Santa Casa de Misericordia Hospital

BACKGROUND:There is a lack of contemporary studies addressing the prevalence rates and antifungal susceptibility of bloodstream infections (BSI) caused by rare yeasts (RY) from the Saccharomycotina subphylum. OBJECTIVES:This 16-year multicentre study (2007-2023) aimed to assess the prevalence and antifungal susceptibility of rare yeasts isolated from BSIs in 28 Brazilian tertiary care hospitals. METHODS:Yeasts from the Saccharomycotina subphylum, excluding common Candida species and Basidiomycota, were selected from BSI episodes. Species were identified using proteomics and molecular methods. Antifungal susceptibility testing was performed by EUCAST broth microdilution. RESULTS:Among 2655 BSI episodes, 100 (3.76%) involved rare yeasts. Prevalence showed a slight, non-significant increase from 3.16% (2007-2015) to 4.17% (2016-2023; p = 0.183). A total of 11 genera and 20 species were identified, with Clavispora lusitaniae (20%), Wickerhamomyces anomalus (16%), Candida haemulonii (14%) and Candida duobushaemulonii (12%) being the most frequent species. Eight species, including Pichia kluyveri and Kodamaea ohmeri, appeared only in the latter period. Most rare yeasts showed low MICs to amphotericin B and anidulafungin, except for Clavispora lusitaniae, Candida haemulonii and Candida duobushaemulonii, which were less susceptible to amphotericin B. Wickerhamomyces anomalus and Candida duobushaemulonii also showed reduced susceptibility to fluconazole. CONCLUSIONS:This study provides valuable insights into the prevalence rates, species distribution and antifungal susceptibility of rare yeasts causing BSIs in tertiary care hospitals. Our findings highlight the need for continuous surveillance, incorporation of new diagnostic and tailored therapeutic strategies to mitigate morbidity and mortality due to invasive infections caused by emerging fungal pathogens.

The peak flow meter is considered a complementary tool to spirometry for monitoring obstructive lung diseases. In many countries, spirometry is not easily accessible for diagnosing asthma in primary care. In this context, there has been growing interest in evaluating the role of the peak expiratory flow meter (PEFM) for asthma management, particularly in primary care settings. This study aims to assess the usefulness of PEFM in detecting airflow limitation (AFL), as identified by conventional spirometry, in a primary health care (PHC) setting in Brazil. This cross-sectional study was nested within a clinical trial. Participants aged 6 to 65, both sexes, with a history of respiratory symptoms suggestive of asthma and uncontrolled disease, from 28 PHC centers across all macroregions of Brazil were included. AFL was defined by spirometry according to international criteria and by PEFM when PEF was < 80

Pain in the dorsoulnar region of the wrist is a common complaint and may be caused by a variety of pathologies. Longitudinal tears of the extensor carpi ulnaris (ECU) tendon are among them, and it has recently been noted that these lesions are more frequent than previously thought. Most ECU injuries can be managed conservatively. Surgical treatment is indicated in cases of tendon rupture, especially when associated with instability or injury to the triangular fibrocartilage complex (TFCC). In such cases, the procedure should include tendon debridement with resection of inflammatory tissue, debridement of the lesion margins, and subsequent suture repair. Traditionally, ECU tendon repairshave been performed through open surgery. However, arthroscopy now allows access to the ECU tendon within the sixth extensor compartment through tenoscopy. On the basis of this, we describe and demonstrate a novel technique for the arthroscopic repair of longitudinal ECU tendon tears, combining wrist arthroscopy with ECU tenoscopy. This procedure enables debridement and tendon repair using horizontal, interrupted sutures in a minimally invasive manner, resulting in less damage to healthy tissues. Furthermore, it allows for the diagnosis and treatment of other ulnar-sided wrist injuries, which are frequently associated with ECU pathology.

Background Pseudoxanthoma elasticum (PXE) is a hereditary disorder causing progressive arterial mineralization that may cause premature coronary disease in children. Case Summary A 14-year-old girl with exertional angina since age 8 was diagnosed with PXE after her mother used an artificial intelligence tool to identify skin lesions. Coronary imaging revealed mid-left anterior descending artery chronic total occlusion without CT macrocalcification. Intravascular ultrasound (IVUS) demonstrated concentric high-echoic wall thickening without acoustic shadowing, consistent with mineralized elastic lamina rather than atherosclerosis. A stentless drug-coated balloon strategy was chosen. At 10 months, she was asymptomatic with sustained left anterior descending artery patency by scheduled angiography. Discussion This is the first reported IVUS-guided chronic total occlusion recanalization in a pediatric PXE patient, illustrating how intravascular imaging can characterize disease biology and guide individualized device selection. Take-Home Messages In children with unexplained exertional symptoms and skin lesions, PXE should be considered. When IVUS identifies a nonatherosclerotic substrate, a stentless strategy may preserve vessel growth potential.