Clinical and epidemiological aspects of Candidemia in eight medical centers in the state of Parana, Brazil: Parana Candidemia Network

ABSTRACT Objectives: Candida spp. has been reported as one of the common agents of nosocomial bloodstream infections and is associated with a high mortality. Therefore, this study evaluated the clinical findings, local epidemiology, and microbiological aspects of candidemia in eight tertiary medical centers in the state of Parana, South of Brazil. Methods: In this study, we reported 100 episodes of candidemia in patients admitted to eight different hospitals in five cities of the state of Parana, Brazil, using data collected locally (2016 and 2017) and tabulated online. Results: The incidence was found to be 2.7 / 1000 patients / day and 1.2 / 1000 admissions. C. albicans was responsible for 49% of all candidemia episodes. Cancer and surgery were the two most common underlying conditions associated with candidemia. The mortality rate within 30 days was 48%, and removal of the central venous catheter (p = 0.029) as well as empirical or prophylactic exposure to antifungals were both related to improved survival (p = 0.033). Conclusions: This study highlights the high burden and mortality rates of candidemia in hospitals from Parana as well as the need to enhance antifungal stewardship program in the enrolled medical centers.

Fatal adenoviral necrotizing bronchiolitis case in a post-cardiac surgery intensive care unit

We report a case of a 67 year-old-male patient admitted to the intensive care unit in the post-coronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach.

Evaluation of a rapid dipstick test, Malar-CheckTM, for the diagnosis of Plasmodium falciparum malaria in Brazil

The present study was carried out to evaluate the Malar-CheckTM Pf test, an immunochromatographic assay that detects Plasmodium falciparum Histidine Rich Protein II, does not require equipment, and is easy and rapid to perform. In dilution assays performed to test sensitivity against known parasite density, Malar-CheckTMwere compared with thick blood smear (TBS), the gold standard for diagnosis. Palo Alto isolate or P. falciparum blood from patients with different parasitemias was used. The average cut-off points for each technique in three independent experiments were 12 and 71 parasites/mm³ (TBS and Malar-CheckTM, respectively). In the field assays, samples were collected from patients with fever who visited endemic regions. Compared to TBS, Malar-CheckTMyielded true-positive results in 38 patients, false-positive results in 3, true-negative results in 23, and false-negative result in 1. Malar-CheckTMperformed with samples from falciparum-infected patients after treatment showed persistence of antigen up to 30 days. Malar-CheckTM should aid the diagnosis of P. falciparum in remote areas and improve routine diagnosis even when microscopy is available. Previous P. falciparum infection, which can determine a false-positive test in cured individuals, should be considered. The prompt results obtained with the Malar-CheckTM for early diagnosis could avoid disease evolution to severe cases

Estudo do crescimento intra-uterino de recém-nascidos normais / Study of intrauterine growth of normal newborn infants

Objetivo: Avaliar o crescimento intra-uterino normal e seus desvios, elaborando uma curva de crescimento intra-uterino na Maternidade do Hospital Universitário Antonio Pedro (UFF-RJ), estudando as variáveis peso ao nascer, comprimento, perímetro cefálico e índice poderal em gestaçöes de fetos únicos. Em seguida, comparar esses dados com os de allguns trabalhos nacionais escolhidos para tal com a clássica curva de Lubchenco, pelo seu difundido uso. Métodos: Foram arrolados 1566 recém-natos no período de abaril de 1992 até Setembro de 1993, sendo esse número reduzido para 1031 devido a exclusöes de recém-natos que sofreram fatores interferentes no crescimento fetal (Doença Hipertensiva Específica da Gravidez, Tabagismo, Hipertensäo Crônica, Malformaçöes maiores), ou devido ao fato de algumas mäes näo se recordarem da data da última menstruaçäo ou esta näo estar de acordo com a idade calculada pelo método de ubowitz em mais de uma semana. Resultados: Ao compararmos a presente curva de crescimento intra-urerino com as escolhidas na literatura notamos semelhanças com curvas nacionais; com exceçäo daquelas que näo excluíram condiçöes capazes de afetar negativamente o crescimento intra-uterino. Em relaçäo à clássica curva de de Lubchenco, notamos pesos menores nas idades gestacionais inferiores e menor desaceleraçäo do ganho ponderal ao final da agestaçäo...