a plausible reaction mechanism for the initial events associated with the generation of both hydroxyl radical â¢OH and superoxide radical anion â¢O2- in the most reactive (110) surface of AP was proposed. AP/PP composites proved to be an attractive avenue to provide human beings with a broad spectrum of biocide activity.
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COVID-19 , Polipropilenos , Humanos , Saúde Pública , SARS-CoV-2 , Staphylococcus aureusRESUMO
Background: Empirical antibiotherapy (EA) should target all bacteria in post-operative peritonitis (PP). Nevertheless, recent studies failed to prove a link between adequacy of EA and prognosis of PP. We sought to confirm this loss of association between adequate EA and prognosis and to analyze the evolution of patients' characteristics and antimicrobial strategies. Methods: This is was retrospective study. Patients with a positive fungal culture were excluded. The cohort was divided into two time periods. Data of survivors and non-survivors were compared within each time period. Differences between the two periods were assessed. A multivariable analysis searched for parameters associated with a higher hospital mortality rate. Results: Two hundred fifty-one patients were included, with 92 patients in the first period (P1) and 152 patients in the second period (P2). Inadequate EA was associated with a worse outcome only in P1. The multivariable analysis in the whole cohort showed that inadequate EA was associated with a higher mortality rate. When the differences noticed between the two periods were entered in the model (presence of resistant gram-positive cocci and EA comprising glycopeptides), inadequate EA was no longer associated with worse outcome. In P1, the most severe patients had more resistant bacteria, hence, had a higher rate of inadequate EA. This artifact disappeared in P2, during which broader antibiotherapies with triple EA were more often prescribed for the most severe patients. Conclusion: This study showed that the link between inadequate EA and outcome of patients with PP was at least partly artifactual in older studies.
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Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório , Mortalidade Hospitalar , Peritonite/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminoglicosídeos/uso terapêutico , Fístula Anastomótica , Líquido Ascítico/microbiologia , Ácidos Clavulânicos/uso terapêutico , Estudos de Coortes , Técnicas de Cultura , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Bacteriana Múltipla , Feminino , Fluoroquinolonas/uso terapêutico , Humanos , Imipenem/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Peritonite/microbiologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/microbiologia , Ticarcilina/uso terapêutico , Resultado do Tratamento , Vancomicina/uso terapêuticoRESUMO
Introduction: Recent studies described the threat of emerging multidrug-resistant (MDR) bacteria in intensive care unit (ICU) patients, but few data are available for necrotizing skin and soft tissue infections (NSTI). In a cohort of ICU patients admitted for NSTI, we describe the dynamic changes of microbial population during repeated surgeries. Materials and Methods: This retrospective study compiled consecutive cases admitted for the management of severe NSTI. Clinical characteristics, NSTI features, morbidity and mortality data were collected. The microbiological characteristics of surgical samples obtained during initial surgery were compared with those obtained during the first reoperation, including persistence of initial pathogens and/or emergence of microorganisms. Risk factors for emergence of microorganisms and MDR bacteria were assessed by univariable and multivariable analyses. Results: Among 100 patients {63% male, 58 years old [interquartile ratio (IQR) 50-68]} admitted for NSTI, 54 underwent reoperation with a median [IQR] delay of 3 (1-7) days. Decreased proportions of susceptible strains and emergence of Gram-negative bacteria, including Pseudomonas aeruginosa, staphylococci and enterococci strains, were reported based on the cultures of surgical specimen collected on reoperation. On reoperation, 22 (27%) of the isolated strains were MDR (p < 0.0001 vs. MDR bacteria cultured from the first samples). Broad-spectrum antibiotic therapy as first-line therapy was significantly associated with a decreased emergence of microorganisms. Adequate antibiotic therapy from the initial surgery did not modify the frequency of emergence of microorganisms (p = 0.79) and MDR bacteria (p = 1.0) or the 1-year survival rate. Conclusion: The emergence of microorganisms, including MDR bacteria, is frequently noted in NSTI without affecting mortality.
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Various investigators agree that the incidence of cholelithiasis is greater in patients with Chagas disease. The most plausible explanation for this is based on the parasympathetic denervation that occurs over the whole digestive tract due to Chagas disease. In order to analyze the occurrence of this alteration, gallbladder neuron counts were performed on cholelithiasis patients with and without Chagas disease who were being treated at the Department of Digestive Surgery, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil. In the present study, a notable reduction in the number of neurons in the gallbladder wall was observed in Chagas patients, in comparison with non-Chagas subjects.