Brazilian Hospital Research Articles

Whole genome sequencing of the multidrug-resistant Chryseobacterium indologenes isolated from a patient in Brazil.

Chryseobacterium indologenes is a non-glucose-fermenting Gram-negative bacillus. This emerging multidrug resistant opportunistic nosocomial pathogen can cause severe infections in neonates and immunocompromised patients. This study aimed to present the first detailed draft genome sequence of a multidrug-resistant C. indologenes strain isolated from the cerebrospinal fluid of an infant hospitalized at the Neonatal Intensive Care Unit of Brazilian Tertiary Hospital. We first analyzed the susceptibility of C. indologenes strain to different antibiotics using the VITEK 2 system. The strain demonstrated an outstanding resistance to all the antibiotic classes tested, including β-lactams, aminoglycosides, glycylcycline, and polymyxin. Next, C. indologenes was whole-genome-sequenced, annotated using Prokka and Rapid Annotation using Subsystems Technology (RAST), and screened for orthologous groups (EggNOG), gene ontology (GO), resistance genes, virulence genes, and mobile genetic elements using different software tools. The draft genome contained one circular chromosome of 4,836,765 bp with 37.32% GC content. The genomic features of the chromosome present numerous genes related to cellular processes that are essential to bacteria. The MDR C. indologenes revealed the presence of genes that corresponded to the resistance phenotypes, including genes to β-lactamases (blaIND–13, blaCIA–3, blaTEM–116, blaOXA–209, blaVEB–15), quinolone (mcbG), tigecycline (tet(X6)), and genes encoding efflux pumps which confer resistance to aminoglycosides (RanA/RanB), and colistin (HlyD/TolC). Amino acid substitutions related to quinolone resistance were observed in GyrA (S83Y) and GyrB (L425I and K473R). A mutation that may play a role in the development of colistin resistance was detected in lpxA (G68D). Chryseobacterium indologenes isolate harbored 19 virulence factors, most of which were involved in infection pathways. We identified 13 Genomic Islands (GIs) and some elements associated with one integrative and conjugative element (ICEs). Other elements linked to mobile genetic elements (MGEs), such as insertion sequence (ISEIsp1), transposon (Tn5393), and integron (In31), were also present in the C. indologenes genome. Although plasmids were not detected, a ColRNAI replicon type and the most resistance genes detected in singletons were identified in unaligned scaffolds. We provided a wide range of information toward the understanding of the genomic diversity of C. indologenes, which can contribute to controlling the evolution and dissemination of this pathogen in healthcare settings.

Educational intervention through a comic book for preoperative anxiety in children, adolescents, and their parents: A randomized clinical trial

BackgroundReducing preoperative anxiety can help optimize surgical care. AimTo analyze the effectiveness of verbal guidance by nurses versus verbal guidance combined with a comic book on preoperative anxiety in children and their parents. MethodsWe conducted a randomized parallel, two-group controlled clinical trial in the pediatric ward and a blinded anxiety assessment in the operating room of a Brazilian hospital. Individuals aged 6–14 years undergoing surgical procedures of up to 4 h for the first time were included in the study. Parents who were adults, literate, and able to communicate verbally were included. The primary outcome was the children's anxiety, measured by the Children Anxiety Questionnaire (CAQ), Visual Analog Scale (VAS), and the modified Yale Preoperative Anxiety Scale (mYPAS); the secondary outcome was the parents' anxiety, assessed by the Hamilton Anxiety Rating Scale. Participants were divided into the intervention (IG; n = 60) and control (CG; n = 60) groups. FindingsThe two groups were homogeneous. The median age of the children was 8 years. No significant differences were observed in the CAQ and VAS scores between the two assessment time points or in the mYPAS scores between the IG and CG. However, parents' anxiety significantly decreased in both groups. Application to practicePreoperative guidance by nurses, either verbal only or verbal information with a comic book proved beneficial in reducing parental anxiety. However, both interventions, performed on the day of surgery, failed to reduce preoperative anxiety in children and adolescents upon admission to the operating room. We recommended the process of preparing the child should begin after scheduling the surgery.

Socio-demographic profiles and obstetrics outcomes of pregnant women with epilepsy in a vulnerability State, Brazil.

IntroductionThe socio-demographic profile of pregnant women in low- and middle- income countries is characterized by low educational attainment and unemployment, leading to social and economic morbidity. characterized by limited opportunities for education, employment, and marriage, which are strongly related to the stigmatization of the disease. The study of the socio- profile and obstetric outcomes of pregnant women with epilepsy in Alagoas, Brazil, may help understand this scenario and facilitate the development of public policy strategies to reduce local morbidity.ObjectivesWe aimed to describe the sociodemographic profile of pregnant women with epilepsy and obstetric outcomes in Alagoas, Brazil.MethodsThis cohort study was based on medical records of pregnant women with epilepsy in Brazilian high-risk maternity hospitals from 2008 to 2020. The following data were collected: age, race, education, marital status, occupation, number of pregnancies, delivery, and abortion. The inclusion criteria were pregnant women with and without epilepsy (control group) aged < 40 years.ResultsThe prevalence of PWWE was 0.49% (n = 224/44,917). Cesarean delivery was more frequent in PWWE than in pregnant women without epilepsy (adjusted odds ratio [OR] = 22.0; 95% confidence interval [CI] = 14.35–33.73; p<0,01). Abortion was associated with PWWE (OR adjusted = 1.72; 95% CI = 1.13–2.61; p = 0.01). Pregnant women in the countryside were more likely to develop epilepsy than those born in the capital (OR = 1.55; 95% CI = 1.12–2.14; p <0.01).ConclusionThe PWWE socio-demographic profile of the Alagoas had a predominance of brown- colored skin, single status, homemakers, and illiteracy with a high proportion residing in the interior of the state. The obstetrics data show a higher incidence of cesarean deliveries and miscarriages.

Anaphylaxis in Brazil between 2011 and 2019.

BackgroundThere is a lack of population‐based studies of anaphylaxis from low‐ and middle‐income countries. This hampers public health planning and investments and may influence availability of adrenaline auto‐injectors.ObjectiveWe conducted the first national population‐based study of anaphylaxis hospitalization in Brazil.MethodsDescriptive study using routinely reported data to the Brazilian Hospital Information System for the years 2011–2019. Information available is coded based on the International Classification of Diseases (ICD)‐10 and covers main cause of hospitalization (primary cause) and any conditions contributing to it (secondary cause).ResultsOver 9 years, we identified 5716 admissions due to anaphylaxis for all causes. The average hospitalization rate related to anaphylaxis was 0.71/100,000 population per year, with a 2.4% (95% CI 1.9%, 2.9%) increase per annum over the study period. Admissions were more frequent among females (52.8%), except for cases due to insect sting. Most admissions occurred in adulthood, from 30 to 59 years (36.3%) but 13.8% in preschool children (0–4 years). There were more young children admitted for food‐related anaphylaxis, and more adults admitted for drug/iatrogenic‐related anaphylaxis. There were 334 cases (5.8% of admissions) of fatal anaphylaxis over the study period, with increased case fatality rate over time.Conclusions and Clinical RelevanceThis is the first study of anaphylaxis hospital admissions using nation‐wide data from a low‐ or middle‐income country. Hospital admissions and fatalities from anaphylaxis in Brazil appear to be increasing.

Domestic violence: A cross-sectional study among pregnant and postpartum women.

To assess the prevalence of domestic violence/intimate partner violence, aggressors, types of violence and associated factors in women who attend an antenatal and postnatal care service in a public hospital in Brazil. Cross-sectional study. We interviewed women attending antenatal and postpartum care services in a Brazilian public tertiary woman's hospital in Campinas, São Paulo, between July 2019 and September 2021. Data were collected through interviewer-administered questionnaires previously used in healthcare settings: Abuse Assessment Screen (AAS); Woman Abuse Screening Tool (WAST); Hurt, Insulted, Threatened with Harm and Screamed (HITS). We evaluated the relationship between the sociodemographic characteristics of women and domestic/intimate violence using bivariate and multivariable logistic regression analyses. Of the 600 pregnant and postpartum women interviewed, 138 (23%) had suffered any abuse. Some participants disclosed physical violence during pregnancy (2.3%) and during the last 12 months (5.3%). The partner was identified as the main aggressor in most of the cases (60%). When women had a partner, 3.5% reported domestic violence and 6.7% disclosed intimate partner violence during pregnancy or postpartum period. Women with non-white skin colour (OR=1.53; 95% CI 1.01-2.34; p=.048), gestational age ≤ 13 weeks (OR=3.41; 95% CI 1.03-11.25; p=.044) and in postpartum period (OR=2.81; 95% CI 1.32-5.99; p=.008) were more likely to experience domestic violence at some time in their lives. Women interviewed before the COVID-19 pandemic were more likely to disclose that they had suffered any abuse. Experience of violence during pregnancy and postpartum period was more frequent in women with non-white skin colour, in their first gestational trimester and in the postpartum period, and was more reported before the COVID-19 pandemic. Antenatal and postpartum care services could be safe places to support violence survivors. Pregnant and postpartum women are a vulnerable group to experiencing domestic violence/intimate partner violence. Violence can negatively affect women's and children's health and well-being. Antenatal and postpartum care should be considered as a moment to routinely inquiry women about past and current violence experiences. Regular contact among healthcare professionals and women during this period offers a window of opportunities for implementing psychosocial interventions among women at risk of violence. Healthcare providers (i.e., physicians, psychologists, social workers, nurses and midwives) have an important role in identifying survivors, offering support and providing quality information to women.

Shift work schedule and damage to nursing workers' health at Brazilian public hospital.

to compare work-related damage between the day and night shifts of nursing workers in at a public hospital. a cross-sectional, and correlational study, conducted with 308 nursing workers from a Brazilian public hospital. Data collection took place from September 2017 to April 2018 using self-administered questionnaires that investigated socio-occupational variables and the effects of work (Work-Related Damage Assessment Scale). Analysis was descriptive and analytical with a 5% significance level. during the day shift, the variables that most influenced nursing professionals' health were body pain, headache, back pain, legs pain, and sleep disorders. When comparing the shifts, it was identified that daytime influences the studied variables more than nighttime. Job tenure was correlated with psychological damage. the results showed a greater influence of the day shift on the health of professionals who work in a hospital environment. Job tenure influences psychological damage.

Environmental management of the disposal of waste from orthopedic metallic explants in hospitals

Metal explants from orthopedic surgical therapy are classified as solid waste with a potential risk for contamination. Objective: To analyze the literature on how environmental management occurs in hospitals through the disposal of waste from orthopedic metallic explants. Methodology: This research was an applied, practical, quantitative, experimental, exploratory, empirical, and cross-sectional study with the investigative objective of confirming the hypotheses. The research was carried out in all Brazilian States, in public and private hospitals considered as references for the treatment of orthopedics and traumatology. Three distinct groups were compared: Brazilian hospitals certified by ISO 14 001; hospitals with ONA accreditation with a level of excellence; and non-certified hospitals, using the inductive method. Main findings: The explants must be registered and controlled in order to be recycled, which is a step included in the health waste management plan (PGRSS). However, their final destination is a large-scale problem due to obstacles in law application created by economic issues. When it comes to the recycling of surgical explants, stainless steel can be completely reused, for instance. Main conclusions: In Brazil, there are limited data regarding the number of generators or the amount of waste produced from health services, and, additionally, explants are improperly discarded as sharps waste.

HLA-DRB1 and cytokine polymorphisms in Brazilian patients with myelodysplastic syndromes and its association with red blood cell alloimmunization.

This study aimed investigate association of HLA-DRB1 and cytokine polymorphisms with red blood cell(RBC) alloimmunization in Brazilian Myelodysplastic syndrome(MDS) patients with prior exposure to RBC transfusion. MDS patients are at risk RBC alloimmunization due to chronic RBC transfusion. However, differences in immune response of MDS transfused patients are not completely known. A retrospective cohort of 87 polytransfused patients with MDS including 28 alloimmunized (PA) and 59 non-alloimmunized (PNA) was evaluated in three Brazilian reference hospitals. HLA-DRB1genotype was performed by polymerase chain reaction (PCR)-SSOP (Luminex platform) and cytokine polymorphisms analysed by PCR and TaqMan assays. While HLA-DRB1 allele frequencies did not differ between groups, IL17A 197G > A SNP and IL4 polymorphisms showed significant correlation with RBC alloimmunization. IL17A 197A allele A and AA genotype were significantly more frequent in PA than PNA(A, 46.4% versus 27.1%, p= 0.012; OR=2.3; 95%CI=1.1-4.9; AA, 25% versus 6.8%, p= 0.041; OR=6.2; 95%CI 1.3-30.8). Moreover, significant association of alloimmunization to Rh antigens with IL17A 197A allele and AA genotype was also identified in PA group(A, 45% versus 27.1%, p= 0.036; OR=2.5; 95% CI 1.1-5.7; AA, 30% versus 6.8%, p= 0.042; OR=7.9; 95%CI 1.5-42.3). Genotype A1A2 of IL4 intron 3 was overrepresented in PA(50% versus 16.9%, p= 0.009; OR=4.97; 95%CI 1.6-15.5). Similarly, IL4-590 CT genotype was overrepresented in PA(53.6% versus 28.8%, p= 0.049; OR=3.3; 95%CI 1.2-9.3). This study showed no association regarding HLA-DRB1 alleles for RBC alloimmunization risk or protection, however the IL17A 197G>A, IL4 intron 3 and IL4 590C>T SNP was significantly associated to RBC alloimmunization risk in this cohort of Brazilian MDS patients.

Drug-induced liver injury causality assessment data from a crosssectional study in Brazil: a call for the use of updated RUCAM in hospital Pharmacy

Objective: to identify the frequency of DILI inpatients from abnormal liver enzyme levels using the updated Roussel Uclaf Causality Assessment Method (RUCAM) causality assessment algorithm, as well as to provide a descriptive analysis of DILI cases. Methods: we conducted a crosssectional study in a medium complexity hospital in southern Brazil. Data regarding DILI was collected retrospectively from electronic medical records (EMR) in 2015. Inclusion criteria were all adult patients (≥ 18 years old) who presented alanine aminotransferase (ALT) greater than twice the superior limit of normality (ALT &gt; 60 UI/L) with concomitant change of aspartate aminotransferase (AST) or alkaline phosphatase (ALP) or change of ALP greater than twice the superior limit of normality (ALP &gt; 250 UI/L) during hospitalization. The RUCAM was applied to all suspected DILI cases. Results: 84,134 inpatients in this period; 178 patients had abnormal liver tests, six patients had sufficient medical information to allow DILI causality assessment, and two patients had DILI described in EMR, although our group could not find suficient information to apply RUCAM retrospectively. Absence of information was mainly related to drug reconciliation at hospital admission, time of onset of suspected drug therapy and no description of previous clinical conditions in EMR. Four patients developed hepatic injury as a result of drug treatment initiated during hospitalization. Suspected drugs were antibiotics, nonsteroidal anti-inflammatory drugs, antiviral, tuberculostatics and platelet antiaggregant. Liver injury pattern was identified as hepatocellular and mixed. Conclusion: DILI appeared as a rare ADR, but absence of data in most EMR affected the application of RUCAM and underestimated DILI frequency. There is an urgency to develop DILI knowledge in Brazilian hospitals. Pharmacists must be aware of the use of the updated RUCAM to prospectively assess possible DILI cases. For future research, we suggest to combine cross-linking DILI tracers such as ICD-10 liver injury codes, abnormal liver biomarkers, search for trigger hepatotoxicity drugs and EMR text search tools, adding artificial intelligence to pharmacovigilance and hospital pharmacy.

A fuzzy multicriteria group decision approach for classification of failure modes in a hospital’s operating room

The operating room (OR) is one of the most important departments of any hospital. Mismanagement can lead to severe problems with patient’s safety and satisfaction, costs, and profitability. The Failure Mode and Effects Analysis (FMEA) is a risk assessment tool used to identify potential failure modes (FM) which should be prioritized to be mitigated. To assess the risks of an OR, some important aspects cannot be neglected: it should be conducted by a team of experts from different functional areas; address the non-compensation between criteria; classify FM, instead of ranking it, since it is easier to understand and support decision making; address the subjectivity present on experts’ opinion; and consider the mitigation complexity, since hospital’s resources are limited. However, were not found studies in the literature which simultaneously covered all these aspects. Therefore, this paper proposes a new group decision model, which combines a consensus reaching process with ELECTRE TRI and double hierarchy hesitant fuzzy linguistic term sets (DHHFLTS). A pilot application of the model was conducted in an OR of a Brazilian hospital. The results have shown that the consensus technique, the mitigation complexity, and the non-compensation can modify the failure modes classification. Also, the DHHFLTS allowed the experts to use more complex linguistic terms to express their opinion. In addition, the pilot application was carried out during the covid-19 pandemic and the results have shown that due to the high number of elective surgeries being rescheduled to give space to urgent surgeries, the patients' health problems become even worst and they turn to urgent surgeries.

Dermatoscopic features of 67 excised melanocytic lesions in patients at high risk of cutaneous malignant melanoma in a Brazilian hospital

Dermatoscopic features of 67 excised melanocytic lesions in patients at high risk of cutaneous malignant melanoma in a Brazilian hospital

Prognostic value of handgrip strength and functional indicators in elderly patients in a southern brazilian hospital

Background: the handgrip strength (HGS) is an important functional indicator in the elderly. The aim of this work was to evaluate the prognostic value of HGS, sociodemographic and functional indicators in elderly patients in a hospital in southern Brazil. Methods: prospective cohort observational study in individuals aged 60 years or older who were admitted to the clinical sectors in a tertiary Hospital of a southern Brazil. Results: a total of 218 participants were evaluated, of which 55% were men, with median age (p25-p75) of 72 years (65.7-78.0). The most prevalent hospitalization diagnoses were respiratory (19.7%) and vascular (19.3%) disorders. The median values (p25-p75) of HGS for men and women were, respectively, 50.00 (25.0-65.0) and 30.0 (20.0-40.0) kgf. As to the outcome, 44 (20.2%) individuals eventually died. The study showed that there was higher chance of mortality in aged patients (OR = 1.063; CI 95% 1.021-1.108) with higher Charlson Comorbidity Index scores (OR = 1.293; CI 95% 1.149-1.256), Glasgow Coma Scale Index scores &lt;15 (OR = 15.656; CI 95% 7.161-34.228), Katz Index scores &lt;6 (OR = 15.617; CI 95% 6.496-37.545), laboratory tests indicating leukocytosis (OR = 4.118; CI 95% 1.984-8.546) and anemia (OR = 3.104; CI 95% 1.307-7.369), lower HGS values (Men: OR = 0.901; CI 95% 0.862-0.941; Women: OR = 0.926; CI 95% 0.896-0.956), and longer length of stay in hospital (OR = 1.088; CI 95% 1.042-1.136). Conclusion: HGS and other epidemiological indicators are highly relevant in the prognostic evaluation of elderly people in hospital admission.&#x0D;

Retinal vascular occlusion in patients with the Covid-19 virus

BackgroundThe coronavirus disease (COVID-19) can cause acute respiratory distress syndrome with dyspnea, anosmia, fever, and cough. Few studies describing ocular findings have been reported. The current case series, reports the clinical findings and natural history of patients with retinal vascular occlusion after COVID-19 infection.Case presentationsPatients from multiple Brazilian hospitals who had clinical and laboratory diagnoses of COVID-19 with retinal vein or arterial occlusion were analyzed retrospectively. The baseline demographics, clinical presentations of COVID-19, comorbidities, risk factors for thromboembolic events, and use of anticoagulant drugs were reviewed. The relevant clinical findings associated with the retinal vascular occlusive event, management, and outcomes were reported. Fourteen cases of retinal vascular occlusion within 3 months of the laboratory confirmed COVID-19 infection were identified. Three of which required hospitalization for COVID-19 management. Eight cases had central retinal vein occlusion, three branch retinal vein occlusion, one hemispheric retinal vein occlusion, and two central arterial occlusion. The mean patient age at presentation was 48 years; the visual acuity ranged from light perception to 20/20. Nine patients received intravitreal injections of anti-angiogenic drugs and one received ketorolac tromethamine drops for the management of secondary macular edema; four were untreated.ConclusionsCOVID-19 patients may rarely have ocular manifestations of the disease. It was presented a case series of vascular occlusion events that may be related to COVID-19 infection, since these thrombotic events are actively involved in the disease pathophysiology. These cases emphasize the need for further investigation of ocular complications associated with this disease.

Antibiotic Consumption and Deviation of Prescribed Daily Dose From the Defined Daily Dose in Critical Care Patients: A Point-Prevalence Study.

Background: The consumption of antibiotics is one of the metrics used to evaluate the impact of antimicrobial stewardship programs (ASP). The aim of this study was to determine the prevalence of antibiotic consumption in Brazilian intensive care units (ICUs) and estimate the deviation of the prescribed daily dose (PDD) from the defined daily dose (DDD). Methods: This is a multicenter, observational, point-prevalence study carried out in adult ICUs of 8 Brazilian hospitals from August 2019, to February 2020. We collected data on the patient’s demographic and clinical characteristics, antibiotic therapy, classification and site of infections. The DU90 (antibiotic accounting for 90% of the volume utilized) was calculated, and the antibiotics were classified by the Anatomical Therapeutic Chemical (ATC) Index and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) groups. For the most prevalent antibiotics, the deviation of PDD from DDD was determined. Results: Three hundred thirty-two patients from 35 ICUs were analyzed. The prevalence of antibiotic use was 52.4%. The patients in use of antibiotics were predominantly over 60 years of age (81.6%) with pulmonary infections (45.8%). A predominance of empirical regimens was observed (62.6%) among antibiotic therapies. The highest frequencies of prescriptions observed were for piperacillin + tazobactam (16.1%), meropenem (13.3%), amoxicillin + clavulanate (7.2%), azithromycin (7.2%), and teicoplanin (6.1%). The watch (64.2%) and reserve (9.6%) categories of the AWaRe classification accounted for 73.8% of all antibiotics, and they were prescribed alone or in combinations. High variability of doses was observed for the most prescribed antibiotics, and large deviations of PDD from the DDD were observed for meropenem, teicoplanin, and tigecycline. Conclusions: The high prevalence of antibiotic prescription was related to a predominance of empirical regimens and antibiotics belonging to the WHO Watch classification. High variability of doses and large deviations of PDD from DDD for meropenem, teicoplanin, and tigecycline was observed, suggesting that DDD may be insufficient to monitor the consumption of these antibiotics in the ICU population. The variability of doses found for the most prescribed antibiotics suggests the need for monitoring and intervention targets for antibiotic stewardship teams.

Vitamin D deficiency predicts 30-day hospital mortality of adults with COVID-19.

Background & aimsSeveral studies have shown conflicting results for the relationship between vitamin D deficiency and COVID-19 outcomes. Here, we aimed to evaluate whether plasma 25(OH)D levels predict mortality in adults admitted with COVID-19, considering potential confounders.MethodsWe conducted a retrospective cohort study that included 115 adults (age 62.1 ± 17.6 years, 65 males) admitted to a Brazilian public hospital for severely symptomatic COVID-19. Subjects were classified into two groups according to their plasma levels of 25(OH)D: sufficiency (≥50 nmol/L) and the deficiency (<50 nmol/L). The diagnosis of COVID-19 was performed using real-time polymerase chain reaction (qPCR). In addition, direct competitive chemiluminescence immunoassay assessed serum 25(OH)D levels.ResultsThe all-cause 30-day mortality was 13.8% (95% CI: 6.5%–21%) in the group of patients with sufficient plasma 25(OH)D levels and 32.1% (95% CI: 14.8%–49.4%) among those with deficient plasma 25(OH)D levels. Cox regression showed that plasma 25(OH)D levels remained a significant predictor of mortality even after adjusting for the covariates sex, age, length of the delay between symptom onset and hospitalization, and disease severity (HR = 0.98, 95% CI: 0.96–1.00; p = 0.02).ConclusionVitamin D deficiency predicts higher mortality risk in adults with COVID-19.

VNTR Polymorphism in Intron 4 of the eNOS Gene and the Risk of Gastrointestinal Bleeding: A Case-control Study

Background and Aims: Considering the lack of knowledge regarding the influence of the variable number of repeats of 27 pb in intron 4 (4b/4a VNTR - rs61722009) of the endothelial nitric oxide synthase (eNOS) on the drug response, we assessed the influence of this polymorphism for the risk of upper gastrointestinal bleeding (UGIB).&#x0D; Methods: A case-control study, including 200 cases and 706 controls, was conducted in a Brazilian hospital complex. Cases were participants with UGIB diagnosis. Controls were participants admitted to surgical procedures not related to gastrointestinal problems. The 4b/4a VNTR was determined through polymerase chain reaction followed by fragment analysis. Conditional logistic regression models were designed. The additive interaction between the presence of the 4b/4a VNTR variant and the use of low-dose aspirin (LDA) and nonsteroidal anti-inflammatory drugs (NSAIDs) was calculated by fitting the Cox regression model through the parameters of Synergism index (S) and Relative Excess Risk Due To Interaction (RERI).&#x0D; Results: The presence of the 4b/4a VNTR variant did not increase the risk of UGIB: carriers of the 4a/4a genotype (OR=0.37, 95%CI: 0.09-1.45) and of the variant allele “4a” (OR=0.91, 95%CI: 0.55-1.51). The risk of UGIB in LDA users carriers of the wild genotype (OR=4.96, 95%CI: 2.04- 2.06) and the variant allele “4a” (OR=3.49, 95%CI: 1.18-10.38) is similar, as well as for NSAID users carriers of the wild genotype (OR=5.73, 95%CI: 2.61-12.60) and variant allele “4a” (OR=5.51, 95%CI: 1.42-15.82). No additive interaction was identified between the presence of the genetic variant and the use of LDA [RERI: -1.44 (95%CI: -6.02–3.14; S: 0.63 (95%CI: -1.97–1.15)] and NSAIDs [RERI: -0.13 (95%CI: -6.79–6.53; S: 0.97 (95%CI: -0.23–4.19)] on the UGIB risk.&#x0D; Conclusion: Our data suggests that there is no increase in the magnitude of UGIB risk in LDA and NSAIDs users’ carrying the variant allele “4a”.

The impact of VITEK 2 implementation for identification and susceptibility testing of microbial isolates in a Brazilian public hospital.

Introduction. The use of automated systems in identification and susceptibility tests can improve antimicrobial therapy, and positively impact clinical outcomes with a decrease in antimicrobial resistance, hospitalization time, costs, and mortality.Aim. The aim of this study was to evaluate the clinical impact of an automated method for identification and susceptibility testing of microbial isolates.Methodology. This was a retrospective cross-sectional study aimed to analyse the results before and after the implementation period of a VITEK 2 system in a Brazilian university hospital. Based on data from medical records, patients with a positive culture of clinical samples from January to July 2017 (conventional method) and from August to December 2017 (automated method) were included in this study. Demographic data, hospitalization time, time interval between culture collection and results, culture results and site, susceptibility profile, minimum inhibitory concentration, and outcome data were evaluated. Chi-square and Fischer's tests were used in the analysis.Results. Of the total samples, 836 were considered valid by the inclusion criteria, with 219 patients before VITEK 2 system implementation group and 545 in the post-implementation group. The comparison between the two periods showed a reduction of 25 % of the time to culture reports, a decrease of 33.5 to 17.0 days of hospitalization, and a reduction in mortality from 44.3-31.0 %, respectively.Conclusion. The VITEK 2 system provided early access to appropriate antimicrobial therapy for patients and effected a positive clinical impact with a reduction in mortality and hospitalization time.

How Is the Quality of Information in a Cancer Hospital Regarding the Completeness and Consistency? A Case Study of the Hospital Cancer Registry of the Brazilian Hospital Bom Pastor.

This study aimed to analyze the measurement of information quality in the Information System of the Brazilian Hospital in terms of data completeness and consistency. The quality of information is a fundamental factor in evaluating the performance of information systems. Its use is a reasonable condition in the management of the health service and attention to the care of patients. The research had a retrospective, descriptive character exploratory with quantitative analysis of the data. The study had some limitations, we observed incomplete information regarding some studied variables; this is because the primary source of information in the cancer registry is the patient's medical record. Therefore, the patient's medical records are relevant and should contain the entire health history, from birth to death. In addition, they support research, the management of health services.

Antimicrobial Stewardship Programmes in Brazil: introductory analysis

Introduction: Antimicrobial Stewardship Program (ASP) aims to reeducate the use of antimicrobials. Objective: To manage and evaluate the implementation of ASP in an Adult Intensive Care Unit in Brazilian hospitals. Method: Prospective cross-sectional study, reporting introductory data and factors that advised and helped to implement the ASP in 954 (55.6%) hospitals, corresponding to 25,565 beds, from all 27 Brazilian states.Results: Of the 954 hospitals, 453 (47.5%) have ASP, with the most regular factors being: 369 (81.5%) top management support; 343 (75.7%) availability of clinical protocols; 276 (60.9%) support and adherence by doctors and 259 (57.2%) official definition of the management team. The most difficult causes were: 202 (44.6%) operational team without defined or insufficient time; 134 (29.6%) lack of information technology support; 173 (38.2%) resistance or opposition from doctors and 116 (25.6%) lack of commitment from the teams. Conclusion: the implementation of ASP is an executable proposal for the optimization and rational use in the management of antimicrobials. In Brazil, this proposal will collaborate for direct actions in ICUs, guided by the government, with a relevant impact on the control of antimicrobial resistance. In Brazil, this proposal will contribute to direct actions in ICUs, guided by the government, with a relevant impact on the control of antimicrobial resistance. Brazil needs to improve all elements, with education and definition of responsibilities and professionals.

Clinical and epidemiological features of penile squamous cell carcinoma according to pathological nodal stage in a Brazilian cancer reference hospital.

e17017 Background: Penile cancer is a rare disease worldwide, but in the developing countries represent 2% of male cancers, and sociocultural issues are closely related to risk. Lymph node status is a key prognostic factor, and almost 60% of patients has lymph node disease at diagnosis. Perioperative treatment for patients with regional lymph node disease is essential for a better outcome. Methods: We retrospectively reviewed all penile cancer patients, with histological confirmation, between 2009 and 2019 at Barretos Cancer Hospital (Brazil). Only squamous cell carcinoma that performed lymphadenectomy were included. Univariable analysis were performed to explore association between clinical and pathological features. Cumulative survival probabilities were calculated using the Kaplan-Meier method and differences between survivals were tested using the log-rank test. Results: One hundred and thirteen patients were eligible for analyses. The mean age was 55.7 year. Most of the patients were declared white, in a stable relationship and had a lower education level, with more than 70% of patients attending only elementary school. Clinical-pathological staging concordance was 43%. Overall survival was related to pathologic lymph node staging (pN), ranging from 111 months for pN0 individuals to 46.9 months for pN3 (p &lt; .001). Considering only pN2-3 stages, only 54% of patients were submitted to adjuvant treatment and those had significantly improved 5 years cumulative survival, almost 50% versus 20% (p = .027). Only one patient was submitted to neoadjuvant therapy. Conclusions: The epidemiological profile matches with the current literature, reaffirming this public health issue in low-income countries. Accurated lymph node staging is essential to define the prognosis and an agressive multi-modality approach could improve results in the perioperative nodal metastatatic setting. Further prospective controlled studies should be stimulated in this context.