OBJECTIVE:To evaluate the prevalence and clinical characteristics of post-surgical infections after coronary and/or valvular heart surgery at a tertiary hospital and to examine the relationship between these infections and prior dental evaluation. METHODS:A retrospective study was conducted among patients who underwent elective cardiac surgery at InCor-HCFMUSP between January 2018 and April 2019. RESULTS:The sample included 1,276 surgeries, of which 10.6% were associated with post-surgical infection. Length of hospital stay and infection-related mortality differed significantly between patients with and without post-surgical infection (p<0.0001). Surgical site infections were the most prevalent infections, accounting for 6.2% of the sample, whereas pneumonia was the least frequent, accounting for 0.2%. Dental evaluation was performed in 62.3% of patients in the Valve Surgery Group and 25.8% of those in the Coronary Surgery Group. Among patients who underwent dental evaluation, 89.8% did not develop infection; dental evaluation was also significantly associated with length of hospital stay in the Valve and Coronary Surgery Groups (p=0.0187 and p=0.0317, respectively). CONCLUSION:Post-surgical infection occurred in 10.6% of surgeries. Prior dental evaluation was not significantly associated with post-surgical infection, although a favorable percentage trend was observed among evaluated patients. Poor oral health is a risk factor for certain infections; however, these infections were not frequent in this sample. Hospital stay was shorter among patients who underwent dental evaluation.
Various extracellular matrix–based biomaterials are used in tissue regeneration; however, challenges remain regarding their applicability, including rejection and production difficulties. The ovine forestomach matrix (OFM) has demonstrated low immunogenicity and high regenerative capacity, aiding wound healing. These properties are related to its production process, which involves decellularization and removal of immunogenic components. As a result, healthcare professionals have applied OFM in different clinical contexts, ranging from wound healing to fistula treatment. This study aimed to analyze the use of OFM in the treatment of human wounds. An integrative descriptive review with a systematic literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Elsevier. The search strategy included the terms “ovine forestomach matrix,” “wound,” “wounds,” and “healing.” Studies involving human subjects that reported clinical outcomes related to wound treatment were included. The methodological quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The study selection process followed PRISMA recommendations. A total of 75 records were identified. After removal of review articles and eligibility screening, 20 studies were included in the final analysis, comprising 1,787 patients and 2,449 wounds. Most studies were case reports or case series, resulting in moderate overall methodological quality. Reported outcomes suggested that OFM may promote granulation tissue formation, support epithelialization, and contribute to wound closure across a variety of clinical scenarios. Mean wound closure time across studies reporting this outcome was approximately 18.4 weeks, although substantial heterogeneity in study design, wound etiology, and outcome reporting was observed. Available evidence suggests that OFM is a promising biomaterial for the management of complex wounds, with potential benefits including accelerated healing and relatively low cost compared with other extracellular matrix products. However, the predominance of observational studies and heterogeneity in reported outcomes highlight the need for well-designed prospective studies and randomized controlled trials to better define its clinical effectiveness. Level of evidence: not gradable.
O presente artigo tem por objeto o exame da responsabilidade civil decorrente da falha no dever de acompanhamento médico, entendendo-se como um conjunto de condutas exigíveis do profissional de saúde e da instituição de hospitalar de vigilância contínua do paciente ao longo de todo o período assistencial, e não apenas durante o ato cirúrgico, internação ou outro procedimento isolado. Parte se da premissa de que a alta hospitalar não encerra a relação de cuidado, mas configura uma etapa crítica de transição que, quando mal conduzida, pode gerar responsabilização civil do médico, do hospital e, em determinadas hipóteses, da operadora de plano de saúde. Por meio de pesquisa bibliográfica e documental, com apoio na legislação civil e consumerista, na ética médica e na jurisprudência do Superior Tribunal de Justiça e dos tribunais estaduais, são analisados os institutos da obrigação de meio e de resultado, do nexo causal, da inversão do ônus da prova, da teoria da perda de uma chance e da responsabilidade solidária das instituições de saúde. Conclui se que a jurisprudência brasileira caminha para uma compreensão sistêmica do cuidado em saúde, deslocando o eixo da responsabilização do erro técnico isolado para a omissão no acompanhamento, o que reforça a centralidade da dignidade da pessoa humana e da continuidade assistencial como valores estruturantes do direito médico contemporâneo.
The emergence of antimicrobial resistance (AMR) poses a critical global health threat, underscoring the interconnectedness of human, animal, and environmental health within the One Health framework. This study describes two multidrug-resistant (MDR) extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli strains, classified as critical priority bacteria by the World Health Organization, identified in recreational freshwater in Brazil. A cross-sectional study was conducted to investigate the presence of ESBL-producing Enterobacterales in water samples from a river in a touristic Brazilian city, including the waterfall, stream, and areas outside the city center. Bacteria were cultured and isolated on MacConkey agar supplemented with ceftriaxone, identified by MALDI-TOF, and antimicrobial susceptibility testing was performed by disk diffusion. ESBL-producing strains were then subjected to whole-genome sequencing and bioinformatic analysis. Two ESBL-producing E. coli strains were recovered from the waterfall (USP-MG-W) and steam (USP-MG-B). These strains showed an MDR profile, with resistance to β-lactams, tetracyclines, aminoglycosides, quinolones and phenicols, but remained susceptible to carbapenems. USP-MG-B and USP-MG-W harbor the ESBL genes blaCTX-M-15 and blaCTX-M-65, respectively, highlighting their broad-spectrum cephalosporin resistance and clinical relevance. Predicted heavy metal resistance genes suggest AMR co-selection. USP-MG-B belongs to pandemic E. coli sequence type (ST) 10, closely related to Brazilian human isolates. At the same time, USP-MG-W is part of clonal complex 155 (ST683), associated with international livestock and poultry strains. Remarkably, this study is the first report of E. coli ST10 in Brazilian rivers and ST683 with blaCTX−M−65 in Brazil. The detection of ESBL clones in freshwater underscores the role of the environment as a reservoir of critical priority pathogens. These findings highlight the urgent need for a One Health approach to the AMR crisis and for strengthening the epidemiological surveillance of ESBL-producing Enterobacterales beyond human settings.
BACKGROUND:Pediatricians play a central role in breastfeeding support, yet educational gaps persist in training programs worldwide. Understanding how educational priorities vary across career stages may help optimize breastfeeding education for health care professionals. OBJECTIVE:This study aimed to identify distinct professional profiles among physicians providing pediatric care attending the Brazilian Congress of Pediatrics and to characterize their self-reported educational priorities regarding breastfeeding in order to inform continuing education initiatives tailored to the needs of different professional profiles. METHODS:A cross-sectional electronic survey was conducted during the 41st Brazilian Congress of Pediatrics (Florianópolis, Brazil; October 2024). Participants included 290 physicians providing pediatric care-board-certified pediatricians (n = 164), pediatric residents (n = 109), and physicians without pediatric specialty certification providing pediatric care (n = 17). Fourteen binary variables representing clinical practice context and perceived causes of early weaning were used for cluster analysis. Educational priorities were assessed through classification of open-ended responses into thematic categories. RESULTS:Three distinct clusters were identified, forming a career-stage gradient. Cluster 1 (n = 111, 38.3%) comprised predominantly early career professionals (mean age, 31.7 years; 64.9% residents) who prioritized technique/management. Cluster 2 (n = 44, 15.2%) showed intermediate characteristics, with emphasis on mother/family education and support network. Cluster 3 (n = 135, 46.6%) included mostly senior pediatricians (mean age, 44.7 years; 77.8% board-certified) who prioritized legislation/work, myths/misinformation, and the pediatrician's role. This gradient emerged despite demographic variables being excluded from the clustering algorithm. CONCLUSIONS:Three distinct professional profiles with differing educational priorities were identified. Educational needs followed a career-stage gradient, ranging from practical clinical skills among early-career professionals to leadership, coordination, and policy competencies among senior pediatricians. The emphasis on the pediatrician's role among senior professionals underscores a perceived need to reassert the pediatrician as the central coordinator of the breastfeeding support team. These findings support the development of career-stage-tailored educational strategies to maximize the relevance and effectiveness of continuing education initiatives.
