RESUMO
PURPOSE: This study aimed to assess the VÌO 2 uptake obtained during a GXT and subsequent verification phase in untrained participants in a hot environment. METHODS: Twelve sedentary males completed a GXT followed by a biphasic supramaximal-load verification phase in a hot environment (39°C, 32% relative humidity). Rest between tests occurred in a temperate chamber and lasted until gastrointestinal temperature returned to baseline. RESULTS: Mean verification phase VÌO 2max (37.8 ± 4.3 mL·kg -1 ·min -1 ) was lower than GXT (39.8 ± 4.1 mL·kg -1 ·min -1 ; P = 0.03) and not statistically equivalent. Using an individualized analysis approach, only 17% (2/12) of participants achieved a VÌO 2 plateau during the GXT. Verification phase confirmed GXT VÌO 2max in 100% of participants, whereas the traditional and the new age-dependent secondary VÌO 2max criteria indicated GXT VÌO 2max achievement at much lower rates (8/12 [67%] vs 7/12 [58%], respectively). Correlational indices between GXT and verification phase VÌO 2max were strong (intraclass correlation coefficient = 0.95, r = 0.86), and Bland-Altman analysis revealed a low mean bias of -2.1 ± 1.9 mL·kg -1 ·min -1 and 95% limits of agreement (-5.8 to 1.7 mL·kg -1 ·min -1 ). CONCLUSIONS: Very few untrained males achieved a VÌO 2 plateau during GXT in the heat. When conducting GXT in a hot condition, the verification phase remains a valuable addition to confirm VÌO 2max in untrained males.
Assuntos
Teste de Esforço , Consumo de Oxigênio , Masculino , HumanosRESUMO
This study evaluated an antibiotic stewardship program (ASP) intervention aimed at reducing inpatient fluoroquinolone (FQ) use and examined its impact on ciprofloxacin susceptibilities of gram-negative bacteria in a large 611-bed community hospital. A two-step ASP intervention was implemented: an electronic medical record algorithm that prompted physicians to re-evaluate FQ use shortly after admission and changed institutional UTI/pneumonia guidelines that recommended options alternate to FQs for first-line empiric antibiotic therapy in 2010 and 2011 respectively. Between 2007 and 2017 FQ use and ciprofloxacin susceptibilities of all non-duplicate cultured isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa obtained ≥72 h after admission were reviewed. Ambulatory care isolates served as a comparison group. FQ utilization rates and relationships to ciprofloxacin susceptibility were evaluated using interrupted time series models. Over the 11-year period, FQ use decreased from 110.0 (2007) to 26.2 (2017) days of therapy/1000 days at risk (p < 0.001). Compared to pre-intervention, the estimated (post-intervention) reduction in FQ utilization was 28.4 (95% CI: 10.9-46) days of therapy/1000 days at risk. Reduced FQ utilization was correlated with increase susceptibilities to ciprofloxacin of hospital onset isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis (p < 0.02), and Pseudomonas aeruginosa (p = 0.07). No significant susceptibility change was observed in the ambulatory care isolates. Persuasive interventions by an ASP successfully modified physicians' inpatient empiric antibiotic use, produced a sustained reduction in FQ utilization rates and increased ciprofloxacin susceptibility to four commonly encountered gram-negative bacteria in a community hospital.
Assuntos
Gestão de Antimicrobianos , Infecções por Escherichia coli , Infecções por Bactérias Gram-Negativas , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Ciprofloxacina/farmacologia , Ciprofloxacina/uso terapêutico , Farmacorresistência Bacteriana , Escherichia coli , Infecções por Escherichia coli/tratamento farmacológico , Fluoroquinolonas/farmacologia , Fluoroquinolonas/uso terapêutico , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Hospitais , Humanos , Klebsiella pneumoniae , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa , Estados Unidos/epidemiologiaRESUMO
WHAT IS KNOWN AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) associated cytokine activation can lead to a rapid progression into respiratory failure, shock and multiorgan failure. Interleukin-6 (IL-6) is a pro-inflammatory cytokine that likely contributes to the pathogenesis of cytokine release syndrome. It is hypothesized that modulating IL-6 levels or its effects with tocilizumab, a recombinant humanized anti-IL-6 receptor monoclonal antibody, may alter the course of disease. METHODS: We examined the association between tocilizumab use and intubation or death at a community hospital in New York City. Data were obtained regarding consecutive patients hospitalized with COVID-19. The primary end point was a composite of intubation or death in a time-to-event analysis. We compared outcomes in patients who received tocilizumab with those in patients who did not, using a multivariable Cox model with inverse probability weighting according to the propensity score. RESULTS AND DISCUSSION: In this single-centre retrospective cohort study involving 1225 hospitalized patients with SARS-CoV-2 infection, the probability to respiratory failure, which was measured as intubation or death, was less frequent in patients who received tocilizumab. WHAT IS NEW AND CONCLUSION: Tocilizumab and other IL-6 receptor monoclonal antibodies may evolve as a viable option in treating patients with moderate and severe COVID-19.