Brazilian Hospital Research Articles

Do the oxidative stress biomarkers predict COVID-19 outcome? An in-hospital cohort study

In SARSCoV-2 infections, excessive activation of the immune system dramatically elevates reactive oxygen species levels, harms cell structures, and directly increases disease severity and mortality. We aimed to evaluate whether plasma oxidative stress biomarker levels could predict mortality in adults admitted with Coronavirus Disease 2019 (COVID-19), considering potential confounders. We conducted a cohort study of 115 adults (62.1 ± 17.6 years, 65 males) admitted to a Brazilian public hospital for severely symptomatic COVID-19. Serum levels of α-tocopherol, glutathione, superoxide dismutase, 8-hydroxy-2′-deoxyguanosine, malondialdehyde, and advanced oxidation protein products were quantified at COVID-19 diagnosis using real-time polymerase chain reaction. Serum levels of α-tocopherol, glutathione, superoxide dismutase, and advanced oxidation protein products differed significantly between survivors and non-survivors. Serum glutathione levels below 327.2 μmol/mL were associated with a significant risk of death in COVID-19 patients, even after accounting for other factors (adjusted hazard ratio = 3.12 [95% CI: 1.83–5.33]).

Evaluation of the applicability of Gail's method in patients undergoing breast biopsy at a brazilian hospital

OBJECTIVES: To verify the accuracy of the Gail Model (GM) in risk assessment in patients with suspected breast cancer and to determine the need to adapt the GM or develop a new model for accurate risk assessment of these patients. METHODS: This is a descriptive, cross-sectional and retrospective study, based on the analysis of data provided by the medical records of 200 patients treated between 2017 and 2021, from the Mastology Outpatient Clinic of the Hospital Universitário Evangélico Mackenzie (HUEM). RESULTS: 155 women were diagnosed with breast cancer and 45 were not. The mean age was 54.23 years and the mean age at menarche was 13 years. Also, only 13 medical records contained information on age at birth of the 1st child or absence of children, and the mean age obtained was 26.77 years. Ethnic prevalence was white and most patients had no first-degree relatives with breast cancer. Regarding previous breast biopsies, most had already performed at least one, but few received a result of atypical hyperplasia. Furthermore, most of the study patients diagnosed with breast cancer had no positive family history of the disease. CONCLUSION: The study shows that the GM isn't reliable in assuming the risk of the studied population to develop breast CA, since, when comparing the GM data between groups that had and didn't have the disease, there was no significant difference.

Genomics and Antimicrobial Susceptibility of Clinical Pseudomonas aeruginosa Isolates from Hospitals in Brazil.

Pseudomonas aeruginosa, an opportunistic pathogen causing infections in immunocompromised patients, usually shows pronounced antimicrobial resistance. In recent years, the frequency of carbapenemases in P. aeruginosa has decreased, which allows use of new beta-lactams/combinations in antimicrobial therapy. Therefore, the in vitro evaluation of these drugs in contemporary isolates is warranted. We evaluated the antimicrobial susceptibility and genomic aspects of 119 clinical P. aeruginosa isolates from 24 different hospitals in Brazil in 2021-2022. Identification was performed via MALDI-TOF-MS, and antimicrobial susceptibility was identified through broth microdilution, gradient tests, or disk diffusion. Whole-genome sequencing was carried out using NextSeq equipment. The most active drug was cefiderocol (100%), followed by ceftazidime-avibactam (94.1%), ceftolozane-tazobactam (92.4%), and imipenem-relebactam (81.5%). Imipenem susceptibility was detected in 59 isolates (49.6%), and the most active aminoglycoside was tobramycin, to which 99 (83.2%) isolates were susceptible. Seventy-one different sequence types (STs) were detected, including twelve new STs described herein. The acquired resistance genes blaCTX-M-2 and blaKPC-2 were identified in ten (8.4%) and two (1.7%) isolates, respectively. Several virulence genes (exoSTUY, toxA, aprA, lasA/B, plcH) were also identified. We found that new antimicrobials are effective against the diverse P. aeruginosa population that has been circulating in Brazilian hospitals in recent years.

Occurrence of antimicrobial-resistant Staphylococcus aureus in a Brazilian veterinary hospital environment.

Antimicrobial resistance is a threat to public health. The emergence of antibiotic-resistant Staphylococcus aureus represents a priority for the implementation of preventive measures. The objective was to isolate S. aureus in humans, animals, and animal health care environment, and to characterize the genotypic and phenotypic profile of antimicrobial resistance in these isolates. We isolated S. aureus from staff, animals, and environment of a veterinary hospital, and identified their antimicrobial resistance profiles. Samples were collected from 20 humans, 13 animals, 14 surfaces, 8 mobile phones, and 7 veterinarians' stethoscopes by using sterile swabs. S. aureus was isolated by culturing on mannitol salt agar and preliminary identification was done by Gram staining and catalase test. Subsequently, a polymerase chain reaction was performed for species confirmation and investigating their antimicrobial-resistant genotypic profiles. Phenotypic profiles of resistant isolates were determined using the disk-diffusion technique. Ten S. aureus isolates were recovered from 5/20 humans (25%), it was also recovered from 2/13 animals (15.38%), including 1 dog and 1 cat, and from 1/14 of surfaces (7.14%). The oxacillin-susceptible mecA-positive Staphylococcus aureus phenotype was identified in a feline. Most of the isolates carried at least two resistance genes of different antimicrobial classes, with 90% (9/10) presenting the gene blaZ, with 10% (1/10) presenting the gene mecA, 20% (2/10) presenting tet38, 10% (1/10) presenting tetM, 90% (9/10) presenting norA, 50% (5/10) presenting norC, 10% (1/10) presenting ermA, and 60% (6/10) presenting ermB. In antibiograms, resistance to penicillin was identified in all the isolates, resistance to erythromycin was identified in 80% (8/10), and all the isolate's resistance to erythromycin presented erythromycin-induced resistance to clindamycin. Antimicrobial resistance in the veterinary hospital requires attention due to the risk of interspecies transmission, gene transfer between bacteria that colonize companion animals and humans and, can make antimicrobial therapy difficult.

A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence.

Carbapenemase production is a global public health threat. Antimicrobial resistance (AMR) data analysis is critical to public health policy. Here we analyzed carbapenemase detection trends using the AMR Brazilian Surveillance Network. Carbapenemase detection data from Brazilian hospitals included in the public laboratory information system dataset were evaluated. The detection rate (DR) was defined as carbapenemase detected by gene tested per isolate per year. The temporal trends were estimated using the Prais-Winsten regression model. The impact of COVID-19 on carbapenemase genes in Brazil was determined for the period 2015-2022. Detection pre- (October 2017 to March 2020) and post-pandemic onset (April 2020 to September 2022) was compared using the χ2 test. Analyses were performed with Stata 17.0 (StataCorp, College Station, TX). 83 282 blaKPC and 86 038 blaNDM were tested for all microorganisms. Enterobacterales DR for blaKPC and blaNDM was 68.6% (41 301/60 205) and 14.4% (8377/58 172), respectively. P. aeruginosa DR for blaNDM was 2.5% (313/12 528). An annual percent increase for blaNDM of 41.1% was observed, and a decrease for blaKPC of -4.0% in Enterobacterales, and an annual increase for blaNDM of 71.6% and for blaKPC of 22.2% in P. aeruginosa. From 2020 to 2022, overall increases of 65.2% for Enterobacterales, 77.7% for ABC, and 61.3% for P. aeruginosa were observed in the total isolates. This study shows the strengths of the AMR Brazilian Surveillance Network with robust data related to carbapenemases in Brazil and the impact of COVID-19 with a change in carbapenemase profiles with blaNDM rising over the years.

Initial evaluation of a multidisciplinary pediatric aerodigestive program in a Brazilian hospital: challenges and mitigation strategies

ObjectiveTo identify clinical and epidemiological characteristics of children evaluated by the pediatric aerodigestive program at the beginning of its activity, describe challenges in follow-up, and suggest mitigation strategies. MethodsA case series was conducted describing the first 25 patients discussed by the aerodigestive team from a Brazilian quaternary public university hospital between April 2019 and October 2020. The median follow-up was 37 months. ResultsDuring the study period 25 children were seen by the group and the median age at first assessment was 45.7 months old. Eight children had a primary airway abnormality, five had a tracheostomy. Nine children had genetic disorders and one had esophageal atresia. Dysphagia was present in 80% of the patients, 68% had a history of chronic or recurrent lung disease, 64% had a gastroenterological diagnosis and 56% had neurological impairment. Moderate to severe dysphagia was identified in 12 children and 7 of these had an exclusive oral diet at the time. The majority of children (72%) had 3 or more comorbidities. Following team discussion, a change in feeding strategy was suggested in 56% of the children. The most frequently ordered exam was pHmetry (44%) and gastrostomy was the surgical procedure with the longest waiting list. ConclusionsDysphagia was the most frequent issue encountered in this initial group of aerodigestive patients. Pediatricians caring for these children must be involved in aerodigestive team discussions and hospital policies must be revised to facilitate access to exams and procedures needed for this population.

Antibiotic dispensing during first year of COVID-19 pandemic in Brazilian public hospitals.

Aim: To evaluate the impact of the first year of the COVID-19 pandemic on antibiotic dispensation in three Brazilian hospitals. Methods: Stock movement was accessed frompharmacy databases and microbiological reports from 2018 to 2021. Results: Reduced antibiotic dispensation occurred during 2020 in all hospitals. The most significant reduction was in April at Hospital Doutor Jayme dos Santos Neves (∼58%), andin May at Hospital Doutor Roberto Arnizaut Silvares (∼66%)and Hospital Doutor Dório Silva (∼29%). However, azithromycin dispensation increased in all hospitals in 2020. Macrolide-resistant bacterial isolates rose from 66.6% in 2019 to 77.1% in 2020 and 88.3% in 2021. Conclusion: Despitereduced antibiotic dispensation, the increase in azithromycin consumption in 2020 highlights the urgency to monitor macrolide resistance after the pandemic and improve stewardship activities.

Cohort study of hospitalized patients with COVID-19 at Brazilian tertiary-care hospital: Occurrence of adverse events and mortality.

Patients hospitalized with COVID-19 are often submitted to invasive procedures and they are at risk for hospital-associated adverse events. To evaluate the epidemiological and clinical aspects of patients hospitalized with COVID-19; the occurrence of adverse events and the risk factors for mortality. Cohort study that included adult patients hospitalized with a diagnosis of SARSCoV-2 infection, at the tertiary University Hospital of UNICAMP from March 2020 to March 2021. Patients were identified through the hospital epidemiological surveillance system and followed until discharge or death. Descriptive, comparative, and logistic regression analysis was performed. 650 adult patients were included. The main adverse events identified were nosocomial infections (31.5%), renal failure (33.8%), thromboembolic and vascular events (12.6%). Mortality was higher among those with bloodstream infections (30.2% vs. 8.6%; p < 0.0001), ventilator-associated pneumonia (VAP, 52.5% vs. 12.3%; p < 0.0001), catheter associated urinary infection (27.3% vs. 7.2%; p < 0.0001); thromboembolic and vascular events (23.0% vs. 9.9%; p < 0.0001) and renal failure (81.3% vs. 20.9%; p < 0.0001). Klebsiella pneumoniae (15.6%), Pseudomonas aeruginosa (14.4%), Enterococcus faecalis (8.6%) were the most isolated bacteria. Logistic regression analysis identified age, (RR=1.03; 95% CI 1.02 to 1.05); ICU admission (RR=3.06; 95% CI 1.59 to 5.87), vasoactive drug use (RR=3.1; 95% CI 1.79 to 4.82); renal failure (RR=7.76; 95% CI 4.54 to 13.26); and VAP (RR=2.2; 95% CI 1.23 to 3.96), independently associated with mortality. adverse events have an important impact on the evolution of patients with COVID-19, reinforcing the need for optimized prevention and control measures as an essential part of care for these patients.

Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil.

To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus. A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression. Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705). Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.

#5292 BRAZILIAN SURVEY ON THE MANAGEMENT OF ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPIES

Abstract Background and Aims Acute kidney injury (AKI) diagnosis, management, the optimal prescription and delivery of renal replacement therapy (RRT) standards for best practice are lacking. The aim of this study was to explore the clinical approach to AKI and RRT in a broad population of Brazilian nephrologists. Method A cross-sectional survey was distributed to all nephrologists from multiple centres of a Brazilian private hospital group. The responses of the participants on several aspects of AKI management and renal replacement therapy were analysed and detailed. Results 97 (66%) nephrologists from 8 Brazilian states responded. 45% referred KDIGO 2 as the stage usually present at time of nephrologist consultation, and mean time for nephrology consultation after AKI diagnosis was 24-48h for 51% of answers. 85% reported creatinine as the only biomarker available for diagnosis, and only 24% reported any AKI alert system. Sepsis was reported as the most frequent etiology by 95%; kidney biopsy indication was considered in less than 10% of the evaluations by 94%. Fluid status assessment is described in Figure 1. The most common criteria for starting RRT was fluid overload (30%) followed by urine output reduction (26%), hyperkalemia (14%) and acidosis (17%). 62% of them usually use furosemide stress test before RRT indication. Seventy-seven percent of participants said that never use peritoneal dialysis in AKI patients, although its available for 44% of responders. Hypotension was the most frequent RRT complication for 91% responders, followed by coagulation of the system for 42% and catheter dysfunction for 33%. CRRT was available for 92% of participants and for 88% this is the RRT for patients using vasoactive drugs. 77% usually use regional anticoagulation with citrate. The most common starting dose is 26 to 30ml/Kg/h and the net ultrafiltration rate is 1,01-1,75 ml/Kg/h. There is no weaning protocol of RRT for 81%, but 90% use the urine output as a weaning tool. Thirty- nine percent said that RRT patients’ mortality stayed between 20 to 50%, and 36% had no information about mortality. Conclusion In our survey, Nephrology consultation occurred after 24h and at KDIGO 2 stage. Early recognition of AKI is impeded by the use of serum creatinine as the only biomarker and the unavailability of AKI alerts. Fluid overload is the main reason for indicating RRT and nephrologists have expanded the use of non-invasive fluid status assessment methods others than physical examination. CRRT is the method of choice for unstable patients in this sample from private medical facilities, where almost all responders have access to CRRT. Effluent doses and net ultrafiltration rate were in accordance with the established in literature. Optimal timing for discontinuing RRT is still defined according to the physician's discretion. Standardization of AKI management and continuing education seem to be a fundamental aspect to anticipate the diagnosis, improve the therapeutic approach and bring better results for AKI patients.

QUALITY OF LIFE OUTCOMES AFTER SURGICAL TREATMENT FOR MANDIBULAR AMELOBLASTOMAS

Objective To evaluate Quality of Life (QoL) scores in patients who underwent surgical treatment of mandibular ameloblastomas without secondary reconstructive surgery. Study Design This is a single-center cross-sectional study conducted at a tertiary care Brazilian hospital. QoL was assessed using University of Washington Quality of Life Questionnaire for patients with Head and Neck Cancer (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaire. Mann-Whitney and independent t-test were used to assess the association of QoL scores with predictive variables. Results Twenty individuals were enrolled, most of whom were male (70%), with a mean age of 29.55±13.28 years. Ten individuals (50%) underwent at least one radical surgical resection. Most of the participants reported an impairment in 'Appearance', 'Chewing', 'Speech' and 'Anxiety' domains of UW-QOL. Mean OHIP-14 score was 4.75±3.36. Worst OHIP-14 scores were associated with anterior tooth loss due to the tumor (p = 0.013). The overall and health-related QoL was rated as 'Good' in 65% and 45% of the cases, respectively. Conclusion Surgical treatment for mandibular ameloblastomas has a significative functional and esthetic impairment in patients' QoL. However, surgical modality and tumor recurrence did not seem to affect QoL. Only anterior tooth loss was a significant predictive factor of worst QoL scores. To evaluate Quality of Life (QoL) scores in patients who underwent surgical treatment of mandibular ameloblastomas without secondary reconstructive surgery. This is a single-center cross-sectional study conducted at a tertiary care Brazilian hospital. QoL was assessed using University of Washington Quality of Life Questionnaire for patients with Head and Neck Cancer (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaire. Mann-Whitney and independent t-test were used to assess the association of QoL scores with predictive variables. Twenty individuals were enrolled, most of whom were male (70%), with a mean age of 29.55±13.28 years. Ten individuals (50%) underwent at least one radical surgical resection. Most of the participants reported an impairment in 'Appearance', 'Chewing', 'Speech' and 'Anxiety' domains of UW-QOL. Mean OHIP-14 score was 4.75±3.36. Worst OHIP-14 scores were associated with anterior tooth loss due to the tumor (p = 0.013). The overall and health-related QoL was rated as 'Good' in 65% and 45% of the cases, respectively. Surgical treatment for mandibular ameloblastomas has a significative functional and esthetic impairment in patients' QoL. However, surgical modality and tumor recurrence did not seem to affect QoL. Only anterior tooth loss was a significant predictive factor of worst QoL scores.

CLINICAL MANIFESTATIONS OF HEAD AND NECK CANCER IN PEDIATRIC PATIENTS

Objective Clinical manifestations of pediatric head and neck cancer (PHNC) are often unspecific and may lead to delayed diagnosis. This study aimed to describe clinical findings of PHNC diagnosed in a single Brazilian hospital Study Design Clinicopathological data, signs and symptoms, and patterns of misdiagnosis were collected from medical records over a 30-year period. All PHNC cases affecting patients aged 19-years and under were interpreted by statistical and descriptive analysis. Results Of the 253 PHNC cases included, 154 (60.9%) affected male patients and the mean age was 9.3 years. Burkitt lymphoma (23.7%), nasopharyngeal carcinoma (15.8%), and rhabdomyosarcoma (15.4%) were the most common histopathological types. Anatomical sites, such as nasopharynx (28.9%), cervical/lymph node region (25.3%), and craniofacial bones (8.3%) were predominant. Significant associations between tumor histology and variables, such as sex (p=0.022), age (p<0.0001), anatomical location (p<0.0001), tumor/swelling (p=0.034), pain (p=0.031), systemic/general manifestations (p=0.004), nasal/breathing alterations (p=0.012), and orbital/ocular alterations (p<0.0001), were observed. Misdiagnosis, such as tonsillitis, otitis, and abscess were frequent. Conclusion Due to the lack of specific clinical findings in PHNC, the suspicion of malignancy should be considered when the main signs and symptoms reported appear and persist in order to conduct a timely diagnosis. Clinical manifestations of pediatric head and neck cancer (PHNC) are often unspecific and may lead to delayed diagnosis. This study aimed to describe clinical findings of PHNC diagnosed in a single Brazilian hospital Clinicopathological data, signs and symptoms, and patterns of misdiagnosis were collected from medical records over a 30-year period. All PHNC cases affecting patients aged 19-years and under were interpreted by statistical and descriptive analysis. Of the 253 PHNC cases included, 154 (60.9%) affected male patients and the mean age was 9.3 years. Burkitt lymphoma (23.7%), nasopharyngeal carcinoma (15.8%), and rhabdomyosarcoma (15.4%) were the most common histopathological types. Anatomical sites, such as nasopharynx (28.9%), cervical/lymph node region (25.3%), and craniofacial bones (8.3%) were predominant. Significant associations between tumor histology and variables, such as sex (p=0.022), age (p<0.0001), anatomical location (p<0.0001), tumor/swelling (p=0.034), pain (p=0.031), systemic/general manifestations (p=0.004), nasal/breathing alterations (p=0.012), and orbital/ocular alterations (p<0.0001), were observed. Misdiagnosis, such as tonsillitis, otitis, and abscess were frequent. Due to the lack of specific clinical findings in PHNC, the suspicion of malignancy should be considered when the main signs and symptoms reported appear and persist in order to conduct a timely diagnosis.

Characterization of consumption and costs of antimicrobials in intensive care units in a Brazilian tertiary hospital

BackgroundThe consumption of antimicrobials and the growing resistance of infectious agents to these drugs are not related only to health issues, but also to economic parameters. ObjectivesThe study objective was to evaluate the consumption of antimicrobials in General and Covid-19 Intensive Care Units (ICUs) and the impact on institutional costs in the largest institute of a tertiary public hospital. MethodsThis is a quantitative and retrospective study, which analyzed consumption, through the Defined Daily Dose (DDD), and the annual direct cost of antimicrobials in Reais (R$) and Dollars (US$), from January to December 2021. ResultsThe total annual consumption (DDD/1000 patient-day) of antimicrobials in the ICUs was 14,368.85. β-Lactams had the highest total annual value, with a DDD/1000 patient-day of 7062.98, being meropenem the antimicrobial that reached the highest consumption (3107.20), followed by vancomycin (2322.6). Total consumption was higher in Covid-19 ICUs than in General ICUs, and the annual direct cost of antimicrobials in ICUs was US$560,680.79. ConclusionsThe study showed high consumption of broad-spectrum antimicrobials, highlighting the importance of structuring programs to manage the use of antimicrobials, both to reduce antimicrobial consumption and hospital costs, consolidating rational use even in pandemic scenarios.

Perinatal Health in Amazon Triple Border Region: Cross-Sectional Analysis Comparing Outcomes in the Brazilian, Peruvian and Colombian Population.

To investigate the perinatal outcomes in Brazilian, Peruvian, and Colombian women in a Brazilian reference maternity hospital based at Amazon triple border region. A cross-sectional case study of data from 3242 live birth certificates issued at the Tabatinga public maternity hospital, in the countryside of Amazonas, in the period between January 2015 and December 2017. Maternal and perinatal independent variables were analysed based on central tendency and variability, and frequency distribution for categorical variables. The Pearson's Chi-Square test and univariate analyses were performed to estimate probability ratios (Odds Ratio-OR). Significant differences were found in the education level in the three population groups, as well as in the number of previous pregnancies, antenatal consultations, month of initial prenatal care, and type of delivery. Brazilian pregnant women had more prenatal consultations, caesarean sections, and premature births. Peruvian and Colombian women started antenatal care later, and those with high-risk pregnancies tended to deliver in their home country. Our findings show some singularities in the care of women and infants in the Amazonian triple border region. The Brazilian Unified Health Care System performs an important role in the guarantee of free access to health services, and ensures comprehensive care for women and infants, promoting human rights in border regions regardless of nationality.

Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.

The assessment of health-related quality of life (QoL) has improved the treatment of gastric cancer. Aiming to compare the influence of skilled surgeons in general hospitals versus specialized hospitals in cancer in Brazil, this study evaluated the relationship between quality of life and types of hospitals (general or cancer) in treating patients with gastric adenocarcinoma operated by surgeons with specific training in Surgical Oncology. This was a cross-sectional study involving 104 patients. Inferential analyses were used to compare two Brazilian general hospitals and a cancer center, evaluating scores of the SF-36 and FACT-Ga QoL questionnaires (Kruskal-Wallis test, Mann-Whitney test); gender, smoking, and Helicobacter pylori tests status (Pearson's Chi-Square test); ethnicity, alcoholism, location of the tumor in the stomach, Lauren's histological types, and type of surgery (Fisher's exact test), number of lymph nodes resected by Surgical Oncologists [Analysis of Variance (ANOVA) with a Fixed Factor], and comparative survival analysis (Log-Rank test). Patients treated at a cancer hospital had higher scores of the FACT-Ga (FACT-G total score, P=0.023; physical well-being, PWB, P=0.006; and functional well-being, FWB, P=0.011). The mean scores of the SF-36 questionnaire showed similar behavior but without reaching a significant difference. Patients operated by Surgical Oncologists at the cancer hospital had better scores in emotional well-being FACT-Ga domain (EWB, P=0.034 and P=0.047) compared to those operated by Surgical Oncologists in general hospitals. There was no significant difference in survival among the three hospitals (P=0.214). In this study, it was possible to suggest the relationship between QoL assessment scores with the centralization of care at specialized cancer hospital in the treatment of patients with gastric adenocarcinoma undergoing surgery with curative intent in Brazil.

Exploring Depressive and Anxiety Symptoms Among Employees from a General Hospital in Need of Mental Health Treatment: A Cross-sectional Study

ObjectiveThis study aimed to investigate the association between occupation and depressive/anxiety symptoms, and education levels, among professionals from a Brazilian General Hospital in need of mental health treatment. Design and settingThis is a cross-sectional study, involving professionals from a teaching hospital in São Paulo. MethodsSocio-demographic data were collected as well as two standardized scales for depression and anxiety symptoms. ResultsData from 506 employees seeking mental health assistance have been described: mean age was 34.6 years, 46.2% of them worked in the administrative sector, 35.0% were nursing assistants, 7.5% were nursing technicians, 6.7% were nurses, and 4.5% reported other occupations. According to the International Classification of Diseases-10th edition (ICD-10) criteria, the rates of diagnosis of depressive disorders and anxiety disorders were 60.9% and 37%, respectively. Nursing technicians and nursing assistants reported higher somatic cluster Beck Depression Inventory (BDI) scores (P=0.012) than other professionals of technical staff, but they were less inclined to receive a psychiatric diagnosis. ConclusionsOur study demonstrated prevalence rates higher than similar studies in university hospitals, fact that associated with difficulties of the studied population as seeing themselves as sick, and the social discrimination suffered by people with mental disorders can make this problem even worse.

Measures to Contain the Transmission of Hepatitis C in a Chronic Kidney Care Hospital Unit in the Triângulo Mineiro in Brazil: A Case Study.

Objectives: Hepatitis C virus elimination is complex. The objective was to analyze measures to eliminate virus transmission in a hemodialysis unit. Methods: Case study composed of multiple units of analysis. The scenario is the hemodialysis unit of a Brazilian public hospital. Population composed of health service records. Descriptive analyzes were performed and the beginning of the event was considered as the moment of increased incidence of HCV. The intentional and purposeful collection of information for understanding the event and implementing interventions. Results: The subunits of analysis were related to: clinical-epidemiological profile, active search, transmission routes, management protocol and results achieved. In August 2019, out of 45 patients, six were reactive for anti-HCV. All received treatment. Patients had exposure to contaminated medical equipment, objects or hands of professionals. Preventive measures were adopted and routine techniques were corrected. Situational Analysis Committee guided the management of the event. No new cases were detected. Conclusions: Strategies for the microelimination of the C virus in a dialysis environment are demonstrated and it shows the multidisciplinary efforts in conducting the event.

Significant increased bacterial contamination with endoscope overnight and weekend storage times.

Forced-air drying (FAD) cabinets are recommended for storage of reprocessed endoscopes, but financial constraints prevent their universal application. The study aimed to determine bacterial contamination in flexible gastroscopes (FG) channels after storage, in a cabinet with filtered air and UV lights, but without FAD. Eight FG in clinical use in an endoscopy service of a large Brazilian hospital were sampled: immediately "Time zero" (N=50), 12h "Time 1" (N=25), and 60h "Time 2" (N=25) after reprocessing. Following a flush-brush-flush of channels, 40-mL sterile water and 3cm of the brush were collected. Each sample was divided, filtered onto two 0.22-μm membranes, and incubated in media without or with disinfectant neutralizer. Automated method was used for identification and antibiotic resistance test of isolated bacteria. Bacterial contamination in times "1" and "2" was 5.9 and 16.1 times greater than that of "Time zero," respectively. Number of positive cultures in media with and without neutralizer was similar at times "1" and "2," while media with neutralizer produced more positive cultures at "Time zero." Most bacteria isolated at "Time 2" were Gram-negative rods (52.3%) and showed resistance to one or more antibiotics (65%). Bacterial contamination was detected on reprocessed FG stored in non-FAD cabinets overnight (12h) and increased with longer storage time (60h). The contamination source is likely to be bacteria in biofilm which multiply in the absence of FAD. Evidence-based criteria should be available for storage time according to the cabinet available.

Radioiodine therapy during the COVID-19 pandemic in a public reference hospital in Brazil: an experience report.

COVID-2019 has resulted in an emerging respiratory infection that has spread as a pandemic since January 2020. Nuclear Medicine Services and its workers experienced a dramatic change in their clinical routine. They were required to adjust protocols for this new health condition. Regarding radioiodine therapy (RIT), initial orientations were to postpone treatments. In Brazil, National Nuclear Energy Commission prepared guidelines. It authorized RIT to employ activities over 1850MBq in an outpatient setting on an exceptional basis. This study reports the RIT experience of a Brazilian hospital during the COVID-19 pandemic, intending to evaluate the applicability of outpatient treatment employing over 1850MBq of I-131 on a large scale. During referred period, 106 patients at our service had an indication for RIT, of which 58 agreed to participate in the research and provided informed consent. Majority of patients did not meet the minimum requirements for outpatient treatment using doses>1850MBq.

High prevalence of mental disorder symptoms among medical and other health specialties residents during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic put healthcare professionals, including residents (postgraduate trainees of health professions), under intense physical and psychological stress, hence at risk for mental disorders. We evaluated the prevalence of mental disorders among healthcare residents during the pandemic.MethodsFrom July to September 2020, residents in medicine and other healthcare specialties in Brazil were recruited. The participants completed electronic forms with validated questionnaires (DASS-21, PHQ-9, BRCS) to screen for depression, anxiety, and stress, and to evaluate resilience. Data on potential predisposing factors for mental disorders were also collected. Descriptive statistics, chi-squared, students t, correlation and logistic regression models were applied. The study received ethical approval, and all participants provided informed consent.ResultsWe included 1313 participants (51.3% medical; 48.7% nonmedical) from 135 Brazilian hospitals; mean (SD) age: 27.8 (4.4) years; 78.2% females; 59.3% white race. Of all participants, 51.3%, 53.4% and 52.6% presented symptoms consistent with depression, anxiety, and stress, respectively; 61.9% showed low resilience. Nonmedical residents exhibited higher anxiety compared to medical residents (DASS-21 anxiety score, mean difference: 2.26; 95% CI: 1.15–3.37; p < 0.001). In multivariate analyses, having any pre-existent, nonpsychiatric chronic disease was associated with higher prevalence of symptoms indicative of depression (odds ratio, OR: 2.05; 95% CI: 1.47–2.85, on DASS-21 | OR: 2.26; 95% CI: 1.59–3.20, on PHQ-9), anxiety (OR: 2.07; 95% CI: 1.51–2.83, on DASS-21), and stress (OR: 1.53; 95% CI: 1.12–2.09, on DASS-21); other predisposing factors were identified; by contrast, high resilience (BRCS score) was protective against symptoms of depression (OR 0.82; 95% CI: 0.79–0.85, on DASS-21 | OR 0.85; 95% CI: 0.82–0.88, on PHQ-9), anxiety (OR 0.90; 95% CI: 0.87–0.93, on DASS-21), and stress (OR 0.88; 95% CI: 0.85–0.91, on DASS-21); p < 0.05 for all outcomes.ConclusionsWe found a high prevalence of mental disorder symptoms among healthcare residents during COVID-19 pandemic in Brazil. Nonmedical residents exhibited higher levels of anxiety than medical ones. Some predisposing factors for depression, anxiety and stress among residents were identified.