Frequency of red blood cell transfusions in preterm neonates in Brazil: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Red blood cell transfusions are frequent in preterm neonates. The proportion of preterm neonates transfused in Brazil remains unknown. We systematically reviewed the literature to estimate the frequency of red blood cell transfusions in preterm neonates in Brazil. MATERIALS AND METHODS: The LILACS, EMBASE, Cochrane, SciELO, MEDLINE (PubMed), Web of Science, Scopus, BDTD and 27 national university institutional databases were searched for studies that analysed red blood cell transfusion in preterm neonates in Brazil without period restriction. The Preferred Reporting Items in Systematic Reviews and Meta-Analyses guidelines were followed, and the GRADE methodology was applied. A random-effects model along with the restricted maximum likelihood method was used, and the Freeman-Tukey transformed proportion was used to estimate effect size. RESULTS: Nine studies, representing 6548 preterm neonates, were included in the qualitative and quantitative analyses. The mean gestational age ranged from 26.0 to 31.6 weeks. Most of the studies were from the Southeast region. The pooled estimated frequency of red blood cell transfusions was 58.0% (95% confidence interval = 52.0%-64.0%, p < 0.001) with low certainty. There was statistically significant heterogeneity among studies (I2 = 92.5%, p < 0.001). CONCLUSION: In this current meta-analysis of the evidence available, which included moderate and extremely preterm neonates, the observed frequency of red blood cell transfusions in preterm neonates in Brazil was 58.0% and this estimate can help health programming. Some Brazilian regions were not included in this study, and further research is needed to provide a more representative overview of Brazil.

Individual acoustic differences in female black-capped chickadee (poecile atricapillus) fee-bee songs.

In songbirds, song has traditionally been considered a vocalization mainly produced by males. However, recent research suggests that both sexes produce song. While the function and structure of male black-capped chickadee (Poecile atricapillus) fee-bee song have been well-studied, research on female song is comparatively limited. Past discrimination and playback studies have shown that male black-capped chickadees can discriminate between individual males via their fee-bee songs. Recently, we have shown that male and female black-capped chickadees can identify individual females via their fee-bee song even when presented with only the bee position of the song. Our results using discriminant function analyses (DFA) support that female songs are individually distinctive. We found that songs could be correctly classified to the individual (81%) and season (97%) based on several acoustic features including but not limited to bee-note duration and fee-note peak frequency. In addition, an artificial neural network was trained to identify individuals based on the selected DFA acoustic features and was able to achieve 90% accuracy by individual and 93% by season. While this study provides a quantitative description of the acoustic structure of female song, the perception and function of female song in this species requires further investigation.

Sepsis death risk factor score based on systemic inflammatory response syndrome, quick sequential organ failure assessment, and comorbidities.

OBJECTIVE: In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score. DESIGN: This retrospective cohort study was conducted between 2016 and 2021. SETTING: Two university hospitals in Brazil. PARTICIPANTS: Patients with sepsis. INTERVENTIONS: Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities. MAIN VARIABLE OF INTEREST: In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis. RESULTS: A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes >12,000 or <4,000 cells/mm3 (OR = 1.61), encephalic vascular accident (OR = 1.88), age >60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis >7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction. CONCLUSIONS: Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.

Diversity and biofilm-production ability among isolates of Escherichia coli phylogroup D belonging to ST69, ST393 and ST405 clonal groups.

BACKGROUND: Phylogenetic group D Escherichia coli clones (ST69, ST393, ST405) are increasingly reported as multidrug resistant strains causing extra-intestinal infections. We aim to characterize inter- and intraclonal diversity of a broad sample (isolates from different geographic locations and origins with variable antibiotic resistance profiles, 1980-2010) and their ability to adhere and form biofilm by both a modified quantitative biofilm producing assay and Field Emission Scanning Electron Microscopy (FESEM). RESULTS: High virulence scores were observed among ST69 (median 14/range 9-15) and ST393 (median 14/range 8-15) clones, particularly enriched in pap alleles, iha, kpsMTII-K5 and ompT, in contrast with ST405 (median 6/range 2-14) isolates, exhibiting frequently fyuA, malX and traT. All ST69 and ST393 and only two ST405 isolates were classified as ExPEC. Biofilm production was detected in two non-clinical ST69 and three ST393 isolates from different origins showing variable virulence profiles. Within each clonal group, and despite the high diversity of PFGE-types observed, isolates from different countries and recovered over large periods of time were clustered in a few groups sharing common virulence gene profiles among ST69 (n = 10 isolates) and ST393 (n = 9 isolates) (fimH-iha-iutA-kpsMTII-K5-(traT)-sat-(ompT)-papA-papEF-papGII-papC) or ST405 (n = 6 isolates) (fimH-traT-fyuA-malX). CONCLUSIONS: This study highlights the circulation of highly transmissible ST69, ST393 and ST405 variants among different settings. Biofilm production seems not to be directly correlated with their epidemiological success.

Black-capped chickadees (Poecile atricapillus) discriminate between naturally-ordered and scramble-ordered chick-a-dee calls and individual preference is related to rate of learning.

Though many forms of animal communication are not reliant on the order in which components of signals are combined to be effective, there is evidence that order does matter for some communication systems. In the light of differential responding to calls of varying note-order observed in black-capped chickadees in the field, we set out to determine whether chickadees recognize syntactically-ordered and incorrectly-ordered chick-a-dee calls as separate and distinct conceptual categories using both an auditory preference task and go/no-go operant conditioning paradigm. Results show that chickadees spent more time on the perch that did not produce sound (i.e., silent perch) than on either of the acoustic perches (i.e., natural and scrambled order chick-a-dee call playback) and visited the perch associated with naturally-ordered calls more often than the perch associated with scrambled-order calls. Birds in both the True natural- and scrambled-order call groups continued to respond according to the contingencies that they learned in Discrimination training, indicating that black-capped chickadees are capable of perceiving and acting upon the categories of natural- versus scrambled-ordered calls.

Characterization of globally spread Escherichia coli ST131 isolates (1991 to 2010).

The characterization of a broad representative sample of ST131 Escherichia coli isolates from different origins and settings (1991 to 2010) revealed that this clonal group has likely diversified recently and that the expansion of particular variants has probably been favored by the capture of diverse, multidrug-resistant IncFII plasmids (pC15-1a, pEK499, pKF3-140-like). The low ability to adhere and to grow as biofilm that was detected in this study suggests unknown mechanisms for the persistence of this clonal group which need to be further explored.

The risks perceived by the consumer in the acceptance of electronic commerce. A study of Bolivia.

The risks perceived by consumers in online shopping can negatively affect the acceptance of electronic commerce, however, the perceived risks are a cultural aspect that can affect consumers differently in different countries. This research examines what dimensions of perceived risk affect the acceptance of electronic commerce in Bolivia, a developing country. The design is quantitative, the TAM model is used with the variables: risk of misuse of information, risk of not obtaining the benefits of the product and risk of inefficiency of the functionality. The results show that the three risks examined do not affect the acceptance of electronic commerce, and that the variables perceived usefulness and ease of use have a positive effect on the acceptance of electronic commerce. The theoretical implications of this study provide empirical evidence from Bolivia, which shows strong variables of perceived usefulness and ease of use, which mitigates the effect of risk´s perception by the consumer, the results are explained in the context of the COVID-19 pandemic that accelerated the rapid acceptance of electronic commerce, increasing the perception of usefulness and ease of use of online shopping. As practical implications, this research provides managers and administrators of online businesses with knowledge about the effect of risk variables perceived by consumers.

Effect of feed-time duration on discrimination of vocalizations in a go/no-go operant paradigm.

Refining and modifying experimental procedures play a vital role in improving methodology while also reducing animal distress. In this study, we asked if an increase in feed time duration affects discrimination in an operant go/no-go task. Specifically, we used zebra finches' sexually dimorphic distance calls as acoustic stimuli to test whether there were any significant differences in performance on an operant discrimination task requiring zebra finches to classify calls according to the sex of the producer when a key experimental parameter, feed time duration, was increased from 1 s to 2 s. We found no differences in learning speed (trials to criterion) between birds that were given 1 s or 2 s of food access following a correct go response. Our results indicate doubling food access duration did not impact the speed of acquisition of distance call discrimination in zebra finches. These findings suggest that we can provide twice as much time for zebra finches to access food, potentially improving animal welfare, with no impact on experimental outcomes.

The impact of anthropogenic noise on individual identification via female song in Black-capped chickadees (Poecile atricapillus).

When anthropogenic noise occurs simultaneously with an acoustic signal or cue, it can be difficult for an animal to interpret the information encoded within vocalizations. However, limited research has focused on how anthropogenic noise affects the identification of acoustic communication signals. In songbirds, research has also shown that black-capped chickadees (Poecile atricapillus) will shift the pitch and change the frequency at which they sing in the presence of anthropogenic, and experimental noise. Black-capped chickadees produce several vocalizations; their fee-bee song is used for mate attraction and territorial defence, and contains information about dominance hierarchy and native geographic location. Previously, we demonstrated that black-capped chickadees can discriminate between individual female chickadees via their fee-bee songs. Here we used an operant discrimination go/no-go paradigm to discern whether the ability to discriminate between individual female chickadees by their song would be impacted by differing levels of anthropogenic noise. Following discrimination training, two levels of anthropogenic noise (low: 40 dB SPL; high: 75 dB SPL) were played with stimuli to determine how anthropogenic noise would impact discrimination. Results showed that even with low-level noise (40 dB SPL) performance decreased and high-level (75 dB SPL) noise was increasingly detrimental to discrimination. We learned that perception of fee-bee songs does change in the presence of anthropogenic noise such that birds take significantly longer to learn to discriminate between females, but birds were able to generalize responding after learning the discrimination. These results add to the growing literature underscoring the impact of human-made noise on avian wildlife, specifically the impact on perception of auditory signals.

Knowledge of healthcare professionals about nonpharmacological pain management in the neonate in a Brazilian rooming-in: a survey study with factor analysis / Conhecimento dos profissionais de saúde sobre o manejo não farmacológico da dor neonatal em um alojamento conjunto no Brasil: estudo tipo survey com análise fatorial

ABSTRACT BACKGROUND AND OBJECTIVES: Neonatal pain management is considered one of the eight principles of neonatal care. This study aims to investigate the construct reflecting neonatal non-pharmacological pain management, in a Brazilian rooming-in unit, and identify the preferred intervention. METHODS: This survey study included 47 health professionals assessed through an in-person questionnaire. Factor analysis was conducted with a rotation using the Varimax method. Cronbach's alpha was 0.78. RESULTS: The construct comprised three factors in the following order: 1) knowledge and impact of neonatal pain on parents, 2) the benefits of pain treatment, and 3) non-pharmacological interventions. Breastfeeding is part of the first factor, revealing its particular importance. The reduction of luminosity is part of the second factor. Non-nutritive sucking with sweet solution, kangaroo position, and music therapy are part of the third factor. CONCLUSION: The construct observed in this rooming-in identified three factors and suggests that breastfeeding is the preferred intervention to implement for non-pharmacological pain management in the neonate.

RESUMO JUSTIFICATIVA E OBJETIVOS: O manejo da dor neonatal é considerado um dos oito princípios do cuidado neonatal. O presente estudo teve como objetivo investigar o construto que reflete o manejo não farmacológico da dor neonatal em uma unidade de alojamento conjunto brasileira e identificar a intervenção preferencial. MÉTODOS: Este estudo de pesquisa incluiu 47 profissionais de saúde avaliados por meio de um questionário presencial. A análise fatorial foi realizada com uma rotação usando o método Varimax. O alfa de Cronbach foi de 0,78. RESULTADOS: O construto foi composto por três fatores na seguinte ordem: 1) conhecimento e impacto da dor neonatal nos pais, 2) benefícios do tratamento da dor e 3) intervenções não farmacológicas. A amamentação faz parte do primeiro fator, revelando sua especial importância. A redução da luminosidade faz parte do segundo fator. A sucção não nutritiva com solução doce, a posição canguru e a musicoterapia fazem parte do terceiro fator. CONCLUSÃO: O construto observado neste alojamento conjunto identificou três fatores e sugere que o aleitamento materno é a intervenção preferencial a ser implementada para o controle não farmacológico da dor no recém-nascido.

Primary health care quality assessment according to the level of satisfaction of elderly users. / Avaliação da qualidade da atenção primária à saúde segundo o nível de satisfação dos idosos.

OBJECTIVE: To evaluate the quality of Primary Health Care according to the level of satisfaction of elderly users. METHOD: An exploratory-descriptive study, with a quantitative approach, performed with 381 elderly users of Primary Health Care. For data collection, the Service Quality scale (SERVQUAL) was adapted to the context of the Primary Health Units (UBS) of Family Health Strategy (ESF) and a questionnaire with 44 questions was elaborated. Data was treated using SSPS® and analyzed using descriptive and inferential statistical techniques. RESULTS: the SERVQUAL subscales "expectations" and "perceptions" exhibited excellent reliability and internal consistency, with Cronbach's Alpha 0.948 and 0.932, respectively. The evaluated dimensions presented negative Gaps results: tangible aspects -0.65, reliability -1.19, responsiveness -0.56, guarantee -0.91, and empathy -0.52. CONCLUSION: negative Gaps in all dimensions show gaps in the quality of services and demonstrates the low satisfaction of the elderly users of UBS/ESF/APS.

Vigilancia epidemiológica del Traumatismo Encéfalo Craneano (TEC) en el Hospital San Bernardo de la Provincia de Salta, Argentina / Epidemiological surveillance of Cranial Brain Injury (TEC) at the San Bernardo Hospital in the Province of Salta, Argentina

Introducción: El TEC es una de las principales causas de discapacidad y muerte en nuestra sociedad. Tiene una mortalidad que ronda el 30% y una morbilidad cercana al 60%1, 2, 3, 4, 5.No hay un estudio estadístico epidemiológico exhaustivo sobre TEC en Argentina, por tal motivo la finalidad de este trabajo es conocer la epidemiología de esta patología en el Hospital San Bernardo (HSB) de Salta. Materiales y métodos: Se realizó un trabajo observacional transversal prospectivo. Se incluyeron todos aquellos pacientes que ingresaban al HSB desde agosto de 2014 hasta agosto de 2015 por el servicio de guardia con diagnóstico de TEC asociado o no a politraumatismo. Para el análisis estadístico se utilizó la versión 3.3.3. del Software R para Windows. Resultados: Se estudiaron un total de 1.496 pacientes de los cuales 76% fueron de sexo masculino y 24% femenino. El 84% de los TEC son leve, el 13% moderado y el 4% grave. Según el mecanismo del trauma, el 39% fue por accidente de tránsito, el 32% fue por agresión física y el 22% por caídas. El 19% de los pacientes fue internado. Los días promedio de internación son 10,27. De los pacientes internados, el 27% requirió cirugía de urgencia. Evaluado el GOS, el 19% tuvo GOS 1, 46% GOS 2 ­ 4 y 35% GOS 5. Conclusión: El TEC es una patología que afecta principalmente a adultos varones jóvenes. Las causas más frecuentes en nuestro medio son los accidentes de tránsito y la agresión física. El TEC en nuestro medio presenta una mortalidad global del 19%, con una morbilidad del 47%. Los datos estadísticos de nuestro Hospital referentes al TEC son concordantes con la bibliografía mundial

Introduction: Head Trauma (TBI) is one of the main causes of disability, death and economic loss in our society. It has a mortality of around 30% and a morbidity close to 60%1, 2, 3, 4, 5.There is no exhaustive statistical study on TBI in Argentina, for this reason the purpose of this project is to know the San Bernardo Hospital epidemiology of this pathology. Materials and methods: A prospective cross-sectional observational study was carried out. Patients who were admitted to the San Bernardo Hospital emergency department from August 2014 to August 2015 with a diagnosis of TBI associated or not with multiple trauma were included. Version 3.3.3 was used for statistical analysis of the R Software for Windows. Results: A total of 1.496 patients were studied, of which 76% were male and 24% female, with range of 14 ­ 97 years old (Table 4). 84% of TBI were mild, 13% moderate, and 4% severe. According to the mechanism of trauma, 39% was due to a traffic accident, 32% was due to physical aggression and 22% due to falls. 19% of the patients were hospitalized. The average days of hospitalization are 10.27. Of the hospitalized patients, 27% required emergency surgery. The patients GOS was 19% GOS 1, 46% GOS 2 ­ 4 and 35% GOS 5. Conclusion: TBI is a prevalent pathology that affects mainly young male adults. The most frequent cause in our environment are traffic accidents and physical aggression. TBI in our setting presents an overall mortality of 19% with a morbidity of 47%. Statistics of diagnosis and treatment of patients with TBI in our Hospital are similar to those published in the world bibliography and guidelines

Avaliação da qualidade da atenção primária à saúde segundo o nível de satisfação dos idosos / Evaluación de la calidad de la atención primaria de la salud según el nivel de satisfacción de los ancianos / Primary health care quality assessment according to the level of satisfaction of elderly users

Resumo OBJETIVO Avaliar a qualidade da Atenção Primária à Saúde segundo o nível de satisfação dos usuários idosos. MÉTODO Estudo exploratório, descritivo, com abordagem quantitativa, realizado com 381 idosos usuários dos serviços da Atenção Primária à Saúde. Para a coleta de dados, o Service Quality (SERVQUAL) foi adaptado ao contexto das Unidades Básicas de Saúde (UBS) da Estratégia Saúde da Família (ESF) e foi elaborado um questionário com 44 questões. Os dados foram tratados utilizando o SSPS® e analisados por meio de técnicas estatísticas descritivas e inferenciais. RESULTADOS O SERVQUAL exibiu excelente confiabilidade e consistência interna das subescalas expectativas e percepções, com Alpha Cronbach 0,948 e 0,932, respectivamente. As dimensões avaliadas apresentaram Gaps negativos: aspectos tangíveis -0,65; confiabilidade -1,19; capacidade de resposta -0,56; garantia -0,91 e empatia -0.52. CONCLUSÃO Os Gaps negativos, em todas as dimensões, evidenciam lacunas na qualidade dos serviços e demonstram a baixa satisfação dos idosos usuários das UBS/ESF/APS.

Resumen OBJETIVO Evaluar la calidad de la Atención Primaria a la Salud según el nivel de satisfacción de los usuarios ancianos. MÉTODO Estudio exploratorio, descriptivo, con abordaje cuantitativo, realizado con 381 ancianos usuarios de los servicios de Atención Primaria Salud. Para la recolección de los datos, el Service Quality (SERVQUAL) fue adaptado al contexto de las Unidades Básicas de Salud (UBS) Estrategia Salud de la Familia (ESF) y elaboró ​​un cuestionario con 44 preguntas. Los datos fueron tratados utilizando SSPS® y analizados a través de las técnicas estadísticas descriptivas e inferenciales. RESULTADOS El SERVQUAL exhibió excelente confiabilidad y consistencia interna de las sub-escalas expectativas y percepciones con Alpha de Cronbach 0,948 y 0,932, respectivamente. Las dimensiones evaluadas presentaron Gaps negativos: aspectos tangibles -0,65, confiabilidad -1,19, capacidad de respuesta -0,56, garantía -0,91 y empatía -0.52. CONCLUSIÓN Los Gaps negativos evidencian lagunas en la calidad de los servicios y demuestran la satisfacción baja de los ancianos usuarios de las UBS/ESF/APS.

Abstract OBJECTIVE To evaluate the quality of Primary Health Care according to the level of satisfaction of elderly users. METHOD An exploratory-descriptive study, with a quantitative approach, performed with 381 elderly users of Primary Health Care. For data collection, the Service Quality scale (SERVQUAL) was adapted to the context of the Primary Health Units (UBS) of Family Health Strategy (ESF) and a questionnaire with 44 questions was elaborated. Data was treated using SSPS® and analyzed using descriptive and inferential statistical techniques. RESULTS the SERVQUAL subscales "expectations" and "perceptions" exhibited excellent reliability and internal consistency, with Cronbach's Alpha 0.948 and 0.932, respectively. The evaluated dimensions presented negative Gaps results: tangible aspects -0.65, reliability -1.19, responsiveness -0.56, guarantee -0.91, and empathy -0.52. CONCLUSION negative Gaps in all dimensions show gaps in the quality of services and demonstrates the low satisfaction of the elderly users of UBS/ESF/APS.

Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery.

OBJECTIVE: To evaluate the use of hyperbaric oxygen therapy as an adjunctive treatment in mediastinitis after coronary artery bypass surgery. METHODS: This is a retrospective descriptive study, performed between October 2010 and February 2012. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite antibiotic therapy. RESULTS: We identified 18 patients with mediastinitis during the study period. Thirty three microorganisms were isolated, and polymicrobial infection was present in 11 cases. Enterobacteriaceae were the most prevalent pathogens and six were multi-resistant agents. There was only 1 hospital death, 7 months after the oxygen therapy caused by sepsis, unrelated to hyperbaric oxygen therapy. This treatment was well-tolerated. CONCLUSION: The initial data showed favorable clinical outcomes.

Comparison of diagnostic criteria for acute kidney injury in cardiac surgery.

BACKGROUND: There is considerable controversy regarding the diagnosis of Acute Kidney Injury (AKI), and there are over 30 different definitions. OBJECTIVE: To evaluate the incidence and risk factors for the development of AKI following cardiac surgery according to the RIFLE, AKIN and KDIGO criteria, and compare the prognostic power of these criteria. METHODS: Cross-sectional study that included 321 consecutively patients (median age 62 [53-71] years; 140 men) undergoing cardiac surgery between June 2011 and January 2012. The patients were followed for up to 30 days, for a composite outcome (mortality, need for dialysis and extended hospitalization). RESULTS: The incidence of AKI ranged from 15% - 51%, accordingly to the diagnostic criterion adopted. While age was associated with risk of AKI in the three criteria, there were variations in the remaining risk factors. During follow-up, 89 patients developed the outcome and all criteria were associated with increased risk in the univariate Cox analysis and after adjustment for age, gender, diabetes, and type of surgery. However, after further adjustment for extracorporeal circulation and the presence of low cardiac output, only AKI diagnosed by the KDIGO criterion maintained this significant association (HR= 1.89 [95% CI: 1.18 - 3.06]). CONCLUSION: The incidence and risk factors for AKI after cardiac surgery vary significantly according to the diagnostic criteria used. In our analysis, AKI the KDIGO criterion was superior to AKIN and RIFLE with regard its prognostic power.

Comparação de critérios diagnósticos de insuficiência renal aguda em cirurgia cardíaca / Comparison of diagnostic criteria for acute kidney injury in cardiac surgery

FUNDAMENTO: Há grande controvérsia quanto ao diagnóstico de Insuficiência Renal Aguda (IRA), existindo mais de 30 diferentes definições. OBJETIVO: Avaliar a incidência e os fatores de risco para desenvolvimento de IRA no pós-operatório de cirurgia cardíaca de acordo com os critérios RIFLE, AKIN e KDIGO, e comparar o poder prognóstico desses critérios. MÉTODOS: Estudo de corte transversal que incluiu 321 pacientes (62 [53 - 71] anos, 140 homens) consecutivamente submetidos a cirurgia cardíaca entre junho de 2011 e janeiro de 2012. Os pacientes foram acompanhados por 30 dias, com vistas ao desenvolvimento de um desfecho composto (mortalidade, necessidade de diálise e internação prolongada). RESULTADOS: A incidência de IRA variou de 15% - 51%, conforme o critério diagnóstico adotado. Enquanto a idade se associou ao risco de IRA nos três critérios, houve variação nos demais determinantes. Durante o acompanhamento, 89 pacientes apresentaram o desfecho e todos os critérios se associaram ao risco aumentado na análise Cox univariada e após o ajuste para idade, sexo, diabetes e tipo de cirurgia. Contudo, após novo ajuste para tempo de circulação extracorpórea e presença de baixo débito cardíaco, apenas o diagnóstico de IRA pelo critério KDIGO manteve esta associação significativa (HR= 1,89 [95% IC: 1,18 - 3,06]). CONCLUSÕES: A incidência e os fatores de risco para IRA pós-cirurgia cardíaca têm grande variação de acordo com os critérios diagnósticos utilizados. Em nossa análise, o critério KDIGO se mostrou superior ao AKIN e ao RIFLE quanto ao seu poder prognóstico.

BACKGROUND: There is considerable controversy regarding the diagnosis of Acute Kidney Injury (AKI), and there are over 30 different definitions. OBJECTIVE: To evaluate the incidence and risk factors for the development of AKI following cardiac surgery according to the RIFLE, AKIN and KDIGO criteria, and compare the prognostic power of these criteria. METHODS: Cross-sectional study that included 321 consecutively patients (median age 62 [53-71] years; 140 men) undergoing cardiac surgery between June 2011 and January 2012. The patients were followed for up to 30 days, for a composite outcome (mortality, need for dialysis and extended hospitalization). RESULTS: The incidence of AKI ranged from 15% - 51%, accordingly to the diagnostic criterion adopted. While age was associated with risk of AKI in the three criteria, there were variations in the remaining risk factors. During follow-up, 89 patients developed the outcome and all criteria were associated with increased risk in the univariate Cox analysis and after adjustment for age, gender, diabetes, and type of surgery. However, after further adjustment for extracorporeal circulation and the presence of low cardiac output, only AKI diagnosed by the KDIGO criterion maintained this significant association (HR= 1.89 [95% CI: 1.18 - 3.06]). CONCLUSION: The incidence and risk factors for AKI after cardiac surgery vary significantly according to the diagnostic criteria used. In our analysis, AKI the KDIGO criterion was superior to AKIN and RIFLE with regard its prognostic power.

Evolução clínica de pacientes com mediastinite pós-cirurgia de revascularização miocárdica submetidos à oxigenoterapia hiperbárica como terapia adjuvante / Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery

OBJETIVO: Avaliação da utilização de oxigenoterapia hiperbárica, como tratamento adjuvante, em casos de mediastinite, em pós-operatório de cirurgia de revascularização miocárdica. MÉTODOS: Estudo descritivo retrospectivo, no período entre outubro de 2010 e fevereiro de 2012. A oxigenoterapia hiperbárica foi indicada nos casos de difícil manejo clínico a despeito da antibioticoterapia. RESULTADOS: Identificaram-se 18 pacientes com mediastinite, nos quais 33 microrganismos foram isolados, estando a infecção polimicrobiana presente em 11 casos. Enterobactérias foram os germes mais prevalentes e seis agentes multirresistentes. Ocorreu 1 óbito, na evolução, 7 meses após o término da oxigenoterapia, por septicemia, não relacionado à terapêutica. O tratamento foi bem tolerado. CONCLUSÃO: Os resultados clínicos iniciais foram favoráveis.

OBJECTIVE: To evaluate the use of hyperbaric oxygen therapy as an adjunctive treatment in mediastinitis after coronary artery bypass surgery. METHODS: This is a retrospective descriptive study, performed between October 2010 and February 2012. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite antibiotic therapy. RESULTS: We identified 18 patients with mediastinitis during the study period. Thirty three microorganisms were isolated, and polymicrobial infection was present in 11 cases. Enterobacteriaceae were the most prevalent pathogens and six were multi-resistant agents. There was only 1 hospital death, 7 months after the oxygen therapy caused by sepsis, unrelated to hyperbaric oxygen therapy. This treatment was well-tolerated. CONCLUSION: The initial data showed favorable clinical outcomes.