Representation of the hierarchical and functional structure of an ambulatory network of medical consultations through Social Network Analysis, with an emphasis on the role of medical specialties.

Background: Ambulatory Health Care Networks (Amb-HCN) are circuits of patient referral and counter-referral that emerge, explicitly or spontaneously, between doctors who provide care in their offices. Finding a meaningful analytical representation for the organic and hierarchical functioning of an Amb-HCN may have managerial and health policymaking implications. We aimed to characterize the structural and functional topology of an Amb-HCN of a private health insurance provider (PHIP) using objective metrics from graph theory.

ICU Admission, Invasive Mechanical Ventilation, and Mortality among Children and Adolescents Hospitalized for COVID-19 in a Private Healthcare System.

Aim: The COVID-19 pandemic devastated healthcare around the world. Data about the COVID-19 outcomes among young people are still scarce. We aim to identify factors associated with the composite outcome among children and adolescents hospitalized due to COVID-19.

[Home care effectiveness assessment in a health maintenance organization in Belo Horizonte, Minas Gerais State, Brazil].

A retrospective cohort study was performed to assess the impact of a Case Management Home Care Program supplied by the Unimed-BH medical cooperative on hospitalization-free survival time among eligible patients 60 years or older. A Cox proportional hazards model was fitted to assess the impact of home visits by health professionals on hospitalization-free survival time in a sample of 2,943 elders, while adjusting for patient age, physical dependence, medicines, feeding route, pressure ulcers, supplemental oxygen therapy, cognitive impairment, outpatient visits, and hospitalizations in the preceding quarter. Risk factors for shorter hospitalization-free survival time were: degree of physical dependence, enteral nutrition, supplemental oxygen therapy, pressure ulcers, and hospital admissions in the previous quarter.

Virologic and immunologic effectiveness at 48 weeks of darunavir-ritonavir-based regimens in treatment-experienced persons living with HIV-1 infection in clinical practice: a multicenter Brazilian cohort.

Introduction: Published data addressing the effectiveness of darunavir-ritonavir (DRV/r)-based therapy for multiexperienced patients in developing countries are scarce. This study evaluated the 48-week virologic and immunologic effectiveness of salvage therapy based on DRV/r for the treatment of multidrug-experienced HIV-1-infected adults in Brazil.

Materials And Methods: A multicenter retrospective cohort study was carried out with multidrug-experienced adults who were on a failing antiretroviral therapy and started a DRV/r-based salvage therapy between 2008 and 2010.

Virologic and immunologic effectiveness of darunavir-based salvage therapy in HIV-1-infected adults in a Brazilian clinical practice setting: results of a multicenter and retrospective cohort study.

Background: Darunavir has been proven efficacious for antiretroviral-experienced HIV-1-infected patients in randomized trials. However, effectiveness of darunavir-based salvage therapy is understudied in routine care in Brazil.

Methods: Retrospective cohort study of HIV-1-infected patients from three public referral centers in Belo Horizonte, who received a darunavir-based therapy between 2008 and 2010, after virologic failure.

Short communication: Effectiveness at 48 weeks of switching from enfuvirtide to raltegravir in virologically suppressed multidrug-resistant HIV type 1-infected patients in a Brazilian cohort.

The effectiveness of switching from enfuvirtide to raltegravir in HIV-1-infected patients on a suppressive antiretroviral regimen has been poorly studied in the clinical practice of developing countries. We conducted a multicenter retrospective cohort study in HIV-1-infected, multidrug-experienced adults (≥18 years old) with plasma HIV-1-RNA <400 copies/ml for at least 4 months on an enfuvirtide-containing therapy between 2005 and 2010, in whom the attending physician switched from enfuvirtide to raltegravir. Effectiveness endpoints were measured at week 48 after switch.

Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients.

Introduction: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV.

Methods: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil.

Results: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects.

Performance, revision, and extension of the National Nosocomial Infections Surveillance system's risk index in Brazilian hospitals.

Objective: To assess the benefit of using procedure-specific alternative cutoff points for National Nosocomial Infections Surveillance (NNIS) risk index variables and of extending surgical site infection (SSI) risk prediction models with a postdischarge surveillance indicator.

Design: Open, retrospective, validation cohort study.

Setting: Five private, nonuniversity Brazilian hospitals.

Resistance-associated mutation prevalence according to subtypes B and non-B of HIV type 1 in antiretroviral-experienced patients in Minas Gerais, Brazil.

The emergence of resistance-associated mutations to the antiretroviral agents and the genetic variability of HIV-1 impose challenges to therapeutic success. We report the results of genotype testing assays performed between 2002 and 2006 in 240 antiretroviral-experienced patients followed up in an HIV reference center in Brazil. Drug resistance mutations and viral subtypes were assessed through the algorithms from the Brazilian Genotyping Network (RENAGENO-Brazil) and from Stanford University.

Rates of surgical site infection as a performance measure: Are we ready?

With the introduction of quality assurance in health care delivery, there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities. Since the 1990s, increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs. Adverse post-operative events, and very especially surgical site infection (SSI) rates after specific procedures, gained popularity as hospital quality indicators in the 1980s.

Accounting for incomplete postdischarge follow-up during surveillance of surgical site infection by use of the National Nosocomial Infections Surveillance system's risk index.

Objective: We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index.

Design: Retrospective cohort study that used data prospectively collected from 1993 through 2006.

Setting: Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil.

Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy.

We assessed the independent contributions of the surgical approach and other variables of the National Nosocomial Infections Surveillance System (NNIS) surgical patient component to the surgical site infection risk after cholecystectomy. Laparoscopic cholecystectomy was associated with a lower overall risk of surgical site infection and a lower risk of incisional infection but not a reduced risk of organ-space infection, compared with open cholecystectomy. The contribution of most of the variables of the NNIS surgical patient component to the risk of surgical site infection depended on the depth of the infection.

Factors influencing the risk of surgical site infection following diagnostic exploration of the abdominal cavity.

Objectives: We assessed the contribution of the surgical approach and the NNIS system's surgical component variables to surgical site infection (SSI) risk after diagnostic exploration of the abdominal cavity.

Methods: Retrospective cohort study with prospective data collection (1993-2006) in five private, non-universitary, secondary or tertiary healthcare facilities. Outcome variable was SSI development within 30 days after surgery.

C-reactive protein-guided approach may shorten length of antimicrobial treatment of culture-proven late-onset sepsis: an intervention study.

Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU).

A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units.

Background: We report on nosocomial infections (NIs), causative organisms, and antimicrobial susceptibility patterns in neonates who were admitted to neonatal intensive care units (NICUs), and assess the performance of birth weight (BW) as a variable for risk-stratified NI rate reporting.

Methods: A prospective, 10-year follow-up, open cohort study that involved six Brazilian NICUs was conducted. The NI incidence rates were calculated using different denominators.

[Community-acquired methicillin-resistant Staphylococcus aureus disseminated disease].

A 21 year old man, previously healthy, presented with subcutaneous nodes consistent with gummas. Ultrasonography disclosed multiple subcutaneous abscesses and images suitable with piomiositis, pleural and pericardium effusion. A puncture-aspirate with fine-needle was performed and produced purulent material, with isolate of Staphylococcus aureus.

[Trichinellosis: epidemiological, clinical and laboratory aspects. A retrospective study (1994-2003)].

Background: Trichinellosis is a parasitic zoonosis caused by ingestion of infected meat containing cysts of Trichinella spp.

Objectives: To analyze the epidemiological, clinical and laboratory findings of trichinellosis patients in our center and compare the results with those from published series. To analyze the relationship between the clinical symptoms and laboratory findings.

[Nocardiosis in patients with human immunodeficiency virus infection].

Background: Nocardiosis is a bacterial disease that occurs in immunocompromised patients, including those infected by the human immunodeficiency virus (HIV).

Methods: We retrospectively analyzed the clinical records of 27 HIV-positive patients with nocardiosis seen during the period of 1993 to 2004. Clinical presentations, diagnostic methods, predominant species, antimicrobial therapy and outcome were analyzed.