Analysis of factors associated with mortality due to sepsis resulting from device-related infections.

INTRODUCTION: Health care-associated infections (HAIs) contribute to morbidity and mortality and to the dissemination of multidrug-resistant organisms. Children admitted to the intensive care unit undergo invasive procedures that increase their risk of developing HAIs and sepsis. The aim of the study was to analyse factors associated with mortality due to sepsis arising from HAIs. PATIENTS AND METHODS: We conducted a case-control study in a 7-bed multipurpose paediatric intensive care unit in a tertiary care teaching hospital. The sample consisted of 90 children admitted between January 2014 and December 2018. The case group consisted of patients who died from sepsis associated with the main health care-associated infections; the control group consisted of patients who survived sepsis associated with the same infections. RESULTS: Death was associated with age less than or equal to 12 months, presence of comorbidity, congenital disease, recurrent ventilator-associated pneumonia and septic shock. In the multiple regression analysis, heart disease (OR, 12.48; CI 2.55-60.93; P = .002), infection by carbapenem-resistant bacteria (OR, 31.51; CI 4.01-247.25; P = .001), cancer (OR, 58.23; CI 4.54-746.27; P = .002), and treatment with adrenaline (OR, 13.14; CI 1.35-128.02; P = .003) continued to be significantly associated with death. CONCLUSIONS: Hospital sepsis secondary to carbapenem-resistant bacteria contributed to a high mortality rate in this cohort. Children with heart disease or neoplasia or who needed vasopressor drugs had poorer outcomes.

Burned and buried: A vibrational spectroscopy analysis of burial-related diagenetic changes of heat-altered human bones.

OBJECTIVES: The analysis of burned human remains can be very challenging due to heat-induced alterations. Occasionally, human bones present these coupled with diagenetic changes, offering even more of a challenge, since there is a lack of studies regarding interactions between both taphonomic phenomena. With this study, we aimed to assess and document the effects of inhumation on the chemical composition of both unburned and burned human skeletal remains. MATERIALS AND METHODS: We buried, for 5 years, four groups of human bone samples comprising unburned bones and bones experimentally burned at 500, 900, and 1050 °C. Periodic exhumations were carried out to collect bone samples to be analyzed through Fourier transform infrared spectroscopy in attenuated total reflectance mode, in order to calculate four chemical indexes: (1) crystallinity index (CI); (2) type B carbonates to phosphate index (BPI); (3) total carbonates (A + B) to carbonate B ratio (C/C); and (4) OH to phosphate ratio (OH/P). RESULTS: After inhumation, CI and C/C of unburned bones and bones burned at 500 °C, and BPI of bones burned at 1050 °C did not vary significantly. However, the remaining indexes showed both relevant increments and reductions throughout observations, depending on burning temperature and index. DISCUSSION: Our results suggest that diagenesis can have an effect in bone's molecular composition. However, these effects do not seem to significantly affect the conclusions that can be taken from the analysis of infrared bone spectra, at least in the case of inhumations with a duration of 5 years or less.

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency.

INTRODUCTION: The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program. OBJECTIVE: To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results. METHODS: Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training. RESULTS: There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject. CONCLUSION: This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency

ABSTRACT Introduction: The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program. Objective: To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results. Methods: Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training. Results: There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject. Conclusion: This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.

Preliminary results of an investigation on postmortem variations in human skeletal mass of buried bones.

Extreme fragmentation can complicate the inventory of human skeletal remains. In such cases, skeletal mass can provide information regarding skeleton completeness and the minimum number of individuals. For that purpose, several references for skeletal mass can be used to establish comparisons and draw inferences regarding those parameters. However, little is known about the feasibility of establishing comparisons between inherently different materials, as is the case of curated reference skeletal collections and human remains recovered from forensic and archaeological settings. The objective of this paper was to investigate the effect of inhumation, weather and heat exposure on the skeletal mass of two different bone types. This was investigated on a sample of 30 human bone fragments (14 trabecular bones and 16 compact bones) that was experimentally buried for two years after being submitted to one of four different heat treatments (left unburned; 500 °C; 900 °C; 1000 °C). Bones were exhumed periodically to assess time-related mass variation. Skeletal mass varied substantially, decreasing and increasing in accordance to the interchanging dry and wet seasons. However, trends were not the same for the two bone types and the four temperature thresholds. The reason for this appears to be related to water absorption and to the differential heat-induced changes in bone microporosity, volume, and composition. Our results suggest that mass comparisons against published references should be performed only after the skeletal remains have been preemptively dried from exogenous water.

Associação entre material particulado atmosférico e hidrocarbonetos policíclicos aromáticos e sintomas respiratórios em pacientes com asma brônquica na cidade de São Paulo / Relation between aromatic polycyclic hydrocarbons and respiratory symptons among patients with asthma living in city of São Paulo, Brazil

A relação entre poluentes atmosféricos e sintomas como tosse e opressão torácica é pouco compreendida. Avaliou-se em 33 pacientes com asma em moradores e trabalhadores no bairro do Butantã a associação entre sintomas respiratório e fluxo expiratório com material particulado e hidrocarbonetos policíclicos aromáticos coletados durante 60 dias de observação nessa região. Detectou-se uma associação direta entre temperatura e fluxo expiratório e correlação inversa entre a concentração de hidrocarbonetos aromáticos (fração grossa) e fluxo expiratório noturno, assim como relação inversa entre umidade do ar e fluxo expiratório noturno. Não houve associação entre poluentes e outros sintomas clínicos.Association between air pollution and symptoms as cough and chest oppression is not well determined. We evaluated 33 patients with asthma who lived and worked at the same neighborhood, the association between respiratory symptoms and peak expiratory flow with particulate matter and polycyclic aromatic hydrocarbons compost. We detect a direct association between outdoor temperature and peak expiratory flow. Moreover, an inverse associaton was observed between humidity and nocturnal peak expiratory flow, and between concentration of polycyclic aromatic hydrocarbon and nocturnal peak expiratory flow. No materially association was determined between air pollutants and symptoms...