The use of minimally invasive techniques in the treatment of primary Achilles rupture has become more popular in the past few decades as they have been associated with a lower wound complication rate. Most of the techniques demand the use of procedure-specific instruments and are designed mainly for midsubstance lesions. This article aims to present a novel technique for Achilles tendon repair that can be used for both insertional and midsubstance ruptures, using a mini-incision and with no special instruments required. Level of Evidence: Diagnostic Level V.

Abstract Background Our study seeks to address three important questions: (a) What is the current rate of HH adherence in Brazilian hospitals? (b) Which of the five moments of HH has the lowest adherence rate in Brazilian hospitals? (c) What is the HH compliance rate, as measured by direct observation, among physicians, nurses, nursing technicians, and other healthcare professionals? And (d) is there a difference in HH adherence rates when comparing private hospitals to public/philanthropic hospitals? Methods We conducted covert, random daily observations to assess hand hygiene compliance in 8 Brazilian hospitals over three months (Jan-Mar/2023). Observations were conducted in both critical and non-critical care units, and data on compliance rates were collected in the SACIH 3i system (https://nsp.sacihweb.com). To calculate the compliance rate, we divided the number of observations in which hand hygiene was performed correctly when necessary by the total number of observed instances where hand hygiene was required. Results We conducted observations on 4,662 hand hygiene opportunities across 8 hospitals in three months. The global hand hygiene adherence rate varied between hospitals, ranging from 14% to 74% (Fig. 1), with a median adherence rate of 57% for Brazilian hospitals. The first moment, before touching a patient, had the lowest adherence rate of 47% (Fig. 2). Nursing technicians were the most frequently observed professional group (69%), with compliance rates of physicians = 51%, nurses = 65%, nursing technicians = 62%, and other healthcare professionals = 54% (p-value < 0.001). There was no difference in the overall hand hygiene rate between private and public/philanthropic hospitals, both with a compliance rate of 60%. However, significant differences were found between hospital types in Moment 1, Moment 2, and Moment 5 (Tab.1 ).Figure 1Hand hygiene adherence in Brazilian hospitals (2023): comparing global rates and adherence across the five moments.Figure 2Hand hygiene adherence rates in Brazilian hospitals (2023): private vs. public/philanthropic hospitals by the five moments.Table 1Hand hygiene adherence rates in Brazilian hospitals (2023): private vs. public/philanthropic hospitals compared across five moments. Conclusion Hand hygiene adherence in Brazilian hospitals remains low at 47%. The first moment, before touching the patient, has the lowest adherence rate, indicating that professionals prioritize their own safety over patients. Physicians have the lowest adherence rate, and private hospitals have better adherence than public/philanthropic hospitals. Disclosures All Authors: No reported disclosures

A new species of Krenakanthus, a member of the bromelioid “Cryptanthoid complex”, is described based on plants discovered through collaborative citizen science. Krenakanthus ribeiranus and its only congener K. roseolilacinus are endemic to the “João Pinto Center of Biodiversity”, a still poorly explored region with Campos Rupestres and associated vegetation in the Rio Doce Valley, in eastern Minas Gerais state, Brazil. The unusual combination of morphological characters of K. ribeiranus, highlighted by plant delicacy and almost all leaf and flower parts covered by uniseriate, hair-like trichomes, is illustrated and discussed in comparison with K. roseolilacinus, including leaf and seed anatomy, as well as pollen morphology. This micro-endemic species is assessed as Critically Endangered, reinforcing the need for strategy to protect the biodiversity of the region. The morphology of the new species validates and strengthens the diagnostic flower characters used in the circumscription of Krenakanthus, suggesting as secondary diagnostic characters the habit, stature, and leaf conformation.

To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Agojie rupicola gen. et sp. nov., a new genus and species of Euptychiina from the campos rupestres and granitic inselbergs of eastern Minas Gerais, southeastern Brazil, is herein described using comparative morphology and ecological data. Diagnoses, photos, and illustrations are also provided, in addition to a discussion on the putative systematic placement of the new taxa and its conservation status. Considering the collecting points, the estimated value for the extent of occurrence (EOO) is 100.263 km2 and the area of occupancy (AOO) is 20 km2, which combined with the reduced number of localities in which the species is known to occur, and the observed continuing decline of the quality of the habitat, we recommend that A. rupicola gen. et sp. nov. should be formally assessed as Endangered based on criteria B1+2(a,biii) of the International Union for Conservation of Nature (IUCN). The results presented here add to the increasing faunistic and floristic novelties that justify the priority for the conservation of these still scientifically underexplored Brazilian mountains.

BackgroundThe optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with nonvalvular atrial fibrillation (AF) remains uncertain. ObjectivesIn this study, the authors sought to compare the efficacy and safety of various antithrombotic strategies after LAAO. MethodsWe searched the Medline, Cochrane, EMBASE, LILACS, and ClinicalTrials.gov databases for studies reporting outcomes after LAAO, stratified by antithrombotic therapy prescribed at postprocedural discharge. Direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no antithrombotic therapy were analyzed. We performed a frequentist random effects model network meta-analysis to estimate the OR and 95% CI for each comparison. P-scores provided a ranking of treatments. ResultsForty-one studies comprising 12,451 patients with nonvalvular AF were included. DAPT, DOAC, DOAC plus SAPT, and VKA were significantly superior to no therapy to prevent device-related thrombosis. DOAC was associated with lower all-cause mortality than VKA (OR: 0.39; 95% CI: 0.17-0.89; P = 0.03). Compared with SAPT, DAPT was associated with fewer thromboembolic events (OR: 0.50; 95% CI: 0.29-0.88; P = 0.02), without a difference in major bleeding. In the analysis of P-scores, DOAC monotherapy was the strategy most likely to have lower thromboembolic events and major bleeding. ConclusionsIn this network meta-analysis comparing initial antithrombotic therapies after LAAO, monotherapy with DOAC had the highest likelihood of lower thromboembolic events and major bleeding. DAPT was associated with a lower incidence of thromboembolic events compared with SAPT and may be a preferred option in patients unable to tolerate anticoagulation.

Infections resulting from cardiac implantable electronic device (CIED) implantation are severely impacting on patients' and on health care systems. The use of TYRXTM absorbable antibiotic-eluting envelope has proven to decrease major CIED infections within 12 months of CIED surgery. The aim is to evaluate the impact of the envelope use on infection-related clinical events in a real-world contemporary patient population. Data on patients undergoing CIED surgery were collected prospectively by participating centers of the One Hospital ClinicalService project. Patients were divided into two groups according to whether TYRXTM absorbable antibiotic-eluting envelope was used or not. Out of 1819 patients, 872 (47.9%) were implanted with an absorbable antibiotic-eluting envelope and included in the Envelope group and 947 (52.1%) patients who did not receive an envelope were included in the Control group. Compared to control, patients in the Envelope group had higher thrombo-embolic or hemorrhagic risk, higher BMI, lower LVEF and more comorbidities. During a mean follow-up of 1.4 years, the incidence of infection-related events was significantly higher in the control compared to the Envelope group (2.4% vs. 0.8%, P = 0.007). The five-year cumulative incidence of infection-related events was 8.1% in the control and 2.1% in the Envelope group (HR: 0.34, 95%CI: 0.14-0.80, P = 0.010). In our analysis, the use of an absorbable antibiotic-eluting envelope in the general CIED population was associated with a lower risk of systemic and pocket infection.

Antecedentes: La infección por el virus SARS-CoV-2 causa la enfermedad por coronavirus 2019 ( COVID-19). Objetivo: Caracterizar epidemiológicamente al paciente con COVID-19, Región Sanitaria Departamental de Francisco Morazán (RSDFM), Honduras, marzo 2020-enero 2021. Métodos: Estudio descriptivo retrospectivo. Incluyó n=11,401 usuarios a quienes se les realizó confirmación diagnóstica en la RSDFM. Se calculó incidencia general y mensual de COVID-19 como tasas por 10,000 habitantes, tasas de incidencia municipal (casos positivos/10,000) y tasa de letalidad (fallecidos/100 casos positivos). Resultados: Del total de 3,680 usuarios, el promedio de edad de los casos positivos fue 36.8 años (DS+/-17.9); sexo femenino 53.3% (1,962), procedencia Valle de Ángeles 20.4% (752). El nexo epidemiológico fue contacto con familiar o amigo positivo o fallecido por COVID-19 en 96.3% (3,544). La tasa general de incidencia fue 92.4/10,000. El municipio de Valle de Ángeles presentó la tasa de incidencia más elevada 366.1/10,000. La tasa de letalidad fue 1.8% (68/3680). Discusión: Los hallazgos de este estudio son compatibles con otros autores con respecto a las características epidemiológicas y sintomatología, identificando mayor riesgo de mortalidad en los individuos con edad ≥60 años (35/418 vs <60 años 32/3194; p=0.000, OR: 8.60, IC95%: 5.15-14.37), así como para el sexo masculino (48/1670 vs 20/1942; p=0.000, OR:2.79, IC95%: 1.61-4.89). Los meses de mayor incidencia de casos en la RSDFM fueron los meses de junio a julio del 2020 y diciembre del 2020 a enero del 2021. Estudios de este tipo fortalecen el abordaje epidemiológico de las epidemias/pandemias.