Association between Clostridium difficile infection and antimicrobial usage in a large group of English hospitals.

AIMS: This study aimed to determine the association between the reduction in the number of Clostridium difficile infection (CDI) cases reported by the English National Health Service (NHS) hospitals and concurrent antimicrobial use. METHODS: A retrospective ecological study for January 2005 to December 2008 was conducted using data from 26 of the 29 NHS trusts (i.e. a trust manages one or more hospitals) located in the North West Strategic Health Authority of England. Antimicrobial use data, for patients of all ages, were provided by IMS Health, and CDI case data for patients aged ≥65 years were provided by the Health Protection Agency. Antimicrobial use was converted into defined daily doses (DDDs). The overall association between antimicrobial use and CDI for the trusts was investigated using multilevel models. RESULTS: Our study shows a positive significant association between the CDI cases and the use of the following antimicrobials: 'third-generation cephalosporins' [11.62 CDI cases per 1000 DDDs; 95% confidence interval (CI), 5.92­17.31]; 'fluoroquinolones' (4.79 CDI cases per 1000 DDDs; 95% CI, 2.83­6.74); and 'second-generation cephalosporins' (4.25 CDI cases per 1000 DDDs; 95% CI, 1.66­6.83). The strength of this association was not significantly different (95% CI) among the antimicrobial groups. CONCLUSIONS: This study shows that the reduction in the number of CDI cases reported by the English NHS hospitals is associated with concurrent reductions in antimicrobial use. This means that the number of CDI cases over time decreased in a similar fashion to the usage of various antimicrobials.

Bayesian factor models for multivariate categorical data obtained from questionnaires.

Factor analysis is a flexible technique for assessment of multivariate dependence and codependence. Besides being an exploratory tool used to reduce the dimensionality of multivariate data, it allows estimation of common factors that often have an interesting theoretical interpretation in real problems. However, standard factor analysis is only applicable when the variables are scaled, which is often inappropriate, for example, in data obtained from questionnaires in the field of psychology, where the variables are often categorical. In this framework, we propose a factor model for the analysis of multivariate ordered and non-ordered polychotomous data. The inference procedure is done under the Bayesian approach via Markov chain Monte Carlo methods. Two Monte Carlo simulation studies are presented to investigate the performance of this approach in terms of estimation bias, precision and assessment of the number of factors. We also illustrate the proposed method to analyze participants' responses to the Motivational State Questionnaire dataset, developed to study emotions in laboratory and field settings.

Evaluation of inorganic elements in cat's claw teas using ICP OES and GF AAS.

The determination of Ba, Ca, Cu, Fe, Mg, Mn, P, Pb, and Zn by inductively coupled plasma optical emission spectrometry (ICP OES), and Se by graphite furnace atomic absorption spectrometry (GF AAS), has been carried out in dry matter and teas from 11 samples of the cat's claw plant. The accuracy and precision values were verified against GBW 07604 (Poplar leaves) certified reference material and by the recovery test. Results showed a high content of Ca in the medicinal plant studied, followed by Mg and P. The values obtained showed that the elements studied have different concentrations depending on the method of tea preparation. The highest levels were observed in Ca and Mg, and the lowest for Se and Pb, by both infusion and decoction. Teas prepared from this plant were found to be at safe levels for human consumption, and may be suitable as sources of these elements in the human diet.

Técnica do "duplo patch" para correção cirúrgica dos defeitos atrioventriculares / Double patch technic for surgical correction of atrioventricular defects

Oito portadores de defeitos atrioventriculares (DAV), com idades entre 11 meses e 19 anos, foram operados com o emprego do "duplo patch", sendo que 5 deles tinham insuficiência mitral pré-operatória. Dois eram do tipo C e os demais, do tipo A. Em uma paciente de 19 anos, com importante insuficiência da valva A-V comum, a técnica do "duplo patch" foi acompanhada de anuloplastia de De Vega no anel tricuspide e autoplastia de Whooler no anel mitral. O estudo hemodinamico pós-operatório detectou insuficiência mitral acentuada e presenca de pequena comunicação interventricular (CIV). Foi reoperada em 15 dias, tendo sido substituida a valva mitral e fechada a CIV. Faleceu nas primeiras horas de pos-operatorio. Os autros 7 pacientes apresentam boa evolução pós-operatória e, em todos, a ausculta e normal sem evidencias clinicas de insuficiência mitral. Concluiu-se que a técnica e aplicável aos três tipos anatômicos de DAV, permite a reconstrução dos componentes da valva A-V comum de maneira simples e sem desfazer a arquitetura valvar, segundo o conceito de Carpentier e o dispositivo, para perfusão cardíaca dissociada da circulação extracorpórea sistemica, e util recurso para correção adequada do defeito

Estudo comparativo do limite de segurança para emprego de técnicas hipotérmicas de prevenção sistêmica em cirurgia cardíaca / Comparative study of the safety limits of systemic prevention for the use of hypothermic technics in heart surgery

Duas tecnicas de apoio transoperatorio tem sido comumente utilizadas em cirurgia cardiovascular pediatrica: a parada circulatoria hipotermica intercalada por curtos periodos de circulacao extracorporea (PC) e a perfusao a fluxo sistemica de 0,5 L/ min/m2 (BF), por periodos relacionados ao grau de hipotermia sistemica (26oC: 30min; 22oC: 45 min; 19o C: 60 min). Contudo, estes procedimentos nao estao livres de complicacoes a curto e longo prazo. O objetivo do estudo foi avaliar os efeitos tardios da hipotermia associada a PC ou BF sobre o sistema nervoso central. A analise retrospectiva de resultados tardios obtidos em 138 pacientes acompanhados e testes de avaliacao das areas intelectual e perceptomotriz, realizados em 24 pacientes, nos permitem concluir que: a) tanto a parada circulatoria quanto o baixo fluxo estao associados a complicacoes neurologicas tardias; b) PC foi segura por periodo de 40 min a 19o C e BF por 45 min a 20o C ou por 30 min a 24o C; c) fatores agravantes da isquemia cerebral devem de prevenidos no perioperatorio