Prospective international validation of the predisposition, infection, response and organ dysfunction (PIRO) clinical staging system among intensive care and general ward patients.

BACKGROUND: Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important. METHODS: Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included. RESULTS: There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10 ± 3 vs 8 ± 4, p < 0.001). The observed mortality was 3%, 15%, 24% and 34% in stage I, II, III and IV, respectively, which was within the predicted intervals of the original model, except for stage IV patients that presented a lower mortality. The hospital survival rate was 84%. The application of the PIRO staging system to the validation cohort resulted in a positive predictive value of 97% for stage I, 91% for stage II, 85% for stage III and 66% for stage IV. The area under the receiver operating characteristics curve (AUROC) was 0.75 for the all cohort and 0.70 if only patients with bacteremia were considered. Patients in stage III and IV who did not have antibiotic therapy administered within the desired time frame had higher mortality rate than those who have timely administration of antibiotic. CONCLUSIONS: To our knowledge, this is the first external validation of this PIRO staging system and it performed well on different patient wards within the hospital and in different types of hospitals. Future studies could apply the PIRO system to decision-making about specific therapeutic interventions and enrollment in clinical trials based on disease stage.

Simulating estuarine nitrous oxide production by means of a dynamic model.

We describe a dynamic model developed from a commercially available modeling package (ECoS-III) to simulate estuarine dissolved inorganic nitrogen (DIN) dynamics, and consequent N(2)O production and atmospheric flux on the timescale of tidal cycles. Simulated model state variables were NH(4)(+), NO(3)(-) and N(2)O concentrations, and salinity. Model outputs were evaluated through comparison with summer field data for the Tyne estuary, UK. The model adequately reproduced the observed axial profiles of NH(4)(+), NO(3)(-) and N(2)O concentrations. Nitrification was shown to be the dominant N(2)O source and estimates of the ratios nitrification to DIN load and N(2)O emission to DIN load are considerably lower than the corresponding values adopted in global scale models of estuarine N(2)O emissions based on DIN transformations. Hence our results are consistent with the requirement imposed by atmospheric N(2)O growth rate constraints that the amount of atmospheric N(2)O arising from agriculturally related sources, including estuarine transformations of N, be revised downward.

Tratamento da anemia ferropriva com hidróxido de ferro polimaltosado: estudo multicêntrico comparativo entre tratamento ministrado com e sem alimentaçäo concomitante

O objetivo do presente estudo foi analisar a interferência da ingestäo concomitante de alimentos, na absorçäo de ferro, em pacientes anêmicos tratados com complexo de ferro polimaltosado. Em estudo multicêntrico foram observados 113 pacientes, randomicamente alocados em dois grupos. Todos os pacientes receberam ferro polimaltosado na dose equivalente a 2,5mg de ferro elementar por dia durante 90 dias. Dos pacientes tratados 53 foram alocados no grupo C e receberam o medicamento com alimentaçäo concomitante, enquanto 60 alocados no grupo S receberam-no longe do período das refeiçöes. A avaliaçäo da eficácia foi feita por parâmetros clínicos (escores de sinais e sintomas) e laboratoriais (contagem de eritrócitos, dosagem de hemoglobina sérica, entre outros). Ao término do estudo houve melhora, estatisticamente significante, tanto nos parâmetros clínicos como nos laboratoriais, em ambos os grupos. As diferenças entre os grupos C e S, que näo eram estatisticamente significantes ao início do estudo, assim se mantiveram ao final das observaçöes. A incidência de efeitos colaterais foi muito pequena em ambos os grupos. Conclui-se que o hidróxido de ferro polimaltosado é igualmente eficiente, quer quando ministrado, quer quando ministrado sem alimento concomitante

Osteocondroses nos pre-escolares e nos escolares. / Osteochondrosis in pre-school and school children

Os autores apresentam 23 casos de osteocondroses, que mais frequentemente incidem nos pre-escolares e nos escolares, tais como: Doencas de Legg-Calve-Perthers, Osgood-Schlatter, Sever e Kohler, chamando a atencao como um importante problema pediatrico. Verificaram que o diagnostico precoce melhora muito o prognostico, com a adequada reparacao ossea, recuperacao completa ou um minimo de comprometimento funcional, principalmente na doenca de LeggCalve-Perthers, que e altamente invalidante, podendo evoluir para uma coxo-artrose