[Direct Cost of Reprocessing Cotton-woven Surgical Drapes: a Case Study]. / Custo direto do reprocessamento de campos cirúrgicosde tecido de algodão: um estudo de caso.

OBJECTIVE: Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD: A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$) originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS: The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%). It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%). CONCLUSION: The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources.

Ebola virus disease in pregnancy: a systematic review and meta-analysis.

This review synthesises and appraises evidence on the effects of Ebola virus disease (EVD) in pregnancy. We searched bibliographic databases from dates of inception to November 2020, yielding 28 included studies. The absolute risk of maternal death associated with EVD was estimated at 67.8% (95% confidence interval [CI] 49.8 to 83.7, I2=85%, p<0.01) and the relative risk of death in pregnant women compared with non-pregnant women was estimated at 1.18 (95% CI 0.59 to 2.35, I2=31.0%, p=0.230). The absolute risk for foetal losses was estimated at 76.9% (95% CI 45.0 to 98.3, I2=96%, p<0.01) and neonatal death was 98.5% (95% CI 84.9 to 100, I2=0.0%, p=0.40). The gap analysis suggests limited or no data on the clinical course, non-fatal perinatal outcomes and EVD management in pregnant women. The review suggests that EVD has a high maternal and perinatal mortality, underscoring the urgent need for preventative and therapeutic solutions and improved screening and follow-up of pregnant women and newborns during outbreaks. There is not enough evidence to conclusively rule out pregnancy as a risk factor for mortality and there is limited evidence on the disease course, outcomes and management of EVD in pregnancy, and this supports the need for robust clinical trials and prospective studies that include pregnant women.

The presence of microvascular complications is associated with a poor evolution of metabolic control in patients with type 1 diabetes mellitus.

OBJECTIVE: To report the evolution of metabolic control and to assess the clinical and metabolic factors associated with the presence of microvascular complications in patients with type 1 diabetes mellitus (T1DM). MATERIAL AND METHODS: This was a retrospective, observational study analysing clinical, laboratory, and therapeutic data from a registry of patients with T1DM created in 2010. RESULTS: Data recorded from 586 patients (males: 50.2%; mean age: 36.1±13.5 years; T1DM duration: 18.0±12.1 years) followed for a mean of 6.0±3.1 years were assessed, and 8133 HbA1c levels (13.2±7.6 measurements/patient) were analysed, with a mean evolutionary HbA1c of 7.9%±1.2%. The mean annual HbA1c level gradually improved from 8.6%±1.6% in 2010 to 7.5%±1.4% in 2019, with 34.3% and 69.0% of patients having HbA1c levels ≤7% and ≤8% respectively. Patients with T1DM duration of <10 years and ≥20 years, non-smokers, CSII users, and those using the insulin/carbohydrate ratio had better current and evolutionary HbA1c levels. The presence of microvascular complications was independently associated with T1DM lasting ≥20 years, the presence of HBP, and evolutionary HbA1c≥7.0%. CONCLUSION: A progressive but still inadequate improvement in metabolic control over 10 years was seen in patients with T1DM. Poor metabolic control (mean HbA1c over 10 years ≥7%) was independently associated with the presence of microvascular complications.

Safety and diagnostic performance of parathyroid hormone assay in fine-needle aspirate in suspicious parathyroid adenomas.

OBJECTIVE: To evaluate the safety and diagnostic performance of parathyroid hormone assay in fine-needle aspirate (PTH-FNA) in patients with primary hyperparathyroidism and suspicious parathyroid adenomas. METHODOLOGY: A retrospective observational study was performed in 47 patients (57.7 ±â€¯11.2 years of average age, 74% women) attending an endocrinology clinic for primary hyperparathyroidism (average calcemia: 11.6 ±â€¯1.6 mg/dl and PTH: 276 ±â€¯477 pg/mL) in which PTH-FNA was made. Sensibility, specificity, positive predictive value and negative predictive value were calculated in all surgical patients. RESULTS: Forty-seven lesions were punctured (mean adenoma maximum diameter: 1.8 ±â€¯2.6 cm): negative image in the sestamibi scan (26 patients); the discordance between ultrasonography and the sestamibi scan (6 patients); possible intrathyroidal adenomas (4 patients); a positive sestamibi scan in 2 or more localizations (4 patients); ectopic adenoma (3 patients); persistent primary hyperparathyroidism (2 patients) and atypical adenomas (2 patients). Mean PTH-FNA was 2853 ±â€¯3957 pg/mL and 68% were considered positive (PTH-FNA ≥ 100 pg/mL). No complications were detected during or after the puncture. Thirty-seven patients were operated on, 95% were cured and no parathyromatosis cases were detected. PTH-FNA ≥ 100 pg/mL as a diagnostic test had a sensitivity of 93.7%, a specificity of 100%, a positive predictive value of 100% and an negative predictive value of 71.4%. CONCLUSION: PTH-FNA is an easy and safe diagnostic test and has a high sensitivity and specificity for differentiating between parathyroid adenomas and other cervical masses in patients with primary hyperparathyroidism.

Lassa fever in pregnancy: a systematic review and meta-analysis.

Lassa fever is a zoonotic infection endemic to West Africa and is known to have adverse effects in pregnancy. We sought to synthesize and critically appraise currently available evidence on the effects of Lassa fever in pregnancy. An exhaustive bibliographic search from dates of inception to 30 September 2019 yielded 13 studies, from which individual patient data were extracted. The absolute risk of maternal death associated with Lassa fever was estimated at 33.73% (95% CI 22.05 to 46.42%, I2=72.40%, p=0.0014). The relative risk of death in pregnant women compared with non-pregnant women was estimated at 2·86 (95% CI 1.77 to 4.63, I2=27.27%, p=0.239). The formal gap analysis shows imprecise data on the risk of Lassa-related maternal and perinatal mortality and insufficient data for other pregnancy outcomes. The currently available evidence for the use of ribavirin in pregnant patients is not conclusive. With a threefold increased risk of mortality, there is a need to prioritize pregnant women as a special subgroup of interest for Lassa research. Robust prospective studies estimating the true incidence of adverse maternal and perinatal outcomes and randomized controlled trials to evaluate the efficacy of therapeutics for maternal Lassa virus infection are urgently needed.

In vivo evidence of significant placental growth factor release by normal pregnancy placentas.

Placental growth factor (PlGF) is an angiogenic factor identified in the maternal circulation, and a key biomarker for the diagnosis and management of placental disorders. Furthermore, enhancing the PlGF pathway is regarded as a promising therapy for preeclampsia. The source of PlGF is still controversial with some believing it to be placental in origin while others refute this. To explore the source of PlGF, we undertook a prospective study enrolling normal pregnant women undergoing elective caesarean section. The level of PlGF was estimated in 17 paired serum samples from the uterine vein (ipsilateral or contralateral to the placental insertion) during caesarean section and from a peripheral vein on the same day and second day post-partum. PlGF levels were higher in the uterine than in the peripheral vein with a median difference of 52.2 (IQR 20.1-85.8) pg/mL p = 0.0006. The difference when the sampled uterine vein was ipsilateral to the placenta was 54.8 (IQR 37.1-88.4) pg/mL (n = 11) and 23.7 (IQR -11; 70.5) pg/mL (n = 6) when the sample was contralateral. Moreover, PlGF levels fell by 83% on day 1-2 post-partum. Our findings strongly support the primary source of PlGF to be placental. These findings will be of value in designing target therapies such as PlGF overexpression, to cure placental disorders during pregnancy.

Arctium lappa Extract Suppresses Inflammation and Inhibits Melanoma Progression.

Background: Arctium lappa has been used as popular medicinal herb and health supplement in Chinese societies. Bioactive components from A. lappa have attracted the attention of researchers due to their promising therapeutic effects. In this study, we investigated the effects of A. lappa hydroalcoholic extract (Alhe) during different models of inflammation, in vivo. Methods: The anti-inflammatory activity was evaluated through the air pouch model. For this, mice received an inflammatory stimulus with lipopolysaccharide (LPS) and were later injected with Alhe. To assess anti-tumoral activity, the animals were inoculated with B16F10 cells and injected with Alhe every 5 days, along the course of 30 days. Controls were submitted to the same conditions and injected with the vehicle. Peritoneal or air pouch fluids were collected to evaluate leukocyte counting or cellular activation via quantification of cytokines and nitric oxide. Results: Alhe injection reduced the neutrophil influx and production of inflammatory mediators in inflammatory foci after LPS or tumor challenges. Furthermore, Alhe injection reduced tumor growth and enhanced mice survival. Conclusions: Collectively, these data suggest that Alhe regulates immune cell migration and activation, which correlates with favorable outcome in mouse models of acute inflammation and melanoma progression.

Direct Cost of Reprocessing Cotton-woven Surgical Drapes: a Case Study / Costo Directo del Reprocesamiento de Campos Quirúrgicos de Tela de Algodón: un Estudio de Caso / Custo direto do reprocessamento de campos cirúrgicos de tecido de algodão: um estudo de caso

OBJECTIVE Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$) originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%). It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%). CONCLUSION The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources. .

OBJETIVO Identificar el costo directo del reprocesamiento de campos de tela de algodón, dobles y sencillos, integrantes del paquete de LAP quirúrgico. MÉTODO Estudio de caso cuantitativo, exploratorio-descriptivo, llevado a cabo en un hospital de enseñanza. Se calculó el costo directo multiplicándose el tiempo empleado por los profesionales involucrados en el reprocesamiento por el costo unitario de la mano de obra directa, sumándose al costo de los materiales. La moneda brasileña (R$) utilizada originalmente para los cálculos se convirtió en moneda estadounidense a la tasa de US$ 0.42/R$. RESULTADOS El costo total medio, por paquete de LAP quirúrgico, fue US$ 9.72, con predominancia del costo con materiales (US$ 8.70), el 89.65%. Se destaca que el costo total medio de los materiales recibió fuerte impacto de los costos de los campos de tela de algodón (US$ 7.99), el 91.90%. CONCLUSIÓN El conocimiento obtenido subsidiará discusiones acerca del reemplazo de campos de tela reutilizables por campos desechables, favoreciendo argumentaciones relativas a las ventajas y desventajas de dicha posibilidad al considerarse los recursos humanos, materiales, estructurales, ambientales y financieros. .

OBJETIVO Identificar o custo direto do reprocessamento de campos de tecido de algodão, duplos e simples, integrantes do pacote de LAP cirúrgico. MÉTODO Estudo de caso quantitativo, exploratório-descritivo, realizado em um hospital de ensino. Calculou-se o custo direto multiplicando-se o tempo despendido por profissionais envolvidos no reprocessamento pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais. A moeda brasileira (R$) utilizada originalmente para os cálculos foi convertida para a moeda norte-americana pela taxa de US$ 0.42/R$. RESULTADOS O custo total médio, por pacote de LAP cirúrgico, foi de US$ 9.72, com predominância do custo com materiais (US$ 8.70) 89.65%. Destaca-se que o custo total médio dos materiais recebeu forte impacto dos custos dos campos de tecido de algodão (US$ 7.99) 91.90%. CONCLUSÃO O conhecimento obtido subsidiará discussões sobre a substituição de campos de tecido reutilizáveis por campos descartáveis, favorecendo argumentações relativas às vantagens e desvantagens dessa possibilidade considerando os recursos humanos, materiais, estruturais, ambientais e financeiros. .

Mapeamento do processo de reprocessamento de campos cirúrgicos de tecido de algodão / Mapping the process of reprocessing cotton drapes

Mapear o processo de reprocessamento de campos de tecido de algodão, duplos e simples, integrantes dos pacotes de LAP cirúrgico. Método: Estudo de caso exploratório, descritivo, conduzido no Serviço de Rouparia (SR) e no Centro de Material e Esterilização (CME) de um hospital de ensino. Acompanhou-se a condução de todo o processo por meio de observações não participantes no SR e no CME e, posteriormente, realizou-se reuniões com profissionais representantes do SR (camareiras) e do CME (auxiliares e técnicos de enfermagem), visando o detalhamento, complementação e validação das etapas e atividades observadas. Resultados: Foram mapeadas quatro etapas: processamento das roupas por lavanderia terceirizada, recepção das roupas no SR, montagem e esterilização dos pacotes de LAP e armazenamento dos pacotes de LAP no CME. Conclusão: O mapeamento possibilitou a visualização dos recursos consumidos nas etapas e atividades constituintes do processo, fornecendo informações que contribuirão para a alocação racional dos recursos envolvidos...

Custo do reprocessamento de campos cirúrgicos de tecido de algodão: um estudo de caso / Cost for reprocessing cotton surgical drapes: a case study

Introdução: Os campos de tecido de algodão constituem uma das barreiras contra a invasão de micro-organismos nos sítios cirúrgicos dos pacientes e para proteção dos profissionais de saúde contra a exposição a fluidos orgânicos. Utiliza-se para cada procedimento, no mínimo, um pacote padrão composto por seis campos cirúrgicos duplos de algodão, um campo cirúrgico simples de algodão e um campo duplo de algodão para embalagem, que são reprocessáveis, denominado LAP cirúrgico. Objetivo: Mapear as etapas e atividades referentes ao processo de reprocessamento de campos de tecido de algodão duplos e simples integrantes dos pacotes de LAP cirúrgico e identificar o custo direto do reprocessamento de campos de tecido de algodão duplos e simples integrantes dos pacotes de LAP cirúrgico. Método: Pesquisa quantitativa, exploratória, descritiva, do tipo estudo de caso único, realizada no Hospital Santa Lucinda (HSL), Hospital de Ensino da Pontifícia Universidade de São Paulo. Calculou-se o custo direto multiplicando-se o tempo despendido por profissionais envolvidos no reprocessamento do pacote de LAP cirúrgico (Camareiras, Auxiliares e Técnicos de Enfermagem) pelo custo unitário da mão de obra direta (MOD), somando-se ao custo dos materiais. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: Foram mapeadas e validadas quatro etapas relativas ao reprocessamento de campos de tecido de algodão: processamento das roupas por lavanderia terceirizada, recepção das roupas no Serviço de Rouparia, montagem e esterilização dos pacotes de LAP cirúrgico e armazenamento dos pacotes de LAP cirúrgico no Centro de Material e Esterilização. O custo direto do reprocessamento, por pacote de LAP cirúrgico, correspondeu a R$ 23,09, sendo o custo com materiais o mais representativo (R$ 20,70 - 92,50%).Os custos, unitário e total, dos campos de tecido de algodão (duplo, duplo para embalagem e simples) impactaram predominantemente no custo total final dos materiais (R$ 19,02 -91,90%) utilizados. A partir do agrupamento das cirurgias/procedimentos relativos às 14 especialidades atendidas no HSL, considerando três meses típicos, estimou-se o consumo médio mensal de 1139 pacotes de LAP cirúrgico, totalizando R$ 33.226,51. Conclusão: O conhecimento do custo direto do reprocessamento do pacote de LAP cirúrgico poderá auxiliar nas tomadas de decisões em relação aos recursos envolvidos evitando desperdícios ao contribuir com elementos que propiciem o gerenciamento de custos.

Introduction: Drapes made of cotton constitute one of the barriers against the invasion of microorganisms into the surgical sites of patients, while protecting health professionals against exposure to organic fluids. Per procedure, at least one standard package is needed, consisting of six double cotton surgical drapes, one simple cotton surgical drape and one double cotton drape for packaging, which may be reprocessed, named surgical LAP. Objective: Map the stages and activities regarding the process of reprocessing double and simple cotton drapes, composing the surgical LAP packages, and identify the direct cost for this reprocessing. Method: Quantitative, exploratory, descriptive, single-case study conducted at Hospital Santa Lucinda (HSL), a teaching hospital of the Pontifical Catholic University of São Paulo. The direct cost was calculated by multiplying the time spent by professionals involved in the reprocessing of surgical LAP packages (cleaners, nursing technicians and nursing aides) by the unitary cost of the direct workforce (DWF), added to the cost of the materials. The Brazilian currency (R$) was used in the calculations. Results: Four stages regarding the reprocessing of cotton drapes were mapped and validated: processing of clothes by an outsourced laundry, entry of the clothes into the Clothing Service, putting together and sterilizing surgical LAP packages and storing surgical LAP packages in the Material and Sterilization Center. The reprocessing direct cost, per surgical LAP package, corresponded to R$ 23.09, with the cost for materials being the most significant(R$ 20.70 - 92.50%).The costs, both unitary and total, for the cotton drapes (double, double for packaging and simple) had a predominant impact on the final total cost for the used materials(R$ 19.02 - 91.90%). Based on the grouping of surgeries/procedures regarding the 14 specialties available in the HSL, considering three typical months, a mean monthly consumption of 1139 surgical LAP packages was estimated, totaling R$ 33,226.51. Conclusion: Learning the direct cost for reprocessing surgical LAP packages may assist in making decisions regarding the resources involved in this process, thus avoiding waste by contributing with elements that enable the management of costs.