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Healthy nutrition is widely considered the cornerstone of optimal athletic performance, both physically and mentally. This study investigates the critical role of healthy nutrition in shaping the physical and mental performance of athletes, with a specific focus on taekwondo. This research aims to explore the potential relationship between taekwondo athletes' attitudes towards healthy nutrition and their mental toughness. The research group comprised 276 active and licensed taekwondo athletes who voluntarily participated in the study (Age M = 17.18 ± SD = 7.13, N = 125 women, N = 151 men). Ethical approval for the research was obtained prior to the commencement of the study. Data collection instruments included the Healthy Nutrition Attitude Scale, Mental Toughness Scale, and a personal information form. Confirmatory factor analysis was conducted to confirm the validity and reliability of the scales. Descriptive statistics, correlation analysis, and regression analysis were performed to explore the relationship between the variables within the research model. The correlation analysis identified two significant, positive, and moderate correlations: (1) between knowledge about nutrition and mental toughness (r = 0.626) and (2) between positive nutrition and mental toughness (r = 0.672). The regression analysis revealed that both knowledge about nutrition (ß = 0.360) and positive nutrition (ß = 0.461) significantly contribute to mental toughness. The findings suggest that as athletes' knowledge of nutrition expands and their attitudes towards healthy eating become more positive, their mental toughness also appears to improve. These results are both important and original, adding significant new insights to the existing research landscape.
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Desempenho Atlético , Dieta Saudável , Masculino , Humanos , Feminino , Reprodutibilidade dos Testes , AtletasRESUMO
OBJECTIVES: In pandemic conditions, patients with febrile neutropenia are also at risk of COVID-19. Aim of this systematic review is to evaluate COVID-19 cases presented with febrile neutropenia and provide information regarding incidence, clinical course and prognosis. METHODS: We systematically searched on COVID-19 and febrile neutropenia cases in PubMed, SCOPUS and Web of Science. RESULTS: A total of 19 febrile neutropenic patients were analyzed. A male predominance was noted. Eleven cases had hematological malignancies. Fourteen of the cases were previously received chemotherapy. Five patients had severe neutropenia: 3 had hematologic cancer and none died. 17 (89.5%) cases have pulmonary involvement and seven of them had severe disease with acute respiratory distress syndrome (ARDS). Three cases with ARDS were died. 12 of them received G-CSF for treatment. Five cases were developed respiratory failure after G-CSF use. Overall mortality was 15.8%, while death was not observed in patients without malignancy and solid organ tumors, the mortality rate was 27% in cases with hematological malignancies. CONCLUSION: In ongoing pandemic, febrile neutropenic patients should be precisely evaluated for COVID-19 disease. It should be remembered that there may not be typical signs and symptoms and laboratory findings of COVID-19 disease because of the immunosuppression.
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COVID-19 , Neutropenia Febril , Neoplasias Hematológicas , Neoplasias , Síndrome do Desconforto Respiratório , Neutropenia Febril/tratamento farmacológico , Feminino , Febre/etiologia , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Masculino , Síndrome do Desconforto Respiratório/etiologiaRESUMO
BACKGROUND: Increasing number of patients with COVID-19-associated mucormycosis have been reported, especially from India recently. We have described a patient with COVID-19-associated mucormycosis and, searched and analyzed current medical literature to delineate the characteristics of COVID-19-associated mucormycosis. METHOD: We reported a patient developed mucormycosis during post-COVID period. We searched literature to describe the incidence, clinical features, and outcomes of COVID-19-associated mucormycosis. Demographic features, risk factors, clinical features, diagnostic methods, treatment and outcome were analyzed. RESULTS: We describe a 54-year-old male, hospitalized due to severe COVID-19 pneumonia. He was given long-term, high doses of systemic steroids. He developed maxillo-fascial mucormycosis and died of sepsis. Our literature search found 30 publications describing 100 patients including present case report. The majority (n = 68) were reported from India. 76% were male. The most commonly seen risk factors were corticosteroid use (90.5%), diabetes (79%), and hypertension (34%). Also, excessive use of broad-spectrum antibiotics were noted in cases. Most frequent involvements were rhino-orbital (50%), followed by rhino-sinusal (17%), and rhino-orbito-cerebral (15%). Death was reported as 33 out of 99 patients (33,3%). CONCLUSIONS: Steroid use, diabetes, environmental conditions, excessive use of antibiotics, and hypoxia are main risk factors. Despite medical and surgical treatment, mortality rate is high. A multidisciplinary approach is essential to improve the conditions facilitating the emergence of COVID-19-associated mucormycosis.
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COVID-19 , Mucormicose , Humanos , Masculino , Pessoa de Meia-Idade , Incidência , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Fatores de Risco , SARS-CoV-2RESUMO
We consider that general anesthesia will be an appropriate and safe method as regional methods could lead to significant time loss in the prevention or minimization of complications. High blockage required for regional anesthetic methods in pregnant women with TGA and the maintenance of hemodynamic stability may become difficult due to neuroaxial sympathectomy even if a successful neuroaxial block has been provided. Agents with minimal effect on cardiovascular functions should be preferred for anesthesia induction and maintenance and close hemodynamic monitoring should be done during intraoperative and postoperative periods.
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Anestesia Obstétrica/métodos , Cesárea/métodos , Cianose/fisiopatologia , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/cirurgia , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/fisiopatologia , Gasometria , Cianose/etiologia , Feminino , Guias como Assunto , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado do Tratamento , Hemorragia Uterina , Adulto JovemRESUMO
Mobile communication devices help accelerate in-hospital flow of medical information, information sharing and querying, and contribute to communications in the event of emergencies through their application and access to wireless media technology. Healthcare-associated infections remain a leading and high-cost problem of global health systems despite improvements in modern therapies. The objective of this article was to review different studies on the relationship between mobile phones (MPs) and bacterial cross-contamination and report common findings. Thirty-nine studies published between 2005 and 2013 were reviewed. Of these, 19 (48.7%) identified coagulase-negative staphylococci (CoNS), and 26 (66.7%) identified Staphylococcus aureus; frequency of growth varied. The use of MPs by healthcare workers increases the risk of repetitive cyclic contamination between the hands and face (e.g., nose, ears, and lips), and differences in personal hygiene and behaviors can further contribute to the risks. MPs are rarely cleaned after handling. They may transmit microorganisms, including multiple resistant strains, after contact with patients, and can be a source of bacterial cross-contamination. To prevent bacterial contamination of MPs, hand-washing guidelines must be followed and technical standards for prevention strategies should be developed.
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Infecções Bacterianas/transmissão , Telefone Celular , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa , Microbiologia Ambiental , Pessoal de Saúde , Infecções Bacterianas/epidemiologia , Infecção Hospitalar/epidemiologia , Humanos , Controle de Infecções/métodosRESUMO
BACKGROUND: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. METHODS: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. RESULTS: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). CONCLUSIONS: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions.
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Infecção da Ferida Cirúrgica/epidemiologia , Cidades , Estudos de Coortes , Hospitais , Humanos , Prevalência , Estudos Prospectivos , Turquia/epidemiologiaRESUMO
AIMS: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. DESIGN: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. RESULTS: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6-93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79-0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73-0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54-0.60, p 0.0001). CONCLUSIONS: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.
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This study is intended to examine the effects of administration of asymmetric dimethylarginine (ADMA) on the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10. A total of 30 Wistar adult albino rats were used. Group I was administrated (n = 10) with 1 mg/kg/day of ADMA, group II (n = 10) was administrated with 2 mg/kg/day of ADMA and the control group was administrated (n = 10) with 0.9% sodium chloride. ADMA was intraperitoneally administrated for 7 days. The serum levels of IL-6, TNF-α and IL-10 were measured. There was a significant decrease in the levels of TNF-α, IL-6 and IL-10 in group I compared with that of the control group (p < 0.001). There was also a significant decrease in the levels of IL-10 in group II compared with that of the control group (p < 0.05) but the increase was much more distinct in the levels of IL-6 and TNF-α (p < 0.001). When comparing the groups by the doses given, no difference between the levels of IL-6 and IL-10 in groups I and II (p > 0.05) was observed; the levels of TNF-α in group II were significantly lower than those of group I (p < 0.05). A significant decrease in the serum levels of inflammatory cytokines IL-6, TNF-α and IL-10, after administration of 1 mg/kg/day and 2 mg/kg/day of ADMA, indicates that ADMA has an effect on inflammation. Increase in ADMA levels in the rats shows that the effects of inflammatory cytokines were suppressed.
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Arginina/análogos & derivados , Inflamação/induzido quimicamente , Interleucina-10/biossíntese , Interleucina-6/biossíntese , Fator de Necrose Tumoral alfa/biossíntese , Animais , Arginina/química , Arginina/farmacologia , Relação Dose-Resposta a Droga , Interleucina-10/sangue , Interleucina-6/sangue , Masculino , Ratos , Ratos Wistar , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/efeitos dos fármacosRESUMO
OBJECTIVE: In this study, our objective was to compare the Cormack and Lehane (C-L) sight scores of direct laryngoscopy in endotracheal intubation with the endoscopic sight scores of the LMA CTrach and video laryngoscope. We also compared the success of endoscopy with the LMA CTrach and video laryngoscopy, intubation time, and its effects on haemodynamic and stress responses. METHODS: The study included 100 patients, with American Society of Anesthesiologists (ASA) scores I-III and aged 18-65, who will undergo elective surgery. Patients were randomly divided into two groups: Group C and Group V. The patients in both groups underwent direct laryngoscopy with a Macintosh laryngoscope, and their C-L scores were recorded. In Group C, the patients were intubated with the LMA CTrach, and in Group V, the patients were intubated with a video laryngoscope. Patients' haemodynamic parameters, oxygen saturation, end-tidal carbondioxide, and endoscopic sight scores were recorded. RESULTS: The demographic characteristics and the ASA classifications of the groups were similar. When endoscopic sight scores were compared with C-L, better sight was obtained in the LMA CTrach group; no significant difference was detected in Group V. Regarding the success of the intubation, no significant difference was detected between groups. However, when intubation times were compared, there was a significant difference between groups. The intubation time was longer in Group C. There was no difference between groups in terms of the percentage changes of haemodynamic parameters, oxygen saturation, and end-tidal carbondioxide values of the patients. CONCLUSION: In this study, when endoscopic sight scores were compared, better visualization was obtained in the LMA CTrach group. Therefore, in cases where intubation is difficult to apply in patients, the LMA CTrach can be an alternative application.
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BACKGROUND: Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. METHODS: We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. RESULTS: During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 - 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. CONCLUSIONS: The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.
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Infecção Hospitalar/sangue , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Unidades de Terapia Intensiva/normas , Adulto , Idoso , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/prevenção & controle , Feminino , Seguimentos , Fidelidade a Diretrizes , Higiene das Mãos , Humanos , Incidência , Controle de Infecções/organização & administração , Controle de Infecções/normas , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Turquia/epidemiologiaRESUMO
PURPOSE: To investigate predictive powers of S100B and cell-free DNA (cfDNA) levels in patients in the intensive care unit (ICU) who have with intracranial hemorrhage (ICH) for prognosis. METHODS: Ninety-nine patients diagnosed with ICH were included in the study. The blood samples were drawn on the day of admittance to ICU and again on the third day. Duration of stay in the ICU and mortality were recorded. RESULTS: A positive correlation was determined between the values of S100B and cfDNA from both the analysis and the Acute Physiology and Chronic Health Evaluation II scores. For all patients, there was a positive correlation between the duration of stay in the ICU and the values of S100B and cfDNA on the third day. The levels of both S100B and cfDNA in patients who died in the ICU were significantly higher than of those who survived on the day of admittance. CONCLUSIONS: Both S100B and cfDNA values can be used as markers to predict the prognosis of ICU patients with ICH. However, S100B is more powerful for predicting the prognosis.
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DNA/sangue , Hemorragias Intracranianas/sangue , Proteínas S100/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Hemorragias Intracranianas/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Índice de Gravidade de DoençaRESUMO
STUDY OBJECTIVE: To assess the effect of two different remifentanil infusion doses on hemodynamic stability and recovery characteristics in children undergoing tracheobronchial foreign body removal during rigid bronchoscopy. DESIGN: Prospective, randomized, clinical comparison study. SETTING: Operating room of a university hospital. PATIENTS: 70 ASA physical status 1 and 2 children, aged 3-12 years, presenting for tracheobronchial foreign body removal during rigid bronchoscopy. INTERVENTIONS: Children were divided equally into two groups to receive either a 0.1 µg/kg/min (Group R1) or 0.2 µg/kg/min (Group R2) remifentanil infusion. Ten minutes after the remifentanil infusion, 3 mg/kg of propofol and 0.02 mg/kg of atropine were given. Anesthesia was maintained with 0.1 µg/kg/min of remifentanil and 100-250 µg/kg/min of propofol in Group R1 and 0.2 µg/kg/min of remifentanil and 100-250 µg/kg/min of propofol in Group R2. After baseline measurements were recorded, 0.2 mg/kg of mivacurium was given intravenously. Ventilation was maintained with 100% O(2) via a "T" piece connected to the side arm of the bronchoscope. MEASUREMENTS: Heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP), and O2 saturation (SpO2) were recorded before (baseline) and after induction, and 1, 3, 5, 10, 15, 20, 25, and 30 minutes after insertion of the rigid bronchoscope into the trachea. Emergence characteristics and complications were noted. Statistical analysis was performed using independent samples t-test, repeated measures, and chi-square test as appropriate. MAIN RESULTS: Groups were similar in demographics and duration of bronchoscopy and anesthesia (P > 0.05). In Group R1, HR, SBP, DBP, and MAP increased one minute after insertion of the bronchoscope in Group R1 (P < 0.01). Propofol consumption was significantly higher in Group R1 (63.6 ± 30.1 mg) than Group R2 (39.8 ± 26.6 mg; P < 0.01). Time to spontaneous eye opening was 8.6 ± 1.3 minutes in Group R1 and 6.3 ± 1.1 minutes in Group R2 (P < 0.05). The time to recovery to an Aldrete score of 9 was greater in Group R1 (19.8±3.0 min) than Group R2 (16.1±3.0 min; P < 0.01). CONCLUSION: A remifentanil 0.2 µg/kg/min infusion with propofol provides hemodynamic stability and early recovery in children undergoing foreign body removal during rigid bronchoscopy.
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Anestésicos Intravenosos/administração & dosagem , Brônquios , Corpos Estranhos/terapia , Piperidinas/administração & dosagem , Propofol/administração & dosagem , Traqueia , Período de Recuperação da Anestesia , Anestésicos Combinados/administração & dosagem , Broncoscopia/métodos , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Estudos Prospectivos , RemifentanilRESUMO
BACKGROUND: We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey. METHODS: A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods. RESULTS: The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001). CONCLUSION: Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey.
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Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Turquia/epidemiologiaRESUMO
OBJECTIVE: Our purpose was to study whether or not intravenous (IV) administration of lidocaine reduces propofol dose requirement as intramuscular (IM) lidocaine in a placebo-controlled manner. SUBJECTS AND METHODS: Seventy-five adult patients with American Society of Anesthesiologists physical status I and II, aged 20-60 years who were scheduled for surgery under general anaesthesia were included in the study. The patients were randomly allocated to 3 groups: IM: intramuscular administration; IV: intravenous administration and C: control. There were 25 patients in each group. The patients in group IM received lidocaine 1.5 mg · kg(-1) administered into the deltoid muscle 10 min before anaesthesia induction. In group IV, the patients received IV lidocaine 1.5 mg · kg(-1), 2 min before anaesthesia induction. Group C patients served as control group who received only propofol injection. Hypnosis after propofol administration was measured with response to verbal commands. RESULTS: There were no statistical differences between group IM (100.8 ± 26.1 mg) and group IV (110.8 ± 30.1 mg) regarding the induction dose of propofol (p > 0.05). In group C, the required propofol dose (151.2 ± 27.4 mg) for anaesthesia induction was significantly higher than in the other groups (p < 0.001). No side effect was observed in any patients. CONCLUSION: In this study, both IV and IM lidocaine administration were effective in reducing the hypnotic dose of propofol without any side effects. In addition, IV lidocaine may be more comfortable for awake patients.
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Anestésicos Locais/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Lidocaína/administração & dosagem , Propofol/administração & dosagem , Propofol/farmacologia , Adulto , Período de Recuperação da Anestesia , Sistema Nervoso Central/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Infusões Intravenosas , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND/OBJECTIVE: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. METHODS: Case reports of 5 patients with cervical spinal cord injury (SCI). RESULTS: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. CONCLUSIONS: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal.
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Febre/complicações , Febre/mortalidade , Traumatismos da Medula Espinal/complicações , Adulto , Vértebras Cervicais , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/mortalidadeRESUMO
BACKGROUND: In comparison with cutaneous pain, the role of alpha(2)-adrenoceptor (alpha(2)-AR) agonists in visceral pain has not been extensively examined. We aimed to characterize the antinociceptive effect of IV dexmedetomidine on visceral pain in rats and to determine whether antinociception thus produced is mediated by opioid receptors. METHODS: Male Sprague Dawley rats (250-300 g) were instrumented with a venous catheter for drug administration and with enameled nichrome electrodes for electromyography of the external oblique muscles. Colorectal distension (CRD) was used as the noxious visceral stimulus, and the visceromotor response to CRD was quantified electromyographically before and 5, 15, 30, 60, 90, and 120 min after dexmedetomidine or clonidine administration. Antagonists were administered 10 min before dexmedetomidine. After confirmation of normal distribution of data, one-way analysis of variance with the Tukey-Kramer post hoc test was used for multiple comparison. RESULTS: IV administration of dexmedetomidine (2.5-20 microg/kg) and clonidine (10-80 microg/kg) produced a dose-dependent reduction in visceromotor response with 50% effective dose values of 10.5 and 37.6 microg/kg, respectively. Administration of the nonspecific alpha(2)-AR antagonist yohimbine (1 mg/kg), but not the peripherally restricted alpha(2)-AR antagonist MK-467 (1 mg/kg), abolished the antinociceptive effect of dexmedetomidine (10 microg/kg). In addition, inhibition of opioid receptors by naloxone (1 mg/kg) attenuated the antinociceptive effect of dexmedetomidine. CONCLUSION: Our data indicate that IV dexmedetomidine exerts pronounced antinociception against CRD-induced visceral pain and suggest that the antinociceptive effect of dexmedotimidine is mediated in part by opioid receptors, but peripheral alpha(2)-ARs are not involved.
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Analgésicos não Narcóticos/farmacologia , Colo/fisiologia , Dexmedetomidina/farmacologia , Dor/tratamento farmacológico , Receptores Opioides/efeitos dos fármacos , Reto/fisiologia , Agonistas alfa-Adrenérgicos/farmacologia , Antagonistas Adrenérgicos alfa/farmacologia , Analgésicos não Narcóticos/administração & dosagem , Animais , Cateterismo , Clonidina/farmacologia , Interpretação Estatística de Dados , Dexmedetomidina/administração & dosagem , Relação Dose-Resposta a Droga , Injeções Intravenosas , Masculino , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Dor/etiologia , Medição da Dor/efeitos dos fármacos , Estimulação Física , Quinolizinas/farmacologia , Ratos , Ratos Sprague-Dawley , Ioimbina/farmacologiaRESUMO
BACKGROUND: The objective of this study was to determine the contamination rate of the healthcare workers' (HCWs') mobile phones and hands in operating room and ICU. Microorganisms from HCWs' hands could be transferred to the surfaces of the mobile phones during their use. METHODS: 200 HCWs were screened; samples from the hands of 200 participants and 200 mobile phones were cultured. RESULTS: In total, 94.5% of phones demonstrated evidence of bacterial contamination with different types of bacteria. The gram negative strains were isolated from mobile phones of 31.3% and the ceftazidime resistant strains from the hands were 39.5%. S. aureus strains isolated from mobile phones of 52% and those strains isolated from hands of 37.7% were methicillin resistant. Distributions of the isolated microorganisms from mobile phones were similar to hands isolates. Some mobile phones were contaminated with nosocomial important pathogens. CONCLUSION: These results showed that HCWs' hands and their mobile phones were contaminated with various types of microorganisms. Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals.
Assuntos
Bactérias/isolamento & purificação , Telefone Celular , Microbiologia Ambiental , Fungos/isolamento & purificação , Mãos/microbiologia , Bactérias/classificação , Portador Sadio/epidemiologia , Farmacorresistência Bacteriana , Fungos/classificação , Pessoal de Saúde , Humanos , Unidades de Terapia Intensiva , Salas Cirúrgicas , PrevalênciaRESUMO
OBJECTIVES: The purpose of this study was to investigate the effects of PEEP on oxygenation and airway pressures during PCV-OLV. DESIGN: Randomized, crossover, clinical study. SETTING: University hospital. PARTICIPANTS: Twenty-five patients undergoing thoracotomy. INTERVENTIONS: During the first 5 minutes of OLV, all patients were ventilated with VCV (PEEP: 0) (VCV-ZEEP). Afterward, ventilation was changed to PCV with PEEP: 0 (PCV-ZEEP) or PEEP: 4 cmH2O (PCV-PEEP) for 20 minutes. In the following 20 minutes, PCV-PEEP and PCV-ZEEP were applied in reverse sequence. MEASUREMENTS AND MAIN RESULTS: At the end of VCV-ZEEP airway pressures (peak airway pressure, plateau airway pressure, mean airway pressure, and pause airway pressure) were recorded. At the end of PCV-PEEP and PCV-ZEEP airway pressures, PaO2 and Qs/Qt were recorded. Ppeak and Pplat were significantly lower with PCV-PEEP compared with VCV-ZEEP (eg, Ppeak: 33.4+/-4.2, 28.3+/-4.1, and 28.9+/-3.7 cmH2O in VCV-ZEEP, PCV-ZEEP, and PCV-PEEP, respectively; p<0.05 for PCV-ZEEP v VCV-ZEEP and PCV-PEEP v VCV-ZEEP). PCV-PEEP was associated with an increased PaO2 (230.3+/-69.8 v 189.0+/-54.8 mmHg, p<0.05) and decreased Qs/Qt (33.4%+/-7.3% v 38.4%+/-5.7%, p<0.05) compared with PCV-ZEEP (mean+/-SD). Eighty-eight percent of the patients have benefited from PEEP. CONCLUSION: During OLV, PCV with a low level of PEEP leads to improved oxygenation with lower airway pressures.