Perioperative cardiac arrest and its mortality in children. A 9-year survey in a Brazilian tertiary teaching hospital

Background: the incidence of perioperative cardiac arrest and mortality in children is higher than in adults. This survey evaluated the incidence, causes, and outcome of perioperative cardiac arrests in a pediatric surgical population in a tertiary teaching hospital between 1996 and 2004.Methods: the incidence of cardiac arrest during anesthesia was identified from an anesthesia database. During the study period, 15 253 anesthetics were performed in children. Data collected included patient demographics, surgical procedures (elective, urgent, or emergency), ASA physical status classification, anesthesia provider information, type of surgery, surgical areas, and outcome. All cardiac arrests were reviewed and grouped by the cause of arrest and death into one of four groups: totally anesthesia-related, partially anesthesia-related, totally surgery-related, or totally child disease or condition-related.Results: There were 35 cardiac arrests (22.9 : 10 000) and 15 deaths (9.8 : 10 000). Major risk factors for cardiac arrest were neonates and children under 1 year of age (P < 0.05) with ASA III or poorer physical status (P < 0.05), in emergency surgery (P < 0.05), and general anesthesia (P < 0.05). Child disease/condition was the major cause of cardiac arrest or death (P < 0.05). There were seven cardiac arrests because of anesthesia (4.58 : 10 000) - four totally (2.62 : 10 000) and three partially related to anesthesia (1.96 : 10 000). There were no anesthesia attributable deaths reported. The main causes of anesthesia attributable cardiac arrest were respiratory events (71.5%) and medication-related events (28.5%).Conclusions: Perioperative cardiac arrests were relatively higher in neonates and infants than in older children with severe underlying disease and during emergency surgery. The fact that all anesthesia attributable cardiac arrests were related to airway management and medication administration is important in prevention strategies.

Detection of SPM and IMP metallo-beta-lactamases in clinical specimens of Pseudomonas aeruginosa from a Brazilian public tertiary hospital

Phenotypic and genotypic SPM and IMP metallo-beta-lactamases (MBL) detection and also the determination of minimal inhibitory concentrations (MIC) to imipenem, meropenem and ceftazidime were evaluated in 47 multidrug-resistant Pseudomonas aeruginosa isolates from clinical specimens. Polymerase chain reaction detected 14 positive samples to either bla(SPM) or bla(IMP) genes, while the best phenotypic assay (ceftazidime substrate and mercaptopropionic acid inhibitor) detected 13 of these samples. Imipenem, meropenem and ceftazidime MICs were higher for MBL positive compared to MBL negative isolates. We describe here the SPM and IMP MBL findings in clinical specimens of P. aeruginosa from the University Hospital of Botucatu Medical School, São Paulo, Brazil, that reinforce local studies showing the high spreading of bla(SPM) and bla(IMP) genes among Brazilian clinical isolates.

Candidemia in a Brazilian tertiary hospital: microbiological and clinical features over a six-year period

Yeasts are becoming a common cause of nosocomial fungal infections in immunocompromised patients. Such infections often develop into sepsis with high mortality rates. The aim of this study was to evaluate some of the numerous factors associated with the development of candidemia. Medical records were retrospectively analyzed of 98 Candida spp. patients. Results showed that the most prevalent risk factors for developing candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); the use of central venous catheter (93.9%); mechanical ventilation (73.5%); and parenteral nutrition (60.2%). The main species of Candida found were: C. parapsilosis (37.76%), C. albicans (33.67%); and others (28.57%). C. glabrata showed the highest mortality rate (75%), followed by C. tropicalis (57.1%) and C. albicans (54.5%). The elevated mortality rate found in this study indicates that preventive measures against candidemia must be emphasized in hospitals.

High Prevalence of bla(CTX-M) Extended Spectrum Beta-Lactamase Genes in Klebsiella pneumoniae Isolates from a Tertiary Care Hospital: First report of bla(SHV-12), bla(SHV-31), bla(SHV-38), and bla(CTX-M-15) in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Tertiary structural changes of the alpha-hemolysin from Staphylococcus aureus on association with liposome membranes

The interaction of alpha-hemolysin (also called alpha-toxin) from Staphylococcus aureus with mixed egg-yolk phosphatidylcholine/cholesterol liposomes has been investigated using the intrinsic tryptophan fluorescence emission (ITFE) signal. The ITFE intensity of alpha-hemolysin, which was obtained using a novel purification protocol, showed a triphasic increase on incubation with liposomes at low protein/lipid ratios. The first, rapid phase results in an increase in ITFE of 10%, which reflects rapid conformation changes in the alpha-hemolysin on association with the liposome membrane, the second phase of the ITFE increase is associated with a red shift from 334 to 339 nm in the maximum emission wavelength, suggesting the transition to a partially unfolded intermediate in the oligomerization process. The third phase of the ITFE intensity change demonstrates a temporal correlation with the appearance of SDS-stable oligomers. The results demonstrate the feasibility of identification of intermediate protein conformations in complex membrane-associated processes by manipulation of the liposomal membrane composition. (C) 1998 Academic Press.

Facies analysis of tertiary alluvial fan deposits in the Jundiai region, São Paulo, southeastern Brazil

This article presents an analysis of facies of sedimentary sequences that occur as discontinuous bodies in the Jundiai region, west of the main Tertiary continental basins of the southeastern Brazil continental rift. Nine identified sedimentary facies, grouped into four associations, suggest the existence of an ancient alluvial fan system whose source area was the Japi mountain range (Serra do Japi). The deposits are considered Tertiary in age and chronocorrelated with those identified in the Atibaia region and at other sites up to 100 km east and northeast of Jundiai. The depositional model adopted to explain the filling of the basin proposes that the alluvial fans, which directly derive from the source area, terminated in a braided channel longitudinal to the basin axis that flowed to northwest, in a similar configuration to that of the present day. This basin may have extended to the Atibaia region or formed a set of small basins laterally contiguous to the faults associated with the rift. Such occurrences show that the formation of rift basins was broader than the area presently occupied by the main deposits. (c) 2005 Elsevier Ltd. All rights reserved.

From Plinthic Acrisols to Plinthosols and Gleysols: iron and groundwater dynamics in the tertiary sediments of the upper Amazon basin

Topography has been reported to be the major factor ruling the spatial distribution of Acrisols, Plinthosols and Gleysols on the seasonally flooded, low elevation plateaux of the upper Amazon basin occupied by Tertiary (Ica & Solimoes) sediments. In this study, detailed morphological and mineralogical investigations conducted in a representative 25-ha site were combined with hydro-geochemical data to relate the vertical and lateral soil differentiations observed to the hydro-geological history of that part of the basin. As a result of the uplift of the Andes, several cuts in the extensive Tertiary marshlands have formed, at first, slightly incised plateaux of low elevation. There, weathering under hot and humid climates would have generated a reddish, freely drained and bioturbated topsoil layer and the vertical differentiation in subsoil sediments of a plinthite over an iron-depleted mottled clay. The second episode of soil differentiation is linked to the replacement of the forest by a savannah under the drier climates of the late Pleistocene, which favours surface runoff and the infill of the incisions by fine particles. This infill, combined with the return to the present humid climate, has then enabled the local groundwater to rise on the plateaux and to generate episaturation at the topsoil/subsoil transition close to the depressions. Nowadays, ferrous iron is released from the partly iron-depleted topsoil weathering front at high water levels during the rainy seasons. It moves from footslope to low-lying positions and from top to bottom in the soil profile according to the groundwater dynamics. The present general trend is thus to the lateral export of iron at high water levels due to subsurface and overland flows, its vertical transfer during the recession of the groundwater and accumulation in a nodular plinthite. In the latter, ferrous iron is adsorbed onto its softest iron masses where it feeds the neoformation of ferrihydrite that rapidly dehydrates into haematite.

Species distribution and antifungal susceptibility patterns of Candida spp. bloodstream isolates from a Brazilian tertiary care hospital

In this work, we collect data from surveys of bloodstream Candida isolates performed in Brazil from 1996 to 2004. Besides, we analyzed the species distribution of bloodstream Candida isolates together with potential risk factors for candidemia and the susceptibility profile of these isolates in patients from Hospital das Clinicas in Goiaonia city, Brazil. Blood samples were collected in the admission day and on every 7 days, in the intensive care unit (ICU) of a tertiary hospital. Candida isolates were identified by standard protocols that included germ tube formation, chlamydoconidia production on cornmeal agar and sugar fermentation and assimilation tests. Data of patients were recorded and analyzed according to age at the time of diagnosis, gender and presence of potential risk factors. Statistical analysis was used to determine if the time of hospital permanence increased Candida colonization in ICU patients' blood. The antifungal susceptibility testing was performed by broth microdilution method according to document NCCLS/CLSI M27-A2. Among the 345 blood samples cultured, candidemia was recovered in 33 patients, which were isolated 51.5% of Candida non-albicans. Fungemia was associated with long-term hospitalization. Fluconazole, itraconzole, voriconazole and amphotericin B exhibited a potent activity against all isolates of Candida. Voriconazole MICs were much low for all isolates tested. This work confirms data of increase of Candida non-albicans species in bloodstream in ICU and shows that voriconazole in vitro activity was higher than those of itraconazole, fluconazole and amphotericin B.

An approach of optimal sensitivity applied in the tertiary loop of the automatic generation control

This paper proposes an approach of optimal sensitivity applied in the tertiary loop of the automatic generation control. The approach is based on the theorem of non-linear perturbation. From an optimal operation point obtained by an optimal power flow a new optimal operation point is directly determined after a perturbation, i.e., without the necessity of an iterative process. This new optimal operation point satisfies the constraints of the problem for small perturbation in the loads. The participation factors and the voltage set point of the automatic voltage regulators (AVR) of the generators are determined by the technique of optimal sensitivity, considering the effects of the active power losses minimization and the network constraints. The participation factors and voltage set point of the generators are supplied directly to a computational program of dynamic simulation of the automatic generation control, named by power sensitivity mode. Test results are presented to show the good performance of this approach. (C) 2008 Elsevier B.V. All rights reserved.

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

The aim of this study was to evaluate the incidence of and mortality due to meningitis and compare data according to microbiological diagnosis. This was a ten-year retrospective study conducted at a neonatal intensive care unit (NICU). Newborns with meningitis confirmed by positive CSF culture were included; those with congenital infection or malformations that made lumbar puncture impossible were excluded. The variables investigated were birth weight, gestational and postnatal age, procedures, hematological and CSF parameters, and complications. Parametric and non-parametric tests were used (statistical value p<0.05). The incidence of meningitis was 0.6% and mortality was 27%. of the 22 cases, 59% involved Gram-negative bacteria; 36% Gram-positive and 5% fungi. The groups did not differ in relation to birth weight, gestational and postnatal age, procedures or hematological and CSF parameters. Sepsis, convulsions and deaths were frequent in both groups, without statistical difference. Gram-negative cases showed abscesses and higher frequency of ventriculitis and hydrocephaly. Meningitis was infrequent, but presented high mortality and frequent complications.

Detection of P. aeruginosa harboring bla(CTX-M-2), bla(GES-1) and bla(GES-5), bla(IMP-1) and bla(SPM-1) causing infections in Brazilian tertiary-care hospital

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cogeneration for small users: case studies for Brazilian tertiary sector

In this paper we present technical and economic studies of cogeneration systems utilizing combustion engines and gas turbines, applied in two establishments of the tertiary sector, regarding Brazilian conditions (according to Silveria, 1994). In the first step cogeneration systems utilizing combustion engines associated to absorption refrigeration systems are studied, in which electricity and cold air for a university building rate produced. In the second step some possibilities of the use of the gas turbine in cogeneration systems for a hospital are shown. In this case, the exhaust gases are utilized for the production of steam in a heat recovery steam generator (HRSG) or cold water in an absorption refrigeration system (for air conditioning) for the hospital building. The dynamic increment of the energy demand of Brazilian tertiary sector in last years can increase the installation of these cogeneration system (in compact version) as well as strengthen the development of the decentralized energy generation in Brazil.

Burial history and porosity evolution of Brazilian upper Jurassic to tertiary sandstone reservoirs

The parameter time-depth index (TDI) is applied in this study to quantify empirically the influence of burial history on sandstone porosity evolution. The TDI, expressed in kilometers per million years of age, is defined as the area in the burial history diagram enclosed by the burial curve of the reservoir and the axes of the diagram. In practice, reservoir depths during burial history are integrated at regular time intervals of 1 m.y. The calculations exclude present-day bathymetry or paleobathymetry. Sandstone reservoirs from several sedimentary basins along the Brazilian continental margin (Santos, Campos, Espírito Santo, Cumuruxatiba, Recôncavo, Sergipe, Alagoas, and Potiguar) were analyzed to investigate the evolution of porosity against TDI. These Upper Jurassic to Tertiary sandstones lie in depths of 700 to 4900 m, and are hydrocarbon charged (oil or gas). Average porosities of most of these reservoirs were obtained from core analysis, and a few porosity data were taken from well log interpretations. Detrital constituents of the sandstones are mainly quartz, feldspar, and granitic/gneissic rock fragments. Sandstones were grouped into three main reservoir types, based on composition (detrital quartz content) and grain sorting: Type I (average quartz content <50%) are very coarse grained to conglomeratic, poorly to very poorly sorted lithic arkoses. Rock fragments are mainly granitic/gneissic and coarse grained. Type II (average quartz content ranging from 50% to 70%) are fine- to coarse-grained (pebbles absent or occurring in small percentages), moderately sorted arkoses. Type III (average quartz content >80%) are fine to coarse, moderately to poorly sorted quartz arenites or subarkoses. Plots of average porosity against depth show great dispersion in porosity values; such dispersion is mostly due to differences in the reservoir burial histories. However, plotting porosity values against the TDI for individual reservoir types produces well-defined trends. The decrease in porosity is less marked in Type III reservoirs, intermediate in Type II, and faster in Type I. Such plots suggest that it is possible to make relatively accurate porosity predictions based on reservoir TDI, texture, and composition,: within the constraints of reservoir depth/age and basin tectonics analyzed in this study.

Study of a fuel cell cogeneration system applied to a Brazilian tertiary sector

In this paper, a methodology for the study of a molten carbonate fuel cell cogeneration system and applied to a computer center building is developed. This system permits the recovery of waste heat, available between 600°C and 700°C, which can be used to the production of steam, hot and cold water, hot and cold air, depending on the recuperation equipment associated. Initially, some technical information about the most diffusing types of the fuel cell demonstration in the world are presented. In conclusion, the fuel cell cogeneration system may have an excellent opportunity to strengthen the decentralized energy production in the Brazilian tertiary sector.