Effects of peep on lung injury, pulmonary function, systemic circulation and mortality in animals with uninjured lungs-a systematic review.

It is well-known that positive end-expiratory pressure (PEEP) can prevent ventilator-induced lung injury (VILI) and improve pulmonary physiology in animals with injured lungs. It's uncertain whether PEEP has similar effects in animals with uninjured lungs. A systematic review of randomized controlled trials (RCTs) comparing different PEEP levels in animals with uninjured lungs was performed. Trials in animals with injured lungs were excluded, as were trials that compared ventilation strategies that also differed with respect to other ventilation settings, e.g., tidal volume size. The search identified ten eligible trials in 284 animals, including rodents and small as well as large mammals. Duration of ventilation was highly variable, from 1 to 6 hours and tidal volume size varied from 7 to 60 mL/kg. PEEP ranged from 3 to 20 cmH2O, and from 0 to 5 cmH2O, in the 'high PEEP' or 'PEEP' arms, and in the 'low PEEP' or 'no PEEP' arms, respectively. Definitions used for lung injury were quite diverse, as were other outcome measures. The effects of PEEP, at any level, on lung injury was not straightforward, with some trials showing less injury with 'high PEEP' or 'PEEP' and other trials showing no benefit. In most trials, 'high PEEP' or 'PEEP' was associated with improved respiratory system compliance, and better oxygen parameters. However, 'high PEEP' or 'PEEP' was also associated with occurrence of hypotension, a reduction in cardiac output, or development of hyperlactatemia. There were no differences in mortality. The number of trials comparing 'high PEEP' or 'PEEP' with 'low PEEP' or 'no PEEP' in animals with uninjured lungs is limited, and results are difficult to compare. Based on findings of this systematic review it's uncertain whether PEEP, at any level, truly prevents lung injury, while most trials suggest potential harmful effects on the systemic circulation.

The role of thromboelastometry in the assessment and treatment of coagulopathy in liver transplant patients / O papel da tromboelastometria na avaliação e no tratamento da coagulopatia em pacientes submetidos ao transplante hepático

ABSTRACT Perioperative monitoring of coagulation is vital to assess bleeding risks, diagnose deficiencies associated with hemorrhage, and guide hemostatic therapy in major surgical procedures, such as liver transplantation. Routine static tests demand long turnaround time and do not assess platelet function; they are determined on plasma at a standard temperature of 37°C; hence these tests are ill-suited for intraoperative use. In contrast, methods which evaluate the viscoelastic properties of whole blood, such as thromboelastogram and rotational thromboelastometry, provide rapid qualitative coagulation assessment and appropriate guidance for transfusion therapy. These are promising tools for the assessment and treatment of hyper- and hypocoagulable states associated with bleeding in liver transplantation. When combined with traditional tests and objective assessment of the surgical field, this information provides ideal guidance for transfusion strategies, with potential improvement of patient outcomes.

RESUMO A monitorização perioperatória da coagulação é fundamental para estimar o risco de sangramento, diagnosticar deficiências causadoras de hemorragia e guiar terapias hemostáticas durante procedimentos cirúrgicos de grande porte, como o transplante hepático. Os testes estáticos, comumente usados na prática clínica, são insatisfatórios no intraoperatório, pois demandam tempo e não avaliam a função plaquetária; são determinados no plasma e realizados em temperatura padrão de 37°C. Os métodos que avaliam as propriedades viscoelásticas do sangue total, como o tromboelastograma e a tromboelastometria rotacional, podem suprir as deficiências dos testes estáticos tradicionais, uma vez que permitem avaliar a coagulação de forma rápida e qualitativa, guiando a terapia transfusional de forma adequada. A tromboelastometria rotacional mostrou-se promissora na avaliação e no tratamento de estados de hipercoagulação e hipocoagulação, associados a sangramento no transplante hepático. Estas informações, combinadas com os testes tradicionais e uma avaliação objetiva do campo cirúrgico, promovem um cenário ótimo para guiar as estratégias transfusionais e potencialmente melhorar o desfecho destes pacientes.

The role of thromboelastometry in the assessment and treatment of coagulopathy in liver transplant patients.

Perioperative monitoring of coagulation is vital to assess bleeding risks, diagnose deficiencies associated with hemorrhage, and guide hemostatic therapy in major surgical procedures, such as liver transplantation. Routine static tests demand long turnaround time and do not assess platelet function; they are determined on plasma at a standard temperature of 37°C; hence these tests are ill-suited for intraoperative use. In contrast, methods which evaluate the viscoelastic properties of whole blood, such as thromboelastogram and rotational thromboelastometry, provide rapid qualitative coagulation assessment and appropriate guidance for transfusion therapy. These are promising tools for the assessment and treatment of hyper- and hypocoagulable states associated with bleeding in liver transplantation. When combined with traditional tests and objective assessment of the surgical field, this information provides ideal guidance for transfusion strategies, with potential improvement of patient outcomes. RESUMO A monitorização perioperatória da coagulação é fundamental para estimar o risco de sangramento, diagnosticar deficiências causadoras de hemorragia e guiar terapias hemostáticas durante procedimentos cirúrgicos de grande porte, como o transplante hepático. Os testes estáticos, comumente usados na prática clínica, são insatisfatórios no intraoperatório, pois demandam tempo e não avaliam a função plaquetária; são determinados no plasma e realizados em temperatura padrão de 37°C. Os métodos que avaliam as propriedades viscoelásticas do sangue total, como o tromboelastograma e a tromboelastometria rotacional, podem suprir as deficiências dos testes estáticos tradicionais, uma vez que permitem avaliar a coagulação de forma rápida e qualitativa, guiando a terapia transfusional de forma adequada. A tromboelastometria rotacional mostrou-se promissora na avaliação e no tratamento de estados de hipercoagulação e hipocoagulação, associados a sangramento no transplante hepático. Estas informações, combinadas com os testes tradicionais e uma avaliação objetiva do campo cirúrgico, promovem um cenário ótimo para guiar as estratégias transfusionais e potencialmente melhorar o desfecho destes pacientes.

Opinion of hypertensive patients on treatment effectiveness and disease-associated risk factors / Opinião de pacientes hipertensos sobre efetividade do tratamento e fatores de risco associados à doença

BACKGROUND AND OBJECTIVES: To determine population knowledge about systemic high blood pressure (SHBP) and to know about hypertensives' opinion of their blood pressure levels and the effectiveness of blood pressure control they perform. METHOD: Cross-sectional study with interviewed volunteersfrom 18 to 65 years of age, excluding pregnant women; patients' subjective opinions about SHBP and treatment effectiveness were addressed, anthropometric measures were collected, and measurement of blood pressure (BP) was performed. All records were included in the research, being stored and analyzed through PAWS Statistics 18 software, using Odds Ratio and Pearson correlation with 95% confidence interval. RESULTS: The sampling comprises 365 patients, 43.8% of males, with 29.6% being hypertensive. According to Pearson correlation, the systolic pressure was related to waist circumference (WC) (0.456), body mass index (BMI) (0.428) and neck circumference (0.326), with diastolic blood pressure (DBP) achieving similar relations but in lesser extent. The most statistically significant relations were between SHBP and diabetes (OR = 7.5), high women waist circumference (OR = 4.5) and BMI ≥ 30 (OR = 3.0). A correlation was found between patients with high systolic and diastolic BP and their opinion that BP was high (OR = 10.2 and 7.2, respectively). There was a relation between being hypertensive and having high systolic or diastolic pressure (OR = 5.4 and 3.5, respectively). When asked about the downsides of long-term SHBP, 20.3% could not inform about theses consequences. CONCLUSION: The authors concluded that antihypertensive therapy in this population does not meet the targets proposed by the VI Brazilian Guidelines on Hypertension.(...)

JUSTIFICATIVA E OBJETIVOS: Mensurar o conhecimento populacional acerca da hipertensão arterial sistêmica (HAS), conhecer a opinião do hipertenso sobre seus níveis tensionais e a eficácia do controle pressórico realizado por eles. MÉTODO: Pesquisa transversal com entrevistados voluntários entre 18 e 65 anos, excluídas gestantes. Abordaram-se opiniões subjetivas do paciente sobre HAS e efetividade do tratamento, colhidas medidas antropométricas e aferição da pressão arterial (PA). Todas as fichas foram incluídas na pesquisa, sendo armazenadas e analisadas no programa PAWS Statistics 18, utilizando-se Odds Ratio e correlação de Pearson com intervalo de confiança de 95%.RESULTADOS: Amostra composta por 365 pacientes, 43,8% do sexo masculino, 29,6% hipertensos. De acordo com a correlação de Pearson, pressão arterial sistólica (PAS) obteve relação com circunferência abdominal (CA) (0,456), índice de massa corpórea (IMC) (0,428) e circunferência do pescoço (0,326),tendo a pressão arterial diastólica (PAD) relações parecidas em menores escalas. As relações mais significantes estatisticamente foram entre HAS e: diabetes (OR = 7,5), CA feminina elevada (OR = 4,5) e IMC ≥ 30 (OR = 3,0). Houve relação entre os pacientes com PAS e PAD elevadas e opinião de achar que a PA está elevada (OR = 10,2 e 7,2, respectivamente). Existiu relação entre ser hipertenso e estar com a PAS ou PAD (OR = 5,4 e 3,5, respectivamente). Quando perguntados sobre os males da HAS em longo prazo, 20,3% não souberam informar tais consequências. CONCLUSÃO: A terapêutica anti-hipertensiva na população estudada está aquém das metas propostas pelas VI Diretrizes de Hipertensão. Os hipertensos em tratamento acreditam que sua PA está elevada antes de aferi-la, o que foi confirmado depois da medição, denotando a insegurança com a terapia e eficácia inadequada do tratamento. (...)

Evaluation of alcohol addiction among Brazilian Northeast medical students through the alcohol use disorders identification test and the relation with body mass index and smoking / Avaliação da dependência alcoólica entre estudantes de medicina no nordeste brasileiro pelo teste de identificação de distúrbio de uso do álcool e a relação com o índice de massa corpórea e tabagismo

BACKGROUND AND OBJECTIVES: The aim of this study was to identify the pattern of physical activities, alcohol consumption, and its influences among medical students. METHOD: Cross-sectional study with 203 Northeast students from a medical school of João Pessoa/state of Paraíba.The following variables were evaluated: physical activity (IPAQ short version), tobacco dependence (Fagerstrõm test) and alcohol dependence (AUDIT test). The associations were identified using Pearson correlations and Odds Ratio, with a confidence interval of 95%. RESULTS: 76.8% of the total sample ingested alcohol, from which 29,6% showed alcohol problems at some level. A significant correlation (p < 0.05) was detected between AUDIT and: body mass index (BMI) (r = 0.397); Fagerstrõm sum (r =0.300). "Problems with alcohol" had a correlation with BMI ? 25 (OR = 5.1), smoking (OR = 6.1), and the number of federal university entrance exams undergone. Respondents with moderate drinking problem showed associations with higher Odds Ratio. CONCLUSION: Alcohol consumption is a serious problem among medical students because of the tensions experienced during the course, and acts as a strong risk factor for weight gain and smoking, possibly because its damages are underestimated by students, which shows the need for awareness campaigns aimed at this population.

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi identificar o padrão de atividade física, ingestão de bebidas alcoólicas e suas influências em estudantes de medicina. MÉTODO: Estudo transversal com 203 estudantes nordestinos de medicina de João Pessoa/PB. Avaliaram-se as seguintes variáveis: atividade física (IPAQ), dependência ao tabaco (Fagerstrõm) e alcoólica (AUDIT). Associações foram identificadas utilizando-se a correlação de Pearson e Odds Ratio com intervalo de confiança de 95%. RESULTADOS: 76,8% da amostra total ingeria álcool, dentre os quais 29,6% mostraram problemas com álcool em algum nível. Foi detectada associação estatisticamente significativa (p < 0,05) entre AUDIT e: índice de massa corpórea (IMC) (r = 0,397);soma do Fagerstrõm (r = 0,300). ?Problemas com álcool? obtevecorrelação com IMC ? 25 (OR = 5,1), tabagismo (OR = 6,1), e o número de vestibulares prestados em universidades federais. Participantes com problemas moderados com álcool mostraram associações com maiores Odds Ratio. CONCLUSÃO: O consumo alcoólico é um sério problema entre estudantes de medicina graças às tensões vivenciadas durante o curso, agindo como um forte fator de risco para ganho ponderale tabagismo, possivelmente porque seus danos são subestimados pelos discentes, o que denota a necessidade de campanhas de conscientização voltadas para esse grupo.