Acessibilidade geográfica aos serviços de reabilitação de crianças com síndrome congênita do vírus Zika / Geographical accessibility to rehabilitation services of children with congenital zika syndrome

Resumo Introdução Alterações neurológicas em crianças com síndrome congênita do vírus Zika (SCZ) repercutem em atrasos no desenvolvimento e deformidades, levando à necessidade da assistência aos serviços de reabilitação. Objetivo Analisar a acessibilidade geográfica de crianças com SCZ na Região Metropolitana do Recife (RMR) e compará-la com a otimizada (distância mais próxima entre a residência da criança e o serviço). Método Estudo descritivo, incluindo 51 crianças com SCZ que residiam na RMR. Utilizaram-se questionários semiestruturados com dados sociodemográficos, econômicos e informações dos serviços de reabilitação utilizados pela criança. Elaboraram-se mapas de distribuição espacial e fluxos pelo Sistema de Informação Geográfica QGis e análises descritivas do perfil da amostra, usando SPSS 20.0. Resultados A maioria era de crianças que viviam em locais de vulnerabilidade, considerando a renda como indicador. Quanto à acessibilidade, os serviços de reabilitação estavam concentrados na cidade do Recife, levando 37,3% das crianças a percorrer acima de 15 km até os serviços. Verificou-se que numa acessibilidade otimizada, 52,9% percorreriam entre 1 e 5 km. Conclusão Uma reorganização dos serviços para garantir maior facilidade de acessibilidade a essas crianças é necessária e imprescindível para garantia de melhor acompanhamento e assistência dessas famílias em longo prazo.

Abstract Background Neurological changes in children with congenital zika virus syndrome (CZS) have delays in development and deformities, leading to the need care for rehabilitation services Objective This study aims to analyze the geographical accessibility of children with CZS in the Metropolitan Region of Recife (RMR), and to compare such with the optimized (closest distance between the child's residence and the service). Method It is a descriptive study, including 51 CZS who resided in the RMR. The instruments used were semi structured questionnaire with sociodemographic data, economic and information from the centers attended by the child. Spatial distribution maps and flows were prepared by the Geographic Information System-QGis and descriptive analyzes of the sample profile, using SPSS 20.0. Results The majority were children who lived in locales of socioeconomic vulnerability. As for the accessibility, it was noted that the rehabilitation services which received these children were concentrated in the city of Recife, leading 37.3% of children to travel over 15 km to services. However, the optimal accessibility, 52,9% would be between 1 and 5 km. Conclusion A reorganization of these services to facilitate accessibility to these children, as well as a follow-up towards better tending to these families in the long term.

Molybdenum Foliar Fertilization Improves Photosynthetic Metabolism and Grain Yields of Field-Grown Soybean and Maize.

Foliar fertilization has been used as a supplemental strategy to plant nutrition especially in crops with high yield potential. Applying nutrients in small doses stimulates photosynthesis and increases yield performance. The aim of this study was to evaluate the efficiency of foliar application of molybdenum (Mo) to soybean and maize. The treatments consisted of the presence (+Mo) and absence (-Mo) of supplementation. Plant nutritional status, nitrate reductase (NR) activity, gas exchange parameters, photosynthetic enzyme activity (Rubisco in soybean and maize and PEPcase in maize), total soluble sugar concentration, leaf protein content, shoot dry matter, shoot nitrogen accumulated, number of grains per plant, mass of 100 grains, and grain yield were evaluated. For soybean and maize, application of Mo increased leaf NR activity, nitrogen and protein content, Rubisco activity, net photosynthesis, and grain yield. These results indicate that foliar fertilization with Mo can efficiently enhance nitrogen metabolism and the plant's response to carbon fixation, resulting in improved crop yields.

Bacillus subtilis Inoculation Improves Nutrient Uptake and Physiological Activity in Sugarcane under Drought Stress.

Sugarcane (Saccharum spp.) is one of the most important crops in the world. Throughout the sugarcane's growth stages, periods of drought are common, causing detrimental effects on plant growth. Therefore, the search for strategies for minimizing the impact of drought on sugarcane development is of great interest. Plant growth-promoting bacteria hold the potential for improving tolerance to drought in agricultural systems. Thus, the present study aimed to evaluate whether inoculation with Bacillus subtilis can reduce the negative effects of drought on the nutritional, physiological, and morphological characteristics of sugarcane plants. For this, sugarcane was cultivated in a greenhouse, under controlled conditions of water and temperature, with the aid of four treatments: without and with inoculation of B. subtilis, in normal conditions of water availability, and in conditions of water restriction (2 × 2 factorial), with four replications. In treatments with inoculation, the pre-emerged seedlings were immersed in a B. subtilis solution and transplanted into experimental pots. Our results showed that inoculation with B. subtilis improved plant nutrition and chlorophyll concentrations. As a result, the gas exchange parameters (especially net photosynthetic rate and water use efficiency) were also improved, even under drought conditions. In addition, stress parameters (antioxidant metabolism activity) were reduced in inoculated plants. The sum of these beneficial effects resulted in increased root growth, tillering, stalk weight, and higher sucrose concentration in the stalks.

Impact of sowing dates on the yield efficiency of upland rice cultivars

The choice of cultivars adapted to different regions and the determination of the best sowing dates are indispensable tools for crop development. This allows the installation of the crop in times favorable to its development, as well as cultivars that manage to reach their maximum yield potential. The objective of this study was to determine the best sowing dates and the cultivars that can adapt to the low-altitude Cerrado region and have the best development and yield efficiency. The experiment was conducted on a typical clayey dystrophic Red Latosol soil. The experimental design was in randomized blocks in a factorial scheme, comprised by four sowing dates during the spring/summer season (October, November, December, and February) and in each sowing date there were eight upland rice cultivars (BRS Esmeralda, ANa 6005, ANa 5015, IPR 117, IAC 203, IAC 500, ANa 7211 and BRSGO Serra Dourada) with four replicates. Sowing in October and November benefited the aerial dry mass and the spikelets fertility however, sowing in November provided higher plant height, which caused lodging in plants. Sowing in December caused the incidence of scald, mainly affecting the cultivar ANa 7211. For all cultivars, sowing in October favored the yield efficiency of upland rice in the low-altitude Cerrado, followed by sowing in November. The cultivars which demonstrated higher yield efficiency in the conditions of the region were BRS Esmeralda and ANa 5015.

Dynamics of Macronutrient Uptake and Removal by Modern Peanut Cultivars.

The productive potential of new peanut cultivars has increased over the years in relation to old cultivars, especially when compared with ones with upright growth habit. Thus, the requirement for macronutrients for these new cultivars may also have increased, making the existing fertilizer recommendation tables obsolete, thus increasing the need for further studies measuring the real macronutrient requirements of these new peanut cultivars. Our study aimed to evaluate the growth patterns and the macronutrient absorption rate throughout the biological cycle of three modern runner peanut cultivars, as well as the potential for producing dry matter, pods, and kernels, and their respective macronutrient accumulations. The experimental design was a randomized complete block with split-plots and nine replications. The experimental plots consisted of three peanut cultivars (IAC Runner 886, IAC 505, and IAC OL3), and subplots consisted of nine plant samplings (14, 28, 42, 56, 70, 84, 105, 126, and 147 days after emergence (DAE)). Our results showed that modern peanut cultivars presented nutrient accumulation around 30 to 40 days earlier than older cultivars, as well as increasing the uptake by K and Ca. IAC 505 absorbed higher amounts of macronutrients and resulted in greater dry matter production compared with IAC OL3 and IAC Runner 886. Our study demonstrated that the most appropriate time for plants to find greater availability of nutrients in the soil is 70 to 84 DAE, in addition to highlighting the need for updates on nutritional recommendations for higher yields of modern peanut cultivars.

Long-Term Lime and Phosphogypsum Amended-Soils Alleviates the Field Drought Effects on Carbon and Antioxidative Metabolism of Maize by Improving Soil Fertility and Root Growth.

Long-term surface application of lime (L) and/or phosphogypsum (PG) in no-till (NT) systems can improve plant growth and physiological and biochemical processes. Although numerous studies have examined the effects of L on biomass and plant growth, comprehensive evaluations of the effects of this practice on net CO2 assimilation, antioxidant enzyme activities and sucrose synthesis are lacking. Accordingly, this study examined the effects of long-term surface applications of L and PG on soil fertility and the resulting impacts on root growth, plant nutrition, photosynthesis, carbon and antioxidant metabolism, and grain yield (GY) of maize established in a dry winter region. At the study site, the last soil amendment occurred in 2016, with the following four treatments: control (no soil amendments), L (13 Mg ha-1), PG (10 Mg ha-1), and L and PG combined (LPG). The long-term effects of surface liming included reduced soil acidity and increased the availability of P, Ca2+, and Mg2+ throughout the soil profile. Combining L with PG strengthened these effects and also increased SO4 2--S. Amendment with LPG increased root development at greater depths and improved maize plant nutrition. These combined effects increased the concentrations of photosynthetic pigments and gas exchange even under low water availability. Furthermore, the activities of Rubisco, sucrose synthase and antioxidative enzymes were improved, thereby reducing oxidative stress. These improvements in the physiological performance of maize plants led to higher GY. Overall, the findings support combining soil amendments as an important strategy to increase soil fertility and ensure crop yield in regions where periods of drought occur during the cultivation cycle.

Magnesium Foliar Supplementation Increases Grain Yield of Soybean and Maize by Improving Photosynthetic Carbon Metabolism and Antioxidant Metabolism.

(1) Background: The aim of this study was to explore whether supplementary magnesium (Mg) foliar fertilization to soybean and maize crops established in a soil without Mg limitation can improve the gas exchange and Rubisco activity, as well as improve antioxidant metabolism, converting higher plant metabolism into grain yield. (2) Methods: Here, we tested foliar Mg supplementation in soybean followed by maize. Nutritional status of plants, photosynthesis, PEPcase and Rubisco activity, sugar concentration on leaves, oxidative stress, antioxidant metabolism, and finally the crops grain yields were determined. (3) Results: Our results demonstrated that foliar Mg supplementation increased the net photosynthetic rate and stomatal conductance, and reduced the sub-stomatal CO2 concentration and leaf transpiration by measuring in light-saturated conditions. The improvement in photosynthesis (gas exchange and Rubisco activity) lead to an increase in the concentration of sugar in the leaves before grain filling. In addition, we also confirmed that foliar Mg fertilization can improve anti-oxidant metabolism, thereby reducing the environmental stress that plants face during their crop cycle in tropical field conditions. (4) Conclusions: Our research brings the new glimpse of foliar Mg fertilization as a strategy to increase the metabolism of crops, resulting in increased grain yields. This type of biological strategy could be encouraged for wide utilization in cropping systems.

Spatial patterns of avoidable fetal mortality and social deprivation.

OBJECTIVE: To develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. METHODS: ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. RESULTS: The social deprivation index selected two factors that, together, explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deprivation), 8.1 per thousand (medium deprivation), 8.8 per thousand (high deprivation), and 10.7 per thousand (very high social deprivation). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: The spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.

Spatial patterns of avoidable fetal mortality and social deprivation / Padrões espaciais da mortalidade fetal evitável e carência social

ABSTRACT: Objective: To develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. Methods: ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. Results: The social deprivation index selected two factors that, together, explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deprivation), 8.1 per thousand (medium deprivation), 8.8 per thousand (high deprivation), and 10.7 per thousand (very high social deprivation). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: The spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.

RESUMO: Objetivo: Elaborar um índice de carência social para a estratificação dos municípios e a identificação de áreas prioritárias para a redução da mortalidade fetal. Métodos: Estudo ecológico, realizado no estado de Pernambuco, entre 2010 e 2017. Utilizou-se a técnica de análise fatorial por componentes principais para a elaboração do índice de carência social. Na análise espacial, aplicou-se o estimador bayesiano empírico local, e verificou-se a autocorrelação espacial de Moran. Resultados: O índice de carência social selecionou dois fatores que, juntos, explicaram 77,63% da variância total. A taxa de mortalidade fetal evitável apresentou aumento entre estratos de carência social, com taxas de 8 por mil nascimentos (baixa carência), 8,1 por mil (média carência), 8,8 por mil (alta carência) e 10,7 por mil (muito alta carência social). Alguns municípios das mesorregiões São Francisco e Sertão tiveram, simultaneamente, elevada mortalidade fetal e fetal evitável, além de índice de carência social muito alto. Conclusão: A análise espacial identificou áreas com maior risco para a mortalidade fetal. O índice de carência social relacionou alguns determinantes das mortes fetais em áreas com piores condições de vida. Detectaram-se áreas prioritárias para a intervenção das políticas públicas de redução da mortalidade fetal e seus determinantes.

Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients.

OBJECTIVES: To determine the association between mean airway pressure and 90-day mortality in patients with acute respiratory failure requiring mechanical ventilation and to compare the predictive ability of mean airway pressure compared with inspiratory plateau pressure and driving pressure. DESIGN: Prospective observational cohort. SETTING: Five ICUs in Lima, Peru. SUBJECTS: Adults requiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of potentially eligible participants (n = 1,500), 65 (4%) were missing baseline mean airway pressure, while 352 (23.5%) were missing baseline plateau pressure and driving pressure. Ultimately, 1,429 participants were included in the analysis with an average age of 59 ± 19 years, 45% female, and a mean PaO2/FIO2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O (interquartile range, 10-16 cm H2O) in participants who died compared to a median mean airway pressure of 12 cm H2O (interquartile range, 10-14 cm H2O) in participants who survived greater than 90 days (p < 0.001). Mean airway pressure was independently associated with 90-day mortality (odds ratio, 1.38 for difference comparing the 75th to the 25th percentile for mean airway pressure; 95% CI, 1.10-1.74) after adjusting for age, sex, baseline Acute Physiology and Chronic Health Evaluation III, baseline PaO2/FIO2 (modeled with restricted cubic spline), baseline positive end-expiratory pressure, baseline tidal volume, and hospital site. In predicting 90-day mortality, baseline mean airway pressure demonstrated similar discriminative ability (adjusted area under the curve = 0.69) and calibration characteristics as baseline plateau pressure and driving pressure. CONCLUSIONS: In a multicenter prospective cohort, baseline mean airway pressure was independently associated with 90-day mortality in mechanically ventilated participants and predicts mortality similarly to plateau pressure and driving pressure. Because mean airway pressure is readily available on all mechanically ventilated patients and all ventilator modes, it is a potentially more useful predictor of mortality in acute respiratory failure.

Toma de decisiones y consideraciones éticas en el soporte ventilatorio en áreas críticas hospitalarias en el contexto de pandemia COVID-19 / Decision-making and ethical considerations in ventilatory support in critical hospital areas in the context of the COVID-19 pandemic

Objetivo. Los recursos hospitalarios resultan insuficientes ante la demanda de pacientes graves con COVID-19. La adecuada gestión de recursos es esencial para brindar la mejor atención posible. Se revisaron criterios que ayuden a tomar decisiones adecuadas y oportunas, siguiendo principios éticos. La priorización del soporte ventilatorio invasivo debe hacerse de manera transparente y objetiva, evaluando integralmente al paciente y basado en criterios objetivos como escalas de pronóstico, ciclo de vida o compromiso clínico. El tratamiento sintomático (incluyendo cuidados paliativos) es indispensable en esta pandemia y la comunicación con el aciente o la familia permiten humanizar la atención del personal de salud.

Objetive. Hospital resources are insufficient given the demand for seriously ill patients with COVID-19. Proper resource management is essential to provide the best possible care. Criteria to help make appropriate and timely decisions were reviewed, following ethical principles. The prioritization of invasive ventilatory support must be done in a transparent and objective manner, comprehensively evaluating the patient and based on objective criteria such as prognostic scales, life cycle or clinical commitment. Symptomatic treatment (including palliative care) is essential in this pandemic and communication with the patient or family makes it possible to humanize the care of health personnel.

Premature, Opportune, and Delayed Weaning in Mechanically Ventilated Patients: A Call for Implementation of Weaning Protocols in Low- and Middle-Income Countries.

OBJECTIVES: Weaning protocols establish readiness-to-wean criteria to determine the opportune moment to conduct a spontaneous breathing trial. Weaning protocols have not been widely adopted or evaluated in ICUs in low- and middle-income countries. We sought to compare clinical outcomes between participants whose weaning trials were retrospectively determined to have been premature, opportune, or delayed based on when they met readiness-to-wean criteria. DESIGN: Prospective, multicenter observational study. SETTING: Five medical ICUs in four public hospitals in Lima, Perú. SUBJECTS: Adults with acute respiratory failure and at least 24 hours of invasive mechanical ventilation (n = 1,657). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We established six readiness-to-wean criteria and retrospectively categorized our sample into three weaning groups: 1) premature: if the weaning trial took place before fulfilling all criteria, 2) opportune: if the weaning trial took place within 24 hours after fulfilling the criteria, and 3) delayed: if the weaning trial took place over 24 hours after fulfilling criteria. We compared 90-day mortality, ventilator-free days, ICU-free days, and hospital-free days between premature, opportune, and delayed weaning groups. In our sample, 761 participants (60.8%) were classified as having a premature weaning trial, 196 underwent opportune weaning (15.7%), and 295 experienced delayed weaning (23.6%). There was no significant difference in 90-day mortality between the groups. Both the premature and delayed weaning groups had poorer clinical outcomes with fewer ventilator-free days (-2.18, p = 0.008) and (-3.49, p < 0.001), ICU-free days (-2.25, p = 0.001) and (-3.72, p < 0.001), and hospital-free days (-2.76, p = 0.044) and (-4.53, p = 0.004), respectively, compared with the opportune weaning group. CONCLUSIONS: Better clinical outcomes occur with opportune weaning compared with premature and delayed weaning. If readiness-to-wean criteria can be applied in resource-limited settings, it may improve ICU outcomes associated with opportune weaning.

Effects of green and nitrogen fertilization on the yield and yield components of irrigated winter beans / Adubação verde e nitrogenada sobre os componentes de produção e produtividade do feijoeiro de inverno irrigado

The contribution of plant residues to the soil is an essential requirement for the success of no-tillage systems, especially in areas with a tropical climate where the organic material decomposition rate is high. The type of straw present on the soil surface can influence the culture implanted subsequently, mainly with regard to the availability of nitrogen (N). The objective of this study was to investigate the effect of cultural remains of maize (exclusive or intercropped with cover crops) on the development and productivity of the common bean grown in succession and fertilized with different N doses. The experimental design was a randomized block arranged in a factorial scheme (5 × 4), with four replications. The treatments consisted of combinations of cultural remains of exclusive maize, maize + Crotalaria spectabilis, maize + Cajanus cajan, maize + Canavalia ensiformis, and maize + Urochloa ruziziensis cultivated previously and of four N rates (0, 40, 80, and 120 kg ha-1) applied to bean crops. The plots consisted of seven lines of 7.5 m length with 0.45 m spacing between the lines. The evaluated parameters were: dry matter of the plant cover, dry matter of the aerial part (beans), production components, weight of 100 grains, and grain yield. The intercropping of maize and cover crops promoted an increase in dry matter over the soil, compared to the exclusive maize crop. There was an increase in the dry matter of bean plants with the increase in N rates in the two years of cultivation; regarding productivity, there was an increment only in the first year of cultivation. The maize consortium with cover plants provided adequate soil cover, but did not influence the productivity of beans cultivated in succession in the two years of cultivation.(AU)

O aporte de resíduos vegetais ao solo é um dos requisitos essenciais para o sucesso do plantio direto, principalmente em áreas de clima tropical, cuja taxa de decomposição do material orgânico é elevada. O tipo de palha presente na superfície do solo pode influenciar a cultura implantada na sequência, principalmente ao que diz respeito à disponibilização de nitrogênio (N). Sendo assim, objetivou-se estudar o efeito dos restos culturais de milho (Zea mays L.) exclusivo ou consorciado com plantas de cobertura no desenvolvimento e produtividade do feijoeiro (Phaseolus vulgaris L.) cultivado em sucessão e adubado com doses de N. O delineamento experimental foi o de blocos casualizados disposto em esquema fatorial 5x4, com quatro repetições. Os tratamentos foram constituídos pela combinação do efeito dos restos culturais de milho exclusivo; milho + Crotalaria spectabilis; milho + Cajanus cajan; milho + Canavalia ensiformis; milho + Urochloa ruziziensis, cultivadas anteriormente e, por quatro doses de N aplicadas em cobertura na cultura do feijão (0, 40, 80 e 120 kg ha-1). As parcelas foram constituídas por 7 linhas de 7,5 m de comprimento com espaçamento de 0,45 m. Os parâmetros avaliados foram: matéria seca da cobertura vegetal, matéria seca da parte aérea (feijão), componentes de produção, massa de 100 grãos e produtividade de grãos. O consórcio entre milho e plantas de cobertura promoveu aumento da matéria seca sobre o solo, comparado ao cultivo de milho exclusivo. Houve incremento na matéria seca de plantas de feijão com as doses crescentes de N nos dois anos de cultivo e para a produtividade houve incremento somente no primeiro ano de cultivo. O consórcio do milho com plantas de cobertura proporcionou adequada cobertura do solo, porém não influenciou a produtividade do feijoeiro cultivado em sucessão nos dois anos de cultivo.(AU)

Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study.

BACKGROUND: Clinical and epidemiological differences between acute respiratory distress syndrome (ARDS) that presents at the initiation of mechanical ventilation [MV] (ARDS at MV onset) and that which develops during the course of MV (ARDS after MV onset) are not well understood. We conducted an observational study in five Peruvian ICUs to characterize differences between ARDS at MV onset and after MV onset and identify risk factors for the development of ARDS after MV onset. METHODS: We consecutively enrolled critically ill patients with acute respiratory failure requiring at least 24 h of mechanical ventilation and followed them prospectively during the first 28 days and compared baseline characteristics and clinical outcomes by ARDS status. RESULTS: We enrolled 1657 participants on MV (mean age 60.0 years, 55% males) of whom 334 (20.2%) had ARDS at MV onset and 180 (10.9%) developed ARDS after MV onset. Average tidal volume at the initiation of MV was 8.7 mL/kg of predicted body weight (PBW) for participants with ARDS at MV onset, 8.6 mL/kg PBW for those who developed ARDS after MV onset, and 8.5 mL/kg PBW for those who never developed ARDS (p = 0.23). Overall, 90-day mortality was 56% and 55% for ARDS after MV onset and ARDS at MV onset, respectively, as compared to 46% among those who never developed ARDS (p < 0.01). Adults with ARDS had a higher body mass index (BMI) than those without ARDS (27.3 vs 26.5 kg/m2, p < 0.01). Higher peak pressure (adjusted interquartile OR = 1.51, 95% CI 1.21-1.88), higher mean airway pressure (adjusted interquartile OR = 1.41, 95% CI 1.13-1.76), and higher positive end-expiratory pressure (adjusted interquartile OR = 1.29, 95% CI 1.10-1.50) at MV onset were associated with a higher odds of developing ARDS after MV onset. CONCLUSIONS: In this study of mechanically ventilated patients, 31% of study participants had ARDS at some point during their ICU stay. Optimal lung-protective ventilation was not used in a majority of patients. Patients with ARDS after MV onset had a similar 90-day mortality as those with ARDS at MV onset. Higher airway pressures at MV onset, higher PEEP, and higher BMI were associated with the development of ARDS after MV onset.

Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort.

OBJECTIVES: We sought to study the association between sedation status, medications (benzodiazepines, opioids, and antipsychotics), and clinical outcomes in a resource-limited setting. DESIGN: A longitudinal study of critically ill participants on mechanical ventilation. SETTING: Five intensive care units (ICUs) in four public hospitals in Lima, Peru. PATIENTS: One thousand six hundred fifty-seven critically ill participants were assessed daily for sedation status during 28 days and vital status by day 90. RESULTS: After excluding data of participants without a Richmond Agitation Sedation Scale score and without sedation, we followed 1338 (81%) participants longitudinally for 18,645 ICU days. Deep sedation was present in 98% of participants at some point of the study and in 12,942 ICU days. Deep sedation was associated with higher mortality (interquartile odds ratio (OR) = 5.42, 4.23-6.95; p < 0.001) and a significant decrease in ventilator (- 7.27; p < 0.001), ICU (- 4.38; p < 0.001), and hospital (- 7.00; p < 0.001) free days. Agitation was also associated with higher mortality (OR = 39.9, 6.53-243, p < 0.001). The most commonly used sedatives were opioids and benzodiazepines (9259 and 8453 patient days respectively), and the latter were associated with a 41% higher mortality in participants with a higher cumulative dose (75th vs 25th percentile, interquartile OR = 1.41, 1.12-1.77; p < 0.01). The overall cumulative dose of benzodiazepines and opioids was high, 774.5 mg and 16.8 g, respectively, by day 7 and by day 28; these doses approximately doubled. Haloperidol was only used in 3% of ICU days; however, the use of it was associated with a 70% lower mortality (interquartile OR = 0.3, 0.22-0.44, p < 0.001). CONCLUSIONS: Deep sedation, agitation, and cumulative dose of benzodiazepines were all independently associated with higher 90-day mortality. Additionally, deep sedation was associated with less ventilator-, ICU-, and hospital-free days. In contrast, haloperidol was associated with lower mortality in our study.

Profile of hospitalizations in Pediatric Intensive Care Units of the Brazilian Unified Health System in the state of Pernambuco, Brazil. / Perfil das internações em Unidades de Terapia Intensiva Pediátrica do Sistema Único de Saúde no estado de Pernambuco, Brasil.

In Brazil, the distribution of pediatric intensive care units (PICUs), causes of admission, costs incurred and how care is provided are still poorly understood. The objective was to describe the profile of hospitalizations in the PICUs of the Brazilian Unified Health System in the state of Pernambuco, in 2010. A cross-sectional study was performed, with 1,915 hospitalizations in the six PICUs, collected in the Hospital Information System. The variables were compared by age group. There was a predominance of male hospitalizations (58.1%), an age range of between one and four years old (32.5%), the use of philanthropic units (64.1%) and type III PICUs (59.2%) and admissions due to neoplasms (28.9%). The mean hospital stay was 14.4 days, and the mean cost was BRL 6,674.80. The mean distance between the municipality of residence and the PICU ranged from 8.7 to 486.5 km. There were 207 deaths (10.8/100 admissions), of which 30% were due to infectious and parasitic diseases. Differences were identified between the age groups (p < 0.05), except regarding gender. In conclusion, admissions to PICUs in Pernambuco show differences in geographical access and sociodemographic characteristics, admissions, and causes of hospitalization and death among age groups.

No Brasil, a distribuição das unidades de terapia intensiva pediátrica (UTIP), causas de admissão, custos despendidos e forma como se presta a assistência ainda são pouco conhecidos. Com o objetivo de descrever o perfil das internações por faixa etária em UTIP do SUS de Pernambuco, em 2010, realizou-se um estudo transversal, com o universo das 1.915 internações nas seis UTIP do estado, captadas no Sistema de Informação Hospitalar. As variáveis foram comparadas por faixa etária. Predominaram internações no sexo masculino (58,1%), na faixa etária de um a quatro anos (32,5%), unidades filantrópicas (64,1%), UTIP tipo III (59,2%) e por neoplasias (28,9%). A permanência média foi de 14,4 dias e o custo médio de R$ 6.674,80. A distância média entre o município de residência e o da UTIP variou de 8,7 a 486,5 km. Ocorreram 207 óbitos (10,8/100 internações), 30% por doenças infectoparasitárias. Identificaram-se diferenças entre as faixas etárias (p < 0,05), exceto quanto ao sexo. Concluindo, em Pernambuco, as internações em UTIP apresentam diferenças no acesso geográfico e nas características sociodemográficas, da admissão e causas de internação e óbito entre faixas etárias.

Perfil das internações em Unidades de Terapia Intensiva Pediátrica do Sistema Único de Saúde no estado de Pernambuco, Brasil / Profile of hospitalizations in Pediatric Intensive Care Units of the Brazilian Unified Health System in the state of Pernambuco, Brazil

Resumo No Brasil, a distribuição das unidades de terapia intensiva pediátrica (UTIP), causas de admissão, custos despendidos e forma como se presta a assistência ainda são pouco conhecidos. Com o objetivo de descrever o perfil das internações por faixa etária em UTIP do SUS de Pernambuco, em 2010, realizou-se um estudo transversal, com o universo das 1.915 internações nas seis UTIP do estado, captadas no Sistema de Informação Hospitalar. As variáveis foram comparadas por faixa etária. Predominaram internações no sexo masculino (58,1%), na faixa etária de um a quatro anos (32,5%), unidades filantrópicas (64,1%), UTIP tipo III (59,2%) e por neoplasias (28,9%). A permanência média foi de 14,4 dias e o custo médio de R$ 6.674,80. A distância média entre o município de residência e o da UTIP variou de 8,7 a 486,5 km. Ocorreram 207 óbitos (10,8/100 internações), 30% por doenças infectoparasitárias. Identificaram-se diferenças entre as faixas etárias (p < 0,05), exceto quanto ao sexo. Concluindo, em Pernambuco, as internações em UTIP apresentam diferenças no acesso geográfico e nas características sociodemográficas, da admissão e causas de internação e óbito entre faixas etárias.

Abstract In Brazil, the distribution of pediatric intensive care units (PICUs), causes of admission, costs incurred and how care is provided are still poorly understood. The objective was to describe the profile of hospitalizations in the PICUs of the Brazilian Unified Health System in the state of Pernambuco, in 2010. A cross-sectional study was performed, with 1,915 hospitalizations in the six PICUs, collected in the Hospital Information System. The variables were compared by age group. There was a predominance of male hospitalizations (58.1%), an age range of between one and four years old (32.5%), the use of philanthropic units (64.1%) and type III PICUs (59.2%) and admissions due to neoplasms (28.9%). The mean hospital stay was 14.4 days, and the mean cost was BRL 6,674.80. The mean distance between the municipality of residence and the PICU ranged from 8.7 to 486.5 km. There were 207 deaths (10.8/100 admissions), of which 30% were due to infectious and parasitic diseases. Differences were identified between the age groups (p < 0.05), except regarding gender. In conclusion, admissions to PICUs in Pernambuco show differences in geographical access and sociodemographic characteristics, admissions, and causes of hospitalization and death among age groups.

Nitrogen supply associated with the application of trinexapac-ethyl in upland rice irrigated by sprinkler / Fornecimento de nitrogênio associado a aplicação de etil-trinexapac em arroz de terras altas irrigado por aspersão

The lodging of rice plants significantly increases the losses of this crop. Lodging is caused by the inadequate management of water and fertilizers, particularly nitrogenous fertilizers. The use of growth regulators causes a reduction in plant height and consequently lodging, and may reduce harvest losses. The objective of this study was to evaluate nitrogen (N) doses with and without application of plant growth regulator in upland rice irrigated by a sprinkler system. The experimental design consisted of randomized blocks arranged in a 4 × 2 factorial design with four replicates. The treatments consisted of four N doses (0, 40, 80, and 120 kg ha-1) combined with the presence or absence of foliar application of a plant growth regulator. The application of 150 g ha-1 of trinexapac-ethyl at the flower differentiation stage reduced plant height and lodging. In addition, this treatment promoted increased 100-grain mass. The use of N doses in topdressing increased plant heights and grain yield. The plant growth regulator did not interfere with the milling yield of upland rice. Nitrogen fertilization in the topdressing did not interfere with the milling yield of upland rice irrigated by a sprinkler system.

O acamamento das plantas de arroz aumenta sensivelmente as perdas dessa cultura, que é ocasionado pelo fornecimento de água e fertilizantes, principalmente os nitrogenados, manejados de forma inadequada. O uso de reguladores vegetais propicia redução na altura de plantas e consequentemente no acamamento, podendo minimizar as perdas na colheita. O objetivo foi avaliar doses de nitrogênio (N) com e sem a aplicação de regulador vegetal em arroz de terras altas irrigado por aspersão. O delineamento experimental utilizado foi o de blocos casualizados, disposto em esquema fatorial 4 × 2, com quatro repetições. Os tratamentos foram constituídos por quatro doses de N em cobertura (0, 40, 80 e 120 kg ha-1) combinadas com ou sem aplicação de regulador vegetal. A aplicação de 150 g ha-1 de etil-trinexapac, por ocasião da diferenciação floral, reduz a altura de plantas e o acamamento, e promove aumento da massa de 100 grãos. O uso de doses de N em cobertura aumenta a altura de plantas e incrementa a produtividade de grãos. O regulador vegetal interfere pouco no rendimento de engenho do arroz de terras altas. A adubação nitrogenada em cobertura praticamente não interfere no rendimento de engenho do arroz de terras altas irrigado por aspersão.