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1.
Rev Bras Ter Intensiva ; 32(1): 17-27, 2020 Mar.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32401988

RESUMEN

OBJECTIVE: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. METHODS: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. RESULTS: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). CONCLUSION: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.


Asunto(s)
Mortalidad Hospitalaria , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Brasil , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo
4.
Rev. Soc. Bras. Clín. Méd ; 10(4)jul.-ago. 2012.
Artículo en Portugués | LILACS | ID: lil-646062

RESUMEN

JUSTIFICATIVA E OBJETIVOS: A pielonefrite enfisematosa (PE) é uma infecção necrotizante rara do parênquima renal, geralmente associada ao diabetes mellitus e a uropatia obstrutiva, com alta mortalidade, a despeito do tratamento clínico agressivo e da abordagem cirúrgica. O objetivo deste estudo foi relatar um caso de PE, com ênfase no manuseio clínico, baseado no suporte intensivo e antibioticoterapia, sem intervenção cirúrgica. RELATO DO CASO: Paciente do sexo feminino, 53 anos, diabética, admitida no pronto-socorro de um hospital terciário, com diagnostico clínico-radiológico compatível com PE, submetida apenas ao tratamento clínico conservador, com sucesso terapêutico. CONCLUSÃO: A PE é uma condição rara e crítica, tradicionalmente abordada com o manuseio cirúrgico. Contudo, relata-se um caso de PE adequadamente tratado com abordagem conservadora.


BACKGROUND AND OBJECTIVES: Emphysematous pyelonephritis (EP) is a rare and severe form of necrotizing infection of the renal parenchyma, commonly in patients with predisposing factors like diabetes mellitus and obstructive uropathy, with high mortality rates, to the detriment of clinical and surgical treatment. The aim of study was described a case of EP in one diabetic female patient, the successfully therapeutic management, critical care, antibiotic use, and non-surgical treatment.CASE REPORT: Female patient, 53-years-old, diabetic was referred to the tertiary hospital's emergency department with EP, successfully managed by non-surgical treatment. CONCLUSION: EP is a rare and life threatening condition and its management has traditionally been surgical. Nevertheless, we report a case of EP fully succeeded managed by conservative treatment.


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Diabetes Mellitus , Pielonefritis , Infecciones Urinarias , Urolitiasis
5.
Arq Bras Endocrinol Metabol ; 54(4): 369-74, 2010 Jun.
Artículo en Portugués | MEDLINE | ID: mdl-20625648

RESUMEN

UNLABELLED: Metabolic changes resulting from type 1 diabetes mellitus (DM1) may put growth and development at risk. OBJECTIVE: To evaluate the final stature of DM1 patients and the interference of DM1 in growth. SUBJECTS AND METHODS: The final height reached by 58 DM1 patients was evaluated according to anthropometric data and metabolic control. RESULTS: Mean age was 26.4 years (15.0-51.0) and the duration of disease was of 9.6 years (1.4-25.0). Final stature was 165.1 cm (149.3-183.0) and the z-score for height was 0.09 (-1.76-2.85). In a subgroup (n = 34), it was possible to evaluate the effect of metabolic control on growth. Mean glycosylated hemoglobin was 12.2% (6.8-24.1) and the correlation between anthropometric data and glucose control was not considered statistically significant (p > 0.05). CONCLUSION: We conclude that DM1 had no effect on the final stature, to the detriment of a poor metabolic control.


Asunto(s)
Estatura/fisiología , Diabetes Mellitus Tipo 1/complicaciones , Trastornos del Crecimiento/diagnóstico , Adolescente , Adulto , Diabetes Mellitus Tipo 1/sangre , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Servicios Externos , Estadísticas no Paramétricas , Factores de Tiempo , Adulto Joven
6.
Arq. bras. endocrinol. metab ; 54(4): 369-374, jun. 2010. graf, tab
Artículo en Portugués | LILACS | ID: lil-550706

RESUMEN

As alterações metabólicas decorrentes do diabetes melito tipo 1 (DM1) podem prejudicar o crescimento e o desenvolvimento. OBJETIVO: Avaliar a estatura final de pacientes com DM1 e a interferência da doença no crescimento. PACIENTES E MÉTODOS: A estatura final de 58 pacientes com DM1 foi avaliada em relação aos dados antropométricos e controle metabólico. RESULTADOS: A idade média foi de 26,4 anos (15,0-51,0) e a duração da doença, de 9,6 anos (1,4-25,0). A estatura final foi 165,1 cm (149,3-183,0) e o z-escore da estatura final foi igual a 0,09 (-1,76-2,85). Num subgrupo (n = 34), foi possível avaliar o controle glicêmico durante a fase de crescimento estatural. A média de hemoglobina glicosilada foi 12,2 por cento (6,8-24,1) e as correlações entre dados antropométricos e controle glicêmico não foram estatisticamente significantes (p > 0,05). CONCLUSÃO: Não houve interferência do DM1 na estatura final, apesar do controle glicêmico inadequado.


Metabolic changes resulting from type 1 diabetes mellitus (DM1) may put growth and development at risk. OBJECTIVE: To evaluate the final stature of DM1 patients and the interference of DM1 in growth. SUBJECTS AND METHODS: The final height reached by 58 DM1 patients was evaluated according to anthropometric data and metabolic control. RESULTS: Mean age was 26.4 years (15.0-51.0) and the duration of disease was of 9.6 years (1.4-25.0). Final stature was 165.1 cm (149.3-183.0) and the z-score for height was 0.09 (-1.76-2.85). In a subgroup (n = 34), it was possible to evaluate the effect of metabolic control on growth. Mean glycosylated hemoglobin was 12.2 percent (6.8-24.1) and the correlation between anthropometric data and glucose control was not considered statistically significant (p > 0.05). CONCLUSION: We conclude that DM1 had no effect on the final stature, to the detriment of a poor metabolic control.


Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Estatura/fisiología , Diabetes Mellitus Tipo 1/complicaciones , Trastornos del Crecimiento/diagnóstico , Diabetes Mellitus Tipo 1/sangre , Hemoglobina Glucada/metabolismo , Servicios Externos , Estadísticas no Paramétricas , Factores de Tiempo
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