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1.
J Ultrasound Med ; 43(2): 223-236, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37915259

RESUMO

INTRODUCTION: Weaning failure is common in mechanically ventilated patients, and whether ultrasound (US) can predict weaning outcome remains controversial. This review aims to evaluate the diaphragmatic function measured by US as a predictor of weaning outcome. METHODS: PubMed was searched to identify original articles about the use of diaphragmatic US in ICU patients. A total of 61 citations were retrieved initially; available data of 26 studies were included in this review. RESULTS: To assess diaphragmatic dysfunction in adults, six studies evaluated excursion, five evaluated thickening fraction, and both in nine. Despite heterogeneity in the diagnostic accuracy of diaphragm US among the studies, the sonographic indices showed good diagnostic performance for predicting weaning outcome. CONCLUSIONS: Diaphragmatic US can be a useful and accurate tool to detect diaphragmatic dysfunction in critically ill patients and predict weaning outcome.


Assuntos
Respiração Artificial , Desmame do Respirador , Adulto , Humanos , Diafragma/diagnóstico por imagem , Estudos Prospectivos , Cuidados Críticos , Ultrassonografia
2.
Curr Opin Crit Care ; 29(5): 457-462, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37641511

RESUMO

PURPOSE OF REVIEW: The increasing incidence of drug-resistant Candida brings a new challenge to the treatment of invasive candidiasis. Although cross-resistance among azoles and echinocandins was generally uncommon, reports of multidrug-resistant (MDR) Candida markedly increased in the last decade. The purpose of this review is to understand mechanisms and risk factors for resistance and how to tackle antifungal resistance. RECENT FINDINGS: The paper describes the action of the three main classes of antifungals - azoles, echinocandins and polyenes - and Candida's mechanisms of resistance. The current evolution from cross-resistance to multiresistance among Candida explains the modern glossary - multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) - imported from bacteria. MDR Candida most commonly involves acquired resistance in species with intrinsic resistance, therefore it mostly involves C. glabrata, C. parapsilosis, C. krusei, C guilliermondii or C. auris , which is intrinsically multidrug resistant. Finally, strategies to tackle antifungal resistance became clearer, ideally implemented through antifungal stewardship. SUMMARY: Avoiding antifungal's overuse and selecting the best drug, dose and duration, when they are needed, is fundamental. Knowledge of risk factors for resistance, microbiological diagnosis to the species, use of susceptibility test supported by antifungal stewardship programs help attaining effective therapy and sustaining the effectiveness of the current antifungal armamentarium.


Assuntos
Candida , Candidíase Invasiva , Humanos , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Equinocandinas , Azóis/farmacologia , Azóis/uso terapêutico
3.
BMC Public Health ; 19(1): 850, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262268

RESUMO

BACKGROUND: Malaria in Cape Verde is unstable, with a sporadic and seasonal transmission of low endemicity. In this sense, the community perceptions regarding malaria transmission, their attitudes and practices against the disease are very important to understand and to better develop the best strategical policies to achieve malaria elimination goal. This study aim to assess the knowledge, attitudes and practices (KAP) of Cape Verdean population about malaria, a country in the elimination step of disease. METHODS: A cross-sectional malaria KAP Survey was performed at the household level. A structured open questionnaire was developed and applied to residents of randomly selected households from 5 islands and 15 municipalities in Cape Verde. Correlation analyses were performed using a logistic regression model to determine the factors that are associated with the complete knowledge of the population about malaria. RESULTS: A total of 1953 fully completed questionnaires were analysed, with majority of questionnaires administered in Santiago island (68.3%), mainly in the capital city of Praia, 38.43%. About 88% of the population knew the correct form of transmission, 96% had knowledge that the entire population is at risk of malaria and identified the main symptoms. Regarding the attitudes, 58% seek treatment atthe nearest health structure upon the apparition of the symptoms, 64% in the first 24 h and 88% within the first 48 h. More than 97% have heard about mosquito nets but only 19% used it. In practice, 53% use coils, 45% rely on household sprays and 43% have benefited from IRS. About 90% received information about malaria from media, mainly the TV and the radio (83 and 43%, respectively). In summary, 54% of the population has complete knowledge of the disease. CONCLUSION: The population of Cape Verde has a high level of knowledge about malaria, including its transmission, main symptoms and preventive and control measures. However, some gaps and misunderstandings have been noticed and contribute to the insufficient community involvement in actions against malaria. Therefore, is necessary to increase the knowledge of the population, leading to their full ownership and participation in community actions to contribute to the malaria elimination in the country.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Adolescente , Adulto , Cabo Verde , Estudos Transversais , Erradicação de Doenças , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
4.
Curr Opin Infect Dis ; 31(2): 187-193, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29324504

RESUMO

PURPOSE OF REVIEW: Filamentous fungi respiratory infections, namely because of Aspergillus, Mucorales, Fusarium, or Scedosporium, show rising incidence and occur more in populations which are not classically immunosuppressed. This and their persistent dismal prognosis are the focus of this review. RECENT FINDINGS: Both an early diagnosis, rooted on a high level of suspicion and based on clinical picture, radiology, cultural microbiological exams, fungal biomarkers, PCR and biopsy, and an early therapy, including immunorecovery, whenever possible, good antifungal selection, and surgery for source control, are paramount to maximize the outcome in these diseases. An evolving antifungal armamentarium and a more Pharmacokinetics/Pharmacodynamics-based antifungal prescription may help to improve the prognosis. SUMMARY: Improved awareness of these infections may increase the level of suspicion, promoting early diagnosis and treatment, ideally supported with expert stewardship.


Assuntos
Antifúngicos/uso terapêutico , Testes Diagnósticos de Rotina/métodos , Gerenciamento Clínico , Unidades de Terapia Intensiva , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Humanos , Incidência , Pneumopatias Fúngicas/epidemiologia
5.
Crit Care ; 20: 53, 2016 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-26956367

RESUMO

BACKGROUND: To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU). METHODS: A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries. RESULTS: Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5-30.5) and 9 days (IQR 3-15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1%), followed by Candida glabrata (15.3%) and Candida parapsilosis (10.2%). No clear source of HAF was detected in 33.3% of the episodes and it was catheter-related in 21.9% of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6% vs. 21.6%; p = 0.0003) and renal dysfunction (25% vs. 12.4%; p = 0.0023) on admission and a higher rate of renal failure (26% vs. 16.2%; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9% vs. 55.3%; p < 0.001). The 28-day all cause fatality was 40.6%. According to multivariate analysis, only liver failure (OR 14.35; 95% CI 1.17-175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95% CI 1.2-65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95% CI 1.25-11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients. CONCLUSIONS: Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40%), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.


Assuntos
Fungemia/mortalidade , Fungemia/patologia , Mortalidade Hospitalar/tendências , Doença Iatrogênica , Idoso , Antifúngicos/uso terapêutico , Infecção Hospitalar/mortalidade , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
6.
Emerg Microbes Infect ; 13(1): 2343911, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38618930

RESUMO

Malaria remains one of the most important infectious diseases globally due to its high incidence and mortality rates. The influx of infected cases from endemic to non-endemic malaria regions like Europe has resulted in a public health concern over sporadic local outbreaks. This is facilitated by the continued presence of competent Anopheles vectors in non-endemic countries.We modelled the potential distribution of the main malaria vector across Spain using the ensemble of eight modelling techniques based on environmental parameters and the Anopheles maculipennis s.l. presence/absence data collected from 2000 to 2020. We then combined this map with the number of imported malaria cases in each municipality to detect the geographic hot spots with a higher risk of local malaria transmission.The malaria vector occurred preferentially in irrigated lands characterized by warm climate conditions and moderate annual precipitation. Some areas surrounding irrigated lands in northern Spain (e.g. Zaragoza, Logroño), mainland areas (e.g. Madrid, Toledo) and in the South (e.g. Huelva), presented a significant likelihood of A. maculipennis s.l. occurrence, with a large overlap with the presence of imported cases of malaria.While the risk of malaria re-emergence in Spain is low, it is not evenly distributed throughout the country. The four recorded local cases of mosquito-borne transmission occurred in areas with a high overlap of imported cases and mosquito presence. Integrating mosquito distribution with human incidence cases provides an effective tool for the quantification of large-scale geographic variation in transmission risk and pinpointing priority areas for targeted surveillance and prevention.


Assuntos
Anopheles , Malária , Mosquitos Vetores , Anopheles/parasitologia , Animais , Malária/epidemiologia , Malária/transmissão , Espanha/epidemiologia , Humanos , Mosquitos Vetores/parasitologia , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/transmissão , Incidência
7.
Semin Respir Crit Care Med ; 33(3): 272-83, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22718213

RESUMO

Despite all advances in its management, community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality requiring a great consumption of health, social, and economic resources. An early and adequate severity assessment is of paramount importance to provide optimized care to these patients. In the last 2 decades, this issue has been the subject of extensive research. Based on 30 day mortality, several prediction rules have been proposed to aid clinicians in deciding on the appropriate site of care. In spite of being well validated, their sensitivity and specificity vary, which limits their widespread use. The utility of biomarkers to overcome this problem has been investigated. At this moment, their full clinical value remains undetermined, and no single biomarker is consistently ideal for assessing CAP severity. Biomarkers should be seen as a complement rather than superseding clinical judgment or validated clinical scores. The search for a gold standard is not over, and new tools, like bacterial DNA load, are in the pipeline. Until then, CAP severity assessment should be based in three key points: a pneumonia-specific score, biomarkers, and clinical judgment.


Assuntos
Carga Bacteriana , Biomarcadores , DNA Bacteriano/análise , Pneumonia/diagnóstico , Índice de Gravidade de Doença , Infecções Comunitárias Adquiridas/diagnóstico , Técnicas de Apoio para a Decisão , Humanos , Prognóstico
8.
Rev Bras Ter Intensiva ; 34(1): 154-162, 2022.
Artigo em Português, Inglês | MEDLINE | ID: mdl-35766665

RESUMO

OBJECTIVE: To evaluate the influence of patient characteristics on hyperlactatemia in an infected population admitted to intensive care units and the influence of hyperlactatemia severity on hospital mortality. METHODS: A post hoc analysis of hyperlactatemia in the INFAUCI study, a national prospective, observational, multicenter study, was conducted in 14 Portuguese intensive care units. Infected patients admitted to intensive care units with a lactate measurement in the first 12 hours of admission were selected. Sepsis was identified according to the Sepsis-2 definition accepted at the time of data collection. The severity of hyperlactatemia was classified as mild (2 - 3.9mmol/L), moderate (4.0 - 9.9mmol/L) or severe (> 10mmol/L). RESULTS: In a total of 1,640 patients infected on admission, hyperlactatemia occurred in 934 patients (57%), classified as mild, moderate and severe in 57.0%, 34.4% and 8.7% of patients, respectively. The presence of hyperlactatemia and a higher degree of hyperlactatemia were both associated with a higher Simplified Acute Physiology Score II, a higher Charlson Comorbidity Index and the presence of septic shock. The lactate Receiver Operating Characteristic curve for hospital mortality had an area under the curve of 0.64 (95%CI 0.61 - 0.72), which increased to 0.71 (95%CI 0.68 - 0.74) when combined with Sequential Organ Failure Assessment score. In-hospital mortality with other covariates adjusted by Simplified Acute Physiology Score II was associated with moderate and severe hyperlactatemia, with odds ratio of 1.95 (95%CI 1.4 - 2.7; p < 0.001) and 4.54 (95%CI 2.4 - 8.5; p < 0.001), respectively. CONCLUSION: Blood lactate levels correlate independently with in-hospital mortality for moderate and severe degrees of hyperlactatemia.


OBJETIVO: Avaliar a influência das características dos pacientes na hiperlactatemia em uma população admitida com infecção em unidades de terapia intensiva, bem como a influência da gravidade da hiperlactatemia na mortalidade hospitalar. METÓDOS: Foi realizada uma análise post hoc da hiperlactatemia no INFAUCI, um estudo nacional prospectivo, observacional e multicêntrico, que incluiu 14 unidades de terapia intensiva portuguesas. Foram selecionados pacientes admitidos com infecção em unidades de terapia intensiva com dosagem de lactato nas primeiras 12 horas de admissão. A sepse foi identificada de acordo com a definição Sepsis-2 aceita no momento da coleta de dados. A gravidade da hiperlactatemia foi classificada como leve (2 - 3,9mmol/L), moderada (4,0 - 9,9mmol/L) ou grave (> 10mmol/L). RESULTADOS: De 1.640 pacientes admitidos com infecção, a hiperlactatemia ocorreu em 934 (57%) e foi classificada como leve, moderada e grave em 57,0%, 34,4% e 8,7% dos pacientes, respectivamente. A presença de hiperlactatemia e um maior grau de hiperlactatemia se associaram a um maior Simplified Acute Physiology Score II, a maior Índice de Comorbidade de Charlson e à presença de choque séptico. Em relação à curva Receiver Operating Characteristic do lactato para mortalidade hospitalar, foi encontrada área sob a curva de 0,64 (IC95% 0,61 - 0,72), que aumentou para 0,71 (IC95% 0,68 - 0,74) quando se combinou o Sequential Organ Failure Assessment. A mortalidade intra-hospitalar com outras covariáveis ajustadas pelo Simplified Acute Physiology Score II se associou à hiperlactatemia moderada e grave, com razão de chances de 1,95 (IC95% 1,4 - 2,7; p < 0,001) e 4,54 (IC95% 2,4 - 8,5; p < 0,001), respectivamente. CONCLUSÃO: Os níveis de lactato sanguíneo correlacionam-se independentemente com a mortalidade intra-hospitalar para graus moderados e graves de hiperlactatemia.


Assuntos
Hiperlactatemia , Sepse , Humanos , Hiperlactatemia/epidemiologia , Unidades de Terapia Intensiva , Ácido Láctico , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Sepse/epidemiologia
9.
Eur Geriatr Med ; 12(5): 1057-1064, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33646536

RESUMO

PURPOSE: Older patients are the fastest expanding subgroup of intensive care units (ICU) and are particularly susceptible to bacterial infections and sepsis. The aim of this study was to address the epidemiology and the main determinants of outcome of infection in old and very old patients admitted to ICU. METHODS: We performed a post hoc analysis of all infected patients admitted to ICU enrolled in a 1-year prospective, observational, multipurpose study. Patients aged < 65, 65-74 and ≥ 75 years were compared. RESULTS: Of the 1652 patients included, 50% were older than 65 years. There were no significant differences between young, old and very old patients in either ICU, hospital length of stay, or nosocomial infection. All-cause mortality was significantly higher in participants aged ≥ 75. Increased Gram-negative microorganisms' isolates occurred in > 65 years (25% versus 31%; p = 0.034). Multidrug-resistant (MDR) microorganisms were directly associated to inappropriate empiric antibiotic therapy (OR 4.73; 95% CI 2.99-7.47) and inversely associated with community-acquired infection (OR 0.39; 95% CI 0.19-0.83). Age (65-74 years: OR 1.10; 95% CI 0.64-1.90 and ≥ 75 years: OR 1.52; 95% CI 0.89-2.59) and sepsis severity (sepsis: OR 0.67; 95% CI 0.18-2.46; severe sepsis: OR 1.17; 95% CI 0.40-3.44; septic shock: OR 0.77; 95% CI 0.27-2.24) were not associated to MDR bacteria. CONCLUSION: Patients > 65 years accounted for 50% of infected patients admitted to an ICU. ICU and hospital length of stay, and nosocomial infection did not increase with age. Age did predispose to increased risk for infection by Gram-negatives. These findings may optimize strategies for infection management in older patients.


Assuntos
Fatores Etários , Infecção Hospitalar , Sepse , Idoso , Estado Terminal , Infecção Hospitalar/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Sepse/epidemiologia
12.
Infect Dis Rep ; 12(3): 61-69, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33153134

RESUMO

Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) is associated with relapsing multifocal skin and soft tissue infections (SSTI), necrotizing pneumonia (NP) and severe musculoskeletal infections. Epidemiology is underknown and underdiagnosis is likely. Recent travel abroad, case clustering and relapsing disease are often reported. We reviewed all cases of PVL-SA infection diagnosed at our center, and found 21 cases over a 43-month period. Most patients were adult males, had relevant travel history, reported recurrent disease and presented with SSTI. Etiologic diagnosis took up to five years; meanwhile, 42% of patients had antibiotic treatments. Draining procedures were required in 43% of patients and intensive care support in 19%. All patients recovered. Methicillin-resistance prevalence was 24%. Only 2/13 decolonized patients had posterior relapsing SSTI, both with likely infected contacts. PVL-SA infection's severity and impact are clear, even in small case series as ours. Physician awareness and active PVL-gene search are crucial for an adequate management.

13.
Zootaxa ; 4674(1): zootaxa.4674.1.2, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31716019

RESUMO

The isolation of a small group of species of the genus Micrambe Thomson, 1863 (Coleoptera: Cryptophagidae) in the eastern mountains of Africa, together with the exclusivity of habitat and the characteristics of their aedeagus have led to proposing a new subgenus, which we have called Neomicrambe subgen. nov. The differential diagnosis is established in relation to a group of other species of the genus. Two species are new records for Kenya.


Assuntos
Besouros , África Oriental , Distribuição Animal , Animais , Quênia
14.
Acta Med Port ; 32(12): 737-745, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31851882

RESUMO

INTRODUCTION: The ideal biomarker to assess response and prognostic assessment in the infected critically ill patient is still not available. The aims of our study were to analyze the association between early C-reactive protein kinetics and duration and appropriateness of antibiotic therapy and its usefulness in predicting mortality in infected critically ill patients. MATERIAL AND METHODS: We have carried out an observational retrospective study in a cohort of 60 patients with community-acquired pneumonia, aspiration pneumonia and bacteremia at an intensive care unit. We have collected C-reactive protein consecutive serum levels for eight days as well as duration and appropriateness of initial antibiotic therapy. C-reactive protein kinetic groups were defined based on the levels at days 0, 4 and 7. With a follow-up of one year, we have evaluated mortality at different time-points. RESULTS: We have obtained three different C-reactive protein kinetic groups from the sample: fast response, delayed but fast response and delayed and slow response. We did not find statistically significant associations between C-reactive protein kinetics and early (intensive care unit, hospital and 28-days) or late (six months and one year) mortality and antibiotic therapy duration (p > 0.05). Although there were no statistically significant differences between the appropriateness of antibiotic therapy and the defined groups (p = 0.265), no patient with inappropriate antibiotic therapy presented a fast response pattern. DISCUSSION: Several studies suggest the importance of this protein in infection. CONCLUSION: Early C-reactive protein kinetics is not associated with response and prognostic assessment in infected critically ill patients. Nevertheless, a fast response pattern tends to exclude initial inappropriate antibiotic therapy.


Introdução: O biomarcador ideal capaz de avaliar a resposta e prognóstico no doente crítico infetado ainda não está disponível. Os objetivos do nosso estudo foram avaliar a relação da cinética precoce da proteína C-reativa com a duração e apropriação da terapêutica antibiótica e a sua utilidade na predição de mortalidade. Material e Métodos: Realizámos um estudo retrospetivo observacional numa coorte de 60 doentes com pneumonia adquirida na comunidade, pneumonia de aspiração e bacteremia numa unidade de cuidados intensivos. Colhemos níveis séricos de proteína C-reativa durante oito dias e a duração e apropriação da terapêutica antibiótica inicial. Definimos grupos de cinética de proteína C-reativa com base nos níveis dos dias 0, 4 e 7. Durante um ano de seguimento, analisámos a mortalidade em diferentes momentos. Resultados: Da amostra obtivemos três grupos de cinética de proteína C-reativa: resposta rápida, resposta atrasada mas rápida e resposta atrasada e lenta. Não observamos associação estatisticamente significativa entre a cinética da proteína C-reativa com a mortalidade precoce (unidade de cuidados intensivos, hospital e aos 28 dias) ou tardia (seis meses e um ano) e duração da terapêutica antibiótica (p > 0,05). Embora não existam diferenças estatisticamente significativas entre a apropriação da terapêutica antibiótica e os grupos definidos (p = 0,265), nenhum doente com terapêutica antibiótica inapropriada apresentou um padrão de resposta rápida. Discussão: Vários estudos sugerem a importância desta proteína na infeção. Conclusão: A cinética precoce da proteína C-reativa não está associada com a avaliação da resposta e prognóstico no doente crítico infectado. Porém, um padrão de resposta rápida tende a excluir terapêutica antibiótica inicial inapropriada.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/sangue , Proteína C-Reativa/metabolismo , Infecções Comunitárias Adquiridas/sangue , Pneumonia Aspirativa/sangue , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Biomarcadores , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/tratamento farmacológico , Pneumonia Aspirativa/mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
15.
J Crit Care ; 53: 38-45, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31177029

RESUMO

PURPOSE: To identify a single/panel of biomarkers and to provide a point score that, after 48 h of treatment, could early predict treatment failure at fifth day of Intensive Care Unit (ICU) stay in severe community-acquired pneumonia (SCAP) patients. MATERIALS AND METHODS: Single-center, prospective cohort study of 107 ICU patients with SCAP. Primary outcome included death or absence of improvement in Sequential Organ Failure Assessment score by ≥2 points within 5 days of treatment. Biomarkers were evaluated within 12 h of first antibiotic dose (D1) and 48 h after the first assessment (D3). RESULTS: A model based on Charlson's score and a panel of biomarkers (procalcitonin on D1 and D3, B-natriuretic peptide on D1, D-dimer and lactate on D3) had good discrimination for primary outcome in both derivation (AUC 0.82) and validation (AUC 0.76) samples and was well calibrated (X2 = 0.98; df = 1; p = .32). A point score system (PRoFeSs score) built on the estimates of regression coefficients presented good discrimination (AUC 0.81; 95% Confidence Interval 0.72-0.89) for primary outcome. CONCLUSIONS: In SCAP, a combination of biomarkers measured at admission and 48 h later may early predict treatment failure. PRoFeSs score may recognize patients with poor short-term prognosis.


Assuntos
Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Índice de Gravidade de Doença , Biomarcadores , Estudos de Coortes , Infecções Comunitárias Adquiridas/mortalidade , Cuidados Críticos , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Portugal , Valor Preditivo dos Testes , Estudos Prospectivos , Falha de Tratamento
16.
Zookeys ; (786): 69-73, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30283236

RESUMO

A new species of Corticarina Reitter, 1881 (Coleoptera: Latridiidae), Corticarinaoscargloriorum sp. n. from Guatemala is described and illustrated. The differential diagnosis is established in relation to a group of other species of the genus.

17.
Rev Bras Ter Intensiva ; 30(1): 80-85, 2018 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29742211

RESUMO

The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated pneumonia. Ventilator-associated tracheobronchitis has an incidence similar to that of ventilator-associated pneumonia, with a high prevalence of isolated multiresistant agents, resulting in an increase in the time of mechanical ventilation and hospitalization but without an impact on mortality. The performance of quantitative cultures may allow better diagnostic definition of tracheobronchitis associated with mechanical ventilation, possibly avoiding the overdiagnosis of this condition. One of the major difficulties in differentiating between ventilator-associated tracheobronchitis and ventilator-associated pneumonia is the exclusion of a pulmonary infiltrate by chest radiography; thoracic computed tomography, thoracic ultrasonography, or invasive specimen collection may also be required. The institution of systemic antibiotic therapy does not improve the clinical impact of ventilator-associated tracheobronchitis, particularly in reducing time of mechanical ventilation, hospitalization or mortality, despite the possible reduced progression to ventilator-associated pneumonia. However, there are doubts regarding the methodology used. Thus, considering the high prevalence of tracheobronchitis associated with mechanical ventilation, routine treatment of this condition would result in high antibiotic usage without clear benefits. However, we suggest the institution of antibiotic therapy in patients with tracheobronchitis associated with mechanical ventilation and septic shock and/or worsening of oxygenation, and other auxiliary diagnostic tests should be simultaneously performed to exclude ventilator-associated pneumonia. This review provides a better understanding of the differentiation between tracheobronchitis associated with mechanical ventilation and pneumonia associated with mechanical ventilation, which can significantly decrease the use of antibiotics in critically ventilated patients.


Assuntos
Antibacterianos/uso terapêutico , Bronquite/tratamento farmacológico , Traqueíte/tratamento farmacológico , Bronquite/diagnóstico , Bronquite/etiologia , Estado Terminal , Diagnóstico Diferencial , Farmacorresistência Bacteriana Múltipla , Humanos , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Respiração Artificial/efeitos adversos , Traqueíte/diagnóstico , Traqueíte/etiologia
18.
Zookeys ; (748): 47-56, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29674913

RESUMO

A new species of Micrambe Thomson, 1863 (Coleoptera, Cryptophagidae), Micrambe camerunensissp. n. from Cameroon is described and illustrated. No other record of any Cryptophagidae of Cameroon is known. The differential diagnosis is established in relation to a group of other species of the genus.

19.
Mol Clin Oncol ; 9(3): 347-349, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30155258

RESUMO

Patients with a Philadelphia chromosome-negative myeloproliferative neoplasm may develop a lymphoproliferative disorder; however, the clinical and molecular determinants and the chronological onset of the two events remain unknown. We herein report the case of a 64-year-old man with concomitant diagnosis of high-risk essential thrombocythemia with evidence of a thrombotic event and high-count monoclonal B-cell lymphocytosis (high-count MBL). The patient harbored a JAK2V617F mutation and one of the most common genetic alterations found in chronic lymphocytic leukemia (CLL) (del 13q), which may represent a sign of disease progression. He was initiated on cytoreductive therapy with hydroxyurea 500 mg 3 times per week and hypocoagulation treatment, and is currently under regular surveillance of MBL without CLL criteria.

20.
PLoS One ; 13(10): e0205799, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325967

RESUMO

Novel ecosystems have emerged through human intervention and are rapidly expanding around the world. Whether they can support animal wildlife has generated considerable controversy. Here we developed a new approach to evaluate the ability of a novel forest ecosystem, dominated by the exotic tree species Eucalyptus globulus, to support animal wildlife in the medium and long term. To evaluate this ability, we took advantage of the fact that species territory size decreases with increasing habitat quality, and we used territoriality of a raptor guild composed of Northern Goshawk (Accipiter gentilis), Eurasian Sparrowhawk (A. nisus) and Common Buzzard (Buteo buteo) as indicator. We compared the territoriality of these species in the novel ecosystem with that in other ecosystems found in the literature. Average distances between con-specifics in the novel ecosystem were similar, or even shorter, than those in other ecosystems. Average distances between Goshawk con-specifics were among the shortest described in the literature. All three species nested preferably in mixed stands abundant in large exotic trees, with high structural complexity and abundance of native species within the stand. Key factors supporting this diverse and dense raptor community were the special forest management system implemented in the study area and the agricultural matrix located close to forest plantations that complements the supply of prey. Our results suggest that forest management that promotes a complex and suitable forest structure can increase the ability of novel forest ecosystems to support wildlife biodiversity, particularly a diverse nesting community of forest-dwelling raptors and their preys. The results further suggest the suitability of territoriality for assessing this potential of novel ecosystems.


Assuntos
Animais Selvagens , Florestas , Aves Predatórias , Territorialidade , Animais , Austrália , Ritmo Circadiano , Ecossistema , Eucalyptus , Falconiformes , Falcões , População , Aves Predatórias/fisiologia
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