Comparison of Urinary Protein/Creatinine Ratio as an Alternative to 24-h Proteinuria in Lupus Nephritis: TUNARI Study.

BACKGROUND: Lupus nephritis (LN) occurs in approximately 50% of people with systemic lupus erythematosus (SLE). The 24-h proteinuria (gold standard) is measured among other tests for the control and monitoring of LN activity. This study investigates the use of the protein/creatinine ratio (PCR) as an alternative for the detection of proteinuria and its accuracy compared to the gold standard in a predominantly non-white population. METHODS: This was a prospective study conducted in Salvador, Brazil, between December 2021 and May 2022. We invited adult patients diagnosed with SLE and LN, regardless of their disease activity. The estimation of the PCR and 24-h proteinuria was performed using conventional methods. The analysis used was Spearman's r correlation coefficient (rs), coefficient of determination (r2), and concordance by the Bland-Altman method. A specific sensitivity was measured by the ROC curve with its respective cut-off by the Youden Index. RESULTS: We compared 112 samples of 75 patients with LN, with a mean age of 34.5 ± 11.8 years. Of these patients, 85% were women, 87.9% were non-white. A high degree of correlation was observed between PCR with 24-h proteinuria (rs = 0.77 and r2 = 0.59). The ROC analysis shows an area under the curve of 0.92 and the cut-off point calculated by the Youden Index was 0.78 with a sensitivity of 90.0% and specificity of 82%. However, the Bland-Altman graph indicated decreasing concordance as the degree of proteinuria increased, despite showing concordance at high levels of proteinuria. CONCLUSION: The PCR shows high sensitivity to follow-up patients with LN when compared with 24-h proteinuria. Our findings suggest that PCR is a useful parameter for the evaluating and monitoring patients in complete remission. However, in cases of partial remission, the utility of PCR is limited.

Outbreak of Stenotrophomonas maltophilia and Burkholderia cepacia Bloodstream Infections at a Hemodialysis Center.

Patients undergoing hemodialysis are at an increased risk for bloodstream infections (BSIs). Infection usually occurs because of contamination of water supply, water treatment, distribution systems, or reprocessing dialyzers. Here, we report an outbreak of BSIs caused by Stenotrophomonas maltophilia (n = 21) and Burkholderia cepacia (n = 22) among dialyzed patients at a large hemodialysis center in Brazil. Overall, three patients died (7%), two of which had bacteremia caused by S. maltophilia and the other had a B. cepacia infection. We collected water samples from different points of the hemodialysis system for culture and typing. Genetic patterns were identified through polymerase chain reaction-random amplified polymorphic DNA (PCR-RAPD) and pulsed-field gel electrophoresis. The same genotypes of S. maltophilia and B. cepacia recovered from blood cultures were found in dialysis water. Also, multiple genetic profiles were identified among water isolates, suggesting heavy contamination. Bacteremia cases persisted even after implementing standard control measures, which led us to believe that the piping system was contaminated with microbial biofilms. Soon after we changed the entire plumbing system, reported cases dropped back to the number typically expected, and the outbreak came to an end.

Delirium rating scales in critically ill patients: a systematic literature review.

OBJECTIVE: To identify scales that can establish a quantitative assessment of delirium symptoms in critically ill patients through a systematic review. METHODS: Studies that evaluated delirium stratification scales in patients hospitalized in intensive care units were selected in a search performed in the MedLine database. Validation studies of these scales and their target patient populations were analyzed, and we identified the examiner and the signs and symptoms evaluated. In addition, the duration of the application and the sensitivity and specificity of each scale were assessed. RESULTS: Six scales were identified: the Delirium Detection Score, the Cognitive Test of Delirium, the Memorial Delirium Assessment Scale, the Intensive Care Delirium Screening Checklist, The Neelon and Champagne Confusion Scale and the Delirium Rating Scale-Revised-98. CONCLUSION: The scales identified allow the stratification and monitoring of critically ill patients with delirium. Among the six scales, the most studied and best suited for use in the intensive care units was the Intensive Care Delirium Screening.

Hypernatremic hemorrhagic encephalopaty: case report and literature review. / Encefalopatia hemorrágica hipernatrêmica: relato de caso e revisão da literatura.

Hypernatremia is a common electrolyte disorder in people with impaired thirst control mechanism or access to water, and may lead from minimal disorders until coma. Among the hypernatremia morbidities, central nervous system hemorrhage is uncommon and poorly studied. We report a case involving a patient admitted to the intensive care unit with reduced consciousness level, hypernatremia and head computed tomography scan showing bilateral parenchyma hemorrhage. A literature review of hypernatremia hemorrhagic encephalopathy was conducted.

Escalas de avaliação de delirium em pacientes graves: revisão sistemática da literatura / Delirium rating scales in critically ill patients: a systematic literature review

OBJETIVO: Identificar escalas capazes de estabelecer uma avaliação quantitativa dos sintomas do delirium em pacientes graves por meio de uma revisão sistemática. MÉTODOS: Foram selecionados estudos que avaliaram escalas de estratificação de delirium em pacientes internados em unidades de terapia intensiva a partir de busca na base de dados MedLine. Os estudos de validação dessas escalas foram analisados, e foram identificados os pacientes alvos para aplicação, o avaliador, os sinais e sintomas avaliados, a duração da aplicação, além da sensibilidade e da especificidade de cada escala. RESULTADOS: Seis escalas foram identificadas: o Delirium Detection Score, o Cognitive Test of Delirium, a Memorial Delirium Assessment Scale, o Intensive Care Delirium Screening Checklist, a The Neelon and Champagne Confusion Scale e a Delirium Rating Scale-Revised-98. CONCLUSÃO: As escalas identificadas permitem estratificação e acompanhamento do paciente grave com delirium. Dentre as seis escalas, a mais estudada e que melhor se adequa ao uso em unidade de terapia intensiva foi o Intensive Care Delirium Screening Checklist.

OBJECTIVE: To identify scales that can establish a quantitative assessment of delirium symptoms in critically ill patients through a systematic review. METHODS: Studies that evaluated delirium stratification scales in patients hospitalized in intensive care units were selected in a search performed in the MedLine database. Validation studies of these scales and their target patient populations were analyzed, and we identified the examiner and the signs and symptoms evaluated. In addition, the duration of the application and the sensitivity and specificity of each scale were assessed. RESULTS: Six scales were identified: the Delirium Detection Score, the Cognitive Test of Delirium, the Memorial Delirium Assessment Scale, the Intensive Care Delirium Screening Checklist, The Neelon and Champagne Confusion Scale and the Delirium Rating Scale-Revised-98. CONCLUSION: The scales identified allow the stratification and monitoring of critically ill patients with delirium. Among the six scales, the most studied and best suited for use in the intensive care units was the Intensive Care Delirium Screening.

Encefalopatia hemorrágica hipernatrêmica: relato de caso e revisão da literatura / Hypernatremic hemorrhagic encephalopaty: case report and literature review

Hipernatremia é um distúrbio hidro-eletrolítico frequente em pessoas nas quais o mecanismo da sede ou o acesso à água está comprometido podendo causar desde morbidades mínimas até coma. Entre as morbidades causadas pela hipernatremia, a hemorragia do sistema nervoso central é infreqüente e pouco estudada. Relatamos um caso de paciente admitido na unidade de terapia intensiva com redução do nível de consciência, hipernatremia e tomografia computadorizada de crânio evidenciando hemorragia intraparenquimatosa bilateral. Foi realizada revisão de literatura de encefalopatia hemorrágica hipernatrêmica.

Hypernatremia is a common electrolyte disorder in people with impaired thirst control mechanism or access to water, and may lead from minimal disorders until coma. Among the hypernatremia morbidities, central nervous system hemorrhage is uncommon and poorly studied. We report a case involving a patient admitted to the intensive care unit with reduced consciousness level, hypernatremia and head computed tomography scan showing bilateral parenchyma hemorrhage. A literature review of hypernatremia hemorrhagic encephalopathy was conducted.

Peritonite por B. subtilis em diálise peritoneal intermitente, crônica / Peritonitis due to B. subtilis in chronic intermittent peritoneal dialysis

Peritonite constitui uma complicaçäo freqüente da diálise peritoneal, sendo importante causa de morbidade e mortalidade. A flora bacteriana mais freqüente envolvida é a de gram-positivos, destacando-se o S. aureus e S. epidermidis, seguidos de estreptococos e de bacilos gram-negativos. Relatamos, no presente, três casos de peritonite em pacientes atendendo programa de diálise peritoneal intemitente, causadas pelo Bacillus subtilis. Habitualmente, o isolamento de Bacillus do líquido de diálise e de secreçöes orgânicas variadas (à exceçäo do B. anthracis) é tido como "contaminaçäo". Nosso relato visa alertar para a importância desse gyenero de bactéria como agente infectante, somando-se áqueles que destacam o papel patogênico dessa bactéria, e chamamos a atençäo para a procura de outros fatores de infecçäo que näo a pele ou aparelho digestivo, nessas situaçöes

Natureza e importância de reaçöes adversas à drogas num hospital geral em nosso ambiente / Nature and importance of adverse effects of drugs in a general hospital

Com o objetivo de se estudar a freqüência, natureza e importância de reaçöes adversas a drogas, foram avaliados, prospectivamente, todos os pacientes internados nas enfermarias de clínica médica do Hospital Prof. Edgard Santos. Nos primeiros 6 meses, 18,8% dos pacientes admitidos nas enfermarias em estudo, desenvolvem reaçöes adversas a drogas; estas foram, freqüentemente, classificadas como leves e moderadas, porém também foram observadas reaçöes graves e fatais. As drogas que mais frequentemente causaram reaçöes foram os anti-bacterianos, anti-parasitários e anti-inflamatórios. No segundo período do estudo, quando avaliados sistematicamente, 35,6% dos pacientes que usaram os medicamentos selecionados no primeiro período, desenvolveram reaçöes adversas; nesse período houve um número considerável de reaçöes sub-clínicas. Concluímos que em nosso ambiente hospitalar, estudando apenas as enfermarias de clínica médica, a prevalência de reaçöes adversas a drogas näo foi, significantemente, diferente do relatado na literatura para hospitais como um todo. As drogas que mais frequentemente causam reaçöes adversas säo, também, aquelas relatadas porém, em nosso ambiente, somam-se a estas, com importância e prevalência, as drogas anti-parasitárias