Santa Casa Hospital

ABSTRACT Critically ill children admitted to pediatric intensive care units (PICUs) face significant neurological risks, but it remains unclear whether neurological assessments are adequately integrated into clinical routines. We aimed to evaluate the global scientific landscape regarding neurological examination in PICU, combining bibliometric analysis with clinical-guided critical analysis. A comprehensive search was conducted on the Web of Science Core Collection (WoS-CC) using terms related to pediatric critical care and neurological evaluation. Eligible publications were original research articles approaching neurological assessment during PICU stay. Bibliometric indicators, science mapping, and study design profiling were analyzed. In a separate, clinically guided interpretative layer, reporting patterns related to timing, tools, and strategies of neurological assessment were synthesized. From 359 records, 128 articles met inclusion criteria. The United States accounted for over half of the publications, while most studies employed retrospective designs and focused on traumatic brain injury or cardiac arrest. Despite the relevance of clinical neurological examination – especially using the Glasgow Coma Scale (GCS) and Pediatric Cerebral Performance Category (PCPC), advanced neuromonitoring tools, e.g., EEG, intracranial pressure monitoring, and biomarkers were inconsistently applied. Notably, neurological evaluations were often underreported at admission and discharge and rarely extended to non-neurological PICU conditions. Our findings reveal a critical gap between the neurological vulnerability of PICU patients, and the limited, inconsistent assessment strategies reported in the literature. Expanding structured neurological evaluation to all critically ill children, not only those with overt neurological diagnoses, seems essential to promote brain health and long-term recovery.

Filamentous fungi are common airborne contaminants in hospitals, posing significant risks to immunocompromised patients. This study assessed the diversity, seasonal distribution, and antifungal susceptibility of airborne filamentous fungi, with a focus on Aspergillus spp., in two inpatient wards of a tertiary hospital in southeastern Brazil. Air samples were collected seasonally from November 2022 to September 2023 using a six-stage Andersen sampler. Fungal isolates were identified based on macro- and micromorphological characteristics, and Aspergillus spp. were further characterised by β-tubulin gene sequencing. In vitro susceptibility to amphotericin B (AMB), itraconazole (ITR), voriconazole (VOR), posaconazole (POS), and anidulafungin (AFG) was evaluated following CLSI guidelines. A total of 583 filamentous fungi were isolated, with Penicillium, Cladosporium and Aspergillus as the most prevalent genera. Fungal concentrations were higher in humidified air and decreased after installation and maintenance of the air-conditioning system. Fourteen Aspergillus species were identified across eight sections, including emerging and cryptic taxa such as A. subramanianii, A. sclerotiorum and A. alboviridis. Resistance to ITR was detected in one isolate of A. fumigatus and one of A. flavus, while isolates from emerging species of the section Circumdati exhibited elevated MICs for AMB and triazoles. All isolates demonstrated low AFG MECs. The study highlights the importance of routine environmental surveillance and antifungal susceptibility testing in hospital settings. The detection of potentially resistant Aspergillus species in hospital air emphasises the need to enhance ventilation, monitoring, and diagnostic capabilities to mitigate the risks of healthcare-associated fungal infections.

Non-invasive facial and body contouring procedures have gained increasing attention from patients and physicians due to their proven effectiveness, minimal downtime, and lower risk of complications compared to invasive methods, such as plastic surgery. Microfocused ultrasound (MFU), injectable biostimulators – including poly-Llactic acid (PLLA) and calcium hydroxyapatite (CaHA) – and fractional radiofrequency microneedling (FRM) are widely employed for treating skin laxity, a prevalent concern in dermatology practice. Although the combination of these treatments in same-day sessions is regarded as safe and effective, there remains a significant gap in the literature assessing the simultaneous use of multiple technologies and injectable treatments for skin laxity and body contouring. We propose a “Sandwich Protocol,” which integrates MFU, injectable biostimulators (PLLA or CaHA), and FRM in a same-day session for the treatment of skin laxity. This protocol involves 1–4 sessions, spaced at least 30 days apart, with the number of sessions tailored to the severity of skin laxity and the patient’s financial considerations, given the high cost of these treatments. The sequential application of these techniques represents a comprehensive and individualized approach to addressing skin laxity and enhancing body contouring outcomes.

The aim was to map and characterize the scientific evidence from 2020 to the time of the search regarding recommendations and guidelines related to aortic aneurysm in elderly people in a hospital setting. This is a structured scoping review protocol following the methodological guidelines of the Joanna Briggs Institute and reported according to PRISMA-ScR. The review question was developed based on the PCC strategy, considering elderly people, care practices, and management of aortic aneurysm in a hospital setting. Searches will be conducted in the MEDLINE/PubMed and Embase databases and in the grey literature of the Virtual Health Library, with study selection by independent reviewers and data extraction using a structured form. It is expected that the results will allow for mapping and systematizing the main evidence on recommendations and care practices directed at elderly people with aortic aneurysm in a hospital setting, contributing to the improvement of care and the identification of gaps in the literature.

BackgroundThe prevalence of allergic contact dermatitis (ACD) differs across various populations, and the sensitization rate can change constantly as new products are introduced to the market. The current Brazilian standard series of patch tests has been used for over two decades. Therefore, the development of a new Brazilian standard series is important to ensure that contact tests remain a reliable diagnostic tool.MethodsA Brazilian multicenter, cross-sectional, prospective study was conducted using a modified series of patch tests between 2023 and 2025. The factors under study were the substances used in the contact tests, and the outcomes were the frequencies of positivity and relevance. Demographic and clinical variables of the participants, who had contact dermatitis without a defined etiology prior to the tests, were evaluated. The required sample size was defined as 523 patients, estimating the prevalence of positivity with a 1.8% confidence interval. Wald's test was considered a 95% confidence level and a 1% expected prevalence of positivity.ResultsA total of 567 participants were included, 77.3% female, with a mean age of 53.3 years, and most belonged to phototypes II, III, and IV. Cleaning services were the most frequent occupational activity, and 43.3% of patients had a personal history of atopy. The overall reactivity of the tests was 69.3%, with 70.2% relevance. Nickel sulfate was the most frequently reactive allergen (28.9%), and 29 substances reached at least 1% positivity.LimitationsLack of representatives from all regions of Brazil and absence of prospective follow-up.ConclusionThe authors propose a new Brazilian standard series of patch tests, with 40 substances, considering the 29 that achieved 1% positivity and another 11 with clinical importance and supported by current literature as emerging and current allergens.

Background: Mucopolysaccharidosis type IIIC (MPS IIIC) is a rare lysosomal storage disorder caused by pathogenic variants in the HGSNAT gene. Data from large patient cohorts remain scarce, particularly in Latin America. Methods: We retrospectively analyzed clinical, biochemical, and genetic data from patients diagnosed with MPS IIIC through the MPS Brazil Network. Diagnosis was based on reduced activity of acetyl-CoA:α-glucosaminide N-acetyltransferase (HGSNAT), elevated urinary glycosaminoglycans (uGAGs), and/or molecular genetics tests. Results: A total of 101 patients were confirmed with MPS IIIC, representing one of the largest cohorts worldwide. Females accounted for 60% of cases. The mean age at symptom onset was 5.4 ± 3.9 years, while the mean age at diagnosis was 11.7 ± 6.9 years, reflecting a 6-year diagnostic delay. Most patients initially presented with developmental delay (82%) and facial dysmorphism (80%), whereas behavioral manifestations were less frequently identified (25%), suggesting a milder phenotype than previously reported. Genetic information was available for 28% of patients, showing recurrent alleles (c.372-2A>G, c.252dupT) and several novel mutations, which expand the mutational spectrum of the disease. Genotype–phenotype similarities with Portuguese, Italian, and Chinese cases suggest shared ancestry contributions. Regional differences included earlier diagnoses in the North of Brazil and high consanguinity rates in the Northeast region. Conclusions: This study describes the largest Brazilian cohort of MPS IIIC, documenting novel variants and regional heterogeneity. Findings highlight diagnostic delays, ancestry influences, and the urgent need for disease-modifying therapies.

Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TARV) is a widely established treatment for symptomatic severe aortic stenosis (AS) in patients with high or intermediate surgical risk. Diabetes mellitus (DM) is prevalent in TAVR patients and is associated with an increased risk of cardiovascular events, which may elevate procedural risks. A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were searched. A random-effects model was applied, with 95% confidence intervals (CIs) and a 5% significance level. Statistical analyses were performed using RStudio version 4.4.1. Twelve studies with 214,444 patients were included, comprising 74,294 diabetic and 140,150 nondiabetic individuals. The analysis revealed no significant differences in all-cause mortality, procedure mortality, 30-day mortality, or complications such as bleeding, myocardial infarction, and major complications. However, 1-year mortality was significantly higher in the diabetic group (RR: 1.51, 95% CI: 1.08-2.13). Diabetic patients were at higher risk for renal injury (RR: 1.46, 95% CI: 1.40-1.51) and lower risk of stroke (RR: 0.91, 95% CI: 0.83-0.99). The length of hospital stay and other major complications showed no significant differences. There was an increased risk of 1-year mortality and renal injury in diabetic patients undergoing TAVI compared to non-diabetics. Surprisingly, the risk for developing stroke in the diabetic group was significantly lower. In any case, the study emphasizes the need for tighter DM control to decrease the risk of such complications in the future.

Recurrent seizures have such a negative impact upon the lives of persons with epilepsy that their prevention is a constant preoccupation of neurologists. Despite the large number of antiseizure medications (ASMs) currently available and of publications on their putative efficacy, adverse effects, and order of preference to start treatment, there is very little information on how to manage treatment over time. Here, we propose the analogy of a chess game to encourage neurologists to develop strategic decisions at each point in time to correctly manage ASMs toward the best possible degree of seizure control. We leverage that the strategy of the chess player must be adapted to each move of the opponent, to emphasize the need to individualize the treatment of epileptic seizures according to variations in response to ASMs that occur over time. The chess player calculates the best move at each point in the chess game just as the neurologist draws upon their knowledge and experience to select the best ASM regimen for a given patient and adjust it based on their "gestalt" of the patient's response to each treatment change. This gestalt, however, is firmly grounded in rational, flexible adaptations to ASM treatment protocols. Strategic decision-making in several epilepsy scenarios is given to illustrate the utility of the chess analogy.