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Arns B, Horvath JDC, Rech GS, Sesin GP, Agani CAJO, da Rosa BS, Dos Santos TM, Brochier LSB, Cavalcanti AB, Tomazini BM, Pereira AJ, Veiga VC, Nascimento GM, Kalil AC, Zavascki AP. A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol. Infect Dis Ther 2024; 13:237-250. [PMID: 38102448 PMCID: PMC10828314 DOI: 10.1007/s40121-023-00897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Shorter courses of antimicrobials have been shown to be non-inferior to longer, "traditional" duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. METHODS This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. PLANNED OUTCOMES The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. CONCLUSION The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. TRIAL REGISTRATION ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE).
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Affiliation(s)
- Beatriz Arns
- Responsabilidade Social-PROADI, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
- Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS, 90035-000, Brazil
| | | | - Gabriela Soares Rech
- Responsabilidade Social-PROADI, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Alexandre P Zavascki
- Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS, 90035-000, Brazil.
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Arns B, Agani CAJO, Sesin GP, Horvath JDC, Fogazzi DV, Romeiro Silva FK, Costa LS, Pereira AJ, Nassar Junior AP, Cavalcanti BT, Dietrich C, Veiga VC, Catarino DGM, Cheno MY, Biasi A, Ferronatto BR, Bassetti BR, Fernandes CCF, Deutschendorf C, Grion CMC, Vidal CFDL, de Oliveira CD, Caser EB, Boschi E, Silva EM, Pizzol FD, Urbano HCDA, Silva I, Maia IS, Rego LRDM, Oliveira LP, Tavares MB, Dracoulakis MDA, Bainy MP, Golin NA, Tomba PO, Kurtz PMP, Foernges RB, Prestes RM, de Melo RMV, Da Silva RR, Toledo TGP, Lima VP, Fernandes VDF, Lovato WJ, Zavascki AP. Erratum: Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study - CORRIGENDUM. Antimicrob Steward Healthc Epidemiol 2023; 3:e102. [PMID: 37396195 PMCID: PMC10311685 DOI: 10.1017/ash.2023.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
[This corrects the article DOI: 10.1017/ash.2023.136.].
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Arns B, Agani CAJO, Sesin GP, Horvath JDC, Fogazzi DV, Romeiro Silva FK, Costa LS, Pereira AJ, Nassar Junior AP, Cavalcanti BT, Dietrich C, Veiga VC, Catarino DG, Cheno MY, Biasi A, Ferronatto BR, Bassetti BR, Fernandes CCF, Deutschendorf C, Grion CMC, Vidal CFDL, de Oliveira CD, Caser EB, Boschi E, Silva EM, Pizzol FD, Urbano HCDA, Silva I, Maia IS, Rego LRDM, Oliveira LP, Tavares MB, Dracoulakis MDA, Bainy MP, Golin NA, Tomba PO, Kurtz PMP, Foernges RB, Prestes RM, de Melo RMV, Da Silva RR, Toledo TGP, Lima VP, Fernandes VDF, Lovato WJ, Zavascki AP. Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study. Antimicrob Steward Healthc Epidemiol 2023; 3:e79. [PMID: 37179767 PMCID: PMC10173283 DOI: 10.1017/ash.2023.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 05/15/2023]
Abstract
Objective Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. Methods This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. Results In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. Conclusions In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.
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Affiliation(s)
- Beatriz Arns
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Infectious Diseases Service, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Author for correspondence: Beatriz Arns, MD, Rua Ramiro Barcelos, 630, sala 815. Bairro Moinhos de Vento, Porto Alegre - RS, Brazil. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emerson Boschi
- Hospital Geral de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | | | | | | | - Iany Silva
- Santa Casa de Misericórdia de São João Del Rei, São João del Rei, Minas Gerais, Brazil
| | - Israel Silva Maia
- HCor Research Institute, São Paulo, Brazil
- Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil
| | | | | | | | | | - Marina Peres Bainy
- Hospital Escola Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Pablo Oscar Tomba
- Hospital do Cancer Barretos, Unidade Jales, Jales, São Paulo, Brazil
| | | | | | | | | | | | | | - Valéria Paes Lima
- Hospital Universitário de Brasília, Brasília, Federal District, Brazil
| | | | - Wilson José Lovato
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Prehn Zavascki
- Infectious Diseases Service, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Bezerra I, Rodrigues M, Sousa EM, Malicia J, Prestes R, Rêgo RC, Mendes A, Sousa A, Nassar Junior AP, Pereira AJ. Patient-level costs in intensive care: a case report of a standardized and scalable approach. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Intensive care units (ICU) costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs (Value-Based Healthcare).
Methods
Case report of a costing methodology implementation, in a 15-bed ICU, in a public, teaching hospital at Teresina/Piauí-Brazil (as part of a broader initiative, with 10 hospitals from all Brazilian regions). All costs incurred during ICU stay were measured from the hospital perspective, applying absorption costing method, by using a standardized approach and a specific central IT system. The study was carried out from Oct/19-Sep/20, including 613 patients, and a team of 10 researchers working with 4 teams of the local hospital (costs, IT, ICU and managers).
Results
ICU fixed costs (personnel, overheads, energy/water, depreciation, non-tracked drugs/medical materials), were divided by service capacity (total bed-hours) for calculation of the costs/minute. Costs were then allocated in the patient level multiplying costs/minute by the ICU length of stay. Variable costs (lab/image tests, transfusions, hemodialysis, and traceable medical materials/drugs) were directly allocated, multiplying the unit cost by the volume consumed per patient. A mini-survey applied 1-year after showed that both cost researchers and hospital staff agreed on the main challenges in measuring patient-level costs (fragmented process; fixed costs available only at the hospital level; lack of control on cost-drivers; indirect costs not considered; any reference for lab/image costs) and that the approach was sufficient to overcome them. The local team also reported increased awareness about the importance of patient-level costs after the experience.
Conclusions
The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
Key messages
ICU costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs. The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
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Affiliation(s)
- I Bezerra
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - M Rodrigues
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - EM Sousa
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - J Malicia
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - R Prestes
- Hospital of the Federal University of Piauí, Teresina, Brazil
| | - RC Rêgo
- Hospital of the Federal University of Piauí, Teresina, Brazil
| | - A Mendes
- Hospital of the Federal University of Piauí, Teresina, Brazil
| | - A Sousa
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - AP Nassar Junior
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - AJ Pereira
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Noritomi DT, Ranzani OT, Ferraz LJR, Dos Santos MC, Cordioli E, Albaladejo R, Serpa Neto A, Correa TD, Berwanger O, de Morais LC, Schettino G, Cavalcanti AB, Rosa RG, Biondi RS, Salluh JI, Azevedo LCP, Pereira AJ. TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE): protocol for a cluster-randomised clinical trial on adult general ICUs in Brazil. BMJ Open 2021; 11:e042302. [PMID: 34155070 PMCID: PMC8217943 DOI: 10.1136/bmjopen-2020-042302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Daily multidisciplinary rounds (DMRs) consist of systematic patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on care performance will reduce ICU length of stay compared with a control group. METHODS AND ANALYSIS A multicentre, controlled, cluster-randomised superiority trial including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised to a complex-intervention composed by daily rounds carried out through Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8 ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an intensivist, specialised or step-down units. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board (IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for submission before the end of patient's enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each participating unit. TRIAL REGISTRATION NUMBER NCT03920501; Pre-results.
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Affiliation(s)
- Danilo Teixeira Noritomi
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Clinical Governance, DASA, Sao Paulo, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Otavio T Ranzani
- Pulmonary Division, Heart Institute, Hospital das Clinicas, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Catalunya, Spain
| | | | - Maura C Dos Santos
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo Cordioli
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Ary Serpa Neto
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
| | - Thiago D Correa
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
| | - Otávio Berwanger
- Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
| | - Lubia Caus de Morais
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Guilherme Schettino
- Institute of Social Responsibility, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- HCor Research Institute, Sao Paulo, SP, Brazil
| | - Regis Goulart Rosa
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Intensive Care, HMV, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Santos Biondi
- Instituto de Cardiologia do Distrito Federal, Brasília, Distrito Federal, Brazil
- Hospital Brasília, Brasília, DF, Brazil
| | - Jorge If Salluh
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Luciano Cesar Pontes Azevedo
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil
- Emergency Medicine Department, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Adriano Jose Pereira
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Postgraduate Program of Health Sciences, Universidade Federal de Lavras, Lavras, MG, Brazil
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Merz TM, Pereira AJ, Jeger V, Stephan JM, Jukka T, Djafarzadeh S. 0093. Mitochondrial function of immune cells in severe sepsis and septic shock - a prospective observational cohort study. Intensive Care Med Exp 2014. [PMCID: PMC4797920 DOI: 10.1186/2197-425x-2-s1-p5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pereira AJ, Jeger V, Corrêa T, Vuda M, Djafarzadeh S, Takala J, Jakob S. Hemodynamic and mitochondrial effects of enalapril in experimental sepsis. Crit Care 2013. [PMCID: PMC3643025 DOI: 10.1186/cc11995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Pereira AJ, Rehder P, Figueiredo LFP, Colombari F, Backer D, Silva E. Myocardial energy metabolism in sepsis and in anemic, stagnant and hypoxic hypoxia. Crit Care 2011. [PMCID: PMC3124154 DOI: 10.1186/cc10152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Silva E, Rehder P, Pereira AJ, Colombari F, Figueiredo LFP. Direct hepatic tissue PO2 measurements in sepsis and tamponade models. Crit Care 2011. [PMCID: PMC3124153 DOI: 10.1186/cc10151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pereira AJ, Rehder P, Dias C, Figueiredo L, Silva E. Lactate generation is not related to tissue partial pressure of oxygen levels in sepsis. Crit Care 2009. [PMCID: PMC4085405 DOI: 10.1186/cc7807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pereira AJ, Erlichman M, Cal R, Sousa E, Affonso A, Guerra M, Corrêa T, Makdisse M, Campos OSA. Animal models and methodology of case simulation: effective strategy in the training of physicians, residents and nurses in the use of the intra-aortic balloon pump. Crit Care 2009. [PMCID: PMC4085427 DOI: 10.1186/cc7829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Correa TD, Pereira AJ, Campos F, Cavalcanti AB, Passos RDH, Ferri MB, Rosa CA, Neto AC. Central venous catheterization: a randomized comparison between external and internal jugular access. Crit Care 2009. [PMCID: PMC4085462 DOI: 10.1186/cc7864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pereira AJ, Rehder P, Dias C, Figueiredo L, Silva E. Do right atrium to mixed venous oxygen saturation gradients mirror heart oxygen uptake? Crit Care 2009. [PMCID: PMC4085404 DOI: 10.1186/cc7806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cavalcanti AB, Eluf-Neto J, Pereira AJ, Caldeira M, Almeida FP, Westphal G, Beims R, Fernandes CC, Correa TD, Gouvea MR, Silva E. A computer-guided insulin protocol causes less hypoglycemia than a strict glycemic control protocol: a randomized controlled trial. Crit Care 2007. [PMCID: PMC3301211 DOI: 10.1186/cc5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pereira AJ, Cavalcanti AB, Correa TD, Almeida FP, Figueiredo EJA, Silva E. Reliability of arterial, capillary and venous point-of-care glucose measurements in the intensive care unit setting: evaluation of two glucometers. Crit Care 2007. [PMCID: PMC3301212 DOI: 10.1186/cc5872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pereira AJ, Broadbent J, Mahgoub H, Morgan O, Bracebridge S, Reacher M, Ibbotson S, Lee JV, Harrison TG, Nair P. Legionnaires' disease: when an 'outbreak' is not an outbreak. Euro Surveill 2006; 11:E061130.3. [PMID: 17213561 DOI: 10.2807/esw.11.48.03089-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
During August 2006, there was a large increase in non-travel related legionella cases throughout England and in the Netherlands.
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Affiliation(s)
- A J Pereira
- Great Yarmouth and Waveney Primary Care Trust, Beccles, Suffolk, United Kingdom.
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Pereira AJ, Lapenta AS, Vidigal-Filho PS, Machado MF. Differential esterase expression in leaves of Manihot esculenta Crantz infected with Xanthomonas axonopodis pv. manihotis. Biochem Genet 2001; 39:289-96. [PMID: 11758725 DOI: 10.1023/a:1012251228986] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The polyacrylamide gel electrophoresis system (PAGE) and inhibition tests for biochemical characterization of alpha- and beta-esterases were used to obtain a functional classification of esterases in plants and to show a differential expression of esterases as markers of pathogenesis in cassava plants (Manihot esculenta Crantz). The characterization of alpha- and beta-esterases from leaves of M. esculenta by the PAGE system was possible using an extraction solution containing two phenol-complexing agents (PVP-40 and sodium metabisulfite), three antioxidant agents (EDTA, beta-mercaptoethanol, and DTT), and one quinone reducer (ascorbic acid). Fourteen esterase isozymes were detected in young unexpanded leaves of M. esculenta cultivars. The inhibition pattern of alpha- and beta-esterases of M. esculenta showed that Est-9 is an arylesterase, and in the unexpanded leaves of the M. esculenta plants infected with Xanthomonas axonopodis pv. manihotis, the Est-7 beta-esterase showed the characteristic staining of an alpha/beta-esterase. This diffrential expression of Est-7 isozyme in young unexpanded leaves of cassava plants can be used as a marker of pathogenesis after infection with X. axonopodis pv. manihotis.
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Affiliation(s)
- A J Pereira
- Department of Cell Biology and Genetics, State University of Maringá, Parana, Brazil
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Pereira AJ, Fidel RA, Fidel SR. Maxillary lateral incisor with two root canals: fusion, gemination or dens invaginatus? Braz Dent J 2001; 11:141-6. [PMID: 11210263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Endodontic retreatment of a maxillary right lateral incisor with two root canals is described. The diagnosis of fusion, gemination or dens invaginatus could not be made, due to conflicting findings, and to previous root canal treatment that erased the original configuration of the pulp chamber.
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Affiliation(s)
- A J Pereira
- Disciplina de Clínica Integrada, Instituto de Odontologia, Universidade Gama Filho, Rio de Janeiro, RJ, Brasil.
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Abstract
Cryptococcosis is considered the most frequent fungal systemic opportunist infection in patients with AIDS. C. neoformans var. neoformans infects the patients with AIDS more often than C. neoformans var. gattii which has been rarely isolated from patients with AIDS. Even in endemic regions of C. neoformans var. gattii, the variety of neoformans is still the most common agent diagnosed in cryptococcosis of patients with AIDS. Cerebrospinal fluid (CSF) from fifty patients with neurocryptococcosis associated with AIDS were studied. The fungi were isolated in agar Sabouraud medium, and were identified by microscopic and macroscopic examination by agar Sabouraud, agar niger and Christensen's urea medium. The variety was determined based on a color characteristic reaction on glycine-L-canavanina-bromothymol blue agar. From all of the fifty patients' cerebrospinal fluid (CSF) we were able to recover C. neoformans. The isolates were identified as C. neoformans var. neoformans in 47 patients and as C. neoformans var. gattii. in the 3 remaining patients. These findings suggest that both varieties, gattii and neoformans, are agents of neurocryptococcosis in patients with AIDS.
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Affiliation(s)
- O de F Fernandes
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO
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de Almeida CE, Pereira AJ, Marechal MH, Pereira G, Cruz JC, Ferraz JC, Giordani AJ, Khalil CM, Martins RH, Menegussi G, Moreira D, Rocha JR, Pinto MA. Intercomparison of calibration procedures for 192Ir HDR sources in Brazil. Phys Med Biol 1999; 44:N31-8. [PMID: 10211813 DOI: 10.1088/0031-9155/44/3/006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The lack of well established dosimetry protocols for HDR sources is a point of great concern regarding the uniformity of procedures within a particular country and worldwide. The main objective of this paper is to report the results from ten institutions of an intercomparison of calibration procedures for 192Ir HDR sources currently in use in Brazil. The treatment irradiator of one institution was calibrated by a reference system and used by all participants with their own measuring electrometers and ionization chambers under the same experimental conditions. Two methods were used: the calibration jig and the well-type ionization chamber. Each participant was allowed to use their own method and formalism. The results of this exercise were very positive since this was the first time in Brazil that a group of users gathered to share their experience and openly discuss the physical concepts behind the calibration procedures. The results were all within +/-3.0%, except one case where -4.6% was observed and later identified as a problem with the Nk value for x-rays. Though the magnitude of the deviations found was generally acceptable considering the diversity of formalisms currently in use, a proposal is now being prepared to be adopted as a national protocol. The identification of the institutions was left out for the sake of confidentiality.
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Affiliation(s)
- C E de Almeida
- Laboratório de Ciências Radiológicas-LCR-DBB-UERJ, Rio de Janeiro, Brazil.
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Pereira AJ, Dalby B, Stewart RJ, Doxsey SJ, Goldstein LS. Mitochondrial association of a plus end-directed microtubule motor expressed during mitosis in Drosophila. J Cell Biol 1997; 136:1081-90. [PMID: 9060472 PMCID: PMC2132485 DOI: 10.1083/jcb.136.5.1081] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/1996] [Revised: 11/12/1996] [Indexed: 02/03/2023] Open
Abstract
The kinesin superfamily is a large group of proteins (kinesin-like proteins [KLPs]) that share sequence similarity with the microtubule (MT) motor kinesin. Several members of this superfamily have been implicated in various stages of mitosis and meiosis. Here we report our studies on KLP67A of Drosophila. DNA sequence analysis of KLP67A predicts an MT motor protein with an amino-terminal motor domain. To prove this directly, KLP67A expressed in Escherichia coli was shown in an in vitro motility assay to move MTs in the plus direction. We also report expression analyses at both the mRNA and protein level, which implicate KLP67A in the localization of mitochondria in undifferentiated cell types. In situ hybridization studies of the KLP67A mRNA during embryogenesis and larval central nervous system development indicate a proliferation-specific expression pattern. Furthermore, when affinity-purified anti-KLP67A antisera are used to stain blastoderm embryos, mitochondria in the region of the spindle asters are labeled. These data suggest that KLP67A is a mitotic motor of Drosophila that may have the unique role of positioning mitochondria near the spindle.
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Affiliation(s)
- A J Pereira
- Program in Molecular Medicine, University of Massachusetts Medical Center, Worcester 01605, USA
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Abstract
The KLP61F gene product is essential for Drosophila development. Mutations in KLP61F display a mitotic arrest phenotype caused by a failure in the proper separation of duplicated centrosomes (Heck et al., 1993). Sequence analysis of KLP61F identified it as a member of the bimC family of kinesin-like microtubule motor proteins. Here we report that KLP61F is distinct from KRP130, a kinesin-like protein recently purified from Drosophila embryos and suggested to be the product of the KLP61F gene (Cole et al., 1994). We also characterized recombinant KLP61F and found that it possesses microtubule-stimulated ATPase and microtubule translocation activities in vitro. In addition, we have used an affinity-purified, KLP61F-specific antiserum to localize native KLP61F and an epitope-tagged KLP61F fusion protein during various stages of mitosis in Drosophila syncytial blastoderm embryos. From early prophase through anaphase, KLP61F is coincident with the distribution of tubulin. Together these results confirm the existence of multiple bimC-like kinesins in Drosophila and suggest that KLP61F function is intrinsic to the mitotic spindle.
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Affiliation(s)
- N R Barton
- Howard Hughes Medical Institute, University of California San Diego, Department of Pharmacology, La Jolla 92093-0683, USA
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Dalby B, Pereira AJ, Goldstein LS. An inverse PCR screen for the detection of P element insertions in cloned genomic intervals in Drosophila melanogaster. Genetics 1995; 139:757-66. [PMID: 7713430 PMCID: PMC1206379 DOI: 10.1093/genetics/139.2.757] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We developed a screening approach that utilizes an inverse polymerase chain reaction (PCR) to detect P element insertions in or near previously cloned genes in Drosophila melanogaster. We used this approach in a large scale genetic screen in which P elements were mobilized from sites on the X chromosome to new autosomal locations. Mutagenized flies were combined in pools, and our screening approach was used to generate probes corresponding to the sequences flanking each site of insertion. These probes then were used for hybridization to cloned genomic intervals, allowing individuals carrying insertions in them to be detected. We used the same approach to perform repeated rounds of sib-selection to generate stable insertion lines. We screened 16,100 insert bearing individuals and recovered 11 insertions in five intervals containing genes encoding members of the kinesin superfamily in Drosophila melanogaster. In addition, we recovered an insertion in the region including the Larval Serum Protein-2 gene. Examination by Southern hybridization confirms that the lines we recovered represent genuine insertions in the corresponding genomic intervals. Our data indicates that this approach will be very efficient both for P element mutagenesis of new genomic regions and for detection and recovery of "local" P element transposition events. In addition, our data constitutes a survey of preferred P element insertion sites in the Drosophila genome and suggests that insertion sites that are mutable at a rate of approximately 10(-4) are distributed every 40-50 kb.
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Affiliation(s)
- B Dalby
- Howard Hughes Medical Institute, Department of Pharmacology, University of California San Diego, La Jolla 92093-0683, USA
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Pereira AJ, Ferreira T, Pereira AT, Correia M. [Visualization of thrombi in the left auricular appendix using transesophageal echocardiography. Apropos of a clinical case]. Rev Port Cardiol 1991; 10:845-8. [PMID: 1786169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A case of Transesophageal Echocardiography (T.E.E.) Assessment of "Rheumatic Mitral Stenosis" is presented. T.E.E. has been recently referred as having superior resolution than transthoracic Echocardiography on the detection of thrombi. In the presented case a thrombi was detected in the left atrial appendage. This fact has allowed a better planning of surgery.
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Affiliation(s)
- A J Pereira
- Serviço de Cardiologia, Hospital Pulido Valente
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Agapito AF, Branco LM, Patrício L, Ferreira ML, Pereira AJ, Oliveira JA, Araújo V, Vargas JM, Magalhães MP, Candido JL. [Surgery for infectious endocarditis]. Rev Port Cardiol 1990; 9:683-6. [PMID: 2257155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE to assess the experience of both departments in the surgical therapy of infective endocarditis--indications and results. DESIGN retrospective analysis on clinical data, surgery and follow up. SETTING patients (pts) studied in the Cardiology Department and Cardiothoracic Surgery Department of the Santa Marta Hospital in Lisbon. PATIENTS AND INTERVENTIONS sequential sample of 28 patients (11 females, 17 males, mean age 39 years) submitted to surgery between 1978 and 1987 for infective endocarditis. MEASUREMENTS AND RESULTS the indications for surgery were: heart failure (15 pts), "resistant" infection (8 pts), emboli (4 pts) and "large" vegetations shown by echocardiography (2 pts). Surgical mortality -27.5%. Four patients developed periprosthetic leaks. There was an improvement in functional class of the survivals. CONCLUSION the indications for surgery were heart failure, "resistant" infection, emboli and "large" vegetations. There was a high surgical mortality, namely in the patients with resistant infection, severe heart failure and periprosthetic leaks. In the follow up there was a net improvement of functional class. The morbidity is due to the periprosthetic leaks, which induced most of the reoperations.
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Affiliation(s)
- A F Agapito
- Serviço de Cardiologia, Hospital de Santa Marta de Lisboa
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Branco LM, Agapito AF, Oliveira JA, Gonçalves JM, Quininha J, Velho HV, Pereira AJ, Ferreira ML, Antunes AM, Bento R. [Infective endocarditis of pulmonary valve. Considerations apropos of a case associated with interventricular communication and aortic insufficiency ]. Rev Port Cardiol 1990; 9:221-5. [PMID: 2390283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We report the case of a 23 year old patient in whom heart disease was detected in childhood. He began to have suddenly fever and symptoms of right side heart failure. There were signs of aortic regurgitation, a systodiastolic murmur in the left parasternal region and a diastolic murmur in the left 4th intercostal space. The bidimensional and Doppler Echocardiogram showed a saccular dilatation in the right ventricular outflow tract. He was submitted to catheterisation which confirmed aortic regurgitation and detected ventricular septal defect and pulmonary hypertension. During surgery, a subaortic ventricular septal defect was seen as well as a dilatation of the right coronary aortic cusp which prolapsed through the defect to the right ventricular outflow tract. Vegetations were seen in the pulmonary valve. The aortic valve and a pulmonary cusp were excised and a Björk Shiley aortic prosthetic valve was inserted. The septal defect was closed. The patient is still alive, symptomless, with 40 months of follow up. We discuss some problems related to this case, particularly the surgical indication and the rarity of the morphology discovered.
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Affiliation(s)
- L M Branco
- Serviço de Cardiologia do Hospital de Santa Marta
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Branco LM, Gonçalves JM, Velho HV, Ferreira MG, Oliveira JA, Agapito AF, Pereira AJ, Ferreira ML, Salomão S, Bento RS. [Isolated hypoplasia of the right ventricle--apropos of a case]. Rev Port Cardiol 1989; 8:791-4. [PMID: 2631828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To report one case of a rare heart disease (Isolated Hypoplasia of the Right Ventricle) and discuss the methodology used to propose surgery with goal. Good follow up results. DESIGN To report a case. SETTING One patient studied in the Cardiology Department of the Santa Marta Hospital, Lisbon, and submitted to surgery in the Cardiothoracic Surgery Department of the same Hospital. PATIENT A 22 years old woman, who had cyanosis since birth, normal cardiac auscultatory findings, pulmonary oligohemia in the chest Roentgenogram and right atrial strain on the Electrocardiogram. INTERVENTIONS She had an echocardiogram (M1 Mode and 2D) and catheterised, with pressure and oximetry measurements. During the latter procedure, the atrial septal defect was occluded for 20 minutes with a Fogarty catheter and pressure and oximetries were reevaluated. She was later operated. MEASUREMENTS AND RESULTS The Echocardiogram showed right ventricular hypoplasia, with a normally inserted tricuspid valve and a dilated right atrium. The hemodynamic study confirmed the presence of an atrial septal defect with right to left shunt, normal pulmonary artery pressure, no gradients and giant "a" wave in the right auriculogram. The right ventriculography showed right ventricular inflow hypoplasia. The occlusion of the atrial septal defect with the balloon catheter decreased the peripheral insaturation, without a significant increase in the right ventricular pressure. With this information, surgery was proposed (closure of the atrial septal defect), with good results (4 years of follow-up). CONCLUSION The interruption of the shunt with a balloon allows us to see if the right ventricle can handle properly the volume load. With this information surgery can be suggested. It may be rather simple as in this case.
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