Antimicrobial resistance (AMR) is a major public health threat of global proportions, which has the potential to lead to approximately ten million deaths per year by 2050. Pressured by this wicked problem, in 2014, the World Health Organization launched a call for member states to share AMR data through the implementation of the Global Antimicrobial Resistance Surveillance System (GLASS), to appropriately scale and monitor the general situation world-widely. In 2017, Brazil joined GLASS and, in 2018, started its own national antimicrobial surveillance program (BR-GLASS) to understand the impact of resistance in the country. We compiled data obtained from the complete routine of three hospitals' microbiology labs during the year of 2018. This pilot data sums up to 200,874 antimicrobial susceptibility test results from 11,347 isolates. It represents 119 different microorganisms recovered from 44 distinct types of clinical samples. Specimens came from patients originating from 301 Brazilian cities, with 4,950 of these isolates from presumed Healthcare-Associated Infections (HAIs) and the other 6,397 community-acquired cases. The female population offered 58% of the collected samples, while the other 42% were of male origin. The urinary tract was the most common topography (6,372/11,347 isolates), followed by blood samples (2,072/11,347). Gram-negative predominated the bacterial isolates: Escherichia coli was the most prevalent in general, representing 4,030 isolates (89.0% of these from the urinary tract). Coagulase-negative Staphylococci were the most prevalent bacteria in blood samples. Besides these two species, the ESKAPE group have consolidated their prevalence. Regarding drug susceptibility results, 141,648 (70.5%) were susceptible, 9,950 (4.9%) intermediate, and 49,276 (24.5%) resistant. Acinetobacter baumannii was the most worrisome microorganism, with 65.3% of the overall antimicrobial susceptibility tests showing resistance, followed by ESBL-producing Klebsiella pneumoniae, with a global resistance rate of 59%. Although this is a pilot project (still limited to one state), this database shows the importance of a nation-wide surveillance program,[153mm][-12mm] Q14 especially considering it already had patients coming from 301 distinct counties and 18 different states. The BR-GLASS Program is an ongoing project that intends to encompass at least 95 hospitals distributed in all five geographical regions in Brazil within the next 5 years.
BackgroudAntithrombotic therapy is the cornerstone of chronic coronary syndrome (CCS) management. However, the best treatment option that optimally balances bleeding risk and efficacy remains undefined. Our objective was to evaluate the effectiveness and safety of antithrombotic options and identify the optimal treatment option for patients with CCS.MethodsWe used the MEDLINE, CENTRAL and Embase databases to search for randomized controlled trials with follow-up periods longer than 12 months that compared aspirin (ASA) monotherapy with other antithrombotic therapies in patients with CCS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Extracted data [hazard ratios (HR)] were pooled using Bayesian fixed-effect models, allowing the estimation of credible intervals (CrI) and posterior probabilities of benefit, harm, and practical equivalence. Confidence in the results was assessed with the Confidence In Network Meta-Analysis (CINeMA) tool. The primary efficacy and safety outcomes were major adverse cardiovascular events (MACE) and primary bleeding, respectively. Secondary outcomes were acute myocardial infarction, ischemic stroke, all-cause, and cardiovascular-specific mortality.ResultsFive trials with a total of 80,605 patients were included. Mean patient age ranged from 61 to 69 years, while 20.3% to 31.4% were women. The reference treatment was ASA monotherapy. ASA + prasugrel 10 mg and clopidogrel 75 mg monotherapy presented the greatest benefit for MACE [HR 0.52 (95% CrI, 0.39–0.71); and 0.68 (95% CrI, 0.54–0.88)]. There was a probability of 98.8% that ASA + ticagrelor was practically equivalent to ASA monotherapy. Regarding the primary bleeding outcome, clopidogrel 75 mg monotherapy performed best [HR 0.64 (0.42, 0.99)]. There was a probability of 97.4% that ASA + Prasugrel 10 mg increases bleeding (HR > 1.0). Secondary outcome results followed a similar treatment ranking pattern as in primary outcomes. Overall, CINeMA confidence ratings were judged as either low or very low.ConclusionsThese results revealed that clopidogrel monotherapy might provide the best risk-benefit balance in treating CCS. However, low CINeMA confidence ratings may preclude more forceful conclusions. Our analysis suggests that current guidelines recommending ASA as first-line therapy for CCS management need to be revised to include additional pharmacological options.
A confecção deste livro é a concretização de que a Liga de Humanização no Cuidado em Saúde - LAHCS - passa a se tornar uma entidade estudantil madura, capaz de almejar voos mais altos com capacidade de expandir suas ideias e metodologias de atuação extraclasse para outros campos acadêmicos, sociais e comunitários, abrangendo todos que se identifiquem o conceito de que a humanização pode ser uma das formas de mudar as relações interpessoais. Consolidamos com o passar do tempo a força das bases filosóficas e dos nossos princípios norteadores de solidariedade, empatia e amor para com o próximo. Esse projeto se baseia na exposição de como a humanização se encaixa em diversos contextos e populações, isto é, como devemos conduzir de maneira empática frente a variadas situações. Importante ponderar que, ao imergir nesse livro, você, leitor, verá que o ato “humanizar” deve ser uma prática constante, mas individualizada para cada circunstância e momento. Temos a plena convicção de que este trabalho se perpetuará por anos e será muito maior que cada um de nós. Por fim, cito aqui como forma de agradecimento, palavras de nosso professor orientador, Dr. Paulo de Tarso Sedrez: “Sinto-me plenamente realizado e feliz por ser um dos idealizadores para que tudo isso acontecesse. Meus mais sinceros agradecimentos a todos por acreditarem que seria possível, pela confiança quando haviam muitas dúvidas e por compartilharmos dos mesmos sonhos e ideais”.
Takotsubo syndrome is known for its association with psychological stress factors. Rarely, it is associated with invasive procedures. We present a case of Takotsubo induced by bronchoscopy, a procedure with a low rate of complications.
Introduction: The infection by the SARS-CoV-2 virus, initially described as an acute disease that only affected the pulmonary system, is now known to chronically affect other systems after the resolution of the acute phase. As a result, a hidden pandemic was born. Still with no clear consensus about its definition and management, post-acute Covid syndrome (PACS) is expected to be the next great burden of health services. Hypothesis: Whether sociodemographic, acute infection, current health, and physical examination variables are associated with PACS in survivors of the different forms of acute COVID-19. Methods: multicentric and observational study, patients from the city of Curitiba and its outskirts diagnosed with COVID-19 between June/2020 and Feb/2022 were referred due to persistent symptoms and evaluated with questionnaires on their acute infection and current symptoms, along with an interdisciplinary physical examination. A telephone consultation also investigated the quality of life. Patients were classified into two groups according to the National Institute for Health and Care Excellence: subacute infection (SI) and PACS. Individuals without sociodemographic and acute infection-related variables were excluded. The primary outcomes included current symptoms, modified Medical Research Council Dyspnea Scale, mini-mental state examination, multisystemic physical exam, quality of life, and new diagnoses variables, which were used in a univariate analysis to evaluate their significance in between groups. Results: 113 COVID-19 survivors were included, 63.71% were diagnosed with PACS. The mean follow-up time from the onset of acute symptoms was 104 days (IQR 46 - 163) and the overall median number of sequelae was of 9.0 (IQR 5.0 - 11.0). In the overall sample, 53.1% were women and the mean age was 51.7 ± 13.2 years. 83% were admitted to the intensive care unit and those were more likely to present with PACS (65.0%) (p=0.037). The same was observed when the use of supplementary oxygen by cannula (SI 67.5%; PACS 87.7%; p=0.022) and non-invasive ventilation were analyzed (SI 47.0%; PACS 69.7%; p=0.026). Sequelae that presented with significantly prevalence in the PACS population were (% SI; % PACS; p): dyspnea (80.5%; 59.7%; 0.036), hair loss (48.8%; 19.4%; 0.001), and upper limbs paresthesia (14.6%; 2.8%; 0.049). Meanwhile, sequelae that were found to have higher prevalence within the PACS population were: cough (17.1%; 44.4%; 0.004), gait issues (9.8%; 34.7%; 0.003); dysgeusia (2.4%; 22.2%; 0.005); anosmia (4.9%; 19.4%; 0.047); tremors (2.4%; 15.3%; 0.053); and nail alterations (2.4%; 15.3%; 0.053). Conclusion: Patients with PACS were generally also the most severe cases of acute infection, also presenting a higher prevalence of specific sequelae. These data should be reproduced in other settings and countries to help define determinants of PACS in a high-risk population.
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