Interobserver agreement of the modified Paris classification and histology prediction of colorectal lesions in patients with inflammatory bowel disease.

BACKGROUND AND AIMS: SCENIC (International Consensus Statement on Surveillance and Management of Dysplasia in IBD) guidelines recommend that visible dysplasia in patients with longstanding inflammatory bowel disease (IBD) should be endoscopically characterized using a modified Paris classification. This study aimed to determine the interobserver agreement (IOA) of the modified Paris classification and endoscopists' accuracy for pathology prediction of IBD visible lesions. METHODS: One hundred deidentified endoscopic still images and 30 videos of IBD visible colorectal lesions were graded by 10 senior and 4 trainee endoscopists from 5 tertiary care centers. Endoscopists were asked to assign 4 classifications for each image: the standard Paris classification, modified Paris classification, pathology prediction, and lesion border. Agreement was measured using Light's kappa coefficient. Consensus of ratings was assessed according to strict majority. RESULTS: The overall Light's kappa for all study endpoints was between .32 and .49. In a subgroup analysis between junior and senior endoscopists, Light's kappa continued to be less than .6 with a slightly higher agreement among juniors. Lesions with the lowest agreement and no consensus were mostly classified as Is, IIa, and mixed Paris classification and sessile and superficial elevated for modified Paris classification. Endoscopist accuracy for prediction of dysplastic, nondysplastic, and serrated pathology was 77%, 56%, and 30%, respectively. There was a strong association (P < .001) between the given morphology classification and the predicted pathology with Ip lesions carrying a much lower expectation of dysplasia than Is/IIc/III and mixed lesions. The agreement for border prediction was .5 for junior and .3 for senior endoscopists. CONCLUSIONS: This study demonstrates very low IOA for Paris and modified Paris classifications and low accuracy and IOA for lesion histopathology prediction. Revisions of these classifications are required to create a clinically useful risk stratification tool and enable eventual application of augmented intelligence tools.

Multicentre Real-world Experience of Upadacitinib in the Treatment of Crohn's Disease.

BACKGROUND: Upadacitinib is a selective Janus kinase inhibitor approved for the management of ulcerative colitis and is under evaluation for the management of Crohn's disease [CD] in Phase 3 clinical trials. AIMS: Our goal was to describe our real-world experience with upadacitinib in CD. METHODS: This is a two-centre retrospective cohort study of adult patients with moderate to severe CD on upadacitinib. The primary outcome was clinical response and remission as determined by stool frequency and abdominal pain scores. Secondary endpoints included endoscopic response and remission as determined by change in Simple Endoscopic Score for CD. Outcomes were assessed at 3 months after starting upadacitinib and at the patient's most recent follow-up. We further evaluated adverse events and dose-related response. RESULTS: A total of 45 CD patients received upadacitinib and were included in the safety analysis. Thirty-six patients received upadacitinib for CD, whereas nine received it for inflammatory arthritis [n = 8] or pyoderma [n = 1]. Thirty-three patients received upadacitinib for 3 months or longer and were included in the efficacy analysis. At the 3-month follow-up, 21 patients achieved clinical response [63.6%] and nine achieved clinical remission [27.2%]. At time of last follow-up, 23 patients had clinical response [69.7%], ten achieved clinical remission [30.3%] and four [28.6%] achieved endoscopic remission. Adverse events occurred in 12 patients [26.7%]. Two patients had a serious adverse event [4.5%] without associated mortality. CONCLUSION: In this real-world cohort of highly refractory CD patients, upadacitinib was effective in inducing remission and had an acceptable safety profile.

Clinical Course and Impact of Immune Checkpoint Inhibitor Colitis Resembling Microscopic Colitis.

Background: Microscopic colitis (MC) is suspected to result from increased immune activity in gut mucosa. Immune checkpoint inhibitors (ICIs) treat cancer by activating the immune system, and further investigation is needed regarding their role in the development of MC. Methods: A retrospective case series investigated cases of endoscopically and histologically confirmed MC developing after administration of ICIs. Clinical notes and medication administration records were reviewed for demographics, symptom duration, and treatment response. Results: Nineteen cases of de novo MC were identified, with 95% of cases requiring steroid treatment, 53% presenting with hospitalization, and colitis-related mortality in 1 individual. Symptom onset occurred a median of 160 days after initiation of ICI therapy and 53 days after their most recent dose of therapy. Patients had a median of 125 days of symptoms, and ICI therapy was held in 70% of individuals due for treatment. Conclusions: MC can develop after ICI administration, and presents with severe symptoms, often requiring hospitalization and steroid treatment. In certain individuals this can require a prolonged treatment course of steroid therapy or immunomodulators. Individuals developing diarrhea after ICI therapy warrant thorough workup including endoscopy and rapid treatment initiation given the disease severity observed in this series.

BMI1 maintains the Treg epigenomic landscape to prevent inflammatory bowel disease.

FOXP3+ Tregs are expanded within the inflamed intestine of human Crohn's disease, yet FOXP3-mediated gene repression within these cells is lost. The polycomb repressive complexes play a role in FOXP3 target gene regulation, but deeper mechanistic insight is incomplete. We have now specifically identified the polycomb-repressive complex 1 (PRC1) family member, BMI1 in the regulation of a proinflammatory enhancer network in both human and murine Tregs. Using human Tregs and lamina propria T cells, we inferred PRC1 to regulate Crohn's associated gene networks through assays of chromatin accessibility. Conditional deletion of BMI1 in murine FOXP3+ cells led to systemic inflammation. BMI1-deficient Tregs beared a TH1/TH17-like phenotype as assessed by assays of genome wide transcription, chromatin accessibility and proteomic techniques. Finally, BMI1 mutant FOXP3+ cells did not suppress colitis in the adoptive transfer model of human inflammatory bowel disease. We propose that BMI1 plays an important role in enforcing Treg identity in vitro and in vivo. Loss of Treg identity via genetic or transient BMI1 depletion perturbs the epigenome and converts Tregs into Th1/Th17-like proinflammatory cells, a transition relevant to human Crohn's disease associated CD4+ T cells.

Preseason Training Improves Perception of Fatigue and Recovery From a Futsal Training Session.

PURPOSE: To compare the posttraining recovery timeline of elite Brazilian futsal athletes before (Pre-PS) and after 10 weeks of the preseason (Post-PS) period of high-intensity technical-tactical training. METHODS: At the start (n = 13) and at the end of the preseason (n = 7), under-20 male futsal players undertook fitness testing for maximal aerobic power, the countermovement jump (CMJ), and the 10-m sprint with change of direction. Furthermore, at both Pre-PS and Post-PS, the players participated in a training session where performance and psychophysiological measures were recorded before, immediately, 3, 24, and 48 hours postsession. The measures included CMJ, 10-m sprint, creatine kinase, Total Quality Recovery Scale, and Brunel Mood Scale. Effect size (ES) analyses compared fitness and posttraining recovery values for each parameter at Pre-PS versus Post-PS. RESULTS: Only trivial ES (-0.02 to 0.11) was evident in maximal aerobic power, CMJ, and 10-m sprint at Post-PS compared with Pre-PS. For the timeline of recovery, only trivial and small ESs were evident for the 10-m sprint (-0.12 to 0.49), though CMJ recovery was improved at 3 hours (0.87) and 48 hours (1.27) at Post-PS and creatine kinase was lower at 48 hours (-1.33) at Post-PS. Perception of recovery was improved in Post-PS at 3 hours (1.50) and 24 hours postsession (0.92). Furthermore, perception of effort was lower immediately after the session (-0.29), fatigue was lower at 3 hours (-0.63), and vigor responses were improved in all postseason assessments (0.59 to 1.13). CONCLUSION: Despite minimal changes in fitness, preseason training attenuated players' perception of effort and fatigue and improved their recovery profile following a high-intensity technical-tactical training session.

Comparison of Physical Fitness and Anthropometrical Profiles Among Brazilian Female Soccer National Teams From U15 to Senior Categories.

ABSTRACT: Ramos, GP, Nakamura, FY, Penna, EM, Mendes, TT, Mahseredjian, F, Lima, AM, Garcia, ES, Prado, LS, and Coimbra, CC. Comparison of physical fitness and anthropometrical profiles among Brazilian female soccer national teams from U15 to senior categories. J Strength Cond Res 35(8): 2302-2308, 2021-This study aimed to compare anthropometric and physical fitness of Brazilian female national team soccer players from the U15 to senior categories, and to compare the physical performance between selected and nonselected players. Subjects included 231 athletes (U15, n = 46, U17, n = 49, U20, n = 98, and Senior, n = 38). Body mass, height, sum of skinfolds, squat jump (SJ), countermovement jump (CMJ), 20-m linear sprint, and Yo-Yo IR1 were assessed. The U15 players were shorter than all other groups (p < 0.01) and lighter than U20 players (p < 0.01). Regarding physical tests, Senior athletes presented higher SJ compared with U20, and both showed higher CMJ and SJ compared with the U15 and U17 (p < 0.05). Senior athletes were also faster than players of all other categories in 20-m sprint (p < 0.01) and covered the greatest distance in the Yo-Yo IR1 (p < 0.05). U20 were better in the Yo-Yo IR1 than the younger groups (p < 0.05). When comparing selected and nonselected players, no differences were identified in anthropometric measures (p > 0.05). However, selected players from U17, U20, and Senior teams showed better performance in Yo-Yo IR1 than nonselected ones (p < 0.05). Finally, selected senior athletes also presented higher CMJ and SJ than nonselected players (p < 0.05). These results suggest that, although there is a tendency for maintenance in anthropometric measures from the age of 15 years, there are substantial improvements in speed, lower-body power, and aerobic capacity from U20 age group. In addition, it seems that intermittent aerobic fitness contributes to the selection of players to international tournaments in national teams.

Use of Immune Checkpoint Inhibitors in Patients With Pre-established Inflammatory Bowel Diseases: Retrospective Case Series.

The etiology of inflammatory bowel disease (IBD) has yet to be fully understood; however, it is thought to be a result of genetic, immunologic, and environmental factors, including changes in the gut microbiome.1,2 Immune checkpoint inhibitors (ICI) have revolutionized treatment of advanced cancer. They activate the immune system by promoting cytotoxic T-cell survival and antitumor effects. A total of 7 ICIs currently are approved by the United States Food and Drug Administration, and target cytotoxic T lymphocyte-associated protein 4 (ipilimumab); anti-programmed cell death 1 (PD-1) (nivolumab, pembrolizumab, and cemiplimab), or anti-PD-ligand 1 (atezolizumab, durvalumab, and avelumab). However, by activating the immune system, these medications also can lead to off-target inflammation and autoimmunity, including ICI-induced colitis, which has been reported in up to 13.6% of patients.3.

Influence of Faster and Slower Recovery-Profile Classifications, Self-Reported Sleep, Acute Training Load, and Phase of the Microcycle on Perceived Recovery in Futsal Players.

PURPOSE: To determine whether daily perceived recovery is explained from a multifactorial single-session classification of recovery (ie, faster vs slower) or other circumstantial factors (ie, previous training load, self-reported sleep, or phase of the microcycle). METHODS: Nineteen elite male futsal players were initially allocated to a recovery-classification group (faster recovery, slower physiological, or slower perceptual) based on previous research using a multifactorial cluster-analysis technique. During 4 ensuing weeks of preseason, training loads were monitored via player load, training impulse, and session rating of perceived exertion. Before each day's training, players reported their perception of recovery (Total Quality of Recovery scale [TQR]) and the number of hours and perceived quality of sleep the night prior. A hierarchical linear mixed model was used to analyze the effect of the different recovery profiles, training load, sleep, and phase of the microcycle (ie, start, middle, end) on daily TQR. RESULTS: The recovery classification of players (P = .20), training load (training impulse, P = .32; player load, P = .23; session rating of perceived exertion, P = .46), and self-reported hours slept the night before (P = .45) did not significantly influence TQR. However, perceived sleep quality (P < .01) and phase of the microcycle (P < .01) were significantly associated with TQR (r2 = .41). CONCLUSIONS: Neither recovery classification nor prior training load influenced perceived recovery during the preseason. However, higher TQR was evident with better self-reported sleep quality, whereas lower values were associated with phases of the training week.

Impact of Bariatric Surgery on the Long-term Disease Course of Inflammatory Bowel Disease.

BACKGROUND: An association between inflammatory bowel disease (IBD) and obesity has been observed. Little is known about the effect of weight loss on IBD course. Our aim was to determine the impact of bariatric surgery on long-term clinical course of obese patients with IBD, either Crohn's disease (CD) or ulcerative colitis (UC). METHODS: Patients with IBD who underwent bariatric surgery subsequent to IBD diagnosis were identified from 2 tertiary IBD centers. Complications after bariatric surgery were recorded. Patients were matched 1:1 for age, sex, IBD subtype, phenotype, and location to patients with IBD who did not undergo bariatric surgery. Controls started follow-up at a time point in their disease similar to the disease duration in the matched case at the time of bariatric surgery. Inflammatory bowel disease medication usage and disease-related complications (need for corticosteroids, hospitalizations, and surgeries) among cases and controls were compared. RESULTS: Forty-seven patients met inclusion criteria. Appropriate matches were found for 25 cases. Median follow-up among cases (after bariatric surgery) and controls was 7.69 and 7.89 years, respectively. Median decrease in body mass index after bariatric surgery was 12.2. Rescue corticosteroid usage and IBD-related surgeries were numerically less common in cases than controls (24% vs 52%; odds ratio [OR], 0.36; 95% confidence interval [CI], 0.08-1.23; 12% vs 28%; OR, 0.2; 95% CI, 0.004-1.79). Two cases and 1 control were able to discontinue biologics during follow-up. CONCLUSIONS: Inflammatory bowel disease patients with weight loss after bariatric surgery had fewer IBD-related complications compared with matched controls. This observation requires validation in a prospective study design.

Activity Profiles in U17, U20, and Senior Women's Brazilian National Soccer Teams During International Competitions: Are There Meaningful Differences?

Ramos, GP, Nakamura, FY, Penna, EM, Wilke, CF, Pereira, LA, Loturco, I, Capelli, L, Mahseredjian, F, Silami-Garcia, E, and Coimbra, CC. Activity profiles in U17, U20, and senior women's Brazilian national soccer teams during international competitions: are there meaningful differences? J Strength Cond Res 33(12): 3414-3422, 2019-The aim of this study was to compare locomotor activity profiles of Brazilian top-class female soccer players competing at distinct age brackets (under 17 [U17], under [U20], and senior). External match load of 14 U17, 14 U20, and 17 senior female soccer players competing in 6-7 full official international matches were assessed using global positioning systems. Total distance covered, distance covered in high intensity (15.6-20 km·h), distance covered in sprints (sprint: >20 km·h), number of accelerations (Acc) >1 m·s, decelerations (Dec) >-1 m·s, and Player Load generally increased across the age brackets (U17

Outcomes of Treatment for Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease Receiving Biologic Therapy.

Background: Treatment for latent tuberculosis infection (LTBI) is of particular concern in patients with inflammatory bowel disease (IBD) initiating biologic therapies to prevent tuberculosis (TB) reactivation. This study aimed to evaluate the effectiveness of LTBI treatment in IBD patients receiving biologic therapy. Methods: There was a retrospective review of all IBD patients diagnosed with LTBI following a tuberculin skin test (TST) and/or interferon gamma release assay (IGRA) and who received biologic therapy between 2002 and 2016. The primary outcome was tuberculosis reactivation after completion of LTBI treatment. Results: Three-hundred twenty-nine IBD patients were identified, and 35 (27 Crohn's disease; 8 ulcerative colitis) met the study inclusion criteria. The mean age was 38.3 years, and 68.6% were male. The most common LTBI treatment regimen was isoniazid (INH) for 9 months (74%). Biologic therapies used were infliximab (40%), adalimumab (29%), vedolizumab (20%), and certolizumab pegol (11%). Combination therapy with an immunomodulator was administered in 57% of cases. The median time from initiation of LTBI treatment to biologics was 43 days. The mean duration of follow-up was 2.9 years. The estimated median annual risk of TB reactivation without treatment was 0.52% by a prediction formula. Only 1 patient taking adalimumab monotherapy developed reactivation of TB several years after completing 6 months of isoniazid therapy. The estimated TB reactivation rate was 0.98 cases per 100 patient-years of follow-up in our cohort. Conclusions: Treatment for LTBI in patients with IBD treated with biologics is effective but does not eliminate the risk of reactivation. 10.1093/ibd/izy133_video1izy133.video15776720675001.

De-novo Inflammatory Bowel Disease After Bariatric Surgery: A Large Case Series.

BACKGROUND: Case reports of inflammatory bowel diseases [IBD] have been reported in patients with a history of bariatric surgery. Our aim was to characterize patients who were diagnosed with IBD after having undergone bariatric surgery. METHODS: Electronic medical records were reviewed at two institutions to identify patients who developed de-novo Crohn's disease or ulcerative colitis [UC] after bariatric surgery. Data on demographics, type of bariatric surgical procedure, IBD subtype, phenotype and medication usage were obtained. The incidence rate of de-novo IBD after bariatric surgery [per 100000 person-years] and standardized incidence ratio [SIR] were estimated from a prospective bariatric surgery database. RESULTS: A total of 44 patients with de-novo IBD after bariatric surgery were identified [31 Crohn's disease, 12 UC, one IBD unclassified]. Most patients were female [88.6%], with median age at IBD onset of 44 years [IQR, 37-52] and median time to IBD diagnosis after bariatric surgery of 7 years [IQR, 3-10]. Sixty-eight per cent underwent Roux-en-Y gastric bypass. In the prospective database, the incidence of IBD in patients who underwent bariatric surgery was 26.7 per 100000 person-years [4.5 for UC and 22.3 for Crohn's disease]. The age-adjusted SIR ranged from 3.56 in the 40-49 year age group to 4.73 in the 30-39 year age group. CONCLUSION: We described a case series of patients developing de-novo IBD after bariatric surgery. There appears to be a numerically higher incidence of Crohn's disease in this population. Confirmation of causality is required in larger patient cohorts.

Mannose-Binding Lectin Does Not Act as a Biomarker for the Progression of Preinvasive Lesions of Invasive Cervical Cancer.

OBJECTIVE: To evaluate serum concentrations of mannose-binding lectin (MBL) in women presenting with different human papillomavirus (HPV)-associated cervical lesions. SUBJECTS AND METHODS: A total of 364 women, who underwent screening for cervical cancer or treatment at the Erasto Gaertner Cancer Hospital (HEG), Curitiba, Brazil, were enrolled in the study. Based on the latest cervical colposcopy-guided biopsy results, the women were divided into 4 groups: cervical intraepithelial neoplasia CIN-I (n = 54), CIN-II (n = 72), CIN-III (n = 145), and invasive cancer (n = 93). A time-resolved immunofluorometric assay was used to measure the MBL concentrations in serum. The statistical analysis was done using GraphPad Prism 6.0. Comparisons were performed by Kruskal-Wallis and Mann-Whitney tests and analyzed by χ2 test; continuous variables are presented as medians and categorical variables as frequencies. RESULTS: The median MBL concentrations in decreasing order were as follows: invasive cancer: 1,452 ng/mL, CIN-I: 1,324 ng/mL, CIN-II: 1,104 ng/mL, and CIN-III 1,098 ng/mL. However, no statistical significance was found among the 4 groups with HPV-associated lesions (p = 0.11). Equally, the MBL levels did not show a significant association between the age of the patients and the severity of the cervical lesions (p = 0.68). No statistical significance was found in the median values of MBL or in the status of MBL deficient (<100 ng/mL) and high producers (>1,000 ng/mL) among the women in each group (p = 0.77). CONCLUSION: In this study, there was no statistically significant difference in MBL serum levels among the groups with CIN. Hence MBL serum concentration appeared not to have influenced the progression of HPV-related preinvasive cervical lesions into invasive cancer.

Evaluation of hydration status by urine, body mass variation and plasma parameters during an official half-marathon.

BACKGROUND: The aim of this study was to verify the agreement of urine, body mass variations and plasma parameters to determine the hydration status of 14 male runners (29±4 years and 54.3±5.5 mLO2/kg/min) in an official 21.1 km road race. METHODS: The mean dry-bulb temperature and air relative humidity during the road race were 25.1±2.1 °C and 54.7±2.2%, respectively. The volume of water ingested by the runners was monitored using marked volumetric plastic bottles provided at the hydration stations located at 0, 2.5, 5.0, 7.5, 10.5, 14.0, 16.0 and 18.5 km from the starting line. Hydration status was assessed using urine specific gravity (USG), urine osmolality (UOSM) and plasma osmolality (POSM). Furthermore, body mass variation (∆BM) was assessed by comparing body mass (BM) immediately prior and after the race. Total sweat was estimated by ∆BM, added water volume ingested and deducted blood volume collected. The sweat rate was calculated through total sweat and total exercise time. RESULTS: The mean water intake was 0.82±0.40 L, and the mean sweat rate and total sweating were 1440.11±182.13 mL/h and 2.67±0.23 L. After the race, the BM reduced by 1.7±0.4 kg. The ∆BM was -2.41±0.47%, and the plasma volume variation was -9.79±4.6% between pre- and post-running measurements. Despite the POSM increased post-race compared to pre-race, the UOSM and USG did not change. No significant correlations were found between POSM variation with UOSM variation (r=-0.08; P=0.71), USG variation (r=-0.11; P=0.78) or ∆BM (r=0.09; P=0.77). CONCLUSIONS: In conclusion, this study shows that both ∆BM and ∆POSM indicated a hypohydration state after exercise even though the ∆BM did not correlate significantly with ∆POSM. These results demonstrate that ∆BM is a practical method and can be sufficiently sensitive to evaluate the hydration state, but it should be utilized with caution.

Metabolic Demand and Internal Training Load in Technical-Tactical Training Sessions of Professional Futsal Players.

Wilke, CF, Ramos, GP, Pacheco, DAS, Santos, WHM, Diniz, MSL, Gonçalves, GGP, Marins, JCB, Wanner, SP, and Silami-Garcia, E. Metabolic demand and internal training load in technical-tactical training sessions of professional futsal players. J Strength Cond Res 30(8): 2330-2340, 2016-The aim of the study was to characterize aspects of technical-tactical training sessions of a professional futsal team. We addressed 4 specific aims: characterize the metabolic demands and intensity of these training sessions, compare the training intensity among players of different positions, compare the intensity of different futsal-specific activities (4 × 4, 6 × 4, and match simulation), and investigate the association between an objective (training impulse; TRIMP) and a subjective method (session rating of perceived exertion; sRPE) of measuring a player's internal training load. Twelve top-level futsal players performed an incremental exercise to determine their maximal oxygen consumption, maximal heart rate (HRmax), ventilatory threshold (VT), and respiratory compensation point (RCP). Each player's HR and RPE were measured and used to calculate energy expenditure, TRIMP, and sRPE during 37 training sessions over 8 weeks. The average intensity was 74 ± 4% of HRmax, which corresponded to 9.3 kcal·min. The players trained at intensities above the RCP, between the RCP and VT and below the VT for 20 ± 8%, 28 ± 6%, and 51 ± 10% of the session duration, respectively. Wingers, defenders, and pivots exercised at a similar average intensity but with different intensity distributions. No difference in intensity was found between the 3 typical activities. A strong correlation between the average daily TRIMP and sRPE was observed; however, this relationship was significant for only 4 of 12 players, indicating that sRPE is a useful tool for monitoring training loads but that it should be interpreted for each player individually rather than collectively.

Physical performance and environmental conditions: 2014 World Soccer Cup and 2016 Summer Olympics in Brazil.

This editorial is for the special issue "Temperature sciences in Brazil" of the journal Temperature. It focuses on the physical performance and environmental conditions during the 2014 World Cup and the coming 2016 Summer Olympics. It emphasizes that a hot and humid environment imposes a great challenge to the human thermoregulation system, can lead to performance decrements, and increases the risk of developing hyperthermia. Adequate hydration, acclimatization, and body cooling strategies are effective interventions to minimize the risks associated with exercise in the heat.

Seasonal humidity may influence Pseudomonas aeruginosa hospital-acquired infection rates.

OBJECTIVE: The objective of this study was to determine the association of seasonal climatic conditions with the incidence of Pseudomonas aeruginosa infections. METHODS: A retrospective study was carried out to evaluate all infections caused by P. aeruginosa in a 660-bed tertiary-care hospital in Brazil over a period of 5 years. To assess seasonal patterns, monthly temperature, relative humidity, and precipitation averages were obtained. Correlations of seasonal variations with infection rates (IR) were determined by Pearson correlation coefficient. Linear regression was used to determine trends, and multivariable linear regression was performed using a Poisson distribution. RESULTS: A total of 844 cases of P. aeruginosa infection were identified for 1 058 501 patient-days during 1826 days (overall IR 7.97/10 000 patient-days). The mean temperature was 18.2±2.8°C, relative humidity was 80.3±3.6%, and precipitation was 104.7±64.38mm. The Pearson correlation was significant between urinary tract infection and temperature (R=0.29; p=0.021) and precipitation (R=0.27; p=0.036). A correlation was also significant between hospital-associated pneumonia and precipitation (R=0.29; p=0.022) and relative humidity (R=0.31; p=0.013). Relative humidity was associated with a higher IR of other infections caused by P. aeruginosa, but it was not possible to build a predictive model when multiple linear regression and Poisson regression were tested. CONCLUSION: Climatic conditions are another factor that may interfere with the IR of Pseudomonas aeruginosa.