Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Modelagem e análise dinâmica de um sistema de conversão de energia eólica dotado de gerador síncrono de imã permanente utilizando a plataforma ATP

Human development requires a broad balance between ecological, social and economic factors in order to ensure its own sustainability. In this sense, the search for new sources of energy generation, with low deployment and operation costs, which cause the least possible impact to the environment, has been the focus of attention of all society segments. To do so, the reduction in exploration of fossil fuels and the encouragement of using renewable energy resources for distributed generation have proved interesting alternatives to the expansion of the energy matrix of various countries in the world. In this sense, the wind energy has acquired an increasingly significant role, presenting increasing rates of power grid penetration and highlighting technological innovations such as the use of permanent magnet synchronous generators (PMSG). In Brazil, this fact has also been noted and, as a result, the impact of the inclusion of this source in the distribution and sub-transmission power grid has been a major concern of utilities and agents connected to Brazilian electrical sector. Thus, it is relevant the development of appropriate computational tools that allow detailed predictive studies about the dynamic behavior of wind farms, either operating with isolated load, either connected to the main grid, taking also into account the implementation of control strategies for active/reactive power generation and the keeping of adequate levels of voltage and frequency. This work fits in this context since it comprises mathematical and computational developments of a complete wind energy conversion system (WECS) endowed with PMSG using time domain techniques of Alternative Transients Program (ATP), which prides itself a recognized reputation by scientific and academic communities as well as by electricity professionals in Brazil and elsewhere. The modeling procedures performed allowed the elaboration of blocks representing each of the elements of a real WECS, comprising the primary source (the wind), the wind turbine, the PMSG, the frequency converter, the step up transformer, the load composition and the power grid equivalent. Special attention is also given to the implementation of wind turbine control techniques, mainly the pitch control responsible for keeping the generator under the maximum power operation point, and the vector theory that aims at adjusting the active/reactive power flow between the wind turbine and the power grid. Several simulations are performed to investigate the dynamic behavior of the wind farm when subjected to different operating conditions and/or on the occurrence of wind intensity variations. The results have shown the effectiveness of both mathematical and computational modeling developed for the wind turbine and the associated controls.