Canine parvovirus: a predicting canine model for sepsis.

BACKGROUND: Sepsis is a severe condition associated with high prevalence and mortality rates. Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression. This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. The main objective of the present study was to evaluate the differences between two sets of SIRS (Systemic Inflammatory Response Syndrome) criteria in outcome prediction: SIRS 1991 and SIRS 2001. The possibility of stratifying and classifying septic dogs was assessed using a proposed animal adapted PIRO (Predisposition, Infection, Response and Organ dysfunction) scoring system. RESULTS: The 72 dogs enrolled in this study were scored for each of the PIRO elements, except for Infection, as all were considered to have the same infection score, and subjected to two sets of SIRS criteria, in order to measure their correlation with the outcome. Concerning SIRS criteria, it was found that the proposed alterations on SIRS 2001 (capillary refill time or mucous membrane colour alteration) were significantly associated with the outcome (OR = 4.09, p < 0.05), contrasting with the 1991 SIRS criteria (p = 0.352) that did not correlate with the outcome. No significant statistical association was found between Predisposition (p = 1), Response (p = 0.1135), Organ dysfunction (p = 0.1135), total PIRO score (p = 0.093) and outcome. To explore the possibility of using the SIRS criteria as a fast decision-making tool, a Fast-and-Frugal tree (FFT) was created with a sensitivity of 92% and a specificity of 29%. CONCLUSION: These results suggest that increasing the SIRS criteria specificity may improve their prognostic value and their clinical usefulness. In order to improve the proposed PIRO scoring system outcome prediction ability, more specific criteria should be added, mainly inflammatory and organ dysfunction biomarkers.

Prolonged QTc intervals on the electrocardiograms of hospitalized malnourished adults.

We investigated whether hospitalized malnourished adults would have longer QTc intervals on their electrocardiograms (ECGs) than non-malnourished adults. Seventy-five consecutive adults hospitalized in the Internal Medicine wards of our teaching hospital were prospectively studied. Main diagnoses, anthropometry, including body mass index (kg/m(2)), ECGs, and simultaneous serum levels of sodium, potassium, magnesium, phosphorus, and calcium were recorded. All QT intervals on ECGs were measured in a semiautomatic image analysis system; and QTc intervals were determined with the Bazett formula. Protein-energy malnutrition (PEM) was diagnosed with body mass index below 18.5 kg/m(2). There was no statistical difference between malnourished (n = 30) and non-malnourished (n = 45) with regard to age (40.7 +/- 18.9 y versus 41.4 +/- 16.2 y), male predominance (66.7% versus 80%), or associated diagnoses. Compared with non-malnourished, malnourished patients had higher percentages of positive C-reactive protein (66.7 versus 23.8%), lower serum levels of albumin (2.51 +/- 0.89 g/dL versus 3.41 +/- 0.74 g/dL) and potassium (3.64 +/- 0.65 mEq/L versus 4.12 +/- 0.65 mEq/L), and increased QTc lengths on ECGs (0.423 +/- 0.033 ms versus 0.396 +/- 0.031 ms). Malnourished adults hospitalized in general clinical wards are more likely to have longer QTc intervals on their ECGs, a phenomenon possibly linked to malnutrition and associated electrolyte disturbances.

[Prevalence of electrocardiographic abnormalities in 2,000 aged and non-aged chagasic patients]. / Prevalência de alterações eletrocardiográficas em 2000 pacientes chagásicos idosos e não idosos.

PURPOSE: To assess the prevalence of main electrocardiographic alterations in chagasic patients at University of Triângulo Mineiro Medical School, and compare such alterations between aged and non-aged patients. METHODS: Electrocardiograms (ECG) of 2,000 chagasic patients were interpreted. Age, color, sex and concomitant systemic hypertension, congestive heart failure (CHF) and megaesophagus and/or megacolon were registered. Chi-square test was employed to compare aged (60 years or more; n = 378) and non-aged (age less than 60 years; n = 1622) chagasics. RESULTS: ECG were normal in 9.6% of the patients. The main alterations were: ventricular premature complexes (VPC) 42.2%, left ventricular enlargement (LVE) 38.8%, right bundle branch block (RBBB) 32.4%, left anterior hemiblock 29.2% and ventricular repolarization changes 28.2%. The aged group exhibited greater (p < 0.05) proportion of male patients (1.7:1 vs 1.1:1), white than non-white (3.6:1 vs 2.2:1) and larger percentages (p < 0.01) of systemic hypertension (18.2 vs 7.5) and CHF (26.4 vs 12.0). The following alterations were significantly more common on aged chagasic: VPC (62.7 vs 37.5), LVE (43.4 vs 37.1), atrial fibrillation (19.6 vs 5.5), supraventricular premature complexes (11.9 vs 5.2), electrically inactive zone (9.5 vs 6.6), wandering atrial pacemaker (4.5 vs 2.2) and 2nd-degree atrioventricular (AV) block (2.9 vs 1.5). The non-aged chagasic had greater percentage (p < 0.05) than aged group of normal ECG (10.7 vs 5.0), RBBB (34.1 vs 24.9) and 1st degree AV block (9.7 vs 6.3). CONCLUSION: There was a high prevalence of ECG alterations in chagasic patients seeking medical attention. The different frequencies of those alterations between aged and non-aged chagasic may result of conditions more frequently seen in aged, like ischemic heart disease, CHF and systemic hypertension or to a probable more severe cardiac denervation in non-aged chagasic.

[Urethral lesion caused by a condom: description of a case]. / Lesione uretrale da "condom": descrizione di un caso.

We report a case of severe urethral lesion in a male patient with a vascular cerebral stroke. The wrong application of condom catheter without pain or other symptoms developed the urethral lesion.

Cardiomiopatia hipocalcemica. / Hypocalcemic cardiomyopathy

Os autores descrevem um caso de hipocalcemia mais ICC, em paciente adulto, com comprovacao bioquimica, eletrocardiografica e radiologica. A insuficiencia cardiaca congestiva mostrou-se refrataria a medicacao digitalica, respondendo prontamente a terapeutica com calcio e vitamina D. Chamam a atencao para a importancia da dosagem do calcio serico nas miocardiopatias de causa desconhecida