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De Oliveira A.F.,University of the Catarina Plateau | Filho H.O.,Clinica Ana Carolina Lages
Jornal Vascular Brasileiro | Year: 2014

Introduction: Diabetic foot infections are a difficult problem to solve, often requiring hospitalization and exposing patients to the risk of amputations. Identification of the most prevalent pathogens is useful for administration of antibiotic therapy, and can reduce mutilations. Objective: To identify the microbiological profile and resistance to antimicrobial drugs in a series of patients with infected diabetic feet. Material and methods: an epidemiological, retrospective and descriptive study based on analysis of medical records from diabetic patients with plantar lesions who underwent surgical treatment over a 24-month period at a public hospital. Data were collected on age, sex, length of hospital stay, cultures from lesions, antibiotic therapy administered, bacterial resistance and surgeries conducted, with statistical analysis of means and standard deviations. Results: There were 66 admissions of diabetic patients, the majority elderly people (77%). Hospital stays ranged from 2 to 29 days, with a mean of 12.42. There were 91 surgical procedures, resulting in some kind of amputation in 65% of cases. The most common bacterial group was enterobacteria (47%), followed by staphylococci (27%). Three patients (4.5%) had multi-resistant organisms. Resistance to clindamycin was the most common at 39 admissions (59%), followed by resistance to cephalexin, seen in 24 admissions (36%). Conclusions: Diabetic foot infections were most often caused by germs found in the community, in particular the enterococci. Bacterial resistance was very widespread and was most commonly associated with drugs for oral administration, in particular clindamycin and cephalexin. © 2014, Sociedade Brasileira de Angiologia e Cirurgia Vascular. All rights reserved. Source

Biting behaviour of pumas at the moment of killing their prey is mentioned in the literature as being delivered either to the throat, nape of the neck and base of skull. Detailed anatomic descriptions of it are, however, largely absent in literature. In this article, the biting behaviour of a puma while attacking a peccary is described based on the perforations found on the skull of the prey. An observer looking at the prey-predator struggle would mistakenly conclude that the bite was meant to reach the throat region with the intent of suffocation, when in fact the bite reached and damaged the ventral and posterior region of the skull, and the spinal cord. According with the most likely hypothesis derived from matching a puma skull with that of the collared-peccary, the predator grasped it with its forepaws from behind, and bit at the upper throat region while the peccary held its head back exposing the throat region, allowing the upper canines to reach and damage the occipital bone and auditory bulla. Although there are no marks on the vertebrae, the evidence from the skull match indicate that the penetration of the upper canines into the skull allowed the top incisors to reach exactly where the atlas vertebrae and the occipital condyle connect. The lower canines held the upper part of the cranium, puncturing slightly at the postorbital process. The unusual behaviour of biting the skull from below may be partially due to the presence of an extended nuchal crest in collared-peccaries, which prevent predators to reach the spinal cord from above. © 2013 by Unisinos. Source

Vendemiatti M.,Hospital Nove de Julho | Siqueira E.S.,University of the Catarina Plateau | Filardi F.,University of South Santa Catarina | Binotto E.,Federal University of Grande Dourados | Simioni F.J.,Santa Catarina State University
Ciencia e Saude Coletiva | Year: 2010

This study analyzes the context of the hospital management professionalization process showing as the main challenges the leadership role to solve the conflict between the doctor, the nurse and the administrative sub-culture. This is a descriptive research and a field investigation based on the survey tools with interview and observation of thirty professionals from the hospital. The results show that the conflict between the various kinds of activities is derivate from the control rules within the hospital, the difference of social assistance and individual values. The conclusion points the need to change the leadership focus from total control to a more flexible kind of management, with emphasis in the dialog and negotiation between these activities in a hospital. Source

Sakata V.M.,University of Sao Paulo | da Silva F.T.,University of the Catarina Plateau | Hirata C.E.,University of Sao Paulo | Marin M.L.C.,University of Sao Paulo | And 5 more authors.
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2015

Purpose: To analyse the rate of clinical recurrences in Brazilian patients with Vogt–Koyanagi–Harada (VKH) disease after early high-dose corticosteroid treatment. Methods: Retrospective study including patients treated with early high-dose corticosteroids (prednisone, 1–1.5 mg/kg/day, or 3-day 1 g methylprednisolone pulsetherapy) within 1 month from disease onset followed by slow taper (at least 6 months). Patients with a minimum 12-month follow-up were subdivided based on the presence of disease recurrence or persistence after 6 months from initial presentation into: acute–resolved (AR, no recurrences), chronic–recurrent (CR), and chronic–recurrent with subretinal fibrosis (SRF). Recurrences were defined as the presence of clinical and/or fluorescein angiography findings. Results: Twenty-nine patients (58 eyes) with a median follow-up of 65 months were included. Six (21 %), 11 (38 %) and 12 (41 %) patients were allocated to AR, CR, and SRF groups respectively. Though having received treatment within 1 month of onset, median time to initial treatment differed among groups (11, 15, and 25 days, in AR, CR, and SRF groups respectively). Intensity of immunosuppression, cataract development, and longer time to achieve logMAR visual acuity ≤0.8 differed significantly among the groups, being more severe in SRF group. HLA-DRB1*0405 allele followed the same trend, though not reaching significance (0.5 in AR group, 0.6 in CR, and 0.8 in SRF). Conclusion: VKH disease in Brazilian patients evolved to chronic–recurrent disease in 79 % of cases; 38 % developed subretinal fibrosis, in spite of similar initial treatment regimens. Time to initiate treatment influenced outcomes. © 2015, Springer-Verlag Berlin Heidelberg. Source

Boing A.F.,Federal University of Santa Catarina | Matos I.B.,University of the Catarina Plateau | de Arruda M.P.,University of the Catarina Plateau | de Oliveira M.C.,University of the Catarina Plateau | Njaine K.,University of the Catarina Plateau
Revista da Associacao Medica Brasileira | Year: 2010

Objective: To describe the prevalence of medical visits and associated factors in an adult population of a medium-sized municipality in Southern Brazil. Methods: A cross-sectional population-based study was carried out in a representative random cluster sampling in Lages, state of Santa Catarina, Brazil. The reference population comprised adults (aged 20 to 59 years) and 2,022 individual were interviewed. The outcome was medical visits during the 12 months prior to the study. Data related to the type of service (public/private) and evaluation of this services were also collected. The independent variables were gender, race/skin color, marital status, income, schooling, health self-perception, nutritional status, self-reported diabetes, high blood pressure, smoking, and alcohol-related problems. Poisson regression was carried out and the prevalence rate was obtained. Results: The prevalence of medical visits was 76.0% (95%CI 73.6-78.4). Women, those with higher income, those who had diabetes, smokers, ex-smokers, those having alcohol-related problems, and those who evaluated their health negatively reported a higher prevalence of medical visits. We also found that among lower income people, medical visits to the Unified Health System (Sistema Único de Saúde) were more frequent. Conclusion: Prevalence of medical visits varied according to the population studied. Health policies at the three government levels must acknowledge such inequality to subsidize actions in the sector to suggest equality policies. Source

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