Double-, single- and none-carbapenem-containing regimens for the treatment of carbapenem-resistant Enterobacterales (CRE) bloodstream infections: a retrospective cohort.

OBJECTIVES: To investigate the effect of double-, single- and none-carbapenem-containing antimicrobial regimens in the treatment of patients with carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs). METHODS: We conducted a retrospective cohort study from 2013 to 2020 in two Brazilian hospitals. Patients ≥18 years old with CRE BSI were included and excluded if death or treatment duration for ≤48 h after BSI or non-Class A-producing carbapenemase isolates. We evaluated the impact of different carbapenem-containing regimens on 30 day mortality through a propensity score adjusted model and a Cox proportional hazards model. RESULTS: Two-hundred and seventy-nine patients were included for analyses: 47 (16.9%), 149 (53.4%) and 83 (29.8%) were treated with double-, single- and none-carbapenem-containing regimens, respectively. One-hundred and seventeen (41.9%) patients died in 30 days. Treatment with a single-carbapenem regimen was associated with a lower risk of death in 30 days compared with therapies containing no carbapenem [adjusted HR (aHR) 0.66, 95% CI 0.44-0.99, P = 0.048], when adjusted for Charlson score and ICU admission at baseline, while double-carbapenem regimens were not associated with a lower risk of death (aHR 0.78, 95% CI 0.46-1.32, P = 0.35). Propensity score adjusted model results went in the same direction. CONCLUSIONS: Double-carbapenem- was not superior to single-carbapenem-containing regimens in patients with CRE BSIs. Single-carbapenem-containing schemes were associated with a lower mortality risk.

Melatonin for prevention of acute kidney injury in patients treated with intravenous polymyxin B: a double-blind, placebo-controlled randomized clinical trial.

OBJECTIVES: To evaluate the effect of melatonin versus placebo on the incidence of acute kidney injury (AKI) in patients treated with polymyxin B. METHODS: We performed a single-centre, double-blind, randomized clinical trial (NCT03725267) of 30-mg oral melatonin versus placebo for patients treated with intravenous polymyxin B. Patients aged ≥18 years receiving polymyxin B for ≤48 hours were eligible. Melatonin or placebo pills were administered until the end of polymyxin B treatment or for a maximum of 14 days. The main outcome was any level of AKI. RESULTS: Eighty-eight patients were randomized: 44 in the melatonin group and 44 in the placebo group. The study ended prematurely because of polymyxin B shortage during the COVID-19 pandemic. The patients' mean age was 63.6 ± 17.3 years, and 60.2% of the patients were men. Forty-six (52.3%, 23 in each group) patients developed AKI during the follow-up period. The incidence rate of AKI was 81.9/1000 and 77.4/1000 patients per day in melatonin and placebo groups, respectively (hazard ratio, 1.09; 95% CI, 0.61-1.94; p 0.78). Renal failure and 30-day mortality were similar between the groups. Moreover, the incidence of AKI was not different in pre-specified sub-groups. DISCUSSION: Melatonin initiated in the first 48 hours of therapy did not reduce the incidence of AKI in patients treated with polymyxin B.

Antimicrobial stewardship programme associated with earlier prescription of in vitro susceptible therapy and lower 14-day mortality in patients with carbapenem-resistant Enterobacterales bacteraemia: a cohort study.

OBJECTIVES: This study analysed the impact of antimicrobial stewardship team (AST) evaluation on time to susceptible in vitro therapy and mortality of patients with carbapenem-resistant Enterobacterales (CRE) bacteraemia. METHODS: We performed a retrospective cohort study (February 2018 to July 2020) to evaluate the impact of AST evaluation, along with other clinical and microbiological variables, on time to appropriate antibiotics, 14-day mortality and in-hospital mortality in patients aged >18 years with CRE bacteraemia. A Cox regression model was used for multivariate analysis. RESULTS: A total of 142 patients were included. The proportion of patients who received appropriate antibiotics in the first 5 days after bacteraemia was 82/92 (89.1%) versus 29/50 (58.0%) evaluated and not evaluated by the AST, respectively (P < 0.01). AST evaluation reduced the median time to appropriate therapy (49.8 h vs. 71.1 h; P = 0.01). AST intervention was independently associated with earlier prescription of appropriate therapy (P = 0.02) when controlled for septic shock (P < 0.01) and CRE isolation in the previous 90 days (P = 0.04). Regarding mortality, 51 patients (35.9%) died within 14 days (25.8% vs. 44.7% with and without AST intervention, respectively; P = 0.02) and 82 patients (57.7%) in hospital (52.2% vs. 68.0% evaluated and not evaluated by the AST, respectively; P = 0.08). AST intervention was independently protective for 14-day mortality (P = 0.03) when controlled for septic shock status (P < 0.01). CONCLUSION: AST guidance improves the quality of antibiotic prescriptions and clinical outcomes in patients with CRE bacteraemia.

Copper-coated hospital surfaces: reduction of total bacterial loads and resistant Acinetobacter spp.

Healthcare-associated infections (HAIs) represent a global challenge and an even more staggering concern when related to microorganisms capable of resisting and surviving for long periods in the environment, such as Acinetobacter spp. Strategies that allow a reduction of pathogens from hospital environments represent an additional barrier in infection control protocols, minimizing transmission to hospitalized patients. Considering the antimicrobial properties of copper, here, the bacterial load and the presence of Acinetobacter spp. were monitored on high handling surfaces covered by 99.9% copper films on intensive and non-intensive care unit bedrooms in a tertiary care hospital. Firstly, copper-coated films were able to inhibit the adhesion and biofilm formation of A. baumannii strains in in vitro assays. On the other hand, Acinetobacter spp. were isolated from both copper-coated and uncoated surfaces in the hospital, although the majority was detected on surfaces without copper. All carbapenem-resistant A. baumannii isolates identified harbored the blaoxa-23 gene, while the A. nosocomialis isolates were susceptible to most antimicrobials tested. All isolates were susceptible to polymyxin B. Regarding the total aerobic bacteria, surfaces with copper-coated films presented lower total loads than those detected for controls. Copper coating films may be a workable strategy to mitigate HAIs, given their potential in reducing bacterial loads in nosocomial environments, including threatening pathogens like A. baumannii.

Left Atrial Septal Pouch and Acute Thromboembolic Ischemia of the Upper Limb.

BACKGROUND A left atrial septal pouch (LASP) was first described in 2010 as a new anatomical entity with potential for embolic events. The prevalences of left, right, and double septal pouches are 40.8%, 5.1%, and 3.7%, respectively. There is a concern about the risk of embolic events due to formation of thrombi in a LASP (especially stroke). CASE REPORT A 60-year-old man presented with sudden onset of right arm pain associated with sweating and neck pain radiating to his left upper extremity. On physical examination, his right arm was cyanotic and he had pain, paresthesia, and no radial pulse. The patient was diagnosed with acute arterial occlusion of his right upper extremity. An arterial embolectomy was performed with a Fogarty catheter at the level of the brachial artery, which resulted in immediate reperfusion. The patient had an embolic event and after efforts to identify the possible etiology, only an LASP was found. Therefore, we hypothesized that he experienced an embolic event in which a thrombus had formed at the site of the LASP. CONCLUSIONS The present case report is designed to raise awareness of the thrombogenic potential of LASP and the possibility of an embolic event to the upper limb of patients with it. LASP can be the source of a thrombus in a patient with a non-stroke embolic event.

Use of health services by quilombola elderly people / Utilização de serviços de saúde por idosos quilombolas

Objective: To analyze the use of health services by quilombola elderly people. Methods: This is a cross-sectional and household-based study conducted in 11 quilombola communities, with 236 elderly people ≥60 years old. Statistical differences were found in the estimates of indicators of the use of health services according to gender and age group. Pearson's Chi-square or Fisher's Exact tests were performed. Differences were considered statistically significant when p<0.05. Results: Most of the elderly people did not have a health insurance plan, seeking mainly public hospital/outpatient unit. The last medical consultation for 80.3% of the participants was performed in the 12 months prior to the interviews, with fewer consultations for men (p= 0.027). There was a low hospitalization rate in the last year and a low demand for health services in the last two weeks. Conclusion: Quilombola women and long-lived elderly people use health services more and, in general, the elderly citizens depend on SUS to exercise their right to health. The public hospital/outpatient unit was the most used service, and PHCU was little sought (AU).

Objetivo: Analisar a utilização de serviços de saúde por idosos quilombolas. Métodos: Trata-se de um estudo transversal, de base domiciliar, realizado em 11 comunidades quilombolas, com 236 idosos ≥60 anos. Verificou-se diferenças estatísticas nas estimativas dos indicadores de uso de serviços de saúde segundo sexo e faixa etária. Realizaram-se testes de Qui-quadrado de Pearson ou Exato de Fisher. As diferenças foram consideradas estatisticamente significantes quando p<0,05. Resultados: A maioria dos idosos não possuía plano de saúde, buscando, principalmente, hospital/ambulatório público. A última consulta médica de 80,3% dos participantes foi realizada nos 12 meses anteriores às entrevistas, com número menor de consulta para os homens (p= 0,027). Houve baixa internação hospitalar no último ano e procura de algum serviço de saúde nas duas últimas semanas. Conclusão: As mulheres quilombolas e os idosos mais velhos utilizam mais os serviços de saúde e, no geral, os idosos dependem do SUS para exercer o seu direito à saúde. O hospital/ambulatório público foi o serviço mais utilizado, e a UBS pouco procurada (AU).

Padrão de desempenho nas atividades de vida diária de idosos Quilombolas / Performance standard in daily life activities of elderly Quilombolas / Patrón de desempeño em lãs actividades de la vida diaria de Quilombolas ancianos

Objetivo: Analisar o padrão de desempenho nas atividades de vida diária em idosos quilombolas maranhenses. Métodos: Estudo transversal, de base domiciliar. Realizado com 208 idosos ≥60 anos de idade, residentes em 11 comunidades remanescentes de Quilombolas no Município de Bequimão, Maranhão. Investigou-se a capacidade funcional para as Atividades Básicas da Vida Diária e Atividades Instrumentais da Vida Diária. Calcularam-se as prevalências e realizaram-se testes Qui-quadrado de Pearson ou Exact de Fisher para diferenças entre sexo e faixa etária. Resultados: A prevalência total de incapacidade funcional foi de 57,7%, sendo 14,4% nas atividades básicas e 56,3% para as atividades instrumentais. A incapacidade para as atividades da vida diária foi maior nas mulheres e aumentou com a idade. As atividades instrumentais variaram de 18,3% (tomar medicamentos) a 43,3% (ir ao médico). Já para as atividades básicas, comer sozinho foi a menor (3,9%) e vestir-se a maior (9,6%). Diferiu estatisticamente a prevalência do acúmulo de incapacidades por sexo e idade, sendo maior número de incapacidades entre os idosos mais velhos. Conclusão: Observou-se elevada prevalência de incapacidade funcional e dependência nas atividades da vida diária. As atividades instrumentais foram as mais comprometidas e as mulheres e os idosos mais velhos foram os mais dependentes. (AU)

Objective: To analyze the pattern of performance in activities of daily living in elderly quilombolas from Maranhão. Methods: Cross-sectional, household-based study. Carried out with 208 elderly people ≥60 years of age, residing in 11 remaining communities of Quilombolas in the Municipality of Bequimão, Maranhão. Functional capacity for Basic Activities of Daily Living and Instrumental Activities of Daily Living was investigated. Prevalences were calculated and Pearson's Chisquare or Fisher's Exact tests were performed for differences between sex and age group. Results: The total prevalence of functional disability was 57.7%, with 14.4% in basic activities and 56.3% in instrumental activities. Inability to perform activities of daily living was greater in women and increased with age. The instrumental activities ranged from 18.3% (taking medication) to 43.3% (going to the doctor). As for basic activities, eating alone was the lowest (3.9%) and dressing the highest (9.6%). The prevalence of the accumulation of disabilities by sex and age was statistically different, with a greater number of disabilities among the older elderly. Conclusion: There was a high prevalence of functional disability and dependence on activities of daily living. Instrumental activities were the most compromised and women and the oldest elderly are the most dependent. (AU)

Objetivo: Analizar el patrón de desempeño em lãs actividades de la vida diária en quilombolas ancianos de Maranhão. Métodos: Estudio transversal de hogares. Realizado con 208 ancianos ≥ 60 años, residentes en 11 comunidades restantes de Quilombolas em el Municipio de Bequimão, Maranhão. Se investigo la capacidad funcional para lãs actividades básicas de la vida diaria y las atividades instrumentales de la vida diaria. Se calcularon las prevalencias y se realizaron las pruebas de Chi-cuadrado de Pearson o Exacto de Fisher para las diferencias entre sexo y grupo de edad. Resultados: La prevalencia total de discapacidad funcional fue de 57,7%, con 14,4% en actividades básicas y 56,3% en atividades instrumentales. La incapacidad para realizar las actividades de la vida diária fue mayor em las mujeres y aumento com la edad. Las actividades instrumentales oscilaron entre el 18,3% (toma de medicación) y el 43,3% (acudir al médico). Encuanto a las actividades básicas, comer solo fue el más bajo (3,9%) y vestirse el más alto (9,6%). La prevalencia de acumulación de discapacidades por sexo y edad fue estadísticamente diferente, com um mayor número de discapacidades entre losancianos. Conclusión: Hubo una alta prevalencia de discapacidad funcional y dependencia de las actividades de la vida diaria. Las atividades instrumentales fue ronlas más comprometidas y lasmujeres y losancianos mayores sonlos más dependientes. (AU)

Perfil das condições de saúde das idosas quilombolas no município de Bequimão, Maranhão: dados do IQUIBEQ / Profile of health conditions of elderly quilombolas in the municipality of Bequimão, Maranhão: data from IQUIBEQ

Objetivo: analisar as condições de saúde de mulheres idosas quilombolas residentes em uma cidade do interior do estado do Maranhão, Brasil. Método: Trata-se de um estudo transversal, de base domiciliar, realizado em 11 comunidades remanescentes de quilombolas no Município de Bequimão, Maranhão. Realizou-se o censo da população de idosos quilombolas, que foi representada por 132 mulheres idosas ≥60 anos. Os dados foram analisados no programa Stata® versão 14, com técnicas de estatística descritiva. Resultados: a mediana das idosas foi de 70 a 79 anos, (61,4%) se declarava na cor/raça preta; (32,6%) eram viúvas, 53,8% das mulheres não sabem ler e escrever. Quanto à situação de saúde, em relação às condições crônicas, 60,6% referiam acometimento por duas ou mais, 38,8% realizaram examepreventivo para câncer de colo doútero há pelo menos três anos. A maioria das idosas nunca realizou uma mamografia (67,2%) e nunca tinha sido submetida a um exame clínico das mamas (56,9%). Conclusão: A maioria das idosas quilombolas vivem em precária situação socioeconômica, sanitária e de saúde, entre eles, a prevalência de multimorbidade foi elevada. (AU)

Objective: to analyze the health conditions of elderly quilombola women living in a city in the interior of the state of Maranhão, Brazil. Method: This is a cross-sectional, household-based study conducted in 11 remaining quilombola communities in the Municipality of Bequimão, Maranhão. A census of the quilombola elderly population was carried out, which was represented by 132 elderly women ≥60 years of age. The data were analyzed in the Stata® version 14 program, with descriptive statistics techniques. Results: the median of the elderly women was 70 to 79 years old, (61.4%) declared themselves as black in color/race; (32.6%) were widows, 53.8% of the women cannot read and write. Regarding their health status, 60.6% reported having two or more chronic conditions, 38.8% had had a cervical cancer preventive exam at least 3 years ago. Most elderly women had never had a mammogram (67.2%) and had never been submitted to a clinical examination of the breasts (56.9%). Conclusion: Most elderly quilom-bola women live in precarious socioeconomic, sanitary, and health situations; among them, the prevalence of mul-ti-morbidity was high. (AU)

Violência intrafamiliar contra criança e adolescente: o papel da enfermagem / Intra-family violence against childrenand adolescents: the role of nursing / Violencia intrafamiliar contra niña y adolescente: el papel de la enfermería

Objetivo: Compreender a assistência de enfermagem diante de crianças e adolescentes vítimas de violência intrafamiliar. Métodos: pesquisa descritiva de abordagem qualitativa, realizada em quatro unidades básicas de saúde de um município de médio porte do Nordeste brasileiro. A coleta de dados foi realizada através de entrevista semiestruturada, com oito enfermeiros. Os dados foram analisados através da técnica do discurso do sujeito coletivo. Resultados: os enfermeiros compreendem o que é violência intrafamiliar, conhecem os tipos de violência e como identificar na sua prática. Acreditam que o papel do enfermeiro é ouvir e orientar os pais, notificar e acionar os órgãos responsáveis. Ainda, relatam que o município é carente em capacitação de profissionais acerca desse assunto. Conclusão: sugere-se que um plano de treinamento e desenvolvimento de profissionais de enfermagem seja implantado na cidade, conferindo-lhes conhecimento necessário para saber abordar e tratar essa situação

Objective:To understand nursing care for children and adolescents victims of intrafamily violence. Methods: descriptive research of a qualitative approach, carried out in four basic health units of a medium-sized municipality in the Brazilian Northeast. Data collection was done through a semistructured interview, with eight nurses. Data were analyzed using the collective subject discourse technique. Results: nurses understand what intrafamily violence is, know the types of violence and how to identify in their practice. They believe that the role of the nurse is to listen and guide the parents, to notify and to activate the responsible organs. They still report that the municipality is lacking in qualification of professionals on this subject. Conclusion: it is suggested that a plan of training and development of nursing professionals be implemented in the city, giving them the necessary knowledge to know how to approach and treat this situation

Objetivo: Comprender la asistencia del enfermería ante los niños y adolescentes víctimas de violencia intrafamiliar. Métodos: investigación descriptiva de abordaje cualitativo, realizada en cuatro unidades básicas de salud de un municipio de mediano porte del Nordeste brasileño. La recolección de datos fue realizada a través de una entrevista semiestructurada, con ocho enfermeros. Los datos fueron analizados a través de la técnica del discurso del sujeto colectivo. Resultados: los enfermeros comprenden lo que es violencia intrafamiliar, conocen los tipos de violencia y cómo identificar en su práctica. Creen que el papel del enfermero es escuchar y orientar a los padres, notificar y accionar a los órganos responsables. También relatan que el municipio es carente en capacitación de profesionales acerca de ese asunto. Conclusión: se sugiere que un plan de entrenamiento y desarrollo de profesionales de enfermería sea implantado en la ciudad, dándoles conocimiento necesario para saber abordar y tratar esa situación

Percepção de docentes de Odontologia sobre o uso de dentes humanos como recurso educativo em atividades pré-clínicas / Perception of dental professorsabout the use of human teeth as an educational resource in pre-clinical activities

O estudo teve por objetivo avaliar a percepção de docentes de Odontologia em relação à utilização de dentes humanos extraídos e dentes artificiais em atividades pré-clínicas. Utilizou-se um questionário com perguntas objetivas e subjetivas aplicado aos professores cirurgiões-dentistas do Curso de Odontologia Centro Universitário de Anápolis -UniEVANGÉLICA. Dos 50 professores que correspondiam aos critérios de elegibilidade, obteve-se taxa de resposta de 76%. A média do tempo de formado dos docentesé de 20±9,7 anos e a média do tempo de docência de 17±10,5 anos. Quando questionados se dentes humanos deveriam ser utilizados como recursos educativos, a maioria (89,4%) respondeu que sim e em relação à aquisição de habilidades psicomotoras dos estudantes 68,4% acreditam que os dentes humanos são mais vantajosos. Citaram como desvantagem do uso aspectos relacionados à biossegurança (36,8%), dificuldade para obtenção dos dentes (21%), riscos de comercialização (15,7%) e aspectos éticos (15,7%). A maioria dos docentes de Odontologia do cursoavaliado entendem que o uso de dentes humanos em atividades pré-clínicas tem maior potencial pedagógico, além de favorecer o desenvolvimento de habilidades motoras em comparaçãoao uso de dentes artificiais (AU).

The present study aimed toassess the dental professor perception in relation to the use of extracted human teeth and artificial teeth in pre-clinical activities.A questionnaire was used with objective and subjective questions applied to professors of dental surgeons from the Dentistry Course Centro Universitário de Anápolis -UniEVANGÉLICA. Of the 50 professorswho met the eligibility criteria, a response rate of 76% was obtained. The average length of time for professorsto graduate is 20 ± 9.7 years andthe average teaching time is 17 ± 10.5 years. When asked whether human teeth should be used as educational resources, the majority (89.4%) answered yes, and concerning the acquisition of psychomotor skills by students, 68.4% believe that human teeth are more advantageous. He mentioned the disadvantage of using aspects related to biosafety (36.8%), difficulty in obtaining teeth (21%), risks of commercialization (15.7%), and ethical aspects (15.7%). Most dental professors in the evaluated course understand that the use of human teeth in pre-clinical activities has greater pedagogical potential, in addition to favoring the development of motor skills compared to the use of artificial teeth (AU).