Análisis epidemiológico del cáncer de cérvix in situ e invasor, periodo 2015-2019 / Epidemilogical analysis of cérvix cancer in situ and invasor, period 2015-2019

El cáncer de cérvix sigue siendo un problema de salud pública a nivel mundial en las mujeres que se presenta mayormente en los países en desarrollo y en niveles de estrato socio económico bajo. Objetivo. Realizar un análisis epidemiológico del cáncer de cérvix in situ e invasor, atendidos en el hospital de SOLCA Guayaquil. Metodología. Estudio observacional, de diseño de investigación tipo corte transversal, descriptivo. Lugar: hospital SOLCA en Guayaquil, período 2015 a 2019. Los sujetos fueron las pacientes con cáncer de cérvix in situ e invasor. Aplicando estadísticas descriptivas como porcentaje y comparación entre variables. Resultados. Cáncer invasor tuvo un incremento entre 2015 al 2019 del 4% e in situ del 4,7%; corroborado al aplicar el modelo de tendencia polinomial. El invasor tuvo topográficamente de mayor frecuencia al Tumor maligno de cuello de útero sin otra especificación (79,59%), mientras en el cáncer in situ al Carcinoma in situ de otras partes especificadas del cuello del útero (53,13%); el invasor se observó en edades de 45 a 54 años e in situ de 30 a 39 años; morfológicamente el invasor tuvo al Carcinoma de células escamosas SAI (38,36%) e in situ al Carcinoma in situ de células escamosas SAI (83,07%). Conclusiones. El cáncer de cérvix presentado en este quinquenio se ha incrementado, siendo el cáncer invasor más frecuente en edades entre 45-54 años y el cáncer in situ en edades más tempranas, considerando que está patología se puede detectar oportunamente, se recomienda fortalecer las campañas de tamizaje para su prevención y control.

Cervical cancer continues being a public health problem worldwide in women, which occurs mainly in developing countries and at low socio-economic levels. Target. Carry out an epidemiological analysis of in situ and invasive cervical cancer treated at the SOLCA Guayaquil hospital. Methodology. Observational, descriptive, cross-sectional research design study. Place: SOLCA hospital in Guayaquil, period 2015 to 2019. The subjects were patients with in situ and invasive cervical cancer. Applying descriptive statistics as a percentage and comparison between variables. Results. Invasive cancer had an increase between 2015 and 2019 of 4% and in situ of 4,7%; corroborated by applying the polynomial trend model. The invader had a topographically higher frequency of malignant neoplasm of the cervix without other specification (79,59%), while in cancer in situ it had Carcinoma in situ of other specified parts of the cervix (53,13%); the invader was observed in ages 45 to 54 years and in situ from 30 to 39 years; Morphologically, the invader had squamous cell carcinoma NOS (38,36%) and in situ squamous cell carcinoma in situ NOS (83,07%). Conclusions. Cervical cancer presented in this five-year period has increased, being the most frequent invasive cancer in ages between 45-54 years and in situ cancer in younger ages, considering that this pathology can be detected in a timely manner, it is recommended to strengthen the campaigns of screening for its prevention and control.

Avaliação de pacientes com insuficiência cardíaca admitidos em hospital secundário / Evaluation of patients with heart failure admitted to a secondary hospital

Objetivo: Elaborar um perfil clínico e epidemiológico de pacientes com insuficiência cardíaca descompensada, de acordo com a etiologia da descompensação, e analisar o desfecho clínico dentre os diferentes grupos etiológicos encontrados. Métodos: Estudo retrospectivo e observacional. Os pacientes foram reunidos em seis grupos, conforme etiologia de descompensação, e comparados de acordo com dados coletados. Realizaram-se verificação por meio da análise de variância e teste exato de Fisher. Obteve-se significância estatística por meio do valor de p <0,10. Resultados: Foram analisados 123 prontuários de pacientes admitidos entre 2016 e 2018. A maior causa de descompensação da doença foi a má aderência ao tratamento (32,5%). Além disso, a doença foi responsável por maior tempo de internação (13,5 dias) e número de óbitos (seis). Conclusão: Otimizando-se os cuidados e o acompanhamento desses pacientes, pode haver um importante impacto sobre a incidência, as complicações e a frequência de descompensações. (AU)

Objective: To develop a clinical and epidemiological profile of patients with decompensated heart failure according to the etiology of decompensation and to analyze the clinical outcome among the different etiological groups found. Methods: This is a retrospective, observational study. Patients were divided in six groups according to etiology of decompensation and were compared according to data collected. Variance analysis and Fisher's exact test were performed. Statistical significance was obtained by means of p-value <0.10. Results: We analyzed 123 medical records of patients admitted between 2016 and 2018. The greatest cause of decompensation was the poor adherence to treatment (32.5%). In addition, the disease was responsible for longer hospitalization time (13.5 days) and number of deaths (six). Conclusion: Optimizing care and follow-up of these patients can have an important impact on the incidence, complications, and frequency of decompensation. (AU)

The social network of adolescents who need special health care / La red social de los adolescentes que necesitan una atención especial a la salud / Rede social de adolescentes que necessitam de atenção especial à saúde

ABSTRACT Objective: To describe the social network of adolescents who need special health care. Method: A qualitative, descriptive and exploratory study conducted between 2016 and 2017 in the pediatric outpatient clinic of a teaching hospital in southern Brazil. Thirty-five semi-structured interviews were conducted with adolescents between 12 and 18 years of age, followed by the construction of genograms and ecomaps. After transcription, the enunciations were subjected to Pêcheux's method of discourse analysis. Results: The institutional network consists of health services, schools and religious entities, as well as adolescents' families and friends. In the family network, women family members—such as mothers, grandmothers and aunts—have a special role. Final Consideration: The adolescents' social network is composed of institutional and family circles. In the view of adolescents, the tertiary service is more capable of solving their problems, and for this reason used the most. In order to ensure these adolescents access to and continuity of care, the articulation between health policies and health services is suggested.

RESUMEN Objetivo: Describir la red social de los adolescentes que necesitan una atención especial a la salud. Método: Estudio cualitativo, descriptivo y exploratorio, realizado entre 2016 y 2017 en la clínica pediátrica de un hospital escuela en la región sur de Brasil. Se realizaron 35 entrevistas semiestructuradas con adolescentes de 12 a 18 años de edad, y después se elaboraron genogramas y ecomapas. Después de la doble transcripción, se sometieron los relatos a análisis de discurso pecheutiano. Resultados: En la red institucional constan de servicios de salud, escuelas y organismos religiosos, así como de familiares y amigos de los adolescentes. En la red de la familia, se elogian a las mujeres, representadas por las madres, las abuelas y las tías. Consideraciones Finales: La red social de los adolescentes se compone de círculos institucionales y familiares. En la perspectiva de los adolescentes, el servicio terciario es más resolutivo, por lo tanto, es lo más utilizado. Se recomienda articular las políticas con los servicios de salud para que se oferte a estos adolescentes el acceso a la salud y la continuidad del cuidado.

RESUMO Objetivo: Descrever a rede social de adolescentes que necessitam de atenção especial à saúde. Método: Estudo qualitativo, descritivo e exploratório realizado entre 2016 e 2017 no ambulatório pediátrico de um hospital de ensino no sul do Brasil. Foram realizadas 35 entrevistas semiestruturadas com adolescentes entre 12 a 18 anos de idade, seguidas pela construção de genogramas e ecomapas. Após a dupla transcrição, as enunciações foram submetidas à análise de discurso pechetiana. Resultados: A rede institucional é composta por serviços de saúde, escolas e entidades religiosas, além de familiares e amigos dos adolescentes. Na rede familiar, as mulheres são enaltecidas, representadas pelas mães, avós e tias. Considerações Finais: A rede social dos adolescentes é composta pelos círculos institucional e familiar. Na ótica dos adolescentes, o serviço terciário é mais resolutivo e por isso é o mais utilizado. Sugere-se articular as políticas e os serviços de saúde para o acesso e continuidade do cuidado desses adolescentes.

Transfusion monitoring: care practice analysis in a public teaching hospital / Monitorização transfusional: análise da prática assistencial em um hospital público de ensino

ABSTRACT Objective To analyze the process of recording transfusion monitoring at a public teaching hospital. Methods A descriptive and retrospective study with a quantitative approach, analyzing the instruments to record transfusion monitoring at a public hospital in a city in the State of Minas Gerais (MG). Data were collected on the correct completion of the instrument, time elapsed from transfusions, records of vital signs, type of blood component more frequently transfused, and hospital unit where transfusion was performed. Results A total of 1,012 records were analyzed, and 53.4% of them had errors in filling in the instruments, 6% of transfusions started after the recommended time, and 9.3% of patients had no vital signs registered. Conclusion Failures were identified in the process of recording transfusion monitoring, and they could result in more adverse events related to the administration of blood components. Planning and implementing strategies to enhance recording and to improve care delivered are challenging.

RESUMO Objetivo Analisar o processo de registro de monitorização do ato transfusional em um hospital público de ensino. Métodos Estudo descritivo, retrospectivo, de abordagem quantitativa. Foram analisados os instrumentos de registro de monitorização do ato transfusional em um hospital público do interior de Minas Gerais (MG). Foram coletados dados relativos a correto preenchimento do instrumento, tempo decorrido das transfusões, registros dos sinais vitais, tipo de hemocomponente mais frequentemente transfundido e setor de ocorrência da transfusão. Resultados Foram analisados 1.012 instrumentos, dos quais 53,4% apresentaram falhas no preenchimento, 6% das infusões foram iniciadas após o tempo preconizado e 9,3% dos pacientes não tiveram os sinais vitais registrados. Conclusão Foram identificadas falhas no processo de registro da monitorização transfusional, que podem gerar maior ocorrência de eventos adversos relacionados à administração de hemocomponentes. É um desafio elaborar e implementar estratégias que possibilitem aprimorar os registros, assim como a assistência prestada.

Possible adverse drug events leading to hospital admission in a Brazilian teaching hospital

OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases. .

Inappropriate surgical chemoprophylaxis and surgical site infection rate at a tertiary care teaching hospital

OBJECTIVES: This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. MATERIALS AND METHODS: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. RESULTS: Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. CONCLUSION: Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation.

Healthcare-associated Staphylococcus aureus bloodstream infection: length of stay, attributable mortality, and additional direct costs

This study aimed to determine the excess length of stay, extra expenditures, and attributable mortality to healthcare-associated S. aureus bloodstream infection (BSI) at a teaching hospital in central Brazil. The study design was a matched (1:1) case-control. Cases were defined as patients > 13 years old, with a healthcare-associated S. aureus BSI. Controls included patients without an S. aureus BSI, who were matched to cases by gender, age (± 7 years), morbidity, and underlying disease. Data were collected from medical records and from the Brazilian National Hospital Information System (Sistema de Informações Hospitalares do Sistema Único de Saúde - SIH/SUS). A Wilcoxon rank sum test was performed to compare length of stay and costs between cases and controls. Differences in mortality between cases and controls were compared using McNemar's tests. The Mantel-Haenzel stratified analysis was performed to compare invasive device utilization. Data analyses were conducted using Epi Info 6.0 and Statistical Package for Social Sciences (SPSS 13.0). 84 case-control pairs matched by gender, age, admission period, morbidity, and underlying disease were analyzed. The mean lengths of hospital stay were 48.3 and 16.2 days for cases and controls, respectively (p < 0.01), yielding an excess hospital stay among cases of 32.1 days. the excess mortality among cases compared to controls that was attributable to s. aureus bloodstream infection was 45.2%. Cases had a higher risk of dying compared to controls (OR 7.3, 95% CI 3.1-21.1). Overall costs of hospitalization (SIH/SUS) reached US$ 123,065 for cases versus US$ 40,247 for controls (p < 0.01). the cost of antimicrobial therapy was 6.7 fold higher for cases compared to controls. healthcare-associated s. aureus BSI was associated with statistically significant increases in length of hospitalization, attributable mortality, and economic burden. Implementation of measures to minimize the risk of healthcare-associated bacterial infections is essential.

Impacto de un programa de control de la calidad de la prescripción de antibióticos en un hospital de La Habana, Cuba / Impact of a quality control program on antibiotic prescription in a hospital in Havana, Cuba

Objetivo. Demostrar la eficacia de un programa de control de la calidad de la prescripción de antibióticos en el Hospital Docente Clínico Quirúrgico Joaquín Albarrán de La Habana, Cuba.Métodos. Estudio de intervención realizado en el período del 1 de mayo de 2008 a 31 de marzo de 2011, que incluyó la evaluación de la calidad de la prescripción y la retroalimentaciónde la información, actividades educativas, funcionamiento de un comité de antibióticos y la elaboración de protocolos de uso de antimicrobianos. Se construyó un gráfico aritméticosimple de la serie temporal y se compararon los valores absolutos de las proporciones de la serie entre sí. Para comprobar la existencia de tendencia en la serie se ajustó a un modelo deregresión lineal simple. Resultados. Se evaluaron las prescripciones de antibióticos de 2 941 pacientes, en las que se observó una serie irregular, con proporción de uso inadecuado entre 48,4% y 30,7% en los primeros tres meses analizados. Se encontró que el valor tomado por la pendiente de regresión, aunque se encontraba cercano a cero, era negativo y significativamente diferente de cero (b =–0,29; P = 0,02). Conclusiones. El programa de control de antibióticos mejoró la calidad de la prescripcióna los pacientes hospitalizados.

Objective. Demonstrate the efficacy of a quality control program on antibioticprescription in Joaquín Albarrán Hospital in Havana, Cuba. Methods. An interventional study was conducted from 1 May 2008 to 31 March 2011. The study included evaluation of prescription quality, information feedback, educational activities, the operations of an antibiotic committee, and the preparation of protocols on antimicrobial drug use. A simple arithmetic graph of the time series was constructed, and the absolute values of the series percentages were compared. Inorder to verify the existence of a series trend, a simple linear regression model was applied. Results. Antibiotic prescription was evaluated in 2 941 patients. An irregular series was observed, with inappropriate use in 30.7%–48.4% of these patients in the first three months analyzed. The value of the regression slope was close to zero, although it was negative and significantly different from zero (b = –0.29; P = 0.02). Conclusions. The antibiotic control program improved the quality of prescribing for hospital patients.

Defectos congénitos mayores en un hospital de tercer nivel en Cali, Colombia 2004-2008 / Major birth defects in a third-level hospital in Cali, Colombia, 2004-2008

Objetivos Determinar la prevalencia de los defectos congénitos diagnosticados al nacimiento y describir los factores sociodemográficos y del recién nacido asociados a la ocurrencia de estas patologías en un hospital de tercer nivel de la ciudad de Cali en Colombia. Metodología Se analizó la información del sistema de vigilancia del Hospital Universitario del Valle entre marzo de 2004 y octubre de 2008. Para determinar la ocurrencia de defectos congénitos se siguió la metodología propuesta por el ECLAMC. Se realizaron tablas y gráficos para describir las características de los recién nacidos y sus padres. Resultados Durante el período de estudio, un total de 4 años y 7 meses entre 2004 y 2008, se atendieron 32 995 nacimientos, de los cuales 735 presentaron al menos un defecto congénito, para una prevalencia de 2,22 por 10 000 nacimientos. Por grupos específicos de defectos congénitos se registraron las prevalencías más altas (casos x 10 000 nacimientos) para: polidactilia (22,1), pie equinovaro (17,6), hidrocefalia (16,4), defectos del tubo neural (16,7), defectos por reducción de extremidades (8,2), labio y/o paladar hendido (10,9), cardiopatías (14,6), hidronefrosis (11,5), gastrosquisis (7,3), ciclopía (2,4) y sirenomelia (1,2). Discusión Las prevalencias de defectos congénitos relacionados con factores ambientales como hidrocefalia, defectos por reducción de extremidades, pie equino varo, hidronefrosis, gastrosquisis, ciclopía y sirenomelia presentaron prevalencias más altas en comparación con lo reportado en la literatura. Se presentan algunas hipótesis que podrían explicar el aumento registrado.

Objective Determining the prevalence of infant birth defects and describing sociodemographic factors associated with the occurrence of these diseases in a tertiary hospital in the city of Cali in Colombia. Methodology Data from the Valle Teaching Hospital's surveillance system was analysed, covering March 2004 to October 2008. The methodology proposed by the Collaborative Study of Congenital Malformations in Latin-America (ECLAMC) was followed for determining birth defect occurrence. Tables and graphs were constructed for describing the characteristics of the new-born, their parents and the resulting pregnancies. Results There were 32,995 births during the study period (4 years and 7 months); there was at least one birth defect in 735 of them, giving a 2.22 per 10,000 births prevalence. The major birth defects having the highest prevalence were polydactyly (22.1 per 10,000 births), clubfoot (17.6), hydrocephalus (16.4), neural tube defects (16.7), limb reduction defects (8.2), cleft lip or cleft palate (10.9), heart defects (14.6), hydronephrosis (11.5), gastroschisis (7.3), cyclopia (2.4) and sirenomelia (1.2), Discussion The prevalence of birth defects related to environmental factors such as hydrocephalus, limb reduction defects, clubfoot, hydronephrosis, gastroschisis, cyclopia and sirenomelia showed higher prevalence compared to those reported in the pertinent literature. Some hypotheses which could explain such increase are reported.

Risk factors for Hospital-Acquired Pneumonia in nonventilated adults

Although most recent publications focus on Ventilator-associated Pneumonia, Non-Ventilator-associated Hospital-acquired pneumonia (NVHAP) is still worrisome. We studied risk factors for NVHAP among patients admitted to a small teaching hospital. Sixty-six NVHAP case patients and 66 controls admitted to the hospital from November 2005 through November 2006 were enrolled in a case-control study. Variables under investigation included: demographic characteristics, comorbidities, procedures, invasive devices and use of medications (Sedatives, Antacids, Steroids and Antimicrobials). Univariate and multivariable analysis (hierarchical models of logistic regression) were performed. The incidence of NVHAP in our hospital was 0.68 percent (1.02 per 1,000 patients-day). Results from multivariable analysis identified risk factors for NVHAP: age (Odds Ratio[OR]=1.03, 95 percent Confidence Interval[CI]=1.01-1.05, p=0.002), use of Antacids (OR=5.29, 95 percentCI=1.89-4.79, p=0.001) and Central Nervous System disease (OR=3.13, 95 percentCI=1.24-7.93, p=0.02). Although our findings are coherent with previous reports, the association of Antacids with NVHAP recalls a controversial issue in the physiopathology of Hospital-Acquired Pneumonia, with possible implications for preventive strategies.

Estudo das características epidemiológicas e clínicas de pacientes portadores do vírus da imunodeficiência humana em Pronto Atendimento do Hospital das Clínicas da Universidade Federal de Minas Gerais / Study on the clinical and epidemiological characteristics of patients with human immunodeficiency virus at the walk-in service of the teaching hospital of the Federal University of Minas Gerais

Este trabalho objetiva a análise prospectiva das características clínicas e epidemiológicas que levam os pacientes adultos com HIV/AIDS a procurarem atendimento clínico de urgência em Pronto Atendimento do Hospital das Clínicas da Universidade Federal de Minas Gerais. Noventa e nove pacientes perfizeram 118 internações. A idade foi em média 39,4 anos. A relação homem e mulher foi de 1,35:1. O tempo desde o diagnóstico até a admissão situou-se de forma mais freqüente entre 0-5 anos em 40,4 por cento dos casos. A terapêutica anti-retroviral era usada regularmente em 56,8 por cento das admissões. A contagem de linfócitos T CD4+ foi inferior a 200 células/mm³ em 45,7 por cento dos pacientes. As queixas mais freqüentes foram aumento da temperatura corpórea, diarréia, tosse e dispnéia. O aparelho respiratório foi o mais acometido. As doenças oportunistas mais freqüentes foram pneumocistose, pneumonia comunitária, síndrome diarréica, e candidiase oral. A demanda de internações de pacientes com HIV representou 2,8 por cento das admissões, com tempo médio de permanência hospitalar de 4,6 dias. Os pacientes possuíam, em sua maioria, contagem de linfócitos TCD4+ baixa, quase metade não usava a terapia anti-retroviral altamente eficaz. Houve tendência à feminização. As doenças relacionadas à AIDS continuam sendo as mais freqüentes no nosso meio.

This study had the aim of prospectively analyzing the clinical and epidemiological characteristics that lead adult patients with HIV/AIDS to seek urgent medical care in the walk-in service of the teaching hospital of the Federal University of Minas Gerais. Over a one-year period, all admissions of adult patients with HIV were evaluated. There were 118 admissions involving 99 patients. Their mean age was 39.4 years. The male-to-female ratio was 1.35:1. The length of time from diagnosis to admission was most frequently 0-5 years (40.4 percent of the cases). Antiretroviral therapy was being regularly used among 56.8 percent of the admissions. The T CD4+ lymphocyte count was less than 200 cells/mm³ in 45.7 percent of the patients. The most frequent complaints were increased body temperature, diarrhea, coughing and dyspnea. The respiratory tract was the region most affected. The most common opportunistic diseases were pneumocystosis, community-acquired pneumonia, diarrheal syndrome and oral candidiasis. The demand for admissions among HIV patients represented 2.8 percent of all admissions, with an average length of stay of 4.6 days. Most of the patients had low T CD4+ lymphocyte counts, and almost half of them were not taking highly active antiretroviral therapy. There was a tendency towards feminization. AIDS-related diseases continue to be the most frequent occurrences within our setting.

Emergencia de infecciones por Enterococcus sp resistente a vancomicina en un hospital universitario en Chile / Emergency of vancomycm-vesistant Enterococcus infections in a teaching hospital in Chile

Introducción. En Chile, se desarrolla una vigilancia activa de portación intestinal de Enterococcus resistente a vancomicina (ERV) desde el año 2000. Sin embargo, no hay publicaciones sobre casos clínicos. Objetivo: Describir casos de infección por ERV en un hospital de nivel terciario. Pacientes y Método: Se obtuvieron de los registros del laboratorio las muestras clínicas o intestinales positivas para ERV (2001 al 2006) y se analizaron en los pacientes afectados los factores de riesgo potenciales, manifestaciones clínicas, tratamiento y evolución. Resultados: Se identificaron 23 casos (tasa de incidencia año 2005 de 0,07 y año 2006 de 0,09/1.000 días camas ocupadas). El promedio de edad fue 62,0 ± 17 años. Antecedentes: cáncer (39,l por cientoo), procedimientos quirúrgicos recientes (54,1 por ciento), hemodiálisis (26,1 por ciento), corticoterapia (26,1 por ciento). El 87 por cientoo había recibido dos o más antimicrobianos, casi un tercio fue transferido desde otros hospitales y 22 por ciento había reingresado antes de 30 días. Los pacientes habían estado principalmente en UCI (60,9 por ciento), el resto en salas nefrológicas u onco-hematológicas. Los cuadros clínicos incluyeron bacteriemias (30,4 por ciento), infecciones del sitio quirúrgico o abscesos (26,1 por ciento), infecciones urinarias (26,1 por ciento) u otros. Tres pacientes fueron asintomáticos (13 por ciento). Los aislados fueron identificados como E. faecium en 82,6 por cientoo del total, el resto como Enterococcus sp. El 66,7 por cientoo de las cepas mostró susceptibilidad intermedia a vancomicina. En 14 cepas con estudio completo para vancomicina y teicoplanina, predominó el fenotipo VanB (85,7 por ciento), seguido de los fenotipos VanA (7,1 por ciento) y VanB/VanD (7,1 por ciento). Quince pacientes fueron tratados en forma médica o médico-quirúrgica, hubo respuesta favorable en 80 por cientoo de ellos. Ocho pacientes no recibieron tratamiento (34,8 por ciento), en dos...

An active surveillance of vancomycin-resistant enterococci (VRE) intestinal colonization in selected group of patients has been developed in Chile since year 2000. Nevertheless, no reports of clinical cases have been published. Aim. To describe main clinical and microbiological features of patients infected by VRE in a tertiary-level teaching Hospital. Patients and methods. Intestinal and clinical samples positive to VRE were provided by laboratory, and a retrospective analysis of potential risk factors, clinical features, treatment and outcomes was performed. Study encompassed years 2001 to 2006. Main results. 23 cases of infections were identified, all cases occurring during 2005 and 2006. Incidence rate was 0.07 and 0.09 cases per 1000 occupied bed-days, respectively. The mean age was 62.0 ± 17 years. A significant proportion of patients had cancer (39.1 percent), recent surgical procedures (54.1 percent), were on dialysis (26.1 percent), or were using steroids (26.1 percent). Most patients had received 2 or more antimicrobial (87 percent), almost a third represented transfers from other hospitals and an additional 22 percent readmissions before 30 days of latest discharge. Patients were mainly hospitalized in the ICU (60.9 percent) but nearly 30 percent were associated exclusively to nephrological or onco-hematological wards. Clinical manifestations included bacteremia (30.4 percent), surgical site infections or abscesses (26.1 percent), urinary tract infections (26.1 percent) and others. . Three patients (13 percent) did not have symptoms. After identification was possible, all isolates were identified as E. faecium (82.6 percent of total), the rest as Enterococcus sp. Most strains showed intermediate susceptibility to vancomycin (66.7 percent). For 14 strains studied both with vancomycin and teicoplanin, , phenotype Van B was predominant (85.7 percent), followed by VanA (7.1 percent) and VanB/VanD type (7.1 percent). No molecular...

Surgery cancelling at a teaching hospital: implications for cost management / Cancelamiento de cirugías en un hospital-escuela: implicaciones para la gestión de costos / Cancelamento cirúrgico em um hospital escola: implicações sobre o gerenciamento de custos

This study discusses the problem of surgery cancellation on the economic-financial perspective. It was carried out in the Surgical Center Unit of a school hospital with the objective to identify and analyze the direct costs (human resources, medications and materials) and the opportunity costs that result from the cancellation of elective surgeries. Data were collected during three consecutive months through institutional documents and a form elaborated by the researchers. Only 58 (23.3 percent) of the 249 cancelled scheduled surgeries represented costs for the institution. The cancellations direct total cost was R$ 1.713.66 (average cost per patient R$ 29.54); distributed as follows: expenses with consumption materials R$ 333.05; sterilization process R$201.22; medications R$149.77 and human resources R$1,029.62. The human resources costs represented the greatest percentile in relation to the total cost (60.40 percent). It was observed that most of the cancellations could be partially avoided. Planning on management; redesigning work processes, training the staff and making early clinical evaluation can be strategies to minimize this occurrence.

Este artículo discute la problemática del cancelamiento de cirugías bajo una perspectiva económico-financiera. Fue llevado a cabo en la Unidad del Centro Quirúrgico de un hospital-escuela con objeto de identificar y analizar los costos directos (recursos humanos, recursos materiales y medicamentos) e indirectos ocasionados por el cancelamiento de cirugías no urgentes. Los datos fueron recogidos durante tres meses consecutivos mediante documentos institucionales y un cuestionario elaborado por las investigadoras. Solamente 58 (23,3 por ciento) de las 249 operaciones previstas y que fueron canceladas resultaron en costos para la institución. El costo directo total de los cancelamientos fue R$ 1.713,66 (costo medio por paciente de R$ 29,54), repartidos así: gastos con materiales de consumo R$ 333,05 y proceso de esterilización R$ 201,22, medicamentos R$ 149,77 y recursos humanos R$ 1.029,62. El costo de los recursos humanos repesentó el mayor porcentaje en relación al costo total (60,1 por ciento). Se constató que la mayor parte de los cancelamientos podría haber sido evitada. Planificación administrativa, rediseño de los procesos de trabajo, medidas educativas del personal y evaluaçión clínica previa constituyen estrategias recomendadas para reducción de los casos de cancelamiento.

Este estudo discute a problemática do cancelamento de cirurgias sob a perspectiva econômico-financeira. Foi realizado na Unidade de Centro Cirúrgico de um hospital de ensino, com o objetivo de identificar e analisar os custos diretos (recursos humanos, medicamentos e materiais) e custo de oportunidade gerados pelo cancelamento de cirurgias eletivas. Os dados foram coletados durantes três meses consecutivos, utilizando-se documentos institucionais e formulário elaborado pelas pesquisadoras. Apenas 58 (23,3 por cento) das 249 cirurgias programadas canceladas representaram custos para a instituição. O custo direto total dos cancelamentos foi de R$ 1.713,66 (custo médio por paciente de R$ 29,54), assim distribuídos: despesas com materiais de consumo R$ 333,05; processo de esterilização R$ 201,22; medicamentos R$ 149,77 e recursos humanos R$ 1.029,62. O custo com recursos humanos representou o maior percentual em relação ao custo total (60,1 por cento). Observou-se que a maior parte dos cancelamentos eram potencialmente evitáveis. Planejamento administrativo, redesenho dos processos de trabalho, medidas educativas de pessoal e avaliação clínica prévia constitue em estratégias recomendadas para minimização da ocorrência.

Hepatitis B in healthcare workers: prevalence, vaccination and relation to occupational factors

The prevalence of hepatitis B virus (HBV) in healthcare workers (HCW) in Brazilian university hospitals is high. However, vaccination of these workers and relations with occupational factors are not well documented. A prospective study was made of 1,433 HCW and 872 administrative employees of the Hospital de Base (HB), São José do Rio Preto, SP, Brazil, and 2,583 blood donor candidates from the Hospital Blood Bank. HCW were observed from January 1994 to December 1999. Data were obtained from exams made when a worker entered hospital service, periodically and after work-related injuries. Serological reactions were analyzed in HCW who received HBV vaccine. Occupational and non-occupational information was obtained through a questionnaire. The prevalence of HBV among HCW (0.8 percent) was significantly higher than in blood-donor candidates (0.2 percent). Among the HCW who were vaccinated, 86.4 percent were immunized. Multivariate analysis revealed that increased age reduced the chance of immunization. Among the occupational factors, time in service contributed to a 14 percent increase in the chances of having positive serology, and work-related injuries increased the risk of HBV infection 4.29 times. The maximum risk sector presented a larger number of HCW with positive anti-HBc serology. There was a higher seroconversion in HCW who received the full set of HBV vaccines. In HCW with positive serology, the factors that presented greatest risks were time in service, work-related injuries and maximum risk sector.

Mortalidad neonatal en un hospital universitario de Chile / Neonatal mortality at a chilean university hospital

Objetivo: relacionar Ias muertes neonatales en un hospital universitario de Santiago de Chile con la edad gestacional, el peso al nacer y las malformaciones congénitas. Pacientes y método: En cuatro años (1 de enero 1992 al 31 de diciembre de 1995) se registraron 10952 recién nacidos vivos en la Maternidad de Hospital Clínico de la Universidad de Chile, 72 de los cuales fallecieron en el hospital (5,8 o/oo): la causa de muerte fue definida en 57 casos por necropsia, en los restantes a partir de los registros clínicos y exámenes complementarios. Resultados: el peso al nacer era bajo (1500 a 2499 g) en 6,8 por ciento y muy bajo (1499 g o menor) en 1,33 por ciento de los nacidos vivos, sin embargo 70,3 por ciento de los fallecidos pesaba al nacer menos de 2500 g y 48,4 por ciento menos de 1500 g. Casi la mitad de las muertes ocurrieron en niños de menos de 32 semanas de edad gestacional y falleció un tercio de los nacidos antes de 28 semanas de gestación. En 58 por ciento de los niños que fallecieron se encontró una malformación congénita que en 52,7 por ciento de ellos fue la causa directa de muerte. Entre los fallecidos, la frecuencia de malformaciones congénitas severas aumentó proporcionalmente con la edad gestacional y el peso al nacer (27,2 por ciento entre los de muy bajo peso y 87 por ciento entre los de 2500 g o más). Conclusión: la prematurez, el bajo peso de nacimiento y las malformaciones congénitas continúan mostrándose fuertemente asociados a la mortalidad neonatal