Improving medication prescribing-related outcomes for vulnerable elderly in transitions on high-risk medications (IMPROVE-IT HRM): a pilot randomized trial protocol.

BACKGROUND: Seniors with recurrent hospitalizations who are taking multiple medications including high-risk medications are at particular risk for serious adverse medication events. We will assess whether an expert Clinical Pharmacology and Toxicology (CPT) medication management intervention during hospitalization with follow-up post-discharge and communication with circle of care is feasible and can decrease drug therapy problems amongst this group. METHODS: The design is a pragmatic pilot randomized trial with 1:1 patient-level concealed randomization with blinded outcome assessment and data analysis. Participants will be adults 65 years and older admitted to internal medicine services for more than 2 days, who have had at least one other hospitalization in the prior year, taking five or more chronic medications including at least one high-risk medication. The CPT intervention identifies medication targets; completes consult, including priorities for improving prescribing negotiated with the patient; starts the care plan; ensures a detailed discharge medication reconciliation and circle-of-care communication; and sees the patient at least twice after hospital discharge via virtual visits to consolidate the care plan in the community. Control group receives usual care. Primary outcomes are feasibility - recruitment, retention, costs, and clinical - number of drug therapy problems improved, with secondary outcomes examining coordination of transitions in care, quality of life, and healthcare utilization and costs. Follow-up is to 3-month posthospital discharge. DISCUSSION: If results support feasibility of ramp-up and promising clinical outcomes, a follow-up definitive trial will be organized using a developing national platform and medication appropriateness network. Since the intervention allows a very scarce medical specialty expertise to be offered via virtual care, there is potential to improve the safety, outcomes, and cost of care widely. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT04077281.

Proarrhythmic major adverse cardiac events with donepezil: A systematic review with meta-analysis.

BACKGROUND: Cholinesterase inhibitors (ChEIs) are regularly used in Alzheimer's disease. Of the three ChEIs approved for dementia, donepezil is among the most prescribed drugs in the United States with nearly 6 million prescriptions in 2020; however, it is classified as a "known risk" QT interval-prolonging medication (QTPmed). Given this claim is derived from observational data including single case reports, we aimed to evaluate high-quality literature on the frequency and nature of proarrhythmic major adverse cardiac events (MACE) associated with donepezil. METHODS: We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central from 1996 onwards for randomized controlled trials (RCTs) involving patients age ≥18 years comparing donepezil to placebo. The MACE composite included mortality, sudden cardiac death, non-fatal cardiac arrest, Torsades de pointes, ventricular tachyarrhythmia, seizure or syncope. Random-effects meta-analyses were performed with a treatment-arm continuity correction for single and double zero event studies. RESULTS: Sixty RCTs (n = 12,463) were included. Twenty-five of 60 trials (n = 5886) investigated participants with Alzheimer's disease and 33 trials monitored electrocardiogram data. The mean follow-up duration was 31 weeks (SD = 36). Mortality was the most commonly reported MACE (252/331, 75.8% events), the remainder were syncope or seizures, with no arrhythmia events. There was no increased risk of MACE with exposure to donepezil compared to placebo (risk ratio [RR] 1.08, 95% CI 0.88-1.33, I2 = 0%) and this was consistent in the subgroup analysis of trials including participants with cardiovascular morbidities (RR 1.14, 95% CI 0.88-1.47). Subgroup analysis suggested a trend toward more events with donepezil with follow-up ≥52 weeks (RR: 1.32, 0.98-1.79). CONCLUSIONS: This systematic review with meta-analysis found donepezil may not be arrhythmogenic. Donepezil was not associated with mortality, ventricular arrhythmias, seizure or syncope, although longer durations of therapy need more study. Further research to clarify actual clinical outcomes related to QTPmed is important to inform prescribing practices.

Developing a reporting item checklist for studies of HIV drug resistance prevalence or incidence: a mixed methods study.

BACKGROUND: Adequate surveillance of HIV drug resistance prevalence is challenged by heterogenous and inadequate data reporting. To address this issue, we recently published reporting guidance documentation for studies of HIV drug resistance prevalence and incidence. OBJECTIVES: In this study, we describe the methods used to develop this reporting guidance. DESIGN: We used a mixed-methods sequential explanatory design involving authors and users of studies of HIV drug resistance prevalence. In the quantitative phase, we conducted a cross-sectional electronic survey (n=51). Survey participants rated various reporting items on whether they are essential to report. Validity ratios were computed to determine the items to discuss in the qualitative phase. In the qualitative phase, two focus group discussions (n=9 in total) discussed this draft item checklist, providing a justification and examples for each item. We conducted a descriptive qualitative analysis of the group discussions to identify emergent themes regarding the qualities of an essential reporting item. RESULTS: We identified 38 potential reporting items that better characterise the study participants, improve the interpretability of study results and clarify the methods used for HIV resistance testing. These items were synthesised to create the reporting item checklist. Qualitative insights formed the basis of the explanation, elaboration, and rationale components of the guidance document. CONCLUSIONS: We generated a list of reporting items for studies on the incidence or prevalence of HIV drug resistance along with an explanation of why researchers believe these items are important. Mixed methods allowed for the simultaneous generation and integration of the item list and qualitative insights. The integrated findings were then further developed to become the subsequently published reporting guidance.

Hydroxychloroquine-Chloroquine, QT-Prolongation, and Major Adverse Cardiac Events: A Meta-analysis and Scoping Review.

OBJECTIVES: We aimed to evaluate the high-quality literature on the frequency and nature of major adverse cardiac events (MACE) associated with either hydroxychloroquine (HCQ) or chloroquine (CQ). DATA SOURCES: We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central from 1996 onward using search strategies created in collaboration with medical science librarians. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled trials (RCTs) published in English language from January 1996 to September 2022, involving adult patients at least 18 years of age, were selected. Outcomes of interest were death, arrhythmias, syncope, and seizures. Random-effects meta-analyses were performed with a Treatment Arm Continuity Correction for single and double zero event studies. DATA SYNTHESIS: By study drug, there were 31 HCQ RCTs (n = 6677), 9 CQ RCTs (n = 622), and 1 combined HCQ-CQ trial (n = 105). Mortality was the most commonly reported MACE at 220 of 255 events (86.3%), with no reports of torsades de pointes or sudden cardiac death. There was no increased risk of MACE with exposure to HCQ-CQ compared with control (risk ratio [RR] = 0.90, 95% CI = 0.69-1.17, I2 = 0%). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: These findings have important implications with respect to patient reassurance and updated guidance for prescribing practices of these medications. CONCLUSIONS: Despite listing as QT-prolonging meds, HCQ-CQ did not increase the risk of MACE.

Effects of erythropoietin on ischaemia-reperfusion when administered before and after ovarian tissue transplantation in mice.

RESEARCH QUESTION: Is the optimal timing for administering erythropoietin to minimize ischaemic injury in ovarian tissue transplantation before ovary removal for cryopreservation and subsequent transplantation or after transplantation? DESIGN: Thirty Swiss mice (nu/nu) were divided into three groups: treatment control group (n = 10); erythropoietin before harvesting group (EPO-BH) (n = 10) and erythropoietin after transplantation group (EPO-AT) (n = 10). Animals underwent bilateral ovariohysterectomy and their hemiovaries were cryopreserved by slow freezing. At the same time, previously cryopreserved hemiovaries were transplanted subcutaneously in the dorsal region. Erythropoietin (250 IU/kg) and sterile 0.9% saline solution were administered every 12/12 h over 5 consecutive days in the EPO-AT and EPO-BH groups, respectively. RESULTS: Administration of erythropoietin in the EPO-AT group improved the viability of ovarian follicles, reducing degeneration and increasing the number of morphologically normal growing follicles at 14 days after transplantation compared with the EPO-BH group (P = 0.002). This group also showed higher percentages of proliferative follicles at 7 days after transplantation (P ≤ 0.03), increased blood vessel count (P ≤ 0.03) and greater tissue area occupied by blood vessels at days 7 and 14 after transplantation (P ≤ 0.03), compared with hormone administration before cryopreservation (EPO-BH group) and the treatment control group. Additionally, treatment with erythropoietin before or after transplantation reduced fibrotic areas at 7 days after transplantation (P = 0.004). CONCLUSION: Erythropoietin treatment after transplantation reduced ischaemic damage in transplanted ovarian tissue, increased angiogenesis, maintenance of ovarian follicle proliferation and reduced fibrosis areas in the grafted tissue.

Physical, chemical and sensory implications of pequi (Caryocar brasiliense Camb.) sweet bread made with flour, pulp and fruit by-product.

This study aimed to develop and evaluate bread with the use of pulp and flours of pequi, in partial replacement of water and wheat flour, to develop a bakery product with good technological, nutritional and sensorial qualities. The pequi husk and pulp flours were obtained by means of a thermal pre-treatment, oven drying and standardization of the dry material. Whereas, the bread formulation was defined through the baker's formulation. Besides, the dehydration process caused significant changes (p<0.05) in the L* value and chromaticity (C*), mainly of the flours (husk and pequi pulp), such changes are due to non-enzymatic oxidative processes and pigment degradation, especially carotenoids. The effect of the substitution of ingredients (wheat flour and water) by husk and pulp flours and pequi pulp contributed to the increase in lipid, crude fiber, nitrogen-free extract and energy value content. However, the substitution promoted changes in the attributes of color and textural properties, such as increased hardness, chewiness and cohesiveness. Nevertheless, all formulations showed good sensory acceptance and thus, pequi sweet breads can be implemented in school meals for contributing and meeting the nutritional recommendations established by the School Feeding Brazilian Program (PNAE).

Lectin-based carbohydrate profile of megakaryocytes in murine fetal liver during development.

Hematopoiesis is the process by which blood cells are generated. During embryonic development, these cells migrate through different organs until they reach the bone marrow, their definitive place in adulthood. Around E10.5, the fetal liver starts budding from the gut, where first hematopoietic cells arrive and expand. Hematopoietic cell migration occurs through cytokine stimulation, receptor expression, and glycosylation patterns on the cell surface. In addition, carbohydrates can modulate different cell activation states. For this reason, we aimed to characterize and quantify fetal megakaryocytic cells in mouse fetal liver according to their glycan residues at different gestational ages through lectins. Mouse fetuses between E11.5 and E18.5 were formalin-fixed and, paraffin-embedded, for immunofluorescence analysis using confocal microscopy. The results showed that the following sugar residues were expressed in proliferating and differentiating megakaryocytes in the fetal liver at different gestational ages: α-mannose, α-glucose, galactose, GlcNAc, and two types of complex oligosaccharides. Megakaryocytes also showed three proliferation waves during liver development at E12.5, E14.5, and E18.5. Additionally, the lectins that exhibited high and specific pattern intensities at liver capsules and vessels were shown to be a less time-consuming and robust alternative alternative to conventional antibodies for displaying liver structures such as capsules and vessels, as well as for megakaryocyte differentiation in the fetal liver.

Morbidity survey of the history of snakebites in different communities in the alto Juruá, western Brazilian Amazon.

The Alto Juruá region has a rich diversity of venomous snakes, and snakebites represent an important cause of morbidity. The present study was carried out in five communities in the Alto Juruá region, and aimed to evaluate the history of snakebites in terms of which snakes were involved and what was the victims' conduct in relation to first aid and prevention. Between 2017 and 2019, semi-structured interviews were applied to 260 residents, 56 (21.53%) of whom had a history of snakebites. The profile of the victims is 73.2% male, a resident of rural areas who develops activities mainly in agriculture and extractivism and who has a low level of education. Just over half of the snakebites occurred during the rainy season (52.8%) and the majority during the day (77%). Bothrops bites were the most frequently reported (90.3%) and B. atrox was the most mentioned snake (jararaca and surucucu) for being responsible for snakebites (80.8%). Approximately 87.5% of the bites occurred to the lower limbs, and 48.2% of the victims were barefoot at the time of the bite. Inadequate first-aid procedures were reported, such as using tourniquets and consuming the drink known as "Específico Pessoa", not drinking water, and treatment with traditional therapy (phytotherapics, zootherapeutics and faith healers), as well as not seeking hospital care. Thus, the need to facilitate access to hospital units in these communities and health education (prevention and first aid) are essential in order to minimize this situation.

Unravelling the sponge microbiome as a promising source of biosurfactants.

Microbial surfactants are particularly useful in bioremediation and heavy metal removal from soil and aquatic environments, amongst other highly valued uses in different economic and biomedical sectors. Marine sponge-associated bacteria are well-known producers of bioactive compounds with a wide array of potential applications. However, little progress has been made on investigating biosurfactants produced by these bacteria, especially when compared with other groups of biologically active molecules harnessed from the sponge microbiome. Using a thorough literature search in eight databases, the purpose of the review was to compile the current knowledge on biosurfactants from sponge-associated bacteria, with a focus on their relevant biotechnological applications. From the publications between the years 1995 and 2021, lipopeptides and glycolipids were the most identified chemical classes of biosurfactants. Firmicutes was the dominant phylum of biosurfactant-producing strains, followed by Actinobacteria and Proteobacteria. Bioremediation led as the most promising application field for the studied surface-active molecules in sponge-derived bacteria, despite the reports endorsed their use as antimicrobial and antibiofilm agents. Finally, we appoint some key strategies to instigate the research appetite on the isolation and characterization of novel biosurfactants from the poriferan microbiome.

Time for a Change! A Spotlight on Many Neglected Facets of Sponge Microbial Biotechnology.

The sponge-microorganism partnership is one of the most successful symbiotic associations exploited from a biotechnological perspective. During the last thirty years, sponge-associated bacteria have been increasingly harnessed for bioactive molecules, notably antimicrobials and cytotoxic compounds. Unfortunately, there are gaps in sponge microbial biotechnology, with a multitude of applications being understudied or ignored. In this context, the current perspective aims to shed light on these underrated facets of sponge microbial biotechnology with a balance of existent reports and proposals for further research in the field. Our overview has showcased that the members of the sponge microbiome produce biomolecules whose usage can be valuable for several economically- relevant and demanding sectors. Outside the exhaustive search for antimicrobial secondary metabolites, sponge-associated microorganisms are gifted producers of antibiofilm, antivirulence and chronic diseases-attenuating substances highly envisaged by the pharmaceutical industry. Despite still at an infant stage of research, anti-ageing enzymes and pigments of special interest for the cosmetic and cosmeceutical sectors have also been reported from the sponge microbial symbionts. In a world urging for sustainability, sponge-associated microorganisms have been proven as fruitful resources for bioremediation, including recovery of heavy-metal contaminated areas, bioleaching processes, and as bioindicators of environmental pollution. In conclusion, we propose alternatives to better assess these neglected biotechnological applications of the sponge microbiome in the hope of sparking the interest of the scientific community toward their deserved exploitation.

Multisite transcranial direct current stimulation associated with cognitive training in episodic memory and executive functions in individuals with Alzheimer's disease: a case report.

BACKGROUND: Dementia is among the most common chronic noncommunicable neurodegenerative diseases. In the long term, it causes disability and loss of autonomy and independence. It is estimated that there are 35.6 million people with Alzheimer's disease worldwide. Several clinical aspects of this disease have been widely studied, but the main focus of study has been memory loss, which is one of the first symptoms. The present study proposes an innovative intervention that combines cognitive training and multisite transcranial direct current stimulation, which interferes with other clinical aspects of the subject. CASE PRESENTATION: In this study, we present two subjects diagnosed with mild Alzheimer's disease. Subject 1 is an 82-year-old Brazilian Latin American woman with a high school education who was diagnosed with Alzheimer's disease 8 years ago and uses an Exelon patch. Subject 2 is an 88-year-old Brazilian Latin American woman with an incomplete primary education who was diagnosed with Alzheimer's disease 1 year ago and received medical orientation to temporarily discontinue medications for Alzheimer's disease. Both participants were subjected to intermittent cognitive training sessions and concomitant transcranial stimulation in three weekly 30-minute sessions in which a brain area was stimulated every 10 minutes for a total of 24 sessions, with a 2-month follow-up. Transcranial stimulation was applied to six different regions of the cortex: the dorsolateral prefrontal cortex bilaterally, the somatosensory association cortex bilaterally and Broca's and Wernicke's areas. Comparing the results of tests performed before and after the treatment period, a 1-point improvement was observed for both subjects on the Word Recall task of the Alzheimer Disease Assessment Scale, which evaluates symptoms related to the decline of episodic memory. Improvement in the executive functions domain was also observed through the results of the Stroop test, Victoria version. CONCLUSIONS: The results from the two presented cases show that multisite transcranial stimulation associated with cognitive training is an effective adjuvant method for the treatment of patients diagnosed with mild Alzheimer's disease. Its effects can benefit patients' daily routines by reducing cognitive deficits by keeping intact areas active and/or compensating for lost functions. Trial registration NCT02772185. Registered 13 May 2016, http://www.clinicaltrials.gov/ct2/show/NCT02772185 . Retrospectively registered.

Transmission of the sponge microbiome: moving towards a unified model.

Sponges have co-evolved for millions of years alongside several types of microorganisms, which aside from participating in the animal's diet, are mostly symbionts. Since most of the genetic repertoire in the holobiont genome is provided by microbes, it is expected that the host-associated microbiome will be at least partially heritable. Sponges can therefore acquire their symbionts in different ways. Both vertical transmission (VT) and horizontal transmission (HT) have different advantages and disadvantages in the life cycle of these invertebrates. However, a third mode of transmission, called leaky vertical transmission or mixed mode of transmission (MMT), which incorporates both VT and HT modes, has gained relevance and seems to be the most robust model. In that regard, the aim of this review is to present the evolving knowledge on these main modes of transmission of the sponge microbiome. Our conclusions lead us to suggest that MMT may be more common for all sponges, with its frequency varying across the transmission spectrum between species and the environment. This hybrid model supports the stable and specific transmission of these microbial partners and reinforces their assistance in the resilience of sponges over the years.

Bacillus Strains Associated to Homoscleromorpha Sponges are Highly Active Against Multidrug Resistant Bacteria.

The search for new, powerful antimicrobials is essential to respond to the current worldwide spread of antibiotic-resistant pathogens. Sponge-associated bacteria have great potential for production of antimicrobials against resistant and multidrug resistant (MDR) pathogenic bacteria, but only few species of the Class Homoscleromorpha have been screened for these activities so far. The aim of this study was to isolate and identify sponge-associated bacteria active against antibiotic-resistant pathogens from sponges of classes Homoscleromorpha and Demospongiae. By employing five different growth conditions, a total of 239 colony-forming units were isolated and remained viable. Among these, 17 (7.1%) isolates presented antimicrobial activity against pathogenic and (multi)drug resistant bacteria including vancomycin-resistant Enterococcus faecalis, Escherichia coli, Citrobacter freundii, Klebsiella penumoniae, Staphylococcus spp. and Streptococcus spp. Bioactive bacteria belonging to genera Bacillus and Vibrio were identified at species level and the DNA fingerprint patterns showed that strains of the same genus were not clonally related. The most active strains belong to genus Bacillus and were isolated from Oscarella sp., Plakina cyanorosea and Chondrilla caribensis. Our results show for the first time that sponge-associated strains of Bacillus pumilus and Bacillus muralis have high anti-MDR activity, and that the Homoscleromorpha may be a better source of such anti-MDR active bacteria than the Demospongiae. These results suggest that marine bacteria associated to homoscleromorph sponges may be an interesting source of new antimicrobial substances with biotechnological potential to treat infections caused by antibiotic-resistant bacteria.

Peeling the Layers Away: The Genomic Characterization of Bacillus pumilus 64-1, an Isolate With Antimicrobial Activity From the Marine Sponge Plakina cyanorosea (Porifera, Homoscleromorpha).

Bacillus pumilus 64-1, a bacterial strain isolated from the marine sponge Plakina cyanorosea, which exhibits antimicrobial activity against both pathogenic and drug-resistant Gram-positive and Gram-negative bacteria. This study aimed to conduct an in-depth genomic analysis of this bioactive sponge-derived strain. The nearly complete genome of strain 64-1 consists of 3.6 Mbp (41.5% GC), which includes 3,705 coding sequences (CDS). An open pangenome was observed when limiting to the type strains of the B. pumilus group and aquatic-derived B. pumilus representatives. The genome appears to encode for at least 12 potential biosynthetic gene clusters (BGCs), including both types I and III polyketide synthases (PKS), non-ribosomal peptide synthetases (NRPS), and one NRPS-T1PKS hybrid, among others. In particular, bacilysin and other bacteriocin-coding genes were found and may be associated with the detected antimicrobial activity. Strain 64-1 also appears to possess a broad repertoire of genes encoding for plant cell wall-degrading carbohydrate-active enzymes (CAZymes). A myriad of genes which may be involved in various process required by the strain in its marine habitat, such as those encoding for osmoprotectory transport systems and the biosynthesis of compatible solutes were also present. Several heavy metal tolerance genes are also present, together with various mobile elements including a region encoding for a type III-B Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) region, four prophage segments and transposase elements. This is the first report on the genomic characterization of a cultivable bacterial member of the Plakina cyanorosea holobiont.

The deadliest snake according to ethnobiological perception of the population of the Alto Juruá region, western Brazilian Amazonia

Abstract INTRODUCTION: We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS: We interviewed 100 villagers who were active in the forests. RESULTS: Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS: The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.

The deadliest snake according to ethnobiological perception of the population of the Alto Juruá region, western Brazilian Amazonia.

INTRODUCTION: We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS: We interviewed 100 villagers who were active in the forests. RESULTS: Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS: The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.

Neurostimulation Combined With Cognitive Intervention in Alzheimer's Disease (NeuroAD): Study Protocol of Double-Blind, Randomized, Factorial Clinical Trial.

Despite advances in the treatment of Alzheimer's disease (AD), there is currently no prospect of a cure, and evidence shows that multifactorial interventions can benefit patients. A promising therapeutic alternative is the use of transcranial direct current stimulation (tDCS) simultaneously with cognitive intervention. The combination of these non-pharmacological techniques is apparently a safe and accessible approach. This study protocol aims to compare the efficacy of tDCS and cognitive intervention in a double-blind, randomized and factorial clinical trial. One hundred participants diagnosed with mild-stage AD will be randomized to receive both tDCS and cognitive intervention, tDCS, cognitive intervention, or placebo. The treatment will last 8 weeks, with a 12-month follow-up. The primary outcome will be the improvement of global cognitive functions, evaluated by the AD Assessment Scale, cognitive subscale (ADAS-Cog). The secondary outcomes will include measures of functional, affective, and behavioral components, as well as a neurophysiological marker (Brain-derived neurotrophic factor, BDNF). This study will enable us to assess, both in the short and long term, whether tDCS is more effective than the placebo and to examine the effects of combined therapy (tDCS and cognitive intervention) and isolated treatments (tDCS vs. cognitive intervention) on patients with AD. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02772185-May 5, 2016.

Caracterização de pacientes com doenças infecciosas internados em Unidade de Terapia Intensiva / Patient characteristics with infectious diseases hospitalized in the Intensive Care Unit / Caracterización de pacientes com enfermedades infecciosas internados en Unidad de Terapia Intensiva

Objetivo: caracterizar o perfil clinicoepidemiológico dos pacientes internados em uma Unidade de Terapia Intensiva de doenças infecciosas. Método: estudo exploratório e descritivo, retrospectivo, com abordagem quantitativa, realizado em um hospital público em Fortaleza/CE, com 203 pacientes. Os dados coletados dos prontuários dos pacientes, de abril a agosto de 2015, foram analisados pela estatística descritiva a partir de tabelas e figuras. Resultados: predominou o sexo masculino (68,5%) e a faixa etária dos 21 aos 35 anos (32%), seguida da faixa dos 36 aos 50 anos (31,5%). O principal diagnóstico médico foi a aids (50,2%). A média de permanência dos pacientes na unidade foi de 11 dias e 49,8% evoluíram para óbito. Conclusão: comprovou-se predomínio do sexo masculino e da faixa etária de 21 a 35 anos, tendo como diagnóstico principal a aids. Os pacientes permaneceram na UTI em média de 11 dias e mais da metade evoluiu para o óbito.(AU)

Objective: to characterize the clinical and epidemiological profile of patients with infectious diseases admitted to an Intensive Care Unit. Method: an exploratory, descriptive, and retrospective study with a quantitative approach, performed in a public hospital in Fortaleza/CE, with 203 patients. The data collected were from medical records of patients from April to August 2015, analyzed using descriptive statistics from tables and figures. Results: males (68.5%) and the age group of 21 to 35 years (32%) predominated followed by the range of 36 to 50 years old (31.5%). The main medical diagnosis was AIDS (50.2%). The average length of stay of patients in the unit was 11 days and 49.8% died. Conclusion: proven to be predominantly male and aged 21 to 35 years old, with AIDS as the main diagnostic. The patients remained in the ICU an average of 11 days and more than half died.(AU)

Objetivo: caracterizar el perfil clínico epidemiológico de los pacientes internados en una unidad de terapia intensiva de enfermedades infecciosas. Método: estudio exploratorio y descriptivo, retrospectivo, con enfoque cuantitativo, realizado en un hospital público en Fortaleza/CE, con 203 pacientes. Los datos recogidos de los prontuarios de los pacientes, de abril a agosto de 2015, fueron analizados por la estadística descriptiva a partir de cuadros y figuras. Resultados: predominó el sexo masculino (68,5%) y la edad de 21 a 35 años (32%), seguida de 36 a 50 años (31,5%). El principal diagnóstico médico fue el SIDA (50,2%). La media de permanencia de los pacientes en la unidad fue de 11 días y 49,8% murieron. Conclusión: se comprobó predominio del sexo masculino y de la edad de 21 a 35 años, teniendo como diagnóstico principal el SIDA. Los pacientes permanecieron en el UTI en media de 11 días y más de la mitad fallecieron.(AU)

Principais bactérias em culturas de urina e aspirado traqueal entre pacientes com doenças infecciosas / Major bacteria in urine cultures and tracheal aspirate from patients with infectious diseases

Objetivo: investigar as bactérias mais comuns em resultados de cultura de urina e de Aspirado Traqueal (AT) de pacientes internados em uma Unidade de Terapia Intensiva (UTI) de doenças infecciosas. Método: estudo exploratório descritivo, retrospectivo, abordagem quantitativa, realizado na UTI de um hospital público,em Fortaleza-Ceará, com 56 pacientes. Dados coletados de abril a agosto de 2015,organizados no Excel, sendo expostos em tabelas e gráficos. A pesquisa foi aprovada pelo Comitê de Ética da instituição, protocolo 037/2011. Resultados: prevaleceu o gênero masculino (68,5%), com a faixa etária variando entre 21 a 84 anos. Dentre os germes presentes nos exames avaliados, destacaram-se as bactérias A.baumannii, P.aeruginosas, E.coli, K.pneumoniae e Staphylococcus Aureus. Além da presença de fungo nas amostras, especificamente a Candida. Conclusão: Verificou-se elevada incidência de bactérias em culturas de urina e AT, com resultados positivos principalmente em amostras de aspirado traqueal e presença de fungo predominantemente nas culturas de urina.

Objective: To investigate the most common bacteria in culture results of urine and tracheal aspirate (TA) of patients admitted to an Intensive Care Unit (ICU) of infectious diseases. Method: descriptive exploratory study, retrospective, quantitative approach, performed in the ICU of a public hospital in Fortaleza, Ceará, with 56 patients. Data collected from April to August 2015, organized in Excel, being exposed in tables and graphs. Study approved by the Ethics Committee of the institution with number 037/2011. Results: Prevailed the male gender (68.5%), with ages ranging from 21-84 years. Among the germs present in the scans studied, stood out bacteria A. baumannii, P.aeruginosa, E. coli, K.pneumoniae and S.aureus. Besides the presence of the fungus in the sample, specifically Candida. Conclusion: There was a high incidence of bacteria in urinecultures and TA, with positive results especially in tracheal aspirate samples, and the presence of the fungusin the sample, being more prevalent in the urine cultures.

Evolução clínica dos pacientes em uso de ventilação mecânica em Unidade de Terapia Intensiva / Clinical outcome of patients on mechanical ventilation in Intensive Care Unit

Objetivo: analisar a evolução clínica dos pacientes em uso de ventilação mecânica (VM) internados em Unidade de terapia intensiva. Método: estudo exploratório descritivo, quantitativo, realizado na UTI de um hospital em Fortaleza-Ceará-Brasil, com 94 pacientes. Os dados foram coletados de janeiro a março de 2012 e expostos em tabelas e gráfico. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, CAEE nº 0419.0.000.042-11. Resultados: 53,19% dos pacientes eram do sexo masculino, com faixa etária predominante de 77 a 98 anos; 61,70% utilizaram somente o tubo orotraqueal, além de sedação, analgesia ou ambas. Após o desmame, 27,66% necessitaram de mais de um tipo de suporte não invasivo. A média de permanência na UTI foi de 26,5 dias e 60,64% evoluíram para óbito. Conclusão: o conhecimento do perfil dos pacientes internados em UTI sob VM é relevante, norteando a assistência pela equipe multiprofissional.(AU)

Objective: to analyze the clinical outcome of patients on mechanical ventilation (MV) in the intensive care unit. Method: this was a descriptive, quantitative exploratory study, performed in the ICU of a hospital in Fortaleza, Ceará, Brazil, with 94 patients. Data were collected from January to March 2012 and reported in tables and graphics. The research project was approved by the Research Ethics Committee, CAEE no. 0419.0.000.042-11. Results: 53.19% of the patients were male, with predominant age group of 77-98 years old; 61.70% used only the endotracheal tube, and sedation, analgesia or both. After weaning, 27.66% required more than one type of non-invasive support. The mean ICU stay was 26.5 days and 60.64% died. Conclusion: the knowledge on the profile of ICU patients on MV is relevant, guiding assistance by the multidisciplinary team.(AU)

Objetivo: analizar la evolución clínica de los pacientes en uso de ventilación mecánica (VM) internados en unidad de cuidados intensivos. Método: estudio exploratorio descriptivo, cuantitativo, realizado en la UTI de un Hospital de Fortaleza- Ceará ­ Brasil, con 94 pacientes. Los datos fueron recogidos de enero a marzo de 2012 y reportados en tablas y gráficas. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAEE no 0419.0.000.042.11. Resultados: 53,19% de los pacientes eran del sexo masculino, con edades predominantes de 77 a 98 años; 61,70% utilizaron solamente el tubo orotraqueal, además de sedación, analgesia o ambas. Después del destete 27,66% necesitaron además de otro tipo de soporte no invasivo. La media de permanencia en la UCI fue de 26,5 días y 60,64% fueron muertos. Conclusión: el conocimiento del perfil de los pacientes internados en UTI bajo VM es relevante, guiando la asistencia por el equipo multiprofesional.(AU)