Revista Do Instituto De Medicina Tropical De Sao Paulo最新文献

Hospital-associated infections (HAIs) pose significant risks in clinical settings, and sterile supply centers management plays a crucial role in infection control. This systematic review and meta-analysis aimed to evaluate the impact of supply center management on the incidence of HAIs and adverse events. The systematic review encompassed studies that compared supply center management protocols with standard care. The PRISMA guidelines were followed to search seven databases for relevant studies. The meta-analysis calculated pooled odds ratios (OR) for HAIs and adverse events, and heterogeneity was assessed using Tau2, Chi-squared, and I2 statistics. Eight studies were included in the final analysis, each assessing intervention efficacy. The results revealed a significant reduction in HAIs (pooled OR=0.3; 95%CI [0.19; 0.49]). Adverse events were also significantly reduced (pooled OR=0.15; 95%CI [0.09; 0.25]). Heterogeneity was low for both HAIs (Tau2=0.00; I2=0%) and adverse events (Tau2=0.04; I2=19%), which indicated a consistent effect across the studies. Sterile supply center management significantly reduced the incidence of HAIs and adverse events. This suggests these interventions are effective in improving clinical outcomes and could be a vital component of infection control strategies in healthcare facilities.

This review explores the landscape of prevalent zoonotic diseases in Sao Paulo State, Brazil, focusing on the role of bats as reservoirs and the application of molecular biology in the diagnosis. The zoonoses covered include visceral and cutaneous leishmaniasis, Chagas disease, toxoplasmosis, bartonellosis, Q fever, Brazilian spotted fever, and leptospirosis. Molecular techniques can improve public health responses by accurately identifying pathogens and tracking their transmission dynamics in populations, thus enhancing early detection, characterization of strains, and monitoring of disease outbreaks. By elucidating the epidemiology and molecular aspects of zoonoses associated with bats in Sao Paulo State, we highlight the importance of integrated surveillance systems and multidisciplinary approaches to effectively manage and prevent these diseases.

Tuberculosis (TB) is the most common comorbidity in people living with HIV/AIDS (PLWH), including those under antiretroviral treatment. PLWH are 28 times more likely to develop TB in Brazil, the leading cause of HIV-related deaths globally, with approximately 161,000 reported deaths worldwide in 2023. Early diagnosis of latent tuberculosis infection (LTBI) and prophylactic therapy can reduce TB cases, prevent disease progression, and decrease transmission in high-risk populations. This study assessed the prevalence of LTBI in PLWH using the interferon-gamma release assay (IGRA) and the impact of the 3HP regimen (isoniazid [INH]/rifapentine [RPT]) as prophylactic treatment. Blood samples from 335 PLWH (78% of the 427 in the cohort) were tested for IGRA; 50 PLWH (15%) tested positive and were treated with 3HP. Treatment included 900 mg of INH and 900 mg of RPT in 12 weekly doses according to the Brazilian health guidelines. No specific risk factors, including nadir CD4+T count, age, gender, or antiretroviral therapy (ART), were more frequently observed in the PLWH with LTBI compared to the PLWH without LTBI. All PLWH with LTBI received treatment and no cases of active TB were observed. Our findings highlight the need for wider LTBI screening and treatment among PLWH in the latent phase, emphasizing more stringent approaches for implementing 3HP prophylaxis.

Tuberculosis (TB) is a treatable disease and one of the leading causes of death worldwide, notably affecting people living with the human immunodeficiency virus. The COVID-2019 pandemic worsened TB outcomes, particularly in high-burden countries such as Brazil. Accurate data on the mortality of hospitalized patients is limited. This study aimed to evaluate clinical and epidemiological characteristics and identify mortality risk factors among all hospitalized patients with TB at a tertiary hospital in Midwest Brazil from 2017 to 2019. The median age of the 154 patients included in the study was 48 years (interquartile range: 38-59 years), and the majority were male (74.68%). The main comorbidities were diabetes mellitus and chronic obstructive pulmonary disease; 44 patients (28.57%) were admitted to the intensive care unit (ICU). The mortality rate was 33.12%, and the leading cause of death was septic shock, followed by respiratory failure due to TB. The main factors associated with death were age (p=0.001), central nervous system TB (p=0.026), reduced consciousness (p<0.001), ICU admission (p<0.001), mechanical ventilation (p<0.001), use of vasoactive drugs (VAD) (p<0.001), and duration of VAD use (p=0.038). A high rate of inpatient deaths was observed, reflecting the severity of TB and the challenges in its clinical management. It is imperative to implement strategies to reduce the mortality rate.

We conducted a prospective randomized controlled trial to evaluate the effect of evidence-based nursing care on length of hospital stay, duration of mechanical ventilation, symptom relief, and complication rates among mechanically ventilated children with severe adenovirus pneumonia. A total of 257 children admitted to Hunan Provincial People's Hospital in Changsha from February 2018 to December 2021 were enrolled. Two patients withdrew from the study, resulting in 124 cases in the conventional care group and 131 cases in the evidence-based care group. Primary outcomes included time to resolution of signs and symptoms, length of hospital stay, complication rates. Secondary outcomes were blood biomarker levels and successful weaning results. The evidence-based care group demonstrated significantly higher overall efficiency than the conventional care group (98.47% vs. 95.97%, p<0.05). Additionally, the evidence-based care group demonstrated quicker resolution of cough, sputum, pulmonary rales, and fever, shorter hospital stays, and reduced need for mechanical ventilation (p < 0.05). The evidence-based care group had a significantly lower complication rate than the conventional care group (9.16% vs. 25.00%, p < 0.05). Post-care blood biomarker analysis showed decreased levels of leukocytes, calcitonin, and C-reactive protein in the evidence-based care group compared to the conventional care group (p<0.05). Evidence-based nursing interventions can improve outcomes for children with adenovirus pneumonia by reducing comorbidities, improving blood gas levels, reducing inflammatory responses, and improving the weaning success rate of mechanically ventilated children with severe adenoviral pneumonia.

Leeches are segmental worms commonly found in fresh water in tropical regions. They can enter the human body via the consumption of contaminated water or through the mouth and nose during washing, generally affecting the upper airway and digestive tract. During the blood-sucking process, the leech releases the anticoagulant enzyme "hirudin" from the wound site into the host's circulation together with an anesthetic to prevent the host from feeling its attachment. Leech endoparasitism is a very rare cause of epistaxis. We report a case of a living leech lodged in the posterior nasal floor in a patient that presented to the emergency department with unilateral epistaxis and a difficult diagnosis.

This study reports the first documented case of COVID-19-associated pulmonary aspergillosis (CAPA) caused by Aspergillus welwitschiae in the Americas, which occurred in a rural area of Sao Paulo State, Brazil. The case involves a 52-year-old woman with COVID-19, hypertension, and dyslipidemia, who was admitted following severe respiratory deterioration. Imaging tests revealed extensive pulmonary involvement, including nodular and cavitary lesions indicative of CAPA. Bronchoalveolar lavage (BAL) analysis identified Aspergillus spp. using morphological and molecular techniques, and sequencing of the benA gene confirmed the isolate as A. welwitschiae, closely related to the reference strain CBS 139.54. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry further validated this identification. Traditionally recognized as a plant pathogen, A. welwitschiae has recently been implicated in human diseases, such as otomycosis, and is increasingly detected in respiratory samples. However, its association with CAPA remains underreported globally, particularly in the Americas. This case highlights the critical importance of accurate fungal diagnosis, as overlapping morphological features among Aspergillus species can hinder clinical management. The identification of A. welwitschiae in this context raises concerns about its potential as an emerging pathogen in agricultural regions, where environmental exposure may drive its epidemiological relevance. Given the growing recognition of A. welwitschiae as a CAPA agent, this report underscores its importance in the epidemiology of the disease and its potential role in regions with high agricultural activity. Accurate identification is essential for guiding targeted interventions and addressing the public health risks posed by this emerging fungal threat toCOVID-19 patients.

Myiasis, a condition stemming from the parasitic infestation of Diptera fly larvae, constitutes a complication for cancer patients, particularly those with malignant skin wounds. The factors that contribute to myiasis include old age, inadequate hygiene, poor living conditions, vascular disease, and diabetes. Cases of myiasis in neoplastic wounds in the head and neck region are rare and guidelines or recommendations regarding the best treatment approach remain lacking. Herein, we describe a case of myiasis that developed into an extensive squamous cell carcinoma of the lip in an older male adult due to the delay in oncological treatment stemming from the COVID-19 pandemic. Patients with oral squamous cell carcinoma, especially those residing in rural areas, face a notable risk of developing oral myiasis. Therefore, it is imperative that patients and caregivers adopt strict preventive measures to avoid fly infestations in wounds. Maintaining optimal hygiene (including meticulous cleaning with antiseptic solutions before daily dressing changes) is essential to prevent myiasis. Adequate wound coverage is crucial, especially during warmer seasons.

Although ketamine is an FDA-approved drug, its mechanism of action is not fully understood. Currently, there is an increase in its recreational use, causing irreparable social and physical damage. We report the case of a musician who developed sepsis due to gas necrosis in his arm after using veterinary ketamine purchased via the internet. Despite the amputation recommendation, it was possible to save the arm and preserve motor and sensory function. The scientific community, as well as the police and the government, must ponder the prescription, efficacy and safety of ketamine for medical treatments.