Early administration of fibrinogen concentrate in patients with polytrauma with thromboelastometry suggestive of hypofibrinogenemia: A randomized feasibility trial

OBJECTIVE: To evaluate the clinical effects of early administration of fibrinogen concentrate in patients with severe trauma and hypofibrinogenemia. METHODS: We conducted an open randomized feasibility trial between December 2015 and January 2017 in patients with severe trauma admitted to the emergency department of a large trauma center. Patients presented with hypotension, tachycardia, and FIBTEM findings suggestive of hypofibrinogenemia. The intervention group received fibrinogen concentrate (50 mg/kg), and the control group did not receive early fibrinogen replacement. The primary outcome was feasibility assessed as the proportion of patients receiving the allocated treatment within 60 min after randomization. The secondary outcomes were transfusion requirements and other exploratory outcomes. Randomization was performed using sequentially numbered and sealed opaque envelopes. ClinicalTrials.gov: NCT02864875. RESULTS: Thirty-two patients were randomized (16 in each group). All patients received the allocated treatment within 60 min after randomization (100%, 95% confidence interval, 86.7%-100%). The median length of intensive care unit stay was shorter in the intervention group (8 days, interquartile range [IQR] 5.75-10.0 vs. 11 days, IQR 8.5-16.0; p=0.02). There was no difference between the groups in other clinical outcomes. No adverse effects related to treatment were recorded in either group. CONCLUSION: Early fibrinogen replacement with fibrinogen concentrate was feasible. Larger trials are required to properly evaluate clinical outcomes.

Restrictive versus liberal fluid therapy for post-cesarean acute kidney injury in severe preeclampsia: a pilot randomized clinical trial

OBJECTIVES: The aim of this study was to determine whether a restrictive compared to a liberal fluid therapy will increase postoperative acute kidney injury (AKI) in patients with severe preeclampsia. METHODS: A total of 46 patients (mean age, 32 years; standard deviation, 6.8 years) with severe preeclampsia were randomized to liberal (1500 ml of lactated Ringer's, n=23) or restrictive (250 ml of lactated Ringer's, n=23) intravenous fluid regimen during cesarean section. The primary outcome was the development of a postoperative renal dysfunction defined by AKI Network stage ≥1. Serum cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) were evaluated at postoperative days 1 and 2. ClinicalTrials.gov: NCT02214186. RESULTS: The rate of postoperative AKI was 43.5% in the liberal fluid group and 43.5% in the restrictive fluid group (p=1.0). Intraoperative urine output was higher in the liberal (116 ml/h, IQR 69-191) than in the restrictive fluid group (80 ml/h, IQR 37-110, p<0.05). In both groups, serum cystatin C did not change from postoperative day 1 compared to the preoperative period and significantly decreased on postoperative day 2 compared to postoperative day 1 (p<0.05). In the restrictive fluid group, NGAL levels increased on postoperative day 1 compared to the preoperative period (p<0.05) and decreased on postoperative day 2 compared to postoperative day 1 (p<0.05). CONCLUSION: Among patients with severe preeclampsia, a restrictive fluid regimen during cesarean section was not associated with increased postoperative AKI.

Epidemiological profile of acute bacterial meningitis in the state of Rio Grande do Norte, Brazil / Perfil epidemiológico da meningite bacteriana aguda no estado do Rio Grande do Norte, Brasil

INTRODUCTION: Acute bacterial meningitis (ABM) remains a public health problem in Brazil. To evaluate the epidemiology of ABM cases at Giselda Trigueiro Hospital, Rio Grande do Norte, a descriptive retrospective survey was conducted covering 2005 to 2008. METHODS: Clinical and laboratory data were collected from the epidemiology department of the hospital and analyzed. RESULTS: Out of 168 ABM cases, 24.4 percent, 10.7 percent, and 2.4 percent were, respectively, caused by Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenza b, and 5.4 percent by other bacteria. The mean age was 22.48 ± 18.7 years old. CONCLUSIONS: Streptococcus pneumoniae was the main causative pathogen in the young urban population.

INTRODUÇÃO: Meningite bacteriana aguda (MBA) permanece um problema de saúde pública no Brasil. Para avaliar a epidemiologia da MBA atendida no Hospital Giselda Trigueiro, Rio Grande do Norte, um estudo retrospectivo-descritivo foi realizado de 2005 a 2008. MÉTODOS: Dados clínicos e laboratoriais foram coletados do departamento de epidemiologia hospitalar e analisados. RESULTADOS: Dos 168 casos de MBA, 24,4 por cento, 10,7 por cento e 2,4 por cento foram, respectivamente, causados por Streptococcus pneumoniae, Neisseria meningitidis e Haemophilus influenzae b e 5,4 por cento por outras bactérias. A média da idade foi 22,48 ± 18,7 anos. CONCLUSÕES: Streptococcus pneumoniae foi o principal patógeno causador na população urbana jovem.

Incidência e fatores de risco da retinopatia da prematuridade no Hospital Universitário Onofre Lopes, Natal (RN) - Brasil / Incidence and risk factors of retinopathy of prematurity in University Hospital Onofre Lopes, Natal (RN) - Brazil

OBJETIVOS: Determinar a incidência de retinopatia da prematuridade e avaliar os principais fatores de risco implicados no seu desenvolvimento. MÉTODOS: Estudo coorte retrospectivo de base hospitalar realizado no período de janeiro de 2004 a dezembro de 2006, no Hospital Universitário Onofre Lopes, Natal (RN) - Brasil. A amostra foi composta por 663 recém-nascidos, com idade gestacional < 36 semanas e/ou peso ao nascimento < 1.500 g e submetidas ao protocolo de retinopatia da prematuridade existente no ambulatório de oftalmologia do hospital. As variáveis estudadas foram: gênero, peso ao nascimento, idade gestacional, tempo de oxigenioterapia, ventilação mecânica, sepse e transfusão sanguínea. Os dados foram analisados por meio dos testes do qui-quadrado, exato de Fisher e da regressão logística múltipla. RESULTADOS: Entre os 663 prontuários, retinopatia da prematuridade ocorreu em 414 casos (62,4 por cento). Do total da amostra, 338 (51,0 por cento) eram do sexo masculino e 282 (42,5 por cento) do feminino. As médias e os desvios-padrão do peso, da idade gestacional e do tempo de oxigenioterapia foram, respectivamente, 1.334,9 ± 345,6 g, 31,9 ± 2,3 semanas e 10,0 ± 14,0 dias. A incidência de retinopatia em prematuros no período foi de 62,4 por cento, com 58,0 por cento dos casos em 2004, 67,2 por cento em 2005 e 63,0 por cento em 2006. A análise de regressão logística múltipla demonstrou que o peso <1.000 g (p<0,001; ORaj=17,18; IC= 6,52-45,29) e entre 1.000 g a 1.500 g (p=0,002; ORaj=4,20; IC= 1,68-10,48), o tempo de oxigenioterapia >20 dias (p=0,022; ORaj=3,40; IC= 1,19-9,69) e a transfusão sanguínea (p=0,022; ORaj=2,06; IC= 1,11-3,83) são fatores independentes de risco para a doença. CONCLUSÕES: O estudo demonstra uma alta incidência da patologia no serviço. O baixo peso ao nascer, um tempo prolongado de oxigenoterapia, bem como a transfusão sanguínea são fatores associados ao desenvolvimento da retinopatia da prematuridade. Idade ...

PURPOSES: To determine the incidence of retinopathy of prematurity and assess the main risk factors involved in its development. METHODS: Retrospective cohort study carried out from January 2004 to December 2006, at University Hospital Onofre Lopes, Natal (RN) - Brazil. The sample was composed of 663 newborns, with less than or equal to 36 weeks of gestational age and/or birth weight less than or equal to 1,500 g, submitted to the protocol of retinopathy of prematurity in the ophthalmology department of the hospital. The variables were: gender, birth weight, gestational age, duration of oxygen therapy, mechanical ventilation, sepsis and blood transfusion. Data were analyzed through the chi-squared test, Fisher's exact test and logistic regression model. RESULTS: Of the 663 cases, retinopathy of prematurity occurred in 414 (62.4 percent). Of the total sample, 338 (51.0 percent) were male and 282 (42.5 percent) female. Mean and standard deviation of weight, gestational age and duration of oxygen therapy were, respectively, 1,334.9 ± 345.6 g, 31.9 ± 2.3 weeks and 10.0 ± 14.0 days. The incidence of retinopathy in premature newborns in the period was 62.4 percent, 58.0 percent of cases in 2004, 67.2 percent in 2005 and 63.0 percent in 2006. The multiple logistic regression analysis showed that the weight less than 1,000 g (p<0.001; adjOR=17.18, CI= 6.52-45.29) and between 1,000 g and 1,500 g (p=0.002; adjOR -4.20 CI= 1.68-10.48), the time of oxygen lounger than 20 days (p=0.022; adjOR=3.40, CI= 1.19-9.69) and blood transfusion (p=0.022; adjOR -2.06, CI= 1.11-3.83) are independent factors for the disease. CONCLUSIONS: The study showed a high incidence of the disease in the service. A low birth weight, a prolonged oxygen therapy and blood transfusion are factors associated with the development of retinopathy of prematurity. Gestational age is not a reliable parameter for screening of newborns in the service.