Long-term gastrointestinal complications of Clostridium difficile associated diarrhea (CDAD)

Background. The incidence of Clostridium difficile -associated diarrhea (CDAD) is increasing worldwide likely because of increased use of broad spectrum antibiotics and the introduction of a clonal hyper-virulent strain called the BI strain. Short-term complications of CDAD include recurrent disease, requirement for colectomy, and persistent disease. However, data on the long-term consequences of CDAD are scarce. Among other infectious diseases (Shigella, Salmonella, and Campylobacter), long-term consequences such as irritable bowel syndrome (IBS), chronic dyspepsia/diarrhea, and other GI effects have been noted. Since the mechanism of action of these agents is similar to C.difficile, we hypothesized that patients with CDAD have greater likelihood of developing IBS and other functional gastrointestinal disorders (FGIDs) in the long-term as compared to a general sample of recently hospitalized patients. ^ Objective. To evaluate the long-term gastrointestinal complications of CDAD, (IBS, functional diarrhea, functional abdominal bloating, functional constipation and functional abdominal pain syndrome). ^ Methods. The current study was a secondary analysis of a previously completed observational case-control outcome study. Adult CDAD patients at St. Luke's Episcopal Hospital, Houston (SLEH) were followed up and interviewed by telephone six months after the initial diagnosis thereafter evaluated for the development of IBS and other FGIDs. A total of 46 patients with CDAD infection were recruited at SLEH between May-November 2007. The comparators were patients hospitalized in SLEH within one month before or after the admission of the reference case, hospital length of stay within one week longer or shorter than reference case, and age within 10 years more or less than the reference case. Cases and comparators were compared using Fisher's exact test. A p<0.05 was considered significant. ^ Results. Thirty CDAD patients responded to the questionnaires and were compared to 40 comparators. No comparator developed a FGID, while 3 (10%) CDAD patients developed new onset IBS (p=0.07), 4 (13.3%) developed new onset Functional Diarrhea (p=0.03), and 3 (10%) developed new onset Functional Constipation (p=0.07). No patient developed Functional Abdominal Bloating and Functional Abdominal Pain Syndrome. ^ Conclusion. In this study, new onset functional diarrhea was significantly more common in patients CDAD within six months after initial infection compared to matched controls.^

Fast food influences among Hispanic women

The purpose of this study was to evaluate the fast food influences such as restaurant frequency and restaurant choice among Hispanic women residing in Houston Texas. We also evaluated associations between BMI and frequency of fast food consumption. Methods: Data was obtained from the BOUNCE program and baseline data was evaluated from mothers enrolled in the study. Descriptive analysis and Fisher's exact test were conducted to evaluate patterns among fast food selection. Results: Nearly 88 percent of women were classified as overweight or obese, the population was predominately immigrants from Mexico with language preference of Spanish. Factors most influencing restaurant choice included quality of food, restaurant atmosphere, and healthy food availability. No associations were found between BMI and frequency of fast foods, however data show a slight association between duration in the U.S and increase in fast food frequency. Conclusion: Though statics are not statistically significant results demonstrate a possible trend in regards to length of stay and frequency eating out. This should be further explored. ^

Thrombolytic therapy for acute myocardial infarction: A cohort study to evaluate a selective approach to invasive diagnosis and therapy. The Corpus Christi Heart Project

Coronary perfusion with thrombolytic therapy and selective reperfusion by percutaneous transluminal coronary angioplasty (PTCA) were examined in the Corpus Christi Heart Project, a population-based surveillance program for hospitalized acute myocardial infarction (MI) patients in a biethnic community of Mexican-Americans (MAs) and non-Hispanic whites (NHWs). Results were based on 250 (12.4%) patients who received thromobolytic therapy in a cohort of 2011 acute MI cases. Out of these 107 (42.8%) underwent PTCA with a mean follow-up of 25 months. There were 186 (74.4%) men and 64 (25.6%) women; 148 (59.2%) were NHWs, 86 (34.4%) were MAs. Thrombolysis and PTCA were performed less frequently in women than in men, and less frequently in MAs than in NHWs.^ According to the coronary reperfusion interventions used, patients were divided in two groups, those that received no-PTCA (57.2%) and the other that underwent PTCA (42.8%) after thrombolysis. The case-fatality rate was higher in no-PTCA patients than in the PTCA (7.7% versus 5.6%), as was mortality at one year (16.2% versus 10.5%). Reperfusion was successful in 48.0% in the entire cohort and (51.4% versus 45.6%) in the PTCA and no-PTCA groups. Mortality in the successful reperfusion patients was 5.0% compared to 22.3% in the unsuccessful reperfusion group (p = 0.00016, 95% CI: 1.98-11.6).^ Cardiac catheterization was performed in 86.4% thrombolytic patients. Severe stenosis ($>$75%) obstruction was present most commonly in the left descending artery (52.8%) and in the right coronary artery (52.8%). The occurrence of adverse in-hospital clinical events was higher in the no-PTCA as compared to the PTCA and catheterized patients with the exception of reperfusion arrythmias (p = 0.140; Fisher's exact test p = 0.129).^ Cox regression analysis was used to study the relationship between selected variables and mortality. Apart from successful reperfusion, age group (p = 0.028, 95% CI: 2.1-12.42), site of acute MI index (p = 0.050) and ejection-fraction (p = 0.052) were predictors of long-term survival. The ejection-fraction in the PTCA group was higher than (median 78% versus 53%) in the no-PTCA group. Assessed by logistic regression analysis history of high cholesterol ($>$200mg/dl) and diabetes mellites did have significant prognostic value (p = 0.0233; p = 0.0318) in long-term survival irrespective of treatment status.^ In conclusion, the results of this study support the idea that the use of PTCA as a selective intervention following thrombolysis improves survival of patients with acute MI. The use of PTCA in this setting appears to be safe. However, we can not exclude the possibility that some of these results may have occurred due to the exclusion from PTCA of high risk patients (selection bias). ^

RELATIONSHIP OF ANTISOCIAL PERSONALITY SYNDROME IN BOYS TO PARENTAL ALCOHOL/DRUG DEPENDENCY

The study focused on the relationship between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency. The population studied was case records of 101 boys coming to a private psychiatrist from 1966 through 1979. The boys were predominantly white and from middle to upper income families.^ A boy was determined to have antisocial personality syndrome if he exhibited antisocial behaviors in four or five major categories, did not exhibit a brain syndrome, and did not exhibit a thought disorder. The five major behavior categories were: (1) self-control (i.e., temper tantrums or hyperactivity), (2) behavior at home (i.e., disobedience or lying), (3) behavior at school (i.e., truancy or cheating), (4) behavior toward peers (i.e., bullying, fighting, or tattling), and (5) behavior against property (i.e., destructiveness or stealing). A boy was determined to be a control if he exhibited antisocial behaviors in two or less behavior categories.^ A parent was determined to have alcohol/drug dependency if s/he exhibited a score above the established threshold (1) for the MacAndrew Alcoholism Scale (28 or above), and (2) for the Holmes Alcoholism Scale (35 or above) which are used with the MMPI. A parent was classified not alcohol/drug dependent if s/he had scores below set thresholds (22 on the MacAndrew Alcoholism Scale and 28 on the Holmes Alcoholism Scale).^ For the final sample (N = 10), there was no reason to believe a relationship exists between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency (Fisher's Exact Test {FET} P = 1.0). The small sample size primarily occurred as a result of 88.12% of the parents being classified in a questionable category in terms of alcohol/drug dependency.^ The sample was suggestive of a relationship between the fathers' Psychopathic Deviate (Pd) Scale scores as a measure of antisocial tendencies and the boy having antisocial personality syndrome (N = 75; P = .12). There was no evidence of such a relationship for mothers (N = 75; P = .97). ^

Pathway analysis of genome-wide association study data in primary biliary cirrhosisa

Genome-wide association studies (GWAS) have successfully identified several genetic loci associated with inherited predisposition to primary biliary cirrhosis (PBC), the most common autoimmune disease of the liver. Pathway-based tests constitute a novel paradigm for GWAS analysis. By evaluating genetic variation across a biological pathway (gene set), these tests have the potential to determine the collective impact of variants with subtle effects that are individually too weak to be detected in traditional single variant GWAS analysis. To identify biological pathways associated with the risk of development of PBC, GWAS of PBC from Italy (449 cases and 940 controls) and Canada (530 cases and 398 controls) were independently analyzed. The linear combination test (LCT), a recently developed pathway-level statistical method was used for this analysis. For additional validation, pathways that were replicated at the P <0.05 level of significance in both GWAS on LCT analysis were also tested for association with PBC in each dataset using two complementary GWAS pathway approaches. The complementary approaches included a modification of the gene set enrichment analysis algorithm (i-GSEA4GWAS) and Fisher's exact test for pathway enrichment ratios. Twenty-five pathways were associated with PBC risk on LCT analysis in the Italian dataset at P<0.05, of which eight had an FDR<0.25. The top pathway in the Italian dataset was the TNF/stress related signaling pathway (p=7.38×10 -4, FDR=0.18). Twenty-six pathways were associated with PBC at the P<0.05 level using the LCT in the Canadian dataset with the regulation and function of ChREBP in liver pathway (p=5.68×10-4, FDR=0.285) emerging as the most significant pathway. Two pathways, phosphatidylinositol signaling system (Italian: p=0.016, FDR=0.436; Canadian: p=0.034, FDR=0.693) and hedgehog signaling (Italian: p=0.044, FDR=0.636; Canadian: p=0.041, FDR=0.693), were replicated at LCT P<0.05 in both datasets. Statistically significant association of both pathways with PBC genetic susceptibility was confirmed in the Italian dataset on i-GSEA4GWAS. Results for the phosphatidylinositol signaling system were also significant in both datasets on applying Fisher's exact test for pathway enrichment ratios. This study identified a combination of known and novel pathway-level associations with PBC risk. If functionally validated, the findings may yield fresh insights into the etiology of this complex autoimmune disease with possible preventive and therapeutic application.^

Venous thromboembolism in patients with acute leukemia: Prevalence, incidence, recurrence of thrombosis, risk factors, and impact on survival

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most preventable cardiovascular disease and a growing public health problem in the United States. The incidence of VTE remains high with an annual estimate of more than 600,000 symptomatic events. DVT affects an estimated 2 million American each year with a death toll of 300,000 persons per year from DVT-related PE. Leukemia patients are at high risk for both hemorrhage and thrombosis; however, little is known about thrombosis among acute leukemia patients. The ultimate goal of this dissertation was to obtain deep understanding of thrombotic issue among acute leukemia patients. The dissertation was presented in a format of three papers. First paper mainly looked at distribution and risk factors associated with development of VTE among patients with acute leukemia prior to leukemia treatment. Second paper looked at incidence, risk factors, and impact of VTE on survival of patients with acute lymphoblastic leukemia during treatment. Third paper looked at recurrence and risk factors for VTE recurrence among acute leukemia patients with an initial episode of VTE. Descriptive statistics, Chi-squared or Fisher's exact test, median test, Mann-Whitney test, logistic regression analysis, Nonparametric Estimation Kaplan-Meier with a log-rank test or Cox model were used when appropriate. Results from analyses indicated that acute leukemia patients had a high prevalence, incidence, and recurrent rate of VTE. Prior history of VTE, obesity, older age, low platelet account, presence of Philadelphia positive ALL, use of oral contraceptives or hormone replacement therapy, presence of malignancies, and co-morbidities may place leukemia patients at an increased risk for VTE development or recurrence. Interestingly, development of VTE was not associated with a higher risk of death among hospitalized acute leukemia patients.^

Risk factors for metabolic syndrome among overweight and obese Hispanic children attending a pediatric clinic in New Braunfels, Texas

Childhood obesity is a persistent problem in the U.S., especially among Hispanics. Health complications like hypertension, type II diabetes, and metabolic syndrome (Met-S) are being seen at younger ages, and current screening procedures may be inadequate. This study sought to describe the risk factors for Met-S present in a sample of 106 overweight and obese Hispanic children, aged 5-14 years, participating in Nutrition and Exercise Start Today (NEST), a randomized weight management intervention trial at a rural health clinic in New Braunfels, Texas; and to determine associations between these factors and other clinical and socio-demographic characteristics linked to obesity. Baseline data was analyzed for the prevalence of large waist circumference (WC), elevated blood pressure (BP), high fasting serum glucose and serum triglycerides (TG), and low serum HDL cholesterol, in relationship with selected sample characteristics. Main findings included high baseline prevalence rates of large WC (77%), reduced HDL (57%), and elevated BP (30%). WC was significantly associated with BMI percentile and the serum liver function test alanine aminotransferase (ALT) by Fisher's exact test (p<0.001 and p=0.032, respectively), while there were significant relationships between HDL and both female gender and ALT. BMI percentile and ALT were associated with all sets of Met-S diagnostic criteria examined. BMI percentile also had a strong association (p=0.005) with total number of Met-S risk factors, while ALT had a weaker association (p=0.093). WC is a low-cost, simple measure whose use may improve clinic surveillance for childhood obesity and complications like Met-S. WC, BP, HDL and ALT may be used as part of targeted screening for obesity complications like Met-S, particularly in situations where resources are limited.^

Survival analysis of circulating tumor cells in triple-negative breast cancer

Background. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% (1.38 million) of the total new cancer cases and 14% (458,400) of the total cancer deaths in 2008. [1] Triple-negative breast cancer (TNBC) is an aggressive phenotype comprising 10–20% of all breast cancers (BCs). [2-4] TNBCs show absence of estrogen, progesterone and HER2/neu receptors on the tumor cells. Because of the absence of these receptors, TNBCs are not candidates for targeted therapies. Circulating tumor cells (CTCs) are observed in blood of breast cancer patients even at early stages (Stage I & II) of the disease. Immunological and molecular analysis can be used to detect the presence of tumor cells in the blood (Circulating tumor cells; CTCs) of many breast cancer patients. These cells may explain relapses in early stage breast cancer patients even after adequate local control. CTC detection may be useful in identifying patients at risk for disease progression, and therapies targeting CTCs may improve outcome in patients harboring them. Methods . In this study we evaluated 80 patients with TNBC who are enrolled in a larger prospective study conducted at M D Anderson Cancer Center in order to determine whether the presence of circulating tumor cells is a significant prognostic factor in relapse free and overall survival . Patients with metastatic disease at the time of presentation were excluded from the study. CTCs were assessed using CellSearch System™ (Veridex, Raritan, NJ). CTCs were defined as nucleated cells lacking the presence of CD45 but expressing cytokeratins 8, 18 or 19. The distribution of patient and tumor characteristics was analyzed using chi square test and Fisher's exact test. Log rank test and Cox regression analysis was applied to establish the association of circulating tumor cells with relapse free and overall survival. Results. The median age of the study participants was 53years. The median duration of follow-up was 40 months. Eighty-eight percent (88%) of patients were newly diagnosed (without a previous history of breast cancer), and (60%) of patients were chemo naïve (had not received chemotherapy at the time of their blood draw for CTC analysis). Tumor characteristics such as stage (P=0.40), tumor size (P=69), sentinel nodal involvement (P=0.87), axillary lymph node involvement (P=0.13), adjuvant therapy (P=0.83), and high histological grade of tumor (P=0.26) did not predict the presence of CTCs. However, CTCs predicted worse relapse free survival (1 or more CTCs log rank P value = 0.04, at 2 or more CTCs P = 0.02 and at 3 or more CTCs P < 0.0001) and overall survival (at 1 or more CTCs log rank P value = 0.08, at 2 or more CTCs P = 0.01 and at 3 or more CTCs P = 0.0001. Conclusions. The number of circulating tumor cells predicted worse relapse free survival and overall survival in TNBC patients.^

Identification of genetic risk factors for cerebellar mutism in pediatric brain tumor patients

Following posterior fossa surgery for resection of childhood medulloblastoma and primitive neuroectodermal tumor (M/PNET), cerebellar mutism (CM) may develop. This is a condition of absent or diminished speech in a conscious patient with no evidence of oral apraxia, which can be accompanied by other symptoms of the posterior fossa syndrome complex, which includes ataxia and hypotonia. Little is known about the etiology. Therefore, we conducted a SNP, gene, and pathway-level analysis to assess the role of host genetic variation on the risk of CM in M/PNET subjects following treatment. Cases (n= 20) and controls (n= 53) were recruited from the Childhood Cancer Epidemiology and Prevention Center, in Houston, TX. DNA samples were genotyped using the Illumina Human 1M Quad SNP chip. Ten pathways were identified from logistic regression used to identify the marginal effect of each SNP on CM risk. The minP test was conducted to identify associations between SNPs categorized to genes and CM risk. Pathways were assessed to determine if there was a significant enrichment of genes in the pathway compared to all other pathways. There were 78 genes that reached the threshold of min P ≤0.05 in 948 genes. The Neurotoxicity pathway was the most significant pathway after adjusting for multiple comparisons (q=0.040 and q=0.005, using Fisher's exact test and a test of proportions, respectively). Most genes within the Neurotoxicity pathway that reached a threshold of minP ≤0.05 were known to have an apoptosis function, possibly inducing neuronal apoptosis in the dentatothalamocortical pathway, and may be important in CM etiology in this population. This is the first study to assess the potential role of genetic risk factors on CM. As an exploratory study, these results should be replicated in a larger sample. ^

Factors associated with the retention of HIV-infected children in care in Botswana

Lost to follow up (LTFU) in the care and treatment of HIV/AIDS represents a particularly problematic aspect when evaluating the success of treatment programs. Identifying modifiable factors that lead to LTFU would be important if we are to design effective retention interventions. The purpose of this study was to identify the challenges faced by children seeking care and treatment at a large HIV Clinic in Botswana. In order to identify those factors, we used mixed methods from different sources of information available at the Baylor Clinic. The first method involved a case-control study through which we interviewed a select representation of children 1-18 years who, at some point in time, have attended clinic at Baylor Clinic in Gaborone, Botswana. We document this in detail using the first journal article. We defined LTFU as patients who had not attended clinic for more than 6 months at the onset of the study; the comparison group was recruited from among those who have attended clinic at any point in the 6 months leading to the start of study. Factors were compared between the cases and controls. The second methodology involved conducting in-depth interviews with health providers to elicit their opinions and experiences dealing with patients at the at the Baylor clinic in general and the LTFU patients in particular. We document this methodology and its findings in the second journal article. ^ We found that most patients that are LTFU failed to engage with the clinic. Most of the LTFU made only one visit to the clinic (47.66%) as compared to less than 1% in the control group (P<0.01, 2-tailed Fisher's exact test). Among the interviewed patients, psychosocial factors such as stigma, religious beliefs, child rebellion and disclosure of HIV status concerns were characteristic of the LTFU population, but psychosocial issues were not cited among the comparison group. We also found that these psychosocial aspects of the patients point towards a bigger problem of mental health that needs to be addressed. Socioeconomic factors such as lack of transport, school-related activities and forgetting check-up dates were cited predominantly by the controls than cases. ^ From these findings, there is need to target interventions towards engaging pediatric patients at their initial clinic visit. Such interventions would focus on psychosocial support, as well as involving faith-based organizations in planning joint responses.^

Epigeal spider occurrence, abundance and diversity in moist acidic and dry heath tundra at Toolik Lake, Alaska

For the 2004-2006 growing seasons, we trapped a total of 6980 spiders (5066 adults, 1914 immatures) using pitfall traps at the Arctic Long Term Experimental Research (LTER) site in Toolik Lake, Alaska. We found 10 families and 51 putative species, with 45 completely identified, in two distinct habitats: Moist Acidic Tundra (MAT) and Dry Heath (DH) Tundra. We captured spiders belonging to the following families (number of species captured): Araneidae (1), Clubionidae (1), Dictynidae (1), Gnaphosidae (4), Linyphiidae (26), Lycosidae (11), Philodromidae (2), Salticidae (1), Theridiidae (1), and Thomisidae (3). Statistical comparisons of families captured at MAT and DH Tundra indicate that the habitats have significantly different spider communities (Chi Square Test: p < 0.0001, and Fisher's Exact Test: p = 0.0018). This finding is further supported by differences in similarity, diversity, evenness, and species richness between the two habitats. In this report, we present eight new state records and five extensions of previously described ranges for spider species. The following species are new state records for Alaska: Emblyna borealis (O.P.-Cambridge 1877), Horcotes strandi (Sytschevskaja 1935), Mecynargus monticola (Holm 1943), Mecynargus tungusicus (Eskov 1981), Metopobactrus prominulus (O.P. -Cambridge 1872), Poeciloneta theridiformis Emerton 1911, and Poeciloneta vakkhanka (Tanasevitch 1989). The following five species have been reported previously in Alaska, but not near Toolik Lake: Hypsosinga groenlandica Simon 1889, Gnaphosa borea Kulczyn'ski 1908, Gnaphosa microps Holm 1939, Haplodrassus hiemalis (Emerton 1909), and Islandiana cristata Eskov 1987. Pairwise similarity indices were calculated across 13 other arctic and subarctic spider communities and statistical tests show that all sites are dissimilar (p = 0.25). These results fit the general pattern of both the patchiness and habitat specificity of arctic spider fauna.

High-sensitivity array analysis of gene expression for the early detection of disseminated breast tumor cells in peripheral blood

Early detection is an effective means of reducing cancer mortality. Here, we describe a highly sensitive high-throughput screen that can identify panels of markers for the early detection of solid tumor cells disseminated in peripheral blood. The method is a two-step combination of differential display and high-sensitivity cDNA arrays. In a primary screen, differential display identified 170 candidate marker genes differentially expressed between breast tumor cells and normal breast epithelial cells. In a secondary screen, high-sensitivity arrays assessed expression levels of these genes in 48 blood samples, 22 from healthy volunteers and 26 from breast cancer patients. Cluster analysis identified a group of 12 genes that were elevated in the blood of cancer patients. Permutation analysis of individual genes defined five core genes (P ≤ 0.05, permax test). As a group, the 12 genes generally distinguished accurately between healthy volunteers and patients with breast cancer. Mean expression levels of the 12 genes were elevated in 77% (10 of 13) untreated invasive cancer patients, whereas cluster analysis correctly classified volunteers and patients (P = 0.0022, Fisher's exact test). Quantitative real-time PCR confirmed array results and indicated that the sensitivity of the assay (1:2 × 108 transcripts) was sufficient to detect disseminated solid tumor cells in blood. Expression-based blood assays developed with the screening approach described here have the potential to detect and classify solid tumor cells originating from virtually any primary site in the body.

Multilocus DNA fingerprinting reveals high rate of heritable genetic mutation in herring gulls nesting in an industrialized urban site.

Genotoxins, such as polycyclic aromatic compounds, are ubiquitous in urban and industrial environments. Our understanding of the role that these chemicals play in generating DNA sequence mutations is predominantly derived from laboratory studies with specific genotoxins or extracts of contaminants from environmental media. Most assays are not indicative of the germinal effects of exposure in situ to complex mixtures of common environmental mutagens. Using multilocus DNA fingerprinting, we found the mutation rate in herring gulls inhabiting a heavily industrialized urban harbor (Hamilton Harbour, Ontario) to be more than twice as high as three rural sites: Kent Island, Bay of Fundy; Chantry Island, Lake Huron; and Presqu'ile Provincial Park in Lake Ontario. Overall we found a mutation rate of 0.017 +/- 0.004 per offspring band in Hamilton, 0.006 +/- 0.002 at Kent Island, 0.002 +/- 0.002 from Chantry Island, and 0.004 +/- 0.002 from Presqu'ile Provincial Park. The mutation rate from the rural sites (pooled) was significantly lower than the rate observed in Hamilton Harbour (Fisher's exact test, two-tailed; P = 0.0006). These minisatellite DNA mutations may be important biomarkers for heritable genetic changes resulting from in situ exposure to environmental genotoxins in a free-living vertebrate species.

Ensaio clínico randomizado do uso do curativo gel de clorexidina para a prevenção da colonização do cateter venoso central em pacientes adultos críticos

Os acessos venosos são indispensáveis para assistência do paciente em situação crítica. O cateter venoso central (CVC) é um acesso que viabiliza a terapêutica dessa clientela, mas o seu uso pode levar à infecções. Estas infecções ocasionam maior permanência hospitalar, elevam os custos totais das instituições e aumentam a morbidade e a mortalidade do paciente. O uso de curativos como cobertura do sítio de saída do CVC é eficaz na prevenção das infecções relacionadas a estes cateteres, em particular, o uso de curativos impregnados com antissépticos como o curativo gel de clorexidina. Este estudo teve como objetivo comparar a efetividade do curativo gel de clorexidina com a do filme transparente de poliuretano na prevenção da colonização do cateter venoso central em pacientes adultos críticos. Trata-se de estudo experimental, do tipo ensaio clínico randomizado, com tratamentos em paralelo, prospectivo e monocêntrico, realizado de acordo com as recomendações do Consolidated Standards of Reporting Trials (CONSORT). O estudo foi realizado na Unidade de Terapia Intensiva e na Unidade Coronariana de um hospital de ensino do interior do Estado de São Paulo. Participaram do estudo 102 indivíduos hospitalizados nestes locais, divididos aleatoriamente em dois grupos: grupo intervenção, no qual o tipo de cobertura utilizada foi o curativo de gel de clorexidina e grupo controle, que utilizou como cobertura o filme transparente de poliuretano. O desfecho primário mensurado foi a colonização do cateter e os desfechos secundários foram a infecção clínica do sítio de saída, a infecção microbiológica do sítio de saída e a infecção da corrente sanguínea relacionada ao cateter. Para a coleta de dados foi elaborado um instrumento, e este validado quanto ao seu conteúdo e forma por 13 enfermeiros pertencentes aos locais do estudo. Estes profissionais foram treinados para a realização dos curativos e coleta das pontas dos cateteres centrais, swabs dos sítios de saída e hemoculturas. Análises descritivas foram usadas para todas as variáveis do estudo. O teste Exato de Fisher foi utilizado para comparar as proporções de cada desfecho nos grupos de intervenção e controle, e a regressão logística para explorar se a colonização no CVC poderia ser associada com o tempo de uso do cateter e com o Acute Physiology and Chronic Health Evaluation II (APACHE II) dos pacientes do estudo. De acordo com os resultados não houve diferença estatisticamente significante entre a colonização nos dois grupos (p valor = 1.00), para a infecção microbiológica do sítio de saída (p valor = 0.08), para a infecção clínica do sítio de saída (p valor = 0.77) e para as infecções da corrente sanguínea relacionadas ao cateter (p valor = 1,00). Conclui-se que o presente estudo pode contribuir para que as unidades de saúde tenham subsídios para realizar a escolha do tipo de curativo baseado em suas necessidades institucionais e no desenvolvimento de protocolos relacionados à medidas de inserção e manutenção do cateter, bem como medidas educativas permanentes

Efeitos da diabetes mellitus e hipertensão arterial sobre a audição de idosos

Introdução: Estudos têm demonstrado que doenças crônicas e alterações metabólicas podem atuar como fator de aceleração na degeneração do sistema auditivo decorrente da idade. Todavia, os estudos sobre a associação entre a perda auditiva com o diabetes mellitus (DM) e com a hipertensão arterial (HA) em idosos mostraram conclusões controversas. Sendo assim, novos estudos sobre este assunto são necessários, a fim de esclarecer o efeito destas doenças crônicas sobre o sistema auditivo. Objetivos: Comparar uma audiometria inicial (A1) com uma audiometria sequencial (A2) realizada com um intervalo de 3 a 4 anos em uma população de idosos portadores de DM e/ou HA; realizar um estudo comparativo entre quatro grupos de idosos: grupo controle (GC), formado por idosos sem alterações crônicas, grupo de idosos portadores de DM; grupo de idosos portadores de HA, grupo de idosos portadores de DM e HA. Métodos: Foi realizado um levantamento em 901 prontuários do Estudo Longitudinal de Saúde Auditiva do Adulto (ELSAA), de indivíduos atendidos no Hospital Universitário (HU) da Universidade de São Paulo, no período de 2009 a 2015. De acordo com os critérios de inclusão, foram selecionados 100 indivíduos para participarem da presente pesquisa. A avaliação inicial (A1), constando de anamnese, audiometria tonal e imitânciometria foram utilizadas e foi feita uma nova avaliação audiológica (A2) após o período de 3 a 4 anos. Os participantes foram distribuídos em quatro grupos: 20 indivíduos portadores de DM (grupo DM), 20 indivíduos portadores de HA (grupo HA), 20 indivíduos portadores de DM e HA (grupo DMHA) e 40 indivíduos não portadores de DM nem de HA (GC). Para cada grupo estudo (HA, DM e DMHA), foram selecionados indivíduos (entre os 40 do GC) de forma a parear as características referentes a idade e sexo. Foram utilizados os testes estatísticos ANOVA, teste exato de Fisher e Kruskal-Wallis, com nível de significância de 0,05. Foi também calculada a odds ratio, com intervalo de confiança de 95%. Resultados: Não houve diferença estatisticamente significante entre as orelhas para nenhum dos grupos; sendo assim, as orelhas direita e esquerda foram agrupadas para as outras comparações. Na comparação da média de aumento anual dos limiares auditivos da primeira avaliação A1 com a segunda avaliação A2 entre os grupos, pode-se observar que para o grupo DM, não houve diferença estatisticamente significante para nenhuma das frequências avaliadas, quando comparado ao seu respectivo controle; para o grupo HA foram observadas diferenças significantes a partir de 4kHz, bem como tendência à diferença estatisticamente significante em 3 kHz, quando comparado a seu respectivo controle. Já para o grupo DMHA, quando comparado a seu grupo controle, foram observadas diferenças significantes nas frequências de 500, 2k, 3k e 8kHz, além de tendência à diferença estatisticamente significante em 4k e 6kHz. Considerando-se os casos novos de perda auditiva, pode-se observar que houve diferença estatisticamente significante apenas para o grupo HA, para as frequências altas. Verificou-se também que, para as frequências altas (3k a 8kHz), os números de casos novos de perda auditiva foram sempre maiores nos grupos estudo quando comparados aos seus respectivos controles. Na comparação das médias dos limiares auditivos, tanto na avaliação A1 quanto na avaliação A2, observou-se que os grupos estudo (DM, HA e DMHA) apresentaram limiares auditivos mais prejudicados, quando comparados a seus respectivos grupos controle. Na comparação entre os grupos apenas para a avaliação A2, pode-se observar que para as frequências altas, houve associação estatisticamente significante entre apresentar as condições clínicas (DM, HA e DMHA) e a presença de perda auditiva. A OR para DM foi de 5,57 (2,9-14,65), para HA foi de 4,2 (1,35-13,06) e para DMHA foi de 5,72 (1,85-17,64). Conclusão: Verificou-se que os idosos portadores de DM, HA ou ambos apresentaram limiares auditivos mais rebaixados quando comparados a seus respectivos grupos controle, principalmente nas altas frequências, o que sugere que estas patologias podem ter um efeito deletério sobre a audição. Além disso, nota-se que o grupo HA apresentou limiares auditivos piores para a maioria das frequências e foi o que apresentou maior queda dos limiares auditivos no segmento de 3 a 4 anos, quando comparado aos outros dois grupos estudo (DMHA e DM), sugerindo que dentre as três condições estudadas, a hipertensão parece ser a que teve maior influência sobre a audição