Repositório RCAAP

Children and adolescents with autistic disorder (AD), cerebral palsy (CP), myelomeningocele (MM) and Down syndrome (DS) all present with impairments in their physical and psychosocial well-being compared to the healthy population. However, there is neither scientific evidence that these neurological diseases has different impacts on health-related quality of life (HRQL) of pediatric patients. The objective of this study was to identify the more vulnerable groups among these diagnoses by evaluating and comparing the HRQL of children and adolescents, from the perspective of the caregiver. Participated in this study 329 children and adolescents who comprised the group of individuals with disabling neurological diseases (DND) (n = 169 [19 with AD, 96 with CP, 30 with MM and 24 with DS]) and the group of healthy individuals (n = 160). The caregivers supplied demographic and clinical information and completed the generic HRQL questionnaire Child Health Questionnaire - Parent Form 50 (CHQ-PF50). The Cronbach s alpha coefficient was calculated to determine the reliability of the HRQL questionnaire. Comparisons were made between the scores of the CHQ-PF50 for children and adolescents (Kruskal-Wallis test) and between the demographic variables of participants and caregivers (Kruskal-Wallis or chi-square test). The median age of the patients with DNI was 8.0 years and in the healthy group was 10.0 years. There was no significant difference between the groups regarding sex. The Cronbach s alpha ranged from -0.34 to 0.97 for the CHQ-PF50. All patients with DND showed impairment in the physical summary and the impact on parent s time scale compared with healthy individuals (p < 0.05). In the psychosocial summary, the scores were lower for individuals with AD. In the physical summary, patients with CP, AD and MM had the lowest scores. The SD group had the highest number of scales and summaries with no significant difference between their scores and the scores of healthy group (p > 0.05). In conclusion, the HRQL of pediatric patients is affected to significantly different extents by the disabling neurological diseases studied. All groups of disabled children and adolescents studied exhibited decreased HRQL scores compared to the healthy population in the same age group, but the most vulnerable groups were those with AD and CP.

Introduction: The carbapenem resistance among bacteria of the family Enterobacteriaceae, particularly Klebsiella pneumoniae, is becoming a serious problem in hospitals through different mechanisms that may act alone or combined, such as changes in outer membrane permeability with the porin loss associated with the overproduction of β-lactamases ESBL and AmpC or the specific production of KPC. These infections by Klebsiella pneumoniae resistant to carbapenems (CRKP) are associated with high morbidity, mortality, and costs. Objectives: In our study, we describe the epidemiology and clinical outcomes associated with CRKP infections as well as the risk factors associated with 30 days hospital mortality among these patients and characterize resistance mechanisms: AmpC, ESBL, MBL and KPC. Methods: Case study (patients with infections CRKP) vs. control (uninfected by KPRC) at a ratio of 1:2, detected by laboratory surveillance and collecting demographics dates, co-morbidities, use of invasive procedures and antimicrobial use and patient outcome by checking medical records, between November / 2007 to May/2011. Characterization of phenotypic AmpC, KPC and ESBL performed with the test boronic acid as neutralizing enzyme test and synergism with imipenem-EDTA for MBL. The presence of genotype blaKPC was performed by PCR. Results: In total, 63 patients were included, with 22 patients infected by CRKP in different anatomical sites, predominantly bloodstream infections (40%). Resistance to ertapenem, meropenem and imipenem was 100%, 68.2% and 45.4%, respectively. Statistical analysis by logistic regression of risk factors for infection by CRKP showed the following as independent variables: malignancy (P = 0.025, OR = 63.74, 95% CI 1.69 to 2409.05), Charlson co-morbidity index ≥ 3 (P = 0.033, OR = 7.90, 95% CI, 1.18 to 52.80) and use of fluoroquinolones (P = 0.005, OR = 18.92, 95% CI, 2.42 - 147.81). The ESBL phenotype was most frequent (90.9%), followed by AmpC (63.6%) and blaKPC (14%), and usually combined. The presence of co morbidities ≥ 3 (P = 0.027, OR = 7.65 95% CI, 1.26 to 46.53) and KPRC infection (P = 0.026, OR = 4.91 95% CI, 1, 21 to 20.05) were associated with 30-day hospital mortality, and there was significant mortality in infected patients 54.5% (P = 0.026, OR = 3.72, 95% CI, 1.24 to 11.19) with an attributed mortality rate of 25.2%. Conclusion: The mortality rate associated with CRKP infection and the limited antimicrobial options for treatment highlight the need for improved laboratory detection, mainly KPC producing isolates, points out that it s crucial to implement efficient infection control measures to limit the spread of these pathogens in hospitals from countries with limited resources as Brazil.

The most important micro-organisms found in cheeses are Staphylococcus aureus, which are transmitted by contaminated milk and/or mishandling. In this work we performed a microbiologic assay in 117 samples Cheese Mines Frescal in 38 cities and one district in Triangulo Mineiro and Alto Paranaiba MG, between the December/2011 August/2009. We identified Staphylococcus coagulase positive in 65 samples (55.55%), with 23 samples (19.67%), unfit for human consumption, counts above threshold tolerated by law 5X102UFC/g. In the 65 samples showed antibiogram profile sensitivity to all antibiotics tested (beta-lactams -Cefaloxina, oxacillin, penicillin) and groups of glicopeptídios (vancomycin and teicoplanin), with the exception of 15 samples that were resistant to penicillin. It was not found strains of multiresistant Staphylococcus coagulase positive. The results point to the frequent presence of this micro-organism in the product studied, when compared with other studies.

Chagas disease is one of the most serious parasitic diseases in Latin America, with social and economic impact that far outweigh the combined effects of other parasitic diseases such as malaria, leishmaniasis and schistosomiasis. Chagas´ disease has two well-defined phases: acute and chronic phase. The acute phase lasts approximately two to three months. After this phase, the individual enters an asymptomatic state, which characterizes the early chronic phase. In the chronic phase of the disease, the destruction of enteric nervous system (ENS) components leads to the development of megacolon. The megacolon is characterized by colon dilatation associated with an inflammatory infiltrate which is the main cause of enteric neurons destruction. These neurons, when suffer some aggression, may exhibit a regeneration process. Knowing the existence of various types of enteric neurons with different functions, this study aimed to evaluate the detailed regeneration process of ENS neuronal subclasses from chagasic patients with megacolon and non-infected individuals. For this, we used a marker of neuronal regeneration (GAP-43) associated with a pan-neuronal marker (Peripherin) and various neuropeptides markers (cChat, substance P, neuropeptide Y, VIP and NOS). Thus, to assess the ability of various subclasses of neuronal regeneration, we verified that the levels of regeneration cChat, substance P and neuropeptide Y are similar in Chagas´ patients and non-infected individuals. However, VIP and NOS neuronal regeneration levels are increased in chagasic patients when compared to non-infected individuals. We believe that the increase in regeneration rate of these neurons may be a consequence of the selective neuronal destruction, representing an attempt to replenish neuronal classes most affected.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Objectives: To compare the perfusion of ophthalmic artery of pregnant smokers and nonsmokers by Doppler index. Correlate these with acute and chronic phase of tobacco consumption, cigarettes per day, years smoking and carbon monoxide expired (COex). Method: Transversal study involving 70 pregnant smokers divided into A group (AG): 33 pregnant women who smoked up to two hours and B group (BG): 37, who smoked between 2 to 24 hours before test. Control group (CG) was made up of 51 pregnant nonsmokers. Doppler ophthalmic artery test was carried out using Medison Sonoace 8000SE multifrequency linear transducer equipment. Coex was measured using portable piCO+ Smokerlyzer_Bendfont CO monitor. Other variables of all smokers taking part were verbally questioned. Doppler indexes were assessed: PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), PI (Pulsatility Index), RI (Resistance Index) and PR (Peak Ratio). ). For assessment of nicotine dependence was used the Fagerstrom Test for Nicotine Dependence (FTND). Groups were compared using ANOVA, Kruskal-Wallis test, Student's t test, Mann-Whitney and Spearman s correlation coefficient, with p<0.05. Results: RI and PI were higher (p<0.01) and PSV and EDV were lower (p<0.05) in B group compared to A group and control. A group were higher PR (p<0.01) compared to control. AG presented years of smoking (p:0.91), cigarettes per day (p:0.048), COex (p:0.003) and interval of last cigarette (p:0.001) greater than BG. Doppler evaluation indices correlated only with the interval of the last cigarette. FTND in the group which smoked less than 2 hours was 6 +/- 3 and in the group which smoked between 2 and 24 hours was 4 +/- 3 (p:0.002). Conclusions: The ophthalmic artery in pregnant smokers show a biphasic pattern in accordance with the time of consuption of the last cigarette. There is vasoconstriction and hypoperfusion to tobacco exposure between 2 and 24 hours and vasodilatation and hyperperfusion to exposure acute. The variation of the perfusion correlated only with the exposure of time last cigarette. There was correlation between the Fagerstrom Test for Nicotine Dependence and the level of carbon monoxide exhaled in population of pregnant smokers.

Multiple sclerosis (MS) is a chronic disease which may exert significant effects on the lives of patients. The Kurtzke Expanded Disability Status Scale (EDSS) remains the most widely used outcome measure in MS, despite its limitations. The use of healthrelated quality of life (HRQoL) as outcome measure has been increasing in the last years, with development and utilization of several instruments. One of most utilized is the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), a generic measure utilized for general population and for many diseases, including MS. The goals of this study are to assess psychometric properties of SF-36 (Brazilian version) in MS patients, and measure HRQoL in MS patients in the city of Uberlândia, state of Minas Gerais, Brazil. HRQoL was measured in 23 MS patients and in 40 subjects of general population (blood donors) in Uberlândia, using the Brazilian version of the SF-36. EDSS score was assigned by neurologic examination at the time of interview. Reliability and validity of SF-36 were assessed. Mean scores of SF-36 domains in general and MS patient groups, general and MS patient subgroup with EDSS < 3.5, and MS patients with EDSS < 3.5 e > 4.0 were compared. Correlations among clinical aspects of disease and SF-36 scores were assessed. The Brazilian version of SF-36 is reliable and valid for use in MS patients. MS patients show lower scores in all SF-36 scales than do the general population, principally in physical function domains (p<0.05). Patients with EDSS scores < 3.5 also show lower scores in all SF-36 scales than control group. The patients with EDSS scores < 3.5 have higher mean scores in physical functioning, bodily pain, general health and energy/vitality domains than do the patients with EDSS scores > 4.0 (p<0.05). There is no correlation among time of disease and time since diagnosis with SF-36 scores. Depressive symptoms and heat intolerance show correlation with SF-36 domains and components. In conclusion, the Brasilian version of SF-36 is valid to measure HRQoL in MS patients. MS patients have a significant negative impact on all HRQoL domains measured by SF-36, including mental and social domains, compared with general population, even in the stages with less disability. Physical SF-36 scales, but not mental and social scales, decrease with EDSS progression.

Introduction: Medical and nursing students are at risk of acquiring infections through occupational accidents due to inexperience and lack of skill in procedures with patients. Objective: To determine the frequency of occupational exposures, risk factors and inadequate post-exposure behaviors among these students in a public university of Southeastern Brazil. Methods: This cross-sectional study was performed in the end of the second semester of 2010. To collect demographic data and the frequency of possible occupational accidents and its characteristics, an anonymous, self-administered and semi-structured questionnaire was distributed to all medical students who were in the clinical course, and for all nursing students who had practical activities at a university hospital. This research project was approved by the Research Ethics Committee of the Universidade Federal de Uberlândia. Results: The questionnaire was completed by 253/320 (79.1%) medical students and 149/200 (74.5%) nursing students. Among medical students, 53 (20.9%) had suffered 73 accidents, which occurred mainly in extracurricular activities (33%); with cutting or piercing objects (56.2%); in the emergency room (39.7%); as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%), in the operating room or wards (72.2%), as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instruction on exposure prevention previously; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 83.8% and 85.2% had no knowledge about the behaviors that should be performed after such exposures; 97.2% and 85.9% were unaware about the behaviors that must be taken in case of contact with body fluids of patients with HIV, HBV and HCV; and 1.4% and 18.9% officially reported injuries. Conclusions: We observed high frequency of occupational exposures among medical and nursing students, low level of knowledge about prevention and post-accidents procedures, and the need for structured training for "standard precautions" to prevent occupational exposures.

The combination of epidemiological, molecular and immunological tools and geographical information system (GIS) can elucidate not only clusters of cases of leprosy, as well as groups at higher risk of developing the disease among household contacts. This study characterized the leprosy in Uberlândia / MG, Brazil, from 2001 to 2008, using epidemiological indicators and GIS for surveillance of infection with M. leprae in household contacts and patients seropositive to ELISA anti-PGL-1 and / or PCR to detect the M. leprae DNA in nasal and buccal swabs. A number of 683 leprosy cases were georeferenced and 262 positive contacts for these exams. Reported cases was observed in the operational classification that more MB was the predominant (67.2%), the clinical form D was the most prevalent (47.9%), the disability grade 2 at diagnosis was 11.1 %. Men accounted for 58.7% of new cases, a rate male/female 1.4, the predominant age group was 35 to 59 years (50.5%). As for the epidemiological indicators, the annual detection rate new cases ranged from 11 to 20 cases remained as highly endemic, with 13.3 cases per 100,000, showing a decline of 35% in detecting new cases at the end of 2008 (p <0.05). The annual detection rate of new cases in children under 15 years ranged from 0 to 2.2 cases to 1.4 cases per 100,000 inhabitants in 2008, maintaining endemic average parameter that indicates recent and active infection in the city. The coefficient ratio new cases with disability grade 2 at diagnosis ranged from 4.2% to 24.3%, with a proportion of 12.7% in 2008, with a high parameter of disabled, indicating a late diagnosis and the evaluation and improvement or record of disability. The detection rates of new cases in 2001 were higher in SSS and SSO, and in 2008, remained high in the SSS and moved to the SSN SSO, coinciding with the expansion of industrialization of the city center, where there was an increase in population density. Clusters hyperendemic leprosy were identified in the SSC and the SSS and these both districts that received the graduates of the leprosy colonies in the 60 and 70 and where it still remains a big factor stigma surrounding the disease by the presence of sequelae. The surveillance of infection with M. leprae in household contacts found that 15.7% of infected and healthy carriers of the bacillus, distributed in 7.2% seropositive to ELISA anti-PGL-I, 5% positive buccal swab and 3.8% in the nasal swab for detection the M. leprae DNA. The highest positivity was found in contacts of index cases MB. As for the ELISA, the seropositivity was higher in women (64%). It was shown in a cluster of infected contacts and SSS or healthy carriers (ELISA seropositive anti-PGL-I and positive to detection the M. leprae DNA), coinciding with the most hyperendemic cluster of cases reported during the entire period, corroborating the hypothesis that this factor remains large district of stigma, making measures of impact on health education for voluntary submission of suspects. Following the 1.4% developed leprosy contacts indicating a nine times greater chance of getting sick in the positive contacts. The PCR positivity did not confer greater risk of illness for these contacts, but demonstrated the potential of transmission of subclinical same, spreading the bacillus in endemic areas. These factors incriminated in this study are of great importance in maintaining the epidemiological chain of transmission, which would impose new intervention strategies such as chemoprophylaxis of contacts. GIS with the epidemiological indicators of evaluation of morbidity and burden of disease associated with immunological and molecular tests of the population at risk has proven to be a tool that enables visibility of leprosy by health district and neighborhoods of cities allowing to improve the surveillance of this disease and serving as an important tool to support planning of health policies to eliminate leprosy as a public health problem.

Introduction: The services of Primary Health Care attend significant part of the Brazilian population, in which alcohol abuse may be a common condition. Primary Health Care professionals are in a favorable position for identifying and managing patients with problems related to alcohol consumption. Objectives: To determine the patterns of alcohol consumption among patients attended in Primary Health Care in a city in Southeastern Brazil. Also, the frequency of questioning patients about their alcohol consumption and recognition of them as risk drinkers, the characteristics of this approach by physicians, the level of knowledge and barriers observed by physicians in screening the alcohol consumption were also investigated. Materials and Methods: This cross-sectional study was conducted in 41 Family Health Units in the city, from November 2010 to November 2011. We interviewed the patients to collect sociodemographic data, assessed the alcohol consumption through questionnaires Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed by criticism, Guilty, Eye-opener (CAGE), and analyzed their medical records to check the frequencies of recognition of alcohol abuse by physicians, and the conduct adopted towards it. Afterward, the 41 Family Health physicians answered a questionnaire about the management of patients in relation to alcohol consumption and their difficulties with this approach. Results: A total of 932 adult patients (576 women and 356 men) were interviewed. Overall, 17.5% had AUDIT ≥ 8 and 10.5% had positive CAGE; among them only 12.6% were recognized as alcoholics, and in approximately 50% of their medical records there was no notes on the conduct adopted by the professional. Men showed risk use (AUDIT ≥ 8), positive CAGE, were asked about alcohol consumption and recognized as alcoholics more often than women. AUDIT ≥ 8 was more common among men who did not cohabitate with a partner, with no religion, with higher income, working and without chronic disease; and among black women, AUDIT ≥ 8 was more often in those with no religion and without chronic disease. Positive CAGE was more frequent among men 35-54 years who did not cohabitate with a partner, and among women with no religion. Questions about alcohol consumption were more frequent among men aged 35 to 54 years and/or with chronic diseases, and among black women and/or with chronic illnesses. Among the physicians, 85.4% evaluated themselves as unsafe in addressing alcohol consumption, and the use of screening instruments for alcohol consumption was not reported. The main barriers mentioned for screening alcohol consumption were lack of training and lack of time by physicians, and refusal to accept the diagnosis and to answer questions about it by patients. A large majority of physicians considered their responsibility in screening, advising and referencing, but not in treating alcohol consumption. Conclusions: Alcohol use is common among patients attended in the Family Health Units, but it is poorly recognized by professionals and a minority of alcoholics is advised about the risk of alcohol consumption. The medical reports suggest that there is a great difficulty in approaching this issue with the patient and emphasize the need to implement strategies of training and motivation for screening the alcohol consumption.

Objective: The mthfr (methylenetetrahydrofolate reductase) gene has a strong impact on DNA methylation, biosynthesis and repair of proliferating cells, and its most common mutation (C677T) has been linked to a reduced enzymatic activity, and consequently involved in various inflammatory diseases probably due to the homocysteine accumulation (Hcy). Methotrexate (MTX) is an antifolate agent widely used as a disease-modifying anti-rheumatic drug (DMARD) for treatment of juvenile idiopathic arthritis (JIA). The objective is to analyze the association between allelic and genotypic distribution of the C677T polymorphism of the gene encoding MTHFR and susceptibility to JIA. Method: A cross-sectional study included 38 patients with JIA and 22 healthy controls, with age range from 3 to 22 years. JIA patients were under MTX treatment, and were monitored for adverse events. Laboratorial analyses and clinical examinations, including toxicity data, were performed during 16 months. Patients underwent peripheral blood sampling for DNA extraction and subsequent analysis by Polymerase Chain Reaction and Sequencing to determine if there were changes in the amplified region. Results: JIA occurrence was significantly associated with the 677T allele and its genotypes (P<0.01). The odds ratios for T allele and genotypes (CT and TT) were eight-times higher towards the disease manifestation, suggesting a dominance effect of the T allele. There was no significant correlation between the C677T polymorphism and laboratorialy analyses and medical history (p>0.05), which was not associated with adverse reactions to MTX therapy (p>0.05) either. We found a new polymorphism was 678 not yet described in the literature. Conclusion: JIA was significantly affected by the polymorphism in the MTHFR gene at the C677T genomic region. The increased prevalence of CT and TT genotypes in JIA patients indicated a dominance effect of the T allele. However, this polymorphism was not associated with MTX intolerance, suggesting that accumulation of substrate is not related to the incapacity of patients to sequester MTX and prevent cellular detoxification.

Objective: To translate into Portuguese and to culturally adapt the malnutrition screening tool for hospitalized children, Strongkids. Methods: This study documents the translation of the tool from the original version (English) into Portuguese. The translation and cultural adaptation of the content of this tool consisted of six stages, according to the methodology proposed by Beaton et al (initial translation, synthesis of translations, back translation, verification of the cultural equivalence process, pre-test, and evaluation of the cultural adaptation process). In the first stage, translation was performed by two independent translators, followed by their synthesis and reconciliation; in the third one, the reconciled version was back translated and, then, a pre-final one that retained all linguistic equivalence was developed. In the fifth step, a pre-test of the pre-final version was performed in order to verify the understanding of the items and a final version of the tool was developed. Results: The pre-final version of the tool was applied to 30 parents/guardians and to 20 healthcare professionals in order to verify its understanding by both. The main alterations were the adaptation of technical terms in order to meet the recommendations of health professionals, and the adjustment of terms for parents/guardians understanding. Conclusions: The Portuguese translation of the tool was easily understood by parents/guardians and health professionals, and it should be useful to screen the risk of malnutrition in hospitalized children.

Cerebral palsy (CP) is considered the most common physical disability in childhood. This disease profoundly affects the health and well-being of its subjects and can influence multiple aspects of their caregivers, especially mothers. The objective of this study was evaluating the effect of a resistance exercises program on health related quality of life (HRQoL), burden perception and intensity of depressive symptoms of mothers of children and adolescents with CP. Twenty-two sedentary mothers able to practice resistance exercises program, caring for children and adolescents with CP, participated in a resistance exercises program, in 2 sessions per week during 12 weeks, with moderate intensity. All participants answered to the HRQoL questionnaires SF-36, Caregiver Burden Scale (CBS) and Beck Depression Inventory (BDI) before and after the intervention program. The scores obtained in the questionnaires before and after the intervention were compared using the Wilcoxon test and the magnitude of the differences was measured by effect size. The median age of the mothers was 41 years, ranging from 18 to 58 years. The median age of children and adolescents was 14 years, ranging from 3 to 21 years. The SF-36 scores were significantly higher after the intervention (p <0.05), except in role physical and role emotional domains, which already scored the highest value before the intervention. CBS and BDI scores were significantly reduced after intervention (p <0.05). The results showed that the regular practice of resistance exercise has a positive impact in HRQoL, burden perception and intensity of depressive symptoms of mothers caregivers of children and adolescents with PC.

The present study aims to evaluate the psychometric properties of the Brazilian version of the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQEI), applied to children with cerebral palsy. The questionary was answered by 45 children with cerebral palsy and 45 healthy children aged 5 to 12 years. The following psychometric properties of the AUQEI were evaluated: data quality (missing data, floor effect and ceiling effect), reliability and validity. The missing data rate varied from 8.8% to 46.7% among the factors, being the largest value found in the autonomy dominion. The floor effect was 0% for the factors. The ceiling effect varied 0 to 4.4% among the factors. In assessing the reliability of the internal consistency of the item the success rate was less than 80.0% only for the autonomy factor (40.0%). The Cronbach alpha coefficient was 0.71 for the general analysis of the instrument and <0.50 for the factors. All factors had a success rate > 80.0% for discriminated validity of the item. The factors were not correlated with each other, in general, indicating adequate discriminated validity. Only the function factor had correlations with the family factors (r = 0.47 and p<0.01) and autonomy (r = 0.41 and p<0.01), because there was no correlation between the factors and the total score of AUQEI with scores of Gross Motor Function Measure (GMFM) (p>0,05), in the assessment of divergent validity. In the construct validity, the total score obtained by AUQEI the patients group was lower (median: 47.0) than the healthy group (median: 51.0) (p<0.01, effect size = 0.89). In conclusion, the AUQEI proved to be a reliable and valid instrument for assessing children with CP when utilizing its total score. The reliability was not adequate for the use of the factors separately. The autonomy factor had higher rates of missing data and lower internal consistency reliability of the items.

Protocols of weaning from mechanical ventilation can improve patient outcomes, although results varied according to different populations. The aim of this study was to evaluate the impact of implementing a multidisciplinary protocol of weaning from mechanical ventilation in intensive care unit of a Brazilian university hospital. We conducted a prospective cohort before and after implementation of a protocol of weaning from mechanical ventilation in adult patients hospitalized in the unit, remained on mechanical ventilation for more than 24 hours and subjected to weaning from mechanical ventilation. We evaluated 96 patients before the implementation of the protocol and 139 patients after. In the first group, weaning was performed according to usual care and decision of physician. In the second group, used data in a systematic protocol and evaluated by a multidisciplinary team. Weaning from mechanical ventilation duration decreased from 6,8 to 3,6 days (p <0,001) and mortality in the intensive care unit from 14,6% to 7,2% (p: 0,03), with increased likelihood survival during hospitalization (p: 0,016) in the protocol group. Furthermore, the protocol was an independent predictor for discharge from the unit. However, it increased the unit stay (23,9 ± 18,5 x 18,6 ± 14,35 days, p: 0;009). We conclude that weaning from mechanical ventilation guided by a multidisciplinary protocol reduced mortality in the intensive care unit and length of mechanical ventilation weaning, but increased length of stay.

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Introduction: Social reintegration is one of the most challenge for those affected by saddle nose deformity due to leprosy. The nasal reconstruction becomes extremely important in the rehabilitation of disfigured victims. This study aimed to describe the technique of structural rhinoplasty with autologous costal cartilage for nasal reconstruction in patients with saddle nose deformity due to leprosy and evaluate the aesthetic results, functional and patient. Methods: A descriptive study was conducted evaluating 10 patients with lepromatous leprosy, who had saddle nose, followed at the National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) / HC / UFU, who underwent structural rhinoplasty with costal cartilage graft, which had already been discharged from polychemotherapy and there were at least one year without leprosy reaction. Results: The preoperative symptoms were, more common, aesthetic complaints and nasal obstruction (100%), followed by nasal crusting (80%), epistaxis (70%) and nasal whistling (20%). After surgery, there was an improvement in nasal obstruction in 70% of patients, nasal crusts in 87.5%, and epistaxis in 85.7% of patients. Corrections of external nasal valve dysfunction were achieved in 100% of patients. Columellar retraction and asymmetry of the nasal tip were observed in 80% and 90% of patients. In total, 62.5% and 55.5% of patients showed improvement after surgery, respectively. The increase of the nasal dorsum was performed with en block graft of costal cartilage, and diced cartilage wrapped in fascia. The resorption and diversion of cartilage grafts were minimal and did not result in significant changes in patient satisfaction. Conclusion: structural rhinoplasty with costal cartilage grafts permits a good quantity of cartilage in the manufacture of allowing a safe nasal reconstruction of the saddle nose due to leprosy. The use of diced cartilage wrapped with temporal fascia increased the nasal dorsum in patients with saddle nose by leprosy and showed a lower risk of twisting and allowed a more natural appearance to the nasal dorsum with satisfactory result. The septal L-strut reconstruction was essential in structuring the nose leading to good functional outcome, improvement of nasal patency, as well as decreased postoperative scar retraction at the post-operative time. According to the degree of satisfaction, patients reported improvement in quality of life and greater social acceptance due to good functional and aesthetic results with increased nasal patency.

Spread of multidrug-resistant microorganisms is a worldwide public health problem. Antimicrobial use in hospitals, especially in Intensive Care Units (ICU) induces and selects resistant microorganisms. These are disseminated through colonized health professionals and patients circulating in the areas intra and inter- hospitals. The aim of this study is to identify the frequency with which patients admitted to Intensive Care Units and healthcare professionals, who provide direct care to them, move between different institutions and the indicia of possible causal relationship between the transit and the occurrence of pathogens microorganisms and antimicrobial resistance. Interviews were conducted with health professionals working in hospitals Intensive Care Units in the cities of Uberlândia and Patrocínio. Microbiology databases of the each hospital were also consulted as well as patients medical records. About half of the interviewed health professionals provide assistance in more than one institution and about a quarter also performed activities in different sectors within the same hospital. Three hundred seventy-six (12.32%) patients had undergone transference, but this percentage varies for each hospital (p = 0.0000). In all studied ICUs the bacteria most frequently isolated so far were: Pseudomonas aeruginosa, Staphylococcus aureus, coagulase-negative Staphylococci, Acinetobacter baumannii, Klebsiela pneumoniae, Escherichia coli, Enterobacter cloacae and Enterococcus faecalis. Bacterial resistance to antimicrobials was also similar in the six ICUs. We conclude that patients and mostly health professionals frequently move between different sectors of the same hospital and between other hospitals in the study region. Therefore, the transit may have epidemiological importance, which is suggested by the similarity of microorganisms isolated in hospitals in the present study.

Introduction: Peripherally inserted central catheters (PICCs) are devices that are used for venous access in neonates. Despite the benefits of PICCs, there may be complications related to their insertion and maintenance. Objective: The objective of the present study was to identify the indications and complications of PICCs. Design: This prospective study included 44 neonates with birth weights less than or equal to 1,500 grams and gestational ages less than 37 weeks who underwent 52 PICC insertions between June 2011 and January 2012. A form was used to collect data on the characteristics of the neonates, including clinical indications for PICC insertion, PICC insertion location and positioning, length of PICC usage, complications and PICC removal. Main results: Prolonged intravenous therapy (94.2% of PICCS), especially involving parenteral nutrition and antimicrobial use, were the main indications for PICC insertion. The neonates had an average age of 5.18 days at the time of PICC insertion, and 38.5% of the PICCs were inserted into neonates aged between 4 and 6 days. The cephalic vein was the most common vessel used for insertions (48.1%). The most frequent complications were mispositioning (67.3%), sepsis (21.1%), difficult progression of the catheter during insertion (17.3%), post-insertion bleeding (9.6%) and signs of inflammation (9.6%). Accidental exits were infrequent. Conclusions: Monitoring and evaluating the occurrence of PICC complications and training the nursing staff on proper PICC handling ensures the safe and effective handling of preterm neonates with very low birth weight.

Pseudomonas aeruginosa is a gram negative bacillus with cosmopolitan distribution. Considered opportunistic pathogen, rarely causes disease in healthy persons. Has naturals and acquireds mechanisms of resistance, doing the clinical handling to be hard. The resistance of multiple drugs have been related in several studies becoming a problem in the hospitals. The proposal of this study was to know the epidemiology of occurrence and antimicrobial resistance of clinical samples of Pseudomonas aeruginosa at a teaching hospital in the countryside of Brazil.Treated from the retrospective analytic observation study, with cases series, P.aeruginosas were studied from the several sites from patients hospitalized in the Clinical Hospital from the Uberlandia`s University Federal (HC-UFU) between 01 April 2010 and March 2011. Positive cultures and patients related to them were identified by searching records of the Clinical Analysis Laboratory of the Hospital de Clinicas, Federal University of Uberlândia. Patient data were obtained from medical records and from the hospital system, \"Hospital Information Service\". It was considered only the first strain from the each patient. The last strain from the patients who isolated more than one strain was used to evaluate the resistance development, even in different sites. Used to statistical analysis the X squared test, calculated in Epi Info program version 3.5.2 and was considered p value of less than 0.05 like statistically significant. 251 patients were assessed. Mean age was 40 years old, male sex prevailed (67.7%). The most common sites were respiratory tract (70; 27.7%), blood/vascular catheter (55; 22.0%) and urine (54; 21.5%). One hundred and twenty (47.8%) patients died, 128 (51.0%) were discharged, two (0.8%) were transferred to another hospital and one (0.4%) was chronically hospitalized until the end of study. Eighty-one (32.2%) patients had more than one positive culture. Except for colistin (sensitivity 100.0%), amikacin was the antibiotic with a higher sensitivity percentage (86.1%).Pseudomonas aeruginosa is a bacterium mainly isolated in the airway, blood/vascular catheter and urine, especially in patients hospitalized for a long time. Almost half of the patients progressed to death. In the hospital studied, there was no colistin-resistant strain, but there were strains exclusively sensitive to this antimicrobial. Other strains were mainly sensitive to amikacin.