Comparative analysis for quality control of mother tinctures in Brazilian reports

Quality control of ahomeopathic mother tincture begins with the analysis of the raw material. Once the product is obtained, some organoleptic characteristics and Physicochemical properties such as appearance, colour, odour, density, dry residue, alcohol content,and chemicalmarker are evaluated. In Brazil, mother tinctures from different suppliers may have high variability in terms of the specifications described in the homeopathic pharmacopoeia. Objective: The aim of the present study was to compare mother tinctures' quality control from different pharmaceutical suppliers based on Brazilian Homeopathic Pharmacopoeia 3rd edition. Methods: Five mother tinctures were selected according to the high number of requests in the pharmacies, also its monographs are in the Brazilian Homeopathic Pharmacopoeia (FHB) 3rd edition. The report of analysis of the product was provided by three homeopathic pharmacies from the city of Rio de Janeiro. The information in the reports wasevaluated and compared to its monograph. Results and discussion: In this study, it was found that the number of laboratories that provide homeopathic pharmaceutical ingredients is rather low. In addition, in some reports, a number of identification tests werenot described properly when compared to the monograph. Besides that, some information diverges from the pharmacopoeia, for example, absence of dry residue testing, replacement of the part of the plant used to prepare the mother tincture,and results that do not meet pharmacopoeia specifications. As can be seen, the quality and effectiveness of homeopathic medicines prepared from these tinctures may be compromised. Conclusion:In order to guarantee consumer protection and the quality and effectiveness of medicines, governments and regulatory agencies should requirea greater commitment from suppliers in the production of homeopathic inputs.

Predictability of adverse outcomes in hypertensive disorders of pregnancy: a multicenter prospective cohort study.

OBJECTIVES: To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). METHODS: Multicenter, prospective, national cohort study. RESULTS: Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06-1.35]), gestational age (OR0.698[0.59-0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001-1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16-1.30), 0.76(0.59-1.02), and 1.1(0.98-1.2), respectively. CONCLUSIONS: Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.

Avaliação microbiológica da água consumida em bebedouros da Universidade Estadual Vale do Acaraú, Sobral – CE / Microbiological evaluation of the water consumed in drinking of the University Vale do Acaraú, Sobral - CE

A má qualidade dos sistemas de distribuição e de reservatórios proporciona a população uma água contaminada que, serve de veículo para vários agentes infecciosos que provocam danos à saúde humana. O presente trabalho teve por objetivo analisar a qualidade e potabilidade das águas dos bebedouros de uma Universidade do município de Sobral - Ce, por meio da quantificação de coliformes totais e coliformes termotolerantes. As amostras foram avaliadas, segundo os requisitos determinados pelo Ministério da Saúde, por meio da Portaria nº 2914 de 2011. Os resultados apresentados após as análises feitas não atenderam aos parâmetros, desta forma as amostras podem ser classificadas como inadequadas para consumo de acordo com parâmetros para coliformes.

The poor quality of distribution systems and tanks to the population provides a contaminated water that serves as a vehicle for various infectious agents that cause damage to human health. This study aims to analyze the quality and potability of water in the troughs of a University of Sobral - Ce municipality, through the quantification of total coliforms and fecal coliforms. The samples were evaluated, whose requirements are determined by the Ministry of Health, through Ordinance No. 2914 of 2011. The results after the analyzes did not meet the parameters, so samples can be classified as unsuitable for consumption according to parameters coliform.

Avaliação microbiológica da água consumida em bebedouros da Universidade Estadual Vale do Acaraú, Sobral - CE

A má qualidade dos sistemas de distribuição e de reservatórios proporciona a população uma água contaminada que, serve de veículo para vários agentes infecciosos que provocam danos à saúde humana. O presente trabalho teve por objetivo analisar a qualidade e potabilidade das águas dos bebedouros de uma Universidade do município de Sobral - CE, por meio da quantificação de coliformes totais e coliformes termotolerantes. As amostras foram avaliadas, segundo os requisitos determinados pelo Ministério da Saúde, por meio da Portaria n° 2914 de 2011. Os resultados apresentados após as análises feitas não atenderam aos parâmetros, desta forma as amostras podem ser classificadas como inadequadas para consumo de acordo com parâmetros para coliformes.(AU)

The poor quality of distribution systems and tanks to the population provides a contaminated water that serves as a vehicle for various infectious agents that cause damage to human health. This study aims to analyze the quality and potability of water in the troughs of a University of Sobral - CE municipality, through the quantification of total coliforms and fecal coliforms. The samples were evaluated, whose requirements are determined by the Ministry of Health, through Ordinance No. 2914 of 2011. The results after the analyzes did not meet the parameters, so samples can be classified as unsuitable for consumption according to parameters coliform.(AU)

Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition.

Undernutrition is a stressor with long-term consequences, and the effect of nutritional recovery on cortisol and thyroid hormone status is unknown. To investigate basal thyroid hormones and the cortisol response to a cold pressor test in children recovered from undernutrition, a cross-sectional study was undertaken on children (6-16 years) separated into four groups: control (n 41), stunted (n 31), underweight (n 27) and recovered (n 31). Salivary cortisol was collected over the course of 10 h: upon awakening, before and after an unpleasant and a pleasant stimulus. Cortisol upon awakening was highest in the stunted and lowest in the underweight groups: control=5·05 (95% CI 3·71, 6·89) nmol/l, stunted=6·62 (95% CI 3·97, 11·02) nmol/l, underweight=2·51 (95% CI 1·75, 3·63) nmol/l and recovered=3·46 (95% CI 2·46, 4·90) nmol/l (P=0·005). Girls had higher cortisol concentrations upon awakening compared with boys (P=0·021). The undernourished groups showed an elevated cortisol response both to the unpleasant stimulus and at the last measurement (16.00 hours) compared with that of the recovered group: AUC, control=2·07 (95% CI 1·69, 2·45) nmol/l×30 min, stunted=2·48 (95% CI 1·91, 3·06) nmol/l×30 min, underweight=2·52 (95% CI 2·07, 2·97) nmol/l×30 min, recovered=1·68 (95% CI 1·26, 2·11) nmol/l×30 min (P=0·042); and control=2·03 (95% CI 1·75, 2·39) nmol/l×30 min, stunted=2·51 (95% CI 1·97, 3·19) nmol/l×30 min, underweight=2·61 (95% CI 2·16, 3·16) nmol/l×30 min, recovered=1·70 (95% CI 1·42, 2·03) nmol/l×30 min (P=0·009). Lower free thyroxine (T4) was found in the recovered and stunted groups: control=1·28 (95% CI 1·18, 1·39) pmol/l, stunted=0·98 (95% CI 0·87, 1·10) pmol/l, underweight=1·10 (95% CI 1·01, 1·21) pmol/l and recovered=0·90 (95% CI 0·83, 0·99) pmol/l (P<0·001). Multivariate analysis showed a lower cortisol concentration along 10 h (06.00-16.00 hours) in the recovered compared with the other groups (P=0·017), and similar concentrations between the recovered and control group. In conclusion, the children with recovery in weight and height had a cortisol stress response similar to control but a lower basal free T4. Longitudinal studies are warranted to determine the extent of these endocrine changes after recovery of undernutrition and in adulthood.

Characteristics, Outcomes, and Predictability of Critically Ill Obstetric Patients: A Multicenter Prospective Cohort Study.

OBJECTIVE: To evaluate pregnant/postpartum patients requiring ICUs admission in Argentina, describe characteristics of mothers and outcomes for mothers/babies, evaluate risk factors for maternal-fetal-neonatal mortality; and compare outcomes between patients admitted to public and private health sectors. DESIGN: Multicenter, prospective, national cohort study. SETTING: Twenty ICUs in Argentina (public, 8 and private, 12). PATIENTS: Pregnant/postpartum (< 42 d) patients admitted to ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three hundred sixty-two patients were recruited, 51% from the public health sector and 49% from the private. Acute Physiology and Chronic Health Evaluation II was 8 (4-12); predicted/observed mortality, 7.6%/3.6%; hospital length of stay, 7 days (5-13 d); and fetal-neonatal losses, 17%. Public versus private health sector patients: years of education, 9 ± 3 versus 15 ± 3; transferred from another hospital, 43% versus 12%; Acute Physiology and Chronic Health Evaluation II, 9 (5-13.75) versus 7 (4-9); hospital length of stay, 10 days (6-17 d) versus 6 days (4-9 d); prenatal care, 75% versus 99.4%; fetal-neonatal losses, 25% versus 9% (p = 0.000 for all); and mortality, 5.4% versus 1.7% (p = 0.09). Complications in ICU were multiple-organ dysfunction syndrome (34%), shock (28%), renal dysfunction (25%), and acute respiratory distress syndrome (20%); all predominated in the public sector. Sequential Organ Failure Assessment (during first 24 hr of admission) score of at least 6.5 presented the best discriminative power for maternal mortality. Independent predictors of maternal-fetal-neonatal mortality were Acute Physiology and Chronic Health Evaluation II, education level, prenatal care, and admission to tertiary hospitals. CONCLUSIONS: Patients spent a median of 7 days in hospital; 3.6% died. Maternal-fetal-neonatal mortality was determined not only by acuteness of illness but to social and healthcare aspects like education, prenatal control, and being cared in specialized hospitals. Sequential Organ Failure Assessment (during first 24 hr of admission), easier to calculate than Acute Physiology and Chronic Health Evaluation II, was a better predictor of maternal outcome. Evident health disparities existed between patients admitted to public versus private hospitals: the former received less prenatal care, were less educated, were more frequently transferred from other hospitals, were sicker at admission, and developed more complications; maternal and fetal-neonatal mortality were higher. These findings point to the need of redesigning healthcare services to account for these inequities.

Symptom burden and health-related quality of life among intensive care unit survivors in Argentina: A prospective cohort study.

PURPOSE: Our goal was to describe the evolution of selected physical and psychologic symptoms and identify the determinants of health-related quality of life (HRQOL) after intensive care unit (ICU) discharge. METHODS: The study is a prospective cohort of consecutive adult patients admitted to a mixed ICU in a university-affiliated hospital, mechanically ventilated for more than 48 hours. During ICU stay, epidemiological data and events probably associated to worsening outcomes were recorded. After discharge, patients were interviewed at 1, 3, 6, and 12 months. Health-related quality of life was assessed with EuroQoL Questionnaire-5 Dimensions, which includes the EQ-index and EQ-Visual Analogue Scale. RESULTS: One hundred twelve patients were followed up, aged 33 [24-49] years, 68% male, 76% previously healthy, and cranial trauma was the main diagnosis. Physical and psychologic symptoms and moderate/severe problems according to the EQ index progressively decreased after discharge, yet were still highly prevalent after 1 year. EQ index improved from 0.22 [0.01-0.69] to 0.52 [0.08-0.81], 0.66 [0.17-0.79], and 0.68 [0.26-0.86] (P < .001, for all vs month 1). EQ-Visual Analogue Scale remained stable, within acceptable values. Independent determinants of EQ-index were time, duration of mechanical ventilation, shock, weakness, and return to study/work. CONCLUSIONS: Determinants of HRQOL after ICU discharge were both related to late sequelae of critical illness and to some events occurring in the ICU. Notwithstanding the high symptom burden, patients still perceived their HRQOL as good.

Hypertensive disease of pregnancy in the ICU: a multicenter study.

OBJECTIVE: To describe characteristics, outcomes and clinical presentations for hypertensive disease of pregnancy (HDP) in patients admitted to three ICUs in Argentina. METHODS: Case-series multicenter study. RESULTS: There were 184 patients with HDP. Mean age 26 ± 8; 90% did not present comorbidity; APACHEII 9[6-14]; SOFA24 2[1-4]; ICU-LOS 3[2-6] days and hospital-LOS 8[5-12] days. Gestational age 34 ± 5 weeks; 46% (85) nulliparous and 71% received routine prenatal care. Maternal mortality 3.3% (6) - 50% attributed to intracranial hemorrhage (ICH). Neonatal mortality 13.6%. Diagnostic categories: eclampsia (64; 35%), severe preeclampsia (60; 32.6%), HELLP (33; 17.9%), eclampsia-HELLP (18; 9.8%) and other (chronic/gestational-hypertension) (9: 4.7%). Severe hypertension in 46%, multiple organ dysfunction in 23%, acute respiratory distress in 8.7% and acute renal failure in 8%. Variables independently associated with eclampsia: maternal age (OR 1.07 [1.02-1.13], gestational age (OR 1.14 [1.04-1.24]) and nulliparity (OR 2.40 [1.19-4.85]). CONCLUSIONS: Although patients were young and the majority received appropriate prenatal care, they spent considerable time in hospital and presented severe morbidity. Maternal mortality was 3.3% and in half of these cases it was attributed to ICH. Eclampsia and severe preeclampsia represented two thirds of the diagnostic categories. Variables independently associated with eclampsia were maternal and gestational ages and nulliparity.

Impact of nutritional recovery with linear growth on the concentrations of adipokines in undernourished children living in Brazilian slums.

Undernutrition in early life has been reported to be closely associated with the development of non-communicable diseases in adulthood. Adequate treatment is important for reversing these effects. In the present study, we investigated the effects of undernutrition and anthropometric recovery on the weights and heights of children in relation to the concentrations of leptin, adiponectin and plasminogen activator inhibitor-1 (PAI-1). A total of 119 children (aged 6-16 years) from the slums of São Paulo were selected according to their nutritional status and divided into three groups as follows: control (healthy without intervention, n 38) with a height-for-age Z score (HAZ) and a BMI-for-age Z score (BAZ) > -1·6; undernourished (HAZ and/or BAZ < -1·6, n 54); recovered from undernutrition (after treatment in a rehabilitation centre; HAZ and BAZ > -1·6, n 27). Blood samples were collected to determine insulin, glucose, leptin, adiponectin and PAI-1 concentrations. Leptin concentrations in the undernourished group were lower than those in the control and recovered groups (mean 0·92 (95% CI 0·67, 1·25), 2·03 (95% CI 1·46, 2·82) and 1·66 (95% CI 1·15, 2·44) ng/ml, P=0·003), which had similar leptin concentrations. There were no differences in adiponectin and PAI-1 concentrations among the groups. A positive correlation between waist circumference and leptin concentrations was observed in all the girls and boys of the control group (control: r 0·729, P<0·01; undernourished: r 0·490, P<0·05; and recovered: r 0·829, P<0·01; r 0·673, P<0·05). Stronger correlations between leptin and insulin concentrations were observed in the recovered group. The results of the present study indicate that normal leptin concentrations are found when normal height and weight are achieved.

Health insurance status and outcomes of critically ill obstetric patients: a prospective cohort study in Argentina.

PURPOSE: In Argentina, uninsured patients receive public health care, and the insured receive private health care. Our aim was to compare different outcomes between critically ill obstetric patients from both sectors. METHODS: This is a prospective cohort, including pregnant/postpartum patients requiring admission to 1 intensive care unit in the public sector (uninsured) and 1 in the private (insured) from January 1, 2008, to September 30, 2011. RESULTS: A total of 151 patients were included in the study. In uninsured (n = 63) vs insured (n = 88) patients, Acute Physiology and Chronic Evaluation II (APACHE II) and Sequential Organ Failure Assessment scores were 11 ± 6.5 vs 8 ± 4 and 3 (2-7) vs 1 (0-2), respectively, and 84% vs 100% received prenatal care (P = .001 for all). Multiple organ dysfunction syndrome (MODS) was present in 32 (54%) uninsured vs 9 (10%) insured patients (P = .001), and acute respiratory distress syndrome developed in 18 (30.5%) of 59 vs 2(2%) of 88 (P = .001). Neonatal survival was 80% vs 96% (P = .003). Variables independently associated with the development of MODS were APACHE II (odds ratio, 1.30 [1.13-1.49]), referral from another hospital (odds ratio, 11.43 [1.86-70.20]), lack of health insurance (odds ratio 6.75 [2.17-20.09]), and shock (odds ratio 4.82 [1.54-15.06]). Three patients died, all uninsured. CONCLUSIONS: Uninsured critically ill obstetric patients (public sector) were more severely ill on admission and experienced worse outcomes than insured patients (private sector). Variables independently associated with MODS were APACHE II, shock, referral from another hospital, and lack of insurance.

Dipyrone attenuates acute sickness response to lipopolysaccharide in mice.

Sickness behavior appears to be the expression of a central motivational state that reorganizes the organism's priorities to cope with infectious pathogens. To evaluate the effect of dipyrone in lipopolysaccharide (LPS)-induced sickness behavior, mice were subjected to the forced swim test (FST), tail suspension test (TST), dark-light box test, open field test, sucrose preference intake test and food intake test. LPS administration increased the immobility time in the TST, increased the time spent floating in the FST, and depressed locomotor activity in the open field test. Treatment with LPS decreased the total number of transitions made between the dark and light compartments of the apparatus and induced anhedonia and anorexia. Pre-treatment with dipyrone (10, 50, or 200 mg/kg) attenuated behavioral changes induced by LPS in the FST, TST, open field and light-dark box tests. In addition, dipyrone prevented anhedonia and anorexia in mice challenged with LPS. Considering that dipyrone attenuates LPS-induced behavioral changes, it is proposed that LPS-induced sickness behavior is dependent on the COX pathway.

Critical care providers' opinion on unsafe abortion in Argentina.

OBJECTIVE: To survey the opinion of critical care providers in Argentina about abortion. METHODS: An anonymous questionnaire was distributed to critical care providers attending the 20th National Critical Care Conference in Argentina. RESULTS: 149 of 1800 attendees completed the questionnaire, 69 (46.3%) of whom were members of the Argentine Society of Critical Care (ASCC). 122 (81.9%) supported abortion decriminalization in situations excluded from the current law; 142 (95.3%) in cases of congenital defects; 133 (89.3%) in cases of rape; 115 (77.2%) when women's mental health is at risk; 71 (47.7%) when pregnancy is unintended; and 61 (40.9%) for economic reasons. 126 (84.6%) supported abortion in public and private institutions, and 121 (81.2%) before 12 weeks of pregnancy. Variables independently associated with abortion support among female versus male attendees were abortion to preserve women's mental health (OR 4.47; 95% CI, 1.61-12.42; P=0.004) and abortion before 12 weeks of pregnancy (OR 3.93; 95% CI, 1.29-11.94; P=0.015). Abortion at request was independently associated with ASCC membership (OR 2.63; 95% CI, 1.07-6.45; P=0.034). CONCLUSION: Critical care providers would support abortion in situations excluded from the current abortion law and before 12 weeks of pregnancy, in both public and private hospitals.

Impacto de la internación en terapia intensiva en la calidad de vida después de 1, 3, 6 y 12 meses / The impact of hospitalization in intensive care units on quality of life after 1, 3, 6 and 12 months

INTRODUCCION: A medida que más pacientes sobreviven a una internación en Unidades de Terapia Intensiva (UTI), se hace necesario conocer las secuelas a largo plazo. La calidad de vida relacionada a la salud tras la enfermedad crítica se mantiene por debajo de la media de la población general aún cinco años después del alta.OBJETIVO: Evaluar la calidad de vida de los pacientes a egreso de UTI mediante el cuestionario EuroQol 5D y predictores de mala evolución. Evaluar secuelas psíquicas y físicas una vez transcurridos 1, 3, 6 y 12 meses después del alta de UTI.METODOS: Se realizó un estudio descriptivo en un Hospital Interzonal de la Provincia de Buenos Aires (estudio prospectivo de serie de casos). Fueron incluidos aquellos pacientes sometidos a asistencia respiratoria mecánica invasiva por un período ≥ 48 horas que egresaron de UTI entre el 01/04/2010 y el 01/04/2011.RESULTADOS: Los criterios de inclusión fueron cumplidos por 51 pacientes. Se entrevistó a 36/46 pacientes (tras un mes), 25/34 pacientes (a los 3 meses), 12/15 pacientes (a los 6 meses) y 5/7 pacientes (a los 12 meses). Los datos demográficos reflejaron edad 33 [25-50] años, 71% de los pacientes de sexo masculino, 57% sin comorbilidades y con un puntaje APACHE II de 14,6 ± 6. El principal motivo de ingreso fue el trauma (50%). La dimensión más afectada fue la realización de actividades cotidianas, seguida de dolor/malestar y movilidad. La incidencia de ansiedad/depresión y estrés postraumático fue la reportada en otros estudios. La anemia, la traqueostomía y la alimentación enteral al alta fueron predictores de mala evolución según el índice EuroQol.CONCLUSIONES: La calidad de vida al alta de UTI se encontró muy deteriorada en la mayoría de las dimensiones. Las secuelas psíquicas se presentaron dentro del rango esperado. El índice EuroQol fue bajo en el primer mes, pero evolucionó favorablemente junto a la percepción de la propia calidad de vida medida por Escala Visual Análoga EuroQol.

INTRODUCTION: As more and more patients survive their hospitalization in Intensive Care Units (ICU), it is of utmost importance to find out and understand the long-term outcomes. Health-related quality of life after a critical illness is still below the average, even five years after discharge.OBJECTIVE: To assess patients quality of life after ICU discharge using the EuroQol-5D score and predictors of unfavorable prognosis. To assess psychological after-effects like anxiety, depression and post-traumatic stress disorder (PTSD), along with physical morbodity at 1, 3, 6 and 12 months after ICU discharge.METHODS: A descriptive study was conducted in a public hospital located in the province of Buenos Aires (prospective case study). It included all patients treated with invasive mechanical ventilation for at least 48 hours that survived ICU from April 1, 2010 through April 1, 2011.RESULTS: 51 patients qualified for inclusion in this study. Interviews were made to 36/46 patients after 1 month; 25/34 patients after 3 months; 12/15 patients after 6 months and 5/7 patients after 12 months. The demographic data showed age 33 [25-50], 71% male, 57% with no comorbidities and 14,6 ± 6,4 points in APACHE II score. The main reason for ICU admission was trauma (50%). The most affected dimension, as measured by EQ-5D, was usual activities, followed by pain/discomfort and self-care or morbility. The incidence of PTSD and anxiety/depression was similar was to what was reported in other studies. Anemia, tracheostomy and enteral feeding at discharge were predictors of unfavorable prognosis as indicated by the EuroQol index.CONCLUSIONS: The quality of life after ICU discharge was severely deteriorated in most dimensions. Psychological after-effects were within the expected values. The EuroQol index was low in the first month, but then it improved along with the quality of life as measured by the EuroQol Visual Analogue Scale.

Impacto de la internación en terapia intensiva en la calidad de vida después de 1, 3, 6 y 12 meses / The impact of hospitalization in intensive care units on quality of life after 1, 3, 6 and 12 months

INTRODUCCION: A medida que más pacientes sobreviven a una internación en Unidades de Terapia Intensiva (UTI), se hace necesario conocer las secuelas a largo plazo. La calidad de vida relacionada a la salud tras la enfermedad crítica se mantiene por debajo de la media de la población general aún cinco años después del alta.OBJETIVO: Evaluar la calidad de vida de los pacientes a egreso de UTI mediante el cuestionario EuroQol 5D y predictores de mala evolución. Evaluar secuelas psíquicas y físicas una vez transcurridos 1, 3, 6 y 12 meses después del alta de UTI.METODOS: Se realizó un estudio descriptivo en un Hospital Interzonal de la Provincia de Buenos Aires (estudio prospectivo de serie de casos). Fueron incluidos aquellos pacientes sometidos a asistencia respiratoria mecánica invasiva por un período ≥ 48 horas que egresaron de UTI entre el 01/04/2010 y el 01/04/2011.RESULTADOS: Los criterios de inclusión fueron cumplidos por 51 pacientes. Se entrevistó a 36/46 pacientes (tras un mes), 25/34 pacientes (a los 3 meses), 12/15 pacientes (a los 6 meses) y 5/7 pacientes (a los 12 meses). Los datos demográficos reflejaron edad 33 [25-50] años, 71% de los pacientes de sexo masculino, 57% sin comorbilidades y con un puntaje APACHE II de 14,6 ± 6. El principal motivo de ingreso fue el trauma (50%). La dimensión más afectada fue la realización de actividades cotidianas, seguida de dolor/malestar y movilidad. La incidencia de ansiedad/depresión y estrés postraumático fue la reportada en otros estudios. La anemia, la traqueostomía y la alimentación enteral al alta fueron predictores de mala evolución según el índice EuroQol.CONCLUSIONES: La calidad de vida al alta de UTI se encontró muy deteriorada en la mayoría de las dimensiones. Las secuelas psíquicas se presentaron dentro del rango esperado. El índice EuroQol fue bajo en el primer mes, pero evolucionó favorablemente junto a la percepción de la propia calidad de vida medida por Escala Visual Análoga EuroQol.

INTRODUCTION: As more and more patients survive their hospitalization in Intensive Care Units (ICU), it is of utmost importance to find out and understand the long-term outcomes. Health-related quality of life after a critical illness is still below the average, even five years after discharge.OBJECTIVE: To assess patients quality of life after ICU discharge using the EuroQol-5D score and predictors of unfavorable prognosis. To assess psychological after-effects like anxiety, depression and post-traumatic stress disorder (PTSD), along with physical morbodity at 1, 3, 6 and 12 months after ICU discharge.METHODS: A descriptive study was conducted in a public hospital located in the province of Buenos Aires (prospective case study). It included all patients treated with invasive mechanical ventilation for at least 48 hours that survived ICU from April 1, 2010 through April 1, 2011.RESULTS: 51 patients qualified for inclusion in this study. Interviews were made to 36/46 patients after 1 month; 25/34 patients after 3 months; 12/15 patients after 6 months and 5/7 patients after 12 months. The demographic data showed age 33 [25-50], 71% male, 57% with no comorbidities and 14,6 ± 6,4 points in APACHE II score. The main reason for ICU admission was trauma (50%). The most affected dimension, as measured by EQ-5D, was usual activities, followed by pain/discomfort and self-care or morbility. The incidence of PTSD and anxiety/depression was similar was to what was reported in other studies. Anemia, tracheostomy and enteral feeding at discharge were predictors of unfavorable prognosis as indicated by the EuroQol index.CONCLUSIONS: The quality of life after ICU discharge was severely deteriorated in most dimensions. Psychological after-effects were within the expected values. The EuroQol index was low in the first month, but then it improved along with the quality of life as measured by the EuroQol Visual Analogue Scale.

Clinical characteristics and outcomes of obstetric patients requiring ICU admission.

OBJECTIVES: To review a series of critically ill obstetric patients admitted to our ICU to assess the spectrum of disease, required interventions, and fetal/maternal mortality, and to identify conditions associated with maternal death. DESIGN: Retrospective cohort. SETTING: Medical-surgical ICU in a university-affiliated hospital. PATIENTS: Pregnant/postpartum admissions between January 1, 1998, and September 30, 2005. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: We studied 161 patients (age, 28 +/- 9 years; mean gestational age, 29 +/- 9 weeks) [mean +/- SD], constituting 10% of 1,571 hospital admissions. APACHE (acute physiology and chronic health evaluation) II score was 14 +/- 8, with 24% predicted mortality; sequential organ failure assessment score was 5 +/- 3; and therapeutic intervention scoring system at 24 h was 25 +/- 9. Forty-one percent of patients required mechanical ventilation (MV). ARDS, shock, and organ dysfunction were present in 19%, 25%, and 48% of patients, respectively. Most patients (63%) were admitted postpartum, and 74% of admissions were of obstetric cause. Hypertensive disease (40%), major hemorrhage (16%), septic abortion (12%), and nonobstetric sepsis (10%) were the principal diagnoses. Maternal mortality was 11%, with multiple organ dysfunction syndrome (44%) and intracranial hemorrhage (39%) as main causes. There were no differences in death rate in patients admitted for obstetric and nonobstetric causes. Fetal mortality was 32%. Only 30% of patients received antenatal care, which was more frequent in survivors (33% vs 6% nonsurvivors, p = 0.014). CONCLUSIONS: Although ARDS, organ failures, shock, and use of MV were extremely frequent in this population, maternal mortality remains within an acceptable range. APACHE II overpredicted mortality in these patients. Septic abortion is still an important modifiable cause of mortality. Efforts should concentrate in increasing antenatal care, which was clearly underprovided in these patients.

Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study.

OBJECTIVE: To assess renal dysfunction and outcome in patients treated exclusively with colistin vs. other antibiotics. DESIGN AND SETTING: Prospective cohort study in a mixed ICU in a university-affiliated hospital. PATIENTS: 185 patients infected with Acinetobacter baumannii and Pseudomonas aeruginosa after an ICU stay longer than 48 h: 55 in the colistin group and 130 in the noncolistin group, similar in age, APACHE II, medical status, and SOFA score. MEASUREMENTS AND RESULTS: We recorded data on epidemiology and severity of illness, site of infection, renal function before and after treatment, clinical cure, and mortality. Clinical cure was defined as simultaneous normalization of central temperature (< or = 38 degrees), leukocyte count (< or = 10,000/mm3), and PaO2/FIO2 ratio (>187). Before treatment creatinine was 0.9+/-0.2 in the colistin group and 0.9+/-0.1 in the noncolistin group; after treatment the value was 1.0+/-0.3 in both groups. The most frequent infection was ventilator-associated pneumonia: 53% vs. 66% in colistin and noncolistin groups, respectively, Acinetobacter was the cause in 65% and 60% and Pseudomonas in 35% and 53%. In the noncolistin group 81% of patients were treated with carbapenems. Inadequate empirical antimicrobial treatment was more frequent in the colistin group (100% vs. 8%), but there were no differences in the frequency of clinical cure on day 6 of treatment (15% and 17%) or in mortality (29% and 24%). CONCLUSIONS: Colistin appears to be as safe and as effective as other antimicrobials for treatment of sepsis caused by Acinetobacter and Pseudomonas in critically ill patients.