Elixhauser comorbidity method in predicting death of Spanish inpatients with asplenia and pneumococcal pneumonia.

BACKGROUND: Pneumococcal pneumonia (PP) is a serious infection caused by Streptococcus pneumoniae (pneumococcus), with a wide spectrum of clinical manifestations. The aim of this study was to analyze the comorbidity factors that influenced the mortality in patients with asplenia according to PP. METHODS: Discharge reports from the Spanish Minimum Basic Data Set (MBDS) was used to retrospectively analyze patients with asplenia and PP, from 1997 to 2021. Elixhauser Comorbidity Index (ECI) was calculated to predict in-hospital mortality (IHM). RESULTS: 97,922 patients with asplenia were included and 381 cases of PP were identified. The average age for men was 63.87 years and for women 65.99 years. In all years, ECI was larger for splenectomized than for non-splenectomized patients, with men having a higher mean ECI than women. An association was found between risk factors ECI, splenectomy, age group, sex, pneumococcal pneumonia, and increased mortality (OR = 0.98; 95% CI: 0.97-0.99; p < 0.001). The IHM increased steadily with the number of comorbidities and index scores in 1997-2021. CONCLUSIONS: Asplenia remain a relevant cause of hospitalization in Spain. Comorbidities reflected a great impact in patients with asplenia and PP, which would mean higher risk of mortality.

Serotype distribution and antimicrobial resistance of pediatric Streptococcus pneumoniae isolated from inpatients and outpatients at Beijing Children's Hospital.

BACKGROUND: Understanding the epidemiology of Streptococcus pneumoniae (S. pneumoniae) isolates is important for pneumonia treatment and prevention. This research aimed to explore the epidemiological characteristics of S. pneumoniae isolated from pediatric inpatients and outpatients during the same period. METHODS: S. pneumoniae were isolated from unsterile samples of inpatients and outpatients younger than five years old between March 2013 and February 2014. The serotypes were determined using diagnostic pneumococcal antisera. The resistance of each strain to 13 antibiotics was tested using either the E-test or the disc diffusion method. The Sequence Types (STs) were analyzed via Multilocus Sequence Typing (MLST). RESULTS: The dominant serotypes obtained from inpatients were 19F (32.9 %), 19A (20.7 %), 23F (10.7 %), 6A (10.0 %), and 14 (8.6 %), while those from outpatients were 19F (13.6 %), 23F (12.9 %), 6A (10.0 %), 6B (10.0 %), and 19A (7.9 %). The coverage rates of 13-valent Pneumococcal Conjugate Vaccine (PCV) formulations were high in both groups. The nonsusceptibility to penicillin, cefuroxime, imipenem, erythromycin, and trimethoprim-sulfamethoxazole among the inpatient isolates was 7.1 %, 92.8 %, 65.7 %, 100 %, and 85.0 %, respectively, while that among the outpatient isolates was 0.7 %, 50.0 %, 38.6 %, 96.4 %, and 65.7 %, respectively. There were 45 and 81 STs detected from the pneumococci isolated from inpatients and outpatients, respectively. CC271 was common among both inpatients and outpatients (43.6 % and 14.3 %). CONCLUSIONS: Pneumococcal vaccine-related serotypes are prevalent among both inpatients and outpatients, especially among inpatients, who exhibit more severe antibiotic resistance. Therefore, universal immunization with PCV13 would decrease the hospitalization rate due to S. pneumoniae and the antibiotic resistance rate of S. pneumoniae.

Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study.

OBJECTIVE: The present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support. METHODS: A prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization. RESULTS: A total of 261 patients were evaluated, with a median age of 61.0 (49.0-69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass. CONCLUSION: There can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.

Perfil epidemiológico de pacientes vítimas de trauma torácico em um hospital de urgência e trauma / Epidemiological profile of patients victims of thoracic trauma in an emergency and trauma hospital

O trauma é responsável por significativos impactos na sociedade. De acordo com dados da Organização Mundial de Saúde (OMS), mais de nove pessoas morrem por minuto, vítimas de trauma. Entre os principais tipos de trauma, o torácico representa na atualidade cerca de 25% dos mortos em politraumatizados, constituindo um problema complexo, tendo em vista os elevados índices de mortalidade e sequelas incapacitantes permanentes. Objetivo: Descrever o perfil epidemiológico dos pacientes atendidos em um hospital de urgências da região centro-oeste, vítimas de trauma torácico. Método: Estudo quantitativo, de caráter transversal e retrospectivo, realizado a partir de coleta de dados efetuada em prontuário eletrônico no período de março a maio de 2022. Resultados: Identificou-se 73 pacientes vítimas de trauma torácico, com maior acometimento de pessoas do sexo masculino, com idade entre 26 e 35 anos. Como causa mais frequente, se destacaram os acidentes motociclísticos, resultando principalmente em lesões do tipo hemopneumotórax. Conclusão: o perfil epidemiológico dos pacientes vítimas de trauma torácico foi representado com maior frequência pelo sexo masculino, com idade entre 26 a 35 anos, causados predominantemente por acidentes motociclísticos, resultando na maioria das vezes em lesões do tipo hemopneumotórax

Trauma is responsible for significant impacts on society. According to data from the World Health Organization (WHO), more than nine people die per minute victims of trauma. Among the main types of trauma, thoracic trauma currently represents about 25% of polytrauma deaths, constituting a complex problem, in view of the high rates of mortality and sequelae permanent disabling. Objective: To describe the epidemiological profile of patients treated at an emergency hospital in the Midwest region, victims of thoracic trauma. Method: Quantitative, cross-sectional and retrospective study carried out from data collection of electronic medical records in the period from March to May of 2022. Results: We identified 73 patients who were victims of chest trauma with higher affecting males aged between 26 and 35 years. As the most frequent cause motorcycle accidents stood out, resulting mainly in lesions of the hemopneumothorax type. Conclusion: the profile epidemiology of patients victims of thoracic trauma was represented with greater frequency by males, aged between 26 and 35 years, caused predominantly by motorcycle accidents, often resulting in hemopneumothorax lesions

Trauma em ambientes rurais: avaliação de pacientes internados em unidade de terapia intensiva / Trauma in rural environments: evaluation of patients interned in intensive care unit / Traumatismos en entornos rurales: evaluación de los pacientes ingresados en una unidad de cuidados intensivos

O acesso limitado do atendimento ao trauma aumenta proporcionalmente à ruralidade, refletindo em uma maior mortalidade e invalidez a longo prazo. A pesquisa objetivou identificar os desfechos de pacientes internados por trauma em Unidades de Terapia Intensiva, acometidos em ambientes rurais. Trata-se de um estudo transversal observacional realizado em uma UTI geral de um hospital da região central do Estado do Paraná entre 2013 a 2019, através da análise de prontuários de 230 pacientes traumatizados em ambiente rural. Os dados foram analisados por meio de testes de Qui-quadrado de Pearson, exato de Fisher ou t de Student. Dentre os desfechos identificados, observou-se associação do sexo feminino com as comorbidades (p=0,024), das regiões mais afetadas de cabeça, pescoço e tórax com a gravidade do trauma (p=0,001), além de variáveis do primeiro atendimento, como suporte respiratório básico, PAS <90mmHg e Glasgow associados à pacientes cirúgicos e pupilas alteradas em pacientes clínicos. Para o desfecho, observou-se que as médias do tempo de permanência hospitalar foi significativamente menor para aqueles que foram a óbito. As características apresentadas assemelham-se às informações mencionadas na literatura, em que as lesões graves com a necessidade de intervenção cirúrgica e maior tempo de permanência hospitalar estão associados ao óbito em traumas rurais. Contudo, o trauma no ambiente rural, apesar de não refletir nem sempre em maior gravidade, apresenta desfechos impactantes para o paciente.

Limited access to trauma care increases proportionally to rurality, reflecting higher mortality and long-term disability. The research aimed to identify the outcomes of patients hospitalized for trauma in Intensive Care Units, affected in rural environments. This is an observational cross-sectional study carried out in a general ICU of a hospital in the central region of the State of Paraná between 2013 and 2019, through the analysis of medical records of 230 trauma patients in a rural environment. Data were analyzed using Pearson's chi-square, Fisher's exact or Student's t tests. Among the outcomes identified, there was an association between female sex and comorbidities (p=0.024), the most affected regions of the head, neck and chest with the severity of the trauma (p=0.001), in addition to variables of the first care, such as basic respiratory support, SBP <90mmHg and Glasgow associated with surgical patients and altered pupils in medical patients. For the outcome, it was observed that the average length of hospital stay was significantly lower for those who died. The characteristics presented are similar to the information mentioned in the literature, in which serious injuries requiring surgical intervention and longer hospital stays are associated with death in rural traumas. However, trauma in the rural environment, although not always reflecting greater severity, has impacting outcomes for the patient.

El acceso limitado a la atención traumatológica aumenta proporcionalmente a la ruralidad, lo que se refleja en una mayor mortalidad y discapacidad a largo plazo. La investigación tenía como objetivo identificar los resultados de los pacientes ingresados por traumatismos en las Unidades de Cuidados Intensivos, afectados en entornos rurales. Se trata de un estudio observacional transversal realizado en una UCI general de un hospital de la región central del Estado de Paraná entre 2013 y 2019, a través del análisis de las historias clínicas de 230 pacientes lesionados en el medio rural. Los datos se analizaron mediante las pruebas de chi-cuadrado de Pearson, exacta de Fisher o t de Student. Entre los resultados identificados, el sexo femenino se asoció con las comorbilidades (p=0,024), las regiones más afectadas de la cabeza, el cuello y el tórax con la gravedad del traumatismo (p=0,001), además de las variables de los primeros cuidados, como la asistencia respiratoria básica, la PAS <90mmHg y el Glasgow asociado a los pacientes quirúrgicos y las pupilas alteradas en los pacientes clínicos. En cuanto al resultado, se observó que la duración media de la estancia hospitalaria fue significativamente menor para los que murieron. Las características presentadas son similares a la información mencionada en la literatura, en la que las lesiones graves con necesidad de intervención quirúrgica y mayor estancia hospitalaria se asocian a la muerte en el trauma rural. Sin embargo, el traumatismo en el medio rural, a pesar de no reflejar siempre una mayor gravedad, presenta resultados impactantes para el paciente.

Perfil clínico e fatores associados ao óbito de pacientes COVID-19 nos primeiros meses da pandemia / Perfil clínico y factores asociados a la muerte de pacientes COVID-19 en los primeros meses de la pandemia / Clinical profile and factors associated with the death of COVID-19 patients in the first months of the pandemic

RESUMO Objetivo analisar as características individuais, clínicas e os fatores associados à mortalidade de pacientes com COVID-19, em hospital público do estado do Paraná, Brasil. Métodos estudo seccional, retrospectivo, documental (n= 86), com pacientes adultos internados, de março a junho de 2020. Resultados a mortalidade foi de 12,8%, o grupo de maior risco foi de idosos com comorbidades, especialmente, cardiovasculares. A chance de óbito foi 58 vezes maior em idosos, comparada aos adultos, e oito vezes maior naqueles com comorbidades, comparadas aos hígidos. A maioria dos pacientes apresentou sintomatologia respiratória, febre e mialgia. Tratamento à base de antibióticos, anticoagulantes e antivirais, associado ao suporte ventilatório. As principais complicações foram hipóxia, insuficiência renal aguda e infecção secundária. Conclusão e implicações para a prática idosos com comorbidades cardiovasculares que necessitaram de cuidados intensivos apresentaram maior chance de óbito. Os resultados de um dos centros de referência na pandemia possibilitam discutir medidas epidemiológicas adotadas, com ênfase em conceitos restritivos nos primeiros meses.

RESUMEN Objetivo analizar las características individuales, clínicas y los factores asociados a la mortalidad en pacientes con COVID-19 en un hospital público del estado de Paraná. Métodos estudio transversal, retrospectivo, documental (n = 86), con pacientes adultos hospitalizados, de marzo a junio de 2020. Resultados la mortalidad fue del 12,8%, grupo de mayor riesgo para los ancianos con comorbilidades, especialmente enfermedades cardiovasculares. La probabilidad de muerte fue 58 veces mayor en los ancianos en comparación con los adultos y ocho veces mayor en aquellos con comorbilidades en comparación con los sanos. La mayoría de los pacientes presentaban síntomas respiratorios, fiebre y mialgia. Tratamiento a base de antibióticos, anticoagulantes y antivirales, asociado al soporte ventilatorio. Las principales complicaciones fueron hipoxia, insuficiencia renal aguda e infección secundaria. Conclusión e implicaciones para la práctica los ancianos con comorbilidades cardiovasculares que requirieron cuidados intensivos tenían una mayor probabilidad de muerte. Los resultados de uno de los centros de referencia pandémica permiten discutir las medidas epidemiológicas adoptadas, con énfasis en conceptos restrictivos en los primeros meses.

ABSTRACT Objective to analyze the individual and clinical characteristics and the factors associated with mortality in patients with COVID-19, in a public hospital in the state of Paraná, Brazil. Methods a cross-sectional, retrospective, documentary study (n= 86), with adult inpatients, from March to June 2020. Results mortality was 12.8%, the highest risk group was the elderly with comorbidities, especially cardiovascular ones. The chance of death was 58 times higher in the elderly compared to adults, and eight times higher in those with comorbidities compared to the healthy ones. Most patients presented with respiratory symptoms, fever, and myalgia. Treatment was based on antibiotics, anticoagulants and antivirals, associated with ventilatory support. The main complications were hypoxia, acute renal failure, and secondary infection. Conclusion and implications for practice elderly people with cardiovascular comorbidities who required intensive care had a higher chance of death. The results from one of the reference centers in the pandemic make it possible to discuss epidemiological measures adopted, with emphasis on restrictive concepts in the first months.

High neutrophil to lymphocytes ratio is associated with nutritional risk in hospitalised, unselected cancer patients: a cross-sectional study.

Cancer patients possess metabolic and pathophysiological changes and an inflammatory environment that leads to malnutrition. This study aimed to (i) determine whether there is an association between neutrophil-to-lymphocyte ratio (NLR) and nutritional risk, and (ii) identify the cut-off value of NLR that best predicts malnutrition by screening for nutritional risk (NRS 2002). This cross-sectional study included 119 patients with unselected cancer undergoing chemotherapy and/or surgery. The NRS 2002 was applied within 24 h of hospitalisation to determine the nutritional risk. Systemic inflammation was assessed by blood collection, and data on C-reactive protein (CRP), neutrophils, and lymphocytes were collected for later calculation of NLR. A receiver operating characteristic (ROC) curve was used to identify the best cut-point for NLR value that predicted nutritional risk. Differences between the groups were tested using the Student's t-, Mann-Whitney U and Chi-Square tests. Logistic regression analyses were performed to assess the association between NLR and nutritional risk. The ROC curve showed the best cut-point for predicting nutritional risk was NLR > 5.0 (sensitivity, 60.9%; specificity, 76.4%). The NLR ≥ 5.0 group had a higher prevalence of nutritional risk than the NLR < 5.0 group (NLR ≥ 5.0: 73.6% vs. NLR < 5.0: 37.9%, p = 0.001). The NLR group ≥ 5.0 showed higher values of CRP and NLR than the NLR < 5.0 group. In addition, patients with NLR ≥ 5.0 also had higher NRS 2002 values when compared to the NLR < 5.0 group (NLR ≥ 5.0: 3.0 ± 1.1 vs. NLR < 5.0: 2.3 ± 1.2, p = 0.0004). Logistic regression revealed an association between NRS and NLR values. In hospitalised unselected cancer patients, systemic inflammation measured by NLR was associated with nutritional risk. Therefore, we highlight the importance of measuring the NLR in clinical practice, with the aim to detect nutritional risk.

Prevalence of malnutrition risk and its association with mortality: nutritionDay Latin America survey results.

BACKGROUND & AIMS: Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. METHODS: On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. RESULTS: The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered. CONCLUSIONS: Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades ago-a compelling rationale for new focus on nutrition education and training of professionals in acute care settings.

Association between cycle threshold (Ct ) values and clinical and laboratory data in inpatients with COVID-19 and asymptomatic health workers.

In-house assays for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by quantitative reverse-transcription polymerase chain reaction (qRT-PCR), are feasible alternatives, particularly in developing countries. Cycle threshold (Ct ) values obtained by qRT-PCR were compared with clinical and laboratory data from saliva of inpatients with COVID-19 and asymptomatic health workers (AHW) were studied. Saliva specimens from 58 inpatients confirmed by qRT-PCR for SARS-CoV-2 using nasopharyngeal specimens, and 105 AHW were studied by qRT-PCR using three sets of primers for the N (N1, N2, and N3) gene of SARS-CoV-2, according to the CDC Diagnostic Panel protocol, showing a positivity of 88% for inpatients and 8% for AHW. Bivariate analysis revealed an association between Ct < 38.0 values for N2 and mechanical ventilation assistance among patients (p = .013). In addition, values of aspartate-transaminase, lactate dehydrogenase, and ferritin showed significant correlations with Ct values of N1 and N3 genes in inpatients. Therefore, our results show that Ct values correlate with some relevant clinical data for inpatients with COVID-19.

[Febrile syndrome in children younger than 29 days]. / Síndrome febril en niños menores de 29 días.

INTRODUCTION: Acute fever of unknown origin (FUO) in children under 29 days is a worrying situation because of the risk of serious bacterial infection (SBI). OBJECTIVE: to study the main clinical and laboratory characteristics of a group of hospitalized children under 29 days with diagnosis of FUO. PATIENTS AND METHOD: Retrospective study of children under 29 days hospitalized due to FUO. The clinical records of the patients were reviewed, recording age, sex, history of fever before consultation, temperature at admission, estimated severity at admission and discharge, discharge diagnoses, laboratory tests, and indicated treatments. Patients were classified according to the severity of the discharge diagnosis, as severe (S) and non-severe (NS). The inclusion criteria were term newborn, age less than 29 days, fe ver > 38°C registered at home or admission, and history of < 4 days. RESULTS: 468 children with FUO were admitted. Concordance between severity at admission and discharge was low (Kappa = 0.125; p = 0.0007). 26.1% of children were S and 73.9% NS. In the S group, urinary tract infection domínate (70.5%) and in the NS, FUO (67.6%). The cut-off levels for leukocytes/mm3, C-reactive protein, and neutrophils/mm3 showed negative predictive values to rule out severe bacterial infection. Conclu sions: Most of the newborns presented mild severity at admission, but 24% of them had SBI, thus hospitalization and close clinical observation are always necessary. Laboratory tests, such as CRP, white blood cell and neutrophils count are not good predictors of SBI. Early treatment with antibio tics for patients who meet the low-risk criteria is debatable.

Epidemiologia, complicações e fatores associados à doença crítica crônica em pacientes hospitalizados por trauma em unidade de terapia intensiva / Epidemiology, complications, and factors associated with chronic critical illness in patients hospitalized by trauma in an intensive care unit

A doença crítica crônica (DCC) descreve pacientes que sobreviveram ao episódio inicial de doença crítica, mas que permanecem dependentes da unidade de terapia intensiva (UTI) por períodos prolongados ou pelo resto de suas vidas. O presente estudo objetivou caracterizar pacientes traumatizados e hospitalizados na Unidade de Terapia Intensiva com Doença Crítica Crônica. Foram coletados dados de internações por trauma UTI no interior do Paraná de 2013 a 2016, dessa maneira, foi traçado o perfil epidemiológico e realizado associações e comparação dos grupos analisados (total de pacientes traumatizados hospitalizados em UTI em comparação com os pacientes traumatizados que desenvolveram DCC). Notou-se que dos 417 indivíduos traumatizados investigados, 41 (9,8%) foram classificados com DCC. Além disso, o sexo masculino, menor índice de comorbidades, maior gravidade do trauma e ferimentos contusos estiveram relacionados ao desenvolvimento da DCC. Os pacientes com DCC apresentaram complicações cirúrgicas (87,8%), e 41,5% evoluíram a óbito. Portanto, os pacientes com DCC permanecem por longo período na UTI (com uma média de 19,88 dias), os quais necessitam de cuidados intensivos de enfermagem e da equipe multiprofissional.(AU)

Chronic critical illness (CCI) describes patients who survived the initial episode of critical illness, but who remain dependent of the intensive care unit (ICU) for extended periods or for the rest of their lives. This study aimed at characterizing traumatized patients hospitalized in the Intensive Care Unit with Chronic Critical Illness. Data from ICU trauma hospitalizations in the interior of the state of Paraná were collected from 2013 to 2016, and with them, the epidemiological profile was drawn up, associations were made, and the analyzed groups were compared (total traumatized patients hospitalized in the ICU compared to traumatized patients who developed CCI). It was observed that from the 417 traumatized individuals investigated, 41 (9.8%) were classified as having CCI. In addition, it was observed that gender (male), a lower rate of comorbidities, greater severity of trauma, and blunt injuries were related to the development of CCI. Patients with CCI had surgical complications (87.8%), and 41.5% died. Therefore, CCI remain in the ICU for a long period (with an average of 19.88 days), which require intensive nursing care and the use of a multidisciplinary team.(AU)

Validity and reliability of the RAC adult infection risk scale: A new instrument to measure healthcare-associated infection risk.

Healthcare-associated infections represent a public health problem, and they have repercussions for patient safety. The aim of this study was to determine the psychometric properties of the Rodríguez-Almeida-Cañon (RAC) adult infection risk scale, focusing on the construct and predictive validity and reliability. The study enrolled 278 patients at a large hospital in southern Brazil. The research process involved the following three phases: construct validation, assessing predictive validity, and assessing reliability. Confirmatory factor analysis showed a good fit using a two-factor model with 15 items. The logistic regression analysis showed an association between the scale score and prediction of developing healthcare-associated infections (odds ratio: 1.18; 95% confidence interval: 1.08-1.28). The Cronbach's alpha was 0.72 for intrinsic factors subscale and 0.71 for extrinsic factors subscale. A high level of inter-rater agreement (intraclass correlation coefficient ≥0.97) was found for both subscales. The Bland and Altman method showed narrow agreement limits, demonstrating good agreement between evaluators. The findings of this study showed that the RAC adult infection risk scale is a new, reliable, and psychometrically valid instrument to assess healthcare-associated infections risk. Future research using this scale may lead to a better understanding of the healthcare-associated infections risk and assist health professionals in decision-making for interventions to improve patient safety.

Condição bucal de mulheres com diabetes mellitus gestacional internadas em um hospital escola no sul do Brasil / Oral condition of women with gestational diabetes mellitus admitted in a school hospital in southern Brazil

Objetivo: avaliar a condição bucal de mulheres com diabetes mellitus gestacional (DMG) internadas no Hospital Escola (HE) da Universidade Federal de Pelotas (UFPel). Métodos: trata-se de um estudo transversal retrospectivo de base hospitalar, em que dois residentes treinados realizaram a coleta dos dados por meio da avaliação dos prontuários médicos e odontológicos, no período de setembro de 2019 a março de 2020. Os dados socioeconômicos e demográficos e o diagnóstico de DMG foram coletados dos prontuários médicos, enquanto hábitos e condição bucal, dos prontuários odontológicos. A análise dos dados foi realizada no programa Stata 11.0, usando os testes Exato de Fisher e Regressão de Poisson. Resultados: foram avaliados os prontuários de 83 gestantes, destas, 37 (44,6%) apresentavam DMG. A presença de DMG esteve asso-ciada com as gestantes de maior faixa etária (62,2%) e no terceiro trimestre de gestação. Em sua maioria, tinham renda de até dois salários mínimos, eram solteiras, tinham filhos e realizaram pré-natal. Em relação à avaliação bucal, apenas a presença de cálculo dental e inflamação gengival foi estatisticamente associada à presença de DMG (p= 0,030 e 0,014 respectivamente). A autopercepção do sorriso foi considerada ruim por 40,5%, e a maioria teve dentes perdidos por cárie (64,9%). Conclusões: a prevalência de DMG foi alta entre as gestantes internadas, sendo maior em mulheres de mais idade. Presença de cálculo dental e inflamação gengival foram fortemente associadas à presença de DMG, enquanto hábitos bucais e presença de cárie não apresentaram associação. Novas pesquisas, com exames periodontais completos, são necessárias para verifi-car as condições periodontais dessas mulheres.(AU)

Aim: to assess the oral condition of women with Gestacional Diabetes Mellitus (GDM) admitted in a School Hospital (HE)/UFPel. Methods: medical and dental records, from September 2019 to March 2020, were evaluated in this hospital-based retrospective cross-sectional study. Socioeconomic and demographic data were collected from medical records, while oral condition and habits were obtained from the dental records. Statistical analysis was performed with Stata 11.0 software using Fisher's exact test and Poisson regression. Results: the medical records of 83 pregnant women were evaluated, of which 37 (44.6%) had GDM. The presence of GDM was associated with pregnant women of older age (62.2%) and most in the third trimester of pregnancy. Most of them had an income of up to two minimum wages, were single, had children and underwent prenatal care. Regarding the oral evaluation, only the presence of dental calculus and gingival inflammation was statistically associated with the presence of GDM (p = 0.030 and 0.014 respectively). The self-perception of the smile was considered bad to 40.5% and many of them had lost teeth due to caries (64.9%). Conclusions: the prevalence of GDM was high in hospitalized pregnant women, being higher in older women. Presence of dental calculus and gingival inflammation were strongly associated with the presence of GDM, while oral habits and the presence of caries were not associated. Further research, with complete periodontal examinations is necessary to verify the periodontal conditions of these women.(AU)

Constipation in Hospitalized Patients: A Study of Prevalence and Associated Factors.

PURPOSE: The purpose of this study was to identify the prevalence of constipation in hospitalized patients, along with sociodemographic and clinical variables associated with its occurrence. DESIGN: Observational, cross-sectional study. SUBJECTS AND SETTINGS: The study sample comprised 343 adult patients hospitalized at a University Hospital in Sao Paulo, Brazil. METHODS: Point-prevalence data were collected on the same day each month over a 4-month period. Data were collected via interviews, physical examination, medical record review, and completion of a data collection form that queried sociodemographic data and incorporated the Bowel Function in the Community instrument. Patients were classified as constipated if they met 2 or more of the Rome III criteria. Logistic regression analyses were used to identify clinical or sociodemographic factors associated with constipation. RESULTS: Fifty-one patients had constipation, reflecting a point-prevalence of 14.8% (95% CI, 11.49-19.02). The prevalence of constipation was 15% in females (n = 29) and 14.7% in males (n = 22). Multivariable logistic regression showed that use of laxatives (OR = 9.98; 95% CI, 3.539-29.666) was associated with a higher likelihood of constipation. CONCLUSION: The prevalence of constipation in hospitalized adult patients was lower than that in previous studies. Patients using laxatives were more likely to experience constipation.

Survival in adult inpatients with COVID-19.

BACKGROUND: The mortality of the coronavirus disease 2019 (COVID-19) pandemic is high, and data regarding its prognosis are scarce. We aimed to assess the survival experience and determining factors in adult inpatients with laboratory-confirmed COVID-19. METHODS: We conducted a nationwide and retrospective cohort study. Data from 66,123 individuals were analyzed using the Kaplan-Meier method, and a multivariate Cox proportional hazard regression model was fitted. RESULTS: The 7-day survival was 72.2% and went to 47.6%, 35.0%, and 23.9% on days 15, 21, and 30 of hospital stay, respectively. In the multiple analysis, factors associated with an increased risk of dying were male gender, age, pneumonia at hospital admission, immunosuppression, and personal history of chronic non-communicable diseases. Reduced risk of a fatal outcome was observed among patients with asthma history. CONCLUSIONS: To the best of our knowledge, this is the largest study analyzing the survival probability in a large subset of Latin-American adults with COVID-19, in whom the disease burden has been high. Our results contribute to achieving a better understanding of disease evolution.

Utilização da ventilação mecânica não invasiva em pacientes internados na unidade de terapia intensiva adulto: sucesso, insucesso, motivo da VNI, tempo de internação, alta ou óbito / Use of noninvasive ventilation in patients admitted to the adult intensive care unit: success, failure, reason for NIV, length of hospital stay, discharge or death

Introdução: A utilização da ventilação não invasiva (VNI) é importante no tratamento de pacientes críticos internados em unidades de terapia intensiva (UTI), apresentando resultados significativos quando avaliada e instituida no momento adequado. Os benefícios da VNI são evidentes em diferentes etiologia, favorecendo a evolução clínica dos pacientes e diminuindo tempo de internação. O uso da VNI como resgate apresenta resultados desfavoráveis, porém o uso de VNI preventiva ou, facilitadora parece promissor neste cenário. Objetivo: Avaliar as indicações para utilização da VNI em pacientes críticos, identificar, e analisar os desfechos da resposta à VNI, o tempo de internação, e outros benefícios para estabelecer possíveis desfechos nos pacientes críticos internados nesta unidade. Métodos: Estudo de coorte retrospectivo, realizado através de análise de prontuários de pacientes maiores de 18 anos, ambos os sexos, admitidos na UTI adulto e submetidos a VNI, no período de agosto de 2018 a agosto de 2019. Resultados: Foram incluídos 114 pacientes, 57% do sexo masculino, com idade de 69 ±13 anos, que ficaram internados por 13,2 ± 11,8 dias, apresentando uma pontuação de SAPS 3 59±14 pontos, sendo a IRpA o motivo do uso de VNI mais frequente, representando 64,9% da amostra, seguido da VNI de forma preventiva após extubação (17,5%). Obtivemos um total de 66,9% de sucesso na utilização da VNI. Conclusão: A utilização da VNI no perfil dos pacientes críticos internados, apresentaram sucesso para o uso na maioria dos casos, mostrando melhores desfechos clínicos e propiciando diminuir o tempo de internação na UTI, e alta desta unidade. (AU)

Introduction: The use of noninvasive ventilation (NIV) is important in the treatment of critically ill patients admitted to the intensive care unit (ICU), showing significant results when evaluated and introduced at the appropriate time. The benefits of NIV are evident in different etiologies by favoring the clinical outcome of patients and reducing the length of hospital stay. The use of NIV as a rescue therapy has produced unfavorable results. However, the use of preventive or facilitating NIV seems promising in this scenario. Objective: To evaluate indications for the use of NIV in critically ill patients and to identify and analyze the outcomes of NIV response, length of hospital stay, and other benefits in order to establish possible outcomes in critically ill ICU patients. Methods: This was a cohort study with a retrospective review of the medical records of patients aged 18 years or older, of both sexes, who were admitted to the adult ICU and received NIV from August 2018 to August 2019. Results: A total of 114 patients were included, 57% were men and the mean age was 69 (SD, 13) years. The mean length of hospital stay was 13.2 (SD, 11.8) days, and SAPS score was 3.59 (SD, 14). Acute respiratory failure was the main reason for NIV use, accounting for 64.9% of cases, followed by preventive NIV after extubation (17.5%). The success rate of NIV use was 66.9%. Conclusions: The use of NIV in critically ill ICU patients was successful in most cases, leading to improved clinical outcomes and reduced length of ICU stay, with faster discharge from this unit. (AU)

Retinal changes in COVID-19 hospitalized cases.

The main objective of this study was to evaluate the retinas of severely or critically ill COVID-19 patients during their hospital stay, at varying time points after symptoms onset. This was a case series observed during May 2020 in two referral centers for COVID-19 treatment in Rio de Janeiro, Brazil. 47 eyes from 25 hospitalized patients with severe or critical confirmed illness were evaluated. A handheld retinal camera was used to acquire bilateral fundus images at several time points after symptoms onset. Electronic health records were retrospectively analyzed and clinical data collected. Severe and critical diseases were noticed in 52% (13/25) and 48% (12/25) of enrolled patients, respectively. Retinal changes were present in 12% (3/25) of patients: a 35 year-old male demonstrated bilateral nerve fiber layer infarcts and microhemorrhages in the papillomacular bundle, but required mechanical ventilation and developed severe anemia and systemic hypotension, acute kidney injury and neurologic symptoms during the course of the disease (critical illness); a 56 year-old male, who required full enoxaparin anticoagulation due to particularly elevated D-dimer (>5.0 mcg/mL), demonstrated unilateral and isolated flame-shaped hemorrhages; and a 49 year-old hypertensive male showed bilateral and discrete retinal dot and blot microhemorrhages. The other 22 patients evaluated did not demonstrate convincing retinal changes upon examination. There was no correlation between disease severity and admission serum levels of CRP, D-dimer and ferritin. This was the first study to show that vascular retinal changes may be present in not insignificant numbers of severe or critical COVID-19 inpatients. These retinal changes, only seen after morbid developments, were likely secondary to clinical intercurrences or comorbidities instead of a direct damage by SARS-CoV-2, and may be important and easily accessible outcome measures of therapeutic interventions and sentinels of neurologic and systemic diseases during COVID-19 pandemic.

Assessment of the impact of inpatient infectious events in pediatric patients with newly diagnosed acute leukemia at Dr. Robert Reid Cabral Children's Hospital, Dominican Republic.

Survival rates for pediatric acute leukemia vary dramatically worldwide. Infections are a leading cause of morbidity and mortality, and the impact is amplified in low and middle-income countries. Defining the epidemiology of infection in a specific health care setting is paramount to developing effective interventions. This study aimed to define the epidemiology of and outcomes from infection in children with acute leukemia treated in a large public pediatric hospital in the Dominican Republic. A retrospective cohort was assembled of children newly diagnosed with acute leukemia between July 1, 2015 to June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database (PONDTM) and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child's home to the hospital was determined using ArcGIS by Esri. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using negative binomial regression. Overall, invasive infections were common and a prominent source of death in this cohort. Rates were highest in the first 60 days after diagnosis. Gastroenteritis/colitis, cellulitis, and pneumonia were most frequent, with bacteremia common early on. Multidrug resistant bacteria were prevalent among a small number of positive cultures. In a multivariate negative binomial regression model, age ≥ 10 years and distance from the hospital > 100 km were each protective against invasive infection in the first 180 days after diagnosis, findings that were unexpected and warrant further investigation. Over one-third of patient deaths were related to infection. Interventions aimed at reducing infection should target the first 60 days after diagnosis, improved supportive care inside and outside the hospital, and increased antimicrobial stewardship and infection prevention and control measures.

Prognostic factors in hospitalized patients diagnosed with SARS-CoV-2 infection, Bogotá, Colombia / [Factores pronósticos en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2 en Bogotá, Colombia].

Introduction: Infection with the new SARS-Cov-2 coronavirus is a worldwide public health emergency; its diagnosis is based on molecular tests, while its prognosis depends on the patient's history and on some paraclinical tests. In Colombia, forecasts are not yet counted. Objective: To assess the factors associated with the development of severe disease in hospitalized patients diagnosed with SARS-CoV-2 infection, as well as the prognostic factors for the outcome of mortality. Materials and methods: We conducted an ambispective cohort study in hospitalized patients at the Fundación Cadioinfantil from March to June, 2020. Results: Of the 104 patients analyzed, 31.7% (n=33) had a severe presentation and 9.6% (n=10) had a mortality outcome. For mortality, the most important prognostic factor was the development of severe disease followed by age over 60 years and malnutrition. For the development of the severe disease, prognostic factors were a history of hemodialysis (HR=135), diabetes (HR=4.4), and an increased level of lactate dehydrogenase (LDH) (HR=1,004), while the lymphocyte count over 1,064 was a protective factor (HR=0.9). In the classification of patients, the National Early Warning Score (NEWS2) score in the high and low-risk categories corresponded to the best performance. There was no difference between the treatments administered. Conclusions: The most important prognostic factors for mortality were being over 60 years of age, hypertension, diabetes, and cirrhosis, while for the development of severe disease they were chronic kidney disease with hemodialysis, NEWS2 with high risk at admission, increased levels of LDH and C reactive protein (CRP), and leukocytosis.

Introducción. La infección por el nuevo coronavirus SARS-Cov-2 es una emergencia de salud pública en todo el mundo; su diagnóstico se basa en pruebas moleculares, en tanto que su pronóstico depende de los antecedentes del paciente y de algunos exámenes paraclínicos. En Colombia aún no se cuenta con datos de pronóstico en una población local. Objetivo. Evaluar los factores asociados con el desarrollo de la enfermedad grave en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2, así como los factores pronósticos de la mortalidad. Materiales y métodos. Se hizo un estudio de cohorte ambispectivo en pacientes hospitalizados en la Fundación Cardioinfantil entre marzo y junio de 2020. Resultados. De los 104 pacientes analizados, en el 31,7 % (n=33) la infección fue grave y en el 9,6 % (n=10) se produjo la muerte. El factor pronóstico más importante de la mortalidad fue el desarrollo de la enfermedad grave, seguido de una edad de más de 60 años y la desnutrición. Para el desarrollo de la enfermedad grave los factores pronósticos fueron los antecedentes de hemodiálisis (hazard ratio, HR=135), diabetes (HR=4,4) y el aumento en el nivel de la lactato deshidrogenasa (LDH) (HR=1,004), en tanto que un conteo de linfocitos superior a 1.064 fue un factor protector (HR=0,9). El puntaje del National Early Warning Score (NEWS2) correspondiente a las categorías de alto y bajo riesgo fue el que mejor rendimiento tuvo. No hubo diferencia entre los tratamientos administrados. Conclusiones. Los factores pronósticos más importantes para la mortalidad fueron tener más de 60 años, hipertensión, diabetes y cirrosis, en tanto que para el desarrollo de la enfermedad grave fueron la enfermedad renal crónica con hemodiálisis, un puntaje de NEWS2 de alto riesgo al ingreso, y aumento en los niveles de LDH y proteína C reactiva, y leucocitosis.

Surgical antibiotic prophylaxis: is the clinical practice based on evidence?

OBJECTIVE: To assess the surgical antibiotic prophylaxis. METHODS: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis. RESULTS: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes. CONCLUSION: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.