Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study.

PURPOSE: To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period. METHODS: We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical-surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model. RESULTS: 32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1-5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91-0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1-1.01)]. CONCLUSION: Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.

External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs.

BACKGROUND: The performance of severity-of-illness scores varies in different scenarios and must be validated prior of being used in a specific settings and geographic regions. Moreover, models' calibration may deteriorate overtime and performance of such instruments should be reassessed regularly. Therefore, we aimed at to validate the SAPS 3 in a large contemporary cohort of patients admitted to Brazilian ICUs. In addition, we also compared the performance of the SAPS 3 with the MPM0-III. METHODS: This is a retrospective cohort study in which 48,816 (medical admissions = 67.9%) adult patients are admitted to 72 Brazilian ICUs during 2013. We evaluated models' discrimination using the area under the receiver operating characteristic curve (AUROC). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration). RESULTS: Mean SAPS 3 score was 44.3 ± 15.4 points. ICU and hospital mortality rates were 11.0 and 16.5%. We estimated predicted mortality using both standard (SE) and Central and South American (CSA) customized equations. Predicted mortality rates were 16.4 ± 19.3% (SAPS 3-SE), 21.7 ± 23.2% (SAPS 3-CSA) and 14.3 ± 14.0% (MPM0-III). Standardized mortality ratios (SMR) obtained for each model were: 1.00 (95% CI, 0.98-0.102) for the SAPS 3-SE, 0.75 (0.74-0.77) for the SAPS 3-CSA and 1.15 (1.13-1.18) for the MPM0-III. Discrimination was better for SAPS 3 models (AUROC = 0.85) than for MPM0-III (AUROC = 0.80) (p < 0.001). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration): the SAPS 3-CSA overestimated mortality throughout all risk classes while the MPM0-III underestimated it uniformly. The SAPS 3-SE did not show relevant deviations from ideal calibration. CONCLUSIONS: In a large contemporary database, the SAPS 3-SE was accurate in predicting outcomes, supporting its use for performance evaluation and benchmarking in Brazilian ICUs.

Oral condition of critical patients and its correlation with ventilator-associated pneumonia: a pilot study / Condição oral de pacientes críticos e sua correlação com pneumonia associada a ventilação mecânica: um estudo piloto

Introduction: Literature has reported inadequate oral hygiene conditions in Intensive Care Unit (ICU) patients and the occurrence of Ventilator-associated pneumonia in about 9%-27% of all intubated patients. Objective: The aim of this study was to evaluate ICU patient's oral conditions and correlate this with the presence of ventilator-associated pneumonia. Material and Method: Twenty-three patients were categorized in the following way: with periodontal disease and ventilator-associated pneumonia, with periodontal disease and without ventilator-associated pneumonia, without periodontal disease and with ventilator-associated pneumonia, and with neither periodontal disease nor ventilator-associated pneumonia. The periodontal disease index, plaque index, and decay-missing-filled index were used in the assessment. Result: There was no statistically significant difference in the incidence of periodontal disease with respect to ventilator-associated pneumonia, but the number of teeth and surfaces with attachment loss above 4 mm was always greater in patients with ventilator-associated pneumonia. Conclusion: The extent of periodontal disease may contribute to the onset of ventilator-associated pneumonia. However, studies with a larger sample are needed to validate this relationship.

Introdução: A literatura vem relatando condições inadequadas de higiene oral de pacientes em unidade de terapia intensiva (UTI) e a ocorrência de Pneumonia associada à ventilação mecânica em cerca de 9%-27% de todos os pacientes intubados. Objetivo: O objetivo deste estudo foi avaliar condições orais de pacientes críticos e correlacionar com a presença de pneumonia associada à ventilação mecânica. Material e Método: Vinte e três pacientes foram categorizados da seguinte maneira: com a doença periodontal e com pneumonia associada à ventilação mecânica, com doença periodontal e sem pneumonia associada à ventilação mecânica, sem doença periodontal e com pneumonia associada à ventilação mecânica e sem doença periodontal e sem pneumonia associada à ventilação mecânica. Foram utilizados na avaliação os índices de placa, de doença periodontal e índice de cariados, perdidos e obturados. Resultado: Não houve diferença estatisticamente significante na incidência da doença periodontal em relação à pneumonia associada à ventilação mecânica, mas o número de dentes e superfícies com perda de inserção acima de 4 mm sempre foi maior em pacientes com pneumonia associada à ventilação mecânica. Conclusão: A extensão da doença periodontal pode contribuir para o aparecimento de pneumonia associada à ventilação mecânica. No entanto, são necessários estudos com uma amostra maior para validar essa relação.

Disposición y enfoques de aprendizaje en estudiantes universitarios de primer año / First-year university students’ disposition and approaches to learning

La investigación del aprendizaje autorregulado ha permitido distinguir estrategias o procesos cognitivos que el estudiante selecciona y ejecuta para alcanzar sus objetivos. Al enfrentar una tarea el estudiante analiza sus características, el contexto y sus propias capacidades adoptando estrategias de planificación y gestión de sus recursos, empleando un enfoque de aprendizaje superficial o profundo. Para describir la relación entre las variables estrategias de disposición y enfoques de aprendizaje se aplicó el Cuestionario de Estrategias de Aprendizaje a 344 estudiantes de primer año de ocho carreras de una universidad chilena. Los resultados mostraron relaciones significativas (r superior a .30, p<.001) entre estrategias de disposición y utilización de enfoque de aprendizaje profundo y entre estas variables y las horas de estudio semanales.

Research on self-regulated learning has recognized cognitive processes that students select and execute to achieve their goals. When performing a task, the student analyzes the task characteristics, context and his own capacities, employing resource planning and management, adopting either deep or superficial learning approaches. To describe the relationship between “disposition to learning strategies and” and “deep and superficial learning approaches”, the “Cuestionario de Formas de Estudio” questionnaire was applied to 344 1st year students from eight study programs of a Chilean university. The results show significant correlation (r greater than 0.30, p lower than 0.001) between disposition to learning strategies and usage ofdeep learning approaches, and between the aforementioned variables and the amount of weekly study time.

[Acetabular reconstruction in revision arthroplasty. Retrospective study of 76 cases. Hospital Español de México]. / Reconstrucción acetabular en la artroplastía de revisión. Estudio retrospectivo de 76 casos. Hospital Español de México.

OBJECTIVE: To review our experience with the various acetabular reconstruction techniques used during revision arthroplasty based on the defect in each patient. MATERIAL AND METHODS: We undertook a retrospective, descriptive, observational study of patients who underwent acetabular reconstruction during revision ar. throplasty, from January 1997 to January 2005. We documented the type of acetabular defect, the type of cup and graft used, the complications, and the pre- and postoperative assessment with the Harris scale. Data were analyzed with the SPSS software and the Wilcoxon test (p < 0.05). RESULTS: Seventy-six patients underwent surgery. Mean time elapsed between the primary replacement and the revision was 5 years. The acetabular defects found were: 16 type I, 22 type II, 30 type IIIA, and 8 type IIIB. The mean Harris score was 44 preoperatively and 76 postoperatively. The most frequently used technique involved the use of an autograft, a structural allograft with a porous threaded cup or a reinforcement ring. The most common complications included dislocation 5%, infection 3%, graft loss and cup loosening 21%, and loss of the hip center of rotation 15% (p < 0.05). CONCLUSIONS: Acetabular reconstruction is technically challenging and involves high failure and complication rates, thus providing little improvement in patient activity. It is important to restore the hip center of rotation to improve function. The reconstruction techniques we used are the most common ones and are described in the literature.

Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates.

INTRODUCTION: Deferred or inappropriate antibiotic treatment in ventilator-associated pneumonia (VAP) is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and to adjust or sometimes withdraw antibiotic treatment. Tracheal aspirates have been shown to be useful for these purposes. Nonetheless, little is known about the usefulness of quantitative findings in tracheal secretions for diagnosing VAP. METHODS: To determine the value of quantification of bacterial colonies in tracheal aspirates for diagnosing VAP, we conducted a prospective follow-up study of 106 intensive care unit patients who were under ventilatory support. In total, the findings from 219 sequential weekly evaluations for VAP were examined. Clinical and radiological parameters were recorded and evaluated by three independent experts; a diagnosis of VAP required the agreement of at least two of the three experts. At the same time, cultures of tracheal aspirates were analyzed qualitatively and quantitatively (10(5) colony-forming units [cfu]/ml and 10(6) cfu/ml) RESULTS: Quantitative cultures of tracheal aspirates (10(5) cfu/ml and 10(6) cfu/ml) exhibited increased specificity (48% and 78%, respectively) over qualitative cultures (23%), but decreased sensitivity (26% and 65%, respectively) as compared with the qualitative findings (81%). Quantification did not improve the ability to predict a diagnosis of VAP. CONCLUSION: Quantitative cultures of tracheal aspirates in selected critically ill patients have decreased sensitivity when compared with qualitative results, and they should not replace the latter to confirm a clinical diagnosis of VAP or to adjust antimicrobial therapy.

Respuesta terapéutica e histológica de pacientes con gastritis crónica y helicobacter pylori / terapéutica and histológica Answer of patients with chronic gastritis and to helicobacter pylori

El propósito de esta investigación fue demostrar el efecto de la terapia para Helicobacter Pylori (HP) sobre la histología de pacientes con gastritis crónica asociada a HP, y comparar el efecto diferencial del tratamiento para erradicación del HP versus los bloqueadores H2 sobre la histología de pacientes con gastritis crónica asociada a HP. Se seleccionaron un total de 120 pacientes con gastritis crónica y HP divididos en dos grupos: un grupo de 60 pacientes que recibieron terapia convencional para erradicación de HP en base a Omeprazol, Amoxicilina y Metronidazol y otro grupo de 60 pacientes que recibieron un bloqueador H2. La edad promedio del grupo de estudio fue de 41 +- 13.4 años, siendo para el grupo I de 40.8 +- 14.6 años y para el grupo II de 42.7 +- 12.2 años (p=0.42). El tratamiento de erradicación para HP demuestra ser más efectivo que el bloqueador H2 para disminuír la congestión (p=0.03), hemorragia (p=0.0002), erosion (p=0.03). Se observó una erradicación del HP luego del tratamiento específico del 88.4 por ciento (p=0.0001).

La proteina C reactiva en el diagnóstico diferencial de la infecciones del tracto urinario altas y bajas, 1994

El,presnte estudio transversal, se realizó entre enero y mayo de 1994, en 138 pacientes hombres y mujeres de una edad comprendida entre los 16 y 86 años, que asistieron a consulta externa de Medicina Interna de los Hospitales; Eugenio Espejo de Quito,Provincial Docente de Ambato, Provincial de Latacunga y Cantonal de Sangolquí, con sintomatología sugerente de infección del tracto urinario (UTI) y a los cuales se les realizó urocultivo para confirmar la infección urinaria y otros exámenes complemetarios como Biometría hemática, Velocidad de eritrosedimentación, urea, glucosa, creatinina, elemental y mocroscópico de orina, urocultivo, antibiograma y proteina c reactiva (PCR), para realizar el diagnóstico diferencial entre infecciones urinarias altas y bajas, por la gran diferencia sobre la morbi-mortalidad de estas dos entidades. De este estudio se obtuvo como resultados: 95 pacientes con infecciones urinarias altas y 39 con infeccciones bajas, de las infecciones altas en 70 casos el PCR fue positivo y solo en 25 casos fue negativo, mientras que en las infecciones bajas 8 casos tuvieron PCR positivo y 31 fueron PCR negativas. Otro resultado de este estudio es que la E. Coli con el 77.5 por ciento es el germen más frecuentemente involucrado en la patogenía de las infecciones de tracto urinario y luego se encuentra proteus con el 8.7 por ciento. También se obtuvo como resultado que las infecciones urinarias presentaron 80 por ciento de resistencia a la ampicilina, 51,5 por ciento a las sulfas y 41.5 por ciento a las cefalosporinas de primera generación. Como conclusión podemos afirmar que le PRC relacionado con otras variables clínicas nos permite orientar el diagnóstico diferencial de las UTI, por lo cual debe ser incluido en todo algoritmo de estudio sobre las mismas, y por otro lado afirmar que todo paciente con sintomatología sugerente de UTI debe realizarse un urocultivo, para en base a ello realizar un tratamiento adecuado:

Programa integral de educación en diabetes tipo 1 / sss

Programa dirigido a personas con diabetes melluitis tipo 1 que usen insulina y sean menores a 35 años. El objetivo mejorar el manejo de la diabetes y la calidad de vida del paciente con diabetes, a través de un programa integral de educación