Brazilian Hospital Research Articles

Abstract 12139: Left Ventricular Myocardial Work in Patients With Chagas Disease From a Quaternary Hospital in Brazil

Background: Left ventricular (LV) function assessment in patients (pts) with Chagas disease (ChD) is challenging. LV ejection fraction (LVEF) as a marker of myocardial contractility in these pts has issues, and alterations in myocardial deformation (MD) may occur in early stages of cardiac disease (CD) before the decline of LVEF. LV global longitudinal strain (GLS) is a good parameter to evaluate LV MD, but is dependent on afterload. LV myocardial work (MW) is a technique which integrates afterload to the calculation of GLS Purpose: To analyze LV function using MW in pts with ChD Methods: 39 pts with positive serology for ChD, (74,4% women, age 68,8 ± 9,7) followed in a quaternary Brazilian hospital, were divided in groups of stages of CD: G1 - normal Echocardiography (Echo) and ECG, G2 - alterations in ECG a/o Echo, normal LVEF, G3 - reduced LVEF. LV MW was measured integrating GLS with non-invasive blood pressure as an afterload index, for generation of pressure-strain loops by specific software(fig.1). Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured. Results: 11 pts (28,2%) were in G1, 14 (35,9%) in G2, and 14 (35,9%) in G3. In overall population median values of MW were within normal ranges: GWI = 1760mmHg% (>968), GCW = 2046mmHg% (>1550), GWW= 178mmHg% (<331), GWE = 92 (>83). Values of GWI, GCW and GWE were significantly lower and GWW was higher in G3, compared to G1 and G2, translating into less LV mechanical efficiency (ME) in these pts with more advanced CD (table 1). Despite LVEF and GLS similar between G1 and G2, values of GCW were 12% lower in G2 compared to G1, which could point to a tendency of early alterations in these pts, although not reaching statistical significance (p > 0,05). Conclusion: In pts with advanced stages with Chagas CD (G3) there were significant alterations in parameters that evaluate ME, with reduced values of GWI, GCW and GWE, with higher GWW

Abstract 11752: Correlation of Myocardial Work Parameters With Left Ventricular Ejection Fraction in Patients With Chagas Disease From a Quaternary Hospital in Brazil

Introduction: Although left ventricular ejection fraction (LVEF) is one important parameter for management of pts with heart diseases and a major prognostic factor in Chagas cardiomyopathy (CC), it has great variability. Myocardial Work (MW) is a new promising technique which integrates afterload to longitudinal strain analysis using noninvasive blood pressure (NIBP) values, calculating pressure x strain loops (PSL). Correlation of MW with LVEF in pts with CC is unknown. Hypothesis: LV MW may have good correlation with LVEF in pts with Chagas Disease (CD). Methods: We included 39 consecutive pts(74,4% women, median age 68,8±9,7) followed in a quaternary Brazilian hospital with diagnosis of CD, dividing them into groups based on the stages of heart disease: Group 1: normal Echocardiography (Echo) and ECG, Group 2: pts with alterations in ECG and/or Echo with preserved LVEF, Group 3: pts with reduced LVEF with or without heart failure. A comprehensive Echo was performed in all pts, and LVEF was measured by 2D biplane Simpson. LV MW was measured using speckle-tracking echo, using NIBP as an afterload index for generation of PSL by a specific software. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured. Results: 11 pts (28,2%) were classified in group 1, 14 (35,9%) in group 2, and 14 (35,9%) in group 3. There was a very strong correlation of LVEF with GWI (p<0,001; r=0,781), GCW (p<0,001; r=0,813), a strong correlation pf LVEF with GWE (p<0,001; r=0,661) and a weak correlation of LVEF with GWW (p=0,046; r=-0,332). All MW parameters, except from GWW had good sensitivity and specificity to detect pts with reduced LVEF, with best cutoff for GWI = 1501mmHg% (AUC=0,980) and GCW=1719,5mmHg% (AUC=0,986). Conclusions: MW parameters, except from GWW, had strong correlation with LVEF in this subset of pts with CD, with good performance for the detection of LVEF≤52%, with high sensitivity and specificity.

Immunoexpression of HER2 pathway related markers in HER2 invasive breast carcinomas treated with trastuzumab

PurposeWe evaluated the immunoexpression of potential markers involved in the HER2 pathway in invasive breast carcinoma with HER2 amplification treated with trastuzumab. MethodsSamples of ninety patients diagnosed and treated at two public Brazilian hospitals with overexpressed invasive carcinoma between 2009 and 2018 were included. Several markers (Bcl-2, CDK4, cyclin D1, EGFR, IGF1, IGF-1R, MDM2, MUC4, p16, p21, p27, p53, PTEN, RA, TNFα, and VEGF) were immune analyzed in the tumor by immunohistochemistry and then correlated with clinicopathological variables. ResultsTumor sample expression results determined potential markers of good prognosis with statistically significant values: cyclin D1 with a nuclear grade, and recurrence; IGF-1 with tumor size, and death; p16 with a response after treatment; PTEN with a response after treatment, and death. Markers of poor prognosis: p53 with histological, and nuclear grade; IGF-1R with a compromised lymph node. The treatment resistance rate after trastuzumab was 40%; the overall survival was 4.13 years (95% CI 5.1–12.5) and the disease-free survival was 3.6 years (95% CI 5.1–13.1). ConclusionsThe tumor samples profile demonstrated that cyclin D1, IGF-1, p16, and PTEN presented the potential for a good prognosis and p53 and IGF-1R for worse.

Functional recovery of chronically critically ill patients in the first days after discharge from the intensive care unit: Feasibility of the 6-minute step test.

Survivors of chronic critical illness often experience weakness and functional dependence to various degrees after their intensive care unit (ICU) stay. Evaluating their functional status with the traditional six-minute walk test is challenging due to space constraints or patient intolerance. Our aim was to evaluate the feasibility of using the six-minute step test (6MST) as a measure of functional capacity in chronically critically ill patients early after ICU discharge. This prospective study was undertaken in a private Brazilian hospital. From July 2019 to July 2020, all chronically critically ill patients were asked to participate 48 hours after ICU discharge. On the day of study inclusion and a week later, those who consented underwent functional assessment comprised of the 6MST, peripheral muscle strength using handgrip strength (HGS), and mobility using the ICU mobility scale (IMS). A total of 40 patients were included. The 6MST was feasible in 40% on the first evaluation and 57% on the second. The median 6MST was 0 [0-5] on the first evaluation and 3.5 [0-7.75] on the second (P = 0.005). The median HGS increased from 11.50 [9.25-18] on the first evaluation to 14.5 [10-20] on the second (P = 0.006). The median IMS was 4.5 [3.25-7] on the first evaluation and 6 [3.25-7] on the second (P<0.001). Despite the significant improvement, all parameters measured remained well below normal. The 6MST was a feasible measure of functional capacity in chronically critically ill patients early after ICU discharge. Patients had functional capacity well below predicted values.

Ankle fractures malreduction rate and its causes in two Brazilian tertiary training hospitals

IntroductionAnkle fractures are one of the most frequent injuries managed by any trauma surgeon. Literature has shown that adequate reduction is of utmost importance to achieve satisfactory functional outcomes. However, malreduction rates remain high worldwide. The objective of the present study is to evaluate the quality of ankle fracture reduction in two major trauma centers in a large Brazilian city and to analyze the factors associated with malreduction MethodsEpidemiologic data of 382 patients (189 men; 193 women) aged between 7 and 87 years who underwent osteosynthesis of the ankle in two trauma centers in a large Brazilian city. Electronic clinical records, preoperative and immediate postoperative radiographs in anteroposterior (AP), lateral and mortise views were evaluated. Pettrone's criteria were used to evaluate the quality of ankle fractures reduction. All radiographs were independently evaluated by two foot and ankle senior surgeons ResultsOverall, malreduction rate was 22.2%. Forty-seven (55.2%) fractures classified as malreduced had medial malleolar displacement The results showed three factors that significantly affected the quality of reduction (p<0.05), patients over 60 years, open fractures and fracture-dislocations. Patients aged over 60 years were twice more likely to have poor reduction of ankle fractures than younger ones. The risk of poor fracture reduction among those individuals with open fractures is 2.15 times greater than among patients with closed injuries. Fracture-dislocation imposed a 2.7 higher risk for malreduction DiscussionWe found a malreduction rate below most series previously published. Further results agree with the literature. Elderly people aged over 60 years, fracture dislocations and open fractures are associated with worse results, influencing the quality of the reduction, clinical outcomes, and the development of post-traumatic arthrosis ConclusionAnkle fractures malreduction are associated with higher age, open fractures, and fracture-dislocations.

The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes.

Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.

Simple or simplistic? Sensitivity of an operating room CFD model to refinement and detailing

Indoor air quality is critical in healthcare facilities since it directly relates to infection risk, mainly in operating rooms (OR). Nowadays, air movement in such environments is often evaluated with computational fluid dynamics (CFD) simulations. However, many users typically oversimplify their OR models by including only major equipment (such as operating tables and surgical lights) that do not require refined computational meshes. This work analyzes the sensitivity of CFD simulations to mesh refinement, air circulation layout, geometry detailing, placement of furniture and equipment, as well as the presence of the surgical staff in the OR. An OR of a Brazilian university hospital was modeled and validated with environmental parameters assessed in-loco. Results showed relative differences up to 375% in air velocity depending on mesh resolution. Including small furniture and changing the OR layout resulted in nine-fold differences in air velocity. Finally, modeling the surgical staff in the OR significantly interfered with air circulation patterns, preventing inflow from the polluted towards the clean and sterile zone. The present work demonstrates the alarming fact that even a validated, sound, but overly simple CFD model may be phenomenologically insufficient to assess real contamination risks in an OR — and, by extension, in other healthcare facilities. Therefore, detailed CFD models regarding the number of elements in the simulation mesh, the positioning and the operating condition of the ventilation system, the inclusion and detailing of furniture, and the presence of the surgical staff in the OR should be employed since early design stages.

Troponin elevation as a marker of short deterioration and one-year death in a high-risk surgical patient cohort in a low and middle income country setting: a postoperative approach to increase surveillance.

Myocardial injury after noncardiac surgery is common and mostly asymptomatic. The ideal target population that will benefit from routine troponin measurements in low and middle income countries (LMICs) is unclear. This study aims to evaluate the clinical outcomes of a cohort of high-risk surgical patients according to high-sensitivity troponin T (hsTnT) in an LMIC setting. We conducted a prospective cohort study of 442 high-risk patients undergoing noncardiac surgery at a Brazilian hospital between February 2019 and March 2020. High-sensitivity troponin T levels were measured preoperatively, 24hr, and 48hr after surgery and stratified into three groups: normal (< 20ng·L-1); minor elevation (20-65ng·L-1); and major elevation (> 65ng·L-1). We performed survival analysis to determine the association between myocardial injury and one-year mortality. We described medical interventions and evaluated unplanned intensive care unit (ICU) admission and complications using multivariable models. Postoperative myocardial injury occurred in 45% of patients. Overall, 30-day mortality was 8%. Thirty-day and one-year mortality were higher in patients with hsTnT ≥ 20ng·L-1. One-year mortality was 18% in the unaltered troponin group vs 31% and 41% for minor and major elevation groups, respectively. Multivariable analysis of one-year survival showed a hazard ratio (HR) of 1.94 (95% confidence interval [CI], 1.22 to 3.09) for the minor elevation group and a HR of 2.73 (95% CI, 1.67 to 4.45) for the troponin > 65ng·L-1 group. Patients with altered troponin had more unplanned ICU admissions (13% vs 5%) and more complications (78% vs 48%). This study supports evidence that hsTnT is an important prognostic marker and a strong predictor of all-cause mortality after surgery. Troponin measurement in high-risk surgical patients could potentially be used as tool to scale-up care in LMIC settings. ClinicalTrials.gov (NCT04187664); first submitted 5 December 2019.

Study of case of the profile of Covid-19 infected in Espirito Santo State in Brazil

The pandemic caused by Severe Acute Respiratory Syndrome - Related Coronavirus 2 (SARS-CoV-2) has made socio-economic inequalities between social classes more evident in the countries in development process. This scenario is also no different in Brazil and it has been demanding from the federal, state and municipal governments broad efforts to combat the consequences of the spread of the disease in Brazil. The rulers have a huge challenge to implement measures to prevent the advance of the transmission of the virus. In addition, state governments need to use the public health system to serve the main population, since the lethality rate is very high directly influenced by social inequality. To minimize the effects of the new coronavirus, the ruler needs planning to give efficient response and requires an understanding of the rich that people about free movement, controlled circulation or total blocking of population movement. In this context, our proposal was to investigate how the disease reached people of different levels of education. And how has been the response of people hospitalized in Brazilian hospitals. We analyzed the public data of reports of Severe Acute Respiratory Syndrome (SRAG). In our research, we considered the variables schooling, ethnicity, gender, time of hospitalization in the Intensive Care Unit (ICU) and use of mechanical ventilators. Our results indicate that the lethality rate is higher for those people who were admitted to the ICU. In addition, people with low schooling and no schooling are 3.6 times more likely to die than people with higher education. This discrepancy highlights the huge disparity of quality treatment in Brazilian states.

Shift in hospital opioid use during the COVID-19 pandemic in Brazil: a time-series analysis of one million prescriptions

The pronounced change in the profile of hospitalized patients during COVID-19 and the severe respiratory component of this disease, with a great need for mechanical ventilation, led to changes in the consumption pattern of some medicines and supplies. This time-series study analyzed the in-hospital consumption of opioids during the COVID-19 pandemic in 24 Brazilian hospitals compared to the pre-pandemic period. Data included 711,883 adult patients who had opioids prescribed. In 2020, the mean consumption was significantly higher compared to 2019 for parenteral fentanyl, enteral methadone, and parenteral methadone. It was significantly lower for parenteral morphine parenteral sufentanil, and parenteral tramadol. For remifentanil, it did not differ. The number of patients in 2020 was lower but the mean consumption was higher for fentanyl, parenteral methadone, and remifentanil. It was lower for enteral methadone and parenteral sufentanil. The consumption of parenteral morphine and parenteral tramadol was stable. There was a relevant increase in hospital consumption of some potent opioids during the COVID-19 pandemic in Brazil. These results reinforce the concern about epidemiological surveillance of opioid use after periods of increased hospital use since in-hospital consumption can be the gateway to the misuse or other than the prescribed use of opioids after discharge.

Compassionate interprofessional and interagency community: palliative care

The year 2023 marks palliative care with a global theme of compassionate communities. This short communication concerns an extension project developed by students, professors, and palliative care and social service staff at a Brazilian public hospital.

Temporal validation of the MMCD score to predict kidney replacement therapy and in-hospital mortality in COVID-19 patients

BackgroundAcute kidney injury has been described as a common complication in patients hospitalized with COVID-19, which may lead to the need for kidney replacement therapy (KRT) in its most severe forms. Our group developed and validated the MMCD score in Brazilian COVID-19 patients to predict KRT, which showed excellent performance using data from 2020. This study aimed to validate the MMCD score in a large cohort of patients hospitalized with COVID-19 in a different pandemic phase and assess its performance to predict in-hospital mortality.MethodsThis study is part of the “Brazilian COVID-19 Registry”, a retrospective observational cohort of consecutive patients hospitalized for laboratory-confirmed COVID-19 in 25 Brazilian hospitals between March 2021 and August 2022. The primary outcome was KRT during hospitalization and the secondary was in-hospital mortality. We also searched literature for other prediction models for KRT, to assess the results in our database. Performance was assessed using area under the receiving operator characteristic curve (AUROC) and the Brier score.ResultsA total of 9422 patients were included, 53.8% were men, with a median age of 59 (IQR 48–70) years old. The incidence of KRT was 8.8% and in-hospital mortality was 18.1%. The MMCD score had excellent discrimination and overall performance to predict KRT (AUROC: 0.916 [95% CI 0.909–0.924]; Brier score = 0.057). Despite the excellent discrimination and overall performance (AUROC: 0.922 [95% CI 0.914–0.929]; Brier score = 0.100), the calibration was not satisfactory concerning in-hospital mortality. A random forest model was applied in the database, with inferior performance to predict KRT requirement (AUROC: 0.71 [95% CI 0.69–0.73]).ConclusionThe MMCD score is not appropriate for in-hospital mortality but demonstrates an excellent predictive ability to predict KRT in COVID-19 patients. The instrument is low cost, objective, fast and accurate, and can contribute to supporting clinical decisions in the efficient allocation of assistance resources in patients with COVID-19.

Does the Radiographic Lateral View of Toes Matter? - A Retrospective Analyses of 378 X-Rays

Category: Lesser Toes; Trauma Introduction/Purpose: Because lateral toes are anatomically on the distal aspect of foot, they are more exposed to axial load (stubbed toe) and crushing injuries. In this context, correct obtainment of imaging exams is fundamental for proper diagnosis of MSI. In the X-ray room, however, due to overlapping of smaller fingers or because the patient`s pain, most common practice is to suppress the lateral view. The purpose of this study is to demonstrate the importance of toe radiographs in diagnosis of interphalangeal fractures and dislocations, emphasizing need for lateral view for diagnosis of these injuries. Methods: 378 radiographs of 126 patients treated between Jan/2018 and Mar/2018 in an emergency care clinic of a Brazilian hospital were retrospectively evaluated for presence of fractures. Patients were selected from a search on medical records using ICD. After, the radiographs of the same patient were duplicated and divided in two groups: standard group (AP and Oblique) and complete profile group (standard views plus lateral view). They were examined by four independent examiners of different degrees of experience. Each examiner randomly evaluated the same patient twice (1 in each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two-proportion equality test was used to calculate statistical significance. Results: Mean age of patients was 37,2 years (4-85yr). 144 fractures were diagnosed in standard group (28,6%) and 266 fractures (52,8%) in complete profile group (p &lt; 0,001). Individually evaluating each examiner, everyone had had an improvement in number of fracture diagnostics when compared the complete profile group with the other (p &lt; 0,001). Kappa index was superior to 0,60 for all examiners in pattern group. Conclusion: Addition of true lateral view was able to improve the number of diagnosed fractures on patients with lesser toes trauma.

Application of Digital Technology in a Surgical Center of a Brazilian Hospital

Application of Digital Technology in a Surgical Center of a Brazilian Hospital

A-289 Emergence of Unusual Non-Fermentative Gram-Negative Bacilli Associated to COVID-19 Period at Brazilian Hospitals

Abstract Background Since the global pandemic of coronavirus disease (COVID-19), some studies have reported on the emergence of opportunistic nosocomial pathogens associated with co-infection on the outcome of COVID-19 patients. The aim of this study was to describe the increase of six unusual species of Non-fermentative Gram-negative bacilli (NF-GNB) clinical isolates recovered from inpatients in several Brazilian hospitals comparing pre-Covid-19 (January 2018 to December 2019) period vs Covid-19 (January 2020 to December 2021) period. Methods This study design was a retrospective, observational analysis based on microbiological data of emergent NF-GNB isolates, detected in several Brazilian tertiary hospitals. The bacterial identification was performed by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF/MS) and the susceptibility of antibiotics was determined using disk diffusion method. Results During the 48 months period, a total of 1665 (2018; 349), (2019; 351), (2020; 485), (2021; 480) emergent NF-GNB isolated from blood (n = 744), respiratory tract (n = 239), skin and soft tissue (n = 264); urine (n = 119), catheter (n = 101), fluid and secretions (n = 113), Cerebrospinal fluid (n = 12) and others (n = 73) were analyzed. The frequency of NF-BGN according to species level identification was Stenotrophomonas maltophilia (1040; 62.5%), Burkholderia cepacea complex (457; 27.4%), Elizabethkingia meningoseptica (64; 3.8%), Elizabethkingia miricola (31; 1.8%), Ochrobactrum anthropi (69; 4.1%) and Ochrobactrum intermedium (4; 0.2%). The prevalence of these NF-BGN detected in pre-Covid-19 period (2018–2019) and Covid-19 period (2020–2021) were 42% and 58%, respectively. The incidence of Stenotrophomonas maltophilia, Burkholderia cepacea complex, Elizabethkingia spp. and Ochrobactrum spp. infection was (47.7% and 52.3%), (42.9% and 57.1%), (43.2% and 56.8%) and (50.7% and 49.3%) among female and man patients, respectively. For Stenotrophomonas maltophilia, Burkholderia cepacea complex and Ochrobactrum spp. the main age range was over 60 years (44.5%, 44.9% and 42.5%) while for Elizabethkingia spp. the main age range was 0–10 years of age with 42.5% of cases in the pre-COVID-19 period and over 60 years old with 43.9% in the COVID-19 period. Compared the two periods (2018–2019 vs 2020–2021) for Stenotrophomonas maltophilia the resistance rate to levofloxacin and sulfamethoxazole-trimethoprim was (3.9% vs 4.6%) and (4% vs 4.2%), respectively. Conclusion Our data point to a scenario wherein the presence of opportunistic pathogens may have been intensified by the covid-19 pandemic. Further studies should be carried out to clarify these findings.

A-288 Molecular Detection of Mycobacterium tuberculosis in Pulmonary and Extra-Pulmonary Samples. Data from a Brazilian Clinical Laboratory

Abstract Background Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), is among the leading infectious causes of death in developing countries. In humans, TB presents as a progressive granulomatous infectious disease that affects lungs causing pulmonary tuberculosis, but can also affect intestines, meninges, bones, joints, lymph nodes, skin and other body tissues causing extra-pulmonary tuberculosis. The aim of this study was to evaluate the frequency of tuberculosis cases detected during the COVID-19 period and the emergence of cases with extrapulmonary diagnosis. Methods This study was a retrospective analysis from January 2017 to December 2022 based on the analysis of 3105 clinical samples processed by the molecular biology section of AFIP Laboratory. All clinical samples were isolated from pulmonary and extra-pulmonary sites recovered from inpatients admitted in several Brazilian tertiary hospitals. In Brief, the DNA extraction was performed according to the type of patient’s samples and, then submitted to Real-Time PCR (qPCR) method using a commercial kit, which contains specific primers and probes to the M. tuberculosis genome. Results Of the 3105 samples tested, 222 (14%) samples were positive for the presence of M. tuberculosis. Out of which, 120/1405 (8,5%) were detected in the pre-Covid-19 period (2017–2019) and 102/1700 (6%) were detected in Covid-19 period (2020–2022). The prevalence of M. tuberculosis infection was 64.5% and 35.5% among men and females, respectively. The main age range was 41 to 50 years (44.7%), while over 60 years comprised 13.5% of cases (Fig. 1). Between the isolate sites, 67.1% of the M. tuberculosis cases were detected in pulmonary and 32.8% in extra-pulmonary body sites, of which, cerebrospinal fluid and blood are among the most frequent, followed by cervical lymph node, ascitic fluid, gastric lavage, urine and others. A total of 95% of M. tuberculosis was detected in patients assisted by public health service. We did not have access to patient’s symptoms, clinical history or further diagnostic procedures. Conclusion Comparing the two periods of the study, a reduction in the positivity rate of new cases was observed in the pandemic period, perhaps this fact can be associated with restrictions on access to the diagnosis of other pathologies in the pandemic period. Despite no information about the severity of the infection, male gender prevalence and age range from 41 to 50 years group need further attention.

Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series

BackgroundTo describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years.MethodsThis retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis.ResultsThe incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035)ConclusionAnti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings.

Beyond the identifiable proteome: Delving into the proteomics of polymyxin-resistant and non-resistant Acinetobacter baumannii from Brazilian hospitals

This work discloses a unique, comprehensive proteomic dataset of Acinetobacter baumannii strains, both resistant and non-resistant to polymyxin B, isolated in Brazil generated using Orbitrap Fusion Lumos. From nearly 4 million tandem mass spectra, the software DiagnoMass produced 240,685 quality-filtered mass spectral clusters, of which PatternLab for proteomics identified 44,553 peptides mapping to 3479 proteins. Crucially, DiagnoMass shortlisted 3550 and 1408 unique mass spectral clusters for the resistant and non-resistant strains, respectively, with only about a third with sequences (and PTMs) identified by PatternLab. Further open-search attempts via FragPipe yielded an additional ∼20% identifications, suggesting the remaining unidentified spectra likely arise from complex combinations of post-translational modifications and amino-acid substitutions. This highlights the untapped potential of the dataset for future discoveries, particularly given the importance of PTMs, which remain elusive to nucleotide sequencing approaches but are crucial for understanding biological mechanisms. Our innovative approach extends beyond the identifications that are typically subjected to the bias of a search engine; we discern which spectral clusters are differential and subject them to increased scrutiny, akin to spectral library matching by comparing captured spectra to themselves. Our analysis reveals adaptations in the resistant strain, including enhanced detoxification, altered protein synthesis, and metabolic adjustments. SignificanceWe present comprehensive proteomic profiles of non-resistant and resistant Acinetobacter baumannii from Brazilian Hospitals strains, and highlight the presence of discriminative and yet unidentified mass spectral clusters. Our work emphasizes the importance of exploring this overlooked data, as it could hold the key to understanding the complex dynamics of antibiotic resistance. This approach not only informs antimicrobial stewardship efforts but also paves the way for the development of innovative diagnostic tools. Thus, our findings have profound implications for the field, as far as methods for providing a new perspective on diagnosing antibiotic resistance as well as classifying proteomes in general.

Leadership to promote patient safety culture in public hospitals managed by social health organizations

PurposeThis paper aims to identify the kind of internal climate leaders should offer health-care professionals to promote a patient safety culture in public hospitals managed by social health organizations in Brazil.Design/methodology/approachTwo surveys were applied to health-care professionals working at three Brazilian public hospitals. The internal climate survey reached 1,013 respondents, and the patient safety culture survey reached 1,302 participants. Both factor and regression analyses were used to analyze the study model and determine how internal climate influences patient safety culture.FindingsResults indicate that to promote a patient safety culture among health-care professionals, leaders should generate an internal climate based on trust to foster pride in working in the hospital. Possibly, the trust dimension is the most important one and must be developed to achieve job satisfaction and provide better services to patients.Research limitations/implicationsAll the hospitals studied were managed by the same Organização Social de Saúde. Due to the limited responses concerning the respondents’ profiles, demographic variables were not analyzed.Practical implicationsThis research reveals that the trust and pride dimensions can most strongly influence a positive patient safety culture, helping hospital leaders face this huge managerial challenge of consistently delivering high standards of patient safety.Originality/valueThis research studies the promotion of a patient safety culture in public hospitals managed by social health organizations, characterized by greater flexibility and autonomy in health-care management and by a greater need for accountability.

National Cross-Sectional Epidemiological Analysis of the Impact of Pandemic COVID-19 on Vascular Procedures in Public Health System: 521,069 Procedures Over 4 Years

During the COVID-19 pandemic, there was a dramatic increase in healthcare demand. Resources were redirected to care patients with COVID-19. Therefore, surgical treatments were affected, including those of vascular diseases. There are no studies evaluating the whole impact of the COVID-19 pandemic, considering all types of vascular procedures, both elective and urgent, in a large country. The aim of the present study was to analyze the impact on all types of vascular procedures performed in Brazilian public hospitals during the COVID-19 pandemic. Cross-sectional population-based analysis of publicly available data referring to vascular procedures. Surgeries two years before the pandemic onset (2018 to 2019) and two years during pandemic (2020 to 2021) were included. We observed a total of 521,069 procedures. Decrease was observed in elective abdominal aortic aneurysm repairs both open surgery (p=0.001) and endovascular surgery (p<0.001), emergency open abdominal AAA repairs (p=0.005), elective thoracic aortic aneurysm repairs (p=0.007), elective open peripheral aneurysm repairs (p=0.038), carotid endarterectomies (p<0.001) and angioplasties (p=0.001), open revascularizations for peripheral arterial disease (p<0.001), surgical treatment of chronic venous disease (p<0.001) and sympathectomies for hyperhidrosis (p<0.001). However, there was a increase of lower limb amputations (p=0.027) and vena cava filter placements (p=0.005). There was a reduction of almost US$17 million in financial investments. The reorganization of health systems led to a significant reduction in vascular procedures and decrease in financial investments. On the other hand, there was a significant increase in the number of lower limb amputations and vena cava filter placements.