RESUMEN
We performed a systematic review and meta-analysis to comprehensively determine the prevalence and the prognostic role of non-thyroidal illness syndrome (NTIS) in critically ill patients. We included studies that assessed thyroid function by measuring the serum thyroid hormone (TH) level and in-hospital mortality in adult septic patients. Reviews, case reports, editorials, letters, animal studies, duplicate studies, and studies with irrelevant populations and inappropriate controls were excluded. A total of 6869 patients from 25 studies were included. The median prevalence rate of NTIS was 58% (IQR 33.2-63.7). In univariate analysis, triiodothyronine (T3) and free T3 (FT3) levels in non-survivors were relatively lower than that of survivors (8 studies for T3; standardized mean difference (SMD) 1.16; 95% CI, 0.41-1.92; I2 = 97%; P < 0.01). Free thyroxine (FT4) levels in non-survivors were also lower than that of survivors (12 studies; SMD 0.54; 95% CI, 0.31-0.78; I2 = 83%; P < 0.01). There were no statistically significant differences in thyrotropin levels between non-survivors and survivors. NTIS was independently associated with increased risk of mortality in critically ill patients (odds ratio (OR) = 2.21, 95% CI, 1.64-2.97, I2 = 65% P < 0.01). The results favor the concept that decreased thyroid function might be associated with a worse outcome in critically ill patients. Hence, the measurement of TH could provide prognostic information on mortality in adult patients admitted to ICU.
RESUMEN
Bochdalek hernia is the most common congenital diaphragmatic hernia. Its symptoms are normally diagnosed and treated during the neonatal period. Conversely, in adults it is usually asymptomatic and, as a consequence, this group is misdiagnosed. A case of a 64-year-old female patient with an uncommon incarcerated right-sided diaphragmatic hernia formed three years after a Roux-en-Y gastric bypass and a significant weight loss is reported. The importance of this abnormality as a complication of the bariatric surgery should be considered(AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Derivación Gástrica/efectos adversos , Hernias Diafragmáticas Congénitas/cirugía , Hernias Diafragmáticas Congénitas/diagnóstico , Hernias Diafragmáticas Congénitas/etiologíaRESUMEN
Mirizzi Syndrome type IV is an extremely rare condition, which is confused with the diagnosis of cholangiocarcinoma in many cases. This report describes a case of a forty-three-year old patient, who was forwarded to our department of general surgery with a high suspicion of a choledochal neoplasic lesion. During the hospitalization he was diagnosed with Mirizzi Syndrome type IV. We concisely describe the case and the literature review about this pathology
Asunto(s)
Neoplasias de los Conductos Biliares , Colangiocarcinoma , Síndrome de MirizziRESUMEN
Objetivos: Comparar a pandemia de gripe espanhola, que coincidiu com o ano de fundação do Hospital São Vicente de Paulo, localizado na cidade de Passo Fundo, RS, com a pandemia de gripe A vivida em 2009, ambas causadas pelo vírus Influenza A H1N1. Fonte de dados: Base de dados do Hospital São Vicente de Paulo (referente a 1918 e 2009) assim como seu site na internet, Arquivo Histórico Regional da Universidade de Passo Fundo, jornais, revistas e relatórios de 1918-1919 e 2009-2010, dados da literatura (principalmente do livro "Banalização da Morte na Cidade Calada", de Janete Silveira Abrão), periódicos científicos e sites oficiais da internet (Ministério da Saúde, Instituto Brasileiro de Geografia e Estatística, Organização Mundial da Saúde). Síntese dos dados: Uma pandemia de gripe espanhola ocorreu no ano de 1918 e causou a morte de mais de 20 milhões de pessoas em apenas um ano. Quase um século depois, surge a pandemia pelo vírus Influenza A H1N1, provocando cerca de 18 mil mortes entre abril de 2009 e maio de 2010. Este trabalho evidencia consequências dessas pandemias na cidade de Passo Fundo, especialmente no Hospital São Vicente de Paulo. Conclusões: Há consideráveis semelhanças entre as pandemias de 1918 e de 2009, sendo que ambas deixaram fortes marcas no Hospital São Vicente de Paulo e na cidade de Passo Fundo.
Aims: To compare the Spanish flu pandemic, which coincided with the year of founding of São Vicente de Paulo Hospital, located in the city of Passo Fundo, Rio Grande do Sul State, Brazil, with the influenza pandemic in 2009, both caused by the Influenza A H1N1 virus. Source of data: Hospital São Vicente de Paulo databases (1918 and 2009) and internet site, Regional Historical Archives of the University of Passo Fundo, newspapers, magazines and reports of 1918-1919 and 2009-2010, data of literature (mainly from the book of Janete Silveira Abrão "Banalização da Morte na Cidade Calada"), scientific journals and official internet sites (Ministry of Health, Brazilian Institute of Geography and Statistics, World Health Organization). Summary of findings: Spanish flu pandemic occurred in 1918 and killed more than 20 million people in just one year. Almost a century later, the Influenza A H1N1 pandemic emerges, causing about 18,000 deaths between April 2009 and May 2010. This work shows consequences of both pandemics in the city of Passo Fundo, especially in the São Vicente de Paulo Hospital. Conclusions: There are considerable similarities between the pandemics of 1918 and 2009, and both of them left strong marks on the São Vicente de Paulo Hospital and in the city of Passo Fundo.