Epidemiological differences, clinical aspects, and short-term prognosis of patients with healthcare-associated and community-acquired infective endocarditis.

Background: The prevalence of healthcare-associated infective endocarditis in Brazil is poorly known. Aim: To analyze the epidemiological, clinical and microbiological characteristics, and the prognosis of healthcare-associated infective endocarditis (HAIE) compared with community-acquired infective endocarditis (CIE) and identify the associated factors with hospital mortality. Method: A historical cohort study was carried out, with a data collection period from January 2009 to December 2019 at the Federal University of São Paulo. Data were collected from medical records of patients with infective endocarditis (IE) hospitalized during the study period. Patients were classified into three groups: CIE, non-nosocomial HAIE (NN-HAIE) and nosocomial HAIE (NHAIE). Results: A total of 204 patients with IE were included; of these, 127 (62.3%) were cases of HAIE, of which 83 (40.7%) were NN-HAIE and 44 (21.6%) were NHAIE. Staphylococcus spp. Were the main causative agents, especially in HAIE groups (P<0.001). Streptococcus spp. were more prevalent in the CIE group (P<0.001). In-hospital mortality was 44.6%, with no differences between groups. Independent risk factors for in-hospital mortality were age ≥ 60 years (odds ratio (OR): 6.742), septic shock (OR 5.264), stroke (OR 3.576), heart failure (OR 7.296), and Intensive Care Unit admission (OR 7.768). Conclusion: HAIE accounted for most cases in this cohort, with a higher prevalence of non-nosocomial infections. Staphylococcus spp. were the main causative agents. Hospital mortality was high, 44.6%, with no difference between groups.

Risco de infecção associado ao exame de ecocardiografia transesofágica e medidas de prevenção: revisão de literatura / Risk of infection associated with transesophageal echocardiography and prevention measures: literature review

Introdução: O ecocardiograma transesofágico é um exame amplamente utilizado na prática clínica para investigação e diagnóstico de doenças cardíacas e não cardíacas. Apesar de seguro, trata-se de exame semi-invasivo e não isento de ris-cos. Casos de infecção associados ao ecocardiograma tran-sesofágico foram descritos e, devido ao potencial risco de transmissão de infecção durante sua realização, o objetivo deste trabalho foi revisar dados da literatura referentes à transmissão de infecção durante a realização do exame, bem como os métodos de prevenção. Métodos: Revisão de literatura sobre o tema realizada entre dezembro de 2017 e janeiro de 2018, por meio de pesquisa em portais científicos de domínio público, nas diferentes bases de dados de ciências da saúde, que incluíram artigos originais, diretrizes, revisões simples e sistemática, e relatos de casos, publicados em periódicos indexados nos últimos 20 anos. Resultados: Preencheram os critérios estabelecidos 13 artigos: uma re-visão sistemática sobre complicações associadas ao ecocar-diograma transesofágico, seis artigos que descreveram surtos bacterianos relacionados ao ecocardiograma transesofágico, a diretriz britânica sobre limpeza e desinfecção para sondas de ecocardiografia transesofágica, quatro artigos sobre reações adversas a resíduos de ortoftaldeído em sondas de ecocardiograma transesofágico e um artigo referente ao uso de capas protetoras para as sondas. Conclusão: O risco de infecção associado ao ecocardiograma transesofágico existe, apesar de pouco descrito na literatura. É recomendado o es-tabelecimento de protocolos específicos de desinfecção das sondas de ecocardiograma transesofágico e inspeção rotinei-ra das sondas. O fortalecimento das equipes de controle de infecção também é essencial para a detecção e a resolução de surtos relacionados ao ecocardiograma transesofágico

Análise de vídeo e imagens com suporte do ATLAS.ti: exemplo de aplicação / Video analysis and images supported by ATLAS.ti: An example of application

O artigo aborda aspectos metodológicos da análise de material audiovisual em pesquisa qualitativa e oferece um modelo simplificado para ajudar o pesquisador a fazer uso combinado de análise verbal e dados visuais em entrevistas gravadas em vídeo, com o suporte do ATLAS.ti.Como exemplo foram usadas as filmagens de relatos de imigrantes de sua experiência no Brasil, em que procurou-se identificar relações entre expressões faciais emocionais negativas e positivas dos imigrantes e o teor de seus depoimentos. Os resultados indicam que as expressões emocionais cumprem funções de acentuar, contradizer e substituir os relatos verbais dos imigrantes. Em alguns casos identificou-se supressão de manifestações emocionais, mesmo em depoimentos mais negativos. Os passos para a análise no ATLAS.ti são apresentados com ilustrações.

The article discusses methodological aspects to guide the audiovisual analysis in qualitative research offering a simplified model to help the researcher to make a combined use of verbal and visual analysis of videotaped interviews with ATLAS.ti support. As an example it was taken the immigrants reports about their experiences in Brazil trying to identify relationships between positive and negative emotional facial expressions of immigrants and the content of their testimony. The results indicate that emotional expressions fulfill different functions such as emphasizing, contradicting and replacing the verbal reports of immigrants. In some cases we identify the suppression of immigrant emotional manifestations, even in the most negative statements. The steps for analysis in ATLAS.ti are presented with illustrations.

[Triage at the Emergency Department: association between triage levels and patient outcome]. / Triagem no serviço de emergência: associação entre as suas categorias e os desfechos do paciente.

OBJECTIVE: Identify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP). METHODS: Retrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05). RESULTS: Men with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001). CONCLUSION: The high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

Triage at the Emergency Department: association between triage levels and patient outcome / Cribado en el Servicio de Emergencia: asociación entre sus categorías y los resultados del paciente / Triagem no Serviço de Emergência: associação entre as suas categorias e os desfechos do paciente

AbstractOBJECTIVEIdentify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP).METHODSRetrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05).RESULTSMen with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001).CONCLUSIONThe high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

ResumenOBJETIVOIdentificar la asociación entre variables sociodemográficas, clínicas y categorías de cribado con resultados del protocolo desarrollado en el Hospital São Paulo (HSP). MÉTODOEstudio de cohorte retrospectivo llevado a cabo con pacientes mayores de 18 años sometidos al protocolo de cribado en agosto de 2012. Se utilizó la regresión logística para asociar las categorías de riesgo a los resultados (p-valor≤0,05).RESULTADOSHombres con edad más avanzada y atendidos por las especialidades clínicas presentaron mayores índices de estancia hospitalaria y defunción. Pacientes con alta prioridad presentaron índice de estancia hospitalaria y defunción cinco y 10,6 veces mayor, respectivamente (p<0,0001).CONCLUSIÓNEl grupo de mayor prioridad se asoció con mayores índices de estancia hospitalaria y defunciones. El protocolo fue capaz de detectar a pacientes con condiciones más urgentes e identificar factores de riesgo para estancia hospitalaria y defunción.

ResumoOBJETIVOIdentificar a associação entre variáveis sociodemográficas, clínicas e categorias de triagem com desfechos do protocolo desenvolvido no Hospital São Paulo (HSP).MÉTODOEstudo de coorte retrospectivo realizado com pacientes maiores de 18 anos submetidos ao protocolo de triagem em agosto de 2012. Utilizou-se regressão logística para associar as categorias de risco aos desfechos (p-valor≤0,05).RESULTADOSHomens com idade mais avançada e atendidos pelas especialidades clínicas apresentaram maiores taxas de internação e óbito. Pacientes com alta prioridade apresentaram taxa de internação e óbitos cinco e 10,6 vezes maior, respectivamente (p<0,0001).CONCLUSÃOO grupo de maior prioridade associou-se a maiores taxas de internação e óbitos. O protocolo foi capaz de detectar pacientes com condições mais urgentes e identificar fatores de risco para internação hospitalar e óbito.

Serotonin gene polymorphisms and psychiatry comorbidities in temporal lobe epilepsy.

OBJECTIVE: Neuropsychiatric comorbidities are frequent in temporal lobe epilepsy (TLE). It is biologically plausible that alterations in serotonin-related genes may be involved in higher susceptibility to psychiatric disease in these individuals. Here we report results of an association study of serotonin gene polymorphisms and psychiatry comorbidities in TLE. METHODS: Case-control study of 155 patients with temporal lobe epilepsy. We evaluate the influence of 5-HTTLPR and 5-HTTVNTR polymorphisms in the 5-HTT gene and the C-1019G polymorphism in the 5-HT1A gene in psychiatric comorbidities of TLE. RESULTS: After logistic regression, female sex (OR=2.34; 95% CI 1.06-5.17; p=0.035) and the presence of C allele of 5-HT1A C-1019G polymorphism (OR=2.77; 95% CI 1.01-7.63; p=0.048) remained independent risk factors for anxiety disorders in temporal lobe epilepsy. CONCLUSION: C allele of 5-HT1A C-1019G polymorphism might be an independent risk factor for anxiety disorders in temporal lobe epilepsy. We believe that other studies in this venue will shade some light on molecular mechanisms involved in psychiatric comorbidities in epilepsy.

Evidence of association between Val66Met polymorphism at BDNF gene and anxiety disorders in a community sample of children and adolescents.

Different lines of evidence support BDNF as a candidate gene in mood and anxiety modulation. More recently, the Met allele of the BDNF Val66Met polymorphism has been implicated in anxiety in animal models and anxiety-traits in humans. The aim of this study is to evaluate the a priori hypothesis that the association between anxiety disorders and Val66Met polymorphism at the BDNF gene would be replicated in a community sample of children and adolescents. 240 subjects from a total sample of 2457 children and adolescents aged 10-17 years from the public schools in the catchment area of the primary care unit of a university hospital participated in this case-control study and were assessed for psychopathology using the K-SADS-PL. A sample of saliva was collected for DNA analysis of Val66Met polymorphism. BDNF was the single gene evaluated in this sample. We found a significant association between carrying one copy of the Met allele and higher chance of anxiety disorders in children and adolescents. The association remained positive even after the adjustment for potential confounders (228 subjects; OR=3.53 (CI95% 1.77-7.06; p<0.001)). Our results support the a priori hypothesis of an association between anxiety and the polymorphism Val66Met. To our knowledge, this is the first study documenting a potential role of this polymorphism in a community sample of anxious children and adolescents.

The BDNF Val66Met polymorphism is an independent risk factor for high lethality in suicide attempts of depressed patients.

Some authors have reported an association of BDNF Val66Met polymorphism with suicidal behavior and/or clinical aspects of suicidal attempts. We evaluated, here, the impact of BDNF Val66Met polymorphism on the clinical characteristics of suicide attempts. The study was conducted on a cohort of 120 consecutive patients who were admitted to the Emergency Hospital of Porto Alegre, Brazil, due to a suicide attempt. Variables of univariate analyses were included in a logistic regression model to test whether the risk factors had independent effect. In univariate analyses, sex, BDNF genotype, intent and method of suicide attempt were all risk factors for high lethality in suicide attempts. After logistic regression analysis, male sex (O.R.=3.03; 95% C.I=1.34-6.84; 0.008) and the presence of BDNF 66Met allele (O.R.=2.62; 95% C.I=1.04-6.57; 0.04) were significantly and independently associated with the high lethality in suicide attempts. The present study showed that BDNF 66Met allele is an independent predictor of high lethality in suicide attempts of depressed patients. This finding is important because it might allow earlier identification of patients at high risk for suicide, perhaps providing better tools for clinical care of these patients in the future.