Evaluation of changes in the faecal resistome associated with children's exposure to domestic animals and food animal production.

OBJECTIVES: The paediatric gut microbiota is a reservoir of antimicrobial resistance genes. Environmental factors such as a child's exposure to faecal contamination and antimicrobial resistance genes of animal origin likely shape the resistome of infants and children. This study measured how different levels of exposure to domestic or food animals affect the structure of the intestinal resistome in children between 1 and 7 years of age. METHODS: One hundred nineteen faecal samples from 39 children were analysed according to the level of exposure to domestic or food animals and categorized into three risk groups. Using high-throughput sequencing with an Illumina NovaSeq 6000 SP platform, we performed faecal resistome analyses using the ResFinder database. Additionally, ResistoXplorer was used to characterize the resistomes of children differentially exposed to domestic animals. RESULTS: Our data indicated that specific antimicrobial resistance genes such as those that confer resistance to MATFPR (macrolide, aminoglycoside, tetracycline, fluoroquinolone, phenicol, and rifamycin) and tetracyclines were statistically less abundant in the group of children without exposure to animals (group 2), compared with the groups exposed to domestic and food animals (groups 1 and 3). However, the overall resistome structure among the children was not affected by the different levels of exposure to animals. CONCLUSIONS: This study suggests that animal exposure is a risk factor for young children acquiring specific antimicrobial resistance genes from domestic animals or animal production areas. However, the overall resistome structure was not affected.

Pharmacist-led medication reconciliation on admission to an acute psychiatric hospital unit.

Background: Therapy management in patients suffering from mental health disorders is complex and the risks derived from changes or interruptions of treatment should not be ignored. Medication reconciliation in psychiatry may reduce medication errors and promote patient safety during transitions of care. Objective: To identify the influence of complementary information sources in the construction of the best possible medication history, and to ascertain the potential clinical impact of discrepancies identified in a medication reconciliation service. Methods: An observational study was conducted in an acute mental hospital unit, with a further validation in an internal medicine unit. Adult patients taking at least one medicine admitted in the unit were included. Patients/caregivers were interviewed upon admission and the information gathered was compared with hospital medical and shared electronic medical records. Once the best possible medication history was gathered, therapeutic information was reconciled against the prescription on admission to identify discrepancies. Potential clinical impact of medication errors was classified using the International Safety Classification. Results: During the study period, 148 patients were admitted, 50.7% females, mean age 54.6 years (SD=16.3). Collaboration of a caregiver was a needed in 74% of the interviews. In total, 1,147 drugs were considered to obtain patients' best possible medication history. After reconciliation, 560 clinically sound intentional discrepancies were identified and 359 discrepancies required further clarification from prescribers: 84.12% "drug omission", 5.57% "drug substitution", 6.96% "dose change", and 3.34% "dosage frequency change". Potential clinical impact of these medication discrepancies was classified as: 95 mild, 100 moderate, and 29 severe medication errors. Conclusion: About 1 in three intentional discrepancies observed in a pharmacists-led medication reconciliation service required further clarification from prescribers, being 80% of them unintentional discrepancies. Results highlight the importance of the caregiver as source of information for the psychiatric patient, the relevance of analyzing shared electronic health records until 6 months before, and the need to use hospital medical records efficiently. Additionally, 29 discrepancies were classified as errors with potentially severe clinical impact. A medication reconciliation service is concluded to be feasible and necessary in a mental health unit.

Pharmacist-led medication reconciliation on admission to an acute psychiatric hospital unit

Background: Therapy management in patients suffering from mental health disorders is complex and the risks derived from changes or interruptions of treatment should not be ignored. Medication reconciliation in psychiatry may reduce medication errors and promote patient safety during transitions of care. Objective: To identify the influence of complementary information sources in the construction of the best possible medication history, and to ascertain the potential clinical impact of discrepancies identified in a medication reconciliation service. Methods: An observational study was conducted in an acute mental hospital unit, with a further validation in an internal medicine unit. Adult patients taking at least one medicine admitted in the unit were included. Patients/caregivers were interviewed upon admission and the information gathered was compared with hospital medical and shared electronic medical records. Once the best possible medication history was gathered, therapeutic information was reconciled against the prescription on admission to identify discrepancies. Potential clinical impact of medication errors was classified using the International Safety Classification. Results: During the study period, 148 patients were admitted, 50.7% females, mean age 54.6 years (SD=16.3). Collaboration of a caregiver was a needed in 74% of the interviews. In total, 1,147 drugs were considered to obtain patients’ best possible medication history. After reconciliation, 560 clinically sound intentional discrepancies were identified and 359 discrepancies required further clarification from prescribers: 84.12% “drug omission”, 5.57% “drug substitution”, 6.96% “dose change”, and 3.34% “dosage frequency change”. Potential clinical impact of these medication discrepancies was classified as: 95 mild, 100 moderate, and 29 severe medication errors. (AU)

Heart quiz: protótipo de game para os estudos em cardiologia / Heart quiz: prototype of game for cardiology studies / Examen del corazón: prototipo del juego para estudios de cardiología

Objetivo: Prototipar um jogo digital para o estudo da Cardiologia por profissionais e estudantes de saúde. Método: Pesquisa de finalidade aplicada do tipo exploratória e de desenvolvimento tecnológico. Desenvolvido em parceria entre a Faculdade de Enfermagem Nossa Senhora das Graças (FENSG) da Universidade de Pernambuco (UPE) e a Faculdade Nova Roma, no período de fevereiro a setembro de 2018. Para a construção, utilizou-se da plataforma Unity versão 2017.1, e a metodologia SCRUM. Resultados: O game que se trata de um quiz com perguntas e respostas que geram pontuação para avançar em sete níveis. Para testar os conhecimentos em cardiologia, os jogadores estarão utilizando um universo tridimensional, com características lúdicas e movimentam-se por um cenário similar a uma emergência hospitalar, encontrando desafios baseados nas necessidades clínicas dos pacientes. Conclusão: A construção do Heart Quiz trouxe uma proposta inovadora para estudos em cardiologia, sendo aplicável em contextos de interesses diferentes, graduação ou pós-graduação. (AU)

Objective: Prototype a digital game for the study of Cardiology by health professionals and students. Methods: Research of applied purpose of the exploratory type and of technological development. Developed in partnership between the Faculty of Nursing Nossa Senhora das Graças of the University of Pernambuco and the Faculty Nova Roma, from February to September 2018. For the construction, it was used the platform Unity version 2017.1, and the Scrum methodology. Results: The game is a quiz with questions and answers that generate scores to advance in seven levels. To test their knowledge in cardiology, players will be using a three-dimensional universe, with playful characteristics and moving through a scenario similar to a hospital emergency, meeting challenges based on the clinical needs of patients. Conclusion: The construction of the Heart Quiz brought an innovative proposal for studies in cardiology, being applicable in contexts of different interests, undergraduate or graduate. (AU)

Objetivo: Prototipo de un juego digital para el estudio de Cardiología por parte de profesionales de la salud y estudiantes. Métodos: Investigación del propósito aplicado del tipo exploratorio y desarrollo tecnológico. Desarrollado en colaboración entre la Facultad de Enfermería Nossa Senhora das Graças de la Universidad de Pernambuco y Faculdade Nova Roma, de febrero a septiembre de 2018. Para el En la construcción, se utilizó la plataforma Unity versión 2017.1 y la metodología Scrum. Resultados: El juego que es un cuestionario con preguntas y respuestas que generan puntuación para avanzar a través de siete niveles. Para probar sus conocimientos en cardiología, los jugadores usarán un universo tridimensional, con características lúdicas y moverse a través de un escenario similar a una emergencia hospitalaria, encontrando desafíos basados en las necesidades clínicas de los pacientes. Conclusión: La construcción de Heart Quiz trajo una propuesta innovadora para estudios en cardiología, siendo aplicable en contextos de diferentes intereses, pregrado o posgrado. (AU)

Environmental Spread of Extended Spectrum Beta-Lactamase (ESBL) Producing Escherichia coli and ESBL Genes among Children and Domestic Animals in Ecuador.

BACKGROUND: There is a significant gap in our understanding of the sources of multidrug-resistant bacteria and resistance genes in community settings where human-animal interfaces exist. OBJECTIVES: This study characterized the relationship of third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) isolated from animal feces in the environment and child feces based on phenotypic antimicrobial resistance (AMR) and whole genome sequencing (WGS). METHODS: We examined 3GCR-EC isolated from environmental fecal samples of domestic animals and child fecal samples in Ecuador. We analyzed phenotypic and genotypic AMR, as well as clonal relationships (CRs) based on pairwise single-nucleotide polymorphisms (SNPs) analysis of 3GCR-EC core genomes. CRs were defined as isolates with fewer than 100 different SNPs. RESULTS: A total of 264 3GCR-EC isolates from children (n=21), dogs (n=20), and chickens (n=18) living in the same region of Quito, Ecuador, were identified. We detected 16 CRs total, which were found between 7 children and 5 domestic animals (5 CRs) and between 19 domestic animals (11 CRs). We observed that several clonally related 3GCR-EC isolates had acquired different plasmids and AMR genes. Most CRs were observed in different homes (n=14) at relatively large distances. Isolates from children and domestic animals shared the same blaCTX-M allelic variants, and the most prevalent were blaCTX-M-55 and blaCTX-M-65, which were found in isolates from children, dogs, and chickens. DISCUSSION: This study provides evidence of highly dynamic horizontal transfer of AMR genes and mobile genetic elements (MGEs) in the E. coli community and shows that some 3GCR-EC and (extended-spectrum ß-lactamase) ESBL genes may have moved relatively large distances among domestic animals and children in semirural communities near Quito, Ecuador. Child-animal contact and the presence of domestic animal feces in the environment potentially serve as important sources of drug-resistant bacteria and ESBL genes. https://doi.org/10.1289/EHP7729.

Contribution of Different Patient Information Sources to Create the Best Possible Medication History.

INTRODUCTION: Obtaining the best possible medication history is the crucial step in medication reconciliation. Our aim was to evaluate the potential contributions of the main data sources available - patient/caregiver, hospital medical records, and shared electronic health records - to obtain an accurate 'best possible medication history'. MATERIAL AND METHODS: An observational cross-sectional study was conducted. Adult patients taking at least one medicine were included. Patient interview was performed upon admission and this information was reconciled with hospital medical records and shared electronic health records, assessed retrospectively. Concordance between sources was assessed. In the shared electronic health records, information was collected for four time-periods: the preceding three, six, nine and 12-months. The proportion of omitted data between time-periods was analysed. RESULTS: A total of 148 patients were admitted, with a mean age of 54.6 ± 16.3 years. A total of 1639 medicines were retrieved. Only 29% were collected simultaneously in the three sources of information, 40% were only obtained in shared electronic health records and only 5% were obtained exclusively from patients. The total number of medicines gathered in shared electronic health records considering the different time frames were 778 (three-months), 1397 (six-months), 1748 (nine-months), and 1933 (12-months). DISCUSSION: The use of shared electronic health records provides data that were omitted in the other data sources available and retrieving the information at six months is the most efficient procedure to establish the basis of the best possible medication history. CONCLUSION: Shared electronic health records should be the preferred source of information to supplement the patient or caregiver interview in order to increase the accuracy of best possible medication history of the patient, particularly if collected within the prior six months.

Introdução: A obtenção da melhor história farmacoterapêutica possível é uma etapa crucial da reconciliação da medicação. O objetivo foi avaliar as potenciais contribuições das principais fontes de informação disponíveis ­ doente/cuidador, Processo Único, Plataforma de Dados da Saúde e ­ para obter uma mais exacta melhor história farmacoterapêutica possível. Material e Métodos: Foi realizado um estudo transversal observacional. Incluíram-se doentes adultos a tomar pelo menos um medicamento. A entrevista com o doente foi realizada na admissão e os dados do Processo Único e da Plataforma de Dados da Saúde recolhidos retrospetivamente. A concordância entre as fontes de informação foi avaliada. Na plataforma de dados da saúde, os dados foram recolhidos em quatro janelas temporais: os últimos três, seis, nove e 12- meses. Os dados omitidos entre os diferentes tempos foram analisados. Resultados: Participaram 148 doentes, com uma idade média de 54,6 ± 16,3 anos. Foram recolhidos 1639 medicamentos. Destes, 29% foram obtidos simultaneamente nas três fontes de informação, 40% foram obtidos apenas na Plataforma de Dados da Saúde e 5% foram obtidos exclusivamente a partir do doente. O número total de fármacos recolhidos na Plataforma de Dados da Saúde nos diferentes tempos foi 778 (três meses), 1397 (seis meses), 1748 (nove meses) e 1933 (12 meses). Discussão: A consulta da Plataforma de Dados da Saúde permite obter dados omitidos nas outras fontes de informação e a recolha dos seis meses precedentes é o procedimento mais eficiente para constituir a base da melhor história farmacoterapêutica possível. Conclusão: A Plataforma de Dados da Saúde deve ser a fonte de informação preferencial para complementar a entrevista do doente/cuidador de forma a aumentar a exatidão da melhor história farmacoterapêutica possível, particularmente se a informação for recolhida em relação aos seis meses precedentes.

A política médica de Brasília e sua organização / Medical policies in Brasilia and your organization

A atuação política na formação das entidades médicasde Brasília ocupa um lugar impar na curtahistória da nossa cidade. O autor apresenta seu testemunhodesse processo por ter ocupado posiçãode liderança nesse processo histórico. Enfatiza quecada um desempenha suas ações de acordo com aconjuntura do momento. Os movimentos políticosmédicos nos primórdios de Brasília foram importantespara que as atuais lideranças exerçam a plenitudede suas atividades perante as entidades médicas.

The political activities for the establishment of medicalentities in Brasilia have a unique importance in the shorthistory of our city. The author shares his point of view onthe subject as he took a leadership role in this historicalprocess. He highlights that each individual acts accordingto the current state of affairs. The medical-politicalmovements that occurred in the early years of Brasiliawere important for the current leaderships to fully actbefore medical entities.

The role of Expressed Emotion, Self-concept, Coping, and Depression in parasuicidal behavior: a follow-up study.

The objective of this study was to characterize Expressed Emotion in families of individuals with parasuicidal behavior, a non-fatal act in which there is self-harm or deliberate excessive ingestion of a substance and to examine the significant relationships between Expressed Emotion (EE), Coping, Depression, Self-concept, and parasuicidal behaviors. The sample consisted of 67 subjects divided into two groups. The first group was made up of 34 parasuicides. Parasuicidal behavior, self-concept, coping, depression and the family's EE were assessed in this group. The control group was composed of 33 young people with identical characteristics (age: 15-24; gender: more female; and residence). All the subjects were followed up for a 9 month period, during which time EE and recurrent parasuicidal behaviors were assessed. Parasuicides showed significant differences (at a 0.05% significance level) in comparison to the control group They showed more Depressed, less Coping, and less Self-concept. There was also an intimate family atmosphere with a high EE. The parasuicides whose families had a high EE showed more recurrent parasuicidal behaviors. The results demonstrate that EE is a predictor of recurrent parasuicidal behaviors and that its assessment in families of young parasuicides is useful.

Perfil dos portadores de GIST operados no Estado do Rio de Janeiro: estudo multicêntrico SBCO / Profile of GIST's patients operated in the State of Rio de Janeiro: SBCO multi-centric trial

Objetivo: o presente estudo tem como objetivo conhecer o perfil dos portadores de tumores estromais gastrointestinais (GISTs) tratados pelos cirurgiões no Estado do Rio de Janeiro. Método: estudo multicêntrico, retrospectivo, implementado pela Sociedade Brasileira de Cirurgia Oncológica (SBCO), tendo início em dezembrode 2006 e término em dezembro de 2007. Foram incluídos 47 casos de GIST tratados cirurgicamente. Resultados: houve predominância do sexo feminino (29 mulheres e 18 homens) e a idade variou de 10 a 81 anos, com mediana de idade de 62 anos. O estômago foi o sítio mais frequente de localização do tumor (44 casos), seguido do intestino delgado (2 casos) e do reto (1 caso). Os sintomas mais comuns foram dor abdominal (48,9 por cento dos casos), massa palpável (46,8 por cento) e sangramento digestivo (27,6 por cento). O tamanho tumoral variou de 0,8 cm a 28 cm, com mediana de 12 cm. A gastrectomia segmentar foi o procedimento cirúrgico mais empregado (21 casos). A incidência de metástase linfonodal foi de 4,2 por cento. A taxa de recidiva foi de 40,4 por cento (todos os casos classificados como GIST de alto risco). Conclusão: a presente casuística revela que o perfil dos portadores de GIST tratados por cirurgiões do Estado do Rio de Janeiro difere em alguns pontos dos relatos da literatura estrangeira, havendo necessidade de estudos nacionais com maior amostragem para confirmação dos dados.

Diagnóstico laboratorial da infeccão pelo vírus herpes simples (HSV) em pacientes transplantados e não-transplantados / Laboratorial diagnosis of herpes simplex virus infection (HSV) in transplanted and non-transplanted patients

INTRODUÇAO: O vírus herpes simples (HSV) é dividido em dois sorotipos (HSV-1 e HSV-2) responsáveis, respectivamente, pelos herpes labial e genital. Embora a infeccão pelo HSV tenha um curso rápido, esse agente está freqüentemente relacionado a complicacões no tratamento de pacientes imunocomprometidos, como indivíduos transplantados, na condicão de agente oportunista. OBJETIVOS: Comparar e avaliar o uso de três técnicas atuais para diagnóstico de HSV em pacientes transplantados e não-transplantados. MATERIAL E MÉTODOS: Oitenta e quatro amostras clínicas consecutivas provenientes de 47 indivíduos transplantados e 37 não-transplantados foram coletadas de junho de 2001 a julho de 2002, sendo, simultaneamente, submetidas a nested multiplex reacão em cadeia da polimerase (PCR) (nmPCR), multiplex PCR (mPCR) e isolamento viral (IV) em células vero. RESULTADOS: Das amostras, 33,3 por cento (28/84) foram positivas para o HSV por IV, 34,5 por cento(29/84) por mPCR e 42,8 por cento (36/84) por nmPCR. Pela técnica de imunofluorescência direta (IFD), 85,7 por cento (24/28) das amostras foram caracterizadas como HSV-1, 86,2 por cento (25/29) pelo mPCR e 88,9 por cento(32/36) pelo nmPCR. Foram caracterizadas como HSV-2 pelas três técnicas empregadas 4,8 por cento(4/84) das amostras. Não houve diferenca significante de deteccão entre as técnicas de diagnóstico do HSV (p = 0,38), embora o nmPCR tenha detectado mais amostras de pacientes transplantados (p = 0,05). CONCLUSAO: Apesar do desempenho similar entre as técnicas, o nmPCR se mostrou ferramenta útil para pacientes transplantados ou para aqueles sob tratamento antiviral, onde é esperada baixa carga viral em suas amostras.

Age patterns of suicide: identification and characterization of European clusters and trends.

Relatively few studies have addressed age patterns of suicide using specifically designed and systematized approaches. Our main objective was to identify and characterize age patterns of suicide in Europe, both on cross-sectional and longitudinal perspectives, based on data comprising the two last decades of the 20th century. A second objective was to determine whether some analytical methods could be useful as complementary approaches to the traditional examination of age-specific rate curves. We identified and characterized four patterns: upward-sloping, convex, downward-sloping, and uniform. The first three reproduce patterns previously described, though we propose some modifications to the respective classification criteria. Longitudinally, pattern stability was found for most countries, but some notable exceptions were detected. From the computation of multiple-decrement life tables by European country, period, and gender, we derived cumulative distributions of age at death for suicide. The results indicate that this methodology is a useful tool, not only for describing and summarizing information, but, more importantly, for providing a better understanding of intrinsic features and complexities of the patterns. Finally, we discuss practical implications of the study in the context of previous theories linking age patterns of suicide to sociological and economic dimensions, and we raise a few questions and hypotheses to be addressed in future research.

Procidência retal: modificaçäo de Notaras na retopexia / Rectal prolapse: Notaras' modification in rectopexy

Atualmente, o tratamento cirúrgico da procidência retal, desde que as condiçöes gerais do paciente o permitam, objetiva a fixaçäo do reto ao sacro, através do acesso abdominal e, basicamente, duas têm sido as técnicas utilizadas nestes últimos anos: a Operaçäo de Ripstein e a esponja de Ivalon. Descreve-se a Técnica de Notaras e tecem-se comentários sobre as vantagens desta modificaçäo na retopexia, em relaçäo aos outros métodos acima. Relatam-se os resultados obtidos em três pacientes por eles operados, e conclui-se ser a Técnica empregada de execuçäo simples, eficiente e isenta de riscos