Neonatal late-onset bloodstream infection: attributable mortality, excess of length of stay and risk factors.

BACKGROUND: Bloodstream infection represents a major threat among neonates under intensive care with considerable impact on morbidity and mortality. This study evaluated extra stay, attributable mortality and the risk factors associated with late-onset bloodstream infection (LO-BSI) among neonates admitted to a neonatal intensive care unit during a 4-year period. METHODS: A retrospective matched cohort study was conducted. For each case, there was one control patient without LO-BSI matched for sex, birth weight, gestational age, duration of hospitalization prior to the date of LO-BSI in the respective cases, underlying illness and birth date. A novel test, sequential plan, was employed for attributable mortality analysis in addition to standard tests. Multiple logistic regression was employed for risk factor analysis. RESULTS: Fifty pairs of cases and controls were compared. LO-BSI prolonged hospital stay of 25.1 days in pairs where both subjects survived. Overall attributable mortality was 24% (95% CI: 9-39% p < 0.01) and specific attributable mortality due to Staphylococcus epidermidis was 26.7% (95% CI: 23-30.4%; p = 0.01). Blood and/or blood components transfusion was independently associated with neonatal LO-BSI (OR: 21.2; 95% CI: 1.1-423). CONCLUSIONS: LO-BSI infection prolongs hospital stay and is associated with increased mortality among neonates. In the present series, blood transfusion was a significant risk factor for LO-BSI.

[Knowledge and practices regarding stroke at a university hospital: Part 1. Education of the nursing staff: priorities for the treatment of cerebral infarction]. / Práticas e nível de conhecimento sobre doença cerebrovascular em um hospital universitário. Parte 1. Educação do corpo de enfermagem: prioridade para o tratamento do infarto cerebral.

BACKGROUND AND PURPOSE: This study was undertaken to evaluate professionals working at a university hospital as to their knowledge and attitudes towards stroke. METHODS: Individuals working in the hospital were divided in two groups, health care workers (HCW) and non-health care workers (NHCW), and further subdivided according to level of schooling, resulting in seven strata. A closed questionnaire addressing epidemiology, risk factors, pathophysiology, typical symptoms, treatment, clinical course and personal attitudes towards smoking and blood pressure control, was applied to a random sample of each stratum (total n = 309). Kruskal-Wallis test for multiple comparisons of non-parametric data was used. RESULTS: Significant differences between the seven groups were found. Knowledge was strongly associated with being a HCW and with level of formal education (p < 0.001), even after excluding physicians from the analysis (p < 0.001). In NHCW groups, knowledge was not associated with level of education (p = 0.421). In these groups, personal fear of suffering a stroke was the only variable predictive of knowledge. Smoking and poor monitoring of blood pressure levels were also more common in strata with the lowest levels of education and among NHCW. CONCLUSION: Poor knowledge and wrong attitudes towards stroke are frequent among individuals working in a Brazilian university hospital. Although these results are not necessarily applicable to the general population, they will certainly be useful for the development of educational programs on stroke.

[Knowledge and practices regarding stroke at a university hospital: Part 2. Medical education in the new era of treatment of cerebral infarction]. / Práticas e nível de conhecimento sobre doença cerebrovascular em um hospital universitário. Parte 2. Educação médica na nova era de tratamento do infarto cerebral.

BACKGROUND AND PURPOSE: This study was undertaken to evaluate professionals working at a University Hospital as to their knowledge and attitudes towards stroke. METHODS: Individuals working in the hospital were divided in two groups, Health care workers (HCW) and non-Health care workers (NHCW), and further subdivided according to level of schooling, resulting in seven strata. A closed questionnaire addressing epidemiology, risk factors, pathophysiology, typical symptoms, treatment, clinical course and personal attitudes towards smoking and blood pressure control, was applied to a random sample of each stratum (total n = 309). The physicians group included 48 individuals. Kruskal-Wallis test for multiple comparisons of non-parametric data was used. Special attention was given to the wrong answers. RESULTS: Physicians correctly answered 92.6% of the questions. Their performance was superior to that of all other groups in all subgroups of questions. However, a large number of errors was found in questions addressing mortality and hospital mortality following stroke and the intimate relation between coronary and cerebral atherosclerosis. Treatment options in cerebral infarction are also poorly recognised. CONCLUSIONS: Although physicians general knowledge about stroke is good, they frequently do not perceive it as a critical disease requiring urgent hospital evaluation and care. The importance of a thorough cardiac evaluation following stroke and of the intimate relation between cardiac and cerebral ischemic disease is also unclear to this group. More hours of stroke teaching and practical training in stroke could possibly fill these gaps.

[Spontaneous and traumatic rupture of the renal parenchyma in primary obstructive megaureter: a report of 2 cases]. / Rottura spontanea e traumatica del parenchima renale nel megauretere ostruttivo primitivo: descrizione di due casi.

Urinary extravasation in infants may occur secondary to a variety of congenital obstructive uropathic conditions. This condition has been reported most often in infants with posterior urethral valves and pelviureteral junction obstruction. We present two cases of perirenal urinary extravasation from the kidney due to primary obstructive megaureter. Clinical presentation, evaluation and treatment of this rare entity are discussed.

In vivo effectiveness of lithium on impaired neutrophil chemotaxis in Shwachman-Diamond syndrome.

The effect of lithium treatment on the impaired neutrophil chemotactic function of a patient affected by Shwachman-Diamond syndrome is reported. We found that (1) a cytoskeletal cellular defect seems to be involved in the impairment of neutrophil function (and perhaps of cellular secretion and chondrocyte function) in the syndrome; (2) intermittent neutropenia is always present in the syndrome, and (3) lithium seems capable, in addition to its capacity of inducing leukocytosis, of modulating leukocyte functions by modulating the microtubular system. The drug, at usual therapeutic dosage, was able to normalize neutrophil functions without side effects. As no therapy is available in this syndrome to date, our data suggest the therapeutic use of lithium in order to improve these cytoskeleton-mediated functions and the degree of neutropenia.