Serum LDH levels may predict poor neurological outcome after aneurysmal subarachnoid hemorrhage.

INTRODUCTION: Serum lactate dehydrogenase (LDH) levels are often elevated in cardiovascular diseases. Their prognostic role after subarachnoid hemorrhage (SAH) remains poorly evaluated. METHODS: This is a retrospective single-center study of patients with non-traumatic SAH admitted to the intensive care unit (ICU) of an University Hospital from 2007 to 2022. Exclusion criteria were pregnancy and incomplete medical records or follow-up data. Baseline information, clinical data, radiologic data, the occurrence of neurological complications as well as serum LDH levels during the first 14 days of ICU stay were collected. Unfavorable neurological outcome (UO) at 3 months was defined as a Glasgow Outcome Scale of 1-3. RESULTS: Five hundred and forty-seven patients were included; median serum LDH values on admission and the highest LDH values during the ICU stay were 192 [160-230] IU/L and 263 [202-351] IU/L, respectively. The highest LDH value was recorded after a median of 4 [2-10] days after ICU admission. LDH levels on admission were significantly higher in patients with UO. When compared with patients with favorable outcome (FO), patients with UO had higher serum LDH values over time. In the multivariate logistic regression model, the highest LDH value over the ICU stay (OR 1.004 [95% CI 1.002 - 1.006]) was independently associated with the occurrence of UO; the area under the receiving operator (AUROC) curve for the highest LDH value over the ICU stay showed a moderate accuracy to predict UO (AUC 0.76 [95% CI 0.72-0.80]; p < 0.001), with an optimal threshold of > 272 IU/L (69% sensitivity and 74% specificity). CONCLUSIONS: The results in this study suggest that high serum LDH levels are associated with the occurrence of UO in SAH patients. As a readily and available biomarker, serum LDH levels should be evaluated to help with the prognostication of SAH patients.

The Effects of Acetazolamide on Cerebral Hemodynamics in Adult Patients with an Acute Brain Injury: A Systematic Review.

BACKGROUND: Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme expressed in different cells of the central nervous system (CNS) and involved in the regulation of cerebral blood flow (CBF). The aim of this review was to understand the effects of acetazolamide on CBF, intracranial pressure (ICP) and brain tissue oxygenation (PbtO2) after an acute brain injury (ABI). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA), we performed a comprehensive, computer-based, literature research on the PubMed platform to identify studies that have reported the effects on CBF, ICP, or PbtO2 of acetazolamide administered either for therapeutic or diagnostic purposes in patients with subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, and hypoxic-ischemic encephalopathy. RESULTS: From the initial search, 3430 records were identified and, through data selection, 11 of them were included for the qualitative analysis. No data on the effect of acetazolamide on ICP or PbtO2 were found. Cerebral vasomotor reactivity (VMR-i.e., the changing in vascular tone due to a vasoactive substance) to acetazolamide tends to change during the evolution of ABI, with the nadir occurring during the subacute stage. Moreover, VMR reduction was correlated with clinical outcome. CONCLUSIONS: This systematic review showed that the available studies on the effects of acetazolamide on brain hemodynamics in patients with ABI are scarce. Further research is required to better understand the potential role of this drug in ABI patients.

Clinical features and 28-day mortality predictors of vaccinated patients admitted to a COVID-19 ICU hub in Italy.

BACKGROUND: COVID-19 vaccination has been proved to be effective in preventing hospitalization and illness progression, even though data on mortality of vaccinated patients in the intensive care unit (ICU) are conflicting. The aim of this study was to investigate the characteristics of vaccinated patients admitted to ICU according to their immunization cycle and to outline the risk factors for 28-day mortality. This observational study included adult patients admitted to ICU for acute respiratory failure (ARF) due to SARS-CoV-2 and who had received at least one dose of vaccine. RESULTS: Fully vaccination was defined as a complete primary cycle from < 120 days or a booster dose from > 14 days. All the other patients were named partially vaccinated. One-hundred sixty patients (91 fully and 69 partially vaccinated) resulted eligible, showing a 28-day mortality rate of 51.9%. Compared to partially vaccinated, fully vaccinated were younger (69 [60-77.5] vs. 74 [66-79] years, p 0.029), more frequently immunocompromised (39.56% vs. 14.39%, p 0.003), and affected by at least one comorbidity (90.11% vs 78.26%, p 0.045), mainly chronic kidney disease (CKD) (36.26% vs 20.29%, p 0.035). At multivariable analysis, independent predictors of 28-day mortality were as follows: older age [OR 1.05 (CI 95% 1.01-1.08), p 0.005], history of chronic obstructive pulmonary disease (COPD) [OR 3.05 (CI 95% 1.28-7.30), p 0.012], immunosuppression [OR 3.70 (CI 95% 1.63-8.40), p 0.002], and admission respiratory and hemodynamic status [PaO2/FiO2 and septic shock: OR 0.99 (CI 95% 0.98-0.99), p 0.009 and 2.74 (CI 95% 1.16-6.48), p 0.022, respectively]. CONCLUSIONS: Despite a full vaccination cycle, severe COVID-19 may occur in patients with relevant comorbidities, especially immunosuppression and CKD. Regardless the immunization status, predisposing conditions (i.e., older age, COPD, and immunosuppression) and a severe clinical presentation were predictors of 28-day mortality.

Hemodynamic response to positive end-expiratory pressure and prone position in COVID-19 ARDS.

BACKGROUND: Use of high positive end-expiratory pressure (PEEP) and prone positioning is common in patients with COVID-19-induced acute respiratory failure. Few data clarify the hemodynamic effects of these interventions in this specific condition. We performed a physiologic study to assess the hemodynamic effects of PEEP and prone position during COVID-19 respiratory failure. METHODS: Nine adult patients mechanically ventilated due to COVID-19 infection and fulfilling moderate-to-severe ARDS criteria were studied. Respiratory mechanics, gas exchange, cardiac output, oxygen consumption, systemic and pulmonary pressures were recorded through pulmonary arterial catheterization at PEEP of 15 and 5 cmH2O, and after prone positioning. Recruitability was assessed through the recruitment-to-inflation ratio. RESULTS: High PEEP improved PaO2/FiO2 ratio in all patients (p = 0.004), and significantly decreased pulmonary shunt fraction (p = 0.012), regardless of lung recruitability. PEEP-induced increases in PaO2/FiO2 changes were strictly correlated with shunt fraction reduction (rho=-0.82, p = 0.01). From low to high PEEP, cardiac output decreased by 18 % (p = 0.05) and central venous pressure increased by 17 % (p = 0.015). As compared to supine position with low PEEP, prone positioning significantly decreased pulmonary shunt fraction (p = 0.03), increased PaO2/FiO2 (p = 0.03) and mixed venous oxygen saturation (p = 0.016), without affecting cardiac output. PaO2/FiO2 was improved by prone position also when compared to high PEEP (p = 0.03). CONCLUSIONS: In patients with moderate-to-severe ARDS due to COVID-19, PEEP and prone position improve arterial oxygenation. Changes in cardiac output contribute to the effects of PEEP but not of prone position, which appears the most effective intervention to improve oxygenation with no hemodynamic side effects.

Poeticizing after sixty: an experience on aging / Poetizando após os sessenta: uma experiência sobre o envelhecer / Sesiones de poesías después de los sesenta: una experiencia sobre el envejecer

The stigmatization of aging by reducing it to losses is due both to the denaturalization of the phenomenon and to the influence of cultural ideas on aging that disregard their subjective aspects. The aim of this paper is to present research participating in a poetry workshop, from a group of older adult women (aged over sixty years) reading and writing poetry. The research monitored whether reading and writing poetry helped in the production of new meanings about aging, as well as the reflection that the older adults had about the aging development phase and its aesthetic, social and cultural ramifications. After reading the poems produced and the descriptive notes of the meetings, the following categories of analysis emerged: the meetings as an area of appropriation, conviviality and reflection for the participants; society and the possibility of an active position in aging; the appropriation of the body in aging: experiences and criticism of the aesthetic model; and memory: recollections and meanings. As a result of the poetry workshop, a space was established for creation, sharing and social recognition; recovery of memories and reflections about the stigmas.

A estigmatização do envelhecimento reduzindo-o às perdas se dá tanto pela desnaturalização do fenômeno quanto pela influência do ideário cultural sobre o envelhecimento que desconsideram seus aspectos subjetivos. O objetivo deste artigo é apresentar uma pesquisa participante em uma oficina de poesias, verificando se a leitura e a produção poéticas auxiliam na produção de novos sentidos sobre o envelhecer. Dos materiais produzidos nas oficinas, bem como dos relatos descritivos dos encontros, emergiram as seguintes categorias de análise: a oficina como espaço de apropriação, convívio e reflexão das participantes; sociedade e possibilidade de uma postura ativa no envelhecimento; a apropriação do corpo no envelhecer: vivências e críticas ao modelo estético; memória: recordações e significados. Como resultado, a oficina de poesias possibilitou um espaço de criação, partilha e reconhecimento social, de retomada de memórias e de reflexões acerca dos estigmas.

La estigmatización del envejecimiento reduciéndolo a las pérdidas se da tanto por la desnaturalización del fenómeno como por la influencia del ideario cultural sobre el envejecimiento que desconsideran sus aspectos subjetivos. El objetivo de este artículo es presentar una investigación participante en sesiones de poesías, identificando si la lectura y la producción poéticas auxilian en la producción de nuevos sentidos sobre el envejecimiento. De los materiales producidos en los talleres así como de los relatos descriptivos de los encuentros, surgieron las siguientes categorías de análisis: sesiones como espacio de apropiación, convivencia y reflexión de las participantes; sociedad y la posibilidad de la postura activa en el envejecimiento; la apropiación del cuerpo en el envejecimiento: vivencias y críticas al modelo estético; memoria: recuerdos y significados. Como resultado, las sesiones de poesías posibilitan un espacio de creación, compartir y reconocimiento social, de la retomada de memorias y de reflexiones acerca de los estigmas.

Significados da escolarização para alunos da educação de jovens e adultos / Meaning of schooling of students of youth and adult education / Significados de la escolarización de los estudiantes de la educación de los jóvenes y adultos

Este artigo visa apresentar a investigação do processo de retorno à escolarização de adultos a partir de seus significados para os alunos de EJA, compreendendo os motivos pelos quais voltaram à escola e o significado desta na vida adulta. Os alunos expressam em suas falas a desvalorização que atribuíam à educação quando criança e como o abandono dos estudos os afetou, pessoal e profissionalmente. Hoje, valorizam a educação por ser essencial para o mercado de trabalho, e não necessariamente pelo seu aprimoramento pessoal; o mesmo mundo do trabalho que tira as crianças da escola, para cuidarem de sua subsistência, exige um retorno do adulto trabalhador aos bancos escolares, para que possa continuar na cadeia produtiva e "superar" sua atual situação socioeconômica. Nota-se, também, a herança histórica da produção do abandono escolar, na qual aqueles de classes mais pobres carregam estigmas de uma suposta lacuna cultural perpassada pela exclusão e pelo preconceito.

The objective of this work is to present the investigation done on the process of return to adults' school, using their meaning of schooling, understanding the reasons why students have returned to school and the meaning that the school acquired in theirs adulthood. We observed the devaluation of education as a child and realization of how the abandonment of studies have affected their lives, personal and professional, in addition, it was observed that nowadays, education is essential to the job market. The same labor market that took children out of school to take care of themselves, now requires of workers a return to school, so that they can continue in production chain and overcome (at least wishfully) your current socioeconomic status. We noticed also the historical heritage of producing dropout, in which those who come from the poorer classes carry stigmas of a supposed cultural gap throw exclusion and prejudice.

Este artículo propone presentar una investigación sobre el proceso de retorno a la escolarización de adultos desde los significados de la escolarización de los estudiantes, teniendo en cuenta los motivos por los cuales volvieron a la escuela y el significado de la misma en la vida adulta. los alumnos expresan en sus discursos la desvalorización que atribuían a la educación cuando eran niños y cómo el abandono de los estudios afectó sus vidas, personales y profesionales, se observó también que hoy, valoran la educación por ser esencial para el mercado de trabajo, y no precisamente por perfeccionarse personalmente, el mismo mundo laboral que saca a los niños de las escuelas, para cuidar de la subsistencia, exige un regreso del adulto trabajador a los pupitres escolares, para que pueda continuar la cadena productiva y superar (al menos ilusoriamente) su actual situación socioeconómica. Nos damos cuenta también de la herencia histórica del abandono escolar, en la cual aquellos de clases más pobres cargan estigmas de una supuesta laguna cultural dejada por la exclusión y el prejuicio.

Preparação para a adoção: grupo de apoio para candidatos / Support group for adoptive parents: an experience psychosocial / Grupo de apoyo para los futuros padres adoptivos: una experiencia psicosocial

A Lei da Convivência Familiar é a atual legislação sobre a adoção no país. Ela cria a obrigatoriedade da habilitação prévia para adotar e considera necessária a preparação psicossocial e jurídica do candidato a adotante. Este artigo busca refletir, a partir de uma experiência em grupo de apoio a candidatos à adoção, sobre a possibilidade de o grupo de apoio ser uma ferramenta de prevenção de conflitos com a criança a ser adotada. Para que possam acolher um filho, os pais precisam entender as filiações, as heranças e os desejos deste, e o grupo de apoio pode ser uma forma de sensibilização e preparação dos candidatos à adoção para temas que permeiam o processo de filiação.

The Law of Family Living is the current law on adoption in the country. It creates an obligation of previous qualification to adopt and considers necessary to prepare adoptive parents in psychosocial and legal ways. This paper reflects, from an experience of support group to prospective adoptive parents, about the possibility of support group works as a tool to conflict prevention between parents and the child to be adopted. We can conclude, that to welcome a child, parents need understand their own filiations, inheritances and desires and the support group can be a form of awareness and preparedness of the adoptive parents for themes that permeate the filiation process.

La Ley de la Coexistencia Familiar es la actual ley de adopción en el país. Ella establece la obligación de licencia previa para adoptar y considere necesaria la preparación psicosocial y legal del candidato adoptante. En este artículo se reflexiona, a partir de una experiencia de grupo de apoyo para los futuros padres adoptivos, sobre la posibilidad de un grupo de apoyo como una herramienta para la prevención de los conflictos con el niño para ser adoptado. Se puede concluir que para dar la bienvenida a un niño requiere que los padres entiendan sus filiaciones, herencias y deseos, y el grupo de apoyo puede ser una forma de conocimiento y preparación de los candidatos a la adopción para los temas que permean el proceso de filiación.

Filhos de mulheres presas: o papel materno na socialização dos indivíduos / Children of jailed women: the role of the mother in the socialization of individuals

O objetivo deste artigo é refletir sobre o processo de socialização dos filhos de mulheres presas e a partir daí entender a influência do aprisionamento materno e do impacto social produzido por ele neste percurso de desenvolvimento. Além de pesquisa bibliográfica, este trabalho está ancorado na coleta de histórias de vida de filhos de mulheres presas. A amostra foi constituída por quatro rapazes e duas moças, com média de idade de 21 anos, que moravam com a própria mãe ou com a família dela quando da prisão materna. Considera-se que no processo de socialização dos filhos de mulheres presas estão presentes, especialmente: a internalização de uma figura materna elaborada entre a figura mítica de mãe e a delinquência materna; a culpa que os sujeitos sentem pela delinquência materna; e a culpabilização da mãe sobre o abandono sofrido na infância.(AU)

The objective of this article is to reflect about the socialization process of children of jailed mothers, and then understand the influence of both the mother’s imprisonment and the social impact generated on this development process. Besides bibliographical research, this work is based on the life histories of children of imprisoned women. The sample was constituted by four young males and two young females, with age average of 21 years, who lived with theirs mothers or with their mother’s family at the time they went to prison. It is considered that in the socialization process of the children of imprisoned women there are: the internalization of the mother figure elaborated between the mythical figure of the mother and the mother’s delinquency; the guilt that the subjects feel for the mother’s delinquency, as well as the blame on the mother for the abandonment suffered in their childhood.(AU)

Filhos de mulheres presas: o papel materno na socialização dos indivíduos / Children of jailed women: the role of the mother in the socialization of individuals

O objetivo deste artigo é refletir sobre o processo de socialização dos filhos de mulheres presas e a partir daí entender a influência do aprisionamento materno e do impacto social produzido por ele neste percurso de desenvolvimento. Além de pesquisa bibliográfica, este trabalho está ancorado na coleta de histórias de vida de filhos de mulheres presas. A amostra foi constituída por quatro rapazes e duas moças, com média de idade de 21 anos, que moravam com a própria mãe ou com a família dela quando da prisão materna. Considera-se que no processo de socialização dos filhos de mulheres presas estão presentes, especialmente: a internalização de uma figura materna elaborada entre a figura mítica de mãe e a delinquência materna; a culpa que os sujeitos sentem pela delinquência materna; e a culpabilização da mãe sobre o abandono sofrido na infância. (AU)

The objective of this article is to reflect about the socialization process of children of jailed mothers, and then understand the influence of both the mother’s imprisonment and the social impact generated on this development process. Besides bibliographical research, this work is based on the life histories of children of imprisoned women. The sample was constituted by four young males and two young females, with age average of 21 years, who lived with theirs mothers or with their mother’s family at the time they went to prison. It is considered that in the socialization process of the children of imprisoned women there are: the internalization of the mother figure elaborated between the mythical figure of the mother and the mother’s delinquency; the guilt that the subjects feel for the mother’s delinquency, as well as the blame on the mother for the abandonment suffered in their childhood. (AU)

Aprisionamento materno e escolarização dos filhos / Encarcelamiento materno y escolarización de los hijos / Mother's aprisionment and children's schooling

O objetivo deste artigo é refletir sobre o impacto do aprisionamento materno na vida escolar dos filhos. Este trabalho está ancorado na coleta de histórias de vida de filhos de mulheres presas. A amostra foi constituída por quatro rapazes e duas moças, com média de idade de 21 anos, que moravam com a própria mãe ou com a família dela quando da prisão materna e se encontravam no processo de escolarização. A partir das entrevistas, verificamos que a prisão materna pode deixar a criança em situação de vulnerabilidade, o que reflete na socialização promovida pela escola, assumindo aspectos como: a criança pode estar emocionalmente tão envolvida com questões de ordem familiar que apresenta pouca disponibilidade e energia para o seu processo de aprendizagem; pode também não ter um acompanhamento sistemático do seu desenvolvimento escolar, já que talvez não possua um adulto significativo que apóie e valorize sua escolarização.

The objective of this article is to reflect on the impact of mother's imprisonment on children's life at school. This work is based on the life histories of children of imprisoned women. The sample was constituted by four young males and two young females, with the average age of 21 years, who were in the schooling process and lived with their mothers or with their mother's families at the time they went to prison. From the interviews we see that mother's imprisonment can leave the child in a vulnerable situation, which reflects on the socialization promoted by the school and may take aspects such as: the child may be so involved with his mother's imprisonment that she or he has limited availability to learn; she or he may not be supervised in his schooling process, since perhaps he doesn't have a significant adult who supports and values her or his schooling.

El objetivo de este artículo es reflexionar sobre el impacto del encarcelamiento materno en la vida escolar de los hijos. Este trabajo tiene por base la recopilación de historias de vida de hijos de mujeres presas. La muestra está constituida por seis jóvenes, cuatro hombres y dos mujeres, con edad promedio de 21 años, que vivían con la propia madre o con su familia durante el encarcelamiento materno y se encontraban en proceso de escolarización. A partir de las entrevistas verificamos que el encarcelamiento materno puede dejar a los niños en situación de vulnerabilidad, hecho que se refleja en la sociabilización promovida por la escuela y que puede asumir aspectos como: el niño puede estar tan envuelto emocionalmente con cuestiones de carácter familiar, que presenta poca disponibilidad y energía para su proceso de aprendizaje; puede no tener acompañamiento sistemático de su desarrollo escolar, ya que tal vez no tenga un adulto significativo que apoye y valore su escolarización.

Aprisionamento materno e escolarização dos filhos / Encarcelamiento materno y escolarización de los hijos / Mother's aprisionment and children's schooling

O objetivo deste artigo é refletir sobre o impacto do aprisionamento materno na vida escolar dos filhos. Este trabalho está ancorado na coleta de histórias de vida de filhos de mulheres presas. A amostra foi constituída por quatro rapazes e duas moças, com média de idade de 21 anos, que moravam com a própria mãe ou com a família dela quando da prisão materna e se encontravam no processo de escolarização. A partir das entrevistas, verificamos que a prisão materna pode deixar a criança em situação de vulnerabilidade, o que reflete na socialização promovida pela escola, assumindo aspectos como: a criança pode estar emocionalmente tão envolvida com questões de ordem familiar que apresenta pouca disponibilidade e energia para o seu processo de aprendizagem; pode também não ter um acompanhamento sistemático do seu desenvolvimento escolar, já que talvez não possua um adulto significativo que apóie e valorize sua escolarização.(AU)

The objective of this article is to reflect on the impact of mother's imprisonment on children's life at school. This work is based on the life histories of children of imprisoned women. The sample was constituted by four young males and two young females, with the average age of 21 years, who were in the schooling process and lived with their mothers or with their mother's families at the time they went to prison. From the interviews we see that mother's imprisonment can leave the child in a vulnerable situation, which reflects on the socialization promoted by the school and may take aspects such as: the child may be so involved with his mother's imprisonment that she or he has limited availability to learn; she or he may not be supervised in his schooling process, since perhaps he doesn't have a significant adult who supports and values her or his schooling.(AU)

El objetivo de este artículo es reflexionar sobre el impacto del encarcelamiento materno en la vida escolar de los hijos. Este trabajo tiene por base la recopilación de historias de vida de hijos de mujeres presas. La muestra está constituida por seis jóvenes, cuatro hombres y dos mujeres, con edad promedio de 21 años, que vivían con la propia madre o con su familia durante el encarcelamiento materno y se encontraban en proceso de escolarización. A partir de las entrevistas verificamos que el encarcelamiento materno puede dejar a los niños en situación de vulnerabilidad, hecho que se refleja en la sociabilización promovida por la escuela y que puede asumir aspectos como: el niño puede estar tan envuelto emocionalmente con cuestiones de carácter familiar, que presenta poca disponibilidad y energía para su proceso de aprendizaje; puede no tener acompañamiento sistemático de su desarrollo escolar, ya que tal vez no tenga un adulto significativo que apoye y valore su escolarización.(AU)