Effect of different strategies for excluding duplicate cultures on the correlation between hospital resistance rates and antibiotic consumption.

INTRODUCTION: Studies may underestimate the impact of antibiotics on bacterial resistance when correlating hospital antibiotic use with resistance rates (RRs) that exclude duplicate cultures as duplicates usually include more resistant isolates. Comparing correlations between antibiotic consumption and RRs resulting from different strategies for excluding duplicates could help explore how their exclusion affects such correlations. METHODS: We obtained antibiotics consumption and Pseudomonas aeruginosa susceptibility data from 2017 to 2021 for seven antibiotics and for carbapenems as a group in a university hospital. We calculated RRs using seven different time criteria for excluding duplicates. We assessed the correlations of antibiotic consumption to the same-year and next-year RR rates for the three most distinct rates. RESULTS: Duplicate cultures represented 53.45% of total cultures. RRs were higher when duplicates were included. We compared RRs resulting from excluding all duplicates, excluding duplicates monthly or admitting one culture per day. All antibiotics except meropenem showed a correlation with same-year RRs, either positive or negative, whereas all antibiotics showed a positive correlation with next-year RRs. For same-year and next-year correlations, the criteria with fewer duplicates (and therefore fewer resistant strains) found more correlations. However, the inclusion of duplicates taken at least 1 month apart found the most correlations. Admitting one culture per day found the fewest correlations. CONCLUSIONS: Excluding duplicates from RRs affects the correlation of antibiotics consumption with RRs in P. aeruginosa. Including at least some duplicate cultures in correlation analyses, such as those taken 1 month apart, should be considered.

Cálculo de los Días de Terapia Antimicrobiana (DOT) en Cuidados Intensivos Pediátricos: una propuesta de metodología basada en el sistema informático de dispensación de medicamentos

Introducción: El método recomendado para la medición de consumo de antimicrobianos (AMB) en pediatría es el cálculo del indicador Días de Terapia estandarizado por ocupación (DOT-std). Sin embargo, en hospitales que no cuentan con fichas electrónicas, obtener el numerador de los días de terapia (DOT) requiere revisión directa de las indicaciones del paciente, dificultando su aplicabilidad. Objetivos: Validar el sistema de registros electrónicos de dispensación de medicamentos desde farmacia como fuente para el cálculo de DOT y DOT-std en la Unidad de Cuidados Intensivos Pediátrica (UCIP). Materiales y Métodos: Se revisaron las prescripciones de AMB desde la ficha clínica (método manual) y se compararon con los registros de dispensación de AMB a la UCIP (método informático) obtenidos del sistema de medicamentos de farmacia. Se evaluó la concordancia entre los DOT obtenidos mediante el Coeficiente de Correlación Intraclase. Resultados: Los AMB más utilizados fueron vancomicina, meropenem y piperacilina/tazobactam. En 9 de 12 AMB se encontró concordancia significativa entre ambos métodos. Conclusiones: Tras un proceso de validación local, los registros del sistema informático de dispensación de medicamentos desde farmacia podrían utilizarse para el cálculo de DOT en pediatría en hospitales que no cuenten con una ficha electrónica que permita su cálculo directo.

Background: The recommended indicator for measuring antimicrobial (AMB) consumption in pediatric patients is the Days of Therapy indicator (DOT), which is then standardized by hospital occupancy rates (DOT-std). However, in hospitals that do not have electronic health records, obtaining the DOT requires a direct review of each pharmacological indication, which is not feasible in the long term. Aims: To validate electronic records from the pharmacy dispensation system as a source for calculating DOT and estimating DOT-std in a Pediatric Intensive Care Unit (PICU). Methods: AMB prescriptions at the PICU of a university hospital were directly reviewed (manual method) and compared with AMB dispensation records (computer method) obtained from the hospital pharmacy system. The Intraclass Correlation Coefficient was used to evaluate the agreement between the DOT obtained by both methods. Results: The most used AMB were vancomycin, meropenem, and piperacillin/tazobactam. A significant agreement between the DOT obtained by using manual and computer methods was found in 9 of 12 evaluated AMB. Conclusions: After a local validation process, the electronic records of the pharmacy drug dispensation system could be considered a valid source for calculating DOT in PICUs in hospitals where electronic health records with prescription data are not yet available.

USE OF THE INTERNET AND SOCIAL NETWORKS IN ORTHOPEDICS AND TRAUMATOLOGY AND PERSPECTIVE OF POST COVID TELEMEDICINE.

The internet has been changing the doctor-patient relationship in the orthopedic area, especially in recent months, due to the COVID-19 pandemic. Objective: To gather information on the use of social networks regarding orthopedics and traumatology, as well as patient opinions on telemedicine. Methods: Cross-sectional study with 237 patients discharged from the orthopedics outpatient clinic of the Odilon Behrens Metropolitan Hospital, in service exclusively for the SUS, answered a questionnaire containing questions related to the use of the internet, social networks, and telemedicine in the current context. Results: Most participants never or rarely look for information on the internet before or after the medical appointment; but when they do, the search results are rarely enlightening. There was a lower demand for information among men when compared with women. There were no significant differences regarding the age of the participants who agreed that most appointments will be carried out over the internet in the future. Conclusion: The search for medical information on social networks is a global reality, but it still generates disagreements regarding its effectiveness and scope. More studies are needed in different orthopedic services for further analysis on the use of social networks within this field. Level of Evidence IV, Case Series.

A internet vem alterando a relação médico-paciente na área ortopédica, principalmente nos últimos meses, em função da pandemia da COVID-19. Objetivo: Reunir informações sobre o uso de redes sociais na ortopedia e traumatologia, assim como opiniões de pacientes sobre telemedicina. Métodos: Estudo do tipo transversal. 237 pacientes egressos do ambulatório de ortopedia do Hospital Odilon Behrens, de uso exclusivo do SUS, responderam a um questionário contendo questões relacionadas ao uso da internet, das redes sociais e da telemedicina no contexto atual. Resultados: A maioria dos participantes nunca ou raramente buscam informações na internet antes ou depois da consulta; mas, quando o fazem, os resultados da pesquisa raramente são esclarecedores. Houve uma menor procura de informações entre os homens quando comparados às mulheres. Não houve diferenças significativas quanto à idade dos participantes que concordaram que grande parte das consultas serão realizadas pela internet no futuro. Conclusão: A busca por informações médicas nas redes sociais é uma realidade mundial, mas ainda gera divergências referentes à sua eficácia e abrangência. São necessários mais estudos em serviços ortopédicos distintos para maior análise sobre o uso das redes sociais nesse segmento. Nível de Evidência IV, Série de Casos.

Perfil etiológico de las meningitis adquiridas en la comunidad en pacientes adultos en el Complejo Asistencial Sótero del Río, Santiago 2011-2017 / Community acquired meningitis in Santiago, Chile, 2011-2017

INTRODUCCIÓN: En Chile existe poca información sobre los microorganismos causantes de meningitis adquirida en la comunidad (MAC), la que es relevante a la hora de escoger el esquema antimicrobiano empírico. OBJETIVO: Describir la microbiología de MAC en pacientes mayores de 15 años atendidos en un hospital público de Santiago (Chile). METODOLOGÍA: Revisión de cultivos de líquido cefalorraquídeo positivos durante 2011-2017. Se recolectó la información clínica de los pacientes incluidos. Se excluyeron cultivos considerados como contaminación y las meningitis post-quirúrgicas. RESULTADOS: Se identificaron 20 episodios de meningitis bacteriana aguda (MBA) y seis episodios de meningitis criptocócica (MC) entre 2.720 cultivos. Los microorganismos causantes de MBA fueron: Streptococcus pneumoniae (50%), Listeria monocytogenes (25%) y otros cinco agentes (25%). Todos los pacientes con infección por L. monocytogenes presentaban alguna comorbilidad significativa. Cuatro de cinco casos de MC presentaban infección por VIH. CONCLUSIÓN: Streptococcus pneumoniae fue el microorganismo más frecuente de las MAC en esta serie, seguido por L. monocytogenes. Las recomendaciones actuales de esquemas empíricos de MAC consideran adecuadamente la cobertura de S. pneumoniae en todos los pacientes y de L. monocytogenes solo ante factores de riesgo. Además, es relevante considerar MC en casos en pacientes inmunocomprometidos.

BACKGROUND: In Chile, there is scarce information on the frequency of the causative microorganisms of community-acquired meningitis (CAM), which is relevant for the choice of empiric treatment. AIM: To describe the microbiology of CAM in patients over 15 years treated at a public hospital in Santiago (Chile). METHODS: Retrospective review of positive cerebrospinal fluid cultures during 2011-2017. Clinical information of the included patients was collected. Cultures considered as contamination and cases of post-surgical meningitis were excluded. RESULTS: We identified 20 episodes of bacterial meningitis (BM) and six episodes of cryptococcal meningitis (CM) in 2720 cultures. The microorganisms identified in BM cases were Streptococcus pneumoniae (50%), Listeria monocytogenes (25%) and five other agents (25%). All patients with L. monocytogenes infection had at least one well-known risk factor for this infection. Four of the five cases of CM had HIV infection. CONCLUSION: Streptococcus pneumoniae was the most frequent causative microorganism of CAM in this series, followed by L. monocytogenes. Current recommendations for empiric CAM regimens adequately consider coverage for S. pneumoniae in all patients and for L. monocytogenes only in those with risk factors. Furthermore, it is relevant to consider CM in cases involving immunocompromised patients.

Use of the internet and social networks in orthopedics and traumatology and perspective of post covid telemedicine / Uso da internet e redes sociais na ortopedia e traumatologia e perspectiva da telemedicina pós-covid

ABSTRACT The internet has been changing the doctor-patient relationship in the orthopedic area, especially in recent months, due to the COVID-19 pandemic. Objective: To gather information on the use of social networks regarding orthopedics and traumatology, as well as patient opinions on telemedicine. Methods: Cross-sectional study with 237 patients discharged from the orthopedics outpatient clinic of the Odilon Behrens Metropolitan Hospital, in service exclusively for the SUS, answered a questionnaire containing questions related to the use of the internet, social networks, and telemedicine in the current context. Results: Most participants never or rarely look for information on the internet before or after the medical appointment; but when they do, the search results are rarely enlightening. There was a lower demand for information among men when compared with women. There were no significant differences regarding the age of the participants who agreed that most appointments will be carried out over the internet in the future. Conclusion: The search for medical information on social networks is a global reality, but it still generates disagreements regarding its effectiveness and scope. More studies are needed in different orthopedic services for further analysis on the use of social networks within this field. Level of Evidence IV, Case Series.

RESUMO A internet vem alterando a relação médico-paciente na área ortopédica, principalmente nos últimos meses, em função da pandemia da COVID-19. Objetivo: Reunir informações sobre o uso de redes sociais na ortopedia e traumatologia, assim como opiniões de pacientes sobre telemedicina. Métodos: Estudo do tipo transversal. 237 pacientes egressos do ambulatório de ortopedia do Hospital Odilon Behrens, de uso exclusivo do SUS, responderam a um questionário contendo questões relacionadas ao uso da internet, das redes sociais e da telemedicina no contexto atual. Resultados: A maioria dos participantes nunca ou raramente buscam informações na internet antes ou depois da consulta; mas, quando o fazem, os resultados da pesquisa raramente são esclarecedores. Houve uma menor procura de informações entre os homens quando comparados às mulheres. Não houve diferenças significativas quanto à idade dos participantes que concordaram que grande parte das consultas serão realizadas pela internet no futuro. Conclusão: A busca por informações médicas nas redes sociais é uma realidade mundial, mas ainda gera divergências referentes à sua eficácia e abrangência. São necessários mais estudos em serviços ortopédicos distintos para maior análise sobre o uso das redes sociais nesse segmento. Nível de Evidência IV, Série de Casos.

Infecciones por Elizabethkingia spp. en un hospital universitario: coinfección con SARS-CoV-2 y primer reporte de Elizabethkingia anophelis en Chile / Elizabethkingia spp. infections in a university hospital: coinfection with SARS-CoV-2 and first report of Elizabethkingia anophelis in Chile

INTRODUCCIÓN: Elizabethkingia es un género de bacterias gramnegativas cuya relevancia como patógeno oportunista en hospederos inmunocomprometidos y pacientes críticos ha sido reconocida progresivamente en los últimos años. Este género está compuesto principalmente por E. meningoseptica, E. anophelis y E. miricola. Si bien inicialmente E. meningoseptica fue considerada la especie patógena más relevante, gracias a los avances en las técnicas de identificación microbiológica se ha reconocido a E. anophelis como el principal patógeno de este grupo. OBJETIVO: Caracterizar los casos de infecciones por Elizabethkingia spp. en una red de salud y realizar una breve revisión de esta infección. MATERIAL Y MÉTODOS: Se realizó una revisión de los cultivos positivos para Elizabethkingia spp. en el Laboratorio de Microbiología de la Red de Salud UC-CHRISTUS (Chile) entre los años 2017 y 2021. RESULTADOS: Se obtuvo 17 cultivos positivos correspondientes a siete casos clínicos, todos procedentes de un hospital universitario. Todos los casos poseían factores de riesgo conocidos de infección por Elizabethkingia spp. incluyendo uso de antimicrobianos recientes, por ejemplo, el uso previo de carbapenémicos en 85,7% de los pacientes. Cuatro casos se presentaron en pacientes con neumonía por SARS-CoV-2, una coinfección no previamente reportada en la literatura. Elizabethkingia anophelis fue identificada mediante secuenciación de ARN ribosomal en 80% de las cepas recuperadas, lo que corresponde al primer reporte de esta especie en Chile CONCLUSIÓN: Comunicamos la experiencia clínica de infecciones por este género en un hospital universitario de Chile, incluyendo los primeros casos de coinfección en pacientes cursando neumonía por SARS-CoV-2 y la primera identificación de Elizabethkingia anophelis en Chile.

BACKGROUND: Elizabethkingia is a genus of gramnegative bacteria whose relevance as an opportunistic pathogen in immunosuppressed hosts and critically ill patients has been progressively recognized in recent years. This genus is mainly composed of E. meningoseptica, E. anophelis, and E. miricola. Although E. meningoseptica was initially reported as the most relevant pathogenic species, thanks to advances in microbiological identificaron techniques E. anophelis has been recognized as the main pathogen of this group. AIM: To characterize Elizabethkingia spp.'s infections in a health network and make a brief review of this infection. METHOD: We conducted a review of clinical cultures that were positive for Elizabethkingia sp. in the Microbiology Laboratory of the UC-CHRISTUS Health Network (Chile), between 2017 and 2021. RESULTS: Seventeen positive cultures were obtained corresponding to seven clinical cases, all originating from a university hospital. All cases had known risk factors for Elizabethkingia sp. infection, including recent use of antibiotics. Notably, previous use of carbapenems was present in 85.7% of the patients. Four cases occurred in patients with SARS-CoV-2 pneumonia, a coinfection not previously reported in the literature. Elizabethkingia anophelis was identified by ribosomal RNA sequencing in 80% of the recovered strains, which corresponds to the first report of this species in Chile. CONCLUSION: We report the clinical experience of a university hospital with infections by Elizabethkingia spp., including the first cases of coinfection in patients with SARS-CoV-2 pneumonía and the first identification of Elizabethkingia anophelis in Chile.

[Elizabethkingia spp. infections in a university hospital: coinfection with SARS-CoV-2 and first report of Elizabethkingia anophelis in Chile]. / Infecciones por Elizabethkingia spp. en un hospital universitario: coinfección con SARS-CoV-2 y primer reporte de Elizabethkingia anophelis en Chile.

BACKGROUND: Elizabethkingia is a genus of gramnegative bacteria whose relevance as an opportunistic pathogen in immunosuppressed hosts and critically ill patients has been progressively recognized in recent years. This genus is mainly composed of E. meningoseptica, E. anophelis, and E. miricola. Although E. meningoseptica was initially reported as the most relevant pathogenic species, thanks to advances in microbiological identificaron techniques E. anophelis has been recognized as the main pathogen of this group. AIM: To characterize Elizabethkingia spp.'s infections in a health network and make a brief review of this infection. METHOD: We conducted a review of clinical cultures that were positive for Elizabethkingia sp. in the Microbiology Laboratory of the UC-CHRISTUS Health Network (Chile), between 2017 and 2021. RESULTS: Seventeen positive cultures were obtained corresponding to seven clinical cases, all originating from a university hospital. All cases had known risk factors for Elizabethkingia sp. infection, including recent use of antibiotics. Notably, previous use of carbapenems was present in 85.7% of the patients. Four cases occurred in patients with SARS-CoV-2 pneumonia, a coinfection not previously reported in the literature. Elizabethkingia anophelis was identified by ribosomal RNA sequencing in 80% of the recovered strains, which corresponds to the first report of this species in Chile. CONCLUSION: We report the clinical experience of a university hospital with infections by Elizabethkingia spp., including the first cases of coinfection in patients with SARS-CoV-2 pneumonía and the first identification of Elizabethkingia anophelis in Chile.

Interobserver Analysis of Albertoni Classification for Mallet Finger, Using Plain Radiography: Importance of the Goniometer.

Objectives The objective of the present study is to evaluate the intraobserver and interobserver reliability of the Albertoni classification for mallet finger. Evaluation of goniometer device application is also an objective. Methods A total of 10 lateral radiographs of patients with mallet finger were selected and measured by 60 orthopedic surgeons with and without the use of goniometer. Results The intra- and interobserver reliability coefficients found were high. With the use of a goniometer, the interobserver reliability coefficient was even higher, but without statistical relevance. Conclusion The Albertoni classification showed high intraobserver and interobserver reliability in assessing mallet finger lesions, and the goniometer is dispensable for this purpose.

Interobserver Analysis of Albertoni Classification for Mallet Finger, Using Plain Radiography: Importance of the Goniometer / Análise interobservador da classificação das lesões em dedo em martelo segundo Albertoni, utilizando-se radiografias simples: Importância do uso do goniômetro

Abstract Objectives The objective of the present study is to evaluate the intraobserver and interobserver reliability of the Albertoni classification for mallet finger. Evaluation of goniometer device application is also an objective. Methods A total of 10 lateral radiographs of patients with mallet finger were selected and measured by 60 orthopedic surgeons with and without the use of goniometer. Results The intra- and interobserver reliability coefficients found were high. With the use of a goniometer, the interobserver reliability coefficient was even higher, but without statistical relevance. Conclusion The Albertoni classification showed high intraobserver and interobserver reliability in assessing mallet finger lesions, and the goniometer is dispensable for this purpose.

Resumo Objetivos Quantificar o grau de concordância intra- e interobservador da classificação Albertoni e avaliar a importância do uso do goniômetro na diferenciação do grau da lesão. Métodos Foram selecionados 10 casos de dedo em martelo, os quais foram avaliados por 60 examinadores. Resultados A concordância interobservador sem o uso do goniômetro foi elevada. Com o uso do goniômetro, obteve-se um "kappa" ainda maior, porém sem relevância estatística. Conclusão A Classificação de Albertoni possui elevada concordância intra- e interobservador, e o uso do goniômetro se mostrou dispensável para classificar.

Transtorno da expressão emocional involuntária: [revisão] / Involuntary emotional expression disorder: [review]

CONTEXTO: O transtorno da expressão emocional involuntária (involuntary emotional expression disorder ou IEED) consiste em um transtorno do afeto, caracterizado por uma dificuldade em controlar a expressão emocional, que se apresenta por episódios breves e estereotipados de riso e/ou choro incontroláveis. Pode estar relacionado a diversas patologias encefálicas, em variadas localizações anatômicas. OBJETIVOS: Revisar aspectos clínicos, epidemiológicos e fisiopatológicos envolvidos no transtorno da expressão emocional involuntária e apresentar as opções atuais e futuras na abordagem terapêutica. MÉTODOS: Pesquisa de base de dados MEDLINE/PUBMED e LILACS utilizando os termos transtorno da expressão emocional involuntária, afeto pseudobulbar, riso e choro patológicos, acidente vascular cerebral, doença de Alzheimer, esclerose múltipla, esclerose lateral amiotrófica. RESULTADOS: No trantorno da expressão emocional involuntária, as crises de choro e/ou riso, além de serem incontroláveis, tendem a ser desproporcionais ao estímulo recebido, podendo estar completamente dissociada do estado de humor do paciente ou mesmo ser contraditória ao contexto no qual o estímulo está inserido. Outros termos são usados na nosografia desse transtorno, como afeto pseudobulbar, riso e choro patológicos, labilidade emocional, emocionalismo e desregulação emocional. Termos como choro forçado, choro involuntário, emocionalidade patológica e incontinência emocional também têm sido utilizados com menor freqüência. Os mecanismos fisiopatológicos específicos envolvidos nesse transtorno ainda não estão bem esclarecidos. Lesões que podem causá-lo estão amplamente distribuídas no encéfalo, mas parecem envolver o lobo frontal, o sistema límbico, o tronco cerebral e o cerebelo, assim como a substância branca que interconecta essa rede. Seu principal diagnóstico diferencial é a depressão. As terapias farmacológicas hoje disponíveis se baseiam em inibidores seletivos de recaptação...

BACKGROUND: Involuntary emotional expression disorder (IEED) is an affect disturbance caracterized by a difficulty of controlling emotional expression, that is presented as short, stereotyped and uncontrollable episodes of laugh-ter, crying, or both. This disorder is associated to multiple encephalic pathologies, in many anatomical locations. OBJECTIVES: The aims of this review are to describe the clinical, epidemiological and pathophysiological features of IEED and present an overview of current and future treatment approaches. METHODS: Research on databases such as MEDLINE/PUBMED and LILACS, using the terms involuntary emotional expression disorder, pseudobulbar affect, pathological laughter and crying, stroke, Alzheimer's disease, multiple sclerosis, amyotrophic lateral sclerosis. RESULTS: Episodes of laughing and crying that occurs in involuntary emotional expression disorder besides being uncontrollable,they are also disproportionate to motivating stimulus, and they can even be completly dissociated from the patient's mood or even contraditory to the context to which stimuli occurs. Other terms have been used in the nosography of this disorder, like pseudobulbar affect, pathological laughter and crying, emotional lability, emotionalism and emotional dysregulation. Terms such as forced crying, involuntary crying, pathological emotionality and emotional incontinence have also been used, although less frequently. At the present, specific pathophysiological mechanisms of this disorder are still not clear. Insults that can lead to it are widely spread in the brain, but generaly they involve frontal cortex, the limbic system, the brainstem, the cerebellum and the underlying white matter that interconnect these networks. The most important differential diagnosis is depression. Nowadays, the available pharmacological therapies are based on selective serotonin reuptake inhibitors, tricyclic antidepressants, and, less often, dopaminergic...